Sample records for revision operation rate

  1. Tumor endoprosthesis revision rates increase with peri-operative chemotherapy but are reduced with the use of cemented implant fixation. (United States)

    Pugh, Luke R; Clarkson, Paul W; Phillips, Amy E; Biau, David J; Masri, Bassam A


    Chemotherapy may reduce osseointegration of tumor endoprosthesis, while delaying chemotherapy may reduce survival. We studied the effects of chemotherapy and cemented fixation on tumor endoprosthesis survivorship with a retrospective analysis of 50 consecutive patients receiving lower limb salvage surgery. We compared rates of radiographic loosening/revision and effect of cement fixation between chemotherapy/no chemotherapy cohorts. Chemotherapy increased the total revision rate (HR = 3.8 [1-14], P = 0.033), but did not affect aseptic loosening. Cement fixation reduced revision for loosening (HR = 0.09 (0.008-0.98), P = 0.012) and showed less radiographic loosening (HR = 0.09 (0.02-0.51), P = 0.00066). Cement fixation had lower rates of revision for loosening and radiographic loosening regardless of whether chemotherapy was given. We conclude that for these implants, cement fixation provides superior results to uncemented fixation. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. Revised estimates for ozone reduction by shuttle operation (United States)

    Potter, A. E.


    Previous calculations by five different modeling groups of the effect of space shuttle operations on the ozone layer yielded an estimate of 0.2 percent ozone reduction for the Northern Hemisphere at 60 launches per year. Since these calculations were made, the accepted rate constant for the reaction between hydroperoxyl and nitric oxide to yield hydroxyl and nitrogen dioxide, HO2 + NO yields OH + NO2, was revised upward by more than an order of magnitude, with a resultant increase in the predicted ozone reduction for chlorofluoromethanes by a factor of approximately 2. New calculations of the shuttle effect were made with use of the new rate constant data, again by five different modeling groups. The new value of the shuttle effect on the ozone layer was found to be 0.25 percent. The increase resulting from the revised rate constant is considerably less for space shuttle operations than for chlorofluoromethane production, because the new rate constant also increases the calculated rate of downward transport of shuttle exhaust products out of the stratosphere.

  3. 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


    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.......001), but with no increased risk of revision. There was no significant difference in the mean WOOS or the risk of revision between designs of resurfacing hemiarthroplasty....

  4. Comparison of Quality Metrics for Pediatric Shunt Surgery and Proposal of the Negative Shunt Revision Rate. (United States)

    Beez, Thomas; Steiger, Hans-Jakob


    Shunt surgery is common in pediatric neurosurgery and is associated with relevant complication rates. We aimed to compare previously published metrics in a single data set and propose the Negative Shunt Revision Rate (NSRR), defined as proportion of shunt explorations revealing a properly working system, as a new quality metric. Retrospective analysis of our shunt surgery activity in 2015 was performed. Demographic, clinical, and radiologic variables were extracted from electronic medical notes. Surgical Activity Rate, Revision Quotient, 30-day shunt malfunction rate, 90-day global shunt revision rate, Preventable Shunt Revision Rate, and novel NSRR were calculated. Of 60 shunt operations analyzed, 18 (39%) were new shunt insertions, and 42 (70%) were revisions. Median age was 18 months (range, 0.03-204 months), and main etiologies were posthemorrhagic (n = 16; 41%), congenital (n = 11; 28%), and tumor-associated (n = 8; 21%) hydrocephalus. Within 90 days after index surgery, 13 shunt failures occurred, predominantly owing to proximal failure (n = 6; 46%). Surgical Activity Rate was 0.127, Revision Quotient was 2.333, 30-day shunt malfunction rate was 0.166, 90-day global shunt revision rate was 21.7%, and Preventable Shunt Revision Rate was 38.5%. NSRR was 7.1%. Our results correlate with published values and offer measurement of quality that can be compared across studies and considered patient-oriented, easily measurable, and potentially modifiable. We propose NSRR as a new quality metric, covering an aspect of shunt surgery that was not addressed previously. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Operating limits Hanford Production Reactors. Revision 2

    Energy Technology Data Exchange (ETDEWEB)

    Owsley, G.F. [comp.


    This report is applicable to the eight operating production reactors, B, C, D, DR, F, H, KE, and KW. It covers the following: operating parameter limitations; reactivity limitations; control and safety systems; reactor fuel loading; coolant requirements with irradiated fuel in reactor; reactor confinement; test facilities; code compliance; safety instrumentation and set points; and control criteria. Also discussed are administrative procedures for process control, training, audits and inspection, and reports and records.

  6. Non-Power Reactor Operator Licensing Examiner Standards. Revision 1

    Energy Technology Data Exchange (ETDEWEB)



    The Non-Power Reactor Operator Licensing Examiner Standards provide policy and guidance to NRC examiners and establish the procedures and practices for examining and licensing of applicants for NRC operator licenses pursuant to Part 55 of Title 10 of the Code of Federal Regulations (10 CFR 55). They are intended to assist NRC examiners and facility licensees to understand the examination process better and to provide for equitable and consistent administration of examinations to all applicants by NRC examiners. These standards are not a substitute for the operator licensing regulations and are subject to revision or other internal operator examination licensing policy changes. As appropriate, these standards will be revised periodically to accommodate comments and reflect new information or experience.

  7. Overview of FRMAC Operations. Revision 2

    Energy Technology Data Exchange (ETDEWEB)


    The purpose of this overview of the Federal Radiological Monitoring and Assessment Center (FRMAC) operations is to describe the FRMAC response to a major radiological emergency and to describe the subsequent response activities which provide radiological monitoring and assessment outside the immediate boundaries of the radiological emergency site. In the event of a major radiological emergency, Federal agencies with various statutory responsibilities have agreed to coordinate their efforts at the emergency scene under the umbrella of the Federal Radiological emergency Response Plan (FRERP). This cooperative effort will assure the State(s) and a designed Lead Federal Agency (LFA) that all Federal radiological assistance is fully supporting their efforts to protect the public and will provide monitoring and assessment results for their immediate use in decision making. The Federal agencies do not relinquish their statutory responsibilities. However, the mandated Federal cooperation ensures that each agency can obtain the data critical to its specific responsibilities.

  8. Comprehensive Operative Note Templates for Primary and Revision Total Hip and Knee Arthroplasty. (United States)

    Electricwala, Ali J; Amanatullah, Derek F; Narkbunnam, Rapeepat I; Huddleston, James I; Maloney, William J; Goodman, Stuart B


    Adequate preoperative planning is the first and most crucial step in the successful completion of a revision total joint arthroplasty. The purpose of this study was to evaluate the availability, adequacy and accuracy of operative notes of primary surgeries in patients requiring subsequent revision and to construct comprehensive templates of minimum necessary information required in the operative notes to further simplify re-operations, if they should become necessary. The operative notes of 144 patients (80 revision THA's and 64 revision TKA's) who underwent revision total joint arthroplasty at Stanford Hospital and Clinics in the year 2013 were reviewed. We assessed the availability of operative notes and implant stickers prior to revision total joint arthroplasty. The availability of implant details within the operative notes was assessed against the available surgical stickers for adequacy and accuracy. Statistical comparisons were made using the Fischer-exact test and a P-value of less than 0.05 was considered statistically significant. The primary operative note was available in 68 of 144 revisions (47%), 39 of 80 revision THAs (49%) and 29 of 66 revision TKAs (44%, p = 0.619). Primary implant stickers were available in 46 of 144 revisions (32%), 26 of 80 revision THAs (32%) and 20 of 66 revision TKAs (30%, p = 0.859). Utilizing the operative notes and implant stickers combined identified accurate primary implant details in only 40 of the 80 revision THAs (50%) and 34 of all 66 revision TKAs (52%, p = 0.870). Operative notes are often unavailable or fail to provide the necessary information required which makes planning and execution of revision hip and knee athroplasty difficult. This emphasizes the need for enhancing the quality of operative notes and records of patient information. Based on this information, we provide comprehensive operative note templates for primary and revision total hip and knee arthroplasty.

  9. 77 FR 6110 - Public Service Company of Colorado; Notice of Petition for Rate Approval and Revised Statement of... (United States)


    ... Energy Regulatory Commission Public Service Company of Colorado; Notice of Petition for Rate Approval and Revised Statement of Operating Conditions Take notice that on January 30, 2012, Public Service Company of... intrastate service on file with the Colorado Public Utilities Commission. In addition, PSCo also proposes to...

  10. 76 FR 77224 - Rocky Mountain Natural Gas LLC; Notice of Petition for Rate Approval and Revised Statement of... (United States)


    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF ENERGY Federal Energy Regulatory Commission Rocky Mountain Natural Gas LLC; Notice of Petition for Rate Approval and Revised Statement of Operating Conditions Take notice that on November 30, 2011, Rocky Mountain Natural...

  11. 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...

  12. Marketing and Distributive Education. Teacher-Coordinator Operational Handbook. Revised. (United States)

    South Carolina State Dept. of Education, Columbia. Office of Vocational Education.

    This handbook, a revision of the 1973 edition, is intended to aid teachers in organizing and conducting a program of work for marketing and distributive education programs. The first section on curriculum in marketing and distributive education covers the instructional framework with 2 major dimensions (5 broad marketing competency areas and 14…

  13. Intra-operative periprosthetic fractures associated with press fit stems in revision total knee arthroplasty: incidence, management, and outcomes. (United States)

    Cipriano, Cara A; Brown, Nicholas M; Della Valle, Craig J; Moric, Mario; Sporer, Scott M


    The purpose of this study is to report the incidence, management, and outcomes of periprosthetic fractures associated with the insertion of press-fit stems during revision total knee arthroplasty (TKA). Immediate and six week post-operative radiographs from 634 stemmed implants (307 femoral, 327 tibial) from 420 consecutive revision TKAs were reviewed. Sixteen tibial (4.9%) and 3 femoral (1%) fractures (combined incidence 3.0%) were identified. All healed uneventfully without operative intervention, with no evidence of implant loosening at a mean of 23 months (range 12 to 47 months). The technique of tightly press fitting stems into the diaphysis is associated with a small rate (3%) of periprosthetic fractures; most were non or minimally displaced, all healed uneventfully with non-operative management and were not associated with implant loosening. Copyright © 2013 Elsevier Inc. All rights reserved.

  14. 76 FR 75836 - Revisions to Distilled Spirits Plant Operations Reports and Regulations (United States)


    ... submissions, such as excise tax returns. These changes would improve the efficiency of operations within TTB... Alcohol and Tobacco Tax and Trade Bureau 27 CFR Part 19 RIN 1513-AB89 Revisions to Distilled Spirits Plant Operations Reports and Regulations AGENCY: Alcohol and Tobacco Tax and Trade Bureau, Treasury. ACTION: Notice...

  15. 77 FR 45599 - CED Rock Springs, Inc.; Supplemental Notice That Revised Market-Based Rate Tariff Filing Includes... (United States)


    ...-2546-000; ER02-2546-001] CED Rock Springs, Inc.; Supplemental Notice That Revised Market- Based Rate... above-referenced proceeding of CED Rock Springs, Inc.'s tariff revision filing, noting that such filing...

  16. Revision rates and complication incidence in single- and multilevel anterior cervical discectomy and fusion procedures: an administrative database study. (United States)

    Veeravagu, Anand; Cole, Tyler; Jiang, Bowen; Ratliff, John K


    The natural history of cervical degenerative disease with operative management has not been well described. Even with symptomatic and radiographic evidence of multilevel cervical disease, it is unclear whether single- or multilevel anterior cervical discectomy and fusion (ACDF) procedures produce superior long-term outcomes. To describe national trends in revision rates, complications, and readmission for patients undergoing single and multilevel ACDF. Administrative database study. Between 2006 and 2010, 92,867 patients were recorded for ACDF procedures in the Thomson Reuters MarketScan database. Restricting to patients with >24 months follow-up, 28,777 patients fulfilled our inclusion criteria, of which 12,744 (44%) underwent single-level and 16,033 (56%) underwent multilevel ACDFs. Revision rates and postoperative complications. We used the MarketScan database from 2006 to 2010 to select ACDF procedures based on Current Procedural Terminology coding at inpatient visit. Outcome measures were ascertained using either International Classification of Disease version 9 or Current Procedural Terminology coding. Perioperative complications were more common in multilevel procedures (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.2-1.6; p<.0001). Single-level ACDF patients had higher rates of postoperative cervical epidural steroid injections (OR, 0.88; 95% CI, 0.8-1.0; p=.01). Within 30 days after index procedure, the multilevel ACDF cohort was 1.6 times more likely to have undergone revision (OR, 1.6; 95% CI, 1.1-2.4; p=.02). At 2 years follow-up, revision rates were 9.13% in the single-level ACDF cohort and 10.7% for multilevel ACDFs (OR, 1.2; 95% CI, 1.1-1.3; p<.0001). In a multivariate analysis at 2 years follow-up, patients from the multilevel cohort were more likely to have received a surgical revision (OR, 1.1; 95% CI, 1.0-1.2; p=.001), to be readmitted into the hospital for any cause (OR, 1.2; 95% CI, 1.1-1.4; p=.007), and to have suffered complications

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

    DEFF Research Database (Denmark)

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


    We present detailed information about early morbidity after aseptic revision knee replacement from a nationwide study. All aseptic revision knee replacements undertaken between 1st October 2009 and 30th September 2011 were analysed using the Danish National Patient Registry with additional...... information from the Danish Knee Arthroplasty Registry. The 1218 revisions involving 1165 patients were subdivided into total revisions, large partial revisions, partial revisions and revisions of unicondylar replacements (UKR revisions). The mean age was 65.0 years (27 to 94) and the median length......, whereas the use of a tourniquet (p = 0.008) and surgery in a low volume centre (p = 0.013) were related to shorter length of stay. In conclusion, we found a similar incidence of early post-operative morbidity after aseptic knee revisions as has been reported after primary procedures. This suggests...

  18. Revision rates after primary hip and knee replacement in England between 2003 and 2006.

    Directory of Open Access Journals (Sweden)

    Nokuthaba Sibanda


    Full Text Available Hip and knee replacement are some of the most frequently performed surgical procedures in the world. Resurfacing of the hip and unicondylar knee replacement are increasingly being used. There is relatively little evidence on their performance. To study performance of joint replacement in England, we investigated revision rates in the first 3 y after hip or knee replacement according to prosthesis type.We linked records of the National Joint Registry for England and Wales and the Hospital Episode Statistics for patients with a primary hip or knee replacement in the National Health Service in England between April 2003 and September 2006. Hospital Episode Statistics records of succeeding admissions were used to identify revisions for any reason. 76,576 patients with a primary hip replacement and 80,697 with a primary knee replacement were included (51% of all primary hip and knee replacements done in the English National Health Service. In hip patients, 3-y revision rates were 0.9% (95% confidence interval [CI] 0.8%-1.1% with cemented, 2.0% (1.7%-2.3% with cementless, 1.5% (1.1%-2.0% CI with "hybrid" prostheses, and 2.6% (2.1%-3.1% with hip resurfacing (p < 0.0001. Revision rates after hip resurfacing were increased especially in women. In knee patients, 3-y revision rates were 1.4% (1.2%-1.5% CI with cemented, 1.5% (1.1%-2.1% CI with cementless, and 2.8% (1.8%-4.5% CI with unicondylar prostheses (p < 0.0001. Revision rates after knee replacement strongly decreased with age.Overall, about one in 75 patients needed a revision of their prosthesis within 3 y. On the basis of our data, consideration should be given to using hip resurfacing only in male patients and unicondylar knee replacement only in elderly patients.

  19. 76 FR 61472 - Revised Fiscal Year 2011 Tariff-Rate Quota Allocations for Refined Sugar (United States)


    ... TRADE REPRESENTATIVE Revised Fiscal Year 2011 Tariff-Rate Quota Allocations for Refined Sugar AGENCY... the fiscal year (FY) 2011 in-quota quantity of the tariff-rate quota (TRQ) for imported refined sugar... imports of refined sugar. Section 404(d)(3) of the Uruguay Round Agreements Act (19 U.S.C. 3601(d)(3...

  20. High revision and reoperation rates using the Agility™ Total Ankle System. (United States)

    Criswell, Braden J; Douglas, Keith; Naik, Rishi; Thomson, A Brian


    Total ankle arthroplasty (TAA) is an evolving treatment for end-stage ankle arthritis, however, there is controversy regarding its longevity. We determined survival of the Agility™ TAA, the overall reoperation rate, and function in patients who retained their implant. We retrospectively reviewed 64 patients who had 65 TAAs between June 1999 and May 2001. Information was gathered through chart reviews, mailed-in questionnaires, and telephone interviews. Nine patients had died; data were available for 41 of the remaining 55 patients. Survival was based on revision as an end point. The minimum followup was 0.5 years (median, 8 years; range, 0.5-11 years). Sixteen of the 41 patients (39%) needed revisions. The average time to revision surgery was 4 years with six of the revisions (38%) occurring within 1 year of the TAA. Of the 25 patients who retained their implants, 12 required secondary surgery for an overall reoperation rate of 28 of 41 (68%) at an average of 8 years followup. The average VAS pain score was 4, the average Foot and Ankle Ability Measure (FAAM) sports subscale score was 33, and the average FAAM activities of daily living subscale score was 57. TAA had high revision and reoperation rates. Patients who retained their implant had only moderate pain relief and function. TAA must be approached with caution. More research is needed to elucidate the role of contemporary TAA.

  1. Annual revision rates of partial versus total knee arthroplasty: A comparative meta-analysis. (United States)

    Chawla, Harshvardhan; van der List, Jelle P; Christ, Alexander B; Sobrero, Maximiliano R; Zuiderbaan, Hendrik A; Pearle, Andrew D


    Utilization of unicompartmental knee arthroplasty (UKA) and patellofemoral arthroplasty (PFA) as alternatives to total knee arthroplasty (TKA) for unicompartmental knee osteoarthritis (OA) has increased. However, no single resource consolidates survivorship data between TKA and partial resurfacing options for each variant of unicompartmental OA. This meta-analysis compared survivorship between TKA and medial UKA (MUKA), lateral UKA (LUKA) and PFA using annual revision rate as a standardized metric. A systematic literature search was performed for studies quantifying TKA, MUKA, LUKA and/or PFA implant survivorship. Studies were classified by evidence level and assessed for bias using the MINORS and PEDro instruments. Annual revision rates were calculated for each arthroplasty procedure as percentages/observed component-year, based on a Poisson-normal model with random effects using the R-statistical software package. One hundred and twenty-four studies (113 cohort and 11 registry-based studies) met inclusion/exclusion criteria, providing data for 374,934 arthroplasties and 14,991 revisions. The overall evidence level was low, with 96.7% of studies classified as level III-IV. Annual revision rates were lowest for TKA (0.49%, CI 0.41 to 0.58), followed by MUKA (1.07%, CI 0.87 to 1.31), LUKA (1.13%, CI 0.69 to 1.83) and PFA (1.75%, CI 1.19 to 2.57). No difference was detected between revision rates for MUKA and LUKA (p=0.222). Revisions of MUKA, LUKA and PFA occur at an annual rate of 2.18, 2.31 and 3.57-fold that of TKA, respectively. These estimates may be used to inform clinical decision-making, guide patient expectations and evaluate the cost-effectiveness of total versus partial knee replacement in the setting of unicompartmental OA. Copyright © 2016 Elsevier B.V. All rights reserved.

  2. Biventricular defibrillator patients have higher complication rates after revision of recalled leads. (United States)

    Brumberg, Genevieve E; Kaseer, Bahaa; Shah, Hemal; Saba, Samir; Jain, Sandeep


    Since the 2009 revised advisory statement regarding Sprint Fidelis® Defibrillator Lead failure rates (Medtronic Inc., Minneapolis, MN, USA), there has been a significant increase in revision of these leads. We sought to establish the frequency of major procedural complications and determine what patient characteristics were associated with these outcomes. We retrospectively reviewed the charts of 621 patients with Fidelis® leads being followed in the University of Pittsburgh Medical Center through January 1, 2010. The population was then examined for rates of lead malfunction, revision, and complication. The average time from implantation of Fidelis® lead to endpoint was 32 ± 16 months. Overall lead survival rates were 89% at 41 months and were lower in biventricular implantable cardioverter defibrillator (BiVICD) as compared to standard implantable cardioverter defibrillator patients (log rank P = 0.053). Prophylactic revisions increased dramatically during 2009 (9.4% vs 1.4%, P < 0.001). Among the 131 patients who underwent revision during the entire time of follow-up, 11 patients had postoperative complications (8.5%). The only significant variable found between patients who did and did not have complications was the presence of a BiVICD (81.8 vs 48.7%, P = 0.036). Of the 40 total patients who underwent lead extraction, all three complications occurred in patients with BiVICDs. The number of prophylactic Fidelis® lead revisions has increased dramatically since 2008, and procedure-related complications have been higher than anticipated. Major procedural complication rates are greater among patients with BiVICDs. Overall, lead extraction does not appear to increase procedural risk as compared to abandonment. ©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

  3. Revised enzyme synthesis rate expression in cybernetic models of bacterial growth. (United States)

    Turner, B G; Ramkrishna, D


    A revised enzyme synthesis rate expression for cybernetic models of bacterial growth is presented. The rate expression, which is comprised of inducible and constitutive contributions, provides for a basal enzyme level that is necessary to predict certain types of commonly observed continuous culture transients. The response of a continuous culture to a step change in feed stream composition is simulated using both the old and new formulations, and the ramifications for the "matching-law" formulation are discussed.

  4. Operation of high rate microstrip gas chambers

    CERN Document Server

    Barr, A J; Bouclier, Roger; Capéans-Garrido, M; Dominik, Wojciech; Manzin, G; Million, Gilbert; Hoch, M; Ropelewski, Leszek; Sauli, Fabio; Sharma, A


    We describe recent measurements carried out in well controlled and reproducible conditions to help understanding the factors affecting the short and long term behaviour of Microstrip Gas Chambers. Special care has been taken concerning the gas purity and choice of materials used in the system and for the detectors construction. Detectors built on glasses with surface resistivity in the range $10^{13}-10^{15} \\Omega/\\Box$ have shown satisfactory performance as they do not show charging-up process at high rate and stand the large doses required for the future high luminosity experiments (~10 mC·cm-1·yr-1). Concerning the lifetime measurements, it has been observed that chambers manufactured on high-resistivity glass are far more susceptible of suffering ageing than detectors made on low resistivity, electron-conducting supports, independently of the metal used for the artwork (chromium or gold) at least in clean gas conditions. The successfully operation in the laboratory of detectors manufactured on diamond-...

  5. Impact of the Revised 10 CFR 835 on the Neutron Dose Rates at LLNL

    Energy Technology Data Exchange (ETDEWEB)

    Radev, R


    In June 2007, 10 CFR 835 [1] was revised to include new radiation weighting factors for neutrons, updated dosimetric models, and dose terms consistent with the newer ICRP recommendations. A significant aspect of the revised 10 CFR 835 is the adoption of the recommendations outlined in ICRP-60 [2]. The recommended new quantities demand a review of much of the basic data used in protection against exposure to sources of ionizing radiation. The International Commission on Radiation Units and Measurements has defined a number of quantities for use in personnel and area monitoring [3,4,5] including the ambient dose equivalent H*(d) to be used for area monitoring and instrument calibrations. These quantities are used in ICRP-60 and ICRP-74. This report deals only with the changes in the ambient dose equivalent and ambient dose rate equivalent for neutrons as a result of the implementation of the revised 10 CFR 835. In the report, the terms neutron dose and neutron dose rate will be used for convenience for ambient neutron dose and ambient neutron dose rate unless otherwise stated. This report provides a qualitative and quantitative estimate of how much the neutron dose rates at LLNL will change with the implementation of the revised 10 CFR 835. Neutron spectra and dose rates from selected locations at the LLNL were measured with a high resolution spectroscopic neutron dose rate system (ROSPEC) as well as with a standard neutron rem meter (a.k.a., a remball). The spectra obtained at these locations compare well with the spectra from the Radiation Calibration Laboratory's (RCL) bare californium source that is currently used to calibrate neutron dose rate instruments. The measurements obtained from the high resolution neutron spectrometer and dose meter ROSPEC and the NRD dose meter compare within the range of {+-}25%. When the new radiation weighting factors are adopted with the implementation of the revised 10 CFR 835, the measured dose rates will increase by up to

  6. Comparison of Revision Rates of Anterior- and Posterior-Approach Ptosis Surgery: A Retrospective Review of 1519 Cases. (United States)

    Chou, Eva; Liu, Jun; Seaworth, Cathleen; Furst, Meredith; Amato, Malena M; Blaydon, Sean M; Durairaj, Vikram D; Nakra, Tanuj; Shore, John W


    To compare revision rates for ptosis surgery between posterior-approach and anterior-approach ptosis repair techniques. This is the retrospective, consecutive cohort study. All patients undergoing ptosis surgery at a high-volume oculofacial plastic surgery practice over a 4-year period. A retrospective chart review was conducted of all patients undergoing posterior-approach and anterior-approach ptosis surgery for all etiologies of ptosis between 2011 and 2014. Etiology of ptosis, concurrent oculofacial surgeries, revision, and complications were analyzed. The main outcome measure is the ptosis revision rate. A total of 1519 patients were included in this study. The mean age was 63 ± 15.4 years. A total of 1056 (70%) of patients were female, 1451 (95%) had involutional ptosis, and 1129 (74.3%) had concurrent upper blepharoplasty. Five hundred thirteen (33.8%) underwent posterior-approach ptosis repair, and 1006 (66.2%) underwent anterior-approach ptosis repair. The degree of ptosis was greater in the anterior-approach ptosis repair group. The overall revision rate for all patients was 8.7%. Of the posterior group, 6.8% required ptosis revision; of the anterior group, 9.5% required revision surgery. The main reason for ptosis revision surgery was undercorrection of one or both eyelids. Concurrent brow lifting was associated with a decreased, but not statistically significant, rate of revision surgery. Patients who underwent unilateral ptosis surgery had a 5.1% rate of Hering's phenomenon requiring ptosis repair in the contralateral eyelid. Multivariable logistic regression for predictive factors show that, when adjusted for gender and concurrent blepharoplasty, the revision rate in anterior-approach ptosis surgery is higher than posterior-approach ptosis surgery (odds ratio = 2.08; p = 0.002). The overall revision rate in patients undergoing ptosis repair via posterior-approach or anterior-approach techniques is 8.7%. There is a statistically higher rate of

  7. [Revision rates in journal publications on joint prostheses with noticeably high failure rates in register data sets]. (United States)

    Labek, G; Todorov, S; Lübbeke-Wolff, A; Haderer, B; Krivanek, S


    The value of outcome quality data from clinical studies is an issue of controversial debate particularly in the context of adverse events. The aim of this study is to present and evaluate the data available from clinical studies for products that show inferior outcome in registers and to assess the possibility to draw valid conclusions from these data. STUDY DESIGN AND ANALYTICAL METHODS: Based on a structured literature research, a comparative analysis was made of the revision rates of 12 products showing significantly inferior average results in registers. The primary outcome parameter was the revision rate for any reason calculated using a standardized methodology and the parameter of revisions per 100 observed component years. For 5 out of 12 products not a single comparable study was available and relatively few data were available for the remaining products. A conventional meta-analysis revealed that only three products showed results that were comparable with those from registers. For 75% of products good results were published. There was not a single case where it would have been possible to identify or isolate the problems that had led to the underperformance observed on the basis of clinical studies alone. Clinical sample-based studies are not a suitable and reliable means to recognize potential product or handling problems and avoid risks for patients and physicians. In this respect registers can provide an essential contribution.

  8. Incontinence rates after midurethral sling revision for vaginal exposure or pain. (United States)

    Jambusaria, Lisa H; Heft, Jessica; Reynolds, W Stuart; Dmochowski, Roger; Biller, Daniel H


    Midurethral slings have become the preferred surgical treatment for stress urinary incontinence. Midline transection of midurethral sling for dysfunctional voiding is an effective treatment and also has a low rate of recurrent stress incontinence. Recurrent stress incontinence after sling revision for pain and mesh exposure has not been well defined. It is therefore difficult to counsel patients on risk of recurrent stress incontinence when sling revision is performed for pain or mesh exposure. We examined the rate of postoperative stress incontinence after midurethral sling revision for the indication of mesh exposure or pain, as well as postoperative pain and urinary urgency. This is a retrospective cohort of 245 patients undergoing a vaginal midurethral sling revision in a 10-year period for the indication of mesh exposure or pain. Preoperative indication for revision, baseline characteristics, and preoperative reports of stress incontinence, pain, and urgency were collected. The type of sling revision was then categorized into partial or complete removal. A partial removal of the sling was defined as removing only the portion of sling exposed or causing pain. A complete removal of the sling was defined as vaginal removal of sling laterally out to the pubic rami. Subjective reports of stress incontinence, pain, and urgency at short-term (16 weeks) and long-term (>16 weeks) follow-up visits were gathered. The primary outcome of the study was recurrent stress incontinence. In our cohort of 245 women who underwent midurethral sling revision, 94 patients had removal for mesh exposure (36 partial and 58 complete) and 151 had removal for pain (25 partial and 126 complete). All patients had a short-term follow-up with a mean time of 5.9 ± 2.8 weeks and 69% patients had long-term follow-up with a mean time of 29.1 ± 17.7 weeks. No differences were seen in preoperative reports of stress incontinence, urgency, or pain in either group. In the patients with revision for

  9. Influence of Demographics and Utilization of Physical Therapy Interventions on Clinical Outcomes and Revision Rates Following Anterior Cruciate Ligament Reconstruction. (United States)

    Miller, Caitlin J; Christensen, Jesse C; Burns, Ryan D


    Study Design Retrospective cohort from the Intermountain Healthcare system, January 2007 to December 2014. Background Recent evolutions in health care delivery are putting physical therapists in the forefront to be more responsible for providing high-quality rehabilitation care in a more cost-effective manner. Studies investigating the association between physical therapy visit utilization and outcomes in vulnerable patient populations following anterior cruciate ligament (ACL) reconstruction may provide useful insights. Objectives To examine the relationship between patient age, sex, physical therapy visit utilization, and physical therapy intervention charges with revision rates and patient-reported outcomes in individuals following primary ACL reconstruction. Methods A sample of 660 patients who had an ACL reconstruction was identified through an electronic medical record database. Age and physical therapy visit utilization were categorized to examine effects between groups (20 years of age or younger, 21 to 34 years of age, 35 years of age or older; fewer than 9 visits, 9 to 14 visits, 15 or more visits). Multilevel mixed-effects linear models were conducted to compare differences between revision rates and patient-reported outcomes during the episode of care. Receiver operating characteristic curve analyses were also used to determine visit-number and charge-per-visit cut points to discriminate patients who achieved at least a minimal clinically important difference on the patient-reported outcomes. Results Of 660 patients, 22 (3.3%) had revision surgery. Compared with patients 20 years and younger, the incidence rate ratio of ACL reconstruction revision was lower in patients who were 35 years and older (85%) and 21 to 34 years (59%). Of 470 patients who attended physical therapy for longer than 3 months, change in Knee Outcome Survey activities of daily living subscale score was significantly lower among patients 20 years of age and younger and in the lowest

  10. Confirmatory Factor Analysis of the Delirium Rating Scale Revised-98 (DRS-R98). (United States)

    Thurber, Steven; Kishi, Yasuhiro; Trzepacz, Paula T; Franco, Jose G; Meagher, David J; Lee, Yanghyun; Kim, Jeong-Lan; Furlanetto, Leticia M; Negreiros, Daniel; Huang, Ming-Chyi; Chen, Chun-Hsin; Kean, Jacob; Leonard, Maeve


    Principal components analysis applied to the Delirium Rating Scale-Revised-98 contributes to understanding the delirium construct. Using a multisite pooled international delirium database, the authors applied confirmatory factor analysis to Delirium Rating Scale-Revised-98 scores from 859 adult patients evaluated by delirium experts (delirium, N=516; nondelirium, N=343). Confirmatory factor analysis found all diagnostic features and core symptoms (cognitive, language, thought process, sleep-wake cycle, motor retardation), except motor agitation, loaded onto factor 1. Motor agitation loaded onto factor 2 with noncore symptoms (delusions, affective lability, and perceptual disturbances). Factor 1 loading supports delirium as a single construct, but when accompanied by psychosis, motor agitation's role may not be solely as a circadian activity indicator.

  11. Effect of Obesity on Total Knee Arthroplasty Costs and Revision Rate. (United States)

    Roche, Martin; Law, Tsun Yee; Kurowicki, Jennifer; Rosas, Samuel; Rush, Augustus J


    An increasing number of total knee arthroplasties (TKAs) are performed on obese patients. It is imperative to remain up to date on the effect of obesity on surgical outcomes and reimbursement trends. The purpose of this study was to evaluate the impact different severities of obesity have on primary and revision TKA, specifically: (1) incidence and trends over time; (2) annual growth rate; and (3) admission costs from 2010 to 2014. A retrospective review of a large commercial private payer database within the PearlDiver Supercomputer application (Warsaw, IN) of TKA procedures was conducted. Patients who underwent TKA and subsequent revision were identified by Current Procedural Terminology (CPT) and ninth revision International Classification of Disease (ICD-9) codes. The index procedure was linked with ICD-9 codes for body mass indexes (BMIs) from 70. Statistical analysis was primarily descriptive to demonstrate the revision incidence and reimbursement deviations due to BMI. Compound annual growth rate (CAGR) was also calculated. Our query returned a total of 87,607 TKA patients within the study BMI ranges. The majority of patients had a BMI of 40 to 44.9 (12.2%) and least in the BMI >70 (0.2%) range. BMI of 40 to 44.9 had the highest overall 5-year mean reimbursement of $11,521 and the highest overall mean 5-year deviation from normal BMI (19-24) patients of $3,300. The incidence and burden of TKA revision was highest in patients with a BMI of 60 to 69.9 (21 and 17.3%, respectively). Average 5-year revision reimbursement and deviation from normal BMI (19-24) was highest in patients with a BMI of 40 to 44.9 ($13,883 and $4,030, respectively). The number of obese patients receiving TKA is steadily rising. The cost of treating obese patients rises as BMI deviates from normal, as does the incidence of revision surgery. Therefore, surgeons must be active in counseling patients on weight optimization as part of preoperative standard of care. Thieme Medical Publishers

  12. The application of atlantoaxial screw and rod fixation in revision operations for postoperative re-dislocation in children. (United States)

    Ma, XiangYang; Yin, QingShui; Xia, Hong; Wu, ZengHui; Yang, JinCheng; Liu, JingFa; Xu, JunJie; Qiu, Feng


    We evaluate the feasibility, safety, and efficacy of atlantoaxial screw and rod fixation for revision operations in the treatment of re-dislocation after atlantoaxial operations in children. Eight consecutive children with atlantoaxial instability required a revision operation due to atlantoaxial re-dislocation caused by the failure of the initial posterior wire fixation. The children were 5-11 years of age with an average age of 8.5 years. The posterior atlantoaxial screw and rod fixation and fusion operation was then performed. Autograft bones harvested from rib (in 3 patients), local bone (2 patients), and the iliac crest bone (3 patients) were used. There were no complications such as vertebral artery or spinal cord injury during the operations or loosening or fracture of the fixations after the operations. Stability and reduction of the atlantoaxial segments were achieved in all patients postoperatively. Follow-up time was 24-55 months, with an average of 35 months. All patients achieved solid osseous fusion demonstrated on plain radiographs or CT scanning. Atlantoaxial screw and rod fixation is feasible in children and may be considered for use during the initial operation in the treatment of atlantoaxial dislocation in children to minimize the need for a revision operation. If a revision operation is required, atlantoaxial screw-rod fixation is a safe and effective method. Because the anatomical structure is complicated in revision operation patients, CAD-RP technology could guide the the procedures of exposure and screw placement.

  13. A revised mineral nutrient supplement increases biomass and growth rate in Chlamydomonas reinhardtii. (United States)

    Kropat, Janette; Hong-Hermesdorf, Anne; Casero, David; Ent, Petr; Castruita, Madeli; Pellegrini, Matteo; Merchant, Sabeeha S; Malasarn, Davin


    Interest in exploiting algae as a biofuel source and the role of inorganic nutrient deficiency in inducing triacylglyceride (TAG) accumulation in cells necessitates a strategy to efficiently formulate species-specific culture media that can easily be manipulated. Using the reference organism Chlamydomonas reinhardtii, we tested the hypothesis that modeling trace element supplements after the cellular ionome would result in optimized cell growth. We determined the trace metal content of several commonly used Chlamydomonas strains in various culture conditions and developed a revised trace element solution to parallel these measurements. Comparison of cells growing in the revised supplement versus a traditional trace element solution revealed faster growth rates and higher maximum cell densities with the revised recipe. RNA-seq analysis of cultures growing in the traditional versus revised medium suggest that the variation in transcriptomes was smaller than that found between different wild-type strains grown in traditional Hutner's supplement. Visual observation did not reveal defects in cell motility or mating efficiency in the new supplement. Ni²⁺-inducible expression from the CYC6 promoter remained a useful tool, albeit with an increased requirement for Ni²⁺ because of the introduction of an EDTA buffer system in the revised medium. Other advantages include more facile preparation of trace element stock solutions, a reduction in total chemical use, a more consistent batch-to-batch formulation and long-term stability (tested up to 5 years). Under the new growth regime, we analyzed cells growing under different macro- and micronutrient deficiencies. TAG accumulation in N deficiency is comparable in the new medium. Fe and Zn deficiency also induced TAG accumulation, as suggested by Nile Red staining. This approach can be used to efficiently optimize culture conditions for other algal species to improve growth and to assay cell physiology. © 2011 The Authors

  14. High proximal migration in cemented acetabular revisions operated with bone impaction grafting; 47 revision cups followed with RSA for 17 years. (United States)

    Mohaddes, Maziar; Herberts, Peter; Malchau, Henrik; Johanson, Per-Erik; Kärrholm, Johan


    Bone impaction grafting is a biologically and mechanically appealing option in acetabular revision surgery, allowing restitution of the bone stock and restoration of the biomechanics. We analysed differences in proximal migration of the revision acetabular components when bone impaction grafting is used together with a cemented or an uncemented cup. 43 patients (47 hips), revised due to acetabular loosening and judged to have less than 50% host bone-implant contact were included. The hips were randomised to either an uncemented (n = 20) or a cemented (n = 27) revision cup. Radiostereometry and radiography was performed postoperatively, at 3 and 6 months, 1, 2, 3, 5, 7, 10 and 13 and 17 years postoperatively. Clinical follow-up was performed at 1, 2 and 5 years postoperatively and thereafter at the same interval as in the radiographic follow-up. There were no differences in the base line demographic data between the 2 groups. At the last follow-up (17 years) 14 hips (10 cemented, 4 uncemented) had been re-revised due to loosening. 3 additional cups (1 uncemented and 2 cemented) were radiographically loose. There was a higher early proximal migration in the cemented cups. Cups operated on with cement showed a higher early migration measured with RSA and also a higher number of late revisions. The reason for this is not known, but factors such as inclusion of cases with severe bone defects, use of smaller bone chips and issues related to the impaction technique might have had various degrees of influence.

  15. Superior return to sports rate after patellar tendon autograft over patellar tendon allograft in revision anterior cruciate ligament reconstruction.

    NARCIS (Netherlands)

    Keizer, Michèle N. J.; Hoogeslag, Roy A. G.; van Raay, Jos J. A. M.; Otten, Bert; Brouwer, Reinoud


    PURPOSE: After revision anterior cruciate ligament reconstruction (ACLR), the rate of return to the pre-injury type of sport (RTS type) is low and graft choice might be an important factor. The aim of this study was to determine whether there is a difference in outcome after revision ACLR using a

  16. [High bone consolidation rates after humeral head-preserving revision surgery in non-unions of the proximal humerus]. (United States)

    Aytac, S D; Schnetzke, M; Hudel, I; Studier-Fischer, S; Grützner, P A; Gühring, T


    showed no bacterial pathogen after 14 days of incubation. DASH score and Constant score were used to evaluate the functional outcome after revision surgery. Bone healing was determined by standard X-rays and evaluated by a modified radiological score. 89% of the patients could be followed for an average of 28 months and the radiological follow-up was at 9 months. The radiological score showed very good (50%), or good results, and a sufficient bone healing was shown in 25 of 27 patients (93%). The pseudarthrosis revision surgery failed in two cases (n = 1 persisting non-union; n = 1 humeral head necrosis after re-operation with angle plate). DASH scores provided a mean of 40 ± 28.8 with a range from 0-97 points, and the results from the Constant score provided 45 ± 25.4. The analysis with variation of age showed a trend for better results in female patients fracture of the iliac bone occurred that healed with conservative treatment. The pseudarthrosis revision surgery with humeral head preserving re-osteosynthesis with bone transplantation is an effective treatment for non-unions of the proximal humerus and the proximal humeral shaft and the current results showed high bone consolidation rates. As the functional results remained limited after revision an individual treatment decision should be made concerning the most appropriate therapy. While a shoulder prosthesis may be considered in the aged patient, a revision strategy with reosteosynthesis should be considered particularly in younger patients. Georg Thieme Verlag KG Stuttgart · New York.

  17. The Revised Body Awareness Rating Questionnaire: Development Into a Unidimensional Scale Using Rasch Analysis. (United States)

    Dragesund, Tove; Strand, Liv Inger; Grotle, Margreth


    The Body Awareness Rating Questionnaire (BARQ) is a self-report questionnaire aimed at capturing how people with long-lasting musculoskeletal pain reflect on their own body awareness. Methods based on classical test theory were applied to the development of the instrument and resulted in 4 subscales. However, the scales were not correlated, and construct validity might be questioned. The primary purpose of this study was to explore the possibility of developing a unidimensional scale from items initially collected for the BARQ using Rasch analysis. A secondary purpose was to investigate the test-retest reliability of a revised version of the BARQ. This was a methodological study. Rasch and reliability analyses were performed for 3 samples of participants with long-lasting musculoskeletal pain. The first Rasch analysis was carried out on 66 items generated for the original BARQ and scored by 300 participants. The items supported by the first analysis were scored by a new group of 127 participants and analyzed in a second Rasch analysis. For the test-retest reliability analysis, 48 participants scored the revised BARQ items twice within 1 week. The 2-step Rasch analysis resulted in a unidimensional 12-item revised version of the BARQ with a 4-point response scale (scores from 0 to 36). It showed a good fit to the Rasch model, with acceptable internal consistency, satisfactory fit residuals, and no disordered thresholds. Test-retest reliability was high, with an intraclass correlation coefficient of .83 (95% CI = .71-.89) and a smallest detectable change of 6.3 points. The small sample size in the second Rasch analysis was a study limitation. The revised BARQ is a unidimensional and feasible measurement of body awareness, recommended for use in the context of body-mind physical therapy approaches for musculoskeletal conditions.

  18. [Failure cause of posterior approach orthopaedic operation of thoracolumbar hemivertebra and strategies of revision]. (United States)

    Li, Bo; Lu, Minpeng; Wang, Qunbo; Yu, Yu; Shao, Gaohai


    To explore the failure cause of posterior approach orthopaedic operation of thoracolumbar hemivertebra, and to summary strategies of revision. The clinical data from 9 cases undergoing posterior approach orthopaedic operation failure of thoracolumbar hemivertebra between June 2003 and June 2008, were retrospectively analyzed. There were 5 males and 4 females with a median age of 12 years (range, 1 year and 10 months to 24 years). All malformations were identified as fully segmented hemivertebra from the original medical records and X-ray films, including 2 cases in thoracic vertebra, 5 cases in thoracolumbar vertebra, and 2 cases in lumbar vertebra. The preoperative scoliotic Cobb angle was (45.4 +/- 17.4) degrees, and kyphotic Cobb angle was (29.8 +/- 22.0) degrees. The reason of primary surgical failure were analyzed and spinal deformity was corrected again with posterior revision. All surgeries were finished successfully. The operation time was 3.0-6.5 hours (mean, 4.5 hours), and the perioperative bleeding was 400-2 500 mL (mean, 950 mL). All incisions healed by first intention; no infection or deep venous thrombosis occurred. Numbness occurred in unilateral lower extremity of 1 case postoperatively, and the symptom was relieved completely after treatment of detumescence and neural nutrition. All cases were followed up 12-30 months (mean, 18 months). No pseudoarthrosis and implant failure occurred. The X-ray films showed that the bone grafts completely fused within 8-14 months (mean, 11 months) after operation. The Cobb angles of scoliosis and kyphosis at 1 week after operation and the last follow-up were obviously improved when compared with preoperative ones, showing significant differences (P < 0.05). No obvious correction loss was observed either in coronal or sagittal plane. The failure causes of posterior approach orthopaedic operation are hemivertebra processing, selection of fixation and fusion range, and selection of internal fixation. If the

  19. A customised collared polished stem may reduce the complication rate of impaction grafting in revision hip surgery: a 12-year follow-up study. (United States)

    Flecher, X; Blanc, G; Sainsous, B; Parratte, S; Argenson, J N


    We describe the results of 81 consecutive revision total hip replacements with impaction grafting in 79 patients using a collared polished chrome-cobalt stem, customised in length according to the extent of distal bone loss. Our hypothesis was that the features of this stem would reduce the rate of femoral fracture and subsidence of the stem. The mean follow-up was 12 years (8 to 15). No intra-operative fracture or significant subsidence occurred. Only one patient suffered a post-operative diaphyseal fracture, which was associated with a fall. All but one femur showed incorporation of the graft. No revision for aseptic loosening was recorded. The rate of survival of the femoral component at 12 years, using further femoral revision as the endpoint, was 100% (95% confidence interval (CI) 95.9 to 100), and at nine years using re-operation for any reason as the endpoint, was 94.6% (95% CI 92.0 to 97.2). These results suggest that a customised cemented polished stem individually adapted to the extent of bone loss and with a collar may reduce subsidence and the rate of fracture while maintaining the durability of the fixation.

  20. Development of the methodology for application of revised source term to operating nuclear power plants in Korea

    Energy Technology Data Exchange (ETDEWEB)

    Kang, M.S.; Kang, P.; Kang, C.S. [Department of Nucler Engineering, Seoul National University, Seoul (Korea, Republic of); Moon, J.H. [Korea Intitute of Nuclear Safety, Taejon (Korea, Republic of)


    Considering the current trend in applying the revised source term proposed by NUREG-1465 to the nuclear power plants in the U.S., it is expected that the revised source term will be applied to the Korean operating nuclear power plants in the near future, even though the exact time can not be estimated. To meet the future technical demands, it is necessary to prepare the technical system including the related regulatory requirements in advance. In this research, therefore, it is intended to develop the methodology to apply the revised source term to operating nuclear power plants in Korea. Several principles were established to develop the application methodologies. First, it is not necessary to modify the existing regulations about source term (i.e., any back-fitting to operating nuclear plants is not necessary). Second, if the pertinent margin of safety is guaranteed, the revised source term suggested by NUREG-1465 may be useful to full application. Finally, a part of revised source term could be selected to application based on the technical feasibility. As the results of this research, several methodologies to apply the revised source term to the Korean operating nuclear power plants have been developed, which include: 1) the selective (or limited) application to use only some of all the characteristics of the revised source term, such as release timing of fission products and chemical form of radio-iodine and 2) the full application to use all the characteristics of the revised source term. The developed methodologies are actually applied to Ulchin 9 and 4 units and their application feasibilities are reviewed. The results of this research are used as either a manual in establishing the plan and the procedure for applying the revised source term to the domestic nuclear plant from the utility's viewpoint; or a technical basis of revising the related regulations from the regulatory body's viewpoint. The application of revised source term to operating

  1. Analysis of intraoperative difficulties and management of operative complications in revision anterior exposure of the lumbar spine: a report of 25 consecutive cases. (United States)

    Flouzat-Lachaniette, Charles-Henri; Delblond, William; Poignard, Alexandre; Allain, Jérôme


    After a first anterior approach to the lumbar spine, formation of adhesions of soft tissues to the spine increases the surgical difficulties and potential for iatrogenic injury during the revision exposure. The objective of this study was to identify the intraoperative difficulties and postoperative complications associated with revision anterior lumbar spine procedures in a single institution. This is a retrospective review of 25 consecutive anterior revision lumbar surgeries in 22 patients (7 men and 15 women) operated on between 1998 and 2011. Patients with trauma or malignancies were excluded. The mean age of the patients at the time of revision surgery was 56 years (range 20-80 years). The complications were analyzed depending on the operative level and the time between the index surgery and the revision. Six major complications (five intraoperatively and one postoperatively) occurred in five patients (20 %): three vein lacerations (12 %) and two ureteral injuries (8 %), despite the presence of a double-J ureteral stent. The three vein damages were repaired or ligated by a vascular surgeon. One of the two ureteral injuries led to a secondary nephrectomy after end-to-end anastomosis failure; the other necessitated secondary laparotomy for small bowel obstruction. Anterior revision of the lumbar spine is technically challenging and is associated with a high rate of vascular or urologic complications. Therefore, the potential complications of the procedure must be weighted against its benefits. When iterative anterior lumbar approach is mandatory, exposure should be performed by an access surgeon in specialized centers that have ready access to vascular and urologic surgeons.

  2. How have alternative bearings and modularity affected revision rates in total hip arthroplasty? (United States)

    Mihalko, William M; Wimmer, Markus A; Pacione, Carol A; Laurent, Michel P; Murphy, Robert F; Rider, Carson


    Total hip arthroplasty (THA) continues to be one of the most successful surgical procedures in the medical field. However, over the last two decades, the use of modularity and alternative bearings in THA has become routine. Given the known problems associated with hard-on-hard bearing couples, including taper failures with more modular stem designs, local and systemic effects from metal-on-metal bearings, and fractures with ceramic-on-ceramic bearings, it is not known whether in aggregate the survivorship of these implants is better or worse than the metal-on-polyethylene bearings that they sought to replace. Have alternative bearings (metal-on-metal and ceramic-on-ceramic) and implant modularity decreased revision rates of primary THAs? In this systematic review of MEDLINE and EMBASE, we used several Boolean search strings for each topic and surveyed national registry data from English-speaking countries. Clinical research (Level IV or higher) with ≥ 5 years of followup was included; retrieval studies and case reports were excluded. We included registry data at ≥ 7 years followup. A total of 32 studies (and five registry reports) on metal-on-metal, 19 studies (and five registry reports) on ceramic-on-ceramic, and 20 studies (and one registry report) on modular stem designs met inclusion criteria and were evaluated in detail. Insufficient data were available on metal-on-ceramic and ceramic-on-metal implants, and monoblock acetabular designs were evaluated in another recent systematic review so these were not evaluated here. There was no evidence in the literature that alternative bearings (either metal-on-metal or ceramic-on-ceramic) in THA have decreased revision rates. Registry data, however, showed that large head metal-on-metal implants have lower 7- to 10-year survivorship than do standard bearings. In THA, modular exchangeable femoral neck implants had a lower 10-year survival rate in both literature reviews and in registry data compared with combined

  3. The Fate of Revision Total Knee Arthroplasty With Preoperative Abnormalities in Either Sedimentation Rate or C-Reactive Protein. (United States)

    Hardcastle, John M; So, David H; Lee, Gwo-Chin


    Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are important markers in the evaluation and treatment of painful total knee arthroplasty (TKA). Elevation of both markers usually occurs with infected TKAs while a normal ESR and CRP usually point to aseptic causes for failure. The purpose of this study is to compare (1) rate of revision, (2) infection, and (3) reason for reoperation in a group of patients undergoing revision TKA with a single abnormality in either ESR or CRP in an otherwise negative conventional infection work-up compared to patients with normal preoperative ESR and CRP. We retrospectively reviewed 791 consecutive revision TKAs performed at our institution between years 2004 and 2011. Following exclusion for infection, periprosthetic fracture, prior revision TKA, positive cultures, incomplete records, and patients with less than 24-month follow-up, a total of 228 aseptic revisions (89 knees with 1 abnormal serologic marker) were available for final analysis. No patients met the current established criteria for infection. All knees underwent revision TKA using antibiotic-impregnated cement. The 2 groups were compared in terms of overall survivorship, infection rate, and rate and causes of subsequent aseptic revision. The average follow-up was 60 months (24-110). There were no significant differences between the 2 groups in terms of age, sex, American Society of Anesthesiologists class, and Charlson comorbidity index. A preoperative abnormality of either ESR or CRP significantly increased the risk for reoperation for all reasons (odds ratio [OR], 3.2; P = .0028), infection (OR, 4.0; P = .034), and revision for aseptic loosening (OR, 3.69; P = .044). There were no differences in reoperations for any other reason. The average time to revision in the study group was 28.3 months compared to 40.0 months in the control group (P = .213). A single abnormality in either the ESR or CRP increased the likelihood of both infection and

  4. Functional outcome, revision rates and mortality after primary total hip replacement--a national comparison of nine prosthesis brands in England.

    Directory of Open Access Journals (Sweden)

    Mark Pennington

    Full Text Available The number of prosthesis brands used for hip replacement has increased rapidly, but there is little evidence on their effectiveness. We compared patient-reported outcomes, revision rates, and mortality for the three most frequently used brands within each prosthesis type: cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee, cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed, and hybrid (Exeter V40 Trilogy, Exeter V40 Trilogy, and CPT Trilogy.We used three national databases of patients who had hip replacements between 2008 and 2011 in the English NHS to compare functional outcome (Oxford Hip Score (OHS ranging from 0 (worst to 48 (best in 43,524 patients at six months. We analysed revisions and mortality in 187,201 patients. We used multiple regression to adjust for pre-operative differences. Prosthesis type had an impact on post-operative OHS and revision rates (both p<0.001. Patients with hybrid prostheses had the best functional outcome (mean OHS 39.4, 95%CI 39.1 to 39.7 and those with cemented prostheses the worst (37.7, 37.3 to 38.1. Patients with cemented prostheses had the lowest reported 5-year revision rates (1.3%, 1.2% to 1.4% and those with cementless prostheses the highest (2.2%, 2.1% to 2.4%. Differences in mortality according to prosthesis type were small and not significant (p = 0.06. Functional outcome varied according to brand among cemented (p = 0.05, with Exeter V40 Duration having the best and cementless prostheses (p = 0.01, with Corail Pinnacle having the best. Revision rates varied according to brand among hybrids (p = 0.05, with Exeter V40 Trident having the lowest.Functional outcomes were better with cementless cups and revision rates were lower with cemented stems, which underlies the good overall performance of hybrids. The hybrid Exeter V40 Trident seemed to produce the best overall results. This brand should be considered as a benchmark in randomised trials.

  5. Functional Outcome, Revision Rates and Mortality after Primary Total Hip Replacement – A National Comparison of Nine Prosthesis Brands in England (United States)

    Pennington, Mark; Grieve, Richard; Black, Nick; van der Meulen, Jan H.


    Background The number of prosthesis brands used for hip replacement has increased rapidly, but there is little evidence on their effectiveness. We compared patient-reported outcomes, revision rates, and mortality for the three most frequently used brands within each prosthesis type: cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee), cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed), and hybrid (Exeter V40 Trilogy, Exeter V40 Trilogy, and CPT Trilogy). Methods and Findings We used three national databases of patients who had hip replacements between 2008 and 2011 in the English NHS to compare functional outcome (Oxford Hip Score (OHS) ranging from 0 (worst) to 48 (best)) in 43,524 patients at six months. We analysed revisions and mortality in 187,201 patients. We used multiple regression to adjust for pre-operative differences. Prosthesis type had an impact on post-operative OHS and revision rates (both phybrid prostheses had the best functional outcome (mean OHS 39.4, 95%CI 39.1 to 39.7) and those with cemented prostheses the worst (37.7, 37.3 to 38.1). Patients with cemented prostheses had the lowest reported 5-year revision rates (1.3%, 1.2% to 1.4%) and those with cementless prostheses the highest (2.2%, 2.1% to 2.4%). Differences in mortality according to prosthesis type were small and not significant (p = 0.06). Functional outcome varied according to brand among cemented (p = 0.05, with Exeter V40 Duration having the best) and cementless prostheses (p = 0.01, with Corail Pinnacle having the best). Revision rates varied according to brand among hybrids (p = 0.05, with Exeter V40 Trident having the lowest). Conclusions Functional outcomes were better with cementless cups and revision rates were lower with cemented stems, which underlies the good overall performance of hybrids. The hybrid Exeter V40 Trident seemed to produce the best overall results. This brand should be considered as a

  6. Functional outcome, revision rates and mortality after primary total hip replacement--a national comparison of nine prosthesis brands in England. (United States)

    Pennington, Mark; Grieve, Richard; Black, Nick; van der Meulen, Jan H


    The number of prosthesis brands used for hip replacement has increased rapidly, but there is little evidence on their effectiveness. We compared patient-reported outcomes, revision rates, and mortality for the three most frequently used brands within each prosthesis type: cemented (Exeter V40 Contemporary, Exeter V40 Duration and Exeter V40 Elite Plus Ogee), cementless (Corail Pinnacle, Accolade Trident, and Taperloc Exceed), and hybrid (Exeter V40 Trilogy, Exeter V40 Trilogy, and CPT Trilogy). We used three national databases of patients who had hip replacements between 2008 and 2011 in the English NHS to compare functional outcome (Oxford Hip Score (OHS) ranging from 0 (worst) to 48 (best)) in 43,524 patients at six months. We analysed revisions and mortality in 187,201 patients. We used multiple regression to adjust for pre-operative differences. Prosthesis type had an impact on post-operative OHS and revision rates (both phybrid prostheses had the best functional outcome (mean OHS 39.4, 95%CI 39.1 to 39.7) and those with cemented prostheses the worst (37.7, 37.3 to 38.1). Patients with cemented prostheses had the lowest reported 5-year revision rates (1.3%, 1.2% to 1.4%) and those with cementless prostheses the highest (2.2%, 2.1% to 2.4%). Differences in mortality according to prosthesis type were small and not significant (p = 0.06). Functional outcome varied according to brand among cemented (p = 0.05, with Exeter V40 Duration having the best) and cementless prostheses (p = 0.01, with Corail Pinnacle having the best). Revision rates varied according to brand among hybrids (p = 0.05, with Exeter V40 Trident having the lowest). Functional outcomes were better with cementless cups and revision rates were lower with cemented stems, which underlies the good overall performance of hybrids. The hybrid Exeter V40 Trident seemed to produce the best overall results. This brand should be considered as a benchmark in randomised trials.

  7. Malposition and revision rates of different imaging modalities for percutaneous iliosacral screw fixation following pelvic fractures: a systematic review and meta-analysis. (United States)

    Zwingmann, Jörn; Hauschild, Oliver; Bode, Gerrit; Südkamp, Norbert P; Schmal, Hagen


    Percutaneous iliosacral screw placement following pelvic trauma is associated with high rates of revisions, screw malpositioning, the risk of neurological damage and inefficient stability. The correct entry point and the small target corridor may be difficult to visualize using only an image intensifier. Therefore, 2D and 3D image-based navigation and reconstruction techniques could be helpful tools. The aim of this systematic review and meta-analysis was to evaluate the best available evidence regarding the rate of malpositioning and revisions using different techniques for screw implantation, i.e., conventional, 2D and 3D image-based navigation and reconstruction techniques, CT navigation. A systematic review and meta-analysis were performed using the data available on Ovid Medline. 430 studies published between 1/1948 and 2/2011 were identified by two independent investigators. Inclusion criteria were percutaneous iliosacral screw fixation after traumatic pelvic fractures with included revision rate or positioning of the screw, language of the article English or German. Exclusion criteria were osteoporotic fracture, tumor, reviews, epidemiological studies, biomechanical/cadaveric studies, studies about operative technique. For statistical analysis the random effect model was used. A total of 51 studies fulfilled the inclusion requirements describing 2,353 percutaneous screw implantations following pelvic trauma in 1,731 patients. The estimated rate of malposition was 0.1 % for 262 screws using CT navigation. This rate was significantly lower (p < 0.0001) than for the conventional technique with malposition rate of 2.6 % (total 1,832 screws). Using 2D and 3D image-based navigation and reconstruction techniques, the malposition rate was 1.3 % (total 445 screws). No significance was observed between the conventional and the 2D and 3D image-based navigation and reconstruction techniques. The rates of revision were not statistically significant with 2.7 % (1

  8. Comparing Cultural Differences in Two Quality Measures in Chinese Kindergartens: The Early Childhood Environment Rating Scale-Revised and the Kindergarten Quality Rating System (United States)

    Hu, Bi Ying


    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…

  9. Low revision rate after total hip arthroplasty in patients with pediatric hip diseases

    DEFF Research Database (Denmark)

    Engesæter, Lars B; Engesæter, Ingvild Ø; Fenstad, Anne Marie


    ). Consequently, an increased risk of revision for hips with a previous pediatric hip disease was seen (risk ratio (RR) 1.4, 95% CI: 1.3-1.5). However, after adjustment for differences in sex and age of the patients, and in fixation of the prostheses, no difference in survival was found (93.6% after pediatric hip......Background The results of primary total hip arthroplasties (THAs) after pediatric hip diseases such as developmental dysplasia of the hip (DDH), slipped capital femoral epiphysis (SCFE), or Perthes' disease have been reported to be inferior to the results after primary osteoarthritis of the hip (OA.......9%) were operated due to pediatric hip diseases (3.1% for Denmark, 8.8% for Norway, and 1.9% for Sweden) and 288,435 THAs (77.8%) were operated due to OA. Unadjusted 10-year Kaplan-Meier survival of THAs after pediatric hip diseases (94.7% survival) was inferior to that after OA (96.6% survival...

  10. Radiological and chemical source terms for Solid Waste Operations Complex. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Boothe, G.F.


    The purpose of this document is to describe the radiological and chemical source terms for the major projects of the Solid Waste Operations Complex (SWOC), including Project W-112, Project W-133 and Project W-100 (WRAP 2A). For purposes of this document, the term ``source term`` means the design basis inventory. All of the SWOC source terms involve the estimation of the radiological and chemical contents of various waste packages from different waste streams, and the inventories of these packages within facilities or within a scope of operations. The composition of some of the waste is not known precisely; consequently, conservative assumptions were made to ensure that the source term represents a bounding case (i.e., it is expected that the source term would not be exceeded). As better information is obtained on the radiological and chemical contents of waste packages and more accurate facility specific models are developed, this document should be revised as appropriate. Radiological source terms are needed to perform shielding and external dose calculations, to estimate routine airborne releases, to perform release calculations and dose estimates for safety documentation, to calculate the maximum possible fire loss and specific source terms for individual fire areas, etc. Chemical source terms (i.e., inventories of combustible, flammable, explosive or hazardous chemicals) are used to determine combustible loading, fire protection requirements, personnel exposures to hazardous chemicals from routine and accident conditions, and a wide variety of other safety and environmental requirements.

  11. Is a Single-Item Operative Performance Rating Sufficient? (United States)

    Williams, Reed G; Verhulst, Steven; Mellinger, John D; Dunnington, Gary L


    A valid measure of resident operative performance ability requires direct observation and accurate rating of multiple resident performances under the normal range of operating conditions. The challenge is to create an operative performance rating (OPR) system that: is easy to use, encourages completion of many ratings immediately after performances and minimally disrupts supervising surgeons' work days. The purpose of this study was to determine whether a score based on a single-item overall OPR provides a valid and stable appraisal of resident operative performances. A retrospective comparison of a single-item OPR with a gold-standard rating based on multiple procedure-specific and general OPR items. Data were collected in the general surgery residency program at Southern Illinois University from 2001 through 2012. Assessments of 1033 operative performances (3 common procedures, 2 laparoscopic, and 1 open) by general surgery residents were collected. OPRs based on single-item overall performance scale scores were compared with gold-standard ratings for the same performances. Differences in performance scores using the 2 scales averaged 0.02 points (5-point scale). Correlations of the single-item and gold-standard scale scores averaged 0.95. Based on generalizability analyses of laparoscopic cholecystectomy ratings, each instrument required 5 observations to achieve reliabilities of 0.80 and 11 observations to achieve reliabilities of 0.90. Only 4.4% of single-item ratings misclassified the performance when compared with the gold-standard rating and all misclassifications were near misses. For 80% of misclassified ratings, single-item ratings were lower. Single-item operative performance measures produced ratings that were virtually identical to gold-standard scale ratings. Misclassifications occurred infrequently and were minor in magnitude. Ratings using the single-item scale: take less time to complete, should increase the sample of procedures rated, and

  12. Delirium subtype identification and the validation of the Delirium Rating Scale--Revised-98 (Dutch version) in hospitalized elderly patients

    NARCIS (Netherlands)

    de Rooij, Sophia E.; van Munster, Barbara C.; Korevaar, Johanna C.; Casteelen, Gerty; Schuurmans, Marieke J.; van der Mast, Roos C.; Levi, Marcel


    BACKGROUND: Delirium is the most common acute neuropsychiatric disorder in hospitalized elderly. The Dutch version of the Delirium Rating Scale-Revised-98 (DRS-R-98) appears to be a reliable method to classify delirium. The aim of this study was to determine the validity and reliability of the

  13. 44 CFR 65.12 - Revision of flood insurance rate maps to reflect base flood elevations caused by proposed... (United States)


    ... will cause base flood elevation increases in excess of those permitted under paragraphs (c)(10) or (d... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Revision of flood insurance rate maps to reflect base flood elevations caused by proposed encroachments. 65.12 Section 65.12...

  14. Lower complication rates for cranioplasty with peri-operative bundle. (United States)

    Le, Catherine; Guppy, Kern H; Axelrod, Yekaterina V; Hawk, Mark W; Silverthorn, James; Inacio, Maria C; Akins, Paul T


    The overall benefits of craniectomy must include procedural risks from cranioplasty. Cranioplasty carries a high risk of surgical site infections (SSI) particularly with antibiotic resistant bacteria. The goal of this study was to measure the effect of a cranioplasty bundle on peri-operative complications. The authors queried a prospective, inpatient neurosurgery database at Kaiser Sacramento Medical Center for craniectomy and cranioplasty over a 7 year period. 57 patients who underwent cranioplasties were identified. A retrospective chart review was completed for complications, including surgical complications such as SSI, wound dehiscence, and re-do cranioplasty. We measured cranioplasty complication rates before and after implementation of a peri-operative bundle, which consisted of peri-operative vancomycin (4 doses), a barrier dressing through post-operative day (POD) 3, and de-colonization of the surgical incision using topical chlorhexidine from POD 4 to 7. The rate of MRSA colonization in cranioplasty patients is three times higher than the average seen on ICU admission screening (19% vs. 6%). The cranioplasty surgical complication rate was 22.8% and SSI rate was 10.5%. The concurrent SSI rate for craniectomy was 1.9%. Organisms isolated were methicillin-resistant Staphylococcus aureus (4), methicillin-sensitive S. aureus (1), Propionibacterium acnes (1), and Escherichia coli (1). Factors associated with SSI were peri-operative vancomycin (68.6% vs. 16.7%, p=0.0217). Complication rates without (n=21) and with (n=36) the bundle were: SSI (23.8% vs. 2.8%, p=0.0217) and redo cranioplasty (19% vs. 0%, p=0.0152). Bundle use did not affect rates for superficial wound dehiscence, seizures, or hydrocephalus. The cranioplasty bundle was associated with reduced SSI rates and the need for re-do cranioplasties. Copyright © 2014 Elsevier B.V. All rights reserved.

  15. Perioperative Serum Lipid Status and Statin Use Affect the Revision Surgery Rate After Arthroscopic Rotator Cuff Repair. (United States)

    Cancienne, Jourdan M; Brockmeier, Stephen F; Rodeo, Scott A; Werner, Brian C


    Recent animal studies have demonstrated that hyperlipidemia is associated with poor tendon-bone healing after rotator cuff repair; however, these findings have not been substantiated in human studies. To examine any association between hyperlipidemia and the failure of arthroscopic rotator cuff repair requiring revision surgery and to investigate whether the use of statin lipid-lowering agents had any influence on observed associations. Cohort study; Level of evidence, 3. From a national insurance database, patients who underwent arthroscopic rotator cuff repair with perioperative lipid levels (total cholesterol, low-density lipoprotein [LDL], and triglycerides) recorded were reviewed. For each lipid test, patients were stratified into normal, moderate, and high groups based on published standards. For the total cholesterol and LDL cohorts, a subgroup analysis of patients stratified by statin use was performed. The primary outcome measure was ipsilateral revision rotator cuff surgery, including revision repair or debridement. A logistic regression analysis controlling for patient demographics and comorbidities was utilized for comparison. There were 30,638 patients included in the study. The rate of revision rotator cuff surgery was significantly increased in patients with moderate (odds ratio [OR], 1.20; 95% CI, 1.03-1.40; P = .022) and high total cholesterol levels (OR, 1.36; 95% CI, 1.10-1.55; P = .006) compared with patients with normal total cholesterol levels perioperatively. Within each of these groups, patients without statin use had significantly higher rates of revision surgery, while those with statin prescriptions did not. The absolute risk reduction for statin use ranged from 0.24% to 1.87% when stratified by the total cholesterol level, yielding a number needed to treat from 54 to 408 patients. The rate of revision surgery was significantly increased in patients with moderate (OR, 1.24; 95% CI, 1.10-1.41; P = .001) and high LDL levels (OR, 1.46; 95

  16. Using the Conners' Teacher Rating Scale-Revised in school children referred for assessment. (United States)

    Charach, Alice; Chen, Shirley; Hogg-Johnson, Sheilah; Schachar, Russell J


    Predictive validity of the Conners' Teacher Rating Scale-Revised (CTRS-R) was evaluated against a semi-structured clinical teacher interview in school children referred for diagnostic assessment of attention-deficit hyperactivity disorder (ADHD). We hypothesized that extreme scale values would increase diagnostic certainty and that classification errors would be associated with comorbid conditions. Children (n = 1038), aged 6 to 12 years, were screened using the CTRS-R and their teachers were interviewed. Three levels of T scores on the 3 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) subscales of the CTRS-R were compared with DSM-IV symptom thresholds by interview. Where subscale scores and interviews showed highest agreement, presence of comorbid disruptive behavioural disorders, reading disability, language impairment, and low IQ were investigated for children classified correctly, compared with incorrectly. T scores of 60 and above on all CTRS-R DSM-IV subscales offered high sensitivity, from 91% to 94%. Only on subscales M (hyperactive-impulsive) and N (total) did T scores of less than 60 offer posttest probabilities of less than 10%, confirming that a child does not reach diagnostic threshold by interview. T scores of 80 and more offered high specificity, from 88% to 93%, but did not provide high posttest probabilities that children reach diagnostic criteria. Classification errors were associated with more language impairment among false positives than true positives on the M (18.9%, compared with 11.3%, P = 0.04) and N (19.0%, compared with 9.5%, P = 0.023) subscales, and more reading disabilities among false positives than among true positives on the N subscale (35.2%, compared with 21.6%, P = 0.009). The ability of the CTRS-R to predict whether clinically referred children reach DSM-IV criteria for ADHD at school is limited.

  17. Childhood depression subscales using repeated sessions on Children's Depression Rating Scale - revised (CDRS-R) scores. (United States)

    Isa, Ameena; Bernstein, Ira; Trivedi, Madhukar; Mayes, Taryn; Kennard, Betsy; Emslie, Graham


    Although acute treatments have been shown to be effective in treating early-onset depression, only one-third or thereabouts reach a remission within 3 months. Unfortunately, delayed time to remission in early-onset depression leads to poorer therapeutic outcomes. Clearly, there is a need to identify, diagnose, and provide effective treatment of a depressed patient quickly. A sophisticated understanding of depression subscales and their change over time with treatment could enhance pathways to individualized treatment approaches for childhood depression. Previous studies have found that the clinician-measured instrument, Children's Depression Rating Scale-Revised (CDRS-R) measures multiple subscales (or components) of depression. The aim of this study was to see how these subscales may change over the course of a 12-week study. This knowledge will help determine if dimensions/subscales of childhood depression (paralleling the adult literature) using the subscales derived from factor analysis procedure is useful. We examined two clinical trials in which youth (n=234) with major depressive disorder (MDD) were treated openly with fluoxetine for eight sessions spread over 12 weeks. The CDRS-R was completed based on clinician interviews with parent and child at each session. Classical test theory and component analysis with associated parallel analysis (oblique rotation) were conducted on each week's scores. Although more factors were needed for the baseline and first two therapy sessions, a two-factor solution sufficed thereafter. Depressed facial affect, listless speech, and hypoactivity best defined Factor I, whereas sleep problems, appetite disturbance, physical symptoms, irritability, guilt, and weeping best defined Factor II. All other symptoms cross-loaded almost equally on the two factors. The scale's reliability (internal consistency) improved from baseline to exit sessions (α=0.65-0.91). As a result, the clinicians' assessments of the various symptoms became

  18. Rating of intra-operative neuro-monitoring results in operative correction of the spinal deformities

    Directory of Open Access Journals (Sweden)

    A. A. Skripnikov


    Full Text Available Purpose of the work was filing the electrophysiological phenomena observed in the process of intra-operative neuromonitoring followed by development of the results’ scale of intra-operative neuro-physiological testing of the pyramidal tract. Materials and мethods. The selection for evaluation included data of 147 protocols of intra-operative neuromonitoring in 135 patients (53 males, 82 females, aged from 1 y. 5 m. to 52 years (14,1±0,7 years with spinal deformities of different etiology who underwent instrumentation spinal correction followed by fixation of thoracic / thoracolumbar spine segments using various variants of internal systems of trans-pedicular fixation. Intra-operative neuro-monitoring was performed using system «ISIS IOM» (Inomed Medizintechnik GmbH, Germany. The changes of motor evoked potentials were evaluated according to this scale. Results. Five types of pyramidal system reaction to operative invasion were revealed. According to neurophysiological criteria three grades of the risk of neurological disorders development during operative spinal deformity correction and, correspondingly, three levels of anxiety for the surgeon were defined. Conclusion. Intra-operative neurophysiological monitoring is the effective highly technological instrument to prevent neurological disorders in the spinal deformity. Offered rating scale of the risk of neurological complications gives the possibility to highlight three levels of anxiety during operative invasion.

  19. Revision of failed hip resurfacing to total hip arthroplasty rapidly relieves pain and improves function in the early post operative period

    Directory of Open Access Journals (Sweden)

    Muirhead-Allwood Sarah K


    Full Text Available Abstract We reviewed the results of 25 consecutive patients who underwent revision of a hip resurfacing prosthesis to a total hip replacement. Revisions were performed for recurrent pain and effusion, infection and proximal femoral fractures. Both components were revised in 20 cases. There were 12 male and 13 female patients with average time to revision of 34.4 and 26.4 months respectively. The mean follow up period was 12.7 months (3 to 31. All patients reported relief of pain and excellent satisfaction scores. Two patients experienced stiffness up to three months post operatively. Pre operative Oxford, Harris and WOMAC hip scores were 39.1, 36.4 and 52.2 respectively. Mean post operative scores at last follow up were 17.4, 89.8 and 6.1 respectively (p

  20. NCLEX-RN pass rate peril: one school's journey through curriculum revision, standardized testing, and attitudinal change. (United States)

    Carr, Suzanne Marie


    Processes used by a university to reverse the downward spiral of NCLEX-RN pass rates are described. Reasons for poor pass rates were found to be multifaceted and included gaps in curriculum content, student attitudes toward taking the licensure exam, delays in taking the exam following graduation, inadequate student preparation for taking standardized exams, and inappropriate and ineffective exit examinations. Various strategies for reversing the trend of the NCLEX failure rate included: addressing areas of weakness in the curriculum; revising courses; engaging students; changing standardized exit exams; employing a midcurricular and other standardized exams; and implementing remedial courses for poor performance on standardized exams. Change was effected and pass rates on the NCLEX-RN improved dramatically. Future possibilities and proactive measure are described.

  1. The relationship between the Early Childhood Environment Rating Scale and its revised form and child outcomes: A systematic review and meta-analysis

    National Research Council Canada - National Science Library

    Ashley Brunsek; Michal Perlman; Olesya Falenchuk; Evelyn McMullen; Brooke Fletcher; Prakesh S Shah


    The Early Childhood Environment Rating Scale (ECERS) and its revised version (ECERS-R) were designed as global measures of quality that assess structural and process aspects of Early Childhood Education and Care...

  2. Defense Nuclear Agency Reaction Rate Handbook. Second Edition. Revision Number 5, June 1975 (United States)


    region are presented in tabular form. 18B-2 Revision No S. June 1975 CHAPTER 18B 18B.3.1 Graphical Data I wo typ<-*« of graph are included...All data arv from Murad (Rtfaranot , and N • 2 2 ares, dato art from Murad (Rafaranca 188-50) obtained using Liimgii call technique« 188 SO...8217Relevance 18B601 obtained using drift tub« spectrometer techniques 18B-34 Rev.s.on No 5. Jun« 1975 CHAPTER 13B 18B.3.2 Tabular Data Hate

  3. Space Operations Center system analysis. Volume 3, book 2: SOC system definition report, revision A (United States)


    The Space Operations Center (SOC) orbital space station program operations are described. A work breakdown structure for the general purpose support equipment, construction and transportation support, and resupply and logistics support systems is given. The basis for the design of each element is presented, and a mass estimate for each element supplied. The SOC build-up operation, construction, flight support, and satellite servicing operations are described. Detailed programmatics and cost analysis are presented.

  4. Water Treatment Plant Operation Volume 2. A Field Study Training Program. Revised. (United States)

    California State Univ., Sacramento. School of Engineering.

    The purpose of this water treatment field study training program is to: (1) develop new qualified water treatment plant operators; (2) expand the abilities of existing operators, permitting better service both to employers and public; and (3) prepare operators for civil service and certification examinations (examinations administered by…

  5. Operation of Wastewater Treatment Plants. Volume 1. A Field Study Training Program. Third Edition. Revised. (United States)

    California State Univ., Sacramento. Dept. of Civil Engineering.

    The purpose of this wastewater treatment field study training program is to: (1) develop new qualified wastewater treatment plant operators; (2) expand the abilities of existing operators, permitting better service both to employers and public; and (3) prepare operators for civil service and certification examinations (examinations administered by…

  6. The use of a lipped acetabular liner decreases the rate of revision for instability after total hip replacement: a study using data from the New Zealand Joint Registry. (United States)

    Insull, P J; Cobbett, H; Frampton, C M; Munro, J T


    We compared the rate of revision for instability after total hip replacement (THR) when lipped and non-lipped acetabular liners were used. We hypothesised that the use of a lipped liner in a modular uncemented acetabular component reduces the risk of revision for instability after primary THR. Using data from the New Zealand Joint Registry, we found that the use of a lipped liner was associated with a significantly decreased rate of revision for instability and for all other indications. Adjusting for the size of the femoral head, the surgical approach and the age and gender of the patient, this difference remained strongly significant (p < 0.001). We conclude that evidence from the New Zealand registry suggests that the use of lipped liners with modular uncemented acetabular components is associated with a decreased rate of revision for instability after primary THR. ©2014 The British Editorial Society of Bone & Joint Surgery.

  7. Hydrocolloid dressing in pediatric burns may decrease operative intervention rates. (United States)

    Martin, Fiachra T; O'Sullivan, John B; Regan, Padraic J; McCann, Jack; Kelly, Jack L


    Partial-thickness scalds are the most common pediatric burn injury, and primary management consists of wound dressings to optimize the environment for reepithelialization. Operative intervention is reserved for burns that fail to heal using conservative methods. Worldwide, paraffin-based gauze (Jelonet) is the most common burn dressing; but literature suggests that it adheres to wounds and requires more frequent dressing change that may traumatize newly epithelialized surfaces. Hydrocolloid dressings (DuoDERM) provide an occlusive moist environment to optimize healing and are associated with less frequent dressing changes. The aim of the study was to retrospectively analyze pediatric burns in a single tertiary referral center over a 10-year period comparing the impact of Jelonet and DuoDERM dressings relative to operative intervention rates. All pediatric burns admitted between 1997 and 2007 were identified using the Hospital Inpatient Enquiry system. Demographics were collected from hospital records and theater logbooks. Acute, partial-thickness burns in patients younger than 15 years were analyzed according to dressing type applied (Jelonet or DuoDERM). Two hundred forty-eight pediatric burns were analyzed between 1997 and 2007. One hundred thirty-nine patients were treated with Jelonet dressings, and 109 were treated with DuoDERM. Debridement and grafting were required in 60 (43%) of the Jelonet patients compared with 10 (9%) of the DuoDERM patients (P pediatric burns.

  8. Westinghouse Hanford Company Conduct of Operations Manual: GOCO cross-cultivation committee. Revision 1, Operational excellence task force

    Energy Technology Data Exchange (ETDEWEB)


    Conduct of Operations is a set of standards which establishes an overall philosophy for achieving excellence in the operation of DOE facilities. These standards have application in many facets of our business and shall be considered by each organization that conducts or supports Operations in their efforts to improve overall organizational performance. The formality and accuracy resulting from the implementation of the elements of this manual will enhance safe operations and result in a higher quality product. The elements of the Conduct of Operations Requirements for DOE Facilities (DOE 5480.19) are tools to do our work. In like manner the tools and methods given in the Maintenance Management Program (DOE 4330.3A) are complementary and are to be used to the fullest. These DOE documents taken together and integrated into site implementation provide the framework for well operated facilities committed to excellence and not just compliance. The goal of this manual is to promote greater ownership and accountability by each individual worker and supervisor. Evidence of our success will include accountability by workers on the floor and in technical inquisitiveness at all levels. Striving for excellence involves all of us and we should not wait for someone else to find our problems.

  9. The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty. (United States)

    Ozkurt, B; Sen, T; Cankaya, D; Kendir, S; Basarır, K; Tabak, Y


    The purpose of this study was to develop an accurate, reliable and easily applicable method for determining the anatomical location of the joint line during revision knee arthroplasty. The transepicondylar width (TEW), the perpendicular distance between the medial and lateral epicondyles and the distal articular surfaces (DMAD, DLAD) and the distance between the medial and lateral epicondyles and the posterior articular surfaces (PMAD, DLAD) were measured in 40 knees from 20 formalin-fixed adult cadavers (11 male and nine female; mean age at death 56.9 years, sd 9.4; 34 to 69). The ratios of the DMAD, PMAD, DLAD and PLAD to TEW were calculated. The mean TEW, DMAD, PMAD, DLAD and PLAD were 82.76 mm (standard deviation (sd) 7.74), 28.95 mm (sd 3.3), 28.57 mm (sd 3), 23.97 mm (sd 3.27) and 24.42 mm (sd 3.14), respectively. The ratios between the TEW and the articular distances (DMAD/TEW, DLAD/TEW, PMAD/TEW and PLAD/TEW) were calculated and their means were 0.35 (sd 0.02), 0.34 (sd 0.02), 0.28 (sd 0.03) and 0.29 (sd 0.03), respectively. This method provides a simple, reproducible and reliable technique enabling accurate anatomical joint line restoration during revision total knee arthroplasty.Cite this article: B. Ozkurt, T. Sen, D. Cankaya, S. Kendir, K. Basarır, Y. Tabak. The medial and lateral epicondyle as a reliable landmark for intra-operative joint line determination in revision knee arthroplasty. Bone Joint Res 2016;5:280-286. DOI: 10.1302/2046-3758.57.BJR-2016-0002.R1. © 2016 Ozkurt et al.

  10. Knowledge and abilities catalog for nuclear power plant operators: Pressurized water reactors. Revision 1

    Energy Technology Data Exchange (ETDEWEB)



    This document provides the basis for the development of content-valid licensing examinations for reactor operators and senior reactor operators. The examinations developed using the PWR catalog will cover those topics listed under Title 10, (ode of Federal Regulations Part 55. The PWR catalog contains approximately 5100 knowledge and ability (K/A) statements for reactor operators and senior reactor operators. The catalog is organized into six major sections: Catalog Organization; Generic Knowledge and Abilities; Plant Systems; Emergency and Abnormal Plant Evolutions; Components and Theory.

  11. Do Rerevision Rates Differ After First-time Revision of Primary THA With a Cemented and Cementless Femoral Component?

    DEFF Research Database (Denmark)

    Gromov, Kirill; Pedersen, Alma B; Overgaard, Søren


    the results of future revision procedures; however, this has not been documented. The purpose of this study was to compare (1) the risk for rerevision of first revision THA; (2) the patterns of femoral bone loss at the time of first revision of primary THA; (3) the reasons for first revision of primary THA......) and 2 years (range, 0-16 years), respectively. Survival of first revision THA, with second revision of the femur as outcome, was evaluated using hazard ratios (HRs) with 95% confidence interval (CI) adjusting for potential confounding. All patient- and surgery-related data are collected from Danish...

  12. Revision rates for metal-on-metal hip resurfacing and metal-on-metal total hip arthroplasty – a systematic review

    DEFF Research Database (Denmark)

    Ras Sørensen, Sofie-amalie L.; Jørgensen, Henrik L.; Sporing, Sune L.


    Purpose To compare revision rates of metal-on-metal (MoM) hip resurfacing (HRS) and MoM total hip arthroplasty (THA), as well as the primary causes for revisions. Methods The PubMed database was queried for potentially relevant articles addressing MoMTHA and MoMHRS, a total of 51 articles were...... cause for revision for both MoMTHA and MoMHRS was loosening 47.6% vs. 37.7%, fracture (MoMTHA 7.69%; MoMHRS 19.62%), metal reactions (MoMTHA 7.69%; MoMHRS 26.92%) infection (MoMTHA 12.08%; MoMHRS 6.54%), instability (MoMTHA 9.13%; MoMHRS 2.69%), manufacturer defect 6.73% for MoMTHA and nonreported...... in revision rate of MoMHRS may indicate a progression in failure....

  13. Nuclear Technology Series. Nuclear Reactor (Plant) Operator Trainee. A Suggested Program Planning Guide. Revised June 80. (United States)

    Center for Occupational Research and Development, Inc., Waco, TX.

    This program planning guide for a two-year postsecondary nuclear reactor (plant) operator trainee program is designed for use with courses 1-16 of thirty-five in the Nuclear Technology Series. The purpose of the guide is to describe the nuclear power field and its job categories for specialists, technicians and operators; and to assist planners,…

  14. Uncertainty assessment via Bayesian revision of ensemble streamflow predictions in the operational river Rhine forecasting system

    NARCIS (Netherlands)

    Reggiani, P.; Renner, M.; Weerts, A.H.; Van Gelder, P.A.H.J.M.


    Ensemble streamflow forecasts obtained by using hydrological models with ensemble weather products are becoming more frequent in operational flow forecasting. The uncertainty of the ensemble forecast needs to be assessed for these products to become useful in forecasting operations. A comprehensive

  15. Developing a model of competence in the operating theatre: psychometric validation of the perceived perioperative competence scale-revised. (United States)

    Gillespie, Brigid M; Polit, Denise F; Hamlin, Lois; Chaboyer, Wendy


    This paper describes the development and validation of the Revised Perioperative Competence Scale (PPCS-R). There is a lack of a psychometrically tested sound self-assessment tools to measure nurses' perceived competence in the operating room. Content validity was established by a panel of international experts and the original 98-item scale was pilot tested with 345 nurses in Queensland, Australia. Following the removal of several items, a national sample that included all 3209 nurses who were members of the Australian College of Operating Room Nurses was surveyed using the 94-item version. Psychometric testing assessed content validity using exploratory factor analysis, internal consistency using Cronbach's alpha, and construct validity using the "known groups" technique. During item reduction, several preliminary factor analyses were performed on two random halves of the sample (n=550). Usable data for psychometric assessment were obtained from 1122 nurses. The original 94-item scale was reduced to 40 items. The final factor analysis using the entire sample resulted in a 40 item six-factor solution. Cronbach's alpha for the 40-item scale was .96. Construct validation demonstrated significant differences (pcompetence scores relative to years of operating room experience and receipt of specialty education. On the basis of these results, the psychometric properties of the PPCS-R were considered encouraging. Further testing of the tool in different samples of operating room nurses is necessary to enable cross-cultural comparisons. Copyright © 2011 Elsevier Ltd. All rights reserved.

  16. Feasibility study report for the 200-BP-1 operable unit. Revision 1

    Energy Technology Data Exchange (ETDEWEB)


    This feasibility study (FS) examines a range of alternatives and provides recommendations for selecting a preferred altemative for remediating contamination at the 200-BP-1 operable unit. The 200-BP-1 operable unit is located in the center of the Hanford Site along the northern boundary of the 200 East Area. The 241-BY Tank Farm is located immediately to the south of the operable unit. 200-BP-1 is a source operable unit with contaminated soils associated primarily with nine inactive cribs (known as the 216-B cribs). These cribs were used for disposal of low-level radioactive liquid waste from U Plant uranium recovery operations, and waste storage tank condensate from the adjacent 241-BY Tank Farm. The cribs used for disposal of U Plant waste were in operation from 1955--1965, and the cribs used for disposal of tank condensate were in operation from 1965-1975. In addition to the cribs, four unplanned releases of radioactive materials have occurred within the operable unit. Contaminated surface soils associated with the unplanned releases have been consolidated over the cribs and covered with clean soil to reduce contaminant migration and exposure. Discharge of wastes to the cribs has resulted in soil and groundwater contamination. The groundwater is being addressed as part of the 200 East Aggregate Area groundwater operable unit. Contaminated soils at the site can be categorized by the types of contaminants, their distribution in the soil column, and the risk posed by the various potential exposure pathways. Below the clean soil cover, the near surface soils contain low-:levels of contamination with cesium-137, radium-226, strontium-90, thorium-228 and uranium. The lifetime incremental cancer risk associated with these soils if they were exposed at the surface is 9 {times} 10{sup 5}.

  17. [Design of Oxygen Saturation, Heart Rate, Respiration Rate Detection System Based on Smartphone of Android Operating System]. (United States)

    Zhu, Mingshan; Zeng, Bixin


    In this paper, we designed an oxygen saturation, heart rate, respiration rate monitoring system based on smartphone of android operating system, physiological signal acquired by MSP430 microcontroller and transmitted by Bluetooth module.

  18. Technology basis for the Liquid Effluent Retention Facility Operating Specifications. Revision 3

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, P.G.


    The Liquid Effluent Retention Facility (LERF) consists of three retention basins, each with a nominal storage capacity of 6.5 million gallons. LERF serves as interim storage of 242-A Evaporator process condensate for treatment in the Effluent Treatment Facility. This document provides the technical basis for the LERF Operating Specifications, OSD-T-151-00029.

  19. The Interface Between Distributed Operating System and High-Level Programming Language. Revision. (United States)


    benefit , of a high-lcel language, most programmers probably would prefer the comparativel. powerful facilities of Char- lotte to the comparatitel...34Process Migration in DEMOS/MP." Proceedings of the Ninth ACAI Svnposium on Operating Stste’ns Principles, 10-13 October 1983. pp. 110-118. In ACV

  20. Interest rate and commercial banks' lending operations in Nigeria: A ...

    African Journals Online (AJOL)

    It was found that Monetary Policy Rate (MPR) and inflation rate exert a positive and significant impact on banks' loans for the period. For the deregulation era, the result showed that MPR and the exchange rate had significant impact on banks' loans and advances. While the former exerted a negative impact, the later had a ...

  1. Environmental Monitoring Plan United States Department of Energy Richland Operations Office. Revision 2

    Energy Technology Data Exchange (ETDEWEB)



    This Environmental Monitoring Plan was prepared for the US Department of Energy`s (DOE`s) Richland Operations Office (RL) to implement the requirements of DOE Order 5400.1. According to the Order, each DOE site, facility, or activity that uses, generates, releases, or manages significant pollutants or hazardous materials shall prepare a written environmental monitoring plan covering two major activities: (1) effluent monitoring and (2) environmental surveillance. The plan is to contain information discussing the rationale and design criteria for the monitoring programs, sampling locations and schedules, quality assurance requirements, program implementation procedures, analytical procedures, and reporting requirements. The plan`s purpose is to assist DOE in the management of environmental activities at the Hanford Site and to help ensure that operations on the site are conducted in an environmentally safe and sound manner.

  2. Hazard and operability study of the multi-function Waste Tank Facility. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Hughes, M.E.


    The Multi-Function Waste Tank Facility (MWTF) East site will be constructed on the west side of the 200E area and the MWTF West site will be constructed in the SW quadrant of the 200W site in the Hanford Area. This is a description of facility hazards that site personnel or the general public could potentially be exposed to during operation. A list of preliminary Design Basis Accidents was developed.

  3. Comparison of the glomerular filtration rate in children by the new revised Schwartz formula and a new generalized formula. (United States)

    Gao, Anja; Cachat, Francois; Faouzi, Mohamed; Bardy, Daniel; Mosig, Dolores; Meyrat, Blaise-Julien; Girardin, Eric; Chehade, Hassib


    The most widely used formula for estimating glomerular filtration rate (eGFR) in children is the Schwartz formula. It was revised in 2009 using iohexol clearances with measured GFR (mGFR) ranging between 15 and 75 ml/min × 1.73 m(2). Here we assessed the accuracy of the Schwartz formula using the inulin clearance (iGFR) method to evaluate its accuracy for children with less renal impairment comparing 551 iGFRs of 392 children with their Schwartz eGFRs. Serum creatinine was measured using the compensated Jaffe method. In order to find the best relationship between iGFR and eGFR, a linear quadratic regression model was fitted and a more accurate formula was derived. This quadratic formula was: 0.68 × (Height (cm)/serum creatinine (mg/dl))-0.0008 × (height (cm)/serum creatinine (mg/dl))(2)+0.48 × age (years)-(21.53 in males or 25.68 in females). This formula was validated using a split-half cross-validation technique and also externally validated with a new cohort of 127 children. Results show that the Schwartz formula is accurate until a height (Ht)/serum creatinine value of 251, corresponding to an iGFR of 103 ml/min × 1.73 m(2), but significantly unreliable for higher values. For an accuracy of 20 percent, the quadratic formula was significantly better than the Schwartz formula for all patients and for patients with a Ht/serum creatinine of 251 or greater. Thus, the new quadratic formula could replace the revised Schwartz formula, which is accurate for children with moderate renal failure but not for those with less renal impairment or hyperfiltration.

  4. Photochemical determination of O densities in the Martian thermosphere: Effect of a revised rate coefficient (United States)

    Fox, Jane L.; Johnson, Austin S.; Ard, Shaun G.; Shuman, Nicholas S.; Viggiano, Albert A.


    We investigate the production and loss rates of O2+ in the photochemical equilibrium region of the Martian ionosphere near the subsolar point. We adopt neutral and ion densities measured by the Mars Atmosphere and Volatiles EvolutioN (MAVEN) Neutral Gas and Ion Mass Spectrometer (NGIMS), electron densities and temperatures measured by the Langmuir Probe and Waves, and ion temperatures measured by the Supra-Thermal and Thermal Ion Composition instruments on the MAVEN spacecraft. Contrary to the conventional wisdom, we find that loss of O2+ by dissociative recombination is balanced mainly by production due to the reaction of O+ with CO2, with a smaller contribution due to the reaction of CO2+ with O. We find that the O densities derived from this calculation are larger than those measured by the NGIMS instrument by a factor that averages about 4 over the range of 130-155 km. This general conclusion is supported by a newly measured rate coefficient for the reaction of O with CO2+, which is smaller by a factor of about 6 than the only value in the literature, which was measured 47 years ago.

  5. Self-inserted foreign body and attention-deficit/hyperactivity disorder: evaluated by the Conners' Parent Rating Scales-Revised. (United States)

    Özcan, Kemal; Özcan, Özlem; Muluk, Nuray Bayar; Cingi, Cemal; Durukan, Kübra


    We aimed to evaluate the relationship between attention-deficit/hyperactivity disorder (ADHD) and self-inserted foreign bodies (SIFBs) in children by the Conners' Parent Rating Scales-Revised (CPRS-R). Forty-five children (31 males and 14 females) with self-inserted foreign body of ear/nose and 37 healthy children (22 males and 15 females) included into the study. They were all between 3 and 9 years old. The parents filled the socio-demographic information form including age, gender, demographic data, previous medical history of the child and features of the family; and completed the Conners' Parent Rating Scales-Revised (CPRS-R) questionnaire. In the SIFB group (study), 55.6% of the children were not attending to the school, 31.1% of them were attending to the primary school and 13.3% of them were the pre-school student. These rates were 37.8%, 32.4% and 29.7%, respectively, in the control group. The all CPRS-R subscale values (CG/I, H, ADHD-I, CGI-DI, DSMIV SS-I, DSM-IV SS-HI and DSM-IV SS-T) were significantly higher in the study group than the control group. There was no significant correlation between gender of the children and CPRS-R subscales. Children with lower school success, and having previous psychiatric problems were related to higher CPRS-R values in all subscales. In older children, hyperactivity scores were lower; and in younger children and the children, not going to the school, hyperactivity scores were higher. CPRS-R scores decreased as the child grown. It was concluded that children with ADHD were more likely to have conditions that might damage himself/herself such as self-inserted foreign body or trauma than normal children. To avoid this condition, these families should closely observe the child; and the child should be provided to participate in activities such as group games and activities that contribute to the development of the child. Warning the children properly and close follow-up of the young children are required to prevent this

  6. Response elimination, reinforcement rate and resurgence of operant behavior. (United States)

    Cançado, Carlos R X; Lattal, Kennon A


    The effects of reinforcement rate of alternative responding on resurgence were studied in six experiments with pigeons. In Experiment 1A, key pecking was maintained on a multiple variable-interval (VI) VI schedule in the Training phase. In the Response-Elimination phase, a variable differential-reinforcement-of-other-behavior (DRO) schedule was in effect in each component. Reinforcement rates were equal and then, higher in one (rich) component, and lower in the other (lean), than in the Training phase. More resurgence occurred in the lean component, but this could have resulted from response-rate differences between components in the Training-phase. Experiment 1B was a replication of Experiment 1A, but with experimentally-naïve pigeons. Response-Elimination phase reinforcement rates were manipulated systematically in subsequent experiments: In Experiment 2, reinforcement rate was equal, in one component, and lower or higher in the other, than in the Training phase. In Experiment 3, reinforcers were discontinued before differential reinforcement rates were effected. In Experiment 4, reinforcement rates first were differential and, then, equal to those in the Training phase. In Experiments 5 and 6, differential reinforcement rates were arranged by using fixed-DROs and VIs for pecking a different key, respectively. Even though resurgence was not obtained with every pigeon, at least some small-magnitude resurgence occurred in each experiment and was not related systematically to reinforcement rates of alternative responding. Schedule differences, response topography, order of conditions and the length of each phase were not sufficient to account for these results. Copyright © 2013 Elsevier B.V. All rights reserved.

  7. Prospective study comparing functional outcomes and revision rates between hip resurfacing and total hip arthroplasty: preliminary results for 2 years

    Directory of Open Access Journals (Sweden)

    Régis Pailhé


    Full Text Available There is a need of independent prospective studies about modern generation of hip resurfacing implants. The aim of this propective observational study was to compare the functional outcomes and revision rates with hip resurfacing arthroplasty and total hip arthroplasty and to present the preliminary results at 2 years. Patients included were recruited prospectively in the Partial Pelvic Replacement Hip Project by a single surgeon between January 2007 and January 2010. Patients were assessed with the Harris Hip Score (HHS and Postel-Merle d’Aubigné (MDA score and Devane Score. The end point of the study was reoperation for any cause related to the prosthesis. At a mean follow up of 38.6 months there were a total of 142 patients with hip resurfacing (group 1 [100 Durom® (Zimmer Inc., Warsaw, IN, USA and 42 Birmingham Hip Resurfacing® (Smith & Nephew, Memphis, TN, USA] and 278 patients with total hip arthroplasty (group 2. The results showed significantly greater gain of HHS, MDA and Devane score with hip resurfacing procedures. However, considering all the complications, the rate was significantly higher in group 16.4% vs 1.79% in group 2 (P<0.0001. In group 1 we observed 6 complications only concerned males with Durom® implants. The follow up of this cohort is still on going and may deliver more information on the evolution of these results in time.

  8. Changes in safety climate and teamwork in the operating room after implementation of a revised WHO checklist: a prospective interventional study. (United States)

    Erestam, Sofia; Haglind, Eva; Bock, David; Andersson, Annette Erichsen; Angenete, Eva


    Inter-professional teamwork in the operating room is important for patient safety. The World Health Organization (WHO) checklist was introduced to improve intraoperative teamwork. The aim of this study was to evaluate the safety climate in a Swedish operating room setting before and after an intervention, using a revised version of the WHO checklist to improve teamwork. This study is a single center prospective interventional study. Participants were personnel working in operating room teams including surgeons, anesthesiologists, scrub nurses, nurse anaesthetists and nurse assistants. The study started with pre-interventional observations of the WHO checklist use followed by education on safety climate, the WHO checklist, and non-technical skills in the operating room. Thereafter a revised version of the WHO checklist was introduced. Post-interventional observations regarding the performance of the WHO checklist were carried out. The Safety Attitude Questionnaire was used to assess safety climate at baseline and post-intervention. At baseline we discovered a need for improved teamwork and communication. The participants considered teamwork to be important for patient safety, but had different perceptions of good teamwork between professions. The intervention, a revised version of the WHO checklist, did not affect teamwork climate. Adherence to the revision of the checklist was insufficient, dominated by a lack of structure. There was no significant change in teamwork climate by use of the revised WHO checklist, which may be due to insufficient implementation, as a lack of adherence to the WHO checklist was detected. We found deficiencies in teamwork and communication. Further studies exploring how to improve safety climate are needed. NCT02329691.

  9. The Behavior Flexibility Rating Scale-Revised (BFRS-R): Factor Analysis, Internal Consistency, Inter-Rater and Intra-Rater Reliability, and Convergent Validity (United States)

    Peters-Scheffer, Nienke; Didden, Robert; Green, Vanessa A.; Sigafoos, Jeff; Korzilius, Hubert; Pituch, Keenan; O'Reilly, Mark F.; Lancioni, Giulio


    We examined the psychometric properties of the behavior flexibility rating scale-revised (BFRS-R), a new scale intended for assessing behavioral flexibility in individuals with developmental disabilities. Seventy-six direct care staff members and 56 parents completed the BFRS-R for 70 children with developmental disabilities. Factor analysis…

  10. The behavior flexibility rating scale-revised (BFRS-R): Factor analysis, internal consistency, inter-rater and intra-rater reliability, and convergent validity

    NARCIS (Netherlands)

    Peters-Scheffer, N.C.; Didden, H.C.M.; Green, V.A.; Sigafoos, J.; Korzilius, H.P.L.M.; Pituch, K.A.; O'Reilly, M.F.; Lancioni, G.E.


    We examined the psychometric properties of the behavior flexibility rating scale-revised (BFRS-R), a new scale intended for assessing behavioral flexibility in individuals with developmental disabilities. Seventy-six direct care staff members and 56 parents completed the BFRS-R for 70 children with

  11. interest rate and commercial banks' lending operations in nigeria

    African Journals Online (AJOL)

    The oil glut of this period notwithstanding, the economy at this point was engulfed in general lull which persisted until. 1986. The Nigerian economy witnessed a major shock following the global fall in oil price in the late 1970's and early 80's. .... in Pakistan, he found that interest rate liberalization has not impacted positively ...

  12. Hydrocolloid dressing in pediatric burns may decrease operative intervention rates.

    LENUS (Irish Health Repository)

    Martin, Fiachra T


    Partial-thickness scalds are the most common pediatric burn injury, and primary management consists of wound dressings to optimize the environment for reepithelialization. Operative intervention is reserved for burns that fail to heal using conservative methods. Worldwide, paraffin-based gauze (Jelonet) is the most common burn dressing; but literature suggests that it adheres to wounds and requires more frequent dressing change that may traumatize newly epithelialized surfaces. Hydrocolloid dressings (DuoDERM) provide an occlusive moist environment to optimize healing and are associated with less frequent dressing changes.

  13. 29 CFR 780.314 - Operations customarily * * * paid on a piece rate basis * * *. (United States)


    ... 29 Labor 3 2010-07-01 2010-07-01 false Operations customarily * * * paid on a piece rate basis... * * * paid on a piece rate basis * * *. A significant test of the exemption is that the hand harvest operation “has been, and is customarily and generally recognized as having been, paid on a piece rate basis...

  14. The multiple sclerosis rating scale, revised (MSRS-R: Development, refinement, and psychometric validation using an online community

    Directory of Open Access Journals (Sweden)

    Wicks Paul


    Full Text Available Abstract Background In developing the PatientsLikeMe online platform for patients with Multiple Sclerosis (MS, we required a patient-reported assessment of functional status that was easy to complete and identified disability in domains other than walking. Existing measures of functional status were inadequate, clinician-reported, focused on walking, and burdensome to complete. In response, we developed the Multiple Sclerosis Rating Scale (MSRS. Methods We adapted a clinician-rated measure, the Guy’s Neurological Disability Scale, to a self-report scale and deployed it to an online community. As part of our validation process we reviewed discussions between patients, conducted patient cognitive debriefing, and made minor improvements to form a revised scale (MSRS-R before deploying a cross-sectional survey to patients with relapsing-remitting MS (RRMS on the PatientsLikeMe platform. The survey included MSRS-R and comparator measures: MSIS-29, PDDS, NARCOMS Performance Scales, PRIMUS, and MSWS-12. Results In total, 816 RRMS patients responded (19% response rate. The MSRS-R exhibited high internal consistency (Cronbach’s alpha = .86. The MSRS-R walking item was highly correlated with alternative walking measures (PDDS, ρ = .84; MSWS-12, ρ = .83; NARCOMS mobility question, ρ = .86. MSRS-R correlated well with comparison instruments and differentiated between known groups by PDDS disease stage and relapse burden in the past two years. Factor analysis suggested a single factor accounting for 51.5% of variance. Conclusions The MSRS-R is a concise measure of MS-related functional disability, and may have advantages for disease measurement over longer and more burdensome instruments that are restricted to a smaller number of domains or measure quality of life. Studies are underway describing the use of the instrument in contexts outside our online platform such as clinical practice or trials. The MSRS-R is released for use under


    Directory of Open Access Journals (Sweden)

    Rajesh T. R


    Full Text Available BACKGROUND Stomach cancer is the fourth most common malignancy in the world. 1 Except in countries where screening for stomach cancer is prevalent, most of the distal stomach tumours are diagnosed at advanced stage. Gastric outlet obstruction is usually believed to be a sign of locally-advanced disease. Complete surgical removal of the disease (R0 is the only potentially curative treatment for resectable gastric cancer. The aim of the study is to finda The operability rate of gastric cancer in our institution and the incidence of Gastric Outlet Obstruction (GOO in patients undergoing gastrectomy for distal gastric cancer. b To compare the postoperative outcome in patients with gastric outlet obstruction and those without gastric outlet obstruction. c To see if the histology of the tumour has any role in the development of GOO. MATERIALS AND METHODS This is a retrospective study. The study includes patients who were admitted with carcinoma stomach and underwent operative or nonoperative treatment in our institution during 2013 to 2015. RESULTS Overall operability rate was 45.8%. Operable patients in the GOO group were 47%. Operability in the no outlet obstruction group were 45%. Data shows a slightly increased predilection for GOO in diffuse and mixed type of tumours (statistically not significant. Intestinal tumours had significant rate of anaemia compared to diffuse tumours (p <0.005. Overall mortality was 6.7%. Mortality is higher in the GOO group (8.8%. CONCLUSION (a. Operability rate of distal gastric cancer in our institution is 45.8%. (b. Incidence of gastric outlet obstruction in patients undergoing gastrectomy is 38.2%. (c. Presence of gastric outlet obstruction does not influence operability rate (47% vs. 45%. (d. Morbidity and mortality after distal radical gastrectomy is comparable in both groups. (e. Both intestinal and diffuse histology have equal incidence of GOO. (f. Chronic blood loss and incidence of anaemia is more in

  16. Does cross-linked polyethylene decrease the revision rate of total hip arthroplasty compared with conventional polyethylene? A meta-analysis. (United States)

    Shen, C; Tang, Z-H; Hu, J-Z; Zou, G-Y; Xiao, R-C; Yan, D-X


    Although cross-linked polyethylene is resistant to wear in comparison to conventional polyethylene, it remains unknown whether it can decrease the wear-related revision rate of total hip arthroplasty. To determine whether cross-linked polyethylene decreases the wear-related revision rate of total hip arthroplasty compared with conventional polyethylene. Electronic databases, including PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, were queried from inception to July 6, 2013. Randomized controlled trials (RCTs) comparing cross-linked polyethylene with conventional polyethylene were included. In addition, the standard 28-mm femoral head was used, and follow-up was performed for a minimum of 5 years. The primary outcome assessed was wear-related revision. The secondary outcome measures evaluated were the incidence of osteolysis, the linear wear rate, and the linear head penetration. The Cochrane Collaboration's tool for assessing the risk of bias was used for quality assessment. Data from eligible studies were pooled using a random effects model. Eight studies involving 735 patients were included in this study. Meta-analysis showed there was no significant difference between cross-linked and conventional polyethylene group in terms of osteolysis or wear-related revision. The pooled mean differences were significantly less for the linear wear rate and linear head penetration for cross-linked polyethylene than for conventional polyethylene. The studies differed with respect to the cross-linked liner brands, manufacturing processes, and radiological evaluation methods. Moreover, the follow-up periods of the RCTs were not long enough. The current limited evidence suggests that cross-linked polyethylene significantly reduced the radiological wear compared with conventional polyethylene at midterm follow-up periods. However, there is no evidence that cross-linked polyethylene had an advantage over conventional polyethylene in terms of reducing

  17. [A project to improve the validity rate for nursing staff operating single door autoclave sterilizers]. (United States)

    Chen, Chun-Hung; Li, Cheng-Chang; Chou, Chuan-Yu; Chen, Shu-Hwa


    This project was designed to improve the low validity rate for nurses responsible to operate single door autoclave sterilizers in the operating room. By investigating the current status, we found that the nursing staff validity rate of cognition on the autoclave sterilizer was 85%, and the practice operating check validity rate was only 80%. Such was due to a lack of in-service education. Problems with operation included: 1. Unsafe behaviors - not following standard procedure, lacking relevant operating knowledge and absence of a check form; 2. Unsafe environment - the conveying steam piping was typically not covered and lacked operation marks. Recommended improvement measures included: 1. holding in-service education; 2. generating an operation procedure flow chart; 3. implementing obstacle eliminating procedures; 4. covering piping to prevent fire and burns; 5. performing regular checks to ensure all procedures are followed. Following intervention, nursing staff cognition rose from 85% to 100%, while the operation validity rate rose from 80% to 100%. These changes ensure a safer operating room environment, and helps facilities move toward a zero accident rate in the healthcare environment.

  18. The measured effect of delay in completing operative performance ratings on clarity and detail of ratings assigned. (United States)

    Williams, Reed G; Chen, Xiaodong Phoenix; Sanfey, Hilary; Markwell, Stephen J; Mellinger, John D; Dunnington, Gary L


    Operative performance ratings (OPRs) need adequate clarity and detail to support self-directed learning and valid progress decisions. This study was designed to determine (1) the elapsed time between observing operative performances and completing performance ratings under field conditions and (2) the effect of increased elapsed time on rating clarity and detail. Overall, 895 OPRs by 19 faculty members for 37 general surgery residents were the focus of this study. The elapsed time between observing the performance and completing the evaluation was recorded. No-delay comparison data included 45 additional ratings of 8 performances collected under controlled conditions immediately following the performance by 17 surgeons whose sole responsibility was to observe and rate the performances. Item-to-item OPR variation and the presence and nature of comments were indicators of evaluation clarity, detail, and quality. Elapsed time between observing and evaluating performances under field conditions were as follows: 1 day or less, 116 performances (13%); 2 to 3 days, 178 performances (20%); 4 to 14 days, 377 performances (42%); and more than 14 days, 224 performances (25%). Overall, 87% of performances rated more than 14 days after observation had no item-to-item ratings variation compared with 62% rated with a delay of 4 to 14 days, 41% rated with a delay of 2 to 3 days, 42% rated within 1 day, and 2% rated immediately. In addition, 70% of ratings completed more than 14 days after observation had no written comments, compared with 49% for those completed with a delay of 4 to 14 days, 45% for those completed in 2 to 3 days, and 46% for those completed within 1 day. Moreover, 47% of comments submitted after more than 14 days were exclusively global comments (less instructionally useful) compared with 7% for those completed with a delay of 4 to 14 days and 5% for those completed in 1 to 3 days. The elapsed time between observation and rating of operative performances should

  19. Expanded Operational Temperature Range for Space Rated Li-Ion Batteries Project (United States)

    National Aeronautics and Space Administration — Quallion's response to this solicitation calls for expanding the nominal operation range of its space rated lithium ion cells, while maintaining their long life...

  20. Expanded Operational Temperature Range for Space Rated Li-Ion Batteries Project (United States)

    National Aeronautics and Space Administration — Quallion's Phase II proposal calls for expanding the nominal operation range of its space rated lithium ion cells, while maintaining their long life capabilities. To...

  1. Union rate after operative treatment of humeral shaft nonunion - A systematic review

    NARCIS (Netherlands)

    Peters, Rinne; Claessen, Femke MAP; Doornberg, Job N.; Kolovich, Gregory P.; Diercks, Ronald; van den Bekerom, Michel P. J.


    Introduction: Humeral shaft nonunions can lead to morbidity from subsequent operations, complications and impaired function. Currently there is no evidenced-based consensus for treatment of humeral shaft nonunions. Aim: We aimed to summarize and analyze union rates and complications after operative

  2. Post-operative hypertension after total knee arthroplasty and the effects on transfusion rates.

    Directory of Open Access Journals (Sweden)

    Russell R Russo

    Full Text Available Transfusions are a cause of significant patient morbidity as well as expense. Anesthesia literature has examined controlled intraoperative hypotension as a means for reducing blood loss and transfusions. Our hypothesis is that inversely increased blood pressure post-operatively would then lead to increased blood loss and transfusions.We examined 105 consecutive patients who underwent TKA. We found a significant odds ratio of 1.123 for pre-operative hematocrit. For post-operative blood pressure, we calculated an insignificant odds ratio of 1.007, proving no relationship between post-operative blood pressure and transfusions.This is the first study to examine increased post-operative blood pressure's contribution to transfusion rates. Although we confirmed that low pre-operative hematocrit contributes to increased transfusions, we did not find a relationship between post-operative blood pressure and transfusions.

  3. Subjects for achievement of blast furnace operation with low reducing agent rate

    Energy Technology Data Exchange (ETDEWEB)

    Ujisawa, Y.; Nakano, K.; Matsukura, Y.; Sunahara, K.; Komatsu, S.; Yamamoto, T. [Sumitomo Metal Industry Ltd., Kashima (Japan). Corp R& amp; D Labs.


    The technology which reduces the reducing agent rate by the improvement in the reaction efficiency of blast furnace leads to reduction of hot metal manufacturing cost, but also solution of recent CO{sub 2} emission reduction. The subjects for achievement of the blast furnace operation with low reducing agent rate were described on reduction measures of the carbon consumption and problem of the measures referring to the example of reducing agent rate of the present state blast furnace concerning blast operation and reactive improvement. And, carried out concrete measures were introduced in order to aim at the low reducing agent rate operation. The following results were obtained. 1) Since it has reached the already high reaction efficiency in present state blast furnace, it is not easy to attempt further reduction of the reducing agent rate. 2) The blast furnace use of high reactivity coke or reduced iron is equal level or over it in comparison with the reduction effect by the assumed blast operation in this paper. 3) The promotion of coke reaction load with the gasification is worried, when it aims at the low reducing agent rate operation by the high reactivity coke use. 4) It is estimated that the threshold also exists for the reducibility of competing ore, when it aims at the low reducing agent rate operation using the high reactivity coke. 5) The use of the low SiO{sub 2} sinter is effective for the improvement on the permeability in the blast furnace, when it aims at the low fuel rate operation. However, the new technology of the permeability improvement is desired, since there is a limit for low SiO{sub 2} of the sintered ore, when future raw material supply and demand is considered.

  4. ATLAS trigger operations: Monitoring with “Xmon” rate prediction system

    CERN Document Server

    Aukerman, Andrew Todd; The ATLAS collaboration


    We present the operations and online monitoring with the “Xmon” rate prediction system for the trigger system at the ATLAS Experiment. A two-level trigger system reduces the LHC’s bunch-crossing rate, 40 MHz at design capacity, to an average recording rate of about 1 kHz, while maintaining a high efficiency of selecting events of interest. The Xmon system uses the luminosity value to predict trigger rates that are, in turn, compared with incoming rates. The predictions rely on past runs to parameterize the luminosity dependency of the event rate for a trigger algorithm. Some examples are given to illustrate the performance of the tool during recent operations.

  5. Dose rate evaluation of workers on the operation floor in Fukushima-Daiichi Unit 3 (United States)

    Matsushita, Kaoru; Kurosawa, Masahiko; Shirai, Keisuke; Matsuoka, Ippei; Mukaida, Naoki


    At Fukushima Daiichi Nuclear Power Plant Unit 3, installation of a fuel handling machine is planned to support the removal of spent fuel. The dose rates at the workplace were calculated based on the source distribution measured using a collimator in order to confirm that the dose rates on the operation floor were within a manageable range. It was confirmed that the accuracy of the source distribution was C/M = 1.0-2.4. These dose rates were then used to plan the work on the operation floor.

  6. Dose rate evaluation of workers on the operation floor in Fukushima-Daiichi Unit 3

    Directory of Open Access Journals (Sweden)

    Matsushita Kaoru


    Full Text Available At Fukushima Daiichi Nuclear Power Plant Unit 3, installation of a fuel handling machine is planned to support the removal of spent fuel. The dose rates at the workplace were calculated based on the source distribution measured using a collimator in order to confirm that the dose rates on the operation floor were within a manageable range. It was confirmed that the accuracy of the source distribution was C/M = 1.0-2.4. These dose rates were then used to plan the work on the operation floor.

  7. Investigation of component failure rates for pulsed versus steady state tokamak operation

    Energy Technology Data Exchange (ETDEWEB)

    Cadwallader, L.C.


    This report presents component failure rate data sources applicable to magnetic fusion systems, and defines multiplicative factors to adjust these data for specific use on magnetic fusion experiment designs. The multipliers address both long pulse and steady state tokamak operation. Thermal fatigue and radiation damage are among the leading reasons for large multiplier values in pulsed operation applications. Field failure rate values for graphite protective tiles are presented, and beryllium tile failure rates in laboratory testing are also given. All of these data can be used for reliability studies, safety analyses, design tradeoff studies, and risk assessments.

  8. A comparison of endoscopic localization error rate between operating surgeons and referring endoscopists in colorectal cancer. (United States)

    Azin, Arash; Saleh, Fady; Cleghorn, Michelle; Yuen, Andrew; Jackson, Timothy; Okrainec, Allan; Quereshy, Fayez A


    Colonoscopy for colorectal cancer (CRC) has a localization error rate as high as 21 %. Such errors can have substantial clinical consequences, particularly in laparoscopic surgery. The primary objective of this study was to compare accuracy of tumor localization at initial endoscopy performed by either the operating surgeon or non-operating referring endoscopist. All patients who underwent surgical resection for CRC at a large tertiary academic hospital between January 2006 and August 2014 were identified. The exposure of interest was the initial endoscopist: (1) surgeon who also performed the definitive operation (operating surgeon group); and (2) referring gastroenterologist or general surgeon (referring endoscopist group). The outcome measure was localization error, defined as a difference in at least one anatomic segment between initial endoscopy and final operative location. Multivariate logistic regression was used to explore the association between localization error rate and the initial endoscopist. A total of 557 patients were included in the study; 81 patients in the operating surgeon cohort and 476 patients in the referring endoscopist cohort. Initial diagnostic colonoscopy performed by the operating surgeon compared to referring endoscopist demonstrated statistically significant lower intraoperative localization error rate (1.2 vs. 9.0 %, P = 0.016); shorter mean time from endoscopy to surgery (52.3 vs. 76.4 days, P = 0.015); higher tattoo localization rate (32.1 vs. 21.0 %, P = 0.027); and lower preoperative repeat endoscopy rate (8.6 vs. 40.8 %, P operating surgeon was protective against localization error on both univariate analysis, OR 7.94 (95 % CI 1.08-58.52; P = 0.016), and multivariate analysis, OR 7.97 (95 % CI 1.07-59.38; P = 0.043). This study demonstrates that diagnostic colonoscopies performed by an operating surgeon are independently associated with a lower localization error rate. Further research exploring the factors

  9. Early morbidity after aseptic revision hip arthroplasty in Denmark: a two-year nationwide study. (United States)

    Lindberg-Larsen, M; Jørgensen, C C; Hansen, T B; Solgaard, S; Kehlet, H


    Data on early morbidity and complications after revision total hip replacement (THR) are limited. The aim of this nationwide study was to describe and quantify early morbidity after aseptic revision THR and relate the morbidity to the extent of the revision surgical procedure. We analysed all aseptic revision THRs from 1st October 2009 to 30th September 2011 using the Danish National Patient Registry, with additional information from the Danish Hip Arthroplasty Registry. There were 1553 procedures (1490 patients) performed in 40 centres and we divided them into total revisions, acetabular component revisions, femoral stem revisions and partial revisions. The mean age of the patients was 70.4 years (25 to 98) and the median hospital stay was five days (interquartile range 3 to 7). Within 90 days of surgery, the readmission rate was 18.3%, mortality rate 1.4%, re-operation rate 6.1%, dislocation rate 7.0% and infection rate 3.0%. There were no differences in these outcomes between high- and low-volume centres. Of all readmissions, 255 (63.9%) were due to 'surgical' complications versus 144 (36.1%) 'medical' complications. Importantly, we found no differences in early morbidity across the surgical subgroups, despite major differences in the extent and complexity of operations. However, dislocations and the resulting morbidity represent the major challenge for improvement in aseptic revision THR. ©2014 The British Editorial Society of Bone & Joint Surgery.

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

    DEFF Research Database (Denmark)

    Palm, Henrik; Jacobsen, Steffen; Krasheninnikoff, Michael


    OBJECTIVE: To investigate the influence of the performing surgeon's experience and degree of supervision on re-operation rate among patients admitted with a proximal femoral fracture (PFF). METHODS: Prospective study of 600 consecutive patients with proximal femoral fracture in our multimodal...... rehabilitation programme, between 2002 and 2004. Re-operation rate was assessed 6 months postoperatively. Surgeons were grouped as unsupervised junior registrars versus experienced surgeons operating or supervising. Fractures were stratified as technically undemanding or demanding. RESULTS: Unsupervised junior...... Society of Anaesthesiologists score, New Mobility Score, time to surgery and type of implant, surgery by unsupervised junior registrars was still a significant independent risk factor for re-operation in technically demanding proximal femoral fractures. CONCLUSION: Unsupervised junior registrars should...

  11. Shutdown Dose Rate Analysis for the long-pulse D-D Operation Phase in KSTAR

    Directory of Open Access Journals (Sweden)

    Park Jin Hun


    Full Text Available KSTAR is a medium size fully superconducting tokamak. The deuterium-deuterium (D-D reaction in the KSTAR tokamak generates neutrons with a peak yield of 3.5x1016 per second through a pulse operation of 100 seconds. The effect of neutron generation from full D-D high power KSTAR operation mode to the machine, such as activation, shutdown dose rate, and nuclear heating, are estimated for an assurance of safety during operation, maintenance, and machine upgrade. The nuclear heating of the in-vessel components, and neutron activation of the surrounding materials have been investigated. The dose rates during operation and after shutdown of KSTAR have been calculated by a 3D CAD model of KSTAR with the Monte Carlo code MCNP5 (neutron flux and decay photon, the inventory code FISPACT (activation and decay photon and the FENDL 2.1 nuclear data library.

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

    DEFF Research Database (Denmark)

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


    INTRODUCTION: Metal-on-metal hip articulations have been intensely debated after reports of adverse reactions and high failure rates. The aim of this study was to retrospectively evaluate the implant of a metal-on.metal total hip articulation (MOM THA) from a single manufacture in a two...... of 53 months. 4 pseudotumors were diagnosed at time of follow up but no substantiated link was made between adverse reactions and re-operations. CONCLUSION: The high re-operation rates found in this study raised concern about the usage of the MOM THA and subsequently lead to the termination......-center study. MATERIALS AND METHODS: 108 CONSERVE(®) MOM THA were implanted in 92 patients between November 2005 and December 2010. Patients had at time of retrospective evaluation their journals reviewed for re-operations and adverse reactions. RESULTS: 20 hips were re-operated (18.4%) at a mean follow up...

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

    DEFF Research Database (Denmark)

    Palm, Henrik; Jacobsen, Steffen; Krasheninnikoff, Michael


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

  14. Revised infant dietary recommendations: the impact of maternal education and other parental factors on adherence rates in Iceland. (United States)

    Thorisdottir, Asa Vala; Gunnarsdottir, Ingibjorg; Thorsdottir, Inga


    Revised infant dietary recommendations from the Icelandic Nutrition Council (Nutrition: the first twelve months. Reykjavík, Iceland: The Icelandic Nutrition Council, 2003) are outlined in a booklet provided during free postnatal care. These focus on increasing the duration of exclusive and total breastfeeding and reducing cow's milk consumption. This study explored whether maternal education and other parental factors affected whether mothers followed the recommendations. Mothers of randomly selected healthy infants (n = 200) completed questionnaires on body mass index (BMI), age, education (basic, medium and higher), household income, smoking and parental factors. Dietary data were collected during home visits by a researcher (0-4 months) and through monthly food records completed by parents or caregivers (5-12 months). Each maternal education level increased breastfeeding duration by 0.72 months (95% CI = 0.04, 1.39) and reduced cow's milk consumption by 36.7 mL/day (95% CI = -70.11, -3.03), when adjusted for maternal BMI, age, smoking and family income. Maternal education was not associated with duration of exclusive breastfeeding. Duration of exclusive and total breastfeeding was inversely associated with maternal BMI, B = -0.10 (95% CI = -0.16, -0.05) and -0.13 (95% CI = -0.23, -0.03), respectively. Mothers with higher education appear to have adapted more easily to the revised recommendations on infant diet, particularly when their infants are 6-12 months old. Higher maternal BMI was associated with shorter duration of both exclusive and total breastfeeding. ©2012 Unit for Nutrition Research/Acta Paediatrica ©2012 Foundation Acta Paediatrica.

  15. Letter of Map Revision (United States)

    Earth Data Analysis Center, University of New Mexico — The National Flood Hazard Layer (NFHL) data incorporates all Digital Flood Insurance Rate Map(DFIRM) databases published by FEMA, and any Letters Of Map Revision...

  16. Revising Translations

    DEFF Research Database (Denmark)

    Rasmussen, Kirsten Wølch; Schjoldager, Anne


    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...... out by specialised revisers, but by staff translators, who revise the work of colleagues and freelancers on an ad hoc basis. Corrections are mostly given in a peer-to-peer fashion, though the work of freelancers and inexperienced in-house translators is often revised in an authoritative (nonnegotiable...

  17. Terry Turbopump Expanded Operating Band Full-Scale Component and Basic Science Detailed Test Plan-Revision 2

    Energy Technology Data Exchange (ETDEWEB)

    Solom, Matthew [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Severe Accident Analysis Dept.; Ross, Kyle [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Severe Accident Analysis Dept.; Cardoni, Jeffrey N. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Severe Accident Analysis Dept.; Osborn, Douglas [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States). Severe Accident Analysis Dept.


    This document details the milestone approach to define the true operating limitations (margins) of the Terry turbopump systems used in the nuclear industry for Milestone 3 (full-scale component experiments) and Milestone 4 (Terry turbopump basic science experiments) efforts. The overall multinational-sponsored program creates the technical basis to: (1) reduce and defer additional utility costs, (2) simplify plant operations, and (3) provide a better understanding of the true margin which could reduce overall risk of operations.

  18. Pre-operative and post-operative estimated glomerular filtration rate in Japanese patients with urological malignancies. (United States)

    Niwa, Naoya; Yoshida, Tadashi; Mizuno, Ryuichi; Kikuchi, Eiji; Miyajima, Akira; Hayashi, Matsuhiko; Oya, Mototsugu


    The suitable methods evaluating glomerular filtration rate (GFR) have not been established in patients undergoing radical nephrectomy (RN) or radical nephroureterectomy (RNU) due to urological malignancies in Japan as well as worldwide. We examined the relationship between creatinine clearance-based measured GFR (mGFR) versus estimated GFR (eGFR) calculated by 3 popular equations, 4-variable Modification of Diet in Renal Disease equation adjusted by Japanese correction coefficient (cmMDRD), 3-variable MDRD equation for Japanese population (eGFRcreat), and Chronic Kidney Disease-Epidemiology Collaboration equation adjusted by Japanese correction coefficient (cmCKD-EPI) in Japanese patients who had undergone RN or RNU due to renal cell carcinoma or upper tract urothelial carcinoma before and after surgery. Among the 3 equations examined, eGFRcreat was the closest to mGFR, although each eGFR was significantly higher than mGFR in the pre-operative period. In the post-operative period, cmMDRD and eGFRcreat, but not cmCKD-EPI, were comparable to mGFR. Each of eGFR was significantly correlated with mGFR in both the pre-operative and post-operative periods. Similar results were obtained by the subanalysis of the patients with pre-operative mGFR of < 60 mL/min/1.73 m2. Results of κ statistics also showed that eGFRcreat was most appropriate to estimate GFR both before and after heminephrectomy, when cut-off value of GFR of < 60 mL/min/1.73 m2 was used. Results of the present study suggest that eGFRcreat is likely to be the most appropriate equation for patients undergoing RN or RNU due to urological malignancies. However, more precise equations will be required for accurately estimating GFR.

  19. Evaluation of the Performance of the PVUSA Rating Methodology Applied to Dual Junction PV Technology: Preprint (Revised)

    Energy Technology Data Exchange (ETDEWEB)

    Myers, D. R.


    The PVUSA (Photovoltaics for Utility Scale Applications) project in the 1990's developed a rating methodology for PV performance evaluation which has become popular, and even incorporated into concentrating PV rating standards This report apply that method to rack-mounted dual-junction PV system, and produces a system rating.

  20. 75 FR 3622 - Revisions to Rules Authorizing the Operation of Low Power Auxiliary Stations in the 698-806 MHz... (United States)


    ... entities that sell or lease these devices must display a consumer disclosure at the point of sale or lease... disclosure at the point of sale or lease informing consumers of the conditions that apply to the operation of... point of sale or lease informing consumers of the conditions that apply to the operation of wireless...

  1. Operative Mortality Rates of Acoustic Neuroma Surgery: A National Cancer Database Analysis. (United States)

    McClelland, Shearwood; Kim, Ellen; Murphy, James D; Jaboin, Jerry J


    Optimal acoustic neuroma (AN) management involves choosing between three treatment modalities: microsurgical excision, radiation, or observation with serial imaging. The reported in-hospital mortality rate of surgery for AN in the United States is 0.5%. However, there has yet to be a nationwide examination of the AN surgery mortality rate encompassing the period beyond initial hospital discharge. The National Cancer Data Base (NCDB) from 2004 to 2013 identified AN patients receiving surgery. Multivariate logistic regression assessed 30-day operative mortality, adjusting for several variables including patient age, race, sex, income, geographic region, primary payer for care, tumor size, and medical comorbidities. Ten thousand one hundred thirty six patients received surgery as solitary treatment for AN. Mortality at 30 days postoperatively occurred in 49 patients (0.5%); only a Charlson/Deyo score of 2 (odds ratio [OR] = 6.6;95% confidence interval [CI] = 2.6-16.6; p = 0.002) was predictive of increased mortality. No other patient demographic including African-American race, minimum age of 65 or government insurance was predictive of 30-day operative mortality. The 30-day mortality rate following surgery for AN is 1 of 200 (0.5%), equivalent to the established in-hospital operative mortality rate, and 2.5 times higher than the cumulative assessment from single-center studies. No patient demographic other than increasing medical comorbidities reached significance in predicting 30-day operative mortality. The nearly identical rates of 30-day and in-hospital mortality from separate nationwide analyses indicate that nearly all of the operative mortality occurs before initial postoperative discharge from the hospital. This mortality rate provides a framework for comparing the true risks and benefits of surgery versus radiation or observation for AN.

  2. Total Hip Arthroplasty in the Spinal Deformity Population: Does Degree of Sagittal Deformity Affect Rates of Safe Zone Placement, Instability, or Revision? (United States)

    DelSole, Edward M; Vigdorchik, Jonathan M; Schwarzkopf, Ran; Errico, Thomas J; Buckland, Aaron J


    Changes in spinal alignment and pelvic tilt alter acetabular orientation in predictable ways, which may have implications on stability of total hip arthroplasty (THA). Patients with sagittal spinal deformity represent a subset of patients who may be at particularly high risk of THA instability because of postural compensation for abnormal spinal alignment. Using standing stereoradiography, we evaluated the spinopelvic parameters, acetabular cup anteversion, and inclination of 139 THAs in 107 patients with sagittal spinal deformity. Standing images were compared with supine pelvic radiographs to evaluate dynamic changes in acetabular cup position. Dislocation and revision rates were procured through retrospective chart review. The spinal parameters and acetabular cup positions among dislocators were compared with those who did not dislocate. The rate of THA dislocation in this cohort was 8.0%, with a revision rate of 5.8% for instability. Patients who sustained dislocations had significantly higher spinopelvic tilt, T1-pelvic angle, and mismatch of lumbar lordosis and pelvic incidence. Among all patients, 78% had safe anteversion while supine, which decreased significantly to 58% when standing due to increases in spinopelvic tilt. Among dislocating THA, 80% had safe anteversion, 80% had safe inclination, and 60% had both parameters within the safe zone. In this cohort, patients with THA and concomitant spinal deformity have a particularly high rate of THA instability despite having an acetabular cup position traditionally thought of as within acceptable alignment. This dislocation risk may be driven by the degree of spinal deformity and by spinopelvic compensation. Surgeons should anticipate potential instability after hip arthroplasty and adjust their surgical plan accordingly. Copyright © 2016 Elsevier Inc. All rights reserved.


    DEFF Research Database (Denmark)

    Freiberg, Florentina J; Brynskov, Troels; Munk, Marion R


    PURPOSE: To evaluate the rate of presumed endophthalmitis (EO) after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections in three European hospitals performed in an operation room (OR) under sterile conditions. METHODS: A retrospective multicenter study between 2003 and 20...

  4. Two-stage revision of infected hip arthroplasty using a shortened post-operative course of antibiotics.

    LENUS (Irish Health Repository)

    McKenna, Paul B


    We present a series of 30 consecutive patients with 31 infected total hip arthroplasties treated by a single surgeon over a 4-year period in whom a shortened post-operative course of antimicrobial chemotherapy was used.

  5. Organizational and operational models for certificate management entities as part of the connected vehicle program : revised working paper (task 2). (United States)


    This report presents the analyses and conclusions from work focused on analyzing multiple options for organizational and operational models for certificate management entities (CMEs) within the connected vehicle system. The report discusses all funct...

  6. Effect of operational parameters on the recovery rate of an oleophilic drum skimmer. (United States)

    Broje, Victoria; Keller, Arturo A


    The primary objective of this research was to determine the relationship between operational variables and oil spill recovery rates, by performing a full-scale oil spill recovery test using an oleophilic drum skimmer. Prototype interchangeable oleophilic skimmer drums with aluminum, polyethylene and Neoprene surfaces were fabricated and tested at the field scale at the Ohmsett-National Oil Spill Response Test Facility. This study determined the effect of the recovery surface material, oil properties, oil slick thickness, temperature and drum rotational speed on the oleophilic drum skimmer recovery rates. It was found that the selection of the recovery surface material can increase the recovery rates up to 20%. The increase in oil slick thickness from 10 to 25 mm led to up to two times higher recovery rates for a viscous oil, but did not have any noticeable effect on the recovery rates of light oil.

  7. Real-time operational feedback: daily discharge rate as a novel hospital efficiency metric. (United States)

    Wong, Hannah J; Wu, Robert C; Caesar, Michael; Abrams, Howard; Morra, Dante


    Part of delivering quality care means providing it in a timely, efficient manner. Improving the efficiency of care requires measurement. The selection of appropriate indicators that are valid and responsive is crucial to focus improvement initiatives. Indicators of operational efficiency should be conceptually simple, generated in real time, calculated using readily available hospital administrative data, sufficiently granular to reveal detail needed to focus improvement, and correlate with other valid indicators of operational efficiency. In this paper, the authors propose daily discharge rate as a novel real-time metric of hospital operational discharge efficiency and compare it with average length of stay. The authors also suggest the use of control charts as an effective way to present daily discharge rate data to clinicians and managers in real time to prompt actionable improvements in discharge efficiency. The authors conclude that daily discharge rate has the potential to drive timely improvements in the discharge process and warrants consideration and further study by others interested in improving hospital operational efficiency and the delivery of quality care.

  8. Process Management and Exception Handling in Multiprocessor Operating Systems Using Object-Oriented Design Techniques. Revised Sep. 1988 (United States)

    Russo, Vincent; Johnston, Gary; Campbell, Roy


    The programming of the interrupt handling mechanisms, process switching primitives, scheduling mechanism, and synchronization primitives of an operating system for a multiprocessor require both efficient code in order to support the needs of high- performance or real-time applications and careful organization to facilitate maintenance. Although many advantages have been claimed for object-oriented class hierarchical languages and their corresponding design methodologies, the application of these techniques to the design of the primitives within an operating system has not been widely demonstrated. To investigate the role of class hierarchical design in systems programming, the authors have constructed the Choices multiprocessor operating system architecture the C++ programming language. During the implementation, it was found that many operating system design concerns can be represented advantageously using a class hierarchical approach, including: the separation of mechanism and policy; the organization of an operating system into layers, each of which represents an abstract machine; and the notions of process and exception management. In this paper, we discuss an implementation of the low-level primitives of this system and outline the strategy by which we developed our solution.

  9. Open-source hardware and software and web application for gamma dose rate network operation. (United States)

    Luff, R; Zähringer, M; Harms, W; Bleher, M; Prommer, B; Stöhlker, U


    The German Federal Office for Radiation Protection operates a network of about 1800 gamma dose rate stations as a part of the national emergency preparedness plan. Each of the six network centres is capable of operating the network alone. Most of the used hardware and software have been developed in-house under open-source license. Short development cycles and close cooperation between developers and users ensure robustness, transparency and fast maintenance procedures, thus avoiding unnecessary complex solutions. This also reduces the overall costs of the network operation. An easy-to-expand web interface has been developed to make the complete system available to other interested network operators in order to increase cooperation between different countries. The interface is also regularly in use for education during scholarships of trainees supported, e.g. by the 'International Atomic Energy Agency' to operate a local area dose rate monitoring test network. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email:

  10. Revision Anterior Cruciate Ligament Reconstruction (United States)

    Wilde, Jeffrey; Bedi, Asheesh; Altchek, David W.


    Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B. PMID:25364483

  11. Safety analysis--200 Area Savannah River Site: Separations Area operations Building 211-H Outside Facilities. Supplement 11, Revision 1

    Energy Technology Data Exchange (ETDEWEB)


    The H-Area Outside Facilities are located in the 200-H Separations Area and are comprised of a number of processes, utilities, and services that support the separations function. Included are enriched uranium loadout, bulk chemical storage, water handling, acid recovery, general purpose evaporation, and segregated solvent facilities. In addition, services for water, electricity, and steam are provided. This Safety Analysis Report (SAR) documents an analysis of the H-Area Outside Facilities and is one of a series of documents for the Separations Area as specified in the SR Implementation Plan for DOE order 5481.1A. The primary purpose of the analysis was to demonstrate that the facility can be operated without undue risk to onsite or offsite populations, to the environment, and to operating personnel. In this report, risks are defined as the expected frequencies of accidents, multiplied by the resulting radiological consequences in person-rem. Following the summary description of facility and operations is the site evaluation including the unique features of the H-Area Outside Facilities. The facility and process design are described in Chapter 3.0 and a description of operations and their impact is given in Chapter 4.0. The accident analysis in Chapter 5.0 is followed by a list of safety related structures and systems (Chapter 6.0) and a description of the Quality Assurance program (Chapter 7.0). The accident analysis in this report focuses on estimating the risk from accidents as a result of operation of the facilities. The operations were evaluated on the basis of three considerations: potential radiological hazards, potential chemical toxicity hazards, and potential conditions uniquely different from normal industrial practice.

  12. A probabilistic risk assessment of the LLNL Plutonium Facility`s evaluation basis fire operational accident. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Brumburgh, G. P.


    The Lawrence Livermore National Laboratory (LLNL) Plutonium Facility conducts numerous programmatic activities involving plutonium to include device fabrication, development of improved and/or unique fabrication techniques, metallurgy research, and laser isotope separation. A Safety Analysis Report (SAR) for the building 332 Plutonium Facility was completed in July 1994 to address operational safety and acceptable risk to employees, the public, government property, and the environmental. This paper outlines the PRA analysis of the Evaluation Basis Fire (EBF) operational accident. The EBF postulates the worst-case programmatic impact event for the Plutonium Facility.

  13. Revised Production Rates for Na-22 and Mn-54 in Meteorites Using Cross Sections Measured for Neutron-induced Reactions (United States)

    Sisterson, J. M.; Kim, K. J.; Reedy, R. C.


    The interactions of galactic cosmic rays (GCR) with extraterrestrial bodies produce small amounts of radionuclides and stable isotopes. The production rates of many relatively short-lived radionuclides, including 2.6-year Na-22 and 312-day Mn-54, have been measured in several meteorites collected very soon after they fell. Theoretical models used to calculate production rates for comparison with the measured values rely on input data containing good cross section measurements for all relevant reactions. Most GCR particles are protons, but secondary neutrons make most cosmogenic nuclides. Calculated production rates using only cross sections for proton-induced reactions do not agree well with measurements. One possible explanation is that the contribution to the production rate from reactions initiated by secondary neutrons produced in primary GCR interactions should be included explicitly. This, however, is difficult to do because so few of the relevant cross sections for neutron-induced reactions have been measured.

  14. Association between Formal Operational Thought and Executive Function as Measured by the Tower of Hanoi-Revised (United States)

    Emick, J.; Welsh, M.


    Executive functions have been defined in the neuropsychological literature as those cognitive processes that underlie future-oriented, goal-directed behavior such as planning, working memory, inhibition, and self-monitoring. Piaget's final stage of cognitive development, formal operations, involves a systematic approach to problem solving that…

  15. 78 FR 34935 - Revisions to Operational Requirements for the Use of Enhanced Flight Vision Systems (EFVS) and to... (United States)


    ... the cockpit window. Finally, the display characteristics and dynamics must be suitable for manual... EFVS equipment installed on certain airplanes, which have resulted in FSB reports that document the... EFVS prior to conducting EFVS operations. These recommendations can be found in the airplane flight...

  16. Early morbidity after aseptic revision hip arthroplasty in Denmark

    DEFF Research Database (Denmark)

    Lindberg-Larsen, M.; Hansen, Torben Bæk


    Data on early morbidity and complications after revision total hip replacement (THR) are limited. The aim of this nationwide study was to describe and quantify early morbidity after aseptic revision THR and relate the morbidity to the extent of the revision surgical procedure. We analysed all.......1%, dislocation rate 7.0% and infection rate 3.0%. There were no differences in these outcomes between high- and low-volume centres. Of all readmissions, 255 (63.9%) were due to 'surgical' complications versus 144 (36.1%) 'medical' complications. Importantly, we found no differences in early morbidity across...... the surgical subgroups, despite major differences in the extent and complexity of operations. However, dislocations and the resulting morbidity represent the major challenge for improvement in aseptic revision THR....

  17. Trends in operation rates for inguinal hernia over five decades in England: database study. (United States)

    Maisonneuve, J J; Yeates, D; Goldacre, M J


    We aimed to study trends over time in operation rates for inguinal hernia with and without obstruction over five decades. Routine hospital statistics were used to analyse trends in National Health Service hospitals in England (1968-2011). All-England admission rates for elective repair of unobstructed inguinal hernia in males were 240.8 episodes per 100,000 population [95 % confidence interval (CI) 234.5-247.2] in 1968 and were relatively stable until 2003 after which they declined to 217.1 (215.4-218.8) by 2011. However, the stability of the all ages rates masked a large decline in admission rates in the young (e.g. 425 per 100,000 in 1968-1970 in males under 1 year of age, down to 155 per 100,000 in 2007-2011) and a large increase in the elderly (e.g. 247 in 1968-1970 per 100,000 males aged 75-84, up to 799 per 100,000 in 2007-2011). All-England admission rates for obstructed inguinal hernia in males almost halved, from 19.3 episodes (17.4-21.2) in 1968 to 10.7 episodes (10.3-11.0) per 100,000 population in 2011. Admission rates for females gradually declined over time for both unobstructed and obstructed inguinal hernia. Hospital admission rates for elective operation on inguinal hernia without obstruction, for all ages combined, have been relatively stable over five decades, but this masked big differences between age groups. Rates of obstructed hernia have declined over time, particularly in the early years covered by the study, and have not shown an increase associated with the recent fall in elective surgery for hernia repair.

  18. Numerical Study of Operating Pressure Effect on Carbon Nanotube Growth Rate and Length Uniformity

    Directory of Open Access Journals (Sweden)

    B. Zahed


    Full Text Available Chemical Vapor Deposition (CVD is one of the most popular methods for producing Carbon Nanotubes (CNTs. The growth rate of CNTs based on CVD technique is investigated by using a numerical model based on finite volume method. Inlet gas mixture, including xylene as carbon source and mixture of argon and hydrogen as carrier gas enters into a horizontal CVD reactor at atmospheric pressure. In this article the operating pressure variations are studied as the effective parameter on CNT growth rate and length uniformity.

  19. Backup power working group best practices handbook for maintenance and operation of engine generators, Volume 1. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Gross, R.; Padgett, A.B.; Burrows, K.P.; Fairchild, P.N.; Lam, T.; Janes, J.


    This handbook is divided into the four chapters. Chapter one covers the design, procurement, storage, handling and testing of diesel fuel oil to be used in DOE backup power supplies. Chapter two discusses the selection of automatic transfer switches to be used in DOE backup power supplies. Chapter three is about low voltage open frame air circuit breaker operation, testing, and maintenance for DOE backup power supplies. And chapter four covers installation, design, and maintenance of engine cooling water and jacket water systems.

  20. No impact of repeated extinction exposures on operant responding maintained by different reinforcer rates. (United States)

    Bai, John Y H; Podlesnik, Christopher A


    Greater rates of intermittent reinforcement in the presence of discriminative stimuli generally produce greater resistance to extinction, consistent with predictions of behavioral momentum theory. Other studies reveal more rapid extinction with higher rates of reinforcers - the partial reinforcement extinction effect. Further, repeated extinction often produces more rapid decreases in operant responding due to learning a discrimination between training and extinction contingencies. The present study examined extinction repeatedly with training with different rates of intermittent reinforcement in a multiple schedule. We assessed whether repeated extinction would reverse the pattern of greater resistance to extinction with greater reinforcer rates. Counter to this prediction, resistance to extinction was consistently greater across twelve assessments of training followed by six successive sessions of extinction. Moreover, patterns of responding during extinction resembled those observed during satiation tests, which should not alter discrimination processes with repeated testing. These findings join others suggesting operant responding in extinction can be durable across repeated tests. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Revision of the 15N(p, γ)16O reaction rate and oxygen abundance in H-burning zones (United States)

    Caciolli, A.; Mazzocchi, C.; Capogrosso, V.; Bemmerer, D.; Broggini, C.; Corvisiero, P.; Costantini, H.; Elekes, Z.; Formicola, A.; Fülöp, Zs.; Gervino, G.; Guglielmetti, A.; Gustavino, C.; Gyürky, Gy.; Imbriani, G.; Junker, M.; Lemut, A.; Marta, M.; Menegazzo, R.; Palmerini, S.; Prati, P.; Roca, V.; Rolfs, C.; Rossi Alvarez, C.; Somorjai, E.; Straniero, O.; Strieder, F.; Terrasi, F.; Trautvetter, H. P.; Vomiero, A.


    Context. The NO cycle takes place in the deepest layer of a H-burning core or shell, when the temperature exceeds T ≃ 30 × 106 K. The O depletion observed in some globular cluster giant stars, always associated with a Na enhancement, may be due to either a deep mixing during the red giant branch (RGB) phase of the star or to the pollution of the primordial gas by an early population of massive asymptotic giant branch (AGB) stars, whose chemical composition was modified by the hot bottom burning. In both cases, the NO cycle is responsible for the O depletion. Aims: The activation of this cycle depends on the rate of the 15N(p, γ)16O reaction. A precise evaluation of this reaction rate at temperatures as low as experienced in H-burning zones in stellar interiors is mandatory to understand the observed O abundances. Methods: We present a new measurement of the 15N(p, γ)16O reaction performed at LUNA covering for the first time the center of mass energy range 70-370 keV, which corresponds to stellar temperatures between 65 × 106 K and 780 × 106 K. This range includes the 15N(p, γ)16O Gamow-peak energy of explosive H-burning taking place in the external layer of a nova and the one of the hot bottom burning (HBB) nucleosynthesis occurring in massive AGB stars. Results: With the present data, we are also able to confirm the result of the previous R-matrix extrapolation. In particular, in the temperature range of astrophysical interest, the new rate is about a factor of 2 smaller than reported in the widely adopted compilation of reaction rates (NACRE or CF88) and the uncertainty is now reduced down to the 10% level.

  2. Operating manual for the U.S. Geological Survey minimonitor, 1988 revised edition; punched-paper-tape model (United States)

    Ficken, James H.; Scott, Carl T.


    This manual describes the U.S. Geological Survey Minimonitor Water Quality Data Measuring and Recording System. Instructions for calibrating, servicing, maintaining, and operating the system are provided. The Survey Minimonitor is a battery-powered , multiparameter water quality monitoring instrument designed for field use. A watertight can containing signal conditioners is connected with cable and waterproof connectors to various water quality sensors. Data are recorded on a punched paper-tape recorder. An external battery is required. The operation and maintenance of various sensors and signal conditioners are discussed, for temperature, specific conductance, dissolved oxygen, and pH. Calibration instructions are provided for each parameter, along with maintenance instructions. Sections of the report explain how to connect the Minimonitor to measure direct-current voltages, such as signal outputs from other instruments. Instructions for connecting a satellite data-collection platform or a solid-state data recorder to the Minimonitor are given also. Basic information is given for servicing the Minimonitor and trouble-shooting some of its electronic components. The use of test boxes to test sensors, isolate component problems, and verify calibration values is discussed. (USGS)

  3. Validation of the revised MDRD formula and the original Cockcroft and Gault formula for estimation of the glomerular filtration rate using Australian data. (United States)

    Jones, Graham R D; Imam, Seyed K


    The estimation of glomerular filtration rate (eGFR) using the MDRD (Modification of Diet in Renal Disease) formula is a recommended practice in Australia, New Zealand and other countries. Since the original development of this formula, an international process to align assays for serum creatinine has been undertaken and a revised version of the MDRD formula has been produced for these assays. Additionally, the Cockcroft and Gault (C&G) formula remains recommended for drug dosing decisions, although there are different versions of the formula using either actual weight or calculated ideal body weight. We aimed to assess these formulae using Australian data. We assessed the revised MDRD and the C&G formulae by comparison with radio-isotope GFR measurements using patients routinely referred for this test. The MDRD was compared to GFR corrected for body surface area and the C&G to the uncorrected GFR. The MDRD was shown to have the expected scatter of over +/-30% but with median values not significantly different from isotopic GFR measurements and without a systematic deviation due to age, gender, height, weight or body mass index (BMI). The original C&G formula generally provided a good estimate of GFR, however the use of ideal body weight rather than actual body weight produced an under-estimated GFR in this population which was more prominent with increasing age and BMI. The MDRD and original C&G formulae were found to be valid in an Australian setting. The C&G formula, when calculated using weight estimated from patient height, was found to underestimate GFR in some patients.

  4. Effects of baseline reinforcement rate on operant ABA and ABC renewal. (United States)

    Berry, Meredith S; Sweeney, Mary M; Odum, Amy L


    Renewal is a relapse phenomenon that occurs when the contextual stimuli present during extinction change, and consequently, an extinguished response increases in rate. Two experiments assessed extinction and renewal of key-pecking in pigeons in a two-component multiple schedule wherein baseline reinforcer rates were delivered at relatively rich or lean rates. In Experiment 1, an ABA design was used in which baseline stimuli were steady key lights (Context A). Food was then removed during extinction, and simultaneously, the context was changed by flashing the key lights (Context B). Following extinction, steady key lights were reintroduced, but food remained unavailable. Key-pecking was more resistant to extinction and recovered to a greater degree in the rich relative to the lean component. In Experiment 2, we introduced novel stimuli following extinction (ABC renewal) rather than reintroducing baseline stimuli. Similar to Experiment 1, in Experiment 2 resistance to change and renewal remained greater in the component associated with higher reinforcer rates during baseline. These findings provide additional support for the context-specificity of operant extinction, and support the prediction of behavioral momentum theory that stimuli associated with higher rates of reinforcement engender greater persistence and relapse than those associated with lower rates of reinforcement. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. The Neuropsychiatric Inventory-Clinician rating scale (NPI-C): reliability and validity of a revised assessment of neuropsychiatric symptoms in dementia. (United States)

    de Medeiros, Kate; Robert, P; Gauthier, S; Stella, F; Politis, A; Leoutsakos, J; Taragano, F; Kremer, J; Brugnolo, A; Porsteinsson, A P; Geda, Y E; Brodaty, H; Gazdag, G; Cummings, J; Lyketsos, C


    Neuropsychiatric symptoms (NPS) affect almost all patients with dementia and are a major focus of study and treatment. Accurate assessment of NPS through valid, sensitive and reliable measures is crucial. Although current NPS measures have many strengths, they also have some limitations (e.g. acquisition of data is limited to informants or caregivers as respondents, limited depth of items specific to moderate dementia). Therefore, we developed a revised version of the NPI, known as the NPI-C. The NPI-C includes expanded domains and items, and a clinician-rating methodology. This study evaluated the reliability and convergent validity of the NPI-C at ten international sites (seven languages). Face validity for 78 new items was obtained through a Delphi panel. A total of 128 dyads (caregivers/patients) from three severity categories of dementia (mild = 58, moderate = 49, severe = 21) were interviewed separately by two trained raters using two rating methods: the original NPI interview and a clinician-rated method. Rater 1 also administered four additional, established measures: the Apathy Evaluation Scale, the Brief Psychiatric Rating Scale, the Cohen-Mansfield Agitation Index, and the Cornell Scale for Depression in Dementia. Intraclass correlations were used to determine inter-rater reliability. Pearson correlations between the four relevant NPI-C domains and their corresponding outside measures were used for convergent validity. Inter-rater reliability was strong for most items. Convergent validity was moderate (apathy and agitation) to strong (hallucinations and delusions; agitation and aberrant vocalization; and depression) for clinician ratings in NPI-C domains. Overall, the NPI-C shows promise as a versatile tool which can accurately measure NPS and which uses a uniform scale system to facilitate data comparisons across studies.

  6. Preliminary remediation goals for use at the US Department of Energy Oak Ridge Operations Office. Revision 1

    Energy Technology Data Exchange (ETDEWEB)



    This technical memorandum presents Preliminary Remediation Goals (PRGs) for use in human health risk assessment efforts under the United States Department of Energy, Oak Ridge Operations Office Environmental Restoration (ER) Division. This document provides the ER Division with standardized PRGs which are integral to the Remedial Investigation/Feasibility Study process. They are used during project scooping (Data Quality Objectives development), in screening level risk assessments to support early action or No Further Investigation decisions, and in the baselines risk assessment where they are employed in the selection of chemicals of potential concern. The primary objective of this document is to standardize these values and eliminate any duplication of effort by providing PRGs to all contractors involved in risk activities. In addition, by managing the assumptions and systems used in PRG derivation, the ER Risk Assessment Program will be able to control the level of quality assurance associated with these risk-based guideline values.

  7. Safety Standard for Hydrogen and Hydrogen Systems: Guidelines for Hydrogen System Design, Materials Selection, Operations, Storage and Transportation. Revision (United States)


    The NASA Safety Standard, which establishes a uniform process for hydrogen system design, materials selection, operation, storage, and transportation, is presented. The guidelines include suggestions for safely storing, handling, and using hydrogen in gaseous (GH2), liquid (LH2), or slush (SLH2) form whether used as a propellant or non-propellant. The handbook contains 9 chapters detailing properties and hazards, facility design, design of components, materials compatibility, detection, and transportation. Chapter 10 serves as a reference and the appendices contained therein include: assessment examples; scaling laws, explosions, blast effects, and fragmentation; codes, standards, and NASA directives; and relief devices along with a list of tables and figures, abbreviations, a glossary and an index for ease of use. The intent of the handbook is to provide enough information that it can be used alone, but at the same time, reference data sources that can provide much more detail if required.

  8. Remedial Investigation/Feasibility Study Work Plan for the 200-UP-1 Groundwater Operable Unit, Hanford Site, Richland, Washington. Revision

    Energy Technology Data Exchange (ETDEWEB)


    This work plan identifies the objectives, tasks, and schedule for conducting a Remedial Investigation/Feasibility Study for the 200-UP-1 Groundwater Operable Unit in the southern portion of the 200 West Groundwater Aggregate Area of the Hanford Site. The 200-UP-1 Groundwater Operable Unit addresses contamination identified in the aquifer soils and groundwater within its boundary, as determined in the 200 West Groundwater Aggregate Area Management Study Report (AAMSR) (DOE/RL 1992b). The objectives of this work plan are to develop a program to investigate groundwater contaminants in the southern portion of the 200 West Groundwater Aggregate Area that were designated for Limited Field Investigations (LFIs) and to implement Interim Remedial Measures (IRMs) recommended in the 200 West Groundwater AAMSR. The purpose of an LFI is to evaluate high priority groundwater contaminants where existing data are insufficient to determine whether an IRM is warranted and collect sufficient data to justify and implement an IRM, if needed. A Qualitative Risk Assessment (QRA) will be performed as part of the LFI. The purpose of an IRM is to develop and implement activities, such as contaminant source removal and groundwater treatment, that will ameliorate some of the more severe potential risks of groundwater contaminants prior to the RI and baseline Risk Assessment (RA) to be conducted under the Final Remedy Selection (FRS) at a later date. This work plan addresses needs of a Treatability Study to support the design and implementation of an interim remedial action for the Uranium-{sup 99}{Tc}-Nitrate multi-contaminant IRM plume identified beneath U Plant.

  9. Coexistence of reward and unsupervised learning during the operant conditioning of neural firing rates.

    Directory of Open Access Journals (Sweden)

    Robert R Kerr

    Full Text Available A fundamental goal of neuroscience is to understand how cognitive processes, such as operant conditioning, are performed by the brain. Typical and well studied examples of operant conditioning, in which the firing rates of individual cortical neurons in monkeys are increased using rewards, provide an opportunity for insight into this. Studies of reward-modulated spike-timing-dependent plasticity (RSTDP, and of other models such as R-max, have reproduced this learning behavior, but they have assumed that no unsupervised learning is present (i.e., no learning occurs without, or independent of, rewards. We show that these models cannot elicit firing rate reinforcement while exhibiting both reward learning and ongoing, stable unsupervised learning. To fix this issue, we propose a new RSTDP model of synaptic plasticity based upon the observed effects that dopamine has on long-term potentiation and depression (LTP and LTD. We show, both analytically and through simulations, that our new model can exhibit unsupervised learning and lead to firing rate reinforcement. This requires that the strengthening of LTP by the reward signal is greater than the strengthening of LTD and that the reinforced neuron exhibits irregular firing. We show the robustness of our findings to spike-timing correlations, to the synaptic weight dependence that is assumed, and to changes in the mean reward. We also consider our model in the differential reinforcement of two nearby neurons. Our model aligns more strongly with experimental studies than previous models and makes testable predictions for future experiments.

  10. Determination of Optimum Frame Rates for Observation of Construction Operations from Time-Lapse Movies

    Directory of Open Access Journals (Sweden)

    Y. M. Ibrahim


    Full Text Available Construction professionals have been using time-lapse movies in monitoring construction operations. However, some amount of detail is always lost in the interval between two consecutive frames in a time-lapse movie. This poses the question: By how much can the frame rate be lowered from the standard 30fps (frames per second to allow for the accurate observation of construction operations from a time-lapse movie? This paper addresses the problem by establishing the optimum frame rates for observation of activities related to mortar mixing and block handling. The activities were first recorded at the standard rate of 30fps. Using the Adobe Premier Pro video editing software, the records were then segregated into still images from which 15 different time-lapse movies of various time intervals were generated. The movies were then shown to 25 Construction Managers. A structured questionnaire was employed to capture the level of accuracy with which Construction Managers could interpret the job site situation from each movie. The results suggest that 1fpm (frame per minute is sufficient for the accurate tracking of labourers involved in mortar mixing while 1 frame in every 20 seconds is sufficient for accurate identification of number of cement bags used. However, for tracking number of blocks off-loaded, and those damaged, 1 frame in every 2 seconds is required.

  11. Defining freight rates as a contribution to the successful operation of container shipping companies

    Directory of Open Access Journals (Sweden)

    Renato Oblak


    Full Text Available The globalization of the world market and the flexibility of containerization to adjust to the constant changes in supply and demand of the international goods market, has led to a continuous increase in the portion of the container transport within the international maritime cargo transport. By the increase of the container transport level, the impact and importance of container freight rates have been growing, the variability of which directly reflects on the world economy. The aim of this paper is to analyze the efficiency of actual methods in establishing the container freight rates according to the problems which appear in the container shipping operation and refer to large differences in the weights of the actual transported cargo and the declared cargo in containers. The consequence of is lower freight rates and higher costs of the vessels exploitation, concerning the increase of the bunker oil consumption. The conducted research is based on actual data that have been collected and analyzed from particular container vessel liner services within period of 90 days and casting off from 16 container ports. The proposed measures could increase the level of usability of the transporting ships capacities and enable a more accurate and correct account of sea freight rates. The results of the research have shown that by increasing the control of accuracy of the cargo weight in containers and by improving the model of accounting, the freight rates can increase the incomes of shipping companies maintaining the same level of container traffic, which can have a direct influence on the efficiency of their successful operation.

  12. Ureteroenteric anastomotic revision as initial management of stricture after urinary diversion. (United States)

    Gin, Greg E; Ruel, Nora H; Parihar, Jaspreet S; Warner, Jonathan N; Yuh, Bertram E; Yamzon, Jonathan; Wilson, Timothy G; Lau, Clayton S; Chan, Kevin G


    To report our experience with ureteroenteric anastomotic revision as initial treatment of stricture after urinary diversion. An institutional review board-approved retrospective study was carried out. A total of 41 patients who underwent primary ureteroenteric anastamotic revision were identified between 2007 and 2015. Data analyzed included patient characteristics, type of diversion, estimated blood loss, operative time, change in renal function, length of stay, postoperative complications and time with nephrostomy/stent. Success of revision was defined as an improvement in hydronephrosis on radiographic imaging and/or reflux during pouchogram. Predictors of length of stay and complications were analyzed using analysis of covariance. A total of 50 renal units were revised with a success rate of 100%. The median length of stay was 6 days (2-16 days). There were a total of 15 complications (one major, 14 minor) in 14 patients (33% 30-day complication rate). The most common were wound infection (n = 4) and arrhythmia (n = 4). Robotic revision (n = 5) had a median length of stay of 3 days (2-4) with no complications. Primary ureteroenteric anastomotic revisions have an excellent success rate at an experienced center and might obviate the need for multiple interventions. Open revision is associated with mostly minor complications. Robotic revision might reduce the morbidity of open revision in select cases. © 2017 The Japanese Urological Association.

  13. "Diamond" over-coated Microstrip Gas Chambers for high rate operation

    CERN Document Server

    Barr, A J; Bouclier, Roger; Capéans-Garrido, M; Dominik, Wojciech; Hoch, M; Manzin, G; Million, Gilbert; Ropelewski, Leszek; Sauli, Fabio; Sharma, A


    We describe the recent developments on the diamond-like carbon (DLC) over-coated Microstrip Gas Chambers made on drawn glass substrates. MSGC surface coating with thin DLC layer of stable and controlled resistivity was proposed to overcome the limitation of detector operation due to surface charging-up under avalanches. This brings also advantages for the detector manufacturing technology. The thin layer, deposited on top of a manufactured MSGC (over-coating), demonstrates excellent mechanical properties and very good stability. We report on recent measurements with DLC over-coated MSGCs of various surface resistivities (ranging from 1013W/r to 1016W/r) on D-263 and AF45 glass substrates. Over-coated MSGCs exhibit good rate capability for the resistivity of the surface around 1015W/r. Stable operation up to 50 mC/cm of accumulated charge from avalanches has been demonstrated.

  14. Assessing Applications of GPM and IMERG Passive Microwave Rain Rates in Modeling and Operational Forecasting (United States)

    Zavodsky, B.; Le Roy, A.; Smith, M. R.; Case, J.


    In support of NASA's recently launched GPM `core' satellite, the NASA-SPoRT project is leveraging experience in research-to-operations transitions and training to provide feedback on the operational utility of GPM products. Thus far, SPoRT has focused on evaluating the Level 2 GPROF passive microwave and IMERG rain rate estimates. Formal evaluations with end-users have occurred, as well as internal evaluations of the datasets. One set of end users for these products is National Weather Service Forecast Offices (WFOs) and National Weather Service River Forecast Centers (RFCs), comprising forecasters and hydrologists. SPoRT has hosted a series of formal assessments to determine uses and utility of these datasets for NWS operations at specific offices. Forecasters primarily have used Level 2 swath rain rates to observe rainfall in otherwise data-void regions and to confirm model QPF for their nowcasting or short-term forecasting. Hydrologists have been evaluating both the Level 2 rain rates and the IMERG rain rates, including rain rate accumulations derived from IMERG; hydrologists have used these data to supplement gauge data for post-event analysis as well as for longer-term forecasting. Results from specific evaluations will be presented. Another evaluation of the GPM passive microwave rain rates has been in using the data within other products that are currently transitioned to end-users, rather than as stand-alone observations. For example, IMERG Early data is being used as a forcing mechanism in the NASA Land Information System (LIS) for real-time soil moisture product over eastern Africa. IMERG is providing valuable precipitation information to LIS in an otherwise data-void region. Results and caveats will briefly be discussed. A third application of GPM data is using the IMERG Late and Final products for model verification in remote regions where high-quality gridded precipitation fields are not readily available. These datasets can now be used to verify NWP

  15. 25 CFR 171.500 - How does BIA determine the annual operation and maintenance assessment rate for the irrigation... (United States)


    ... maintenance assessment rate for the irrigation facility servicing my farm unit? 171.500 Section 171.500 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER IRRIGATION OPERATION AND... annual operation and maintenance assessment rate for the irrigation facility servicing my farm unit? (a...

  16. Operational and Strategic Implementation of Dynamic Line Rating for Optimized Wind Energy Generation Integration

    Energy Technology Data Exchange (ETDEWEB)

    Gentle, Jake Paul [Idaho National Lab. (INL), Idaho Falls, ID (United States)


    One primary goal of rendering today’s transmission grid “smarter” is to optimize and better manage its power transfer capacity in real time. Power transfer capacity is affected by three main elements: stability, voltage limits, and thermal ratings. All three are critical, but thermal ratings represent the greatest opportunity to quickly, reliably and economically utilize the grid’s true capacity. With the “Smarter Grid”, new solutions have been sought to give operators a better grasp on real time conditions, allowing them to manage and extend the usefulness of existing transmission infrastructure in a safe and reliable manner. The objective of the INL Wind Program is to provide industry a Dynamic Line Rating (DLR) solution that is state of the art as measured by cost, accuracy and dependability, to enable human operators to make informed decisions and take appropriate actions without human or system overloading and impacting the reliability of the grid. In addition to mitigating transmission line congestion to better integrate wind, DLR also offers the opportunity to improve the grid with optimized utilization of transmission lines to relieve congestion in general. As wind-generated energy has become a bigger part of the nation’s energy portfolio, researchers have learned that wind not only turns turbine blades to generate electricity, but can cool transmission lines and increase transfer capabilities significantly, sometimes up to 60 percent. INL’s DLR development supports EERE and The Wind Energy Technology Office’s goals by informing system planners and grid operators of available transmission capacity, beyond typical Static Line Ratings (SLR). SLRs are based on a fixed set of conservative environmental conditions to establish a limit on the amount of current lines can safely carry without overheating. Using commercially available weather monitors mounted on industry informed custom brackets developed by INL in combination with Computational

  17. 78 FR 13011 - Non-Vessel-Operating Common Carrier Negotiated Rate Arrangements; Tariff Publication Exemption (United States)


    ... through payment of taxes or use of American products, materials or labor.'' 13 CFR 121.105(a)(1). As... exemption. 0 9. In Sec. 532.7, revise paragraph (b) to read as follows: Sec. 532.7 Recordkeeping and audit...

  18. Item response theory analysis of the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised in the Pooled Resource Open-Access ALS Clinical Trials Database. (United States)

    Bacci, Elizabeth D; Staniewska, Dorota; Coyne, Karin S; Boyer, Stacey; White, Leigh Ann; Zach, Neta; Cedarbaum, Jesse M


    Our objective was to examine dimensionality and item-level performance of the Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised (ALSFRS-R) across time using classical and modern test theory approaches. Confirmatory factor analysis (CFA) and Item Response Theory (IRT) analyses were conducted using data from patients with amyotrophic lateral sclerosis (ALS) Pooled Resources Open-Access ALS Clinical Trials (PRO-ACT) database with complete ALSFRS-R data (n = 888) at three time-points (Time 0, Time 1 (6-months), Time 2 (1-year)). Results demonstrated that in this population of 888 patients, mean age was 54.6 years, 64.4% were male, and 93.7% were Caucasian. The CFA supported a 4* individual-domain structure (bulbar, gross motor, fine motor, and respiratory domains). IRT analysis within each domain revealed misfitting items and overlapping item response category thresholds at all time-points, particularly in the gross motor and respiratory domain items. Results indicate that many of the items of the ALSFRS-R may sub-optimally distinguish among varying levels of disability assessed by each domain, particularly in patients with less severe disability. Measure performance improved across time as patient disability severity increased. In conclusion, modifications to select ALSFRS-R items may improve the instrument's specificity to disability level and sensitivity to treatment effects.

  19. Comparing Results of Five Glomerular Filtration Rate-Estimating Equations in the Korean General Population: MDRD Study, Revised Lund-Malmö, and Three CKD-EPI Equations. (United States)

    Ji, Misuk; Lee, Yoon Hee; Hur, Mina; Kim, Hyesun; Cho, Han Ik; Yang, Hyun Suk; Navarin, Silvia; Di Somma, Salvatore


    Estimated glomerular filtration rate (eGFR) is a widely used index of kidney function. Recently, new formulas such as the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations or the Lund-Malmö equation were introduced for assessing eGFR. We compared them with the Modification of Diet in Renal Disease (MDRD) Study equation in the Korean adult population. The study population comprised 1,482 individuals (median age 51 [42-59] yr, 48.9% males) who received annual physical check-ups during the year 2014. Serum creatinine (Cr) and cystatin C (CysC) were measured. We conducted a retrospective analysis using five GFR estimating equations (MDRD Study, revised Lund-Malmö, and Cr and/or CysC-based CKD-EPI equations). Reduced GFR was defined as eGFR EPI(CysC) and -20.5 for CKD-EPI(Cr-CysC)). CysC-based equations decreased the prevalence of reduced GFR by one third (9.4% in the MDRD Study and 2.4% in CKD-EPI(CysC)). Our data shows that there are remarkable differences in eGFR assessment in the Korean population depending on the equation used, especially in normal or mildly decreased categories. Further prospective studies are necessary in various clinical settings.

  20. Complications after hip rearthroplastics with revision endoprosthesis. (United States)

    Maricević, Antun; Erceg, Marinko; Gulan, Goran; Srsen, Darko


    The stability of the revision endoprosthesis components is more difficult to achieve than in primary endoprosthesis due to large bone defects and/or decreased bone mass quality. That is the reason for more frequent complications for revision than in primary arthroplasty. The aim of this study was to investigate the frequency of complications in 122 patients who were operated with the revision endoprosthesis in the Department of Orthopedics in University Hospital Split in the period of 1998 to 2007 and accepted to participate in this study. There were 3 patients treated on bought hips. The average follow up time was four years (0.6-10.6). There were 32 (26.2%) males and 90 (73.8%) females. The average age was 70.66 +/- 7.63 years. The average time from operation to physical therapy was 3.53 +/- 2.56 days. There were 27 (21.6%) complications. The most common complication was infection in 9 (7.2%) cases. From those cases, 4 (3.2%) had superficial, and 5 (4%) had deep infection. From other complications, there were 5 (4%) endoprosthesis reluxations, 2 (1.6%) periprosthetic femur fractures, 5 (4%) urinary infections, and 6 (4.8%) other complications (lung mycroembolia, heart infarction, lumbal plexus lesion from L2, spinal cord infarction with paraplegia, pneumonia and severe sacral bed-sore). There were 10 (8%) re-interventions following the revision arthroplasty. The result was good or excellent in 80% of operated patients, satisfied in 17%, and bad in 3%. The revision hip procedures are characterized with a high complications incidence rate. Our results are comparable with the results from literature.

  1. Longitudinally excited CO2 laser with short laser pulse operating at high repetition rate (United States)

    Li, Jianhui; Uno, Kazuyuki; Akitsu, Tetsuya; Jitsuno, Takahisa


    A short-pulse longitudinally excited CO2 laser operating at a high repetition rate was developed. The discharge tube was made of a 45 cm-long or 60 cm-long dielectric tube with an inner diameter of 16 mm and two metallic electrodes at the ends of the tube. The optical cavity was formed by a ZnSe output coupler with a reflectivity of 85% and a high-reflection mirror. Mixed gas (CO2:N2:He = 1:1:2) was flowed into the discharge tube. A high voltage of about 33 kV with a rise time of about 200 ns was applied to the discharge tube. At a repetition rate of 300 Hz and a gas pressure of 3.4 kPa, the 45 cm-long discharge tube produced a short laser pulse with a laser pulse energy of 17.5 mJ, a spike pulse energy of 0.2 mJ, a spike width of 153 ns, and a pulse tail length of 90 μs. The output power was 5.3 W. The laser pulse waveform did not depend on the repetition rate, but the laser beam profile did. At a low repetition rate of less than 50 Hz, the laser beam had a doughnut-like shape. However, at a high repetition rate of more than 150 Hz, the discharge concentrated at the center of the discharge tube, and the intensity at the center of the laser beam was higher. The laser beam profile depended on the distribution of the discharge. An output power of 7.0 W was achieved by using the 60 cm-long tube.

  2. Dentin bond strength after ablation using a CO2 laser operating at high pulse repetition rates (United States)

    Hedayatollahnajafi, Saba; Staninec, Michal; Watanabe, Larry; Lee, Chulsung; Fried, Daniel


    Pulsed CO2 lasers show great promise for the rapid and efficient ablation of dental hard tissues. Our objective was to demonstrate that CO2 lasers operated at high repetition rates can be used for the rapid removal of dentin without excessive thermal damage and without compromising adhesion to restorative materials. Human dentin samples (3x3mm2) were rapidly ablated with a pulsed CO2 laser operating at a wavelength of 9.3-µm, pulse repetition rate of 300-Hz and an irradiation intensity of 18-J/cm2. The bond strength to composite was determined by the modified single plane shear test. There were 8 test groups each containing 10 blocks: negative control (non-irradiated non-etched), positive control (non-irradiated acid-etched), and six laser treated groups (three etched and three non-etched sets). The first and second etched and non-etched sets were ablated at a speed of 25 mm/sec and 50 mm/sec with water, respectively. The third set was also ablated at 50 mm/sec without application of water during laser irradiation. Minimal thermal damage was observed on the dentin surfaces for which water cooling was applied. Bond strengths exceeded 20 MPa for laser treated surfaces that were acid-etched after ablation (25-mm/sec: 29.9-MPa, 50-mm/sec: 21.3-MPa). The water-cooled etched laser groups all produced significantly stronger bonds than the negative control (pbond strength than the positive control (pbond strength than the acid-etched control samples is clinically significant where durability of these bonded restoration supersedes high bond strength.

  3. An extracorporeal carbon dioxide removal (ECCO2R) device operating at hemodialysis blood flow rates. (United States)

    Jeffries, R Garrett; Lund, Laura; Frankowski, Brian; Federspiel, William J


    Extracorporeal carbon dioxide removal (ECCO2R) systems have gained clinical appeal as supplemental therapy in the treatment of acute and chronic respiratory injuries with low tidal volume or non-invasive ventilation. We have developed an ultra-low-flow ECCO2R device (ULFED) capable of operating at blood flows comparable to renal hemodialysis (250 mL/min). Comparable operating conditions allow use of minimally invasive dialysis cannulation strategies with potential for direct integration to existing dialysis circuitry. A carbon dioxide (CO2) removal device was fabricated with rotating impellers inside an annular hollow fiber membrane bundle to disrupt blood flow patterns and enhance gas exchange. In vitro gas exchange and hemolysis testing was conducted at hemodialysis blood flows (250 mL/min). In vitro carbon dioxide removal rates up to 75 mL/min were achieved in blood at normocapnia (pCO2 = 45 mmHg). In vitro hemolysis (including cannula and blood pump) was comparable to a Medtronic Minimax oxygenator control loop using a time-of-therapy normalized index of hemolysis (0.19 ± 0.04 g/100 min versus 0.12 ± 0.01 g/100 min, p = 0.169). In vitro performance suggests a new ultra-low-flow extracorporeal CO2 removal device could be utilized for safe and effective CO2 removal at hemodialysis flow rates using simplified and minimally invasive connection strategies.

  4. Technology Survey to Support Revision to the Remedial Investigation/Feasibility Study Work Plan for the 200­-SW­-2 Operable Unit at the U.S. Department of Energy’s Hanford Site

    Energy Technology Data Exchange (ETDEWEB)

    Truex, Michael J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Johnson, Christian D. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Nimmons, Michael J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)


    A survey of technologies was conducted to provide information for a Data Quality Objectives process being conducted to support revision of the Remedial Investigation/Feasibility Study Work Plan for the 200-SW-2 Operable Unit. The technology survey considered remediation and characterization technologies. This effort was conducted to address, in part, comments on the previous version of the Remedial Investigation/Feasibility Study Work Plan for the 200-SW-2 Operable Unit as documented in 200­SW­1 and 200­SW­2 Collaborative Workshops-Agreement, Completion Matrix, and Supporting Documentation. By providing a thorough survey of remediation and characterization options, this report is intended to enable the subsequent data quality objectives and work plan revision processes to consider the full range of potential alternatives for planning of the Remedial Investigation/Feasibility Study activities.

  5. Heart rate calculation from ensemble brain wave using wavelet and Teager-Kaiser energy operator. (United States)

    Srinivasan, Jayaraman; Adithya, V


    Electroencephalogram (EEG) signal artifacts are caused by various factors, such as, Electro-oculogram (EOG), Electromyogram (EMG), Electrocardiogram (ECG), movement artifact and line interference. The relatively high electrical energy cardiac activity causes EEG artifacts. In EEG signal processing the general approach is to remove the ECG signal. In this paper, we introduce an automated method to extract the ECG signal from EEG using wavelet and Teager-Kaiser energy operator for R-peak enhancement and detection. From the detected R-peaks the heart rate (HR) is calculated for clinical diagnosis. To check the efficiency of our method, we compare the HR calculated from ECG signal recorded in synchronous with EEG. The proposed method yields a mean error of 1.4% for the heart rate and 1.7% for mean R-R interval. The result illustrates that, proposed method can be used for ECG extraction from single channel EEG and used in clinical diagnosis like estimation for stress analysis, fatigue, and sleep stages classification studies as a multi-model system. In addition, this method eliminates the dependence of additional synchronous ECG in extraction of ECG from EEG signal process.

  6. The relationship between the Early Childhood Environment Rating Scale and its revised form and child outcomes: A systematic review and meta-analysis. (United States)

    Brunsek, Ashley; Perlman, Michal; Falenchuk, Olesya; McMullen, Evelyn; Fletcher, Brooke; Shah, Prakesh S


    The Early Childhood Environment Rating Scale (ECERS) and its revised version (ECERS-R) were designed as global measures of quality that assess structural and process aspects of Early Childhood Education and Care (ECEC) programs. Despite frequent use of the ECERS/ECERS-R in research and applied settings, associations between it and child outcomes have not been systematically reviewed. The objective of this research was to evaluate the association between the ECERS/ECERS-R and children's wellbeing. Searches of Medline, PsycINFO, ERIC, websites of large datasets and reference sections of all retrieved articles were completed up to July 3, 2015. Eligible studies provided a statistical link between the ECERS/ECERS-R and child outcomes for preschool-aged children in ECEC programs. Of the 823 studies selected for full review, 73 were included in the systematic review and 16 were meta-analyzed. The combined sample across all eligible studies consisted of 33, 318 preschool-aged children. Qualitative systematic review results revealed that ECERS/ECERS-R total scores were more generally associated with positive outcomes than subscales or factors. Seventeen separate meta-analyses were conducted to assess the strength of association between the ECERS/ECERS-R and measures that assessed children's language, math and social-emotional outcomes. Meta-analyses revealed a small number of weak effects (in the expected direction) between the ECERS/ECERS-R total score and children's language and positive behavior outcomes. The Language-Reasoning subscale was weakly related to a language outcome. The enormous heterogeneity in how studies operationalized the ECERS/ECERS-R, the outcomes measured and statistics reported limited our ability to meta-analyze many studies. Greater consistency in study methodology is needed in this area of research. Despite these methodological challenges, the ECERS/ECERS-R does appear to capture aspects of quality that are important for children's wellbeing

  7. Pink Wastewater Treatment Costs for a Granular Carbon System Operating at Flow Rates at or Below Design Capacity. (United States)


    capacity after reduced flow values of the wastewaters are collected and stored versus the daily operation of the plant regardless of the influent flow ... rates . Examined and qualified in Present-VAlue dollars was the effect of dedicated versus part-time labor for operation of the carbon plant. The

  8. [Hip revision arthroplasty (long-term results)]. (United States)

    Tarasevicius, Sarūnas; Zegunis, Vidmantas; Tarasevicius, Rimantas; Kalesinskas, Romas Jonas; Janusonis, Vinsas


    To evaluate the risk factors after total hip replacement arthroplasty for rerevision and to analyze complications after hip revision surgery. We obtained data from 117 hip revisions and 12 hip rerevision arthroplasties performed in 1992-2001 in the Department of Orthopedics of Klaipeda Hospital. Special forms were filled in for every patient who participated in the study. Name, operation date, type of implants, operative technique, revision diagnosis, intraoperative and postoperative complications were recorded. All patients were checked for death until 2003. Hip revisions were performed for 77 (66%) women and 50 (44%) men in 1992-2001. We revised 22 (19%) cups, 6 (5%) stems, 86 (74%) total hip revisions; femoral head was exchanged for 3 patients. Revision diagnoses were: aseptic loosening in 106 (90%) cases, recurrent dislocations in 7 (6%) cases, and periprosthetic fractures in 4 (4%) cases. Patients' age varied from 26-82 years, average 63.5 years. In revision group only 8% of patients were less than 50 years old, compared to 33% in rerevision group. Morselized allografts and bone impaction technique for reconstruction of bone defects were used in 70 (60%) of cases. We rerevised one cup only for which revision morselized allografts were used. Eight (67%) rerevisions were performed after first 28 (24%) hip revisions. Patients, who underwent revision surgery being younger than 50 years old, were at higher risk for rerevision surgery. Revision with morselized bone allografts and bone impaction technique decreases number of rerevisions. Learning curve was steep and had great influence to our results.

  9. High-Rate Communications Outage Recorder Operations for Optimal Payload and Science Telemetry Management Onboard the International Space Station (United States)

    Shell, Michael T.; McElyea, Richard M. (Technical Monitor)


    All International Space Station (ISS) Ku-band telemetry transmits through the High-Rate Communications Outage Recorder (HCOR). The HCOR provides the recording and playback capability for all payload, science, and International Partner data streams transmitting through NASA's Ku-band antenna system. The HCOR is a solid-state memory recorder that provides recording capability to record all eight ISS high-rate data during ISS Loss-of-Signal periods. NASA payloads in the Destiny module are prime users of the HCOR; however, NASDA and ESA will also utilize the HCOR for data capture and playback of their high data rate links from the Kibo and Columbus modules. Marshall Space Flight Center's Payload Operations Integration Center manages the HCOR for nominal functions, including system configurations and playback operations. The purpose of this paper is to present the nominal operations plan for the HCOR and the plans for handling contingency operations affecting payload operations. In addition, the paper will address HCOR operation limitations and the expected effects on payload operations. The HCOR is manifested for ISS delivery on flight 9A with the HCOR backup manifested on flight 11A. The HCOR replaces the Medium-Rate Communications Outage Recorder (MCOR), which has supported payloads since flight 5A.1.

  10. Perceptual Accent Rating and Attribution in Psychogenic FAS: Some Further Evidence Challenging Whitaker's Operational Definition. (United States)

    Keulen, Stefanie; Verhoeven, Jo; Bastiaanse, Roelien; Mariën, Peter; Jonkers, Roel; Mavroudakis, Nicolas; Paquier, Philippe


    A 40-year-old, non-aphasic, right-handed, and polyglot (L1: French, L2: Dutch, and L3: English) woman with a 12-year history of addiction to opiates and psychoactive substances, and clear psychiatric problems, presented with a foreign accent of sudden onset in L1. Speech evolved toward a mostly fluent output, despite a stutter-like behavior and a marked grammatical output disorder. The psychogenic etiology of the accent foreignness was construed based on the patient's complex medical history and psychodiagnostic, neuropsychological, and neurolinguistic assessments. The presence of a foreign accent was affirmed by a perceptual accent rating and attribution experiment. It is argued that this patient provides additional evidence demonstrating the outdatedness of Whitaker's (1982) definition of foreign accent syndrome, as only one of the four operational criteria was unequivocally applicable to our patient: her accent foreignness was not only recognized by her relatives and the medical staff but also by a group of native French-speaking laymen. However, our patient defied the three remaining criteria, as central nervous system damage could not conclusively be demonstrated, psychodiagnostic assessment raised the hypothesis of a conversion disorder, and the patient was a polyglot whose newly gained accent was associated with a range of foreign languages, which exceeded the ones she spoke.

  11. Thoracic Epidural Catheter Placement in a Preoperative Block Area Improves Operating Room Efficiency and Decreases Epidural Failure Rate. (United States)

    Gleicher, Yehoshua; Singer, Oskar; Choi, Stephen; McHardy, Paul

    The primary aim of this study was to review the impact of inserting thoracic epidural catheters in a preoperative block room setting on operating room efficiency. We conducted a retrospective preintervention/postintervention review of thoracic epidurals inserted over a 12-month period. The review included 6 months of data prior to implementation of the regional anesthesia block room and 6 months of data following implementation. The primary outcome measure was anesthesia-controlled operating room time, defined as time from patient arrival to the operating room to time of surgical site sterile preparation. Secondary measures included operating room waiting time for the patient arrival, thoracic epidural failure rate, and number of epidural insertion attempts. Data from thoracic epidurals for 112 patients of preblock room and 142 patients of postblock room implementation were collected. Anesthesia-controlled operating room time was reduced by an average of 22.9 minutes per patient (95% confidence interval, 19.3-26.3 minutes; P operating room waiting time for patient arrival increased by 3.8 minutes (95% confidence interval, 1.0-6.5 minutes; P operating room time savings of 19.1 minutes per epidural. The epidural failure rate decreased from 16.0% to 5.6% (P room setting can significantly reduce anesthesia-controlled operating room time and epidural failure rates.

  12. 14 CFR 91.1077 - Training program and revision: Initial and final approval. (United States)


    ... RULES Fractional Ownership Operations Program Management § 91.1077 Training program and revision... outline of the proposed or revised curriculum, that provides enough information for a preliminary...

  13. Measurement of peak impact loads differ between accelerometers - Effects of system operating range and sampling rate. (United States)

    Ziebart, Christina; Giangregorio, Lora M; Gibbs, Jenna C; Levine, Iris C; Tung, James; Laing, Andrew C


    A wide variety of accelerometer systems, with differing sensor characteristics, are used to detect impact loading during physical activities. The study examined the effects of system characteristics on measured peak impact loading during a variety of activities by comparing outputs from three separate accelerometer systems, and by assessing the influence of simulated reductions in operating range and sampling rate. Twelve healthy young adults performed seven tasks (vertical jump, box drop, heel drop, and bilateral single leg and lateral jumps) while simultaneously wearing three tri-axial accelerometers including a criterion standard laboratory-grade unit (Endevco 7267A) and two systems primarily used for activity-monitoring (ActiGraph GT3X+, GCDC X6-2mini). Peak acceleration (gmax) was compared across accelerometers, and errors resulting from down-sampling (from 640 to 100Hz) and range-limiting (to ±6g) the criterion standard output were characterized. The Actigraph activity-monitoring accelerometer underestimated gmax by an average of 30.2%; underestimation by the X6-2mini was not significant. Underestimation error was greater for tasks with greater impact magnitudes. gmax was underestimated when the criterion standard signal was down-sampled (by an average of 11%), range limited (by 11%), and by combined down-sampling and range-limiting (by 18%). These effects explained 89% of the variance in gmax error for the Actigraph system. This study illustrates that both the type and intensity of activity should be considered when selecting an accelerometer for characterizing impact events. In addition, caution may be warranted when comparing impact magnitudes from studies that use different accelerometers, and when comparing accelerometer outputs to osteogenic impact thresholds proposed in literature. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  14. Characterization of gaseous pollutant and particulate matter emission rates from a commercial broiler operation part II: Correlated emission rates (United States)

    Roumeliotis, Taylor S.; Dixon, Brad J.; Van Heyst, Bill J.


    Emission rates of ammonia, acid gases, inorganic aerosols, methane, and size fractionated particulate matter were measured from a commercial broiler facility. This paper discusses the statistically influential parameters on numerous pollutants' emission from a broiler chicken facility and generates emission correlations to fill data gaps and develop averaged emission factors. Live mass of the birds was commonly a significant variable to each pollutant's emission. Some variables significantly impacted the pollutants' emissions, such as litter moisture content, but were measured discretely and cannot be used for filling in data gaps. House parameter correlations were, therefore, developed using parameters measured at the facility, such as indoor temperature, relative humidity, and the live mass of the birds, and relied on the mutual behaviour of discretely measured explanatory parameters and continuously monitored confounding variables. The live mass and the difference in the indoor temperature and the house set-point temperature were the most significant variables in each pollutant's correlation. The correlations predicted each pollutants emission to within 20% (total mass basis) over most broiler production cycles. Their validation on independent datasets also successfully estimated the flocks' emissions to within 3%. Emission factors (EFs) were developed for methane, ammonia, and size fractionated particulate matter using measured data and correlated emissions to fill in data gaps. PM 10 (particulate matter ≤10 microns) EFs were estimated to be 4.6 and 5.9 g d -1 [Animal Unit, AU] -1 for five and six week production cycles, respectively. PM 2.5 (PM ≤ 2.5 microns) EFs were 0.8 and 1.4 g d -1 AU -1 for five and six week cycles, respectively. Ammonia and methane emission factors were estimated at 120.8 and 197.0 g d -1 AU -1, respectively for a five week production cycle.

  15. 7 CFR 1430.506 - Payment rate and dairy operation payment. (United States)


    ... be made to dairy operations only on the first 26,000 cwt of milk produced by them from cows in the... pounds of milk to cwt; (2) Totaling the eligible cwt (not to exceed 26,000 cwt) of milk marketed... (a) (3) of this section by the dairy operation's eligible production. (c) In the event that approval...

  16. Studi Pengaruh Operating Heat Rate Terhadap Efisiensi Kinerja Pltu Labuhan Angin Sibolga


    Simanjuntak, Sari Manna


    130402104 Heat rate merupakan ukuran keandalan dari suatu unit pembangkit. Heat rate didefinisikan sebagai jumlah energi bahan bakar yang dibutuhkan untuk menghasilkan listrik sebesar 1 kWh. Tujuan penelitian ini adalah mengevaluasi kinerja PLTU dari pengaruh beban terhadap pemakaian konsumsi spesifik bahan bakar, heat rate dan efisiensi termal pada PLTU Labuhan Angin Sibolga. Perhitungan nilai heat rate dilakukan dengan menggunakan metode langsung atau sering dikenal den...

  17. A population based study of variations in operation rates for breast cancer, of comorbidity and prognosis at diagnosis: failure to operate for early breast cancer in older women. (United States)

    Bates, T; Evans, T; Lagord, C; Monypenny, I; Kearins, O; Lawrence, G


    Older women are less likely to have surgery for operable breast cancer. This population-based study examines operation rates by age and identifies groups which present with early or late disease. 37 000 cancer registrations for 2007 were combined with Hospital Episode Statistics comorbidity data for England. Operation rates were examined by age, ethnicity, deprivation, comorbidity, screen-detection, tumour size, grade and nodal status. Early and late presentation were correlated with Nottingham Prognostic Index (NPI) groups and tumour size. The proportion of women not having surgery increased from 7-10% at ages 35-69 to 82% from age 90. From age 70, the proportion not having surgery rose by an average of 3.1% per year of age. Women with a Charlson Comorbidity Index score of ≥1 (which increased with age), with tumours >50 mm or who were node positive, were less likely to have surgery. Although women aged 70-79 were more likely to have larger tumours, their tumours were also more likely to have an excellent or good NPI (p women aged 0-39, the deprived and certain ethnic groups (p breast cancer. Younger women and certain ethnic groups presented with more advanced tumours. Older women had larger tumours which were otherwise of good prognosis, and this would not account for the failure to operate which may in part be related to comorbidity in this age group. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. A self-adaptive toll rate algorithm for high occupancy toll (HOT) lane operations. (United States)


    Dramatically increasing travel demands and insufficient traffic facility supplies have resulted in severe : traffic congestion. High Occupancy Toll (HOT) lane operations have been proposed as one of the most : applicable and cost-effective countermea...

  19. Revised Total Coliform Rule Assessments and Corrective Actions (United States)

    EPA has developed the Revised Total Coliform Rule Assessment and Corrective Actions Guidance Manual for public water systems (e.g., owners and operators) to assist in complying with the requirements of the Revised Total Coliform Rule.

  20. Influence of the experience of operator and assistant on the survival rate of proximal ART restorations: two-year results

    NARCIS (Netherlands)

    Kemoli, A.M.; van Amerongen, W.E.; Opinya, G.


    AIM: The objective of the study was to determine the influence of the experience of the operator and the assistant on the survival rate of proximal ART- restorations after 2 years when placed using two methods of tooth-isolation and three glass ionomer cement-brands. STUDY DESIGN: A clinical

  1. Off-Gas Generation Rate during Chemical Cleaning Operations at the Savannah River Site - 12499

    Energy Technology Data Exchange (ETDEWEB)

    Wiersma, Bruce J. [Savannah River National Laboratory, Aiken, SC 29808 (United States); Subramanian, Karthik H.; Ketusky, Edward T. [Savannah River Remediation, Aiken, SC 29808 (United States)


    The enhanced chemical cleaning process (ECC) is being developed at the Savannah River Site (SRS) to remove the residual radioactive sludge heel that remains in a liquid waste storage tank. Oxalic acid is the chemical agent utilized for this purpose. However, the acid also corrodes the carbon steel tank wall and cooling coils. If the oxalic acid has little interaction with the sludge, hydrogen gas could conceivably evolve at cathodic areas due to the corrosion of the carbon steel. Scenarios where hydrogen evolution could occur during ECC include the initial filling of the tank prior to agitation and near the end of the process when there is little or no sludge present. The purpose of this activity was to provide a bounding estimate for the hydrogen generation rate during the ECC process. Sealed vessel coupon tests were performed to estimate the hydrogen generation rate due to corrosion of carbon steel by oxalic acid. These tests determined the maximum instantaneous hydrogen generation rate, the rate at which the generation rate decays, and the total hydrogen generated. The tests were performed with polished ASTM A285 Grade C carbon steel coupons. This steel is representative of the Type I and II waste tanks at SRS. Bounding conditions were determined for the solution environment. The oxalic acid concentration was 2.5 wt.% and the test temperature was 75 deg. C. The test solution was agitated and contained no sludge simulant. Duplicate tests were performed and showed excellent reproducibility for the hydrogen generation rate and total hydrogen generated. The results showed that the hydrogen generation rate was initially high, but decayed rapidly within a couple of days. A statistical model was developed to predict the instantaneous hydrogen generation rate as a function of exposure time by combining both sets of data. An upper bound on the maximum hydrogen generation rate was determined from the upper 95% confidence limit. The upper bound limit on the maximum

  2. Primary and revision lumbar discectomy: A three-year review from one center

    Directory of Open Access Journals (Sweden)

    Acharya K


    Full Text Available Background: Despite variations in technique, the results of primary and revision lumbar discectomy have been good. The aim of this study was to retrospectively review cases of primary and revision lumbar discectomy performed in our institute over a three-year period. Materials and Methods: The case records of 273 patients who underwent lumbar discectomy between January 2001-2004 and fulfilled our inclusion and exclusion criteria were reviewed. Of these, 259 were primary discectomies and 14 were revision surgeries. Recurrence was defined as ipsilateral disc herniation at the previously operated level. Demographic parameters, magnetic resonance imaging of the disc, patient satisfaction and rate of recurrence were analyzed. Results: The primary surgery group had 52 (20.08% contained and 207 (79.92% extruded or sequestered discs, while the numbers in the revision group were three (21.43% and 11 (78.57% respectively. "Satisfactory" outcome was noted in 96.5% of the primary surgeries, with a recurrence rate of 3.5%. In the revision group 78.6% had "satisfactory" outcome. In 9.4% of the primary group we encountered complications, while it was 21.43% in the revision group. Conclusions: Lumbar discectomy is a safe, simple and effective procedure with satisfactory outcome in 96.5% of primary disc surgery and 78.6% of revision disc surgery.

  3. Innovative Test Operations to Support Orion and Future Human Rated Missions (United States)

    Koenig, William J.; Garcia, Rafael; Harris, Richard F.; See, Michael J.; Van Lear, Benjamin S.; Dobson, Jill M.; Norris, Scott Douglas


    This paper describes how the Orion program is implementing new and innovative test approaches and strategies in an evolving development environment. The early flight test spacecraft are evolving in design maturity and complexity requiring significant changes in the ground test operations for each mission. The testing approach for EM-2 is planned to validate innovative Orion production acceptance testing methods to support human exploration missions in the future. Manufacturing and testing at Kennedy Space Center in the Neil Armstrong Operations and Checkout facility will provide a seamless transition directly to the launch site avoiding transportation and checkout of the spacecraft from other locations.

  4. The effects of operational conditions on the respiration rate of Tubificidae.

    Directory of Open Access Journals (Sweden)

    Juqing Lou

    Full Text Available Tubificidae is often used in the wastewater treatment systems to minimize the sludge production because it can be fed on the activated sludge. The process conditions have effect on the growth, reproduction, and sludge reduction efficiency of Tubificidae. The effects of the water quality, density of worms, pH, temperature and dissolved oxygen (DO concentration on the respiration rate of Tubificidae were investigated to determine the optimal conditions for the growth and metabolism of the worms and reveal the mechanisms involving the efficient sludge reduction in terms of these conditions. It was observed that the respiration rate was highest in the water discharged from an ecosystem that included symbiotic Tubificidae and microbes and was lowest in distilled water. Considering density of the worms, the highest rate was 81.72±5.12 mg O2/g(dry weight·h·L with 0.25 g (wet weight of worms in 1 L test flask. The maximum Tubificidae respiration rate was observed at a pH of 8.0±0.05, a rate that was more than twice as high as those observed at other pH values. The respiration rate increased in the temperature range of ∼8°C-22°C, whereas the rate declined in the temperature range of ∼22°C-30°C. The respiration rate of Tubificidae was very high for DO range of ∼3.5-4.5 mg/L, and the rates were relatively low for out of this DO range. The results of this study revealed the process conditions which influenced the growth, and reproduction of Tubificidae and sludge reduction at a microscopic level, which could be a theoretical basis for the cultivation and application of Tubificidae in wastewater treatment plants.

  5. On the optimal determination of differential rates in the presence of higher-dimensional operators

    CERN Document Server

    Fichet, Sylvain; Rebello Teles, Patricia


    When the Standard Model is interpreted as the renormalizable sector of a low-energy effective theory, the effects of new physics are encoded into a set of higher-dimensional operators. These operators potentially deform the shapes of Standard Model differential distributions of final states observable at colliders. We describe a simple and systematic method to obtain optimal estimations of these deformations when using numerical tools, like Monte Carlo simulations. A crucial aspect of this method is minimization of the estimation uncertainty: we demonstrate how the operator coefficients have to be set in the simulations in order to get optimal results. The uncertainty on the interference term turns out to be the most difficult to control and grows very quickly when the interference is suppressed. We exemplify our method by computing the deformations induced by the ${\\cal O}_{3W}$ operator in $W^+W^-$ production at the LHC, and by deriving a bound on ${\\cal O}_{3W}$ using 8 TeV CMS data.

  6. 77 FR 33971 - Non-Vessel-Operating Common Carriers Negotiated Rate Arrangements; Tariff Filing Exemption (United States)


    ... to rates; eliminating the requirement that the bill of lading include a notice that a shipment is... Commission published a correction to its final rule clarifying that NRAs must be agreed to prior to receipt...

  7. 77 FR 28451 - Unsatisfactory Safety Rating; Revocation of Operating Authority Registration; Technical Amendments (United States)


    ..., (d)2, making a grammatical correction so that the singular word ``Material'' is plural; and (5) in 49... FMCSA has committed an error in assigning its proposed or final safety rating in accordance with Sec...

  8. Efficient quantum repeater with respect to both entanglement-concentration rate and complexity of local operations and classical communication (United States)

    Su, Zhaofeng; Guan, Ji; Li, Lvzhou


    Quantum entanglement is an indispensable resource for many significant quantum information processing tasks. However, in practice, it is difficult to distribute quantum entanglement over a long distance, due to the absorption and noise in quantum channels. A solution to this challenge is a quantum repeater, which can extend the distance of entanglement distribution. In this scheme, the time consumption of classical communication and local operations takes an important place with respect to time efficiency. Motivated by this observation, we consider a basic quantum repeater scheme that focuses on not only the optimal rate of entanglement concentration but also the complexity of local operations and classical communication. First, we consider the case where two different two-qubit pure states are initially distributed in the scenario. We construct a protocol with the optimal entanglement-concentration rate and less consumption of local operations and classical communication. We also find a criterion for the projective measurements to achieve the optimal probability of creating a maximally entangled state between the two ends. Second, we consider the case in which two general pure states are prepared and general measurements are allowed. We get an upper bound on the probability for a successful measurement operation to produce a maximally entangled state without any further local operations.

  9. Circumcision revision in male children

    Directory of Open Access Journals (Sweden)

    Mohammed A. Al-Ghazo


    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.

  10. Uroflowmetric changes, success rate and complications following Tension-free Vaginal Tape Obturator (TVT-O) operation in obese females. (United States)

    Fouad, Reham; El-Faissal, Yahia M; Hashem, Ahmed T; Gad Allah, Sherine H


    The goal of this study was to evaluate the outcome of Tension-free Vaginal Tape Obturator (TVT-O) operation in the treatment of urodynamic stress incontinence (USI) in obese females, with respect to uroflowmetric changes, success rate and postoperative complications. This prospective observational study included 26 patients with USI at the Obstetrics & Gynecology department-Cairo University hospital during the year 2015. The participants had body mass index (BMI)≥30. Patients underwent TVT-O operation. Follow up of the patients was performed by cough test and uroflowmetry after one week, one month, three months and six months. Postoperative complications such as groin pain, sense of incomplete emptying, need to strain to complete micturition and urinary tract infection were recorded. Comparisons between groups were done using Chi square, Phi-Cramer test for categorical variables. The mean age for the subjects was 43.58±9.01years. The mean BMI was 33.4±2.1. The success rate of TVT-O operation was 21 out of 26 patients (≈81%). Normal maximum flow rate was in 88% of patients at week one and was normal in 100% of patients at months three and six (p=0.101 & 0.101). Postoperative groin pain was the main complaint during the first week after operation and decreased significantly from week one to the 1st month postoperative (84.62% & 65.38%, P=0.041). TVT-O operation showed a high success rate in treatment of USI in obese patients without affecting the voiding function of the bladder as proven by the uroflowmetry. The main postoperative complaint was the groin pain which significantly improved after one month. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. The rate of acquisition of formal operational schemata in adolescence: A secondary analysis (United States)

    Eckstein, Shulamith G.; Shemesh, Michal

    A theoretical model of cognitive development is applied to the study of the acquisition of formal operational schemata by adolescents. The model predicts that the proportion of adolescents who have not yet acquired the ability to perform a a specific Piagetian-like task is an exponentially decreasing function of age. The model has been used to analyze the data of two large-scale studies performed in the United States and in Israel. The functional dependence upon age was found to be the same in both countries for tasks which are used to assess the following formal operations: proportional reasoning, probabilistic reasoning, correlations, and combinatorial analysis. Different functional dependence was found for tasks assessing conservation, control of variables, and prepositional logic. These results give support to the unity hypothesis of cognitive development, that is, the hypothesis that the various schemata of formal thought appear simultaneously.

  12. A Compilation of Data on Rates of Advance in Land Combat Operations (United States)


    Encyclopedia of Military History: From 3500 B.C. to the Present b. Author: Dupuy, R. Ernest and Trevor N. Dupuy c. Date: 1970 d. Organization: Harper & Row...Title: Encyclopedia of Military History: From 3500 B.C. to the Present b. Author: Dupuy, R. Ernest and Trevor N. Dupuy c. Date: 1970 d. Organization...Organization: Encyclopaedia Brittanica, Inc., Helen Hemingway Benton, Publisher, Chicago, IL 2. Notes: The Pony Express operated from April 1S60 to

  13. Private and Commercial Pilot: Ligher-Than-Air Airship. Flight Test Guide. (Part 61 Revised). (United States)

    Federal Aviation Administration (DOT), Washington, DC. Flight Standards Service.

    The flight test guide assists the applicant and his instructor in preparing for the flight test for the Private or Commercial Pilot Certificate with a Lighter-Than-Air Category and Airship Class Rating under Part 61 (revised) of Federal Aviation Regulations. It contains information and guidance concerning pilot operations, procedures, and…

  14. Private and Commercial Pilot: Gyroplane. Flight Test Guide, Part 61 Revised 1973, AC 61-60. (United States)

    Federal Aviation Administration (DOT), Washington, DC. Flight Standards Service.

    This flight test guide assists the applicant and his instructor in preparing for the Private or Commercial Pilot Rotocraft Certificate with Gyroplane Rating under Part 61 (revised) of Federal Aviation Regulations. It contains information concerning pilot operations, procedures, and maneuvers relevant to the flight test required for these…

  15. Private and Commercial Pilot: Glider. Flight Test Guide, Part 61 Revised, AC 61-61. (United States)

    Federal Aviation Administration (DOT), Washington, DC. Flight Standards Service.

    This flight test guide assists the applicant and his instructor in preparing for the Private or Commercial Pilot Certificate with Glider Rating under Part 61 (revised) of Federal Aviation Regulations. It contains information and guidance concerning the pilot operations, procedures, and maneuvers relevant to the flight test required for that…

  16. Commercial Pilot; Airplane. Flight Test Guide, Part 61 Revised, AC 61-55. (United States)

    Federal Aviation Administration (DOT), Washington, DC. Flight Standards Service.

    This flight test guide assists the applicant and his instructor in preparing for the Commercial Pilot Certificate with Airplane Rating under Part 61 (revised) of Federal Aviation Regulations. It contains information concerning pilot operations, procedures, and maneuvers relevant to the flight test required for the certificate. Preflight duties,…

  17. Private and Commercial Pilot; Heliocoptor. Flight Test Guide, Part 61 Revised, AC 61-59. (United States)

    Federal Aviation Administration (DOT), Washington, DC. Flight Standards Service.

    This flight test guide assists the applicant and his instructor in preparing for the Private or Commercial Pilot Rotocraft Certificate with Helicopter Rating under Part 61 (revised) of Federal Aviation Regulations. It contains information and guidance concerning the pilot operations, procedures, and maneuvers relevant to the flight test required…

  18. 78 FR 10579 - TRICARE Revision to CHAMPUS DRG-Based Payment System, Pricing of Hospital Claims (United States)


    ... the beneficiary's discharge by the hospital, but using the rules, weights, and rates that were in... used to reimburse hospitals at that time. For patients admitted after implementation of the DRG-based... the hospital was an effective operational policy for TRICARE. It is now time, however, to revise this...

  19. Examination of Factors that Influence the Operation Income and Expenditure Balance Difference Rate of 20 Educational Foundation Universities. (United States)

    Nakajima, Hisato; Yano, Kouya; Nagasawa, Kaoko; Katou, Satoka; Yokota, Kuninobu


    The objective of this study is to examine the factors that influence the operation income and expenditure balance ratio of school corporations running university hospitals by multiple regression analysis. 1. We conducted cluster analysis of the financial ratio and classified the school corporations into those running colleges and universities.2. We conducted multiple regression analysis using the operation income and expenditure balance ratio of the colleges as the variables and the Diagnosis Procedure Combination data as the explaining variables.3. The predictive expression was used for multiple regression analysis. 1. The school corporations were divided into those running universities (7), colleges (20) and others. The medical income ratio and the debt ratio were high and the student payment ratio was low in the colleges.2. The numbers of emergency care hospitalizations, operations, radiation therapies, and ambulance conveyances, and the complexity index had a positive influence on the operation income and expenditure balance ratio. On the other hand, the number of general anesthesia procedures, the cover rate index, and the emergency care index had a negative influence.3. The predictive expression was as follows.Operation income and expenditure balance ratio = 0.027 × number of emergency care hospitalizations + 0.005 × number of operations + 0.019 × number of radiation therapies + 0.007 × number of ambulance conveyances - 0.003 × number of general anesthesia procedures + 648.344 × complexity index - 5877.210 × cover rate index - 2746.415 × emergency care index - 38.647Conclusion: In colleges, the number of emergency care hospitalizations, the number of operations, the number of radiation therapies, and the number of ambulance conveyances and the complexity index were factors for gaining ordinary profit.

  20. How to revise a total preorder

    CSIR Research Space (South Africa)

    Booth, R


    Full Text Available determining one-step revision. But in those approaches describing a family of operators there is usually little indication of how to proceed uniquely after the first revision step. In this paper we contribute towards addressing that deficiency by providing a...


    Directory of Open Access Journals (Sweden)

    Ignat Papazov


    Full Text Available The term "currency" has different meanings but is usually defined as any means of payment that is not in local currency units. The ratio between the foreign currency and local currency units results into exchange rate. When arranging payment transactions abroad, local entities - natural and legal persons must exchange their national currency in advance for the currency of the country in which they are due or in another currency commonly accepted as an international payment. Under this regime, the national currency is quoted in relation to another currency, that is exchange rate.

  2. Effect of Increased Operational Tempo (Post 9/11) on Retention Rate of Hospital Corpsmen (United States)


    employers, including the military, are concerned with employee retention for several reasons. One of the most important reasons is that high rates of...64. 11. Gering, J. & Conner, J. (2002). A strategic approach to employee retention . Healthcare Financial Management, 56, 40-44. 12. Glaser, D.N., The

  3. 76 FR 19706 - Non-Vessel-Operating Common Carrier Negotiated Rate Arrangements; Correction (United States)


    ... rules tariff and bills of lading or equivalent shipping documents.'' By the Commission. Karen V. Gregory... correction clarifies that the negotiated rate arrangement must be agreed to prior to receipt of the cargo and... agreed to by both NRA shipper and NVOCC, prior to receipt of cargo by the common carrier or its agent...

  4. Pediatric peri-operative fractionated high-dose-rate brachytherapy for recurrent Wilms’ tumor using a reconstructed Freiburg flap

    Directory of Open Access Journals (Sweden)

    Emily Flower


    Full Text Available Purpose : To report peri-operative fractionated high-dose-rate (HDR brachytherapy with a 3D customized Freiburg flap applicator to treat locally recurrent Wilms’ tumor, followed by immediate hyperthermic intraperitoneal chemotherapy for a 16-year-old with a second recurrence of nephroblastoma (Wilms’ tumor. Material and methods: The tumor was excised and surgical bed was treated with fractionated HDR brachytherapy using a Freiburg flap applicator. Hyperthermic intraperitoneal chemotherapy was performed immediately after the removal of brachytherapy applicator. Results: The Freiburg flap was successfully reconstructed to enable delivery of conformable peri-operative HDR brachytherapy. The clinical target volume (CTV D90 was 26 Gy in 5 fractions. Conclusions : Peri-operative fractionated HDR brachytherapy with a customized Freiburg flap applicator was delivered successfully across a large multi-disciplinary team.

  5. Personnel Attrition Rates in Historical Land Combat Operations: An Annotated Bibliography (United States)


    Issus, Arbela, Jaxartes, and Hydaspes . 10. Summary of Findings Regarding Battle Casualties. States that "The wounded are mostly estimated at the usual...ersonnel, combat, attrition, battle , casualties, losses, bibliography. 472 16. PRICE CODE 17. SECURITY CLASSIFICATION IR. SECURITY CLASSIFICATION 19...20814-2797 CAA-RP-93-2 PREFACE The Personnel Attrition Rates (PAR) Study is limited to studying personnel strengths and battle casualties in historical

  6. Status of the ALICE TPC upgrade for high-rate operation

    Energy Technology Data Exchange (ETDEWEB)

    Gasik, Piotr [TU Muenchen, Physik Department E12, Excellence Cluster ' ' Universe' ' , D-85748, Garching (Germany); Collaboration: ALICE-Collaboration


    A large Time Projection Chamber (TPC) is the main device for tracking and charged particle identification in the ALICE experiment at the CERN LHC. After the second long shutdown in 2018/2019, the LHC will deliver Pb beams colliding at an interaction rate of about 50 kHz, which is about a factor of 100 above the present readout rate of the TPC. This will result in a significant improvement on the sensitivity of rare probes that are considered key observables to characterise the hot and dense QCD matter created in such collisions. In order to make full use of this luminosity, a major upgrade of the TPC is required. It is foreseen to replace the existing MWPC-based readout chambers by Gas Electron Multiplier (GEM) detectors to overcome the rate limitations imposed by the present gated readout scheme. An extensive R and D program has been launched to reach the challenging requirements of the upcoming upgrade of the detector. In this presentation the most recent results are discussed concerning ion backflow suppression, gain stability, energy and dE/dx resolution and stability against discharges. The status of the upgrade of the online calibration and data reduction system, which includes advanced techniques for online corrections of space-charge distortions, as well as the development of a new readout electronics are reported.

  7. Analysis of the patient occupancy rate (BOR), operational cost budget and activity ratio on financial performance based on income capability of PNBP covering operational cost of public service agency (BLU) of DKI Jakarta provincial hospital.


    Putri, Istiqomah Dwi; Fauzi, Achmad


    The purpose of this research is to know  the influence of activity, operational cost budgeting, and bed occupancy rate on financial performance based on ability of (PNBP) revenue  to cover operating cost public service agency hospital. This study aims to determine the effect of patient occupancy rate (BOR), operational budget and activities of financial performance is based on the ability of non-tax revenue to cover operating costs hospital public service agencies in the province of...

  8. Analysis of the patient occupancy rate (BOR), operational cost budget and activity ratio on financial performance based on income capability of PNBP covering operational cost of public service agency (BLU) of DKI Jakarta provincial hospital.


    Istiqomah Dwi Putri; Achmad Fauzi


    The purpose of this research is to know the influence of activity, operational cost budgeting, and bed occupancy rate on financial performance based on ability of (PNBP) revenue to cover operating cost public service agency hospital. This study aims to determine the effect of patient occupancy rate (BOR), operational budget and activities of financial performance is based on the ability of non-tax revenue to cover operating costs hospital public service agencies in the province of Jakarta p...

  9. Evaluation of economic and technical efficiency of diesel engines operation on the basis of volume combustion rate

    Directory of Open Access Journals (Sweden)

    І. О. Берестовой


    Full Text Available The article deals with a new approach to evaluation of complex efficiency of diesel engines. Traditionally, cylinder’s capacity, rotation frequency, average efficient pressure inside cylinder, piston’s stroke, average piston’s velocity, fuel specific consumption and other indices are used as generalizing criteria, characterizing diesel engine’s efficiency, but they do not reflect interrelation between engine’s complex efficiency and a set of economic, mass-dimensional, operational and ecological efficiency. The approach applied in the article makes it possible to reveal the existing and modify the existing methods of solving the problem of improving diesel engine’s efficiency with due regard to interrelation of the parameters, characterizing efficiency of their operation. Statistic analyses were carried out, on the basis of which an assumption regarding the existence of interrelation between specific fuel consumption and the analyzed engine’s parameters was made. Processing of statistical data for various analyzed functions of diesel engines helped offer a function, illustrating the link between volume combustion rate, piston’s area and nominal theoretical specific fuel consumption. Interrelation between volume combustion rate, nominal parameters of diesel operation and efficiency indices, obtained by processing statistical data of more than 500 models of diesels of different series was evaluated, the main feature of it being a mathematical trend. The analysis of the obtained function makes it possible to establish an interrelation between economic efficiency of a diesel, its main index being specific fuel consumption and volume combustion rate and design peculiarities

  10. Hospitalization rates and post-operative mortality for abdominal aortic aneurysm in Italy over the period 2000-2011.

    Directory of Open Access Journals (Sweden)

    Luigi Sensi

    Full Text Available BACKGROUND: Recent studies have reported declines in incidence, prevalence and mortality for abdominal aortic aneurysms (AAAs in various countries, but evidence from Mediterranean countries is lacking. The aim of this study is to examine the trend of hospitalization and post-operative mortality rates for AAAs in Italy during the period 2000-2011, taking into account the introduction of endovascular aneurysm repair (EVAR in 1990s. METHODS: This retrospective cohort study was carried out in Emilia-Romagna, an Italian region with 4.5 million inhabitants. A total of 19,673 patients hospitalized for AAAs between 2000 and 2011, were identified from the hospital discharge records (HDR database. Hospitalization rates, percentage of OSR and EVAR and 30-day mortality rates were calculated for unruptured (uAAAs and ruptured AAAs (rAAAs. RESULTS: Adjusted hospitalization rates decreased on average by 2.9% per year for uAAAs and 3.2% for rAAAs (p<0.001. The temporal trend of 30-day mortality rates remained stable for both groups. The percentage of EVAR for uAAAs increased significantly from 2006 to 2011 (42.7 versus 60.9% respectively, mean change of 3.9% per year, p<0.001. No significant difference in mortality was found between OSR and EVAR for uAAAs and rAAAs. CONCLUSIONS: The incidence and trend of hospitalization rates for rAAAs and uAAAs decreased significantly in the last decade, while 30-day mortality rates in operated patients remained stable. OSR continued to be the most common surgery in rAAAs, although the gap between OSR and EVAR recently declined. The EVAR technique became the preferred surgery for uAAAs since 2008.

  11. Operative strategy based in low rate; Estrategia operativa basada en bajo caudal

    Energy Technology Data Exchange (ETDEWEB)

    Mejia S, D.M. [ININ, 52045 Ocoyoacac, Estado de Mexico (Mexico); Torres A, C. [CFE, Mexico D.F. (Mexico)


    This work describes the possibility of the reactor operation of the unit 1 of the Laguna Verde Nuclear Power plant (CNLV) with a low flow, compared with the Cycle 10 that it was called Cycle 10 similar for this work. The main objective is to analyze the advantages or disadvantages that are obtained when going down the flow from the reactor to an interval that varies, from 81% to 106%, being a flow window but big of the one that it was used that is from 93.1% to 100.8%. It is found that making this type of changes, a favorable response is obtained, without any possibility of fault of the reactor. (Author)

  12. Operational measurements of stack flow rates in a nuclear power plant with ultrasonic anemometer

    Energy Technology Data Exchange (ETDEWEB)

    Voelz, E. [E.ON Kernkraft GmbH, Hannover (Germany); Kirtzel, H.-J. [Metek GmbH, Elmshorn (Germany); Ebenhoech, E. [Kernkraftwerk Wuergassen (Germany)


    The calculation of the impact of radio nuclides within the surroundings of nuclear power stations requires quantitative measurements of the stack emission. As a standard method, propeller anemometers have been installed inside the stack, but due to the wear and tear of the moving parts in such conventional sensors the servicing and maintenance are costly and may cause restrictions in the operation of the stack. As an alternative to propeller anemometers ultrasonic sensors have been applied which employ no moving parts and are almost free of maintenance. Furthermore, any shifts in internal calibration parameters can be identified by the sensor electronics with on-line plausibility checks. The tests have proven that ultrasonic systems are able to measure adequately and reliably the flow inside the stack. (orig.)

  13. Response Load Extrapolation for Wind Turbines during Operation Based on Average Conditional Exceedance Rates

    DEFF Research Database (Denmark)

    Toft, Henrik Stensgaard; Naess, Arvid; Saha, Nilanjan


    within a hierarchical model where the variables that influence the loading are divided into ergodic variables and time-invariant non-ergodic variables. The presented method for statistical response load extrapolation was compared with the existing methods based on peak extrapolation for the blade out-of-plane...... bending moment and the tower mudline bending moment of a pitch-controlled wind turbine. In general, the results show that the method based on average conditional exceedance rates predicts the extrapolated characteristic response loads at the individual mean wind speeds well and results in more consistent...

  14. Radiographic failure and rates of re-operation after acromioclavicular joint reconstruction: a comparison of surgical techniques. (United States)

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


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

  15. Didactic revision of the operative magnitudes system ICRU for the evaluation of the equivalent dose in radiation external fields; Revision didactica del sistema de magnitudes operativas ICRU para la evaluacion de la dosis equivalente en campos externos de radiacion

    Energy Technology Data Exchange (ETDEWEB)

    Alvarez R, J. T., E-mail: [ININ, Departamento de Metrologia de Radiaciones Ionizantes, Carretera Mexico-Toluca s/n, 52750 Ocoyoacac, Estado de Mexico (Mexico)


    In this work is presented in a didactic way the operative magnitudes system ICRU, showing as these magnitudes carry out an appropriate estimate of the effective equivalent doses H{sub E} and the effective dose. The objective is to present the basic concepts of the dosimetry for radiation external fields with purposes of radiological protection, because the assimilation lack and technological development of this dosimetric magnitudes system has persisted for near 50 years, in terms of practice of the radiological protection in Mexico. Also, this system is an essential part of safety basic standards of the IAEA and ICRP recommendations 26, 60, 74 and 103, as well as of the ICRU 25, 39, 43, 51 and 57. (Author)

  16. Operative correction of judoists’ training loads on the base of on-line monitoring of heart beats rate

    Directory of Open Access Journals (Sweden)

    Liu Yong Qiang


    Full Text Available Purpose: ensure increase of effectiveness of training process’s control by means of operative correction of training loads of different qualification judo wrestlers’ heart beats rate indicators. Material: the research was conducted on the base of Brest SCJSOR № 1. Judo wrestlers of different sport qualification (age 17-19 years old, n=15 participated in the research. Monitoring of judo wrestlers’ heart beats rate was carried out with the help of system “Polar”. Results: we have found factorial structure of functional fitness in every profile of sportsmen. Model characteristics of judo wrestlers were supplemented with the most important sides of functional fitness. Analysis of indicators of restoration effectiveness indicators (REI in both groups of judo wrestlers showed high level of organism’s responsiveness to training load of special and power orientation in comparison with speed power load. We have worked out algorithm of operative correction of training loads by indicators of heart beats rate in training process, depending on orientation and intensity of loads’ physiological influence on judo wrestler. Conclusions: Telemetric on-line monitoring of sportsman’s heart beats rate and calculation of REI permit to objectively assess effectiveness of training’s construction and of micro-cycle in total and detect in due time the trend to development of over-loading and failure of adaptation.

  17. Overseas Contingency Operations: OMB and DOD Should Revise the Criteria for Determining Eligible Costs and Identify the Costs Likely to Endure Long Term (United States)


    Component personnel mobilized to support war missions. Special Operations Command Operations and equipment that meet the criteria in this guidance...GAO Reports and Testimony Order by Phone Connect with GAO To Report Fraud, Waste, and Abuse in Federal Programs Congressional Relations...Public Affairs Strategic Planning and External Liaison Please Print on Recycled Paper.

  18. High rate partial-state-of-charge operation of VRLA batteries (United States)

    Moseley, Patrick T.

    The world market for 12 V SLI batteries currently stands at around US$ 12 billion. The lack of a serious challenge from other battery types has allowed lead-acid products to serve this market exclusively, with minimal demand for product improvement through research and development, and a sharp competition has, over time, cut sales prices to commodity levels. The electrochemical storage of energy in automobiles now faces the possibility of a major change, in the form of the proposed 36/42 V electrical systems for vehicles that remain primarily powered by internal combustion engines, and of the hybrid electric vehicle. The duty cycle for these two applications sees the battery held at a partial-state-of-charge (PSoC) for most of its life and required to supply, and to accept, charge at unprecedented rates. The remarkable advances achieved with VRLA battery technology for electric vehicles during the past 8-10 years will be of only passing value in overcoming the challenges posed by high rate PSoC service in 36/42 V and HEV duty. This is because the failure modes seen in PSoC are quite different from those faced in EV (deep cycle) use. The replacement of the 12 V SLI will not take place rapidly. However, if the applications which take its place are to be satisfied by a lead-acid product (probably VRLA), rather than by a battery of a different chemistry, a program of development as successful as that mounted for deep cycle duty will be required. The present phase of the Advanced Lead-Acid Battery Consortium (ALABC) R&D program has begun to shed light on those aspects of the function of a VRLA battery which currently limit its life in high rate PSoC duty. The program is also pursuing the several technologies which show promise of overcoming those limits, including multiple tab plate design, mass transport facilitation and minor component (both beneficial and detrimental impurity) management. This paper presents a brief review of the changes which are taking place in

  19. Injury rates on new and old technology oil and gas rigs operated by the largest United States onshore drilling contractor. (United States)

    Blackley, David J; Retzer, Kyla D; Hubler, Warren G; Hill, Ryan D; Laney, A Scott


    Occupational fatality rates among oil and gas extraction industry and specifically among drilling contractor workers are high compared to the U.S. all-industry average. There is scant literature focused on non-fatal injuries among drilling contractors, some of which have introduced engineering controls to improve rig efficiency and reduce injury risk. We compared injury rates on new and old technology rigs operated by the largest U.S. drilling contractor during 2003-2012, stratifying by job type and grouping outcomes by injury severity and body part affected. Six hundred seventy-one injuries were recorded over 77.4 million person-hours. The rate on new rigs was 66% of that on old rigs. Roughnecks had lower injury rates on new rigs, largely through reduced limb injury rates. New rigs had lower rates in each non-fatal injury severity category. For this company, new technology rigs appear to provide a safer environment for roughnecks. Future studies could include data from additional companies. © 2014 Wiley Periodicals, Inc.

  20. Injury Rates on New and Old Technology Oil and Gas Rigs Operated by the Largest United States Onshore Drilling Contractor (United States)

    Blackley, David J.; Retzer, Kyla D.; Hubler, Warren G.; Hill, Ryan D.; Laney, A. Scott


    Background Occupational fatality rates among oil and gas extraction industry and specifically among drilling contractor workers are high compared to the U.S. all-industry average. There is scant literature focused on non-fatal injuries among drilling contractors, some of which have introduced engineering controls to improve rig efficiency and reduce injury risk. Methods We compared injury rates on new and old technology rigs operated by the largest U.S. drilling contractor during 2003–2012, stratifying by job type and grouping outcomes by injury severity and body part affected. Results Six hundred seventy-one injuries were recorded over 77.4 million person-hours. The rate on new rigs was 66% of that on old rigs. Roughnecks had lower injury rates on new rigs, largely through reduced limb injury rates. New rigs had lower rates in each non-fatal injury severity category. Conclusions For this company, new technology rigs appear to provide a safer environment for roughnecks. Future studies could include data from additional companies. PMID:25164118

  1. Technology and operational considerations for low-heat-rate trajectories. [of future winged earth reentry vehicles (United States)

    Wurster, K. E.; Eldred, C. H.


    A broad parametric study which examines several critical aspects of low-heat-rate entry trajectories is performed. Low planform loadings associated with future winged earth-entry vehicles coupled with the potential application of metallic thermal protection systems (TPS) suggest that such trajectories are of particular interest. Studied are three heating conditions - reference, stagnation, and windward centerline, for both laminar and turbulent flow; configuration-related factors including planform loading and hypersonic angle of attack; and mission-related factors such as cross-range and orbit inclination. Results indicate benefits in the design of TPS to be gained by utilizing moderate angles of attack as opposed to high-lift coefficient, high angles of attack, during entry. An assessment of design and technology implications is made.

  2. Characterization of gaseous pollutant and particulate matter emission rates from a commercial broiler operation part I: Observed trends in emissions (United States)

    Roumeliotis, Taylor S.; Dixon, Brad J.; Van Heyst, Bill J.


    This paper characterizes the emission rates of size fractionated particulate matter, inorganic aerosols, acid gases, ammonia and methane measured over four flocks at a commercial broiler chicken facility. Mean emission rates of each pollutant, along with sampling notes, were reported in this paper, the first in a series of two. Sampling notes were needed because inherent gaps in data may bias the mean emission rates. The mean emission rates of PM 10 and PM 2.5 were 5.0 and 0.78 g day -1 [Animal Unit, AU] -1, respectively, while inorganic aerosols mean emission rates ranged from 0.15 to 0.46 g day -1 AU -1 depending on the season. The average total acid gas emission rate was 0.43 g day -1 AU -1 with the greatest contribution from nitrous and nitric acids and little contribution from sulfuric acid (as SO 2). Ammonia emissions were seasonally dependent, with a mean emission rate of 66.0 g day -1 AU -1 in the cooler seasons and 94.5 g day -1 AU -1 during the warmer seasons. Methane emissions were relatively consistent with a mean emission rate of 208 g day -1 AU -1. The diurnal pattern in each pollutant's emission rate was relatively consistent after normalizing the hourly emissions according to each daily mean emission rate. Over the duration of a production cycle, all the measured pollutants' emissions increased proportionally to the total live mass of birds in the house, with the exception of ammonia. Interrelationships between pollutants provide evidence of mutually dependent release mechanisms, which suggests that it may be possible to fill data gaps with minimal data requirements. In the second paper (Roumeliotis, T.S., Dixon, B.J., Van Heyst, B.J. Characterization of gaseous pollutants and particulate matter emission rates from a commercial broiler operation part II: correlated emission rates. Atmospheric Environment, 2010.), regression correlations are developed to estimate daily mean emission rates for data gaps and, using the normalized hourly diurnal

  3. Operative treatment of calcaneal fractures: improved outcomes and low complications rates with a strict management protocol. (United States)

    Vasukutty, N; Kumar, V; Diab, M; Moussa, W


    This is a retrospective review of 80 intra-articular calcaneal fractures treated with open reduction and internal fixation by a specialist team under supervision of a single surgeon in a tertiary centre between 2005 and 2014. The fractures were evaluated with plain radiography and computed tomography, and graded using the Eastwood-Atkins classification. A lateral approach was used and all fractures were fixed with calcaneal plates. All patients had clinical and radiological follow-up. Clinical assessment included foot and ankle disability index, SF-36 ® and Kerr-Atkins scores. The mean follow-up duration was 72 months (range: 12-130 months). The mean age of patients was 49 years (range: 17-73 years). There were three open fractures and eight patients had other injuries. The mean Bohler's angle improved from 6° preoperatively to 26° postoperatively. The mean foot and ankle disability index score was 78.62, the mean SF-36 ® scores were 45.5 (physical component) and 52.6 (mental component), and the mean Kerr-Atkins score was 72 (range: 36-100). Early complications included one case of screw protrusion in the subtalar joint (which warranted a repeat procedure), one sural nerve injury and one wound breakdown, which healed with non-operative measures. Twelve patients had symptomatic subtalar joint osteoarthritis. Four of these had subtalar fusion. We believe that our strict protocols of patient selection, intraoperative and postoperative management produced long-term results comparable with those in the peer reviewed literature.

  4. Dose optimization of intra-operative high dose rate interstitial brachytherapy implants for soft tissue sarcoma

    Directory of Open Access Journals (Sweden)

    Jamema Swamidas


    Full Text Available Objective : A three dimensional (3D image-based dosimetric study to quantitatively compare geometric vs. dose-point optimization in combination with graphical optimization for interstitial brachytherapy of soft tissue sarcoma (STS. Materials and Methods : Fifteen consecutive STS patients, treated with intra-operative, interstitial Brachytherapy, were enrolled in this dosimetric study. Treatment plans were generated using dose points situated at the "central plane between the catheters", "between the catheters throughout the implanted volume", at "distances perpendicular to the implant axis" and "on the surface of the target volume" Geometrically optimized plans had dose points defined between the catheters, while dose-point optimized plans had dose points defined at a plane perpendicular to the implant axis and on the target surface. Each plan was graphically optimized and compared using dose volume indices. Results : Target coverage was suboptimal with coverage index (CI = 0.67 when dose points were defined at the central plane while it was superior when the dose points were defined at the target surface (CI=0.93. The coverage of graphically optimized plans (GrO was similar to non-GrO with dose points defined on surface or perpendicular to the implant axis. A similar pattern was noticed with conformity index (0.61 vs. 0.82. GrO were more conformal and less homogeneous compared to non-GrO. Sum index was superior for dose points defined on the surface of the target and relatively inferior for plans with dose points at other locations (1.35 vs. 1.27. Conclusions : Optimization with dose points defined away from the implant plane and on target results in superior target coverage with optimal values of other indices. GrO offer better target coverage for implants with non-uniform geometry and target volume.

  5. Recent Revisions to PVWATTS

    Energy Technology Data Exchange (ETDEWEB)

    Marion, B.; Anderberg, M.; Gray-Hann, P.


    PVWATTS is an Internet-accessible software program that allows the user to easily calculate the energy production and cost savings for grid-connected photovoltaic (PV) systems located throughout the United States. To ensure that PVWATTS continues to meet its users' needs, an online survey form was provided to users to identify areas for improvement. The results of the survey were used to prioritize improvements to PVWATTS in FY2005. PVWATTS was revised by changing the PV system specification input for system size from an AC power rating to a nameplate DC power rating; adding an input for an overall DC to AC derate factor; updating the residential electric rates; adding monthly and yearly solar radiation values for the PV array; and simplifying the user interface for Version 2.

  6. Logistics Modeling of Emplacement Rate and Duration of Operations for Generic Geologic Repository Concepts

    Energy Technology Data Exchange (ETDEWEB)

    Kalinina, Elena Arkadievna; Hardin, Ernest


    This study identified potential geologic repository concepts for disposal of spent nuclear fuel (SNF) and (2) evaluated the achievable repository waste emplacement rate and the time required to complete the disposal for these concepts. Total repository capacity is assumed to be approximately 140,000 MT of spent fuel. The results of this study provide an important input for the rough-order-of-magnitude (ROM) disposal cost analysis. The disposal concepts cover three major categories of host geologic media: crystalline or hard rock, salt, and argillaceous rock. Four waste package sizes are considered: 4PWR/9BWR; 12PWR/21BWR; 21PWR/44BWR, and dual purpose canisters (DPCs). The DPC concepts assume that the existing canisters will be sealed into disposal overpacks for direct disposal. Each concept assumes one of the following emplacement power limits for either emplacement or repository closure: 1.7 kW; 2.2 kW; 5.5 kW; 10 kW; 11.5 kW, and 18 kW.

  7. Pre-title I safety evaluation for the retrieval operations of transuranic waste drums in the Solid Waste Disposal Facility. Revision 2

    Energy Technology Data Exchange (ETDEWEB)

    Rabin, M.S.


    Phase I of the Transuranic (TRU) Waste Facility Line Item Project includes the retrieval and safe storage of the pad drums that are stored on TRU pads 2-6 in the Solid Waste Disposal Facility (SWDF). Drums containing TRU waste were placed on these pads as early as 1974. The pads, once filled, were mounded with soil. The retrieval activities will include the excavation of the soil, retrieval of the pad drums, placing the drums in overpacks (if necessary) and venting and purging the retrieved drums. Once the drums have been vented and purged, they will be transported to other pads within the SWDF or in a designated area until they are eventually treated as necessary for ultimate shipment to the Waste Isolation Pilot Plant in Carlsbad, New Mexico. This safety evaluation provides a bounding assessment of the radiological risk involved with the drum retrieval activities to the maximally exposed offsite individual and the co-located worker. The results of the analysis indicate that the risk to the maximally exposed offsite individual and the co-located worker using maximum frequencies and maximum consequences are within the acceptance criteria defined in WSRC Procedural Manual 9Q. The purpose of this evaluation is to demonstrate the incremental risk from the SWDF due to the retrieval activities for use as design input only. As design information becomes available, this evaluation can be revised to satisfy the safety analysis requirements of DOE Orders 4700 and 5480.23.

  8. C-band disk-loaded-type accelerating structure for a high acceleration gradient and high-repetition-rate operation

    Directory of Open Access Journals (Sweden)

    T. Sakurai


    Full Text Available A high-acceleration-gradient linear accelerator (LINAC for an x-ray free electron laser (XFEL offers the advantages of a short accelerator length and low construction costs. In addition, the high pulse repetition rate of the LINAC, which can drive multiple x-ray beam lines, provides additional user opportunities for experiments involving XFEL. A C-band disk-loaded-type accelerating structure was developed to achieve a high acceleration gradient of >50  MV/m and an rf-pulse repetition rate of 120 pps, which is twice as high as that of the XFEL facility, SACLA (60 pps. The structure has a quasiconstant gradient and a traveling wave type with an accelerating mode of TM01−2π/3. To reduce the surface electric fields, we employed a cross section with an ellipsoidal curvature around an iris aperture. The accelerating structure was manufactured for SACLA. High-power rf conditioning was conducted to investigate its performance. Owing to the conditioning, the acceleration gradient reached a value of more than 50.1  MV/m. The structure was operated without any serious issues at a repetition rate of 120 pps. The accelerating structures were installed in the dedicated accelerator for EUV-FEL at SACLA beam line-1. Finally, we obtained accelerated electron beams with the structures operated at an acceleration gradient of 41.4  MV/m.

  9. C -band disk-loaded-type accelerating structure for a high acceleration gradient and high-repetition-rate operation (United States)

    Sakurai, T.; Ego, H.; Inagaki, T.; Asaka, T.; Suzuki, D.; Miura, S.; Otake, Y.


    A high-acceleration-gradient linear accelerator (LINAC) for an x-ray free electron laser (XFEL) offers the advantages of a short accelerator length and low construction costs. In addition, the high pulse repetition rate of the LINAC, which can drive multiple x-ray beam lines, provides additional user opportunities for experiments involving XFEL. A C -band disk-loaded-type accelerating structure was developed to achieve a high acceleration gradient of >50 MV /m and an rf-pulse repetition rate of 120 pps, which is twice as high as that of the XFEL facility, SACLA (60 pps). The structure has a quasiconstant gradient and a traveling wave type with an accelerating mode of TM 01 -2 π /3 . To reduce the surface electric fields, we employed a cross section with an ellipsoidal curvature around an iris aperture. The accelerating structure was manufactured for SACLA. High-power rf conditioning was conducted to investigate its performance. Owing to the conditioning, the acceleration gradient reached a value of more than 50.1 MV /m . The structure was operated without any serious issues at a repetition rate of 120 pps. The accelerating structures were installed in the dedicated accelerator for EUV-FEL at SACLA beam line-1. Finally, we obtained accelerated electron beams with the structures operated at an acceleration gradient of 41.4 MV /m .

  10. Operational specification and forecasting advances for Dst, LEO thermospheric densities, and aviation radiation dose and dose rate (United States)

    Tobiska, W. Kent

    Space weather’s effects upon the near-Earth environment are due to dynamic changes in the energy transfer processes from the Sun’s photons, particles, and fields. Of the space environment domains that are affected by space weather, the magnetosphere, thermosphere, and even troposphere are key regions that are affected. Space Environment Technologies (SET) has developed and is producing innovative space weather applications. Key operational systems for providing timely information about the effects of space weather on these domains are SET’s Magnetosphere Alert and Prediction System (MAPS), LEO Alert and Prediction System (LAPS), and Automated Radiation Measurements for Aviation Safety (ARMAS) system. MAPS provides a forecast Dst index out to 6 days through the data-driven, redundant data stream Anemomilos algorithm. Anemomilos uses observational proxies for the magnitude, location, and velocity of solar ejecta events. This forecast index is used by satellite operations to characterize upcoming geomagnetic storms, for example. In addition, an ENLIL/Rice Dst prediction out to several days has also been developed and will be described. LAPS is the SET fully redundant operational system providing recent history, current epoch, and forecast solar and geomagnetic indices for use in operational versions of the JB2008 thermospheric density model. The thermospheric densities produced by that system, driven by the LAPS data, are forecast to 72-hours to provide the global mass densities for satellite operators. ARMAS is a project that has successfully demonstrated the operation of a micro dosimeter on aircraft to capture the real-time radiation environment due to Galactic Cosmic Rays and Solar Energetic Particles. The dose and dose-rates are captured on aircraft, downlinked in real-time via the Iridium satellites, processed on the ground, incorporated into the most recent NAIRAS global radiation climatology data runs, and made available to end users via the web and




  12. Real-World fuel use and gaseous emission rates for flex fuel vehicles operated on E85 versus gasoline. (United States)

    Delavarrafiee, Maryam; Frey, H Christopher


    Flex Fuel Vehicles (FFVs) typically operate on gasoline or E85, an 85%/15% volume blend of ethanol and gasoline, E85. Differences in FFV fuel use and tailpipe emission rates are quantified for E85 versus gasoline based on real-world measurements of five FFVs with a portable emissions measurement system (PEMS), supplemented chassis dynamometer data and estimates from the MOtor Vehicle Emission Simulator (MOVES) model. Because of inter-vehicle variability, an individual FFV may have higher nitrogen oxides (NO x ) or carbon monoxide (CO) emission rates on E85 versus gasoline, even though average rates are lower. Based on PEMS data, the comparison of tailpipe emission rates for E85 versus gasoline is sensitive to vehicle specific power (VSP). For example, although CO emission rates are lower for all VSP modes, they are proportionally lowest at higher VSP. Driving cycles with high power demand are more advantageous with respect to CO emissions, but less advantageous for NO x , compared. Chassis dynamometer data are available for 121 FFVs at 50,000 useful life miles. Based on the dynamometer data, the average difference in tailpipe emissions for E85 versus gasoline is -23% for NO x , -30% for CO, and no significant difference for hydrocarbons (HC). To account for both the fuel cycle and tailpipe emissions from the vehicle, a life cycle inventory was conducted. Although tailpipe NO x emissions are lower for E85 versus gasoline for FFVs and thus benefit areas where the vehicles operate, the life cycle NO x emissions are higher because the NO x emissions generated during fuel production are higher. The fuel production emissions take place typically in rural areas. Although there are not significant differences in the total hydrocarbon emissions, there are differences in HC speciation. The net effect of lower tailpipe NO x emissions and differences in HC speciation on ozone formation should be further evaluated. Implications Reported comparisons of Flex Fuel Vehicle (FFV

  13. The Padua Inventory: Do Revisions Need Revision? (United States)

    Gonner, Sascha; Ecker, Willi; Leonhart, Rainer


    The purpose of the present study was to examine the psychometric properties, factorial structure, and validity of the Padua Inventory-Washington State University Revision and of the Padua Inventory-Revised in a large sample of patients with obsessive-compulsive disorder (n = 228) and with anxiety disorders and/or depression (n = 213). The…

  14. Reanalysis of Rate Data for the Reaction CH3 + CH3 → C2H6 Using Revised Cross Sections and a Linearized Second-Order Master Equation. (United States)

    Blitz, M A; Green, N J B; Shannon, R J; Pilling, M J; Seakins, P W; Western, C M; Robertson, S H


    Rate coefficients for the CH3 + CH3 reaction, over the temperature range 300-900 K, have been corrected for errors in the absorption coefficients used in the original publication ( Slagle et al., J. Phys. Chem. 1988 , 92 , 2455 - 2462 ). These corrections necessitated the development of a detailed model of the B̃(2)A1' (3s)-X̃(2)A2″ transition in CH3 and its validation against both low temperature and high temperature experimental absorption cross sections. A master equation (ME) model was developed, using a local linearization of the second-order decay, which allows the use of standard matrix diagonalization methods for the determination of the rate coefficients for CH3 + CH3. The ME model utilized inverse Laplace transformation to link the microcanonical rate constants for dissociation of C2H6 to the limiting high pressure rate coefficient for association, k∞(T); it was used to fit the experimental rate coefficients using the Levenberg-Marquardt algorithm to minimize χ(2) calculated from the differences between experimental and calculated rate coefficients. Parameters for both k∞(T) and for energy transfer ⟨ΔE⟩down(T) were varied and optimized in the fitting procedure. A wide range of experimental data were fitted, covering the temperature range 300-2000 K. A high pressure limit of k∞(T) = 5.76 × 10(-11)(T/298 K)(-0.34) cm(3) molecule(-1) s(-1) was obtained, which agrees well with the best available theoretical expression.

  15. Hip revision arthroplasty for failed osteosynthesis in periprosthetic Vancouver type B1 fractures using a cementless, modular, tapered revision stem. (United States)

    Fink, B; Oremek, D


    To evaluate the hypothesis that failed osteosynthesis of periprosthetic Vancouver type B1 fractures can be treated successfully with stem revision using a transfemoral approach and a cementless, modular, tapered revision stem with reproducible rates of fracture healing, stability of the revision stem, and clinically good results. A total of 14 patients (11 women, three men) with a mean age of 72.4 years (65 to 90) undergoing revision hip arthroplasty after failed osteosynthesis of periprosthetic fractures of Vancouver type B1 were treated using a transfemoral approach to remove the well-fixed stem before insertion of a modular, fluted titanium stem which obtained distal fixation. These patients were clinically and radiologically followed up for a mean 52.2 months (24 to 144). After a mean of 15.5 weeks (standard deviation (sd) 5.7) all fractures had healed. No stems subsided and bony-ingrowth fixation had occurred according to the classification of Engh et al. The mean Harris Hip Score increased from a pre-operative score of 22.2 points (sd 9.7) to 81.5 points (sd 16.8) 24 months post-operatively. All hips had obtained an excellent result according to the classification of Beals and Tower. The technique described here for stem revision provides reproducibly good results in the treatment of failed osteosynthesis for Vancouver types B1 periprosthetic fractures of the hip. Cite this article: Bone Joint J 2017;99-B(4 Supple B):11-16. ©2017 Fink et al.

  16. RCRA and operational monitoring (ROM): Multi-year program plan and fiscal year 96 work plan. WBS 1.5.3, Revision 1

    Energy Technology Data Exchange (ETDEWEB)



    The RCRA & Operational Monitoring (ROM) Program Office manages the Hanford Site direct funded Resource Conservation and Recovery Act (RCRA) and Operational Monitoring under Work Breakdown Structure (WBS) The ROM Program Office is included in Hanford Technical Services, a part of Projects & Site Services of Westinghouse Hanford Company (WHC). The 1996 Multi-Year Program Plan (MYPP) includes the Fiscal Year Work Plan (FYWP). The Multi-Year Program Plan takes its direction from the Westinghouse Planning Baseline Integration Organization. The MYPP provides both the near term, enhanced details and the long term, projected details for the Program Office to use as baseline Cost, Scope and Schedule. Change Control administered during the fiscal year is against the baseline provided by near term details of this document. The MYPP process has been developed by WHC to meet its internal planning and integration needs and complies with the requirements of the US Department of Energy, Richland Operations Office (RL) Long Range Planning Process Directive (RLID 5000.2). Westinghouse Hanford Company (WHC) has developed the multi-year planning process for programs to establish the technical, schedule and cost baselines for program and support activities under WHC`s scope of responsibility. The baseline information is developed by both WHC indirect funded support services organization, and direct funded programs in WHC. WHC Planning and Integration utilizes the information presented in the program specific MYPP and the Program Master Baseline Schedule (PMBS) to develop the Site-Wide Integrated Schedule.

  17. Rates and causes of accidents for general aviation aircraft operating in a mountainous and high elevation terrain environment. (United States)

    Aguiar, Marisa; Stolzer, Alan; Boyd, Douglas D


    Flying over mountainous and/or high elevation terrain is challenging due to rapidly changeable visibility, gusty/rotor winds and downdrafts and the necessity of terrain avoidance. Herein, general aviation accident rates and mishap cause/factors were determined (2001-2014) for a geographical region characterized by such terrain. Accidents in single piston engine-powered aircraft for states west of the US continental divide characterized by mountainous terrain and/or high elevation (MEHET) were identified from the NTSB database. MEHET-related-mishaps were defined as satisfying any one, or more, criteria (controlled flight into terrain/obstacles (CFIT), downdrafts, mountain obscuration, wind-shear, gusting winds, whiteout, instrument meteorological conditions; density altitude, dust-devil) cited as factors/causal in the NTSB report. Statistics employed Poisson distribution and contingency tables. Although the MEHET-related accident rate declined (p<0.001) 57% across the study period, the high proportion of fatal accidents showed little (40-43%) diminution (χ 2 =0.935). CFIT and wind gusts/shear were the most frequent accident cause/factor categories. For CFIT accidents, half occurred in degraded visibility with only 9% operating under instrument flight rules (IFR) and the majority (85%) involving non-turbo-charged engine-powered aircraft. For wind-gust/shear-related accidents, 44% occurred with a cross-wind exceeding the maximum demonstrated aircraft component. Accidents which should have been survivable but which nevertheless resulted in a fatal outcome were characterized by poor accessibility (60%) and shoulder harness under-utilization (41%). Despite a declining MEHET-related accident rate, these mishaps still carry an elevated risk of a fatal outcome. Airmen should be encouraged to operate in this environment utilizing turbo-charged-powered airplanes and flying under IFR to assure terrain clearance. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. The influence of the assimilation operator, speech rate and linguistic boundary on the production of /z/ in Croatian

    Directory of Open Access Journals (Sweden)

    Damir Horga


    Full Text Available It is widely accepted that invariant and discrete phonological units at the linguistic level are transformed into variable and continuous movements of speech organs, which in turn results in equally continuous acoustical results. The variability of phonemic units depends on neighbouring phonetic units, but also on the various linguistic, communicational and pragmatic contexts of a particular speech act. The influence of phonetic units upon each other results in adaptations, coarticulations and assimilations. By means of assimilation at least one distinctive feature of a phoneme is changed, so the observed phoneme becomes similar to its neighbouring sound – the assimilation operator. This paper is aimed at analysing the influence of speech rate on assimilation processes in the voiced fricative /z/, when it is preceded by sounds /s, z, ʃ, ʒ / in four different types of articulatory joint: sentence, clausal, lexemic and proclitical. The articulatory joint refers to the production of two phonemes separated by different types of linguistic boundaries. Twenty female native speakers of Croatian with no history of speech or hearing impairments read a text at both natural and fast speech rates. The acoustical recording was performed in a sound-treated room. The Praat software was used to analyse six variables in all occurrences of the sound /z/: duration, spectrum centre of gravity, standard deviation of the centre of gravity, spectral skewness, spectral kurtosis, and harmonic to noise ratio. The results showed that various linguistic boundaries, speech rates and sounds as assimilation operators influence the degree of assimilation of the phoneme /z/, as measured by the acoustic variables.

  19. Pulsed-dose-rate peri-operative brachytherapy as an interstitial boost in organ-sparing treatment of breast cancer

    Directory of Open Access Journals (Sweden)

    Krystyna Serkies


    Full Text Available Purpose : To evaluate peri-operative multicatheter interstitial pulsed-dose-rate brachytherapy (PDR-BT with an intra-operative catheter placement to boost the tumor excision site in breast cancer patients treated conservatively. Material and methods: Between May 2002 and October 2008, 96 consecutive T1-3N0-2M0 breast cancer patients underwent breast-conserving therapy (BCT including peri-operative PDR-BT boost, followed by whole breast external beam radiotherapy (WBRT. The BT dose of 15 Gy (1 Gy/pulse/h was given on the following day after surgery. Results: No increased bleeding or delayed wound healing related to the implants were observed. The only side effects included one case of temporary peri-operative breast infection and 3 cases of fat necrosis, both early and late. In 11 patients (11.4%, subsequent WBRT was omitted owing to the final pathology findings. These included eight patients who underwent mastectomy due to multiple adverse prognostic pathological features, one case of lobular carcinoma in situ, and two cases with no malignant tumor. With a median follow-up of 12 years (range: 7-14 years, among 85 patients who completed BCT, there was one ipsilateral breast tumor and one locoregional nodal recurrence. Six patients developed distant metastases and one was diagnosed with angiosarcoma within irradiated breast. The actuarial 5- and 10-year disease free survival was 90% (95% CI: 84-96% and 87% (95% CI: 80-94%, respectively, for the patients with invasive breast cancer, and 91% (95% CI: 84-97% and 89% (95% CI: 82-96%, respectively, for patients who completed BCT. Good cosmetic outcome by self-assessment was achieved in 58 out of 64 (91% evaluable patients. Conclusions : Peri-operative PDR-BT boost with intra-operative tube placement followed by EBRT is feasible and devoid of considerable toxicity, and provides excellent long-term local control. However, this strategy necessitates careful patient selection and histological confirmation

  20. Loosening After Acetabular Revision

    DEFF Research Database (Denmark)

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


    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)...

  1. Operation of a horizontal subsurface flow constructed wetland--microbial fuel cell treating wastewater under different organic loading rates. (United States)

    Villaseñor, J; Capilla, P; Rodrigo, M A; Cañizares, P; Fernández, F J


    The aim of the present work is to determine whether a horizontal subsurface flow constructed wetland treating wastewater could act simultaneously as a microbial fuel cell (MFC). Specifically, and as the main variable under study, different organic loading rates were used, and the response of the system was monitored. The installation consisted of a synthetic domestic wastewater-feeding system and a pilot-scale constructed wetland for wastewater treatment, which also included coupled devices necessary to function as an MFC. The wetland worked under continuous operation for 180 d, treating three types of synthetic wastewater with increasing organic loading rates: 13.9 g COD m(-2) d(-1), 31.1 g COD m(-2) d(-1), and 61.1 g COD m(-2) d(-1). The COD removal efficiencies and the cell voltage generation were continuously monitored. The wetland worked simultaneously as an MFC generating electric power. Under low organic loading rates, the wastewater organic matter was completely oxidised in the lower anaerobic compartment, and there were slight aerobic conditions in the upper cathodic compartment, thus causing an electrical current. Under high organic loading rates, the organic matter could not be completely oxidised in the anodic compartment and flowed to the cathodic one, which entered into anaerobic conditions and caused the MFC to stop working. The system developed in this work offered similar cell voltage, power density, and current density values compared with the ones obtained in previous studies using photosynthetic MFCs, sediment-type MFCs, and plant-type MFCs. The light/darkness changes caused voltage fluctuations due to the photosynthetic activity of the macrophytes used (Phragmites australis), which affected the conditions in the cathodic compartment. Copyright © 2013 Elsevier Ltd. All rights reserved.

  2. Fluid dynamics analysis of a gas attenuator for X-ray FELs under high-repetition-rate operation. (United States)

    Yang, Bo; Wu, Juhao; Raubenheimer, Tor O; Feng, Yiping


    Newtonian fluid dynamics simulations were performed using the Navier-Stokes-Fourier formulations to elucidate the short time-scale (µs and longer) evolution of the density and temperature distributions in an argon-gas-filled attenuator for an X-ray free-electron laser under high-repetition-rate operation. Both hydrodynamic motions of the gas molecules and thermal conductions were included in a finite-volume calculation. It was found that the hydrodynamic wave motions play the primary role in creating a density depression (also known as a filament) by advectively transporting gas particles away from the X-ray laser-gas interaction region, where large pressure and temperature gradients have been built upon the initial energy deposition via X-ray photoelectric absorption and subsequent thermalization. Concurrent outward heat conduction tends to reduce the pressure in the filament core region, generating a counter gas flow to backfill the filament, but on an initially slower time scale. If the inter-pulse separation is sufficiently short so the filament cannot recover, the depth of the filament progressively increases as the trailing pulses remove additional gas particles. Since the rate of hydrodynamic removal decreases while the rate of heat conduction back flow increases as time elapses, the two competing mechanisms ultimately reach a dynamic balance, establishing a repeating pattern for each pulse cycle. By performing simulations at higher repetition rates but lower per pulse energies while maintaining a constant time-averaged power, the amplitude of the hydrodynamic motion per pulse becomes smaller, and the evolution of the temperature and density distributions approach asymptotically towards, as expected, those calculated for a continuous-wave input of the equivalent power.

  3. The utility of erythrocyte sedimentation rate values and white blood cell counts after spinal deformity surgery in the early (≤3 months) post-operative period. (United States)

    Kuhn, Margaret G; Lenke, Lawrence G; Bridwell, Keith H; O'Donnell, June C; Luhmann, Scott J


    The erythrocyte sedimentation rate (ESR) and white blood cell (WBC) count are frequently obtained in the work-up of post-operative fever. However, their diagnostic utility depends upon comparison with normative peri-operative trends which have not yet been described. The purpose of this study is to define a range of erythrocyte sedimentation rates and white blood cell counts following spinal instrumentation and fusion in non-infected patients. Seventy-five patients underwent spinal instrumentation and fusion. The erythrocyte sedimentation rate and white blood cell count were recorded pre-operatively, at 3 and 7 days post-operatively, and at 1 and 3 months post-operatively. Both erythrocyte sedimentation rate and white blood cell count trends demonstrated an early peak, followed by a gradual return to normal. Peak erythrocyte sedimentation rates occurred within the first week post-operatively in 98% of patients. Peak white blood cell counts occurred with the first week in 85% of patients. In the absence of infection, the erythrocyte sedimentation rate was abnormally elevated in 78% of patients at 1 month and in 53% of patients at 3 months post-operatively. The white blood cell count was abnormally elevated in only 6% of patients at 1 month post-operatively. Longer surgical time was associated with elevated white cell count at 1 week post-operatively. The fusion of more vertebral levels had a negative relationship with elevated erythrocyte sedimentation rate at 1 week post-operatively. The anterior surgical approach was associated with significantly lower erythrocyte sedimentation rate at 1 month post-operatively and with lower white cell count at 1 week post-operatively. In non-infected spinal fusion surgeries, erythrocyte sedimentation rates are in the abnormal range in 78% of patients at 1 month and in 53% of patients at 3 months post-operatively, suggesting that the erythrocyte sedimentation rate is of limited diagnostic value in the early post-operative

  4. Safety analysis, 200 Area, Savannah River Plant: Separations area operations. Building 221-H, B-Line, Scrap Recovery Facility (Supplement 2A): Revision 1

    Energy Technology Data Exchange (ETDEWEB)



    The now HB-Line is located an top of the 221-H Building on the fifth and sixth levels and is designed to replace the aging existing HB-Line production facility. The new HB-Line consists of three separate facilities: the Scrap Recovery Facility, Neptunium Facility, and Plutonium Oxide Facility. The Scrap Recovery Facility is designed to routinely generate nitrate solutions of {sup 235}U{sup 239}Pu and Pu-238 fromscrap for purification by anion exchange or by solvent extraction in the canyon. The now facility incorporates improvements in: (1) engineered controls for nuclear criticality, (2) cabinet integrity and engineered barriers to contain contamination and minimize personnel exposure to airborne contamination, (3) shielding and remote operations to decrease radiation exposure, and (4) equipment and ventilation design to provide flexibility and improved process performance.

  5. Revision for a failed reverse: a 12-year review of a lateralized implant. (United States)

    Stephens, Brent C; Simon, Peter; Clark, Rachel E; Christmas, Kaitlyn N; Stone, Geoffrey P; Lorenzetti, Adam J; Frankle, Mark A


    The purpose of this study was (1) to evaluate the rates of reverse shoulder arthroplasty (RSA) revisions during a 12-year period, (2) to assess the influence of primary diagnosis and the impact of implant modifications on revisions, (3) to describe surgical management of failed RSA, and (4) to analyze outcomes of patients with minimum 24-month follow-up. A retrospective database review identified primary diagnosis for 1418 patients who underwent RSA from 2000 to 2012. A subgroup of 85 patients required return to the operating room for removal or exchange of components. Indication to reoperate, intraoperative management, and outcomes were reviewed. Indications were grouped into 7 categories: baseplate failure, humeral component dissociation, glenosphere dissociation, glenohumeral dislocation, aseptic humeral loosening, periprosthetic fracture, and infection. During the study, design modifications were made to the baseplate, humeral socket, and glenosphere. Surgical strategies were analyzed through operative reports. Range of motion, American Shoulder and Elbow Surgeons scores, and Simple Shoulder Test scores were collected before and after surgery and compared for 58 patients with 2-year follow-up. Overall revision rate was 6%. Patients undergoing RSA for failed hemiarthroplasty had the highest revision rate (10%). Indications for revision included baseplate failure (2.5%), infection (1.3%), humeral dissociation (0.7%), glenosphere dissociation (0.6%), periprosthetic fracture (0.4%), glenohumeral dislocation (0.4%), and aseptic humeral loosening (0.3%). Baseplate modifications reduced the incidence of baseplate failure to 0.3%. Range of motion and the Simple Shoulder Test and American Shoulder and Elbow Surgeons scores improved. Although revision RSA is challenging, with higher risk for complications compared with primary RSA, patients still exhibit significant clinical improvements. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees

  6. Bringing High-Rate, CO2-Based Microbial Electrosynthesis Closer to Practical Implementation through Improved Electrode Design and Operating Conditions. (United States)

    Jourdin, Ludovic; Freguia, Stefano; Flexer, Victoria; Keller, Jurg


    The enhancement of microbial electrosynthesis (MES) of acetate from CO2 to performance levels that could potentially support practical implementations of the technology must go through the optimization of key design and operating conditions. We report that higher proton availability drastically increases the acetate production rate, with pH 5.2 found to be optimal, which will likely suppress methanogenic activity without inhibitor addition. Applied cathode potential as low as -1.1 V versus SHE still achieved 99% of electron recovery in the form of acetate at a current density of around -200 A m(-2). These current densities are leading to an exceptional acetate production rate of up to 1330 g m(-2) day(-1) at pH 6.7. Using highly open macroporous reticulated vitreous carbon electrodes with macropore sizes of about 0.6 mm in diameter was found to be optimal for achieving a good balance between total surface area available for biofilm formation and effective mass transfer between the bulk liquid and the electrode and biofilm surface. Furthermore, we also successfully demonstrated the use of a synthetic biogas mixture as carbon dioxide source, yielding similarly high MES performance as pure CO2. This would allow this process to be used effectively for both biogas quality improvement and conversion of the available CO2 to acetate.

  7. Cementless, modular, distally fixed stem in hip revision arthroplasty: a single-center study of 132 consecutive hips. (United States)

    Hashem, Ali; Al-Azzawi, Ammar; Riyadh, Hasan; Mukka, Sebastian; Sayed-Noor, Arkan


    The use of cementless, modular, distally fixed stem in hip revision arthroplasty has increased during the last decades. We aimed to analyze the early and late postoperative complications, re-operation rate, and survival rate of the MP stem operated at our county hospital with relatively limited caseload. In this retrospective study, we included 132 hips operated with MP stem between January 2007-2014. An independent observer reviewed patients' medical records in July 2015 (18-102 months postoperatively, median 52.5) to collect the following data: age, sex, American Society of Anesthesiologists (ASA) class, body mass index, indication of revision, type of operation, early and late complications, re-operation rate, and mortality during study period. The commonest indication for MP stem operation was aseptic loosening (72%). We found early and late postoperative complications in 29% of cases. The most common complication was prosthetic dislocation (8%), followed by intra-operative peri-prosthetic fracture (5%). The commonest indication for MP re-operation was soft tissue revision for infection (7%) followed by closed reduction for prosthetic dislocation (6%). We found no correlation between the age, sex, ASA class, and type of operation and the re-operation risk. Only one prosthesis was extracted giving a survival rate for 99% for the study period. This study showed good results of the MP prosthesis with reasonable complication and re-operation rates and negligible extraction rate, indicating the good performance of this implant even when used in the setting of a county hospital with limited caseload.

  8. ANEMOS: A computer code to estimate air concentrations and ground deposition rates for atmospheric nuclides emitted from multiple operating sources

    Energy Technology Data Exchange (ETDEWEB)

    Miller, C.W.; Sjoreen, A.L.; Begovich, C.L.; Hermann, O.W.


    This code estimates concentrations in air and ground deposition rates for Atmospheric Nuclides Emitted from Multiple Operating Sources. ANEMOS is one component of an integrated Computerized Radiological Risk Investigation System (CRRIS) developed for the US Environmental Protection Agency (EPA) for use in performing radiological assessments and in developing radiation standards. The concentrations and deposition rates calculated by ANEMOS are used in subsequent portions of the CRRIS for estimating doses and risks to man. The calculations made in ANEMOS are based on the use of a straight-line Gaussian plume atmospheric dispersion model with both dry and wet deposition parameter options. The code will accommodate a ground-level or elevated point and area source or windblown source. Adjustments may be made during the calculations for surface roughness, building wake effects, terrain height, wind speed at the height of release, the variation in plume rise as a function of downwind distance, and the in-growth and decay of daughter products in the plume as it travels downwind. ANEMOS can also accommodate multiple particle sizes and clearance classes, and it may be used to calculate the dose from a finite plume of gamma-ray-emitting radionuclides passing overhead. The output of this code is presented for 16 sectors of a circular grid. ANEMOS can calculate both the sector-average concentrations and deposition rates at a given set of downwind distances in each sector and the average of these quantities over an area within each sector bounded by two successive downwind distances. ANEMOS is designed to be used primarily for continuous, long-term radionuclide releases. This report describes the models used in the code, their computer implementation, the uncertainty associated with their use, and the use of ANEMOS in conjunction with other codes in the CRRIS. A listing of the code is included in Appendix C.

  9. 25 CFR 171.565 - How will I know if BIA plans to adjust my annual operation and maintenance assessment rate? (United States)


    ... 25 Indians 1 2010-04-01 2010-04-01 false How will I know if BIA plans to adjust my annual operation and maintenance assessment rate? 171.565 Section 171.565 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER IRRIGATION OPERATION AND MAINTENANCE Financial Matters: Assessments...

  10. Gender-, age-, and race/ethnicity-based differential item functioning analysis of the movement disorder society-sponsored revision of the Unified Parkinson's disease rating scale. (United States)

    Goetz, Christopher G; Liu, Yuanyuan; Stebbins, Glenn T; Wang, Lu; Tilley, Barbara C; Teresi, Jeanne A; Merkitch, Douglas; Luo, Sheng


    Assess MDS-UPDRS items for gender-, age-, and race/ethnicity-based differential item functioning. Assessing differential item functioning is a core rating scale validation step. For the MDS-UPDRS, differential item functioning occurs if item-score probability among people with similar levels of parkinsonism differ according to selected covariates (gender, age, race/ethnicity). If the magnitude of differential item functioning is clinically relevant, item-score interpretation must consider influences by these covariates. Differential item functioning can be nonuniform (covariate variably influences an item-score across different levels of parkinsonism) or uniform (covariate influences an item-score consistently over all levels of parkinsonism). Using the MDS-UPDRS translation database of more than 5,000 PD patients from 14 languages, we tested gender-, age-, and race/ethnicity-based differential item functioning. To designate an item as having clinically relevant differential item functioning, we required statistical confirmation by 2 independent methods, along with a McFadden pseudo-R2 magnitude statistic greater than "negligible." Most items showed no gender-, age- or race/ethnicity-based differential item functioning. When differential item functioning was identified, the magnitude statistic was always in the "negligible" range, and the scale-level impact was minimal. The absence of clinically relevant differential item functioning across all items and all parts of the MDS-UPDRS is strong evidence that the scale can be used confidently. As studies of Parkinson's disease increasingly involve multinational efforts and the MDS-UPDRS has several validated non-English translations, the findings support the scale's broad applicability in populations with varying gender, age, and race/ethnicity distributions. © 2016 International Parkinson and Movement Disorder Society. © 2016 International Parkinson and Movement Disorder Society.

  11. Minimally Invasive Transforaminal Lumbar Interbody Fusion with Unilateral Pedicle Screw Fixation: Comparison between Primary and Revision Surgery (United States)

    Kang, Moo Sung; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun


    Minimally invasive surgery with a transforaminal lumbar interbody fusion (MIS TLIF) is an important minimally invasive fusion technique for the lumbar spine. Lumbar spine reoperation is challenging and is thought to have greater complication risks. The purpose of this study was to compare MIS TLIF with unilateral screw fixation perioperative results between primary and revision surgeries. This was a prospective study that included 46 patients who underwent MIS TLIF with unilateral pedicle screw. The patients were divided into two groups, primary and revision MIS TLIF, to compare perioperative results and complications. The two groups were similar in age, sex, and level of operation, and were not significantly different in the length of follow-up or clinical results. Although dural tears were more common with the revision group (primary 1; revision 4), operation time, blood loss, total perioperative complication, and fusion rates were not significantly different between the two groups. Both groups showed substantial improvements in VAS and ODI scores one year after surgical treatment. Revision MIS TLIF performed by an experienced surgeon does not necessarily increase the risk of perioperative complication compared with primary surgery. MIS TLIF with unilateral pedicle screw fixation is a valuable option for revision lumbar surgery. PMID:24949483

  12. Use of Lateral Access in the Treatment of the Revision Spine Patient

    Directory of Open Access Journals (Sweden)

    Samuel S. Bederman


    Full Text Available With the rate of spinal surgery increasing, we have seen a concomitant increase in the number of revision cases. It is, therefore, important to have a systematic approach to the management of these complicated patients with unique problems. A thorough understanding of the different pathologies affecting revision spine patients is critical to an effective treatment recommendation. Lateral access is a useful management approach since it can avoid the complications of operating through previous approaches. Furthermore, it possesses certain advantages for treatment in specific circumstances outlined in this paper. Long-term studies are needed to demonstrate the safety and efficacy of the lateral approach compared to the anterior and posterior approaches in the treatment of revision spine patients.

  13. Revision of infected knee arthroplasties in Denmark

    DEFF Research Database (Denmark)

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


    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...

  14. Determining air pollutant emission rates based on mass balance using airborne measurement data over the Alberta oil sands operations (United States)

    Gordon, M.; Li, S.-M.; Staebler, R.; Darlington, A.; Hayden, K.; O'Brien, J.; Wolde, M.


    Top-down approaches to measure total integrated emissions provide verification of bottom-up, temporally resolved, inventory-based estimations. Aircraft-based measurements of air pollutants from sources in the Canadian oil sands were made in support of the Joint Canada-Alberta Implementation Plan for Oil Sands Monitoring during a summer intensive field campaign between 13 August and 7 September 2013. The measurements contribute to knowledge needed in support of the Joint Canada-Alberta Implementation Plan for Oil Sands Monitoring. This paper describes the top-down emission rate retrieval algorithm (TERRA) to determine facility emissions of pollutants, using SO2 and CH4 as examples, based on the aircraft measurements. In this algorithm, the flight path around a facility at multiple heights is mapped to a two-dimensional vertical screen surrounding the facility. The total transport of SO2 and CH4 through this screen is calculated using aircraft wind measurements, and facility emissions are then calculated based on the divergence theorem with estimations of box-top losses, horizontal and vertical turbulent fluxes, surface deposition, and apparent losses due to air densification and chemical reaction. Example calculations for two separate flights are presented. During an upset condition of SO2 emissions on one day, these calculations are within 5 % of the industry-reported, bottom-up measurements. During a return to normal operating conditions, the SO2 emissions are within 11 % of industry-reported, bottom-up measurements. CH4 emissions calculated with the algorithm are relatively constant within the range of uncertainties. Uncertainty of the emission rates is estimated as less than 30 %, which is primarily due to the unknown SO2 and CH4 mixing ratios near the surface below the lowest flight level.

  15. 40 CFR Table 1 to Subpart Pppp of... - Operating Limits if Using the Emission Rate With Add-On Controls Option (United States)


    ... Rate With Add-On Controls Option 1 Table 1 to Subpart PPPP of Part 63 Protection of Environment... 63—Operating Limits if Using the Emission Rate With Add-On Controls Option If you are required to... pressure in each duct between a capture device and add-on control device inlet in any 3-hour period must...

  16. 40 CFR Table 1 to Subpart Mmmm of... - Operating Limits if Using the Emission Rate With Add-On Controls Option (United States)


    ... Rate With Add-On Controls Option 1 Table 1 to Subpart MMMM of Part 63 Protection of Environment... MMMM of Part 63—Operating Limits if Using the Emission Rate With Add-On Controls Option If you are... between a capture device and add-on control device inlet in any 3-hour period must not fall below the...

  17. Ozone application in water sources: effects of operational parameters and water quality variables on ozone residual profiles and decay rates

    Directory of Open Access Journals (Sweden)

    F. A. Lage Filho


    Full Text Available Systematic ozonation tests were conducted by means of a mobile pilot plant. Water source 1 was a low turbidity stream with very low solids content and very low turbidity, apparent color and alkalinity. Water source 2 was reservoir water with higher turbidity, solids content and alkalinity than source 1. The ozone plant was a counter-current contactor composed of four columns in series. Variations in contact time, in the feed gas concentration (in terms of percent by weight of ozone and in splitting of the total applied ozone dosage between columns 1 and 2 were tested. Concentration - time (CT products were calculated and decay coefficients K were estimated from experimental data. The relative importance of water quality and certain operational parameters with regard to CT products and ozone decay was assessed. Total CT values seemed to increase with: (a total applied ozone dosage, (b percent by weight of ozone in the feed gas to the bubble contactor, (c increasing contact time and (d higher water quality, with regard to turbidity, apparent color, total organic carbon and particle counts. As the total applied ozone dosage was increased, the more important the contact time and ozone dosage configuration became for the total CT value. The apparent first order ozone decay rate constant (K decreased with increasing total applied ozone dosage. The contact time appeared to exert a much stronger influence on total CT values than on K values, particularly so as the total applied ozone dosage was increased.

  18. Pyrosequencing as a tool for the detection of Phytophthora species: error rate and risk of false Molecular Operational Taxonomic Units. (United States)

    Vettraino, A M; Bonants, P; Tomassini, A; Bruni, N; Vannini, A


    To evaluate the accuracy of pyrosequencing for the description of Phytophthora communities in terms of taxa identification and risk of assignment for false Molecular Operational Taxonomic Units (MOTUs). Pyrosequencing of Internal Transcribed Spacer 1 (ITS1) amplicons was used to describe the structure of a DNA mixture comprising eight Phytophthora spp. and Pythium vexans. Pyrosequencing resulted in 16 965 reads, detecting all species in the template DNA mixture. Reducing the ITS1 sequence identity threshold resulted in a decrease in numbers of unmatched reads but a concomitant increase in the numbers of false MOTUs. The total error rate was 0·63% and comprised mainly mismatches (0·25%) Pyrosequencing of ITS1 region is an efficient and accurate technique for the detection and identification of Phytophthora spp. in environmental samples. However, the risk of allocating false MOTUs, even when demonstrated to be low, may require additional validation with alternative detection methods. Phytophthora spp. are considered among the most destructive groups of invasive plant pathogens, affecting thousands of cultivated and wild plants worldwide. Simultaneous early detection of Phytophthora complexes in environmental samples offers an unique opportunity for the interception of known and unknown species along pathways of introduction, along with the identification of these organisms in invaded environments. © 2012 The Authors Letters in Applied Microbiology © 2012 The Society for Applied Microbiology.

  19. Perceptual accent rating and attribution in psychogenic FAS: some further evidence challenging Whitaker’s operational definition.

    Directory of Open Access Journals (Sweden)

    Stefanie eKeulen


    Full Text Available A 40-year-old, non-aphasic, right-handed, and polyglot (L1: French, L2: Dutch, L3: English woman with a 12 year history of addiction to opiates and psychoactive substances, and clear psychiatric problems, presented with a foreign accent of sudden onset in L1. Speech evolved towards a mostly fluent output, despite a stutter-like behavior and a marked grammatical output disorder. The psychogenic etiology of the accent foreignness was construed based upon the patient’s complex medical history, and psychodiagnostic, neuropsychological, and neurolinguistic assessments. The presence of a foreign accent was affirmed by a perceptual accent rating and attribution experiment. It is argued that this patient provides additional evidence demonstrating the outdatedness of Whitaker’s (1982 definition of Foreign Accent Syndrome, as only one of the four operational criteria was unequivocally applicable to our patient: her accent foreignness was not only recognized by her relatives and the medical staff, but also by a group of native French-speaking laymen. However, our patient defied the three remaining criteria, as central nervous system damage could not conclusively be demonstrated, psychodiagnostic assessment raised the hypothesis of a conversion disorder, and the patient was a polyglot whose newly gained accent was associated with a range of foreign languages, which exceeded the ones she spoke.

  20. Perceptual Accent Rating and Attribution in Psychogenic FAS: Some Further Evidence Challenging Whitaker’s Operational Definition (United States)

    Keulen, Stefanie; Verhoeven, Jo; Bastiaanse, Roelien; Mariën, Peter; Jonkers, Roel; Mavroudakis, Nicolas; Paquier, Philippe


    A 40-year-old, non-aphasic, right-handed, and polyglot (L1: French, L2: Dutch, and L3: English) woman with a 12-year history of addiction to opiates and psychoactive substances, and clear psychiatric problems, presented with a foreign accent of sudden onset in L1. Speech evolved toward a mostly fluent output, despite a stutter-like behavior and a marked grammatical output disorder. The psychogenic etiology of the accent foreignness was construed based on the patient’s complex medical history and psychodiagnostic, neuropsychological, and neurolinguistic assessments. The presence of a foreign accent was affirmed by a perceptual accent rating and attribution experiment. It is argued that this patient provides additional evidence demonstrating the outdatedness of Whitaker’s (1982) definition of foreign accent syndrome, as only one of the four operational criteria was unequivocally applicable to our patient: her accent foreignness was not only recognized by her relatives and the medical staff but also by a group of native French-speaking laymen. However, our patient defied the three remaining criteria, as central nervous system damage could not conclusively be demonstrated, psychodiagnostic assessment raised the hypothesis of a conversion disorder, and the patient was a polyglot whose newly gained accent was associated with a range of foreign languages, which exceeded the ones she spoke. PMID:26973488

  1. Survivorship and relative risk of revision in computer-navigated versus conventional total knee replacement at 8-year follow-up. (United States)

    Dyrhovden, Gro S; Fenstad, Anne M; Furnes, Ove; Gøthesen, Øystein


    Background and purpose - The long-term effects of computer-assisted surgery in total knee replacement (CAS) compared to conventionally operated knee replacement (CON) are still not clear. We compared survivorship and relative risk of revision in CAS and CON based on data from the Norwegian Arthroplasty Register. Patients and methods - We assessed primary total knee replacements without patellar resurfacing reported to the Norwegian Arthroplasty Register from 2005 through 2014. The 5 most used implants and the 3 most common navigation systems were included. The groups (CAS, n = 3,665; CON, n = 20,019) were compared using a Cox regression analysis adjusted for age, sex, ASA category, prosthesis brand, fixation method, previous surgery, and diagnosis with the risk of revision for any reason as endpoint. Secondary outcomes were reasons for revision and effects of prosthesis brand, fixation method, age (± 65 years), and hospital volume. Results - Prosthesis survival and risk of revision were similar for CAS and CON. CAS had significantly fewer revisions due to malalignment. Otherwise, no statistically significant difference was found between the groups in analyses of secondary outcomes. Mean operating time was 13 minutes longer in CAS. Interpretation - At 8 years of follow-up, CAS and CON had similar rates of overall revision, but CAS had fewer revisions due to malalignment. According to our findings, the benefits of CAS at medium-term follow-up are limited. Further research may identify subgroups that benefit from CAS, and it should also emphasize patient-reported outcomes.

  2. Descriptor revision belief change through direct choice

    CERN Document Server

    Hansson, Sven Ove


    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.

  3. Fast-track revision knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B


    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...... undergoing revision TKA for non-septic reasons may be included in fast-track protocols. Outcome appears to be similar to that of primary TKA regarding LOS, morbidity, and satisfaction. Our findings call for larger confirmatory studies and studies involving other indications (revision THA, 1-stage septic...

  4. Concordance between DSM-IV and DSM-5 criteria for delirium diagnosis in a pooled database of 768 prospectively evaluated patients using the delirium rating scale-revised-98. (United States)

    Meagher, David J; Morandi, Alessandro; Inouye, Sharon K; Ely, Wes; Adamis, Dimitrios; Maclullich, Alasdair J; Rudolph, James L; Neufeld, Karin; Leonard, Maeve; Bellelli, Giuseppe; Davis, Daniel; Teodorczuk, Andrew; Kreisel, Stefan; Thomas, Christine; Hasemann, Wolfgang; Timmons, Suzanne; O'Regan, Niamh; Grover, Sandeep; Jabbar, Faiza; Cullen, Walter; Dunne, Colum; Kamholz, Barbara; Van Munster, Barbara C; De Rooij, Sophia E; De Jonghe, Jos; Trzepacz, Paula T


    The Diagnostic and Statistical Manual fifth edition (DSM-5) provides new criteria for delirium diagnosis. We examined delirium diagnosis using these new criteria compared with the Diagnostic and Statistical Manual fourth edition (DSM-IV) in a large dataset of patients assessed for delirium and related presentations. Patient data (n = 768) from six prospectively collected cohorts, clinically assessed using DSM-IV and the Delirium Rating Scale-Revised-98 (DRS-R98), were pooled. Post hoc application of DRS-R98 item scores were used to rate DSM-5 criteria. 'Strict' and 'relaxed' DSM-5 criteria to ascertain delirium were compared to rates determined by DSM-IV. Using DSM-IV by clinical assessment, delirium was found in 510/768 patients (66%). Strict DSM-5 criteria categorized 158 as delirious including 155 (30%) with DSM-IV delirium, whereas relaxed DSM-5 criteria identified 466 as delirious, including 455 (89%) diagnosed by DSM-IV (P DSM-IV and the strict DSM-5, 91% (ĸ = 0.82) between the DSM-IV and relaxed DSM-5 criteria and 60% (ĸ = 0.29) between the strict versus relaxed DSM-5 criteria. Only 155 cases were identified as delirium by all three approaches. The 55 (11%) patients with DSM-IV delirium who were not rated as delirious by relaxed criteria had lower mean DRS-R98 total scores than those rated as delirious (13.7 ± 3.9 versus 23.7 ± 6.0; P DSM-5 criteria was consistent with suggested cutoff scores for full syndromal delirium. Only 11 cases met DSM-5 criteria that were not deemed to have DSM-IV delirium. The concordance between DSM-IV and the new DSM-5 delirium criteria varies considerably depending on the interpretation of criteria. Overly-strict adherence for some new text details in DSM-5 criteria would reduce the number of delirium cases diagnosed; however, a more 'relaxed' approach renders DSM-5 criteria comparable to DSM-IV with minimal impact on their actual application and is thus recommended.

  5. Fatigue failure of the cephalomedullary nail: revision options, outcomes and review of the literature. (United States)

    Tucker, Adam; Warnock, Michael; McDonald, Sinead; Cusick, Laurence; Foster, Andrew P


    Cephalomedullary nail (CMN) failure is a rare entity following hip fracture treatment. However, it poses significant challenges for revision surgery, both mechanically and biologically. Nail failure rates have been reported at failure, compared to "adequate" and "good" (p = 0.027). Tip-Apex Distance (TAD) mean was 23.2 ± 8.3 mm, and an adequate TAD with three-point fixation was seen in only 35% of cases. Mean time to failure was 401.0 ± 237.2 days, with mean age at failure of 74.0 ± 14.8 years. Options after failure included revision CMN nail, proximal femoral locking plate (PFLP), long-stem or restoration arthroplasty, or femoral endoprosthesis. Barthel Functional Index scores showed no significant difference at 3 and 12 months post-operatively, nor any difference between treatment groups. Mean 12-month mortality was 30%, akin to a primary hip fracture mortality risk according to NICE guidelines. Mortality rates were lowest in revision nails. Subsequent revision rates were higher in the PFLP group. There is no reported evidence on the best surgical technique for managing the failed CMN, with no clear functional benefit in the options above. Good surgical technique at the time of primary CMN surgery is critical in minimising fatigue failure. After revision, overall mortality rates were equivalent to reported primary hip fracture mortality rates. Further multicentre evaluations are required to assess which technique convey the best functional outcomes without compromising 12-month mortality rates.

  6. Developing a virtual reality application for training nuclear power plant operators: setting up a database containing dose rates in the refuelling plant. (United States)

    Ródenas, J; Zarza, I; Burgos, M C; Felipe, A; Sánchez-Mayoral, M L


    Operators in Nuclear Power Plants can receive high doses during refuelling operations. A training programme for simulating refuelling operations will be useful in reducing the doses received by workers as well as minimising operation time. With this goal in mind, a virtual reality application is developed within the framework of the CIPRES project. The application requires doses, both instantaneous and accumulated, to be displayed at all times during operator training. Therefore, it is necessary to set up a database containing dose rates at every point in the refuelling plant. This database is based on radiological protection surveillance data measured in the plant during refuelling operations. Some interpolation routines have been used to estimate doses through the refuelling plant. Different assumptions have been adopted in order to perform the interpolation and obtain consistent data. In this paper, the procedures developed to set up the dose database for the virtual reality application are presented and analysed.

  7. 77 FR 71190 - Cobra Pipeline Ltd.; Notice of Petition for Rate Approval (United States)


    ... Energy Regulatory Commission Cobra Pipeline Ltd.; Notice of Petition for Rate Approval Take notice that on November 19, 2012, Cobra Pipeline Ltd. (Cobra) filed a Rate Election pursuant to 284.123(b)(1) of the Commissions regulations and to revise its Statement of Operating Conditions. Cobra proposes to...

  8. ATR Operations Document Revision 1.0

    Energy Technology Data Exchange (ETDEWEB)

    MacKay, Waldo [Brookhaven National Lab. (BNL), Upton, NY (United States); Satogata, Todd [Brookhaven National Lab. (BNL), Upton, NY (United States); Tanaka, S. [Brookhaven National Lab. (BNL), Upton, NY (United States)


    RHIC is a duel ring collider for ions from protons up to fully stripped gold (100GeV/byckeon). Over 670 meters of beam line are being built to transfer ions from the AGS to both of the collider rings. These transfer lines are divided into four sections: the U-line which matches beam from the AGS and provides final stripping of gold ions, the W-line which brings the beam along the 6-o'clock-to 12-o' clock symmetry line of RHIC. Starting at the switch magnet just upstream of a beam dump are the two large arcs: the X-line which brings the beam around to the Blue (cw) ring, and the Y-line which brings the beam around to the Yellow (ccw) ring.

  9. Applied Mathematicians and Naval Operators. Revised. (United States)


    and Thorndike , A., "Antisubmarine Warfare in World War II," OEG Report 51, Reprinted 1977 [41 Koopman, B. 0., "Search and Screening," OEG Report 56...Trost, R. P., Lurl . PhflIp and Berger. Edward . "A Note on Lee, Lung-FeE, &S. Mdal, and R. P. Trost "Asmptotic Estimting Continuous Time Decislon...PP 340 PP 324 Luria, Philip, Trost, R. P., and Berger. Edward "A Method Horowitz, Stanley A., "uantifylng Seapomer Readiness." for Analyzing Multiple

  10. Operation STEADFAST Phased Implementation Plan. Revised (United States)


    Division is dependent upon the availability of skilled computer personnel and computer hardware and software. Prototype testing is scheduled for...for trained ADP personnel, system tested equipment and the modified ADP systems tested using live data from all 36 input installations is critical...DCSLOG 8. AG 9. !MIS 10 . lC 11. SJA 12. !0 l3. CHAPLAIN 14. PM 15. SURGEON ·-IIQ TIIIRD USA-- 1. DCS< niPT 2. DCSPI!lt 3. DCSIIiT 4

  11. Doubly Fed Induction Generator in an Offshore Wind Power Plant Operated at Rated V/Hz: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Muljadi, E.; Singh, M.; Gevorgian, V.


    This paper introduces the concept of constant Volt/Hz operation of offshore wind power plants. The deployment of offshore WPPs requires power transmission from the plant to the load center inland. Since this power transmission requires submarine cables, there is a need to use High-Voltage Direct Current transmission, which is economical for transmission distances longer than 50 kilometers. In the concept presented here, the onshore substation is operated at 60 Hz synced with the grid, and the offshore substation is operated at variable frequency and voltage, thus allowing the WPP to be operated at constant Volt/Hz.

  12. Revision of the DELFIC Particle Activity Module

    Energy Technology Data Exchange (ETDEWEB)

    Hooper, David A [ORNL; Jodoin, Vincent J [ORNL


    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.

  13. Revision of migrated pelvic acetabular components in THA with or without vascular involvement

    Directory of Open Access Journals (Sweden)

    Ștefan Cristea


    Full Text Available Purpose. The literature describes a high rate of mortality in cases of intrapelvic acetabular component migration, which is a rare but serious complication. Our aim is to establish and propose a treatment protocol according to our results and experience. Material and Methods. We performed eight (8 total hip revisions with acetabular cup migration between 2006 and 2012. A vascular graft was needed in four (4 of these cases. Two (2 cases were revisions after a spacer for infected arthroplasties. The protocol included the following: X-Ray examination (frontal and lateral views, CT angiography, a biological evaluation, a suitable pre-operative plan, at least six (6 units of blood stock, an experienced anesthesiologist, an experienced surgical team that included a vascular surgeon and a versatile arsenal of revision prostheses, bone grafts and vascular grafts. The anterolateral approach was generally used for hip revisions and the retroperitoneal approach in the dorsal decubitus position was used when vascular risk was involved. Results: The acetabular defect was reconstructed using bone grafts and tantalum revision cups in 4 cases, Burch-Schneider cages in 2 cases, a Kerboull ring in 1 case and a cementless oblong cup (Cotyle Espace in 1 case. In 4 cases, an iliac vessel graft procedure was conducted by the vascular surgeon. All patients survived the revision procedures and returned regularly for subsequent check-ups, during which they did not show any septic complications. Conclusions: Intrapelvic acetabular cup migration is a rare but serious complication that can occur after total hip arthroplasty in either septic or aseptic cases. An experienced, multidisciplinary team of surgeons should be involved in planning and conducting such complicated revisions.

  14. Ontology merging using belief revision and defeasible logic programming


    Gómez, Sergio Alejandro; Simari, Guillermo Ricardo


    We combine argumentation, belief revision and description logic ontologies for extending the -ontologies framework to show how to merge two ontologies in which the union of the strict terminologies could lead to inconsistency. To solve this problem, we revisit a procedure presented by Falappa et al. in which part of the o ending terminologies are turned defeasible by using a kernel revision operator.

  15. Effects of intra-operative end-tidal carbon dioxide levels on the rates of post-operative complications in adults undergoing general anesthesia for percutaneous nephrolithotomy: A clinical trial

    Directory of Open Access Journals (Sweden)

    Mahmoud Saghaei


    Full Text Available Background: A retrospective study has shown lesser days of hospital stay in patients with increased levels of intra-operative end-tidal carbon dioxide (ETCO 2 . It is probable that hypercapnia may exert its beneficial effects on patients′ outcome through optimization of global hemodynamic and tissue oxygenation, leading to a lower rate of post-operative complications. This study was designed to test the hypothesis that higher values of intra-operative ETCO 2 decrease the rate of post-operative complications. Materials and Methods: In this randomized, double-blind clinical trial, 78 adult patients scheduled for percutaneous nephrolithotomy (PCNL were prospectively enrolled and randomly divided into three groups. ETCO 2 was set and maintained throughout the procedure at 31-33, 37-39 and 43-45 mmHg in the hypocapnia, normocapnia and hypercapnia groups, respectively. The rates of post-operative complications were compared among the three groups. Results: Seventy-five patients completed the study (52 male and 23 female. Ten (38.5%, four (16% and two (8.3% patients developed post-operative vomiting in the hypocapnia, normocapnia and hypercapnia groups, respectively (P = 0.025. The nausea score was significantly lower in the hypercapnic group compared with the other groups (3.9 ± 1.8, 3.2 ± 2.1 and 1.3 ± 1.8 in the hypocapnia, normocapnia and hypercapnia groups, respectively; P = 0.000. Time to return of spontaneous respiration and awakening were significantly decreased in the hypercapnia group compared with the other groups (P < 0.01. Conclusion: Mild intra-operative hypercapnia has a protecting effect against the development of post-operative nausea and vomiting and decreases the duration of emergence and recovery from general anesthesia.

  16. Report for Batch Leach Analyses on Sediments at 100-HR-3 Operable Unit, Boreholes C7620, C7621, C7622, C7623, C7626, C7627, C7628, C7629, C7630, and C7866. Revision 1.

    Energy Technology Data Exchange (ETDEWEB)

    Lindberg, Michael J.


    This is a revision to a previously released report. This revision contains additional analytical results for the sample with HEIS number B2H4X7. Between November 4, 2010 and October 26, 2011 sediment samples were received from 100-HR-3 Operable Unit for geochemical studies. The analyses for this project were performed at the 331 building located in the 300 Area of the Hanford Site. The analyses were performed according to Pacific Northwest National Laboratory (PNNL) approved procedures and/or nationally recognized test procedures. The data sets include the sample identification numbers, analytical results, estimated quantification limits (EQL), and quality control data. The preparatory and analytical quality control requirements, calibration requirements, acceptance criteria, and failure actions are defined in the on-line QA plan 'Conducting Analytical Work in Support of Regulatory Programs' (CAW). This QA plan implements the Hanford Analytical Services Quality Assurance Requirements Documents (HASQARD) for PNNL. Samples were received with a chain of custody (COC) and were analyzed according to the sample identification numbers supplied by the client. All Samples were refrigerated upon receipt until prepared for analysis. All samples were received with custody seals intact unless noted in the Case Narrative. Holding time is defined as the time from sample preparation to the time of analyses. The prescribed holding times were met for all analytes unless noted in the Case Narrative. All reported analytical results meet the requirements of the CAW or client specified SOW unless noted in the case narrative. Due to the requirements of the statement of work and sampling events in the field, the 28 day and the 48 hr requirements cannot be met. The statement of work requires samples to be selected at the completion of the borehole. It is not always possible to complete a borehole and have the samples shipped to the laboratory within the hold time requirements

  17. Analysis of the patient occupancy rate (BOR, operational cost budget and activity ratio on financial performance based on income capability of PNBP covering operational cost of public service agency (BLU of DKI Jakarta provincial hospital.

    Directory of Open Access Journals (Sweden)

    Istiqomah Dwi Putri


    Full Text Available The purpose of this research is to know the influence of activity, operational cost budgeting, and bed occupancy rate on financial performance based on ability of (PNBP revenue to cover operating cost public service agency hospital. This study aims to determine the effect of patient occupancy rate (BOR, operational budget and activities of financial performance is based on the ability of non-tax revenue to cover operating costs hospital public service agencies in the province of Jakarta period 2011-2015. Descriptive analysis showed that: (a the value of BOR at Hospital studied quite well with a range of over 60%, (b the absorption of operational budget is considered quite efficient because it has a small difference from the budget, (c the ratio of activity with time measurement average receivables collectible on average figures, The results of this study indicate that patient occupancy rate (BOR, and Budget operasionalof positive and significant impact on the financial performance Hospital General Services Agency activity while variable does not affect the financial performance of the Hospital

  18. [Prevention of prothesis dislocation after the revision of total hip arthroplasty]. (United States)

    Li, Yong-jiang; Zhang, Li-cheng; Yang, Guo-jing; Zhang, Chun-cai; Wang, Wei-liang; Lin, Rui-xin; Cai, Chun-yuan


    To explore the role of reconstruction of the posterior capsule and external rotators in prevention of postoperative dislocation in total hip arthroplasty revision following the posterolateral approach. Forty-five patients (47 hips) with the mean age of 65 years (55 to 78 years)of failed total hip arthroplasty were revised following the posterolateral approach. Posterior capsule was sutured to the anterosuperior portion of the capsule from where it had been detached, and the external rotators were then reattached to the soft tissue at the tip of the greater trochanter using 1.0 silk suture in surgery. The dislocation rate and risk factors were reviewed retrospectively to determine if closing the posterior capsule resulted in fewer dislocations. The femoral prosthesis and acetabular prosthesis were revised in 29 patients (31 hips), the liner was exchanged in 5 patients (5 hips), and the acetabular prosthesis or femoral components were revised in 10 patients (10 hips) and one patient (one hip) respectively. The procedure was the patient's first revision in 29 patients (30 hips), the second revision in 15 patients (16 hips), and the third revision in one patient(one hip). Radiographic evaluation included lower limb discrepancy, acetabular phase, femoral offset, anteversion angle, prosthetic loosening before and after revision. Function evaluation based on Harris score system. All patients were followed up with an average of 2.7 years. None of the patients sustained dislocation or infection, except one patient felt the anterior instability but without dislocation, X-ray revealed the acetabular component was in excessively anteversion. Lower leg discrepancy, acetabular abduction, anteversion femoral offest and collodiaphyseal angle were restored to normal level after operation on the basis of X-ray. One of the acetabular components and one of the femoral components were loose without dislocation. The Harris hip score improved from (49.13 +/- 15.53) points preoperatively

  19. Vancouver type B2 and B3 periprosthetic fractures treated with revision total hip arthroplasty. (United States)

    Amenabar, Tomas; Rahman, Wael A; Avhad, Vineet V; Vera, Ramiro; Gross, Allan E; Kuzyk, Paul R


    Periprosthetic fractures are the fourth most common cause for hip revision and a devastating complication. Our purpose is to report results and quality of life following revision THA for Vancouver B2 and B3 fractures. This was a retrospective review from January 2000 to November 2012 to identify all revision THA performed for Vancouver types B2 and B3 that had a minimum follow-up of two years. Routine post-operative and radiographic evaluation to assess patient survival, implant failure, complications and quality of life was involved. Statistical analysis was made with the Kaplan-Meier survival curve with 95 % confidence interval and the log rank (Mantel-Cox) test. A total of 76 fractures were included, with an average follow-up 74.4 months. Mean age at the revision surgery was 75.7 years (range, 41-97 years; SD, 12.4). Sixty-six cases were classified as Vancouver B2 and treated with distal fixation stem. Ten cases were Vancouver B3 and a proximal femoral allograft technique was used. The overall five-year Kaplan-Meier survival rate for the patients was 77.9 % (95 % CI, 67.4-88.4), and the ten-year rate was 65.1 % (95 % CI, 51.4-78.8). Five-year Kaplan-Meier survival rate for the implants was 89.6 % (95 % CI, 82.2-97); we presented seven failures. The mean SF-12 mental was 55.1 (range, 31-68; SD, 8.1) and the physical was 37.4 (range, 16-55; SD, 9.4). Mortality rate after periprosthetic fractures is high as compared to other hip surgeries; our Kaplan-Meier analysis showed that it tends to plateau after five years. In our series the failure rate was low and occurred early in the post-operative period.

  20. Publishing and Revising Content (United States)

    Editors and Webmasters can publish content without going through a workflow. Publishing times and dates can be set, and multiple pages can be published in bulk. Making an edit to published content created a revision.

  1. Scar revision - slideshow (United States)

    ... this page: // Scar revision - series—Normal anatomy To use the sharing ... entire body, and acts as a protective barrier. Scar tissue forms as skin heals after an injury ( ...

  2. Revised Total Coliform Rule (United States)

    The Revised Total Coliform Rule (RTCR) aims to increase public health protection through the reduction of potential pathways for fecal contamination in the distribution system of a public water system (PWS).

  3. Katz's revisability paradox dissolved

    NARCIS (Netherlands)

    Tamminga, Allard; Verhaegh, Sander


    Quine's holistic empiricist account of scientific inquiry can be characterized by three constitutive principles: noncontradiction, universal revisability and pragmatic ordering. We show that these constitutive principles cannot be regarded as statements within a holistic empiricist's scientific

  4. Comparative economic efficiency, operating costs and fuel consumption rates of freight transport modes between the largest industrial cities and seaports in South Africa

    Directory of Open Access Journals (Sweden)

    W J (Wessel Pienaar


    Full Text Available The paper deals with aspects of efficiency within the five modes of freight transport, with special reference to the operating cost and fuel consumption rates between South Africa’s largest industrial cities and seaports. In particular, the paper deals with (a the opportunities that exist for the achievement of efficiency in freight transport; (b the subgroups of economies that can enhance efficiency attainment in the freight transport industry; (c prevailing cost structures, operating cost and fuel consumption rates within the five modes of freight transport; and (d the salient economic features of the freight transport market. The research approach and methodology combine (a a literature survey; (b empiric research, (c an analysis of the cost structures of freight transport operators from different modes of transport; and (d interviews conducted with specialists in the freight transport industry.

  5. A Study to Compare the Cost of Operation and Maintenance in Green Building Index (GBI and Non-Green Building Index (Non-GBI Rated Building in Malaysia

    Directory of Open Access Journals (Sweden)

    Ping Lee Zheng


    Full Text Available Urges for sustainable development had pushed the government and professional bodies to respond and react by implementing regulations where possible to direct development in that manner. However, the outcome in most financial conferences and dialogues on sustainable buildings flagged on high construction and maintenance cost. Thus, this study is conducted to collect and analyze actual building operation and maintenance cost between GBI and Non-GBI rated buildings in Malaysia which are more than 2 years fully operated buildings. There are two categories of selected buildings which are residential and non-residential type of building. Each category of the building consists of similar building’s characteristic such as geographic location, mode of operation, building heights, total numbers of floors and units. The scope of building’s maintenance for this study is mainly on wear and tear of the wall painting, electrical light fittings, ceiling panels, roofing system and mechanical services like water pump system are recorded for their replacement frequency of service and the cost involved within a consistent period of 12 months operation at cost percentage saving of 78.9% and 40.4% for residential and non-residential buildings respectively compare against Non-GBI rated buildings. Electricity consumption for GBI rated buildings are lower than Non-GBI rated buildings which recorded at the cost variance of 23.8% and 6.3% and water consumption at 35.9% and 44.0% for the above mentioned two main categories of selected case study buildings. Results from this study conclude major savings on residential buildings category in term of maintenance cost and electricity consumption for GBI rated buildings. Whereby, non-residential category of buildings, GBI rated building had been proven to obtain significant savings in terms of maintenance cost and water consumption.

  6. A Formula for the Units to Satisfy an Operation's Desired Rate of Return in CVP Analysis--A Conceptual Approach (United States)

    Anderson, Johann A.; Leese, Wallace R.


    A common formula presented in many managerial- and cost-accounting textbooks makes possible the determination of the quantity of units which must be produced and sold to generate a desired dollar-amount of operating income. This article addresses the question "What formula can be used to determine the quantity of units needed to yield a…

  7. Operational nitrogen fertilizer management in dairy farming systems: identification of criteria and derivation of fertilizer application rates

    NARCIS (Netherlands)

    Vellinga, T.V.; Andre, G.; Schils, R.L.M.; Oenema, O.


    Fertilizer-nitrogen (N) management is a decisive factor in grass-based, intensive dairy farming, as it strongly influences economic and environmental performance but little attention has been paid to providing guidance on N-fertilizer management at an operational level to meet these criteria of

  8. Pyrosequencing as a tool for the detection of Phytophthora species: error rate and risk of false Molecular Operational Taxonomic Units

    NARCIS (Netherlands)

    Vettraino, A.M.; Bonants, P.J.M.; Tomassini, A.; Bruni, N.; Vannini, A.


    Aims: To evaluate the accuracy of pyrosequencing for the description of Phytophthora communities in terms of taxa identification and risk of assignment for false Molecular Operational Taxonomic Units (MOTUs). Methods and Results: Pyrosequencing of Internal Transcribed Spacer 1 (ITS1) amplicons was

  9. 14 CFR 121.405 - Training program and revision: Initial and final approval. (United States)


    ... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Training program and revision: Initial and... AND OPERATIONS OPERATING REQUIREMENTS: DOMESTIC, FLAG, AND SUPPLEMENTAL OPERATIONS Training Program § 121.405 Training program and revision: Initial and final approval. (a) To obtain initial and final...

  10. Productivity of the Regional Bell Operating Companies Under Rate-of-Return and Price-Cap Regulation


    Kelly, Tracey Elizabeth


    In 1991, the Federal Communications Commission began regulating the tariffed rates of the nation's largest local exchange carriers under a new regulatory scheme: price-cap regulation. Price caps were intended to "remedy" the ills of traditional rate-of-return regulation. They were to provide incentive for the telephone companies to adopt innovative technology, cost-cutting measures and provide telephone services more efficiently. To test the effectiveness of this incentive, this study exami...

  11. Multinational telecommunications operators : impact of market factors and foreign currency exchange rate variations in their stock returns


    Oliveira, Maria da Conceição T. F. Monteiro H.


    Mestrado em Finanças Firms are exposed to foreign exchange risk when the results of their projects depend on future exchange rates and those exchange rates can not be fully anticipated. Through the last 50 years, exchange risk management has received increasing attention in both corporate practice and literature. Firms are also exposed to other market factors, domestic and internationally, with a major impact on their stock returns. During the past decade the telecommunications sector has ...

  12. Operator-Adjustable Frame Rate, Resolution, and Gray Scale Tradeoff in Fixed-Bandwidth Remote Manipulator Control. (United States)


    easier. During the Campeche blowout, both a manned and an unmanned submersible were sent for. The remotely controlled TREAC submersible was loaded...hose into a socket would be easiest with high resolution and * relatively low gray scale and frame rate, while selecting the blue valve from a bank of

  13. A System-Wide Approach to Physician Efficiency and Utilization Rates for Non-Operating Room Anesthesia Sites. (United States)

    Tsai, Mitchell H; Huynh, Tinh T; Breidenstein, Max W; O'Donnell, Stephen E; Ehrenfeld, Jesse M; Urman, Richard D


    There has been little in the development or application of operating room (OR) management metrics to non-operating room anesthesia (NORA) sites. This is in contrast to the well-developed management framework for the OR management. We hypothesized that by adopting the concept of physician efficiency, we could determine the applicability of this clinical productivity benchmark for physicians providing services for NORA cases at a tertiary care center. We conducted a retrospective data analysis of NORA sites at an academic, rural hospital, including both adult and pediatric patients. Using the time stamps from WiseOR® (Palo Alto, CA), we calculated site utilization and physician efficiency for each day. We defined scheduling efficiency (SE) as the number of staffed anesthesiologists divided by the number of staffed sites and stratified the data into three categories (SE 1). The mean physician efficiency was 0.293 (95% CI, [0.281, 0.305]), and the mean site utilization was 0.328 (95% CI, [0.314, 0.343]). When days were stratified by scheduling efficiency (SE 1), we found differences between physician efficiency and site utilization. On days where scheduling efficiency was less than 1, that is, there are more sites than physicians, mean physician efficiency (95% CI, [0.326, 0.402]) was higher than mean site utilization (95% CI, [0.250, 0.296]). We demonstrate that scheduling efficiency vis-à-vis physician efficiency as an OR management metric diverge when anesthesiologists travel between NORA sites. When the opportunity to scale operational efficiencies is limited, increasing scheduling efficiency by incorporating different NORA sites into a "block" allocation on any given day may be the only suitable tactical alternative.

  14. Correlation between erythropoietic activity and body growth rate in hypertransfused polycythemic growing rats as the result of an erythropoietin-dependent operating mechanism

    Energy Technology Data Exchange (ETDEWEB)

    Bozzini, C.E.; Alippi, R.M.; Barcelo, A.C.; Caro, J.


    The established relationship between erythropoietic activity and body growth rate in the polycythemic growing rat could be the result of either an erythropoietin (EPO)-dependent or an EPO-independent operating mechanism. The present study was thus undertaken to elucidate the nature of the aforementioned mechanism by assessing the ratio between plasma immunoreactive EPO (iEPO) concentration and erythropoietic activity in young hypertransfused rats for different body growth rates. Red blood cell (RBC)-59Fe uptake was about 75% in 21-day-old rats; it rapidly decreased with time when the animals were placed on a protein-free diet, approaching a level of about 1% by the 10th day of protein starvation. Over the same period plasma iEPO decreased from 55 mU/ml to 7 mU/ml. Body growth rate was 0. Following this ''protein depletion period'' the rats received diets containing different amounts of casein (''protein repletion period'') added isocalorically to the protein-free diet to elicit a rise in body growth rate. Statistically significant relationships (p less than 0.001) were found between dietary casein concentration and body growth rate (r = 0.991), dietary casein concentration and RBC-59Fe uptake (r = 0.991), dietary casein concentration and plasma iEPO level (r = 0.992), body growth rate and RBC-59Fe (r = 0.986), and body growth rate and plasma iEPO level (r = 0.994) in hypertransfused polycythemic rats during the protein repletion period. These findings suggest that the correlation between erythropoietic activity and growth rate in the growing rat is the result of an erythropoietin-dependent operating mechanism, which appears to be independent of the ratio tissue oxygen supply/tissue oxygen demand.

  15. Pre-asymptotic response rates as a function of the delay-of-reinforcement gradient summation for Catania's Operant Reserve: A reply to Berg & McDowell (2011). (United States)

    Li, Don; Elliffe, Douglas; Hautus, Michael J


    Catania's Operant Reserve (COR; Catania, 2005) is a computational model of operant behaviour. In COR, responding depletes the reserve while reinforcement replenishes the reserve. The replenishment to the reserve depends on the location of responses within the most recent inter-reinforcement interval. The rule that maps replenishment to the responses within an inter-reinforcement interval is given by a delay-of-reinforcement gradient (DOR). Previous research (Berg and McDowell, 2011) found that non-linear DORs produce sigmoidal response rates on single variable-interval schedules while a linear DOR produces hyperbolic response rates. Berg and McDowell took these sigmoidal response rates as evidence against the viability of COR for modelling variable-interval performance. However, Berg and McDowell did not consider the effect of the slope of each DOR. The present conjecture is that the response rates from COR can be made hyperbolic by manipulating the area under the DOR. Our results show that the manipulation of the area under the DOR allows COR to produce hyperbolic response rates regardless of the parametric form of the DOR. Hence, if COR is to be used to model single variable-interval performance, the reinforcement effect over time should be taken into consideration through the manipulation of the area under the DOR. Copyright © 2017 Elsevier B.V. All rights reserved.

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

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


    To investigate whether magnetic resonance imaging (MRI) changes the management of patients with screen-detected invasive lobular carcinoma (ILC). A retrospective, controlled, single-centre analysis of 138 cases of screen-detected ILC was performed. All patients were assessed by a single multidisciplinary team as to whether preoperative MRI altered the initial management decision or reduced re-operation rates. Forty-three percent of patients had preoperative MRI. MRI guided surgical management in 40.7% patients. Primary mastectomy rates were not significantly different between the MRI and non-MRI groups (32% and 30% respectively, p=0.71). The MRI group had a lower secondary surgery rate (6.8% versus 15.2%); however, the results did not reach statistical significance, and there were no unnecessary mastectomies. MRI can be used appropriately to guide primary surgery in screen-detected ILC cases and affects the initial management decision in 40.7% of patients. It does not significantly affect the overall mastectomy rate or re-operation rates, but reduces the likelihood of the latter. As a result of this review, the authors' local policy for the use of MRI in screen-detected ILC patients has been modified. For patients undergoing mastectomy for ILC, MRI is no longer performed routinely to search for contralateral malignancy as this has no proven added benefit. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  17. Rate of epithelialisation and re-operations in corneal ulcers treated with amniotic membrane transplantation combined with botulinum toxin-induced ptosis. (United States)

    Fuchsluger, Thomas; Tuerkeli, Emre; Westekemper, Henrike; Esser, Joachim; Steuhl, Klaus-Peter; Meller, Daniel


    To examine the efficacy of amniotic membrane transplantation (AMT) and/or botulinum toxin type A-induced ptosis (Dysport) in the treatment of corneal ulcerations of different entities. Retrospective evaluation of 137 cases of corneal ulcers which have been treated with AMT, botulinum toxin type A and perforating keratoplasty (pKP). Regarding corneal ulcerations the patients were divided into three groups: group A, patients initially having received an AMT (92 eyes eventually followed by AMT or pKP as a second intervention); group B, patients initially having received an AMT (32 eyes followed by botulinum toxin type A injection in the upper lid as a second intervention); group C, patients initially treated only by botulinum toxin type A injection (13 eyes followed occasionally by AMT or pKP or additional botulinum toxin type A injection). Additionally, we analysed the complete epithelialisation rate of the ocular surface in respect to different ocular and systemic diseases and compared the frequency of re-operations in each group. The overall follow-up was 14.2 (+/-14.7 months; range from 1 to 60 months). The total frequency of re-operations was 45.3% (overall time until complete epithelialisation 12.7 (+/-6.1) days). If the patient was initially treated with an AMT (group A), the re-operation rate was 44.6%. Treating affected eyes in this group with a subsequent amniotic membrane resulted in a reduction of re-operation rate to 30.4%. In cases with induced ptosis by injecting botulinum toxin type A in the M. levator palpebrae (group B), the re-operation frequency could be reduced to 34.4% with similar times of epithelialisation [group A: 12.0 (+/-6.5) days and group B: 11.7 (+/-5.5) days]. In group C, with botulinum toxin type A alone initially, the re-operation rate of 69.2% was the highest one compared with groups A and B; this rate could be drastically reduced by a following AMT to 23.1%. Surprisingly, in the few successful cases with botulinum toxin type A alone

  18. Microbial Population Dynamics and Ecosystem Functions of Anoxic/Aerobic Granular Sludge in Sequencing Batch Reactors Operated at Different Organic Loading Rates. (United States)

    Szabó, Enikö; Liébana, Raquel; Hermansson, Malte; Modin, Oskar; Persson, Frank; Wilén, Britt-Marie


    The granular sludge process is an effective, low-footprint alternative to conventional activated sludge wastewater treatment. The architecture of the microbial granules allows the co-existence of different functional groups, e.g., nitrifying and denitrifying communities, which permits compact reactor design. However, little is known about the factors influencing community assembly in granular sludge, such as the effects of reactor operation strategies and influent wastewater composition. Here, we analyze the development of the microbiomes in parallel laboratory-scale anoxic/aerobic granular sludge reactors operated at low (0.9 kg m -3 d -1 ), moderate (1.9 kg m -3 d -1 ) and high (3.7 kg m -3 d -1 ) organic loading rates (OLRs) and the same ammonium loading rate (0.2 kg NH 4 -N m -3 d -1 ) for 84 days. Complete removal of organic carbon and ammonium was achieved in all three reactors after start-up, while the nitrogen removal (denitrification) efficiency increased with the OLR: 0% at low, 38% at moderate, and 66% at high loading rate. The bacterial communities at different loading rates diverged rapidly after start-up and showed less than 50% similarity after 6 days, and below 40% similarity after 84 days. The three reactor microbiomes were dominated by different genera (mainly Meganema, Thauera, Paracoccus , and Zoogloea ), but these genera have similar ecosystem functions of EPS production, denitrification and polyhydroxyalkanoate (PHA) storage. Many less abundant but persistent taxa were also detected within these functional groups. The bacterial communities were functionally redundant irrespective of the loading rate applied. At steady-state reactor operation, the identity of the core community members was rather stable, but their relative abundances changed considerably over time. Furthermore, nitrifying bacteria were low in relative abundance and diversity in all reactors, despite their large contribution to nitrogen turnover. The results suggest that the OLR

  19. Is the operative delivery rate in low-risk women dependent on the level of birth care? : a randomised controlled trial


    Bernitz, Stine; Rolland, Rune; Blix, Ellen; Jacobsen, Morten; Sjøborg, Katrine Dønvold; Øian, Pål


    Objective: To investigate possible differences in operative delivery rate among low-risk women, randomised to an alongside midwifery-led unit or to standard obstetric units within the same hospital. Design: Randomised controlled trial. Setting: Department of Obstetrics and Gynaecology, Østfold Hospital Trust, Tromsø, Norway. Population: A total of 1111 women assessed to be at low risk at onset of spontaneous labour. Methods: Randomisation into one of three birth units: the special...

  20. Thin film organic photodetectors for indirect X-ray detection demonstrating low dose rate sensitivity at low voltage operation

    Energy Technology Data Exchange (ETDEWEB)

    Starkenburg, Daken J. [Department of Materials Science and Engineering, University of Florida, Gainesville, Florida 32611, USA; Johns, Paul M. [Nuclear Engineering Program, University of Florida, Gainesville, Florida 32611, USA; Detection Systems Group, Pacific Northwest National Laboratory, Richland, Washington 99354, USA; Baciak, James E. [Department of Materials Science and Engineering, University of Florida, Gainesville, Florida 32611, USA; Nuclear Engineering Program, University of Florida, Gainesville, Florida 32611, USA; Nino, Juan C. [Department of Materials Science and Engineering, University of Florida, Gainesville, Florida 32611, USA; Xue, Jiangeng [Department of Materials Science and Engineering, University of Florida, Gainesville, Florida 32611, USA


    Developments in the field of organic semiconductors have generated organic photodetectors with high quantum efficiency, wide spectral sensitivity, low power consumption, and unique form factors that are flexible and conformable to their substrate shape. In this work, organic photodetectors coupled with inorganic CsI(Tl) scintillators are used to showcase the low dose rate sensitivity that is enabled when high performance organic photodetectors and scintillator crystals are integrated. The detection capability of these organic-inorganic coupled systems to high energy radiation highlights their potential as an alternative to traditional photomultiplier tubes for nuclear spectroscopy applications. When exposed to Bremsstrahlung radiation produced from an X-ray generator, SubPc:C60, AlPcCl:C70, and P3HT:PC61BM thin film photodetectors with active layer thicknesses less than 100 nm show detection of incident radiation at low and no applied bias. Remarkably low dose rates, down to at least 0.28 µGy/s, were detectable with a characteristic linear relationship between exposure rate and photodetector current output. These devices also demonstrate sensitivities as high as 5.37 mC Gy-1 cm-2 when coupled to CsI(Tl). Additionally, as the tube voltage across the X-ray generator was varied, these organic-inorganic systems showed their ability to detect a range of continuous radiation spectra spanning several hundred keV.

  1. Thin film organic photodetectors for indirect X-ray detection demonstrating low dose rate sensitivity at low voltage operation (United States)

    Starkenburg, Daken J.; Johns, Paul M.; Baciak, James E.; Nino, Juan C.; Xue, Jiangeng


    Developments in the field of organic semiconductors have generated organic photodetectors with high quantum efficiency, wide spectral sensitivity, low power consumption, and unique form factors that are flexible and conformable to their substrate shape. In this work, organic photodetectors coupled with inorganic CsI(Tl) scintillators are used to showcase the low dose rate sensitivity that is enabled when high performance organic photodetectors and scintillator crystals are integrated. The detection capability of these organic-inorganic coupled systems to high energy radiation highlights their potential as an alternative to traditional photomultiplier tubes for nuclear spectroscopy applications. When exposed to Bremsstrahlung radiation produced from an X-ray generator, SubPc:C60, AlPcCl:C70, and P3HT:PC61BM thin film photodetectors with active layer thicknesses less than 100 nm show detection of incident radiation at low and no applied bias. Remarkably low dose rates, down to at least 0.18 μGy/s, were detectable with a characteristic linear relationship between exposure rate and photodetector current output. These devices also demonstrate sensitivities as high as 5.37 mC Gy-1 cm-2 when coupled to CsI(Tl). Additionally, as the tube voltage across the X-ray generator was varied, these organic-inorganic systems showed their ability to detect a range of continuous radiation spectra spanning several hundred keV.

  2. Higher risk of revision for infection using systemic clindamycin prophylaxis than with cloxacillin. (United States)

    Robertsson, Otto; Thompson, Olof; W-Dahl, Annette; Sundberg, Martin; Lidgren, Lars; Stefánsdóttir, Anna


    Background and purpose - Clindamycin has not been compared with other antibiotics for prophylaxis in arthroplasty. Since 2009, the Swedish Knee Arthroplasty Register (SKAR) has been collecting information on the prophylactic antibiotic regime used at every individual operation. In Sweden, when there is allergy to penicillin, clindamycin has been the recommended alternative. We examined whether there were differences in the rate of revision due to infection depending on which antibiotic was used as systemic prophylaxis. Patients and methods - Patients who had a total knee arthroplasty (TKA) performed due to osteoarthritis (OA) during the years 2009-2015 were included in the study. Information on which antibiotic was used was available for 80,018 operations (55,530 patients). Survival statistics were used to calculate the rate of revision due to infection until the end of 2015, comparing the group of patients who received cloxacillin with those who received clindamycin as systemic prophylaxis. Results - Cloxacillin was used in 90% of the cases, clindamycin in 7%, and cephalosporins in 2%. The risk of being revised due to infection was higher when clindamycin was used than when cloxacillin was used (RR =1.5, 95% CI: 1.2-2.0; p = 0.001). There was no significant difference in the revision rate for other causes (p = 0.2). Interpretation - We advise that patients reporting allergic reaction to penicillin should have their allergic history explored. In the absence of a clear history of type-I allergic reaction (e.g. urticaria, anaphylaxis, or bronchospasm), we suggest the use of a third-generation cephalosporin instead of clindamycin as perioperative prophylaxis when undergoing a TKR. No recommendation can be given regarding patients with type-1 allergy.

  3. Outcomes of Constrained Prostheses in Primary and Revision TKR (United States)

    Parkinson, Ben; Lorimer, Michelle; Lewis, Peter


    Introduction: The decision to use varus/valgus constrained or hinge knee prostheses in complex Total Knee Replacement (TKR) cases is difficult. There are few publications that compare survival rates, to aid this decision-making. This study compares the survival rates of unlinked fully constrained and hinge constrained prostheses in the primary and revision settings. Methods: Data from the AOANJRR to 31st of December 2013 was analysed to determine the survival rate of unlinked and hinge constrained TKR in the primary and revision settings (excluding the diagnosis of tumour and infection). Only first-time revisions of a known primary TKR were included in the revision analysis. Kaplan-Meier estimates of survivorship were calculated for the two categories of constraint and were matched for age and diagnosis in both primary and revision TKR situations. Hazard ratios using the Cox proportional-hazards model were used. The survivorship of individual prosthesis models was determined. Results: There were 3237 prostheses implanted during the study period that met the inclusion criteria. Of these, 1896 were for primary TKR and 1341 for revision TKR. There were 1349 unlinked fully constrained and 547 hinge prostheses for primary TKR and 991 unlinked fully constrained and 350 hinge prostheses for revision TKR. In both the primary and revision settings when matched by age, there was no difference in rates of revision for either level of constraint. When matched by indication in the primary setting, there was no difference in the rates of revision for either level of constraint. The rate of revision for both categories of constrained prosthesis was significantly higher in younger patients <55 years of age (p < 0.05). There were no differences in survival rates of individual models of constrained TKR. Conclusions: The survival rates of unlinked constrained and hinge knee prostheses are similar when matched by age or diagnosis. In complex TKR instability cases, surgeons should feel

  4. Revision to malabsorptive Roux-en-Y gastric bypass (MRNYGBP) provides long-term (10 years) durable weight loss in patients with failed anatomically intact gastric restrictive operations: long-term effectiveness of a malabsorptive Roux-en-Y gastric bypass in salvaging patients with poor weight loss or complications following gastroplasty and adjustable gastric bands. (United States)

    Srikanth, Myur Srinivasan; Oh, Ki Hyun; Fox, Samuel Ross


    Twenty percent of gastric restrictive operations require revision. Conversion to Proximal Roux-en-Y gastric bypass (PRNYGBP) is associated with weight regain. Forty-one percent of these fail to achieve a body mass index (BMI) gastric restrictive operation (S1) at least a year out from revision (S2) to a MRNYGBP: small lesser curve 22 ± 10 (11-55) cm(3) pouch, long biliopancreatic limb, 150 cm alimentary limb, 141 ± 24 (102-190) cm common channel. Staple-line disruptions were excluded. Thirty-eight (37 F, 1 M) patients aged 46 ± 8 (17-56) years underwent conversion to a MRYGBP 8 ± 5 (2-23) years after: gastroplasty 25, adjustable gastric band 13 for weight regain (79%), gastroesophageal reflux disease (GERD; 29%), and band problems (24%). S1 provided only 24 ± 25% excess weight loss (EWL; 5.9 ± 6.3 BMI drop) and caused GERD in 32% of patients (p = 0.0124). There were no deaths or leaks. BMI dropped from 41.4 ± 7.8 to 27.3 ± 5.6 (down 20.5 ± 8.3 from S1), 80.1 ± 23.3% EWL (n = 32) at year 1 (p gastric restrictive operations. Non-compliant patients are at a higher risk for malnutrition, anemia, and osteoporosis.

  5. Harmonized Tariff Schedule of the United States (2015) - Revision 1 (United States)

    US International Trade Commission — This dataset is the 2015 Harmonized Tariff Schedule Revision 1 effective July 1, 2015. It provides the applicable tariff rates and statistical categories for all...

  6. Study of long-term sustained operation of gaseous detectors for the high rate environment in CMS

    CERN Document Server

    AUTHOR|(INSPIRE)INSPIRE-00366989; Sharma, Archana

    The muon system of CMS aims to provide an efficient and fast identification of the muons produced in the proton-proton collisions. However, the forward region of the end-caps is only instrumented with Cathode Strip Chambers. This lack of redundancy will be problematic after the high-luminosity upgrade of the LHC (HL-LHC), for which the increase of the background rate would degrade the Level-1 trigger performance and thus the selection of interesting physics channels. The goal of the CMS muon upgrade is to maintain the L1 trigger rate with maximum selection efficiency in order to fully exploit the HL-LHC. The CMS GEM Collaboration has proposed to instrument the vacant high-eta region of the muon end-caps with Gas Electron Multiplier (GEM) detectors, called GE1/1 chambers. The Ph.D. subject proposed by the CMS GEM Collaboration aims to demonstrate that the GE1/1 technology is the most suitable choice for the upgrade of the muon end-caps. Three main research projects were conducted in this context. The first pro...

  7. Revising and editing for translators

    CERN Document Server

    Mossop, Brian


    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...

  8. Revision without ordinals

    NARCIS (Netherlands)

    Rivello, Edoardo


    We show that Herzberger’s and Gupta’s revision theories of truth can be recast in purely inductive terms, without any appeal neither to the transfinite ordinal numbers nor to the axiom of Choice. The result is presented in an abstract and general setting, emphasising both its validity for a wide

  9. Revision of Meiogyne (Annonaceae)

    NARCIS (Netherlands)

    Heusden, van E.C.H.


    In the present revision of Meiogyne (Annonaceae) nine species are recognized, of which one is new, M. glabra; five new combinations are made; M. hainanensis is re-established. Meiogyne in its new sense includes the former genera Ancana, Chieniodendron, Guamia, Meiogyne, Oncodostigma, and Polyaulax.

  10. Revising China's Environmental Law

    NARCIS (Netherlands)

    He, G.; Zhang, L.; Mol, A.P.J.; Lu, Y.; Liu, Wenling; Liu, J.


    China's Environmental Protection Law (EPL) is the main national environmental legislative framework. Yet the environmental legal system is incomplete, and implementation and enforcement of environmental laws have shown major shortcomings (1–3). A controversial attempt to revise the EPL could have

  11. Belief and Its Revision

    NARCIS (Netherlands)

    Bewersdorf, Benjamin


    The role of experience for belief revision is seldom explicitly discussed. This is surprising as it seems obvious that experiences play a major role for most of our belief changes. In this work, the two most plausible views on the role of experience for belief change are investigated: the view that

  12. Digital holographic interferometry accelerated with GPU: application in mechanical micro-deformation measurement operating at video rate (United States)

    Múnera Ortiz, N.; Trujillo, C. A.; García-Sucerquia, J.


    The quantification of the deformations presented by mechanical parts is a useful tool for several applications in engineering; regularly this quantification is performed a posteriori. In this work, a digital holographic interferometer for measuring micro-deformation at video rate is presented. The interferometer is developed with the use of the parallel paradigm of CUDA™ (Compute Unified Device Architecture). A commercial Graphics Processor Unit (GPU) is used to accelerate phase processing from the recorded holograms. The proposed method can process record holograms of 1024x1024 pixels in 48 milliseconds. At the best performance of the method, it processes 21 frames per second (FPS). This benchmark surpasses 133-times the best performance of the method on a regular CPU.

  13. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period. (United States)


    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the

  14. Orthogonality and Hecke operators

    Indian Academy of Sciences (India)

    E-mail:; MS received 16 January 2006; revised 21 April 2009. Abstract. In this article we analyze orthogonality relations between old forms and the connection to the theory of Hecke operators. Keywords. Hecke operator; eigenvalue; orthogonality; Atkin–Lehner ...

  15. 78 FR 59982 - Revisions to Radiation Protection (United States)


    ...The U.S. Nuclear Regulatory Commission (NRC) is issuing final revisions to the following sections of NUREG-0800, ``Standard Review Plan for the Review of Safety Analysis Reports for Nuclear Power Plants: LWR Edition'': Section 12.1, ``Assuring that Occupational Radiation Exposures Are As Low As Is Reasonably Achievable,'' Section 12.2, ``Radiation Sources,'' Section 12.3 -12.4, ``Radiation Protection Design Features,'' and Section 12.5, ``Operational Radiation Protection Program.''

  16. [Post-operative cardiac rehabilitation programs for early returning to daily life activities: self-measurement of heart rate and blood pressure during staying at home trial]. (United States)

    Nagashio, Mami; Suzuki, Yoshiko; Onishi, Yumiko; Tomatsu, Ayumi; Shimada, Yoko; Okamura, Shizuko; Shirai, Midori


    Recently, early mobilization and discharge after cardiac surgery have been recommended. However, many patients are anxious about returning to daily life soon after undergoing heart operations. To resolve this problem, an individualized rehabilitation plan for each patient is important. Rehabilitation programs must estimate the level of cardiac function in daily life. This study evaluated self-measurements of heart rate and blood pressure during home-based exercise training. Thirty-six patients, 28 men and 8 women (mean age 58 +/- 19 years) who underwent cardiac operations were enrolled in this study. None of the patients experienced postoperative complications. Changes in heart rate and blood pressure during daily activities at home were measured by the patients. This data was then used to plan individual rehabilitation programs. The blood pressure rose from 114 +/- 17 to 139 +/- 21 mmHg (mean increase of 25 +/- 15 mmHg) when the patients were asked to walk up and down a set of stairs. Thirteen patients (36%) exhibited an increase in blood pressure of 30 mmHg or more while ascending the stairs. The patients' blood pressure returned to its pre-exercise level after 5 min. The heart rate rose from 84 +/- 15 to 113 +/- 14 beats/min (mean increase of 29 +/- 8 beats/min) during the exercise. During the home-based training period, the maximum blood pressure was 133 +/- 22 mmHg, and the maximum heart rate was 97 +/- 13 beats/min. The patients were very careful during their trial outpatient period, as this was their first post-cardiac surgery experience. Consequently, the degree of exercise at home was even more mild than in hospital. Self-measurement of heart rate and blood pressure was feasible. By referring to these measurements, the patients were able to monitor and increase their level of exercise. This post-cardiac surgery rehabilitation program is helpful for early returning to daily life activities.

  17. Effect of organic loading rate on the stability, operational parameters and performance of a secondary upflow anaerobic sludge bed reactor treating piggery waste. (United States)

    Sánchez, E; Borja, R; Travieso, L; Martín, A; Colmenarejo, M F


    A study of anaerobic digestion of piggery wastewater was carried out in a laboratory-scale sludge bed reactor as a secondary treatment. The effect of organic volumetric loading rates (BV) in the range of 1.0-8.1 g TCOD/ld on the process performance was evaluated. The best results were obtained at BV equal to or lower than 4 g TCOD/ld. At higher BV values, the removal efficiency of the process decreased suddenly. A linear relationship was found between the effluent SCOD and the TVFA/alkalinity ratio (P). A relationship was found among the different operational variables (BV , removal efficiency, effluent soluble COD, soluble COD removal rate (R), retention factor (phi), specific microbial growth rate (mu), methane production rate per volume of reactor and per volume of waste treated--QM and qM, respectively) and the corresponding regression equations were obtained. An increase of BV determined a decrease of removal efficiency, phi and qM and an increase of effluent soluble COD, mu, R and QM. The value of the maximum specific microbial growth rate (muM) determined through the equation that correlated BV and mu was found to be 0.19 d(-1). This value was of the same magnitude as those reported in other works of anaerobic digestion of piggery waste.

  18. Long-term outcomes of cement in cement technique for revision endoprosthesis surgery. (United States)

    Bernthal, Nicholas M; Hegde, Vishal; Zoller, Stephen D; Park, Howard Y; Ghodasra, Jason H; Johansen, Daniel; Eilber, Frederick; Eilber, Fritz C; Chandhanayingyong, Chandhanarat; Eckardt, Jeffrey J


    Cemented endoprosthetic reconstruction after resection of primary bone sarcomas has been a standard-of-care option for decades. With increased patient survival, the incidence of failed endoprostheses requiring revision surgery has increased. Revision of cemented endoprotheses by cementing into the existing cement mantle (CiC) is technically demanding. This is a retrospective review of our endoprosthesis database of 512 consecutive cemented endoprosthetic reconstructions performed for oncologic diagnoses between 1980 and 2014. A total of 54 implants (mean patient age 32 years, range 13-81) were revised with a CiC technique. Outcomes evaluated were prosthesis survival, revision surgery categorized according to the Henderson Failure Mode Classification, complications, and functional scores. Fifteen-year Kaplan-Meier survival rate was 34% for initial revision and 39% for subsequent revision implants. Mean revised Musculoskeletal Tumor Society (MSTS) Score was 27 at latest follow-up. Infection rate was 2%, 9%, and 13% for primary endoprostheses, initial revisions, and subsequent revisions, respectively. Limb salvage rate was 87%. At long-term follow up, endoprostheses revised with the CiC technique showed consistent 15-year survival from initial (34%) to subsequent (39%) revision. Despite a relatively high failure rate, these results are encouraging and demonstrate that this is a conservative, repeatable technique. © 2017 Wiley Periodicals, Inc.

  19. Does rating the operation videos with a checklist score improve the effect of E-learning for bariatric surgical training? Study protocol for a randomized controlled trial. (United States)

    De La Garza, Javier Rodrigo; Kowalewski, Karl-Friedrich; Friedrich, Mirco; Schmidt, Mona Wanda; Bruckner, Thomas; Kenngott, Hannes Götz; Fischer, Lars; Müller-Stich, Beat-Peter; Nickel, Felix


    Laparoscopic training has become an important part of surgical education. Laparoscopic Roux-en-Y gastric bypass (RYGB) is the most common bariatric procedure performed. Surgeons must be well trained prior to operating on a patient. Multimodality training is vital for bariatric surgery. E-learning with videos is a standard approach for training. The present study investigates whether scoring the operation videos with performance checklists improves learning effects and transfer to a simulated operation. This is a monocentric, two-arm, randomized controlled trial. The trainees are medical students from the University of Heidelberg in their clinical years with no prior laparoscopic experience. After a laparoscopic basic virtual reality (VR) training, 80 students are randomized into one of two arms in a 1:1 ratio to the checklist group (group A) and control group without a checklist (group B). After all students are given an introduction of the training center, VR trainer and laparoscopic instruments, they start with E-learning while watching explanations and videos of RYGB. Only group A will perform ratings with a modified Bariatric Objective Structured Assessment of Technical Skill (BOSATS) scale checklist for all videos watched. Group B watches the same videos without rating. Both groups will then perform an RYGB in the VR trainer as a primary endpoint and small bowel suturing as an additional test in the box trainer for evaluation. This study aims to assess if E-learning and rating bariatric surgical videos with a modified BOSATS checklist will improve the learning curve for medical students in an RYGB VR performance. This study may help in future laparoscopic and bariatric training courses. German Clinical Trials Register, DRKS00010493 . Registered on 20 May 2016.

  20. Using heart rate "Sigma sport 1300" in the operational control of special endurance cyclists of higher discharges (for example, cross-country

    Directory of Open Access Journals (Sweden)

    Voropay Sergej Nikolaevich


    Full Text Available It is shown the efficiency of the use of «Sigma Sport 1300» in operational control of special endurance athletes. The study involved 10 athletes of higher discharges. At baseline for each athlete was defined range of indicators of heart rate and intensity of the zone. It is established that the best indicators of changes in special endurance observed in the control of the intensity of objective internal performance. It is noted that the subjective assessment can be influenced by many extraneous factors: the cumulative effect of exercise, emotional athlete to the start of classes.

  1. Cumulative Revision Map


    Kim, Seungyeon; Dillon, Joshua V.; Lebanon, Guy


    Unlike static documents, version-controlled documents are edited by one or more authors over a certain period of time. Examples include large scale computer code, papers authored by a team of scientists, and online discussion boards. Such collaborative revision process makes traditional document modeling and visualization techniques inappropriate. In this paper we propose a new visualization technique for version-controlled documents that reveals interesting authoring patterns in papers, comp...

  2. Evaluation of survival rate, bone loss and post operative complication in fixed retained prosthesis with All-on-4 technique: review article

    Directory of Open Access Journals (Sweden)

    Marzieh Alikhasi


    Full Text Available   Background and Aims The purpose of this study was to evaluate the survival rate, mean bone loss and post operative complication of implants inserted in All-on-4 technique .   Materials and Methods: The literature was searched using keywords angled implant, All-on-4, tilted implant and graftless technique in the last 10 years (2001 to 2011 and clinical trial article that evaluated survival rate and mean bone loss around axial and tilted implants in All-on-4 technique was selected and evaluated.   A total of 73 articles were found by searching. After evaluation of titles and abstracts, finally 10 clinical trial, that were fully consistent with including criteria such as mean of bone loss and survival rate was selected and evaluated.   Conclusion: Results showed that the survival rate (96-100% and mean bone loss (0.34-1.9 mm with All-on-4 technique in immediate loading is comparable with other implant support treatment plan. Comparison of implant survival and bone loss in axial and tilted implant in All-on-4 system is shown this treatment plan has consistent result with other conventional implant support prosthesis. Also, postoperative complication including fractures of the acrylic temporary prosthesis, detachment of the teeth, abutment or prosthesis screw loosening have been reported with All-on-4 technique.

  3. Pilot-scale comparison of constructed wetlands operated under high hydraulic loading rates and attached biofilm reactors for domestic wastewater treatment. (United States)

    Fountoulakis, M S; Terzakis, S; Chatzinotas, A; Brix, H; Kalogerakis, N; Manios, T


    Four different pilot-scale treatment units were constructed to compare the feasibility of treating domestic wastewater in the City of Heraklio, Crete, Greece: (a) a free water surface (FWS) wetland system, (b) a horizontal subsurface flow (HSF) wetland system, (c) a rotating biological contactor (RBC), and (d) a packed bed filter (PBF). All units operated in parallel at various hydraulic loading rates (HLR) ranging from 50% to 175% of designed operating HLR. The study was conducted during an 8 month period and showed that COD removal efficiency of HSF was comparable (>75%) to that of RBC and PBF, whereas that of the FWS system was only 57%. Average nutrient removal efficiencies for FWS, HSF, RBC and PBF were 6%, 21%, 40% and 43%, respectively for total nitrogen and 21%, 39%, 41% and 42%, respectively for total phosphorus. Removals of total coliforms were lowest in FWS and PBF (1.3 log units) and higher in HSF and RBC (2.3 to 2.6 log units). HSF showed slightly lower but comparable effluent quality to that of RBC and PBF systems, but the construction cost and energy requirements for this system are significantly lower. Overall the final decision for the best non-conventional wastewater treatment system depends on the construction and operation cost, the area demand and the required quality of effluent.

  4. Pilot-scale comparison of constructed wetlands operated under high hydraulic loading rates and attached biofilm reactors for domestic wastewater treatment

    Energy Technology Data Exchange (ETDEWEB)

    Fountoulakis, M.S. [School of Agricultural Technology, Technological Educational Institute of Crete, Heraklion (Greece)], E-mail:; Terzakis, S. [School of Agricultural Technology, Technological Educational Institute of Crete, Heraklion (Greece); Department of Environmental Engineering, Technical University of Crete, Chania (Greece); Chatzinotas, A. [UFZ, Helmholtz Centre for Environmental Research - UFZ, Department of Environmental Microbiology, Permoserstrasse 15, D-04318 Leipzig (Germany); Brix, H. [Department of Biological Sciences, Aarhus University (Denmark); Kalogerakis, N. [Department of Environmental Engineering, Technical University of Crete, Chania (Greece); Manios, T. [School of Agricultural Technology, Technological Educational Institute of Crete, Heraklion (Greece); Greek Open University, School of Science and Technology, Patras (Greece)


    Four different pilot-scale treatment units were constructed to compare the feasibility of treating domestic wastewater in the City of Heraklio, Crete, Greece: (a) a free water surface (FWS) wetland system, (b) a horizontal subsurface flow (HSF) wetland system, (c) a rotating biological contactor (RBC), and (d) a packed bed filter (PBF). All units operated in parallel at various hydraulic loading rates (HLR) ranging from 50% to 175% of designed operating HLR. The study was conducted during an 8 month period and showed that COD removal efficiency of HSF was comparable (> 75%) to that of RBC and PBF, whereas that of the FWS system was only 57%. Average nutrient removal efficiencies for FWS, HSF, RBC and PBF were 6%, 21%, 40% and 43%, respectively for total nitrogen and 21%, 39%, 41% and 42%, respectively for total phosphorus. Removals of total coliforms were lowest in FWS and PBF (1.3 log units) and higher in HSF and RBC (2.3 to 2.6 log units). HSF showed slightly lower but comparable effluent quality to that of RBC and PBF systems, but the construction cost and energy requirements for this system are significantly lower. Overall the final decision for the best non-conventional wastewater treatment system depends on the construction and operation cost, the area demand and the required quality of effluent.

  5. Long-term results of 56 revision total knee replacements. (United States)

    Gustilo, T; Comadoll, J L; Gustilo, R B


    Fifty-six consecutive revised total knee arthroplasties (TKA) were followed for an average of 8.3 years (range: 3 to 15 years). The purpose of this study was to evaluate the results of revision TKA to determine any trends in either the good outcomes or the failures. We found that the success rate for revision TKA was comparable to that for primary TKA. Eighty-nine percent of the knees rated at least fair, with 73% of these rating good or excellent, and 4% poor result. Moreover, the findings suggest that if prostheses are aligned correctly at implantation, there is only slight deterioration in their performance over time. Outcome was not affected by the type of prosthesis used in either the previous surgery or the revision. There is a correlation between the number of revisions and the functional knee rating; the more revisions, the less chance for success. There was also a direct correlation between varus knee alignment and significant increased incidence of failure. No appreciable difference was found between degenerative arthritis patients and rheumatoid patients, except that the rheumatoid patients had a higher incidence of delayed infections.

  6. Revision of Minimally Invasive Sacroiliac Joint Fixation: Technical Considerations and Case Studies Using Decortication and Threaded Implant Fixation. (United States)

    MenMuir, Brett; Fielding, Louis C


    Sacroiliac joint (SIJ) disease is increasingly recognized as a common source of low back pain. Arthrodesis of the SIJ has been shown to be clinically effective for this condition. In the last decade, minimally invasive (MI) SIJ fusion procedures have been developed to achieve the clinical effectiveness of open fusion procedures, with lower operative morbidity and faster recovery. However, SIJ fusion patients occasionally present with symptomatic nonunions necessitating revision. Four patients who previously underwent MI SIJ arthrodesis returned with complaints of SIJ related pain confirmed by examination. Radiographic assessment showed lucency after fixation with triangular titanium interference implants. Loose implants were removed, and the patients were revised with a different MI SIJ fusion system that utilizes decortication, placement of autograft and graft extender, and fixation with cannulated threaded implants. The trajectory of the revision implants was in a more ventral-to-dorsal and caudal-to-cranial trajectory to place the implants perpendicularly through the articular portion of the SIJ. The triangular implants typically exhibited haloing lucency on radiographs and CT scans, and most were easily removed using the manufacturer's instrumentation; only one implant was left in place as it was well-fixed. The removed implants exhibited little or no bony ongrowth. Decortication of the SIJ was performed, followed by placement of local autograft and fixation with 12.5 mm or 14.5mm diameter implants, as required. A more ventral-todorsal and caudal-to-cranial trajectory was established for the revision implants through the center of the articular region of the joint in order to maximize implant purchase in residual bone stock and achieve bony fusion through the articular portion of the SIJ. By six to twelve months post-revision, the presenting symptoms were successfully resolved in all patients. Patients demonstrating symptomatic pseudoarthrosis after SIJ

  7. Trends in Primary and Revision Hip Arthroplasty Among Orthopedic Surgeons Who Take the American Board of Orthopedics Part II Examination. (United States)

    Eslam Pour, Aidin; Bradbury, Thomas L; Horst, Patrick K; Harrast, John J; Erens, Greg A; Roberson, James R


    A certified list of all operative cases performed within a 6-month period is a required prerequisite for surgeons taking the American Board of Orthopaedic Surgery Part II oral examination. Using the American Board of Orthopaedic Surgery secure Internet database database containing these cases, this study (1) assessed changing trends for primary and revision total hip arthroplasty (THA) and (2) compared practices and early postoperative complications between 2 groups of examinees, those with and without adult reconstruction fellowship training. Secure Internet database was searched for all 2003-2013 procedures with a Current Procedural Terminology code for THA, hip resurfacing, hemiarthroplasty, revision hip arthroplasty, conversion to THA, or removal of hip implant (Girdlestone, static, or dynamic spacer). Adult reconstruction fellowship-trained surgeons performed 60% of the more than 33,000 surgeries identified (average 28.1) and nonfellowship-trained surgeons performed 40% (average 5.2) (P < .001). Fellowship-trained surgeons performed significantly more revision surgeries for infection (71% vs 29%)(P < .001). High-volume surgeons had significantly fewer complications in both primary (11.1% vs 19.6%) and revision surgeries (29% vs 35.5%) (P < .001). Those who passed the Part II examination reported higher rates of complications (21.5% vs 19.9%). In early practice, primary and revision hip arthroplasties are often performed by surgeons without adult reconstruction fellowship training. Complications are less frequently reported by surgeons with larger volumes of joint replacement surgery who perform either primary or more complex cases. Primary hip arthroplasty is increasingly performed by surgeons early in practice who have completed an adult reconstructive fellowship after residency training. This trend is even more pronounced for more complex cases such as revision or management of infection. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Needle revision of failed filtering blebs using 5-Fluorouracil and a combined ab-externo and ab-interno approach. (United States)

    Pasternack, James J; Wand, Martin; Shields, M Bruce; Abraham, Deepa


    To evaluate a surgical technique to revise a failed filtering bleb using subconjunctival 5-Fluorouracil with a combined ab-externo and ab-interno approach. This study is a retrospective review of the outcome of 77 consecutive bleb revisions, with greater than 6-month follow-up, performed by a single glaucoma surgeon (MW). All eyes had previously functioning filtering blebs with currently inadequately controlled intraocular pressures (IOP) prior to the bleb revisions. All surgery was performed in the operating room, using a retrobulbar injection and a microscope. Visco-elastic was injected into the anterior chamber. 5-Fluorouracil (0.1 mL; 50 mg/ml) was infiltrated around the bleb. A 30-gauge needle was used to lyse subconjunctival fibrosis and episcleral scar tissue binding down the scleral flap, and elevate the scleral flap. Through an inferior paracentesis, a cyclodialysis spatula was used to confirm and enlarge the communication with the subconjunctival space. The main outcome measurements were IOP and number of glaucoma medications. A successful outcome was defined as a 20% reduction from baseline IOP and a maximum IOP of 18 mm Hg, with or without medications, and a minimal follow-up of 6 months. 52% of patients achieved success after one revision with an average follow-up of 29.6 +/- 14.4 months. In successful cases, the mean IOP decreased from 22.7 +/- 4.5 mm Hg to 11.3 +/- 3.5 mm Hg and medications were reduced from an average of 2.2 +/- 1.1 to 0.4 +/- 0.7. Kaplan-Meier survival analysis calculated a success of 77% at 1 year, 68% at 2 years, and 58% at 3 years. In failed filtering blebs, needle revision with 5-Fluorouracil and a combined ab-externo and ab-interno approach results in high success and low complication rates. The outcome of this procedure compares favorably with previously reported revision techniques.

  9. Outcomes of revision surgery for cubital tunnel syndrome. (United States)

    Aleem, Alexander W; Krogue, Justin D; Calfee, Ryan P


    To compare both validated patient-rated and objective outcomes of patients following revision cubital tunnel surgery to a similar group of patients who underwent primary surgery. This case-control investigation enrolled 56 patients treated surgically for cubital tunnel syndrome (28 revision cases, 28 primary controls) at a tertiary center. Patients with a minimum of 2 years of follow-up were eligible. All patients completed an in-office study evaluation. Revision participants represented 55% of potential patients in our practice and controls (treated only with primary surgery) were chosen at random from our practice to reach a 1:1 case to control ratio. Preoperative McGowan grading was confirmed similar between the groups. Outcome measures included validated patient outcome questionnaires (Patient-Rated Elbow Evaluation, Levine-Katz questionnaire), symptoms, and physical examination findings. Statistical analyses were conducted to compare the patient groups. Despite 79% of revision patients reporting symptomatic improvement, revision patients reported worse outcomes on all measured standardized questionnaires compared with primary patients. The Levine-Katz questionnaire indicated mild residual symptoms in the primary group (1.6) versus moderate remaining symptoms following revision surgery (2.3). The Patient-Rated Elbow Evaluation also indicated superior results for the control group (9 ± 10) compared with the revision group (32 ± 22). Revision patients had a higher frequency of constant symptoms, elevated 2-point discrimination, and diminished pinch strength. McGowan grading improved after 25% of revision surgeries versus 64% of primary surgeries, and 21% of revision patients had deterioration of their McGowan grade. Subjective and objective outcomes of revision patients in this cohort were inferior to outcomes of similar patients following primary surgery. Revision surgery can be offered in the setting of persistent or recurrent symptoms that are unexplained

  10. The effect of enemy combat tactics on PTSD prevalence rates: A comparison of Operation Iraqi Freedom deployment phases in a sample of male and female veterans. (United States)

    Green, Jonathan D; Bovin, Michelle J; Erb, Sarah E; Lachowicz, Mark; Gorman, Kaitlyn R; Rosen, Raymond C; Keane, Terence M; Marx, Brian P


    Research suggests that the nature of combat may affect later development of posttraumatic stress disorder (PTSD) in combat veterans. Studies comparing rates of PTSD across different conflicts indicate that the use of asymmetric or guerilla-style tactics by enemy fighters may result in higher rates of PTSD among U.S. military personnel than the use of symmetric tactics, which mirror tactics used by U.S. forces. Investigations of the association between enemy combat tactics and PTSD across conflicts were limited because of cohort effects and a focus on male veterans. The current study examined rates of PTSD diagnosis in a sample of male and female veterans deployed to Operation Iraqi Freedom (OIF), a conflict with 3 distinct phases marked by varying enemy tactics. Participants were 738 veterans enrolled in Project VALOR (Veterans' After-Discharge Longitudinal Registry) who deployed once to OIF. Participants completed a clinician interview as well as self-report measures. Male veterans deployed during the OIF phase marked by asymmetric tactics were more than twice as likely to be diagnosed with PTSD as those deployed during the other 2 phases, even after controlling for extent of combat exposure, demographic characteristics, and other deployment-related risk factors for PTSD. Differing rates of PTSD across the 3 OIF phases were not observed among female participants. The nature of combat (specifically, asymmetric enemy tactics) may be a risk factor for the development of PTSD among males. Factors other than enemy tactics may be more important to the development of PTSD among females. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

  11. On-Site Determination and Monitoring of Real-Time Fluence Delivery for an Operating UV Reactor Based on a True Fluence Rate Detector. (United States)

    Li, Mengkai; Li, Wentao; Qiang, Zhimin; Blatchley, Ernest R


    At present, on-site fluence (distribution) determination and monitoring of an operating UV system represent a considerable challenge. The recently developed microfluorescent silica detector (MFSD) is able to measure the approximate true fluence rate (FR) at a fixed position in a UV reactor that can be compared with a FR model directly. Hence it has provided a connection between model calculation and real-time fluence determination. In this study, an on-site determination and monitoring method of fluence delivery for an operating UV reactor was developed. True FR detectors, a UV transmittance (UVT) meter, and a flow rate meter were used for fundamental measurements. The fluence distribution, as well as reduction equivalent fluence (REF), 10th percentile dose in the UV fluence distribution (F 10 ), minimum fluence (F min ), and mean fluence (F mean ) of a test reactor, was calculated in advance by the combined use of computational fluid dynamics and FR field modeling. A field test was carried out on the test reactor for disinfection of a secondary water supply. The estimated real-time REF, F 10 , F min , and F mean decreased 73.6%, 71.4%, 69.6%, and 72.9%, respectively, during a 6-month period, which was attributable to lamp output attenuation and sleeve fouling. The results were analyzed with synchronous data from a previously developed triparameter UV monitoring system and water temperature sensor. This study allowed demonstration of an accurate method for on-site, real-time fluence determination which could be used to enhance the security and public confidence of UV-based water treatment processes.

  12. Should hip fractures be operated upon only by specialist hip unit surgeons in order to lower rates of surgical site infection? (United States)

    Guerado, Enrique; Cano, Juan R; Cruz, Encarnacion; Bertrand, María Luisa; Hirschfeld, Miguel; Benitez-Parejo, Nicolas


    The purpose of this study was to compare outcomes of hip fractures treated by orthopaedic surgeons, performed by specialist vs. non-specialist surgeons. The rate of surgical site infection (SSI) obtained is taken as the main variable. This was a prospective controlled cohort study of 814 patients presenting with hip fractures, operated on by a group of orthopaedic surgeons within the same hospital department. Patients were classified according to whether the surgeons belonged to a specialist hip unit (group A = 212 cases) or not (group B = 602 cases). Multivariate logistic regression showed that there was no relation between gender, SSI, Charlson's index, preoperative period, surgical technique or study groups (A or B). Only age was a determinant factor (rank-sum test p = 0.03; OR 95% CI = 1.07, p = 0.005). Since there were no differences in the SSI outcome between surgeons working in a specialist hip unit and the general orthopaedic surgeons, delaying operative treatment for hip fractures to enable treatment in such a unit or creating a new unit of this type is not necessary. In this respect, the only significant variable is the patient's age.

  13. Difference of Success Rates of Mineral Trioxide Aggregate Pulpotomies Performed Both by Undergraduate Dental Students and by an Expert Operator: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Marco Pasini


    Full Text Available Aim. The aim of this retrospective study was to evaluate the clinical and radiographic success of pulpotomy on primary molars performed by dental students compared to that performed by an expert operator. Methods. The study was conducted on 142 second primary molars in 102 children. The patients were randomly selected from the available records. The test group (treated by dental students included 51 subjects (28 males and 23 females, mean age: 7.2±1 and the control group included 51 children (29 males and 22 females, mean age: 7.4±1.2 years. After pulpotomy, a clinical and radiographic evaluation after 12 months was performed. Chi-square test and odds ratio were calculated and significance level was set at p<0.05. Results. The success rate was significantly lower, 81.6% (p<0.05, in the test group than in the control group (93%. The test group showed less clinical and radiographic success (86% and 80%, resp. compared to the control group (97.2% for clinical success and 93% for radiographic success. Conclusions. Pulpotomy with MTA is an effective method that ensures a good percentage of success. The clinical experience of the operator is a contributing factor.

  14. Impression formation and revision in social anxiety disorder. (United States)

    Haker, Ayala; Aderka, Idan M; Marom, Sofi; Hermesh, Haggai; Gilboa-Schechtman, Eva


    Interpersonal relations are markedly impaired in social anxiety. Yet, little is known about the ways social anxiety affects social cognition. We examined impression formation and impression revision among individuals with social anxiety disorder (SAD, n = 26) and non-anxious individuals (n = 29). Participants read initial descriptions of protagonists depicted as dominant, neutral or submissive and rated them on social rank and affiliation dimensions. Next, participants were presented with behavioral acts that were either congruent, incongruent or irrelevant to the initial descriptions, and re-rated the protagonists. Individuals with SAD (a) rated others as more extreme on social rank dimension, (b) rated others as lower on the affiliation dimension, and (c) revised their impressions of others to a greater extent than did the non-anxious individuals. Understanding the ways social anxiety affects the formation and revision of perceptions of others can improve our understanding of maintaining processes in SAD. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Difference in clinical outcome between total shoulder arthroplasty and reverse shoulder arthroplasty used in hemiarthroplasty revision surgery

    NARCIS (Netherlands)

    Hartel, B.P.; Alta, T.D.; Sewnath, M.E.; Willems, W.J.H.


    INTRODUCTION: The increase of shoulder replacements will lead to a higher revision rate of shoulder arthroplasties. The aim of this study is to evaluate the clinical results of revision surgery performed in our hospital, distinguish the differences in clinical outcome according to revision

  16. Operation of low-noise single-gap RPC modules exposed to ionisation rates up to 1 kHz/cm$^2$

    CERN Document Server

    Cwiok, M; Dominik, Wojciech; Górski, M; Królikowski, J; 10.1016/j.nima.2004.06.123


    Two single gap medium-size RPC modules, made of bakelite plates of very good mechanical quality of the surface and having initial volume resistivity of 1 multiplied by 10**1**0 omegacm, were tested in the Gamma Irradiation Facility at CERN at ionisation rates up to 1 kHz/cm **3. The internal surfaces facing the gas volume of one RPC module were cladded with a thin layer of linseed oil varnish for comparison of oiled and non-oiled RPC operation. The results refer to the gas mixture of C//2H//2F //4/isobutane (97:3) with SF//6 addition below 1%. The single gap modules exhibited full detection efficiency plateau for the high voltage range of about 1 kV at full intensity of gamma rays. Good timing characteristics allowed to reach 95% efficiency at fully opened irradiation source with time window of 20 ns. The intrinsic noise rate for a non-oiled and an oiled RPC gap was, respectively, below 5 and 1 Hz/cm**2 at full efficiency over 1 k V voltage range.

  17. Impact of organic loading rate on the performance of psychrophilic dry anaerobic digestion of dairy manure and wheat straw: long-term operation. (United States)

    Saady, Noori M Cata; Massé, Daniel I


    Development of efficient processes for valorising animal wastes would be a major advancement in cold-climate regions. This paper reports the results of long term (315 days experiment) of novel psychrophilic (20°C) dry anaerobic digestion (PDAD) of cow feces and wheat straw in laboratory scale sequence batch reactor operated at increasing organic loading rate. The PDAD process fed with a mixture of feces and straw (TS of 27%) over a treatment cycle length of 21 days at organic loading rate (OLR) 4.0, 5.0 and 6.0 g TCOD kg(-1) inoculum d(-1) (of 2.9 ± 0.1, 3.7 ± 0.1, and 4.4 ± 0.1g VS kg(-1) inoculum d(-1), respectively) resulted in average specific methane yield (SMY) of 187.3 ± 18.1, 163.6 ± 39.5, 150.8 ± 32.9 N L CH4 kg(-1)VS fed, respectively. PDAD of cow feces and wheat straw is possible with VS-based inoculum-to-substrate ratio of 1.4 at OLR of 6.0 g TCOD kg(-1) inoculum d(-1). Hydrolysis was the limiting step reaction. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  18. Study of high-pressure hydrogen-operated wire chambers designed for a precision measurement of the singlet mu p capture rate

    CERN Document Server

    Maev, E M; Case, T A; Crowe, K M; Dick, P U; Dijksman, A; Egger, J; Fetisov, A A; Ganzha, V A; Herold, W D; Hartmann, F J; Kammel, P; Krivchitch, A G; Maev, O E; Petitjean, C; Petrov, G E; Prieels, R; Sadetsky, S M; Schapkin, G N; Schmidt, R; Semenchuk, G G; Soroka, M; Vorobyov, A A; Voropaev, N I


    This work was carried out as part of a project aiming at a greatly improved measurement of the muon capture rate from the singlet state of the mu p atom. The experiment will be performed at the intense muon beam of PSI using a new experimental method allowing high precision measurements of the lifetime of muons stopped in ultra-pure deuterium-depleted hydrogen (protium). The basic element of the detector is a time projection chamber operating in hydrogen gas at 10 bar pressure. The arrival times and trajectories of the incoming muons and the outgoing decay electrons are measured with this device providing effective suppression of background. The system of chambers and electronics is designed for the large muon stop rates required for attaining high statistical accuracy. During four beam periods at PSI, data were taken. Also, various studies of the MWPC performance in hydrogen were made including ageing studies of the chambers under irradiation with stopped muons and with alpha and beta sources. It was demonst...

  19. Multimodal Revision Techniques in Webtexts (United States)

    Ball, Cheryl E.


    This article examines how an online scholarly journal, "Kairos: Rhetoric, Technology, Pedagogy," mentors authors to revise their webtexts (interactive, digital media scholarship) for publication. Using an editorial pedagogy in which multimodal and rhetorical genre theories are merged with revision techniques found in process-based…

  20. 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....

  1. Emotion Processes in Knowledge Revision (United States)

    Trevors, Gregory J.; Kendeou, Panayiota; Butterfuss, Reese


    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…

  2. Effect of variations in the nitrogen loading rate and seasonality on the operation of a free water surface constructed wetland for treatment of swine wastewater. (United States)

    Plaza de Los Reyes, Catalina; Vidal, Gladys


    The aim of this study was to evaluate the effects of variations in the nitrogen loading rate (NLR) and seasonality on the operational efficiency of a free-water surface constructed wetland (FWS) and on the processes involved in total nitrogen (TN) removal in treating swine wastewater. The system, which operated for 550 days, consisted of a FWS mesocosm inoculated with Typha angustifolia L., using swine wastewater from a storage lagoon as an influent. After operating with nitrogen loading rates (NLRs) of 2.0 to 30.2 kg TN ha(-1)·d(-1), the FWS reduced total nitrogen (TN) concentration by between 21.6 and 51.0%, achieving maximum removal (48.2 ± 3.0%) when the system operated at a NLR below 15.0 kg TN ha(-1)·d(-1). Moreover, operations over 25.0 kg TN ha(-1)·d(-1) resulted in a 50.6% decrease in the maximum FWS efficiency, which may have been related to increased anoxic conditions (organic matter in the system (12.3 ± 10.5 g TCOD L(-1)), which hindered nitrification. Ammonia volatilization is considered the main method to remove TN, with an average value of 14.4 ± 6.5% (3.1-26.2%). Maximum volatilization occurred during the summer (21.5 ± 2.4°C) at an NLR higher than 25 kg TN ha(-1)·d(-1) (26.6%), favored by higher temperatures (17.3-19.7°C), and high NH4(+)-N (>600.0 9 mg NH4(+)-N L(-1)) and pH levels (7.1-7.9). Uptake by plants accounted for 14.9% of the TN removed, with the vegetative peak in summer (height: 105.3 cm; diameter: 2.1 cm) at an NLR of 25.3 ± 0.3 kg TN ha(-1)·d(-1). However, growth decreased to 94.4% at an NLR of over 25.3 ± 0.3 kg TN ha(-1)·d(-1) (>379.9 mg NH4(+)-N L(-1)) in autumn (17.4 ± 2.4°C). This was associated with the period of plant senescence and the effects of ammonium phytotoxicity (379.9-624.2 mg NH4(+)-N L(-1)) and continued to the end of the study with the complete loss of macrophyte species. Finally, 1.5% of the TN removed was incorporated into the sediments where NH4(+)-N is the main form of nitrogen, with an

  3. Receiver-operating characteristics of adjusted urine measurements of oxycodone plus metabolites to distinguish between three different rates of oxycodone administration. (United States)

    McCloskey, Laura J; Dellabadia, Kristine A; Stickle, Douglas F


    In a study by Couto et al. (Use of an algorithm applied to urine drug screening to assess adherence to an oxycontin regimen. J Opioid Manag 2009;5:359-64), adjusted urine measurements of oxycodone plus metabolites noroxycodone and oxymorphone were determined among volunteer subjects in three groups according to oxycodone administration rates (A: 80 mg/day; B: 160 mg/day; C: 240 mg/day). We performed receiver-operating characteristic (ROC) analyses of the distribution data from this study to determine the ability to correctly categorize individual measurements with respect to each group. For groups A-C, assumed reference ranges were defined as median-centered intervals encompassing a designated central percentage of the group's distribution. By varying assumed reference ranges across all possible reference ranges, ROC analyses of the ability of each group's reference ranges to appropriately include or exclude members of all groups were calculated. This generated six ROC curves (sensitivity vs. specificity): A vs. (B or C); B vs. (A or C); C vs. (A or B). Overlaps of distributions A, B, and C were large, such that none of the ROC curves exceeded areas-under-curves of 0.8. The greatest sensitivity-specificity combination had a sensitivity of 74% for C with specificity of 75% for A, for which oxycodone administration rates were different by a factor of 3. ROC analyses of data from a previous study demonstrated that, even under experimentally controlled conditions, adjusted urine drug measurements could not be used reliably to correctly categorize individual subjects' results according to their known oxycodone administration rates in the range of 80-240 mg/day. Misclassifications of results were 25% or greater. Copyright © 2012 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  4. Surgical scar revision: An overview

    Directory of Open Access Journals (Sweden)

    Shilpa Garg


    Full Text Available Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods.

  5. Impact of different operational definitions on mild cognitive impairment rate and MMSE and MoCA performance in transient ischaemic attack and stroke. (United States)

    Pendlebury, Sarah T; Mariz, Jose; Bull, Linda; Mehta, Ziyah; Rothwell, Peter M


    Mild cognitive impairment (MCI) is at least as prevalent as dementia after transient ischaemic attack (TIA)/stroke and is increasingly recognised as an important outcome in observational studies and randomised trials. However, there is no consensus on how impairment should be defined, and numerous different criteria exist. Previous studies have shown that different criteria for cognitive impairment impact on prevalence rates in epidemiological studies. However, there are few data on how operational differences within established criteria (e.g. Petersen-MCI) affect measured impairment rates and the performance of short cognitive tests such as the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), particularly in cerebrovascular disease. We therefore evaluated the effect of different operational definitions on measured rates of Petersen-MCI and on reliability of short cognitive tests in patients with TIA and stroke. Consecutive patients underwent the MMSE, MoCA and neuropsychological battery ≥1 year after TIA or stroke in a population-based study. MCI was defined using the Petersen method and subclassified as single or multiple domain, both with (original) and without (modified) subjective memory impairment. Different cut-offs (>1, >1.5 and >2 standard deviations, SD) on a given test relative to published norms were compared together with use of single versus multiple tests to define domain impairment. 91 non-demented subjects completed neuropsychological testing (mean age ± SD 69.7 ± 11.6 years, 54 male, 49 stroke) at a mean of 3.1 ± 1.9 years after the index event. Rates of cognitive impairment ranged from 14/91 (15%) for MCI-original at >2 SD cut-off to 61/91 (67%) MCI-modified at >1 SD cut-off, and the proportion of MCI that was multiple domain varied, e.g. 24/46 (52%) versus only 5/27 (20%) at 1 versus 2 SD cut-off for MCI-modified. Requirement for subjective memory complaint approximately halved estimates [e.g. 17 (19%) vs

  6. Philippines revises power plans

    Energy Technology Data Exchange (ETDEWEB)

    Hayes, D.


    Following an unexpected surge in electricity demand the Philippines has revised its medium term power development programme. The sharp increase in electricity consumption follows three years of slack demand due to civil disturbances before the end of the Macros administration and the election of Corazon Aquino as President in 1986. Originally, the Aquino government's medium term power development plans called for about 500MW of generating capacity to be installed between 1986 and 1992. The three proposed plants were scheduled for commissioning in 1991 and 1992. However, a spurt in power demand growth during the past nine months has caused concern among industrialists that power shortages could occur by the end of the decade. So additional capacity will be installed to prevent an anticipated shortfall in electricity supplies by the early 1990s.

  7. The influence of cemented femoral stem choice on the incidence of revision for periprosthetic fracture after primary total hip arthroplasty: an analysis of national joint registry data. (United States)

    Palan, J; Smith, M C; Gregg, P; Mellon, S; Kulkarni, A; Tucker, K; Blom, A W; Murray, D W; Pandit, H


    Periprosthetic fracture (PF) after primary total hip arthroplasty (THA) is an uncommon but potentially devastating complication. This study aims to investigate the influence of cemented stem designs on the risk of needing a revision for a PF. We analysed data on 257 202 primary THAs with cemented stems and 390 linked first revisions for PF recorded in the National Joint Registry (NJR) of England, Wales and Northern Ireland to determine if a cemented femoral stem brand was associated with the risk of having revision for a PF after primary THA. All cemented femoral stem brands with more than 10 000 primary operations recorded in the NJR were identified. The four most commonly used cemented femoral stems were the Exeter V40 (n = 146 409), CPT (n = 24 300), C-Stem (n = 15 113) and Charnley (n = 20 182). We compared the revision risk ratios due to PF amongst the stems using a Poisson regression model adjusting for patient factors. Compared with the Exeter V40, the age, gender and ASA grade adjusted revision rate ratio was 3.89 for the cemented CPT stem (95% confidence interval (CI) 3.07 to 4.93), 0.89 for the C-Stem (95% CI 0.57 to 1.41) and 0.41 for the Charnley stem (95% CI 0.24 to 0.70). The limitations of the study include incomplete data capture, analysis of only PF requiring revision and that observation does not imply causality. Nevertheless, this study demonstrates that the choice of a cemented stem may influence the risk of revision for PF. Cite this article: Bone Joint J 2016;98-B:1347-54. ©2016 The British Editorial Society of Bone & Joint Surgery.

  8. 30 CFR 903.774 - Revision; renewal; and transfer, assignment, or sale of permit rights. (United States)


    ... operation, or likely interest in the proposed revision; and (4) Possible adverse impacts from the proposed revision on fish or wildlife, endangered species, bald or golden eagles, or cultural resources. (d) The... of either the publication of the newspaper notice required by § 774.17(b)(2) of this chapter, or...

  9. Development and first validation of a simplified CT-based classification system of soft tissue changes in large-head metal-on-metal total hip replacement: intra- and interrater reliability and association with revision rates in a uniform cohort of 664 arthroplasties

    Energy Technology Data Exchange (ETDEWEB)

    Boomsma, Martijn F.; Warringa, Niek [Isala Hospital, Department of Radiology, Zwolle (Netherlands); Edens, Mireille A. [Isala Hospital, Department of Innovation and Science, Zwolle (Netherlands); Lingen, Christiaan P. van; Ettema, Harmen B.; Verheyen, Cees C.P.M. [Isala Hospital, Department of Orthopaedics, Zwolle (Netherlands); Maas, Mario [AMC, Department of Radiology, Amsterdam (Netherlands)


    After implantation of a metal-on-metal total hip arthroplasty (MoM THA), a large incidence of pseudotumor formation has been described recently. Several centers have invited patients for follow-up in order to screen for pseudotumor formation. The spectrum of abnormalities found by CT in MoM THA patients can be unfamiliar to radiologists and orthopedic surgeons. Previously, a CT five-point grading scale has been published. In this paper, a simplification into a three-point classification system gives insight in the morphological distinction of abnormalities of the postoperative hip capsule in MoM implants in relation to the decision for revision. The reliability of this simplified classification regarding intra- and interrater reliability and its association with revision rate is investigated and discussed. All patients who underwent MoM THA in our hospital were invited for screening. Various clinical measures and CT scan were obtained in a cross-sectional fashion. A decision on revision surgery was made shortly after screening. CT scans were read in 582 patients, of which 82 patients were treated bilaterally. CT scans were independently single read by two board-certified radiologists and classified into categories I-V. In a second meeting, consensus was obtained. Categories were subsequently rubricated in class A (categories I and II), B (category III), and C (categories IV and V). Intra- and inter-radiologist agreement on MoM pathology was assessed by means of the weighted Cohen's kappa. Categorical data were presented as n (%), and tested by means of Fisher's exact test. Continuous data were presented as median (min-max) and tested by means of Mann-Whitney U test (two group comparison) or Kruskal-Wallis test (three group comparison). Logistic regression analysis was performed in order to study independence of CT class for association with revision surgery. Univariate statistically significant variables were entered in a multiple model. All statistical

  10. Outcomes of different bearings in total hip arthroplasty - implant survival, revision causes, and patient-reported outcome

    DEFF Research Database (Denmark)

    Varnum, Claus


    Total hip arthroplasty (THA) is a common and successful treatment of patients suffering from severe osteoarthritis that significantly reduces pain and improves hip function and quality of life. Traditionally, the outcome of THA has been evaluated by orthopaedic surgeons and assessed in morbidity...... and mortality rates, and implant survival. As patients and surgeons may assess outcome after THA differently, patient-reported outcomes (PROMs) have gained much more interest and are today recognized as very important tools for evaluating the outcome and satisfaction after THA. One of the prognostic factors......, Sweden, and Finland, was used. In study I, 11,096 patients operated from 2002 through 2009 with cementless THA were included. Of these, 16% had CoC THA and 84% had MoP THA. At 8.7-year follow-up, no difference in RR of revision for any cause was found for CoC compared to MoP THA. One cause of revision...

  11. Request for interim approval to operate Trench 94 of the 218-E-12B Burial Ground as a chemical waste landfill for disposal of polychlorinated biphenyl waste in submarine reactor compartments. Revision 2

    Energy Technology Data Exchange (ETDEWEB)

    Cummins, G.D.


    This request is submitted to seek interim approval to operate a Toxic Substances Control Act (TSCA) of 1976 chemical waste landfill for the disposal of polychlorinated biphenyl (PCB) waste. Operation of a chemical waste landfill for disposal of PCB waste is subject to the TSCA regulations of 40 CFR 761. Interim approval is requested for a period not to exceed 5 years from the date of approval. This request covers only the disposal of small 10 quantities of solid PCB waste contained in decommissioned, defueled submarine reactor compartments (SRC). In addition, the request applies only to disposal 12 of this waste in Trench 94 of the 218-E-12B Burial Ground (Trench 94) in the 13 200 East Area of the US Department of Energy`s (DOE) Hanford Facility. Disposal of this waste will be conducted in accordance with the Compliance 15 Agreement (Appendix H) between the DOE Richland Operations Office (DOE-RL) and 16 the US Environmental Protection Agency (EPA), Region 10. During the 5-year interim approval period, the DOE-RL will submit an application seeking final 18 approval for operation of Trench 94 as a chemical waste landfill, including 19 any necessary waivers, and also will seek a final dangerous waste permit from 20 the Washington State Department of Ecology (Ecology) for disposal of lead 21 shielding contained in the SRCS.

  12. Are the Wells Score and the Revised Geneva Score valuable for the diagnosis of pulmonary embolism in pregnancy? (United States)

    Touhami, Omar; Marzouk, Sofiene Ben; Bennasr, Laidi; Touaibia, Maha; Souli, Iheb; Felfel, Mohamed Amine; Kehila, Mehdi; Channoufi, Mohamed Badis; Magherbi, Hayen El


    To evaluate and to compare the predictive accuracy of the Wells score and the revised Geneva scores for the diagnosis of pulmonary embolism in the pregnant and postpartum population. All pregnant or post-partum patients with a suspected PE and for whom a diagnostic imaging testing was performed (VQ scintigraphy or computed tomography pulmonary angiography) over a 3-year period were included in the study. The Wells and Revised Geneva Scores were calculated on the same cohort of patients and dichotomized into low and intermediate/high probability groups. The sensitivities and specificities were calculated. Overall accuracy was determined using receiver operator characteristic curve analysis. A total of 103 patients were included. The overall prevalence of PE was 26.2% (27/103). Using the Wells Score, the prevalence of patients with PE in the low, intermediate and high probability categories was 20.5%, 43.5% and 50% respectively. Using the Revised Geneva Score, the prevalence of patients with PE in the low, intermediate and high probability categories was 17%, 36.2 and 33.3% respectively. In low risk groups of the Wells score and the simplified revised Geneva score the prevalence of PE was not statistically significantly different: respectively: 20.5% and 17.5% (p = 0,232). The agreement on clinical assessment using the Wells score and using the revised Geneva score was weak (κ coefficient = 0.154). In total, 26 (25.2%) patients were classified differently using the 2 scores. There was no significant difference in the overall accuracies of the Wells (0.67, 95% CI 0.54-0.79) and Revised Geneva Scores (0.64, 95% CI 0.52-0.76) as determined by the area under the ROC curves (P = 0.628). The sensitivity, specificity, PPV and NPV of the Wells score and the revised Geneva score were respectively: 40.7%, 81.5%, 44%, 79.4% and 62.9%, 59.2%, 35.4%, 81.8%. The Wells score and the revised Geneva seems not to be valuable in the pregnant and post partum population. A

  13. The Outcomes of Bleb Revision Surgery Techniques After Trabeculectomy

    Directory of Open Access Journals (Sweden)

    Orhan Ayar


    Full Text Available Pur po se: To evaluate the techniques and the results of revision surgeries in order to manage bleb failure after trabeculectomy. Ma te ri al and Met hod: The records of 23 eyes who had undergone bleb revision surgery because of bleb failure after trabeculectomy between December 2002 and September 2009 were analyzed retrospectively. The mean age of the patients was 53.7±24.5 years. The mean intraocular pressure (IOP before revision surgery was 32,4 ± 8,1 mmHg. Seven cases had needling, 7 had bleb revision surgery, 8 had repeat trabeculectomy, and 1 had scleral suture removal. Re sults: Sixteen cases were successfully treated, while 2 cases had this success with medication and 7 were unsuccessful with revision surgeries. The decrease in the IOP values was statistically significant in all visits after the surgeries (p<0.05. Four of 7 needling cases were successfully treated and 3 were unsuccessful. Four of 7 cases which had undergone bleb revision surgery were successful, whereas 3 were unsuccessful. Seven of 8 cases which had undergone repeat trabeculectomy were successful and 1 was unsuccessful. One case got the target IOP with antiglaucomatous medication after scleral suture removal. Dis cus si on: Despite the high success rates of trabeculectomy performed to decrease IOP which is the main risk factor in glaucoma, it is possible to get unsuccessful results because of the early or late bleb failure. Several revision surgery techniques were defined to manage these situations. The success rates of these techniques were not as high as the primary surgeries, but they can maintain structural and functional improvement. However, large series especially comparing the success rates of surgical techniques are needed. (Turk J Ophthalmol 2012; 42: 207-10

  14. Clinical Outcomes Following Revision Anterior Shoulder Stabilization (United States)

    Frank, Rachel M.; Mellano, Chris; Shin, Jason J.; Feldheim, Terrence F.; Mascarenhas, Randhir; Yanke, Adam Blair; Cole, Brian J.; Nicholson, Gregory P.; Romeo, Anthony A.; Verma, Nikhil N.


    Objectives: The purpose of this study was to determine the clinical outcomes following revision anterior shoulder stabilization performed either via all-arthroscopic soft tissue repair or via Latarjet coracoid transfer. Methods: A retrospective review of prospectively collected data on 91 shoulders undergoing revision anterior shoulder stabilization was performed. All patients underwent prior soft tissue stabilization; those with prior open bone grafting procedures were excluded. For patients with 25% glenoid bone loss, Latarjet was performed (n=28). Patients were queried regarding recurrent instability (subluxation or dislocation). Clinical outcomes were evaluated using validated patient reported outcome questionnaires including the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), visual analog scale (VAS) for pain, and Western Ontario Shoulder Instability Index (WOSI). Results: A total of 63 shoulders in 62 patients (46 males, 16 females) with an average age of 23.2 ± 6.9 years were included in the revision arthroscopy group. At an average follow-up of 46.9 ± 16.8 months (range, 15 to 78), the mean WOSI score was 80.1 (range, 15.0 to 100), and there were significant improvements (pLatarjet group. Thirteen (46%) had more than one previous stabilization attempt. ), the average WOSI score was 71.9, and there were significant improvements (pLatarjet. Conclusion: Both arthroscopic revision stabilization and Latarjet coracoid transfer result in satisfactory outcomes in patients who have failed previous arthroscopic capsulolabral repair. Recurrent instability rates were higher in the all-arthroscopic group (19% versus 7%). Longer-term studies are required to determine whether similar results are maintained over time, and to provide guidance on focused clinical indications for this challenging patient population.

  15. Operating stability of a self-breakdown spark-gap frequency switch rated at a voltage of 300 kV and a switched power of up to 450 J (United States)

    Koval'chuk, B. M.; Korolev, Yu. D.; Kumpyak, E. V.; Frants, O. B.; Shemyakin, I. A.


    A test bench for studying two-electrode spark gaps rated at a voltage of 300 kV and a pulse repetition rate of up to 10 Hz and operating in air at elevated pressure. The typical time of pulse charging of a capacitive storage in the bench equals about 100 μs. The object of investigation is a spark gap the operating stability of which at a level of 10% of the rate voltage is achieved by initiating a corona discharge at the prebreakdown stage. It is shown that unstable operation is due to the accumulation of nitrogen oxides in the gap. To maintain the oxide content at an acceptable level, continuous gas purging is applied and necessary gas flow rates are estimated.

  16. Diana Reference Manual. Revision 3, (United States)


    private -To be filled in... ead Diana ; External Representation of DIANA Page 145 CHAPTER 5 EXTERNAL REPRESENTATION OF DIANA This chapter describes how a...1 1 mml L.~ 2 .i i .- . .... c7- 0/0 04 TARTAN LABORATOR4IES *dOORPORATED 00 N DIANA REFERENCE MANUAL Revision 3 Arthur Evans Jr. MCC Kenneth J...Butler Tartan Laboratories Incorporated Editors. Revised Diana Reference Manual G0. GOOD Inatitut fuer Informatik 11. Universitmet Karlsruhe Win. A. Wuif

  17. Trust Revision for Conflicting Sources (United States)


    analyst wants to include the realistic possibility that there can be rain and sunshine simultaneously, then the domain would need to include a...tative and idempotent; but it is not associative. IV. TRUST DISCOUNTING The general idea behind trust discounting is to express degrees of trust in an...A:C X is revised. Trust revision consists of increasing distrust at the cost of trust and uncertainty. The idea is that sources found to be unreliable

  18. State of California; Mojave Desert AQMD; Proposed Approval of Air Plan Revisions; VOC Emissions (United States)

    EPA is proposing to approve a revision to the Mojave Desert Air Quality Management District (MDAQMD) portion of the California SIP concerning emissions of volatile organic compounds (VOCs) from marine and pleasure craft coating operations.

  19. State of California; Sacramento Metropolitan AQMD; Approval of Air Plan Revisions; VOC Emissions (United States)

    EPA is taking final action to approve a revision to the Sacramento Metropolitan AQMD portion of the California State Implementation Plan (SIP), concerning volatile organic compound (VOC) emissions from Organic Chemical Manufacturing Operations.

  20. Towards Revised Step IV MICE Optics in the Absence of M1 SSD

    Energy Technology Data Exchange (ETDEWEB)

    Bayes, R. [Univ. of Glasgow, Scotland (United Kingdom); Berg, J. S. [Brookhaven National Lab. (BNL), Upton, NY (United States); Blackmore, V. [Imperial College, London (United Kingdom); Hunt, C. [Imperial College, London (United Kingdom); Liu, A. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Pasternak, J. [Imperial College, London (United Kingdom); Rogers, C. T. [Science and Technology Facilities Council (STFC), Oxford (United Kingdom). Rutherford Appleton Lab. (RAL)


    During magnet commissioning in September 2015, the leads on coil M1 of the downstream spectrometer solenoid failed. The coil will not be operational for MICE Step IV. Revised optics settings for the Step IV data taking are reviewed.


    Jia, Di; Li, Yanlin; Wang, Guoliang; Gao, Huanyu; Yu, Yang


    To conclude the revision reason of unicompartmental knee arthroplasty (UKA) using computer-assisted technology so as to provide reference for reducing the revision incidence and improving the level of surgical technique and rehabilitation. The relevant literature on analyzing revision reason of UKA using computer-assisted technology in recent years was extensively reviewed. The revision reasons by computer-assisted technology are fracture of the medial tibial plateau, progressive osteoarthritis of reserved compartment, dislocation of mobile bearing, prosthesis loosening, polyethylene wear, and unexplained persistent pain. Computer-assisted technology can be used to analyze the revision reason of UKA and guide the best operating method and rehabilitation scheme by simulating the operative process and knee joint activities.

  2. Revised numerical wrapper for PIES code (United States)

    Raburn, Daniel; Reiman, Allan; Monticello, Donald


    A revised external numerical wrapper has been developed for the Princeton Iterative Equilibrium Solver (PIES code), which is capable of calculating 3D MHD equilibria with islands. The numerical wrapper has been demonstrated to greatly improve the rate of convergence in numerous cases corresponding to equilibria in the TFTR device where magnetic islands are present. The numerical wrapper makes use of a Jacobian-free Newton-Krylov solver along with adaptive preconditioning and a sophisticated subspace-restricted Levenberg-Marquardt backtracking algorithm. The details of the numerical wrapper and several sample results are presented.

  3. Long-term results after non-operative and operative treatment of radial neck fractures in adults. (United States)

    Keil, Holger; Schnetzke, Marc; Kocharyan, Arpine; Vetter, Sven Yves; Beisemann, Nils; Swartman, Benedict; Grützner, Paul-Alfred; Franke, Jochen


    The aim of this study is to determine the functional long-term outcome after non-operative and operative treatment of radial neck fractures in adults. Thirty-four consecutive patients with a mean age of 46.4 (18.0 to 63.0) years with a fracture of the radial neck who were treated between 2000 and 2014 were examined regarding the clinical and radiological outcome. Twenty patients were treated non-operatively, and 14 patients underwent surgery. After a mean follow-up of 5.7 (2.0 to 15.7) years, the clinical scores showed good results in both groups. The Disabilities of Arm, Shoulder and Hand score was 16.1 (0 to 71.6) in the non-operative group and 8.8 (0 to 50.8) in the operative group, respectively. The Mayo Elbow Performance Score was 80.0 (30 to 95) in the non-operative group and 82.5 (35 to 95) in the non-operative group, respectively. The initial angle of the radial head towards the shaft (RHSA) was significantly higher in the operative group in the anterior-posterior plane (12.8° [2 to 23] vs. 26.3° [1 to 90], p = 0.015). In the follow-up radiographs, the RHSA was significantly lower in the operative group (15.1° [3 to 30] vs. 10.9° [3 to 18], p = 0.043). Five patients developed 7 complications in the non-operative group, and 7 patients developed 12 complications in the operative group. Revision rates were higher in the operative groups as 1 patient received radial head resection in the non-operative (5%) group while 7 patients in the operative group (50%) needed revision surgery. A good functional long-term outcome can be expected after operative and non-operative treatment of radial neck fractures in adults. If needed due to major displacement, open reduction is associated with a higher risk of complications and the need for revision surgery but can achieve similar clinical results. DRKS DRKS00012836 (retrospectively registered).

  4. Waste Management Program management plan. Revision 1

    Energy Technology Data Exchange (ETDEWEB)



    As the prime contractor to the Department of Energy Idaho Operations Office (DOE-ID), Lockheed Martin Idaho Technologies Company (LMITCO) provides comprehensive waste management services to all contractors at the Idaho National Engineering and Environmental Laboratory (INEEL) through the Waste Management (WM) Program. This Program Management Plan (PMP) provides an overview of the Waste Management Program objectives, organization and management practices, and scope of work. This document will be reviewed at least annually and updated as needed to address revisions to the Waste Management`s objectives, organization and management practices, and scope of work. Waste Management Program is managed by LMITCO Waste Operations Directorate. The Waste Management Program manages transuranic, low-level, mixed low-level, hazardous, special-case, and industrial wastes generated at or transported to the INEEL.

  5. Spectrum-dose conversion operator of NaI(Tl) and CsI(Tl) scintillation detectors for air dose rate measurement in contaminated environments. (United States)

    Tsuda, Shuichi; Saito, Kimiaki


    Spectrum-dose conversion operators, the G(E) functions, for common NaI(Tl) scintillation survey meters and CsI(Tl) detectors are obtained for measurements in a semi-infinite plane of contaminated ground field by photon-emitting radionuclides (ground source). The calculated doses at a height of 100 cm from the ground in (137)Cs-contaminated environments by the Monte Carlo simulation technique are compared with those obtained using the G(E) functions by assuming idealized irradiation geometries such as anterior-posterior or isotropic. The simulation reveals that one could overestimate air dose rates in the environment by a maximum of 20-30% for NaI(Tl) detectors and 40-50% for CsI(Tl) detectors depending on photon energy when using the G(E) functions assuming idealized irradiation geometries for ground source measurements. Measurements obtained after the nuclear accident in Fukushima reveal that the doses calculated using a G(E) function for a unidirectional irradiation geometry are 1.17 times higher than those calculated using a G(E) function for the ground source in the case of a CsI(Tl) scintillation detector, which has a rectangular parallelepiped crystal (13 × 13 × 20 mm(3)). However, if a G(E) function is used assuming irradiation to a surface of the detector, the doses agree with those of the ground source within 2%. These results indicate that in contaminated environments, the commonly used scintillation-based detectors overestimate doses within the acceptable limit. In addition, the degree of overestimation depends on the irradiation direction of each detector assumed for developing the G(E) function. With regard to directional dependence of the detectors, reliable air dose rates in the environment can be obtained using the G(E) function determined in unidirectional irradiation geometry, provided that the irradiation surface of the crystal is determined properly. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. 78 FR 6140 - Discount Rates for Cost-Effectiveness Analysis of Federal Programs (United States)


    ... BUDGET Discount Rates for Cost-Effectiveness Analysis of Federal Programs AGENCY: Office of Management... and Budget revised Circular A-94 in 1992. The revised Circular specified certain discount rates to be... States Government were changed. These discount rates are found in Appendix C of the revised Circular. The...

  7. 77 FR 1743 - Discount Rates for Cost-Effectiveness Analysis of Federal Programs (United States)


    ... BUDGET Discount Rates for Cost-Effectiveness Analysis of Federal Programs AGENCY: Office of Management... and Budget revised Circular A-94 in 1992. The revised Circular specified certain discount rates to be... States Government were changed. These discount rates are found in Appendix C of the revised Circular. The...

  8. 76 FR 7881 - Discount Rates for Cost-Effectiveness Analysis of Federal Programs (United States)


    ... BUDGET Discount Rates for Cost-Effectiveness Analysis of Federal Programs AGENCY: Office of Management... and Budget revised Circular A-94 in 1992. The revised Circular specified certain discount rates to be... States Government were changed. These discount rates are found in Appendix C of the revised Circular. The...

  9. Revision by comparison as a unifying framework: Severe withdrawal, irrevocable revision and irrefutable revision

    National Research Council Canada - National Science Library

    Rott, Hans


    ... has both characteristics of belief contraction (with respect to the ‘reference sentence’) and characteristics of belief revision (with respect to the ‘input sentence’). Using...

  10. Possible revisions in reservoir operation rules as an adaptation to climate change assessed by a global hydrological model with anthropogenic activities and a state-of-the-art river routing model (United States)

    Oki, T.; Mateo, C. M. R.; Hanasaki, N.; Yamazaki, D.; Watanabe, S.; Kiguchi, M.; Komori, D.; Champathong, A.


    In the past decade, several advances have been made in incorporating anthropogenic impacts such as reservoir operation in global hydrological models. However, detailed examination of their performance in regional or large river basins is still lacking. The Chao Phraya River Basin in Thailand is a good site for a case study because of the availability of detailed and long-term hydrological records which include the operation of two huge reservoirs, the Bhumibol and Sirikit Reservoirs, in the basin. The ensemble means of the simulation results using eight bias-corrected CMIP5 general circulation models (GCMs), selected based on the availability of the atmospheric forcing inputs needed in a water balance model with human activities, the H08 model, under two representative concentration path scenarios (RCP), RCP4.5 and RCP8.5, for the near future from 2041 to 2059 were compared with the base period simulation from 1981 to 1999. The estimates projected an increase in runoff of 10-15% in RCP4.5 and 40-50% in RCP8.5. While the change in dry season ranges from -10mm to 10mm, the wet season runoff could increase by as much as 160mm in RCP8.5. Hence, the frequency of reservoir emptying will decrease while spilling will increase by as much as 5 times of that of the base period in RCP8.5. In RCP4.5, the frequency of reservoir emptying will not significantly change while spilling will most likely double. Consequently, flooding in the basin will be more frequent and more severe. It was found that the mean inundated area downstream of the two reservoirs, simulated by CaMa-Flood, will increase by approximately 30% in RCP4.5 and about 130% in RCP8.5. At flood inundation depth greater than 1.00m, flooded area will increase by about 95% and 460% in RCP4.5 and RCP8.5, respectively. Possible reservoir operation rules adapting to these changes are examined to minimize flooded area and inundation depth in the downstream area, and to avoid full water levels of the reservoirs. It is


    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov


    Full Text Available The revision rate of total hip arthroplasty (THA is increasing with growth of number primary THA. The problems of revision procedures are associated with high technical demands and high incidence of poor results. Besides of medical problems the cost of revisions has impact on health care system even in developed countries. With improving of funding Russian Health Care System there is significant growth of number of total hip arthroplasties in Russia. Hence it is interesting to find out about world experience, forecasts of experts involved in the issue and current trends in revision hip arthroplasty.

  12. 5 CFR 532.415 - Application of new or revised wage schedules. (United States)


    ... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Application of new or revised wage schedules. 532.415 Section 532.415 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PREVAILING RATE SYSTEMS Pay Administration § 532.415 Application of new or revised wage schedules...

  13. Toy Modification Note. Revised. (United States)

    Vanderheiden, Gregg C.; And Others

    Described are toy modifications which enable handicapped individuals to operate battery-powered toys. A battery interrupter is explained as a device which fits between the batteries in a toy and provides the ability to have a separate on-off switch which can be custom designed to fit a handicapped user's needs. Construction and use of three types…

  14. MIDAS Website. Revised (United States)

    Goodman, Allen; Shively, R. Joy (Technical Monitor)


    MIDAS, Man-machine Integration Design and Analysis System, is a unique combination of software tools aimed at reducing design cycle time, supporting quantitative predictions of human-system effectiveness and improving the design of crew stations and their associated operating procedures. This project is supported jointly by the US Army and NASA.

  15. Outcomes in revision Tommy John surgery in Major League Baseball pitchers. (United States)

    Liu, Joseph N; Garcia, Grant H; Conte, Stan; ElAttrache, Neal; Altchek, David W; Dines, Joshua S


    With the recent rise in the number of Tommy John surgeries, a proportionate rise in revisions is expected. However, much is unknown regarding the current revision rate of Tommy John surgery, return to play, and change in performance in Major League Baseball (MLB) pitchers. Publicly available databases were used to obtain a list of all MLB pitchers who underwent primary and revision Tommy John surgery. Pitching performance preoperatively and postoperatively for pitchers who returned to 1 or more MLB games after revision surgery was compared with controls matched for age and position. Since 1999, 235 MLB pitchers have undergone Tommy John surgeries; 31 pitchers (13.2%) underwent revision surgery, and 37% underwent revision within 3 years of the index procedure. Twenty-six revisions had more than 2 years of follow-up; 17 pitchers (65.4%) returned to pitch at least 1 major league game, whereas only 11 (42.3%) returned to pitch 10 or more games. Of those who returned to MLB competition, the average length of recovery was 20.76 months. Compared with controls matched for age and position, MLB pitchers undergoing revision surgery had a statistically shorter career after revision surgery (4.9 vs 2.6 seasons, P = .002), pitched fewer innings, and had fewer total pitches per season. The rate of revision Tommy John surgery is substantially higher than previously reported. For MLB pitchers, return to play after revision surgery is much lower than after primary reconstruction. The overall durability of MLB pitchers after revision ulnar collateral ligament reconstruction decreases significantly compared with controls matched for age and matched controls. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  16. Primary total hip arthroplasty revision due to dislocation: prospective French multicenter study. (United States)

    Girard, J; Kern, G; Migaud, H; Delaunay, C; Ramdane, N; Hamadouche, M


    Dislocation following total hip arthroplasty (THA) may require surgical revision, and is one of the most frequent causes for revision in national registers. The goals of this study were to determine the characteristics of revision THA for dislocation and identify the typical features of hips revised due to dislocation. A prospective multicenter study (30 centers) was performed in first revision THA performed between January 1, 2010 and December 31, 2011 (multiple revisions were excluded). Two hundred nineteen (10.4%) of all first revisions (2153 cases in 2107 patients) were for dislocation, which was the fifth cause of revision. There were 135 men and 84 women, mean age 65.9 years old (24.3-92.4) at primary THA and 72.9 years old (31.9-98.8) at revision. Revision surgery was performed a mean 7.1 years (± 7.1) after primary THA. The predictive risk factors for dislocation were: a 22.2mm diameter femoral head (risk × 2.4), a posterolateral approach (risk × 1.7), older age (risk × 1.1), an elevated rim liner for primary THA (risk × 6.6). The use of a dual mobility cup did not influence the rate of revision for dislocation (8.8%) compared to the use of a flat rim liner (9.1%). The 10.4% rate of revision of THA for dislocation seems markedly lower than the results in the literature both for frequency and ranking. The use of elevated rim or constrained liners designed to decrease the risk of dislocation does not improve results compared to standard liners. Level IV, prospective prognostic study without a control group. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  17. Rayleigh's Scattering Revised (United States)

    Kolomiets, Sergey; Gorelik, Andrey

    Mie’s waves while sounding within coincident volumes. Being sensitive to the size of scatters, Mie’s waves can give us additional information about particle size distribution. But how about using several wavelengths corresponding to Rayleigh’s diffraction on scatters only? Can any effects be detected in such a case and what performance characteristics of the equipment are required to detect them? The deceptive simplicity of the negative answer to the first part of the question posed will disappear if one collects different definitions of Rayleigh's scattering and consider them more closely than usually. Several definitions borrowed from the introductory texts and most popular textbooks and articles can be seen as one of the reasons for the research presented in the report. Hopefully, based on the comparison of them all, anyone could easily conclude that Rayleigh's scattering has been analyzed extensively, but despite this extensive analysis made fundamental ambiguities in introductory texts are not eliminated completely to date. Moreover, there may be found unreasonably many examples on how these ambiguities have already caused an error to be foreseen, published on the one article, amplified in another one, then cited with approval in the third one, before being finally corrected. Everything indicated that in the light of all the lesions learned and based on modern experimental data, it is time to address these issues again. After the discussion of ambiguities of Rayleigh's scattering concepts, the development of the corrections to original ideas looks relatively easy. In particular, there may be distinguished at least three characteristic regions of the revised models application from the point of view of the scattered field statistical averaging. The authors of the report suggest naming them Rayleigh’s region, Einstein’s region and the region with compensations of the scattering intensity. The most important fact is that the limits of applicability of all

  18. Draft revision of human factors guideline HF-010

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Chul; Lee, Yong Hee; Oh, In Seok; Lee, Jung Woon [KAERI, Taejon (Korea, Republic of); Cha, Woo Chang [Kumoh National Institute of Technology, Gumi (Korea, Republic of); Lee, Dhong Ha [Suwon University, Suwon (Korea, Republic of)


    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.

  19. Risk factors for revision of primary total hip arthroplasty: a systematic review

    Directory of Open Access Journals (Sweden)

    Prokopetz Julian JZ


    Full Text Available Abstract Background Numerous papers have been published examining risk factors for revision of primary total hip arthroplasty (THA, but there have been no comprehensive systematic literature reviews that summarize the most recent findings across a broad range of potential predictors. Methods We performed a PubMed search for papers published between January, 2000 and November, 2010 that provided data on risk factors for revision of primary THA. We collected data on revision for any reason, as well as on revision for aseptic loosening, infection, or dislocation. For each risk factor that was examined in at least three papers, we summarize the number and direction of statistically significant associations reported. Results Eighty-six papers were included in our review. Factors found to be associated with revision included younger age, greater comorbidity, a diagnosis of avascular necrosis (AVN as compared to osteoarthritis (OA, low surgeon volume, and larger femoral head size. Male sex was associated with revision due to aseptic loosening and infection. Longer operating time was associated with revision due to infection. Smaller femoral head size was associated with revision due to dislocation. Conclusions This systematic review of literature published between 2000 and 2010 identified a range of demographic, clinical, surgical, implant, and provider variables associated with the risk of revision following primary THA. These findings can inform discussions between surgeons and patients relating to the risks and benefits of undergoing total hip arthroplasty.

  20. 40 CFR Table 1 to Subpart Rrrr of... - Operating Limits if Using the Emission Rate With Add-on Controls Option (United States)


    ... Rate With Add-on Controls Option 1 Table 1 to Subpart RRRR of Part 63 Protection of Environment... Limits if Using the Emission Rate With Add-on Controls Option If you are required to comply with... volumetric flow rate or duct static pressure in each duct between a capture device and add-on control device...

  1. Lifelong Adaptability: A Cultural Literacy Perspective (Revised Edition) (United States)

    Moyer, John Thayer


    This revised 1997 ex post facto study attempted to identify a lifelong adaptability curriculum from a cultural literacy perspective. It investigated students' lifelong adaptability ratings of 15 general school subjects as predicted by family structure, parental age, parental educational level, student cultural literacy, and student gender;…

  2. The Revised Gesell Preschool Examination and Later Competence. (United States)

    Walker, Richard N.

    A sample of 640 children between 2.5 and 6 years old provided norms for scales of the Revised Gesell Preschool Examination. Scales focused on motor, adaptive, verbal, number, and personal and social development. A total of 272 children were reevaluated at 8.5 years on 22 variables derived from teacher ratings, parent questionnaires, and tests. The…

  3. 75 FR 45080 - Revisions to the California State Implementation Plan (United States)


    ... Implementation Plan (SIP). These revisions concern oxides of nitrogen (NO X ) emissions from boilers, steam... Boilers, Steam Generators 12/17/09 05/17/10 and Process Heaters-- 0.75 to less than 2.0 MMbtu/hr. On June... from boilers, steam generators, process heaters and water heaters with a total rated heat input equal...

  4. Revising a College 101 Course for Sustained Impact: Early Outcomes (United States)

    Karp, Melinda Mechur; Raufman, Julia; Efthimiou, Chris; Ritze, Nancy


    In response to strikingly low completion rates in public 2-year colleges, including for students who are well-prepared academically, most community colleges across the country offer student success courses as one approach to improving outcomes for students. Some colleges have begun to revise these courses in response to research indicating that…

  5. Effect of femoral head size and surgical approach on risk of revision for dislocation after total hip arthroplasty. (United States)

    Zijlstra, Wierd P; De Hartog, Bas; Van Steenbergen, Liza N; Scheurs, B Willem; Nelissen, Rob G H H


    Background and purpose - Recurrent dislocation is the commonest cause of early revision of a total hip arthropasty (THA). We examined the effect of femoral head size and surgical approach on revision rate for dislocation, and for other reasons, after total hip arthroplasty (THA). Patients and methods - We analyzed data on 166,231 primary THAs and 3,754 subsequent revision THAs performed between 2007 and 2015, registered in the Dutch Arthroplasty Register (LROI). Revision rate for dislocation, and for all other causes, were calculated by competing-risk analysis at 6-year follow-up. Multivariable Cox proportional hazard regression ratios (HRs) were used for comparisons. Results - Posterolateral approach was associated with higher dislocation revision risk (HR =1) than straight lateral, anterolateral, and anterior approaches (HR =0.5-0.6). However, the risk of revision for all other reasons (especially stem loosening) was higher with anterior and anterolateral approaches (HR =1.2) and lowest with posterolateral approach (HR =1). For all approaches, 32-mm heads reduced the risk of revision for dislocation compared to 22- to 28-mm heads (HR =1 and 1.6, respectively), while the risk of revision for other causes remained unchanged. 36-mm heads increasingly reduced the risk of revision for dislocation but only with the posterolateral approach (HR =0.6), while the risk of revision for other reasons was unchanged. With the anterior approach, 36-mm heads increased the risk of revision for other reasons (HR =1.5). Interpretation - Compared to the posterolateral approach, direct anterior and anterolateral approaches reduce the risk of revision for dislocation, but at the cost of more stem revisions and other revisions. For all approaches, there is benefit in using 32-mm heads instead of 22- to 28-mm heads. For the posterolateral approach, 36-mm heads can safely further reduce the risk of revision for dislocation.

  6. Effect of femoral head size and surgical approach on risk of revision for dislocation after total hip arthroplasty (United States)

    Zijlstra, Wierd P; De Hartog, Bas; Van Steenbergen, Liza N; Scheurs, B Willem; Nelissen, Rob G H H


    Background and purpose Recurrent dislocation is the commonest cause of early revision of a total hip arthropasty (THA). We examined the effect of femoral head size and surgical approach on revision rate for dislocation, and for other reasons, after total hip arthroplasty (THA). Patients and methods We analyzed data on 166,231 primary THAs and 3,754 subsequent revision THAs performed between 2007 and 2015, registered in the Dutch Arthroplasty Register (LROI). Revision rate for dislocation, and for all other causes, were calculated by competing-risk analysis at 6-year follow-up. Multivariable Cox proportional hazard regression ratios (HRs) were used for comparisons. Results Posterolateral approach was associated with higher dislocation revision risk (HR =1) than straight lateral, anterolateral, and anterior approaches (HR =0.5–0.6). However, the risk of revision for all other reasons (especially stem loosening) was higher with anterior and anterolateral approaches (HR =1.2) and lowest with posterolateral approach (HR =1). For all approaches, 32-mm heads reduced the risk of revision for dislocation compared to 22- to 28-mm heads (HR =1 and 1.6, respectively), while the risk of revision for other causes remained unchanged. 36-mm heads increasingly reduced the risk of revision for dislocation but only with the posterolateral approach (HR =0.6), while the risk of revision for other reasons was unchanged. With the anterior approach, 36-mm heads increased the risk of revision for other reasons (HR =1.5). Interpretation Compared to the posterolateral approach, direct anterior and anterolateral approaches reduce the risk of revision for dislocation, but at the cost of more stem revisions and other revisions. For all approaches, there is benefit in using 32-mm heads instead of 22- to 28-mm heads. For the posterolateral approach, 36-mm heads can safely further reduce the risk of revision for dislocation. PMID:28440704

  7. 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


    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.)

  8. HEDR modeling approach: Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Shipler, D.B.; Napier, B.A.


    This report is a revision of the previous Hanford Environmental Dose Reconstruction (HEDR) Project modeling approach report. This revised report describes the methods used in performing scoping studies and estimating final radiation doses to real and representative individuals who lived in the vicinity of the Hanford Site. The scoping studies and dose estimates pertain to various environmental pathways during various periods of time. The original report discussed the concepts under consideration in 1991. The methods for estimating dose have been refined as understanding of existing data, the scope of pathways, and the magnitudes of dose estimates were evaluated through scoping studies.

  9. Revision for recurrent dislocation of total hip replacement. (United States)

    Rogers, Mark; Blom, Ashley W; Barnett, Andrew; Karantana, Alexia; Bannister, Gordon C


    Dislocation is one of the commonest complications of total hip arthroplasty with an incidence of between 0.5 and 9.2%. Despite this, little is known of the outcome of treatment strategies for dislocation. The aim of this study was to establish the optimal strategy for the operative management of recurrent dislocation following THA taking account of the surgical approach employed in the replacement that became unstable and the direction of the instability that followed. We reviewed 70 patients who underwent revision surgery for recurrent dislocation after total hip arthroplasty (THA), 38 through the transgluteal (Hardinge) and 32 through the posterior approach.52 of these followed primary and 18 followed revision THA for reasons other than instability.We recorded the surgical approach, the direction of dislocation and the operative strategy employed for each case. We achieved stability in 75% of patients who dislocated after primary and 50% after revision THA. 77% of dislocations performed initially through the transgluteal approach were anterior and 88% through the posterior approach were posterior. Following the transgluteal approach, we stabilised anterior dislocation in 54% of cases. Following the posterior approach we stabilised posterior dislocation in 79%. The most successful operative strategy overall was cup augmentation which conferred stability in 90% of cases. Instability after primary total hip replacement is easier to treat (75% chance of success) than after revision total hip replacement (50% chance of success). Although previous studies have shown that the posterior approach has a slightly higher risk of dislocation, this study has shown that achieving stability after a posterior dislocation is more likely than after an anterior dislocation. The outcome of revision for instability depends on the surgical approach used initially, and the direction of dislocation.

  10. The impact of a restrictive transfusion trigger on post-operative complication rate and well-being following elective orthopaedic surgery: a post-hoc analysis of a randomised study (United States)

    So-Osman, Cynthia; Nelissen, Rob; Brand, Ronald; Faber, Frank; Slaa, Ron Te; Stiggelbout, Anne; Brand, Anneke


    Background Peri-operative red blood cell transfusions have been associated with post-operative complications in patients undergoing elective orthopaedic hip or knee replacement surgery. Materials and methods We performed a post-hoc analysis of data extracted from a randomised study on transfusion triggers using pre-storage leucocyte-depleted red blood cells. Patients who were assigned to the most restrictive transfusion policy ("restrictive group") were compared with patients who were assigned to the most liberal policy ("liberal group"). End-points were red blood cell use, hospital stay, haemoglobin levels, post-operative complications and quality of life scores. Results Of 603 patients, 26.4% patients in the restrictive group and 39.1% in the liberal group were transfused (P =0.001). The rate of post-operative infections was lower, although not statistically significantly so, in the restrictive group than in the liberal group (5.4% vs 10.2%, respectively) as was the rate of respiratory complications (1.7% vs 4.9%, respectively), whereas hospital stay, cardiovascular complications and mortality rate were not different in the two groups. Quality of life scores were not associated with type of transfusion policy, the number of red blood cell transfusions or the transfusion status. Discussion A restrictive transfusion protocol was not associated with worse outcome and resulted in a lower transfusion rate compared to the liberal policy. Well-being (quality of life) was not associated with transfusion policy or with red blood cell transfusions. PMID:23399367

  11. A biomechanical evaluation of three revision screw strategies for failed lateral mass fixation. (United States)

    Hostin, Richard A; Wu, Chunhui; Perra, Joseph H; Polly, David W; Akesen, Burak; Wroblewski, Jill M


    This is a biomechanical study evaluating 3 revision strategies for failed cervical lateral mass screw fixation. Our primary objective was to compare, following a Magerl trajectory screw failure in the subaxial cervical spine, the pullout strength of (1) a revision screw in the same trajectory, (2) a Roy-Camille trajectory, and (3) pedicle screw fixation. We additionally analyzed the contributions of bone mineral density (BMD) and peak insertional torque to pullout strength. Biomechanical studies that have examined revision screw strategies for lateral mass fixation have found either unsatisfactory or highly variable performance. Fresh frozen cervical spinal segments were harvested and BMD testing performed. Bicortical (3.5-mm Vertex) lateral mass screws were placed in a Magerl trajectory in 57 fresh frozen human subaxial cervical vertebrae. All screws were then stripped and revision screws (4.0-mm Vertex) placed using either the same screw path or conversion to a Roy-Camille trajectory. In line pullout testing was performed on each of the revision screws (57 in Magerl revision group, 55 in Roy-Camille). Specimens that had not fractured during testing then had cervical pedicle screws (3.5-mm Vertex) placed and in-line pullout testing repeated (64 pedicles were instrumented) The pullout failure results of the Magerl revision, Roy-Camille revision, and pedicle screw revision groups were compared. No significant difference was noted in insertional torque (0.28-Nm Magerl, 0.35 Nm Roy-Camille, P > 0.05) or pullout (382-N Magerl, 351 N Roy-Camille, P > 0.05) between the Magerl and Roy-Camille revision groups. Pedicle screw revision had greater pullout strength (566 N) when compared with either the Magerl (382 N) or Roy-Camille (351 N) revision groups (P advantage over placement of an increased diameter salvage screw using the same trajectory. Pedicle screw fixation provides superior biomechanical fixation but was associated with a significant breech rate.

  12. Revised SNAP III Training Manual

    Energy Technology Data Exchange (ETDEWEB)

    Moss, Calvin Elroy [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Gonzales, Samuel M. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Myers, William L. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Nelson, Mark Andrew [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Rothrock, Richard Brian [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Salazar, Samuel A. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Sorensen, Eric Byron [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Sundby, Gary M. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)


    The Shielded Neutron Assay Probe (SNAP) technique was developed to determine the leakage neutron source strength of a radioactive object. The original system consisted of an EberlineTM Mini-scaler and discrete neutron detector. The system was operated by obtaining the count rate with the EberlineTM instrument, determining the absolute efficiency from a graph, and calculating the neutron source strength by hand. In 2003 the SNAP III, shown in Figure 1, was designed and built. It required the operator to position the SNAP, and then measure the source-to-detector and detectorto- reflector distances. Next the operator entered the distance measurements and started the data acquisition. The SNAP acquired the required count rate and then calculated and displayed the leakage neutron source strength (NSS). The original design of the SNAP III is described in SNAP III Training Manual (ER-TRN-PLN-0258, Rev. 0, January 2004, prepared by William Baird) This report describes some changes that have been made to the SNAP III. One important change is the addition of a LEMO connector to provide neutron detection output pulses for input to the MC-15. This feature is useful in active interrogation with a neutron generator because the MC-15 has the capability to only record data when it is not gated off by a pulse from the neutron generator. This avoids recording of a lot of data during the generator pulses that are not useful. Another change was the replacement of the infrared RS-232 serial communication output by a similar output via a 4-pin LEMO connector. The current document includes a more complete explanation of how to estimate the amount of moderation around a neutron-emitting source.

  13. Revised Human Health Risk Assessment on Chlorpyrifos (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.

  14. Special Consolidated Checklists for Toxicity Characteristics Revisions (United States)

    This checklist consolidates the changes to the Federal code addressed by the Toxicity Characteristic (TC) Rule [55 FR 11798; March 29, 1990; Revision Checklist 74] and subsequent revisions which have occurred through December 31, 2002.

  15. [Revised practice guideline 'Anaemia in midwifery practice'

    NARCIS (Netherlands)

    Beentjes, M.; Jans, S.M.P.J.


    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

  16. Diet History Questionnaire: Database Revision History (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.

  17. Air Pollution Primer. Revised Education. (United States)

    Corman, Rena

    This revised and updated book is written to inform the citizens on the nature, causes, and effects of air pollution. It is written in terms familiar to the layman with the purpose of providing knowledge and motivation to spur community action on clean air policies. Numerous charts and drawings are provided to support discussion of air pollution…

  18. Psychological considerations in revision rhinoplasty. (United States)

    Ambro, Bryan T; Wright, Richard J


    Revision rhinoplasty is a unique challenge. In addition to the technical considerations that are inherently more difficult than those of primary cases, the surgeon must also be mindful of the psychological considerations that revision rhinoplasty presents. These patients are by definition unhappy with their prior rhinoplasty experience, and this perception of a suboptimal result is both legitimate and real, even if the surgeon is not in agreement. Tantamount to any intraoperative technique, the preoperative ability of the surgeon to sift through the myriad psychological and psychosocial issues is critical to achieving satisfactory outcomes for both patient and surgeon. Reasons for dissatisfaction with a primary surgery, reasons for seeking revision surgery, and the psychological profiles of revision rhinoplasty patients can differ from those related to other facial cosmetic procedures. This article attempts to provide the reader with a better understanding of the complex interplay of these issues and with this understanding help the reader to distinguish one who is a favorable surgical candidate from one who is best left unrevised.

  19. A revision of Ichnocarpus (Apocynaceae)

    NARCIS (Netherlands)

    Middleton, D.J.


    The genus Ichnocarpus is revised. A total of 12 species are recognised, of which one new species is described. Three new combinations in Ichnocarpus and one in Anodendron are made. Micrechites and Lamechites are treated as synonyms of Ichnocarpus. Nomina nuda and species exclusae have been given as

  20. Revised Industry Projections to 1985 (United States)

    Mooney, Thomas J.; Tschetter, John H.


    Revised Bureau of Labor Statistics projections, which reflect assumptions about unemployment, labor productivity, and government taxes and spending, provide information about long-term trends of industry output and employment. One projection made is that health services and computer-related industries will continue to be the leaders in job growth.…

  1. Concise revision of the Sarcospermataceae

    NARCIS (Netherlands)

    Lam, H.J.; Royen, van P.


    After the senior writer, together with W. W. Varossieau, had published a revision of this monogeneric family (Blumea III, 1938—’39 and IV, 1941), some more material has been examined by us and, moreover, some new species have been described. Thanks to the courtesy of Prof. F. Gagnepain of Paris, and

  2. Medical writing, revising and editing

    DEFF Research Database (Denmark)

    Pilegaard, Morten


    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...

  3. Molecular dynamics simulation methods revised

    NARCIS (Netherlands)

    Bekker, Hendrik


    Korte beschrijving: In this thesis, all the subjects mentioned in the previous section are revised, except neighbor searching and integration. So, the following subjects are discussed: non-bonded force calculations, bonded force calculations, constraint dynamics, and box shapes. Moreover, mapping

  4. Outcomes of different bearings in total hip arthroplasty - implant survival, revision causes, and patient-reported outcome. (United States)

    Varnum, Claus


    Total hip arthroplasty (THA) is a common and successful treatment of patients suffering from severe osteoarthritis that significantly reduces pain and improves hip function and quality of life. Traditionally, the outcome of THA has been evaluated by orthopaedic surgeons and assessed in morbidity and mortality rates, and implant survival. As patients and surgeons may assess outcome after THA differently, patient-reported outcomes (PROMs) have gained much more interest and are today recognized as very important tools for evaluating the outcome and satisfaction after THA. One of the prognostic factors for the outcome of THA is the type of bearings. This PhD thesis focuses on the influence of different types of bearings on implant survival, revision causes, PROMs, and noises from THA. The aims of the thesis were: Study I: To examine the revision risk and to investigate the causes of revision of cementless ceramic-on-ceramic (CoC) THAs comparing them to those of "standard" metal-on-polyethylene (MoP) THAs. Study II: To compare the six-year revision risk for metal-on-metal (MoM) with that for MoP bearings in cementless stemmed THA, and further to study the revision risk for different designs of stemmed MoM THAs and the causes of revision. Study III: To examine the association between CoC, MoM, and MoP bearings and both generic and disease-specific PROMs, and furthermore to examine the incidence and types of noises from the three types of bearings and identify the effect of noises on PROM scores. In study I and III, we used data from the Danish Hip Arthroplasty Registry combined with data from the Civil Registration System and the Danish National Patient Registry. In study II, data from the Nordic Arthroplasty Register Association, containing data from hip arthroplasty registries in Denmark, Norway, Sweden, and Finland, was used. In study I, 11,096 patients operated from 2002 through 2009 with cementless THA were included. Of these, 16% had CoC THA and 84% had MoP THA. At

  5. Implantable Cardioverter Defibrillator Outcomes in Pediatric and Congenital Heart Disease: Time to System Revision. (United States)

    Dechert, Brynn E; Bradley, David J; Serwer, Gerald A; Dick Ii, Macdonald; Lapage, Martin J


    Implantable cardioverter defibrillators (ICDs) are intended to prevent sudden cardiac death yet also impose a risk of morbidity. This study describes the outcomes of ICDs in a pediatric and congenital heart disease (CHD) population from a single center. Retrospective cohort study of all patients with an ICD followed at the University of Michigan Congenital Heart Center from 2005-2013. The primary outcome was ICD system revision for any reason excluding routine generator change for battery depletion. There were 191 ICD systems in 131 patients, including 57 with CHD, 24 with hypertrophic cardiomyopathy, and 45 with structurally normal hearts. Median age was 16 years at initial implant. Total follow-up was 850 patient-years; median 4.9 years/patient. There were 43 (33%) patients who required 60 ICD revisions; 70 revisions/1,000 patient-years of follow-up. Revisions included 25 lead extractions with replacement, 21 lead additions, five lead repositions, and four full system revisions. Kaplan-Meier (K-M) median time to appropriate shock was similar to the median time to system revision. K-M time to system revision was significantly affected by recalled lead performance. The need for ICD system revision is high in this pediatric and CHD population and occurs at a rate similar to the rate of receiving appropriate therapy. These results highlight the need for judicious implant criteria and improved device longevity. © 2016 Wiley Periodicals, Inc.

  6. Energy Release Rate in hydraulic fracture: can we neglect an impact of the hydraulically induced shear stress?

    CERN Document Server

    Wrobel, Michal; Piccolroaz, Andrea


    A novel hydraulic fracture (HF) formulation is introduced which accounts for the hydraulically induced shear stress at the crack faces. It utilizes a general form of the elasticity operator alongside a revised fracture propagation condition based on the critical value of the energy release rate. It is shown that the revised formulation describes the underlying physics of HF in a more accurate way and is in agreement with the asymptotic behaviour of the linear elastic fracture mechanics. A number of numerical simulations by means of the universal HF algorithm previously developed in Wrobel & Mishuris (2015) are performed in order to: i) compare the modified HF formulation with its classic counterpart and ii) investigate the peculiarities of the former. Computational advantages of the revised HF model are demonstrated. Asymptotic estimations of the main solution elements are provided for the cases of small and large toughness. The modified formulation opens new ways to analyse the physical phenomenon of HF ...

  7. Soft tissue trauma and scar revision. (United States)

    Mobley, Steven R; Sjogren, Phayvanh P


    Numerous techniques and treatments have been described for scar revision, with most studies focusing on the adult population. A comprehensive review of the literature reveals a paucity of references related specifically to scar revision in children. This review describes the available modalities in pediatric facial scar revision. The authors have integrated current practices in soft tissue trauma and scar revision, including closure techniques and materials, topical therapy, steroid injection, cutaneous laser therapy, and tissue expanders. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. The value of intraoperative Gram stain in revision spine surgery. (United States)

    Shifflett, Grant D; Nwachukwu, Benedict U; Bjerke-Kroll, Benjamin T; Kueper, Janina; Koltsov, Jayme B; Sama, Andrew A; Girardi, Federico P; Cammisa, Frank P; Hughes, Alexander P


    Intraoperative cultures and Gram stains are often obtained in cases of revision spine surgery even when clinical signs of infection are not present. The clinical utility and cost-effectiveness of this behavior remain unproven. The aim was to evaluate the clinical utility and cost-effectiveness of routine intraoperative Gram stains in revision spine surgery. This was a retrospective clinical review performed at an academic center in an urban setting. One hundred twenty-nine consecutive adult revision spine surgeries were performed. The outcome measures included intraoperative Gram stains. We retrospectively reviewed the records of 594 consecutive revision spine surgeries performed by four senior surgeons between 2008 and 2013 to identify patients who had operative cultures and Gram stains performed. All revision cases including cervical, thoracic, and lumbar fusion and non-fusion, with and without instrumentation were reviewed. One hundred twenty-nine (21.7%) patients had operative cultures obtained and were included in the study. The most common primary diagnosis code at the time of revision surgery was pseudarthrosis, which was present in 41.9% of cases (54 of 129). Infection was the primary diagnosis in 10.1% (13 of 129) of cases. Operative cultures were obtained in 129 of 595 (21.7%) cases, and 47.3% (61 of 129) were positive. Gram stains were performed in 98 of 129 (76.0%) cases and were positive in 5 of 98 (5.1%) cases. Overall, there was no correlation between revision diagnosis and whether or not a Gram stain was obtained (p=.697). Patients with a history of prior instrumentation were more likely to have a positive Gram stain (pstaining was found to have a sensitivity of 10.9% (confidence interval [CI] 3.9%-23.6%) and specificity of 100% (CI 93.1%-100%). The positive and negative predictive values were 100% (CI 48.0%-100%) and 57.3% (CI 45.2%-66.2%), respectively. Kappa coefficient was calculated to be 0.1172 (CI 0.0194-0.2151). The cost per discrepant

  9. Transients analysis of the NPP-L V under conditions of extended power up rate using the extended operation domain; Analisis de transitorios de la CNLV en condiciones de aumento de potencia extendida empleando el dominio de operacion extendido

    Energy Technology Data Exchange (ETDEWEB)

    Lopez G, A.; Francois L, J. L. [UNAM, Facultad de Ingenieria, Ciudad Universitaria, 04510 Mexico D. F. (Mexico); Nunez C, A., E-mail: [Comision Nacional de Seguridad Nuclear y Salvaguardias, Dr. Barragan No. 779, Col. Narvarte, 03020 Mexico D. F. (Mexico)


    The extended operation domain of the map flow-power allows operating to an extended power with a reduced flow in the core, this implies to expand the operation frontier to allow 120% of the original licensed thermal power (OLTP), with a flow in the core so low as 80% of the nominal flow, with a high pattern of control rods. The present work has as objective to study the response to recirculation operational transients of the nuclear power plant of Laguna Verde under conditions of Extended Power Up rate (EPU) and under the extended operation domain of the map flow-power. The content of this work covers the analysis of the thermal-hydraulic uncertainties obtained of the simulation of the recirculation pumps shot, as well as of the transition of high to low speed of these pumps. Both simulations were carried out for EPU conditions (120% of OLTP and 100% of flow in the core) and for the extended operation domain of the map flow-power, (120% of OLTP and 80% of flow in the core), this because the reactor will be situated in a region of high probability of uncertainty. At the present time any plant at world level has operated under EPU conditions under the extended operation domain of the map flow-power, for what the results of this work are innovative in this field, allowing to know the responses to the presented transients, and later on to develop the operative and regulatory conditions necessary for the operation of this domain, with the purpose of guaranteeing the safety. (Author)

  10. Risk-adjusted operative delivery rates and maternal-neonatal outcomes as measures of quality assessment in obstetric care: a multicenter prospective study. (United States)

    Maso, Gianpaolo; Monasta, Lorenzo; Piccoli, Monica; Ronfani, Luca; Montico, Marcella; De Seta, Francesco; Parolin, Sara; Businelli, Caterina; Travan, Laura; Alberico, Salvatore


    Although the evaluation of caesarean delivery rates has been suggested as one of the most important indicators of quality in obstetrics, it has been criticized because of its controversial ability to capture maternal and neonatal outcomes. In an "ideal" process of labor and delivery auditing, both caesarean (CD) and assisted vaginal delivery (AVD) rates should be considered because both of them may be associated with an increased risk of complications. The aim of our study was to evaluate maternal and neonatal outcomes according to the outlier status for case-mix adjusted CD and AVD rates in the same obstetric population. Standardized data on 15,189 deliveries from 11 centers were prospectively collected. Multiple logistic regression was used to estimate the risk-adjusted probability of a woman in each center having an AVD or a CD. Centers were classified as "above", "below", or "within" the expected rates by considering the observed-to-expected rates and the 95% confidence interval around the ratio. Adjusted maternal and neonatal outcomes were compared among the three groupings. Centers classified as "above" or "below" the expected CD rates had, in both cases, higher adjusted incidence of composite maternal (2.97%, 4.69%, 3.90% for "within", "above" and "below", respectively; p = 0.000) and neonatal complications (3.85%, 9.66%, 6.29% for "within", "above" and "below", respectively; p = 0.000) than centers "within" CD expected rates. Centers with AVD rates above and below the expected showed poorer and better composite maternal (3.96%, 4.61%, 2.97% for "within", "above" and "below", respectively; p = 0.000) and neonatal (6.52%, 9.77%, 3.52% for "within", "above" and "below", respectively; p = 0.000) outcomes respectively than centers with "within" AVD rates. Both risk-adjusted CD and AVD delivery rates should be considered to assess the level of obstetric care. In this context, both higher and lower-than-expected rates of CD and "above" AVD rates

  11. Extended porous femoral stems in hip revisions.

    Directory of Open Access Journals (Sweden)

    Pablo Bruno


    Full Text Available Introduction: The porous coated cylindrical  stem are one of the most popular option in the set of hip revison surgery. The poupose of this study is present the clinical and radiographic results of a group of patients treated with this stem. Material and Methods: Between 1997 and 2010, we retrospectively evaluated 150 stem in 148 patients. The indication for revisión was aseptic loosening in 88 cases (58.6%, septic loosening in 41 cases (27.3%, periprosthetic fracture in 14 cases (9.3%, failed hip ostesynthesis in 4 cases (2.6% and stem fracture in 3 cases (2%. We followed the patient on average for 7.7 years. Results: We achived bone-ingrowth fixation in 135 patients (90 %,,  fibrous tissue fixation in 12 (8% and unstable fixation in 3 (2 %. The mean Harris hip score improved to 92 points at last follow-up. Three stem were revised (2%. One patient had revisión becouse of stem loosening. The other two becouse of deep infection required a 2 staged revision.  Three patient (2% had dislocation and was treated succesfully with closed reduction. Conclusion:  The porous coated cylindrical stem is a predictable technique with excellent survival rates  in  the set of  revisión hip surgery.

  12. The JFK Coma Recovery Scale--Revised. (United States)

    Kalmar, Kathleen; Giacino, Joseph T


    The JFK Coma Recovery Scale (CRS) was developed to help characterise and monitor patients functioning at Rancho Levels I-IV and has been used widely in both clinical and research settings within the US and Europe. The CRS was recently revised to address a number of concerns emanating from our own clinical experience with the scale, feedback from users and researchers as well as the results of Rasch analyses. Additionally, the CRS did not include all of the behavioural criteria necessary to diagnose the minimally conscious state (MCS), thereby limiting diagnostic utility. The revised JFK Coma Recovery Scale (CRS-R) includes addition of new items, merging of items found to be statistically similar, deletion or modification of items showing poor fit with the scale's underlying construct, renaming of items, more stringent scoring criteria, and quantification of elicited behaviours to improve accuracy of rating. Psychometric properties of the CRS-R appear to meet standards for measurement and evaluation tools for use in clinical and research settings, and diagnostic application suggests that the scale is capable of discriminating patients in the minimally conscious state from those in the vegetative state.

  13. Impact of Using Intra-Operative Ultrasound Guided Breast- Conserving Surgery on Positive Margin and Re-Excision Rates in Breast Cancer Cases with Current SSO/ASTRO Guidelines. (United States)

    Thanasitthichai, Somchai; Chaiwerawattana, Arkom; Phadhana-Anake, Oradee


    To review the impact of using intra-operative ultrasound guided breast conserving surgery with frozen sections on nal pathological margin outcome with the current guidelines set forth by the Society of Surgical Oncology (SSO) and the American Society of Surgical Oncology (ASTRO). A retrospective review including all cases of intra-operative ultrasound guided breast conserving surgery was performed at the National Cancer Institute Thailand between 2013 and 2016. Patient demographics, tumor variables, intraoperative frozen section and nal pathological margin outcomes were collected. Factors for positive or close margins were analyzed. A total of 86 patients aged between 27 and 75 years with intra- operative ultrasound guided breast conserving surgery were included. Three cases (3.5%) of positive margin were detected by intra-operative frozen section and 4 cases (4.7%) by final pathology reports. There were 18 cases (20.9%) with a close margin (ASTRO for adequate margin guidelines, using intra-operative ultrasound to locate the boundary for resection with breast conserving surgery provided a high success rate in obtaining final pathology free margin outcomes and minimizing re-operation risks especially when combined with intra-operative frozen section assessment. The chance of finding positive or close margins appears higher in cases of IDC combined with DCIS, ILC and with multi-foci cancers.

  14. Laser scar revision. (United States)

    Lupton, Jason R; Alster, Tina S


    A variety of lasers can be used to treat scars and striae effectively. It is of paramount importance that the type of scar be properly classified on initial examination so that the most appropriate method of treatment can be chosen. Classification also allows the laser surgeon to discuss with the patient the anticipated response to treatment. The 585-nm pulsed dye laser (PDL) is the most appropriate system for treating hypertrophic scars, keloids, erythematous scars, and striae. The PDL carries a low risk of side effects and complications when operated at appropriate treatment parameters and time intervals. Atrophic scars are best treated with ablative CO2 and Er:YAG lasers; however, proliferative keloids and hypertrophic scars should not be vaporized because of the high risk of scar recurrence or progression. The appropriate choice and use of lasers can significantly improve most scars. As research in laser-skin interaction continues, further refinements in laser technology coupled with the addition of alternate treatment procedures will allow improved clinical efficacy and predictability.

  15. A Prospective Observational Study of Abdominal Injury Management in Contemporary Military Operations: Damage Control Laparotomy Is Associated With High Survivability and Low Rates of Fecal Diversion (United States)


    civilian trauma,1 thus averting the coagulopathic consequences of the “ bloody vicious cycle.”2 Now termed “damage control” laparotomy (DCL),3 this pre...Operation Iraqi Freedom. J Trauma. 2004;57:201–207. 37. Chambers LW, Rhee P, Baker BC, et al. Initial experience of US Marine Corps forward resuscitative

  16. The performance and subjective responses of call-center operators with new and used supply air filters at two outdoor air supply rates

    DEFF Research Database (Denmark)

    Wargocki, Pawel; Wyon, David; Fanger, Povl Ole


    of these independent variables was changed each week for 8 weeks. The interventions did not affect room temperature, relative humidity or noise level. The 26 operators were blind to conditions and each week returned questionnaires recording their environmental perceptions and Sick Building Syndrome (SBS) symptoms...

  17. 40 CFR Table 1 to Subpart Nnnn of... - Operating Limits if Using the Emission Rate With Add-On Controls Option (United States)


    ... returned to service until the recorded temperature of the carbon bed is at or below the temperature limit... pressure drop limit, and maintaining the direction of air flow into the enclosure at all times. b. the... 40 Protection of Environment 12 2010-07-01 2010-07-01 true Operating Limits if Using the Emission...

  18. 40 CFR Table 3 to Subpart Qqqq of... - Operating Limits if Using the Emission Rate With Add-On Controls Option (United States)


    ... recorded temperature of the carbon bed is at or below the temperature limit. 4. Condenser a. The average... drop limit, and maintaining the direction of air flow into the enclosure at all times. b. The average... 40 Protection of Environment 12 2010-07-01 2010-07-01 true Operating Limits if Using the Emission...

  19. Modern operating systems

    CERN Document Server

    Tanenbaum, Andrew S


    Modern Operating Systems, Fourth Edition, is intended for introductory courses in Operating Systems in Computer Science, Computer Engineering, and Electrical Engineering programs. It also serves as a useful reference for OS professionals ' The widely anticipated revision of this worldwide best-seller incorporates the latest developments in operating systems (OS) technologies. The Fourth Edition includes up-to-date materials on relevant'OS. Tanenbaum also provides information on current research based on his experience as an operating systems researcher. ' Modern Operating Systems, Third Editionwas the recipient of the 2010 McGuffey Longevity Award. The McGuffey Longevity Award recognizes textbooks whose excellence has been demonstrated over time.' " Teaching and Learning Experience This program will provide a better teaching and learning experience-for you and your students. It will help: ' *Provide Practical Detail on the Big Picture Concepts: A clear and entertaining writing s...

  20. Development of high energy, sub-15 fs OPCPA system operating at 1 kHz repetition rate for ELI-Beamlines facility (United States)

    Bakule, Pavel; Antipenkov, Roman; Green, Jonathan T.; Novák, Jakub; Batysta, František; Rus, Bedřich; Boge, Robert; Hubka, Zbyněk.; Naylon, Jack A.; Horáček, Martin; Horáček, Jakub; Strkula, Petr; Snopek, David; Indra, Lukaš; Tykalewicz, Boguslaw


    We report on the status of the high repetition rate, high energy, L1 laser beamline at the ELI-Beamlines facility. The beamline is based on picosecond optical parametric chirped pulse amplification (OPCPA) of pulses from a mode-locked Ti:Sapphire oscillator and has a target energy/repetition rate of 100 mJ/1 kHz with architecture design considerations to achieve our goals of long term stability are discussed.

  1. Space-contained conflict revision, for geographic information


    Doukari, Omar; Jeansoulin, Robert


    14 pages; International audience; Using qualitative reasoning with geographic information, contrarily, for instance, with robotics, looks not only fastidious (i.e.: encoding knowledge Propositional Logics PL), but appears to be computational complex, and not tractable at all, most of the time. However, knowledge fusion or revision, is a common operation performed when users merge several different data sets in a unique decision making process, without much support. Introducing logics would be...

  2. KSOS System Security Plan. Revision 2. Kernelized Secure Operating System. (United States)


    1972) j. (Hoare 73b] Hoare, C. A. R., "Proof of a Structured Program: the Sieve of Eratosthenes ", Computer Journal, 15 pp 321-325, (November 1972). k...desire for improved system security permeates every design and implementation decision. 4 Rev 2 KSOS System Security Plan The model of security which...Modula encourages modularization and information hiding, two features which improve the robustness and maintainability of the system. The testing

  3. Dredging: An Annotated Bibliography on Operations, Equipment, and Processes. Revision. (United States)


    trates use of Monte Carlo simulation techniques in this context. 0856 1977. "Transient Considerations in Maintenance Dredging," Terra et Aqua, No. 12...Pipeline dredges are underutilized and in need of modernization. 0034 BRAHME , S. B. and HERBICH, J. B. 1977. "Dredging in India - Suggested...follow the actual movement of sediments and give information about transport parameters in practice. 0788 SAXENA, P. C., VAIDYARAMAN, B. P., and BRAHME


    Directory of Open Access Journals (Sweden)

    S. V. Kolesov


    Full Text Available The authors presented 19 clinical observations of patients undergoing surgery at the primary idiopathic scoliosis using plate endocorrectors. The following characteristics were determined: the fixation of posterior elements of the spine there is no possibility of adequate derotation scoliotic vertebrae arc and require extensive fixation of the spine (Th2-L4, significantly reducing the functional activity of the patients. The lack of the fusion is accompanied by system micromotion, causes the instability of the upper pole of the metal construction and provokes the formation of a fistula. The presence of fibrous scar, and later - bone block, doesn’t allow to realize the lengthening effect during the patient’s growth and causes the development of Crankshaft-phenomenon, the correction of which requires a long, traumatic, multi-stage surgery.

  5. Stadium IB - IIA cervical cancer patient’s survival rate after receiving definitive radiation and radical operation therapy followed by adjuvant radiation therapy along with analysis of factors affecting the patient’s survival rate (United States)

    Ruslim, S. K.; Purwoto, G.; Widyahening, I. S.; Ramli, I.


    To evaluate the characteristics and overall survival rates of early stage cervical cancer (FIGO IB-IIA) patients who receive definitive radiation therapy and those who are prescribed adjuvant postoperative radiation and to conduct a factors analysis of the variables that affect the overall survival rates in both groups of therapy. The medical records of 85 patients with cervical cancer FIGO stages IB-IIA who were treated at the Department of Radiotherapy of Cipto Mangunkusumo Hospital were reviewed and analyzed to determine their overall survival and the factors that affected it between a definitive radiation group and an adjuvant postoperative radiation group. There were 25 patients in the definitive radiation and 60 patients in the adjuvant radiation group. The overall survival rates in the adjuvant radiation group at years one, two, and three were 96.7%, 95%, and 93.3%, respectively. Negative lymph node metastasis had an average association with overall survival (p 12 g/dl was a factor with an average association with the overall survival (p cervical cancer FIGO stage IB-IIA patients who received definitive radiation or adjuvant postoperative radiation. Negative lymph node metastasis had an effect on the overall survival rate in the adjuvant postoperative radiation group, while a preradiation Hb level >12 g/dl tended to affect the overall survival in the definitive radiation group patients.

  6. Financial analysis of revision knee surgery based on NHS tariffs and hospital costs: does it pay to provide a revision service? (United States)

    Kallala, R F; Vanhegan, I S; Ibrahim, M S; Sarmah, S; Haddad, F S


    Revision total knee arthroplasty (TKA) is a complex procedure which carries both a greater risk for patients and greater cost for the treating hospital than does a primary TKA. As well as the increased cost of peri-operative investigations, blood transfusions, surgical instrumentation, implants and operating time, there is a well-documented increased length of stay which accounts for most of the actual costs associated with surgery. We compared revision surgery for infection with revision for other causes (pain, instability, aseptic loosening and fracture). Complete clinical, demographic and economic data were obtained for 168 consecutive revision TKAs performed at a tertiary referral centre between 2005 and 2012. Revision surgery for infection was associated with a mean length of stay more than double that of aseptic cases (21.5 vs 9.5 days, p service. Moreover, especially as greater costs are incurred for infected cases. These losses may adversely affect the provision of revision surgery in the NHS. ©2015 The British Editorial Society of Bone & Joint Surgery.

  7. Bipolar Thermofusion BiClamp 150 in Thyroidectomy: A Review of 1156 Operations

    Directory of Open Access Journals (Sweden)

    Tomáš Pniak


    Full Text Available Objectives. To compare the bipolar thermofusion BiClamp 150 with conventional ligature techniques for thyroid gland surgery, and report the advantages/disadvantages of both techniques. Methods. In this retrospective comparative study, all thyroid gland operations performed in the ENT Clinic Faculty Hospital Ostrava from 2006 to 2013 were included (1156 operations, 2122 lobes. Patients were categorized into two groups according to the type of vessel sealing method used, group I (BiClamp, n=819 operations and group II (conventional ligature, n=337 operations. The number of revision surgeries due to wound hematoma was recorded as a bleeding event. Statistical analysis of the complication rate (bleeding rate, recurrent nerve palsy and time of duration was performed. Results. The rate of revision surgery performed due to postoperative wound hematoma was significantly lower in group I (15/819, 1.83% compared with group II (14/337, 4.15% (P=0.022. There was no statistically significant difference in the frequency of recurrent laryngeal nerve palsy between groups I and II (P=0.36. The average surgery time was significantly shorter in group I (P<0.001. Conclusion. Bipolar thermofusion BiClamp is an effective vessel sealing method that leads to a significant reduction in postoperative wound bleeding rates and reduces surgical time compared with conventional vessel ligature.

  8. Comparing SSN Index to X-ray Flare and Coronal Mass Ejection Rates from Solar Cycles 22-24


    Winter, Lisa M.; Pernak, Rick; Balasubramaniam, K. S.


    The newly revised sunspot number series allows for placing historical geoeffective storms in the context of several hundred years of solar activity. Using statistical analyses of the Geostationary Operational Environmental Satellites (GOES) X-ray observations from the past ~30 years and the Solar and Heliospheric Observatory (SOHO) Large Angle and Spectrometric Coronagraph (LASCO) Coronal Mass Ejection (CME) catalog (1996-present), we present sunspot-number-dependent flare and CME rates. In p...

  9. Operation Pied Piper: a geographical reappraisal of the impact of wartime evacuation on scarlet fever and diphtheria rates in England and Wales, 1939-1945. (United States)

    Smallman-Raynor, M R; Cliff, A D


    This paper examines the geographical impact of the British Government's wartime evacuation scheme on notified rates of two common acute childhood diseases (scarlet fever and diphtheria) in the 1470 local government districts of England and Wales, 1939-1945. Drawing on the notifications of communicable diseases collated by the General Register Office (GRO), we establish pre-war (baseline) disease rates for the 1470 districts. For the war years, techniques of binary logistic regression analysis are used to assess the associations between (a) above-baseline ('raised') disease rates in evacuation, neutral and reception districts and (b) the major phases of the evacuation scheme. The analysis demonstrates that the evacuation was temporally associated with distinct national and regional effects on notified levels of disease activity. These effects were most pronounced in the early years of the dispersal (1939-1941) and corresponded with initial levels of evacuation-related population change at the regional and district scales.

  10. The impact of transcutaneous electrical stimulation therapy on appendicostomy operation rates for children with chronic constipation--a single-institution experience. (United States)

    Yik, Yee Ian; Leong, L C Y; Hutson, John M; Southwell, Bridget R


    Appendicostomy for antegrade continence enema is a minimally invasive surgical intervention that has helped many children with chronic constipation. At our institution, since 2006, transcutaneous electrical stimulation (TES) has been trialed to treat slow-transit constipation (STC) in children. This retrospective audit aimed to determine if TES use affected appendicostomy-formation rates and to monitor changes in practice. We hypothesized that appendicostomy rates have decreased for STC but not for other indications. Appendicostomy-formation rate was determined for the 5 years before and after 2006. Children were identified as STC or non-STC from nuclear transit scintigraphy and patient records. Since 1999, 317 children were diagnosed with STC using nuclear transit scintigraphy with 121 during 2001 to 2005 (24.2/year) and 147 during 2006 to 2010 (29.4/year). Seventy-four children had appendicostomy formation. For 2001 to 2005, appendicostomy-formation rates for STC and non-STC children were similar: 5.4 per year (n = 27) and 4.8 per year (n = 24), respectively. For 2006 to 2010, appendicostomy-formation rates were 1.2 per year (n = 6) for STC and 3.2 per year (n = 16) for non-STC (χ(2), P = .04). Since 2006, appendicostomy-formation rates have significantly reduced in STC but not in non-STC children at our institute, coinciding with the introduction of TES as an alternative treatment for STC. Transcutaneous electrical stimulation has not been tested on non-STC children in this period. Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.

  11. Remote implementation of quantum operations

    Energy Technology Data Exchange (ETDEWEB)

    Huelga, Susana F [Quantum Physics Group, STRI, Department of Physics, Astrophysics and Mathematics, University of Hertfordshire, Hatfield, Herts AL10 9AB (United Kingdom); Plenio, Martin B [QOLS, Blackett Laboratory, Imperial College London, London SW7 2BW (United Kingdom); Xiang Guoyong [Key Laboratory of Quantum Information and Department of Physics, University of Science and Technology of China, Hefei 230026 (China); Li Jian [Key Laboratory of Quantum Information and Department of Physics, University of Science and Technology of China, Hefei 230026 (China); Guo Guangcan [Key Laboratory of Quantum Information and Department of Physics, University of Science and Technology of China, Hefei 230026 (China)


    Shared entanglement allows, under certain conditions, the remote implementation of quantum operations. We revise and extend recent theoretical results on the remote control of quantum systems as well as experimental results on the remote manipulation of photonic qubits via linear optical elements.

  12. Outcomes of Ahmed Glaucoma Valve Revision in Pediatric Glaucoma. (United States)

    Al-Omairi, Ahmed Mansour; Al Ameri, Aliah H; Al-Shahwan, Sami; Khan, Arif O; Al-Jadaan, Ibrahim; Mousa, Ahmed; Edward, Deepak P


    Encapsulation of the Ahmed glaucoma valve (AGV) plate is a common cause for postoperative elevation of intraocular pressure, especially in children. Many reports have described the outcomes of AGV revision in adults. However, the outcomes of AGV revision in children are poorly documented. The aim of this study was to determine the outcomes of AGV revision in children. Retrospective cross-sectional study. A retrospective chart review of patients less than 15 years of age who underwent AGV revision with a minimum postoperative follow-up of 6 months was conducted. Outcome measures included reduction in intraocular pressure from baseline, survival analysis, and reduction in the number of antiglaucoma medications. Postoperative complications were also noted. Complete success was defined as an IOP of 21 mm Hg or less without medications, while qualified success was defined as having an IOP of 21 mm Hg or less with medications. A total of 44 eyes met the inclusion criteria. Primary congenital glaucoma was present in 39 eyes (88.6%), aphakic glaucoma in 4 eyes (9.1%), and Peters anomaly-associated glaucoma in 1 eye (2.3%). The mean number of previous surgeries was 1.4, and the mean age was 6.7 years (range, 1.9-13 years) with a median follow-up of 12 months (range, 6-24 months). The IOP was reduced from a preoperative mean of 30.4 (± 10.3) to 24.9 (± 10.6) mm Hg at 6 months postoperatively. Kaplan-Meier analysis showed that the complete success rate at 1 month was 100% followed by a rapid decline at 6 months to 38.6%, 27.7% at 1 year, and 5.5% at 2 years. Qualified success rate was 100% at 1 month followed by a 6-month and 1-year survival rate of approximately 50% and a 2-year survival rate of approximately 16%. The median survival time was 14 months. No specific risk factors for failure were identified. Visual acuity remained unchanged following revision. The most common complication was recurrence of encapsulation with elevated IOP (15.9%). Other

  13. Revisions for screw malposition and clinical outcomes after robot-guided lumbar fusion for spondylolisthesis. (United States)

    Schröder, Marc L; Staartjes, Victor E


    OBJECTIVE The accuracy of robot-guided pedicle screw placement has been proven to be high, but little is known about the impact of such guidance on clinical outcomes such as the rate of revision surgeries for screw malposition. In addition, there are very few data about the impact of robot-guided fusion on patient-reported outcomes (PROs). Thus, the clinical benefit for the patient is unclear. In this study, the authors analyzed revision rates for screw malposition and changes in PROs following minimally invasive robot-guided pedicle screw fixation. METHODS A retrospective cohort study of patients who had undergone minimally invasive posterior lumbar interbody fusion (MI-PLIF) or minimally invasive transforaminal lumbar interbody fusion was performed. Patients were followed up clinically at 6 weeks, 12 months, and 24 months after treatment and by mailed questionnaire in March 2016 as a final follow-up. Visual analog scale (VAS) scores for back and leg pain severity, Oswestry Disability Index (ODI), screw revisions, and socio-demographic factors were analyzed. A literature review was performed, comparing the incidence of intraoperative screw revisions and revision surgery for screw malposition in robot-guided, navigated, and freehand fusion procedures. RESULTS Seventy-two patients fit the study inclusion criteria and had a mean follow up of 32 ± 17 months. No screws had to be revised intraoperatively, and no revision surgery for screw malposition was needed. In the literature review, the authors found a higher rate of intraoperative screw revisions in the navigated pool than in the robot-guided pool (p robot-guided procedures (p robotic guidance to reduce the rate of revision surgery for screw malposition as compared with other techniques of pedicle screw insertion described in peer-reviewed publications. Larger comparative studies are required to assess differences in PROs following a minimally invasive approach in spinal fusion surgeries compared with other

  14. Belief Revision and Argumentation Theory (United States)

    Falappa, Marcelo Alejandro; Kern-Isberner, Gabriele; Simari, Guillermo Ricardo

    Belief revision is the process of changing beliefs to adapt the epistemic state of an agent to a new piece of information. The logical formalization of belief revision is a topic of research in philosophy, logic, and in computer science, in areas such as databases or artificial intelligence. On the other hand, argumentation is concerned primarily with the evaluation of claims based on premises in order to reach conclusions. Both provide basic and substantial techniques for the art of reasoning, as it is performed by human beings in everyday life situations and which goes far beyond logical deduction. Reasoning, in this sense, makes possible to deal successfully with problems in uncertain, dynamic environments and has been promoting the development of human societies.

  15. Revising Academic Library Governance Handbooks

    Directory of Open Access Journals (Sweden)

    Jen Stevens


    Full Text Available Regardless of our status (tenure track, non-tenure track, staff, and/or union, academic librarians at colleges and universities may use a handbook or similar document as a framework for self-governance. These handbooks typically cover rank descriptions, promotion requirements, and grievance rights, among other topics. Unlike employee handbooks used in the corporate world, these documents may be written and maintained by academic librarians themselves1. In 2010, a group of academic librarians at George Mason University was charged with revising our Librarians’ Handbook. Given the dearth of literature about academic librarians’ handbooks and their revision, we anticipate our library colleagues in similar situations will benefit from our experience and recommendations.

  16. Within-Subject Testing of the Signaled-Reinforcement Effect on Operant Responding as Measured by Response Rate and Resistance to Change (United States)

    Reed, Phil; Doughty, Adam H.


    Response rates under random-interval schedules are lower when a brief (500 ms) signal accompanies reinforcement than when there is no signal. The present study examined this signaled-reinforcement effect and its relation to resistance to change. In Experiment 1, rats responded on a multiple random-interval 60-s random-interval 60-s schedule, with…

  17. Reaction rate uncertainties and the operation of the neNa and MgAl chains during HBB in intermediate-mass AGB stars

    NARCIS (Netherlands)

    Izzard, R.G.; Lugaro, M.A.; Karakas, A.I.; Iliadis, C.; van Raai, M.A.


    We test the effect of proton-capture reaction rate uncertainties on the abundances of the Ne, Na, Mg and Al isotopes processed by the NeNa and MgAl chains during hot bottom burning (HBB) in asymptotic giant branch (AGB) stars of intermediate mass between 4 and 6 solar masses and metallicities

  18. An inductively-coupled 64b organic RFID tag operating at 13.56MHz with a data rate of 787b/s

    NARCIS (Netherlands)

    Myny, K.; Winckel, S. van; Steudel, S.; Vicca, P.; Jonge, S. de; Beenhakkers, M.J.; Sele, C.W.; Aerle, N.A.J.M. van; Gelinck, G.H.; Genoe, J.; Heremans, P.L.


    A 64b inductively coupled organic RFID tag on foil is demonstrated at 13.56MHz. The digital logic foil comprises 414 pentacene transistors and is powered by a pentacene double half-wave rectifier, connected to an inductive antenna. The data rate is 787b/s with load modulation behind the rectifier

  19. Clean Air Act. Revision 5

    Energy Technology Data Exchange (ETDEWEB)


    This Reference Book contains a current copy of the Clean Air Act, as amended, and those regulations that implement the statute and appear to be most relevant to DOE activities. The document is provided to DOE and contractor staff for informational purposes only and should not be interpreted as legal guidance. This Reference Book has been completely revised and is current through February 15, 1994.

  20. ATLAS Distributed Computing Operations in the First Two Years of Data Taking

    CERN Document Server

    Ueda, I; The ATLAS collaboration


    The ATLAS experiment has had two years of steady data taking in 2010 and 2011. Data are calibrated, reconstructed, distributed and analysed at over 100 different sites using the World-wide LHC Computing Grid. Following the experience in 2010, the data distribution policies were revised to address scalability issues due to the increase in luminosity and trigger rate in 2011. The structure in the ATLAS computing model has also been revised to optimise the usage of the resources, according to effective transfer rates between sites and site availability. Some new infrastructures were introduced for the software installation at the sites and for database access to reduce the bottlenecks in the data processing. Issues in the end-user analysis were studied and automated control system of the analysis queues based on functional tests has been introduced. The monitoring tools have been implemented and improved to review the ATLAS activities by categories. In this talk, we will report on the operational experience and ...

  1. Revised dietary guidelines for Koreans. (United States)

    Jang, Young Ai; Lee, Haeng Shin; Kim, Bok Hee; Lee, Yoonna; Lee, Hae Jeung; Moon, Jae Jin; Kim, Cho-il


    With rapidly changing dietary environment, dietary guidelines for Koreans were revised and relevant action guides were developed. First, the Dietary Guidelines Advisory Committee was established with experts and government officials from the fields of nutrition, preventive medicine, health promotion, agriculture, education and environment. The Committee set dietary goals for Koreans aiming for a better nutrition state of all after a thorough review and analysis of recent information related to nutritional status and/or problems of Korean population, changes in food production/supply, disease pattern, health policy and agricultural policy. Then, the revised dietary guidelines were proposed to accomplish these goals in addition to 6 different sets of dietary action guides to accommodate specific nutrition and health problems of respective age groups. Subsequently, these guidelines and guides were subjected to the focus group review, consumer perception surveys, and a public hearing for general and professional comments. Lastly, the language was clarified in terms of public understanding and phraseology. The revised Dietary guidelines for Koreans are as follows: eat a variety of grains, vegetables, fruits, fish, meat, poultry and dairy products; choose salt-preserved foods less, and use less salt when you prepare foods; increase physical activity for a healthy weight, and balance what you eat with your activity; enjoy every meal, and do not skip breakfast; if you drink alcoholic beverages, do so in moderation; prepare foods properly, and order sensible amounts; enjoy our rice-based diet.

  2. MCQ tests in Advanced Trauma Life Support (ATLS©): Development and revision. (United States)

    Bustraan, Jacqueline; Henny, Walter; Kortbeek, John B; Brasel, Karen J; Hofmann, Marzellus; Schipper, Inger B


    In Advanced Trauma Life Support (ATLS©) courses, multiple choice question (MCQ) tests are used to assess student's post course knowledge. As part of the ninth Edition Revision Process, existing MCQ tests were reviewed and revised by an International MCQ Revision group. The aim of this study was to evaluate the revision procedure and its effects. Based on psychometric data and evidence based guidelines for adequate MCQ item and test development, a detailed stepwise approach was determined and followed to evaluate the existing MCQs, and to guide test item revision or replacement. The MCQ Revision group composed three new draft test versions comprising of 40 MCQs each. These were beta-tested among ATLS Instructors in various countries involved in ATLS. Psychometric analysis demonstrated that a minority of MCQ items required revision to create three equally balanced tests. After these final adjustments, a new set of three validated MCQ tests was available for use in 9th edition ATLS provider courses. Beta testing was performed using instructors but not students. The failure rate amongst students of ATLS provider courses increased significantly after introduction of the new MCQ tests. ATLS tests were revised and updated using current evidence based guidelines and psychometric analysis. Difficulty of the tests was not initially beta-tested on students. Increasing test item discrimination and quality resulted in lower test scores by students. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. The fate of ventriculo-peritonea1 shunts and outcome of revision ...

    African Journals Online (AJOL)

    Three patients had signs of infected CSF on pre-operative examination ancl underwent antibiotic treatment before VPS insertion. There was no operative mortality. Postoperative complications were: pneumonia (2), abdominal aetiology of the hydrocephalus in the revision group was meningitis in nine (45%); congenital in ...

  4. Endoscopic revision (StomaphyX) versus formal surgical revision (gastric bypass) for failed vertical band gastroplasty. (United States)

    Bolton, Johan; Gill, Richdeep S; Al-Jahdali, Akram; Byrns, Simon; Shi, Xinzhe; Birch, Daniel W; Karmali, Shahzeer


    Weight regain secondary to VBG pouch dilation is a typical referral for Bariatric surgeons. In this study we compare an endoluminal pouch reduction (Stomaphyx) to RYGB for revision. A retrospective review was completed for patients with a previous VBG presenting with weight regain between 2003-2010. Thirty patients were identified for study 23 RYGB, 14 StomaphyX. Significant post procedure BMI loss was seen in each cohort (RYGB, 47.7 ± 7 kg/m(2) to 35 ± 7 kg/m(2); StomaphyX 43 ± 10 kg/m(2) to 40 ± 9 kg/m(2), P = 0.0007). Whereas nausea and headache were the only complications observed in StomaphyX patients, the RYGB group had a 43.5% complication rate and 1 mortality. Complications following RYGB include: incisional hernia (13%), anastomotic leak (8.7%), respiratory failure (8.7%), fistula (8.7%), and perforation (4.35%). The median length of stay following RYGB was 6 days compared to 1.5 ± 0.5 days following StomaphyX. This study suggests that while RYGB revision may achieve greater weight loss, the complication rates and severity is discouraging. StomaphyX may be a safe alternative. Further technical modifications of the device and longer follow-up may clarify the role of this approach.

  5. Risk factors predicting revision surgery after medial epicondylectomy for primary cubital tunnel syndrome. (United States)

    Gaspar, Michael P; Jacoby, Sidney M; Osterman, A Lee; Kane, Patrick M


    Medial epicondylectomy (ME) is one of several accepted surgical options for the treatment of cubital tunnel syndrome (CuTS). Although reported outcomes after ME are generally favorable, few data exist regarding which patients are prone to poorer outcomes requiring revision surgery. The goal of this study was to identify risk factors predicting the need for revision surgery after ME for the treatment of CuTS. We conducted a retrospective chart review of all patients treated at our institution with ME for CuTS from 2006 through 2011. We identified patients who underwent additional operations for recurrent or persistent ulnar nerve symptoms as the revision cohort. We performed bivariate analysis to determine which variables had a significant influence on the need for revision surgery. We examined qualitative factors associated with revision, including the degree of bony resection performed during the index ME, and intraoperative findings at the time of revision surgery. Revision surgery was required in 13.3% of cases (11 of 83). On bivariate analysis, younger age, associated workers' compensation claims, lesser disease severity, and preoperative opioid use were all significant predictors of the need for revision surgery. Perineural scarring and heterotopic bone formation about the elbow were the 2 most common findings at the time of revision. For patients with CuTS, the risk of revision surgery after ME is higher in younger patients, patients with less severe disease, patients taking opioid medications preoperatively, and patients with associated workers' compensation claims. Level IV; Case Series; Treatment Study. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  6. Quantitative analysis of quantum noise masking in quantum stream cipher by intensity modulation operating at G-bit/sec data rate (United States)

    Iwakoshi, Takehisa; Futami, Fumio; Hirota, Osamu


    In any communication system, all data including encrypted data by the mathematical cipher are transmitted under the strict rule of the interface frame. Attacker can easily acquire the whole data the same as the data of legitimate users including the address, routing information and so on from the transmission line by tapping. This is very risky, especially for the secret sharing data center operations. So to hide the whole data in the transmission line is very attractive to ensure the high security level. This can be realized by Y-00 type random cipher that the ciphertext of simple mathematical cipher by PRNG is randomized by quantum noise and it gives a masking effect against the attacker's security analysis. This paper clarifies quantitative properties on the masking effect in the random cipher by Y-00 protocol, and shows the fact that a scheme by the intensity modulation may provide the greatest masking effect, even if the attacker employs the universal heterodyne receiver.

  7. Reaction rate uncertainties and the operation of the NeNa and MgAl chains during HBB in intermediate-mass AGB stars (United States)

    Izzard, R. G.; Lugaro, M.; Karakas, A. I.; Iliadis, C.; van Raai, M.


    Context: We test the effect of proton-capture reaction rate uncertainties on the abundances of the Ne, Na, Mg and Al isotopes processed by the NeNa and MgAl chains during hot bottom burning (HBB) in asymptotic giant branch (AGB) stars of intermediate mass between 4 and 6 M⊙ and metallicities between Z = 0.0001 and 0.02. Aims: We provide uncertainty ranges for the AGB stellar yields, for inclusion in galactic chemical evolution models, and indicate which reaction rates are most important and should be better determined. Methods: We use a fast synthetic algorithm based on detailed AGB models. We run a large number of stellar models, varying one reaction per time for a very fine grid of values, as well as all reactions simultaneously. Results: We show that there are uncertainties in the yields of all the Ne, Na, Mg and Al isotopes due to uncertain proton-capture reaction rates. The most uncertain yields are those of 26Al and 23Na (variations of two orders of magnitude), 24Mg and 27Al (variations of more than one order of magnitude), 20Ne and 22Ne (variations between factors 2 and 7). In order to obtain more reliable Ne, Na, Mg and Al yields from IM-AGB stars the rates that require more accurate determination are: 22Ne(p,γ)23Na, 23Na(p,γ)24Mg, 25Mg(p,γ)26Al, 26Mg(p,γ)27Al and 26Al(p,γ)27Si. Conclusions: Detailed galactic chemical evolution models should be constructed to address the impact of our uncertainty ranges on the observational constraints related to HBB nucleosynthesis, such as globular cluster chemical anomalies. Table 13 is only available in electronic form at the CDS via anonymous ftp to ( or via

  8. Early complications after revision total hip arthroplasty with cemented dual-mobility socket and reinforcement ring. (United States)

    Pattyn, Christophe; Audenaert, Emmanuel


    Encouraged by the success of dual-mobility sockets in achieving implant stability in primary hip replacement, surgeons have started to use the implant in revision hip arthroplasty. However, very little is known yet about the postoperative complication rate of this type of implant when fixation in a reinforcement ring is required. In our department, 37 dual-mobility sockets were cemented in a reinforcement ring for revision hip arthroplasty in 36 patients over a period of two years. The mean follow-up period was 16 months (range, 6-27 months). Indications for revision hip arthroplasty included, among others, recurrent dislocation (3 cases) and implant loosening (9 cases) with extensive bone loss. We observed two single re-dislocations (5.40%), one infection and one mechanical failure of the reinforcement ring; the literature mentions dislocation rates of 2.7 to 10.6% after revisions not specifically for recurrent dislocation. Revision hip arthoplasty combining dual-mobility sockets with reinforcement ring fixation thus had a relatively low early postoperative complication rate in this challenging group of patients. The design therefore seems to be a valid alternative to constrained implants, especially in high-risk revision cases. Despite the short follow-up period, cemented dual-mobility sockets seem to be a valuable option when reinforcement rings need to be used, with an acceptable dislocation rate in this challenging group of patients. But long-term survival studies are mandatory to evaluate stability and fixation longevity.

  9. Comparison of mode of failure between primary and revision total knee arthroplasties. (United States)

    Liang, H; Bae, J K; Park, C H; Kim, K I; Bae, D K; Song, S J


    Cognizance of common reasons for failure in primary and revision TKA, together with their time course, facilitates prevention. However, there have been few reports specifically comparing modes of failure for primary vs. revision TKA using a single prosthesis. The goal of the study was to compare the survival rates, modes of failure, and time periods associated with each mode of failure, of primary vs. revision TKA. The survival rates, modes of failure, time period for each mode of failure, and risk factors would differ between primary and revision TKA. Data from a consecutive cohort comprising 1606 knees (1174 patients) of primary TKA patients, and 258 knees (224 patients) of revision TKA patients, in all of whom surgery involved a P.F.C(®) prosthesis (Depuy, Johnson & Johnson, Warsaw, IN), was retrospectively reviewed. The mean follow-up periods of primary and revision TKAs were 9.2 and 9.8 years, respectively. The average 10- and 15-year survival rates for primary TKA were 96.7% (CI 95%,±0.7%) and 85.4% (CI 95%,±2.0%), and for revision TKA 91.4% (CI 95%,±2.5%) and 80.5% (CI 95%,±4.5%). Common modes of failure included polyethylene wear, loosening, and infection. The most common mode of failure was polyethylene wear in primary TKA, and infection in revision TKA. The mean periods (i.e., latencies) of polyethylene wear and loosening did not differ between primary and revision TKAs, but the mean period of infection was significantly longer for revision TKA (1.2 vs. 4.8 years, P=0.003). Survival rates decreased with time, particularly more than 10 years post-surgery, for both primary and revision TKAs. Continuous efforts are required to prevent and detect the various modes of failure during long-term follow-up. Greater attention is necessary to detect late infection-induced failure following revision TKA. Case-control study, Level III. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  10. Technical aspects of revision and functional outcome after revision of the Oxford unicompartmental knee arthroplasty. (United States)

    Somford, Matthijs P; Brouwer, Reinoud W; Haen, Pieter-Stijn W A; van Raay, Jos J A M; van Raaij, Tom M


    This study analysed the technical aspects of revision of the Oxford unicompartmental knee arthroplasty (OUKA) and functional results after revision. In a historic cohort study we analysed all revised OUKAs that were primarily implanted at our clinic over a 10-year period (1998-2009). The primary aim was to investigate surgical difficulties encountered during revision surgery of the OUKA. Outcomes were the knee society score (KSS), WOMAC (Western Ontario and McMaster Universities), SF-36, VAS pain and VAS satisfaction after revision. During the study period, 331 OUKAs were inserted. With an average follow-up of six years and five months (range one month to nine years and eight months), there were 44 (13.3%) OUKAs that needed one or more revision surgery procedures. The average time to revision was three years and eight months (range one month to nine years and five months). The main reasons for revision surgery were bearing dislocation, malpositioning or loosening of a component and progression of osteoarthritis. Most revisions, mainly conversion to primary total knee arthroplasty (TKA), gave few surgical problems. Minor bone loss that needed no augmentation was seen most frequently. The functional outcomes after revision surgery were moderate. A limited amount of surgical difficulty during revision of OUKA was found; in all total revision cases a primary TKA was implanted. However, in most patients there were moderate functional results as well as disappointing pain and satisfaction scores after revision. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Directionality Effects of Aligned Wind and Wave Loads on a Y-Shape Semi-Submersible Floating Wind Turbine under Rated Operational Conditions

    Directory of Open Access Journals (Sweden)

    Shengtao Zhou


    Full Text Available The Y-shape (triangular semi-submersible foundation has been adopted by most of the built full-scale floating wind turbines, such as Windfloat, Fukushima Mirai and Shimpuu. Considering the non-fully-symmetrical shape and met-ocean condition, the foundation laying angle relative to wind/wave directions will not only influence the downtime and power efficiency of the floating turbine, but also the strength and fatigue safety of the whole structure. However, the dynamic responses induced by various aligned wind and wave load directions have scarcely been investigated comparatively before. In our study, the directionality effects are investigated by means of combined wind and wave tests and coupled multi-body simulations. By comparing the measured data in three load directions, it is found that the differences of platform motions are mainly derived from the wave loads and larger pitch motion can always be observed in one of the directions. To make certain the mechanism underlying the observed phenomena, a coupled multi-body dynamic model of the floating wind turbine is established and validated. The numerical results demonstrate that the second-order hydrodynamic forces contribute greatly to the directionality distinctions for surge and pitch, and the first-order hydrodynamic forces determine the variations of tower base bending moments and nacelle accelerations. These findings indicate the directionality effects should be predetermined comprehensively before installation at sea, which is important for the operation and maintenance of the Y-shape floating wind turbines.

  12. Revised diagnostic criteria for neurocysticercosis. (United States)

    Del Brutto, O H; Nash, T E; White, A C; Rajshekhar, V; Wilkins, P P; Singh, G; Vasquez, C M; Salgado, P; Gilman, R H; Garcia, H H


    A unified set of criteria for neurocysticercosis (NCC) has helped to standardize its diagnosis in different settings. Cysticercosis experts were convened to update current diagnostic criteria for NCC according to two principles: neuroimaging studies are essential for diagnosis, and all other information provides indirect evidence favoring the diagnosis. Recent diagnostic advances were incorporated to this revised set. This revised set is structured in absolute, neuroimaging and clinical/exposure criteria. Absolute criteria include: histological confirmation of parasites, evidence of subretinal cysts, and demonstration of the scolex within a cyst. Neuroimaging criteria are categorized as major (cystic lesions without scolex, enhancing lesions, multilobulated cysts, and calcifications), confirmative (resolution of cysts after cysticidal drug therapy, spontaneous resolution of single enhancing lesions, and migrating ventricular cysts on sequential neuroimaging studies) and minor (hydrocephalus and leptomeningeal enhancement). Clinical/exposure criteria include: detection of anticysticercal antibodies or cysticercal antigens by well-standardized tests, systemic cysticercosis, evidence of a household Taenia carrier, suggestive clinical manifestations, and residency in endemic areas. Besides patients having absolute criteria, definitive diagnosis can be made in those having two major neuroimaging criteria (or one major plus one confirmative criteria) plus exposure. For patients presenting with one major and one minor neuroimaging criteria plus exposure, definitive diagnosis of NCC requires the exclusion of confounding pathologies. Probable diagnosis is reserved for individuals presenting with one neuroimaging criteria plus strong evidence of exposure. This revised set of diagnostic criteria provides simpler definitions and may facilitate its more uniform and widespread applicability in different scenarios. Copyright © 2016 The Authors. Published by Elsevier B.V. All

  13. Relativistic timescale analysis suggests lunar theory revision (United States)

    Deines, Steven D.; Williams, Carol A.


    The SI second of the atomic clock was calibrated to match the Ephemeris Time (ET) second in a mutual four year effort between the National Physical Laboratory (NPL) and the United States Naval Observatory (USNO). The ephemeris time is 'clocked' by observing the elapsed time it takes the Moon to cross two positions (usually occultation of stars relative to a position on Earth) and dividing that time span into the predicted seconds according to the lunar equations of motion. The last revision of the equations of motion was the Improved Lunar Ephemeris (ILE), which was based on E. W. Brown's lunar theory. Brown classically derived the lunar equations from a purely Newtonian gravity with no relativistic compensations. However, ET is very theory dependent and is affected by relativity, which was not included in the ILE. To investigate the relativistic effects, a new, noninertial metric for a gravitated, translationally accelerated and rotating reference frame has three sets of contributions, namely (1) Earth's velocity, (2) the static solar gravity field and (3) the centripetal acceleration from Earth's orbit. This last term can be characterized as a pseudogravitational acceleration. This metric predicts a time dilation calculated to be -0.787481 seconds in one year. The effect of this dilation would make the ET timescale run slower than had been originally determined. Interestingly, this value is within 2 percent of the average leap second insertion rate, which is the result of the divergence between International Atomic Time (TAI) and Earth's rotational time called Universal Time (UT or UTI). Because the predictions themselves are significant, regardless of the comparison to TAI and UT, the authors will be rederiving the lunar ephemeris model in the manner of Brown with the relativistic time dilation effects from the new metric to determine a revised, relativistic ephemeris timescale that could be used to determine UT free of leap second adjustments.

  14. Revised hypothesis and future perspectives

    DEFF Research Database (Denmark)

    Norsk, P; Drummer, C; Christensen, N J


    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...... activated by spaceflight? Why are the renal responses to saline and water stimuli in space attenuated compared with those of ground simulations? How can the effects of weightlessness on fluid and electrolyte regulation be correctly simulated on the ground? The information obtained from space may...

  15. Deep Borehole Emplacement Mode Hazard Analysis Revision 0

    Energy Technology Data Exchange (ETDEWEB)

    Sevougian, S. David [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)


    This letter report outlines a methodology and provides resource information for the Deep Borehole Emplacement Mode Hazard Analysis (DBEMHA). The main purpose is identify the accident hazards and accident event sequences associated with the two emplacement mode options (wireline or drillstring), to outline a methodology for computing accident probabilities and frequencies, and to point to available databases on the nature and frequency of accidents typically associated with standard borehole drilling and nuclear handling operations. Risk mitigation and prevention measures, which have been incorporated into the two emplacement designs (see Cochran and Hardin 2015), are also discussed. A key intent of this report is to provide background information to brief subject matter experts involved in the Emplacement Mode Design Study. [Note: Revision 0 of this report is concentrated more on the wireline emplacement mode. It is expected that Revision 1 will contain further development of the preliminary fault and event trees for the drill string emplacement mode.

  16. The Seasonal Variation of TKR Infection Rates (United States)

    Parkinson, Ben; Armit, Drew; Reid, Michael; Lorimer, Michelle; Harris, Ian


    Introduction: A seasonal variation in the incidence of surgical site infections has been described following a number of common surgical procedures. However in the setting of elective Total Knee Replacement (TKR), the role of environmental factors is an area of research that is currently lacking from the literature. Data recently presented from our institution demonstrates a possible trend toward higher infection rates during periods of increased temperature and humidity. The aim of this study was to investigate if seasonal and geographical factors influence the rate of TKR infection within Australia. Methods: Data from the AOA National Joint Registry for all primary TKRs performed within the last 5 years was analysed to determine the revision rates for early (<12 months) post-operative infection. The infection rates for tropical regions (Darwin, Cairns, Townsville, Mackay) were compared to the remainder of the country. A month-by-month analysis was performed to determine if there was a seasonal variation within the 2 study groups. Results: During the study period a total of 207,540 primary TKRs were performed (6,514 tropical vs 201,026 non-tropical regions). Overall, the rate of revision for infection was significantly higher for the tropical regions of Australia (0.80% vs 0.39%). In non-tropical regions, there was no observed seasonal variation of infection rates. In tropical regions, there was a clear seasonal variation found, with the winter months being associated with a significantly lower rate of infection than the remainder of the year (0.37% vs 0.94%). The infection rates were not significantly different between tropical (0.37%) and non- tropical (0.38%) regions during the winter period. Conclusion: To the best of our knowledge, this is the first study to investigate and demonstrate a significant influence from seasonal variation on primary TKR infection rates. This phenomenon is evident only within tropical regions, with the periods of warmer and humid

  17. Revision Surgery of Deep Brain Stimulation Leads. (United States)

    Falowski, Steven M; Bakay, Roy A E


    Deep brain stimulation (DBS) is widely used for various movement disorders. DBS lead revisions are becoming more common as the indications and number of cases increases. Patients undergoing DBS lead revisions at a single institution were retrospectively analyzed based on diagnosis, reason for revision, where the lead was relocated, and surgical technique. We reviewed 497 consecutive DBS lead placements and found that there was need for 25 DBS lead revisions with at least six months of follow-up. Loss of efficacy and development of adverse effects over time were the most common reasons for lead revision across all diagnosis. Lead malfunction was the least common. Ten patients requiring 19 DBS lead revisions that underwent their original surgery at another institution were also analyzed. Surgical technique dictated replacing with a new lead while maintaining brain position and tract with the old lead until final placement. Methods to seal exposed wire were developed. Surgical technique, as well as variable options are important in lead revision and can be dictated based on reason for revision. Over time patients who have had adequate relief with DBS placement may experience loss of efficacy and development of adverse effects requiring revision of the DBS lead to maintain its effects. © 2016 International Neuromodulation Society.

  18. Vagus nerve stimulation after lead revision. (United States)

    Dlouhy, Brian J; Viljoen, Steven V; Kung, David K; Vogel, Timothy W; Granner, Mark A; Howard, Matthew A; Kawasaki, Hiroto


    Vagus nerve stimulation (VNS) has demonstrated benefit in patients with medically intractable partial epilepsy. As in other therapies with mechanical devices, hardware failure occurs, most notably within the VNS lead, requiring replacement. However, the spiral-designed lead electrodes wrapped around the vagus nerve are often encased in dense scar tissue hampering dissection and removal. The objective in this study was to characterize VNS lead failure and lead revision surgery and to examine VNS efficacy after placement of a new electrode on the previously used segment of vagus nerve. The authors reviewed all VNS lead revisions performed between October 2001 and August 2011 at the University of Iowa Hospitals and Clinics. Twenty-four patients underwent 25 lead revisions. In all cases, the helical electrodes were removed, and a new lead was placed on the previously used segment of vagus nerve. All inpatient and outpatient records of the 25 lead revisions were retrospectively reviewed. Four cases were second lead revisions, and 21 cases were first lead revisions. The average time to any revision was 5 years (range 1.8-11.1 years), with essentially no difference between a first and second lead revision. The most common reason for a revision was intrinsic lead failure resulting in high impedance (64%), and the most common symptom was increased seizure frequency (72%). The average duration of surgery for the initial implantation in the 15 patients whose VNS system was initially implanted at the authors' institution was much shorter (94 minutes) than the average duration of lead revision surgery (173 minutes). However, there was a significant trend toward shorter surgical times as more revision surgeries were performed. Sixteen of the 25 cases of lead revision were followed up for more than 3 months. In 15 of these 16 cases, the revision was as effective as the previous VNS lead. In most of these cases, both the severity and frequency of seizures were decreased to levels

  19. Revision surgery after third generation autologous chondrocyte implantation in the knee. (United States)

    Niethammer, Thomas R; Niethammer, Thomas; Valentin, Siegfried; Ficklscherer, Andreas; Gülecyüz, Mehmet F; Gülecyüz, Mehmet; Pietschmann, Matthias F; Pietschmann, Matthias; Müller, Peter E; Müller, Peter


    Third generation autologous chondrocyte implantation (ACI) is an established treatment for full thickness cartilage defects in the knee joint. However, little is known about cases when revision surgery is needed. The aim of the present study is to investigate the complication rates and the main reasons for revision surgery after third generation autologous chondrocyte implantation in the knee joint. It is of particular interest to examine in which cases revision surgery is needed and in which cases a "wait and see" strategy should be used. A total of 143 consecutive patients with 171 cartilage defects were included in this study with a minimum follow-up of two years. All defects were treated with third generation ACI (NOVACART®3D). Clinical evaluation was carried out after six months, followed by an annual evaluation using the International Knee Documentation Committee (IKDC) subjective score and the visual analogue scale (VAS) for rest and during activity. Revision surgery was documented. The revision rate was 23.4 % (n = 36). The following major reasons for revision surgery were found in our study: symptomatic bone marrow edema (8.3 %, n = 3), arthrofibrosis (22.2 %, n = 8) and partial graft cartilage deficiency (47.2 %, n = 17). The following revision surgery was performed: retrograde drilling combined with Iloprost infusion therapy for bone marrow oedema (8.4 %, n = 3), arthroscopic arthrolysis of the suprapatellar recess (22.2 %, n = 8) and microfracturing/antegrade drilling (47.3 %, n = 17). Significant improvements of clinical scores after revision surgery were observed. Revision surgery after third generation autologous chondrocyte implantation is common and is needed primarily in cases with arthrofibrosis, partial graft cartilage deficiency and symptomatic bone marrow oedema resulting in a significantly better clinical outcome.

  20. A systematic review of outcomes after revision amputation for treatment of traumatic finger amputation (United States)

    Yuan, Frank; McGlinn, Evan P.; Giladi, Aviram M.; Chung, Kevin C.


    Background Revision amputations are often the treatment for traumatic finger amputation injuries. However, patient outcomes are inadequately reported, and their impact poorly understood. We performed a systematic review to evaluate outcomes of revision amputations and amputation wound coverage techniques. Methods We searched all available English literature in PubMed and EMBASE for articles reporting outcomes of non-replantation treatments for traumatic finger amputation injuries, including revision amputation, local digital flaps, skin grafting, and conservative treatment. Data extracted were study characteristics, patient demographic data, sensory and functional outcomes, patient-reported outcomes (PROs), and complications. Results 1659 articles were screened, yielding 43 studies for review. Mean static 2-point discrimination (2-PD) was 5.0 ± 1.5 mm (n=23 studies) overall. Mean static 2-PD was 6.1 ± 2.4 mm after local flap procedures and 3.8 ± 0.4 mm after revision amputation. Mean total active motion (TAM) was 93 ± 8% of normal (n=6 studies) overall. Mean TAM was 90 ± 9% of normal after local flap procedures and 95% of normal after revision amputation. 77% of patients report cold intolerance after revision amputation. 91% of patients (217/238) report “satisfactory” or “good/excellent” ratings regardless of treatment. Conclusion Revision amputation and conservative treatments result in better static 2-PD outcomes compared to local flaps. All techniques preserve TAM, although arc of motion is slightly better with revision amputation. Revision amputation procedures are frequently associated with cold intolerance. Patients report “satisfactory,” “good,” or “excellent” ratings in appearance and quality of life with all non-replantation techniques. Level of Evidence III PMID:26111316

  1. 78 FR 44459 - Rate Regulation Reforms (United States)


    ... unlawfully high (from the current T-bill rate to the U.S. Prime Rate, as published in the Wall Street Journal... reasons set forth in the preamble, the Surface Transportation Board revises part 1141 of title 49, chapter... be computed shall be the most recent U.S. Prime Rate as published by The Wall Street Journal. The...

  2. Pharmacotherapy follow-up: The Dader method (3rd revision: 2005

    Directory of Open Access Journals (Sweden)

    Pharmaceutical Care Research Group, University of Granada (Spain.


    Full Text Available The Dader Method for Pharmacotherapy Follow-Up was created in 1999 to implement the process laid out by the Dader Programme and it was revised in 2003. Since then, pharmacists have provided us with their remarks and comments on the programme, and some research was also made. Some of those have allowed for another revision to be carried out. The aim of this work is to present the Dader Programme in its current state, following its third revision. This revision has been carried out with the aims being globalisation and simplification of the programme. Globalisation, so that the programme is standard practice and can be used by any pharmacist working with any patient, whatever the treatment for their illness. And simplification, because for a procedure to become a widespread practice, it has to be as easy as possible to follow, without losing the precision of a standardised operational procedure.

  3. Preoperative Risk Factors Associated With Poor Outcomes of Revision Surgery for "Pseudotumors" in Patients With Metal-on-Metal Hip Arthroplasty. (United States)

    Liow, Ming Han Lincoln; Dimitriou, Dimitris; Tsai, Tsung-Yuan; Kwon, Young-Min


    Revision surgery of failed metal-on-metal (MoM) total hip arthroplasty (THA) for adverse tissue reaction (pseudotumor) can be challenging as a consequence of soft tissue and muscle necrosis. The aims of this study were to (1) report the revision outcomes of patients who underwent revision surgery for failed MoM hip arthroplasty due to symptomatic pseudotumor and (2) identify preoperative risk factors associated with revision outcomes. Between January 2011 and January 2013, a total of 102 consecutive large head MoM hip arthroplasties in 97 patients (male: 62, female: 35), who underwent revision surgery were identified from the database of a multidisciplinary referral center. At minimum follow-up of 2 years (range: 26-52 months), at least one complication had occurred in 14 of 102 revisions (14%). Prerevision radiographic loosening (P = .01), magnetic resonance imaging (MRI) findings of solid lesions with abductor deficiency on MRI (P Metal ion levels declined in most patients after removal of MoM articulation. Revision outcomes of revision surgery for failed MoM THA due to symptomatic pseudotumor demonstrated 14% complication rate and 7% re-revision rate at 30-month follow-up. Our study identified prerevision radiographic loosening, solid lesions/abductor deficiency on MRI, and high grade intraoperative tissue damage as risk factors associated with poorer revision outcomes. This provides clinically useful information for preoperative planning and perioperative counseling of MoM THA patients undergoing revision surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Revision of IAU Style Manual (United States)

    Wilkins, G. A.

    The 1989 edition of the "IAU Style Manual" is in need of revision to reflect the changes in practice that have taken place since its preparation. These changes include the use of desk-top systems for the production of high-quality copy, the electronic transmission of text with embedded typesetting codes and the electronic publication of papers and reports, which may contain numerical data and images. The Manual should give advice and recommendations about the new procedures and typographical formats, but it is more important than ever that it should give clear and appropriate recommendations on matters that affect the quality of the content of all astronomical publications. The Manual should provide especially for the needs of astronomers who do not have English as their first language and it should include advice to them on the oral presentation of their papers. The editor. G. A. Wilkins, would be pleased to have the assistance of astronomers and others who are concerned with the quality of astronomical publications and who would be willing to participate in any aspect of the revision.

  5. A high repetition rate TEA CO II laser operating at λ=9.3-μm for the rapid and conservative ablation and modification of dental hard tissues (United States)

    Fan, Kenneth; Fried, Daniel


    TEA CO II lasers tuned to the strong mineral absorption of hydroxyapatite near λ=9-μm are ideally suited for the efficient ablation of dental hard tissues if the laser-pulse is stretched to greater than 5-10-μs to avoid plasma shielding phenomena. Such CO II lasers are capable of operating at high repetition rates for the rapid removal of dental hard tissues. An Impact 2500 TEA CO II laser system from GSI Lumonics (Rugby, UK) custom modified by LightMachinery (Ottawa, Canada) with a repetition rate of 0-500 Hz was used for rapid tissue removal. The single pulse ablation rates through enamel were determined for incident fluence ranging from (1-160 J/cm2). Lateral incisions using a computer controlled scanning stage and water spray were produced and the crater morphology and chemical composition were measured using optical microscopy and high-resolution synchrotron radiation infrared spectromicroscopy. The transmission through 2-meter length 300, 500, 750 and 1000-μm silica hollow waveguides was measured and 80% transmission was achieved with 40-mJ per pulse. The λ=9.3-μm laser pulses efficiently removed dental enamel at rates exceeding 15-μm per pulses with minimal heat accumulation. The residual energy remaining in tooth samples was measured to be 30-40% without water cooling, significantly lower than for longer CO II laser pulses. These results suggest that high repetition rate TEA CO II laser systems operating at λ=9.3-μm with pulse durations of 10-20-μs are ideally suited for dental application.

  6. Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision (United States)

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


    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 financial loss for the operating department. PMID:28107366

  7. The efficacy of hypotonic and near-isotonic saline for parenteral fluid therapy given at low maintenance rate in preventing significant change in plasma sodium in post-operative pediatric patients: protocol for a prospective randomized non-blinded study

    Directory of Open Access Journals (Sweden)

    Stigzelius Shayarina


    Full Text Available Abstract Background Hyponatremia is the most frequent electrolyte abnormality observed in post-operative pediatric patients receiving intravenous maintenance fluid therapy. If plasma sodium concentration (p-Na+ declines to levels below 125 mmol/L in vs. restricted rate of infusion and the composition of solutions used for parenteral maintenance fluid therapy (hypotonic vs. isotonic solutions contribute to the development of hyponatremia. So far, there is no definitive pediatric data to support a particular choice of parenteral fluid for maintenance therapy in post-surgical patients. Methods/Design Our prospective randomized non-blinded study will be conducted in healthy children and adolescents aged 1 to 14 years who have been operated for acute appendicitis. Patients will be randomized either to intravenous hypotonic (0.23% or 0.40% sodium chloride in glucose, respectively or near-isotonic (0.81% sodium chloride in glucose solution given at approximately three-fourths of the average maintenance rate. The main outcome of interest from this study is to evaluate 24 h post-operatively whether differences in p-Na+ between treatment groups are large enough to be of clinical relevance. In addition, water and electrolyte balance as well as regulatory hormones will be measured. Discussion This study will provide valuable information on the efficacy of hypotonic and near-isotonic fluid therapy in preventing a significant decrease in p-Na+. Finally, by means of careful electrolyte and water balance and by measuring regulatory hormones our results will also contribute to a better understanding of the physiopathology of post-operative changes in p-Na+ in a population at risk for hyponatremia. Trial registration The protocol for this study is registered with the current controlled trials registry; registry number: ISRCTN43896775.

  8. Clinical and radiographic results of 184 consecutive revision total knee arthroplasties placed with modular cementless stems. (United States)

    Peters, Christopher L; Erickson, Jill A; Gililland, Jeremy M


    Clinical and radiographic outcomes of 184 consecutive revision total knee arthroplasties (TKAs) placed with cemented components and press-fit fluted cementless stems were reviewed at average follow-up of 49 months. Revision was performed for septic failure in 53 of 184 knees, periprosthetic fracture in 10 of 184 knees, and aseptic failure in 121 of 184 knees. The press-fit cementless stems were placed to tightly contact the endosteum of the metadiaphyseal area of the femur and tibia. No knees were re-revised for aseptic loosening. There were 15 failures (15/184, 8.2%): 13 were septic failures, 9 of which were recurrence of sepsis and 4 of which were new cases of sepsis. Average Knee Society knee score improved from 134.6 to 167.8 (P < .05). Revision TKA with modular cementless stems provided excellent fixation with no revisions for aseptic loosening. Re-revision for sepsis was the dominant failure mechanism with an overall rate of 7%. Given the increasing prevalence of revision TKA, sepsis prevention strategies should receive increased attention.

  9. Postoperative pain treatment' practice guideline revised

    NARCIS (Netherlands)

    Houweling, P.L.; Molag, M.L.; Boekel, R.L.M. van; Verbrugge, S.J.; Haelst, I.M. van; Hollmann, M.W.


    - On the initiative of the Dutch Association of Anaesthesiologists, a multidisciplinary workgroup has revised the 2003 practice guideline on 'Postoperative pain treatment' for adults and children.- The main reason for revision was the availability of new drugs and new methods of administration. The

  10. Taxonimic revision of Endiandra (Lauraceae) in Borneo

    NARCIS (Netherlands)

    Arifiani, Deby


    The genus Endiandra R.Br. (Lauraceae) has not been revised since Meissner (1864). Flora treatments and local revisions for this genus of about 100 species have been produced for Peninsular Malaysia (Kochummen, 1989) and Australia (Hyland, 1989) with ten and thirty-eight species, respectively. A

  11. 76 FR 4258 - Occupational Radiation Protection; Revision (United States)


    ...The Department of Energy (DOE) proposes to revise the values in an appendix to its Occupational Radiation Protection requirements. The derived air concentration values for air immersion are calculated using several parameters. One of these, exposure time, is better represented by the hours in the workday, rather than the hours in a calendar day, and is therefore used in the revised calculations.

  12. Revising Matumo's Setswana– English–Setswana Dictionary

    African Journals Online (AJOL)


    Abstract: The aim of this article is to design a revision strategy for the Setswana to English side of the Setswana–English–Setswana Dictionary compiled by Z.I. Matumo in 1993. An existing general organic Setswana corpus as well as a dedicated corpus compiled for the purposes of the revision will be used as a basis for ...

  13. Assessing Speaking in the Revised FCE. (United States)

    Saville, Nick; Hargreaves, Peter


    Describes the Speaking Test, which forms part of the revised First Certificate of English (FCE) examination of the University of Cambridge Local Examinations Syndicate. Discusses key revisions, including use of paired-testing format, and notes the role of the oral examiners. Considers why the new design provides improvements in the assessment of…

  14. A taxonomic revision of Harpullia (Sapindaceae)

    NARCIS (Netherlands)

    Leenhouts, P.W.; Vente, Magda


    The present taxonomic revision of Harpullia was started by the second author as the main part of her work for a M. Sc. in biology at Leiden University. She concentrated on a revision of the species occurring in New Guinea, paid only a more superficial attention to the rest of the genus. The first

  15. Revising Child Support Orders: The Wisconsin Experience. (United States)

    Kost, Kathleen A.; And Others


    Provides an overview of the Wisconsin child support system. Explores policy and program implications of the child support revision process and makes recommendations for improving revision. Advocates expressing child support orders as a percentage of the noncustodial parents' income to keep the orders updated automatically and replace the need for…

  16. An analysis of clinical activity, admission rates, length of hospital stay, and economic impact after a temporary loss of 50% of the non-operative podiatrists from a tertiary specialist foot clinic in the United Kingdom. (United States)

    Gooday, Catherine; Murchison, Rachel; Dhatariya, Ketan


    Podiatrists form an integral part of the multidisciplinary foot team in the treatment of diabetic foot-related complications. A set of unforeseen circumstances within our specialist diabetes foot service in the United Kingdom caused a loss of 50% of our non-operative podiatry team for almost 7 months during 2010. Some of this time was filled by non-specialist community non-operative podiatrists. We assessed the economic impact of this loss by examining data for the 5 years prior to this 7-month interruption, and for the 2 years after 'normal service' was resumed. Our data show that the loss of the non-operative podiatrists led to a significant rise in the numbers of admissions into hospital, and hospital length of stay also increased. At our institution a single bed day cost is £275. During the time that the numbers of specialist non-operative podiatry staff were depleted, and for up to 6 months after they returned to normal activities, the extra costs increased by just less than £90,000. The number of people admitted directly from specialist vascular and orthopaedic clinics is likely to have increased due to the lack of capacity to manage them in the diabetic foot clinic. Our data were unable to assess these individuals and did not look at the costs saved from avoiding surgery. Thus the actual costs incurred are likely to be higher. Our data suggest that specialist non-operative podiatrists involved in the treatment of the diabetic foot may prevent unwarranted hospital admission and increased hospitalisation rates by providing skilled assessment and care in the outpatient clinical settings.

  17. Is Climate Associated With Revision for Prosthetic Joint Infection After Primary TKA? (United States)

    Parkinson, Ben; Armit, Drew; McEwen, Peter; Lorimer, Michelle; Harris, Ian A


    Climate factors have been shown to be associated with spontaneous musculoskeletal and some surgical site infections with increased rates of infection during warmer periods. To date, little research has been performed to determine if this phenomenon is associated with differences in the risk of revision for prosthetic joint infection (PJI) in primary TKA. (1) Does the rate of revision for early PJI within the first year after primary TKA differ between tropical and nontropical regions? (2) Is there a seasonal variation in the rate of revision for PJI? (3) Is the geographic and seasonal variation (if present) associated with the sex, age, and/or American Society of Anesthesiologists (ASA) grade of the patient? All 219,983 primary TKAs performed for osteoarthritis over a 5-year period (2011-2015) in the Australian Orthopaedic Association National Joint Replacement Registry were examined based on the month of the primary procedure to determine the rate of revision for PJI within 12 months. The data were analyzed to determine the differences in the risk of revision for PJI based on geographic region and season of the primary procedure adjusting for sex, age, and ASA grade of the patient. The early revision rate for PJI was higher in the tropical compared with the nontropical region of Australia (0.73% versus 0.37%; odds ratio [OR], 1.87; 95% confidence interval [CI], 1.44-2.42; p region of Australia demonstrated a seasonal variation in the rate of revision for PJI with a higher rate during the warmer monsoon wet season of summer and fall (summer/fall 0.98% versus winter/spring 0.51%; OR, 1.88; 95% CI, 1.12-3.16; p = 0.02). A seasonal variation was not seen in the nontropical region (OR, 1.03; 95% CI, 0.90-1.19; p = 0.64). The regional and seasonal changes were independent of sex, age, and ASA grade. Climate factors are associated with the risk of early revision for PJI in patients undergoing primary TKA with rates of such revisions approximately double in tropical

  18. The rating reliability calculator

    Directory of Open Access Journals (Sweden)

    Solomon David J


    Full Text Available Abstract Background Rating scales form an important means of gathering evaluation data. Since important decisions are often based on these evaluations, determining the reliability of rating data can be critical. Most commonly used methods of estimating reliability require a complete set of ratings i.e. every subject being rated must be rated by each judge. Over fifty years ago Ebel described an algorithm for estimating the reliability of ratings based on incomplete data. While his article has been widely cited over the years, software based on the algorithm is not readily available. This paper describes an easy-to-use Web-based utility for estimating the reliability of ratings based on incomplete data using Ebel's algorithm. Methods The program is available public use on our server and the source code is freely available under GNU General Public License. The utility is written in PHP, a common open source imbedded scripting language. The rating data can be entered in a convenient format on the user's personal computer that the program will upload to the server for calculating the reliability and other statistics describing the ratings. Results When the program is run it displays the reliability, number of subject rated, harmonic mean number of judges rating each subject, the mean and standard deviation of the averaged ratings per subject. The program also displays the mean, standard deviation and number of ratings for each subject rated. Additionally the program will estimate the reliability of an average of a number of ratings for each subject via the Spearman-Brown prophecy formula. Conclusion This simple web-based program provides a convenient means of estimating the reliability of rating data without the need to conduct special studies in order to provide complete rating data. I would welcome other researchers revising and enhancing the program.

  19. Potentialities of Revised Quantum Electrodynamics

    Directory of Open Access Journals (Sweden)

    Lehnert B.


    Full Text Available The potentialities of a revised quantum electrodynamic theory (RQED earlier established by the author are reconsidered, also in respect to other fundamental theories such as those by Dirac and Higgs. The RQED theory is characterized by intrinsic linear symmetry breaking due to a nonzero divergence of the electric field strength in the vacuum state, as supported by the Zero Point Energy and the experimentally confirmed Casimir force. It includes the results of electron spin and antimatter by Dirac, as well as the rest mass of elementary particles predicted by Higgs in terms of spontaneous nonlinear symmetry breaking. It will here be put into doubt whether the approach by Higgs is the only theory which becomes necessary for explaining the particle rest masses. In addition, RQED theory leads to new results beyond those being available from the theories by Dirac, Higgs and the Standard Model, such as in applications to leptons and the photon.

  20. Radiological control manual. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Kloepping, R.


    This Lawrence Berkeley National Laboratory Radiological Control Manual (LBNL RCM) has been prepared to provide guidance for site-specific additions, supplements and interpretation of the DOE Radiological Control Manual. The guidance provided in this manual is one methodology to implement the requirements given in Title 10 Code of Federal Regulations Part 835 (10 CFR 835) and the DOE Radiological Control Manual. Information given in this manual is also intended to provide demonstration of compliance to specific requirements in 10 CFR 835. The LBNL RCM (Publication 3113) and LBNL Health and Safety Manual Publication-3000 form the technical basis for the LBNL RPP and will be revised as necessary to ensure that current requirements from Rules and Orders are represented. The LBNL RCM will form the standard for excellence in the implementation of the LBNL RPP.

  1. Heart donation in Japan before and after the revision of the Japanese Transplantation Act. (United States)

    Fukushima, N; Ono, M; Saito, S; Saiki, Y; Kubota, S; Tanoue, Y; Konaka, S; Ashikari, J


    After the revision of the Organ Transplant Act in July 2010, brain dead organ donation increased from 13 to 45 per year, and heart donation increased. The purpose of this study was to review 166 consecutive brain dead heart donors to evaluate our strategies to identify and manage organ donors. This study reviewed 166 consecutive brain dead heart donors since the Act was issued. Whereas 69 heart donations were performed between October 1997 and July 2010 before the revision of the Act, 97 heart donations were performed for the 3 years after the revision. Since November 2002, special transplant management doctors were sent to donor hospitals to assess donor organ function and to identify which organs could be transplanted. They also intensively cared for the donors to stabilize hemodynamics and to improve cardiac function by giving intravenous antidiuretic hormones and by pulmonary toileting via bronchofiberscope. The mean heart donor age increased from 41.0 to 43.9 years after the revision. Notably, 11 hearts from donors more than 60 years old were transplanted successfully after the revision. Before the revision, the cause of death was 37 cerebrovascular disease (SAH 34, stroke 1, bleeding 2), 18 head trauma, 13 asphyxia, and 2 postresuscitation brain damage. After the revision, there were 49 cerebrovascular disease (SAH 37, stroke 2, bleeding 16, and other 4), 17 head trauma, 10 asphyxia, and 11 postresuscitation brain damage. A total of 58 donors had a history of cardiac arrest, 58 required a high dose of catecholamine drip infusion, and only 1 recipient died of primary graft dysfunction. Patient survival rate at 3 years after heart transplantation was not different before and after the revision of the Act (98.6% vs 92.2%). Although donor age was increased and donors who died of cerebral bleeding or postresuscitation after the revision of the Act increased, the outcome after heart transplantation was not changed. Copyright © 2014 Elsevier Inc. All rights

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

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, W.S.


    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.

  3. Second language processing and revision of garden-path sentences: a visual word study. (United States)

    Pozzan, Lucia; Trueswell, John C


    We asked whether children's well-known difficulties revising initial sentence processing commitments characterize the immature or the learning parser. Adult L2 speakers of English acted out temporarily ambiguous and unambiguous instructions. While online processing patterns indicate that L2 adults experienced garden-paths and were sensitive to referential information to a similar degree as native adults, their act-out patterns indicate increased difficulties revising initial interpretations, at rates similar to those observed for 5-year-old native children (e.g., Trueswell, Sekerina, Hill & Logrip, 1999). We propose that L2 learners' difficulties with revision stem from increased recruitment of cognitive control networks during processing of a not fully proficient language, resulting in the reduced availability of cognitive control for parsing revisions.

  4. Endoscopic Revision (StomaphyX versus Formal Surgical Revision (Gastric Bypass for Failed Vertical Band Gastroplasty

    Directory of Open Access Journals (Sweden)

    Johan Bolton


    Full Text Available Background. Weight regain secondary to VBG pouch dilation is a typical referral for Bariatric surgeons. In this study we compare an endoluminal pouch reduction (Stomaphyx to RYGB for revision. Methods. A retrospective review was completed for patients with a previous VBG presenting with weight regain between 2003–2010. Results. Thirty patients were identified for study 23 RYGB, 14 StomaphyX. Significant post procedure BMI loss was seen in each cohort (RYGB, 47.7 ± 7 kg/m2 to 35 ± 7 kg/m2; StomaphyX 43 ± 10 kg/m2 to 40 ± 9 kg/m2, P=0.0007. Whereas nausea and headache were the only complications observed in StomaphyX patients, the RYGB group had a 43.5% complication rate and 1 mortality. Complications following RYGB include: incisional hernia (13%, anastomotic leak (8.7%, respiratory failure (8.7%, fistula (8.7%, and perforation (4.35%. The median length of stay following RYGB was 6 days compared to 1.5 ± 0.5 days following StomaphyX. Conclusion. This study suggests that while RYGB revision may achieve greater weight loss, the complication rates and severity is discouraging. StomaphyX may be a safe alternative. Further technical modifications of the device and longer follow-up may clarify the role of this approach.

  5. An Operative Complexity Index Shows Higher Volume Hospitals and Surgeons Perform More Complex Adult Spine Deformity Operations. (United States)

    Paul, Justin C; Lonner, Baron S; Goz, Vadim; Karia, Raj; Toombs, Courtney S; Errico, Thomas J


    Though previous studies have shown improved outcomes associated with higher volume surgeons and hospitals, this may not be replicated in ASDS due to case complexity variation. We hypothesized that high-volume surgeons perform more complex surgeries. Therefore, we defined an Operative Complexity Index (OCI), specifically for the National Inpatient Samples (NIS) data, which provides information on in-hospital postoperative complications, to assess rates of adult spine deformity surgery (ASDS) cases as they relate to surgeon and hospital operative volume. The 2001 to 2010 NIS was queried for patients greater than 21 years of age with in-hospital stays, including a spine arthrodesis for a diagnosis of scoliosis. Surgeon and hospital identifiers were used to allocate records into volume quartiles by number of surgeries per year. The OCI was devised considering the number of fusion levels, surgical approach, revision status, and use of osteotomy. The index was validated using blood-loss-related diagnostic and procedural codes. One-way ANOVA assessed continuous measures. Chi-square assessed categorical measures. 141,357 ASDS cases met the inclusion criteria. High-volume surgeons performed a higher rate of longfusions (> 8 levels), revision surgeries, and surgeries requiring osteotomy. The OCI showed weak, but significant, correlation with blood loss values: acute blood loss anemia (r = 0.21) and treatment with blood products (r = 0.12) (p < 0.001). High OCI also was also associated with increased length of stay (r = 0.27) and total charges (r = 0.41) (p < 0.001). The operative complexity index (OCI) for ASDS increases with high-volume surgeons and centers, indicating it can be useful to adjust for surgical invasiveness in the NIS database. Operative complexity must be considered when evaluating patient safety and quality indices among hospitals and surgeons.

  6. 76 FR 19716 - Airworthiness Directives; BAE SYSTEMS (Operations) Limited Model 4101 Airplanes (United States)


    ...: * * * BAE Systems (Operations) Ltd has issued Revision 33 of the AMM to amend Chapter 05-10-10 by adding one... condition for the specified products. The MCAI states: The Jetstream J41 Aircraft Maintenance Manual (AMM... issuance of that AD, BAE Systems (Operations) Ltd has issued Revision 33 of the AMM to amend Chapter 05-10...

  7. Study of corrosion product activity due to non-linearly rising corrosion rates coupled with pH effects for long-term operating cycles in pressurized water reactors

    Directory of Open Access Journals (Sweden)

    Malik Javaid I.


    Full Text Available This work is a study of changes in coolant activity due to corrosion products of extended burn-up cycles of 18-24 months duration, in a typical pressurized water reactor, under pH and boric acid variations. It deals with non-linearly changing corrosion rates coupled with pH effects. The CPAIR-P computer program was modified to accommodate for time-dependent rising corrosion and effects of coolant chemistry. These simulations suggest that the effect of an increase in pH value for an extended 24-month cycle on a specific activity, in the form of a decrease in the said activity, is smeared by the rising corrosion. The new saturation values for activity at the end-of-cycle are lower than with a reactor operated at constant low pH/natural boric acid in the coolant. For a non-linear rise in the corrosion rate coupled with a pH rise from 6.9 to 7.4 and the use of enriched boric acid (30%-40%, coolant activity first rises to a peak value during the cycle and then approaches a much smaller saturation value at the end of the cycle, when compared with the activity for the system having a constant low pH value (6.9 in the coolant. In this work, we have shown that the use of enriched boric acid as a chemical shim actually lowers primary coolant activity when higher pH values, rather than natural boric acid, are employed in the coolant. For multiple long-term operating cycles, the saturation value of corrosion product activity increases in the first two cycles and becomes constant in subsequent ones, due to the high operational pH value for enriched boric acid (40% as a chemical shim.

  8. 77 FR 66650 - Proposed Revisions to Radiation Protection (United States)


    ...The U.S. Nuclear Regulatory Commission (NRC or the Commission) is revising the following sections in Chapter 12, ``Radiation Protection'' and soliciting public comment on NUREG-0800, ``Standard Review Plan for the Review of Safety Analysis Reports for Nuclear Power Plants: LWR Edition,'' Section 12.1, ``Assuring that Occupational Radiation Exposures Are As Low As Is Reasonably Achievable,'' Section 12.2, ``Radiation Sources,'' 12.3-12.4, ``Radiation Protection Design Features,'' and Section 12.5, ``Operational Radiation Protection Program.''

  9. [TKA revision of semiconstraint components using the 3-step technique]. (United States)

    Hube, R; Matziolis, G; Kalteis, T; Mayr, H O


    The surgical goal is to achieve a pain free and stable knee joint after revision total knee arthroplasty in three steps. An important component of the technique is the reproducible restoration of the joint line. Revision total knee arthroplasty. Complete bone loss at the knee joint (epicondyles and tibia plateau), persistent joint infection, loss of the extension apparatus, and neurological disease with progressive ligament instability. Implantation of revision components is performed in three steps. The first step is the positioning of the tibia component at the correct height and rotation. As the position of the tibial articular surface is independent of the knee position, the tibia serves as a reference both in extension and in flexion. The second step consists of balancing the knee joint in flexion and, thereby, definition of the flexion gap and the rotation of the femoral component. In the third step, the reconstruction and balancing of the knee joint in extension is performed. Mobilization with weight bearing and range of motion as tolerated depending on osseous and soft tissue condition at surgery. The surgical technique does not influence the further treatment. In a prospective study, 168 consecutive knee revisions operated by the first author were examined clinically and radiologically preoperatively and at a mean follow-up of 38 months (range 22-61 months). There were 96 knees from women and 72 were from men with an average age of 74.6 years (range 51-92 years). Clinical results were based on the American Knee Society score. The score showed 47.6 (range 32-63) preoperatively and 81.5 (range 62-95) at follow-up. Radiologically, 92.7% of the knees showed a malposition <3°. The joint line was correctly reconstructed in 86.3% based on the preoperative plan; 89% of the patella showed correct tracking in the patella tangential view.

  10. Operators for Formal Modelling of Organizations


    Jonker, C.; Sharpanskykh, A.; Treur, J.; Yolum, P.


    Organizational design is an important topic in the literature on organizations. Usually the design principles are addressed informally in this literature. This paper makes a first attempt to formally introduce design operators to formalize the design steps in the process of designing organizations. These operators help an organization designer create an organization design from scratch as well as offer the possibility to revise existing designs of organizations. The operators offer both top-d...

  11. 77 FR 75362 - Funding and Fiscal Affairs, Loan Policies and Operations, and Funding Operations (United States)


    ... From the Federal Register Online via the Government Publishing Office FARM CREDIT ADMINISTRATION 12 CFR Part 615 Funding and Fiscal Affairs, Loan Policies and Operations, and Funding Operations CFR Correction 0 In Title 12 of the Code of Federal Regulations, Parts 600 to 899, revised as of January 1, 2012...

  12. [Osteosynthesis and cup revision in periprosthetic acetabulum fractures using a Kocher-Langenbeck approach]. (United States)

    Schwabe, P; Märdian, S; Perka, C; Schaser, K-D


    Reconstruction/stable fixation of the acetabular columns to create an adequate periacetabular requirement for the implantation of a revision cup. Displaced/nondisplaced fractures with involvement of the posterior column. Resulting instability of the cup in an adequate bone stock situation. Periprosthetic acetabulum fractures with inadequate bone stock. Extended periacetabular defects with loss of anchorage options. Isolated periprosthetic fractures of the anterior column. Septic loosening. Dorsal approach. Dislocation of hip. Mechanical testing of inlaying acetabular cup. With unstable cup situation explantation of the cup, fracture fixation of acetabulum with dorsal double plate osteosynthesis along the posterior column. Cup revision. Hip joint reposition. Early mobilization; partial weight bearing for 12 weeks. Thrombosis prophylaxis. Clinical and radiological follow-ups. Periprosthetic acetabular fracture in 17 patients with 9 fractures after primary total hip replacement (THR), 8 after revision THR. Fractures: 12 due to trauma, 5 spontaneously; 7 anterior column fractures, 5 transverse fractures, 4 posterior column fractures, 1 two column fracture after hemiendoprosthesis. 5 type 1 fractures and 12 type 2 fractures. Operatively treated cases (10/17) received 3 reinforcement ring, 2 pedestal cup, 1 standard revision cup, cup-1 cage construct, 1 ventral plate osteosynthesis, 1 dorsal plate osteosynthesis, and 1 dorsal plate osteosynthesis plus cup revision (10-month Harris Hip Score 78 points). Radiological follow-up for 10 patients: consolidation of fractures without dislocation and a fixed acetabular cup. No revision surgeries during follow-up; 2 hip dislocations, 1 transient sciatic nerve palsy.

  13. Can Teicoplanin Be an Effective Choice for Antibiotic-Impregnated Cement Spacer in Two-Stage Revision Total Knee Arthroplasty? (United States)

    Buyuk, Abdul Fettah; Sofu, Hakan; Camurcu, Ismet Yalkin; Ucpunar, Hanifi; Kaygusuz, Mehmet Akif; Sahin, Vedat


    The main purpose of this study was to evaluate the clinical results of two-stage revision total knee arthroplasty using a teicoplanin-impregnated cement spacer for infected primary total knee replacements. Twenty-five patients operated between 2005 and 2012 were included in this study. At the clinical status analysis, rate of infection eradication was assessed, physical examination was performed, Knee Society Score (KSS) was noted, isolated microorganisms were recorded, and the radiographic evaluation was performed. The mean KSS improved from 40 (range, 25-69) preoperatively to 77 (range, 32-96) at the latest follow-up (p Teicoplanin was found to be an effective choice for antibiotic-impregnated cement spacer applied for the eradication of the infection. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  14. Scar Revision Surgery: The Patient's Perspective

    Directory of Open Access Journals (Sweden)

    Benjamin H Miranda


    Full Text Available BackgroundInsufficient satisfaction outcome literature exists to assist consultations for scar revision surgery; such outcomes should reflect the patient's perspective. The aim of this study was to prospectively investigate scar revision patient satisfaction outcomes, according to specified patient-selection criteria.MethodsPatients (250 were randomly selected for telephone contacting regarding scar revisions undertaken between 2007-2011. Visual analogue scores were obtained for scars pre- and post-revision surgery. Surgery selection criteria were; 'presence' of sufficient time for scar maturation prior to revision, technical issues during or wound complications from the initial procedure that contributed to poor scarring, and 'absence' of site-specific or patient factors that negatively influence outcomes. Patient demographics, scar pathogenesis (elective vs. trauma, underlying issue (functional/symptomatic vs. cosmetic and revision surgery details were also collected with the added use of a real-time, hospital database.ResultsTelephone contacting was achieved for 211 patients (214 scar revisions. Satisfaction outcomes were '2% worse, 16% no change, and 82% better'; a distribution maintained between body sites and despite whether surgery was functional/symptomatic vs. cosmetic. Better outcomes were reported by patients who sustained traumatic scars vs. those who sustained scars by elective procedures (91.80% vs. 77.78%, P=0.016 and by females vs. males (85.52% vs. 75.36%, P<0.05, particularly in the elective group where males (36.17% were more likely to report no change or worse outcomes versus females (16.04% (P<0.01.ConclusionsSuccessful scar revision outcomes may be achieved using careful patient selection. This study provides useful information for referring general practitioners, and patient-surgeon consultations, when planning scar revision.

  15. Persistent pain and comorbidity among Operation Enduring Freedom/Operation Iraqi Freedom/operation New Dawn veterans. (United States)

    Higgins, Diana M; Kerns, Robert D; Brandt, Cynthia A; Haskell, Sally G; Bathulapalli, Harini; Gilliam, Wesley; Goulet, Joseph L


    Chronic pain is a significant concern for the Veterans Health Administration (VHA), with chronic pain conditions among those most frequently reported by Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) veterans. The current study examined VHA electronic medical record data to examine variation in demographics and high prevalence and high impact medical and mental health conditions in order to characterize the differences between patients with persistent pain and no pain. A conservative operational definition of chronic or "persistent pain" based on multiple indicators of pain (i.e., pain intensity ratings, prescription opioids, pain clinic visits, International Classification of Diseases, Ninth Revision codes) was employed. Analyses included the entire roster of longitudinal clinical data on OEF/OIF/OND veterans who used VHA care to compare those with persistent pain with those with no clinical evidence of pain. Results of logistic regression models suggest that sex, race, education, military variables, body mass index (BMI), traumatic brain injury (TBI), and mental health conditions, but not age, reliably discriminate the two groups. Those with persistent pain were more likely to be Black, female, on active duty, enlisted, Army service members, have a high school education or less, and have diagnoses of mood disorders, post-traumatic stress disorder, substance use disorders, anxiety disorders, TBI, and have a BMI consistent with overweight and obesity. The operational definition of chronic pain used in this study may have research implications for examining predictors of incident and chronic pain. These data have important clinical implications in that addressing comorbid conditions of persistent pain may improve adaptive coping and functioning in these patients. Wiley Periodicals, Inc.

  16. Human Factors Engineering Program Review Model (NUREG-0711)Revision 3: Update Methodology and Key Revisions

    Energy Technology Data Exchange (ETDEWEB)

    OHara J. M.; Higgins, J.; Fleger, S.


    The U.S. Nuclear Regulatory Commission (NRC) reviews the human factors engineering (HFE) programs of applicants for nuclear power plant construction permits, operating licenses, standard design certifications, and combined operating licenses. The purpose of these safety reviews is to help ensure that personnel performance and reliability are appropriately supported. Detailed design review procedures and guidance for the evaluations is provided in three key documents: the Standard Review Plan (NUREG-0800), the HFE Program Review Model (NUREG-0711), and the Human-System Interface Design Review Guidelines (NUREG-0700). These documents were last revised in 2007, 2004 and 2002, respectively. The NRC is committed to the periodic update and improvement of the guidance to ensure that it remains a state-of-the-art design evaluation tool. To this end, the NRC is updating its guidance to stay current with recent research on human performance, advances in HFE methods and tools, and new technology being employed in plant and control room design. NUREG-0711 is the first document to be addressed. We present the methodology used to update NUREG-0711 and summarize the main changes made. Finally, we discuss the current status of the update program and the future plans.

  17. Revision of capillary cone-jet physics: electrospray and flow focusing. (United States)

    Gañán-Calvo, Alfonso M; Montanero, José M


    Capillary cone jets are natural microfluidic structures arising in steady capillary tip streaming, whose paradigms are electrospray and flow focusing phenomena. In this work, we make a profound revision of the basic underlying physics of generic cone jets from thousands of experimental measurements, most of them reported in the literature. First, the boundaries of the stability region of steady jetting are calculated. We describe these limitations by instability mechanisms associated with the local flow structure in the tip and the issuing jet and with the global behavior of the meniscus. Second, to undertake a general physical treatment of cone jets in steady regime, we analyze the energy balance taking place in the tips of both flow focusing and electrospray. This analysis yields a fundamental result: if the electrospray data are expressed in terms of an effective pressure drop, both phenomena satisfy the same scaling law for the droplet size, which exhibits nearly complete similarity in the parameter window where quasimonodisperse sprays are produced. That effective pressure drop is a function of the liquid properties exclusively, i.e., it does not depend on the operational parameters (flow rate and applied voltage). Moreover, the stability limits of the operational regimes are analyzed in detail, finding fundamental coincidences between flow focusing and electrospray as well. These results provide most useful general description and predictive scaling laws for nearly monodisperse microspraying or nanospraying based on steady cone jets, of immediate applicability in analytical chemistry, chemical engineering, biochemistry, pharmaceutical and food technologies, painting, and many other technological fields.

  18. Quantum Field Theory, Revised Edition (United States)

    Mandl, F.; Shaw, G.


    Quantum Field Theory Revised Edition F. Mandl and G. Shaw, Department of Theoretical Physics, The Schuster Laboratory, The University, Manchester, UK When this book first appeared in 1984, only a handful of W± and Z° bosons had been observed and the experimental investigation of high energy electro-weak interactions was in its infancy. Nowadays, W± bosons and especially Z° bosons can be produced by the thousand and the study of their properties is a precise science. We have revised the text of the later chapters to incorporate these developments and discuss their implications. We have also taken this opportunity to update the references throughout and to make some improvements in the treatment of dimen-sional regularization. Finally, we have corrected some minor errors and are grateful to various people for pointing these out. This book is designed as a short and simple introduction to quantum field theory for students beginning research in theoretical and experimental physics. The three main objectives are to explain the basic physics and formalism of quantum field theory, to make the reader fully proficient in theory calculations using Feynman diagrams, and to introduce the reader to gauge theories, which play such a central role in elementary particle physics. The theory is applied to quantum electrodynamics (QED), where quantum field theory had its early triumphs, and to weak interactions where the standard electro-weak theory has had many impressive successes. The treatment is based on the canonical quantization method, because readers will be familiar with this, because it brings out lucidly the connection between invariance and conservation laws, and because it leads directly to the Feynman diagram techniques which are so important in many branches of physics. In order to help inexperienced research students grasp the meaning of the theory and learn to handle it confidently, the mathematical formalism is developed from first principles, its physical

  19. [Biological downsizing : Acetabular defect reconstruction in revision total hip arthroplasty]. (United States)

    Koob, S; Scheidt, S; Randau, T M; Gathen, M; Wimmer, M D; Wirtz, D C; Gravius, S


    Periacetabular bony defects remain a great challenge in revision total hip arthroplasty. After assessment and classification of the defect and selection of a suitable implant the primary stable fixation and sufficient biological reconstitution of a sustainable bone stock are essential for long term success in acetabular revision surgery. Biological defect reconstruction aims for the down-sizing of periacetabular defects for later revision surgeries. In the field of biological augmentation several methods are currently available. Autologous transplants feature a profound osseointegrative capacity. However, limitations such as volume restrictions and secondary complications at the donor site have to be considered. Structural allografts show little weight bearing potential in the long term and high failure rates. In clinical practice, the usage of spongious chips implanted via impaction bone grafting technique in combination with antiprotrusio cages for the management of contained defects have shown promising long time results. Nevertheless, when dealing with craniolateral acetabular and dorsal column defects, the additional implantation of macroporous metal implants or augments should be considered since biological augmentation has shown little clinical success in these particular cases. This article provides an overview of the current clinically available biological augmentation methods of peri-acetabular defects. Due to the limitations of autologous and allogeneic bone transplants in terms of size and availability, the emerging field of innovative implantable tissue engineering constructs gains interest and will also be discussed in this article.

  20. 76 FR 71922 - Revisions to the California State Implementation Plan, Placer County Air Pollution Control... (United States)


    ... AGENCY 40 CFR Part 52 Revisions to the California State Implementation Plan, Placer County Air Pollution... County Air Pollution Control District (PCAPCD) and Sacramento Metropolitan Air Quality Management... following local rules: PCAPCD Rule 236 (Wood Products and Coating Operations), PCAPCD Rule 238 (Factory...