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Sample records for surgery technical note

  1. Technical Note

    African Journals Online (AJOL)

    Administratör

    In this report on four patients, we did not use any of these techniques. The existence and the site of the fistulas was clearly demonstrated using basic but important preoperative detailed assessment and two intraoperative findings. The preoperative referral note that indicated the site of technical difficulty during the previous ...

  2. NOTES: issues and technical details with introduction of NOTES into a small general surgery residency program.

    Science.gov (United States)

    Kavic, Michael S; Mirza, Brian; Horne, Walter; Moskowitz, Jesse B

    2008-01-01

    Natural orifice translumenal endoscopic surgery (NOTES) is a development of recent origin. In 2004, Kalloo et al first described NOTES investigation in an animal model. Since then, several investigators have pursued NOTES study in animal survival and nonsurvival models. Our objectives for this project included studying NOTES intervention in a laboratory environment using large animal (swine) models and learning to do so in a safe, controlled manner. Ultimately, we intend to introduce NOTES methodology into our surgical residency training program. The expertise of an experienced laparoscopic surgeon, fellowship-trained laparoendoscopic surgeon, and veterinarian along with a senior surgical resident was utilized to bring the input of several disciplines to this study. The Institutional Animal Care and Use Committee (IACUC) of Northeastern Ohio Universities College of Medicine and Pharmacy (NEOUCOM/COP) approved this study. A series of 5 laboratory sessions using mixed breed farm swine varying in weight from 37 kg to 43.1 kg was planned for the initial phase of NOTES introduction into our residency program. Animals were not kept alive in this investigation. All animals were anesthetized using a standard swine protocol and euthanized following guidelines issued by the American Veterinary Medical Association Panel on Euthanasia. Equipment included a Fujinon EVE endoscope 0.8 cm in diameter with a suction/irrigation channel and one working channel. Initially, a US Endoscopy gastric overtube, 19.5 mm OD and 50 cm in length, was used to facilitate passage of the endoscope. However, this device was found to have insufficient length. Subsequently, commercially available 5/8" diameter clear plastic tubing, 70 cm to 80 cm in length, was adapted for use as an overtube. Standard endoscopic instruments included Boston Scientific biopsy forceps, needle-knife, papillotome, endoscopic clip applier, and Valley Lab electrosurgical unit. A Karl Storz laparoscope and tower were used for

  3. Writing a technical note.

    Science.gov (United States)

    Ng, K H; Peh, W C G

    2010-02-01

    A technical note is a short article giving a brief description of a specific development, technique or procedure, or it may describe a modification of an existing technique, procedure or device applicable to medicine. The technique, procedure or device described should have practical value and should contribute to clinical diagnosis or management. It could also present a software tool, or an experimental or computational method. Technical notes are variously referred to as technical innovations or technical developments. The main criteria for publication will be the novelty of concepts involved, the validity of the technique and its potential for clinical applications.

  4. Precision in robotic rectal surgery using the da Vinci Xi system and integrated table motion, a technical note.

    Science.gov (United States)

    Panteleimonitis, Sofoklis; Harper, Mick; Hall, Stuart; Figueiredo, Nuno; Qureshi, Tahseen; Parvaiz, Amjad

    2017-09-15

    Robotic rectal surgery is becoming increasingly more popular among colorectal surgeons. However, time spent on robotic platform docking, arm clashing and undocking of the platform during the procedure are factors that surgeons often find cumbersome and time consuming. The newest surgical platform, the da Vinci Xi, coupled with integrated table motion can help to overcome these problems. This technical note aims to describe a standardised operative technique of single docking robotic rectal surgery using the da Vinci Xi system and integrated table motion. A stepwise approach of the da Vinci docking process and surgical technique is described accompanied by an intra-operative video that demonstrates this technique. We also present data collected from a prospectively maintained database. 33 consecutive rectal cancer patients (24 male, 9 female) received robotic rectal surgery with the da Vinci Xi during the preparation of this technical note. 29 (88%) patients had anterior resections, and four (12%) had abdominoperineal excisions. There were no conversions, no anastomotic leaks and no mortality. Median operation time was 331 (249-372) min, blood loss 20 (20-45) mls and length of stay 6.5 (4-8) days. 30-day readmission rate and re-operation rates were 3% (n = 1). This standardised technique of single docking robotic rectal surgery with the da Vinci Xi is safe, feasible and reproducible. The technological advances of the new robotic system facilitate the totally robotic single docking approach.

  5. Hybrid Microscopic-Endoscopic Surgery for Craniopharyngioma in Neurosurgical Suite: Technical Notes.

    Science.gov (United States)

    Ichikawa, Tomotsugu; Otani, Yoshihiro; Ishida, Joji; Fujii, Kentaro; Kurozumi, Kazuhiko; Ono, Shigeki; Date, Isao

    2016-01-01

    The best chance of curing craniopharyngioma is achieved by microsurgical total resection; however, its location adjacent to critical structures hinders complete resection without neurologic deterioration. Unrecognized residual tumor within microscopic blind spots might result in tumor recurrences. To improve outcomes, new techniques are necessary to visualize tissue within these blind spots. We examined the success of hybrid microscopic-endoscopic neurosurgery for craniopharyngioma in a neurosurgical suite. Four children with craniopharyngiomas underwent microscopic resection. When the neurosurgeon was confident that most of the visible tumor was removed but was suspicious of residual tumor within the blind spot, he or she used an integrated endoscope-holder system to inspect and remove any residual tumor. Two ceiling monitors were mounted side by side in front of the surgeon to display both microscopic and endoscopic views and to view both monitors simultaneously. Surgery was performed in all patients via the frontobasal interhemispheric approach. Residual tumors were observed in the sella (2 patients), on the ventral surface of the chiasm and optic nerve (1 patient), and in the third ventricle (1 patient) and were resected to achieve total resection. Postoperatively, visual function was improved in 2 patients and none exhibited deterioration related to the surgery. Simultaneous microscopic and endoscopic observation with the use of dual monitors in a neurosurgical suite was ergonomically optimal for the surgeon to perform microsurgical procedures and to avoid traumatizing surrounding vessels or neural tissues. Hybrid microscopic-endoscopic neurosurgery may contribute to safe, less-invasive, and maximal resection to achieve better prognosis in children with craniopharyngioma. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Posterior fossa decompression with duraplasty in Chiari surgery: A technical note

    Directory of Open Access Journals (Sweden)

    Marcelo Ferreira Sabba

    Full Text Available Summary Chiari malformation (CM is the most common and prevalent symptomatic congenital craniocervical malformation. Radiological diagnosis is established when the cerebellar tonsils are located 5 mm or more below the level of the foramen magnum on magnetic resonance imaging (MRI. Surgical treatment is indicated whenever there is symptomatic tonsillar herniation or syringomyelia/hydrocephalus. The main surgical treatment for CM without craniocervical instability (such as atlantoaxial luxation is posterior fossa decompression, with or without duraplasty. The authors describe in details and in a stepwise fashion the surgical approach of patients with CM as performed at the State University of Campinas, emphasizing technical nuances for minimizing the risks of the procedure and potentially improving patient outcome.

  7. Technical note on drainage systems

    DEFF Research Database (Denmark)

    Bentzen, Thomas Ruby

    This technical note will present simple but widely used methods for the design of drainage systems. The note will primarily deal with surface water (rainwater) which on a satisfactorily way should be transport into the drainage system. Traditional two types of sewer systems exist: A combined system......, where rainwater and sewage is transported in the same pipe, and a separate system where the two types of water are transported in individual pipe. This note will only focus on the separate rain/stormwater system, however, if domestic sewage should be included in the dimensioning procedure, it......’s not major different than described below - just remember to include this contribution for combined systems where the surface water (rain) and sewage are carried in the same pipes in the system and change some of the parameters for failure allowance (this will be elaborated further later on). The technical...

  8. Endoscopic endonasal skull base surgery: advantages, limitations, and our techniques to overcome cerebrospinal fluid leakage: technical note.

    Science.gov (United States)

    Ishii, Yudo; Tahara, Shigeyuki; Teramoto, Akira; Morita, Akio

    2014-01-01

    In recent years, resections of midline skull base tumors have been conducted using endoscopic endonasal skull base (EESB) approaches. Nevertheless, many surgeons reported that cerebrospinal fluid (CSF) leakage is still a major complication of these approaches. Here, we report the results of our 42 EESB surgeries and discuss the advantages and limits of this approach for resecting various types of tumors, and also report our technique to overcome CSF leakage. All 42 cases involved midline skull base tumors resected using the EESB technique. Dural incisions were closed using nasoseptal flaps and fascia patch inlay sutures. Total removal of the tumor was accomplished in seven pituitary adenomas (33.3%), five craniopharyngiomas (62.5%), five tuberculum sellae meningiomas (83.3%), three clival chordomas (100%), and one suprasellar ependymoma. Residual regions included the cavernous sinus, the outside of the intracranial part of the internal carotid artery, the lower lateral part of the posterior clivus, and the posterior pituitary stalk. Overall incidence of CSF leakage was 7.1%. Even though the versatility of the approach is limited, EESB surgery has many advantages compared to the transcranial approach for managing mid-line skull base lesions. To avoid CSF leakage, surgeons should have skills and techniques for complete closure, including use of the nasoseptal flap and fascia patch inlay techniques.

  9. Correspondence in relation to the case report "Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note." published in May issue of Journal of Brachial Plexus and Peripheral Nerve Injury

    Directory of Open Access Journals (Sweden)

    Bhakta Pradipta

    2008-10-01

    Full Text Available Abstract Comment on 'Capnography as an aid in localizing the phrenic nerve in brachial plexus surgery. Technical note' Bhagat H, Agarwal A, Sharma MS Journal of Brachial Plexus and Peripheral Nerve Injury 2008, 3:14 (22 May 2008

  10. Platelet-rich plasma-enriched autologous fat graft in regenerative and aesthetic facial surgery: Technical note.

    Science.gov (United States)

    Picard, F; Hersant, B; La Padula, S; Meningaud, J-P

    2017-09-01

    The goal of adding platelet-rich plasma (PRP) to autologous fat graft is to increase the survival rate of the graft. After their activation, platelets release some important growth factors. As a result, PRP may increase the proliferation and differentiation of Adipose-derived stem cells (ASCs) into adipocytes, improve fat graft vascularisation, and may block the apoptosis of grafted adipocytes. The other benefit expected from the addition of PRP to fat graft is the improvement of cutaneous trophicity above the grafted areas. An exhaustive review of the literature retrieved 11 clinical studies on humans and 7 on animals. A statistically significant increase of the survival rate of fat grafts has been found in 9 comparative studies. Our synthesis allowed us to set up the following protocol: addition of 20% of PRP activated with calcium hydrochloride to fat grafts. It may enhance the results of autologous facial fat graft in regenerative and aesthetic facial surgery. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  11. Minilaparoscopic Colorectal Resections: Technical Note

    Directory of Open Access Journals (Sweden)

    S. Bona

    2012-01-01

    Full Text Available Laparoscopic colorectal resections have been shown to provide short-term advantages in terms of postoperative pain, general morbidity, recovery, and quality of life. To date, long-term results have been proved to be comparable to open surgery irrefutably only for colon cancer. Recently, new trends keep arising in the direction of minimal invasiveness to reduce surgical trauma after colorectal surgery in order to improve morbidity and cosmetic results. The few reports available in the literature on single-port technique show promising results. Natural orifices endoscopic techniques still have very limited application. We focused our efforts in standardising a minilaparoscopic technique (using 3 to 5 mm instruments for colorectal resections since it can provide excellent cosmetic results without changing the laparoscopic approach significantly. Thus, there is no need for a new learning curve as minilaparoscopy maintains the principle of instrument triangulation. This determines an undoubted advantage in terms of feasibility and reproducibility of the procedure without increasing operative time. Some preliminary experiences confirm that minilaparoscopic colorectal surgery provides acceptable results, comparable to those reported for laparoscopic surgery with regard to operative time, morbidity, and hospital stay. Randomized controlled studies should be conducted to confirm these early encouraging results.

  12. [Natural Orifice Transluminal Endoscopic Surgery (NOTES)].

    Science.gov (United States)

    Kim, Yong Sik; Kim, Chul Young; Chun, Hoon Jai

    2008-03-01

    Recently, the field of gastrointestinal endoscopy is developing rapidly. Once limited to the gastroinstestinal lumen, the endoscopic technology is now breaking the barriers and extending its boundary to peritoneal and pleural space. In 2004, Dr. Kalloo, a gastroenterologist, observed intraperitoneal organs of a pig using a conventional endoscope through the stomach wall. Since then, new endoscopic technique of intraperitoneal intervention with transluminal approach named the Natural Orifice Transluminal Endoscopic Surgery or NOTES has been introduced. NOTES reaches the target organ by inserting the endoscope through a natural orifice (e.g. mouth, anus, vagina, urethra) and entering the peritoneal lumen by means of making an incision on the luminal wall. After a series of successful experiences in animal studies, NOTES are now being tried on human subjects. There are still many obstacles to overcome, but bright future for this new technology is expected because of its proposed advantages of less pain, lower complication rate, short recovery time, and scarless access. In this review, we plan to learn about NOTES.

  13. Modified three-dimensional skull base model with artificial dura mater, cranial nerves, and venous sinuses for training in skull base surgery: technical note.

    Science.gov (United States)

    Mori, Kentaro; Yamamoto, Takuji; Oyama, Kazutaka; Ueno, Hideaki; Nakao, Yasuaki; Honma, Keiichirou

    2008-12-01

    Experience with dissection of the cavernous sinus and the temporal bone is essential for training in skull base surgery, but the opportunities for cadaver dissection are very limited. A modification of a commercially available prototype three-dimensional (3D) skull base model, made by a selective laser sintering method and incorporating surface details and inner bony structures such as the inner ear structures and air cells, is proposed to include artificial dura mater, cranial nerves, venous sinuses, and the internal carotid artery for such surgical training. The transpetrosal approach and epidural cavernous sinus surgery (Dolenc's technique) were performed on this modified model using a high speed drill or ultrasonic bone curette under an operating microscope. The model could be dissected in almost the same way as a real cadaver. The modified 3D skull base model provides a good educational tool for training in skull base surgery.

  14. Multiple-hook fixation in revision spinal deformity surgery for patients with a previous multilevel fusion mass: technical note and preliminary outcomes.

    Science.gov (United States)

    Liu, Ning; Wood, Kirkham B

    2017-03-01

    OBJECTIVE A previous multilevel fusion mass encountered during revision spinal deformity surgery may obscure anatomical landmarks, making instrumentation unworkable or incurring substantial blood loss and operative time. This study introduced a surgical technique of multiple-hook fixation for fixating previous multilevel fusion masses in revision spinal deformity surgeries and then evaluated its outcomes. METHODS Patients with a previous multilevel fusion mass who underwent revision corrective surgery down to the lumbosacral junction were retrospectively studied. Multiple hooks were used to fixate the fusion mass and linked to distal pedicle screws in the lumbosacral-pelvic complex. Radiological and clinical outcomes were evaluated. RESULTS The charts of 8 consecutive patients with spinal deformity were retrospectively reviewed (7 women, 1 man; mean age 56 years). The primary diagnoses included flat-back deformity (6 cases), thoracolumbar kyphoscoliosis (1 case), and lumbar spondylosis secondary to a previous scoliosis fusion (1 case). The mean follow-up duration was 30.1 months. Operations were performed at T3/4-ilium (4 cases), T7-ilium (1 case), T6-S1 (1 case), T12-S1 (1 case), and T9-L5 (1 case). Of 8 patients, 7 had sagittal imbalance preoperatively, and their mean C-7 plumb line improved from 10.8 ± 2.9 cm preoperatively to 5.3 ± 3.6 cm at final follow-up (p = 0.003). The mean lumbar lordosis of these patients at final follow-up was significantly greater than that preoperatively (35.2° ± 12.6° vs 16.8° ± 11.8°, respectively; p = 0.005). Two perioperative complications included osteotomy-related leg weakness in 1 patient and a stitch abscess in another. CONCLUSIONS The multiple-hook technique provides a viable alternative option for fixating a previous multilevel fusion mass in revision spinal deformity surgery.

  15. Preservation of the Myofascial Cuff During Posterior Fossa Surgery to Reduce the Rate of Pseudomeningocele Formation and Cerebrospinal Fluid Leak: A Technical Note.

    Science.gov (United States)

    Felbaum, Daniel R; Mueller, Kyle; Anaizi, Amjad; Mason, Robert B; Jean, Walter C; Voyadzis, Jean M

    2016-12-28

     Suboccipital craniotomy is a workhorse neurosurgical operation for approaching the posterior fossa but carries a high risk of pseudomeningocele and cerebrospinal fluid (CSF) leak. We describe our experience with a simple T-shaped fascial opening that preserves the occipital myofascial cuff as compared to traditional methods to reduce this risk.  A single institution, retrospective review of prospectively collected database was performed of patients that underwent a suboccipital craniectomy or craniotomy. Patient data was reviewed for craniotomy or craniectomy, dural graft, and/or sealant use as well as CSF complications. A pseudomeningocele was defined as a subcutaneous collection of cerebrospinal fluid palpable clinically and confirmed on imaging. A CSF leak was defined as a CSF-cutaneous fistula manifested by CSF leaking through the wound. All patients underwent regular postoperative visits of two weeks, one month, and three months.  Our retrospective review identified 33 patients matching the inclusion criteria. Overall, our cohort had a 21% (7/33) rate of clinical and radiographic pseudomeningocele formation with 9% (3/33) requiring surgical revision or a separate procedure. The rate of clinical and radiographic pseudomeningocele formation in the myofascial cuff preservation technique was less than standard techniques (12% and 31%, respectively). Revision or further surgical procedures were also reduced in the myofascial cuff preservation technique vs. the standard technique (6% vs 13%).  Preservation of the myofascial cuff during posterior fossa surgery is a simple and adoptable technique that reduces the rate of pseudomeningocele formation and CSF leak as compared with standard techniques.

  16. Minimally invasive tethered cord release in children: A technical note

    Directory of Open Access Journals (Sweden)

    S. Kağan Başarslan

    2014-03-01

    Full Text Available Tethered cord release is commonly performed in pediatric neurosurgery. Nowadays, minimally invasive procedures are created growing interest due to its highly tolerable nature for surgery. It has been main purpose a minimal damaging on access route and maximum protection of normal structures in surgery. We present a surgical treatment of tethered cord syndrome, by which is provided the cord releasing unlike the many methods being applied with tissue removal. The main advantage of performing this surgery through 2 cm hole is to avoid removing ligamentum flavum and bony structure like lamina in addition to reduce the length of the incision and the related scar tissue. J Clin Exp Invest 2014; 5 (1: 115-117 Technical note: the patient was taken on the operating table in the sitting-prone position, and L5-S1 distance was determined by fluoroscopy. The skin and subcutaneous tissues was passed via a 2 cm vertical incision settled in 0.5 cm laterally from midline. L5-S1 distance and its covering ligamentum flavum are displayed by the guidance of L5 lamina. Williams’s retractor was placed in the distance after fetching microscope. The foregoing procedures are the same with microdiscectomic surgery. By a vertical incision made on the flavum, its both layer was lifted up and hanged with simple suture on the back tissue for a comfortable exposure of the Dura. Thecal sac was opened by 0.5 cm long vertical incision on the Dura after obtaining secure CSF drainage with the help of yellow-tipped syringe needle. With finding by a nerve hook, the phylum was burned and released securely. Then the Dura was sutured primarily for the closure by means of microsurgery instruments, and flavum was laid on it again.

  17. [Laparoscopic colorectal surgery - SILS, robots, and NOTES.

    NARCIS (Netherlands)

    D'Hoore, André; Wolthuis, Albert M.; Mizrahi, Hagar; Parker, Mike; Bemelman, Willem A.; Wara, Pål

    2011-01-01

    Single incision laparoscopic surgery resection of colon is feasible, but so far evidence of benefit compared to standard laparoscopic technique is lacking. In addition to robot-controlled camera, there is only one robot system on the market capable of performing laparoscopic surgery. The da Vinci

  18. Technical note An investigation of the franchising option for water ...

    African Journals Online (AJOL)

    Technical note An investigation of the franchising option for water services operation ... of water services, and outlines the need to formulate a franchise model that ... made available to emerging entrepreneurs as the basis of a viable business.

  19. Earth-covered buildings: technical notes

    Energy Technology Data Exchange (ETDEWEB)

    Moreland, F L; Higgs, F; Shih, J [eds.

    1978-01-01

    John Cable, Architectural and Engineering Systems Branch, Division of Buildings and Community Systems, Department of Energy, kicked off the conference and spelled out the role of DOE in this area. One of his points was that the technical problems are easier than the institutional problems. A separate abstract was prepared for each of the 18 papers of this volume; all of the abstracts will appear in Energy Research Abstracts (ERA), and 16 were selected for Energy Abstractss for Policy Analysis (EAPA). (DCK)

  20. Natural orifice translumenal endoscopic surgery (NOTES) for innovation in hepatobiliary and pancreatic surgery: preface.

    Science.gov (United States)

    Sugimoto, Maki

    2009-01-01

    Natural orifice translumenal endoscopic surgery (NOTES) has captured the interest of interventional endoscopists and may represent the next stage of evolution of minimally invasive surgery. It provides the potential for performance of incisionless operations. It is gaining momentum both in the animal laboratory and in human case reports. Developments in the field of NOTES have led to the formation of the Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) in 2006. In this special issue, the current trends in NOTES in the field of hepatobiliary and pancreatic surgery are featured, including NOTES cholecystectomy, hepatectomy splenectomy, pancreatic necrosectomy, and the future of NOTES. In this issue, we discuss the potential benefits of these procedures in hepatobiliary and pancreatic surgery. We have just started the evaluation process for this new technology. The concept of NOTES is becoming established and is enormously advantageous for the patient. Both the surgeon and gastroenterologist should contribute to developing NOTES in making use of their specialties.

  1. Non-technical skills assessment in surgery.

    Science.gov (United States)

    Sharma, Bharat; Mishra, Amit; Aggarwal, Rajesh; Grantcharov, Teodor P

    2011-09-01

    Adverse events in surgery have highlighted the importance of non-technical skills, such as communication, decision-making, teamwork, situational awareness and leadership, to effective organizational performance. These skills carry particular importance to surgical oncology, as members of a multidisciplinary team must work cohesively to formulate effective patient care plans. Several non-technical skills evaluation tools have been developed for use in surgery, without adequate comparison and consensus on which should be standard for training. Eleven articles describing the use of three non-technical evaluation tools related to surgery: NOTSS (Non Technical Skills for Surgeons), NOTECHS (Non Technical Skills) and OTAS (Observational Teamwork Assessment for Surgery) were analyzed with respect to scale formulation, validity, reliability and feasibility. Furthermore, their use in training thus far and the future of non-technical rating scales in surgical curricula was discussed. Future work should focus on incorporating these assessment tools into training and into a real operating room setting to provide formative evaluations for surgical residents. Copyright © 2010 Elsevier Ltd. All rights reserved.

  2. Technical note: New table look-up lossless compression method ...

    African Journals Online (AJOL)

    Technical note: New table look-up lossless compression method based on binary index archiving. ... International Journal of Engineering, Science and Technology ... This paper intends to present a common use archiver, made up following the dictionary technique and using the index archiving method as a simple and ...

  3. Technical note: Development of a Linear Flow Channel Reactor for ...

    African Journals Online (AJOL)

    Technical note: Development of a Linear Flow Channel Reactor for sulphur removal ... AFRICAN JOURNALS ONLINE (AJOL) · Journals · Advanced Search ... 000 mg∙ℓ-1 Na2SO4 solution) and the Liner Flow Channel Reactors (surface area ...

  4. Technical Note: Application of Decision Theory Based Criteria for ...

    African Journals Online (AJOL)

    Technical Note: Application of Decision Theory Based Criteria for Structural Appraisal of a Building during Construction. ... Nigerian Journal of Technology ... reliability of concrete in a structure during construction, a case study of laboratory block for College of Continuing Education, University of Port Harcourt, Rivers State.

  5. Technical note The formulation of synthetic domestic wastewater ...

    African Journals Online (AJOL)

    Technical note The formulation of synthetic domestic wastewater sludge medium to study anaerobic biological treatment of acid mine drainage in the laboratory. ... Journal Home > Vol 42, No 2 (2016) > ... Domestic wastewater sludge is however highly variable in its composition, making laboratory experimentation difficult.

  6. The quality of operative notes at a general surgery unit.

    Science.gov (United States)

    Rogers, A; Bunting, M; Atherstone, A

    2008-09-01

    With the increasingly litigious nature of medical practice, accurate documentation is critical. This is particularly true for operative procedures, and medical councils have identified this and published guidelines to aid surgeons. However, these remain a frequently cited weakness in their defence in medico-legal cases. This study assessed the accuracy of operative notes in a general surgery unit in order to improve our practice. An audit of 100 consecutive operative notes was performed, and notes were assessed using the Royal College of Surgeons guidelines. The quality of note-taking of trainees was compared with that of consultant surgeons. A series of operation note pro formas was designed in response to the findings. Of the notes, 66% were completed by trainees. The vast majority of notes had no diagram to demonstrate the surgical findings or illustrate the actions. Specialist surgeons were more likely to describe the actions accurately, but less likely to describe wound closure methods or dressings used. They were also less likely to complete adequate postoperative orders. This study identifies key areas of weakness in our operative note-keeping. Pro formas should be introduced and made available for commonly performed procedures, and diagrams should be used wherever possible.

  7. Dealer Group or Financial Planning Group? A Brief Technical Note

    Directory of Open Access Journals (Sweden)

    Lujer Santacruz

    2011-06-01

    Full Text Available This technical note examines whether the industry practice of using the term dealer group when referring to afinancial planning group contributes to the general perception that financial advisers are not objective whenmaking financial product recommendations. An experimental design carried out through an online survey isused. This is supplemented by a direct comparison survey on the two terminologies. The results provide acase for the industry to adopt a new terminology.

  8. Current status of natural orifice trans-endoscopic surgery (NOTES and laparoendoscopic single site surgery (LESS in urologic surgery

    Directory of Open Access Journals (Sweden)

    Rafael E. Sanchez-Salas

    2010-08-01

    Full Text Available Laparoendoscopic single site surgery (LESS and natural orifice transluminal endoscopic surgery (NOTES represent novel approaches in urological surgery. To perform a review of the literature in order describe the current status of LESS and NOTES in Urology. References for this manuscript were obtained by performing a review of the available literature in PubMed from 01-01-02 to 15-05-09. Search terms included single port, single site, NOTES, LESS and single incision. A total of 412 manuscripts were initially identified. Out of these, 64 manuscripts were selected based in their urological content. The manuscript features subheadings for experimental and clinical studies, as NOTES-LESS is a new surgical technique and its future evolution will probably rely in initial verified feasibility. A subheading for reviews presents information regarding common language and consensus for the techniques. The issue of complications published in clinical series and the future needs of NOTES-LESS, are also presented.

  9. Technical note: the humeral canal approach to the brachial plexus.

    LENUS (Irish Health Repository)

    Frizelle, H P

    2012-02-03

    Many variations to the axillary approach to the brachial plexus have been described. However, the success rate varies depending on the approach used and on the definition of success. Recent work describes a new approach to regional anaesthesia of the upper limb at the humeral\\/brachial canal using selective stimulation of the major nerves. This report outlines initial experience with this block, describing the technique and results in 50 patients undergoing hand and forearm surgery. All patients were assessed for completeness of motor and sensory block. The overall success rate was 90 percent. Motor block was present in 80 percent of patients. Completion of the block was necessary in 5 patients. Two patients required general anaesthesia. The preponderance of ulnar deficiencies agrees with previously published data on this technique. No complications were described. Initial experience confirms the high success rate described using the Dupre technique. This technically straightforward approach with minimal complications can be recommended for regional anaesthesia of the upper limb.

  10. A review on the status of natural orifice transluminal endoscopic surgery (NOTES cholecystectomy: techniques and challenges

    Directory of Open Access Journals (Sweden)

    Michael C Meadows

    2010-09-01

    Full Text Available Michael C Meadows1,3, Ronald S Chamberlain1,2,31Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA; 2Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA; 3Saint George’s University, School of Medicine, West Indies, GrenadaIntroduction: The evolution of techniques for the performance of a cholecystectomy over the last 25 years has been swift. The laparoscopic approach is now the gold standard for removal of the gall bladder and is the most frequently performed minimally invasive procedure globally. Currently in its infancy stage, natural orifice transluminal endoscopy surgery, or NOTES, is purported to be the next leap forward in minimally invasive approaches. The safety, feasibility, and effectiveness of this procedure, as well as the significance of potential benefits to patients beyond current surgical approaches are yet undetermined.Methods: A comprehensive literature search was conducted using PubMed, a search engine ­created by the National Library of Medicine. Keywords used in the search included “natural orifice transluminal endoscopic surgery”, “NOTES”, “cholecystectomy”, “transcolonic”, “transvaginal”, and “transgastric”. The accumulated literature was critically analyzed and reviewed.Results: One-hundred and eighty-six cases of NOTES cholecystectomies have been published to date. Of these, 174 have been performed through a transvaginal approach. The remainder of the procedures were performed transgastrically. There are no published reports of ­transcolonic cholecystectomies performed in humans. Four of 186 cases (2.15% were converted to traditional laparoscopy due to intraoperative complications. No significant complications or mortalities have been reported.Conclusion: NOTES cholecystectomy appears to be a feasible procedure. However, technical, safety, and ethical issues remain relatively unresolved. Besides improved cosmesis, whether additional

  11. Electronic property measurements for piezoelectric ceramics. Technical notes

    International Nuclear Information System (INIS)

    Cain, M.; Stewart, M.; Gee, M.

    1998-01-01

    A series of measurement notes are presented, with emphasis placed on the technical nature of the testing methodology, for the determination of key electronic properties for piezoelectric ceramic materials that are used as sensors and actuators. The report is segmented into 'sections' that may be read independently from the rest of the report. The following measurement issues are discussed: Polarisation/Electric field (PE) loop measurements including a discussion of commercial and an in-house constructed system that measures PE loops; Dielectric measurements at low and high stress application, including some thermal and stress dependency modelling of piezo materials properties, developed at NPL; Strain measurement techniques developed at CMMT; Charge measurement techniques suitable for PE loop and other data acquisition; PE loop measurement and software analysis developed at CMMT and Manchester University. The primary objective of this report is to provide a framework on which the remainder of the testing procedures are to be developed for measurements of piezoelectric properties at high stress and stress rate. These procedures will be the subject of a future publication. (author)

  12. Suporte de cabeça para cirurgia da coluna vertebral: nota técnica Soporte de cabeza para cirúgia de columna vertebral: nota técnica Head support for spinal surgery: technical note

    Directory of Open Access Journals (Sweden)

    Guilherme Zanini Rocha

    2012-09-01

    Full Text Available Descreve-se um suporte de cabeça para cirurgia da coluna vertebral, que permite a colocação da cabeça do paciente em alinhamento neutro com o corpo e monitorização da posição de olhos, boca, nariz e tubo orotraqueal, evitando danos decorrentes de mau posicionamento durante a cirurgia.Se describe un soporte de cabeza para la cirugía de columna vertebral que permite la colocación de la cabeza del paciente en alineación neutra con el cuerpo y el control de la posición de ojos, boca, nariz y tubo oro-traqueal, evitando los daños causados por el posicionamiento incorrecto durante la cirugía.We describe a head support for spinal surgery that allows the placement of the patient's head in neutral alignment with the body and monitoring the position of the eyes, mouth, nose and orotracheal tube, preventing damages from poor positioning during surgery.

  13. Objective assessment of technical skills in surgery

    OpenAIRE

    Moorthy, Krishna; Munz, Yaron; Sarker, Sudip K; Darzi, Ara

    2003-01-01

    In the past few years, considerable developments have been made in the objective assessment of technical proficiency of surgeons. Technical skills should be assessed during training, and various methods have been developed for this purpose

  14. PLAY HANDS PROTECTIVE GLOVES: TECHNICAL NOTE ON DESIGN AND CONCEPT.

    Science.gov (United States)

    Houston-Hicks, Michele; Lura, Derek J; Highsmith, M Jason

    2016-09-01

    Cerebral Palsy (CP) is the leading cause of childhood motor disability, with a global incidence of 1.6 to 2.5/1,000 live births. Approximately 23% of children with CP are dependent upon assistive technologies. Some children with developmental disabilities have self-injurious behaviors such as finger biting but also have therapeutic needs. The purpose of this technical note is to describe design considerations for a protective glove and finger covering that maintains finger dexterity for children who exhibit finger and hand chewing (dermatophagia) and require therapeutic range of motion and may benefit from sensory stimulation resulting from constant contact between glove and skin. Protecting Little and Adolescent Youth (PLAY) Hands are protective gloves for children with developmental disorders such as CP who injure themselves by biting their hands due to pain or sensory issues. PLAY Hands will be cosmetically appealing gloves that provide therapeutic warmth, tactile sensory feedback, range of motion for donning/ doffing, and protection to maximize function and quality of life for families of children with developmental disorders. The technology is either a per-finger protective orthosis or an entire glove solution designed from durable 3D-printed biodegradable/bioabsorbable materials such as thermoplastics. PLAY Hands represent a series of protective hand wear interventions in the areas of self-mutilating behavior, kinematics, and sensation. They will be made available in a range of protective iterations from single- or multi-digit finger orthoses to a basic glove design to a more structurally robust and protective iteration. To improve the quality of life for patients and caregivers, they are conceptualized to be cosmetically appealing, protective, and therapeutic.

  15. Technical note - Considerations for MR imaging of small animals

    International Nuclear Information System (INIS)

    Baker, Martin A.

    2011-01-01

    Routine clinical veterinary use of MR scanning is becoming more common. This article addresses the major technical considerations for radiographers performing MR examinations on small animals and provides practical advice for scanning techniques.

  16. TECHNICAL DESIGN NOTE: Picosecond resolution programmable delay line

    Science.gov (United States)

    Suchenek, Mariusz

    2009-11-01

    The note presents implementation of a programmable delay line for digital signals. The tested circuit has a subnanosecond delay range programmable with a resolution of picoseconds. Implementation of the circuit was based on low-cost components, easily available on the market.

  17. Technical Note: Development of a Photobioreactor for Microalgae ...

    African Journals Online (AJOL)

    In view of the technical and biological limitations of open pond systems, a study was conducted to develop a cost-effective experimental photobioreactor that would permit efficient cultivation of microalgae for biodiesel production. The photobioreactor was developed using low cost materi- als, cylindrical translucent tubes ...

  18. Undocumented College Students, Taxation, and Financial Aid: A Technical Note

    Science.gov (United States)

    Olivas, Michael A.

    2009-01-01

    A surprising amount of litigation and legislation has erupted over undocumented college students. Victims at the federal level are the DREAM Act and immigration reform. Financial aid raises technical issues for undocumented college applicants and for the citizen children of undocumented parents. Generally, the undocumented are ineligible for…

  19. Technical note: New applications for on-line automated solid phase extraction

    OpenAIRE

    MacFarlane, John D.

    1997-01-01

    This technical note explains the disadvantages of manual solid phase extraction (SPE) techniques and the benefits to be gained with automatic systems. The note reports on a number of general and highly specific applications using the Sample Preparation Unit OSP-2A.

  20. Technical note on drainage systems:design of pipes and detention facilities for rainwater

    OpenAIRE

    Bentzen, Thomas Ruby

    2014-01-01

    This technical note will present simple but widely used methods for the design of drainage systems. The note will primarily deal with surface water (rainwater) which on a satisfactorily way should be transport into the drainage system. Traditional two types of sewer systems exist: A combined system, where rainwater and sewage is transported in the same pipe, and a separate system where the two types of water are transported in individual pipe. This note will only focus on the separate rain/st...

  1. Taking NOTES: translumenal flexible endoscopy and endoscopic surgery.

    Science.gov (United States)

    Willingham, Field F; Brugge, William R

    2007-09-01

    To review the current state of natural orifice surgery and examine the concerns, challenges, and opportunities presented by translumenal research. Translumenal endoscopic procedures have been the focus of extensive research. Researchers have reported natural orifice translumenal endoscopic surgery in a swine model in several areas involving the abdominal cavity. Diagnostic procedures have included endoscopic peritoneoscopy, liver biopsy, lymphadenectomy, and abdominal exploration. Several gynecologic procedures including tubal ligation, oophorectomy, and partial hysterectomy have been demonstrated using current commercial endoscopes. Gastrointestinal surgical procedures, including gastrojejunostomy, cholecystectomy, splenectomy, and distal pancreatectomy have been performed successfully via transgastric and/or transcolonic approaches. There have been no studies of natural orifice translumenal endoscopic surgery procedures published in humans. While fundamental questions about the emerging technology have not been scrutinized, limitations of the large animal model will pose a challenge to the development of large randomized trials. While natural orifice translumenal endoscopic surgery may represent a paradigm shift and may offer significant benefits to patients, rigorous testing of the techniques is lacking and current data have been drawn from case series.

  2. Customizable rigid head fixation for infants: technical note.

    Science.gov (United States)

    Udayakumaran, Suhas; Onyia, Chiazor U

    2016-01-01

    The need and advantages of rigid fixation of the head in cranial surgeries are well documented (Berryhill et al., Otolaryngol Head Neck Surg 121:269-273, 1999). Head fixation for neurosurgical procedures in infants and in early years has been a challenge and is fraught with risk. Despite the fact that pediatric pins are designed, rigid head fixation involving direct application of pins to the head of infants and slightly older children is still generally not safe (Agrawal and Steinbok, Childs Nerv Syst 22:1473-1474, 2006). Yet, there are some surgeries in which some form of rigid fixation is required (Agrawal and Steinbok, Childs Nerv Syst 22:1473-1474, 2006). We describe a simple technique to achieve rigid fixation of the head in infants for neurosurgical procedures. This involves applying a head band made of Plaster of Paris (POP) around the head and then applying the fixation pins of the fixation frame directly on to the POP. We have used this technique of head fixation successfully for infants with no complications.

  3. Scarless abdominal fat graft harvest for neurosurgical procedures: technical note.

    Science.gov (United States)

    Trinh, Victoria T; Duckworth, Edward A M

    2015-02-01

    Background Abdominal fat grafts are often harvested for use in skull base reconstruction and cerebrospinal fluid (CSF) leak repairs, and for operations traversing the nasal sinuses or mastoid bone. Although the endoscopic transnasal surgery has gained significant popularity, in part because it is considered "scarless," a common adjunct, the abdominal fat graft, can result in a disfiguring scar across the abdomen. Objective This is the first report of a scarless abdominal fat graft technique for skull base reconstruction. Methods Ten patients with a median age of 56.5 years (range: 45-73 years) underwent endoscopic transsphenoidal tumor resection with intraumbilical fat graft harvest. Careful circumferential fat dissection at the umbilicus, with progressive retraction of the graft, was crucial to ensure maximal visualization and to prevent injury to the subcutaneous vessels and rectus fascia. Results Following reconstruction of the sellar skull base, all patients did well postoperatively with no evidence of CSF leak. At 12-week follow-up for all patients, there was no evidence of scar, intracavity hematoma, or wound infection. Conclusions Fat graft harvest through an intraumbilical incision results in a scar-free abdominal harvest, and is a useful procedural adjunct to complement "scarless" brain surgery.

  4. Parotid Duct Repair with Intubation Tube: Technical Note

    Science.gov (United States)

    Öztürk, Muhammed Beşir; Barutca, Seda Asrufoğlu; Keskin, Elif Seda; Atik, Bekir

    2017-01-01

    The parotid duct can be damaged in traumatic injuries and surgical interventions. Early diagnosis and treatment of a duct injury is of great importance because complications such as sialocele and salivary gland fistula may develop if the duct is not surgically repaired. We think the cuff of an intubation tube is an ideal material in parotid duct repair, because of its technical characteristics, easiness of availability, and low-cost. In this paper, we described the use of the cuff cannula of an intubation tube for the diagnosis and treatment of parotid duct laceration, as a low-cost and easy to access material readily available in every operating room. PMID:28713751

  5. The role of non-technical skills in surgery.

    Science.gov (United States)

    Agha, Riaz A; Fowler, Alexander J; Sevdalis, Nick

    2015-12-01

    Non-technical skills are of increasing importance in surgery and surgical training. A traditional focus on technical skills acquisition and competence is no longer enough for the delivery of a modern, safe surgical practice. This review discusses the importance of non-technical skills and the values that underpin successful modern surgical practice. This narrative review used a number of sources including written and online, there was no specific search strategy of defined databases. Modern surgical practice requires; technical and non-technical skills, evidence-based practice, an emphasis on lifelong learning, monitoring of outcomes and a supportive institutional and health service framework. Finally these requirements need to be combined with a number of personal and professional values including integrity, professionalism and compassionate, patient-centred care.

  6. The role of non-technical skills in surgery

    Science.gov (United States)

    Agha, Riaz A.; Fowler, Alexander J.; Sevdalis, Nick

    2015-01-01

    Non-technical skills are of increasing importance in surgery and surgical training. A traditional focus on technical skills acquisition and competence is no longer enough for the delivery of a modern, safe surgical practice. This review discusses the importance of non-technical skills and the values that underpin successful modern surgical practice. This narrative review used a number of sources including written and online, there was no specific search strategy of defined databases. Modern surgical practice requires; technical and non-technical skills, evidence-based practice, an emphasis on lifelong learning, monitoring of outcomes and a supportive institutional and health service framework. Finally these requirements need to be combined with a number of personal and professional values including integrity, professionalism and compassionate, patient-centred care. PMID:26904193

  7. Cirugía endoscópica transluminal por orificios naturales: NOTES Natural orifice transluminal endoscopic surgery: NOTES

    Directory of Open Access Journals (Sweden)

    M. J. Varas Lorenzo

    2009-04-01

    Full Text Available Se presenta una revisión actual, puesta al día, y punto de vista de los autores sobre un tema sumamente novedoso y atractivo, como es la Cirugía Endoscópica Transluminal por Orificios Naturales (NOTES: Natural Orifice Translumenal Endoscopic Surgery. La mayoría de los trabajos revisados se han realizado en animales de experimentación, pero la publicación de la colecistectomía por vía transvaginal, y la aparición de editoriales y artículos de revisión sobre el tema, nos llevan a realizar una serie de preguntas no resueltas actualmente sobre este tipo de cirugía, que representa un avance potencial para conseguir "una cirugía endoscópica sin cicatrices, sin infecciones, con mínimos requerimientos de anestesia y una inmediata recuperación".A current review and update of an exceedingly novel and appealing topic, namely natural orifice transluminal endoscopic surgery (NOTES, is discussed, as well as the authors' viewpoint thereon. Most reviewed studies were performed in laboratory animals, but reports on transvaginal cholecystectomy and the emergence of editorials and review articles on this topic pose a number of as yet unanswered questions on this type of surgery, which represents a potential advance towards "endoscopic surgery with no scars, no infection, minimal anesthesia requirements, and immediate recovery".

  8. Technical note: Ruminal cannulation technique in young Holstein calves:

    DEFF Research Database (Denmark)

    Kristensen, Niels Bastian; Engbæk, Marie; Vestergaard, Mogens

    2010-01-01

    Ruminal cannulation techniques are frequently used to study fermentation in the ruminant forestomach. Unsatisfactory results with the traditionally applied procedure for cannulation of young calves stimulated the development of a simpler and more robust procedure; this procedure was tested for ef...... no major effect on apparent animal health and performance traits, and the cannula proved useful for multiple samplings of ruminal contents in young calves.......Ruminal cannulation techniques are frequently used to study fermentation in the ruminant forestomach. Unsatisfactory results with the traditionally applied procedure for cannulation of young calves stimulated the development of a simpler and more robust procedure; this procedure was tested...... for effects on performance traits and gross anatomy of the gastrointestinal tract compared with a control group not undergoing surgery. Five calves were ruminally cannulated at approximately 10 d of age and 5 matching calves were used as controls. All calves were fed milk replacer and a diet based on clover...

  9. Mandibular angle resection and masticatory muscle hypertrophy - a technical note and morphological optimization.

    Science.gov (United States)

    Andreishchev, A R; Nicot, R; Ferri, J

    2014-11-01

    Mandibular angle resection is rarely used, but is a highly effective means of correcting facial defects. We report a mandibular angle resection technique associated with the removal of a part of hypertrophic masseter muscles and resection of buccal fat pad. Anatomical reminders: the most important entities are the facial artery and vein, crossing the lower margin of the jaw just in front of the anterior boarder of the masseter muscle and the temporomaxillary vein, passing through the temporomaxillary fossa; preoperative aspects: the preoperative examination included a radiological assessment of the shape and size of the mandibular angle; surgical technique: an intra-oral approach was usually used. The most effective and convenient method for the osteotomy was using a reciprocating saw. This technique allowed achieving a smooth contour of masseter muscles during masticatory movements or at rest. Eleven mandibular angle resections were performed from 2001 to 2009. The surgery was supplemented by remodeling the lower margin of the jaw for 5 other patients. No permanent facial palsy was noted. One patient presented a unilateral long-term loss of sensitivity of the lower lip and chin. This surgical technique if simple even requires using good technical equipment, and observing a set of rules. Using these principles allows simplifying the surgical technique, and decreasing its morbidity. A part of the masseter muscles and the buccal fat pad can sometimes be resected to improve the morphological results. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  10. Technical and Technological Skills Assessment in Laparoscopic Surgery

    Science.gov (United States)

    Chang, Avril; Vincent, Charles

    2006-01-01

    Objectives: Surgical appraisal and revalidation are key components of good surgical practice and training. Assessing technical skills in a structured manner is still not widely used. Laparoscopic surgery also requires the surgeon to be competent in technological aspects of the operation. Methods: Checklists for generic, specific technical, and technological skills for laparoscopic cholecystectomies were constructed. Two surgeons with >12 years postgraduate surgical experience assessed each operation blindly and independently on DVD. The technological skills were assessed in the operating room. Results: One hundred operations were analyzed. Eight trainees and 10 consultant surgeons were recruited. No adverse events occurred due to technical or technological skills. Mean interrater reliability was kappa=0.88, P=technical and technological skills between trainee and consultant surgeons were significant, Mann-Whitney P=technical and technological skills can be measured to assess performance of laparoscopic surgeons. This technical and technological assessment tool for laparoscopic surgery seems to have face, content, concurrent, and construct validities and could be modified and applied to any laparoscopic operation. The tool has the possibility of being used in surgical training and appraisal. We aim to modify and apply this tool to advanced laparoscopic operations. PMID:17212881

  11. Intraoperative Hypoglossal Nerve Mapping During Carotid Endarterectomy: Technical Note.

    Science.gov (United States)

    Kojima, Atsuhiro; Saga, Isako; Ishikawa, Mami

    2018-05-01

    Hypoglossal nerve deficit is a possible complication caused by carotid endarterectomy (CEA). The accidental injury of the hypoglossal nerve during surgery is one of the major reasons for permanent hypoglossal nerve palsy. In this study, we investigated the usefulness of intraoperative mapping of the hypoglossal nerve to identify this nerve during CEA. Five consecutive patients who underwent CEA for the treatment of symptomatic or asymptomatic carotid artery stenosis were studied. A hand-held probe was used to detect the hypoglossal nerve in the operative field, and the tongue motor evoked potentials (MEPs) were recorded. The tongue MEPs were obtained in all the patients. The invisible hypoglossal nerve was successfully identified without any difficulty when the internal carotid artery was exposed. Intraoperative mapping was particularly useful for identifying the hypoglossal nerve when the hypoglossal nerve passed beneath the posterior belly of the digastric muscle. In 1 of 2 cases, MEP was also elicited when the ansa cervicalis was stimulated, although the resulting amplitude was much smaller than that obtained by direct stimulation of the hypoglossal nerve. Postoperatively, none of the patients presented with hypoglossal nerve palsy. Intraoperative hypoglossal nerve mapping enabled us to locate the invisible hypoglossal nerve during the exposure of the internal carotid artery accurately without retracting the posterior belly of the digastric muscle and other tissues in the vicinity of the internal carotid artery. Copyright © 2018 Elsevier Inc. All rights reserved.

  12. 3-Dimensional printing guide template assisted percutaneous vertebroplasty: Technical note.

    Science.gov (United States)

    Li, Jian; Lin, JiSheng; Yang, Yong; Xu, JunChuan; Fei, Qi

    2018-06-01

    Percutaneous vertebroplasty (PVP) is currently considered as an effective treatment for pain caused by acute osteoporotic vertebral compression fracture. Recently, puncture-related complications are increasingly reported. It's important to find a precise technique to reduce the puncture-related complications. We report a case and discussed the novel surgical technique with step-by-step operating procedures, to introduce the precise PVP assisted by a 3-dimensional printing guide template. Based on the preoperative CT scan and infrared scan data, a well-designed individual guide template could be established in a 3-dimensional reconstruction software and printed out by a 3-dimensional printer. In real operation, by matching the guide template to patient's back skin, cement needles' insertion orientation and depth were easily established. Only 14 times C-arm fluoroscopy with HDF mode (total exposure dose was 4.5 mSv) were required during the procedure. The operation took only 17 min. Cement distribution in the vertebral body was very good without any puncture-related complications. Pain was significantly relieved after surgery. In conclusion, the novel precise 3-dimensional printing guide template system may allow (1) comprehensive visualization of the fractured vertebral body and the individual surgical planning, (2) the perfect fitting between skin and guide template to ensure the puncture stability and accuracy, and (3) increased puncture precision and decreased puncture-related complications, surgical time and radiation exposure. Copyright © 2018 Elsevier Ltd. All rights reserved.

  13. Preformed titanium cranioplasty after resection of skull base meningiomas - a technical note.

    Science.gov (United States)

    Schebesch, Karl-Michael; Höhne, Julius; Gassner, Holger G; Brawanski, Alexander

    2013-12-01

    Meningiomas of the fronto-basal skull are difficult to manage as the treatment usually includes extensive resection of the lesion, consecutive reconstruction of the meninges and of the skull. Especially after removal of spheno-orbital and sphenoid-wing meningiomas, the cosmetic result is of utmost importance. In this technical note, we present our institutional approach in the treatment of skull base meningiomas, focussing on the reconstruction of the neurocranium with individually preformed titanium cranioplasty (CRANIOTOP(®), CL Instruments, Germany). Two female patients (40 years, 64 years) are presented. Both patients presented with skull base lesions suggestive of meningiomas. The preoperative thin-sliced CT scan was processed to generate a 3D-model of the skull. On it, the resection was mapped and following a simulated resection, the cranioplasty was manufactured. Intra-operatively, the titanium plate served as a template for the skull resection and was implanted after microsurgical tumour removal, consecutively. The cosmetic result was excellent. Immediate postoperative CT scan revealed accurate fitting and complete tumour removal. Control Magnetic Resonance Imaging (MRI) within 12 weeks was possible without any artifacts. The comprehensive approach described indicates only one surgical procedure for tumour removal and for reconstruction of the skull. The titanium plate served as an exact template for complete resection of the osseous parts of the tumour. Cosmetic outcome was excellent and control MRI was possible post operatively. CRANIOTOP(®) cranioplasty is a safe and practical tool for reconstruction of the skull after meningioma surgery. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  14. 'Smart' electronic operation notes in surgery: an innovative way to improve patient care.

    Science.gov (United States)

    Ghani, Yaser; Thakrar, Raj; Kosuge, Dennis; Bates, Peter

    2014-01-01

    Operation notes are the only comprehensive account of what took place during surgery. Accurate and detailed documentation of surgical operation notes is crucial, both for post-operative management of patients and for medico-legal clarity. The aims of this study were to compare operation documentation against the Royal College of Surgeons of England guidelines and to compare the before-and-after effect of introducing an electronic operation note system. Fifty consecutive operation notes for inpatients that had undergone emergency orthopaedic trauma surgery were audited. An electronic operation note proforma was then introduced and a re-audit carried out after its implementation. The results after implementation of electronic operation notes, demonstrated a marked improvement. All notes contained an operation note (previously 5/6). Seventy five percent included time of surgery and age of patient (vs. 0% previously). A hundred percent included closure details and antibiotic selection at induction (vs. 60% and 69% respectively). Post-operative instructions improved to 100%. All were typed, making for 100% legibility as compared to only 66% of operation notes with legible hand writing in the initial audit. We used our pilot audit to target specific information that was commonly omitted and we 'enforced' these areas using drop-down selections in electronic operation note. This study has demonstrated that implementation of an electronic operation note system markedly improved the quality of documentation, both in terms of information detail and readability. We would recommend this template system as a standard for operation note documentation. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  15. Technical note: Bayesian calibration of dynamic ruminant nutrition models.

    Science.gov (United States)

    Reed, K F; Arhonditsis, G B; France, J; Kebreab, E

    2016-08-01

    Mechanistic models of ruminant digestion and metabolism have advanced our understanding of the processes underlying ruminant animal physiology. Deterministic modeling practices ignore the inherent variation within and among individual animals and thus have no way to assess how sources of error influence model outputs. We introduce Bayesian calibration of mathematical models to address the need for robust mechanistic modeling tools that can accommodate error analysis by remaining within the bounds of data-based parameter estimation. For the purpose of prediction, the Bayesian approach generates a posterior predictive distribution that represents the current estimate of the value of the response variable, taking into account both the uncertainty about the parameters and model residual variability. Predictions are expressed as probability distributions, thereby conveying significantly more information than point estimates in regard to uncertainty. Our study illustrates some of the technical advantages of Bayesian calibration and discusses the future perspectives in the context of animal nutrition modeling. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  16. The examination assessment of technical competence in vascular surgery.

    Science.gov (United States)

    Pandey, V A; Wolfe, J H N; Liapis, C D; Bergqvist, D

    2006-09-01

    The European Board of Surgery Qualification in Vascular Surgery is a pan-European examination for vascular surgeons who have attained a national certificate of completion of specialist training. A 2-year study was conducted before the introduction of a technical skills assessment in the examination. The study included 30 surgeons: 22 candidates and eight examiners. They were tested on dissection (on a synthetic saphenofemoral junction model), anastomosis (on to anterior tibial artery of a synthetic leg model) and dexterity (a knot-tying simulator with electromagnetic motion analysis). Validated rating scales were used by two independent examiners. Composite knot-tying scores were calculated for the computerized station. The stations were weighted 35, 45 and 20 percent, respectively. Examiners performed better than candidates in the dissection (P<0.001), anastomosis (P=0.002) and dexterity (P=0.005) stations. Participants performed consistently in the examination (dissection versus anastomosis: r=0.79, P<0.001; dexterity versus total operative score: r=-0.73, P<0.001). Interobserver reliability was high (alpha=0.91). No correlation was seen between a candidate's technical skill and oral examination performance or logbook-accredited scores. Current surgical examinations do not address technical competence. This model appears to be a valid assessment of technical skills in an examination setting. The standards are set at a level appropriate for a specialist vascular surgeon. Copyright (c) 2006 British Journal of Surgery Society Ltd.

  17. Technical Note: Updated durability/composition relationships for Hanford high-level waste glasses

    International Nuclear Information System (INIS)

    Piepel, G.F.; Hartley, S.A.; Redgate, P.E.

    1996-03-01

    This technical note presents empirical models developed in FYI 995 to predict durability as functions of glass composition. Models are presented for normalized releases of B, Li, Na, and Si from the 7-day Product Consistency Test (PCT) applied to quenched and canister centerline cooled (CCC) glasses as well as from the 28-day Materials Characterization Center-1 (MCC-1) test applied to quenched glasses. Models are presented for Composition Variation Study (CVS) data from low temperature melter (LTM) studies (Hrma, Piepel, et al. 1994) and high temperature melter (HTM) studies (Vienna et al. 1995). The data used for modeling in this technical note are listed in Appendix A

  18. Development of a Virtual Reality Simulator for Natural Orifice Translumenal Endoscopic Surgery (NOTES) Cholecystectomy Procedure.

    Science.gov (United States)

    Ahn, Woojin; Dargar, Saurabh; Halic, Tansel; Lee, Jason; Li, Baichun; Pan, Junjun; Sankaranarayanan, Ganesh; Roberts, Kurt; De, Suvranu

    2014-01-01

    The first virtual-reality-based simulator for Natural Orifice Translumenal Endoscopic Surgery (NOTES) is developed called the Virtual Translumenal Endoscopic Surgery Trainer (VTESTTM). VTESTTM aims to simulate hybrid NOTES cholecystectomy procedure using a rigid scope inserted through the vaginal port. The hardware interface is designed for accurate motion tracking of the scope and laparoscopic instruments to reproduce the unique hand-eye coordination. The haptic-enabled multimodal interactive simulation includes exposing the Calot's triangle and detaching the gall bladder while performing electrosurgery. The developed VTESTTM was demonstrated and validated at NOSCAR 2013.

  19. Standard distribution for unclassified scientific and technical reports: instructions and category scope notes

    International Nuclear Information System (INIS)

    1980-12-01

    The US Department of Energy Technical Information Center (DOE/TIC) uses a subject category scheme for classifying and distributing DOE-originated or -sponsored unclassified scientific and technical reports. This document contains the subject category scope notes used for these purposes. Originators of DOE or DOE-sponsored scientific and technical reports are urged to adhere to the instructions contained this publication. A limited number of copies of the unabridged version (addresses included) are available to Department of Energy offices and their contractors as DOE/TIC-4500(Rev.69)(Unabridged)

  20. Technical note

    International Nuclear Information System (INIS)

    Moshier, W.C.; Tack, W.T.; Phull, B.

    1992-01-01

    Lithium is a potent addition to Al alloys for increasing their specific strength and stiffness, which makes Li-containing Al alloys attractive materials for typical aerospace applications in which reduced weight and increased strength and stiffness can improve system performance. Weldalite 049 (AA X2094) [Al-(4.0-6.3) Cu-1.3 Li-0.4 Ag-0.4 Mg-0.14 Zr] was recently developed as an ultra-high strength, weldable alloy designed for use in launch vehicle structures. Standard SCC testing contains the inherent difficulty of test duration and unclear interpretation of results. Use of slow strain rate tests (SSRTs) on aluminum alloys has met with mixed results, and the purpose of this paper is to evaluate the feasibility of using SSRT to evaluate the SCC susceptibility of two Weldalite 049 variants

  1. Technical note

    DEFF Research Database (Denmark)

    Vargas-Bello-Pérez, E.; Cancino-Padilla, N.; Romero, J.

    2016-01-01

    Molecular techniques are important tools for microbiological studies in different habitats, and the internal transcribed spacer (ITS) has been proved to be useful for analyzing fungal diversity. The aim of this study was to use the ITS region to generate ruminal yeast profile and to identify rumi...

  2. Technical note

    DEFF Research Database (Denmark)

    Nunes, S F; Bexiga, R; Cavaco, L M

    2007-01-01

    To evaluate the antimicrobial resistance traits of staphylococci responsible for subclinical bovine mastitis in Portugal, the minimum inhibitory concentrations (MIC) of 7 antimicrobial agents, frequently administered for mastitis treatment, were determined for 30 Staphylococcus aureus and 31...

  3. Technical note

    DEFF Research Database (Denmark)

    Hermansen, Jonas S; Fonslet, Jesper; Søndergaard, Lasse R

    2017-01-01

    PURPOSE: To provide a faster and more intuitive way of designing shielding for PET facilities, while still relying on the principles of the AAPM 108 Taskforce guidelines, as well as illustrating the calculation output using dose maps that are easily evaluated. METHODS: A graphical user interface ...

  4. Technical note:

    Indian Academy of Sciences (India)

    WIN uE10

    de Ciencias, Universidad de La Serena, Av. Raúl Bitrán 1305, La Serena, ... this key species of high-Andean ecosystems, and assist restoration and conservation ... environmental conditions (3500-4200 m) in the high-Andean Río Estrecho ...

  5. Publications and services of the Cryogenics Division, National Bureau of Standards, 1953--1977. Technical note

    International Nuclear Information System (INIS)

    Frizen, D.J.; Mendenhall, J.R.

    1978-04-01

    This NBS Technical Note catalogs the publications of the Cryogenics Division, along with author and subject indexes, for the period 1953 through 1977. It also contains a listing of available thermodynamic properties charts, bibliographies, and miscellaneous reports of cryogenic interest. A resume of the activities of and services provided by the Cryogenics Division is also included

  6. Technical Note: On The Usage and Development of the AWAKE Web Server and Web Applications

    CERN Document Server

    Berger, Dillon Tanner

    2017-01-01

    The purpose of this technical note is to give a brief explanation of the AWAKE Web Server, the current web applications it serves, and how to edit, maintain, and update the source code. The majority of this paper is dedicated to the development of the server and its web applications.

  7. Cognitive training for technical and non-technical skills in robotic surgery: a randomised controlled trial.

    Science.gov (United States)

    Raison, Nicholas; Ahmed, Kamran; Abe, Takashige; Brunckhorst, Oliver; Novara, Giacomo; Buffi, Nicolò; McIlhenny, Craig; van der Poel, Henk; van Hemelrijck, Mieke; Gavazzi, Andrea; Dasgupta, Prokar

    2018-05-07

    To investigate the effectiveness of motor imagery (MI) for technical skill and non-technical skill (NTS) training in minimally invasive surgery (MIS). A single-blind, parallel-group randomised controlled trial was conducted at the Vattikuti Institute of Robotic Surgery, King's College London. Novice surgeons were recruited by open invitation in 2015. After basic robotic skills training, participants underwent simple randomisation to either MI training or standard training. All participants completed a robotic urethrovesical anastomosis task within a simulated operating room. In addition to the technical task, participants were required to manage three scripted NTS scenarios. Assessment was performed by five blinded expert surgeons and a NTS expert using validated tools for evaluating technical skills [Global Evaluative Assessment of Robotic Skills (GEARS)] and NTS [Non-Technical Skills for Surgeons (NOTSS)]. Quality of MI was assessed using a revised Movement Imagery Questionnaire (MIQ). In all, 33 participants underwent MI training and 29 underwent standard training. Interrater reliability was high, Krippendorff's α = 0.85. After MI training, the mean (sd) GEARS score was significantly higher than after standard training, at 13.1 (3.25) vs 11.4 (2.97) (P = 0.03). There was no difference in mean NOTSS scores, at 25.8 vs 26.4 (P = 0.77). MI training was successful with significantly higher imagery scores than standard training (mean MIQ score 5.1 vs 4.5, P = 0.04). Motor imagery is an effective training tool for improving technical skill in MIS even in novice participants. No beneficial effect for NTS was found. © 2018 The Authors BJU International © 2018 BJU International Published by John Wiley & Sons Ltd.

  8. Technical aspects of pediatric epilepsy surgery: Report of a multicenter, multinational web-based survey by the ILAE Task Force on Pediatric Epilepsy Surgery.

    Science.gov (United States)

    Cukiert, Arthur; Rydenhag, Bertil; Harkness, William; Cross, J Helen; Gaillard, William D

    2016-02-01

    Surgical techniques may vary extensively between centers. We report on a web-based survey aimed at evaluating the current technical approaches in different centers around the world performing epilepsy surgery in children. The intention of the survey was to establish technical standards. A request was made to 88 centers to complete a web-based survey comprising 51 questions. There were 14 questions related to general issues, 13 questions investigating the different technical aspects for children undergoing epilepsy surgery, and 24 questions investigating surgical strategies in pediatric epilepsy surgery. Fifty-two centers covering a wide geographic representation completed the questionnaire. The median number of resective procedures per center per year was 47. Some important technical practices appeared (>80% of the responses) such as the use of prophylactic antibiotics (98%), the use of high-speed drills for bone opening (88%), nonresorbable material for bone flap closure (85%), head fixation (90%), use of the surgical microscope (100%), and of free bone flaps. Other questions, such as the use of drains, electrocorticography (ECoG) and preoperative withdrawal of valproate, led to mixed, inconclusive results. Complications were noted in 3.8% of the patients submitted to cortical resection, 9.9% hemispheric surgery, 5% callosotomy, 1.8% depth electrode implantation, 5.9% subdural grids implantation, 11.9% hypothalamic hamartoma resection, 0.9% vagus nerve stimulation (VNS), and 0.5% deep brain stimulation. There were no major differences across regions or countries in any of the subitems above. The present data offer the first overview of the technical aspects of pediatric epilepsy surgery worldwide. Surprisingly, there seem to be more similarities than differences. That aside many of the evaluated issues should be examined by adequately designed multicenter randomized controlled trials (RCTs). Further knowledge on these technical issues might lead to increased

  9. Republic of Poland; Technical Note on Stress Testing the Banking Sector

    OpenAIRE

    International Monetary Fund

    2013-01-01

    This Technical Note discusses results of stress testing of the banking sector in Poland. The Polish banking system is well capitalized and liquid, as confirmed by stress tests results. Polish banks are, in aggregate, resilient even under severe adverse scenarios. Some small banks could fail to meet minimum regulatory capital and liquidity requirements in these scenarios, but with little impact on the overall banking system. Tests showed that only small banks, together representing up to 30 pe...

  10. Mexico; Financial Sector Assessment Program Update: Technical Note: Derivatives Market: Overview and Potential Vulnerabilities

    OpenAIRE

    International Monetary Fund

    2007-01-01

    This technical note provides an overview of Mexico’s derivatives markets, and describes concisely the derivatives regulatory framework and risk management practices in financial institutions active in these markets. The most important derivatives market in Mexico is the over-the-counter (OTC) derivatives market, which is fully integrated with the global derivatives market. The origin of the OTC derivatives market can be traced back to the 1994 Mexican crisis that forced Mexico to abandon its ...

  11. Denmark; Systemic Issues in Mortgage Loans and Covered Bond Finance: Technical Note

    OpenAIRE

    International Monetary Fund

    2014-01-01

    This technical note analyzes systemic issues in mortgage loans and covered bond finance in Denmark. Mortgage lending has seen significant product innovation in recent years. Loans with adjustable interest rates and/or interest-only periods, which have been introduced since the late 1990s, had grown to 75 percent and 53 percent, respectively, of total outstanding mortgage loans at the end of 2013. The major changes in the characteristics of the underlying mortgage loans have naturally been ref...

  12. Noted

    Science.gov (United States)

    Nunberg, Geoffrey

    2013-01-01

    Considering how much attention people lavish on the technologies of writing--scroll, codex, print, screen--it's striking how little they pay to the technologies for digesting and regurgitating it. One way or another, there's no sector of the modern world that is not saturated with note-taking--the bureaucracy, the liberal professions, the…

  13. Integrating technical and non-technical skills coaching in an acute trauma surgery team training: Is it too much?

    Science.gov (United States)

    Alken, Alexander; Luursema, Jan-Maarten; Weenk, Mariska; Yauw, Simon; Fluit, Cornelia; van Goor, Harry

    2017-08-25

    Research on effective integration of technical and non-technical skills in surgery team training is sparse. In a previous study we found that surgical teachers predominantly coached on technical and hardly on non-technical skills during the Definitive Surgical and Anesthetic Trauma Care (DSATC) integrated acute trauma surgery team training. This study aims to investigate whether the priming of teachers could increase the amount of non-technical skills coaching during such a training. Coaching activities of 12 surgical teachers were recorded on audio and video. Six teachers were primed on non-technical skills coaching prior to the training. Six others received no priming and served as controls. Blind observers reviewed the recordings of 2 training scenario's and scored whether the observed behaviors were directed on technical or non-technical skills. We compared the frequency of the non-technical skills coaching between the primed and the non-primed teachers and analyzed for differences according to the trainees' level of experience. Surgical teachers coached trainees during the highly realistic DSATC integrated acute trauma surgery team training. Trainees performed damage control surgery in operating teams on anesthetized porcine models during 6 training scenario's. Twelve experienced surgical teachers participated in this study. Coaching on non-technical skills was limited to about 5%. The primed teachers did not coach more often on non-technical skills than the non-primed teachers. We found no differences in the frequency of non-technical skills coaching based on the trainees' level of experience. Priming experienced surgical teachers does not increase the coaching on non-technical skills. The current DSATC acute trauma surgery team training seems too complex for integrating training on technical and non-technical skills. Patient care, Practice based learning and improvement. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Non-technical skills in minimally invasive surgery teams

    DEFF Research Database (Denmark)

    Gjeraa, Kirsten; Spanager, Lene; Konge, Lars

    2016-01-01

    BACKGROUND: Root cause analyses show that up to 70 % of adverse events are caused by human error. Strong non-technical skills (NTS) can prevent or reduce these errors, considerable numbers of which occur in the operating theatre. Minimally invasive surgery (MIS) requires manipulation of more...... complex equipment than open procedures, likely requiring a different set of NTS for each kind of team. The aims of this study were to identify the MIS teams' key NTS and investigate the effect of training and assessment of NTS on MIS teams. METHODS: The databases of PubMed, Cochrane Library, Embase, Psyc...... were included. All were observational studies without blinding, and they differed in aims, types of evaluation, and outcomes. Only two studies evaluated patient outcomes other than operative time, and overall, the studies' quality of evidence was low. Different communication types were encountered...

  15. Technical consideration of transforaminal endoscopic spine surgery for central herniation

    Directory of Open Access Journals (Sweden)

    Girish P Datar

    2017-01-01

    Full Text Available Introduction: Lumbar disc prolapse is most common between 30 and 50 years of age and is associated with severe disability and pain. It commonly occurs at L4/5 and L5/S1. Transforaminal endoscopic discectomy is an emerging technique for treatment of degenerative disc disease. Literature has shown clinical outcomes, comparable to classical open and micro lumbar discectomy. Central disc herniations in lumbar spine pose technical challenge for transforaminal endoscopic decompression due to its location. Existing techniques to access central herniations and ventral epidural space have trajectory related challenges due to the proximity of the retroperitoneal space and abdominal organs and technically difficult for the less experienced surgeon. Materials and Methods: Thirty patients – 19 males and 11 females – with central, multifocal, central-paracentral disc herniations in the lumbar spine operated in 2015 and 2016 were considered in this study. All patients underwent selective endoscopic discectomy under monitored care anesthesia and local anesthesia with modification of the classical technique, medialization of annulotomy, undercutting the nonarticular part of superior articular process (foraminotomy and use of articulating and long jaw instruments either alone or in combination. Results: In all the thirty patients, we were able to achieve adequate decompression with neurological recovery. All patients improved in their neurological status. Postoperatively, visual analog scale dropped from 7.8 to 1.8 and ODI dropped from 73.46% to 32. 90% of the patients reported excellent and good results. One patient had recurrent herniation and was treated with transforaminal surgery. One patient had persistent back pain and reported poor outcome. Three patients underwent medial branch block for facet joint pain followed by medial branch rhizotomy and reported excellent and good results. Conclusion: Transforaminal endoscopic spine surgery with modifications

  16. Technical note: A simple rumen collection device for calves: An adaptation of a manual rumen drenching system.

    Science.gov (United States)

    Klopp, R N; Oconitrillo, M J; Sackett, A; Hill, T M; Schlotterbeck, R L; Lascano, G J

    2018-07-01

    A limited amount of research is available related to the rumen microbiota of calves, yet there has been a recent spike of interest in determining the diversity and development of calf rumen microbial populations. To study the microbial populations of a calf's rumen, a sample of the rumen fluid is needed. One way to take a rumen fluid sample from a calf is by fistulating the animal. This method requires surgery and can be very stressful on a young animal that is trying to adapt to a new environment and has a depressed immune system. Another method that can be used instead of fistulation surgery is a rumen pump. This method requires a tube to be inserted into the rumen through the calf's esophagus. Once inside the rumen, fluid can be pumped out and collected in a few minutes. This method is quick, inexpensive, and does not cause significant stress on the animal. This technical note presents the materials and methodology used to convert a drenching system into a rumen pump and its respective utilization in 2 experiments using dairy bull calves. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  17. Robotic liver surgery: technical aspects and review of the literature

    Science.gov (United States)

    Bianco, Francesco Maria; Daskalaki, Despoina; Gonzalez-Ciccarelli, Luis Fernando; Kim, Jihun; Benedetti, Enrico

    2016-01-01

    Minimally invasive surgery for liver resections has a defined role and represents an accepted alternative to open techniques for selected cases. Robotic technology can overcome some of the disadvantages of the laparoscopic technique, mainly in the most complex cases. Precise dissection and microsuturing is possible, even in narrow operative fields, allowing for a better dissection of the hepatic hilum, fine lymphadenectomy, and biliary reconstruction even with small bile ducts and easier bleeding control. This technique has the potential to allow for a greater number of major resections and difficult segmentectomies to be performed in a minimally invasive fashion. The implementation of near-infrared fluorescence with indocyanine green (ICG) also allows for a more accurate recognition of vascular and biliary anatomy. The perspectives of this kind of virtually implemented imaging are very promising and may be reflected in better outcomes. The overall data present in current literature suggests that robotic liver resections are at least comparable to both open and laparoscopic surgery in terms of perioperative and postoperative outcomes. This article provides technical details of robotic liver resections and a review of the current literature. PMID:27500143

  18. Zebra Mussel Research Technical Notes. Impacts of Zebra Mussel Infestations on Water Quality. Section 1 - Environmental Testing

    National Research Council Canada - National Science Library

    Ashby, Steven

    1998-01-01

    ..., and sediment quality. The purpose of this technical note describes potential changes in water quality as a result of zebra mussel infestations in aquatic systems, based on a review of the literature...

  19. Natural-orifice transluminal endoscopic surgery (NOTES) in Europe: summary of the working group reports of the Euro-NOTES meeting 2010

    DEFF Research Database (Denmark)

    Meining, A; Feussner, H; Swain, P

    2011-01-01

    The fourth Euro-NOTES workshop took place in September 2010 and focused on enabling intensive scientific dialogue and interaction between participants to discuss the state of the practice and development of natural-orifice transluminal endoscopic surgery (NOTES) in Europe. Five working groups were...... collaboration and indications, robotics and platforms, and matters related to training and education. This review summarizes consensus statements of the working groups to give an overview of what has been achieved so far and what might be relevant for research related to NOTES in the near future....

  20. HOW TO ACHIEVE AND MAINTAIN NOTE 6: POSTGRADUATE PROGRAM IN TRANSLATIONAL SURGERY - UNIFESP

    Directory of Open Access Journals (Sweden)

    Miguel Sabino-Neto

    Full Text Available Objective: To show the way to reach and stay in note 6 in the evaluation process of Medicine III of CAPES. Methods: Capes determinations were reviewed concerning this topic, grades 6 and 7, and also the difficulties and facilities of running a program that amounted to Note 6 after restructuring and being in compliance with regulations. Results: The main points to achieve and maintain Note 6 were: 1 regular production of master's and doctoral theses with appropriate distribution among all teachers; 2 average time of appropriate titration, as well as strict selection of students who resets the withdrawals and cancellations; 3 production of scientific articles in high impact journals and with academic and student participation in most part; 4 progressive and substantial increase in fundraising and patent search; 5 progressive increase in international exchanges with joint production; 6 visibility through new bilingual website and updated weekly; 7 numerous solidarity activities in research, but also in health services for the population and even in basic education; 8 rigorous selection of students (through design analysis, curriculum and teacher training program; 9 maintenance of high levels teachers production; 10 preparing new teachers for guidance through participation as co-supervision and involvement in the program to fit the needs. Conclusion: The Postgraduate Program in Translational Surgery went through difficult times; was submitted to a series of measures, adjustments, cooperation and understanding of the teaching staff, that took the program from note 3 - and almost closing - to a level of excellence keeping note 6 for three consecutive three-year periods of evaluation.

  1. Technical Note: Introduction of variance component analysis to setup error analysis in radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Matsuo, Yukinori, E-mail: ymatsuo@kuhp.kyoto-u.ac.jp; Nakamura, Mitsuhiro; Mizowaki, Takashi; Hiraoka, Masahiro [Department of Radiation Oncology and Image-applied Therapy, Kyoto University, 54 Shogoin-Kawaharacho, Sakyo, Kyoto 606-8507 (Japan)

    2016-09-15

    Purpose: The purpose of this technical note is to introduce variance component analysis to the estimation of systematic and random components in setup error of radiotherapy. Methods: Balanced data according to the one-factor random effect model were assumed. Results: Analysis-of-variance (ANOVA)-based computation was applied to estimate the values and their confidence intervals (CIs) for systematic and random errors and the population mean of setup errors. The conventional method overestimates systematic error, especially in hypofractionated settings. The CI for systematic error becomes much wider than that for random error. The ANOVA-based estimation can be extended to a multifactor model considering multiple causes of setup errors (e.g., interpatient, interfraction, and intrafraction). Conclusions: Variance component analysis may lead to novel applications to setup error analysis in radiotherapy.

  2. Technical Note: Introduction of variance component analysis to setup error analysis in radiotherapy

    International Nuclear Information System (INIS)

    Matsuo, Yukinori; Nakamura, Mitsuhiro; Mizowaki, Takashi; Hiraoka, Masahiro

    2016-01-01

    Purpose: The purpose of this technical note is to introduce variance component analysis to the estimation of systematic and random components in setup error of radiotherapy. Methods: Balanced data according to the one-factor random effect model were assumed. Results: Analysis-of-variance (ANOVA)-based computation was applied to estimate the values and their confidence intervals (CIs) for systematic and random errors and the population mean of setup errors. The conventional method overestimates systematic error, especially in hypofractionated settings. The CI for systematic error becomes much wider than that for random error. The ANOVA-based estimation can be extended to a multifactor model considering multiple causes of setup errors (e.g., interpatient, interfraction, and intrafraction). Conclusions: Variance component analysis may lead to novel applications to setup error analysis in radiotherapy.

  3. The production costs of the French nuclear fleet. Synthesis and conclusions. Technical note

    International Nuclear Information System (INIS)

    2017-09-01

    Whereas the French Energy Multi-year Programming (PPE) notably aims at preserving the purchasing power of consumers and the competitiveness of energy prices, this note aims at reporting an assessment of the production cost of the French present nuclear fleet, i.e. the electric power cost at the output of the production installation. The authors first discuss the choice for the methodology of 'cash costs' for the decision to continue of not the exploitation of existing units. They propose a mean assessment of about 33 euro/MWh, state that the present nuclear-based power production in France is profitable, and consider that there is no 'investment wall' to be faced in the near future. They also state that nuclear costs are hardly supposed to increase because they are little sensitive to uranium prices. They consider that dismantling and waste costs are covered at more than 100 per cent by dedicated assets. A technical note comes with this discussion. It discusses cost calculation methods, the assessment of the production cost of French existing reactors (second generation), and some additional elements regarding some cost components

  4. Endoscopic extradural supraorbital approach to the temporal pole and adjacent area: technical note.

    Science.gov (United States)

    Komatsu, Fuminari; Imai, Masaaki; Shigematsu, Hideaki; Aoki, Rie; Oda, Shinri; Shimoda, Masami; Matsumae, Mitsunori

    2017-08-25

    The authors' initial experience with the endoscopic extradural supraorbital approach to the temporal pole and adjacent area is reported. Fully endoscopic surgery using the extradural space via a supraorbital keyhole was performed for tumors in or around the temporal pole, including temporal pole cavernous angioma, sphenoid ridge meningioma, and cavernous sinus pituitary adenoma, mainly using 4-mm, 0° and 30° endoscopes and single-shaft instruments. After making a supraorbital keyhole, a 4-mm, 30° endoscope was advanced into the extradural space of the anterior cranial fossa during lifting of the dura mater. Following identification of the sphenoid ridge, orbital roof, and anterior clinoid process, the bone lateral to the orbital roof was drilled off until the dura mater of the anterior aspect of the temporal lobe was exposed. The dura mater of the temporal lobe was incised and opened, exposing the temporal pole under a 4-mm, 0° endoscope. Tumors in or around the temporal pole were safely removed under a superb view through the extradural corridor. The endoscopic extradural supraorbital approach was technically feasible and safe. The anterior trajectory to the temporal pole using the extradural space under endoscopy provided excellent visibility, allowing minimally invasive surgery. Further surgical experience and development of specialized instruments would promote this approach as an alternative surgical option.

  5. Important Non-Technical Skills in Video-Assisted Thoracoscopic Surgery Lobectomy

    DEFF Research Database (Denmark)

    Gjeraa, Kirsten; Mundt, Anna S.; Spanager, Lene

    2017-01-01

    Background Safety in the operating room is dependent on the team's non-technical skills. The importance of non-technical skills appears to be different for minimally invasive surgery as compared with open surgery. The aim of this study was to identify which non-technical skills are perceived...... with complementary and overlapping scopes of practice between surgical and anesthesia subteams. Conclusions This study identified six non-technical skills that serve as the foundation for shared mental models of the patient, the current situation, and team resources. These findings contribute three important...... by team members to be most important for patient safety, in the setting of video-assisted thoracoscopic surgery (VATS) lobectomy. Methods This was an explorative, semistructured interview-based study with 21 participants from all four thoracic surgery centers in Denmark that perform VATS lobectomy. Data...

  6. Technical note 2. A review of the creep ductility of copper for nuclear waste canister application

    International Nuclear Information System (INIS)

    Pettersson, Kjell

    2011-03-01

    Background: The Swedish Radiation Safety Authority (SSM) reviews the Swedish Nuclear Fuel Company's (SKB) applications under the Act on Nuclear Activities (SFS 1984:3) for the construction and operation of a repository for spent nuclear fuel and for an encapsulation facility. As part of the review, SSM commissions consultants to carry out work in order to obtain information on specific issues. The results from the consultants' tasks are reported in SSM's Technical Note series. Objectives of the project: This project is part of SSM:s review of SKB:s license application for final disposal of spent nuclear fuel. The assignment concerns review of creep mechanisms for copper material used as a corrosion barrier in canisters for nal disposal of nuclear fuel in Sweden. Summary by the author: SKB has presented insufficient evidence to justify their position that the OFP copper has an adequate creep ductility during long term storage. Their large body of experiments only serves to prove that the creep ductility is sufficient for much shorter time spans than the intended storage times. There is a clear need for a credible theory of creep brittleness of OFP copper which will permit extrapolations to long term storage. The theory presented by SKB does not in its present state permit credible extrapolations. Alternatively SKB needs to find an explanation to the effect of phosphorus on the creep ductility and that it ensures the absence of creep brittleness in OFP copper. It is interesting to note that SKB has presented experimental evidence that intergranular cracks can form in OFP material tested in cracked specimens. Perhaps it is possible to more systematically study formation and growth of intergranular cracks in specimens of OFP copper with cracks

  7. Pulmonary Arteriovenous Malformations Embolized Using a Micro Vascular Plug System: Technical Note on a Preliminary Experience

    Energy Technology Data Exchange (ETDEWEB)

    Boatta, Emanuele, E-mail: emanuele.boatta@yahoo.it; Jahn, Christine, E-mail: christine.jahn@chru-strasbourg.fr [Hôpitaux Universitaires de Strasbourg, Service de Imagerie Interventionelle, Nouvel Hôpital Civil (France); Canuet, Matthieu, E-mail: matthieu.canuet@chru-strasbourg.fr [Hôpitaux Universitaires de Strasbourg, Service Service de Pneumologie, Nouvel Hôpital Civil (France); Garnon, Julien, E-mail: juleiengarnon@gmail.com [Hôpitaux Universitaires de Strasbourg, Service de Imagerie Interventionelle, Nouvel Hôpital Civil (France); Ramamurthy, Nitin, E-mail: nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it; Gangi, Afshin, E-mail: gangi@unistra.fr [Hôpitaux Universitaires de Strasbourg, Service de Imagerie Interventionelle, Nouvel Hôpital Civil (France)

    2017-02-15

    AIMTo report our preliminary experience using a Micro Vascular Plug (MVP) deployed through a 2.8Fr micro-catheter for the treatment of pulmonary arteriovenous malformations (PAVMs) in a cohort of patients affected by Hereditary Haemorrhagic Telangiectasia (HHT).Materials and MethodsFour consecutive female patients (mean age 38.0 years; range 25–55 years) with PAVMs diagnosed on echocardiogram/bubble test and contrast-enhanced CT (CECT) underwent MVP embolization. One patient was symptomatic with recent transient ischaemic attack. Follow-up was undertaken at 1-month post-procedure with CECT to assess PAVMs permeability and MVP positioning and at 1-, 6-, and 12-month post-procedure, with echocardiography/bubble test and standard neurological history, to confirm absence of right-to-left shunts and recurrent symptoms.ResultsEight PAVMs were treated in 4 patients over 5 interventional sessions (mean 1.6 PAVMs per session). All PAVMs were simple, with mean feeding artery diameter of 4.25 mm. Eight 6.5 mm MVPs were deployed in total (one per lesion). Technical success was 100%. Mean procedural time and patient dose per session were 70 min (range 40–70 min) and 53418 mGy.cm{sup 2} (range 6113–101628 mGy.cm{sup 2}), respectively. No signs of reperfusion neither of MPV migration were noted at 1-month CECT follow-up. At early follow-up (mean 3.75 months; range 1–12 months), clinical success was 100% with no evidence of recurrent right-to-left shunt, and no neurological symptoms. No immediate or late complications were observed.ConclusionsMVP embolization of PAVMs appears technically feasible, safe, and effective at early follow-up. Further prospective studies are required to confirm long-term safety and efficacy of this promising technique.

  8. Time Value of Money and Its Applications in Corporate Finance: A Technical Note on Linking Relationships between Formulas

    Science.gov (United States)

    Chen, Jeng-Hong

    2009-01-01

    Time Value of Money (TVM) is the most important chapter in the basic corporate finance course. It is imperative to understand TVM formulas because they imply important TVM concepts. Students who really understand TVM concepts and formulas can learn better in chapters of TVM applications. This technical note intends to present more complete TVM…

  9. The flying buttress construct for posterior spinopelvic fixation: a technical note

    Directory of Open Access Journals (Sweden)

    van Ooij Bas

    2011-04-01

    Full Text Available Abstract Background Posterior fusion of the spine to the pelvis in paediatric and adult spinal deformity is still challenging. Especially assembling of the posterior rod construct to the iliac screw is considered technically difficult. A variety of spinopelvic fixation techniques have been developed. However, extreme bending of the longitudinal rods or the use of 90-degree lateral offset connectors proved to be difficult, because the angle between the rod and the iliac screw varies from patient to patient. Methods We adopted a new spinopelvic fixation system, in which iliac screws are side-to-side connected to the posterior thoracolumbar rod construct, independent of the angle between the rod and the iliac screw. Open angled parallel connectors are used to connect short iliac rods from the posterior rod construct to the iliac screws at both sides. The construct resembles in form and function an architectural Flying Buttress, or lateral support arches, used in Gothic cathedrals. Results and discussion Three different cases that illustrate the Flying Buttress construct for spinopelvic fixation are reported here with the clinical details, radiographic findings and surgical technique used. Conclusion The Flying Buttress construct may offer an alternative surgical option for spinopelvic fixation in circumstances wherein coronal or sagittal balance cannot be achieved, for example in cases with significant residual pelvic obliquity, or in revision spinal surgery for failed lumbosacral fusion.

  10. The flying buttress construct for posterior spinopelvic fixation: a technical note

    Science.gov (United States)

    2011-01-01

    Background Posterior fusion of the spine to the pelvis in paediatric and adult spinal deformity is still challenging. Especially assembling of the posterior rod construct to the iliac screw is considered technically difficult. A variety of spinopelvic fixation techniques have been developed. However, extreme bending of the longitudinal rods or the use of 90-degree lateral offset connectors proved to be difficult, because the angle between the rod and the iliac screw varies from patient to patient. Methods We adopted a new spinopelvic fixation system, in which iliac screws are side-to-side connected to the posterior thoracolumbar rod construct, independent of the angle between the rod and the iliac screw. Open angled parallel connectors are used to connect short iliac rods from the posterior rod construct to the iliac screws at both sides. The construct resembles in form and function an architectural Flying Buttress, or lateral support arches, used in Gothic cathedrals. Results and discussion Three different cases that illustrate the Flying Buttress construct for spinopelvic fixation are reported here with the clinical details, radiographic findings and surgical technique used. Conclusion The Flying Buttress construct may offer an alternative surgical option for spinopelvic fixation in circumstances wherein coronal or sagittal balance cannot be achieved, for example in cases with significant residual pelvic obliquity, or in revision spinal surgery for failed lumbosacral fusion. PMID:21489256

  11. Pure natural orifice transluminal endoscopic surgery (NOTES) with ultrasonography-guided transgastric access and over-the-scope-clip closure

    DEFF Research Database (Denmark)

    Donatsky, Anders Meller; Andersen, Luise; Nielsen, Ole Lerberg

    2012-01-01

    Most natural orifice transluminal endoscopic surgery (NOTES) procedures to date rely on the hybrid technique with simultaneous laparoscopic access to protect against access-related complications and to achieve adequate triangulation for dissection. This is done at the cost of the potential benefi...

  12. The role of non-technical skills in surgery

    Directory of Open Access Journals (Sweden)

    Riaz A. Agha

    2015-12-01

    This narrative review used a number of sources including written and online, there was no specific search strategy of defined databases. Modern surgical practice requires; technical and non-technical skills, evidence-based practice, an emphasis on lifelong learning, monitoring of outcomes and a supportive institutional and health service framework. Finally these requirements need to be combined with a number of personal and professional values including integrity, professionalism and compassionate, patient-centred care.

  13. Relationship between intraoperative non-technical performance and technical events in bariatric surgery.

    Science.gov (United States)

    Fecso, A B; Kuzulugil, S S; Babaoglu, C; Bener, A B; Grantcharov, T P

    2018-03-30

    The operating theatre is a unique environment with complex team interactions, where technical and non-technical performance affect patient outcomes. The correlation between technical and non-technical performance, however, remains underinvestigated. The purpose of this study was to explore these interactions in the operating theatre. A prospective single-centre observational study was conducted at a tertiary academic medical centre. One surgeon and three fellows participated as main operators. All patients who underwent a laparoscopic Roux-en-Y gastric bypass and had the procedures captured using the Operating Room Black Box ® platform were included. Technical assessment was performed using the Objective Structured Assessment of Technical Skills and Generic Error Rating Tool instruments. For non-technical assessment, the Non-Technical Skills for Surgeons (NOTSS) and Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS) tools were used. Spearman rank-order correlation and N-gram statistics were conducted. Fifty-six patients were included in the study and 90 procedural steps (gastrojejunostomy and jejunojejunostomy) were analysed. There was a moderate to strong correlation between technical adverse events (r s  = 0·417-0·687), rectifications (r s  = 0·380-0·768) and non-technical performance of the surgical and nursing teams (NOTSS and SPLINTS). N-gram statistics showed that after technical errors, events and prior rectifications, the staff surgeon and the scrub nurse exhibited the most positive non-technical behaviours, irrespective of operator (staff surgeon or fellow). This study demonstrated that technical and non-technical performances are related, on both an individual and a team level. Valuable data can be obtained around intraoperative errors, events and rectifications. © 2018 BJS Society Ltd Published by John Wiley & Sons Ltd.

  14. The E052 - GSI Experiment, Deceleration of highly charged ions by crystal channeling. (Technical notes)

    International Nuclear Information System (INIS)

    Kirsch, R.

    2003-01-01

    The report on the E052 - GSI Experiment, devoted to 'Deceleration of highly charged ions by crystal channeling' present the technical notes and the status of this experiment in 2003. The report contains 13 sections and two annexes. The sections deal with the following issues: 1. File system of the 'PC monitor' for E052 - GSI Experiment in 2003; 2. Parameters of the 'PC monitor' file system; 3. Operation of the two PCs; 3.1. Layout of goniometer remote control; 3.2. 'PC motors' side by the beam hall; 3.3. RS232 connection cabling; 3.4. RS232 configuration on the COM1 ports of the two PCs; 4. Motor connection; 4.1. SubD-25 acquisition PC monitor arm on 'COM1'; 4.2. Motors step by step feeding side SubD-25 on 'COM1'; 4.3. Distribution of digital step by step control signals; 4.5. Upper an lower goniometer connection; 4.6. Rotation and inclination outer goniometer connection; 4.7. Ultra vacuum inner rotation and inclination connection; 5. Motor characteristics; 5.1. Upstream and downstream; 5.2. Rotation; 5.3 Inclination; 5.4. Feedings; 6. Goniometer in-beam positioning; 6.1. Height fine motor positioning; 6.2. Side manual positioning; 7. Goniometer movements; 8. Crystals and electron detection; 8.1. General layout; 8.2. 1 μm Si(100) crystal; 8.3. 33 μm Si(100) crystal; 8.4. Crystal mounting; 8.5. Electron detection; 9. Reference laser positioning of angular movements; 10. Beam track and collimators upstream the target; 11. User manual - Monitoring programme; 11.Start scanning program (GSIscan.exe); 11.2. SCANNING the crystal (Scan Control window); 11.3. MOVING THE GONIOMETER MANUALY (goniometer control window); 11.4. USING THE COUNTERS (counter display window); 11.5. MULTISCALER PLOT DISPLAY; 11.6. SELECT ACTIVE PLOT; 11.7. CURSORS; 11.8. STATISTICS; 11.9. Y SCALE change; 11.10. PLOT view and hide counter; 11.11. SAVE multiscaler spectra; 11.12. PRINT plot; 12. Simplified acquisition electronic setup; 13. The 'PC motors' software; 13.1. The code structure; 13

  15. Technical errors and complications in orthopaedic trauma surgery

    NARCIS (Netherlands)

    Meeuwis, M.A.; de Jongh, M.A.C.; Roukema, J.A.; van der Heijden, F.H.W.M.; Verhofstad, M. H. J.

    2016-01-01

    Introduction Adverse events and associated morbidity and subsequent costs receive increasing attention in clinical practice and research. As opposed to complications, errors are not described or analysed in literature on fracture surgery. The aim of this study was to provide a description of errors

  16. Technical note. A review of the mechanical integrity of the canister

    International Nuclear Information System (INIS)

    Segle, Peter

    2012-01-01

    Background: The Swedish Radiation Safety Authority (SSM) reviews the Swedish Nuclear Fuel Company's (SKB) applications under the Act on Nuclear Activities (SFS 1984:3) for the construction and operation of a repository for spent nuclear fuel and for an encapsulation facility. As part of the review, SSM commissions consultants to carry out work in order to obtain information on specific issues. The results from the consultants' tasks are reported in SSM's Technical Note series. Objectives of the project: This project is part of SSM:s review of SKB:s license application for final disposal of spent nuclear fuel. The assignment concerns a review of the mechanical integrity of the canister. Summary by the author: An introductory review of SR-Site has been conducted with respect to the mechanical integrity of the canister. The review is focused on the copper canister and the nodular cast iron insert. Review results show that a number of loads and loading scenarios for the copper canister has not been analysed by SKB. The importance of sufficient creep ductility of the copper material and sufficient ductility and fracture toughness of the nodular cast iron material is pointed out in the review. A sensitivity study is suggested where the impact of these properties on the mechanical integrity of the canister is investigated. It is also suggested that potential damage mechanisms influencing these properties are further investigated. SKB's modelling of creep elongation at rupture under repository conditions is questioned. Needs for complementary information from SKB for the main review of SR-Site is listed. A list of review topics for SSM is also suggested

  17. Some technical notes on using UAV-based remote sensing for post disaster assessment

    Science.gov (United States)

    Rokhmana, Catur Aries; Andaru, Ruli

    2017-07-01

    Indonesia is located in an area prone to disasters, which are various kinds of natural disasters happen. In disaster management, the geoinformation data are needed to be able to evaluate the impact area. The UAV (Unmanned Aerial Vehicle)-Based remote sensing technology is a good choice to produce a high spatial resolution of less than 15 cm, while the current resolution of the satellite imagery is still greater than 50 cm. This paper shows some technical notes that should be considered when using UAV-Based remote sensing system in post disaster for rapid assessment. Some cases are Aceh Earthquake in years 2013 for seeing infrastructure damages, Banjarnegara landslide in year 2014 for seeing the impact; and Kelud volcano eruption in year 2014 for seeing the impact and volumetric material calculation. The UAV-Based remote sensing system should be able to produce the Orthophoto image that can provide capabilities for visual interpretation the individual damage objects, and the changes situation. Meanwhile the DEM (digital Elevation model) product can derive terrain topography, and volumetric calculation with accuracy 3-5 pixel or sub-meter also. The UAV platform should be able for working remotely and autonomously in dangerous area and limited infrastructures. In mountainous or volcano area, an unconventional flight plan should implemented. Unfortunately, not all impact can be seen from above such as wall crack, some parcel boundaries, and many objects that covered by others higher object. The previous existing geoinformation data are also needed to be able to evaluate the change detection automatically.

  18. Technical note: Improving modeling of coagulation, curd firming, and syneresis of sheep milk.

    Science.gov (United States)

    Cipolat-Gotet, Claudio; Pazzola, Michele; Ferragina, Alessandro; Cecchinato, Alessio; Dettori, Maria L; Vacca, Giuseppe M

    2018-04-18

    The importance of milk coagulation properties for milk processing, cheese yield, and quality is widely recognized. The use of traditional coagulation traits presents several limitations for testing bovine milk and even more for sheep milk, due to its rapid coagulation and curd firming, and early syneresis of coagulum. The aim of this technical note is to test and improve model fitting for assessing coagulation, curd firming, and syneresis of sheep milk. Using milk samples from 87 Sarda ewes, we performed in duplicate lactodynamographic testing. On each of the 174 analyzed milk aliquots, using 180 observations from each aliquot (one every 15 s for 45 min after rennet addition), we compared 4 different curd firming models as a function of time (CF t , mm) using a nonlinear procedure. The most accurate and informative results were observed using a modified 4-parameter model, structured as follows: [Formula: see text] , where t is time, RCT eq (min) is the gelation time, CF P (mm) is the potential asymptotical CF at an infinite time, k CF (%/min) is the curd firming rate constant, and k SR (%/min) is the curd syneresis rate constant. To avoid nonconvergence and computational problems due to interrelations among the equation parameters, CF P was preliminarily defined as a function of maximum observed curd firmness (CF max , mm) recorded during the analysis. For this model, all the modeling equations of individual sheep milk aliquots were converging, with a negligible standard error of the estimates (coefficient of determination >0.99 for all individual sample equations). Repeatability of the modeled parameters was acceptable, also in the presence of curd syneresis during the lactodynamographic analysis. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  19. Important Non-Technical Skills in Video-Assisted Thoracoscopic Surgery Lobectomy: Team Perspectives.

    Science.gov (United States)

    Gjeraa, Kirsten; Mundt, Anna S; Spanager, Lene; Hansen, Henrik J; Konge, Lars; Petersen, René H; Østergaard, Doris

    2017-07-01

    Safety in the operating room is dependent on the team's non-technical skills. The importance of non-technical skills appears to be different for minimally invasive surgery as compared with open surgery. The aim of this study was to identify which non-technical skills are perceived by team members to be most important for patient safety, in the setting of video-assisted thoracoscopic surgery (VATS) lobectomy. This was an explorative, semistructured interview-based study with 21 participants from all four thoracic surgery centers in Denmark that perform VATS lobectomy. Data analysis was deductive, and directed content analysis was used to code the text into the Oxford Non-Technical Skills system for evaluating operating teams' non-technical skills. The most important non-technical skills described by the VATS teams were planning and preparation, situation awareness, problem solving, leadership, risk assessment, and teamwork. These non-technical skills enabled the team to achieve shared mental models, which in turn facilitated their efforts to anticipate next steps. This was viewed as important by the participants as they saw VATS lobectomy as a high-risk procedure with complementary and overlapping scopes of practice between surgical and anesthesia subteams. This study identified six non-technical skills that serve as the foundation for shared mental models of the patient, the current situation, and team resources. These findings contribute three important additions to the shared mental model construct: planning and preparation, risk assessment, and leadership. Shared mental models are crucial for patient safety because they enable VATS teams to anticipate problems through adaptive patterns of both implicit and explicit coordination. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. Switzerland; Financial Sector Assessment Program: Technical Note: An Assessment of Insurance Core Principles for the Reinsurance Industry

    OpenAIRE

    International Monetary Fund

    2007-01-01

    This technical note discusses key findings of the assessment of Insurance Core Principles (ICP) for the reinsurance industry for Switzerland. It reveals that the Swiss reinsurance market is dominated by three large players with a strong international presence. The reinsurance industry comprises 20 professional reinsurers and 50 reinsurance captives with gross premiums written totaling SwF 37.4 billion for 2005. Swiss Re, European Re, and Converium have consistently maintained more than 75 per...

  1. HOW TO ACHIEVE AND MAINTAIN NOTE 6: POSTGRADUATE PROGRAM IN TRANSLATIONAL SURGERY - UNIFESP.

    Science.gov (United States)

    Sabino-Neto, Miguel; Ferreira, Lydia Masako

    2015-01-01

    To show the way to reach and stay in note 6 in the evaluation process of Medicine III of CAPES. Capes determinations were reviewed concerning this topic, grades 6 and 7, and also the difficulties and facilities of running a program that amounted to Note 6 after restructuring and being in compliance with regulations. The main points to achieve and maintain Note 6 were: 1) regular production of master's and doctoral theses with appropriate distribution among all teachers; 2) average time of appropriate titration, as well as strict selection of students who resets the withdrawals and cancellations; 3) production of scientific articles in high impact journals and with academic and student participation in most part; 4) progressive and substantial increase in fundraising and patent search; 5) progressive increase in international exchanges with joint production; 6) visibility through new bilingual website and updated weekly; 7) numerous solidarity activities in research, but also in health services for the population and even in basic education; 8) rigorous selection of students (through design analysis, curriculum and teacher training program); 9) maintenance of high levels teachers production; 10) preparing new teachers for guidance through participation as co-supervision and involvement in the program to fit the needs. The Postgraduate Program in Translational Surgery went through difficult times; was submitted to a series of measures, adjustments, cooperation and understanding of the teaching staff, that took the program from note 3 - and almost closing - to a level of excellence keeping note 6 for three consecutive three-year periods of evaluation. Mostrar o caminho para alcançar e se manter na nota 6 no processo de avaliação da Medicina III da Capes. Foram revisadas as determinações da Capes concernentes ao tema, conceitos 6 e 7, e também as dificuldades e facilidades próprias da execução de um programa que ascendeu à nota 6 após reestruturação e

  2. TECHNICAL DESIGN NOTE: Currency verification by a 2D infrared barcode

    Science.gov (United States)

    Schirripa Spagnolo, Giuseppe; Cozzella, Lorenzo; Simonetti, Carla

    2010-10-01

    Nowadays all the National Central Banks are continuously studying innovative anti-counterfeiting systems for banknotes. In this note, an innovative solution is proposed, which combines the potentiality of a hylemetric approach (methodology conceptually similar to biometry), based on notes' intrinsic characteristics, with a well-known and consolidated 2D barcode identification system. In particular, in this note we propose to extract from the banknotes a univocal binary control sequence (template) and insert an encrypted version of it in a barcode printed on the same banknote. For a more acceptable look and feel of a banknote, the superposed barcode can be stamped using IR ink that is visible to near-IR image sensors. This makes the banknote verification simpler.

  3. Prospective randomized clinical trial comparing laparoscopic cholecystectomy and hybrid natural orifice transluminal endoscopic surgery (NOTES) (NCT00835250).

    Science.gov (United States)

    Noguera, José F; Cuadrado, Angel; Dolz, Carlos; Olea, José M; García, Juan C

    2012-12-01

    Natural orifice transluminal endoscopic surgery (NOTES) is a technique still in experimental development whose safety and effectiveness call for assessment through clinical trials. In this paper we present a three-arm, noninferiority, prospective randomized clinical trial of 1 year duration comparing the vaginal and transumbilical approaches for transluminal endoscopic surgery with the conventional laparoscopic approach for elective cholecystectomy. Sixty female patients between the ages of 18 and 65 years who were eligible for elective cholecystectomy were randomized in a ratio of 1:1:1 to receive hybrid transvaginal NOTES (TV group), hybrid transumbilical NOTES (TU group) or conventional laparoscopy (CL group). The main study variable was parietal complications (wound infection, bleeding, and eventration). The analysis was by intention to treat, and losses were not replaced. Cholecystectomy was successfully performed on 94% of the patients. One patient in the TU group was reconverted to CL owing to difficulty in maneuvering the endoscope. After a minimum follow-up period of 1 year, no differences were noted in the rate of parietal complications. Postoperative pain, length of hospital stay, and time off from work were similar in the three groups. No patient developed dyspareunia. Surgical time was longer among cases in which a flexible endoscope was used (CL, 47.04 min; TV, 64.85 min; TU, 59.80 min). NOTES approaches using the flexible endoscope are not inferior in safety or effectiveness to conventional laparoscopy. The transumbilical approach with flexible endoscope is as effective and safe as the transvaginal approach and is a promising, single-incision approach.

  4. Simulation-Based Laparoscopic Surgery Crisis Resource Management Training-Predicting Technical and Nontechnical Skills.

    Science.gov (United States)

    Goldenberg, Mitchell G; Fok, Kai H; Ordon, Michael; Pace, Kenneth T; Lee, Jason Y

    2017-12-19

    To develop a unique simulation-based assessment using a laparoscopic inferior vena cava (IVC) injury scenario that allows for the safe assessment of urology resident's technical and nontechnical skills, and investigate the effect of personality traits performance in a surgical crisis. Urology residents from our institution were recruited to participate in a simulation-based training laparoscopic nephrectomy exercise. Residents completed demographic and multidimensional personality questionnaires and were instructed to play the role of staff urologist. A vasovagal response to pneumoperitoneum and an IVC injury event were scripted into the scenario. Technical and nontechnical skills were assessed by expert laparoscopic surgeons using validated tools (task checklist, GOALS, and NOTSS). Ten junior and five senior urology residents participated. Five residents were unable to complete the exercise safely. Senior residents outperformed juniors on technical (checklist score 15.1 vs 9.9, p Technical performance scores correlated with NOTSS scores (p technical performance (p technical score (p = 0.03) and pass/fail rating (p = 0.04). Resident level of training and laparoscopic experience correlated with technical performance during a simulation-based laparoscopic IVC injury crisis management scenario, as well as multiple domains of nontechnical performance. Personality traits of our surgical residents are similar and did not predict technical skill. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  5. A New Era of Minimally Invasive Surgery: Progress and Development of Major Technical Innovations in General Surgery Over the Last Decade.

    Science.gov (United States)

    Siddaiah-Subramanya, Manjunath; Tiang, Kor Woi; Nyandowe, Masimba

    2017-10-01

    Minimally invasive surgery (MIS) continues to play an important role in general surgery as an alternative to traditional open surgery as well as traditional laparoscopic techniques. Since the 1980s, technological advancement and innovation have seen surgical techniques in MIS rapidly grow as it is viewed as more desirable. MIS, which includes natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS), is less invasive and has better cosmetic results. The technological growth and adoption of NOTES and SILS by clinicians in the last decade has however not been uniform. We look at the differences in new developments and advancement in the different techniques in the last 10 years. We also aim to explain these differences as well as the implications in general surgery for the future.

  6. Technical specifications (replaces note T.62). Irradiation of graphite at ambient temperature, Note T. 76; Specification technique, (Annule et remplace la note T. 62), Irradiation de graphite a temperature ambiante, Note T. 76

    Energy Technology Data Exchange (ETDEWEB)

    Reseau, R A [Services des grandes piles experimentales, Section ' Physique et Experimentation, Saclay (France)

    1962-12-15

    The objective is to study the effects of fast neutron irradiation of different graphite samples. The irradiation conditions should be as follows: integral fast neutron flux should be higher than 10{sup 20} neutrons/cm{sup 2}, the reactor should operate at steady state for 15 days, the temperature od samples should not be higher than 100 deg C, preferably 80 deg C. Note T. 62 which is replaced by this Note is attached.

  7. Inicial nasal mucosa detachment using piezoelectric device in the Le Fort I osteotomy: A technical note

    OpenAIRE

    Shinohara, Elio Hitoshi; Kaba, Shajadi Carlos Pardo; Ruiz, Marcelo Martinson; Horikawa, Fernando Kendi

    2013-01-01

    In maxillary Le Fort I type osteotomy the detachment of the nasal mucosa should be done carefully. Piezoelectric surgery contributed much to increase the safety of osteotomies, despite the initial advantage of minimizing the risk of injury in nervous tissue, mainly in bilateral sagittal split osteotomy; we use the piezoelectric device for the initial detachment of the nasal mucosa in the maxillary osteotomy.

  8. 50-year of the Technical Assistance Service to Industry (SATI): notes from a heterodoxy

    International Nuclear Information System (INIS)

    Enriquez, Santiago N.

    2011-01-01

    This report is in honor of the 50° creation anniversary of the Service of Technical Assistance to Industry (SATI),a service with no background in Argentina. This occasion is appropriate to think the historical conditions which made possible the existence of the SATI in the National Atomic Energy Commission. Secondly, this report describes its operative characteristics and its achievements in different fields: from the technical and industry-learning aspects, up to the development of the conception about the relation between Science, Technology and Society. (author) [es

  9. Reviewing subchondral cartilage surgery: considerations for standardised and outcome predictable cartilage remodelling: a technical note.

    Science.gov (United States)

    Benthien, Jan P; Behrens, Peter

    2013-11-01

    The potential of subchondral mesenchymal stem cell stimulation (MSS) for cartilage repair has led to the widespread use of microfracture as a first line treatment for full thickness articular cartilage defects. Recent focus on the effects of subchondral bone during cartilage injury and repair has expanded the understanding of the strengths and limitations in MSS and opened new pathways for potential improvement. Comparative studies have shown that bone marrow access has positive implications for pluripotential cell recruitment, repair quality and quantity, i.e. deeper channels elicited better cartilage fill, more hyaline cartilage character with higher type II collagen content and lower type I collagen content compared to shallow marrow access. A subchondral needling procedure using standardised and thin subchondral perforations deep into the subarticular bone marrow making the MSS more consistent with the latest developments in subchondral cartilage remodelling is proposed. As this is a novel method clinical studies have been initiated to evaluate the procedure especially compared to microfracturing. However, the first case studies and follow-ups indicate that specific drills facilitate reaching the subchondral bone marrow while the needle size makes perforation of the subchondral bone easier and more predictable. Clinical results of the first group of patients seem to compare well to microfracturing. The authors suggest a new method for a standardised procedure using a new perforating device. Advances in MSS by subchondral bone marrow perforation are discussed. It remains to be determined by clinical studies how this method compares to microfracturing. The subchondral needling offers the surgeon and the investigator a method that facilitates comparison studies because of its defined depth of subchondral penetration and needle size.

  10. Technical note: CT-guided biopsy of lung masses using an automated guiding apparatus

    International Nuclear Information System (INIS)

    Chellathurai, Amarnath; Kanhirat, Saneej; Chokkappan, Kabilan; Swaminathan, Thiruchendur S; Kulasekaran, Nadhamuni

    2009-01-01

    Automated guiding apparatuses for CT-guided biopsies are now available. We report our experience with an indigenous system to guide lung biopsies. This system gave results similar to those with the manual technique. Automated planning also appears to be technically easier, it requires fewer number of needle passes, consumes less time, and requires fewer number of check scans

  11. Primary Ewing's sarcoma of the skull: radical resection and immediate cranioplasty after chemotherapy. A technical note.

    Science.gov (United States)

    Castle, Maria; Rivero, Mónica; Marquez, Javier

    2013-02-01

    The current standard treatment of Ewing's sarcoma is chemotherapy followed by surgery, making an immediate cranial reconstruction in a one-step surgical procedure possible. We describe the technique used to repair a cranial defect after the resection of a primary Ewing's sarcoma of the skull in a one-step surgical procedure. Bone repair with a custom-made cranioplasty immediately after resection of a primary Ewing's sarcoma of the skull avoids deformities and late complications associated with reconstructive surgery after radiotherapy and not interfere with radiotherapy and neither with follow-up. A one-step surgical procedure after chemotherapy for primary Ewing's sarcoma of the skull could be safer, less aggressive and more radical; avoiding deformities and late complications.

  12. Inicial nasal mucosa detachment using piezoelectric device in the Le Fort I osteotomy: A technical note

    Science.gov (United States)

    Shinohara, Elio Hitoshi; Kaba, Shajadi Carlos Pardo; Ruiz, Marcelo Martinson; Horikawa, Fernando Kendi

    2013-01-01

    In maxillary Le Fort I type osteotomy the detachment of the nasal mucosa should be done carefully. Piezoelectric surgery contributed much to increase the safety of osteotomies, despite the initial advantage of minimizing the risk of injury in nervous tissue, mainly in bilateral sagittal split osteotomy; we use the piezoelectric device for the initial detachment of the nasal mucosa in the maxillary osteotomy. PMID:23853472

  13. Inicial nasal mucosa detachment using piezoelectric device in the Le Fort I osteotomy: A technical note

    Directory of Open Access Journals (Sweden)

    Elio Hitoshi Shinohara

    2013-01-01

    Full Text Available In maxillary Le Fort I type osteotomy the detachment of the nasal mucosa should be done carefully. Piezoelectric surgery contributed much to increase the safety of osteotomies, despite the initial advantage of minimizing the risk of injury in nervous tissue, mainly in bilateral sagittal split osteotomy; we use the piezoelectric device for the initial detachment of the nasal mucosa in the maxillary osteotomy.

  14. The Quality of Operative Notes at a General Surgery Unit | Rogers ...

    African Journals Online (AJOL)

    practice, accurate documentation is critical. This is particularly true for operative procedures, and medical councils have identified this and published guidelines to aid surgeons. However, these remain a frequently cited weakness in their defence in medico-legal cases. This study assessed the accuracy of operative notes in ...

  15. Application of objective clinical human reliability analysis (OCHRA) in assessment of technical performance in laparoscopic rectal cancer surgery.

    Science.gov (United States)

    Foster, J D; Miskovic, D; Allison, A S; Conti, J A; Ockrim, J; Cooper, E J; Hanna, G B; Francis, N K

    2016-06-01

    Laparoscopic rectal resection is technically challenging, with outcomes dependent upon technical performance. No robust objective assessment tool exists for laparoscopic rectal resection surgery. This study aimed to investigate the application of the objective clinical human reliability analysis (OCHRA) technique for assessing technical performance of laparoscopic rectal surgery and explore the validity and reliability of this technique. Laparoscopic rectal cancer resection operations were described in the format of a hierarchical task analysis. Potential technical errors were defined. The OCHRA technique was used to identify technical errors enacted in videos of twenty consecutive laparoscopic rectal cancer resection operations from a single site. The procedural task, spatial location, and circumstances of all identified errors were logged. Clinical validity was assessed through correlation with clinical outcomes; reliability was assessed by test-retest. A total of 335 execution errors identified, with a median 15 per operation. More errors were observed during pelvic tasks compared with abdominal tasks (p technical performance of laparoscopic rectal surgery.

  16. [Depressor anguli oris sign (DAO) in facial paresis. How to search it and release the smile (technical note)].

    Science.gov (United States)

    Labbé, D; Bénichou, L; Iodice, A; Giot, J-P

    2012-06-01

    After facial paralysis recovery, it is common to note a co-contraction between depressor anguli oris (DAO) muscle and zygomatic muscles. This DAO co-contraction will "obstruct" the patient's smile. The purpose of this technical note is to show how to find the DAO sign and how to free up the smile. TECHNICAL: This co-contraction between the zygomatic muscles and DAO research is placing a finger on marionette line, asking the patient to smile: we perceive a rope under the skin corresponding to the abnormal contraction and powerful DAO. A diagnostic test with lidocaine injection into the DAO can be performed to confirm the diagnosis. The treatment of pathological DAO's contraction can be by injection of botulinum toxin in the DAO, or by surgical myectomy. In all cases, a speech therapy complete the treatment. The DAO sign is a semiological entity easy to find. His treatment releases smile without negative effect on the facial expression as the DAO is especially useful in the expression of disgust. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  17. Insight into the da Vinci® Xi - technical notes for single-docking left-sided colorectal procedures.

    Science.gov (United States)

    Ngu, James Chi-Yong; Sim, Sarah; Yusof, Sulaiman; Ng, Chee-Yung; Wong, Andrew Siang-Yih

    2017-12-01

    The adoption of robot-assisted laparoscopic colorectal surgery has been hampered by issues with docking, operative duration, technical difficulties in multi-quadrant access, and cost. The da Vinci® Xi has been designed to overcome some of these limitations. We describe our experience with the system and offer technical insights to its application in left-sided colorectal procedures. Our initial series of left-sided robotic colorectal procedures was evaluated. Patient demographics and operative outcomes were recorded prospectively using a predefined database. Between March 2015 and April 2016, 54 cases of robot-assisted laparoscopic left-sided colorectal procedures were successfully completed with no cases of conversion. The majority were low anterior resections for colorectal malignancies. Using the da Vinci® Xi Surgical System, multi-quadrant surgery involving dissection from the splenic flexure to the pelvis was possible without redocking. The da Vinci® Xi simplifies the docking procedure and makes single-docking feasible for multi-quadrant left-sided colorectal procedures. Copyright © 2016 John Wiley & Sons, Ltd.

  18. Technical note: Endoscopic resection of a dermoid cyst anchored to the anterior optic chiasm

    Directory of Open Access Journals (Sweden)

    Yuichiro Yoneoka, MD, PhD

    2014-06-01

    Conclusion: To the best of our knowledge, ours is the only case of a dermoid cyst anchored to the anterior optic chiasma, which was visually confirmed under endoscopic observation. After surgery, the patient presented a transient impairment of the visual field, which was not evident at four month follow-up. It will contribute to a similar case, in which surgeons hesitate to make an incision in the optic chiasm. A subtotal excision should be considered in cases of dermoid cysts anchored to the anterior optic chiasm, because all the previously reported cases of suprasellar dermoid cysts are young people or those who have a relatively long life expectancy.

  19. Developing the Blueprint for a General Surgery Technical Skills Certification Examination: A Validation Study.

    Science.gov (United States)

    de Montbrun, Sandra; Louridas, Marisa; Szasz, Peter; Harris, Kenneth A; Grantcharov, Teodor P

    There is a recognized need to develop high-stakes technical skills assessments for decisions of certification and resident promotion. High-stakes examinations requires a rigorous approach in accruing validity evidence throughout the developmental process. One of the first steps in development is the creation of a blueprint which outlines the potential content of examination. The purpose of this validation study was to develop an examination blueprint for a Canadian General Surgery assessment of technical skill certifying examination. A Delphi methodology was used to gain consensus amongst Canadian General Surgery program directors as to the content (tasks or procedures) that could be included in a certifying Canadian General Surgery examination. Consensus was defined a priori as a Cronbach's α ≥ 0.70. All procedures or tasks reaching a positive consensus (defined as ≥80% of program directors rated items as ≥4 on the 5-point Likert scale) were then included in the final examination blueprint. Two Delphi rounds were needed to reach consensus. Of the 17 General Surgery Program directors across the country, 14 (82.4%) and 10 (58.8%) program directors responded to the first and second round, respectively. A total of 59 items and procedures reached positive consensus and were included in the final examination blueprint. The present study has outlined the development of an examination blueprint for a General Surgery certifying examination using a consensus-based methodology. This validation study will serve as the foundational work from which simulated model will be developed, pilot tested and evaluated. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  20. Treatment of movement disorders using deep brain stimulation – illustrative case reports and technical notes

    Directory of Open Access Journals (Sweden)

    Tadej Strojnik

    2012-05-01

    Full Text Available Operative neuromodulation is the field of electrically or chemically altering the signal transmission in the nervous system by implanted devices in order to excite, inhibit or tune the activities of neurons or neural networks to produce therapeutic effects. Deep brain stimulation (DBS is an important component of the therapy of movement disorders and has almost completely replaced high-frequency coagulation of brain tissue in stereotactic neurosurgery. This article presents the first DBS cases in Slovenia. In the article the technical features and adjustments of magnetic resonance (MR imaging and development of a new microdrive, which was clinically successfully tested, are described and discussed.

  1. Anterior maxillary osteotomy: A technical note for superior repositioning: A bird wing segment

    Directory of Open Access Journals (Sweden)

    V Sadesh Kannan

    2014-01-01

    Full Text Available Aim: The aim of this study is to evaluate the efficacy of a single piece bird wing osteotectomy segment during anterior maxillary osteotomy (AMO markedly reduces the duration of the surgery by nearly one-half of the time during bone removal with the conventional method thereby reducing the kinking effect to the palatal pedicle and gives good perfusion to the anterior segment. Materials and Methods: This study was conducted at Karpaga Vinayaga Institute of Dental Sciences composing of 20 patients in which male: female ratio was 8:12, with a mean age of 25-30 years. This bird wing segment technique is performed following presurgical orthodontics under the guidance of clinical assessment of the gummy smile with an incisal show when the lip is at repose (vertical maxillary excess, especially for the calculated amount of superior repositioning. It is calculated by subtracting 2 mm from the total amount of an incisor show when the lip is at repose. The normal incisal show when the lip is at repose is 2 mm. After conventional primary AMO cut was performed, the precise calculated. Results: All our cases were tested positive for pulp vitality, no relapse, and minimal edema and with no changes in the bite or dentoalveolar relation followed until 1 year postoperatively indicating a good perfusion to the anterior segment and all the patients were satisfied esthetically and free of complaints. Conclusion: This simple technique allows the precise amount of calculated bone removal in a single piece from the nasal floor markedly reduces the duration of the surgery by nearly one-half of the time during bone removal with the conventional method there by reducing the kinking effect to the palatal pedicle and maintains good perfusion.

  2. Rapid Clearance of Lateral Ventricular Hematoma via Frontal Eminence Puncture and Aspiration: A Technical Note.

    Science.gov (United States)

    Li, Zhaojian; Yao, Weicheng; Han, Kun; Lan, Xiaolei; Bo, Yongli

    2017-01-01

    Background  Intraventricular extension of a parenchymal hemorrhage is an independent predictor of poor outcome and might be complicated by delayed hydrocephalus. We describe a method for the rapid and effective removal of a lateral ventricular hematoma via catheter-based puncture and aspiration. Methods  A catheter-based aspiration of a ventricular hematoma via a frontal eminence (FE) puncture was performed in 10 patients with thalamic and ganglionic hemorrhage perforating into the lateral ventricle. Paralleling the long axis of the lateral ventricle, a flexible silicone catheter was moved anteroposteriorly and rotated simultaneously to facilitate clot aspiration and removal. Computed tomography scans before and after surgery were compared for assessment of ventricular clot volume, Graeb score, and the ventriculocranial ratio (VCR). The Glasgow Coma Scale (GCS) score and Glasgow Outcome Scale (GOS) score were assessed at 14 days and 12 months following surgery, respectively. Results  In all 10 patients, catheter-based aspiration resulted in substantial hematoma removal with a clearance rate of 64.9%, a reduced Graeb score by 61.8%, and an elevated GCS score by 52.7%. The procedure was performed safely without occurrence of another hemorrhage, infection, and catheter obstruction in any case. At 12-month follow-up, VCR was reduced by 22.5%, no delayed hydrocephalus occurred, and a favorable outcome with an average GOS of 4.6 was observed in this small cohort of patients. Conclusion  Catheter-based aspiration of a ventricular hematoma via FE puncture rapidly, efficiently, and safely reduced the clot in the ventricular system, prevented delayed hydrocephalus sufficiently, and produced a favorable outcome. Georg Thieme Verlag KG Stuttgart · New York.

  3. “Next Door” intraoperative magnetic resonance imaging for awake craniotomy: Preliminary experience and technical note

    Science.gov (United States)

    Mathias, Roger Neves; de Aguiar, Paulo Henrique Pires; da Luz Oliveira, Evandro Pinto; Verst, Silvia Mazzali; Vieira, Vinícius; Docema, Marcos Fernando; Calfat Maldaun, Marcos Vinícius

    2016-01-01

    Background: During glioma surgery “maximal safe resection” must be the main goal. Intraoperative magnetic resonance imaging (iMRI) associated with awake craniotomy (AC) is a valuable tool to achieve this objective. In this article, AC with a “next-door” iMRI concept is described in a stepwise protocol. Methods: This is a retrospective analysis of 18 patients submitted to AC using iMRI; a stepwise protocol is also discussed. Results: The mean age was 41.7 years. Hemiparesis, aphasia, and seizures were the main initial symptoms of the patients. Sixty-six percent of the tumors were located in the left hemisphere. All tumors were near or within eloquent areas. Fifty-three percent of the cases were glioblastomas multiforme and 47% of the patients had low grade gliomas. The mean surgical time and iMRI time were 4 h 4 min and 30 min, respectively. New resection was performed in 33% after iMRI. Extent of resection (EOR) higher than 95% was possible in 66.7% of the patients. The main reason of EOR lower than 95% was positive mapping of eloquent areas (6 patients). Eighty percent of the patients experienced improvement of their deficits immediately after the surgery or had a stable clinical status whereas 20% had neurological deterioration, however, all of them improved after 30 days. Conclusion: AC associated with “next-door” iMRI is a complex procedure, but if performed using a meticulous technique, it may improve the overall tumor resection and safety of the patients. PMID:28144477

  4. Intraoperative Spinal Navigation for the Removal of Intradural Tumors: Technical Notes.

    Science.gov (United States)

    Stefini, Roberto; Peron, Stefano; Mandelli, Jaime; Bianchini, Elena; Roccucci, Paolo

    2017-08-05

    In recent years, spinal surgery has incorporated the many advantages of navigation techniques to facilitate the placement of pedicle screws during osteosynthesis, mainly for degenerative diseases. However, spinal intradural tumors are not clearly visible by intraoperative fluoroscopy or computed tomography scans, thereby making navigation necessary. To evaluate the use of spinal navigation for the removal of intradural and spinal cord tumors using spinal magnetic resonance imaging (MRI) merged with intraoperative 3-dimensional (3-D) fluoro images. After fixing the patient reference frame on the spinous process, the 3-D fluoro images were obtained in the surgical room. Using this image as the reference, the preoperative volumetric MRI images and intraoperative 3-D fluoro images were merged using automated software or manually. From January to July 2016, we performed 10 navigated procedures for intradural spinal tumors by merging MRI and 3-D fluoro images. Nine patients had an intradural extramedullary tumor, 6 had neurinomas, and 3 had meningiomas; 1 patient had an intramedullary spinal cord metastasis. The surgically demonstrated benefits of spinal navigation for the removal of intradural tumors include the decreased risk of surgery at the wrong spinal level, a minimal length of skin incision and muscle strip, and a reduction in bone removal extension. Furthermore, this technique offers the advantage of opening the dura as much as is necessary and, in the case of intrinsic spinal cord tumors, it allows the tumor to be centered. Otherwise, this would not be visible, thus enabling the precise level and the posterior midline sulcus to be determined when performing a mielotomy. Copyright © 2017 by the Congress of Neurological Surgeons

  5. Sir Harold Delf Gillies, the otolaryngologist and father of modern facial plastic surgery: review of his rhinoplasty case notes.

    Science.gov (United States)

    Spencer, C R

    2015-06-01

    Sir Harold Gillies, born in New Zealand, is widely considered a British icon and the father of modern plastic surgery. This article provides an overview of his life and the circumstances which led to him laying the foundations of plastic surgery in Britain in the early twentieth century. A hand search and review of case notes from the Gillies Archives at Queen Mary's Hospital in Sidcup, UK, where he made history, was conducted. Gillies' ongoing legacy was found to also include his influence on the development of his cousin Sir Archibald McIndoe's work. Gillies was a talented sportsman who engaged in charitable activities. Additionally, he was a gifted teacher, with his hospital attracting many young surgeons from around the world. He was found to have expressed genius in both the design and execution of the art and science of surgery. He incepted reconstructive techniques ranging from the world's first gender reassignment operation to facial reanimation procedures for the treatment of facial paralysis. His operative work on ex-servicemen in need of complex rhinoplasty and in particular the inception of the tubed pedicle flap are depicted.

  6. Technical note: An inverse method to relate organic carbon reactivity to isotope composition from serial oxidation

    Directory of Open Access Journals (Sweden)

    J. D. Hemingway

    2017-11-01

    Full Text Available Serial oxidation coupled with stable carbon and radiocarbon analysis of sequentially evolved CO2 is a promising method to characterize the relationship between organic carbon (OC chemical composition, source, and residence time in the environment. However, observed decay profiles depend on experimental conditions and oxidation pathway. It is therefore necessary to properly assess serial oxidation kinetics before utilizing decay profiles as a measure of OC reactivity. We present a regularized inverse method to estimate the distribution of OC activation energy (E, a proxy for bond strength, using serial oxidation. Here, we apply this method to ramped temperature pyrolysis or oxidation (RPO analysis but note that this approach is broadly applicable to any serial oxidation technique. RPO analysis directly compares thermal reactivity to isotope composition by determining the E range for OC decaying within each temperature interval over which CO2 is collected. By analyzing a decarbonated test sample at multiple masses and oven ramp rates, we show that OC decay during RPO analysis follows a superposition of parallel first-order kinetics and that resulting E distributions are independent of experimental conditions. We therefore propose the E distribution as a novel proxy to describe OC thermal reactivity and suggest that E vs. isotope relationships can provide new insight into the compositional controls on OC source and residence time.

  7. Technical note: An inverse method to relate organic carbon reactivity to isotope composition from serial oxidation

    Science.gov (United States)

    Hemingway, Jordon D.; Rothman, Daniel H.; Rosengard, Sarah Z.; Galy, Valier V.

    2017-11-01

    Serial oxidation coupled with stable carbon and radiocarbon analysis of sequentially evolved CO2 is a promising method to characterize the relationship between organic carbon (OC) chemical composition, source, and residence time in the environment. However, observed decay profiles depend on experimental conditions and oxidation pathway. It is therefore necessary to properly assess serial oxidation kinetics before utilizing decay profiles as a measure of OC reactivity. We present a regularized inverse method to estimate the distribution of OC activation energy (E), a proxy for bond strength, using serial oxidation. Here, we apply this method to ramped temperature pyrolysis or oxidation (RPO) analysis but note that this approach is broadly applicable to any serial oxidation technique. RPO analysis directly compares thermal reactivity to isotope composition by determining the E range for OC decaying within each temperature interval over which CO2 is collected. By analyzing a decarbonated test sample at multiple masses and oven ramp rates, we show that OC decay during RPO analysis follows a superposition of parallel first-order kinetics and that resulting E distributions are independent of experimental conditions. We therefore propose the E distribution as a novel proxy to describe OC thermal reactivity and suggest that E vs. isotope relationships can provide new insight into the compositional controls on OC source and residence time.

  8. Technical Note: Modeling a complex micro-multileaf collimator using the standard BEAMnrc distribution

    International Nuclear Information System (INIS)

    Kairn, T.; Kenny, J.; Crowe, S. B.; Fielding, A. L.; Franich, R. D.; Johnston, P. N.; Knight, R. T.; Langton, C. M.; Schlect, D.; Trapp, J. V.

    2010-01-01

    Purpose: The component modules in the standard BEAMnrc distribution may appear to be insufficient to model micro-multileaf collimators that have trifaceted leaf ends and complex leaf profiles. This note indicates, however, that accurate Monte Carlo simulations of radiotherapy beams defined by a complex collimation device can be completed using BEAMnrc's standard VARMLC component module. Methods: That this simple collimator model can produce spatially and dosimetrically accurate microcollimated fields is illustrated using comparisons with ion chamber and film measurements of the dose deposited by square and irregular fields incident on planar, homogeneous water phantoms. Results: Monte Carlo dose calculations for on-axis and off-axis fields are shown to produce good agreement with experimental values, even on close examination of the penumbrae. Conclusions: The use of a VARMLC model of the micro-multileaf collimator, along with a commissioned model of the associated linear accelerator, is therefore recommended as an alternative to the development or use of in-house or third-party component modules for simulating stereotactic radiotherapy and radiosurgery treatments. Simulation parameters for the VARMLC model are provided which should allow other researchers to adapt and use this model to study clinical stereotactic radiotherapy treatments.

  9. Technical note: Use of a simplified equation for estimating glomerular filtration rate in beef cattle.

    Science.gov (United States)

    Murayama, I; Miyano, A; Sasaki, Y; Hirata, T; Ichijo, T; Satoh, H; Sato, S; Furuhama, K

    2013-11-01

    This study was performed to clarify whether a formula (Holstein equation) based on a single blood sample and the isotonic, nonionic, iodine contrast medium iodixanol in Holstein dairy cows can apply to the estimation of glomerular filtration rate (GFR) for beef cattle. To verify the application of iodixanol in beef cattle, instead of the standard tracer inulin, both agents were coadministered as a bolus intravenous injection to identical animals at doses of 10 mg of I/kg of BW and 30 mg/kg. Blood was collected 30, 60, 90, and 120 min after the injection, and the GFR was determined by the conventional multisample strategies. The GFR values from iodixanol were well consistent with those from inulin, and no effects of BW, age, or parity on GFR estimates were noted. However, the GFR in cattle weighing less than 300 kg, aged<1 yr old, largely fluctuated, presumably due to the rapid ruminal growth and dynamic changes in renal function at young adult ages. Using clinically healthy cattle and those with renal failure, the GFR values estimated from the Holstein equation were in good agreement with those by the multisample method using iodixanol (r=0.89, P=0.01). The results indicate that the simplified Holstein equation using iodixanol can be used for estimating the GFR of beef cattle in the same dose regimen as Holstein dairy cows, and provides a practical and ethical alternative.

  10. Technical Performance as a Predictor of Clinical Outcomes in Laparoscopic Gastric Cancer Surgery.

    Science.gov (United States)

    Fecso, Andras B; Bhatti, Junaid A; Stotland, Peter K; Quereshy, Fayez A; Grantcharov, Teodor P

    2018-03-23

    The purpose of this study was to evaluate the relationship between technical performance and patient outcomes in laparoscopic gastric cancer surgery. Laparoscopic gastrectomy for cancer is an advanced procedure with high rate of postoperative morbidity and mortality. Many variables including patient, disease, and perioperative management factors have been shown to impact postoperative outcomes; however, the role of surgical performance is insufficiently investigated. A retrospective review was performed for all patients who had undergone laparoscopic gastrectomy for cancer at 3 teaching institutions between 2009 and 2015. Patients with available, unedited video-recording of their procedure were included in the study. Video files were rated for technical performance, using Objective Structured Assessments of Technical Skills (OSATS) and Generic Error Rating Tool instruments. The main outcome variable was major short-term complications. The effect of technical performance on patient outcomes was assessed using logistic regression analysis with backward selection strategy. Sixty-one patients with available video recordings were included in the study. The overall complication rate was 29.5%. The mean Charlson comorbidity index, type of procedure, and the global OSATS score were included in the final predictive model. Lower performance score (OSATS ≤29) remained an independent predictor for major short-term outcomes (odds ratio 6.49), while adjusting for comorbidities and type of procedure. Intraoperative technical performance predicts major short-term outcomes in laparoscopic gastrectomy for cancer. Ongoing assessment and enhancement of surgical skills using modern, evidence-based strategies might improve short-term patient outcomes. Future work should focus on developing and studying the effectiveness of such interventions in laparoscopic gastric cancer surgery.

  11. Transient recycling of resected bone to facilitate mandibular reconstruction--a technical note.

    Science.gov (United States)

    Lee, Jing-Wei; Tsai, Shin-Sheng; Kuo, Yao-Lung

    2006-10-01

    Mandibular reconstruction requires considerable sculptural skills. The intriguingly complex configuration of the structure is difficult to reproduce. It is thus imperative for surgeons to seek a technique that improves the precision of the reconstruction. A 55-year-old male presented with a full thickness cancer (T4+) of his left cheek. Radical ablative surgery resulted in an extensive loss of bone and soft tissue mandating major reconstruction. The resected bony specimen was thoroughly denuded, autoclaved, and then placed back into its original site so that the mandible resumed its pre-surgical configuration. A reconstruction plate was applied to maintain structural stability, then the "recycled bone" was used as a template and replaced with a free fibular graft. The patient fared well and a follow-up panoramic radiograph demonstrated good alignment and symmetry of the reconstructed mandible. This method is a viable option for segmental mandibulectomy defect repair in selected cases. Using this technique, it is possible to restore the original bony contour expediently and accurately.

  12. The impact of nontechnical skills on technical performance in surgery: a systematic review.

    Science.gov (United States)

    Hull, Louise; Arora, Sonal; Aggarwal, Rajesh; Darzi, Ara; Vincent, Charles; Sevdalis, Nick

    2012-02-01

    Failures in nontechnical and teamwork skills frequently lie at the heart of harm and near-misses in the operating room (OR). The purpose of this systematic review was to assess the impact of nontechnical skills on technical performance in surgery. MEDLINE, EMBASE, PsycINFO databases were searched, and 2,041 articles were identified. After limits were applied, 341 articles were retrieved for evaluation. Of these, 28 articles were accepted for this review. Data were extracted from the articles regarding sample population, study design and setting, measures of nontechnical skills and technical performance, study findings, and limitations. Of the 28 articles that met inclusion criteria, 21 articles assessed the impact of surgeons' nontechnical skills on their technical performance. The evidence suggests that receiving feedback and effectively coping with stressful events in the OR has a beneficial impact on certain aspects of technical performance. Conversely, increased levels of fatigue are associated with detriments to surgical skill. One article assessed the impact of anesthesiologists' nontechnical skills on anesthetic technical performance, finding a strong positive correlation between the 2 skill sets. Finally, 6 articles assessed the impact of multiple nontechnical skills of the entire OR team on surgical performance. A strong relationship between teamwork failure and technical error was empirically demonstrated in these studies. Evidence suggests that certain nontechnical aspects of performance can enhance or, if lacking, contribute to deterioration of surgeons' technical performance. The precise extent of this effect remains to be elucidated. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  13. Setting Performance Standards for Technical and Nontechnical Competence in General Surgery.

    Science.gov (United States)

    Szasz, Peter; Bonrath, Esther M; Louridas, Marisa; Fecso, Andras B; Howe, Brett; Fehr, Adam; Ott, Michael; Mack, Lloyd A; Harris, Kenneth A; Grantcharov, Teodor P

    2017-07-01

    The objectives of this study were to (1) create a technical and nontechnical performance standard for the laparoscopic cholecystectomy, (2) assess the classification accuracy and (3) credibility of these standards, (4) determine a trainees' ability to meet both standards concurrently, and (5) delineate factors that predict standard acquisition. Scores on performance assessments are difficult to interpret in the absence of established standards. Trained raters observed General Surgery residents performing laparoscopic cholecystectomies using the Objective Structured Assessment of Technical Skill (OSATS) and the Objective Structured Assessment of Non-Technical Skills (OSANTS) instruments, while as also providing a global competent/noncompetent decision for each performance. The global decision was used to divide the trainees into 2 contrasting groups and the OSATS or OSANTS scores were graphed per group to determine the performance standard. Parametric statistics were used to determine classification accuracy and concurrent standard acquisition, receiver operator characteristic (ROC) curves were used to delineate predictive factors. Thirty-six trainees were observed 101 times. The technical standard was an OSATS of 21.04/35.00 and the nontechnical standard an OSANTS of 22.49/35.00. Applying these standards, competent/noncompetent trainees could be discriminated in 94% of technical and 95% of nontechnical performances (P < 0.001). A 21% discordance between technically and nontechnically competent trainees was identified (P < 0.001). ROC analysis demonstrated case experience and trainee level were both able to predict achieving the standards with an area under the curve (AUC) between 0.83 and 0.96 (P < 0.001). The present study presents defensible standards for technical and nontechnical performance. Such standards are imperative to implementing summative assessments into surgical training.

  14. Technical Note: Seasonality in alpine water resources management - a regional assessment

    Science.gov (United States)

    Vanham, D.; Fleischhacker, E.; Rauch, W.

    2008-01-01

    Alpine regions are particularly affected by seasonal variations in water demand and water availability. Especially the winter period is critical from an operational point of view, as being characterised by high water demands due to tourism and low water availability due to the temporal storage of precipitation as snow and ice. The clear definition of summer and winter periods is thus an essential prerequisite for water resource management in alpine regions. This paper presents a GIS-based multi criteria method to determine the winter season. A snow cover duration dataset serves as basis for this analysis. Different water demand stakeholders, the alpine hydrology and the present day water supply infrastructure are taken into account. Technical snow-making and (winter) tourism were identified as the two major seasonal water demand stakeholders in the study area, which is the Kitzbueheler region in the Austrian Alps. Based upon different geographical datasets winter was defined as the period from December to March, and summer as the period from April to November. By determining potential regional water balance deficits or surpluses in the present day situation and in future, important management decisions such as water storage and allocation can be made and transposed to the local level.

  15. Technical Note: The Modular Earth Submodel System (MESSy - a new approach towards Earth System Modeling

    Directory of Open Access Journals (Sweden)

    P. Jöckel

    2005-01-01

    Full Text Available The development of a comprehensive Earth System Model (ESM to study the interactions between chemical, physical, and biological processes, requires coupling of the different domains (land, ocean, atmosphere, .... One strategy is to link existing domain-specific models with a universal coupler, i.e. an independent standalone program organizing the communication between other programs. In many cases, however, a much simpler approach is more feasible. We have developed the Modular Earth Submodel System (MESSy. It comprises (1 a modular interface structure to connect to a , (2 an extendable set of such for miscellaneous processes, and (3 a coding standard. MESSy is therefore not a coupler in the classical sense, but exchanges data between a and several within one comprehensive executable. The internal complexity of the is controllable in a transparent and user friendly way. This provides remarkable new possibilities to study feedback mechanisms (by two-way coupling. Note that the MESSy and the coupler approach can be combined. For instance, an atmospheric model implemented according to the MESSy standard could easily be coupled to an ocean model by means of an external coupler. The vision is to ultimately form a comprehensive ESM which includes a large set of submodels, and a base model which contains only a central clock and runtime control. This can be reached stepwise, since each process can be included independently. Starting from an existing model, process submodels can be reimplemented according to the MESSy standard. This procedure guarantees the availability of a state-of-the-art model for scientific applications at any time of the development. In principle, MESSy can be implemented into any kind of model, either global or regional. So far, the MESSy concept has been applied to the general circulation model ECHAM5 and a number of process boxmodels.

  16. Technical Note: Statistical dependences between channels in radiochromic film readings. Implications in multichannel dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    González-López, Antonio, E-mail: antonio.gonzalez7@carm.es [Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena, El Palmar, Murcia 30120 (Spain); Vera-Sánchez, Juan Antonio [Servicio de Protección Radiológica y Física Médica Hospital Universitari Sant Joan de Reus, Av. del Dr. Josep Laporte, 2, Reus, Tarragona 43204 (Spain); Ruiz-Morales, Carmen [Hospital IMED Elche, Max Planck No. 3, Elche, Alicante 03203 (Spain)

    2016-05-15

    Purpose: This note studies the statistical relationships between color channels in radiochromic film readings with flatbed scanners. The same relationships are studied for noise. Finally, their implications for multichannel film dosimetry are discussed. Methods: Radiochromic films exposed to wedged fields of 6 MV energy were read in a flatbed scanner. The joint histograms of pairs of color channels were used to obtain the joint and conditional probability density functions between channels. Then, the conditional expectations and variances of one channel given another channel were obtained. Noise was extracted from film readings by means of a multiresolution analysis. Two different dose ranges were analyzed, the first one ranging from 112 to 473 cGy and the second one from 52 to 1290 cGy. Results: For the smallest dose range, the conditional expectations of one channel given another channel can be approximated by linear functions, while the conditional variances are fairly constant. The slopes of the linear relationships between channels can be used to simplify the expression that estimates the dose by means of the multichannel method. The slopes of the linear relationships between each channel and the red one can also be interpreted as weights in the final contribution to dose estimation. However, for the largest dose range, the conditional expectations of one channel given another channel are no longer linear functions. Finally, noises in different channels were found to correlate weakly. Conclusions: Signals present in different channels of radiochromic film readings show a strong statistical dependence. By contrast, noise correlates weakly between channels. For the smallest dose range analyzed, the linear behavior between the conditional expectation of one channel given another channel can be used to simplify calculations in multichannel film dosimetry.

  17. Cervical Hemilaminoplasty with Miniplates in Long Segment Intradural Extramedullary Ependymoma: Case Report and Technical Note.

    Science.gov (United States)

    Oral, Sukru; Tumturk, Abdulfettah; Kucuk, Ahmet; Menku, Ahmet

    2018-01-01

    The surgical approaches for spinal tumors, to a great extent, have been developed in accordance with the developments in medical technology. Today, many surgical techniques are implemented as anterior, anterolateral, posterior, posterolateral and combined approaches. Due to its low morbidity, the posterior approach is the more preferred one. Laminectomy is a widely used technique, especially in neoplastic lesions. However, following laminectomy, there are numerous complications such as instability, kyphotic deformity and scar formation. In this paper, the excision of a tumor that was located intradural-extramedullary at the C3-C7 level with the cervical hemilaminoplasty technique is described. A 47-year-old female patient presented to our clinic with increasing complaints of neck and left arm pain, left arm numbness and searing pain for the last 10 years. On examination, hypoesthesia at the C4-7 dermatomes in the left upper extremity, an increase in deep tendon reflexes, and bilateral positive Hoffmann reflexes were observed. C3-C7 laminae were opened unilaterally on the right side with a midline skin incision. The laminae were drilled with a high-speed drill to provide a wide opening, both on the midline obliquely and from the border of the lamina-facet joint. After the tumor was totally excised, hemilaminae were placed into the previous position and reconstructed with mini-plates and screws. Cervical hemilaminoplasty provides a wide field of vision in tumor surgery of this region. Besides, the reconstruction of hemilaminae is important for stability. As the integrity of the spinal canal is preserved during reoperations of this region, the risk of complications is decreased.

  18. 23Na-MRI of recurrent glioblastoma multiforme after intraoperative radiotherapy: technical note

    International Nuclear Information System (INIS)

    Haneder, Stefan; Buesing, Karen A.; Schoenberg, Stefan O.; Ong, Melissa M.; Giordano, Frank A.; Wenz, Frederik; Konstandin, Simon; Schad, Lothar R.; Brehmer, Stefanie; Schmiedek, Peter

    2015-01-01

    We report the first case of an intraoperative radiotherapy (IORT) in a patient with recurrent glioblastoma multiforme (GBM) who was followed up with a novel magnetic resonance imaging (MRI) method - 23 Na-MRI - in comparison to a standard contrast-enhanced 1 H-MRI and 18 F-FET-PET. A 56-year-old female patient with diagnosed GBM in July 2012 underwent tumor resection, radiochemotherapy, and three cycles of chemotherapy. After a relapse, 6 months after the initial diagnosis, an IORT was recommended which was performed in March 2013 using the INTRABEAM system (Carl Zeiss Meditec AG, Germany) with a 3-cm applicator and a surface dose of 20 Gy. Early post-operative contrast-enhanced and 1-month follow-up 1 H-MRI and a 18 F-FET-PET were performed. In addition, an IRB-approved 23 Na-MRI was performed on a 3.0-T MR scanner (MAGNETOM TimTrio, Siemens Healthcare, Germany). After re-surgery and IORT in March 2013, only a faint contrast enhancement but considerable surrounding edema was visible at the medio-posterior resection margins. In April 2013, new and progressive contrast enhancement, edema, 23 Na content, and increased uptake in the 18 F-FET-PET were visible, indicating tumor recurrence. Increased sodium content within the area of contrast enhancement was found in the 23 Na-MRI, but also exceeding this area, very similar to the increased uptake depicted in the 18 F-FET-PET. The clearly delineable zone of edema in both examinations exhibits a lower 23 Na content compared to areas with suspected proliferating tumor tissue. 23 Na-MRI provided similar information in the suspicious area compared to 18 F-FET-PET, exceeding conventional 1 H-MRI. Still, 23 Na-MRI remains an investigational technique, which is worth to be further evaluated. (orig.)

  19. Technical Note: Rapid prototyping of 3D grid arrays for image guided therapy quality assurance

    International Nuclear Information System (INIS)

    Kittle, David; Holshouser, Barbara; Slater, James M.; Guenther, Bob D.; Pitsianis, Nikos P.; Pearlstein, Robert D.

    2008-01-01

    Three dimensional grid phantoms offer a number of advantages for measuring imaging related spatial inaccuracies for image guided surgery and radiotherapy. The authors examined the use of rapid prototyping technology for directly fabricating 3D grid phantoms from CAD drawings. We tested three different fabrication process materials, photopolymer jet with acrylic resin (PJ/AR), selective laser sintering with polyamide (SLS/P), and fused deposition modeling with acrylonitrile butadiene styrene (FDM/ABS). The test objects consisted of rectangular arrays of control points formed by the intersections of posts and struts (2 mm rectangular cross section) and spaced 8 mm apart in the x, y, and z directions. The PJ/AR phantom expanded after immersion in water which resulted in permanent warping of the structure. The surface of the FDM/ABS grid exhibited a regular pattern of depressions and ridges from the extrusion process. SLS/P showed the best combination of build accuracy, surface finish, and stability. Based on these findings, a grid phantom for assessing machine-dependent and frame-induced MR spatial distortions was fabricated to be used for quality assurance in stereotactic neurosurgical and radiotherapy procedures. The spatial uniformity of the SLS/P grid control point array was determined by CT imaging (0.6x0.6x0.625 mm 3 resolution) and found suitable for the application, with over 97.5% of the control points located within 0.3 mm of the position specified in CAD drawing and none of the points off by more than 0.4 mm. Rapid prototyping is a flexible and cost effective alternative for development of customized grid phantoms for medical physics quality assurance.

  20. Technical Note: PLASTIMATCH MABS, an open source tool for automatic image segmentation

    International Nuclear Information System (INIS)

    Zaffino, Paolo; Spadea, Maria Francesca; Raudaschl, Patrik; Fritscher, Karl; Sharp, Gregory C.

    2016-01-01

    Purpose: Multiatlas based segmentation is largely used in many clinical and research applications. Due to its good performances, it has recently been included in some commercial platforms for radiotherapy planning and surgery guidance. Anyway, to date, a software with no restrictions about the anatomical district and image modality is still missing. In this paper we introduce PLASTIMATCH MABS, an open source software that can be used with any image modality for automatic segmentation. Methods: PLASTIMATCH MABS workflow consists of two main parts: (1) an offline phase, where optimal registration and voting parameters are tuned and (2) an online phase, where a new patient is labeled from scratch by using the same parameters as identified in the former phase. Several registration strategies, as well as different voting criteria can be selected. A flexible atlas selection scheme is also available. To prove the effectiveness of the proposed software across anatomical districts and image modalities, it was tested on two very different scenarios: head and neck (H&N) CT segmentation for radiotherapy application, and magnetic resonance image brain labeling for neuroscience investigation. Results: For the neurological study, minimum dice was equal to 0.76 (investigated structures: left and right caudate, putamen, thalamus, and hippocampus). For head and neck case, minimum dice was 0.42 for the most challenging structures (optic nerves and submandibular glands) and 0.62 for the other ones (mandible, brainstem, and parotid glands). Time required to obtain the labels was compatible with a real clinical workflow (35 and 120 min). Conclusions: The proposed software fills a gap in the multiatlas based segmentation field, since all currently available tools (both for commercial and for research purposes) are restricted to a well specified application. Furthermore, it can be adopted as a platform for exploring MABS parameters and as a reference implementation for comparing against

  1. Technical Note: PLASTIMATCH MABS, an open source tool for automatic image segmentation

    Energy Technology Data Exchange (ETDEWEB)

    Zaffino, Paolo; Spadea, Maria Francesca [Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro 88100 (Italy); Raudaschl, Patrik; Fritscher, Karl [Institute for Biomedical Image Analysis, Private University of Health Sciences, Medical Informatics and Technology, Hall in Tirol 6060 (Austria); Sharp, Gregory C. [Department for Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114 (United States)

    2016-09-15

    Purpose: Multiatlas based segmentation is largely used in many clinical and research applications. Due to its good performances, it has recently been included in some commercial platforms for radiotherapy planning and surgery guidance. Anyway, to date, a software with no restrictions about the anatomical district and image modality is still missing. In this paper we introduce PLASTIMATCH MABS, an open source software that can be used with any image modality for automatic segmentation. Methods: PLASTIMATCH MABS workflow consists of two main parts: (1) an offline phase, where optimal registration and voting parameters are tuned and (2) an online phase, where a new patient is labeled from scratch by using the same parameters as identified in the former phase. Several registration strategies, as well as different voting criteria can be selected. A flexible atlas selection scheme is also available. To prove the effectiveness of the proposed software across anatomical districts and image modalities, it was tested on two very different scenarios: head and neck (H&N) CT segmentation for radiotherapy application, and magnetic resonance image brain labeling for neuroscience investigation. Results: For the neurological study, minimum dice was equal to 0.76 (investigated structures: left and right caudate, putamen, thalamus, and hippocampus). For head and neck case, minimum dice was 0.42 for the most challenging structures (optic nerves and submandibular glands) and 0.62 for the other ones (mandible, brainstem, and parotid glands). Time required to obtain the labels was compatible with a real clinical workflow (35 and 120 min). Conclusions: The proposed software fills a gap in the multiatlas based segmentation field, since all currently available tools (both for commercial and for research purposes) are restricted to a well specified application. Furthermore, it can be adopted as a platform for exploring MABS parameters and as a reference implementation for comparing against

  2. Effects of filtering methods on muscle and fat cross-sectional area measurement by pQCT: a technical note

    International Nuclear Information System (INIS)

    Sherk, Vanessa D; Bemben, Michael G; Palmer, Ian J; Bemben, Debra A

    2011-01-01

    Peripheral quantitative computed tomography (pQCT) is most commonly used for bone density and morphology assessment of the limbs, but it can also be used for soft tissue area quantification by segmenting regions representing different tissues. Scanning and analyzing cross-sectional areas of larger thighs present a special challenge due to increased statistical noise created from fewer detected x-ray photons. The purpose of this technical note is to compare total, muscle and fat cross-sectional area (CSA) measurements of the midthigh with Stratec 3000 pQCT scans using no filter, a weak smoothing filter and a strong smoothing filter to CSA measurements of midthigh MRI scans analyzed by Image J, a public domain image processing program. Nine healthy men and women participated in this study. CSAs did not differ significantly between MRI and strongly filtered pQCT images with per cent differences ranging from −3.1% for muscle to +6.5% for fat. The per cent difference in muscle CSA values between MRI and pQCT with the weak filter (−24.0 ± 38.0%) or no filter (−44.9 ± 22.7%) was strongly related to total thigh CSA (r = 0.78–0.92, p < 0.05). We propose that the midthigh can be assessed for soft tissue area measurements with pQCT, provided that strong smoothing filter is utilized. (note)

  3. Technical Note: Experimental results from a prototype high-field inline MRI-linac

    Energy Technology Data Exchange (ETDEWEB)

    Liney, G. P., E-mail: gary.liney@sswahs.nsw.gov.au [Department of Medical Physics, Ingham Institute for Applied Medical Research, Liverpool NSW 2170 (Australia); Dong, B.; Zhang, K. [Department of Medical Physics, Ingham Institute for Applied Medical Research, Liverpool NSW 2170 (Australia); and others

    2016-09-15

    Purpose: The pursuit of real-time image guided radiotherapy using optimal tissue contrast has seen the development of several hybrid magnetic resonance imaging (MRI)-treatment systems, high field and low field, and inline and perpendicular configurations. As part of a new MRI-linac program, an MRI scanner was integrated with a linear accelerator to enable investigations of a coupled inline MRI-linac system. This work describes results from a prototype experimental system to demonstrate the feasibility of a high field inline MR-linac. Methods: The magnet is a 1.5 T MRI system (Sonata, Siemens Healthcare) was located in a purpose built radiofrequency (RF) cage enabling shielding from and close proximity to a linear accelerator with inline (and future perpendicular) orientation. A portable linear accelerator (Linatron, Varian) was installed together with a multileaf collimator (Millennium, Varian) to provide dynamic field collimation and the whole assembly built onto a stainless-steel rail system. A series of MRI-linac experiments was performed to investigate (1) image quality with beam on measured using a macropodine (kangaroo) ex vivo phantom; (2) the noise as a function of beam state measured using a 6-channel surface coil array; and (3) electron contamination effects measured using Gafchromic film and an electronic portal imaging device (EPID). Results: (1) Image quality was unaffected by the radiation beam with the macropodine phantom image with the beam on being almost identical to the image with the beam off. (2) Noise measured with a surface RF coil produced a 25% elevation of background intensity when the radiation beam was on. (3) Film and EPID measurements demonstrated electron focusing occurring along the centerline of the magnet axis. Conclusions: A proof-of-concept high-field MRI-linac has been built and experimentally characterized. This system has allowed us to establish the efficacy of a high field inline MRI-linac and study a number of the technical

  4. Technical Aspects on the Use of Ultrasonic Bone Shaver in Spine Surgery: Experience in 307 Patients

    Directory of Open Access Journals (Sweden)

    Derya Burcu Hazer

    2016-01-01

    Full Text Available Aim. We discuss technical points, the safety, and efficacy of ultrasonic bone shaver in various spinal surgeries within our own series. Methods. Between June 2010 and January 2014, 307 patients with various spinal diseases were operated on with the use of an ultrasonic bone curette with microhook shaver (UBShaver. Patients’ data were recorded and analyzed retrospectively. The technique for the use of the device is described for each spine surgery procedure. Results. Among the 307 patients, 33 (10.7% cases had cervical disorder, 17 (5.5% thoracic disorder, 3 (0.9% foramen magnum disorder, and 254 (82.7% lumbar disorders. Various surgical techniques were performed either assisted or alone by UBShaver. The duration of the operations and the need for blood replacement were relatively low. The one-year follow-up with Neck Disability Index (NDI and Oswestry Disability Index (ODI scores were improved. We had 5 cases of dural tears (1.6% in patients with lumbar spinal disease. No neurological deficit was found in any patients. Conclusion. We recommend this device as an assistant tool in various spine surgeries and as a primary tool in foraminotomies. It is a safe device in spine surgery with very low complication rate.

  5. Early assessment of feasibility and technical specificities of transoral robotic surgery using the da Vinci Xi.

    Science.gov (United States)

    Gorphe, Philippe; Von Tan, Jean; El Bedoui, Sophie; Hartl, Dana M; Auperin, Anne; Qassemyar, Quentin; Moya-Plana, Antoine; Janot, François; Julieron, Morbize; Temam, Stephane

    2017-12-01

    The latest generation Da Vinci ® Xi™ Surgical System Robot released has not been evaluated to date in transoral surgery for head and neck cancers. We report here the 1-year results of a non-randomized phase II multicentric prospective trial aimed at assessing its feasibility and technical specificities. Our primary objective was to evaluate the feasibility of transoral robotic surgery using the da Vinci ® Xi™ Surgical System Robot. The secondary objective was to assess peroperative outcomes. Twenty-seven patients, mean age 62.7 years, were included between May 2015 and June 2016 with tumors affecting the following sites: oropharynx (n = 21), larynx (n = 4), hypopharynx (n = 1), parapharyngeal space (n = 1). Eighteen patients were included for primary treatment, three for a local recurrence, and six for cancer in a previously irradiated field. Three were reconstructed with a FAMM flap and 6 with a free ALT flap. The mean docking time was 12 min. "Chopsticking" of surgical instruments was very rare. During hospitalization following surgery, 3 patients experienced significant bleeding between day 8 and 9 that required surgical transoral hemostasis (n = 1) or endovascular embolization (n = 2). Transoral robotic surgery using the da Vinci ® Xi™ Surgical System Robot proved feasible with technological improvements compared to previous generation surgical system robots and with a similar postoperative course. Further technological progress is expected to be of significant benefit to the patients.

  6. A National Needs Assessment to Identify Technical Procedures in Vascular Surgery for Simulation Based Training.

    Science.gov (United States)

    Nayahangan, L J; Konge, L; Schroeder, T V; Paltved, C; Lindorff-Larsen, K G; Nielsen, B U; Eiberg, J P

    2017-04-01

    Practical skills training in vascular surgery is facing challenges because of an increased number of endovascular procedures and fewer open procedures, as well as a move away from the traditional principle of "learning by doing." This change has established simulation as a cornerstone in providing trainees with the necessary skills and competences. However, the development of simulation based programs often evolves based on available resources and equipment, reflecting convenience rather than a systematic educational plan. The objective of the present study was to perform a national needs assessment to identify the technical procedures that should be integrated in a simulation based curriculum. A national needs assessment using a Delphi process was initiated by engaging 33 predefined key persons in vascular surgery. Round 1 was a brainstorming phase to identify technical procedures that vascular surgeons should learn. Round 2 was a survey that used a needs assessment formula to explore the frequency of procedures, the number of surgeons performing each procedure, risk and/or discomfort, and feasibility for simulation based training. Round 3 involved elimination and ranking of procedures. The response rate for round 1 was 70%, with 36 procedures identified. Round 2 had a 76% response rate and resulted in a preliminary prioritised list after exploring the need for simulation based training. Round 3 had an 85% response rate; 17 procedures were eliminated, resulting in a final prioritised list of 19 technical procedures. A national needs assessment using a standardised Delphi method identified a list of procedures that are highly suitable and may provide the basis for future simulation based training programs for vascular surgeons in training. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  7. {sup 23}Na-MRI of recurrent glioblastoma multiforme after intraoperative radiotherapy: technical note

    Energy Technology Data Exchange (ETDEWEB)

    Haneder, Stefan; Buesing, Karen A.; Schoenberg, Stefan O.; Ong, Melissa M. [Heidelberg University, Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Mannheim (Germany); Giordano, Frank A.; Wenz, Frederik [University of Heidelberg, Department of Radiation Oncology, University Medical Center Mannheim, Mannheim (Germany); Konstandin, Simon; Schad, Lothar R. [Heidelberg University, Computer Assisted Clinical Medicine, Mannheim (Germany); Brehmer, Stefanie; Schmiedek, Peter [Heidelberg University, Department of Neurosurgery, University Medical Center Mannheim, Mannheim (Germany)

    2015-03-01

    We report the first case of an intraoperative radiotherapy (IORT) in a patient with recurrent glioblastoma multiforme (GBM) who was followed up with a novel magnetic resonance imaging (MRI) method - {sup 23}Na-MRI - in comparison to a standard contrast-enhanced {sup 1}H-MRI and {sup 18}F-FET-PET. A 56-year-old female patient with diagnosed GBM in July 2012 underwent tumor resection, radiochemotherapy, and three cycles of chemotherapy. After a relapse, 6 months after the initial diagnosis, an IORT was recommended which was performed in March 2013 using the INTRABEAM system (Carl Zeiss Meditec AG, Germany) with a 3-cm applicator and a surface dose of 20 Gy. Early post-operative contrast-enhanced and 1-month follow-up {sup 1}H-MRI and a {sup 18}F-FET-PET were performed. In addition, an IRB-approved {sup 23}Na-MRI was performed on a 3.0-T MR scanner (MAGNETOM TimTrio, Siemens Healthcare, Germany). After re-surgery and IORT in March 2013, only a faint contrast enhancement but considerable surrounding edema was visible at the medio-posterior resection margins. In April 2013, new and progressive contrast enhancement, edema, {sup 23}Na content, and increased uptake in the {sup 18}F-FET-PET were visible, indicating tumor recurrence. Increased sodium content within the area of contrast enhancement was found in the {sup 23}Na-MRI, but also exceeding this area, very similar to the increased uptake depicted in the {sup 18}F-FET-PET. The clearly delineable zone of edema in both examinations exhibits a lower {sup 23}Na content compared to areas with suspected proliferating tumor tissue. {sup 23}Na-MRI provided similar information in the suspicious area compared to {sup 18}F-FET-PET, exceeding conventional {sup 1}H-MRI. Still, {sup 23}Na-MRI remains an investigational technique, which is worth to be further evaluated. (orig.)

  8. Technical Note: A deep learning-based autosegmentation of rectal tumors in MR images.

    Science.gov (United States)

    Wang, Jiazhou; Lu, Jiayu; Qin, Gan; Shen, Lijun; Sun, Yiqun; Ying, Hongmei; Zhang, Zhen; Hu, Weigang

    2018-04-16

    Manual contouring of gross tumor volumes (GTV) is a crucial and time-consuming process in rectum cancer radiotherapy. This study aims to develop a simple deep learning-based autosegmentation algorithm to segment rectal tumors on T2-weighted MR images. MRI scans (3T, T2-weighted) of 93 patients with locally advanced (cT3-4 and/or cN1-2) rectal cancer treated with neoadjuvant chemoradiotherapy followed by surgery were enrolled in this study. A 2D U-net similar network was established as a training model. The model was trained in two phases to increase efficiency. These phases were tumor recognition and tumor segmentation. An opening (erosion and dilation) process was implemented to smooth contours after segmentation. Data were randomly separated into training (90%) and validation (10%) datasets for a 10-folder cross-validation. Additionally, 20 patients were double contoured for performance evaluation. Four indices were calculated to evaluate the similarity of automated and manual segmentation, including Hausdorff distance (HD), average surface distance (ASD), Dice index (DSC), and Jaccard index (JSC). The DSC, JSC, HD, and ASD (mean ± SD) were 0.74 ± 0.14, 0.60 ± 0.16, 20.44 ± 13.35, and 3.25 ± 1.69 mm for validation dataset; and these indices were 0.71 ± 0.13, 0.57 ± 0.15, 14.91 ± 7.62, and 2.67 ± 1.46 mm between two human radiation oncologists, respectively. No significant difference has been observed between automated segmentation and manual segmentation considering DSC (P = 0.42), JSC (P = 0.35), HD (P = 0.079), and ASD (P = 0.16). However, significant difference was found for HD (P = 0.0027) without opening process. This study showed that a simple deep learning neural network can perform segmentation for rectum cancer based on MRI T2 images with results comparable to a human. © 2018 American Association of Physicists in Medicine.

  9. Technical Note: Approximate Bayesian parameterization of a process-based tropical forest model

    Science.gov (United States)

    Hartig, F.; Dislich, C.; Wiegand, T.; Huth, A.

    2014-02-01

    Inverse parameter estimation of process-based models is a long-standing problem in many scientific disciplines. A key question for inverse parameter estimation is how to define the metric that quantifies how well model predictions fit to the data. This metric can be expressed by general cost or objective functions, but statistical inversion methods require a particular metric, the probability of observing the data given the model parameters, known as the likelihood. For technical and computational reasons, likelihoods for process-based stochastic models are usually based on general assumptions about variability in the observed data, and not on the stochasticity generated by the model. Only in recent years have new methods become available that allow the generation of likelihoods directly from stochastic simulations. Previous applications of these approximate Bayesian methods have concentrated on relatively simple models. Here, we report on the application of a simulation-based likelihood approximation for FORMIND, a parameter-rich individual-based model of tropical forest dynamics. We show that approximate Bayesian inference, based on a parametric likelihood approximation placed in a conventional Markov chain Monte Carlo (MCMC) sampler, performs well in retrieving known parameter values from virtual inventory data generated by the forest model. We analyze the results of the parameter estimation, examine its sensitivity to the choice and aggregation of model outputs and observed data (summary statistics), and demonstrate the application of this method by fitting the FORMIND model to field data from an Ecuadorian tropical forest. Finally, we discuss how this approach differs from approximate Bayesian computation (ABC), another method commonly used to generate simulation-based likelihood approximations. Our results demonstrate that simulation-based inference, which offers considerable conceptual advantages over more traditional methods for inverse parameter estimation

  10. Technical Note: Approximate Bayesian parameterization of a complex tropical forest model

    Science.gov (United States)

    Hartig, F.; Dislich, C.; Wiegand, T.; Huth, A.

    2013-08-01

    Inverse parameter estimation of process-based models is a long-standing problem in ecology and evolution. A key problem of inverse parameter estimation is to define a metric that quantifies how well model predictions fit to the data. Such a metric can be expressed by general cost or objective functions, but statistical inversion approaches are based on a particular metric, the probability of observing the data given the model, known as the likelihood. Deriving likelihoods for dynamic models requires making assumptions about the probability for observations to deviate from mean model predictions. For technical reasons, these assumptions are usually derived without explicit consideration of the processes in the simulation. Only in recent years have new methods become available that allow generating likelihoods directly from stochastic simulations. Previous applications of these approximate Bayesian methods have concentrated on relatively simple models. Here, we report on the application of a simulation-based likelihood approximation for FORMIND, a parameter-rich individual-based model of tropical forest dynamics. We show that approximate Bayesian inference, based on a parametric likelihood approximation placed in a conventional MCMC, performs well in retrieving known parameter values from virtual field data generated by the forest model. We analyze the results of the parameter estimation, examine the sensitivity towards the choice and aggregation of model outputs and observed data (summary statistics), and show results from using this method to fit the FORMIND model to field data from an Ecuadorian tropical forest. Finally, we discuss differences of this approach to Approximate Bayesian Computing (ABC), another commonly used method to generate simulation-based likelihood approximations. Our results demonstrate that simulation-based inference, which offers considerable conceptual advantages over more traditional methods for inverse parameter estimation, can

  11. A National Needs Assessment to Identify Technical Procedures in Vascular Surgery for Simulation Based Training

    DEFF Research Database (Denmark)

    Nayahangan, L J; Konge, L; Schroeder, T V

    2017-01-01

    to identify technical procedures that vascular surgeons should learn. Round 2 was a survey that used a needs assessment formula to explore the frequency of procedures, the number of surgeons performing each procedure, risk and/or discomfort, and feasibility for simulation based training. Round 3 involved...... eliminated, resulting in a final prioritised list of 19 technical procedures. Conclusion A national needs assessment using a standardised Delphi method identified a list of procedures that are highly suitable and may provide the basis for future simulation based training programs for vascular surgeons......Objectives and background Practical skills training in vascular surgery is facing challenges because of an increased number of endovascular procedures and fewer open procedures, as well as a move away from the traditional principle of “learning by doing.” This change has established simulation...

  12. Introduction of a fresh cadaver laboratory during the surgery clerkship improves emergency technical skills.

    Science.gov (United States)

    Nematollahi, Saman; Kaplan, Stephen J; Knapp, Christopher M; Ho, Hang; Alvarado, Jared; Viscusi, Rebecca; Adamas-Rappaport, William

    2015-08-01

    Student acquisition of technical skills during the clinical years of medical school has been steadily declining. To address this issue, the authors instituted a fresh cadaver-based Emergency Surgical Skills Laboratory (ESSL). Sixty-three medical students rotating through the third-year surgery clerkship participated in a 2-hour, fresh cadaver-based ESSL conducted during the first 2 days of the clerkship. The authors evaluated students utilizing both surgical skills and written examination before the ESSL and at 4 weeks post ESSL. Students demonstrated a mean improvement of 64% (±11) (P cadaver laboratory is an effective method to provide proficiency in emergency technical skills not acquired during the clinical years of medical school. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Correlates of non-technical skills in surgery: a prospective study.

    Science.gov (United States)

    Gillespie, Brigid M; Harbeck, Emma; Kang, Evelyn; Steel, Catherine; Fairweather, Nicole; Chaboyer, Wendy

    2017-01-30

    Communication and teamwork failures have frequently been identified as the root cause of adverse events and complications in surgery. Few studies have examined contextual factors that influence teams' non-technical skills (NTS) in surgery. The purpose of this prospective study was to identify and describe correlates of NTS. We assessed NTS of teams and professional role at 2 hospitals using the revised 23-item Non-TECHnical Skills (NOTECHS) and its subscales (communication, situational awareness, team skills, leadership and decision-making). Over 6 months, 2 trained observers evaluated teams' NTS using a structured form. Interobserver agreement across hospitals ranged from 86% to 95%. Multiple regression models were developed to describe associations between operative time, team membership, miscommunications, interruptions, and total NOTECHS and subscale scores. We observed 161 surgical procedures across 8 teams. The total amount of explained variance in NOTECHS and its 5 subscales ranged from 14% (adjusted R 2 0.12, p<0.001) to 24% (adjusted R 2 0.22, p<0.001). In all models, inverse relationships between the total number of miscommunications and total number of interruptions and teams' NTS were observed. Miscommunications and interruptions impact on team NTS performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  14. Technical skills acquisition in surgery-bound senior medical students: an evaluation of student assertiveness.

    Science.gov (United States)

    Talbott, Vanessa A; Marks, Joshua A; Bodzin, Adam S; Comeau, Jason A; Maxwell, Pinckney J; Isenberg, Gerald A; Martin, Niels D

    2012-01-01

    To prepare students pursuing surgical careers, we devised a senior subinternship curriculum supplement that focused on the acquisition of technical skills required of surgical residents. We hypothesized that more assertive students, those that accomplished more of the curriculum, would perform better on a technical skills Objective Structured Clinical Examination (OSCE). Senior medical students rotating on their first general surgery subinternship were administered a 6-station OSCE on the first day of their subinternship and again during the final week of the month-long rotation. A self-directed, 38-task "scavenger hunt" representing common intern level clinical skills, procedures, and patient care activities was provided to each student. The study was performed at Jefferson Medical College, a large, private medical school in Philadelphia, PA. Forty-nine senior students completed surgical subinternships between July 2009 and September 2010, and participated both in the pre-/post-OSCEs and the scavenger hunt. Students performed significantly better on the post-rotation OSCE than on the pre-rotation OSCE; 70.2% ± 8.1% vs. 60.4% ± 12.0%, p Assertiveness scores from the "scavenger hunt" did not correlate with final OSCE scores (r = -0.328, p = 0.25), and were negatively correlated with the change between pre- and post-OSCE scores (r = -0.573, p assertiveness scores were determined by the number of tasks completed over the course of the rotation. As surgical education becomes more streamlined with evolving work hour restrictions, medical school education is playing an increasingly pivotal role in preparing students for internship. In our study, individual assertiveness in completing structured self-directed learning tasks did not directly predict the acquisition of proficiency in technical skills. We feel assertiveness is overshadowed by other factors that may carry more weight in terms of technical skills acquisition. Further studies are required to delineate these

  15. A Technical Note

    African Journals Online (AJOL)

    naturally to become Ulanzi, the highly cherished alcoholic drink by the people in the vicinities and some townships. There are three main problems associated with traditional production of Ulanzi. First, the handling conditions of the product from production to consumption are unhygienic, secondly, there are large price ...

  16. A Technical Note

    African Journals Online (AJOL)

    2Department of Food Science and Technology Sokoine University of ... Key words: Traditional foods, bamboo juice, Oxytenanthera abysinica~ .... No 14. February 1993, IDRC- South Asia ... contributed to the fast sales given that the sensory.

  17. Computer-simulation movie of ionospheric electric fields and currents for a magnetospheric substorm life cycle. Technical note

    International Nuclear Information System (INIS)

    Kamide, Y.; Matsushita, S.

    1980-07-01

    Numerical solution of the current conservation equation gives the distributions of electric fields and currents in the global ionosphere produced by the field-aligned currents. By altering ionospheric conductivity distributions as well as the field-aligned current densities and configurations to simulate a magnetospheric substorm life cycle, which is assumed to last for five hours, various patterns of electric fields and currents are computed for every 30-second interval in the life cycle. The simulated results are compiled in the form of a color movie, where variations of electric equi-potential curves are the first sequence, electric current-vector changes are the second, and fluctuations of the electric current system are the third. The movie compresses real time by a factor of 1/180, taking 1.7 minutes of running time for one sequence. One of the most striking features of this simulation is the clear demonstration of rapid and large scale interactions between the auroral zone and middle-low latitudes during the substorm sequences. This technical note provides an outline of the numerical scheme and world-wide contour maps of the electric potential, ionospheric current vectors, and the equivalent ionospheric current system at 5-minute intervals as an aid in viewing the movie and to further detailed study of the 'model' substorms

  18. Clinically Relevant Subregions of Articular Cartilage of the Hip for Analysis and Reporting Quantitative Magnetic Resonance Imaging: A Technical Note.

    Science.gov (United States)

    Surowiec, Rachel K; Lucas, Erin P; Wilson, Katharine J; Saroki, Adriana J; Ho, Charles P

    2014-01-01

    Before quantitative imaging techniques can become clinically valuable, the method, and more specifically, the regions of locating and reporting these values should be standardized toward reproducibility comparisons across centers and longitudinal follow-up of individual patients. The purpose of this technical note is to describe a rigorous and reproducible method of locating, analyzing, and reporting quantitative MRI values in hip articular cartilage with an approach that is consistent with current orthopedic literature. To demonstrate this localization and documentation, 3 patients (age, 23 ± 5.1 years; 2 males, 1 female) who presented with symptomatic mixed-type femoroacetabular impingement (α angle, 63.3° ± 2.1°; center edge angle, 39° ± 4.2°) were evaluated with T2-mapping at 3 T MRI prior to hip arthroscopy. Manual segmentation was performed and cartilage of the acetabulum and femur was divided into 12 subregions adapted from the geographic zone method. Bone landmarks in the acetabulum and femur, identifiable both in arthroscopy and MR images, were manually selected and the coordinates exported for division of cartilage. Mean T2 values in each zone are presented. The current work outlines a standardized system to locate and describe quantitative mapping values that could aid in surgical decision making, planning, and the noninvasive longitudinal follow-up of implemented cartilage preservation and restoration techniques.

  19. Evaluation of a technical and nontechnical skills curriculum for students entering surgery.

    Science.gov (United States)

    Shipper, Edward S; Miller, Sarah E; Hasty, Brittany N; Merrell, Sylvia Bereknyei; Lin, Dana T; Lau, James N

    2017-11-01

    Prior interventions to address declining interest in surgical careers have focused on creating early exposure and fostering mentorship at the preclinical medical student level. Navigating the surgical environment can be challenging, however, and preclinical students may be more likely to pursue a surgical career if they are given the tools to function optimally. We designed a 10-wk technical and nontechnical skills curriculum to provide preclinical students with knowledge and skills necessary to successfully navigate the surgical learning environment, followed by placement in high-fidelity surgical simulations and scrubbing in on operative cases with attending surgeons. We administered pre-post surveys to assess student confidence levels in operative skills, self-perceptions of having a mentor, overall course efficacy, and interest in a career in surgery. The overall response rates presurvey and postsurvey were 100% (30 of 30) and 93.3% (28 of 30), respectively. Confidence levels across all operative skills increased significantly after completing the course. Faculty mentorship increased significantly from 30.0% before to 61.5% after the course. Overall effectiveness of the course was 4.00 of 5 (4 = "very effective"), and although insignificant, overall interest in a career in surgery increased at the completion of the course from 3.77 (standard deviation = 1.01) to 4.17 (standard deviation = 0.94). Our curriculum was effective in teaching the skills necessary to enjoy positive experiences in planned early exposure and mentorship activities. Further study is warranted to determine if this intervention leads to an increase in students who formally commit to a career in surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Technical note: Analysis of claims and disputes in contracts for oil and gas development projects in Iran with solutions

    Directory of Open Access Journals (Sweden)

    Fathollah Sajedi

    2017-08-01

    Full Text Available Contracts for oil and gas development projects are naturally complex, they are explained with some of maps and technical specifications. To supply the goals of contracts, it is necessary to construct by a team having owner, consulting engineer and contractor. The unique aspects of each project and team working are resulting to disagreements. It should be noted that the majority of team workers have not previously worked together. It may not be expected to forecast all project aspects in design and preparation of tender documents process. However, in some cases it will occur inconsistencies in contract documents and possibly may be disagreements on commentary of the cases which there are in the provisions of the contract. Every root of disagreement resulted in to claim and finally dispute. Lack of foresight and/or existing ambiguous texts in some provisions of contract, not being aware of components of the project to conditions and obligations and rules of contract will complex and sometimes impossible the agreement on implementation problems. Therefore, the claims will be resulted in disputes and inflict financial losses to contractors and/or owners and then the projects will not be completed. In Iran many activities have not been carried out about claims and disputes in different orientations especially in areas futures and hence, it was studied in this research. Firstly, research history was considered and the causes of claims and disputes were identified in process of different levels of oil projects construction from primary to exploitation and then a questionnaire was prepared using the comments of experts. Finally, the questionnaire was analysed by SPSS and the approved factors in creation of claims and disputes and in their roots were ranked.

  1. Are 2 Years Enough? Exploring Technical Skills Acquisition Among General Surgery Residents in Brazil.

    Science.gov (United States)

    Santos, Elizabeth G; Salles, Gil F

    2016-01-01

    Phenomenon: Recent studies have shown that up to 40% of the General Surgery (GS) residents are not confident with their surgical skills. There is concern that residents are at risk of receiving inadequate training due to the low number of operations they perform. In Brazil, although all GS residents receive by law the Board Certification at the end of their programs, the assessment of their technical skills is not mandatory in Medical Residency programs' training. Consequently, our concern was that current GS medical residency format might be insufficient to create competent and autonomous general surgery residents after 2 years of regular training. Hence, the aim was to assess GS residents' surgical skills in their final months of training to evaluate the present format of GS residency programs in Brazil. Trained surgical faculty members directly observed 11 operations of varying difficulty performed by 2nd-year regular GS residents and by 4th-year residents in the optional Advanced Program in General Surgery. Participants were located at 3 university and 3 nonuniversity hospitals in Rio de Janeiro and Sao Paulo (Brazil's largest cities). Surgical skills were assessed using an internally developed observation checklist reviewed by subject matter experts. Sixty residents (46 regular 2nd-year trainees and 14 advanced 4th-year trainees) were assessed on performing 499 operations. Only 10 residents (17%), all advanced 4th-year residents, satisfactorily performed all operations and were considered eligible for the Board Certification. Even after excluding the 2 operations of greatest difficulty, only 24 regular 2nd-year residents (52%) satisfactorily performed the other 9 operations. Residents from hospitals with open Emergency Departments performed better than those from hospitals without Emergency Departments. Insights: The results of this pilot study suggest that residents with 2 years of training are not prepared for independent high-level surgical practice. The

  2. Intraoperative adverse events can be compensated by technical performance in neonates and infants after cardiac surgery: a prospective study.

    Science.gov (United States)

    Nathan, Meena; Karamichalis, John M; Liu, Hua; del Nido, Pedro; Pigula, Frank; Thiagarajan, Ravi; Bacha, Emile A

    2011-11-01

    Our objective was to define the relationship between surgical technical performance score, intraoperative adverse events, and major postoperative adverse events in complex pediatric cardiac repairs. Infants younger than 6 months were prospectively followed up until discharge from the hospital. Technical performance scores were graded as optimal, adequate, or inadequate based on discharge echocardiograms and need for reintervention after initial surgery. Case complexity was determined by Risk Adjustment in Congenital Heart Surgery (RACHS-1) category, and preoperative illness severity was assessed by Pediatric Risk of Mortality (PRISM) III score. Intraoperative adverse events were prospectively monitored. Outcomes were analyzed using nonparametric methods and a logistic regression model. A total of 166 patients (RACHS 4-6 [49%]), neonates [50%]) were observed. Sixty-one (37%) had at least 1 intraoperative adverse event, and 47 (28.3%) had at least 1 major postoperative adverse event. There was no correlation between intraoperative adverse events and RACHS, preoperative PRISM III, technical performance score, or postoperative adverse events on multivariate analysis. For the entire cohort, better technical performance score resulted in lower postoperative adverse events, lower postoperative PRISM, and lower length of stay and ventilation time (P events, including surgical revisions, provided technical performance score is at least adequate. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  3. A socio-technical, probabilistic risk assessment model for surgical site infections in ambulatory surgery centers.

    Science.gov (United States)

    Bish, Ebru K; El-Amine, Hadi; Steighner, Laura A; Slonim, Anthony D

    2014-10-01

    To understand how structural and process elements may affect the risk for surgical site infections (SSIs) in the ambulatory surgery center (ASC) environment, the researchers employed a tool known as socio-technical probabilistic risk assessment (ST-PRA). ST-PRA is particularly helpful for estimating risks in outcomes that are very rare, such as the risk of SSI in ASCs. Study objectives were to (1) identify the risk factors associated with SSIs resulting from procedures performed at ASCs and (2) design an intervention to mitigate the likelihood of SSIs for the most common risk factors that were identified by the ST-PRA for a particular surgical procedure. ST-PRA was used to study the SSI risk in the ASC setting. Both quantitative and qualitative data sources were utilized, and sensitivity analysis was performed to ensure the robustness of the results. The event entitled "fail to protect the patient effectively" accounted for 51.9% of SSIs in the ambulatory care setting. Critical components of this event included several failure risk points related to skin preparation, antibiotic administration, staff training, proper response to glove punctures during surgery, and adherence to surgical preparation rules related to the wearing of jewelry, watches, and artificial nails. Assuming a 75% reduction in noncompliance on any combination of 2 of these 5 components, the risk for an SSI decreased from 0.0044 to between 0.0027 and 0.0035. An intervention that targeted the 5 major components of the major risk point was proposed, and its implications were discussed.

  4. Austria; Financial Sector Assessment Program Update Technical Note: Factual Update and Analysis of the IOSCO Objectives and Principles of Securities Regulation

    OpenAIRE

    International Monetary Fund

    2008-01-01

    This technical note focuses on the International Organization of Securities Commissions objectives and principles of securities regulations of Austria. The 2003 assessment found that Austria had fully broadly implemented a large majority of principles. The human resources of the Securities Supervision Department of the Financial Market Authority (FMA) should be increased, especially to conduct on-site inspections, in addition to the 14 planned appointments. Administrative fines should be rais...

  5. Technical procedures for template-guided surgery for mandibular reconstruction based on digital design and manufacturing.

    Science.gov (United States)

    Liu, Yun-feng; Xu, Liang-wei; Zhu, Hui-yong; Liu, Sean Shih-Yao

    2014-05-23

    The occurrence of mandibular defects caused by tumors has been continuously increasing in China in recent years. Conversely, results of the repair of mandibular defects affect the recovery of oral function and patient appearance, and the requirements for accuracy and high surgical quality must be more stringent. Digital techniques--including model reconstruction based on medical images, computer-aided design, and additive manufacturing--have been widely used in modern medicine to improve the accuracy and quality of diagnosis and surgery. However, some special software platforms and services from international companies are not always available for most of researchers and surgeons because they are expensive and time-consuming. Here, a new technical solution for guided surgery for the repair of mandibular defects is proposed, based on general popular tools in medical image processing, 3D (3 dimension) model reconstruction, digital design, and fabrication via 3D printing. First, CT (computerized tomography) images are processed to reconstruct the 3D model of the mandible and fibular bone. The defect area is then replaced by healthy contralateral bone to create the repair model. With the repair model as reference, the graft shape and cutline are designed on fibular bone, as is the guide for cutting and shaping. The physical model, fabricated via 3D printing, including surgical guide, the original model, and the repair model, can be used to preform a titanium locking plate, as well as to design and verify the surgical plan and guide. In clinics, surgeons can operate with the help of the surgical guide and preformed plate to realize the predesigned surgical plan. With sufficient communication between engineers and surgeons, an optimal surgical plan can be designed via some common software platforms but needs to be translated to the clinic. Based on customized models and tools, including three surgical guides, preformed titanium plate for fixation, and physical models of

  6. Cirurgia por orifícios naturais transcolônica: acesso NOTES peri-retal (PNA para excisão mesoretal total Transcolonic natural orifice surgery: peri-rectal NOTES access (PNA for total mesorectal excision

    Directory of Open Access Journals (Sweden)

    Ricardo Zorron

    2010-03-01

    Full Text Available OBJETIVOS: Cirurgia por orifícios naturais tem sido recentemente aplicada em series clínicas para cirurgia abdominal. Apesar de potenciais vantagens do acesso NOTES transcolônico para doenças colorretais, este ainda não havia sido utilizado clinicamente. O presente trabalho descreve a primeira aplicação bem-sucedida de NOTES transcolônico da literatura, em uma nova abordagem de excisão mesoretal total (TME para cancer de reto. MÉTODOS: Foi obtida aprovação de Comitê de Ética em Pesquisa para cirurgias por orifícios naturais, e o paciente assinou termo de consentimento informado. Em um paciente de 54 anos portador de adenocarcinoma de reto, o procedimento de retossigmoidectomia e linfadenectomia, com excisão mesoretal total foi realizada utilizando um acesso posterior transcolônico pouco acima da borda anal. A dissecção mesorretal foi conseguida utilizando um colonoscópio flexível e instrumentos endoscópicos, com assistência laparoscópica. O espécime foi retirado via transanal, e anastomose foi transorificial, com estoma proximal de proteção. RESULTADOS: O tempo operatório foi de 350 min, não ocorrendo complicações operatórias. A evolução pós-operatória foi favorável, e o paciente recebeu alta no sexto dia de pós-operatório com dieta plena. CONCLUSÃO: Este primeiro relato bem sucedido de cirurgia NOTES transcolônica traz potencialmente novas fronteiras de aplicações clínicas na cirurgia minimamente invasiva. O tratamento de doenças colorretais utilizando o novo acesso flexível PNA (Perirectal NOTES Access é uma promissora nova abordagem, paralelamente à laparoscopia e cirurgia aberta, para melhoria do tratamento dos pacientes.OBJECTIVES: Clinical natural orifice surgery has been applied for abdominal surgery in recent years. Despite potential advantages of transcolonic NOTES for colorectal diseases, it was since now not yet clinically applied. The study describes the first successful human

  7. SPIDER ® sleeve gastrectomy--a new concept in single-trocar bariatric surgery: initial experience and technical details.

    Science.gov (United States)

    Noel, P; Nedelcu, M; Gagner, M

    2014-04-01

    Single port instrument delivery extended reach (SPIDER(®)) surgical system is a revolutionary surgical platform that allows triangulation of the surgical instruments while eliminating the crossing of instruments, the problematic characteristic of single access laparoscopic surgery. The purpose of this study was to analyze our initial experience with SPIDER(®) sleeve gastrectomy and to present the technical details of this new minimally invasive approach, performed in ten patients at the La Casamance Private Hospital between November 2012 and April 2013. All patients were reviewed at scheduled post-operative consultations at 1, 3 and 6 months. In addition to clinical examination, the post-operative consultation at one month also included a satisfaction survey using the Moorehead-Ardelt questionnaire. An initial series of ten sleeve gastrectomies were performed in female patients with a mean age of 41.5 years (range: 2-52). The mean BMI was 40.11 (range: 37.25-44.3). The intervention was performed through a single trocar in all patients with no "conversion" to classic laparoscopy or open surgery. The mean operative time was 61 ± 15.22 minutes (SD=standard deviation) (range: 43-96 min). The mean BMI at one month was 35.5 (SD:± 3.58, SEM: ± 1.13) (SEM=standard error of mean) with an average percentage of excess weight loss (%EWL) of 32.9% (SD:± 8.56%, SEM:± 2.71%). The mean BMI at three months was 32.4 (SD: ± 2.78, SEM: ± 0.88) with an average %EWL of 52.7% (SD: ± 8.64%, SEM: ± 2.73%). The mean BMI at six months was 29.9 (SD:± 2.60, SEM: ± 0.98) with a mean %EWL of 68.8% (SD: ± 8.38%, SEM:± 3.17%). Complete remission of co-morbid conditions was observed in four patients, improvement in three others, and no change in a single patient. The mean duration of hospitalization was 3.1 days. The mean follow-up period was 161 days (SD:± 57.4 days, range: 90-243 days). There was no mortality and no intra-operative and post-operative complications were noted. The

  8. Transsphenoidal surgery in patients with acromegaly: operative strategies for overcoming technically challenging anatomical variations.

    Science.gov (United States)

    Zada, Gabriel; Cavallo, Luigi M; Esposito, Felice; Fernandez-Jimenez, Julio Cesar; Tasiou, Anastasia; De Angelis, Michelangelo; Cafiero, Tullio; Cappabianca, Paolo; Laws, Edward R

    2010-10-01

    In addition to difficulties with anesthetic and medical management, transsphenoidal operations in patients with longstanding acromegaly are associated with inherent intraoperative challenges because of anatomical variations that occur frequently in these patients. The object of this study was to review the overall safety profile and anatomical/technical challenges associated with transsphenoidal surgery in patients with acromegaly. The authors performed a retrospective analysis of 169 patients who underwent endoscopic transsphenoidal operations for growth hormone-secreting adenomas to assess the incidence of surgical complications. A review of frequently occurring anatomical challenges and operative strategies employed during each phase of the operation to address these particular issues was performed. Of 169 cases reviewed, there was no perioperative mortality. Internal carotid artery injury occurred in 1 patient (0.6%) with complex sinus anatomy, who remained neurologically intact following endovascular unilateral carotid artery occlusion. Other complications included: significant postoperative epistaxis (5 patients [3%]), transient diabetes insipidus (5 patients [3%]), delayed symptomatic hyponatremia (4 patients [2%]), CSF leak (2 patients [1%]), and pancreatitis (1 patient [0.6%]). Preoperative considerations in patients with acromegaly should include a cardiopulmonary evaluation and planning regarding intubation and other aspects of the anesthetic technique. During the nasal phase of the transsphenoidal operation, primary challenges include maintaining adequate visualization and hemostasis, which is frequently compromised by redundant, edematous nasal mucosa and bony hypertrophy of the septum and the nasal turbinates. During the sphenoid phase, adequate bony removal, optimization of working space, and correlation of imaging studies to intraoperative anatomy are major priorities. The sellar phase is frequently challenged by increased sellar floor thickness

  9. Reduced-port robotic total mesorectal resection for rectal cancer using a single-port access: a technical note.

    Science.gov (United States)

    Bae, Sung Uk; Jeong, Woon Kyung; Baek, Seong Kyu

    2017-12-01

    Single-port laparoscopic surgery has some advantages, including improved cosmetic outcomes and minimized parietal trauma. However, pure single-port laparoscopic rectal cancer surgery is challenging because of the difficulties in creating triangulation and applying the laparoscopic staplers with sufficient distal margins in the narrow pelvic cavity. Recently, a reduced-port robotic operation with a robotic single-port access plus one wristed robotic arm for colon cancer was introduced to overcome the limitations of single-port laparoscopic rectal surgery. Single-port laparoscopic surgery has some advantages, including improved cosmetic outcomes and minimized parietal trauma. However, the pure single-port laparoscopic rectal cancer operation is challenging. Recently, a reduced-port robotic operation with a robotic single-port access plus one wristed robotic arm for colon cancer was introduced to overcome the limitations of single-port laparoscopic rectal surgery. We performed a single-port plus an additional port robotic operation using a robotic single-port access through the umbilical incision, and the wristed robotic instruments were inserted through an additional robotic port in the right lower quadrant. The total operative and docking times were 310 min and 25 min, respectively. The total number of lymph nodes harvested was 12, and the proximal and distal resection margins were 11.1 and 2 cm, respectively. The patient was discharged on postoperative day 12 uneventfully. Based on a representative case, reduced-port robotic total mesorectal excision for rectal cancer using the single-port access appears to be feasible and safe. This approach could overcome the limitations of single-port laparoscopic rectal surgery.

  10. Technical Note: The Effect of The Fed’s Quantitative Easing Policy on the Performance of Listed Companies and the Banking Sector in Indonesia

    Directory of Open Access Journals (Sweden)

    Yanuar Rizky

    2015-12-01

    Full Text Available Abstract While the efficient market hypothesis suggests that stock price reflects the fundamental condition of companies, which could affect investors’ decisions, this technical note reports empirical evidence that stock price is also influenced by the public’s perception of the market situation. This note shows that the source of funds circulating in the Indonesia Stock Exchange is related to excess liquidity resulting from the policy of quantitative easing (QE by developed countries’ central banks. Banks funding assets with debt results in leverage relationships with the Capital Adequacy Ratio (CAR negatively affected. Thus it is evident that the Indonesian banking strategy is "reactive" and is influenced by external factors. External factors can be influenced by global issues as well as internal (enterprise performance issues. Therefore foreign and global issues may be important (perhaps dominant in determining the perceptions of the Indonesian stock market.

  11. A guiding oblique osteotomy cut to prevent bad split in sagittal split ramus osteotomy: a technical note

    Directory of Open Access Journals (Sweden)

    Gururaj Arakeri

    2015-06-01

    Full Text Available Aim: To present a simple technical modification of a medial osteotomy cut which prevents its misdirection and overcomes various anatomical variations as well as technical problems. Methods: The medial osteotomy cut is modified in the posterior half at an angle of 15°-20° following novel landmarks. Results: The proposed cut exclusively directs the splitting forces downwards to create a favorable lingual fracture, preventing the possibility of an upwards split which would cause a coronoid or condylar fracture. Conclusion: This modification has proven to be successful to date without encountering the complications of a bad split or nerve damage.

  12. Development and validation of a tool for non-technical skills evaluation in robotic surgery-the ICARS system.

    Science.gov (United States)

    Raison, Nicholas; Wood, Thomas; Brunckhorst, Oliver; Abe, Takashige; Ross, Talisa; Challacombe, Ben; Khan, Mohammed Shamim; Novara, Giacomo; Buffi, Nicolo; Van Der Poel, Henk; McIlhenny, Craig; Dasgupta, Prokar; Ahmed, Kamran

    2017-12-01

    Non-technical skills (NTS) are being increasingly recognised as vital for safe surgical practice. Numerous NTS rating systems have been developed to support effective training and assessment. Yet despite the additional challenges posed by robotic surgery, no NTS rating systems have been developed for this unique surgical environment. This study reports the development and validation of the first NTS behavioural rating system for robotic surgery. A comprehensive index of all relevant NTS behaviours in robotic surgery was developed through observation of robotic theatre and interviews with robotic surgeons. Using a Delphi methodology, a panel of 16 expert surgeons was consulted to identify behaviours important to NTS assessment. These behaviours were organised into an appropriate assessment template. Experts were consulted on the feasibility, applicability and educational impact of ICARS. An observational trial was used to validate ICARS. 73 novice, intermediate and expert robotic surgeons completed a urethrovesical anastomosis within a simulated operating room. NTS were tested using four scripted scenarios of increasing difficulty. Performances were video recorded. Robotic and NTS experts assessed the videos post hoc using ICARS and the standard behavioural rating system, NOn-Technical Skills for Surgeons (NOTSS). 28 key non-technical behaviours were identified by the expert panel. The finalised behavioural rating system was organised into four principle domains and seven categories. Expert opinion strongly supported its implementation. ICARS was found to be equivalent to NOTSS on Bland-Altman analysis and accurately differentiated between novice, intermediate and expert participants, p = 0.01. Moderate agreement was found between raters, Krippendorff's alpha = 0.4. The internal structure of ICARS was shown to be consistent and reliable (median Cronbach alpha = 0.92, range 0.85-0.94). ICARS is the first NTS behavioural rating system developed for robotic

  13. Design of a box trainer for objective assessment of technical skills in single-port surgery

    NARCIS (Netherlands)

    Horeman, Tim; Sun, Siyu; Tuijthof, Gabrielle J. M.; Jansen, Frank William; Meijerink, Jeroen W. J. H. J.; Dankelman, Jenny

    2015-01-01

    Laparoscopic single-port (SP) surgery uses only a single entry point for all instruments. The approach of SP has been applied in multiple laparoscopic disciplines owing to its improved cosmetic result. However, in SP surgery, instrument movements are further restricted, resulting in increased

  14. Technical Note: Example of the Application of Jet Grouting to the Neutralisation of Geotechnical Hazard in Shaft Structures

    Directory of Open Access Journals (Sweden)

    Dybeł Piotr

    2015-09-01

    Full Text Available The article presents a geotechnical hazard neutralisation technology for shaft structures. The diagnosis of problems with uncontrolled subsidence of the ventilation duct provided by the authors enabled the development of a schedule of works required for the protection and reinforcement of foundation soil in the shaft area. The technology of protection works was selected after the analysis of the technical condition of shaft structures as well as hydrological and geomechanical conditions. Due to the closeness of the shaft lining, it was necessary to form grout columns using jet grouting and low-pressure grouting technologies. The article presents the issues related to the selected technology and its application to the neutralisation of the emergent geotechnical hazard. The method of performance of recommended works was also described together with their impact on the technical condition of structures discussed as well as their functionality and usage.

  15. Notes for a pedagogical approach to skills training for entrepreneurship in technical and technological institutes of Ecuador

    OpenAIRE

    Rosa Roxana Chiquito-Chilán; Blanca Cortón-Romero

    2016-01-01

    The enterprise value has increased with the passage of time; and today has special significance especially in countries as in the case of Ecuador; where efforts to changing the productive matrix, a process that involves a productive revolution through the development of knowledge and human talent develop. The achievement of the purposes of this strategy depends largely on the quality of the formation of enterprising professionals. A technical and technological institutes are in business techn...

  16. Technical note: Evaluation of the simultaneous measurements of mesospheric OH, HO2, and O3 under a photochemical equilibrium assumption - a statistical approach

    Science.gov (United States)

    Kulikov, Mikhail Y.; Nechaev, Anton A.; Belikovich, Mikhail V.; Ermakova, Tatiana S.; Feigin, Alexander M.

    2018-05-01

    This Technical Note presents a statistical approach to evaluating simultaneous measurements of several atmospheric components under the assumption of photochemical equilibrium. We consider simultaneous measurements of OH, HO2, and O3 at the altitudes of the mesosphere as a specific example and their daytime photochemical equilibrium as an evaluating relationship. A simplified algebraic equation relating local concentrations of these components in the 50-100 km altitude range has been derived. The parameters of the equation are temperature, neutral density, local zenith angle, and the rates of eight reactions. We have performed a one-year simulation of the mesosphere and lower thermosphere using a 3-D chemical-transport model. The simulation shows that the discrepancy between the calculated evolution of the components and the equilibrium value given by the equation does not exceed 3-4 % in the full range of altitudes independent of season or latitude. We have developed a statistical Bayesian evaluation technique for simultaneous measurements of OH, HO2, and O3 based on the equilibrium equation taking into account the measurement error. The first results of the application of the technique to MLS/Aura data (Microwave Limb Sounder) are presented in this Technical Note. It has been found that the satellite data of the HO2 distribution regularly demonstrate lower altitudes of this component's mesospheric maximum. This has also been confirmed by model HO2 distributions and comparison with offline retrieval of HO2 from the daily zonal means MLS radiance.

  17. Intraarticular Sacroiliac Joint Injection Under Computed Tomography Fluoroscopic Guidance: A Technical Note to Reduce Procedural Time and Radiation Dose

    International Nuclear Information System (INIS)

    Paik, Nam Chull

    2016-01-01

    PurposeA technique for computed tomography fluoroscopy (CTF)-guided intraarticular (IA) sacroiliac joint (SIJ) injection was devised to limit procedural time and radiation dose.MethodsOur Institutional Review Board approved this retrospective analysis and waived the requirement for informed consent. Overall, 36 consecutive diagnostic or therapeutic IA SIJ injections (unilateral, 20; bilateral, 16) performed in 34 patients (female, 18; male, 16) with a mean age of 45.5 years (range 20–76 years) under CTF guidance were analyzed, assessing technical success (i.e., IA contrast spread), procedural time, and radiation dose.ResultsAll injections were successful from a technical perspective and were free of serious complications. Respective median procedural times and effective doses of SIJ injection were as follows: unilateral, 5.28 min (range 3.58–8.00 min) and 0.11 millisievert (mSv; range 0.07–0.24 mSv); and bilateral, 6.72 min (range 4.17–21.17 min) and 0.11 mSv (range 0.09–0.51 mSv).ConclusionsGiven the high rate of technical success achieved in limited time duration and with little radiation exposure, CTF-guided IA SIJ injection is a practical and low-risk procedure.

  18. Intraarticular Sacroiliac Joint Injection Under Computed Tomography Fluoroscopic Guidance: A Technical Note to Reduce Procedural Time and Radiation Dose

    Energy Technology Data Exchange (ETDEWEB)

    Paik, Nam Chull, E-mail: pncspine@gmail.com [Arumdaun Wooldul Spine Hospital, Department of Radiology (Korea, Republic of)

    2016-07-15

    PurposeA technique for computed tomography fluoroscopy (CTF)-guided intraarticular (IA) sacroiliac joint (SIJ) injection was devised to limit procedural time and radiation dose.MethodsOur Institutional Review Board approved this retrospective analysis and waived the requirement for informed consent. Overall, 36 consecutive diagnostic or therapeutic IA SIJ injections (unilateral, 20; bilateral, 16) performed in 34 patients (female, 18; male, 16) with a mean age of 45.5 years (range 20–76 years) under CTF guidance were analyzed, assessing technical success (i.e., IA contrast spread), procedural time, and radiation dose.ResultsAll injections were successful from a technical perspective and were free of serious complications. Respective median procedural times and effective doses of SIJ injection were as follows: unilateral, 5.28 min (range 3.58–8.00 min) and 0.11 millisievert (mSv; range 0.07–0.24 mSv); and bilateral, 6.72 min (range 4.17–21.17 min) and 0.11 mSv (range 0.09–0.51 mSv).ConclusionsGiven the high rate of technical success achieved in limited time duration and with little radiation exposure, CTF-guided IA SIJ injection is a practical and low-risk procedure.

  19. Intraoperative definition of bottom-of-sulcus dysplasia using intraoperative ultrasound and single depth electrode recording - A technical note.

    Science.gov (United States)

    Miller, Dorothea; Carney, Patrick; Archer, John S; Fitt, Gregory J; Jackson, Graeme D; Bulluss, Kristian J

    2018-02-01

    Bottom of sulcus dysplasias (BOSDs) are localized focal cortical dysplasias (FCDs) centred on the bottom of a sulcus that can be highly epileptogenic, but difficult to delineate intraoperatively. We report on a patient with refractory epilepsy due to a BOSD, successfully resected with the aid of a multimodal surgical approach using neuronavigation based on MRI and PET, intraoperative ultrasound (iUS) and electrocorticography (ECoG) using depth electrodes. The lesion could be visualized on iUS showing an increase in echogenicity at the grey-white matter junction. IUS demonstrated the position of the depth electrode in relation to the lesion. Depth electrode recording showed almost continuous spiking. Thus, intraoperative imaging and electrophysiology helped confirm the exact location of the lesion. Post-resection ultrasound demonstrated the extent of the resection and depth electrode recording did not show any epileptiform activity. Thus, both techniques helped assess completeness of resection. The patient has been seizure free since surgery. Using a multimodal approach including iUS and ECoG is a helpful adjunct in surgery for BOSD and may improve seizure outcome. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Technical skill set training in natural orifice transluminal endoscopic surgery: how should we approach it?

    LENUS (Irish Health Repository)

    Nugent, Emmeline

    2011-03-01

    The boundaries in minimally invasive techniques are continually being pushed further. Recent years have brought new and exciting changes with the advent of natural orifice transluminal endoscopic surgery. With the evolution of this field of surgery come challenges in the development of new instruments and the actual steps of the procedure. Included in these challenges is the idea of developing a proficiency-based curriculum for training.

  1. Some Notes About Medical Vocabulary in 18th Century New Spain: Technical and Colloquial Words for the Denomination of Illnesses

    Directory of Open Access Journals (Sweden)

    José Luis RAMÍREZ LUENGO

    2016-06-01

    Full Text Available Whereas the 18th Century medical vocabulary is something that has been studied during recent years in Spain, the situation is very different in Latin America, where papers on this subject are very limited. In this case, this paper aims to study the denominations for illnesses that were discovered in a 18th Century New Spain document corpus: to do so, the corpus will be described and then the vocabulary used in the documents will be analysed; the paper will pay special attention to questions such as neologisms, fluctuating words and the presence of colloquial vocabulary. Thus, the purposes of the paper are three: 1 to demonstrate the importance of official documents for the study of medical vocabulary; 2 to provide some data for writing the history of this vocabulary; and 3 to note some analyses that should be done in the future. 

  2. Lecture notes of the technical training curriculum of the Institute of Nuclear Study, University of Tokyo, 1990

    International Nuclear Information System (INIS)

    1993-06-01

    This report is a transcript of lectures for the technical staff, held in the Institute of Nuclear Study, University of Tokyo, from November 1990 to April 1992. Following themes are included in this report. (1) Cyclotron technology, (2) measuring technology of the peripheral devices for cyclotron, (3) heavy ion cyclotron technology, (4) beam cooling technology, (5) proton linac technology, (6) heavy ion linac technology, (7) measuring technology of electron and its equipments, (8) the latest high energy large experimental device and its measurement (HERA, ZENS experiment), (9) superconducting kaon spectrometer (SKS) and large superconducting magnet, (10) present status of the precision technology for accelerators, (11) the computer as basic technology of elementary particle and nuclear experiments, (12) present status of radiation management and measurement technology, (13) handling and processing method of the hazardous materials, (14) analog technology of the equipments for accelerators, and the summary of NIRS-Heavy Ion Medical Accelerator in Chiba (HIMAC). (T.F.)

  3. Notes for a pedagogical approach to skills training for entrepreneurship in technical and technological institutes of Ecuador

    Directory of Open Access Journals (Sweden)

    Rosa Roxana Chiquito-Chilán

    2016-10-01

    Full Text Available The enterprise value has increased with the passage of time; and today has special significance especially in countries as in the case of Ecuador; where efforts to changing the productive matrix, a process that involves a productive revolution through the development of knowledge and human talent develop. The achievement of the purposes of this strategy depends largely on the quality of the formation of enterprising professionals. A technical and technological institutes are in business technologists have a key role in such training, in this sense the author of this article as part of the doctoral studies performed in Cuba works, this article contains the fundamentals and Ideas around which develops a pedagogical approach to skills training for entrepreneurship.

  4. Simulated lumbar minimally invasive surgery educational model with didactic and technical components.

    Science.gov (United States)

    Chitale, Rohan; Ghobrial, George M; Lobel, Darlene; Harrop, James

    2013-10-01

    The learning and development of technical skills are paramount for neurosurgical trainees. External influences and a need for maximizing efficiency and proficiency have encouraged advancements in simulator-based learning models. To confirm the importance of establishing an educational curriculum for teaching minimally invasive techniques of pedicle screw placement using a computer-enhanced physical model of percutaneous pedicle screw placement with simultaneous didactic and technical components. A 2-hour educational curriculum was created to educate neurosurgical residents on anatomy, pathophysiology, and technical aspects associated with image-guided pedicle screw placement. Predidactic and postdidactic practical and written scores were analyzed and compared. Scores were calculated for each participant on the basis of the optimal pedicle screw starting point and trajectory for both fluoroscopy and computed tomographic navigation. Eight trainees participated in this module. Average mean scores on the written didactic test improved from 78% to 100%. The technical component scores for fluoroscopic guidance improved from 58.8 to 52.9. Technical score for computed tomography-navigated guidance also improved from 28.3 to 26.6. Didactic and technical quantitative scores with a simulator-based educational curriculum improved objectively measured resident performance. A minimally invasive spine simulation model and curriculum may serve a valuable function in the education of neurosurgical residents and outcomes for patients.

  5. Technical Note: Experimental determination of the effective point of measurement of two cylindrical ionization chambers in a clinical proton beam

    Energy Technology Data Exchange (ETDEWEB)

    Sugama, Yuya, E-mail: yuya.sugama@gmail.com [Proton Therapy Center, Aizawa Hospital, Nagano 390-0821, Japan and Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi 409-3898 (Japan); Nishio, Teiji [Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551 (Japan); Onishi, Hiroshi [Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi 409-3898 (Japan)

    2015-07-15

    Purpose: IAEA TRS-398 notes that cylindrical ionization chambers are preferred for reference proton dosimetry. If a cylindrical ionization chamber is used in a phantom to measure the dose as a function of depth, the effective point of measurement (EPOM) must be taken into account. IAEA TRS-398 recommends a displacement of 0.75 times the inner cavity radius (0.75R) for heavy ion beams. Theoretical models by Palmans and by Bhullar and Watchman confirmed this value. However, the experimental results vary from author to author. The purpose of this study is to accurately measure the displacement and explain the past experimental discrepancies. Methods: In this work, we measured the EPOM of cylindrical ionization chambers with high accuracy by comparing the Bragg-peak position obtained with cylindrical ionization chambers (PTW 30013, PTW 31016) to that obtained using a plane-parallel ionization chamber (PTW 34045). Results: The EPOMs of PTW 30013 and 31016 were shifted by 0.92 ± 0.07 R with R = 3.05 mm and 0.90 ± 0.14 R with R = 1.45 mm, respectively, from the reference point toward the source. Conclusions: The EPOMs obtained were greater than the value of 0.75R proposed by the IAEA TRS-398 and the analytical results.

  6. Spinal endoscopy combined with selective CT myelography for dural closure of the spinal dural defect with superficial siderosis: technical note.

    Science.gov (United States)

    Arishima, Hidetaka; Higashino, Yoshifumi; Yamada, Shinsuke; Akazawa, Ayumi; Arai, Hiroshi; Tsunetoshi, Kenzo; Matsuda, Ken; Kodera, Toshiaki; Kitai, Ryuhei; Awara, Kousuke; Kikuta, Ken-Ichiro

    2018-01-01

    The authors describe a new procedure to detect the tiny dural hole in patients with superficial siderosis (SS) and CSF leakage using a coronary angioscope system for spinal endoscopy and selective CT myelography using a spinal drainage tube. Under fluoroscopy, surgeons inserted the coronary angioscope into the spinal subarachnoid space, similar to the procedure of spinal drainage, and slowly advanced it to the cervical spine. The angioscope clearly showed the small dural hole and injured arachnoid membrane. One week later, the spinal drainage tube was inserted, and the tip of the drainage tube was located just below the level of the dural defect found by the spinal endoscopic examination. This selective CT myelography clarifies the location of the dural defect. During surgery, the small dural hole could be easily located, and it was securely sutured. It is sometimes difficult to detect the actual location of the small dural hole even with thin-slice MRI or dynamic CT myelography in patients with SS. The use of a coronary angioscope for the spinal endoscopy combined with selective CT myelography may provide an effective examination to assess dural closure of the spinal dural defect with SS in cases without obvious dural defects on conventional imaging.

  7. [A new human machine interface in neurosurgery: The Leap Motion(®). Technical note regarding a new touchless interface].

    Science.gov (United States)

    Di Tommaso, L; Aubry, S; Godard, J; Katranji, H; Pauchot, J

    2016-06-01

    Currently, cross-sectional imaging viewing is used in routine practice whereas the surgical procedure requires physical contact with an interface (mouse or touch-sensitive screen). This type of contact results in a risk of lack of aseptic control and causes loss of time. The recent appearance of devices such as the Leap Motion(®) (Leap Motion society, San Francisco, USA) a sensor which enables to interact with the computer without any physical contact is of major interest in the field of surgery. However, its configuration and ergonomics produce key challenges in order to adapt to the practitioner's requirements, the imaging software as well as the surgical environment. This article aims to suggest an easy configuration of the Leap Motion(®) in neurosurgery on a PC for an optimized utilization with Carestream(®) Vue PACS v11.3.4 (Carestream Health, Inc., Rochester, USA) using a plug-in (to download at: https://drive.google.com/?usp=chrome_app#folders/0B_F4eBeBQc3ybElEeEhqME5DQkU) and a video tutorial (https://www.youtube.com/watch?v=yVPTgxg-SIk). Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  8. Preoperative Navigated Transcranial Magnetic Stimulation and Tractography to Guide Endoscopic Cystoventriculostomy: A Technical Note and Case Report.

    Science.gov (United States)

    Hendrix, Philipp; Senger, Sebastian; Griessenauer, Christoph J; Simgen, Andreas; Linsler, Stefan; Oertel, Joachim

    2018-01-01

    To report a technique for endoscopic cystoventriculostomy guided by preoperative navigated transcranial magnetic stimulation (nTMS) and tractography in a patient with a large speech eloquent arachnoid cyst. A 74-year old woman presented with a seizure and subsequent persistent anomic aphasia from a progressive left-sided parietal arachnoid cyst. An endoscopic cystoventriculostomy and endoscope-assisted ventricle catheter placement were performed. Surgery was guided by preoperative nTMS and tractography to avoid eloquent language, motor, and visual pathways. Preoperative nTMS motor and language mapping were used to guide tractography of motor and language white matter tracts. The ideal locations of entry point and cystoventriculostomy as well as trajectory for stent-placement were determined preoperatively with a pseudo-3-dimensional model visualizing eloquent language, motor, and visual cortical and subcortical information. The early postoperative course was uneventful. At her 3-month follow-up visit, her language impairments had completely recovered. Additionally, magnetic resonance imaging demonstrated complete collapse of the arachnoid cyst. The combination of nTMS and tractography supports the identification of a safe trajectory for cystoventriculostomy in eloquent arachnoid cysts. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Rapid and Minimally Traumatic Replacement of Stimulator Extension Cables: Technical Note on a Novel Use for Sternal Wire.

    Science.gov (United States)

    Henderson, Fraser; Takacs, Istvan

    2017-01-01

    Troubleshooting of deep brain stimulators (DBSs, Activa SC/PC/RC Medtronic PLC, Minneapolis, Minnesota, USA) sometimes results in a decision to replace a tunneled stretch-coil extension cable. We present a simple technique to accomplish this atraumatically without a tunneling tool. In the treatment of patients with a DBS, complication avoidance and efficiency of operative time are paramount. We sought to find the safest, most effective, and fastest method of performing the conceptually simple yet technically nuanced act of replacing lead extension cables. We connected #6 (8.0 metric) surgical steel 18″ (45-cm) monofilament (Ethicon US, LLC, Somerville, New Jersey, USA), also known as #6 sternal wire, in line with DBS extension cables (Medtronic DBS Extension 37086-60) in novel fashion to overcome intraprocedural hurdles encountered during the past decade in a busy functional neurosurgery service. Patients tolerate the procedure well and return home shortly after recovery with no complications. A less expensive and faster technique for passing pulse generator extension cables may be the use of a sternal wire. Using the described technique, pulse generators may be quickly and safely adjusted from side to side and site to site as the clinical situation dictates. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. "Surgery interrupted": The effect of multitasking on cognitive and technical tasks in medical students.

    Science.gov (United States)

    Evans, C H; Schneider, E; Shostrom, V; Schenarts, P J

    2017-02-01

    Today's medical learners are Millennials, and reportedly, multitasking pros. We aim to evaluate effect of multitasking on cognitive and technical skills. 16 medical students completed a mock page and laceration closure separately on day 1 and day 13, and in parallel on day 14. Suturing was graded using GRS and mock pages scored. Total time, suturing and loading times, and percent correct on mock page were compared. Percent correct on mock page improved from days 1-13 and 14 (p multitasking results in longer times to complete the complex component of the technical task. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Technical Note: Animal-borne CTD-Satellite Relay Data Loggers for real-time oceanographic data collection

    Directory of Open Access Journals (Sweden)

    L. Boehme

    2009-12-01

    Full Text Available The increasing need for continuous monitoring of the world oceans has stimulated the development of a range of autonomous sampling platforms. One novel addition to these approaches is a small, relatively inexpensive data-relaying device that can be deployed on marine mammals to provide vertical oceanographic profiles throughout the upper 2000 m of the water column. When an animal dives, the CTD-Satellite Relay Data Logger (CTD-SRDL records vertical profiles of temperature, conductivity and pressure. Data are compressed once the animal returns to the surface where it is located by, and relays data to, the Argos satellite system. The technical challenges met in the design of the CTD-SRDL are the maximising of energy efficiency and minimising size, whilst simultaneously maintaining the reliability of an instrument that cannot be recovered and is required to survive its lifetime attached to a marine mammal. The CTD-SRDLs record temperature and salinity with an accuracy of better than 0.005 °C and 0.02 respectively. However, due to the limited availability of reference data, real-time data from remote places are often associated with slightly higher errors. The potential to collect large numbers of profiles cost-effectively makes data collection using CTD-SRDL technology particularly beneficial in regions where traditional oceanographic measurements are scarce or even absent. Depending on the CTD-SRDL configuration, it is possible to sample and transmit hydrographic profiles on a daily basis, providing valuable and often unique information for a real-time ocean observing system.

  12. Phrenic nerve neurotization utilizing the spinal accessory nerve: technical note with potential application in patients with high cervical quadriplegia.

    Science.gov (United States)

    Tubbs, R Shane; Pearson, Blake; Loukas, Marios; Shokouhi, Ghaffar; Shoja, Mohammadali M; Oakes, W Jerry

    2008-11-01

    High cervical quadriplegia is associated with high morbidity and mortality. Artificial respiration in these patients carries significant long-term risks such as infection, atelectasis, and respiratory failure. As phrenic nerve pacing has been proven to free many of these patients from ventilatory dependency, we hypothesized that neurotization of the phrenic nerve with the spinal accessory nerve (SAN) may offer one potential alternative to phrenic nerve stimulation via pacing and may be more efficacious and longer lasting without the complications of an implantable device. Ten cadavers (20 sides) underwent exposure of the cervical phrenic nerve and the SAN in the posterior cervical triangle. The SAN was split into anterior and posterior halves and the anterior half transposed to the ipsilateral phrenic nerve as it crossed the anterior scalene muscle. The mean distance between the cervical phrenic nerve and the SAN in the posterior cervical triangle was 2.5 cm proximally, 4 cm at a midpoint, and 6 cm distally. The range for these measurements was 2 to 4 cm, 3.5 to 5 cm, and 4 to 8.5 cm, respectively. The mean excess length of SAN available after transposition to the more anteromedially placed phrenic nerve was 5 cm (range 4 to 6.5 cm). The mean diameter of these regional parts of the spinal accessory and phrenic nerves was 2 and 2.5 mm, respectively. No statistically significant difference was found for measurements between sides. To our knowledge, using the SAN for neurotization to the phrenic nerve for potential use in patients with spinal cord injury has not been previously explored. Following clinical trials, these data may provide a mechanism for self stimulation of the diaphragm and obviate phrenic nerve pacing in patients with high cervical quadriplegia. Our study found that such a maneuver is technically feasible in the cadaver.

  13. Technical note: Validation of an automated system for monitoring and restricting water intake in group-housed beef steers.

    Science.gov (United States)

    Allwardt, K; Ahlberg, C; Broocks, A; Bruno, K; Taylor, A; Place, S; Richards, C; Krehbiel, C; Calvo-Lorenzo, M; DeSilva, U; VanOverbeke, D; Mateescu, R; Goad, C; Rolf, M M

    2017-09-01

    The Insentec Roughage Intake Control (RIC) system has been validated for the collection of water intake; however, this system has not been validated for water restriction. The objective of this validation was to evaluate the agreement between direct observations and automated intakes collected by the RIC system under both ad libitum and restricted water conditions. A total of 239 crossbred steers were used in a 3-d validation trial, which assessed intake values generated by the RIC electronic intake monitoring system for both ad libitum water intake ( = 122; BASE) and restricted water intake ( = 117; RES). Direct human observations were collected on 4 Insentec water bins for three 24-h periods and three 12-h periods for BASE and RES, respectively. An intake event was noted by the observer when the electronic identification of the animal was read by the transponder and the gate lowered, and starting and ending bin weights were recorded for each intake event. Data from direct observations across each validation period were compared to automated observations generated from the RIC system. Missing beginning or ending weight values for visual observations occasionally occurred due to the observer being unable to capture the value before the monitor changed when bin activity was high. To estimate the impact of these missing values, analyses denoted as OBS were completed with the incomplete record coded as missing data. These analyses were contrasted with analyses where observations with a single missing beginning or end weight (but not both) were assumed to be identical to that which was recorded by the Insentec system (OBS). Difference in mean total intake across BASE steers was 0.60 ± 2.06 kg OBS (0.54 ± 1.99 kg OBS) greater for system observations than visual observations. The comparison of mean total intake across the 3 RES validation days was 0.53 ± 2.30 kg OBS (0.13 ± 1.83 kg OBS) greater for system observations than direct observations. Day was not a

  14. Toolbox of assessment tools of technical skills in otolaryngology-head and neck surgery: A systematic review.

    Science.gov (United States)

    Labbé, Mathilde; Young, Meredith; Nguyen, Lily H P

    2017-10-08

    To support the development of programs of assessment of technical skills in the operating room (OR), we systematically reviewed the literature to identify assessment tools specific to otolaryngology-head and neck surgery (OTL-HNS) core procedures and summarized their characteristics. We systematically searched Embase, MEDLINE, PubMed, and Cochrane to identify and report on assessment tools that can be used to assess residents' technical surgical skills in the operating room for OTL-HNS core procedures. Of the 736 unique titles retrieved, 16 articles met inclusion criteria, covering 11 different procedures (in otology, rhinology, laryngology, head and neck, and general otolaryngology). The tools were composed of a task-specific checklist and/or global rating scale and were developed in the OR, on human cadavers, or in a simulation setting. Our study reports on published tools for assessing technical skills for OTL-HNS residents during core procedures conducted in the OR. These assessment tools could facilitate the provision of timely feedback to trainees including specific goals for improvement. However, the paucity of publications suggests little agreement on how to best perform work-based direct-observation assessment for core surgical procedures in OTL-HNS. The sparsity of tools specific to OTL-HNS may become a barrier to a fluid transition to competency-based medical education. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  15. Combination acetabular radiofrequency ablation and cementoplasty using a navigational radiofrequency ablation device and ultrahigh viscosity cement: technical note.

    Science.gov (United States)

    Wallace, Adam N; Huang, Ambrose J; Vaswani, Devin; Chang, Randy O; Jennings, Jack W

    2016-03-01

    Percutaneous radiofrequency ablation and cementoplasty is an alternative palliative therapy for painful metastases involving axial load-bearing bones. This technical report describes the use of a navigational radiofrequency probe to ablate acetabular metastases from an anterior approach followed by instillation of ultrahigh viscosity cement under CT-fluoroscopic guidance. The tumor ablation databases of two institutions were retrospectively reviewed to identify patients who underwent combination acetabular radiofrequency ablation and cementoplasty using the STAR Tumor Ablation and StabiliT Vertebral Augmentation Systems (DFINE; San Jose, CA). Pre-procedure acetabular tumor volume was measured on cross-sectional imaging. Pre- and post-procedure pain scores were measured using the Numeric Rating Scale (10-point scale) and compared. Partial pain improvement was categorically defined as ≥ 2-point pain score reduction. Patients were evaluated for evidence of immediate complications. Electronic medical records were reviewed for evidence of delayed complications. During the study period, 12 patients with acetabular metastases were treated. The median tumor volume was 54.3 mL (range, 28.3-109.8 mL). Pre- and post-procedure pain scores were obtained from 92% (11/12) of the cohort. The median pre-procedure pain score was 8 (range, 3-10). Post-procedure pain scores were obtained 7 days (82%; 9/11), 11 days (9.1%; 1/11) or 21 days (9.1%; 1/11) after treatment. The median post-treatment pain score was 3 (range, 1-8), a statistically significant difference compared with pre-treatment (P = 0.002). Categorically, 73% (8/11) of patients reported partial pain relief after treatment. No immediate symptomatic complications occurred. Three patients (25%; 3/12) were discharged to hospice within 1 week of treatment. No delayed complications occurred in the remaining 75% (9/12) of patients during median clinical follow-up of 62 days (range, 14-178 days). Palliative percutaneous

  16. Cytoreductive Surgery for Advanced Epithelial Tumors of the Ovary: Technical Considerations and Outcome

    International Nuclear Information System (INIS)

    Khalil, E.A.; Fakhr, I.; Younis, A.; El-Shahawy, M.; Adel, I.

    2005-01-01

    The role of cytoreductive surgery in the management of advanced epithelial tumors of the ovary and its effect on survival. Patients and Methods: A prospective study of fifty eight female patients presenting with stage III and VI epithelial ovarian tumors attending the National Cancer Institute, Cairo University during the period from January 2003 to of December 2004. All patients were evaluated clinically, radiologically (including plain chest-X-ray and abdomen-pelvic ultrasound and/or CT), laboratory work up and CA-125. Abdominal exploration under general anesthesia with intent of maximum surgical cytoreduction was performed for all patients. Patients were followed up during the period of the study by history and physical examination, CA-125 measurement and abdomen-pelvic ultrasound or CT. Our study included 58 female patients with advanced epithelial tumors of the ovary. Their age ranged from 18 to 73 years with a mean age of 49 years. Pathological distribution of the lesions were borderline malignancy in 5 patients (8.6%) and malignant in 53 patients (91.4%). According to FIGO classification there were 46 patients stage III (79%) and 12 patients stage VI disease (21 %). Eighteen patients (31 %) had surgery prior to admission to NCI. Cytoreductive surgery was done for 51 patients (88%), while 7 patients (12%) had exploration and biopsy only, one of whom had palliative colostomy for large bowel obstruction. Intraoperative surgical complications were encountered in 5 patients (8.6%), all were managed intraoperatively. We had no early postoperative mortalities and 8 postoperative morbidities (13.7%). All patients were referred for chemotherapy. Thirteen patients (22.4%) had local recurrence within the follow up period of the study which was between 8-24 months. One patient died from locally advanced disease and the rest of the patients were explored and lesions were surgically resected. Surgery remains a major line of therapy in ovarian cancer including advanced

  17. The technical development of steerable catheter robot in performing interventional vascular surgery

    International Nuclear Information System (INIS)

    He Zhixiu; Qian Wei; Song Chengli

    2011-01-01

    Minimally invasive surgery is one of the primary means for the treatment of vascular diseases. The catheter is one of the main operating tools. As the vascular system is quite complicated and tiny, it is usually very difficult for the operator to accurately and bare-handily accomplish the whole intravascular procedure. Therefore, with the rapid development of minimally invasive surgeries the practical study related to the clinical employment of steerable catheter robot has attracted the researchers' attention. This paper aims to describe the emergence and development history of steerable catheter robot and also to introduce the main achievements as well as the up-to-date progress in the researches relevant to steerable catheter robot that the have been obtained by research workers all over the world so far. The prospects for the future development of steerable catheter robot are briefly discussed. (authors)

  18. Technical and instrumental prerequisites for single-port laparoscopic solo surgery: state of art.

    Science.gov (United States)

    Kim, Say-June; Lee, Sang Chul

    2015-04-21

    With the aid of advanced surgical techniques and instruments, single-port laparoscopic surgery (SPLS) can be accomplished with just two surgical members: an operator and a camera assistant. Under these circumstances, the reasonable replacement of a human camera assistant by a mechanical camera holder has resulted in a new surgical procedure termed single-port solo surgery (SPSS). In SPSS, the fixation and coordinated movement of a camera held by mechanical devices provides fixed and stable operative images that are under the control of the operator. Therefore, SPSS primarily benefits from the provision of the operator's eye-to-hand coordination. Because SPSS is an intuitive modification of SPLS, the indications for SPSS are the same as those for SPLS. Though SPSS necessitates more actions than the surgery with a human assistant, these difficulties seem to be easily overcome by the greater provision of static operative images and the need for less lens cleaning and repositioning of the camera. When the operation is expected to be difficult and demanding, the SPSS process could be assisted by the addition of another instrument holder besides the camera holder.

  19. Assessing Technical Performance and Determining the Learning Curve in Cleft Palate Surgery Using a High-Fidelity Cleft Palate Simulator.

    Science.gov (United States)

    Podolsky, Dale J; Fisher, David M; Wong Riff, Karen W; Szasz, Peter; Looi, Thomas; Drake, James M; Forrest, Christopher R

    2018-06-01

    This study assessed technical performance in cleft palate repair using a newly developed assessment tool and high-fidelity cleft palate simulator through a longitudinal simulation training exercise. Three residents performed five and one resident performed nine consecutive endoscopically recorded cleft palate repairs using a cleft palate simulator. Two fellows in pediatric plastic surgery and two expert cleft surgeons also performed recorded simulated repairs. The Cleft Palate Objective Structured Assessment of Technical Skill (CLOSATS) and end-product scales were developed to assess performance. Two blinded cleft surgeons assessed the recordings and the final repairs using the CLOSATS, end-product scale, and a previously developed global rating scale. The average procedure-specific (CLOSATS), global rating, and end-product scores increased logarithmically after each successive simulation session for the residents. Reliability of the CLOSATS (average item intraclass correlation coefficient (ICC), 0.85 ± 0.093) and global ratings (average item ICC, 0.91 ± 0.02) among the raters was high. Reliability of the end-product assessments was lower (average item ICC, 0.66 ± 0.15). Standard setting linear regression using an overall cutoff score of 7 of 10 corresponded to a pass score for the CLOSATS and the global score of 44 (maximum, 60) and 23 (maximum, 30), respectively. Using logarithmic best-fit curves, 6.3 simulation sessions are required to reach the minimum standard. A high-fidelity cleft palate simulator has been developed that improves technical performance in cleft palate repair. The simulator and technical assessment scores can be used to determine performance before operating on patients.

  20. A technical case report on use of tubular retractors for anterior cervical spine surgery.

    Science.gov (United States)

    Kulkarni, Arvind G; Patel, Ankit; Ankith, N V

    2017-12-19

    The authors put-forth this technical report to establish the feasibility of performing an anterior cervical corpectomy and fusion (ACCF) and a two-level anterior cervical discectomy and fusion (ACDF) using a minimally invasive approach with tubular retractors. First case: cervical spondylotic myelopathy secondary to a large postero-inferiorly migrated disc treated with corpectomy and reconstruction with a mesh cage and locking plate. Second case: cervical disc herniation with radiculopathy treated with a two-level ACDF. Both cases were operated with minimally invasive approach with tubular retractor using a single incision. Technical aspects and clinical outcomes have been reported. No intra or post-operative complications were encountered. Intra-operative blood loss was negligible. The patients had a cosmetic scar on healing. Standard procedure of placement of tubular retractors is sufficient for adequate surgical exposure with minimal invasiveness. Minimally invasive approach to anterior cervical spine with tubular retractors is feasible. This is the first report on use of minimally invasive approach for ACCF and two-level ACDF.

  1. Fotonovela. Technical Note No. 13.

    Science.gov (United States)

    Barriga, Patricio; Villacis, Rodrigo

    This report contains a description of a program that sought to develop the fotonovela as an instrument for increasing literacy and consciousness awareness in Ecuador. Following a general introduction to the work of the Nonformal Education Project, the creator of this program, the report presents information about the antecedents and…

  2. Sphenopalatine artery ligation: technical note.

    Science.gov (United States)

    Pothier, David D; Mackeith, Samuel; Youngs, Robin

    2005-10-01

    Epistaxis is a common problem. Most patients presenting to hospital will stop bleeding with simple first-aid measures or with nasal packing. Those who do not stop will usually require surgical management. For persistent posterior epistaxis, the sphenopalatine artery may be ligated as the artery leaves the sphenopalatine foramen to enter the nasal mucosa of the lateral wall of the nose. This may be performed endoscopically. We describe the anatomy of the area and the surgical technique. We also present a brief review of the literature on this technique.

  3. Technical note: A hydrological routing scheme for the Ecosystem Demography model (ED2+R tested in the Tapajós River basin in the Brazilian Amazon

    Directory of Open Access Journals (Sweden)

    F. F. Pereira

    2017-09-01

    Full Text Available Land surface models are excellent tools for studying how climate change and land use affect surface hydrology. However, in order to assess the impacts of Earth processes on river flows, simulated changes in runoff need to be routed through the landscape. In this technical note, we describe the integration of the Ecosystem Demography (ED2 model with a hydrological routing scheme. The purpose of the study was to create a tool capable of incorporating to hydrological predictions the terrestrial ecosystem responses to climate, carbon dioxide, and land-use change, as simulated with terrestrial biosphere models. The resulting ED2+R model calculates the lateral routing of surface and subsurface runoff resulting from the terrestrial biosphere models' vertical water balance in order to determine spatiotemporal patterns of river flows within the simulated region. We evaluated the ED2+R model in the Tapajós, a 476 674 km2 river basin in the southeastern Amazon, Brazil. The results showed that the integration of ED2 with the lateral routing scheme results in an adequate representation (Nash–Sutcliffe efficiency up to 0.76, Kling–Gupta efficiency up to 0.86, Pearson's R up to 0.88, and volume ratio up to 1.06 of daily to decadal river flow dynamics in the Tapajós. These results are a consistent step forward with respect to the no river representation common among terrestrial biosphere models, such as the initial version of ED2.

  4. Testing REACH draft technical guidance notes for conducting chemical safety assessments-the experience of a downstream user of a preparation.

    Science.gov (United States)

    Gade, Anne Lill; Ovrebø, Steinar; Hylland, Ketil

    2008-07-01

    The goal of REACH is the safe use of chemicals. This study examines the efficiency and usefulness of two draft technical guidance notes in the REACH Interim Project 3.2-2 for the development of the chemical safety report and exposure scenarios. A case study was carried out for a paint system for protection of structural steel. The focuses of the study were risk assessment of preparations based on Derived No Effect Level (DNEL) and Predicted No Effect Concentrations (PNEC) and on effective and accurate communication in the supply chain. Exposure scenarios and generic descriptions of uses, risk management measures, and exposure determinants were developed. The study showed that communication formats, software tools, and guidelines for chemical risk assessment need further adjustment to preparations and real-life situations. Web platforms may simplify such communication. The downstream formulator needs basic substance data from the substance manufacturer during the pre-registration phase to develop exposure scenarios for preparations. Default values need to be communicated in the supply chain because these were critical for the derivation of applicable risk management demands. The current guidelines which rely on the available toxicological knowledge are insufficient to advise downstream users on how to develop exposure scenarios for preparations.

  5. Artificial tactile sensing in minimally invasive surgery - a new technical approach.

    Science.gov (United States)

    Schostek, Sebastian; Ho, Chi-Nghia; Kalanovic, Daniel; Schurr, Marc O

    2006-01-01

    The loss of tactile sensation is a commonly known drawback of minimally invasive surgery (MIS). Since the advent of MIS, research activities in providing tactile information to the surgeon are still ongoing, in order to improve patient safety and to extend the indications for MIS. We have designed a tactile sensor system comprising a tactile laparoscopic grasper for surgical palpation. For this purpose, we developed a novel tactile sensor technology which allows the manufacturing of an integrated sensor array within an acceptable price range. The array was integrated into the jaws of a 10mm laparoscopic grasper. The tactile data are transferred wirelessly via Bluetooth and are presented visually to the surgeon. The goal was to be able to obtain information about the shape and consistency of tissue structures by gently compressing the tissue between the jaws of the tactile instrument and thus to be able to recognize and assess anatomical or pathological structures, even if they are hidden in the tissue. With a prototype of the tactile sensor system we have conducted bench-tests as well as in-vitro and in-vivo experiments. The system proved feasibility in an experimental environment, it was easy to use, and the novel tactile sensor array was applicable for both palpation and grasping manoeuvres with forces of up to 60N. The tactile data turned out to be a useful supplement to the minimal amount of haptic feedback that is provided by current endoscopic instruments and the endoscopic image under certain conditions.

  6. Development of a train-to-proficiency curriculum for the technical skills component of the fundamentals of endoscopic surgery exam.

    Science.gov (United States)

    Gearhart, Susan; Marohn, Michael; Ngamruengphong, Saowanee; Adrales, Gina; Owodunni, Oluwafemi; Duncan, Kim; Petrusa, Emil; Lipsett, Pamela

    2018-01-08

    The demonstration of competency in endoscopy is required prior to obtaining American Board of Surgery Certification. To demonstrate competency, the resident must pass a national high-stakes cognitive test and a technical skills exam on a virtual reality simulator. The purpose of this preliminary study was to design a proficiency-based endoscopy simulation curriculum to meet this competency requirement. This is a mixed methods prospective cohort study at a single academic medical institution. Prior to taking the national exam, surgery residents were required to participate in a skills lab and demonstrate proficiency on 10 simulation tasks. Proficiency was based on time and percent of objects targeted/mucosa seen. Simulation practice time, number of task repetitions to proficiency, and prior endoscopic experience were recorded. Resident's self-reported confidence scores in endoscopic skills prior to and following simulation lab training were obtained. From January 1, 2016 through August 1, 2017, 20 surgical residents (8 PGY2, 8 PGY3, 4 PGY4) completed both a faculty-supervised endoscopy skills lab and independent learning with train-to-proficiency simulation tasks. Median overall simulator time per resident was 306 min (IQR: 247-405 min). Median overall time to proficiency in all tasks was 235 min (IQR: 208-283 min). The median time to proficiency decreased with increasing PGY status (r = 0.4, P = 0.05). There was no correlation between prior real-time endoscopic experience and time to proficiency. Reported confidence in endoscopic skills increased significantly from mean of 5.75 prior to 7.30 following the faculty-supervised endoscopy skills lab (P = 0.0002). All 20 residents passed the national exam. In this preliminary study, a train-to-proficiency curriculum in endoscopy improved surgical resident's confidence in their endoscopic skills and 100% of residents passed the FES technical skills test on their first attempt. Our findings also indicate

  7. EFFECTS OF NATURAL ORIFICE SECRETIONS IN PERITONEAL CAVITY IN THE BACKGROUND OF NATURAL ORIFICE TRANSLUMINAL ENDOSCOPIC SURGERY (NOTES AN EXPERIMENTAL STUDY IN ANIMALS

    Directory of Open Access Journals (Sweden)

    Devendra

    2015-03-01

    Full Text Available Natural Orifice Transluminal Endoscopic Surgery (NOTES is a new form of minimally invasive surgery which eliminates traditional skin incisions by accessing internal body cavities through natural orifices. In our experimental animal study, we compared the incidences intraperitoneal abscess formation , culture swab of peritoneal cavity positive for organism, intraperitoneal adhesion formation and mean adhesion score before and after lavaging the portal of entry of albino rat , i.e. transgastric and transvaginal. On vaginal route as a portal of entry into peritoneal cavity , on the 7th day , 66% rats developed abscesses , 88% rats had culture swab positive and 88% rats developed intraperitoneal adhesion (grade - 2 before any cleansing of vaginal cavity with antiseptic solution . Now after lavage with povidone iodine solution, only 11% developed abscesses , 22% were peritoneal swab culture positive and 33% had interbowel and parietal adhesion of (grade 0 - 1. On 21 st day , the complication observed was adhesion formation in pre lavage group of 66% incidence and 16% after vaginal lavage. The incidence of complications were reduced significantly after lavage with antiseptic solution as shown by p values (p<0.01 for abscess formation, p< 0.01 for culture positivity and p< 0.01 for adhesions formation. Also the mean adhesion scoring was significantly reduced (p <0.02 after vaginal lavage on the 7 th day. Gastric route as the portal of entry into the peritoneal cavity, again the same variables were compared on the 7th and the 21st day , but wash was given with antibiotic solution (Cefazolin. On the 7th day , 44% had abscesses, 77% were culture positive and 66% had adhesions (Grade 1 - 2 before gastric lavage with antibiotic solution . After wash of stomach, 11% were culture positive and 44% developed adhesions (Grade 0 - 1. Here, abscess formation (p<0.02 and mean adhesion scoring (p<0.05 were significantly reduced after stomach wash. On the 21st day

  8. Intraoperative monitoring of lower cranial nerves in skull base surgery: technical report and review of 123 monitored cases.

    Science.gov (United States)

    Topsakal, Cahide; Al-Mefty, Ossama; Bulsara, Ketan R; Williford, Veronica S

    2008-01-01

    The fundamental goal of skull base surgery is tumor removal with preservation of neurological function. Injury to the lower cranial nerves (LCN; CN 9-12) profoundly affects a patient's quality of life. Although intraoperative cranial nerve monitoring (IOM) is widely practiced for other cranial nerves, literature addressing the LCN is scant. We examined the utility of IOM of the LCN in a large patient series. One hundred twelve patients underwent 123 skull base operations with IOM between January 1994 to December 1999. The vagus nerve (n=37), spinal accessory nerve (n=118), and the hypoglossal nerve (n=83) were monitored intraoperatively. Electromyography (EMG) and compound muscle action potentials (CMAP) were recorded from the relevant muscles after electrical stimulation. This data was evaluated retrospectively. Patients who underwent IOM tended to have larger tumors with more intricate involvement of the lower cranial nerves. Worsening of preoperative lower cranial nerve function was seen in the monitored and unmonitored groups. With the use of IOM in the high risk group, LCN injury was reduced to a rate equivalent to that of the lower risk group (p>0.05). The immediate feedback obtained with IOM may prevent injury to the LCN due to surgical manipulation. It can also help identify the course of a nerve in patients with severely distorted anatomy. These factors may facilitate gross total tumor resection with cranial nerve preservation. The incidence of high false positive and negative CMAP and the variability in CMAP amplitude and threshold can vary depending on individual and technical factors.

  9. Educational and training aspects of new surgical techniques: experience with the endoscopic–laparoscopic interdisciplinary training entity (ELITE) model in training for a natural orifice translumenal endoscopic surgery (NOTES) approach to appendectomy.

    Science.gov (United States)

    Gillen, Sonja; Gröne, Jörn; Knödgen, Fritz; Wolf, Petra; Meyer, Michael; Friess, Helmut; Buhr, Heinz-Johannes; Ritz, Jörg-Peter; Feussner, Hubertus; Lehmann, Kai S

    2012-08-01

    Natural orifice translumenal endoscopic surgery (NOTES) is a new surgical concept that requires training before it is introduced into clinical practice. The endoscopic–laparoscopic interdisciplinary training entity (ELITE) is a training model for NOTES interventions. The latest research has concentrated on new materials for organs with realistic optical and haptic characteristics and the possibility of high-frequency dissection. This study aimed to assess both the ELITE model in a surgical training course and the construct validity of a newly developed NOTES appendectomy scenario. The 70 attendees of the 2010 Practical Course for Visceral Surgery (Warnemuende, Germany) took part in the study and performed a NOTES appendectomy via a transsigmoidal access. The primary end point was the total time required for the appendectomy, including retrieval of the appendix. Subjective evaluation of the model was performed using a questionnaire. Subgroups were analyzed according to laparoscopic and endoscopic experience. The participants with endoscopic or laparoscopic experience completed the task significantly faster than the inexperienced participants (p = 0.009 and 0.019, respectively). Endoscopic experience was the strongest influencing factor, whereas laparoscopic experience had limited impact on the participants with previous endoscopic experience. As shown by the findings, 87.3% of the participants stated that the ELITE model was suitable for the NOTES training scenario, and 88.7% found the newly developed model anatomically realistic. This study was able to establish face and construct validity for the ELITE model with a large group of surgeons. The ELITE model seems to be well suited for the training of NOTES as a new surgical technique in an established gastrointestinal surgery skills course.

  10. 1. On note taking.

    Science.gov (United States)

    Plaut, Alfred B J

    2005-02-01

    In this paper the author explores the theoretical and technical issues relating to taking notes of analytic sessions, using an introspective approach. The paper discusses the lack of a consistent approach to note taking amongst analysts and sets out to demonstrate that systematic note taking can be helpful to the analyst. The author describes his discovery that an initial phase where as much data was recorded as possible did not prove to be reliably helpful in clinical work and initially actively interfered with recall in subsequent sessions. The impact of the nature of the analytic session itself and the focus of the analyst's interest on recall is discussed. The author then describes how he modified his note taking technique to classify information from sessions into four categories which enabled the analyst to select which information to record in notes. The characteristics of memory and its constructive nature are discussed in relation to the problems that arise in making accurate notes of analytic sessions.

  11. Safety in the operating room during orthopedic trauma surgery-incidence of adverse events related to technical equipment and logistics

    NARCIS (Netherlands)

    van Delft, E. A. K.; Schepers, T.; Bonjer, H. J.; Kerkhoffs, G. M. M. J.; Goslings, J. C.; Schep, N. W. L.

    2017-01-01

    Safety in the operating room is widely debated. Adverse events during surgery are potentially dangerous for the patient and staff. The incidence of adverse events during orthopedic trauma surgery is unknown. Therefore, we performed a study to quantify the incidence of these adverse events. Primary

  12. Debriefing Note Secondary Education Support Programme

    DEFF Research Database (Denmark)

    Webster, Neil; Vagnby, Bo Hellisen; Thomsen, Thomas J.

    Debriefing note regarding joint programming for the Secondary Education Support Programme (2003- 2007). The note specifies preparation of SIP Physical Guidelines; Training needs assessment for Physical School Status and Rapid Technical Assessments; SIP/DEP preparation; Selection criteria...

  13. Research Note:

    DEFF Research Database (Denmark)

    Behuria, Pritish; Buur, Lars; Gray, Hazel

    2017-01-01

    its core conceptual and methodological features. This Research Note starts by setting out our understanding of political settlements and provides an overview of existing political settlements literature on African countries. The note then explores how the key concept of ‘holding power’ has been...

  14. Balloon Occlusion of the Contralateral Iliac Artery to Assist Recanalization of the Ipsilateral Iliac Artery in Total Aortoiliac Occlusion: A Technical Note

    Directory of Open Access Journals (Sweden)

    Abdel Aziz A. Jaffan

    2013-01-01

    Full Text Available Endovascular recanalization of chronic total aortoiliac occlusion is technically challenging. Inability to reenter the true aortic lumen, following retrograde iliac recanalization, is one of the most common causes of failure. We describe a case of a total aortoiliac occlusion where balloon occlusion of the right common iliac artery, following its recanalization from a brachial approach, was used to facilitate antegrade recanalization of the occluded contralateral left common iliac artery.

  15. RESEARCH NOTE

    Indian Academy of Sciences (India)

    Navya

    RESEARCH NOTE. CDKN2A and MC1R ... Department of Pharmacy and Department of Nursing, School of Health Sciences, Frederick. University, Nicosia ..... Appears with highest frequency in African, Asian-Indian, and Papua. New Guinean ...

  16. Editorial note

    Directory of Open Access Journals (Sweden)

    Tore Ahlbäck

    2009-01-01

    Full Text Available Editorial note of the Scripta Instituti Donneriani Aboensis, vol. 21, Postmodern Spirituality, based on papers read at the symposium on Postmodern Spirituality held at Åbo, Finland, on 11–13 June 2008.

  17. Project Notes

    Science.gov (United States)

    School Science Review, 1978

    1978-01-01

    Presents sixteen project notes developed by pupils of Chipping Norton School and Bristol Grammar School, in the United Kingdom. These Projects include eight biology A-level projects and eight Chemistry A-level projects. (HM)

  18. Preservation of the Myofascial Cuff During Posterior Fossa Surgery to Reduce the Rate of Pseudomeningocele Formation and Cerebrospinal Fluid Leak: A Technical Note

    OpenAIRE

    Felbaum, Daniel R; Mueller, Kyle; Anaizi, Amjad; Mason, Robert B; Jean, Walter C; Voyadzis, Jean M

    2016-01-01

    Introduction:?Suboccipital craniotomy is a workhorse neurosurgical operation for approaching the posterior fossa?but carries a high risk of pseudomeningocele and cerebrospinal fluid (CSF) leak. We describe our experience with a simple T-shaped fascial opening that preserves the occipital myofascial cuff as compared to traditional methods to reduce this risk. Methods:?A single institution, retrospective review of prospectively collected database was performed of patients that underwent a suboc...

  19. Use of the bioactive resorbable plate system for zygoma and zygomatic arch replacement and fixation with modified Crockett's method for maxillectomy: A technical note.

    Science.gov (United States)

    Sukegawa, Shintaro; Kanno, Takahiro; Shibata, Akane; Matsumoto, Kenichi; Sukegawa-Takahashi, Yuka; Sakaida, Kyousuke; Furuki, Yoshihiko

    2017-07-01

    As a surgical approach targeting the pterygopalatine fossa following maxillary cancer due to tumor invasion, Crockett's method is conventional and useful. However, if the tumor is confined to the area between the maxilla and pterygopalatine fossa, it is not necessary to include the zygomatico-orbital in the access osteotomy, and the orbital floor may be preserved. Depending on the range of tumor invasion, the current study reports a more minimally invasive, modified Crockett's surgery that may be considered, which includes resection with modified osteotomy lines and repositioning with fixation of the zygoma and zygomatic arch following maxillary cancer ablation. In addition, the majority of patients with advanced maxillary cancer may require postoperative radiotherapy or chemoradiotherapy following maxillectomy according to several guidelines. Therefore, using a low-profile bioactive resorbable plate system as a method of repositioning and fixing the resected and preserved zygoma and zygomatic arch may be more effective in this modified Crockett's method for maxillectomy.

  20. Portable Intraoperative Computed Tomography Scan in Image-Guided Surgery for Brain High-grade Gliomas: Analysis of Technical Feasibility and Impact on Extent of Tumor Resection.

    Science.gov (United States)

    Barbagallo, Giuseppe M V; Palmucci, Stefano; Visocchi, Massimiliano; Paratore, Sabrina; Attinà, Giancarlo; Sortino, Giuseppe; Albanese, Vincenzo; Certo, Francesco

    2016-03-01

    Intraoperative magnetic resonance imaging is the gold standard among image-guided techniques for glioma surgery. Scant data are available on the role of intraoperative computed tomography (i-CT) in high-grade glioma (HGG) surgery. To verify the technical feasibility and usefulness of portable i-CT in image-guided surgical resection of HGGs. This is a retrospective series control analysis of prospectively collected data. Twenty-five patients (Group A) with HGGs underwent surgery using i-CT and 5-aminolevulinic acid (5-ALA) fluorescence. A second cohort of 25 patients (Group B) underwent 5-ALA fluorescence-guided surgery but without i-CT. We used a portable 8-slice CT scanner and, in both groups, neuronavigation. Extent of tumor resection (ETOR) and pre- and postoperative Karnofsky performance status (KPS) scores were measured; the impact of i-CT on overall survival (OS) and progression-free survival (PFS) was also analyzed. In 8 patients (32%) in Group A, i-CT revealed residual tumor, and in 4 of them it helped to also resect pathological tissue detached from the main tumor. EOTR in these 8 patients was 97.3% (96%-98.6%). In Group B, residual tumor was found in 6 patients, whose tumor's mean resection was 98% (93.5-99.7). The Student t test did not show statistically significant differences in EOTR in the 2 groups. The KPS score decreased from 67 to 69 after surgery in Group A and from 74 to 77 in Group B (P = .07 according to the Student t test). Groups A and B did not show statistically significant differences in OS and PFS (P = .61 and .46, respectively, by the log-rank test). No statistically significant differences in EOTR, KPS, PFS, and OS were observed in the 2 groups. However, i-CT helped to verify EOTR and to update the neuronavigator with real-time images, as well as to identify and resect pathological tissue in multifocal tumors. i-CT is a feasible and effective alternative to intraoperative magnetic resonance imaging. Portable i-CT can provide useful

  1. Neurophysiological Identification of Cranial Nerves During Endoscopic Endonasal Surgery of Skull Base Tumors: Pilot Study Technical Report.

    Science.gov (United States)

    Shkarubo, Alexey Nikolaevich; Chernov, Ilia Valerievich; Ogurtsova, Anna Anatolievna; Moshchev, Dmitry Aleksandrovich; Lubnin, Andrew Jurievich; Andreev, Dmitry Nicolaevich; Koval, Konstantin Vladimirovich

    2017-02-01

    Intraoperative identification of cranial nerves is crucial for safe surgery of skull base tumors. Currently, only a small number of published papers describe the technique of trigger electromyography (t-EMG) in endoscopic endonasal removal of such tumors. To assess the effectiveness of t-EMG in preventing intraoperative cranial nerve damage in endoscopic endonasal surgery of skull base tumors. Nine patients were operated on using the endoscopic endonasal approach within a 1-year period. The tumors included large skull base chordomas and trigeminal neurinomas localized in the cavernous sinus. During the surgical process, cranial nerve identification was carried out using monopolar and bipolar t-EMG methods. Assessment of cranial nerve functional activity was conducted both before and after tumor removal. We mapped 17 nerves in 9 patients. Third, fifth, and sixth cranial nerves were identified intraoperatively. There were no cases of postoperative functional impairment of the mapped cranial nerves. In one case we were unable to get an intraoperative response from the fourth cranial nerve and observed its postoperative transient plegia (the function was normal before surgery). t-EMG allows surgeons to control the safety of cranial nerves both during and after skull base tumor removal. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Improved Bone Graft Method for Upper Cervical Surgery with Posterior Approach: Technical Description and Report of 52 Cases.

    Science.gov (United States)

    Wang, Yong-Li; Wang, Xiang-Yang

    2018-02-21

    We sought to report a minimum 12 months' follow-up results of our improved bone graft method for upper cervical surgery with the posterior approach. Among 52 consecutive cases, odontoid nonunion occurred in 33 patients, atlantoaxial instability in 11 patients, and occipitocervical deformity in 8 patients who underwent posterior C1-C2 transarticular screw/screw-rod internal fixation (41 cases) and occipitocervical fusion (11 cases) with the improved bone graft technique. Each surgical procedure was performed by the same senior spine surgeon. We took lateral cervical standing roentgenograms before surgery and immediately after surgery. Then we conducted craniocerebral computed tomography examination with reconstruction at 3, 6, 12, and 24 months and annually thereafter. The postoperative follow-up times are about 12-38 months. All cases showed satisfactory screw fixation by radiographic examination, and there were no postoperative neurologic complications. One case had postoperative retropharyngeal infection after the transoral release and posterior reduction by pedicle screw instrumentation. All patients got solid fusions, and no pseudarthrosis occurred. All cases had solid fusions at the 3-month follow-up. Good bone graft bed, enough bone graft material, solid local fixation, and effective bone graft method are prerequisites for a successful bone graft. By analyzing postoperative follow-up in the consecutive cases in this study, our bone graft method describing a new bone graft structure is a reliable posterior fusion technique. It is worth considering, and further research is needed. Copyright © 2018. Published by Elsevier Inc.

  3. Indocyanine Green Videoangiography for Surgery of a Ruptured Dissecting Aneurysm in the Precommunicating Anterior Cerebral Artery: A Technical Case Report.

    Science.gov (United States)

    Nagai, Yasunori; Goto, Masanori; Toda, Hiroki; Nishida, Namiko; Yoshimoto, Naoya; Iwasaki, Koichi

    2017-08-01

    Indocyanine green videoangiography (ICG-VA) is an important intraoperative adjunct for saccular aneurysm surgery, but its efficacy in surgery for dissecting aneurysms has rarely been reported. The authors describe the usefulness of preclipping ICG-VA in a rare case of a ruptured dissecting aneurysm located at the precommunicating (A1) segment of the anterior cerebral artery. A 52-year-old woman, with no history of connective tissue diseases or vascular disorders, presented with sudden headache and convulsion. The CT scan showed that the patient had subarachnoid hemorrhage. Angiography showed a dissecting aneurysm in the left A1 segment of the anterior cerebral artery. Thus, the patient underwent trapping of the dissecting aneurysm. ICG-VA was used as an intraoperative adjunct before and after clipping. The preclipping ICG-VA showed the heterogeneously bright dissecting aneurysm and branching arteries even in the presence of hematoma. Preclipping ICG-VA may enhance the advantage of direct surgery for dissecting aneurysm by allowing visualization of the extent of the dissected vascular wall and the related branching arteries. ICG-VA can be an indispensable adjunct to minimize the compromise from the surgical treatment for intracranial dissecting aneurysms. Copyright © 2017 by the Congress of Neurological Surgeons

  4. 18F-FDOPA PET/CT-Guided Radiofrequency Ablation of Liver Metastases from Neuroendocrine Tumours: Technical Note on a Preliminary Experience

    Energy Technology Data Exchange (ETDEWEB)

    Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it; Garnon, Julien, E-mail: juleiengarnon@gmail.com [Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Department of Interventional Radiology (France); Ramamurthy, Nitin, E-mail: nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Tsoumakidou, Georgia, E-mail: georgia.tsoumakidou@chru-strasbourg.fr [Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Department of Interventional Radiology (France); Imperiale, Alessio, E-mail: alessio.imperiale@chru-strasbourg.fr; Namer, Izzie Jacques, E-mail: izzie.jacques.namer@chru-strasbourg.fr [Hôpital de Hautepierre (Hôpitaux Universitaires de Strasbourg, HUS), Department of Biophysics and Nuclear Medicine (France); Bachellier, Philippe, E-mail: philippe.bachellier@chru-strasbourg.fr [Hôpital de Hautepierre (Hôpitaux Universitaires de Strasbourg, HUS), Hepato-Pancreato-Biliary Surgery and Liver Transplantation (France); Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr; Rao, Pramod, E-mail: pramodrao@me.com; Koch, Guillaume, E-mail: guillaume.koch@chru-strasbourg.fr; Gangi, Afshin, E-mail: gangi@unistra.fr [Nouvel Hôpital Civil (Hôpitaux Universitaires de Strasbourg, HUS), Department of Interventional Radiology (France)

    2016-09-15

    AimTo review our preliminary experience with 6-l-18F-fluorodihydroxyphenylalanine (18F-FDOPA) PET/CT-guided radiofrequency ablation (RFA) of liver metastases from neuroendocrine tumours (NETs).Materials and MethodsThree patients (mean age 51.3 years; range 43–56) with gastro-entero pancreatic NET (GEP-NET) liver metastases underwent 18F-FDOPA PET/CT-guided RFA. Patients were referred with oligometastatic hepatic-confined disease (1–6 metastases; <3 cm) on 18F-FDOPA PET/CT; poor lesion visualisation on US, CT, and MR; and ongoing symptoms. Procedures were performed in an interventional PET/CT scanner under general anaesthesia using a split-dose protocol. Lesion characteristics, procedural duration and technical success (accurate probe placement and post-procedural ablation-zone photopaenia), complications, patient and operator dose, and clinical outcomes were evaluated.ResultsThirteen liver metastases (mean size 11.4 mm, range 8–16) were treated in three patients (two presented with “carcinoid syndrome”). Technical success was 100 % with a mean procedural duration of 173.3 min (range 90–210) and no immediate complications. Mean patient dose was 2844 mGy·cm (range 2104–3686). Operator and radiographer doses were acceptable other than the operator’s right hand in the first case (149 µSv); this normalised in the second case. There was no local tumour or extra-hepatic disease progression at mid-term follow-up (mean 12.6 months; range 6–20); however, two cases progressed with new liver metastases at different sites. There was 100 % clinical success (n = 2) in resolving carcinoid syndrome symptoms.Conclusion18F-FDOPA PET/CT-guided RFA appears technically feasible, safe, and effective in patients with GEP-NETs and low-burden hepatic metastases. Further prospective studies are required to elucidate its precise role in tailored multimodality management of GEP-NET liver metastases.

  5. SAFETY NOTES

    CERN Document Server

    TIS Secretariat

    2001-01-01

    Please note that the revisions of safety notes no 3 (NS 3 Rev. 2) and no 24 (NS 24 REV.) entitled respectively 'FIRE PREVENTION FOR ENCLOSED SPACES IN LARGE HALLS' and 'REMOVING UNBURIED ELV AND LVA ELECTRIC CONDUITS' are available on the web at the following urls: http://edmsoraweb.cern.ch:8001/cedar/doc.download?document_id=322811&version=1&filename=version_francaise.pdf http://edmsoraweb.cern.ch:8001/cedar/doc.download?document_id=322861&version=2&filename=version_francaise.pdf Paper copies can also be obtained from the TIS Divisional Secretariat, email tis.secretariat@cern.ch

  6. Flexibilization of methanization units in Germany. Overview of technical approaches, of the regulatory framework, and of the importance for the energy system - Synthesis note

    International Nuclear Information System (INIS)

    Trommler, Marcus; Dotzauer, Martin; Barchmann, Tino; Lauer, Markus; Hennig, Christiane; Mauky, Eric; Liebetrau, Jan; Thraen, Daniela; Risler, Julian

    2016-03-01

    Technologies of valorisation of biomass offer opportunities to produce a flexible and renewable energy suitable to compensate the intermittency of wind and solar energies which depend on meteorological conditions. As methanization units operated in a flexible way are now mainly present in Germany, notably due to public financial supports to flexibility, this publication describes the status of flexibilization in German methanization units, and highlights relationships with the electricity system, technical approaches to flexibility (implemented technology, gas valorisation in biomethane and injection in the natural gas network, adjustment of gas production for supply management, methanization units and hybrid concepts), and incentive policy (flexibility premium, marketing strategy). The publication finally discusses perspectives for these flexible methanization units

  7. Validation of a structured training and assessment curriculum for technical skill acquisition in minimally invasive surgery: a randomized controlled trial.

    Science.gov (United States)

    Palter, Vanessa N; Orzech, Neil; Reznick, Richard K; Grantcharov, Teodor P

    2013-02-01

    : To develop and validate an ex vivo comprehensive curriculum for a basic laparoscopic procedure. : Although simulators have been well validated as tools to teach technical skills, their integration into comprehensive curricula is lacking. Moreover, neither the effect of ex vivo training on learning curves in the operating room (OR), nor the effect on nontechnical proficiency has been investigated. : This randomized single-blinded prospective trial allocated 20 surgical trainees to a structured training and assessment curriculum (STAC) group or conventional residency training. The STAC consisted of case-based learning, proficiency-based virtual reality training, laparoscopic box training, and OR participation. After completion of the intervention, all participants performed 5 sequential laparoscopic cholecystectomies in the OR. The primary outcome measure was the difference in technical performance between the 2 groups during the first laparoscopic cholecystectomy. Secondary outcome measures included differences with respect to learning curves in the OR, technical proficiency of each sequential laparoscopic cholecystectomy, and nontechnical skills. : Residents in the STAC group outperformed residents in the conventional group in the first (P = 0.004), second (P = 0.036), third (P = 0.021), and fourth (P = 0.023) laparoscopic cholecystectomies. The conventional group demonstrated a significant learning curve in the OR (P = 0.015) in contrast to the STAC group (P = 0.032). Residents in the STAC group also had significantly higher nontechnical skills (P = 0.027). : Participating in the STAC shifted the learning curve for a basic laparoscopic procedure from the operating room into the simulation laboratory. STAC-trained residents had superior technical proficiency in the OR and nontechnical skills compared with conventionally trained residents. (The study registration ID is NCT01560494.).

  8. Please note

    CERN Multimedia

    2006-01-01

    Members of the personnel are invited to take note that only parcels corresponding to official orders or contracts will be handled at CERN. Individuals are not authorised to have private merchandise delivered to them at CERN and private deliveries will not be accepted by the Goods Reception services. Thank you for your understanding. (Version française la semaine prochaine.)

  9. Editor's Note

    African Journals Online (AJOL)

    On another note: the editor and the editorial team acknowledge the financial support of the Carnegie Corporation of New York through the University of Ghana Building A New Generation of Academics in Africa (BANGA-Africa) Project. We also use this platform to express our gratitude for the support of various stakeholders, ...

  10. Coupled thermo-hydro-mechanical experiment at Kamaishi mine. Technical note 08-96-01. Measurement data related to excavation of the test pit

    International Nuclear Information System (INIS)

    Fujita, T.; Chijimatsu, M.; Sugita, Y.; Ishikawa, H.

    1997-07-01

    It is an important part of the near field performance assessment of nuclear waste disposal to evaluate coupled thermo-hydro-mechanical (T-H-M) phenomena, e.g., thermal effects on groundwater flow through rock matrix and water seepage into the buffer material, the generation of swelling pressure of the buffer material, and thermal stresses potentially affecting porosity and fracture apertures of the rock. An in-situ T-H-M experiment named Engineered Barrier Experiment ' has been conducted at the Kamaishi Mine, of which host rock is granodiorite, in order to establish conceptual models of the coupled T-H-M processes and to build confidence in mathematical models and computer codes. In 1995, fourteen boreholes were excavated in order to install the various sensors. After the hydraulic tests, mechanical tests were carried out to obtain the rock properties. After that, a test pit, 1.7 m in diameter and 5.0 m in depth, was excavated. During the excavation, the change of pore pressure, displacement and temperature of rock mass were measured. Furthermore, pit convergence was measured. This note shows the results of mechanical tests and measurement data during the excavation of test pit. (author)

  11. Technical note: ruminal cannulation technique in young Holstein calves: effects of cannulation on feed intake, body weight gain, and ruminal development at six weeks of age.

    Science.gov (United States)

    Kristensen, N B; Engbaek, M; Vestergaard, M; Harmon, D L

    2010-02-01

    Ruminal cannulation techniques are frequently used to study fermentation in the ruminant forestomach. Unsatisfactory results with the traditionally applied procedure for cannulation of young calves stimulated the development of a simpler and more robust procedure; this procedure was tested for effects on performance traits and gross anatomy of the gastrointestinal tract compared with a control group not undergoing surgery. Five calves were ruminally cannulated at approximately 10 d of age and 5 matching calves were used as controls. All calves were fed milk replacer and a diet based on clover grass silage and sodium hydroxide-treated wheat. Ruminal fluid was collected from cannulated calves once weekly for 3 consecutive weeks. All calves were euthanized at 43+/-3 d of age. No apparent adverse effects of cannulation were observed. Feed intake, BW gain, and gross anatomy of the gastrointestinal tract were not affected by cannulation. Minimum ruminal pH increased with sampling week, but average ruminal pH, total volatile fatty acids concentration, and volatile fatty acids proportions were not affected by sampling week. In conclusion, the implemented surgical technique was found to have no major effect on apparent animal health and performance traits, and the cannula proved useful for multiple samplings of ruminal contents in young calves. Copyright 2010 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  12. Usefulness of high-resolution 3D multifusion medical imaging for preoperative planning in patients with posterior fossa hemangioblastoma: technical note.

    Science.gov (United States)

    Yoshino, Masanori; Nakatomi, Hirofumi; Kin, Taichi; Saito, Toki; Shono, Naoyuki; Nomura, Seiji; Nakagawa, Daichi; Takayanagi, Shunsaku; Imai, Hideaki; Oyama, Hiroshi; Saito, Nobuhito

    2017-07-01

    Successful resection of hemangioblastoma depends on preoperative assessment of the precise locations of feeding arteries and draining veins. Simultaneous 3D visualization of feeding arteries, draining veins, and surrounding structures is needed. The present study evaluated the usefulness of high-resolution 3D multifusion medical imaging (hr-3DMMI) for preoperative planning of hemangioblastoma. The hr-3DMMI combined MRI, MR angiography, thin-slice CT, and 3D rotated angiography. Surface rendering was mainly used for the creation of hr-3DMMI using multiple thresholds to create 3D models, and processing took approximately 3-5 hours. This hr-3DMMI technique was used in 5 patients for preoperative planning and the imaging findings were compared with the operative findings. Hr-3DMMI could simulate the whole 3D tumor as a unique sphere and show the precise penetration points of both feeding arteries and draining veins with the same spatial relationships as the original tumor. All feeding arteries and draining veins were found intraoperatively at the same position as estimated preoperatively, and were occluded as planned preoperatively. This hr-3DMMI technique could demonstrate the precise locations of feeding arteries and draining veins preoperatively and estimate the appropriate route for resection of the tumor. Hr-3DMMI is expected to be a very useful support tool for surgery of hemangioblastoma.

  13. Influence able and Avoidable Risk Factors for Systemic Air Embolism due to Percutaneous CT-Guided Lung Biopsy: Patient Positioning and Coaxial Biopsy Technique-Case Report, Systematic Literature Review, and a Technical Note

    International Nuclear Information System (INIS)

    Rott, G.; Boecker, F.

    2014-01-01

    Following the first case of a systemic air embolism due to percutaneous CT-guided lung biopsy in our clinic we analysed the literature regarding this matter in view of influence able or avoidable risk factors. A systematic review of literature reporting cases of systemic air embolism due to CT-guided lung biopsy was performed to find out whether prone positioning might be a risk factor regarding this issue. In addition, a technical note concerning coaxial biopsy practice is presented. Prone position seems to have relevance for the development and/or clinical manifestation of air embolism due to CT-guided lung biopsy and should be considered a risk factor, at least as far as lesions in the lower parts of the lung are concerned. Biopsies of small or cavitary lesions in coaxial technique should be performed using a hemo static valve.

  14. Ex-vivo release of Pipeline Embolization Device polytetrafluoroethylene (PTFE) sleeves for improved distal landing zone accuracy in-vivo: A technical note.

    Science.gov (United States)

    Griessenauer, Christoph J; Gupta, Raghav; Moore, Justin; Thomas, Ajith J; Ogilvy, Christopher S

    2016-12-01

    Distal landing zone accuracy is critical in some intracranial aneurysms treated with the Pipeline Embolization Device (PED), and delayed opening of the distal end of the device can complicate the procedure. Here, we report a technical nuance that facilitates accurate placement of the distal end of the PED by ex-vivo, pre-implantation release of the PED Flex polytetrafluoroethylene (PTFE) sleeves. The PED Flex is partially pushed out of the introducer sheath ex-vivo, pre-implantation until the distal PED opens entirely and the PTFE sleeves are located distal to the device. Without inverting the PTFE sleeves, the PED is carefully pulled back into the introducer sheath placing the PTFE sleeves inside the device. The PED is loaded into the microcatheter and advanced toward the site of implantation. When the PED is initially deployed and pushed out of the microcatheter, it opens immediately and provides an anchor for the remainder of the deployment process. We present a video (supplementary material) that illustrates the technique along with an illustrative case. Ex-vivo, pre-implantation release of the PTFE sleeves is an option in aneurysm treatment where distal landing accuracy is critical. Even without the protection of the PTFE sleeves, our clinical observation shows that the PED can be advanced safely through the microcatheter in selected cases. © The Author(s) 2016.

  15. Creating a Strain Relief Loop during S1 Transforaminal Lead Placement for Dorsal Root Ganglion Stimulation for Foot Pain: A Technical Note.

    Science.gov (United States)

    van Velsen, Valery; van Helmond, Noud; Chapman, Kenneth B

    2018-04-01

    Chronic neuropathic pain is often refractory to conventional medical treatments and leads to significant disability and socio-economic burden. Dorsal root ganglion (DRG) stimulation has recently emerged as a treatment for persistent neuropathic pain, but creating a strain relief loop at the S1 level has thus far been a challenging technical component of DRG lead placement. We describe a refined technique for strain relief loop formation at the S1 level using a transforaminal approach that we employed in a 45-year-old patient with intractable foot pain. We successfully placed a strain relief loop in the sacral space in a predictable and easily reproducible manner using a transforaminal anchorless approach. The patient experienced a decrease in visual analog pain score (85%), and improvement in function during the trial period, and proceeded with permanent implantation. The described sacral transforaminal strain relief loop formation technique appears to be a more reliable and predictable technique of DRG lead placement in the sacrum than those previously documented. © 2017 World Institute of Pain.

  16. Technical Note: Error metrics for estimating the accuracy of needle/instrument placement during transperineal magnetic resonance/ultrasound-guided prostate interventions.

    Science.gov (United States)

    Bonmati, Ester; Hu, Yipeng; Villarini, Barbara; Rodell, Rachael; Martin, Paul; Han, Lianghao; Donaldson, Ian; Ahmed, Hashim U; Moore, Caroline M; Emberton, Mark; Barratt, Dean C

    2018-04-01

    Image-guided systems that fuse magnetic resonance imaging (MRI) with three-dimensional (3D) ultrasound (US) images for performing targeted prostate needle biopsy and minimally invasive treatments for prostate cancer are of increasing clinical interest. To date, a wide range of different accuracy estimation procedures and error metrics have been reported, which makes comparing the performance of different systems difficult. A set of nine measures are presented to assess the accuracy of MRI-US image registration, needle positioning, needle guidance, and overall system error, with the aim of providing a methodology for estimating the accuracy of instrument placement using a MR/US-guided transperineal approach. Using the SmartTarget fusion system, an MRI-US image alignment error was determined to be 2.0 ± 1.0 mm (mean ± SD), and an overall system instrument targeting error of 3.0 ± 1.2 mm. Three needle deployments for each target phantom lesion was found to result in a 100% lesion hit rate and a median predicted cancer core length of 5.2 mm. The application of a comprehensive, unbiased validation assessment for MR/US guided systems can provide useful information on system performance for quality assurance and system comparison. Furthermore, such an analysis can be helpful in identifying relationships between these errors, providing insight into the technical behavior of these systems. © 2018 American Association of Physicists in Medicine.

  17. Flat-Panel Cone-Beam Ct-Guided Radiofrequency Ablation of Very Small (≤1.5 cm) Liver Tumors: Technical Note on a Preliminary Experience

    Energy Technology Data Exchange (ETDEWEB)

    Cazzato, Roberto Luigi, E-mail: r.cazzato@unicampus.it; Buy, Xavier, E-mail: x.buy@bordeaux.unicancer.fr; Alberti, Nicolas, E-mail: nicoalbertibdx@gmail.com; Fonck, Mariane, E-mail: m.fonk@bordeaux.unicancer.fr [Institut Bergonié 229 Cours de l’Argonne, Department of Radiology (France); Grasso, Rosario Francesco, E-mail: r.grasso@unicampus.it [Università “Campus Bio-Medico di Roma”, Department of Radiology and Diagnostic Imaging (Italy); Palussière, Jean, E-mail: j.palussiere@bordeaux.unicancer.fr [Institut Bergonié 229 Cours de l’Argonne, Department of Radiology (France)

    2015-02-15

    PurposeThe aim of the present study was to investigate the technical feasibility of flat-panel cone-beam CT (CBCT)-guided radiofrequency ablation (RFA) of very small (<1.5 cm) liver tumors.Materials and MethodsPatients included were candidates for hepatic percutaneous RFA as they had single biopsy-proven hepatic tumors sized ≤1.5 cm and poorly defined on ultrasonography. Following apnea induction, unenhanced CBCT scans were acquired and used to deploy the RF electrode with the aid of a virtual navigation system. If the tumor was not clearly identified on the unenhanced CBCT scan, a right retrograde arterial femoral access was established to carry out hepatic angiography and localize the tumor. Patients’ lesions and procedural variables were recorded and analyzed.ResultsThree patients (2 male and 1 female), aged 68, 76, and 87 years were included; 3 lesions (2 hepato-cellular carcinoma and 1 metastasis from colorectal cancer) were treated. One patient required hepatic angiography. Cycles of apnea used to acquire CBCT images and to deploy the electrode lasted <120 s. Mean fluoroscopic time needed to deploy the electrode was 36.6 ± 5.7 min. Mean overall procedural time was 66.0 ± 22.9 min. No peri- or post-procedural complications were noted. No cases of incomplete ablation were noted at 1-month follow-up.ConclusionPercutaneous CBCT-guided liver RFA with or without arterial hepatic angiography is technically feasible.

  18. First clinical results of minimally invasive vector lumbar interbody fusion (MIS-VLIF) in spondylodiscitis and concomitant osteoporosis: a technical note.

    Science.gov (United States)

    Rieger, Bernhard; Jiang, Hongzhen; Ruess, Daniel; Reinshagen, Clemens; Molcanyi, Marek; Zivcak, Jozef; Tong, Huaiyu; Schackert, Gabriele

    2017-12-01

    First description of MIS-VLIF, a minimally invasive lumbar stabilization, to evaluate its safety and feasibility in patients suffering from weak bony conditions (lumbar spondylodiscitis and/or osteoporosis). After informed consent, 12 patients suffering from lumbar spondylodiscitis underwent single level MIS-VLIF. Eight of them had a manifest osteoporosis, either. Pre- and postoperative clinical status was documented using numeric rating scale (NRS) for leg and back pain. In all cases, the optimal height for the cage was preoperatively determined using software-based range of motion and sagittal balance analysis. CT scans were obtained to evaluate correct placement of the construct and to verify fusion after 6 months. Since 2013, 12 patients with lumbar pyogenic spondylodiscitis underwent MIS-VLIF. Mean surgery time was 169 ± 28 min and average blood loss was less than 400 ml. Postoperative CT scans showed correct placement of the implants. Eleven patients showed considerable postoperative improvement in clinical scores. In one patient, we observed screw loosening. After documented bony fusion in the CT scan, the fixation system was removed in two cases to achieve lower material load. The load-bearing trajectories (vectors) of MIS-VLIF are different from those of conventional coaxial pedicle screw implantation. The dorsally converging construct combines the heads of the dorsoventral pedicle screws with laminar pedicle screws following cortical bone structures within a small approach. In case of lumbar spondylodiscitis and/or osteoporosis, MIS-VLIF relies on cortical bony structures for all screw vectors and the construct does not depend on conventional coaxial pedicle screws in the presence of inflamed, weak, cancellous or osteoporotic bone. MIS-VLIF allows full 360° lumbar fusion including cage implantation via a small, unilateral dorsal midline approach.

  19. Technical note: New particle formation event forecasts during PEGASOS-Zeppelin Northern mission 2013 in Hyytiälä, Finland

    Science.gov (United States)

    Nieminen, T.; Yli-Juuti, T.; Manninen, H. E.; Petäjä, T.; Kerminen, V.-M.; Kulmala, M.

    2015-11-01

    New particle formation (NPF) occurs frequently in the global atmosphere. During recent years, detailed laboratory experiments combined with intensive field observations in different locations have provided insights into the vapours responsible for the initial formation of particles and their subsequent growth. In this regard, the importance of sulfuric acid, stabilizing bases such as ammonia and amines as well as extremely low volatile organics, have been proposed. The instrumentation to observe freshly formed aerosol particles has developed to a stage where the instruments can be implemented as part of airborne platforms, such as aircrafts or a Zeppelin-type airship. Flight measurements are technically more demanding and require a greater detail of planning than field studies at the ground level. The high cost of flight hours, limited time available during a single research flight for the measurements, and different instrument payloads in Zeppelin airship for various flight missions demanded an analysis tool that would forecast whether or not there is a good chance for an NPF event. Here we present a methodology to forecast NPF event probability at the SMEAR II site in Hyytiälä, Finland. This methodology was used to optimize flight hours during the PEGASOS (Pan-European Gas Aerosol Climate Interaction Study)-Zeppelin Northern mission in May-June 2013. Based on the existing knowledge, we derived a method for estimating the nucleation probability that utilizes forecast air mass trajectories, weather forecasts, and air quality model predictions. With the forecast tool we were able to predict the occurrence of NPF events for the next day with more than 90 % success rate (10 out of 11 NPF event days correctly predicted). To our knowledge, no similar forecasts of NPF occurrence have been developed for other sites. This method of forecasting NPF occurrence could be applied also at other locations, provided that long-term observations of conditions favouring particle

  20. Endoscopic Transseptal Approach with Posterior Nasal Spine Removal: A Wide Surgical Corridor to the Craniovertebral Junction and Odontoid: Technical Note and Case Series.

    Science.gov (United States)

    Rossini, Zefferino; Milani, Davide; Nicolosi, Federico; Costa, Francesco; Lasio, Giovanni Battista; D'Angelo, Vincenzo Antonio; Fornari, Maurizio; Colombo, Giovanni

    2018-02-01

    The transnasal approach to lesions involving the craniovertebral junction represents a technical challenge because of limited inferior exposure. The endoscopic transseptal approach (EtsA) with posterior nasal spine (PNS) removal is described. This technique can create a wide exposure of the craniovertebral junction, thereby increasing the caudal exposure. On patients undergoing anterior craniovertebral junction decompression, we calculated the degree of exposure on the sagittal plan through a paraseptal route, an EtsA without and with PNS removal. The horizontal exposure and working area with the latter approach were also evaluated. Five patients underwent the transnasal procedure. The age of patients ranged from 34-71 years. All patients harbored basilar impression. The mean postoperative Nurick grade (1, 8) was improved versus the average preoperative grade (3). The average follow-up duration was 16 months. All patients underwent occipitocervical fixation. The mean vertical distances, from the clinoid recess to the inferior most limit with the paraseptal approach, EtsA without and with PNS removal were 38.52, 44.12, and 51.16 mm, respectively. The difference between our approach and a standard paraseptal route was statistically significant (P = 0.041; P< 0.05). The mean horizontal distances were 31.68 mm (mononostril entry) and 35.37 mm (binostril entry). The mean working area was 1795.53 mm 2 . Endoscopic endonasal approaches to the craniovertebral junction are increasing, but the downward extension on the anterior cervical spine represents a limit. Therefore, many surgeons prefer transoral or transcervical approaches. The EtsA with PNS removal allows for a more caudal exposure than the standard paraseptal approach, with reduced nasal trauma. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Percutaneous Biopsy and Radiofrequency Ablation of Osteoid Osteoma with Excess Reactive New Bone Formation and Cortical Thickening Using a Battery-Powered Drill for Access: A Technical Note

    Energy Technology Data Exchange (ETDEWEB)

    Filippiadis, D., E-mail: dfilippiadis@yahoo.gr; Gkizas, C., E-mail: chgkizas@gmail.com; Kostantos, C., E-mail: drkarpen@yahoo.gr; Mazioti, A., E-mail: argyromazioti@yahoo.gr; Reppas, L., E-mail: l.reppas@yahoo.com; Brountzos, E., E-mail: ebrountz@med.uoa.gr; Kelekis, N., E-mail: kelnik@med.uoa.gr; Kelekis, A., E-mail: akelekis@med.uoa.gr [University General Hospital “ATTIKON”, 2nd Radiology Department (Greece)

    2016-10-15

    PurposeTo report our experience with the use of a battery-powered drill in biopsy and radiofrequency ablation of osteoid osteoma with excess reactive new bone formation. The battery-powered drill enables obtaining the sample while drilling.Materials and MethodsDuring the last 18 months, 14 patients suffering from painful osteoid osteoma with excess reactive new bone formation underwent CT-guided biopsy and radiofrequency ablation. In order to assess and sample the nidus of the osteoid osteoma, a battery-powered drill was used. Biopsy was performed in all cases. Then, coaxially, a radiofrequency electrode was inserted and ablation was performed with osteoid osteoma protocol. Procedure time (i.e., drilling including local anesthesia), amount of scans, technical and clinical success, and the results of biopsy are reported.ResultsAccess to the nidus through the excess reactive new bone formation was feasible in all cases. Median procedure time was 50.5 min. Histologic verification of osteoid osteoma was performed in all cases. Radiofrequency electrode was coaxially inserted within the nidus and ablation was successfully performed in all lesions. Median amount CT scans, performed to control correct positioning of the drill and precise electrode placement within the nidus was 11. There were no complications or material failure reported in our study.ConclusionsThe use of battery-powered drill facilitates access to the osteoid osteoma nidus in cases where excess reactive new bone formation is present. Biopsy needle can be used for channel creation during the access offering at the same time the possibility to extract bone samples.

  2. A hybrid clinical-research depth electrode for acute and chronic in vivo microelectrode recording of human brain neurons. Technical note.

    Science.gov (United States)

    Howard, M A; Volkov, I O; Granner, M A; Damasio, H M; Ollendieck, M C; Bakken, H E

    1996-01-01

    For several decades, important scientific information has been gained from in vivo microelectrode recordings of individual human cerebral cortical neurons in patients with epilepsy. The experimental methods used, however, are technically complex and require a highly skilled intraoperative team. There are also significant experimental time limitations, as well as constraints on the type of behavioral tests conducted, and the brain regions that may be safely studied. In this report, a new method is described for obtaining in vivo microelectrode recordings using a hybrid depth electrode (HDE). High-impedance research recording contacts are interspersed between low-impedance clinical electroencephalographic (EEG) contacts along the HDE shaft. The HDE has the same external physical properties as a standard clinical depth electrode (DE). Following preclinical laboratory testing, 15 HDEs were used in the evaluation of six patients with medically refractory epilepsy. High-quality EEG recordings were obtained in all cases (two acute intraoperative, four from the chronic epilepsy monitoring unit). Action potentials from individual neurons were successfully recorded during all experimental sessions; however, the chronic preparations were clearly superior. Chronic HDEs are placed using a standard stereotactic system, and the locations of recording contacts are documented on a postimplantation imaging study. The quality of the chronic research recordings was excellent over study periods ranging from 5 to 14 days. The patients rested comfortably on the ward and were able to cooperate with complex experimental instructions. Basic neuroscientists participated fully in all aspects of the chronic investigations. The use of an HDE in place of a standard clinical DE may now allow detailed physiological investigations of any brain region targeted for clinical DE implantation.

  3. Application note :

    Energy Technology Data Exchange (ETDEWEB)

    Russo, Thomas V.

    2013-08-01

    The development of the XyceTM Parallel Electronic Simulator has focused entirely on the creation of a fast, scalable simulation tool, and has not included any schematic capture or data visualization tools. This application note will describe how to use the open source schematic capture tool gschem and its associated netlist creation tool gnetlist to create basic circuit designs for Xyce, and how to access advanced features of Xyce that are not directly supported by either gschem or gnetlist.

  4. Consequences of Avulsion Fracture of the Proximal Phalanx Caused by a Technical Failure of Hallux Valgus Surgery.

    Science.gov (United States)

    Park, Young Uk; Lee, Kyung Tai; Jegal, Hyuk; Kim, Ki Chun; Choo, Ho Sik; Kweon, Heon Ju

    2016-01-01

    Several cases of avulsion fracture of the proximal phalanx of the big toe during the lateral capsular release procedure were observed. However, these fractures have not been reported as a complication of hallux valgus surgery. The purpose of the present study was to report the proximal phalanx base fracture as an unrecognized complication and to evaluate the clinical and radiographic consequences of this complication. We retrospectively reviewed 225 feet that had undergone hallux valgus surgery involving proximal chevron osteotomy and distal soft tissue release from May 2009 to December 2012. Of these 225 feet (198 patients), 12 (5.3%) developed proximal phalanx base fracture postoperatively. These patients were assigned to the fracture group. The remaining patients were assigned to the nonfracture group. Patients were followed to observe whether the fractures united and whether degenerative changes developed at the first metatarsophalangeal joint because of this fracture. The mean follow-up period was 36 (range 12 to 72) months. All the subjects in the fracture and nonfracture groups underwent weightbearing anteroposterior and lateral radiographs of the foot at the initial presentation and final follow-up point. The 2 groups were compared with respect to the hallux valgus angle, intermetatarsal angle, range of motion, American Orthopaedic Foot and Ankle Society score, satisfaction, and degenerative changes. No significant differences were found in age, follow-up period, hallux valgus angle, intermetatarsal angle, range of motion of the first metatarsophalangeal joint, American Orthopaedic Foot and Ankle Society score, satisfaction, and degenerative changes between the 2 groups. Ten (83.3%) of the 12 fractures healed, 2 (16.7% of the fractures, 0.89% of the operated feet) progressed to asymptomatic nonunion, and 3 (1.33%) developed first metatarsophalangeal joint degeneration. Avulsion fracture of the proximal phalanx of the big toe is an uncommon complication of

  5. Technical Notes: Notes and Proposed Guidelines on Updated ...

    African Journals Online (AJOL)

    In light of recent expansion in the planning and construction of major building structures as well as other infrastructures such as railways, masshousing, dams, bridges, etc, this paper reviews the extent of seismic hazard in Ethiopia and proposes a review and update of the current out-dated and - in most cases ...

  6. Integration of image guidance and rapid prototyping technology in craniofacial surgery.

    Science.gov (United States)

    Bullock, P; Dunaway, D; McGurk, L; Richards, R

    2013-08-01

    This technical note demonstrates the benefits of preoperative planning, involving the use of rapid prototype models and rehearsal of the surgical procedure, using image-guided navigational surgery. Optimum reconstruction of large defects can be achieved with this technique. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. Euro-NOTES Status Paper: from the concept to clinical practice.

    Science.gov (United States)

    Fuchs, K H; Meining, A; von Renteln, D; Fernandez-Esparrach, G; Breithaupt, W; Zornig, C; Lacy, A

    2013-05-01

    The concept of natural orifice transluminal endoscopic surgery (NOTES) consists of the reduction of access trauma by using a natural orifice access to the intra-abdominal cavity. This could possibly lead to less postoperative pain, quicker recovery from surgery, fewer postoperative complications, fewer wound infections, and fewer long-term problems such as hernias. The Euro-NOTES Foundation has organized yearly meetings to work on this concept to bring it safely into clinical practice. The aim of this Euro-NOTES status update is to assess the yearly scientific working group reports and provide an overview on the current clinical practice of NOTES procedures. After the Euro-NOTES meeting 2011 in Frankfurt, Germany, an analysis was started regarding the most important topics of the European working groups. All prospectively documented information was gathered from Euro-NOTES and D-NOTES working groups from 2007 to 2011. The top five topics were analyzed. The statements of the working group activities demonstrate the growing information and changing insights. The most important selected topics were infection issue, peritoneal access, education and training, platforms and new technology, closure, suture, and anastomosis. The focus on research topics changed over time. The principle of hybrid access has overcome the technical and safety limitations of pure NOTES. Currently the following NOTES access routes are established for several indications: transvaginal access for cholecystectomy, appendectomy and colon resections; transesophageal access for myotomy; transgastric access for full-thickness small-tumor resections; and transanal/transcolonic access for rectal and colon resections. NOTES and hybrid NOTES techniques have emerged for all natural orifices and were introduced into clinical practice with a good safety record. There are different indications for different natural orifices. Each technique has been optimized for the purpose of finding a safe and realistic

  8. How to minimize ischemic complication related to swollen temporalis muscle following indirect revascularization surgery in moyamoya disease: a technical report.

    Science.gov (United States)

    Joo, Sung Pil; Kim, Tae Sun; Moon, Hyung Sik

    2014-05-01

    There are several reports in the literature of postoperative ischemic events due to swelling of the temporalis muscle after indirect revascularization surgery. Here, we report our surgical technique for preventing ischemic events during the acute postoperative recovery period in moyamoya patients. We used various types of titanium mesh to cover the bony defect area in 8 patients (10 operations) with moyamoya disease. The mesh was cut and manipulated according to the shape of the bony defect. Surgical results were favorable, with no newly developed ischemic event or infarction in the acute recovery period. The mesh formed an outer table of skull, so there was no compressive effect on the temporalis muscle and no cosmetic defects. The titanium mesh appears to be effective and useful for prevention of ischemic insult in the treatment of moyamoya disease. The choice of this procedure depends on both the operative findings of temporalis muscle thickness and the status of ischemic vulnerability of moyamoya brain. Georg Thieme Verlag KG Stuttgart · New York.

  9. Systematic review and meta-analysis of the role of mental training in the acquisition of technical skills in surgery.

    Science.gov (United States)

    Rao, Ahsan; Tait, Ian; Alijani, Afshin

    2015-09-01

    Mental training is rehearsal of mental imagery without physically performing the task. The aim of the study was to perform systematic review and meta-analysis on all the available data to evaluate the role of mental training in the acquisition of surgical technical skills. The following search databases were used: EMBASE, MEDLINE, Web of Science, Clinicaltrials.gov.uk, SIGN guidelines, NICE guidelines, and Cochrane review register. Meta-analysis was performed using Revman 5.2 statistical software. There were a total of 9 randomized controlled trials with 474 participants, of which 189 participants received mental training. Five randomized controlled trials concluded positive impact of mental training. Mental training group did not show any significant improvement in overall performance of the task carried in each study (P = .06). Mental training can be used as an important supplementary tool in learning surgical skills when run in parallel with physical training and applied to trainees with some experience of the skill. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Evaluation of radiation protection and technical procedures in Wad Madani Heart Diseases and Surgery Center (WHDSC) (cardiac catheterization laboratory)

    International Nuclear Information System (INIS)

    Gesmallah, A. H. A.

    2013-07-01

    The purpose of this study is conducted in order to evaluate the application of radiation protection program, evaluate the design of cardiac catheterization laboratory, evaluate the effectiveness of radiation protection devices, evaluate personal monitoring, usage of G-Arm x-ray machine, to evaluate the responsibilities of radiation protection officer (RPO), to assess monitoring devices if available, and to assess patient patient dose in Wad Madani hear disease and surgery center in a period from march 2013 to june 2013. The most data in this study was obtained from the results of the team of quality assurance and control of radiation safety institute when they visited hospital on 14/2/2011 for inspection and calibration for issue of registration and licenses, except the data of patients dose which obtained from exposure parameters and dosimetric information's in the archive of G-arm x-ray fluoroscopic machine (which were 110 of cardiac catheterization diagnostic and therapeutic cases, 60 of adult patients and 50 of children. The patient data included age, weight, kv, mAs, DAP, air kerma, and fluoro time. The results of this study show that there is radiation protection program need correction and partially applied, the design of cardiac catheterization laboratory is accepted according to radiation safety institute team of quality control. Also the study shows that the radiation protection program devices are available and good condition and enough in number. The study shows that there are no personal monitoring devices and services and the radiological technologist are well trained to dial with the G-arm x-ray machine and to apply the radiation protection program effectively. Also the study states that the radiation protection officer could apply his responsibilities partially. Finally the study shows that there is a direct linear relationship between the patient's weight and (DAP, air kerma, kv, and mAs) concludes that there is excessive radiation dose in cardiac

  11. Miniature surgical robots in the era of NOTES and LESS: dream or reality?

    Science.gov (United States)

    Zygomalas, Apollon; Kehagias, Ioannis; Giokas, Konstantinos; Koutsouris, Dimitrios

    2015-02-01

    Laparoscopy is an established method for the treatment of numerous surgical conditions. Natural orifice transluminal endoscopic surgery (NOTES) is a novel surgical technique that uses the natural orifices of the human body as entrances to the abdominal cavity. An alternative concept of minimally invasive approach to the abdominal cavity is to insert all the laparoscopic instruments through ports using a single small incision on the abdominal wall. A suggested name for this technique is laparoendoscopic single-site surgery (LESS). Considering the technical difficulties in NOTES and LESS and the progress in informatics and robotics, the use of robots seems ideal. The aim of this study is to investigate if there is at present, a realistic possibility of using miniature robots in NOTES or LESS in daily clinical practice. An up-to-date review on in vivo surgical miniature robots is made. A Web-based research of the English literature up to March 2013 using PubMed, Scopus, and Google Scholar as search engines was performed. The development of in vivo miniature robots for use in NOTES or LESS is a reality with great advancements, potential advantages, and possible application in minimally invasive surgery in the future. However, true totally NOTES or LESS procedures on humans using miniature robots either solely or as assistance, remain a dream at present. © The Author(s) 2014.

  12. Editors' note

    Science.gov (United States)

    Denker, Carsten; Feller, Alex; Schmidt, Wolfgang; von der Lühe, Oskar

    2012-11-01

    This topical issue of Astronomische Nachrichten/Astronomical Notes is a collection of reference articles covering the GREGOR solar telescope, its science capabilities, its subsystems, and its dedicated suite of instruments for high-resolution observations of the Sun. Because ground-based telescopes have life spans of several decades, it is only natural that they continuously reinvent themselves. Literally, the GREGOR telescope builds on the foundations of the venerable Gregory-Coudé Telescope (GCT) at Observatorio del Teide, Tenerife, Spain. Acknowledging the fact that new discoveries in observational solar physics are driven by larger apertures to collect more photons and to scrutinize the Sun in finer detail, the GCT was decommissioned and the building was made available to the GREGOR project.

  13. Editorial note

    DEFF Research Database (Denmark)

    Gani, Rafiqul; Hrymak, A.; Lee, J.

    2009-01-01

    industrial and educational applications. These articles will highlight theory, models, algorithms and applications with respect to value preservation and/or value creation or growth within the chemical product supply chain. To highlight and motivate research in the emerging challenges in PSE, we plan...... components of PSE—modeling, numerical analysis, optimization, systems and control theory, computer science, and, management science will be highlighted through the published articles (full-length papers, perspective papers, review papers, short notes and letters to the editor). They will cover...... and intelligent systems, integrated approaches to design, control and data analysis, systematic techniques for managing complexity, etc.), PSE emerging domains (product-process design, enterprise-wide optimization, energy and sustainability, biological engineering, pharmaceutical engineering, etc.) and novel...

  14. Editorial Note

    Science.gov (United States)

    van der Meer, F.; Ommen Kloeke, E.

    2015-07-01

    With this editorial note we would like to update you on the performance of the International Journal of Applied Earth Observation and Geoinformation (JAG) and inform you about changes that have been made to the composition of the editorial team. Our Journal publishes original papers that apply earth observation data for the management of natural resources and the environment. Environmental issues include biodiversity, land degradation, industrial pollution and natural hazards such as earthquakes, floods and landslides. As such the scope is broad and ranges from conceptual and more fundamental work on earth observation and geospatial sciences to the more problem-solving type of work. When I took over the role of Editor-in-Chief in 2012, I together with the Publisher set myself the mission to position JAG in the top-3 of the remote sensing and GIS journals. To do so we strived at attracting high quality and high impact papers to the journal and to reduce the review turnover time to make JAG a more attractive medium for publications. What has been achieved? Have we reached our ambitions? We can say that: The submissions have increased over the years with over 23% for the last 12 months. Naturally not all may lead to more papers, but at least a portion of the additional submissions should lead to a growth in journal content and quality.

  15. Note & Recensioni

    Directory of Open Access Journals (Sweden)

    2014-12-01

    Full Text Available VolumiVito Campanelli, Web Aesthetics. How Digital Media Affect Culture and Society; Id., Remix It Yourself. Analisi socio-estetica delle forme comunicative del Web [Emanuele Crescimanno] • Jean-François Bordron, Image et vérité. Essais sur les dimensions iconiques de la connaissance [Veronica Estay Stange] • Stéphane Dumas, Les peaux créatrices – Esthétique de la sécrétion [Marc-Vincent Howlett]NoteQuidam veritatis effectus. A proposito di A Plea for Balance in Philosophy. Essays in honour of Paolo Parrini [Fabrizio Desideri] • A Single Face to Capture the Whole World: Literary Shapes and Shadows. An Interview With Tolm Coibin [Fabrizia Abbate] •Convegno Le sensible a l’oeuvre: savoirs du corps entre esthetique et neurosciences, Parigi, 15 Maggio 2014 [Jessica Murano] 

  16. Technical note: Spine loading in automotive seating

    NARCIS (Netherlands)

    Zenk, R.; Franz, M.; Bubb, H.; Vink, P.

    2012-01-01

    For car manufacturers, seat comfort is becoming more important in distinguishing themselves from their competitors. Therefore, many studies on participative seat comfort are carried out. In this paper, an objective assessment approach is reported which evaluates the concept of "optimal load

  17. Technical Note: Effect of Incorporating Expanded Polystyrene ...

    African Journals Online (AJOL)

    Incorporating expanded polystyrene granules in concrete matrix can produce lightweight polystyrene aggregate concrete of various densities. Workability which is an important property of concrete, aects the rate of placement and the degree of compaction of concrete. Inadequate compaction leads to reduction in both ...

  18. Letter Dice. Technical Note No. 6.

    Science.gov (United States)

    Gunter, Jock

    Letter and syllable dice devised for a project in rural Ecuador provide inexpensive, easily reproducible learning materials for practice in basic literary skills. Eleven wooden cubes with six letters on each cube are cast onto a surface and the player constructs words from the letters on the top side of the dice. After a word is formed and…

  19. TECHNICAL NOTES SEISMIC SOIL-STRUCTURE INTERACTION ...

    African Journals Online (AJOL)

    dell

    SEISMIC SOIL-STRUCTURE INTERACTION AS A POTENTIAL TOOL FOR. ECONOMICAL ... ground motion at the interface with the rock. The soil can .... half space have an elastic modulus of E and a mass density of ρ . .... The trial solution to.

  20. The Facilitator. Technical Note No. 11.

    Science.gov (United States)

    Barriga, Patricio; And Others

    This paper describes the concept, training, and experiences of community facilitators as change agents in a nonformal education project in rural Ecuador. Presently, the social, economic, and political context of the rural Ecuadorian consists of poverty, racial prejudice, economic exploitation, and psychological dependency. The project attempted to…

  1. Technical note: Design flood under hydrological uncertainty

    Science.gov (United States)

    Botto, Anna; Ganora, Daniele; Claps, Pierluigi; Laio, Francesco

    2017-07-01

    Planning and verification of hydraulic infrastructures require a design estimate of hydrologic variables, usually provided by frequency analysis, and neglecting hydrologic uncertainty. However, when hydrologic uncertainty is accounted for, the design flood value for a specific return period is no longer a unique value, but is represented by a distribution of values. As a consequence, the design flood is no longer univocally defined, making the design process undetermined. The Uncertainty Compliant Design Flood Estimation (UNCODE) procedure is a novel approach that, starting from a range of possible design flood estimates obtained in uncertain conditions, converges to a single design value. This is obtained through a cost-benefit criterion with additional constraints that is numerically solved in a simulation framework. This paper contributes to promoting a practical use of the UNCODE procedure without resorting to numerical computation. A modified procedure is proposed by using a correction coefficient that modifies the standard (i.e., uncertainty-free) design value on the basis of sample length and return period only. The procedure is robust and parsimonious, as it does not require additional parameters with respect to the traditional uncertainty-free analysis. Simple equations to compute the correction term are provided for a number of probability distributions commonly used to represent the flood frequency curve. The UNCODE procedure, when coupled with this simple correction factor, provides a robust way to manage the hydrologic uncertainty and to go beyond the use of traditional safety factors. With all the other parameters being equal, an increase in the sample length reduces the correction factor, and thus the construction costs, while still keeping the same safety level.

  2. Technical note: Examining ozone deposition over seawater

    Science.gov (United States)

    Surface layer resistance plays an important role in determining ozone deposition velocity over sea-water and can be influenced by chemical interactions at the air-water interface. Here, we examine the effect of chemical interactions of iodide, dimethylsulfide, dissolved organic c...

  3. Freehand technique for putaminal hemorrhage. Technical note

    International Nuclear Information System (INIS)

    Yokosuka, Kimihiko; Uno, Masaaki; Hirano, Kazuhiro; Toi, Hiroyuki; Matsuzaki, Kazuhito; Matsubara, Shunji

    2011-01-01

    We designed a new endoscopic surgical procedure for putaminal hemorrhage (freehand technique) and evaluated its effectiveness and safety in patients with putaminal hemorrhage. Computed tomography (CT) data sets from 40 healthy patients were used. The CT data were transformed into three-dimensional images using AZE VirtualPlace Plus. The nasion and external auditory foramen were the intraoperative reference points. The median point from medial of the globus pallidus to the insula was the target point. The location of the burr hole point was 80-125 mm above and 27.5 mm lateral to the nasion, and the direction was parallel to the midline and a line drawn from the burr hole to the ipsilateral external auditory foramen. This point was used for 15 patients with putaminal hemorrhage. In all cases, only one puncture was required, and there were no complications. The median surgical time was 91.7 minutes, and the median hematoma removal rate was 95.9%. No recurrent bleeding or operative complications occurred. The freehand technique is a simple and safe technique for patients with putaminal hemorrhage. We believe that this technique of endoscopic hematoma evacuation may provide a less-invasive method for treating patients with putaminal hemorrhage. (author)

  4. "Technical note. Harmonization of the multi-scale multi-model activities HTAP, AQMEII and MICS-Asia: simulations, emission inventories, boundary conditions and output formats." For submission to ACP Special Issue on "Global and regional assessment of intercontinental transport of air pollution: results from HTAP, AQMEII and MICS"

    Science.gov (United States)

    The ACP Special Issue is being organized to draw together analysis of a set of cooperative modeling experiments (referred to as HTAP2). The purpose of this technical note is to provide a common description of the experimental design and set up for HTAP2 that can be referred to b...

  5. Writing otorhinolaryngology head & neck surgery operative reports.

    Science.gov (United States)

    Laccourreye, O; Rubin, F; Villeneuve, A; Bonfils, P

    2017-09-01

    Only about ten articles devoted to operative reports have been published in the medical literature, but this document is essential, both medically and legally, to ensure optimal management of operated patients. In this technical note, based on published studies on this subject, the authors describe the key features of operating reports after otorhinolaryngology head & neck surgery and emphasize the need to write this document during the minutes after the end of the operation, the importance of standardization and its teaching role during surgical training. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  6. Hybrid NOTES: TEO for transanal total mesorectal excision: intracorporeal resection and anastomosis.

    Science.gov (United States)

    Serra-Aracil, Xavier; Mora-López, Laura; Casalots, Alex; Pericay, Carles; Guerrero, Raul; Navarro-Soto, Salvador

    2016-01-01

    Laparoscopic surgery for rectal TME achieves better patient recovery, lower morbidity, and shorter hospital stay than open surgery. However, in laparoscopic rectal surgery, the overall conversion rate is nearly 20%. Transanal TME combined with laparoscopy, known as Hybrid NOTES, is a less invasive procedure that provides adequate solutions to some of the limitations of rectal laparoscopy. Transanal TME via TEO with technical variants (intracorporeal resection and anastomosis, TEO review of the anastomosis) attempts to standardize and simplify the procedure. Prospective observational study was used describe and assess the technique in terms of conversion to open surgery, overall morbidity, surgical site infection and hospital stay. The sample comprised consecutive patients diagnosed with rectal tumor less than 10 cm from the anal verge who were candidates for low anterior resection using TME (except T4). Demographic, surgical, postoperative, and pathological variables were analyzed, as well as morbidity rates. From September 2012 to August 2014, 32 patients were included. The conversion rate was 0%. Overall morbidity was 31.3%, SSI rate was 9.4%, and mean hospital stay was 8 days. Oncological radical criteria were achieved with pathological parameters of 94% of complete TME and a median circumferential margin of 13 mm. The introduction of technical variants of TEO for transanal resection can facilitate a procedure that requires extensive experience in transanal and laparoscopic surgery. Studies of sphincter function, quality of life, and long-term oncological outcome are now necessary.

  7. Annals of Pediatric Surgery

    African Journals Online (AJOL)

    The Annals of Pediatric Surgery is striving to fill an important niche that provides focus to clinical care, technical innovation and clinical research. The Annals of Pediatric Surgery has the responsibility to serve not only pediatric surgeons in the Middle East and North Africa but also should be an important conduit for scientific ...

  8. About Hand Surgery

    Science.gov (United States)

    ... Find a hand surgeon near you. © 2009 American Society for Surgery of the Hand. Definition developed by ASSH Council. Other Links CME Mission Statement and Disclaimer Policies and Technical Requirements Exhibits and Partners ASSH 822 W. Washington Blvd. ... 2018 by American Society for Surgery of the Hand × Search Tips Tip ...

  9. Surgery via natural orifices in human beings: yesterday, today, tomorrow.

    Science.gov (United States)

    Moris, Demetrios N; Bramis, Konstantinos J; Mantonakis, Eleftherios I; Papalampros, Efstathios L; Petrou, Athanasios S; Papalampros, Alexandros E

    2012-07-01

    We performed an evaluation of models, techniques, and applicability to the clinical setting of natural orifice surgery (mainly natural orifice transluminal endoscopic surgery [NOTES]) primarily in general surgery procedures. NOTES has attracted much attention recently for its potential to establish a completely alternative approach to the traditional surgical procedures performed entirely through a natural orifice. Beyond the potentially scar-free surgery and abolishment of dermal incision-related complications, the safety and efficacy of this new surgical technology must be evaluated. Studies were identified by searching MEDLINE, EMBASE, Cochrane Library, and Entrez PubMed from 2007 to February 2011. Most of the references were identified from 2009 to 2010. There were limitations as far as the population that was evaluated (only human beings, no cadavers or animals) was concerned, but there were no limitations concerning the level of evidence of the studies that were evaluated. The studies that were deemed applicable for our review were published mainly from 2007 to 2010 (see Methods section). All the evaluated studies were conducted only in human beings. We studied the most common referred in the literature orifices such as vaginal, oral, gastric, esophageal, anal, or urethral. The optimal access route and method could not be established because of the different nature of each procedure. We mainly studied procedures in the field of general surgery such as cholecystectomy, intestinal cancers, renal cancers, appendectomy, mediastinoscopy, and peritoneoscopy. All procedures were feasible and most of them had an uneventful postoperative course. A number of technical problems were encountered, especially as far as pure NOTES procedures are concerned, which makes the need of developing new endoscopic instruments, to facilitate each approach, undeniable. NOTES is still in the early stages of development and more robust technologies will be needed to achieve reliable

  10. technical note: technical note: on the correctness of load loss factor ...

    African Journals Online (AJOL)

    eobe

    Load Loss Factor (LLF) is a function of the estimate of the losses between the grid supply point and the consumers. estimate ... i.e. the ratio of average demand to peak demand, and using this ratio to determine an approximation to the. LLF via ...

  11. Modificação técnica na cirurgia da estenose aórtica supravalvar Technical modifications in the surgery of supravalvar aortic stenosis

    Directory of Open Access Journals (Sweden)

    Magaly Arrais dos Santos

    1996-12-01

    íodo pós-operatório de 3 meses a 4 anos e 5 meses, não houve óbito; todos os pacientes estão assintomáticos, evoluindo satisfatoriamente, sem gradiente entre a cavidade livre do ventrículo esquerdo e aorta ascendente, conforme ecocardiograma, Doppler, ressonância nuclear magnética e estudo hemodinâmico. Estes resultados nos permitem concluir ser esta técnica adequada para a correção cirúrgica da estenose supravalvar aórtica localizada, por não utilizar enxertos artificiais e realizar a sutura da aorta em uma linha sinusoidal, evitando, assim, reestenose.A technical modification in the surgery of supravalvar aortic stenosis has been developed since October 1991 to December 1995, without using artificial grafts, but only healthy tissue of the ascending aorta thus permitting a suitable enlargement of the aortic root. The aim of this technique is to avoid complications of re-estenosis of aortic root in the late evolution of patientes submitted to surgical treatment of localized supravalvar aortic stenosis which was provoked by calcification and hardening of prosthetic material used for the enlargement of one or more Valsalva sinuses, with or whitout transversal section of the aorta. Ten patients underwent a surgery in this meantime, with clinical and hemodynamic diagnosis of localized supravalvar aortic stenosis. Their ages varied from 11 months to 38 years (mean = 13.2 years, the weight varied from 7.500 kg to 56 kg (mean = 29.1 kg, and the height varied from 72 cm to 1.68 m (mean = 1.5 m. Six of these patients were male. Three of them were asymptomatic; 4 had dyspnea, 2 were tired at efforts, 2 had palpitations, 1 had paresthesia in the lower limbs, and 1 cyanosis at crying; 6 of them bore Williams syndrome. The systolic gradient between free cavity of left ventricle and aorta varied from 50 to 100 mmHg (mean = 73.5.The patients were operated on with extracorporeal circulation, moderate hypothermia, crystalloid cardioplegia in the 7 first cases and bloody

  12. Note Taking and Recall

    Science.gov (United States)

    Fisher, Judith L.; Harris, Mary B.

    1974-01-01

    To study the effect of note taking and opportunity for review on subsequent recall, 88 college students were randomly assigned to five treatment groups utilizing different note taking and review combinations. No treatment effects were found, although quality of notes was positively correlated with free recall an multiple-choice measures.…

  13. PET-Probe: Evaluation of Technical Performance and Clinical Utility of a Handheld High-Energy Gamma Probe in Oncologic Surgery.

    Science.gov (United States)

    Gulec, Seza A; Daghighian, Farhad; Essner, Richard

    2016-12-01

    Positron emission tomography (PET) has become an invaluable part of patient evaluation in surgical oncology. PET is less than optimal for detecting lesions PET-positive lesions can be challenging as a result of difficulties in surgical exposure. We undertook this investigation to assess the utility of a handheld high-energy gamma probe (PET-Probe) for intraoperative identification of 18 F-deoxyglucose (FDG)-avid tumors. Forty patients underwent a diagnostic whole-body FDG-PET scan for consideration for surgical exploration and resection. Before surgery, all patients received an intravenous injection of 7 to 10 mCi of FDG. At surgery, the PET-Probe was used to determine absolute counts per second at the known tumor site(s) demonstrated by whole-body PET and at adjacent normal tissue (at least 4 cm away from tumor-bearing sites). Tumor-to-background ratios were calculated. Thirty-two patients (80%) underwent PET-Probe-guided surgery with therapeutic intent in a recurrent or metastatic disease setting. Eight patients underwent surgery for diagnostic exploration. Anatomical locations of the PET-identified lesions were neck and supraclavicular (n = 8), axilla (n = 5), groin and deep iliac (n = 4), trunk and extremity soft tissue (n = 3), abdominal and retroperitoneal (n = 19), and lung (n = 2). PET-Probe detected all PET-positive lesions. The PET-Probe was instrumental in localization of lesions in 15 patients that were not immediately apparent by surgical exploration. The PET-Probe identified all lesions demonstrated by PET scanning and, in selected cases, was useful in localizing FDG-avid disease not seen with conventional PET scanning.

  14. Comparison of Inflammatory Response to Transgastric and Transcolonic NOTES

    Czech Academy of Sciences Publication Activity Database

    Hucl, T.; Beneš, M.; Kočík, M.; Šplíchalová, Alla; Malušková, J.; Krak, M.; Lánská, V.; Heczková, M.; Kieslichová, E.; Oliverius, M.; Špičák, J.

    2016-01-01

    Roč. 2016, MAY (2016), s. 7320275 ISSN 1687-6121 Institutional support: RVO:61388971 Keywords : TRANSLUMINAL ENDOSCOPIC SURGERY * NOTES TRANSVAGINAL CHOLECYSTECTOMY * PORCINE SURVIVAL MODEL Subject RIV: EE - Microbiology, Virology Impact factor: 1.863, year: 2016

  15. Ensino técnico: uma necessidade ou uma falácia? Notas para a compreensão da filosofia do ensino técnico em Portugal e no Brasil - Technical teaching: a necessity or a fallacy? Notes for the comprehension of the philosophy of technical teaching in Portugal

    Directory of Open Access Journals (Sweden)

    Luís Alberto Marques Alves, Portugal.

    2013-08-01

    Full Text Available 1024x768 Falar de ensino técnico obriga a cruzar vertentes científicas diversas - história, sociologia, economia - e contextualizar a informação no âmbito da História da Educação. A herança recebida do sistema corporativo, a partilha de responsabilidades entre público e privado, as expectativas sociais e económicas, a sua relação com o desenvolvimento e a difícil relação entre o nacional e o internacional são algumas das vertentes que importa analisar quando procuramos fazer um trajeto breve na dimensão mais alargada no tempo. Inserir ainda uma preocupação comparativa entre Portugal e Brasil, ainda que pontual, exige uma síntese das ideias nucleares marginalizando o acessório. Procura este artigo, numa cronologia que vai do século 18 aos fins do 20, elencar as mudanças de filosofia, de investimento, de credibilidade social e de necessidade económica.Palavras-chave: ensino técnico, profissionalização, capitalismo industrial, neoprofissionalismo, Portugal, Brasil, ensino secundário. TECHNICAL TEACHING: A NECESSITY OR A FALLACY? NOTES FOR THE COMPREHENSION OF THE PHILOSOPHY OF TECHNICAL TEACHING IN PORTUGAL AND BRAZILAbstractTo talk about technical teaching forces us to cross several scientific fields - history, sociology, economy - and to contextualize the information regarding the History of Education. The inheritance received from the corporative system, the share of responsibilities between public and private, the social and economical expectations, its relation with development and the difficult relation between national and international are some of the fields that we must analyse when we aim to create a path brief in its dimension but stretched in time. To also insert a comparative concern between Portugal and Brazil, even if punctual, demands a synthesis of the nuclear ideas marginalizing the accessory. This article aims to, in a chronology going from the 18 century to the late 20th, specify the changes in the

  16. SHORT COMMUNICATIONS, NOTES AND REPORTS Record of ...

    African Journals Online (AJOL)

    Campbell Murn

    50. SHORT COMMUNICATIONS, NOTES AND. REPORTS. Record of Cinereous Vulture Aegypius monachus from Mukundara Hills Tiger Reserve, Rajasthan,. India. Sailaja Nayak1*, Sunny Shah2 and Jimmy Borah2 .... Prey status and abundance in Mukundara Hills Tiger. Reserve. Technical Report, WWF-India. Rao, J.P. ...

  17. Botswana - Accrual Accounting Policy Note and Guide

    OpenAIRE

    World Bank

    2011-01-01

    This paper comprises two volumes: volume one, this concise policy and guidance note that deals with the request as outlined, and a volume two which provides more detailed technical guidance on the implementation of International Public Sector accounting Standards (IPSAS) accrual based standards. Recommended reforms directly relevant to this paper include: 1) fiscal reforms on both the reve...

  18. Laparoendoscopic single site in pelvic surgery

    Science.gov (United States)

    Sanchez-Salas, Rafael; Clavijo, Rafael; Barret, Eric; Sotelo, Rene

    2012-01-01

    Laparoendoscopic single site (LESS) has recently gained momentum as feasible techniques for minimal access surgery. Our aim is to describe the current status of laparoendoscopic single site (LESS) in pelvic surgery. A comprehensive revision of the literature in LESS pelvic surgery was performed. References for this manuscript were obtained by performing a review of the available literature in PubMed from 01-01-01 to 30-11-11. References outside the search period were obtained selected manuscript΄s bibliography. Search terms included: pelvic anatomy, less in gynecology, single port colectomy, urological less, single port, single site, NOTES, LESS and single incision. 314 manuscripts were initially identified. Out of these, 46 manuscripts were selected based in their pelvic anatomy or surgical content; including experimental experience, clinical series and literature reviews. LESS drastically limit the surgeon's ability to perform in the operative field and the latter becomes hardened by the lack of space in anatomical location like the pelvis. Potential advantages of LESS are gained with the understanding that the surgical procedure is more technically challenging. Pelvic surgical procedures related to colorectal surgery, gynecology and urology have been performed with LESS technique and information available is mostly represented by case reports and short case series. Comparative series remain few. LESS pelvic surgery remain in its very beginning and due to the very specific anatomical conditions further development of LESS surgery in the mentioned area can be clearly be facilitated by using robotic technology. Standardization ad reproducibility of techniques are mandatory to further develop LESS in the surgical arena.. PMID:22557719

  19. Laparoendoscopic single site in pelvic surgery

    Directory of Open Access Journals (Sweden)

    Rafael Sanchez-Salas

    2012-01-01

    Full Text Available Laparoendoscopic single site (LESS has recently gained momentum as feasible techniques for minimal access surgery. Our aim is to describe the current status of laparoendoscopic single site (LESS in pelvic surgery. A comprehensive revision of the literature in LESS pelvic surgery was performed. References for this manuscript were obtained by performing a review of the available literature in PubMed from 01-01-01 to 30-11-11. References outside the search period were obtained selected manuscript΄s bibliography. Search terms included: pelvic anatomy, less in gynecology, single port colectomy, urological less, single port, single site, NOTES, LESS and single incision. 314 manuscripts were initially identified. Out of these, 46 manuscripts were selected based in their pelvic anatomy or surgical content; including experimental experience, clinical series and literature reviews. LESS drastically limit the surgeon′s ability to perform in the operative field and the latter becomes hardened by the lack of space in anatomical location like the pelvis. Potential advantages of LESS are gained with the understanding that the surgical procedure is more technically challenging. Pelvic surgical procedures related to colorectal surgery, gynecology and urology have been performed with LESS technique and information available is mostly represented by case reports and short case series. Comparative series remain few. LESS pelvic surgery remain in its very beginning and due to the very specific anatomical conditions further development of LESS surgery in the mentioned area can be clearly be facilitated by using robotic technology. Standardization ad reproducibility of techniques are mandatory to further develop LESS in the surgical arena..

  20. Video-assisted-thoracoscopic surgery in left-to-right Nuss procedure for pectus excavatum for prevention of serious complications - technical aspects based on 1006 patients.

    Science.gov (United States)

    Pawlak, Krystian; Gąsiorowski, Łukasz; Gabryel, Piotr; Dyszkiewicz, Wojciech

    2018-03-01

    Additional use of the video-assisted thoracoscopic surgery (VATS) technique in the Nuss procedure has been globally accepted for the improvement of safety of surgical treatment as well as for decreased frequency of serious intraoperative and postoperative complications. To evaluate VATS in surgical treatment of patients with pectus excavatum by the left-to-right Nuss procedure for prevention of serious intra- and postoperative complications. From 2002 to 2016, 1006 patients with pectus excavatum aged 7 to 62 years (mean: 18.6) underwent the Nuss procedure. There were 796 males and 210 females. The clinical records of all patients were analyzed retrospectively. The follow-up varied from 1 to 172 months (mean: 80.7 ±43). The early 30-day postoperative mortality was zero. Early thoracoscopy-dependent postoperative complications, the majority transient and non-life-threatening, occurred in 35.6% of patients. The most frequent complication was pneumothorax, diagnosed in 24.5% of patients. Two patients required repeat surgery. One patient required VATS pleurectomy due to persistent postoperative air leakage. In another patient left thoracotomy following bleeding from the pleural cavity was performed. The use of VATS in the left-to-right Nuss procedure for pectus excavatum ensures the safety of surgical treatment and minimizes the occurrence of serious intra- and postoperative complications concerning injury of the mediastinum, lung, diaphragm or abdominal cavity.

  1. The future of NOTES from the conservative point of view.

    Science.gov (United States)

    Kano, Nobuyasu

    2009-01-01

    Recently, the unfamiliar term "natural orifice transluminal endoscopic surgery (NOTES)" appeared in my field. Actually, I am hesitant to accept this technique in my surgical practice. In this paper, I will review some references and try to establish my position toward NOTES. The author has been skeptical and ironical about the clinical potentiality of NOTES since hearing the presentation about NOTES for the first time. I have been concerned about making a puncture in the gastrointestinal tract as an old surgeon who believes that intestinal injury must not occur during surgery. However, recent advances in the research of NOTES are changing my stubborn belief. What I have to do is to avoid interrupting or disturbing young surgeons' challenges to develop NOTES. I remember that some senior surgeons were against us when we started laparoscopic surgery around 1990. Senior surgeons and physicians must be generous, considerate, helpful and supportive to our followers. I have been enthusiastic about the development and spread of laparoscopic surgery since 1987 and have been doing various surgical procedures myself, including those involving the biliary tract, pancreas, spleen, upper and lower gastrointestinal tract, adrenal, kidney and gynecologic organs. Recently, the unfamiliar term "NOTES" appeared in my field. Actually, I am hesitant to accept this technique in my surgical practice. In this paper I will review some references and try to establish my position toward NOTES.

  2. A note on notes: note taking and containment.

    Science.gov (United States)

    Levine, Howard B

    2007-07-01

    In extreme situations of massive projective identification, both the analyst and the patient may come to share a fantasy or belief that his or her own psychic reality will be annihilated if the psychic reality of the other is accepted or adopted (Britton 1998). In the example of' Dr. M and his patient, the paradoxical dilemma around note taking had highly specific transference meanings; it was not simply an instance of the generalized human response of distracted attention that Freud (1912) had spoken of, nor was it the destabilization of analytic functioning that I tried to describe in my work with Mr. L. Whether such meanings will always exist in these situations remains a matter to be determined by further clinical experience. In reopening a dialogue about note taking during sessions, I have attempted to move the discussion away from categorical injunctions about what analysis should or should not do, and instead to foster a more nuanced, dynamic, and pair-specific consideration of the analyst's functioning in the immediate context of the analytic relationship. There is, of course, a wide variety of listening styles among analysts, and each analyst's mental functioning may be affected differently by each patient whom the analyst sees. I have raised many questions in the hopes of stimulating an expanded discussion that will allow us to share our experiences and perhaps reach additional conclusions. Further consideration may lead us to decide whether note taking may have very different meanings for other analysts and analyst-patient pairs, and whether it may serve useful functions in addition to the one that I have described.

  3. Nigerian Journal of Surgery

    African Journals Online (AJOL)

    The Nigerian Journal of Surgery publishes original articles, special articles (by invitation), reviews, case reports, correspondences and notes. Materials cited for publication will include scientific research papers read at the meetings of the Nigerian Surgical Research Society, and of the Association of Surgeons of Nigeria and ...

  4. The role of Multidetector CT in the evaluation of the left atrium and pulmonary veins anatomy before and after radio-frequency catheter ablation for atrial fibrillation. Preliminary results and work in progress.Technical note

    International Nuclear Information System (INIS)

    Centoze, Maurizio; Della Sala, Sabino Walter; Dalla Palma, Francesco; Del Greco, Maurizio; Marini, Massimiliano; Nollo, Giandomenico; Ravelli, Flavia

    2005-01-01

    Radio-frequency catheter ablation (RFCA) of the distal pulmonary veins is increasingly being used to treat recurrent or refractory atrial fibrillation that doesn't respond to pharmacologic therapy or cardioversion. Successful RFCA of atrial al fibrillation depends on the pre-procedural understanding of the complex anatomy of the distal pulmonary veins and the left atrium. Aim of this parer is to describe the technical main features that characterise the multidetector helical computed tomography in the evaluation of this anatomic region before and after RFCA procedure. The 3D post-processing techniques useful for pre-RFCA planning are straightforward [it

  5. Animal Surgery and Resources Core

    Data.gov (United States)

    Federal Laboratory Consortium — The ASR services for NHLBI research animals include: animal model development, surgery, surgical support, post-operative care as well as technical services such as...

  6. Summary list of CEA notes published by the French Atomic Energy Commission (April 1953 - September 1957)

    International Nuclear Information System (INIS)

    1957-09-01

    This document is a summary list of the bibliographic references of all technical notes (CEA-N) published by the French Atomic Energy Commission between April 1953 and September 1957 (note number, authors, title)

  7. Summary list of CEA notes published by the French Atomic Energy Commission (October 1957 - January 1958)

    International Nuclear Information System (INIS)

    1959-01-01

    This document is a summary list of the bibliographic references of all technical notes (CEA-N) published by the French Atomic Energy Commission between October 1957 and January 1958 (note number, authors, title)

  8. On that Note...

    Science.gov (United States)

    Stein, Harry

    1988-01-01

    Provides suggestions for note-taking from books, lectures, visual presentations, and laboratory experiments to enhance student knowledge, memory, and length of attention span during instruction. Describes topical and structural outlines, visual mapping, charting, three-column note-taking, and concept mapping. Benefits and application of…

  9. Making Notes, Making Meaning.

    Science.gov (United States)

    Burke, Jim

    2002-01-01

    Introduces notetaking tools used successfully with English-as-a-second-language students and low-achieving high school freshmen. Provides an overview of each tool and explains how students use them to take notes when reading textbooks and articles. Notes these tools and academic habits have helped students succeed in their mainstream academic…

  10. A note on Fukui’s note

    Directory of Open Access Journals (Sweden)

    Tsai Cheng-Yu Edwin

    2015-12-01

    Full Text Available This commentary relates Fukui’s (2015 note on weak vs. strong generation to two aspects of quantification in Chinese: quantifier scope and the syntactic licensing conditions of noninterrogative wh-expressions. It is shown that the phenomena under discussion echo Fukui’s (2015 view that only strong generation allows for a deeper understanding of natural language and that dependencies are to be distinguished structurally.

  11. Semiannual report for the period October 1, 1979-March 31, 1980 of work on: (1) superconducting power transmission system development; (2) cable insulation development. Power Transmission Project Technical Note No. 106

    Energy Technology Data Exchange (ETDEWEB)

    1980-07-07

    Progress is reported in a program whose objective is to develop an underground superconducting power transmission system which is economical and technically attractive to the utility industry. The system would be capable of carrying very large blocks of electric power, and would supplant overhead lines in urban and suburban areas and regions of natural beauty. The program consisted initially of work in the laboratory to develop suitable materials, cryostats, and cable concepts. The materials work covers the development and testing of suitable superconductors and dielectric insulation. The laboratory work has now been extended to an outside test facility which represents an intermediate step between the laboratory scale and a full-scale system. The facility will allow cables several hundred feet long to be tested under realistic conditions. In addition, the refrigerator has been designed for optimum service for utility applications.

  12. MixedNotes

    DEFF Research Database (Denmark)

    Jokela, Tero; Lucero, Andrés

    2014-01-01

    Affinity Diagramming is a technique to organize and make sense of qualitative data. It is commonly used in Contextual Design and HCI research. However, preparing notes for and building an Affinity Diagram remains a laborious process, with a wide variety of different approaches and practices....... In this paper, we present MixedNotes, a novel technique to prepare physical paper notes for Affinity Diagramming, and a software tool to support this technique. The technique has been tested with large real-life Affinity Diagrams with overall positive results....

  13. Annals of Pediatric Surgery

    African Journals Online (AJOL)

    The Annals of Pediatric Surgery is striving to fill an important niche that provides focus to clinical care, technical innovation and clinical research. ... Nonconventionalmesocaval prosthetic shunt interposition in refractory case with portal hypertension in a 10-kg female infant · EMAIL FREE FULL TEXT EMAIL FREE FULL ...

  14. Lagos Notes and Records

    African Journals Online (AJOL)

    PROMOTING ACCESS TO AFRICAN RESEARCH ... Lagos Notes and Records is an annual, interdisciplinary journal of the humanities. ... Insuring the Nation: Europeans and the Emergence of Modern Insurance Business in Colonial Nigeria ...

  15. Notes on Contributors

    African Journals Online (AJOL)

    NOTES ON CONTRIBUTORS. Samuel AMOAKO, Associate Researcher, South African Research Unit in Social Change. Contact Details: C/o Lucinda Bercony, Humanities Research Village (House No. 3). University of Johannesburg, P. O. Box 524. Bunting Road Campus, Auckland Park, 2006.

  16. NCEP Internal Office Notes

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The National Centers for Environmental Prediction (NCEP) and its predecessors have produced internal publications, known as Office Notes, since the mid-1950's. In...

  17. Writing a Condolence Note

    Science.gov (United States)

    ... through the eyes of others. For example, a mother whose son had died found out that her ... few suggestions on ending your condolence note: “Our love and support will always be here for you.” “ ...

  18. Analytical dynamics course notes

    CERN Document Server

    Lindenbaum, Samuel D

    1994-01-01

    This book comprises a set of lecture notes on rational mechanics, for part of the graduate physics curriculum, delivered by the late Prof. Shirley L. Quimby during his tenure at Columbia University, New York. The notes contain proofs of basic theorems, derivations of formulae and amplification of observations, as well as the presentation and solution of illustrative problems. Collateral readings from more than 50 source references are indicated at appropriate places in the text.

  19. Note Taking and Note Sharing While Browsing Campaign Information

    DEFF Research Database (Denmark)

    Robertson, Scott P.; Vatrapu, Ravi; Abraham, George

    2009-01-01

    Participants were observed while searching and browsing the internet for campaign information in a mock-voting situation in three online note-taking conditions: No Notes, Private Notes, and Shared Notes. Note taking significantly influenced the manner in which participants browsed for information...

  20. Transesophageal NOTES--a critical analysis of relevant problems.

    Science.gov (United States)

    Grund, Karl E; Lehmann, Thorsten G

    2010-10-01

    The transesophageal access route has not become a principal topic in the discussion about NOTES up to now. Analyzing the problems in this new field of surgery, however, the transesophageal route shows high relevance. Here, all possibilities, limitations, and problems of NOTES become obvious. This paper contains a critical analysis of the literature published to date (nine full papers, five abstracts). Nearly all publications represent experimental studies in living pigs. In most cases a submucosal tunnel technique is performed as access route to mediastinum, pleural cavity, and heart. Interventions and operations include simple mediastinoscopies as well as epicardial operations after exposition of the heart. For access and manipulation, conventional flexible endoscopes and instruments are used. Clips, T-bars, or a combination of both achieve the closure. Some studies rely on spontaneous closure of the incision without any suturing or approximation. In such experimental settings, the following results are presented: Access is achieved in 90% of cases, the aim of the operation is met in 92%, technical success in closure is achieved in 90%, healing of incision assessed as good in two of five studies, satisfactory in three of five studies. Mortality, ranging from 6 to 25%, and complication rates were (surprisingly) high. It has to be stressed that analyzing these papers published to date, no adequate attention is paid to basic facts and problems of general and thoracic surgery (e.g. different forms, prevention, diagnosis and therapy of pneumothorax or differentiated forms of ventilation). Relevant differences in the anatomy and physiology of the esophagus and mediastinum between humans and pigs should additionally be taken into account to choose optimal experimental parameters when transferring results to human settings. Moreover, requirements regarding sterility and hygiene in a structure like the mediastinum, which is at high risk from the point of view of infection

  1. Lecture notes for criticality safety

    International Nuclear Information System (INIS)

    Fullwood, R.

    1992-03-01

    These lecture notes for criticality safety are prepared for the training of Department of Energy supervisory, project management, and administrative staff. Technical training and basic mathematics are assumed. The notes are designed for a two-day course, taught by two lecturers. Video tapes may be used at the options of the instructors. The notes provide all the materials that are necessary but outside reading will assist in the fullest understanding. The course begins with a nuclear physics overview. The reader is led from the macroscopic world into the microscopic world of atoms and the elementary particles that constitute atoms. The particles, their masses and sizes and properties associated with radioactive decay and fission are introduced along with Einstein's mass-energy equivalence. Radioactive decay, nuclear reactions, radiation penetration, shielding and health-effects are discussed to understand protection in case of a criticality accident. Fission, the fission products, particles and energy released are presented to appreciate the dangers of criticality. Nuclear cross sections are introduced to understand the effectiveness of slow neutrons to produce fission. Chain reactors are presented as an economy; effective use of the neutrons from fission leads to more fission resulting in a power reactor or a criticality excursion. The six-factor formula is presented for managing the neutron budget. This leads to concepts of material and geometric buckling which are used in simple calculations to assure safety from criticality. Experimental measurements and computer code calculations of criticality are discussed. To emphasize the reality, historical criticality accidents are presented in a table with major ones discussed to provide lessons-learned. Finally, standards, NRC guides and regulations, and DOE orders relating to criticality protection are presented

  2. Turbinate surgery

    Science.gov (United States)

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...

  3. Bariatric Surgery

    Science.gov (United States)

    ... often. Each type of surgery has advantages and disadvantages. Bariatric Surgery Benefits Bariatric surgery can improve many ... Grants & Grant History Research Resources Research at NIDDK Technology Advancement & Transfer Meetings & Workshops Health Information Diabetes Digestive ...

  4. Lung surgery

    Science.gov (United States)

    ... are thoracotomy and video-assisted thoracoscopic surgery (VATS). Robotic surgery may also be used. Lung surgery using ... Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, ...

  5. Plastic Surgery

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Plastic Surgery KidsHealth / For Teens / Plastic Surgery What's in ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ...

  6. Assessment of Robotic Console Skills (ARCS): construct validity of a novel global rating scale for technical skills in robotically assisted surgery.

    Science.gov (United States)

    Liu, May; Purohit, Shreya; Mazanetz, Joshua; Allen, Whitney; Kreaden, Usha S; Curet, Myriam

    2018-01-01

    Skill assessment during robotically assisted surgery remains challenging. While the popularity of the Global Evaluative Assessment of Robotics Skills (GEARS) has grown, its lack of discrimination between independent console skills limits its usefulness. The purpose of this study was to evaluate construct validity and interrater reliability of a novel assessment designed to overcome this limitation. We created the Assessment of Robotic Console Skills (ARCS), a global rating scale with six console skill domains. Fifteen volunteers who were console surgeons for 0 ("novice"), 1-100 ("intermediate"), or >100 ("experienced") robotically assisted procedures performed three standardized tasks. Three blinded raters scored the task videos using ARCS, with a 5-point Likert scale for each skill domain. Scores were analyzed for evidence of construct validity and interrater reliability. Group demographics were indistinguishable except for the number of robotically assisted procedures performed (p = 0.001). The mean scores of experienced subjects exceeded those of novices in dexterity (3.8 > 1.4, p  1.8, p  2.2, p  1.9, p = 0.001), and force sensitivity (4.3 > 2.6, p  1.4, p = 0.002), field of view (2.8 > 1.8, p = 0.021), instrument visualization (3.2 > 2.2, p = 0.045), manipulator workspace (3.1 > 1.9, p = 0.004), and force sensitivity (3.7 > 2.6, p = 0.033). The mean scores of experienced subjects exceeded those of intermediates in dexterity (3.8 > 2.8, p = 0.003), field of view (4.1 > 2.8, p  3.2, p = 0.044). Rater agreement in each domain demonstrated statistically significant concordance (p skills plateau faster than others. Therefore, ARCS may be more useful than GEARS to evaluate distinct console skills. Future studies will examine why some domains did not adequately differentiate between subjects and applications for intraoperative use.

  7. Medical Malpractice Litigation Following Arthroscopic Surgery.

    Science.gov (United States)

    Shah, Kalpit N; Eltorai, Adam E M; Perera, Sudheesha; Durand, Wesley M; Shantharam, Govind; Owens, Brett D; Daniels, Alan H

    2018-04-10

    Our study aims to analyze a variety of factors involving malpractice lawsuits following arthroscopy, focusing on reasons for lawsuit and establishing predictors for the outcome of the lawsuit. Two legal databases, VerdictSearch and Westlaw, were queried for arthroscopic cases in adult patients. For all included cases, clinical and demographic data were recorded. The effects of plaintiff demographics, joint involved, lawsuit allegation, case ruling, and size of indemnity payments were assessed. Of the 240 included cases, 62 (26%) resulted in plaintiff verdict, 160 (67%) resulted in defense verdict, and 18 (8%) were settled without trial. Plaintiff demographics (age and sex) had no effect on the case ruling. There was no statistical difference between indemnity awards for plaintiff verdicts ($1,013,494) and settled cases ($848,331; P = .13). Patient death was noted in 20 cases (8.3%); a significantly higher proportion of these cases were settled versus went to trial (P = .0022), including 19 patients (95%) who had knee arthroscopy and 16 deaths (80%) resulting from a pulmonary embolus. Plaintiff verdict or settlement were seen significantly more frequently for vascular complications and wrong-sided surgery. Alternatively, defense verdicts followed lawsuits alleging surgeon technical error. Wrong-sided surgery, retained instruments, deep venous thrombosis, and postoperative infections were seen at a significantly higher proportion after knee arthroscopy than after arthroscopy of other joints. Similarly, neurological injury was significantly associated with elbow and hip arthroscopy, while allegations of technical error by the surgeon and block-related complications were associated with shoulder arthroscopy. Plaintiff verdict or settlement were seen for vascular complications and wrong-sided surgery, while defense verdicts followed lawsuits alleging surgeon technical error and block-related complications. We also identified types of allegations that were associated

  8. Prototipagem como forma alternativa para realização de cranioplastia com metilmetacrilato: nota técnica Prototyping as an alternative to cranioplasty using methylmethacrylate: technical note

    Directory of Open Access Journals (Sweden)

    Adriano Yacubian-Fernandes

    2004-09-01

    Full Text Available A prototipagem, método de reconstrução de segmentos do corpo humano através de programas de computação, tem sido usada na neurocirurgia para reproduzir o crânio de pacientes permitindo a programação de atos cirúrgicos e a produção de próteses para reconstruir falhas ósseas no crânio. Apresentamos dois casos de cranioplastia realizadas com o uso de próteses de acrílico construídas por prototipagem. Após 10 meses de acompanhamento, os pacientes não apresentaram sinais de infecção e apresentam bom resultado estético. As vantagens apontadas na literatura para este método (redução do tempo cirúrgico, facilidade técnica e bom resultado estético foram observadas.The prototyping is a method for reconstruction of human body segments by computer software. It has been used in neurosurgery for cranial reproduction in patients allowing the programming of surgical procedures and the production of prosthesis to reconstruct bone failures in the skull. We present two cases of cranioplasty performed with the use of acrylic prosthesis constructed by prototyping. After 10 months of follow-up, they donot present signs of infection and show good aesthetic result. The advantages pointed at the literature for this method (reduction of surgical time, easy technical handle, and good aesthetic result were confirmed.

  9. Essential hand surgery procedures for mastery by graduating plastic surgery residents: a survey of program directors.

    Science.gov (United States)

    Noland, Shelley S; Fischer, Lauren H; Lee, Gordon K; Friedrich, Jeffrey B; Hentz, Vincent R

    2013-12-01

    This study was designed to establish the essential hand surgery procedures that should be mastered by graduating plastic surgery residents. This framework can then be used as a guideline for developing Objective Structured Assessment of Technical Skill to teach technical skills in hand surgery. Ten expert hand surgeons were surveyed regarding the essential hand surgery procedures that should be mastered by graduating plastic surgery residents. The top 10 procedures from this survey were then used to survey all 89 Accreditation Council for Graduate Medical Education-approved plastic surgery program directors. There was a 69 percent response rate to the program director survey (n = 61). The top nine hand surgery procedures included open carpal tunnel release, open A1 pulley release, digital nerve repair with microscope, closed reduction and percutaneous pinning of metacarpal fracture, excision of dorsal or volar ganglion, zone II flexor tendon repair with multistrand technique, incision and drainage of the flexor tendon sheath for flexor tenosynovitis, flexor tendon sheath steroid injection, and open cubital tunnel release. Surgical educators need to develop objective methods to teach and document technical skill. The Objective Structured Assessment of Technical Skill is a valid method for accomplishing this task. There has been no consensus regarding which hand surgery procedures should be mastered by graduating plastic surgery residents. The authors have identified nine procedures that are overwhelmingly supported by plastic surgery program directors. These nine procedures can be used as a guideline for developing Objective Structured Assessment of Technical Skill to teach and document technical skills in hand surgery.

  10. The Effect of Product Safety Courses on the Adoption and Outcomes of LESS Surgery.

    Science.gov (United States)

    Toomey, Paul G; Ross, Sharona B; Choung, Edward; Donn, Natalie; Vice, Michelle; Luberice, Kenneth; Albrink, Michael; Rosemurgy, Alexander S

    2015-01-01

    As technology in surgery evolves, the medical instrument industry is inevitability involved in promoting the use and appropriate (ie, effective and safe) application of its products. This study was undertaken to evaluate industry-supported product safety courses in laparoendoscopic single-site (LESS) surgery, by using the metrics of surgeons' adoption of the technique, safety of the procedure, and surgeons' perception of the surgery. LESS surgery courses that involved didactic lectures, operative videos, operation observation, collaborative learning, and simulation, were attended by 226 surgeons. With Florida Hospital Tampa Institutional Review Board approval, the surgeons were queried before and immediately after the course, to assess their attitudes toward LESS surgery. Then, well after the course, the surgeons were contacted, repeatedly if necessary, to complete questionnaires. Before the course, 82% of the surgeons undertook more than 10 laparoscopic operations per month. Immediately after the course, 86% were confident that they were prepared to perform LESS surgery. Months after the course, 77% of the respondents had adopted LESS surgery, primarily cholecystectomy; 59% had added 1 or more trocars in 0-20% of their procedures; and 73% held the opinion that operating room observation was the most helpful learning experience. Complications with LESS surgery were noted 12% of the time. Advantages of the technique were better cosmesis (58%) and patient satisfaction (38%). Disadvantages included risk of complications (37%) and higher technical demand (25%). Seventy-eight percent viewed LESS surgery as an advancement in surgical technique. In multifaceted product safety courses, operating room observation is thought to provide the most helpful instruction for those wanting to undertake LESS surgery. The procedure has been safely adopted by surgeons who frequently perform laparoscopies. The tradeoff is in performing a more difficult technique to obtain better

  11. The Effect of Product Safety Courses on the Adoption and Outcomes of LESS Surgery

    Science.gov (United States)

    Toomey, Paul G.; Ross, Sharona B.; Choung, Edward; Donn, Natalie; Vice, Michelle; Luberice, Kenneth; Albrink, Michael

    2015-01-01

    Background and Objectives: As technology in surgery evolves, the medical instrument industry is inevitability involved in promoting the use and appropriate (ie, effective and safe) application of its products. This study was undertaken to evaluate industry-supported product safety courses in laparoendoscopic single-site (LESS) surgery, by using the metrics of surgeons' adoption of the technique, safety of the procedure, and surgeons' perception of the surgery. Methods: LESS surgery courses that involved didactic lectures, operative videos, operation observation, collaborative learning, and simulation, were attended by 226 surgeons. With Florida Hospital Tampa Institutional Review Board approval, the surgeons were queried before and immediately after the course, to assess their attitudes toward LESS surgery. Then, well after the course, the surgeons were contacted, repeatedly if necessary, to complete questionnaires. Results: Before the course, 82% of the surgeons undertook more than 10 laparoscopic operations per month. Immediately after the course, 86% were confident that they were prepared to perform LESS surgery. Months after the course, 77% of the respondents had adopted LESS surgery, primarily cholecystectomy; 59% had added 1 or more trocars in 0–20% of their procedures; and 73% held the opinion that operating room observation was the most helpful learning experience. Complications with LESS surgery were noted 12% of the time. Advantages of the technique were better cosmesis (58%) and patient satisfaction (38%). Disadvantages included risk of complications (37%) and higher technical demand (25%). Seventy-eight percent viewed LESS surgery as an advancement in surgical technique. Conclusion: In multifaceted product safety courses, operating room observation is thought to provide the most helpful instruction for those wanting to undertake LESS surgery. The procedure has been safely adopted by surgeons who frequently perform laparoscopies. The tradeoff is in

  12. Physicians’ Progress Notes

    DEFF Research Database (Denmark)

    Bansler, Jørgen; Havn, Erling C.; Mønsted, Troels

    2013-01-01

    in patient care, they have not dealt specifically with the role, structure, and content of the progress notes. As a consequence, CSCW research has not yet taken fully into account the fact that progress notes are coordinative artifacts of a rather special kind, an open-ended chain of prose texts, written...... sequentially by cooperating physicians for their own use as well as for that of their colleagues. We argue that progress notes are the core of the medical record, in that they marshal and summarize the overwhelming amount of data that is available in the modern hospital environment, and that their narrative...... format is uniquely adequate for the pivotal epistemic aspect of cooperative clinical work: the narrative format enables physicians to not only record ‘facts’ but also—by filtering, interpreting, organizing, and qualifying information—to make sense and act concertedly under conditions of uncertainty...

  13. Technical writing versus technical writing

    Science.gov (United States)

    Dillingham, J. W.

    1981-01-01

    Two terms, two job categories, 'technical writer' and 'technical author' are discussed in terms of industrial and business requirements and standards. A distinction between 'technical writing' and technical 'writing' is made. The term 'technical editor' is also considered. Problems inherent in the design of programs to prepare and train students for these jobs are discussed. A closer alliance between industry and academia is suggested as a means of preparing students with competent technical communication skills (especially writing and editing skills) and good technical skills.

  14. Grouping Notes Through Nodes

    DEFF Research Database (Denmark)

    Dove, Graham; Abildgaard, Sille Julie Jøhnk; Biskjær, Michael Mose

    , both individually and when grouped, and their role in categorisation in semantic long-term memory. To do this, we adopt a multimodal analytical approach focusing on interaction between humans, and between humans and artefacts, alongside language. We discuss in detail examples of four different...... externalisation functions served by Post-ItTM notes, and show how these functions are present in complex overlapping combinations rather than being discrete. We then show how the temporal development of Post-ItTM note interactions supports categorisation qualities of semantic long-term memory....

  15. Grouping Notes Through Nodes

    DEFF Research Database (Denmark)

    Dove, Graham; Abildgaard, Sille Julie; Biskjær, Michael Mose

    2017-01-01

    , both individually and when grouped, and their role in categorisation in semantic long-term memory. To do this, we adopt a multimodal analytical approach focusing on interaction between humans, and between humans and artefacts, alongside language. We discuss in detail examples of four different...... externalisation functions served by Post-ItTM notes, and show how these functions are present in complex overlapping combinations rather than being discrete. We then show how the temporal development of Post-ItTM note interactions supports categorisation qualities of semantic long-term memory....

  16. Notes on Piezoelectricity

    Energy Technology Data Exchange (ETDEWEB)

    Redondo, Antonio [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2016-02-03

    These notes provide a pedagogical discussion of the physics of piezoelectricity. The exposition starts with a brief analysis of the classical (continuum) theory of piezoelectric phenomena in solids. The main subject of the notes is, however, a quantum mechanical analysis. We first derive the Frohlich Hamiltonian as part of the description of the electron-phonon interaction. The results of this analysis are then employed to derive the equations of piezoelectricity. A couple of examples with the zinc blende and and wurtzite structures are presented at the end

  17. "Plug" ósseo autógeno para orifícios de trepanação: nota técnica Autogenic bone plug to seal burr holes: technical note

    Directory of Open Access Journals (Sweden)

    JOSUÉ GUIMARÃES GRANHA VIALOGO

    1999-12-01

    Full Text Available Vários materiais são utilizados para ocluir os orifícios de trepanação em neurocirurgia, por motivos variados: para evitar fístula liquórica após trepanações, para auxiliar a fixação do "flap" ósseo e por motivos estéticos, na região frontal. Dentre estes materiais citamos os heterólogos (botões de silicone, miniplacas de metal, cera de osso, metilmetacrilato, gelfoam, cimento de polímero vegetal, cerâmica de hidroxiapatita, e os autólogos (pó de osso originado da trepanação, gordura, músculo, aponeurose. Os materiais heterólogos ou sintéticos podem provocar reação de corpo estranho com erosão da pele e exposição do material, tornando necessária sua retirada, em tempo variável no pós-operatório. Há cerca de três anos, o autor vem utilizando um botão ou "plug" ósseo autólogo, feito com surgicel e o pó de osso proveniente da trepanação, com bom resultado estético eliminando as desconfortáveis depressões cranianas pós-trepanação. Apresentamos a técnica de confecção deste prático `plug ósseo autólogo'. Nas neuroendoscopias, praticamente sanou-se o problema da fístula liquórica e reação de corpo estranho. Encorajamos a utilização deste botão ósseo autólogo em nosso meio, como método eficiente, econômico e biologicamente aceitável para ocluir orifícios cranianos de trepanação.Many neurosurgical procedures can be performed by a single burr hole: neuroendoscopy, microvascular decompression, stereotactic procedures, chronic subdural haematomas. It is technically difficult to suture and close the dura, located at the bottom of such holes, which can lately lead to CSF leakage. On the other hand, the surgical material used to seal the burr holes can be divided in heterogenic (metal screws, silicon plugs, gelfoam, bone wax, metilmetacrilate, hidroxiapatite, and autogenic (fat, aponeurosis, muscle, and bone dust from trephination. The heterogenic group always brings the possibility of

  18. New trends in minimally invasive urological surgery: what is beyond the robot?

    Science.gov (United States)

    Micali, Salvatore; Pini, Giovannalberto; Teber, Dogu; Sighinolfi, Maria Chiara; De Stefani, Stefano; Bianchi, Giampaolo; Rassweiler, Jens

    2013-06-01

    To review the minimal-invasive development of surgical technique in urology focusing on nomenclature, history and outcomes of Laparo-Endoscopic Single-site Surgery (LESS), Natural Orifice Translumenal Endoscopic Surgery (NOTES) and Computer-Assisted Surgery (CAS). A comprehensive literature search was conducted in order to find article related to LESS, NOTES and CAS in urology. The most relevant papers over the last 10 years were selected in base to the experience from the panel of experts, journal, authorship and/or content. Seven hundred and fifty manuscripts were found. Papers on LESS describe feasibility/safety in most of the procedures with a clinical experience of more than 300 cases and five compared results to standard laparoscopy without showing significant differences. NOTES accesses have been proved their feasibility/safety in experimental study. In human, the only procedures performed are on kidney and through a hybrid-Transvaginal route. New robots overcome the main drawbacks of the DaVinci® platform. The use of CAS is increasing its popularity in urology. LESS has been applied in clinical practice, but only ongoing technical and instrumental refinement will define its future role and overall benefit. The transition to a clinical application of NOTES seems at present only possible with multiple NOTES access and transvaginal access. Robot and Soft Tissue Navigation appear to be important to improve surgical skills. We are already witness to the advantages offered by the former even if costs need to be redefined based on pending long-term results. The latter will probably upgrade the quality of surgery in a near future.

  19. Note by Note: a New Revolution in Cooking

    OpenAIRE

    Burke, Roisin; Danaher, Pauline

    2016-01-01

    Note by note cooking is an application of Molecular Gastronomy. It was first proposed by French Physical Chemist and Molecular Gastronomy Co-founder, Hervé This. Note by Note dishes are being created as part of Ph.D. research in the Dublin Institute of Technology, Cathal Brugha Street.

  20. LHC Availability 2017: Technical Stop 1 to Technical Stop 2

    CERN Document Server

    Todd, Benjamin; Apollonio, Andrea; Walsh, David John; CERN. Geneva. ATS Department

    2017-01-01

    This document summarises the LHC machine availability for the period of Technical Stop 1 (TS1) to Technical Stop 2 (TS2) in 2017. This period was dedicated to proton physics with a bunch spacing of 25ns. This note has been produced and ratified by the Availability Working Group which has complied fault information for the period in question using the Accelerator Fault Tracker.

  1. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  2. Note Taking for Geography Students.

    Science.gov (United States)

    Kneale, Pauline E.

    1998-01-01

    Addresses geography students' questions about why, when, and how to take notes. Outlines a step-by-step process for taking notes from written sources and from class lectures. Discusses what types of notes are appropriate for various types of sources. Suggests some ideas for making notes useful for individual learning styles. (DSK)

  3. OpenLabNotes

    DEFF Research Database (Denmark)

    List, Markus; Franz, Michael; Tan, Qihua

    2015-01-01

    be advantageous if an ELN was Integrated with a laboratory information management system to allow for a comprehensive documentation of experimental work including the location of samples that were used in a particular experiment. Here, we present OpenLabNotes, which adds state-of-the-art ELN capabilities to Open......LabFramework, a powerful and flexible laboratory information management system. In contrast to comparable solutions, it allows to protect the intellectual property of its users by offering data protection with digital signatures. OpenLabNotes effectively Closes the gap between research documentation and sample management......, thus making Open-Lab Framework more attractive for laboratories that seek to increase productivity through electronic data management....

  4. SAJS 970 - Paediatric Surgery.indd

    African Journals Online (AJOL)

    two signs are noted: colicky pain, bloody stools, and a mass in the abdominal ... revealed a palpable intra-abdominal mass (n=57) and rectal blood in all patients .... breast, endocrine, upper GIT and general surgery, plus an ethics session.

  5. Viscoless microincision cataract surgery

    Directory of Open Access Journals (Sweden)

    Guy Sallet

    2008-06-01

    Full Text Available Guy SalletDepartment of Opthamology, Aalsters Stedelijk Ziekenhuis, BelgiumAbstract: A cataract surgery technique is described in which incisions, continuous circular capsulorhexis and hydrodissection are made without the use of any viscoelastics. Two small incisions are created through which the different parts of the procedure can take place, maintaining a stable anterior chamber under continuous irrigation. Subsequent bimanual phacoemulsification can be done through these microincisions. At the end of the procedure, an intraocular lens can be inserted through the self-sealing incision under continuous irrigation. 50 consecutive cataract patients were operated on without the use of viscoelastics and then compared with a group of 50 patients who had been helped with viscoelastics. No difference in outcome, endothelial cell count or pachymetry was noted between the two groups. No intraoperative complication was encountered. Viscoless cataract surgery was a safe procedure with potential advantages.Keywords: ophthalmic visco-surgical device, viscoless cataract surgery, microincision

  6. A note on Marx

    OpenAIRE

    Olesen, Finn; Jensen, Frank

    2001-01-01

    Throughout all his life Karl Marx wrote angrily about capitalism. By use of a dialectic approach he was convinced that the working class had to unite and make a social revolution and thereby free them selves from exploitation. Marx himself was in many ways a dialectic person as we try to show in the note. So in some sense he became one with his scientific methodology.

  7. Needs analysis for developing a virtual-reality NOTES simulator.

    Science.gov (United States)

    Sankaranarayanan, Ganesh; Matthes, Kai; Nemani, Arun; Ahn, Woojin; Kato, Masayuki; Jones, Daniel B; Schwaitzberg, Steven; De, Suvranu

    2013-05-01

    INTRODUCTION AND STUDY AIM: Natural orifice translumenal endoscopic surgery (NOTES) is an emerging surgical technique that requires a cautious adoption approach to ensure patient safety. High-fidelity virtual-reality-based simulators allow development of new surgical procedures and tools and train medical personnel without risk to human patients. As part of a project funded by the National Institutes of Health, we are developing the virtual transluminal endoscopic surgery trainer (VTEST) for this purpose. The objective of this study is to conduct a structured needs analysis to identify the design parameters for such a virtual-reality-based simulator for NOTES. A 30-point questionnaire was distributed at the 2011 National Orifice Surgery Consortium for Assessment and Research meeting to obtain responses from experts. Ordinal logistic regression and the Wilcoxon rank-sum test were used for analysis. A total of 22 NOTES experts participated in the study. Cholecystectomy (CE, 68 %) followed by appendectomy (AE, 63 %) (CE vs AE, p = 0.0521) was selected as the first choice for simulation. Flexible (FL, 47 %) and hybrid (HY, 47 %) approaches were equally favorable compared with rigid (RI, 6 %) with p virtual NOTES simulator in training and testing new tools for NOTES were rated very high by the participants. Our study reinforces the importance of developing a virtual NOTES simulator and clearly presents expert preferences. The results of this analysis will direct our initial development of the VTEST platform.

  8. Robotic surgery

    Science.gov (United States)

    ... with this type of surgery give it some advantages over standard endoscopic techniques. The surgeon can make ... Elsevier Saunders; 2015:chap 87. Muller CL, Fried GM. Emerging technology in surgery: Informatics, electronics, robotics. In: ...

  9. Nose Surgery

    Science.gov (United States)

    ... Patient Health Home Copyright © 2018 American Academy of Otolaryngology–Head and Neck Surgery. Reproduction or republication strictly ... Terms of Use © Copyright 2018. American Academy of Otolaryngology — Head and Neck Surgery 1650 Diagonal Rd Alexandria, ...

  10. After Surgery

    Science.gov (United States)

    ... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

  11. Thyroid Surgery

    Science.gov (United States)

    ... Hypothyroidism in Children and Adolescents Pediatric Differentiated Thyroid Cancer Thyroid Nodules in Children and Adolescents Thyroid Surgery Resources Thyroid Surgery Brochure PDF Thyroid Surgery FAQs PDF En Español Cirugia De La Tiroides El folleto de Cirugia De La Tiroides Search Thyroid ...

  12. Technical Note: Filler and superplasticizer usage on high strength concrete

    Directory of Open Access Journals (Sweden)

    Sümer, M.

    2007-08-01

    Full Text Available In this research, the effects of filler (rock-dust usage on high strength concrete have been investigated through lab experiments and some results have been obtained. The experiments involved three series of concrete with different cement proportions of 375 kg/m3, 400 kg/m3, and 425 kg/m3. For each series of concrete, three different groups of samples have been prepared, the first one being the reference concrete which contained 0% chemical admixture and 0% filler, the second one contained 1.5% chemical admixture and 0% filler and finally the last group contained 1.5% chemical admixture and 5% filler to the weight of cement used. The chemical admixture used was a type of Super plasticizer with a brand name of “DARACEM 190”, and the cement used was Ordinary Portland Cement of target compressive strength 42.5 N/mm2, obtained from Nuh Cement Plant. For each batch, Slump Tests and Unit Weight Tests were performed. For each stage and group, two 15 cm cubic samples have been tested for Compressive Strength after being cured in water at 20 ± 2 °C for ages of 3 days, 7 days, 28 and 60 days. The total number of samples was 72. As a result, filler usage was found to reduce the porosity of Concrete, increase the Unit Weight of Concrete, increase the need for water and improve the Compressive Strength Properties of Concrete.En el presente trabajo se estudia la influencia de la utilización de un “filler” (polvo mineral en el comportamiento del hormigón de altas prestaciones. Para ello, se realizan ensayos de laboratorio en los que se emplean tres series de hormigón, cada una con una dosificación de cemento distinta, de 375, 400 y 425 kg/m3. Se preparan tres grupos de probetas de cada serie, el primero o de referencia con 0% de aditivo químico y 0% de “filler”, el segundo con un 1,5% del aditivo químico y 0% de “filler” y el tercero con un 1,5% del aditivo químico y un 5% de “filler” en peso del cemento. Como aditivo se utiliza un superplastificante de nombre comercial “DARACEM 190”, siendo el cemento, suministrado por la Nuh Cement Plant, de tipo Portland con una resistencia a la compresión característica de 42,5 N/mm2. En todas las amasadas se realizan los ensayos del cono de Abrams y de densidad. Para cada serie y grupo, se fabrican dos probetas cúbicas de 15 x 15 x 15 cm que se someten a ensayos de resistencia a la compresión, previo curado en agua a 20 ± 2 ºC durante 3, 7, 28 y 60 días. En total, se fabrican 72 probetas. Los resultados confirman que la utilización del “filler” reduce la porosidad del hormigón, aumentando tanto su densidad como su demanda de agua y mejorando sus propiedades mecánicas.

  13. Technical note: New table look-up lossless compression method ...

    African Journals Online (AJOL)

    International Journal of Engineering, Science and Technology. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 1, No 1 (2009) >. Log in or Register to get access to full text downloads.

  14. Three-dimensional digital projection in neurosurgical education: technical note.

    Science.gov (United States)

    Martins, Carolina; Ribas, Eduardo Carvalhal; Rhoton, Albert L; Ribas, Guilherme Carvalhal

    2015-10-01

    Three-dimensional images have become an important tool in teaching surgical anatomy, and its didactic power is enhanced when combined with 3D surgical images and videos. This paper describes the method used by the last author (G.C.R.) since 2002 to project 3D anatomical and surgical images using a computer source. Projecting 3D images requires the superposition of 2 similar but slightly different images of the same object. The set of images, one mimicking the view of the left eye and the other mimicking the view of the right eye, constitute the stereoscopic pair and can be processed using anaglyphic or horizontal-vertical polarization of light for individual use or presentation to larger audiences. Classically, 3D projection could be obtained by using a double set of slides, projected through 2 slide projectors, each of them equipped with complementary filters, shooting over a medium that keeps light polarized (a silver screen) and having the audience wear appropriate glasses. More recently, a digital method of 3D projection has been perfected. In this method, a personal computer is used as the source of the images, which are arranged in a Microsoft PowerPoint presentation. A beam splitter device is used to connect the computer source to 2 digital, portable projectors. Filters, a silver screen, and glasses are used, similar to the classic method. Among other advantages, this method brings flexibility to 3D presentations by allowing the combination of 3D anatomical and surgical still images and videos. It eliminates the need for using film and film developing, lowering the costs of the process. In using small, powerful digital projectors, this method substitutes for the previous technology, without incurring a loss of quality, and enhances portability.

  15. Technical Note: Spot characteristic stability for proton pencil beam scanning.

    Science.gov (United States)

    Chen, Chin-Cheng; Chang, Chang; Moyers, Michael F; Gao, Mingcheng; Mah, Dennis

    2016-02-01

    The spot characteristics for proton pencil beam scanning (PBS) were measured and analyzed over a 16 month period, which included one major site configuration update and six cyclotron interventions. The results provide a reference to establish the quality assurance (QA) frequency and tolerance for proton pencil beam scanning. A simple treatment plan was generated to produce an asymmetric 9-spot pattern distributed throughout a field of 16 × 18 cm for each of 18 proton energies (100.0-226.0 MeV). The delivered fluence distribution in air was measured using a phosphor screen based CCD camera at three planes perpendicular to the beam line axis (x-ray imaging isocenter and up/down stream 15.0 cm). The measured fluence distributions for each energy were analyzed using in-house programs which calculated the spot sizes and positional deviations of the Gaussian shaped spots. Compared to the spot characteristic data installed into the treatment planning system, the 16-month averaged deviations of the measured spot sizes at the isocenter plane were 2.30% and 1.38% in the IEC gantry x and y directions, respectively. The maximum deviation was 12.87% while the minimum deviation was 0.003%, both at the upstream plane. After the collinearity of the proton and x-ray imaging system isocenters was optimized, the positional deviations of the spots were all within 1.5 mm for all three planes. During the site configuration update, spot positions were found to deviate by 6 mm until the tuning parameters file was properly restored. For this beam delivery system, it is recommended to perform a spot size and position check at least monthly and any time after a database update or cyclotron intervention occurs. A spot size deviation tolerance of spot positions were <2 mm at any plane up/down stream 15 cm from the isocenter.

  16. Technical Note: Spot characteristic stability for proton pencil beam scanning

    International Nuclear Information System (INIS)

    Chen, Chin-Cheng; Chang, Chang; Mah, Dennis; Moyers, Michael F.; Gao, Mingcheng

    2016-01-01

    Purpose: The spot characteristics for proton pencil beam scanning (PBS) were measured and analyzed over a 16 month period, which included one major site configuration update and six cyclotron interventions. The results provide a reference to establish the quality assurance (QA) frequency and tolerance for proton pencil beam scanning. Methods: A simple treatment plan was generated to produce an asymmetric 9-spot pattern distributed throughout a field of 16 × 18 cm for each of 18 proton energies (100.0–226.0 MeV). The delivered fluence distribution in air was measured using a phosphor screen based CCD camera at three planes perpendicular to the beam line axis (x-ray imaging isocenter and up/down stream 15.0 cm). The measured fluence distributions for each energy were analyzed using in-house programs which calculated the spot sizes and positional deviations of the Gaussian shaped spots. Results: Compared to the spot characteristic data installed into the treatment planning system, the 16-month averaged deviations of the measured spot sizes at the isocenter plane were 2.30% and 1.38% in the IEC gantry x and y directions, respectively. The maximum deviation was 12.87% while the minimum deviation was 0.003%, both at the upstream plane. After the collinearity of the proton and x-ray imaging system isocenters was optimized, the positional deviations of the spots were all within 1.5 mm for all three planes. During the site configuration update, spot positions were found to deviate by 6 mm until the tuning parameters file was properly restored. Conclusions: For this beam delivery system, it is recommended to perform a spot size and position check at least monthly and any time after a database update or cyclotron intervention occurs. A spot size deviation tolerance of <15% can be easily met with this delivery system. Deviations of spot positions were <2 mm at any plane up/down stream 15 cm from the isocenter

  17. Scaled multiple holes suction tip for microneurosurgery; Technical note

    Directory of Open Access Journals (Sweden)

    Abdolkarim Rahmanian, Associate Professor of Neurosurgery

    2017-12-01

    Conclusion: The new suction tip permits easy and precise adjustment of suction power in microneurosirgical operations. Our scaled 3 and 4-hole suction tip is a simple and useful device for controlling the suction power during the microneurosurgeical procedures.

  18. Zebra Mussel Research Technical Notes. Section 1 - Environmental Testing

    National Research Council Canada - National Science Library

    1998-01-01

    ...: Biology, Ecology, and Recommended Control Strategies, Larval Monitoring in a Chlorine Treatment Program to Prevent Zebra Mussel Settlement in Hydropower Facilities, Louisville District Initiates...

  19. A Technical Note on Australian Default Superannuation Investment Strategies

    Directory of Open Access Journals (Sweden)

    Loretta Iskra

    2012-06-01

    Full Text Available Superannuation has become more complex over time. Individual investors are inclined to seek the ‘path of least resistance’ and invest in default investment funds which are typically concentrated in high risk assets. Understanding how these funds will meet the individual needs of members relative to their changing circumstances can provide peace of mind and confidence in the market. Given the value of superannuation as an investment in terms of the economy, it is paramount than an appropriate mechanism be in place for default fund investors. This paper will clarify the existing position relative to default fund investment options and outline future research which will provide the impetus for change in terms ofgovernment policy, the financial planning profession and for industry superannuation funds.

  20. Technical Note: Spot characteristic stability for proton pencil beam scanning

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Chin-Cheng, E-mail: chen.ccc@gmail.com; Chang, Chang; Mah, Dennis [ProCure Treatment Center, Somerset, New Jersey 08873 (United States); Moyers, Michael F. [ProCure Treatment Center, Somerset, New Jersey 08873 and Shanghai Proton and Heavy Ion Center, Shanghai 201321 (China); Gao, Mingcheng [CDH Proton Center, Warrenville, Illinois 60555 (United States)

    2016-02-15

    Purpose: The spot characteristics for proton pencil beam scanning (PBS) were measured and analyzed over a 16 month period, which included one major site configuration update and six cyclotron interventions. The results provide a reference to establish the quality assurance (QA) frequency and tolerance for proton pencil beam scanning. Methods: A simple treatment plan was generated to produce an asymmetric 9-spot pattern distributed throughout a field of 16 × 18 cm for each of 18 proton energies (100.0–226.0 MeV). The delivered fluence distribution in air was measured using a phosphor screen based CCD camera at three planes perpendicular to the beam line axis (x-ray imaging isocenter and up/down stream 15.0 cm). The measured fluence distributions for each energy were analyzed using in-house programs which calculated the spot sizes and positional deviations of the Gaussian shaped spots. Results: Compared to the spot characteristic data installed into the treatment planning system, the 16-month averaged deviations of the measured spot sizes at the isocenter plane were 2.30% and 1.38% in the IEC gantry x and y directions, respectively. The maximum deviation was 12.87% while the minimum deviation was 0.003%, both at the upstream plane. After the collinearity of the proton and x-ray imaging system isocenters was optimized, the positional deviations of the spots were all within 1.5 mm for all three planes. During the site configuration update, spot positions were found to deviate by 6 mm until the tuning parameters file was properly restored. Conclusions: For this beam delivery system, it is recommended to perform a spot size and position check at least monthly and any time after a database update or cyclotron intervention occurs. A spot size deviation tolerance of <15% can be easily met with this delivery system. Deviations of spot positions were <2 mm at any plane up/down stream 15 cm from the isocenter.

  1. Technical note: Equivalent genomic models with a residual polygenic effect.

    Science.gov (United States)

    Liu, Z; Goddard, M E; Hayes, B J; Reinhardt, F; Reents, R

    2016-03-01

    Routine genomic evaluations in animal breeding are usually based on either a BLUP with genomic relationship matrix (GBLUP) or single nucleotide polymorphism (SNP) BLUP model. For a multi-step genomic evaluation, these 2 alternative genomic models were proven to give equivalent predictions for genomic reference animals. The model equivalence was verified also for young genotyped animals without phenotypes. Due to incomplete linkage disequilibrium of SNP markers to genes or causal mutations responsible for genetic inheritance of quantitative traits, SNP markers cannot explain all the genetic variance. A residual polygenic effect is normally fitted in the genomic model to account for the incomplete linkage disequilibrium. In this study, we start by showing the proof that the multi-step GBLUP and SNP BLUP models are equivalent for the reference animals, when they have a residual polygenic effect included. Second, the equivalence of both multi-step genomic models with a residual polygenic effect was also verified for young genotyped animals without phenotypes. Additionally, we derived formulas to convert genomic estimated breeding values of the GBLUP model to its components, direct genomic values and residual polygenic effect. Third, we made a proof that the equivalence of these 2 genomic models with a residual polygenic effect holds also for single-step genomic evaluation. Both the single-step GBLUP and SNP BLUP models lead to equal prediction for genotyped animals with phenotypes (e.g., reference animals), as well as for (young) genotyped animals without phenotypes. Finally, these 2 single-step genomic models with a residual polygenic effect were proven to be equivalent for estimation of SNP effects, too. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  2. Technical Notes: Glare pollution in Urban areas | Gelan | Zede Journal

    African Journals Online (AJOL)

    Glare pollution is an unnatural element in the global environment that has emerged as a result of human beings inefficient and destructive use of technology and resources. It refers to the tangible and the intangible interaction of natural light reflecting off synthetic materials, for example sunlight on rooftops, walls, windows, ...

  3. Technical note: Measurement and expression of granular filter ...

    African Journals Online (AJOL)

    The problem of dirty filter media at water treatment plants, despite having good backwash systems, is a serious challenge that requires constant monitoring and maintenance. To aid the systematic analysis of filter media and the troubleshooting of problem filters, this paper firstly proposes a standard procedure for ...

  4. Road-to-Birth Game. Technical Note No. 24.

    Science.gov (United States)

    Burns, Julie; Bialosiewicz, Frank

    Intended to help pregnant women in Third World regions acquire the attitudes and skills necessary to help them maintain their health and that of their unborn children, the game uses role playing and simulation to stress the importance of prenatal care, teach the recognition and treatment of common pregnancy problems and danger signals, and…

  5. TECHNICAL NOTE LIQUID WASTE DISPOSAL IN URBAN LOW ...

    African Journals Online (AJOL)

    In the ideal case the liquid waste can safely be disposed of in a properly designed and integrated network of pipes, which collect and transmit the liquid waste into a treatment plant. However, such a system is costly and needs a substantial amount of initial investment to start operating and subsequently to maintain.

  6. Technical Note: Computation of Electric Field Strength Necessary for ...

    African Journals Online (AJOL)

    Obviously, electric field is established by this charge. The effects of this field on the objects lying within its vicinity depend on its intensity. In this paper, the electric field of 33kV overhead line is considered. The aim of the paper is to determine the maximum electric field strength or potential gradient, E of the 33kV overhead ...

  7. Technical notes: when all things are not equal.

    Science.gov (United States)

    Wasson, John H

    2006-01-01

    This article addresses 2 questions. First, how useful is adult patients' information about health and healthcare when they use the Internet for a "health checkup"? We find that patietns' reports are very strongly associated with medical record information for blood pressure, cholesterol, and blood glucose. Second, what are the biases in information from Internet respondents? Although we find that "health checkup" Internet users seem to be representative for patients in actual practice, much more research will be needed to fully address this question.

  8. Technical note: Combining quantile forecasts and predictive distributions of streamflows

    Science.gov (United States)

    Bogner, Konrad; Liechti, Katharina; Zappa, Massimiliano

    2017-11-01

    The enhanced availability of many different hydro-meteorological modelling and forecasting systems raises the issue of how to optimally combine this great deal of information. Especially the usage of deterministic and probabilistic forecasts with sometimes widely divergent predicted future streamflow values makes it even more complicated for decision makers to sift out the relevant information. In this study multiple streamflow forecast information will be aggregated based on several different predictive distributions, and quantile forecasts. For this combination the Bayesian model averaging (BMA) approach, the non-homogeneous Gaussian regression (NGR), also known as the ensemble model output statistic (EMOS) techniques, and a novel method called Beta-transformed linear pooling (BLP) will be applied. By the help of the quantile score (QS) and the continuous ranked probability score (CRPS), the combination results for the Sihl River in Switzerland with about 5 years of forecast data will be compared and the differences between the raw and optimally combined forecasts will be highlighted. The results demonstrate the importance of applying proper forecast combination methods for decision makers in the field of flood and water resource management.

  9. Technical Note: Methionine, a precursor of methane in living plants

    Science.gov (United States)

    Lenhart, K.; Althoff, F.; Greule, M.; Keppler, F.

    2015-03-01

    When terrestrial plants were identified as producers of the greenhouse gas methane, much discussion and debate ensued not only about their contribution to the global methane budget but also with regard to the validity of the observation itself. Although the phenomenon has now become more accepted for both living and dead plants, the mechanism of methane formation in living plants remains to be elucidated and its precursor compounds to be identified. We made use of stable isotope techniques to verify the in vivo formation of methane, and, in order to identify the carbon precursor, 13C positionally labeled organic compounds were employed. Here we show that the amino acid L-methionine acts as a methane precursor in living plants. Employing 13C-labeled methionine clearly identified the sulfur-bound methyl group of methionine as a carbon precursor of methane released from lavender (Lavandula angustifolia). Furthermore, when lavender plants were stressed physically, methane release rates and the stable carbon isotope values of the emitted methane greatly increased. Our results provide additional support that plants possess a mechanism for methane production and suggest that methionine might play an important role in the formation of methane in living plants, particularly under stress conditions.

  10. Technical note: Computer-manufactured inserts for prosthetic sockets.

    Science.gov (United States)

    Sanders, Joan E; McLean, Jake B; Cagle, John C; Gardner, David W; Allyn, Katheryn J

    2016-08-01

    The objective of this research was to use computer-aided design software and a tabletop 3-D additive manufacturing system to design and fabricate custom plastic inserts for trans-tibial prosthesis users. Shape quality of inserts was tested right after they were inserted into participant's test sockets and again after four weeks of wear. Inserts remained properly positioned and intact throughout testing. Right after insertion the inserts caused the socket to be slightly under-sized, by a mean of 0.11mm, approximately 55% of the thickness of a nylon sheath. After four weeks of wear the under-sizing was less, averaging 0.03mm, approximately 15% of the thickness of a nylon sheath. Thus the inserts settled into the sockets over time. If existing prosthetic design software packages were enhanced to conduct insert design and to automatically generate fabrication files for manufacturing, then computer manufactured inserts may offer advantages over traditional methods in terms of speed of fabrication, ease of design, modification, and record keeping. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

  11. Technical note: Alternatives to reduce adipose tissue sampling bias.

    Science.gov (United States)

    Cruz, G D; Wang, Y; Fadel, J G

    2014-10-01

    Understanding the mechanisms by which nutritional and pharmaceutical factors can manipulate adipose tissue growth and development in production animals has direct and indirect effects in the profitability of an enterprise. Adipocyte cellularity (number and size) is a key biological response that is commonly measured in animal science research. The variability and sampling of adipocyte cellularity within a muscle has been addressed in previous studies, but no attempt to critically investigate these issues has been proposed in the literature. The present study evaluated 2 sampling techniques (random and systematic) in an attempt to minimize sampling bias and to determine the minimum number of samples from 1 to 15 needed to represent the overall adipose tissue in the muscle. Both sampling procedures were applied on adipose tissue samples dissected from 30 longissimus muscles from cattle finished either on grass or grain. Briefly, adipose tissue samples were fixed with osmium tetroxide, and size and number of adipocytes were determined by a Coulter Counter. These results were then fit in a finite mixture model to obtain distribution parameters of each sample. To evaluate the benefits of increasing number of samples and the advantage of the new sampling technique, the concept of acceptance ratio was used; simply stated, the higher the acceptance ratio, the better the representation of the overall population. As expected, a great improvement on the estimation of the overall adipocyte cellularity parameters was observed using both sampling techniques when sample size number increased from 1 to 15 samples, considering both techniques' acceptance ratio increased from approximately 3 to 25%. When comparing sampling techniques, the systematic procedure slightly improved parameters estimation. The results suggest that more detailed research using other sampling techniques may provide better estimates for minimum sampling.

  12. Technical Note: Assessment of Impact Damage to Apple Fruits ...

    African Journals Online (AJOL)

    An impact damage assessment of fresh apple fruits was carried out to ascertain the effects of height and surfaces on bruise area and impact energy. Five different impact surfaces namely: Cardboard (E), wood (F), metal (G), plastic (H) and foam (I) were used for the experiment. The weighed fruits were dropped from different ...

  13. Technical Note: Homogeneity of Gafchromic EBT2 film

    International Nuclear Information System (INIS)

    Hartmann, Bernadette; Martisikova, Maria; Jaekel, Oliver

    2010-01-01

    Purpose: The self-developing Gafchromic EBT film is a radiochromic film, widely used for relative photon dosimetry. Recently, the manufacturer has replaced the well-investigated EBT film by the new Gafchromic EBT2 film. It has the same sensitive component and, in addition, it contains a yellow marker dye in order to protect the film against ambient light exposure and to serve as a base for corrections of small differences in film response. Furthermore, the configuration of the film layers as well as the binder material have been changed in comparison to the EBT film. When investigating the properties of EBT2 film, all characteristics were found to be similar to those of EBT film, except for the film response homogeneity. Thus, in this article special focus was put on examining the homogeneity of EBT2 film. Methods: A scan protocol established for EBT film and published previously was used. The uniformity of the film coloration was investigated for unirradiated and irradiated EBT2 film sheets. The dose response of EBT2 film was measured and the influence of film inhomogeneities on dose determination was evaluated. Results: Inhomogeneities in pixel values of up to ±3.7% within one film were detected. The relative inhomogeneities were found to be approximately independent of the dose. Nonuniformities of the film response lead to uncertainties in dose determination of ±8.7% at 1 Gy. When using net optical densities for dose calibration, uncertainties in dose determination amount to more than ±6%. Conclusions: EBT2 films from the lot investigated in this study show response inhomogeneities, which lead to uncertainties in dose determination exceeding the commonly accepted tolerance levels. It is important to test further EBT2 lots regarding homogeneity before using the film in clinical routine.

  14. Technical note: An inorganic water chemistry dataset (1972–2011 ...

    African Journals Online (AJOL)

    A national dataset of inorganic chemical data of surface waters (rivers, lakes, and dams) in South Africa is presented and made freely available. The dataset comprises more than 500 000 complete water analyses from 1972 up to 2011, collected from more than 2 000 sample monitoring stations in South Africa. The dataset ...

  15. Properties of selected superconductive materials, 1978 supplement. Technical note

    International Nuclear Information System (INIS)

    Roberts, B.W.

    1978-10-01

    This report includes data on additional superconductive materials extracted from the world literature up to fall 1977 and is an addendum to the data set published in J. Phys. Chem. Ref. Data 5, no. 3, 581-821 (1976) (Reprint no. 84). The data presented are new values and have not been selected or compared to values (except for selected values of the elements) previously assembled by the Superconductive Materials Data Center. The properties included are composition, critical temperature, critical magnetic field, crystal structure and the results of negative experiments. Special tabulations of high magnetic field materials with Type II behavior and materials with organic components are included. All entries are keyed to the literature. A list of recent reviews centered on superconductive materials is included

  16. Technical note: Guide to groundwater monitoring for the coal industry

    African Journals Online (AJOL)

    It is well established in literature that the environmental impacts associated with the coal industry are numerous. In respect of South Africa's groundwater resources the major impact of the coal industry is a reduction in groundwater quantity and quality. There is therefore a need to proactively prevent or minimise these ...

  17. Technical note: River modelling to infer flood management framework

    African Journals Online (AJOL)

    River hydraulic models have successfully identified the weaknesses and areas for improvement with respect to flooding in the Sarawak River system, and can also be used to support decisions on flood management measures. Often, the big question is 'how'. This paper demonstrates a theoretical flood management ...

  18. Technical note - the incorporation of ash content into gas content

    Energy Technology Data Exchange (ETDEWEB)

    Creech, M.; Mahoney, M. [Powercoal Pty. Ltd., Budgewoi, NSW (Australia)

    1995-12-31

    For gas content analysis in recent years, it has been standard procedure to report results on a `dry ash free` (daf) basis, under the assumption that gas only adsorbs onto coaly material. In order to test the relationship between ash and gas content, samples of various rock types were taken from two drillholes in the Newcastle Coalfield. The results of this study confirmed the correlation between gas content and ash, providing an accurate means of relating gas contents for all carbonaceous rock types. 4 refs., 5 figs., 1 tab.

  19. Technical Note: Calibration device for the krypton hygrometer KH20

    Directory of Open Access Journals (Sweden)

    T. Foken

    2012-08-01

    Full Text Available A calibration device for krypton hygrometers (KH20, Campbell Scientific, Inc. with variable path length is presented. This unit allows for in-situ calibrations of the krypton hygrometer, which is typically not very stable over time, during measuring campaigns. It was constructed mainly for application at high altitudes and low temperatures, where further improvements are needed to the IR-hygrometers which are normally used. The changing path length requires that a changing concentration of the absorber be simulated. Because oxygen absorbs more strongly than water vapour, the calibration is made against oxygen and transferred to water vapour. The design of the calibration instrument is made as one unit containing a stepper motor system, PC and humidity sensor. For the calibration, it is necessary to install the krypton hygrometer on this unit.

  20. Quantifying ataxia: ideal trajectory analysis--a technical note

    Science.gov (United States)

    McPartland, M. D.; Krebs, D. E.; Wall, C. 3rd

    2000-01-01

    We describe a quantitative method to assess repeated stair stepping stability. In both the mediolateral (ML) and anterioposterior (AP) directions, the trajectory of the subject's center of mass (COM) was compared to an ideal sinusoid. The two identified sinusoids were unique in each direction but coupled. Two dimensionless numbers-the mediolateral instability index (IML) and AP instability index (IAP)-were calculated using the COM trajectory and ideal sinusoids for each subject with larger index values resulting from less stable performance. The COM trajectories of nine nonimpaired controls and six patients diagnosed with unilateral or bilateral vestibular labyrinth hypofunction were analyzed. The average IML and IAP values of labyrinth disorder patients were respectively 127% and 119% greater than those of controls (panalysis distinguishes persons with labyrinth disorder from those without. The COM trajectories also identify movement inefficiencies attributable to vestibulopathy.

  1. Technical note: stress analysis of cellulosic-manure composites

    Science.gov (United States)

    Y.H. Ro; J.F. Hunt; R.E. Rowlands

    2017-01-01

    Ability to determine stresses in loaded, perforated cellulosic-manure composites from recorded temperature information was demonstrated. Being able to stress analyze such green materials addresses several societal issues. These include providing engineering members fabricated from materials that are suitable for developed and developing nations, relieving a troubling...

  2. Technical note: Significance and determination of fraction of non ...

    African Journals Online (AJOL)

    The degree of destabilisation ä corresponds to the collision frequency factor áP in the Smoluchowski equation for the perikinetic coagulation. The degree of aggregation áA corresponds to the collision frequency factor áO in the Smoluchowski equation for orthokinetic coagulation. Keywords: non-separable particles, number ...

  3. Dural opening/removal for combined petrosal approach: technical note.

    Science.gov (United States)

    Terasaka, Shunsuke; Asaoka, Katsuyuki; Kobayashi, Hiroyuki; Sugiyama, Taku; Yamaguchi, Shigeru

    2011-03-01

    Detailed descriptions of stepwise dural opening/removal for combined petrosal approach are presented. Following maximum bone work, the first dural incision was made along the undersurface of the temporal lobe parallel to the superior petrosal sinus. Posterior extension of the dural incision was made in a curved fashion, keeping away from the transverse-sigmoid junction and taking care to preserve the vein of Labbé. A second incision was made perpendicular to the first incision. After sectioning the superior petrosal sinus around the porus trigeminus, the incision was extended toward the posterior fossa dura in the middle fossa region. The tentorium was incised toward the incisura at a point just posterior to the entrance of the trochlear nerve. A third incision was made longitudinally between the superior petrosal sinus and the jugular bulb. A final incision was initiated perpendicular to the third incision in the presigmoid region and extended parallel to the superior petrosal sinus connecting the second incision. The dural complex consisting of the temporal lobe dura, the posterior fossa dura, and the freed tentorium could then be removed. In addition to extensive bone resection, our strategic cranial base dural opening/removal can yield true advantages for the combined petrosal approach.

  4. Technical note: Rapid calculation of genomic evaluations for new animals.

    Science.gov (United States)

    Wiggans, G R; VanRaden, P M; Cooper, T A

    2015-03-01

    A method was developed to calculate preliminary genomic evaluations daily or weekly before the release of official monthly evaluations by processing only newly genotyped animals using estimates of single nucleotide polymorphism effects from the previous official evaluation. To minimize computing time, reliabilities and genomic inbreeding are not calculated, and fixed weights are used to combine genomic and traditional information. Correlations of preliminary and September official monthly evaluations for animals with genotypes that became usable after the extraction of genotypes for August 2014 evaluations were >0.99 for most Holstein traits. Correlations were lower for breeds with smaller population size. Earlier access to genomic evaluations benefits producers by enabling earlier culling decisions and genotyping laboratories by making workloads more uniform across the month. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  5. Technical Note: SCUDA: A software platform for cumulative dose assessment

    Energy Technology Data Exchange (ETDEWEB)

    Park, Seyoun; McNutt, Todd; Quon, Harry; Wong, John; Lee, Junghoon, E-mail: rshekhar@childrensnational.org, E-mail: junghoon@jhu.edu [Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland 21231 (United States); Plishker, William [IGI Technologies, Inc., College Park, Maryland 20742 (United States); Shekhar, Raj, E-mail: rshekhar@childrensnational.org, E-mail: junghoon@jhu.edu [IGI Technologies, Inc., College Park, Maryland 20742 and Sheikh Zayed Institute for Pediatric Surgical Innovation, Children’s National Health System, Washington, DC 20010 (United States)

    2016-10-15

    Purpose: Accurate tracking of anatomical changes and computation of actually delivered dose to the patient are critical for successful adaptive radiation therapy (ART). Additionally, efficient data management and fast processing are practically important for the adoption in clinic as ART involves a large amount of image and treatment data. The purpose of this study was to develop an accurate and efficient Software platform for CUmulative Dose Assessment (SCUDA) that can be seamlessly integrated into the clinical workflow. Methods: SCUDA consists of deformable image registration (DIR), segmentation, dose computation modules, and a graphical user interface. It is connected to our image PACS and radiotherapy informatics databases from which it automatically queries/retrieves patient images, radiotherapy plan, beam data, and daily treatment information, thus providing an efficient and unified workflow. For accurate registration of the planning CT and daily CBCTs, the authors iteratively correct CBCT intensities by matching local intensity histograms during the DIR process. Contours of the target tumor and critical structures are then propagated from the planning CT to daily CBCTs using the computed deformations. The actual delivered daily dose is computed using the registered CT and patient setup information by a superposition/convolution algorithm, and accumulated using the computed deformation fields. Both DIR and dose computation modules are accelerated by a graphics processing unit. Results: The cumulative dose computation process has been validated on 30 head and neck (HN) cancer cases, showing 3.5 ± 5.0 Gy (mean±STD) absolute mean dose differences between the planned and the actually delivered doses in the parotid glands. On average, DIR, dose computation, and segmentation take 20 s/fraction and 17 min for a 35-fraction treatment including additional computation for dose accumulation. Conclusions: The authors developed a unified software platform that provides accurate and efficient monitoring of anatomical changes and computation of actually delivered dose to the patient, thus realizing an efficient cumulative dose computation workflow. Evaluation on HN cases demonstrated the utility of our platform for monitoring the treatment quality and detecting significant dosimetric variations that are keys to successful ART.

  6. Technical Note: How to use Winbugs to infer animal models

    DEFF Research Database (Denmark)

    Damgaard, Lars Holm

    2007-01-01

    This paper deals with Bayesian inferences of animal models using Gibbs sampling. First, we suggest a general and efficient method for updating additive genetic effects, in which the computational cost is independent of the pedigree depth and increases linearly only with the size of the pedigree....... Second, we show how this approach can be used to draw inferences from a wide range of animal models using the computer package Winbugs. Finally, we illustrate the approach in a simulation study, in which the data are generated and analyzed using Winbugs according to a linear model with i.i.d errors...... having Student's t distributions. In conclusion, Winbugs can be used to make inferences in small-sized, quantitative, genetic data sets applying a wide range of animal models that are not yet standard in the animal breeding literature...

  7. Technical note: A linear model for predicting δ13 Cprotein.

    Science.gov (United States)

    Pestle, William J; Hubbe, Mark; Smith, Erin K; Stevenson, Joseph M

    2015-08-01

    Development of a model for the prediction of δ(13) Cprotein from δ(13) Ccollagen and Δ(13) Cap-co . Model-generated values could, in turn, serve as "consumer" inputs for multisource mixture modeling of paleodiet. Linear regression analysis of previously published controlled diet data facilitated the development of a mathematical model for predicting δ(13) Cprotein (and an experimentally generated error term) from isotopic data routinely generated during the analysis of osseous remains (δ(13) Cco and Δ(13) Cap-co ). Regression analysis resulted in a two-term linear model (δ(13) Cprotein (%) = (0.78 × δ(13) Cco ) - (0.58× Δ(13) Cap-co ) - 4.7), possessing a high R-value of 0.93 (r(2)  = 0.86, P analysis of human osseous remains. These predicted values are ideal for use in multisource mixture modeling of dietary protein source contribution. © 2015 Wiley Periodicals, Inc.

  8. Technical Note: Calibration and validation of geophysical observation models

    NARCIS (Netherlands)

    Salama, M.S.; van der Velde, R.; van der Woerd, H.J.; Kromkamp, J.C.; Philippart, C.J.M.; Joseph, A.T.; O'Neill, P.E.; Lang, R.H.; Gish, T.; Werdell, P.J.; Su, Z.

    2012-01-01

    We present a method to calibrate and validate observational models that interrelate remotely sensed energy fluxes to geophysical variables of land and water surfaces. Coincident sets of remote sensing observation of visible and microwave radiations and geophysical data are assembled and subdivided

  9. Technical note Flood map development by coupling satellite maps ...

    African Journals Online (AJOL)

    Flood maps are important for local authorities in designing mitigation plans to minimise damage and loss due to flooding. In recent years, flood events in the Sarawak River Basin, Malaysia have caused damage to property, loss of life and disruption of productive activities. Currently, the available flood map for Sarawak River ...

  10. The Manufacture of Mail in Medieval Europe: A technical note

    Directory of Open Access Journals (Sweden)

    Williams, Alan R.

    1980-12-01

    Full Text Available THE oldest specimen of interlinked mail yet found has been excavated from a 3rd cent. B. C. Celtic grave in Romania, and this was probably developed from protective garments made up of rings threaded onto cords, like netting. A fragment of such a garment has been found in a Hallstatt grave, perhaps of the 8th cent. B. C. in Bohemia. Representations of Roman soldiers prior to the 1st cent. A. D. show them clad in mail-shirts rather than in plate. Mail returned to favour in the straitened economic circumstances of the Migration Period. and. indeed. remained the basis of most personal armour in the Middle Ages until gradually replaced by plate again in the 15th cent.

    No disponible.

  11. Technical Note: On maximizing Cherenkov emissions from medical linear accelerators.

    Science.gov (United States)

    Shrock, Zachary; Yoon, Suk W; Gunasingha, Rathnayaka; Oldham, Mark; Adamson, Justus

    2018-04-19

    Cherenkov light during MV radiotherapy has recently found imaging and therapeutic applications but is challenged by relatively low fluence. Our purpose is to investigate the feasibility of increasing Cherenkov light production during MV radiotherapy by increasing photon energy and applying specialized beam-hardening filtration. GAMOS 5.0.0, a GEANT4-based framework for Monte Carlo simulations, was used to model standard clinical linear accelerator primary photon beams. The photon source was incident upon a 17.8 cm 3 cubic water phantom with a 94 cm source to surface distance. Dose and Cherenkov production was determined at depths of 3-9 cm. Filtration was simulated 15 cm below the photon beam source. Filter materials included aluminum, iron, and copper with thicknesses of 2-20 cm. Histories used depended on the level of attenuation from the filter, ranging from 100 million to 2 billion. Comparing average dose per history also allowed for evaluation of dose-rate reduction for different filters. Overall, increasing photon beam energy is more effective at improving Cherenkov production per unit dose than is filtration, with a standard 18 MV beam yielding 3.3-4.0× more photons than 6 MV. Introducing an aluminum filter into an unfiltered 2400 cGy/min 10 MV beam increases the Cherenkov production by 1.6-1.7×, while maintaining a clinical dose rate of 300 cGy/min, compared to increases of ~1.5× for iron and copper. Aluminum was also more effective than the standard flattening filter, with the increase over the unfiltered beam being 1.4-1.5× (maintaining 600 cGy/min dose rate) vs 1.3-1.4× for the standard flattening filter. Applying a 10 cm aluminum filter to a standard 18 MV, photon beam increased the Cherenkov production per unit dose to 3.9-4.3× beyond that of 6 MV (vs 3.3-4.0× for 18 MV with no aluminum filter). Through a combination of increasing photon energy and applying specialized beam-hardening filtration, the amount of Cherenkov photons per unit radiotherapy dose can be increased substantially. © 2018 American Association of Physicists in Medicine.

  12. Electrocautery skin incision for neurosurgery procedures--technical note.

    Science.gov (United States)

    Nitta, Naoki; Fukami, Tadateru; Nozaki, Kazuhiko

    2011-01-01

    The reluctance to incise skin with electrocautery is partly attributable to concerns about excessive scarring and poor wound healing. However, recently no difference was reported in wound complications between the cold scalpel and electrocautery scalpel. We assessed the safety and efficacy of electrocautery skin incision in 22 scalp incisions, including 4 cases of reoperation. Electrocautery skin incisions were created using a sharp needle electrode. The generator unit was set on cutting mode, with power of 6 W and 330 kHz sinusoid waveform. Subcutaneous dissections also used the sharp needle electrode, set on coagulating mode, with power of 10 W and 1 MHz pulse-modulated waveform. Galea incisions used a standard blade tip, set on coagulating mode, with power of 20 W and 1 MHz pulse-modulated waveform. Skin incision with the sharp needle electrode caused no charring of the wound. Little bleeding or oozing were observed and skin clips were not necessary. No wound complication such as necrosis or infection occurred. Electrocautery skin incisions for re-operations were also performed safely without complications. Electrocautery skin incision is sufficiently safe procedure not only for first operation but also for re-operation. Electrocautery skin incision is efficacious, especially for extended operation times, because of little blood loss from the edges of skin incision and possible avoidance of skin edge necrosis or alopecia caused by skin clips.

  13. Construction cost forecast model : model documentation and technical notes.

    Science.gov (United States)

    2013-05-01

    Construction cost indices are generally estimated with Laspeyres, Paasche, or Fisher indices that allow changes : in the quantities of construction bid items, as well as changes in price to change the cost indices of those items. : These cost indices...

  14. Examination of Cervical Spine Histological Sections - A Technical Note

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Ullerup, Rita; Vesterby, Annie

    2006-01-01

    Detailed knowledge of the cervical spine facet joints morphology and anatomy is increasingly important since improved understanding of clinical syndromes, such as whiplash injuries, and therapeutic interventions is based on this knowledge. So far systematic examination of the age-related morphology...... of these joints has not yet been performed, nor has any generally accepted histological classification system for degenerative changes in the cervical spine facet joints been proposed. In the case of whiplash injuries the presented histological method has particular relevance since it allows detailed description...

  15. Dangers of collapsible ventricular drainage systems. Technical note.

    Science.gov (United States)

    Kaye, A H; Wallace, D

    1982-02-01

    Ventricular drainage systems employing a collapsible plastic bag for fluid collection were postulated to cause an increasing back-pressure produced in part by the elasticity of the bag. This postulate was shown to be correct in an experimental situation. There was a logarithmic rise in cerebrospinal fluid pressure as the bag filled. By increasing the size of the bag, the problem was overcome.

  16. Examination of Cervical Spine Histological Sections - A Technical Note

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Ullerup, Rita; Vesterby, Annie

    2006-01-01

    Detailed knowledge of the cervical spine facet joints morphology and anatomy is increasingly important since improved understanding of clinical syndromes, such as whiplash injuries, and therapeutic interventions is based on this knowledge. So far systematic examination of the age-related morphology...... of these joints has not yet been performed, nor has any generally accepted histological classification system for degenerative changes in the cervical spine facet joints been proposed. In the case of whiplash injuries the presented histological method has particular relevance since it allows detailed description...... of the anatomy and pathoanatomical status of the osteo-cartilagenous structures, including the facet joints from where a major portion of chronic whiplash patients experience their pain symptoms....

  17. Thinking ahead of the surgeon. An interview study to identify scrub nurses' non-technical skills.

    Science.gov (United States)

    Mitchell, Lucy; Flin, Rhona; Yule, Steven; Mitchell, Janet; Coutts, Kathy; Youngson, George

    2011-07-01

    Efforts to reduce adverse event rates in healthcare have revealed the importance of identifying the essential non-technical (cognitive and social) skills for safe and effective performance. Previous research on non-technical skills for operating theatre staff has concentrated on doctors rather than nursing professionals. The aim of the study was to identify the critical non-technical skills that are essential for safe and effective performance as an operating theatre scrub nurse. Experienced scrub nurses (n = 25) and consultant surgeons (n = 9) from four Scottish hospitals were interviewed using a semi-structured format. The protocols were designed to identify the main social and cognitive skills required by scrub nurses. Interviews were digitally recorded, transcribed verbatim and independently coded to extract behaviours in order to produce a list of the main non-technical skills for safe and effective scrub nurse performance. The non-technical skills of situation awareness, communication, teamwork, task management and coping with stress were identified as key to successful scrub nurse task performance. Component sets of behaviours for each of these categories were also noted. The interviews with subject matter experts from scrub nursing and surgery produced preliminary evidence that situation awareness, communication, teamwork and coping with stress are the principal non-technical skills required for effective performance as a scrub nurse. Copyright © 2010 Elsevier Ltd. All rights reserved.

  18. Notes on Laser Acceleration

    International Nuclear Information System (INIS)

    Tajima, T.

    2008-01-01

    This note intends to motivate our effort toward the advent of new methods of particle acceleration, utilizing the fast rising laser technology. By illustrating the underlying principles in an intuitive manner and thus less jargon-clad fashion, we seek a direction in which we shall be able to properly control and harness the promise of laser acceleration. First we review the idea behind the laser wakefield. We then go on to examine ion acceleration by laser. We examine the sheath acceleration in particular and look for the future direction that allows orderly acceleration of ions in high energies

  19. MISCELLANEOUS BOTANICAL NOTES 2

    Directory of Open Access Journals (Sweden)

    A.J.G.H KOSTERMANS

    2014-01-01

    Full Text Available 1.   Durio  cupreus Ridley is considered to  represent a  distinct  species.2.   Durio wyatt-smithii Kosterm. is reported from Borneo.3.   Machilus nervosa Merr. represents Meliosma bontoeensis Merr.4.   Beilschmiedia brassii Allen represents Vavaea brassii (Allen Kosterm.5.   The author of the generic name Heritiera is Aiton.6.   Heritiera macrophylla (non Wall. Merr. is conspecific with H. ungus-tata Pierre.7.   Some specimens from N. Celebes, attributed formerly to H. sylvatica Merr., belong to H. arafurensis Kosterm.8.   Additional note on Heritiera littoralis Ait. and H. macrophylla Wall, ex Kurz.9.   Heritiera   montana   Kosterm.,   nov.   spec,   from   New   Guinea   and H. khidii Kosterm., nov. spec, from Northern Siam.10.   Additional note on Heritiera, novoguineensis Kosterm. and H. pereo-riacea Kosterm. and an undescribed species.11.   Heritiera acuminata Wall, ex Kurz represents a distinct species.12.   Heritiera  solomonensis  Kosterm.,  nov.  spec,  from the  Solomon  Isl.13.   A note on Firmiana bracteata A. DC.14.   Firmiana fulgens (Wall, ex King  Corner is based on a mixtum com-positum and has been the source of constant confusion. For the element, which occurs in Malaysia a new name is coined: F. malayana Kosterm. It does not occur in Tenasserim.15.   A revised bibliography of Firmiana colorata R. Br., F. pallens Stearn and F. malayana Kosterm. is presented.16.   Additional note on Firmiana hainanensis Kosterm.17.   Firmiana kerrii (Craib Kosterm., comb, nov., based on Sterculia kerrii Craib.18.   Additional specimens of Firmiana papuana Mildbr.19.   Cryptocarya hintonii Allen is referred to Primus as Primus hintonii (Allen  Kosterm.20.   Beilschmiedia wallichiana (G. Don   Kosterm., based on Sideroxylon wallichianum, G. Don, is described. Formerly it was relegated to Litsea by Kurz.21.   New species in Lauraceae: Beilschmiedia aborensis Kosterm., B

  20. Notes on functional analysis

    CERN Document Server

    Bhatia, Rajendra

    2009-01-01

    These notes are a record of a one semester course on Functional Analysis given by the author to second year Master of Statistics students at the Indian Statistical Institute, New Delhi. Students taking this course have a strong background in real analysis, linear algebra, measure theory and probability, and the course proceeds rapidly from the definition of a normed linear space to the spectral theorem for bounded selfadjoint operators in a Hilbert space. The book is organised as twenty six lectures, each corresponding to a ninety minute class session. This may be helpful to teachers planning a course on this topic. Well prepared students can read it on their own.

  1. Imagining Technicities

    DEFF Research Database (Denmark)

    Liboriussen, Bjarke; Plesner, Ursula

    2011-01-01

    to the elements of taste and skill. In the final analysis those references were synthesized as five imagined technicities: the architect, the engineer, the client, the Chinese, and the Virtual World native. Because technicities are often assumed and rarely discussed as actants who influence practice, their role......, this article focuses on innovative uses of virtual worlds in architecture. We interviewed architects, industrial designers and other practitioners. Conceptually supported by an understanding of technicity found in Cultural Studies, the interviews were then coded with a focus on interviewees’ references...... in cooperation and development of ICTs seems to pass unnoticed. However, since they are aligned into ICTs, technicities impact innovation....

  2. Teaching Furlow palatoplasty: the sticky note method.

    Science.gov (United States)

    Liu, Mona Mengyue; Kim, JeeHong; Jabbour, Noel

    2014-11-01

    The double-opposing Z-plasty (Furlow palatoplasty) procedure is a well-established method for palate repair in children. We propose a simple and easily accessible sticky note model to demonstrate the lengthening in palatal anatomy afforded by this technically challenging procedure. Our model involves creating a lengthened three-dimensional representation of the Z-plasty through making specified incisions and rearrangements of the palatal layers. The sticky note model was made a total of 20 times and length of the palate model pre and post Z-plasty was measured. The average length of the palate pre-procedure was 72 mm. The average length of the palate post procedure was 78.9 mm, showing an increase of 6.9 mm (9.6%). Our model provides an accurate and valuable educational tool that will aid in the visualization and understanding of the Furlow palatoplasty procedure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  3. CT after transsphenoidal surgery

    International Nuclear Information System (INIS)

    Tazawa, Satoru

    1991-01-01

    Two hundred and ten CT studies of 95 patients after transsphenoidal surgery were reviewed. Spheno-ethmoid opacificaiton, intrasellar hematoma and gas bubbles were noted within 2 weeks after surgery. Bone defect of the sellar floor and bone stent were seen on coronal scans in most cases. The packing material frequently disappeared on follow-up studies. Hormonal assessment of the functioning tumor, according to which the effect of treatment was evaluated, was correlated with CT findings. Because differentiation between postoperative changes and residual mass was difficult, there was no definite CT criteria to indicate residual functioning tumor except upward convexity of the diaphragma sellae on CT more than 3 months after surgery. Initial follow up CT study is recommended to be performed at about 3 months after surgery, at which time the immediate postoperative inflammatory changes have been disappeared. The incidence of recurrence was 3/47 (6%), which was shown on follow-up CT from 4 to 10 years after surgery. Therefore, subsequent CT study should be done in every year or two, taking the clinical symptoms and hormonal data into consideration. (author)

  4. CT after transsphenoidal surgery

    Energy Technology Data Exchange (ETDEWEB)

    Tazawa, Satoru [Tohoku Univ., Sendai (Japan). School of Medicine

    1991-03-01

    Two hundred and ten CT studies of 95 patients after transsphenoidal surgery were reviewed. Spheno-ethmoid opacificaiton, intrasellar hematoma and gas bubbles were noted within 2 weeks after surgery. Bone defect of the sellar floor and bone stent were seen on coronal scans in most cases. The packing material frequently disappeared on follow-up studies. Hormonal assessment of the functioning tumor, according to which the effect of treatment was evaluated, was correlated with CT findings. Because differentiation between postoperative changes and residual mass was difficult, there was no definite CT criteria to indicate residual functioning tumor except upward convexity of the diaphragma sellae on CT more than 3 months after surgery. Initial follow up CT study is recommended to be performed at about 3 months after surgery, at which time the immediate postoperative inflammatory changes have been disappeared. The incidence of recurrence was 3/47 (6%), which was shown on follow-up CT from 4 to 10 years after surgery. Therefore, subsequent CT study should be done in every year or two, taking the clinical symptoms and hormonal data into consideration. (author).

  5. Technical Note A note on the occuffence of mycotoxins in cereals ...

    African Journals Online (AJOL)

    came from food companies, co-operatives, insurance compa- nies, millers, hospitals, rural ..... culture for the detection of mycotoxins. Letts. Appl. Microbiol. ... Symposium on Mycotoxins and Phytotoxins, Mexico City,. Mexico. TAKITANI, S.

  6. New methods of magnet-based instrumentation for NOTES.

    Science.gov (United States)

    Magdeburg, Richard; Hauth, Daniel; Kaehler, Georg

    2013-12-01

    Laparoscopic surgery has displaced open surgery as the standard of care for many clinical conditions. NOTES has been described as the next surgical frontier with the objective of incision-free abdominal surgery. The principal challenge of NOTES procedures is the loss of triangulation and instrument rigidity, which is one of the fundamental concepts of laparoscopic surgery. To overcome these problems necessitates the development of new instrumentation. material and methods: We aimed to assess the use of a very simple combination of internal and external magnets that might allow the vigorous multiaxial traction/counter-traction required in NOTES procedures. The magnet retraction system consisted of an external magnetic assembly and either small internal magnets attached by endoscopic clips to the designated tissue (magnet-clip-approach) or an endoscopic grasping forceps in a magnetic deflector roll (magnet-trocar-approach). We compared both methods regarding precision, time and efficacy by performing transgastric partial uterus resections with better results for the magnet-trocar-approach. This proof-of-principle animal study showed that the combination of external and internal magnets generates sufficient coupling forces at clinically relevant abdominal wall thicknesses, making them suitable for use and evaluation in NOTES procedures, and provides the vigorous multiaxial traction/counter-traction required by the lack of additional abdominal trocars.

  7. International Conference on Natural Orifice Transluminal Endoscopic Surgery (NOTES)

    Science.gov (United States)

    2006-06-01

    hemangiomas, and one simple cyst), five were malignant in five patients (five hepatocarcinoma ). and four patients had an uncertain preoperative diagnosis...In the first three cases [ hepatocarcinoma (HCO of segment II, hydatid cyst of segment VI. and hemangioma of segment II], we used the Kellyclasia...HCC HCC HCC HCC HCC Hemangiomab l-’NH vs adenoma FNH vs adenoma FNH vs adenoma FHN. focal nodular hyperplasia; HCC, hepatocarcinoma 1

  8. Note e Recensioni

    Directory of Open Access Journals (Sweden)

    a cura di Mariagrazia Portera

    2013-12-01

    Full Text Available Volumi Winfried Menninghaus, La promessa della bellezza, [Fabrizio Desideri, p. 272] • David Rothenberg, Survival of the Beautiful. Art, Science and Evolution [Danae Crocchiola, p. 274] • Lev Manovich, Software Takes Command [Angela Maiello, p. 277]. Note Method in Aesthetics: Philosophy, Evolution and the Cognitive Sciences [Aaron Meskin, Matthew Kieran, Gregory Currie, p. 280] • L’Abitare possibile. Estetica, Architettura e New Media, Ravello, Auditorium Oscar Niemeyer, 28-30 maggio 2013 [Sara Matetich, p. 282] • Copenhagen Summer School in Phenomenology and Philosophy of Mind, University of Copenhagen, 12-16 Agosto 2013 [Raoul Frauenfelder, p. 289] • Ciò che è vivo e ciò che è morto nell’estetica di Archibald Ali- son. Nota a margine del convegno: Neoestetica ed emozione. Archibald Alison e l’estetica con- temporanea, Palermo, 4-5 ottobre 2013 [Giuseppe Pucci, p. 294

  9. Bioethics for Technical Experts

    Science.gov (United States)

    Asano, Shigetaka

    Along with rapidly expanding applications of life science and technology, technical experts have been implicated more and more often with ethical, social, and legal problems than before. It should be noted that in this background there are scientific and social uncertainty elements which are inevitable during the progress of life science in addition to the historically-established social unreliability to scientists and engineers. In order to solve these problems, therefore, we should establish the social governance with ‘relief’ and ‘reliance’ which enables for both citizens and engineers to share the awareness of the issues, to design social orders and criterions based on hypothetical sense of values for bioethics, to carry out practical use management of each subject carefully, and to improve the sense of values from hypothetical to universal. Concerning these measures, the technical experts can learn many things from the present performance in the medical field.

  10. Technical Network

    CERN Multimedia

    2007-01-01

    In order to optimize the management of the Technical Network (TN), to ease the understanding and purpose of devices connected to the TN, and to improve security incident handling, the Technical Network Administrators and the CNIC WG have asked IT/CS to verify the "description" and "tag" fields of devices connected to the TN. Therefore, persons responsible for systems connected to the TN will receive email notifications from IT/CS asking them to add the corresponding information in the network database. Thank you very much for your cooperation. The Technical Network Administrators & the CNIC WG

  11. Technical Network

    CERN Multimedia

    2007-01-01

    In order to optimise the management of the Technical Network (TN), to facilitate understanding of the purpose of devices connected to the TN and to improve security incident handling, the Technical Network Administrators and the CNIC WG have asked IT/CS to verify the "description" and "tag" fields of devices connected to the TN. Therefore, persons responsible for systems connected to the TN will receive e-mails from IT/CS asking them to add the corresponding information in the network database at "network-cern-ch". Thank you very much for your cooperation. The Technical Network Administrators & the CNIC WG

  12. Y-Notes; Introductory Sessions on Nuclear Technology

    International Nuclear Information System (INIS)

    2001-01-01

    This chapter is divided into next parts: What is 'Y-Notes ; Young generation opening session; Nuclear education and transfer of know-how; Nuclear technology; Other applications of nuclear technology; Nuclear programs and technical cooperation; Political aspects; Environment and safety; Communication and public perception; Economics; Fuel cycle challenges; Video

  13. Review of orthognathic surgery and related papers published in the British Journal of Oral and Maxillofacial Surgery 2011-2012.

    Science.gov (United States)

    Goodson, Alexander M C; Payne, Karl F B; Tahim, Arpan; Colbert, Serryth; Brennan, Peter A

    2015-04-01

    This review summarises all orthognathic and related papers published between January 2011 and December 2012 in the British Journal of Oral and Maxillofacial Surgery (BJOMS). A total of 36 articles were published, a high proportion of which (78%) were full-length papers. The remainder consisted of short communications and technical notes. The topics included operative planning and postoperative outcomes, and there was a strong focus on distraction osteogenesis. There were fewer orthognathic articles published in BJOMS than articles on other subspecialties such as trauma or head and neck oncology. Only 8 (29%) of the full-length articles were prospective studies or randomised trials, which highlights a need for well-designed clinical studies in orthognathic research. Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  14. Comprehensive review on endonasal endoscopic sinus surgery

    Science.gov (United States)

    Weber, Rainer K.; Hosemann, Werner

    2015-01-01

    Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful. These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3–4, medial maxillectomy, prelacrimal approach) and sphenoid sinus. In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment. PMID:26770282

  15. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ...

  16. Colonic stenting as a bridge to surgery for obstructive colorectal cancer: advantages and disadvantages.

    Science.gov (United States)

    Haraguchi, Naotsugu; Ikeda, Masataka; Miyake, Masakazu; Yamada, Takuya; Sakakibara, Yuko; Mita, Eiji; Doki, Yuichiro; Mori, Masaki; Sekimoto, Mitsugu

    2016-11-01

    To clarify the advantages and disadvantages of stenting as a bridge to surgery (BTS) by comparing the clinical features and outcomes of patients who underwent BTS with those of patients who underwent emergency surgery (ES). We assessed technical success, clinical success, surgical procedures, stoma formation, complications, clinicopathological features, and Onodera's prognostic nutritional index (OPNI) in patients who underwent BTS and those who underwent ES. Twenty-six patients underwent stenting, which was successful in 22 (BTS group). The remaining four patients with unsuccessful stenting underwent emergency surgery. A total of 22 patients underwent emergency surgery (ES group). The rates of technical and clinical success were 85.0 and 81.0 %, respectively. The proportion of patients able to be treated by laparoscopic surgery (P = 0.0001) and avoid colostomy (P = 0.0042) was significantly higher in the BTS group. Although the incidence of anastomotic leakage in the two groups was not significantly different, it was significantly reduced by colonoscopic evaluation of obstructive colitis (P = 0.0251). The mean number of harvested lymph nodes (P = 0.0056) and the proportion of D3 lymphadenectomy (P = 0.0241) were significantly greater in the BTS group. Perineural invasion (PNI) was noted in 59.1 and 18.2 % of the BTS group and ES group patients, respectively (P = 0.0053). OPNI and serum albumin decreased significantly after stenting (P = 0.0084). The advantages of stenting as a BTS were that it avoided colostomy and allowed for laparoscopic surgery and lymphadenectomy, whereas its disadvantage lay in the decreased PNI and OPNI levels. A larger study including an analysis of prognosis is warranted.

  17. Laparoscopic and open stone surgery

    NARCIS (Netherlands)

    Hruza, Marcel; Zuazu, Jorge Rioja; Goezen, Ali Serdar; de La Rosette, Jean J. M. C. H.; Rassweiler, Jens J.

    2010-01-01

    INTRODUCTION: Due to the increasing spread and technical enhancement of endourological methods, open surgery for renal and ureteral calculi almost disappeared. MATERIALS AND METHODS: Based on an actual review of literature, we describe indications, technique and clinical importance of the open and

  18. Conventional surgery in breast cancer

    International Nuclear Information System (INIS)

    Tapia Herrera, Andres

    2013-01-01

    General aspects of breast cancer were described from the epidemiological point of view, clinical and pathological, as well as its impact at global and national levels. Parenchyma conservative surgery and/or breast skin was analyzed exhaustively as a cancer treatment analyzed exhaustively, to your specifications, requirements, technical aspects, risks, benefits, degree of oncological safety and benefits for patients [es

  19. GENERAL SURGERY

    African Journals Online (AJOL)

    in the endoscopy room. GENERAL SURGERY. T du Toit, O C Buchel, S J A Smit. Department of Surgery, University of the Free State, Bloemfontein, ... The lack of video instrumentation in developing countries: Redundant fibre-optic instruments (the old. “eye scope”) are still being used. This instrument brings endoscopists ...

  20. GENERAL SURGERY

    African Journals Online (AJOL)

    mean time to first surgery post burn was 11.5 days with a median volume of 0.73 mls/kg/% ..... Mode. Mean (SD). Upper limit. 95% CI. Lower limit. 95% CI. Mode. Elective surgery .... evaluating single-unit red blood cell transfusions in reducing.

  1. Gender trends in authorship in oral and maxillofacial surgery literature: A 30-year analysis.

    Science.gov (United States)

    Nkenke, Emeka; Seemann, Rudolf; Vairaktaris, Elefterios; Schaller, Hans-Günter; Rohde, Maximilian; Stelzle, Florian; Knipfer, Christian

    2015-07-01

    The aim of the present study was to perform a bibliometric analysis of the gender distribution of first and senior authorships in important oral and maxillofacial journals over the 30-year period from 1980 to 2010. Articles published in three representative oral and maxillofacial surgery journals were selected. The years 1980, 1990, 2000, and 2010 were chosen as representative points in time for article selection. Original research, case reports, technical notes, and reviews were included in the analysis. Case reports and technical notes were pooled in one group. For each article, the gender of the first author as well as that of the senior author was determined, based on the inspection of their first name. The type of article was determined and the country of origin of the article was documented. A total 1412 articles were subjected to the data analysis. A significant increase in female authorship in oral and maxillofacial surgery could be identified over the chosen 30-year period. However, the number of publications by male authors was still significantly higher at all points of time, exceeding those of female authors by at least 3.8 fold in 2010. As there is a trend towards feminization of medicine and dentistry, the results of the present study may serve as the basis for further analysis of the current situation, and the identification of necessary actions to accelerate the closure of the gender gap in publishing in oral and maxillofacial surgery. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  2. Choosing surgery

    DEFF Research Database (Denmark)

    Thorstensson, Carina; Lohmander, L; Frobell, Richard

    2009-01-01

    -depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed......ABSTRACT: BACKGROUND: The objective was to understand patients' views of treatment after acute anterior cruciate ligament (ACL) injury, and their reasons for deciding to request surgery despite consenting to participate in a randomised controlled trial (to 'cross-over'). METHODS: Thirty-four in...... before surgery, and 11 were interviewed at least 6 months after surgery. To provide additional information, 12 patients were interviewed before randomisation. Interviews were audio-recorded, transcribed and analysed using the Framework approach. RESULTS: Strong preference for surgery was commonplace...

  3. Notes in Colombian Herpetology, II Notes in Colombian Herpetology, II

    Directory of Open Access Journals (Sweden)

    Dunn Emmett Reid

    1944-03-01

    Full Text Available The Lizard Genus Echinosaura (Teiidae in Colombia / Notes on the habits of the Tadpole-Carrying Frog Hyloxalus granuliventris / A New Marsupian Frog (Gastrotheca from Colombia The Lizard Genus Echinosaura (Teiidae in Colombia / Notes on the habits of the Tadpole-Carrying Frog Hyloxalus granuliventris / A New Marsupian Frog (Gastrotheca from Colombia.

  4. An audit of the quality of surgical operation notes in a Nigerian ...

    African Journals Online (AJOL)

    Methods: Operation notes completed by doctors in the Surgery Department over a 2-month period were audited for completeness, legibility and conformity to the standards of the Royal College of Surgeons of England. Results: There were 100 operation notes reviewed, two-thirds of these were written by Senior Registrars, ...

  5. Transgastric pure-NOTES peritoneoscopy and endoscopic ultrasonography for staging of gastrointestinal cancers

    DEFF Research Database (Denmark)

    Donatsky, Anders Meller; Vilmann, Peter; Meisner, Søren

    2012-01-01

    BACKGROUND: Human natural orifice transluminal endoscopic surgery (NOTES) has mainly been based on simultaneous laparoscopic assistance (hybrid NOTES), forgoing the theoretical benefits of the NOTES technique. This is due to a lack of NOTES-specific instruments and endoscopes, making pure-NOTES...... procedures difficult and time consuming. An area where pure NOTES could be adopted at its present stage of development is minimally invasive staging of gastrointestinal (GI) cancer. The aim of this study is to evaluate the feasibility of combining transgastric (TG) pure-NOTES peritoneoscopy...... and intraperitoneal endoscopic ultrasonography (ip-EUS) with intraluminal EUS (il-EUS) for peritoneal evaluation. METHODS: This was a feasibility and survival study where il-EUS followed by ip-EUS and peritoneoscopy was performed in 10 pigs subjected to TG pure NOTES. A score was given with regard to achieved...

  6. General Surgery

    African Journals Online (AJOL)

    bbshehu

    Methods: We reviewed all case-notes, radiological records and histology reports of ... contamination, anastomotic technique, emergency ... identified at laparotomy for peritonitis or during post mortem; 3) Clinical features of a leak confirmed by.

  7. A note on axial symmetries

    International Nuclear Information System (INIS)

    Beetle, Christopher; Wilder, Shawn

    2015-01-01

    This note describes how to characterize and normalize an axial Killing field on a general Riemannian geometry or four-dimensional Lorentzian geometry. No global assumptions are necessary, such as that the orbits of the Killing field all have period 2π. Rather, any Killing field that vanishes at at least one point necessarily has the expected global properties. (note)

  8. The Anatomy of a Note.

    Science.gov (United States)

    Moore, Herb

    1986-01-01

    Suggests that students can learn the physics of a musical note by learning how to synthesize sounds on a computer. Discusses ADSR (attack, decay, sustain, and release of a note) and includes a program (with listing) which students can use to examine ADSR on a Commodore 64 microcomputer. (JN)

  9. Cataract Surgery

    Science.gov (United States)

    ... Oncology Oculoplastics/Orbit Refractive Management/Intervention Retina/Vitreous Uveitis Focus On Pediatric Ophthalmology ... Are Cataracts? Pediatric Cataracts Cataract Diagnosis and Treatment Cataract Surgery IOL Implants: Lens Replacement After Cataracts ...

  10. Brain surgery

    Science.gov (United States)

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... cut depends on where the problem in the brain is located. The surgeon creates a hole in ...

  11. Foot Surgery

    Science.gov (United States)

    ... coding trends along with compliance guidelines and practice marketing materials, APMA has you covered whether you are ... crutches after the surgery or in a cast. Fusions: Fusions are usually performed to treat arthritic or ...

  12. Hemorrhoid surgery

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/002939.htm Hemorrhoid surgery To use the sharing features on this page, please enable JavaScript. Hemorrhoids are swollen veins around the anus. They may ...

  13. PLASTIC SURGERY

    African Journals Online (AJOL)

    Department of Plastic and Reconstructive Surgery Sefako Makgatho Health Science University, ... We report on a pilot study on the use of a circumareolar excision and the use of .... and 1 gynecomastia patient) requested reduction in NAC size.

  14. GENERAL SURGERY

    African Journals Online (AJOL)

    influence medical students in pursuing a career in surgery. ... training, females reported significantly higher levels of agreement that surgical training would be better overseas when ..... mentoring surgical research or educational lectures and.

  15. GENERAL SURGERY

    African Journals Online (AJOL)

    1 Department of Surgery, Nelson R Mandela School of Medicine, University of ... in 51 reports. Four reports were illegible; one was conducted by a junior consultant, two by a fourth year trainee specialist ... The study period was 12 months from.

  16. Sinus Surgery

    Science.gov (United States)

    ... sinus computed tomography (CT) scan (without contrast), nasal physiology (rhinomanometry and nasal cytology), smell testing, and selected ... altered anatomical landmarks, or where a patient’s sinus anatomy is very unusual, making typical surgery difficult. Image ...

  17. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures...... undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...

  18. TECHNICAL COORDINATION

    CERN Multimedia

    A. Ball

    2010-01-01

    Operational Experience At the end of the first full-year running period of LHC, CMS is established as a reliable, robust and mature experiment. In particular common systems and infrastructure faults accounted for <0.6 % CMS downtime during LHC pp physics. Technical operation throughout the entire year was rather smooth, the main faults requiring UXC access being sub-detector power systems and rack-cooling turbines. All such problems were corrected during scheduled technical stops, in the shadow of tunnel access needed by the LHC, or in negotiated accesses or access extensions. Nevertheless, the number of necessary accesses to the UXC averaged more than one per week and the technical stops were inevitably packed with work packages, typically 30 being executed within a few days, placing a high load on the coordination and area management teams. It is an appropriate moment for CMS Technical Coordination to thank all those in many CERN departments and in the Collaboration, who were involved in CMS techni...

  19. TECHNICAL COORDINATION

    CERN Multimedia

    A. Ball

    2010-01-01

    Operational Experience Since the closure of the detector in February, the technical operation of CMS has been quite smooth and reliable. Some minor interventions in UXC were required to cure failures of power supplies, fans, readout boards and rack cooling connections, but all these failures were repaired in scheduled technical stops or parasitically during access dedicated to fixing LHC technical problems. The only occasion when CMS had to request an access between fills was to search for the source of an alarm from the leak-detection cables mounted in the DT racks. After a few minutes of diagnostic search, a leaking air-purge was found. Replacement was complete within 2 hours. This incident demonstrated once more the value of these leak detection cables; the system will be further extended (during the end of year technical stop) to cover more racks in UXC and the floor beneath the detector. The magnet has also been operating reliably and reacted correctly to the 14s power cut on 29 May (see below). In or...

  20. Technical endoscopy

    International Nuclear Information System (INIS)

    Cavalar, K.O.

    1988-01-01

    A survey is provided on different versions of endoscopes, taking into account the new developments of video endoscopy. With a variety of practical examples it is shown that technical tests using endoscopy are a demanding task for nondestructive testing, whose requirements can only be met on a customized basis. (orig./HP) [de

  1. Applications of piezoelectric surgery in endodontic surgery: a literature review.

    Science.gov (United States)

    Abella, Francesc; de Ribot, Joan; Doria, Guillermo; Duran-Sindreu, Fernando; Roig, Miguel

    2014-03-01

    Piezosurgery (piezoelectric bone surgery) devices were developed to cut bone atraumatically using ultrasonic vibrations and to provide an alternative to the mechanical and electrical instruments used in conventional oral surgery. Indications for piezosurgery are increasing in oral and maxillofacial surgery, as in other disciplines, such as endodontic surgery. Key features of piezosurgery instruments include their ability to selectively cut bone without damaging adjacent soft tissue, to provide a clear operative field, and to cut without generating heat. Although piezosurgery instruments can be used at most stages of endodontic surgery (osteotomy, root-end resection, and root-end preparation), no published data are available on the effect of piezosurgery on the outcomes of endodontic surgery. To our knowledge, no study has evaluated the effect of piezosurgery on root-end resection, and only 1 has investigated root-end morphology after retrograde cavity preparation using piezosurgery. We conducted a search of the PubMed and Cochrane databases using appropriate terms and keywords related to the use and applications of piezoelectric surgery in endodontic surgery. A hand search also was conducted of issues published in the preceding 2 years of several journals. Two independent reviewers obtained and analyzed the full texts of the selected articles. A total of 121 articles published between January 2000 and December 2013 were identified. This review summarizes the operating principles of piezoelectric devices and outlines the applications of piezosurgery in endodontic surgery using clinical examples. Piezosurgery is a promising technical modality with applications in several aspects of endodontic surgery, but further studies are necessary to determine the influence of piezosurgery on root-end resection and root-end preparation. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  2. Enhanced Recovery After Surgery Protocols in Major Urologic Surgery

    Directory of Open Access Journals (Sweden)

    Natalija Vukovic

    2018-04-01

    Full Text Available The purpose of the reviewThe analysis of the components of enhanced recovery after surgery (ERAS protocols in urologic surgery.Recent findingsERAS protocols has been studied for over 20 years in different surgical procedures, mostly in colorectal surgery. The concept of improving patient care and reducing postoperative complications was also applied to major urologic surgery and especially procedure of radical cystectomy. This procedure is technically challenging, due to a major surgical resection and high postoperative complication rate that may reach 65%. Several clinical pathways were introduced to improve perioperative course and reduce the length of hospital stay. These protocols differ from ERAS modalities in other surgeries. The reasons for this are longer operative time, increased risk of perioperative transfusion and infection, and urinary diversion achieved using transposed intestinal segments. Previous studies in this area analyzed the need for mechanical bowel preparation, postoperative nasogastric tube decompression, as well as the duration of urinary drainage. Furthermore, the attention has also been drawn to perioperative fluid optimization, pain management, and bowel function.SummaryNotwithstanding partial resemblance between the pathways in major urologic surgery and other pelvic surgeries, there are still scarce guidelines for ERAS protocols in urology, which is why further studies should assess the importance of preoperative medical optimization, implementation of thoracic epidural anesthesia and analgesia, and perioperative nutritional management.

  3. Technical Training: Technical Training Seminar

    CERN Multimedia

    2004-01-01

    TECHNICAL TRAINING Monique Duval tel. 74924 technical.training@cern.ch Monday 9 February 2004 From 10:00 to 12:00 - IT Auditorium - bldg. 31, 3rd floor ANSOFT High-Frequency Seminar David Prestaux, Application Engineer, ANSOFT F-78535 BUC, France This Technical Training seminar will present two Ansoft application products: Ansoft HFSS and Ansoft Designer. Ansoft HFSS makes use of the Finite Element Method (FEM) to calculate field solutions from first principles. It can accurately predict all high-frequency behaviours such as dispersion, mode conversion, and losses due to materials and radiation. Ansoft Designer is a suite of design tools to fully integrate high-frequency, physics-based electromagnetic simulations into a seamless system-level simulation environment. Ansoft Designer uses a simple interface to give complete control over every design task, by a method allowing multiple solvers, Solver on Demand. • Introduction • Overview of the Ansoft Total solution • Ansoft HFSS 9...

  4. Tennis elbow surgery

    Science.gov (United States)

    Lateral epicondylitis - surgery; Lateral tendinosis - surgery; Lateral tennis elbow - surgery ... Surgery to repair tennis elbow is often an outpatient surgery. This means you will not stay in the hospital overnight. You will be given ...

  5. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more ... find out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment ...

  6. Mohs micrographic surgery

    Science.gov (United States)

    Skin cancer - Mohs surgery; Basal cell skin cancer - Mohs surgery; Squamous cell skin cancer - Mohs surgery ... Mohs surgery usually takes place in the doctor's office. The surgery is started early in the morning and is ...

  7. Credit with Education and Title II Programs. Technical Note. Food and Nutrition Technical Assistance.

    Science.gov (United States)

    Reid, Helen

    "Credit with Education" is a way to provide self-financing microfinance (or small-scale banking) to women, primarily in very poor rural areas, while at the same time providing education for business and family survival. Within the village banking environment, attempts to integrate education with village bank meetings have fallen into two…

  8. Masculinizing Top Surgery: A Systematic Review of Techniques and Outcomes.

    Science.gov (United States)

    Wilson, Stelios C; Morrison, Shane D; Anzai, Lavinia; Massie, Jonathan P; Poudrier, Grace; Motosko, Catherine C; Hazen, Alexes

    2018-02-02

    Chest wall masculinization by means of mastectomy is an important gender affirming surgery for transmasculine and non-binary patients. Limited data exist comparing commonly used techniques in masculinizing top surgery, and most are single institution studies. A systematic review was performed on primary literature dedicated specifically to the technical aspects and outcomes of mastectomy for masculinizing top surgery. For each study, patient demographics and surgical outcomes were compared. Eight studies met inclusion criteria. There were 2138 breasts with an average patient age of 28.6 years and the average breast weight was 353 g. The most commonly reported techniques are those without skin resection (8.0%), those with periareolar skin resection (34.1%), inferior pedicle mammoplasty (15.7%), and inframammary fold skin excision with free nipple grafting (FNG, 42.2%). In total, 6.0% of all breasts required acute reoperation for hematoma and 26.5% required secondary operations. Acute reoperation occurred significantly less often in the FNG cohort (4.8%) compared with both the inferior pedicle mammaplasty cohort (8.9%, P < 0.05) and techniques without skin resection cohort (10.3%, P < 0.05). Secondary operations occurred significantly more often in the periareolar skin resection cohort (37.5%) than techniques without skin resection cohort (19.0%, P < 0.01), inferior pedicle mammaplasty cohort (27.9%, P < 0.01), and FNG cohort (20.3%, P < 0.05). In addition, secondary operations occurred significantly more often in inferior pedicle mammaplasty cohort (27.9%) compared with FNG cohort (20.3%, P < 0.01). This analysis notes several significant differences with regard to percentage requiring acute reoperation and percentage requiring secondary revision based on technique. Candidates for masculinizing top surgery should be educated on these differences.

  9. Factors that affect scrub practitioner non-technical skills: A literature review.

    Science.gov (United States)

    McClelland, Guy

    2018-04-01

    Non-technical skills are the cognitive and interpersonal behaviours that compliment clinical competence in surgery. Effective use of non-technical skills is essential for scrub practice, because they facilitate anticipation of the surgeon's requirements and promote appropriate communication behaviours. This literature review analyses the factors that may influence a scrub practitioner's use of non-technical skills during surgery. Recommendations are made that are intended to improve their use by reducing behavioural variations during surgery.

  10. Note on the ABC Conjecture

    OpenAIRE

    Carella, N. A.

    2006-01-01

    This note imparts heuristic arguments and theorectical evidences that contradict the abc conjecture over the rational numbers. In addition, the rudimentary datails for transforming this problem into the doimain of equidistribution theory are provided.

  11. Lecture notes on quantum statistics

    NARCIS (Netherlands)

    Gill, R.D.

    2000-01-01

    These notes are meant to form the material for an introductory course on quantum statistics at the graduate level aimed at mathematical statisticians and probabilists No background in physics quantum or otherwise is required They are still far from complete

  12. Alcune Note di Analisi Matematica

    OpenAIRE

    Vasselli, Ezio

    2011-01-01

    Lectures notes (in italian) of some arguments of classical analysis, with exercises. A particular emphasis to functional analysis and elementary operator algebra theory is given, by means of exercises and examples.

  13. Orthognathic Surgery

    DEFF Research Database (Denmark)

    Kjærgaard Larsen, Marie; Thygesen, Torben Henrik

    2016-01-01

    The literature shows that the indications for orthognathic surgery (OS) are often functional problems and unsatisfactory facial esthetics. This study investigated the esthetic outcomes and overall satisfaction following OS. Somatosensory change is a relatively common complication and its influence...... on the level of satisfaction was studied. The social-networking web site Facebook was used to identify the study population. An online questionnaire was performed using the website SurveyMonkey. In all, 105 (9%) respondents from the Danish Facebook group about OS, called Kaebeoperation (jaw surgery), were...... in beauty than women (P = 0.030). Sixty-four percent replied that their attractiveness had been increased after OS. Eighty-six percent were happy with the results and 89% would recommend the surgery to others in need. No significant differences in esthetic results and satisfaction were seen with regard...

  14. TECHNICAL COORDINATION

    CERN Multimedia

    A. Ball

    Overview From a technical perspective, CMS has been in “beam operation” state since 6th November. The detector is fully closed with all components operational and the magnetic field is normally at the nominal 3.8T. The UXC cavern is normally closed with the radiation veto set. Access to UXC is now only possible during downtimes of LHC. Such accesses must be carefully planned, documented and carried out in agreement with CMS Technical Coordination, Experimental Area Management, LHC programme coordination and the CCC. Material flow in and out of UXC is now strictly controlled. Access to USC remains possible at any time, although, for safety reasons, it is necessary to register with the shift crew in the control room before going down.It is obligatory for all material leaving UXC to pass through the underground buffer zone for RP scanning, database entry and appropriate labeling for traceability. Technical coordination (notably Stephane Bally and Christoph Schaefer), the shift crew and run ...

  15. TECHNICAL COORDINATION

    CERN Multimedia

    A. Ball and W. Zeuner

    2011-01-01

    In this report we will review the main achievements of the Technical Stop and the progress of several centrally-managed projects to support CMS operation and maintenance and prepare the way for upgrades. Overview of the extended Technical Stop  The principal objectives of the extended Technical Stop affecting the detector itself were the installation of the TOTEM T1 telescopes on both ends, the readjustment of the alignment link-disk in YE-2, the replacement of the light-guide sleeves for all PMs of both HFs, and some repairs on TOTEM T2 and CASTOR. The most significant tasks were, however, concentrated on the supporting infrastructure. A detailed line-by-line leak search was performed in the C6F14 cooling system of the Tracker, followed by the installation of variable-frequency drives on the pump motors of the SS1 and SS2 tracker cooling plants to reduce pressure transients during start-up. In the electrical system, larger harmonic filters were installed in ...

  16. SAFETY INSTRUCTION AND SAFETY NOTE

    CERN Multimedia

    TIS Secretariat

    2002-01-01

    Please note that the SAFETY INSTRUCTION N0 49 (IS 49) and the SAFETY NOTE N0 28 (NS 28) entitled respectively 'AVOIDING CHEMICAL POLLUTION OF WATER' and 'CERN EXHIBITIONS - FIRE PRECAUTIONS' are available on the web at the following urls: http://edms.cern.ch/document/335814 and http://edms.cern.ch/document/335861 Paper copies can also be obtained from the TIS Divisional Secretariat, email: TIS.Secretariat@cern.ch

  17. Diagnostic pure transgastric NOTES in an intensive therapy unit patient

    Directory of Open Access Journals (Sweden)

    Maciej Michalik

    2011-06-01

    Full Text Available Natural orifice transluminal endoscopic surgery (NOTES is a natural consequence of evolution in minimally invasivesurgery. It allows one to reduce surgical trauma and the number of complications and to improve cosmetic outcomes.It also shortens the patient’s recovery time. So far there have been only nine NOTES procedures performed in Polandand around 200 NOTES interventions performed worldwide. In this paper a transgastric diagnostic NOTES procedurein a critically ill patient is described. A 60-year-old male patient with multi-organ failure (circulatory, respiratory andrenal insufficiency, with co-morbid hypothyroidism and diabetes mellitus hospitalized in the intensive therapy unit(ITU with unknown cause of his condition was qualified for transgastric diagnostic NOTES procedure. This interventionrevealed the diagnosis of metastatic neoplastic disease and allowed persistent therapy to be avoided. DiagnosticNOTES in selected patients seems to be a very useful. It provides fast diagnosis with relatively small perioperativetrauma. It is an easy procedure that requires a regular or operative endoscope, one surgeon and an endoscopic nurse.It can be done anywhere, including at the patient’s bedside. It provides specimens for histopathology and speeds updiagnostics and decision making, especially in terminally ill patients.

  18. Metabolic syndrome after laparoscopic bariatric surgery.

    Science.gov (United States)

    Nugent, Clare; Bai, Chunhong; Elariny, Hazem; Gopalakrishnan, Priya; Quigley, Caitlin; Garone, Michael; Afendy, Mariam; Chan, Oscar; Wheeler, Angela; Afendy, Arian; Younossi, Zobair M

    2008-10-01

    Metabolic syndrome (MS) is common among morbidly obese patients undergoing bariatric surgery. The aim of this study was to assess the impact and predictors of bariatric surgery on the resolution of MS. Subjects included 286 patients [age 44.0 +/- 11.5, female 78.2%, BMI 48.7 +/- 9.4, waist circumference 139 +/- 20 cm, AST 23.5 +/- 14.9, ALT 30.0 +/- 20.1, type 2 diabetes mellitus (DM) 30.1% and MS 39.2%] who underwent bariatric surgery. Of the entire cohort, 27.3% underwent malabsorptive surgery, 55.9% underwent restrictive surgery, and 16.8% had combination restrictive-malabsorptive surgery. Mean weight loss was 33.7 +/- 20.1 kg after restrictive surgery (follow up period 298 +/- 271 days), 39.4 +/- 22.9 kg after malabsorptive surgery (follow-up period 306 +/- 290 days), and 28.3 +/- 14.1 kg after combination surgery (follow-up period 281 +/- 239 days). Regardless of the type of bariatric surgery, significant improvements were noted in MS (p values from <0.0001-0.01) as well as its components such as DM (p values from <0.0001-0.0005), waist circumference (p values <0.0001), BMI (p values <0.0001), fasting serum triglycerides (p values <0.0001 to 0.001), and fasting serum glucose (p values <0.0001). Additionally, a significant improvement in AST/ALT ratio (p value = 0.0002) was noted in those undergoing restrictive surgery. Multivariate analysis showed that patients who underwent malabsorptive bariatric procedures experienced a significantly greater percent excess weight loss than patients who underwent restrictive procedures (p value = 0.0451). Percent excess weight loss increased with longer postoperative follow-up (p value <0.0001). Weight loss after bariatric surgery is associated with a significant improvement in MS and other metabolic factors.

  19. Intestinal Surgery.

    Science.gov (United States)

    Desrochers, André; Anderson, David E

    2016-11-01

    A wide variety of disorders affecting the intestinal tract in cattle may require surgery. Among those disorders the more common are: intestinal volvulus, jejunal hemorrhage syndrome and more recently the duodenal sigmoid flexure volvulus. Although general principles of intestinal surgery can be applied, cattle has anatomical and behavior particularities that must be known before invading the abdomen. This article focuses on surgical techniques used to optimize outcomes and discusses specific disorders of small intestine. Diagnoses and surgical techniques presented can be applied in field conditions. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Computer assisted radiology and surgery. CARS 2010

    International Nuclear Information System (INIS)

    Anon.

    2010-01-01

    The conference proceedings include contributions to the following topics: (1) CARS Clinical Day: minimally invasive spiral surgery, interventional radiology; (2) CARS - computer assisted radiology and surgery: ophthalmology, stimulation methods, new approaches to diagnosis and therapy; (3) Computer assisted radiology 24th International congress and exhibition: computer tomography and magnetic resonance, digital angiographic imaging, digital radiography, ultrasound, computer assisted radiation therapy, medical workstations, image processing and display; (4) 14th Annual conference of the International Society for computer aided surgery; ENT-CMF head and neck surgery computer-assisted neurosurgery, cardiovascular surgery, image guided liver surgery, abdominal and laparoscopic surgery, computer-assisted orthopedic surgery, image processing and visualization, surgical robotics and instrumentation, surgical modeling, simulation and education; (5) 28th International EuroPACS meeting: image distribution and integration strategies, planning and evaluation, telemedicine and standards, workflow and data flow in radiology; (6) 11th CARS/SPIE/EuroPACS joint workshop on surgical PACS and the digital operating, management and assessment of OR systems and integration; (7) 12th International workshop on computer-aided diagnosis: special session on breast CAD, special session on thoracic CAD, special session on abdominal brain, lumbar spine CAD; (8) 16th computed Maxillofacial imaging congress: computed maxillofacial imaging in dental implantology, orthodontics and dentofacial orthopedics; approaches to 3D maxillofacial imaging; surgical navigation; (9) 2nd EuroNOTES/CARS workshop on NOTES: an interdisciplinary challenge; (10) 2nd EPMA/CARS workshop on personalized medicine and ICT.; (11)poster sessions.

  1. Computer assisted radiology and surgery. CARS 2010

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    2010-06-15

    The conference proceedings include contributions to the following topics: (1) CARS Clinical Day: minimally invasive spiral surgery, interventional radiology; (2) CARS - computer assisted radiology and surgery: ophthalmology, stimulation methods, new approaches to diagnosis and therapy; (3) Computer assisted radiology 24th International congress and exhibition: computer tomography and magnetic resonance, digital angiographic imaging, digital radiography, ultrasound, computer assisted radiation therapy, medical workstations, image processing and display; (4) 14th Annual conference of the International Society for computer aided surgery; ENT-CMF head and neck surgery computer-assisted neurosurgery, cardiovascular surgery, image guided liver surgery, abdominal and laparoscopic surgery, computer-assisted orthopedic surgery, image processing and visualization, surgical robotics and instrumentation, surgical modeling, simulation and education; (5) 28th International EuroPACS meeting: image distribution and integration strategies, planning and evaluation, telemedicine and standards, workflow and data flow in radiology; (6) 11th CARS/SPIE/EuroPACS joint workshop on surgical PACS and the digital operating, management and assessment of OR systems and integration; (7) 12th International workshop on computer-aided diagnosis: special session on breast CAD, special session on thoracic CAD, special session on abdominal brain, lumbar spine CAD; (8) 16th computed Maxillofacial imaging congress: computed maxillofacial imaging in dental implantology, orthodontics and dentofacial orthopedics; approaches to 3D maxillofacial imaging; surgical navigation; (9) 2nd EuroNOTES/CARS workshop on NOTES: an interdisciplinary challenge; (10) 2nd EPMA/CARS workshop on personalized medicine and ICT.; (11)poster sessions.

  2. Robotic surgery in gynecology

    Directory of Open Access Journals (Sweden)

    Jean eBouquet De Jolinière

    2016-05-01

    Full Text Available Abstract Minimally invasive surgery (MIS can be considered as the greatest surgical innovation over the past thirty years. It revolutionized surgical practice with well-proven advantages over traditional open surgery: reduced surgical trauma and incision-related complications, such as surgical-site infections, postoperative pain and hernia, reduced hospital stay, and improved cosmetic outcome. Nonetheless, proficiency in MIS can be technically challenging as conventional laparoscopy is associated with several limitations as the two-dimensional (2D monitor reduction in-depth perception, camera instability, limited range of motion and steep learning curves. The surgeon has a low force feedback which allows simple gestures, respect for tissues and more effective treatment of complications.Since 1980s several computer sciences and robotics projects have been set up to overcome the difficulties encountered with conventional laparoscopy, to augment the surgeon's skills, achieve accuracy and high precision during complex surgery and facilitate widespread of MIS. Surgical instruments are guided by haptic interfaces that replicate and filter hand movements. Robotically assisted technology offers advantages that include improved three- dimensional stereoscopic vision, wristed instruments that improve dexterity, and tremor canceling software that improves surgical precision.

  3. GENERAL SURGERY

    African Journals Online (AJOL)

    surgery. Since the first laparoscopic treatment of hydatid disease was described in 1992,14 there has been a steady growth in reports of the laparoscopic treatment of hydatid cysts of liver. Although early reported laparoscopic treatment of liver hydatid disease was confined to simple drainage, more advanced laparoscopic ...

  4. GENERAL SURGERY

    African Journals Online (AJOL)

    Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town,. South Africa ... included all district, regional and tertiary hospitals in the nine provinces. Clinics and so-called ..... large contingency of senior general surgeons from countries such as Cuba, who have ...

  5. TRAUMA SURGERY

    African Journals Online (AJOL)

    meet the criteria for damage control surgery, and ligation of the AVC is a .... There were two vertebral body fractures, one penetrating brain injury from a gunshot wound to the head, one ... two hand fractures, three haemothoraces, one pelvic fracture, .... One patient with an intimal flap injury to his left common iliac artery ...

  6. GENERAL SURGERY

    African Journals Online (AJOL)

    Schwab , using a three-phase approach.5 In 1998, Moore et al. extended the concept and described the five-stage approach.6. The aim of damage control surgery is to prevent severely injured patients from developing the “lethal triad” of hypothermia, coagulopathy and worsening acidosis, as this confers a dismal prognosis ...

  7. Rodding Surgery

    Science.gov (United States)

    ... Physical activity prior to surgery,  Length of the operation; anesthesia issues,  Reason for the choice of rod,  Time in the hospital,  Length of recovery time at home,  Pain management including control of muscle spasms,  The rehabilitation plan. ...

  8. Technical Training: Technical Training Seminar

    CERN Multimedia

    2004-01-01

    Tuesday 30 March TECHNICAL TRAINING SEMINAR From 9:00 to 12:00 and from 13:00 to 16:00 hrs - Council Chamber, Salle B, Salle des Pas Perdus National Instruments (NI) on Tour 2004 Claudia Jüngel, Evrem Yarkin, Joel Clerc, Hervé Baour / NATIONAL INSTRUMENTS The special event NI on Tour 2004, run in Germany, Austria and Switzerland, will be at CERN on March 30. Technical seminars and free introductory courses will be offered all day long in the Council Chamber, Salle B, and Salle des Pas Perdus (buildings 61 and 503). Technical conferences: 09:00 - 12:00 Data acquisition systems on PCs. Industrial measurement and control techniques. 13:00 - 16:00 Advanced LabVIEW software and PXI instrumentation. Measuring instruments and system components for teststand automation. Introductory courses: 09:00 - 12:00 DIAdem: Data analysis and presentation 13:00 - 16:00 Data acquisition with LabVIEW Language: English and French Free special seminar. Registration is recommended with National Instruments Switzerland (please sp...

  9. Technical Training: Technical Training Seminar

    CERN Multimedia

    2004-01-01

    Tuesday 30 March TECHNICAL TRAINING SEMINAR From 9:00 to 12:00 and from 13:00 to 16:00 hrs - Council Chamber, Salle B, Salle des Pas Perdus National Instruments (NI) on Tour 2004 Claudia Jüngel, Evrem Yarkin, Joel Clerc, Hervé Baour / NATIONAL INSTRUMENTS The special event NI on Tour 2004, run in Germany, Austria and Switzerland, will be at CERN on March 30. Technical seminars and free introductory courses will be offered all day long in the Council Chamber, Salle B, and Salle des Pas Perdus (buildings 61 and 503). Technical conferences: 09:00 - 12:00 Data acquisition systems on PCs. Industrial measurement and control techniques. 13:00 - 16:00 Advanced LabVIEW software and PXI instrumentation. Measuring instruments and system components for teststand automation. Introductory courses: 09:00 - 12:00 DIAdem: Data analysis and presentation 13:00 - 16:00 Data acquisition with LabVIEW Language: English and French Free special seminar. Registration is recommended with National Instruments Swi...

  10. INDOT Technical Training Plan : [Technical Summary

    Science.gov (United States)

    2012-01-01

    A wide range of job classifications, increasing technical : performance expectations, licensing and certification requirements, : budget restrictions and frequent department : reorganization has made technical training of employees : more difficult, ...

  11. Carotid artery surgery

    Science.gov (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  12. TECHNICAL COORDINATION

    CERN Document Server

    A. Ball and W. Zeuner

    2013-01-01

    For the reporting period, the CMS common systems and infrastructure worked well, without failures that caused significant data losses. One more disconnection of the magnet cold box occurred in the shadow of interruptions in data taking, caused by a series of technical faults. The recognition during 2012 that re-connection can only safely be done at around 2 T implies a minimum magnet recovery time of 12 hours and raises serious concerns about the number of ramping cycles of the magnet these incidents cause. This has triggered studies of how to make the cryo-system of the magnet more robust against failures. The proton-proton run ended just before the end-of-year CERN closure, during which CASTOR was installed on the negative end of CMS and both ZDC calorimeters were installed in TAN absorbers the LHC tunnel, in preparation for the heavy-ion run. The installation of CASTOR was an excellent “engineering test” of procedures for working in an activated environment. Despite some technical pr...

  13. TECHNICAL COORDINATION

    CERN Multimedia

    Austin Ball

    Summary of progress since last CMS week. Ten years of construction work have been completed. CMS is closed, in very close to the ideal low luminosity configuration, and performed well in the first tests with LHC beam. Behind this encouraging news is the story of a summer of intense commitment by many teams (from the collaboration and 3 CERN departments) working together, against the clock and despite many minor setbacks, to ensure that the experiment was ready to play a leading role in the excitement of September 10. Following beampipe bakeout and refill with pure neon, a magnificent effort by the ECAL group and the pt 5 technical crew made it possible to install and commission all 4 ECAL endcap Dees before the end of August. In the shadow of this activity, the barrel and forward pixel trackers and part of the beam monitoring were installed within the vac tank. The pt 5 technical teams then succeeded in safely removing the 20t installation tables and their support blocks from beneath the already installed ...

  14. TECHNICAL COORDINATION

    CERN Multimedia

    A. Ball and W. Zeuner

    2011-01-01

      Operational experience 2011 CMS is approaching the end of a very successful year of operation. Proton- proton running ended in the late afternoon of 30th October with a stunning 5.73 fb–1 delivered by LHC, of which CMS recorded 5.22 fb–1. During heavy-ion operation, which continues until 7th December, both the accelerator and the CMS detector have also performed very well. Despite the encouraging overall reliability of technical operation, several infrastructure failures which occurred since the last Bulletin are worthy of mention, with one leading for the first time to significant data-loss. On 10th July, a CERN-wide power failure brought down essentially all services including the magnet, due to an MCS setting being left in “manual” after the recent technical stop, but there was no significant damage and the detector was operational before the LHC, despite a slow and tortuous recovery (one of several indications this year that there is room for improve...

  15. Note

    DEFF Research Database (Denmark)

    Kullman, Mikael; Campillo, Javier; Dahlquist, Erik

    2016-01-01

    Globally, more than 50% of all people are living in cities today. Enhancing sustainability and efficiency of urban energy systems is thus of high priority for global sustainable development. The European research project PLEEC (Planning for Energy Efficient Cities) focuses on technological...

  16. TECHNICAL COURSES

    CERN Multimedia

    Enseignement Technique; Technical Training; Monique Duval - Tel. 74924

    2000-01-01

    C++ for Particle Physicists By Paul KUNZ Please note that Paul Kunz will be giving his very popular and highly recommended C++ course again on 20 ­ 24 November. The course costs 200 CHF, and advance registration is required. People with CERN EDH accounts can apply electronically directly from the Web course description page : C++ for Particle Physicists Team Visitors should ask their Group Leader to send an e-mail to the DTO of EP Division, M. Burri, referring to the ‘C++ for Particle Physicists’ course and giving their name, CERN ID number, the Team account number to which the course fee should be charged, and VERY IMPORTANTLY an email address to which an invitation to the course can be sent.

  17. TECHNICAL COURSES

    CERN Multimedia

    Technical Training; Tel. 74924

    2000-01-01

    C++ for Particle Physicists By Paul KUNZ Please note that Paul Kunz will be giving his very popular and highly recommended C++ course again on 20 ­ 24 November. The course costs 200 CHF, and advance registration is required. People with CERN EDH accounts can apply electronically directly from the Web course description page : http://www.cern.ch/Training/ENSTEC/P9798/Software/cpppp_e.htm Team Visitors should ask their Group Leader to send an e-mail to the DTO of EP Division, M. Burri, referring to the ‘C++ for Particle Physicists’ course and giving their name, CERN ID number, the Team account number to which the course fee should be charged, and VERY IMPORTANTLY an email address to which an invitation to the course can be sent.

  18. Gaz de France. Operation note

    International Nuclear Information System (INIS)

    2003-01-01

    This note was published for the public at the occasion of the admission to Euronext's Eurolist of the existing shares that make the capital of Gaz de France company, the French gas utility. The note gives some informations about Gaz de France activity, and about its strategy of development in the European gas market. Then it describes the offer relative to the opening of Gaz de France capital. Some selected financial data and some precision about the risk factors and the management of the company complete the document. (J.S.)

  19. Metabolic Surgery

    DEFF Research Database (Denmark)

    Pareek, Manan; Schauer, Philip R; Kaplan, Lee M

    2018-01-01

    The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus. Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Randomized trials have recently shown...... the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity....... Moreover, observational data suggest that the reduction in cardiovascular risk factors translates to better patient outcomes. This review describes commonly used metabolic surgical procedures and their current indications and summarizes the evidence related to weight loss and glycemic outcomes. It further...

  20. Preparing for Surgery

    Science.gov (United States)

    ... Events Advocacy For Patients About ACOG Preparing for Surgery Home For Patients Search FAQs Preparing for Surgery ... Surgery FAQ080, August 2011 PDF Format Preparing for Surgery Gynecologic Problems What is the difference between outpatient ...

  1. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ...

  2. Corrective Jaw Surgery

    Science.gov (United States)

    ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ...

  3. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  4. Facial Cosmetic Surgery

    Science.gov (United States)

    ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  5. Heart bypass surgery

    Science.gov (United States)

    Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Bypass surgery - heart; CABG; Coronary artery bypass graft; Coronary artery bypass surgery; Coronary bypass surgery; Coronary artery disease - CABG; CAD - CABG; Angina - ...

  6. Customization of a tool to assess Danish surgeons´ non-technical skills in the operating room

    DEFF Research Database (Denmark)

    Spanager, Lene; Lyk-Jensen, Helle Teglgaard; Dieckmann, Peter

    2012-01-01

    Errors in surgery often stem from failure related to non-technical skills such as communication and teamwork. Tools for training and assessment of non-technical skills are needed to ensure safe surgery. The aim of this study was to customize the Non-Technical Skills for Surgeons (NOTSS) rating...

  7. Pure NOTES rectosigmoid resection: transgastric endoscopic IMA dissection and transanal rectal mobilization in animal models.

    Science.gov (United States)

    Park, Sun Jin; Lee, Kil Yeon; Choi, Sung Il; Kang, Byung Mo; Huh, Chang; Choi, Dong Hyun; Lee, Chang Kyun

    2013-07-01

    We report a pure natural orifice translumenal endoscopic surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and the Society of American Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) rectosigmoidectomy in animal models using transgastric endoscopic inferior mesenteric artery (IMA) dissection and transanal rectal mobilization. Ten live animals (2 pigs weighing 35-40 kg each and 8 dogs weighing 25-30 kg each) were used. A gastrotomy was made using a needle-knife puncture and the balloon dilatation technique or following the creation of a submucosal tunnel. A circular stapler shaft was transanally inserted up to the sigmoid colon for spatial orientation and traction of the mesocolon. The IMA was endoscopically dissected using a Coagrasper™ (Olympus, Tokyo, Japan) and then clipped. Endoscopic division of the sigmoid mesocolon was conducted laterally toward the marginal artery. Transanal full-thickness circumferential rectal and mesorectal dissections were performed, and a colorectal anastomosis was performed using a circular stapler with a single stapling technique. During the transanal approach, the gastrotomy was closed using four endoscopic clips. Endoscopic dissection of the IMA was successful in all cases, but minor bleedings occurred in 3 cases. The mean time from dissection and clipping to division of the IMA was 36.7 minutes (range, 25-45 minutes). The mean operation time was 180.5 minutes (range, 145-210 minutes). There were no intraoperative complications or hemodynamic instability. The mean length of the resected specimen was 11.2 cm (range, 9-17 cm). A pure NOTES approach to rectosigmoid resection using transgastric endoscopic IMA dissection is technically feasible in animal models.

  8. Technical presentation

    CERN Multimedia

    GS Department

    2010-01-01

    10 March 2010 DYNEOS 10:00 – 12:00 - Main Building, Room B, 61-1-009 Dyneos AG is active in the fields of photonics, laser and high-precision positioning. Our highly qualified engineer team has more than 30 years of experience in electro-optical solutions sales. The engineers are supported by a technical and administrative team. We are focused on the Swiss market and represent six suppliers (Coherent, PI Physik Instrumente, SIOS, Nanonics Imaging, APE, Ekspla) in order to give a qualified sales and service support to our customers. Our products are dedicated to the research field as well as to industry. In addition to standard catalog products, we offer custom designs to fulfill the specific needs of OEM customers or specific applications.

  9. Technical presentation

    CERN Document Server

    FP Department

    2009-01-01

    07 April 2009 Technical presentation by Leuze Electronics: 14.00 – 15.00, Main Building, Room 61-1-017 (Room A) Photoelectric sensors, data identification and transmission systems, image processing systems. We at Leuze Electronics are "the sensor people": we have been specialising in optoelectronic sensors and safety technology for accident prevention for over 40 years. Our dedicated staff are all highly customer oriented. Customers of Leuze Electronics can always rely on one thing – on us! •\tFounded in 1963 •\t740 employees •\t115 MEUR turnover •\t20 subsidiaries •\t3 production facilities in southern Germany Product groups: •\tPhotoelectric sensors •\tIdentification and measurements •\tSafety devices

  10. TECHNICAL COORDINATION

    CERN Multimedia

    A. Ball and W. Zeuner

    2010-01-01

    Overview Once again, the bulk of this article reviews the intense activity of a recently completed shutdown, which, although quite unforeseeable until a few weeks before it started, proved by its success that our often advertised capability to conduct major maintenance within a two month period is real. Although safely completed, on-time to remarkable precision, the activity was not without incident, and highlighted our dependence on many experienced, specialist teams and their precise choreography. Even after the yoke was safely closed, magnet re-commissioning and beampipe pumpdown showed new and thought-provoking behaviour. The struggle to maintain adequate technical resources will be a pre-occupation over the coming months, in parallel with the start of truly sustained operation, for which various procedures are still being put in place. Planning for future shutdowns must now become a high priority, with many working groups and task forces already in existence to prepare infrastructure improvements and to...

  11. Technical presentation

    CERN Document Server

    FI Department

    2008-01-01

    RADIOSPARES, the leading catalogue distributor of components (electronic, electrical, automation, etc.) and industrial supplies will be at CERN on Friday 3 October 2008 (Main Building, Room B, from 9.00 a.m. to 3.00 p.m.) to introduce its new 2008/2009 catalogue. This will be the opportunity for us to present our complete range of products in more detail: 400 000 part numbers available on our web site (Radiospares France, RS International, extended range of components from other manufacturers); our new services: quotations, search for products not included in the catalogue, SBP products (Small Batch Production: packaging in quantities adapted to customers’ requirements); partnership with our focus manufacturers; demonstration of the on-line purchasing tool implemented on our web site in conjunction with CERN. RADIOSPARES will be accompanied by representatives of FLUKE and TYCO ELECTRONICS, who will make presentations, demonstrate materials and answer any technical questio...

  12. Introduction-Pediatric epilepsy surgery techniques.

    Science.gov (United States)

    Rydenhag, Bertil; Cukiert, Arthur

    2017-04-01

    This supplement includes the proceedings from the Pediatric Epilepsy Surgery Techniques Meeting held in Gothenburg (July 4-5, 2014), which focused on presentations and discussions regarding specific surgical technical issues in pediatric epilepsy surgery. Pediatric epilepsy neurosurgeons from all over the world were present and active in very fruitful and live presentations and discussions. These articles represent a synopsis of the areas and subjects dealt with there. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

  13. Technical Training: Technical Training Seminar

    CERN Multimedia

    2004-01-01

    TECHNICAL TRAINING Monique Duval tel. 74924 technical.training@cern.ch Tuesday 3 February 2004 From 09:00 to 13:30 - Training Centre Auditorium - bldg. 593, room 11 USB (Universal Serial Bus) CYPRESS Seminar Claudia Colombini, Field Application Engineer CYPRESS ActiveComp Electronic GmbH D-85077 MANCHING, Germany As a pioneer in USB, CYPRESS sets the standard for cost-effective solutions without sacrificing functionality, performance or reliability. Having shipped over 200 million USB devices, Cypress is the undisputed market leader and demonstrates unmatched USB expertise. With the industry's broadest selection of USB solutions, Cypress has the right silicon, software and support for every USB application, from Low-speed to High-Speed and USB On-The-Go (OTG). 9:00 - 10:30 Overview of USB systems. USB CYPRESS product overview. Peripherals: Low Speed, Full Speed, High Speed (1.1 and 2.0). Hub Solutions, Embedded Host Solutions, On-The-Go (OTG) and wireless USB. USB Development Tools (first part) 10:30 -...

  14. Churchill on Stalin: A note.

    NARCIS (Netherlands)

    Ellman, M.J.

    2006-01-01

    The purpose of this note is to draw attention to two limitations of Churchill's war memoirs as a source of accurate information about Stalin, his views ans actions. they concern, first Stalin's alleged remarks in 1942 about collectivisation, and second Stalin's allleged response to Churchill's

  15. Lecture notes on ideal magnetohydrodynamics

    International Nuclear Information System (INIS)

    Goedbloed, J.P.

    1983-03-01

    Notes, prepared for a course of lectures held at the Instituto de Fisica, Universidade Estadual de Campinas, Brazil (June-August 1978). An extensive theoretical treatment of the behaviour of hot plasmas caught in equations and mathematical models is presented in 12 chapters

  16. Developing INDCs: a guidance note

    DEFF Research Database (Denmark)

    Bakkegaard, Riyong Kim; Bee, Skylar; Naswa, Prakriti

    needs and low capability, would need means of implementation (MoI) for adaptation and to take ambitious mitigation actions. Developing countries would include MoI needs in the context of mitigation and adaptation. The note explains briefly how countries can identify their unconditional contributions....

  17. A note on hypoplastic yielding

    OpenAIRE

    Nader, José Jorge

    2010-01-01

    This note discusses briefly the definition of yield surface in hypoplasticity in connection with the physical notion of yielding. The relation of yielding with the vanishing of the material time derivative of the stress tensor and the vanishing of the corotational stress rate is investigated.

  18. TECHNICAL COORDINATION

    CERN Multimedia

    A. Ball

    2011-01-01

    1 Operational experience 2011 1.1 Overview Starting on a positive note, it is encouraging that, for the period of this report, the operation of CMS and its entire infrastructure at Point 5 was remarkably stable and efficient. No luminosity was lost due to failures of common systems or infrastructure. The major faults were two failures of rack ventilation turbines, a leak in a water pump in the endcap circuit and the first fast dump of the magnet since underground commissioning. As the rack ventilation units have two turbines, these single turbine failures were tolerated until the next possible access. The water pump survived until the end of the fill after which the circuit was switched to a reserve pump (which in principle is also possible “on the fly”). A faulty position controller of a cryo-valve serving the cryo-power leads caused a spontaneous closure of the valve leading to the fast dump of the magnet. In this case, CMS was lucky once again, since the incident happened on the first ...

  19. Downsizing Technical Communication Staff: The Risk to Corporate Success.

    Science.gov (United States)

    Smudde, Peter M.

    1993-01-01

    Notes that companies responding to the struggling economy are downsizing staff, including technical communicators. Maintains that such cutbacks affect not only employee confidence and productivity but also product quality, customer satisfaction, and future sales. States that technical communicators' critical knowledge is an asset that companies…

  20. 75 FR 33989 - Export Administration Regulations: Technical Corrections

    Science.gov (United States)

    2010-06-16

    ... 0694-AE69 Export Administration Regulations: Technical Corrections AGENCY: Bureau of Industry and... section of Export Control Classification Number 2B001 and the other is in the Technical Note on Adjusted... language regarding certain performance criteria of turning machines covered by Export Control...

  1. Reducing surgery of volume for the pulmonary emphysema

    International Nuclear Information System (INIS)

    Ramirez, Juan Camilo

    1997-01-01

    The paper includes aspects as selection approaches, functional evaluation, imagenologic evaluation, cardiovascular evaluation, technical aspects and results among other topics related with the reducing surgery of volume of the pulmonary emphysema

  2. TECHNICAL COORDINATION

    CERN Multimedia

    Austin Ball

    2013-01-01

      Since the last report, much visible progress has been made, as the LS1 programme approaches the halfway point. From early October, technical and safety shift-crew have been present around the clock, allowing detectors to stay switched on overnight, ensuring that safety systems are operational and instructions for non-expert shift-crew are clear. LS1 progress Throughout the summer, whilst the solenoid vacuum tank and YB0 surfaces were accessible, an extensive installation programme took place to prepare for Tracker colder operation and the PLT installation, in 2014, the Phase 1 Pixel Tracker installation, in 2016–’17, and the HCAL Phase 1 upgrade completion, ending in LS2. This included pipework for N2 or dry air to flush the Tracker bulkhead region, many sensors to monitor temperature and dew point in the Tracker and its service channels, heating wires outside the Tracker cooling bundles, supports for the new vacuum-jacketed, concentric, CO2 Pixel cooling lines, the PLT cool...

  3. TECHNICAL COORDINATION

    CERN Multimedia

    A. Ball and W. Zeuner

    2012-01-01

      UXC + detectors As explained in detail in the November 2011 bulletin, the bellows unit at −18.5 m from the CMS interaction point was identified as a prime candidate for the regularly occurring pressure spikes which occasionally led to sustained severe background conditions in 2011, affecting dead time and data quality. Similar regions in LHC with vacuum instabilities were observed to be close to bellows, which radiography showed to have distorted RF-fingers — on removal, they proved to have been severely overheated. The plans for the Year-End Technical Stop were adapted to prioritise radiography of the bellows at 16 m to 18 m either end of CMS. Excellent work by the beam pipe, survey and heavy mechanical teams allowed the X-rays to be taken as planned on 20th December, showing that the bellow at −18.5m had an obvious non-conformity. The RF-fingers were found inside the end of the opposing flared pipe instead of outside. In addition, the overlap between fingers and...

  4. Surgery for achalasia: 1998.

    Science.gov (United States)

    Shiino, Y; Filipi, C J; Awad, Z T; Tomonaga, T; Marsh, R E

    1999-01-01

    Technical controversies abound regarding the surgical treatment of achalasia. To determine the value of a concomitant antireflux procedure, the best antireflux procedure, the correct length for gastric myotomy, the optimal surgical approach (thoracic or abdominal), and the equivalency of minimally invasive surgery, a literature review was carried out. The review is based on 23 articles on open transabdominal or transthoracic myotomy, 14 articles on laparoscopic myotomy, and four articles on thoracoscopic myotomy. Postoperative results of traditional open thoracic or transabdominal myotomy as determined by symptomatology were better with fundoplication than without fundoplication. The incidence of postoperative reflux as proved by pH monitoring was high in patients who had an open transabdominal myotomy without fundoplication. The type of antireflux procedure used and the length of gastric myotomy had little effect on results. The results of transthoracic Heller myotomy do not require a concomitant fundoplication. Laparoscopic and thoracoscopic myotomy had excellent results at short-term follow-up. A fundoplication must be added if the myotomy is performed transabdominally. A randomized prospective study is required to determine the best fundoplication and the extent of gastric myotomy. Although minimally invasive surgery for achalasia has excellent initial results, longer follow-up in a larger population of patients is needed.

  5. Reevaluation of needlescopic surgery.

    Science.gov (United States)

    Tagaya, Nobumi; Kubota, Keiichi

    2012-01-01

    Although the use of single-incision laparoscopic surgery (SILS) has spread rapidly, most procedures employ additional needlescopic instruments to ensure safety and shorten the operation time. Therefore, on the basis of results obtained in our department, the present study was conducted to reevaluate the current state of needlescopic surgery (NS) to improve the cosmetic results and postoperative quality of life of patients and to reduce cost and degree of stress on surgeons. Between May 1998 and February 2011, we performed NS in 202 patients. The diagnoses included gallbladder diseases in 151 patients, spontaneous pneumothorax in 11, thyroid tumor and axillary lymph node metastases in 10 patients each, splenic cyst and appendicitis in 4 patients each, idiopathic thrombocytopenic purpura and postoperative abdominal wall hernia in 3 patients each, primary aldosteronism and hepatic cyst in 2 patients each, and adhesional bowel obstruction and gastric stromal tumor in 1 patient each. Under general anesthesia, one 12-mm and tow or three 2- or 3-mm ports were introduced into the operative field. The specimen was retrieved via the 12-mm wound using a plastic bag. The operations were completed in all patients without the need to convert to an open procedure. In 8 (5.3%) of the 151 cholecystectomies, a change to 5-mm instruments was required. There were no perioperative complications. Pertinent technical points included avoidance of direct organ mobilization to minimize injury, rotation of the operating table and utilization of organ gravity to create a better operative field, minimum use of needlescope to ensure safe maneuvering, and improvement of the bi-hand technique. NS is a safe and feasible procedure that allows experienced surgeons to achieve minimally invasive surgery with low morbidity, without the need to convert to a conventional or open procedure.

  6. Notes on instrumentation and control

    CERN Document Server

    Roy, G J

    2013-01-01

    Notes on Instrumentation and Control presents topics on pressure (i.e., U-tube manometers and elastic type gauges), temperature (i.e. glass thermometer, bi-metallic strip thermometer, filled system thermometer, vapor pressure thermometer), level, and flow measuring devices. The book describes other miscellaneous instruments, signal transmitting devices, supply and control systems, and monitoring systems. The theory of automatic control and semi-conductor devices are also considered. Marine engineers will find the book useful.

  7. Notes on modeling and simulation

    Energy Technology Data Exchange (ETDEWEB)

    Redondo, Antonio [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2017-03-10

    These notes present a high-level overview of how modeling and simulation are carried out by practitioners. The discussion is of a general nature; no specific techniques are examined but the activities associated with all modeling and simulation approaches are briefly addressed. There is also a discussion of validation and verification and, at the end, a section on why modeling and simulation are useful.

  8. 30 Years of Robotic Surgery.

    Science.gov (United States)

    Leal Ghezzi, Tiago; Campos Corleta, Oly

    2016-10-01

    The idea of reproducing himself with the use of a mechanical robot structure has been in man's imagination in the last 3000 years. However, the use of robots in medicine has only 30 years of history. The application of robots in surgery originates from the need of modern man to achieve two goals: the telepresence and the performance of repetitive and accurate tasks. The first "robot surgeon" used on a human patient was the PUMA 200 in 1985. In the 1990s, scientists developed the concept of "master-slave" robot, which consisted of a robot with remote manipulators controlled by a surgeon at a surgical workstation. Despite the lack of force and tactile feedback, technical advantages of robotic surgery, such as 3D vision, stable and magnified image, EndoWrist instruments, physiologic tremor filtering, and motion scaling, have been considered fundamental to overcome many of the limitations of the laparoscopic surgery. Since the approval of the da Vinci(®) robot by international agencies, American, European, and Asian surgeons have proved its factibility and safety for the performance of many different robot-assisted surgeries. Comparative studies of robotic and laparoscopic surgical procedures in general surgery have shown similar results with regard to perioperative, oncological, and functional outcomes. However, higher costs and lack of haptic feedback represent the major limitations of current robotic technology to become the standard technique of minimally invasive surgery worldwide. Therefore, the future of robotic surgery involves cost reduction, development of new platforms and technologies, creation and validation of curriculum and virtual simulators, and conduction of randomized clinical trials to determine the best applications of robotics.

  9. Erro médico em cirurgia do aparelho digestivo: contribuição para o estudo das provas técnicas, periciais e documentais e suas implicações jurídicas Medical malpractice in digestive system surgeries: a contribution to the study of technical, expertise and documentary evidence and its legal implications

    Directory of Open Access Journals (Sweden)

    João Batista Opitz Jr.

    2007-03-01

    1996 to 2002 related solely to digestive system surgery. The practical importance of the subject for the medical-social evolution has been addressed in the first place. The points looked for in this research were: physician/patient relationship (even during the claim; the information about medical procedures and limitations to the patient and family; the technical/legal documentation attached to the case; the professional's education and specialization. The analysis was based exclusively on the documents attached to the case record, trying to find the breach of the physician/patient relationship and the existence of informed consent. An examination of the documentation attached to the defense by the parties or court request, was also done. RESULTS: In 93,34% of the cases rupture in the physician/patient relationship occurred. Informed consent was found in only 10%. In 85% no or incomplete medical records were found. In 79%, absence of physical examination, and the same in 59% in clinical evolution, was noted. In 80% the writing was illegible. No medical identification was found in 61%. Information about previous allergies were not asked in 89% of the patients. Surgical descriptions were illegible in 80% and too brief in 47%, and all of them had no citation of the defense arguments to the malpractice accusation. Regarding medical post-graduation status, 7% had medical residency, 13% were in course of residency program, 67% had specialization certificates and 13% had a master or phD degree. CONCLUSION: Among the preventive ways to avoid a civil action for damages due to medical malpractice, the main points are: good relationship between doctors and patients; the formulation of complete patient records, being legible, stamped, and signed and an informed consent. The professional's technical experience and background do not constitute a mitigating circumstance for fullfiling the action.

  10. Technical innovation and management

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Yang Cheol

    1982-08-15

    This book gives explanations of the conception of technical innovation, development plan in Korea, connection between technology and a growth factor in national income, problem of technical innovation in developing country, analysis on cooperation between a developed country and a developing country, evaluation and strategy of technical development in Korea, technical innovation of industry, management of technical industry, analysis of special condition in Korea.

  11. Technical innovation and management

    International Nuclear Information System (INIS)

    Yoon, Yang Cheol

    1982-08-01

    This book gives explanations of the conception of technical innovation, development plan in Korea, connection between technology and a growth factor in national income, problem of technical innovation in developing country, analysis on cooperation between a developed country and a developing country, evaluation and strategy of technical development in Korea, technical innovation of industry, management of technical industry, analysis of special condition in Korea.

  12. Critical concepts and important anatomic landmarks encountered during transanal total mesorectal excision (taTME): toward the mastery of a new operation for rectal cancer surgery.

    Science.gov (United States)

    Atallah, S; Albert, M; Monson, J R T

    2016-07-01

    Over the past 3 years, colorectal surgeons have begun to adapt the technique of transanal total mesorectal excision. As international experience has been quickly forged, an improved recognition of the pitfalls and the practical details of this disruptive technique have been realized. The purpose of this technical note was to express the various nuances of transanal total mesorectal excision as learned during the course of its clinical application and international teaching, so as to rapidly communicate and share important insights with other surgeons who are in the early adoption phase of this approach. The technical points specific to transanal total mesorectal excision are addressed herein. When correctly applied, these will likely improve the quality of surgery and decrease morbidity attributable to inexperience with the transanal approach to total mesorectal excision.

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

    Science.gov (United States)

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

    2016-01-01

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

  14. Total Vaginal NOTES Hysterectomy: A New Approach to Hysterectomy.

    Science.gov (United States)

    Baekelandt, Jan

    2015-01-01

    The aim of this study was to demonstrate the feasibility of a total hysterectomy performed entirely by transvaginal natural orifice transluminal endoscopic surgery (vNOTES). Conventional, reusable laparoscopic instruments were used, inserted through an inexpensive, self-constructed single-port device. Ten total vaginal NOTES hysterectomies (TVNHs) were performed by a single surgeon. The self-constructed single-port device was made by assembling a surgical glove, a wound protector or modified laryngeal mask airway, 1 reusable 10-mm trocar, and 4 reusable 5-mm trocars. This gloveport was inserted into the vagina to create a pneumovagina. The conventional steps of a vaginal hysterectomy were followed, but performed endoscopically with standard reusable endoscopic instruments. The patient and perioperative data were analyzed. No conversion to standard laparoscopy or laparotomy was necessary in any of the 10 patients who underwent a TVNH. Mean operation time was 97 min (range: 60-120); mean drop in hemoglobin level was 1.5 g/dL (range: 0.5-2.4). There were no operative complications, and postoperative pain scores were very low. This first report on a small number of patients demonstrates that TVNH is possible. By incorporating the advantages of endoscopic surgery, TVNH broadens the indications for vaginal hysterectomy and helps overcome its limitations. At the same time, the NOTES approach avoids abdominal wall wounds and trocar-related complications. TVNH is feasible, even when performed with reusable, conventional laparoscopic instruments. This frugally innovative technique also enables surgeons to perform hysterectomies by vNOTES in low resource settings. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  15. Notes on elementary particle physics

    CERN Document Server

    Muirhead, William Hugh

    1972-01-01

    Notes of Elementary Particle Physics is a seven-chapter text that conveys the ideas on the state of elementary particle physics. This book emerged from an introductory course of 30 lectures on the subject given to first-year graduate students at the University of Liverpool. The opening chapter deals with pertinent terminologies in elementary particle physics. The succeeding three chapters cover the concepts of transition amplitudes, probabilities, relativistic wave equations and fields, and the interaction amplitude. The discussion then shifts to tests of electromagnetic interactions, particul

  16. Technical Training: Places available

    CERN Multimedia

    Monique Duval

    2004-01-01

    The number of places available may vary. Please check our Web site to find out the current availability. Places are available in the following courses: Programmation STEP7 niveau 1 : 14-17.9.2004 (4 jours) ANSYS : Thermal Analysis : 22 - 24.9.2004 (3 days) LabVIEW Migration 6 à 7 : 23.9.2004 (one day) ANSYS : Advanced Topics : 27.9 - 1.10.2004 (5 days) Word 2003 - niveau 2 : 27 & 28.9.2004 (2 jours) LabVIEW - Basics 1 : 27 - 29.9.2004 (3 days) MAGNE-04 : Magnétisme pour l'électrotechnique : 28 - 30.9.2004 (3 jours) LabVIEW - Basics 2 : 30.9 & 1.10.2004 (2 days) Introduction à Windows XP au CERN : 4.10.2004 (matin) FrontPage 2003 - niveau 1 : 7 & 8.10.04 (2 jours) Outlook (short course I) : E-mail : 22.10.2004 (2 hours, morning) Outlook (short course II) : Calendar, Tasks and Notes: 22.10.2004 (2 hours, afternoon) Introduction à ANSYS : 23 - 26.11.2004 (4 jours) ENSEIGNEMENT TECHNIQUE TECHNICAL TRAINING Monique Duval 74924...

  17. Danish surgeons' views on minimally invasive surgery

    DEFF Research Database (Denmark)

    Edwards, Hellen; Jørgensen, Lars Nannestad

    2014-01-01

    BACKGROUND AND AIM: Advancements in minimally invasive surgery have led to increases in popularity of single-incision laparoscopic surgery (SILS) and natural orifice translumenal surgery (NOTES(®); American Society for Gastrointestinal Endoscopy [Oak Brook, IL] and Society of American...... Gastrointestinal and Endoscopic Surgeons [Los Angeles, CA]) due to their postulated benefits of better cosmesis, less pain, and quicker recovery. This questionnaire-based study investigated Danish surgeons' attitudes toward these new procedures. SUBJECTS AND METHODS: A 26-item questionnaire was developed...... and distributed electronically via e-mail to a total of 1253 members of The Danish Society of Surgeons and The Danish Society of Young Surgeons. RESULTS: In total, 352 (approximately 30%) surgeons completed the questionnaire, 54.4% were over 50 years of age, and 76.6% were men. When choosing surgery, the most...

  18. Tennis elbow surgery - discharge

    Science.gov (United States)

    ... epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... long as you are told. This helps ensure tennis elbow will not return. You may be prescribed a ...

  19. Lung surgery - discharge

    Science.gov (United States)

    ... Lung biopsy - discharge; Thoracoscopy - discharge; Video-assisted thoracoscopic surgery - discharge; VATS - discharge ... milk) for 2 weeks after video-assisted thoracoscopic surgery and 6 to 8 weeks after open surgery. ...

  20. Gastric Sleeve Surgery

    Science.gov (United States)

    ... Videos for Educators Search English Español Gastric Sleeve Surgery KidsHealth / For Teens / Gastric Sleeve Surgery What's in ... or buying healthy food ) Preparing for Gastric Sleeve Surgery Preparing for this major operation takes months of ...