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Sample records for surgical center occupies

  1. Surgical decompression for space-occupying hemispheric infarction

    NARCIS (Netherlands)

    Hofmeijer, J.

    2007-01-01

    Patients with a hemispheric infarct and massive space-occupying edema formation have a poor prognosis. Mortality rates of about 80% have been described, despite maximal medical therapy on an intensive care unit. The aim of the research presented in this thesis was to investigate the benefit of deco

  2. Quality of life after surgical decompression for space-occupying middle cerebral artery infarction: systematic review

    NARCIS (Netherlands)

    Middelaar, T. van; Nederkoorn, P.J.; Worp, H.B. van der; Stam, J.; Richard, E.

    2015-01-01

    BACKGROUND AND PURPOSE: In patients with space-occupying middle cerebral artery infarction, surgical decompression strongly reduces risk of death and increases the chance of a favorable outcome. This comes at the expense of an increase in the risk of survival with (moderately) severe disability. We

  3. An Open-Air Self-Managed Social Center Called Occupy

    Directory of Open Access Journals (Sweden)

    Sophie Toupin

    2013-10-01

    Full Text Available I propose the concept of squatting as a way of exploring and understanding the recent Occupy movement and other manifestations that have taken hold of a physical and virtual space. To do this, I focus on squatting as a protest tactic employed by social movements, to gather, create and transform private and public spaces in common spaces. I follow Miguel Martinez (2006 premise that squatting has been aimed at constructing liberating spaces for living, communicating, and criticizing the global city and confronting capitalism. Using such framework to analyse the Occupy movement helps bring to the forefront what appears to be a somewhat similar experience, this time however, not solely via the occupation of buildings, but also via the occupation of parks or squares. The act of reclaiming and decommodifying open ‘public’ spaces in an attempt to create autonomous experiments visible to and ‘experimentable’ by all seem to have brought much visibility, appeal and relative openness to and of the occupy movement. From there, I discuss the particularities with moments of squatting, particularly with the occupied social centers movement, and instances of occupy sites in North America to underline a number of hidden and visible characteristics and features these phenomena share. In North America, the concept of squatting, including the practice of occupied social centers, seems to have had much less prevalence and impact on social movements than in Europe, but the occupy movement seems to have opened up new repertoire of actions for both activist and non-activists a like.

  4. Surgical decompression for space-occupying cerebral infarction: outcomes at 3 years in the randomized HAMLET trial.

    Science.gov (United States)

    Geurts, Marjolein; van der Worp, H Bart; Kappelle, L Jaap; Amelink, G Johan; Algra, Ale; Hofmeijer, Jeannette

    2013-09-01

    We assessed whether the effects of surgical decompression for space-occupying hemispheric infarction, observed at 1 year, are sustained at 3 years. Patients with space-occupying hemispheric infarction, who were enrolled in the Hemicraniectomy After Middle cerebral artery infarction with Life-threatening Edema Trial within 4 days after stroke onset, were followed up at 3 years. Outcome measures included functional outcome (modified Rankin Scale), death, quality of life, and place of residence. Poor functional outcome was defined as modified Rankin Scale >3. Of 64 included patients, 32 were randomized to decompressive surgery and 32 to best medical treatment. Just as at 1 year, surgery had no effect on the risk of poor functional outcome at 3 years (absolute risk reduction, 1%; 95% confidence interval, -21 to 22), but it reduced case fatality (absolute risk reduction, 37%; 95% confidence interval, 14-60). Sixteen surgically treated patients and 8 controls lived at home (absolute risk reduction, 27%; 95% confidence interval, 4-50). Quality of life improved between 1 and 3 years in patients treated with surgery. In patients with space-occupying hemispheric infarction, the effects of decompressive surgery on case fatality and functional outcome observed at 1 year are sustained at 3 years. http://www.controlled-trials.com. Unique identifier: ISRCTN94237756.

  5. Surgicopathological classification of hepatic space-occupying lesions: A single-center experience with literature review

    Institute of Scientific and Technical Information of China (English)

    Wen-Ming Cong; Hui Dong; Lu Tan; Xu-Xu Sun; Meng-Chao Wu

    2011-01-01

    Accompanying rapid developments in hepatic surgery, the number of surgeries and identifications of histological types of primary hepatic space-occupying lesions (PHSOLs) have increased dramatically. This has led to many changes in the surgicopathological spectrum of PHSOLs, and has contributed to a theoretical basis for modern hepatic surgery and oncological pathology. Between 1982 and 2009 at the Eastern Hepatobiliary Surgery Hospital (EHBH) in Shanghai, 31 901 patients underwent surgery and were diagnosed as having a PHSOL. In this paper, we present an analysis of the PHSOL cases at the EHBH for this time period, along with results from a systematic literature review. We describe a surgicopathological spectrum comprising more than 100 types of PHSOLs that can be stratified into three types: tumor-like, benign, and malignant. We also stratified the PHSOLs into six subtypes derived from hepatocytes; cholangiocytes; vascular, lymphoid and hemopoietic tissues; muscular, fibrous and adipose tissues; neural and neuroendocrine tissues; and miscellaneous tissues. The present study provides a new classification system that can be used as a current reference for clinicians and pathologists to make correct diagnoses and differential diagnoses among various PHSOLs.

  6. Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial.

    Science.gov (United States)

    Hofmeijer, Jeannette; Kappelle, L Jaap; Algra, Ale; Amelink, G Johan; van Gijn, Jan; van der Worp, H Bart

    2009-04-01

    Patients with space-occupying hemispheric infarctions have a poor prognosis, with case fatality rates of up to 80%. In a pooled analysis of randomised trials, surgical decompression within 48 h of stroke onset reduced case fatality and improved functional outcome; however, the effect of surgery after longer intervals is unknown. The aim of HAMLET was to assess the effect of decompressive surgery within 4 days of the onset of symptoms in patients with space-occupying hemispheric infarction. Patients with space-occupying hemispheric infarction were randomly assigned within 4 days of stroke onset to surgical decompression or best medical treatment. The primary outcome measure was the modified Rankin scale (mRS) score at 1 year, which was dichotomised between good (0-3) and poor (4-6) outcome. Other outcome measures were the dichotomy of mRS score between 4 and 5, case fatality, quality of life, and symptoms of depression. Analysis was by intention to treat. This trial is registered, ISRCTN94237756. Between November, 2002, and October, 2007, 64 patients were included; 32 were randomly assigned to surgical decompression and 32 to best medical treatment. Surgical decompression had no effect on the primary outcome measure (absolute risk reduction [ARR] 0%, 95% CI -21 to 21) but did reduce case fatality (ARR 38%, 15 to 60). In a meta-analysis of patients in DECIMAL (DEcompressive Craniectomy In MALignant middle cerebral artery infarction), DESTINY (DEcompressive Surgery for the Treatment of malignant INfarction of the middle cerebral arterY), and HAMLET who were randomised within 48 h of stroke onset, surgical decompression reduced poor outcome (ARR 16%, -0.1 to 33) and case fatality (ARR 50%, 34 to 66). Surgical decompression reduces case fatality and poor outcome in patients with space-occupying infarctions who are treated within 48 h of stroke onset. There is no evidence that this operation improves functional outcome when it is delayed for up to 96 h after stroke onset

  7. Occupy Education

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    Dana Blanchard

    2013-05-01

    Full Text Available As I sit at my desk and begin to unpack my materials for the new school year, I come across the poster from the November 2nd General Strike in Oakland. The image is of protesters with signs and flags on top of container trucks silhouetted against the setting sun at the port of Oakland. It is an image that has come to represent the high point of the Occupy struggle in the Bay Area and served as inspiration for what has become possible in the struggle against the 1%.

  8. Treatment of Chlorinated Solvents in Groundwater Beneath an Occupied Building at the Young-Rainey STAR Center, Pinellas, FL

    Energy Technology Data Exchange (ETDEWEB)

    Daniel, Joe [Navarro Research and Engineering; Surovchak, Scott [Dept. of Energy (DOE), Legacy Management; Tabor, Charles [Navarro Research and Engineering

    2016-03-01

    Groundwater contamination, consisting of two dissolved-phase plumes originating from chlorinated solvent source areas, in the southeastern portion of the Young- Rainey Star Center (also known as the Pinellas County, Florida, Site) in Largo, Florida, has migrated beyond the property boundary, beneath the roadways, and beneath adjacent properties to the south and east. Groundwater contamination will persist as long as the onsite contaminant source remains. The origin of the contamination appears to be multiple long-term point sources beneath Building 100, a 4.5 ha (11 acre) building that housed manufacturing facilities during US DOE operations at the site. The site is now owned by Pinellas County, and most of the space inside the building is leased to private companies, so DOE chose not to conduct characterization or remediation through the floor of the building, instead choosing to conduct all work from outside the building. Injection of emulsified soybean oil and a microbial culture has been used at other areas of the site to accelerate naturally occurring bacterial processes that degrade groundwater contaminants to harmless compounds, and that same approach was chosen for this task. The technical approach consisted of installing horizontal wells from outside the building footprint, extending through and around the identified subsurface treatment areas, and terminating beneath the building. Two 107 m (350 ft) long wells, two 122 m (400 ft) long wells, and four 137 m (450 ft) long wells have been installed to intersect the inferred source areas and confirmed contaminant plumes beneath the building. DOE then injected emulsified vegetable oil and a microbial culture into the horizontal wells at each of several target areas beneath the building where the highest groundwater contaminant concentrations have been detected. The target areas are the northwest corner of the building between the old drum storage pad locations and monitoring well PIN12-S35B, the vicinity of

  9. [Surgical Center environment and its elements: implications for nursing care].

    Science.gov (United States)

    Silva, Denise Conceição; Alvim, Neide Aparecida Titonelli

    2010-01-01

    The purpose of this qualitative research was to characterize the elements that constitute the environment of the Surgical Center and to analyze its implications for dynamic of care and nursing care. Based on the Environmental Theory's principals. Participated twelve nurses from the Surgical Center of a College Hospital in Rio de Janeiro. Data were gathered through the creativity and sensitivity technique "Map-Speaker", semi-structered interviews and participant observation, and were analyzed by thematic categories. The results showed that care can happen directly and indirectly in favor of full client recovery, counting the environment that the integrate in purpose to maintain harmonic and balanced. The nurse interventions aim to maintain the environment in favorable conditions so that a higher standard of care can be promoted.

  10. NURSING ASSISTANCE FOR PATIENTS IN SURGICAL CENTER ADMISSION

    OpenAIRE

    Zulene Maria de Vasconcelos Varela; Enêde Andrade da Cruz

    2002-01-01

    We objectified in this study with qualitative handling, to analyze the nurse's care in the people'sadmission in Surgical Center, starting from this professional's assistematic observation, accomplishing thisprocedure. In the chosen institution, the space for admission is common to all the elements of the team, to thepeople's flow and customers, that stay close one of the other ones, generating erroneous interpretations in thecommunication, hindering of that the efective care. The nurse's conc...

  11. Partly occupied Wannier functions

    DEFF Research Database (Denmark)

    Thygesen, Kristian Sommer; Hansen, Lars Bruno; Jacobsen, Karsten Wedel

    2005-01-01

    We introduce a scheme for constructing partly occupied, maximally localized Wannier functions (WFs) for both molecular and periodic systems. Compared to the traditional occupied WFs the partly occupied WFs possess improved symmetry and localization properties achieved through a bonding-antibondin......We introduce a scheme for constructing partly occupied, maximally localized Wannier functions (WFs) for both molecular and periodic systems. Compared to the traditional occupied WFs the partly occupied WFs possess improved symmetry and localization properties achieved through a bonding...

  12. NURSING ASSISTANCE FOR PATIENTS IN SURGICAL CENTER ADMISSION

    Directory of Open Access Journals (Sweden)

    Zulene Maria de Vasconcelos Varela

    2002-06-01

    Full Text Available We objectified in this study with qualitative handling, to analyze the nurse's care in the people'sadmission in Surgical Center, starting from this professional's assistematic observation, accomplishing thisprocedure. In the chosen institution, the space for admission is common to all the elements of the team, to thepeople's flow and customers, that stay close one of the other ones, generating erroneous interpretations in thecommunication, hindering of that the efective care. The nurse's concern, in developing the admission, as ownprerogative and humanização was evident. The continuity of that procedure, it is hindered by the surgical team,for the patient's liberation, what is leaving out the care alternatives and generating dissatisfaction in theprofessionals.

  13. Comparison of CDE data in phacoemulsification between an open hospital-based ambulatory surgical center and a free-standing ambulatory surgical center

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    Ming Chen

    2010-11-01

    Full Text Available Ming Chen1, Mindy Chen21University of Hawaii, Honolulu, HI, USA; 2University of California, Irvine, CA, USAAbstract: Mean CDE (cumulative dissipated energy values were compared for an open hospital-based surgical center and a free-standing surgical center. The same model of phacoemulsifier (Alcon Infiniti Ozil was used. Mean CDE values showed that surgeons (individual private practice at the free-standing surgical center were more efficient than surgeons (individual private practice at the open hospital-based surgical center (mean CDE at the hospital-based surgical center 18.96 seconds [SD = 12.51]; mean CDE at the free-standing surgical center 13.2 seconds [SD = 9.5]. CDE can be used to monitor the efficiency of a cataract surgeon and surgical center in phacoemulsification. The CDE value may be used by institutions as one of the indicators for quality control and audit in phacoemulsification.Keywords: CDE (cumulative dissipated energy, open hospital-based ambulatory surgical center, free-standing surgical center, phacoemulsification 

  14. Stress Generators for employees of surgical nursing center

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    João Paulo Belini Jacques

    2015-03-01

    Full Text Available The aim of this study was to identify factors that contribute to stress among workers in a surgical center. Descriptive qualitative research, performed in a surgery center of a university hospital in the state of Paraná. Data were collected between the months of August and September 2013, through semi-structured interviews with 15 members of the nursing team. Applied if the thematic content analysis resulting in three categories: work overload; lack of planning, human resources, materials and equipment and confinement. It is concluded that nursing professionals have experienced work related stress factors of objective nature such as work overload, lack of activity planning, human resources and materials and equipment and living in a closed environment.

  15. Occupy and Education: Introduction

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    Joseph Entin

    2013-05-01

    Full Text Available We were inspired by Occupy Wall Street (OWS and the rapid spread of Occupy across the United States and beyond. The commune-like camp sites, the general assemblies and use of the people’s mic, the marches and demonstrations, the provocative refusal to issue demands, the proliferation of working groups and spokes councils, the creative explosion of revolutionary slogans and art, the direct condemnation of corporate finance and of the massive inequalities that structure our society, the “free university” teach-ins, the campaigns against foreclosure and debt—all these elements of Occupy gave us new hope that radical change might happen in our time.

  16. Construction in Occupied Spaces

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    Ward Andrew E.

    2017-06-01

    Full Text Available Conducting construction activities in occupied environments presents a great challenge due to the additional logistical requirements and the presence of the building occupants. The aim of this research is to gather and evaluate the means and methods to successfully plan, manage, and execute construction activities in occupied spaces in an effort to provide consolidated industry tools and strategies for maintaining a schedule and minimizing the impact on the occupants. The methodology of the research utilizes an exploratory approach to gather qualitative data. The data was collected through interviews with industry professionals to identify industry best practices. The semi-structured interviews provided a platform for the documents, lessons learned, and the techniques and strategies used for occupied construction by the construction industry. The information obtained in the interview process identified six themes that are critical to achieving and maintaining quality in occupied construction. These themes of the schedule, cost, customer satisfaction, planning, fire/life safety and utilities, and contractor management are reviewed in detail, and the paper discusses how to manage each element. The analysis and extracted management techniques, procedures and strategies can be used by the construction industry for future projects by focusing on the critical aspects of occupied construction and the manner in which to succeed with it.

  17. Construction in Occupied Spaces

    Science.gov (United States)

    Ward, Andrew E.; Azhar, Salman; Khalfan, Malik

    2017-06-01

    Conducting construction activities in occupied environments presents a great challenge due to the additional logistical requirements and the presence of the building occupants. The aim of this research is to gather and evaluate the means and methods to successfully plan, manage, and execute construction activities in occupied spaces in an effort to provide consolidated industry tools and strategies for maintaining a schedule and minimizing the impact on the occupants. The methodology of the research utilizes an exploratory approach to gather qualitative data. The data was collected through interviews with industry professionals to identify industry best practices. The semi-structured interviews provided a platform for the documents, lessons learned, and the techniques and strategies used for occupied construction by the construction industry. The information obtained in the interview process identified six themes that are critical to achieving and maintaining quality in occupied construction. These themes of the schedule, cost, customer satisfaction, planning, fire/life safety and utilities, and contractor management are reviewed in detail, and the paper discusses how to manage each element. The analysis and extracted management techniques, procedures and strategies can be used by the construction industry for future projects by focusing on the critical aspects of occupied construction and the manner in which to succeed with it.

  18. Occupy Wall Street

    DEFF Research Database (Denmark)

    Jensen, Michael J.; Bang, Henrik

    2013-01-01

    This article analyzes the political form of Occupy Wall Street on Twitter. Drawing on evidence contained within the profiles of over 50,000 Twitter users, political identities of participants are characterized using natural language processing. The results find evidence of a traditional oppositio......This article analyzes the political form of Occupy Wall Street on Twitter. Drawing on evidence contained within the profiles of over 50,000 Twitter users, political identities of participants are characterized using natural language processing. The results find evidence of a traditional...... oppositional social movement alongside a legitimizing countermovement, but also a new notion of political community as an ensemble of discursive practices that are endogenous to the constitution of political regimes from the “inside out.” These new political identities are bound by thin ties of political...

  19. Managing disorder of sexual development surgically: A single center experience

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    Jatinder Kumar

    2012-01-01

    Full Text Available Introduction: Ambiguous genitalia are a major cause of parental anxiety and create psychological and social problems to patient, if not managed properly. Here we present our experience in managing patients with ambiguous genitalia. Material and Methods: We retrospectively reviewed clinical records of all patients with ambiguous genitalia managed surgically at out institute between December 1989 and January 2011. Relevant history, clinical examination , investigations and surgical procedures performed were analyzed and results were evaluated in terms of anatomical, functional and psychosexual outcomes. Results: Female pseudohermaphroditism was the most common cause of genital ambiguity in our patients. Male and female genitoplasty was done according to gender of rearing, genital anatomy and parental choice. Twenty six patients (86.6% reported satisfactory cosmetic outcome and 22 (73.3% satisfactory functional outcome on long term follow-up. Among the 24 patients diagnosed as male pseudohermaphroditism 14 (82.3% patient have reported satisfactory cosmetic outcome and 13 (76.4% have reported satisfactory functional outcome. In patients with mixed gonadal dysgenesis and true hermaphroditism satisfactory cosmetic and functional outcome was seen in 70% patient. Conclusion: Managing patients of genital ambiguity according to gender of rearing, genital anatomy and parental choice carries good prognosis in terms of anatomical, functional and psychosexual outcome.

  20. The Alternative to Occupy?

    DEFF Research Database (Denmark)

    Husted, Emil; Hansen, Allan Dreyer

    2017-01-01

    In this paper, we compare the political anatomy of two distinct enactments of (leftist) radical politics: Occupy Wall Street, a large social movement in the United States, and The Alternative, a recently elected political party in Denmark. Based on Ernesto Laclau’s conceptualization of ‘the...... universal’ and ‘the particular’, we show how the institutionalization of radical politics (as carried out by The Alternative) entails a move from universality towards particularity. This move, however, comes with the risk of cutting off supporters who no longer feel represented by the project. We refer...

  1. The Alternative to Occupy

    DEFF Research Database (Denmark)

    Husted, Emil; Hansen, Allan Dreyer

    2017-01-01

    In this paper, we compare the political anatomy of two distinct enactments of (leftist) radical politics: Occupy Wall Street and The Alternative, a recently elected political party in Denmark. Departing from Ernesto Laclau’s conceptualization of ‘the universal’ and ‘the particular’, we show how...... the institutionalization of radical politics (as carried out by The Alternative) entails a move from universality towards particularity. This move, however, comes with the risk of cutting-off supporters who no longer feel represented by the project. We refer to this problem as ‘the problem of particularization...

  2. #Occupy IR: Exposing the Orthodoxy

    OpenAIRE

    Ivan Manokha; Mona Chalabi

    2012-01-01

    The #occupy IR/IPE initiative was created in response to the #occupy movement, whose own roots can be traced backed to the latest crisis of global finance. In this contribution, we link #occupy and the crisis in a different way. We argue that we must occupy IR/IPE because of the discipline’s failure to apprehend and acknowledge the crisis itself, just as the Occupy movement is calling for their overarching authorities to notice and help address the social and economic inequalities produced by...

  3. Poems from the Occupy Movement

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    Pam Annas

    2013-05-01

    Full Text Available From the beginning of the Occupy Movement, poetry has occupied a major supporting role.  Both the New York and Boston encampments immediately set up a library tent, and poetry readings were a regular part of the camp’s activities.

  4. [Perception of the organizational climate in the surgical center of a specialized hospital].

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    Spiri, W C

    1998-01-01

    The aim of this study is to identify how a new team of the surgical center staff in a specialized hospital perceive the organization climate. A qualitative approach was utilized. As a theoretical reference to measure the organization climate, we have used CHIAVENATO, that defines organization climate as the interior of an organization that influences its members behavior. The organization climate could be favourable, unfavourable or neutral. The speeches showed a favourable organization climate considering the adopted methodology.

  5. Body, stress and nursing: ethnography of an Intensive Care and Surgical Center

    OpenAIRE

    Martins, Maria das Graças Teles [UNIFESP; Castro, Odilon; Pereira,Pedro Paulo Gomes

    2013-01-01

    This text seeks to reflect on the concepts of stress among nurses that work in the Surgical and Intensive Care Centers of a teaching hospital in the State of Paraíba. Qualitative ethnographic research allowed us to perceive that when talking about stress, these professionals mentioned their bodies and bodily manifestations. The research undertaken allowed us to understand the intimate relationships between the body, stress and nursing.

  6. Optimal design of a novel remote center-of-motion mechanism for minimally invasive surgical robot

    Science.gov (United States)

    Sun, Jingyuan; Yan, Zhiyuan; Du, Zhijiang

    2017-06-01

    Surgical robot with a remote center-of-motion (RCM) plays an important role in minimally invasive surgery (MIS) field. To make the mechanism has high flexibility and meet the demand of movements during processing of operation, an optimized RCM mechanism is proposed in this paper. Then, the kinematic performance and workspace are analyzed. Finally, a new optimization objective function is built by using the condition number index and the workspace index.

  7. The cost of waste of consumable materials in a surgical center

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    Liliana Cristina de Castro

    2013-12-01

    Full Text Available OBJECTIVES: to identify the types, quantities and cost of the consumable materials sent, used, returned unopened and wasted in surgical operations; to classify the incidences of waste as avoidable or unavoidable losses, and to calculate the rate of waste of the consumable materials in the peri-operative period in the Surgical Center of a São Paulo university hospital. METHOD: a descriptive-exploratory case study with a quantitative approach. The convenience sample corresponded to 105 types of consumable materials sent for the 275 operations observed between February and May 2011. RESULTS: the items wasted most were surgical sutures, surgical cotton sutures, and gauze compresses. The total cost of the waste was R$ 709.84. The mean percentage of waste in the sample was 9.34%, of which 1.23% was avoidable and 8.14% unavoidable. CONCLUSION: the study evidenced that the effective management of material resources reduces the costs of the processes, and reduces waste.

  8. The impact of interhospital transfers on surgical quality metrics for academic medical centers.

    Science.gov (United States)

    Crippen, Cristina J; Hughes, Steven J; Chen, Sugong; Behrns, Kevin E

    2014-07-01

    The emergence of pay-for-performance systems pose a risk to an academic medical center's (AMC) mission to provide care for interhospital surgical transfer patients. This study examines quality metrics and resource consumption for a sample of these patients from the University Health System Consortium (UHC) and our Department of Surgery (DOS). Standard benchmarks, including mortality rate, length of stay (LOS), and cost, were used to evaluate the impact of interhospital surgical transfers versus direct admission (DA) patients from January 2010 to December 2012. For 1,423,893 patients, the case mix index for transfer patients was 38 per cent (UHC) and 21 per cent (DOS) greater than DA patients. Mortality rates were 5.70 per cent (UHC) and 6.93 per cent (DOS) in transferred patients compared with 1.79 per cent (UHC) and 2.93 per cent (DOS) for DA patients. Mean LOS for DA patients was 4 days shorter. Mean total costs for transferred patients were greater $13,613 (UHC) and $13,356 (DOS). Transfer patients have poorer outcomes and consume more resources than DA patients. Early recognition and transfer of complex surgical patients may improve patient rescue and decrease resource consumption. Surgeons at AMCs and in the community should develop collaborative programs that permit collective assessment and decision-making for complicated surgical patients.

  9. Surgery for gastrointestinal malignant melanoma:Experience from surgical training center

    Institute of Scientific and Technical Information of China (English)

    Thawatchai; Akaraviputh; Satida; Arunakul; Varut; Lohsiriwat; Cherdsak; Iramaneerat; Atthaphorn; Trakarnsanga

    2010-01-01

    AIM:To characterize clinical features,surgery,outcome,and survival of malignant melanoma(MM) of the gastrointestinal(GI) tract in a surgical training center in Bangkok,Thailand. METHODS:A retrospective review was performed for all patients with MM of the GI tract treated at our institution between 1997 and 2007. RESULTS:Fourteen patients had GI involvement either in a metastatic form or as a primary melanoma. Thirteen patients with sufficient data were reviewed. The median age of the patients was 66 years(r...

  10. Usefulness of Surgical Media Center as a Cataract Surgery Educational Tool

    Science.gov (United States)

    Ogawa, Tomoichiro; Shiba, Takuya; Tsuneoka, Hiroshi

    2016-01-01

    Purpose. This study retrospectively analyzed cataract surgeries to examine the usefulness of Surgical Media Center (SMC) (Abbott Medical Optics Inc.), a new cataract surgery recording device, for training of cataract surgery. Methods. We studied five hundred cataract surgeries conducted with a phacoemulsification system connected to the SMC. After surgery, the surgical procedures were reviewed, with changes in aspiration rate, vacuum level, and phaco power displayed as graphs superimposed on the surgical video. We examined whether use of SMC is able to demonstrate the differences in technique between experienced and trainee operators, to identify inappropriate phacoemulsification techniques from analyzing the graphs, and to elucidate the cause of intraoperative complications. Results. Significant differences in the time taken to reach maximum vacuum and the speed of increase in vacuum during irrigation and aspiration were observed between experienced and trainee operators. Analysis of the graphs displayed by SMC detected inappropriate phacoemulsification techniques mostly in cases operated by trainee operators. Conclusions. Using SMC, it was possible to capture details of cataract surgery objectively. This recording device allows surgeons to review cataract surgery techniques and identify the cause of intraoperative complication and is a useful education tool for cataract surgery. PMID:26881060

  11. Usefulness of Surgical Media Center as a Cataract Surgery Educational Tool

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    Tomoichiro Ogawa

    2016-01-01

    Full Text Available Purpose. This study retrospectively analyzed cataract surgeries to examine the usefulness of Surgical Media Center (SMC (Abbott Medical Optics Inc., a new cataract surgery recording device, for training of cataract surgery. Methods. We studied five hundred cataract surgeries conducted with a phacoemulsification system connected to the SMC. After surgery, the surgical procedures were reviewed, with changes in aspiration rate, vacuum level, and phaco power displayed as graphs superimposed on the surgical video. We examined whether use of SMC is able to demonstrate the differences in technique between experienced and trainee operators, to identify inappropriate phacoemulsification techniques from analyzing the graphs, and to elucidate the cause of intraoperative complications. Results. Significant differences in the time taken to reach maximum vacuum and the speed of increase in vacuum during irrigation and aspiration were observed between experienced and trainee operators. Analysis of the graphs displayed by SMC detected inappropriate phacoemulsification techniques mostly in cases operated by trainee operators. Conclusions. Using SMC, it was possible to capture details of cataract surgery objectively. This recording device allows surgeons to review cataract surgery techniques and identify the cause of intraoperative complication and is a useful education tool for cataract surgery.

  12. [Knowledge of nursing professionals of a surgical center regarding malignant hyperthermia].

    Science.gov (United States)

    Sousa, Cristina Silva; Cunha, Ana Lucia Mirancos

    2014-09-01

    The objective of this study was to assess the knowledge of the nursing professionals in a surgical center about malignant hyperther- mia.This is a descriptive exploratory study on malignant hyperthermia conducted with mid- and high-level nursing professionals in the surgical center of an institution located in the city of São Paulo, where the research was conducted between August and September 2013. Analysis of the data was descriptive and the average of the correct answers was compared using Student's t-test Among the 96 participants, the two items in which at least 70% of the team showed knowledge were: the definition of malignant hyperthermia and the professionals involved in the health care provided. With respect to all test items, 70% of nurses answered 50% correctly. The same percentage of mid-level professionals answered only 20% correctly.There was no statistically significant difference between the professional categories. This study revealed insufficient knowledge on the part of the nursing team about malignant hyperthermia.

  13. Surgical treatment of refractory epilepsy associated with space occupying lesions experience and review Tratamento cirúrgico da epilepsia refratária associada a lesões expansivas: experiência e revisão

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    Paulo Thadeu Brainer-Lima

    1996-09-01

    Full Text Available Surgery for space occupying lesions of the brain associated with intractable epilepsy represents a special problem because relief of the epilepsy is as much an operative goal as excision of the space occupying lesion itself. This study concerns 32 patients with space occupying lesions and intractable epilepsy who underwent excision of the lesion with acute intraoperative electrocorticography guided resection of the epileptogenic focus. Of the 32 patients, 16 formed a subgroup of gangliogliomas alone. The remaining were mixed lesions, predominantly benign. The duration of seizures in these patients ranged from 2 to 30 years, and the seizure frequency varied from 1 to 300 convulsions per month. The operative procedures included temporal corticectomy, amygdalo-hippocampectomy, and extratemporal corticectomies. Twenty nine patients were in Engel class I postoperatively, and three patients were in Engel class II. The findings with gangliogliomas are also considered in a separate group. This study strongly suggests that the operative procedure under electrocorticography guidance improves seizure outcome in space occuping lesions related intractable epilepsy.O tratamento cirúrgico das lesões que ocupam espaço (LOE do sistema nervoso associadas a epilepsia intratável representa um problema clínico especial, já que tanto o tratamento da lesão como o da epilepsia são relevantes. Estudaram-se 32 pacientes com LOEs que foram submetidos a lesionectomia com margens guiadas por eletrocorticografia. Destes, 16 possuíam gangliogliomas e os restantes lesões variadas, predominantemente benignas. A duração das crises nesses pacientes variou de 2 a 30 anos e a frequência das crises de 1 a 300 por mês. Os procedimentos cirúrgicos incluíram corticectomia temporal, amigdalo-hipocampectomia e corticectomias extra-temorais. Vinte e nove pacientes estvam em grau I de Engel pós-operatoriamente e 3 em grau II. Os achados em relação aos gangliogliomas

  14. #Occupy: Strategic Dilemmas, Lessons Learned?

    Directory of Open Access Journals (Sweden)

    David J. Bailey

    2012-03-01

    Full Text Available What is #Occupy? For William Connolly, it is ‘better described’ as ‘the 99% movement’ (Connolly, 2011. But even this is potentially too narrow as it refers only to those explicitly adopting the 99% slogan. In the UK, the ‘Uncut’ movement has arguably gained more traction. Outside of the Anglo-sphere, we witness the Spanish indignados , and the General Strikes in Greece, along with related demonstrations in Syntagma Square. There is, then, on the one hand a narrowly-defined #Occupy movement, and on the other hand a more broadly defined movement seeking to challenge – through popular mobilisation, direct action, and/or civil disobedience – the austerity measures that are being introduced in the wake of the post-2007 global economic crisis. In each case, we witness the strategy of occupation as a means of highlighting popular dissatisfaction; of presenting an illustration of the disruptive potential of the dissatisfied; and of prefiguring modes of social organisation preferable to those being opposed. If we focus too narrowly on the #Occupy movement as the form of mobilised, extra parliamentary, resistance to the current restructuring of advanced industrial democracies, then there is a risk that we lose sight of the broader movement of which this is a part.

  15. Analysis of Parallelogram Mechanism used to Preserve Remote Center of Motion for Surgical Telemanipulator

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    Trochimczuk R.

    2017-02-01

    Full Text Available This paper presents an analysis of a parallelogram mechanism commonly used to provide a kinematic remote center of motion in surgical telemanipulators. Selected types of parallel manipulator designs, encountered in commercial and laboratory-made designs described in the medical robotics literature, will serve as the research material. Among other things, computer simulations in the ANSYS 13.0 CAD/CAE software environment, employing the finite element method, will be used. The kinematics of the solution of manipulator with the parallelogram mechanism will be determined in order to provide a more complete description. These results will form the basis for the decision regarding the possibility of applying a parallelogram mechanism in an original prototype of a telemanipulator arm.

  16. Management role of surgical center nurses: perceptions by means of images

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    Camila Dalcól

    2016-06-01

    Full Text Available The objective of this study was to analyze the perceptions of surgical center nurses concerning their work environment and management role. Qualitative study conducted with 10 nurse supervisors in public and private hospitals, by means of individual projective interviews, from February to August 2013. The interviews were transcribed and submitted to content analysis. The results allowed analysis of the perceptions of nurses by means of images, such as: strategist, chameleon, conductor, flagship, owl head, and superhero. Regarding the environment, they described images associated with purposes and physical characteristics of the unit, highlighting it as the heart of the hospital. Regarding the management role, the images were associated with leadership, decision-making, adaptation, flexibility, teamwork and supervision. The results showed that nurses had a proactive but sometimes idealized view of their performance. It is of utmost importance that they reflect on their role and try to give their performance higher visibility.

  17. [Standardization of activities in an oncology surgical center according to nursing intervention classification].

    Science.gov (United States)

    Possari, João Francisco; Gaidzinski, Raquel Rapone; Fugulin, Fernanda Maria Togeiro; Lima, Antônio Fernandes Costa; Kurcgant, Paulina

    2013-06-01

    This study was undertaken in a surgical center specializing in oncology, and it aimed to identify nursing activities performed during the perioperative period and to classify and validate intervention activities according to the Nursing Interventions Classification (NIC). A survey of activities was conducted using records and by direct observation of nursing care across four shifts. Activities were classified as NIC nursing interventions using the cross-mapping technique. The list of interventions was validated by nursing professionals in workshops. Forty-nine interventions were identified: 34 of direct care and 15 of indirect care. Identifying nursing interventions facilitates measuring the time spent in their execution, which is a fundamental variable in the quantification and qualification of nurses' workloads.

  18. Analysis of Parallelogram Mechanism used to Preserve Remote Center of Motion for Surgical Telemanipulator

    Science.gov (United States)

    Trochimczuk, R.

    2017-02-01

    This paper presents an analysis of a parallelogram mechanism commonly used to provide a kinematic remote center of motion in surgical telemanipulators. Selected types of parallel manipulator designs, encountered in commercial and laboratory-made designs described in the medical robotics literature, will serve as the research material. Among other things, computer simulations in the ANSYS 13.0 CAD/CAE software environment, employing the finite element method, will be used. The kinematics of the solution of manipulator with the parallelogram mechanism will be determined in order to provide a more complete description. These results will form the basis for the decision regarding the possibility of applying a parallelogram mechanism in an original prototype of a telemanipulator arm.

  19. Use of the nursing intervention classification for identifying the workload of a nursing team in a surgical center

    OpenAIRE

    João Francisco Possari; Raquel Rapone Gaidzinski; Antônio Fernandes Costa Lima; Fernanda Maria Togeiro Fugulin; Tracy Heather Herdman

    2015-01-01

    Objective: to analyze the distribution of nursing professionals' workloads, according to the Nursing Intervention Classification (NIC), during the transoperative period at a surgical center specializing in oncology. Methods: this was an observational and descriptive cross-sectional study. The sample consisted of 11 nurses, 25 nursing technicians who performed a variety of roles within the operating room, 16 nursing technicians who worked with the surgical instrumentation and two nursing techn...

  20. Maximum surgical blood ordering schedule in a tertiary trauma center in northern India: A proposal

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    Arulselvi Subramanian

    2012-01-01

    Full Text Available Context: Over ordering of blood is a common practice in elective surgical practice. Considerable time and effort is spent on cross-matching for each patient undergoing a surgical procedure. Aims: The aim of this study was to compile and review the blood utilization for two key departments (Neurosurgery and Surgery in a level 1 trauma center. A secondary objective was to formulate a rational blood ordering practice for elective procedures for these departments. Materials and Methods: Analysis of prospectively compiled blood bank records of the patients undergoing elective surgical, neurosurgical procedures was carried out between April 2007 and March 2009. Indices such as the cross-matched/transfused ratio (C/T ratio, transfusion index and transfusion probability were calculated. The number of red cell units required for each procedure was calculated using the equation proposed by Nuttall et al, using preoperative hemoglobin and postoperative hemoglobin for each elective surgical procedure. Results: There were 252 surgery patients (age range: 2-80 years in the study. One thousand and eighty-eight units of blood were cross-matched, 432 were transfused (CT ratio 2.5. 44.0% patients did not require transfusion during entire hospital stay. Three (50% elective procedures had CT ratio >2.5and 4 (66.6% elective procedures had TI 2.5, with five of them exceeding 4. In procedures like spinal instrumentation the CT ratio was <2.5 and 10 (90.9% of elective procedures had TI <0.5. Conclusions: In this study 40% and 22% of cross-matched blood was being utilized for elective general surgery and neurosurgical procedures, respectively. The calculated required blood units for all elective Trauma surgery procedures were more than 2 units. The calculated required blood units were less than 0.5 units in four of the 11 neurosurgical procedures, and hence only one unit should be arranged for them. It is crucial for every institutional blood bank to formulate a blood

  1. SURVIVAL OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CATHETERS: AN EVALUATION OF SURGICAL AND NON-SURGICAL FACTORS (SINGLE CENTER STUDY

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    A. Keshvari

    2006-06-01

    Full Text Available Peritoneal dialysis is an established form of renal replacement therapy used in many patients with end-stage renal disease. The key to a successful chronic peritoneal dialysis is a permanent and safe access to the peritoneal cavity. This study was conducted in order to evaluate the catheter survival and its related factors in Imam Khomeini Hospital. A total of 80 catheters were inserted into 69 patients (52 men and 28 women with end-stage chronic renal failure during a period of 84 months. Retrospectively the correlation between catheter survival (overall and event free with demographic factors (sex and age, surgical factors (surgeons and surgical methods, nephrologic factors (the causes of peritoneal dialysis selection and the history of hemodialysis and peritonitis factors (the history and number of peritonitis has been evaluated. The mean age of the patients was 48.35 years (16 to 79 years. The overall survival of catheters or the probability of having a functioning catheter after one, two and three years was 53%, 41%, 22%, respectively. The event free survival of the catheter or the probability of having a functioning catheter without any problems after one year was 14%. It has been found out that among all factors in this study only history of hemodialysis had statistically significant effect on the overall survival of continuous ambulatory peritoneal dialysis catheter (P = 0.04. It seems that the overall survival of catheters is better when CAPD is started before any other attempts for hemodialysis.

  2. Perception of the nursing team of a Surgical Center regarding Hospital Accreditation at a University Hospital.

    Science.gov (United States)

    Fernandes, Hellen Maria de Lima Graf; Peniche, Aparecida de Cássia Giani

    2015-02-01

    Objective To analyze the perception of nursing teams at a surgical center regarding the process of hospital accreditation, in the evaluative aspects of structure, process, and result. Method The study takes a quantitative and exploratory-descriptive approach, carried out at a university hospital. Result The population consisted of 69 nursing professionals, and the data collection was performed in the months of January and February 2014 by way of a questionnaire, utilizing the Likert scale. The methodology used a Cronbach's Alpha equal to 0.812. In the comparison of the three aspects, the one with the highest favorability score was "result", with an average of 47.12 (dp±7.23), and the smallest was "structure," with an average of 40.70 (dp±5.19). Conclusion This situational diagnostic can assist in the restructuring of the vulnerable areas evaluated in these three aspects, mainly in the aspect of structure, with a goal of level 2 accreditation by the ONA (Brazilian's National Organization for Accreditation) defended by the Institution.

  3. Use of the nursing intervention classification for identifying the workload of a nursing team in a surgical center

    Directory of Open Access Journals (Sweden)

    João Francisco Possari

    2015-10-01

    Full Text Available Objective: to analyze the distribution of nursing professionals' workloads, according to the Nursing Intervention Classification (NIC, during the transoperative period at a surgical center specializing in oncology.Methods: this was an observational and descriptive cross-sectional study. The sample consisted of 11 nurses, 25 nursing technicians who performed a variety of roles within the operating room, 16 nursing technicians who worked with the surgical instrumentation and two nursing technicians from patient reception who worked in the surgical center during the transoperative period. An instrument was developed to collect data and the interventions were validated according to NIC taxonomy.Results: a total of 266 activities were identified and mapped into 49 nursing interventions, seven domains and 20 classes of the NIC. The most representative domains were Physiological-Complex (61.68% and Health System (22.12%, while the most frequent interventions were Surgical Care (30.62% and Documentation (11.47%, respectively. The productivity of the nursing team reached 95.34%.Conclusions: use of the Nursing Intervention Classification contributes towards the discussion regarding adequate, professional nursing staffing levels, because it shows the distribution of the work load.

  4. Evaluation of surgical complications after cochlear implantation in Fars center, south of Iran

    Directory of Open Access Journals (Sweden)

    2008-06-01

    Full Text Available Introduction: Cochlear implant, which used in patients with profound hearing loss, may followed by some major or minor complications. These complications depend on age of patient, kind of device, kind of incision, surgical technique and surgeon’s skill. Major complications mostly need surgical intervention for treatment and, may persist for long time. Minor complications need medical treatment and don’t need surgical intervention. Materials and Methods: In this descriptive study between 2004-2007, 100 patients subjected to cochlear implantation were evaluated for post operative complications. Results: Overall complication rate was 14%. We had 4 major complications, including 2 device failure, one misplaced electrode and one cases with major hematoma .These complications managed successfully by surgical intervention or reimplantation. Facial nerve damage or wound breakdown were not seen in these patients. Minor complications including small hematoma, edema, wound infection, dizziness were seen in 10 cases that managed medically. Conclusion: In the recent years complications of cochlear implantation are reduced with increasing surgeon’s skill, new surgical methods and development in device technology.  

  5. Surgical Residency Training at a University-Based Academic Medical Center.

    Science.gov (United States)

    Hoffman, Rebecca L; Morris, Jon B; Kelz, Rachel R

    2016-02-01

    The past two decades have been witness to some of the most dynamic changes that have occurred in surgical education in all of its history. Political policies, social revolution, and the competing priorities of a new generation of surgical trainees are defining the needs of modern training paradigms. Although the university-based academic program's tripartite mission of clinical service, research, and education has remained steadfast, the mechanisms for achieving success in this mission necessitate adaptation and innovation. The resource-rich learning environment and the unique challenges that face university-based programs contribute to its ability to generate the future leaders of the surgical workforce. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Efficacy of neoadjuvant therapy and surgical rescue for locally advanced hepatoblastomas: 10 year single-center experience and literature review

    Science.gov (United States)

    Ayllon Teran, Dolores; Gómez Beltran, Oscar; Ciria Bru, Rubén; Mateos González, Elena; Peña Rosa, María José; Luque Molina, Antonio; López Cillero, Pedro; Briceño Delgado, Javier

    2014-01-01

    AIM: To report our experience with long-term outcomes after multimodal management therapy. METHODS: An observational retrospective study was performed containing seven patients with hepatoblastoma (Hbl) treated in our institution, a tertiary referral center, from 2003 to 2011. Demographic, preoperative, surgical, and outcome variables were collected. A survival analysis and a review of the current literature related to combination neoadjuvant chemotherapy and surgical resection on Hbl were performed. RESULTS: The median age at surgery was 14.4 mo, with a male to female ratio of 4:3. Pretext staging at diagnosis was as follows: stage I, 4 cases; stage II, 2 patients; and stage III, 1 case. Mean pretreatment tumor volume was 735 cm3. Five out of seven patients received neoadjuvant chemotherapy according to SIOPEL-3 or SIOPEL-6 protocols. Tumor volume and alpha-fetoprotein levels significantly dropped after neoadjuvant therapy. Surgical procedures performed included hemihepatectomies, segmentectomies and atypical resection. All patients received chemotherapy after surgery. Median postoperative hospital stay was 8 d. All patients were alive and disease-free after a median follow-up period of 23 mo. With regards to the literature review, seventeen articles were found that were related to our search. CONCLUSION: Our series shows how multimodal management of Hbl, exhaustive control and a meticulous surgical approach leads to almost 100% complete resection with optimal postoperative results. PMID:25110441

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

    Science.gov (United States)

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

    2013-07-01

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

  8. Surgical approach for ulcerated locally advanced breast cancer. A single Center experience: a retrospective study.

    Science.gov (United States)

    Laforgia, Rita; Punzo, Clelia; Panebianco, Annunziata; Volpi, Annalisa; Minafra, Marina; Sederino, Maria Grazia

    2017-01-01

    The aim of our retrospective study is to analyze surgical possibilities for the extended LABC in those cases not suitable for a neoadjuvant chemotherapy step and to consider various reconstruction techniques. Between 2009 and 2015 we enrolled 11 patients, admitted to the Emergency Department, presenting ulcerated LABC that needed palliative surgical demolitive procedures because of bleeding and anemia and in which was necessary to use natural tissues transposition or synthetic substitutes for the reconstruction of the skin flaps. The mean follow up was 12 months. Mortality rate was 82% (9 patients); in 2 cases there was local relapse after 6 months; 9 months was the longest disease free survival. Thanks to multidisciplinary strategies LABC's surgical treatment improved results with a five-year survival rate between 30-40% and better quality of survival. Despite extended demolitive approach, there is still a 50% of death because of metastases. Our results confirm that musculocutaneous flap, skin anterior thigh grafts, bilayer matrix wound dressing are excellent reconstructive strategies in locally advanced ulcerated breast cancer after aggressive extended surgery even if palliative to improve patients' further survival. Our data also showed that those patients presenting medium level of malignancy as "luminal b" subtype (7 patients) if treated earlier with a radical surgical procedure would have better prognosis. Oncoplastic techniques, Ulcerated breast cancer.

  9. Impact of surgical delay on outcomes in elderly patients undergoing emergency surgery: A single center experience

    Institute of Scientific and Technical Information of China (English)

    Marc; Ong; Tan; Yu; Guang; Tan; Kok; Yang

    2015-01-01

    AIM: To determine predisposing factors leading to surgical delay in elderly patients with acute abdominal conditions and its impact on surgical outcomes.METHODS: A retrospective review of a total of 144 patients aged 60 years and older who had undergone emergency abdominal surgery between 2010 and 2013 at a regional general hospital was analysed. The operations analysed were limited to perforated or gangrenous viscus and strangulated hernia. Patient demographic features, time taken to obtain a computed tomography scan, time taken to surgery and the impact on postoperative morbidity and mortality were analysed.RESULTS: The mean age was 70.5 ± 9.1 years and median time taken to surgery was 9 h. The overall mortality and complication rates(Clavien Dindo 3 and above) were 9% and 13.1% respectively. Diabetes mellitus was a significant predisposing factor which had an impact on surgical delays. Delays in surgery more than 24 h led to higher complication rates at 38.9%(P = 0.003), with multivariate analysis confirming it as an independent factor. Delays in obtaining a computed tomography(CT) scan was also shown to result in higher complication rates(Clavien Dindo 3 and above).CONCLUSION: Delays in performing emergency surgery in elderly lead to higher complication rates. Obtaining CT scans early also may facilitate prompt diagnosis of certain abdominal emergencies where presentation is more equivocal and this may lead to improved surgical outcomes.

  10. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017.

    Science.gov (United States)

    Berríos-Torres, Sandra I; Umscheid, Craig A; Bratzler, Dale W; Leas, Brian; Stone, Erin C; Kelz, Rachel R; Reinke, Caroline E; Morgan, Sherry; Solomkin, Joseph S; Mazuski, John E; Dellinger, E Patchen; Itani, Kamal M F; Berbari, Elie F; Segreti, John; Parvizi, Javad; Blanchard, Joan; Allen, George; Kluytmans, Jan A J W; Donlan, Rodney; Schecter, William P

    2017-08-01

    The human and financial costs of treating surgical site infections (SSIs) are increasing. The number of surgical procedures performed in the United States continues to rise, and surgical patients are initially seen with increasingly complex comorbidities. It is estimated that approximately half of SSIs are deemed preventable using evidence-based strategies. To provide new and updated evidence-based recommendations for the prevention of SSI. A targeted systematic review of the literature was conducted in MEDLINE, EMBASE, CINAHL, and the Cochrane Library from 1998 through April 2014. A modified Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence and the strength of the resulting recommendation and to provide explicit links between them. Of 5759 titles and abstracts screened, 896 underwent full-text review by 2 independent reviewers. After exclusions, 170 studies were extracted into evidence tables, appraised, and synthesized. Before surgery, patients should shower or bathe (full body) with soap (antimicrobial or nonantimicrobial) or an antiseptic agent on at least the night before the operative day. Antimicrobial prophylaxis should be administered only when indicated based on published clinical practice guidelines and timed such that a bactericidal concentration of the agents is established in the serum and tissues when the incision is made. In cesarean section procedures, antimicrobial prophylaxis should be administered before skin incision. Skin preparation in the operating room should be performed using an alcohol-based agent unless contraindicated. For clean and clean-contaminated procedures, additional prophylactic antimicrobial agent doses should not be administered after the surgical incision is closed in the operating room, even in the presence of a drain. Topical antimicrobial agents should not be applied to the surgical incision. During surgery, glycemic control should be

  11. Diagnosis and surgical treatment of pancreatic endocrine tumors in 36 patients: a single-center report

    Institute of Scientific and Technical Information of China (English)

    LIU Hong; ZHANG Su-zhan; WU Yu-lian; FANG He-qing; LI Jiang-tao; SHENG Hong-wei; WANG Yong

    2007-01-01

    Background Pancreatic endocrine tumors (PETs) are rare and their surgical treatment is often debated. The purpose of this retrospective study was to analyze the diagnosis and surgical strategy of functioning and non-functioning PETs.Methods From May 1980 to March 2006, 36 patients with pancreatic endocrine tumors at the Second Affiliated Hospital of Zhejiang University were retrospectively studied.Results Among the 36 patients, 29 (81%) had functioning tumors, and 7 (19%) had nonfunctioning tumors. Ninety-two percent of insulinomas were benign, whereas 4 (57%) of nonfunctioning PETs were malignant. The size of functioning tumors was (2.3±0.3) cm, that of nonfunctioning tumors was less than (5.1±0.5) cm. The combination CT and transabdominal ultrasonography resulted in a diagnostic sensitivity of 84%. Thirty-three primary lesions were precisely located in 32 patients (89%). Atypical tumor resection was performed for 73% of functioning tumors, while typical pancreatectomy was performed for 6 (85%) of nonfunctioning tumors. Moreover, 5 liver resections and 1 lymph node dissection were performed. During the follow-up, fifteen complications occurred in 12 (36%) patients after operation. The 5-year survival rate for patients with benign tumors was 92% compared to 50% for those with malignant tumors. Surgical cure was achieved in 95% of patients with benign insulinomas.Conclusions Surgical strategy for PETs depends on the size and location of the tumor and the risk of malignancy. The optimal surgical procedure is key to prevent postoperative complication. Radical resection including initial and metastatic lesion may benefit patients with malignant PETs.

  12. Granulomatous hypophysitis: experience with eight surgical cases of a single center

    Institute of Scientific and Technical Information of China (English)

    Yan Xu; Lin Lou; TianHua Wang; YuanYuan Zhao; XueXiang Cai; Jie Ma; Gang Lu

    2016-01-01

    Background:Although primary hypophysitis is not uncommon,a granulomatous etiology of hypophysitis is relatively rare.Radiological and diagnostic characteristics of several isolated cases have been described to date.However,to the best of our knowledge,surgical treatment of eight cases of granulomatous hypophysitis confirmed by histopathology has not yet been reported.Methods:A retrospective study was performed to review cases of granulomatous hypophysitis from November 2003 to November 2013 in our neurosurgical department.Only eight out of 1345 operations were diagnosed with granulomatous hypophysitis.Results:The cohort included two men and six women.The most common manifestations reported were headache,fatigue and polyuria.All six female patients presented with either menstrual disorders or amenorrhea.Seven of eight patients suffered polyuria.Two patients suffered bitemporal hemianopsia.One was accompanied with eosinophilic granuloma of the skull.Prolactin levels were increased in six patients,four of them were noted to have thyroid axis imbalances,one was noted to be deficient in the gonadotropin axis and two were deficient in the adrenal axis.The lesion demonstrated homogenous enhancement and an abnormally thickened pituitary stalk.A histological diagnosis of granulomatous hypophysitis was established in all eight patients,who were treated surgically.Characteristic granulomas formed by epithelioid histiocytes and multinucleated giant cells were observed.Conclusions:Pure glucocorticoid therapy is less effective than surgical intervention and has not been recommended for the treatment of granulomatous hypophysitis.Although replacement therapy can relieve associated symptoms,we conclude surgical intervention,particularly minimally invasive surgery via a transsphenoidal approach,to be mandatory in establishing a diagnosis and reducing the size of the inflammatory mass.Adjuvant corticosteroids therapy is recommended.

  13. Surgical Management of Internal Pancreatic Fistula in Chronic Pancreatitis: A Single-Center Experience

    Directory of Open Access Journals (Sweden)

    Siarhei M Rashchynski

    2016-09-01

    Full Text Available Management of internal pancreatic fistula is challenging because it is a rare and uncommon complication of chronic pancreatitis. The aim of this study was to evaluate the efficiency of the different ways of diagnostics and treatment for internal pancreatic fistula. Material and methods The prospective analysis of surgical treatment of the internal pancreatic fistula among 39 patients was carried out. Patients’ data, diagnostic findings and surgical procedure were analyzed. The comparative estimation of surgical interventions was executed using questionnaire SF-36 v2тм. Results The results of the current study demonstrate good facilities of computed tomography, magnetic resonance cholangiopancreatography (92.3% for determination of internal pancreatic fistula. 28 patients underwent Frey’s procedure, 8 - cystopancreatojejunal anastomosis using Roux-en-Y loop, 3 - combination of Frey’s procedure and cystopancreatojejunal. Total morbidity and mortality was 12.8% and 2.6% respectively. We admitted significant improvement in comparison of life quality before and after operation (p<0.01. Conclusion Surgery remains an excellent and safe option for patients suffering from internal pancreatic fistula in chronic pancreatitis with significant improvement in their quality of life.

  14. Implications of Surgical Training on Operating Room Throughput at Wilford Hall Medical Center

    Science.gov (United States)

    2008-06-26

    its physician specialists, 85 percent of dental specialists, and a full spectrum of other training. The medical center’s fourth mission is clinical...dedicated to training dental officers of the three services in one facility. The medical center’s support of San Antonio’s emergency medicine structure...P. (2006). Resident teaching versus the operating room schedule: An independent observer- based study of 1558 cases. Anesthesia and Analgesia , 103

  15. What does it mean to occupy?

    Directory of Open Access Journals (Sweden)

    Tim Gilman-Sevcik

    2012-04-01

    Full Text Available What work does an occupation do? What affordances are provided by refusing to articulate a platform for redressing public grievances? The authors provide here a brief aesthetic contemplation of the Occupy movement.

  16. The digital evolution of occupy wall street.

    Science.gov (United States)

    Conover, Michael D; Ferrara, Emilio; Menczer, Filippo; Flammini, Alessandro

    2013-01-01

    We examine the temporal evolution of digital communication activity relating to the American anti-capitalist movement Occupy Wall Street. Using a high-volume sample from the microblogging site Twitter, we investigate changes in Occupy participant engagement, interests, and social connectivity over a fifteen month period starting three months prior to the movement's first protest action. The results of this analysis indicate that, on Twitter, the Occupy movement tended to elicit participation from a set of highly interconnected users with pre-existing interests in domestic politics and foreign social movements. These users, while highly vocal in the months immediately following the birth of the movement, appear to have lost interest in Occupy related communication over the remainder of the study period.

  17. The Digital Evolution of Occupy Wall Street

    CERN Document Server

    Conover, Michael D; Menczer, Filippo; Flammini, Alessandro

    2013-01-01

    We examine the temporal evolution of digital communication activity relating to the American anti-capitalist movement Occupy Wall Street. Using a high-volume sample from the microblogging site Twitter, we investigate changes in Occupy participant engagement, interests, and social connectivity over a fifteen month period starting three months prior to the movement's first protest action. The results of this analysis indicate that, on Twitter, the Occupy movement tended to elicit participation from a set of highly interconnected users with pre-existing interests in domestic politics and foreign social movements. These users, while highly vocal in the months immediately following the birth of the movement, appear to have lost interest in Occupy related communication over the remainder of the study period.

  18. [Analysis of teaching of the discipline Nursing in Surgical Center in schools of São Paulo].

    Science.gov (United States)

    Leite, Aline Suelem; Turrini, Ruth Natalia Teresa

    2014-01-01

    The study aimed to characterize the teaching of Nursing in Surgical Center in relation to work load, content and specific curriculum component; and to identify the perspectives and experiences of teachers in teaching this content. This is a descriptive study of quantitative and qualitative approach, that used a semi structured instrument for data collection, with questions related to teaching discipline, sent by email to the coordinators of the courses of Bachelor of Nursing from 219 schools in the state of São Paulo, registered in the website of the Brazilian Ministry of Education. Of the 52 respondents, 90.4% were from private schools, mostly located in the interior of the state (71.1%). From the total of courses, 53.8% ministered the content surgical center within another discipline. The median of content hours was of 64h (40-300h). The respondents commented on the extensive content for a small work load, both practical and theoretical, and its importance for the formation of the generalist nurse.

  19. Surgical management of gastric gastrointestinal stromal tumor: A single center experience

    Directory of Open Access Journals (Sweden)

    Ehab El-Hanafy

    2011-01-01

    Full Text Available Background/Aim: Gastrointestinal stromal tumors (GISTs are the most common mesenchymal tumors of the gastrointestinal tract. Surgery remains the mainstay of curative treatment. Our objective is to evaluate the outcome of surgical treatment of primary gastric GIST. Materials and Methods: Between January 1997 and April 2008, thirty seven consecutive patients underwent resection for GISTs (35 patients with primary gastric GISTs and two patients with intestinal GISTs who were excluded from the study. These patients underwent upper endoscopy ± biopsy, barium meal and abdominal CT scan. Patients′ demographics and clinical presentations were analyzed. Perioperative parameters measured included operative times, estimated blood loss, intraoperative finding, surgical techniques, morbidity and length of hospitalization. Recurrence and survival were also analyzed. Results: Of the 35 patients with gastric GISTs included in the study, 63% were female. The median age was 59 ± 14 years (range, 23 to 75 years. The primary presenting symptoms were bleeding and dyspepsia; 43% of these tumors were located mainly in the body of the stomach. Tumor size was < 10 cm in 80% of the patients. The average tumor size was 6.3 ±3.2 cm (range from 3 to 13 cm. Regarding the surgical management, 20 patients (57% underwent gastric wedge resection, eight patients (23% underwent partial gastrectomy and the remaining seven patients (20% underwent total gastrectomy. Radical resections were found in 32 patients (91.5% while palliative resections were found in three patients (8.5%. The resected lymph nodes were negative in 32 patients (91.5%. Recurrence was noted in three patients, with a median time to recurrence of 14.3 months (range, 7 to 28 months. The three- and five-years survival in patients who underwent wedge resection was 92% and 81%, respectively, where it was 95% and 87%, respectively, in patients who underwent gastrectomy (either partial or total. There were no major

  20. The effect of night extension orthoses following surgical release of Dupuytren contracture: a single-center, randomized, controlled trial.

    Science.gov (United States)

    Collis, Julie; Collocott, Shirley; Hing, Wayne; Kelly, Edel

    2013-07-01

    To clarify the efficacy and detrimental effects of orthoses used to maintain finger extension following surgical release of Dupuytren contracture. We conducted a single-center, randomized, controlled trial to investigate the effect of night extension orthoses on finger range of motion and hand function for 3 months following surgical release of Dupuytren contracture. We also wanted to determine how well finger extension was maintained in the total sample. We randomized 56 patients to receive a night extension orthosis plus hand therapy (n = 26) or hand therapy alone (n = 30). The primary outcome was total active extension of the operated fingers (°). Secondary outcomes were total active flexion of the operated fingers (°), active distal palmar crease (cm), grip strength (kg), and self-reported hand function using the Disabilities of the Arm, Shoulder, and Hand questionnaire (0-100 scale). There were no statistically significant differences between the no-orthosis and orthosis groups for total active extension or for any of the secondary outcomes. Between the first postoperative measure and 3 months after surgery, 62% of little fingers had maintained or improved total active extension. The use of a night extension orthosis in combination with standard hand therapy has no greater effect on maintaining finger extension than hand therapy alone in the 3 months following surgical release of Dupuytren contracture. Our results indicate that the practice of providing every patient with a night extension orthosis following surgical release of Dupuytren contracture may not be justified except for cases in which extension loss occurs after surgery. Our results also challenge clinicians to research ways of maintaining finger extension in a greater number of patients. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  1. Robot-assisted cardiac surgery using the da vinci surgical system: a single center experience.

    Science.gov (United States)

    Kim, Eung Re; Lim, Cheong; Kim, Dong Jin; Kim, Jun Sung; Park, Kay Hyun

    2015-04-01

    We report our initial experiences of robot-assisted cardiac surgery using the da Vinci Surgical System. Between February 2010 and March 2014, 50 consecutive patients underwent minimally invasive robot-assisted cardiac surgery. Robot-assisted cardiac surgery was employed in two cases of minimally invasive direct coronary artery bypass, 17 cases of mitral valve repair, 10 cases of cardiac myxoma removal, 20 cases of atrial septal defect repair, and one isolated CryoMaze procedure. Average cardiopulmonary bypass time and average aorta cross-clamping time were 194.8±48.6 minutes and 126.1±22.6 minutes in mitral valve repair operations and 132.0±32.0 minutes and 76.1±23.1 minutes in myxoma removal operations, respectively. During atrial septal defect closure operations, the average cardiopulmonary bypass time was 128.3±43.1 minutes. The median length of stay was between five and seven days. The only complication was that one patient needed reoperation to address bleeding. There were no hospital mortalities. Robot-assisted cardiac surgery is safe and effective for mitral valve repair, atrial septal defect closure, and cardiac myxoma removal surgery. Reducing operative time depends heavily on the experience of the entire robotic surgical team.

  2. Complication rate of posterior capsule rupture with vitreous loss during phacoemulsification at a Hawaiian cataract surgical center: a clinical audit

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    Chen M

    2014-02-01

    Full Text Available Ming Chen,1 Kara C LaMattina,2 Thomas Patrianakos,2 Surendar Dwarakanathan2 1Department of Surgery, Division of Ophthalmology, University of Hawaii, Honolulu, HI, USA; 2Division of Ophthalmology, John H Stroger, Jr Hospital of Cook County, Chicago, IL, USA Purpose: To compare the complication rate of posterior capsule rupture (PCR with vitreous loss during phacoemulsification at an ambulatory surgical center with published results as a clinical audit for quality control. Methods: A retrospective chart review of 3,339 consecutive patients who underwent routine phacoemulsification by four experienced private practice surgeons from January 1, 2011 to June 30, 2012 at The Surgical Suites, Honolulu, HI, USA. All cases with PCR and vitreous loss were identified and selected for the study. Risk factors of this complication were further examined. Data were sent to John H Stroger Jr Hospital of Cook County, Division of Ophthalmology, for literature review, analysis, and write-up. Results: Twenty-three of the 3,339 cases incurred PCR and vitreous loss during phacoemulsification, for an incidence rate of 0.68%. Miosis, shallow chamber, restlessness, pseudoexfoliation syndrome, floppy iris syndrome, and zonulopathy were the main causes. In addition, surgeon volume (number of cases was inversely correlated with PCR. Conclusion: The rate of PCR with vitreous loss during phacoemulsification in this study may be lower than other published results done at academic centers. However, there was no compatible study available for comparison, as existing studies performed at academic centers included resident cases. This study identified risk factors for PCR/vitreous loss both preoperatively and postoperatively that may assist in application of preventive measures to decrease rates of PCR/vitreous loss. Keywords: phacoemulsification complications, posterior capsule rupture, vitreous loss, vitrectomy, miosis, pseudoexfoliation, floppy iris syndrome, zonulopathy

  3. Surgical analysis of pediatric and adolescent sporadic pheochromocytoma: single center experience.

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    Osman, Yasser; Hussein, Naser; Sarhan, Osama; Shorrab, Ahmed A; Dawaba, Mohamed; Ghoneim, Mohamed A

    2011-12-01

    The aim of this study is to review our experience with sporadic pheochromocytoma in pediatrics and adolescents focusing upon surgical approach, incidence of malignancy, and recurrence rate. Between 1990 and 2007, 8 pediatric patients were diagnosed with sporadic pheochromocytoma. Demographic data, clinical and radiological findings, laboratory profile, preoperative preparation, surgical approach, operative findings, postoperative course as well as pathologic diagnosis of the removed specimen were reviewed. Mean age of presentation was 13.1 ± 4.7 years. Five patients had right-sided masses, 1 harbored left-sided mass, and bilaterality was observed in 2 with mean size of 5.7 ± 1.3 cm. Computed tomography showed no evidence of local infiltration, regional lymphadenopathy or distant metastasis in all patients but two. Six masses were excised through thoraco-abdominal approach, 3 were removed laparoscopically, while percutaneous alcohol ablation was adopted for the last. We had one postoperative death (12.5%:1/8), and the remaining 7 patients were followed for a mean of 8.6 ± 3 years. Five patients never had recurrence. Bilateral recurrence developed in 2 patients, where they were safely excised in one patient and was a part of disseminated disease in the other. Malignant nature of the disease was proved in 2 patients and showed poor survival. Under adequate anesthetic control, pediatric pheochromocytoma could be safely managed through both the open and laparoscopic approaches. Advanced radiological stage would suggest the malignant nature of the disease with dismal outcome. Long-term follow-up is warranted for possibility of delayed curable recurrence.

  4. Vagal nerve stimulation for refractory epilepsy: the surgical procedure and complications in 100 implantations by a single medical center.

    Science.gov (United States)

    Horowitz, Gilad; Amit, Moran; Fried, Itzhak; Neufeld, Miri Y; Sharf, Liad; Kramer, Uri; Fliss, Dan M

    2013-01-01

    In 1997, the US Food and Drug Administration approved the use of intermittent stimulation of the left vagal nerve as adjunctive therapy for seizure control. Vagal nerve stimulation (VNS) has since been considered a safe and effective treatment for medically intractable seizures. The objective of this study is to present our experience with the surgical procedure and outcomes after VNS insertion in the first 100 consecutive patients treated at the Tel-Aviv "Sourasky" Medical Center (TASMC). All patients who underwent VNS device implantation by the authors at TASMC between 2005 and 2011 were studied. The collected data included age at onset of epilepsy, seizure type, duration of epilepsy, age at VNS device implantation, seizure reduction, surgical complications, and adverse effects of VNS over time. Fifty-three males and 47 females, age 21.2 ± 11.1 years, underwent VNS implantation. Indications for surgery were medically refractory epilepsy. The most common seizure type was focal (55 patients, 55 %). Seizure duration until implantation was 14.4 ± 9 years. Mean follow-up time after device insertion was 24.5 ± 22 months. Complications were encountered in 12 patients. The most common complication was local infection (6 patients, 6 %). Six devices were removed-four due to infection and two due to loss of clinical effect. Currently, 63 patients remain in active long-term follow-up; of these, 35 patients have >50 % reduction in frequency of attacks.VNS is a well-tolerated and effective therapeutic alternative in the management of medically refractory epilepsy. The surgical procedure is safe and has a low complication rate.

  5. Musculo-skeletal tumors incidence and surgical treatment - A single center 5-year retrospective.

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    Patrascu, J M; Vermesan, D; Mioc, M L; Lazureanu, V; Florescu, S; Tarullo, A; Tatullo, M; Abbinante, A; Caprio, M; Cagiano, R; Haragus, H

    2014-01-01

    Muscle-skeletal tumors represent a challenging pathology for orthopedic surgeons worldwide. The extremely invasive character, the local destruction, the high recurrence rate, the high incidence in young patients and the unfavorable prognosis are all very well known. For these patients it is very important to produce an accelerated functional, social and psychological postoperative rehabilitation. We studied 121 cases of muscle-skeletal tumors which were treated in our hospital over a 5 years period. We noticed a high prevalence in males and mainly between the 2nd-3rd and 5th-7th decades of their life. At our observation, most patients were suffering in advanced stages of malignant lesions. We try to manage amputations below 5%, with a significant reduction in introducing reconstructive surgical methods as a choice of treatment (10 prostheses and 12 cases of filling with acrylic cement or bone substituent increased with internal fixation). In this way we could observe an unusual ratio between benign and malignant tumors, probably caused by the patient's lack of concern for minimal symptoms. The rural citizen's addressability towards the medical system is alarmingly low, due to the big gap existing from diagnosis to treatment. There is still an hard effort to develop better reconstructive techniques for the treatment of muscle-skeletal tumors and more studies must be made in order to achieve this goal.

  6. A proposed algorithm for multimodal liver trauma management from a surgical trauma audit in a western European trauma center.

    Science.gov (United States)

    Di Saverio, S; Sibilio, A; Coniglio, C; Bianchi, E; Biscardi, A; Villani, S; Gordini, G; Tugnoli, G

    2014-11-01

    Management of liver trauma is challenging and may vary widely given the heterogeneity of liver injuries' anatomical configuration, the hemodynamic status, the settings and resources available. Perhaps the use of non-operative management (NOM) may have potential drawbacks and the role of damage control surgery (DCS) and angioembolization represents a major evolving concept.1 Most severe liver trauma in polytrauma patients accounts for a significant morbidity and mortality. Major liver trauma with extensive parenchymal injury and uncontrollable bleeding is therefore a challenge for the trauma team. However a safe and effective surgical hemostasis and a carefully planned multidisciplinary approach can improve the outcome of severe liver trauma. The technique of perihepatic packing, according to DCS approach, is often required to achieve fast, early and effective control of hemorrhage in the highest grades of liver trauma and in unstable patients. A systematic and standardized technique of perihepatic packing may contribute to improve hemostatic efficacy and overall outcomes if wisely combined in a stepwise "sandwich" multimodal approach. DCS philosophy evolved alongside with damage control resuscitation (DCR) in the management of trauma patients, requiring close interaction between surgery and resuscitation. Therefore, as a result of a combined surgical and critical care clinical audit activity in our western European trauma center, a practical algorithm for multimodal sequential management of liver trauma has been developed based on a historical cohort of 253 liver trauma patients and subsequently validated on a prospective cohort of 135 patients in the period 2010-2013.

  7. Bovine pericardium for portal vein reconstruction in abdominal surgery: a surgical guide and first experiences in a single center.

    Science.gov (United States)

    Jara, Maximilian; Malinowski, Maciej; Bahra, Marcus; Stockmannn, Martin; Schulz, Antje; Pratschke, Johann; Puhl, Gero

    2015-01-01

    Resection and reconstruction of infiltrated vessels achieve resectability of extended pancreatic tumors. The aim of the present study was to assess the feasibility of bovine pericardium as graft material for the individualised portal vein reconstruction and demonstrate a surgical technique for abdominal vein repair. We performed a MEDLINE search to review the methods for complex abdominal vein reconstruction in the course of extended pancreatectomy. Moreover, clinical data of patients receiving portal vein reconstruction using a bovine pericardial patch at our institution were retrospectively analyzed. Based on the results of a review of the literature, autologous venous grafts using the internal jugular vein represent the most popular option for segmental portal vein reconstruction in case of impossible direct suture. At our center, segmental portal vein reconstruction with bovine pericardial patch in course of pancreatic surgery was performed in 4 patients. No case of vascular complications such as occlusion, segmental stenosis or thrombosis occurred. Our experience suggests a surgical procedure for an individual size-matched portal vein reconstruction using bovine pericardium. Although first results appear promising, prospective studies are required to objectively assess the patency of bovine pericardium compared with autologous and synthetic interposition grafts for portal vein reconstruction. © 2015 S. Karger AG, Basel.

  8. Evaluation of non-surgical causes of cardiac tamponade in children at a cardiac surgery center.

    Science.gov (United States)

    Ozturk, Erkut; Tanidir, Ibrahim Cansaran; Saygi, Murat; Ergul, Yakup; Guzeltas, Alper; Odemis, Ender

    2014-02-01

    The aim of this study was to examine the causes of cardiac tamponade in children undergoing percutaneous pericardiocentesis. Patients who presented with other complaints but were diagnosed with cardiac tamponade based on clinical and echocardiographic findings between January 2010 and January 2013 were retrospectively investigated. Electrocardiography, telecardiography and transthoracic echocardiography were performed. Pericardiocentesis was performed percutaneously under continuous blood pressure and rhythm monitoring with echocardiography and fluoroscopy. Pericardial fluid was analyzed on hemography and biochemistry. Fourteen patients (six boys, eight girls; median age, 7 years) underwent pericardiocentesis for cardiac tamponade. At presentation, 78% had dyspnea, 56% chest pain, and 49% fever. All had cardiomegaly, and their cardiothoracic index was 0.56-0.72. Also, all patients had sinus tachycardia; 78%, low QRS voltage; 70%, ST-T changes; and 50% QRS alternans. On echocardiography the widest diameter of pericardial effusion was between 12 mm and 36 mm depth around the heart. The pericardial fluid was purulent in one, serohemorrhagic in seven, serofibrinous in two, and serous in four cases. Pericardiocentesis was unsuccessful in two patients, who underwent open surgical drainage, with no complications. Based on pericardial fluid characteristics and additional tests, cardiac tamponade was caused by an infection in five patients, hypothyroidism in two, familial Mediterranean fever in two, malignancy in one, acute rheumatic fever in one, collagen tissue disease (systemic lupus erythematosus) in one, catheter placement-associated damage in one, and idiopathic pulmonary arterial hypertension in one patient. Pericardial effusion and cardiac tamponade in children have varied causes, and early treatment is life saving. © 2013 The Authors. Pediatrics International © 2013 Japan Pediatric Society.

  9. Atrial Fibrillation Following Surgical Management of Ischemic Heart Disease; One Year, Single Center, Single Surgeon Results

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    Ahmet Barış Durukan

    2012-08-01

    Full Text Available Introduction: Postoperative atrial fibrillation is the most common arrhythmia following bypasssurgery with significant morbidity, mortality and increased healthcare costs. The aim of this studyis to determine the incidence and timing of atrial fibrillation, identify the risk factors coveringpreoperative and intraoperative periods, evaluate rate of return to sinus rhythm by disharge, andexplore the impact on postoperative outcomes in a large group of patients operated in a singlecenter by a single surgeon.Patients and Methods: Between January 2011 and January 2012, 418 patients on preoperativesinus rhythm were operated for ischemic heart disease and associated complications (left ventricleaneurysm repair and ischemic mitral insufficiency in a single center, by a single surgeon.The preoperative, intraoperative and postoperative variables were studied.Results: The mean age of the patients were 61.92 ± 10.05, and 77.5% were male. Atrial fibrillationdeveloped in 68 (16.3% patients. The incidence peaked at second day. Patients with atrialfibrillation were older (p< 0.001. Gender, preoperative comorbidities, ejection fraction, left atrialdiameter, preoperative beta-blocker use, leukocyte count, type of operation and intraoperativevariables did not affect its occurence. Intensive care unit and hospital length of stay were longer(p< 0.05. 95.5% (n= 65 of patients were in normal sinus rhythm at discharge.Conclusion: Postoperative atrial fibrillation is a popular subject with unknowns and controversialresults which may lead to wrong interpretations. We believe that every center has its own risk factors related with the population of that region. Discussion will last, but simple precautions and close monitoring will help to minimizeadverse outcomes.

  10. Effect of Lean Processes on Surgical Wait Times and Efficiency in a Tertiary Care Veterans Affairs Medical Center.

    Science.gov (United States)

    Valsangkar, Nakul P; Eppstein, Andrew C; Lawson, Rick A; Taylor, Amber N

    2017-01-01

    There are an increasing number of veterans in the United States, and the current delay and wait times prevent Veterans Affairs institutions from fully meeting the needs of current and former service members. Concrete strategies to improve throughput at these facilities have been sparse. To identify whether lean processes can be used to improve wait times for surgical procedures in Veterans Affairs hospitals. Databases in the Veterans Integrated Service Network 11 Data Warehouse, Veterans Health Administration Support Service Center, and Veterans Information Systems and Technology Architecture/Dynamic Host Configuration Protocol were queried to assess changes in wait times for elective general surgical procedures and clinical volume before, during, and after implementation of lean processes over 3 fiscal years (FYs) at a tertiary care Veterans Affairs medical center. All patients evaluated by the general surgery department through outpatient clinics, clinical video teleconferencing, and e-consultations from October 2011 through September 2014 were included. Patients evaluated through the emergency department or as inpatient consults were excluded. The surgery service and systems redesign service held a value stream analysis in FY 2013, culminating in multiple rapid process improvement workshops. Multidisciplinary teams identified systemic inefficiencies and strategies to improve interdepartmental and patient communication to reduce canceled consultations and cases, diagnostic rework, and no-shows. High-priority triage with enhanced operating room flexibility was instituted to reduce scheduling wait times. General surgery department pilot projects were then implemented mid-FY 2013. Planned outcome measures included wait time, clinic and telehealth volume, number of no-shows, and operative volume. Paired t tests were used to identify differences in outcome measures after the institution of reforms. Following rapid process improvement workshop project rollouts, mean

  11. Outcomes of Surgical Repair for Persistent Truncus Arteriosus from Neonates to Adults: A Single Center's Experience

    Science.gov (United States)

    Chen, Qiuming; Gao, Huawei; Hua, Zhongdong; Yang, Keming; Yan, Jun; Zhang, Hao; Ma, Kai; Zhang, Sen; Qi, Lei; Li, Shoujun

    2016-01-01

    Objective This study aimed to report our experiences with surgical repair in patients of all ages with persistent truncus arteriosus. Methods From July 2004 to July 2014, 50 consecutive patients with persistent truncus arteriosus who underwent anatomical repair were included in the retrospective review. Median follow-up time was 3.4 years (range, 3 months to 10 years). Results Fifty patients underwent anatomical repair at a median age of 19.6 months (range, 20 days to 19.1 years). Thirty patients (60%) were older than one year. The preoperative pulmonary vascular resistance and mean pulmonary artery pressure were 4.1±2.1 (range, 0.1 to 8.9) units.m2 and 64.3±17.9 (range, 38 to 101) mmHg, respectively. Significant truncal valve regurgitation was presented in 14 (28%) patients. Hospital death occurred in 3 patients, two due to pulmonary hypertensive crisis and the other due to pneumonia. Three late deaths occurred at 3, 4 and 11 months after surgery. The actuarial survival rates were 87.7% and 87.7% at 1 year and 5 years, respectively. Multivariate analysis identified significant preoperative truncal valve regurgitation was a risk factor for overall mortality (odds ratio, 7.584; 95%CI: 1.335–43.092; p = 0.022). Two patients required reoperation of truncal valve replacement. One patient underwent reintervention for conduit replacement. Freedom from reoperation at 5 years was 92.9%. At latest examination, there was one patient with moderate-to-severe truncal valve regurgitation and four with moderate. Three patients had residual pulmonary artery hypertension. All survivors were in New York Heart Association class I-II. Conclusions Complete repair of persistent truncus arteriosus can be achieved with a relatively low mortality and acceptable early- and mid-term results, even in cases with late presentation. Significant preoperative truncal valve regurgitation remains a risk factor for overall mortality. The long-term outcomes warrant further follow-up. PMID:26752522

  12. Outcomes of Surgical Repair for Persistent Truncus Arteriosus from Neonates to Adults: A Single Center's Experience.

    Directory of Open Access Journals (Sweden)

    Qiuming Chen

    Full Text Available This study aimed to report our experiences with surgical repair in patients of all ages with persistent truncus arteriosus.From July 2004 to July 2014, 50 consecutive patients with persistent truncus arteriosus who underwent anatomical repair were included in the retrospective review. Median follow-up time was 3.4 years (range, 3 months to 10 years.Fifty patients underwent anatomical repair at a median age of 19.6 months (range, 20 days to 19.1 years. Thirty patients (60% were older than one year. The preoperative pulmonary vascular resistance and mean pulmonary artery pressure were 4.1±2.1 (range, 0.1 to 8.9 units.m2 and 64.3±17.9 (range, 38 to 101 mmHg, respectively. Significant truncal valve regurgitation was presented in 14 (28% patients. Hospital death occurred in 3 patients, two due to pulmonary hypertensive crisis and the other due to pneumonia. Three late deaths occurred at 3, 4 and 11 months after surgery. The actuarial survival rates were 87.7% and 87.7% at 1 year and 5 years, respectively. Multivariate analysis identified significant preoperative truncal valve regurgitation was a risk factor for overall mortality (odds ratio, 7.584; 95%CI: 1.335-43.092; p = 0.022. Two patients required reoperation of truncal valve replacement. One patient underwent reintervention for conduit replacement. Freedom from reoperation at 5 years was 92.9%. At latest examination, there was one patient with moderate-to-severe truncal valve regurgitation and four with moderate. Three patients had residual pulmonary artery hypertension. All survivors were in New York Heart Association class I-II.Complete repair of persistent truncus arteriosus can be achieved with a relatively low mortality and acceptable early- and mid-term results, even in cases with late presentation. Significant preoperative truncal valve regurgitation remains a risk factor for overall mortality. The long-term outcomes warrant further follow-up.

  13. Characteristics of positive surgical margins in robotic-assisted radical prostatectomy, open retropubic radical prostatectomy, and laparoscopic radical prostatectomy: a comparative histopathologic study from a single academic center.

    Science.gov (United States)

    Albadine, Roula; Hyndman, Matthew E; Chaux, Alcides; Jeong, J Y; Saab, Shahrazad; Tavora, Fabio; Epstein, Jonathan I; Gonzalgo, Mark L; Pavlovich, Christian P; Netto, George J

    2012-02-01

    Studies detailing differences in positive surgical margin among open retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robotic-assisted laparoscopic radical prostatectomy are lacking. A retrospective review of all prostatectomies with positive surgical margin performed at our center in 2007 disclosed 99 cases, 6 (5%) of which were reinterpreted cases as having negative margins. Ninety-three cases were, therefore, included, corresponding to 37 retropubic radical prostatectomies, 19 laparoscopic radical prostatectomies, and 37 robotic-assisted laparoscopic radical prostatectomies. The relationship of positive surgical margin characteristics to clinicopathologic parameters and biochemical recurrence was assessed. The most commonly found positive surgical margin site was the apex/distal third in all groups (62% retropubic prostatectomies, 79% laparoscopic prostatectomies, 60% robotic-assisted prostatectomies). Total linear length of positive surgical margin sites was significantly correlated with preoperative prostate-specific antigen, preoperative prostate-specific antigen density, pT stage, and tumor volume (P ≤ .001). We found no significant differences among the 3 groups with respect to total linear length, number of foci, laterality, or location of positive surgical margin. The rate of biochemical recurrence was also comparable in the 3 groups. On univariate analyses, biochemical recurrence was significantly associated with preoperative prostate-specific antigen values, preoperative prostate-specific antigen density, Gleason score, number of positive surgical margins, and total linear length of positive surgical margin (P ≤ .02). Only preoperative prostate-specific antigen density and number of positive surgical margin foci were statistically significant (P ≤ .03) independent predictors of biochemical recurrence. We found no significant difference in positive surgical margin characteristics or biochemical recurrence among the 3

  14. Histopathological evaluation of surgically treated adult renal tumors: Report from a tertiary care center in India

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    B Datta

    2016-01-01

    Full Text Available Background: This retrospective study was performed in a tertiary care center from India analyzing the histopathological reports and the clinical data of the adult patients admitted in this institute with a diagnosis of renal tumors and had undergone nephrectomy for the disease. Objective: The objective of this study is to determine the relative frequencies of different renal tumors in adults (above the age of 16 years and to analyze the histopathological characters of the tumors. Materials and Methods: In this retrospective study, we have analyzed the histopathology reports along with the demographic and clinical data of the adult patients who had undergone nephrectomy for renal tumors in our institute from January 2005 to December 2011. Results: A total 113 adult patients underwent tumor nephrectomy during the last 7 years in our institute. Mean age of the patients was 54.5 years (range 16-69 years. Male:Female ratio was 1.9:1. Out of 131 cases of adult renal tumors, 91.6% cases were malignant and 8.45 cases were benign tumors. Among the malignant tumors, renal cell carcinoma was the most common type. There were 2 cases of renal primitive neuroectodermal tumors and one case of renal myofibroblastoma in our series. Conclusion: The spectrum of adult renal tumors in this series is consistent with the other series of cases reported by different authors. Only few cases of the renal tumors were diagnosed incidentally among our patients which is just opposite to the rate of renal tumors diagnosed incidentally in the developed countries. Myofibroblastoma, a benign kidney tumor diagnosed in our series is probably the first reported case in the world.

  15. Ambulatory Surgical Facilities, Identify the locations of Ambulatory Surgical Centers, Published in 2012, 1:2400 (1in=200ft) scale, Miami-Dade County, Information Technology Department.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Ambulatory Surgical Facilities dataset, published at 1:2400 (1in=200ft) scale, was produced all or in part from Other information as of 2012. It is described as...

  16. Changing Indications and Surgical Techniques for Corneal Transplantation Between 2004 and 2009 at a Tertiary Referral Center

    Science.gov (United States)

    Zare, Mohammad; Javadi, Mohammad A.; Einollahi, Bahram; Karimian, Farid; Rafie, Ali R. B.; Feizi, Sepehr; Azimzadeh, Ahmad

    2012-01-01

    Purpose: The aim of this study is to report the indications, techniques, and clinical outcomes of corneal transplantation and investigate any changing trends in surgical techniques over a 6 year period. Materials and Methods: Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran, from January 2004 to December 2009 were reviewed to determine the indications and types of corneal transplantation. Postoperative best-corrected visual acuity, refractive error, graft clarity, and complications were reported. Results: During this period, 1859 eyes of 1624 patients with a mean age of 41.3 ± 21.3 years underwent corneal transplantation. The most common indication was keratoconus (38.4%) followed by aphakic/pseudophakic bullous keratopathy (11.7%), previous failed grafts (10.6%), infectious corneal ulcers (10.1%), non-herpetic corneal scars (7.6%), trachoma keratopathy (4.7%), stromal corneal dystrophies (4.6%), post-herpetic corneal scar (3.7%), Fuchs’ endothelial dystrophy (0.8%), and congenital hereditary endothelial dystrophy (0.4%). Techniques of corneal transplantation included penetrating keratoplasty (PKP; 70.9%), deep anterior lamellar keratoplasty (DALK; 20.1%), conventional lamellar keratoplasty (LKP; 4.4%), and Descemet's stripping automated endothelial keratoplasty (DSAEK; 2.3%). Over the study period, there was a significant increase in the relative frequency of infectious corneal ulcers, failed grafts, and trachoma keratopathy. Additionally, a significant reduction was observed in PKP and LKP procedures, and volume of DALK and DSAEK increased significantly. At final follow-up, 69.0% of grafts were clear in the PKP group. This figure was 82.6%, 82.7%, and 97.6% in the DALK, LKP, and DSAEK groups, respectively. Conclusion: Keratoconus was the most common indication and PKP was the most prevalent technique used for corneal transplantation. However, significant changes in the indications and

  17. Clinical relevance of surgical site infection as defined by the criteria of the Centers for Disease Control and Prevention.

    Science.gov (United States)

    Henriksen, N A; Meyhoff, C S; Wetterslev, J; Wille-Jørgensen, P; Rasmussen, L S; Jorgensen, L N

    2010-07-01

    Surgical site infection (SSI) is a common complication after abdominal surgery and the Centers for Disease Control and Prevention (CDC) criteria are commonly used for diagnosis and surveillance. The aim of this study was to evaluate whether SSI diagnosed according to CDC is clinically relevant (CRSSI) and whether there is agreement between evaluations according to the CDC criteria, the ASEPSIS score (Additional treatment, presence of Serous discharge, Erythema, Purulent exudate, Separation of the deep tissues, Isolation of bacteria and duration of Stay) and CRSSI. We included 54 patients diagnosed with SSI and a matched control group (N=46) without SSI according to the CDC criteria after laparotomy. Two blinded experienced surgeons evaluated the hospital records and determined whether patients had CRSSI, based on the following criteria: antibiotic treatment, surgical intervention, prolonged hospital stay or referral to an intensive care unit for SSI. The rate of CRSSI was 38 of 54 (70%) in patients with CDC-diagnosed SSI and none in patients without a CDC-diagnosed SSI. Sixty-one percent of the CDC-diagnosed SSIs were superficial, of which 48% were considered clinically relevant. There was substantial agreement between the CDC criteria and CRSSI [kappa=0.69; 95% confidence interval (CI): 0.55-0.83] and fair agreement between the ASEPSIS score and the CDC criteria (kappa=0.23; 95% CI: 0-0.49) and between the ASEPSIS score and CRSSI (kappa=0.39; 95% CI: 0.17-0.61). The CDC criteria represent a suitable standard definition for monitoring and identifying SSI, even if some cases of less clinically significant superficial SSI are included.

  18. Changing indications and surgical techniques for corneal transplantation between 2004 and 2009 at a tertiary referral center

    Directory of Open Access Journals (Sweden)

    Mohammad Zare

    2012-01-01

    Full Text Available Purpose: The aim of this study is to report the indications, techniques, and clinical outcomes of corneal transplantation and investigate any changing trends in surgical techniques over a 6 year period. Materials and Methods: Records of patients who had undergone any kind of corneal transplantation at Labbafinejad Medical Center, Tehran, Iran, from January 2004 to December 2009 were reviewed to determine the indications and types of corneal transplantation. Postoperative best-corrected visual acuity, refractive error, graft clarity, and complications were reported. Results: During this period, 1859 eyes of 1624 patients with a mean age of 41.3 ± 21.3 years underwent corneal transplantation. The most common indication was keratoconus (38.4% followed by aphakic/pseudophakic bullous keratopathy (11.7%, previous failed grafts (10.6%, infectious corneal ulcers (10.1%, non-herpetic corneal scars (7.6%, trachoma keratopathy (4.7%, stromal corneal dystrophies (4.6%, post-herpetic corneal scar (3.7%, Fuchs′ endothelial dystrophy (0.8%, and congenital hereditary endothelial dystrophy (0.4%. Techniques of corneal transplantation included penetrating keratoplasty (PKP; 70.9%, deep anterior lamellar keratoplasty (DALK; 20.1%, conventional lamellar keratoplasty (LKP; 4.4%, and Descemet′s stripping automated endothelial keratoplasty (DSAEK; 2.3%. Over the study period, there was a significant increase in the relative frequency of infectious corneal ulcers, failed grafts, and trachoma keratopathy. Additionally, a significant reduction was observed in PKP and LKP procedures, and volume of DALK and DSAEK increased significantly. At final follow-up, 69.0% of grafts were clear in the PKP group. This figure was 82.6%, 82.7%, and 97.6% in the DALK, LKP, and DSAEK groups, respectively. Conclusion: Keratoconus was the most common indication and PKP was the most prevalent technique used for corneal transplantation. However, significant changes in the indications

  19. Movements in Parties: OccupyPD

    Directory of Open Access Journals (Sweden)

    Donatella della Porta

    2015-03-01

    Full Text Available When the United States activists called for people to Occupy#everywhere, it is unlikely they were thinking of the headquarters of the Italian centre-left party. Parties and movements are often considered to be worlds apart. In reality, parties have been relevant players in movement politics, and movements have influenced parties, often through the double militancy of many of their members. OccupyPD testifies to a continuous fluidity at the movement-party border, but also to a blockage in the party’s interactions with society that started long before the economic crisis but drastically accelerated with it. In this paper we present the OccupyPD Movement as a case of interaction between party politics and social movement politics, and in particular between the base membership of a centre-left party and the broader anti-austerity movement that diffused from the US to Europe adopting similar forms of actions and claims. Second, by locating it within the context of the economic and democratic crisis that erupted in 2007, we understand its emergence as a reaction towards politics in times of crisis of responsibility, by which we mean a drastic drop in the capacity of the government to respond to citizens’ requests. To fulfil this double aim, we bridge social movement studies with research on party change, institutional trust and democratic theory, looking at some political effects of the economic crisis in terms of a specific form of legitimacy crisis, as well as citizens’ responses to it, with a particular focus on the political meaning of recent anti-austerity protests. In this analysis, we refer to both quantitative and qualitative data from secondary liter-ature and original in-depth interviews carried out with a sample of OccupyPD activists.

  20. Human telomeric proteins occupy selective interstitial sites

    Institute of Scientific and Technical Information of China (English)

    Dong Yang; Yuanyan Xiong; Hyyeung Kim; Quanyuan He; Yumei Li; Rui Chen; Zhou Songyang

    2011-01-01

    Human telomeres are bound and protected by protein complexes assembled around the six core telomeric proteins RAP1, TRF1, TRF2, TIN2, TPP1, and POT1. The function of these proteins on telomeres has been studied extensively. Recently, increasing evidence has suggested possible roles for these proteins outside of telomeres. However, the non-canonical (extra-telomeric) function of human telomeric proteins remains poorly understood. To this end, we systematically investigated the binding sites of telomeric proteins along human chromosomes, by performing wholegenome chromatin immunoprecipitation (ChIP) for RAP1 and TRF2. ChIP sequencing (ChIP-seq) revealed that RAP1 and TRF2 could be found on a small number of interstitial sites, including regions that are proximal to genes. Some of these binding sites contain short telomere repeats, suggesting that telomeric proteins could directly bind to interstitial sites. Interestingly, only a small fraction of the available interstitial telomere repeat-containing regions were occupied by RAP1 and TRF2. Ectopically expressed TRF2 was able to occupy additional interstitial telomere repeat sites, suggesting that protein concentration may dictate the selective targeting of telomeric proteins to interstitial sites. Reducing RAP1 and TRF2 expression by RNA interference led to altered transcription of RAP1- and TRF2-targeted genes. Our results indicate that human telomeric proteins could occupy a limited number of interstitial sites and regulate gene transcription.

  1. [Craniectomy in space-occupying middle cerebral artery infarcts].

    Science.gov (United States)

    Schwab, S; Rieke, K; Krieger, D; Hund, E; Aschoff, A; von Kummer, R; Hacke, W

    1995-06-01

    Space occupying supratentorial ischemic stroke has a high mortality. The benefit of decompressive surgery in these patients is still matter of debate. In a prospective study we performed craniectomy in 37 patients with acute middle cerebral artery infarction and progressive deterioration under conservative antiedematous therapy. Twenty-one patients treated conservatively during the same period served as control group. All survivors were reexamined between one to two years after surgical decompression. In addition, neuropsychological tests were performed, including an Aachener Aphasie Test (AAT) in those patients with infarction of speech-dominant hemisphere. Clinical evaluation was graded using the Barthel index (BI). Mortality rate in the operated group was 37%. Twenty-three patients survived acute stroke and were reexamined. Despite complete hemispheric infarction, no patient suffered from complete hemiplegia or was permanently wheel chair bound. In speech dominant hemispheric infarction (n = 8) only mild to moderate aphasia could be detected. Mean BI was 64. Mortality rate in the conservatively treated group was 76%. The clinical outcome following craniectomy for the treatment of severe ischemic hemispheric infarction is unexpectedly good. Therefore, decompressive surgery should be considered in cases of space-occupying hemispheric infarctions and conservatively uncontrollable intracranial pressure.

  2. Laparoscopic Colorectal Cancer Resection in High-Volume Surgical Centers: Long-Term Outcomes from the LAPCOLON Group Trial.

    Science.gov (United States)

    Huscher, Cristiano G S; Bretagnol, Frederic; Corcione, Francesco

    2015-08-01

    Strong evidence has confirmed the benefit of laparoscopy in colorectal cancer resection but remains a challenging procedure. It is not clear that such promising results in selected patients translate into a favorable risk-benefit balance in real practice. We conducted a multicenter national observational registry to assess operative and oncologic long-term outcomes following laparoscopic colorectal cancer resection. All patients with laparoscopic colorectal cancer resection between 2001 and 2004 were included. Data were extracted from the prospective Italian national database of 10 high-volume centers (≥40 colorectal cancer laparoscopic resections per year). Surgical technique and follow-up were standardized. Survivals were analyzed by Kaplan-Meier method. We reported 1832 patients with colon (58.5%) and rectal cancer (41.5%). TNM stage was 0-I-II in 1044 patients (57%) and III-IV in 788 patients (43%). Surgery included a totally laparoscopic procedure in 1820 patients (99.3%). Conversion was 10.5%. Postoperative morbidity and 30-day mortality rates were 17 and 1.2%, respectively. Clinical anastomotic leakage rate was 8.3% (n=152). R0 resection was 95%. With a median follow-up of 54.2 months, cancer recurrence rate was 13.3%. At 5 years, cancer-free survival was 86.7%. Upon multivariate analysis, age (P=0.001) and TNM stage (Pcancer-free survival. Predictive factors of cancer recurrence were gender (P=0.029) and TNM stage (Pcancer achieves good operative results with satisfactory long-term oncologic results. Even in the laparoscopy era, age, gender, and TNM stage remain the most powerful predictor of oncologic outcomes.

  3. Why Matter Occupies so Large a Volume?

    Science.gov (United States)

    E. B., Manoukian

    2013-12-01

    The paper represents a rigorous treatment of the underlying quantum theory, not just in words but providing the underlying technical details, as to why matter occupies so large a volume and its intimate connection with the Pauli exclusion principle, as more and more matter is put together, as well as of the contraction or shrinkage of “bosonic matter”, upon collapse, for which the Pauli exclusion is abolished. From the derived explicit bounds of integrals of powers of the particle number densities, explicit bounds on probabilities of the occurrences of the events just described are extracted. These probabilities lead one to infer the change of the “size” or extension of such matter, upon expansion or contraction, respectively, as their content is increased.

  4. Introduction to the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infections.

    Science.gov (United States)

    Solomkin, Joseph S; Mazuski, John; Blanchard, Joan C; Itani, Kamal M F; Ricks, Philip; Dellinger, E Patchen; Allen, George; Kelz, Rachel; Reinke, Caroline E; Berríos-Torres, Sandra I

    Surgical site infection (SSI) is a common type of health-care-associated infection (HAI) and adds considerably to the individual, social, and economic costs of surgical treatment. This document serves to introduce the updated Guideline for the Prevention of SSI from the Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC). The Core section of the guideline addresses issues relevant to multiple surgical specialties and procedures. The second procedure-specific section focuses on a high-volume, high-burden procedure: Prosthetic joint arthroplasty. While many elements of the 1999 guideline remain current, others warrant updating to incorporate new knowledge and changes in the patient population, operative techniques, emerging pathogens, and guideline development methodology.

  5. World Health Organization (WHO) surgical safety checklist implementation and its impact on perioperative morbidity and mortality in an academic medical center in Chile

    Science.gov (United States)

    Lacassie, Hector J.; Ferdinand, Constanza; Guzmán, Sergio; Camus, Lorena; Echevarria, Ghislaine C.

    2016-01-01

    Abstract Health care organizations are unsafe. Numerous centers have incorporated the WHO Surgical Safety Checklist in their processes with good results; however, only limited information is available about its effectiveness in Latin America. We aimed to evaluate the impact of the checklist implementation on the in-hospital morbidity and mortality rate in a tertiary health care center. After Institutional review board approval, and using data from our hospital administrative records, we conducted a retrospective analysis of all surgical encounters (n = 70,639) over the period from January 2005 to December 2012. Propensity scoring (PS) methods (matching and inverse weighting) were used to compare the pre and postintervention period, after controlling for selection bias. After PS matching (n = 29,250 matched pairs), the in-hospital mortality rate was 0.82% [95% confidence interval (CI), 0.73–0.92] before and 0.65% (95% CI, 0.57–0.74) after checklist implementation [odds ratio (OR) 0.73; 95% CI, 0.61–0.89]. The median length of stay was 3 days [interquartile range (IQR), 1–5] and 2 days (IQR, 1–4) for the pre and postchecklist period, respectively (P < 0.01). This is the first Latin American study reporting a decrease in mortality after the implementation of the WHO Surgical Checklist in adult surgical patients. This is a strong and simple tool to make health care safer, especially in developing countries. PMID:27281092

  6. World Health Organization (WHO) surgical safety checklist implementation and its impact on perioperative morbidity and mortality in an academic medical center in Chile.

    Science.gov (United States)

    Lacassie, Hector J; Ferdinand, Constanza; Guzmán, Sergio; Camus, Lorena; Echevarria, Ghislaine C

    2016-06-01

    Health care organizations are unsafe. Numerous centers have incorporated the WHO Surgical Safety Checklist in their processes with good results; however, only limited information is available about its effectiveness in Latin America. We aimed to evaluate the impact of the checklist implementation on the in-hospital morbidity and mortality rate in a tertiary health care center. After Institutional review board approval, and using data from our hospital administrative records, we conducted a retrospective analysis of all surgical encounters (n = 70,639) over the period from January 2005 to December 2012. Propensity scoring (PS) methods (matching and inverse weighting) were used to compare the pre and postintervention period, after controlling for selection bias. After PS matching (n = 29,250 matched pairs), the in-hospital mortality rate was 0.82% [95% confidence interval (CI), 0.73-0.92] before and 0.65% (95% CI, 0.57-0.74) after checklist implementation [odds ratio (OR) 0.73; 95% CI, 0.61-0.89]. The median length of stay was 3 days [interquartile range (IQR), 1-5] and 2 days (IQR, 1-4) for the pre and postchecklist period, respectively (P < 0.01).This is the first Latin American study reporting a decrease in mortality after the implementation of the WHO Surgical Checklist in adult surgical patients. This is a strong and simple tool to make health care safer, especially in developing countries.

  7. Quality of laparoscopic radical hysterectomy in developing countries: a comparison of surgical and oncologic outcomes between a comprehensive cancer center in the United States and a cancer center in Colombia.

    Science.gov (United States)

    Pareja, Rene; Nick, Alpa M; Schmeler, Kathleen M; Frumovitz, Michael; Soliman, Pamela T; Buitrago, Carlos A; Borrero, Mauricio; Angel, Gonzalo; Reis, Ricardo Dos; Ramirez, Pedro T

    2012-05-01

    To help determine whether global collaborations for prospective gynecologic surgery trials should include hospitals in developing countries, we compared surgical and oncologic outcomes of patients undergoing laparoscopic radical hysterectomy at a large comprehensive cancer center in the United States and a cancer center in Colombia. Records of the first 50 consecutive patients who underwent laparoscopic radical hysterectomy at The University of Texas MD Anderson Cancer Center in Houston (between April 2004 and July 2007) and the first 50 consecutive patients who underwent the same procedure at the Instituto de Cancerología-Clínica las Américas in Medellín (between December 2008 and October 2010) were retrospectively reviewed. Surgical and oncologic outcomes were compared between the 2 groups. There was no significant difference in median patient age (US 41.9 years [range 23-73] vs. Colombia 44.5 years [range 24-75], P=0.09). Patients in Colombia had a lower median body mass index than patients in the US (24.4 kg/m(2) vs. 28.7 kg/m(2), P=0.002). Compared to patients treated in Colombia, patients who underwent surgery in the US had a greater median estimated blood loss (200 mL vs. 79 mL, P<0.001), longer median operative time (328.5 min vs. 235 min, P<0.001), and longer postoperative hospital stay (2 days vs. 1 day, P<0.001). Surgical and oncologic outcomes of laparoscopic radical hysterectomy were not worse at a cancer center in a developing country than at a large comprehensive cancer center in the United States. These results support consideration of developing countries for inclusion in collaborations for prospective surgical studies. Copyright © 2011 Elsevier B.V. All rights reserved.

  8. Integration of the clinical engineering specialist at a high complexity children's hospital. Our professional experience at a surgical center

    Energy Technology Data Exchange (ETDEWEB)

    Vargas Enriquez, M J; Chazarreta, B; Emilio, D G; Fernandez Sarda, E [Surgical Center-Neurophysiology Division of Medical Tecnology Department, Garrahan Children' s Hospital, Combate de los Pozos 1881, Buenos Aires (Argentina)

    2007-11-15

    This document aims to find relating points between the current and future Clinical Engineer professional in order to discuss about the hospital environment, its characteristics and its realities which lead to our professional development. The main aim is to depict our experience through a retrospective analysis based on the underwriting experience and consequently to arrive at conclusions that will support the inclusion and active interaction of the Clinic Engineer Specialist as part of a Hospital's Surgical Center.

  9. Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008–2012

    OpenAIRE

    Mekaj, Agon Y; Morina, Arsim A; Mekaj, Ymer H; Suzana Manxhuka-Kerliu; Miftari, Ermira I; Duci, Shkelzen B; Hamza, Astrit R.; Gashi, Musli M.; Mentor R Gjelaj; Kelmendi, Fatos M; Qamile Sh. Morina

    2015-01-01

    Background: Chronic subdural hematoma (CSDH) is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. Materials and Methods: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008-2012. The data were collected and analyzed from the archives and protocols of the University Clinical...

  10. Integrated surgical emergency training plan in the internship: A step toward improving the quality of training and emergency center management.

    Science.gov (United States)

    Akhlaghi, Mohammad Reza; Vafamehr, Vajiheh; Dadgostarnia, Mohammad; Dehghani, Alireza

    2013-01-01

    In this study, by using a problem-oriented approach in the needs assessment, identifying the defects and deficiencies in emergency health training centers has been determined as the basis for the requirements. The main objective of the study was the implementation of surgical emergencies integration of the five surgical groups (general surgery, urology, orthopedics, neurosurgery, and ENT) to meet the needs and determining its efficacy. THIS INTERVENTIONAL STUDY WAS CONDUCTED IN THREE PHASES: (1) Phase I (design and planning): Needs assessment, recognition of implementation barriers and providing the objectives and training program for integrated emergencies. (2) Phase II (implementation): Justification of the main stakeholders of the project, preparation of students' duties in the emergency department, preparation of on-duty plans, supervising the implementation of the program, and reviewing the plan in parallel with the implementation based on the problems. (3) Phase III (evaluation): Reviewing the evidences based on the amount of efficiency of the plan and justification for its continuation. In the first and the second phase, the data were collected through holding focus group meetings and interviews. In the third phase, the opened-reply and closed-reply researcher-made questionnaires were used. The questionnaire face and content validity were confirmed by experts and the reliability was assessed by calculating the Cronbach's alpha. ACCORDING TO THE VIEWS OF THE INTERNS, ASSISTANTS, TEACHERS, AND EMERGENCY PERSONNEL, THE POSITIVE FEATURES OF THE PLAN INCLUDED THE FOLLOWING: Increasing the patients' satisfaction, reducing the patients' stay in the Emergency Department, increasing the speed of handling the patients, balancing the workloads of the interns, direct training of interns by young teachers of emergency medicine, giving the direct responsibility of the patient to the intern, practical and operational training of emergency issues, increasing the teamwork

  11. Analysis of direct single nasal-transsphenoidal microscope combined nasal endoscopy surgical in treatment of sphenoid sinus inside space-occupying lesions in 18 cases%直接单鼻腔-蝶窦入路显微镜联合鼻内窥镜手术治疗蝶窦内占位性病变18例分析

    Institute of Scientific and Technical Information of China (English)

    王宝莲; 李国建

    2011-01-01

    Objective To explore direct single nasal - transsphenoidal microscope combined nasal endoscopic surgery sphenoid sinus inside space - occupying lesions. Methods Retrospective analysis on January 2006 -2011 January we adopt direct single nasal - transsphenoidal microscope combined nasal endoscopic surgery in 18 cases sphenoid sinus space - occupying lesions of data. Results All patients were total resection of the tumor polyps, cyst eas adequate drainage. No complications. Clinical symptoms disappeared basically. Conclusions Direct single nasal - transsphenoidal microscope combined nasal endoscopic surgery for sphenoid sinus inside space - occupying lesions thoroughly, less bleeding, route short, simple operation, the damage mild, less complications.%目的 探讨直接单鼻腔-蝶窦入路显微镜联合鼻内镜手术治疗蝶窦内占位性病变的术式.方法 回顾分析2006年1月至2011年1月开封市妇幼保健院采用直接单鼻腔-蝶窦入路显微镜联合鼻内镜手术治疗18例蝶窦内占位性病变的资料.结果 本组患者肿瘤息肉均得以全切,囊肿均得以充分引流.无并发症.临床症状基本消失.结论 直接单鼻腔-蝶窦入路显微镜联合鼻内窥镜手术治疗蝶窦内占位性病变彻底,出血少,径路短,操作简单,损伤轻微,并发症少.

  12. Incidence and Predicted Risk Factors of Pressure Ulcers in Surgical Patients: Experience at a Medical Center in Taipei, Taiwan

    OpenAIRE

    Ling Fu Shaw; Pao-Chu Chang; Jung-Fen Lee; Huei-Yu Kung; Tao-Hsin Tung

    2014-01-01

    Purpose. To explore the context of incidence of and associated risk factors for pressure ulcers amongst the population of surgical patients. Methods. The initial study cohort was conducted with a total of 297 patients admitted to a teaching hospital for a surgical operation from November 14th to 27th 2006 in Taipei, Taiwan. The Braden scale, pressure ulcers record sheet, and perioperative patient outcomes free from signs and symptoms of injury related to positioning and related nursing interv...

  13. Procurement of Human Tissues for Research Banking in the Surgical Pathology Laboratory: Prioritization Practices at Washington University Medical Center

    Science.gov (United States)

    Chernock, Rebecca D.; Leach, Tracey A.; Kahn, Ajaz A.; Yip, James H.; Rossi, Joan; Pfeifer, John D.

    2011-01-01

    Academic hospitals and medical schools with research tissue repositories often derive many of their internal human specimen acquisitions from their site's surgical pathology service. Typically, such acquisitions come from appropriately consented tissue discards sampled from surgical resections. Because the practice of surgical pathology has patient care as its primary mission, competing needs for tissue inevitably arise, with the requirement to preserve adequate tissue for clinical diagnosis being paramount. A set of best-practice gross pathology guidelines are summarized here, focused on the decision for tissue banking at the time specimens are macroscopically evaluated. These reflect our collective experience at Washington University School of Medicine, and are written from the point of view of our site biorepository. The involvement of trained pathology personnel in such procurements is very important. These guidelines reflect both good surgical pathology practice (including the pathologic features characteristic of various anatomic sites) and the typical objectives of research biorepositories. The guidelines should be helpful to tissue bank directors, and others charged with the procurement of tissues for general research purposes. We believe that appreciation of these principles will facilitate the partnership between surgical pathologists and biorepository directors, and promote both good patient care and strategic, value-added banking procurements. PMID:23386925

  14. Preoperative Embolization to Improve the Surgical Management and Outcome of Juvenile Nasopharyngeal Angiofibroma (JNA) in a Single Center

    DEFF Research Database (Denmark)

    Lutz, J; Holtmannspötter, M; Flatz, W;

    2016-01-01

    . RESULTS: In these 15 patients (mean age, 15 years), a total of 27 surgical procedures were performed. One patient was at stage Ia, two were at stage Ib, two were at stage IIa, six were at stage IIb, one was at stage IIc, and three were at stage IIIa based on the Radkowsky classification. All patients...

  15. Different surgical strategies for chronic pancreatitis significantly improve long-term outcome: a comparative single center study

    Directory of Open Access Journals (Sweden)

    Hildebrand P

    2010-08-01

    Full Text Available Abstract Objective In general, chronic pancreatitis (CP primarily requires conservative treatment. The chronic pain syndrome and complications make patients seek surgical advice, frequently after years of progression. In the past, surgical procedures involving drainage as well as resection have been employed successfully. The present study compared the different surgical strategies. Patients and Methods From March 2000 until April 2005, a total of 51 patients underwent surgical treatment for CP at the Department of surgery, University of Schleswig-Holstein, Campus Lübeck. Out of those 51 patients, 39 (76.5% were operated according to the Frey procedure, and in 12 cases (23.5% the Whipple procedure was performed. Patient data were documented prospectively throughout the duration of the hospital stay. The evaluation of the postoperative pain score was carried out retrospectively with a validated questionnaire. Results Average operating time was 240 minutes for the Frey group and 411 minutes for the Whipple group. The medium number of blood transfusions was 1 in the Frey group and 4.5 in the Whipple group. Overall morbidity was 21% in the Frey group and 42% in the Whipple group. 30-day mortality was zero for all patients. During the median follow-up period of 50 months, an improvement in pain score was observed in 93% of the patients of the Frey group and 67% of the patients treated according to the Whipple procedure. Conclusion The results show that both the Frey procedure as well as partial pancreaticoduodenectomy are capable of improving chronic pain symptoms in CP. As far as later endocrine and exocrine pancreatic insufficiency is concerned, however, the extended drainage operation according to Frey proves to be advantageous compared to the traditional resection procedure by Whipple. Accordingly, the Frey procedure provides us with an organ-preserving surgical procedure which treats the complications of CP sufficiently, thus being an

  16. Effect of patient Age on surgical outcomes for Graves’ disease: a case–control study of 100 consecutive patients at a high volume thyroid surgical center

    Directory of Open Access Journals (Sweden)

    Breuer Christopher K

    2013-01-01

    Full Text Available Abstract Objective To compare outcomes between children ( Summary of background data Reported complication rates for children undergoing surgery for Graves’ disease are worse than for adults. Methods 100 consecutive patients (32 children; 68 adults who underwent total thyroidectomy for Graves’ disease (GD by a high-volume endocrine surgery team from were compared. Results The mean patient age was 9.7 yrs (range 3.4-17.9 yrs in children versus 44.9 yrs (range 18.4-84.2 yrs in adults. Operative times were longer in children (2.18 ± 0.08 hrs than in adults (1.66 ± 0.03 hrs (p = 0.003. Pediatric thyroid specimens averaged 38.6.0 ± 8.9 gm (range: 9–293 gm and adult thyroid specimens averaged 48.0 ± 6.4 gm (range: 6.6-203 gm (p = 0.34. Thyroid to body weight ratios were greater in children (0.94 ± 0.11 gm/kg than adults (0.67 ± 0.8 gm/kg (p = 0.05. In all patients, the hyperthyroid state resolved after surgery. There was no operative mortality, recurrence, or permanent hypoparathyroidism. Transient post-operative hypocalcemia requiring calcium infusion was greater in children than adults (6/32 vs. 1/68; p = 0.004. Transient recurrent laryngeal nerve dysfunction occurred in two children and in no adults (p = 0.32. Postoperative hematoma occurred in two adults and in no children (p = 0.46. The length of stay was longer for children (1.41 ± 0.12 days than for adults (1.03 ±0.03 days (p = 0.004. Conclusion Surgical management of GD is technically more challenging in children as evidenced by longer operative times. Whereas temporary hypocalcemia occurs more commonly in children than adults, the risks of major complications including disease recurrence, permanent hypoparathyroidism, recurrent laryngeal nerve injury, or neck hematoma were indistinguishable. These data suggest that excellent and equivalent outcomes can be achieved for GD surgery in children and adults when care is rendered

  17. Spinal dural arterio-venous fistula: Clinico-radiological profile and outcome following surgical occlusion in an Indian neurosurgical center

    Directory of Open Access Journals (Sweden)

    Sivashanmugam Dhandapani

    2013-01-01

    Full Text Available Background: Spinal dural arteriovenous fistula (SDAVF is a common type of spinal vascular lesion. However, there has not been any published study on its clinico-radiological characteristics or surgical outcome from India. Aim: The aim of this study was to determine the clinico-radiological features of patients with SDAVF, outcomes following surgical ligation of the fistula and the various factors involved. Materials and Methods: Patients who were operated for SDAVF were studied for demographic details, symptoms, clinical severity, radiological features and neurological outcome in the form of improvement in gait disability grades. Appropriate statistical tests were performed. Results: There were 22 (19 males, 3 females patients of SDAVF who underwent surgical ligation with a mean age of 55 years. The mean duration of symptoms at presentation was 15 months. Three patients had acute onset while the rest had insidious onset of symptoms. Out of the 22 patients, 11 (50% had motor weakness as the first symptom, 13 (59% were bedridden and 19 (86.4% had bladder involvement at presentation. Thirteen patients had fistulae in thoracic spine, whereas eight had fistulae in the lumbar spine. All had a favorable outcome in the form of at least non-progression of gait disability (14 had improvement while 8 had stabilized. The improvement was non-significantly associated with younger age, acute onset, ambulant status and fistula below T9. It was inversely associated with pain as the first symptom and fluctuant clinical course. Conclusion: Surgical occlusion of SDAVF is usually associated with either improvement or stabilization of motor weakness.

  18. Surgical Treatment of Giant Liver Hemangioma Larger Than 10 cm: A Single Center's Experience With 86 Patients

    Science.gov (United States)

    Zhang, Wei; Huang, Zhi-Yong; Ke, Chang-Shu; Wu, Chao; Zhang, Zhi-Wei; Zhang, Bi-Xiang; Chen, Yi-Fa; Zhang, Wan-Guang; Zhu, Peng; Chen, Xiao-Ping

    2015-01-01

    Abstract The ideal surgical treatment of giant liver hemangioma is still controversial. This study aims to compare the outcomes of enucleation with those of resection for liver hemangioma larger than 10 cm in different locations of the liver and establish the preoperative predictors of increased intraoperative blood loss. Eighty-six patients underwent enucleation or liver resection for liver hemangioma larger than 10 cm was retrospectively reviewed. Patient demographic, tumor characteristics, surgical indications, the outcomes of both surgical treatment, and the clinicopathological parameters influencing intraoperative blood loss were analyzed. Forty-six patients received enucleation and 40 patients received liver resection. Mean tumor size was 14.1 cm with a range of 10–35 cm. Blood loss, blood product usage, operative time, hepatic vascular occlusion time and frequency, complications and postsurgical hospital stay were similar between liver resections and enucleation for right-liver and left-liver hemangiomas. There was no surgery-related mortality in either group. Bleeding was more related to adjacency of major vascular structures than the size of hemangioma. Adjacency to major vascular structures and right or bilateral liver hemangiomas were independently associated with blood loss >550 mL (P = 0.000 and 0.042, respectively). Both enucleation and liver resection are safe and effective surgical treatments for liver hemangiomas larger than 10 cm. The risk of intraoperative blood loss is related to adjacency to major vascular structures and the location of hemangioma. PMID:26313792

  19. Sperm recovery and IVF after testicular sperm extraction (TESE: effect of male diagnosis and use of off-site surgical centers on sperm recovery and IVF.

    Directory of Open Access Journals (Sweden)

    Kenan Omurtag

    Full Text Available OBJECTIVE: Determine whether testicular sperm extractions and pregnancy outcomes are influenced by male and female infertility diagnoses, location of surgical center and time to cryopreservation. PATIENTS: One hundred and thirty men undergoing testicular sperm extraction and 76 couples undergoing 123 in vitro fertilization cycles with testicular sperm. OUTCOME MEASURES: Successful sperm recovery defined as 1-2 sperm/0.5 mL by diagnosis including obstructive azoospermia (n = 60, non-obstructive azoospermia (n = 39, cancer (n = 14, paralysis (n = 7 and other (n = 10. Obstructive azoospermia was analyzed as congenital absence of the vas deferens (n = 22, vasectomy or failed vasectomy reversal (n = 37 and "other"(n = 1. Sperm recovery was also evaluated by surgical site including infertility clinic (n = 54, hospital operating room (n = 67 and physician's office (n = 11. Treatment cycles were evaluated for number of oocytes, fertilization, embryo quality, implantation rate and clinical/ongoing pregnancies as related to male diagnosis, female diagnosis, and use of fresh or cryopreserved testicular sperm. RESULTS: Testicular sperm recovery from azoospermic males with all diagnoses was high (70 to 100% except non-obstructive azoospermia (31% and was not influenced by distance from surgical center to laboratory. Following in vitro fertilization, rate of fertilization was significantly lower with non-obstructive azoospermia (43%, p = <0.0001 compared to other male diagnoses (66%, p = <0.0001, 59% p = 0.015. No differences were noted in clinical pregnancy rate by male diagnosis; however, the delivery rate per cycle was significantly higher with obstructive azoospermia (38% p = 0.0371 compared to diagnoses of cancer, paralysis or other (16.7%. Women diagnosed with diminished ovarian reserve had a reduced clinical pregnancy rate (7.4% p = 0.007 compared to those with other diagnoses (44

  20. A prospective single center study to assess the impact of surgical stabilization in patients with rib fracture.

    Science.gov (United States)

    Khandelwal, Gaurav; Mathur, R K; Shukla, Sumit; Maheshwari, Ankur

    2011-01-01

    To compare the intensity of pain and duration of return to normal activity in patients with rib fractures treated with surgical stabilization with plating versus conventional treatment modalities. This study was conducted over a 12 month period. Patients with rib fractures were assessed by numerical pain scale. Patients having pain scale less than 5 were excluded from study. Patients having pain scale of 5 or more than 5 were treated with conventional treatment for next 10 days. On 11th day patients were again assessed by numerical pain scale and patients having score less than 5 were excluded from study. Patients having pain scale of 5, 6, and 7 were treated with conventional treatment and patients having pain scale of 8, 9, and 10 were selected for operative management. Operative and control group were compared on basis of intensity of pain and duration of return to normal activity. Follow up was done on 5, 15, and 30 post operative day. There was less pain in operative group as compared to control group. Mean rib fracture pain in operative group was 9.15, 2.31, 1.12 as compared to 6.25, 5.96, 4.50 in control group on 5, 15 and 30 post operative days. Also there was early return to normal activity in operative group. Surgical stabilization of rib fracture, an underutilized intervention is better than conventional conservative management in terms of both, decrease in intensity of pain and early return to normal activity. Copyright © 2011 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  1. Fluoroscopic bone fragment tracking for surgical navigation in femur fracture reduction by incorporating optical tracking of hip joint rotation center.

    Science.gov (United States)

    Nakajima, Yoshikazu; Tashiro, Takahito; Sugano, Nobuhiko; Yonenobu, Kazuo; Koyama, Tsuyoshi; Maeda, Yuki; Tamura, Yuichi; Saito, Masanobu; Tamura, Shin'ichi; Mitsuishi, Mamoru; Sugita, Naohiko; Sakuma, Ichiro; Ochi, Takahiro; Matsumoto, Yoichiro

    2007-09-01

    A new method for fluoroscopic tracking of a proximal bone fragment in femoral fracture reduction is presented. The proposed method combines 2-D and 3-D image registration from single-view fluoroscopy with tracking of the head center position of the proximal femoral fragment to improve the accuracy of fluoroscopic registration without the need for repeated manual adjustment of the C-arm as required in stereo-view registrations. Kinematic knowledge of the hip joint, which has a positional correspondence with the femoral head center and the pelvis acetabular center, allows the position of the femoral fragment to be determined from pelvis tracking. The stability of the proposed method with respect to fluoroscopic image noise and the desired continuity of the fracture reduction operation is demonstrated, and the accuracy of tracking is shown to be superior to that achievable by single-view image registration, particularly in depth translation.

  2. Technical success and short-term results of surgical treatment of gastrointestinal stromal tumors: an experience of three centers.

    Science.gov (United States)

    Gluzman, Mark Igorevich; Kashchenko, Victor Anatolevich; Karachun, Aleksei Mikhailovich; Orlova, Rashida Vakhidovna; Nakatis, Iakov Aleksandrovich; Pelipas, Iurii Vasilevich; Vasiukova, Evgenia Leonidovna; Rykov, Ivan Vladimirovich; Petrova, Veronika Vladimirovna; Nepomniashchaia, Svetlana Leonidovna; Klimov, Anton Sergeevich

    2017-01-01

    Gastrointestinal stromal tumors (GIST) comprise about 80% of gastrointestinal sarcomas. In patients with localized disease, surgery is considered as "Gold Standard" treatment. Organ-sparing radical en-block resection is widely accepted practice. Since lymph node dissection is not routinely indicated, minimally invasive approach is of particular interest. The aim of this study is to investigate the short-term outcomes of different surgical treatment of GISTs. We analyzed data of 116 patients who received surgical treatment for localized forms of GIST. Tumors were located in the stomach in 87 (75%) cases, in the small intestine in 26 (22.4%) cases, and extragastrointestinal GISTs were found in 3 (2.6%) patients. Four different approaches were used-open surgery (OpS, n=48), laparoscopic surgery (LS, n=40), endoscopic procedures (EP, n=22) and hybrid rendezvous (HR, n=6). Patient demographics, clinical presentation of tumors, characteristics of operation procedures (duration, intraoperative blood loss, frequency of R0-resection and fragmentation of tumor), postoperative complications and length of hospital stay were examined in all these groups. Radical treatment (R0-resection) was performed in all patients. There were no cases of tumor ruptures during surgical procedure. Mean size of GIST in OpS was 9.1±2.0 [2-35] cm; in LS: 4.9±0.8 (1.5-15) cm; in HR: 3.5±0.8 (2-4.5) cm and in EP: 2.3±0.3 (0.4-3.5) cm. Intraoperative blood loss in OpS was 369.7±209.5 [0-4,000] mL; LS: 63.9±16.0 [0-150] mL; in HR: 96.7±44.3 [50-200] mL; in EP: 33.3±11.0 [0-150] mL. Duration of operation in OpS was 160±20.4 [50-310] min; in LS: 104.7±12.7 [50-185]; in HR: 176.7±44.0 [110-260] min and in EP: 89.8±15.5 [25-190] min. Complication rate in OpS was 5 (10.4%); in LS: 3 (7.5%); in HR: 0% and in EP: 3 (13.6%). Length of hospital stay in OpS was 13.8±2.2 [7-52] days; in LS: 11, 4±2.2 [4-21] days; in HR: 11±3.2 [7-15] days and in EP: 11, 9±2.1 [5-22] days. There were no

  3. Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience

    Directory of Open Access Journals (Sweden)

    George J Hadeed

    2016-01-01

    Full Text Available Objectives: Early diagnosis and emergent surgical debridement of necrotizing soft tissue infections (NSTIs remains the cornerstone of care. We aimed to study the effect of early surgery on patients' outcomes and, in particular, on hospital length of stay (LOS and Intensive Care Unit (ICU LOS. Materials and Methods: Over a 6-year period (January 2003 through December 2008, we analyzed the records of patients with NSTIs. We divided patients into two groups based on the time of surgery (i.e., the interval from being diagnosed and surgical intervention: Early (<6 h and late (≥6 h intervention groups. For these two groups, we compared baseline demographic characteristics, symptoms, and outcomes. For our statistical analysis, we used the Student's t-test and Pearson Chi-square (χ2 test. To evaluate the clinical predictors of early diagnosis of NSTIs, we performed multivariate logistic regression analysis. Results: In the study population (n = 87; 62% males and 38% females, age, gender, wound locations, and comorbidities were comparable in the two groups. Except for higher proportion of crepitus, the clinical presentations showed no significant differences between the two groups. There were significantly shorter hospital LOS and ICU LOS in the early than late intervention group. The overall mortality rate in our study patients with NSTIs was 12.5%, but early intervention group had a mortality of 7.5%, but this did not reach statistical significance. Conclusions: Our findings show that early surgery, within the first 6 h after being diagnosed, improves in-hospital outcomes in patients with NSTIs.

  4. A PROSPECTIVE STUDY TO ASSESS RISK FACTORS FOR SURGICAL SITE INFECTI ONS IN A TERTIARY CARE CENTER

    Directory of Open Access Journals (Sweden)

    Ashwin

    2015-03-01

    Full Text Available CONTEXT: Surgical site infections (SSI remain a significant problem following an operation and the second most frequently reported nosocomial infections. Aim: The current study was undertaken to identify various risk factors for SSI. MATERIAL AND METHODS: The prospective study was carried out on 50 abdominal surgeries of class III and class IV contamination. Details various functional parameters, laboratory inve stigation and surgery of patient were evaluated and analyzed with occurrence of wound infection . RESULTS AND CONCLUSIONS: The infection rate was 36.0% in our study population. The SSI rate was 19.04 % in contaminated ones and 48.2% in dirty surgeries. Male patients were affected more (21% than the female patients (18.88%. The SSI rate increased with increasing age and it also increased in patients with low hemoglobin. The SSI rate was higher in emergency surgeries as compared to the elective surgeries. Th e infection rate was significantly higher as the order and the duration of the surgery increased.

  5. Ordinary Men? Collaboration and Resistance in Occupied Mogilevskaya Oblast'

    Directory of Open Access Journals (Sweden)

    Luke Rodeheffer

    2010-08-01

    Full Text Available The focus of this research is to examine developments in Mogilevskaya Oblast' in eastern Belarus. How the region fell under occupation, the attitudes of the thousands of Soviet citizens who decided to collaborate with the fascist occupiers, and the divisions that developed in the population as a result of collaboration are discussed. At roughly the same time, a resistance movement, made up of partisans and underground urban fighters, developed in these occupied territories. The development, tactics, and effectiveness of these partisans and resistance fighters will be analyzed, along with the reactions of the occupying powers to this insurgency.

  6. Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008–2012

    Science.gov (United States)

    Mekaj, Agon Y.; Morina, Arsim A.; Mekaj, Ymer H.; Manxhuka-Kerliu, Suzana; Miftari, Ermira I.; Duci, Shkelzen B.; Hamza, Astrit R.; Gashi, Musli M.; Xhelaj, Mentor R.; Kelmendi, Fatos M.; Morina, Qamile Sh.

    2015-01-01

    Background: Chronic subdural hematoma (CSDH) is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. Materials and Methods: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008–2012. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Patients were analyzed in many aspects such as age, gender, etiological factors, clinical features, localization, diagnoses, methods of surgical interventions, recurrences and mortality of patients. Results: From 137 patients with CSDH, 106 (77.3%) were males and 31 (22.7%) females. Average age of patients was 62.85 years. Analyzed according to the decades, the highest number of causes with CSDH was between 70 and 79 years (46%). The head trauma has been responsible for CSDH in 88 patients (64.3%), while the main symptom was headache (92 patients or 67.1%). One burr-hole trepanation with closed drainage system has been used in majority of cases (in 101 patients or 73.7%). The recurrence of CSDH was 6.5%, whereas mortality 2.9%. Conclusion: CSDH is more common in elderly patients. The male-female ratio is 3.4:1. Like other authors we also think that treatment with one burr-hole and drainage is a method of choice, because of its simplicity and safety. PMID:25883478

  7. Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008-2012

    Directory of Open Access Journals (Sweden)

    Agon Y Mekaj

    2015-01-01

    Full Text Available Background: Chronic subdural hematoma (CSDH is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. Materials and Methods: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008-2012. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Patients were analyzed in many aspects such as age, gender, etiological factors, clinical features, localization, diagnoses, methods of surgical interventions, recurrences and mortality of patients. Results: From 137 patients with CSDH, 106 (77.3% were males and 31 (22.7% females. Average age of patients was 62.85 years. Analyzed according to the decades, the highest number of causes with CSDH was between 70 and 79 years (46%. The head trauma has been responsible for CSDH in 88 patients (64.3%, while the main symptom was headache (92 patients or 67.1%. One burr-hole trepanation with closed drainage system has been used in majority of cases (in 101 patients or 73.7%. The recurrence of CSDH was 6.5%, whereas mortality 2.9%. Conclusion: CSDH is more common in elderly patients. The male-female ratio is 3.4:1. Like other authors we also think that treatment with one burr-hole and drainage is a method of choice, because of its simplicity and safety.

  8. Estimated occupied range of the lesser prairie-chicken

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — Shown are the current estimated occupied range and the historical range of the Lesser Prairie-Chicken. The current range was updated in January 2011 by the Lesser...

  9. Attempts to prevent displacement in the occupied Palestinian territories

    OpenAIRE

    Karim Khalil

    2012-01-01

    Prevention has become a strategy increasingly adopted by the humanitarian community in addressing forced displacement in the occupied Palestinian territories, as well as responding to immediate emergency needs for families displaced or at risk of displacement.

  10. Robotic surgical telepathology between the Iron Mountain and Milwaukee Department of Veterans Affairs Medical Centers: a 12-year experience.

    Science.gov (United States)

    Dunn, Bruce E; Choi, Hongyung; Recla, Daniel L; Kerr, Sarah E; Wagenman, Benjamin L

    2009-08-01

    Since mid-1996, we have operated a diagnostic robotic telepathology (TP) system at the Iron Mountain, MI, Department of Veterans Affairs Medical Center (VAMC) from the Milwaukee, WI, VAMC, located some 220 miles away. No on-site pathologist is present in Iron Mountain. Instead, an experienced, well-trained pathologist assistant, under direction of pathologists located in Milwaukee, is responsible for tissue grossing and sectioning. The pathologist assistant places slides onto the stage of the robotic microscope, which is then controlled by pathologists in Milwaukee. Each case read by TP is subsequently read by light microscopy (LM) by the same pathologist. Three distinct phases of TP have been recognized. Our experience during phase I (mid-1996 to early 1999) has been published previously. During phase II (early 1999 to mid-2004), 1 of the 2 senior telepathologists in phase I retired, and 3 junior pathologists were hired. During phase III (mid-2004 to June 2008), 2 new junior pathologists were hired, and ASAP Imaging (Apollo Telemedicine, Inc., Falls Church, VA) was implemented. The number of TP case opportunities in phases I, II, and III was 2200, 5841, and 3512, respectively, resulting in a total of 11 553. A total of 1834 cases were deferred to LM for a variety of reasons. The number of TP diagnoses rendered in phases I, II, and III was 2144, 4636, and 2939, respectively, resulting in a total of 9719. The major discordance rates in phases I, II, and III were 0.33%, 0.45%, and 0.20%, respectively, with an overall rate of 0.35%. Pathologist-specific discordance rates were not significantly different and ranged from a low of 0.12% to a high of 0.77%, whereas case deferral rates were significantly different (P Iron Mountain clinicians have expressed great satisfaction with the services provided by their off-site pathologist colleagues.

  11. Robotic surgical telepathology between the Iron Mountain and Milwaukee Department of Veterans Affairs Medical Centers: a twelve year experience.

    Science.gov (United States)

    Dunn, Bruce E; Choi, Hongyung; Recla, Daniel L; Kerr, Sarah E; Wagenman, Benjamin L

    2009-11-01

    Since mid-1996 we have operated a diagnostic robotic telepathology (TP) system at the Iron Mountain, Michigan, Department of Veterans Affairs Medical Center (VAMC) from the Milwaukee, Wisconsin VAMC, located some 220 miles away. No on-site pathologist is present in Iron Mountain. Instead, an experienced, well-trained pathologist assistant, under direction of pathologists located in Milwaukee, is responsible for tissue grossing and sectioning. The pathologist assistant places slides onto the stage of the robotic microscope, which is then controlled by pathologists in Milwaukee. Each case read by TP is subsequently read by light microscopy (LM) by the same pathologist. Three distinct phases of TP have been recognized. Our experience during Phase I (mid-1996 through early 1999) has been published previously. During Phase II (early 1999 through mid-2004), one of the two senior telepathologists in Phase I retired and three junior pathologists were hired. During Phase III (mid-2004 though June 2008), two new junior pathologists were hired and ASAP Imaging (Apollo Telemedicine, Inc., Falls Church, VA) was implemented. The number of TP case opportunities in Phases I, II and III was 2,200; 5,841 and 3,512; respectively resulting in a total of 11,553. A total of 1,834 cases were deferred to LM for a variety of reasons. The number of TP diagnoses rendered in Phases I, II and III was 2,144; 4,636 and 2,939; respectively, for a total of 9,719. The major discordance rates in Phases I, II and III were 0.33%, 0.45% and 0.20%, respectively with an overall rate of 0.35%. Pathologist-specific discordance rates were not significantly different and ranged from a low of 0.12% to a high of 0.77%, while case deferral rates were significantly different (P Iron Mountain clinicians have expressed great satisfaction with the services provided by their off-site pathologist colleagues.

  12. Segmentation of brain structures in presence of a space-occupying lesion.

    Science.gov (United States)

    Pollo, Claudio; Cuadra, Meritxell Bach; Cuisenaire, Olivier; Villemure, Jean-Guy; Thiran, Jean-Philippe

    2005-02-15

    Brain deformations induced by space-occupying lesions may result in unpredictable position and shape of functionally important brain structures. The aim of this study is to propose a method for segmentation of brain structures by deformation of a segmented brain atlas in presence of a space-occupying lesion. Our approach is based on an a priori model of lesion growth (MLG) that assumes radial expansion from a seeding point and involves three steps: first, an affine registration bringing the atlas and the patient into global correspondence; then, the seeding of a synthetic tumor into the brain atlas providing a template for the lesion; finally, the deformation of the seeded atlas, combining a method derived from optical flow principles and a model of lesion growth. The method was applied on two meningiomas inducing a pure displacement of the underlying brain structures, and segmentation accuracy of ventricles and basal ganglia was assessed. Results show that the segmented structures were consistent with the patient's anatomy and that the deformation accuracy of surrounding brain structures was highly dependent on the accurate placement of the tumor seeding point. Further improvements of the method will optimize the segmentation accuracy. Visualization of brain structures provides useful information for therapeutic consideration of space-occupying lesions, including surgical, radiosurgical, and radiotherapeutic planning, in order to increase treatment efficiency and prevent neurological damage.

  13. Abortion - surgical

    Science.gov (United States)

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  14. Ambulatory Surgical Measures - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  15. Ambulatory Surgical Measures - Facility

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  16. Humanización de la Atención de Enfermería en el Quirófano Humanization of caring: Nursing at Surgical Center

    Directory of Open Access Journals (Sweden)

    Carolina Heluy de Castro

    2004-06-01

    Full Text Available En el quirófano, muchas veces, la atención al paciente es impersonal y, naturalmente, los problemas individuales son ignorados. El estudio pretende identificar lo que representa la humanización para los profesionales y su relación con la satisfacción del paciente de este quirófano, a través del contacto directo con ellos. Probablemente, una atención humanizada es el primer paso para alcanzar el éxito y la calidad asistencial en los servicios de salud.Often, in surgical center, patient´s attendance is impersonal and, naturally, peculiar problems are unawarred. The aim of this study is to recognize professionals and their relationship with patients´satisfaction representing around humanization, an in-depth direct contact with sanitary staff and patients at those operating rooms. Probably, a humanization of caring is the first steep to reach success and quality of attendance in the health services.

  17. 24 CFR 882.509 - Overcrowded and under occupied units.

    Science.gov (United States)

    2010-04-01

    ... PERSONS WITH DISABILITIES PROGRAM) SECTION 8 MODERATE REHABILITATION PROGRAMS Special Procedures for Moderate Rehabilitation-Program Development and Operation § 882.509 Overcrowded and under occupied units... OF HOUSING AND URBAN DEVELOPMENT (SECTION 8 HOUSING ASSISTANCE PROGRAMS, SECTION 202 DIRECT...

  18. The Academic Manifesto: From an Occupied to a Public University

    Science.gov (United States)

    Halffman, Willem; Radder, Hans

    2015-01-01

    Universities are occupied by management, a regime obsessed with "accountability" through measurement, increased competition, efficiency, "excellence", and misconceived economic salvation. Given the occupation's absurd side-effects, we ask ourselves how management has succeeded in taking over our precious universities. An…

  19. Political Education--Occupy Wall Street's First Year

    Directory of Open Access Journals (Sweden)

    Jackie DiSalvo

    2013-05-01

    Full Text Available While Occupy Wall Street (OWS is easily identified with direct action in the streets, equal recognition should be given to the vast amount of political education that took place. This article will give an overview of that and briefly assess its emphases and absences.

  20. Effect of fine management in sterilization of surgical instruments in disinfection supply center%精细化管理在消毒供应中心手术器械消毒灭菌中的应用

    Institute of Scientific and Technical Information of China (English)

    李翠娟

    2016-01-01

    目的:探讨精细化管理在消毒供应中心手术器械消毒灭菌中的应用效果。方法在1856包手术器械消毒灭菌中引入精细化管理理念。了解手术器械消毒灭菌合格率和手术室人员使用满意度。结果1856包手术器械灭菌合格率为100.0%,手术室人员满意度为99.7%。结论运用精细化管理加强对消毒供应中心手术器械的质量管理能有效提高器械灭菌的合格率,提高手术人员的满意度。%Objective To investigate the effect of fine management in disinfection and sterilization of surgical instruments in Disinfection Supply Center. Method The surgical instrument sterilization and disinfection pass rate differences and operating room personnel satisfaction were investigated. Result The pass rate of disinfection and sterilization in surgical instruments of observation group was 100.0%, the surgeon satisfaction in using surgical instruments was 99.7%. Conclusion Application of fine management in sterilization of surgical instruments in disinfection supply center can improve the passing rate of the sterilization, improve the satisfaction of the surgical staff, and also to ensure the quality of the surgical instrument in sterilization, reduce the risk of infection in patients, protect patient safety, which is worth further clinical application.

  1. Surgical Assisting

    Science.gov (United States)

    ... Insert and remove Foley urinary bladder catheter Place pneumatic tourniquet Confirm procedure with surgeon Drape patient within ... Technology and Surgical Assisting (NBSTSA) offers the CertifiedSurgical First Assistant (CSFA) credential, and the National Surgical Assistant ...

  2. Music in Nazi-Occupied Poland between 1939 and 1945

    Directory of Open Access Journals (Sweden)

    Naliwajek-Mazurek Katarzyna

    2016-12-01

    Full Text Available The paper is a survey of research on music in territories of occupied Poland conducted by the author in recent years, as well as a review of selected existing literature on this topic. A case study illustrates a principal thesis of this essay according to which music was used by the German Nazis in the General Government as a key elements of propaganda and in appropriation of conquered territories as both physical and symbolic spaces.

  3. Singly and Doubly Occupied Higher Quantum States in Nanocrystals.

    Science.gov (United States)

    Jeong, Juyeon; Yoon, Bitna; Kwon, Young-Wan; Choi, Dongsun; Jeong, Kwang Seob

    2017-02-08

    Filling the lowest quantum state of the conduction band of colloidal nanocrystals with a single electron, which is analogous to the filling the lowest unoccupied molecular orbital in a molecule with a single electron, has attracted much attention due to the possibility of harnessing the electron spin for potential spin-based applications. The quantized energy levels of the artificial atom, in principle, make it possible for a nanocrystal to be filled with an electron if the Fermi-energy level is optimally tuned during the nanocrystal growth. Here, we report the singly occupied quantum state (SOQS) and doubly occupied quantum state (DOQS) of a colloidal nanocrystal in steady state under ambient conditions. The number of electrons occupying the lowest quantum state can be controlled to be zero, one (unpaired), and two (paired) depending on the nanocrystal growth time via changing the stoichiometry of the nanocrystal. Electron paramagnetic resonance spectroscopy proved the nanocrystals with single electron to show superparamagnetic behavior, which is a direct evidence of the SOQS, whereas the DOQS of the two- or zero-electron occupied nanocrystals in the 1Se exhibit diamagnetic behavior. In combination with the superconducting quantum interference device measurement, it turns out that the SOQS of the HgSe colloidal quantum dots has superparamagnetic property. The appearance and change of the steady-state mid-IR intraband absorption spectrum reflect the sequential occupation of the 1Se state with electrons. The magnetic property of the colloidal quantum dot, initially determined by the chemical synthesis, can be tuned from diamagnetic to superparamagnetic and vice versa by varying the number of electrons through postchemical treatment. The switchable magnetic property will be very useful for further applications such as colloidal nanocrystal based spintronics, nonvolatile memory, infrared optoelectronics, catalyst, imaging, and quantum computing.

  4. Occupy's predicament: the moment and the prospects for the movement.

    Science.gov (United States)

    Gitlin, Todd

    2013-03-01

    Occupy Wall Street has stalled in its attempt to make a transition from a moment to a movement. It had a sizable impact upon the presidential election, driving America's political centre of gravity toward the left, but has been unable or unwilling to evolve beyond its original core into a 'full-service movement' that welcomes contributions from a wide range of activists at varying levels of commitment and skill and plausibly campaigns for substantial reforms. In contrast to earlier American social movements of the twentieth century, the Occupy movement began with a large popular base of support. Propped up by that support, its 'inner movement' of core activists with strong anarchist and 'horizontalist' beliefs transformed the political environment even as they disdained formal reform demands and conducted decisions in a demanding, fully participatory manner. But the core was deeply suspicious of the 'cooptive' and 'hierarchical' tendencies of the unions and membership organizations - the 'outer movement' - whose supporters made up the bulk of the participants who turned out for Occupy's large demonstrations. The 'inner movement's' awkward fit with that 'outer movement' blocked transformation into an enduring structure capable of winning substantial reforms over time. When the encampments were dispersed by governmental authorities, the core lost its ability to convert electronic communications into the energy and community that derive from face-to-face contact. The outlook for the effectiveness of the movement is decidedly limited unless an alliance of disparate groups develops to press for reforms within the political system.

  5. Conservative approach to recurrent calcifying cystic odontogenic tumor occupying the maxillary sinus: a case report

    Science.gov (United States)

    2016-01-01

    Calcifying cystic odontogenic tumor (CCOT) is an uncommon benign cystic neoplasm of the jaw that develops from the odontogenic epithelium. Invasion into the maxillary sinus by a CCOT is not a typical, and the recurrence of the cystic variant of CCOT in the posterior maxilla is rare. This report describes a recurrent CCOT occupying most of the maxillary sinus of a 24-year-old male patient. As a treatment, marsupialization was carried out as a means of decompression, and the involved teeth were all endodontically treated. Afterward, surgical enucleation was performed. The size of the lesion continued to shrink after marsupialization, and the maxillary sinus restored its volume. This patient has been followed-up for 3 years after the surgery, and there have not been any signs of recurrence. PMID:27847742

  6. Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience.

    Science.gov (United States)

    Sherrod, Brandon A; Arynchyna, Anastasia A; Johnston, James M; Rozzelle, Curtis J; Blount, Jeffrey P; Oakes, W Jerry; Rocque, Brandon G

    2017-04-01

    OBJECTIVE Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional data set specifically for better understanding SSI. METHODS The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program-Pediatric (ACS NSQIP-P) database for the years 2012-2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations. SSI included deep (intracranial abscesses, meningitis, osteomyelitis, and ventriculitis) and superficial wound infections. The authors performed univariate analyses of SSI association with procedure, demographic, comorbidity, operative, and hospital variables, with subsequent multivariate logistic regression analysis to determine independent risk factors for SSI within 30 days of the index procedure. A similar analysis was performed using a detailed institutional infection database from Children's of Alabama (COA). RESULTS A total of 9296 nonshunt procedures were identified in NSQIP-P with an overall 30-day SSI rate of 2.7%. The 30-day SSI rate in the COA institutional database was similar (3.3% of 1103 procedures, p = 0.325). Postoperative time to SSI in NSQIP-P and COA was 14.6 ± 6.8 days and 14.8 ± 7.3 days, respectively (mean ± SD). Myelomeningocele (4.3% in NSQIP-P, 6.3% in COA), spine (3.5%, 4.9%), and epilepsy (3.4%, 3.1%) procedure categories had the highest SSI rates by procedure category in both NSQIP-P and COA. Independent SSI risk factors in NSQIP-P included postoperative pneumonia (OR 4.761, 95% CI 1.269-17.857, p = 0.021), immune disease/immunosuppressant use (OR 3.671, 95% CI 1.371-9.827, p = 0.010), cerebral palsy (OR 2.835, 95% CI 1.463-5.494, p = 0.002), emergency operation (OR 1

  7. Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience

    Science.gov (United States)

    Sherrod, Brandon A.; Arynchyna, Anastasia A.; Johnston, James M.; Rozzelle, Curtis J.; Blount, Jeffrey P.; Oakes, W. Jerry; Rocque, Brandon G.

    2017-01-01

    Objective Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional dataset specifically for better understanding SSI. Methods The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS NSQIP-P) database for the years 2012–2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations. SSI included deep (intracranial abscesses, meningitis, osteomyelitis, and ventriculitis) and superficial wound infections. The authors performed univariate analyses of SSI association with procedure, demographic, comorbidity, operative, and hospital variables, with subsequent multivariate logistic regression analysis to determine independent risk factors for SSI within 30 days of the index procedure. A similar analysis was performed using a detailed institutional infection database from Children’s Hospital of Alabama (COA). Results A total of 9296 nonshunt procedures were identified in NSQIP-P with an overall 30-day SSI rate of 2.7%. The 30-day SSI rate in the COA institutional database was similar (3.3% of 1103 procedures, p = 0.325). Postoperative time to SSI in NSQIP-P and COA was 14.6 ± 6.8 days and 14.8 ± 7.3 days, respectively (mean ± SD). Myelomeningocele (4.3% in NSQIP-P, 6.3% in COA), spine (3.5%, 4.9%), and epilepsy (3.4%, 3.1%) procedure categoriess had the highest SSI rates by procedure category in both NSQIP-P and COA. Independent SSI risk factors in NSQIP-P included postoperative pneumonia (OR 4.761, 95% CI 1.269–17.857, p = 0.021), immune disease/immunosuppressant use (OR 3.671, 95% CI 1.371–9.827, p = 0.010), cerebral palsy (OR 2.835, 95% CI 1.463–5.494, p = 0.002), emergency

  8. Maternal and child health in the occupied Palestinian territory.

    Science.gov (United States)

    Rahim, Hanan F Abdul; Wick, Laura; Halileh, Samia; Hassan-Bitar, Sahar; Chekir, Hafedh; Watt, Graham; Khawaja, Marwan

    2009-03-14

    The Countdown to 2015 intervention coverage indicators in the occupied Palestinian territory are similar to those of other Arab countries, although there are gaps in continuity and quality of services across the continuum of the perinatal period. Since the mid 1990s, however, access to maternity facilities has become increasingly unpredictable. Mortality rates for infants (age sustainable development, and the universal right to health care, women and children should not have to wait. Urgent action from international and local decision makers is needed for sustainable access to high-quality care and basic health entitlements.

  9. Trust the process: community health psychology after Occupy.

    Science.gov (United States)

    Cornish, Flora; Montenegro, Cristian; van Reisen, Kirsten; Zaka, Flavia; Sevitt, James

    2014-01-01

    This article argues that community health psychology's core strategy of 'community mobilisation' is in need of renewal and proposes a new way of conceptualising community health action. Taking the Occupy movement as an example, we critique modernist understandings of community mobilisation, which are based on instrumental action in the service of a predetermined goal. Aiming to re-invigorate the 'process' tradition of community health psychology, we explore possibilities of an open-ended, anti-hierarchical and inclusive mode of community action, which we label 'trusting the process'. The gains to be made are unpredictable, but we suggest that the risk is worth taking.

  10. Ambulatory Surgical Facilities, Licensed Ambulatory Sugery Centers, Published in 2007, 1:24000 (1in=2000ft) scale, State of California - Office of the State Chief Information Officer.

    Data.gov (United States)

    NSGIC GIS Inventory (aka Ramona) — This Ambulatory Surgical Facilities dataset, published at 1:24000 (1in=2000ft) scale, was produced all or in part from Published Reports/Deeds information as of...

  11. The Southeast Fisheries Science Center (SEFSC)

    Data.gov (United States)

    Federal Laboratory Consortium — The Southeast Fisheries Science Center (SEFSC) is headquartered in Miami, FL. The SEFSC is responsible for scientific research on living marine resources that occupy...

  12. Experimental Investigation of Ventilation Efficiency in a Dentistry Surgical Room

    Directory of Open Access Journals (Sweden)

    Oladokun Majeed Olaide

    2016-01-01

    Full Text Available As a response to the need to provide an acceptable thermal comfort and air quality in indoor environments, various ventilation performance indicators were developed over the years. These metrics are mainly geared towards air distribution, heat and pollutant removals. Evidence exists of influencing factors on these indicators as centered on ventilation design and operations. Unlike other indoor environments, health care environment requires better performance of ventilation system to prevent an incidence of nosocomial and other hospital acquired illnesses. This study investigates, using in-situ experiments, the ventilation efficiency in a dentistry surgical room. Thermal and hygric parameters were monitored on the air terminal devices and occupied zone over a period of one week covering both occupied and unoccupied hours. The resulting time-series parameters were used to evaluate the room’s ventilation effectiveness. Also, the obtained parameters were benchmarked against ASHRAE 170 (2013 and MS1525 (2014 requirements for ventilation in health care environment and building energy efficiency respectively. The results show that the mean daily operative conditions failed to satisfy the provisions of both standards. Regarding effectiveness, the findings reveal that the surgical room ventilation is ineffective with ventilation efficiency values ranging between 0 and 0.5 indicating air distribution short-circuiting. These results suggest further investigations, through numerical simulation, on the effect of this short-circuiting on thermal comfort, infection risk assessments and possible design improvements, an endeavour that forms our next line of research inquiries.

  13. Mesenteric gastrointestinal stromal tumour presenting as intracranial space occupying lesion

    Science.gov (United States)

    Puri, Tarun; Gunabushanam, Gowthaman; Malik, Monica; Goyal, Shikha; Das, Anup K; Julka, Pramod K; Rath, Goura K

    2006-01-01

    Background Gastrointestinal stromal tumours (GIST) usually present with non-specific gastrointestinal symptoms such as abdominal mass, pain, anorexia and bowel obstruction. Methods We report a case of a 42 year old male who presented with a solitary intracranial space occupying lesion which was established as a metastasis from a mesenteric tumour. Results The patient was initially treated as a metastatic sarcoma, but a lack of response to chemotherapy prompted testing for CD117 which returned positive. A diagnosis of mesenteric GIST presenting as solitary brain metastasis was made, and the patient was treated with imatinib. Conclusion We recommend that all sarcomas with either an intraabdominal or unknown origin be routinely tested for CD117 to rule out GIST. PMID:17105654

  14. Occupy Wall Street, the Global Crisis, and Antisystemic Movements

    Directory of Open Access Journals (Sweden)

    Thomas Reifer

    2015-08-01

    Full Text Available The ancient discussion about the purposes of wealth and the conflict between oligarchy- rule of the rich - and democracy- the rule of the demos/the people comes to the fore once again within the current systemic crisis, from the Arab Spring to the Occupy protests, to the Arab Fall. Even as counterrevolution and growing regional and global turbulence - political, economic and military - appear to be triumphing over the new wave of democratic revolutions and rebellions, at least in the Arab world, with the threat of regional and global conflagration all too real, the underlying structural causes reality of a militarized capitalist world-system in deep crisis will ensure continued waves of antisystemic protests for years to come.

  15. Occupy Wall Street: From Representation to Post-Representation

    Directory of Open Access Journals (Sweden)

    Simon Tormey

    2012-03-01

    Full Text Available Trying to assess something as recent and dynamic as Occupy Wall Street (OWS presents problems for political analysts. There is always a danger that by the time one has written in judgement the event-movement will have morphed into something quite different. For this reason alone we need to be careful about offering too definitive a judgment on what it represents, about what we think is new in the phenomenon as well as what we think presents linkages to the past. On the one hand, OWS is still in the process of becoming-something . On the other hand, though, we can see the outline of more or less familiar characteristics that might help orientate us towards something that is being greeted as a new departure.

  16. Occupy Wall Street’ and IPE: Insights and Implications

    Directory of Open Access Journals (Sweden)

    Elizabeth Cobbett

    2012-03-01

    Full Text Available The academic discipline of International Political Economy (IPE is a hard-nosed and empirically-oriented field of study. The usual subjects of IPE often include the organization of international trade, global finance, transnational production, national welfare and competitiveness, productivity levels and of course state actions and expenditures. The actions of a handful of protestors such as the ‘Occupy Wall Street’(OWS movement rarely attract academic attention. In this case, however, we should take note. In our view, the actions of OWS provide further clues that we are entering an era of significant transformation in the organization and structure of world order. The insights generated by reflecting on this movement suggest that the inter-subjective mentality at the heart of global capitalism is no longer coherent, with the implication thatwe are at long last about to leave behind a half century of American hegemony.

  17. Containment testing for occupied and unoccupied laboratory chemical hoods

    Energy Technology Data Exchange (ETDEWEB)

    Greenley, P.L.; DiBerardinis, L.J.; Lorch, F.A.

    1999-07-01

    Containment of hazards in a laboratory chemical hood is based on the principle that air drawn through the face area of the hood is sufficient to overcome the many challenges at or near the opening. Challenges to overcome include, but are not limited to, air velocities near the hood, movement of the researcher, people walking past the hood, location of equipment inside the hood, size of the sash opening, and the shape and configuration of entrance conditions. To overcome these challenges, a sufficient face velocity must be maintained. Determining that proper face velocity must be maintained. Determining that proper face velocity for a given hood should be resolved by the system designer, facility safety officer, and researcher with these and other issues in mind. This research tests for containment at 100 feet per minute (fpm) face velocity on occupied hoods and tests the same hoods for containment at the reduced velocity of 60 fpm when unoccupied. Three laboratory chemical hoods of different sizes with several ash positions are used. The test results show that under ideal conditions in a test laboratory, an unoccupied hood (without a manikin) at 60 fpm contains as good as, if not better than, an occupied hood (with a manikin) at 100 fpm, as measured by the tracer gas tests specified in ANSI/ASHRAE 110-1995, Method of Testing Performance of Laboratory Fume Hoods (ASHRAE 1995). Further testing is needed to determine if this relationship is the same under conditions of actual use, i.e., cluttered hoods and presence of cross-drafts.

  18. Risk factors of positive surgical margin and biochemical recurrence of patients treated with radical prostatectomy:a single-center 10-year report

    Institute of Scientific and Technical Information of China (English)

    LI Kin; LI Hong; YANG Yong; Ian Lap-hong; Pun Wai-hong; Ho Son-fat

    2011-01-01

    Background Many studies have shown that positive surgical margin and biochemical recurrence could impact the life of patients with prostate cancer treated with radical prostatectomy. With more and more patients with prostate cancer appeared in recent 20 years in China,it is necessary to investigate the risk of positive surgical margin and biochemical recurrence,and their possible impact on the prognosis of patients treated with radical prostatectomy. In this study,we analyzed the characteristics of patients with prostate cancer who had undergone radical prostatectomy in Macau area and tried to find any risk factor of positive surgical margin and biochemical recurrence and their relationship with the prognosis of these patients.Methods From 2000 to 2009,149 patients with prostate cancer received radical prostatectomy and were followed up.Among these patients,111 received retropubic radical prostatectomies,38 received laparoscopic radical prostatectomies.All patients were followed-up on in the 3rd month,6th month and from that point on every 6 months after operation. At each follow-up a detailed record of any complaint,serum prostate-specific antigen (PSA),full biochemical test and uroflowmetry was acquired.Results The average age was (69.0±6.1) years,preoperative average serum PSA was (10.1 ±12.1) ng/ml and average Gleason score was 6.4±1.3. The incidence of total complications was about 47.7%,the incidence of the most common complication,bladder outlet obstruction,was about 26.8%,and that of the second most common complication,urinary stress incontinence,was about 16.1% (mild 9.4% and severe 6.7%). The incidence of positive surgical margin was about 38.3%. The preoperative serum PSA ((13.4±17.6) ng/ml),average Gleason score (7.1±1.3) and pathological T stage score (7.0±1.4) were higher in patients with positive surgical margins than those with negative margins ((8.0±5.8) ng/ml,6.0±1.2 and 5.4±1.4,respectively) (P=0.004,P=0.001 and P=0.001,respectively). A

  19. Number of Published Randomized Controlled Multi Center Trials Testing Pharmacological Interventions or Devices Is Increasing in Both Medical and Surgical Specialties

    DEFF Research Database (Denmark)

    Danielsen, Anne Kjaergaard; Okholm, Cecilie; Pommergaard, Hans-Christian;

    2014-01-01

    in 1995 to 1,273 in 2010, with a larger share of multicenter studies being performed in Europe and North America. The pharmacological interventions were primarily being tested in medical studies followed by the device tests predominantly in surgical studies. The number of included patients as well...

  20. Blood transfusion in the surgical treatment of adolescent idiopathic scoliosis-a single-center experience of patient blood management in 210 cases

    DEFF Research Database (Denmark)

    Ohrt-Nissen, Søren; Bukhari, Naeem; Dragsted, Casper

    2017-01-01

    BACKGROUND: The surgical treatment of adolescent idiopathic scoliosis can be associated with substantial blood loss, requiring allogeneic red blood cell (RBC) transfusion. This study describes the use of RBC and the effect of a standardized perioperative patient blood management program. STUDY...

  1. In-hospital Surgical Delay Does Not Increase the Risk for Perforated Appendicitis in Children: A Single-center Retrospective Cohort Study.

    Science.gov (United States)

    Almström, Markus; Svensson, Jan F; Patkova, Barbora; Svenningsson, Anna; Wester, Tomas

    2017-03-01

    To investigate the correlation between in-hospital surgical delay before appendectomy for suspected appendicitis and the finding of perforated appendicitis in children. All children undergoing acute appendectomy for suspected acute appendicitis at Karolinska University Hospital, Stockholm, Sweden from 2006 to 2013 were reviewed for the exposure of surgical delay. Primary endpoint was the histopathologic finding of perforated appendicitis. The main explanatory variable was in-hospital surgical delay, using surgery within 12 hours as reference. Secondary endpoints were postoperative wound infection, intra-abdominal abscess, reoperation, length of hospital stay, and readmission. To adjust for selection bias, a logistic regression model was created to estimate odds ratios for the main outcome measures. Missing data were replaced using multiple imputation. The study comprised 2756 children operated for acute appendicitis. Six hundred sixty-one (24.0%) had a histopathologic diagnosis of perforated appendicitis. In the multivariate logistic regression analysis, increased time to surgery was not associated with increased risk of histopathologic perforation. There was no association between the timing of surgery and postoperative wound infection, intra-abdominal abscess, reoperation, or readmission. In-hospital delay of acute appendectomy in children was not associated with an increased rate of histopathologic perforation. Timing of surgery was not an independent risk factor for postoperative complications. The results were not dependent on the magnitude of the surgical delay. The findings are analogous with previous findings in adults and may aid the utilization of available hospital- and operative resources.

  2. The accuracy of echocardiography versus surgical and pathological classification of patients with ruptured mitral chordae tendineae: a large study in a Chinese cardiovascular center

    Directory of Open Access Journals (Sweden)

    Bai Zhigang

    2011-07-01

    Full Text Available Abstract Background The accuracy of echocardiography versus surgical and pathological classification of patients with ruptured mitral chordae tendineae (RMCT has not yet been investigated with a large study. Methods Clinical, hemodynamic, surgical, and pathological findings were reviewed for 242 patients with a preoperative diagnosis of RMCT that required mitral valvular surgery. Subjects were consecutive in-patients at Fuwai Hospital in 2002-2008. Patients were evaluated by thoracic echocardiography (TTE and transesophageal echocardiography (TEE. RMCT cases were classified by location as anterior or posterior, and classified by degree as partial or complete RMCT, according to surgical findings. RMCT cases were also classified by pathology into four groups: myxomatous degeneration, chronic rheumatic valvulitis (CRV, infective endocarditis and others. Results Echocardiography showed that most patients had a flail mitral valve, moderate to severe mitral regurgitation, a dilated heart chamber, mild to moderate pulmonary artery hypertension and good heart function. The diagnostic accuracy for RMCT was 96.7% for TTE and 100% for TEE compared with surgical findings. Preliminary experiments demonstrated that the sensitivity and specificity of diagnosing anterior, posterior and partial RMCT were high, but the sensitivity of diagnosing complete RMCT was low. Surgical procedures for RMCT depended on the location of ruptured chordae tendineae, with no relationship between surgical procedure and complete or partial RMCT. The echocardiographic characteristics of RMCT included valvular thickening, extended subvalvular chordae, echo enhancement, abnormal echo or vegetation, combined with aortic valve damage in the four groups classified by pathology. The incidence of extended subvalvular chordae in the myxomatous group was higher than that in the other groups, and valve thickening in combination with AV damage in the CRV group was higher than that in the other

  3. RENT Gross Rent for Renter Occupied Units NMHD 2000

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The 2006 Second Edition TIGER/Line files are an extract of selected geographic and cartographic information from the Census TIGER database. The geographic coverage...

  4. HOUSING TENURE Occupied Units by Tenure NMSD 2000

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The 2006 Second Edition TIGER/Line files are an extract of selected geographic and cartographic information from the Census TIGER database. The geographic coverage...

  5. RENT Gross Rent for Renter Occupied Units NMSD 2000

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The 2006 Second Edition TIGER/Line files are an extract of selected geographic and cartographic information from the Census TIGER database. The geographic coverage...

  6. HOUSING UNITS Units in Structure for Occupied Units NMSD 2000

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The 2006 Second Edition TIGER/Line files are an extract of selected geographic and cartographic information from the Census TIGER database. The geographic coverage...

  7. HOUSING TENURE Occupied Units by Tenure NMHD 2000

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The 2006 Second Edition TIGER/Line files are an extract of selected geographic and cartographic information from the Census TIGER database. The geographic coverage...

  8. HOUSING UNITS Units in Structure for Occupied Units NMHD 2000

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The 2006 Second Edition TIGER/Line files are an extract of selected geographic and cartographic information from the Census TIGER database. The geographic coverage...

  9. Problems and solutions of management of external surgical instruments in sterilization supply center%外来手术器械在消毒供应中心管理中的问题和对策

    Institute of Scientific and Technical Information of China (English)

    武立娟; 刘春宇

    2011-01-01

    Objective: To introduce the problems and management strategies of taking over external surgical instruments by the sterilization supply center. Methods: The external surgical instruments were divided into the long-term fixed site storage and temporary outgoing delivery, of which both were included into the standardized management processes of the sterilization supply center entirely. The criteria for receiving, cleaning, disinfection, packaging, sterilization, storage, distri -bution and quality inspection were standardized, and the quality control management and quality retrospective registration system were established. Results: The air cleanliness of the operating room was promoted and the cleaning, packaging and sterilization quality of external surgical instruments were improved, which guaranteed the safe use of external instruments and the effective control of hospital infection. Conclusion: The sterilization supply center taking over external surgical instruments can make the best of the modern cleaning, disinfection and sterilization resources of the center, thereby making the nursing work more specialized and standardized.%目的:介绍消毒供应中心承接外来手术器械管理中存在的问题和管理对策.方法:将外来手术器械分为长期定点存放和临时外送两部分,并将这两部分器械全面纳入消毒供应中心标准化管理流程,规范了接收、清洗、消毒、包装、灭菌、存放、发放、质量检测标准,构建了质量监控管理、质量追溯登记制度.结果:提升了洁净手术室空气的洁净度,提高了外来手术器械清洗、包装、灭菌质量,确保外来器械的安全使用,有效控制医院感染的发生.结论:消毒供应中心承接外来手术器械管理,可充分利用中心供应室现代化清洗、消毒、灭菌资源,使护理工作更加专业化、标准化.

  10. The Topology of a Discussion: The #Occupy Case.

    Directory of Open Access Journals (Sweden)

    Floriana Gargiulo

    Full Text Available We analyse a large sample of the Twitter activity that developed around the social movement 'Occupy Wall Street', to study the complex interactions between the human communication activity and the semantic content of a debate.We use a network approach based on the analysis of the bipartite graph @Users-#Hashtags and of its projections: the 'semantic network', whose nodes are hashtags, and the 'users interest network', whose nodes are users. In the first instance, we find out that discussion topics (#hashtags present a high structural heterogeneity, with a relevant role played by the semantic hubs that are responsible to guarantee the continuity of the debate. In the users' case, the self-organisation process of users' activity, leads to the emergence of two classes of communicators: the 'professionals' and the 'amateurs'.Both the networks present a strong community structure, based on the differentiation of the semantic topics, and a high level of structural robustness when certain sets of topics are censored and/or accounts are removed.By analysing the characteristics of the dynamical networks we can distinguish three phases of the discussion about the movement. Each phase corresponds to a specific moment of the movement: from declaration of intent, organisation and development and the final phase of political reactions. Each phase is characterised by the presence of prototypical #hashtags in the discussion.

  11. Esophageal space-occupying lesion caused by Ascaris lumbricoides

    Institute of Scientific and Technical Information of China (English)

    Ping-Ping Zheng; Bing-Yuan Wang; Fei Wang; Ran Ao; Ying Wang

    2012-01-01

    Ascaris lumbricoides is the largest intestinal nematode parasite of man,which can lead to various complications because of its mobility.As the esophagus is not normal habitat of Ascaris,the report of esophageal ascariasis is rare.An old female presented with dysphagia after an intake of several red bean buns and haw jellies.The barium meal examination revealed a spherical defect in the lower esophagus.Esophageal bezoar or esophageal carcinoma was considered at the beginning.The patient fasted,and received fluid replacement treatment as well as some oral drugs such as proton pump inhibitor and sodium bicarbonate.Then upper gastrointestinal endoscopy was done to further confirm the diagnosis and found a live Ascaris lumbricoides in the gastric antrum and two in the duodenal bulb.The conclusive diagnosis was ascariasis.The esophageal space-occupying lesion might be the entangled worm bolus.Anthelmitnic treatment with mebendazole improved patient's clinical manifestations along with normalization of the radiological findings during a 2-wk follow-up.Authors report herein this rare case of Ascaris lumbricoides in the esophagus,emphasizing the importance of awareness of this parasitic infection as it often presents with different and unspecific symptoms.

  12. Esophageal space-occupying lesion caused by Ascaris lumbricoides.

    Science.gov (United States)

    Zheng, Ping-Ping; Wang, Bing-Yuan; Wang, Fei; Ao, Ran; Wang, Ying

    2012-04-07

    Ascaris lumbricoides is the largest intestinal nematode parasite of man, which can lead to various complications because of its mobility. As the esophagus is not normal habitat of Ascaris, the report of esophageal ascariasis is rare. An old female presented with dysphagia after an intake of several red bean buns and haw jellies. The barium meal examination revealed a spherical defect in the lower esophagus. Esophageal bezoar or esophageal carcinoma was considered at the beginning. The patient fasted, and received fluid replacement treatment as well as some oral drugs such as proton pump inhibitor and sodium bicarbonate. Then upper gastrointestinal endoscopy was done to further confirm the diagnosis and found a live Ascaris lumbricoides in the gastric antrum and two in the duodenal bulb. The conclusive diagnosis was ascariasis. The esophageal space-occupying lesion might be the entangled worm bolus. Anthelmitnic treatment with mebendazole improved patient's clinical manifestations along with normalization of the radiological findings during a 2-wk follow-up. Authors report herein this rare case of Ascaris lumbricoides in the esophagus, emphasizing the importance of awareness of this parasitic infection as it often presents with different and unspecific symptoms.

  13. Conservative/surgical treatment predictors of maternal hydronephrosis: results of a single-center retrospective non-randomized non-controlled observational study.

    Science.gov (United States)

    Ercil, Hakan; Arslan, Burak; Ortoglu, Ferhat; Alma, Ergun; Unal, Umut; Deniz, Mehmet Eflatun; Senturk, Aykut Bugra; Gurbuz, Zafer Gokhan

    2017-08-01

    To determine the parameters that may help the clinicians decide the best suitable treatment method for the pregnant women with symptomatic hydronephrosis which will be based on the easily accessible laboratory tests, monitoring methods and clinical symptoms. Digital data and documents of 246 pregnant women with symptomatic hydronephrosis who were hospitalized in our clinic between the dates of January 2011 and January 2016 were retrospectively evaluated. All patients were statistically evaluated in terms of age, symptomatic maximal anterior-posterior diameter of the renal pelvis (MADP), parity, C-reactive protein (CRP) level, white blood cell count (WBC), presence of pyuria, growth of urine culture, fever, serum urine and creatinine levels, visual analog scale (VAS) score of pre- and post-therapy and threatened preterm labor. The study includes a total of 211 pregnant women with symptomatic hydronephrosis. In the second and third trimester groups, the surgical treatment group statistically provided higher levels of CRP, WBC and VAS. Mean MADP in the second trimester of the conservative and surgical groups where symptomatic hydronephrosis was on the right side was 16.67 ± 4.67 and 28.68 ± 7.70 mm, respectively. Mean MADP in the third trimester group of the conservative and surgical groups where symptomatic hydronephrosis was on the right side was 16.96 ± 5.96 and 28.85 ± 7.64 mm, respectively. In patients with symptomatic pregnancy hydronephrosis, the likelihood of surgical treatment for CRP levels, WBC counts and VAS is high.

  14. Three-year and five-year outcomes of surgical resection for pancreatic ductal adenocarcinoma: Long-term experiences in one medical center.

    Science.gov (United States)

    Hsu, Chih-Po; Hsu, Jun-Te; Liao, Chien-Hung; Kang, Shih-Ching; Lin, Being-Chuan; Hsu, Yu-Pao; Yeh, Chun-Nan; Yeh, Ta-Sen; Hwang, Tsann-Long

    2016-12-20

    Pancreatic ductal adenocarcinoma is one of the most malignant types of cancer. This study evaluated the 3-year and 5-year surgical outcomes associated with the cancer and determined whether statistically identified factors can be used to predict survival. This retrospective review was conducted from 1995 to 2010. Patients who had resectable pancreatic ductal adenocarcinoma and received surgical treatment were included. Cases of hospital mortality were excluded. The relationships between several clinicopathological factors and the survival rate were analyzed. A total of 223 patients were included in this study. The 3-year and 5-year survival rates were 21.4% and 10.1%, respectively, and the median survival was 16.1 months. Tumor size, N status, and resection margins were independent predictive factors for 3-year survival. Tumor size independently predicted 5-year survival. Tumor size is the most important independent prognostic factor for 3-year and 5-year survival. Lymph node status and the resection margins also independently affected the 3-year survival. These patient outcomes might be improved by early diagnosis and radical resection. Future studies should focus on the tumor biology of this aggressive cancer. Copyright © 2016. Published by Elsevier Taiwan.

  15. From occupying to inhabiting - a change in conceptualising comfort

    Science.gov (United States)

    Jaffari, Svenja D.; Matthews, Ben

    2009-11-01

    ; secondly, that it promotes technologies that treat environmental parameters as variables for our manipulation, rather than opportunities to reflect on, and adjust our own (temporal human) fit with our environment. Borrowing from Cole et al. [4], we argue for technologies that enable users to inhabit rather than occupy the built environment.

  16. Infarct size in primary angioplasty without on-site cardiac surgical backup versus transferal to a tertiary center: a single photon emission computed tomography study

    Energy Technology Data Exchange (ETDEWEB)

    Knaapen, Paul; Rossum, Albert C. van [VU University Medical Center, Department of Cardiology, Amsterdam (Netherlands); Mulder, Maarten de; Peels, Hans O.; Cornel, Jan H.; Umans, Victor A.W.M. [Medical Center Alkmaar, Department of Cardiology, Alkmaar (Netherlands); Zant, Friso M. van der [Medical Center Alkmaar, Department of Nuclear Medicine, Alkmaar (Netherlands); Twisk, Jos W.R. [VU University Medical Center, Department of Clinical Epidemiology and Biostatistics, Amsterdam (Netherlands)

    2009-02-15

    Primary percutaneous coronary intervention (PCI) performed in large community hospitals without cardiac surgery back-up facilities (off-site) reduces door-to-balloon time compared with emergency transferal to tertiary interventional centers (on-site). The present study was performed to explore whether off-site PCI for acute myocardial infarction results in reduced infarct size. One hundred twenty-eight patients with acute ST-segment elevation myocardial infarction were randomly assigned to undergo primary PCI at the off-site center (n = 68) or to transferal to an on-site center (n = 60). Three days after PCI, {sup 99m}Tc-sestamibi SPECT was performed to estimate infarct size. Off-site PCI significantly reduced door-to-balloon time compared with on-site PCI (94 {+-} 54 versus 125 {+-} 59 min, respectively, p < 0.01), although symptoms-to-treatment time was only insignificantly reduced (257 {+-} 211 versus 286 {+-} 146 min, respectively, p = 0.39). Infarct size was comparable between treatment centers (16 {+-} 15 versus 14 {+-} 12%, respectively p = 0.35). Multivariate analysis revealed that TIMI 0/1 flow grade at initial coronary angiography (OR 3.125, 95% CI 1.17-8.33, p = 0.023), anterior wall localization of the myocardial infarction (OR 3.44, 95% CI 1.38-8.55, p < 0.01), and development of pathological Q-waves (OR 5.07, 95% CI 2.10-12.25, p < 0.01) were independent predictors of an infarct size > 12%. Off-site PCI reduces door-to-balloon time compared with transferal to a remote on-site interventional center but does not reduce infarct size. Instead, pre-PCI TIMI 0/1 flow, anterior wall infarct localization, and development of Q-waves are more important predictors of infarct size. (orig.)

  17. Surgical Management of Fistula-in-ano Among Patients With Crohn's Disease: Analysis of Outcomes After Fistulotomy or Seton Placement-Single-Center Experience.

    Science.gov (United States)

    Papaconstantinou, I; Kontis, E; Koutoulidis, V; Mantzaris, G; Vassiliou, I

    2017-09-01

    Fistula-in-ano is a common problem among patients with Crohn's disease and carries significant morbidity. We aimed to study the outcomes of surgical treatment of fistula-in-ano after fistulotomy or seton placement in patients with perianal fistulizing Crohn's disease. A retrospective observational study of 59 patients diagnosed with Crohn's disease, who were treated surgically for fistula-in-ano between 2010 and 2014 in our department. The assessment of disease complexity included a detailed physical examination, magnetic resonance imaging of the rectum, and examination under anesthesia. Outcomes for analysis included wound healing rate and postoperative incontinence. High transsphincteric fistula was found in 44% of the patients, while mid or low transsphincteric fistulas were found in 51%. Three women (5%) had a rectovaginal fistula. All patients with high transsphincteric fistulas were treated with loose seton placement. Patients with mid- or low-level transsphincteric fistula were offered either fistulotomy or seton placement based on the clinical evaluation. The mean follow-up duration was 1.6 ± 1.1 years. In terms of recurrence, one patient treated with seton placement presented with recurrence 6 months after seton removal and one patient with fistulotomy failed to achieve wound healing. Minor incontinence was found in six patients treated with fistulotomy and in three patients treated with seton placement; however, this difference was not significant (chi-square = 1.723, df = 1, Monte-Carlo: p = 0.273). Fistulotomy could achieve good results in terms of wound healing and incontinence in strictly selected patients with Crohn's disease suffering from low-lying transsphincteric fistulae. For more high-lying or complicated fistulae, seton placement is more appropriate. For high transsphincteric fistulae, the only option is placement of loose seton.

  18. Acute Traumatic Subdural Hematoma: Surgical Management in the Presence of Cerebral Herniation-A Single-Center Series and Multivariate Analysis.

    Science.gov (United States)

    Hamed, Motaz; Schuss, Patrick; Daher, Frederick H; Borger, Valeri; Güresir, Ági; Vatter, Hartmut; Güresir, Erdem

    2016-10-01

    Traumatic acute subdural hematoma (aSDH) is a severe disease. Surgical treatment is still controversially discussed, especially in patients with additional signs of cerebral herniation. However, previously investigated patient populations were heterogeneous. We therefore performed an analysis of our institutional data in a large homogenous selection of patients with traumatic aSDH to analyze factors determining clinical outcome. Between 2010 and 2014, 196 patients with aSDH underwent surgical treatment in our department. Information including patient characteristics, treatment modality, radiologic features, and functional outcome were analyzed. Outcome was assessed according to the Glasgow Outcome Scale (GOS) at 6 months and was dichotomized into favorable (GOS score, 1-3) and unfavorable (GOS score 4-5) outcome. Furthermore, a multivariate analysis was performed to identify independent predictors of functional outcome. Overall, 26% of patients with aSDH achieved favorable outcome. In further analysis, unilateral or bilateral dilated pupils as a sign of cerebral herniation were present in 47% of the included patients. In the multivariate analysis, age >70 years and the presence of cerebral herniation were significant prognostic predictors for unfavorable outcome in patients with aSDH. However, 15% of patients with aSDH and signs of cerebral herniation achieved favorable outcome during follow-up. We provide detailed data on patients with aSDH and signs of cerebral herniation. Despite mydriasis, favorable outcome may be achieved in many patients. Nevertheless, careful individual decision making is necessary for each patient, especially when signs of cerebral herniation have persisted for a long time. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Pancreaticoduodenectomy in patients ≥ 75 years of age: Are there any differences with other age ranges in oncological and surgical outcomes? Results from a tertiary referral center.

    Science.gov (United States)

    Paiella, Salvatore; De Pastena, Matteo; Pollini, Tommaso; Zancan, Giovanni; Ciprani, Debora; De Marchi, Giulia; Landoni, Luca; Esposito, Alessandro; Casetti, Luca; Malleo, Giuseppe; Marchegiani, Giovanni; Tuveri, Massimiliano; Marrano, Enrico; Maggino, Laura; Secchettin, Erica; Bonamini, Deborah; Bassi, Claudio; Salvia, Roberto

    2017-05-07

    To compare surgical and oncological outcomes after pancreaticoduodenectomy (PD) in patients ≥ 75 years of age with two younger cohorts of patients. The prospectively maintained Institutional database of pancreatic resection was queried for patients aged ≥ 75 years (late elderly, LE) submitted to PD for any disease from January 2010 to June 2015. We compared clinical, demographic and pathological features and survival outcomes of LE patients with 2 exact matched cohorts of younger patients [≥ 40 to 64 years of age (adults, A) and ≥ 65 to 74 years of age (young elderly, YE)] submitted to PD, according to selected variables. The final LE population, as well as the control groups, were made of 96 subjects. Up to 71% of patients was operated on for a periampullary malignancy and pancreatic cancer (PDAC) accounted for 79% of them. Intraoperative data (estimated blood loss and duration of surgery) did not differ among the groups. The overall complication rate was 65.6%, 61.5% and 58.3% for LE, YE and A patients, respectively, P = NS). Reoperation and cardiovascular complications were significantly more frequent in LE than in YE and A groups (P = 0.003 and P = 0.019, respectively). When considering either all malignancies and PDAC only, the three groups did not differ in survival. Considering all benign diseases, the estimated mean survival was 58 and 78 mo for ≥ and < 75 years of age (YE + A groups), respectively (P = 0.012). Age is not a contraindication for PD. A careful selection of LE patients allows to obtain good surgical and oncological results.

  20. Surgical Navigation

    DEFF Research Database (Denmark)

    Azarmehr, Iman; Stokbro, Kasper; Bell, R. Bryan

    2017-01-01

    were identified in the field of traumatology. Treatment of complex orbital fractures was considerably improved by the use of SN compared with traditionally treated control groups. Conclusions: SN seems to be a very promising addition to the surgical toolkit. Planning details of the surgical procedure...... in a 3-dimensional virtual environment and execution with real-time guidance can significantly improve precision. Among factors to be considered are the financial investments necessary and the learning curve....

  1. Length of stay and cost for surgical site infection after abdominal and cardiac surgery in Japanese hospitals: multi-center surveillance.

    Science.gov (United States)

    Kusachi, Shinya; Kashimura, Nobuichi; Konishi, Toshiro; Shimizu, Junzo; Kusunoki, Masato; Oka, Masaaki; Wakatsuki, Toshiro; Kobayashi, Junjiro; Sawa, Yoshiki; Imoto, Hiroshi; Motomura, Noboru; Makuuchi, Haruo; Tanemoto, Kazuo; Sumiyama, Yoshinobu

    2012-08-01

    This study evaluated the influence of surgical site infections (SSIs) after abdominal or cardiac surgery on the post-operative duration of hospitalization and cost. A retrospective 1:1 matched case-control study of length of stay and healthcare expenditures for patients who were discharged from nine hospitals, between April 1, 2006 and March 31, 2008, after undergoing abdominal or cardiac surgery and who did and did not have a SSI. Information was obtained from 246 pairs of patients who had undergone abdominal surgery and 27 pairs of patients who had undergone cardiac surgery. Overall, the mean post-operative hospitalization was 20.7 days longer and the mean post-operative healthcare expenditure was $8,791 higher in the SSI group than for the SSI-free group. Among the patients who had undergone abdominal surgery, development of SSI extended the average hospitalization by 17.6 days and increased the average healthcare expenditure by $6,624. Among the patients who had undergone cardiac surgery, SSI extended the post-operative hospitalization by an average of 48.9 days and increased the post-operative healthcare expenditure by an average of $28,534. Under the current healthcare system in Japan, the development of SSI after abdominal surgery necessitates extension of hospitalization two-fold and increases the post-operative healthcare expenditure 2.5-fold. Development of SSI after cardiac surgery necessitates extension of hospitalization fourfold and increases the healthcare expenditure six-fold.

  2. Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one-year experience at an ambulatory surgical center.

    Science.gov (United States)

    Jorns, Julie M; Visscher, Daniel; Sabel, Michael; Breslin, Tara; Healy, Patrick; Daignaut, Stephanie; Myers, Jeffrey L; Wu, Angela J

    2012-11-01

    Intraoperative frozen section (FS) margin evaluation is not common practice for patients undergoing breast conservation therapy (BCT), but offers a significant reduction in reoperation. In this study, a technique to allow for more effective freezing of breast tissue was developed to perform FS evaluation of lumpectomy margins (FSM) for all patients undergoing BCT at an ambulatory surgery center. FS evaluation of sentinel lymph node biopsy specimens was performed concurrently. One hundred eighty-one study and 188 control patients, with and without FS evaluation, were compared. Reexcision was reduced 34% (from 48.9% to 14.9%) and reoperation was reduced 36% (from 55.3% to 19.3%) with FS evaluation. Most of the decrease in reoperative rate was because of a decrease in the need for margin reexcision. The number of patients requiring 1, 2, or 3 operations to complete therapy was 84, 92, and 12, respectively, in the control group, and 146, 33, and 2, respectively, in the study group. Lobular subtype, multifocal disease, and larger tumor size (≥2 cm) were significantly associated with failure of FSM to prevent reoperation, but reoperation rates were still significantly decreased in this subgroup of patients (from 75.5% to 43.8%) with FSM. This study highlights an innovative yet simple and adaptable FS approach that resulted in a nearly 3-fold reduction in reoperation for patients undergoing BCT.

  3. How local networks shape a global movement: comparing occupy in Amsterdam and Los Angeles

    NARCIS (Netherlands)

    Uitermark, J.; Nicholls, W.

    2012-01-01

    The Occupy encampments erupting around the world in Fall and Winter of 2011 developed into local platforms where activists from different milieus came together and forged relations and shared understandings. While Occupy protests broke out around the world in a synchronized fashion and used similar

  4. Occupy Education: Living and Learning Sustainability. Global Studies in Education. Volume 22

    Science.gov (United States)

    Evans, Tina Lynn

    2012-01-01

    "Occupy Education" is motivated by the sustainability crisis and energized by the drive for social justice that inspired the Occupy movement. Situated within the struggle for sustainability taking place amid looming resource shortages, climate change, economic instability, and ecological breakdown, the book is a timely contribution to community…

  5. 26 CFR 1.822-6 - Real estate owned and occupied.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Real estate owned and occupied. 1.822-6 Section... Premium Deposits) § 1.822-6 Real estate owned and occupied. Section 822(d)(1) provides that the amount allowable as a deduction for taxes, expenses, and depreciation on or with respect to any real estate owned...

  6. 26 CFR 1.822-2 - Real estate owned and occupied.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Real estate owned and occupied. 1.822-2 Section... Premium Deposits) § 1.822-2 Real estate owned and occupied. The limitation in section 822(d)(1) on the amount allowable as a deduction for taxes, expenses, and depreciation upon or with respect to any real...

  7. 26 CFR 1.803-5 - Real estate owned and occupied.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Real estate owned and occupied. 1.803-5 Section... (CONTINUED) INCOME TAXES Life Insurance Companies § 1.803-5 Real estate owned and occupied. The amount allowable as a deduction for taxes, expenses, and depreciation upon or with respect to any real estate owned...

  8. 26 CFR 1.822-9 - Real estate owned and occupied.

    Science.gov (United States)

    2010-04-01

    ... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Real estate owned and occupied. 1.822-9 Section... Premium Deposits) § 1.822-9 Real estate owned and occupied. Section 822(d)(1) provides that the amount allowable as a deduction for taxes, expenses, and depreciation on or with respect to any real estate owned...

  9. Competitive abilities of oystercatchers (Haematopus ostralegus) occupying territories of different quality

    NARCIS (Netherlands)

    Bruinzeel, LW; de Pol, MV; Trierweiler, C

    2006-01-01

    In territorial species, habitat heterogeneity results in some individuals occupying poor quality sites while others occupy high quality sites. Floaters (mature nonbreeders) may accept a low quality territory, because it is the best they can get and defend ('inferior phenotype hypothesis'), or becaus

  10. Surgical treatment for infective endocarditis and hospital mortality in a Brazilian single-center Tratamento cirúrgico para endocardite infecciosa e mortalidade hospitalar em centro único brasileiro

    Directory of Open Access Journals (Sweden)

    Maurício Nassau Machado

    2013-03-01

    Full Text Available OBJECTIVE: We evaluated patients underwent cardiac valve surgery in the presence of infective endocarditis in an attempt to identify independent predictors of 30-day mortality. METHODS: We evaluated 837 consecutive patients underwent cardiac valve surgery from January 2003 to May 2010 in a tertiary hospital in São José do Rio Preto, São Paulo (SP, Brazil. The study group comprised patients who underwent intervention in the presence of infective endocarditis and was compared to the control group (without infective endocarditis, evaluating perioperative clinical outcomes and 30-day all cause mortality. RESULTS: In our series, 64 patients (8% underwent cardiac valve surgery in the presence of infective endocarditis, and 37.5% of them had surgical intervention in multiple valves. The study group had prolonged ICU length of stay (16%, greater need for dialysis (9% and higher 30-day mortality (17% compared to the control group (7%, P=0.020; 2%, P=0.002 and 9%, P=0.038; respectively. In a Cox regression analysis, age (P = 0.007, acute kidney injury (P = 0.004, dialysis (P = 0.026, redo surgery (P = 0.026, re-exploration for bleeding (P = 0.013, tracheal reintubation (P OBJETIVO: Avaliamos pacientes submetidos à cirurgia valvar em vigência de endocardite infecciosa na tentativa de identificar preditores independentes de mortalidade intrahospitalar em 30 dias. MÉTODOS: Foram avaliados 837 pacientes consecutivamente submetidos à cirurgia valvar, no período de janeiro de 2003 a maio de 2010, em um hospital terciário de São José do Rio Preto, SP, Brasil. O Grupo de Estudo compreendeu indivíduos submetidos à intervenção em vigência de endocardite infecciosa e foi comparado ao Grupo Controle, considerando complicações clínicas perioperatórias e óbito por todas as causas em 30 dias. RESULTADOS: Em nossa casuística, 64 (8% pacientes foram submetidos à cirurgia valvar em vigência de endocardite infecciosa, sendo 37,5% deles com indica

  11. Percutaneous Lung Thermal Ablation of Non-surgical Clinical N0 Non-small Cell Lung Cancer: Results of Eight Years’ Experience in 87 Patients from Two Centers

    Energy Technology Data Exchange (ETDEWEB)

    Palussiere, Jean, E-mail: J.Palussiere@bordeaux.unicancer.fr [Institut Bergonié, Comprehensive Cancer Centre, Department of Interventional Radiology (France); Lagarde, Philippe, E-mail: P.Lagarde@bordeaux.unicancer.fr [Institut Bergonié, Comprehensive Cancer Center, Radiation Oncology Department (France); Aupérin, Anne, E-mail: auperin@igr.fr [Institut Gustave-Roussy, Unit of Biostatistics and Epidemiology (France); Deschamps, Frédéric, E-mail: frederic.deschamps@igr.fr [Institut Gustave-Roussy, Department of Interventional Radiology (France); Chomy, François, E-mail: F.Chomy@bordeaux.unicancer.fr [Institut Bergonié, Comprehensive Cancer Center, Department of medical oncology (France); Baere, Thierry de, E-mail: debaere@igr.fr [Institut Gustave-Roussy, Department of Interventional Radiology (France)

    2015-02-15

    PurposeTo evaluate the survival outcomes of percutaneous thermal ablation (RFA + microwaves) for patients presenting N0 non-small-cell lung cancer (NSCLC) ineligible for surgery.Materials and MethodsEighty-seven patients from two comprehensive cancer centers were included. Eighty-two patients were treated with RFA electrodes and five with microwave antenna. Overall survival (OS) and disease-free survival (DFS) were estimated and predictive factors of local tumor progression, OS and DFS identified and compared by univariate and multivariate analysesResultsMedian follow-up was 30.5 months (interquartile range 16.7–51) and tumor size was 21 mm (range 10–54 mm). Treatment was incomplete for 14 patients with a local tumor progression of 11.5, 18.3, and 21.1 % at 1, 2, and 3 years, respectively. Two patients presented with neurological (grade III or IV) complications, and one died of respiratory and multivisceral failure as a result of the procedure at 29 days. In univariate analysis, increasing tumor size (P = 0.003) was the only predictive factor related to risk of local tumor progression. 5-year OS and DFS were 58.1 and 27.9 %, respectively. Sex (P = 0.044), pathology (P = 0.032), and tumor size >2 cm (P = 0.046) were prognostic factors for DFS. In multivariate analysis, pathology (P = 0.033) and tumor size >2 cm (P = 0.032) were independent prognostic factors for DFS.ConclusionsOversized and overlapping ablation of N0 NSCLC was well tolerated, effective, with few local tumor progressions, even over long-term follow-up. Increasing tumor size was the main prognostic factor linked to OS, DFS, and local tumor progression.

  12. Surgical education through video broadcasting.

    Science.gov (United States)

    Nagengast, Eric S; Ramos, Margarita S; Sarma, Hiteswar; Deshpande, Gaurav; Hatcher, Kristin; Magee, William P; Campbell, Alex

    2014-09-01

    Surgical training is facing new obstacles. As advancements in medicine are made, surgeons are expected to know more and to be able to perform more procedures. In the western world, increasing restrictions on residency work hours are adding a new hurdle to surgical training. In low-resource settings, a low attending-to-resident ratio results in limited operative experience for residents. Advances in telemedicine may offer new methods for surgical training. In this article, the authors share their unique experience using live video broadcasting of surgery for educational purposes at a comprehensive cleft care center in Guwahati, India.

  13. Distributions of owner-occupiers' housing wealth, debt and interest expenditure ratios as financial soundness indicators

    DEFF Research Database (Denmark)

    Lunde, Jens

    -occupier families is analysed using relevant financial indicators for the owner-occupiers' capital structure and interest payments. Tax statistics for the owner-occupier families are used here. In a financial soundness perspective macro data are of limited importance as they express total and average changes....... Distributional data at the micro level, formed at the family (household) level, are important for recognizing changes in the financial soundness of the nation. The data are used to estimate important financial indicators as debt/income, housing wealth/income, debt/housing wealth and net interest expenditure...

  14. Patterns of surface burrow plugging in a colony of black-tailed prairie dogs occupied by black-footed ferrets

    Science.gov (United States)

    Eads, David E.; Biggins, Dean E.

    2012-01-01

    Black-tailed prairie dogs (Cynomys ludovicianus) can surface-plug openings to a burrow occupied by a black-footed ferret (Mustela nigripes). At a coarse scale, surface plugs are more common in colonies of prairie dogs occupied by ferrets than in colonies without ferrets. However, little is known about spatial and temporal patterns of surface plugging in a colony occupied by ferrets. In a 452-ha colony of black-tailed prairie dogs in South Dakota, we sampled burrow openings for surface plugs and related those data to locations of ferrets observed during spotlight surveys. Of 67,574 burrow openings in the colony between June and September 2007, 3.7% were plugged. In a colony-wide grid of 80 m × 80 m cells, the occurrence of surface plugging (≥1 opening plugged) was greater in cells used by ferrets (93.3% of cells) than in cells not observably used by ferrets (70.6%). Rates of surface plugging (percentages of openings plugged) were significantly higher in cells used by ferrets (median = 3.7%) than in cells without known ferret use (median = 3.2%). Also, numbers of ferret locations in cells correlated positively with numbers of mapped surface plugs in the cells. To investigate surface plugging at finer temporal and spatial scales, we compared rates of surface plugging in 20-m-radius circle-plots centered on ferret locations and in random plots 1–4 days after observing a ferret (Jun–Oct 2007 and 2008). Rates of surface plugging were greater in ferret-plots (median = 12.0%) than in random plots (median = 0%). For prairie dogs and their associates, the implications of surface plugging could be numerous. For instance, ferrets must dig to exit or enter plugged burrows (suggesting energetic costs), and surface plugs might influence microclimates in burrows and consequently influence species that cannot excavate soil (e.g., fleas that transmit the plague bacterium Yersinia pestis).

  15. Patterns of surface burrow plugging in a colony of black-tailed prairie dogs occupied by black-footed ferrets

    Science.gov (United States)

    Eads, D.A.; Biggins, D.E.

    2012-01-01

    Black-tailed prairie dogs (Cynomys ludovicianus) can surface-plug openings to a burrow occupied by a black-footed ferret (Mustela nigripes). At a coarse scale, surface plugs are more common in colonies of prairie dogs occupied by ferrets than in colonies without ferrets. However, little is known about spatial and temporal patterns of surface plugging in a colony occupied by ferrets. In a 452-ha colony of black-tailed prairie dogs in South Dakota, we sampled burrow openings for surface plugs and related those data to locations of ferrets observed during spotlight surveys. Of 67,574 burrow openings in the colony between June and September 2007, 3.7% were plugged. In a colony-wide grid of 80 m × 80 m cells, the occurrence of surface plugging (≥1 opening plugged) was greater in cells used by ferrets (93.3% of cells) than in cells not observably used by ferrets (70.6%). Rates of surface plugging (percentages of openings plugged) were significantly higher in cells used by ferrets (median = 3.7%) than in cells without known ferret use (median = 3.2%). Also, numbers of ferret locations in cells correlated positively with numbers of mapped surface plugs in the cells. To investigate surface plugging at finer temporal and spatial scales, we compared rates of surface plugging in 20-m-radius circle-plots centered on ferret locations and in random plots 1–4 days after observing a ferret (Jun–Oct 2007 and 2008). Rates of surface plugging were greater in ferret-plots (median = 12.0%) than in random plots (median = 0%). For prairie dogs and their associates, the implications of surface plugging could be numerous. For instance, ferrets must dig to exit or enter plugged burrows (suggesting energetic costs), and surface plugs might influence microclimates in burrows and consequently influence species that cannot excavate soil (e.g., fleas that transmit the plague bacterium Yersinia pests).

  16. Occupied and unoccupied electronic structure of Na doped MoS{sub 2}(0001)

    Energy Technology Data Exchange (ETDEWEB)

    Komesu, Takashi; Zhang, Xin; Dowben, P. A. [Department of Physics and Astronomy, Theodore Jorgensen Hall, 855 N 16th St., University of Nebraska, Lincoln, Nebraska 68588-0299 (United States); Le, Duy; Rahman, Talat S. [Department of Physics, University of Central Florida, 4000 Central Florida Blvd., Orlando, Florida 32816 (United States); Ma, Quan; Bartels, Ludwig [Department of Chemistry and the Materials Science and Engineering Program, University of California - Riverside, Riverside, California 92521 (United States); Schwier, Eike F.; Iwasawa, Hideaki; Shimada, Kenya [Hiroshima Synchrotron Radiation Center, Hiroshima University, Higashi-Hiroshima 739-0046 (Japan); Kojima, Yohei; Zheng, Mingtian [Graduate School of Science, Hiroshima University, Higashi-Hiroshima 739-8526 (Japan); Taniguchi, Masaki [Hiroshima Synchrotron Radiation Center, Hiroshima University, Higashi-Hiroshima 739-0046 (Japan); Graduate School of Science, Hiroshima University, Higashi-Hiroshima 739-8526 (Japan)

    2014-12-15

    The influence of sodium on the band structure of MoS{sub 2}(0001) and the comparison of the experimental band dispersion with density functional theory show excellent agreement for the occupied states (angle-resolved photoemission) and qualitative agreement for the unoccupied states (inverse photoemission spectroscopy). Na-adsorption leads to charge transfer to the MoS{sub 2} surface causing an effect similar to n-type doping of a semiconductor. The MoS{sub 2} occupied valence band structure shifts rigidly to greater binding with little change in the occupied state dispersion. Likewise, the unoccupied states shift downward, approaching the Fermi level, yet the amount of the shift for the unoccupied states is greater than that of the occupied states, effectively causing a narrowing of the MoS{sub 2} bandgap.

  17. 41 CFR 301-31.7 - May my family and I occupy lodging at different locations?

    Science.gov (United States)

    2010-07-01

    ... Federal Travel Regulation System TEMPORARY DUTY (TDY) TRAVEL ALLOWANCES ALLOWABLE TRAVEL EXPENSES 31-THREATENED LAW ENFORCEMENT/INVESTIGATIVE EMPLOYEES § 301-31.7 May my family and I occupy lodging at different...

  18. Ambulatory Surgical Center (ASC) Payment System

    Data.gov (United States)

    U.S. Department of Health & Human Services — This file contains a summary of service utilization by ASC supplier and is derived from 2011 ASC line item level data, updated through June 2012, that is, line...

  19. Ambulatory Surgical Center (ASC) Payment System

    Data.gov (United States)

    U.S. Department of Health & Human Services — This file contains a summary of service utilization by ASC supplier and is derived from 2011 ASC line item level data, updated through June 2012, that is, line items...

  20. Ambulatory Surgical Center Payment Rates Archive Page

    Data.gov (United States)

    U.S. Department of Health & Human Services — These files contain the procedure codes which may be performed in an ASC under the Medicare program as well as the ASC payment group assigned to each of the...

  1. Surgical Complications of Cochlear Implantation

    Directory of Open Access Journals (Sweden)

    Basir Hashemi

    2010-03-01

    Full Text Available Cochlear implantation is a method used for the treatment ofpatients with profound hearing loss. This procedure may theaccompanied by some major or minor complications. Weevaluated the surgical complications of cochlear implantationin Fars province (south of Iran. A total of 150 patients withcochlear implantation were enrolled in the present study. Mostof the patients were pre-lingual children and most of our deviceswere nucleus prosthesis. We had three device failuresand four major complications, including one misplaced electrode,one case of meningitis, one case of foreign body reactionto suture and one case with extensive hematoma. Thesecomplications were managed successfully by surgical interventionor re-implantation. Facial nerve damage or woundbreakdown was not seen. Minor complications including smallhematoma, edema, stitch infection and dizziness were found in15 cases, which were managed medically. In our center, therate of minor complications was comparable to other centersin the world. But the rate of major surgical complications waslower than other centers.

  2. Integrating palliative care in the surgical and trauma intensive care unit: a report from the Improving Palliative Care in the Intensive Care Unit (IPAL-ICU) Project Advisory Board and the Center to Advance Palliative Care.

    Science.gov (United States)

    Mosenthal, Anne C; Weissman, David E; Curtis, J Randall; Hays, Ross M; Lustbader, Dana R; Mulkerin, Colleen; Puntillo, Kathleen A; Ray, Daniel E; Bassett, Rick; Boss, Renee D; Brasel, Karen J; Campbell, Margaret; Nelson, Judith E

    2012-04-01

    Although successful models for palliative care delivery and quality improvement in the intensive care unit have been described, their applicability in surgical intensive care unit settings has not been fully addressed. We undertook to define specific challenges, strategies, and solutions for integration of palliative care in the surgical intensive care unit. We searched the MEDLINE database from inception to May 2011 for all English language articles using the term "surgical palliative care" or the terms "surgical critical care," "surgical ICU," "surgeon," "trauma" or "transplant," and "palliative care" or "end-of- life care" and hand-searched our personal files for additional articles. Based on review of these articles and the experiences of our interdisciplinary expert Advisory Board, we prepared this report. We critically reviewed the existing literature on delivery of palliative care in the surgical intensive care unit setting focusing on challenges, strategies, models, and interventions to promote effective integration of palliative care for patients receiving surgical critical care and their families. Characteristics of patients with surgical disease and practices, attitudes, and interactions of different disciplines on the surgical critical care team present distinctive issues for intensive care unit palliative care integration and improvement. Physicians, nurses, and other team members in surgery, critical care and palliative care (if available) should be engaged collaboratively to identify challenges and develop strategies. "Consultative," "integrative," and combined models can be used to improve intensive care unit palliative care, although optimal use of trigger criteria for palliative care consultation has not yet been demonstrated. Important components of an improvement effort include attention to efficient work systems and practical tools and to attitudinal factors and "culture" in the unit and institution. Approaches that emphasize delivery of

  3. Social Movements and Media: The Representation of “Occupy Wall Street” Movement in the Media

    Directory of Open Access Journals (Sweden)

    Fulya Şen

    2012-01-01

    Full Text Available In this study, the representation of the “Occupy Wall Street” in main stream and alternative media has been examined in Turkey. The construction of dominant meanings concerning the “Occupy Wall Street”movement in alternative and main stream news media have been discussed in order to show the approach of the media in the face of social movements which have become an important tool of the citizen participation. In this context, the priorities and preferences of media on “Occupy Wall Street” movement, the forms of actions narrative and the construction of dominant meanings have been researched and the production of these meanings have been tried to analysed through Van Dijk’s critical discourse analysis methodology.

  4. How social media matter: Repression and the diffusion of the Occupy Wall Street movement.

    Science.gov (United States)

    Suh, Chan S; Vasi, Ion Bogdan; Chang, Paul Y

    2017-07-01

    This study explores the role played by social media in reshaping the repression-mobilization relationship. Drawing on the case of the Occupy Wall Street movement, we examine the impact of Facebook and Twitter on the spatial diffusion of protests during a period of heightened state repression. Results from event history analyses suggest that the effects of repression on protest diffusion are contingent on the presence of social media accounts supporting the movement. We find that state repression at earlier protest sites encouraged activists to create Facebook and Twitter accounts in their own cities, which then served as important vehicles for the initiation of new Occupy protests. Moreover, results suggest that repression incidents can directly facilitate future protests in cities that already have Occupy Facebook accounts. This study highlights the potential of social media to both mediate and moderate the influence of repression on the diffusion of contemporary movements. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Lessons from #Occupy in Canada: Contesting Space, Settler Consciousness and Erasures within the 99%

    Directory of Open Access Journals (Sweden)

    Konstantin Kilibarda

    2012-03-01

    Full Text Available Under a slogan of ‘We are the 99%’, the #occupy movement has won praise for its bold reclamations of public space and for re-centring class analysis in North America. Despite this, however, important critiques of the movement’s elisions and erasures have also beenraised. This article examines how three #occupy encampments in Canada have engaged with these calls to #decolonise the movement and to address divisions within the 99%. These critiques question #occupy’s ability to fix a ‘broken social contract’, ‘reclaim Canada’, or ‘take back our democracy’ without addressing the underlying racial contracts foundational to North American settler-states. Practical experiences with raising postcolonial critiques are examined through in-depth interviews with organisers at #occupy encampments in Montréal, Toronto and Vancouver.

  6. Density-dependent changes in effective area occupied for sea-bottom-associated marine fishes

    DEFF Research Database (Denmark)

    Thorson, James T.; Rindorf, Anna; Gao, Jin

    2016-01-01

    The spatial distribution of marine fishes can change for many reasons, including density-dependent distributional shifts. Previous studies show mixed support for either the proportional-density model (PDM; no relationship between abundance and area occupied, supported by ideal-free distribution...... marine regions, to determine whether the BM or PDM provides a better description for sea-bottom-associated fishes. We fit a spatio-temporal model and estimate changes in effective area occupied and abundance, and combine results to estimate the average abundance–area relationship as well as variability...... for every 10% abundance increase) followed by Pleuronectiformes and Scorpaeniformes, and the Eastern Bering Sea shows a strong relationship between abundance and area occupied relative to other regions. We conclude that the BM explains a small but important portion of spatial dynamics for sea...

  7. A Study on Role of Magnetic Resonance Imaging (MRI in Intracranial Space Occupying Lesions

    Directory of Open Access Journals (Sweden)

    Bhavesh Ramjibhai Goyani

    2015-03-01

    Full Text Available Background: The high morbidity and mortality associated with Intracranial Space Occupying Lesions necessitates their early diagnosis so as to plan the intervention that is required. In the present study cases of either clinically suspected brain space occupying lesions or already diagnosed cases of brain space occupying lesions were studied by cross sectional imaging of MRI. Methodology: The present cross-sectional study was conducted presented with symptoms of raised ICT of sub acute onset and had lateralizing sign. A semi-structured questionnaire was prepared and demographic and clinical data like age, sex, symptoms and various morphological characters of Supratentorial SOLs were studied. A clinico-radiological correlation and confirmation of Radiological diagnosis was done by biopsy/surgery/MRI whenever possible to minimize patient follow up. Results: Majority of the patients were in the fourth decade (28.5%. Metastases were the most common single group of intracranial space occupying lesion (27%, Gliomas were the most common brain tumors (31.4%. Of the Gliomas, astrocytomas accounted for (81.8%. Most common hemisphere to be involved was the parietal lobe (31.4%. Intra-axial involvement (78.58 % was most common localization in present study. Edema was the most common associated MRI finding (74.3%. Conclusion: The diagnostic accuracy of MRI in evaluation of intracranial space occupying lesion was 98.57 %. MRI remains the first line investigation for diagnosing and evaluation Intracranial space occupying lesion with a reasonable degree of diagnostic accuracy and with the advent of newer modifications of MRI such as MR Spectroscopy, 3-Tesla MRI, and newer techniques like MR Perfusion. [Natl J Med Res 2015; 5(1.000: 18-21

  8. The evolution of epilepsy surgery between 1991 and 2011 in nine major epilepsy centers across the United States, Germany, and Australia

    Science.gov (United States)

    Jehi, Lara; Friedman, Daniel; Carlson, Chad; Cascino, Gregory; Dewar, Sandra; Elger, Christian; Engel, Jerome; Knowlton, Robert; Kuzniecky, Ruben; McIntosh, Anne; O’Brien, Terence J.; Spencer, Dennis; Sperling, Michael R.; Worrell, Gregory; Bingaman, Bill; Gonzalez-Martinez, Jorge; Doyle, Werner; French, Jacqueline

    2016-01-01

    Summary Objective Epilepsy surgery is the most effective treatment for select patients with drug-resistant epilepsy. In this article, we aim to provide an accurate understanding of the current epidemiologic characteristics of this intervention, as this knowledge is critical for guiding educational, academic, and resource priorities. Methods We profile the practice of epilepsy surgery between 1991 and 2011 in nine major epilepsy surgery centers in the United States, Germany, and Australia. Clinical, imaging, surgical, and histopathologic data were derived from the surgical databases at various centers. Results Although five of the centers performed their highest number of surgeries for mesial temporal sclerosis (MTS) in 1991, and three had their highest number of MTS surgeries in 2001, only one center achieved its peak number of MTS surgeries in 2011. The most productive year for MTS surgeries varied then by center; overall, the nine centers surveyed performed 48% (95% confidence interval [CI] −27.3% to −67.4%) fewer such surgeries in 2011 compared to either 1991 or 2001, whichever was higher. There was a parallel increase in the performance of surgery for nonlesional epilepsy. Further analysis of 5/9 centers showed a yearly increase of 0.6 ± 0.07% in the performance of invasive electroencephalography (EEG) without subsequent resections. Overall, although MTS was the main surgical substrate in 1991 and 2001 (proportion of total surgeries in study centers ranging from 33.3% to 70.2%); it occupied only 33.6% of all resections in 2011 in the context of an overall stable total surgical volume. Significance These findings highlight the major aspects of the evolution of epilepsy surgery across the past two decades in a sample of well-established epilepsy surgery centers, and the critical current challenges of this treatment option in addressing complex epilepsy cases requiring detailed evaluations. Possible causes and implications of these findings are discussed

  9. Occupy: A Case Illustration of Social Movements in Global Citizenship Education

    Science.gov (United States)

    Catalano, Theresa A.

    2013-01-01

    Due to the complex nature of global understanding and practice of citizenship, it is essential to understand how to educate for a responsive public sphere with active and emancipated citizens. This study aims to clarify how social movements (through a case illustration of Occupy) are representative of global citizenship goals while illuminating…

  10. Disparate relatives: Life histories vary more in genera occupying intermediate environments

    NARCIS (Netherlands)

    Hermant, M.; Hennion, F.; Bartish, I.V.; Yguel, B.; Prinzing, A.

    2012-01-01

    Species within clades are commonly assumed to share similar life history traits, but within a given region some clades show much greater variability in traits than others. Are variable clades older, allowing more time for trait diversification? Or do they occupy particular environments, providing a

  11. Imaging Findings Associated with Space-Occupying Edema in Patients with Large Middle Cerebral Artery Infarcts

    NARCIS (Netherlands)

    Horsch, A D|info:eu-repo/dai/nl/341748145; Dankbaar, J W|info:eu-repo/dai/nl/314079408; Stemerdink, T A; Bennink, E|info:eu-repo/dai/nl/358202906; van Seeters, T; Kappelle, L J; Hofmeijer, J; de Jong, H W; van der Graaf, Y|info:eu-repo/dai/nl/072825847; Velthuis, B K|info:eu-repo/dai/nl/176956301

    2016-01-01

    BACKGROUND AND PURPOSE: Prominent space-occupying cerebral edema is a devastating complication occurring in some but not all patients with large MCA infarcts. It is unclear why differences in the extent of edema exist. Better knowledge of factors related to prominent edema formation could aid treatm

  12. Imaging Findings Associated with Space-Occupying Edema in Patients with Large Middle Cerebral Artery Infarcts

    NARCIS (Netherlands)

    Horsch, A D; Dankbaar, J W; Stemerdink, T A; Bennink, E; van Seeters, T; Kappelle, L J; Hofmeijer, J; de Jong, H W; van der Graaf, Y; Velthuis, B K

    2016-01-01

    BACKGROUND AND PURPOSE: Prominent space-occupying cerebral edema is a devastating complication occurring in some but not all patients with large MCA infarcts. It is unclear why differences in the extent of edema exist. Better knowledge of factors related to prominent edema formation could aid treatm

  13. Purity and Epidemic Danger in German Occupied Poland during the First World War.

    Science.gov (United States)

    Weindling, Paul

    1997-01-01

    Explores the efforts of the German public-health authorities to cleanse occupied areas of formerly Russian Poland of pathogenic hazards during the First World War. The program used sanitary measures and educational programs to encourage a more hygienic lifestyle. Originally sympathetic to the Jewish population, it grew increasingly anti-semitic.…

  14. The interaction between design and occupier behaviour in the safety of new homes.

    Science.gov (United States)

    McDermott, Hilary; Haslam, Roger; Gibb, Alistair

    2007-03-01

    The design of new homes includes many safety features intended to protect occupiers from injury or ill health within the home, however the effectiveness of these primary intervention measures is likely to be affected by user behaviour. This study examined the interaction between user activity and dwelling design and how this might affect health and safety. It aimed to identify how people use features within new homes and how this may limit the protection afforded by building design, codes and regulations. Forty, home-based, semi-structured, in-depth interviews and home inspections were conducted with individuals recently inhabiting a new home. A range of behaviours were reported in relation to building features including fire doors, pipes and cables, and loft access, which may lead to increased risk of injury or ill-health. For example, occupiers described interfering with the self-closing mechanisms on fire doors and drilling into walls without considering the location of services. They also reported knowingly engaging in unsafe behaviour when accessing the loft, increasing their risk of falls. The accounts suggest that designers and builders need to give greater consideration to how occupier behaviour interacts with building features so that improvements in both design and occupier education can lead to improved health and safety.

  15. Anticommunism and Academic Freedom: Walter C. Eells and the "Red Purge" in Occupied Japan

    Science.gov (United States)

    Kumano, Ruriko

    2010-01-01

    In August 1945, Imperial Japan surrendered to the Allied Powers. From September 1945 to April 1952, the United States occupied the defeated country. Douglas MacArthur, an American army general and the Supreme Commander for the Allied Powers (SCAP), attempted to transform Japanese society from an authoritarian regime into a budding democracy.…

  16. Measurement of air velocity in animal occupied zones using an ultrasonic anemometer

    NARCIS (Netherlands)

    Wagenberg, van A.V.; Leeuw, de M.T.J.

    2003-01-01

    The air velocity in the animal occupied zone (AOZ) of a pig facility influences the thermal comfort of pigs and is affected by the ventilation system in the building. Little is known about the relationship between the air velocity in the AOZ and the ventilation system design. This article describes

  17. Media Spectacle, Insurrection and the Crisis of Neoliberalism from the Arab Uprisings to Occupy Everywhere!

    Science.gov (United States)

    Kellner, Douglas

    2013-01-01

    I argue that 2011 witnessed a series of challenges to neoliberalism on a global scale perhaps not seen since the political upheavals of 1968, and that media spectacle provided the form of a series of global insurgences from the North African Arab Uprisings to the Occupy movements. Crises of neoliberalism also generated movements in Italy, Spain,…

  18. Dance Education in the Occupied Palestinian Territories: Hegemony, Counter-Hegemony and Anti-Hegemony

    Science.gov (United States)

    Rowe, Nicholas

    2008-01-01

    This article presents a historical, ethnographic and practice-based study of dance education in the Occupied Palestinian Territories. The concepts of dance learning, hegemony and counter-hegemony are analysed in the context of cross-cultural interventions in politically marginalized communities, and the theoretical concept of anti-hegemony is…

  19. An overview of pre-surgical evaluation

    Directory of Open Access Journals (Sweden)

    Kurupath Radhakrishnan

    2014-01-01

    Full Text Available The success of an epilepsy surgery program depends upon the early identification of potential surgical candidates and selecting from them, ideal candidates for surgery, who are destined to have a post-operative seizure-free outcome without any unacceptable neurological deficits. Since epilepsy surgery centers in resource-poor countries will lack the full range of state-of-the-art technologies usually available in resource-rich countries to perform pre-surgical evaluation, cost-effectively utilization of the locally available investigative facilities to select the surgical candidates becomes challenging. In the present era of rapid electronic communications and telemedicine, it has become possible for epilepsy surgery centers to pool their technological and human resources and to partner with centers nationally and internationally in implementing pre-surgical evaluation strategies.

  20. Synovial cysts of the spine: long-term follow-up after surgical treatment of 141 cases in a single-center series and comprehensive literature review of 2900 degenerative spinal cysts.

    Science.gov (United States)

    Bruder, Markus; Cattani, Adriano; Gessler, Florian; Droste, Christian; Setzer, Matthias; Seifert, Volker; Marquardt, Gerhard

    2017-09-01

    OBJECTIVE Synovial cysts of the spine are rare lesions, predominantly arising in the lumbar region. Despite their generally benign behavior, they can cause severe symptoms due to compression of neural structures in the spinal canal. Treatment strategies are still a matter of discussion. The authors performed a single-center survey and literature search focusing on long-term results after minimally invasive surgery. METHODS A total of 141 consecutive patients treated for synovial cysts of the lumbar spine between 1997 and 2014 in the authors' department were analyzed. Medical reports with regard to signs and symptoms, operative findings, complications, and short-term outcome were reviewed. Assessment of long-term outcome was performed with a standardized telephone questionnaire based on the Oswestry Disability Index (ODI). Furthermore, patients were questioned about persisting pain, symptoms, and further operative procedures, if any. Subjective satisfaction was classified as excellent, good, fair, or poor based on the Macnab classification. RESULTS The approach most often used for synovial cyst treatment was partial hemilaminectomy in 70%; hemilaminectomy was necessary in 27%. At short-term follow-up, the presence of severe and moderate leg pain had decreased from 93% to 5%. The presence of low-back pain decreased from 90% to 5%. Rates of motor and sensory deficits were reduced from 40% to 14% and from 45% to 6%, respectively. The follow-up rate was 58%, and the mean follow-up period was 9.3 years. Both leg pain and low-back pain were still absent in 78%. Outcome based on the Macnab classification was excellent in 80%, good in 14%, fair in 1%, and poor in 5%. According to the ODI, 78% of patients had no or only minimal disability, 16% had moderate disability, and 6% had severe disability at the time of follow-up. In this cohort, 7% needed surgery due to cyst recurrence, and 9% required a delayed stabilization procedure after the initial operation. CONCLUSIONS

  1. Evaluation of adherence to measures for the prevention of surgical site infections by the surgical team

    OpenAIRE

    Adriana Cristina de Oliveira; Camila Sarmento Gama

    2015-01-01

    AbstractOBJECTIVEEvaluate pre- and intraoperative practices adopted by medical and nursing teams for the prevention of surgical infections.METHODA prospective study carried out in the period of April to May 2013, in a surgical center of a university hospital in Belo Horizonte, Minas Gerais.RESULTS18 surgeries were followed and 214 surgical gloves were analyzed, of which 23 (10.7%) had postoperative glove perforation detected, with 52.2% being perceived by users. Hair removal was performed on ...

  2. Neuronavigation. Principles. Surgical technique.

    Science.gov (United States)

    Ivanov, Marcel; Ciurea, Alexandru Vlad

    2009-01-01

    Neuronavigation and stereotaxy are techniques designed to help neurosurgeons precisely localize different intracerebral pathological processes by using a set of preoperative images (CT, MRI, fMRI, PET, SPECT etc.). The development of computer assisted surgery was possible only after a significant technological progress, especially in the area of informatics and imagistics. The main indications of neuronavigation are represented by the targeting of small and deep intracerebral lesions and choosing the best way to treat them, in order to preserve the neurological function. Stereotaxis also allows lesioning or stimulation of basal ganglia for the treatment of movement disorders. These techniques can bring an important amount of confort both to the patient and to the neurosurgeon. Neuronavigation was introduced in Romania around 2003, in four neurosurgical centers. We present our five-years experience in neuronavigation and describe the main principles and surgical techniques.

  3. Density-dependent changes in effective area occupied for sea-bottom-associated marine fishes.

    Science.gov (United States)

    Thorson, James T; Rindorf, Anna; Gao, Jin; Hanselman, Dana H; Winker, Henning

    2016-10-12

    The spatial distribution of marine fishes can change for many reasons, including density-dependent distributional shifts. Previous studies show mixed support for either the proportional-density model (PDM; no relationship between abundance and area occupied, supported by ideal-free distribution theory) or the basin model (BM; positive abundance-area relationship, supported by density-dependent habitat selection theory). The BM implies that fishes move towards preferred habitat as the population declines. We estimate the average relationship using bottom trawl data for 92 fish species from six marine regions, to determine whether the BM or PDM provides a better description for sea-bottom-associated fishes. We fit a spatio-temporal model and estimate changes in effective area occupied and abundance, and combine results to estimate the average abundance-area relationship as well as variability among taxa and regions. The average relationship is weak but significant (0.6% increase in area for a 10% increase in abundance), whereas only a small proportion of species-region combinations show a negative relationship (i.e. shrinking area when abundance increases). Approximately one-third of combinations (34.6%) are predicted to increase in area more than 1% for every 10% increase in abundance. We therefore infer that population density generally changes faster than effective area occupied during abundance changes. Gadiformes have the strongest estimated relationship (average 1.0% area increase for every 10% abundance increase) followed by Pleuronectiformes and Scorpaeniformes, and the Eastern Bering Sea shows a strong relationship between abundance and area occupied relative to other regions. We conclude that the BM explains a small but important portion of spatial dynamics for sea-bottom-associated fishes, and that many individual populations merit cautious management during population declines, because a compressed range may increase the efficiency of harvest.

  4. NEURODYNAMIC AND PREDICTABILITY OF ALPHA-STIMULATING BIOFEEDBACK COURSE IN SPORTSMEN AND PERSONS OCCUPYING PHYSICAL CULTURE

    Directory of Open Access Journals (Sweden)

    L. P. Cherapkina

    2013-01-01

    Full Text Available The 15-days neurofeedback course was conducted with the purpose of neurodynamic and predictability assessment of mastering of arbitrary regulation skill of electroencephalographic (EEG spectral power in alpha-band in sportsmen (n=260 and persons (n=69 occupying physical culture. The electroencephalographic parameters being predictors of neurofeedback course were defined in result of research. It was showed that different neurodynamical changes in examined groups supported training successfulness.

  5. Discerning urban spiritualities: Tahrir Square, Occupy Wall Street and the idols of global market capitalism

    Directory of Open Access Journals (Sweden)

    Calvyn C. du Toit

    2015-03-01

    Full Text Available Discernment might be said to be a process of searching for meaning in the light of an (un articulated Absolute. This search takes place in the tension between the private and public spheres of life, mostly mitigated by a community. Intermediate communities, such as churches or social movements, construct symbolic spirituality systems for its adherers to search for meaning in the light of an (unarticulated Absolute. The urban events of Occupy Wall Street and Tahrir Square also step into the tension between the public and private spheres of life, creating a (temporary symbolic spirituality system for its adherers. These events were attempts to construct alternatives to the meta-narrative of global market capitalism. As events attempting to symbolise an urban spirituality, Tahrir Square and Occupy Wall Street dissipated rapidly, effecting rather little change at the heart of global market capitalism. This article theorises a possible reason for these urban spiritualities� dissipation, namely an overlap with global market capitalism�s idols of instant gratification and technology.Interdisciplinary Implications: Viewing Occupy Walls Street and Tahrir Square as symbolic systems of spirituality further strengthens theological urban discourse whilst adding weight to viewing mass movements as spiritualities attempting discernment.

  6. [Application of philosophy on comprehensive analysis of adenoid hypertrophy space occupying effect in meticulous adenoidectomy].

    Science.gov (United States)

    Lu, Yuanyuan; Zhang, Qingxiang; Yu, Zhenkun

    2015-07-01

    To achieve targeted and meticulous surgery of adenoid hypertrophy, a comprehensive analysis of adenoid hypertrophy space occupying effect and morphological evaluation were conducted and the clinical results were retrospectively analyzed. One hundred and sixty-three children with adenoid hypertrophy were treated in our department from May 2013 to May 2014. All children received three examinations preoperatively, including: Nasopharyngo-fiberoscopy, Audiometry and Tympanometry. Based on the results, space occupying effect of adenoid hypertrophy was divided into three types: vertical hypertrophy type, horizontal hypertrophy type and vertical & horizontal hypertrophy type. We assumed the causal relationship with vertical hypertrophy type to snoring (nasal blockage) and horizontal hypertrophy type to secretory otitis media respectively. All children received transoral endoscopic adenoidectomy with radiofrequency ablation. The postoperative followup of these children for 6 to 12 months showed that the vertical hypertrophy type and horizontal hypertrophy type children all recovered from the syndromes of snoring (nasal blockage) and secretory otitis media respectively. The nasopharyngo-fiberoscopy showed that the nasopharyngeal space was smooth and the bilateral choanas opened well. No recurrence was found. The philosophy of comprehensive analysis on adenoid hypertrophy space occupying effect could help the surgeons understand adenoid hypertrophy better and can guide the adenoidectomy more meticulously.

  7. Micro-surgical endodontics.

    Science.gov (United States)

    Eliyas, S; Vere, J; Ali, Z; Harris, I

    2014-02-01

    Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

  8. Surgical innovation as sui generis surgical research.

    Science.gov (United States)

    Lotz, Mianna

    2013-12-01

    Successful innovative 'leaps' in surgical technique have the potential to contribute exponentially to surgical advancement, and thereby to improved health outcomes for patients. Such innovative leaps often occur relatively spontaneously, without substantial forethought, planning, or preparation. This feature of surgical innovation raises special challenges for ensuring sufficient evaluation and regulatory oversight of new interventions that have not been the subject of controlled investigatory exploration and review. It is this feature in particular that makes early-stage surgical innovation especially resistant to classification as 'research', with all of the attendant methodological and ethical obligations--of planning, regulation, monitoring, reporting, and publication--associated with such a classification. This paper proposes conceptual and ethical grounds for a restricted definition according to which innovation in surgical technique is classified as a form of sui generis surgical 'research', where the explicit goal of adopting such a definition is to bring about needed improvements in knowledge transfer and thereby benefit current and future patients.

  9. Application of da Vinci surgical system in hepatobiliary and pancreatic surgery: a single center experience%“达芬奇”机器人在肝胆胰手术中的应用(单中心报道)

    Institute of Scientific and Technical Information of China (English)

    顾磊; 詹茜; 邓侠兴; 彭承宏; 沈柏用

    2013-01-01

    目的:总结“达芬奇”机器人手术系统在我中心进行肝胆胰手术的临床经验.方法:回顾性分析我科2010年3月至2013年3月间机器人肝胆胰手术124例临床资料和手术并发症的发生率.结果:肝脏手术组15例,中转开腹1例,中转腹腔镜手术1例,该组所有病人围手术期无并发症,无死亡病例.手术时间(199.6±110.5)min,术中出血(703.3±1 260.7)mL,术后住院(11.0±3.6)d.胆囊手术组7例,无中转开腹病人,并发症发生率14.3%,无死亡病例.手术时间(212.9±64.2) min,术中出血(257.1±127.2)mL,术后住院(6.8±2.5)d.胰腺手术组102例,其中良性病人中1例中转开腹,并发症发生率50.0%,无死亡病例;恶性病人中2例中转开腹,并发症发生率55.9%,1例死亡.胰十二指肠切除术31例,手术时间(450.4±102.1)min,术中出血(506.5±266.5)mL,术后住院(34.4±7.8)d;胰体尾切除术42例,手术时间(161.0±68.7)min,术中出血(278.0±331.5) mL,术后住院(20.9±10.9)d;胰腺中段切除术16例,手术时间(215.6±45.7) min,术中出血(145.6±118.4)mL,术后住院(22.7±8.0)d;Beger术7例,手术时间(284.2±35.8) min,术中出血(321.7±244.2)mL,术后住院(26.3±7.7)d;局部切除术6例,手术时间(116.7±37.2)min,术中出血(61.7±69.1)mL,术后住院(27.8±11.8)d.结论:“达芬奇”机器人系统可独立完成各类肝胆胰手术,安全可行,推动了微创外科领域的发展进程,尤其在复杂的肝胆胰手术方面,有效地补充传统的腹腔镜手术.但在机器人手术开展初期,应慎重选择胰腺手术病人.%Objective To summarize the clinical experience of robotic hepatobiliary and pancreatic surgery in our center.Methods da Vinci surgical system was applied to perform robotic hepatobiliary and pancreatic operations for 124 patients from Mar 2010 to Mar 2013.The intra-and post-operative data including morbidity were analyzed.Results The robotic hepatectomy was performed in 15 cases.One case was

  10. An efficient method for calculating maxima of symmetric homogeneous functions of orthogonal matrices: Applications to localized occupied orbitals

    Energy Technology Data Exchange (ETDEWEB)

    Subotnik, Joseph E.; Shao, Yihan; Liang, WanZhen; Head-Gordon, Martin

    2004-06-04

    The authors present here three new algorithms (one purely iterative and two DIIS-like) to compute maxima of symmetric homogeneous functions of orthogonal matrices. These algorithms revolve around the mathematical lemma that, given an invertible matrix A, the function f(U) = Tr(AU) has exactly one local (and global) maximum for U special orthogonal (i.e. UU{sup T} = 1 and det(U) = 1). This is proved in the appendix. One application of these algorithms is the computation of localized orbitals, including, for example, Boys and Edmiston-Reudenberg (ER) orbitals. The Boys orbitals are defined as the set of orthonormal orbitals which, for a given vector space of orbitals, maximize the sum of the distances between orbital centers. The ER orbitals maximize total self-interaction energy. The algorithm presented here computes Boys orbitals roughly as fast as the traditional method (Jacobi sweeps), while, for large systems, it finds ER orbitals potentially much more quickly than traditional Jacobi sweeps. In fact, the required time for convergence of the algorithm scales quadratically in the region of a few hundred basis functions (though cubicly asymptotically), while Jacobi sweeps for the ER orbitals traditionally scale as the number of occupied orbitals to the fifth power. As an example of the utility of the method, they provide the ER orbitals of nitrated and nitrosated benzene, and they discuss the chemical implications.

  11. Opinion Paper: International law and government responsibilities in relation to the activities of Veolia Corporation in the occupied Palestinian Territories

    NARCIS (Netherlands)

    J.D. Handmaker (Jeff); P. van den Biesen (Phon)

    2014-01-01

    textabstractIntroduction Our first position in this opinion paper is that Veolia’s activities in occupied Palestinian territories, and in particular a light rail line on occupied and annexed Palestinian land in East Jerusalem is illegal. The light rail follows mainly the Green Line. Land was c

  12. An indoor air aerosol model for outdoor contaminant transmission into occupied rooms

    Institute of Scientific and Technical Information of China (English)

    XIE Hui; ZHAO Shen; CAO Guo-qing

    2014-01-01

    The paper presents a simple model for outdoor air contaminant transmission into occupied rooms. In the model, several factors such as filtration, ventilation, deposition, re-emission, outdoor concentration and indoor sources are included. The model results show that the air exchange rate plays an important role in the transmission of outdoor contaminants into the indoor environment. The model shows that increasing the value of the filtration efficiency decreases the mass concentration of indoor particles. In addition, if outdoor aerosol particles have a periodic behaviour, indoor aerosol particles also behave periodically but smoother. Indoor sources are found to be able to increase indoor concentrations greatly and continuously.

  13. Coming of age under Hitler and Stalin: the everyday life of adolescent girls in occupied Latvia.

    Science.gov (United States)

    McDowell, Linda

    2010-01-01

    This article explores the possibility of the continuation of everyday life in occupied Europe through a case study of the lives of twenty-five adolescent girls and young women living in Latvia between 1939 and 1944. Late adolescence is the period in which young women are struggling to establish some degree of independence, especially through leaving the parental home and entering the labour market. These transitions are the conventional markers of adulthood in modern societies. The article explores how occupation by the Soviet Union and the Third Reich affected daily life and the speed and nature of the transition to adulthood.

  14. An exploratory study of the ways in which mothers keep their infants occupied

    Directory of Open Access Journals (Sweden)

    A. Botha

    1992-09-01

    Full Text Available The mother child relationship can help or hinder the social, emotional and intellectual development of the infant. Research has shown that the interaction between mother and child can affect the child’s cognitive development. Research has shown that mothers from the lower socio-economic groups do not stimulate their babies optimally and that this may affect the children negatively. In this study 86 underprivileged mothers from two different cultural backgrounds were asked to describe the ways in which they kept their infants occupied during the first year of their infants’ lives. The differences between the two groups are discussed and recommendations are made.

  15. Surface shift of the occupied and unoccupied 4f levels of the rare-earth metals

    DEFF Research Database (Denmark)

    Aldén, Magnus; Johansson, Börje; Skriver, Hans Lomholt

    1995-01-01

    The surface energy shifts of the occupied and unoccupied 4f levels for the lanthanide metals have been calculated from first principles by means of a Green’s-function technique within the tight-binding linear muffin-tin orbitals method. We use the concept of complete screening to identify the occ...... played by the initial and the different final states of the core-excitation process, permitted by the fact that the so-called initial-state effect is identical upon 4f removal and 4f addition. Surface energy and work function calculations are also reported....

  16. 外来手术器械全程质量管理在消毒供应中心医院感染控制中的应用%Application of total quality management of foreign surgical instruments in nosocomial infection control in the sterilization and supply center

    Institute of Scientific and Technical Information of China (English)

    焦丽玲; 耿汇涓; 刘根生

    2012-01-01

    Objective To investigate the effect of total quality management of foreign surgical instruments in nosocomial infection control in the sterilization and supply center. Methods The effect before and after the application of total quality management for foreign surgical instruments in the control of nosocomial infection in the sterilization and supply center was comparatively analyzed. Results The results showed that after the application of total quality management for foreign surgical instruments,the onetime passing rate of sterilization and limits of microbial detection of surgical instruments increased significantly compared with that before application.The passing rate after application was significantly higher than before.The difference was significant.The implementation rate of planed surgery depending on foreign surgical instruments was 98.3%,the rate was 92.4% before application.There was a significant difference before and after application,the nosocomial infection rate after surgery depending on foreign surgical instruments was 0.88%,before the application was 6.50%,there was a significant difference before and after application. Conclusions Application of total quality management of foreign surgical instruments can significantly improve the efficiency of the use of foreign equipment and working efficiency of the operation room,reduce costs and the incidence of nosocomial infection significantly.It should be applied in the management of foreign surgical instruments in the sterilization and supply center.%目的 探讨全程质量管理用于消毒供应中心外来手术器械管理控制医院感染(简称院感)中的效果.方法 对比分析消毒供应中心将全程质量管理理念引入对外来手术器械管理以控制院感前后的效果,综合评价全程质量管理在控制外来手术器械引发院感方面的作用.结果 结果显示,对外来手术器械实施全程质量管理后,外来手术器械无菌或微生物限度

  17. Hernia Surgical Mesh Implants

    Science.gov (United States)

    ... Prosthetics Hernia Surgical Mesh Implants Hernia Surgical Mesh Implants Share Tweet Linkedin Pin it More sharing options ... majority of tissue used to produce these mesh implants are from a pig (porcine) or cow (bovine) ...

  18. Urogynecologic Surgical Mesh Implants

    Science.gov (United States)

    ... Prosthetics Urogynecologic Surgical Mesh Implants Urogynecologic Surgical Mesh Implants Share Tweet Linkedin Pin it More sharing options ... majority of tissue used to produce these mesh implants are from a pig (porcine) or cow (bovine). ...

  19. American Pediatric Surgical Association

    Science.gov (United States)

    American Pediatric Surgical Association Search for: Login Resources + For Members For Professionals For Training Program Directors For Media For ... Surgical Outcomes Surveys & Results Publications Continuing Education + ExPERT Pediatric Surgery NaT Annual Meeting CME MOC Requirements Residents / ...

  20. Optimizing surgical f

    Directory of Open Access Journals (Sweden)

    Sabry Mohamed Amin

    2016-07-01

    Conclusions: In our study both dexmedetomidine and esmolol were effective in reducing MABP, and lowering the heart rate providing dry surgical field and ensured good surgical condition during cochlear implant surgery in pediatric patients.

  1. Abortion - surgical - aftercare

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  2. Role of dynamic CT perfusion study in evaluating various intracranial space-occupying lesions

    Directory of Open Access Journals (Sweden)

    Ravindra B Kamble

    2015-01-01

    Full Text Available Aims: Differentiating intracranial mass lesions on CT scan is challenging. The purpose of our study was to determine the perfusion parameters in various intracranial space-occupying lesions (ICSOL, differentiate benign and malignant lesions, and differentiate between grades of gliomas. Materials and Methods: We performed CT perfusion (CTP in 64 patients, with age ranging from 17 to 68 years, having space-occupying lesions in brain and calculated relative cerebral blood flow (rCBF and relative cerebral blood volume (rCBV. Results: We found significantly lower perfusion in low-grade gliomas as compared to high-grade tumors, lymphoma, and metastases. Similarly in infective lesions, TWT and abscesses showed significantly lower perfusion compared to TOT. In ring enhancing lesions, capsule of TWT showed significantly lower perfusion as compared to abscesses, TOT, and metastases. Conclusion: Thus, in conclusion, infective lesions can be differentiated from tumors like lymphomas, high-grade gliomas, or metastases based on perfusion parameters. The cut off value of rCBV 1.64 can be used to differentiate between low grade and high grade gliomas. However, depending only on perfusion parameters, differentiation between the tumors like lymphomas, high-grade gliomas, and metastases may not be possible.

  3. Attitudes toward the health of men that regularly occupy in a trainer hall.

    Directory of Open Access Journals (Sweden)

    Adamchhuk Ja.

    2012-02-01

    Full Text Available It is accepted to consider that by motivation for people that practice in a trainer hall is an improvement of health and original appearance. The aim of this research was to determine whether there is training by part of forming of positive attitude toward the health of men-sportsmen-amateurs that occupy in a trainer hall. In research took part 100 men that engage in the power training in one of three trainer halls of Warsaw. Investigational divided by two groups: 50 persons that occupy in a trainer hall more than one year, but no more than 3 years (group A and 50 persons that practice more than 3 (group B. It is well-proven that training positively influences on the emotional state of men. It was discovered at the same time, that than greater experience of sportsman-amateur, the considerably more often he used additions (including by a stimulant. There was no medical control in both groups. Positive influence of the power training shows that they can be the important element of prophylaxis and physiotherapy.

  4. Erasing the Material Base of Occupy Wall Street: When Soft Means Fail

    Directory of Open Access Journals (Sweden)

    Christopher Leary

    2015-12-01

    Full Text Available When Occupy Wall Street proved able to reach mass circulation in 2011, it registered as a threat to the status quo in the United States, where corporate entities with close relation to government normally control the flow of discourse. The Occupy encampments, therefore, were intolerable, not merely an annoyance that could be ignored or ridiculed. Once Occupy’s anti-corporate rhetoric had spread widely, the mainstream media took steps to derail the mass appeal of Occupy’s oppositional discourse through accusations of incoherence and indecency. However, such “soft” means of organizing consent from the public were very weak in 2011 because of the 2008 economic collapse which had been provoked by Wall Street. With instruments of soft persuasion weak, the dominant group turned to instruments of hard persuasion — arrests, harassments, beatings, random grabs, and finally the orchestrated assault carried out on November 15th, an operation that saw the media censored and sequestered, at night, in the dark, with no filmed images, and all subway stations and street access blocked.

  5. Different information by MRI compare to ultrasound in fetal intracranial space occupying lesions.

    Science.gov (United States)

    Xia, Wei; Kasprian, Gregor; Hu, Daoyu; Xiao, Peng; Yang, Wenzhong; Chen, Xinlin

    2017-07-10

    The purpose of this study was to evaluate the value of prenatal magnetic resonance imaging (MRI) in characterizing fetal intracranial space occupying lesions in comparison to prenatal ultrasound. This retrospective study included 50 fetuses (mean age 26 years, mean gestational weeks 31 + 1 GW) with intracranial space occupying lesions, suspected by prenatal screening ultrasound. T2-weighted, T1-weighted, SSFP, and diffusion-weighted sequences of the fetal brain were obtained on a 1.5 T unit. Pathology (n = 5), postmortem MRI (n = 3), or postnatal US (n = 42) was available as standard of reference. The fetal MRI provided correct diagnosis in 49 cases (98%), while 35 (70%) by ultrasound, and MRI failed in 1 case (2%), while ultrasound failed in 15 cases (30%). Fetal MR and ultrasound were concordant in 35 of 50 cases (70%), completely discordant in 4 (8%), and partially discordant in 11 (22%) cases. MRI could provide detailed information about the minor lesions, such as focal hemorrhage and periventricular nodules. Meanwhile, it could provide whole view of the lesion in order to delineate the surrounding anatomical structure. But there are still some limitations of its soft-tissue resolution in a case with teratoma; more effort is needed to improve the sequences.

  6. Polygamain, a new microtubule depolymerizing agent that occupies a unique pharmacophore in the colchicine site.

    Science.gov (United States)

    Hartley, R M; Peng, J; Fest, G A; Dakshanamurthy, S; Frantz, D E; Brown, M L; Mooberry, S L

    2012-03-01

    Bioassay-guided fractionation was used to isolate the lignan polygamain as the microtubule-active constituent in the crude extract of the Mountain torchwood, Amyris madrensis. Similar to the effects of the crude plant extract, polygamain caused dose-dependent loss of cellular microtubules and the formation of aberrant mitotic spindles that led to G(2)/M arrest. Polygamain has potent antiproliferative activities against a wide range of cancer cell lines, with an average IC(50) of 52.7 nM. Clonogenic studies indicate that polygamain effectively inhibits PC-3 colony formation and has excellent cellular persistence after washout. In addition, polygamain is able to circumvent two clinically relevant mechanisms of drug resistance, the expression of P-glycoprotein and the βIII isotype of tubulin. Studies with purified tubulin show that polygamain inhibits the rate and extent of purified tubulin assembly and displaces colchicine, indicating a direct interaction of polygamain within the colchicine binding site on tubulin. Polygamain has structural similarities to podophyllotoxin, and molecular modeling simulations were conducted to identify the potential orientations of these compounds within the colchicine binding site. These studies suggest that the benzodioxole group of polygamain occupies space similar to the trimethoxyphenyl group of podophyllotoxin but with distinct interactions within the hydrophobic pocket. Our results identify polygamain as a new microtubule destabilizer that seems to occupy a unique pharmacophore within the colchicine site of tubulin. This new pharmacophore will be used to design new colchicine site compounds that might provide advantages over the current agents.

  7. FCJ-197 Entanglements with Media and Technologies in the Occupy Movement

    Directory of Open Access Journals (Sweden)

    Megan Boler

    2015-06-01

    Full Text Available This essay explores the paradox of activists using corporate-owned platforms—the ‘master’s tools’ (Lorde, 1984—in the context of the Occupy Wall Street movement. Grounded in findings from interviews with 30 women activists from eight North American Occupy sites, this essay reveals the frictions that result from the entangled paradox between philosophies embedded within technologies and activists’ philosophies. We document entanglements between corporate platforms and radical democratic ideals, and subsequent frictions between activists’ ideals and more pragmatic, DIY practices. We also investigate frictions between aspirations of openness, and the realities of surveillance and infiltration by the police state. We examine entanglements through the theoretical lenses of ‘connective labor’ (Boler et al, 2014, ‘veillance’ (Mann, 2004, and the ‘master’s tools’ (Lorde, 1984, and lay the groundwork for ‘queering the binary of individuals and groups’ (Barad, 2012 and recognising the non-linear, dynamic relations of social movements.

  8. Blonanserin extensively occupies rat dopamine D3 receptors at antipsychotic dose range.

    Science.gov (United States)

    Baba, Satoko; Enomoto, Takeshi; Horisawa, Tomoko; Hashimoto, Takashi; Ono, Michiko

    2015-03-01

    Antagonism of the dopamine D3 receptor has been hypothesized to be beneficial for schizophrenia cognitive deficits, negative symptoms and extrapyramidal symptoms. However, recent animal and human studies have shown that most antipsychotics do not occupy D3 receptors in vivo, despite their considerable binding affinity for this receptor in vitro. In the present study, we investigated the D3 receptor binding of blonanserin, a dopamine D2/D3 and serotonin 5-HT2A receptors antagonist, in vitro and in vivo. Blonanserin showed the most potent binding affinity for human D3 receptors among the tested atypical antipsychotics (risperidone, olanzapine and aripiprazole). Our GTPγS-binding assay demonstrated that blonanserin acts as a potent full antagonist for human D3 receptors. All test-drugs exhibited antipsychotic-like efficacy in methamphetamine-induced hyperactivity in rats. Treatment with blonanserin at its effective dose blocked the binding of [(3)H]-(+)-PHNO, a D2/D3 receptor radiotracer, both in the D2 receptor-rich region (striatum) and the D3 receptor-rich region (cerebellum lobes 9 and 10). On the other hand, the occupancies of other test-drugs for D3 receptors were relatively low. In conclusion, we have shown that blonanserin, but not other tested antipsychotics, extensively occupies D3 receptors in vivo in rats. Copyright © 2015 Japanese Pharmacological Society. Production and hosting by Elsevier B.V. All rights reserved.

  9. Blonanserin extensively occupies rat dopamine D3 receptors at antipsychotic dose range

    Directory of Open Access Journals (Sweden)

    Satoko Baba

    2015-03-01

    Full Text Available Antagonism of the dopamine D3 receptor has been hypothesized to be beneficial for schizophrenia cognitive deficits, negative symptoms and extrapyramidal symptoms. However, recent animal and human studies have shown that most antipsychotics do not occupy D3 receptors in vivo, despite their considerable binding affinity for this receptor in vitro. In the present study, we investigated the D3 receptor binding of blonanserin, a dopamine D2/D3 and serotonin 5-HT2A receptors antagonist, in vitro and in vivo. Blonanserin showed the most potent binding affinity for human D3 receptors among the tested atypical antipsychotics (risperidone, olanzapine and aripiprazole. Our GTPγS-binding assay demonstrated that blonanserin acts as a potent full antagonist for human D3 receptors. All test-drugs exhibited antipsychotic-like efficacy in methamphetamine-induced hyperactivity in rats. Treatment with blonanserin at its effective dose blocked the binding of [3H]-(+-PHNO, a D2/D3 receptor radiotracer, both in the D2 receptor-rich region (striatum and the D3 receptor-rich region (cerebellum lobes 9 and 10. On the other hand, the occupancies of other test-drugs for D3 receptors were relatively low. In conclusion, we have shown that blonanserin, but not other tested antipsychotics, extensively occupies D3 receptors in vivo in rats.

  10. Spherical mechanism analysis of a surgical robot for minimally invasive surgery -- analytical and experimental approaches.

    Science.gov (United States)

    Rosen, Jacob; Lum, Mitch; Trimble, Denny; Hannaford, Blake; Sinanan, Mika

    2005-01-01

    Recent advances in technology have led to the fusion of MIS techniques and robot devices. However, current systems are large and cumbersome. Optimizing the surgical robot mechanism will eventually lead to its integration into the operating room (OR) of the future becoming the extended presence of the surgeon and nurses in a room occupied by the patient alone. By optimizing a spherical mechanism using data collected in-vivo during MIS procedures, this study is focused on a bottom-up approach to developing a new class of surgical robotic arms while maximizing their performance and minimizing their size. The spherical mechanism is a rotational manipulator with all axes intersecting at the center of the sphere. Locating the rotation center of the mechanism at the MIS port makes this class of mechanism a suitable candidate for the first two links of a surgical robot for MIS. The required dexterous workspace (DWS) is defined as the region in which 95% of the tool motions are contained based on in-vivo measurements. The extended dexterous workspace (EDWS) is defined as the entire abdominal cavity reachable by a MIS instruments. The DWS is defined by a right circular cone with a vertex angle of 60 degrees and the EDWS is defined by a cone with an elliptical cross section created by two orthogonal vertex angles of 60 degrees and 90 degrees. A compound function based on the mechanism's isotropy and the mechanism stiffness was considered as the performance metric cost function. Optimization across both the DWS and the EDWS lead to a serial mechanism configuration with link length angles of 74 degrees and 60 degrees for a serial configuration. This mechanism configuration maximized the kinematic performance in the DWS while keeping the EDWS as its reachable workspace. Surgeons, using a mockup of two mechanisms in a MIS setup, validated these results experimentally. From these experiments the serial configuration was deemed most applicable for MIS robotic applications compared

  11. Evaluation of the application effect of cleaning packaging of surgical medical apparatus and instruments in sterilization and supply center of hospital%医院消毒供应中心实施手术医疗器械清洗包装的效果评价

    Institute of Scientific and Technical Information of China (English)

    焦丽玲; 刘文红; 赵俊霞

    2012-01-01

    目的 探讨医院消毒供应中心实施手术医疗器械清洗包装的效果.方法 对我院消毒供应中心实施手术医疗器械清洗包装前后的清洗质量一次合格率、包装质量一次合格率、无菌检查一次合格率、院内感染发生率等指标进行比较,综合评价医院消毒供应中心实施手术医疗器械清洗包装的效果.结果 消毒供应中心实施手术医疗器械清洗包装后,手术器械清洗质量检查一次合格率、包装质量一次合格率、无菌检查合格率均较实施前有明显提高,前后比较差异显著;比较实施前后的院内感染发生率,实施后的院内感染率为1.5%,实施前为5.5%,前后比较差异显著.结论 医院消毒供应中心实施手术医疗器械的清洗包装,可有效控制手术器械的清洗质量及包装质量,保证了后续消毒灭菌的彻底性,大大降低了因手术器械质量不过关而导致的院内感染发生率,为患者创造了可靠、值得信赖的医疗环境,取得了良好的社会效益和经济效益,值得推广应用.%Objective To investigate the application effect of cleaning packaging of surgical medical apparatus and instruments in sterilization and supply center of hospital. Methods The first-time qualification rate of cleaning,packaging and sterility test and incidence rate of nosocomial infection before and after the application of cleaning packaging of surgical medical apparatus and instruments in sterilization and supply center of hospital.The application effect was comprehensively evaluated. Results The first-time qualification rate of cleaning,packaging and sterility test after the application of cleaning packaging of surgical medical apparatus and instruments in sterilization and supply center were significantly increased.The incidence rate of nosocomial infection was 1.5% before and 5.5% after the application of cleaning packaging of surgical medical apparatus and instruments,the difference

  12. The Pathogen-Occupied Vacuoles of Anaplasma phagocytophilum and Anaplasma marginale Interact with the Endoplasmic Reticulum.

    Science.gov (United States)

    Truchan, Hilary K; Cockburn, Chelsea L; Hebert, Kathryn S; Magunda, Forgivemore; Noh, Susan M; Carlyon, Jason A

    2016-01-01

    The genus Anaplasma consists of tick-transmitted obligate intracellular bacteria that invade white or red blood cells to cause debilitating and potentially fatal infections. A. phagocytophilum, a human and veterinary pathogen, infects neutrophils to cause granulocytic anaplasmosis. A. marginale invades bovine erythrocytes. Evidence suggests that both species may also infect endothelial cells in vivo. In mammalian and arthropod host cells, A. phagocytophilum and A. marginale reside in host cell derived pathogen-occupied vacuoles (POVs). While it was recently demonstrated that the A. phagocytophilum-occupied vacuole (ApV) intercepts membrane traffic from the trans-Golgi network, it is unclear if it or the A. marginale-occupied vacuole (AmV) interacts with other secretory organelles. Here, we demonstrate that the ApV and AmV extensively interact with the host endoplasmic reticulum (ER) in endothelial, myeloid, and/or tick cells. ER lumen markers, calreticulin, and protein disulfide isomerase, and the ER membrane marker, derlin-1, were pronouncedly recruited to the peripheries of both POVs. ApV association with the ER initiated early and continued throughout the infection cycle. Both the ApV and AmV interacted with the rough ER and smooth ER. However, only derlin-1-positive rough ER derived vesicles were delivered into the ApV lumen where they localized with intravacuolar bacteria. Transmission electron microscopy identified multiple ER-POV membrane contact sites on the cytosolic faces of both species' vacuoles that corresponded to areas on the vacuoles' lumenal faces where intravacuolar Anaplasma organisms closely associated. A. phagocytophilum is known to hijack Rab10, a GTPase that regulates ER dynamics and morphology. Yet, ApV-ER interactions were unhindered in cells in which Rab10 had been knocked down, demonstrating that the GTPase is dispensable for the bacterium to parasitize the ER. These data establish the ApV and AmV as pathogen-host interfaces that directly

  13. Surgical Lasers In Gynecology

    Science.gov (United States)

    Schellhas, Helmut F.; Barnes, Alfonso E.

    1982-12-01

    Multipurpose surgical CO2 lasers marketed in the USA have been developed to be applicable to a variety of surgical procedures in many surgical fields. They are all suited for endoscopic surgical procedures and can be fitted to all standard surgical microscopes. They all can adjust the focal length of the laser beam to the different standard focal lengths of the surgical microscope which for instance in laryngoscopy is 400 mm and in colposcopy 300 mm. One laser instrument can even change the spot size in a given focal distance which is very advantageous for some microsurgical procedures (Merrimack Laboratories 820). All multipurpose surgical CO2 laser systems provide a multi-articulated surgical arm for free-hand surgery. The surgical arms are cumbersome to use but they are adapted to the surgeons needs with ingenuity. The practicality of the multi-articulated surgical arms depends mostly on the distance of the handpiece from the surgical console which now is also overbridged by the laser tube in most surgical laser system. The spot size of the beam is variable in most handpieces by interchangeable lenses which modify the focal distance of the beam and the power density. Another common feature in all systems is a coaxial He-Ne pilot light which provides a red spot which unfortunately becomes invisible in a bleeding surgical field. Most surgical laser systems have a spacial mode of TEM 00 which is essential for incisional surgery. The continuous mode of beam delivery is used for incisional surgery and also for most endoscopic procedures.

  14. Occupy Wall Street? Position-Blindness in the New Leftist Revolution

    Directory of Open Access Journals (Sweden)

    Agnes Gagyi

    2012-03-01

    Full Text Available The following I write as an Eastern European sociologist and activist, departing from the basic question of how local movements in my region might connect with Occupy Wall Street (OWS. By this time, it is evident that OWS has made an indelible mark on present-day discussions on globalisation and world order. Immanuel Wallerstein (2011, for example, has spoken directly of an ongoing transformation in world economy, asking whether the present crisis in the dominant model of capitalism-cum-democracy will be resolved through a shift towards a less democratic and more unequal system, or whether global social movements might help bring about a more equal and democratic social order. Keeping in sight the controversial lessons of the alter-globalism movement in Eastern Europe, I will argue that certain characteristics of the OWS movementthemselves pose an obstacle to the development of a truly global social movement

  15. Highest Occupied Molecular Orbital of Cyclopentanone by Binary (e, 2e) Spectroscopy

    Institute of Scientific and Technical Information of China (English)

    ZHANG Shu-Feng; NING Chuan-Gang; DENG Jing-Kang; REN Xue-Guang; SU Guo-Lin; YANG Tie-Cheng; HUANG Yan-Ru

    2006-01-01

    @@ We report the first measurements of the momentum profiles of highest occupied molecular orbital (HOMO) and the complete valence shell binding energy spectra of cyclopentanone with impact energies of 600 and 1200 eV by a binary (e, 2e) spectrometer. The experimental momentum profiles of the HOMO orbital are compared with the theoretical momentum distribution calculated using the Hartree-Fock and density functional theory methods with various basis sets. However, none of these calculations gives a completely satisfactory description of the momentum distributions of the HOMO 7b2. The inadequacy of the calculations could result in the intensity difference of the second maximum at p ~l.2a.u. between the experiment and the theory. The discrepancy between experimental and theoretical data in the low-momentum region is explained with the distorted wave effect.

  16. The High-Redshift Clusters Occupied by Bent Radio AGN (COBRA) Survey

    CERN Document Server

    Paterno-Mahler, R; Ashby, M L N; Brodwin, M; Wing, J D; Anand, G; Decker, B; Golden-Marx, E

    2016-01-01

    We present 238 high-redshift galaxy cluster candidates based on galaxy overdensities in the Spitzer/IRAC imaging of the fields surrounding 646 bent, double-lobed radio sources drawn from the Clusters Occupied by Bent Radio AGN (COBRA) Survey. The COBRA sources were chosen as objects in the VLA FIRST survey that lack optical counterparts in the Sloan Digital Sky Survey (SDSS) to a limit of $m_r=22$, making them likely to lie at high redshift. This is confirmed by our observations: the redshift distribution of COBRA sources with estimated redshifts peaks near $z=1$, and extends out to $z\\approx3$. Cluster candidates were identified by comparing our sources to a background field and searching for overdensities. Forty-one of these sources are quasars with known spectroscopic redshifts, which may be tracers of some of the most distant clusters known.

  17. Effect of ensemble generalization on the highest-occupied Kohn-Sham eigenvalue

    CERN Document Server

    Kraisler, Eli; Kümmel, Stephan; Kronik, Leeor

    2015-01-01

    There are several approximations to the exchange-correlation functional in density-functional theory that accurately predict total energy-related properties of many-electron systems, such as binding energies, bond lengths, and crystal structures. Other approximations are designed to describe potential-related processes, such as charge transfer and photoemission. However, the development of a functional which can serve the two purposes simultaneously is a long-standing challenge. Trying to address it, we employ in the current work the ensemble generalization procedure proposed in Phys. Rev. Lett. 110, 126403 (2013). Focusing on the prediction of the ionization potential via the highest occupied Kohn-Sham eigenvalue, we examine a variety of exchange-correlation approximations: the local spin-density approximation, semi-local generalized gradient approximations, and global and local hybrid functionals. Results for a test set of 26 diatomic molecules and single atoms are presented. We find that the aforementioned...

  18. Estimate of the area occupied by reforestation programs in Rio de Janeiro state

    Directory of Open Access Journals (Sweden)

    Hugo Barbosa Amorim

    2012-03-01

    Full Text Available This study was based on a preliminary survey and inventory of existing reforestation programs in Rio de Janeiro state, through geoprocessing techniques and collection of field data. The reforested area was found to occupy 18,426.96 ha, which amounts to 0.42% of the territory of the state. Much of reforestation programs consists of eucalyptus (98%, followed by pine plantations (0.8%, and the remainder is distributed among 10 other species. The Médio Paraíba region was found to contribute the most to the reforested area of the state (46.6%. The estimated volume of eucalyptus timber was nearly two million cubic meters. This study helped crystallize the ongoing perception among those militating in the forestry sector of Rio de Janeiro state that the planted area and stock of reforestation timber is still incipient in the state.

  19. Influence of caster diameter on the static and dynamic forward stability of occupied wheelchairs.

    Science.gov (United States)

    Kirby, R L; McLean, A D; Eastwood, B J

    1992-01-01

    The hypothesis that the static and dynamic forward stability of an occupied wheelchair would increase as a function of the caster diameter was tested in 20 able-bodied subjects. A device was attached to the wheelchair frame so that casters with different diameters could be used. With platform testing of static stability, the occupied wheelchair equipped with casters with diameters of 10.2, 20.3, 25.4, and 33.0cm, tipped at mean (+/- 1SD) angles of 23.8 degrees (+/- 1.3 degrees), 25.2 degrees (+/- 1.4 degrees), 26.1 degrees (+/- 1.4 degrees), and 28.2 degrees (+/- 1.9 degrees), respectively. The relationship between static stability (y, in degrees) and caster diameter (x, in cm) can be expressed by the equation y = 23.5-.0196 chi + .00484 x2 (p = .0001). Dynamic stability was tested by having subjects descend a 5 degree ramp, by gravity alone, from progressively farther up the ramp until a full forward tip occurred (footrests contacted the floor) when the wheelchair struck a 5-cm-high obstruction with sufficient speed. The mean tipping speeds for the dynamic tests were .85 (+/- .08), .85 (+/- .08), .89 (+/-.07), and 1.04 (+/- .14) m/sec for the wheelchair fitted with the caster diameters ranging from smallest to largest, respectively. The relationship between dynamic stability (y, tipping speed in m/sec) and caster diameter (chi, in cm) can be expressed by the equation y = .788 + .0139 chi-.00110 chi 2 + .0000276 chi 3 (p = .0001). The relationship between caster diameter and forward wheelchair stability should be considered in wheelchair design and prescription.

  20. Mammal assemblages in forest fragments and landscapes occupied by black howler monkeys.

    Science.gov (United States)

    Rangel-Negrín, Ariadna; Coyohua-Fuentes, Alejandro; Canales-Espinosa, Domingo; Dias, Pedro Américo D

    2014-07-01

    Species assemblages in disturbed habitats vary as a function of the interaction between species requirements and the spatial configuration of the habitat. There are many reports accounting for the presence of howler monkeys in fragments where other mammals are absent, suggesting that they are more resilient. In the present study we explored this idea and predicted that if howler monkeys were more resilient to habitat loss and fragmentation than other mammals, mammal assemblages in fragments occupied by howler monkeys should include fewer species with decreasing amount of habitat (smaller fragment size and less habitat in the landscape) and increasing number of forest fragments. We explored these relationships by additionally considering the feeding and life habits of mammal species, as well as the isolation and proximity of each fragment to human settlements and roads. We sampled the presence of mammals in five fragments occupied by black howler monkeys (Alouatta pigra) in the Mexican state of Campeche. Through direct sights performed during 240 h in each fragment, we observed 23 species. At the landscape scale, higher fragmentation was associated with a decrease in herbivores, omnivores and total number of species. At the fragment scale semiarboreal, omnivore, and total number of species increased with increasing fragment size. This study supports the idea that howler monkeys are more resilient to forest loss and fragmentation than other native mammals, and our exploratory analyses suggest that the specific mammal assemblages that are found in fragments are related to both landscape and fragment scale spatial attributes, as well as with species-specific characteristics.

  1. Surgical treatment of cleft lip

    Directory of Open Access Journals (Sweden)

    Mateus Domingues Miachon

    Full Text Available We performed a systematic review of the literature on the surgical treatment of cleft lip, emphasizing the prevalence, complications associated with the treatment and the points of disagreement between authors. We conducted a literature cross-sectional search that analyzed publications in books, articles and on the databases SciELO - Scientific Electronic Library Online, PubMed, of the National Center for Biotechnology Information. We conclude that: 1 the severity of the cleft will indicate the technique presenting more advantages; 2 the different approaches indicate that there is no consensus on the optimal technique; and 3 the surgeon experience contributes to choosing the best option.

  2. Relationship between patient complaints and surgical complications

    Science.gov (United States)

    Murff, H J; France, D J; Blackford, J; Grogan, E L; Yu, C; Speroff, T; Pichert, J W; Hickson, G B

    2006-01-01

    Background Patient complaints are associated with increased malpractice risk but it is unclear if complaints might be associated with medical complications. The purpose of this study was to determine whether an association exists between patient complaints and surgical complications. Methods A retrospective analysis of 16 713 surgical admissions was conducted over a 54 month period at a single academic medical center. Surgical complications were identified using administrative data. The primary outcome measure was unsolicited patient complaints. Results During the study period 0.9% of surgical admissions were associated with a patient complaint. 19% of admissions associated with a patient complaint included a postoperative complication compared with 12.5% of admissions without a patient complaint (p = 0.01). After adjusting for surgical specialty, co‐morbid illnesses and length of stay, admissions with complications had an odds ratio of 1.74 (95% confidence interval 1.01 to 2.98) of being associated with a complaint compared with admissions without complications. Conclusions Admissions with surgical complications are more likely to be associated with a complaint than surgical admissions without complications. Further research is necessary to determine if patient complaints might serve as markers for poor clinical outcomes. PMID:16456204

  3. Extending boundaries in minimally invasive procedures with simultaneous bilateral video endoscopic inguinal lymphadenectomy (veil for penile cancer: initial Denver health medical center and ABC school of medicine experience and surgical considerations

    Directory of Open Access Journals (Sweden)

    Alexandre Pompeo

    2013-07-01

    Full Text Available Purpose To report the surgical technique, procedural outcomes, and feasibility of simultaneous bilateral Video Endoscopic Inguinal Lymphadenectomy (VEIL in the management of patients with indication for inguinal lymphadenectomy. Surgical Technique: VEIL was applied in all patients using the oncological landmarks (the adductor longus muscle medially, the sartorius muscle laterally and the inguinal ligament superiorly. A 1.5 cm incision was made 2 cm distally to the lower vertex of the femoral triangle. A second incision was made 2 cm proximally and 6 cm medially. Two 10 mm Hasson trocars were inserted in these incisions and the working space was insufflated with CO2 at 5-15 mmHg. The final trocar was placed 2 cm proximally and 6 cm laterally from the first port. Results: A total of 5 VEIL procedures in 3 patients were performed. Two patients underwent simultaneous bilateral VEIL while another underwent simultaneous bilateral surgery with VEIL on the right and open lymphadenectomy on the left side due to an enlarged node. All laparoscopic procedures were successfully performed without conversion and maintained the oncological templates. One lymphocele occurred in the patient who underwent the open procedure. None of the patients presented with skin necrosis after the procedure. Mean number of nodes retrieved was 6 from each side and 2 patients presented with positive inguinal nodes. After one year of follow-up no recurrences were observed. Conclusion: Simultaneous lymphadenectomy procedures are feasible. Improvement in operative and anesthesia time could decrease the morbidity associated with inguinal lymphadenectomy while maintaining the oncological principles.

  4. Career satisfaction of surgical specialties.

    Science.gov (United States)

    Deshpande, Satish P; Deshpande, Sagar S

    2011-05-01

    To examine the factors that impact career satisfaction for various surgical specialties. An acute shortage of surgeons is anticipated in the future. Career dissatisfaction can make this already difficult situation worse. It is important to understand and address factors that influence career satisfaction of surgeons to prolong tenure of existing surgeons and understand anticipated needs of future surgeons. The Center for Studying Health System Change 2008 Health Tracking Physician Survey data were used in this study. Regression analysis was done to examine the impact of various practice-related factors, compensation-related factors, practice location, extent of minority patient, and various demographics on career satisfaction of various surgical specialties (n = 762). Among practice related factors, although threat of malpractice had a significant negative impact on career satisfaction, ability to provide quality care to patients and time with patients had a significant positive impact on career satisfaction of surgical specialists. Among compensation related factors, income and financial incentives to expand services had a significant positive impact on career satisfaction. Among practice location factors, those who primarily worked in medical schools were significantly more satisfied with their careers than others. Among minority factors, those treating a large proportion of Hispanic patients were significantly less likely to be satisfied with their careers. Ability to provide quality care, time with patients, income, and financial incentives had a significant positive impact on career satisfaction. Similarly, threat of malpractice and high proportion of Hispanic patients had a negative impact on career satisfaction.

  5. Manual of Surgical Instruments

    Directory of Open Access Journals (Sweden)

    Olga Lidia Sánchez Sarría

    2014-10-01

    Full Text Available Surgical instruments are the group of tools used in surgical procedures. They are very expensive and sophisticated. Consequently, a standardized and meticulous care is essential; they should go through the decontamination, cleaning and sterilization process. These instruments are designed in order to provide surgeons with tools that help them to perform a basic surgical procedure; there are multiple variations and the design depends on their function. This paper aims at showing all surgical instruments that can be used in an operating room during surgery and are not generally included in the medical literature.

  6. Modelagem e análise de um novo centro cirúrgico para um hospital em crescimento: uma abordagem baseada em simulação Modeling and analysis of a new surgical center for a growing hospital: a simulation-based approach

    Directory of Open Access Journals (Sweden)

    Élcio Douglas Joaquim

    2009-01-01

    Full Text Available Uma instituição hospitalar precisa de constante aperfeiçoamento para ser eficiente no seu principal negócio: o bem-estar do ser humano. Este artigo descreve um projeto realizado no Hospital Universitário da PUCPR, cujo principal objetivo é avaliar alterações no Centro Cirúrgico com o intuito de se preparar melhor para o aumento de demanda esperado para os próximos anos. Foram simulados e analisados quatro novos cenários, os quais incluíram restruturação de atividades de atendimento e ampliação do número de salas cirúrgicas. Os modelos de simulação mostraram que em geral as alterações sugeridas trarão benefícios ao centro e que o melhor cenário deverá ter duas novas salas de cirurgia e uma restruturação das atividades internas do centro. Isto reduzirá o tempo de espera do paciente por sala cirúrgica e também a própria taxa de ocupação das salas, além de atender bem à comunidade até 2010/2011.A hospital institution needs frequent improvement to be efficient at its core business: the care of the human being. This paper describes a project conducted at PUCPR's University Hospital, which main objective is to evaluate changes to the Surgical Center aiming at being better prepared for the demand increase expected for the coming years. Four new scenarios were simulated and analyzed, which included restructuring of internal activities and the increase on the number of surgical rooms. The simulation models showed that the suggested changes will benefit the center and that the best scenario should have two new surgical rooms along with the restructuring of the internal activities flow. This will reduce the patient waiting time for surgical room and the rooms' utilization, besides providing a good service to the community until 2010/2011.

  7. HOUSING UNITS Pct Units in Structure for Occupied Units NMSD 2000

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The 2006 Second Edition TIGER/Line files are an extract of selected geographic and cartographic information from the Census TIGER database. The geographic coverage...

  8. HOUSING UNITS Pct Units in Structure for Occupied Units NMHD 2000

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The 2006 Second Edition TIGER/Line files are an extract of selected geographic and cartographic information from the Census TIGER database. The geographic coverage...

  9. HOUSING UNITS Units in Structure for Renter Occupied Units NMSD 2000

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The 2006 Second Edition TIGER/Line files are an extract of selected geographic and cartographic information from the Census TIGER database. The geographic coverage...

  10. HOUSING UNITS Units in Structure for Owner Occupied Units NMSD 2000

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The 2006 Second Edition TIGER/Line files are an extract of selected geographic and cartographic information from the Census TIGER database. The geographic coverage...

  11. HOUSING UNITS Units in Structure for Renter Occupied Units NMHD 2000

    Data.gov (United States)

    Earth Data Analysis Center, University of New Mexico — The 2006 Second Edition TIGER/Line files are an extract of selected geographic and cartographic information from the Census TIGER database. The geographic coverage...

  12. Experimental validation of the buildings energy performance (PEC assessment methods with reference to occupied spaces heating

    Directory of Open Access Journals (Sweden)

    Cristian PETCU

    2010-01-01

    Full Text Available This paper is part of the series of pre-standardization research aimed to analyze the existing methods of calculating the Buildings Energy Performance (PEC in view of their correction of completing. The entire research activity aims to experimentally validate the PEC Calculation Algorithm as well as the comparative application, on the support of several case studies focused on representative buildings of the stock of buildings in Romania, of the PEC calculation methodology for buildings equipped with occupied spaces heating systems. The targets of the report are the experimental testing of the calculation models so far known (NP 048-2000, Mc 001-2006, SR EN 13790:2009, on the support provided by the CE INCERC Bucharest experimental building, together with the complex calculation algorithms specific to the dynamic modeling, for the evaluation of the occupied spaces heat demand in the cold season, specific to the traditional buildings and to modern buildings equipped with solar radiation passive systems, of the ventilated solar space type. The schedule of the measurements performed in the 2008-2009 cold season is presented as well as the primary processing of the measured data and the experimental validation of the heat demand monthly calculation methods, on the support of CE INCERC Bucharest. The calculation error per heating season (153 days of measurements between the measured heat demand and the calculated one was of 0.61%, an exceptional value confirming the phenomenological nature of the INCERC method, NP 048-2006. The mathematical model specific to the hourly thermal balance is recurrent – decisional with alternating paces. The experimental validation of the theoretical model is based on the measurements performed on the CE INCERC Bucharest building, within a time lag of 57 days (06.01-04.03.2009. The measurements performed on the CE INCERC Bucharest building confirm the accuracy of the hourly calculation model by comparison to the values

  13. Optimization of care for the pediatric surgical patient: Why now?

    Science.gov (United States)

    Arca, Marjorie J; Goldin, Adam B; Oldham, Keith T

    2015-12-01

    In 2015, the American College of Surgeons (ACS) has begun to verify hospitals and ambulatory centers which meet consensus based optimal resource standards as "Children׳s Surgical Centers." The intent is to identify children-specific resources available within an institution and using a stratification system similar to the ACS Trauma Program match these to the needs of infants and children with surgical problems. This review briefly summarizes the history, supporting data and processes which drove this initiative.

  14. The surgical treatment of acromegaly.

    Science.gov (United States)

    Buchfelder, Michael; Schlaffer, Sven-Martin

    2017-02-01

    Surgical extraction of as much tumour mass as possible is considered the first step of treatment in acromegaly in many centers. In this article the potential benefits, disadvantages and limitations of operative acromegaly treatment are reviewed. Pertinent literature was selected to provide a review covering current indications, techniques and results of operations for acromegaly. The rapid reduction of tumour volume is an asset of surgery. To date, in almost all patients, minimally invasive, transsphenoidal microscopic or endoscopic approaches are employed. Whether a curative approach is feasible or a debulking procedure is planned, can be anticipated on the basis of preoperative magnetic resonance imaging. The radicality of adenoma resection essentially depends on localization, size and invasive character of the tumour. The normalization rates of growth hormone and IGF-1 secretion, respectively, depend on tumour-related factors such as size, extension, the presence or absence of invasion and the magnitude of IGF-1 and growth hormone oversecretion. However, also surgeon-related factors such as experience and patient load of the centers have been shown to strongly affect surgical results and the rate of complications. As compared to most medical treatments, surgery is relatively cheap since the costs occur only once and not repeatedly. There are several new technical gadgets which aid in the surgical procedure: navigation and variants of intraoperative imaging. For the mentioned reasons, current algorithms of acromegaly management suggest an initial operation, unless the patients are unfit for surgery, refuse an operation or only an unsatisfactory resection is anticipated. A few suggestions are made when a re-operation could be considered.

  15. Surgical ethics and the challenge of surgical innovation.

    Science.gov (United States)

    Angelos, Peter

    2014-12-01

    Surgical ethics as a specific discipline is relatively new to many. Surgical ethics focuses on the ethical issues that are particularly important to the care of surgical patients. Informed consent for surgical procedures, the level of responsibility that surgeons feel for their patients' outcomes, and the management of surgical innovation are specific issues that are important in surgical ethics and are different from other areas of medicine. The future of surgical progress is dependent on surgical innovation, yet the nature of surgical innovation raises specific concerns that challenge the professionalism of surgeons. These concerns will be considered in the following pages.

  16. From drawing board to occupied space : assessing the design process of a transformational learning space

    Energy Technology Data Exchange (ETDEWEB)

    Cook, M.; Naz, F. [Gifford, London (United Kingdom)

    2009-07-01

    Schools in the United Kingdom are facing a challenge to make better teaching spaces. This paper reported on a study that evaluated the design of a special needs school. Several areas of design were considered, including form and orientation; natural ventilation and daylighting; visibility and openness; solar control; materials and embodied thermal mass; and noise attenuation. The study involved building monitoring and post occupancy evaluation in 2009. This paper outlined the research methodology that will be followed to evaluate the design against the predicted assumptions and the actual occupied building. The questionnaires from the post-occupancy evaluation will serve to identify the design gaps in the construction process and the results will be used to help designers predict comfort and user patterns in a special needs school. The evaluation was carried out in two ways. First, the performance of the building was monitored based on 3 parameters, notably energy consumption, environmental impact and occupant satisfaction. The pre-construction environmental and energy modeling results were then compared against the monitored results obtained from the actual built structure and energy data. This paper acted as a briefing paper, identifying the objective, scope and the methodology of the study. Results will be presented in a second paper. 6 refs., 2 tabs., 5 figs. 6 refs., 2 tabs., 5 figs.

  17. Fish assemblages in stream stretches occupied by cattail (Typhaceae, Angiospermae stands in Southeast Brazil

    Directory of Open Access Journals (Sweden)

    Fabíola Carla da Rocha

    Full Text Available Macrophytes are a major component of lentic and lotic aquatic ecosystems. As consequences of environmental degradation, species of cattail (genus Typha may become dominant along streams. The purpose of this study was to investigate the structure and feeding of fish assemblages in stream stretches under influence of Typha sp., also addressing the influences of temporal variation on composition, abundance, biomass, diversity, species richness, and feeding of fish. Six streams (labelled S1-S6 in the upper rio Turvo basin, southeast Brazil, with dense stands of Typha sp. in the instream and riparian habitat, were studied in six campaigns during three central months in both of the dry and wet periods, by using a standardized collection effort. Thirty-seven fish species were registered, totaling 4,228 individuals and 3.9 kg of biomass. Abundance, biomass, diversity, and species richness was higher in the wet period, but only the temporal variation in the species richness revealed to be statistically significant. Cluster analyses with composition and abundance showed little temporal similarity, but indicated two groups of streams (S1-S2-S5 and S3-S4-S6, that were corroborated along the axis 1 of the ordination analysis. Resident species was represented by six species, most of them considered tolerant and generalists. Chironomidae aquatic larvae and detritus were the most important items in the fish diet. These results suggest that the fish populations are opportunistic in exploring stream stretches occupied by cattail.

  18. Perspectives on induced abortion among Palestinian women: religion, culture and access in the occupied Palestinian territories.

    Science.gov (United States)

    Shahawy, Sarrah; Diamond, Megan B

    2017-07-19

    Induced abortion is an important public health issue in the occupied Palestinian territories (OPT), where it is illegal in most cases. This study was designed to elicit the views of Palestinian women on induced abortion given the unique religious, ethical and social challenges in the OPT. Sixty Palestinian women were interviewed on their perceptions of the religious implications, social consequences and accessibility of induced abortions in the OPT at Al-Makassed Islamic Charitable Hospital in East Jerusalem. Themes arising from the interviews included: the centrality of religion in affecting women's choices and views on abortion; the importance of community norms in regulating perspectives on elective abortion; and the impact of the unique medico-legal situation of the OPT on access to abortion under occupation. Limitations to safe abortion access included: legal restrictions; significant social consequences from the discovery of an abortion by one's community or family; and different levels of access to abortion depending on whether a woman lived in East Jerusalem, the West Bank, or Gaza. This knowledge should be incorporated to work towards a legal and medical framework in Palestine that would allow for safe abortions for women in need.

  19. Exact exchange potential evaluated solely from occupied Kohn-Sham and Hartree-Fock solutions

    CERN Document Server

    Cinal, M

    2011-01-01

    The reported new algorithm determines the exact exchange potential v_x in a iterative way using energy and orbital shifts (ES, OS) obtained - with finite-difference formulas - from the solutions (occupied orbitals and their energies) of the Hartree-Fock-like equation and the Kohn-Sham-like equation, the former used for the initial approximation to v_x and the latter - for increments of ES and OS due to subsequent changes of v_x. Thus, solution of the differential equations for OS, used by Kummel and Perdew (KP) [Phys. Rev. Lett. 90, 043004 (2003)], is avoided. The iterated exchange potential, expressed in terms of ES and OS, is improved by modifying ES at odd iteration steps and OS at even steps. The modification formulas are related to the OEP equation (satisfied at convergence) written as the condition of vanishing density shift (DS) - they are obtained, respectively, by enforcing its satisfaction through corrections to approximate OS and by determining optimal ES that minimize the DS norm. The proposed met...

  20. Polynomial scaling approximations and dynamic correlation corrections to doubly occupied configuration interaction wave functions.

    Science.gov (United States)

    Van Raemdonck, Mario; Alcoba, Diego R; Poelmans, Ward; De Baerdemacker, Stijn; Torre, Alicia; Lain, Luis; Massaccesi, Gustavo E; Van Neck, Dimitri; Bultinck, Patrick

    2015-09-14

    A class of polynomial scaling methods that approximate Doubly Occupied Configuration Interaction (DOCI) wave functions and improve the description of dynamic correlation is introduced. The accuracy of the resulting wave functions is analysed by comparing energies and studying the overlap between the newly developed methods and full configuration interaction wave functions, showing that a low energy does not necessarily entail a good approximation of the exact wave function. Due to the dependence of DOCI wave functions on the single-particle basis chosen, several orbital optimisation algorithms are introduced. An energy-based algorithm using the simulated annealing method is used as a benchmark. As a computationally more affordable alternative, a seniority number minimising algorithm is developed and compared to the energy based one revealing that the seniority minimising orbital set performs well. Given a well-chosen orbital basis, it is shown that the newly developed DOCI based wave functions are especially suitable for the computationally efficient description of static correlation and to lesser extent dynamic correlation.

  1. Phospholipids occupy the internal lumen of the c ring of the ATP synthase of Escherichia coli.

    Science.gov (United States)

    Oberfeld, Benjamin; Brunner, Josef; Dimroth, Peter

    2006-02-14

    The occupancy of the central cavity of the membrane-embedded c ring of the ATP synthase of Escherichia coli was investigated with a photo-cross-linking approach. Single cysteine mutants were created at c subunit positions 4, 8, and 11, which are oriented to the inside of the ring. These cysteines were alkylated with reagents carrying a photoactivatable substituent and illuminated. Subunit c and derivatives were then isolated and subjected to mass spectrometric analyses. The most noticeable product, which was found exclusively in irradiated samples, had a mass increase of 719 Da, consistent with a cross-link product between the substituted c subunit and phosphatidylethanolamine. Digestion with phospholipase C converted this product into one with a mass diminished by 126 Da, indicating that the phosphoethanolamine moiety was cleaved off. Hence, the cross-link forms to the diacylglycerol moiety of phosphatidylethanolamine. Control experiments showed that the subunit c-phospholipid adducts were formed in the ATP synthase complex in its natural membrane environment and were not artifacts arising from monomeric c subunits. We conclude therefore that the inner lumen of the c ring is occupied with phospholipids. No evidence was found for an extension of subunit a into this space.

  2. Deaths among young, single women in 2000-2001 in the West Bank, Palestinian Occupied Territories.

    Science.gov (United States)

    Al-Adili, Nadim; Shaheen, Mohammad; Bergström, Staffan; Johansson, Annika

    2008-05-01

    A study in 2000-2001 of causes of death of women of reproductive age (15-49) in the West Bank, Palestinian Occupied Territories, found that 154 of the 411 deceased women aged 15-49 with known marital status were single. Death notification forms for reported deaths were analysed and verbal autopsies carried out, where possible, with relatives of the deceased women. We found important differences in the age at death and causes of death among the single and married women, which can be attributed to the disadvantaged social status of single women in Palestinian society, exacerbated by the current unstable political situation. 41% of the deceased single women were under 25 years of age at death compared to 8% of the married women. The proportion of violent deaths and suicides among the single women was almost twice as high as among the married women, mainly in those below age 25. The single women were also more likely to die from medical conditions which indicated that they faced barriers to accessing health care. The fieldwork was conducted at the height of the Intifada and the Israeli military response, with heavy restrictions on mobility, limiting the possibility of probing deeper into the circumstances surrounding sensitive deaths. More research into the socio-cultural context of single women in Palestine society is needed as a basis for intervention.

  3. Effect of ensemble generalization on the highest-occupied Kohn-Sham eigenvalue

    Energy Technology Data Exchange (ETDEWEB)

    Kraisler, Eli; Kronik, Leeor [Department of Materials and Interfaces, Weizmann Institute of Science, Rehovoth 76100 (Israel); Schmidt, Tobias; Kümmel, Stephan [Theoretical Physics IV, University of Bayreuth, 95440 Bayreuth (Germany)

    2015-09-14

    There are several approximations to the exchange-correlation functional in density-functional theory, which accurately predict total energy-related properties of many-electron systems, such as binding energies, bond lengths, and crystal structures. Other approximations are designed to describe potential-related processes, such as charge transfer and photoemission. However, the development of a functional which can serve the two purposes simultaneously is a long-standing challenge. Trying to address it, we employ in the current work the ensemble generalization procedure proposed by Kraisler and Kronik [Phys. Rev. Lett. 110, 126403 (2013)]. Focusing on the prediction of the ionization potential via the highest occupied Kohn-Sham eigenvalue, we examine a variety of exchange-correlation approximations: the local spin-density approximation, semi-local generalized gradient approximations, and global and local hybrid functionals. Results for a test set of 26 diatomic molecules and single atoms are presented. We find that the aforementioned ensemble generalization systematically improves the prediction of the ionization potential, for various systems and exchange-correlation functionals, without compromising the accuracy of total energy-related properties. We specifically examine hybrid functionals. These depend on a parameter controlling the ratio of semi-local to non-local functional components. The ionization potential obtained with ensemble-generalized functionals is found to depend only weakly on the parameter value, contrary to common experience with non-generalized hybrids, thus eliminating one aspect of the so-called “parameter dilemma” of hybrid functionals.

  4. Giant lizards occupied herbivorous mammalian ecospace during the Paleogene greenhouse in Southeast Asia.

    Science.gov (United States)

    Head, Jason J; Gunnell, Gregg F; Holroyd, Patricia A; Hutchison, J Howard; Ciochon, Russell L

    2013-07-22

    Mammals dominate modern terrestrial herbivore ecosystems, whereas extant herbivorous reptiles are limited in diversity and body size. The evolution of reptile herbivory and its relationship to mammalian diversification is poorly understood with respect to climate and the roles of predation pressure and competition for food resources. Here, we describe a giant fossil acrodontan lizard recovered with a diverse mammal assemblage from the late middle Eocene Pondaung Formation of Myanmar, which provides a historical test of factors controlling body size in herbivorous squamates. We infer a predominately herbivorous feeding ecology for the new acrodontan based on dental anatomy, phylogenetic relationships and body size. Ranking body masses for Pondaung Formation vertebrates indicates that the lizard occupied a size niche among the larger herbivores and was larger than most carnivorous mammals. Paleotemperature estimates of Pondaung Formation environments based on the body size of the new lizard are approximately 2-5°C higher than modern. These results indicate that competitive exclusion and predation by mammals did not restrict body size evolution in these herbivorous squamates, and elevated temperatures relative to modern climates during the Paleogene greenhouse may have resulted in the evolution of gigantism through elevated poikilothermic metabolic rates and in response to increases in floral productivity.

  5. Invasion of an occupied niche by the crayfish Orconectes rusticus: potential importance of growth and mortality.

    Science.gov (United States)

    Hill, Anna M; Sinars, Damon M; Lodge, David M

    1993-06-01

    We are exploring mechanisms of an invasion that contradicts the oft-cited generalization that species invade vacant niches. In northern Wisconsin lakes, the introduced crayfish Orconectes rusticus is replacing two ecologically similar resident congeners, O. virilis and O. propinquus. In laboratory experiments, we compared growth and mortality of individually maintained crayfish offered one of five ad libitum diets: invertebrates, macrophytes, dentritus, periphyton or all items combined. Mortality was highest for O. virilis and lowest for O. rusticus. Macrophyte diets yielded the highest mortality. All three species grew best on invertebrate and combination diets but grew little or not at all on diets of periphyton, detritus or macrophytes. O. rusticus and O. virilis grew more than O. propinquus. O. rusticus grew more quickly and/or was better able to survive overall than its congeners. Therefore, O. rusticus would probably have advantages over O. virilis and O. propinquus in competitive interactions, reproductive success and avoiding size-selective fish predation. Subtle interspecific differences may interact strongly with other ecological factors and contribute to the displacement of resident species from a well-occupied niche.

  6. High-pressure synthesis of fully occupied tetragonal and cubic tungsten bronze oxides

    Energy Technology Data Exchange (ETDEWEB)

    Ikeuchi, Yuya; Takatsu, Hiroshi; Tassel, Cedric; Goto, Yoshihiro; Murakami, Taito; Kageyama, Hiroshi [Graduate School of Engineering, Kyoto University (Japan)

    2017-05-15

    A high-pressure reaction yielded the fully occupied tetragonal tungsten bronze K{sub 3}W{sub 5}O{sub 15} (K{sub 0.6}WO{sub 3}). The terminal phase shows an unusual transport property featuring slightly negative temperature-dependence in resistivity (dρ/dT<0) and a large Wilson ratio of R{sub W}=3.2. Such anomalous metallic behavior possibly arises from the low-dimensional electronic structure with a van Hove singularity at the Fermi level and/or from enhanced magnetic fluctuations by geometrical frustration of the tungsten sublattice. The asymmetric nature of the tetragonal tungsten bronze K{sub x}WO{sub 3}-K{sub 0.6-y}Ba{sub y}WO{sub 3} phase diagram implies that superconductivity for x≤0.45 originates from the lattice instability because of potassium deficiency. A cubic perovskite KWO{sub 3} phase was also identified as a line phase - in marked contrast to Na{sub x}WO{sub 3} and Li{sub x}WO{sub 3} with varying quantities of x (<1). This study presents a versatile method by which the solubility limit of tungsten bronze oxides can be extended. (copyright 2017 Wiley-VCH Verlag GmbH and Co. KGaA, Weinheim)

  7. The High-redshift Clusters Occupied by Bent Radio AGN (COBRA) Survey: The Spitzer Catalog

    Science.gov (United States)

    Paterno-Mahler, R.; Blanton, E. L.; Brodwin, M.; Ashby, M. L. N.; Golden-Marx, E.; Decker, B.; Wing, J. D.; Anand, G.

    2017-07-01

    We present 190 galaxy cluster candidates (most at high redshift) based on galaxy overdensity measurements in the Spitzer/IRAC imaging of the fields surrounding 646 bent, double-lobed radio sources drawn from the Clusters Occupied by Bent Radio AGN (COBRA) Survey. The COBRA sources were chosen as objects in the Very Large Array FIRST survey that lack optical counterparts in the Sloan Digital Sky Survey to a limit of m r = 22, making them likely to lie at high redshift. This is confirmed by our observations: the redshift distribution of COBRA sources with estimated redshifts peaks near z = 1 and extends out to z≈ 3. Cluster candidates were identified by comparing our target fields to a background field and searching for statistically significant (≥slant 2σ ) excesses in the galaxy number counts surrounding the radio sources; 190 fields satisfy the ≥slant 2σ limit. We find that 530 fields (82.0%) have a net positive excess of galaxies surrounding the radio source. Many of the fields with positive excesses but below the 2σ cutoff are likely to be galaxy groups. Forty-one COBRA sources are quasars with known spectroscopic redshifts, which may be tracers of some of the most distant clusters known.

  8. Recognizing surgical patterns

    NARCIS (Netherlands)

    Bouarfa, L.

    2012-01-01

    In the Netherlands, each year over 1700 patients die from preventable surgical errors. Numerous initiatives to improve surgical practice have had some impact, but problems persist. Despite the introduction of checklists and protocols, patient safety in surgery remains a continuing challenge. This is

  9. Surgical medical record

    DEFF Research Database (Denmark)

    Bulow, S.

    2008-01-01

    A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15......A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15...

  10. A influência da atividade lúdica sobre a ansiedade da criança durante o período pré-operatório no centro cirúrgico ambulatorial The influence of playful activities on children's anxiety during the preoperative period at the outpatient surgical center

    Directory of Open Access Journals (Sweden)

    Fernanda Seganfredo Weber

    2010-06-01

    Full Text Available OBJETIVO: Verificar a influência das atividades lúdicas realizadas durante o pré-operatório sobre a ansiedade de crianças participantes do projeto de recreação terapêutica desenvolvido no Centro Cirúrgico Ambulatorial (CCA do Hospital de Clínicas de Porto Alegre, Porto Alegre (RS. MÉTODOS: Para a realização do estudo, foi aplicada a Escala de Ansiedade Pré-operatória de Yale modificada (modified Yale Preoperative Anxiety Scale, mYPAS em 50 crianças de 5 a 12 anos submetidas a procedimentos médicos no CCA. As crianças foram divididas em dois grupos: grupo recreação (participou de intervenções lúdicas na sala de recreação e grupo controle (não participou de intervenções lúdicas. A ansiedade foi mensurada através da escala mYPAS em dois momentos: logo que os indivíduos chegaram ao CCA (minuto 0 e 15 minutos após a primeira medida. RESULTADOS: Os resultados mostraram que, logo ao entrar no CCA, os pacientes não apresentaram diferenças significativas com relação à ansiedade, sendo os valores elevados. No entanto, após 15 minutos de espera ou intervenção, as crianças do grupo recreação diminuíram a ansiedade, e as do grupo controle permaneceram ansiosas. CONCLUSÕES: Durante o período pré-operatório, crianças que participam de atividades lúdicas na sala de recreação diminuem a sua ansiedade em comparação àquelas que somente ficam na sala de espera pelo menos durante 15 minutos.OBJECTIVE: To verify the influence of playful activities during the preoperative period on the anxiety of children participating in the therapeutic recreation project conducted at the outpatient surgical center of Hospital de Clínicas de Porto Alegre (HCPA, Porto Alegre, Brazil. METHODS: The modified Yale Preoperative Anxiety Scale (mYPAS was administered to 50 children between 5 and 12 years of age undergoing medical procedures at the outpatient surgical center. The children were divided in two groups: recreation group

  11. Vertical orbital dystopia--surgical correction.

    Science.gov (United States)

    Edgerton, M T; Jane, J A

    1981-02-01

    The surgical correction of vertical malpositions of the human eye has been made relatively safe and reliable by recent surgical techniques. The authors define this condition as vertical orbital dystopia and review the etiology of this deformity in 38 recent consecutive cases that were surgically treated at the Craniofacial Anomalies Center of The University of Virginia. Some new and useful tests are described that are of value to the plastic surgeon in analysis of the facial deformity and in planning the appropriate surgical procedure to correct the vertical dystopia of one or both eyes. Several cases are illustrated that describe the principal surgical methods of moving the eye up or down without loss of vision. The vertical eye shifts in this series have been in the range of 2 to 3 mm to over 22 mm. No loss of vision was produced by these corrections. The most common difficulties and complications of orbital dystopia corrections are described. The implications of this type of surgery in terms of visual physiology are suggested. The authors conclude that surgical correction of vertical orbital dystopias is possible, safe, and rewarding to the patients. However, they advise that the correction is best performed in young children and by a specially trained team of plastic surgeons, neurosurgeons, and ophthalmologists.

  12. Immediate Intrauterine Device Insertion Following Surgical Abortion.

    Science.gov (United States)

    Patil, Eva; Bednarek, Paula H

    2015-12-01

    Placement of an intrauterine device (IUD) immediately after a first or second trimester surgical abortion is safe and convenient and decreases the risk of repeat unintended pregnancy. Immediate postabortion IUD placement is not recommended in the setting of postprocedure hemorrhage, uterine perforation, infection, or hematometra. Otherwise, there are few contraindications to IUD placement following surgical abortion. Sexually transmitted infection screening should follow US Centers for Disease Control and Prevention guidelines. No additional antibiotics are needed beyond those used for the abortion. Placing immediate postabortion IUDs makes highly-effective long-acting reversible contraception more accessible to women.

  13. A study on the attitudes and behavioural influence of construction waste management in occupied Palestinian territory.

    Science.gov (United States)

    Al-Sari, Majed I; Al-Khatib, Issam A; Avraamides, Marios; Fatta-Kassinos, Despo

    2012-02-01

    As a step towards comprehending what drives the management of construction waste in the occupied Palestinian territory, this paper quantifies construction waste generation and examines how the local contractors' waste management attitudes and behaviour are influenced. Collection of data was based on a survey, carried out in the southern part of the West Bank between April and May 2010. The survey targeted contractors who specialized in the construction of buildings. A logistic regression model was used to investigate the relationship between various attributes and the attitudes and behaviour that the local contractors demonstrate towards waste management. The results showed that during the construction of buildings, 17 to 81 kg of construction waste are generated per square metre of building floor. Although the area of a building is the key factor determining 74.8% of the variation of construction waste generation, the employment of labour-intensive techniques in the study area means that human factors such as the contractor's attitude and behaviour towards waste management, exert a key influence on waste generation. Attitudes towards the 3Rs of waste minimization and behaviour towards waste disposal are generally positive with smaller contractors exhibiting more positive attitudes and more satisfactory behaviour towards waste management. Overall, while contractors' behaviour towards waste sorting and disposal tends to be more satisfactory among contractors who are more conscious about the potential environmental impacts of construction waste, it was generally observed that in the absence of a regulatory framework, the voluntary attitudes and behaviour among the local contractors are mostly driven by direct economic considerations.

  14. Ecospaces occupied by Homo erectus and Homo sapiens in insular Southeast Asia in the Pleistocene

    Science.gov (United States)

    Hertler, Christine; Haupt, Susanne; Volmer, Rebekka; Bruch, Angela

    2014-05-01

    Hominins migrated to the islands of the Sunda Shelf multiple times. At least two immigration events are evident, an early immigration of Homo erectus in the late Early Pleistocene and a second immigration of Homo sapiens during the Late Pleistocene. Regional environments changed considerably in the Pleistocene. Expansion patterns among hominins are at least co-determined by their ecologies and environmental change. We examine these expansion patterns on the basis of habitat reconstructions. Mammalian communities provide a geographically extensive record and permit to assess hominin ecospaces. Although chronological resolution is low, they represent the most complete record of habitat changes associated with hominin expansion patterns. In order to reconstruct and compare hominin ecospaces on a quantitative scale, we set up a reference sample consisting of mammalian communities of 117 national parks in South Asia and Sub-Saharan Africa. The diversity of such communities is assessed by ecological profiling of specialized herbivore taxa. Moreover, datasets on climate and vegetation correlate with the diversity structure of such specialized herbivore communities. Reconstructing the diversity structure of communities at key sites in Pleistocene Southeast Asia permits to infer features of the climatic and vegetation framework associated with different hominin taxa. Our results show that Homo erectus and Homo sapiens did not occupy similar ecospaces. The ecospace of Homo erectus is characterized by comparatively low diversity among frugivorous and folivorous taxa, while obligate grazers are part of the assemblages. Specialized herbivore communities with such a diversity structure occur at present in East Africa, while they are absent in Southeast Asia. In the reference sample, this type of ecospace corresponds to seasonal wetlands. Although Homo sapiens still inhabits this type of environment in Southeast Asia, his ecospace is wider. Homo sapiens is associated with

  15. Potential 'ecological traps' of restored landscapes: koalas Phascolarctos cinereus re-occupy a rehabilitated mine site.

    Science.gov (United States)

    Cristescu, Romane H; Banks, Peter B; Carrick, Frank N; Frère, Céline

    2013-01-01

    With progressively increasing anthropogenic habitat disturbances, restoration of impacted landscapes is becoming a critical element of biodiversity conservation. Evaluation of success in restoration ecology rarely includes faunal components, usually only encompassing abiotic and floral components of the ecosystems. Even when fauna is explicitly included, it is usually only species presence/absence criteria that are considered. If restoration is to have a positive outcome, however, populations in restored habitats should exhibit comparable survival and reproductive rates to populations found in undisturbed surroundings. If a species recolonises restored areas but later experiences decreased fitness, restored areas could become ecological sinks or traps. We investigated this possibility in a case study of koalas Phascolarctos cinereus occupying rehabilitated mining areas on North Stradbroke Island, Australia. Our holistic approach compared rehabilitated and undisturbed areas on the basis of their vegetation characteristics, of koalas' body condition, roosting trees, diet, as well as predator index. Koalas using rehabilitated areas appeared to be able to access an adequate supply of roosting and fodder trees, were in good condition and had high reproductive output. We did not find any significant differences in predator density between rehabilitated areas and undisturbed surroundings. The results presented in this study showed there was no evidence that the post-mining rehabilitated areas constitute ecological sinks or traps. However, to reach a definitive conclusion as to whether areas rehabilitated post-mining provide at least equivalent habitat to undisturbed locations, additional research could be undertaken to assess foliar nutrient/water/toxin differences and predation risk in rehabilitated areas compared with undisturbed areas. More generally, the evaluation of whether restoration successfully produces a functional ecological community should include criteria

  16. Potential 'ecological traps' of restored landscapes: koalas Phascolarctos cinereus re-occupy a rehabilitated mine site.

    Directory of Open Access Journals (Sweden)

    Romane H Cristescu

    Full Text Available With progressively increasing anthropogenic habitat disturbances, restoration of impacted landscapes is becoming a critical element of biodiversity conservation. Evaluation of success in restoration ecology rarely includes faunal components, usually only encompassing abiotic and floral components of the ecosystems. Even when fauna is explicitly included, it is usually only species presence/absence criteria that are considered. If restoration is to have a positive outcome, however, populations in restored habitats should exhibit comparable survival and reproductive rates to populations found in undisturbed surroundings. If a species recolonises restored areas but later experiences decreased fitness, restored areas could become ecological sinks or traps. We investigated this possibility in a case study of koalas Phascolarctos cinereus occupying rehabilitated mining areas on North Stradbroke Island, Australia. Our holistic approach compared rehabilitated and undisturbed areas on the basis of their vegetation characteristics, of koalas' body condition, roosting trees, diet, as well as predator index. Koalas using rehabilitated areas appeared to be able to access an adequate supply of roosting and fodder trees, were in good condition and had high reproductive output. We did not find any significant differences in predator density between rehabilitated areas and undisturbed surroundings. The results presented in this study showed there was no evidence that the post-mining rehabilitated areas constitute ecological sinks or traps. However, to reach a definitive conclusion as to whether areas rehabilitated post-mining provide at least equivalent habitat to undisturbed locations, additional research could be undertaken to assess foliar nutrient/water/toxin differences and predation risk in rehabilitated areas compared with undisturbed areas. More generally, the evaluation of whether restoration successfully produces a functional ecological community

  17. Heat loss may explain bill size differences between birds occupying different habitats.

    Directory of Open Access Journals (Sweden)

    Russell Greenberg

    Full Text Available BACKGROUND: Research on variation in bill morphology has focused on the role of diet. Bills have other functions, however, including a role in heat and water balance. The role of the bill in heat loss may be particularly important in birds where water is limiting. Song sparrows localized in coastal dunes and salt marsh edge (Melospiza melodia atlantica are similar in size to, but have bills with a 17% greater surface area than, those that live in mesic habitats (M. m. melodia, a pattern shared with other coastal sparrows. We tested the hypotheses that sparrows can use their bills to dissipate "dry" heat, and that heat loss from the bill is higher in M. m. atlantica than M. m. melodia, which would indicate a role of heat loss and water conservation in selection for bill size. METHODOLOGY/PRINCIPAL FINDINGS: Bill, tarsus, and body surface temperatures were measured using thermal imaging of sparrows exposed to temperatures from 15-37°C and combined with surface area and physical modeling to estimate the contribution of each body part to total heat loss. Song sparrow bills averaged 5-10°C hotter than ambient. The bill of M. m atlantica dissipated up to 33% more heat and 38% greater proportion of total heat than that of M. m. melodia. This could potentially reduce water loss requirements by approximately 7.7%. CONCLUSIONS/SIGNIFICANCE: This >30% higher heat loss in the bill of M. m. atlantica is independent of evaporative water loss and thus could play an important role in the water balance of sparrows occupying the hot and exposed dune/salt marsh environments during the summer. Heat loss capacity and water conservation could play an important role in the selection for bill size differences between bird populations and should be considered along with trophic adaptations when studying variation in bill size.

  18. [Surgical research in Germany. Organization, quality and international competitiveness].

    Science.gov (United States)

    Menger, M D; Laschke, M W

    2012-04-01

    Surgical research in Germany is performed within surgical clinics by individual working groups or in surgical research divisions. Additionally, a few independent institutes and departments of surgical research have been established at medical faculties. The number of these institutions, however, is too small. To increase productivity in surgical research, structural changes are necessary, including additional establishment of further institutes and professorships. The quality of clinical research in surgery in Germany is critically discussed. International comparison shows that Germany has a low ranking with respect to the number of clinical studies published in leading surgical journals. However, there has been some improvement in the quality of clinical studies performed in surgical departments during the last 15 years. The establishment of the study center of the German Society of Surgery shows that excellent clinical studies with adequate numbers of patients can also be performed in Germany and can be published in leading journals. Accordingly, there is need to distribute the structures and the competence necessary to perform clinical studies in a standardized manner to all surgical departments involved in clinical research. The experimental surgical research in Germany is not adequately visible, although over the last 10 years the most relevant publications from institutions for surgical research have been placed in journals with a mean impact factor of 8. This may be due to the fact that 85% of these top publications are published in non-surgical journals. The aim for the future must therefore be to increase the impact factor and, thus, the attractiveness of surgical journals. This may be achieved by publishing the highest quality results from experimental surgical research not in non-surgical but in surgical journals.

  19. Surgical Treatment for Chronic Pancreatitis: Past, Present, and Future

    Directory of Open Access Journals (Sweden)

    Stephanie Plagemann

    2017-01-01

    Full Text Available The pancreas was one of the last explored organs in the human body. The first surgical experiences were made before fully understanding the function of the gland. Surgical procedures remained less successful until the discovery of insulin, blood groups, and finally the possibility of blood donation. Throughout the centuries, the surgical approach went from radical resections to minimal resections or only drainage of the gland in comparison to an adequate resection combined with drainage procedures. Today, the well-known and standardized procedures are considered as safe due to the high experience of operating surgeons, the centering of pancreatic surgery in specialized centers, and optimized perioperative treatment. Although surgical procedures have become safer and more efficient than ever, the overall perioperative morbidity after pancreatic surgery remains high and management of postoperative complications stagnates. Current research focuses on the prevention of complications, optimizing the patient’s general condition preoperatively and finding the appropriate timing for surgical treatment.

  20. Surgical Treatment for Chronic Pancreatitis: Past, Present, and Future

    Science.gov (United States)

    Welte, Maria; Izbicki, Jakob R.; Bachmann, Kai

    2017-01-01

    The pancreas was one of the last explored organs in the human body. The first surgical experiences were made before fully understanding the function of the gland. Surgical procedures remained less successful until the discovery of insulin, blood groups, and finally the possibility of blood donation. Throughout the centuries, the surgical approach went from radical resections to minimal resections or only drainage of the gland in comparison to an adequate resection combined with drainage procedures. Today, the well-known and standardized procedures are considered as safe due to the high experience of operating surgeons, the centering of pancreatic surgery in specialized centers, and optimized perioperative treatment. Although surgical procedures have become safer and more efficient than ever, the overall perioperative morbidity after pancreatic surgery remains high and management of postoperative complications stagnates. Current research focuses on the prevention of complications, optimizing the patient's general condition preoperatively and finding the appropriate timing for surgical treatment. PMID:28819358

  1. Surgical ethics: surgical virtue and more.

    Science.gov (United States)

    Vercler, Christian J

    2015-01-01

    The encounter between a patient and her surgeon is unique for several reasons. The surgeon inflicts pain upon a patient for the patient's own good. An operative intervention is irreducibly personal, such that the decisions about and performance of operations are inseparable from the idiosyncrasies of the individual surgeon. Furthermore, there is a chasm of knowledge between the patient and surgeon that is difficult to cross. Hence, training in the discipline of surgery includes the inculcation of certain virtues and practices to safeguard against abuses of this relationship and to make sure that the best interests of the patient are prioritized. The stories in this issue are evidence that in contemporary practice this is not quite enough, as surgeons reflect on instances they felt were ethically challenging. Common themes include the difficulty in communicating surgical uncertainty, patient-surgeon relationships, ethical issues in surgical training, and the impact of the technological imperative on caring for dying patients.

  2. Occupy als Jugendbewegung für Generationengerechtigkeit?: Mediatisierte Aushandlungen des ‚Politischen‘ durch junge Menschen

    Directory of Open Access Journals (Sweden)

    Stehling, Miriam

    2015-08-01

    Full Text Available Ausgehend von der Debatte um eine ‚Politikverdrossenheit‘ der Jugend diskutiert der Artikel, welche Bedeutung Generationengerechtigkeit bei den Occupy-Protesten zukommt. Vor dem Hintergrund eines erweiterten Begriffs des ‚Politischen‘ wird zum einen argumentiert, dass junge Menschen gegenwärtig in einen Bereich neuartiger Politikformen und Praktiken eingebunden sind, der eng mit der Omnipräsenz digitaler Medien verknüpft ist. Zum anderen wird herausgearbeitet, wie Medien bei den Occupy-Protesten genutzt werden, um Forderungen nach sozialer Gerechtigkeit zu artikulieren.

  3. Multiscale Surgical Telerobots

    Energy Technology Data Exchange (ETDEWEB)

    Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L

    2002-01-23

    A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

  4. Policy Instruments to Improve Energy Performance of Existing Owner Occupied Dwellings

    Directory of Open Access Journals (Sweden)

    Lorraine Colette Murphy

    2016-11-01

    Full Text Available The aim of this thesis is to add knowledge to the role and impact of policy instruments in meeting energy performance ambition in the existing owner occupied housing stock. The focus was instruments available in the Netherlands in 2011 and 2012. These instruments represented the ‘on the ground’ efforts to meet climate change targets and many continue to do so today in the same or slightly altered forms. At international level there is a recognized need to keep global temperatures within the range of 1.5 - 2°C above pre-industrial levels (Carrington, 2016. At European level, the 2020 package contains a series of binding legislation to help the EU meet its more immediate climate and energy targets. 2020 targets include 20% reduction in greenhouse gas emission, 20% of EU energy obtained from renewable sources and 20% improvement in energy efficiency. 2020 targets for the Netherlands are a 20% reduction in greenhouse gas emissions and a 14% increase in energy generation from renewable sources (Vringer et al., 2014. A raft of policies has been produced over the last number of decades from international to local level to orientate action towards targets. At European level the Energy Performance of Buildings Directive (EPBD drives efforts at reducing energy among one of the biggest players, the building sector. By requiring a mandatory certificate at the point of sale and rent of buildings and making regulatory demands on existing buildings the EPBD upped the ante of what could be expected from the building sector, but especially the existing dwelling stock. National governments have already been tackling existing dwellings for decades propelled by the energy crisis and later by climate change policy. Information campaigns, subsidies, energy taxes, energy loans and tailored advice are among the instruments that have been available to homeowners to carry out works on their dwellings to reduce energy consumption. In recent

  5. Subspecialist training in surgical gynecological oncology in the nordic countries

    DEFF Research Database (Denmark)

    Antonsen, Sofie L; Avall-Lundqvist, Elisabeth; Salvesen, Helga B;

    2011-01-01

    To survey the centers that can provide subspecialty surgical training and education in gynecological oncology in the Nordic countries we developed an online questionnaire in cooperation with the Nordic Society of Gynecological Oncology. The link to the survey was mailed to 22 Scandinavian...... gynecological centers in charge of surgical treatment of cancer patients. Twenty centers (91%) participated. Four centers reported to be accredited European subspecialty training centers, a further six were interested in being accredited, and 11 centers were accredited by the respective National Board. Fourteen...... (74%) centers were interested in being listed for exchange of fellows. Our data show a large Nordic potential and interest in improving the gynecologic oncology standards and can be used to enhance the awareness of gynecological oncology training in Scandinavia and to facilitate the exchange...

  6. Correlation of Routine Histo-Pathology, Frozen Section and Squash Preparation in The Diagnosis of Space Occupying Lesions of Central Nervous System

    Directory of Open Access Journals (Sweden)

    Aritra Ash

    2016-06-01

    Full Text Available Intra-operative consultation is an important part of the management of patients with space occupying lesions (SOL of central nervous system. The correlation between intra-operative frozen section diagnosis with final histopathological diagnosis is an integral part of quality assurance in surgical pathology. Aim of study-1To study the correlation of routine histopathology, frozen section (FS and squash preparation in the diagnosis of SOL of central nervous system (CNS.2 To find out incidence of various types of lesions of CNS.3 To study sensitivity of frozen section, squash cytology and routine histopathology for diagnosis of SOLs of CNS. Materials and Methods-Total 100 cases of SOLs of CNS were studied retrospectively which were diagnosed and reported with frozen section followed by routine histopathology. The diagnoses on frozen sections and squash cytology were compared with the final diagnosis on paraffin sections to assess the concordance and discordance rates between both as well as to find out the incidence of various lesions of CNS. Results- In present study, the overall concordance rate was 88%, discordance rate was 12% in our institution. In cases where the FS and the routine histopathology diagnosis were discordant the final diagnosis was derived from the findings of routine histopathological examination. Astrocytoma (38% was the most common diagnosis with highest incidence rate in frozen section as well as routine histology in the present study.

  7. Guide to Surgical Specialists

    Science.gov (United States)

    ... have expertise in the following areas of responsibility: neonatal surgery (specialized knowledge in the surgical repair of ... and non-operative management of certain types of pain. Common conditions managed by neurologic surgeons include disorders ...

  8. Surgical Critical Care Initiative

    Data.gov (United States)

    Federal Laboratory Consortium — The Surgical Critical Care Initiative (SC2i) is a USU research program established in October 2013 to develop, translate, and validate biology-driven critical care....

  9. Surgical site infections

    African Journals Online (AJOL)

    and mortality as well as significant financial implications. Worldwide it has ... common nosocomial infection amongst surgical patients with up to 38% .... antibiotics as soon as the sensitivity results are available. ... Breast surgery. Staph Aureus/ ...

  10. 小儿外科重大疾病术前贫血与干预多中心调查%Multi-center epidemiological survey of preoperative anemia and intervention status of some major pediatric surgical diseases

    Institute of Scientific and Technical Information of China (English)

    林茹; 刘晋萍; 周荣华; 李鹏; 王斌; 郑珊; 舒强

    2014-01-01

    目的 了解国内部分地区小儿外科某些重大疾病术前贫血与干预状况,为进一步开展小儿围术期血液管理提供依据.方法 研究单位分别选择2012年5月至2014年3月期间住院的非紫绀先天性心脏病、先天性巨结肠和胆总管囊肿患儿做回顾性问卷调查.纳入标准:最接近手术日的术前血常规报告血红蛋白(Hb)值低于120 g/L即诊断贫血.干预措施指对术前贫血是否采用输血或补充促红细胞生成素(rHuEPO)、铁剂、维生素等等.结果 共调查北京、上海、杭州、西安、深圳和成都地区6家医院874例患儿.其中先天性心脏病组458例,男282例,女176例;年龄2个月至13.5岁,平均(28.58±29.79)个月.Hb低于120 g/L有276例,总发生率为60.3%,其中轻度贫血(Hb<120 g/L,≥90 g/L)为58.1%(266/458),中度以上贫血(Hb<90 g/L)为2.2%(10/458).福利院、小于1岁或/和肺动脉高压的患儿贫血发生率分别明显高于总发生率(P=0.008、P<0.001、P<0.001);普外组416例中,男204例,女212例,年龄2个月至16.25岁,平均(28.60±32.30)个月.Hb低于120 g/L有331例,总发生率为79.6%,其中轻度贫血为71.4%(297/416),中度以上贫血为8.2%(34/416).术前贫血发生率各个地区存在明显差异,从50%到100%不等;对术前贫血不处理直接手术的比例达到89.1%以上;除个别医院术前采用rHuEPO,较少有其他干预措施.结论 国内部分地区小儿外科某些重大疾病术前贫血发生率较高,不干预直接手术的状况十分普遍,应引起重视.%Objective To explore the incidence of preoperative anemia and intervention status of some major pediatric surgical diseases in some domestic areas so as to provide scientific rationales for perioperative blood management in children.Methods The hospitalized patients with non-cyanotic congenital heart disease,Hirschsprug's diseaseor choledochal cyst from May 2012 to March 2014 at all study units were surveyed

  11. A hybridized membrane-botanical biofilter for improving air quality in occupied spaces

    Science.gov (United States)

    Llewellyn, David; Darlington, Alan; van Ras, Niels; Kraakman, Bart; Dixon, Mike

    Botanical biofilters have been shown to be effective in improving indoor air quality through the removal of complex mixtures of gaseous contaminants typically found in human-occupied environments. Traditional, botanical biofilters have been comprised of plants rooted into a thin and highly porous synthetic medium that is hung on vertical surfaces. Water flows from the top of the biofilter and air is drawn horizontally through the rooting medium. These botanical biofilters have been successfully marketed in office and institutional settings. They operate efficiently, with adequate contaminant removal and little maintenance for many years. Depending on climate and outdoor air quality, botanical biofiltration can substantially reduce costs associated with ventilation of stale indoor air. However, there are several limitations that continue to inhibit widespread acceptance: 1. Current designs are architecturally limiting and inefficient at capturing ambient light 2. These biofilters can add significant amounts of humidity to an indoor space. This water loss also leads to a rapid accumulation of dissolved salts; reducing biofilter health and performance 3. There is the perception of potentially actively introducing harmful bioaerosols into the air stream 4. Design and practical limitations inhibit the entrance of this technology into the lucrative residential marketplace This paper describes the hybridization of membrane and botanical biofiltration technologies by incorporating a membrane array into the rootzone of a conventional interior planting. This technology has the potential for addressing all of the above limitations, expanding the range of indoor settings where botanical biofiltration can be applied. This technology was developed as the CSA-funded Canadian component an ESA-MAP project entitled: "Biological airfilter for air quality control of life support systems in manned space craft and other closed environments", A0-99-LSS-019. While the project addressed a

  12. Climate control based on temperature measurement in the animal-occupied zone of a pig room with ground channel ventilation

    NARCIS (Netherlands)

    Wagenberg, van A.V.; Aerts, J.M.; Brecht, van A.; Vranken, E.; Leroy, T.; Berckmans, D.

    2005-01-01

    It is known that there can be a significant temperature difference between the position of the climate controller sensor (room temperature) and the animal-occupied zone (AOZ) in a pig room. This study explores the advantages of using AOZ temperature in climate control. The objectives were: (1) to ev

  13. Origin of the lattice sites occupied by implanted Co in Si

    CERN Document Server

    Silva, Daniel; Wahl, Ulrich; Martins Correia, Joao; Da Costa Pereira, Lino Miguel; Amorim, Lígia; Castro Ribeiro Da Silva, Manuel; Esteves De Araujo, Araujo Joao Pedro

    2014-01-01

    We have investigated the lattice location of implanted 61Co in silicon. By means of emission channeling, three different lattice sites have been identified: ideal substitutional sites, displaced bond-centered sites and displaced tetrahedral interstitial sites. To assess the origin of the observed lattice sites we have compared our results to emission channeling studies on 59Fe and 65Ni and to Mössbauer spectroscopy experiments on 57Co, present in literature. The possible interpretation of several 57Co Mössbauer lines is discussed in the light of our new results on the 61Co lattice location. The conclusions are relevant for the microscopic understanding of some gettering techniques.

  14. Measured Performance of Occupied, Side-by-Side, South Texas Homes

    Energy Technology Data Exchange (ETDEWEB)

    Chasar, Dave; vonSchramm, Valerie

    2012-09-01

    The performance of three homes in San Antonio, Texas with identical floor plans and orientation were evaluated through a partnership between the Florida Solar Energy Center (FSEC), CPS Energy, and Woodside Homes of South Texas. Measurements included whole house gas and electric use as well as heating, cooling, hot water, major appliances and indoor and outdoor conditions. One home built to builder standard practice served as the control, while the other homes demonstrated high performance features. Utility peak electric load comparisons of these dual-fuel homes provide an assessment of envelope and equipment improvements.

  15. Excel Center

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Citigroup,one of the World top 500 companies,has now settled in Excel Center,Financial Street. The opening ceremony of Excel Center and the entry ceremony of Citigroup in the center were held on March 31.Government leaders of Xicheng District,the Excel CEO and the heads of Asia-Pacific Region leaders of Citibank all participated in the ceremony.

  16. 3D Surgical Simulation

    Science.gov (United States)

    Cevidanes, Lucia; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael

    2009-01-01

    This paper discusses the development of methods for computer-aided jaw surgery. Computer-aided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. Supported by NIDCR DE017727, and DE018962 PMID:20816308

  17. Anxiety in veterinary surgical students

    DEFF Research Database (Denmark)

    Langebæk, Rikke; Eika, Berit; Jensen, Asger Lundorff

    2012-01-01

    The surgical educational environment is potentially stressful and this can negatively affect students' learning. The aim of this study was to investigate whether veterinary students' level of anxiety is higher in a surgical course than in a non-surgical course and if pre-surgical training...... in a Surgical Skills Lab (SSL) has an anxiety reducing effect. Investigations were carried out as a comparative study and a parallel group study. Potential participants were fourth-year veterinary students who attended a surgical course (Basic Surgical Skills) and a non-surgical course (Clinical Examination...... and 28 students from 2010). Our results show that anxiety levels in veterinary students are significantly higher in a surgical course than in a non-surgical course (p...

  18. Surgical bleeding in microgravity

    Science.gov (United States)

    Campbell, M. R.; Billica, R. D.; Johnston, S. L. 3rd

    1993-01-01

    A surgical procedure performed during space flight would occur in a unique microgravity environment. Several experiments performed during weightlessness in parabolic flight were reviewed to ascertain the behavior of surgical bleeding in microgravity. Simulations of bleeding using dyed fluid and citrated bovine blood, as well as actual arterial and venous bleeding in rabbits, were examined. The high surface tension property of blood promotes the formation of large fluid domes, which have a tendency to adhere to the wound. The use of sponges and suction will be adequate to prevent cabin atmosphere contamination with all bleeding, with the exception of temporary arterial droplet streams. The control of the bleeding with standard surgical techniques should not be difficult.

  19. Surgical management of presbyopia

    Directory of Open Access Journals (Sweden)

    Torricelli AA

    2012-09-01

    Full Text Available André AM Torricelli, Jackson B Junior, Marcony R Santhiago, Samir J BecharaDivision of Ophthalmology, University of São Paulo Medical School, São Paulo, BrazilAbstract: Presbyopia, the gradual loss of accommodation that becomes clinically significant during the fifth decade of life, is a physiologic inevitability. Different technologies are being pursued to achieve surgical correction of this disability; however, a number of limitations have prevented widespread acceptance of surgical presbyopia correction, such as optical and visual distortion, induced corneal ectasia, haze, anisometropy with monovision, regression of effect, decline in uncorrected distance vision, and the inherent risks with invasive techniques, limiting the development of an ideal solution. The correction of the presbyopia and the restoration of accommodation are considered the final frontier of refractive surgery. The purpose of this paper is to provide an update about current procedures available for presbyopia correction, their advantages, and disadvantages.Keywords: presbyopia, surgical correction, treatment

  20. Accelerated detection of intracranial space-occupying lesions with CUDA based on statistical texture atlas in brain HRCT.

    Science.gov (United States)

    Liu, Wei; Feng, Huanqing; Li, Chuanfu; Huang, Yufeng; Wu, Dehuang; Tong, Tong

    2009-01-01

    In this paper, we present a method that detects intracranial space-occupying lesions in two-dimensional (2D) brain high-resolution CT images. Use of statistical texture atlas technique localizes anatomy variation in the gray level distribution of brain images, and in turn, identifies the regions with lesions. The statistical texture atlas involves 147 HRCT slices of normal individuals and its construction is extremely time-consuming. To improve the performance of atlas construction, we have implemented the pixel-wise texture extraction procedure on Nvidia 8800GTX GPU with Compute Unified Device Architecture (CUDA) platform. Experimental results indicate that the extracted texture feature is distinctive and robust enough, and is suitable for detecting uniform and mixed density space-occupying lesions. In addition, a significant speedup against straight forward CPU version was achieved with CUDA.

  1. The Begun Center for Violence Prevention Research and Education at Case Western Reserve University

    Science.gov (United States)

    Flannery, Daniel J.; Singer, Mark I.

    2015-01-01

    Established in the year 2000, the Begun Center for Violence Prevention Research and Education is a multidisciplinary center located at a school of social work that engages in collaborative, community-based research and evaluation that spans multiple systems and disciplines. The Center currently occupies 4,200 sq. ft. with multiple offices and…

  2. Normal Pressure Hydrocephalus as an Unusual Presentation of Supratentorial Extraventricular Space-Occupying Processes: Report on Two Cases

    Directory of Open Access Journals (Sweden)

    E. Naydenov

    2012-03-01

    Full Text Available Normal pressure hydrocephalus (NPH is a clinical and radiographic syndrome characterized by ventriculomegaly, abnormal gait, urinary incontinence, and dementia. The condition may occur due to a variety of secondary causes but may be idiopathic in approximately 50% of patients. Secondary causes may include head injury, subarachnoid hemorrhage, meningitis, and central nervous system tumor. Here, we describe two extremely rare cases of supratentorial extraventricular space-occupying processes: meningioma and glioblastoma multiforme, which initially presented with NPH.

  3. Challenging Social Class In American Political Discourse: Bernie Sanders, Occupy Wall Street, and the New Discourse of Inequality

    OpenAIRE

    2016-01-01

    This thesis examines how the dominant ideas about social class in American political discourse have been challenged by the rhetoric of the Bernie Sanders campaign in the 2016 presidential primary election. Through critical discourse analysis, I find that Bernie Sanders is the main bearer of a new discourse of inequality in American political and public discourse, which has its roots in the Occupy Wall Street movement in 2011 and previous developing strands from the 1990s and early 2000s.

  4. Complex evaluation of health status and life quality of employees occupied in mining and processing of hydrocarbon raw materials

    OpenAIRE

    G.G. Gimranova; A.B. Bakirov; L.K. Karimova; Z.F. Gimaeva; N.A. Beigul

    2016-01-01

    A complex social-hygienic investigation for the assessment of health-related life quality and living standards among 1200 male workers occupied in mining and primary processing of hydrocarbon raw materials has been performed. The study included the method of the anonymous survey for the employee with using a questionnaire developed by WHO experts for the realization of Health, environment and social capital management in enterprises (HESME). The health risk factors’ prevalence associated with...

  5. Distribution of Menin-Occupied Regions in Chromatin Specifies a Broad Role of Menin in Transcriptional Regulation

    Directory of Open Access Journals (Sweden)

    Sunita K. Agarwal

    2007-02-01

    Full Text Available Menin is the protein product of the MEN1 tumorsuppressor gene; one allele of MEN1 is inactivated in the germ line of patients with “multiple endocrine neoplasia type 1” (MEN1 cancer syndrome. Menin interacts with several proteins involved in transcriptional regulation. RNA expression analyses have identified several menin-regulated genes that could represent proximal or distal interaction sites for menin. This report presents a substantial and unbiased sampling of menin-occupied chromatin regions using Serial Analysis of Chromatin Occupancy; this method combines chromatin immunoprecipitation with Serial Analysis of Gene Expression. Hundreds of menin-occupied genomic sites were identified in promoter regions (32% of menin-occupied loci, near the 3' end of genes (14%, or inside genes (21%, extending other data about menin recruitments to many sites of transcriptional activity. A large number of meninoccupied sites (33% were located outside known gene regions. Additional annotation of the human genome could help in identifying genes at these loci, or these might be gene-free regions of the genome where menin occupancy could play some structural or regulatory role. Menin occupancy at many intragenic positions distant from the core promoter reveals an unexpected type of menin target region at many loci in the genome. These unbiased data also suggest that menin could play a broad role in transcriptional regulation.

  6. Receipt of Antibiotics in Hospitalized Patients and Risk for Clostridium difficile Infection in Subsequent Patients Who Occupy the Same Bed.

    Science.gov (United States)

    Freedberg, Daniel E; Salmasian, Hojjat; Cohen, Bevin; Abrams, Julian A; Larson, Elaine L

    2016-12-01

    To assess whether receipt of antibiotics by prior hospital bed occupants is associated with increased risk for CDI in subsequent patients who occupy the same bed. This is a retrospective cohort study of adult patients hospitalized in any 1 of 4 facilities between 2010 and 2015. Patients were excluded if they had recent CDI, developed CDI within 48 hours of admission, had inadequate follow-up time, or if their prior bed occupant was in the bed for less than 24 hours. The primary exposure was receipt of non-CDI antibiotics by the prior bed occupant and the primary outcome was incident CDI in the subsequent patient to occupy the same bed. Incident CDI was defined as a positive result from a stool polymerase chain reaction for the C difficile toxin B gene followed by treatment for CDI. Demographics, comorbidities, laboratory data, and medication exposures are reported. Among 100 615 pairs of patients who sequentially occupied a given hospital bed, there were 576 pairs (0.57%) in which subsequent patients developed CDI. Receipt of antibiotics in prior patients was significantly associated with incident CDI in subsequent patients (log-rank P bed occupants were associated with increased risk for CDI in subsequent patients. Receipt of antibiotics by prior bed occupants was associated with increased risk for CDI in subsequent patients. Antibiotics can directly affect risk for CDI in patients who do not themselves receive antibiotics.

  7. Measured Performance of Occupied, Side-by-Side, South Texas Homes

    Energy Technology Data Exchange (ETDEWEB)

    Chasar, D.; vonSchramm, V.

    2012-09-01

    The performance of three homes in San Antonio, Texas with identical floor plans and orientation were evaluated through a partnership between the Florida Solar Energy Center (FSEC), CPS Energy, and Woodside Homes of South Texas. Measurements included whole house gas and electric use as well as heating, cooling, hot water, major appliances and indoor and outdoor conditions. One home built to builder standard practice served as the control, while the other homes demonstrated high performance features. Utility peak electric load comparisons of these dual-fuel homes provide an assessment of envelope and equipment improvements. The control home used natural gas for space and water heating only, while the improved homes had gas heating and major appliances with the exception of a high efficiency heat pump in one home. Data collection began in July of 2009 and continued through April of 2011. Energy ratings for the homes yielded E-Scales (aka HERS indices) of 86 for the control home, 54 for one improved home and 37 for the other home which has a 2.4kW photovoltaic array.

  8. [Optimizing surgical hand disinfection].

    Science.gov (United States)

    Kampf, G; Kramer, A; Rotter, M; Widmer, A

    2006-08-01

    For more than 110 years hands of surgeons have been treated before a surgical procedure in order to reduce the bacterial density. The kind and duration of treatment, however, has changed significantly over time. Recent scientific evidence suggests a few changes with the aim to optimize both the efficacy and the dermal tolerance. Aim of this article is the presentation and discussion of new insights in surgical hand disinfection. A hand wash should be performed before the first disinfection of a day, ideally at least 10 min before the beginning of the disinfection as it has been shown that a 1 min hand wash significantly increases skin hydration for up to 10 min. The application time may be as short as 1.5 min depending on the type of hand rub. Hands and forearms should be kept wet with the hand rub for the recommended application time in any case. A specific rub-in procedure according to EN 12791 has been found to be suitable in order to avoid untreated skin areas. The alcohol-based hand rub should have a proven excellent dermal tolerance in order to ensure appropriate compliance. Considering these elements in clinical practice can have a significant impact to optimize the high quality of surgical hand disinfection for prevention of surgical site infections.

  9. Pre Surgical Evaluation of Scrotal Cystocele by Conventional Radiography (Cystogram)

    OpenAIRE

    Mohinder Kumar Malhotra; Yamini Kapoor

    2012-01-01

    Urinary bladder is a known content of sliding inguinal hernias but rarely presents as irreducible direct inguinal hernia. As inguinal hernia repair is commonly undertaken even at peripheral surgical centers. Cystogram a simple radiological investigation (picturesque view) is useful for pre-surgical evaluation as it can prevent iatrogenic bladder injury during inguinal hernia repair. This investigation can be performed where other radiological expertises like computerized tomography scan/magne...

  10. Pre surgical evaluation of scrotal cystocele by conventional radiography (cystogram).

    Science.gov (United States)

    Malhotra, Mohinder Kumar; Kapoor, Yamini

    2012-01-01

    Urinary bladder is a known content of sliding inguinal hernias but rarely presents as irreducible direct inguinal hernia. As inguinal hernia repair is commonly undertaken even at peripheral surgical centers. Cystogram a simple radiological investigation (picturesque view) is useful for pre-surgical evaluation as it can prevent iatrogenic bladder injury during inguinal hernia repair. This investigation can be performed where other radiological expertises like computerized tomography scan/magnetic resonance imaging or even ultrasound facilities are not readily available.

  11. Pre surgical evaluation of scrotal cystocele by conventional radiography (Cystogram

    Directory of Open Access Journals (Sweden)

    Mohinder Kumar Malhotra

    2012-01-01

    Full Text Available Urinary bladder is a known content of sliding inguinal hernias but rarely presents as irreducible direct inguinal hernia. As inguinal hernia repair is commonly undertaken even at peripheral surgical centers. Cystogram a simple radiological investigation (picturesque view is useful for pre-surgical evaluation as it can prevent iatrogenic bladder injury during inguinal hernia repair. This investigation can be performed where other radiological expertises like computerized tomography scan/magnetic resonance imaging or even ultrasound facilities are not readily available.

  12. [da Vinci surgical system].

    Science.gov (United States)

    Watanabe, Gou; Ishikawa, Norihiro

    2014-07-01

    The da Vinci surgical system was developed by Intuitive Surgical Inc. in the United States as an endoscopic surgical device to assist remote control surgeries. In 1998, the Da Vinci system was first used for cardiothoracic procedures. Currently a combination of robot-assisted internal thoracic artery harvest together with coronary artery bypass grafting (CABG) through a mini-incision (ThoraCAB) or totally endoscopic procedures including anastomoses under robotic assistance (TECAB) are being conducted for the treatment of coronary artery diseases. With the recent advances in catheter interventions, hybrid procedures combining catheter intervention with ThoraCAB or TECAB are anticipated in the future.On the other hand, with the decrease in number of coronary artery bypass surgeries, the share of valvular surgeries is expected to increase in the future. Among them, mitral valvuloplasty for mitral regurgitation is anticipated to be conducted mainly by low-invasive procedures, represented by minimally invasive cardiac surgery( MICS) and robot-assisted surgery. Apart from the intrinsic good surgical view, robotic-assisted systems offer additional advantages of the availability of an amplified view and the easy to observe the mitral valve in the physiological position. Thus, robotic surgical surgeries that make complicated procedures easier are expected to accomplish further developments in the future. Furthermore, while the number of surgeries for atrial septal defects has decreased dramatically following the widespread use of Amplatzer septal occluder, robotic surgery may become a good indication for cases in which the Amplatzer device is not indicated. In Japan, clinical trial of the da Vinci robotic system for heart surgeries has been completed. Statutory approval of the da Vinci system for mitral regurgitation and atrial septal defects is anticipated in the next few years.

  13. Distribution center

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    Distribution center is a logistics link fulfill physical distribution as its main functionGenerally speaking, it's a large and hiahly automated center destined to receive goods from various plants and suppliers,take orders,fill them efficiently,and deliver goods to customers as quickly as possible.

  14. Development of a vision integration framework for laparoscopic surgical robot.

    Science.gov (United States)

    Shin, Jung W; Park, Jun W; Lee, Chul H; Hong, Soyoung; Jo, Yungho; Choi, Jaesoon

    2006-01-01

    In order to realize intelligent laparoscopic surgical robot, a vision integrated system constitutes one of the fundamental components. The authors have constructed a vision framework in the current version of NCC (National Cancer Center) laparoscopic surgical robot controlled on a real-time OS (RTLinux-Pro, FSMLabs Inc., U.S.A.). Adding vision framework, we have been applying and testing image processing algorithms- edge detection of object for positioning surgical tool, Watersheds for recognizing object. This paper documents the implementation of the framework and preliminary results of the image segmentation using Watersheds algorithm. Finally the real-time processing capability of our vision system is discussed.

  15. Surgical site infection rates following laparoscopic urological procedures.

    Science.gov (United States)

    George, Arvin K; Srinivasan, Arun K; Cho, Jane; Sadek, Mostafa A; Kavoussi, Louis R

    2011-04-01

    Surgical site infections have been categorized by the Centers for Medicare and Medicaid Services as "never events". The incidence of surgical site infection following laparoscopic urological surgery and its risk factors are poorly defined. We evaluated surgical site infection following urological laparoscopic surgery and identified possible factors that may influence occurrence. Patients who underwent transperitoneal laparoscopic procedures during a 4-year period by a single laparoscopic surgeon were retrospectively reviewed. Surgical site infections were identified postoperatively and defined using the Centers for Disease Control criteria. Clinical parameters, comorbidities, smoking history, preoperative urinalysis and culture results as well as operative data were analyzed. Nonparametric testing using the Mann-Whitney U test, multivariable logistic regression and Spearman's rank correlation coefficient were used for data analysis. In 556 patients undergoing urological laparoscopic procedures 14 surgical site infections (2.5%) were identified at mean postoperative day 21.5. Of the 14 surgical site infections 10 (71.4%) were located at a specimen extraction site. Operative time, procedure type and increasing body mass index were significantly associated with the occurrence of surgical site infections (p = 0.007, p = 0.019, p = 0.038, respectively), whereas history of diabetes mellitus (p = 0.071) and intraoperative transfusion (p = 0.053) were found to trend toward significance. Age, gender, positive urine culture, steroid use, procedure type and smoking history were not significantly associated with surgical site infection. Body mass index and operative time remained significant predictors of surgical site infection on multivariate logistic regression analysis. Surgical site infection is an infrequent complication following laparoscopic surgery with the majority occurring at the specimen extraction site. Infection is associated with prolonged operative time and

  16. Using Mössbauer spectroscopy to choose the sites that can be occupied by divalent tin

    Science.gov (United States)

    Dénès, Georges; Merazig, Hocine; Muntasar, Abdualhafed

    2014-04-01

    either the (4b) or (4e) tin site since both an inversion center and a 2-fold axis would generate a second lone pair unless the 2-fold axis were along the tin-lone pair axis.

  17. [Inguinofemoral hernia: multicenter study of surgical techniques].

    Science.gov (United States)

    Porrero, José L; Sánchez-Cabezudo, Carlos; Bonachía, Oscar; López-Buenadicha, Adolfo; Sanjuánbenito, Alfonso; Hidalgo, Manuel

    2005-07-01

    The present study was performed by the Spanish Association of surgeons through its abdominal wall and sutures section. The aim was to determine the current situation of inguinofemoral hernias in Spain and was based on an anonymous multicenter study with the participation of various national hospitals. Fifty general surgery departments in distinct surgical centers throughout Spain responded to an anonymous survey in 2000. The survey gathered data on anesthetic features, surgical techniques and complications in the treatment of inguinofemoral hernias. Sixty-six percent of hospital centers had a specific abdominal wall unit and 24% performed laparoscopic hernia surgery. Prosthetic techniques (especially Lichtenstein) were the most frequently used in the treatment of primary inguinal hernia (72%) and recurrent hernia (100%). The most frequently used prosthetic material was polypropylene mesh (76%). Only 28% of the departments surveyed performed anatomic techniques in the repair of primary inguinal hernia (Shouldice and Bassini). The most frequent treatment for femoral hernia was the Lichtenstein "plug" (78%). Sixty-eight percent of the centers surveyed performed regional anesthesia, 18% used general anesthesia and only 14% used local anesthesia with sedation. Severe complications were found in 20% of departments. Clinical postoperative follow-up was performed in 96% of the centers and telephone follow-up was used in 4%. The recurrence rate was 1.2% for primary inguinal hernia, 2.7% for recurrent inguinal hernia and 0.3% for femoral hernia. In Spain the most commonly used surgical technique in the treatment of inguinal hernia is Lichtenstein hernioplasty under spinal anesthesia and with polypropylene prosthesis. The Lichtenstein plug is the most commonly used technique in the treatment of femoral hernia.

  18. Surgical treatment of trigonocephalies and associated hypoteleorbitism.

    Science.gov (United States)

    Hinojosa, J; Esparza, J; Muñoz, M J; Salván, R; Romance, A; Alén, J F; Muñoz, A

    2002-12-01

    Premature closure of metopic suture is a relatively uncommon form of craniosyostosis with an estimated incidence of 0,3 per 1000 live births, comprising about 7% of surgical craniosynostosis referred to craniofacial centers. A broad phenotypical spectrum spreads from minor metopic ridges to severe trigonocephaly with pterional indentation supraorbital bar retrusion, temporal and parietal compensating bossings and hypotelorism. Most of the cases arise spontaneously although autosomal dominant inheritance has been described and association with cromosomal abnormalities and different syndromes has been widely reported. Surgical correction has been attempted with good cosmetic results using several variations of the standard frontoorbitary advance. However there is still a number of questions to be solved in relation to this entity, mainly on its pathogenesis, but also on its development, natural history and treatment. Direct surgical approach to associated hypotelorism is a matter of argument when considering the reestablishment of normal interorbitary distances. We have conducted a retrospective analysis of our serie consisting of twenty-eight cases of trigonocephalies. Surgical correction of hypotelorism was attempted in eleven cases while the resting seven children remained "not treated". The objective was to review the functional outcome and cosmetic results comparing the different techniques applied to the frontal bone and to observe evolution of the hypoteleorbitism after the treatment with or without osteotomies and grafting of the nasoethmoidal area.

  19. Conference Support - Surgery in Extreme Environments - Center for Surgical Innovation

    Science.gov (United States)

    2007-01-01

    benzodiazepine , hypnotics, beta blockers, direct versus indirect agonists, pressors, fluids, and code drugs. In addition, he discussed methods of...Urology 1999; 53: 892-97. 37. Kaplansky A, Durnova G, Burkovskaya T, Vorotnikova E. The Effect of Microgravity on Bone Fracture Healing in Rats Flown

  20. [Knowledge of hypothermia in nursing professionals of surgical center].

    Science.gov (United States)

    Mendoza, Isabel Yovana Quispe; Peniche, Aparecida de Cássia Giani; Püschel, Vilanice Alves de Araujo

    2012-10-01

    The objective was to identify the difference in knowledge about hypothermia in nursing assistant after an educational intervention. The conceptual basis of education is based on the prospect of meaningful learning allied to the construction of the conceptual map and the case study. Data were collected through the questionnaire validated by experts. The average knowledge after the educational intervention was (-3.49), however, there was no significant difference in knowledge as related to sociodemographic variables studied. We conclude that the educational intervention was satisfactory in that new information was anchored modified and expanded the cognitive structure of study subjects.

  1. Vitiligo- A surgical approach

    Directory of Open Access Journals (Sweden)

    Deepti Ghia

    2012-01-01

    Full Text Available Aims and objective- To describe the spectrum of surgical modalities for stable vitiligo patients Methods- Patients having stable vitiligo since past 2 years with no improvement with medical line of treatment were enrolled for surgery after informed consent. Depending upon the size and location of vitiligo patch different modalities were performed. Suction blister, mini-punch grafting, split thickness skin grafting, trypsinised melanocyte-keratinocyte transfer and non-trypsinised melanocyte- keratinocyte transfer (Jodhpur technique and follicular grafting technique have been described photographically which have been performed at a tertiary care hospital. Conclusion- Vitiligo is often difficult to treat, stable patches resistant to medical line of management do respond to surgical treatment; however it is very important to choose the modality of surgery according location of the patch, size of the lesion and available resources.

  2. Spacecraft surgical scrub system

    Science.gov (United States)

    Abbate, M.

    1980-01-01

    Ease of handling and control in zero gravity and minimizing the quantity of water required were prime considerations. The program tasks include the selection of biocidal agent from among the variety used for surgical scrub, formulation of a dispensing system, test, and delivery of flight dispensers. The choice of an iodophore was based on effectiveness on single applications, general familiarity among surgeons, and previous qualification for space use. The delivery system was a choice between the squeeze foamer system and impregnated polyurethane foam pads. The impregnated foam pad was recommended because it is a simpler system since the squeeze foamer requires some applicator to effectively clean the skin surfaces, whereas the form pad is the applicator and agent combined. Testing demonstrated that both systems are effective for use as surgical scrubs.

  3. Gossypiboma—Retained Surgical Sponge

    Directory of Open Access Journals (Sweden)

    Hung-Shun Sun

    2007-11-01

    Full Text Available Intra-abdominal retained surgical sponge is an uncommon surgical error. Herein, we report a 92-year-old woman who was brought to the emergency room for acute urinary retention. She had a history of vaginal hysterectomy for uterine prolapse 18 years previously, performed at our hospital. Retained surgical sponge in the pelvic cavity was suspected by abdominal computed tomography. The surgical gauze was removed by laparotomy excision and the final diagnosis was gossypiboma.

  4. Hepatic surgical anatomy.

    Science.gov (United States)

    Skandalakis, John E; Skandalakis, Lee J; Skandalakis, Panajiotis N; Mirilas, Petros

    2004-04-01

    The liver, the largest organ in the body, has been misunderstood at nearly all levels of organization, and there is a tendency to ignore details that do not fit the preconception. A complete presentation of the surgical anatomy of the liver includes the study of hepatic surfaces, margins, and fissures; the various classifications of lobes and segments; and the vasculature and lymphatics. A brief overview of the intrahepatic biliary tract is also presented.

  5. Louis Pasteur surgical revolution.

    Science.gov (United States)

    Toledo-Pereyra, Luis H

    2009-01-01

    Louis Pasteur (1822-1895) is considered the most notable medical scientist of his time and perhaps one of the most distinguished of all times in the history of medicine. From Dole in France to Paris, from a student of crystals to "living ferments," and from chemistry to biology and medicine, Pasteur changed the world for the benefit of humanity. The genius of Pasteur dealt with the most pressing issues of his time, basing the germ theory on the effects that microorganisms had on fermentation and putrefaction of organic matter, which gave birth to the science of bacteriology. Many other difficult problems in medicine and biology were tackled by Pasteur, culminating in the spectacular results seen with the treatment of rabies. Surgery was no exception to the scientific conquests of Pasteur. The transformation of the surgical world arose from the antiseptic concepts of Lister that were based on the germ theory of the disease, which had been derived from the germ theory of fermentation and putrefaction discovered by Pasteur. The acceptance of these principles represented the surgical revolution brought on by the science of Pasteur, a revolution that is now accepted in our daily care of surgical patients.

  6. Guideline implementation: Surgical attire.

    Science.gov (United States)

    Cowperthwaite, Liz; Holm, Rebecca L

    2015-02-01

    Surgical attire helps protect patients from microorganisms that may be shed from the hair and skin of perioperative personnel. The updated AORN "Guideline for surgical attire" provides guidance on scrub attire, shoes, head coverings, and masks worn in the semirestricted and restricted areas of the perioperative setting, as well as how to handle personal items (eg, jewelry, backpacks, cell phones) that may be taken into the perioperative suite. This article focuses on key points of the guideline to help perioperative personnel adhere to facility policies and regulatory requirements for attire. The key points address the potential benefits of wearing scrub attire made of antimicrobial fabric, covering the arms when in the restricted area of the surgical suite, removing or confining jewelry when wearing scrub attire, disinfecting personal items that will be taken into the perioperative suite, and sending reusable attire to a health care-accredited laundry facility after use. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

  7. Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 2: Advantages of anterior decompression and fusion over laminoplasty.

    Science.gov (United States)

    Iwasaki, Motoki; Okuda, Shin'ya; Miyauchi, Akira; Sakaura, Hironobu; Mukai, Yoshihiro; Yonenobu, Kazuo; Yoshikawa, Hideki

    2007-03-15

    Retrospective study of 27 patients who underwent anterior decompression and fusion (ADF) for treatment of cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL). To compare surgical outcome of ADF with that of laminoplasty. During the period 1986 and 1996, laminoplasty was the only surgical treatment selected for cervical myelopathy at our institutions. According to surgical results of laminoplasty performed during this period, we have performed either laminoplasty or ADF for patients with OPLL since 1996. We reviewed clinical data obtained in 27 patients who underwent ADF between 1996 and 2003. Mean duration of follow-up was 6.0 years (range, 2-10 years). Surgical outcomes were assessed using the Japanese Orthopedic Association (JOA) scoring system for cervical myelopathy. Surgical results of ADF were compared with those of laminoplasty, which was performed in 66 patients during the period 1986 and 1996. ADF yielded a better neurologic outcome at final follow-up than laminoplasty in patients with occupying ratio > or =60%, although graft complications occurred in 15% and additional surgical intervention was required in 26%. Neither occupying ratio of OPLL, sagittal shape of ossification, nor cervical alignment was found to be related to surgical outcome of ADF. Although ADF is technically demanding and has a higher incidence of surgery-related complications, it is preferable to laminoplasty for patients with occupying ratio of OPLL > or =60%.

  8. Surgical navigation with QR codes

    Directory of Open Access Journals (Sweden)

    Katanacho Manuel

    2016-09-01

    Full Text Available The presented work is an alternative to established measurement systems in surgical navigation. The system is based on camera based tracking of QR code markers. The application uses a single video camera, integrated in a surgical lamp, that captures the QR markers attached to surgical instruments and to the patient.

  9. Novel approach for evaluation of air change rate in naturally ventilated occupied spaces based on metabolic CO2 time variation

    DEFF Research Database (Denmark)

    Melikov, Arsen Krikor; Markov, Detelin G.

    2014-01-01

    at low rate. This paper describes a new approach for ACR evaluation in naturally ventilated occupied spaces. Actual metabolic CO2 time variation record in an interval of time is compared with the computed variation of metabolic CO2 for the same time interval under reference conditions: sleeping occupants......, air-tight space, constant indoor pressure and temperature. The proposed approach for ACR evaluation can be applied to time intervals with any length, even with varying parameters of both indoor and outdoor air, in which metabolic CO2 generation rate is known and constant. This approach makes possible...

  10. Debridement for surgical wounds.

    Science.gov (United States)

    Dryburgh, Nancy; Smith, Fiona; Donaldson, Jayne; Mitchell, Melloney

    2008-07-16

    Surgical wounds that become infected are often debrided because clinicians believe that removal of this necrotic or infected tissue will expedite wound healing. There are numerous methods available but no consensus on which one is most effective for surgical wounds. The aim of this review is to determine the effect of different methods of debridement on the rate of debridement and healing of surgical wounds. We developed a search strategy to search the following electronic databases: Wounds Group Specialised Trials Register (searched 3/3/08) , Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2008, issue 1), MEDLINE (1950 to February Week 3 2008 ), EMBASE (1980 to 2008 Week 09) and CINHAL (1982 to February Week 4 2008). We checked the citations within obtained studies to identify additional papers and also relevant conference proceedings. We contacted manufactures of wound debridement agents to ascertain the existence of published, unpublished and ongoing trials. Our search was not limited by language or publication status. We included relevant randomised controlled trials (RCT) with outcomes including at least one of the following: time to complete debridement, or time to complete healing. Two authors independently reviewed the abstracts and titles obtained from the search, two extracted data independently using a standardised extraction sheet, and two independently assessed methodological quality. One author was involved in all stages of the data collection and extraction process, thus ensuring continuity. Five RCTs were eligible for inclusion; all compared treatments for infected surgical wounds and reported time required to achieve a clean wound bed (complete debridement). One trial compared an enzymatic agent (Streptokinase/streptodornase) with saline-soaked dressings and reported the time to complete debridement. Four of the trials compared the effectiveness of dextranomer beads or paste with other products (different comparator

  11. Evaluation of adherence to measures for the prevention of surgical site infections by the surgical team

    Directory of Open Access Journals (Sweden)

    Adriana Cristina de Oliveira

    2015-10-01

    Full Text Available AbstractOBJECTIVEEvaluate pre- and intraoperative practices adopted by medical and nursing teams for the prevention of surgical infections.METHODA prospective study carried out in the period of April to May 2013, in a surgical center of a university hospital in Belo Horizonte, Minas Gerais.RESULTS18 surgeries were followed and 214 surgical gloves were analyzed, of which 23 (10.7% had postoperative glove perforation detected, with 52.2% being perceived by users. Hair removal was performed on 27.7% of patients in the operating room, with the use of blades in 80% of the cases. Antibiotic prophylaxis was administered to 81.8% of patients up to 60 minutes prior to surgical incision. An average of nine professionals were present during surgery and the surgery room door remained open in 94.4% of the procedures.CONCLUSIONPartial adhesion to the recommended measures was identified, reaffirming a need for greater attention to these critical steps/actions in order to prevent surgical site infection.

  12. Empyema thoracis: Surgical management in children

    Directory of Open Access Journals (Sweden)

    Menon Prema

    2009-01-01

    Full Text Available Empyema thoracis can produce significant morbidity in children if inadequately treated. Correct evaluation of the stage of the disease, the clinical condition of the child and proper assessment of the response to conservative treatment is crucial in deciding the mode of further surgical intervention. This ranges from intercostal chest tube drainage and video-assisted thoracoscopic surgery to open decortication. Surgical decortication becomes mandatory in neglected cases; it gives very gratifying results ameliorating the disease rapidly and is well tolerated by young patients. This article reviews the current literature and discusses the important considerations while managing these patients. Indications for surgery are highlighted, based on our large experience at a tertiary care center.

  13. New Frontiers in Surgical Innovation.

    Science.gov (United States)

    Jackson, Ryan S; Schmalbach, Cecelia E

    2017-08-01

    It is an exciting time for head and neck surgical innovation with numerous advances in the perioperative planning and intraoperative management of patients with cancer, trauma patients, and individuals with congenital defects. The broad and rapidly changing realm of head and neck surgical innovation precludes a comprehensive summary. This article highlights some of the most important innovations from surgical planning with sentinel node biopsy and three-dimensional, stereolithic modeling to intraoperative innovations, such as transoral robotic surgery and intraoperative navigation. Future surgical innovations, such as intraoperative optical imaging of surgical margins, are also highlighted. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Characteristics of the Social Status of Students at Military Centers

    Science.gov (United States)

    Karlova, E. N.

    2013-01-01

    Research on the motivations of Russian college students in military training centers and military departments, and cadets enrolled in military service academies shows that the first two occupy a marginal position. This is reflected in the ambiguity of their status and the fact that they are at the interface between two cultures, manifested in…

  15. Tuning oxygen vacancy photoluminescence in monoclinic Y2WO6 by selectively occupying yttrium sites using lanthanum

    Science.gov (United States)

    Ding, Bangfu; Han, Chao; Zheng, Lirong; Zhang, Junying; Wang, Rongming; Tang, Zilong

    2015-01-01

    The effect of isovalent lanthanum (La) doping on the monoclinic Y2WO6 photoluminescence was studied. Introducing the non-activated La3+ into Y2WO6 brings new excitation bands from violet to visible regions and strong near-infrared emission, while the bands position and intensity depend on the doping concentration. It is interesting to find that doping La3+ into Y2WO6 promotes the oxygen vacancy formation according to the first-principle calculation, Raman spectrum, and synchrotron radiation analysis. Through the Rietveld refinement and X-ray photoelectron spectroscopy results, La3+ is found to mainly occupy the Y2 (2f) site in low-concentration doped samples. With increasing doping concentration, the La3+ occupation number at the Y3 (4g) site increases faster than those at the Y1 (2e) and Y2 (2f) sites. When La3+ occupies different Y sites, the localized energy states caused by the oxygen vacancy pair change their position in the forbidden band, inducing the variation of the excitation and emission bands. This research proposes a feasible method to tune the oxygen vacancy emission, eliminating the challenge of precisely controlling the calcination atmosphere. PMID:25821078

  16. Aerial surveys adjusted by ground surveys to estimate area occupied by black-tailed prairie dog colonies

    Science.gov (United States)

    Sidle, John G.; Augustine, David J.; Johnson, Douglas H.; Miller, Sterling D.; Cully, Jack F.; Reading, Richard P.

    2012-01-01

    Aerial surveys using line-intercept methods are one approach to estimate the extent of prairie dog colonies in a large geographic area. Although black-tailed prairie dogs (Cynomys ludovicianus) construct conspicuous mounds at burrow openings, aerial observers have difficulty discriminating between areas with burrows occupied by prairie dogs (colonies) versus areas of uninhabited burrows (uninhabited colony sites). Consequently, aerial line-intercept surveys may overestimate prairie dog colony extent unless adjusted by an on-the-ground inspection of a sample of intercepts. We compared aerial line-intercept surveys conducted over 2 National Grasslands in Colorado, USA, with independent ground-mapping of known black-tailed prairie dog colonies. Aerial line-intercepts adjusted by ground surveys using a single activity category adjustment overestimated colonies by ≥94% on the Comanche National Grassland and ≥58% on the Pawnee National Grassland. We present a ground-survey technique that involves 1) visiting on the ground a subset of aerial intercepts classified as occupied colonies plus a subset of intercepts classified as uninhabited colony sites, and 2) based on these ground observations, recording the proportion of each aerial intercept that intersects a colony and the proportion that intersects an uninhabited colony site. Where line-intercept techniques are applied to aerial surveys or remotely sensed imagery, this method can provide more accurate estimates of black-tailed prairie dog abundance and trends

  17. Surgical Treatment in Uveal Tumors

    Directory of Open Access Journals (Sweden)

    Kaan Gündüz

    2014-09-01

    Full Text Available Surgical treatment in uveal tumors can be done via iridectomy, partial lamellar sclerouvectomy (PLSU and endoresection. Iridectomy is done in iris tumors without angle and ciliary body involvement. PLSU is performed in tumors with ciliary body and choroidal involvement. For this operation, a partial thickness scleral flap is dissected, the intraocular tumor is excised, and the flap is sutured back in position. PLSU surgery is done in iridociliary and ciliary body tumors with less than 3 clock hours of iris and ciliary body involvement and in choroidal tumors with a base diameter less than 15 mm. However, it can be employed in any size tumor for biopsy purposes. Potential complications of PLSU surgery include vitreous hemorrhage, cataract, retinal detachment, and endophthalmitis. Endoresection is a technique whereby the intraocular tumor is excised using vitrectomy techniques. The rationale for performing endoresection is based on the fact that irradiated uveal melanomas may be associated with exudation and neovascular glaucoma and removing the dead tumor tissue may contribute to better visual outcome. There are some centers where endoresection is done without prior radiotherapy. Allegedly, avoidance of radiation retinopathy and papillopathy are the main advantages of using endoresection without prior radiotherapy. (Turk J Ophthalmol 2014; 44: Supplement 29-34

  18. Ambiente do Centro Cirúrgico e os elementos que o integram: implicações para os cuidados de enfermagem Ambiente del quirófano y sus elementos: implicaciones para la atención de enfermería Surgical Center environment and its elements: implications for nursing care

    Directory of Open Access Journals (Sweden)

    Denise Conceição Silva

    2010-06-01

    Full Text Available Pesquisa qualitativa que objetivou caracterizar os elementos que integram o ambiente do Centro Cirúrgico e analisar suas implicações para a dinâmica de cuidar e de cuidados de enfermagem. Ancorou-se nos princípios da Teoria Ambientalista. Participaram 12 enfermeiras do centro cirúrgico de um Hospital Universitário do Rio de Janeiro. Os dados foram produzidos pela técnica de criatividade e sensibilidade "Mapa-Falante", entrevista semi-estruturada e observação participante; e analisados por categorias temáticas. Os resultados apontam que o cuidado ocorre direta e indiretamente, em prol da plena restauração do cliente, incluindo o ambiente que o integra, de modo a manter-se harmônico e equilibrado. As intervenções da enfermeira são no sentido de manter o ambiente em condições favoráveis de modo a torná-lo promotor de cuidados.Investigación cualitativa que objetivó caracterizar los elementos que integran el ambiente del quirófano y analizar sus implicaciones para la dinamica del cuidar y del cuidado de enfermería. Basada en los principios de la Teoría Ambientalista. Participaran 12 enfermeras del quirófano de un Hospital Universitario del Río de Janeiro. Los datos foran producidos por la técnica de creatividad y sensibilidad "Mapa-Hablante", entrevista semi estructurada y observación participante; y analizados por categorías temáticas. Los resultados apuntan que el cuidado ocurre directa e indirectamente, a favor de la plena restauración del cliente, incluyendo el ambiente que lo integra, de modo a mantenerse harmónico y equilibrado. Las intervenciones de la enfermera son en el sentido de mantener el ambiente en condiciones favorables de modo a tornalo promotor de los cuidados.The purpose of this qualitative research was to characterize the elements that constitute the environment of the Surgical Center and to analyze its implications for dynamic of care and nursing care. Based on the Environmental Theory

  19. Analysis of surgical intervention populations using generic surgical process models.

    Science.gov (United States)

    Neumuth, Thomas; Jannin, Pierre; Schlomberg, Juliane; Meixensberger, Jürgen; Wiedemann, Peter; Burgert, Oliver

    2011-01-01

    According to differences in patient characteristics, surgical performance, or used surgical technological resources, surgical interventions have high variability. No methods for the generation and comparison of statistical 'mean' surgical procedures are available. The convenience of these models is to provide increased evidence for clinical, technical, and administrative decision-making. Based on several measurements of patient individual surgical treatments, we present a method of how to calculate a statistical 'mean' intervention model, called generic Surgical Process Model (gSPM), from a number of interventions. In a proof-of-concept study, we show how statistical 'mean' procedure courses can be computed and how differences between several of these models can be quantified. Patient individual surgical treatments of 102 cataract interventions from eye surgery were allocated to an ambulatory or inpatient sample, and the gSPMs for each of the samples were computed. Both treatment strategies are exemplary compared for the interventional phase Capsulorhexis. Statistical differences between the gSPMs of ambulatory and inpatient procedures of performance times for surgical activities and activity sequences were identified. Furthermore, the work flow that corresponds to the general recommended clinical treatment was recovered out of the individual Surgical Process Models. The computation of gSPMs is a new approach in medical engineering and medical informatics. It supports increased evidence, e.g. for the application of alternative surgical strategies, investments for surgical technology, optimization protocols, or surgical education. Furthermore, this may be applicable in more technical research fields, as well, such as the development of surgical workflow management systems for the operating room of the future.

  20. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule.

    Science.gov (United States)

    2012-08-31

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers

  1. Estudo sobre a percepção do clima organizacional do centro cirúrgico de um hospital especializado Estudio sobre la percepción del clima organizacional del centro quirúrgico de un hospital especializado Study on the perception of the organization climate of the surgical center in a specialized hospital

    Directory of Open Access Journals (Sweden)

    Wilza Carla Spiri

    1998-01-01

    Full Text Available O presente estudo tem o objetivo de identificar como o grupo de funcionários recém-admitidos no centro cirúrgico de um hospital especializado, percebe o clima organizacional existente, utilizando uma abordagem qualitativa. Como referencial teórico para interpretar o clima organizacional utilizamos os conceitos de CHIAVENATO, que define clima organizacional como meio interno de uma organização e que através de sua experienciação pelos participantes influencia o comportamento dos mesmos, podendo ser favorável, desfavorável e neutro. Os discursos reiteram um clima organizacional favorável, considerando o referencial teórico adotado.El presente estudio tiene el objetivo de identificar cómo el grupo de funcionarios recién admitidos en el centro quirúrgico denota el clima organizacional existente, utilizando un abordaje cualitative. Como referencial teórico para interpretar el clima organizacional utilizamos los conceptos de CHIAVENATO, que define clima organizacional como el medio interno de una organización y que a través de su experiencia los participantes influéncian el comportamiento de los mismos, pudiendo ser favorable, desfavorable y neutro. Los discursos revelaron un clima organizacional favorable, considerándo el referencial teórico adoptado.The aim of this study is to identify how a new team of the surgical center staff in a specialized hospital perceive the organization climate. A qualitative approach was utilized. As a theoretical reference to measure the organization climate, we have used CHIAVENATO, that defines organization climate as the interior of an organization that influences its members´ behavior. The organization climate could be favourable, unfavourable or neutral. The speechs showed a favourable organization climate considering the adopted methodology.

  2. Association between the fMRI manifestations of activated brain areas and muscle strength in patients with space-occupying lesions in motor cortex

    Institute of Scientific and Technical Information of China (English)

    Wenbin Zheng; Xiaoke Chen; Guorui Liu; Renhua Wu

    2006-01-01

    BACKGROUND: Functional magnetic resonance imaging (fMRI) studies have disclosed the changes of the motor function in the motor cortex of ipsilateral and contralateral hemispheres of tumor, which have special significance for making the surgical planning and most greatly minimizing the postoperative functional damages.OBJECTIVE: To analyze the association between the manifestation characteristics of hand functional area and motor dysfunction using fMRI in patients with space-occupying lesions of tumor in motor cortex.DESIGN: A case-controlled observation.SETTING: Department of Radiology, Second Affiliated Hospital, Shantou University Medical College.PARTICIPANTS: Twenty-three patients (13 males and 10 females) with space-occupying lesions of central sulcus area, aged 21-53 years with a mean age of (47±1) years were selected from the Second Affiliated Hospital of Shantou University Medical College. All the patients were diagnosed by MR scanning as space-occupying lesions of motor area, and pathologically confirmed that the lesions involved central sulcus and central Iobule; Lesions occurred in left and right hemispheres in 13 and 10 cases respectively. The tumcr types were astrocytoma (n =8), metastatic tumours (n =7), meningiomas (n =5) and oligodendroglioma (n =3). The muscle strength was normal in 11 cases (grade 5) and obviously decreased in 12 cases (grade 2-3 in 3 cases and grade 4 in 9 cases); muscle strengths of both upper and lower limbs were decreased in 7 cases, and only that of upper limbs was decreased in 5 cases. Informed consents were obtained from all the subjects. Meanwhile, 9 healthy physical examinees (5 males and 4 females) of 20-56 years old with an average of (34±1) years were taken as controls. All the patients and healthy subjects were right-handed.METHODS: All the enrolled subjects were examined with MR scanning and functional imaging. Twenty cases whose clinical symptoms were mild in the patient group and 9 healthy volunteers adopted

  3. [Duane vertical surgical treatment].

    Science.gov (United States)

    Merino, M L; Gómez de Liaño, P; Merino, P; Franco, G

    2014-04-01

    We report 3 cases with a vertical incomitance in upgaze, narrowing of palpebral fissure, and pseudo-overaction of both inferior oblique muscles. Surgery consisted of an elevation of both lateral rectus muscles with an asymmetrical weakening. A satisfactory result was achieved in 2 cases, whereas a Lambda syndrome appeared in the other case. The surgical technique of upper-insertion with a recession of both lateral rectus muscles improved vertical incomitance in 2 of the 3 patients; however, a residual deviation remains in the majority of cases. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  4. Diverticulitis: selective surgical management.

    Science.gov (United States)

    Rugtiv, G M

    1975-08-01

    The surgical treatment of complications of diverticulitis remains most challenging. A review of twenty years' experience with one hundred fifteen cases is presented with one proved anastomotic leak and no deaths. Interval primary resection with anastomosis for chronic recurrent disease including colovesical fistula and mesocolic abscess was proved sate with low morbidity. The three-stage procedure for perforated diverticulitis with spreading peritonitis or pericolic abscess was associated with a high rate of complications and morbidity. An aggressive approach with resection without anastomosis in two stages is indicated.

  5. [Surgical practice in the Mexican Empire].

    Science.gov (United States)

    Romero y Huesca, Andrés; Pérez-Chávez, Francisco; Anota-Rivera, Maria; Ortega-Alvarez, Adriana; Avilés-Tabares, Jonathan; Espinoza-Cerón, Karina; Bautista-Vera, Ernesto; Moreno-Aguilera, Eduardo; Ponce-Landín, Francisco Javier; Lavín-Lozano, Arturo Javier; Ramírez-Bollas, Julio

    2008-01-01

    The prehispanic medicines of Mexico are considered as testimony of the splendor of the Meso-American cultures; their great scientific advance and technical allowed them to accumulate a vast collection of clinical and pathological data based on the observation and experimentation. They integrated a nomenclature medical surgical that reflected their advance in those fields of the knowledge, where the anatomy and surgery occupied a preponderant paper. The medicine was known generically as ticiotl, of where it derives the term tícitl for the doctor. In their concept health-illness the limits among the magic, religion and the empiricism for natural causes were not clear, therefore they considered that the divine, human or natural origin of the illnesses influenced in an important way in its nature. Inside this complex causal system, the illnesses caused by the gods, spirits and celestial beings were considered as hot, while those caused by beings of the other realm were cold. The practice of the medicine had a very established organization designing a very advanced system of specialties that allowed them to accumulate a vast experience for the handling of chronic and acute illnesses in different progression phases, which managed with an integral therapy that had a plurality of resources of vegetable origin, animal, and mineral. The surgery was designated as texoxotlaliztli and its cures tepatiliztli. The surgeon was designated as texoxotlaticitl and it developed advanced techniques in the handling of sutures, wounded, drainage of abscesses, fractures and joint dislocations, pterygium, tonsillitis, circumcision, and amputations.

  6. Occupy Education: Living and Learning Sustainability. By Tina Lynn Evans, Peter Lang Publishing, 2012; 356 Pages. Price: $39.95, ISBN 978-1-4331-1966-8

    Directory of Open Access Journals (Sweden)

    Shu-Kun Lin

    2013-02-01

    Full Text Available Occupy Education is motivated by the sustainability crisis and energized by the drive for social justice that inspired the Occupy movement. Situated within the struggle for sustainability taking place amid looming resource shortages, climate change, economic instability, and ecological breakdown, the book is a timely contribution to community education and action. It opens a whole realm of integrated theory to educators and sustainability activists-and demonstrates how that theory can be moved into practice. Occupy Education is an excellent text for courses in sustainability studies, social philosophy, globalization, social justice, food system praxis, sustainability education, political economy, and environmental studies.

  7. Minimally invasive surgical technique for tethered surgical drains

    Directory of Open Access Journals (Sweden)

    Shane R Hess

    2017-01-01

    Full Text Available A feared complication of temporary surgical drain placement is from the technical error of accidentally suturing the surgical drain into the wound. Postoperative discovery of a tethered drain can frequently necessitate return to the operating room if it cannot be successfully removed with nonoperative techniques. Formal wound exploration increases anesthesia and infection risk as well as cost and is best avoided if possible. We present a minimally invasive surgical technique that can avoid the morbidity associated with a full surgical wound exploration to remove a tethered drain when other nonoperative techniques fail.

  8. Who occupies disability?

    Directory of Open Access Journals (Sweden)

    Nick Pollard

    2017-06-01

    Full Text Available Locating occupational therapy within gendered and racialized systems of power, the authors consider the intersectional nature of critical disability studies discourse and the need for occupational therapy to incorporate such values into practice. This article discusses ways in which occupational therapy as a profession and individual therapists can align with or resist the economic determination which has come to dominate medical systems. It considers some of the political background to the history of the profession and its relationship with power. This positioning of the profession is explored against the impact of neoliberal economic policy on health, rights, service delivery and disability, and against some key issues, the pressure of ageing populations and the positon of occupational therapists as women professionals. Current policies present a critical challenge to central occupational therapy tenets. Occupational therapists may find themselves working both in alliance with disabled people and disability activists, and against them.

  9. Surgical scar revision: An overview

    Directory of Open Access Journals (Sweden)

    Shilpa Garg

    2014-01-01

    Full Text Available Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods.

  10. Multidisciplinary Design Optimization of A Human Occupied Vehicle Based on Bi-Level Integrated System Collaborative Optimization

    Institute of Scientific and Technical Information of China (English)

    赵敏; 崔维成; 李翔

    2015-01-01

    The design of Human Occupied Vehicle (HOV) is a typical multidisciplinary problem, but heavily dependent on the experience of naval architects at present engineering design. In order to relieve the experience dependence and improve the design, a new Multidisciplinary Design Optimization (MDO) method “Bi-Level Integrated System Collaborative Optimization (BLISCO)” is applied to the conceptual design of an HOV, which consists of hull module, resistance module, energy module, structure module, weight module, and the stability module. This design problem is defined by 21 design variables and 23 constraints, and its objective is to maximize the ratio of payload to weight. The results show that the general performance of the HOV can be greatly improved by BLISCO.

  11. Tendency to occupy a statistically dominant spatial state of the flow as a driving force for turbulent transition

    CERN Document Server

    Chekmarev, Sergei F

    2012-01-01

    A simple analytical model for a turbulent flow is proposed, which considers the flow as a collection of localized spatial structures that are composed of elementary "cells" in which the state of the particles (atoms or molecules) is uncertain. The Reynolds number is associated with the ratio between the total phase volume for the system and that for the elementary cell. Calculating the statistical weights of the collections of the localized structures, it is shown that as the Reynolds number increases, the elementary cells group into the localized structures, which successfully explains the onset of turbulence and some other characteristic properties of turbulent flows. It is also shown that the basic assumptions underlying the model are involved in the derivation of the Navier-Stokes equation, which suggests that the driving force for the turbulent transition described with the hydrodynamic equations is essentially the same as in the present model, i.e. the tendency of the system to occupy a statistically do...

  12. Tailoring the highest occupied molecular orbital level of poly(N-vinylcarbazole) hole transport layers in organic multilayer heterojunctions

    Energy Technology Data Exchange (ETDEWEB)

    Park, Young Ran [Graphene Research Institute, Sejong University, Gwangjin-gu, Seoul 143-747 (Korea, Republic of); Kim, Hyeong Jin; Hong, Young Joon, E-mail: shink@sejong.ac.kr, E-mail: yjhong@sejong.ac.kr [Graphene Research Institute, Sejong University, Gwangjin-gu, Seoul 143-747 (Korea, Republic of); Faculty of Nanotechnology and Advanced Materials Engineering, Sejong University, Gwangjin-gu, Seoul 143-747 (Korea, Republic of); Hybrid Materials Research Center, Sejong University, Gwangjin-gu, Seoul 143-747 (Korea, Republic of); Im, Sungjin; Shin, Koo, E-mail: shink@sejong.ac.kr, E-mail: yjhong@sejong.ac.kr [Graphene Research Institute, Sejong University, Gwangjin-gu, Seoul 143-747 (Korea, Republic of); Department of Chemistry, Sejong University, Gwangjin-gu, Seoul 143-747 (Korea, Republic of); Seo, Sunae [Graphene Research Institute, Sejong University, Gwangjin-gu, Seoul 143-747 (Korea, Republic of); Department of Physics, Sejong University, Gwangjin-gu, Seoul 143-747 (Korea, Republic of); Choi, Won Kook [Materials and Life Science Research Division, Korea Institute of Science and Technology, Hwarang-ro 14-gil, Seoul 136-791 (Korea, Republic of)

    2016-01-11

    We report the tailoring of the electronic structure of poly(N-vinylcarbazole) (PVK) using a mixture layer of polyaniline:poly(p-styrenesulfonic acid) (PANI:PSS) in organic multilayer PVK/PANI:PSS/poly(3,4-ethylenedioxythiophene):PSS heterojunctions. The overall electronic structure of the PVK overlayer was systematically down-shifted while the work function of PANI:PSS increased as a function of the PSS-to-PANI weight ratio for the ratio range from 1 to 11 in the PANI:PSS film. The down-shift in the highest occupied molecular orbital of PVK markedly reduced the hole injection barrier from PVK to quantum-dot (QD) layers in QD-light emitting diode (QD-LED) structures, resulting in superior electrical and electroluminescent characteristics for QD-LEDs. The influences of PANI:PSS thickness on the electronic structure of PVK and the performance of QD-LEDs are also discussed.

  13. CaCu3Pt4O12: the first perovskite with the B site fully occupied by Pt(4+).

    Science.gov (United States)

    Yamada, Ikuya; Takahashi, Yuka; Ohgushi, Kenya; Nishiyama, Norimasa; Takahashi, Ryoji; Wada, Kohei; Kunimoto, Takehiro; Ohfuji, Hiroaki; Kojima, Yohei; Inoue, Toru; Irifune, Tetsuo

    2010-08-02

    A novel A-site ordered perovskite CaCu(3)Pt(4)O(12) was synthesized under high pressure and high temperature of 12 GPa and 1250 degrees C. CaCu(3)Pt(4)O(12) is the first perovskite in which the B site is fully occupied by Pt(4+). The crystal structure refinement based on the synchrotron powder X-ray diffraction data shows that CaCu(3)Pt(4)O(12) crystallizes in the space group Im3 (cubic) with a lattice constant of a = 7.48946(10) A. The magnetic susceptibility data show the antiferromagnetic transition at T(N) = 40 K, which is attributed to the magnetic ordering of Cu(2+) spins with S = 1/2.

  14. Traumatic induced total myelomalacia of the cervical spinal cord associated with a space-occupying subdural hematoma.

    Science.gov (United States)

    Oehmichen, M; Meissner, C

    1999-01-01

    We report the case of a 20-year-old male driver who suffered from a trauma to the cervical vertebral column in a head-on collision with a tree. The injuries included subluxation of the 2nd and 3rd cervical vertebrae and fracture of the odontoid process of the axis with ventrally directed displacement of the proximal fragment and dorsally directed displacement of the distal fragment. Already at admission to hospital a space-occupying spinal subdural hematoma was diagnosed. Clinically, paraplegia was diagnosed with progressive loss of consciousness. Pneumonia led to death 40 days after the accident. Autopsy disclosed a total myelomalacia of the cervical spinal cord obviously resulting from an ischemia caused by a traumatic lesion of the dorsal truncus arteriosus spinalis as well as a compression by the spinal subdural hematoma.

  15. N-phenylpropyl-N'-substituted piperazines occupy sigma receptors and alter methamphetamine-induced hyperactivity in mice.

    Science.gov (United States)

    Miller, Dennis K; Park, Eric S; Lever, Susan Z; Lever, John R

    This study examined the effect of the N-phenylpropyl-N'-substituted piperazine ligands SA4503 (3.4-dimethoxyphenethyl), YZ-067 (4-methoxyphenethyl), YZ-185 (3-methoxyphenethyl) and Nahas-3h (4-methoxybenzyl) on methamphetamine-induced hyperactivity in mice. In a previous study in rats, SA4503 increased methamphetamine-induced hyperactivity at a lower ligand dose and enhanced it at a higher dose. The other ligands have not been investigated in this assay. Presently, mice were administered sigma ligands, and specific [(125)I]E-IA-DM-PE-PIPZE and [(125)I]RTI-121 binding was measured to determine σ1 sigma receptor and dopamine transporter occupancy, respectively. Mice were also administered sigma ligands followed by methamphetamine, and locomotor activity was measured. Each of the ligands occupied σ1 sigma receptors (ED50=0.2-0.6μmol/kg) with similar potency, but none occupied the transporter (ED50>10μmol/kg). At the highest dose tested (31.6μmol/kg) all four sigma ligands significantly attenuated methamphetamine-induced hyperactivity. Interestingly, SA4503, YZ-067 and Nahas-3h, but not YZ-185, enhanced methamphetamine-induced hyperactivity at lower ligand doses (1-3.16μmol/kg). These results suggest that these ligands function as stimulant agonists at lower doses and as antagonists at higher does, with subtle changes in the substitution pattern at the 3- and 4-positions of the phenethyl group contributing to the nature of the interactions. Overall, these data indicate a complex role for σ1 sigma receptor ligands in methamphetamine's behavioral effects. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Complex evaluation of health status and life quality of employees occupied in mining and processing of hydrocarbon raw materials

    Directory of Open Access Journals (Sweden)

    G.G. Gimranova

    2016-06-01

    Full Text Available A complex social-hygienic investigation for the assessment of health-related life quality and living standards among 1200 male workers occupied in mining and primary processing of hydrocarbon raw materials has been performed. The study included the method of the anonymous survey for the employee with using a questionnaire developed by WHO experts for the realization of Health, environment and social capital management in enterprises (HESME. The health risk factors’ prevalence associated with alcohol, smoking, low physical activity, poor nutrition, stress in the workplace has been established. The feeling of stress and nervousness is generated by the fear of dismissal (18 % of employees, conflicts with administration (4% and by financial problems. About 47% of persons are anxious about social and economic instability. Not more than 4% of employees consider that the health deterioration is directly related to harmful working conditions. The survey has revealed an inflated self-esteem regarding the health. Thus 59.00 % of employee considers their health status to be excellent or normal, while an objective assessment revealed only 29.7 % of healthy employee. Due to the employee’s opinion, the saving of health is conditioned by healthy lifestyle, but the practice of self-preservation behavior is poorly spread. Not more than 37 % of respondents follow the doctors’ recommendations. Among the positive process there are changes in dietary habits in everyday life, namely 60 % of the respondents have chosen the balanced diet. The obtained data regarding the quality and way of life of the employee, occupied in mining and processing of hydrocarbon raw materials, should be taken into consideration when developing complex social development programs on an enterprise.

  17. Tophi - surgical treatment.

    Science.gov (United States)

    Słowińska, Iwona; Słowiński, Radosław; Rutkowska-Sak, Lidia

    2016-01-01

    Gout is an inflammatory joint disease associated with deposition of monosodium urate crystals in the bones forming the joints, in periarticular tissues and in other organs. The disease is one of the most frequent causes of disability. This paper presents the case of a 57-year-old male patient treated for generalised gout. A "clinical mask" suggesting another disease was the cause of making the correct diagnosis only six years after the occurrence of the first manifestations. The patient, with high values of inflammatory markers, severe pain and advanced joint destruction, was given an aggressive anti-inflammatory treatment. The unsatisfactory effect of the conservative treatment forced the authors to perform surgical resection of the gouty nodules in the hands. After several operations the function of the hand joints operated on, appearance of the hands and the quality of the patient's life improved significantly.

  18. Tophi – surgical treatment

    Science.gov (United States)

    Słowińska, Iwona; Słowiński, Radosław

    2016-01-01

    Gout is an inflammatory joint disease associated with deposition of monosodium urate crystals in the bones forming the joints, in periarticular tissues and in other organs. The disease is one of the most frequent causes of disability. This paper presents the case of a 57-year-old male patient treated for generalised gout. A “clinical mask” suggesting another disease was the cause of making the correct diagnosis only six years after the occurrence of the first manifestations. The patient, with high values of inflammatory markers, severe pain and advanced joint destruction, was given an aggressive anti-inflammatory treatment. The unsatisfactory effect of the conservative treatment forced the authors to perform surgical resection of the gouty nodules in the hands. After several operations the function of the hand joints operated on, appearance of the hands and the quality of the patient’s life improved significantly. PMID:27994273

  19. Surgical education in Mexico.

    Science.gov (United States)

    Cervantes, Jorge

    2010-05-01

    Surgical education in Mexico basically follows the same model as in the United States, with a selection process resembling the matching program. There is a 4-year training period during which residents in their third year spend 4 months as the sole surgeon in a rural community. During the senior year they are entitled to an elective period in a place of their choosing. After completion of the 4 years, residents have to present a thesis and undergo an oral examination before getting a university diploma. They are then encouraged to pass the written and oral examination of the Mexican Board of Surgery before they are fully certified to enter practice in a public or private hospital.

  20. Risk Factors for Surgical-Site Infection Following Common Femoral Artery Endarterectomy

    NARCIS (Netherlands)

    Derksen, Wouter J. M.; Verhoeven, Bart A. N.; van de Mortel, Rob H. W.; Moll, Frans L.; de Vries, Jean-Paul P. M.

    2009-01-01

    Surgical-site infection is a major complication following endarterectomy of the common femoral artery. The aim of this single-center study was to determine risk factors for surgical-site infection after endarterectomy of the common femoral artery and especially the possible association between patch

  1. Identification of potential surgical site infections leveraging an enterprise clinical information warehouse.

    Science.gov (United States)

    Santangelo, Jennifer; Erdal, Selnur; Wellington, Linda; Mekhjian, Hagop; Kamal, Jyoti

    2008-11-06

    At The Ohio State University Medical Center (OSUMC), infection control practitioners (ICPs) need an accurate list of patients undergoing defined operative procedures to track surgical site infections. Using data from the OSUMC Information Warehouse (IW), we have created an automated report detailing required data. This report also displays associated surgical and pathology text or dictated reports providing additional information to the ICPs.

  2. [Medico-social and administrative aspects of optimization of thoracoabdominal aortic aneurism surgical treatment].

    Science.gov (United States)

    Belov, Iu V; Komarov, R N

    2008-01-01

    Improvement of diagnostics, availability and quality of surgical help for patients with thoracoabdominal aneurisms is necessary. Cardiosurgical hospitals should be supplied with modern equipment, new technologies should be wider introduced to practice. Establishing departments of aortic surgery with the concentration of patients in the single center together with the risin the level of surgical skills are crucial.

  3. Integrated flexible endoscopy training during surgical residency.

    Science.gov (United States)

    Morales, Mario P; Mancini, Gregory J; Miedema, Brent W; Rangnekar, Nitin J; Koivunen, Debra G; Ramshaw, Bruce J; Eubanks, W Stephen; Stephenson, Hugh E

    2008-09-01

    New advances in endoscopic surgery make it imperative that future gastrointestinal surgeons obtain adequate endoscopy skills. An evaluation of the 2001-02 general surgery residency endoscopy experience at the University of Missouri revealed that chief residents were graduating with an average of 43 endoscopic cases. This met American Board of Surgery (ABS) and Accreditation Council for Graduate Medical Education (ACGME) requirements but is inadequate preparation for carrying out advanced endoscopic surgery. Our aim was to determine if endoscopy volume could be improved by dedicating specific staff surgeon time to a gastrointestinal diagnostic center at an affiliated Veterans Administration Hospital. During the academic years 2002-05, two general surgeons who routinely perform endoscopy staffed the gastrointestinal endoscopy center at the Harry S. Truman Hospital two days per week. A minimum of one categorical surgical resident participated during these endoscopy training days while on the Veterans Hospital surgical service. A retrospective observational review of ACGME surgery resident case logs from 2001 to 2005 was conducted to document the changes in resident endoscopy experience. The cases were compiled by postgraduate year (PGY). Resident endoscopy case volume increased 850% from 2001 to 2005. Graduating residents completed an average of 161 endoscopies. Endoscopic experience was attained at all levels of training: 26, 21, 34, 23, and 26 mean endoscopies/year for PGY-1 to PGY-5, respectively. Having specific endoscopy training days at a VA Hospital under the guidance of a dedicated staff surgeon is a successful method to improve surgical resident endoscopy case volume. An integrated endoscopy training curriculum results in early skills acquisition, continued proficiency throughout residency, and is an efficient way to obtain endoscopic skills. In addition, the foundation of flexible endoscopic skill and experience has allowed early integration of surgery

  4. Recurrent periductal mastitis: Surgical treatment.

    Science.gov (United States)

    Taffurelli, Mario; Pellegrini, Alice; Santini, Donatella; Zanotti, Simone; Di Simone, Domenico; Serra, Margherita

    2016-12-01

    Recurrent periductal mastitis is a benign breast disorder that often features a mammary fistula that runs between periareolar skin and the ductal mammary system. Due to the high recurrence rate of this disease, its management is controversial. This study was designed to assess the efficacy of fistulectomy (Hadfield operation), particularly with regard to its long-term outcome. We reviewed all women with recurrent periductal mastitis who underwent the Hadfield operation in the Breast Center in S.Orsola-Malpighi Hospital (Bologna University) from 2005 to 2015. All but one of the patients were heavy smokers and presented with a recurrent periareolar abscess and a periareolar mammary fistula. Eighteen women underwent the Hadfield surgical treatment. Mean age at the time of presentation was 42 years; 17 of 18 women smoked >10 cigarettes/d. All patients had a breast ultrasonography or mammography. Half of the patients had undergone antibiotic therapy with one or more prior abscess drainages or another form of operative treatment. All patients who underwent operative treatment had no postoperative events and were satisfied with the cosmetic results. Squamous metaplasia was always present in the specimens. After a median follow-up of 36 months, 2 patients developed a recurrence after a few months; neither had stopped smoking. Based on our review of the literature and taking into account the results of this study, it seems clear that the best treatment involves a combined total excision of the affected duct and the fistulous tract. Due to the important role of smoking in this disease, it is important to encourage patients to stop smoking. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Protocol for the BAG-RECALL clinical trial: a prospective, multi-center, randomized, controlled trial to determine whether a bispectral index-guided protocol is superior to an anesthesia gas-guided protocol in reducing intraoperative awareness with explicit recall in high risk surgical patients.

    Science.gov (United States)

    Avidan, Michael S; Palanca, Ben J; Glick, David; Jacobsohn, Eric; Villafranca, Alex; O'Connor, Michael; Mashour, George A

    2009-11-30

    Awareness with explicit recall of intra-operative events is a rare and distressing complication that may lead to severe psychological symptoms. Candidate depth of anesthesia monitors have been developed, partly with the aim of preventing this complication. Despite conflicting results from clinical trials and the lack of incisive validation, such monitors have enjoyed widespread clinical adoption, in particular the bispectral index. The American Society of Anesthesiologists has called for adequately powered and rigorously designed clinical trials to determine whether the use of such monitors decreases the incidence of awareness in various settings. The aim of this study is to determine with increased precision whether incorporating the bispectral index into a structured general anesthesia protocol decreases the incidence of awareness with explicit recall among a subset of surgical patients at increased risk for awareness and scheduled to receive an inhalation gas-based general anesthetic. BAG-RECALL is a multi-center, randomized, controlled clinical trial, in which 6,000 patients are being assigned to bispectral index-guided anesthesia (target range, 40 to 60) or end-tidal anesthetic gas-guided anesthesia (target range, 0.7 to 1.3 age-adjusted minimum alveolar concentration). Postoperatively, patients are being assessed for explicit recall at two intervals (0 to 72 hours, and 30 days after extubation). The primary outcome of the trial is awareness with explicit recall. Secondary outcomes include postoperative mortality, psychological symptoms, intensive care and hospital length of stay, average anesthetic gas administration, postoperative pain and nausea and vomiting, duration of stay in the recovery area, intra-operative dreaming, and postoperative delirium. This trial has been designed to complement two other clinical trials: B-Unaware and MACS (ClinicalTrials.gov numbers, NCT00281489 and NCT00689091). With the large patient numbers and complementary rigorous

  6. Protocol for the BAG-RECALL clinical trial: a prospective, multi-center, randomized, controlled trial to determine whether a bispectral index-guided protocol is superior to an anesthesia gas-guided protocol in reducing intraoperative awareness with explicit recall in high risk surgical patients

    Directory of Open Access Journals (Sweden)

    Villafranca Alex

    2009-11-01

    Full Text Available Abstract Background Awareness with explicit recall of intra-operative events is a rare and distressing complication that may lead to severe psychological symptoms. Candidate depth of anesthesia monitors have been developed, partly with the aim of preventing this complication. Despite conflicting results from clinical trials and the lack of incisive validation, such monitors have enjoyed widespread clinical adoption, in particular the bispectral index. The American Society of Anesthesiologists has called for adequately powered and rigorously designed clinical trials to determine whether the use of such monitors decreases the incidence of awareness in various settings. The aim of this study is to determine with increased precision whether incorporating the bispectral index into a structured general anesthesia protocol decreases the incidence of awareness with explicit recall among a subset of surgical patients at increased risk for awareness and scheduled to receive an inhalation gas-based general anesthetic. Methods/Design BAG-RECALL is a multi-center, randomized, controlled clinical trial, in which 6,000 patients are being assigned to bispectral index-guided anesthesia (target range, 40 to 60 or end-tidal anesthetic gas-guided anesthesia (target range, 0.7 to 1.3 age-adjusted minimum alveolar concentration. Postoperatively, patients are being assessed for explicit recall at two intervals (0 to 72 hours, and 30 days after extubation. The primary outcome of the trial is awareness with explicit recall. Secondary outcomes include postoperative mortality, psychological symptoms, intensive care and hospital length of stay, average anesthetic gas administration, postoperative pain and nausea and vomiting, duration of stay in the recovery area, intra-operative dreaming, and postoperative delirium. Discussion This trial has been designed to complement two other clinical trials: B-Unaware and MACS (ClinicalTrials.gov numbers, NCT00281489 and NCT00689091

  7. Acquiring minimally invasive surgical skills

    NARCIS (Netherlands)

    Hiemstra, Ellen

    2012-01-01

    Many topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and evaluation of minimally invasive surgical skills in a training setting and in practice in the operating room.

  8. Surgical innovations in canine gonadectomy

    NARCIS (Netherlands)

    Van Goethem, Bart

    2016-01-01

    In this thesis some recent technological developments in human surgery are evaluated for their potential use in veterinary medicine by introducing them as surgical innovations for canine gonadectomy. Barbed sutures achieve wound apposition without surgical knot tying and thus avoid knot-associated n

  9. Surgical treatment of acquired tracheocele.

    Science.gov (United States)

    Porubsky, Edward A; Gourin, Christine G

    2006-06-01

    Acquired tracheoceles are rare clinical entities that can cause a variety of chronic and recurrent aerodigestive tract symptoms. The management of acquired tracheoceles is primarily conservative, but surgical intervention may be indicated for patients with refractory symptoms. We present a case of acquired tracheocele and describe a method of successful surgical management.

  10. Surgical innovations in canine gonadectomy

    NARCIS (Netherlands)

    Van Goethem, Bart

    2016-01-01

    In this thesis some recent technological developments in human surgery are evaluated for their potential use in veterinary medicine by introducing them as surgical innovations for canine gonadectomy. Barbed sutures achieve wound apposition without surgical knot tying and thus avoid knot-associated n

  11. Centering research

    DEFF Research Database (Denmark)

    Katan, Lina Hauge; Baarts, Charlotte

    and collected 24 portfolios in which students reflect auto-ethnographically on their educational practices. Analyzing this qualitative material, we explore how researchers and students respectively read and write to develop and advance their thinking in those learning processes that the two groups fundamentally...... share as the common aim of both research and education. Despite some similarities, we find that how the two groups engage in and benefit from reading and writing diverges significantly. Thus we have even more reason to believe that centering practice-based teaching on these aspects of research is a good...

  12. Surgical infection in art.

    Science.gov (United States)

    Meakins, J L

    1996-12-01

    The earliest images of medicine and surgery in Western art are from the late Middle Ages. Although often attractive, at that time they were illustrative and mirrored the text on how to diagnose or treat a specific condition. These drawings in medieval manuscripts represent management of abscesses, perianal infection and fistulas, amputation, and wound dressings. With the Renaissance, art in all its forms flourished, and surgeons were represented at work draining carbuncles, infected bursae, and mastoiditis; managing ulcers, scrofula, and skin infections; and performing amputations. Specific diagnosis can be made, such as streptococcal infection in the discarded leg of the miraculous transplantation performed by Saints Cosmas and Damian and in the works of Rembrandt van Rijn and Frederic Bazille. Evocations of cytokine activity are evident in works by Albrecht Dürer, Edvard Munch, and James Tissot. The iconography of society's view of a surgeon is apparent and often not complimentary. The surgeon's art is a visual art. Astute observation leads to early diagnosis and better results in surgical infection and the septic state. Learning to see what we look at enhances our appreciation of the world around us but, quite specifically, makes us better clinicians.

  13. Recommendation Analysis for an Ambulatory Surgical Center at Brooke Army Medical Center

    Science.gov (United States)

    2005-06-10

    provided at this time. Operating Rooms There would be seven operating rooms configured in the most optimum way with ergonomic considerations addressed...each $5,000.00 $350.00 N/A $5,350.00 4 $21,400.00 Computer for X-Ray visualization each $5,000.00 $350.00 N/A $5,350.00 4 $21,400.00 Stools ...sitting each $200.00 $14.00 N/A $214.00 4 $856.00 Stools - rolling each $300.00 $21.00 N/A $321.00 4 $1,284.00 Step stools each $100.00 $7.00 N/A $107.00 4

  14. Testis-specific transcriptional regulators selectively occupy BORIS-bound CTCF target regions in mouse male germ cells

    Science.gov (United States)

    Rivero-Hinojosa, Samuel; Kang, Sungyun; Lobanenkov, Victor V.; Zentner, Gabriel E.

    2017-01-01

    Despite sharing the same sequence specificity in vitro and in vivo, CCCTC-binding factor (CTCF) and its paralog brother of the regulator of imprinted sites (BORIS) are simultaneously expressed in germ cells. Recently, ChIP-seq analysis revealed two classes of CTCF/BORIS-bound regions: single CTCF target sites (1xCTSes) that are bound by CTCF alone (CTCF-only) or double CTCF target sites (2xCTSes) simultaneously bound by CTCF and BORIS (CTCF&BORIS) or BORIS alone (BORIS-only) in germ cells and in BORIS-positive somatic cancer cells. BORIS-bound regions (CTCF&BORIS and BORIS-only sites) are, on average, enriched for RNA polymerase II (RNAPII) binding and histone retention in mature spermatozoa relative to CTCF-only sites, but little else is known about them. We show that subsets of CTCF&BORIS and BORIS-only sites are occupied by several testis-specific transcriptional regulators (TSTRs) and associated with highly expressed germ cell-specific genes and histone retention in mature spermatozoa. We also demonstrate a physical interaction between BORIS and one of the analyzed TSTRs, TATA-binding protein (TBP)-associated factor 7-like (TAF7L). Our data suggest that CTCF and BORIS cooperate with additional TSTRs to regulate gene expression in developing male gametes and histone retention in mature spermatozoa, potentially priming certain regions of the genome for rapid activation following fertilization. PMID:28145452

  15. Contribution made by computed tomography to assessment of space-occupying growths and malformations of the skeletal system

    Energy Technology Data Exchange (ETDEWEB)

    Koenig, R.; van Kaick, G.; Braun, A.

    1983-03-01

    The contribution made by computed tomography to the diagnostics of the skeletal system was studied in the basis of 53 examinations in patients with space-occupying growths and malformations. With reference to clinical final diagnoses the CT findings were graded into I. Correct diagnosis or diagnosis by exclusion, II. Contribution to determining the growth of the process, III. No additional information obtained via CT. The distribution of these grades was as follows: Grad I = 34%, II = 49%, III = 17%. Indications for CT of the skeletal system were based on the following problems: primary malignant bone tumours; bone metastases in the region on the vertebral column; benign and potentially malignant bone tumours and abscesses in the region of the skeleton itself and of the skull; suspected diastematomyelia; assessment of the vertebral canal in case of suspected inflammatory or tumorous changes of the adjacent areas as well as exclusion of osseous changes in the region of the vertebral canal with peripheral neurological symptoms. CT serves to determine the exact dimension of the growth; to prove infiltration of organs and stuctures; for the planning of operations; for controlling the course; and for diagnosing relapses.

  16. Thrombin inhibits HMGB1-mediated proinflammatory signaling responses when endothelial protein C receptor is occupied by its natural ligand

    Directory of Open Access Journals (Sweden)

    Jong-Sup Bae

    2013-11-01

    Full Text Available High mobility group box 1 (HMGB1 is involved in thepathogenesis of vascular diseases. Unlike activated protein C(APC, the activation of PAR-1 by thrombin is known to elicitproinflammatory responses. To determine whether the occupancyof EPCR by the Gla-domain of APC is responsible for thePAR-1-dependent antiinflammatory activity of the protease, wepretreated HUVECs with the PC zymogen and then activatedPAR-1 with thrombin. It was found that thrombin downregulatesthe HMGB1-mediated induction of both TNF-α andIL-6 and inhibits the activation of both p38 MAPK and NF-κB inHUVECs pretreated with PC. Furthermore, thrombin inhibitedHMGB1-mediated hyperpermeability and leukocyte adhesion/migration by inhibiting the expression of cell adhesion moleculesin HUVECs if EPCR was occupied. Collectively, theseresults suggest the concept that thrombin can initiate proinflammatoryresponses in vascular endothelial cells through theactivation of PAR-1 may not hold true for normal vesselsexpressing EPCR under in vivo conditions. [BMB Reports 2013;46(11: 544-549

  17. Rift Valley fever in a zone potentially occupied by Aedes vexans in Senegal: dynamics and risk mapping

    Directory of Open Access Journals (Sweden)

    Cécile Vignolles

    2009-05-01

    Full Text Available This paper presents an analysis of the interaction between the various variables associated with Rift Valley fever (RVF such as the mosquito vector, available hosts and rainfall distribution. To that end, the varying zones potentially occupied by mosquitoes (ZPOM, rainfall events and pond dynamics, and the associated exposure of hosts to the RVF virus by Aedes vexans, were analyzed in the Barkedji area of the Ferlo, Senegal, during the 2003 rainy season. Ponds were identified by remote sensing using a high-resolution SPOT-5 satellite image. Additional data on ponds and rainfall events from the Tropical Rainfall Measuring Mission were combined with in-situ entomological and limnimetric measurements, and the localization of vulnerable ruminant hosts (data derived from QuickBird satellite. Since “Ae. vexans productive events” are dependent on the timing of rainfall for their embryogenesis (six days without rain are necessary to trigger hatching, the dynamic spatio-temporal distribution of Ae. vexans density was based on the total rainfall amount and pond dynamics. Detailed ZPOM mapping was obtained on a daily basis and combined with aggressiveness temporal profiles. Risks zones, i.e. zones where hazards and vulnerability are combined, are expressed by the percentages of parks where animals are potentially exposed to mosquito bites. This new approach, simply relying upon rainfall distribution evaluated from space, is meant to contribute to the implementation of a new, operational early warning system for RVF based on environmental risks linked to climatic and environmental conditions.

  18. Lower extremity deep venous thrombosis with fatal pulmonary thromboembolism caused by benign pelvic space-occupying lesions--an overview.

    Science.gov (United States)

    Rosenfeld, Hannah; Byard, Roger W

    2012-05-01

    Venous stasis predisposes to thrombosis. One hundred and sixty cases of fatal pulmonary thromboembolism were reviewed to determine how many cases had deep venous thromboses associated with venous blood flow reduction caused by external pressure from benign pelvic masses. Three cases were identified, representing 2% of cases overall (3/160): a 44-year-old woman with a large uterine leiomyoma (1048 g); a 74-year-old man with prostatomegaly and bladder distension (containing 1 L of urine); and a 70-year-old man with prostatomegaly and bladder distension (containing 3 L of urine). Although a rare cause of fatal deep venous thrombosis and pulmonary thromboembolism, space-occupying pelvic lesions can lead to extrinsic pressure on adjacent veins reducing blood flow and causing stasis and thrombosis. Individuals with large pelvic masses may, therefore, be at increased risk of pulmonary thromboembolism from deep venous thrombosis, particularly in the presence of concurrent risk factors such as immobility, thrombophilias, malignancy, and significant cardiopulmonary disease.

  19. The Surgical Treatment of Mycetoma.

    Science.gov (United States)

    Suleiman, Suleiman Hussein; Wadaella, El Sammani; Fahal, Ahmed Hassan

    2016-06-01

    Surgical intervention is an integral component in the diagnosis and management of mycetoma. Surgical treatment is indicated for small, localised lesions and massive lesions to reduce the mycetoma load and to enable better response to medical therapy. It is also a life-saving procedure in patients with massive disease and sepsis. Surgical options for mycetoma treatment range from a wide local surgical excision to repetitive debridement excisions to amputation of the affected part. Adequate anaesthesia, a bloodless field, wide local excision with adequate safety margins in a suitable surgical facility, and expert surgeons are mandatory to achieve the best surgical outcome. Surgical intervention in mycetoma is associated with considerable morbidity, deformities, and disabilities, particularly in advanced disease. These complications can be reduced by educating patients to seek medical advice earlier when the lesion is small, localised, and amenable to surgery. There is no evidence for mycetoma hospital cross infection. This communication is based on the authors' experience in managing over 7,200 mycetoma patients treated at the Mycetoma Research Centre, University of Khartoum, Sudan.

  20. The Surgical Treatment of Mycetoma.

    Directory of Open Access Journals (Sweden)

    Suleiman Hussein Suleiman

    2016-06-01

    Full Text Available Surgical intervention is an integral component in the diagnosis and management of mycetoma. Surgical treatment is indicated for small, localised lesions and massive lesions to reduce the mycetoma load and to enable better response to medical therapy. It is also a life-saving procedure in patients with massive disease and sepsis. Surgical options for mycetoma treatment range from a wide local surgical excision to repetitive debridement excisions to amputation of the affected part. Adequate anaesthesia, a bloodless field, wide local excision with adequate safety margins in a suitable surgical facility, and expert surgeons are mandatory to achieve the best surgical outcome. Surgical intervention in mycetoma is associated with considerable morbidity, deformities, and disabilities, particularly in advanced disease. These complications can be reduced by educating patients to seek medical advice earlier when the lesion is small, localised, and amenable to surgery. There is no evidence for mycetoma hospital cross infection. This communication is based on the authors' experience in managing over 7,200 mycetoma patients treated at the Mycetoma Research Centre, University of Khartoum, Sudan.

  1. The importance of scale in Occupy movement protests: a case study of a local Occupy protest as a tool of communication through Public Relations and Social Media/La importancia de la magnitud de las protestas del movimiento Occupy: el caso de una protesta

    Directory of Open Access Journals (Sweden)

    Ana Adi

    2012-12-01

    Full Text Available AbstractThis paper explores the persuasive communications (public relations and branding through social media of a micro Occupy event, namely a nine-day appearance of the global protest movement at Bournemouth University (BU, on the south coast of the UK. It reflects on how student and town protesters used digital and social media in comparison to the wider and more successful UK movement. It interviews the student leader, and asks questions about the role social networks like Occupii.org played in formulating communication strategies as well as how they integrated with more popular social media platforms like Facebook and Twitter. The conclusions coming from our micro case study suggest that without a supportive geographic and civic location; clear and focused messages, and robust strategic communication planning and execution, Occupy events will remain very small.ResumenEste artículo explora las comunicaciones persuasivas (relaciones públicas y branding a través de los medios de comunicación social de un minúsculo evento de Ocupación, la Ocupación de nueve días del campus de la Universidad de Bournemouth (BU, en la costa sur del Reino Unido. El articulo refleja cómo los ciudadanos y estudiantes manifestantes utilizan los medios digitales y sociales y los compara con el movimiento más amplio y exitoso de Ocupación en el Reino Unido. En este artículo se incluye la entrevista al líder estudiantil del movimiento, con preguntas sobre cómo el papel que redes sociales como Occupii.org han jugado en la formulación de estrategias de comunicación de ese grupo, y como el grupo integra sus comunicaciones con las plataformas sociales más populares como Facebook y Twitter. Las conclusiones de nuestro estudio sugieren que sin una ubicación geográfica favorable y cívica, sin mensajes claros y concretos, y sin una sólida y planificada estrategia de comunicación, las Ocupaciones se quedarán muy pequeñas.

  2. Network analysis of surgical innovation: Measuring value and the virality of diffusion in robotic surgery.

    Science.gov (United States)

    Garas, George; Cingolani, Isabella; Panzarasa, Pietro; Darzi, Ara; Athanasiou, Thanos

    2017-01-01

    Existing surgical innovation frameworks suffer from a unifying limitation, their qualitative nature. A rigorous approach to measuring surgical innovation is needed that extends beyond detecting simply publication, citation, and patent counts and instead uncovers an implementation-based value from the structure of the entire adoption cascades produced over time by diffusion processes. Based on the principles of evidence-based medicine and existing surgical regulatory frameworks, the surgical innovation funnel is described. This illustrates the different stages through which innovation in surgery typically progresses. The aim is to propose a novel and quantitative network-based framework that will permit modeling and visualizing innovation diffusion cascades in surgery and measuring virality and value of innovations. Network analysis of constructed citation networks of all articles concerned with robotic surgery (n = 13,240, Scopus®) was performed (1974-2014). The virality of each cascade was measured as was innovation value (measured by the innovation index) derived from the evidence-based stage occupied by the corresponding seed article in the surgical innovation funnel. The network-based surgical innovation metrics were also validated against real world big data (National Inpatient Sample-NIS®). Rankings of surgical innovation across specialties by cascade size and structural virality (structural depth and width) were found to correlate closely with the ranking by innovation value (Spearman's rank correlation coefficient = 0.758 (p = 0.01), 0.782 (p = 0.008), 0.624 (p = 0.05), respectively) which in turn matches the ranking based on real world big data from the NIS® (Spearman's coefficient = 0.673;p = 0.033). Network analysis offers unique new opportunities for understanding, modeling and measuring surgical innovation, and ultimately for assessing and comparing generative value between different specialties. The novel surgical innovation metrics developed may

  3. Direct Participation in and Indirect Exposure to the Occupy Central Movement and Depressive Symptoms: A Longitudinal Study of Hong Kong Adults.

    Science.gov (United States)

    Ni, Michael Y; Li, Tom K; Pang, Herbert; Chan, Brandford H Y; Yuan, Betty Y; Kawachi, Ichiro; Schooling, C Mary; Leung, Gabriel M

    2016-11-01

    Despite the extensive history of social movements around the world, the evolution of population mental health before, during, and after a social movement remains sparsely documented. We sought to assess over time the prevalence of depressive symptoms during and after the Occupy Central movement in Hong Kong and to examine the associations of direct and indirect exposures to Occupy Central with depressive symptoms. We longitudinally administered interviews to 909 adults who were randomly sampled from the population-representative FAMILY Cohort at 6 time points from March 2009 to March 2015: twice each before, during, and after the Occupy Central protests. The Patient Health Questionnaire-9 was used to assess depressive symptoms and probable major depression (defined as Patient Health Questionnaire-9 score ≥10). The absolute prevalence of probable major depression increased by 7% after Occupy Central, regardless of personal involvement in the protests. Higher levels of depressive symptoms were associated with online and social media exposure to protest-related news (incidence rate ratio (IRR) = 1.28, 95% confidence interval (CI): 1.06, 1.55) and more frequent Facebook use (IRR = 1.38, 95% CI: 1.12, 1.71). Higher levels of intrafamilial sociopolitical conflict was associated with more depressive symptoms (IRR = 1.05, 95% CI: 1.01, 1.09). The Occupy Central protests resulted in substantial and sustained psychological distress in the community.

  4. Surgical treatment of pediatric rhinosinusitis.

    Science.gov (United States)

    Isaacson, G

    2015-08-01

    Pediatric rhinosinusitis is a common sequela of upper respiratory infections in children. It is usually a self-limited disease, sometimes requiring antibiotic therapy. Surgery may be indicated in children who suffer complication of acute rhinosinusitis, severe recurrent acute rhinosinusitis, rhinosinusitis in cystic fibrosis with or without polyposis, chronic rhinosinusitis refractory to maximal medical management, allergic fungal sinusitis, and paranasal sinus mucoceles. Surgical options include, adenoidectomy, sinus puncture and lavage, open surgical approaches, endoscopic sinus surgery, balloon sinuplasty, and turbinectomy or turbinate reduction. This paper reviews the anatomy and physiology of rhinosinusitis in children and current knowledge of the indications and best methods of surgical treatment.

  5. Towards Safe Robotic Surgical Systems

    DEFF Research Database (Denmark)

    Sloth, Christoffer; Wisniewski, Rafael

    2015-01-01

    A proof of safety is paramount for an autonomous robotic surgical system to ensure that it does not cause trauma to patients. However, a proof of safety is rarely constructed, as surgical systems are too complex to be dealt with by most formal verification methods. In this paper, we design...... a controller for motion compensation in beating-heart surgery, and prove that it is safe, i.e., the surgical tool is kept within an allowable distance and orientation of the heart. We solve the problem by simultaneously finding a control law and a barrier function. The motion compensation system is simulated...

  6. Surgical Skills Beyond Scientific Management

    Science.gov (United States)

    Whitfield, Nicholas

    2015-01-01

    During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel’s attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel–Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice. PMID:26090737

  7. Retained surgical sponge: An enigma

    Directory of Open Access Journals (Sweden)

    Gurjit Singh

    2013-01-01

    Full Text Available Retained surgical sponge in the body following a surgery is called "gossypiboma". A 27-year-old female who had undergone lower segment cesarean section 4 months earlier was admitted with complaints of pain abdomen with a palpable mass in left iliac fossa. X-ray, ultrasonography, and CT scan findings were suggestive of retained surgical sponge. Surgical sponge was removed following laparotomy. Surgeons must be aware of the risk factors that lead to gossypiboma, and measures should be taken to prevent it. Besides increasing morbidity and possible mortality, it may result in libel suit for compensation.

  8. Surgical research using national databases.

    Science.gov (United States)

    Alluri, Ram K; Leland, Hyuma; Heckmann, Nathanael

    2016-10-01

    Recent changes in healthcare and advances in technology have increased the use of large-volume national databases in surgical research. These databases have been used to develop perioperative risk stratification tools, assess postoperative complications, calculate costs, and investigate numerous other topics across multiple surgical specialties. The results of these studies contain variable information but are subject to unique limitations. The use of large-volume national databases is increasing in popularity, and thorough understanding of these databases will allow for a more sophisticated and better educated interpretation of studies that utilize such databases. This review will highlight the composition, strengths, and weaknesses of commonly used national databases in surgical research.

  9. Postoperative Surgical Infection After Spinal Surgery in Rheumatoid Arthritis.

    Science.gov (United States)

    Koyama, Kensuke; Ohba, Tetsuro; Ebata, Shigeto; Haro, Hirotaka

    2016-05-01

    Individuals with rheumatoid arthritis are at higher risk for infection than the general population, and surgical site infection after spinal surgery in this population can result in clinically significant complications. The goal of this study was to identify risk factors for acute surgical site infection after spinal surgery in patients with rheumatoid arthritis who were treated with nonbiologic (conventional) disease-modifying antirheumatic drugs (DMARDs) alone or with biologic DMARDs. All patients treated with biologic agents were treated with nonbiologic agents as well. The authors performed a retrospective, single-center review of 47 consecutive patients with rheumatoid arthritis who underwent spinal surgery and had follow-up of 3 months or longer. The incidence of surgical site infection was examined, and multivariate logistic regression analysis was performed to test the association of surgical site infection with putative risk factors, including the use of biologic agents, methotrexate, and prednisolone, as well as the duration of rheumatoid arthritis, the presence of diabetes, patient age, length of surgery, and number of operative levels. After spinal surgery, 14.89% (7 of 47) of patients had surgical site infection. Use of methotrexate and/or prednisolone, patient age, diabetes, duration of rheumatoid arthritis, length of surgery, number of operative levels, and use of biologic DMARDs did not significantly increase the risk of infection associated with spinal surgery. All patients who had surgical site infection had undergone spinal surgery with instrumentation. The findings show that greater attention to preventing surgical site infection may be needed in patients with rheumatoid arthritis who undergo spinal surgery with instrumentation. To the authors' knowledge, this is the first study to show that the use of biologic agents did not increase the incidence of surgical site infection after spinal surgery in patients with rheumatoid arthritis

  10. Performance improvement initiative: prevention of surgical site infection (SSI).

    Science.gov (United States)

    Ng, Wai Khuan; Awad, Nawal

    2015-01-01

    Mafraq Hospital performs an average of 10,000 surgeries every year. The impact of having high volume high risk surgical procedures calls for the need to ensure safe surgery and a prevention of surgical site infection (SSI). SSI represents a significant portion of healthcare-associated infections (HAIs). The impact on morbidity, mortality, and cost of care has resulted in identifying the need to reduce SSI as a top priority to prevent healthcare associated infections. The good news is that the majority of SSIs are preventable. Mafraq Hospital performs a range of surgical procedures that covers 14 surgical specialties. The infection prevention and control team performs surveillance for SSI for all patients who undergo operative procedure included in Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) Operative Procedure Category (40 surgical procedures). Out of the 40 CDC NHSN listed, 33 operative procedures were performed at Mafraq Hospital, of which 17 were reported with SSI for 2013 and 2014. Surgical site infection has implicated an increase average length of stay from seven to 10 additional postoperative hospital days and additional costs of AED 10,000 to AED 100,000/SSI depending on procedure and pathogen. A multidisciplinary team was formed to develop and implement measures to reduce/eliminate surgical site infection, as well as evaluate and monitor compliance. Hence a group of multidisciplinary teams were initiated to analyse the results, find out the gaps, and implement a quality improvement project to correct the deficits. Recommendations for appropriate improvement measures were formed on evidence-based international guidelines from the Institute for Healthcare Improvement (IHI) and CDC. Evidence based practice supports that many of the causes of surgical site infection can be prevented with proper medical attention and care.

  11. Is surgical intervention more effective than non-surgical treatment for acute Achilles tendon rupture? A systematic review of overlapping meta-analyses.

    Science.gov (United States)

    Wu, Yaohong; Lin, Linghan; Li, Hao; Zhao, Yachao; Liu, Longgang; Jia, Zhiwei; Wang, Deli; He, Qing; Ruan, Dike

    2016-12-01

    There is discordance in the results from meta-analyses on surgical versus non-surgical treatment for acute Achilles tendon rupture. We systematically reviewed the overlapping meta-analyses on this topic to provide information that will be helpful to decision makers when selecting treatments based on the current best available evidence. We comprehensively searched multiple databases for systematic reviews that compared surgical and non-surgical treatments for acute Achilles tendon rupture. We only included meta-analyses that comprised randomized controlled trials (RCTs). The methodological quality and extracted data were assessed. The meta-analysis that offered the best evidence was ascertained with the Jadad decision algorithm. Nine meta-analyses were included in our study and all of them included RCTs with Level-II evidence. Assessment of Multiple Systematic Reviews (AMSTAR) scores ranged from 5 to 10 (median 7). The Jadad decision algorithm was used to select a high-quality meta-analysis with more RCTs. The results from this study showed that when functional rehabilitation was used, non-surgical intervention was similar to surgical treatment regarding the incidence of range of motion, rerupture, calf circumference and functional outcomes, and the incidence of other complications was reduced. Non-surgical intervention significantly increased the rerupture rate if functional rehabilitation was not considered. The findings of meta-analyses regarding surgical versus non-surgical treatment for acute Achilles tendon rupture are inconsistent. According to this systematic review of overlapping meta-analyses, the current best available evidence suggests that centers offering functional rehabilitation may prefer non-surgical intervention. Surgical treatment may be preferred at centers that do not have functional rehabilitation. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  12. Surgical Templates for Dental Implant Positioning; Current ...

    African Journals Online (AJOL)

    applied scientifically based research techniques to develop an endosseous implant that forms ... KEYWORDS: Dental implants, surgical templates, surgical procedure, stent .... during the surgical stage for single implant therapy.[24] Afterward,.

  13. Evidence-based surgical wound care on surgical wound infection.

    Science.gov (United States)

    Reilly, Jaqueline

    2002-09-01

    Surgical wound infection is an important outcome indicator in the postoperative period. A 3-year prospective cohort epidemiological study of 2202 surgical patients from seven surgical wards across two hospitals was carried out using gold standard surveillance methodology. This involved following patients up as inpatients and postdischarge surveillance to 30 days by an independent observer. The results led to the development of a mathematical model for risk of clean, elective surgical wound infection. Risk of surgical wound infection was increased by smoking, higher body mass index, presence of malignancy, haematoma formation, increasing numbers of people in theatre, adherent dressing usage, and higher times to suture removal (P<0.05). The results show that this type of surveillance is an effective way of collecting accurate data on wound infection rates. It was noted that patient care practices affected the surgical wound infection rate and the surveillance was used to facilitate the adoption of evidence-based practice, through recommendations for clean surgery, to reduce the risk from extrinsic risk factors for wound infection. As a result of the implementation of this evidence-based practice there was a significant reduction (P<0.05) in the clean wound infection rate.

  14. Non-photorealistic rendering of virtual implant models for computer-assisted fluoroscopy-based surgical procedures

    Science.gov (United States)

    Zheng, Guoyan

    2007-03-01

    Surgical navigation systems visualize the positions and orientations of surgical instruments and implants as graphical overlays onto a medical image of the operated anatomy on a computer monitor. The orthopaedic surgical navigation systems could be categorized according to the image modalities that are used for the visualization of surgical action. In the so-called CT-based systems or 'surgeon-defined anatomy' based systems, where a 3D volume or surface representation of the operated anatomy could be constructed from the preoperatively acquired tomographic data or through intraoperatively digitized anatomy landmarks, a photorealistic rendering of the surgical action has been identified to greatly improve usability of these navigation systems. However, this may not hold true when the virtual representation of surgical instruments and implants is superimposed onto 2D projection images in a fluoroscopy-based navigation system due to the so-called image occlusion problem. Image occlusion occurs when the field of view of the fluoroscopic image is occupied by the virtual representation of surgical implants or instruments. In these situations, the surgeon may miss part of the image details, even if transparency and/or wire-frame rendering is used. In this paper, we propose to use non-photorealistic rendering to overcome this difficulty. Laboratory testing results on foamed plastic bones during various computer-assisted fluoroscopybased surgical procedures including total hip arthroplasty and long bone fracture reduction and osteosynthesis are shown.

  15. Subdural intracranial pressure, cerebral perfusion pressure, and degree of cerebral swelling in supra- and infratentorial space-occupying lesions in children

    DEFF Research Database (Denmark)

    Stilling, M; Karatasi, E; Rasmussen, Mads

    2005-01-01

    UNLABELLED: To our knowledge comparative studies of intracranial pressure (ICP) and degree of cerebral swelling during craniotomy for supratentorial or infratentorial space occupying lesion in children are not available. In this prospective study subdural ICP, cerebral perfusion pressure (CPP......), dural tension, and the degree of cerebral swelling were analysed in supine and prone positioned children subjected to craniotomy for space occupying lesions. MATERIAL AND METHOD: 48 children with space occupying tumours were subjected to either isoflurane/nitrous oxide 50%/fentanyl (n = 22) or propofol....../fentanyl/air/oxygen (n = 26). 25 children were operated supratentorially in supine position, while 23 patients were operated infratentorially in the prone position. Subdural ICP, mean arterial blood pressure (MABP), and CPP were measured just before opening of the dura. Dural tension was estimated before opening of dura...

  16. Surgical Treatment of Winged Scapula

    National Research Council Canada - National Science Library

    Galano, Gregory J; Bigliani, Louis U; Ahmad, Christopher S; Levine, William N

    2008-01-01

    .... Although nonoperative treatment is successful in some patients, failures have led to the evolution of surgical techniques involving various combinations of fascial graft and/or transfer of adjacent muscles...

  17. Essential Tremor (ET): Surgical Options

    Science.gov (United States)

    ... t respond to propranolol, primidone, or other common ET medications and whose tremor has become debilitating, there ... treatments were first introduced. Current surgical options for ET include Deep Brain Stimulation (DBS) , Focused Ultrasound Thalamotomy , ...

  18. Surgical treatment of cranial neuralgias.

    Science.gov (United States)

    Franzini, Angelo; Ferroli, Paolo; Messina, Giuseppe; Broggi, Giovanni

    2010-01-01

    The most common types of cranial neuralgias amenable to surgical therapeutic options are trigeminal neuralgia and glossopharyngeal neuralgia, the former having an approximate incidence of 5/100000 cases per year and the latter of 0.05/100000 cases per year. Surgical therapy of these pathological conditions encompasses several strategies, going from ablative procedures to neurovascular decompression, to radiosurgery. The choice of the most appropriate surgical option (which must be taken into account when all conservative treatments have proven to be unsuccessful) has to take into account many factors, the most important ones being neuroradiological evidence of a neurovascular conflict, severity of symptoms, the age and clinical history of the patient, and the patient's overall medical condition. In this chapter we report our experience with the treatment of trigeminal and glossopharyngeal neuralgia, describing the surgical procedures performed and reviewing the most recent aspects on this subject in the past literature.

  19. Surgical trainees and trauma emergencies.

    Science.gov (United States)

    Wybaillie, E; Broos, P L O

    2010-01-01

    An accident and emergency (A&E) training has been suggested as an essential part of the basic surgical training. The A&E curriculum should be divided into three sections: a critical curriculum, a core curriculum and a comprehensive curriculum. For instance, the critical curriculum contains topics that provide the opportunity to translate the ABCDE principles of trauma management into practice. Furthermore, a post in the A&E department provides the surgical trainee with significant exposure to the management of the polytrauma patient and to the management of other acute general surgical, urological and orthopaedic conditions. By presenting better educational programs and by reducing the non-medical tasks a trainee has to deal with, the education of surgical trainees during A&E attachment can be improved.

  20. Access to Specialized Surgical Care

    African Journals Online (AJOL)

    to reduce the global burden of disease (GBD), it is ... global players have supported efforts to improve access and safety of surgery ... (i) strengthening surgical services at district hospitals ... of the surrounding community and a model for other.

  1. RDI's Wisdom Way Solar Village Final Report: Includes Utility Bill Analysis of Occupied Homes

    Energy Technology Data Exchange (ETDEWEB)

    Robb Aldrich, Steven Winter Associates

    2011-07-01

    In 2010, Rural Development, Inc. (RDI) completed construction of Wisdom Way Solar Village (WWSV), a community of ten duplexes (20 homes) in Greenfield, MA. RDI was committed to very low energy use from the beginning of the design process throughout construction. Key features include: 1. Careful site plan so that all homes have solar access (for active and passive); 2. Cellulose insulation providing R-40 walls, R-50 ceiling, and R-40 floors; 3. Triple-pane windows; 4. Airtight construction (~0.1 CFM50/ft2 enclosure area); 5. Solar water heating systems with tankless, gas, auxiliary heaters; 6. PV systems (2.8 or 3.4kWSTC); 7. 2-4 bedrooms, 1,100-1,700 ft2. The design heating loads in the homes were so small that each home is heated with a single, sealed-combustion, natural gas room heater. The cost savings from the simple HVAC systems made possible the tremendous investments in the homes' envelopes. The Consortium for Advanced Residential Buildings (CARB) monitored temperatures and comfort in several homes during the winter of 2009-2010. In the Spring of 2011, CARB obtained utility bill information from 13 occupied homes. Because of efficient lights, appliances, and conscientious home occupants, the energy generated by the solar electric systems exceeded the electric energy used in most homes. Most homes, in fact, had a net credit from the electric utility over the course of a year. On the natural gas side, total gas costs averaged $377 per year (for heating, water heating, cooking, and clothes drying). Total energy costs were even less - $337 per year, including all utility fees. The highest annual energy bill for any home evaluated was $458; the lowest was $171.

  2. DNA methylation directly silences genes with non-CpG island promoters and establishes a nucleosome occupied promoter.

    Science.gov (United States)

    Han, Han; Cortez, Connie C; Yang, Xiaojing; Nichols, Peter W; Jones, Peter A; Liang, Gangning

    2011-11-15

    Despite the fact that 45% of all human gene promoters do not contain CpG islands, the role of DNA methylation in control of non-CpG island promoters is controversial and its relevance in normal and pathological processes is poorly understood. Among the few studies which investigate the correlation between DNA methylation and expression of genes with non-CpG island promoters, the majority do not support the view that DNA methylation directly leads to transcription silencing of these genes. Our reporter assays and gene reactivation by 5-aza-2'-deoxycytidine, a DNA demethylating agent, show that DNA methylation occurring at CpG poor LAMB3 promoter and RUNX3 promoter 1(RUNX3 P1) can directly lead to transcriptional silencing in cells competent to express these genes in vitro. Using Nucleosome Occupancy Methylome- Sequencing, NOMe-Seq, a single-molecule, high-resolution nucleosome positioning assay, we demonstrate that active, but not inactive, non-CpG island promoters display a nucleosome-depleted region (NDR) immediately upstream of the transcription start site (TSS). Furthermore, using NOMe-Seq and clonal analysis, we show that in RUNX3 expressing 623 melanoma cells, RUNX3 P1 has two distinct chromatin configurations: one is unmethylated with an NDR upstream of the TSS; another is methylated and nucleosome occupied, indicating that RUNX3 P1 is monoallelically methylated. Together, these results demonstrate that the epigenetic signatures comprising DNA methylation, histone marks and nucleosome occupancy of non-CpG island promoters are almost identical to CpG island promoters, suggesting that aberrant methylation patterns of non-CpG island promoters may also contribute to tumorigenesis and should therefore be included in analyses of cancer epigenetics.

  3. Genomic androgen receptor-occupied regions with different functions, defined by histone acetylation, coregulators and transcriptional capacity.

    Directory of Open Access Journals (Sweden)

    Li Jia

    Full Text Available BACKGROUND: The androgen receptor (AR is a steroid-activated transcription factor that binds at specific DNA locations and plays a key role in the etiology of prostate cancer. While numerous studies have identified a clear connection between AR binding and expression of target genes for a limited number of loci, high-throughput elucidation of these sites allows for a deeper understanding of the complexities of this process. METHODOLOGY/PRINCIPAL FINDINGS: We have mapped 189 AR occupied regions (ARORs and 1,388 histone H3 acetylation (AcH3 loci to a 3% continuous stretch of human genomic DNA using chromatin immunoprecipitation (ChIP microarray analysis. Of 62 highly reproducible ARORs, 32 (52% were also marked by AcH3. While the number of ARORs detected in prostate cancer cells exceeded the number of nearby DHT-responsive genes, the AcH3 mark defined a subclass of ARORs much more highly associated with such genes -- 12% of the genes flanking AcH3+ARORs were DHT-responsive, compared to only 1% of genes flanking AcH3-ARORs. Most ARORs contained enhancer activities as detected in luciferase reporter assays. Analysis of the AROR sequences, followed by site-directed ChIP, identified binding sites for AR transcriptional coregulators FoxA1, CEBPbeta, NFI and GATA2, which had diverse effects on endogenous AR target gene expression levels in siRNA knockout experiments. CONCLUSIONS/SIGNIFICANCE: We suggest that only some ARORs function under the given physiological conditions, utilizing diverse mechanisms. This diversity points to differential regulation of gene expression by the same transcription factor related to the chromatin structure.

  4. Review on Viewport Used in Human Occupied Vehicle%载人潜水器观察窗研究综述

    Institute of Scientific and Technical Information of China (English)

    林景高; 张文明; 冯雅丽; 康翌婷

    2013-01-01

    为解决载人潜水器观察窗的变形协调和疲劳寿命预测等技术难题,对观察窗的材料、失效模式、结构形式、安装和密封以及载荷谱进行了详细论述,并综述了国内外的研究现状.国外学者从上世纪中期从事这方面的研究且已取得很大进展,我国随着“蛟龙”号成功研制,也开始进行观察窗的理论和试验研究.丙烯酸塑料蠕变机理,疲劳寿命预测、裂纹扩展研究以及寻找新材料将成为未来主要的研究方向.%In order to solve such technical difficulties in developing human occupied vehicle (HOV) as deformation and fatigue life prediction of viewport,the material,failure mode,structure type,arrangement,sealing,and load spectrum of viewport are described in detail.The research situation on this subject at home and abroad is reviewed Foreign scholars started the research on this subject since the middle period of the past century,and have got great achievements.Domestic researchers also made a few theoretical and experimental researches due to the success in the development of "Jiaolong" HOV.Creep deformation mechanism of acrylicplastic,prediction of fatigue life,crack propagation and new materials to substitute acrylic plastic are main research directions in the future.

  5. SOX2 co-occupies distal enhancer elements with distinct POU factors in ESCs and NPCs to specify cell state.

    Directory of Open Access Journals (Sweden)

    Michael A Lodato

    Full Text Available SOX2 is a master regulator of both pluripotent embryonic stem cells (ESCs and multipotent neural progenitor cells (NPCs; however, we currently lack a detailed understanding of how SOX2 controls these distinct stem cell populations. Here we show by genome-wide analysis that, while SOX2 bound to a distinct set of gene promoters in ESCs and NPCs, the majority of regions coincided with unique distal enhancer elements, important cis-acting regulators of tissue-specific gene expression programs. Notably, SOX2 bound the same consensus DNA motif in both cell types, suggesting that additional factors contribute to target specificity. We found that, similar to its association with OCT4 (Pou5f1 in ESCs, the related POU family member BRN2 (Pou3f2 co-occupied a large set of putative distal enhancers with SOX2 in NPCs. Forced expression of BRN2 in ESCs led to functional recruitment of SOX2 to a subset of NPC-specific targets and to precocious differentiation toward a neural-like state. Further analysis of the bound sequences revealed differences in the distances of SOX and POU peaks in the two cell types and identified motifs for additional transcription factors. Together, these data suggest that SOX2 controls a larger network of genes than previously anticipated through binding of distal enhancers and that transitions in POU partner factors may control tissue-specific transcriptional programs. Our findings have important implications for understanding lineage specification and somatic cell reprogramming, where SOX2, OCT4, and BRN2 have been shown to be key factors.

  6. Potential ‘Ecological Traps’ of Restored Landscapes: Koalas Phascolarctos cinereus Re-Occupy a Rehabilitated Mine Site

    Science.gov (United States)

    Cristescu, Romane H.; Banks, Peter B.; Carrick, Frank N.; Frère, Céline

    2013-01-01

    With progressively increasing anthropogenic habitat disturbances, restoration of impacted landscapes is becoming a critical element of biodiversity conservation. Evaluation of success in restoration ecology rarely includes faunal components, usually only encompassing abiotic and floral components of the ecosystems. Even when fauna is explicitly included, it is usually only species presence/absence criteria that are considered. If restoration is to have a positive outcome, however, populations in restored habitats should exhibit comparable survival and reproductive rates to populations found in undisturbed surroundings. If a species recolonises restored areas but later experiences decreased fitness, restored areas could become ecological sinks or traps. We investigated this possibility in a case study of koalas Phascolarctos cinereus occupying rehabilitated mining areas on North Stradbroke Island, Australia. Our holistic approach compared rehabilitated and undisturbed areas on the basis of their vegetation characteristics, of koalas' body condition, roosting trees, diet, as well as predator index. Koalas using rehabilitated areas appeared to be able to access an adequate supply of roosting and fodder trees, were in good condition and had high reproductive output. We did not find any significant differences in predator density between rehabilitated areas and undisturbed surroundings. The results presented in this study showed there was no evidence that the post-mining rehabilitated areas constitute ecological sinks or traps. However, to reach a definitive conclusion as to whether areas rehabilitated post-mining provide at least equivalent habitat to undisturbed locations, additional research could be undertaken to assess foliar nutrient/water/toxin differences and predation risk in rehabilitated areas compared with undisturbed areas. More generally, the evaluation of whether restoration successfully produces a functional ecological community should include criteria

  7. SOX2 co-occupies distal enhancer elements with distinct POU factors in ESCs and NPCs to specify cell state.

    Directory of Open Access Journals (Sweden)

    Michael A Lodato

    Full Text Available SOX2 is a master regulator of both pluripotent embryonic stem cells (ESCs and multipotent neural progenitor cells (NPCs; however, we currently lack a detailed understanding of how SOX2 controls these distinct stem cell populations. Here we show by genome-wide analysis that, while SOX2 bound to a distinct set of gene promoters in ESCs and NPCs, the majority of regions coincided with unique distal enhancer elements, important cis-acting regulators of tissue-specific gene expression programs. Notably, SOX2 bound the same consensus DNA motif in both cell types, suggesting that additional factors contribute to target specificity. We found that, similar to its association with OCT4 (Pou5f1 in ESCs, the related POU family member BRN2 (Pou3f2 co-occupied a large set of putative distal enhancers with SOX2 in NPCs. Forced expression of BRN2 in ESCs led to functional recruitment of SOX2 to a subset of NPC-specific targets and to precocious differentiation toward a neural-like state. Further analysis of the bound sequences revealed differences in the distances of SOX and POU peaks in the two cell types and identified motifs for additional transcription factors. Together, these data suggest that SOX2 controls a larger network of genes than previously anticipated through binding of distal enhancers and that transitions in POU partner factors may control tissue-specific transcriptional programs. Our findings have important implications for understanding lineage specification and somatic cell reprogramming, where SOX2, OCT4, and BRN2 have been shown to be key factors.

  8. Intermittent exotropia: Surgical treatment strategies

    Directory of Open Access Journals (Sweden)

    Jai Aditya Kelkar

    2015-01-01

    Full Text Available Surgical management of intermittent exotropias (IXTs is ambiguous, with techniques of management varying widely between institutions. This review aims to examine available literature on the surgical management of IXT. A literature search was performed using PubMed, Web of Knowledge, LILACS, and the University of Liverpool Orthoptic Journals and Conference Transactions Database. All English-language papers published between 1958 and the present day were considered.

  9. Aesthetic Surgical Crown Lengthening Procedure.

    Science.gov (United States)

    de Oliveira, Pablo Santos; Chiarelli, Fabio; Rodrigues, José A; Shibli, Jamil A; Zizzari, Vincenzo Luca; Piattelli, Adriano; Iezzi, Giovanna; Perrotti, Vittoria

    2015-01-01

    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most habitual surgical periodontal treatment.

  10. Aesthetic Surgical Crown Lengthening Procedure

    Science.gov (United States)

    de Oliveira, Pablo Santos; Chiarelli, Fabio; Rodrigues, José A.; Shibli, Jamil A.; Zizzari, Vincenzo Luca; Piattelli, Adriano; Iezzi, Giovanna; Perrotti, Vittoria

    2015-01-01

    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most habitual surgical periodontal treatment. PMID:26609452

  11. Aesthetic Surgical Crown Lengthening Procedure

    Directory of Open Access Journals (Sweden)

    Pablo Santos de Oliveira

    2015-01-01

    Full Text Available The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey, crown lengthening is the most habitual surgical periodontal treatment.

  12. Surgical Treatment of Facial Paralysis

    OpenAIRE

    Mehta, Ritvik P.

    2009-01-01

    The management of facial paralysis is one of the most complex areas of reconstructive surgery. Given the wide variety of functional and cosmetic deficits in the facial paralysis patient, the reconstructive surgeon requires a thorough understanding of the surgical techniques available to treat this condition. This review article will focus on surgical management of facial paralysis and the treatment options available for acute facial paralysis (2 yr). For acute facial paralysis, the main surgi...

  13. Innovation in pediatric surgical education.

    Science.gov (United States)

    Clifton, Matthew S; Wulkan, Mark L

    2015-06-01

    Pediatric surgical training in the United States remained basically unchanged from the model developed by Ladd and Gross in the 1930s until recently. Standardized curriculum and novel evaluation methods are now being implemented. Pediatric Surgical education is currently undergoing a transition to competency-based evaluation and promotion. Unfortunately, there is little data on the efficacy of these changes. This presents an opportunity for further study of how we conduct training, and how we evaluate and promote our trainees.

  14. Evolution of surgical skills training

    Institute of Scientific and Technical Information of China (English)

    Kurt E Roberts; Robert L Bell; Andrew J Duffy

    2006-01-01

    Surgical training is changing: one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients.Simulation training can be as straight forward as using real instruments and video equipment to manipulate simulated "tissue" in a box trainer. More advanced,virtual reality simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations.The Accreditation Council of Graduate Medical Education's (ACGME) has mandated the development of novel methods of training and evaluation. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and to credential surgeons as technically competent.Simulators in their current form have been demonstrated to improve the operating room performance of surgical residents. Development of standardized training curricula remains an urgent and important agenda, particularly for minimal invasive surgery.An innovative and progressive approach, borrowing experiences from the field of aviation, can provide the foundation for the next century of surgical training,ensuring the quality of the product. As the technology develops, the way we practice will continue to evolve, to the benefit of physicians and patients.

  15. An Unusual Presentation of Neurocysticercosis: A Space-Occupying Lesion in the Fourth Ventricle Associated with Progressive Cognitive Decline.

    Science.gov (United States)

    Kurz, Carolin; Schmidt, Veronika; Poppert, Holger; Wilkins, Patricia; Noh, John; Poppert, Sven; Schlegel, Jürgen; Delbridge, Claire; da Costa, Clarissa Prazeres; Winkler, Andrea S

    2016-01-01

    We communicate a case of a middle-aged Brazilian patient with an unusual presentation of fourth ventricular neurocysticercosis: occurrence of two intraventricular cysts at different locations in the brain within 2 years and cognitive decline as the only neurological symptom. Neurocysticercosis was confirmed by magnetic resonance imaging, serology, histology, and genetic analysis. Neurocysticercosis should be considered as a differential diagnosis in cases with atypical neurologic or psychiatric symptoms, atypical neuroimaging and travel history. Especially, fourth ventricular cysts carry the risk of obstructive hydrocephalus and brainstem compression and therefore should be extirpated completely. If complete removal of the cystic structures cannot be proven in cases with surgically treated neurocysticercosis, anthelminthic therapy and thorough follow-up examinations should be conducted.

  16. Bacterial migration through punctured surgical gloves under real surgical conditions

    Directory of Open Access Journals (Sweden)

    Heidecke Claus-Dieter

    2010-07-01

    Full Text Available Abstract Background The aim of this study was to confirm recent results from a previous study focussing on the development of a method to measure the bacterial translocation through puncture holes in surgical gloves under real surgical conditions. Methods An established method was applied to detect bacterial migration from the operating site through the punctured glove. Biogel™ double-gloving surgical gloves were used during visceral surgeries over a 6-month period. A modified Gaschen-bag method was used to retrieve organisms from the inner glove, and thus-obtained bacteria were compared with micro-organisms detected by an intra-operative swab. Results In 20 consecutive procedures, 194 gloves (98 outer gloves, 96 inner gloves were examined. The rate of micro-perforations of the outer surgical glove was 10% with a median wearing time of 100 minutes (range: 20-175 minutes. Perforations occurred in 81% on the non-dominant hand, with the index finger most frequently (25% punctured. In six cases, bacterial migration could be demonstrated microbiologically. In 5% (5/98 of outer gloves and in 1% (1/96 of the inner gloves, bacterial migration through micro-perforations was observed. For gloves with detected micro-perforations (n = 10 outer layers, the calculated migration was 50% (n = 5. The minimum wearing time was 62 minutes, with a calculated median wearing time of 71 minutes. Conclusions This study confirms previous results that bacterial migration through unnoticed micro-perforations in surgical gloves does occur under real practical surgical conditions. Undetected perforation of surgical gloves occurs frequently. Bacterial migration from the patient through micro-perforations on the hand of surgeons was confirmed, limiting the protective barrier function of gloves if worn over longer periods.

  17. Technical Basis for the Use of Alarming Personal Criticality Detectors to Augment Permanent Nuclear Incident Monitor (NIM) Systems in Areas Not Normally Occupied

    CERN Document Server

    Yates, K R

    2003-01-01

    The technical basis for the use of alarming personal criticality detectors (APCDs) to augment permanent Nuclear Incident Monitor (NIM) Systems in areas not normally occupied is evaluated. All applicable DOE O 420.1A and ANSI/ANS-8.3-1997 criticality alarm system requirements and recommendations are evaluated for applicability to APCDs. Based on this evaluation, design criteria and administrative requirements are presented for APCDs. Siemens EPD/Mk-2 and EPD-N devices are shown to meet the design criteria. A definition of not normally occupied is also presented.

  18. Aplicação da Liderança Situacional na enfermagem de centro cirúrgico Aplicación del Liderazgo Situacional en la enfermería de centro quirúrgico Use of the Situational Leadership in surgical center nursing

    Directory of Open Access Journals (Sweden)

    Marcos Antonio da Silva

    2007-03-01

    , sugiriendo que los liderados investigados presentaban nivel de madurez alto (M4.This study was aimed at identifying the correspondence of opinions between nurses in surgical centers and the nursing team regarding the leadership style exercised by nurses and the leadership style these professionals should adopt in relation to the maturity level of their subordinates. Situational Leadership was adopted as a theoretical reference frame-work. We elaborated instruments that were submitted to appearance and content validation and then applied them to 15 nurses, two technicians and 13 nursing auxiliaries. The results showed that the most frequent leadership style among nurses was E3 (to share. With respect to the leadership style nurses should adopt in relation to the maturity level of their subordinates in view of the activities in the operating room, style E4 (to delegate predominated, which suggests that the studied subordinates present a high maturity level (M4.

  19. [The Marburg surgical curriculum - improving the attraction of medical education by teaching central surgical competence].

    Science.gov (United States)

    Schwarting, T; Ruchholtz, S; Josephs, D; Oberkircher, L; Bartsch, D K; Fendrich, V

    2012-04-01

    The quality of medical education is an ongoing challenge due to the continuing changes of the health-care politics and general social conditions. At many German university hospitals the dominating picture is overfilled courses, lack of hands-on practice, reduced patient contact and the dull provision of theoretical, abstract knowledge. The reformed surgical curriculum at the University of Marburg university hospital is used to demonstrate that, in spite of large student numbers, a practice-oriented, small-group training at a high didactic level is possible. The surgical training courses are organized in detail and coordinated. Course contents and structure are media available in print and online versions for both students and teachers and thus fulfill not only transparency needs but also contemporary requirements. The strategy of a practice- and patient-oriented, small-group training is followed strictly in the surgical curriculum. In addition, accompanying tutorial possibilities for individual study in an up-to-date learning center are offered. Here the students have the opportunity to intensify knowledge acquired in previous or future courses with numerous attractive education means. Continuous evaluation of the individual training courses at the end of each semester not only document motivation of the students but also serve to continuously improve the training concepts. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Open Cholecystectomy for Surgical Treatment of Gallstones

    Directory of Open Access Journals (Sweden)

    Jorge Luis Estepa Pérez

    2015-02-01

    Full Text Available Background: cholecystectomy is one of the surgical procedures that are still practiced despite the passing of time. It remains the appropriate method to perform in the absence of advanced technology. Objective: to describe the results of the open cholecystectomy in the treatment of gallstones. Methods: a descriptive study was conducted in patients operated on for gallstones in 2012 in the María G. Guerrero Ramos Comprehensive Diagnostic Center in the Capital District, Bolivarian Republic of Venezuela. The information was obtained from medical records and a data collection model. The variables analyzed were: age, sex, associated diseases, signs and symptoms, results of the surgical treatment, outcome and complications. Results: a total of 147 patients underwent surgery; the 41-60 year age group and female patients predominated; right hypochondrial pain and intolerance to fatty foods and grains were the major signs and symptoms. Cefazolin was the most widely used antibiotic. Patients recovered satisfactorily, complications were minimal. Conclusions: open cholecystectomy remains useful for the treatment of gallstones in the absence of advanced technology.

  1. Independent Navigation System for a Surgical Colonoscope

    Directory of Open Access Journals (Sweden)

    Lilia A. Ochoa-Luna

    2013-08-01

    Full Text Available This paper provides a novel algorithm to attain the independent navigation of a colonoscopy surgical endoscope. First, it introduces a brief description of this issue through the scientist advance for medical robotics. It then makes a quickly count of the existent methods and at the end it provides the basis in order to propose a new alternative solution with help from vision-guidance. That means that images will be processed and interpreted with the purpose of maintaining the endoscope always at the intestine center. All this considered will help us to reduce colonoscopy surgeries consequences and the most important advantage of this new method proposed is that surgeons will accomplish their work easier and more efficiently.

  2. Radicality of surgical treatment for cervical cancer.

    Science.gov (United States)

    Mirković, L; Petković, S; Mirković, D; Jeremić, K; Milenković, V; Maksimović, M

    2009-01-01

    Analyses were carried out on 545 Wertheim-Meigs radical hysterectomies performed at the Institute of Gynecology and Obstetrics of the Clinical Center of Serbia during a four-year period from 2002 to 2006. More than ten lymphatic glands in 84.4% of patients were removed. The apical part of the vagina was removed in 77.8% of cases, and 77.6% of patients had the right part of the vagina removed. Distribution of surgical radicality according to FIGO stage of disease has been demonstrated. Comparison of research results in the period from 1996 to 2000 shows a significantly more radical approach concerning the number of lymphatic glands removed during this period.

  3. SURGICAL TACTICS REGARDING CEREBRAL METASTASES WITH HEMORRHAGES

    Directory of Open Access Journals (Sweden)

    E. V. Prozorenko

    2015-01-01

    Full Text Available Cerebral metastases occur with 10 to 30 % of all oncological patients. Hemorrhages into cerebral metastases are one of the most dangerous complications of the metastatic process. With that, cerebral metastases of such widespread solid malignant tumors as melanoma, kidney cancer, germ cell tumors, less frequently, lung cancer and breast cancer are prone to hemorrhages. The purpose of the work is to improve the results of surgical treatment of patients with brain metastases complicated with hemorrhages.Materials  and  methods. Surgical  treatment  of  69  patients  with  brain  metastases complicated  with  hemorrhages was  performed in N.N. Blokhin Russian Cancer Research Center. Hemorrhage on the macroscopic level was confirmed intraoperatively and in accordance with the results of the morphological study of surgical drugs. Total microsurgical resection of one or several cerebral metastases with hemor rhages was performed regarding all patients studied. The time interval of observation of patients after the surgical treatment comprises 1 to 72 months. There were 27 women and 42 men. The age range was from 18 to 74 y.o. Besides, the state of veins of lower extremities and the state of the coagulation blood system in accordance with the data of coagulograms was studies. The analysis of the macrostructure and the microstructure of metastases with hemorrhages as well as the morphological study of the brain tissue adjacent to hematomas was performed with a morphological study and histological techniques. The patients were distributed in accordance with the RPA (recursive partitioning analysis classes: I class (n = 7, II class (n = 39, III class (n = 23; in accordance with the hemorrhage type: intratumoral type (26 metastases, perifocal type (20, mixed type (32; in accordance with the histological principle: melanoma (n = 25, lung cancer (n = 13, kidney cancer (n = 17, breast cancer (n = 4, colorectal cancer (n = 1, soft tissue sarcoma (n

  4. Surgical versus non-surgical treatment of congenital hyperinsulinism.

    Science.gov (United States)

    Mazor-Aronovitch, Kineret; Landau, Heddy; Gillis, David

    2009-03-01

    Congenital hyperinsulinism is a functional disorder of insulin secretion. In its diffuse severe form, it is traditionally treated with over 95% pancreatectomy. However, even after this procedure normoglycemia is not always achieved. Non-surgical therapy with frequent or continuous feeding, medication and close monitoring is another alternative. In this review we compare the two approaches to this condition focusing on early complications, diabetes, neurological outcome and home management issues. Early complications of pancreatectomy include mechanical, metabolic and infectious complications. Non-surgical interventions can be complicated by unwarranted effects of medications and of invasive procedures. Diabetes occurs with both approaches but much less frequently and years later with non-surgical treatment. Regarding neurodevelopmental outcome, most data come from heterogeneous groups. Nevertheless, it appears that outcome is not adversely affected by avoiding surgery. Home management is far more difficult for the non-surgical form. When the non-surgical approach is successful in achieving normoglycemia and parents are highly motivated, this mode of therapy should be considered.

  5. Behavioural responses of females of two anopheline mosquito species to human-occupied, insecticide-treated and untreated bed nets

    Science.gov (United States)

    2014-01-01

    Background Insecticide-treated bed nets (ITNs), used extensively to reduce human exposure to malaria, work through physical and chemical means to block or deter host-seeking mosquitoes. Despite the importance of ITNs, very little is known about how host-seeking mosquitoes behave around occupied bed nets. As a result, evidence-based evaluations of the effects of physical damage on bed net effectiveness are not possible and there is a dearth of knowledge on which to base ITN design. Methods The dispersion of colony-raised female Anopheles gambiae and Anopheles albimanus was observed in 2-hr laboratory experiments in which up to 200 mosquitoes were released inside a mosquito-proof 3 m × 3 m tent housing a bed net arrayed with 18 30 cm × 30 cm sticky screen squares on the sides, ends and roof. Numbers of mosquitoes caught on the sticky squares were interpreted as the ‘mosquito pressure’ on that part of the net. Results Presence of a human subject in the bed net significantly increased total mosquito pressure on the net for both species and significantly re-oriented An. gambiae to the roof of the net. Anopheles albimanus pressure was greatest on the bed net roof in both host-present and no-host conditions. The effects of different human subjects in the bed net, of different ambient conditions (dry, cool conditions vs warm, humid conditions) and of bed net treatment (deltamethrin-treated or no insecticide) on mosquito pressure patterns were tested for both species. Species-specific pressure patterns did not vary greatly as a result of any of these factors though some differences were noted that may be due the size of the different human subjects. Conclusions As a result of the interaction between host-seeking responses and the convective plume from the net occupant, species-specific mosquito pressure patterns manifest more or less predictably on the bed net. This has implications for bed net design and suggests that current methods of assessing damaged

  6. Role of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis of space occupying lesions of the pancreas

    Directory of Open Access Journals (Sweden)

    S Palaniappan

    2014-01-01

    Full Text Available Introduction: Space occupying lesions (SOLs of the pancreas are commonly encountered in day to day practice either as an incidental finding or during evaluation of symptomatic patients. The aim of the present study was to compare the final diagnosis at follow-up with diagnosis made at computed tomography (CT/magnetic resonance imaging (MRI and endoscopic ultrasound (EUS. Materials and Methods: Retrospective analysis of EUS data of 131 patients referred for tissue diagnosis of SOL in pancreas was done. The lesions were classified as malignant, benign, and nonneoplastic by both CT/MRI and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA in conjunction with clinical presentation, biochemical parameters, and tumor markers. Follow-up cases with a final diagnosis alone were included for the comparative analysis. Statistical Analysis: Chi-square test, sensitivity, specificity, positive predictive value (PPV, and negative predictive values (NPV for CT/MRI and EUS-FNA were computed against the follow-up data. Results: Of the 131, there were 78 males (59.5%. The median age of presentation was 48 years (range: 11-82 years. Follow-up information on the final diagnosis was available for 54 patients. Confirmed diagnosis at follow-up was malignant lesion in 18, benign in 13 and 23 with a nonneoplastic lesion. When EUS-FNA outcome was compared with the definitive diagnosis of the 54 patients, it had a higher sensitivity for malignant (66.7% vs. 61.1% and nonneoplastic lesions (78.3% vs. 73.9% and was similar to CT/MRI for benign lesions (76.9% for both. EUS-FNA had a higher specificity (87.8% vs. 80.5% with a good PPV for benign lesions (66.7% vs. 55.6%. CT/MRI was less accurate than EUS-FNA in predicting benign (79.6% vs. 85.2% and nonneoplastic lesions (79.6% vs. 81.5% compared to malignant lesions wherein it was similar at 81.5%. The high NPV with a lower PPV for both EUS/FNA and CT/MRI suggests that follow-up definitive diagnosis was superior to

  7. Play in the Sandpit: A University and a Child-Care Center Collaborate in Facilitated-Action Research

    Science.gov (United States)

    Jarrett, Olga; French-Lee, Stacey; Bulunuz, Nermin; Bulunuz, Mizrap

    2010-01-01

    Sand play commonly occupies children at preschools, child-development centers, and school and park playgrounds. The authors review the research on sand play and present a small study on outdoor sand play conducted at a university-based, child-development center using a method they call "facilitated-action research." This study had four…

  8. "Bat Wing Surgical Approach for the Temporomandibular Joint".

    Science.gov (United States)

    Garcia Y Sanchez, J M; Davila Torres, J; Pacheco Rubio, G; Gómez Rodríguez, C L

    2015-09-01

    The temporomandibular joint (TMJ) is anatomically complex; with its close proximity to neurovascular structures, including the facial nerve that gives a high degree of difficulty during surgical exposure. When the first description on TMJ surgery by Orlow in 1913 was published it gave an account describing the basic retroauricular, preauricular, endoaural and submandibular approaches, on treatment of articular pathologies as used today. The proposed study of the 'Bat Wing' approach, first described in 1993 by Garcia y Sanchez J.M. as a surgical alternative, offers great advantages is that it avoids the section of the ear canal and provides a wide surgical field. The management of the proposed technique has wide application with multiple joints addressed, achieving major objectives such as avoiding facial nerve damage, as well as avoiding the section of the external auditory canal with an optimum visibility of the operative field. The Department of Maxillofacial Surgery National Medical Center XXI Century records over a period of approximately 18 months have completed twenty TMJ surgeries using the 'Bat Wing', approach. The bat wing approach is a surgical alternative that offers broad exposure of the surgical field in TMJ, it is effective and meets the goal of exposing the area to intervene safely, good visibility and access to the site to intervene. It perfectly fulfills the above described.

  9. IBMISPS (International Brain Mapping & Intraoperative Surgical Planning Symposium)

    Science.gov (United States)

    2005-12-01

    zona incerta, zi and STN subparts): mean value of current leading a benefit 13 5. Conclusions Beyond the surgical spin-offs, in terms of time...associated wet -lab (UCI Chao Cancer Center) is performing a set of experiments to obtain a consistent set of parameters that should yield more...derived from the literature. Our model predictions accord with experiments on histocultures found in the literature. Our associated wet -lab is

  10. IMPACT OF HEATING AND AIR CONDITIONING SYSTEM OPERATION AND LEAKAGE ON VENTILATION AND INTERCOMPARTMENT TRANSPORT: STUDIES IN UNOCCUPIED AND OCCUPIED TENNESSEE VALLEY HOMES

    Science.gov (United States)

    Forced-air heating and air conditioning (HAC) systems caused an average and maximum increase in air infiltration rates of 1.8- and 4.3-fold, respectively, during brief whole-house studies of tracer gas decay In 39 occupied houses. An average Increase in air infiltration rate of 0...

  11. Work-Based Learning Programmes for Young People in the Mediterranean Region: Algeria, Egypt, Israel, Jordan, Lebanon, Morocco, the Occupied Palestinian Territory, Syria, Tunisia and Turkey. Comparative Analyses

    Science.gov (United States)

    Sweet, Richard

    2009-01-01

    This report examines programmes for youth that combine learning in classrooms with participation in work in 10 Mediterranean countries: Algeria, Egypt, Israel, Jordan, Lebanon, Morocco, the Occupied Palestinian Territory, Syria, Tunisia and Turkey. It is one element, together with the development of a network of policymakers and experts from the…

  12. Work-Based Learning Programmes for Young People in the Mediterranean Region: Algeria, Egypt, Israel, Jordan, Lebanon, Morocco, the Occupied Palestinian Territory, Syria, Tunisia and Turkey. Comparative Analyses

    Science.gov (United States)

    Sweet, Richard

    2009-01-01

    This report examines programmes for youth that combine learning in classrooms with participation in work in 10 Mediterranean countries: Algeria, Egypt, Israel, Jordan, Lebanon, Morocco, the Occupied Palestinian Territory, Syria, Tunisia and Turkey. It is one element, together with the development of a network of policymakers and experts from the…

  13. Film Distribution in Occupied Belgium (1940–1944): German Film Politics and its Implementation by the ‘Corporate’ Organisations and the Film Guild

    NARCIS (Netherlands)

    Vande Winkel, Roel

    2017-01-01

    textabstractThe military successes achieved by the Wehrmacht in the first years of World War II, provided Nazi Germany with the opportunity to realise a long-dormant ambition of cultural hegemony. This article, focusing on film distribution in German-occupied Belgium (1940–1944), investigates the

  14. Using dummies for surgical skills training

    DEFF Research Database (Denmark)

    Langebæk, Rikke

    2011-01-01

    teaching methods for veterinary surgical training. At the Department of Small Animal Clinical Sciences, Faculty of Life Sciences, a number of low fidelity, stuffed toy animal dummies was developed for the Surgical Skills Lab in order to teach 4th year students the basic surgical skills. In the Surgical...... this a relatively low budget solution with a big ethical benefit....

  15. 21 CFR 878.4040 - Surgical apparel.

    Science.gov (United States)

    2010-04-01

    ... known as scrub suits, are excluded. (b) Classification. (1) Class II (special controls) for surgical... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Surgical apparel. 878.4040 Section 878.4040 Food... DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4040 Surgical apparel....

  16. [Current trends in medical and surgical treatment of epilepsy].

    Science.gov (United States)

    Ambrosetto, C; Ambrosetto, P

    1979-01-01

    The AA., after a critical review of the literature, discuss the actual problems related to the various forms of the epilepsie susceptible of an appropriate surgical treatment. The AA. consider that the modern S.E.E.G. techniques, such as the formed in the highly specialized center of Bancaud and Talairach, open new perspectives particularly for the cases resistant to medical treatment and without evidence of focalisation. The AA. discuss the criteria, justifying such limitations and auspicate the institution of a much limited number of such centers, also in Italy.

  17. Mississippi Technology Transfer Center

    Science.gov (United States)

    1987-01-01

    The Mississippi Technology Transfer Center at the John C. Stennis Space Center in Hancock County, Miss., was officially dedicated in 1987. The center is home to several state agencies as well as the Center For Higher Learning.

  18. Surgical treatment for male prolactinoma

    Science.gov (United States)

    Song, Yi-Jun; Chen, Mei-Ting; Lian, Wei; Xing, Bing; Yao, Yong; Feng, Ming; Wang, Ren-Zhi

    2017-01-01

    Abstract A total of 184 cases of surgically treated male prolactinoma were analyzed retrospectively to summarize the outcome of this surgical intervention. We analyzed the general characteristics, clinical manifestations, hormone levels, imaging features, preoperative treatments, surgical outcomes, pathology results, and follow-up records for all included patients. The most common clinical manifestations included sexual dysfunction (47.4%), headache (55.9%), and visual disturbance (46.7%). Serum prolactin levels ranged from 150 to 204,952 ng/mL. Tumor size varied from 6 to 70 mm. Pituitary adenomas grew in a parasellar pattern with visual deficits occurring 40.7% of the time. After surgical therapy, 88.6% of patients achieved symptom relief, and 98.4% experienced an immediate postoperative decline in prolactin level. Fifty-seven patients (31.0%) achieved initial remission, and 26 patients (45.6%) experienced recurrence. Hence, our results suggest that in male prolactinoma characterized by a large pituitary diameter and high serum prolactin level, tumor size predicts the degree of gross resection. The prognostic predictors included preoperative tumor growth pattern and Ki-67 index. Citation: Yi-jun S, Mei-ting C, Wei L, Bing X, Yong Y, Ming F, Ren-zhi W. (2016) Surgical treatment for male prolactinoma: a retrospective study of 184 cases PMID:28079813

  19. Can we measure surgical resilience?

    Science.gov (United States)

    Graham, David; Becerril-Martinez, Guillermo; Quinto, Lena; Zhao, Dong Fang

    2016-01-01

    Surgical resilience describes psychological resilience within a surgical setting. Within a surgical setting, psychologically resilient patients have improved recovery and wound-healing. The search for biological correlates in resilient patients has led to the hypothesis that certain endogenous biomarkers (namely neuropeptide Y (NPY), testosterone, and dehydroepiandrosterone (DHEA)) are altered in resilient patients. The concept of surgical resilience raises the question of whether enhanced recovery following surgery can be demonstrated in patients with high titres of resilience biomarkers as compared to patients with low titres of resilience biomarkers. To determine the prognostic value of resilience biomarkers in surgical recovery, a cohort of patients undergoing major surgery should initially be psychometrically tested for their resilience levels before and after surgery so that biomarker levels of NPY, testosterone and DHEA can be compared to a validated psychometric test of resilience. The primary outcome would be length of hospital stay with and without an enhanced recovery program. Secondary outcome measures such as complications, time in rehabilitation and readmission could also be included. If the hypothesis is upheld, resilience biomarkers could be used to support more individualised perioperative management and lead to more efficient and effective allocation of healthcare resources.

  20. Surgical Robotics Research in Cardiovascular Disease

    Energy Technology Data Exchange (ETDEWEB)

    Pohost, Gerald M; Guthrie, Barton L; Steiner, Charles

    2008-02-29

    This grant is to support a research in robotics at three major medical centers: the University of Southern California-USC- (Project 1); the University of Alabama at Birmingham-UAB-(Project 2); and the Cleveland Clinic Foundation-CCF-(Project 3). Project 1 is oriented toward cardiovascular applications, while projects 2 and 3 are oriented toward neurosurgical applications. The main objective of Project 1 is to develop an approach to assist patients in maintaining a constant level of stress while undergoing magnetic resonance imaging or spectroscopy. The specific project is to use handgrip to detect the changes in high energy phosphate metabolism between rest and stress. The high energy phosphates, ATP and phosphocreatine (PCr) are responsible for the energy of the heart muscle (myocardium) responsible for its contractile function. If the blood supply to the myocardium in insufficient to support metabolism and contractility during stress, the high energy phosphates, particularly PCr, will decrease in concentration. The high energy phosphates can be tracked using phosphorus-31 magnetic resonance spectroscopy ({sup 31}P MRS). In Project 2 the UAB Surgical Robotics project focuses on the use of virtual presence to assist with remote surgery and surgical training. The goal of this proposal was to assemble a pilot system for proof of concept. The pilot project was completed successfully and was judged to demonstrate that the concept of remote surgical assistance as applied to surgery and surgical training was feasible and warranted further development. The main objective of Project 3 is to develop a system to allow for the tele-robotic delivery of instrumentation during a functional neurosurgical procedure (Figure 3). Instrumentation such as micro-electrical recording probes or deep brain stimulation leads. Current methods for the delivery of these instruments involve the integration of linear actuators to stereotactic navigation systems. The control of these delivery

  1. Mike O’Callaghan Federal Medical Center Campus Environmental Assessment

    Science.gov (United States)

    2012-03-01

    Center Campus Final EA Departments to the basement, outpatient clinics and medical center diagnostics to the first floor, surgical services to the...Center Campus Final EA 3.8.1 Vegetation The Integrated Natural Resource Management Plan (INRMP) describes the desert scrub creosote bush/white bursage...domestic geese and ducks. The areas with the most diverse wildlife are those containing native desert scrub vegetation, mostly located in clear

  2. Diagnostic value of fiberoptic ductoscopy for bilateral multiple ductal nipple discharge with intraductal space occupying lesions%乳管镜对双乳多孔溢液乳管内占位的诊断与价值

    Institute of Scientific and Technical Information of China (English)

    郭丽英; 马方婧; 迪丽米娜·伊拉木

    2011-01-01

    Objective To investigate the diagnostic value of fiberoptic ductoscopy ( FDS ) for cases of bilateral multiple ductal nipple discharge with intraductal space occupying lesions. Methods The clinical data of 135 cases of bilateral multiple ductal nipple discharge with intraductal space occupying lesions treated in our center, from June 2004 to May 2009, were analyzed retrospectively. Results The coincidence rate between FDS and pathological diagnosis was 75. 0% for bilateral intraductal papilloma and 78.2% for unilateral intraductal papilloma. The total coincidence rate between FDS and pathological diagnosis was 82.2%. In cases of bilateral intraductal papilloma, the yellow nipple discharge was significantly more frequent than other qualities of discharges (x2 = 23. 5675, P < 0.05 ). Conclusions FDS diagnosis for intraductal space occupying lesions has high consistency with the postoperative pathological diagnosis, and it can be used as the first choice for nipple discharge diagnosis. Special attention shoud be paid to the yellow nipple discharge, which accounts for a larger proportion of bilateral multiple ductal nipple discharge due to bilateral intraductal papilloma.%目的 探讨纤维乳管内视镜(乳管镜)对双乳多孔溢液乳管内占位的诊断的价值.方法 回顾性分析2004年6月-2009年5月诊治的双乳多孔溢液乳管内占位性病变135例患者的临床资料.结果 乳管镜诊断双乳乳管内乳头状瘤与病理符合率为75.0%,单乳乳管内乳头状瘤与病理符合率为78.2%,病理总符合率为82.2%,对于双乳乳管内乳头状瘤,黄色溢液较其他性质溢液明显为多(X=23.5675,P<0.05).结论 乳管镜对乳管内占位诊断符合率高,在乳头溢液的诊断上可作为首选检查方法,双乳多孔溢液中黄色溢液的双乳乳管内乳头状瘤所占比例较大,应予重视.

  3. Comparing ‘remifentanil-propofol’ and ‘fentanyl-propofol’ in patients undergoing craniotomy for supratentorial space-occupying lesions

    Directory of Open Access Journals (Sweden)

    S Yousef Zadeghan

    2012-12-01

    Full Text Available Background: Control of intracranial pressure (ICP before, during and after neurosurgical operations is crucially important. Therefore, trying different methods and drug combinations to attain this goal is an ongoing effort in anesthesiology. In this study we compared two combinations of a narcotic agent with propofol in neurosurgical operations to control intracranial pressure.Methods: In this prospective randomized double-blind clinical trial, we enrolled 34 patients with supratentorial brain tumors who were candidates for craniotomy in Alzahra Hospital in Isfahan, Iran from April 2008 to April 2009. The patients were randomly divided into two groups of 17, in whom the first and the second group, respectively, received a combination of "propofol and fentanyl" and a combination of "propofol and remifentanyl" as maintenance of anesthesia. The hemodynamic status, ICP during the surgery, and post-surgical complications in recovery unit were observed for and registered in a questionnaire.Results: Hemodynamic status was similar in both groups and they did not differ in recovery complications except for pain which was more prevalent in remifentanil group (P<0.03. Although the patients in fentanyl group better responded to the drug for lowering ICP than remifentanyl group, but the difference was not statistically significant.Conclusion: There is no difference between these two anesthetic agent combinations and both could be useful in the anesthesia of neurosurgical operations. However combination of propofol and fentanyl seem to be superior because of more pain relief and a smoother recovery period.  

  4. Foreword – Upon the Second Anniversary of Occupy Campaign / Umbrella Movement in Hong Kong: Essays in Honour of a Pro-Democracy Sociopolitical Movement

    Directory of Open Access Journals (Sweden)

    Emile Kok-Kheng Yeoh

    2016-08-01

    Full Text Available 28th September 2016 is the second anniversary of the Occupy Campaign / Umbrella Movement in Hong Kong. It is also the last anniversary of the said sociopolitical event, which arguably represented a most important milestone in Hong Kong’s post-1997 development, before 1st July 2017 that will mark the 20th anniversary of the “Handover”. It was on 28th September two years ago that pro-democracy protestors occupy the Admiralty, Causeway Bay, Mong Kok and Tsim Sha Tsui areas of Hong Kong in a momentous campaign initially planned out earlier by the “Occupy Central with Love and Peace” (OCLP movement, but launched earlier than scheduled when overtaken by the development of events, metamorphosed into unprecedented scale of demonstrations at multiple locations and was transformed into what was dubbed by the world media as the “Umbrella Movement” when umbrellas, which protestors were using to protect themselves when the police attacked them with tear gas and pepper spray, became a symbol of the occupation campaign. To commemorate this second anniversary of this Occupy Campaign a.k.a. Umbrella Movement, the present issue of Contemporary Chinese Political Economy and Strategic Relations: An International Journal entitled From Handover to Occupy Campaign: Democracy, Identity and the Umbrella Movement of Hong Kong represents a collection of specially selected articles focusing on this momentous event, its background of determining factors, theoretical and ideological underpinnings, as well as its implications for the future of the Hong Kong people’s valiant struggle for democracy against the backdrop of the formidable odds, since the 1997 “Handover”, as being under the sovereignty of a gigantic country with a entrenched ruling Chinese Communist Party (CCP6 regime that has no foreseeable intention of allowing for a transition from the present repressive one-party dictatorship to liberal democracy that would respect political freedom and

  5. Surgical strategy for cervical myelopathy due to ossification of the posterior longitudinal ligament: Part 1: Clinical results and limitations of laminoplasty.

    Science.gov (United States)

    Iwasaki, Motoki; Okuda, Shin'ya; Miyauchi, Akira; Sakaura, Hironobu; Mukai, Yoshihiro; Yonenobu, Kazuo; Yoshikawa, Hideki

    2007-03-15

    Retrospective study of 66 patients who underwent laminoplasty for treatment of cervical myelopathy due to ossification of the posterior longitudinal ligament (OPLL). The present study describes surgical results of laminoplasty for treatment of cervical myelopathy due to OPLL and aims to clarify 1) factors predicting outcome and 2) limitations of laminoplasty. During the period 1986 and 1996, laminoplasty was the only surgical treatment selected for cervical myelopathy at our institutions. We reviewed data obtained in 66 patients who underwent laminoplasty for treatment of cervical myelopathy due to OPLL. Mean duration of follow-up was 10.2 years (range, 5-20 years). Surgical outcomes were assessed using the Japanese Orthopaedic Association (JOA) scoring system for cervical myelopathy. Surgical outcome was significantly poorer in patients with occupying ratio greater than 60%. Multiple regression analysis showed that the most significant predictor of poor outcome after laminoplasty was hill-shaped ossification, followed by lower preoperative JOA score, postoperative change in cervical alignment, and older age at surgery. Laminoplasty is effective and safe for most patients with occupying ratio of OPLL less than 60% and plateau-shaped ossification. However, neurologic outcome of laminoplasty for cervical OPLL was poor or fair in patients with occupying ratio greater than 60% and/or hill-shaped ossification.

  6. Surgical treatment of facial paralysis.

    Science.gov (United States)

    Mehta, Ritvik P

    2009-03-01

    The management of facial paralysis is one of the most complex areas of reconstructive surgery. Given the wide variety of functional and cosmetic deficits in the facial paralysis patient, the reconstructive surgeon requires a thorough understanding of the surgical techniques available to treat this condition. This review article will focus on surgical management of facial paralysis and the treatment options available for acute facial paralysis (facial paralysis (3 weeks to 2 yr) and chronic facial paralysis (>2 yr). For acute facial paralysis, the main surgical therapies are facial nerve decompression and facial nerve repair. For facial paralysis of intermediate duration, nerve transfer procedures are appropriate. For chronic facial paralysis, treatment typically requires regional or free muscle transfer. Static techniques of facial reanimation can be used for acute, intermediate, or chronic facial paralysis as these techniques are often important adjuncts to the overall management strategy.

  7. MALNUTRITION IN THE SURGICAL PATIENTS

    Directory of Open Access Journals (Sweden)

    Andonovska Biljana J.

    2016-12-01

    Full Text Available The term 'malnutrition' is a broad term used to describe any imbalance in the diet. In 2009 it was confirmed that malnutrition is an urgent health problem. The reasons for which malnutrition may develop are different. Loss on cellular, physical and physiological level happens as a consequence of malnutrition. Studies show that in surgical practice there is malnutrition in 50% of patients and that there is an association between inadequate nutritional status and surgical result. It leads to prolonged treatment, increasing of the level of morbidity and mortality, increased hospital costs, etc. Sometimes malnutrition is unrecognised, untreated and worsened in hospitals. For this reason this paper will elaborate: nutrition and a surgical patient, assessment of a nutritional status, assessment of energy requirements, and enteral and parenteral nutrition in order to determine the conditions and procedures that affect the appearance, recognition and treatment of malnutrition.

  8. Nutrition support in surgical oncology.

    Science.gov (United States)

    Huhmann, Maureen B; August, David A

    2009-01-01

    This review article, the second in a series of articles to examine the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients, evaluates the evidence related to the use of nutrition support in surgical oncology patients. Cancer patients develop complex nutrition issues. Nutrition support may be indicated in malnourished cancer patients undergoing surgery, depending on individual patient characteristics. As with the first article in this series, this article provides background concerning nutrition issues in cancer patients, as well as discusses the role of nutrition support in the care of surgical cancer patients. The goal of this review is to enrich the discussion contained in the clinical guidelines as they relate to recommendations made for surgical patients, cite the primary literature more completely, and suggest updates to the guideline statements in light of subsequently published studies.

  9. [Surgical adrenal approaches: learned experiences].

    Science.gov (United States)

    Bravo-Lázaro, Santos; Hernandis-Villalba, Juan; Meroño-Carbajosa, Emilio; Navío-Perales, Juan; Marzal-Felici, Vicente

    2014-01-01

    Laparoscopic surgery is the standard approach for surgical adrenal gland pathology. However, the open procedure still has its role. Our intention is to report our results and experience using different techniques. A retrospective study of 40 patients was carried out. Demographic and surgical data were analyzed. Thirty two patients had benign pathology and eight had malignant tumors. Laparotomy was performed in 18 patients: seven patients with malignant tumors and 11 with benign pathology. Young's approach was indicated in four patients. Laparoscopic aproach was indicated in 25 patients with seven patients requiring conversion to laparotomy. The conversion rate was 28% In most cases, the laparoscopic approach is the standard technique. Appropriate case selection is of primary importance. Other surgical techniques should be considered if necessary.

  10. The structure of the hydrated electron in bulk and at interfaces: Does the hydrated electron occupy a cavity?

    Science.gov (United States)

    Casey, Jennifer Ryan

    Since its discovery over fifty years ago, the hydrated electron has been the subject of much interest. Hydrated electrons, which are free electrons in water, are found in fields ranging from biochemistry to radiation chemistry, so it is important that we understand the structure and dynamics of this species. Because of its high reactivity, the hydrated electron's structure has proven difficult to pin down, especially its molecular details. One-electron mixed quantum/classical molecular dynamics simulations have proven useful in helping elucidate the structure of the hydrated electron. The picture most commonly presented from these studies is one of the electron residing in a cavity, disrupting the local water structure much like an anion the size of bromide. Our group has recently proposed a completely different structure for the hydrated electron, which arose from rigorous calculations of a new electron-water potential. The picture that emerged was of an electron that does not occupy a cavity but instead draws water within itself; this non-cavity electron resides in a region of enhanced water density. The one-electron cavity and non-cavity models all predict similar experimental observables that probe the electronic structure of the hydrated electron, such as the optical absorption spectrum, which makes it difficult to determine which model most accurately describes the true structure of the hydrated electron. In this thesis, we work to calculate experimental observables for various simulated cavity and non-cavity models that are particularly sensitive to the local water structure near the electron, in an effort to distinguish the various models from each other. Two particular observables we are interested in are the resonance Raman spectrum and the temperature dependent optical absorption spectrum of the hydrated electron. We find that for both of these experiments, only the non-cavity model has qualitative agreement with experiment; the cavity models miss the

  11. Analysis of electron correlation effects and contributions of NMR J-couplings from occupied localized molecular orbitals.

    Science.gov (United States)

    Zarycz, Natalia; Aucar, Gustavo A

    2012-02-02

    NMR J-coupling calculations at the second-order of polarization propagator approach, SOPPA, are among the most reliable. They include a high percentage of the total electron correlation effects in saturated and unsaturated molecular systems. Furthermore, J-couplings are quite sensitive to the whole electronic molecular framework. We present in this article the first study of all three response mechanisms, Fermi contact, FC, spin-dipolar, SD and paramagnetic spin-orbital, PSO, for J-couplings with occupied localized molecular orbitals at the SOPPA level of approach. Even though SOPPA results are not invariant under unitary transformations, the difference between results obtained with canonical and localized molecular orbitals, LMOs, are small enough to permit its application with confidence. The following small-size saturated and unsaturated compounds were analyzed: CH(4), CH(3)F, C(2)H(6), NH(3), C(2)H(4), CH(2)NH, H(2)C═CHF, and FHC═CHF. The local character of the FC mechanism that appears in J-couplings of these molecular models is shown through the analysis of contributions from LMOs. The importance of including the electron correlation on the engaged bonding orbitals for one-bond couplings is emphasized. Almost all electron correlation effects are included in such orbitals. Interesting findings were the large contributions by s-type LMOs to the C-H and C-C J-couplings; they are responsible for the variation of (1)J(C-C) when going from ethane to ethene and to 1,2-difluoroethene. The previously proposed hyperconjugative transfer mechanism has been tested. Among other tests we found the difference anti-syn of one-bond (1)J(C-H) in imine as due to both the corresponding σ(C-H) and the lone-pair, LP, contribution. Geminal and vicinal J-couplings were also analyzed. Our findings are in accord with a previous work by Pople and Bothner-by, who considered results taken from calculations or empirical data. For all geminal couplings the pattern of J-couplings, like

  12. Emotions in veterinary surgical students

    DEFF Research Database (Denmark)

    Langebæk, Rikke; Eika, Berit; Pedersen, Lene Tanggaard

    2012-01-01

    A surgical educational environment is potentially stressful and can negatively affect students' learning. The aim of the present study was to investigate the emotions experienced by veterinary students in relation to their first encounter with live-animal surgery and to identify possible sources...... of positive and negative emotions, respectively. During a Basic Surgical Skills course, 155 veterinary fourth-year students completed a survey. Of these, 26 students additionally participated in individual semi-structured interviews. The results of the study show that students often experienced a combination...

  13. Hospital transfers and patterns of mortality in very low birth weight neonates with surgical necrotizing enterocolitis.

    Science.gov (United States)

    Fullerton, Brenna S; Sparks, Eric A; Morrow, Kate A; Edwards, Erika M; Soll, Roger F; Jaksic, Tom; Horbar, Jeffrey D; Modi, Biren P

    2016-06-01

    The objectives of this study were to evaluate mortality rates in very low birth weight (VLBW) infants with surgical necrotizing enterocolitis (NEC) by level of available surgical resources and to determine the effect of hospital transfer on mortality. Mortality among 4328 VLBW neonates with surgical NEC born 2009-2013 was assessed using the Vermont Oxford Network database. NICUs were classified by availability of resources as a marker of overall center capability: type A (restrictions on ventilation or do not routinely perform major neonatal surgery), type B (perform major neonatal surgery but not cardiac bypass), and type C (perform major surgery, including cardiac bypass in infants). Mortality was higher among those who had surgery at type B centers versus type C centers (44.3% vs 36.4%, adjusted prevalence ratio 1.20 (95% CI: 1.08, 1.33)). Neonates who were not transferred between birth and surgery had a higher mortality compared to those transferred (44.6% vs 31.6%, adjusted prevalence ratio 1.39 (95% CI: 1.25, 1.55)). Transfer between birth and surgery and a higher level of surgical resources at the operative center were associated with lower mortality. Early transfer of high risk neonates to centers with higher levels of surgical resources may be warranted. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Auxiliares e Técnicos de enfermagem e controle de infecção hospitalar em centro cirúrgico: mitos e verdades Auxiliares y técnicos de enfermería y control de infección hospitalaria en centro quirúrgico: mitos y verdades Nursing auxiliaries and technicians and hospital infection control in surgical centers: myths and truths

    Directory of Open Access Journals (Sweden)

    Sônia Regina Melon Kunzle

    2006-06-01

    ía infectada y rutina de limpieza, enfermedades ocupacionales, infección hospitalaria, infección del área quirúrgica y tiempo operatorio, pudimos detectar mitos y rituales referentes al control de infección, que están relacionados sobre todo a la cultura de quienes los practican, perpetuando resistencia a los cambios.This analytical and descriptive study is aimed at detecting concepts that translate myths and truths on hospital infection among nursing auxiliaries and technicians at the surgical centers of three hospitals. The data collection instrument consisted of 28 affirmative statements (15 true and 13 false encompassing factors related to the patient, the surgical team, the environment, and procedures. The statements contain a three-point scale (I agree, I am in doubt, I disagree. We received 72% of adequate answers and 28% of non-adequate, which indicates that perioperative nursing professionals have satis-factory knowledge of hospital infection control. In the items use of safety footwear, rings and other objects, hair as a pathogen, hand scrubbing, use of humid gown and surgical area, infected surgery and cleaning routine, occupational diseases, hospital infection, surgical site infection and surgery time we were able to detect myths and rituals about infection control, which are mainly related to the culture of those who practice them, thus perpetuating resistance to change.

  15. Resultados de la revascularización coronaria en el cardiocentro del Hospital «Hermanos Ameijeiras», en un período de 20 años Results of coronary revascularization in the Cardiac Center of the "Hermanos Ameijeiras" Clinical Surgical Hospital over 20 years

    Directory of Open Access Journals (Sweden)

    Manuel Nafeh Abi-Rezk

    2011-03-01

    ón coronaria tuvo una tendencia ascendente en estos 20 años, sobre todo en pacientes de la tercera edad y del sexo masculino, en los que el tabaquismo y la hipertensión arterial fueron los factores de riesgo mayormente asociados. Predominó la revascularización con tres puentes y el uso de la safena, pero con tendencia al uso ascendente de la arteria mamaria interna. La mortalidad tuvo un comportamiento decreciente.INTRODUCTION. In Cardiac Center of the "Hermanos Ameijeiras" Clinical Surgical Hospital cardiovascular surgery is done from more twenty years ago introducing and developing different techniques of myocardial revascularization. The objective of present research was to describe the results of coronary revascularization over that period. METHODS. A retrospective, longitudinal and descriptive research with five-year cross-sectional cuts was conducted comparing each five-year period with the following one. From the total of 763 patients underwent coronary revascularization from January,1985 to December, 2004, 17 patients were excluded due to missing medical records or with incomplete data and 15 patients operated on without extracorporeal circulation, thus, the universe included 731 patients operated on with this technique. RESULTS. There was predominance the patients aged between 51 and 60years and male sex where smoking and high blood pressure were the more frequent risk factors. The predominant clinical stages were the chronic stable angina and the unstable angina as well as revascularization with three bridges and a trend to rise, as well as the saphenous vein use but with an ascending evolution as the only duct. The time of extracorporeal circulation and anoxic arrest showed a trend to decrease. The more frequent complications were the urinary and respiratory sepsis. There was a decrease of deaths from cardiac causes among which the multiorgan failure and the low cardiac output were the major ones. The low transoperative output decreased but there was a trend to

  16. MRI对桥小脑角池占位病变的诊断价值分析%Analysis of Diagnostic Value of MRI for Occupied Lesions in Cerebellopontine Angle

    Institute of Scientific and Technical Information of China (English)

    蒋君军; 罗庆华

    2014-01-01

    Objective To investigate the radiological appearances and diagnostic value of MRI of occupied lesions in cerebellopon-tine angle, and to provide effective diagnostic basis for clinic. Methods 35 cases of patients with cerebellopontine angle proved surgically and pathologically in our hospital from January 2010 to May 2014 were selected, the preoperative MRI of these patients were retrospectively investigated. Results 15 cases were meningeoma, accounting for 43%;10 cases were acoustic neuroma, accounting for 29%;5 cases were epidermoid cyst, accounting for 14%;2 cases were arachroid cyst, 2 cases were dermoid cyst and 1 case was lipoma, which totally accounted for 14%. Conclusions As MRI can clearly reflect the shape, size and scope of the occupied lesions in cerebellopontine angle, we can make a qualitative diagnosis combining with MRI, thus to provide effective basis for clinical surgery.%目的:探讨桥小脑角池内占位病变的M砸陨影像学表现及诊断价值,为临床提供有效的诊断依据。方法收集我院2010年1月至2014年5月共35例经手术及病理证实桥小脑角池内占位病变,回顾分析患者术前的M砸陨检查图像。结果15例为脑膜瘤,占43豫;10例为听神经瘤,占29豫;5例为表皮样囊肿,占14豫;2例为蛛网膜囊肿,2例为皮样囊肿,1例为脂肪瘤,共占14豫。结论M砸陨影像可清楚地反映桥小脑角池占位病灶的形态、大小、范围等。结合M砸陨影像学表现可以做出定性诊断,为临床手术治疗提供有效的依据。

  17. Diluted manganese on the bond-centered site in germanium

    CERN Document Server

    Decoster, S; Cottenier, S; Wahl, U; Correia, JG; Pereira, LMC; Lacasta, C; Da Silva, MR

    2010-01-01

    The functional properties of Mn-doped Ge depend to large extent on the lattice location of the Mn impurities. Here, we present a lattice location study of implanted diluted Mn by means of electron emission channeling. Surprisingly, in addition to the expected substitutional lattice position, a large fraction of the Mn impurities occupies the bond-centered site. Corroborated by ab initio calculations, the bond-centered Mn is related to Mn-vacancy complexes. These unexpected results call for a reassessment of the theoretical studies on the electrical and magnetic behavior of Mn-doped Ge, hereby including the possible role of Mn-vacancy complexes.

  18. Establishment of the Center for Biomedical Technology Innovation

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-12-15

    The report discussed the following topics: (1) Orthopedic Devices; (2) Hybrid Vector and Method Resulting in Protein Overproduction by Eukaryotic Cells; (3) Surgical Simulator; (4) CBTI (Center for Biomedical Technology Innovation) as an Incubator for Start-up Companies; (5) Voice-activated, computer-assisted surgical robotics; (6) Through transmission ultrasonic 3-D holography for diagnostic imaging; (7) CBTI's Scibermed{trademark} Virtual Institute (SVI); and (8) Laser Oxygenation Tomography.

  19. The surgical treatment of cloaca.

    Science.gov (United States)

    Bischoff, Andrea

    2016-04-01

    Similar to other anorectal malformations, cloaca also represents a spectrum of defects that goes from "benign" cloaca with a good functional prognosis that can be repaired with a relatively simple surgical technique, to very complex malformations with many anatomic variations that require different surgical maneuvers to be able to successfully reconstruct those patients. The group of patients born with a "benign" type of cloaca will have bowel and urinary control, will become sexually active and may get pregnant and deliver by cesarean section. All this is possible, provided the malformation is repaired with a meticulous and delicate technique. Fortunately this represents more than 50% of all cloacas. Our belief is that the surgical technique to repair this group of defects is reproducible and can be taught to pediatric surgical trainees. On the other hand, complex cloaca with a common channel longer than 3 cm should be repaired by surgeons fully dedicated to repair these malformations. The experience reported in this paper is based on 570 patients with cloaca operated by Dr. Alberto Peña and the author in the last 8 years. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Surgical treatment of primary hyperparathyroidism

    DEFF Research Database (Denmark)

    Brasso, K; Karstrup, S; Lundby, C M

    1994-01-01

    One hundred and two patients with primary hyperparathyroidism underwent a total of 108 bilateral neck explorations with attempted identification and biopsy of all four glands. Hypercalcaemia was surgically eliminated in 97 of 102 patients (95%). Of the remaining hypercalcaemic patients one was cu......--including bilateral neck exploration and attempted biopsies of all parathyroid glands--is safe with a high cure rate....

  1. Surgical Training in the Netherlands

    NARCIS (Netherlands)

    Borel Rinkes, I.H.M.; Gouma, D.J.; Hamming, J.F.

    2008-01-01

    Surgical training in the Netherlands has traditionally been characterized by learning on the job under the classic master-trainee doctrine. Over the past decades, it has become regionally organized with intensive structural training courses, and a peer-based quality control system. Recently, the nat

  2. Surgical smoke and infection control.

    NARCIS (Netherlands)

    Alp, E.; Bijl, D.; Bleichrodt, R.P.; Hansson, B.M.; Voss, A.

    2006-01-01

    Gaseous byproducts produced during electrocautery, laser surgery or the use of ultrasonic scalpels are usually referred to as 'surgical smoke'. This smoke, produced with or without a heating process, contains bio-aerosols with viable and non-viable cellular material that subsequently poses a risk of

  3. Posterior fossa meningioma (surgical experiences)

    African Journals Online (AJOL)

    Wael M. Moussa

    2012-08-27

    Aug 27, 2012 ... Morbidity included decreased level of consciousness, cranial nerve palsy and wound infection. ..... (10 cases), trigeminal nerve compression (6 cases), facial nerve .... and magnetic resonance imaging for surgical planning for menin- ... anatomy scanning in the operation of intracranial parasagittal.

  4. Surgical pearl: the temporary assistant.

    Science.gov (United States)

    Jacobs, Aleda A; Orengo, Ida F

    2008-04-15

    A simple maneuver is presented which simultaneously facilitates both adequate surgical site exposure and sufficient traction. A single suture with high tensile strength can be utilized to this end. This technique is especially helpful when the cutaneous surgeon is operating alone.

  5. Surgical options after Fontan failure

    DEFF Research Database (Denmark)

    van Melle, Joost P; Wolff, Djoeke; Hörer, Jürgen;

    2016-01-01

    OBJECTIVE: The objective of this European multicenter study was to report surgical outcomes of Fontan takedown, Fontan conversion and heart transplantation (HTX) for failing Fontan patients in terms of all-cause mortality and (re-)HTX. METHODS: A retrospective international study was conducted by...

  6. Surgical Lasers In Veterinary Medicine

    Science.gov (United States)

    Newman, H. C.

    1987-03-01

    Veterinary medicine is a latecomer in benefiting from the advent of surgical lasers. It is ironic that although most of the basic work in lasers is carried out in animal species with which we are most conversant, veterinary medicine as a profession has not been very extensively involved.

  7. Surgical management of tubal pregnancy

    NARCIS (Netherlands)

    Mol, F.

    2013-01-01

    The work presented in this thesis first addresses the magnitude of the clinical problem of surgically treated tubal pregnancy in The Netherlands. Next, we studied the adherence to recommendations from the Dutch guideline on diagnosis and management of ectopic pregnancy. A systematic review and meta-

  8. Surgical Treatment of Mirizzi Syndrome

    Directory of Open Access Journals (Sweden)

    Е.М. Goch

    2010-06-01

    Full Text Available The results of treatment of 53 patients with Mirizzi syndrome are presented in the work. The article focuses on the modern classification of syndrome, diagnostics and surgical approach according to the severity of duct damage. Mirizzi syndrome proves to be the complication of cholelithiasis. It is one of the most complicated problems of biliary surgery

  9. [Surgical education has its price].

    Science.gov (United States)

    Schröder, W; Krones, C J

    2012-04-01

    The radical economisation of the German health-care system has caused an increasing cost awareness. Following this trend, medical education has been identified as a possible expense factor. The theoretical and practical training of young doctors needs time and costs money. However, a detailed cost analysis is still not available, since the complex daily work schedule of young professionals only allows the calculation of single cost factors. Investigations in the USA estimate the costs of surgical training at US$ 80 000 per year and per resident. At present in Germany, surgical training is indirectly financed by the DRG flat rates of the health insurance companies. Possible alternatives include the implementation of a "training fond" which is financed by a percentage fee of the DRG's as well as an on-top funding by the federal government. This "training fond" would support only those surgical units that offer a structured and certified training to surgical residents. However, a systematic cost analysis of such a structured curriculum is necessary for any further discussion.

  10. Pseudothrombocytopenia in cardiac surgical practice.

    Science.gov (United States)

    Nair, Sukumaran K; Shah, Roma; Petko, Matus; Keogh, Bruce E

    2007-08-01

    Pseudothrombocytopenia is observed occasionally in post-cardiac surgical patients. It is commonly due to EDTA-mediated immunological mechanisms, which lead to agglutination of functionally intact platelets. This condition is harmless and does not warrant platelet transfusion. We describe an instance of pseudothrombocytopenia in our practice and discuss its clinical relevance.

  11. Surgical smoke and infection control.

    NARCIS (Netherlands)

    Alp, E.; Bijl, D.; Bleichrodt, R.P.; Hansson, B.M.; Voss, A.

    2006-01-01

    Gaseous byproducts produced during electrocautery, laser surgery or the use of ultrasonic scalpels are usually referred to as 'surgical smoke'. This smoke, produced with or without a heating process, contains bio-aerosols with viable and non-viable cellular material that subsequently poses a risk of

  12. Surgical treatment of post-infarction left ventricular pseudoaneurysm: Case series highlighting various surgical strategies

    Directory of Open Access Journals (Sweden)

    Edvin Prifti, MD, PhD

    2017-04-01

    Conclusion: In conclusion, this study revealed that surgical repair of post infarct left ventricular pseudoaneurysm was associated with an acceptable surgical mortality rate, that cardiac rupture did not occur in surgically treated patients.

  13. The surgical management of urogenital tuberculosis our experience and long-term follow-up

    OpenAIRE

    Punit Bansal; Neeru Bansal

    2015-01-01

    Introduction: Urogenital tuberculosis (TB) is common in developing countries. We present our experience of surgically managed cases of genitourinary TB (GUTB). Materials and Methods: We retrospectively reviewed 60 cases GUTB who underwent surgery at our center from January 2003 to January 2010. Mode of presentation, organ involvement, investigation, surgical treatment and follow-up were studied. Results: There were 38 males and 22 females with a mean age of 32.5 years. The most common...

  14. Surgical travellers: tapestry to Bayeux.

    Science.gov (United States)

    Hedley-Whyte, John; Milamed, Debra R

    2014-09-01

    The planning for surgery in war was revisited in 1937 when Ian Fraser was elected a member of the Surgical Travellers. At their 1938 Surgical Travellers meeting in Vienna, Ian and Eleanor Fraser were evicted from their hotel room by the Nazis. The 1939 meeting in Belfast discussed the organization of surgery and the conduct of Emergency Medical Service Hospitals in the United Kingdom; the vast majority were to be under civilian government and military control. From 1943 lengthy and informative organizational meetings were held at least monthly under the chairmanship of Sir Alexander Hood, KBE, Head of the RAMC. Surgical Consultants, now Major Generals, Brigadiers or Full Colonels in the British and U.S. Armies stationed in the UK, prepared for the invasion of Europe. The allocation of medical, surgical, nursing and auxiliary responsibilities was delineated. Liaison with the RAF and US Army Air Force was close as it was with the proposed leaders, Ulstermen Brooke and Montgomery. Montgomery chose Arthur Porritt as Surgeon in Chief to Supreme Headquarters Allied Expeditionary Force (SHAEF), and Eisenhower, General Albert W. Kenner. Just after D-Day, Porritt met Ian Fraser, who had waded in on Arromanches Beach. The triage and evacuation plans for Allied casualties had been controversial, particularly as regards Landing Ship Tanks (LSTs). The dispute with the Hood-selected surgeons on one side, against medical and surgical deployment of LSTs, and Admiral Ernest King and Winston Churchill on the other, favouring LST use for surgery and evacuation. King and Churchill were correct but total Allied air superiority allowed wide use of many of the Allies' Dakotas; 10,000 DC-3s were eventually in service. Supported by forty Allied combat planes to each Luftwaffe, the dispute about Landing Ship Tank use in about a fortnight became moot. The multifaceted role of the Princess Royal in the Emergency Medical Services of the United Kingdom and her close liaison with the Consultant

  15. Surgical management of chronic pancreatitis

    Institute of Scientific and Technical Information of China (English)

    Stavros Gourgiotis; Stylianos Germanos; Marco Pericoli Ridolifni

    2007-01-01

    BACKGROUND:Treatment of chronic pancreatitis (CP) is a challenging condition for surgeons. During the last decades, increasing knowledge about pathophysiology of CP, improved results of major pancreatic resections, and integration of sophisticated diagnostic methods in clinical practice have resulted in signiifcant changes in surgery for CP. DATA SOURCES:To detail the indications for CP surgery, the surgical procedures, and outcome, a Pubmed database search was performed. The abstracts of searched articles about surgical management of CP were reviewed. The articles could be identiifed and further scrutinized. Further references were extracted by cross-referencing. RESULTS: Main indications of CP for surgery are intractable pain, suspicion of malignancy, and involvement of adjacent organs. The goal of surgical treatment is to improve the quality of life of patients. The surgical approach to CP should be individualized according to pancreatic anatomy, pain characteristics, baseline exocrine and endocrine function, and medical co-morbidity. The approach usually involves pancreatic duct drainage and resection including longitudinal pancreatojejunostomy, pancreatoduodenectomy (Whipple's procedure), pylorus-preserving pancreatoduodenectomy, distal pancreatectomy, total pancreatectomy, duodenum-preserving pancreatic head resection (Beger's procedure), and local resection of the pancreatic head with longitudinal pancreatojejunostomy (Frey's procedure). Non-pancreatic and endoscopic management of pain has also been advocated. CONCLUSIONS:Surgical procedures provide long-term pain relief, a good postoperative quality of life with preservation of endocrine and exocrine pancreatic function, and are associated with low early and late mortality and morbidity. In addition to available results from randomized controlled trials, new studies are needed to determine which procedure is the most effective for the management of patients with CP.

  16. The food security under another look: analysis on the evolution of the Brazilian population occupied in activities of self-consumption

    Directory of Open Access Journals (Sweden)

    Flávio Sacco dos Anjos

    2011-02-01

    Full Text Available The article analyzes the evolution of the Brazilian active population occupied in activities of self-consumption between 2001 and 2006 years. The date used come from the National Research on Sample of Domiciles. The authors examine the situation since the point of view the individuals and families (rural or urban, also classified as employers, self employed e and workers families, besides others forms of classification (exclusively agrarian, no-agrarian and pluriactive. The study reveals an important and general increment on the population employed in the self-consumption activities. However this research showed that this kind of activity is essentially feminine which occupies approximately 6.1 million of families in rural and urban areas of Brazil.

  17. Development of AR Surgical Navigation Systems for Multiple Surgical Regions.

    Science.gov (United States)

    Suzuki, Naoki; Hattori, Asaki; Iimura, Jiro; Otori, Nobuyoshi; Onda, Shinji; Okamoto, Tomoyoshi; Yanaga, Katsuhiko

    2014-01-01

    The purpose of our research is to develop surgical navigation systems to enhance surgical safety. Our systems make use of augmented reality technology to superimpose, on the surgery screen on a real time basis, patients' organ models reconstructed in 3D from their X-ray CT data taken before surgery. By doing so, the systems display anatomical risk materials, tumors and blood vessels which surgeons cannot see with their naked eyes. This will in turn lead to surgeons intuitively grasping the inner structures of the operational fields. We so far have been developing navigation systems that can conduct surgeries in various fields. The basic structure of the navigation systems are the same. The navigation systems uses different peripheral equipment and different methods to display navigation images which best meet the demands of each type of surgery. In this thesis, we report on our navigation systems for 2 types of surgery - endoscopic sinus surgery and hepatobilialy-pancreatic surgery.

  18. Preoperative Prevalence of Staphylococcus Aureus in Cardiothoracic and Neurological Surgical Patients

    Directory of Open Access Journals (Sweden)

    Ritu eKapoor

    2014-11-01

    Full Text Available Methicillin-resistant Staphylococcus aureus (MRSA is a global cause of both hospital and community-acquired infection. This retrospective, observational study determined the prevalence of MRSA carriers in cardiothoracic and neurological surgical patients presenting to an outpatient preoperative assessment center in Columbus, OH. MRSA may cause aggressive skin and soft-tissue infection with potentially fatal complications, and cardiothoracic and neurological surgical patients are at high risk for surgical-site infection. Results indicated that 4.25% of the sample carried MRSA and 25.25% carried methicillin-sensitive Staphylococcus aureus.

  19. Early surgical intervention for fulminant pseudomembranous colitis.

    Science.gov (United States)

    Ali, Syed O; Welch, John P; Dring, Robert J

    2008-01-01

    The objective of this study of a retrospective case series was to determine factors associated with survival after surgical intervention in pseudomembranous colitis (PMC). The study was conducted at a tertiary care medical center and comprised 36 patients who underwent colectomy for fulminant PMC from 1995 to 2006. Patients including 21 females ranged from 40 to 89 years of age (mean, 70 years). Comorbidities included diabetes (39%), cardiovascular disease (77%), chronic obstructive pulmonary disease (47%), and intake of immunosuppressive medications (45%). Seventy-two per cent received antibiotics in the previous 2 months. Only patients with a confirmation of PMC on pathology specimens were included in the study. All patients underwent colectomy. Patients were stratified into two groups: survivors and nonsurvivors. Various clinical factors/ parameters used in the management of patients with PMC were studied in these two groups. Survival was correlated with mean white blood cell count (23,000 survivors versus 40,000 nonsurvivors, P < 0.01); multisystem organ failure (16 per cent survivors versus 47 per cent nonsurvivors, P < 0.05); and preoperative pressors (16 per cent survivors versus 47 per cent nonsurvivors, P < 0.05). Overall mortality for the study period was 47 per cent. Mortality rate analysis revealed a lower rate for the more recent years (32 per cent for 2000 to 2006 versus 65 per cent for 1995 to 1999, P < 0.05). In the more recent years, the time elapsing before colectomy was also lower (1.4 days versus 2.5 days, nonsignificant), and patients had less preoperative hemodynamic instability (70 per cent versus 31 per cent, P < 0.03). In one institution, survival after surgery for PMC was found to be associated with a mean white blood cell count (< 37,000), nondependence on preoperative vasopressors, and surgical intervention before the onset of hemodynamic instability.

  20. Hemicraniectomy after middle cerebral artery infarction with life-threatening Edema trial (HAMLET). Protocol for a randomised controlled trial of decompressive surgery in space-occupying hemispheric infarction.

    Science.gov (United States)

    Hofmeijer, Jeannette; Amelink, G Johan; Algra, Ale; van Gijn, Jan; Macleod, Malcolm R; Kappelle, L Jaap; van der Worp, H Bart

    2006-09-11

    Patients with a hemispheric infarct and massive space-occupying brain oedema have a poor prognosis. Despite maximal conservative treatment, the case fatality rate may be as high as 80%, and most survivors are left severely disabled. Non-randomised studies suggest that decompressive surgery reduces mortality substantially and improves functional outcome of survivors. This study is designed to compare the efficacy of decompressive surgery to improve functional outcome with that of conservative treatment in patients with space-occupying supratentorial infarction The study design is that of a multi-centre, randomised clinical trial, which will include 112 patients aged between 18 and 60 years with a large hemispheric infarct with space-occupying oedema that leads to a decrease in consciousness. Patients will be randomised to receive either decompressive surgery in combination with medical treatment or best medical treatment alone. Randomisation will be stratified for the intended mode of conservative treatment (intensive care or stroke unit care). The primary outcome measure will be functional outcome, as determined by the score on the modified Rankin Scale, at one year.

  1. Surgical treatment of double primary liver cancer

    Science.gov (United States)

    Li, Aijun; Ma, Senlin; Pawlik, Timothy; Wu, Bin; Yang, Xiaoyu; Cui, Longjiu; Wu, Mengchao

    2016-01-01

    Abstract Double primary liver cancer (DPLC) is a special type of clinical situation. As such, a detailed analysis of the surgical management and prognosis of patients with DPLC is lacking. The objective of the current study was to define the management and outcome of patients undergoing surgery for DPLC at a major hepatobiliary center. A total of 87 patients treated by surgical resection at the Eastern Hepatobiliary Surgery Hospital from January 1st, 2007 to October 31st, 2013 who had DPLC demonstrated by final pathological diagnosis were identified. Among these, 50 patients had complete clinical and prognostic data. Demographic and tumor characteristics as well as the prognosis were analyzed. The proportion of hepatitis B surface antigen (HBsAg) (+) and hepatitis B virus e antigen (HBeAg) (+), HBsAg (+), and HBeAg (−) hepatocirrhosis in all patients was 21.84%, 67.82%, and 63.22%, respectively. Incidental findings accounted for 58.62% of patients; among those who had symptoms, the main symptom was abdominal pain (31.03%). Nonanatomic wedge resection was the main operative approach (62.07%). Postoperatively, the main complications included seroperitoneum (11.49%), hypoproteinemia (10.34%), and pleural effusion (8.05%). Factors associated with disease-free survival (DFS) included intrahepatic cholangiocarcinoma (ICC) tumor size (P = 0.002) and use of postoperative prophylactic transcatheter arterial chemoembolization (TACE) treatment (P = 0.015). Meanwhile, hepatocellular carcinoma (HCC) size (P = 0.045), ICC size (P < 0.001), and liver function (including aspartate aminotransferase [P = 0.001] and r-glutamyl transferase [P < 0.001]) were associated with overall survival (OS). Hepatitis B virus (HBV)-related hepatitis or cirrhosis is also an important factor in the pathogenesis of DPLC and surgical treatment is safe for it with low complication rates. In addition, it is effective to prolong DFS that DPLC patients undergo postoperative

  2. Children's cancer centers

    Science.gov (United States)

    Pediatric cancer center; Pediatric oncology center; Comprehensive cancer center ... Treating childhood cancer is not the same as treating adult cancer. The cancers are different. So are the treatments and the ...

  3. Transplant Center Search Form

    Science.gov (United States)

    ... Share Your Story Give Us Feedback - A + A Transplant Center Search Form Welcome to the Blood & Marrow ... transplant centers for patients with a particular disease. Transplant Center login Username: * Password: * Request new password Join ...

  4. The Watergate Learning Center

    Science.gov (United States)

    Training in Business and Industry, 1971

    1971-01-01

    The Watergate Learning Center, recently opened by Sterling Learning Center in Washington, D. C., blueprints the plan established by Sterling and Marriott Hotels for a national chain of learning centers with much the same facilities. (EB)

  5. [Aspects of development of surgical service of modem Navy].

    Science.gov (United States)

    Kabanov, M Iu; Gaĭdash, A A; Rukhliada, N V; Solov'ev, I A; Titov, R V; Utochkin, A P; Smirnov, S I; Smolin, N V; Tiurin, M V

    2013-06-01

    The article is devoted to the aspects of a current state of surgical service in the Navy, prospects of development of professianl training for navy surgeons, formation of modern training comlex, united electronic library, containig the issues about combat surgical trauma, software technologies, realizing of the application methodology during the process of training and practical activity for the development of the training system for surgeons of Navy and improvement of effectiveness. Formation of normative technical documents, regulating activity of navy surgians is also among the expectations. The authors also touched on the issues of development of modern technologies in bone grafting with the help of domestic implants based on the osteoinductive nanostructured nonorganic matrices (titanium) with defined structure and composition. Department of navy and hospital surgery participate in this debelopment. Due to increased amount of oncologic patients, it was decided to establish the Cancer Center of the Ministry of Defense based on department of navy and hospital surgery of the Kirov Military Medical Academy. It makes possible to perform the following procedures: canser surgery; surgical repair; plastic repair of major vessels, bone and soft tissue grafting, removal of residual cancer cells with the help of loco-regional methods of hyperthermic intracavitary and intravascular chemoperfusion; diagnostics and treatment of recurrent tumors (surgical and radiation treatment, systemic chemotherapy, loco-regional chemoembolization. Each of the given methods help to develop and improve the innovation technologies.

  6. Pre-Surgical Evaluation of Intractable Epilepsy in Children

    Directory of Open Access Journals (Sweden)

    Hadi Kazemi

    2011-05-01

    Full Text Available AbstractObjectiveThis review summarizes some patterns of pre-surgical evaluation of epilepsyin children with medically refractory seizures. Epilepsy surgery is a valuabletherapeutic option for many children with intractable epilepsy. The most effectivetreatment for intractable partial epilepsy is a focal cortical resection with excisionof the area of ictal onset and initial seizure propagation (the epileptogenic zone.EEG monitoring continues to prove indispensable in pre-surgical planning ofrefractory epileptic patients by defining the epileptogenic zone. Technologicalprogresses in both structural and functional neuroimaging techniques have ledmany medical centers to consider surgical treatment of epilepsy. In childrenundergoing pre-surgical evaluation, the goals of neuroimaging studies includethe identification of structural abnormalities in the brain, eloquent regions of thebrain including language, memory, and sensorimotor functions, and the relationof these regions to the potential epileptogenic region. Neuropsychological testingplays a crucial role in assessing the potential impact of surgery on cognitivefunction of the patients and helps in lateralizing the cerebral hemispheredominant for verbal and nonverbal function in older children. The Wada testis an invasive procedure to determine language dominance and can be usedto assess the risk of postoperative memory deficits in children with temporallobe epilepsy. Some children scheduled for resection still need to undergofurther precise localization of the epileptogenic zone and functional mappingwith invasive EEG monitoring through intracranial subdural grid and/or depthelectrodes. Epilepsy surgery has the potential of changing the life quality ofchildren by improving or eliminating seizures in carefully selected patients.

  7. Surgical and Nonsurgical Management of Bilateral Periapical ...

    African Journals Online (AJOL)

    Journal of Surgical Technique and Case Report | Jan-Jun 2011 | Vol-3 | Issue-1. 44. Surgical .... incisor and canine. Same was ... The operative field was isolated, and access preparation .... environment in which periapical healing can occur.

  8. Surgical intervention in patients with necrotizing pancreatitis

    NARCIS (Netherlands)

    Besselink, MG; de Bruijn, MT; Rutten, JP; Boermeester, MA; Hofker, HS; Gooszen, HG

    2006-01-01

    Background: This study evaluated the various surgical strategies for treatment of (suspected) infected necrotizing pancreatitis (INP) and patient referrals for this condition in the Netherlands. Methods: This retrospective study included all 106 consecutive patients who had surgical treatment for IN

  9. Surgical skin-marking techniques.

    Science.gov (United States)

    Granick, M S; Heckler, F R; Jones, E W

    1987-04-01

    Surgical skin-marking inks and dyes are in everyday use for designing and planning incisions in plastic and reconstructive surgery. We have traced the historical development of surgical skin-marking techniques from ancient times to the present. The biochemical characteristics of the commonly used marking agents are discussed. A three-part experiment utilizing a pig model was carried out to test the tissue inflammatory response to the various dyes and inks when used intradermally as tattoos, the persistence of such tattoos, and the ease of skin erasure for each of eight stains. Methylene blue and gentian violet are recommended as the best all-purpose marking agents. The use of proprietary inks is discouraged.

  10. Surgical considerations about amyloid goiter.

    Science.gov (United States)

    García Villanueva, Augusto; García Villanueva, María Jesús; García Villanueva, Mercedes; Rojo Blanco, Roberto; Collado Guirao, María Vicenta; Cabañas Montero, Jacobo; Beni Pérez, Rafael; Moreno Montes, Irene

    2013-05-01

    Amyloidosis is an uncommon syndrome consisting of a number of disorders having in common an extracellular deposit of fibrillary proteins. This results in functional and structural changes in the affected organs, depending on deposit location and severity. Amyloid infiltration of the thyroid gland may occur in 50% and up to 80% of patients with primary and secondary amyloidosis respectively. Amyloid goiter (AG) is a true rarity, usually found associated to secondary amyloidosis. AG may require surgical excision, usually because of compressive symptoms. We report the case of a patient with a big AG occurring in the course of a secondary amyloidosis associated to polyarticular onset juvenile idiopathic arthritis who underwent total thyroidectomy. Current literature is reviewed, an attempt is made to provide action guidelines, and some surgical considerations on this rare condition are given.

  11. Sushruta: Foundation for Surgical Practice

    Directory of Open Access Journals (Sweden)

    Siddharth P. Dubhashi

    2016-04-01

    Full Text Available Sushruta was an ancient Indian surgeon (600 B.C. who resided in Varanasi.The teachings and work of Sushruta is compiled in a treatise called Sushruta Samhita (Sushruta's compendium, which is believed to be a part of Atharvaveda. It contains 184 chapters, descriptions of 1,120 illnesses, 300 surgical procedures, classification of human surgery in 8 categories, over 120 surgical instruments and around 700 drugs of animal, plant and mineral origin. Sushruta was one of the earliest exponents of surgery as an art and science. Sushruta's principles and teachings took surgery in ancient India to a noteworthy pedestal, making it the Golden Age of Surgery. He is truly the “Father of Surgery” and “Father of Plastic Surgery”. It is extremely essential that we put his principles into practice, and preserve the dignity of our noble profession. That would be the ideal tribute to this legendary figure.

  12. Surgical training in the Netherlands.

    Science.gov (United States)

    Borel-Rinkes, Inne H M; Gouma, Dirk J; Hamming, Jaap F

    2008-10-01

    Surgical training in the Netherlands has traditionally been characterized by learning on the job under the classic master-trainee doctrine. Over the past decades, it has become regionally organized with intensive structural training courses, and a peer-based quality control system. Recently, the nationwide programme has been modernized further and now involves a systematic, competency-based education with structural training courses, formalized assessment and room for reflection by residents under the supervision of surgical teaching groups. To this end, a uniform web-based digital portfolio is being introduced to facilitate monitoring of the individual resident's progress. Though requiring inspirational leadership, commitment, and determination, this modernization has sparked enthusiasm among trainees and teachers.

  13. Surgical tools and medical devices

    CERN Document Server

    Jackson, Mark

    2016-01-01

    This new edition presents information and knowledge on the field of biomedical devices and surgical tools. The authors look at the interactions between nanotechnology, nanomaterials, design, modeling, and tools for surgical and dental applications, as well as how nanostructured surfaces can be created for the purposes of improving cell adhesion between medical devices and the human body. Each original chapter is revised in this second edition and describes developments in coatings for heart valves, stents, hip and knee joints, cardiovascular devices, orthodontic applications, and regenerative materials such as bone substitutes. There are also 8 new chapters that address: Microvascular anastomoses Inhaler devices used for pulmonary delivery of medical aerosols Surface modification of interference screws Biomechanics of the mandible (a detailed case study) Safety and medical devices The synthesis of nanostructured material Delivery of anticancer molecules using carbon nanotubes Nano and micro coatings for medic...

  14. [Surgical treatment of paralytic lagophthalmos].

    Science.gov (United States)

    Schrom, T; Bast, F

    2010-03-01

    Impairment of the peripheral or central part of the facial nerve causes an ipsilateral peripheral facial nerve paresis. It is quite a common syndrome and affects 20-35 persons per 100,000 per year in Western Europe and the United States. A possible complication of facial palsy is paralytic lagophthalmos with aesthetic and functional impairment for the patient. Beside primary nerve reconstructive procedures plastic-reconstructive procedures play a major role in correcting paralytic lagophthalmos. The eyebrow, upper and lower lids, medial and lateral lid angle as well as the lacrimal system need to be seen as functional units and can be corrected with local surgical procedures. Restoration of eye closure is the most important goal in treating the affected eye. Due to the significant aesthetic limitations and resultant psychological stress for the patient cosmetic aspects must be included in the surgical concept.

  15. A New Surgical Technique for Ingrown Toenail

    OpenAIRE

    Seyed Reza Mousavi; Jaledin Khoshnevice

    2012-01-01

    Background. Ingrowing toenails are a common condition which, when recurrent and painful, are often treated surgically. The aim of this study is to present a new simple surgical technique for ingrown toenails with good results. Method and Patients. The selected 250 patients with affected toes were surgically treated by our technique and observed from 1998 to 2004. Marginal nail elevation combined with surgical excision of the granulation tissue was more successful. For fixing the nail margin o...

  16. 68 INVITED Personalized surgical treatment for sarcoma

    National Research Council Canada - National Science Library

    Hohenberger, P

    2007-01-01

    ... belongtothemodernsurgicalapproachinthebattleagainstlocalisedand locallyadvancedprostatecancer. 67 INVITED Personalized surgical treatment for early breast cancer E.Rutgers. The Netherlands Cancer Institute, Department...

  17. Aesthetic Surgical Crown Lengthening Procedure

    OpenAIRE

    2015-01-01

    The aim of this case report was to describe the surgical sequence of crown lengthening to apically reposition the dentogingival complex, in addition to an esthetic restorative procedure. Many different causes can be responsible for short clinical crown. In these cases, the correct execution of a restorative or prosthetic rehabilitation requires an increasing of the crown length. According to the 2003 American Academy of Periodontology (Practice Profile Survey), crown lengthening is the most h...

  18. Surgical checklists: the human factor.

    LENUS (Irish Health Repository)

    O Connor, Paul

    2013-05-14

    BACKGROUND: Surgical checklists has been shown to improve patient safety and teamwork in the operating theatre. However, despite the known benefits of the use of checklists in surgery, in some cases the practical implementation has been found to be less than universal. A questionnaire methodology was used to quantitatively evaluate the attitudes of theatre staff towards a modified version of the World Health Organisation (WHO) surgical checklist with relation to: beliefs about levels of compliance and support, impact on patient safety and teamwork, and barriers to the use of the checklist. METHODS: Using the theory of planned behaviour as a framework, 14 semi-structured interviews were conducted with theatre personnel regarding their attitudes towards, and levels of compliance with, a checklist. Based upon the interviews, a 27-item questionnaire was developed and distribute to all theatre personnel in an Irish hospital. RESULTS: Responses were obtained from 107 theatre staff (42.6% response rate). Particularly for nurses, the overall attitudes towards the effect of the checklist on safety and teamworking were positive. However, there was a lack of rigour with which the checklist was being applied. Nurses were significantly more sensitive to the barriers to the use of the checklist than anaesthetists or surgeons. Moreover, anaesthetists were not as positively disposed to the surgical checklist as surgeons and nurse. This finding was attributed to the tendency for the checklist to be completed during a period of high workload for the anaesthetists, resulting in a lack of engagement with the process. CONCLUSION: In order to improve the rigour with which the surgical checklist is applied, there is a need for: the involvement of all members of the theatre team in the checklist process, demonstrated support for the checklist from senior personnel, on-going education and training, and barriers to the implementation of the checklist to be addressed.

  19. [Surgical anatomy of the nose].

    Science.gov (United States)

    Nguyen, P S; Bardot, J; Duron, J B; Jallut, Y; Aiach, G

    2014-12-01

    Thorough knowledge of the anatomy of the nose is an essential prerequisite for preoperative analysis and the understanding of surgical techniques. Like a tent supported by its frame, the nose is an osteo-chondral structure covered by a peri-chondroperiosteal envelope, muscle and cutaneous covering tissues. For didactic reasons, we have chosen to treat this chapter in the form of comments from eight key configurations that the surgeon should acquire before performing rhinoplasty.

  20. [Surgical options in ulcerative colitis].

    Science.gov (United States)

    Hultén, L; Ecker, K W

    1998-01-01

    Surgery is needed in every second patient with pancolitis. Historically four surgical options have been developed: conventional ileostomy, ileorectostomy, continent ileostomy (Kock's pouch) and ileo-anal pouch. However, in emergent or unclear situations subtotal colectomy, ileostomy and preservation of the rectum is the most suitable operation. After recovery and in elective indications proctectomy and proctocolectomy establish the general surgical standard. Today, in most cases ileo-pouch-anal anastomosis is performed instead of creation of an ileostomy. Both lowered frequency of defecation and acceptable continence contribute to a better quality of life. However, functional disturbances are not uncommon and result in most cases from complications of the demanding technique. Definitive cure of the colitis is in interference with the risk of pouchitis in about 30%. The cumulative probability to loose the pouch may rise to 15-20% in the long-term course. Thus, ileorectostomy may be considered as a first step of surgical treatment, since pelvic nerve damage is excluded, function is much better and persistent proctitis can be treated topically. The attractively is that ileo-anal pouch can be performed later on, when decreasing function and increasing risk of malignant change will eventually require proctectomy. A Kock-pouch is seldom considered, especially in patients with ileostomy wishing sure fecal control. But the continent reservoir becomes more and more interesting again since it can be reconstructed from a failed ileo-anal pouch without loss of bowel. Conventional ileostomy should be reserved for patients not suitable for reconstructive methods or those who consider pough operations risk. However, it is the safest procedure with absolute cure of disease. The optimal choice of method considers medical and surgical aspects as well as patients conception and desire.