Endoscopic hematoma evacuation in patients with spontaneous supratentorial intracerebral hemorrhage

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Wei-Hsin Wang

2015-02-01

Conclusion: With the introduction of the minimally invasive techniques and the evolution of the neuroendoscope and hemostatic agents, the median operative time and blood loss have been significantly decreased. Although the hematoma evacuation rates were similar between the endoscope (90% and craniotomy (85% groups, the median intensive care unit stay was decreased from 11 days to 6 days due to reduced surgical invasiveness. This represents an important advancement in treating spontaneous supratentorial ICH, and provides a measured preview of the promising results that can be expected in the future.

Flexible endoscope-assisted evacuation of chronic subdural hematomas.

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Májovský, Martin; Masopust, Václav; Netuka, David; Beneš, Vladimír

2016-10-01

Chronic subdural hematoma (CSDH) is a common neurosurgical condition with an increasing incidence. Standard treatment of CSDHs is surgical evacuation. The objective of this study is to present a modification of standard burr-hole hematoma evacuation using a flexible endoscope and to assess the advantages and risks. Prospectively, 34 consecutive patients diagnosed with CSDH were included in the study. Epidemiological, clinical and radiographical data were collected and reviewed. All patients underwent a burr-hole evacuation of CSDH. A flexible endoscope was inserted and subdural space inspected during surgery. The surgeon was looking specifically for the presence of septations, draining catheter position and acute bleeding. Thirty-four patients underwent 37 endoscope-assisted surgeries. Presenting symptoms were hemiparesis (79%), decreased level of consciousness (18%), gait disturbances (15%), headache (12%), aphasia (6%), cognitive disturbances (6%) and epileptic seizure (3%). Average operative time was 43 min, and the average increase in operative time due to the use of the endoscope was 6 min. Recurrence rate was 8.8%, and clinical outcome was favorable (defined as mRS ≤ 2) in 97% of the cases. To our knowledge, the present cohort of 34 patients is the largest group of patients with CSDH treated using an endoscope. This technique allows decent visualization of the hematoma cavity while retaining the advantages of a minimally invasive approach under a local anesthesia. The main advantages are correct positioning of the catheter under visual control, identification of septations and early detection of cortex or vessel injury during surgery.

Percutaneous evacuation for treatment of subdural hematoma and outcome in 28 patients.

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Mostofi, Keyvan; Marnet, Dominique

2011-01-01

Chronic subdural hematoma is a frequently encountered entity in neurosurgery in particular in elderly patients. There in a high variance in the treatment in literature. We report our experience of percutaneous evacuation of chronic subdural hematoma in 28 patients. From January 2007 to July 2009, 28 patients underwent percutaneous evacuation. 27 of the 28 patients (96.4%) became asymptomatic or improved clinically. Six weeks later, the scan showed the hematoma had completely disappeared in 18 of the cases. We did not have any postoperative infection. Treatment of chronic subdural hematoma using a percutaneous operative technique is a minimally invasive method with sufficient outcome and a therapeutic alternative to the craniotomy.

Medical Evacuation from Vietnam of an Elderly with Tuberculosis Spondylitis

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Ying-Hua Shieh

2007-09-01

Full Text Available Despite the growth in economy in Vietnam, the infrastructure of dependable medical care is still lacking. Therefore, aeromedical evacuation of patients to other countries for further medical interventions has become an important medical service in the region. We report a case where an elderly man who was aeromedically evacuated from Ho Chi Minh City, Vietnam to Taipei Medical University–Municipal Wan Fang Hospital in Taipei, Taiwan. The patient developed a sudden onset of quadriplegia because of an epidural abscess at the cervical spine C6–C7. Antituberculous medication was prescribed for suspected tuberculous spondylitis, because his cerebral spinal fluid showed elevated white blood cells with a predominance of lymphocytes, and mildly elevated total protein. However, whole body tumor scan (67Ga mCi and whole body bone scan (99mTc methylene diphosphonate, 25 mCi did not reveal any specific results. Surgical intervention was arranged because of cervical spine instability and the need for a diagnostic biopsy. Adenocarcinoma of the prostate was found incidentally and was treated with bilateral orchiectomy and radiation therapy. This was the first medical evacuation by the Family Medical Practice group in Ho Chi Minh City, Vietnam to Taiwan.

Mirror image extradural hematoma in elderly population: management strategy with surgical bilateral or unilateral evacuation or conservative treatment modality with literature review

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Satyarthee Guru Dutta

2017-12-01

Full Text Available Extradural hematomas (EDH represent one of common imaging findings in cases sustaining traumatic brain injury. Bilateral extradural haematoma is considered rare and even rarer in elder people male. Bilateral extradural hematoma is usually acute, and generally associated with severe traumatic head injury. Mirror-image extradural hematomas (MEDH constitute a special type of bilateral extradural hamatomas, which is placed anatomically symmetrically on both the sides of the intracranial compartment, requires prompt diagnosis and emergent surgical intervention as it carry high mortality if evacuation of hematoma is not carried out expeditely. The mortality rate still remains higher in comparison to unilateral single extradural hematomas. The postoperative outcome depends on preoperative neurological status, total volume of blood, accurate diagnosis and prompt shifting to neurosurgical facility, expatiation of surgical procedure, pre- hospital care. Authors report a case of a - 65-year-old man who presented with acute simultaneous bilateral extradural haematomas following road traffic accident, underwent bilateral trephine craniotomy and simultaneous evacuation on both side led to good recovery.

The added value of mifepristone to non-surgical treatment regimens for uterine evacuation in case of early pregnancy failure: a systematic review of the literature

NARCIS (Netherlands)

Berg, J. van den; Gordon, B.B.; Snijders, M.P.M.L.; Vandenbussche, F.P.H.A.; Coppus, S.F.P.J.

2015-01-01

OBJECTIVE(S): Early pregnancy failure (EPF) is a common complication of pregnancy. Surgical intervention carries a risk of complications and, therefore, medical treatment appears to be a safe alternative. Unfortunately, the current medical treatment with misoprostol alone has complete evacuation

Surgical smoke.

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Fan, Joe King-Man; Chan, Fion Siu-Yin; Chu, Kent-Man

2009-10-01

Surgical smoke is the gaseous by-product formed during surgical procedures. Most surgeons, operating theatre staff and administrators are unaware of its potential health risks. Surgical smoke is produced by various surgical instruments including those used in electrocautery, lasers, ultrasonic scalpels, high speed drills, burrs and saws. The potential risks include carbon monoxide toxicity to the patient undergoing a laparoscopic operation, pulmonary fibrosis induced by non-viable particles, and transmission of infectious diseases like human papilloma virus. Cytotoxicity and mutagenicity are other concerns. Minimisation of the production of surgical smoke and modification of any evacuation systems are possible solutions. In general, a surgical mask can provide more than 90% protection to exposure to surgical smoke; however, in most circumstances it cannot provide air-tight protection to the user. An at least N95 grade or equivalent respirator offers the best protection against surgical smoke, but whether such protection is necessary is currently unknown.

Risk factors in surgical management of thoracic empyema in elderly patients.

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Hsieh, Ming-Ju; Liu, Yun-Hen; Chao, Yin-Kai; Lu, Ming-Shian; Liu, Hui-Ping; Wu, Yi-Cheng; Lu, Hung-I; Chu, Yen

2008-06-01

Although elderly patients with thoracic disease were considered to be poor candidates for thoracotomy before, recent advances in preoperative and postoperative care as well as surgical techniques have improved outcomes of thoracotomies in this patient group. The aim of this study was to investigate surgical risk factors and results in elderly patients (aged > or =70 years) with thoracic empyema. Seventy-one elderly patients with empyema thoracis were enrolled and evaluated from July 2000 to April 2003. The following characteristics and clinical data were analysed: age, sex, aetiology of empyema, comorbid diseases, preoperative conditions, postoperative days of intubation, length of hospital stay after surgery, complications and mortality. Surgical intervention, including total pneumonolysis and evacuation of the pleura empyema cavity, was carried out in all patients. Possible influent risk factors on the outcome were analysed. The sample group included 54 men and 17 women with an average age of 76.8 years. The causes of empyema included parapneumonic effusion (n = 43), lung abscess (n = 8), necrotizing pneumonitis (n = 8), malignancy (n = 5), cirrhosis (n = 2), oesophageal perforation (n = 2), post-traumatic empyema (n = 2) and post-thoracotomy complication (n = 1). The 30-day mortality rate was 11.3% and the in-hospital mortality rate was 18.3% (13 of 71). Mean follow up was 9.4 months and mean duration of postoperative hospitalization was 35.8 days. Analysis of risk factors showed that patients with necrotizing pneumonitis or abscess had the highest mortality rate (10 of 18, 62.6%). The second highest risk factor was preoperative intubation or ventilator-dependency (8 of 18, 44.4%). This study presents the clinical features and outcomes of 71 elderly patients with empyema thoracis who underwent surgical treatment. The 30-day surgical mortality rate was 11.3%. Significant risk factors in elderly patients with empyema thoracis were necrotizing pneumonitis, abscess

Surgery for bilateral large intracranial traumatic hematomas: evacuation in a single session.

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Kompheak, Heng; Hwang, Sun-Chul; Kim, Dong-Sung; Shin, Dong-Sung; Kim, Bum-Tae

2014-06-01

Management guidelines for single intracranial hematomas have been established, but the optimal management of multiple hematomas has little known. We present bilateral traumatic supratentorial hematomas that each has enough volume to be evacuated and discuss how to operate effectively it in a single anesthesia. In total, 203 patients underwent evacuation and/or decompressive craniectomies for acute intracranial hematomas over 5 years. Among them, only eight cases (3.9%) underwent operations for bilateral intracranial hematomas in a single session. Injury mechanism, initial Glasgow Coma Scale score, types of intracranial lesions, surgical methods, and Glasgow outcome scale were evaluated. The most common injury mechanism was a fall (four cases). The types of intracranial lesions were epidural hematoma (EDH)/intracerebral hematoma (ICH) in five, EDH/EDH in one, EDH/subdural hematoma (SDH) in one, and ICH/SDH in one. All cases except one had an EDH. The EDH was addressed first in all cases. Then, the evacuation of the ICH was performed through a small craniotomy or burr hole. All patients except one survived. Bilateral intracranial hematomas that should be removed in a single-session operation are rare. Epidural hematomas almost always occur in these cases and should be removed first to prevent the hematoma from growing during the surgery. Then, the other hematoma, contralateral to the EDH, can be evacuated with a small craniotomy.

Prognostic Significance of Ultraearly Hematoma Growth in Spontaneous Intracerebral Hemorrhage Patients Receiving Hematoma Evacuation.

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Yu, Zhiyuan; Zheng, Jun; Guo, Rui; Ma, Lu; Li, Mou; Wang, Xiaoze; Lin, Sen; You, Chao; Li, Hao

2018-01-01

To investigate the association between ultraearly hematoma growth (uHG) and clinical outcome in patients with spontaneous intracerebral hemorrhage (sICH) receiving hematoma evacuation. Supratentorial sICH patients receiving hematoma evacuation within 24 hours after ictus were enrolled in this study. uHG was defined as baseline hematoma volume/onset-to-computed tomography (CT) time (mL/h). The outcome was assessed by the modified Rankin Scale (mRS) score at 3 months. Unfavorable outcome was defined as mRS >2. A total of 93 patients were enrolled in this study. The mean uHG was 10.3 ± 5.5 mL/h. In 69 (74.2%) of patients, the outcome was unfavorable at 3 months. The uHG in patients with unfavorable outcome were significantly higher than in those with favorable outcome (11.0 ± 6.1 mL/h vs. 8.3 ± 2.5 mL/h, P = 0.003). The optimal cutoff of uHG for predicting unfavorable outcome was 8.7 mL/h. The sensitivity, specificity, positive predictive value, and negative predictive value of uHG >8.7 mL/h for predicting unfavorable outcome were 56.5%, 75.0%, 86.7%, and 37.5%, respectively. uHG is a helpful predictor of unfavorable outcome in sICH patients treated with hematoma evacuation. The optimal cutoff of uHG to assist in predicting unfavorable outcome in sICH patients receiving hematoma evacuation is 8.7mL/h. Copyright © 2017 Elsevier Inc. All rights reserved.

Case series: Bladder clot evacuation using a prostate morcellation device.

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Doersch, Karen M; Navetta, Andrew F; Bird, Erin T; El Tayeb, Marawan M

2017-07-01

We sought to provide a technical update on the use of a prostate morcellator device (PMD) to manage organized blood clots of the bladder following laser prostatectomy. Herein, we describe our experience in using the Wolf Piranha morcellator in managing organized bladder blood clots supplemented with a retrospective chart review of the patients in whom this procedure was performed. Six patients, all male with a mean age of 75 ± 8.9 years, had organized bladder clots following either holmium laser enucleation or photoselective vaporization of the prostate managed with a PMD. Clots were recognized based on hematuria or urinary retention a median of 3.5 days following the aforementioned procedures. Initial management was attempted with more conservative measures, including a three-way Foley catheter, followed by cystoscopy with an Ellik evacuator, or a glass Tommey syringe. Morcellation times were a mean of 10.2 ± 6.15 minutes (range 2-18). This technique was able to manage clots that were an average of 173.3 ± 115.9 cc in size. The procedure was well-tolerated. No patients experienced intraoperative or morcellator-related complications. Benign prostatic hypertrophy frequently requires surgical endoscopic management and can be complicated by hematuria and bladder blood clot formation. When these clots become organized, this can lead to urinary retention and the required management, evacuation, may be difficult. The use of a Wolf Piranha PMD is a safe, well-tolerated, and effective in evacuating organized blood clots of the bladder.

Minimally Invasive Subcortical Parafascicular Transsulcal Access for Clot Evacuation (Mi SPACE for Intracerebral Hemorrhage

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Benjamin Ritsma

2014-01-01

Full Text Available Background. Spontaneous intracerebral hemorrhage (ICH is common and causes significant mortality and morbidity. To date, optimal medical and surgical intervention remains uncertain. A lack of definitive benefit for operative management may be attributable to adverse surgical effect, collateral tissue injury. This is particularly relevant for ICH in dominant, eloquent cortex. Minimally invasive surgery (MIS offers the potential advantage of reduced collateral damage. MIS utilizing a parafascicular approach has demonstrated such benefit for intracranial tumor resection. Methods. We present a case of dominant hemisphere spontaneous ICH evacuated via the minimally invasive subcortical parafascicular transsulcal access clot evacuation (Mi SPACE model. We use this report to introduce Mi SPACE and to examine the application of this novel MIS paradigm. Case Presentation. The featured patient presented with a left temporal ICH and severe global aphasia. The hematoma was evacuated via the Mi SPACE approach. Postoperative reassessments showed significant improvement. At two months, bedside language testing was normal. MRI tractography confirmed limited collateral injury. Conclusions. This case illustrates successful application of the Mi SPACE model to ICH in dominant, eloquent cortex and subcortical regions. MRI tractography illustrates collateral tissue preservation. Safety and feasibility studies are required to further assess this promising new therapeutic paradigm.

Prevalence and Factors Associated with Hydatidiform Mole among Patients Undergoing Uterine Evacuation at Mbarara Regional Referral Hospital

OpenAIRE

Mulisya, Olivier; Roberts, Drucilla J.; Sengupta, Elizabeth S.; Agaba, Elly; Laffita, Damaris; Tobias, Tusabe; Mpiima, Derrick Paul; Henry, Lugobe; Augustine, Ssemujju; Abraham, Masinda; Hillary, Twizerimana; Mugisha, Julius

2018-01-01

Objective. We sought to determine the prevalence of and factors associated with hydatidiform molar gestations amongst patients undergoing uterine evacuation at Mbarara Regional Referral Hospital (MRRH), Mbarara, Uganda. Methods. This was a cross-sectional study carried out from November 2016 to February 2017. All patients admitted for uterine evacuation for nonviable pregnancy were included. The study registered 181 patients. Data were collected on sociodemographics, medical conditions, obste...

Appendicostomy irrigation for facilitating colonic evacuation in colostomy patients. Preliminary report.

Science.gov (United States)

Kotanagi, H; Koyama, K; Sato, Y; Takahashi, K

1998-08-01

A method for bowel irrigation through an appendicostomy (antegrade colonic enema) for patients with a left colostomy is described. The appendicostomy is easily constructed without morbidity. Irrigation through the appendicostomy is performed with minimum equipment, uses a small volume of irrigation water, and takes a relatively short time. This may improve colonic evacuation in patients with left colostomy.

Predictive value of impaired evacuation at proctography in diagnosing anismus.

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Halligan, S; Malouf, A; Bartram, C I; Marshall, M; Hollings, N; Kamm, M A

2001-09-01

We aimed to determine the positive predictive value of impaired evacuation during evacuation proctography for the subsequent diagnosis of anismus. Thirty-one adults with signs of impaired evacuation (defined as the inability to evacuate two thirds of a 120 mL contrast enema within 30 sec) during evacuation proctography underwent subsequent anorectal physiologic testing for anismus. A physiologic diagnosis of anismus was based on a typical clinical history of the condition combined with impaired rectal balloon expulsion or abnormal surface electromyogram. Twenty-eight (90%) of the 31 patients with impaired proctographic evacuation were found to have anismus at subsequent physiologic testing. Among the 28 were all 10 patients who evacuated no contrast medium and all 11 patients with inadequate pelvic floor descent, giving evacuation proctography a positive predictive value of 90% for the diagnosis of anismus. A prominent puborectal impression was seen in only three subjects during proctography, one of whom subsequently showed no physiologic sign of anismus. Impaired evacuation during evacuation proctography is highly predictive for diagnosis of anismus.

A prospective randomized study of use of drain versus no drain after burr-hole evacuation of chronic subdural hematoma.

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Singh, Amit Kumar; Suryanarayanan, Bhaskar; Choudhary, Ajay; Prasad, Akhila; Singh, Sachin; Gupta, Laxmi Narayan

2014-01-01

Chronic subdural hematoma (CSDH) recurs after surgical evacuation in 5-30% of patients. Inserting subdural drain might reduce the recurrence rate, but is not commonly practiced. There are few prospective studies to evaluate the effect of subdural drains. A prospective randomized study to investigate the effect of subdural drains in the on recurrence rates and clinical outcome following burr-hole drainage (BHD) of CSDH was undertaken. During the study period, 246 patients with CSDH were assessed for eligibility. Among 200 patients fulfilling the eligibility criteria, 100 each were assigned to "drain group" (drain inserted into the subdural space following BHD) and "without drain group" (subdural drain was not inserted following BHD) using random allocation software. The primary end point was recurrence needing re-drainage up to a period of 6 months from surgery. Recurrence occurred in 9 of 100 patients with a drain, and 26 of 100 patients in without drain group (P = 0.002). The mortality was 5% in patients with drain and 4% in patients without drain group (P = 0.744). The medical and surgical complications were comparable between the two study groups. Use of a subdural drain after burr-hole evacuation of a CSDH reduces the recurrence rate and is not associated with increased complications.

Dose reduction in evacuation proctography

International Nuclear Information System (INIS)

Hare, C.; Halligan, S.; Bartram, C.I.; Gupta, R.; Walker, A.E.; Renfrew, I.

2001-01-01

The goal of this study was to reduce the patient radiation dose from evacuation proctography. Ninety-eight consecutive adult patients referred for proctography to investigate difficult rectal evacuation were studied using a digital imaging system with either a standard digital program for barium examinations, a reduced dose digital program (both with and without additional copper filtration), or Video fluoroscopy. Dose-area products were recorded for each examination and the groups were compared. All four protocols produced technically acceptable examinations. The low-dose program with copper filtration (median dose 382 cGy cm 2 ) and Video fluoroscopy (median dose 705 cGy cm 2 ) were associated with significantly less dose than other groups (p < 0.0001). Patient dose during evacuation proctography can be reduced significantly without compromising the diagnostic quality of the examination. A digital program with added copper filtration conveyed the lowest dose. (orig.)

Intrarectal pressures and balloon expulsion related to evacuation proctography.

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Halligan, S; Thomas, J; Bartram, C

1995-01-01

Seventy four patients with constipation were examined by standard evacuation proctography and then attempted to expel a small, non-deformable rectal balloon, connected to a pressure transducer to measure intrarectal pressure. Simultaneous imaging related the intrarectal position of the balloon to rectal deformity. Inability to expel the balloon was associated proctographically with prolonged evacuation, incomplete evacuation, reduced anal canal diameter, and acute anorectal angulation during evacuation. The presence and size of rectocoele or intussusception was unrelated to voiding of paste or balloon. An independent linear combination of pelvic floor descent and evacuation time on proctography correctly predicted maximum intrarectal pressure in 74% of cases. No patient with both prolonged evacuation and reduced pelvic floor descent on proctography could void the balloon, as maximum intrarectal pressure was reduced in this group. A prolonged evacuation time on proctography, in combination with reduced pelvic floor descent, suggests defecatory disorder may be caused by inability to raise intrarectal pressure. A diagnosis of anismus should not be made on proctography solely on the basis of incomplete/prolonged evacuation, as this may simply reflect inadequate straining. PMID:7672656

Optimization-based decision support to assist in logistics planning for hospital evacuations.

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Glick, Roger; Bish, Douglas R; Agca, Esra

2013-01-01

The evacuation of the hospital is a very complex process and evacuation planning is an important part of a hospital's emergency management plan. There are numerous factors that affect the evacuation plan including the nature of threat, availability of resources and staff the characteristics of the evacuee population, and risk to patients and staff. The safety and health of patients is of fundamental importance, but safely moving patients to alternative care facilities while under threat is a very challenging task. This article describes the logistical issues and complexities involved in planning and execution of hospital evacuations. Furthermore, this article provides examples of how optimization-based decision support tools can help evacuation planners to better plan for complex evacuations by providing real-world solutions to various evacuation scenarios.

The role of repairing lung lacerations during video-assisted thoracoscopic surgery evacuations for retained haemothorax caused by blunt chest trauma.

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Chou, Yi-Pin; Kuo, Liang-Chi; Soo, Kwan-Ming; Tarng, Yih-Wen; Chiang, Hsin-I; Huang, Fong-Dee; Lin, Hsing-Lin

2014-07-01

Retained haemothorax and pneumothorax are the most common complications after blunt chest traumas. Lung lacerations derived from fractures of the ribs are usually found in these patients. Video-assisted thoracoscopic surgery (VATS) is usually used as a routine procedure in the treatment of retained pleural collections. The objective of this study was to find out if there is any advantage in adding the procedure for repairing lacerated lungs during VATS. Patients who were brought to our hospital with blunt chest trauma were enrolled into this prospective cohort study from January 2004 to December 2011. All enrolled patients had rib fractures with type III lung lacerations diagnosed by CT scans. They sustained retained pleural collections and surgical drainage was indicated. On one group, only evacuation procedure by VATS was performed. On the other group, not only evacuations but also repair of lung injuries were performed. Patients with penetrating injury or blunt injury with massive bleeding, that required emergency thoracotomy, were excluded from the study, in addition to those with cardiovascular or oesophageal injuries. During the study period, 88 patients who underwent thoracoscopy were enrolled. Among them, 43 patients undergoing the simple thoracoscopic evacuation method were stratified into Group 1. The remaining 45 patients who underwent thoracoscopic evacuation combined with resection of lung lacerations were stratified into Group 2. The rates of post-traumatic infection were higher in Group 1. The durations of chest-tube drainage and ventilator usage were shorter in Group 2, as were the lengths of patient intensive care unit stay and hospital stay. When compared with simple thoracoscopic evacuation methods, repair and resection of the injured lungs combined may result in better clinical outcomes in patients who sustained blunt chest injuries. © The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio

Evacuation exercise

CERN Multimedia

AUTHOR|(CDS)2094367

2017-01-01

In the event of an emergency, it is important that staff and visitors are evacuated safely and efficiently. Hence CERN organises regularly emergency response and evacuation exercise (also known as an ‘evacuation drill’) in different buildings across the sites.

The Safety and Feasibility of Image-Guided BrainPath-Mediated Transsulcul Hematoma Evacuation: A Multicenter Study.

Science.gov (United States)

Labib, Mohamed A; Shah, Mitesh; Kassam, Amin B; Young, Ronald; Zucker, Lloyd; Maioriello, Anthony; Britz, Gavin; Agbi, Charles; Day, J D; Gallia, Gary; Kerr, Robert; Pradilla, Gustavo; Rovin, Richard; Kulwin, Charles; Bailes, Julian

2017-04-01

Subcortical injury resulting from conventional surgical management of intracranial hemorrhage may counteract the potential benefits of hematoma evacuation. To evaluate the safety and potential benefits of a novel, minimally invasive approach for clot evacuation in a multicenter study. The integrated approach incorporates 5 competencies: (1) image interpretation and trajectory planning, (2) dynamic navigation, (3) atraumatic access system (BrainPath, NICO Corp, Indianapolis, Indiana), (4) extracorporeal optics, and (5) automated atraumatic resection. Twelve neurosurgeons from 11 centers were trained to use this approach through a continuing medical education-accredited course. Demographical, clinical, and radiological data of patients treated over 2 years were analyzed retrospectively. Thirty-nine consecutive patients were identified. The median Glasgow Coma Scale (GCS) score at presentation was 10 (range, 5-15). The thalamus/basal ganglion regions were involved in 46% of the cases. The median hematoma volume and depth were 36 mL (interquartile range [IQR], 27-65 mL) and 1.4 cm (IQR, 0.3-2.9 cm), respectively. The median time from ictus to surgery was 24.5 hours (IQR, 16-66 hours). The degree of hematoma evacuation was ≥90%, 75% to 89%, and 50% to 74% in 72%, 23%, and 5.0% of the patients, respectively. The median GCS score at discharge was 14 (range, 8-15). The improvement in GCS score was statistically significant ( P < .001). Modified Rankin Scale data were available for 35 patients. Fifty-two percent of those patients had a modified Rankin Scale score of ≤2. There were no mortalities. The approach was safely performed in all patients with a relatively high rate of clot evacuation and functional independence. Copyright © 2016 by the Congress of Neurological Surgeons

Surgical Management of the Recent Orbital War Injury.

Science.gov (United States)

Riyadh, Safaa; Abdulrazaq, Saif Saadedeen; Zirjawi, Ali Mhana Sabeeh

2018-05-08

Maxillofacial trauma affects sensitive and essential functions for the human being such as smell, breathing, talking, and the most importantly the sight. Trauma to the orbit may cause a vision loss especially if this trauma yields a high kinetic energy like that encountered during wars. The purpose of the study was to evaluate the surgical outcomes of the orbital war trauma, enriching the literature with the experience of the authors in this field. A total of 16 patients were injured, evacuated, and managed, between June 2014 and June 2017, from the fight between the Iraqi army and the Islamic State of Iraq and Syria (ISIS) in different areas of Iraq. Two-stage protocol was adopted, that is debridement and reconstruction. There were 14 military patients and 2 civilians. The cause of trauma was either bullet or shrapnel from an explosion. In the battlefield, delayed evacuation of the casualties led to increase the morbidity and mortality. Wearing a protective shield over the eye during the war along with fast evacuation highly improved the survival rates.

Evacuated aerogel glazings

DEFF Research Database (Denmark)

Schultz, Jørgen Munthe; Jensen, Karsten Ingerslev

2008-01-01

This paper describes the main characteristics of monolithic silica aerogel and its application in evacuated superinsulating aerogel glazing including the evacuation and assembling process. Furthermore, the energetic benefit of aerogel glazing is quantified. In evacuated aerogel glazing the space ......) combined with a solar energy transmittance above 0.75.......This paper describes the main characteristics of monolithic silica aerogel and its application in evacuated superinsulating aerogel glazing including the evacuation and assembling process. Furthermore, the energetic benefit of aerogel glazing is quantified. In evacuated aerogel glazing the space...... between the glass panes is filled with monolithic silica aerogel evacuated to a rough vacuum of approximately 1-10 hPa. The aerogel glazing does not depend on use of low emissive coatings that have the drawback of absorbing a relatively large part of the solar radiation that otherwise could reduce...

Evacuation of Children

DEFF Research Database (Denmark)

Larusdottir, Aldis Run

is to provide new data and information on children’s evacuation, which is a step towards including children in evacuation models and calculations. Little is known about children’s evacuation characteristics in fire compared to other parts of the population. In recent years there has been more focus on children’s...... evacuation which is reflected in a rising number of publications on the topic. This thesis comprises evacuation experiments in daycares for children 0-6 years old and elementary schools for children aged 6-15 years. Full scale evacuations were filmed allowing detailed data analysis. Findings and results...... to isolate single factors and findings. Although an engineering approach fits best to the measurable parameters, the other areas are at least equally important when investigating or predicting children’s evacuation. The key findings of the thesis are: Children are very dependent on adults for initiating...

Dynamic imaging of posterior compartment pelvic floor dysfunction by evacuation proctography: Techniques, indications, results and limitations

International Nuclear Information System (INIS)

Maglinte, Dean D.T.; Bartram, Clive

2007-01-01

The clinical management of patients with anorectal and pelvic floor dysfunction is often difficult. Evacuation proctography has evolved from a method to evaluate the anorectum for functional disorders to its current status as a practical method for evaluating anorectal dysfunction and pelvic floor prolapse. It has a high observer accuracy and yield of positive diagnosis. Clinicians find it of major benefit and has altered management from surgical to medical and vice versa in a significant number of cases

Prevalence and Factors Associated with Hydatidiform Mole among Patients Undergoing Uterine Evacuation at Mbarara Regional Referral Hospital

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Olivier Mulisya

2018-01-01

Full Text Available Objective. We sought to determine the prevalence of and factors associated with hydatidiform molar gestations amongst patients undergoing uterine evacuation at Mbarara Regional Referral Hospital (MRRH, Mbarara, Uganda. Methods. This was a cross-sectional study carried out from November 2016 to February 2017. All patients admitted for uterine evacuation for nonviable pregnancy were included. The study registered 181 patients. Data were collected on sociodemographics, medical conditions, obstetrics, and gynecological factors. The evacuated tissue received a full gross and histopathologic examination. Cases of pathologically suspected complete hydatidiform mole were confirmed by p57 immunohistochemistry. Data were analyzed using STATA 13. Results. The prevalence of hydatidiform mole was 6.1% (11/181. All detected moles were complete hydatidiform moles, and there were no diagnosed partial hydatidiform moles. Clinical diagnosis of molar pregnancy was suspected in 13 patients, but only 69.2% (9/13 were confirmed as molar pregnancies histologically. Two cases were clinically unsuspected. Factors that had a significant relationship with complete hydatidiform mole included maternal age of 35 years and above (aOR 13.5; CI: 1.46–125.31; p=0.00, gestational age beyond the first trimester at the time of uterine evacuation (aOR 6.2; CI: 1.07–36.14; p=0.04, and history of previous abortion (aOR 4.3; CI: 1.00–18.57; p=0.05. Conclusion. The prevalence of complete hydatidiform mole was high at 6.1%. Associated risk factors included advanced maternal age (35 years and above, history of previous abortions, and gestational age beyond the first trimester at the time of evacuations. Recommendations. We recommend putting in place capacity to do routine histopathological examination of all products of conception especially those at high risk for a molar gestation either by clinical suspicion or by risk factors including advanced maternal age, advanced gestational

Indoor guided evacuation: TIN for graph generation and crowd evacuation

Directory of Open Access Journals (Sweden)

Mengchao Xu

2016-05-01

Full Text Available This paper presents two complementary methods: an approach to compute a network data-set for indoor space of a building by using its two-dimensional (2D floor plans and limited semantic information, combined with an optimal crowd evacuation method. The approach includes three steps: (1 generate critical points in the space, (2 connect neighbour points to build up the network, and then (3 run the optimal algorithm for optimal crowd evacuation from a room to the exit gates of the building. Triangulated Irregular Network (TIN is used in the first two steps. The optimal evacuation crowd is not based on the nearest evacuation gate for a person but relies on optimal sorting of the waiting lists at each gate of the room to be evacuated. As an example case, a rectangular room with 52 persons with two gates is evacuated in 102 elementary interval times (one interval corresponds to the time for one step for normal velocity walking, whereas it would have been evacuated in not less than 167 elementary steps. The procedure for generating the customized network involves the use of 2D floor plans of a building and some common Geographic Information System (GIS functions. This method combined with the optimal sorting lists will be helpful for guiding crowd evacuation during any emergency.

Initial management of hospital evacuations caused by Hurricane Rita: a systematic investigation.

Science.gov (United States)

Downey, Erin L; Andress, Knox; Schultz, Carl H

2013-06-01

Hurricanes remain a major threat to hospitals throughout the world. The authors attempted to identify the planning areas that impact hospital management of evacuations and the challenges faced when sheltering-in-place. This observational, retrospective cohort study examined acute care institutions from one hospital system impacted by Hurricane Rita in 2005. Investigators used a standardized survey instrument and interview process, previously used in the hospital evacuation context, to examine hospitals' initial internal situational awareness and subsequent decision making that resulted in evacuation due to Hurricane Rita. Participants from each hospital included representatives from senior leadership and clinical and nonclinical staff that comprised the Incident Management Team (IMT). The main measured outcomes were responses to 95 questions contained in the survey. Seven of ten eligible hospitals participated in the study. All facilities evacuated the sickest patients first. The most significant factors prompting evacuation were the issuing of mandatory evacuation orders, storm dynamics (category, projected path, storm surge), and loss of regional communications. Hospitals that sheltered-in-place experienced staff shortages, interruptions to electrical power, and loss of water supplies. Three fully-evacuated institutions experienced understaffing of 40%-60%, and four hospitals sustained depressed staffing levels for over four weeks. Five hospitals lost electricity for a mean of 4.8 days (range .5-11 days). All facilities continued to receive patients to their Emergency Departments (EDs) while conducting their own evacuation. Hospital EDs should plan for continuous patient arrival during evacuation. Emergency Operation Plans (EOPs) that anticipate challenges associated with evacuation will help to maximize initial decision making and management during a crisis situation. Hospitals that shelter-in-place face critical shortages and must provide independent patient

Endoscopic burr hole evacuation of an acute subdural hematoma.

Science.gov (United States)

Codd, Patrick J; Venteicher, Andrew S; Agarwalla, Pankaj K; Kahle, Kristopher T; Jho, David H

2013-12-01

Acute subdural hematoma evacuations frequently necessitate large craniotomies with extended operative times and high relative blood loss, which can lead to additional morbidity for the patient. While endoscopic minimally invasive approaches to chronic subdural collections have been successfully demonstrated, this technique has not previously been applied to acute subdural hematomas. The authors report their experience with an 87-year-old patient presenting with a large acute right-sided subdural hematoma successfully evacuated via an endoscopic minimally invasive technique. The operative approach is outlined, and the literature on endoscopic subdural collection evacuation reviewed. Copyright © 2013. Published by Elsevier Ltd.

Stoma management in a tropical country: colostomy irrigation versus natural evacuation.

Science.gov (United States)

Leong, A F; Yunos, A B

1999-11-01

People with ostomies in Singapore were initially resistant to colostomy irrigation. This study, a prospective crossover study of 26 patients who underwent abdominoperineal resection, compared colostomy irrigation with the natural evacuation method. During the colostomy-irrigation phase of the study, all 26 patients reported an improvement in continence and fewer problems with sleep, sex, and skin complications compared to the natural-evacuation phase. The study also found a reduction in monthly expenses with colostomy irrigation compared to natural evacuation. Patient satisfaction scores were also superior during the colostomy-irrigation phase. This difference in satisfaction scores was less marked in those who were more than 1-year postsurgery than in those who were less than 1-year postsurgery. The difference in satisfaction between colostomy irrigation and natural evacuation scores was statistically significant in the group that was less than 1-year postsurgery, but not in the group that was more than 1-year postsurgery. The study concluded that colostomy irrigation after abdominoperineal resection is superior to natural evacuation in terms of cost and patient satisfaction and should be introduced soon after surgery.

Evacuation proctography - examination technique and method of evaluation

International Nuclear Information System (INIS)

Braunschweig, R.; Schott, U.; Starlinger, M.

1993-01-01

Evacuation proctography is the most important imaging technique to supplement findings of physical examination, manometry, and endoscopy in patients presenting with pathologies in anorectal morphology and function. Indications for evacuation proctography include obstructed defecation or incomplete evacuation, imaging of ileal pouches following excision of the rectum, and suspected anorectal fistulae. Evacuation proctography with thick barium sulfate is performed under fluoroscopy. Documentation of the study can either be done by single-shot X-rays, video recording, or imaging with a 100-mm spot-film camera. Evacuation proctography shows morphologic changes such as spastic pelvic floor, rectocele, enterocele, intussusception and anal prolapse. Measurements can be performed to obtain the anorectal angle, location and mobility of the pelvic floor, and size as well as importance of a rectocele. Qualitative and quantitative data can only be interpreted along with clinical and manometric data. (orig.) [de

Long-term outcomes of patients evacuated from hospitals near the Fukushima Daiichi nuclear power plant after the Great East Japan Earthquake.

Science.gov (United States)

Igarashi, Yutaka; Tagami, Takashi; Hagiwara, Jun; Kanaya, Takahiro; Kido, Norihiro; Omura, Mariko; Tosa, Ryoichi; Yokota, Hiroyuki

2018-01-01

After the accident of the Fukushima Daiichi nuclear power plant due to the Great East Japan Earthquake in March 2011, the Japanese government issued a mandatory evacuation order for people living within a 20 km radius of the nuclear power plant. The aim of the current study was to investigate long-term outcomes of these patients and identify factors related to mortality. Patients who were evacuated from hospitals near the Fukushima Daiichi nuclear power plant to the Aizu Chuo Hospital from 15 to 26 March, 2011 were included in this study. The following data were collected from medical records: age, sex, activities of daily life, hospital they were admitted in at the time of earthquake, distance between the facility and the nuclear power plant, reasons of evacuation and number of transfers. The patient outcomes were collected from medical records and/or investigated on the telephone in January 2012. A total of 97 patients (28 men and 69 women) were transferred from 10 hospitals via ambulances or buses. No patients died or experienced exacerbation during transfer. Median age of the patients was 86 years. Of the total, 36 patients were not able to obey commands, 44 were bed-ridden and 61 were unable to sustain themselves via oral intake of food. Among 86 patients who were followed-up, 41 (48%) died at the end of 2011. Multiple-regression analysis showed that non-oral intake [Hazard Ratio (HR): 6.07, 95% Confidence interval (CI): 1.94-19.0] and male sex [HR: 8.35, 95% CI: 2.14-32.5] had significant impact on mortality. This study found that 48% of the evacuated patients died 9 months after the earthquake and they had significantly higher mortality rate than the nursing home residents. Non-oral intake and male sex had significant impact on mortality. These patients should be considered as especially vulnerable in case of hospital evacuation.

Surgical Management of Calcified Liver Hydatid Cyst Complicated with Thoracobiliary Fistula: A Case Series and Literature Review

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Mohsen Sokouti

2016-06-01

Full Text Available Thoracobiliary fistula is a rare complication of hydatid cyst of the liver especially in the calcified form. Surgery is the only medical option. The treatment consists of radical surgical procedures in the majority of the patients. Conservative surgical treatments are performed with high mortality rate. Herein, we will describe two patients of calcified hydatid cysts of the liver whose condition becomes complicated with Thoracobiliary fistula. The first patient was treated with right thoracotomy and resection of pleural hydatid cysts. Then, were evacuated the ruptured laminated membrane and daughter cysts of infected hepatic hydatid cysts through diaphragmatic opening and sub diaphragmatic drainage of the calcified liver hydatid cyst. The second patient was also treated with right thoracotomy, resection of pulmonary hydatid cysts, evacuation of ruptured bile stained laminated membrane and daughter cysts of hepatic hydatid cysts through diaphragmatic opening and sub diaphragmatic drainage of the calcified cyst cavity. Our patients underwent conservative surgery which posed a severe risk. Both cases are discussed together with review of the literature.

Gastic content evacuation rate in healthy persons and in patients (a radionuyclide study)

International Nuclear Information System (INIS)

Ablyazov, A.A.; Dudurev, A.L.; Yakovleva, L.A.

1991-01-01

A method is proposed for the determination of differences in the rate of evacuation of 3 types of test brakfast: boiled semolina, boiled semolina with proteins or fat. Evacuatory function of food mass mixed with RP of the gastroduodenal system was investigated in healthy persons and in 44 patients using a gamma-camera. The results obtained indicate the complex nature of gastric content evacuatory disorders in gastroenterologic patients, and it should be taken into account in differential diagnosis and therapy

Early surgical treatment of middle cerebral artery aneurysms associated with intracerebral haematoma.

Science.gov (United States)

Prat, Ricardo; Galeano, Inmaculada

2007-06-01

Patients with haematoma secondary to middle cerebral artery aneurysm often require urgent surgical treatment consisting of evacuation of the haematoma and aneurysmal clipping. . We present our experience over 5 years with 12 patients who underwent surgery before the first 8h of bleeding. Surgery included craniotomy, evacuation of the haematoma, and aneurysmal clipping. Preoperative angiography was performed in all cases. All patients had a score of 4 or 5 on the scale of the World Federation of Neurological Surgeons. Five of the patients were evolving well after 1 year. Clinical status upon admission, temporal lobe versus sylvian location of the haematoma, right-hemisphere involvement, and a midline deviation of less than 2 cm, were all most frequently associated with a good prognosis. In our experience, and in the literature available to us, early surgery in patients with haematoma secondary to middle cerebral artery aneurysm offers acceptable results in patients with World Federation of Neurological Surgeons scores of 4 or 5.

Fatal collapse due to autonomic dysreflexia during manual self-evacuation of bowel in a tetraplegic patient living alone: lessons to learn

Directory of Open Access Journals (Sweden)

Vaidyanathan S

2017-11-01

Full Text Available Subramanian Vaidyanathan,1 Bakul M Soni,1 Paul Mansour,2 Tun Oo1 1Regional Spinal Injuries Centre, 2Department of Histopathology, Southport and Formby District General Hospital, Town Lane, Southport, UK Background: To identify areas for improvement, the National Health Service in England mandates the review of case reports of patients who have died, which should be translated into improved care for other patients. Case report: A 49-year-old Caucasian man sustained C-7 tetraplegia in a motorcycle accident in 1992. In 2009, he developed seizures and collapsed in the lavatory on a number of occasions during manual self-evacuation of his bowel. A 24-hour electrocardiogram recording at that time showed sinus rhythm with a maximum heart rate of 97 and a minimum of 39 beats per minute; there were no significant arrhythmias that could have contributed to his episodes of collapse. In 2015, the patient again collapsed while performing manual evacuation of his bowel; on this occasion, he did not suffer a seizure. He was found unresponsive in the bathroom by his daughter, who contacted the emergency services. He recovered consciousness on arrival at the Accident and Emergency Department. A noncontrast computed tomography scan of his head revealed no acute intracranial pathology. In 2016, he suffered a fatal collapse in the lavatory, again while performing manual bowel evacuation. At autopsy, no other significant disease was found that might have caused death, and given the clinical history, the cause of death was recorded as autonomic dysreflexia. Conclusion: There were delays in 1 recognizing that his episodes of collapse in the lavatory were due to autonomic dysreflexia induced by manual bowel evacuation; 2 recommending the prior application of topical 2% lidocaine jelly to prevent or limit autonomic dysreflexia occurring during manual bowel evacuation; and 3 considering alternative bowel management such as stimulant laxatives, transanal irrigation, or

Feasibility of evacuation

International Nuclear Information System (INIS)

1988-01-01

The main question is whether evacuation of people is feasible in case of accidents with a nuclear power plant. The limiting conditions of this question are extracted from other studies. This study is therefore focused on a postulated accident in a newly built nuclear power plant with an electric capacity of 1000 Megawatt and a source term of one percent. In this particular case an evacuation should take place within the period between the accident and the emission of nuclear materials. Initial focus is on the administrative-organizational aspects of evacuation. Then bottlenecks in the technical implementation of evacuation are determined. An analysis is made for each potential Dutch location (Borssele, Eemshaven, Maasvlakte, Moerdijk and Westelijke Noordoostpolderdijk) of a nuclear power plant. By means of a model the following question is examined: can the population leave the danger area or be evacuated on time, under certain circumstances. It is concluded that preventive evacuation of the population from the planned locations is feasible, but at Moerdijk complications may occur because of the presence of some homes for the elderly and a nursing home. 18 refs.; 7 figs.; 2 tabs

Behavior-based evacuation planning

KAUST Repository

Rodriguez, Samuel

2010-05-01

In this work, we present a formulation of an evacuation planning problem that is inspired by motion planning and describe an integrated behavioral agent-based and roadmap-based motion planning approach to solve it. Our formulation allows users to test the effect on evacuation of a number of different environmental factors. One of our main focuses is to provide a mechanism to investigate how the interaction between agents influences the resulting evacuation plans. Specifically, we explore how various types of control provided by a set of directing agents effects the overall evacuation planning strategies of the evacuating agents. ©2010 IEEE.

Behavior-based evacuation planning

KAUST Repository

Rodriguez, Samuel; Amato, Nancy M

2010-01-01

In this work, we present a formulation of an evacuation planning problem that is inspired by motion planning and describe an integrated behavioral agent-based and roadmap-based motion planning approach to solve it. Our formulation allows users to test the effect on evacuation of a number of different environmental factors. One of our main focuses is to provide a mechanism to investigate how the interaction between agents influences the resulting evacuation plans. Specifically, we explore how various types of control provided by a set of directing agents effects the overall evacuation planning strategies of the evacuating agents. ©2010 IEEE.

Evacuation of Hospitals during Disaster, Establishment of a Field Hospital, and Communication

OpenAIRE

Tekin, Erdal; Bayramoglu, Atif; Uzkeser, Mustafa; Cakir, Zeynep

2017-01-01

The buildings, working personnel, and patients and their relatives may directly or indirectly be affected by the disasters. Here we will discuss evacuation, establishing a field hospital, communication, the role of the media in disasters, and defending against sabotage. The affected individuals should be evacuated and transferred to secure zones safely and rapidly. How the decision for evacuation should be made and how the evacuation triage should be performed are important issues. Field hosp...

Evacuation of the ICU: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement.

Science.gov (United States)

King, Mary A; Niven, Alexander S; Beninati, William; Fang, Ray; Einav, Sharon; Rubinson, Lewis; Kissoon, Niranjan; Devereaux, Asha V; Christian, Michael D; Grissom, Colin K

2014-10-01

Despite the high risk for patient harm during unanticipated ICU evacuations, critical care providers receive little to no training on how to perform safe and effective ICU evacuations. We reviewed the pertinent published literature and offer suggestions for the critical care provider regarding ICU evacuation. The suggestions in this article are important for all who are involved in pandemics or disasters with multiple critically ill or injured patients, including front-line clinicians, hospital administrators, and public health or government officials. The Evacuation and Mobilization topic panel used the American College of Chest Physicians (CHEST) Guidelines Oversight Committee's methodology to develop seven key questions for which specific literature searches were conducted to identify studies upon which evidence-based recommendations could be made. No studies of sufficient quality were identified. Therefore, the panel developed expert opinion-based suggestions using a modified Delphi process. Based on current best evidence, we provide 13 suggestions outlining a systematic approach to prepare for and execute an effective ICU evacuation during a disaster. Interhospital and intrahospital collaboration and functional ICU communication are critical for success. Pre-event planning and preparation are required for a no-notice evacuation. A Critical Care Team Leader must be designated within the Hospital Incident Command System. A three-stage ICU Evacuation Timeline, including (1) no immediate threat, (2) evacuation threat, and (3) evacuation implementation, should be used. Detailed suggestions on ICU evacuation, including regional planning, evacuation drills, patient transport preparation and equipment, patient prioritization and distribution for evacuation, patient information and tracking, and federal and international evacuation assistance systems, are also provided. Successful ICU evacuation during a disaster requires active preparation, participation

Hurricane Evacuation Routes

Data.gov (United States)

Department of Homeland Security — Hurricane Evacuation Routes in the United States A hurricane evacuation route is a designated route used to direct traffic inland in case of a hurricane threat. This...

Factors associated with high-rise evacuation: qualitative results from the World Trade Center Evacuation Study.

Science.gov (United States)

Gershon, Robyn R M; Qureshi, Kristine A; Rubin, Marcie S; Raveis, Victoria H

2007-01-01

Due to the fact that most high-rise structures (i.e., >75 feet high, or eight to ten stories) are constructed with extensive and redundant fire safety features, current fire safety procedures typically only involve limited evacuation during minor to moderate fire emergencies. Therefore, full-scale evacuation of high-rise buildings is highly unusual and consequently, little is known about how readily and rapidly high-rise structures can be evacuated fully. Factors that either facilitate or inhibit the evacuation process remain under-studied. This paper presents results from the qualitative phase of the World Trade Center Evacuation Study, a three-year, five-phase study designed to improve our understanding of the individual, organizational, and environmental factors that helped or hindered evacuation from the World Trade Center (WTC) Towers 1 and 2, on 11 September 2001. Qualitative data from semi-structured, in-depth interviews and focus groups involving WTC evacuees were collected and analyzed. On the individual level, factors that affected evacuation included perception of risk (formed largely by sensory cues), preparedness training, degree of familiarity with the building, physical condition, health status, and footwear. Individual behavior also was affected by group behavior and leadership. At the organizational level, evacuation was affected by worksite preparedness planning, including the training and education of building occupants, and risk communication. The environmental conditions affecting evacuation included smoke, flames, debris, general condition and degree of crowdedness on staircases, and communication infrastructure systems (e.g., public address, landline, cellular and fire warden's telephones). Various factors at the individual, organizational, and environmental levels were identified that affected evacuation. Interventions that address the barriers to evacuation may improve the full-scale evacuation of other high-rise buildings under extreme

Surgical Treatment of Acute Pancreatitis.

Science.gov (United States)

Werner, Jens; Uhl, Waldemar; Büchler, Markus W.

2003-10-01

Patients with predicted severe necrotizing pancreatitis as diagnosed by C-reactive protein (>150 mg/L) and/or contrast-enhanced computed tomography should be managed in the intensive care unit. Prophylactic broad-spectrum antibiotics reduce infection rates and survival in severe necrotizing pancreatitis. Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy is a causative therapy for gallstone pancreatitis with impacted stones, biliary sepsis, or obstructive jaundice. Fine needle aspiration for bacteriology should be performed to differentiate between sterile and infected pancreatic necrosis in patients with sepsis syndrome. Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for surgery. Patients with sterile pancreatic necrosis should be managed conservatively. Surgery in patients with sterile necrosis may be indicated in cases of persistent necrotizing pancreatitis and in the rare cases of "fulminant acute pancreatitis." Early surgery, within 14 days after onset of the disease, is not recommended in patients with necrotizing pancreatitis. The surgical approach should be organ-preserving (debridement/necrosectomy) and combined with a postoperative management concept that maximizes postoperative evacuation of retroperitoneal debris and exudate. Minimally invasive surgical procedures have to be regarded as an experimental approach and should be restricted to controlled trials. Cholecystectomy should be performed to avoid recurrence of gallstone-associated acute pancreatitis.

Uncertainty in a spatial evacuation model

Science.gov (United States)

Mohd Ibrahim, Azhar; Venkat, Ibrahim; Wilde, Philippe De

2017-08-01

Pedestrian movements in crowd motion can be perceived in terms of agents who basically exhibit patient or impatient behavior. We model crowd motion subject to exit congestion under uncertainty conditions in a continuous space and compare the proposed model via simulations with the classical social force model. During a typical emergency evacuation scenario, agents might not be able to perceive with certainty the strategies of opponents (other agents) owing to the dynamic changes entailed by the neighborhood of opponents. In such uncertain scenarios, agents will try to update their strategy based on their own rules or their intrinsic behavior. We study risk seeking, risk averse and risk neutral behaviors of such agents via certain game theory notions. We found that risk averse agents tend to achieve faster evacuation time whenever the time delay in conflicts appears to be longer. The results of our simulations also comply with previous work and conform to the fact that evacuation time of agents becomes shorter once mutual cooperation among agents is achieved. Although the impatient strategy appears to be the rational strategy that might lead to faster evacuation times, our study scientifically shows that the more the agents are impatient, the slower is the egress time.

Surgical management of traumatic brain injury

DEFF Research Database (Denmark)

Hartings, Jed A; Vidgeon, Steven; Strong, Anthony J

2014-01-01

in the treatment of TBI at 2 academic medical centers to document variations in real-world practice and evaluate the efficacies of different approaches on postsurgical course and long-term outcome. METHODS: Patients 18 years of age or older who required neurosurgical lesion evacuation or decompression for TBI were...... monitoring of spreading depolarizations; injury characteristics, physiological monitoring data, and 6-month outcomes were collected prospectively. CT scans and medical records were reviewed retrospectively to determine lesion characteristics, surgical indications, and procedures performed. RESULTS: Patients......%-52%), signs of mass effect (midline shift ≥ 5 mm: 43%-52%), and preoperative intracranial pressure (ICP). At VCU, however, surgeries were performed earlier (median 0.51 vs 0.83 days posttrauma, p performed...

Rhabdomyolysis in Critically Ill Surgical Patients.

Science.gov (United States)

Kuzmanovska, Biljana; Cvetkovska, Emilija; Kuzmanovski, Igor; Jankulovski, Nikola; Shosholcheva, Mirjana; Kartalov, Andrijan; Spirovska, Tatjana

2016-07-27

Rhabdomyolysis is a syndrome of injury of skeletal muscles associated with myoglobinuria, muscle weakness, electrolyte imbalance and often, acute kidney injury as severe complication. of this study is to detect the incidence of rhabdomyolysis in critically ill patients in the surgical intensive care unit (ICU), and to raise awareness of this medical condition and its treatment among the clinicians. A retrospective review of all surgical and trauma patients admitted to surgical ICU of the University Surgical Clinic "Mother Teresa" in Skopje, Macedonia, from January 1 st till December 31 st 2015 was performed. Patients medical records were screened for available serum creatine kinase (CK) with levels > 200 U/l, presence of myoglobin in the serum in levels > 80 ng/ml, or if they had a clinical diagnosis of rhabdomyolysis by an attending doctor. Descriptive statistical methods were used to analyze the collected data. Out of totally 1084 patients hospitalized in the ICU, 93 were diagnosed with rhabdomyolysis during the course of one year. 82(88%) patients were trauma patients, while 11(12%) were surgical non trauma patients. 7(7.5%) patients diagnosed with rhabdomyolysis developed acute kidney injury (AKI) that required dialysis. Average values of serum myoglobin levels were 230 ng/ml, with highest values of > 5000 ng/ml. Patients who developed AKI had serum myoglobin levels above 2000 ng/ml. Average values of serum CK levels were 400 U/l, with highest value of 21600 U/l. Patients who developed AKI had serum CK levels above 3000 U/l. Regular monitoring and early detection of elevated serum CK and myoglobin levels in critically ill surgical and trauma patients is recommended in order to recognize and treat rhabdomyolysis in timely manner and thus prevent development of AKI.

Pedestrian evacuation modeling to reduce vehicle use for distant tsunami evacuations in Hawaiʻi

Science.gov (United States)

Wood, Nathan J.; Jones, Jamie; Peters, Jeff; Richards, Kevin

2018-01-01

Tsunami waves that arrive hours after generation elsewhere pose logistical challenges to emergency managers due to the perceived abundance of time and inclination of evacuees to use vehicles. We use coastal communities on the island of Oʻahu (Hawaiʻi, USA) to demonstrate regional evacuation modeling that can identify where successful pedestrian-based evacuations are plausible and where vehicle use could be discouraged. The island of Oʻahu has two tsunami-evacuation zones (standard and extreme), which provides the opportunity to examine if recommended travel modes vary based on zone. Geospatial path distance models are applied to estimate population exposure as a function of pedestrian travel time and speed out of evacuation zones. The use of the extreme zone triples the number of residents, employees, and facilities serving at-risk populations that would be encouraged to evacuate and slightly reduces the percentage of residents (98–76%) that could evacuate in less than 15 min at a plausible speed (with similar percentages for employees). Areas with lengthy evacuations are concentrated in the North Shore region for the standard zone but found all around the Oʻahu coastline for the extreme zone. The use of the extreme zone results in a 26% increase in the number of hotel visitors that would be encouraged to evacuate, and a 76% increase in the number of them that may require more than 15 min. Modeling can identify where pedestrian evacuations are plausible; however, there are logistical and behavioral issues that warrant attention before localized evacuation procedures may be realistic.

Optimal control of diarrhea transmission in a flood evacuation zone

Science.gov (United States)

Erwina, N.; Aldila, D.; Soewono, E.

2014-03-01

Evacuation of residents and diarrhea disease outbreak in evacuation zone have become serious problem that frequently happened during flood periods. Limited clean water supply and infrastructure in evacuation zone contribute to a critical spread of diarrhea. Transmission of diarrhea disease can be reduced by controlling clean water supply and treating diarrhea patients properly. These treatments require significant amount of budget, which may not be fulfilled in the fields. In his paper, transmission of diarrhea disease in evacuation zone using SIRS model is presented as control optimum problem with clean water supply and rate of treated patients as input controls. Existence and stability of equilibrium points and sensitivity analysis are investigated analytically for constant input controls. Optimum clean water supply and rate of treatment are found using optimum control technique. Optimal results for transmission of diarrhea and the corresponding controls during the period of observation are simulated numerically. The optimum result shows that transmission of diarrhea disease can be controlled with proper combination of water supply and rate of treatment within allowable budget.

Auditory evacuation beacons

NARCIS (Netherlands)

Wijngaarden, S.J. van; Bronkhorst, A.W.; Boer, L.C.

2005-01-01

Auditory evacuation beacons can be used to guide people to safe exits, even when vision is totally obscured by smoke. Conventional beacons make use of modulated noise signals. Controlled evacuation experiments show that such signals require explicit instructions and are often misunderstood. A new

Surgical management of spontaneous hypertensive brainstem hemorrhage

Directory of Open Access Journals (Sweden)

Bal Krishna Shrestha

2015-09-01

Full Text Available Spontaneous hypertensive brainstem hemorrhage is the spontaneous brainstem hemorrhage associated with long term hypertension but not having definite focal or objective lesion. It is a catastrophic event which has a poor prognosis and usually managed conservatively. It is not uncommon, especially in eastern Asian populations, accounting approximately for 10% of the intracerebral hemorrhage. Before the advent of computed tomography, the diagnosis of brainstem hemorrhage was usually based on the clinical picture or by autopsy and believed to be untreatable via surgery. The introduction of computed tomography permitted to categorize the subtypes of brainstem hemorrhage with more predicted outcome. Continuous ongoing developments in the stereotactic surgery and microsurgery have added more specific surgical management in these patients. However, whether to manage conservatively or promptly with surgical evacuation of hematoma is still a controversy. Studies have shown that an accurate prognostic assessment based on clinical and radiological features on admission is critical for establishing a reasonable therapeutic approach. Some authors have advocate conservative management, whereas others have suggested the efficacy of surgical treatment in brainstem hemorrhage. With the widening knowledge in microsurgical techniques as well as neuroimaging technology, there seems to have more optimistic hope of surgical management of spontaneous hypertensive brainstem hemorrhage for better prognosis. Here we present five cases of severe spontaneous hypertensive brainstem hemorrhage patients who had undergone surgery; and explore the possibilities of surgical management in patients with the spontaneous hypertensive brainstem hemorrhage.

Surgical treatment of chronic pancreatitis in young patients.

Science.gov (United States)

Zhou, Feng; Gou, Shan-Miao; Xiong, Jiong-Xin; Wu, He-Shui; Wang, Chun-You; Liu, Tao

2014-10-01

The main treatment strategies for chronic pancreatitis in young patients include therapeutic endoscopic retrograde cholangio-pancreatography (ERCP) intervention and surgical intervention. Therapeutic ERCP intervention is performed much more extensively for its minimally invasive nature, but a part of patients are referred to surgery at last. Historical and follow-up data of 21 young patients with chronic pancreatitis undergoing duodenum-preserving total pancreatic head resection were analyzed to evaluate the outcomes of therapeutic ERCP intervention and surgical intervention in this study. The surgical complications of repeated therapeutic ERCP intervention and surgical intervention were 38% and 19% respectively. During the first therapeutic ERCP intervention to surgical intervention, 2 patients developed diabetes, 5 patients developed steatorrhea, and 5 patients developed pancreatic type B pain. During the follow-up of surgical intervention, 1 new case of diabetes occurred, 1 case of steatorrhea recovered, and 4 cases of pancreatic type B pain were completely relieved. In a part of young patients with chronic pancreatitis, surgical intervention was more effective than therapeutic ERCP intervention on delaying the progression of the disease and relieving the symptoms.

Peculiarities of Intestine Motor-Evacuation Function in Patients with Various Forms of Irritable Bowel Syndrome

Directory of Open Access Journals (Sweden)

S.A. Nagieva

2016-04-01

Full Text Available To assess motor and evacuation function of gastrointestinal tract in irritable bowel syndrome (IBS several methods can be used. Our aim was to study colonic motility in patients with different variants of IBS using dynamic scintigraphy. Materials and methods. 107 patients with IBS by Rome III criteria (2006 were enrolled. All patients were divided into 4 groups: I group — IBS with constipation (36/107, 33.6 %, II group — IBS with diarrhea (35/107, 32.7 %, III group — unspecified IBS (22/107, 20.7 %, IV group — mixed IBS (14/107, 13.0 %. Dynamic scintigraphy was done using scintillation gamma-room OFECT‑1 and EBM. Medium activity of radiopharmaceutical was taken at a rate of 10 MBq/kg body weight of the patient. Results. The results showed that in case of the IBS with constipation the passage of radiopharmaceutical decreased (increased radioactivity in the abdomen (> 60 % and asymmetry of the right and left parts of the bowel is 2 5 %, p 0.05. Conclusion. Using dynamic scintigraphy we found expressed slowing of the passage of radiopharmaceutical in IBS patients with constipation (p < 0.05, while in case of IBS with diarrhea the speed of radiopharmaceutical evacuation was increased (p < 0.05. In a case of other variants of IBS no statistically significant changes were detected.

Optimal crowd evacuation

NARCIS (Netherlands)

Hoogendoorn, S.P.; Daamen, W.; Duives, D.C.; Van Wageningen-Kessels, F.L.M.

2013-01-01

This paper deals with the optimal allocation of routes, destination, and departure times to members of a crowd, for instance in case of an evacuation or another hazardous situation in which the people need to leave the area as quickly as possible. The generic approach minimizes the evacuation times,

Peritoneocele and enterocele. Formation and transformation during rectal evacuation as studied by means of defaeco-peritoneography

International Nuclear Information System (INIS)

Bremmer, S.; Uden, R.; Mellgren, A.; Holmstroem, B.

1998-01-01

Purpose: To study, by means of defaeco-peritoneography, the formation and transformation of the peritoneocele, with and without an enterocele, during rectal evacuation. Material and Methods: Forty-six patients with a peritoneocele at defaecoperitoneography were selected for the study, and examined at three different stages:(1) at the start with a contrast-filled rectum; (2) at maximum straining; and (3) at rest after rectal evacuation. Results: Fourteen patients had a peritoneocele at the start. These peritoneoceles were largest at maximum straining and were all still present at rest after rectal evacuation. In 32 patients defaeco-peritoneography was regarded as normal at the start. At maximum straining these patients developed a peritoneocele and 20 of these were still present after rectal evacuation. No enterocele was seen at the start. At maximum straining 21 patients developed an enterocele and 15 of these were still present after rectal evacuation. Liquid in varying amounts was found in the peritoneoceles. Conclusion: The present study demonstrated that peritoneoceles were present at different stages of the defaeco-peritoneographic investigations. (orig./MG)

Routes to effective evacuation planning primer series : evacuating populations with special needs.

Science.gov (United States)

2009-04-01

Evacuation operations are conducted under the authority of, and based on decisions by, local and state authorities. The purpose of this primer, Evacuating Populations with Special Needs, is to provide local and state emergency managers, government of...

Intraoperative intracranial pressure and cerebral perfusion pressure for predicting surgical outcome in severe traumatic brain injury

Directory of Open Access Journals (Sweden)

Tai-Hsin Tsai

2013-10-01

Full Text Available Intraoperative intracranial pressure (ICP and cerebral perfusion pressure (CPP were evaluated for use as prognostic indicators after surgery for severe traumatic brain injury (TBI, and threshold ICP and CPP values were determined to provide guidelines for patient management. This retrospective study reviewed data for 66 patients (20 females and 46 males aged 13–83 years (average age, 48 years who had received decompressive craniectomy and hematoma evacuation for severe TBI. The analysis of clinical characteristics included Glascow Coma Scale score, trauma mechanism, trauma severity, cerebral hemorrhage type, hematoma thickness observed on computed tomography scan, Glasgow Outcome Scale score, and mortality. Patients whose treatment included ICP monitoring had significantly better prognosis (p < 0.001 and significantly lower mortality (p = 0.016 compared to those who did not receive ICP monitoring. At all three major steps of the procedure, i.e., creation of the burr hole, evacuation of the hematoma, and closing of the wound, intraoperative ICP and CPP values significantly differed. The ICP and CPP values were also significantly associated with surgical outcome in the severe TBI patients. Between hematoma evacuation and wound closure, ICP and CPP values differed by 6.8 ± 4.5 and 6.5 ± 4.6 mmHg, respectively (mean difference, 6 mmHg. Intraoperative thresholds were 14 mmHg for ICP and 56mmH for CPP. Monitoring ICP and CPP during surgery improves management of severe TBI patients and provides an early prognostic indicator. During surgery for severe TBI, early detection of increased ICP is also crucial for enabling sufficiently early treatment to improve surgical outcome. However, further study is needed to determine the optimal intraoperative ICP and CPP thresholds before their use as subjective guidelines for managing severe TBI patients.

Patient satisfaction: does surgical volume matter?

Science.gov (United States)

Tevis, Sarah E; Kennedy, Gregory D

2015-06-01

Patient satisfaction is an increasing area of interest due to implications of pay for performance and public reporting of results. Although scores are adjusted for patient factors, little is known about the relationship between hospital structure, postoperative outcomes, and patient satisfaction with the hospital experience. Hospitals participating in the University HealthSystem Consortium database from 2011-2012 were included. Patients were restricted to those discharged by general surgeons to isolate surgical patients. Hospital data were paired with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) results from the Hospital Compare website. Postoperative outcomes were dichotomized based on the median for all hospitals and stratified based on surgical volume. The primary outcome of interest was high on overall patient satisfaction, whereas other HCAHPS domains were assessed as secondary outcomes. Chi square and binary logistic regression analyses were performed to evaluate whether postoperative outcomes or surgical volume more significantly influenced high patient satisfaction. The study population consisted of 171 hospitals from the University HealthSystem Consortium database. High surgical volume was a more important predictor of overall patient satisfaction regardless of hospital complication (P patient satisfaction on the HCAHPS survey than postoperative outcomes, whereas volume was less predictive in other HCAHPS domains. Patients may require more specific questioning to identify high quality, safe hospitals. Copyright © 2015 Elsevier Inc. All rights reserved.

Hurricane Elena and Pinellas County, Florida: Some Lessons Learned from the Largest Evacuation of Nursing Home Patients in History.

Science.gov (United States)

Mangum, Wiley P.; And Others

1989-01-01

Studied prior planning for and problems associated with evacuation of 1,860 nursing home patients in Pinellas County, Florida, due to Hurricane Elena in 1985 through questionnaires administered to nursing home administrators and public documents. Found most serious problems to be transporting patients to shelters in timely fashion, delayed passage…

Evacuation of a mental health center during a forest fire in Israel.

Science.gov (United States)

Kreinin, Anatoly; Shakera, Tatiana; Sheinkman, Ayala; Levi, Tamar; Tal, Vered; Polakiewicz, Jacob

2014-08-01

Tirat Carmel Mental Health Center was successfully evacuated in December 2010 during a ravaging forest fire in the nearby Carmel Mountains. A total of 228 patients were successfully evacuated from the center within 45 minutes. No fatalities or injuries associated with the evacuation occurred. We believe that the efficient functioning of the administrative and medical staff provides a replicable model that can contribute to the level of awareness and readiness of hospital staff members for natural and manmade disasters.

Influence of minimally invasive hematoma evacuation combined with nerve growth factor preparation on neurological function injury in patients with hypertensive cerebral hemorrhage

Directory of Open Access Journals (Sweden)

Jiang Tao

2017-05-01

Full Text Available Objective: To study the influence of minimally invasive hematoma evacuation combined with nerve growth factor preparation on neurological function injury in patients with hypertensive cerebral hemorrhage. Methods: A total of 112 patients with hypertensive cerebral hemorrhage who were treated in our hospital between July 2013 and February 2016 were collected, and according to random number table, they were divided into the control group (n=56 who underwent minimally invasive hematoma evacuation therapy and the observation group (n=56 who underwent minimally invasive hematoma evacuation combined with nerve growth factor preparation therapy. Serum contents of inflammatory mediators, nerve injury indexes and neurotransmitters were compared between two groups of patients before and after treatment. Results: Before treatment, there were no significant differences in serum contents of inflammatory mediators, nerve injury indexes and neurotransmitters between the two groups. After treatment, serum contents of inflammatory mediators such as CRP, PCT, IL-1β and IL-6 in observation group were lower than those in control group; serum contents of nerve injury indexes such as NSE, S100B, GEAP and MBP were lower than those in control group; serum contents of neurotransmitters such as SP, NPY, Glu and Asp were lower than those in control group while GABA and Gly were higher than those in control group. Conclusion: Minimally invasive hematoma evacuation combined with nerve growth factor preparation can effectively reduce neurological function injury, and has positive clinical significance.

External factors impacting hospital evacuations caused by Hurricane Rita: the role of situational awareness.

Science.gov (United States)

Downey, Erin L; Andress, Knox; Schultz, Carl H

2013-06-01

The 2005 Gulf Coast hurricane season was one of the most costly and deadly in US history. Hurricane Rita stressed hospitals and led to multiple, simultaneous evacuations. This study systematically identified community factors associated with patient movement out of seven hospitals evacuated during Hurricane Rita. This study represents the second of two systematic, observational, and retrospective investigations of seven acute care hospitals that reported off-site evacuations due to Hurricane Rita. Participants from each hospital included decision makers that comprised the Incident Management Team (IMT). Investigators applied a standardized interview process designed to assess evacuation factors related to external situational awareness of community activities during facility evacuation due to hurricanes. The measured outcomes were responses to 95 questions within six sections of the survey instrument. Investigators identified two factors that significantly impacted hospital IMT decision making: (1) incident characteristics affecting a facility's internal resources and challenges; and (2) incident characteristics affecting a facility's external evacuation activities. This article summarizes the latter and reports the following critical decision making points: (1) Emergency Operations Plans (EOP) were activated an average of 85 hours (3 days, 13 hours) prior to Hurricane Rita's landfall; (2) the decision to evacuate the hospital was made an average of 30 hours (1 day, 6 hours) from activation of the EOP; and (3) the implementation of the evacuation process took an average of 22 hours. Coordination of patient evacuations was most complicated by transportation deficits (the most significant of the 11 identified problem areas) and a lack of situational awareness of community response activities. All evacuation activities and subsequent evacuation times were negatively impacted by an overall lack of understanding on the part of hospital staff and the IMT regarding how to

Postoperative digestive function after radical versus conservative surgical philosophy for deep endometriosis infiltrating the rectum.

Science.gov (United States)

Roman, Horace; Vassilieff, Maud; Tuech, Jean Jacques; Huet, Emmanuel; Savoye, Guillaume; Marpeau, Loïc; Puscasiu, Lucian

2013-05-01

To compare delayed digestive outcomes in women managed by two different surgical philosophies: a radical approach mainly related to colorectal resection, and a conservative approach involving rectal shaving and rectal nodule excision. "Before and after" comparative retrospective study. University tertiary referral center. Seventy-five patients managed by surgery for deep endometriosis infiltrating the rectum. Twenty-four women were managed during a period when surgeons pursued a radical philosophy toward treatment, and 51 women were managed during a period when a conservative philosophy was adopted. Standardized gastrointestinal questionnaires: the Gastrointestinal Quality of Life Index, the Knowles-Eccersley-Scott Symptom Questionnaire, the Bristol Stool Score, and the Fecal Incontinence Quality of Life Score. Preoperative patient characteristics, rectal nodule features, and associated localizations of the disease were comparable between the two groups. During the radical period, colorectal resection was carried out in 67% of patients, whereas during the second period only 20% of women underwent colorectal resection. Women managed according to the conservative philosophy had significantly improved results on the Knowles-Eccersley-Scott Symptom Questionnaire, Gastrointestinal Quality of Life Index, and depression/self-perception Fecal Incontinence Quality of Life Score, and significantly improved values for various items related to postoperative constipation: unsuccessful evacuatory attempts, feeling incomplete evacuation, abdominal pain, time taken to evacuate, difficulty evacuating causing a painful effort, and stool consistency. It seems that reducing the rate of colorectal resection leads to better functional outcomes in women presenting with rectal endometriosis, lending support to the conservative surgical philosophy over mandatory colorectal resection. Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights

The Impact of Transport Time on Outcomes Following Evacuation from Point of Injury

Science.gov (United States)

2017-06-16

reasonable in relation to anticipated benefits and the importance of the knowledge that may reasonably be expected to result. The subject selection is...patients with traumatic injuries require urgent medical attention and expeditious evacuation to improve survival. Aeromedical evacuation platforms such as

Surgical intervention in patients with necrotizing pancreatitis

NARCIS (Netherlands)

Besselink, MG; de Bruijn, MT; Rutten, JP; Boermeester, MA; Hofker, HS; Gooszen, HG

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

Surgical Management of Aneurysmal Hematomas: Prognostic Factors and Outcome.

Science.gov (United States)

Meneghelli, P; Cozzi, F; Hasanbelliu, A; Locatelli, F; Pasqualin, Alberto

2016-01-01

From 1991 until 2013, 304 patients with intracranial hematomas from aneurysmal rupture were managed surgically in our department, constituting 17 % of all patients with aneurysmal rupture. Of them, 242 patents presented with isolated intracerebral hematomas (in 69 cases associated with significant intraventricular hemorrhage), 50 patients presented with combined intracerebral and subdural hematomas (in 11 cases associated with significant intraventricular hemorrhage), and 12 presented with an isolated subdural hematoma. The surgical procedure consisted of simultaneous clipping of the aneurysm and evacuation of the hematoma in all cases. After surgery, 16 patients (5 %) submitted to an additional decompressive hemicraniectomy, and 66 patients (21 %) submitted to a ventriculo-peritoneal shunt. Clinical outcomes were assessed at discharge and at 6 months, using the modified Rankin Scale (mRS); a favorable outcome (mRS 0-2) was observed in 10 % of the cases at discharge, increasing to 31 % at 6 months; 6-month mortality was 40 %. Applying uni- and multivariate analysis, the following risk factors were associated with a significantly worse outcome: age >60; preoperative Hunt-Hess grades IV-V; pupillary mydriasis (only on univariate); midline shift >10 mm; hematoma volume >30 cc; and the presence of hemocephalus (i.e., packed intraventricular hemorrhage). Based on these results, an aggressive surgical treatment should be adopted for most cases with aneurysmal hematomas, excluding patients with bilateral mydriasis persisting after rescue therapy.

Considerations for the head-injured air-evacuated patient: a case report of frontal sinus fracture and review of the literature.

Science.gov (United States)

Helling, Eric; McKinlay, Alex J

2005-07-01

Head and neck injuries are not uncommon in combat environments and may be increasing due to survivable injuries from the use of kevlar helmets and body armor. With the current capability of rapid evacuation from the battlefield, acutely injured patients with frontal sinus injuries may undergo further barometric challenges. Proper care during transport can prevent the occurrence of secondary injury (increased intracranial pressure, tension pneumocephalus) that would complicate the patient's management at the next level of care. Management principles (importance of low-level flight/pressurized cabin, preflight use of decongestants, avoidance of valsalva, and ability to manage complications either procedurally or by landing) are reviewed. In addition, we propose a simple mechanism for pressure equilibration of a compromised frontal sinus during air evacuation using an angiocatheter placed through the wound before closure.

Evacuation dynamics of children

DEFF Research Database (Denmark)

Larusdottir, Aldis Run; Dederichs, Anne

2010-01-01

higher walking speeds in spiral stairs when the children are familiar with the evacuation path. Higher per-son densities and faster flow through doors were obtained among the children than found in literature on adults. Children in the younger age group are generally slower than the older children....... The children walk slower in horizontal plan than adults, however they are keen to run during evacuations, in the latter case their travel speed increases and exceeds the adults’. Since the evacuation characte-ristics of children differ in many ways from those of adults, nowadays models badly comprehend...

Improved patient selection by stratified surgical intervention

DEFF Research Database (Denmark)

Wang, Miao; Bünger, Cody E; Li, Haisheng

2015-01-01

BACKGROUND CONTEXT: Choosing the best surgical treatment for patients with spinal metastases remains a significant challenge for spine surgeons. There is currently no gold standard for surgical treatments. The Aarhus Spinal Metastases Algorithm (ASMA) was established to help surgeons choose...... the most appropriate surgical intervention for patients with spinal metastases. PURPOSE: The purpose of this study was to evaluate the clinical outcome of stratified surgical interventions based on the ASMA, which combines life expectancy and the anatomical classification of patients with spinal metastases...... survival times in the five surgical groups determined by the ASMA were 2.1 (TS 0-4, TC 1-7), 5.1 (TS 5-8, TC 1-7), 12.1 (TS 9-11, TC 1-7 or TS 12-15, TC 7), 26.0 (TS 12-15, TC 4-6), and 36.0 (TS 12-15, TC 1-3) months. The 30-day mortality rate was 7.5%. Postoperative neurological function was maintained...

Evacuation drill at CMS

CERN Multimedia

Niels Dupont-Sagorin and Christoph Schaefer

2012-01-01

Training personnel, including evacuation guides and shifters, checking procedures, improving collaboration with the CERN Fire Brigade: the first real-life evacuation drill at CMS took place on Friday 3 February from 12p.m. to 3p.m. in the two caverns located at Point 5 of the LHC.   CERN personnel during the evacuation drill at CMS. Evacuation drills are required by law and have to be organized periodically in all areas of CERN, both above and below ground. The last drill at CMS, which took place in June 2007, revealed some desiderata, most notably the need for a public address system. With this equipment in place, it is now possible to broadcast audio messages from the CMS control room to the underground areas.   The CMS Technical Coordination Team and the GLIMOS have focused particularly on preparing collaborators for emergency situations by providing training and organizing regular safety drills with the HSE Unit and the CERN Fire Brigade. This Friday, the practical traini...

[Nutritional support response in critically ill patients; differences between medical and surgical patients].

Science.gov (United States)

Zamora Elson, M; Serón Arbeloa, C; Labarta Monzón, L; Garrido Ramírez de Arellano, I; Lander Azcona, A; Marquina Lacueva, M I; López Claver, J C; Escós Orta, J

2012-01-01

To assess the nutritional response of a group of critically ill patients, as well as the differences in the response to nutritional support between medical and surgical patients. One-year long retrospective study including critically ill patients on artificial nutrition for 7 days. Throughout the first week, three nutritional biochemical controls were done that included albumin, prealbumin, transferrin, cholesterol, and electrolytes. Other data gathered were: nutritional risk index, age, gender, weight, height, APACHE, delay of onset of nutritional support, access route, predicted and real caloric intake, medical or surgical patient, hospital stay, duration of the central venous catheter, urinary tube, and/or mechanical ventilation, incidence and density of incidence of nosocomial infections. Sixty-three patients were studied, 30 (47%) medical and 33 (53%) surgical/trauma patients, with a usage of EN higher among medical patients (16/30, 53% vs. 5/33, 15%), PN higher among surgical patients (25/33, 76%), and mixed nutrition similar in both groups (5 medical and 3 surgical patients) (p = 0.001). There were no differences between medical and surgical patients regarding: both predicted and real caloric and nitrogenous intake, APACHE, delay of onset of nutrition, phosphorus, magnesium or glucose levels, mortality and incidence of nosocomial infections. There were no differences either in hospital stay or use of mechanical ventilation, although these tended to be lower in surgical patients. The baseline biochemical parameters did not show differences between both groups, although they were worse among surgical patients. These patients presented during the study period steady albumin levels with improvement in the remaining parameters, whereas medical patients showed a decrease in albumin and transferrin levels, steady prealbumin levels, and slightly improvement in cholesterol levels. We have observed higher usage of PN among surgical patients, which showed worse

Evacuation decision-making: process and uncertainty

Energy Technology Data Exchange (ETDEWEB)

Mileti, D.; Sorensen, J.; Bogard, W.

1985-09-01

The purpose was to describe the processes of evacuation decision-making, identify and document uncertainties in that process and discuss implications for federal assumption of liability for precautionary evacuations at nuclear facilities under the Price-Anderson Act. Four major categories of uncertainty are identified concerning the interpretation of hazard, communication problems, perceived impacts of evacuation decisions and exogenous influences. Over 40 historical accounts are reviewed and cases of these uncertainties are documented. The major findings are that all levels of government, including federal agencies experience uncertainties in some evacuation situations. Second, private sector organizations are subject to uncertainties at a variety of decision points. Third, uncertainties documented in the historical record have provided the grounds for liability although few legal actions have ensued. Finally it is concluded that if liability for evacuations is assumed by the federal government, the concept of a ''precautionary'' evacuation is not useful in establishing criteria for that assumption. 55 refs., 1 fig., 4 tabs.

Evacuation decision-making: process and uncertainty

International Nuclear Information System (INIS)

Mileti, D.; Sorensen, J.; Bogard, W.

1985-09-01

The purpose was to describe the processes of evacuation decision-making, identify and document uncertainties in that process and discuss implications for federal assumption of liability for precautionary evacuations at nuclear facilities under the Price-Anderson Act. Four major categories of uncertainty are identified concerning the interpretation of hazard, communication problems, perceived impacts of evacuation decisions and exogenous influences. Over 40 historical accounts are reviewed and cases of these uncertainties are documented. The major findings are that all levels of government, including federal agencies experience uncertainties in some evacuation situations. Second, private sector organizations are subject to uncertainties at a variety of decision points. Third, uncertainties documented in the historical record have provided the grounds for liability although few legal actions have ensued. Finally it is concluded that if liability for evacuations is assumed by the federal government, the concept of a ''precautionary'' evacuation is not useful in establishing criteria for that assumption. 55 refs., 1 fig., 4 tabs

Evacuation Shelters - MDC_HurricaneShelter

Data.gov (United States)

NSGIC Local Govt | GIS Inventory — A label feature class of Miami-Dade County Hurricane Evacuation Shelters (HEC) including Special Need Evacuation Centers (SNEC) and Medical Management Facilities...

A method of emotion contagion for crowd evacuation

Science.gov (United States)

Cao, Mengxiao; Zhang, Guijuan; Wang, Mengsi; Lu, Dianjie; Liu, Hong

2017-10-01

The current evacuation model does not consider the impact of emotion and personality on crowd evacuation. Thus, there is large difference between evacuation results and the real-life behavior of the crowd. In order to generate more realistic crowd evacuation results, we present a method of emotion contagion for crowd evacuation. First, we combine OCEAN (Openness, Extroversion, Agreeableness, Neuroticism, Conscientiousness) model and SIS (Susceptible Infected Susceptible) model to construct the P-SIS (Personalized SIS) emotional contagion model. The P-SIS model shows the diversity of individuals in crowd effectively. Second, we couple the P-SIS model with the social force model to simulate emotional contagion on crowd evacuation. Finally, the photo-realistic rendering method is employed to obtain the animation of crowd evacuation. Experimental results show that our method can simulate crowd evacuation realistically and has guiding significance for crowd evacuation in the emergency circumstances.

Evacuate or Shelter-in-place? The Role of Corporate Memory and Political Environment in Hospital-evacuation Decision Making.

Science.gov (United States)

Ricci, Karen A; Griffin, Anne R; Heslin, Kevin C; Kranke, Derrick; Dobalian, Aram

2015-06-01

Hospital-evacuation decisions are rarely straightforward in protracted advance-warning events. Previous work provides little insight into the decision-making process around evacuation. This study was conducted to identify factors that most heavily influenced the decisions to evacuate the US Department of Veterans Affairs (VA) New York Harbor Healthcare System's (NYHHS; New York USA) Manhattan Campus before Hurricane Irene in 2011 and before Superstorm Sandy in 2012. Semi-structured interviews with 11 senior leaders were conducted on the processes and factors that influenced the evacuation decisions prior to each event. The most influential factor in the decision to evacuate the Manhattan Campus before Hurricane Irene was New York City's (NYC's) hospital-evacuation mandate. As a federal facility, the Manhattan VA medical center (VAMC) was exempt from the city's order, but decision makers felt compelled to comply. In the case of Superstorm Sandy, corporate memory of a similar 1992 storm that crippled the Manhattan facility drove the decision to evacuate before the storm hit. Results suggest that hospital-evacuation decisions are confounded by political considerations and are influenced by past disaster experience. Greater shared situational awareness among at-risk hospitals, along with a more coordinated approach to evacuation decision making, could reduce pressure on hospitals to make these high-stakes decisions. Systematic mechanisms for collecting, documenting, and sharing lessons learned from past disasters are sorely needed at the institutional, local, and national levels.

[Diary of a hospital evacuation. Discovery of a 5 hundredweight bomb from World War II].

Science.gov (United States)

Katter, I; Kunitz, O; Deller, A

2008-07-01

The discovery of an aircraft bomb from World War II made the complete evacuation of a tertiary care hospital with 629 beds and 17 specialist departments including a neonatal intensive care unit necessary. Some months before an alarm plan had been issued and a fire practice had been carried out which made it obvious to all concerned how important such measures are. Nevertheless, more room for improvement could be learned from the evacuation, in particular the rapid classification of the patients into categories and the fact that 20-30% of the patients needed stretcher-based transport for evacuation.

ARKTOS full-scale evacuation tests

Energy Technology Data Exchange (ETDEWEB)

Seligman, B.; Hatfield, P. [ARKTOS Developments Ltd., Surrey, BC (Canada); Bercha, F. [Bercha Group, Calgary, AB (Canada)

2008-09-15

The ARKTOS amphibious vehicle can be used for evacuation operations in both open water and ice conditions. It is approved as an evacuation system by various regulators, such as the United States Coast Guard, and is operational in several marine cold regions as an escape, evacuation, and rescue (EER) system. An EER research project was performed in 2006 that provided a general reliability evaluation of the ARKTOS system. However, the project did not have the benefit of detailed full-scale tests in order to validate the associated computer model in drill or non-life threatening evacuation conditions. This paper described a follow-up set of full-scale evacuation tests designed to provide more detailed information and validation data for the reliability that the computer model described in the 2006 research project. A description and photographic illustrations of the ARKTOS system were presented. The tests and subsequent analyses were described. Specifically, the paper described the observations, and presented the statistical results from the data collected, and compared observed results with predicted results of a probabilistic EER simulation computer model. Conclusions and recommendations for reliability improvements were also provided. It was concluded that under the benign conditions, the drill performance was satisfactory in all aspects, both in the evacuation activities and the rescue or de-boarding activities. 3 refs., 1 tab., 17 figs.

CT guided stereotactic evacuation of hypertensive and traumatic intracerebral hematomas

International Nuclear Information System (INIS)

Hondo, Hideki; Matsumoto, Keizo

1983-01-01

Recent advancement of CT system provides not only definite diagnosis and location of intracerebral hematoma but also coordinates of the center of the hematoma. Trials of stereotactic evacuation of the hematoma have been reported by some authors in the cases of subacute or chronic stages of hypertensive intracerebral hemorrhage. In this series, similar surgery has been performed in 33 cases of hypertensive intracerebral hematoma including 22 cases in acute stage, and 2 cases of traumatic hematoma. Clinical outcomes were investigated and the results were considered to be equivalent or rather better in the conventional microsurgery with evacuation of hematoma under direct vision. However, there still remained controversial problems in the cases of threatened herniation signs, because in these cases regular surgery with total evacuation of the hematoma at one time might have been preferable. The benefits of this CT guided stereotactic approach for the evacuation of the hematoma were thought to be as follow: 1) the procedure is simple and safe, 2) operation is readily performed under local anesthesia, and 3) the hematoma was drained out totally by means of urokinase activity. It is our impression that this surgery not only is indicated as emergency treatment for the patients of high-age or in high risk, but also can institute as a routine surgery for the intracerebral hematomas in patients showing no herniation sign. (J.P.N.)

Evacuating populations with special needs

Science.gov (United States)

2009-04-01

Evacuation operations are conducted under the authority of, and based on decisions by, local and state authorities. The purpose of this primer, Evacuating Populations with Special Needs, is to provide local and state emergency managers, government of...

Patient-specific surgical simulation.

Science.gov (United States)

Soler, Luc; Marescaux, Jacques

2008-02-01

Technological innovations of the twentieth century have provided medicine and surgery with new tools for education and therapy definition. Thus, by combining Medical Imaging and Virtual Reality, patient-specific applications providing preoperative surgical simulation have become possible.

Alternative evacuation strategies for nuclear power accidents

International Nuclear Information System (INIS)

Hammond, Gregory D.; Bier, Vicki M.

2015-01-01

In the U.S., current protective-action strategies to safeguard the public following a nuclear power accident have remained largely unchanged since their implementation in the early 1980s. In the past thirty years, new technologies have been introduced, allowing faster computations, better modeling of predicted radiological consequences, and improved accident mapping using geographic information systems (GIS). Utilizing these new technologies, we evaluate the efficacy of alternative strategies, called adaptive protective action zones (APAZs), that use site-specific and event-specific data to dynamically determine evacuation boundaries with simple heuristics in order to better inform protective action decisions (rather than relying on pre-event regulatory bright lines). Several candidate APAZs were developed and then compared to the Nuclear Regulatory Commission’s keyhole evacuation strategy (and full evacuation of the emergency planning zone). Two of the APAZs were better on average than existing NRC strategies at reducing either the radiological exposure, the population evacuated, or both. These APAZs are especially effective for larger radioactive plumes and at high population sites; one of them is better at reducing radiation exposure, while the other is better at reducing the size of the population evacuated. - Highlights: • Developed framework to compare nuclear power accident evacuation strategies. • Evacuation strategies were compared on basis of radiological and evacuation risk. • Current strategies are adequate for smaller scale nuclear power accidents. • New strategies reduced radiation exposure and evacuation size for larger accidents

Patient satisfaction and quality of surgical care in US hospitals.

Science.gov (United States)

Tsai, Thomas C; Orav, E John; Jha, Ashish K

2015-01-01

The relationship between patient satisfaction and surgical quality is unclear for US hospitals. Using national data, we examined if hospitals with high patient satisfaction have lower levels of performance on accepted measures of the quality and efficiency of surgical care. Federal policymakers have made patient satisfaction a core measure for the way hospitals are evaluated and paid through the value-based purchasing program. There is broad concern that performance on patient satisfaction may have little or even a negative correlation with the quality of surgical care, leading to potential trade-offs in efforts to improve patient experience with other surgical quality measures. We used the Hospital Consumer Assessment of Healthcare Providers and Systems survey data from 2010 and 2011 to assess performance on patient experience. We used national Medicare data on 6 common surgical procedures to calculate measures of surgical efficiency and quality: risk-adjusted length of stay, process score, risk-adjusted mortality rate, risk-adjusted readmission rate, and a composite z score across all 4 metrics. Multivariate models adjusting for hospital characteristics were used to assess the independent relationships between patient satisfaction and measures of surgical efficiency and quality. Of the 2953 US hospitals that perform one of these 6 procedures, the median patient satisfaction score was 69.5% (interquartile range, 63%-75.5%). Length of stay was shorter in hospitals with the highest levels of patient satisfaction (7.1 days vs 7.7 days, P patient satisfaction had the higher process of care performance (96.5 vs 95.5, P patient satisfaction also had a higher composite score for quality across all measures (P patient satisfaction provided more efficient care and were associated with higher surgical quality. Our findings suggest there need not be a trade-off between good quality of care for surgical patients and ensuring a positive patient experience.

The Variable Scale Evacuation Model (VSEM: a new tool for simulating massive evacuation processes during volcanic crises

Directory of Open Access Journals (Sweden)

J. M. Marrero

2010-04-01

Full Text Available Volcanic eruptions are among the most awesome and powerful displays of nature's force, constituting a major natural hazard for society (a single eruption can claim thousands of lives in an instant. Consequently, assessment and management of volcanic risk have become critically important goals of modern volcanology. Over recent years, numerous tools have been developed to evaluate volcanic risk and support volcanic crisis management: probabilistic analysis of future eruptions, hazard and risk maps, event trees, etc. However, there has been little improvement in the tools that may help Civil Defense officials to prepare Emergency Plans. Here we present a new tool for simulating massive evacuation processes during volcanic crisis: the Variable Scale Evacuation Model (VSEM. The main objective of the VSEM software is to optimize the evacuation process of Emergency Plans during volcanic crisis. For this, the VSEM allows the simulation of an evacuation considering different strategies depending on diverse impact scenarios. VSEM is able to calculate the required time for the complete evacuation taking into account diverse evacuation scenarios (number and type of population, infrastructure, road network, etc. and to detect high-risk or "blackspots" of the road network. The program is versatile and can work at different scales, thus being capable of simulating the evacuation of small villages as well as huge cities.

Postoperative Haematocrit and Outcome in Critically Ill Surgical Patients.

Science.gov (United States)

Lopes, Ana Martins; Silva, Diana; Sousa, Gabriela; Silva, Joana; Santos, Alice; Abelha, Fernando José

2017-08-31

Haematocrit has been studied as an outcome predictor. The aim of this study was to evaluate the correlation between low haematocrit at surgical intensive care unit admission and high disease scoring system score and early outcomes. This retrospective study included 4398 patients admitted to the surgical intensive care unit between January 2006 and July 2013. Acute physiology and chronic health evaluation and simplified acute physiology score II values were calculated and all variables entered as parameters were evaluated independently. Patients were classified as haematocrit if they had a haematocrit < 30% at surgical intensive care unit admission. The correlation between admission haematocrit and outcome was evaluated by univariate analysis and linear regression. A total of 1126 (25.6%) patients had haematocrit. These patients had higher rates of major cardiac events (4% vs 1.9%, p < 0.001), acute renal failure (11.5% vs 4.7%, p < 0.001), and mortality during surgical intensive care unit stay (3% vs 0.8%, p < 0.001) and hospital stay (12% vs 5.9%, p < 0.001). A haematocrit level < 30% at surgical intensive care unit admission was frequent and appears to be a predictor for poorer outcome in critical surgical patients. Patients with haematocrit had longer surgical intensive care unit and hospital stay lengths, more postoperative complications, and higher surgical intensive care unit and hospital mortality rates.

Patient Satisfaction with Surgical Outcome after Hypospadias Correction

NARCIS (Netherlands)

Dokter, E.M.J.; Moues, C.M.; Rooij, I.A.L.M. van; Biezen, J.J. van der

2017-01-01

Background: Hypospadias is a congenital malformation in which surgical correction is indicated in most cases. Postoperative patient satisfaction is important because of its influence on the child's psychological development. Objective: To evaluate patient satisfaction with surgical outcome after

Introduction of a Surgical Navigator in the Perioperative Process Improves Patient Satisfaction

Directory of Open Access Journals (Sweden)

Brett G Marshall

2017-03-01

Full Text Available Background: Patients who had received surgical services at Bellin Hospital reported anxiety with the surgical flow. This study tested the hypothesis that the introduction of a surgical navigator, someone who guided the patient and their accompanying others throughout the surgical process, would improve patient satisfaction. Methods: Ambulatory surgical patients were randomized to control and study groups. The study group patients were assigned a surgical navigator. Prior to discharge from the hospital, patients were asked to complete a patient satisfaction survey. Results: The study group had significantly higher mean scores (P value ≤ 0.026, top box scores (P value ≤ 0.021, and positive comments. Conclusion: The addition of a surgical navigator to the perioperative process significantly enhanced patient satisfaction in ambulatory surgical patients.

Fecoflowmetric Analysis of Anorectal Motor Function in Postoperative Anal-Preserving Surgery Patients With Low Rectal Cancer Comparison With the Wexner Score and Anorectal Manometry

Science.gov (United States)

Ryu, Yasuhiko; Akagi, Yoshito; Yagi, Minoru; Sasatomi, Teruo; Kinugasa, Tetsushi; Yamaguchi, Keizo; Oka, Yousuke; Fukahori, Suguru; Shiratsuchi, Ichitaro; Yoshida, Takefumi; Gotanda, Yukito; Tanaka, Natsuki; Ohchi, Takafumi; Romeo, Kansakar; Shirouzu, Kazuo

2015-01-01

The aim of this study was to elucidate whether fecoflowmetry (FFM) could evaluate more detailed evacuative function than anorectal manometry by comparing between FFM or anorectal manometric findings and the clinical questionnaires and the types of surgical procedure in the patients who received anal-preserving surgery. Fifty-three patients who underwent anal-preserving surgery for low rectal cancer were enrolled. The relationships between FFM or the manometric findings and the clinical questionnaires and the types of procedure of anal-preserving surgery were evaluated. There were significant differences between FFM markers and the clinical questionnaire and the types of the surgical procedure, whereas no significant relationship was observed between the manometric findings and the clinical questionnaire and the types of the surgical procedure. FFM might be feasible and useful for the objective assessment of evacuative function and may be superior to manometry for patients undergoing anal-preserving surgery. PMID:25594637

Hospital evacuation; planning, assessment, performance and evaluation

OpenAIRE

Nero C Wabo; P Örtenwall; A Khorram-Manesh

2012-01-01

Objective: Malfunction in hospitals' complex internal systems, or extern threats, may result in a hospital evacuation. Factors contributing to such evacuation must be identified, analyzed and action plans should be prepared. Our aims in this study were 1) to evaluate the use of risk and vulnerability analysis as a basis for hospital evacuation plan, 2) to identify risks/hazards triggering an evacuation and evaluate the respond needed and 3) to propose a template with main key points for plann...

Evacuation of bedridden occupants: experimental research outcomes

OpenAIRE

Strating, N.; van Herpen, R.; Zeiler, W.

2017-01-01

Bedridden building occupants in hospitals and nursing homes who are not able to rescue themselves in case of a fire emergency require assistance during an evacuation. A building emergency team usually fulfils this function and will have to remove the occupants from the room. The speed at which such an evacuation is conducted however is unknown. Experiments in practice were conducted in hospitals to obtain insight in the evacuation speed and absolute evacuation times required. Furthermore, a s...

Experimental study on occupant evacuation in narrow seat aisle

Science.gov (United States)

Huang, Shenshi; Lu, Shouxiang; Lo, Siuming; Li, Changhai; Guo, Yafei

2018-07-01

Narrow seat aisle is an important area in the train car interior due to the large passenger population, however evacuation therein has not gained enough concerns. In this experimental study, the occupant evacuation of the narrow seat aisle area is investigated, with the aisle width of 0.4-0.6 m and the evacuation direction of forward and backward. The evacuation behaviors are analyzed based on the video record, and the discussion is carried out in the aspect of evacuation time, crowdedness, evacuation order, and aisle conflicts. The result shows that with the increasing aisle width, total evacuation time and the average specific evacuation rate decrease. The aisle is crowded for some time, with a large linear occupant densities. The evacuation order of each occupant is mainly related to the seat position. Moreover, it is found that the aisle conflicts can be well described by Burstedde's model. This study gives a useful benchmark for evacuation simulation of narrow seat aisle, and provides reference to safety design of seat area in train cars.

Getting passengers out : evacuation behaviours

NARCIS (Netherlands)

Boer, L.C.

2003-01-01

When disaster strikes, mass transportation means mass evacuation. The issue is especially urgent if, despite precautions, a train comes to a stop in a tunnel and there is a fire. Adequate behaviour of passengers is a major success factor of an evacuation. Passengers should replace their original

Tsunami evacuation buildings and evacuation planning in Banda Aceh, Indonesia.

Science.gov (United States)

Yuzal, Hendri; Kim, Karl; Pant, Pradip; Yamashita, Eric

Indonesia, a country of more than 17,000 islands, is exposed to many hazards. A magnitude 9.1 earthquake struck off the coast of Sumatra, Indonesia, on December 26, 2004. It triggered a series of tsunami waves that spread across the Indian Ocean causing damage in 11 countries. Banda Aceh, the capital city of Aceh Province, was among the most damaged. More than 31,000 people were killed. At the time, there were no early warning systems nor evacuation buildings that could provide safe refuge for residents. Since then, four tsunami evacuation buildings (TEBs) have been constructed in the Meuraxa subdistrict of Banda Aceh. Based on analysis of evacuation routes and travel times, the capacity of existing TEBs is examined. Existing TEBs would not be able to shelter all of the at-risk population. In this study, additional buildings and locations for TEBs are proposed and residents are assigned to the closest TEBs. While TEBs may be part of a larger system of tsunami mitigation efforts, other strategies and approaches need to be considered. In addition to TEBs, robust detection, warning and alert systems, land use planning, training, exercises, and other preparedness strategies are essential to tsunami risk reduction.

Comparison of oral and vaginal misoprostol for cervical ripening before evacuation of first trimester missed miscarriage

International Nuclear Information System (INIS)

Jabir, Maysoon M.; Smeet, Rania I.

2009-01-01

Objective was to assess the effectiveness of misoprostol in cervical ripening before evacuation of conception in the first trimester missed miscarriages and to compare between oral and vaginal routes of administration. A randomized control study was carried out in Baghdad Teaching Hospital, Baghdad, Iraq in 2006. One hundred and twenty women with first fist trimester missed miscarriages were divided into 2 study groups, randomized for oral and vaginal (400 mcg) misoprostol priming of cervix and 2 control groups randomized for oral and vaginal placebo, before undergoing surgical evacuation of conception after 3 hours. Measured outcomes were: post medication cervical dilatation, time needed to dilate the cervix surgically, blood loss and developments of the side effects of misoprostol. Post medication cervical dilation was higher in the misoprostol group (7.07+-1.36 mm for oral misoprostol, 7.77+-1.22 mm for vaginal misoprostol), versus the control groups (2.43+-0.5 mm). Post medication cervical dilatation was significantly higher in the vaginal misoprostol group, compared to the oral group (p=0.04). The time required to dilate the cervix in the misoprostol group was shorter, compared with placebo. There were no significant differences in the amount of blood loss between oral (p=0.074) and vaginal misoprostol groups (p=0.62) and gastrointestinal side effects were significantly more in the oral misoprostol group (p=0.014). Misoprostol is an effective cervical priming agent when administered either orally or vaginally before evacuation of conception in the termination of the first trimester missed miscarriage. (author)

Evacuation routes performances and fire safety of buildings

Directory of Open Access Journals (Sweden)

Laban Mirjana Đ.

2015-01-01

Full Text Available Residential buildings, public and business facilities with large number of occupants are particularly exposed to the risk of event with catastrophic consequences, especially in case of fire. Evacuation routes must be separated fire compartments with surfaces made of non-combustible materials. Safe evacuation of building occupants in case of fire is a crucial requirement for the preservation of human life in building. In our engineering practice, calculation model is usually applied in order to determine the time required for evacuation (SRPS TP 21. However, evacuation simulation models are more present in research papers, contributing to better assessment of flow of evacuation in the real time. These models could provide an efficient way of testing the safety of a building in the face of fire and indicate critical points at the evacuation paths. Computer models enable the development and analysis of multiple various scenarios during a fire event, contributing to defining the measures for improving the safety of the building in case of fire. This paper analyses the fulfilment of technical requirements for the safe evacuation and proposes improvement measures based on a comparative analysis of the time required for occupants' evacuation from the building (Department of Civil Engineering and Geodesy in Novi Sad, obtained by calculation model and by using evacuation simulation software.

The added value of mifepristone to non-surgical treatment regimens for uterine evacuation in case of early pregnancy failure: a systematic review of the literature.

Science.gov (United States)

van den Berg, Joyce; Gordon, Bernardus B M; Snijders, Marcus P M L; Vandenbussche, Frank P H A; Coppus, Sjors F P J

2015-12-01

Early pregnancy failure (EPF) is a common complication of pregnancy. Surgical intervention carries a risk of complications and, therefore, medical treatment appears to be a safe alternative. Unfortunately, the current medical treatment with misoprostol alone has complete evacuation rates between 53% and 87%. Some reports suggest that sequential treatment with mifepristone and misoprostol leads to higher success rates than misoprostol alone. To evaluate the added value of mifepristone to current non-surgical treatment regimens in women with EPF we performed a systematic literature search. Electronic databases were searched: PubMed, Cochrane Library, Current Controlled Trials, and ClinicalTrials.gov. Clinical studies, both randomised and non-randomised trials, reporting on the added value of mifepristone to current non-surgical treatment regimens in women with EPF were included. Data of sixteen studies were extracted using a data extraction sheet (based on the Cochrane Consumers and Communication Review Group's data extraction template). The methodological quality was assessed using the Cochrane Collaboration Risk of Bias tool. In five randomised and eleven non-randomised trials, success rates of sequential treatment with mifepristone and misoprostol in case of EPF varied between 52% and 95%. Large heterogeneity existed in treatment regimens and comparators between studies. The existing evidence is insufficient to draw firm conclusions about the added value of mifepristone to misoprostol alone. A sufficiently powered randomised, double blinded placebo-controlled trial is urgently required to test whether, in EPF, the sequential combination of mifepristone with misoprostol is superior to misoprostol only. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Research on evacuation planning as nuclear emergency preparedness

International Nuclear Information System (INIS)

Yamamoto, Kazuya

2007-10-01

The International Atomic Energy Agency (IAEA) has introduced new concepts of precautionary action zone (PAZ) and urgent protective action planning zone (UPZ) in 'Preparedness and Response for a Nuclear or Radiological Emergency' (GS-R-2 (2002)), in order to reduce substantially the risk of severe deterministic health effects. Open literature based research was made to reveal problems on evacuation planning and the preparedness for nuclear emergency arising from introduction of PAZ into Japan that has applied the emergency planning zone (EPZ) concept currently. In regard to application of PAZ, it should be noted that the requirements for preparedness and response for a nuclear or radiological emergency are not only dimensional but also timely. The principal issue is implementation of evacuation of precautionary decided area within several hours. The logic of evacuation planning for a nuclear emergency and the methods of advance public education and information in the U.S. is effective for even prompt evacuation to the outside of the EPZ. As concerns evacuation planning for a nuclear emergency in Japan, several important issues to be considered were found, that is, selection of public reception centers which are outside area of the EPZ, an unique reception center assigned to each emergency response planning area, public education and information of practical details about the evacuation plan in advance, and necessity of the evacuation time estimates. To establish a practical evacuation planning guide for nuclear emergencies, further researches on application of traffic simulation technology to evacuation time estimates and on knowledge of actual evacuation experience in natural disasters and chemical plant accidents are required. (author)

SURGICAL TREATMENT OF ENDOMETRIOSIS IN INFERTILE PATIENTS

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Andrej Vogler

2003-12-01

Full Text Available Background. Endometriosis is nowadays probably the most frequent cause of infertility or subfertility and is revealed in approximately 30–40% of infertile women. The association between fertility and minimal or mild endometriosis remains unclear and controversial. Moderate and severe forms of the disease distort anatomical relations in the minor pelvis, resulting in infertility. The goals of endometriosis treatment are relief of pain symptoms, prevention of the disease progression and fertility improvement. Treatment of stages I and II endometriosis (according to the R-AFS classification may be expectative, medical or surgical. In severely forms of the disease (stage III and IV the method of choice is surgical treatment. Combined medical and surgical treatment is justified only in cases, in which the complete endometriotic tissue removal is not possible or recurrence of pain symptoms occur. Nowadays, laparoscopic surgical treatment is the golden standard being the diagnostic and therapeutic tool during the same procedure. The aim of this study was to evaluate the fertility rate after surgical treatment of different stages of endometriosis.Patients and methods. In prospectively designed study 100 infertile women were included. The only known cause of infertility was endometriosis. In group A there were 51 patients with stage I and II endometriosis, whereas in group B there were 49 patients with stage III and IV of the disease. Endometriosis was diagnosed and treated laparoscopically. Endometriotic implants were removed either with bipolar coagulation or CO2 laser vaporisation, whereas adhesions were sharp or blunt dissected, and endometriomas stripped out of ovaries. Pregnancy rates were calculated for both groups of patients, and statistically compared between the groups.Results. Mean age of patients was 29.25 (SD ± 4.08 years and did not significantly differ between the groups of patients (29.5 years in group A and 29 years in group B. In

Study of the components of evacuation times

International Nuclear Information System (INIS)

Mills, G.S.; Neuhauser, K.S.; Smith, J.D.

1997-11-01

The magnitudes of accident dose risks calculated by the RADTRAN code depend directly on the time span between an accidental release and evacuation of the affected area surrounding potential radionuclide releases. In a previous study of truck and rail transportation accidents, and other incidents requiring evacuations, a lognormal distribution of evacuation times (time span from decision to evacuate until complete) was developed, which provided a better model for this parameter than the practice of using a highly conservative value of 24 hours. However, the distribution did not account for time required for responders to arrive on the scene, to evaluate the hazards to surrounding population and to initiate an evacuation. Data from US Department of Transportation (DOT) accident statistics have been collected and their distribution functions determined. The separate distribution functions were combined into a single, comprehensive distribution which may be sampled to supply values of the RADTRAN input parameter, EVACUATION. A sample RADTRAN calculation illustrating the effect on risks of using the distribution versus the original (24 hour), conservative point-estimate are also presented

Study of the components of evacuation times

International Nuclear Information System (INIS)

Mills, G.S.; Neuhauser, K.S.; Smith, J.D.

1998-01-01

The magnitudes of accident dose-risks calculated by the RADTRAN code depend directly on the time span between an accidental release and evacuation of the affected area surrounding potential radionuclide releases. In a previous study of truck and rail transportation accidents, and other incidents requiring evacuations (Mills et al., 1995) a lognormal distribution of evacuation times (time span from decision to evacuate until complete) was developed, which provided a better model for this parameter than the practice of using a highly conservative value of 24 hours. However, the distribution did not account for time required for responders to arrive on the scene, to evaluate the hazards to surrounding population and to initiate an evacuation. Data from U.S. Department of Transportation (DOT) accident statistics have been collected and their distribution functions determined. The separate distribution functions were combined into a single, comprehensive distribution which may be sampled to supply values of the RADTRAN input parameter, EVACUATION. A sample RADTRAN calculation illustrating the effect on risks of using the distribution versus the original (24 hours), conservative point-estimate are also presented. (authors)

Dual effects of guide-based guidance on pedestrian evacuation

Energy Technology Data Exchange (ETDEWEB)

Ma, Yi, E-mail: yima23-c@my.cityu.edu.hk; Lee, Eric Wai Ming; Shi, Meng

2017-06-15

This study investigates the effects of guide-based guidance on the pedestrian evacuation under limited visibility via the simulations based on an extended social force model. The results show that the effects of guides on the pedestrian evacuation under limited visibility are dual, and related to the neighbor density within the visual field. On the one hand, in many cases, the effects of guides are positive, particularly when the neighbor density within the visual field is moderate; in this case, a few guides can already assist the evacuation effectively and efficiently. However, when the neighbor density within the visual field is particularly small or large, the effects of guides may be adverse and make the evacuation time longer. Our results not only provide a new insight into the effects of guides on the pedestrian evacuation under limited visibility, but also give some practical suggestions as to how to assign guides to assist the evacuation under different evacuation conditions. - Highlights: • Extended social force model is used to simulate guided pedestrian evacuation. • Effects of guides on pedestrian evacuation under limited visibility are dual. • Effects of guides on pedestrian evacuation under limited visibility are related to neighbor density within visual field.

Study on rapid evacuation in high-rise buildings

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Xin Zhang

2017-06-01

Full Text Available More and more high rising buildings emerged in modern cities, but emergency evacuation of tall buildings has been a worldwide difficult problem. In this paper, a new evacuation device for high rising buildings in fire accident was proposed and studied. This device mainly consisted of special spiral slideway and shunt valve. People in this device could fast slide down to the first floor under gravity without any electric power and physical strength, which is suitable for various emergency evacuation including mobility-impaired persons. The plane simulation test has shown that human being in alternative clockwise and counterclockwise movement will not become dizzy. The evacuated people should wear protection pad, which can prevent slider from being injured by surface friction with the slide, and eliminate the friction coefficient difference caused by different clothes and slide surface. The calculation results show that the evacuation speed of the new device is much faster than traditional staircases. Moreover, such new evacuation device can also be used as a means of vertical transportation in high-rise buildings partly. People can take it from any floor to ground floor directly, which not only save time for waiting for the lifts but also save the power. The new evacuation system is of simple structure, easy to use, and suitable for evacuation and partly used as vertical downwards traffic, which shows light on solving world-wide difficulties on fast evacuation in high-rise buildings.

Prospective randomized controlled study on small-window craniotomy versus ordinary large-window craniotomy in the evacuation of epidural hematoma

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Lian-shui HU

2014-05-01

Full Text Available There is still controversy on the clinical efficacy of small-window craniotomy (SWCT for acute epidural hematoma with concurrent early-phase cerebral herniation. This study compared multiple surgical and prognostic parameters of SWCT versus ordinary large-window craniotomy (LWCT, which aimed at providing evidences for surgical decision. Compared with LWCT (N = 51, SWCT (N = 44 displayed shortened average operation time (P = 0.000, reduced intraoperative blood loss (P = 0.000 and lessened intraoperative blood transfusion (P = 0.031. Moreover, there was no differences of postoperative residual hematoma (P = 0.141, postoperative palinesthesia time (P = 0.201, the ratio of postoperative secondary ischemia (P = 0.865 or cerebral edema (P = 0.879, and 6-month Glasgow Outcome Scale (GOS score (P = 0.603 between the two surgical approaches.  Results suggested that, for patients with acute epidural hematoma and concurrent early-phase cerebral herniation, SWCT could effectively evacuate hematoma and relief brain herniation without significant differences of effect and prognosis from LWCT. In addition, SWCT has several advantages such as significantly reduced operation time, intraoperative blood loss and blood transfusion. doi: 10.3969/j.issn.1672-6731.2014.05.013

Research on Evacuation Based on Social Force Model

Science.gov (United States)

Liu, W.; Deng, Z.; Li, W.; Lin, J.

2017-09-01

Crowded centers always cause personnel casualties in evacuation operations. Stampede events often occur by hit, squeeze and crush due to panic. It is of vital important to alleviate such situation. With the deepening of personnel evacuation research, more and more researchers are committed to study individual behaviors and self-organization phenomenon in evacuation process. The study mainly includes: 1, enrich the social force model from different facets such as visual, psychological, external force to descript more realistic evacuation; 2, research on causes and effects of self - organization phenomenon. In this paper, we focus on disorder motion that occurs in the crowded indoor publics, especially the narrow channel and safety exits and other special arteries. We put forward the improved social force model to depict pedestrians' behaviors, an orderly speed-stratification evacuation method to solve disorder problem, and shape-changed export to alleviate congestion. The result of this work shows an improvement of evacuation efficiency by 19.5 %. Guiding pedestrians' direction to slow down the influence of social forces has a guidance function in improving the efficiency of indoor emergency evacuation.

The simulation of sanitary objects evacuation: An example of hotel 'Radon' in Niška Banja

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Jevtić Radoje B.

2015-01-01

Full Text Available Object evacuation is one of the most important, the most responsible and the most complex tasks for human safety in objects generally. This is especially important for objects with lot oh humans, such as health facilities, high residential objects, hotels, schools, etc. This is still an open and ongoing problem which can be confirmed by many injured people who were not evacuated in the disasters. This paper has written to show the possible evacuation situation and calculate minimal time for evacuation in case of Hotel Radon in Niška Banja, as one specific health facility with hardly moving and immobile patients.

Intelligent Transportation and Evacuation Planning A Modeling-Based Approach

CERN Document Server

Naser, Arab

2012-01-01

Intelligent Transportation and Evacuation Planning: A Modeling-Based Approach provides a new paradigm for evacuation planning strategies and techniques. Recently, evacuation planning and modeling have increasingly attracted interest among researchers as well as government officials. This interest stems from the recent catastrophic hurricanes and weather-related events that occurred in the southeastern United States (Hurricane Katrina and Rita). The evacuation methods that were in place before and during the hurricanes did not work well and resulted in thousands of deaths. This book offers insights into the methods and techniques that allow for implementing mathematical-based, simulation-based, and integrated optimization and simulation-based engineering approaches for evacuation planning. This book also: Comprehensively discusses the application of mathematical models for evacuation and intelligent transportation modeling Covers advanced methodologies in evacuation modeling and planning Discusses principles a...

Approach to Pediatric Patients during Surgical Interventions

OpenAIRE

Seher Ünver; Meltem Yıldırım

2013-01-01

A child’s surgical period usually contains unpleasant and difficult experiences, for the child and the parents. The child in this period experiences greater anxiety and distress. On the other hand, pediatric patients have complex states that directly effects their perioperative care during. Because their perioperative care includes not only the knowledge of general surgical procedure and care of a patient in the operating room. It also includes the specific understanding of a child’s airway, ...

Assessment of total evacuation systems for tall buildings

CERN Document Server

Ronchi, Enrico

2014-01-01

This SpringerBrief focuses on the use of egress models to assess the optimal strategy for total evacuation in high-rise buildings. It investigates occupant relocation and evacuation strategies involving the exit stairs, elevators, sky bridges and combinations thereof. Chapters review existing information on this topic and describe case study simulations of a multi-component exit strategy. This review provides the architectural design, regulatory and research communities with a thorough understanding of the current and emerging evacuation procedures and possible future options. A model case study simulates seven possible strategies for the total evacuation of two identical twin towers linked with two sky-bridges at different heights. The authors present the layout of the building and the available egress components including both vertical and horizontal egress components, namely stairs, occupant evacuation elevators (OEEs), service elevators, transfer floors and sky-bridges. The evacuation strategies employ a ...

[Surgical treatment of Marfan syndrome; analysis of the patients required multiple surgical interventions].

Science.gov (United States)

Yamazaki, F; Shimamoto, M; Fujita, S; Nakai, M; Aoyama, A; Chen, F; Nakata, T; Yamada, T

2002-07-01

Without treatment, the life expectancy of patients with Marfan syndrome is reduced by the associated cardiovascular abnormalities. In this study, we reviewed our experience of the patients with Marfan syndrome who required multiple surgical interventions to identify the optimal treatment for these patients. Between January 1986 and December 2000, 44 patients with Marfan syndrome were operated on at Shizuoka City Hospital (SCH). Among them, 10 patients (22.7%) underwent multiple surgical interventions. There were 5 male and 5 female patients with a mean age of 40.6 +/- 16.1 years at the initial surgery. Only one patient was operated on at another hospital for his first, second, and third operations. His fourth operation was carried out at SCH. The remaining 9 patients underwent a total of 14 additional surgical procedures at SCH. Computed tomography (CT) scans were taken every 6 months postoperatively, and aortic diameter greater than 60 mm was considered as the indication for the additional surgery. There were no early death and one late death. The causes of additional surgery were enlargement of true aneurysm in 6, enlargement of residual dissection in 4, new dissection in 4, false aneurysm at the coronary anastomosis of Bentall procedure in 1. In 9 patients, both ascending and descending aorta were replaced. Among these 9 patients, only 3 patients underwent total arch replacement, and remaining 6 patients had their arch left in place with or without dissection. Our current strategy of the treatment of Marfan patients with acute type A dissection is total arch replacement with an elephant trunk at the initial emergent surgery.

Surgical site infection among patients undergone orthopaedic ...

African Journals Online (AJOL)

Surgical site infection among patients undergone orthopaedic surgery at Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania. ... of surgical site infection at Muhimbili Orthopedic Institute was high. This was associated with more than 2 hours length of surgery, lack of prophylaxis use, and pre-operative hospital stay.

Post V-P shunt surgical site EDH an uncommon complication: case report

Directory of Open Access Journals (Sweden)

Garg Manish

2017-06-01

Full Text Available ventriculoparitoneal shunt is well established modality of treatment for hydrocephalous. Complication of v-p shunt are also mentioned in literature like shunt infection shunt migration etc [8]. Here we are describing a rare complication of vp shunt which barely mentioned in literature. A 22 yr male admitted with complain of headache & vomiting patient was diagnosed to have tubercular meningities with hydrocephalous. Patient planned for ventriculoparietoneal shunt surgery and vp shunt was done. On 3rd post-surgery day patient develop weakness in Left side of body. Urgent ncct head done which showed EDH at surgical site. Immediate craniotomy and evacuation of hematoma was done patient improved and discharged. Thus we are discussing the importance of meticulous surgery for v-p shunt, post op ct scan and treatment.

Optimization of Evacuation Warnings Prior to a Hurricane Disaster

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Dian Sun

2017-11-01

Full Text Available The key purpose of this paper is to demonstrate that optimization of evacuation warnings by time period and impacted zone is crucial for efficient evacuation of an area impacted by a hurricane. We assume that people behave in a manner consistent with the warnings they receive. By optimizing the issuance of hurricane evacuation warnings, one can control the number of evacuees at different time intervals to avoid congestion in the process of evacuation. The warning optimization model is applied to a case study of Hurricane Sandy using the study region of Brooklyn. We first develop a model for shelter assignment and then use this outcome to model hurricane evacuation warning optimization, which prescribes an evacuation plan that maximizes the number of evacuees. A significant technical contribution is the development of an iterative greedy heuristic procedure for the nonlinear formulation, which is shown to be optimal for the case of a single evacuation zone with a single evacuee type case, while it does not guarantee optimality for multiple zones under unusual circumstances. A significant applied contribution is the demonstration of an interface of the evacuation warning method with a public transportation scheme to facilitate evacuation of a car-less population. This heuristic we employ can be readily adapted to the case where response rate is a function of evacuation number in prior periods and other variable factors. This element is also explored in the context of our experiment.

An analysis of evacuation options for nuclear accidents

Energy Technology Data Exchange (ETDEWEB)

Tawil, J J; Strenge, D L; Schultz, R W

1987-11-01

The threat of release of a hazardous substance into the atmosphere will sometimes require that the population at risk be evacuated. If the substance is particularly hazardous or the release is exceptionally large, then an extensive area may have to be evacuated at substantial cost. In this report we consider the threat posed by the accidental release of radionuclides from a nuclear power plant. The report's objective is to establish relationships between radiation dose and the cost of evacuation under a wide variety of conditions. The dose can almost always be reduced by evacuating the population from a larger area. However, extending the evacuation zone outward will cause evacuation costs to increase. The purpose of this analysis was to provide the Environmental Protection Agency (EPA) a data base for evaluating whether implementation costs and risks averted could be used to justify evacuation at lower doses than would be required based on acceptable risk of health effects alone. The procedures used and results of these analyses are being made available as background information for use by others. In this report we develop cost/dose relationships for 54 scenarios that are based upon the severity of the reactor accident, meteorological conditions during the release of radionuclides into the environment, and the angular width of the evacuation zone. The 54 scenarios are derived from combinations of three accident severity levels, six meteorological conditions and evacuation zone widths of 70 deg, 90 deg, and 180 deg. Appendix tables are provided to allow acceptable evaluation of the cost/dose relationships for a wide variety of scenarios. Guidance and examples are provided in the text to show how these tables can be used.

Evacuation decision-making at Three Mile Island

International Nuclear Information System (INIS)

Zeigler, D.J.; Johnson, J.H. Jr.

1987-01-01

During the emergency at the Three Mile Island generating station in the United States, evacuation became a common adaptive response among the local population. The planning for nuclear emergencies in the US has proceeded as if there were no significant differences between nuclear and other types of disasters requiring evacuation. In the United Kingdom, emergency planning for a new generation of pressurized water reactors, about which there is legitimate safety concern, has been influenced not at all by the experience with the Three Mile Island PWR in 1979. The TMI accident has been the US's most serious experience with a nuclear plant accident and therefore is an appropriate analogy for predicting the evacuation response to future nuclear emergencies. In this light, the authors accept the need to develop models that will enable them to predict the magnitude of the evacuation shadow phenomenon around other nuclear power sites and estimate its impact on our plans to remove the threatened population from the hazard zone in the minimum amount of time. Rather than depend on education and information control to stifle evacuation response, the authors believe that evacuation plans need to build on people's natural behavioural inclinations to protect themselves in response to the nuclear hazard

Patients at High-Risk for Surgical Site Infection.

Science.gov (United States)

Mueck, Krislynn M; Kao, Lillian S

Surgical site infections (SSIs) are a significant healthcare quality issue, resulting in increased morbidity, disability, length of stay, resource utilization, and costs. Identification of high-risk patients may improve pre-operative counseling, inform resource utilization, and allow modifications in peri-operative management to optimize outcomes. Review of the pertinent English-language literature. High-risk surgical patients may be identified on the basis of individual risk factors or combinations of factors. In particular, statistical models and risk calculators may be useful in predicting infectious risks, both in general and for SSIs. These models differ in the number of variables; inclusion of pre-operative, intra-operative, or post-operative variables; ease of calculation; and specificity for particular procedures. Furthermore, the models differ in their accuracy in stratifying risk. Biomarkers may be a promising way to identify patients at high risk of infectious complications. Although multiple strategies exist for identifying surgical patients at high risk for SSIs, no one strategy is superior for all patients. Further efforts are necessary to determine if risk stratification in combination with risk modification can reduce SSIs in these patient populations.

Cephalohematoma in a Patient with Ehlers-Danlos Syndrome

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Brent M Felton

2013-09-01

Full Text Available Ehlers-Danlos syndrome is a rarely encountered connective tissue disorder characterized by skin hyper-elasticity, joint hyper-flexibility, and vasculature fragility. We report a 41-year-old female presenting with scalp swelling following minor head trauma. The patient presented with a large cephalohematoma that despite compressive measures and Factor IX administration continued to progress, necessitating transfer for definitive surgical intervention. The patient underwent surgical evacuation of approximately 1 liter of blood, followed by drain placement and compression dressing. This case underscores the importance for emergency physicians to recognize the potential vascular catastrophes these patients may present with following even minor injury. [West J Emerg Med. 2013;14(5:419-420.

Second branchial cleft fistulae: patient characteristics and surgical outcome.

Science.gov (United States)

Kajosaari, Lauri; Mäkitie, Antti; Salminen, Päivi; Klockars, Tuomas

2014-09-01

Second branchial cleft anomalies predispose to recurrent infections, and surgical resection is recommended as the treatment of choice. There is no clear consensus regarding the timing or surgical technique in the operative treatment of these anomalies. Our aim was to compare the effect of age and operative techniques to patient characteristics and treatment outcome. A retrospective study of pediatric patients treated for second branchial sinuses or fistulae during 1998-2012 at two departments in our academic tertiary care referral center. Comparison of patient characteristics, preoperative investigations, surgical techniques and postoperative sequelae. Our data is based on 68 patients, the largest series in the literature. One-fourth (24%) of patients had any infectious symptoms prior to operative treatment. Patient demographics, preoperative investigations, use of methylene blue, or tonsillectomy had no effect on the surgical outcome. There were no re-operations due to residual disease. Three complications were observed postoperatively. Our patient series of second branchial cleft sinuses/fistulae is the largest so far and enables analyses of patient characteristics and surgical outcomes more reliably than previously. Preoperative symptoms are infrequent and mild. There was no difference in clinical outcome between the observed departments. Performing ipsilateral tonsillectomy gave no outcome benefits. The operation may be delayed to an age of approximately three years when anesthesiological risks are and possible harms are best avoided. Considering postoperative pain and risk of postoperative hemorrhage a routine tonsillectomy should not be included to the operative treatment of second branchial cleft fistulae. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

FIRE EVACUATION FROM HIGH-RISE BUILDINGS

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Korol'chenko Aleksandr Yakovlevich

2012-10-01

Full Text Available The authors argue that no collapse of structures is likely in the event of a fire emergency in multistoried buildings, rather, other fire-related factors may endanger the lives of people inside high-rise buildings exposed to the fire emergency, including open fire, sparks, high ambient temperature, smoke and toxic combustion products, reduced concentration of oxygen, and combined influence of various factors. In case of fire, the temperature inside buildings reaches 1100 °С. It exceeds the temperature of the ambient air acceptable for humans by far (70 °С. The experiments demonstrate that combustion products contain hundreds of toxic chemical compounds. The most hazardous of them include carbon oxide, carbon dioxide, chloride and cyanic hydrogen, aldehydes and acrolein. The author provides the pattern of their influence on the human body. The smoke consists of unburned particles of carbon and aerosols. The size of particles fluctuates within 0.05-50 MMK. Smoke produces a physiological and psychological impact on human beings. It has been proven that dangerous fire factors emerge within the first five to ten minutes of the emergency situation. Evacuation is the principal method of safety assurance. However, the velocity of propagation of smoke and heat is so high that even if the fire prevention system is in operation, people may be blocked both on the floors that are exposed to the fire and those that escape its propagation. New evacuation and rescue methods are recommended by the author. Various ways and methods of use of life-saving facilities are also provided. Safe evacuation is feasible from buildings where the number of stories does not exceed 10- 12. During evacuation, high density human streams are formed inside buildings, therefore, the period of stay in a burning building is increased. The calculations have proven that a two-minute delay of evacuation converts into a safe evacuation of only 13-15% of people. Low reliability of

Surgical Trial in Lobar Intracerebral Haemorrhage (STICH II Protocol

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Rowan Elise N

2011-05-01

Full Text Available Abstract Background Within the spectrum of spontaneous intracerebral haemorrhage there are some patients with large or space occupying haemorrhage who require surgery for neurological deterioration and others with small haematomas who should be managed conservatively. There is equipoise about the management of patients between these two extremes. In particular there is some evidence that patients with lobar haematomas and no intraventricular haemorrhage might benefit from haematoma evacuation. The STICH II study will establish whether a policy of earlier surgical evacuation of the haematoma in selected patients will improve outcome compared to a policy of initial conservative treatment. Methods/Design an international multicentre randomised parallel group trial. Only patients for whom the treating neurosurgeon is in equipoise about the benefits of early craniotomy compared to initial conservative treatment are eligible. All patients must have a CT scan confirming spontaneous lobar intracerebral haemorrhage (≤1 cm from the cortex surface of the brain and 10-100 ml in volume. Any clotting or coagulation problems must be corrected and randomisation must take place within 48 hours of ictus. With 600 patients, the study will be able to demonstrate a 12% benefit from surgery (2p Stratified randomisation is undertaken using a central 24 hour randomisation service accessed by telephone or web. Patients randomised to early surgery should have the operation within 12 hours. Information about the status (Glasgow Coma Score and focal signs of all patients through the first five days of their trial progress is also collected in addition to another CT scan at about five days (+/- 2 days. Outcome is measured at six months via a postal questionnaire to the patient. Primary outcome is death or severe disability defined using a prognosis based 8 point Glasgow Outcome Scale. Secondary outcomes include: Mortality, Rankin, Barthel, EuroQol, and Survival. Trial

A large scale evacuation. Tasks of evacuator. Collapse of medical system at the time of areal indication for large scale indoor refuge and problems for restoration

International Nuclear Information System (INIS)

Oikawa, Tomoyoshi

2012-01-01

About the evacuation from disasters of quake/tsunami on Mar. 11, 2011, and Fukushima Nuclear Power Plant Accident (Mar. 12-15), described are its social background, influence on the local society, medicare and works of medical staff. The disaster immediately blocked means of communication and transportation in Minamisoma City, and the Japan government indicated the indoor refuge of residents in the zone at 3 km distance from the Plant, then at 20 km on 12th and 30 km on 15th. About 123 thousands residents nearby had to evacuate after all: the largest scale of evacuation by the nuclear accident in Japan. Author's Minamisoma Citizens' Hospital (MCH) was located at 23 km from the Plant. Residents could know about the government indications through various media before their official announcements, and many had begun to evacuate. MCH accepted >100 victims, and measured their contamination as well as the ambient dose, using GM counter from 12th. The highest dose was 16 mc-Sv/h on 20th. Following the hydrogen explosion of no.3 reactor on 14th, residents were bewildered by the indication of indoor refuge, which impacted social activities like stoppage of commerce and brought about residents' mental conflict and solitary. Movement of all 107 hospitalized patients to neighboring facilities in Niigata prefecture started on 18th and actually completed on 20th with help from Self Defense Force. Children, pregnant women and certain patients were prohibited to enter the newly defined emergent evacuation preparation (EEP) zone on Apr. 11, within 30 km afar from the Plant, which inhibited the areal restoration and medicare. At present that 1.5 years have passed since the disaster, the number of medical stuff is quite insufficient near the old EEP zone. There, now 2/3 of population before the disaster are beginning their life, and most are elderly, suggesting the necessity of rearrangement of medical systems which were seemingly once collapsed. (T.T.)

The role of the defaecating pouchogram in the assessment of evacuation difficulty after restorative proctocolectomy and pouch-anal anastomosis.

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Stellingwerf, M E; Maeda, Y; Patel, U; Vaizey, C J; Warusavitarne, J; Bemelman, W A; Clark, S K

2016-08-01

Restorative proctocolectomy (RPC) with ileal pouch-anal anastomosis (IPAA) is the most frequently performed operation for intractable ulcerative colitis (UC) and for many patients with familial adenomatous polyposis (FAP). It can be complicated by a functional evacuation difficulty, which is not well understood. We aimed to evaluate the role of defaecating pouchography in an attempt to assess the mechanism of evacuation difficulty in pouch patients. All RPC patients who had had a defaecating pouchogram for evacuation difficulty at one hospital between 2006 and 2014 were retrospectively reviewed. The findings and features were correlated with the symptoms. Demographic, clinical and radiological variables were analysed. Eighty-seven [55 (63%) female] patients aged 47.6 ± 12.5 years (mean standard ± SD) were identified. Thirty-five had a mechanical outlet obstruction and 52 had no identified mechanical cause to explain the evacuation difficulty. The mean age of these 52 [33 (63%) female] patients was 48.2 ± 13 years. Of these 52 patients, significantly more used anti-diarrhoeal medication (P = 0.029), complained of a high frequency of defaecation (P = 0.005), experienced a longer time to the initiation of defaecation (P = 0.049) and underwent pouchoscopy (P = 0.003). Biofeedback appeared to improve the symptoms in 7 of 16 patients with a nonmechanical defaecatory difficulty. The most common findings on defaecating pouchography included residual barium of more than 33% after an attempted evacuation (46%, n = 24), slow evacuation (35%, n = 18) and mucosal irregularity (33%, n = 17). Correlation between radiological features and symptoms showed a statistically significant relationship between straining, anal pain, incontinence and urgency with patterns of anismus or pelvic floor descent or weakness seen on the defaecating pouchogram. Symptoms of incomplete evacuation, difficulty in the initiation of defaecation, high defaecatory frequency and

Surgical care of the pediatric Crohn's disease patient.

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Stewart, Dylan

2017-12-01

Despite the significant advances in the medical management of inflammatory bowel disease over the last decade, surgery continues to play a major role in the management of pediatric Crohn's disease (CD). While adult and pediatric Crohn's disease may share many clinical characteristics, pediatric Crohn's patients often have a more aggressive phenotype, and the operative care given by the pediatric surgeon to the newly diagnosed Crohn's patient is very different in nature to the surgical needs of adult patients after decades of disease progression. Children also have the unique surgical indication of growth failure to consider in the overall clinical decision making. While surgery is never curative in CD, it has the ability to transform the disease process in children, and appropriately timed operations may have tremendous impact on a child's physical and mental maturation. This monograph aims to address the surgical care of Crohn's disease in general, with a specific emphasis on the surgical treatment of small intestinal and ileocecal involvement. Copyright © 2017 Elsevier Inc. All rights reserved.

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

Effect of Surgical Safety Checklist on Mortality of Surgical Patients in the α University Hospitals

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R. Mohebbifar

2014-01-01

Full Text Available Background & Aims: Patient safety is one of the indicators of risk management in clinical governance system. Surgical care is one of the most sophisticated medical care in the hospitals. So it is not surprising that nearly half of the adverse events, 66% were related to surgery. Pre-flight aircraft Inspection model is starting point for designing surgical safety checklist that use for audit procedure. The aim of this study is to evaluate the effect of the use of surgical safety checklist on surgical patients mortality and complications. Materials and Methods: This is a prospective descriptive study. This study was conducted in 2012 in the North West of Iran. The population consisted of patients who had undergoing surgery in α university of medical science`s hospital which have surgical department. In this study, 1125 patients underwent surgery within 3 months were studied. Data collection tool was designed based on WHO model and Surgcical Care and Outcomes Assessment Program(SCOAP. Data analysis was performed using the SPSS-20 statistical software and logistic regression analysis was used to calculate P values for each comparison. Results: No significant differences between patients in the two periods (before and after There was. All complications rate reduced from 11 percent to 4 percent after the intervention by checklist (p<0.001. In the all hospitals mortality rate was decreased from 3.44% to 1.3% (p <0.003. Overall rate of surgical site infection and unplanned return to the operating room was reduced (p<0.001 and p<0.046. Conclusion: Many people every year due to lack of safety in hospitals, lose their lives. Despite the risks, such as leaving surgery sets in patient body and wrong surgery is due to lack of proper safety programs during surgery. By using safety checklist in all hospitals mortality rate and complications was reduced but this reduction was extremely in α3 hospital (from 5.2% to 1.48%.

Building Evacuation with Mobile Devices

OpenAIRE

Merkel, Sabrina

2014-01-01

The rapidly growing world population and increasingly dense settlements demand ever-larger and more complex buildings from today's engineers. In comparison to this technological progress, a building's equipment for emergency evacuation has been hardly developed further. This work presents a concept for a building evacuation system based on mobile devices. Furthermore, various algorithms for route planning with mobile devices and for indoor localization of mobile devices are addressed.

Availability of cardiac surgical care in surgical correction of acquired heart defects in patients of older age group

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Kubatbek S. Urmanbetov

2018-02-01

Full Text Available Objective: A study of accessibility of surgical care to elderly patients (aged 60 and above with valvular heart disease has been conducted at the BSCCS "Bakulev Scientific Center of Cardiovascular Surgery» of the Ministry of Health of the Russian Federation. Methods: A retrospective analysis of structure of hospitalizations of 1726 patients, that were hospitalized between 2009 and 2010 at the BSCCS for surgical correction of valvular heart disease was performed. Results: Our study demonstrated that age, on one hand, is not the most significant barrier in the geographical accessibility of cardiac surgical care. On the other hand, it can influence the availability in general, taking into account other factors (urban / rural areas, the presence of cardiac surgical clinics, and clinical status. Provision of cardiac surgical care for patients with heart defects at the BSCCS per 1 million population varies considerably in the context of federal districts and is 0.4 for the Siberian Federal District 30 for the Central Federal District (the highest is 42 for the Moscow Region. Conclusion: Thus, our study demonstrated accessibility of surgical care for elderly patients is the highest for the urban areas with specialized cardiac surgery centers, where patients referred from rural regions

Surgical dislocation of the hip in patients with femoroacetabular impingement: Surgical techniques and our experience

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Mladenović Marko

2015-01-01

Full Text Available Background/Aim. Arthrosis of the hip is the most common cause of a hip joint disorders. The aim of this study was to present our experience in the application of a safe surgical dislocation of the hip in patients with minor morphological changes in the hip joint, which, through the mechanism of femoroacetabular impingement, cause damage to the acetabular labrum and adjacent cartilage as an early sign of the hip arthrosis. Methods. We have operated 51 patients with different morphological bone changes in the hip area and resultant soft tissue damage of the acetabular labrum and its adjacent cartilage. Surgical technique that we applied in this group of patients, was adapted to our needs and capabilities and it was minimaly modified compared to the original procedure. Results. The surgical technique presented in this paper, proved to be a good method of treatment of bone and soft tissue pathomorphological changes of the hip in patients with femoroacetabular impingement. We had no cases with avascular necrosis of the femoral head, and two patients had nonunion of the greater trochanter, 9 patients developed paraarticular ossification, without subjective symptoms, while 3 patients suffered from postoperative pain in the groin during more energetic physical activities. Conclusion. Utilization of our partly modified surgical technique of controlled and safe dislocation of the hip can solve all the bone and soft tissue problems in patients with femoroacetibular impingement to stop already developed osteoarthritis of the hip or to prevent mild form of it.

Patient-perceived surgical indication influences patient expectations of surgery for degenerative spinal disease.

Science.gov (United States)

Wilson, Thomas J; Franz, Eric; Vollmer, Carolyn F; Chang, Kate W-C; Upadhyaya, Cheerag; Park, Paul; Yang, Lynda J-S

2017-06-01

Patients frequently have misconceptions regarding diagnosis, surgical indication, and expected outcome following spinal surgery for degenerative spinal disease. In this study, we sought to understand the relationship between patient-perceived surgical indications and patient expectations. We hypothesized that patients reporting appendicular symptoms as a primary surgical indication would report a higher rate of having expectations met by surgery compared to those patients reporting axial symptoms as a primary indication. Questionnaires were administered to patients who had undergone surgery for degenerative spinal disease at 2 tertiary care institutions. Questions assessed perception of the primary indication for undergoing surgery (radicular versus axial), whether the primary symptom improved after surgery, and whether patient expectations were met with surgery. Outcomes of interest included patient-reported symptomatic improvement following surgery and expectations met by surgery. Various factors were assessed for their relationship to these outcomes of interest. There were 151 unique survey respondents. Respondents were nearly split between having a patient-perceived indication for surgery as appendicular symptoms (55.6%) and axial symptoms (44.4%). Patient-perceived surgical indication being appendicular symptoms was the only factor predictive of patient-reported symptomatic improvement in our logistic regression model (OR 2.614; 95% CI 1.218-5.611). Patient-perceived surgical indication being appendicular symptoms (OR 3.300; 95% CI 1.575-6.944) and patient-reported symptomatic improvement (OR 33.297; 95% CI 12.186-90.979) were predictive of patients reporting their expectations met with surgery in both univariate and multivariate logistic regression modeling. We found that patient-reported appendicular symptoms as the primary indication for surgery were associated with a higher rate of both subjective improvement following surgery and having expectations met

Oral misoprostol in the prevention of uterine bleeding after surgical ...

African Journals Online (AJOL)

2013-03-13

Mar 13, 2013 ... Oral misoprostol in the prevention of uterine bleeding after surgical evacuation of first trimester abortion: A comparative study of three uterotonic agents. TM Aramide, AK Olusegun1, AC Akinfolarin2, DF Oriola. Department of Obstetrics and Gynaecology, LAUTECH Teaching Hospital, Ogbomoso, Oyo State, ...

APPROXIMATION OF THE TIME TO INITIATE THE EVACUATION

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Jiří POKORNÝ

2016-06-01

Full Text Available One of the basic prerequisites for securing the safety of people at large group events is to ensure their evacuation in case of emergencies. This article deals with the approximations of time to initiate the evacuation of persons in case of a fire at large group events organized in outdoor spaces. The solution is based on the principles of determining the period to initiate the evacuation of persons in terms of international ISO standards. Considering the specificities of the given outdoor space and possible related security measures, the article recommends the relevant sufficient amount of time to initiate an evacuation.

City evacuations an interdisciplinary approach

CERN Document Server

Binner, Jane; Branicki, Layla; Galla, Tobias; Jones, Nick; King, James; Kolokitha, Magdalini; Smyrnakis, Michalis

2015-01-01

Evacuating a city is a complex problem that involves issues of governance, preparedness education, warning, information sharing, population dynamics, resilience and recovery. As natural and anthropogenic threats to cities grow, it is an increasingly pressing problem for policy makers and practitioners.   The book is the result of a unique interdisciplinary collaboration between researchers in the physical and social sciences to consider how an interdisciplinary approach can help plan for large scale evacuations.  It draws on perspectives from physics, mathematics, organisation theory, economics, sociology and education.  Importantly it goes beyond disciplinary boundaries and considers how interdisciplinary methods are necessary to approach a complex problem involving human actors and increasingly complex communications and transportation infrastructures.   Using real world case studies and modelling the book considers new approaches to evacuation dynamics.  It addresses questions of complexity, not only ...

Charles Bernard Puestow (1902-1973): American surgeon and commander of the 27th Evacuation Hospital during the Second World War.

Science.gov (United States)

Bosmia, Anand N; Christein, John D

2017-08-01

Dr. Charles Bernard Puestow (1902-1973) was an American surgeon who is well known for developing the longitudinal pancreaticojejunostomy, which is known as the "Puestow procedure" in his honor. Puestow served in the American military during the Second World War and commanded the 27th Evacuation Hospital, which provided medical and surgical services to wounded individuals in Europe and North Africa. In 1946, he founded the surgical residency training program at the Hines Veterans Hospital, which was the first such program in the United States based at a veterans hospital.

Outcomes after endoscopic port surgery for spontaneous intracerebral hematomas.

Science.gov (United States)

Ochalski, Pawel; Chivukula, Srinivas; Shin, Samuel; Prevedello, Daniel; Engh, Johnathan

2014-05-01

Spontaneous intracerebral hemorrhages (ICHs) cause significant morbidity and mortality. Traditional open surgical management strategies offer limited benefit except for the most superficial hemorrhages in select patients. Recent reports suggest that endoscopic approaches may improve outcomes, particularly for deep subcortical hemorrhages. However, the management of these patients remains controversial. We reviewed our experience using endoscopic port surgery to identify characteristics that may predict acceptable outcomes. We completed a retrospective chart and imaging review of patients who underwent endoscopic port surgery for evacuation of spontaneous ICH at a single center. Data were gathered regarding patient demographics, hemorrhage locations, operative findings, and clinical outcomes. From 2007 to 2011, 18 patients underwent evacuation of spontaneous intracerebral hematomas using an endoscopic port. The mean age in years was 62 years (range, 43-84 years). Six of 18 patients (33%) died before discharge, and 2 others (11%) died after at least 1 month of survival. Of 12 initial survivors, all were discharged to a rehabilitation or nursing facility. Complete hematoma evacuation was achieved in 7 of 18 patients, with the remaining 11 having a partial evacuation. The patients who died (n = 6) before discharge were statistically more likely to have a left-sided hemorrhage, partial evacuation, or older age than the survivors; death at least 1  month after evacuation was additionally associated with greater preoperative hematoma volumes. Our series demonstrates that endoscopic port surgery for acute intracerebral hematoma evacuation has the ability to achieve significant decompression of large and deep-seated hematomas. Patient age, extent of evacuation, laterality, and preoperative hematoma volume appear to influence patient outcome. Most overall outcomes remain poor. Future studies are necessary to determine if surgical evacuation is in fact superior to best

Evacuation a serious game for preparation

NARCIS (Netherlands)

Kolen, B.; Thonus, B.; van Zuilekom, Kasper M.; de Romph, E.

2011-01-01

Mass evacuation is a measure to reduce possible loss of life in the case of potential disasters. Planning for mass evacuation is only useful if these plans are tested and evaluated by government and the public in reality or in simulated events. As a result, any prior experience is likely to be

Comparison of calculation and simulation of evacuation in real buildings

Science.gov (United States)

Szénay, Martin; Lopušniak, Martin

2018-03-01

Each building must meet requirements for safe evacuation in order to prevent casualties. Therefore methods for evaluation of evacuation are used when designing buildings. In the paper, calculation methods were tested on three real buildings. The testing used methods of evacuation time calculation pursuant to Slovak standards and evacuation time calculation using the buildingExodus simulation software. If calculation methods have been suitably selected taking into account the nature of evacuation and at the same time if correct values of parameters were entered, we will be able to obtain almost identical times of evacuation in comparison with real results obtained from simulation. The difference can range from 1% to 27%.

A controlled trial of colostomy management by natural evacuation, irrigation and foam enema.

Science.gov (United States)

Doran, J; Hardcastle, J D

1981-10-01

Twenty patients entered a prospective controlled trial of colostomy management by three techniques--natural evacuation, colostomy irrigation and foam enema. Every patient spent 2 months using each technique. The mean number of colostomy actions weekly was 17 during natural evacuation, 6 during irrigation and 10 with the enema. There was no significant difference in the time taken to manage the colostomy by each technique. Eighteen patients considered that both irrigation and the foam enema improved the quality of their life, and opted to continue with irrigation on completion of the study. There were no major complications during the trial but leakage of foam and an increase in flatus were problems with the foam enema. It is concluded that patients should be made aware of the alternative methods available for colostomy management and be encouraged to use the method of their choice.

Outcome of anesthesia in elective surgical patients with comorbidities.

Science.gov (United States)

Eyelade, Olayinka; Sanusi, Arinola; Adigun, Tinuola; Adejumo, Olufemi

2016-01-01

Presence of comorbidity in surgical patients may be associated with adverse perioperative events and increased the risk of morbidity and mortality. This audit was conducted to determine the frequencies of comorbidities in elective surgical patients and the outcome of anesthesia in a Tertiary Hospital in Nigeria. Observational study of a cross-section of adult patients scheduled for elective surgery over a 6-month period. A standardized questionnaire was used to document patients' demographics, the presence of comorbidity and type, surgical diagnosis, anesthetic technique, intraoperative adverse events, and outcome of anesthesia. The questionnaire was administered pre- and post-operatively to determine the effects of the comorbidities on the outcome of anesthesia. One hundred and sixty-five adult patients aged between 18 and 84 years were studied. There were 89 (53.9%) females and 76 (46.1%) males. Forty-five (27.3%) have at least one comorbidity. Hypertension was the most common (48.8%) associated illness. Other comorbidities identified include anemia (17.8%), asthma (8.9%), diabetes mellitus (6.7%), chronic renal disease (6.7%), and others. The perioperative period was uneventful in majority of patients (80.6%) despite the presence of comorbidities. Intraoperative adverse events include hypotension, hypertension, shivering, and vomiting. No mortality was reported. Hypertension was the most common comorbidity in this cohort of patients. The presence of comorbidity did not significantly affect the outcome of anesthesia in elective surgical patients.

Beyond consent--improving understanding in surgical patients.

LENUS (Irish Health Repository)

Mulsow, Jürgen J W

2012-01-01

Little is known of the actual understanding that underlies patient choices with regard to their surgical treatment. This review explores current knowledge of patient understanding and techniques that may be used to improve this understanding.

Influence of minimally invasive hematoma evacuation combined with nerve growth factor preparation on neurological function injury in patients with hypertensive cerebral hemorrhage

OpenAIRE

Jiang Tao; Feng Ai-Ping; Liu Lun-Bo; Huang Qi-Jun; Du Chen

2017-01-01

Objective: To study the influence of minimally invasive hematoma evacuation combined with nerve growth factor preparation on neurological function injury in patients with hypertensive cerebral hemorrhage. Methods: A total of 112 patients with hypertensive cerebral hemorrhage who were treated in our hospital between July 2013 and February 2016 were collected, and according to random number table, they were divided into the control group (n=56) who underwent minimally invasive he...

A Case of Re-Expansion Pulmonary Edema after Rapid Pleural Evacuation

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SH Shahbazi

2007-07-01

Full Text Available Introduction & Objective: Pulmonary edema after chest tube insertion is a rare complication and is associated with high mortality. The cause of this phenomenon is not clear, although causes such as decrease in surfactant and inflammatory process have been defined. Early diagnosis and treatment decrease the mortality. This study introduces a case of re-expansion pulmonary edema after rapid pleural evacuation. Case: The case is a 4.5 y/o boy, a case of Tetralogy of Fallot, who developed respiratory distress after surgery (Total Correction in ICU of Namazi Hospital in 1385. Chest X ray showed pneumothorax of left lung. For the patient, chest tube was inserted and the symptoms improved. After few hours the patient developed tachypnea, tachycardia, and CXR showed pulmonary edema of left lung. Appropriate treatment was done for the patient and his condition improved. Conclusion: Pulmonary edema after sudden evacuation of pleura is a rare phenomenon and early diagnosis decreases the mortality.

CT-guided stereotactic evacuation of hypertensive intracerebral hematomas

International Nuclear Information System (INIS)

Hondo, Hideki

1983-01-01

Computerized tomography (CT) is now effective not only for definite diagnosis and location of intracerebral hematomas but also for coordination of the center of a hematoma. CT-guided stereotactic evacuation of hypertensive intracerebral hematoma was performed in 51 cases: 34 of basal ganglionic hematoma with or without ventricular perforation, 11 of subcortical hematoma, 3 of thalamic hematoma and 3 of cerebellar hematoma. Three dimensional CT images or biplane CT images were taken to determine the coordinates of the target point, which was the center of the hematoma. Then, a silicon tube (O.D. 3.5 phi, I.D. 2.1 phi) was inserted into the center of the hematoma through a burr-hole under local anesthesia, and the liquid or solid hematoma was aspirated as completely as possible with a syringe. Urokinase (6,000 I.U./5 ml saline) was administered through this silicon tube every 6 or 12 hours for several days until the hematoma had drained out competely. The silicon tube was taken out when repeated CT scanning revealed no hematoma. The results of clinical follow-ups indicated that this procedure is as good as, or rather better than conventional microsurgery with evacuation of hematoma under direct vision. Moreover this CT-guided stereotactic approach for evacuation of the hematoma has the following advantages: 1) the procedure is simple and safe, 2) operation can be performed under local anesthesia, and 3) the hematoma is drained out completely with the aid of urokinase. This surgery seems indicated as an emergency treatment for high-age or high risk patients and also as a routine surgery for intracerebral hematomas in patients showing no herination signs. (author)

Surgical Site Infection in Diabetic and Non-Diabetic Patients Undergoing Laparoscopic Cholecystectomy

International Nuclear Information System (INIS)

Butt, U. I.; Khan, A.; Nawaz, A.; Mansoor, R.; Malik, A. A.; Sher, F.; Ayyaz, M.

2016-01-01

Objective: To compare the frequency of surgical site infections in patients with type II diabetes undergoing laparoscopic cholecystectomy as compared with non-diabetic patients. Study Design: Cohort study. Place and Duration of Study: Surgical Unit 2, Services Hospital, Lahore, from May to October 2012. Methodology: Patients were divided into two groups of 60 each, undergoing laparoscopic cholecystectomy. Group A comprised non-diabetic patients and group B comprised type II diabetic patients. Patients were followed postoperatively upto one month for the development of SSIs. Proportion of patients with surgical site infections or otherwise was compared between the groups using chi-square test with significance of p < 0.05. Results: In group A, 35 patients were above the age of 40 years. In group B, 38 patients were above the age of 40 years. Four patients in group A developed a surgical site infection. Seven patients in group B developed SSIs (p = 0.07). Conclusion: Presence of diabetes mellitus did not significantly affect the onset of surgical site infection in patients undergoing laparoscopic cholecystectomy. (author)

Surgical treatment of diplopia in Graves' Orbitopathy patients

NARCIS (Netherlands)

Jellema, H.M.

2016-01-01

This thesis addresses several aspects of the surgical treatment of diplopia in patients with Graves’ Orbitopathy (GO). We evaluated retrospectively the surgical outcome of different types of surgery on eye muscles to correct the diplopia. Each operated muscle seems to have its own dose-effect

CLEAR (Calculates Logical Evacuation And Response): A generic transportation network model for the calculation of evacuation time estimates

International Nuclear Information System (INIS)

Moeller, M.P.; Desrosiers, A.E.; Urbanik, T. II

1982-03-01

This paper describes the methodology and application of the computer model CLEAR (Calculates Logical Evacuation And Response) which estimates the time required for a specific population density and distribution to evacuate an area using a specific transportation network. The CLEAR model simulates vehicle departure and movement on a transportation network according to the conditions and consequences of traffic flow. These include handling vehicles at intersecting road segments, calculating the velocity of travel on a road segment as a function of its vehicle density, and accounting for the delay of vehicles in traffic queues. The program also models the distribution of times required by individuals to prepare for an evacuation. In order to test its accuracy, the CLEAR model was used to estimate evacuation times for the emergency planning zone surrounding the Beaver Valley Nuclear Power Plant. The Beaver Valley site was selected because evacuation time estimates had previously been prepared by the licensee, Duquesne Light, as well as by the Federal Emergency Management Agency and the Pennsylvania Emergency Management Agency. A lack of documentation prevented a detailed comparison of the estimates based on the CLEAR model and those obtained by Duquesne Light. However, the CLEAR model results compared favorably with the estimates prepared by the other two agencies. (author)

Resident perception of volcanic hazards and evacuation procedures

Directory of Open Access Journals (Sweden)

D. K. Bird

2009-02-01

Full Text Available Katla volcano, located beneath the Mýrdalsjökull ice cap in southern Iceland, is capable of producing catastrophic jökulhlaup. The Icelandic Civil Protection (ICP, in conjunction with scientists, local police and emergency managers, developed mitigation strategies for possible jökulhlaup produced during future Katla eruptions. These strategies were tested during a full-scale evacuation exercise in March 2006. A positive public response during a volcanic crisis not only depends upon the public's knowledge of the evacuation plan but also their knowledge and perception of the possible hazards. To improve the effectiveness of residents' compliance with warning and evacuation messages it is important that emergency management officials understand how the public interpret their situation in relation to volcanic hazards and their potential response during a crisis and apply this information to the ongoing development of risk mitigation strategies. We adopted a mixed methods approach in order to gain a broad understanding of residents' knowledge and perception of the Katla volcano in general, jökulhlaup hazards specifically and the regional emergency evacuation plan. This entailed field observations during the major evacuation exercise, interviews with key emergency management officials and questionnaire survey interviews with local residents. Our survey shows that despite living within the hazard zone, many residents do not perceive that their homes could be affected by a jökulhlaup, and many participants who perceive that their homes are safe, stated that they would not evacuate if an evacuation warning was issued. Alarmingly, most participants did not receive an evacuation message during the exercise. However, the majority of participants who took part in the exercise were positive about its implementation. This assessment of resident knowledge and perception of volcanic hazards and the evacuation plan is the first of its kind in

Evacuation transportation management : task five : operational concept.

Science.gov (United States)

2009-06-26

Much of what is known about evacuations is based on preparations for incidents, such as hurricanes, for which there is advance warning. With advance warning, evacuations can be planned and managed using procedures and systems that have been developed...

Evacuation transportation management. Task five, Operational concept

Science.gov (United States)

2006-01-01

Much of what is known about evacuations is based on preparations for incidents, such as hurricanes, for which there is advance warning. With advance warning, evacuations can be planned and managed using procedures and systems that have been developed...

Surgical effects in patients with Duane retraction syndrome

Directory of Open Access Journals (Sweden)

Shui-Lian Zhou

2017-03-01

Full Text Available AIM: To investigate the clinical characteristics and surgical effects in patients with Duane retraction syndrome(DRS.METHODS: Totally 13 patients with DRS during June 2011 to December 2015 were analyzed retrospectively. The data including clinical types and manifestations, surgical methods and outcomes were reviewed and analyzed. RESULTS: There were 11 male cases and 2 female cases who all had no ocular and systemic anomalies. The left eye was involved in 9 cases, the right eye was involved in 3 cases and 1 case involved in both eyes. Six cases were type Ⅰ,1 case was typeⅡand 6 cases were type Ⅲ. Eleven cases had abnormal head posture(AHP, 9 cases had the up- or down-shoot phenomenon. The surgical treatment was designed according to subtypes and clinical features which included medial rectus recession, lateral rectus recession, recession of both horizontal rectus muscles and lateral rectus recession combined with Y splitting. After surgery, horizontal deviation was less than ±10△ in all patients, and AHP disappeared in 4 cases and improved in 7 cases. The up- or down-shoot and global retraction disappeared in 5 cases and improved in 4 cases. Simultaneously, the restriction of ocular motility was improved in all patients. CONCLUSION: The clinical features of DRS are variant in different types. Detailed examination before surgery and reasonable surgical design are important in treatment of patients with DRS.

Transforming Patient Value: Comparison of Hospital, Surgical, and General Surgery Patients.

Science.gov (United States)

Pitt, Henry A; Tsypenyuk, Ella; Freeman, Susan L; Carson, Steven R; Shinefeld, Jonathan A; Hinkle, Sally M; Powers, Benjamin D; Goldberg, Amy J; DiSesa, Verdi J; Kaiser, Larry R

2016-04-01

Patient value (V) is enhanced when quality (Q) is increased and cost (C) is diminished (V = Q/C). However, calculating value has been inhibited by a lack of risk-adjusted cost data. The aim of this analysis was to measure patient value before and after implementation of quality improvement and cost reduction programs. Multidisciplinary efforts to improve patient value were initiated at a safety-net hospital in 2012. Quality improvement focused on adoption of multiple best practices, and minimizing practice variation was the strategy to control cost. University HealthSystem Consortium (UHC) risk-adjusted quality (patient mortality + safety + satisfaction + effectiveness) and cost (length of stay + direct cost) data were used to calculate patient value over 3 fiscal years. Normalized ranks in the UHC Quality and Accountability Scorecard were used in the value equation. For all hospital patients, quality scores improved from 50.3 to 66.5, with most of the change occurring in decreased mortality. Similar trends were observed for all surgery patients (42.6 to 48.4) and for general surgery patients (30.9 to 64.6). For all hospital patients, cost scores improved from 71.0 to 2.9. Similar changes were noted for all surgical (71.6 to 27.1) and general surgery (85.7 to 23.0) patients. Therefore, value increased more than 30-fold for all patients, 3-fold for all surgical patients, and almost 8-fold for general surgery patients. Multidisciplinary quality and cost efforts resulted in significant improvements in value for all hospitalized patients as well as general surgery patients. Mortality improved the most in general surgery patients, and satisfaction was highest among surgical patients. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Complex multimaterial insulating frames for windows with evacuated glazing

Energy Technology Data Exchange (ETDEWEB)

Fang, Yueping; Eames, Philip C.; Hyde, Trevor J. [Centre for Sustainable Technologies, School of the Built Environment, University of Ulster, Newtownabbey, N. Ireland BT37 0QB (United Kingdom); Norton, Brian [Dublin Institute of Technology, Aungier Street, Dublin 2 (Ireland)

2005-09-01

The thermal performance of a complex multimaterial frame consisting of an exoskeleton framework and cavities filled with insulant materials enclosing an evacuated glazing was simulated using a two-dimensional finite element model and the results were validated experimentally using a guarded hot box calorimeter. The analysed 0.5m by 0.5m evacuated glazing consisted of two low-emittance film coated glass panes supported by an array of 0.32mm diameter pillars spaced 25mm apart, contiguously sealed by a 10mm wide metal edge seal. Thermal performance of windows employing evacuated glazing set in various complex multimaterial frames were analysed in detail. Very good agreement was found between simulations and experimental measurements of surface temperatures of the evacuated glazing window system. The heat loss from a window with an evacuated glazing and a complex multimaterial frame is about 80% of that for a window comprised of an evacuated glazing set in a single material solid frame. (author)

Complex multimaterial insulating frames for windows with evacuated glazing

Energy Technology Data Exchange (ETDEWEB)

Yueping Fang; Eames, P.C.; Hyde, T.J. [University of Ulster, Newtonabbey (United Kingdom). Centre for Sustainable Technologies; Norton, B. [Dublin Institute of Technology, Dublin (Ireland)

2005-09-01

The thermal performance of a complex multimaterial frame consisting of an exoskeleton framework and cavities filled with insulant materials enclosing an evacuated glazing was simulated using a two-dimensional finite element model and the results were validated experimentally using a guarded hot box calorimeter. The analysed 0.5 m by 0.5 m evacuated glazing consisted of two low-emittance film coated glass panes supported by an array of 0.32 mm diameter pillars spaced 25 mm apart, contiguously sealed by a 10 mm wide metal edge seal. Thermal performance of windows employing evacuated glazing set in various complex multimaterial frames were analysed in detail. Very good agreement was found between simulations and experimental measurements of surface temperatures of the evacuated glazing window system. The heat loss from a window with an evacuated glazing and a complex multimaterial frame is about 80% of that for a window comprised of an evacuated glazing set in a single material solid frame. (author)

An Integrated Approach to Modeling Evacuation Behavior

Science.gov (United States)

2011-02-01

A spate of recent hurricanes and other natural disasters have drawn a lot of attention to the evacuation decision of individuals. Here we focus on evacuation models that incorporate two economic phenomena that seem to be increasingly important in exp...

Spinal Anaesthesia is Safe in a Patient with Wolff-Parkinson-White Syndrome Undergoing Evacuation of Molar Pregnancy.

Science.gov (United States)

Deviseti, Pravalika; Pujari, Vinayak S

2016-02-01

Wolff-Parkinson-White (WPW) syndrome is an uncommon cardiac condition where there is an abnormal band of atrial tissue connecting atria and ventricles which can electrically bypass atrioventricular node. The anaesthetic management in these patients is challenging as life threatening complications can occur perioperatively like paroxysmal supraventricular tachycardia and atrial fibrillation. Also, regional anaesthetic technique like subarachnoid block is a safe and cost effective alternative to general anaesthesia as it avoids polypharmacy. We report the successful anaesthetic management of Wolff Parkinson White syndrome in a primi with hydatiform mole posted for suction and evacuation.

Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients

DEFF Research Database (Denmark)

Reardon, Michael J; Van Mieghem, Nicolas M; Popma, Jeffrey J

2017-01-01

BACKGROUND: Although transcatheter aortic-valve replacement (TAVR) is an accepted alternative to surgery in patients with severe aortic stenosis who are at high surgical risk, less is known about comparative outcomes among patients with aortic stenosis who are at intermediate surgical risk. METHO...

Information Needs of Hepato-Pancreato-Biliary Surgical Oncology Patients.

Science.gov (United States)

Gillespie, Jacqueline; Kacikanis, Anna; Nyhof-Young, Joyce; Gallinger, Steven; Ruthig, Elke

2017-09-01

A marked knowledge gap exists concerning the information needs of hepato-pancreato-biliary (HPB) surgical oncology patients. We investigated the comprehensive information needs of this patient population, including the type and amount of information desired, as well as the preferred method of receiving information. A questionnaire was administered to patients being treated surgically for cancers of the liver, pancreas, gallbladder, or bile ducts at Toronto General Hospital, part of the University Health Network, in Toronto, Canada. The questionnaire examined patients' information needs across six domains of information: medical, practical, physical, emotional, social, and spiritual. Among 36 respondents, the importance of information and amount of information desired differed significantly by domain (both p < 0.001). This group of patients rated information in the medical and physical domains as most important, though they also desired specific items of information from the emotional, practical, and social domains. Patients' overwhelming preference was to receive information via a one-on-one consultation with a healthcare provider. It is important for healthcare providers working with HPB surgical oncology patients to be comprehensive when providing information related to patients' cancer diagnosis, prognosis, associated symptoms, and side effects of treatment. Certain emotional, practical, and social issues (e.g., fears of cancer recurrence, drug coverage options, relationship changes) should be addressed as well. Face-to-face interactions should be the primary mode of delivering information to patients. Our findings are being used to guide the training of healthcare providers and the development of educational resources specific to HPB surgical oncology patients.

Aircraft industry workers in evacuation: conditions of life of evacuated plants' workers in 1941-1945

Directory of Open Access Journals (Sweden)

Михаил Юрьевич Мухин

2010-09-01

Full Text Available The article is devoted to the work of the factories in 1941-1945 in the evacuation. The author analyzes the living conditions of workers in evacuated aviation plants, their daily life, maintenance, etc. The author concludes that in the early years of the War the conditions of life of the aviation industry's workers were very difficult, and the welfare and financial situation improved in 1944, the sure sign of fracture in the Second world war.

Surgical Face Masks Worn by Patients with Multidrug-Resistant Tuberculosis

Science.gov (United States)

Mphahlele, Matsie; Stoltz, Anton; Venter, Kobus; Mathebula, Rirhandzu; Masotla, Thabiso; Lubbe, Willem; Pagano, Marcello; First, Melvin; Jensen, Paul A.; van der Walt, Martie; Nardell, Edward A.

2012-01-01

Rationale: Drug-resistant tuberculosis transmission in hospitals threatens staff and patient health. Surgical face masks used by patients with tuberculosis (TB) are believed to reduce transmission but have not been rigorously tested. Objectives: We sought to quantify the efficacy of surgical face masks when worn by patients with multidrug-resistant TB (MDR-TB). Methods: Over 3 months, 17 patients with pulmonary MDR-TB occupied an MDR-TB ward in South Africa and wore face masks on alternate days. Ward air was exhausted to two identical chambers, each housing 90 pathogen-free guinea pigs that breathed ward air either when patients wore surgical face masks (intervention group) or when patients did not wear masks (control group). Efficacy was based on differences in guinea pig infections in each chamber. Measurements and Main Results: Sixty-nine of 90 control guinea pigs (76.6%; 95% confidence interval [CI], 68–85%) became infected, compared with 36 of 90 intervention guinea pigs (40%; 95% CI, 31–51%), representing a 56% (95% CI, 33–70.5%) decreased risk of TB transmission when patients used masks. Conclusions: Surgical face masks on patients with MDR-TB significantly reduced transmission and offer an adjunct measure for reducing TB transmission from infectious patients. PMID:22323300

Evacuation decision-making at three mile island

International Nuclear Information System (INIS)

Zeigler, Donald. J.; Johnson, James. H.

1987-01-01

The accident at the Three Mile Island nuclear power plant in 1979 provoked an unanticipated and unprecedented spontaneous evacuation of people living in the area. Following the accident, revised and upgraded emergency preparedness and response regulations were issued by the Nuclear Regulatory Commission (NRC) and the Federal Emergency Management Agency. (FEMA). This includes the assumption that public education and awareness will minimise the tendency of people to evacuate spontaneously from the vicinity of an accident. This assumption is challenged. Results of an empirical test of a casual model of emergency evacuation decision-making are given. This test was devised to aid understanding of the public behaviour at the time of the Three Mile Island incident. The emergency plans for the Sizewell-B reactor are subject to brief critical consideration. It is concluded that evacuation plans need to reflect people's natural inclinations to move away from a nuclear hazard. (UK)

Dual effects of pedestrian density on emergency evacuation

Energy Technology Data Exchange (ETDEWEB)

Ma, Yi, E-mail: yima23-c@my.cityu.edu.hk [School of Transportation and Logistics, Southwest Jiaotong University, Chengdu (China); Department of Architecture and Civil Engineering, City University of Hong Kong, Kowloon (Hong Kong); Lee, Eric Wai Ming; Yuen, Richard Kwok Kit [Department of Architecture and Civil Engineering, City University of Hong Kong, Kowloon (Hong Kong)

2017-02-05

This paper investigates the effect of the pedestrian density in building on the evacuation dynamic with simulation method. In the simulations, both the visibility in building and the exit limit of building are taken into account. The simulation results show that the effect of the pedestrian density in building on the evacuation dynamics is dual. On the one hand, when the visibility in building is very large, the increased pedestrian density plays a negative effect. On the other hand, when the visibility in building is very small, the increased pedestrian density can play a positive effect. The simulation results also show that when both the exit width and visibility are very small, the varying of evacuation time with regard to the pedestrian density is non-monotonous and presents a U-shaped tendency. That is, in this case, too large or too small pedestrian density in building is disadvantageous to the evacuation process. Our findings provide a new insight about the effect of the pedestrian density in building on the evacuation dynamic. - Highlights: • Pedestrian density inside buildings has dual effects on evacuation. • Increased pedestrian density has a negative effect in cases of increased visibility. • Increased pedestrian density has a positive effect in cases of decreased visibility.

Dual effects of pedestrian density on emergency evacuation

International Nuclear Information System (INIS)

Ma, Yi; Lee, Eric Wai Ming; Yuen, Richard Kwok Kit

2017-01-01

This paper investigates the effect of the pedestrian density in building on the evacuation dynamic with simulation method. In the simulations, both the visibility in building and the exit limit of building are taken into account. The simulation results show that the effect of the pedestrian density in building on the evacuation dynamics is dual. On the one hand, when the visibility in building is very large, the increased pedestrian density plays a negative effect. On the other hand, when the visibility in building is very small, the increased pedestrian density can play a positive effect. The simulation results also show that when both the exit width and visibility are very small, the varying of evacuation time with regard to the pedestrian density is non-monotonous and presents a U-shaped tendency. That is, in this case, too large or too small pedestrian density in building is disadvantageous to the evacuation process. Our findings provide a new insight about the effect of the pedestrian density in building on the evacuation dynamic. - Highlights: • Pedestrian density inside buildings has dual effects on evacuation. • Increased pedestrian density has a negative effect in cases of increased visibility. • Increased pedestrian density has a positive effect in cases of decreased visibility.

Surgical outcome in patients with epilepsy and dual pathology.

Science.gov (United States)

Li, L M; Cendes, F; Andermann, F; Watson, C; Fish, D R; Cook, M J; Dubeau, F; Duncan, J S; Shorvon, S D; Berkovic, S F; Free, S; Olivier, A; Harkness, W; Arnold, D L

1999-05-01

High-resolution MRI can detect dual pathology (an extrahippocampal lesion plus hippocampal atrophy) in about 5-20% of patients with refractory partial epilepsy referred for surgical evaluation. We report the results of 41 surgical interventions in 38 adults (mean age 31 years, range 14-63 years) with dual pathology. Three patients had two operations. The mean postoperative follow-up was 37 months (range 12-180 months). The extrahippocampal lesions were cortical dysgenesis in 15, tumour in 10, contusion/infarct in eight and vascular malformation in five patients. The surgical approach aimed to remove what was considered to be the most epileptogenic lesion, and the 41 operations were classified into lesionectomy (removal of an extrahippocampal lesion); mesial temporal resection (removal of an atrophic hippocampus); and lesionectomy plus mesial temporal resection (removal of both the lesion and the atrophic hippocampus). Lesionectomy plus mesial temporal resection resulted in complete freedom from seizures in 11/15 (73%) patients, while only 2/10 (20%) patients who had mesial temporal resection alone and 2/16 (12.5%) who had a lesionectomy alone were seizure-free (P dual pathology removal of both the lesion and the atrophic hippocampus is the best surgical approach and should be considered whenever possible.

Clinical Experience and Learning Style of Flight Nurse and Aeromedical Evacuation Technician Students.

Science.gov (United States)

De Jong, Marla J; Dukes, Susan F; Dufour, Karey M; Mortimer, Darcy L

2017-01-01

The clinical experience and preferred learning style of U.S. Air Force flight nurses and aeromedical evacuation technicians are unknown. Using a cross-sectional survey design, we gathered data regarding the clinical experience, level of comfort providing clinical care, and preferred learning style of 77 active duty (AD), Air Force Reserve (AFR), and Air National Guard (ANG) nurses enrolled in the U.S. Air Force School of Aerospace Medicine Flight Nurse course, and 121 AD, AFR, and ANG medical technicians enrolled in the Aeromedical Evacuation Technician course. Nurses and medical technicians reported 7.6 ± 5.5 and 3.9 ± 4.5 yr of experience, respectively. AD, AFR, and ANG nurses had comparable years of experience: 5.8 ± 3.2, 8.3 ± 6.6, and 7.9 ± 4.2 yr, respectively; however, AD medical technicians had more years of experience (5.6 ± 4.4 yr) than AFR (3.1 ± 4.8 yr) and ANG (1.9 ± 2.8 yr) medical technicians. Both nurses and medical technicians reported infrequently caring for patients with various disease processes and managing equipment or devices that they will routinely encounter when transporting patients as an aeromedical evacuation clinician. Nurses and medical technicians preferred a kinesthetic learning style or a multimodal learning style that included kinesthetic learning. Nearly all (99%) nurses and 97% of medical technicians identified simulation as their preferred teaching method. These findings confirm faculty concerns regarding the clinical experience of flight nurse and aerospace evacuation technician students.De Jong MJ, Dukes SF, Dufour KM, Mortimer DL. Clinical experience and learning style of flight nurse and aeromedical evacuation technician students. Aerosp Med Hum Perform. 2017; 88(1):23-29.

Surgical Treatment of Severe Traumatic Brain Injury in Switzerland: Results from a Multicenter Study.

Science.gov (United States)

Rossi-Mossuti, Frédéric; Fisch, Urs; Schoettker, Patrick; Gugliotta, Marinella; Morard, Marc; Schucht, Philippe; Schatlo, Bawarjan; Levivier, Marc; Walder, Bernhard; Fandino, Javier

2016-01-01

Since the introduction of modern surgical techniques and monitoring tools for the treatment of severe traumatic brain injury (TBI) in Switzerland, standardized nationwide operative procedures are still lacking. This study aimed to assess surgical management and monitoring strategies in patients admitted throughout Switzerland with severe TBI. Demographic, clinical, and radiologic data from a prospective national cohort study on severe brain-injured patients (Patient-relevant Endpoints after Brain Injury from Traumatic Accidents [PEBITA]) were collected during a 3-year period. This study evaluated patients admitted to 7 of the 11 trauma centers included in PEBITA. We retrospectively analyzed surgery-related computed tomography (CT) findings prior to and after treatment, intracranial pressure (ICP) monitoring, size and technical features of craniotomy, as well as surgical complications. ResULTS: This study included 353 of the 921 patients enrolled in PEBITA who underwent surgical treatment for severe TBI. At admission, acute subdural hematoma was the most frequent focal lesion diagnosed (n = 154 [44%]), followed by epidural hematoma (n = 96 [27%]) and intracerebral hematoma (n = 84 [24%]). A total of 198 patients (61%) presented with midline shift. Clinical deterioration in terms of Glasgow Coma Scale scores or intractable ICP values as an indication for surgical evacuation or decompression were documented in 20% and 6%, respectively. A total of 97 (27.5%) only received a catheter/probe for ICP monitoring. Surgical procedures to treat a focal lesion or decompress the cerebrum were performed in 256 patients (72.5%). Of the 290 surgical procedures (excluding ICP probe implantation), craniotomy (137 [47.2%]) or decompressive craniectomy (133 [45.9%]) were performed most frequently. The mean size of craniectomy in terms of maximal linear width on the CT axial slice was 8.4 ± 2.9 cm. Intraoperative ICP monitoring was reported in 61% of the interventions. Significant

Long term mental health outcomes of Finnish children evacuated to Swedish families during the second world war and their non-evacuated siblings: cohort study.

Science.gov (United States)

Santavirta, Torsten; Santavirta, Nina; Betancourt, Theresa S; Gilman, Stephen E

2015-01-05

To compare the risks of admission to hospital for any type of psychiatric disorder and for four specific psychiatric disorders among adults who as children were evacuated to Swedish foster families during the second world war and their non-evacuated siblings, and to evaluate whether these risks differ between the sexes. Cohort study. National child evacuation scheme in Finland during the second world war. Children born in Finland between 1933 and 1944 who were later included in a 10% sample of the 1950 Finnish census ascertained in 1997 (n = 45,463; women: n = 22,021; men: n = 23,442). Evacuees in the sample were identified from war time government records. Adults admitted to hospital for psychiatric disorders recorded between 1971 and 2011 in the Finnish hospital discharge register. We used Cox proportional hazards models to estimate the association between evacuation to temporary foster care in Sweden during the second world war and admission to hospital for a psychiatric disorder between ages 38 and 78 years. Fixed effects methods were employed to control for all unobserved social and genetic characteristics shared among siblings. Among men and women combined, the risk of admission to hospital for a psychiatric disorder did not differ between Finnish adults evacuated to Swedish foster families and their non-evacuated siblings (hazard ratio 0.89, 95% confidence interval 0.64 to 1.26). Evidence suggested a lower risk of admission for any mental disorder (0.67, 0.44 to 1.03) among evacuated men, whereas for women there was no association between evacuation and the overall risk of admission for a psychiatric disorder (1.21, 0.80 to 1.83). When admissions for individual psychiatric disorders were analyzed, evacuated girls were significantly more likely than their non-evacuated sisters to be admitted to hospital for a mood disorder as an adult (2.19, 1.10 to 4.33). The Finnish evacuation policy was not associated with an increased overall risk of admission to hospital

Pediatric hospitalist comanagement of surgical patients: structural, quality, and financial considerations.

Science.gov (United States)

Rappaport, David I; Rosenberg, Rebecca E; Shaughnessy, Erin E; Schaffzin, Joshua K; O'Connor, Katherine M; Melwani, Anjna; McLeod, Lisa M

2014-11-01

Comanagement of surgical patients is occurring more commonly among adult and pediatric patients. These systems of care can vary according to institution type, comanagement structure, and type of patient. Comanagement can impact quality, safety, and costs of care. We review these implications for pediatric surgical patients. © 2014 Society of Hospital Medicine.

[Management of patients with bronchial asthma received general anesthesia and surgical intervention].

Science.gov (United States)

To, Masako; Tajima, Makoto; Ogawa, Cyuhei; Otomo, Mamoru; Suzuki, Naohito; Sano, Yasuyuki

2002-01-01

Stimulation to bronchial mucosa is one of the major risk factor of asthma attack. When patients receive surgical intervention and general anesthesia, they are always exposed to stimulation to bronchial mucosa. Prevention method of bronchial asthma attack during surgical intervention is not established yet. We investigated that clinical course of patients with bronchial asthma who received general anesthesia and surgical intervention. Seventy-six patients with bronchial asthma were received general anesthesia and surgical intervention from 1993 to 1998. Twenty-four patients were mild asthmatic patients, 39 were moderate asthmatic patients and 13 were severe asthmatic patients. Preoperative treatment for preventing asthma attack was as follows; Eight patients were given intravenous infusion of aminophylline before operation. Fifty-two patients were given intravenous infusion of aminophylline and hydrocortisone before operation. Three patients were given intravenous infusion of hydrocortisone for consecutive 3 days before operation. Thirteen patients were given no treatment for preventing asthma attack. One patient was suffered from asthma attack during operation. She was given no preventing treatment for asthma attack before operation. Three patients were suffered from asthma attack after operation. No wound dehiscence was observed in all patients. To prevent asthma attack during operation, intravenous infusion of steroid before operation is recommended, when patients with asthma receive general anesthesia and surgical intervention.

Prognostic significance of surgical extranodal extension in head and neck squamous cell carcinoma patients.

Science.gov (United States)

Matsumoto, Fumihiko; Mori, Taisuke; Matsumura, Satoko; Matsumoto, Yoshifumi; Fukasawa, Masahiko; Teshima, Masanori; Kobayashi, Kenya; Yoshimoto, Seiichi

2017-08-01

Lymph node metastasis with extranodal extension represents one of the most important adverse prognostic factors for survival in patients with head and neck squamous cell carcinoma. We propose that extranodal extension occurs to differing extents. The aim of this study was to determine the prognostic significance of extranodal extension in patients with head and neck squamous cell carcinoma. Two hundred and ninety-eight patients with head and neck squamous cell carcinoma who underwent surgical resection and neck dissection were included. Cervical lymph nodes were classified into four categories: (i) pathological N negative, (ii) extranodal extension negative, (iii) non-surgical extranodal extension and (iv) surgical extranodal extension. Lymph node metastases were detected in 67.1% of laryngeal/hypopharyngeal cancer patients and 52.7% of oral cancer patients. The 3-year disease-specific survival rates for patients in the pathological N negative, extranodal extension negative, non-surgical extranodal extension and surgical extranodal extension groups were 90.9%, 79.6%, 63.8% and 48.3%, respectively. In laryngeal/hypopharyngeal cancer patients, surgical extranodal extension was associated with a significantly poorer disease-specific survival than a pathological N negative, extranodal extension negative or non-surgical extranodal extension status. In oral cancer patients, no significant differences were observed between the non-surgical and surgical extranodal extension groups. However, non-surgical extranodal extension was associated with a poorer disease-specific survival than a pathological N negative or extranodal extension negative status. Surgical extranodal extension was a poor prognostic factor in patients with head and neck squamous cell carcinoma. The prognostic significance of surgical extranodal extension differed between laryngeal/hypopharyngeal and oral cancer patients. The clinical significance of surgical extranodal extension was much greater for

Evolution of general surgical problems in patients with left ventricular assist devices.

Science.gov (United States)

McKellar, Stephen H; Morris, David S; Mauermann, William J; Park, Soon J; Zietlow, Scott P

2012-11-01

Left ventricular assist devices (LVADs) are increasingly used to treat patients with end-stage heart failure. These patients may develop acute noncardiac surgical problems around the time of LVAD implantation or, as survival continues to improve, chronic surgical problems as ambulatory patients remote from the LVAD implant. Previous reports of noncardiac surgical problems in LVAD patients included patients with older, first-generation devices and do not address newer, second-generation devices. We describe the frequency and management of noncardiac surgical problems encountered during LVAD support with these newer-generation devices to assist noncardiac surgeons involved in the care of patients with LVADs. We retrospectively reviewed the medical records of consecutive patients receiving LVADs at our institution. We collected data for any consultation by noncardiac surgeons within the scope of general surgery during LVAD support and subsequent treatment. Ninety-nine patients received implantable LVADs between 2003 and 2009 (first-generation, n = 19; second-generation, n = 80). Excluding intestinal hemorrhage, general surgical opinions were rendered for 34 patients with 49 problems, mostly in the acute recovery phase after LVAD implantation. Of those, 27 patients underwent 28 operations. Respiratory failure and intra-abdominal pathologies were the most common problems addressed, and LVAD rarely precluded operation. Patients with second-generation LVADs were more likely to survive hospitalization (P = .04) and develop chronic, rather than emergent, surgical problems. Patients with LVADs frequently require consultation from noncardiac surgeons within the scope of general surgeons and often require operation. Patients with second-generation LVADs are more likely to become outpatients and develop more elective surgical problems. Noncardiac surgeons will be increasingly involved in caring for patients with LVADs and should anticipate the problems unique to this patient

Results of surgical excision of urethral prolapse in symptomatic patients.

Science.gov (United States)

Hall, Mary E; Oyesanya, Tola; Cameron, Anne P

2017-11-01

Here, we present the clinical presentation and surgical outcomes of women with symptomatic urethral prolapse presenting to our institution over 20 years, and seek to provide treatment recommendations for management of symptomatic urethral prolapse and caruncle. A retrospective review of medical records from female patients who underwent surgery for symptomatic urethral prolapse from June 1995 to August 2015 was performed. Surgical technique consisted of a four-quadrant excisional approach for repair of urethral prolapse. A total of 26 patients were identified with a mean age of 38.8 years (range 3-81). The most common presentations were vaginal bleeding, hematuria, pain, and dysuria. All patients underwent surgical excision of urethral prolapse via a standard approach. Follow-up data was available in 24 patients. Six patients experienced temporary postoperative bleeding, and one patient required placement of a Foley catheter for tamponade. One patient experienced temporary postoperative urinary retention requiring Foley catheter placement. Three patients had visible recurrence of urethral prolapse, for which one later underwent re-excision. Surgical excision of urethral prolapse is a reasonable treatment option in patients who have tried conservative management without relief, as well as in those who present with severe symptoms. Possible complications following excision include postoperative bleeding and recurrence, and patients must be counseled accordingly. In this work, we propose a treatment algorithm for symptomatic urethral prolapse. © 2017 Wiley Periodicals, Inc.

[Emergency and disaster response in critical care unit in the Mexican Social Security Institute: triage and evacuation].

Science.gov (United States)

Echevarría-Zuno, Santiago; Cruz-Vega, Felipe; Elizondo-Argueta, Sandra; Martínez Valdés, Everardo; Franco-Bey, Rubén; Méndez-Sánchez, Luis Miguel

2013-01-01

Providing medical assistance in emergencies and disaster in advance makes the need to maintain Medical Units functional despite the disturbing phenomenon that confronts the community, but conflict occurs when the Medical Unit needs support and needs to be evacuated, especially when the evacuation of patients in a Critical Care Unit is required. In world literature there is little on this topic, and what is there usually focuses on the conversion of areas and increased ability to care for mass casualties, but not about how to evacuate if necessary, and when a wrong decision can have fatal consequences. That is why the Mexican Social Security Institute gave the task of examining these problems to a working group composed of specialists of the Institute. The purpose was to evaluate and establish a method for performing a protocol in the removal of patients and considering always to safeguard both staff and patients and maintain the quality of care.

Information of the Home Office for the planning of evacuations

International Nuclear Information System (INIS)

1983-01-01

This information contains the legal basis, scope and jurisdiction for evacuations in cases of accident. The general evacuation plan must schedule the following: private and public transport, information equipment, supply and care services, evacuation routes and traffic control checkpoints, etc. Particular evacuation plans must be established e.g. for nuclear plants and barrages. The planning is based on a survey of measures represented by a flowchart or a checklist. (HSCH) [de

Multi-objective evacuation routing optimization for toxic cloud releases

International Nuclear Information System (INIS)

Gai, Wen-mei; Deng, Yun-feng; Jiang, Zhong-an; Li, Jing; Du, Yan

2017-01-01

This paper develops a model for assessing the risks associated with the evacuation process in response to potential chemical accidents, based on which a multi-objective evacuation routing model for toxic cloud releases is proposed taking into account that the travel speed on each arc will be affected by disaster extension. The objectives of the evacuation routing model are to minimize travel time and individual evacuation risk along a path respectively. Two heuristic algorithms are proposed to solve the multi-objective evacuation routing model. Simulation results show the effectiveness and feasibility of the model and algorithms presented in this paper. And, the methodology with appropriate modification is suitable for supporting decisions in assessing emergency route selection in other cases (fires, nuclear accidents). - Highlights: • A model for assessing and visualizing the risks is developed. • A multi-objective evacuation routing model is proposed for toxic cloud releases. • A modified Dijkstra algorithm is designed to obtain an solution of the model. • Two heuristic algorithms have been developed as the optimization tool.

Planning for spontaneous evacuation during a radiological emergency

International Nuclear Information System (INIS)

Johnson, J.H. Jr.

1984-01-01

The Federal Emergency Management Agency's (FEMA's) radiological emergency preparedness program ignores the potential problem of spontaneous evacuation during a nuclear reactor accident. To show the importance of incorporating the emergency spatial behaviors of the population at risk in radiological emergency preparedness and response plans, this article presents empirical evidence that demonstrates the potential magnitude and geographic extent of spontaneous evacuation in the event of an accident at the Long Island Lighting Company's Shoreham Nuclear Power Station. The results indicate that, on the average, 39% of the population of Long Island is likely to evacuate spontaneously and thus to cast an evacuation shadow extending at least 25 miles beyond the plant. On the basis of these findings, necessary revisions to FEMA's radiological emergency preparedness program are outlined

Surgical myocardial revascularization in patients with reduced systolic left ventricular function.

Science.gov (United States)

Bruno, Piergiorgio; Iafrancesco, Mauro; Massetti, Massimo

2018-04-20

Surgical myocardial revascularization in patients with reduced left ventricular function has been a matter of debate for decades. Recently published 10-years extension follow-up of the STICH trial have conclusively demonstrated benefit of surgical myocardial revascularization in patients with significant coronary artery disease and low left ventricular ejection fraction. However, selection of patients for surgery remains challenging as well as decision to perform percutaneous rather than surgical revascularization in this class of patients. New evidence helped to clarify the role of preoperative patients' characteristics as risk factors for surgery and to identify those patients who may benefit the most from surgery. Focus of this review is to review epidemiology, aetiology and pathophysiology of coronary artery disease in patients with reduced left ventricular function, role of viability and results of observational and investigational studies on revascularization in patients with reduced left ventricular function with a particular emphasis on relative indication of coronary artery bypass grafting and percutaneous coronary intervention and the surgical implications of development of ischemic mitral regurgitation or ischemic left ventricular aneurysm.

Dual effects of pedestrian density on emergency evacuation

Science.gov (United States)

Ma, Yi; Lee, Eric Wai Ming; Yuen, Richard Kwok Kit

2017-02-01

This paper investigates the effect of the pedestrian density in building on the evacuation dynamic with simulation method. In the simulations, both the visibility in building and the exit limit of building are taken into account. The simulation results show that the effect of the pedestrian density in building on the evacuation dynamics is dual. On the one hand, when the visibility in building is very large, the increased pedestrian density plays a negative effect. On the other hand, when the visibility in building is very small, the increased pedestrian density can play a positive effect. The simulation results also show that when both the exit width and visibility are very small, the varying of evacuation time with regard to the pedestrian density is non-monotonous and presents a U-shaped tendency. That is, in this case, too large or too small pedestrian density in building is disadvantageous to the evacuation process. Our findings provide a new insight about the effect of the pedestrian density in building on the evacuation dynamic.

Pedestrian evacuation at the subway station under fire

Science.gov (United States)

Xiao-Xia, Yang; Hai-Rong, Dong; Xiu-Ming, Yao; Xu-Bin, Sun

2016-04-01

With the development of urban rail transit, ensuring the safe evacuation of pedestrians at subway stations has become an important issue in the case of an emergency such as a fire. This paper chooses the platform of line 4 at the Beijing Xuanwumen subway station to study the emergency evacuation process under fire. Based on the established platform, effects of the fire dynamics, different initial pedestrian densities, and positions of fire on evacuation are investigated. According to simulation results, it is found that the fire increases the air temperature and the smoke density, and decreases pedestrians’ visibility and walking velocity. Also, there is a critical initial density at the platform if achieving a safe evacuation within the required 6 minutes. Furthermore, different positions of fire set in this paper have little difference on crowd evacuation if the fire is not large enough. The suggestions provided in this paper are helpful for the subway operators to prevent major casualties. Project supported by the National Natural Science Foundation of China (Grant Nos. 61322307 and 61233001).

In-hospital mortality after pre-treatment with antiplatelet agents or oral anticoagulants and hematoma evacuation of intracerebral hematomas.

Science.gov (United States)

Stein, Marco; Misselwitz, Björn; Hamann, Gerhard F; Kolodziej, Malgorzata; Reinges, Marcus H T; Uhl, Eberhard

2016-04-01

Pre-treatment with antiplatelet agents is described to be a risk factor for mortality after spontaneous intracerebral hemorrhage (ICH). However, the impact of antithrombotic agents on mortality in patients who undergo hematoma evacuation compared to conservatively treated patients with ICH remains controversial. This analysis is based on a prospective registry for quality assurance in stroke care in the State of Hesse, Germany. Patients' data were collected between January 2008 and December 2012. Only patients with the diagnosis of spontaneous ICH were included (International Classification of Diseases 10th Revision codes I61.0-I61.9). Predictors of in-hospital mortality were determined by univariate analysis. Predictors with Phematoma evacuation (odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.24-4.97; P=0.010) compared to patients without antiplatelet pre-treatment treatment (OR: 0.9; 95% CI: 0.79-1.09; P=0.376). In conclusion a higher rate of in-hospital mortality after pre-treatment with antiplatelet agents in combination with hematoma evacuation after spontaneous ICH was observed in the presented cohort. Copyright © 2015 Elsevier Ltd. All rights reserved.

14 CFR 121.570 - Airplane evacuation capability.

Science.gov (United States)

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Airplane evacuation capability. 121.570... REQUIREMENTS: DOMESTIC, FLAG, AND SUPPLEMENTAL OPERATIONS Flight Operations § 121.570 Airplane evacuation capability. (a) No person may cause an airplane carrying passengers to be moved on the surface, take off, or...

Differences in characteristics and patient-reported questionnaire responses in patients who choose non-surgical versus surgical treatment for severe hip osteoarthritis

DEFF Research Database (Denmark)

Have, Mads; Overgaard, Søren; Jensen, Carsten

Background: Preoperative patient characteristics may influence patient choice for participating in RCT’s. Purpose / Aim of Study: This study aimed to compare patient characteristics, level of pain, physical function and joint space width in patients with severe hip osteoarthritis (OA) who accepted...... or refused to participate in a RCT. Materials and Methods: In this prospective cohort study a total of 137 patients with primary hip OA were asked to choose between surgical or non- surgical treatment. We then compared the characteristics of each patient cohort (demographics, pain level and duration......, analgesic use, exercise habits), the radiographic hip OA state and their responses to Hip dysfunction and Osteoarthritis Outcome Score (HOOS, 0-100) and European Quality of Life Scale (EQ-5D-5L) questionnaires. Findings / Results: The between-group HOOS scores were significantly different in three out...

Pediatric issues in disaster management, part 2: evacuation centers and family separation/reunification.

Science.gov (United States)

Mace, Sharon E; Sharieff, Ghazala; Bern, Andrew; Benjamin, Lee; Burbulys, Dave; Johnson, Ramon; Schreiber, Merritt

2010-01-01

Although children and infants are likely to be victims in a disaster and are more vulnerable in a disaster than adults, disaster planning and management has often overlooked the specific needs of pediatric patients. We discuss key components of disaster planning and management for pediatric patients including emergency medical services, hospital/facility issues, evacuation centers, family separation/reunification, children with special healthcare needs, mental health issues, and overcrowding/surge capacity. Specific policy recommendations and an appendix with detailed practical information and algorithms are included. The first part of this three part series on pediatric issues in disaster management addresses the emergency medical system from the field to the hospital and surge capacity including the impact of crowding. The second part addresses the appropriate set up and functioning of evacuation centers and family separation and reunification. The third part deals with special patient populations: the special healthcare needs patient and mental health issues.

Patient views on financial relationships between surgeons and surgical device manufacturers.

Science.gov (United States)

Camp, Mark W; Gross, Allan E; McKneally, Martin F

2015-10-01

Over the past decade, revelations of inappropriate financial relationships between surgeons and surgical device manufacturers have challenged the presumption that surgeons can collaborate with surgical device manufacturers without damaging public trust in the surgical profession. We explored postoperative Canadian patients' knowledge and opinions about financial relationships between surgeons and surgical device manufacturers. This complex issue was explored using qualitative methods. We conducted semistructured face-to-face interviews with postoperative patients in follow-up arthroplasty clinics at an academic hospital in Toronto, Canada. Interviews were audiotaped, transcribed and analyzed. Patient-derived concepts and themes were uncovered. We interviewed 33 patients. Five major themes emerged: 1) many patients are unaware of the existence of financial relationships between surgeons and surgical device manufacturers; 2) patients approve of financial relationships that support innovation and research but are opposed to relationships that involve financial incentives that benefit only the surgeon and the manufacturer; 3) patients do not support disclosure of financial relationships during the consent process as it may shift focus away from the more important risks; 4) patients support oversight at the professional level but reject the idea of government involvement in oversight; and 5) patients entrust their surgeons to make appropriate patient-centred choices. This qualitative study deepens our understanding of financial relationships between surgeons and industry. Patients support relationships with industry that provide potential benefit to current or future patients. They trust our ability to self-regulate. Disclosure combined with appropriate oversight will strengthen public trust in professional collaboration with industry.

Solar Heating Systems with Evacuated Tubular Solar Collector

DEFF Research Database (Denmark)

Qin, Lin; Furbo, Simon

1998-01-01

Recently different designed evacuated tubular solar collectors were introduced on the market by different Chinese companies. In the present study, investigations on the performance of four different Chinese evacuated tubular collectors and of solar heating systems using these collectors were...... carried out, employing both laboratory test and theoretical calculations. The collectors were tested in a small solar domestic hot water (SDHW) system in a laboratory test facility under realistic conditions. The yearly thermal performance of solar heating systems with these evacuated tubular collectors......, as well as with normal flat-plate collectors was calculated under Danish weather conditions. It is found that, for small SDHW systems with a combi tank design, an increase of 25% -55% net utilized solar energy can be achieved by using these evacuated tubular collectors instead of normal flat...

Neurological and functional outcomes of subdural hematoma evacuation in patients over 70 years of age

Directory of Open Access Journals (Sweden)

Patrick Mulligan

2013-01-01

Full Text Available Background: Subdural hematoma (SDH is a common disease entity treated by neurosurgical intervention. Although the incidence increases in the elderly population, there is a paucity of studies examining their surgical outcomes. Objectives: To determine the neurological and functional outcomes of patients over 70 years of age undergoing surgical decompression for subdural hematoma. Materials and Methods: We retrospectively reviewed data on 45 patients above 70 years who underwent craniotomy or burr holes for acute, chronic or mixed subdural hematomas. We analyzed both neurological and functional status before and after surgery. Results: Forty-five patients 70 years of age or older were treated in our department during the study period. There was a significant improvement in the neurological status of patients from admission to follow up as assessed using the Markwalder grading scale (1.98 vs. 1.39; P =0.005, yet no improvement in functional outcome was observed as assessed by Glasgow Outcome Score. Forty-one patients were admitted from home, however only 20 patients (44% were discharged home, 16 (36% discharged to nursing home or rehab, 6 (13% to hospice and 3 (7% died in the postoperative period. Neurological function improved in patients who were older, had a worse pre-operative neurological status, were on anticoagulation and had chronic or mixed acute and chronic hematoma. However, no improvement in functional status was observed. Conclusion: Surgical management of SDH in patients over 70 years of age provides significant improvement in neurological status, but does not change functional status.

Dynamics-Based Stranded-Crowd Model for Evacuation in Building Bottlenecks

Directory of Open Access Journals (Sweden)

Lidi Huang

2013-01-01

Full Text Available In high-density public buildings, it is difficult to evacuate. So in this paper, we propose a novel quantitative evacuation model to insure people’s safety and reduce the risk of crowding. We analyze the mechanism of arch-like clogging phenomena during evacuation and the influencing factors in emergency situations at bottleneck passages; then we design a model based on crowd dynamics and apply the model to a stadium example. The example is used to compare evacuation results of crowd density with different egress widths in stranded zones. The results show this model proposed can guide the safe and dangerous egress widths in performance design and can help evacuation routes to be selected and optimized.

Evacuation exercise at the Kindergarten

CERN Multimedia

2001-01-01

Every year fire evacuation exercises are organized through out CERN and our facility's Kindergarten is no exception. Just a few weeks ago, a fire simulation was carried out in the Kindergarten kitchen facility using synthetic smoke. The purpose of the exercise was to teach staff to react in a disciplined and professional manner when in the presence of danger. The simulation is always carried out at a random time so as to ensure that people in the area under the test are not aware of the exercise. For the Kindergarten the exercise was held early in the school year so as to train those who are new to the establishment. The evacuation was a complete success and all went as it was supposed to. When the children and teachers smelt smoke they followed the prescribed evacuation routes and left the building immediately. Once outside the situation was revealed as an exercise and everyone went back to business as usual, everyone that is, except the fire brigade and fire inspector.  The fire brigade checked t...

Innovative financing for rural surgical patients: Experience in mission hospitals

Directory of Open Access Journals (Sweden)

Gnanaraj Jesudian

2016-01-01

Full Text Available In rural India most of the surgical patients become impoverished due to surgical treatment pushing several families below poverty line. We describe the various methods that we tried to help these patients pay for the surgical procedures without becoming impoverished. Some of them were successful and many of them were not so successful. The large turnover and innovative methods helped the mission hospitals to serve the poor and the marginalized. Some of these methods might not be relevant in areas other than Northeast India while many could be used in other areas.

[The assessment of surgical treatment of patients with malignant pleural effusion].

Science.gov (United States)

Lazarev, S M; Reshetov, A V; Kakysheva, O E; Nikolaev, G V; Kirillov, Iu V; Volgin, G N

2013-01-01

An analysis of results of 498 patients with malignant pleural effusion was made. All patients were divided into three groups depending on methods of treatment: in the first group of patients the puncture of pleural cavity and the evacuation of liquid were made against the background of complex treatment; in the second group of patients the thoracocentesis and suspension induction were performed; in the third group the video thoracoscopy was carried out. In an assessment of each method of treatment, the researchers came to the conclusion that in case when the patient had the sufficient functional capabilities, the doctors should give preference to the thoracoscopy operations and in case of severe somatic status the doctors should give preference to the drainage of pleural cavity with release from exudates and with subsequent introduction of talc as the most effective sclerosing agent.

Variable population exposure and distributed travel speeds in least-cost tsunami evacuation modelling

Science.gov (United States)

Fraser, Stuart A.; Wood, Nathan J.; Johnston, David A.; Leonard, Graham S.; Greening, Paul D.; Rossetto, Tiziana

2014-01-01

Evacuation of the population from a tsunami hazard zone is vital to reduce life-loss due to inundation. Geospatial least-cost distance modelling provides one approach to assessing tsunami evacuation potential. Previous models have generally used two static exposure scenarios and fixed travel speeds to represent population movement. Some analyses have assumed immediate departure or a common evacuation departure time for all exposed population. Here, a method is proposed to incorporate time-variable exposure, distributed travel speeds, and uncertain evacuation departure time into an existing anisotropic least-cost path distance framework. The method is demonstrated for hypothetical local-source tsunami evacuation in Napier City, Hawke's Bay, New Zealand. There is significant diurnal variation in pedestrian evacuation potential at the suburb level, although the total number of people unable to evacuate is stable across all scenarios. Whilst some fixed travel speeds approximate a distributed speed approach, others may overestimate evacuation potential. The impact of evacuation departure time is a significant contributor to total evacuation time. This method improves least-cost modelling of evacuation dynamics for evacuation planning, casualty modelling, and development of emergency response training scenarios. However, it requires detailed exposure data, which may preclude its use in many situations.

Application of Catastrophe Risk Modelling to Evacuation Public Policy

Science.gov (United States)

Woo, G.

2009-04-01

The decision by civic authorities to evacuate an area threatened by a natural hazard is especially fraught when the population in harm's way is extremely large, and where there is considerable uncertainty in the spatial footprint, scale, and strike time of a hazard event. Traditionally viewed as a hazard forecasting issue, civil authorities turn to scientists for advice on a potentially imminent dangerous event. However, the level of scientific confidence varies enormously from one peril and crisis situation to another. With superior observational data, meteorological and hydrological hazards are generally better forecast than geological hazards. But even with Atlantic hurricanes, the track and intensity of a hurricane can change significantly within a few hours. This complicated and delayed the decision to call an evacuation of New Orleans when threatened by Hurricane Katrina, and would present a severe dilemma if a major hurricane were appearing to head for New York. Evacuation needs to be perceived as a risk issue, requiring the expertise of catastrophe risk modellers as well as geoscientists. Faced with evidence of a great earthquake in the Indian Ocean in December 2004, seismologists were reluctant to give a tsunami warning without more direct sea observations. Yet, from a risk perspective, the risk to coastal populations would have warranted attempts at tsunami warning, even though there was significant uncertainty in the hazard forecast, and chance of a false alarm. A systematic coherent risk-based framework for evacuation decision-making exists, which weighs the advantages of an evacuation call against the disadvantages. Implicitly and qualitatively, such a cost-benefit analysis is undertaken by civic authorities whenever an evacuation is considered. With the progress in catastrophe risk modelling, such an analysis can be made explicit and quantitative, providing a transparent audit trail for the decision process. A stochastic event set, the core of a

Natural history and surgical results in patients with unruptured intracranial aneurysms

International Nuclear Information System (INIS)

Okiyama, Koichi; Nagano, Osamu; Machida, Toshio; Serizawa, Toru; Ono, Junichi; Higuchi, Yoshinori

2008-01-01

The management of patients with unruptured intracranial aneurysms (UIAs) is controversial. We aimed to assess the natural history of UIAs and evaluate the surgical results. We analyzed 154 patients (181 saccular UIAs) with no history of subarachnoid hemorrhage (SAH) from a different aneurysm. Aneurysms were detected by magnetic resonance angiography (MRA) or by 3-dimensional CT angiography. Although the most frequent reason for the diagnosis was routine brain examinations of healthy patients or a vague symptom such as headache or dizziness, 15 patients were symptomatic. The natural history in patients who did not have surgery (follow-up group: 76 cases, 95 aneurysms) was assessed, and the surgical outcome of UIAs (surgical group: 78 cases, 86 aneurysms) was evaluated. Among 76 patients in the follow-up group, 7 had SAH. The mean latency period to aneurysm rupture was 3.2 months. The aneurysms with subsequent bleeding ranged from 5 to 25 mm (19.3 mm on average), whereas those without ranged from 1 to 28 mm (4.5 mm on average). The rupture rates of UIAs in anterior and posterior circulation were 6.2% and 14.3%, respectively. All ruptured cases were females. Mortality and morbidity associated with UIAs in the follow-up group were 3.9% and 3.9%, respectively. In the surgical group, no mortality was noted. Permanent morbidity associated with prospective repair of UIAs was 5.1%, although the morbidity of the patients with preoperative Rankin scores of 0 or 1 was 1.3%. Transient morbidity was observed in 6 patients (7.7%) with the size of the aneurysm 19.8 mm on average. The natural history and surgical results in patients with UIAs are modified by several factors including aneurysm size and location, the patient's age and gender, the medical status and the patient's preoperative Rankin score. The present results indicated that these factors should be considered in deciding whether to treat UIAs, and that careful assessment of the surgical benefits might be essential

Pedestrian collective motion in competitive room evacuation.

Science.gov (United States)

Garcimartín, A; Pastor, J M; Martín-Gómez, C; Parisi, D; Zuriguel, I

2017-09-07

When a sizable number of people evacuate a room, if the door is not large enough, an accumulation of pedestrians in front of the exit may take place. This is the cause of emerging collective phenomena where the density is believed to be the key variable determining the pedestrian dynamics. Here, we show that when sustained contact among the individuals exists, density is not enough to describe the evacuation, and propose that at least another variable -such as the kinetic stress- is required. We recorded evacuation drills with different degrees of competitiveness where the individuals are allowed to moderately push each other in their way out. We obtain the density, velocity and kinetic stress fields over time, showing that competitiveness strongly affects them and evidencing patterns which have been never observed in previous (low pressure) evacuation experiments. For the highest competitiveness scenario, we detect the development of sudden collective motions. These movements are related to a notable increase of the kinetic stress and a reduction of the velocity towards the door, but do not depend on the density.

Modelling gastric evacuation in gadoids feeding on crustaceans

DEFF Research Database (Denmark)

Andersen, Niels Gerner; Chabot, Denis; Couturier, C. S.

2016-01-01

A mechanistic, prey surface-dependent model was expanded to describe the course and rate of gastric evacuation in predatory fishes feeding on crustacean prey with robust exoskeletons. This was accomplished by adding a layer of higher resistance to the digestive processes outside the inner softer...... parts of a prey cylinder abstraction and splitting up the prey evacuation into two stages: an initial stage where the exoskeleton is cracked and a second where the prey remains are digested and evacuated. The model was parameterized for crustaceans with different levels of armour fed to Atlantic cod...... and Chionoecetes opilio. In accordance with the apparent intraspecific isometric relationship between exoskeleton mass and total body mass, the model described stage duration and rate of evacuation of the crustacean prey independently of meal and prey sizes. The duration of the first stage increased (0-33 h...

Analysis of community tsunami evacuation time: An overview

Science.gov (United States)

Yunarto, Y.; Sari, A. M.

2018-02-01

Tsunami in Indonesia is defined as local tsunami due to its occurrences which are within a distance of 200 km from the epicenter of the earthquake. A local tsunami can be caused by an earthquake, landslide, or volcanic eruption. Tsunami arrival time in Indonesia is generally between 10-60 minutes. As the estimated time of the tsunami waves to reach the coast is 30 minutes after the earthquake, the community should go to the vertical or horizontal evacuation in less than 30 minutes. In an evacuation, the city frequently does the evacuation after obtaining official directions from the authorities. Otherwise, they perform an independent evacuation without correct instructions from the authorities. Both of these ways have several strengths and limitations. This study analyzes these methods regarding time as well as the number of people expected to be saved.

Effect of minimally invasive evacuation of hematoma combined with Xingnaojing therapy on neurological function injury and cytokine level in patients with hypertensive cerebral hemorrhagen

OpenAIRE

Yong-Feng Li; Wei Li

2017-01-01

Objective: To study the effect of minimally invasive evacuation of hematoma combined with Xingnaojing therapy on neurological function damage and cytokine level in patients with hypertensive cerebral hemorrhage. Methods: A total of 80 patients with hypertensive cerebral hemorrhage treated in our hospital between June 2010 and September 2015 were selected as the research subjects, the treatment methods and test results were reviewed, and then they were divided into the control g...

Surgical management and perioperative morbidity of patients with primary borderline ovarian tumor (BOT).

Science.gov (United States)

Trillsch, Fabian; Ruetzel, Jan David; Herwig, Uwe; Doerste, Ulrike; Woelber, Linn; Grimm, Donata; Choschzick, Matthias; Jaenicke, Fritz; Mahner, Sven

2013-07-09

Surgery is the cornerstone for clinical management of patients with borderline ovarian tumors (BOT). As these patients have an excellent overall prognosis, perioperative morbidity is the critical point for decision making when the treatment strategy is developed and the primary surgical approach is defined. Clinical and surgical parameters of patients undergoing surgery for primary BOT at our institutions between 1993 and 2008 were analyzed with regard to perioperative morbidity depending on the surgical approach (laparotomy vs. laparoscopy). A total of 105 patients were analyzed (44 with primary laparoscopy [42%], 61 with primary laparotomy [58%]). Complete surgical staging was achieved in 33 patients at primary surgical approach (31.4%) frequently leading to formal indication of re-staging procedures. Tumor rupture was significantly more frequent during laparoscopy compared to laparotomy (29.5% vs. 13.1%, p = 0.038) but no other intraoperative complications were seen in laparoscopic surgery in contrast to 7 of 61 laparotomies (0% vs. 11.5%, p = 0.020). Postoperative complication rates were similar in both groups (19.7% vs. 18.2%, p = 0.848). Irrespective of the surgical approach, surgical management of BOT has acceptable rates of perioperative complications and morbidity. Choice of initial surgical approach can therefore be made independent of complication-concerns. As the recently published large retrospective AGO ROBOT study observed similar oncologic outcome for both approaches, laparoscopy can be considered for staging of patients with BOT if this appears feasible. An algorithm for the surgical management of BOT patients has been developed.

Performance analysis of a solar still coupled with evacuated heat pipes

Science.gov (United States)

Pramod, B. V. N.; Prudhvi Raj, J.; Krishnan, S. S. Hari; Kotebavi, Vinod

2018-02-01

In developing countries the need for better quality drinking water is increasing steadily. We can overcome this need by using solar energy for desalination purpose. This process includes fabrication and analysis of a pyramid type solar still coupled with evacuated heat pipes. This experiment using evacuated heat pipes are carried in mainly three modes namely 1) Still alone 2) Using heat pipe with evacuated tubes 3)Using evacuated heat pipe. For this work single basin pyramid type solar still with 1m2 basin area is fabricated. Black stones and Black paint are utilised in solar still to increase evaporation rate of water in basin. The heat pipe’s evaporator section is placed inside evacuated tube and the heat pipe’s condenser section is connected directly to the pyramid type solar still’s lower portion. The output of distillate water from still with evacuated heat pipe is found to be 40% more than the still using only evacuated tubes.

Computer simulation-based framework for transportation evacuation in major trip generator.

Science.gov (United States)

2009-01-01

Since emergencies including both natural disasters and man-made incidents, are happening more and more : frequently, evacuation, especially transportation evacuation, is becoming a hot research focus in recent years. : Currently, transportation evacu...

[PTSD-positive screening and factors influencing the mental state in victims evacuated/ not evacuated from Wenchuan earthquake area within 1 month].

Science.gov (United States)

Gao, Xueping; Luo, Xingwei

2009-06-01

To explore posttraumatic stress disorder (PTSD) positive screening and factors influencing the mental state in victims who were evacuated/were not evacuated from Wenchuan earthquake area within 1 month. The 3 groups included 235 victims who were not evacuated from Shifang territory (the incident scene, Group A), 44 victims who were evacuated to Second Xiangya Hospital (the wounded, Group B) and 36 relatives (the relatives, Group C). The mental state of all subjects was evaluated by Impact of Event Scale-Revised (IES-R) and other tools. (1) One month after the disaster, and the positive rate of PTSD screening in these survivors was 35.56%, the positive rate in women was significantly higher than that in men (chi(2)=16.27,PGender, place of residence and evacuating from the earthquake area or not were factors of PTSD symptoms. One month after the earthquake, the victims suffered psychologically. PTSD symptoms, anxiety and depression symptoms were their major mental problems, more attention to especially women victims. The protection factors include dispersing victims to the secure place as soon as possible, expanding and strengthening society support. Early psychological interventions will help victims to raise their psychological endurance and prevent PTSD effectively.

Simulated Evacuations Into Water

National Research Council Canada - National Science Library

McLean, Garnet

2004-01-01

.... Actual emergency data to support ditching certification are not available; there have been questions as to whether evacuation flow rates onto land are appropriate for use in ditching-related flotation time computations...

21 CFR 882.5850 - Implanted spinal cord stimulator for bladder evacuation.

Science.gov (United States)

2010-04-01

... bladder by reflex means or by the intermittent use of catheters. The stimulator consists of an implanted... an external transmitter for transmitting the stimulating pulses across the patient's skin to the... cord stimulator for bladder evacuation shall have an approved PMA or a declared completed PDP in effect...

Using Three-Dimensional Printing to Fabricate a Tubing Connector for Dilation and Evacuation.

Science.gov (United States)

Stitely, Michael L; Paterson, Helen

2016-02-01

This is a proof-of-concept study to show that simple instrumentation problems encountered in surgery can be solved by fabricating devices using a three-dimensional printer. The device used in the study is a simple tubing connector fashioned to connect two segments of suction tubing used in a surgical procedure where no commercially available product for this use is available through our usual suppliers in New Zealand. A cylindrical tubing connector was designed using three-dimensional printing design software. The tubing connector was fabricated using the Makerbot Replicator 2X three-dimensional printer. The connector was used in 15 second-trimester dilation and evacuation procedures. Data forms were completed by the primary operating surgeon. Descriptive statistics were used with the expectation that the device would function as intended in all cases. The three-dimensional printed tubing connector functioned as intended in all 15 instances. Commercially available three-dimensional printing technology can be used to overcome simple instrumentation problems encountered during gynecologic surgical procedures.

Surgical misadventure: A case for thoughtful patient preoperative ...

African Journals Online (AJOL)

An assessment of the psychological impact of losing a breast in this patient was not possible as patient was lost to follow up. Optimal clinical examination by the surgeon and preoperative cytological diagnosis would ensure that the patient is spared unnecessary mutilating surgery. Nigerian Journal of Surgical Research Vol.

The extent of surgical patients' understanding.

Science.gov (United States)

Pugliese, Omar Talhouk; Solari, Juan Lombardi; Ferreres, Alberto R

2014-07-01

The notion that consent to surgery must be informed implies not only that information should be provided by the surgeon but also that the information should be understood by the patient in order to give a foundation to his or her decision to accept or refuse treatment and thus, achieve autonomy for the patient. Nonetheless, this seems to be an idyllic situation, since most patients do not fully understand the facts offered and thus the process of surgical informed consent, as well as the patient's autonomy, may be jeopardized. Informed consent does not always mean rational consent.

[Croatian guidelines for perioperative enteral nutrition of surgical patients].

Science.gov (United States)

Zelić, Marko; Bender, Darija Vranesić; Kelecić, Dina Ljubas; Zupan, Zeljko; Cicvarić, Tedi; Maldini, Branka; Durut, Iva; Rahelić, Velimir; Skegro, Mate; Majerović, Mate; Perko, Zdravko; Sustić, Alan; Madzar, Tomislav; Kovacić, Borna; Kekez, Tihomir; Krznarić, Zeljko

2014-01-01

Nutritional status of patients significantly affects the outcome of surgical treatment, whether it's about being obese or malnutrition with loss of muscle mass. Inadequate nutritional support in the perioperative period compromises surgical procedures even in patients who are adequately nourished. In this paper, particular attention was paid to malnourished patients, and their incidence in population hospitalized in surgical wards can be high up to 30%. Special emphasis was paid to the appropriateness of preoperative fasting and to the acceptance of new knowledge in this area of treatment. The aim of this working group was to make guidelines for perioperative nutritional support with different modalities of enteral nutrition. The development of these guidelines was attended by representatives of Croatian Medical Association: Croatian Society for Digestive Surgery, Croatian Society for Clinical Nutrition, Croatian Society of Surgery, Croatian Society for Endoscopic Surgery, Croatian Trauma Society and the Croatian Society of Anesthesiology and Intensive Care. The guidelines are designed as a set of questions that arise daily in clinical practice when preparing patients for surgery and after the surgical treatment, which relate to the assessment of nutritional status, perioperative nutritional support, duration of preoperative fasting period and the selection of food intake route. Assessment of nutritional status and the use of different modes of enteral nutrition should enter into standard protocols of diagnosis and treatment in the Croatian hospitals.

Systematic Review of Patient-Specific Surgical Simulation: Toward Advancing Medical Education.

Science.gov (United States)

Ryu, Won Hyung A; Dharampal, Navjit; Mostafa, Ahmed E; Sharlin, Ehud; Kopp, Gail; Jacobs, William Bradley; Hurlbert, Robin John; Chan, Sonny; Sutherland, Garnette R

Simulation-based education has been shown to be an effective tool to teach foundational technical skills in various surgical specialties. However, most of the current simulations are limited to generic scenarios and do not allow continuation of the learning curve beyond basic technical skills to prepare for more advanced expertise, such as patient-specific surgical planning. The objective of this study was to evaluate the current medical literature with respect to the utilization and educational value of patient-specific simulations for surgical training. We performed a systematic review of the literature using Pubmed, Embase, and Scopus focusing on themes of simulation, patient-specific, surgical procedure, and education. The study included randomized controlled trials, cohort studies, and case-control studies published between 2005 and 2016. Two independent reviewers (W.H.R. and N.D) conducted the study appraisal, data abstraction, and quality assessment of the studies. The search identified 13 studies that met the inclusion criteria; 7 studies employed computer simulations and 6 studies used 3-dimensional (3D) synthetic models. A number of surgical specialties evaluated patient-specific simulation, including neurosurgery, vascular surgery, orthopedic surgery, and interventional radiology. However, most studies were small in size and primarily aimed at feasibility assessments and early validation. Early evidence has shown feasibility and utility of patient-specific simulation for surgical education. With further development of this technology, simulation-based education may be able to support training of higher-level competencies outside the clinical settingto aid learners in their development of surgical skills. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Hands-On Surgical Training Workshop: an Active Role-Playing Patient Education for Adolescents.

Science.gov (United States)

Wongkietkachorn, Apinut; Boonyawong, Pangpoom; Rhunsiri, Peera; Tantiphlachiva, Kasaya

2017-09-01

Most patient education involves passive learning. To improve patient education regarding surgery, an active learning workshop-based teaching method is proposed. The objective of this study was to assess level of patient surgical knowledge, achievement of workshop learning objectives, patient apprehension about future surgery, and participant workshop satisfaction after completing a surgical training workshop. A four-station workshop (surgical scrub, surgical suture, laparoscopic surgery, and robotic surgery) was developed to teach four important components of the surgical process. Healthy, surgery-naive adolescents were enrolled to attend this 1-h workshop-based training program. Training received by participants was technically and procedurally identical to training received by actual surgeons. Pre- and post-workshop questionnaires were used to assess learning outcomes. There were 1312 participants, with a mean age 15.9 ± 1.1 years and a gender breakdown of 303 males and 1009 females. For surgical knowledge, mean pre-workshop and post-workshop scores were 6.1 ± 1.5 and 7.5 ± 1.5 (out of 10 points), respectively (p education is an effective way to improve understanding of surgery-related processes. This teaching method may also decrease apprehension that patients or potential patients harbor regarding a future surgical procedure.

Evacuation proctography - examination technique and method of evaluation; Evakuationsproktographie. Untersuchungstechnik und Auswertemethodik

Energy Technology Data Exchange (ETDEWEB)

Braunschweig, R. [Abt. fuer Diagnostische Radiologie, Eberhard-Karls-Universitaet, Tuebingen (Germany); Schott, U. [Abt. fuer Diagnostische Radiologie, Eberhard-Karls-Universitaet, Tuebingen (Germany); Starlinger, M. [Abt. fuer Allgemeine Chirurgie, Eberhard-Karls-Universtaet, Tuebingen (Germany)

1993-12-31

Evacuation proctography is the most important imaging technique to supplement findings of physical examination, manometry, and endoscopy in patients presenting with pathologies in anorectal morphology and function. Indications for evacuation proctography include obstructed defecation or incomplete evacuation, imaging of ileal pouches following excision of the rectum, and suspected anorectal fistulae. Evacuation proctography with thick barium sulfate is performed under fluoroscopy. Documentation of the study can either be done by single-shot X-rays, video recording, or imaging with a 100-mm spot-film camera. Evacuation proctography shows morphologic changes such as spastic pelvic floor, rectocele, enterocele, intussusception and anal prolapse. Measurements can be performed to obtain the anorectal angle, location and mobility of the pelvic floor, and size as well as importance of a rectocele. Qualitative and quantitative data can only be interpreted along with clinical and manometric data. (orig.) [Deutsch] Neben klinischen, manometrischen und endoskopischen Untersuchungstechniken stellt die Evakuationsproktographie das wesentlichste bildgebende Verfahren zur Erfassung morphologischer und funktioneller Befunde am Anorektum dar. Einsatzgebiet sind zum einen klinische Befunde wie Obstipation und unvollstaendige Entleerung und zum anderen die Roentgenkontrolle eines Duenndarmpouches nach Rectumexstirpation sowie der Nachweis oder Ausschluss von Fisteln. Die Untersuchung wird unter Verwendung von Kontrastmittelsuspensionen durchleuchtungsgezielt durchgefuehrt. Zur Dokumentation stehen die Einzelbildtechnik im seitlichen Strahlengang, die Videotechnik bzw. 100mm-Kamera-Technik zur Verfuegung. Morphologisch koennen Befunde wie Anismus, Rectocele, Enterocele, Intussuszeption bzw. Schleimhautprolaps sowie der Analprolaps erfasst werden. Messtechnisch koennen u.a. der Anorektalwinkel und die Beweglichkeit bzw. Lage des Beckenbodens sowie die Groesse und funktionelle Bedeutung

Providing care for critically ill surgical patients: challenges and recommendations.

Science.gov (United States)

Tisherman, Samuel A; Kaplan, Lewis; Gracias, Vicente H; Beilman, Gregory J; Toevs, Christine; Byrnes, Matthew C; Coopersmith, Craig M

2013-07-01

Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record. The new acute care surgery training paradigm (including trauma, surgical critical care, and emergency general surgery) has been developed to increase interest in trauma and surgical critical care, but the number of interested trainees remains too few. Recommendations are made for broadening the multidisciplinary training and practice opportunities in surgical critical care for intensivists from all base specialties and for maintaining the intensivist model within acute care surgery practice. Support from academic and administrative leadership, as well as national organizations, will be needed.

Differential diagnostic value of procalcitonin in surgical and medical patients with septic shock.

Science.gov (United States)

Clec'h, Christophe; Fosse, Jean-Philippe; Karoubi, Philippe; Vincent, Francois; Chouahi, Imad; Hamza, Lilia; Cupa, Michel; Cohen, Yves

2006-01-01

To assess whether different diagnostic and prognostic cutoff values of procalcitonin should be considered in surgical and in medical patients with septic shock. Prospective observational study. Intensive care unit of the Avicenne teaching hospital, France. All patients with septic shock or noninfectious systemic inflammatory response syndrome within 48 hrs after admission. None. Patients were allocated to one of the following groups: group 1 (surgical patients with septic shock), group 2 (surgical patients with noninfectious systemic inflammatory response syndrome), group 3 (medical patients with septic shock), and group 4 (medical patients with noninfectious systemic inflammatory response syndrome). Procalcitonin at study entry was compared between group 1 and group 2 and between group 3 and group 4 to determine the diagnostic cutoff value in surgical and in medical patients, respectively. Procalcitonin was compared between survivors and nonsurvivors from group 1 and group 3 to determine its prognostic cutoff value. One hundred forty-three patients were included: 31 in group 1, 36 in group 2, 36 in group 3, and 40 in group 4. Median procalcitonin levels (ng/mL [interquartile range]) were higher in group 1 than in group 3 (34.00 [7.10-76.00] vs. 8.40 [3.63-24.70], p = .01). In surgical patients, the best diagnostic cutoff value was 9.70 ng/mL, with 91.7% sensitivity and 74.2% specificity. In medical patients, the best diagnostic cutoff value was 1.00 ng/mL, with 80% sensitivity and 94% specificity. Procalcitonin was a reliable early prognostic marker in medical but not in surgical patients with septic shock. A cutoff value of 6.00 ng/mL had 76% sensitivity and 72.7% specificity for separating survivors from nonsurvivors. The diagnostic cutoff value of procalcitonin was higher in surgical than in medical patients. Early procalcitonin was of prognostic interest in medical patients.

Self-efficacy and barriers to disaster evacuation in Hong Kong.

Science.gov (United States)

Newnham, Elizabeth A; Balsari, Satchit; Lam, Rex Pui Kin; Kashyap, Shraddha; Pham, Phuong; Chan, Emily Y Y; Patrick, Kaylie; Leaning, Jennifer

2017-12-01

To investigate specific challenges to Hong Kong's capacity for effective disaster response, we assessed perceived barriers to evacuation and citizens' self-efficacy. Global positioning system software was used to determine random sampling locations across Hong Kong, weighted by population density. The resulting sample of 1023 participants (46.5% female, mean age 40.74 years) were invited to complete questionnaires on emergency preparedness, barriers to evacuation and self-efficacy. Latent profile analysis and multinomial logistic regression were used to identify self-efficacy profiles and predictors of profile membership. Only 11% of the sample reported feeling prepared to respond to a disaster. If asked to evacuate in an emergency, 41.9% of the sample cited significant issues that would preclude them from doing so. Self-efficacy was negatively associated with barriers to disaster response so that participants reporting higher levels of self-efficacy cited fewer perceived barriers to evacuation. Hong Kong has established effective strategies for emergency response, but concerns regarding evacuation and mobilisation remain. The findings indicate that improving self-efficacy for disaster response has potential to increase evacuation readiness.

Sensitivity Analysis of Evacuation Speed in Hypothetical NPP Accident by Earthquake

Energy Technology Data Exchange (ETDEWEB)

Kim, Sung-yeop; Lim, Ho-Gon [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

2016-10-15

Effective emergency response in emergency situation of nuclear power plant (NPP) can make consequences be different therefore it is regarded important when establishing an emergency response plan and assessing the risk of hypothetical NPP accident. Situation of emergency response can be totally changed when NPP accident caused by earthquake or tsunami is considered due to the failure of roads and buildings by the disaster. In this study evacuation speed has been focused among above various factors and reasonable evacuation speed in earthquake scenario has been investigated. Finally, sensitivity analysis of evacuation speed in hypothetical NPP accident by earthquake has been performed in this study. Evacuation scenario can be entirely different in the situation of seismic hazard and the sensitivity analysis of evacuation speed in hypothetical NPP accident by earthquake has been performed in this study. Various references were investigated and earthquake evacuation model has been developed considering that evacuees may convert their evacuation method from using a vehicle to walking when they face the difficulty of using a vehicle due to intense traffic jam, failure of buildings and roads, and etc. The population dose within 5 km / 30 km have been found to be increased in earthquake situation due to decreased evacuation speed and become 1.5 - 2 times in the severest earthquake evacuation scenario set up in this study. It is not agreed that using same emergency response model which is used for normal evacuation situations when performing level 3 probabilistic safety assessment for earthquake and tsunami event. Investigation of data and sensitivity analysis for constructing differentiated emergency response model in the event of seismic hazard has been carried out in this study.

Sensitivity Analysis of Evacuation Speed in Hypothetical NPP Accident by Earthquake

International Nuclear Information System (INIS)

Kim, Sung-yeop; Lim, Ho-Gon

2016-01-01

Effective emergency response in emergency situation of nuclear power plant (NPP) can make consequences be different therefore it is regarded important when establishing an emergency response plan and assessing the risk of hypothetical NPP accident. Situation of emergency response can be totally changed when NPP accident caused by earthquake or tsunami is considered due to the failure of roads and buildings by the disaster. In this study evacuation speed has been focused among above various factors and reasonable evacuation speed in earthquake scenario has been investigated. Finally, sensitivity analysis of evacuation speed in hypothetical NPP accident by earthquake has been performed in this study. Evacuation scenario can be entirely different in the situation of seismic hazard and the sensitivity analysis of evacuation speed in hypothetical NPP accident by earthquake has been performed in this study. Various references were investigated and earthquake evacuation model has been developed considering that evacuees may convert their evacuation method from using a vehicle to walking when they face the difficulty of using a vehicle due to intense traffic jam, failure of buildings and roads, and etc. The population dose within 5 km / 30 km have been found to be increased in earthquake situation due to decreased evacuation speed and become 1.5 - 2 times in the severest earthquake evacuation scenario set up in this study. It is not agreed that using same emergency response model which is used for normal evacuation situations when performing level 3 probabilistic safety assessment for earthquake and tsunami event. Investigation of data and sensitivity analysis for constructing differentiated emergency response model in the event of seismic hazard has been carried out in this study

Sensitivity of tsunami evacuation modeling to direction and land cover assumptions

Science.gov (United States)

Schmidtlein, Mathew C.; Wood, Nathan J.

2015-01-01

Although anisotropic least-cost-distance (LCD) modeling is becoming a common tool for estimating pedestrian-evacuation travel times out of tsunami hazard zones, there has been insufficient attention paid to understanding model sensitivity behind the estimates. To support tsunami risk-reduction planning, we explore two aspects of LCD modeling as it applies to pedestrian evacuations and use the coastal community of Seward, Alaska, as our case study. First, we explore the sensitivity of modeling to the direction of movement by comparing standard safety-to-hazard evacuation times to hazard-to-safety evacuation times for a sample of 3985 points in Seward's tsunami-hazard zone. Safety-to-hazard evacuation times slightly overestimated hazard-to-safety evacuation times but the strong relationship to the hazard-to-safety evacuation times, slightly conservative bias, and shorter processing times of the safety-to-hazard approach make it the preferred approach. Second, we explore how variations in land cover speed conservation values (SCVs) influence model performance using a Monte Carlo approach with one thousand sets of land cover SCVs. The LCD model was relatively robust to changes in land cover SCVs with the magnitude of local model sensitivity greatest in areas with higher evacuation times or with wetland or shore land cover types, where model results may slightly underestimate travel times. This study demonstrates that emergency managers should be concerned not only with populations in locations with evacuation times greater than wave arrival times, but also with populations with evacuation times lower than but close to expected wave arrival times, particularly if they are required to cross wetlands or beaches.

Analysis of the readability of patient education materials from surgical subspecialties.

Science.gov (United States)

Hansberry, David R; Agarwal, Nitin; Shah, Ravi; Schmitt, Paul J; Baredes, Soly; Setzen, Michael; Carmel, Peter W; Prestigiacomo, Charles J; Liu, James K; Eloy, Jean Anderson

2014-02-01

Patients are increasingly using the Internet as a source of information on medical conditions. Because the average American adult reads at a 7th- to 8th-grade level, the National Institutes of Health recommend that patient education material be written between a 4th- and 6th-grade level. In this study, we assess and compare the readability of patient education materials on major surgical subspecialty Web sites relative to otolaryngology. Descriptive and correlational design. Patient education materials from 14 major surgical subspecialty Web sites (American Society of Colon and Rectal Surgeons, American Association of Endocrine Surgeons, American Society of General Surgeons, American Society for Metabolic and Bariatric Surgery, American Association of Neurological Surgeons, American Congress of Obstetricians and Gynecologists, American Academy of Ophthalmology, American Academy of Orthopedic Surgeons, American Academy of Otolaryngology-Head and Neck Surgery, American Pediatric Surgical Association, American Society of Plastic Surgeons, Society for Thoracic Surgeons, and American Urological Association) were downloaded and assessed for their level of readability using 10 widely accepted readability scales. The readability level of patient education material from all surgical subspecialties was uniformly too high. Average readability levels across all subspecialties ranged from the 10th- to 15th-grade level. Otolaryngology and other surgical subspecialties Web sites have patient education material written at an education level that the average American may not be able to understand. To reach a broader population of patients, it might be necessary to rewrite patient education material at a more appropriate level. N/A. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Bilevel Traffic Evacuation Model and Algorithm Design for Large-Scale Activities

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Danwen Bao

2017-01-01

Full Text Available This paper establishes a bilevel planning model with one master and multiple slaves to solve traffic evacuation problems. The minimum evacuation network saturation and shortest evacuation time are used as the objective functions for the upper- and lower-level models, respectively. The optimizing conditions of this model are also analyzed. An improved particle swarm optimization (PSO method is proposed by introducing an electromagnetism-like mechanism to solve the bilevel model and enhance its convergence efficiency. A case study is carried out using the Nanjing Olympic Sports Center. The results indicate that, for large-scale activities, the average evacuation time of the classic model is shorter but the road saturation distribution is more uneven. Thus, the overall evacuation efficiency of the network is not high. For induced emergencies, the evacuation time of the bilevel planning model is shortened. When the audience arrival rate is increased from 50% to 100%, the evacuation time is shortened from 22% to 35%, indicating that the optimization effect of the bilevel planning model is more effective compared to the classic model. Therefore, the model and algorithm presented in this paper can provide a theoretical basis for the traffic-induced evacuation decision making of large-scale activities.

Surgical palliation of unresectable pancreatic head cancer in elderly patients

Science.gov (United States)

Hwang, Sang Il; Kim, Hyung Ook; Son, Byung Ho; Yoo, Chang Hak; Kim, Hungdai; Shin, Jun Ho

2009-01-01

AIM: To determine if surgical biliary bypass would provide improved quality of residual life and safe palliation in elderly patients with unresectable pancreatic head cancer. METHODS: Nineteen patients, 65 years of age or older, were managed with surgical biliary bypass (Group A). These patients were compared with 19 patients under 65 years of age who were managed with surgical biliary bypass (Group B). In addition, the results for group A were compared with those obtained from 17 patients, 65 years of age or older (Group C), who received percutaneous transhepatic biliary drainage to evaluate the quality of residual life. RESULTS: Five patients (26.0%) in Group A had complications, including one intraabdominal abscess, one pulmonary atelectasis, and three wound infections. One death (5.3%) occurred on postoperative day 3. With respect to morbidity, mortality, and postoperative hospitalization, no statistically significant difference was noted between Groups A and B. The number of readmissions and the rate of recurrent jaundice were lower in Group A than in Group C, to a statistically significant degree (P = 0.019, P = 0.029, respectively). The median hospital-free survival period and the median overall survival were also significantly longer in Group A (P = 0.001 and P < 0.001, respectively). CONCLUSION: Surgical palliation does not increase the morbidity or mortality rates, but it does increase the survival rate and improve the quality of life in elderly patients with unresectable pancreatic head cancer. PMID:19248198

Rapid health assessments of evacuation centres in areas affected by Typhoon Haiyan

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Ruth Alma Ramos

2015-11-01

Full Text Available Introduction: Typhoon Haiyan caused thousands of deaths and catastrophic destruction, leaving many homeless in Region 8 of the Philippines. A team from the Philippine Field Epidemiology Training Program conducted a rapid health assessment survey of evacuation centres severely affected by Haiyan. Methods: A descriptive study was conducted whereby a convenience sample of evacuation centres were assessed on the number of toilets per evacuee, sanitation, drinking-water, food supply source and medical services. Results: Of the 20 evacuation centres assessed, none had a designated manager. Most were located in schools (70% with the estimated number of evacuees ranging from 15 to 5000 per centre. Only four (20% met the World Health Organization standard for number of toilets per evacuee; none of the large evacuation centres had even half the recommended number of toilets. All of the evacuation centres had available drinking-water. None of the evacuation centres had garbage collection, vector control activities or standby medical teams. Fourteen (70% evacuation centres had onsite vaccination activities for measles, tetanus and polio virus. Many evacuation centres were overcrowded. Conclusion: Evacuation centres are needed in almost every disaster. They should be safely located and equipped with the required amenities. In disaster-prone areas such as the Philippines, schools and community centres should not be designated as evacuation centres unless they are equipped with adequate sanitation services.

The Swedish study of Irrigation-fluid temperature in the evacuation of Chronic subdural hematoma (SIC!)

DEFF Research Database (Denmark)

Bartley, Andreas; Jakola, Asgeir S; Bartek, Jiri

2017-01-01

BACKGROUND: Chronic subdural hematoma (cSDH) is one of the most common conditions encountered in neurosurgical practice. Recurrence, observed in 5-30% of patients, is a major clinical problem. The temperature of the irrigation fluid used during evacuation of the hematoma might theoretically...... and health-related quality of life. DISCUSSION: Irrigation-fluid temperature might influence recurrence rates in the evacuation of chronic subdural hematomas. We present a study protocol for a multicenter randomized controlled trial investigating our hypothesis that irrigation fluid at body temperature...

CLEAR (Calculates Logical Evacuation And Response): A Generic Transportation Network Model for the Calculation of Evacuation Time Estimates

Energy Technology Data Exchange (ETDEWEB)

Moeller, M. P.; Urbanik, II, T.; Desrosiers, A. E.

1982-03-01

This paper describes the methodology and application of the computer model CLEAR (Calculates Logical Evacuation And Response) which estimates the time required for a specific population density and distribution to evacuate an area using a specific transportation network. The CLEAR model simulates vehicle departure and movement on a transportation network according to the conditions and consequences of traffic flow. These include handling vehicles at intersecting road segments, calculating the velocity of travel on a road segment as a function of its vehicle density, and accounting for the delay of vehicles in traffic queues. The program also models the distribution of times required by individuals to prepare for an evacuation. In order to test its accuracy, the CLEAR model was used to estimate evacuatlon tlmes for the emergency planning zone surrounding the Beaver Valley Nuclear Power Plant. The Beaver Valley site was selected because evacuation time estimates had previously been prepared by the licensee, Duquesne Light, as well as by the Federal Emergency Management Agency and the Pennsylvania Emergency Management Agency. A lack of documentation prevented a detailed comparison of the estimates based on the CLEAR model and those obtained by Duquesne Light. However, the CLEAR model results compared favorably with the estimates prepared by the other two agencies.

Exit selection strategy in pedestrian evacuation simulation with multi-exits

International Nuclear Information System (INIS)

Yue Hao; Zhang Bin-Ya; Shao Chun-Fu; Xing Yan

2014-01-01

A mixed strategy of the exit selection in a pedestrian evacuation simulation with multi-exits is constructed by fusing the distance-based and time-based strategies through a cognitive coefficient, in order to reduce the evacuation imbalance caused by the asymmetry of exits or pedestrian layout, to find a critical density to distinguish whether the strategy of exit selection takes effect or not, and to analyze the exit selection results with different cognitive coefficients. The strategy of exit selection is embedded in the computation of the shortest estimated distance in a dynamic parameter model, in which the concept of a jam area layer and the procedure of step-by-step expending are introduced. Simulation results indicate the characteristics of evacuation time gradually varying against cognitive coefficient and the effectiveness of reducing evacuation imbalance caused by the asymmetry of pedestrian or exit layout. It is found that there is a critical density to distinguish whether a pedestrian jam occurs in the evacuation and whether an exit selection strategy is in effect. It is also shown that the strategy of exit selection has no effect on the evacuation process in the no-effect phase with a low density, and that evacuation time and exit selection are dependent on the cognitive coefficient and pedestrian initial density in the in-effect phase with a high density. (general)

Critical care admission of South African (SA surgical patients: Results of the SA Surgical Outcomes Study

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David Lee Skinner

2017-05-01

Full Text Available Background. Appropriate critical care admissions are an important component of surgical care. However, there are few data describing postoperative critical care admission in resource-limited low- and middle-income countries. Objective. To describe the demographics, organ failures, organ support and outcomes of non-cardiac surgical patients admitted to critical care units in South Africa (SA. Methods. The SA Surgical Outcomes Study (SASOS was a 7-day national, multicentre, prospective, observational cohort study of all patients ≥16 years of age undergoing inpatient non-cardiac surgery between 19 and 26 May 2014 at 50 government-funded hospitals. All patients admitted to critical care units during this study were included for analysis. Results. Of the 3 927 SASOS patients, 255 (6.5% were admitted to critical care units; of these admissions, 144 (56.5% were planned, and 111 (43.5% unplanned. The incidence of confirmed or strongly suspected infection at the time of admission was 35.4%, with a significantly higher incidence in unplanned admissions (49.1 v. 24.8%, p<0.001. Unplanned admission cases were more frequently hypovolaemic, had septic shock, and required significantly more inotropic, ventilatory and renal support in the first 48 hours after admission. Overall mortality was 22.4%, with unplanned admissions having a significantly longer critical care length of stay and overall mortality (33.3 v. 13.9%, p<0.001. Conclusion. The outcome of patients admitted to public sector critical care units in SA is strongly associated with unplanned admissions. Adequate ‘high care-dependency units’ for postoperative care of elective surgical patients could potentially decrease the burden on critical care resources in SA by 23%. This study was registered on ClinicalTrials.gov (NCT02141867.

Public assessment of the usefulness of "draft" tsunami evacuation maps from Sydney, Australia – implications for the establishment of formal evacuation plans

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F. Dall'Osso

2010-08-01

Full Text Available Australia is at risk from tsunamis and recent work has identified the need for models to assess the vulnerability of exposed coastal areas – a fundamental element of the risk management process. Outputs of vulnerability assessment can be used as a baseline for the generation of tsunami prevention and mitigation measures, including evacuation maps. Having noted that no evacuation maps exist for Manly, Sydney (an area recently subjected to high resolution building vulnerability assessment by Dall'Osso et al., 2009b, we use the results of the analysis by Dall'Osso et al. (2009b to "draft" tsunami evacuation maps that could be used by the local emergency service organisations. We then interviewed 500 permanent residents of Manly in order to gain a rapid assessment on their views about the potential usefulness of the draft evacuation maps we generated. Results of the survey indicate that residents think the maps are useful and understandable, and include insights that should be considered by local government planners and emergency risk management specialists during the development of official evacuation maps (and plans in the future.

Evacuation of the NET vacuum chamber

International Nuclear Information System (INIS)

Muller, R.A.

1987-01-01

Parametric calculations of the evacuation process were carried out for the NET-vacuum chamber involving two blanket designs. The results show that with an acceptable vacuum pumping capacity the required start vacuum conditions can be realized within reasonable time. The two blanket concepts do not differ remarkably in their evacuation behaviour. The remaining large pressure differences between the different locations of the vacuum chamber can be reduced if approximately 30% of the total gas flow is extracted from the heads of the blanket replacement ports

Evacuation of the NET vacuum chamber

International Nuclear Information System (INIS)

Mueller, R.

1986-01-01

Parametric calculations of the evacuation process were carried out for the NET-vacuum chamber involving two blanket designs. The results show that with an acceptable vacuum pumping capacity the required start vacuum conditions can be realized within reasonable time. The two blanket concepts do not differ remarkably in their evacuation behaviour. The remaining large pressure differences between the different locations of the vacuum chamber can be reduced if approximately 30% of the total gas flow is extracted from the heads of the blanket replacement ports. (author)

Conservative vs. Surgical Management of Post-Traumatic Epidural Hematoma: A Case and Review of Literature

Science.gov (United States)

Maugeri, Rosario; Anderson, David Greg; Graziano, Francesca; Meccio, Flavia; Visocchi, Massimiliano; Iacopino, Domenico Gerardo

2015-01-01

Patient: Male, 30 Final Diagnosis: Acute epidural hematoma Symptoms: — Medication: — Clinical Procedure: Observation Specialty: Neurosurgery Objective: Unusual clinical course Background: Trauma is the leading cause of death in people younger than 45 years and head injury is the main cause of trauma mortality. Although epidural hematomas are relatively uncommon (less than 1% of all patients with head injuries and fewer than 10% of those who are comatose), they should always be considered in evaluation of a serious head injury. Patients with epidural hematomas who meet surgical criteria and receive prompt surgical intervention can have an excellent prognosis, presumably owing to limited underlying primary brain damage from the traumatic event. The decision to perform a surgery in a patient with a traumatic extraaxial hematoma is dependent on several factors (neurological status, size of hematoma, age of patients, CT findings) but also may depend on the judgement of the treating neurosurgeon. Case Report: A 30-year old man arrived at our Emergency Department after a traumatic brain injury. General examination revealed severe headache, no motor or sensory disturbances, and no clinical signs of intracranial hypertension. A CT scan documented a significant left fronto-parietal epidural hematoma, which was considered suitable for surgical evacuation. The patient refused surgery. Following CT scan revealed a minimal increase in the size of the hematoma and of midline shift. The neurologic examination maintained stable and the patient continued to refuse the surgical treatment. Next follow up CT scans demonstrated a progressive resorption of hematoma. Conclusions: We report an unusual case of a remarkable epidural hematoma managed conservatively with a favorable clinical outcome. This case report is intended to rather add to the growing knowledge regarding the best management for this serious and acute pathology. PMID:26567227

Use of Subdural Evacuating Port System Following Open Craniotomy with Excision of Native Dura and Membranes for Management of Chronic Subdural Hematoma.

Science.gov (United States)

Cage, Tene; Bach, Ashley; McDermott, Michael W

2017-04-26

An 86-year-old woman was admitted to the intensive care unit with a chronic subdural hematoma (CSDH) and rapid onset of worsening neurological symptoms. She was taken to the operating room for a mini-craniotomy for evacuation of the CSDH including excision of the dura and CSDH membrane. Postoperatively, a subdural evacuation port system (SEPS) was integrated into the craniotomy site and left in place rather than a traditional subdural catheter drain to evacuate the subdural space postoperatively. The patient had a good recovery and improvement of symptoms after evacuation and remained clinically well after the SEPS was removed. We offer the technique of dura and CSDH membrane excision plus SEPS drain as an effective postoperative alternative to the standard craniotomy leaving the native dura intact with traditional subdural drain that overlies the cortical surface of the brain in treating patients with CSDH.

Empirical study on social groups in pedestrian evacuation dynamics

Science.gov (United States)

von Krüchten, Cornelia; Schadschneider, Andreas

2017-06-01

Pedestrian crowds often include social groups, i.e. pedestrians that walk together because of social relationships. They show characteristic configurations and influence the dynamics of the entire crowd. In order to investigate the impact of social groups on evacuations we performed an empirical study with pupils. Several evacuation runs with groups of different sizes and different interactions were performed. New group parameters are introduced which allow to describe the dynamics of the groups and the configuration of the group members quantitatively. The analysis shows a possible decrease of evacuation times for large groups due to self-ordering effects. Social groups can be approximated as ellipses that orientate along their direction of motion. Furthermore, explicitly cooperative behaviour among group members leads to a stronger aggregation of group members and an intermittent way of evacuation.

Surgical patient safety: analysis and interventions

NARCIS (Netherlands)

de Vries, E.N.

2010-01-01

One in every 150 patients admitted to a hospital will die as a result of an ‘adverse event’: an unintended injury or complication caused by health care management, rather than by the patient’s underlying disease. More than half of these adverse events can be attributed to a surgical discipline. The

TextWithSurgeryPatients - A Research Hypothesis in Enhancing Education and Physical Assessment for Abdominal Surgical Patients.

Science.gov (United States)

Hansen, Margaret

2016-01-01

Medical surgical nurses may not have the time or resources to provide effective pre- and post-operative instructions for patients in today's healthcare system. And, making timely physical assessments following discharge from the hospital is not always straightforward. Therefore, the risk for readmission associated with post-surgical complications is a concern. At present, mobile healthcare technologies and patient care are precipitously evolving and may serve as a resource to enhance communication between the healthcare provider and patient. A mobile telephone text message (short message service [SMS]) intervention for abdominal surgical patients may foster effective education (communication) and timely self-reported physical assessment in the home environment hence preventing deleterious outcomes. The aim of this research proposal is to identify the feasibility of using a SMS intervention via smart phones to improve health outcomes via timely communication, reach large numbers of at-risk surgical patients and, establish and sustain uniform protocols in a cost-efficient manner.

Experiment and modeling of paired effect on evacuation from a three-dimensional space

Energy Technology Data Exchange (ETDEWEB)

Jun, Hu [MOE Key Laboratory for Urban Transportation Complex Systems Theory and Technology, Beijing Jiaotong University, Beijing 100044 (China); School of Traffic and Transportation, Beijing Jiaotong University, Beijing 100044 (China); Faculty of Computer Science, Chengdu Normal University, Chengdu 611130 (China); Huijun, Sun, E-mail: hjsun1@bjtu.edu.cn [MOE Key Laboratory for Urban Transportation Complex Systems Theory and Technology, Beijing Jiaotong University, Beijing 100044 (China); School of Traffic and Transportation, Beijing Jiaotong University, Beijing 100044 (China); Juan, Wei [Faculty of Computer Science, Chengdu Normal University, Chengdu 611130 (China); Xiaodan, Chen [College of Information Science and Technology, Chengdu University, Chengdu 610106 (China); Lei, You [Faculty of Computer Science, Chengdu Normal University, Chengdu 611130 (China); College of Information Science and Technology, Chengdu University, Chengdu 610106 (China); Musong, Gu [Faculty of Computer Science, Chengdu Normal University, Chengdu 611130 (China)

2014-10-24

A novel three-dimensional cellular automata evacuation model was proposed based on stairs factor for paired effect and variety velocities in pedestrian evacuation. In the model pedestrians' moving probability of target position at the next moment was defined based on distance profit and repulsive force profit, and evacuation strategy was elaborated in detail through analyzing variety velocities and repulsive phenomenon in moving process. At last, experiments with the simulation platform were conducted to study the relationships of evacuation time, average velocity and pedestrian velocity. The results showed that when the ratio of single pedestrian was higher in the system, the shortest route strategy was good for improving evacuation efficiency; in turn, if ratio of paired pedestrians was higher, it is good for improving evacuation efficiency to adopt strategy that avoided conflicts, and priority should be given to scattered evacuation. - Highlights: • A novel three-dimensional evacuation model was presented with stair factor. • The paired effect and variety velocities were considered in evacuation model. • The cellular automata model is improved by repulsive force.

Experiment and modeling of paired effect on evacuation from a three-dimensional space

International Nuclear Information System (INIS)

Jun, Hu; Huijun, Sun; Juan, Wei; Xiaodan, Chen; Lei, You; Musong, Gu

2014-01-01

A novel three-dimensional cellular automata evacuation model was proposed based on stairs factor for paired effect and variety velocities in pedestrian evacuation. In the model pedestrians' moving probability of target position at the next moment was defined based on distance profit and repulsive force profit, and evacuation strategy was elaborated in detail through analyzing variety velocities and repulsive phenomenon in moving process. At last, experiments with the simulation platform were conducted to study the relationships of evacuation time, average velocity and pedestrian velocity. The results showed that when the ratio of single pedestrian was higher in the system, the shortest route strategy was good for improving evacuation efficiency; in turn, if ratio of paired pedestrians was higher, it is good for improving evacuation efficiency to adopt strategy that avoided conflicts, and priority should be given to scattered evacuation. - Highlights: • A novel three-dimensional evacuation model was presented with stair factor. • The paired effect and variety velocities were considered in evacuation model. • The cellular automata model is improved by repulsive force

Dispositional and situational variables related to evacuation at Three Mile Island

International Nuclear Information System (INIS)

Miller, I.S.

1981-01-01

The purpose of this study was to explore some of the factors influential in local residents' evacuating or remaining in the Three Mile Island area during the nuclear power plant accident of March, 1979. Investigated variables included individuals' behavioral dispositions to attend or to avoid threatening stimuli as well as situational concerns related to demographic characteristics and subjective experience. Investigation of situational variables also probed respondents' concerns about accident-related fears. Two main relationships were investigated. The first hypothesized that positive relationships existed both between dispositional attention to threat and evacuation and between dispositional avoidance of threat and remaining. The second investigation task of the research explored evacuation-related situational variables in regard to individuals' awareness of potential danger at TMI. No support was found for the hypothesized relationships between evacuation and dispositions relative to threat. Situational variables significantly related to evacuation included: specific directives to evacuate the area; disruption of telephone service during the week of the accident; and household proximity to TMI

Surgical management for early-stage bilateral breast cancer patients in China.

Directory of Open Access Journals (Sweden)

Jia-jian Chen

Full Text Available The aim of this study was to investigate the current surgical management strategy for bilateral breast cancer (BBC patients and to assess the changes in this strategy in China.This is a retrospective review of all patients with early-stage BBC who underwent surgical treatment at the Fudan University Shanghai Cancer Center between June 2007 and June 2014.A total of 15,337 patients with primary breast cancer were identified. Of these patients, 218 (1.5% suffered from synchronous bilateral breast cancer (sBBC, and 296 (2.0% suffered from metachronous bilateral breast cancer (mBBC. Patients with a lobular carcinoma component, those with estrogen receptor-positive cancer, and those with an accompanying sclerosing adenosis in the affected breast tended to develop BBC. The rates of bilateral mastectomy, breast conserving therapy, reconstruction, and combined surgeries were 86.2%, 6.4%, 3.7%, and 3.7%, respectively, for patients with sBBC and 81.1%, 4.4%, 3.0%, and 11.5%, respectively, for patients with mBBC. The interval between bilateral cancers, age at first diagnosis of breast cancer, histopathological type, and stage have significant impacts on the choice of surgery for patients with BBC.Bilateral mastectomy was the dominant surgical management for patients with BBC in China, despite the increased application of breast reconstruction surgery observed in recent years. Bilateral prosthetic breast reconstruction was the ideal choice for patients with sBBC. Chinese surgeons should take responsibility for patient education and inform their patients about their surgical options.

Critical care admission of South African (SA) surgical patients ...

African Journals Online (AJOL)

Critical care admission of South African (SA) surgical patients: Results of the SA Surgical Outcomes Study. D.L. Skinner, K de Vasconcellos, R Wise, T.M. Esterhuizen, C Fourie, A Goolam Mahomed, P.D. Gopalan, I Joubert, H Kluyts, L.R. Mathivha, B Mrara, J.P. Pretorius, G Richards, O Smith, M.G.L. Spruyt, R.M. Pearse, ...

Mechanical ventilation strategies for the surgical patient

NARCIS (Netherlands)

Schultz, Marcus J.; Abreu, Marcelo Gama de; Pelosi, Paolo

2015-01-01

Purpose of review To summarize clinical evidence for intraoperative ventilation settings, which could protect against postoperative pulmonary complications (PPCs) in surgical patients with uninjured lungs. Recent findings There is convincing evidence for protection against PPCs by low tidal volumes:

Who evacuates when hurricanes approach? The role of risk, information, and location.

Science.gov (United States)

Stein, Robert M; Dueñas-Osorio, Leonardo; Subramanian, Devika

2010-01-01

This article offers an expanded perspective on evacuation decision making during severe weather. In particular, this work focuses on uncovering determinants of individual evacuation decisions. We draw on a survey conducted in 2005 of residents in the eight-county Houston metropolitan area after Hurricane Rita made landfall on September 24, 2005. We find that evacuation decisions are influenced by a heterogeneous set of parameters, including perceived risk from wind, influence of media and neighbors, and awareness of evacuation zone, that are often at variance with one of the primary measures of risk used by public officials to order or recommend an evacuation (i.e., storm surge). We further find that perceived risk and its influence on evacuation behavior is a local phenomenon more readily communicated by and among individuals who share the same geography, as is the case with residents living inside and outside official risk areas. Who evacuates and why is partially dependent on where one lives because perceptions of risk are not uniformly shared across the area threatened by an approaching hurricane and the same sources and content of information do not have the same effect on evacuation behavior. Hence, efforts to persuade residential populations about risk and when, where, and how to evacuate or shelter in place should originate in the neighborhood rather than emanating from blanket statements from the media or public officials. Our findings also raise important policy questions (included in the discussion section) that require further study and consideration by those responsible with organizing and implementing evacuation plans.

Agent-based Modeling with MATSim for Hazards Evacuation Planning

Science.gov (United States)

Jones, J. M.; Ng, P.; Henry, K.; Peters, J.; Wood, N. J.

2015-12-01

Hazard evacuation planning requires robust modeling tools and techniques, such as least cost distance or agent-based modeling, to gain an understanding of a community's potential to reach safety before event (e.g. tsunami) arrival. Least cost distance modeling provides a static view of the evacuation landscape with an estimate of travel times to safety from each location in the hazard space. With this information, practitioners can assess a community's overall ability for timely evacuation. More information may be needed if evacuee congestion creates bottlenecks in the flow patterns. Dynamic movement patterns are best explored with agent-based models that simulate movement of and interaction between individual agents as evacuees through the hazard space, reacting to potential congestion areas along the evacuation route. The multi-agent transport simulation model MATSim is an agent-based modeling framework that can be applied to hazard evacuation planning. Developed jointly by universities in Switzerland and Germany, MATSim is open-source software written in Java and freely available for modification or enhancement. We successfully used MATSim to illustrate tsunami evacuation challenges in two island communities in California, USA, that are impacted by limited escape routes. However, working with MATSim's data preparation, simulation, and visualization modules in an integrated development environment requires a significant investment of time to develop the software expertise to link the modules and run a simulation. To facilitate our evacuation research, we packaged the MATSim modules into a single application tailored to the needs of the hazards community. By exposing the modeling parameters of interest to researchers in an intuitive user interface and hiding the software complexities, we bring agent-based modeling closer to practitioners and provide access to the powerful visual and analytic information that this modeling can provide.

Tsunami evacuation mathematical model for the city of Padang

International Nuclear Information System (INIS)

Kusdiantara, R.; Hadianti, R.; Badri Kusuma, M. S.; Soewono, E.

2012-01-01

Tsunami is a series of wave trains which travels with high speed on the sea surface. This traveling wave is caused by the displacement of a large volume of water after the occurrence of an underwater earthquake or volcano eruptions. The speed of tsunami decreases when it reaches the sea shore along with the increase of its amplitudes. Two large tsunamis had occurred in the last decades in Indonesia with huge casualties and large damages. Indonesian Tsunami Early Warning System has been installed along the west coast of Sumatra. This early warning system will give about 10-15 minutes to evacuate people from high risk regions to the safe areas. Here in this paper, a mathematical model for Tsunami evacuation is presented with the city of Padang as a study case. In the model, the safe areas are chosen from the existing and selected high rise buildings, low risk region with relatively high altitude and (proposed to be built) a flyover ring road. Each gathering points are located in the radius of approximately 1 km from the ring road. The model is formulated as an optimization problem with the total normalized evacuation time as the objective function. The constraints consist of maximum allowable evacuation time in each route, maximum capacity of each safe area, and the number of people to be evacuated. The optimization problem is solved numerically using linear programming method with Matlab. Numerical results are shown for various evacuation scenarios for the city of Padang.

Tsunami evacuation mathematical model for the city of Padang

Energy Technology Data Exchange (ETDEWEB)

Kusdiantara, R.; Hadianti, R.; Badri Kusuma, M. S.; Soewono, E. [Department of Mathematics Institut Teknologi Bandung, Bandung 40132 (Indonesia); Department of Civil Engineering Institut Teknologi Bandung, Bandung 40132 (Indonesia); Department of Mathematics Institut Teknologi Bandung, Bandung 40132 (Indonesia)

2012-05-22

Tsunami is a series of wave trains which travels with high speed on the sea surface. This traveling wave is caused by the displacement of a large volume of water after the occurrence of an underwater earthquake or volcano eruptions. The speed of tsunami decreases when it reaches the sea shore along with the increase of its amplitudes. Two large tsunamis had occurred in the last decades in Indonesia with huge casualties and large damages. Indonesian Tsunami Early Warning System has been installed along the west coast of Sumatra. This early warning system will give about 10-15 minutes to evacuate people from high risk regions to the safe areas. Here in this paper, a mathematical model for Tsunami evacuation is presented with the city of Padang as a study case. In the model, the safe areas are chosen from the existing and selected high rise buildings, low risk region with relatively high altitude and (proposed to be built) a flyover ring road. Each gathering points are located in the radius of approximately 1 km from the ring road. The model is formulated as an optimization problem with the total normalized evacuation time as the objective function. The constraints consist of maximum allowable evacuation time in each route, maximum capacity of each safe area, and the number of people to be evacuated. The optimization problem is solved numerically using linear programming method with Matlab. Numerical results are shown for various evacuation scenarios for the city of Padang.

Management experience of surgical complications of dengue fever patients at hameed latif hospital, Lahore

International Nuclear Information System (INIS)

Ahmad, F.

2012-01-01

Objective: This study was designed to determine the frequency, pattern and management of surgical complications among patients with dengue fever. Design: Cross sectional study design was used. Settings: Hameed Latif Hospital, Lahore. Methods: From March - 2009 to December - 2011 total of 875 patients of dengue fever with positive anti-dengue immunoglobulin M (IgM) serology were included in this study. Complete blood count, liver function test, blood urea, serum creatinin, serum amylase were determined in all patients admitted with the diagnosis of dengue fever. All the patients were evaluated for the presence of surgical complications by physical examination and real time ultrasound abdomen. Patient had CT - abdomen and brain where it was required. Patients having surgical complications were managed in dengue ward and ICU with multidisciplinary approach. Data entry and analysis was done by using SPSS 16. Results: Among 875 patients with dengue fever, 491 (43.9%) patients were men and 384 (48.9%) were women with age range (18 - 70) years. Surgical complications were detected in 121 (13.8%) patients: acute cholecystitis in 46 (5.26%); acute pancreatitis in 19 (2.17%); injection abscess in 14 (1.6%); gastrointestinal bleed in 24 (2.74%); forearm compartment syndrome in 3 (0.34%); abdominal compartment syndrome in 2 (0.23%) and acute appendicitis, 4 (0.46%) patients. Cerebral bleed, retroperitoneal hematoma, abdominal wall hematoma and splenic rupture was seen among 3 (0.34%), 2 (0.23%), 3 (0.34%), and 1 (0.11%) patients, respectively. Out of 121 patients surgery was done in 20 (16.5%) patients while rest of 101 (83.5%) patients were managed conservatively. Two patients died. Conclusion: Surgical complications are common and should be suspected in every patient with dengue fever. Majority of surgical manifestations of dengue fever were managed conservatively however surgical intervention was done in certain cases with favorable outcome. (author)

Dynamic changes during evacuation of a left temporal abscess in open MRI: technical case report

International Nuclear Information System (INIS)

Bernays, R.L.; Yonekawa, Y.; Kollias, S.S.

2002-01-01

We demonstrate the usefulness of ''near real-time'' neuro-navigation by open MRI systems for guidance of stereotactic evacuation of intracranial abscesses. A 70-year-old patient was referred to our institution with an intracranial left temporal abscess. He presented with headache, senso-motor aphasia and mild right hemiparesis. The abscess (35 x 25 mm) was stereotactically evacuated under MRI guidance, and a recurrence of a daughter abscess was again evacuated on the 9th postoperative day. ''Near real-time'' imaging showed an indentation of the abscess wall of 11 mm along the trajectory. A thermosensitive MRI protocol demonstrated a higher temperature around the abscess capsule than in the brain tissue more distant to the capsule, demonstrating the inflammatory process. The patient had 6 weeks of antibiotic therapy for gram-negative bacteria and was discharged with improved clinical symptoms 5 weeks after admission. Follow-up CT 2 months postoperatively showed a complete resolution of the abscess. Open MRI-guided interventions with ''near real-time'' imaging demonstrate the anatomical changes during an ongoing procedure and can be accommodated for enhancing the overall precision of stereotactic procedures. Thermosensitive MRI protocols are capable of revealing temperature gradients around inflammatory processes. (orig.)

The validation of evacuation simulation models through the analysis of behavioural uncertainty

International Nuclear Information System (INIS)

Lovreglio, Ruggiero; Ronchi, Enrico; Borri, Dino

2014-01-01

Both experimental and simulation data on fire evacuation are influenced by a component of uncertainty caused by the impact of the unexplained variance in human behaviour, namely behavioural uncertainty (BU). Evacuation model validation studies should include the study of this type of uncertainty during the comparison of experiments and simulation results. An evacuation model validation procedure is introduced in this paper to study the impact of BU. This methodology is presented through a case study for the comparison between repeated experimental data and simulation results produced by FDS+Evac, an evacuation model for the simulation of human behaviour in fire, which makes use of distribution laws. - Highlights: • Validation of evacuation models is investigated. • Quantitative evaluation of behavioural uncertainty is performed. • A validation procedure is presented through an evacuation case study

Pathways toward a low cost evacuated collector system

Science.gov (United States)

Hull, J. R.; Schertz, W. W.; Allen, J. W.; Ogallagher, J. J.; Winston, R.

The goal of widespread use of solar thermal collectors will only be achieved when they are proven to be economically superior to competing energy sources. Evacuated tubular collectors appear to have the potential to achieve this goal. An advanced evacuated collector using nonimaging concentration under development at the University of Chicago and Argonne can achieve a 50% seasonal efficiency at heat delivery temperatures in excess of 170C. The same collector has an optical efficiency so that low temperature performance is also excellent. In this advanced collector design all of the critical components are enclosed in the vacuum, and the collector has an inherently long lifetime. The current cost of evacuated systems is too high, mainly because the volume of production has been too low to realize economies of mass production. It appears that certain design features of evacuated collectors can be changed (e.g., use of heat pipe absorbers) so as to introduce new system design and market strategy options that can reduce the balance of system cost.

Evaluating the effects of increasing surgical volume on emergency department patient access.

Science.gov (United States)

Levin, S; Dittus, R; Aronsky, D; Weinger, M; France, D

2011-02-01

To determine how increases in surgical patient volume will affect emergency department (ED) access to inpatient cardiac services. To compare how strategies to increase cardiology inpatient throughput can either accommodate increases in surgical volume or improve ED patient access. A stochastic discrete event simulation was created to model patient flow through a cardiology inpatient system within a US, urban, academic hospital. The simulation used survival analysis to examine the relationship between anticipated increases in surgical volume and ED patient boarding time (ie, time interval from cardiology admission request to inpatient bed placement). ED patients boarded for a telemetry and cardiovascular intensive care unit (CVICU) bed had a mean boarding time of 5.3 (median 3.1, interquartile range 1.5-6.9) h and 2.7 (median 1.7, interquartile range 0.8-3.0) h, respectively. Each 10% incremental increase in surgical volume resulted in a 37 and 33 min increase in mean boarding time to the telemetry unit and CVICU, respectively. Strategies to increase cardiology inpatient throughput by increasing capacity and decreasing length of stay for specific inpatients was compared. Increasing cardiology capacity by one telemetry and CVICU bed or decreasing length of stay by 1 h resulted in a 7-9 min decrease in average boarding time or an 11-19% increase in surgical patient volume accommodation. Simulating competition dynamics for hospital admissions provides prospective planning (ie, decision making) information and demonstrates how interventions to increase inpatient throughput will have a much greater effect on higher priority surgical admissions compared with ED admissions.

Simulation of the shopping center 'Zona I' evacuation

Directory of Open Access Journals (Sweden)

Jevtić Radoje B.

2014-01-01

Full Text Available One of the most important and the most complex tasks in human protection and human safety in objects is the projecting of the object evacuation. There are many factors that could effect on the opportune living of object such as object assignment, arrangement of rooms, arrangement of furniture, arrangement of exits, occupant speed and many other that human lives and material properties depend on. This is very important for objects with great number of humans, such as high residential objects, shopping centers, schools, hospitals etc. This paper has written to show the possible evacuation situations and calculate minimal time for evacuation in case of the shopping center 'Zona I' in Niš.

Evacuation exercise at the CERN Kindergarten

CERN Document Server

2001-01-01

Every year fire evacuation exercises are organized through out CERN and our facility's Kindergarten is no exception. Just a few weeks ago, a fire simulation was carried out in the Kindergarten kitchen facility using synthetic smoke. The purpose of the exercise was to teach staff to react in a disciplined and professional manner when in the presence of danger. The simulation is always carried out at a random time so as to ensure that people in the area under the test are not aware of the exercise. For the Kindergarten the exercise was held early in the school year so as to train those who are new to the establishment. The evacuation was a complete success and all went as it was supposed to. When the children and teachers smelt smoke they followed the prescribed evacuation routes and left the building immediately. Once outside the situation was revealed as an exercise and everyone went back to business as usual, everyone that is, except the fire brigade and fire inspector. The fire brigade checked that the buil...

Radical vs. Conservative Surgical Treatment of Hepatic Hydatid Cyst: A 10- Year Experience

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M Ghaemi

2009-07-01

Full Text Available Introduction: Hepatic hydatid cyst is caused by echinococcosis granulosis. It is a major health problem in endemic areas. The modern treatment of hydatid cysts of the liver varies from surgical intervention to percutaneous drainage or medical therapy. A high rate of complications following percutaneous drainage, and ineffectiveness of medical therapy have shown not to be the definitive treatments for the disease. Thus, surgery is still the best choice for the treatment of hydatid cyst of the liver. Surgical treatment methods can be divided into radical and conservative approaches. There is controversy regarding efficacy of the two surgical methods. In this study, we aimed to present a retrospective evaluation of the two surgical methods in patients treated for the hepatic hydatid cyst. Methods: This retrospective study reviewed medical records of 135 patients who underwent surgery for hepatic hydatid cyst from 1997 to 2007. Surgery comprised conservative methods (evacuation of the cyst content and excision of the inner cyst layers and radical methods (total excision of the cyst and removal of its outer layer. Results: One hundred thirty five patients underwent liver surgery. Conservative surgery was performed for 71 (53%, whereas, the remaining 64 patients (47% underwent radical surgery. Postoperative complications were 28% and 19%, respectively. Recurrence of the cyst in the conservative and radical surgery groups was noted to be 12.5 and 1.5%, respectively. The mean length of hospital stay was shorter in the radical surgery group (5 vs. 15 days. Conclusion: Radical surgery may be the preferred treatment for the hepatic hydatid cyst because of its low rate of postoperative complications and recurrence, as well as short hospital stay. Selection of the most appropriate treatment depends on the size, number, and location of the cyst(s, and presence of cystobiliary communications, and the availability of an experienced surgeon.

A Simulation-Based Dynamic Stochastic Route Choice Model for Evacuation

Directory of Open Access Journals (Sweden)

Xing Zhao

2012-01-01

Full Text Available This paper establishes a dynamic stochastic route choice model for evacuation to simulate the propagation process of traffic flow and estimate the stochastic route choice under evacuation situations. The model contains a lane-group-based cell transmission model (CTM which sets different traffic capacities for links with different turning movements to flow out in an evacuation situation, an actual impedance model which is to obtain the impedance of each route in time units at each time interval and a stochastic route choice model according to the probit-based stochastic user equilibrium. In this model, vehicles loading at each origin at each time interval are assumed to choose an evacuation route under determinate road network, signal design, and OD demand. As a case study, the proposed model is validated on the network nearby Nanjing Olympic Center after the opening ceremony of the 10th National Games of the People's Republic of China. The traffic volumes and clearing time at five exit points of the evacuation zone are calculated by the model to compare with survey data. The results show that this model can appropriately simulate the dynamic route choice and evolution process of the traffic flow on the network in an evacuation situation.

A spatiotemporal optimization model for the evacuation of the population exposed to flood hazard

Science.gov (United States)

Alaeddine, H.; Serrhini, K.; Maizia, M.

2015-03-01

Managing the crisis caused by natural disasters, and especially by floods, requires the development of effective evacuation systems. An effective evacuation system must take into account certain constraints, including those related to traffic network, accessibility, human resources and material equipment (vehicles, collecting points, etc.). The main objective of this work is to provide assistance to technical services and rescue forces in terms of accessibility by offering itineraries relating to rescue and evacuation of people and property. We consider in this paper the evacuation of an urban area of medium size exposed to the hazard of flood. In case of inundation, most people will be evacuated using their own vehicles. Two evacuation types are addressed in this paper: (1) a preventive evacuation based on a flood forecasting system and (2) an evacuation during the disaster based on flooding scenarios. The two study sites on which the developed evacuation model is applied are the Tours valley (Fr, 37), which is protected by a set of dikes (preventive evacuation), and the Gien valley (Fr, 45), which benefits from a low rate of flooding (evacuation before and during the disaster). Our goal is to construct, for each of these two sites, a chronological evacuation plan, i.e., computing for each individual the departure date and the path to reach the assembly point (also called shelter) according to a priority list established for this purpose. The evacuation plan must avoid the congestion on the road network. Here we present a spatiotemporal optimization model (STOM) dedicated to the evacuation of the population exposed to natural disasters and more specifically to flood risk.

Surgical rehabilitation of patients with spinal neurotrophic decubitus

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S. G. Shapovalov

2016-01-01

Full Text Available The greatest weight neurodystrophic process develops in traumatic spinal cord injury, appears as neurotrophic decubitus (bedsores. There is a high risk of wound infection in the event of pressure ulcers. Surgical repair of the skin integrity in spinal patients of 3 and 4 grade is a basic prerequisite for the further complex of the rehabilitation measures. Work objective: to develop the concept of innovative technologies of treatment of local physical impacts and to implement it in surgical system of rehabilitation of patients with spinal cord lesion with neurotrophic decubitus of 3 and 4 grade. Clinical studies subjected 49 (100% patients with spinal cord lesions and neurotrophic decubitus of 3 and 4 grade. All patients were divided into two groups: 1– (study group 1 29 patients; 2 – (control group 2 20 patients. The managed negative pressure system S042 NPWT VivanoTec (Hartmann, a method of ultrasonic cavitation (Sonoca%180, the system for the hydro surgery Versajet Smith and Nephew were used in the 1%st group. Traditional dressings for the preparation of a plastic closure of the wound defect neurotrophic decubitus of the grade 3%4 were used in the 2nd group. Statistical analysis was performed using package of Microsoft Excel%97 Statistica for Windows 6.0, SPSS 10.0 for Windows. The study showed that the use of complex methods of vacuum therapy, ultrasound cavitation and hydro surgical in the 1st group significantly reduces the duration of treatment compared with conservative methods in the 2nd group. In group 1, the mean duration of treatment was 19.9±13.9 days, in group 2 (comparison group – 40.0±28.2 days (p<0.05. The usage of physical methods (managed negative pressure system, ultrasonic processing method, hydro surgical system local treatment is a highly effective method of preparation neurotrophic decubitus grade 3 and 4 to the early recovery of the skin. Physical methods of local treatment have a positive effect on tissue

A Study of Flood Evacuation Center Using GIS and Remote Sensing Technique

Science.gov (United States)

Mustaffa, A. A.; Rosli, M. F.; Abustan, M. S.; Adib, R.; Rosli, M. I.; Masiri, K.; Saifullizan, B.

2016-07-01

This research demonstrated the use of Remote Sensing technique and GIS to determine the suitability of an evacuation center. This study was conducted in Batu Pahat areas that always hit by a series of flood. The data of Digital Elevation Model (DEM) was obtained by ASTER database that has been used to delineate extract contour line and elevation. Landsat 8 image was used for classification purposes such as land use map. Remote Sensing incorporate with GIS techniques was used to determined the suitability location of the evacuation center from contour map of flood affected areas in Batu Pahat. GIS will calculate the elevation of the area and information about the country of the area, the road access and percentage of the affected area. The flood affected area map may provide the suitability of the flood evacuation center during the several levels of flood. The suitability of evacuation centers can be determined based on several criteria and the existing data of the evacuation center will be analysed. From the analysis among 16 evacuation center listed, there are only 8 evacuation center suitable for the usage during emergency situation. The suitability analysis was based on the location and the road access of the evacuation center toward the flood affected area. There are 10 new locations with suitable criteria of evacuation center proposed on the study area to facilitate the process of rescue and evacuating flood victims to much safer and suitable locations. The results of this study will help in decision making processes and indirectly will help organization such as fire-fighter and the Department of Social Welfare in their work. Thus, this study can contribute more towards the society.

Simulating the effects of social networks on a population's hurricane evacuation participation

Science.gov (United States)

Widener, Michael J.; Horner, Mark W.; Metcalf, Sara S.

2013-04-01

Scientists have noted that recent shifts in the earth's climate have resulted in more extreme weather events, like stronger hurricanes. Such powerful storms disrupt societal function and result in a tremendous number of casualties, as demonstrated by recent hurricane experience in the US Planning for and facilitating evacuations of populations forecast to be impacted by hurricanes is perhaps the most effective strategy for reducing risk. A potentially important yet relatively unexplored facet of people's evacuation decision-making involves the interpersonal communication processes that affect whether at-risk residents decide to evacuate. While previous research has suggested that word-of-mouth effects are limited, data supporting these assertions were collected prior to the widespread adoption of digital social media technologies. This paper argues that the influence of social network effects on evacuation decisions should be revisited given the potential of new social media for impacting and augmenting information dispersion through real-time interpersonal communication. Using geographic data within an agent-based model of hurricane evacuation in Bay County, Florida, we examine how various types of social networks influence participation in evacuation. It is found that strategies for encouraging evacuation should consider the social networks influencing individuals during extreme events, as it can be used to increase the number of evacuating residents.

A Method for Formulizing Disaster Evacuation Demand Curves Based on SI Model

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Yulei Song

2016-10-01

Full Text Available The prediction of evacuation demand curves is a crucial step in the disaster evacuation plan making, which directly affects the performance of the disaster evacuation. In this paper, we discuss the factors influencing individual evacuation decision making (whether and when to leave and summarize them into four kinds: individual characteristics, social influence, geographic location, and warning degree. In the view of social contagion of decision making, a method based on Susceptible-Infective (SI model is proposed to formulize the disaster evacuation demand curves to address both social influence and other factors’ effects. The disaster event of the “Tianjin Explosions” is used as a case study to illustrate the modeling results influenced by the four factors and perform the sensitivity analyses of the key parameters of the model. Some interesting phenomena are found and discussed, which is meaningful for authorities to make specific evacuation plans. For example, due to the lower social influence in isolated communities, extra actions might be taken to accelerate evacuation process in those communities.

Endoscope-assisted, minimally invasive evacuation of sub-acute/chronic epidural hematoma: Novelty or paradox of Theseus?

Science.gov (United States)

Ansari, Ishtyaque; Futane, Sameer; Ansari, Ashfaque

2016-08-01

Sub-acute/chronic epidural hematoma (EDH) may present with nagging symptoms of headache, nausea, vomiting, lethargy, etc. We attempted to offer a minimally invasive, single burr hole, endoscope-assisted evacuation of EDHs instead of a conventional craniotomy. Seven patients with sub-acute/chronic EDH (six supratentorial and one infratentorial) presented to us 3 to 7 days after low-velocity road traffic accidents with complaints of headache and lethargy. The EDH volumes measured between 20 to 50 ml, and the patients were operated on using a single burr hole made through a small incision. We used 0-, 30- and 70-degree, angulated, rigid, high-definition endoscopes to identify and evacuate the organized clots in the extradural space. Flexible catheters were used for suction and irrigation. After achieving hemostasis, the dura was hitched back to the burr hole site. The wound was closed over a negative suction drain. All patients had prompt recovery from symptoms. Postoperative CT scans showed complete or near complete evacuation of the hematomas. The hospital stay and analgesic requirements were minimal. There was no infective complication or conversion to conventional open surgery. The average time for surgery was 77.8 min, and average blood loss was 328.5 ml. Endoscope-assisted evacuation of sub-acute/chronic EDH is a novel concept, which offers quick relief from symptoms in a minimally invasive fashion and a cosmetically acceptable way. None of the standard principles of surgery are hampered. It avoids extensive dissection of the temporalis or sub-occipital muscles. However, achieving hemostasis can be difficult. Further study and better equipment will validate the procedure.

Effect of non-surgical periodontal treatment on chronic kidney disease patients

Directory of Open Access Journals (Sweden)

Hilana Paula Carillo Artese

2010-12-01

Full Text Available Chronic kidney disease (CKD is a debilitating systemic condition. Our working hypothesis is that CKD predialysis patients with periodontitis would respond poorly to periodontal treatment owing to immunologic compromise. Twenty-one predialysis patients (group 1 and 19 individuals without clinical evidence of kidney disease (group 2 with chronic periodontitis were subjected to non-surgical periodontal treatment with no antibiotics. Clinical periodontal and systemic parameters were evaluated at baseline and 3 months after treatment. Both groups showed significant and similar post-treatment improvements in all periodontal parameters examined. Most interestingly, periodontal treatment had a statistically significant positive effect on the glomerular filtration rate of each individual (group 1, p = 0.04; group 2, p = 0.002. Our results indicate that chronic periodontitis in predialysis kidney disease patients improved similarly in patients with chronic periodontitis and no history of CKD after receiving non-surgical periodontal therapy. This study demonstrates that CKD predialysis patients show a good response to non-surgical periodontal treatment.

Evacuation and Sheltering of Hospitals in Emergencies: A Review of International Experience

OpenAIRE

Bagaria, Jayshree; Heggie, Caroline; Abrahams, Jonathan; Murray, Virginia

2017-01-01

Abstract Objective: A scoping exercise to establish how common hospital evacuations are, identify hospital evacuation policies and review case studies to identify trig-gers, processes and challenges involved in the evacuation of hospitals globally. Design: A systematic search of PubMed and disaster agency online resources, search of grey literature and media reports. Results: This study showed that hospitals are vulnerable to both natural and man made disasters and that hospital evacuations d...

A comparison of body image, marital satisfaction, and public health among breast cancer patients with breast evacuation, breast keeping and normal people in Tehran

Directory of Open Access Journals (Sweden)

Zahra Esfandiari

2015-09-01

Full Text Available Abstract Purpose and background: despite outstanding breakthroughs in medical sciences, breast cancer is still considered one of the most important disease and the most prevalent women cancer and the second reason of death among them. The present study was conducted aiming to compare public health and marital satisfaction among breast cancer patients with breast evacuation, breast keeping and normal women in Tehran. Material and methods: the method of the present study, due to the lack of interference to alter the research variables, was causal comparative. The statistical population included all women with breast cancer and normal women in the city of Tehran. From these people in each group (breast cancer patients with breast evacuation, breast keeping and normal people 80 individuals were selected through available sampling from clients of medical centers and special hospitals in Tehran during October 2012 to December 2013. The applied instruments were the questionnaires of public health, body image, and marital satisfaction. The achieved data were analyzed via one-way ANOVA and Tukey test by SPSS software. Findings: the results of the analysis showed that there is a significant difference between the mean scores of marital satisfaction, body image and public health in three groups (women with cancer who evacuated their breast, those who didn't and normal ones(p<0.01. Conclusion: according to the findings of the present study the women with breast cancer are in more different state in variables of marital satisfaction, mental health and body image comparing to normal group. So it seems necessary for cancer treatment centers to consider psychological treatment courses for these people.

Exploring challenges and solutions in the preparation of surgical patients

DEFF Research Database (Denmark)

Møller, Thea Palsgaard; Münter, Kristine Husum; Østergaard, Doris

2015-01-01

management system tasks, 26% of anaesthesia record tasks, 24% of medication tasks, 14% of blood test tasks and 12% of patient record tasks. In two workshops held for each of four specialties, a total of 21 participants mapped the preoperative patient journey with related responsibilities, tasks and written......, workshops including table simulations involving the various professions and specialties were held. RESULTS: In total, 314 surgical procedures were performed of which 196 were eligible for analysis. Emergency procedures showed the poorest results with non-completed tasks comprising 58% of electronic patient...... documentation. Furthermore, challenges and suggestions for solutions were identified. CONCLUSIONS: Completion of mandatory tasks for surgical patient preparation was poor. Workshops with table simulations actively involved the stakeholders from various professions and specialties in describing the patient...

Time matters: post-surgical recovery of gastric evacuation rate in Atlantic cod

DEFF Research Database (Denmark)

Behrens, Jane; Gräns, Albin; Andersen, Niels Gerner

GER was affected after surgically introducing dummies of a blood-flow biotelemetry system into the abdominal cavity of Atlantic cod. Two days post surgery the cod with implants were, together with a control group, force-fed a standardized meal and the stomach contents recovered 24h later...

A surgical approach in the management of mucormycosis in a trauma patient.

Science.gov (United States)

Zahoor, B A; Piercey, J E; Wall, D R; Tetsworth, K D

2016-11-01

Mucormycosis as a consequence of trauma is a devastating complication; these infections are challenging to control, with a fatality rate approaching 96% in immunocompromised patients. We present a case where a proactive approach was successfully employed to treat mucormycosis following complex polytrauma. Aggressive repeated surgical debridement, in combination with appropriate antifungal therapy, proved successful in this instance. In our opinion, mucormycosis in trauma mandates an aggressive surgical approach. This prevents ascending dissemination of mucormycosis and certainly reduces the risk of patient mortality as a direct result. Anti-fungal therapy should be used secondarily as an adjunct together with surgical debridement, or as an alternative when surgical intervention is not feasible.

Pre-evacuation hCG glycoforms in uneventful complete hydatidiform mole and persistent trophoblastic disease.

NARCIS (Netherlands)

Thomas, C.M.G.; Kerkmeijer, L.G.W.; Ariaens, H.J.; Steen, R. van der; Massuger, L.F.A.G.; Sweep, F.C.

2010-01-01

OBJECTIVE: To investigate whether the glycoform distribution patterns of human chorionic gonadotropin (hCG) obtained by chromatofocusing in pre-evacuation serum are different for patients who will eventually develop into persistent trophoblastic disease in case of complete hydatidiform mole

Effectiveness of Misoprostol for Induction of First-Trimester Miscarriages; Experience at a single tertiary care centre in Oman

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Qamariya Ambusaidi

2015-11-01

Full Text Available Objectives: Non-invasive methods of inducing a miscarriage are now considered an effective alternative to surgical evacuation (dilatation and curettage. This study aimed to evaluate the effectiveness of misoprostol in the termination of first-trimester miscarriages. Methods: This prospective study was conducted between October 2009 and September 2010 and assessed all patients admitted to the Royal Hospital in Muscat, Oman, for the termination of first-trimester miscarriages during the study period. All patients received misoprostol and the rates of successful termination were measured. Patient satisfaction was assessed using a short questionnaire. Results: A total of 290 women were included in the study. Termination with misoprostol was successful in 61.38% of the subjects. Of the remaining subjects requiring additional surgical evacuation (n = 112, 58.93% required evacuation due to failed termination with misoprostol and 65.18% underwent early evacuation (≤24 hours since their last misoprostol dose. The majority of patients experienced no side-effects due to misoprostol (89.66%. Pain was controlled with simple analgesics in 70.00% of the subjects. A high satisfaction rate (94.83% with the misoprostol treatment was reported. Conclusion: Misoprostol was a well-tolerated drug which reduced the rate of surgical evacuation among the study subjects. This medication can therefore be used safely in the management of incomplete miscarriages.

War casualties: recent trends in evacuation, triage and the golden hour

International Nuclear Information System (INIS)

Safdar, C. A.

2010-01-01

Prompt medical treatment and early evacuation is the goal of military medicine in the battlefield. 'Triage' is a process of sorting the casualties according to the severity of injury and the prioritization of treatment. In trauma management 'Golden Hour' is the first sixty minutes or so after injury; this emphasizes that the chances of the victim's survival are the greatest if definitive care is given as early as possible. Our evacuation protocols follow the triage but the time to treatment is beyond sixty minutes. Many Armies have developed evacuation systems which allow the casualty to be seen within this specified time. This has been achieved by streamlining the evacuation chain, extensive incorporation of air transport and training of paramedics in advanced life support measures. In line with the modern trends we need to modernize our own system of casualty evacuation and treatment. (author)

Effectiveness and risks associated with sheltering and evacuation

International Nuclear Information System (INIS)

Mohseni, A.; McKenna, T.

1995-01-01

The United States Nuclear Regulatory Commission (NRC) and the Environmental Protection Agency (EPA) have assessed the risks and benefits associated with evacuation and sheltering following a severe reactor accident. In the case of a severe accident and the associated uncertainties with the source term and containment behaviour, these assessments suggest that prompt evacuation of areas close to the plant offers the highest protection of the public against acute doses. Sheltering may be used as an alternative in special circumstances where evacuation may not be feasible. The source term associated with reactor accidents and containment failure mechanism affect the effectiveness of different protective measures. A comparison of different protective measures is made and results discussed. (Author). 9 refs., 4 figs., 2 tabs

Surgical resident education in patient safety: where can we improve?

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Putnam, Luke R; Levy, Shauna M; Kellagher, Caroline M; Etchegaray, Jason M; Thomas, Eric J; Kao, Lillian S; Lally, Kevin P; Tsao, KuoJen

2015-12-01

Effective communication and patient safety practices are paramount in health care. Surgical residents play an integral role in the perioperative team, yet their perceptions of patient safety remain unclear. We hypothesized that surgical residents perceive the perioperative environment as more unsafe than their faculty and operating room staff despite completing a required safety curriculum. Surgeons, anesthesiologists, and perioperative nurses in a large academic children's hospital participated in multifaceted, physician-led workshops aimed at enhancing communication and safety culture over a 3-y period. All general surgery residents from the same academic center completed a hospital-based online safety curriculum only. All groups subsequently completed the psychometrically validated safety attitudes questionnaire to evaluate three domains: safety culture, teamwork, and speaking up. Results reflect the percent of respondents who slightly or strongly agreed. Chi-square analysis was performed. Sixty-three of 84 perioperative personnel (75%) and 48 of 52 surgical residents (92%) completed the safety attitudes questionnaire. A higher percentage of perioperative personnel perceived a safer environment than the surgical residents in all three domains, which was significantly higher for safety culture (68% versus 46%, P = 0.03). When stratified into two groups, junior residents (postgraduate years 1-2) and senior residents (postgraduate years 3-5) had lower scores for all three domains, but the differences were not statistically significant. Surgical residents' perceptions of perioperative safety remain suboptimal. With an enhanced safety curriculum, perioperative staff demonstrated higher perceptions of safety compared with residents who participated in an online-only curriculum. Optimal surgical education on patient safety remains unknown but should require a dedicated, systematic approach. Copyright © 2015 Elsevier Inc. All rights reserved.

A Simple Evacuation Modeling and Simulation Tool for First Responders

Energy Technology Data Exchange (ETDEWEB)

Koch, Daniel B [ORNL; Payne, Patricia W [ORNL

2015-01-01

Although modeling and simulation of mass evacuations during a natural or man-made disaster is an on-going and vigorous area of study, tool adoption by front-line first responders is uneven. Some of the factors that account for this situation include cost and complexity of the software. For several years, Oak Ridge National Laboratory has been actively developing the free Incident Management Preparedness and Coordination Toolkit (IMPACT) to address these issues. One of the components of IMPACT is a multi-agent simulation module for area-based and path-based evacuations. The user interface is designed so that anyone familiar with typical computer drawing tools can quickly author a geospatially-correct evacuation visualization suitable for table-top exercises. Since IMPACT is designed for use in the field where network communications may not be available, quick on-site evacuation alternatives can be evaluated to keep pace with a fluid threat situation. Realism is enhanced by incorporating collision avoidance into the simulation. Statistics are gathered as the simulation unfolds, including most importantly time-to-evacuate, to help first responders choose the best course of action.

Evacuation Risks: a tentative approach for quantification

International Nuclear Information System (INIS)

Bastien, M.C.; Dumas, M.; Laporte, J; Parmentier, N.

1985-01-01

This study tries to assess the risk of deaths and injuries from motor vehicle accidents associated with an evacuation of population groups in case of nuclear plant accidents. The risk per person-km is evaluated using: (a) data from previous evacuation: information from Soufriere evacuation (Guadeloupe Island 1976) and Mississauga (1979), added to Hans and Sell's data: no road accident occurred for a sample of 1,500,000 persons; (b) national recording system for motor vehicle accident: the rates of 2.2 10 -8 deaths per person-km and 32 10 -8 injuries per person-km is calculated as an average. These last rates in France overestimate the number of casualties. A reasonable hypothesis is to assume that the probability of road accident occurrence follows a Poisson distribution, as these events are independent and unfrequent, as no accident was observed in a sample of 1,500,000 persons the probability is between 0 and an upper value of 0.24 10 -8 deaths per person-km and 3.29 10 -8 injuries per person-km. The average and maximum population involved within different radii around French and U.S. Nuclear power sites are taken as a sample size in order to study the total risk of deaths and injuries in the hypothesis of an evacuation being necessary to protect the populations

Tsunami evacuation analysis, modelling and planning: application to the coastal area of El Salvador

Science.gov (United States)

Gonzalez-Riancho, Pino; Aguirre-Ayerbe, Ignacio; Aniel-Quiroga, Iñigo; Abad Herrero, Sheila; González Rodriguez, Mauricio; Larreynaga, Jeniffer; Gavidia, Francisco; Quetzalcoalt Gutiérrez, Omar; Álvarez-Gómez, Jose Antonio; Medina Santamaría, Raúl

2014-05-01

Advances in the understanding and prediction of tsunami impacts allow the development of risk reduction strategies for tsunami-prone areas. Conducting adequate tsunami risk assessments is essential, as the hazard, vulnerability and risk assessment results allow the identification of adequate, site-specific and vulnerability-oriented risk management options, with the formulation of a tsunami evacuation plan being one of the main expected results. An evacuation plan requires the analysis of the territory and an evaluation of the relevant elements (hazard, population, evacuation routes, and shelters), the modelling of the evacuation, and the proposal of alternatives for those communities located in areas with limited opportunities for evacuation. Evacuation plans, which are developed by the responsible authorities and decision makers, would benefit from a clear and straightforward connection between the scientific and technical information from tsunami risk assessments and the subsequent risk reduction options. Scientifically-based evacuation plans would translate into benefits for the society in terms of mortality reduction. This work presents a comprehensive framework for the formulation of tsunami evacuation plans based on tsunami vulnerability assessment and evacuation modelling. This framework considers (i) the hazard aspects (tsunami flooding characteristics and arrival time), (ii) the characteristics of the exposed area (people, shelters and road network), (iii) the current tsunami warning procedures and timing, (iv) the time needed to evacuate the population, and (v) the identification of measures to improve the evacuation process, such as the potential location for vertical evacuation shelters and alternative routes. The proposed methodological framework aims to bridge the gap between risk assessment and risk management in terms of tsunami evacuation, as it allows for an estimation of the degree of evacuation success of specific management options, as well as

Prey exoskeletons influence the course of gastric evacuation in Atlantic cod Gadus morhua

DEFF Research Database (Denmark)

Couturier, C. S.; Andersen, N. G.; Audet, C.

2013-01-01

species, Pandalus borealis, Pandalus montagui and Eualus macilentus, and the crab Chionoecetes opilio, were evacuated from the stomach at different rates. The duration of all stages increased with increasing ash (and carbonate) content of the fresh prey. Thickness, chemical composition and morphology...... of the prey exoskeleton all affected gastric evacuation: duration of initial delay, overall evacuation rate and a decreased evacuation rate at the end of the process. The power exponential function (PEF), with its shape parameter, described the course of evacuation for these prey types well, especially...

Evaluating Disparities in Inpatient Surgical Cancer Care Among American Indian/Alaska Native Patients

Science.gov (United States)

Simianu, Vlad V.; Morris, Arden M.; Varghese, Thomas K.; Porter, Michael P.; Henderson, Jeffrey A.; Buchwald, Dedra S.; Flum, David R.; Javid, Sara H.

2016-01-01

Background American Indian/Alaska Native (AI/AN) patients with cancer have the lowest survival rates of all racial and ethnic groups, possibly because they are less likely to receive “best practice” surgical care than patients of other races. Methods Prospective cohort study comparing adherence to generic and cancer-specific guidelines on processes of surgical care between AI/AN and non-Hispanic white (NHW) patients in Washington State (2010–2014). Results 156 AI/AN and 6,030 NHW patients underwent operations for 10 different cancers, and had similar mean adherence to generic surgical guidelines (91.5% vs 91.9%, p=0.57). AI/AN patients with breast cancer less frequently received preoperative diagnostic core-needle biopsy (81% versus 94%, p=0.004). AI/AN patients also less frequently received care adherent to prostate cancer-specific guidelines (74% versus 92%,p=0.001). Conclusions While AI/ANs undergoing cancer operations in Washington receive similar overall best practice surgical cancer care to NHW patients, there remain important, modifiable disparities that may contribute to their lower survival. PMID:26846176

Surgical results of strabismus correction in patients with myelomeningocele

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Dayane Cristine Issaho

2015-02-01

Full Text Available Purpose: Myelomeningocele is one of the most common birth defects. It is associated with severe neurological deficiencies, and ocular changes, such as strabismus, are very common. The purpose of this study was to describe indications for strabismus surgery in patients with myelomeningocele and to evaluate the results achieved with surgical correction. Methods: We retrospectively reviewed records of all patients with myelomeningocele who underwent surgery for strabismus correction in a 5-year period in an institution for disabled children. Results: The main indications for strabismus surgery were esotropia and A-pattern anisotropia. Excellent surgical results were achieved in 60.9% of patients, satisfactory in 12.2%, and unsatisfactory in 26.9%. Conclusion: Patients with myelomeningocele and strabismus had a high incidence of esotropia and A-pattern anisotropia. Strabismus surgery in these patients had an elevated percentage of excellent and satisfactory results, not only for the ocular deviation, but also for improvement of head posture.

Study of evacuation times based on recent accident history

International Nuclear Information System (INIS)

Mills, G.S.; Neuhauser, K.S.

1995-01-01

A key parameter in the calculation of accident dose-risks by the RADTRAN 4 code is the time assigned for evacuation of the affected area surrounding the accident. Currently, in the interest of assured conservatism, this time is set at 24 hrs. Casual anecdotal evidence has indicated that this value is overly conservative and results in assignment of overly conservative estimates of accident dose-risk. Therefore, a survey of recent truck accidents involving various hazardous materials which required evacuation of surrounding populations reported in various news media was undertaken. Accounts of pertinent scenarios were gleaned from databases citing newspapers and other periodicals, and the local authorities involved in each were contacted to get details of the evacuation including time required. This paper presents the data obtained in the study and the resultant mean evacuation time plus limits and factors influencing specific results together with conclusions regarding the appropriate value to be used in the RADTRAN 4 code

Social influence on evacuation behavior in real and virtual environments

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Max Kinateder

2016-07-01

Full Text Available Virtual reality (VR is a promising tool to study evacuation behavior as it allows experimentally controlled, safe simulation of otherwise dangerous situations. However, validation studies comparing evacuation behavior in real and virtual environments are still scarce. We compare the decision to evacuate in response to a fire alarm in matched physical and virtual environments. 150 participants were tested individually in a one-trial experiment in one of three conditions. In the Control condition, the fire alarm sounded while the participant performed a bogus perceptual matching task. In the Passive bystander condition, the participant performed the task together with a confederate who ignored the fire alarm. In the Active bystander condition, the confederate left the room when the fire alarm went off. Half of the participants in each condition experienced the scenario in the real laboratory, and the other half in a matched virtual environment with a virtual bystander, presented in a head-mounted display. The active bystander group was more likely to evacuate, and the passive bystander group less likely to evacuate, than the control group. This pattern of social influence was observed in both the real and virtual environments, although the overall response to the virtual alarm was reduced; positive influence was comparable, whereas negative influence was weaker in VR. We found no reliable gender effects for the participant or the bystander. These findings extend the bystander effect to the decision to evacuate, revealing a positive as well as the previous negative social influence. The results support the ecological validity of VR as a research tool to study evacuation behavior in emergency situations, with the caveat that effect sizes may be smaller in VR.

[Clinical research progress of direct surgical repair of lumbar spondylolysis in young patients].

Science.gov (United States)

Liu, Haichao; Qian, Jixian

2013-01-01

To review and summarize the surgical techniques and their outcomes for the treatment of lumbar spondylolysis in young patients by direct surgical repair. Both home and abroad literature on the surgical techniques and their outcomes respectively for the treatment of lumbar spondylolysis in young patients by direct surgical repair was reviewed extensively and summarized. Direct surgical repair of lumbar spondylolysis can offer a simple reduction and fixation for the injured vertebra, which is also in accord with normal anatomy and physiology. In this way, normal anatomy of vertebra can be sustained. As reported surgical techniques of direct repair, such as single lag screw, hook screw, cerclage wire, pedicle screw cable, pedicle screw rod, and pedicle screw hook system, they all can provide acceptable results for lumbar spondylolysis in young patients. Furthermore, to comply strictly with the inclusion criteria of surgical management and select the appropriate internal fixation can also contribute to a good effectiveness. Within the various methods of internal fixation, pedicle screw hook system has been widely recognized. Pedicle screw hook system fixation is simple and safe clinically. With the gradual improvement of this method and the development of minimally invasive technologies, it will have broad application prospects.

Successful evacuation of large perirenal hematoma after extracorporeal shock wave lithotripsy (ESWL) - step 1 of the IDEAL recommendations of surgical innovation.

Science.gov (United States)

Hallmann, Steffen; Petersein, Jan; Ruttloff, Jürgen; Ecke, Thorsten H

2017-02-01

Larger perirenal hematomas after extracorporeal shock wave lithotripsy (ESWL) are sometimes related to the loss of renal function due to compression of the normal renal tissue. After computed tomography-guided drainage and locally applied urokinase, the hematoma was fractionally evacuated. This procedure is a save and fast way to recover normal renal function.

Chemical Agents: Facts about Evacuation

Science.gov (United States)

... What CDC is Doing Blog: Public Health Matters Chemical Agents: Facts About Evacuation Format: Select One PDF [ ... on Facebook Tweet Share Compartir Some kinds of chemical accidents or attacks, such as a train derailment ...

Gender differences in both the pathology and surgical outcome of patients with esophageal achalasia.

Science.gov (United States)

Tsuboi, Kazuto; Omura, Nobuo; Yano, Fumiaki; Hoshino, Masato; Yamamoto, Se-Ryung; Akimoto, Shusuke; Masuda, Takahiro; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

2016-12-01

Esophageal achalasia is a relatively rare disease that occurs usually in middle-aged patients. The laparoscopic Heller-Dor (LHD) procedure is the gold-standard surgical treatment for esophageal achalasia. There are many studies on the pathology and surgical outcome of esophageal achalasia from various perspectives, but there are no studies on gender differences in both the pathology and surgical outcome. This study aimed to evaluate gender differences in the surgical outcome with the LHD procedure and in the pathology of esophageal achalasia patients. The study included 474 LHD-treated patients who were postoperatively followed up for 6 months or more. The patients were divided into 2 groups by gender, to compare the preoperative pathology, surgical outcome, symptom scores before and after LHD, symptom score improvement frequency, and patient satisfaction with the surgery. The study population consisted of 248 male and 226 female, having a mean age of 45.1 years. There were no gender differences in the preoperative pathology, but a significantly lower BMI (p achalasia were characterized by low BMI, less esophageal dilation, and increased frequency and severity of chest pain. LHD improved the chest pain in the female patients, whereas the surgical outcome and satisfaction with the surgery were excellent regardless of gender.

Spatial memory enhances the evacuation efficiency of virtual pedestrians under poor visibility condition

Science.gov (United States)

Ma, Yi; Lee, Eric Wai Ming; Shi, Meng; Kwok Kit Yuen, Richard

2018-03-01

Spatial memory is a critical navigation support tool for disoriented evacuees during evacuation under adverse environmental conditions such as dark or smoky conditions. Owing to the complexity of memory, it is challenging to understand the effect of spatial memory on pedestrian evacuation quantitatively. In this study, we propose a simple method to quantitatively represent the evacueeʼs spatial memory about the emergency exit, model the evacuation of pedestrians under the guidance of the spatial memory, and investigate the effect of the evacueeʼs spatial memory on the evacuation from theoretical and physical perspectives. The result shows that (i) a good memory can significantly assist the evacuation of pedestrians under poor visibility conditions, and the evacuation can always succeed when the degree of the memory exceeds a threshold (\\varphi > 0.5); (ii) the effect of memory is superior to that of “follow-the-crowd” under the same environmental conditions; (iii) in the case of multiple exits, the difference in the degree of the memory between evacuees has a significant effect (the greater the difference, the faster the evacuation) for the evacuation under poor visibility conditions. Our study provides a new quantitative insight into the effect of spatial memory on crowd evacuation under poor visibility conditions. Project supported by the Research Grants Council of the Hong Kong Special Administrative Region, China (Grant No. 11203615).

Surgical treatment of secondary hyperparathyroidism in elderly patients: an institutional experience.

Science.gov (United States)

Polistena, Andrea; Sanguinetti, Alessandro; Lucchini, Roberta; Galasse, Segio; Avenia, Stefano; Monacelli, Massimo; Johnson, Louis Banka; Jeppsson, Bengt; Avenia, Nicola

2017-02-01

Secondary hyperparathyroidism in elderly fragile patients presents clinical difficulties due to severity of symptoms and related comorbidity. The optimal surgical approach for this group of patients is still debated. The aim of the study was to define the optimal technique of parathyroidectomy in elderly patients with secondary hyperparathyroidism. Retrospective analysis in a series of 253 patients including 35 elderly individuals at a single institution was carried out. Postoperative parathyroid hormone decrease, surgical complications and symptoms control were analyzed for all patients in relation to the types of parathyroidectomy performed. In elderly patients, total parathyroidectomy was the most used approach. Subtotal parathyroidectomy was mostly reserved for younger patients suitable for kidney transplantation. No elderly patients treated with total parathyroidectomy were autotransplanted. No significant difference in surgical complications was observed between younger and elderly patients and considering the different procedures. Adequate symptom control after surgery was achieved in almost 90% of patients. A limited rate of recurrence requiring repeat surgery was observed only after subtotal parathyroidectomy. Considering the features of all types of parathyroidectomy, very low recurrence rate, contained postoperative hypocalcemia and limited complications following total parathyroidectomy, might represent specific advantages for elderly patients. Total parathyroidectomy without parathyroid transplantation is safe for elderly patients with secondary hyperparathyroidism and a good alternative to the well-established total parathyroidectomy with autografting.

Providing surgical care in Somalia: A model of task shifting.

Science.gov (United States)

Chu, Kathryn M; Ford, Nathan P; Trelles, Miguel

2011-07-15

Somalia is one of the most political unstable countries in the world. Ongoing insecurity has forced an inconsistent medical response by the international community, with little data collection. This paper describes the "remote" model of surgical care by Medecins Sans Frontieres, in Guri-El, Somalia. The challenges of providing the necessary prerequisites for safe surgery are discussed as well as the successes and limitations of task shifting in this resource-limited context. In January 2006, MSF opened a project in Guri-El located between Mogadishu and Galcayo. The objectives were to reduce mortality due to complications of pregnancy and childbirth and from violent and non-violent trauma. At the start of the program, expatriate surgeons and anesthesiologists established safe surgical practices and performed surgical procedures. After January 2008, expatriates were evacuated due to insecurity and surgical care has been provided by local Somalian doctors and nurses with periodic supervisory visits from expatriate staff. Between October 2006 and December 2009, 2086 operations were performed on 1602 patients. The majority (1049, 65%) were male and the median age was 22 (interquartile range, 17-30). 1460 (70%) of interventions were emergent. Trauma accounted for 76% (1585) of all surgical pathology; gunshot wounds accounted for 89% (584) of violent injuries. Operative mortality (0.5% of all surgical interventions) was not higher when Somalian staff provided care compared to when expatriate surgeons and anesthesiologists. The delivery of surgical care in any conflict-settings is difficult, but in situations where international support is limited, the challenges are more extreme. In this model, task shifting, or the provision of services by less trained cadres, was utilized and peri-operative mortality remained low demonstrating that safe surgical practices can be accomplished even without the presence of fully trained surgeon and anesthesiologists. If security improves

Organization and development of surgical rehabilitation of patients with traumas and their effects

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Barabash А.P.

2012-06-01

Full Text Available Objective: To improve the efficiency of surgical rehabilitation of patients with traumas, their effects. Materials and methods: Short-term and follow-up results of the surgical treatment of patients with traumas and their effects have been analyzed. Statistical research methods have been used. Results: the efficiency of medical technologies during the early rehabilitation of patients has been demonstrated. Conclusion: Adoption of the most efficient medical technologies of general surgical treatment and postoperative rehabilitation of patients with traumas and their effects in daily practice provides high-grade restoration of the extremity's function, shortening of treatment period, decrease in number of complications and invalidism

Aero-medical evacuation from the second Israel-Lebanon war: a descriptive study.

Science.gov (United States)

Schwartz, Dagan; Resheff, Avram; Geftler, Alex; Weiss, Aviram; Birenbaum, Erez; Lavon, Ophir

2009-05-01

The second Lebanon war started as a limited operation and progressed to a large-scale campaign. Most of the fighting took place in mountainous villages and small towns inhabited with civilians. The Israeli Defense Forces (IDF) Airborne rescue and evacuation unit is charged with air evacuation of soldiers and civilians in times of peace, limited conflict, and war. We describe this unit's activities in the second Lebanon war, analyzing injury, treatment, and evacuation characteristics Data were collected from flight medical reports, debriefings of aero-medical team members (usually immediately upon return from mission), ground units medical reports and debriefings, and hospital records. 725 IDF soldiers were injured and 117 killed either in Lebanon or near the Israeli-Lebanese border during the war. A total of 338 (46%) were evacuated in 95 airlifts (averaging 4.5 evacuees per airlift) from the fighting zones or the border. Air evacuation used dedicated helicopters with advanced care capacities, and most victims were evacuated straight from the battlefield, as the fighting was ensuing. Many wounded first received advanced medical care upon the arrival of the aero-medical teams. In military operations within civilian populated areas with threats to ground transport, air evacuation can sometimes be the only readily available option. Providing timely ground advanced medical care proved difficult in many instances. Thus, for many, the rescue helicopter was the first point of access to such care. Aero-medical aircrafts and personnel faced threats from gunfire and missiles, causing both delays in evacuation and a high average number of evacuees per airlift. This article proposes ways of coping with situations in which similar rescue and evacuation problems are likely.

Dynamic changes during evacuation of a left temporal abscess in open MRI: technical case report

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Bernays, R.L.; Yonekawa, Y. [Department of Neurosurgery, University Hospital, Zurich (Switzerland); Kollias, S.S. [Institute of Neuroradiology, University Hospital of Zurich (Switzerland)

2002-05-01

We demonstrate the usefulness of ''near real-time'' neuro-navigation by open MRI systems for guidance of stereotactic evacuation of intracranial abscesses. A 70-year-old patient was referred to our institution with an intracranial left temporal abscess. He presented with headache, senso-motor aphasia and mild right hemiparesis. The abscess (35 x 25 mm) was stereotactically evacuated under MRI guidance, and a recurrence of a daughter abscess was again evacuated on the 9th postoperative day. ''Near real-time'' imaging showed an indentation of the abscess wall of 11 mm along the trajectory. A thermosensitive MRI protocol demonstrated a higher temperature around the abscess capsule than in the brain tissue more distant to the capsule, demonstrating the inflammatory process. The patient had 6 weeks of antibiotic therapy for gram-negative bacteria and was discharged with improved clinical symptoms 5 weeks after admission. Follow-up CT 2 months postoperatively showed a complete resolution of the abscess. Open MRI-guided interventions with ''near real-time'' imaging demonstrate the anatomical changes during an ongoing procedure and can be accommodated for enhancing the overall precision of stereotactic procedures. Thermosensitive MRI protocols are capable of revealing temperature gradients around inflammatory processes. (orig.)

Leveraging Twitter to gauge evacuation compliance: Spatiotemporal analysis of Hurricane Matthew.

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Martín, Yago; Li, Zhenlong; Cutter, Susan L

2017-01-01

Hurricane Matthew was the deadliest Atlantic storm since Katrina in 2005 and prompted one of the largest recent hurricane evacuations along the Southeastern coast of the United States. The storm and its projected landfall triggered a massive social media reaction. Using Twitter data, this paper examines the spatiotemporal variability in social media response and develops a novel approach to leverage geotagged tweets to assess the evacuation responses of residents. The approach involves the retrieval of tweets from the Twitter Stream, the creation and filtering of different datasets, and the statistical and spatial processing and treatment to extract, plot and map the results. As expected, peak Twitter response was reached during the pre-impact and preparedness phase, and decreased abruptly after the passage of the storm. A comparison between two time periods-pre-evacuation (October 2th-4th) and post-evacuation (October 7th-9th)-indicates that 54% of Twitter users moved away from the coast to a safer location, with observed differences by state on the timing of the evacuation. A specific sub-state analysis of South Carolina illustrated overall compliance with evacuation orders and detailed information on the timing of departure from the coast as well as the destination location. These findings advance the use of big data and citizen-as-sensor approaches for public safety issues, providing an effective and near real-time alternative for measuring compliance with evacuation orders.

Leveraging Twitter to gauge evacuation compliance: Spatiotemporal analysis of Hurricane Matthew.

Directory of Open Access Journals (Sweden)

Yago Martín

Full Text Available Hurricane Matthew was the deadliest Atlantic storm since Katrina in 2005 and prompted one of the largest recent hurricane evacuations along the Southeastern coast of the United States. The storm and its projected landfall triggered a massive social media reaction. Using Twitter data, this paper examines the spatiotemporal variability in social media response and develops a novel approach to leverage geotagged tweets to assess the evacuation responses of residents. The approach involves the retrieval of tweets from the Twitter Stream, the creation and filtering of different datasets, and the statistical and spatial processing and treatment to extract, plot and map the results. As expected, peak Twitter response was reached during the pre-impact and preparedness phase, and decreased abruptly after the passage of the storm. A comparison between two time periods-pre-evacuation (October 2th-4th and post-evacuation (October 7th-9th-indicates that 54% of Twitter users moved away from the coast to a safer location, with observed differences by state on the timing of the evacuation. A specific sub-state analysis of South Carolina illustrated overall compliance with evacuation orders and detailed information on the timing of departure from the coast as well as the destination location. These findings advance the use of big data and citizen-as-sensor approaches for public safety issues, providing an effective and near real-time alternative for measuring compliance with evacuation orders.

An Evaluation of Infrastructure for Tsunami Evacuation in Padang, West Sumatra, Indonesia (Invited)

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Cedillos, V.; Canney, N.; Deierlein, G.; Diposaptono, S.; Geist, E. L.; Henderson, S.; Ismail, F.; Jachowski, N.; McAdoo, B. G.; Muhari, A.; Natawidjaja, D. H.; Sieh, K. E.; Toth, J.; Tucker, B. E.; Wood, K.

2009-12-01

Padang has one of the world’s highest tsunami risks due to its high hazard, vulnerable terrain and population density. The current strategy to prepare for tsunamis in Padang is focused on developing early warning systems, planning evacuation routes, conducting evacuation drills, and raising local awareness. Although these are all necessary, they are insufficient. Padang’s proximity to the Sunda Trench and flat terrain make reaching safe ground impossible for much of the population. The natural warning in Padang - a strong earthquake that lasts over a minute - will be the first indicator of a potential tsunami. People will have about 30 minutes after the earthquake to reach safe ground. It is estimated that roughly 50,000 people in Padang will be unable to evacuate in that time. Given these conditions, other means to prepare for the expected tsunami must be developed. With this motivation, GeoHazards International and Stanford University’s Chapter of Engineers for a Sustainable World partnered with Indonesian organizations - Andalas University and Tsunami Alert Community in Padang, Laboratory for Earth Hazards, and the Ministry of Marine Affairs and Fisheries - in an effort to evaluate the need for and feasibility of tsunami evacuation infrastructure in Padang. Tsunami evacuation infrastructure can include earthquake-resistant bridges and evacuation structures that rise above the maximum tsunami water level, and can withstand the expected earthquake and tsunami forces. The choices for evacuation structures vary widely - new and existing buildings, evacuation towers, soil berms, elevated highways and pedestrian overpasses. This interdisciplinary project conducted a course at Stanford University, undertook several field investigations, and concluded that: (1) tsunami evacuation structures and bridges are essential to protect the people in Padang, (2) there is a need for a more thorough engineering-based evaluation than conducted to-date of the suitability of

Age is not associated with increased surgical complications in patients after laparoscopic sleeve gastrectomy.

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Jędrzejewski, Emil; Liszka, Maciej; Maciejewski, Marcin; Kowalewski, Piotr K; Walędziak, Maciej; Paśnik, Krzysztof; Janik, Michał R

2018-03-01

Age is considered as a risk factor in bariatric surgery. The observation was made on the basis of results from studies where patients underwent different type of surgery, but laparoscopic sleeve gastrectomy (LSG) was not among them. It is necessary to reevaluate the association of age with adverse events in the group of patients after LSG. To investigate the association of age with surgery-related adverse events in patients after LSG. Retrospective analysis of medical data was performed. The study involved 345 patients who underwent LSG in our institution between January 2013 and December 2014. The patients were subdivided by age into four groups according to quartiles. In 30-day follow-up adverse events were evaluated. We considered the presence of the following events as the endpoint of our study: death, medical events and surgical events. In general, we observed adverse events in 36 (10.4%) patients. The mortality rate in our study was 0.59%. Nineteen events were surgical and 18 medical. In 1 patient a surgical event was associated with a medical event. Bleeding was the most common surgical event and was observed in 17 (4.9%) cases. Age was not associated with surgical events (OR = 1.032, 95% CI: 0.991-1.075, p = 0.33) or medical events (OR = 0.997, 95% CI: 0.956-1.039, p = 0.89). The LSG is a safe bariatric procedure with low mortality. Bleeding is the most frequent surgical complication. Our findings suggest that age is not associated with increased risk of surgical or medical adverse events after LSG.

Case study of medical evacuation before and after the Fukushima Daiichi nuclear power plant accident in the great east Japan earthquake.

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Okumura, Tetsu; Tokuno, Shinichi

2015-01-01

In Japan, participants in the disaster-specific medical transportation system have received ongoing training since 2002, incorporating lessons learned from the Great Hanshin Earthquake. The Great East Japan Earthquake occurred on March 11, 2011, and the very first disaster-specific medical transport was performed. This article reviews in detail the central government's control and coordination of the disaster medical transportation process following the Great East Japan Earthquake and the Fukushima Daiichi Nuclear Power Plant Accident. In total, 124 patients were air transported under the coordination of the C5 team in the emergency response headquarter of the Japanese Government. C5 includes experts from the Cabinet Office, Cabinet Secretariat, Fire Defense Agency, Ministry of Health, Labour and Welfare, and Ministry of Defense. In the 20-30 km evacuation zone around the Fukushima Daiichi nuclear power plant, 509 bedridden patients were successfully evacuated without any fatalities during transportation. Many lessons have been learned in disaster-specific medical transportation. The national government, local government, police, and fire agencies have made significant progress in their mutual communication and collaboration. Fortunately, hospital evacuation from the 20-30 km area was successfully performed with the aid of local emergency physicians and Disaster Medical Assistance Teams (DMATs) who have vast experience in patient transport in the course of day-to-day activities. The emergency procedures that are required during crises are an extension of basic daily procedures that are performed by emergency medical staff and first responders, such as fire fighters, emergency medical technicians, or police officers. Medical facilities including nursing homes should have a plan for long-distance (over 100 km) evacuation, and the plan should be routinely reevaluated with full-scale exercises. In addition, hospital evacuation in disaster settings should be

[Rendering surgical care to wounded with neck wounds in an armed conflict].

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Samokhvalov, I M; Zavrazhnov, A A; Fakhrutdinov, A M; Sychev, M I

2001-10-01

The results of rendering of the medical care (the first aid, qualified and specialized) obtained in 172 servicemen with neck injuries who stayed in Republic of Chechnya during the period from 09.08.1999 to 28.07.2000 were analyzed. Basing on the results of analysis and experience of casualties' treatment the authors discuss the problems of sequence and volume of surgical care in this group of casualties with reference to available medical evacuation system, surgical tactics at the stage of specialized care. They also consider the peculiarities of operative treatment of the casualties with neck injuries.

A spatio-temporel optimization model for the evacuation of the population exposed to natural disasters

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Alaeddine, H.; Serrhini, K.; Maïzia, M.; Néron, E.

2015-01-01

The importance of managing the crisis caused by natural disasters, and especially by flood, requires the development of an effective evacuation systems. An effective evacuation system must take into account certain constraints, including those related to network traffic, accessibility, human resources and material equipment (vehicles, collecting points, etc.). The main objective of this work is to provide assistance to technical services and rescue forces in terms of accessibility by offering itineraries relating to rescue and evacuation of people and property. We consider in this paper the evacuation of an urban area of medium size exposed to the hazard of flood. In case of inundation, most people will be evacuated using their own vehicles. Two evacuation types are addressed in this paper, (1) a preventive evacuation based on a flood forecasting system and (2) an evacuation during the disaster based on flooding scenarios. The two study sites on which the evacuation model developed is applied are the valley of Tours (Fr, 37) which is protected by a set of dikes (preventive evacuation) and the valley of Gien (Fr, 45) which benefits of a low rate of flooding (evacuation before and during the disaster). Our goal is to construct, for each of these two sites, a chronological evacuation plan i.e. computing for each individual the departure date and the path to reach the assembly point (also called shelter) associated according to a priorities list established for this purpose. Evacuation plan must avoid the congestion on the road network. Here we present a Spatio-Temporal Optimization Model (STOM) dedicated to the evacuation of the population exposed to natural disasters and more specifically to flood risk.

Repeated Surgical or Endoscopic Myotomy for Recurrent Dysphagia in Patients After Previous Myotomy for Achalasia.

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Fumagalli, Uberto; Rosati, Riccardo; De Pascale, Stefano; Porta, Matteo; Carlani, Elisa; Pestalozza, Alessandra; Repici, Alessandro

2016-03-01

Surgical myotomy of the lower esophageal sphincter has a 5-year success rate of approximately 91 %. Peroral endoscopic myotomy can provide similar results for controlling dysphagia. Some patients experience either persistent or recurrent dysphagia after myotomy. We present here a retrospective analysis of our experience with redo myotomy for recurrent dysphagia in patients with achalasia. From March 1996 to February 2015, 234 myotomies for primary or recurrent achalasia were performed in our center. Fifteen patients (6.4 %) had had a previous myotomy and were undergoing surgical redo myotomy (n = 9) or endoscopic redo myotomy (n = 6) for recurrent symptoms. Patients presented at a median of 10.4 months after previous myotomy. Median preoperative Eckardt score was 6. Among the nine patients undergoing surgical myotomy, three esophageal perforations occurred intraoperatively (all repaired immediately). Surgery lasted 111 and 62 min on average (median) in the surgical and peroral endoscopic myotomy (POEM) groups, respectively. No postoperative complications occurred in either group. Median postoperative stay was 3 and 2.5 days in the surgical and POEM groups, respectively. In the surgical group, Eckardt score was dysphagia. Preliminary results using POEM indicate that the technique can be safely used in patients who have undergone previous surgical myotomy.

Making Multi-Level Tsunami Evacuation Playbooks Operational in California and Hawaii

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Wilson, R. I.; Peterson, D.; Fryer, G. J.; Miller, K.; Nicolini, T.; Popham, C.; Richards, K.; Whitmore, P.; Wood, N. J.

2016-12-01

In the aftermath of the 2010 Chile, 2011 Japan, and 2012 Haida Gwaii tsunamis in California and Hawaii, coastal emergency managers requested that state and federal tsunami programs investigate providing more detailed information about the flood potential and recommended evacuation for distant-source tsunamis well ahead of their arrival time. Evacuation "Playbooks" for tsunamis of variable sizes and source locations have been developed for some communities in the two states, providing secondary options to an all or nothing approach for evacuation. Playbooks have been finalized for nearly 70% of the coastal communities in California, and have been drafted for evaluation by the communities of Honolulu and Hilo in Hawaii. A key component to determining a recommended level of evacuation during a distant-source tsunami and making the Playbooks operational has been the development of the "FASTER" approach, an acronym for factors that influence the tsunami flood hazard for a community: Forecast Amplitude, Storm, Tides, Error in forecast, and the Run-up potential. Within the first couple hours after a tsunami is generated, the FASTER flood elevation value will be computed and used to select the appropriate minimum tsunami phase evacuation "Playbook" for use by the coastal communities. The states of California and Hawaii, the tsunami warning centers, and local weather service offices are working together to deliver recommendations on the appropriate evacuation Playbook plans for communities to use prior to the arrival of a distant-source tsunami. These partners are working closely with individual communities on developing conservative and consistent protocols on the use of the Playbooks. Playbooks help provide a scientifically-based, minimum response for small- to moderate-size tsunamis which could reduce the potential for over-evacuation of hundreds of thousands of people and save hundreds of millions of dollars in evacuation costs for communities and businesses.

Clarifying evacuation options through fire behavior and traffic modeling

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Carol L. Rice; Ronny J. Coleman; Mike. Price

2011-01-01

Communities are becoming increasingly concerned with the variety of choices related to wildfire evacuation. We used ArcView with Network Analyst to evaluate the different options for evacuations during wildfire in a case study community. We tested overlaying fire growth patterns with the road network and population characteristics to determine recommendations for...

Sublingual misoprostol versus standard surgical care for treatment of incomplete abortion in five sub-Saharan African countries

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Shochet Tara

2012-11-01

Full Text Available Abstract Background In low-resource settings, where abortion is highly restricted and self-induced abortions are common, access to post-abortion care (PAC services, especially treatment of incomplete terminations, is a priority. Standard post-abortion care has involved surgical intervention but can be hard to access in these areas. Misoprostol provides an alternative to surgical intervention that could increase access to abortion care. We sought to gather additional evidence regarding the efficacy of 400 mcg of sublingual misoprostol vs. standard surgical care for treatment of incomplete abortion in the environments where need for economical non-surgical treatments may be most useful. Methods A total of 860 women received either sublingual misoprostol or standard surgical care for treatment of incomplete abortion in a multi-site randomized trial. Women with confirmed incomplete abortion, defined as past or present history of vaginal bleeding during pregnancy and an open cervical os, were eligible to participate. Participants returned for follow-up one week later to confirm clinical status. If abortion was incomplete at that time, women were offered an additional follow-up visit or immediate surgical evacuation. Results Both misoprostol and surgical evacuation are highly effective treatments for incomplete abortion (misoprostol: 94.4%, surgical: 100.0%. Misoprostol treatment resulted in a somewhat lower chance of success than standard surgical practice (RR = 0.90; 95% CI: 0.89-0.92. Both tolerability of side effects and women’s satisfaction were similar in the two study arms. Conclusion Misoprostol, much easier to provide than surgery in low-resource environments, can be used safely, successfully, and satisfactorily for treatment of incomplete abortion. Focus should shift to program implementation, including task-shifting the provision of post-abortion care to mid- and low- level providers, training and assurance of drug availability. Trial

Transcranial Evacuation of Atypical Progressive Supradiaphragmatic Hematoma After Transsphenoidal Complete Resection of Pituitary Adenoma.

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Metwali, Hussam; Fahlbusch, Rudolf

2017-06-01

Supradiaphragmatic hematoma is a type of hematoma that occurs after transsphenoidal (TS) resection of pituitary adenoma and requires special management. Two patients had symptomatic supradiaphragmatic hematomas after total TS resection of pituitary adenomas in the absence of vascular anomalies. Both patients also had hydrocephalus at the time of diagnosis of the hematoma. The initial endoscopic endonasal inspection showed no subdiaphragmatic bleeding. The hematoma was evacuated via a frontolateral approach after insertion of an external ventricular drain (EVD). The supradiaphragmatic hematoma could be clinically and radiologically distinguished. It presented early with visual deterioration without headache. The patients developed hydrocephalus, which was associated with deterioration of level of consciousness. Radiologically, the hematoma filled the suprasellar space and was associated with the extension of bleeding in the basal cisterns. Recovery was good in both patients. There were no permanent neurologic deficits. The EVD was removed in both patients. One patient required a ventriculoperitoneal shunt because of delayed hydrocephalus. Supradiaphragmatic hematoma can be clinically and radiologically distinguished from other types of hematoma occurring after TS resection of pituitary adenoma. Transcranial surgery should be performed to manage supradiaphragmatic hematoma, when symptomatic. Insertion of an EVD at the time of evacuation is mandatory to relax the brain and to alleviate the hydrocephalus. Copyright © 2017 Elsevier Inc. All rights reserved.

Transit-Based Emergency Evacuation with Transit Signal Priority in Sudden-Onset Disaster

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Ciyun Lin

2016-01-01

Full Text Available This study presents methods of transit signal priority without transit-only lanes for a transit-based emergency evacuation in a sudden-onset disaster. Arterial priority signal coordination is optimized when a traffic signal control system provides priority signals for transit vehicles along an evacuation route. Transit signal priority is determined by “transit vehicle arrival time estimation,” “queuing vehicle dissipation time estimation,” “traffic signal status estimation,” “transit signal optimization,” and “arterial traffic signal coordination for transit vehicle in evacuation route.” It takes advantage of the large capacities of transit vehicles, reduces the evacuation time, and evacuates as many evacuees as possible. The proposed methods were tested on a simulation platform with Paramics V6.0. To evaluate and compare the performance of transit signal priority, three scenarios were simulated in the simulator. The results indicate that the methods of this study can reduce the travel times of transit vehicles along an evacuation route by 13% and 10%, improve the standard deviation of travel time by 16% and 46%, and decrease the average person delay at a signalized intersection by 22% and 17% when the traffic flow saturation along an evacuation route is 0.81.0, respectively.

A Global System for Transportation Simulation and Visualization in Emergency Evacuation Scenarios

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Lu, Wei [ORNL; Liu, Cheng [ORNL; Thomas, Neil [ORNL; Bhaduri, Budhendra L [ORNL; Han, Lee [University of Tennessee, Knoxville (UTK)

2015-01-01

Simulation-based studies are frequently used for evacuation planning and decision making processes. Given the transportation systems complexity and data availability, most evacuation simulation models focus on certain geographic areas. With routine improvement of OpenStreetMap road networks and LandScanTM global population distribution data, we present WWEE, a uniform system for world-wide emergency evacuation simulations. WWEE uses unified data structure for simulation inputs. It also integrates a super-node trip distribution model as the default simulation parameter to improve the system computational performance. Two levels of visualization tools are implemented for evacuation performance analysis, including link-based macroscopic visualization and vehicle-based microscopic visualization. For left-hand and right-hand traffic patterns in different countries, the authors propose a mirror technique to experiment with both scenarios without significantly changing traffic simulation models. Ten cities in US, Europe, Middle East, and Asia are modeled for demonstration. With default traffic simulation models for fast and easy-to-use evacuation estimation and visualization, WWEE also retains the capability of interactive operation for users to adopt customized traffic simulation models. For the first time, WWEE provides a unified platform for global evacuation researchers to estimate and visualize their strategies performance of transportation systems under evacuation scenarios.

Critical roles of orthopaedic surgeon leadership in healthcare systems to improve orthopaedic surgical patient safety.

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Kuo, Calvin C; Robb, William J

2013-06-01

The prevention of medical and surgical harm remains an important public health problem despite increased awareness and implementation of safety programs. Successful introduction and maintenance of surgical safety programs require both surgeon leadership and collaborative surgeon-hospital alignment. Documentation of success of such surgical safety programs in orthopaedic practice is limited. We describe the scope of orthopaedic surgical patient safety issues, define critical elements of orthopaedic surgical safety, and outline leadership roles for orthopaedic surgeons needed to establish and sustain a culture of safety in contemporary healthcare systems. We identified the most common causes of preventable surgical harm based on adverse and sentinel surgical events reported to The Joint Commission. A comprehensive literature review through a MEDLINE(®) database search (January 1982 through April 2012) to identify pertinent orthopaedic surgical safety articles found 14 articles. Where gaps in orthopaedic literature were identified, the review was supplemented by 22 nonorthopaedic surgical references. Our final review included 36 articles. Six important surgical safety program elements needed to eliminate preventable surgical harm were identified: (1) effective surgical team communication, (2) proper informed consent, (3) implementation and regular use of surgical checklists, (4) proper surgical site/procedure identification, (5) reduction of surgical team distractions, and (6) routine surgical data collection and analysis to improve the safety and quality of surgical patient care. Successful surgical safety programs require a culture of safety supported by all six key surgical safety program elements, active surgeon champions, and collaborative hospital and/or administrative support designed to enhance surgical safety and improve surgical patient outcomes. Further research measuring improvements from such surgical safety systems in orthopaedic care is needed.

Evacuation emergency response model coupling atmospheric release advisory capability output

International Nuclear Information System (INIS)

Rosen, L.C.; Lawver, B.S.; Buckley, D.W.; Finn, S.P.; Swenson, J.B.

1983-01-01

A Federal Emergency Management Agency (FEMA) sponsored project to develop a coupled set of models between those of the Lawrence Livermore National Laboratory (LLNL) Atmospheric Release Advisory Capability (ARAC) system and candidate evacuation models is discussed herein. This report describes the ARAC system and discusses the rapid computer code developed and the coupling with ARAC output. The computer code is adapted to the use of color graphics as a means to display and convey the dynamics of an emergency evacuation. The model is applied to a specific case of an emergency evacuation of individuals surrounding the Rancho Seco Nuclear Power Plant, located approximately 25 miles southeast of Sacramento, California. The graphics available to the model user for the Rancho Seco example are displayed and noted in detail. Suggestions for future, potential improvements to the emergency evacuation model are presented

Mortality and health-related quality of life in patients surgically treated for spondylodiscitis

DEFF Research Database (Denmark)

Dragsted, Casper; Aagaard, Theis; Ohrt-Nissen, Søren

2017-01-01

center. Indications for surgery, pre- and postoperative neurological impairment, comorbidities, and mortality were recorded. A survey was conducted on all eligible patients with the EuroQol 5-dimension (EQ-5D) questionnaire and Oswestry Disability Index (ODI). RESULTS: Sixty-five patients were diagnosed...... neurological impairment. CONCLUSIONS: Several years after surgery, patients surgically treated for spondylodiscitis have significantly lower HRQL and more disability than the background population. Neurological impairment prior to index surgery predicts adverse outcome in terms of disability and lower HRQL.......PURPOSE: To assess mortality, disability, and health-related quality of life (HRQL) in patients surgically treated for spondylodiscitis. METHODS: A retrospective longitudinal study was conducted on all patients surgically treated for spondylodiscitis over a 6-year period at a single tertiary spine...

Preoperative Surgical Discussion and Information Retention by Patients.

Science.gov (United States)

Feiner, David E; Rayan, Ghazi M

2016-10-01

To assess how much information communicated to patients is understood and retained after preoperative discussion of upper extremity procedures. A prospective study was designed by recruiting patients prior to undergoing upper extremity surgical procedures after a detailed discussion of their operative technique, postoperative care and treatment outcomes. Patients were given the same 20-item questionnaire to fill out twice, at two pre operative visits. An independent evaluator filled out a third questionnaire as a control. Various discussion points of the survey were compared among the 3 questionnaires and retained information and perceived comprehension were evaluated. The average patients' age was 50.3 (27-75) years The average time between the two surveys preoperative 1 and preoperative 2 was 40.7 (7-75) days,. The average patient had approximately 2 years of college or an associate's degree. Patients initially retained 73% (52-90%) of discussion points presented during preoperative 1 and 61% (36-85%) of the information at preoperative 2 p = .002. 50% of patients felt they understood 100% of the discussion, this dropped to only 10% at their preoperative 2 visit. 15% of our patients did not know what type of anesthesia they were having at preoperative 2. A communication barrier between patients and physicians exists when patients are informed about their preoperative surgical discussion. The retention of information presented is worsened with elapsing time from the initial preoperative discussion to the second preoperative visit immediately prior to surgery. Methods to enhance patients' retention of information prior to surgery must be sought and implemented which will improve patients' treatment outcome.

Essential fatty acid deficiency in surgical patients.

Science.gov (United States)

O'Neill, J A; Caldwell, M D; Meng, H C

1977-01-01

Parenteral nutrition may protect patients unable to eat from malnutrition almost indefinitely. If fat is not also given EFAD will occur. This outlines a prospective study of 28 surgical patients on total intravenous fat-free nutrition to determine the developmental course of EFAD and the response to therapy. Twenty-eight patients ranging from newborn to 66 years receiving parenteral nutrition without fat had regular determinations of the composition of total plasma fatty acids and the triene/tetraene ratio using gas liquid chromatography. Physical signs of EFAD were looked for also. Patients found to have evidence of EFAD were treated with 10% Intralipid. Topical safflower oil was used in three infants. Total plasma fatty acid composition was restudied following therapy. In general, infants on fat-free intravenous nutrition developed biochemical EFAD within two weeks, but dermatitis took longer to become evident. Older individuals took over four weeks to develop a diagnostic triene/tetraene ratio (greater than 0.4; range 0.4 to 3.75). Therapeutic correction of biochemical EFAD took 7 to 10 days but dermatitis took longer to correct. Cutaneous application of safflower oil alleviated the cutaneous manifestations but did not correct the triene/tetraene ratio of total plasma fatty acids. These studies indicate that surgical patients who are unable to eat for two to four weeks, depending upon age and expected fat stores, should receive fat as a part of their intravenous regimen. Images Fig. 7. PMID:404973

Evacuation of children - movement on stairs and on Horizontal Plane

DEFF Research Database (Denmark)

Larusdottir, Aldis Run; Dederichs, Anne

2012-01-01

in full scale evacuation experiments where two age groups 0-2 years and 3-6 years were analyzed separately. It was found that flow through doors, walking speeds and densities were age-dependent and differed strongly from the data in existing literature. The results showed higher walking speeds in spiral...... slower in horizontal plane than adults, however they were keen to run during the evacuations, in the latter case their travel speed increased and exceeded the adults’. Since the evacuation characteristics of children differ in many ways from those of adults, nowadays models badly comprehend...

Herbal medications for surgical patients: a systematic review protocol.

Science.gov (United States)

Arruda, Ana Paula Nappi; Ayala, Ana Patricia; Lopes, Luciane C; Bergamaschi, Cristiane C; Guimarães, Caio; Grossi, Mariana Del; Righesso, Leonardo A R; Agarwal, Arnav; El Dib, Regina

2017-07-26

Postoperative nausea and vomiting (PONV) affect approximately 80% of surgical patients and is associated with increased length of hospital stay and systemic costs. Preoperative and postoperative pain, anxiety and depression are also commonly reported. Recent evidence regarding their safety and effectiveness has not been synthesised. The aim of this systematic review is to evaluate the efficacy and safety of herbal medications for the treatment and prevention of anxiety, depression, pain and PONV in patients undergoing laparoscopic, obstetrical/gynaecological and cardiovascular surgical procedures. The following electronic databases will be searched up to 1 October 2016 without language or publication status restrictions: CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science and LILACS. Randomised clinical trials enrolling adult surgical patients undergoing laparoscopic, obstetrical/gynaecological and cardiovascular surgeries and managed with herbal medication versus a control group (placebo, no intervention or active control) prophylactically or therapeutically will be considered eligible. Outcomes of interest will include the following: anxiety, depression, pain, nausea and vomiting. A team of reviewers will complete title and abstract screening and full-text screening for identified hits independently and in duplicate. Data extraction, risk of bias assessments and evaluation of the overall quality of evidence for each relevant outcome reported will be conducted independently and in duplicate using the Grading of Recommendations Assessment Development and Evaluation classification system. Dichotomous data will be summarised as risk ratios; continuous data will be summarised as standard average differences with 95% CIs. This is one of the first efforts to systematically summarise existing evidence evaluating the use of herbal medications in laparoscopic, obstetrical/gynaecological and cardiovascular surgical patients. The findings of this review will be disseminated

Postoperative adverse outcomes in intellectually disabled surgical patients: a nationwide population-based study.

Directory of Open Access Journals (Sweden)

Jui-An Lin

Full Text Available BACKGROUND: Intellectually disabled patients have various comorbidities, but their risks of adverse surgical outcomes have not been examined. This study assesses pre-existing comorbidities, adjusted risks of postoperative major morbidities and mortality in intellectually disabled surgical patients. METHODS: A nationwide population-based study was conducted in patients who underwent inpatient major surgery in Taiwan between 2004 and 2007. Four controls for each patient were randomly selected from the National Health Insurance Research Database. Preoperative major comorbidities, postoperative major complications and 30-day in-hospital mortality were compared between patients with and without intellectual disability. Use of medical services also was analyzed. Adjusted odds ratios using multivariate logistic regression analyses with 95% confidence intervals were applied to verify intellectual disability's impact. RESULTS: Controls were compared with 3983 surgical patients with intellectual disability. Risks for postoperative major complications were increased in patients with intellectual disability, including acute renal failure (odds ratio 3.81, 95% confidence interval 2.28 to 6.37, pneumonia (odds ratio 2.01, 1.61 to 2.49, postoperative bleeding (odds ratio 1.35, 1.09 to 1.68 and septicemia (odds ratio 2.43, 1.85 to 3.21 without significant differences in overall mortality. Disability severity was positively correlated with postoperative septicemia risk. Medical service use was also significantly higher in surgical patients with intellectual disability. CONCLUSION: Intellectual disability significantly increases the risk of overall major complications after major surgery. Our findings show a need for integrated and revised protocols for postoperative management to improve care for intellectually disabled surgical patients.

Elementary students' evacuation route choice in a classroom: A questionnaire-based method

Science.gov (United States)

Chen, Liang; Tang, Tie-Qiao; Huang, Hai-Jun; Song, Ziqi

2018-02-01

Children evacuation is a critical but challenging issue. Unfortunately, existing researches fail to effectively describe children evacuation, which is likely due to the lack of experimental and empirical data. In this paper, a questionnaire-based experiment was conducted with children aged 8-12 years to study children route choice behavior during evacuation from in a classroom with two exits. 173 effective questionnaires were collected and the corresponding data were analyzed. From the statistical results, we obtained the following findings: (1) position, congestion, group behavior, and backtracking behavior have significant effects on children route choice during evacuation; (2) age only affects children backtracking behavior, and (3) no prominent effects based on gender and guidance were observed. The above findings may help engineers design some effective evacuation strategies for children.

BRUCELLA ENDOCARDITIS IN IRANIAN PATIENTS: COMBINED MEDICAL AND SURGICAL TREATMENT

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Ebrahim Nematipour

1995-06-01

Full Text Available Brucella endocarditis is a Tare but serious complication ofbrucellosis and is the main cause of death reuuedto thisdisease: Itis not rare in the endemic areas and aaualiy accounts for up to 8~lO% ofendocarditis infections: We report seven adult cases of brucella endocarditis in lmam-Khorneini Hospual: Contrary to previous independent reports, female patients were not rare in this study and accountedfor three out ofseven. Four patients were cared for by combined medical and surgical treatment and were recovered Three of the patients that did not receive the combined theraPl could not he saved This report confirms the necessity of prompt combined medical and surgical treatment ofbrucella endocarditis.

A heterogeneous lattice gas model for simulating pedestrian evacuation

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Guo, Xiwei; Chen, Jianqiao; Zheng, Yaochen; Wei, Junhong

2012-02-01

Based on the cellular automata method (CA model) and the mobile lattice gas model (MLG model), we have developed a heterogeneous lattice gas model for simulating pedestrian evacuation processes in an emergency. A local population density concept is introduced first. The update rule in the new model depends on the local population density and the exit crowded degree factor. The drift D, which is one of the key parameters influencing the evacuation process, is allowed to change according to the local population density of the pedestrians. Interactions including attraction, repulsion, and friction between every two pedestrians and those between a pedestrian and the building wall are described by a nonlinear function of the corresponding distance, and the repulsion forces increase sharply as the distances get small. A critical force of injury is introduced into the model, and its effects on the evacuation process are investigated. The model proposed has heterogeneous features as compared to the MLG model or the basic CA model. Numerical examples show that the model proposed can capture the basic features of pedestrian evacuation, such as clogging and arching phenomena.

Surgical checklist application and its impact on patient safety in pediatric surgery

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S N Oak

2015-01-01

Full Text Available Background: Surgical care is an essential component of health care of children worldwide. Incidences of congenital anomalies, trauma, cancers and acquired diseases continue to rise and along with that the impact of surgical intervention on public health system also increases. It then becomes essential that the surgical teams make the procedures safe and error proof. The World Health Organization (WHO has instituted the surgical checklist as a global initiative to improve surgical safety. Aims: To assess the acceptance, application and adherence to the WHO Safe Surgery Checklist in Pediatric Surgery Practice at a university teaching hospital. Materials and Methods: In a prospective study, spanning 2 years, the checklist was implemented for all patients who underwent operative procedures under general anesthesia. The checklist identified three phases of an operation, each corresponding to a specific period in the normal flow of work: Before the induction of anesthesia ("sign in", before the skin incision ("time out" and before the patient leaves the operating room ("sign out". In each phase, an anesthesiologist,-"checklist coordinator," confirmed that the anesthesia, surgery and nursing teams have completed the listed tasks before proceeding with the operation and exit. The checklist was used for 3000 consecutive patients. Results: No major perioperative errors were noted. In 54 (1.8% patients, children had the same names and identical surgical procedure posted on the same operation list. The patient identification tag was missing in four (0.1% patients. Mention of the side of procedures was missing in 108 (3.6% cases. In 0.1% (3 of patients there was mix up of the mention of side of operation in the case papers and consent forms. In 78 (2.6% patients, the consent form was not signed by parents/guardians or the side of the procedure was not quoted. Antibiotic orders were missing in five (0.2% patients. In 12 (0.4% cases, immobilization of the

Community disruptions and business costs for distant tsunami evacuations using maximum versus scenario-based zones

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Wood, Nathan J.; Wilson, Rick I.; Ratliff, Jamie L.; Peters, Jeff; MacMullan, Ed; Krebs, Tessa; Shoaf, Kimberley; Miller, Kevin

2017-01-01

Well-executed evacuations are key to minimizing loss of life from tsunamis, yet they also disrupt communities and business productivity in the process. Most coastal communities implement evacuations based on a previously delineated maximum-inundation zone that integrates zones from multiple tsunami sources. To support consistent evacuation planning that protects lives but attempts to minimize community disruptions, we explore the implications of scenario-based evacuation procedures and use the California (USA) coastline as our case study. We focus on the land in coastal communities that is in maximum-evacuation zones, but is not expected to be flooded by a tsunami generated by a Chilean earthquake scenario. Results suggest that a scenario-based evacuation could greatly reduce the number of residents and employees that would be advised to evacuate for 24–36 h (178,646 and 159,271 fewer individuals, respectively) and these reductions are concentrated primarily in three counties for this scenario. Private evacuation spending is estimated to be greater than public expenditures for operating shelters in the area of potential over-evacuations ($13 million compared to $1 million for a 1.5-day evacuation). Short-term disruption costs for businesses in the area of potential over-evacuation are approximately $122 million for a 1.5-day evacuation, with one-third of this cost associated with manufacturing, suggesting that some disruption costs may be recouped over time with increased short-term production. There are many businesses and organizations in this area that contain individuals with limited mobility or access and functional needs that may have substantial evacuation challenges. This study demonstrates and discusses the difficulties of tsunami-evacuation decision-making for relatively small to moderate events faced by emergency managers, not only in California but in coastal communities throughout the world.

A study on evacuation time from lecture halls in Faculty of Engineering, Universiti Putra Malaysia

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Othman, W. N. A. W.; Tohir, M. Z. M.

2018-04-01

An evacuation situation in any building involves many risks. The geometry of building and high potential of occupant load may affect the efficiency of evacuation process. Although fire safety rules and regulations exist, they remain insufficient to guarantee the safety of all building occupants and do not prevent the dramatic events to be repeated. The main objective of this project is to investigate the relationship between the movement time, travel speed and occupant density during a series of evacuation drills specifically for lecture halls. Generally, this study emphasizes on the movement of crowd within a limited space and includes the aspects of human behaviour. A series of trial evacuations were conducted in selected lecture halls at Faculty of Engineering, Universiti Putra Malaysia with the aim of collecting actual data for numerical analysis. The numerical data obtained during trial evacuations were used to determine the evacuation time, crowd movement and behaviour during evacuation process particularly for lecture halls. The evacuation time and number of occupants exiting from each exit were recorded. Video camera was used to record and observe the movement behaviour of occupants during evacuations. EvacuatioNZ was used to simulate the trials evacuations of DK 5 and the results predicted were compared with experimental data. EvacuatioNZ was also used to predict the evacuation time and the flow of occupants exiting from each door for DK 4 and DK 8.

Oral Surgical Procedures Performed Safely in Patients With Head and Neck Arteriovenous Malformations: A Retrospective Case Series of 12 Patients.

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Karim, Abdul Basit; Lindsey, Sean; Bovino, Brian; Berenstein, Alejandro

2016-02-01

This case series describes patients with head and neck arteriovenous malformations who underwent oral and maxillofacial surgical procedures combined with interventional radiology techniques to minimize blood loss. Twelve patients underwent femoral cerebral angiography to visualize the extent of vascular malformation. Before the surgical procedures, surgical sites were devascularized by direct injection of hemostatic or embolic agents. Direct puncture sclerotherapy at the base of surgical sites was performed using Surgiflo or n-butylcyanoacrylate glue. Surgical procedures were carried out in routine fashion. A hemostatic packing of FloSeal, Gelfoam, and Avitene was adapted to the surgical sites. Direct puncture sclerotherapy with Surgiflo or n-butylcyanoacrylate glue resulted in minimal blood loss intraoperatively. Local application of the FloSeal, Gelfoam, and Avitene packing sustained hemostasis and produced excellent healing postoperatively. Patients with arteriovenous malformations can safely undergo routine oral and maxillofacial surgical procedures with minimal blood loss when appropriate endovascular techniques and local hemostatic measures are used by the interventional radiologist and oral and maxillofacial surgeon. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Endovascular Versus Open Surgical Intervention in Patients with Takayasu's Arteritis: A Meta-analysis.

Science.gov (United States)

Jung, Jae Hyun; Lee, Young Ho; Song, Gwan Gyu; Jeong, Han Saem; Kim, Jae-Hoon; Choi, Sung Jae

2018-06-01

Although medical treatment has advanced, surgical treatment is needed to control symptoms of Takayasu's arteritis (TA), such as angina, stroke, hypertension, or claudication. Endovascular or open surgical intervention is performed; however, there are few comparative studies on these methods. This meta-analysis and systematic review aimed to examine the outcome of surgical treatment of TA. A meta-analysis comparing outcomes of endovascular and open surgical intervention was performed using MEDLINE and Embase. This meta-analysis included only observational studies, and the evidence level was low to moderate. Data were pooled and analysed using a fixed or random effects model with the I 2 statistic. The included studies involved a total of 770 patients and 1363 lesions, with 389 patients treated endovascularly and 420 treated by surgical revascularization. Restenosis was more common with endovascular than open surgical intervention (odds ratio [OR] 5.18, 95% confidence interval [CI] 2.78-9.62; p open surgical intervention patients in the coronary artery, supra-aortic branches, and renal artery. In both the active and inactive stages, restenosis was more common in those treated endovascularly than in those treated by open surgery. However, stroke occurred less often with endovascular intervention than with open surgical intervention (OR 0.33, 95% CI 0.12-0.90; p = .003). Mortality and complications other than stroke and mortality did not differ between endovascular and open surgical intervention. This meta-analysis has shown a lower risk of restenosis with open surgical intervention than with endovascular intervention. Stroke was generally more common with open surgical intervention than with endovascular intervention. However, there were differences according to the location of the lesion, and the risk of stroke in open surgery is higher when the supra-aortic branches are involved rather than the renal arteries. Copyright © 2018 European Society for Vascular

Surgical and survival outcomes of lung cancer patients with intratumoral lung abscesses.

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Yamanashi, Keiji; Okumura, Norihito; Takahashi, Ayuko; Nakashima, Takashi; Matsuoka, Tomoaki

2017-05-26

Intratumoral lung abscess is a secondary lung abscess that is considered to be fatal. Therefore, surgical procedures, although high-risk, have sometimes been performed for intratumoral lung abscesses. However, no studies have examined the surgical outcomes of non-small cell lung cancer patients with intratumoral lung abscesses. The aim of this study was to investigate the surgical and survival outcomes of non-small cell lung cancer patients with intratumoral lung abscesses. Eleven consecutive non-small cell lung cancer patients with intratumoral lung abscesses, who had undergone pulmonary resection at our institution between January 2007 and December 2015, were retrospectively analysed. The post-operative prognoses were investigated and prognostic factors were evaluated. Ten of 11 patients were male and one patient was female. The median age was 64 (range, 52-80) years. Histopathologically, 4 patients had Stage IIA, 2 patients had Stage IIB, 2 patients had Stage IIIA, and 3 patients had Stage IV tumors. The median operative time was 346 min and the median amount of bleeding was 1327 mL. The post-operative morbidity and mortality rates were 63.6% and 0.0%, respectively. Recurrence of respiratory infections, including lung abscesses, was not observed in all patients. The median post-operative observation period was 16.1 (range, 1.3-114.5) months. The 5-year overall survival rate was 43.3%. No pre-operative, intra-operative, or post-operative prognostic factors were identified in the univariate analyses. Surgical procedures for advanced-stage non-small cell lung cancer patients with intratumoral lung abscesses, although high-risk, led to satisfactory post-operative mortality rates and acceptable prognoses.

Simulating crowd evacuation with socio-cultural, cognitive, and emotional elements

NARCIS (Netherlands)

van der Wal, C. Natalie; Formolo, Daniel; Robinson, Mark A.; Minkov, Michael; Bosse, Tibor

2017-01-01

In this research, the effects of culture, cognitions, and emotions on crisis management and prevention are analysed. An agent-based crowd evacuation simulation model was created, named IMPACT, to study the evacuation process from a transport hub. To extend previous research, various socio-cultural,

Ventricular tachycardia in post-myocardial infarction patients. Results of surgical therapy.

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Viganò, M; Martinelli, L; Salerno, J A; Minzioni, G; Chimienti, M; Graffigna, A; Goggi, C; Klersy, C; Montemartini, C

1986-05-01

This report addresses the problems related to surgical treatment of post-infarction ventricular tachycardia (VT) and is based on a 5 year experience of 36 consecutive patients. In every case the arrhythmia was unresponsive to pharmacological therapy. All patients were operated on after the completion of a diagnostic protocol including preoperative endocardial, intra-operative epi-endocardial mapping, the latter performed automatically when possible. Surgical techniques were: classical Guiraudon's encircling endocardial ventriculotomy (EEV); partial EEV, endocardial resection (ER); cryoablation or a combination of these procedures. The in-hospital mortality (30 days) was 8.3% (3 patients). During the follow-up period (1-68 months), 3 patients (9%) died of cardiac but not VT related causes. Of the survivors, 92% are VT-free. We consider electrophysiologically guided surgery a safe and reliable method for the treatment of post-infarction VT and suggest its more extensive use. We stress the importance of automatic mapping in pleomorphic and non-sustained VT, and the necessity of tailoring the surgical technique to the characteristics of each case.

Effect of form of obstacle on speed of crowd evacuation

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Yano, Ryosuke

2018-03-01

This paper investigates the effect of the form of an obstacle on the time that a crowd takes to evacuate a room, using a toy model. Pedestrians are modeled as active soft matter moving toward a point with intended velocities. An obstacle is placed in front of the exit, and it has one of four shapes: a cylindrical column, a triangular prism, a quadratic prism, or a diamond prism. Numerical results indicate that the evacuation-completion time depends on the shape of the obstacle. Obstacles with a circular cylinder (C.C.) shape yield the shortest evacuation-completion time in the proposed model.

Injuries in air transport emergency evacuations.

Science.gov (United States)

1979-02-01

Twelve air transport evacuations are reviewed. Injuries are discussed with emphasis on configurational and procedural contributing factors. Recommendations and information about possible methods of reducing injuries are provided.

Fluid Line Evacuation and Freezing Experiments for Digital Radiator Concept

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Berisford, Daniel F.; Birur, Gajanana C.; Miller, Jennifer R.; Sunada, Eric T.; Ganapathi, Gani B.; Stephan, Ryan; Johnson, Mark

2011-01-01

The digital radiator technology is one of three variable heat rejection technologies being investigated for future human-rated NASA missions. The digital radiator concept is based on a mechanically pumped fluid loop with parallel tubes carrying coolant to reject heat from the radiator surface. A series of valves actuate to start and stop fluid flow to di erent combinations of tubes, in order to vary the heat rejection capability of the radiator by a factor of 10 or more. When the flow in a particular leg is stopped, the fluid temperature drops and the fluid can freeze, causing damage or preventing flow from restarting. For this reason, the liquid in a stopped leg must be partially or fully evacuated upon shutdown. One of the challenges facing fluid evacuation from closed tubes arises from the vapor generated during pumping to low pressure, which can cause pump cavitation and incomplete evacuation. Here we present a series of laboratory experiments demonstrating fluid evacuation techniques to overcome these challenges by applying heat and pumping to partial vacuum. Also presented are results from qualitative testing of the freezing characteristics of several different candidate fluids, which demonstrate significant di erences in freezing properties, and give insight to the evacuation process.

An exact approach for relating recovering surgical patient workload to the master surgical schedule

NARCIS (Netherlands)

Vanberkel, P.T.; Boucherie, Richardus J.; Hans, Elias W.; Hurink, Johann L.; van Lent, Wineke A.M.; van Lent, W.A.M.; van Harten, Wim H.; van Harten, Willem H.

2009-01-01

No other department influences the workload of a hospital more than the Department of Surgery and in particular, the activities in the operating room. These activities are governed by the master surgical schedule (MSS), which states which patient types receive surgery on which day. In this paper we

An exact approach for relating recovering surgical patient workload to the master surgical schedule

NARCIS (Netherlands)

Vanberkel, P.T.; Boucherie, Richardus J.; Hans, Elias W.; Hurink, Johann L.; van Lent, W.A.M.; van Harten, Willem H.

2011-01-01

No other department influences the workload of a hospital more than the Department of Surgery and in particular, the activities in the operating room. These activities are governed by the master surgical schedule (MSS), which states which patient types receive surgery on which day. In this paper, we

Comparison of surgical and non-surgical orthodontic treatment approaches on occlusal and cephalometric outcomes in patients with Class II Division I malocclusions

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Sheila Daniels

2017-07-01

Full Text Available Abstract Background This study aimed to examine end-of-treatment outcomes of severe Class II Division I malocclusion patients treated with surgical or non-surgical approaches. This study tests the hypotheses that occlusal outcomes (ABO-OGS and cephalometric outcomes differ between these groups. Methods A total of 60 patients were included: 20 of which underwent surgical correction and 40 of which did not. Cast grading of initial and final study models was performed and information was gathered from pre- to post-treatment cephalometric radiographs. The end-of-treatment ABO-OGS and cephalometric outcomes were compared to Mann-Whitney U tests and multivariable linear regression models. Results Following adjustment for multiple confounders (age, gender, complexity of case, and skeletal patterns, the final deband score (ABO-OGS was similar for both groups (23.8 for surgical group versus 22.5 for non-surgical group. Those treated surgically had a significantly larger reduction in ANB angle, 3.4° reduction versus 1.5° reduction in the non-surgical group (p = 0.002. The surgical group also showed increased maxillary incisor proclination (p = 0.001 compared to the non-surgical group. This might be attributed to retroclination of maxillary incisors during treatment selection in the non-surgical group—namely, extraction of premolars to mask the discrepancy. Conclusions Those treated surgically had a significantly larger reduction in ANB angle and increased maxillary incisor proclination compared to those treated non-surgically with no significant changes in occlusal outcomes.

People's Risk Recognition Preceding Evacuation and Its Role in Demand Modeling and Planning.

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Urata, Junji; Pel, Adam J

2018-05-01

Evacuation planning and management involves estimating the travel demand in the event that such action is required. This is usually done as a function of people's decision to evacuate, which we show is strongly linked to their risk awareness. We use an empirical data set, which shows tsunami evacuation behavior, to demonstrate that risk recognition is not synonymous with objective risk, but is instead determined by a combination of factors including risk education, information, and sociodemographics, and that it changes dynamically over time. Based on these findings, we formulate an ordered logit model to describe risk recognition combined with a latent class model to describe evacuation choices. Our proposed evacuation choice model along with a risk recognition class can evaluate quantitatively the influence of disaster mitigation measures, risk education, and risk information. The results obtained from the risk recognition model show that risk information has a greater impact in the sense that people recognize their high risk. The results of the evacuation choice model show that people who are unaware of their risk take a longer time to evacuate. © 2017 Society for Risk Analysis.

Selection of oncoplastic surgical technique in Asian breast cancer patients

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Eui Sun Shin

2018-01-01

Full Text Available Background Oncoplastic surgery is being increasingly performed in Korean women; however, unlike Westerners, Korean women usually have small to moderate-sized breasts. To achieve better outcomes in reconstructed breasts, several factors should be considered to determine the optimal surgical method. Methods A total of 108 patients who underwent oncoplastic surgery from January 2013 to December 2016 were retrospectively investigated. We used various methods, including glandular tissue reshaping, latissimus dorsi (LD flap transposition, and reduction oncoplasty, to restore the breast volume and symmetry. Results The mean weight of the tumor specimens was 40.46 g, and the ratio of the tumor specimen weight to breast volume was 0.12 g/mL in the patients who underwent glandular tissue reshaping (n=59. The corresponding values were 101.47 g and 0.14 g/mL, respectively, in the patients who underwent reduction oncoplasty (n=17, and 82.54 g and 0.20 g/mL, respectively, in those treated with an LD flap (n=32. Glandular tissue reshaping was mostly performed in the upper outer quadrant, and LD flap transposition was mostly performed in the lower inner quadrant. No major complications were noted. Most patients were satisfied with the aesthetic results. Conclusions We report satisfactory outcomes of oncoplastic surgical procedures in Korean patients. The results regarding specimen weight and the tumor-to-breast ratio of Asian patients will be a helpful reference point for determining the most appropriate oncoplastic surgical technique.

Application of fire and evacuation models in evaluation of fire safety in railway tunnels

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Cábová, Kamila; Apeltauer, Tomáš; Okřinová, Petra; Wald, František

2017-09-01

The paper describes an application of numerical simulation of fire dynamics and evacuation of people in a tunnel. The software tool Fire Dynamics Simulator is used to simulate temperature resolution and development of smoke in a railway tunnel. Comparing to temperature curves which are usually used in the design stage results of the model show that the numerical model gives lower temperature of hot smoke layer. Outputs of the numerical simulation of fire also enable to improve models of evacuation of people during fires in tunnels. In the presented study the calculated high of smoke layer in the tunnel is in 10 min after the fire ignition lower than the level of 2.2 m which is considered as the maximal limit for safe evacuation. Simulation of the evacuation process in bigger scale together with fire dynamics can provide very valuable information about important security conditions like Available Safe Evacuation Time (ASET) vs Required Safe Evacuation Time (RSET). On given example in software EXODUS the paper summarizes selected results of evacuation model which should be in mind of a designer when preparing an evacuation plan.

An indoor augmented reality mobile application for simulation of building evacuation

Science.gov (United States)

Sharma, Sharad; Jerripothula, Shanmukha

2015-03-01

Augmented Reality enables people to remain connected with the physical environment they are in, and invites them to look at the world from new and alternative perspectives. There has been an increasing interest in emergency evacuation applications for mobile devices. Nearly all the smart phones these days are Wi-Fi and GPS enabled. In this paper, we propose a novel emergency evacuation system that will help people to safely evacuate a building in case of an emergency situation. It will further enhance knowledge and understanding of where the exits are in the building and safety evacuation procedures. We have applied mobile augmented reality (mobile AR) to create an application with Unity 3D gaming engine. We show how the mobile AR application is able to display a 3D model of the building and animation of people evacuation using markers and web camera. The system gives a visual representation of a building in 3D space, allowing people to see where exits are in the building through the use of a smart phone or tablets. Pilot studies were conducted with the system showing its partial success and demonstrated the effectiveness of the application in emergency evacuation. Our computer vision methods give good results when the markers are closer to the camera, but accuracy decreases when the markers are far away from the camera.

Evacuation of mixed populations from trains on bridges

DEFF Research Database (Denmark)

Kindler, C.; Sørensen, J.G.; Dederichs, A.S.

2012-01-01

An understanding of human evacuation dynamics and performance are important when designing complex buildings such as bridges and when applying performance-based codes in order to reduce the risk of exposing occupants to critical conditions in case of fire. The majority of previous studies deal....... The discussion of "equal access" is only followed slowly by the demand on "equal egress". However, the passengers on trains on bridges are rarely homogeneous mixture. At the same time equal egress is far from assured today. In this paper the evacuation of mixed populations from trains on bridges are considered....... The populations applied in the experiment are mixed according to a composition corresponding to the population of Denmark. The study has the following findings: the total evacuation times increase with a factor 1.5 when accounting for a mixed population comprehending a variety of age and impairments. The seating...

Predictive Score Card in Lumbar Disc Herniation: Is It Reflective of Patient Surgical Success after Discectomy?

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Parisa Azimi

Full Text Available Does the Finneson-Cooper score reflect the true value of predicting surgical success before discectomy? The aim of this study was to identify reliable predictors for surgical success two year after surgery for patients with LDH. Prospective analysis of 154 patients with LDH who underwent single-level lumbar discectomy was performed. Pre- and post-surgical success was assessed by the Oswestry Disability Index (ODI over a 2-year period. The Finneson-Cooper score also was used for evaluation of the clinical results. Using the ODI, surgical success was defined as a 30% (or more improvement on the ODI score from the baseline. The ODI was considered the gold standard in this study. Finally, the sensitivity, specificity, and positive and negative predictive power of the Finneson-Cooper score in predicting surgical success were calculated. The mean age of the patients was 49.6 (SD = 9.3 years and 47.4% were male. Significant improvement from the pre- to post-operative ODI scores was observed (P < 0.001. Post-surgical success was 76.0% (n = 117. The patients' rating on surgical success assessments by the ODI discriminated well between sub-groups of patients who differed with respect to the Finneson-Cooper score. Regarding patients' surgical success, the sensitivity, specificity, and accuracy of the Finneson-Cooper ratings correlated with success rate. The findings indicated that the Finneson-Cooper score was reflective of surgical success before discectomy.

Radioisotopic monitoring of esophageal motility in patients with achalasia cardiae after surgical treatment

International Nuclear Information System (INIS)

Tran Dinh Ha; Szilvasi, J.

1994-01-01

Results of the radioisotope esophageal motility studies in patients after surgical treatment of achalasia are presented. 28 patients were studied. In both group of the patients (after Belsey-Mark and modified Nissen antireflux surgical techniques) slightly delayed esophageal transit time was found. Mean transit time of the esophagus proved to be a useful practical parameter. This simple, noninvasive, physiological radioisotope technique is recommended for follow-up studies of patients after gastroesophageal surgery. (N.T.). 10 refs., 2 figs

Household evacuation characteristics in American Samoa during the 2009 Samoa Islands tsunami

Science.gov (United States)

Apatu, Emma J. I.; Gregg, Chris E.; Wood, Nathan J.; Wang, Liang

2016-01-01

Tsunamis represent significant threats to human life and development in coastal communities. This quantitative study examines the influence of household characteristics on evacuation actions taken by 211 respondents in American Samoa who were at their homes during the 29 September 2009 Mw 8.1 Samoa Islands earthquake and tsunami disaster. Multiple logistic regression analysis of survey data was used to examine the association between evacuation and various household factors. Findings show that increases in distance to shoreline were associated with a slightly decreased likelihood of evacuation, whereas households reporting higher income had an increased probability of evacuation. The response in American Samoa was an effective one, with only 34 fatalities in a tsunami that reached shore in as little as 15 minutes. Consequently, future research should implement more qualitative study designs to identify event and cultural specific determinants of household evacuation behaviour to local tsunamis.

Virtual environment simulation as a tool to support evacuation planning

International Nuclear Information System (INIS)

Mol, Antonio C.; Grecco, Claudio H.S.; Santos, Isaac J.A.L.; Carvalho, Paulo V.R.; Jorge, Carlos A.F.; Sales, Douglas S.; Couto, Pedro M.; Botelho, Felipe M.; Bastos, Felipe R.

2007-01-01

This work is a preliminary study of the use of a free game-engine as a tool to build and to navigate in virtual environments, with a good degree of realism, for virtual simulations of evacuation from building and risk zones. To achieve this goal, some adjustments in the game engine have been implemented. A real building with four floors, consisting of some rooms with furniture and people, has been virtually implemented. Simulations of simple different evacuation scenarios have been performed, measuring the total time spent in each case. The measured times have been compared with their corresponding real evacuation times, measured in the real building. The first results have demonstrated that the virtual environment building with the free game engine is capable to reproduce the real situation with a satisfactory level. However, it is important to emphasize that such virtual simulations serve only as an aid in the planning of real evacuation simulations, and as such must never substitute the later. (author)

Radioisotope monitoring of gastro-esophageal reflux in patients with achalasia cardiae after surgical treatment

International Nuclear Information System (INIS)

Tran Dinh Ha; Szilvasi, J.

1994-01-01

Results of a radioisotope method of the gastro-esophageal reflux are presented in patients with achalasia cardiae after different types of surgical treatment. Both Belsey-Mark and modified Nissen techniques are effective in preventing spontaneous gastroesophageal reflux, however 2 patients after Nissen fundoplication demonstrated gastro-esophageal reflux provoked by abdominal compression. This simple, noninvasive and physiologic method is an appropriate diagnostic tool for evaluating the efficiency of different anti reflux surgical techniques and is recommended for follow-up studies of patients after gastro-esophageal surgical intervention. (N.T.). 8 refs., 1 fig

The Group Evacuation Behavior Based on Fire Effect in the Complicated Three-Dimensional Space

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Jun Hu

2014-01-01

Full Text Available In order to effectively depict the group evacuation behavior in the complicated three-dimensional space, a novel pedestrian flow model is proposed with three-dimensional cellular automata. In this model the calculation methods of floor field and fire gain are elaborated at first, and the transition gain of target position at the next moment is defined. Then, in consideration of pedestrian intimacy and velocity change, the group evacuation strategy and evolution rules are given. Finally, the experiments were conducted with the simulation platform to study the relationships of evacuation time, pedestrian density, average system velocity, and smoke spreading velocity. The results had shown that large-scale group evacuation should be avoided, and in case of large pedestrian density, the shortest route of evacuation strategy would extend system evacuation time.

Preoperative imaging and surgical margins in maxillectomy patients

NARCIS (Netherlands)

Kreeft, Anne Marijn; Smeele, Ludwig E.; Rasch, Coen R. N.; Hauptmann, Michael; Rietveld, Derk H. F.; Leemans, C. René; Balm, Alfons J. M.

2012-01-01

Background High rates of positive surgical margins are reported after a maxillectomy. A large part of tumors that are preoperatively considered operable can thus not be resected with tumor-free margins. Methods This was a retrospective study on medical files of 69 patients that underwent

Prevalence of Recognised and Unrecognised Depression among Medical and Surgical Patients in a Tertiary Care Hospital

International Nuclear Information System (INIS)

Rahman, A. S.; Jamal, Q.; Riaz, M.

2015-01-01

Objective: To observe the prevalence of recognised and unrecognised depression among in-patients. Methods: The cross-sectional study was conducted from June 2012 to May 2013 at a tertiary care hospital in Karachi, and comprised patients admitted in the Medicine and Surgical departments at the time. Patients with known history of depression or on anti-depressants or on anti-psychotics, or with suicidal attempt were excluded. The prevalence of unrecognised depression was then perceived using Patient Health Qurstionnaire-9. Statistical analysis was performed using SPSS 20. Results: Of the 1180 patients, 432(36.6 percent) either had history of depression or on were on anti-depressants. The study sample, as such, comprised 748(65 percent), and of them 399(53 percent) were from the Medicine and 349(47 percent) patients were from Surgery department. Prevalence of recognised depression was 36.6 percent; 48 percent in Medical and 14 percent in Surgical patients. Unrecognised depression was 51.2 percent; 45.3 percent in Medical and 53.6 in Surgical patients. Overall prevalence was 87.9 percent; 93.4 percent in Medical and 53 percent in Surgical patients. Gender was not found to be significantly associated with depression in Medical (p= 0.367) and Surgical (p=0.606) patients. No depression was found in 48(12 percent) Medical patients and 131(37.5 percent) Surgical patients. Conclusion: More than one-third of in-patients had co-morbid depression diagnoses, mostly unrecognised by their clinicians. (author)

Evaluation of the effect of cognitive therapy on perioperative anxiety and depression among Nigerian surgical patients.

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Osinowo, H O; Olley, B O; Adejumo, A O

2003-12-01

Surgical paients have been known to benefit immensely from psychological interventions. This study set out to assess the pre and postoperative anxiety levels and depression and the effect of cognitive therapy among Nigerian surgical patients. The effects of gender and educational status on perioperative anxiety and depression were also evaluated. The study utilized a controlled outcome design to evaluate the efficacy of self-instructional training (SIT) and rational emotive therapy (RET) in surgical patients. Preoperative anxiety and depression scores were used as co-variants. Thirty-three (33) elective surgical patients were sampled randomly, divided into 3 groups of eleven (11) patients each. Eight (8) subjects underwent gynaecological procedures while the remaining 25 subjects had general surgical procedures. The mean age was 32.72 +/- 15.83 years (range = 17-16 years.) The major instruments used in the study were the State Anxiety Subscale of the Speilberger State Trait Anxiety Inventory (STAI) and Hospital Anxiety and Depression Inventory. SIT had the potential to reduce anxiety level among subjects postoperatively (t = 2.06; df = 10; p < 0.05). The use of RET reduced depression among surgical patients (t = 1.23; df = 10; p < 0.05). It was concluded that surgical patients manifest varying degrees of anxiety preoperatively and postoperatively. Patient's pre and postoperative anxiety and depression can be reduced by the introduction of SIT and RET.

Management of brain abscess by open evacuation of pus: a comparative study of cases between 1985-90 and 1998-99

International Nuclear Information System (INIS)

Qureshi, N.A.; Munir, A.J.

2001-01-01

Two hospital studies were carried out at the combined Military Hospital, Rawalpindi from August, 1985-August, 1990 and later from April, 1998-june, 1999 to evaluate the open evacuation of pus in the management of brain abscess. The first study (group A 1985-1990) included 16 cases. Out of these, 10 cases were managed by open evacuation method. The Second study (group B 1998-1999) included 18 cases, out of which 16 cases where managed by open method. The age of patients ranged between 9 years to 50 years (mean 19 years) in the first group and between 4 months to 36 years (mean 20 years ) in the second group. Majority of the patients had a good glasgow coma score. The pre-treatment neurological status, site and size of the abscess, etiology and pus cultures were analysed. CT scan was the investigation of choice, Inferences were drawn as regard to the postoperative morbidity and mortality in all the patients treated by this method. It was clearly seen that open evacuation of pus had a definite edge in the management of brain abscess especially in those setups where CT scans are not freely available. (author)

Advanced evacuation model managed through fuzzy logic during an accident in LNG terminal

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Stankovicj, Goran; Petelin, Stojan [Faculty for Maritime Studies and Transport, University of Ljubljana, Portorozh (Sierra Leone); others, and

2014-07-01

Evacuation of people located inside the enclosed area of an LNG terminal is a complex problem, especially considering that accidents involving LNG are potentially very hazardous. In order to create an evacuation model managed through fuzzy logic, extensive influence must be generated from safety analyses. A very important moment in the optimal functioning of an evacuation model is the creation of a database which incorporates all input indicators. The output result is the creation of a safety evacuation route which is active at the moment of the accident. (Author)

Is there a Relationship between Patient Satisfaction and Favorable Surgical Outcomes?

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Tevis, Sarah E.; Kennedy, Gregory D.; Kent, K. Craig

2015-01-01

Summary Satisfaction of patients with their health care is gaining importance as a measure of hospital quality due to public reporting of these values and an increasing connection between hospital reimbursement and scores on the current tool to measure satisfaction, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. We found that high hospital and surgical volume and low rates of risk-adjusted mortality are associated with high patient satisfaction. However, other favorable patient outcomes are not consistently associated with positive satisfaction scores on HCAHPS. Contributors to patients' perceptions of their care are likely multifactorial and not related just to outcomes traditionally assessed by surgeons or hospitals. Moving in a direction of patient centered care, with a focus on increased understanding and involvement of patients in the care process, will likely strengthen the relationship between surgical outcomes and patient satisfaction. PMID:26299501

SCALING AN URBAN EMERGENCY EVACUATION FRAMEWORK: CHALLENGES AND PRACTICES

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Karthik, Rajasekar [ORNL; Lu, Wei [ORNL

2014-01-01

Critical infrastructure disruption, caused by severe weather events, natural disasters, terrorist attacks, etc., has significant impacts on urban transportation systems. We built a computational framework to simulate urban transportation systems under critical infrastructure disruption in order to aid real-time emergency evacuation. This framework will use large scale datasets to provide a scalable tool for emergency planning and management. Our framework, World-Wide Emergency Evacuation (WWEE), integrates population distribution and urban infrastructure networks to model travel demand in emergency situations at global level. Also, a computational model of agent-based traffic simulation is used to provide an optimal evacuation plan for traffic operation purpose [1]. In addition, our framework provides a web-based high resolution visualization tool for emergency evacuation modelers and practitioners. We have successfully tested our framework with scenarios in both United States (Alexandria, VA) and Europe (Berlin, Germany) [2]. However, there are still some major drawbacks for scaling this framework to handle big data workloads in real time. On our back-end, lack of proper infrastructure limits us in ability to process large amounts of data, run the simulation efficiently and quickly, and provide fast retrieval and serving of data. On the front-end, the visualization performance of microscopic evacuation results is still not efficient enough due to high volume data communication between server and client. We are addressing these drawbacks by using cloud computing and next-generation web technologies, namely Node.js, NoSQL, WebGL, Open Layers 3 and HTML5 technologies. We will describe briefly about each one and how we are using and leveraging these technologies to provide an efficient tool for emergency management organizations. Our early experimentation demonstrates that using above technologies is a promising approach to build a scalable and high performance urban

Analysis of sheltering and evacuation strategies for an urban nuclear detonation scenario.

Energy Technology Data Exchange (ETDEWEB)

Yoshimura, Ann S.; Brandt, Larry D.

2009-05-01

Development of an effective strategy for shelter and evacuation is among the most important planning tasks in preparation for response to a low yield, nuclear detonation in an urban area. This study examines shelter-evacuate policies and effectiveness focusing on a 10 kt scenario in Los Angeles. The goal is to provide technical insights that can support development of urban response plans. Results indicate that extended shelter-in-place can offer the most robust protection when high quality shelter exists. Where less effective shelter is available and the fallout radiation intensity level is high, informed evacuation at the appropriate time can substantially reduce the overall dose to personnel. However, uncertainties in the characteristics of the fallout region and in the exit route can make evacuation a risky strategy. Analyses indicate that only a relatively small fraction of the total urban population may experience significant dose reduction benefits from even a well-informed evacuation plan.

An interval-parameter mixed integer multi-objective programming for environment-oriented evacuation management

Science.gov (United States)

Wu, C. Z.; Huang, G. H.; Yan, X. P.; Cai, Y. P.; Li, Y. P.

2010-05-01

Large crowds are increasingly common at political, social, economic, cultural and sports events in urban areas. This has led to attention on the management of evacuations under such situations. In this study, we optimise an approximation method for vehicle allocation and route planning in case of an evacuation. This method, based on an interval-parameter multi-objective optimisation model, has potential for use in a flexible decision support system for evacuation management. The modeling solutions are obtained by sequentially solving two sub-models corresponding to lower- and upper-bounds for the desired objective function value. The interval solutions are feasible and stable in the given decision space, and this may reduce the negative effects of uncertainty, thereby improving decision makers' estimates under different conditions. The resulting model can be used for a systematic analysis of the complex relationships among evacuation time, cost and environmental considerations. The results of a case study used to validate the proposed model show that the model does generate useful solutions for planning evacuation management and practices. Furthermore, these results are useful for evacuation planners, not only in making vehicle allocation decisions but also for providing insight into the tradeoffs among evacuation time, environmental considerations and economic objectives.

Surgical treatment in lumbar spondylolisthesis: experience with 45 patients

International Nuclear Information System (INIS)

Pasha, I.; Haider, I.Z.; Qureshi, M.A.; Malik, A.S.

2012-01-01

Background: Spondylolithesis is forward slipping of upper vertebra in relation to its lower one, which at times requires surgery. The objective of present study is to document the outcome of surgical treatment in spondylolisthesis of lumbosacral region. Methods: We reviewed outcome of surgery in 45 patients with spondylolisthesis. Improvement in pain intensity, neurological status and union achieved after surgery was studied. All patients requiring surgical treatment were included in the study. The patients were operated by single spine surgeon. A proforma was made for each patient and records were kept in a custom built Microsoft access database. Results: Majority of our patient were in 4th and 5th decade with some male domination. Pain was main indication for surgery which was excruciating in 6, severe in 33, and moderate in 6 cases. The neurological status was normal in 34 cases while 11 patients had some deficit. L5-S1 was affected in 26, L4-L5 in 13 and multi or high level was found in rest of cases. Slip grade was measured with Meyerding grades, 18 had grade II, 15 had I, 9 had III and 3 had IV spondylolisthesis. Posterior lumbar inter body fusion (PLIF) was done in 24 patients, posterolateral, transforaminal lumbar inter body and anterior inter body fusion in others. Translaminar screw fixation, transpedicular transdiscal transcorporial and Delta fixation in some cases. Pedicle screw fixation was done in most cases, AO fixator internae and 4.5 mm screw in others. Average follow up was 2 years and 5 months, max 5 years and minimum 6 months. Pain relief was achieved in 82%, neurological improvement 60% and union in 91% cases. There was no deterioration of neurological status, two implant failure and one wound infection. Conclusion: Surgical procedure for Spondylolisthesis must be individualised. Young patients with spondylolysis can be treated with osteosynthesis and sparing of motion segment. PLIF provides satisfactory results in majority of low to moderate

Adult surgical emergencies in a developing country: the experience of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.

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Chianakwana, Gabriel U; Ihegihu, Chima C; Okafor, Pius I S; Anyanwu, Stanley N C; Mbonu, Okechukwu O

2005-06-01

The goal of this study was to examine the adult surgical emergencies seen at the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, with a view to proffering preventive solutions where appropriate and improving outcome. From the register of patients seen at the Casualty department and from the operations register in the main operation room of NAUTH, names and hospital numbers of adult patients treated as emergencies over a 5-year period, from 7 September 1998 to 6 September 2003, were obtained. The hospital folders were then retrieved from the Records Department. From each folder, the following details about each patient were extracted: age, sex, diagnosis at presentation, causative factors, treatment given, and outcome. A total of 902 adult patients were treated during the period. The commonest emergency operation was appendectomy for acute appendicitis in 139 patients (97 women and 42 men), followed closely by road traffic accidents (RTAs) involving 137 patients (103 men and 34 women). Gunshot injuries, which resulted mainly from armed robbery attacks, accounted for 127 cases. More men (113) sustained gunshot injuries than women (14). Of the 92 cases of acute intestinal obstruction seen, 62 occurred in women and 30 in men. Some 126 men presented with acute urinary retention, and two others presented with priapism. Governments at various levels should provide modern diagnostic tools for the accurate preoperative diagnosis of surgical emergencies in hospitals. Governments should also inculcate strict discipline into drivers using the highways, particularly in relation to abuse of alcohol and drugs. Good roads and adequate security should be provided for the people. The need for Pre-Hospital Care for the efficient evacuation of accident victims is emphasized. These measures will help to improve the management and outcome of surgical emergencies, and decrease the number of surgical emergencies resulting from RTAs and gunshot wounds.

Early waning and evacuation from Tsunami, volcano, flood and other hazards

Science.gov (United States)

Sugimoto, M.

2012-12-01

In reconsideration of the great sacrifice among the people, evacuation calls for evacuation through Japan Meteorological Agency (JMA), local governments and Medias have been drastically changed after the 2011 Tohoku tsunami in Japan. One of example is that JMA changed from forecasted concrete figure of tsunami height to one of 3 levels of tsunami height. A data shows the border between life and death is just 2 minutes of earlier evacuation in case of the 2011 tsunami. It shows how importance for communities to prompt early evacuation for survivals. However, the 2011 Tohoku tsunami revealed there is no reliable trigger to prompt early evacuation to people in case of blackout under disasters, excluding effective education. The warning call was still complicated situations in Japan in July 2012. The 2012 Northern Kyusyu downpours was at worst around 110 millimeters an hour and casualties 30 in Japan. JMA learned from the last tsunami. In this time JMA informed to local governments as a waning call "Unexpected severe rains" to local governments. However, local governments did not notice the call from JMA in the same as usual informed way. One of the local government said "We were very busy for preparing for staffs. We looked at the necessary information of the water levels of rivers and flood prevention under emergent situation" (NHK 2012). This case shows JMA's evacuation calls from upstream to midstream of local government and downstream of communities started, however upstream calls have not engaged with midstream and communities yet. Calls of early warning from upstream is still a self-centered idea for both midstream and downstream. Finally JMA could not convey a crisis mentality to local government. The head of Oarai town independently decided to use the different warning call "Order townspersons to evacuate immediately" in Ibaraki prefecture, Japan from the other municipalities in 2011 though there was not such a manuals calls in Japan. This risk communication

Reflection on Lessons Learned: An Analysis of the Adverse Outcomes Observed During the Hurricane Rita Evacuation.

Science.gov (United States)

Baker, Karen

2018-02-01

In September 2005, nearly 3.7 million people evacuated the Texas coastline in advance of Hurricane Rita's landfall, making the event the largest emergency evacuation in US history. The Rita evacuation underscored the importance of planning for domestic mass-evacuation events, as the evacuation itself led to over 100 of the at least 119 deaths attributed to the storm. In the days preceding Rita's landfall, several cascading, interrelated circumstances precipitated such adverse outcomes. This article explores the series of events leading up to the evacuation's poor outcomes, the response following Rita to amend evacuation plans, and how Texas successfully implemented these changes during later storms to achieve better outcomes. (Disaster Med Public Health Preparedness. 2018;12:115-120).

A Dynamic Optimization Method of Indoor Fire Evacuation Route Based on Real-time Situation Awareness

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DING Yulin

2016-12-01

Full Text Available How to provide safe and effective evacuation routes is an important safeguard to correctly guide evacuation and reduce the casualties during the fire situation rapidly evolving in complex indoor environment. The traditional static path finding method is difficult to adjust the path adaptively according to the changing fire situation, which lead to the evacuation decision-making blindness and hysteresis. This paper proposes a dynamic method which can dynamically optimize the indoor evacuation routes based on the real-time situation awareness. According to the real-time perception of fire situation parameters and the changing indoor environment information, the evacuation route is optimized dynamically. The integrated representation of multisource indoor fire monitoring sensor observations oriented fire emergency evacuation is presented at first, real-time fire threat situation information inside building is then extracted from the observation data of multi-source sensors, which is used to constrain the dynamical optimization of the topology of the evacuation route. Finally, the simulation experiments prove that this method can improve the accuracy and efficiency of indoor evacuation routing.

SURGICAL TREATMENT OF POLYCYSTIC OVARIES IN INFERTILE PATIENTS

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Martina Ribič Pucelj

2003-12-01

Full Text Available Background. Polycystic ovaries (PCO are manifested either independently or as a syndrome (PCOS. They are one of the commonest endocrinopathy in women of reproductive age. Despite a variable clinical picture one of the leading symptoms is infertility for anovulation. Surgical treatment of the disease witnessed a revival after the introduction of minimally invasive operative laparoscopy. Various techniques of ovarian tissue destruction have been applied, the most common being laparoscopic electrocoagulation of the ovaries (LECO. The aim of this retrospective study was to assess the pregnancy rates and pregnancy outcomes following LECO.Patients and methods. From 1993 and 2000 inclusive LECO was performed at the Reproductive Unit, Department of Obstetrics and Gynecology Ljubljana in 222 infertile patients with PCO(S, in whom previous medical ovulation induction failed or in whom overreaction of the ovaries to gonadotropin treatment occurred. To the questionnaire, mailed to the patients, 185 (83.3% responded. The evaluation of the outcome of LECO treatment involved 157 patients, since the patients who underwent in vitro fertilization (IVF-ET treatment for other causes of infertility prior to LECO, were exclude from the analysis. LECO was performed under general endotracheal anesthesia using a 3-puncture technique. On each ovary 5– 15 (mean 10 punctures were made with a monopolar electric needle, energy of 300 W, and duration of 4 seconds. Statistical analysis was done using Chi-square test and odds ratios.Results. After LECO 99 (63.3% of the 157 patients conceived, 56 (54.6% spontaneously and 43 (45.4% after additional postoperative ovarian stimulation. Pregnancy was registered in 58 (59.0% patients with primary, and in 41 (41% patients with secondary infertility, in 20 (57% patients with PCO, 79 (65% with PCOS, in 71 (64.1% patients with a normal partner’s spermiogram, and in 28 (46.1% patients with the partner’s oligoasthenoteratospermia of

Patient engagement with surgical site infection prevention: an expert panel perspective

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E. Tartari

2017-05-01

Full Text Available Abstract Despite remarkable developments in the use of surgical techniques, ergonomic advancements in the operating room, and implementation of bundles, surgical site infections (SSIs remain a substantial burden, associated with increased morbidity, mortality and healthcare costs. National and international recommendations to prevent SSIs have been published, including recent guidelines by the World Health Organization, but implementation into clinical practice remains an unresolved issue. SSI improvement programs require an integrative approach with measures taken during the pre-, intra- and postoperative care from the numerous stakeholders involved. The current SSI prevention strategies have focused mainly on the role of healthcare workers (HCWs and procedure related risk factors. The importance and influence of patient participation is becoming an increasingly important concept and advocated as a means to improve patient safety. Novel interventions supporting an active participative role within SSI prevention programs have not been assessed. Empowering patients with information they require to engage in the process of SSI prevention could play a major role for the implementation of recommendations. Based on available scientific evidence, a panel of experts evaluated options for patient involvement in order to provide pragmatic recommendations for pre-, intra- and postoperative activities for the prevention of SSIs. Recommendations were based on existing guidelines and expert opinion. As a result, 9 recommendations for the surgical patient are presented here, including a practice brief in the form of a patient information leaflet. HCWs can use this information to educate patients and allow patient engagement.

Patient engagement with surgical site infection prevention: an expert panel perspective.

Science.gov (United States)

Tartari, E; Weterings, V; Gastmeier, P; Rodríguez Baño, J; Widmer, A; Kluytmans, J; Voss, A

2017-01-01

Despite remarkable developments in the use of surgical techniques, ergonomic advancements in the operating room, and implementation of bundles, surgical site infections (SSIs) remain a substantial burden, associated with increased morbidity, mortality and healthcare costs. National and international recommendations to prevent SSIs have been published, including recent guidelines by the World Health Organization, but implementation into clinical practice remains an unresolved issue. SSI improvement programs require an integrative approach with measures taken during the pre-, intra- and postoperative care from the numerous stakeholders involved. The current SSI prevention strategies have focused mainly on the role of healthcare workers (HCWs) and procedure related risk factors. The importance and influence of patient participation is becoming an increasingly important concept and advocated as a means to improve patient safety. Novel interventions supporting an active participative role within SSI prevention programs have not been assessed. Empowering patients with information they require to engage in the process of SSI prevention could play a major role for the implementation of recommendations. Based on available scientific evidence, a panel of experts evaluated options for patient involvement in order to provide pragmatic recommendations for pre-, intra- and postoperative activities for the prevention of SSIs. Recommendations were based on existing guidelines and expert opinion. As a result, 9 recommendations for the surgical patient are presented here, including a practice brief in the form of a patient information leaflet. HCWs can use this information to educate patients and allow patient engagement.

[Class III surgical patients facilitated by accelerated osteogenic orthodontic treatment].

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Wu, Jia-qi; Xu, Li; Liang, Cheng; Zou, Wei; Bai, Yun-yang; Jiang, Jiu-hui

2013-10-01

To evaluate the treatment time and the anterior and posterior teeth movement pattern as closing extraction space for the Class III surgical patients facilitated by accelerated osteogenic orthodontic treatment. There were 10 skeletal Class III patients in accelerated osteogenic orthodontic group (AOO) and 10 patients in control group. Upper first premolars were extracted in all patients. After leveling and alignment (T2), corticotomy was performed in the area of maxillary anterior teeth to accelerate space closing.Study models of upper dentition were taken before orthodontic treatment (T1) and after space closing (T3). All the casts were laser scanned, and the distances of the movement of incisors and molars were digitally measured. The distances of tooth movement in two groups were recorded and analyzed. The alignment time between two groups was not statistically significant. The treatment time in AOO group from T2 to T3 was less than that in the control group (less than 9.1 ± 4.1 months). The treatment time in AOO group from T1 to T3 was less than that in the control group (less than 6.3 ± 4.8 months), and the differences were significant (P 0.05). Accelerated osteogenic orthodontic treatment could accelerate space closing in Class III surgical patients and shorten preoperative orthodontic time. There were no influence on the movement pattern of anterior and posterior teeth during pre-surgical orthodontic treatment.

Prospective validation of a surgical complications grading system in a cohort of 2114 patients.

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Mazeh, Haggi; Cohen, Oded; Mizrahi, Ido; Hamburger, Tamar; Stojadinovic, Alexander; Abu-Wasel, Bassam; Alaiyan, Bilal; Freund, Herbert R; Eid, Ahmed; Nissan, Aviram

2014-05-01

We recently reported a grading system for surgical complications. This system proved to have a high sensitivity for recording minor but meaningful complications prolonging hospital stay in patients after colorectal surgery. We aimed to prospectively validate the complication grading system in a general surgery department over 1 year. All surgical procedures and related complications were prospectively recorded between January 1st and December 31st, 2009. Surgical complications were graded on a severity scale of 1-5. The system classifies short-term outcome by grade emphasizing intensity of therapy required for treatment of the defined complication. During the study period, 2114 patients underwent surgery. Elective and oncological surgeries were performed in 1606 (76%) and 465 (22%) patients, respectively. There were 422 surgical complications in 304 (14%) patients (Grade 1/2: 203 [67%]; Grade 3/4: 90 [29%]; Grade 5: 11 [4%]). Median length of stay correlated significantly with complication severity: 2.3 d for no complication, 6.2 and 11.8 d for Grades 1/2 and 3/4, respectively (P 2 (OR 2.07, P Grade (OR 1.85, P = 0.001), oncological (OR 2.82, P 120 min (OR 2.08, P grading surgical complications permits standardized reporting of surgical morbidity according to the severity of impact. Prospective validation of this system supports its use in a general surgery setting as a tool for surgical outcome assessment and quality assurance. Copyright © 2014 Elsevier Inc. All rights reserved.

Use of α-Lipoic Acid and Benfotiamine for Correction of Disturbance of Gastric Motor-Evacuation Function in Type 1 Diabetic Patients

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I.O. Kostitska

2015-09-01

Full Text Available The therapeutic effectiveness of α-lipoic acid and benfotiamine in treating symptoms of gastroparesis in type 1 diabetic patients was evaluated. Pathogenetic correlations between increased concentration of peripheral myelin protein and a decrease in the gastric motor-evacuation function were determined. The results of a three-month course of pathogenetic therapy demonstrate the effectiveness of combination therapy which is not associated with an improved compensation of carbohydrate and lipid metabolism. It is a result of the direct effect of preparations on the investigated metabolic processes and restoration of myelination of the nerve fibers.

Adherence to the use of the surgical checklist for patient safety

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Eliane Cristina Sanches Maziero

Full Text Available Objective: Evaluate adherence to the checklist of the Programa Cirurgias Seguras (safe surgery programme at a teaching hospital. Methods: Evaluative study conducted at a teaching hospital in the south of Brazil in 2012. Data were collected by means of non-participant observation in 20 hip and knee replacement surgeries and an instrument that was created for research based on the checklist and used by the institution. Results: In the observed procedures (n = 20 there was significant adhesion (p<0.05 to the instrument in relation to the verification of documentation, fasting, hair removal in the surgical site, absence of nail varnish and accessories, identification of the patient and surgical site on admission to the surgical unit, availability of blood and functionality of materials. However, there was no significant adherence to the checklist in the operating room in relation to patient identification, procedure and laterality, team introduction, surgical break and materials count. Conclusion: The results showed that the items on the checklist were verified nonverbally and there was no significant adherence to the instrument.

Pedestrian and Evacuation Dynamics 2005

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Gattermann, Peter; Knoflacher, Hermann; Schreckenberg, Michael

2007-01-01

Due to an increasing number of reported catastrophes all over the world, the safety especially of pedestrians today, is a dramatically growing field of interest, both for practitioners as well as scientists from various disciplines. The questions arising mainly address the dynamics of evacuating people and possible optimisations of the process by changing the architecture and /or the procedure. This concerns not only the case of ships, stadiums or buildings, all with restricted geometries, but also the evacuation of complete geographical regions due to natural disasters. Furthermore, also ‘simple’ crowd motion in ‘relaxed’ situations poses new questions with respect to higher comfort and efficiency since the number of involved persons at large events is as high as never before. In addition, as a new research topic in this field, collective animal behaviour is attracting increasing attention. All this was in the scope of the conference held in Vienna, September 28–30, 2005, the third one in a series ...

Evacuation Route: Restoring the Railway Transportation of People During the Great Patriotic War

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Potemkina Marina Nikolaevna

2015-11-01

Full Text Available The paper is devoted to the role of the railway transport in migration from the frontline to the Soviet rear during the Great Patriotic War. The research is based on the analysis of the published and archival documents, personal diaries, letters, memoirs, texts of interview with the people who lived through the evacuation. The methodological foundation of the research was based on the theoretical principles made by the Everyday History. Surge attack of the German troops and cruel occupational policy caused the necessity of evacuation of civilians to the Eastern regions of the country. The evacuation was both spontaneous and organized and helped to save millions of human lives. The lack of evacuation plans in case of a war, incompleteness of the railway transport renovation, transport routes destroyed by the enemy and the stream of refugees were among the main factors which complicated evacuation process. The conditions of transportation differed according to the time and the circumstances of the evacuation and a person’s position in social hierarchy. There were some problems during the evacuation, such as regulation of the rail service, sanitation of the carriages, nutrition system, psychological shock. People had to spend weeks in the carriages suffering from cold, hunger and diseases. During the evacuation a new alternative reality appeared with its rules and regulations which changed the concepts of tangible assets and moral values. The priority for any person was to survive, which meant to be independent and to do everything possible.

Success of single-balloon enteroscopy in patients with surgically altered anatomy.

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Kurzynske, Frank C; Romagnuolo, Joseph; Brock, Andrew S

2015-08-01

Single-balloon enteroscopy (SBE) was introduced in 2007 to diagnose and treat small-bowel disorders. No study to date has evaluated SBE in patients with surgically altered anatomy outside of ERCP. To evaluate the efficacy, yield, and safety of SBE in patients with surgically altered anatomy. Retrospective study. Tertiary-care academic medical center. All patients with altered surgical anatomy who underwent SBE at the Medical University of South Carolina from July 2007 to September 2013. SBE. Diagnostic yield, therapeutic yield, technical success, and adverse events. A total of 48 patients met inclusion criteria. Mean age was 56 years (77% female). Eleven patients underwent single-balloon PEG placement, 8 single-balloon ERCP, 22 non-PEG/non-ERCP anterograde SBE, and 7 retrograde SBE. Previous surgeries included Roux-en-Y gastric bypass (n=26), small-intestine resection (n=6), colon resection (n=5), Whipple procedure (n=4), choledochojejunostomy (n=3), hepaticojejunostomy (n=1), Billroth I (n=1), Billroth II (n=1), and Puestow procedure (n=1). Procedural indications were PEG tube placement (n=11), choledocholithiasis (n=2), biliary stricture (n=2), obstructive jaundice (n=1), cholangitis (n=1), ampullary mass (n=1), sphincter of Oddi dysfunction (n=1), anemia and/or bleeding (n=15), abdominal pain (n=9), radiologic evidence of obstruction (n=3), and Peutz-Jeghers syndrome (n=2). The technical success rate was 73% in single-balloon PEG placement, 88% in single-balloon ERCP, 82% in other anterograde SBEs, and 86% in retrograde SBEs. No intraprocedural or postprocedural adverse events were observed. Single center, retrospective study. SBE is safe and effective in patients with surgically altered anatomy. Copyright © 2015 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Surgical Management Of Porencephalic Cyst In Patients With ...

African Journals Online (AJOL)

Objective: To detect the ability of surgical management of porencephalic cyst to control intractable epilepsy. Methods: Five patients diagnosed with porencephalic cyst causing epilepsy that could not be controlled with adequate dosing of three anti-epileptic drugs were included in the study. The study included four males ...

Surgical Patients\\' Knowledge and Acceptance of Autologous Blood ...

African Journals Online (AJOL)

Background: Homologous blood transfusion carries a well-documented array of risks especially in an HIV endemic environment like Nigeria. It is therefore imperative to consider other forms of restoring blood volume in surgical patients. Autologous blood transfusion (ABT) is one of the ways the problem of HIV transmission ...

Emergency canine surgery in a deployed forward surgical team: a case report.

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Beitler, Alan L; Jeanette, Joseph P; McGraw, Andrew L; Butera, Jennifer R; Vanfosson, Christopher A; Seery, Jason M

2011-04-01

Forward surgical teams (FSTs) perform a variety of non-doctrinal functions. During their deployment to Afghanistan, the 541st FST (Airborne) performed emergency surgery on a German shepherd military working dog (MWD). Retrospective examination of a case of veterinary surgery in a deployed FST. A 5 1/2-year-old German shepherd MWD presented with extreme lethargy, tachycardia, excessive drooling, and a firm, distended abdomen. These conditions resulted from gastric dilatation with volvulus. Since evacuation to a veterinarian was untenable, emergency laparotomy was performed in the FST. The gastric dilatation with volvulus was treated by detorsion and gastropexy, and the canine patient fully recovered. Canine surgery can be safely performed in an FST. Based on the number of MWDs deployed throughout the theater, FSTs may be called upon to care for them in the absence of available veterinary care.

Integrating Decentralized Indoor Evacuation with Information Depositories in the Field

Directory of Open Access Journals (Sweden)

Haifeng Zhao

2017-07-01

Full Text Available The lonelier evacuees find themselves, the riskier become their wayfinding decisions. This research supports single evacuees in a dynamically changing environment with risk-aware guidance. It deploys the concept of decentralized evacuation, where evacuees are guided by smartphones acquiring environmental knowledge and risk information via exploration and knowledge sharing by peer-to-peer communication. Peer-to-peer communication, however, relies on the chance that people come into communication range with each other. This chance can be low. To bridge between people being not at the same time at the same places, this paper suggests information depositories at strategic locations to improve information sharing. Information depositories collect the knowledge acquired by the smartphones of evacuees passing by, maintain this information, and convey it to other passing-by evacuees. Multi-agent simulation implementing these depositories in an indoor environment shows that integrating depositories improves evacuation performance: It enhances the risk awareness and consequently increases the chance that people survive and reduces their evacuation time. For evacuating dynamic events, deploying depositories at staircases has been shown more effective than deploying them in corridors.

Photodynamic therapy in surgical treatment of patients by a skin melanom

Directory of Open Access Journals (Sweden)

G. I. Gafton

2013-01-01

Full Text Available In experimental and clinical research carried out studying of influence of neoadjyuvant photodynamic therapy on T- and B-cellular immune answer in surgical treatment of patients of a melanoma of skin of the I–III stage. PDT was executed to 25 patients two days prior to surgical removal of primary tumor from July, 2012 to January, 2013. As a result of the conducted research it was revealed that: the increase in concentration fotoditaziny doesn‘t lead to increase in quantity of tumoral cages at stages early apoptosis; lengthening of time of an exposition leads to increase in a share of late forms apoptosis, and FDT use with fotoditaziny in a dose of 50,0 mg with the subsequent radiation (662 nanometers, 400 J in 2 days prior to surgical intervention promotes T- and B-cellular link of immune system.

Quantifying surgical complexity with machine learning: looking beyond patient factors to improve surgical models.

Science.gov (United States)

Van Esbroeck, Alexander; Rubinfeld, Ilan; Hall, Bruce; Syed, Zeeshan

2014-11-01

To investigate the use of machine learning to empirically determine the risk of individual surgical procedures and to improve surgical models with this information. American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) data from 2005 to 2009 were used to train support vector machine (SVM) classifiers to learn the relationship between textual constructs in current procedural terminology (CPT) descriptions and mortality, morbidity, Clavien 4 complications, and surgical-site infections (SSI) within 30 days of surgery. The procedural risk scores produced by the SVM classifiers were validated on data from 2010 in univariate and multivariate analyses. The procedural risk scores produced by the SVM classifiers achieved moderate-to-high levels of discrimination in univariate analyses (area under receiver operating characteristic curve: 0.871 for mortality, 0.789 for morbidity, 0.791 for SSI, 0.845 for Clavien 4 complications). Addition of these scores also substantially improved multivariate models comprising patient factors and previously proposed correlates of procedural risk (net reclassification improvement and integrated discrimination improvement: 0.54 and 0.001 for mortality, 0.46 and 0.011 for morbidity, 0.68 and 0.022 for SSI, 0.44 and 0.001 for Clavien 4 complications; P risk for individual procedures. This information can be measured in an entirely data-driven manner and substantially improves multifactorial models to predict postoperative complications. Copyright © 2014 Elsevier Inc. All rights reserved.

A novel grid-based mesoscopic model for evacuation dynamics

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Shi, Meng; Lee, Eric Wai Ming; Ma, Yi

2018-05-01

This study presents a novel grid-based mesoscopic model for evacuation dynamics. In this model, the evacuation space is discretised into larger cells than those used in microscopic models. This approach directly computes the dynamic changes crowd densities in cells over the course of an evacuation. The density flow is driven by the density-speed correlation. The computation is faster than in traditional cellular automata evacuation models which determine density by computing the movements of each pedestrian. To demonstrate the feasibility of this model, we apply it to a series of practical scenarios and conduct a parameter sensitivity study of the effect of changes in time step δ. The simulation results show that within the valid range of δ, changing δ has only a minor impact on the simulation. The model also makes it possible to directly acquire key information such as bottleneck areas from a time-varied dynamic density map, even when a relatively large time step is adopted. We use the commercial software AnyLogic to evaluate the model. The result shows that the mesoscopic model is more efficient than the microscopic model and provides more in-situ details (e.g., pedestrian movement pattern) than the macroscopic models.

Efficacy of promethazine suppositories dispensed to outpatient surgical patients.

Science.gov (United States)

Wright, C. D.; Jilka, J.; Gentry, W. B.

1998-01-01

Postoperative nausea and vomiting frequently complicate outpatient anesthesia and surgery. The duration of treatment for this complication must occasionally extend beyond discharge from the hospital. In this study, we evaluated the commonly used anti-emetic promethazine for its efficacy in the post-discharge period. Adult outpatient surgical patients who had excessive postoperative nausea and vomiting in the recovery room, or who were at risk for postoperative nausea and vomiting following discharge were given two promethazine suppositories (25 mg) for home use. All patients were contacted by our recovery room nurses on the first business day after their surgery and questioned as to their use of the suppositories and, if used, their efficacy. We found that 55 percent of patients given promethazine suppositories for home use had nausea and vomiting in the post-discharge period. Of the patients given promethazine, 89 percent used the suppositories. All of these patients reported improvement in their symptoms following use of the suppositories. None reported adverse effects from the promethazine suppositories. In conclusion, we found promethazine suppositories to be an inexpensive and efficacious treatment for nausea and vomiting in adult outpatient surgical patients following discharge from the hospital. Side-effects were minimal, and our patients voiced no complaints about this mode of therapy. We recommend this therapy for treatment of nausea and vomiting after hospital discharge following adult outpatient surgery. PMID:10527366

Role of RENAL nephrometry scoring system in planning surgical intervention in patients with localized renal mas

OpenAIRE

Mohamed Samir Shaaban; Tamer Mohammed Abou Youssif; Ahmed Mostafa; Hossam Eldin Hegazy; Mohammed Adel Atta

2015-01-01

Purpose: The study was designed to validate the value of preoperative planning using RENAL nephrometry scoring system in patients having organ confined renal tumors and undergoing surgical intervention and to assess its correlation with the surgical technique. Patient and methods: Forty patients with organ-confined renal masses underwent RENAL nephrometry scoring which was correlated with the surgical technique either radical or nephron-sparing surgery. Result: RENAL nephrometry scoring...

Enhancing Evacuation Plans with a Situation Awareness System Based on End-User Knowledge Provision

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Augusto Morales

2014-06-01

Full Text Available Recent disasters have shown that having clearly defined preventive procedures and decisions is a critical component that minimizes evacuation hazards and ensures a rapid and successful evolution of evacuation plans. In this context, we present our Situation-Aware System for enhancing Evacuation Plans (SASEP system, which allows creating end-user business rules that technically support the specific events, conditions and actions related to evacuation plans. An experimental validation was carried out where 32 people faced a simulated emergency situation, 16 of them using SASEP and the other 16 using a legacy system based on static signs. From the results obtained, we compare both techniques and discuss in which situations SASEP offers a better evacuation route option, confirming that it is highly valuable when there is a threat in the evacuation route. In addition, a study about user satisfaction using both systems is presented showing in which cases the systems are assessed as satisfactory, relevant and not frustrating.

High-frequency ultrasound in carpal tunnel syndrome: assessment of patient eligibility for surgical treatment

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Katarzyna Kapuścińska

2015-09-01

Full Text Available Carpal tunnel syndrome (CTS is the most common entrapment neuropathy and a frequent cause of sick leaves because of work-related hand overload. That is why an early diagnosis and adequate treatment (conservative or surgical are essential for optimal patient management. Aim: The aim of the study is to assess the usefulness of high-frequency ultrasound in CTS for the assessment of patient eligibility for surgical treatment. Material and methods: The study involved 62 patients (50 women and 12 men, aged 28–70, mean age 55.2 with scheduled surgeries of CTS on the basis of clinical symptoms, physical examination performed by a neurosurgeon and a positive result of EMG testing. The ultrasound examinations of the wrist were performed in all these patients. On the basis of the collected data, the author has performed multiple analyses to confi rm the usefulness of ultrasound imaging in assessing patient eligibility for surgical treatment of CTS. Results: US examinations showed evidence of median nerve compression at the level of the carpal tunnel in all of the examined patients. This was further confi rmed during surgical procedures. The mean value of the cross-sectional area at the proximal part of the pisiform bone was 17.45 mm2 (min. 12 mm2 , max. 31 mm2 . Nerve hypoechogenicity proximal to the nerve compression site was visible in all 62 patients (100%. Increased nerve vascularity on the transverse section was present in 50 patients (80.65%. Conclusions: Ultrasonography with the use of high-frequency transducers is a valuable diagnostic tool both for assessing patient eligibility for surgical treatment of CTS, and in postoperative assessment of the treatment efficacy.

Visitors’ awareness of the tsunami evacuation plan in Pasar Raya Padang, Indonesia

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Kemal, B. M.; Yosritzal; Purnawan; Putra, H.

2018-04-01

This paper presents an investigation into the visitors’ awareness of the tsunami evacuation plan at Pasar Raya Padang, a traditional market at the central business district of Padang City, Indonesia. This study has been motivated by the fact that Pasar Raya Padang is the largest traditional market in West Sumatera and visited by many visitors from various origins. Pasar Raya Padang is chosen because it is located at a tsunami prone area, but local government managed to keep businesses in the area running and attract visitors. The awareness of the people in the market would be crucial to increase the possibility to safe their life during an evacuation. As much as 500 respondents were interviewed during daytime in the market. The study found that most of the visitors are not aware of the tsunami evacuation plan in the area. Local government is suggested to develop standard procedure for the evacuation, to place more sign and make it more visible for most of the visitors and do evacuation simulations periodically.

Surgical patient selection and counseling.

Science.gov (United States)

Ziegelmann, Matt; Köhler, Tobias S; Bailey, George C; Miest, Tanner; Alom, Manaf; Trost, Landon

2017-08-01

The objectives of patient selection and counseling are ultimately to enhance successful outcomes. However, the definition for success is often narrowly defined in published literature (ability to complete surgery, complications, satisfaction) and fails to account for patient desires and expectations, temporal changes, natural history of underlying diseases, or independent validation. Factors associated with satisfaction and dissatisfaction are often surgery-specific, although correlation with pre-operative expectations, revisions, and complications are common with most procedures. The process of appropriate patient selection is determined by the integration of patient and surgeon factors, including psychological capacity to handle unsatisfactory results, baseline expectations, complexity of case, and surgeon volume and experience. Using this model, a high-risk scenario includes one in which a low-volume surgeon performs a complex case in a patient with limited psychological capacity and high expectations. In contrast, a high-volume surgeon performing a routine case in a male with low expectations and abundant psychiatric reserve is more likely to achieve a successful outcome. To further help identify patients who are at high risk for dissatisfaction, a previously published mnemonic is recommended: CURSED Patient (compulsive/obsessive, unrealistic, revision, surgeon shopping, entitled, denial, and psychiatric). Appropriate patient counseling includes setting appropriate expectations, reviewing the potential and anticipated risks of surgery, post-operative instruction to limit complications, and long-term follow-up. As thorough counseling is often a time-consuming endeavor, busy practices may elect to utilize various resources including educational materials, advanced practice providers, or group visits, among others. The consequences for poor patient selection and counseling may range from poor surgical outcomes and patient dissatisfaction to lawsuits, loss of

[Qualified and emergency specialized surgical care for those with wounds to the extremities].

Science.gov (United States)

Iurkevich, V V; Fidarov, E Z; Bauér, V A

1997-06-01

Experience of organization of the surgical care in the military hospital to 438 wounded in extremities during armed conflict in Republic of Chechnya is generalized. Maximum reduction of stages of medical evacuation of the wounded in extremities, approaching of the qualified and urgent specialized surgical care directly to the region of battle actions, use of opportunities for it one-moment rendering corresponded to principles of the modern military-medical doctrine. Due to realization of the requirements of the doctrine life of many wounded ++ was saved, terms of treatment, medical and social rehabilitation are reduced. Besides lethality, treatment cost and numbers of transferring to the reserve from the Armed Forces were reduced.

Interventional and surgical treatment of a hemothorax caused by a ruptured vertebral artery in a patient with neurofibromatosis type I

Energy Technology Data Exchange (ETDEWEB)

Lee, Ji Hoon; Kim, Dong Hun; Kim, Dong Hyun; Seo, Hong Joo [Chosun University College of Medicine, Gwangju (Korea, Republic of)

2014-04-15

We report a case of a massive hemothorax arising from a ruptured vertebral artery aneurysm in a patient with neurofibromatosis type 1 suffering from sudden onset of dyspnea. The vertebral artery aneurysm was treated with endovascular coil embolization. Then, an open thoracotomy was performed to evacuate the hematoma.

Prediction of evacuation time for emergency planning zone of Uljin nuclear site

International Nuclear Information System (INIS)

Jeon, In Young; Lee, Jai Ki

2002-01-01

The time for evacuation of residents in Emergency Planning Zone (EPZ) of Uljin nuclear site in case of a radiological emergency was estimated with traffic analysis. Evacuees were classified into 4 groups by considering population density, local jurisdictions, and whether they are residents or transients. The survey to investigate the behavioral characteristics of the residents was made for 200 households and included a hypothetical scenario explaining the accident situation and questions such as dwelling place, time demand for evacuation preparation, transportation means for evacuation, sheltering place, and evacuation direction. The microscopic traffic simulation model, CORSIM, was used to simulate the behavior of evacuating vehicles on networks. The results showed that the evacuation time required for total vehicles to move out from EPZ took longer in the daytime than at night in spite that the delay times at intersections were longer at night than in the daytime. This was analyzed due to the differences of the trip generation time distribution. To validate whether the CORSIM model can appropriately simulate the congested traffic phenomena assumable in case of emergency, a benchmark study was conducted at an intersection without an actuated traffic signal near Uljin site during the traffic peak-time in the morning. This study indicated that the predicted output by the CORSIM model was in good agreement with the observed data, satisfying the purpose of this study

Urokinase vs Tissue-Type Plasminogen Activator for Thrombolytic Evacuation of Spontaneous Intracerebral Hemorrhage in Basal Ganglia

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Yuqian Li

2017-08-01

Full Text Available Spontaneous intracerebral hemorrhage (ICH is a devastating form of stroke, which leads to a high rate of mortality and poor neurological outcomes worldwide. Thrombolytic evacuation with urokinase-type plasminogen activator (uPA or tissue-type plasminogen activator (tPA has been showed to be a hopeful treatment for ICH. However, to the best of our knowledge, no clinical trials were reported to compare the efficacy and safety of these two fibrinolytics administrated following minimally invasive stereotactic puncture (MISP in patients with spontaneous basal ganglia ICH. Therefore, the authors intended here to evaluate the differential impact of uPA and tPA in a retrospective study. In the present study, a total of 86 patients with spontaneous ICH in basal ganglia using MISP received either uPA (uPA group, n = 45 or tPA (tPA group, n = 41, respectively. The clinical baseline characteristics prior to the operation were collected. In addition, therapeutic responses were assessed by the short-term outcomes within 30 days postoperation, as well as long-term outcomes at 1 year postoperation. Our findings showed that, in comparison with tPA, uPA was able to better promote hematoma evacuation and ameliorate perihematomal edema, but the differences were not statistically significant. Moreover, the long-term functional outcomes of both groups were similar, with no statistical difference. In conclusion, these results provide evidence supporting that uPA and tPA are similar in the efficacy and safety for thrombolytic evacuation in combination with MISP in patients with spontaneous basal ganglia ICH.

Measuring patient participation in surgical treatment decision-making from healthcare professionals' perspective.

Science.gov (United States)

Heggland, Liv-Helen; Mikkelsen, Aslaug; Øgaard, Torvald; Hausken, Kjell

2014-02-01

To develop, empirical test, and validate an instrument measuring patient participation in surgical treatment decision-making from healthcare professionals' perspective. Since the advent of New Public Management in many Western countries, patient participation in healthcare decision-making has been considered to be a best practice. A common notion is that well-educated and well-informed public want to choose their own treatments and providers and want to ask questions about the quality of their health services. Survey. A self-report-measuring instrument was designed and administered to 620 healthcare professionals. Items were developed, validated and tested by 451 nurses and physicians working in six surgical wards in a University Hospital in Norway. A 16-item scale with the following four dimensions was developed: information dissemination, formulation of options, integration of information and control. Factor analysis procedures and reliability testing were performed. A one-way, between-groups analysis of variance was conducted to compare doctors' and nurses' opinions on four dimensions of patient participation in surgical treatment decision-making. This article shows that patient participation in surgical treatment decision-making can be measured by a 16-item scale and four distinct dimensions. The analysis demonstrated a reasonable level of construct validity and reliability. Nurses and physicians have a positive attitude towards patient participation overall, but the two groups differ in the extent to which they accept the idea of patient participation in treatment decision-making. The instrument can be a tool for managers and healthcare professionals in the implementation of patient participation in clinical practice. Data from the instrument can be useful to identify health services being provided and what areas that could strengthen patient participation. © 2013 Blackwell Publishing Ltd.

The effects of meal size, body size and temperature on gastric evacuation in pikeperch

DEFF Research Database (Denmark)

Koed, Anders

2001-01-01

Prey size had no effect on the gastric evacuation rate of pikeperch Stizostedion lucioperca. The gastric evacuation was adequately described applying an exponent of 0.5 in the power model. Applying length instead of weight of pikeperch in the gastric evacuation model resulted in a change of estim...

Canada's evacuation policy for pregnant First Nations women: Resignation, resilience, and resistance.

Science.gov (United States)

Lawford, Karen M; Giles, Audrey R; Bourgeault, Ivy L

2018-02-10

Aboriginal peoples in Canada are comprised of First Nations, Métis, and Inuit. Health care services for First Nations who live on rural and remote reserves are mostly provided by the Government of Canada through the federal department, Health Canada. One Health Canada policy, the evacuation policy, requires all First Nations women living on rural and remote reserves to leave their communities between 36 and 38 weeks gestational age and travel to urban centres to await labour and birth. Although there are a few First Nations communities in Canada that have re-established community birthing and Aboriginal midwifery is growing, most First Nations communities are still reliant on the evacuation policy for labour and birthing services. In one Canadian province, Manitoba, First Nations women are evacuated to The Pas, Thompson, or Winnipeg but most - including all women with high-risk pregnancies - go to Winnipeg. To contribute scholarship that describes First Nations women's and community members' experiences and perspectives of Health Canada's evacuation policy in Manitoba. Applying intersectional theory to data collected through 12 semi-structured interviews with seven women and five community members (four females, one male) in Manitoba who had experienced the evacuation policy. The data were analyzed thematically, which revealed three themes: resignation, resilience, and resistance. The theme of resignation was epitomized by the quote, "Nobody has a choice." The ability to withstand and endure the evacuation policy despite poor or absent communication and loneliness informed of resilience. Resistance was demonstrated by women who questioned the necessity and requirement of evacuation for labour and birth. In one instance, resistance took the form of a planned homebirth with Aboriginal registered midwives. There is a pressing need to improve the maternity care services that First Nations women receive when they are evacuated out of their communities, particularly

A generic method to optimize instructions for the control of evacuations

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