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Sample records for surgical technology unit

  1. Acute surgical unit: The consultant experience

    Directory of Open Access Journals (Sweden)

    Patrick J Stokes

    2016-07-01

    Full Text Available Background Establishment of the Acute Surgical Unit (ASU has redefined the approach to emergency surgery in Australia with quantitative data showing improvement in patient outcomes. However, as qualitative data regarding the ASU remains scarce, we sought to determine the impact of the ASU on overall surgeon job satisfaction. Aims The aim of this paper was to specifically address the impact of the ASU on consultant surgeons overall job satisfaction. Methods We designed a 34 – item questionnaire with consultant general surgeons addressing important aspects of the ASU. Themes included on – call rostering and workload, academic pursuits, surgical training, work – life balance and overall job satisfaction. Results We received responses from 88 surgeons currently working on ASU units, responding correctly and in full to the survey. Overall, our surveyed cohort reported better on – call rostering, improved surgical training and higher levels of job satisfaction and overall work – life balance with ASU implementation. Conclusion Preliminary qualitative results indicate that the ASU may improve on – call rostering, work – life balance and overall job satisfaction.

  2. A cost evaluation methodology for surgical technologies.

    Science.gov (United States)

    Ismail, Imad; Wolff, Sandrine; Gronfier, Agnes; Mutter, Didier; Swanström, Lee L; Swantröm, Lee L

    2015-08-01

    To create and validate a micro-costing methodology that surgeons and hospital administrators can use to evaluate the cost of implementing innovative surgical technologies. Our analysis is broken down into several elements of fixed and variable costs which are used to effectively and easily calculate the cost of surgical operations. As an example of application, we use data from 86 robot assisted gastric bypass operations made in our hospital. To validate our methodology, we discuss the cost reporting approaches used in 16 surgical publications with respect to 7 predefined criteria. Four formulas are created which allow users to import data from their health system or particular situation and derive the total cost. We have established that the robotic surgical system represents 97.53 % of our operating room's medical device costs which amounts to $4320.11. With a mean surgery time of 303 min, personnel cost per operation amounts to $1244.73, whereas reusable instruments and disposable costs are, respectively, $1539.69 and $3629.55 per case. The literature survey demonstrates that the cost of surgery is rarely reported or emphasized, and authors who do cover this concept do so with variable methodologies which make their findings difficult to interpret. Using a micro-costing methodology, it is possible to identify the cost of any new surgical procedure/technology using formulas that can be adapted to a variety of operations and healthcare systems. We hope that this paper will provide guidance for decision makers and a means for surgeons to harmonise cost reporting in the literature.

  3. Discharge from an emergency department observation unit and a surgical assessment unit

    DEFF Research Database (Denmark)

    Schultz, Helen; Qvist, Niels; Backer Mogensen, Christian;

    2014-01-01

    To investigate the experiences of patients with acute abdominal pain at discharge from an emergency department observation unit compared with discharge from a surgical assessment unit.......To investigate the experiences of patients with acute abdominal pain at discharge from an emergency department observation unit compared with discharge from a surgical assessment unit....

  4. Application Technology Research Unit

    Data.gov (United States)

    Federal Laboratory Consortium — To conduct fundamental and developmental research on new and improved application technologies to protect floricultural, nursery, landscape, turf, horticultural, and...

  5. Surgical Technology Integration with Tools for Cognitive Human Factors (STITCH)

    Science.gov (United States)

    2010-10-01

    endoscope. 2. Bi-channel Stereo Scope: Intuitive Surgical’s da Vinci ® Surgical System is a robotic surgical platform. As such, it is capable of handling...with two separate lenses embedded inside a single tube. The da Vinci ® Surgical System incorporates high-definition technology at a resolution of...data of using the software on the Da vinci and Vista laparoscopes. The models used are human phantom models. In the table the test is done via two

  6. Caring for migrant farm workers on medical-surgical units.

    Science.gov (United States)

    Anthony, Maureen J

    2011-01-01

    Over 3 million migrant farm workers are employed in the United States. Many factors place them at risk for work-related disease and injury. Knowledge of workers' health issues can prepare medical-surgical nurses to anticipate and meet the needs of this underserved population.

  7. Managing a surgical unit using google drive - a feasibility study

    Directory of Open Access Journals (Sweden)

    Ashley Solomon C.

    2016-10-01

    Conclusions: It is feasible to use google drive as a patient management system by a surgical unit to organise work. This system is efficient, secure and cost effective. [Int J Res Med Sci 2016; 4(10.000: 4365-4369

  8. Empiric therapy for pneumonia in the surgical intensive care unit.

    Science.gov (United States)

    Fabian, T C

    2000-02-01

    Empiri c therapy of ventilator-associated pneumonia (VAP) in surgical patients should be based on intensive care unit (ICU)-specific surveillance data, because microbial flora patterns vary widely between geographic regions as well as within hospitals. Surgical ICUs have higher VAP rates than other units. Data from the National Nosocomial Infection Surveillance (NNIS) System report Pseudomonas aeruginosa and Staphylococcus aureus to be the most frequent isolates (each 17.4%). Data from the NNIS documents high resistance patterns in ICUs compared with hospitals at large, as well as unit-specific patterns. VAP risk factors for surgical patients include thoracoabdominal surgery, altered level of consciousness, advanced age, diabetes mellitus, malnutrition, chronic obstructive pulmonary disease, and prior antibiotic administration. Promising prevention strategies include restricting ventilator circuit changes, in-line heat moisture exchange filters, semi-recumbant positioning, and continuous subglottic aspiration. Pharmacodynamics should be considered when choosing antibiotic regimens. Postantibiotic effect and time-dependent versus concentration-dependent killing should be studied in clinical trials. Current guidelines for choosing regimens have been well developed by the American Thoracic Society.

  9. Assessment methods in surgical training in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Evgenios Evgeniou

    2013-02-01

    Full Text Available A career in surgery in the United Kingdom demands a commitment to a long journey of assessment. The assessment methods used must ensure that the appropriate candidates are selected into a programme of study or a job and must guarantee public safety by regulating the progression of surgical trainees and the certification of trained surgeons. This review attempts to analyse the psychometric properties of various assessment methods used in the selection of candidates to medical school, job selection, progression in training, and certification. Validity is an indicator of how well an assessment measures what it is designed to measure. Reliability informs us whether a test is consistent in its outcome by measuring the reproducibility and discriminating ability of the test. In the long journey of assessment in surgical training, the same assessment formats are frequently being used for selection into a programme of study, job selection, progression, and certification. Although similar assessment methods are being used for different purposes in surgical training, the psychometric properties of these assessment methods have not been examined separately for each purpose. Because of the significance of these assessments for trainees and patients, their reliability and validity should be examined thoroughly in every context where the assessment method is being used.

  10. [Perspective technologies of surgical care to the wounded].

    Science.gov (United States)

    Samokhvalov, I M; Badalov, V I; Reva, V A; Golovko, K P; Petrov, A N; Kaznacheev, M V; Rozov, A I

    2013-06-01

    A goal of this study is to review perspective technologies of surgical care to the wounded on the basis of an analysis of the experience in medical support in local armed conflicts and a study of the achievements of modern trauma surgery. The study is based on the analysis of personal experience, results of scientific researches being carried out in the Military Medical Academy and a comparison review of available papers and works in the field of our study. Perspective technologies of surgical care to the wounded are strongly dependent on the pre-hospital care: high technologies in personal medical equipment, special disposable devices used in case of life-threatening consequences of injuries and traumas during emergency medical care and advanced trauma management. The main innovation of the last ten years in war surgery is considered to be damage control surgery. Wide application of abbreviated surgical operations (the first phase of damage control surgery) makes the use of remote surgery (telesurgery) for treatment of the wounded more practicable. Increasing effectiveness of military surgeon education is based on the use of all possible achievements in education and information technologies. Feedback in surgical care to the wounded is supplied with analysis of its results in the medical Register of the wounded military.

  11. The application of digital surgical diagnosis and treatment technology: a promising strategy for surgical reconstruction of craniomaxillofacial defect and deformity.

    Science.gov (United States)

    Wang, Li-ya; Du, Hong-ming; Zhang, Gang; Tang, Wei; Liu, Lei; Jing, Wei; Long, Jie

    2011-12-01

    The craniomaxillofacial defect and deformity always leads to serious dysfunction in mastication and facial contour damage, significantly reducing patients' quality of life. However, surgical reconstruction of a craniomaxillofacial hard tissue defect or deformity is extremely complex and often does not result in desired facial morphology. Improving the result for patients with craniomaxillofacial defect and deformity remains a challenge for surgeons. Using digital technology for surgical diagnosis and treatment may help solve this problem. Computer-assisted surgical technology and surgical navigation technology are included in the accurate digital diagnosis and treatment system we propose. These technologies will increase the accuracy of the design of the operation plan. In addition, the intraoperative real-time navigating location system controlling the robotic arm or advanced intelligent robot will provide accurate, individualized surgical treatment for patients. Here we propose the hypothesis that a digital surgical diagnosis and treatment technology may provide a new approach for precise surgical reconstruction of complicated craniomaxillofacial defect and deformity. Our hypothesis involves modern digital surgery, a three-dimensional navigation surgery system and modern digital imaging technology, and our key aim is to establish a technological platform for customized digital surgical design and surgical navigation for craniomaxillofacial defect and deformity. If the hypothesis is proven practical, this novel therapeutic approach could improve the result of surgical reconstruction for craniomaxillofacial defect and deformity for many patients.

  12. Technological Innovations in Surgical Approach for Thyroid Cancer

    Directory of Open Access Journals (Sweden)

    Brian Hung-Hin Lang

    2010-01-01

    Full Text Available Over the last decade, surgeons have witnessed dramatic changes in surgical practice as a result of the introduction of new technological advancement. Some of these changes include refinement of techniques in thyroid cancer surgery. The development of various endoscopic thyroidectomy techniques, the addition of the da Vinci robot, and the use of operative adjuncts in thyroid surgery, such as intraoperative neuromonitoring and quick intraoperative parathyroid hormone, have made thyroid cancer surgery not only safer and better accepted by patients with thyroid cancer but also offer them more surgical treatment options.

  13. Family experience survey in the surgical intensive care unit.

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    Twohig, Bridget; Manasia, Anthony; Bassily-Marcus, Adel; Oropello, John; Gayton, Matthew; Gaffney, Christine; Kohli-Seth, Roopa

    2015-11-01

    The experience of critical care is stressful for both patients and their families. This is especially true when patients are not able to make their own care decisions. This article details the creation of a Family Experience Survey in a surgical intensive care unit (SICU) to capture and improve overall experience. Kolcaba's "Enhanced Comfort Theory" provided the theoretical basis for question formation, specifically in regards to the four aspects of comfort: "physical," "psycho-spiritual," "sociocultural" and "environmental." Survey results were analyzed in real-time to identify and implement interventions needed for issues raised. Overall, there was a high level of satisfaction reported especially with quality of care provided to patients, communication and availability of nurses and doctors, explanations from staff, inclusion in decision making, the needs of patients being met, quality of care provided to patients and cleanliness of the unit. It was noted that 'N/A' was indicated for cultural needs and spiritual needs, a chaplain now rounds on all patients daily to ensure these services are more consistently offered. In addition, protocols for doctor communication with families, palliative care consults, daily bleach cleaning of high touch areas in patient rooms and nurse-led progressive mobility have been implemented. Enhanced comfort theory enabled the opportunity to identify and provide a more 'broad' approach to care for patients and families. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. New technologies and surgical innovation: five years of a local health technology assessment program in a surgical department.

    Science.gov (United States)

    Poulin, Paule; Austen, Lea; Kortbeek, John B; Lafrenière, René

    2012-06-01

    There is pressure for surgical departments to introduce new and innovative health technologies in an evidence-based manner while ensuring that they are safe and effective and can be managed with available resources. A local health technology assessment (HTA) program was developed to systematically integrate research evidence with local operational management information and to make recommendations for subsequent decision by the departmental executive committee about whether and under what conditions the technology will be used. The authors present a retrospective analysis of the outcomes of this program as used by the Department of Surgery & Surgical Services in the Calgary Health Region over a 5-year period from December 2005 to December 2010. Of the 68 technologies requested, 15 applications were incomplete and dropped, 12 were approved, 3 were approved for a single case on an urgent/emergent basis, 21 were approved for "clinical audit" for a restricted number of cases with outcomes review, 14 were approved for research use only, and 3 were referred to additional review bodies. Subsequent outcome reports resulted in at least 5 technologies being dropped for failure to perform. Decisions based on local HTA program recommendations were rarely "yes" or "no." Rather, many technologies were given restricted approval with full approval contingent on satisfying certain conditions such as clinical outcomes review, training protocol development, or funding. Thus, innovation could be supported while ensuring safety and effectiveness. This local HTA program can be adapted to a variety of settings and can help bridge the gap between evidence and practice.

  15. The incidence, root-causes, and outcomes of adverse events in surgical units: implication for potential prevention strategies

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    Groenewegen Peter P

    2011-05-01

    Full Text Available Abstract Background We need to know the scale and underlying causes of surgical adverse events (AEs in order to improve the safety of care in surgical units. However, there is little recent data. Previous record review studies that reported on surgical AEs in detail are now more than ten years old. Since then surgical technology and quality assurance have changed rapidly. The objective of this study was to provide more recent data on the incidence, consequences, preventability, causes and potential strategies to prevent AEs among hospitalized patients in surgical units. Methods A structured record review study of 7,926 patient records was carried out by trained nurses and medical specialist reviewers in 21 Dutch hospitals. The aim was to determine the presence of AEs during hospitalizations in 2004 and to consider how far they could be prevented. Of all AEs, the consequences, responsible medical specialty, causes and potential prevention strategies were identified. Surgical AEs were defined as AEs attributable to surgical treatment and care processes and were selected for analysis in detail. Results Surgical AEs occurred in 3.6% of hospital admissions and represented 65% of all AEs. Forty-one percent of the surgical AEs was considered to be preventable. The consequences of surgical AEs were more severe than for other types of AEs, resulting in more permanent disability, extra treatment, prolonged hospital stay, unplanned readmissions and extra outpatient visits. Almost 40% of the surgical AEs were infections, 23% bleeding, and 22% injury by mechanical, physical or chemical cause. Human factors were involved in the causation of 65% of surgical AEs and were considered to be preventable through quality assurance and training. Conclusions Surgical AEs occur more often than other types of AEs, are more often preventable and their consequences are more severe. Therefore, surgical AEs have a major impact on the burden of AEs during hospitalizations

  16. Quality of life after stay in surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Castro Maria A

    2007-07-01

    Full Text Available Abstract Background In addition to mortality, Health Related Quality of Life (HRQOL has increasingly been claimed as an important outcome variable. The aim of this study was to assess HRQOL and independence in activities of daily living (ADL six months after discharge from an Intensive Care Unit (ICU, and to study its determinants. Methods All post-operative adult patients admitted to a surgical ICU between October 2004 and July 2005, were eligible for the study. The following variables were recorded on admission: age, gender, American Society of Anesthesiologists physical status (ASA-PS, type and magnitude of surgical procedure, ICU and hospital length of stay (LOS, mortality and Simplified Acute Physiology Score II (SAPS II. Six months after discharge, a Short Form-36 questionnaire (SF-36 and a questionnaire to assess dependency in ADL were sent to all survivors. Descriptive statistics was used to summarize data. Patient groups were compared using non-parametric tests. A logistic regression analysis was performed to identify covariate effects of each variable on dependency in personal and instrumental ADL, and for the change-in-health question of SF-36. Results Out of 333 hospital survivors, 226 completed the questionnaires. Fifty-nine percent reported that their general level of health was better on the day they answered the questionnaire than 12 months earlier. Patients with greater co-morbidities (ASA-PS III/IV, had lower SF-36 scores in all domains and were more frequently dependent in instrumental and personal ADL. Logistic regression showed that SAPS II was associated with changes in general level of health (OR 1.06, 95%CI, 1.01 – 1.11, p = 0,016. Six months after ICU discharge, 60% and 34% of patients, respectively, were dependent in at least one activity in instrumental ADL (ADLI and personal ADL (ADLP. ASA-PS (OR 3.00, 95%CI 1.31 – 6.87, p = 0.009 and age (OR 2.36, 95%CI, 1.04 – 5.34, p = 0.04 were associated with dependency in

  17. Factors influencing nursing care in a surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Raj John

    2006-01-01

    Full Text Available Context: The total time spent in nursing care depends on the type of patient and the patient′s condition. We analysed factors that influenced the time spent in nursing a patient. Aims : To analyse the factors in a patient′s condition that influenced time spent in nursing a patient. Materials and Methods: This study was performed in the Surgical Intensive Care Unit of a tertiary referral centre, over a period of one month. The total time spent on a patient in nursing care for the first 24 hours of admission, was recorded. This time was divided into time for routine nursing care, time for interventions, time for monitoring and time for administering medications. Statistical analysis used: A backward stepwise linear regression analysis using the age, sex, diagnosis, type of admission and ventilatory status as variables, was done. Results: Patients admitted after elective surgery required less time (852.4 ± 234.1 minutes, than those admitted after either emergency surgery (1069.5 ± 187.3 minutes, or directly from the ward or the emergency room (1253.7 ± 42.1 minutes. Patients who were ventilated required more time (1111.5 ± 132.5 minutes, than those brought on a T-piece (732.2 ± 134.8 minutes or extubated (639.5 ± 155.6 minutes. The regression analysis showed that only the type of admission and the ventilatory status significantly affected the time. Conclusions : This study showed that the type of admission and ventilatory status significantly influenced the time spent in nursing care. This will help optimal utilization of nursing resources.

  18. The Business Engineering Surgical Technologies (BEST) teaching method: incubating talents for surgical innovation.

    Science.gov (United States)

    de Ruijter, V; Halvax, P; Dallemagne, B; Swanström, L; Marescaux, J; Perretta, S

    2015-01-01

    Technological innovation in surgical science and healthcare is vital and calls for close collaboration between engineering and surgery. To meet this objective, BEST was designed as a free sustainable innovative teaching method for young professionals, combining surgery, engineering, and business in a multidisciplinary, high-quality, low-cost, and learning-by-doing philosophy. This paper reviews the initial outcomes of the program and discusses lessons learned and future directions of this innovative educational method. BEST educational method is delivered in two parts: the first component consisting of live streaming or pre-recorded online lectures, with an interdisciplinary profile focused on surgery, engineering, and business. The second component is an annual 5-day on-site course, organized at IRCAD-IHU, France. The program includes workshops in engineering, entrepreneurship team projects, and in-depth hands-on experience in laparoscopy, robotic surgery, interventional radiology, and flexible endoscopy with special emphasis on the interdisciplinary aspect of the training. A panel of surgeons, engineers, well-established entrepreneurs, and scientists assessed the team projects for potential patent application. From November 2011 till September 2013, 803 individual and institutional users from 79 different countries attended the online course. In total, 134 young professionals from 32 different countries applied to the onsite course. Sixty participants were selected each year for the onsite course. In addition, five participants were selected for a web-based team. Thirteen provisional patents were filed for the most promising projects. BEST proved to be a global talent incubator connecting students to high-quality education despite institutional and economical boundaries. Viable and innovative ideas arose from this revolutionary approach which is likely to spin-off significant technology transfer and lead the way for future interdisciplinary hybrid surgical

  19. Documentation of surgical specimens using digital video technology.

    Science.gov (United States)

    Melín-Aldana, Héctor; Carter, Barbara; Sciortino, Debra

    2006-09-01

    Digital technology is commonly used for documentation of specimens in anatomic pathology and has been mainly limited to still photographs. Technologic innovations, such as digital video, provide additional, in some cases better, options for documentation. To demonstrate the applicability of digital video to the documentation of surgical specimens. A Canon Elura MC40 digital camcorder was used, and the unedited movies were transferred to a Macintosh PowerBook G4 computer. Both the camcorder and specimens were hand-held during filming. The movies were edited using the software iMovie. Annotations and histologic photographs may be easily incorporated into movies when editing, if desired. The finished movies are best viewed in computers which contain the free program QuickTime Player. Movies may also be incorporated onto DVDs, for viewing in standard DVD players or appropriately equipped computers. The final movies are on average 2 minutes in duration, with a file size between 2 and 400 megabytes, depending on the intended use. Because of file size, distribution is more practical via CD or DVD, but movies may be compressed for distribution through the Internet (e-mail, Web sites) or through internal hospital networks. Digital video is a practical, easy, and affordable methodology for specimen documentation, permitting a better 3-dimensional understanding of the specimens. Discussions with colleagues, student education, presentation at conferences, and other educational activities can be enhanced with the implementation of digital video technology.

  20. 21 CFR 878.4494 - Absorbable poly(hydroxybutyrate) surgical suture produced by recombinant DNA technology.

    Science.gov (United States)

    2010-04-01

    ... produced by recombinant DNA technology. 878.4494 Section 878.4494 Food and Drugs FOOD AND DRUG... recombinant DNA technology. (a) Identification. An absorbable poly(hydroxybutyrate) surgical suture is an...) Surgical Suture Produced by Recombinant DNA Technology.” For the availability of this guidance document...

  1. The low therapeutic efficacy of postoperative chest radiographs for surgical intensive care unit patients

    NARCIS (Netherlands)

    A. Kröner; E. van Iperen; J. Horn; J.M. Binnekade; P.E. Spronk; J. Stoker; M.J. Schultz

    2011-01-01

    Background. The clinical value of postoperative chest radiographs (CXRs) for surgical intensive care unit (ICU) patients is largely unknown. In the present study, we determined the diagnostic and therapeutic efficacy of postoperative CXRs for different surgical subgroups and related their efficacy t

  2. [Wound prevention in the surgical intensive care unit].

    Science.gov (United States)

    Le Moel, Carole; Mounier, Roman; Ardic-Pulas, Taline

    2012-11-01

    Literature reports a high prevalence of wounds in the hospital environment. A study devoted to wounds encountered in post-surgical intensive care has been carried out in a university hospital. This work highlighted the diversity of acute wounds mainly observed in intensive care and the difficulties nurses have in managing them.

  3. BENIGN PAROTID TUMORS : AN EXPERIENCE IN A GENERAL SURGICAL UNIT

    Directory of Open Access Journals (Sweden)

    Vijaya

    2015-04-01

    Full Text Available Parotid tumors are mostly benign, but their evaluation and treatment require a thorough knowledge of the relevant anatomy and pathology. Surgical treatment of benign tumors is aimed at complete removal of the mass with facial nerve preservation. The aim of this study was to evaluate the post - operative complications of superficial parotidectomy in benign parotid tumors.

  4. Perspectives of patients with acute abdominal pain in an emergency department observation unit and a surgical assessment unit

    DEFF Research Database (Denmark)

    Schultz, Helen; Qvist, Niels; Mogensen, Christian B;

    2014-01-01

    AIMS AND OBJECTIVES: To investigate the patient perspective when admitted with acute abdominal pain to an emergency department observation unit compared with the perspective when admitted to a surgical assessment unit. BACKGROUND: An increase in emergency department observation units has led...... to more short-term admissions and has changed the patient journey from admission to specialised wards staffed by specialist nurses to stays in units staffed by emergency nurses. DESIGN: A comparative field study. METHODS: The study included 21 patients. Participant observation and qualitative interviews...... were performed, and the analyses were phenomenological-hermeneutic. RESULTS: Emergency department observation unit patients had extensive interaction with health professionals, which could create distrust. Surgical assessment unit patients experienced lack of interaction with nurses, also creating...

  5. Technological advances in the surgical treatment of movement disorders.

    Science.gov (United States)

    Gross, Robert E; McDougal, Margaret E

    2013-08-01

    Technological innovations have driven the advancement of the surgical treatment of movement disorders, from the invention of the stereotactic frame to the adaptation of deep brain stimulation (DBS). Along these lines, this review will describe recent advances in inserting neuromodulation modalities, including DBS, to the target, and in the delivery of therapy at the target. Recent radiological advances are altering the way that DBS leads are targeted and inserted, by refining the ability to visualize the subcortical targets using high-field strength magnetic resonance imaging and other innovations, such as diffusion tensor imaging, and the development of novel targeting devices enabling purely anatomical implantations without the need for neurophysiological monitoring. New portable computed tomography scanners also are facilitating lead implantation without monitoring, as well as improving radiological verification of DBS lead location. Advances in neurophysiological mapping include efforts to develop automatic target verification algorithms, and probabilistic maps to guide target selection. The delivery of therapy at the target is being improved by the development of the next generation of internal pulse generators (IPGs). These include constant current devices that mitigate the variability introduced by impedance changes of the stimulated tissue and, in the near future, devices that deliver novel stimulation patterns with improved efficiency. Closed-loop adaptive IPGs are being tested, which may tailor stimulation to ongoing changes in the nervous system, reflected in biomarkers continuously recorded by the devices. Finer-grained DBS leads, in conjunction with new IPGs and advanced programming tools, may offer improved outcomes via current steering algorithms. Finally, even thermocoagulation-essentially replaced by DBS-is being advanced by new minimally-invasive approaches that may improve this therapy for selected patients in whom it may be preferred. Functional

  6. United Nations Human Space Technology Initiative (HSTI)

    CERN Document Server

    Ochiai, M; Steffens, H; Balogh, W; Haubold, H J; Othman, M; Doi, T

    2015-01-01

    The Human Space Technology Initiative was launched in 2010 within the framework of the United Nations Programme on Space Applications implemented by the Office for Outer Space Affairs of the United Nations. It aims to involve more countries in activities related to human spaceflight and space exploration and to increase the benefits from the outcome of such activities through international cooperation, to make space exploration a truly international effort. The role of the Initiative in these efforts is to provide a platform to exchange information, foster collaboration between partners from spacefaring and non-spacefaring countries, and encourage emerging and developing countries to take part in space research and benefit from space applications. The Initiative organizes expert meetings and workshops annually to raise awareness of the current status of space exploration activities as well as of the benefits of utilizing human space technology and its applications. The Initiative is also carrying out primary ...

  7. Surgical Management of Severe Colitis in the Intensive Care Unit.

    Science.gov (United States)

    Halaweish, Ihab; Alam, Hasan B

    2015-12-01

    Severe colitis, an umbrella encompassing several entities, is one of the most common acute gastrointestinal disorders resulting in critical illness. Clostridium difficile infection is responsible for the majority of nosocomial diarrhea with fulminant C difficile colitis (CDC) carrying a high mortality. Optimal outcomes can be achieved by early identification and treatment of fulminant CDC, with appropriate surgical intervention when indicated. Ischemic colitis, on the other hand, is uncommon with a range of etiological factors including abdominal aortic surgery, inotropic drugs, rheumatoid diseases, or often no obvious triggering factor. Most cases resolve with nonsurgical management; however, prompt recognition of full-thickness necrosis and gangrene is crucial for good patient outcomes. Fulminant colitis is a severe disease secondary to progressive ulcerative colitis with systemic deterioration. Surgical intervention is indicated for hemorrhage, perforation, or peritonitis and failure of medical therapy to control the disease. Although, failure of medical management is the most common indication, it can be difficult to define objectively and requires a collaborative multidisciplinary approach. This article proposes some simple management algorithms for these clinical entities, with a focus on critically ill patients.

  8. Ethical Issues in Surgical Critical Care: The Complexity of Interpersonal Relationships in the Surgical Intensive Care Unit.

    Science.gov (United States)

    Sur, Malini D; Angelos, Peter

    2016-08-01

    A major challenge in the era of shared medical decision making is the navigation of complex relationships between the physicians, patients, and surrogates who guide treatment plans for critically ill patients. This review of ethical issues in adult surgical critical care explores factors influencing interactions among the characters most prominently involved in health care decisions in the surgical intensive care unit: the patient, the surrogate, the surgeon, and the intensivist. Ethical tensions in the surgeon-patient relationship in the elective setting may arise from the preoperative surgical covenant and the development of surgical complications. Unlike that of the surgeon, the intensivist's relationship with the individual patient must be balanced with the need to serve other acutely ill patients. Due to their unique perspectives, surgeons and intensivists may disagree about decisions to pursue life-sustaining therapies for critically ill postoperative patients. Finally, although surrogates are asked to make decisions for patients on the basis of the substituted judgment or best interest standards, these models may underestimate the nuances of postoperative surrogate decision making. Strategies to minimize conflicts regarding treatment decisions are centered on early, honest, and consistent communication between all parties.

  9. Surgical technology and pharmacology of hyperthermic perioperative chemotherapy

    Science.gov (United States)

    Van der Speeten, Kurt

    2016-01-01

    Although cytoreductive surgery (CRS) and hyperthermic perioperative chemotherapy (HIPEC) have not been shown to be effective by themselves, as a combined treatment they are now standard of care for peritoneal metastases from appendiceal cancer and from colorectal cancer as well as peritoneal mesothelioma. The timing of the HIPEC in relation to the CRS is crucial in that the HIPEC is to destroy minimal residual disease that remains following the CRS and prevent microscopic tumor emboli within the abdomen and pelvis from implanting within the resection site, within fibrinous clot, or within blood clot. Proper selection of chemotherapy agents is crucial to the long-term benefit of CRS and HIPEC. One must consider the response expected with the cancer chemotherapy agent, its area under the curve (AUC) ratio indicating the amount of dose intensity within the peritoneal space, and the drug retention within the peritoneal space for a prolonged exposure. Hyperthermia will augment the cytotoxicity of the cancer chemotherapy agents and improve drug penetration. Irrigation techniques should not be overlooked as an important means of reducing the cancer cell burden within the abdomen and pelvis. Multiple technologies for HIPEC exist and these have advantages and disadvantages. The techniques vary from a totally open technique with a vapor barrier over the open abdominal space to a totally closed technique whereby the HIPEC is administered at the completion of the surgical procedure. The open techniques depend on a table-mounted retractor for suspension of the skin edges allowing a reservoir to occur within the abdomen and pelvis. There are nearly a dozen commercially available hyperthermia pumps, all of which seem to perform adequately for HIPEC although there is a variable degree of convenience and documentation of the HIPEC procedure. As the management of peritoneal metastases has progressed over three decades, early cases are now seen in which a laparoscopic CRS and HIPEC

  10. The United Nations Human Space Technology Initiative

    Science.gov (United States)

    Balogh, Werner; Miyoshi, Takanori

    2016-07-01

    The United Nations Office for Outer Space Affairs (OOSA) launched the Human Space Technology Initiative (HSTI) in 2010 within the United Nations Programme on Space Applications, based on relevant recommendations of the Third United Nations Conference on the Exploration and Peaceful Uses of Outer Space (UNISPACE III). The activities of HSTI are characterized by the following "Three Pillars": International Cooperation, Outreach, and Capacity-building. For International Cooperation, OOSA and the Japan Aerospace Exploration Agency (JAXA) jointly launched a new programme entitled "KiboCUBE". KiboCUBE aims to provide educational or research institutions located in developing countries with opportunities to deploy cube satellites of their own design and manufacture from Japanese Experiment Module "Kibo" on-board the International Space Station (ISS). The Announcement of Opportunity was released on 8 September 2015 and the selected institution is to be announced by 1 August 2016. OOSA is also collaborating with WHO and with the COPUOS Expert Group on Space and Global Health to promote space technologies and ground- and space-based research activities that can contribute to improving global health. For Outreach, OOSA and the government of Costa Rica are jointly organising the United Nations/Costa Rica Workshop on Human Space Technology from 7 to 11 March 2016. Participants will exchange information on achievements in human space programmes and discuss how to promote international cooperation by further facilitating the participation of developing countries in human space exploration-related activities. Also, it will address the role of space industries in human space exploration and its related activities, considering that they have become significant stakeholders in this field. For Capacity-building, OOSA has been carrying out two activities: the Zero-Gravity Instrument Project (ZGIP) and the Drop Tower Experiment Series (DropTES). In ZGIP, OOSA has annually distributed

  11. [NIC as a tool for assessing competences of nursing students in clinical placement at surgical units].

    Science.gov (United States)

    Celma Vicente, Matilde; Ajuria-Imaz, Eloisa; Lopez-Morales, Manuel; Fernandez-Marín, Pilar; Menor-Castro, Alicia; Cano-Caballero Galvez, Maria Dolores

    2015-01-01

    This paper shows the utility of a NIC standardized language to assess the extent of nursing student skills at Practicum in surgical units To identify the nursing interventions classification (NIC) that students can learn to perform in surgical units. To determine the level of difficulty in learning interventions, depending on which week of rotation in clinical placement the student is. Qualitative study using Delphi consensus technique, involving nurses with teaching experience who work in hospital surgical units, where students undertake the Practicum. The results were triangulated through a questionnaire to tutors about the degree of conformity. A consensus was reached about the interventions that students can achieve in surgical units and the frequency in which they can be performed. The level of difficulty of each intervention, and the amount of weeks of practice that students need to reach the expected level of competence was also determined. The results should enable us to design better rotations matched to student needs. Knowing the frequency of each intervention that is performed in each unit determines the chances of learning it, as well as the indicators for its assessment. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  12. What Does a Hospital Survey on Patient Safety Reveal About Patient Safety Culture of Surgical Units Compared With That of Other Units?

    Science.gov (United States)

    Shu, Qin; Cai, Miao; Tao, Hong-Bing; Cheng, Zhao-Hui; Chen, Jing; Hu, Yin-Huan; Li, Gang

    2015-07-01

    The objective of this study was to examine the strengths and weaknesses of surgical units as compared with other units, and to provide an opportunity to improve patient safety culture in surgical settings by suggesting targeted actions using Hospital Survey on Patient Safety Culture (HSOPSC) investigation.A Hospital Survey on Patient Safety questionnaire was conducted to physicians and nurses in a tertiary hospital in Shandong China. 12 patient safety culture dimensions and 2 outcome variables were measured.A total of 23.5% of respondents came from surgical units, and 76.5% worked in other units. The "overall perceptions of safety" (48.1% vs 40.4%, P < 0.001) and "frequency of events reported" (63.7% vs 60.7%, P = 0.001) of surgical units were higher than those of other units. However, the communication openness (38.7% vs 42.5%, P < 0.001) of surgical units was lower than in other units. Medical workers in surgical units reported more events than those in other units, and more respondents in the surgical units assess "patient safety grade" to be good/excellent. Three dimensions were considered as strengths, whereas 5 other dimensions were considered to be weaknesses in surgical units. Six dimensions have potential to aid in improving events reporting and patient safety grade. Appropriate working times will also contribute to ensuring patient safety. Medical staff with longer years of experience reported more events.Surgical units outperform the nonsurgical ones in overall perception of safety and the number of events reported but underperform in the openness of communication. Four strategies, namely deepening the understanding about patient safety of supervisors, narrowing the communication gap within and across clinical units, recruiting more workers, and employing the event reporting system and building a nonpunitive culture, are recommended to improve patient safety in surgical units in the context of 1 hospital.

  13. Ileus development in the trauma/surgical intensive care unit: a process improvement evaluation.

    Science.gov (United States)

    Phipps, Marcy; Bush, Jeffrey A; Buhrow, Dianne; Tittle, Mary B; Singh, Deepak; Harcombe, Julianne; Riddle, Evanthia

    2011-01-01

    Ileus development has been associated with a wide range of complications among hospitalized patients, ranging from increased patient pain and discomfort to malnutrition, aspiration, delayed rehabilitation, and sepsis. This article examines factors that appeared to correlate with an increase in ileus development among patients in a trauma/surgical intensive care unit, with the goal of preventing the condition through nursing practice changes.

  14. Hospital-acquired acute kidney injury in medical, surgical, and intensive care unit: A comparative study

    Directory of Open Access Journals (Sweden)

    T B Singh

    2013-01-01

    Full Text Available Acute kidney injury (AKI is a common complication in hospitalized patients. There are few comparative studies on hospital-acquired AKI (HAAKI in medical, surgical, and ICU patients. This study was conducted to compare the epidemiological characteristics, clinical profiles, and outcomes of HAAKI among these three units. All adult patients (>18 years of either gender who developed AKI based on RIFLE criteria (using serum creatinine, 48 h after hospitalization were included in the study. Patients of acute on chronic renal failure and AKI in pregnancy were excluded. Incidence of HAAKI in medical, surgical, and ICU wards were 0.54%, 0.72%, and 2.2% respectively ( P < 0.0001. There was no difference in age distribution among the groups, but onset of HAAKI was earliest in the medical ward ( P = 0.001. RIFLE-R was the most common AKI in medical (39.2% and ICU (50% wards but in the surgical ward, it was RIFLE-F that was most common (52.6%. Acute tubular necrosis was more common in ICU ( P = 0.043. Most common etiology of HAAKI in medical unit was drug induced (39.2%, whereas in surgical and ICU, it was sepsis (34% and 35.2% respectively. Mortality in ICU, surgical and medical units were 73.5%, 43.42%, and 37.2%, respectively ( P = 0.003. Length of hospital stay in surgical, ICU and medical units were different ( P = 0.007. This study highlights that the characters of HAAKI are different in some aspects among different hospital settings.

  15. Innovation in surgical technology and techniques: Challenges and ethical issues.

    Science.gov (United States)

    Geiger, James D; Hirschl, Ronald B

    2015-06-01

    The pace of medical innovation continues to increase. The deployment of new technologies in surgery creates many ethical challenges including how to determine safety of the technology, what is the timing and process for deployment of a new technology, how are patients informed before undergoing a new technology or technique, how are the outcomes of a new technology evaluated and how are the responsibilities of individual patients and society at large balanced. Ethical considerations relevant to the implementation of ECMO and robotic surgery are explored to further discussion of how we can optimize the delicate balance between innovation and regulation.

  16. [Analysis of key vision position technologies in robot assisted surgical system for total knee replacement].

    Science.gov (United States)

    Zhao, Zijian; Liu, Yuncai; Wu, Xiaojuan; Liu, Hongjian

    2008-02-01

    Robot assisted surgery is becoming a widely popular technology and is now entering the total knee replacement. The development of total knee replacement and the operation system structure are introduced in this paper. The vision position technology and the related calibration technology, which are very important, are also analyzed. The experiments of error analysis in our WATO system demonstrate that the position and related calibration technologies have a high precision and can satisfy surgical requirement.

  17. Real-time Graphics Processing Unit Based Fourier Domain Optical Coherence Tomography and Surgical Applications

    Science.gov (United States)

    Zhang, Kang

    2011-12-01

    In this dissertation, real-time Fourier domain optical coherence tomography (FD-OCT) capable of multi-dimensional micrometer-resolution imaging targeted specifically for microsurgical intervention applications was developed and studied. As a part of this work several ultra-high speed real-time FD-OCT imaging and sensing systems were proposed and developed. A real-time 4D (3D+time) OCT system platform using the graphics processing unit (GPU) to accelerate OCT signal processing, the imaging reconstruction, visualization, and volume rendering was developed. Several GPU based algorithms such as non-uniform fast Fourier transform (NUFFT), numerical dispersion compensation, and multi-GPU implementation were developed to improve the impulse response, SNR roll-off and stability of the system. Full-range complex-conjugate-free FD-OCT was also implemented on the GPU architecture to achieve doubled image range and improved SNR. These technologies overcome the imaging reconstruction and visualization bottlenecks widely exist in current ultra-high speed FD-OCT systems and open the way to interventional OCT imaging for applications in guided microsurgery. A hand-held common-path optical coherence tomography (CP-OCT) distance-sensor based microsurgical tool was developed and validated. Through real-time signal processing, edge detection and feed-back control, the tool was shown to be capable of track target surface and compensate motion. The micro-incision test using a phantom was performed using a CP-OCT-sensor integrated hand-held tool, which showed an incision error less than +/-5 microns, comparing to >100 microns error by free-hand incision. The CP-OCT distance sensor has also been utilized to enhance the accuracy and safety of optical nerve stimulation. Finally, several experiments were conducted to validate the system for surgical applications. One of them involved 4D OCT guided micro-manipulation using a phantom. Multiple volume renderings of one 3D data set were

  18. Tracking surgical day care patients using RFID technology

    NARCIS (Netherlands)

    L.S.G.L. Wauben; A.C.P. Guédon; D.F. de Korne (Dirk); J.J. van den Dobbelsteen (John)

    2015-01-01

    markdownabstract__Abstract__ __Objective__: Measure wait times, characterise current information flow and define requirements for a technological information system that supports the patient’s journey. __Design__: First, patients were observed during eight random weekdays and the durations of act

  19. Tracking surgical day care patients using RFID technology

    National Research Council Canada - National Science Library

    Wauben, L.S.G.L; Guédon, A.C.P; Korne, Dirk; Dobbelsteen, John

    2015-01-01

    ... (RFID) technology was installed and patients were tracked during 52 weekdays. Length of hospital stay, length of stay and wait times per phase, and differences in wait times between the two types of administered anaesthesia were analysed...

  20. Variation in Surgical Antibiotic Prophylaxis for Outpatient Pediatric Urological Procedures at United States Children's Hospitals.

    Science.gov (United States)

    Chan, Katherine H; Bell, Teresa; Cain, Mark; Carroll, Aaron; Benneyworth, Brian D

    2017-03-01

    Guidelines recommend surgical antibiotic prophylaxis for clean-contaminated procedures but none for clean procedures. The purpose of this study was to describe variations in surgical antibiotic prophylaxis for outpatient urological procedures at United States children's hospitals. Using the PHIS (Pediatric Health Information System®) database we performed a retrospective cohort study of patients younger than 18 years who underwent clean and/or clean-contaminated outpatient urological procedures from 2012 to 2014. We excluded those with concurrent nonurological procedures or an abscess/infected wound. We compared perioperative antibiotic charges for clean vs clean-contaminated procedures using a multilevel logistic regression model with a random effect for hospital. We also examined whether hospitals that were guideline compliant for clean procedures, defined as no surgical antibiotic prophylaxis, were also compliant for clean-contaminated procedures using the Pearson correlation coefficient. We examined hospital level variation in antibiotic rates using the coefficient of variation. A total of 131,256 patients with a median age of 34 months at 39 hospitals met study inclusion criteria. Patients undergoing clean procedures were 14% less likely to receive guideline compliant surgical antibiotic prophylaxis than patients undergoing clean-contaminated procedures (OR 0.86, 95% CI 0.84-0.88, p variation was seen for hospital level compliance with surgical antibiotic prophylaxis for clean-contaminated procedures (range 9.8% to 97.8%, coefficient of variation 0.36) than for clean procedures (range 35.0% to 98.2%, coefficient of variation 0.20). Hospitals that used surgical antibiotic prophylaxis appropriately for clean-contaminated procedures were likely to use surgical antibiotic prophylaxis inappropriately for clean procedures. More variation was seen in hospital level guideline compliance for clean-contaminated procedures. Copyright © 2017 American Urological

  1. The United States Department of Energy Office of Industrial Technology`s Technology Benefits Recording System

    Energy Technology Data Exchange (ETDEWEB)

    Hughes, K.R.; Moore, N.L.

    1994-09-01

    The U.S. Department of Energy (DOE) Office of Industrial Technology`s (OIT`s) Technology Benefits Recording System (TBRS) was developed by Pacific Northwest Laboratory (PNL). The TBRS is used to organize and maintain records of the benefits accrued from the use of technologies developed with the assistance of OIT. OIT has had a sustained emphasis on technology deployment. While individual program managers have specific technology deployment goals for each of their ongoing programs, the Office has also established a separate Technology Deployment Division whose mission is to assist program managers and research and development partners commercialize technologies. As part of this effort, the Technology Deployment Division developed an energy-tracking task which has been performed by PNL since 1977. The goal of the energy-tracking task is to accurately assess the energy savings impact of OIT-developed technologies. In previous years, information on OIT-sponsored technologies existed in a variety of forms--first as a hardcopy, then electronically in several spreadsheet formats that existed in multiple software programs. The TBRS was created in 1993 for OIT and was based on information collected in all previous years from numerous industrial contacts, vendors, and plants that have installed OIT-sponsored technologies. The TBRS contains information on technologies commercialized between 1977 and the present, as well as information on emerging technologies in the late development/early commercialization stage of the technology life cycle. For each technology, details on the number of units sold and the energy saved are available on a year-by-year basis. Information regarding environmental benefits, productivity and competitiveness benefits, or impact that the technology may have had on employment is also available.

  2. The role of the intensive care unit in the management of the critically ill surgical patient.

    Science.gov (United States)

    Cuthbertson, B H; Webster, N R

    1999-10-01

    Surgical patients make up 60-70% of the work load of intensive care units in the UK. There is a recognised short fall in the resource allocation for high dependency units (HDUs) and intensive care units (ICUs) in this country, despite repeated national audits urging that this resource be increased. British ICUs admit patients later and with higher severity of illness scores than elsewhere and this leads to higher ICU mortality. How can this situation be improved? Scoring systems that allow selection of appropriate patients for admission to ICU and avoid inappropriate admission are still in development. Pre-operative admission and optimisation in ICU is rare in this country despite increasing evidence to support this practice in high risk surgical patients. Early admission to ICU, with potential improvement in outcomes, could also be achieved using multi-disciplinary medical emergency teams. These teams would be alerted by ward staff in response to set specific conditions and physiological criteria. These proposals are still under trial but may offer benefit by reducing mortality in critically ill surgical patients.

  3. Surgical Assisting

    Science.gov (United States)

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

  4. Robotic Surgical System for Radical Prostatectomy: A Health Technology Assessment

    Science.gov (United States)

    Wang, Myra; Xie, Xuanqian; Wells, David; Higgins, Caroline

    2017-01-01

    Background Prostate cancer is the second most common type of cancer in Canadian men. Radical prostatectomy is one of the treatment options available, and involves removing the prostate gland and surrounding tissues. In recent years, surgeons have begun to use robot-assisted radical prostatectomy more frequently. We aimed to determine the clinical benefits and harms of the robotic surgical system for radical prostatectomy (robot-assisted radical prostatectomy) compared with the open and laparoscopic surgical methods. We also assessed the cost-effectiveness of robot-assisted versus open radical prostatectomy in patients with clinically localized prostate cancer in Ontario. Methods We performed a literature search and included prospective comparative studies that examined robot-assisted versus open or laparoscopic radical prostatectomy for prostate cancer. The outcomes of interest were perioperative, functional, and oncological. The quality of the body of evidence was examined according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group criteria. We also conducted a cost–utility analysis with a 1-year time horizon. The potential long-term benefits of robot-assisted radical prostatectomy for functional and oncological outcomes were also evaluated in a 10-year Markov model in scenario analyses. In addition, we conducted a budget impact analysis to estimate the additional costs to the provincial budget if the adoption of robot-assisted radical prostatectomy were to increase in the next 5 years. A needs assessment determined that the published literature on patient perspectives was relatively well developed, and that direct patient engagement would add relatively little new information. Results Compared with the open approach, we found robot-assisted radical prostatectomy reduced length of stay and blood loss (moderate quality evidence) but had no difference or inconclusive results for functional and oncological outcomes

  5. Identification of surgical instruments using UHF-RFID technology

    Directory of Open Access Journals (Sweden)

    Bourouah Mohamed

    2015-09-01

    Full Text Available The paper presents research, development and advantage of Radio Frequency IDentification (RFID technology based system for medical instrument management and safe usage. The system is developed for two scenarios. In the first scenario, a Ultra High Frequency (UHF is used and the UHF–interrogator system with UHF-antennas is constructed to work as conveyor-belt and instruments are placed between two antennas. Second scenario, suitable for the operating rooms, includes four antennas, placed under the table with instruments, system’s phase shifter, inserted between the antenna and reader in order to reduce the effect of dead spots, caused by the electromagnetic reflections. High reliable identification rate is achieved by synchronizing phase shifters with particular interrogator. The system is software calibrated and can be re-calibrated at run-time to achieve high efficiency of power transmission to the antenna and in order to enable the receiver to decode the tag signals. With currently on the market available RFID tags and previously mentioned technology approaches, detection rate of 87.5% can be achieved.

  6. Integrating Geospatial Technologies in an Energy Unit

    Science.gov (United States)

    Kulo, Violet A.; Bodzin, Alec M.

    2011-01-01

    This article presents a design-based research study of the implementation of an energy unit developed for middle school students. The unit utilized Google Earth and a geographic information system (GIS) to support student understanding of the world's energy resources and foster their spatial thinking skills. Findings from the prototype study…

  7. Healthcare information technology and medical-surgical nurses: the emergence of a new care partnership.

    Science.gov (United States)

    Moore, An'Nita; Fisher, Kathleen

    2012-03-01

    Healthcare information technology in US hospitals and ambulatory care centers continues to expand, and nurses are expected to effectively and efficiently utilize this technology. Researchers suggest that clinical information systems have expanded the realm of nursing to integrate technology as an element as important in nursing practice as the patient or population being served. This study sought to explore how medical surgical nurses make use of healthcare information technology in their current clinical practice and to examine the influence of healthcare information technology on nurses' clinical decision making. A total of eight medical surgical nurses participated in the study, four novice and four experienced. A conventional content analysis was utilized that allowed for a thematic interpretation of participant data. Five themes emerged: (1) healthcare information technology as a care coordination partner, (2) healthcare information technology as a change agent in the care delivery environment, (3) healthcare information technology-unable to meet all the needs, of all the people, all the time, (4) curiosity about healthcare information technology-what other bells and whistles exist, and (5) Big Brother is watching. The results of this study indicate that a new care partnership has emerged as the provision of nursing care is no longer supplied by a single practitioner but rather by a paired team, consisting of nurses and technology, working collaboratively in an interdependent relationship to achieve established goals.

  8. Acquired Muscle Weakness in the Surgical Intensive Care Unit: Nosology, Epidemiology, Diagnosis, and Prevention.

    Science.gov (United States)

    Farhan, Hassan; Moreno-Duarte, Ingrid; Latronico, Nicola; Zafonte, Ross; Eikermann, Matthias

    2016-01-01

    Muscle weakness is common in the surgical intensive care unit (ICU). Low muscle mass at ICU admission is a significant predictor of adverse outcomes. The consequences of ICU-acquired muscle weakness depend on the underlying mechanism. Temporary drug-induced weakness when properly managed may not affect outcome. Severe perioperative acquired weakness that is associated with adverse outcomes (prolonged mechanical ventilation, increases in ICU length of stay, and mortality) occurs with persistent (time frame: days) activation of protein degradation pathways, decreases in the drive to the skeletal muscle, and impaired muscular homeostasis. ICU-acquired muscle weakness can be prevented by early treatment of the underlying disease, goal-directed therapy, restrictive use of immobilizing medications, optimal nutrition, activating ventilatory modes, early rehabilitation, and preventive drug therapy. In this article, the authors review the nosology, epidemiology, diagnosis, and prevention of ICU-acquired weakness in surgical ICU patients.

  9. Impact of introduction of an acute surgical unit on management and outcomes of small bowel obstruction.

    Science.gov (United States)

    Musiienko, Anton M; Shakerian, Rose; Gorelik, Alexandra; Thomson, Benjamin N J; Skandarajah, Anita R

    2016-10-01

    The acute surgical unit (ASU) is a recently established model of care in Australasia and worldwide. Limited data are available regarding its effect on the management of small bowel obstruction. We compared the management of small bowel obstruction before and after introduction of ASU at a major tertiary referral centre. We hypothesized that introduction of ASU would correlate with improved patient outcomes. A retrospective review of prospectively maintained databases was performed over two separate 2-year periods, before and after the introduction of ASU. Data collected included demographics, co-morbidity status, use of water-soluble contrast agent and computed tomography. Outcome measures included surgical intervention, time to surgery, hospital length of stay, complications, 30-day readmissions, use of total parenteral nutrition, intensive care unit admissions and overall mortality. Total emergency admissions to the ASU increased from 2640 to 4575 between the two time periods. A total of 481 cases were identified (225 prior and 256 after introduction of ASU). Mortality decreased from 5.8% to 2.0% (P = 0.03), which remained significant after controlling for confounders with multivariate analysis (odds ratio = 0.24, 95% confidence interval 0.08-0.73, P = 0.012). The proportion of surgically managed patients increased (20.9% versus 32.0%, P = 0.003) and more operations were performed within 5 days from presentation (76.6% versus 91.5%, P = 0.02). Fewer patients received water-soluble contrast agent (27.1% versus 18.4%, P = 0.02), but more patients were investigated with a computed tomography (70.7% versus 79.7%, P = 0.02). The ASU model of care resulted in decreased mortality, shorter time to intervention and increased surgical management. Overall complications rate and length of stay did not change. © 2015 Royal Australasian College of Surgeons.

  10. The effect of robotic telerounding in the surgical intensive care units impact on medical education.

    Science.gov (United States)

    Marini, Corrado Paolo; Ritter, Garry; Sharma, Cordelia; McNelis, John; Goldberg, Michael; Barrera, Rafael

    2015-03-01

    Robotic telerounding is effective from the standpoint of patients' satisfaction and patients' care in teaching and community hospitals. However, the impact of robotic telerounding by the intensivist rounding remotely in the surgical intensive care unit (SICU), on patients' outcome and on the education of medical students physician assistants and surgical residents, as well as on nurses' satisfaction has not been studied. Prospective evaluation of robotic telerounding (RT) using a Likert Scale measuring tool to assess whether it can replace conventional rounding (CR) from the standpoint of patients' care and outcome, nursing satisfaction, and educational effectiveness. RT did not have a negative impact on patients' outcome during the study interval: mortality 5/42 (12 %) versus 6/37 (16 %), RT versus CR, respectively, p = 0.747. The intensivists rounding in the SICU were satisfied with their ability to deliver the same patients' care remotely (Likert score 4.4 ± 0.2). The educational experience of medical students, physicia assistants, and surgical residents was not affected by RT (average Likert score 4.5 ± 0.2, 3.9 ± 0.4, and 4.4 ± 0.4 for surgical residents, medical students and PAs, respectively, p > 0.05). However, as shown by a Likert score of 3.5 ± 1.0, RT did not meet nurses' expectations from several standpoints. Intensivists regard robotic telerounding as an effective alternative to conventional rounding from the standpoint of patients' care and teaching. Medical students, physician assistants (PA's), and surgical residents do not believe that RT compromises their education. Despite similar patients' outcome, nurses have a less favorable opinion of RT; they believe that the physical presence of the intensivist is favorable at all times.

  11. Introduction to Surgical Technology. Third Edition. Teacher Edition [and] Student Edition.

    Science.gov (United States)

    Bushey, Vicki; Hildebrand, Bob; Hildebrand, Dinah; Johnson, Dave; Sikes, John; Tahah, Ann; Walker, Susan; Zielsdorf, Lani

    These teacher and student editions provide instructional materials for an introduction to surgical technology course. Introductory materials in the teacher edition include information on use, instructional/task analysis, academic and workplace skill classifications and definitions, related academic and workplace skill list, and crosswalk to…

  12. Using Appreciative Inquiry to Discover and Deliver Change for Surgical Technology Students

    Science.gov (United States)

    Cabai, Katherine A.

    2012-01-01

    The purpose of this study was to examine efficacious teaching-learning strategies that community college stakeholders employ that enhance surgical technology student outcomes. Knowles's adult learning theory, constructivist theory, and appreciative inquiry served as the theoretical foundation for this study. Discovering effective aspects and…

  13. High-speed nonlinear finite element analysis for surgical simulation using graphics processing units.

    Science.gov (United States)

    Taylor, Z A; Cheng, M; Ourselin, S

    2008-05-01

    The use of biomechanical modelling, especially in conjunction with finite element analysis, has become common in many areas of medical image analysis and surgical simulation. Clinical employment of such techniques is hindered by conflicting requirements for high fidelity in the modelling approach, and fast solution speeds. We report the development of techniques for high-speed nonlinear finite element analysis for surgical simulation. We use a fully nonlinear total Lagrangian explicit finite element formulation which offers significant computational advantages for soft tissue simulation. However, the key contribution of the work is the presentation of a fast graphics processing unit (GPU) solution scheme for the finite element equations. To the best of our knowledge, this represents the first GPU implementation of a nonlinear finite element solver. We show that the present explicit finite element scheme is well suited to solution via highly parallel graphics hardware, and that even a midrange GPU allows significant solution speed gains (up to 16.8 x) compared with equivalent CPU implementations. For the models tested the scheme allows real-time solution of models with up to 16,000 tetrahedral elements. The use of GPUs for such purposes offers a cost-effective high-performance alternative to expensive multi-CPU machines, and may have important applications in medical image analysis and surgical simulation.

  14. New technologies applied to surgical processes: Virtual Reality and rapid prototyping.

    Science.gov (United States)

    Suárez-Mejías, Cristina; Gomez-Ciriza, Gorka; Valverde, Israel; Parra Calderón, Carlos; Gómez-Cía, Tomás

    2015-01-01

    AYRA is software of virtual reality for training, planning and optimizing surgical procedures. AYRA was developed under a research, development and innovation project financed by the Andalusian Ministry of Health, called VirSSPA. Nowadays AYRA has been successfully used in more than 1160 real cases and after proving its efficiency it has been introduced in the clinical practice at the Virgen del Rocío University Hospital . Furthermore, AYRA allows generating physical 3D biomodels using rapid prototyping technology. They are used for surgical planning support, intraoperative reference or defect reconstruction. In this paper, some of these tools and some real cases are presented.

  15. Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States.

    Science.gov (United States)

    Raymond, Elizabeth G; Grossman, Daniel; Weaver, Mark A; Toti, Stephanie; Winikoff, Beverly

    2014-11-01

    The recent surge of new legislation regulating induced abortion in the United States is ostensibly motivated by the desire to protect women's health. To provide context for interpreting the risk of abortion, we compared abortion-related mortality to mortality associated with other outpatient surgical procedures and selected nonmedical activities. We calculated the abortion-related mortality rate during 2000-2009 using national data. We searched PubMed and other sources for contemporaneous data on mortality associated with other outpatient procedures commonly performed on healthy young women, marathon running, bicycling and driving. The abortion-related mortality rate in 2000-2009 in the United States was 0.7 per 100,000 abortions. Studies in approximately the same years found mortality rates of 0.8-1.7 deaths per 100,000 plastic surgery procedures, 0-1.7deaths per 100,000 dental procedures, 0.6-1.2 deaths per 100,000 marathons run and at least 4 deaths among 100,000 cyclists in a large annual bicycling event. The traffic fatality rate per 758 vehicle miles traveled by passenger cars in the United States in 2007-2011 was about equal to the abortion-related mortality rate. The safety of induced abortion as practiced in the United States for the past decade met or exceeded expectations for outpatient surgical procedures and compared favorably to that of two common nonmedical voluntary activities. The new legislation restricting abortion is unnecessary; indeed, by reducing the geographic distribution of abortion providers and requiring women to travel farther for the procedure, these laws are potentially detrimental to women's health. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. The impact of a surgical assessment unit on numbers of general surgery outliers.

    Science.gov (United States)

    Jacobson, Alexandra; Poole, Garth; Hill, Andrew G; Biggar, Magdalena

    2016-12-02

    Patient care and efficiency outcomes are improved if acute patients admitted to non-specialty (outlier) wards are minimised.1 Assessment units may help to reduce numbers of outlier patients.2 A surgical assessment unit (SAU) was recently established at Middlemore Hospital. We aimed to determine the impact of its introduction on numbers of general surgery outliers on post-acute ward rounds. A 10-bed SAU was introduced in July 2015, coinciding with the closure of 20 beds on the general surgical wards. The numbers and locations of patients on post-acute ward rounds before and after the establishment of the SAU were compared. A student two-tailed t-test was used for statistical comparisons, with poutlier wards after the introduction of the SAU (mean 1.7 before vs 0.8 after, p=0.04). Despite a net reduction in general surgery beds and no change in the overall number of post-acute patients, the establishment of a SAU was associated with a reduction in outliers.

  17. Risk factors for aminoglycoside-associated nephrotoxicity in surgical intensive care unit patients

    Science.gov (United States)

    Gerlach, Anthony T; Stawicki, Stanislaw P; Cook, Charles H; Murphy, Claire

    2011-01-01

    Background: Aminoglycosides are commonly used antibiotics in the intensive care unit (ICU), but are associated with nephrotoxicity. This study evaluated the development of aminoglycoside-associated nephrotoxicity (AAN) in a single surgical intensive care unit. Materials and Methods: Adult patients in our surgical ICU who received more than two doses of aminoglycosides were retrospectively reviewed for demographics, serum creatinine, receipt of nephrotoxins [angiotensin converting enzyme (ACE) inhibitors, angiotensin-II receptor blockers, diuretics, non-steroidal anti-inflammatory drugs, cyclosporine, tacrolimus, vasopressors, vancomycin and intravenous iodinated contrast] and the need for dialysis. AAN was defined as an increase in serum creatinine >0.5 mg/dL on at least 2 consecutive days. Univariate and multiple regression analyses were performed. Results: Sixty-one patients (43 males) receiving aminoglycoside were evaluated. Mean age, weight, initial serum creatinine, and duration of aminoglycoside therapy were 58.7 (±15) years, 83.3 (±24.4) kg, 0.9 (±0.5) mg/dL, and 4 (±2.3) days, respectively. Thirty-one (51%) aminoglycoside recipients also received additional nephrotoxins. Seven aminoglycoside recipients (11.5%) developed AAN, four of whom required dialysis and all had received additional nephrotoxins. Only concurrent use of vasopressors (P = 0.041) and vancomycin (P = 0.002) were statistically associated with AAN. Receipt of vasopressors or vancomycin were independent predictors of acute kidney insufficiency (AKI) with odds ratios of 19.9 (95% CI: 1.6–245, P = 0.019) and 49.8 (95% CI: 4.1–602, P = 0.002), respectively. Four patients (6.6%) required dialysis. Conclusions: In critically ill surgical patients receiving aminoglycosides, AAN occurred in 11.5% of the patients. Concurrent use of aminoglycosides with other nephrotoxins increased the risk of AAN. PMID:22096769

  18. [Antibiotic Consumption and the Development of Antibiotic Resistance in Surgical Units].

    Science.gov (United States)

    Tammer, I; Geginat, G; Lange, S; Kropf, S; Lodes, U; Schlüter, D; Lippert, H; Meyer, F

    2016-02-01

    Antibiotic resistence is increasing worldwide. A longitudinal analysis of the influence of the density of antibiotic use on the development of resistance in surgical units was undertaken. Over five years the incidence of pathogens and the resistance rates of isolates from patients of normal surgical units and those of a surgical ICU at a university hospital were examined. The resistence rates were correlated with the density of antibiotic use - calculated from the antibiotic consumption (in DDD) and the number of patient-days. At both units, Enterobacteriaceae and Enterococci were mostly cultured. Among the Enterobacteriaceae, E. coli, Klebsiella spp., Proteus mirabilis and Enterobacter predominated. In the group of Enterococci, E. faecalis predominated at wards whereas at ICU E. faecium was the most frequent. Anaerobes ranked third at normal wards and Candida spp. at ICU. From 2007 to 2011, there was an increasing resistance against ciprofloxacin in P. mirabilis (r = 0.87; p = 0.054) and against imipenem (r = 0.86; p = 0.06) and piperacillin (r = 0.81; p = 0.09) in P. aeruginosa at normal wards. At ICU, the resistance rates of imipenem in P. aeruginosa rose (r = 0.88; p = 0.049). Resistance against ciprofloxacin in E. coli increased (r = 0.65; p = 0.23). Due to the increasing use of ciprofloxacin and meropenem at normal wards, the density of antibiotic usage rose 1.4 %/year (r = 0.94; p = 0.02). Despite the increase of meropenem use at ICU (r = 0.9; p = 0.035), the total antibiotic uptake rate remained almost constant. The antibiotic usage density was 3-fold higher at ICU than at normal wards. At normal wards, the ciprofloxacin usage correlated with the rate of resistance against ciprofloxacin in P. mirabilis P. m. At ICU, an association was detected between the uptake rate of ceftazidime and the rate of resistance against cefotaxime in the CES group. In P. aeruginosa, the use of piperacillin and the rate

  19. Profile of Congenital Surgical Anomalies in Neonates Admitted to Tertiary Care Neonatal Intensive Care Unit of Saurashtra Region

    Directory of Open Access Journals (Sweden)

    Zalak Shah

    2016-06-01

    Full Text Available Background: Congenital surgical anomaly is a major indication for admission of a neonate to an intensive care unit. Profile of surgical conditions is variable by system affecting the neonate and outcomes of the individual conditions depending upon treatment and post surgical facilities. This study was undertaken to highlight the surgical conditions, their burden and their prognosis encountered in our newborn care unit. Methodology: This study is a cross sectional study. All information was collected from the case records of all neonates admitted in newborn care unit of our centre between 1st April, 2011 and 31st October, 2014 with congenital surgical conditions and the following information extracted: surgical condition, age, sex, maturity, birth weight, its treatment and outcome, and other associated features were studied. Result: A total of 9213 neonates were admitted in the study period, of which 328 neonates (3.6% had surgical conditions. Surgery was performed in 225 neonates. Commonest congenital surgical condition was of gastrointestinal tract (GIT. Commonest GIT anomalies were tracheo-oesophageal fistula (28.6%, intestinal obstruction (23.7%, anorectal malformation (17.9%, and omphalocoele (7%. The overall mortality in neonates with congenital surgical condition in this study was 51.2%. Significantly, more deaths occurred in preterm than in term neonates (P = 0.00003 and low birth weight babies more than normal weight (p=0.0002. Conclusion: High mortality is found in neonates suffering from surgical conditions. Commonest anomaly includes conditions of Gastrointestinal tract. Prematurity and low birth weight is a significant factor associated with high mortality. [Natl J Med Res 2016; 6(2.000: 168-170

  20. Surveillance of antimicrobial susceptibility of Enterobacteriaceae pathogens isolated from intensive care units and surgical units in Russia.

    Science.gov (United States)

    Partina, Irina; Kalinogorskaya, Olga; Kojima, Satoshi; Gostev, Vladimir; Volkova, Marina; Ageevets, Vladimir; Lobzin, Yuri; Sidorenko, Sergey

    2016-02-01

    A total of 473 strains of Enterobacteriaceae, including Escherichia coli, Klebsiella spp., Proteus spp., Citrobacter spp., Enterobacter spp., Serratia spp. and Providencia spp., were isolated from patients admitted to intensive care units and surgical units in Russia. About 90% of the isolates carried factors resistant to beta-lactams. The isolation rates of the extended-spectrum beta-lactamase (ESBL) producer defined in this study among E. coli, Klebsiella spp. and Proteus spp. were 45%, 48% and 17%, respectively. In the settings with high prevalence of the ESBL producer, flomoxef, which belongs to the oxacephem subgroup, and carbapenems retain their activity. The MIC₅₀ of flomoxef, meropenem and imipenem against total isolates were 1 µg/mL, ≤ 0.063 µg/mL and 0.25 µg/mL, respectively. Fifty-five carbapenem-resistant strains were isolated in this study. The carbapenem resistant rates of E. coli, Klebsiella spp. and Proteus spp. were 3%, 16% and 29%, respectively

  1. Proposal for a United Nations Basic Space Technology Initiative

    CERN Document Server

    Balogh, W R

    2012-01-01

    The United Nations Programme on Space Applications, implemented by the United Nations Office for Outer Space Affairs, promotes the benefits of space-based solutions for sustainable economic and social development. The Programme assists Member States of the United Nations to establish indigenous capacities for the use of space technology and its applications. In the past the Programme has primarily been focusing on the use of space applications and on basic space science activities. However, in recent years there has been a strong interest in a growing number of space-using countries to build space technology capacities, for example, the ability to develop and operate small satellites. In reaction to this development, the United Nations in cooperation with the International Academy of Astronautics has been organizing annual workshops on small satellites in the service of developing countries. Space technology related issues have also been addressed as part of various other activities of the Programme on Space ...

  2. The vacuum system for technological unit development and design

    Science.gov (United States)

    Zhukeshov, A. M.; Gabdullina, A. T.; Amrenova, A. U.; Giniyatova, Sh G.; Kaibar, A.; Sundetov, A.; Fermakhan, K.

    2015-11-01

    The paper shows results of development of plasma technological unit on the basis of accelerator of vacuum arc and automated system. During the previous years, the authors investigated the operation of pulsed plasma accelerator and developed unique technologies for hardening of materials. Principles of plasma formation in pulsed plasma accelerator were put into basis of the developed unit. Operation of the pulsed arc accelerator was investigated at different parameters of the charge. The developed vacuum system is designed for production of hi-tech plasma units in high technologies in fields of nanomaterials, mechanical and power engineering and production with high added value. Unlike integrated solutions, the system is a module one to allow its low cost, high reliability and simple maintenance. The problems of use of robots are discussed to modernize the technological process.

  3. Perception of night-time sleep by surgical patients in an intensive care unit.

    Science.gov (United States)

    Nicolás, Ana; Aizpitarte, Eva; Iruarrizaga, Angélica; Vázquez, Mónica; Margall, Angeles; Asiain, Carmen

    2008-01-01

    The night-time sleep of patients hospitalized in intensive care is a very important feature within the health or disease process, as it has a direct repercussion on their adequate recovery. (1) To describe how surgical patients perceive their sleep in the intensive care unit; (2) to compare the subjective perception of patients with the nursing records and analyse these for the degree of agreement. Descriptive research. One hundred and four surgical patients were recruited to the study. Patients completed the Richards-Campbell Sleep Questionnaire, a five-item visual analogue scale, to subjectively measure their perceived level of sleep (range 0-100 mm). The observation of patient sleep by nurses, demographic data, nursing care during the night and use of specific pharmacological treatments were also collected from the nursing records. The total mean score of sleep on the first post-operative night was 51.42 mm, 28% of patients had a good sleep, 46% a regular sleep and 26% a bad sleep. The sleep profile of these patients has been characterized by the patients having a light sleep, with frequent awakening and generally little difficulty to go back to sleep after the awakenings. The agreement between the nurses' perceptions of patients' sleep and the patients' perception of their sleep was tested by means of one-factor analysis of variance (p nurse-patient perception, we obtained 44% of total agreement and 56% of disagreement. When discrepancy was found, the nurse generally overestimated the patients' perception. Surgical patients' perceptions of their sleep in the ICU suggest that this is inadequate. Nurses' perceptions of patients' sleep partially coincides with the latter's perception, but we have also found that the former frequently overestimate patients' sleep.

  4. Optimized Technology for Residuum Processing in the ARGG Unit

    Institute of Scientific and Technical Information of China (English)

    Pan Luoqi; Yuan hongxing; Nie Baiqiu

    2006-01-01

    The influence of feedstock property on operation in the FCC unit was studied to identify the cause leading to deteriorated products distribution related with increasingly heavier feedstock for the ARGG unit. In order to maximize the economic benefits of the ARGG unit a string of measures, including the modification of catalyst formulation, retention of high catalyst activity, application of mixed termination agents to control the reaction temperature and once-through operation, and optimization of catalyst regeneration technique, were adopted to adapt the ARGG unit to processing of the heavy feedstock with its carbon residue equating to 7% on an average. The heavy oil processing technology has brought about apparent economic benefits.

  5. [Reducing patient pressure sore incidence density in the pediatric surgical intensive care unit].

    Science.gov (United States)

    Huang, Wei-Chen; Chang, Shiow-Ru; Tang, Chi-Min

    2014-04-01

    Our unit recorded 21 cases of pressure sores from January 2011 to June 2011. The resulting pressure-sore incidence density of 0.74% exceeded the Taiwan Clinical Performance Indicator (TCPI) for medical centers (0.62%) as well as the mean incidence density for our unit (0.55%) during the same period in 2010. We developed this project to decrease the incidence density of pressure sores at our pediatric-surgical-intensive-care unit from 0.74% to 0.31%. Strategies implemented included: 1. providing on-the-job education; 2. providing bedside teaching; 3. developing a series of pictures to illustrate proper sitting, lying, and changing positions and the proper fixation of catheters; 4. implementing a reminder mechanism; 5. introducing pressure-preventing devices; 6. and establishing an audit team. Incidence density decreased from 0.74% (Jan. to Jun. 2011) to 0.18% (Mar. to Jul. 2012). We demonstrated that the developed improvement program effectively reduced the incidence density of pressure sores and increased the quality of nursing care.

  6. Reorganizing nursing work on surgical units: a time-and-motion study.

    Science.gov (United States)

    Desjardins, France; Cardinal, Linda; Belzile, Eric; McCusker, Jane

    2008-01-01

    A time-and-motion study was conducted in response to perceptions that the surgical nursing staff at a Montreal hospital was spending an excessive amount of time on non-nursing care. A sample of 30 nurse shifts was observed by trained observers who timed nurses' activities for their entire working shift using a hand-held Personal Digital Assistant. Activities were grouped into four main categories: direct patient care, indirect patient care, non-nursing and personal activities. Break and meal times were excluded from the denominator of total worked hours. A total of 201 working hours were observed, an average of 6 hours, 42 minutes per nurse shift. The mean proportions of each nurse shift spent on the main activity categories were: direct care 32.8%, indirect care 55.7%, non-nursing tasks 9.0% and personal 2.5%. Three activities (communication among health professionals, medication verification/preparation and documentation) comprised 78.9% of indirect care time. Greater time on indirect care was associated with work on night shifts and on the short-stay surgical unit. Subsequent work reorganization focused on reducing time spent on communication and medications. The authors conclude that time-and-motion studies are a useful method of monitoring appropriate use of nursing staff, and may provide results that assist in restructuring nursing tasks.

  7. Obstetric patients in a surgical intensive care unit: prognostic factors and outcome.

    Science.gov (United States)

    Mjahed, K; Hamoudi, D; Salmi, S; Barrou, L

    2006-07-01

    The objective of this study was to assess the incidence, prognostic factors and the outcome of obstetric patients admitted in a surgical intensive care unit (SICU) during the ante-partum or postpartum period (within 6 weeks of delivery). Between 1995 and 2002, the patients transferred from the department of obstetrics were retrospectively included into the study. Demographics included: obstetric data, medical and surgical histories, diagnosis, simplified acute physiology score (SAPS II), acute physiology and chronic health evaluation system APACHE II score; and the occurrence of organ failure, therapeutic interventions, length of stay in the SICU and outcome were recorded. During the study period, 364 obstetric patients were admitted to the SICU. Obstetric admissions to the SICU represented 0.6% of all deliveries and the SICU utilisation rate was 14.96%. The main indications for admission were eclampsia (70.6%) and postpartum haemorrhage (16.2%). The overall mortality rate was 16.7% (n = 61). In a logistic regression model, risk factors for death included organ system failure (odds ratio (OR) = 3.95 confidence interval (CI) [1.84 - 8.48], bilirubin >12 mg/l (OR = 1.017 CI [1.00 - 1.03]), and prolonged prothrombin time (OR = 0.97 CI [0.95 - 0.99]). Median length of stay was longer in non- survivors (6.5 +/- 7.3 vs 5.5 +/- 4.6 days). Maternal condition on admission and associated complications are the major determinant of maternal outcome.

  8. 76 FR 5834 - International Business Machines Corporation, Global Technology Services Business Unit, Integrated...

    Science.gov (United States)

    2011-02-02

    ... Employment and Training Administration International Business Machines Corporation, Global Technology Services Business Unit, Integrated Technology Services, Cost and Expense Team, Payroll, Travel and Mobility... Business Machines Corporation, Global Technology Services Business Unit, Integrated Technology...

  9. Three phases of disaster relief in Haiti--pediatric surgical care on board the United States Naval Ship Comfort.

    Science.gov (United States)

    Walk, Ryan M; Donahue, Timothy F; Sharpe, Richard P; Safford, Shawn D

    2011-10-01

    On January 12, 2010, Haiti experienced the western hemisphere's worst-ever natural disaster. Within 24 hours, the United States Naval Ship Comfort received orders to respond, and a group of more than 500 physicians, nurses, and staff undertook the largest and most rapid triage and treatment since the inception of hospital ships. These data represent pediatric surgical patients treated aboard the United States Naval Ship Comfort between January 19 and February 27, 2010. Prospective databases managed by patient administration, radiology, blood bank, laboratory services, and surgical services were combined to create an overall patient care database that was retrospectively reviewed for this analysis. Two hundred thirty-seven pediatric surgical patients were treated, representing 27% of the total patient population. These patients underwent a total of 213 operations composed of 243 unique procedures. Orthopedic procedures represented 71% of the total caseload. Patients returned to the operating room up to 11 times and required up to 28 days for completion of surgical management. This represents the largest cohort of pediatric surgical patients in an earthquake response. Our analysis provides a model for anticipating surgical caseload, injury patterns, and duration of surgical course in preparing for future disaster response missions. Moreover, we propose a 3-phased response to disaster medicine that has not been previously described. Published by Elsevier Inc.

  10. The Application of Wearable Technology in Surgery: Ensuring the Positive Impact of the Wearable Revolution on Surgical Patients

    Directory of Open Access Journals (Sweden)

    Jesse Alan Slade Shantz

    2014-09-01

    Full Text Available Wearable technology has become an important trend in consumer electronics in the past year. The miniaturization and mass production of myriad sensors has made possible the integration of sensors and output devices in wearable platforms. Despite the consumer focus of the wearable revolution some surgical applications are being developed. These fall into augmentative, assistive and assessment functions and primarily layer onto current surgical workflows. Some challenges to the adoption of wearable technologies are discussed and a conceptual framework for understanding the potential of wearable technology to revolutionize surgical practice are presented.

  11. The application of wearable technology in surgery: ensuring the positive impact of the wearable revolution on surgical patients.

    Science.gov (United States)

    Slade Shantz, Jesse Alan; Veillette, Christian J H

    2014-01-01

    Wearable technology has become an important trend in consumer electronics in the past year. The miniaturization and mass production of myriad sensors have made possible the integration of sensors and output devices in wearable platforms. Despite the consumer focus of the wearable revolution some surgical applications are being developed. These fall into augmentative, assistive, and assessment functions and primarily layer onto current surgical workflows. Some challenges to the adoption of wearable technologies are discussed and a conceptual framework for understanding the potential of wearable technology to revolutionize surgical practice are presented.

  12. Post-Caesarean Section Surgical Site Infection Surveillance Using an Online Database and Mobile Phone Technology.

    Science.gov (United States)

    Castillo, Eliana; McIsaac, Corrine; MacDougall, Bhreagh; Wilson, Douglas; Kohr, Rosemary

    2017-08-01

    Obstetric surgical site infections (SSIs) are common and expensive to the health care system but remain under reported given shorter postoperative hospital stays and suboptimal post-discharge surveillance systems. SSIs, for the purpose of this paper, are defined according to the Center for Disease Control and Prevention (1999) as infection incurring within 30 days of the operative procedure (in this case, Caesarean section [CS]). Demonstrate the feasibility of real-life use of a patient driven SSIs post-discharge surveillance system consisting of an online database and mobile phone technology (surgical mobile app - how2trak) among women undergoing CS in a Canadian urban centre. Estimate the rate of SSIs and associated predisposing factors. Prospective cohort of consecutive women delivering by CS at one urban Canadian hospital. Using surgical mobile app-how2trak-predetermined demographics, comorbidities, procedure characteristics, and self-reported symptoms and signs of infection were collected and linked to patients' incision self-portraits (photos) on postpartum days 3, 7, 10, and 30. A total of 105 patients were enrolled over a 5-month period. Mean age was 31 years, 13% were diabetic, and most were at low risk of surgical complications. Forty-six percent of surgeries were emergency CSs, and 104/105 received antibiotic prophylaxis. Forty-five percent of patients (47/105) submitted at least one photo, and among those, one surgical site infection was detected by photo appearance and self-reported symptoms by postpartum day 10. The majority of patients whom uploaded photos did so multiple times and 43% of them submitted photos up to day 30. Patients with either a diagnosis of diabetes or self-reported Asian ethnicity were less likely to submit photos. Post-discharge surveillance for CS-related SSIs using surgical mobile app how2trak is feasible and deserves further study in the post-discharge setting. Copyright © 2017. Published by Elsevier Inc.

  13. [Reducing patient pressure sore incidence in the surgical intensive care unit].

    Science.gov (United States)

    Chung, Hui-Ting; Shu, Ling-Hui; Pan, Chao-Chun; Yang, Shu-Yen; Chen, Wan-I

    2011-06-01

    Pressure ulcers were an increasingly significant problem among patients in the authors' ward. The eight patients diagnosed with pressure ulcers (0.42% of all inpatients) during the first half of 2009 represented a 140% increase over the first half of 2008 (0.28% of all inpatients). This project was designed to reduce pressure ulcer incidence in the surgical intensive care unit (ICU) to 0.05%. Intervention measures included: 1) holding professional training on preventing pressure ulcers; 2) specifying appropriate patient turnover tools; 3) creating and distributing to nurses a proper turnover technique and positioning manual; 4) creating and distributing to nurses a comprehensive patient skin inspection checklist; and 5) organizing a permanent pressure ulcer care quality and audit committee. Pressure ulcer incidence fell from 0.42% to 0.04% following implementation of the methods. Results demonstrate the effectiveness of using the proposed methods to reduce pressure ulcer incidence and enhance nursing care quality.

  14. Surgical Procedures of the Elbow: A Nationwide Cross-Sectional Observational Study in the United States

    Directory of Open Access Journals (Sweden)

    Ahmet Kinaci

    2015-01-01

    Full Text Available Background:  Elbow surgery is shared by several subspecialties. We were curious about the most common elbow surgeries and their corresponding diagnoses in the United States.   Methods:  We used the National Hospital Discharge Survey (NHDS and the National Survey of Ambulatory Surgery (NSAS data gathered in 2006-databases that together provide an estimate of all inpatient and ambulatory surgical care in the US.  Results:  An estimated 150,000 elbow surgeries were performed in the US in 2006, 75% in an outpatient setting. The most frequent diagnosis treated operative was enthesopathy (e.g. lateral epicondylitis and it was treated with several different procedures. More than three quarters of all elbow surgeries treated enthesopathy, cubital tunnel syndrome, or fracture (radial head in particular. Arthroscopy and arthroplasty accounted for less than 10% of all elbow surgeries.  Conclusions:  Elbow surgery in the United States primarily addresses enthesopathies such as tennis elbow, cubital tunnel syndrome, and trauma. It is notable that some of the most common elbow surgeries (those that address enthesopathy and radial head fracture are some of the most variably utilized and debated.

  15. Patterns of antimicrobial resistance in a surgical intensive care unit of a university hospital in Turkey

    Directory of Open Access Journals (Sweden)

    Balci Iclal

    2006-10-01

    Full Text Available Abstract Background Several studies have reported higher rates of antimicrobial resistance among isolates from intensive care units than among isolates from general patient-care areas. The aims of this study were to review the pathogens associated with nosocomial infections in a surgical intensive care unit of a university hospital in Turkey and to summarize rates of antimicrobial resistance in the most common pathogens. The survey was conducted over a period of twelve months in a tertiary-care teaching hospital located in the south-eastern part of Turkey, Gaziantep. A total of 871 clinical specimens from 615 adult patients were collected. From 871 clinical specimens 771 bacterial and fungal isolates were identified. Results Most commonly isolated microorganisms were: Pseudomonas aeruginosa (20.3%, Candida species (15% and Staphylococcus aureus (12.9%. Among the Gram-negative microorganisms P. aeruginosa were mostly resistant to third-generation cephalosporins (71.3–98.1%, while Acinetobacter baumannii were resistant in all cases to piperacillin, ceftazidime and ceftriaxone. Isolates of S. aureus were mostly resistant to penicillin, ampicillin, and methicillin (82–95%, whereas coagulase-negative staphylococci were 98.6% resistant to methicillin and in all cases resistant to ampicillin and tetracycline. Conclusion In order to reduce the emergence and spread of antimicrobial-resistant pathogens in ICUs, monitoring and optimization of antimicrobial use in hospitals are strictly recommended. Therefore local resistance surveillance programs are of most value in developing appropriate therapeutic guidelines for specific infections and patient types.

  16. ENERGY EFFICIENT AND SAFE VALVE TESTING UNIT USING WIRELESS TECHNOLOGIES

    Directory of Open Access Journals (Sweden)

    V. Dhivya

    2013-04-01

    Full Text Available The valve testing unit is a high pressure test equipment to test the valve manufactured in industries. Valves are tested to ensure that they sustain high pressure in the range of 10000 to 15000 PSI for the required amount of time without any leakage. It has few drawbacks such as inefficient usage of power, fatal accidents due to the proximity of the users with the testing unit to note the valve pressure during operation. It is much dangerous for the industry personnel to note the valve pressure for every minute during operation. There are chances of bolts fitted in the valve thrown away due to the issues in the bolt fittings and the immense pressure inside the valve. Therefore in order to avoid fatal accidents andto improve the industrial safety an efficient valve testing unit is designed and developed using ZigBee wireless transmission technology. The proposed efficient pressure monitoring unit uses emerging technologies like ZigBee, RFID along with ARM 7 processor. The proposed system uses LabVIEW software to develop the monitoring unit in PC. ZigBee wireless transmission technology is used for remote monitoring of valve pressure for every minute. RFID module is used for uniquely identifying the valve and to track the test results. The proposed unit saves energy by sending a signal to turn off the air driven booster pump once the prescribed pressure level is reached. Theproposed unit also indicates the oil level of the test unit which avoids the manual intervention to verify the oil level and also detects issues in the bolts fitted in the valve by using a distance sensor which is to avoid fatal accidents by stopping the valve testing unit.

  17. Commercial Application of the MIP Technology in RFCC Unit

    Institute of Scientific and Technical Information of China (English)

    Sun Yanming; Guo Lichang

    2007-01-01

    PetroChina Jinxi Petrochemical Branch Company has applied the MIP technology in its RFCC unit to maximize the light distillate while using the paraffinic gas oil blended with resid and the coker gasoil as the feedstocks.The outcome of the unit operating according to the MIP mode has revealed that the olefin content in the stabilized gasoline could be reduced to less than 35% with its research octane number equivalent to and its motor octane number slightly higher than the octane rating of the FCC naphtha obtained by the former operational mode of the RFCC unit,and the diesel yield could reach over 30m%.The total liquid yield(LPG+gasoline+diesel)of the unit operating according to the MIP mode Was by over 1.5 percentage points higher than that achieved in the former RFCC unit.

  18. Application of Virtual Surgical Planning with Computer Assisted Design and Manufacturing Technology to Cranio-Maxillofacial Surgery

    Directory of Open Access Journals (Sweden)

    Linping Zhao

    2012-07-01

    Full Text Available Computer aided design and manufacturing (CAD/CAM technology today is the standardin manufacturing industry. The application of the CAD/CAM technology, together withthe emerging 3D medical images based virtual surgical planning (VSP technology, tocraniomaxillofacial reconstruction has been gaining increasing attention to reconstructivesurgeons. This article illustrates the components, system and clinical management of theVSP and CAD/CAM technology including: data acquisition, virtual surgical and treatmentplanning, individual implant design and fabrication, and outcome assessment. It focusesprimarily on the technical aspects of the VSP and CAD/CAM system to improve thepredictability of the planning and outcome.

  19. Compatibility of Radiofrequency Surgical Sponge Detection Technology with Cardiac Implantable Electronic Devices and Temporary Pacemakers.

    Science.gov (United States)

    Salcedo, Jonathan D; Pretorius, Victor G; Hsu, Jonathan C; Lalani, Gautam G; Schricker, Amir A; Hebsur, Shrinivas M; McGARRY, Thomas J; Hunter, Jessica A; Lewis, Kathryn E; Krummen, David E; Feld, Gregory K; Birgersdotter-Green, Ulrika

    2016-11-01

    Radiofrequency (RF) technology has improved detection of retained surgical sponges with a reported 100% sensitivity and specificity. However, the potential for interactions of the RF signals emitted by the detection system with cardiac implantable electronic devices (CIEDs) or temporary pacemakers may limit its use in those patients with these devices. This study investigated whether RF detection technology causes interference or clinically significant changes in the programmed settings of implanted pacemakers and defibrillators or temporary epicardial pacemakers. Fifty patients who were scheduled either for CIED removal or placement of a temporary epicardial pacemaker (at the time of open heart surgery) were recruited for this study. Device settings and measurements from separate interrogations before and after scanning with the RF detection system were compared. For the temporary pacemakers, we observed for any changes in hemodynamics or signs of pacing interference. Twenty (40%) pacemakers, 20 (40%) implantable cardioverter defibrillators, and 10 (20%) temporary pacemakers were analyzed in this study. During scanning, no signal interference was detected in any permanent device, and there were no significant changes in programmed settings after scanning with the RF detection system. However, pacing inhibition was detected with temporary pacing systems when programmed to a synchronous mode (DDD). RF detection technology can be safely used to scan for retained surgical sponges in patients with permanent CIEDs and temporary pacemakers set to asynchronous mode. © 2016 Wiley Periodicals, Inc.

  20. Using virtual reality technology and hand tracking technology to create software for training surgical skills in 3D game

    Science.gov (United States)

    Zakirova, A. A.; Ganiev, B. A.; Mullin, R. I.

    2015-11-01

    The lack of visible and approachable ways of training surgical skills is one of the main problems in medical education. Existing simulation training devices are not designed to teach students, and are not available due to the high cost of the equipment. Using modern technologies such as virtual reality and hands movements fixation technology we want to create innovative method of learning the technics of conducting operations in 3D game format, which can make education process interesting and effective. Creating of 3D format virtual simulator will allow to solve several conceptual problems at once: opportunity of practical skills improvement unlimited by the time without the risk for patient, high realism of environment in operational and anatomic body structures, using of game mechanics for information perception relief and memorization of methods acceleration, accessibility of this program.

  1. The surgical stress response and the potential role of preoperative glucocorticoids on post-anesthesia care unit recovery

    DEFF Research Database (Denmark)

    Steinthorsdottir, Kristin J; Kehlet, Henrik; Aasvang, Eske K

    2017-01-01

    The immediate postoperative course in the post-anaesthesia care unit (PACU) remains a challenge across surgical procedures. Postoperative pain, sedation/cognitive dysfunction, nausea and vomiting (PONV), circulatory and respiratory problems and orthostatic intolerance constitute the bulk of the d...

  2. Nasal Carriage of Staphylococcus Aureus and Cross-Contamination in a Surgical Intensive Care Unit: Efficacy of Mupirocin Ointment

    NARCIS (Netherlands)

    D. Talon; C. Rouget; V. Cailleaux; P. Bailly; M. Thouverez; F. Barale; Y. Michel-Briand

    1995-01-01

    textabstractA six month prospective study was carried out in a surgical intensive care unit (SICU) of a university hospital to assess the incidence and routes of exogenous colonization by Staphylococcus aureus. A total of 157 patients were included in the study. One thousand one hundred and eleven s

  3. A Daily Goals Tool to Facilitate Indirect Nurse-Physician Communication During Morning Rounds on a Medical-Surgical Unit.

    Science.gov (United States)

    Perry, Veronica; Christiansen, Mollie; Simmons, Angela

    2016-01-01

    Interprofessional bedside rounds are essential for patient-centered care. However, it may be difficult for nurses to round with physicians on medical-surgical units. Using a daily goals tool for indirect rounds improved nurse-physician communication and interprofessional care for patients.

  4. Quality Outcomes in the Surgical Intensive Care Unit after Electronic Health Record Implementation.

    Science.gov (United States)

    Flatow, V H; Ibragimova, N; Divino, C M; Eshak, D S A; Twohig, B C; Bassily-Marcus, A M; Kohli-Seth, R

    2015-01-01

    The electronic health record (EHR) is increasingly viewed as a means to provide more coordinated, patient-centered care. Few studies consider the impact of EHRs on quality of care in the intensive care unit (ICU) setting. To evaluate key quality measures of a surgical intensive care unit (SICU) following implementation of the Epic EHR system in a tertiary hospital. A retrospective chart review was undertaken to record quality indicators for all patients admitted to the SICU two years before and two years after EHR implementation. Data from the twelve-month period of transition to EHR was excluded. We collected length of stay, mortality, central line associated blood stream infection (CLABSI) rates, Clostridium difficile (C. diff.) colitis rates, readmission rates, and number of coded diagnoses. To control for variation in the patient population over time, the case mix indexes (CMIs) and APACHE II scores were also analyzed. There was no significant difference in length of stay, C. diff. colitis, readmission rates, or case mix index before and after EHR. After EHR implementation, the rate of central line blood stream infection (CLABSI) per 1 000 catheter days was 85% lower (2.16 vs 0.39; RR, 0.18; 95% CI, 0.05 to 0.61, p < .005), and SICU mortality was 28% lower (12.2 vs 8.8; RR, 1.35; 95% CI, 1.06 to 1.71, p < .01). Moreover, after EHR there was a significant increase in the average number of coded diagnoses from 17.8 to 20.8 (p < .000). EHR implementation was statistically associated with reductions in CLABSI rates and SICU mortality. The EHR had an integral role in ongoing quality improvement endeavors which may explain the changes in CLABSI and mortality, and this invites further study of the impact of EHRs on quality of care in the ICU.

  5. [Perception of night-time sleep by the surgical patients in an intensive care unit].

    Science.gov (United States)

    Nicolás, A; Aizpitarte, E; Iruarrizaga, A; Vázquez, M; Margall, M A; Asiain, M C

    2002-01-01

    Night-time rest of the patients hospitalized in Intensive Care is a very important feature within the health/disease process since it has a direct repercussion on their adequate recovery. The objectives of this investigation are: 1) describe how the surgical patients perceive their night-time sleep in the Polyvalent Intensive Care Unit: 2) compare the subjective perception of the patients with the nursing record in the care plan and analyze the degree of agreement between both assessments. Night-time sleep has been studied in 104 patients; surgery patients from emergencies, patients who are intubated, with previous psychiatric treatment, sleep apnea, drinking habit or impossibility of adequate communication were not included. To measure the patient's perception, the five item sleep questionnaire of Richards-Campbell and the assessment of sleep by the nurse, as well as the remaining variables included in a computerized care plan, were used. The total mean score of the sleep on the first post-operative night was 51.42 mm. When the scores obtained in each one of the questionnaire items are analyzed, it is seen that the sleep profile of these patients has been characterized by being light sleep, with frequent wakenings and generally with little difficulty to go back to sleep when woke op or were awakened. The assessment of the night-time sleep performed by the nurse coincides with the perception of the patients on many occasions, and when there is discrepancy, the nurse has overestimated the patient's sleep.

  6. In-hospital fellow coverage reduces communication errors in the surgical intensive care unit.

    Science.gov (United States)

    Williams, Mallory; Alban, Rodrigo F; Hardy, James P; Oxman, David A; Garcia, Edward R; Hevelone, Nathanael; Frendl, Gyorgy; Rogers, Selwyn O

    2014-06-01

    Staff coverage strategies of intensive care units (ICUs) impact clinical outcomes. High-intensity staff coverage strategies are associated with lower morbidity and mortality. Accessible clinical expertise, team work, and effective communication have all been attributed to the success of this coverage strategy. We evaluate the impact of in-hospital fellow coverage (IHFC) on improving communication of cardiorespiratory events. A prospective observational study performed in an academic tertiary care center with high-intensity staff coverage. The main outcome measure was resident to fellow communication of cardiorespiratory events during IHFC vs home coverage (HC) periods. Three hundred twelve cardiorespiratory events were collected in 114 surgical ICU patients in 134 study days. Complete data were available for 306 events. One hundred three communication errors occurred. IHFC was associated with significantly better communication of events compared to HC (Pcommunicated 89% of events during IHFC vs 51% of events during HC (PCommunication patterns of junior and midlevel residents were similar. Midlevel residents communicated 68% of all on-call events (87% IHFC vs 50% HC, Pcommunicated 66% of events (94% IHFC vs 52% HC, PCommunication errors were lower in all ICUs during IHFC (Pcommunication errors. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Effect of a "Lean" intervention to improve safety processes and outcomes on a surgical emergency unit.

    Science.gov (United States)

    McCulloch, Peter; Kreckler, Simon; New, Steve; Sheena, Yezen; Handa, Ashok; Catchpole, Ken

    2010-11-02

    Emergency surgical patients are at high risk for harm because of errors in care. Quality improvement methods that involve process redesign, such as “Lean,” appear to improve service reliability and efficiency in healthcare. Interrupted time series. The emergency general surgery ward of a university hospital in the United Kingdom. Seven safety relevant care processes. A Lean intervention targeting five of the seven care processes relevant to patient safety. 969 patients were admitted during the four month study period before the introduction of the Lean intervention (May to August 2007), and 1114 were admitted during the four month period after completion of the intervention (May to August 2008). Compliance with the five process measures targeted for Lean intervention (but not the two that were not) improved significantly (relative improvement 28% to 149%; PLean can substantially and simultaneously improve compliance with a bundle of safety related processes. Given the interconnected nature of hospital care, this strategy might not translate into improvements in safety outcomes unless a system-wide approach is adopted to remove barriers to change.

  8. The Application of Wearable Technology in Surgery: Ensuring the Positive Impact of the Wearable Revolution on Surgical Patients

    OpenAIRE

    Slade Shantz, Jesse Alan; Veillette, Christian J. H.

    2014-01-01

    Wearable technology has become an important trend in consumer electronics in the past year. The miniaturization and mass production of myriad sensors have made possible the integration of sensors and output devices in wearable platforms. Despite the consumer focus of the wearable revolution some surgical applications are being developed. These fall into augmentative, assistive, and assessment functions and primarily layer onto current surgical workflows. Some challenges to the adoption of wea...

  9. The Application of Wearable Technology in Surgery: Ensuring the Positive Impact of the Wearable Revolution on Surgical Patients

    OpenAIRE

    Jesse Alan Slade Shantz; Christian Henri Veillette

    2014-01-01

    Wearable technology has become an important trend in consumer electronics in the past year. The miniaturization and mass production of myriad sensors has made possible the integration of sensors and output devices in wearable platforms. Despite the consumer focus of the wearable revolution some surgical applications are being developed. These fall into augmentative, assistive and assessment functions and primarily layer onto current surgical workflows. Some challenges to the adoption of w...

  10. Scoring Systems for Outcome Prediction in a Cardiac Surgical Intensive Care Unit: A Comparative Study.

    Science.gov (United States)

    Exarchopoulos, Themistocles; Charitidou, Efstratia; Dedeilias, Panagiotis; Charitos, Christos; Routsi, Christina

    2015-07-01

    Most scoring systems used to predict clinical outcome in critical care were not designed for application in cardiac surgery patients. To compare the predictive ability of the most widely used scoring systems (Acute Physiology and Chronic Health Evaluation [APACHE] II, Simplified Acute Physiology Score [SAPS] II, and Sequential Organ Failure Assessment [SOFA]) and of 2 specialized systems (European System for Cardiac Operative Risk Evaluation [EuroSCORE] II and the cardiac surgery score [CASUS]) for clinical outcome in patients after cardiac surgery. Consecutive patients admitted to a cardiac surgical intensive care unit (CSICU) were prospectively studied. Data on the preoperative condition, intraoperative parameters, and postoperative course were collected. EuroSCORE II, CASUS, and scores from 3 general severity-scoring systems (APACHE II, SAPS II, and SOFA) were calculated on the first postoperative day. Clinical outcome was defined as 30-day mortality and in-hospital morbidity. A total of 150 patients were included. Thirty-day mortality was 6%. CASUS was superior in outcome prediction, both in relation to discrimination (area under curve, 0.89) and calibration (Brier score = 0.043, χ(2) = 2.2, P = .89), followed by EuroSCORE II for 30-day mortality (area under curve, 0.87) and SOFA for morbidity (Spearman ρ= 0.37 and 0.35 for the CSICU length of stay and duration of mechanical ventilation, respectively; Wilcoxon W = 367.5, P = .03 for probability of readmission to CSICU). CASUS can be recommended as the most reliable and beneficial option for benchmarking and risk stratification in cardiac surgery patients. ©2015 American Association of Critical-Care Nurses.

  11. DESIGNING FEATURES OF POWER OPTICAL UNITS FOR TECHNOLOGICAL EQUIPMENT

    Directory of Open Access Journals (Sweden)

    M. Y. Afanasiev

    2016-03-01

    Full Text Available This paper considers the question of an optical unit designing for transmitting power laser radiation through an optical fiber. The aim of this work is designing a simple construction unit with minimized reflection losses. The source of radiation in the optical unit described below is an ultraviolet laser with diode pumping. We present the general functioning scheme and designing features for the three main parts: laser beam deflecting system, laser beam dump and optical unit control system. The described laser beam deflection system is composed of a moving flat mirror and a spherical scattering mirror. Comparative analysis of the production technology for such mirrors was carried out, and, as a result, the decision was made to produce both mirrors of 99.99 % pure molybdenum without coating. A moving mirror deflects laser emission from a source through a fiber or deflects it on a spherical mirror and into the laser beam dump, moreover, switching from one position to another occurs almost immediately. It is shown that a scattering mirror is necessary, otherwise, the absorbing surface of the beam dump is being worn out irregularly. The laser beam dump is an open conical cavity, in which the conical element with its spire turned to the emission source is placed. Special microgeometry of the internal surface of the beam dump is suggested for the better absorption effect. An optical unit control system consists of a laser beam deflection system, laser temperature sensor, deflection system solenoid temperature sensor, and deflection mirror position sensor. The signal processing algorithm for signals coming from the sensors to the controller is described. The optical unit will be used in special technological equipment.

  12. Does Wearable Medical Technology With Video Recording Capability Add Value to On-Call Surgical Evaluations?

    Science.gov (United States)

    Gupta, Sameer; Boehme, Jacqueline; Manser, Kelly; Dewar, Jannine; Miller, Amie; Siddiqui, Gina; Schwaitzberg, Steven D

    2016-10-01

    Background Google Glass has been used in a variety of medical settings with promising results. We explored the use and potential value of an asynchronous, near-real time protocol-which avoids transmission issues associated with real-time applications-for recording, uploading, and viewing of high-definition (HD) visual media in the emergency department (ED) to facilitate remote surgical consults. Study Design First-responder physician assistants captured pertinent aspects of the physical examination and diagnostic imaging using Google Glass' HD video or high-resolution photographs. This visual media were then securely uploaded to the study website. The surgical consultation then proceeded over the phone in the usual fashion and a clinical decision was made. The surgeon then accessed the study website to review the uploaded video. This was followed by a questionnaire regarding how the additional data impacted the consultation. Results The management plan changed in 24% (11) of cases after surgeons viewed the video. Five of these plans involved decision making regarding operative intervention. Although surgeons were generally confident in their initial management plan, confidence scores increased further in 44% (20) of cases. In addition, we surveyed 276 ED patients on their opinions regarding concerning the practice of health care providers wearing and using recording devices in the ED. The survey results revealed that the majority of patients are amenable to the addition of wearable technology with video functionality to their care. Conclusions This study demonstrates the potential value of a medically dedicated, hands-free, HD recording device with internet connectivity in facilitating remote surgical consultation.

  13. State of the art in surgical robotics: clinical applications and technology challenges.

    Science.gov (United States)

    Cleary, K; Nguyen, C

    2001-01-01

    Although it has been over 15 years since the first recorded use of a robot for a surgical procedure, the field of medical robotics is still an emerging one that has not yet reached a critical mass. Although robots have the potential to improve the precision and capabilities of physicians, the number of robots in clinical use is still very small. In this review article, we begin with a short historical review of medical robotics, followed by an overview of clinical applications where robots have been applied. The clinical applications are then discussed; they include neurosurgery, orthopedics, urology, maxillofacial surgery, radiosurgery, ophthalmology, and cardiac surgery. We conclude with a listing of technology challenges and research areas, including system architecture, software design, mechanical design, imaging compatible systems, user interface, and safety issues.

  14. Application of space syntax theory in the study of medical-surgical nursing units in urban hospitals.

    Science.gov (United States)

    Trzpuc, Stefnee J; Martin, Caren S

    2010-01-01

    Additional research is needed to explore how the design of urban, medical-surgical nursing units influences communication patterns, perceptions of social support, and overall job satisfaction for nurses. Space syntax theory has typically been used to study communication in office environments; more recently, it has been applied to the study of healthcare environments. The purpose of this study was to explore the applicability of space syntax theory as a theoretical framework for studying nurses' communication in medical-surgical nursing units in urban hospitals. The nursing profession is rapidly changing, and nurses' work is psychologically and physically intense. At the same time, nurses are responsible for patient safety, optimal care delivery, and patient outcomes (Bureau of Labor Statistics, 2009; Clarke, 2007; Clarke & Donaldson, 2008; Institute of Medicine, 2000; Institute of Medicine, 2004). Nurses are central to the delivery of care and act as a conduit for communication among members of the patient care team. Some of the design characteristics that create a more appealing environment for patients, such as views of nature and single-patient rooms, may not be fully understood as they relate to nurses' tasks and responsibilities, and they could be detrimental to nursing communication. This study analyzed three medical-surgical nursing unit floor plans using two constructs of space syntax theory, and it verified analysis through three semi-structured interviews with end users. The use of space syntax theory for analyzing medical-surgical nursing unit floor plans is complex. Findings indicated that nurses' perceptions of two constructs of space syntax theory, visibility and accessibility, did not consistently match the anticipated benefits of the floor plan designs. Understanding how and when nurses communicate with each other could help designers of healthcare spaces create more effective environments that support nurses' work and personal health and welfare

  15. Introduction of an acute surgical unit: comparison of performance indicators and outcomes for operative management of acute appendicitis.

    Science.gov (United States)

    Lancashire, John F; Steele, M; Parker, D; Puhalla, H

    2014-08-01

    The Acute Surgical Unit (ASU) is a recent change in management of acute general surgical patients in hospitals worldwide. In contrast to traditional management of acute surgical presentations by a rotating on-call system, ASUs are shown to deliver improved efficiency and patient outcomes. This study investigated the impact of an ASU on operative management of appendicitis, the most common acute surgical presentation, by comparing performance indicators and patient outcomes prior to and after introduction of an ASU at the Gold Coast Hospital, Queensland, Australia. A retrospective study of patients admitted from the Emergency Department (ED) and who underwent emergency appendectomy from February 2010 to January 2011 (pre-ASU) and after introduction of the ASU from February 2011 to January 2012 (post-ASU). A total of 548 patients underwent appendectomy between February 2010 and January 2012, comprising 247 pre-ASU and 301 post-ASU patients. Significant improvements were demonstrated: reduced time to surgical review, fewer complications arising from operations commencing during ASU in-hours, and more appendectomies performed during the daytime attended by the consultant. There was no significant difference in total cost of admission or total admission length of stay. This study demonstrated that ASUs have potential to significantly improve the outcomes for operative management of acute appendicitis compared to the traditional on-call model. The impact of the ASU was limited by access to theaters and restricted ASU operation hours. Further investigation of site-specific determinants could be beneficial to optimize this new model of acute surgical care.

  16. Correlation of APACHE II and SOFA scores with length of stay in various surgical intensive care units.

    Science.gov (United States)

    Milić, Morena; Goranović, Tatjana; Holjevac, Jadranka Katancić

    2009-09-01

    The aim of this study was to evaluate the usefulness of using Acute Physiology and Chronic Health Evaluation (APACHE) II score and Sequential Organ Failure Assessment (SOFA) score as the predictors of length of stay (LOS) in various surgical intensive care units (ICUs) and to test the hypothesis that the significance of scoring for predicting LOS is greater in specialized surgical ICUs. We scored patients in a non-specialized general surgical ICU (n = 328) and in a specialized cardiosurgical ICU (n = 158) consecutively on admission (APACHE II-1st day; SOFA-1st day) and on third day of stay (APACHE II-3rd day; SOFA-3rd day) in a 4-month period. LOS and APACHE II/SOFA scores were significantly correlated both on admission and on third day of stay in the general surgical ICU (APACHE II-1st day r = 0.289; SOFA-1st day r = 0.306; APACHE II-3rd day r = 0.728; SOFA-3rd day r = 0.725). LOS and APACHE II on admission were not significantly correlated in the cardiosurgical ICU (APACHE II-1st day r = 0.092), while SOFA on admission and APACHE II and SOFA on third day were significantly correlated (SOFA-1st day r = 0.258; APACHE II-3rd day r = 0.716; SOFA-3rd day r = 0.719). Usefulness of scoring for predicting LOS in ICU varied between different surgical ICUs. Contrary to our hypothesis, scoring had greater value for predicting LOS in the non-specialized general surgical ICU. APACHE II score on admission had no value for predicting LOS in the cardiosurgical ICU.

  17. The United Nations Human Space Technology Initiative (HSTI): Science Activities

    CERN Document Server

    Niu, A; Haubold, H J; Doi, T

    2012-01-01

    The United Nations Human Space Technology Initiative (HSTI) aims at promoting international cooperation in human spaceflight and space exploration-related activities; creating awareness among countries on the benefits of utilizing human space technology and its applications; and building capacity in microgravity education and research. HSTI has been conducting various scientific activities to promote microgravity education and research. The primary science activity is called 'Zero-gravity Instrument Distribution Project', in which one-axis clinostats will be distributed worldwide. The distribution project will provide unique opportunities for students and researchers to observe the growth of indigenous plants in their countries in a simulated microgravity condition and is expected to create a huge dataset of plant species with their responses to gravity.

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

    Science.gov (United States)

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

    2012-04-01

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

  19. Use of iPod™ technology in medical-surgical nursing courses: effect on grades.

    Science.gov (United States)

    Johnston, Robert; Hepworth, Joseph; Goldsmith, Melissa; Lacasse, Cheryl

    2010-01-01

    Advances in computer technology, such as the portable and affordable iPod™, allow students to view lectures anywhere at any time. iPods™ are of special interest for nurse educators who strive to meet demands posed by a critical nursing shortage. A mixed-methods pilot study was conducted to assess whether iPod™ could be an effective teaching tool for medical-surgical nursing lectures. In a randomized study with 35 participants, together with eight students having their own iPods™, grades of students given pre-recorded class lectures on iPods™ were compared with grades of those who attended lectures without iPods™. Learning styles, amount and use of students devoted to iPod™ lectures were considered as well as grades. Most results were not significant, but there was some evidence that the control groups who attended classroom lectures received better grades than iPod™ users, and individuals who used iPod™ more frequently before the final exam received lower grades. These somewhat surprising results suggest the need for further research in the use of this technology as a resource for nursing education delivery.

  20. Comparison of patient-ventilator asynchrony during pressure support ventilation and proportional assist ventilation modes in surgical Intensive Care Unit: A randomized crossover study

    Directory of Open Access Journals (Sweden)

    Parshotam Lal Gautam

    2016-01-01

    Full Text Available Background: The patient-ventilator asynchrony is almost observed in all modes of ventilation, and this asynchrony affects lung mechanics adversely resulting in deleterious outcome. Innovations and advances in ventilator technology have been trying to overcome this problem by designing newer modes of ventilation. Pressure support ventilation (PSV is a commonly used flow-cycled mode where a constant pressure is delivered by ventilator. Proportional assist ventilation (PAV is a new dynamic inspiratory pressure assistance and is supposed to be better than PSV for synchrony and tolerance, but reports are still controversial. Moreover, most of these studies are conducted in chronic obstructive pulmonary disease patients with respiratory failure; the results of these studies may not be applicable to surgical patients. Thus, we proposed to do compare these two modes in surgical Intensive Care Unit (ICU patients as a randomized crossover study. Aims: Comparison of patient-ventilator asynchrony between PSV and PAV plus (PAV+ in surgical patients while weaning. Subjects and Methods: After approval by the Hospital Ethics Committee, we enrolled twenty patients from surgical ICU of tertiary care institute. The patients were ventilated with pressure support mode (PSV and PAV+ for 12 h as a crossover from one mode to another after 6 h while weaning. Results: Average age and weight of patients were 41.80 ± 15.20 years (mean ± standard deviation [SD] and 66.50 ± 12.47 (mean ± SD kg, respectively. Comparing the asynchronies between the two modes, the mean number of total asynchronous recorded breaths in PSV was 7.05 ± 0.83 and 4.35 ± 5.62, respectively, during sleep and awake state, while the same were 6.75 ± 112.24 and 10.85 ± 11.33 in PAV+. Conclusion: Both PSV and PAV+ modes of ventilation performed similarly for patient-ventilator synchrony in surgical patients. In surgical patients with acute respiratory failure, dynamic inspiratory pressure

  1. Coblation technology for surgical wound debridement: principle, experimental data, and technical data.

    Science.gov (United States)

    Trial, Chloé; Brancati, Antonio; Marnet, Olivier; Téot, Luc

    2012-12-01

    Debridement is required to prepare the wound bed, essentially in removing undesired tissues observed both in acute wound after burns or trauma and in chronic wounds such as pressure ulcers, leg ulcers, and diabetic foot ulcers. Surgical debridement has been described as one of the most effective methods but can be contraindicated in the elderly, arteriopathic context, or patients under effective anticoagulation. Recently described debridement technologies are based on application of important mechanical severing forces over the wound surface using high-power hydrojets. High water flux acts as a vector for separating necrotic and sloughy tissues from the wound bed and aspirates them out of the wound immediately. Electrical powered techniques and lasers were also scarcely described. The Coblation debridement technology presented here is based on the local induction of a focused plasma field chemically deleting undesired tissues. This technique is a modification of conventional electrosurgical devices, developed in 1928 where tissue excision and coagulation of tissues were observed. Principles of plasma-mediated debridement are based on a bipolar radiofrequency energizing the molecules, thus creating a plasma field. This glow discharge plasma produces chemically active radical species from dissociation of water, breaking molecular bonds, and causing tissue dissolution. The thermal effects are a by-product, which can be modulated by modifying the electrode construction, limiting the local temperature to less than 50°C in order not to induce wound bed renecrosis. The authors describe here the principle, the first technical adaptation for wound debridement, and the potential clinical interest of the Coblation technology.

  2. Nursing assessment of continuous vital sign surveillance to improve patient safety on the medical/surgical unit.

    Science.gov (United States)

    Watkins, Terri; Whisman, Lynn; Booker, Pamela

    2016-01-01

    Evaluate continuous vital sign surveillance as a tool to improve patient safety in the medical/surgical unit. Failure-to-rescue is an important measure of hospital quality. Patient deterioration is often preceded by changes in vital signs. However, continuous multi-parameter vital sign monitoring may decrease patient safety with an abundance of unnecessary alarms. Prospective observational study at two geographically disperse hospitals in a single hospital system. A multi-parameter vital sign monitoring system was installed in a medical/surgical unit in Utah and one in Alabama providing continuous display of SpO2, heart rate, blood pressure and respiration rate on a central station. Alarm thresholds and time to alert annunciations were set based on prior analysis of the distribution of each vital sign. At the end of 4 weeks, nurses completed a survey on their experience. An average alert per patient, per day was determined retrospectively from the saved vital signs data and knowledge of the alarm settings. Ninety-two per cent of the nurses agreed that the number of alarms and alerts were appropriate; 54% strongly agreed. On average, both units experienced 10·8 alarms per patient, per day. One hundred per cent agreed the monitor provided valuable patient data that increased patient safety; 79% strongly agreed. Continuous, multi-parameter patient monitoring could be performed on medical/surgical units with a small and appropriate level of alarms. Continuous vital sign assessment may have initiated nursing interventions that prevented failure-to-rescue events. Nurses surveyed unanimously agreed that continuous vital sign surveillance will help enhance patient safety. Nursing response to abnormal vital signs is one of the most important levers in patient safety, by providing timely recognition of early clinical deterioration. This occurs through diligent nursing surveillance, involving assessment, interpretation of data, recognition of a problem and meaningful

  3. 75 FR 20388 - International Business Machines Corporation, Global Technology Services Business Unit, Integrated...

    Science.gov (United States)

    2010-04-19

    ... Employment and Training Administration International Business Machines Corporation, Global Technology Services Business Unit, Integrated Technology Services, Cost and Expense Team, Working From Various States..., applicable to workers of International Business Machines Corporation, Global Technology Services...

  4. Real-time monitoring for detection of retained surgical sponges and team motion in the surgical operation room using radio-frequency-identification (RFID) technology: a preclinical evaluation.

    Science.gov (United States)

    Kranzfelder, Michael; Zywitza, Dorit; Jell, Thomas; Schneider, Armin; Gillen, Sonja; Friess, Helmut; Feussner, Hubertus

    2012-06-15

    Technical progress in the surgical operating room (OR) increases constantly, facilitating the development of intelligent OR systems functioning as "safety backup" in the background of surgery. Precondition is comprehensive data retrieval to identify imminent risky situations and inaugurate adequate security mechanisms. Radio-frequency-identification (RFID) technology may have the potential to meet these demands. We set up a pilot study investigating feasibility and appliance reliability of a stationary RFID system for real-time surgical sponge monitoring (passive tagged sponges, position monitoring: mayo-stand/abdominal situs/waste bucket) and OR team tracking (active transponders, position monitoring: right/left side of OR table). In vitro: 20/20 sponges (100%) were detected on the mayo-stand and within the OR-phantom, however, real-time detection accuracy declined to 7/20 (33%) when the tags were moved simultaneously. All retained sponges were detected correctly. In vivo (animal): 7-10/10 sterilized sponges (70%-100%) were detected correctly within the abdominal cavity. OR-team: detection accuracy within the OR (surveillance antenna) and on both sides of the OR table (sector antenna) was 100%. Mean detection time for position change (left to right side and contrariwise) was 30-60 s. No transponder failure was noted. This is the first combined RFID system that has been developed for stationary use in the surgical OR. Preclinical evaluation revealed a reliable sponge tracking and correct detection of retained textiles (passive RFID) but also demonstrated feasibility of comprehensive data acquisition of team motion (active RFID). However, detection accuracy needs to be further improved before implementation into the surgical OR. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. Step-by-step surgical technique for mandibular reconstruction with fibular free flap: application of digital technology in virtual surgical planning.

    Science.gov (United States)

    Succo, G; Berrone, M; Battiston, B; Tos, P; Goia, F; Appendino, P; Crosetti, E

    2015-06-01

    At present, mandibular reconstruction with a fibular free flap is the gold standard for functional and esthetic rehabilitation after oncological surgery. The purpose of this study was to describe the computer-assisted mandibular reconstruction procedure adopting the customized solution Synthes ProPlan CMF. The study reports five consecutive patients with benign or malignant disease requiring mandibular reconstruction using a microvascular fibular free flap, pre-operative virtual planning, construction of cutting guides and customized laser pre-bent titanium plates. The surgical technique is discussed in a step-by-step fashion. The average post-operative hospital stay was 18 ± 3 days. Ischemia time was recorded in all five cases, with an average of 75 ± 8 min. No problems were encountered in any surgical step and there were no major complications. Excellent precision of cutting guides and a good fit of pre-bent plates were found on both the mandible and fibula. There was excellent precision in bone to bone contact and position between mandible and fibula graft. Measurement data from the pre-operative and post-operative CT scans were compared. The average difference (Δ) between programed segment lengths and CT control segment lengths was 0.098 ± 0.077 cm. Microsurgical mandibular reconstruction using a virtual surgical planning yields significantly shorter ischemia times and allows more precise osteotomies. The technology is becoming increasingly recognized for its ability to optimize surgical outcomes and minimize operating time. Considering that the extent of resection can be wider than predicted, this results in safer modeling of the fibula only after frozen sections have demonstrated the radicality of resection.

  6. The Surgical Optimal Mobility Score predicts mortality and length of stay in an Italian population of medical, surgical, and neurologic intensive care unit patients.

    Science.gov (United States)

    Piva, Simone; Dora, Giancarlo; Minelli, Cosetta; Michelini, Mariachiara; Turla, Fabio; Mazza, Stefania; D'Ottavi, Patrizia; Moreno-Duarte, Ingrid; Sottini, Caterina; Eikermann, Matthias; Latronico, Nicola

    2015-12-01

    We validated the Italian version of Surgical Optimal Mobility Score (SOMS) and evaluated its ability to predict intensive care unit (ICU) and hospital length of stay (LOS), and hospital mortality in a mixed population of ICU patients. We applied the Italian version of SOMS in a consecutive series of prospectively enrolled, adult ICU patients. Surgical Optimal Mobility Score level was assessed twice a day by ICU nurses and twice a week by an expert mobility team. Zero-truncated Poisson regression was used to identify predictors for ICU and hospital LOS, and logistic regression for hospital mortality. All models were adjusted for potential confounders. Of 98 patients recruited, 19 (19.4%) died in hospital, of whom 17 without and 2 with improved mobility level achieved during the ICU stay. SOMS improvement was independently associated with lower hospital mortality (odds ratio, 0.07; 95% confidence interval [CI], 0.01-0.42) but increased hospital LOS (odds ratio, 1.21; 95% CI: 1.10-1.33). A higher first-morning SOMS on ICU admission, indicating better mobility, was associated with lower ICU and hospital LOS (rate ratios, 0.89 [95% CI, 0.80-0.99] and 0.84 [95% CI, 0.79-0.89], respectively). The first-morning SOMS on ICU admission predicted ICU and hospital LOS in a mixed population of ICU patients. SOMS improvement was associated with reduced hospital mortality but increased hospital LOS, suggesting the need of optimizing hospital trajectories after ICU discharge. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Surgical management of pneumothorax: significance of effective admission or communication strategies between the district general hospitals and specialized unit.

    Science.gov (United States)

    Aslam, Muhammad I; Martin-Ucar, Antonio E; Nakas, Apostolos; Waller, David A

    2011-11-01

    A preoperative delay in emergency surgery for spontaneous pneumothorax is associated with a poor outcome after surgery and a prolonged hospital stay. To reduce preoperative delays, all tertiary referrals from district general hospitals to our thoracic surgery unit were processed through a 'clinical decisions unit' (CDU). Prior to the establishment of the CDU, these patients were added to a waiting list for a surgical bed. This study has reviewed the effect of this change in admission policy on the efficiency of treatment for non-elective spontaneous pneumothorax. An intergroup comparison (pre-CDU group vs. post-CDU group) was made of the following parameters: referral to transfer time, transfer to surgery time and length of inpatient stay in the referring and tertiary hospitals. There were no significant differences in gender, diagnosis, treatment in the referring hospitals, postoperative clinical outcome, or indications for or type of surgery. The total length of inpatient stay in the referring and tertiary hospitals was significantly reduced for the post-CDU group (12 vs. 15 days; P<0.001), which was attributed to the earlier transfer of patients (18 vs. 78 hours; P<0.001) hours. Allowing surgical access to a traditional medical admission unit is therefore, cost-effective and significantly improves the efficiency of non-elective pneumothorax surgery.

  8. Health Technology Assessment report on the presurgical evaluation and surgical treatment of drug-resistant epilepsy.

    Science.gov (United States)

    Marras, Carlo Efisio; Canevini, Maria Paola; Colicchio, Gabriella; Guerrini, Renzo; Rubboli, Guido; Scerrati, Massimo; Spreafico, Roberto; Tassi, Laura; LoRusso, Giorgio; Tinuper, Paolo

    2013-10-01

    Epilepsy is a neurologic disorder with major social impact. Surgery is a valuable option in patients who are not responding to antiepileptic drugs. The literature reports demonstrate that a proportion ranging from 40 to 100% of patients with epilepsy achieve seizure remission after surgery. A presurgical evaluation (clinical and instrumental) must be performed in all patients with drug-resistant epilepsy to assess their suitability for surgical intervention. Health Technology Assessment (HTA) represents a modern approach to the analysis of technologies used for health care. HTA could be considered a bridge between science that produces evidence and the decisions that can be taken on the basis of that evidence at different levels of the health care system. The aim of this study is the HTA of epilepsy surgery including clinical, ethical, social, and economic features. The present study includes an analysis of the diagnostic and surgical workup performed at the Italian centers for the diagnosis and treatment of drug-resistant epilepsy (DRE). The study includes the following issues: (1) social, ethical impact, and costs of the disease; (2) clinical results, efficacy, and safety of surgery; (3) ethics and quality of life after surgery; and (4) economic impact and productivity regained after surgery. The cost of managing a patient with DRE included in the presurgical study was estimated by the bottom-up microcosting technique that starts from a detailed collection of data on consumption of resources and full costing. The phases analyzed were (1) noninvasive diagnostic workup; (2) neurosurgical intervention; and (3) follow-up. The literature reports indicate epilepsy surgery as an effective treatment both on clinical results and on ethical, social, and quality of life aspects. The workup including the noninvasive presurgical study followed by surgery has a total cost of €20,827. Management of short-term follow-up increases the overhead to €22,291 at the first year

  9. [[Technology Surgical Intervention in Ulcerative Colitis Modeling Descending Part of the Colon in Rats Line "Wistar"].

    Science.gov (United States)

    Kim, A D; Petuhova, S A; Chashkova, Ye Y U; Gol'dberg, O A; Shedoeva, L R

    2016-01-01

    Ulcerative colitis (UC) is a chronic immune inflammatory condition of the colon with an unknown aetiology, leading to disability and reduced quality of life of patients. UC primarily affects young adults. In most cases, inflammatory bowel disease (iBD) debuts at reproductive age. The incidence of UC and severe clinical course has increased overall across the world. The study of the mechanisms of pathogenesis and aetiology of this disease contributes to the development of new effective methods of treatment. The aim of our study was to develop technology of the surgery directed to induction of reversible ischemic damage, the erosive-ulceration of gut mucosae (descending colon) at rats of the WISTAR line. Experimental research was done using male rats (n=40), their age was more than 6 months, weight of body is 280 - 350 grams. The animals were separated into 3 groups: 1 - (n=14) Sholimov's operative method, 2 group (n=16) - model using special technology, 3 group (n=10) - Coopr's H. S. induction ulcerative colitis. Observation was been done during 10 days. We offered special surgical technique: parietal ligation on every vasa recta of colon descendens of rats the length 3 cm along colon, on the apex vesicae and then vasa recta are cut. Then during 7 days 1% solution of dextran sulfate sodium (DSN) was given for experimental animals after postoperative period. By the histolog- ical biopsy of colon mucosa the results were estimated. we have created erosive-ulceration of gut mucosae (descending colon) of rat with productive inflam- mation, vasculitis and plasmatic impregnation of the vessel walls and intimal thickening. Our model of ulcerative colitis can be used for the development and testing of new methods for the study and treatment of this pathology.

  10. Scythian trepanations in the Gorny Altai in Hippocratic times: modern expert appraisal of ancient surgical technologies.

    Science.gov (United States)

    Krivoshapkin, Alexey L; Chikisheva, Tatiana A; Zubova, Alisa V; Kurbatov, Vladislav P; Titov, Anatoli T; Volkov, Pavel V

    2014-11-01

    To report the analysis of 3 cases of ancient trepanation discovered in the craniological collection (153 skulls) of the Pazyryk nomadic culture (500-300 bc) from the Gorny Altai, Russia, and to evaluate the technique, instrumentation, and materials used for cranial surgery as well as the motivation for the trepanations in Scythian times. A multidisciplinary approach was chosen to study the trepanned skulls. Visual inspection and examination under magnification, multislice computed tomography, high-field magnetic resonance imaging, and coupled plasma mass spectrometry and synchrotron radiation-induced x-ray fluorescence analysis of the bone samples from the site of trephination were used. In the Pazyryk culture, trepanation was very likely used to perform the intracranial procedures that were not yet indicated by Hippocrates. No signs of bone infection were detected. Higher copper abundance found at the site of trepanation showed that a bronze knife was the most likely tool used by Scythian surgeons. Our data suggest that the Scythian population of the Altai Mountains had sufficient medical knowledge to perform sophisticated and successful manipulations on the human skulls. Scraping technique with bronze tools was quite effective for prevention of wound infection and resulted in a high survival rate after surgery. In the era of methicillin-resistant Staphylococcus aureus, it may be useful to consider some ancient surgical technologies. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. Clinical application of implantological surgical unit in broken root extraction%牙种植机在断根拔除术中的临床应用研究

    Institute of Scientific and Technical Information of China (English)

    陈冶

    2012-01-01

    Objective To investigate effects of clinical application of implantological surgical unit in broken root extraction. Methods 56 cases of broken root in clinical tooth extraction were collected in the department of dentistry in affiliated Hanyang hospital of Wuhan University Of Science and Technology from October 2009 to December 2011,then they were randomly and equally divided into two groups:traditional extraction group and implantological surgical unit-assisted extraction group.Operative time and postoperative wound pain on the 3rd day were compared. Results Broken root was pulled out in 16 of 28 cases in tranditional group.the other 12 cases adopted implantological surgical unit instead because of operational difficuities.All broken roots were pulled out in implantoiogical surgical unit group.The operation time of implantological surgical unit group was shorter compared with tranditional group (P<0.01).The pain level of implantological surgical unit group was obviously lighter than tranditional group (P<0.01). Conclusion Application of implantological surgical unit in broken root extraction is characterized by shorter operative duration , definite effect,minimal-invasion and less complications,which deserves popularization for its advantages.%目的:评估牙种植机在断根拔除术的临床应用效果.方法:收集2009年10月~ 2011年12月在武汉科技大学附属汉阳医院口腔科门诊拔牙中断根的患者56例,分成两组.分别采用传统拔除法和牙种植机辅助断根拔除法,比较手术时间及术后3天创口疼痛程度.结果:传统组28例拔除16例,另12例因操作困难改种植机法全部拔除,归为中转组;种植机组28例全部拔除.手术时间种植机组明显短于传统组(P<0.01),疼痛程度种植机组明显轻于传统组(P<0.01).结论:牙种植机应用于断根拔除术具有手术时间短、效果确切、创伤小、并发症少的优点,值得推广.

  12. "The study on surgical services for the United States": a valid prescription for American surgery?

    Science.gov (United States)

    Hughes, E F; Lewit, E M; Pauly, M V

    1977-01-01

    The overall approach of SOSSUS to the study of surgical services, the interpretation of findings, and policy recommendations are rightly called into question. But singular concern with the consequences of monopolistic control by the profession is no substitute for analysis of the dynamics among demand, production, and supply of surgery. Any delivery system--and many models are feasible--involving consumers, providers, and payers is a market in which multidimensional behavior must be anticipated.

  13. Improving deep vein thrombosis prophylaxis with mechanical modalities in surgical intensive care unit.

    Science.gov (United States)

    Restrepo, Paula; Jameson, Deborah L; Carroll, Diane L

    2015-01-01

    Deep vein thrombosis remains a source of adverse outcomes in surgical patients. Deep vein thrombosis is preventable with prophylactic intervention. The success of noninvasive mechanical modalities for prophylaxis relies on compliance with correct application. The goals of this project were to create a guideline that reflected current evidence and expert thinking about mechanical modalities use, assess compliance with mechanical modalities, and develop strategies to disseminate an evidence-based guideline for deep vein thrombosis prophylaxis.

  14. Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit: a review.

    Science.gov (United States)

    Meyer, Zainna C; Schreinemakers, Jennifer M J; de Waal, Ruud A L; van der Laan, Lijckle

    2015-09-01

    We reviewed the use of the levels of C-reactive protein, lactate and procalcitonin and/or the Sequential Organ Failure Assessment score to determine their diagnostic accuracy for predicting surgical complications in critically ill general post-surgery patients. Included were all studies published in PubMed from inception to July 2013 that met the following inclusion criteria: evaluation of the above parameters, describing their diagnostic accuracy and the risk stratification for surgical complications in surgical patients admitted to an intensive care unit. No difference in the Sequential Organ Failure Assessment scores was seen between patients with or without complications. The D-lactate levels were significantly higher in those who developed colonic ischemic complications after a ruptured abdominal aortic aneurysm. After gastro-intestinal surgery, contradictory data were reported, with both positive and negative use of C-reactive protein and procalcitonin in the diagnosis of septic complications. However, in trauma patients, the C-reactive protein levels may help to discriminate between those with and without infectious causes. We conclude that the Sequential Organ Failure Assessment score, lactate concentration and C-reactive protein level have no significant predictive value for early postoperative complications in critically ill post-surgery patients. However, procalcitonin seems to be a useful parameter for diagnosing complications in specific patient populations after surgery and/or after trauma.

  15. Development Status of the Fission Power System Technology Demonstration Unit

    Science.gov (United States)

    Briggs, Maxwell H.; Gibson, Marc A.; Geng, Steven M.; Pearson, Jon Boise; Godfoy, Thomas

    2012-01-01

    This paper summarizes the progress that has been made in the development of the Fission Power System Technology Demonstration Unit (TDU). The reactor simulator core and Annular Linear Induction Pump have been fabricated and assembled into a test loop at the NASA Marshall Space Flight Center. A 12 kWe Power Conversion Unit (PCU) is being developed consisting of two 6 kWe free-piston Stirling engines. The two 6 kWe engines have been fabricated by Sunpower Inc. and are currently being tested separately prior to integration into the PCU. The Facility Cooling System (FCS) used to reject convertor waste heat has been assembled and tested at the NASA Glenn Research Center (GRC). The structural elements, including a Buildup Assembly Platform (BAP) and Upper Truss Structure (UTS) have been fabricated, and will be used to test cold-end components in thermal vacuum prior to TDU testing. Once all components have been fully tested at the subsystem level, they will be assembled into an end-to-end system and tested in thermal vacuum at GRC.

  16. Post-riser Regeneration Technology in FCC Unit

    Institute of Scientific and Technical Information of China (English)

    Liu Xiancheng; Lu Chunxi; Shi Mingxian

    2007-01-01

    In our present work,a post-riser regeneration technology (PRRT) for fluid catalytic cracking (FCC) units was developed to deal with increasingly heavier feedstock and hereby the larger amount of coke deposited on the catalyst particles during reaction.This technology can make full use of the advantages of riser regenerator,such as high coke-burning efficiency and low residual carbon,and at the same time overcome its disadvantages,such as difficulty in starting combustion.The average particles concentration on the cross section of the system was studied on a large scale cold model experimental set-up.Also a necessary software was developed by combining the hydrodynamics research results in our work with the coke-burning kinetics model and the heat and mass transfer model developed by previous researchers.The simulation results showed that the PRRT could increase regeneration capability by 16.28%-26.24% over the conventional turbulent fluidized bed regenerator under the similar operation conditions,and that the residual carbon could be kept below 0.1 wt%.

  17. Accessibility to surgical robot technology and prostate-cancer patient behavior for prostatectomy.

    Science.gov (United States)

    Sugihara, Toru; Yasunaga, Hideo; Matsui, Hiroki; Nagao, Go; Ishikawa, Akira; Fujimura, Tetsuya; Fukuhara, Hiroshi; Fushimi, Kiyohide; Ohori, Makoto; Homma, Yukio

    2017-07-01

    To examine how surgical robot emergence affects prostate-cancer patient behavior in seeking radical prostatectomy focusing on geographical accessibility. In Japan, robotic surgery was approved in April 2012. Based on data in the Japanese Diagnosis Procedure Combination database between April 2012 and March 2014, distance to nearest surgical robot and interval days to radical prostatectomy (divided by mean interval in 2011: % interval days to radical prostatectomy) were calculated for individual radical prostatectomy cases at non-robotic hospitals. Caseload changes regarding distance to nearest surgical robot and robot introduction were investigated. Change in % interval days to radical prostatectomy was evaluated by multivariate analysis including distance to nearest surgical robot, age, comorbidity, hospital volume, operation type, hospital academic status, bed volume and temporal progress. % Interval days to radical prostatectomy became wider for distance to nearest surgical robot robot emerged within 30 and 10 km, the prostatectomy caseload in non-robot hospitals reduced by 13 and 18% within 6 months, respectively, while the robot hospitals gained +101% caseload (P robotic minimally invasive radical prostatectomies in 483 non-robot hospitals revealed a significant inverse association between distance to nearest surgical robot and % interval days to radical prostatectomy (B = -17.3% for distance to nearest surgical robot ≥30 km and -11.7% for 10-30 km versus distance to nearest surgical robot Robotic surgery accessibility within 30 km would make patients less likely select conventional surgery. The nearer a robot was, the faster the caseload reduction was.

  18. Trends in operative experience of pediatric surgical residents in the United States and Canada.

    Science.gov (United States)

    Fingeret, Abbey L; Stolar, Charles J H; Cowles, Robert A

    2013-01-01

    Expansion of the number of training programs in pediatric surgery occurred from 2003 through 2010. We sought to determine the effect of program expansion on case volume and distribution of operative experience. Public domain data on pediatric surgery resident summary statistics available from the Accreditation Council for Graduate Medical Education (ACGME) from July 2003 through June 2010 were analyzed. Total case volume as primary surgeon or teaching assistant, mean case volume per resident, standard deviation, mode, minimum, and maximum number of cases per resident were evaluated. Mean total cases per resident, minimally invasive laparoscopic and thoracoscopic cases, and requisite cases as defined by the ACGME categories of: tumor, important pediatric surgical, and neonatal cases were analyzed by a Cuzick Wilcoxon-type nonparametric trend statistic using a significance level of 0.05. Skew was assessed by Pearson coefficient with levels of -0.5 to 0.5 defining a parametric distribution. The number of pediatric surgical training residents increased by 42% during the years reported, from 24 to 34. No statistically significant difference was found in the mean number of total cases or requisite cases per resident. The mean volume of minimally invasive procedures increased significantly. Case volume per resident was non-parametrically distributed with increasing positive skew over time. The increase in number of pediatric surgical resident training positions has not adversely affected overall operative experience or exposure to highly specialized requisite cases, on average. The increasing positive skew of total and index cases, however, suggests that variability between programs in case exposure is increasing over time. Copyright © 2013 Elsevier Inc. All rights reserved.

  19. Challenges implementing bar-coded medication administration in the emergency room in comparison to medical surgical units.

    Science.gov (United States)

    Glover, Nancy

    2013-03-01

    Bar-coded medication administration has been successfully implemented and utilized to decrease medication errors at a number of hospitals in recent years. The purpose of this article was to discuss the varying success in utilization of bar-coded medication administration on medical-surgical units and in the emergency department. Utilization reports were analyzed to better understand the challenges between the units. Many factors negatively impacted utilization in the emergency department, including the inability to use bar-coded medication administration for verbal orders or to document medications distributed by the prescribing providers, unique aspects of emergency department nursing workflow, additional steps to chart when using bar-coded medication administration, and alert fatigue. Hardware problems affected all users. Bar-coded medication administration in its current form is more suitable for use on medical-surgical floors than in the emergency department. New solutions should be developed for bar-coded medication administration in the emergency department, keeping in mind requirements to chart medications when there is no order in the system, document medications distributed by prescribing providers, adapt to unpredictable nursing workflow, minimize steps to chart with bar-coded medication administration, limit alerts to those that are clinically meaningful, and choose reliable hardware with adequate bar-code scanning capability.

  20. Environmental Impacts of Surgical Procedures: Life Cycle Assessment of Hysterectomy in the United States

    Science.gov (United States)

    2015-01-01

    The healthcare sector is a driver of economic growth in the U.S., with spending on healthcare in 2012 reaching $2.8 trillion, or 17% of the U.S. gross domestic product, but it is also a significant source of emissions that adversely impact environmental and public health. The current state of the healthcare industry offers significant opportunities for environmental efficiency improvements, potentially leading to reductions in costs, resource use, and waste without compromising patient care. However, limited research exists that can provide quantitative, sustainable solutions. The operating room is the most resource-intensive area of a hospital, and surgery is therefore an important focal point to understand healthcare-related emissions. Hybrid life cycle assessment (LCA) was used to quantify environmental emissions from four different surgical approaches (abdominal, vaginal, laparoscopic, and robotic) used in the second most common major procedure for women in the U.S., the hysterectomy. Data were collected from 62 cases of hysterectomy. Life cycle assessment results show that major sources of environmental emissions include the production of disposable materials and single-use surgical devices, energy used for heating, ventilation, and air conditioning, and anesthetic gases. By scientifically evaluating emissions, the healthcare industry can strategically optimize its transition to a more sustainable system. PMID:25517602

  1. Technology-based innovation for independent living: policy and innovation in the United Kingdom, Scandinavia, and the United States.

    Science.gov (United States)

    Berridge, Clara; Furseth, Peder Inge; Cuthbertson, Richard; Demello, Steven

    2014-01-01

    Interest in utilizing technology to help older adults remain living at home is growing; however, uptake remains low. We present a conceptual framework for understanding independent living technology innovation within health and social services. Public policy and innovation in the United States, the United Kingdom, and Scandinavia are profiled as case studies. In all profiled countries, independent living technology is more rapidly advancing than associated state policy, regulation, and payment systems. The findings from this comparative analysis reveal areas for further exploration, including policy subsystem environments in which technologies and services are regulated, as well as trends and desires of older adults and their caregivers within particular cultural contexts.

  2. Fission Surface Power Technology Demonstration Unit Test Results

    Science.gov (United States)

    Briggs, Maxwell H.; Gibson, Marc A.; Geng, Steven M.; Sanzi, James L.

    2016-01-01

    The Fission Surface Power (FSP) Technology Demonstration Unit (TDU) is a system-level demonstration of fission power technology intended for use on manned missions to Mars. The Baseline FSP systems consists of a 190 kWt UO2 fast-spectrum reactor cooled by a primary pumped liquid metal loop. This liquid metal loop transfers heat to two intermediate liquid metal loops designed to isolate fission products in the primary loop from the balance of plant. The intermediate liquid metal loops transfer heat to four Stirling Power Conversion Units (PCU), each of which produce 12 kWe (48 kW total) and reject waste heat to two pumped water loops, which transfer the waste heat to titanium-water heat pipe radiators. The FSP TDU simulates a single leg of the baseline FSP system using an electrically heater core simulator, a single liquid metal loop, a single PCU, and a pumped water loop which rejects the waste heat to a Facility Cooling System (FCS). When operated at the nominal operating conditions (modified for low liquid metal flow) during TDU testing the PCU produced 8.9 kW of power at an efficiency of 21.7 percent resulting in a net system power of 8.1 kW and a system level efficiency of 17.2 percent. The reduction in PCU power from levels seen during electrically heated testing is the result of insufficient heat transfer from the NaK heater head to the Stirling acceptor, which could not be tested at Sunpower prior to delivery to the NASA Glenn Research Center (GRC). The maximum PCU power of 10.4 kW was achieved at the maximum liquid metal temperature of 875 K, minimum water temperature of 350 K, 1.1 kg/s liquid metal flow, 0.39 kg/s water flow, and 15.0 mm amplitude at an efficiency of 23.3 percent. This resulted in a system net power of 9.7 kW and a system efficiency of 18.7 percent.

  3. Emerging technology in surgical education: combining real-time augmented reality and wearable computing devices.

    Science.gov (United States)

    Ponce, Brent A; Menendez, Mariano E; Oladeji, Lasun O; Fryberger, Charles T; Dantuluri, Phani K

    2014-11-01

    The authors describe the first surgical case adopting the combination of real-time augmented reality and wearable computing devices such as Google Glass (Google Inc, Mountain View, California). A 66-year-old man presented to their institution for a total shoulder replacement after 5 years of progressive right shoulder pain and decreased range of motion. Throughout the surgical procedure, Google Glass was integrated with the Virtual Interactive Presence and Augmented Reality system (University of Alabama at Birmingham, Birmingham, Alabama), enabling the local surgeon to interact with the remote surgeon within the local surgical field. Surgery was well tolerated by the patient and early surgical results were encouraging, with an improvement of shoulder pain and greater range of motion. The combination of real-time augmented reality and wearable computing devices such as Google Glass holds much promise in the field of surgery.

  4. The Rationalization of Automatic Units for HPDC Technology

    Directory of Open Access Journals (Sweden)

    A. Herman

    2012-04-01

    Full Text Available The paper deals with problem of optimal used automatic workplace for HPDC technology - mainly from aspects of operations sequence, efficiency of work cycle and planning of using and servicing of HPDC casting machine. Presented are possible ways to analyse automatic units for HPDC. The experimental part was focused on the rationalization of the current work cycle time for die casting of aluminium alloy. The working place was described in detail in the project. The measurements were carried out in detail with the help of charts and graphs mapped cycle of casting workplace. Other parameters and settings have been identified.The proposals for improvements were made after the first measurements and these improvements were subsequently verified. The main actions were mainly software modifications of casting center. It is for the reason that today's sophisticated workplaces have the option of a relatively wide range of modifications without any physical harm to machines themselves. It is possible to change settings or unlock some unsatisfactory parameters.

  5. Compassion fatigue, moral distress, and work engagement in surgical intensive care unit trauma nurses: a pilot study.

    Science.gov (United States)

    Mason, Virginia M; Leslie, Gail; Clark, Kathleen; Lyons, Pat; Walke, Erica; Butler, Christina; Griffin, Martha

    2014-01-01

    Preparation for replacing the large proportion of staff nurses reaching retirement age in the next few decades in the United States is essential to continue delivering high-quality nursing care and improving patient outcomes. Retaining experienced critical care nurses is imperative to successfully implementing the orientation of new inexperienced critical care nurses. It is important to understand factors that affect work engagement to develop strategies that enhance nurse retention and improve the quality of patient care. Nurses' experience of moral distress has been measured in medical intensive care units but not in surgical trauma care units, where nurses are exposed to patients and families faced with sudden life-threatening, life-changing patient consequences.This pilot study is a nonexperimental, descriptive, correlational design to examine the effect of compassion satisfaction, compassion fatigue, moral distress, and level of nursing education on critical care nurses' work engagement. This is a partial replication of Lawrence's dissertation. The study also asked nurses to describe sources of moral distress and self-care strategies for coping with stress. This was used to identify qualitative themes about the nurse experiences. Jean Watson's theory of human caring serves as a framework to bring meaning and focus to the nursing-patient caring relationship.A convenience sample of 26 of 34 eligible experienced surgical intensive care unit trauma nurses responded to this survey, indicating a 77% response rate. Twenty-seven percent of the nurses scored high, and 73% scored average on compassion satisfaction. On compassion fatigue, 58% scored average on burnout and 42% scored low. On the secondary traumatic stress subscale, 38% scored average, and 62% scored low. The mean moral distress situations subscale score was 3.4, which is elevated. The mean 9-item Utrecht Work Engagement Scale total score, measuring work engagement, was 3.8, which is considered low

  6. Patient safety culture in a Dutch pediatric surgical intensive care unit: an evaluation using the Safety Attitudes Questionnaire.

    Science.gov (United States)

    Poley, Marten J; van der Starre, Cynthia; van den Bos, Ada; van Dijk, Monique; Tibboel, Dick

    2011-11-01

    Nowadays, the belief is widespread that a safety culture is crucial to achieving patient safety, yet there has been virtually no analysis of the safety culture in pediatric hospital settings so far. Our aim was to measure the safety climate in our unit, compare it with benchmarking data, and identify potential deficiencies. Prospective longitudinal survey study at two points in time. Pediatric surgical intensive care unit at a Dutch university hospital. All unit personnel. To measure the safety climate, the Safety Attitudes Questionnaire was administered to physicians, nurses, nursing assistants, pharmacists, technicians, and ward clerks in both May 2006 and May 2007. This questionnaire assesses caregiver attitudes through use of the six following scales: teamwork climate, job satisfaction, perceptions of management, safety climate, working conditions, and stress recognition. Earlier research showed that the Safety Attitudes Questionnaire has good psychometric properties and produced benchmarking data that can be used to evaluate strengths and weaknesses in a given clinical unit against peers. The response rates for the Safety Attitudes Questionnaire were 85% (May 2006) and 74% (May 2007). There were mixed findings regarding the difference between physicians and nurses: on three scales (i.e., teamwork climate, safety climate, and stress recognition), physicians scored better than nurses at both points in time. On another two scales (i.e., perceptions of management and working conditions), nurses consistently had higher mean scale scores. Probably due to the small number of physicians, only some of these differences between physicians and nurses reached the level of statistical significance. Compared to benchmarking data, scores on perceptions of management were higher than expected (p culture in our unit was good when compared to benchmark data, there is still room for improvement. This requires us to continue working on interventions intended to improve the safety

  7. Design and implementation of GRIP: a computerized glucose control system at a surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Zijlstra Felix

    2005-12-01

    Full Text Available Abstract Background Tight glucose control by intensive insulin therapy has become a key part of critical care and is an important field of study in acute coronary care. A balance has to be found between frequency of measurements and the risk of hypoglycemia. Current nurse-driven protocols are paper-based and, therefore, rely on simple rules. For safety and efficiency a computer decision support system that employs complex logic may be superior to paper protocols. Methods We designed and implemented GRIP, a stand-alone Java computer program. Our implementation of GRIP will be released as free software. Blood glucose values measured by a point-of-care analyzer were automatically retrieved from the central laboratory database. Additional clinical information was asked from the nurse and the program subsequently advised a new insulin pump rate and glucose sampling interval. Results Implementation of the computer program was uneventful and successful. GRIP treated 179 patients for a total of 957 patient-days. Severe hypoglycemia ( Conclusion A computer driven protocol is a safe and effective means of glucose control at a surgical ICU. Future improvements in the recommendation algorithm may further improve safety and efficiency.

  8. Successful implementation of a packed red blood cell and fresh frozen plasma transfusion protocol in the surgical intensive care unit.

    Directory of Open Access Journals (Sweden)

    Benjamin E Szpila

    Full Text Available Blood product transfusions are associated with increased morbidity and mortality. The purpose of this study was to determine if implementation of a restrictive protocol for packed red blood cell (PRBC and fresh frozen plasma (FFP transfusion safely reduces blood product utilization and costs in a surgical intensive care unit (SICU.We performed a retrospective, historical control analysis comparing before (PRE and after (POST implementation of a restrictive PRBC/FFP transfusion protocol for SICU patients. Univariate analysis was utilized to compare patient demographics and blood product transfusion totals between the PRE and POST cohorts. Multivariate logistic regression models were developed to determine if implementation of the restrictive transfusion protocol is an independent predictor of adverse outcomes after controlling for age, illness severity, and total blood products received.829 total patients were included in the analysis (PRE, n=372; POST, n=457. Despite higher mean age (56 vs. 52 years, p=0.01 and APACHE II scores (12.5 vs. 11.2, p=0.006, mean units transfused per patient were lower for both packed red blood cells (0.7 vs. 1.2, p=0.03 and fresh frozen plasma (0.3 vs. 1.2, p=0.007 in the POST compared to the PRE cohort, respectively. There was no difference in inpatient mortality between the PRE and POST cohorts (7.5% vs. 9.2%, p=0.39. There was a decreased risk of urinary tract infections (OR 0.47, 95%CI 0.28-0.80 in the POST cohort after controlling for age, illness severity and amount of blood products transfused.Implementation of a restrictive transfusion protocol can effectively reduce blood product utilization in critically ill surgical patients with no increase in morbidity or mortality.

  9. Recent technological developments: in situ histopathological interrogation of surgical tissues and resection margins

    Directory of Open Access Journals (Sweden)

    Upile Tahwinder

    2007-03-01

    Full Text Available Abstract Objectives The tumour margin is an important surgical concept significantly affecting patient morbidity and mortality. We aimed in this prospective study to apply the microendoscope on tissue margins from patients undergoing surgery for oral cancer in vivo and ex vivo and compare it to the gold standard "paraffin wax", inter-observer agreement was measured; also to present the surgical pathologist with a practical guide to the every day use of the microendoscope both in the clinical and surgical fields. Materials and methods Forty patients undergoing resection of oral squamous cell carcinoma were recruited. The surgical margin was first marked by the operator followed by microendoscopic assessment. Biopsies were taken from areas suggestive of close or positive margins after microendoscopic examination. These histological samples were later scrutinized formally and the resection margins revisited accordingly when necessary. Results Using the microendoscope we report our experience in the determination of surgical margins at operation and later comparison with frozen section and paraffin section margins "gold standard". We were able to obtain a sensitivity of 95% and a specificity of 90%. Inter-observer Kappa scores comparing the microendoscope with formal histological analysis of normal and abnormal mucosa were 0.85. Conclusion The advantage of this technique is that a large area of mucosa can be sampled and any histomorphological changes can be visualized in real time allowing the operator to make important informed decisions with regards the intra-operative resection margin at the time of the surgery.

  10. Nuclear Systems (NS): Technology Demonstration Unit (TDU) Project

    Data.gov (United States)

    National Aeronautics and Space Administration — The Nuclear Systems Project demonstrates nuclear power technology readiness to support the goals of NASA’s Space Technology Mission Directorate. To this end,...

  11. Elementary Education Teacher Candidates' Integration of Technology in the Design of Interdisciplinary Units

    Science.gov (United States)

    Polly, Drew; Rock, Tracy

    2016-01-01

    In this paper the authors evaluate 85 elementary education teacher candidates' integration of technology into interdisciplinary units that the candidates wrote during the semester before their full-time student teaching internship. An inductive analysis of the units revealed that teachers used a wide variety of technologies with a large dependence…

  12. Practical experience in a surgical unit when changing from scrub to rub.

    Science.gov (United States)

    Asensio, A; de Gregorio, L

    2013-02-01

    Concurring with the move to a new facility at the end of 2008, alcohol-based hand rub (AHR) dispensers were allocated in all anterooms of operating theatres in a tertiary care hospital in Madrid, Spain. Routine educational sessions on surgical hand disinfection (SHD) were performed by infection control personnel, emphasizing the preferred method of AHR. Our aim was to evaluate the knowledge about SHD, as well as the performance of SHD and perceptions concerning the use of AHR or antiseptic soap hand scrub (ASHS) by surgeons and operating room nurses (ORNs). An anonymous survey on SHD was circulated to the surgeons, resident surgeons and nurses who perform SHD in our hospital. In all, 70 surveys were completed, corresponding to 27 ORNs (38.6%), 20 resident surgeons (29%), and 23 staff surgeons (33%), 41 (59%) of them being females. Forty percent of them perform mostly disinfectant soap hand scrub (DSHS) and 19% mostly hand rubs; 41% perform both methods. AHR rub is believed to be more efficacious than DSHS in reducing hand contamination (mean 6.5 vs 5.6; P > 0.001). Almost half of the personnel (49%) perform AHR >50% of the time (AHR users). AHR use is associated with ORNs (odds ratio: 3.4; 95% confidence interval [CI] 1.2-9.3; P = 0.018) but not with resident surgeons (odds ratio: 4.1; 95% CI 1.3-13.2; P = 0.017). When comparing both methods of SHD, personnel favour AHR for its colour (P > 0.01) and speed of drying (P > 0.01). Compared with surgeons, ORNs scored DSHS as more skin-irritating (4.1 vs 5.2; P = 0.013), more associated with skin dryness (3.2 vs 4.7; P > 0.001), and inferior overall score (4.7 vs 5.6; P > 0.005). Most of the personnel agree that AHR (85%) improves compliance with SHD. Nevertheless ASHS is the method preferred for surgeons (63%) whereas AHR is the method preferred by nurses (70%; P 0.05). In addition, nurses scored ASHS lower than did surgeons in terms of skin redness (4.7 vs 6.0; P > 0.001), lack of skin integrity (4.8 vs 5.9; P = 0

  13. Care of the gut in the surgical intensive care unit: fact or fashion?

    Science.gov (United States)

    Steinmetz, O K; Meakins, J L

    1991-06-01

    The traditional approach to the care of the gastrointestinal tract in the intensive care unit has been one of neglect. However, recent evidence has linked enteric flora to the generation of clinical sepsis in the absence of other infectious foci. The role of the bowel as an efficient barrier to the invasion of its own flora is addressed in this paper. A variety of insults disrupt the integrity of the barrier function of the gut, allowing the entry of bowel organisms or endotoxins, or both, into the portal and systemic circulatory systems. In animal and early clinical studies, a number of interventions, aimed at altering the enteric flora and enhancing the bowel's barrier function, have been shown to modulate the host's resistance to different insults and may even improve clinical outcome. Such interventions include maintenance of enteral feeding, glutamine supplementation of hyperalimentation solutions and selective bacterial decontamination of the bowel.

  14. Anatomy and Physiology. Module Set II: Major Body Systems. Teacher Edition [and] Student Edition. Surgical Technology.

    Science.gov (United States)

    Hilley, Robert

    This document, which is the second part of a two-part set of modules on anatomy and physiology for future surgical technicians, contains the teacher and student editions of an introduction to anatomy and physiology that consists of modules on the following body systems: integumentary system; skeletal system; muscular system; nervous system;…

  15. NEW TECHNOLOGIES IN THE DIAGNOSIS AND REHABILITATION TREATMENT OF DYSURIA AFTER SURGICAL TREATMENT FOR PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    T. G. Markosyan

    2014-07-01

    Full Text Available The paper deals with the latest neurophysiological technologies for the recognition and treatment of neurogenic disorders of urination and erection in a group of patients operated on for prostate cancer (PC. Acicular electromyography of pelvic floor muscles with transcranial magnetic stimulation of micturition and erectile centers has been put into practice to examine this category of patients. The basic neurophysiological parameters of the muscles examined (cortical and segmental evoked motor response the latency, central motor conduction time (CMCT, and motor unit potential (MUP amplitude and duration were estimated. To develop a normative base, the neurophysiological features of the pelvic floor were studied in healthy volunteers (n = 12 who formed a control group. Examinations were made in 17 patients who had undergone operations for PC at Moscow hospitals 3 to 18 months before, such as retropubic prostatectomy (n = 11 and transurethral resection plus high-intensity focused ultrasound (HIFU ablation (n = 6. Spontaneous urination was absent in 4 (23.5% of cases; urinary incontinence was observed in 6 (35.2% patients. The study group patients were found to have significant disorders of corticospinal tract conduction and those of perineal muscle contraction as potential fibrillation and positive pointed waves, as well as considerable CMCM prolongation and MUP polyphasia. Denervation alterations in PC patients after surgery and delayed reinnervation processes, nerve control recovery are determined by not only the surgery itself, but also by the features of the course of the underlying cancer process. Pelvic floor muscle studies indicated that HIFU was a very traumatic treatment for PC due to the fact that physical exposure spread outside the prostate to the neuromuscular structures. The denervation alterations detected in the pelvic floor muscles became essential in the elaboration of adequate treatment policy. The use of agents improving the

  16. NEW TECHNOLOGIES IN THE DIAGNOSIS AND REHABILITATION TREATMENT OF DYSURIA AFTER SURGICAL TREATMENT FOR PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    T. G. Markosyan

    2012-01-01

    Full Text Available The paper deals with the latest neurophysiological technologies for the recognition and treatment of neurogenic disorders of urination and erection in a group of patients operated on for prostate cancer (PC. Acicular electromyography of pelvic floor muscles with transcranial magnetic stimulation of micturition and erectile centers has been put into practice to examine this category of patients. The basic neurophysiological parameters of the muscles examined (cortical and segmental evoked motor response the latency, central motor conduction time (CMCT, and motor unit potential (MUP amplitude and duration were estimated. To develop a normative base, the neurophysiological features of the pelvic floor were studied in healthy volunteers (n = 12 who formed a control group. Examinations were made in 17 patients who had undergone operations for PC at Moscow hospitals 3 to 18 months before, such as retropubic prostatectomy (n = 11 and transurethral resection plus high-intensity focused ultrasound (HIFU ablation (n = 6. Spontaneous urination was absent in 4 (23.5% of cases; urinary incontinence was observed in 6 (35.2% patients. The study group patients were found to have significant disorders of corticospinal tract conduction and those of perineal muscle contraction as potential fibrillation and positive pointed waves, as well as considerable CMCM prolongation and MUP polyphasia. Denervation alterations in PC patients after surgery and delayed reinnervation processes, nerve control recovery are determined by not only the surgery itself, but also by the features of the course of the underlying cancer process. Pelvic floor muscle studies indicated that HIFU was a very traumatic treatment for PC due to the fact that physical exposure spread outside the prostate to the neuromuscular structures. The denervation alterations detected in the pelvic floor muscles became essential in the elaboration of adequate treatment policy. The use of agents improving the

  17. Using evidence to improve satisfaction with medication side-effects education on a neuro-medical surgical unit.

    Science.gov (United States)

    Ahrens, Susan L; Wirges, Ashley M

    2013-10-01

    Patient satisfaction is viewed as a significant indicator of quality of care. More specifically, improving patient satisfaction related to communication about medications and potential side effects can improve healthcare outcomes. Patient satisfaction scores related to medication side effects on a neuro-medical surgical unit were monitored following a quality improvement program. These patients frequently experience cognitive impairment and functional difficulties that can affect the way they understand and handle medications. The purpose of this quality improvement practice change was to (a) develop an educational approach for post acute neurosurgical patients and (b) evaluate whether the use of the approach is successful in improving patient satisfaction scores related to medication education on side effects. The quality improvement program interventions included (a) patient informational handouts inserted into admission folders, (b) nurse education about the importance of providing education on side effects to patient and discussion of their involvement with the program, (c) unit flyers with nurse education, and (d) various communications with bedside nurses through personal work mail and emails. The primary focus was for nurses to employ the "teach back" method to review and reinforce the medication side-effect teaching with patients. Evaluation of the data showed an increase in patient satisfaction after the implementation of the "Always Ask" program.

  18. Urban Ecology for Secondary Schools, Unit I - Technology and Environmental Pollution, Parts 1 and 2.

    Science.gov (United States)

    New York City Board of Education, Brooklyn, NY. Bureau of Curriculum Development.

    Materials for a course on Urban Ecology are developed in these two documents which represent the first unit - Technology and Environmental Pollution. The entire course consists of seven units dealing with the many aspects of our way of life that produce an effect on, and in turn affected by, the quality of our physical environment. Unit I treats…

  19. Current projects of the Application Technology Research Unit (ATRU) USDA-ARS, Wooster/Toledo, Ohio

    Science.gov (United States)

    The Application Technology Research Unit (ATRU) is the largest multidisciplinary research team in the United States Department of Agriculture, Agricultural Research Service, conducting studies on floricultural and nursery crops. On-farm research is a major approach to the mission of this Unit. The...

  20. Outcomes in achalasia from a surgical unit where pneumatic dilatation is first-line therapy.

    Science.gov (United States)

    Howard, J M; Mongan, A-M; Manning, B J; Byrne, P; Lawler, P; Ravi, N; Reynolds, J V

    2010-08-01

    The management of achalasia remains controversial, with little consensus on the optimal patient treatment pathway. In our own esophageal unit, we offer pneumatic dilatation as the initial therapy in most patients as first-line therapy. In this study, we aimed to examine the safety and efficacy of our own approach to the management of patients with a diagnosis of achalasia, examining symptomatic outcomes, patient satisfaction, and need for further intervention, as well as examining patient factors associated with treatment failure. Sixty-seven consecutive patients underwent pneumatic dilatation as first-line therapy (53% male, mean age 46 years). All attended regular outpatient follow-up (mean 37, range 3-132 months). Twenty-five percent of patients required a second intervention because of symptom recurrence, at a median period of 4.5 months. Symptomatic outcomes were excellent or good in 80%. Significant predictors of treatment failure and poor symptom score included a younger age at the time of diagnosis and increased esophageal diameter on barium swallow. This study suggests that pneumatic dilatation is a safe and effective approach as first-line therapy in patients with newly diagnosed achalasia.

  1. Future Energy Technology. A Basic Teaching Unit on Energy. Revised.

    Science.gov (United States)

    McDermott, Hugh, Ed.; Scharmann, Larry, Ed.

    Recommended for grades 7-12 language arts, science, and social studies classes, this 5-7 day unit encourages students to investigate alternative energy sources through research. Focusing on geothermal energy, tide and ocean, fusion, wind, biomass, and solar energy as possible areas of consideration, the unit attempts to create an awareness of the…

  2. Correlation between antibiotic use and changes in susceptibility patterns of Pseudomonas aeruginosa in a medical-surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Kallel Hatem

    2008-01-01

    Full Text Available Context: Multiple surveillance programmes have reported a decline in antibiotic susceptibility of P. aeruginosa. Aim: Our study aimed to study the relationship between the use of antipseudomonal drugs and the development of resistance of P. aerogenosa to these drugs. Setting and Design: Our study is retrospective. It was conducted in a medical surgical intensive care unit during a five-year period (January 1 st , 1999 to December 31, 2003, which was divided into 20 quarters. We had monitored the use of antipseudomonal agents and the resistance rates of P. aeruginosa to these drugs. Statistical Methods: The associations between use and resistance were quantified using non-partial and partial correlation coefficients according to Pearson and Spearman. Results: Over the study period, the most frequently used antipseudomonal agent was Imipenem (152 ± 46 DDD/1000 patients-day and the resistance rate of P. aeruginosa to Imipenem was 44.3 ± 9.5% (range, 30 and 60%. In addition, Imipenem use correlated significantly with development of resistance to Imipenem in the same ( P < 0.05 and in the following quarter (P < 0.05; and Ciprofloxacin use correlated significantly with resistance to Ciprofloxacin in the following quarter ( P < 0.05. However, use of Ceftazidime or Amikacine had no apparent association with development of resistance. Conclusion: We conclude that the extensive use of imipenem or ciprofloxacin in intensive care units may lead to the emergence of imipenem- and ciprofloxacin-resistant strains of P. aeruginosa and that antibiotic prescription policy has a significant impact on P. aeruginosa resistance rates in an intensive care unit.

  3. Incidence, microbiological profile of nosocomial infections, and their antibiotic resistance patterns in a high volume Cardiac Surgical Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Manoj Kumar Sahu

    2016-01-01

    Full Text Available Background: Nosocomial infections (NIs in the postoperative period not only increase morbidity and mortality, but also impose a significant economic burden on the health care infrastructure. This retrospective study was undertaken to (a evaluate the incidence, characteristics, risk factors and outcomes of NIs and (b identify common microorganisms responsible for infection and their antibiotic resistance profile in our Cardiac Surgical Intensive Care Unit (CSICU. Patients and Methods: After ethics committee approval, the CSICU records of all patients who underwent cardiovascular surgery between January 2013 and December 2014 were reviewed retrospectively. The incidence of NI, distribution of NI sites, types of microorganisms and their antibiotic resistance, length of CSICU stay, and patient-outcome were determined. Results: Three hundred and nineteen of 6864 patients (4.6% developed NI after cardiac surgery. Lower respiratory tract infections (LRTIs accounted for most of the infections (44.2% followed by surgical-site infection (SSI, 11.6%, bloodstream infection (BSI, 7.5%, urinary tract infection (UTI, 6.9% and infections from combined sources (29.8%. Acinetobacter, Klebsiella, Escherichia coli, and Staphylococcus were the most frequent pathogens isolated in patients with LRTI, BSI, UTI, and SSI, respectively. The Gram-negative bacteria isolated from different sources were found to be highly resistant to commonly used antibiotics. Conclusion: The incidence of NI and sepsis-related mortality, in our CSICU, was 4.6% and 1.9%, respectively. Lower respiratory tract was the most common site of infection and Gram-negative bacilli, the most common pathogens after cardiac surgery. Antibiotic resistance was maximum with Acinetobacter spp.

  4. Incidence, microbiological profile of nosocomial infections, and their antibiotic resistance patterns in a high volume Cardiac Surgical Intensive Care Unit.

    Science.gov (United States)

    Sahu, Manoj Kumar; Siddharth, Bharat; Choudhury, Arin; Vishnubhatla, Sreenivas; Singh, Sarvesh Pal; Menon, Ramesh; Kapoor, Poonam Malhotra; Talwar, Sachin; Choudhary, Shiv; Airan, Balram

    2016-01-01

    Nosocomial infections (NIs) in the postoperative period not only increase morbidity and mortality, but also impose a significant economic burden on the health care infrastructure. This retrospective study was undertaken to (a) evaluate the incidence, characteristics, risk factors and outcomes of NIs and (b) identify common microorganisms responsible for infection and their antibiotic resistance profile in our Cardiac Surgical Intensive Care Unit (CSICU). After ethics committee approval, the CSICU records of all patients who underwent cardiovascular surgery between January 2013 and December 2014 were reviewed retrospectively. The incidence of NI, distribution of NI sites, types of microorganisms and their antibiotic resistance, length of CSICU stay, and patient-outcome were determined. Three hundred and nineteen of 6864 patients (4.6%) developed NI after cardiac surgery. Lower respiratory tract infections (LRTIs) accounted for most of the infections (44.2%) followed by surgical-site infection (SSI, 11.6%), bloodstream infection (BSI, 7.5%), urinary tract infection (UTI, 6.9%) and infections from combined sources (29.8%). Acinetobacter, Klebsiella, Escherichia coli, and Staphylococcus were the most frequent pathogens isolated in patients with LRTI, BSI, UTI, and SSI, respectively. The Gram-negative bacteria isolated from different sources were found to be highly resistant to commonly used antibiotics. The incidence of NI and sepsis-related mortality, in our CSICU, was 4.6% and 1.9%, respectively. Lower respiratory tract was the most common site of infection and Gram-negative bacilli, the most common pathogens after cardiac surgery. Antibiotic resistance was maximum with Acinetobacter spp.

  5. Surgical Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging

    OpenAIRE

    Elmi-Terander, Adrian; Skulason, Halldor; Söderman, Michael; Racadio, John; Homan, Robert; Babic, Drazenko; van der Vaart, Nijs; Nachabe, Rami

    2016-01-01

    Study Design. A cadaveric laboratory study. Objective. The aim of this study was to assess the feasibility and accuracy of thoracic pedicle screw placement using augmented reality surgical navigation (ARSN). Summary of Background Data. Recent advances in spinal navigation have shown improved accuracy in lumbosacral pedicle screw placement but limited benefits in the thoracic spine. 3D intraoperative imaging and instrument navigation may allow improved accuracy in pedicle screw placement, with...

  6. Optimizing Patient Preparation and Surgical Experience Using eHealth Technology.

    Science.gov (United States)

    Waller, Amy; Forshaw, Kristy; Carey, Mariko; Robinson, Sancha; Kerridge, Ross; Proietto, Anthony; Sanson-Fisher, Rob

    2015-09-01

    With population growth and aging, it is expected that the demand for surgical services will increase. However, increased complexity of procedures, time pressures on staff, and the demand for a patient-centered approach continue to challenge a system characterized by finite health care resources. Suboptimal care is reported in each phase of surgical care, from the time of consent to discharge and long-term follow-up. Novel strategies are thus needed to address these challenges to produce effective and sustainable improvements in surgical care across the care pathway. The eHealth programs represent a potential strategy for improving the quality of care delivered across various phases of care, thereby improving patient outcomes. This discussion paper describes (1) the key functions of eHealth programs including information gathering, transfer, and exchange; (2) examples of eHealth programs in overcoming challenges to optimal surgical care across the care pathway; and (3) the potential challenges and future directions for implementing eHealth programs in this setting. The eHealth programs are a promising alternative for collecting patient-reported outcome data, providing access to credible health information and strategies to enable patients to take an active role in their own health care, and promote efficient communication between patients and health care providers. However, additional rigorous intervention studies examining the needs of potential role of eHealth programs in augmenting patients' preparation and recovery from surgery, and subsequent impact on patient outcomes and processes of care are needed to advance the field. Furthermore, evidence for the benefits of eHealth programs in supporting carers and strategies to maximize engagement from end users are needed.

  7. Rotator cuff repair: a review of surgical techniques, animal models, and new technologies under development.

    Science.gov (United States)

    Deprés-Tremblay, Gabrielle; Chevrier, Anik; Snow, Martyn; Hurtig, Mark B; Rodeo, Scott; Buschmann, Michael D

    2016-12-01

    Rotator cuff tears are the most common musculoskeletal injury occurring in the shoulder. Current surgical repair fails to heal in 20% to 95% of patients, depending on age, size of the tear, smoking, time of repair, tendon quality, muscle quality, healing response, and surgical treatments. These problems are worsened by the limited healing potential of injured tendons attributed to the presence of degenerative changes and relatively poor vascularity of the cuff tendons. Development of new techniques to treat rotator cuff tears requires testing in animal models to assess safety and efficacy before clinical testing. Hence, it is important to evaluate appropriate animal models for rotator cuff research with degeneration of tendons, muscular atrophy, and fatty infiltration similar to humans. This report reviews current clinical treatments and preclinical approaches for rotator cuff tear repair. The review will focus on current clinical surgical treatments, new repair strategies under clinical and preclinical development, and will also describe different animal models available for rotator cuff research. These findings and future directions for rotator cuff tear repair will be discussed. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  8. Development of Key Technologies of Large Hydro Unit in HEC

    Institute of Scientific and Technical Information of China (English)

    Wu Weizhang

    2010-01-01

    @@ Introduction to HEC Harbin Electric Machinery Company Limited (HEC) is a pivotal company that produces large electric machinery and accessorial control equipment in China.The hydro units made by HEC have accounted for about half of the large-and medium-size hydropower units installed in China,while the thermal generator units occupy about one-third of the total thermal capacity of China.HEC has the ability to develop,design and manufacture products independently,and its typical products include hydro turbine,hydro generator,turbo generator and control equipment.

  9. Having faith in each other: not-for-profit giant Ascension Health hooks up with United Surgical Partners for ASC joint venture.

    Science.gov (United States)

    Romano, Michael

    2004-09-13

    In the biggest deal of its kind, not-for-profit giant Ascension is going to build ambulatory surgery centers with for-profit United Surgical Partners, which already has a deal with Baylor, left. "Hospitals are realizing that outpatient services are the future. This strategy is sound," one healthcare consultant said.

  10. Invasive Candida infections in surgical patients in intensive care units: a prospective, multicentre survey initiated by the European Confederation of Medical Mycology (ECMM) (2006-2008)

    NARCIS (Netherlands)

    Klingspor, L.; Tortorano, A.M.; Peman, J.; Willinger, B.; Hamal, P.; Sendid, B.; Velegraki, A.; Kibbler, C.; Meis, J.F.G.M.; Sabino, R.; Ruhnke, M.; Arikan-Akdagli, S.; Salonen, J.; Doczi, I.

    2015-01-01

    A prospective, observational, multicentre study of invasive candidosis (IC) in surgical patients in intensive care units (ICUs) was conducted from 2006 to 2008 in 72 ICUs in 14 European countries. A total of 779 patients (62.5% males, median age 63 years) with IC were included. The median rate of ca

  11. Invasive Candida infections in surgical patients in intensive care units: a prospective, multicentre survey initiated by the European Confederation of Medical Mycology (ECMM) (2006-2008)

    NARCIS (Netherlands)

    Klingspor, L.; Tortorano, A.M.; Peman, J.; Willinger, B.; Hamal, P.; Sendid, B.; Velegraki, A.; Kibbler, C.; Meis, J.F.G.M.; Sabino, R.; Ruhnke, M.; Arikan-Akdagli, S.; Salonen, J.; Doczi, I.

    2015-01-01

    A prospective, observational, multicentre study of invasive candidosis (IC) in surgical patients in intensive care units (ICUs) was conducted from 2006 to 2008 in 72 ICUs in 14 European countries. A total of 779 patients (62.5% males, median age 63 years) with IC were included. The median rate of

  12. Advanced computer-aided intraoperative technologies for information-guided surgical management of gliomas: Tokyo Women's Medical University experience.

    Science.gov (United States)

    Iseki, H; Nakamura, R; Muragaki, Y; Suzuki, T; Chernov, M; Hori, T; Takakura, K

    2008-10-01

    The availability of the intraoperative MRI and real-time neuronavigation has dramatically changed the principles of surgery for gliomas. Current intraoperative computer-aided technologies permit perfect localization of the neoplasm, precise estimation of its volume, and clear definition of its interrelationships with the eloquent brain structures. This allows maximal tumor resection with minimal risk of postoperative disabilities. Under such conditions the medical treatment has become significantly dependent on the quality of the provided information and can be designated as information-guided management. Therefore, appropriate management of the wide spectrum of the intraoperative medical data and its adequate distribution between members of the surgical team for facilitation of the clinical decision-making is very important for attainment of the best possible outcome. Further progress in advanced neurovisualization, robotics, and comprehensive medical information technology has a great potential to increase the safety of the neurosurgical procedures for parenchymal brain tumors in the eloquent brain areas.

  13. Development of Key Technologies of Large Hydro Unit in HEC

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Introduction to HEC Harbin Electric Machinery Company Limited (HEC) is a pivotal company that produces large electric machinery and accessorial control equipment in China. The hydro units made by HEC have accounted

  14. United States geothermal technology: Equipment and services for worldwide applications

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1995-05-01

    This document has two intended audiences. The first part, ``Geothermal Energy at a Glance,`` is intended for energy system decision makers and others who are interested in wide ranging aspects of geothermal energy resources and technology. The second part, ``Technology Specifics,`` is intended for engineers and scientists who work with such technology in more detailed ways. The glossary at the end of the document defines many of the specialized terms. A directory of US geothermal industry firms who provide goods and services for clients around the world is available on request.

  15. special issue: Technology transfer in United States universities

    OpenAIRE

    Ann-Charlotte Fridh; Bo Carlsson

    2002-01-01

    This paper examines the role of offices of technology transfer (OTT) in 12 U.S. universities in 1998 in commercializing research results in the form of patents, licenses, and start-ups of new companies. We study the organization and place of OTTs within the university structure, the process of technology transfer, and the staffing and funding of the office. Data were collected through a mail questionnaire followed up through telephone interviews. We also conducted a statistical analysis of da...

  16. Managing medical technology: lessons for the United States from Quebec and France.

    Science.gov (United States)

    Rosenau, P V

    2000-01-01

    Important modifications to technology assessment, diffusion, adoption, and utilization must take place if the United States is to better employ medical technology and save resources so as to assure access for the uninsured and underinsured. The United States can learn from other health systems that are more successful in achieving these goals. The author selects for comparison the health systems of France and Quebec. The discussion focuses on the differences between the three systems in the management of medical technology on a range of policy-relevant dimensions, including health system structure, attitudes about planning versus market competition, government regulation, the balance between decentralization and centralization, the needs of the individual and those of the society, linkages between technology assessment and policy-making, and the importance of medical technology assessment for medical practice. Seven specific recommendations are made for better managing medical technology in the United States, drawing on what can be observed from the experiences of Quebec and France.

  17. Revisiting endotracheal self-extubation in the surgical and trauma intensive care unit: Are they all fine?

    Science.gov (United States)

    Fontenot, Ashleigh M; Malizia, Robert A; Chopko, Michael S; Flynn, William J; Lukan, James K; Wiles, Charles E; Guo, Weidun Alan

    2015-12-01

    Endotracheal self-extubation (ESE) is a serious health care concern. We designed this study to test our hypothesis that not all patients with ESE are successful in spontaneous breathing and reintubation has negative impact on outcomes. Data on all 39 patients of ESE in our surgical and trauma intensive care unit (ICU) in 2012 were prospectively collected and retrospectively analyzed. There were 42 episodes of ESE in 39 of 939 intubated patients (frequency, 4.0%), with 54% of events requiring reintubation. Pre-ESE positive end-expiratory pressure was higher and Pao2/fraction of inspired oxygen ratio was lower, and the post-ESE respiration rate was higher in the reintubated group. On univariate analysis, weaning and spontaneous breathing trial before ESE were favorable predictors for nonreintubation. Multivariate regression analysis demonstrated that agitation before ESE was an independent predictor of reintubation. The need for reintubation was associated with increased risk of pulmonary infectious complications, ventilator days, the need for tracheostomy, and ICU and hospital LOS. The financial costs for ventilator days and ICU rooms were significantly higher in patients with reintubation. Not all patients were fine after ESE. We have not decreased the frequency of ESE or improved outcomes if the patients were reintubated. The need for reintubation was not only associated with a high pulmonary complication rate but also prolonged duration on mechanical ventilation and hospital/ICU stay and increased the hospital costs. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Value of abdominal CT in patients of the surgical intensive care unit; Stellenwert der abdominellen CT bei chirurgischen Intensivpatienten

    Energy Technology Data Exchange (ETDEWEB)

    Rieger, J. [Abt. fuer Radiologie, Klinikum Innenstadt, Ludwig-Maximilians-Universitaet, Muenchen (Germany); Kerner, T. [Abt. fuer Chirurgie, Klinikum Innenstadt, Ludwig-Maximilians-Universitaet, Muenchen (Germany); Waydhas, C. [Abt. fuer Chirurgie, Klinikum Innenstadt, Ludwig-Maximilians-Universitaet, Muenchen (Germany); Schenk, F. [Abt. fuer Radiologie, Klinikum Innenstadt, Ludwig-Maximilians-Universitaet, Muenchen (Germany); Pfeifer, K.J. [Abt. fuer Radiologie, Klinikum Innenstadt, Ludwig-Maximilians-Universitaet, Muenchen (Germany)

    1996-09-01

    The purpose of the retrospective study reported was to examine the indications, findings and therapeutic consequences of 88 consecutive CT examinations of the abdomen of 62 patients of a surgical intensive care unit. The CT examinations were performed within 12 hours following indication. The most frequent indications were sepsis with suspected intra-abdominal foci (72.7%), suspected lesion of intra-abdominal organs due to a serious accident (13.6%), and acutely necrotising pancreatitis (11.4%). Clinically relevant findings were obtained in 71.6% of the patients, in 43.2% the decision was for invasive treatment (of 38 patients, 28 treated by surgery, and 10 by other interventional measures) within 48 hours, which meant an essential modification of hitherto planned treatment. Patients with a high MOF score (>5) exhibited a significantly higher rate of pathologic findings than patients with a low MOF score (0-2). In the cases of suspected organ lesions, CT did not add any further information. (orig./MG)

  19. The Compliance Rates of Hand Hygiene in Intensive Care Unit and Surgical Services at a State Hospital in Turkey

    Directory of Open Access Journals (Sweden)

    Serap Süzük

    2015-12-01

    Full Text Available Objective: The most efficient and most cost effective method for preventing health care associated infections is hand hygiene. Although hand hygiene is the most effective and simple method, compliance rates are very low among health care workers. It was aimed to evaluate the rates of compliance of healthcare workers in a state hospital. Material and Method: In this study, totally 112 healthcare workers (31 doctors and 81 nurses were evaluated with the 5-indication observation method in a period between January and July 2013. Results: A total of 754 (65.9% out of 1.144 cases were resulted in accurate hand washing and hand-rubbing. When the intensive care unit and surgical clinics were evaluated together, it was found that hand hygiene compliance rates were 51.26% in 199 cases and 66.85% in 591 cases for doctors and nurses, respectively. Conclusion: Consequently, we think that pre-informed observations are important training instruments for hand hygiene compliance.

  20. Anticoagulation Strategies in Venovenous Hemodialysis in Critically Ill Patients: A Five-Year Evaluation in a Surgical Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Christoph Sponholz

    2014-01-01

    Full Text Available Renal failure is a common complication among critically ill patients. Timing, dosage, and mode of renal replacement (RRT are under debate, but also anticoagulation strategies and vascular access interfere with dialysis success. We present a retrospective, five-year evaluation of patients requiring RRT on a multidisciplinary 50-bed surgical intensive care unit of a university hospital with special regard to anticoagulation strategies and vascular access. Anticoagulation was preferably performed with unfractionated heparin or regional citrate application (RAC. Bleeding and suspected HIT-II were most common causes for RAC. In CVVHD mode filter life span was significantly longer under RAC compared to heparin or other anticoagulation strategies (P=0.001. Femoral vascular access was associated with reduced filter life span (P=0.012, especially under heparin anticoagulation (P=0.015. Patients on RAC had higher rates of metabolic alkalosis (P=0.001, required more transfusions (P=0.045, and showed higher illness severity measured by SOFA scores (P=0.001. RRT with unfractionated heparin represented the most common anticoagulation strategy in this study population. However, patients with bleeding risk and severe organ dysfunction were more likely placed on RAC. Citrate provided longer filter life spans regardless of vascular access site. Attention has to be paid to metabolic disturbances.

  1. Digital Technologies in Providing Development of Algorithms Surgical Treatment of Supraventricular Arrhythmias

    Directory of Open Access Journals (Sweden)

    Evtushenko Vladimir

    2016-01-01

    Full Text Available The aim of the study was the development and clinical application of patient selection algorithm for surgical treatment of longlasting persistent atrial fibrillation. The study included 235 patients with acquired heart disease and coronary artery disease, which in the period from 1999 to 2015 performed surgical treatment of long-term persistent atrial fibrillation (RF “MAZE III” procedure in conjunction with the correction of the underlying heart disease. The patients were divided into 2 groups according to the method of operation: the group 1 – 135 patients (76 women and 59 men who have applied an integrated approach to surgery for atrial fibrillation, including penetrating method of RF effects on atrial myocardium and the study of the function of the sinus node before and after the operation (these patients were operated on from 2008 to 2015. The group 2 – 100 patients (62 women and 38 men with a “classical” method of monopolar RF “MAZE III”, which the sinus node function was not studied. We used the combined (epi- and endocardial method of RF «MAZE». This algorithm is decreasing of possible permanent pacemaker postoperatively. The initial sinus node function in these patients, measured using the original method, the basic line of this algorithm was taken. The results showed that use this algorithm for selection of patients allows significantly reduce the possibility of pacemaker implantation in the postoperative period.

  2. Air Guard Unit Capitalizing on Leading-Edge Technology

    OpenAIRE

    Center for Homeland Defense and Security

    2012-01-01

    Center for Homeland Defense and Security, PRESS RELEASES When the California Air National Guard 129th Rescue Wing deploys next year to the Horn of Africa and Afghanistan, it plans to have a new, game-changing technology developed at the...

  3. Surgical Instrument Decontamination Unit

    Science.gov (United States)

    1989-02-15

    against rhinovirus tested both in suspension and on carriers (Mentel; 1973). Hydrogen peroxide in r2atively high concentrations (10 to 25%) is also...ultrasonic cavitation does not rely solely upon a chemical reaction between the hydroxyl radical and bacterial cell structures or components, although...from textiles without damaging the textile structure . It is used as a gas generator for foam products and very large quantities are used annually for

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

    Data.gov (United States)

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

  5. The provision of assistive technology products and services for people with dementia in the United Kingdom.

    Science.gov (United States)

    Gibson, Grant; Newton, Lisa; Pritchard, Gary; Finch, Tracy; Brittain, Katie; Robinson, Louise

    2016-07-01

    In this review we explore the provision of assistive technology products and services currently available for people with dementia within the United Kingdom. A scoping review of assistive technology products and services currently available highlighted 171 products or product types and 331 services. In addition, we assimilated data on the amount and quality of information provided by assistive technology services alongside assistive technology costs. We identify a range of products available across three areas: assistive technology used 'by', 'with' and 'on' people with dementia. Assistive technology provision is dominated by 'telecare' provided by local authorities, with services being subject to major variations in pricing and information provision; few currently used available resources for assistive technology in dementia. We argue that greater attention should be paid to information provision about assistive technology services across an increasingly mixed economy of dementia care providers, including primary care, local authorities, private companies and local/national assistive technology resources.

  6. Surgical Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging

    Science.gov (United States)

    Elmi-Terander, Adrian; Skulason, Halldor; Söderman, Michael; Racadio, John; Homan, Robert; Babic, Drazenko; van der Vaart, Nijs; Nachabe, Rami

    2016-01-01

    Study Design. A cadaveric laboratory study. Objective. The aim of this study was to assess the feasibility and accuracy of thoracic pedicle screw placement using augmented reality surgical navigation (ARSN). Summary of Background Data. Recent advances in spinal navigation have shown improved accuracy in lumbosacral pedicle screw placement but limited benefits in the thoracic spine. 3D intraoperative imaging and instrument navigation may allow improved accuracy in pedicle screw placement, without the use of x-ray fluoroscopy, and thus opens the route to image-guided minimally invasive therapy in the thoracic spine. Methods. ARSN encompasses a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D capabilities, integrated optical cameras for augmented reality navigation, and noninvasive patient motion tracking. Two neurosurgeons placed 94 pedicle screws in the thoracic spine of four cadavers using ARSN on one side of the spine (47 screws) and free-hand technique on the contralateral side. X-ray fluoroscopy was not used for either technique. Four independent reviewers assessed the postoperative scans, using the Gertzbein grading. Morphometric measurements of the pedicles axial and sagittal widths and angles, as well as the vertebrae axial and sagittal rotations were performed to identify risk factors for breaches. Results. ARSN was feasible and superior to free-hand technique with respect to overall accuracy (85% vs. 64%, P < 0.05), specifically significant increases of perfectly placed screws (51% vs. 30%, P < 0.05) and reductions in breaches beyond 4 mm (2% vs. 25%, P < 0.05). All morphometric dimensions, except for vertebral body axial rotation, were risk factors for larger breaches when performed with the free-hand method. Conclusion. ARSN without fluoroscopy was feasible and demonstrated higher accuracy than free-hand technique for thoracic pedicle screw placement. Level of Evidence: N/A PMID:27513166

  7. 31 CFR 560.418 - Release of technology or software in the United States or a third country.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Release of technology or software in... IRANIAN TRANSACTIONS REGULATIONS Interpretations § 560.418 Release of technology or software in the United States or a third country. The release of technology or software in the United States, or by a United...

  8. The application of surgical navigation system using optical molecular imaging technology in orthotopic breast cancer and metastasis studies

    Science.gov (United States)

    Chi, Chongwei; Zhang, Qian; Kou, Deqiang; Ye, Jinzuo; Mao, Yamin; Qiu, Jingdan; Wang, Jiandong; Yang, Xin; Du, Yang; Tian, Jie

    2014-02-01

    Currently, it has been an international focus on intraoperative precise positioning and accurate resection of tumor and metastases. The methods such as X-rays, computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) have played an important role in preoperative accurate diagnosis. However, most of them are inapplicable for intraoperative surgery. We have proposed a surgical navigation system based on optical molecular imaging technology for intraoperative detection of tumors and metastasis. This system collects images from two CCD cameras for real-time fluorescent and color imaging. For image processing, the template matching algorithm is used for multispectral image fusion. For the application of tumor detection, the mouse breast cancer cell line 4T1-luc, which shows highly metastasis, was used for tumor model establishment and a model of matrix metalloproteinase (MMP) expressing breast cancer. The tumor-bearing nude mice were given tail vein injection of MMP 750FAST (PerkinElmer, Inc. USA) probe and imaged with both bioluminescence and fluorescence to assess in vivo binding of the probe to the tumor and metastases sites. Hematoxylin and eosin (H&E) staining was performed to confirm the presence of tumor and metastasis. As a result, one tumor can be observed visually in vivo. However liver metastasis has been detected under surgical navigation system and all were confirmed by histology. This approach helps surgeons to find orthotopic tumors and metastasis during intraoperative resection and visualize tumor borders for precise positioning. Further investigation is needed for future application in clinics.

  9. Communications Technology in the Future of Higher Education in the United States.

    Science.gov (United States)

    Morgan, Robert P.

    An examination is made of the potential role of communications media and technology in the future of higher education in the United States (U.S.). The status of U.S. higher education is reviewed, important trends are identified, and the rationale for increased technological utilization is discussed. This is followed by a description of selected…

  10. The Supply and Demand of Technology and Engineering Teachers in the United States: Who Knows?

    Science.gov (United States)

    Moye, Johnny J.

    2017-01-01

    The purpose of this study was to determine the supply and demand of technology and engineering teachers in the United States. Once gathered, the resulting data (that was available) was compared to previous studies to determine trends. The researcher reviewed the 2010-11 through 2015-16 Technology & Engineering Teacher Education Directories. To…

  11. Transmission dynamics of carbapenemase-producing Klebsiella pneumoniae and anticipated impact of infection control strategies in a surgical unit.

    Directory of Open Access Journals (Sweden)

    Vana Sypsa

    Full Text Available BACKGROUND: Carbapenemase-producing Klebsiella pneumoniae (CPKP has been established as important nosocomial pathogen in many geographic regions. Transmission from patient to patient via the hands of healthcare workers is the main route of spread in the acute-care setting. METHODOLOGY/PRINCIPAL FINDINGS: Epidemiological and infection control data were recorded during a prospective observational study conducted in a surgical unit of a tertiary-care hospital in Greece. Surveillance culture for CPKP were obtained from all patients upon admission and weekly thereafter. The Ross-Macdonald model for vector-borne diseases was applied to obtain estimates for the basic reproduction number R(0 (average number of secondary cases per primary case in the absence of infection control and assess the impact of infection control measures on CPKP containment in endemic and hyperendemic settings. Eighteen of 850 patients were colonized with CPKP on admission and 51 acquired CPKP during hospilazation. R(0 reached 2 and exceeded unity for long periods of time under the observed hand hygiene compliance (21%. The minimum hand hygiene compliance level necessary to control transmission was 50%. Reduction of 60% to 90% in colonized patients on admission, through active surveillance culture, contact precautions and isolation/cohorting, in combination with 60% compliance in hand hygiene would result in rapid decline in CPKP prevalence within 8-12 weeks. Antibiotics restrictions did not have a substantial benefit when an aggressive control strategy was implemented. CONCLUSIONS/SIGNIFICANCE: Surveillance culture on admission and isolation/cohorting of colonized patients coupled with moderate hand hygiene compliance and contact precautions may lead to rapid control of CPKP in endemic and hyperendemic healthcare settings.

  12. CTS United States experiments - A progress report. [Communications Technology Satellite for high power broadcasting

    Science.gov (United States)

    Robbins, W. H.; Donoughe, P. L.

    1976-01-01

    The Communications Technology Satellite (CTS) is a high-power broadcast satellite launched by NASA on January 17, 1976. CTS is the first satellite to operate at a frequency of 12 gigahertz and incorporates technology making possible new satellite telecommunications services. CTS is a cooperative program of the United States and Canada. This paper presents the results of the United States experimental activity to date. Wide segments of the population are involved in the Experiments Program, including the scientific community, other government agencies, industry, and the education and health entities. The experiments are associated with both technological objectives and the demonstration of new community and social services via satellite.

  13. Medical devices; general and plastic surgery devices; classification of absorbable poly(hydroxybutyrate) surgical suture produced by recombinant DNA technology. Final rule.

    Science.gov (United States)

    2007-08-03

    The Food and Drug Administration (FDA) is classifying the absorbable poly(hydroxybutyrate) surgical suture produced by recombinant deoxyribonucleic acid (DNA) technology into class II (special controls). The special control that will apply to the device is the guidance document entitled "Class II Special Controls Guidance Document: Absorbable Poly(hydroxybutyrate) Surgical Suture Produced by Recombinant DNA Technology." The agency is classifying these devices into class II (special controls) in order to provide a reasonable assurance of safety and effectiveness of these devices. Elsewhere in this issue of the Federal Register, FDA is announcing the availability of the guidance document that will serve as the special control for this device.

  14. Delayed assessment and eager adoption of laparoscopic cholecystectomy:Implications for developing surgical technologies

    Institute of Scientific and Technical Information of China (English)

    Alexander; C; Allori; I; Michael; Leitman; Elizabeth; Heitman

    2010-01-01

    Despite the prevailing emphasis in the medical literature on establishing evidence,many changes in the practice of surgery have not been achieved using proper evidence-based assessment.This paper examines the adoption of laparoscopic cholecystectomy(LC)into regular use for the treatment of cholecystitis and the process of its acceptance,focusing on the limited role of technology assessment in its appraisal.A review of the published medical literature concerning LC was performed.Approximately 3000 studies of...

  15. Technology of research of hydroturbine unit work using seismic methods

    Science.gov (United States)

    Seleznev, V. S.; Liseikin, A. V.; Gromyko, P. V.; Soloviev, V. M.

    2013-05-01

    On August, 17, 2009 one of the most significant accident in hydropower engineering was happened at Sayano-Shushenskaya Hydroelectric Power Station. Specialists of Geophysical Survey SB RAS took part in the State Committee on investigation of the accident cause at Sayano-Shushenskaya HPS. It was determined, that the cause of the accident was a break of stud-bolts on the turbine cover. Why stud-bolts did not stand a load? There were assumptions that hydraulic shock provoked the accident. But, if it is so, seismic station "Cheremushky", situated in 4 km away from the HPS, should has a record of this event. First of all, investigating the record, got at the seismic station in the moment of the accident, it was determined that strength of seismic waves, recorded at the moment of the accident, did not exceed strength of waves got at trotyl explosion of 500 g at a distance to 4 km. The version of hydraulic shock was not proved. There were distinguished low-frequency oscillations and it was determined that the hydroturbine unit (HU) had been raised up more then 10 m in height for 10 sec. Analyzing the seismic station records during the period of more than a year before the accident and records of operating modes of different HU, there was determined that oscillations radiated by second (damaged) HU were approximately 1.5 times more intense than oscillations from all other HU. After the accident at Sayano-Shushenskaya HPS hydroturbine units were started in turns: at first there were started hydroturbine units of old construction (3, 4, 5, 6), then HP of new construction (1, 7, 8, 9). We installed 10 - 15 three-component seismic stations in different points around a HU and studied field of seismic oscillations from it's work. It was determined, that HU radiates a set of monochromatic oscillations divisible by speed of rotation equal to 2.381 Hz. Change of these signals amplitude is connected with change of HU operation modes. Research of changes in oscillations spectral

  16. 78 FR 22302 - United States v. United Technologies Corporation and Goodrich Corporation; Public Comments and...

    Science.gov (United States)

    2013-04-15

    ... is confidential, possibly including information relating to the acquired company's customers.\\2... company. Mr. Oak has retired, and the United States does not believe it would be reasonable to require UTC... proposed remedies, its perception of the market structure, and its views of the nature of the case). \\5\\ Cf...

  17. TREATING DISCUS HERNIA USING A SELF DEVELOPED METHOD - A NEW TECHNOLOGY WITHOUT SURGICAL INTERVENTION

    Directory of Open Access Journals (Sweden)

    Mitrička Stardelova

    2014-12-01

    Full Text Available This paper includes an experiment that was performed on a hundred patients by using our self-developed methods during a two year period. The treatment of discus hernia was carried out by using our self-developed methods combined with a completely new technology, as well as clinical biomechanics, chiropractics, massotherapy, thermotherapy, cryotherapy and various other specific exercises practiced in esthetic and orthopedic kinesiology - kinesitherapy.50 females and 50 males aged 35 to 55 underwent our therapy and the results we obtained display very high curative effects.

  18. Technology and Thematic Units: An Elementary Example on Japan (Technology Links to Literacy).

    Science.gov (United States)

    Wepner, Shelley B.

    1993-01-01

    Uses a thematic unit on Japan to show how software can become an additional resource for elementary students' literacy learning in social studies, science, language arts, and art. Notes that the five-week unit addresses Japan's culture and customs. (RS)

  19. Fathering premature infants and the technological imperative of the neonatal intensive care unit: an interpretive inquiry.

    Science.gov (United States)

    Pohlman, Shawn

    2009-01-01

    The experiences of 9 fathers of premature infants in the technological environment of the neonatal intensive care unit were examined using interpretive methods. Fathers were interviewed 6 to 8 times each. Findings revealed emotional costs for fathers as technology often took precedence. Fathers' feelings of frustration, fear, and alienation were hidden from nurses, as fathers were silent and silenced. Fathers perceived a power dynamic between themselves and nurses, which may be due, in part, to a complex interplay between the technological imperative and gender dynamics. Two exemplars illustrated how fathers forged emotional connections with their babies despite the technological imperative.

  20. Molecular typing and resistance mechanisms of carbapenem resistant Pseudomonas aeruginosa isolated from a Chinese surgical intensive care unit

    Institute of Scientific and Technical Information of China (English)

    Yi Meiying; Wang Pengyuan; Liu Yucun

    2014-01-01

    Background Carbapenems are an important class of drugs for the treatment of Pseudomonas aeruginosa (P.aeruginosa) infections.However,carbapenem resistance has been commonly observed in nonfermenter species of bacteria.The purpose of this study was to investigate the molecular epidemiology and carbapenem resistant mechanisms of P.aeruginosa isolated from a surgical intensive care unit (SICU) in China.Methods The molecular typing was analyzed by REP-PCR.Enzyme activity was measured with a 260 nm wavelength spectrophotometer.The levels of outer membrane proteins OprD and OprN were measured by Western blotting.The levels of mexA gene transcriptional expression were measured by quantitative real-time PCR.The metallo-beta-lactamase genes IMP,VIM,SPM,GES,and GIM were amplified by PCR.DNA fragments were sequenced by an automated ABI PRISM 3700.Results Forty-two strains resistant to carbapenems isolated from a SICU were analyzed.REP-PCR revealed 34 belonging to type A,a predominant strain in this SICU.But we did not find metallo-beta-lactamases IMP,VIM,SPM,GES,or GIM genes by PCR.With a three-dimensional extract test,we found 34 strains producing high levels of AmpC enzymes.We also observed the activity of beta-lactamases enzymes in the imipenem resistant group,which was statistically different from the sensitive group.Western blotting revealed that 23 strains showed loss of OprD,18 strains had decreased OprD expression,and 14 strains expressed OprN.We discovered 27 strains that overexpressed mexA by quantitative real-time PCR,and the resistance rate to meropenem was statistically different between the overexpressing group and the lowexpressing group.Nucleotide sequences and deduced amino acid sequence analysis revealed that eight strains carried mutations in the mexR gene operon down regulating MexAB-OprM.The nucleotide sequences of mexR genes from PA36,PA41 and PA48 were submitted to the Genebank with accession numbers of AY899299,AY899300,and AY899301.Conclusions There

  1. Consumer-based technology for distribution of surgical videos for objective evaluation.

    Science.gov (United States)

    Gonzalez, Ray; Martinez, Jose M; Lo Menzo, Emanuele; Iglesias, Alberto R; Ro, Charles Y; Madan, Atul K

    2012-08-01

    The Global Operative Assessment of Laparoscopic Skill (GOALS) is one validated metric utilized to grade laparoscopic skills and has been utilized to score recorded operative videos. To facilitate easier viewing of these recorded videos, we are developing novel techniques to enable surgeons to view these videos. The objective of this study is to determine the feasibility of utilizing widespread current consumer-based technology to assist in distributing appropriate videos for objective evaluation. Videos from residents were recorded via a direct connection from the camera processor via an S-video output via a cable into a hub to connect to a standard laptop computer via a universal serial bus (USB) port. A standard consumer-based video editing program was utilized to capture the video and record in appropriate format. We utilized mp4 format, and depending on the size of the file, the videos were scaled down (compressed), their format changed (using a standard video editing program), or sliced into multiple videos. Standard available consumer-based programs were utilized to convert the video into a more appropriate format for handheld personal digital assistants. In addition, the videos were uploaded to a social networking website and video sharing websites. Recorded cases of laparoscopic cholecystectomy in a porcine model were utilized. Compression was required for all formats. All formats were accessed from home computers, work computers, and iPhones without difficulty. Qualitative analyses by four surgeons demonstrated appropriate quality to grade for these formats. Our preliminary results show promise that, utilizing consumer-based technology, videos can be easily distributed to surgeons to grade via GOALS via various methods. Easy accessibility may help make evaluation of resident videos less complicated and cumbersome.

  2. Fewer intensive care unit refusals and a higher capacity utilization by using a cyclic surgical case schedule

    NARCIS (Netherlands)

    Houdenhoven, van Mark; Oostrum, van Jeroen M.; Wullink, Gerhard; Hans, Erwin; Hurink, Johann L.; Bakker, Jan; Kazemier, Geert

    2008-01-01

    Purpose: Mounting health care costs force hospital managers to maximize utilization of scarce resources and simultaneously improve access to hospital services. This article assesses the benefits of a cyclic case scheduling approach that exploits a master surgical schedule (MSS). An MSS maximizes ope

  3. Searching for predictors of surgical complications in critically ill surgery patients in the intensive care unit: a review

    NARCIS (Netherlands)

    Meyer, Z.C.; Schreinemakers, J.M.J.; Waal, R.A. de; Laan, L. van der

    2015-01-01

    We reviewed the use of the levels of C-reactive protein, lactate and procalcitonin and/or the Sequential Organ Failure Assessment score to determine their diagnostic accuracy for predicting surgical complications in critically ill general post-surgery patients. Included were all studies published in

  4. Sentinel lymph node detection in breast cancer patients using surgical navigation system based on fluorescence molecular imaging technology

    Science.gov (United States)

    Chi, Chongwei; Kou, Deqiang; Ye, Jinzuo; Mao, Yamin; Qiu, Jingdan; Wang, Jiandong; Yang, Xin; Tian, Jie

    2015-03-01

    Introduction: Precision and personalization treatments are expected to be effective methods for early stage cancer studies. Breast cancer is a major threat to women's health and sentinel lymph node biopsy (SLNB) is an effective method to realize precision and personalized treatment for axillary lymph node (ALN) negative patients. In this study, we developed a surgical navigation system (SNS) based on optical molecular imaging technology for the precise detection of the sentinel lymph node (SLN) in breast cancer patients. This approach helps surgeons in precise positioning during surgery. Methods: The SNS was mainly based on the technology of optical molecular imaging. A novel optical path has been designed in our hardware system and a feature-matching algorithm has been devised to achieve rapid fluorescence and color image registration fusion. Ten in vivo studies of SLN detection in rabbits using indocyanine green (ICG) and blue dye were executed for system evaluation and 8 breast cancer patients accepted the combination method for therapy. Results: The detection rate of the combination method was 100% and an average of 2.6 SLNs was found in all patients. Our results showed that the method of using SNS to detect SLN has the potential to promote its application. Conclusion: The advantage of this system is the real-time tracing of lymph flow in a one-step procedure. The results demonstrated the feasibility of the system for providing accurate location and reliable treatment for surgeons. Our approach delivers valuable information and facilitates more detailed exploration for image-guided surgery research.

  5. Economic and humanistic burden of post-trauma and post-surgical neuropathic pain among adults in the United States

    Directory of Open Access Journals (Sweden)

    Parsons B

    2013-06-01

    Full Text Available Bruce Parsons,1 Caroline Schaefer,2 Rachael Mann,3 Alesia Sadosky,1 Shoshana Daniel,4 Srinivas Nalamachu,5 Brett R Stacey,6 Edward C Nieshoff,7 Michael Tuchman,8 Alan Anschel91Pfizer, Inc, New York, NY, USA; 2Covance Market Access Services, Inc, Gaithersburg, MD, USA; 3Covance Market Access Services, Inc, San Diego, CA, USA; 4Covance Market Access Services, Inc, Conshohocken, PA, USA; 5International Clinical Research Institute, Overland Park, KS, USA; 6Oregon Health and Science University, Portland, OR, USA; 7Rehabilitation Institute of Michigan/Wayne State University, Detroit, MI, USA; 8Palm Beach Neurological Center, Palm Beach Gardens, FL, USA; 9Rehabilitation Institute of Chicago, Chicago, IL, USABackground: Neuropathic pain (NeP can be chronic, debilitating, and can interfere with sleep, functioning, and emotional well being. While there are multiple causes of NeP, few studies have examined the disease burden and treatment patterns associated with post-traumatic/post-surgical (PTPS NeP.Objective: To characterize pain, health status, function, health care resource utilization, lost productivity, and costs among subjects with PTPS NeP in the United States.Methods: This observational study enrolled 100 PTPS NeP subjects recruited during routine visits from general practitioner and specialist sites. Subjects completed a one-time questionnaire with validated measures of pain severity and pain interference, health status, sleep, anxiety and depression, productivity, and study-specific items on demographics, employment status, and out-of-pocket expenses. Investigators completed a case report form based on a 6-month retrospective chart review, recording subjects' clinical characteristics as well as current and previous medications/treatments for NeP. Subjects were stratified into mild, moderate, and severe pain groups.Results: Subjects' demographic characteristics were: mean age of 54.9 years, 53% female, and 22% employed for pay. Mean pain

  6. Guiding principles for good practices in hospital-based health technology assessment units

    DEFF Research Database (Denmark)

    Sampietro-Colom, Laura; Lach, Krzysztof; Pasternack, Iris

    2015-01-01

    OBJECTIVES: Health technology assessment (HTA) carried out for policy decision making has well-established principles unlike hospital-based HTA (HB-HTA), which differs from the former in the context characteristics and ways of operation. This study proposes principles for good practices in HB....... In total, 385 people from twenty countries have participated in defining the principles for good practices in HB-HTA units. RESULTS: Fifteen guiding principles for good practices in HB-HTA units are grouped in four dimensions. Dimension 1 deals with principles of the assessment process aimed at providing......- and long-term impact of the overall performance of HB-HTA units. Finally, nine core guiding principles were selected as essential requirements for HB-HTA units based on the expertise of the HB-HTA units participating in the project. CONCLUSIONS: Guiding principles for good practices set up a benchmark...

  7. Effectiveness of Information Technology Infrastructure Library Process Implementations by Information Technology Departments within United States Organizations

    Science.gov (United States)

    Persinger, Jon F.

    2010-01-01

    This research study examined whether the overall effectiveness of the Information Technology Infrastructure Library (ITIL) could be predicted by measuring multiple independent variables. The primary variables studied included the number of ITIL process modules adopted and the overall ITIL "maturity level." An online survey was used to…

  8. Effectiveness of Information Technology Infrastructure Library Process Implementations by Information Technology Departments within United States Organizations

    Science.gov (United States)

    Persinger, Jon F.

    2010-01-01

    This research study examined whether the overall effectiveness of the Information Technology Infrastructure Library (ITIL) could be predicted by measuring multiple independent variables. The primary variables studied included the number of ITIL process modules adopted and the overall ITIL "maturity level." An online survey was used to…

  9. Technology to Support Teachers Using Evidence from Student Work to Customize Technology-Enhanced Inquiry Units

    Science.gov (United States)

    Matuk, Camillia F.; Linn, Marcia C.; Eylon, Bat-Sheva

    2015-01-01

    Teachers' involvement in curriculum design is essential for sustaining the relevance of technology-enhanced learning materials. Customizing--making small adjustments to tailor given materials to particular situations and settings--is one design activity in which busy teachers can feasibly engage. Research indicates that customizations based…

  10. Stages of Adoption Concern and Technology Acceptance in a Critical Care Nursing Unit.

    Science.gov (United States)

    Berg, Gina M; LoCurto, Jamie; Lippoldt, Diana

    2017-09-01

    The aim of this study is to examine the stages of concern (self, task, and impact) and usability (trust, perceived usefulness, and ease of use) shifts experienced by nurses adopting new technology. Patient care processes in critical care units can be disrupted with the incorporation of information technology. New users of technology typically transition through stages of concern and experience shifts in acceptance during assimilation. Critical care nurses (N = 41) were surveyed twice: (1) pre, immediately after training, and (2) post, 3 months after implementation of technology. From presurvey to postsurvey, self-concerns decreased 14%, whereas impact concerns increased 22%. Furthermore, there was a 30% increase in trust and a 17% increase in perceived usefulness, even with a 27% decrease in ease of use. Adoption of new technology requires critical care nurses to adapt current practices, which may improve trust and perceived usefulness yet decrease perceptions of ease of use.

  11. The Effectiveness of a Unit Study-Technology Approach within the High School Band Rehearsal Setting

    Science.gov (United States)

    Gustafson-Hinds, Melissa A.

    2010-01-01

    The purpose of this research study was to investigate the usefulness of implementing a Comprehensive Musicianship (CMP)--Unit Study within a high school band rehearsal setting, using music technology as a supplementary tool. While previous studies have emphasized the many benefits of Comprehensive Musicianship, it is not clear how such an approach…

  12. ENVIRONMENTAL TECHNOLOGY VERIFICATION REPORT: COMM ENGINEERING, USA ENVIRONMENTAL VAPOR RECOVERY UNIT (EVRU)

    Science.gov (United States)

    This report documents the testing of a new technology that recovers and utilizes vapors from crude oil storage tanks employed in the oil production and processing industry. The COMM Engineering, USA Environmental Vapor Recovery Unit (EVRU) is a non-mechanical eductor, or jet pump...

  13. The United Nations Human Space Technology Initiative (HSTI): Activity Status in 2012

    CERN Document Server

    Ochiai, M; Haubold, H J; Doi, T

    2012-01-01

    In 2010, the Human Space Technology Initiative (HSTI) was launched by the United Nations Office for Outer Space Affairs (UNOOSA) within the United Nations Programme on Space Applications. The Initiative aims at promoting international cooperation in human spaceflight and space exploration-related activities, creating awareness among countries on the benefits of utilizing human space technology and its applications, and building capacity in microgravity education and research. HSTI has conducted a series of outreach activities and expert meetings bringing together participants from around the world. HSTI will also be implementing science and educational activities in relevant areas to raise the capacities, particularly in developing countries, in pursuit of the development goals of the United Nations, thus contributing to promoting the peaceful uses of outer space.

  14. Abortion - surgical

    Science.gov (United States)

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

  15. Daily skin cleansing with chlorhexidine did not reduce the rate of central-line associated bloodstream infection in a surgical intensive care unit.

    Science.gov (United States)

    Popovich, Kyle J; Hota, Bala; Hayes, Robert; Weinstein, Robert A; Hayden, Mary K

    2010-05-01

    Cleansing the skin of intensive care unit (ICU) patients daily with chlorhexidine gluconate (CHG) has been associated with beneficial effects, including a reduction in central-line-associated bacteremias (CLABSIs). Most studies have been done in medical ICUs. In this study, we evaluated the effectiveness of daily chlorhexidine skin cleansing on CLABSI rates in a surgical ICU. In Fall 2005, the 30-bed surgical ICU at Rush University Medical Center discontinued daily soap-and-water bathing of patients and substituted skin cleansing with no-rinse, 2% CHG-impregnated cloths. This change was made without research investigator input or oversight. Using administrative, microbiological and infection control practitioner databases, we compared rates of CLABSIs and blood culture contamination during soap-and-water bathing (September 2004-October 2005) and CHG cleansing (November 2005-October 2006) periods. Rates of other nosocomial infections that were not expected to be affected by CHG bathing (secondary bacteremia, Clostridium difficile-associated diarrhea, ventilator-associated pneumonia, urinary tract infection) were included as control variables. There was no significant difference in the CLABSI rate between soap-and-water and CHG bathing periods (3.81/1,000 central line days vs. 4.6/1,000 central line days; p = 0.57). Blood culture contamination declined during CHG bathing (5.97/1,000 to 2.41/1,000 patient days; p = 0.003). Rates of other nosocomial infections did not change significantly. In this real-world effectiveness trial, daily cleansing of surgical ICU patients' skin with CHG had no effect on CLABSI rates, but was associated with half the rate of blood culture contamination. Controlled trials in surgical ICUs are needed to determine whether CHG bathing can prevent infections in this setting.

  16. An overview of remote sensing technology transfer in Canada and the United States

    Science.gov (United States)

    Strome, W. M.; Lauer, D. T.

    1977-01-01

    To realize the maximum potential benefits of remote sensing, the technology must be applied by personnel responsible for the management of natural resources and the environment. In Canada and the United States, these managers are often in local offices and are not those responsible for the development of systems to acquire, preprocess, and disseminate remotely sensed data, nor those leading the research and development of techniques for analysis of the data. However, the latter organizations have recognized that the technology they develop must be transferred to the management agencies if the technology is to be useful to society. Problems of motivation and communication associated with the technology transfer process, and some of the methods employed by Federal, State, Provincial, and local agencies, academic institutions, and private organizations to overcome these problems are explored.

  17. Impacts of reproductive technologies on beef production in the United States.

    Science.gov (United States)

    Dahlen, Carl; Larson, Jamie; Lamb, G Cliff

    2014-01-01

    Estimations of world population growth indicate that by the year 2050 we will reach nine billion habitants on earth. These estimates impose a tremendous challenge in the current agricultural systems as food supply will need to increase by 100 % in the next 40 years (Food and Agriculture Organization of the United Nations 2009). Beef will be a primary protein source that will assist in meeting the requirements for a portion of the protein in diets of this expanding global populace. Beef is a high-quality protein that contains all essential amino acids for the human body and also contains additional essential nutrients such as iron, zinc, B vitamins, riboflavin, selenium, choline, and conjugated linoleic acid (CLA). Adopting reproductive technologies at greater rates than currently used is a viable method to dramatically enhance production efficiency of beef cattle enterprises.Artificial insemination (AI), estrous synchronization and fixed-time AI (TAI), semen and embryo cryopreservation, multiple ovulation and embryo transfer (MOET), in vitro fertilization, sex determination of sperm or embryos, and nuclear transfer are technologies that are used to enhance the production efficiency of beef operations. In many cases, the development of these technologies is responsible for significant changes to traditional livestock production practices. However, adoption of these technologies appears to has not grown at the same rate in the United States as other formidable beef producing nations. For example, sales of beef semen for AI increased from 3.3 to 11.9 million units between 1993 and 2011 in Brazil, whereas that in the United States has increased from 2.9 to 3.8 million units during the same period. The significant increases in adoption of reproductive technologies in developing countries is likely as a result of the development of practical estrous synchronization and TAI systems that have allowed beef producers the opportunity to eliminate detection of estrus in their

  18. Peer-to-peer nursing rounds and hospital-acquired pressure ulcer prevalence in a surgical intensive care unit: a quality improvement project.

    Science.gov (United States)

    Kelleher, Alyson Dare; Moorer, Amanda; Makic, MaryBeth Flynn

    2012-01-01

    We conducted a quality improvement project in order to evaluate the effect of nurse-to-nurse bedside "rounding" as a strategy to decrease hospital-acquired pressure ulcers (HAPU) in a surgical intensive care unit. We instituted weekly peer-to-peer bedside skin rounds in a 17-bed surgical intensive care unit. Two nurses were identified as skin champions and trained by the hospital's certified WOC nurse to conduct skin rounds. The skin champion nurses conducted weekly peer-to-peer rounds that included discussions about key elements of our patients' skin status including current Braden Scale for Pressure Sore Risk score, and implementation of specific interventions related to subscale risk assessment. If a pressure ulcer was present, the current action plan was reevaluated for effectiveness. Quarterly HAPU prevalence studies were conducted from January 2008 to December 2010. Nineteen patients experienced a HAPU: 17 were located on the coccyx and 2 on the heel. Ten ulcers were classified as stage II, 3 PU were stage IV, 5 were deemed unstageable, and 1 was classified as a deep tissue injury. The frequency of preventive interventions rose during our quality improvement project. Specifically, the use of prevention surfaces increased 92%, repositioning increased 30%, nutrition interventions increased 77%, and moisture management increased 100%. Prior to focused nursing rounds, the highest HAPU prevalence rate was 27%. After implementing focused nursing rounds, HAPU rates trended down and were 0% for 3 consecutive quarters.

  19. Research Progress of Delirium in Surgical Intensive Care Unit%外科重症监护室中谵妄的研究进展

    Institute of Scientific and Technical Information of China (English)

    郭勇

    2011-01-01

    谵妄在外科重症监护室发病率很高,并可带来多种并发症.关于外科重症监护室中谵妄的发病机制有多种学说.通过使用特定的简单的筛选列表可以尽快地诊断谵妄,尽可能地消除或减少危险因素可预防谵妄.对于可处置的危险因素可采取护理干预或医疗干预.谵妄的治疗需要寻找潜在原因,明确了原因实施非药物治疗无效时才考虑药物治疗.%Delirium occurs frequently in surgical intensive care unit and results in multiple complications. The pathological mechanism of delirium occurring in surgical intensive care unit is attributed to multiple theories. The use of a simple routine screening list allows the rapid diagnosis of delirium and minimizes the risk factors for the prevention of delirium. The manageable risk factors can be intervened by appropriate nursing or medical treatment. The treatment of delirium requires the identification of underlying causes whereas drug treatment is only indicated in the case of ineffective non-medical treatment with known cause.

  20. Distribution of methicillin-resistant coagulase-positive staphylococci (MRCoPS) in a surgical unit and cystotomy operation sites in a veterinary teaching hospital.

    Science.gov (United States)

    Fungwithaya, Punpichaya; Brikshavana, Pasakorn; Chanchaithong, Pattrarat; Prapasarakul, Nuvee

    2017-02-28

    This study aimed to investigate the spread of methicillin-resistant coagulase-positive staphylococci (MRCoPS) among veterinary staff, hand-touch sites and surgical tissue during cystotomy operations on cats and dogs that were patients, and to analyze the genetic relatedness and antimicrobial resistance profiles of the isolates. Human and environmental samples were obtained from the nasal passageways of 12 surgeons and veterinary assistants and from 29 hand-touch sites of instruments in operative units and subjected to bacterial isolation and enumeration. Swab samples were collected in triplicate from 29 dogs and three cats at the site of incision, from the incision area, from the peritoneum during surgery and from the peritoneum before suture. MRCoPS were identified by mecA gene detection and characterized by their antibiogram profile, SCCmec type and pulsed-field gel electrophoresis. Twenty-four staphylococci were isolated, derived from one veterinary assistant, 12 operating room floor areas and hand-touch sites, three dogs and one cat. Methicillin-resistant S. pseudintermedius (MRSP) was found on an electric clipper and rebreathing circuits in the operating room. Three dogs were positive for MRSP during surgery, and one methicillin-resistant S. aureus (MRSA) was detected in a cat. All MRCoPS were resistant to doxycycline, erythromycin, clindamycin and enrofloxacin, but no patients developed surgical site infections. According to their genotypic patterns, the clones obtained from the environment and human sources differed from the animal clones. Despite intensive hygienic management, a variety of MRCoPS clones were present within the surgical unit and during surgery.

  1. A tailored relocation stress intervention programme for family caregivers of patients transferred from a surgical intensive care unit to a general ward.

    Science.gov (United States)

    Lee, Seul; Oh, HyunSoo; Suh, YeonOk; Seo, WhaSook

    2017-03-01

    To develop and examine a relocation stress intervention programme tailored for the family caregivers of patients scheduled for transfer from a surgical intensive care unit to a general ward. Family relocation stress syndrome has been reported to be similar to that exhibited by patients, and investigators have emphasised that nurses should make special efforts to relieve family relocation stress to maximise positive contributions to the well-being of patients by family caregivers. A nonequivalent control group, nonsynchronised pretest-post-test design was adopted. The study subjects were 60 family caregivers of patients with neurosurgical or general surgical conditions in the surgical intensive care unit of a university hospital located in Incheon, South Korea. Relocation stress and family burden were evaluated at three times, that is before intervention, immediately after transfer and four to five days after transfer. This relocation stress intervention programme was developed for the family caregivers based on disease characteristics and relocation-related needs. In the experimental group, relocation stress levels significantly and continuously decreased after intervention, whereas in the control group, a slight nonsignificant trend was observed. Family burden levels in the control group increased significantly after transfer, whereas burden levels in the experimental group increased only marginally and nonsignificantly. No significant between-group differences in relocation stress or family burden levels were observed after intervention. Relocation stress levels of family caregivers were significantly decreased after intervention in the experimental group, which indicates that the devised family relocation stress intervention programme effectively alleviated family relocation stress. The devised intervention programme, which was tailored to disease characteristics and relocation-related needs, may enhance the practicality and efficacy of relocation stress

  2. Coverage Range and Cost Comparison of Remote Antenna Unit Designs for Inbuilding Radio over Fiber Technology

    Directory of Open Access Journals (Sweden)

    Razali Ngah

    2013-09-01

    Full Text Available Future communication needs to be ubiquitous, broadband, convergent, and seamless. Radio over fiber (RoF technology is one of the most important enabler in access network for the technologies. Adoption of RoF faces bottleneck in optoelectronics, that they are still expensive, high power consumption, and limited in bandwidth. To solve the problem, transceiver in remote antenna unit (RAU is developed, i.e. electroabsorption transceiver (EAT and asymmetric FabryPerot modulator (AFPM. This paper compares their coverage range and cost in providing WCDMA and WLAN services. Needed gain of RF amplifier for supporting picocell is also discussed.

  3. Battlefield Lessons: The Forward Air Surgical Team (FAST) Response

    Science.gov (United States)

    2011-02-24

    roster of diverse emergency and surgical specialties (emergency medicine, general surgery , orthopedic, oral - maxillofacial , ear- nose-throat, trauma, and...Forefront: The Army Forward Surgical Team,” Clinical Care Nursing North America , June, 2003, in PubMed.Gov, http://www.ncbi.nlm.nih.gov/pubmed/12755185...service members of the United States of America enjoy the latest aviation technology available. Sikorsky’s UH-60 “Blackhawk” is the most current

  4. Imagining Nanotechnology: Cultural Support for technological Innovation in Europe and the United States

    OpenAIRE

    2005-01-01

    Abstract This paper compares public perceptions of technologies in the United States and Europe. Asked whether nanotechnology will improve our way of life, 50 percent of the US sample say ?yes? and 35 percent say ?don?t know.? The European figures are almost the mirror image, 29 percent saying ?yes? and 53 percent saying ?don?t know.? People in the US are also more opti...

  5. Research of the evaporative unit in technology of non-alcoholic beer

    Directory of Open Access Journals (Sweden)

    Віталій Михайлович Таран

    2016-03-01

    Full Text Available In this work it is considered non-alcoholic beer production technology – the method of evaporating the alcohol from alcoholic beer. Equipment of the evaporative unit with natural circulation, external reboiler and separator for separating beer and alcohol vapor are proposed. This equipment had not been used in the production of non-alcoholic beer. The modeling process of dealcoholizing is done

  6. Regional characteristics of individual housing units in Serbia from the aspect of applied building technologies

    Directory of Open Access Journals (Sweden)

    Jovanović-Popović Milica

    2014-01-01

    Full Text Available Individual housing units in Serbia have been studied from the aspect of applied technical solutions. Analyzed data have been collected during a field research in accordance with the current administrative regional division, and they represent a basis for definition of regional typology of individual housing units. Characteristic types of objects of each region’s typology have been further analyzed. Upon these analyses regional characteristics of individual housing units regarding applied construction types, building technologies and materials have been defined and presented. [Projekat Ministarstva nauke Republike Srbije, br. TR 36034: Investigation and Systematization of Serbian Housing in Context of Globalization and European Integration in the Framework of Quality and Living-Standard Improvement

  7. ALTERNATIVE REMEDIATION TECHNOLOGY STUDY FOR GROUNDWATER TREATMENT AT 200-PO-1 OPERABLE UNIT AT HANFORD SITE

    Energy Technology Data Exchange (ETDEWEB)

    DADO MA

    2008-07-31

    This study focuses on the remediation methods and technologies applicable for use at 200-PO-I Groundwater Operable Unit (OU) at the Hanford Site. The 200-PO-I Groundwater au requires groundwater remediation because of the existence of contaminants of potential concern (COPC). A screening was conducted on alternative technologies and methods of remediation to determine which show the most potential for remediation of groundwater contaminants. The possible technologies were screened to determine which would be suggested for further study and which were not applicable for groundwater remediation. COPCs determined by the Hanford Site groundwater monitoring were grouped into categories based on properties linking them by remediation methods applicable to each COPC group. The screening considered the following criteria. (1) Determine if the suggested method or technology can be used for the specific contaminants found in groundwater and if the technology can be applied at the 200-PO-I Groundwater au, based on physical characteristics such as geology and depth to groundwater. (2) Evaluate screened technologies based on testing and development stages, effectiveness, implementability, cost, and time. This report documents the results of an intern research project conducted by Mathew Dado for Central Plateau Remediation in the Soil and Groundwater Remediation Project. The study was conducted under the technical supervision of Gloria Cummins and management supervision of Theresa Bergman and Becky Austin.

  8. Design and Test Plans for a Non-Nuclear Fission Power System Technology Demonstration Unit

    Science.gov (United States)

    Mason, Lee; Palac, Donald; Gibson, Marc; Houts, Michael; Warren, John; Werner, James; Poston, David; Qualls, Arthur Lou; Radel, Ross; Harlow, Scott

    2012-01-01

    A joint National Aeronautics and Space Administration (NASA) and Department of Energy (DOE) team is developing concepts and technologies for affordable nuclear Fission Power Systems (FPSs) to support future exploration missions. A key deliverable is the Technology Demonstration Unit (TDU). The TDU will assemble the major elements of a notional FPS with a non-nuclear reactor simulator (Rx Sim) and demonstrate system-level performance in thermal vacuum. The Rx Sim includes an electrical resistance heat source and a liquid metal heat transport loop that simulates the reactor thermal interface and expected dynamic response. A power conversion unit (PCU) generates electric power utilizing the liquid metal heat source and rejects waste heat to a heat rejection system (HRS). The HRS includes a pumped water heat removal loop coupled to radiator panels suspended in the thermal-vacuum facility. The basic test plan is to subject the system to realistic operating conditions and gather data to evaluate performance sensitivity, control stability, and response characteristics. Upon completion of the testing, the technology is expected to satisfy the requirements for Technology Readiness Level 6 (System Demonstration in an Operational and Relevant Environment) based on the use of high-fidelity hardware and prototypic software tested under realistic conditions and correlated with analytical predictions.

  9. Use of 3D printer technology to facilitate surgical correction of a complex vascular anomaly with esophageal entrapment in a dog.

    Science.gov (United States)

    Dundie, A; Hayes, G; Scrivani, P; Campoy, L; Fletcher, D; Ash, K; Oxford, E; Moïse, N S

    2017-04-01

    A 10 week old female intact Staffordshire terrier was presented with a total of five congenital cardio-thoracic vascular anomalies consisting of a patent ductus arteriosus (PDA) with an aneurysmic dilation, pulmonic stenosis, persistent right aortic arch, aberrant left subclavian artery and persistent left cranial vena cava. These abnormalities were identified with a combination of echocardiogram and computed tomography angiography (CTA). The abnormalities were associated with esophageal entrapment, regurgitation, and volume overload of the left heart with left atrial and ventricular enlargement. A 2 cm diameter aneurysmic dilation at the junction of the PDA, right aortic arch and aberrant left subclavian artery presented an unusual surgical challenge and precluded simple circumferential ligation and transection of the structure. A full scale three dimensional model of the heart and vasculature was constructed from the CTA and plasma sterilized. The model was used preoperatively to facilitate surgical planning and enhance intraoperative communication and coordination between the surgical and anesthesia teams. Intraoperatively the model facilitated spatial orientation, atraumatic vascular dissection, instrument sizing and positioning. A thoracoabdominal stapler was used to close the PDA aneurysm prior to transection. At the four-month postoperative follow-up the patient was doing well. This is the first reported application of new imaging and modeling technology to enhance surgical planning when approaching correction of complex cardiovascular anomalies in a dog. Copyright © 2016 Elsevier B.V. All rights reserved.

  10. [Utilization of technological resources within the framework of operation of a Mobile Mental Health Unit].

    Science.gov (United States)

    Garoni, D; Sarantidis, D; Katsadoros, K

    2016-01-01

    Telepsychiatry was introduced in the early 1950's for the provision of mental health services from a distance. In 1990 the progress made in telecommunications technologies caused a significant expansion in telepsychiatry services. It can refer to store and forward technologies, interactive technologies, remote monitoring technologies and it is applied to contribute to the lift of restrictions placed on providing mental health services. Restrictions may exist due to geographic isolation, lack of specialized services, high cost of moving patients etc. The positive cost-benefit analysis and the reliability of diagnosis and efficacy of interventions through telepsychiatry have been documented in various research papers referring to a wide range of contexts such as prisons, remote areas, general and psychiatric hospitals. Since 2003 the Mobile Mental Health Unit of South- Eastern (SE) Cyclades has been using videoconferencing in order to provide mental health services in thirteen islands. This area shares many of the characteristics of remote areas such as residential dispersion, lack of mental health services and frequent lack of access to services in urban centers. Telepsychiatry in conjunction with physical presence of professionals was launched by the Mobile Mental Health Unit in order to provide assistance to the evaluation of patients, to therapeutic interventions, to medicine prescription, to crisis intervention, to psychoeducation of patients and their families and to the implementation of educational and administrative activities . The use of existing technology in combination with the development of human resources has enabled continuity of care, crisis intervention and avoidance of involuntary hospitalization for a significant number of persons. Moreover, it has improved cooperation and coordination between the interdisciplinary team and local authorities and agencies. When professionals located in different parts are collaborating via telepsychiatry it is

  11. Commercial Application of the MIP-CGP Technology for Olefin Reduction in FCC Unit

    Institute of Scientific and Technical Information of China (English)

    Su Wensheng

    2009-01-01

    The refinery of Yanshan Petrochemical Company has twice retrofitted a 2.0-Mt/a RFCC unit with the MIP-CGP technology aimed at maximization ofisoparaffins/clean gasoline and increased output ofpropylene. By modi-fying the riser reactor with addition of the second reaction zone coupled with an added external catalyst cooler outside the regenerator and adoption of the CGP catalyst to control the cracking depth the refiners have realized the target of reducing olefin content in gasoline and increasing the yield of LPG. The results of retrofitting the RFCC unit have revealed that after revamp of FCC unit the yield of LPG was increased by 7.31%, the conversion rate was increased by 9.06%, and the total liquid yield was decreased by 0.3%. After revamp of the RFCC unit the olefin content in gasoline was reduced by 19.5 v%, and the RON rating of gasoline was increased by 0.7 units to meet the demand of Beijing municipality for manufacture of the Olympic clean gasoline.

  12. Research on Key Technologies of Unit-Based CNC Machine Tool Assembly Design

    Directory of Open Access Journals (Sweden)

    Zhongqi Sheng

    2014-01-01

    Full Text Available Assembly is the part that produces the maximum workload and consumed time during product design and manufacturing process. CNC machine tool is the key basic equipment in manufacturing industry and research on assembly design technologies of CNC machine tool has theoretical significance and practical value. This study established a simplified ASRG for CNC machine tool. The connection between parts, semantic information of transmission, and geometric constraint information were quantified to assembly connection strength to depict the assembling difficulty level. The transmissibility based on trust relationship was applied on the assembly connection strength. Assembly unit partition based on assembly connection strength was conducted, and interferential assembly units were identified and revised. The assembly sequence planning and optimization of parts in each assembly unit and between assembly units was conducted using genetic algorithm. With certain type of high speed CNC turning center, as an example, this paper explored into the assembly modeling, assembly unit partition, and assembly sequence planning and optimization and realized the optimized assembly sequence of headstock of CNC machine tool.

  13. Study of Candida Bloodstream Infections in Surgical Intensive Care Unit Patients and Susceptibility Profile of the Isolates

    Directory of Open Access Journals (Sweden)

    Vijaya S. Rajmane

    2015-01-01

    Full Text Available Background: The increased incidence of fungal infections in the past two decades has been overwhelming. Despite the fact that invasive fungal infections are still under-diagnosed and underreported, bloodstream infection due to Candida is now being recognized as an important public health problem especially in ICU patients with considerable morbidity, mortality and health care costs. Objective: To study the incidence, risk factors and antifungal susceptibility of Candida bloodstream infection in our hospital. Material and Methods: In the present study, the blood samples were collected from patients admitted in Surgical ICU. Samples were processed and antifungal susceptibility of the isolates was performed using standard protocol. Results: Out of total 93 patients, 14 (15.05% were positive for candidemia with equal distribution of both C. albicans and nonalbicans Candida spp. The risk factors associated with candidemia showing statistical significance were length of ICU stay > 7 days, mechanical ventilation, central venous catheters and uncontrolled diabetes. Among the patients with candidemia the mortality rate was 78.57 %. Resistance to Amphotericin B was seen in 33.33 % isolates of C. tropicalis and 100 % isolates of C. rugosa. 33.33 % of C. tropicalis and 50 % of C. rugosa showed dose dependent susceptibility to Fluconazole. Conclusion: Early diagnosis and antifungal susceptibility testing is very important in the treatment of candidemia for reducing the mortality rate.

  14. Relationships among NANDA-I diagnoses, nursing outcomes classification, and nursing interventions classification by nursing students for patients in medical-surgical units in Korea.

    Science.gov (United States)

    Noh, Hyun Kyung; Lee, Eunjoo

    2015-01-01

    The purpose of this study was to identify NANDA-I, Nursing Outcomes Classification (NOC), and Nursing Interventions Classification (NIC; NNN) linkages used by Korean nursing students during their clinical practice in medical-surgical units. A comparative descriptive research design was used to measure the effects of nursing interventions from 153 nursing students in South Korea. Nursing students selected NNN using a Web-based nursing process documentation system. Data were analyzed by paired t-test. Eighty-two NANDA-I diagnoses, 116 NOC outcomes, and 163 NIC interventions were identified. Statistically significant differences in patients' preintervention and postintervention outcome scores were observed. By determining patient outcomes linked to interventions and how the degree of outcomes change after interventions, the effectiveness of the interventions can be evaluated. © 2014 NANDA International, Inc.

  15. [Opportunity for development of laparoscopic procedures in the hospital setting: costs and benefits for the surgical unit].

    Science.gov (United States)

    Vino, F; Trerotoli, P; Serio, G

    2002-01-01

    Physician are induced, by technical development, to demand new devices and instruments and to introduce new method for diagnosis and treatment. In order to do a right economic planning in public health, it's necessary to evaluate costs of technologies, because sometimes there isn't neither a right plan for acquisition nor an efficient control system. One the most stressed medical branch by innovative technologies is the surgery, in particular after the coming of laparoscopic surgery. The will to do, in every way laparoscopic approach, induces to evaluate costs of this surgery, specially cholecystectomy, that is identified by four specific DRGs. In this paper we compare laparotomic versus laparoscopic cholecystectomy in terms of costs and length of stay; the break-even analysis has been performed to determine the number of laparoscopic operations necessary to balance the costs.

  16. Survey of Technology with Possible Applications to United States Coast Guard Buoy Tenders. Volume 1. Technology Assessment.

    Science.gov (United States)

    1987-09-01

    performance. Zig - zag tests show SWATH ships have half the overshoot of conventional ships. At slow speeds, the widely separated propulsion units aid...Ii S2 2-13 C, Lb 0 00 2-14 ’rkpl I% -W N~ louw W ME ’ K’.MM w~~b Af’- w~t W pw -.J 1 W ’W SS U. C ’U . 2-15 Mill ll WRII9PqWWmWIK"-wPFll7TW W.F K...Evaluation of a Compound Cycle Engine for Shipboard Gensets," Report No. DTNSRDC-PASD-CR-1886. 6.19 Mills , R.G., "Innovative Technology on Steam

  17. Functional unit, technological dynamics, and scaling properties for the life cycle energy of residences.

    Science.gov (United States)

    Frijia, Stephane; Guhathakurta, Subhrajit; Williams, Eric

    2012-02-07

    Prior LCA studies take the operational phase to include all energy use within a residence, implying a functional unit of all household activities, but then exclude related supply chains such as production of food, appliances, and household chemicals. We argue that bounding the functional unit to provision of a climate controlled space better focuses the LCA on the building, rather than activities that occur within a building. The second issue explored in this article is how technological change in the operational phase affects life cycle energy. Heating and cooling equipment is replaced at least several times over the lifetime of a residence; improved efficiency of newer equipment affects life cycle energy use. The third objective is to construct parametric models to describe LCA results for a family of related products. We explore these three issues through a case study of energy use of residences: one-story and two-story detached homes, 1,500-3,500 square feet in area, located in Phoenix, Arizona, built in 2002 and retired in 2051. With a restricted functional unit and accounting for technological progress, approximately 30% of a building's life cycle energy can be attributed to materials and construction, compared to 0.4-11% in previous studies.

  18. Technology and place: A geography of waste-to-energy in the United States

    Science.gov (United States)

    Howell, Jordan Patterson

    The adoption of technologies differs across space, for reasons attributed to economics, politics, and culture, but also due to limitations imposed by both the physical environment and the technology itself. This dissertation considers the case of waste-to-energy (WTE) incinerators in the United States, and asks why this technology is used in some places but rejected in others. The answer to this simple question is remarkably complex, as understandings and arguments about technology and the environment are mobilized differently by various actors to champion, oppose, or in some cases remain ambivalent about the installation and operation of WTE facilities. In this dissertation I explore the geography of WTE incineration in the United States since the 19th century. Informed by the insights of actor-network theory and the social construction of technology school, I employ the tools of discourse analysis to examine published and unpublished statements, papers, project studies, policy briefs, and archival materials generated alongside the development of WTE facilities in the United States, considering the specific case studies discussed below but also WTE technology in general. I look at federal, state, and local environmental agency documents as well as the papers of consulting firms, environmental and industry advocacy groups, and private companies. I also devote significant attention to the analysis of news media outlets in communities where WTE facilities are located or have been considered. In addition to these literal texts, I examine non-written and visual materials associated with WTE facilities, including films, websites, signage and logos, advertising campaigns, facility architecture, and artwork, as well as more abstract `texts' such as industry conferences, trade-show handouts, promotional materials, and academic and industry research programs. I build on this textual analysis with observations of WTE facilities in action. After an introductory chapter, I

  19. An unusual case of corneal perforation secondary to Pseudomonas keratitis complicating a patient's surgical/trauma intensive care unit stay.

    Science.gov (United States)

    Johnson, J L; Sagraves, S G; Feild, C J; Block, E F; Cheatham, M L

    2000-10-01

    We report a case of corneal perforation secondary to bacterial keratitis caused by Pseudomonas aeruginosa in a trauma patient in our intensive care unit. A 43-year-old man was involved in a motorcycle crash and suffered multiple injuries necessitating a prolonged intensive care unit (ICU) stay. Subsequently P. aeruginosa was cultured from his sputum, blood, and open abdomen. He developed a bacterial keratitis in his right eye, which also grew P. aeruginosa. This infection rapidly progressed to corneal perforation requiring a Gunderson conjunctival flap and lateral tarsorrhaphy in addition to aggressive antibiotic treatment. At the time of discharge from the hospital the patient had the return of vision to light only in his right eye. Corneal perforation is an unusual event in the ICU. Prevention or early detection of bacterial keratitis with aggressive antibiotic treatment is needed to prevent such complications. Pseudomonas is one of the more virulent organisms that can infect the cornea and early identification is paramount for a good outcome. Management of this complicated case is discussed and the limited amount of literature on nosocomial bacterial keratitis in the ICU is reviewed.

  20. Needs assessment for remote systems technology at the Chornobyl Unit 4 shelter

    Energy Technology Data Exchange (ETDEWEB)

    Carteret, B.A. [Pacific Northwest National Lab., Richland, WA (United States); Holliday, M.A.; Jones, E.D. [Lawrence Livermore National Lab., CA (United States)] [and others

    1997-12-01

    The accident at Chornobyl Unit 4 on April 26, 1986, resulted in a series of unprecedented scientific and technical challenges. The reactor building was damaged extensively. Following the accident, immediate action was needed to seal off the gaping crater created by the accident, which was a continuing source of airborne contamination. Under extreme conditions, a structure called the {open_quotes}Shelter{close_quotes} was built over the remains of the reactor building. The Shelter, which was quickly completed in November 1986, was meant to provide immediate but temporary containment. Now, 11 years later, there are significant concerns about its structural integrity and projected life expectancy. The United States and other participating G-7 countries are supporting nuclear safety upgrade efforts in Eastern Europe with a primary focus on placing the Chornobyl Nuclear Power Plant (ChNPP) Unit 4 Shelter in a stable and environmentally acceptable condition. Application of remote systems technologies will play an important part in achieving the goals of this program. The G-7 nations have agreed to support these efforts, including the identification and development of remote system technologies for fuel removal. However at this time they have taken a firm stance against funding actual fuel removal activities. The U.S. Department of Energy Office of Nuclear Energy, Science and Technology requested that a needs assessment be performed to evaluate the requirements for applying remote systems, including robotics, at the Shelter. This document is intended to be used to identify remote systems needs and requirements at the Shelter and to provide general information on the conditions in the Shelter that could impact the use of remote systems. This document is intended as a source of information to assist those who will be implementing the Shelter Implementation Plan tasks. The document provides background information and general guidance on the application of remote systems.

  1. Voice-coil technology for the E-ELT M4 Adaptive Unit

    Science.gov (United States)

    Gallieni, D.; Tintori, M.; Mantegazza, M.; Anaclerio, E.; Crimella, L.; Acerboni, M.; Biasi, R.; Angerer, G.; Andrigettoni, M.; Merler, A.; Veronese, D.; Carel, J.-L.; Marque, G.; Molinari, E.; Tresoldi, D.; Toso, G.; Spanó, P.; Riva, M.; Mazzoleni, R.; Riccardi, A.; Mantegazza, P.; Manetti, M.; Morandini, M.; Vernet, E.; Hubin, N.; Jochum, L.; Madec, P.; Dimmler, M.; Koch, F.

    We present our design of the E-ELT M4 Adaptive Unit based on voice-coil driven deformable mirror technology. This technology was developed by INAF-Arcetri, Microgate and ADS team in the past 15 years and it has been adopted by a number of large ground based telescopes as the MMT, LBT, Magellan and lastly the VLT in the frame of the Adaptive Telescope Facility project. Our design is based on contactless force actuators made by permanent magnets glued on the back of the deformable mirror and coils mounted on a stiff reference structure. We use capacitive sensors to close a position loop co-located with each actuator. Dedicated high performance parallel processors are used to implement the local de-centralized control at actuator level and a centralized feed-forward computation of all the actuators forces. This allowed achieving in our previous systems dynamic performances well in line with the requirements of the M4 Adaptive Unit (M4AU) case. The actuator density of our design is in the order of 30-mm spacing for a figure of about 6000 actuators on the M4AU and it allows fulfilling the fitting error and corrections requirements of the E-ELT high order DM. Moreover, our contact-less technology makes the Deformable Mirror tolerant to up 5% actuators failures without spoiling system capability to reach its specified performances, besides allowing large mechanical tolerances between the reference structure and the deformable mirror. Finally, we present the Demonstration Prototype we are building in the frame of the M4AU Phase B study to measure the optical dynamical performances predicted by our design. Such a prototype will be fully representative of the M4AU features, in particular it will address the controllability of two adjacent segments of the 2-mm thick mirror and implement the actuators "brick" modular concept that has been adopted to dramatically improve the maintainability of the final unit.

  2. Research on Energy-saving Technology of Crank Balanced Pumping Unit

    Directory of Open Access Journals (Sweden)

    Feng Ziming

    2013-12-01

    Full Text Available In order to saving energy and emission reduction, a secondary balance technology was used to reform the conventional beam pumping unit. The output torque from the reduction gearbox of conventional beam pumping units is usually characterized by its periodic drastic changes. Based on the idea of "cutting peak and filling valley" and the theory of the Fourier series expansion for torque curve, the second balance device is designed in order to slow down the fluctuations in the torque curve. The second balance device, with the similar balance principle to the crank balance, is connected to the output shaft of the reduction gearbox and can further reduce torque fluctuation rate and peak torque. Field test result of the secondary balance device shows that the Root-Mean-Square (RMS torque is decreased by 22.7% and the energy-saving rate of motor reaches 6.54%.

  3. Groundwater Monitoring Plan for the Reactor Technology Complex Operable Unit 2-13

    Energy Technology Data Exchange (ETDEWEB)

    Richard P. Wells

    2007-03-23

    This Groundwater Monitoring Plan describes the objectives, activities, and assessments that will be performed to support the on-going groundwater monitoring requirements at the Reactor Technology Complex, formerly the Test Reactor Area (TRA). The requirements for groundwater monitoring were stipulated in the Final Record of Decision for Test Reactor Area, Operable Unit 2-13, signed in December 1997. The monitoring requirements were modified by the First Five-Year Review Report for the Test Reactor Area, Operable Unit 2-13, at the Idaho National Engineering and Environmental Laboratory to focus on those contaminants of concern that warrant continued surveillance, including chromium, tritium, strontium-90, and cobalt-60. Based upon recommendations provided in the Annual Groundwater Monitoring Status Report for 2006, the groundwater monitoring frequency was reduced to annually from twice a year.

  4. Pervasive technology in Neonatal Intensive Care Unit: a prototype for newborns unobtrusive monitoring.

    Science.gov (United States)

    Ciani, Oriana; Piccini, Luca; Parini, Sergio; Rullo, Alessia; Bagnoli, Franco; Marti, Patrizia; Andreoni, Giuseppe

    2008-01-01

    Pervasive computing research is introducing new perspectives in a wide range of applications, including healthcare domain. In this study we explore the possibility to realize a prototype of a system for unobtrusive recording and monitoring of multiple biological parameters on premature newborns hospitalized in the Neonatal Intensive Care Unit (NICU). It consists of three different units: a sensitized belt for Electrocardiogram (ECG) and chest dilatation monitoring, augmented with extrinsic transducers for temperature and respiratory activity measure, a device for signals pre-processing, sampling and transmission through Bluetooth(R) (BT) technology to a remote PC station and a software for data capture and post-processing. Preliminary results obtained by monitoring babies just discharged from the ward demonstrated the feasibility of the unobtrusive monitoring on this kind of subjects and open a new scenario for premature newborns monitoring and developmental cares practice in NICU.

  5. Evaluation of incidence and severity of postoperative hypoxemia in neurosurgical patients during transportation from operation theater to surgical intensive care unit in a tertiary care unit, Kashmir, India

    Directory of Open Access Journals (Sweden)

    Abdul Waheed Mir

    2012-07-01

    Full Text Available Background:Postoperative hypoxemia during transportation from operation theater to intensive care unit is common among neurosurgical patients. Methadology: Arterial oxygen saturation (Spo2 and arterial blood gas analysis was performed postoperatively before and after shifting a group of sixty patients with ASA I and ASA II status undergoing various elective neurosurgical procedures under general anesthesia at Sheri-Kashmir Institute of Medical Sciences Srinagar , Kashmir. Statistical analysis: The data was analyzed using SPSS version 13. The chi-square test was used for categorical variables and student’s t test was used for continuous variables with normal distribution. The data was collected, compiled and statistically analyzed using analysis of variance (ANOVA. The values were expressed as mean±SD and a p value <0.05 was taken as statistically significant. Results: SpO2 before and after transporting the patients to SICU in group I was 98.90±0.45 and 86.70±3.85 respectively, whereas in group II, the SpO2 values were 98.80±0.52 and 93.95±3.99 respectively. In group III the mean SpO2 before and after transportation was 97.60±1.96 and 83.95±8.64 respectively. The difference in SpO2 in all the three groups before and after transportation was statistically significant (p<0.05. Conclusion: We recommend supplemental oxygen administration in all neurosurgical patients during transportation from operation theater to intensive care unit.

  6. Soft technologies as generating satisfaction in users of a Family Health Unit

    Directory of Open Access Journals (Sweden)

    Sonia Mara Neves Ferri

    2007-01-01

    Full Text Available This study had the purpose to evaluate the quality of the health service provided at a Family Health Unit (FHU, with emphasis on user satisfaction, based on soft technologies. Furthermore, this study also aimed to analyze the aspects of health care that generated user satisfaction or dissatisfaction regarding attachment, accountability, providing solutions, expectations, relationship, comfort, and access, and to identify recommendations for local interventions. The authors made a general characterization of the population seen at the studied service, and then selected the subjects. The study used a qualitative approach. Data were collected in semi-structured interviews, and ordered using the Collective Subject Discourse (CSD method. The analysis reveals the importance that service users assign to the soft technologies, but also shows the need to reduce the waiting time for medical consultations and referrals, and to obtain access to medication and dental care at the same location. These factors generated great dissatisfaction among users.

  7. Quality and productivity drive innovation and improvement at United Technologies Aerospace Operations, Inc.

    Science.gov (United States)

    Jamar, L. G.

    1986-01-01

    Quality and innovation are the hallmarks of the national space program. In programs that preceded the Shuttle Program the emphasis was on meeting the risks and technical challenges of space with safety, quality, reliability, and success. At United Technologies Aerospace Operations, Inc. (UTAO), the battle has developed along four primary fronts. These fronts include programs to motivate and reward people, development and construction of optimized processes and facilities, implementation of specifically tailored management systems, and the application of appropriate measurement and control systems. Each of these initiatives is described. However, to put this quality and productivity program in perspective, UTAO and its role in the Shuttle Program are described first.

  8. Technology and educational innovation. The thirty-year history of a learning unit in quantitative geography

    Directory of Open Access Journals (Sweden)

    Giampaolo Chiappini

    2014-04-01

    Full Text Available This article describes a project in computer-mediated educational innovation for the teaching of geography which has been carried out at the Don Milani Experimental Middle School in Genoa. The project concerns a learning unit in quantitative geography that has helped to change the way this discipline is taught in the school. Given its special features and durability over time (28 years, this experience represents a benchmark for studying (a the way in which a technology-mediated educational innovation project can germinate and grow to involve all school classes, and (b the conditions that ensure sustainability over time.

  9. A reappraisal of the role of Gram's stains of tracheal aspirates in guiding antibiotic selection in the surgical intensive care unit.

    Science.gov (United States)

    Namias, N; Harvill, S; Ball, S; McKenney, M G; Sleeman, D; Ladha, A; Civetta, J

    1998-01-01

    Tracheal aspirate Gram's stains are used to guide antibiotic selection in empiric pneumonia treatment in the surgical intensive care unit (SICU). We questioned whether Gram's stains predict the organism cultured. A retrospective review of prospectively collected data. Gram's stains correlated with the cultured organism in 284 of 543 (52%) SICU cultures and in 226 of 403 (56%) trauma intensive care unit (TICU) cultures. Gram-negative rod (GNR) stains yielded GNR organisms in 182 of 205 (89%) SICU cultures and in 160 of 176 (91%) TICU cultures. Gram-positive coccus (GPC) stains yielded GPC organisms in 75 of 228 (33%) SICU cultures and in 52 of 149 (35%) TICU cultures. Noncorrelates in the GPC group were predominantly GNRs (185 of 250 (74%)). When the clinical decision has been made that empiric antibiotic coverage is necessary, GNR coverage should be instituted regardless of Gram's stain result. The decision to institute GPC coverage needs to be supported by clinical data other than the Gram's stain.

  10. Symbol RFID Technology to be Deployed at United States Defense Logistics Agency’s Distribution Centers Worldwide

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Symbol Technologies, Inc., The Enterprise Mobility Company, today announced that it had been selected by ODIN technologies, the leader in the physics of RFID testing, software and deployment, to support its recent contract win with the United States Defense Logistics Agency (DLA), the United States Department of Defense’s (DoD) logistics combat support agency that provides supplies and services to America’s military forces worldwide.

  11. Surgical Site Infection (SSI) Rates in the United States, 1992-1998: The National Nosocomial Infections Surveillance System Basic SSI Risk Index

    National Research Council Canada - National Science Library

    Robert P. Gaynes; David H. Culver; Teresa C. Horan; Jonathan R. Edwards; Chesley Richards; James S. Tolson; The National Nosocomial Infections Surveillance System

    2001-01-01

    By use of the National Nosocomial Infections Surveillance (NNIS) System's surgical patient surveillance component protocol, the NNIS basic risk index was examined to predict the risk of a surgical site infection (SSI...

  12. An Examination of Information Technology and Its Perceived Quality Issues in Single System Hospitals in the United States

    Science.gov (United States)

    Byrd, Linda W.

    2009-01-01

    The safety and quality of healthcare is of great concern in the United States. The positive effects of information technology reported in past research, especially case studies, has encouraged expectations that information technology may increase the quality of healthcare while reducing costs of healthcare. The goals of this study was to examine…

  13. Technology assessment of vertical and horizontal air drilling potential in the United States. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Carden, R.S.

    1993-08-18

    The objective of the research was to assess the potential for vertical, directional and horizontal air drilling in the United States and to evaluate the current technology used in air drilling. To accomplish the task, the continental United States was divided into drilling regions and provinces. The map in Appendix A shows the divisions. Air drilling data were accumulated for as many provinces as possible. The data were used to define the potential problems associated with air drilling, to determine the limitations of air drilling and to analyze the relative economics of drilling with air versus drilling mud. While gathering the drilling data, operators, drilling contractors, air drilling contractors, and service companies were contacted. Their opinion as to the advantages and limitations of air drilling were discussed. Each was specifically asked if they thought air drilling could be expanded within the continental United States and where that expansion could take place. The well data were collected and placed in a data base. Over 165 records were collected. Once in the data base, the information was analyzed to determine the economics of air drilling and to determine the limiting factors associated with air drilling.

  14. Benefits to the United States of Increasing Global Uptake of Clean Energy Technologies

    Energy Technology Data Exchange (ETDEWEB)

    Kline, D.

    2010-07-01

    A previous report describes an opportunity for the United States to take leadership in efforts to transform the global energy system toward clean energy technologies (CET). An accompanying analysis to that report provides estimates of the economic benefits to the United States of such a global transformation on the order of several hundred billion dollars per year by 2050. This report describes the methods and assumptions used in developing those benefit estimates. It begins with a summary of the results of the analysis based on an updated and refined model completed since the publication of the previous report. The framework described can be used to estimate the economic benefits to the U.S. of coordinated global action to increase the uptake of CETs worldwide. Together with a Monte Carlo simulation engine, the framework can be used to develop plausible ranges for benefits, taking into account the large uncertainty in the driving variables and economic parameters. The resulting estimates illustrate that larger global clean energy markets offer significant opportunities to the United States economy.

  15. Use of technological equipment in critical care units: nurses' perceptions in Greece.

    Science.gov (United States)

    Kiekkas, Panagiotis; Karga, Maria; Poulopoulou, Maria; Karpouhtsi, Irini; Papadoulas, Vasileios; Koutsojannis, Constantinos

    2006-02-01

    The aim of this study was to determine the perceptions of nurses who work in critical care units about positive and negative effects related to the use of technological equipment and identify relationships between these perceptions and demographic characteristics of participants. Previous researchers have investigated the perceptions of nursing personnel about the effects of technology on clinical practice. However, most of them focus on specific negative effects. Positive and negative effects have never been studied as a whole. Critical care nurses were surveyed to elicit their perceptions regarding the use of technological equipment. The instrument comprised a 14-item questionnaire and a series of demographic characteristics. A five-point Likert scale was used for each of these 14 questions. The questionnaire was administered to 122 nurses working at the four critical care units of a major academic hospital in Patras, Greece, from 1/10/2003 to 31/12/2003. The completion of the questionnaires was achieved by means of a personal interview. A total of 118 questionnaires were completed. The majority of nurses recognized the positive effects of equipment regarding patient care and clinical practice. At the same time, they agreed that use of equipment possibly leads to increased risk due to human errors or mechanical faults, increased stress and restricted autonomy of nursing personnel. The use of machines does not add to nursing prestige and this may be related to decreased autonomy. Human errors, mechanical faults and increased stress do not seem to come as a result of time constriction but rather of inadequate education. Undergraduate and continuing education should respond efficiently to the needs of contemporary critical care. Recognition of positive and negative effects of machines through the investigation of perceptions of nurses is the first step before looking for ways of maximizing advantages and facing disadvantages of equipment use.

  16. Implementation of smart pump technology in a paediatric intensive care unit.

    Science.gov (United States)

    Manrique-Rodríguez, Silvia; Sánchez-Galindo, Amelia C; de Lorenzo-Pinto, Ana; González-Vives, Leticia; López-Herce, Jesús; Carrillo-Álvarez, Ángel; Sanjurjo-Sáez, María; Fernández-Llamazares, Cecilia M

    2015-09-01

    Patient safety is a matter of major concern that involves every health professional. Nowadays, emerging technologies such as smart pumps can diminish medication errors as well as standardise and improve clinical practice with the subsequent benefits for patients. The aim of this paper was to describe the smart pump implementation process in a paediatric intensive care unit (PICU) and to present the most relevant infusion-related programming errors that were prevented. This was a comparative study between CareFusion Alaris Guardrails(®) and Hospira MedNet(®) systems, as well as a prospective and intervention study with analytical components carried out in the PICU of Gregorio Marañón General and Teaching Hospital. All intravenous infusions programmed with a pump in the eleven beds of the unit were analyzed. A drug library was developed and subsequently loaded into CareFusion and Hospira pumps that were used during a three month period each. The most suitable system for implementation was selected according to their differences in features and users' acceptance. Data stored in the pumps were analyzed to assess user compliance with the technology, health care setting and type of errors intercepted. The implementation process was carried out with CareFusion systems. Compliance with the technology was 92% and user acceptance was high. Vacation substitution and drug administration periods were significantly associated with a greater number of infusion-related programming errors. High risk drugs were involved in 48% of intercepted errors. Based on these results we can conclude that implementation of smart pumps proved effective in intercepting infusion-related programming errors from reaching patients. User awareness of the importance of programming infusions with the drug library is the key to succeed in the implementation process. © The Author(s) 2013.

  17. [Surveying the status of continuous blood purification technology application in Chinese pediatric intensive care unit].

    Science.gov (United States)

    Li, Leilei; Lu, Guoping

    2014-03-01

    To learn application status of continuous blood purification (CBP) in pediatric intensive care unit (PICU), to provide reference to promote the development of CBP technology. The survey of CBP application was conducted using questionnaire in 40 hospitals providing intensive care, which included children's hospitals and the pediatric sections of general hospitals from 28 provinces/municipalities/autonomous regions in China during March to July of 2012. Totally 38 hospital replied, 25 hospitals carried out CBP technology, first carried out in 1997, the median year was 2008, 21 hospitals' PICU could independently carry out CBP device, 18 hospitals had the nurses who could professionally operate, routinely maintain the device. Continuous veno-venous hemodiafiltration was the largest implementation mode of CBP, accounting for 51.9%. Twenty-three hospitals used ordinary heparin, and 2 hospitals used low molecular weight heparin; 21 hospitals chose activated partial thromboplastin time as the coagulation testing, due to lack of equipment, only four hospitals chose activated clotting time as coagulation testing. Only 3 hospitals could apply before and after dilution joint technology. Kidney failure is still the disease accounting for the highest proportion of diseases requiring CBP application, accounting for 38.1%, followed by sepsis, 19.1%, drug poisoning 16.7%. CBP started 10 years ago, and got attention and promotion nearly five years ago in China, but the associated personnel, equipment were inadequate, anticoagulation, before and after dilution and other technical applications were not complete enough, high volume hemofiltration mode was seldom used.

  18. Early Rehabilitation in the Medical and Surgical Intensive Care Units for Patients With and Without Mechanical Ventilation: An Interprofessional Performance Improvement Project.

    Science.gov (United States)

    Corcoran, John R; Herbsman, Jodi M; Bushnik, Tamara; Van Lew, Steve; Stolfi, Angela; Parkin, Kate; McKenzie, Alison; Hall, Geoffrey W; Joseph, Waveney; Whiteson, Jonathan; Flanagan, Steven R

    2017-02-01

    Most early mobility studies focus on patients on mechanical ventilation and the role of physical and occupational therapy. This Performance Improvement Project (PIP) project examined early mobility and increased intensity of therapy services on patients in the intensive care unit (ICU) with and without mechanical ventilation. In addition, speech-language pathology rehabilitation was added to the early mobilization program. We sought to assess the efficacy of early mobilization of patients with and without mechanical ventilation in the ICU on length of stay (LOS) and patient outcomes and to determine the financial viability of the program. PIP. Prospective data collection in 2014 (PIP) compared with a historical patient population in 2012 (pre-PIP). Medical and surgical ICUs of a Level 2 trauma hospital. There were 160 patients in the PIP and 123 in the pre-PIP. Interprofessional training to improve collaboration and increase intensity of rehabilitation therapy services in the medical and surgical intensive care units for medically appropriate patients. Demographics; intensity of service; ICU and hospital LOS; medications; pain; discharge disposition; functional mobility; and average cost per day were examined. Rehabilitation therapy services increased from 2012 to 2014 by approximately 60 minutes per patient. The average ICU LOS decreased by almost 20% from 4.6 days (pre-PIP) to 3.7 days (PIP) (P = .05). A decrease of over 40% was observed in the floor bed average LOS from 6.0 days (pre-PIP) to 3.4 days (PIP) (P ICU and floor bed decreased in the PIP group, resulting in an annualized net cost savings of $1.5 million. The results of the PIP indicate that enhanced rehabilitation services in the ICU is clinically feasible, results in improved patient outcomes, and is fiscally sound. Most early mobility studies focus on patients on mechanical ventilation. The results of this PIP project demonstrate that there are significant benefits to early mobility and increased

  19. Beyond Volume: Hospital-Based Healthcare Technology for Better Outcomes in Cerebrovascular Surgical Patients Diagnosed With Ischemic Stroke: A Population-Based Nationwide Cohort Study From 2002 to 2013.

    Science.gov (United States)

    Kim, Jae-Hyun; Park, Eun-Cheol; Lee, Sang Gyu; Lee, Tae-Hyun; Jang, Sung-In

    2016-03-01

    We examined whether the level of hospital-based healthcare technology was related to the 30-day postoperative mortality rates, after adjusting for hospital volume, of ischemic stroke patients who underwent a cerebrovascular surgical procedure. Using the National Health Insurance Service-Cohort Sample Database, we reviewed records from 2002 to 2013 for data on patients with ischemic stroke who underwent cerebrovascular surgical procedures. Statistical analysis was performed using Cox proportional hazard models to test our hypothesis. A total of 798 subjects were included in our study. After adjusting for hospital volume of cerebrovascular surgical procedures as well as all for other potential confounders, the hazard ratio (HR) of 30-day mortality in low healthcare technology hospitals as compared to high healthcare technology hospitals was 2.583 (P technology hospitals with high volume as compared to high healthcare technology hospitals with high volume was the highest (10.014, P technology hospitals had the highest 30-day mortality rate, irrespective of hospital volume. Although results of our study provide scientific evidence for a hospital volume/30-day mortality rate relationship in ischemic stroke patients who underwent cerebrovascular surgical procedures, our results also suggest that the level of hospital-based healthcare technology is associated with mortality rates independent of hospital volume. Given these results, further research into what components of hospital-based healthcare technology significantly impact mortality is warranted.

  20. Analysis on blood stream infections in patients in surgical intensive care unit%SICU 患者血流感染危险因素分析

    Institute of Scientific and Technical Information of China (English)

    李楠; 任军红; 李双玲; 王东信

    2015-01-01

    OBJECTIVE To investigate the risk factors and prognosis of blood stream infections in surgical critically ill patients and simultaneously analyze the sources ,distribution and characteristics of drug resistance of the patho‐gens so as to guide clinical practice in anti‐infection therapy , especially in empirical anti‐infection therapy . METHODS The clinical data of 59 patients confirmed to have infections in surgical intensive care unit between 2007 and 2013 were collected .The risk factors of blood stream infections ,source ,distribution and characteristics of drug resistance of the pathogens ,and prognosis of the patients were analyzeds .The software Windows SPSS17 .0 was used for statistical analysis .RESULTS A total of 96 strains of pathogens were isolated from the 59 patients with blood stream infections .Gram‐positive bacteria ,gram‐negative bacteria and fungi accounted for 30 .20% (29 strains) ,47 .92% (46 strains) ,21 .88% (21 strains) respectively .Multidrug‐resistant bacteria accounted for 45 .83% (44 strains) of all bacteria .Staphylococcus aureus had 100 .00% resistance to linezolid ,K lebsiella pneu‐moniae and Pseudomonas aeruginosa had 100 .00% resistance to ampicillin .CONCLUSION Patients with blood stream infections in surgical intensive care unit had various risk factors with a variety of pathogens from different sources .Their prognosis was very poor .Enhanced monitoring and effective anti‐infection strategy should be a‐dopted .%目的:了解外科重症监护病房(S IC U )患者血流感染的危险因素、病原菌来源及分布、耐药特点、患者预后,为临床抗感染治疗尤其是经验性抗感染治疗提供指导。方法收集2007-2013年SICU确诊为血流感染的59例患者临床资料,对其感染的危险因素、病原菌来源及分布、耐药性及预后进行描述性研究,采用 Window s SPSS17.0进行统计分析。结果59例血流感染患者共检出病原菌96

  1. Different patterns of inappropriate antimicrobial use in surgical and medical units at a tertiary care hospital in Switzerland: a prevalence survey.

    Directory of Open Access Journals (Sweden)

    Alexia Cusini

    Full Text Available BACKGROUND: Unnecessary or inappropriate use of antimicrobials is associated with the emergence of antimicrobial resistance, drug toxicity, increased morbidity and health care costs. Antimicrobial use has been reported to be incorrect or not indicated in 9-64% of inpatients. We studied the quality of antimicrobial therapy and prophylaxis in hospitalized patients at a tertiary care hospital to plan interventions to improve the quality of antimicrobial prescription. METHODOLOGY/PRINCIPAL FINDINGS: Experienced infectious diseases (ID fellows performed audits of antimicrobial use at regular intervals among all patients--with or without antimicrobials--hospitalized in predefined surgical, medical, haemato-oncological, or intensive care units. Data were collected from medical and nursing patient charts with a standardized questionnaire. Appropriateness of antimicrobial use was evaluated using a modified algorithm developed by Gyssens et al.; the assessment was double-checked by a senior ID specialist. We evaluated 1577 patients of whom 700 (44.4% had antimicrobials, receiving a total of 1270 prescriptions. 958 (75.4% prescriptions were for therapy and 312 (24.6% for prophylaxis. 37.0% of therapeutic and 16.6% of prophylactic prescriptions were found to be inappropriate. Most frequent characteristics of inappropriate treatments included: No indication (17.5%; incorrect choice of antimicrobials (7.6%; incorrect application of drugs (9.3%; and divergence from institutional guidelines (8%. Characteristics of inappropriate prophylaxes were: No indication (9%; incorrect choice of antimicrobials (1%; duration too long or other inappropriate use (6.7%. Patterns of inappropriate antimicrobial varied widely in the different hospital units; empirical prescriptions were more frequently incorrect than prescriptions based on available microbiological results. CONCLUSIONS/SIGNIFICANCE: Audits of individual patient care provide important data to identify local

  2. Trial of universal gloving with emollient-impregnated gloves to promote skin health and prevent the transmission of multidrug-resistant organisms in a surgical intensive care unit.

    Science.gov (United States)

    Bearman, Gonzalo; Rosato, Adriana E; Duane, Therese M; Elam, Kara; Sanogo, Kakotan; Haner, Cheryl; Kazlova, Valentina; Edmond, Michael B

    2010-05-01

    To compare the efficacy of universal gloving with emollient-impregnated gloves with standard contact precautions for the control of multidrug-resistant organisms (MDROs) and to measure the effect on healthcare workers' (HCWs') hand skin health. Prospective before-after trial. An 18-bed surgical intensive care unit. During phase 1 (September 2007 through March 2008) standard contact precautions were used. During phase 2 (March 2008 through September 2008) universal gloving with emollient-impregnated gloves was used, and no contact precautions. Patients were screened for vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). HCW hand hygiene compliance and hand skin health and microbial contamination were assessed. The incidences of device-associated infection and Clostridium difficile infection (CDI) were determined. The rate of compliance with contact precautions (phase 1) was 67%, and the rate of compliance with universal gloving (phase 2) was 78% (P = .01). Hand hygiene compliance was higher during phase 2 than during phase 1 (before patient care, 40% vs 35% of encounters; P = .001; after patient care, 63% vs 51% of encounters; P emollient-impregnated gloves was associated with improved hand hygiene compliance and skin health. No statistically significant change in the rates of device-associated infection, CDI, or patient MDRO acquisition was observed. Universal gloving may be an alternative to contact precautions.

  3. Dual Comb Unit High-g Accelerometer Based on CMOS-MEMS Technology

    Directory of Open Access Journals (Sweden)

    Mehrdad Mottaghi

    2009-04-01

    Full Text Available In this paper a capacitive based high-g accelerometer with superior level of sensitivity is presented. It takes advantage of dual comb unit configuration and surface micromachining fabrication process. All aspects of mechanical design such as sensor structure, modal analysis, energy dissipations, dynamic response and stresses in moving structure as well as anchors are described. Electrical circuit based on CMOS technology and its output signal is presented. Fabrication process and packaging are also discussed. The proposed sensor can endure impact loads up to 120,000 g (g = 9.81 m.s-2 and achieves 16.75 µV.g-1 sensitivity with 5 V bridge excitation voltage. Main resonant frequency of structure is found to be 42.4 kHz. Intended applications of suggested sensor include military and aerospace industries as well as field of impact engineering.

  4. Payload influences on technology development and utilization of the Space Shuttle extravehicular mobility unit

    Science.gov (United States)

    Patrick, J. W.; Kraly, E. F.

    1976-01-01

    Historical EVA approaches are examined. The considered data emphasize the overall importance of EVA for Shuttle payload operations. Twenty requirement categories related to crew protection, crew performance, and payload protection are listed in a table. Attention is given to a preliminary assessment of payload related requirements, an evaluation of the natural thermal environment in the case of the Shuttle orbiter bay, and the ability of the extravehicular mobility unit (EMU) to protect the crewman from induced or natural radiation as found in the Van Allen radiation belt South Atlantic anomaly. On the basis of the evaluation it appears very likely that design improvements alone can make the EMU meet payload requirements without requiring significant technology advances.

  5. Multiscale Surgical Telerobots

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-01-23

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

  6. Surgical Navigation Technology Based on Augmented Reality and Integrated 3D Intraoperative Imaging: A Spine Cadaveric Feasibility and Accuracy Study.

    Science.gov (United States)

    Elmi-Terander, Adrian; Skulason, Halldor; Söderman, Michael; Racadio, John; Homan, Robert; Babic, Drazenko; van der Vaart, Nijs; Nachabe, Rami

    2016-11-01

    A cadaveric laboratory study. The aim of this study was to assess the feasibility and accuracy of thoracic pedicle screw placement using augmented reality surgical navigation (ARSN). Recent advances in spinal navigation have shown improved accuracy in lumbosacral pedicle screw placement but limited benefits in the thoracic spine. 3D intraoperative imaging and instrument navigation may allow improved accuracy in pedicle screw placement, without the use of x-ray fluoroscopy, and thus opens the route to image-guided minimally invasive therapy in the thoracic spine. ARSN encompasses a surgical table, a motorized flat detector C-arm with intraoperative 2D/3D capabilities, integrated optical cameras for augmented reality navigation, and noninvasive patient motion tracking. Two neurosurgeons placed 94 pedicle screws in the thoracic spine of four cadavers using ARSN on one side of the spine (47 screws) and free-hand technique on the contralateral side. X-ray fluoroscopy was not used for either technique. Four independent reviewers assessed the postoperative scans, using the Gertzbein grading. Morphometric measurements of the pedicles axial and sagittal widths and angles, as well as the vertebrae axial and sagittal rotations were performed to identify risk factors for breaches. ARSN was feasible and superior to free-hand technique with respect to overall accuracy (85% vs. 64%, P < 0.05), specifically significant increases of perfectly placed screws (51% vs. 30%, P < 0.05) and reductions in breaches beyond 4 mm (2% vs. 25%, P < 0.05). All morphometric dimensions, except for vertebral body axial rotation, were risk factors for larger breaches when performed with the free-hand method. ARSN without fluoroscopy was feasible and demonstrated higher accuracy than free-hand technique for thoracic pedicle screw placement. N/A.

  7. [An analysis of cost and profit of a nursing unit using performance-based costing: case of a general surgical ward in a general hospital].

    Science.gov (United States)

    Lim, Ji Young

    2008-02-01

    The aim of this study was to analyze net income of a surgical nursing ward in a general hospital. Data collection and analysis was conducted using a performance-based costing and activity-based costing method. Direct nursing activities in the surgical ward were 68, indirect nursing activities were 10. The total cost volume of the surgical ward was calculated at won 119,913,334.5. The cost volume of the allocated medical department was won 91,588,200.3, and the ward consumed cost was won 28,325,134.2. The revenue of the surgical nursing ward was won 33,269,925.0. The expense of a surgical nursing ward was 28,325,134.2. Therefore, the net income of a surgical nursing ward was won 4,944,790.8. We suggest that to develop a more refined nursing cost calculation model, a standard nursing cost calculation system needs to be developed.

  8. Integrating Smartphone Technology at the Time of Discharge from a Child and Adolescent Inpatient Psychiatry Unit.

    Science.gov (United States)

    Gregory, Jonathan M; Sukhera, Javeed; Taylor-Gates, Melissa

    2017-01-01

    As smartphone technology becomes an increasingly important part of youth mental health, there has been little to no examination of how to effectively integrate smartphone-based safety planning with inpatient care. Our study sought to examine whether or not we could effectively integrate smartphone-based safety planning into the discharge process on a child and adolescent inpatient psychiatry unit. Staff members completed a survey to determine the extent of smartphone ownership in a population of admitted child and adolescent inpatients. In addition to quantifying smartphone ownership, the survey also tracked whether youth would integrate their previously-established safety plan with a specific safety planning application on their smartphone (Be Safe) at the time of discharge. Sixty-six percent (50/76) of discharged youth owned a smartphone, which is consistent with prior reports of high smartphone ownership in adult psychiatric populations. A minority of youth (18%) downloaded the Be Safe app prior to discharge, with most (68%) suggesting they would download the app after discharge. Notably, all patients who downloaded the app prior to discharge were on their first admission to a psychiatric inpatient unit. Child and adolescent psychiatric inpatients have a clear interest in smartphone-based safety planning. Our results suggest that integrating smartphone-related interventions earlier in an admission might improve access before discharge. This highlights the tension between restricting and incorporating smartphone access for child and adolescent inpatients and may inform future study in this area.

  9. Cold-end Subsystem Testing for the Fission Power System Technology Demonstration Unit

    Science.gov (United States)

    Briggs, Maxwell; Gibson, Marc; Ellis, David; Sanzi, James

    2013-01-01

    The Fission Power System (FPS) Technology Demonstration Unit (TDU) consists of a pumped sodium-potassium (NaK) loop that provides heat to a Stirling Power Conversion Unit (PCU), which converts some of that heat into electricity and rejects the waste heat to a pumped water loop. Each of the TDU subsystems is being tested independently prior to full system testing at the NASA Glenn Research Center. The pumped NaK loop is being tested at NASA Marshall Space Flight Center; the Stirling PCU and electrical controller are being tested by Sunpower Inc.; and the pumped water loop is being tested at Glenn. This paper describes cold-end subsystem setup and testing at Glenn. The TDU cold end has been assembled in Vacuum Facility 6 (VF 6) at Glenn, the same chamber that will be used for TDU testing. Cold-end testing in VF 6 will demonstrate functionality; validated cold-end fill, drain, and emergency backup systems; and generated pump performance and system pressure drop data used to validate models. In addition, a low-cost proof-of concept radiator has been built and tested at Glenn, validating the design and demonstrating the feasibility of using low-cost metal radiators as an alternative to high-cost composite radiators in an end-to-end TDU test.

  10. Testing of an Annular Linear Induction Pump for the Fission Surface Power Technology Demonstration Unit

    Science.gov (United States)

    Polzin, K. A.; Pearson, J. B.; Webster, K.; Godfoy, T. J.; Bossard, J. A.

    2013-01-01

    Results of performance testing of an annular linear induction pump that has been designed for integration into a fission surface power technology demonstration unit are presented. The pump electromagnetically pushes liquid metal (NaK) through a specially-designed apparatus that permits quantification of pump performance over a range of operating conditions. Testing was conducted for frequencies of 40, 55, and 70 Hz, liquid metal temperatures of 125, 325, and 525 C, and input voltages from 30 to 120 V. Pump performance spanned a range of flow rates from roughly 0.3 to 3.1 L/s (4.8 to 49 gpm), and pressure heads of <1 to 104 kPa (<0.15 to 15 psi). The maximum efficiency measured during testing was 5.4%. At the technology demonstration unit operating temperature of 525 C the pump operated over a narrower envelope, with flow rates from 0.3 to 2.75 L/s (4.8 to 43.6 gpm), developed pressure heads from <1 to 55 kPa (<0.15 to 8 psi), and a maximum efficiency of 3.5%. The pump was supplied with three-phase power at 40 and 55 Hz using a variable-frequency motor drive, while power at 55 and 70 Hz was supplied using a variable-frequency power supply. Measured performance of the pump at 55 Hz using either supply exhibited good quantitative agreement. For a given temperature, the peak in efficiency occurred at different flow rates as the frequency was changed, but the maximum value of efficiency was relative insensitive within 0.3% over the frequency range tested, including a scan from 45 to 78 Hz. The objectives of the FSP technology project are as follows:5 • Develop FSP concepts that meet expected surface power requirements at reasonable cost with added benefits over other options. • Establish a nonnuclear hardware-based technical foundation for FSP design concepts to reduce overall development risk. • Reduce the cost uncertainties for FSP and establish greater credibility for flight system cost estimates. • Generate the key nonnuclear products to allow Agency

  11. Industrial Sector Technology Use Model (ISTUM): industrial energy use in the United States, 1974-2000. Volume 4. Technology appendix

    Energy Technology Data Exchange (ETDEWEB)

    1978-06-19

    This volume of the 4-volume ISTUM documentation gives information on the individual technology specifications. The first chapter presents a general overview of the ISTUM technology data bases. It includes an explanation of the data-base printouts and how the separate-cost building blocks are combined to derive an aggregate-technology cost. The remaining chapters document the specific-technology-cost specifications. Boiler technologies (conventional coal steam, conventional natural gas and oil in the steam-service sector, black liquor and wood boilers, and space-heat service sector) and non-boiler conventional technologies (natural gas non-boiler, oil-fired non-boiler, coal-fired non-boiler technologies and non-boiler primary system costs) are covered in Chapter II. Chapter III, Fossil Energy Technologies, covers atmospheric fluidized-bed combustion, low-Btu gasification of coal, and medium-Btu gasification. Chapter IV, Cogeneration and Self-Generation Technologies, covers the steam service sector, machine-drive service sector, and electrolytic service sector. Solar and geothermal technologies (solar steam, solar space heat, and geothermal steam technologies) are covered in Chapter V, while Chapter VI covers conservation technologies. (MCW)

  12. Report to the United States Congress clean coal technology export markets and financing mechanisms

    Energy Technology Data Exchange (ETDEWEB)

    1994-05-01

    This report responds to a Congressional Conference Report that requests that $625,000 in funding provided will be used by the Department to identify potential markets for clean coal technologies in developing countries and countries with economies in transition from nonmarket economies and to identify existing, or new, financial mechanisms or financial support to be provided by the Federal government that will enhance the ability of US industry to participate in these markets. The Energy Information Administration (EIA) expects world coal consumption to increase by 30 percent between 1990 and 2010, from 5.1 to 6.5 billion short tons. Five regions stand out as major foreign markets for the export of US clean coal technologies: China; The Pacific Rim (other than China); South Asia (primarily India); Transitional Economies (Central Europe and the Newly Independent States); and Other Markets (the Americas and Southern Africa). Nearly two-thirds of the expected worldwide growth in coal utilization will occur in China, one quarter in the United States. EIA forecasts nearly a billion tons per year of additional coal consumption in China between 1990 and 2010, a virtual doubling of that country`s coal consumption. A 30-percent increase in coal consumption is projected in other developing countries over that same period. This increase in coal consumption will be accompanied by an increase in demand for technologies for burning coal cost-effectively, efficiently and cleanly. In the Pacific Rim and South Asia, rapid economic growth coupled with substantial indigenous coal supplies combine to create a large potential market for CCTS. In Central Europe and the Newly Independent States, the challenge will be to correct the damage of decades of environmental neglect without adding to already-considerable economic disruption. Though the situation varies, all these countries share the basic need to use indigenous low-quality coal cleanly and efficiently.

  13. Evaluation of adjusted central venous blood gases versus arterial blood gases of patients in post-operative paediatric cardiac surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Naveen G Singh

    2015-01-01

    Full Text Available Background and Aims: Central venous catheters are in situ in most of the intensive care unit (ICU patients, which may be an alternative for determining acid-base status and can reduce complications from prolonged arterial cannulation. The aim of this study was to examine the reliability between adjusted central venous blood gas (aVBG and arterial blood gas (ABG samples for pH, partial pressure of carbon-di-oxide (pCO2, bicarbonate (HCO3−, base excess (BE and lactates in paediatric cardiac surgical ICU. Methods: We applied blood gas adjustment rule, that is aVBG pH = venous blood gas (VBG pH +0.05, aVBG CO2 = VBG pCO2 - 5 mm Hg from the prior studies. In this study, we validated this relationship with simultaneous arterial and central venous blood obtained from 30 patients with four blood sample pairs each in paediatric cardiac surgical ICU patients. Results: There was a strong correlation (R i.e., Pearson's correlation between ABG and aVBG for pH = 0.9544, pCO2 = 0.8738, lactate = 0.9741, HCO3− = 0.9650 and BE = 0.9778. Intraclass correlation co-efficients (ICCs for agreement improved after applying the adjustment rule to venous pH (0.7505 to 0.9454 and pCO2 (0.4354 to 0.741. Bland Altman showed bias (and limits of agreement for pH: 0.008 (−0.04 to + 0.057, pCO2: −3.52 (–9.68 to +2.65, lactate: −0.10 (−0.51 to +0.30, HCO3−: −2.3 (–5.11 to +0.50 and BE: −0.80 (−3.09 to +1.49. Conclusion: ABG and aVBG samples showed strong correlation, acceptable mean differences and improved agreement (high ICC after adjusting the VBG. Hence, it can be promising to use trend values of VBG instead of ABG in conjunction with a correction factor under stable haemodynamic conditions.

  14. Characterization of a clinical unit for digital radiography based on irradiation side sampling technology

    Energy Technology Data Exchange (ETDEWEB)

    Rivetti, Stefano [Fisica Medica, Ospedale di Sassuolo S.p.A., 41049 Sassuolo (Italy); Lanconelli, Nico [Alma Mater Studiorum, Physics Department, University of Bologna, 40127 Bologna (Italy); Bertolini, Marco; Nitrosi, Andrea [Medical Physics Unit, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, 42123 Reggio Emilia (Italy); Burani, Aldo [Ospedale di Sassuolo S.p.A., 41049 Sassuolo (Italy)

    2013-10-15

    Purpose: A characterization of a clinical unit for digital radiography (FUJIFILM FDR D-EVO) is presented. This system is based on the irradiation side sampling (ISS) technology and can be equipped with two different scintillators: one traditional gadolinium-oxysulphide phosphor (GOS) and a needle structured cesium iodide (CsI) phosphor panel.Methods: The characterization was achieved in terms of response curve, modulation transfer function (MTF), noise power spectra (NPS), detective quantum efficiency (DQE), and psychophysical parameters (contrast-detail analysis with an automatic reading of CDRAD images). For both scintillation screens the authors accomplished the measurements with four standard beam conditions: RAQ3, RQA5, RQA7, and RQA9.Results: At the Nyquist frequency (3.33 lp/mm) the MTF is about 35% and 25% for CsI and GOS detectors, respectively. The CsI scintillator has better noise properties than the GOS screen in almost all the conditions. This is particularly true for low-energy beams, where the noise for the GOS system can go up to a factor 2 greater than that found for CsI. The DQE of the CsI detector reaches a peak of 60%, 60%, 58%, and 50% for the RQA3, RQA5, RQA7, and RQA9 beams, respectively, whereas for the GOS screen the maximum DQE is 40%, 44%, 44%, and 35%. The contrast-detail analysis confirms that in the majority of cases the CsI scintillator is able to provide improved outcomes to those obtained with the GOS screen.Conclusions: The limited diffusion of light produced by the ISS reading makes possible the achievement of very good spatial resolution. In fact, the MTF of the unit with the CsI panel is only slightly lower to that achieved with direct conversion detectors. The combination of very good spatial resolution, together with the good noise properties reached with the CsI screen, allows achieving DQE on average about 1.5 times greater than that obtained with GOS. In fact, the DQE of unit equipped with CsI is comparable to the best

  15. Commercial Application of RMC Technology in the 1.5 Mt/a Hydrocracking Unit at Shanghai Petrochemical Company

    Institute of Scientific and Technical Information of China (English)

    Xiong Zhenlin; Wang Yiguan; Zhang Maoying; Lin Baohua; Mao Yichao

    2003-01-01

    The RMC technology developed by RIPP has been applied in a 1.5 Mt/a medium pressure hydrocracking unit at Shanghai Petrochemical Company. The unit was successfully put on stream in September 2002. Calibration of the performance of the commercial unit has shown that the RMC technology has higher hydrogenation activity and selectivity, and high quality product can be obtained under lower reaction temperature. The heavy naphtha with less than 0.5 ppm of sulfur and 58.5 m% potential aromatic content is a good feedstock for catalytic reforming unit. The diesel with less than 0.5 ppm of sulfur, 6.6 m% aromatics and cetane rating of 56 is a high-grade diesel fuel. The hydrocracked tail oil containing more than 14 m% hydrogen and mere 1.7m% aromatics could be used as a good feedstock for steam cracking process to produce ethylene.

  16. Development of an Educational Game to Set Up Surgical Instruments on the Mayo Stand or Back Table: Applied Research in Production Technology.

    Science.gov (United States)

    Paim, Crislaine Pires Padilha; Goldmeier, Silvia

    2017-01-10

    Existing research suggests that digital games can be used effectively for educational purposes at any level of training. Perioperative nursing educators can use games to complement curricula, in guidance and staff development programs, to foster team collaboration, and to give support to critical thinking in nursing practice because it is a complex environment. To describe the process of developing an educational game to set up surgical instruments on the Mayo stand or back table as a resource to assist the instructor in surgical instrumentation training for students and nursing health professionals in continued education. The study was characterized by applied research in production technology. It included the phases of analysis and design, development, and evaluation. The objectives of the educational game were developed through Bloom's taxonomy. Parallel to the physical development of the educational game, a proposed model for the use of digital elements in educational game activities was applied to develop the game content. The development of the game called "Playing with Tweezers" was carried out in 3 phases and was evaluated by 15 participants, comprising students and professional experts in various areas of knowledge such as nursing, information technology, and education. An environment was created with an initial screen, menu buttons containing the rules of the game, and virtual tour modes for learning and assessment. The "digital" nursing student needs engagement, stimulation, reality, and entertainment, not just readings. "Playing with Tweezers" is an example of educational gaming as an innovative teaching strategy in nursing that encourages the strategy of involving the use of educational games to support theoretical or practical classroom teaching. Thus, the teacher does not work with only 1 type of teaching methodology, but with a combination of different methodologies. In addition, we cannot forget that skill training in an educational game does not

  17. Development of an Educational Game to Set Up Surgical Instruments on the Mayo Stand or Back Table: Applied Research in Production Technology

    Science.gov (United States)

    2017-01-01

    Background Existing research suggests that digital games can be used effectively for educational purposes at any level of training. Perioperative nursing educators can use games to complement curricula, in guidance and staff development programs, to foster team collaboration, and to give support to critical thinking in nursing practice because it is a complex environment. Objective To describe the process of developing an educational game to set up surgical instruments on the Mayo stand or back table as a resource to assist the instructor in surgical instrumentation training for students and nursing health professionals in continued education. Methods The study was characterized by applied research in production technology. It included the phases of analysis and design, development, and evaluation. The objectives of the educational game were developed through Bloom’s taxonomy. Parallel to the physical development of the educational game, a proposed model for the use of digital elements in educational game activities was applied to develop the game content. Results The development of the game called “Playing with Tweezers” was carried out in 3 phases and was evaluated by 15 participants, comprising students and professional experts in various areas of knowledge such as nursing, information technology, and education. An environment was created with an initial screen, menu buttons containing the rules of the game, and virtual tour modes for learning and assessment. Conclusions The “digital” nursing student needs engagement, stimulation, reality, and entertainment, not just readings. “Playing with Tweezers” is an example of educational gaming as an innovative teaching strategy in nursing that encourages the strategy of involving the use of educational games to support theoretical or practical classroom teaching. Thus, the teacher does not work with only 1 type of teaching methodology, but with a combination of different methodologies. In addition, we

  18. Can Sarcopenia Quantified by Ultrasound of the Rectus Femoris Muscle Predict Adverse Outcome of Surgical Intensive Care Unit Patients as well as Frailty? A Prospective, Observational Cohort Study.

    Science.gov (United States)

    Mueller, Noomi; Murthy, Sushila; Tainter, Christopher R; Lee, Jarone; Riddell, Kathleen; Fintelmann, Florian J; Grabitz, Stephanie D; Timm, Fanny P; Levi, Benjamin; Kurth, Tobias; Eikermann, Matthias

    2016-12-01

    To compare sarcopenia and frailty for outcome prediction in surgical intensive care unit (SICU) patients. Frailty has been associated with adverse outcomes and describes a status of muscle weakness and decreased physiological reserve leading to increased vulnerability to stressors. However, frailty assessment depends on patient cooperation. Sarcopenia can be quantified by ultrasound and the predictive value of sarcopenia at SICU admission for adverse outcome has not been defined. We conducted a prospective, observational study of SICU patients. Sarcopenia was diagnosed by ultrasound measurement of rectus femoris cross-sectional area. Frailty was diagnosed by the Frailty Index Questionnaire based on 50 variables. Relationship between variables and outcomes was assessed by multivariable regression analysis NCT02270502. Sarcopenia and frailty were quantified in 102 patients and observed in 43.1% and 38.2%, respectively. Sarcopenia predicted adverse discharge disposition (discharge to nursing facility or in-hospital mortality, odds ratio 7.49; 95% confidence interval 1.47-38.24; P = 0.015) independent of important clinical covariates, as did frailty (odds ratio 8.01; 95% confidence interval 1.82-35.27; P = 0.006); predictive ability did not differ between sarcopenia and frailty prediction model, reflected by χ values of 21.74 versus 23.44, respectively, and a net reclassification improvement (NRI) of -0.02 (P = 0.87). Sarcopenia and frailty predicted hospital length of stay and the frailty model had a moderately better predictive accuracy for this outcome. Bedside diagnosis of sarcopenia by ultrasound predicts adverse discharge disposition in SICU patients equally well as frailty. Sarcopenia assessed by ultrasound may be utilized as rapid beside modality for risk stratification of critically ill patients.

  19. Levelised unit electricity cost comparison of alternate technologies for baseload generation in Ontario

    Energy Technology Data Exchange (ETDEWEB)

    Ayres, M.; McRae, M.; Stogran, M.

    2004-08-15

    This report provides a comparison of the lifetime cost of constructing, operating and decommissioning new generation suitable for supplying baseload power by early in the next decade. New baseload generation options in Ontario are nuclear, coal-fired steam turbines or combined cycle gas turbines (CCGT). Nuclear and coal-fired units are characterised by high capital costs and low operating costs. As such, they are candidates for baseload operation only. Gas-fired generation is characterised by lower capital costs and higher operating costs and thus may meet the requirements for operation as peaking and/or baseload generation. The comparison of baseload generating technologies is made by reference to the estimated levelised unit electricity cost (LUEC). The LUEC can be thought of as a 'supply cost', where the unit cost is the price needed to recover all costs over the period. It is determined by finding the price that sets the sum of all future discounted cash flows (net present value, or NPV) to zero. It can also be thought of as representing the constant real wholesale price of electricity that meets the financing cost, debt repayment, income tax and cash flow constraints associated with the construction operation and decommissioning of a generating plant. Levelised unit cost comparisons are usually made with different sets of financing assumptions. This report considers two base cases, which we describe as 'merchant' and 'public' financing. The term 'merchant plant' is used to refer to ones that are built and operated by private investors. These investors pay for their capital through debt and by raising equity, and thus pay return on equity and interest on debt throughout their lifetime. These projects include income taxes, both provincial and federal. Publicly financed projects typically are not subject to income taxes or to the same constraints on raising finance through issuing debt and equity. However, they are

  20. The Lawrence D. Dorr Surgical Techniques & Technologies Award: Differences in Postoperative Outcomes Between Total Hip Arthroplasty for Fracture vs Osteoarthritis.

    Science.gov (United States)

    Qin, Charles D; Helfrich, Mia M; Fitz, David W; Hardt, Kevin D; Beal, Matthew D; Manning, David W

    2017-09-01

    Hip fracture is an increasingly common expanded indication for total hip arthroplasty (THA) and warrants outcome analysis so as to best inform risk assessment models, public reporting of outcome, and value-based reimbursement schemes. The National Surgical Quality Improvement Program data file from 2011 to 2014 was used to identify all patients undergoing THA via current procedural terminology code 27130. Propensity score matching in a 1:5 fashion was used to compare 2 cohorts: THA for osteoarthritis and THA for fracture. Primary outcomes included Centers for Medicare and Medicaid Services (CMS) reportable complications, unplanned readmission, postsurgical length of stay, and discharge destination. χ(2) tests for categorical variables and Student t test for continuous variables were used to compare the 2 cohorts and adjusted linear regression analysis used to determine the association between hip fracture and THA outcomes of interest. A total of 58,302 patients underwent elective THA for osteoarthritis and 1580 patients underwent THA for hip fracture. Rates of CMS-reported complications (4.0% vs 10.7%; P < .001), non-homebound discharge (39.8% vs 64.7%; P < .001), readmission (4.7% vs 8.0%; P < .001), and mean days of postsurgical hospital stay (3.2 vs 4.4; P < .001) were greater in the hip fracture cohort. THA for hip fracture was significantly associated with increased risk of CMS-reportable complications (odds ratio [OR], 2.67; 95% confidence interval [CI], 2.17-3.28), non-homebound discharge (OR, 1.73; 95% CI, 1.39-2.15), and readmission (OR, 2.78; 95% CI, 2.46-3.12). Our findings support recent advocacy for the exclusion of THA for fracture from THA bundled pricing methodology and public reporting of outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Augmented reality telementoring (ART) platform: a randomized controlled trial to assess the efficacy of a new surgical education technology.

    Science.gov (United States)

    Vera, Angelina M; Russo, Michael; Mohsin, Adnan; Tsuda, Shawn

    2014-12-01

    Laparoscopic skills training has evolved over recent years. However, conveying a mentor's directions using conventional methods, without realistic on-screen visual cues, can be difficult and confusing. To facilitate laparoscopic skill transference, an augmented reality telementoring (ART) platform was designed to overlay the instruments of a mentor onto the trainee's laparoscopic monitor. The aim of this study was to compare the effectiveness of this new teaching modality to traditional methods in novices performing an intracorporeal suturing task. Nineteen pre-medical and medical students were randomized into traditional mentoring (n = 9) and ART (n = 10) groups for a laparoscopic suturing and knot-tying task. Subjects received either traditional mentoring or ART for 1 h on the validated fundamentals of laparoscopic surgery intracorporeal suturing task. Tasks for suturing were recorded and scored for time and errors. Results were analyzed using means, standard deviation, power regression analysis, correlation coefficient, analysis of variance, and student's t test. Using Wright's cumulative average model (Y = aX (b)) the learning curve slope was significantly steeper, demonstrating faster skill acquisition, for the ART group (b = -0.567, r (2) = 0.92) than the control group (b = -0.453, r (2) = 0.74). At the end of 10 repetitions or 1 h of practice, the ART group was faster versus traditional (mean 167.4 vs. 242.4 s, p = 0.014). The ART group also had fewer fails (8) than the traditional group (13). The ART Platform may be a more effective training technique in teaching laparoscopic skills to novices compared to traditional methods. ART conferred a shorter learning curve, which was more pronounced in the first 4 trials. ART reduced the number of failed attempts and resulted in faster suture times by the end of the training session. ART may be a more effective training tool in laparoscopic surgical training for complex tasks than traditional methods.

  2. Cyclone Boiler Field Testing of Advanced Layered NOx Control Technology in Sioux Unit 1

    Energy Technology Data Exchange (ETDEWEB)

    Marc A. Cremer; Bradley R. Adams

    2006-06-30

    A four week testing program was completed during this project to assess the ability of the combination of deep staging, Rich Reagent Injection (RRI), and Selective Non-Catalytic Reduction (SNCR) to reduce NOx emissions below 0.15 lb/MBtu in a cyclone fired boiler. The host site for the tests was AmerenUE's Sioux Unit 1, a 500 MW cyclone fired boiler located near St. Louis, MO. Reaction Engineering International (REI) led the project team including AmerenUE, FuelTech Inc., and the Electric Power Research Institute (EPRI). This layered approach to NOx reduction is termed the Advanced Layered Technology Approach (ALTA). Installed RRI and SNCR port locations were guided by computational fluid dynamics (CFD) based modeling conducted by REI. During the parametric testing, NOx emissions of 0.12 lb/MBtu were achieved consistently from overfire air (OFA)-only baseline NOx emissions of 0.25 lb/MBtu or less, when firing the typical 80/20 fuel blend of Powder River Basin (PRB) and Illinois No.6 coals. From OFA-only baseline levels of 0.20 lb/MBtu, NOx emissions of 0.12 lb/MBtu were also achieved, but at significantly reduced urea flow rates. Under the deeply staged conditions that were tested, RRI performance was observed to degrade as higher blends of Illinois No.6 were used. NOx emissions achieved with ALTA while firing a 60/40 blend were approximately 0.15 lb/MBtu. NOx emissions while firing 100% Illinois No.6 were approximately 0.165 lb/MBtu. Based on the performance results of these tests, economics analyses of the application of ALTA to a nominal 500 MW cyclone unit show that the levelized cost to achieve 0.15 lb/MBtu is well below 75% of the cost of a state of the art SCR.

  3. Design of Heat Exchanger Network for VCM Distillation Unit Using Pinch Technology

    Directory of Open Access Journals (Sweden)

    VISHAL G. BOKAN

    2015-06-01

    Full Text Available In process industries, heat exchanger networks represent an important part of the plant structure. The purpose of the networks is to maximize heat recovery, thereby lowering the overall plant costs. In process industries, during operation of any heat exchanger network (HEN, the major aim is to focus on the best performance of the network As in present condition of fuel crises is one of the major problem faced by many country & industrial utility is majorly depend on this. There is technique called process integration which is used for integrate heat within loop so optimize the given process and minimize the heating load and cooling load .In the present study of heat integration on VCM (vinyl chloride monomer distillation unit, Heat exchanger network (HEN is designed by using Aspen energy analyzer V8.0 software. This software implements a methodology for HEN synthesis with the use of pinch technology. Several heat integration networks are designed with different ΔT min and total annualized cost compared to obtain the optimal design. The network with a ΔT min of 90C is the most optimal where the largest energy savings are obtained with the appropriate use of utilities (Save 15.3764% for hot utilities and 47.52% for cold utilities compared with the current plant configuration. Percentage reduction in total operating cost is 18.333%. From calculation Payback Period for new design is 3.15 year. This save could be done through a plant revamp, with the addition of two heat exchangers. This improvement are done in the process associated with this technique are not due to the use of advance unit operation, but to the generation of heat integration scheme. The Pinch Design Method can be employed to give good designs in rapid time and with minimum data.

  4. Assessing the level of healthcare information technology adoption in the United States: a snapshot

    Directory of Open Access Journals (Sweden)

    Middleton Blackford

    2006-01-01

    Full Text Available Abstract Background Comprehensive knowledge about the level of healthcare information technology (HIT adoption in the United States remains limited. We therefore performed a baseline assessment to address this knowledge gap. Methods We segmented HIT into eight major stakeholder groups and identified major functionalities that should ideally exist for each, focusing on applications most likely to improve patient safety, quality of care and organizational efficiency. We then conducted a multi-site qualitative study in Boston and Denver by interviewing key informants from each stakeholder group. Interview transcripts were analyzed to assess the level of adoption and to document the major barriers to further adoption. Findings for Boston and Denver were then presented to an expert panel, which was then asked to estimate the national level of adoption using the modified Delphi approach. We measured adoption level in Boston and Denver was graded on Rogers' technology adoption curve by co-investigators. National estimates from our expert panel were expressed as percentages. Results Adoption of functionalities with financial benefits far exceeds adoption of those with safety and quality benefits. Despite growing interest to adopt HIT to improve safety and quality, adoption remains limited, especially in the area of ambulatory electronic health records and physician-patient communication. Organizations, particularly physicians' practices, face enormous financial challenges in adopting HIT, and concerns remain about its impact on productivity. Conclusion Adoption of HIT is limited and will likely remain slow unless significant financial resources are made available. Policy changes, such as financial incentivesto clinicians to use HIT or pay-for-performance reimbursement, may help health care providers defray upfront investment costs and initial productivity loss.

  5. Survey of information technology in Intensive Care Units in Ontario, Canada

    Directory of Open Access Journals (Sweden)

    Hallett David

    2008-01-01

    Full Text Available Abstract Background The Intensive Care Unit (ICU is a data-rich environment where information technology (IT may enhance patient care. We surveyed ICUs in the province of Ontario, Canada, to determine the availability, implementation and variability of information systems. Methods A self-administered internet-based survey was completed by ICU directors between May and October 2006. We measured the spectrum of ICU clinical data accessible electronically, the availability of decision support tools, the availability of electronic imaging systems for radiology, the use of electronic order entry and medication administration systems, and the availability of hardware and wireless or mobile systems. We used Fisher's Exact tests to compare IT availability and Classification and Regression Trees (CART to estimate the optimal cut-point for the number of computers per ICU bed. Results We obtained responses from 50 hospitals (68.5% of institutions with level 3 ICUs, of which 21 (42% were university-affiliated. The majority electronically accessed laboratory data and imaging reports (92% and used picture archiving and communication systems (PACS (76%. Other computing functions were less prevalent (medication administration records 46%, physician or nursing notes 26%; medication order entry 22%. No association was noted between IT availability and ICU size or university affiliation. Sites used clinical information systems from15 different vendors and 8 different PACS systems were in use. Half of the respondents described the number of computers available as insufficient. Wireless networks and mobile computing systems were used in 23 ICUs (46%. Conclusion Ontario ICUs demontrate a high prevalence of the use of basic information technology systems. However, implementation of the more complex and potentially more beneficial applications is low. The wide variation in vendors utilized may impair information exchange, interoperability and uniform data collection.

  6. Modern technologies for rendering information support to cogeneration steam turbine units in their design and operation stages

    Science.gov (United States)

    Brezgin, V. I.; Brodov, Yu. M.; Chubarov, A. A.; Brezgin, D. V.

    2013-08-01

    Application of modern information technologies in different stages of the lifecycle of cogeneration turbines is considered as one of possible ways for improving their competitiveness. Specific features relating to rendering information support for steam turbine units during the periods of their design and operation, which are the main stages of their life cycle, are presented. Three-dimension modeling, adaptive, and parametric design technologies are applied in the equipment design stages. Information support technologies developed by the authors are applied during the operation stage. Information is integrated by using a product lifecycle management (PLM) system.

  7. Use of 3-dimensional printing technology and silicone modeling in surgical simulation: development and face validation in pediatric laparoscopic pyeloplasty.

    Science.gov (United States)

    Cheung, Carling L; Looi, Thomas; Lendvay, Thomas S; Drake, James M; Farhat, Walid A

    2014-01-01

    Pediatric laparoscopy poses unique training challenges owing to smaller workspaces, finer sutures used, and potentially more delicate tissues that require increased surgical dexterity when compared with adult analogs. We describe the development and face validation of a pediatric pyeloplasty simulator using a low-cost laparoscopic dry-laboratory model developed with 3-dimensional (3D) printing and silicone modeling. The organs (the kidney, renal pelvis, and ureter) were created in a 3-step process where molds were created with 3D modeling software, printed with a Spectrum Z510 3D printer, and cast with Dragon Skin 30 silicone rubber. The model was secured in a laparoscopy box trainer. A pilot study was conducted at a Canadian Urological Association meeting. A total of 24 pediatric urology fellows and 3 experienced faculty members then assessed our skills module during a minimally invasive surgery training course. Participants had 60 minutes to perform a right-side pyeloplasty using laparoscopic tools and 5-0 VICRYL suture. Face validity was demonstrated on a 5-point Likert scale. The dry-laboratory model consists of a kidney, a replaceable dilated renal pelvis and ureter with an obstructed ureteropelvic junction, and an overlying peritoneum with an inscribed fundamentals of laparoscopic surgery pattern-cutting exercise. During initial validation at the Canadian Urological Association, participants rated (out of 5) 4.75 ± 0.29 for overall impression, 4.50 ± 0.41 for realism, and 4.38 ± 0.48 for handling. During the minimally invasive surgery course, 22 of 24 fellows and all the faculty members completed the scoring. Usability was rated 4 or 5 by 14 participants (overall, 3.6 ± 1.22 by novices and 3.7 ± 0.58 by experts), indicating that they would use the model in their own training and teaching. Esthetically, the model was rated 3.5 ± 0.74 (novices) and 3.3 ± 0.58 (experts). We developed a pediatric pyeloplasty simulator by applying a low-cost reusable model

  8. New source and detector technology for the realization of photometric units

    Science.gov (United States)

    Dönsberg, Timo; Pulli, Tomi; Poikonen, Tuomas; Baumgartner, Hans; Vaskuri, Anna; Sildoja, Meelis; Manoocheri, Farshid; Kärhä, Petri; Ikonen, Erkki

    2014-12-01

    The production of incandescent light bulbs is bound to end, as incandescent lighting is being phased out globally in favour of more energy-efficient and sustainable solutions. Temporally stable light-emitting diodes (LEDs) are potential candidates to replace incandescent lamps as photometric source standards. However, traditional V(λ) filter based photometers may have large uncertainty when LEDs are measured instead of incandescent lamps. This is due to the narrow and complicated spectra of LEDs. When the spectra of LEDs are limited to the visible wavelength range, new silicon detector technology can be advantageously exploited in photometry. We present a novel method—based on the recently introduced Predictable Quantum Efficient Detector (PQED)—for the realization of photometric units which completely eliminates the need to use V(λ) filters. Instead, the photometric weighting is taken into account numerically by measuring the relative spectral irradiance. The illuminance values of a blue and a red LED were determined using the new method and a conventional reference photometer. The values obtained by the two methods deviated from each other by -0.06% and 0.48% for the blue and red LED, respectively. The PQED-based values have much lower standard uncertainty (0.17% to 0.18%) than the uncertainty of the values based on the conventional photometer (0.46% to 0.51%).

  9. Survey of technology for hybrid vehicle auxiliary power units. Interim report, April 1994-June 1995

    Energy Technology Data Exchange (ETDEWEB)

    Widener, S.K.

    1995-10-01

    The state-of-the-art of heat engines for use as auxiliary power units in hybrid vehicles is surveyed. The study considers reciprocating or rotary heat engines, excluding gas turbines and fuel cells. The relative merits of various engine-generator concepts are compared. The concepts are ranked according to criteria tailored for a series-type hybrid drive. The two top APU concepts were the free-piston engine/linear generator (FPELG) and the Wankel rotary` engine. The FPELG is highly ranked primarily because of thermal efficiency cost, producibility. reliability, and transient response advantages; it is a high risk concept because of unproven technology. The Wankel engine is proven. with high power density, low cost and low noise. Four additional competitive concepts include two-stroke spark-ignition engine. two-stroke gas generator with turboalternator, free-piston engine gas generator with turboalternator, and homogeneous charge compression ignition engine. This study recommends additional work, including cycle simulation development and preliminary design to better quantify thermal efficiency and power density. Auxiliary concepts were also considered, including two which warrant further study: electrically actuated valves, and lean turndown of a normally stoichiometric engine. These concepts should be evaluated by retrofitting to existing engines.

  10. Social Studies: Application Units. Course II, Teachers. Computer-Oriented Curriculum. REACT (Relevant Educational Applications of Computer Technology).

    Science.gov (United States)

    Tecnica Education Corp., San Carlos, CA.

    This book is one of a series in Course II of the Relevant Educational Applications of Computer Technology (REACT) Project. It is designed to point out to teachers two of the major applications of computers in the social sciences: simulation and data analysis. The first section contains a variety of simulation units organized under the following…

  11. Proteção renal na unidade de terapia intensiva cirúrgica Renal protection in a surgical intensive care unit

    Directory of Open Access Journals (Sweden)

    Luciana Moraes dos Santos

    2006-09-01

    increase of life expectancy, older patients with more co-morbidity are being submitted to high risk surgical procedures, what make clinical practice related to organ protection possible modifier of short and long term survival. This review about renal protection in surgical intensive care unit points risk factors and discusses scientific evidence related to reduction of renal dysfunction in perioperative. CONTENTS: Although low extraction and adequate renal reserve of oxygen, the kidney is extremely sensible to hypoperfusion being renal acute insufficiency a frequent complication of hemodynamic instability. This apparent paradox, high oxygen content and reduced extraction with high incidence of renal damage to hypotension reflects the intra-renal gradient of oxygen, what makes renal medulla highly susceptible to ischemia. Factors associated with renal lesion are observed in all fases of perioperative period: fasting, contrast use, hypovolemia, hypotension, catecholamine and cytokine release, extracorporeal circulation, trauma, rabdomiolisys and aortic clamp. CONCLUSIONS: Management of renal damage is based in principals of perioperative renal physiology and glomerular hemodynamic. Clinical practice directed to organic protection should be implemented to minimize the impact this dysfunction.

  12. Oil atlas: National Petroleum Technology Office activities across the United States

    Energy Technology Data Exchange (ETDEWEB)

    Tiedemann, H.A.

    1998-03-01

    Petroleum imports account for the largest share of the US trade deficit. Over one-third of the 1996 merchandise trade deficit is attributed to imported oil. The good news is that substantial domestic oil resources, both existing and yet-to-be-discovered, can be recovered using advanced petroleum technologies. The Energy Information Agency estimates that advanced technologies can yield 10 billion additional barrels, equal to $240 billion in import offsets. The US Department of Energy`s National Petroleum Technology Office works with industry to develop advanced petroleum technologies and to transfer successful technologies to domestic oil producers. This publication shows the locations of these important technology development efforts and lists DOE`s partners in this critical venture. The National Petroleum Technology Office has 369 active technology development projects grouped into six product lines: Advanced Diagnostics and Imaging Systems; Advanced Drilling, Completion, and Stimulation; Reservoir Life Extension and Management; Emerging Processing Technology Applications; Effective Environmental Protection; and Crosscutting Program Areas.

  13. Surgical innovations in canine gonadectomy

    NARCIS (Netherlands)

    Van Goethem, Bart

    2016-01-01

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

  14. Surgical innovations in canine gonadectomy

    NARCIS (Netherlands)

    Van Goethem, Bart

    2016-01-01

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

  15. Recent Weather Technologies Delivered to America's Space Program by the Applied Meteorology Unit

    Science.gov (United States)

    Bauman, WIlliam, H., III; Crawford, Winifred

    2009-01-01

    The Applied Meteorology Unit (AMU) is a unique joint venture of NASA, the Air Force and the National Weather Service (NWS) and has been supporting the Space Program for nearly two decades. The AMU acts as a bridge between the meteorological research community and operational forecasters by developing, evaluating and transitioning new technology and techniques to improve weather support to spaceport operations at the Eastern Range (ER) and Kennedy Space Center. Its primary customers are the 45th Weather Squadron at Cape Canaveral Air Force Station (CCAFS), the Spaceflight Meteorology Group at Johnson Space Center and the National Weather Service Office in Melbourne, FL. Its products are used to support NASA's Shuttle and ELV programs as well as Department of Defense and commercial launches from the ER. Shuttle support includes landing sites beyond the ER. The AMU is co-located with the Air Force operational forecasters at CCAFS to facilitate continuous two-way interaction between the AMU and its operational customers. It is operated under a NASA, Air Force, and NWS Memorandum of Understanding (MOU) by a competitively-selected contractor. The contract, which is funded and managed by NASA, provides five full time professionals with degrees in meteorology or related fields, some of whom also have operational experience. NASA provides a Ph.D.- level NASA civil service scientist as Chief of the AMU. The AMU is tasked by its customers through a unique, nationally recognized process. The tasks are limited to development, evaluation and operational transition of technology to improve weather support to spaceport operations and providing expert advice to the customers. The MOU expressly forbids using the AMU resources to conduct operations or do basic research. The presentation will provide a brief overview of the AMU and how it is tasked by its customers to provide high priority products and services. The balance of the presentation will cover a sampling of products

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

    Science.gov (United States)

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

    2011-01-01

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

  17. Measuring relative efficiency of applied science and technology universities in province of Semnan, Iran and providing suggestions for merging units

    Directory of Open Access Journals (Sweden)

    Abolfazl Danaei

    2013-03-01

    Full Text Available University of applied science and technology has been designed to create a platform for multilateral activities such as industrial, military and academic in developing countries to promote science and scientific research applications. These universities are responsible to promote practical training in quantitative and qualitative indicators and they provide appropriate infrastructure to implement theoretical graduates to solve practical problems to build necessary infrastructure to transfer modern technology into developing countries. During the past few years, there have been tremendous development on these units but some of them have not been efficient. In this paper, we present an empirical study to measure the relative efficiencies of various units of applied science and technology universities using data envelopment analysis. The proposed model of this paper uses two inputs including human resources as well as total assets and two outputs including the number of graduate students as well as operating profit. The results of the study have indicated that some of the units are inefficient and need to be merged with other units to increase the relative efficiency of these universities.

  18. Surgical Navigation

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  19. Surgical smoke - a health hazard in the operating theatre: a study to quantify exposure and a survey of the use of smoke extractor systems in UK plastic surgery units.

    Science.gov (United States)

    Hill, D S; O'Neill, J K; Powell, R J; Oliver, D W

    2012-07-01

    Surgeons and operating theatre personnel are routinely exposed to the surgical smoke plume generated through thermal tissue destruction. This represents a significant chemical and biological hazard and has been shown to be as mutagenic as cigarette smoke. It has previously been reported that ablation of 1 g of tissue produces a smoke plume with an equivalent mutagenicity to six unfiltered cigarettes. We studied six human and 78 porcine tissue samples to find the mass of tissue ablated during 5 min of monopolar diathermy. The total daily duration of diathermy use in a plastic surgery theatre was electronically recorded over a two-month period. On average the smoke produced daily was equivalent to 27-30 cigarettes. Our survey of smoke extractor use in UK plastic surgery units revealed that only 66% of units had these devices available. The Health and Safety Executive recommend specialist smoke extractor use, however they are not universally utilised. Surgical smoke inhalation is an occupational hazard in the operating department. Our study provides data to quantify this exposure. We hope this evidence can be used together with current legislation to make the use of surgical smoke extractors mandatory to protect all personnel in the operating theatre.

  20. Coverage Range and Cost Comparison of Remote Antenna Unit Designs for In-building Radio over Fiber Technology

    Directory of Open Access Journals (Sweden)

    Razali Ngah

    2008-05-01

    Full Text Available Future communication needs to be ubiquitous, broadband, convergent, and seamless. Radio over fiber (RoF technology is one of the most important enabler in access network for the technologies. Adoption of RoF faces bottleneck in optoelectronics, that they are still expensive, high power consumption, and limited in bandwidth. To solve the problem, transceiver in remote antenna unit (RAU is developed, i.e. electroabsorption transceiver (EAT and asymmetric Fabry-Perot modulator (AFPM. This paper compares their coverage range and cost in providing WCDMA and WLAN services. Needed gain of RF amplifier for supporting picocell is also discussed.

  1. [Technology and humanization of the neonatal intensive care unit: reflections in the context of the health-illness process].

    Science.gov (United States)

    da Silva, Laura Johanson; da Silva, Leila Rangel; Christoffel, Marialda Moreira

    2009-09-01

    This article reflects on technology and humanization in care of newborns, having as theoretical premise the health-illness process. Some parallels are established among the several conceptions of health and illness, and their influences in the way we behave and think about the care spaces as subjects of the neonatal care. The Kangaroo Mother Care is presented as a relational technology that proposes to shelter the family-baby unity in the Neonatal Intensive Care Unit, valuing experiences and major needs of affection and comprehension.

  2. Thermochemical Process Development Unit: Researching Fuels from Biomass, Bioenergy Technologies (Fact Sheet)

    Energy Technology Data Exchange (ETDEWEB)

    2009-01-01

    The Thermochemical Process Development Unit (TCPDU) at the National Renewable Energy Laboratory (NREL) is a unique facility dedicated to researching thermochemical processes to produce fuels from biomass.

  3. Operative and technological management of super-large united power grids: lessons of major world's blackouts

    Science.gov (United States)

    Brinkis, K.; Kreslins, V.; Mutule, A.

    2014-02-01

    Power system (PS) blackouts still persist worldwide, evidencing that the existing protective structures need to be improved. The discussed requirements and criteria to be met for joint synchronous operation of large and super-large united PSs should be based on close co-ordination of operative and technological management of all PSs involved in order to ensure secure and stable electricity supply and minimise or avoid the threat of a total PS blackout. The authors analyse the July 2012 India blackout - the largest power outage in history, which affected over 620 million people, i.e. half of India's population and spread across its 22 states. The analysis is of a general character, being applicable also to similar blackouts that have occurred in Europe and worldwide since 2003. The authors summarise and develop the main principles and methods of operative and technological management aimed at preventing total blackouts in large and super-large PSs. Neskatoties uz sasniegumiem elektroenerģētikas jomā un energosistēmu nepārtrauktu modernizāciju, pasaulē regulāri notiek sabrukumu avārijas. Rakstā apskatīti lielu un superlielu energosistēmu apvienību savstarpējas sinhronas darbības nodrošinājuma prasības un kritēriji, kas pamatojas uz operatīvās un tehnoloģiskās vadības ciešu koordināciju starp energosistēmām. Savstarpējas sinhronas darbības nodrošinājuma prasībām un kritērijiem ir izšķiroša nozīme, lai panāktu elektroapgādes drošumu un stabilitāti katrā energosistēmā, kas darbojas apvienotas energosistēmas sastāvā. Šo prasību un kritēriju ievērošana sekmē totālo avāriju izcelšanās iespēju samazināšanu un to novēršanu. Indijas 2012.gada totālo avāriju un citu analogo avāriju Eiropā un Amerikā analīze un izvērtējums laika posmā no 2003.gada, deva iespēju apkopot un izstrādāt lielu un superlielu energosistēmu operatīvās un tehnoloģiskās vadības principus un metodoloģiju, lai novērstu vai

  4. Has information technology finally been adopted in Flemish intensive care units?

    Directory of Open Access Journals (Sweden)

    Steurbaut Kristof

    2010-10-01

    Full Text Available Abstract Background Information technology (IT may improve the quality, safety and efficiency of medicine, and is especially useful in intensive Care Units (ICUs as these are extremely data-rich environments with round-the-clock changing parameters. However, data regarding the implementation rates of IT in ICUs are scarce, and restricted to non-European countries. The current paper aims to provide relevant information regarding implementation of IT in Flemish ICU's (Flanders, Belgium. Methods The current study is based on two separate but complementary surveys conducted in the region of Flanders (Belgium: a written questionnaire in 2005 followed by a telephone survey in October 2008. We have evaluated the actual health IT adoption rate, as well as its evolution over a 3-year time frame. In addition, we documented the main benefits and obstacles for taking the decision to implement an Intensive Care Information System (ICIS. Results Currently, the computerized display of laboratory and radiology results is almost omnipresent in Flemish ICUs, (100% and 93.5%, respectively, but the computerized physician order entry (CPOE of these examinations is rarely used. Sixty-five % of Flemish ICUs use an electronic patient record, 41.3% use CPOE for medication prescriptions, and 27% use computerized medication administration recording. The implementation rate of a dedicated ICIS has doubled over the last 3 years from 9.3% to 19%, and another 31.7% have plans to implement an ICIS within the next 3 years. Half of the tertiary non-academic hospitals and all university hospitals have implemented an ICIS, general hospitals are lagging behind with 8% implementation, however. The main reasons for postponing ICIS implementation are: (i the substantial initial investment costs, (ii integration problems with the hospital information system, (iii concerns about user-friendly interfaces, (iv the need for dedicated personnel and (v the questionable cost-benefit ratio

  5. Explaining technological change of wind power in China and the United States: Roles of energy policies, technological learning, and collaboration

    Science.gov (United States)

    Tang, Tian

    The following dissertation explains how technological change of wind power, in terms of cost reduction and performance improvement, is achieved in China and the US through energy policies, technological learning, and collaboration. The objective of this dissertation is to understand how energy policies affect key actors in the power sector to promote renewable energy and achieve cost reductions for climate change mitigation in different institutional arrangements. The dissertation consists of three essays. The first essay examines the learning processes and technological change of wind power in China. I integrate collaboration and technological learning theories to model how wind technologies are acquired and diffused among various wind project participants in China through the Clean Development Mechanism (CDM)--an international carbon trade program, and empirically test whether different learning channels lead to cost reduction of wind power. Using pooled cross-sectional data of Chinese CDM wind projects and spatial econometric models, I find that a wind project developer's previous experience (learning-by-doing) and industrywide wind project experience (spillover effect) significantly reduce the costs of wind power. The spillover effect provides justification for subsidizing users of wind technologies so as to offset wind farm investors' incentive to free-ride on knowledge spillovers from other wind energy investors. The CDM has played such a role in China. Most importantly, this essay provides the first empirical evidence of "learning-by-interacting": CDM also drives wind power cost reduction and performance improvement by facilitating technology transfer through collaboration between foreign turbine manufacturers and local wind farm developers. The second essay extends this learning framework to the US wind power sector, where I examine how state energy policies, restructuring of the electricity market, and learning among actors in wind industry lead to

  6. Surgical ethics: surgical virtue and more.

    Science.gov (United States)

    Vercler, Christian J

    2015-01-01

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

  7. Influence of information technology on labour relations in the United Arab Emirates / Matar Alneyadi

    OpenAIRE

    Alneyadi, Matar Humaid

    2005-01-01

    Information technology has fundamentally exercised an impact on the employment relationship. Firstly, and most obviously, technology is often used as a substitute for labour. However, improvements in information technology have also served to complement labour. Thus triggered employees to strive to maintain their status not just as another commodity of production, but a vital cog in the organisation. Organisational structures changed to such an extent that employers consult the...

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

    Science.gov (United States)

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

    2012-05-01

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

  9. Low Energy Technology. A Unit of Instruction on Energy Conservation in Field Crop Production.

    Science.gov (United States)

    Davis, George; Scanlon, Dennis C.

    This unit of instruction on energy conservation in field crop production was designed for use by agribusiness and natural resources teachers in Florida high schools and by agricultural extension agents as they work with adults and students. It is one of a series of 11 instructional units (see note) written to help teachers and agents to educate…

  10. The Global Energy Situation on Earth, Student Guide. Computer Technology Program Environmental Education Units.

    Science.gov (United States)

    Northwest Regional Educational Lab., Portland, OR.

    This is the student guide in a set of five computer-oriented environmental/energy education units. Contents of this guide are: (1) Introduction to the unit; (2) The "EARTH" program; (3) Exercises; and (4) Sources of information on the energy crisis. This guide supplements a simulation which allows students to analyze different aspects of…

  11. Low Energy Technology. A Unit of Instruction in Florida Agriculture. Crop Protection with Integrated Pest Management.

    Science.gov (United States)

    Florida Univ., Gainesville. Inst. of Food and Agricultural Sciences.

    This unit of instruction on integrated pest management was designed for use by agribusiness and natural resources teachers in Florida high schools and by agricultural extension agents as they work with adults and students. It is one of a series of 11 instructional units (see note) written to help teachers and agents to educate their students and…

  12. Surgical management of presbyopia

    Directory of Open Access Journals (Sweden)

    Torricelli AA

    2012-09-01

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

  13. Application of Super-Synchronization Speed Control Technology in Two 80 MVA Motor-Generator Units of HL-2A

    Institute of Scientific and Technical Information of China (English)

    LI Huajun; WANG Fen; WANG Xiaoping; DU Chang; XUAN Weiming; PEN Jianfei; HU Haotian; LIU Lin; KANG Li; XU Lirong; HUANG Zhaorong

    2007-01-01

    Two sets of super-synchronization speed control assemblies for two 80 MVA motorgenerator units have been developed successfully in order to satisfy the demand of the toroidal field system in the HL-2A tokamak.Based on the three-phase logical no-circumfluence a.c./a.c.cycloconverter,the speeds of two 2500 kW double fed drive motors have been regulated by means of the vector control technology.The maximum operating speed of each motor- generator unit has been raised from 1488 rpm (revolutions per minute) to 1650 rpm and the released energy of each unit during a pulsed discharge can reach 500 MJ.As a result,the toroidal field system has the capacity to provide 2.8 tesla (T) in HL-2A experiments.

  14. Application of Super-Synchronization Speed Control Technology in Two 80 MVA Motor-Generator Units of HL-2A

    Science.gov (United States)

    Li, Huajun; Du, Chang; Xuan, Weiming; Pen, Jianfei; Hu, Haotian; Liu, Lin; Kang, Li; Xu, Lirong; Huang, Zhaorong; Wang, Fen; Wang, Xiaoping

    2007-04-01

    Two sets of super-synchronization speed control assemblies for two 80 MVA motor-generator units have been developed successfully in order to satisfy the demand of the toroidal field system in the HL-2A tokamak. Based on the three-phase logical no-circumfluence a.c./a.c. cycloconverter, the speeds of two 2500 kW double fed drive motors have been regulated by means of the vector control technology. The maximum operating speed of each motor- generator unit has been raised from 1488 rpm (revolutions per minute) to 1650 rpm and the released energy of each unit during a pulsed discharge can reach 500 MJ. As a result, the toroidal field system has the capacity to provide 2.8 tesla (T) in HL-2A experiments.

  15. ANALISIS KEPUASAN PEGAWAI TERHADAP LAYANAN UNIT SISTEM INFORMASI MENGGUNAKAN TECHNOLOGY ACCEPTANCE MODEL DI PT KERETA API INDONESIA (PERSERO

    Directory of Open Access Journals (Sweden)

    Yuda Yuliana

    2016-09-01

    Full Text Available Abstract Satisfaction in work is an individual thing. Each individual will have a level of satisfaction varies according to the system of values prevailing in him. This study was conducted to determine the level of employee satisfaction with the services in the information systems unit PT Kereta Api Indonesia (Persero in order to get results that can make service information systems unit to be better again. Based on the analysis of Multiple Linear Regression method Technology Acceptance Model , obtained the result that the employees satisfied with the usability factor ( Perceived Usefulness the variable Perceived Usefulness and Perceived Ease of Use influencing variable Attitude Toward Using With his existing results of scientific research , the expected improvement in the quality of services provided to the employee information systems unit.   Keywords: Employee Satisfaction, Perceived Usefulness, Perceived Ease of Use, Attitude Toward Using.

  16. The Status of Technology and Engineering Education in the United States: A Fourth Report of the Findings from the States (2011-12)

    Science.gov (United States)

    Moye, Johnny J.; Dugger, William E., Jr.; Starkweather, Kendall N.

    2012-01-01

    Technology and engineering education continues to evolve as it becomes more apparent that students need this information to become more successful in college and careers. The International Technology and Engineering Educators Association (ITEEA ) has tracked the status of technology education in the United States in three separate studies over the…

  17. [The value of surgical experience gained during the Great Patriotic War for the modern military surgery].

    Science.gov (United States)

    Efimenko, N A; Samokhvalov, L M

    2015-05-01

    The surgical experience gained during the Great Patriotic War (1941-1945) is a basis of the modern Russian military surgery, which allows providing any options for surgical care to the wounded. The article describes the main achievements of the military surgeons in our country during the Great Patriotic War, which helped the Soviet (Russian) military field surgery to achieve a leading position in the world of military medicine. The role of the united martial medical doctrine, three editions of "Guidelines for the military surgery", the qualified surgical assistance as a mean that helped to deliver surgical care to the wounded, the introduction of specialized medical care, technology development of medical triage, as well as the origins of the tactics of a multi-stage surgical treatment of combat trauma and special treatment of minimally wounded during the war. The problems in establishing registers of combat injuries. and training military surgeons are analysed.

  18. UNITED STATES DEPARTMENT OF ENERGY OFFICE OF ENVIRONMENTAL MANAGEMENT WASTE PROCESSING ANNUAL TECHNOLOGY DEVELOPMENT REPORT 2008

    Energy Technology Data Exchange (ETDEWEB)

    Bush, S.

    2009-11-05

    The Office of Waste Processing identifies and reduces engineering and technical risks and uncertainties of the waste processing programs and projects of the Department of Energy's Environmental Management (EM) mission through the timely development of solutions to technical issues. The risks, and actions taken to mitigate those risks, are determined through technology readiness assessments, program reviews, technology information exchanges, external technical reviews, technical assistance, and targeted technology development and deployment. The Office of Waste Processing works with other DOE Headquarters offices and project and field organizations to proactively evaluate technical needs, identify multi-site solutions, and improve the technology and engineering associated with project and contract management. Participants in this program are empowered with the authority, resources, and training to implement their defined priorities, roles, and responsibilities. The Office of Waste Processing Multi-Year Program Plan (MYPP) supports the goals and objectives of the U.S. Department of Energy (DOE) - Office of Environmental Management Engineering and Technology Roadmap by providing direction for technology enhancement, development, and demonstration that will lead to a reduction of technical risks and uncertainties in EM waste processing activities. The MYPP summarizes the program areas and the scope of activities within each program area proposed for the next five years to improve safety and reduce costs and environmental impacts associated with waste processing; authorized budget levels will impact how much of the scope of activities can be executed, on a year-to-year basis. Waste Processing Program activities within the Roadmap and the MYPP are described in these seven program areas: (1) Improved Waste Storage Technology; (2) Reliable and Efficient Waste Retrieval Technologies; (3) Enhanced Tank Closure Processes; (4) Next-Generation Pretreatment Solutions; (5

  19. Short rotation woody crops: Using agroforestry technology for energy in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Wright, L L; Ranney, J W

    1991-01-01

    Agroforestry in the United States is being primarily defined as the process of using trees in agricultural systems for conservation purposes and multiple products. The type of agroforestry most commonly practiced in many parts of the world, that is the planting of tree crops in combination with food crops or pasture, is the type least commonly practiced in the United States. One type of agroforestry technique, which is beginning now and anticipated to expand to several million acres in the United States, is the planting of short-rotation woody crops (SRWCs) primarily to provide fiber and fuel. Research on SRWC's and environmental concerns are described.

  20. Logistic Regression Analysis and Nursing Interven-tions for High-risk Factors for Pressure Sores in Pa-tients in a Surgical Intensive Care Unit

    Institute of Scientific and Technical Information of China (English)

    Xin-Ran Wang∗; Bin-Ru Han

    2015-01-01

    Objective: To investigate the risk factors related to the development of pressure sores in critically ill surgical patients and to establish a basis for the formulation of effective precautions. Methods: A questionnaire regarding the factors for pressure sores in critically ill surgical patients was created using a case control study with reference to the pertinent literature. After being exam-ined and validated by experts, the questionnaire was used to collect data about critically ill surgical patients in a grade A tertiary hospital. Among the 47 patients enrolled into the study, the 14 who developed nosocomial pressure sores were allocated to the pressure sore group, and the remaining 33 patients who met the inclusion criteria and did not exhibit pressure sores were allocated to the control group. Univariate and multivariate logistic regression analyses were employed to examine the differences in 22 indicators between the two groups in an attempt to identify the risk factors for pressure sores. Results: According to the univariate analyses, the maximum value of lactic acid in the arterial blood, the number of days of norepinephrine use, the number of days of mechanical ventilation, the number of days of blood purification, and the number of days of bowel incontinence were sta-tistically greater in the pressure sore group than in the control group ( P Conclusions: The best method for preventing and control pressure sores in surgical critically ill patients is to strongly emphasize the duration of the critical status and to give special attention to patients in a continuous state of shock. The adoption of measures specific to high-risk patient groups and risk factors, including the active control of primary diseases and the application of de-compression measures during the treatment of the patients, are helpful for improving the quality of care in the prevention and control of pressure sores in critically ill patients.

  1. Technology used to operate the 300-MW power unit topped with a GTE-110 gas turbine

    Science.gov (United States)

    Berezinets, P. A.; Doverman, G. I.

    2010-09-01

    Results obtained from mathematical simulation of operations for starting the 300-MW power unit topped with a GTE-110 gas turbine installed at the GRES-24 district power station of OAO OGK-6 wholesale power-generating company are described. It is shown that operations on speeding up the steam turbine from a cold state to its idle running mode can be carried out solely by using the heat of exhaust gases from the gas turbine unit without supplying fuel to the boiler.

  2. USE OF SPACE TECHNOLOGY IN FEDERALLY FUNDED LAND PROCESSES RESEARCH IN THE UNITED STATES.

    Science.gov (United States)

    Thorley, G.A.; McArdle, R.

    1986-01-01

    A review of the use of space technology in federally funded earth science research in the US was carried out in 1985 by the President's Office of Science and Technology Policy. Five departments and three independent agencies, representing the primary earth science research agencies in the Federal government, participated in the review. The review by the subcommittee indicated that, while there is considerable overlap in the legislated missions of the earth science agencies, most of the space-related land processes research is complementary. Summaries are provided of the current and projected uses of space technology in land processes activities within the eight Federal organizations.

  3. Technology Reconciliation in the Remote Sensing ERA of United States Civilian Weather Forecasting: 1957 -1987.

    Science.gov (United States)

    Courain, Margaret Eileen

    This dissertation seeks to advance an understanding of the management of a major technological change in meteorology. The study examines the connection between changes in production and real-time use of data products derived from remote -sensing data collection and the evolution of U.S. civilian weather forecasting 1957-1987. The role of data collection in weather forecasting throughout history is examined, giving most attention to the 1957-1987 period. Critical to the real-time use of remote-sensing data was technology reconciliation. As defined by the author, it is the function or process by which data products and information derived from a new technology are made consistent or congruent with the existing data representations of a science in order to be used effectively. No model had been developed for a technology reconciliation process, or definition of the major role technology reconciliators played in the 30-year evolution of the science of weather forecasting. In order to assess the new remote-sensing data resource and its use in U.S. civilian weather forecasting, a Data Accountability and Review Technique (DART) was developed by the author in 1989. This technique was used to identify 16 of the technology reconciliators who developed and reconciled 25 new remote-sensing data products with the weather charts, maps and computer models of the National Weather Service. In five separate program teams, they were responsible for 15 improvements in the products--forecasts--and 18 improvement in the process of weather forecasting. A model of the technology reconciliation is proposed which can be applied to understanding the contemporary history of other sciences. The model, as well as the methods developed by the author to recognize the process of technology reconciliation has a much more general applicability beyond the sciences. Any field implementing new technology that promises to improve its whole way of working will be faced with the task of technology

  4. Full Field Digital Mammography (FFDM) versus CMOS Technology, Specimen Radiography System (SRS) and Tomosynthesis (DBT) - Which System Can Optimise Surgical Therapy?

    Science.gov (United States)

    Schulz-Wendtland, R; Dilbat, G; Bani, M; Fasching, P A; Heusinger, K; Lux, M P; Loehberg, C R; Brehm, B; Hammon, M; Saake, M; Dankerl, P; Jud, S M; Rauh, C; Bayer, C M; Beckmann, M W; Uder, M; Meier-Meitinger, M

    2013-05-01

    Aim: This prospective clinical study aimed to evaluate whether it would be possible to reduce the rate of re-excisions using CMOS technology, a specimen radiography system (SRS) or digital breast tomosynthesis (DBT) compared to a conventional full field digital mammography (FFDM) system. Material and Method: Between 12/2012 and 2/2013 50 patients were diagnosed with invasive breast cancer (BI-RADS™ 5). After histological verification, all patients underwent breast-conserving therapy with intraoperative imaging using 4 different systems and differing magnifications: 1. Inspiration™ (Siemens, Erlangen, Germany), amorphous selenium, tungsten source, focus 0.1 mm, resolution 85 µm pixel pitch, 8 lp/mm; 2. BioVision™ (Bioptics, Tucson, AZ, USA), CMOS technology, photodiode array, flat panel, tungsten source, focus 0.05, resolution 50 µm pixel pitch, 12 lp/mm; 3. the Trident™ specimen radiography system (SRS) (Hologic, Bedford, MA, USA), amorphous selenium, tungsten source, focus 0.05, resolution 70 µm pixel pitch, 7.1 lp/mm; 4. tomosynthesis (Siemens, Erlangen, Germany), amorphous selenium, tungsten source, focus 0.1 mm, resolution 85 µm pixel pitch, 8 lp/mm, angular range 50 degrees, 25 projections, scan time > 20 s, geometry: uniform scanning, reconstruction: filtered back projection. The 600 radiographs were prospectively shown to 3 radiologists. Results: Of the 50 patients with histologically proven breast cancer (BI-RADS™ 6), 39 patients required no further surgical therapy (re-excision) after breast-conserving surgery. A retrospective analysis (n = 11) showed a significant (p < 0.05) increase of sensitivity with the BioVision™, the Trident™ and tomosynthesis compared to the Inspiration™ at a magnification of 1.0 : 2.0 or 1.0 : 1.0 (tomosynthesis) (2.6, 3.3 or 3.6 %), i.e. re-excision would not have been necessary in 2, 3 or 4 patients, respectively, compared to findings obtained with a standard

  5. Internet and technology transfer in acute care hospitals in the United States: survey-2000.

    Science.gov (United States)

    Hatcher, M

    2001-12-01

    This paper provides the results of the survey-2000 measuring technology transfer and, specifically, Internet usage. The purpose of the survey was to measure the levels of Internet and Intranet existence and usage in acute care hospitals. The depth of the survey includes e-commerce for both business-to-business and customers. These results are compared with responses to the same questions in survey-1997. Changes in response are noted and discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the third of three articles based upon the results of the survey-2000. Readers are referred to prior articles by the author, which discuss the survey design and provide a tutorial on technology transfer in acute care hospitals. (1) Thefirst article based upon the survey results discusses technology transfer, system design approaches, user involvement, and decision-making purposes. (2)

  6. TO APPLICATION OF BIO-GAS UNITS: ORGANIZATIONAL AND TECHNOLOGICAL MODEL

    Directory of Open Access Journals (Sweden)

    Thuy Nga Nguyen

    2011-01-01

    Full Text Available Analysis of the published papers written by national and foreign researchers reveals that an increasing global energy deficit, exhaustion of  fossil organic and nuclear fuels, chemical and radio-active contamination of the environment are main reasons in favour of  thorough investigation  and wide introduction of non-conventional and renewable energy sources. Nowadays Vietnamese Institute of Energy Science has been developing the state-of-the-art bio-gas technologies on the  basis of application and modernization of Chinese and Dutch family-style technologies. The most rational technologies are combined ones which operate using various types of energy raw materials, for example, solar and bio-gas energy because usage of solar energy expands operational possibilities of the bio-gas system, ensures its operation within wide temperature range creating necessary parameters for the required technological task.

  7. Technological innovation and its effect on public health in the United States

    Directory of Open Access Journals (Sweden)

    Gill PS

    2013-01-01

    Full Text Available Preetinder Singh GillCollege of Technology, Eastern Michigan University, Ypsilanti, MI, USABackground: Good public health ensures an efficient work force. Organizations can ensure a prominent position on the global stage by staying on the leading edge of technological development. Public health and technological innovation are vital elements of prosperous economies. It is important to understand how these elements affect each other. This research study explored and described the relationship between these two critical elements/constructs.Methods: Indicators representing technological innovation and public health were identified. Indicator data from 2000 to 2009 were collected from various US federal government sources, for the four US Census regions. The four US Census regions were then compared in terms of these indicators. Canonical correlation equations were formulated to identify combinations of the indicators that are strongly related to each other. Additionally, the cause–effect relationship between public health and technological innovation was described using the structural equation modeling technique.Results: The four US Census regions ranked differently in terms of both type of indicators in a statistically significant manner. The canonical correlation analysis showed that the first set of canonical variables had a fairly strong relationship, with a magnitude > 0.65 at the 95% confidence interval, for all census regions. Structural equation modeling analysis provided β < −0.69 and Student’s t statistic > 12.98, for all census regions. The threshold Student’s t statistic was 1.98. Hence, it was found that the β values were significant at the 95% confidence interval, for all census regions.Discussion: The results of the study showed that better technological innovation indicator scores were associated with better public health indicator scores. Furthermore, the study provided preliminary evidence that technological innovation

  8. Technology Strategy and Industrial Relations: Case Studies of Japanese Multinationals in the United States

    OpenAIRE

    1983-01-01

    Eight case studies of U.S. manufacturing subsidiaries of Japanese multinationals are analyzed in terms of variations in competitive strategies and industrial relations practices. Based on data collected in 1980 on-site visits, each firm is reviewed in light of the technology contributions coming from the Japanese parent and is categorized as having product-, process-, and/or management-centered technology strategies. The industrial relations practices are also grouped according to similaritie...

  9. Review, Analyses and Recommendations Related to Modern International Use of Nuclear Space Technologies with Focus on United States and Russia

    Science.gov (United States)

    Smith, T.

    The current Administration under President Barack Obama has given NASA a new directive in manned spaceflight. Instead of building a fleet of Ares rockets with various load specifications to deliver astronauts to the International Space Station (ISS) and return them to the Moon, the 2011 NASA Strategic Plan [1] states that NASA will develop ``integrated architecture and capabilities for safe crewed and cargo missions beyond Low Earth Orbit.'' The technologies developed within this architecture will take astronauts beyond the Moon, to destinations such as Mars or asteroids and will most likely require the use of Nuclear Space Technologies (NSTs).While there are other proposals for novel power generation and propulsion, such as fusion technology, these technologies are immature and it may be decades before they have demonstrated feasibility; in contrast NSTs are readily available, proven to work in space, and flight qualified. However, NSTs such as nuclear thermal propulsion (NTP) may or may not reach completion - especially with the lack of a mission in which they may be developed. Prospects and progress in current NST projects, ranging from power sources to propulsion units, are explored within this study, mainly in the United States, with an overview of projects occurring in other countries. At the end of the study, recommendations are made in order to address budget and political realities, aerospace export control and nuclear non-proliferation programs, and international issues and potentials as related to NSTs. While this report is not fully comprehensive, the selection of chosen projects illustrates a range of issues for NSTs. Secondly, the reader would be keen to make a distinction between technologies that have flown in the past, projects that have been tested and developed yet not flown, and concepts that have not yet reached the bench for testing.

  10. [Aspects of development of surgical service of modem Navy].

    Science.gov (United States)

    Kabanov, M Iu; Gaĭdash, A A; Rukhliada, N V; Solov'ev, I A; Titov, R V; Utochkin, A P; Smirnov, S I; Smolin, N V; Tiurin, M V

    2013-06-01

    The article is devoted to the aspects of a current state of surgical service in the Navy, prospects of development of professianl training for navy surgeons, formation of modern training comlex, united electronic library, containig the issues about combat surgical trauma, software technologies, realizing of the application methodology during the process of training and practical activity for the development of the training system for surgeons of Navy and improvement of effectiveness. Formation of normative technical documents, regulating activity of navy surgians is also among the expectations. The authors also touched on the issues of development of modern technologies in bone grafting with the help of domestic implants based on the osteoinductive nanostructured nonorganic matrices (titanium) with defined structure and composition. Department of navy and hospital surgery participate in this debelopment. Due to increased amount of oncologic patients, it was decided to establish the Cancer Center of the Ministry of Defense based on department of navy and hospital surgery of the Kirov Military Medical Academy. It makes possible to perform the following procedures: canser surgery; surgical repair; plastic repair of major vessels, bone and soft tissue grafting, removal of residual cancer cells with the help of loco-regional methods of hyperthermic intracavitary and intravascular chemoperfusion; diagnostics and treatment of recurrent tumors (surgical and radiation treatment, systemic chemotherapy, loco-regional chemoembolization. Each of the given methods help to develop and improve the innovation technologies.

  11. Impact of complementary therapies via mobile technologies on Icelandic same day surgical patients' reports of anxiety, pain and self-efficacy in healing: a randomized controlled trial in process.

    Science.gov (United States)

    Hansen, Margaret M

    2013-01-01

    Complementary and Alternative Therapies (CAT) are increasingly being utilized in conjunction with conventional medicine. Health Information Technology (HIT) and CAT are being scrutinized for evidence based health outcomes. The aim of this randomized controlled trial (RCT) is to determine if the use of mobile technologies delivering CAT, specifically relaxation technique (RT), medical music intervention (MMI), nature landscape applications with (NLAM) and without music (NLAWM) compared with no intervention (control group) will assist in decreasing pre- and post-surgical patients' anxiety and pain levels while increasing post-operative healing self-efficacy levels.

  12. Importance of Ethics in Surgical Practice

    Directory of Open Access Journals (Sweden)

    Vedat Menderes Özçiftçi

    2017-04-01

    Full Text Available The field of ethics, also called moral philosophy, involves systematizing, defending, and recommending concepts of right and wrong behavior. Ethics is an established system of moral principles that govern the rules of conduct. Medical ethics define what the physician ought to do and how he or she should behave. Some of us may think that ethics are unimportant in surgery, however, we should be aware that surgeons operate daily in the theater of moral choice. Ethical considerations, such as diagnosis and treatment, are essential features of the surgical care for each patient (1. Surgeons working in surgical units increasingly face ethical problems owing to growth in scientific knowledge and technology, and the availability of new diagnostic equipment and treatment opportunities. The applications become more complex and the decisions more difficult as advancing technology provides greater opportunities to save lives and relieve pain and suffering. More and more surgical procedures are now carried out in older patients who have multiple and more serious diseases than ever before (2. Doctors often face with ethical dilemmas related to providing care that maintains patients’ dignity while attending their advanced medical treatment. Organizational and financial constraints in hospitals, and professional relationships with colleagues and other healthcare providers also create ethical problems for surgeons as they try to act appropriately towards patients and relatives (3. Studies have shown, however, that physicians often are in doubt about the best and correct actions to take for the patients in specific situations (2-4. In fact, the majority of surgeons with little or no education in bioethics face many ethical challenges in daily practice. The overall aim of this article was to analyze surgeons’ experiences of living with ethical difficulties in their work, and highlight the importance of ethical requirements in surgical practice.

  13. Critical issues for the application of integrated MEMS/CMOS technologies to inertial measurement units

    Energy Technology Data Exchange (ETDEWEB)

    Smith, J.H.; Ellis, J.R.; Montague, S.; Allen, J.J.

    1997-03-01

    One of the principal applications of monolithically integrated micromechanical/microelectronic systems has been accelerometers for automotive applications. As integrated MEMS/CMOS technologies such as those developed by U.C. Berkeley, Analog Devices, and Sandia National Laboratories mature, additional systems for more sensitive inertial measurements will enter the commercial marketplace. In this paper, the authors will examine key technology design rules which impact the performance and cost of inertial measurement devices manufactured in integrated MEMS/CMOS technologies. These design parameters include: (1) minimum MEMS feature size, (2) minimum CMOS feature size, (3) maximum MEMS linear dimension, (4) number of mechanical MEMS layers, (5) MEMS/CMOS spacing. In particular, the embedded approach to integration developed at Sandia will be examined in the context of these technology features. Presently, this technology offers MEMS feature sizes as small as 1 {micro}m, CMOS critical dimensions of 1.25 {micro}m, MEMS linear dimensions of 1,000 {micro}m, a single mechanical level of polysilicon, and a 100 {micro}m space between MEMS and CMOS. This is applicable to modern precision guided munitions.

  14. Critical issues for the application of integrated MEMS/CMOS technologies to inertial measurement units

    Science.gov (United States)

    Smith, James H.; Montague, Stephen; Allen, James J.; Ellis, J. R.; Burgett, Scott M.

    1997-06-01

    One of the principal applications of monolithically integrated micromechanical/microelectronic systems has been accelerometers for automotive applications. As integrated MEMS/CMOS technologies such as those developed by U.C. Berkeley, Analog Devices, and Sandia National Laboratories mature, additional systems for more sensitive inertial measurements will enter the commercial marketplace. In this paper, we will examine the key technology design rules which impact the performance and cost of inertial measurement devices manufactured in integrated MEMS/CMOS technologies. These design parameters include: (1) Minimum MEMS feature size, (2) Minimum CMOS feature size, (3) Maximum MEMS linear dimension, (4) Number of mechanical MEMS layers, and (5) MEMS/CMOS spacing. In particular, the embedded approach to integration developed at Sandia will be examined in the context of these technology features. Presently, this technology offers MEMS feature sizes as small as 1 micrometers , CMOS critical dimensions of 1.25 micrometers , MEMS linear dimensions of 1000 micrometers , a single mechanical level of polysilicon, and a 100 micrometers space between MEMS and CMOS.

  15. Towards a wireless patient: chronic illness, scarce care and technological innovation in the United Kingdom.

    Science.gov (United States)

    May, Carl; Finch, Tracy; Mair, Frances; Mort, Maggie

    2005-10-01

    'Modernization' is a key health policy objective in the UK. It extends across a range of public service delivery and organizational contexts, and also means there are radical changes in perspective on professional behaviour and practice. New information and communications technologies have been seen as one of the key mechanisms by which these changes can be engendered. In particular, massive investment in information technologies promises the rapid distribution and deployment of patient-centred information across internal organizational boundaries. While the National Health Service (NHS) sits on the edge of a pound sterling 6 billion investment in electronic patient records, other technologies find their status as innovative vehicles for professional behaviour change and service delivery in question. In this paper, we consider the ways that telemedicine and telehealthcare systems have been constructed first as a field of technological innovation, and more recently, as management solutions to problems around the distribution of health care. We use NHS responses to chronic illness as a medium for understanding these shifts. In particular, we draw attention to the shifting definitions of 'innovation' and to the ways that these shifts define a move away from notions of technological advance towards management control.

  16. Technological and environmental characteristics of intensive care units. Implications for job redesign.

    Science.gov (United States)

    Mark, B A; Hagenmueller, A C

    1994-04-01

    Nurse executives are experiencing severe pressures to create systems of care delivery that provide services in more cost-conscious ways. Before care systems can be restructured, a systematic assessment of the work and the environment of the nursing unit must take place. This study found significant differences among nine intensive care units regarding both the nature of their work and their environments. These differences provided information that can be used in staffing decisions, nurse/physician interaction, and staff nurse and managerial recruitment.

  17. Use of Technology for HIV Prevention Among Adolescent and Adult Women in the United States.

    Science.gov (United States)

    Blackstock, Oni J; Patel, Viraj V; Cunningham, Chinazo O

    2015-12-01

    Although the proportion of new HIV infections in the USA among women has decreased over the last few years, still, approximately 20 % of new infections occur annually among adolescent and adult women. The development of effective evidence-based prevention interventions remains an important approach to further decreasing these numbers. Technology-delivered prevention interventions hold tremendous potential due, in part, to their ability to reach beyond the walls of brick-and-mortar intervention sites to engage individuals where they are. While most technology-delivered interventions have focused on adolescents and men who have sex with men, much fewer have specifically targeted adolescent or adult women despite evidence showing that interventions tailored to specific target populations are most effective. We summarize the recently published literature on technology-delivered HIV prevention interventions for US adolescent and adult women and provide suggestions for next steps in this nascent but emergent area of prevention research.

  18. Science, Technology and Innovation for Achieving United Nations Millennium Development Goals

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    @@ In September 2000, 147 heads of State and Government, and 189 nations intotal,committed themselves by year 2015 to roduce significantly global poverty and the related problems of illiteracy,hunger,discrimination against women, unsafe drinking water,and degraded environments and ecosystems,through the United Nations Millennium Declaration[A/RES/55/2].

  19. Innovation in pediatric surgical education.

    Science.gov (United States)

    Clifton, Matthew S; Wulkan, Mark L

    2015-06-01

    Pediatric surgical training in the United States remained basically unchanged from the model developed by Ladd and Gross in the 1930s until recently. Standardized curriculum and novel evaluation methods are now being implemented. Pediatric Surgical education is currently undergoing a transition to competency-based evaluation and promotion. Unfortunately, there is little data on the efficacy of these changes. This presents an opportunity for further study of how we conduct training, and how we evaluate and promote our trainees.

  20. Molecular epidemiology and drug resistance of pandrug-resistant acinetobacter baumannii in surgical intensive care unit%外科ICU泛耐药鲍氏不动杆菌分子流行特征及耐药性研究

    Institute of Scientific and Technical Information of China (English)

    王倩; 郭毅; 欧阳金鸣

    2011-01-01

    OBJECTIVE To study the molecular epidemiology and antibiotic resistance of pandrug-resistant Acinetobacter baumannii (PDRAB) in surgical intensive care unit, and provide referrence for prevention and control of hospital-acquired infection. METHODS The clinical data of non-repetitive 27 PDRAB isolated from inpatients and environment in surgical intensive care unit were reviewed. The molecular typing of PDRAB was determined by pulsed field gel electrophoresis. The value of minimal inhibitory concentration of PDRAB clone was determined by E test. RESULTS In surgical intensive care unit, PDRAB infections were hospital-acquired infections. The main type of infection was pneumonia (80.8%), then was blood infection (7.7%). Most of patients got improvement (46.2%) and recovery (30.8%) via treatment. The molecular typing of PDRAB showed four types of clones, and clone A and clone C were epidemic. The PDRAB isolates from inpatients and environment were homologous in surgical intensive care unit. The clone A and clone C were high-level resistance to most common antimicrobial agents tested, just susceptible to minocycline and polymixin B. In addition, the clone C was intermediate to cefoperazone/sulbactam. CONCLUSION It benefits the prevention and control of PDRAB outbreak by strengthening the target monitoring of PDRAB in surgical intensive care unit.%目的 研究外科ICU泛耐药鲍氏不动杆菌(PDRAB)分子流行特征及耐药性,分析其流行趋势,为有效预防和控制PDRAB医院感染提供参考资料.方法 回顾性研究医院外科ICU患者及环境非重复分离的27例PDRAB临床资料,应用脉冲场凝胶电泳(PFGE)技术对PDRAB进行分子分型,E试验法检测PDRAB最低抑菌浓度(MIC)值.结果 外科ICU患者PDRAB感染均为医院获得性感染,感染类型以肺部感染为主,占80.8%,其次血液感染占7.7%,大多患者治疗后好转占46.2%,治愈占30.8%;PDRAB分子分型共4种克隆,A型和C型是主

  1. Technology meets tradition: The perceived impact of the introduction of information and communication technology on ward rounds in the intensive care unit.

    Science.gov (United States)

    Plumb, Jennifer J; Hains, Isla; Parr, Michael J; Milliss, David; Herkes, Robert; Westbrook, Johanna I

    2017-09-01

    Public policy in many health systems is currently dominated by the quest to find ways to 'do more with less'-to achieve better outcomes at a reduced cost. The success or failure of initiatives in support of this quest are often understood in terms of an adversarial dynamic or struggle between the professional logics of medicine and of management. Here, we use the case of the introduction of information and communication technology (ICT) to a well-established ritual of medical autonomy (the medical ward round) to articulate a more nuanced explanation of how and why new ways of working with technology are accepted and adopted (or not). The study was conducted across four intensive care units (ICUs) in major teaching hospitals in Sydney, Australia. Using interviews, we examined 48 doctors' perceptions of the impact of ICT on ward round practice. We applied the concept of institutional logics to frame our analysis. Interview transcripts were analysed using a hybrid of deductive and inductive thematic analysis. The doctors displayed a complex engagement with the technology that belies simplistic characterisations of medical rejection of managerial encroachment. In fact, they selectively welcomed into the ward round aspects of the technology which reinforced the doctor's place in the healthcare hierarchy and which augmented their role as scientists. At the same time, they guarded against allowing managerial logic embedded in ICT to de-emphasise their embodied subjectivity in relation to the patient as a person rather than as a collection of parameters. ICT can force the disruption of some aspects of existing routines, even where these are long-established rituals. Resistance arose when the new technology did not fit with the 'logic of care'. Incorporation of the logic of care into the design and customisation of clinical information systems is a challenge and potentially counterproductive, because it could attempt to apply a technological fix to what is essentially a

  2. RM12-2703 Advanced Rooftop Unit Control Retrofit Kit Field Demonstration: Hawaii and Guam Energy Improvement Technology Demonstration Project

    Energy Technology Data Exchange (ETDEWEB)

    Doebber, I.; Dean, J.; Dominick, J.; Holland, G.

    2014-03-01

    As part of its overall strategy to meet its energy goals, the Naval Facilities Engineering Command (NAVFAC) partnered with U.S. Department of Energy's (DOE) National Renewable Energy Laboratory (NREL) to rapidly demonstrate and deploy cost-effective renewable energy and energy efficiency technologies. This was one of several demonstrations of new and underutilized commercial energy efficiency technologies. The consistent year-round demand for air conditioning and dehumidification in Hawaii provides an advantageous demonstration location for advanced rooftop control (ARC) retrofit kits to packaged rooftop units (RTUs). This report summarizes the field demonstration of ARCs installed on nine RTUs serving a 70,000-ft2 exchange store (large retail) and two RTUs, each serving small office buildings located on Joint Base Pearl Harbor-Hickam (JBPHH).

  3. Evaluation and Screening of Remedial Technologies for Uranium at the 300-FF-5 Operable Unit, Hanford Site, Washington

    Energy Technology Data Exchange (ETDEWEB)

    Nimmons, Michael J.

    2007-08-01

    Pacific Northwest National Laboratory (PNNL) is presently conducting a re-evaluation of remedies addressing persistent dissolved uranium concentrations in the upper aquifer under the 300 Area of the Hanford Site in southeastern Washington State. This work is being conducted as a Phase III feasibility study for the 300-FF-5 Operable Unit on behalf of the U.S. Department of Energy. As part of the feasibility study process, a comprehensive inventory of candidate remedial technologies was conducted by PNNL. This report documents the identification and screening of candidate technologies. The screening evaluation was conducted in accordance with guidance and processes specified by U.S. Environmental Protection Agency regulations associated with implementation of the Comprehensive Environmental Response, Compensation, and Liability Act process.

  4. The Impact of Population Ageing on Technological Progress and TFP Growth, with Application to United States: 1950-2050

    OpenAIRE

    Izmirlioglu, Yusuf

    2008-01-01

    I examine the effect of age-distribution of the society on economic growth through technological progress. I build a multisector economy model that involves population pyramid. I characterize the steady-state of the model for low and high population growth rate. Higher population growth rate yields faster TFP and output growth in the long-run. I analyze dynamic behavior of the economy. I calibrate the model for United States, 1950-2000 and using the estimated parameters I make predictions abo...

  5. Wind Technology, Cost, and Performance Trends in Denmark, Germany, Ireland, Norway, the European Union, and the United States: 2007 - 2012; NREL (National Renewable Energy Laboratory)

    Energy Technology Data Exchange (ETDEWEB)

    Hand, Maureen

    2015-06-15

    This presentation provides a summary of IEA Wind Task 26 report on Wind Technology, Cost, and Performance Trends in Denmark, Germany, Ireland, Norway, the European Union, and the United States: 2007-2012

  6. A strategy for nontimber forest products research and technology transfer for southern United States

    Science.gov (United States)

    James L. Chamberlain

    2003-01-01

    In mid-2001, the Southern Research Station (SRS) and the Southern Regional Office (R8) of the U.S. Forest Service worked through a 3-day facilitated discussion to develop a strategy to guide research and technology transfer on non-timber forest products (NTFPs). In all, more than 14 specialists took part in developing the strategy, representing the Forest Service...

  7. United States Offshoring of Information Technology: An Empirical Investigation of Factors Inhibiting Sub-Saharan Africa

    Science.gov (United States)

    Omoregie, Harry O.

    2012-01-01

    In the last decade, the global information technology offshoring (ITO) and business process outsourcing (BPO) services have grown significantly, especially in Asia. The increased demand for offshore services in Asia has presented a difficult problem for U.S. organizations because countries such as India are now experiencing saturation of labor…

  8. Testing Predictive Models of Technology Integration in Mexico and the United States

    Science.gov (United States)

    Velazquez, Cesareo Morales

    2008-01-01

    Data from Mexico City, Mexico (N = 978) and from Texas, USA (N = 932) were used to test the predictive validity of the teacher professional development component of the Will, Skill, Tool Model of Technology Integration in a cross-cultural context. Structural equation modeling (SEM) was used to test the model. Analyses of these data yielded…

  9. Identifying Disruptive Technologies Facing the United States in the Next 20 Years

    Science.gov (United States)

    2009-12-11

    believes that anandamine is the chemical ―most likely responsible for flow states.‖23 The article also talks of endorphins and the current theory is that...anandamine is the chemical that helps endorphins move in the brain.24 This technology has been studied for at least 30 years and the prediction on a

  10. Testing Predictive Models of Technology Integration in Mexico and the United States

    Science.gov (United States)

    Velazquez, Cesareo Morales

    2008-01-01

    Data from Mexico City, Mexico (N = 978) and from Texas, USA (N = 932) were used to test the predictive validity of the teacher professional development component of the Will, Skill, Tool Model of Technology Integration in a cross-cultural context. Structural equation modeling (SEM) was used to test the model. Analyses of these data yielded…

  11. Updating United States Advanced Battery Consortium and Department of Energy battery technology targets for battery electric vehicles

    Science.gov (United States)

    Neubauer, Jeremy; Pesaran, Ahmad; Bae, Chulheung; Elder, Ron; Cunningham, Brian

    2014-12-01

    Battery electric vehicles (BEVs) offer significant potential to reduce the nation's consumption of petroleum based products and the production of greenhouse gases however, their widespread adoption is limited largely by the cost and performance limitations of modern batteries. With recent growth in efforts to accelerate BEV adoption (e.g. the Department of Energy's (DOE) EV Everywhere Grand Challenge) and the age of existing BEV battery technology targets, there is sufficient motivation to re-evaluate the industry's technology targets for battery performance and cost. Herein we document the analysis process that supported the selection of the United States Advanced Battery Consortium's (USABC) updated BEV battery technology targets. Our technology agnostic approach identifies the necessary battery performance characteristics that will enable the vehicle level performance required for a commercially successful, mass market full BEV, as guided by the workgroup's OEM members. The result is an aggressive target, implying that batteries need to advance considerably before BEVs can be both cost and performance competitive with existing petroleum powered vehicles.

  12. Are Physicians Likely to Adopt Emerging Mobile Technologies? Attitudes and Innovation Factors Affecting Smartphone Use in the Southeastern United States

    Science.gov (United States)

    Putzer, Gavin J; Park, Yangil

    2012-01-01

    The smartphone has emerged as an important technological device to assist physicians with medical decision making, clinical tasks, and other computing functions. A smartphone is a device that combines mobile telecommunication with Internet accessibility as well as word processing. Moreover, smartphones have additional features such as applications pertinent to clinical medicine and practice management. The purpose of this study was to investigate the innovation factors that affect a physician's decision to adopt an emerging mobile technological device such as a smartphone. The study sample consisted of 103 physicians from community hospitals and academic medical centers in the southeastern United States. Innovation factors are elements that affect an individual's attitude toward using and adopting an emerging technology. In our model, the innovation characteristics of compatibility, job relevance, the internal environment, observability, personal experience, and the external environment were all significant predictors of attitude toward using a smartphone. These influential innovation factors presumably are salient predictors of a physician's attitude toward using a smartphone to assist with clinical tasks. Health information technology devices such as smartphones offer promise as a means to improve clinical efficiency, medical quality, and care coordination and possibly reduce healthcare costs. PMID:22737094

  13. Are physicians likely to adopt emerging mobile technologies? Attitudes and innovation factors affecting smartphone use in the Southeastern United States.

    Science.gov (United States)

    Putzer, Gavin J; Park, Yangil

    2012-01-01

    The smartphone has emerged as an important technological device to assist physicians with medical decision making, clinical tasks, and other computing functions. A smartphone is a device that combines mobile telecommunication with Internet accessibility as well as word processing. Moreover, smartphones have additional features such as applications pertinent to clinical medicine and practice management. The purpose of this study was to investigate the innovation factors that affect a physician's decision to adopt an emerging mobile technological device such as a smartphone. The study sample consisted of 103 physicians from community hospitals and academic medical centers in the southeastern United States. Innovation factors are elements that affect an individual's attitude toward using and adopting an emerging technology. In our model, the innovation characteristics of compatibility, job relevance, the internal environment, observability, personal experience, and the external environment were all significant predictors of attitude toward using a smartphone. These influential innovation factors presumably are salient predictors of a physician's attitude toward using a smartphone to assist with clinical tasks. Health information technology devices such as smartphones offer promise as a means to improve clinical efficiency, medical quality, and care coordination and possibly reduce healthcare costs.

  14. Surgical research using national databases.

    Science.gov (United States)

    Alluri, Ram K; Leland, Hyuma; Heckmann, Nathanael

    2016-10-01

    Recent changes in healthcare and advances in technology have increased the use of large-volume national databases in surgical research. These databases have been used to develop perioperative risk stratification tools, assess postoperative complications, calculate costs, and investigate numerous other topics across multiple surgical specialties. The results of these studies contain variable information but are subject to unique limitations. The use of large-volume national databases is increasing in popularity, and thorough understanding of these databases will allow for a more sophisticated and better educated interpretation of studies that utilize such databases. This review will highlight the composition, strengths, and weaknesses of commonly used national databases in surgical research.

  15. UNITED STATES DEPARTMENT OF ENERGY WASTE PROCESSING ANNUAL TECHNOLOGY DEVELOPMENT REPORT 2007

    Energy Technology Data Exchange (ETDEWEB)

    Bush, S

    2008-08-12

    The Office of Environmental Management's (EM) Roadmap, U.S. Department of Energy--Office of Environmental Management Engineering & Technology Roadmap (Roadmap), defines the Department's intent to reduce the technical risk and uncertainty in its cleanup programs. The unique nature of many of the remaining facilities will require a strong and responsive engineering and technology program to improve worker and public safety, and reduce costs and environmental impacts while completing the cleanup program. The technical risks and uncertainties associated with cleanup program were identified through: (1) project risk assessments, (2) programmatic external technical reviews and technology readiness assessments, and (3) direct site input. In order to address these needs, the technical risks and uncertainties were compiled and divided into the program areas of: Waste Processing, Groundwater and Soil Remediation, and Deactivation and Decommissioning (D&D). Strategic initiatives were then developed within each program area to address the technical risks and uncertainties in that program area. These strategic initiatives were subsequently incorporated into the Roadmap, where they form the strategic framework of the EM Engineering & Technology Program. The EM-21 Multi-Year Program Plan (MYPP) supports the goals and objectives of the Roadmap by providing direction for technology enhancement, development, and demonstrations that will lead to a reduction of technical uncertainties in EM waste processing activities. The current MYPP summarizes the strategic initiatives and the scope of the activities within each initiative that are proposed for the next five years (FY2008-2012) to improve safety and reduce costs and environmental impacts associated with waste processing; authorized budget levels will impact how much of the scope of activities can be executed, on a year-to-year basis. As a result of the importance of reducing technical risk and uncertainty in the EM Waste

  16. Chronic unlimited recording electrocorticography-guided resective epilepsy surgery: technology-enabled enhanced fidelity in seizure focus localization with improved surgical efficacy.

    Science.gov (United States)

    DiLorenzo, Daniel J; Mangubat, Erwin Z; Rossi, Marvin A; Byrne, Richard W

    2014-06-01

    Epilepsy surgery is at the cusp of a transformation due to the convergence of advancements in multiple technologies. Emerging neuromodulatory therapies offer the promise of functionally correcting neural instability and obviating the need for resective or ablative surgery in select cases. Chronic implanted neurological monitoring technology, delivered as part of a neuromodulatory therapeutic device or as a stand-alone monitoring system, offers the potential to monitor patients chronically in their normal ambulatory setting with outpatient medication regimens. This overcomes significant temporal limitations, pharmacological perturbations, and infection risks inherent in the present technology comprising subacute percutaneous inpatient monitoring of presurgical candidates in an epilepsy monitoring unit. As part of the pivotal study for the NeuroPace Responsive Neurostimulation (RNS) System, the authors assessed the efficacy of the RNS System to control seizures in a group of patients with medically refractory epilepsy. Prior to RNS System implantation, these patients were not candidates for further resective surgery because they had temporal lobe epilepsy with bilateral temporal sources, frontal lobe reflex epilepsy with involvement of primary motor cortex, and occipital lobe epilepsy with substantial involvement of eloquent visual cortex. Without interfering with and beyond the scope of the therapeutic aspect of the RNS System study, the authors were able to monitor seizure and epileptiform activity from chronically implanted subdural and depth electrodes in these patients, and, in doing so, they were able to more accurately localize the seizure source. In 5 of these study patients, in whom the RNS System was not effective, the notion of resective surgery was revisited and considered in light of the additional information gleaned from the chronic intracranial recordings obtained from various permutations of electrodes monitoring sources in the frontal, temporal

  17. Tetrahydrofuran Unit Adopting Davy's Latest Maleic Anhydride Technology to Come Online

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    @@ The 1,4-butanediol (BDO)/tetrahydrofuran (THF) project constructed by the Blue Star (Nanjing) New Chemical Ma-terials Co., Ltd. adopting a whole package of the world's latest patented technology will come on-stream by the end of 2008. It is told that by that time Blue Star will rank among the global leaders in terms of quality of BDO and THF products, which can substitute for around 40% of imported high-quality products.

  18. Performance Evaluation Criteria and Analysis of Navigation Systems Using Inertial Measurement Unit Technology

    Science.gov (United States)

    2014-06-26

    level. The strapdown IMU mechanization relies on microelectromechanical systems ( MEMS ) technology for the accelerometer and gyroscope triads. The...every system, the outputs of the single-axis sensors that make up the accelerometer and gyroscope are used in conjunction with the navigation system...triads are stationary with respect to the IMU case; thus, the attitude is dead-reckoned numerically using the gyroscope data to provide the vehicle

  19. Past, present, and future activities in space power technology in the United States of America

    Science.gov (United States)

    Ambrus, Judith H.

    1987-01-01

    Space power technology research in the U.S. is examined. The objectives for advanced power systems are long life, safety, flexibility, modularity, growth capability, and autonomy. Research in the areas of photovoltaic arrays, electrical energy storage, and the development of solar dynamic power systems and radio thermal generators is described. The applications of advances in power generation, energy storage, and power management and distribution to the Space Station are discussed.

  20. Banana Bark as A Part of Acoustic Design Unit by Hybrid Technology Application

    Directory of Open Access Journals (Sweden)

    Maharani Dian Permanasari

    2014-10-01

    Full Text Available Abstract. Banana bark is one of tropical indigenous natural resources that can be used as main material for many products. Being a fast-growing renewable material, it is durable and has natural patterns that people find visually attractive. Naturally, its textures and patterns are its main values; therefore it has the potential to be developed further. This research is needed to optimize the growth of small craft industries of banana bark, including the community where production activities take place, and also to provide information or reference of banana bark utilizations. Previous experiments conclude that banana bark has porous structure, high flexibility, relatively water-resistant due to its natural wax coating that resists water droplets, unless being washed down immensely. Also, due to its softwood- and paper-like properties, ithas many possibilities to be formed and processed into various functional products, mostly as craft products. In the subsequent study, the research about the utilization of banana bark in small industries starting from the harvesting system, handling problems in raw material supply, applying proper technology in improving the material’s quality, improving the human-resource working culture by appropriate technologies, and also innovating the product’s designs. The recommended designs can be implemented to improve the performance and qualities of banana bark products.Keywords: applied technology; banana bark; renewable materials; design; sustainability.

  1. UNITED STATES DEPARTMENT OF ENERGY OFFICE OF ENVIRONMENTAL MANAGEMENT TECHNOLOGY DEVELOPMENT REPORT FISCAL YEAR 2010

    Energy Technology Data Exchange (ETDEWEB)

    Bush, S.

    2010-10-22

    The mission of the Department of Energy's (DOE's) Office of Environmental Management (EM) is to clean up the environmental legacy of nuclear weapons research and production during the Cold War. That mission includes cleaning up nuclear waste, contaminated groundwater and soil, nuclear materials, and contaminated facilities covering two million acres of land in thirty-five states. EM's principal program goals include timely completion of tank waste treatment facilities, reduction of the life-cycle costs and acceleration of the cleanup of the Cold War legacy, and reduction of the EM footprint. The mission of the EM Technology Innovation and Development program is to transform science and innovation into practical solutions to achieve the EM mission. During fiscal year 2010 (October 2009-September 2010), EM focused upon accelerating environmental cleanup by expeditiously filling identified gaps in available knowledge and technology in the EM program areas. This report describes some of the approaches and transformational technologies in tank waste processing, groundwater and soil remediation, nuclear materials disposition, and facility deactivation and decommissioning developed during fiscal year 2010 that will enable EM to meet its most pressing program goals.

  2. Status report on compact gasifier cogeneration units in Germany. Applications of the cogeneration gasifier technology; Stand kleintechnischer Vergaser-BHKW-Anlagen in Deutschland. Einsatz der BHKW-Vergasertechnologie

    Energy Technology Data Exchange (ETDEWEB)

    Zschunke, Tobias; Schuessler, Ingmar; Salomo, Bert [Hochschule Zittau/Goerlitz (Germany); Braekow, Dieter [Foerdergesellschaft Erneuerbare Energien e.V., Berlin (Germany); Treppe, Konrad [Technische Univ. Dresden (Germany). Inst. fuer Verfahrenstechnik und Umwelttechnik

    2010-07-01

    In contrast to biogas, the use of solid biomass with low water content in cogeneration units is lagging several years of development behind. A promising variant is a wood gas engine cogeneration unit. Different energy sources can be combined, e.g. in an Otto engine and a Stirling engine. The authors describe the technology for compact systems. (orig.)

  3. “Too busy to think, too tired to learn” - the attrition of the apprenticeship model of surgical training in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Andrea Kelly

    2006-04-01

    Full Text Available Abstract: This article examines the notion of apprenticeship as experienced by trainee surgeons within the modern NHS, and attempts to demonstrate some unintended consequences of managerial target setting upon the training process. It argues that this situation is made more critical by the lack of explicit standards and curriculum by which trainees may assess their progress, and also that the potential grafting of behaviourist competence-based training models onto older notions of apprenticeship will be inadequate to meet the need for an holistic account of the development of professional practice. Alternative theoretical perspectives are examined, in particular social accounts of shared and collaborative expertise such as Lave and Wenger’s “community of practice” and Vygotsky’s thinking on the “zone of proximal development” with its emphasis on a highly active pedagogic role for both mentor and peers. A parallel is also suggested with Leder’s work on therapeutic discourse, in the sense that both patient and trainee actively construct shared interpretative modes with the doctor-mentor. These accounts challenge the traditional model of medical education which assumes a linear hierarchy of learning, effectively ignoring the cyclic nature of surgical development, and the mutual learning needs of “new comers” and “old-timers”. In order to initiate the modelling of surgical development, it is suggested that: • a dynamic and non-linear view of progress is required; • the link between formal structured training and opportunistic learning “on the job” is crucial; • assessment strategies are needed that promote, rather than hinder, the learning that derives from reflective practice.

  4. Science and Technology Teachers' Opinions about Problems Faced While Teaching 8th Grade Science Unit "Force and Motion" and Suggestions for Solutions

    Science.gov (United States)

    Bozdogan, Aykut Emre; Uzoglu, Mustafa

    2015-01-01

    The aim of this study is to explore the problems encountered while teaching force and motion unit in 8th grade science and technology course from teachers' perspectives and offer solutions to eliminate these problems. The study was conducted with 248 science and technology teachers working in 7 regions in Turkey in 2012-2013 academic year.…

  5. Interdisciplinary Navigation Unit for Mathematics and Earth Science Using Geospatial Technology

    Science.gov (United States)

    Smaglik, S. M.; Harris, V.

    2006-12-01

    Central Wyoming College (CWC) is located northeast of the Wind River Mountains. Although many people find recreation in the wilderness and remote areas surrounding the area, people still lose their lives because they become lost or disoriented. Creating an interdisciplinary field-based curriculum unit within mathematics (MATH 1000) and earth science (GEOL 1070) courses for non-science and education majors, provides students an opportunity to develop critical thinking skills and quantitative literacy. It also provides some necessary skills for survival and an understanding of landscape formation and wilderness navigation using geoscience. A brief history of navigation, including the importance of finding latitude and longitude, and the fairly recent implementation of the Global Positioning System, precedes activities in which students learn to use a basic compass. In addition to learning how to adjust for magnetic declination they read topographic maps, specifically USGS quadrangles, and learn how to use the scale in the legend to verify calculations using the Pythagorean Theorem. Students learn how to estimate distance and time required for traveling a pre- determined distance while using dimensional analysis to convert from the English system to metric. They learn how to read and measure latitude and longitude, as well as universal transverse Mercator projection measurements (UTM's), to find their position. The basic mathematical skills are assessed through hands-on activities such as finding their location on a map using a compass, a GPS unit, and Google Earth, and using a combination of maps, compasses, and GPS units to navigate through a course. Our goal is to provide life-saving information to students while incorporating necessary core curriculum from both mathematics and earth science classes. We work to create field-based activities, as well as assessments, to insure that students who complete the course are prepared to safely enjoy the outdoors and are

  6. Advanced Motor Control Test Facility for NASA GRC Flywheel Energy Storage System Technology Development Unit

    Science.gov (United States)

    Kenny, Barbara H.; Kascak, Peter E.; Hofmann, Heath; Mackin, Michael; Santiago, Walter; Jansen, Ralph

    2001-01-01

    This paper describes the flywheel test facility developed at the NASA Glenn Research Center with particular emphasis on the motor drive components and control. A four-pole permanent magnet synchronous machine, suspended on magnetic bearings, is controlled with a field orientation algorithm. A discussion of the estimation of the rotor position and speed from a "once around signal" is given. The elimination of small dc currents by using a concurrent stationary frame current regulator is discussed and demonstrated. Initial experimental results are presented showing the successful operation and control of the unit at speeds up to 20,000 rpm.

  7. Comparison of Advanced Residential Water Heating Technologies in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Maguire, Jeff [National Renewable Energy Lab. (NREL), Golden, CO (United States); Fang, Xia [National Renewable Energy Lab. (NREL), Golden, CO (United States); Wilson, Eric [National Renewable Energy Lab. (NREL), Golden, CO (United States)

    2013-05-01

    In this study, gas storage, gas tankless, condensing, electric storage, heat pump, and solar water heaters were simulated in several different climates across the United States, installed in both conditioned and unconditioned space and subjected to several different draw profiles. While many pre-existing models were used, new models of condensing and heat pump water heaters were created specifically for this work. In each case modeled, the whole house was simulated along with the water heater to capture any interactions between the water heater and the space conditioning equipment.

  8. [da Vinci surgical system].

    Science.gov (United States)

    Watanabe, Gou; Ishikawa, Norihiro

    2014-07-01

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

  9. Occurrence of nosocomial methicillin-resistant Staphylococcus aureus as a marker for transmission in a surgical intensive care unit in China

    NARCIS (Netherlands)

    Chen, Yong; Zhao, Wei; Liu, Hui; Song, Qing; Wang, Yan; Zhao, Jingya; Zheng, Dongyu; Han, Xuelin; Hu, Xiaohua; Grundmann, Hajo; Han, Li

    2014-01-01

    In 2008, an intensive care unit (ICU) in a large Chinese hospital was moved from a 6-bed old ward to a 20-bed new ward. After the move, the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in patients and environmental sites decreased significantly, but the number of ICU-acquired cas

  10. Performance-Based Technology Selection Filter application report for Teledyne Wah Chang Albany Operable Unit Number One

    Energy Technology Data Exchange (ETDEWEB)

    Richardson, J.G.; Morrison, J.L.; Morneau, R.A.; O' Brien, M.C.; Rudin, M.J.

    1992-05-01

    This report summarizes the application of the Performance-Based Technology Selection Filter (PBTSF) developed for the Idaho National Laboratory's Buried Waste Integrated Demonstration Program as applied to remediation activities conducted at the Teledyne Wah Chang Albany (TWCA) Superfund Site, Operable Unit One. The remedial action at the TWCA Operable Unit One consisted of solidification, excavation, transportation, and monocell disposal of the contents of two sludge ponds contaminated with various inorganic and organic compounds. Inorganic compounds included low levels of uranium and radium isotopes, as well zirconium, hafnium, chromium, mercury, and nickel. Organic compounds included methylene chloride, 1,1,1-trichloroethane, 1,1-dichloroethane, tetrachloroethane, and hexachlorobenzene. Remediation began in June 1991, and was completed in November 1991. The TWCA Operable Unit One configuration option consisted of 15 functional subelements. Data were gathered on these subelements and end-to-end system operation to calculate numerical values for 28 system performance measures. These were then used to calculate a system performance score. An assessment was made of the availability and definitional clarity of these performance measures, applicability of PBTSF utility functions, and rollup methodology. The PBTSF scoring function worked well, with few problems noted in data gathering, utility function normalization, and scoring calculation. The application of this process to an actual in situ treatment and excavation technical process option clarified the specific terms and bounds of the performance score functions, and identified one problem associated with the definition of system boundary.

  11. Technologies for sorting, assaying, classifying, and certifying transuranic waste within the United States

    Energy Technology Data Exchange (ETDEWEB)

    Pound, D.G. (Idaho National Engineering Lab., Idaho Falls, ID (USA))

    1990-01-01

    At the Idaho National Engineering Laboratory (INEL), the Stored Waste Examination Pilot Plant (SWEPP) was developed to provide nondestructive examination and assay techniques for examining and certifying TRU wastes without opening the waste container. This technology was developed, primarily for stored TRU waste, to evaluate waste package compliance with Waste Disposal Acceptance Criteria and Transportation requirements prior to shipment. These techniques include real-time x-ray radiography, passive and active neutron assay, and ultrasonic container integrity examination. These techniques provide the necessary information to ensure safe transportation, handling, and disposal of the waste at the Waste Isolation Pilot Plant (WIPP). 1 ref., 3 figs.

  12. Technologies for sorting, assaying, classifying, and certifying transuranic waste within the United States

    Energy Technology Data Exchange (ETDEWEB)

    Pound, D.G. (Idaho National Engineering Lab., Idaho Falls (USA))

    1990-01-01

    At the Idaho National Engineering Laboratory (INEL), the Stored Waste Examination Pilot Plant (SWEPP) was developed to provide nondestructive examination and assay techniques for examining and certifying TRU wastes without opening the waste container. This technology was developed, primarily for stored TRU waste, to evaluate waste package compliance with Waste Disposal Acceptance Criteria and Transportation requirements prior to shipment. These techniques include real-time x-ray radiography, passive and active neutron assay, and ultrasonic container integrity examination. These techniques provide the necessary information to ensure safe transportation, handling, and disposal of the waste at the Waste Isolation Pilot Plant (WIPP). (orig.).

  13. CTS /Hermes/ - United States experiments and operations summary. [Communications Technology Satellite

    Science.gov (United States)

    Donoughe, P. L.; Hunczak, H. R.

    1977-01-01

    The U.S. experiments conducted with the Communications Technology Satellite, a joint Canadian-U.S. venture launched in 1976, are discussed. The 14/12 GHz frequencies employed by the 200-W transmitter on board the satellite provide two-way television and voice communications. Applications of the satellite in the categories of health care, community services and education are considered; experiments have also made use of the special properties of the super-high frequency band (e.g. link characterization and digital communications). Time-sharing of the 14/12 GHz communication between the U.S. and Canada has functioned well.

  14. Ultrasonic inspection technology development and search units design examples of practical applications

    CERN Document Server

    Brook, Mark V

    2012-01-01

    "Ultrasonic testing is a relatively new branch of science and industry. The development of ultrasonic testing started in the late 1920s. At the beginning, the fundamentals of this method were borrowed from basic physics, geometrical and wave optics, acoustics and seismology. Later it became clear that some of these theories and calculation methods could not always explain the phenomena observed in many specific cases of ultrasonic testing. Without knowing the nuances of the ultrasonic wave propagation in the test object it is impossible to design effective inspection technique and search units for it realization. This book clarifies the theoretical differences of ultrasonics from the other wave propagation theories presenting both basics of physics in the wave propagation, elementary mathematic and advanced practical applications. Almost every specific technique presented in this book is proofed by actual experimental data and examples of calculations"--

  15. Comparison of metoprolol tartrate multiple-unit lipid matrix systems produced by different technologies.

    Science.gov (United States)

    Aleksovski, Aleksandar; Van Bockstal, Pieter-Jan; Roškar, Robert; Sovány, Tamás; Regdon, Géza; De Beer, Thomas; Vervaet, Chris; Dreu, Rok

    2016-06-10

    The aim of this study was to develop, evaluate and compare extended release mini-matrices based on metoprolol tartrate (MPT) and either glyceryl behenate (GB) or glyceryl palmitostearate (GPS). Mini-matrices were produced by three different techniques: hot melt extrusion, compression of melt granulates and prilling. Hot-melt extrusion and compression of granules obtained from melted material proved to be reliable, robust and reproducible techniques with aim of obtaining extended release matrices. Prilling tended to be susceptible to increased melt viscosity. Direct compression was not applicable for mini-matrix production due to poor powder flow. In general MPT release from all matrices was affected by its loading and the size of the units/particles. Processing of GB-MPT mixtures by different techniques did not lead to different drug release rates and patterns, while in case of GPS differently obtained matrices provided diverse MPT release outcomes. Matrices based on GB tended to have higher porosity compared to ones composed of GPS and thus most of the GB-based formulations showed faster drug delivery. FT-IR analysis revealed no interactions between primary components used for matrix production and Raman mapping outlined uniform MPT distribution throughout the units. DSC and X-ray studies revealed significant changes in the crystallinity of glycerides after storage under room conditions (GPS samples) and at increased temperature (GB and GPS samples), which was correlated to the changes seen in drug release rate and pattern after storage. Media composition in general tended to insignificantly affect GB matrices, while in case of GPS matrices increasing the pH and presence of biorelevant compounds induced faster drug release.

  16. Comparing Single and Dual Console Systems in the Robotic Surgical Training of Graduating OB/GYN Residents in the United States

    Directory of Open Access Journals (Sweden)

    Emad Mikhail

    2016-01-01

    Full Text Available Objective. To assess the impact of a single versus dual console robotic system on the perceptions of program directors (PD and residents (RES towards robotic surgical training among graduating obstetrics and gynecology residents. Design. An anonymous survey was developed using Qualtrics, a web-based survey development and administration system, and sent to obstetrics and gynecology program directors and graduating residents. Participants. 39 program directors and 32 graduating residents (PGY4. Results. According to residents perception, dual console is utilized in about 70% of the respondents’ programs. Dual console system programs were more likely to provide a robotics training certificate compared to single console programs (43.5% versus 0%, p=0.03. A greater proportion of residents graduating from a dual console program perform more than 20 robotic-assisted total laparoscopic hysterectomies, 30% versus 0% (p=0.15. Conclusions. Utilization of dual console system increased the likelihood of obtaining robotic training certification without significantly increasing the case volume of robotic-assisted total laparoscopic hysterectomy.

  17. Comparing Single and Dual Console Systems in the Robotic Surgical Training of Graduating OB/GYN Residents in the United States.

    Science.gov (United States)

    Mikhail, Emad; Salemi, Jason L; Hart, Stuart; Imudia, Anthony N

    2016-01-01

    Objective. To assess the impact of a single versus dual console robotic system on the perceptions of program directors (PD) and residents (RES) towards robotic surgical training among graduating obstetrics and gynecology residents. Design. An anonymous survey was developed using Qualtrics, a web-based survey development and administration system, and sent to obstetrics and gynecology program directors and graduating residents. Participants. 39 program directors and 32 graduating residents (PGY4). Results. According to residents perception, dual console is utilized in about 70% of the respondents' programs. Dual console system programs were more likely to provide a robotics training certificate compared to single console programs (43.5% versus 0%, p = 0.03). A greater proportion of residents graduating from a dual console program perform more than 20 robotic-assisted total laparoscopic hysterectomies, 30% versus 0% (p = 0.15). Conclusions. Utilization of dual console system increased the likelihood of obtaining robotic training certification without significantly increasing the case volume of robotic-assisted total laparoscopic hysterectomy.

  18. Impact of the FY 2009 Building Technologies Program on United States Employment and Earned Income

    Energy Technology Data Exchange (ETDEWEB)

    Livingston, Olga V.; Scott, Michael J.; Hostick, Donna J.; Dirks, James A.; Cort, Katherine A.

    2008-06-17

    The Department of Energy (DOE) Office of Energy Efficiency and Renewable Energy (EERE) is interested in assessing the potential economic impacts of its portfolio of subprograms on national employment and income. A special purpose input-output model called ImSET is used in this study of 14 Building Technologies Program subprograms in the EERE final FY 2009 budget request to the Office of Management and Budget in February 2008. Energy savings, investments, and impacts on U.S. national employment and earned income are reported by subprogram for selected years to the year 2025. Energy savings and investments from these subprograms have the potential of creating a total of 258,000 jobs and about $3.7 billion in earned income (2007$) by the year 2025.

  19. United States Supports Distributed Wind Technology Improvements; NREL (National Renewable Energy Laboratory)

    Energy Technology Data Exchange (ETDEWEB)

    Sinclair, Karin

    2015-06-15

    This presentation provides information on the activities conducted through the Competitiveness Improvement Project (CIP), initiated in 2012 by the U.S. Department of Energy (DOE) and executed through the National Renewable Energy Laboratory (NREL) to support the distributed wind industry. The CIP provides research and development funding and technical support to improve distributed wind turbine technology and increase the competitiveness of U.S. small and midsize wind turbine manufacturers. Through this project, DOE/NREL assists U.S. manufacturers to lower the levelized cost of energy of wind turbines through component improvements, manufacturing process upgrades, and turbine testing. Ultimately, this support is expected to lead to turbine certification through testing to industry-recognized wind turbine performance and safety standards.

  20. 高频电刀使用安全与质量控制中关键因素的分析%Analysis on key factors of safety in use and quality control for high frequency surgical unit

    Institute of Scientific and Technical Information of China (English)

    徐恒; 田金; 许锋

    2014-01-01

    Objective: To analysis the key factors of quality control for high frequency surgical unit to provide reference to ensure accurate and standard. Methods:To analysis the details of quality control on protective earth impendence, resistor-capacitor network, test error on definition, structure, magnitude and other aspects. Results:To master the key factors of quality control is important for the promotion of operability of the quality control work and decrease the using risk, and then to improve the quality of medical services ensure the safety of patients and medical staff. Conclusion: To analysis the each key factor is important significance to the quality control for high frequency surgical unit.%目的:分析高频电刀质量控制中的各个关键因素,为质量控制工作提供具体参考,以保证质量控制的准确和规范。方法:从保护接地阻抗、阻容网络及测试误差等因素的定义、结构、量值及其他方面分析质量控制细节。结果:掌握高频电刀质量控制中的各个关键因素后,提高其可操作性,有效降低使用风险,提高医疗服务质量,保障患者和使用人员安全。结论:分析各个关键因素,对全面深入地做好高频电刀的质量控制工作具有重要意义。

  1. Risk of Ectopic Pregnancy Associated With Assisted Reproductive Technology in the United States, 2001–2011

    Science.gov (United States)

    Perkins, Kiran M.; Boulet, Sheree L.; Kissin, Dmitry M.; Jamieson, Denise J.

    2015-01-01

    OBJECTIVE To assess national trends in ectopic pregnancy incidence among assisted reproductive technology users and identify risk factors associated with ectopic pregnancy. METHODS We identified 553,577 pregnancies reported to the National ART Surveillance System between 2001 and 2011. Of those, 9,480 were ectopic, of which 485 were heterotopic. As a result of small numbers, ectopic and heterotopic pregnancies were combined for analysis. We assessed temporal trends in annual ectopic pregnancy rates using Poisson regression. We used log-binomial regression models with generalized estimating equations for correlated outcomes within clinics to calculate unadjusted and adjusted risk ratios for the association between ectopic pregnancy and selected patient characteristics and treatment factors. RESULTS The rate of ectopic pregnancy declined from 2.0% (n5735, 95% confidence interval [CI] 1.9–2.2) in 2001 to 1.6% (n=968, 95% CI 1.5–1.7) in 2011 (P for trend ,.001). The ectopic pregnancy rate ranged from 2.0% (n=7,469, 95% CI 1.9–2.0) for fresh, nondonor cycles to 1.0% (n=641, 95% CI 0.9–1.1) for fresh, donor cycles. Among fresh, nondonor cycles, the rate of ectopic pregnancy was 1.6% (95% CI 1.4–1.7) when one embryo was transferred compared with 1.7% (95% CI 1.7–1.8), 2.2% (95% CI 2.1–2.3), and 2.5% (95% CI 2.4–2.6) when two, three, or four or more embryos were transferred, respectively (adjusted risk ratios 1.11, 95% CI 0.94–0.30; 1.33, 95% CI 1.12–1.56; and 1.49, 95% CI 1.25–1.78). CONCLUSION Ectopic pregnancy incidence after assisted reproductive technology has decreased over time, but factors such as multiple embryo transfer increase the risk of ectopic pregnancy. PMID:25560107

  2. Industrial Sector Technology Use Model (ISTUM): industrial energy use in the United States, 1974-2000. Volume 4. Technology appendix. Final Report

    Energy Technology Data Exchange (ETDEWEB)

    1979-10-01

    Volume IV of the ISTUM documentation gives information on the individual technology specifications, but relates closely with Chapter II of Volume I. The emphasis in that chapter is on providing an overview of where each technology fits into the general-model logic. Volume IV presents the actual cost structure and specification of every technology modeled in ISTUM. The first chapter presents a general overview of the ISTUM technology data base. It includes an explanation of the data base printouts and how the separate-cost building blocks are combined to derive an aggregate-technology cost. The remaining chapters are devoted to documenting the specific-technology cost specifications. Technologies included are: conventional technologies (boiler and non-boiler conventional technologies); fossil-energy technologies (atmospheric fluidized bed combustion, low Btu coal and medium Btu coal gasification); cogeneration (steam, machine drive, and electrolytic service sectors); and solar and geothermal technologies (solar steam, solar space heat, and geothermal steam technologies), and conservation technologies.

  3. The adjusting mining technology of combining fully mechanized with individual prop, rotating, hilt, irregular form, and double unit face on thin coal seam of Tianchen Mine

    Institute of Scientific and Technical Information of China (English)

    SONG Hua-ling; WEN Guo-feng; LI Jin-ke

    2008-01-01

    Analyzed the situations and characteristics of thin coal seam mining and its mining technologies, and introduced the mining innovation technology used by Tianchen Coal Mine of Zhaozhuang Coal Company of China. This innovation technology combined the fully mechanized mining with individual props, and the working face of mining is over length, irregular form and double units. The rotational adjusting mining technology on thin coal seam is also practiced in this new mining technology. The detail technologies, such as outlays of working face and ways, mining methods, equipments of cutting, transporting and sporting, have been introduced. So that, using the synthetic and creative mining tech-nologies, Tianchen Coal Mine solves the mining problems of thin coal seam successfully.

  4. An Analysis of Information Technology Adoption by IRBs of Large Academic Medical Centers in the United States.

    Science.gov (United States)

    He, Shan; Botkin, Jeffrey R; Hurdle, John F

    2015-02-01

    The clinical research landscape has changed dramatically in recent years in terms of both volume and complexity. This poses new challenges for Institutional Review Boards' (IRBs) review efficiency and quality, especially at large academic medical centers. This article discusses the technical facets of IRB modernization. We analyzed the information technology used by IRBs in large academic institutions across the United States. We found that large academic medical centers have a high electronic IRB adoption rate; however, the capabilities of electronic IRB systems vary greatly. We discuss potential use-cases of a fully exploited electronic IRB system that promise to streamline the clinical research work flow. The key to that approach utilizes a structured and standardized information model for the IRB application.

  5. Development of the Novel Grid Type Multi-stage Regeneration Technology for FCC Unit

    Institute of Scientific and Technical Information of China (English)

    Zhang Zhenqian; Tian Geng

    2006-01-01

    Based on the results of cold model tests, LPEC has developed a technology for regeneration of FCC catalyst in a regenerator with novel grid type internals in order to intensify the contact between gas and solid and enhance the coke burning efficiency in the regenerator. Test results have revealed that the density change in the fluidized bed equipped with grid internals is relatively homogeneous and the bubbling frequency is obviously reduced with apparent improvements in the dead fluidized zone adjacent to the regenerator wall, and this device can be applied to the intensified regeneration of catalyst in the FCC regenerator.The commercial application of this device in a 0.8 Mt/a RFCCU at the refinery A had indicated that the carbon content of regenerated catalyst was reduced to 0.03% from 0.18%, and the amount of coke burned was increased by 5% with a definite reduction in main air consumption of the regenerator and some density reduction in the dilute phase section of the regenerator.

  6. Science, Technology and Innovation through Entrepreneurship Education in the United Arab Emirates (UAE

    Directory of Open Access Journals (Sweden)

    Irfan Hameed

    2016-12-01

    Full Text Available The purpose of this study is to investigate the ways of achieving Science, Technology and Innovation (STI in UAE. Previously, sustainability within an entrepreneurship context has been related to economic viability as opposed to sustainability in its broadest sense. Through a survey research method, we have highlighted the effects of three independent variables and two intervening variables on three important outcomes, innovation, need for achievement and motivation, which ultimately contributes towards STI. These data have been collected from the students of a well-known university in Al-Ain, UAE. The responses of 251 students have been utilized for analysis. For hypotheses testing, we used AMOS 18 (Structural Equation Modeling and SPSS 20. The study revealed that all of the predictors have a strong effect on the outcome variables, which leads to STI in UAE. There is a strong need to revise the curriculum of higher education institutions of UAE to develop self-confidence, locus of control and risk taking propensity among students. The study provides novel insight into entrepreneurship education and serves as an initial benchmark in the field.

  7. Comparison of surgical outcomes among infants in neonatal intensive care units treated by pediatric surgeons versus general surgeons: The need for pediatric surgery specialists.

    Science.gov (United States)

    Boo, Yoon Jung; Lee, Eun Hee; Lee, Ji Sung

    2017-01-31

    This study compared the outcomes of infants who underwent surgery in neonatal intensive care units by pediatric surgeons and by general surgeons. This was a retrospective study of infants who underwent surgery in neonatal intensive care units between 2010 and 2014. A total of 227 patients were included. Of these patients, 116 were operated on by pediatric surgeons (PS) and 111 were operated on by general surgeons (GS). The outcome measures were the overall rate of operative complications, unplanned reoperation, mortality rate, length of stay, operative time, and number of total number of operative procedures. The overall operative complication rate was higher in the GS group compared with the PS group (18.7% vs. 7.0%, p=0.0091). The rate of unplanned reoperations was also higher in the GS group (10.8% vs. 3.5%, p=0.0331). The median operation time (90min vs. 75min, p=0.0474) and median length of stay (24days vs. 18days, p=0.0075) were significantly longer in the GS group. The adjusted odd ratios of postoperative complications for GS were 2.9 times higher than that of PS (OR 2.90, p=0.0352). The operative quality and patient outcomes of the PS group were superior to those of the GS group. III. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Behind the Curtain: Keeping Surgical Patients Warmer Fights Infection

    Science.gov (United States)

    ... Cleveland Clinic, Ohio Photo courtesy of NIGMS Keeping Surgical Patients Warmer Fights Infection As recently as the mid- ... His research led to a new conclusion: Keep surgical patients warm. No new drugs, no fancy technology. Warming ...

  9. Public engagement in health technology assessment and coverage decisions: a study of experiences in France, Germany, and the United Kingdom.

    Science.gov (United States)

    Kreis, Julia; Schmidt, Harald

    2013-02-01

    In the United States and internationally, the trend for public engagement in health policy and practice is increasing, particularly regarding health technology assessment (HTA), which informs often controversial coverage decisions. However, there is no consensus about which members of the public should be involved in which processes or what the respective rationales and benefits of public engagement are. This article explores operational processes and underlying rationales of public engagement at HTA agencies in France, Germany, and the United Kingdom. The analysis is based on website information, legal framework documents, published and gray literature, and semistructured, in-depth interviews with top officials at these agencies. Engagement processes differ across agencies, particularly regarding the areas in which the public is involved, which groups of the public are involved, what weight they have in influencing decisions, how they are recruited and supported, and how potential conflicts of interests are addressed. Different emphases on rationales and drivers behind public engagement partly reflect the respective political environments. Interviewees indicated a range of benefits of engagement and factors influencing success or failure. The results highlight the need to be clear about the purpose and conduct of engagement in order to maximize the benefits of this increasingly widespread policy tool.

  10. Low-impact sampling under an active solid low-level radioactive waste disposal unit using horizontal drilling technology

    Energy Technology Data Exchange (ETDEWEB)

    Puglisi, C.V.; Vold, E.L.

    1995-12-01

    The purpose of this project was to determine the performance of the solid low-level radioactive waste (LLRW) disposal units located on a mesa top at TA-54, Area G, Los Alamos National Laboratory (LANL), Los Alamos, NM, and to provide in-situ (vadose zone) site characterization information to Area G`s Performance Assessment. The vadose zone beneath an active disposal unit (DU 37), was accessed by utilizing low-impact, air-rotary horizontal drilling technology. Core samples were pulled, via wire-line core method, in 3 horizontal holes fanning out below DU 37 at approximately 5 foot intervals depending on recovery percentage. Samples were surveyed and prepared in-field following Environmental Restoration (ER) guidelines. Samples were transferred from the field to the CST-9 Radvan for initial radiological screening. Following screening, samples were delivered to CST-3 analytical lab for analyses including moisture content, 23 inorganics, 60 volatile organic compounds (VOC`s), 68 semivolatile organic compounds (SVOC`s), tritium, lead 210, radium 226 & 228, cesium 137, isotopic plutonium, americium 241, strontium 90, isotopic uranium, and isotopic thorium. Other analyses included matric potential, alpha spectroscopy, gamma spectroscopy, and gross alpha/beta. The overall results of the analysis identified only tritium as having migrated from the DU. Am-241, Eu-152, and Pu-238 were possibly identified above background but the results are not definitive. Of all organics analysed for, only ethyl acetate was tentatively identified slightly above background. All inorganics were found to be well below regulatory limits. Based on the results of the above mentioned analyses, it was determined that Area G`s disposal units are performing well and no significant liquid phase migration of contaminants has occurred.

  11. The Integration of Technology and Management in the Competitiveness of the United States Short Staple Yarn Manufacturing Industry

    Directory of Open Access Journals (Sweden)

    Suvalee T. Tangboonritruthai

    2014-01-01

    Full Text Available The purpose of this research was to investigate whether a balance of technology and management could be used in order to sustain a viable United States (US short staple yarn production industry. The methodology used in this study consisted of primary research comprising two phases. The first phase consisted of interviews with industry executives in order to find out what US yarn manufacturers think are the important factors in maintaining a competitive yarn industry. The second phase was an online survey with industry customers in order to find out why weavers and knitters buy from US manufacturers. Results reveal that US manufacturers have competitive advantages over other countries because of skill level of workforce, variety of products offered, customer relationships, innovation and technology, and product quality. In order to keep these competitive advantages, “technology” and “management” strategies should be implemented. Results also reveal the areas in which the US yarn manufacturers should focus their resources in order to stay competitive or indeed survive.

  12. Distribution of male infertility specialists in relation to the male population and assisted reproductive technology centers in the United States.

    Science.gov (United States)

    Nangia, Ajay K; Likosky, Donald S; Wang, Dongmei

    2010-07-01

    To describe the spatial distribution of assisted reproductive technology (ART) centers and male infertility specialists by location, driving distance from ART center, and potential male population in need of these resources. Cross-sectional study. Male population in the reproductive years (20-49 years old) based on U.S. Census Bureau data in 2000. Urology male infertility specialists as defined by 2005 specialty society membership directories. ART centers registered with the Society for Assisted Reproductive Technology in 2005. Male population and male infertility specialists within the service area served by in-state and neighboring-state ART centers, as defined by a 60-minute travel time. One hundred ninety-seven male infertility specialists and 390 ART centers were identified. On a state level, the highest male population in the reproductive years was seen in California, Texas, and Florida. The highest male populations per male specialist were found in Oregon, Tennessee, and Oklahoma. The highest number of ART centers per male specialist was found in Tennessee. The highest proximities of male specialists within the 60-minute driving service area of different ART centers were found in the North East and Southern California. The Midwest to Northwest had the least. A disparity of urology male infertility specialists exists in the United States, with large areas of the country being underserved and overserved based on the location of ART centers. Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  13. Medical-Surgical II. Teacher Edition.

    Science.gov (United States)

    Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

    This publication is designed to provide students with the knowledge they need to pursue a career in medical-surgical nursing. Fifteen units are provided. Each instructional unit includes some or all of the basic components of a unit of instruction: performance objectives, suggested activities for the teacher, information sheets, job sheets,…

  14. Medical-Surgical I. Teacher Edition.

    Science.gov (United States)

    Oklahoma State Dept. of Vocational and Technical Education, Stillwater. Curriculum and Instructional Materials Center.

    This publication is designed to provide students with the knowledge they need to pursue a career in medical-surgical nursing. Eight units are provided. Each instructional unit includes some or all of the basic components of a unit of instruction: performance objectives, suggested activities for the teacher, information sheets, job sheets, written…

  15. Technology diffusion of anesthesia information management systems into academic anesthesia departments in the United States.

    Science.gov (United States)

    Stol, Ilana S; Ehrenfeld, Jesse M; Epstein, Richard H

    2014-03-01

    Anesthesia information management systems (AIMS) are electronic health records that automatically import vital signs from patient monitors and allow for computer-assisted creation of the anesthesia record. When most recently surveyed in 2007, it was estimated that at least 16% of U.S. academic hospitals (i.e., with an anesthesia residency program) had installed an AIMS. At least an additional 28% reported that they were in the process of implementing, or searching for an AIMS. In this study, we updated the adoption figures as of May 2013 and examined the historical trend of AIMS deployment in U.S. anesthesia residency programs from the perspective of the theory of diffusion of technologic innovations. Questionnaires were sent by e-mail to program directors or their identified contact individuals at the 130 U.S. anesthesiology residency programs accredited as of June 30, 2012 by the Accreditation Council for Graduate Medical Education. The questionnaires asked whether the department had an AIMS, the year of installation, and, if not present, whether there were plans to install an AIMS within the next 12 months. Follow-up e-mails and phone calls were made until responses were obtained from all programs. Results were collected between February and May 2013. Implementation percentages were determined using the number of accredited anesthesia residency programs at the start of each academic year between 1987 and 2013 and were fit to a logistic regression curve using data through 2012. Responses were received from all 130 programs. Eighty-seven (67%) reported that they currently are using an AIMS. Ten programs without a current AIMS responded that they would be installing an AIMS within 12 months of the survey. The rate of AIMS adoption by year was well fit by a logistic regression curve (P = 0.90). By the end of 2014, approximately 75% of U.S. academic anesthesiology departments will be using an AIMS, with 84% adoption expected between 2018 and 2020. Historical adoption

  16. Investigation on the application of radio frequency identification technology in the pasteurization of surgical devices%无线射频识别技术在手术灭菌器械管理中的应用研究

    Institute of Scientific and Technical Information of China (English)

    马俊; 汤维娟; 侯斌

    2014-01-01

    目的:调查无线射频识别( RFID)技术在我院使用的现状,为进一步推广使用提供依据。方法选取2013年6月本院消毒供应中心、手术室及病房262名工作人员,采取自制问卷进行调查,问卷Cronbach′s α系数为0.824。结果 RFID技术使用最多的为消毒供应中心及手术室。66.96%的使用者认为RFID“操作简便”,80.18%认为“使器械管理更规范”,80.36%认为RFID“能确保每个环节质量”,75.9%认为RFID技术的“器械包追溯功能”给临床带来的帮助最大,71.4%认为RFID技术优于传统器械管理在于“信息核对准确”。另外,RFID技术还需要在速度、信息上传点、标签管理等方面进行改进。结论 RFID技术能增加规范化管理,提升工作效率,保证工作质量,在临床使用取得良好的效果。%Objective To investigate the application of radio frequency identification ( RFID) in clinical practice in our hos-pital, so as to provide evidence for further extension of FRID technology.Methods Two hundred and sixty-two nurses from the central pasteurization and supply center ( CSSC) , the surgical suites and wards of the hospital in June 2013 were surveyed by a questionnaire developed by ourselves.The Cronbach′s αof the questionnaire was 0.824.Results FRID technology was used most frequently in the central pasteurization and supply center and surgical suites.66.96%of the people thought RFID was easy to operate, 80.18%of them held that it made surgical management more standard, and 80.36%agreed that the FRID technology could ensure the quality of all the links in the work.75.9%of the people surveyed had the opinion that the tracing function of the surgical kit inherent in the FRID tech-nology was most helpful to clinical work.And 71.4% of the people thought the superiority of RFID over conventional surgical device management lied in the accuracy of information check.However, further

  17. Initial medical management of rotator cuff tears: a demographic analysis of surgical and nonsurgical treatment in the United States Medicare population.

    Science.gov (United States)

    Varkey, Dax T; Patterson, Brendan M; Creighton, R Alexander; Spang, Jeffrey T; Kamath, Ganesh V

    2016-12-01

    Rotator cuff tears have a lifetime incidence between 25% and 40% in the United States, but optimum treatment strategies and protocol have not yet been widely accepted. This study evaluated the proportions of patients treated with nonoperative and operative modalities and how this proportion has changed during an 8-year period (2005-2012) among patients with Medicare. Using the PearlDiver patient record database, we identified Medicare patients having been diagnosed with a rotator cuff tear. These patients were then stratified on the basis of treatment with physical therapy, subacromial/glenohumeral injection, or rotator cuff repair. We analyzed the data in regard to standard demographic information, comorbidities, and the Charlson Comorbidity Index. During the study period, 878,049 patients were identified and 397,116 patients had rotator cuff repair. The proportion of patients treated initially with physical therapy dropped from 30.0% in 2005 to 13.2% in 2012, and the subacromial/glenohumeral injection proportion decreased from 6.00% to 4.19% (P rotator cuff repair increased from 33.8% to 40.4% from 2005 to 2012 (P rotator cuff repair had fewer comorbidities than those undergoing nonoperative treatments. It also demonstrates that patients who had a trial of injection had a higher incidence of eventual rotator cuff repair compared with the patients with an initial trial of physical therapy. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  18. DEVELOPMENT OF THEORY AND METHODS OF USE OF INFORMATION AND COMMUNICATION TECHNOLOGIES IN TEACHING MATHEMATICS OF ENGINEERING SPECIALITIES STUDENTS IN THE UNITED STATES

    OpenAIRE

    Nataliia M. Kiianovska; Natalia V. Rashevska; Serhii O. Semerikov

    2014-01-01

    The article deals with the problems of information and communication technologies (ICT) development in teaching mathematics of engineering specialities students in the United States. In the article the nature of trends of convergence of information system in higher technical education and other tendencies in the USA are сharacterized. The main historical stages of development of the theory and methods of ICT use in teaching mathematics of engineering specialities students in the United States...

  19. Governing new technology: A comparative analysis of government support for nanotechnology in the Netherlands and the United States

    Science.gov (United States)

    Eijmberts, Johannes

    This study examines this variance in national government support for nanotechnology---its shape, size, and policy priorities---by comparing the United States and the Netherlands. Our operating hypothesis is that national government support for nanotechnology development is driven not by the intrinsic nature of the technology but by longstanding structural and institutional arrangements. That is, in the U.S., pluralist political traditions and reliance on classical liberal market economics would suggest a detached national government approach, leaving any initiative to market actors. At the same time, legacies of corporatism in the Dutch political system and a tradition of greater direct government involvement in the national economy would suggest a government-led policy on nanotechnology development. The findings show otherwise. Early on, the U.S. government established the National Nanotechnology Initiative, an overarching federal mechanism to promote and coordinate nanotechnology development. Yet, despite its appearance of central direction and coordination, the NNI reflected pluralist arrangements by leaving ample autonomy for participating federal departments and agencies. The creation of the NNI was driven particularly by concerns of about foreign challenges to American global leadership in science and technology. In the Netherlands, by contrast, the path taken shows the legacy of Dutch corporatist practice---slow, incremental, and embedded in pre-existing institutional arrangements. The Dutch government initially took no directive role, relying instead on established links among universities, public research funding organizations, and industries to advance nanotechnology development in the Netherlands. However, over time, Dutch government involvement in nanotechnology grew to be more supportive, sizeable, comprehensive, and directive---particulary by requiring substantial investments in risk-related research as a condition for public funding and, notably, by

  20. Prevention of Heel Pressure Injuries and Plantar Flexion Contractures With Use of a Heel Protector in High-Risk Neurotrauma, Medical, and Surgical Intensive Care Units: A Randomized Controlled Trial.

    Science.gov (United States)

    Meyers, Tina

    The purpose of this study was to compare the use of a heel protector to standard of care (pillows) in the prevention of hospital-acquired pressure injuries (HAPI) of the heels and prevention of plantar flexion contractures. Randomized controlled trial. The study took place on a surgical intensive care unit, medical intensive care unit, and neurotrauma intensive care unit. Inclusion criteria were a minimum of 5 days of sedation related to care for a critical illness, immobility for 6 to 8 hours before study initiation, a Braden Scale for Pressure Sore Risk score 18 or less, and a mobility subscale score 2 or less. Patients were included if they had preexisting heel pressure injury or plantar flexion contracture. The sample comprised 54 subjects; 37 were randomly allocated to the intervention group and 17 to the control group. Their average age-mean (standard deviation)-was 40.7 (14.96) years in the control group and 44.6 (17.15) years in the intervention group. Data were collected from patients' electronic medical records. We recorded subject demographics, presence of diabetes mellitus or peripheral vascular disease, Glasgow Coma Scale scores (every shift), Braden Scale for Pressure Sore Risk scores (every shift), heel skin assessments (every shift), goniometric measurements (every other day), and adverse events (every shift). Assessments and measurements were continued until the patient was discharged from the study. None of the patients in the intervention group developed HAPI of the heels, as compared to 7 in the control group (0% vs 41%, P prevention of HAPI of the heel and contractures as compared to standard care using pillows to position the heel and redistribute pressure.

  1. Evolution of surgical skills training

    Institute of Scientific and Technical Information of China (English)

    Kurt E Roberts; Robert L Bell; Andrew J Duffy

    2006-01-01

    Surgical training is changing: one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients.Simulation training can be as straight forward as using real instruments and video equipment to manipulate simulated "tissue" in a box trainer. More advanced,virtual reality simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations.The Accreditation Council of Graduate Medical Education's (ACGME) has mandated the development of novel methods of training and evaluation. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and to credential surgeons as technically competent.Simulators in their current form have been demonstrated to improve the operating room performance of surgical residents. Development of standardized training curricula remains an urgent and important agenda, particularly for minimal invasive surgery.An innovative and progressive approach, borrowing experiences from the field of aviation, can provide the foundation for the next century of surgical training,ensuring the quality of the product. As the technology develops, the way we practice will continue to evolve, to the benefit of physicians and patients.

  2. Critical factors for bioenergy technology implementation. Five case studies of bioenergy markets in the United States, Sweden and Austria

    Energy Technology Data Exchange (ETDEWEB)

    Roos, Anders [Swedish Univ. of Agricultural Sciences, Uppsala (Sweden). Dept. of Forest-Industry-Market Studies

    1998-07-01

    This report analyses the driving forces of, and barriers to, biomass energy technology implementation with the objective of defining the most important factors behind the growth of bioenergy markets and suggesting strategies for policy makers and investors. The approach is to describe the important factors for the development of real bioenergy markets at two levels: (1) Institutional, primarily policy, and (2) market structure. Concepts from economic theory, primarily transaction cost theory and industrial organisation, are used in a qualitative way. The report is based on literature studies and field studies of bioenergy markets in three countries: the United States of America, Austria, and Sweden. It is divided into five sections. After the introduction in section one, literature with relevance for this study is reviewed in section two. In section three the energy policy and energy sectors of each country are described. The descriptions include an overview of the biomass energy sectors. Five cases of developed bioenergy markets in the three countries are presented in section four. The cases are residential heating with wood pellets in New Hampshire, United States, biomass power production in Maine, residential heating with pellets in Sweden, biomass district heating in Sweden, and biomass district heating in Austria. All markets are described in terms of the historical development, technical issues, economics, market structure and local policy influences. In the discussion in section five a number of key factors behind the success or failure of bioenergy are presented. Six factors are most important: (1) Complementaries between the bioenergy operations and another activity (for instance when the bioenergy production uses biomass waste products from another industry); (2) economics of scale within the bioenergy business through larger production series, standards, specialization etc.; (3) a competitive bioenergy market (Many sellers and buyers operate in the

  3. Epidemiologia e desfecho de pacientes cirúrgicos não cardíacos em unidades de terapia intensiva no Brasil Epidemiology and outcomes of non-cardiac surgical patients in Brazilian intensive care units

    Directory of Open Access Journals (Sweden)

    Suzana Margareth Lobo

    2008-12-01

    Full Text Available OBJETIVO: Devido aos avanços da medicina e ao envelhecimento da população, a proporção de pacientes em risco de morte após cirurgias está aumentando. Nosso objetivo foi avaliar o desfecho e a epidemiologia de cirurgias não cardíacas em pacientes admitidos em unidade de terapia intensiva. MÉTODOS: Estudo prospectivo, observacional, de coorte, realizado em 21 unidades de terapia intensiva. Um total de 885 pacientes adultos, cirúrgicos, consecutivamente admitidos em unidades de terapia intensiva no período de abril a junho de 2006 foi avaliado e destes, 587 foram incluídos. Os critérios de exclusão foram; trauma, cirurgias cardíacas, neurológicas, ginecológicas, obstétricas e paliativas. Os principais desfechos foram complicações pós-cirúrgicas e mortalidade na unidade de terapia intensiva e 90 dias após a cirurgia. RESULTADOS: Cirurgias de grande porte e de urgência foram realizadas em 66,4% e 31,7%, dos pacientes, respectivamente. A taxa de mortalidade na unidade de terapia intensiva foi de 15%, e 38% dos pacientes tiveram complicações no pós-operatório. A complicação mais comum foi infecção ou sepse (24,7%. Isquemia miocárdica foi diagnosticada em apenas 1,9%. Um total de 94 % dos pacientes que morreram após a cirurgia tinha co-morbidades associadas (3,4 ± 2,2. A principal causa de óbito foi disfunção de múltiplos órgãos (53%. CONCLUSÃO: Sepse é a causa predominante de morbidade em pacientes submetidos a cirurgias não cardíacas. A grande maioria dos óbitos no pós-operatório ocorreu por disfunção de múltiplos órgãos.OBJECTIVES: Due to the dramatic medical breakthroughs and an increasingly ageing population, the proportion of patients who are at risk of dying following surgery is increasing over time. The aim of this study was to evaluate the outcomes and the epidemiology of non-cardiac surgical patients admitted to the intensive care unit. METHODS: A multicenter, prospective, observational

  4. Task 2: Mild gasification technology development process research unit tests using slipstream sampling, February 1988--March 1990

    Energy Technology Data Exchange (ETDEWEB)

    Knight, R.A.; Gissy, J.; Onischak, M.; Babu, S.P.; Wootten, J.M.; Duthie, R.G.

    1990-07-01

    Under USDOE sponsorship, a project team consisting of the Institute of Gas Technology (IGT), Peabody Holding Company, Inc., and Bechtel Group is developing a process for the mild gasification of coal in a 100-pound/hour capacity isothermal process research unit (PRU) at IGT in Chicago. The IGT process is capable of converting bituminous coals to value-added co-products that can open new markets for the US coal industry. The conceptual IGT mild gasification process incorporates an integrated fluidized-/entrained-bed reactor supplying heat indirectly by a combination of char and gas recycle. The use of mild operating conditions (1000{degree} to 1300{degree}F), low pressures (<50 psig), and continuous operation in closed reactors, combined with the sale of value-added co-products, offer an environmentally sound and economical approach to advanced coal utilization. The PRU consists of an 8-inch-ID {times} 8-foot-long fluidized-bed reactor closely coupled to a 4-inch-ID {times} 13-foot-long entrained-bed reactor. The PRU test results have demonstrated process performance, including the effect of coal type and temperature on mild gasification co-product yields and their properties. The fates of the heteroatoms have also been analyzed. 9 refs., 16 figs., 41 tabs.

  5. Assistive Technology Needs, Functional Difficulties, and Services Utilization and Coordination of Children with Developmental Disabilities in the United States.

    Science.gov (United States)

    Lin, Sue C; Gold, Robert S

    2017-01-31

    Assistive technology (AT) enhances the ability of individuals with disabilities to be fully engaged in activities at home, at school, and within their communities-especially for children with developmental disabilities (DD) with physical, sensory, learning, and/or communication impairments. The prevalence of children with DD in the United States has risen from 12.84% in 1997 to 15.04% in 2008. Thus, it is important to monitor the status of their AT needs, functional difficulties, services utilization, and coordination. Using data from the 2009-2010 National Survey on Children with Special Health Care Needs (NS-CSHCN), we conducted bivariate and multivariate statistical analysis, which found that 90% or more of parents of both children with DD and other CSHCN reported that their child's AT needs were met for vision, hearing, mobility, communication, and durable medical equipment; furthermore, children with DD had lower odds of AT needs met for vision and hearing and increased odds for meeting AT needs in mobility and communication. Our findings outline the current AT needs of children with DD nationally. Fulfilling these needs has the potential to engender positive lifelong effects on the child's disabilities, sense of independence, self-confidence, and productivity.

  6. Wireless sensor and data transmission needs and technologies for patient monitoring in the operating room and intensive care unit.

    Science.gov (United States)

    Paksuniemi, M; Sorvoja, H; Alasaarela, E; Myllyla, R

    2005-01-01

    In the intensive care unit, or during anesthesia, patients are attached to monitors by cables. These cables obstruct nursing staff and hinder the patients from moving freely in the hospital. However, rapidly developing wireless technologies are expected to solve these problems. To this end, this study revealed problem areas in current patient monitoring and established the most important medical parameters to monitor. In addition, usable wireless techniques for short-range data transmission were explored and currently employed wireless applications in the hospital environment were studied. The most important parameters measured of the patient include blood pressures, electrocardiography, respiration rate, heart rate and temperature. Currently used wireless techniques in hospitals are based on the WMTS and WLAN standards. There are no viable solutions for short-range data transmission from patient sensors to patient monitors, but potentially usable techniques in the future are based on the WPAN standards. These techniques include Bluetooth, ZigBee and UWB. Other suitable techniques might be based on capacitive or inductive coupling. The establishing of wireless techniques depends on ensuring the reliability of data transmission, eliminating disturbance by other wireless devices, ensuring patient data security and patient safety, and lowering the power consumption and price.

  7. Effect of Computer Animation Technique on Students' Comprehension of the "Solar System and Beyond" Unit in the Science and Technology Course

    Science.gov (United States)

    Aksoy, Gokhan

    2013-01-01

    The purpose of this study is to determine the effect of computer animation technique on academic achievement of students in the "Solar System and Beyond" unit lecture as part of the Science and Technology course of the seventh grade in primary education. The sample of the study consists of 60 students attending to the 7th grade of primary school…

  8. Construction and validation of a tool to Assess the Use of Light Technologies at Intensive Care Units.

    Science.gov (United States)

    Marinho, Pabliane Matias Lordelo; Campos, Maria Pontes de Aguiar; Rodrigues, Eliana Ofélia Llapa; Gois, Cristiane Franca Lisboa; Barreto, Ikaro Daniel de Carvalho

    2016-12-19

    to construct and validate a tool to assess the use of light technologies by the nursing team at Intensive Care Units. methodological study in which the tool was elaborated by means of the psychometric method for construction based on the categorization of health technologies by Merhy and Franco, from the National Humanization Policy, using the Nursing Intervention Classification taxonomy to categorize the domains of the tool. Agreement Percentages and Content Validity Indices were used for the purpose of validation. The result of the application of the Interrater Agreement Percentage exceeded the recommended level of 80%, highlighting the relevance for the proposed theme in the assessment, with an agreement rate of 99%. the tool was validated with four domains (Bond, Autonomy, Welcoming and Management) and nineteen items that assess the use of light technologies at Intensive Care Units. construir e validar um instrumento para avaliação do uso de tecnologias leves, pela equipe de enfermagem, em Unidades de Terapia Intensiva. estudo metodológico no qual o instrumento foi elaborado utilizando o método psicométrico para construção com base na categorização das tecnologias em saúde de Merhy e Franco, da Política Nacional de Humanização, utilizando-se a taxonomia Nursing Intervention Classification para categorizar os domínios do instrumento. Utilizou-se o Percentual de Concordância e o Índice de Validade de Conteúdo (IVC) para validação. o resultado da aplicação do Percentual de Concordância entre os juízes foi superior ao recomendado de 80%, havendo destaque na avaliação da pertinência ao tema proposto, apresentando um percentual de concordância de 99%. o instrumento foi validado com quatro domínios (Vínculo, Autonomia, Acolhimento e Gestão) e dezenove itens que avaliam o uso das tecnologias leves em Unidade de Terapia Intensiva. construir y validar un instrumento para evaluación del uso de tecnologías leves, por el equipo de enfermer

  9. 疗医合编单位技术建设发展探析%Technology Construction and Development in the Unit Combining Recuperating and Medical Works

    Institute of Scientific and Technical Information of China (English)

    斯友良; 过贵元; 施文兴; 阮英轶; 宋启哲; 孙清华

    2013-01-01

    Combining with the practice in the units combining recuperating and medical works, the article introduces some considerations on the technology development from four aspects, including the medical special center, special key discipline, medical technology innovations and the building of specialized talented persons. It affords a useful lesson for the technology development in such units.%结合疗医合编单位实际,从医学专科中心、特色重点学科、疗养医疗技术创新和专业人才队伍建设四个方面探讨技术建设的思路,为疗医合编单位技术建设发展提供借鉴.

  10. TECHNOLOGICAL INNOVATION IN PROJECTS OF NEW PRODUCT DEVELOPMENT: AN EXPLORATORY STUDY ON RELATIONSHIP MANAGEMENT INTEGRATION AMONG UNITS OF A MULTINATIONAL COMPANY

    Directory of Open Access Journals (Sweden)

    Daniel Jugend

    2012-04-01

    Full Text Available Although the topic of integration in product development is widely debated in the literature, there are few studies that address the participation by subsidiaries of multinational and R & D centers around the world in development projects of new products. Focusing on the perception of the Brazilian unit, this paper aims to present and analyze integration practices among subsidiaries, headquarters and R&D centers in product development projects in a multinational high tech company. For this purpose, was conducted an exploratory and qualitative researched operationalized by case study. Among the main results, it was noted collaboration between locals marketing and engineering with the R & D centers, important role of senior management in the Brazilian unit to communicate outcomes of the strategic planning of products and technologies established by the headquarters to the subsidiary, the adoption of technological and information mechanisms and the application of methods such as technology roadmap.

  11. Surgical education in Mexico.

    Science.gov (United States)

    Cervantes, Jorge

    2010-05-01

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

  12. Micro-surgical endodontics.

    Science.gov (United States)

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

    2014-02-01

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

  13. Surgical innovation as sui generis surgical research.

    Science.gov (United States)

    Lotz, Mianna

    2013-12-01

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

  14. Technology.

    Science.gov (United States)

    Online-Offline, 1998

    1998-01-01

    Focuses on technology, on advances in such areas as aeronautics, electronics, physics, the space sciences, as well as computers and the attendant progress in medicine, robotics, and artificial intelligence. Describes educational resources for elementary and middle school students, including Web sites, CD-ROMs and software, videotapes, books,…

  15. Neuronavigation. Principles. Surgical technique.

    Science.gov (United States)

    Ivanov, Marcel; Ciurea, Alexandru Vlad

    2009-01-01

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

  16. [Surgical treatment of paralytic lagophthalmos].

    Science.gov (United States)

    Schrom, T; Bast, F

    2010-03-01

    Impairment of the peripheral or central part of the facial nerve causes an ipsilateral peripheral facial nerve paresis. It is quite a common syndrome and affects 20-35 persons per 100,000 per year in Western Europe and the United States. A possible complication of facial palsy is paralytic lagophthalmos with aesthetic and functional impairment for the patient. Beside primary nerve reconstructive procedures plastic-reconstructive procedures play a major role in correcting paralytic lagophthalmos. The eyebrow, upper and lower lids, medial and lateral lid angle as well as the lacrimal system need to be seen as functional units and can be corrected with local surgical procedures. Restoration of eye closure is the most important goal in treating the affected eye. Due to the significant aesthetic limitations and resultant psychological stress for the patient cosmetic aspects must be included in the surgical concept.

  17. Trends in OMI NO2 observations over the United States: effects of emission control technology and the economic recession

    Science.gov (United States)

    Russell, A. R.; Valin, L. C.; Cohen, R. C.

    2012-12-01

    Observations of tropospheric NO2 vertical column densities over the United States (US) for 2005-2011 are evaluated using the OMI Berkeley High Resolution (BEHR) retrieval algorithm. We assess changes in NO2 on day-of-week and interannual timescales to assess the impact of changes in emissions from mobile and non-mobile sources on the observed trends. We observe consistent decreases in cities across the US, with an average total reduction of 32 ± 7% across the 7 yr. Changes for large power plants have been more variable (-26 ± 12%) due to regionally-specific regulation policies. An increasing trend of 10-20% in background NO2 columns in the northwestern US is observed. We examine the impact of the economic recession on emissions and find that decreases in NO2 column densities over cities were moderate prior to the recession (-6 ± 5% yr-1), larger during the recession (-8 ± 5% yr-1), and then smaller after the recession (-3 ± 4% yr-1). Differences in the trends observed on weekdays and weekends indicate that prior to the economic recession, NO2 reductions were dominated by technological improvements to the light-duty vehicle fleet but that a decrease in diesel truck activity has contributed to emission reductions since the recession. We use the satellite observations to estimate a 34% decrease in NO2 from mobile sources in cities for 2005-2011 and use that value to infer changes in non-mobile sources. We find that reductions in NO2 from non-mobile sources in cities have been both more modest and more variable than NO2 reductions from mobile sources (-10 ± 13%).

  18. A feasibility pilot study on the use of complementary therapies delivered via mobile technologies on Icelandic surgical patients’ reports of anxiety, pain, and self-efficacy in healing

    OpenAIRE

    Hansen, Margaret M

    2015-01-01

    Background Complementary therapies (CT), such as relaxation technique, massage, guided imagery, and accupuncture have shown to benefit patients undergoing surgery. The aim of this study was to determine the feasibility of using audio relaxation technique (ART), music intervention (MI), nature video application with music (NVAM), and nature video application without music (NVA) delivered via mobile technologies in a clinical setting. Secondary, the effects of ART, MI, NVAM and NVA on patients’...

  19. Modification of technological control units for superheated steam temperature at 210-MW power units of the Primor'ye Power Plant

    Energy Technology Data Exchange (ETDEWEB)

    V.V. Slesarenko; A.A. Belousov; V.V. Milush [Far East State Engineering University, Vladivostok (Russian Federation)

    2008-06-15

    The results of analysis of operation of the temperature control system for superheated steam at the BKZ-670-140F boilers of the Primor'ye Power Plant (GRES) are presented. The possibility of updating of the injection system to improve the reliability and economic efficiency of power units of electric power plants is considered.

  20. Modification of technological control units for superheated steam temperature at 210-MW power units of the Primor'ye Power Plant

    Science.gov (United States)

    Slesarenko, V. V.; Belousov, A. A.; Milush, V. V.

    2008-06-01

    The results of analysis of operation of the temperature control system for superheated steam at the BKZ-670-140F boilers of the Primor’ye Power Plant (GRES) are presented. The possibility of updating of the injection system to improve the reliability and economic efficiency of power units of electric power plants is considered.

  1. Exploring Instructors' Technology Readiness, Attitudes and Behavioral Intentions towards E-Learning Technologies in Egypt and United Arab Emirates

    Science.gov (United States)

    El Alfy, Shahira; Gómez, Jorge Marx; Ivanov, Danail

    2017-01-01

    This paper explores the association between technology readiness, (a meta-construct consisting of optimism, innovativeness, discomfort, and insecurity), attitude, and behavioral intention towards e-learning technologies adoption within an education institution context. The empirical study data is collected at two private universities located in…

  2. Management of refractory atrial fibrillation post surgical ablation

    OpenAIRE

    Altman, Robert K.; PROIETTI, RICCARDO; Barrett, Conor D.; Paoletti Perini, Alessandro; Santangeli, Pasquale; Danik, Stephan B.; Di Biase, Luigi; Natale, Andrea

    2014-01-01

    Over the past two decades, invasive techniques to treat atrial fibrillation (AF) including catheter-based and surgical procedures have evolved along with our understanding of the pathophysiology of this arrhythmia. Surgical treatment of AF may be performed on patients undergoing cardiac surgery for other reasons (concomitant surgical ablation) or as a stand-alone procedure. Advances in technology and technique have made surgical intervention for AF more widespread. Despite improvements in out...

  3. Developing Tomorrow’s Innovative Surgical Solutions

    Directory of Open Access Journals (Sweden)

    Philip Breedon

    2009-11-01

    Full Text Available Designers are increasingly becoming aware of the potential use and integration of smart materials and technologies within their designs. One of the critical steps towards building innovative surgical solutions will be to link physicians and product designers utilising the appropriate materials and technologies to provide tangible improvements in patient care and treatment.

  4. Technology

    Directory of Open Access Journals (Sweden)

    Xu Jing

    2016-01-01

    Full Text Available The traditional answer card reading method using OMR (Optical Mark Reader, most commonly, OMR special card special use, less versatile, high cost, aiming at the existing problems proposed a method based on pattern recognition of the answer card identification method. Using the method based on Line Segment Detector to detect the tilt of the image, the existence of tilt image rotation correction, and eventually achieve positioning and detection of answers to the answer sheet .Pattern recognition technology for automatic reading, high accuracy, detect faster

  5. 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

  6. Peer Review and Surgical Innovation: Robotic Surgery and Its Hurdles.

    Science.gov (United States)

    Vyas, Dinesh; Cronin, Sean

    2015-12-01

    The peer review processes as outlined in the Health Care Quality Improvement Act (HCQIA) is meant ensure quality standard of care through a self-policing mechanism by the medical community. This process grants immunity for people filing a peer review, which is meant to protect whistleblowers. However, it also creates a loophole that can be used maliciously to hinder competition. This is accentuated when surgeons are integrating new technologies, such as robotic surgery, into their practice. With more than 2000 da Vinci robots in use and more than 300 new units being shipped each year, robotic surgery has become a mainstay in the surgical field. The applications for robots continue to expand as surgeons discover their expanding capability. We need a better peer review process. That ensures the peer review is void of competitive bias. Peer reviewers need to be familiar with the procedure and the technology. The current process could stymie innovation in the name of competition.

  7. Surgical repair for acute type A aortic dissection in octogenarians.

    Science.gov (United States)

    El-Sayed Ahmad, Ali; Papadopoulos, Nestoras; Detho, Faisal; Srndic, Edin; Risteski, Petar; Moritz, Anton; Zierer, Andreas

    2015-02-01

    Despite limited data, the necessity for immediate surgical intervention in octogenarians with acute type A aortic dissection (AAD) has recently been questioned because the surgical risk may outweigh its potential benefits. At the same time, evolving stent graft technologies are pushing in the market for pathology within the ascending aorta, even for treatment of AAD. Against this background, we analyzed our institutional experience in this patient cohort during the last 8 years. Between October 2005 and October 2013, 39 patients aged older than 80 years (82 ± 2 years) underwent surgical repair for AAD, of which 29 patients (74%) were men. Owing to patient age and comorbidities, we aimed to limit the operation to supracoronary hemiarch replacement whenever possible. Clinical data were prospectively entered into our institutional database. Late follow-up was 3.6 ± 2.8 years and was 100% complete. Hemiarch replacement was performed in 32 patients (82%), and full arch replacement was necessary in the remaining 7. In 31 patients (79%), the aortic root could be glued and reconstructed or remained untouched. The remaining 8 patients (21%) underwent the bio-Bentall procedure. Mean ventilation time was 46 ± 23 hours, and the intensive care unit stay was 5 ± 9 days. We observed new postoperative permanent neurologic deficits in 2 patients (5%) and transient neurologic deficits in 3 (8%). The 30-day mortality was 26% (n = 10). Kaplan-Meier estimates for late survival were 46% ± 16% at 5 years. Given the guidelines regarding the predicted risk of death in patients with untreated AAD, current data suggest a survival benefit with immediate open surgical intervention even in octogenarians. Similarly to the early days of transcatheter-based aortic valve implantation, open surgical reference data are warranted to set the bar for upcoming endovascular treatment of AAD in octogenarians. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights

  8. Surgical Vision: Google Glass and Surgery.

    Science.gov (United States)

    Chang, Johnny Yau Cheung; Tsui, Lok Yee; Yeung, Keith Siu Kay; Yip, Stefanie Wai Ying; Leung, Gilberto Ka Kit

    2016-08-01

    Google Glass is, in essence, a smartphone in the form of a pair of spectacles. It has a display system, a bone conduction "speaker," video camera, and connectivity via WiFi or Bluetooth technologies. It can also be controlled by voice command. Seizing Google Glass' capabilities as windows of opportunity, surgeons have been the first group of doctors trying to incorporate the technology into their daily practices. Experiences from different groups have demonstrated Google Glass' potential in improving perioperative care, intraoperative communication and documentation, surgical outcome as well as surgical training. On the other hand, the device has technical limitations, notably suboptimal image qualities and a short battery life. Its operational functions also bring forth concerns on the protection of patient privacy. Nonetheless, the technological advances that this device embodies hold promises in surgical innovations. Further studies are required, and surgeons should explore, investigate, and embrace similar technologies with keen and informed anticipation.

  9. Evaluation of cytomegalovirus (CMV)-specific T-cell immunity for the assessment of the risk of active CMV infection in non-immunosuppressed surgical and trauma intensive care unit patients.

    Science.gov (United States)

    Clari, María A; Aguilar, Gerardo; Benet, Isabel; Belda, Javier; Giménez, Estela; Bravo, Dayana; Carbonell, José A; Henao, Liliana; Navarro, David

    2013-10-01

    The current study was designed to assess the predictive value of the evaluation of cytomegalovirus (CMV)-specific T-cell immunity early following admission to the intensive care unit for inferring the risk of active CMV infection in non-immunosuppressed surgical and trauma patients. A total of 31 CMV-seropositive patients were included. Patients were screened for the presence of CMV DNA in plasma and in tracheal aspirates by real-time PCR. Enumeration of CMV pp65 and IE-1-specific IFN-γ CD8(+) and CD4(+) T cells was performed by flow cytometry for intracellular cytokine staining. Virological and immunological monitoring was conducted once or twice a week. Active CMV infection occurred in 17 out of 31 patients. Undetectable levels of pp65 and IE-1-specific IFN-γ CD8(+) and CD4(+) T-cell subsets cells were observed in 10 patients who developed active CMV infection and in one who did not (at a median of 2 days following ICU admission). Peak CMV DNA loads in both tracheal aspirates and plasma were substantially higher (P = 0.018 and P = 0.091, respectively) in patients with undetectable IFN-γ T-cell responses than in patients with detectable responses. The expansion of both CMV-specific T-cell subsets following detection of active CMV infection was demonstrated in 9 out of 14 patients with active CMV infection. In conclusion, the evaluation of CMV pp65 and IE-1-specific IFN-γ-producing CD8(+) and CD4(+) T cells early following ICU admission may allow the identification of patients most at risk of either having or developing an episode of active CMV infection, particularly those associated with high-level virus replication.

  10. S. 473: A Bill to promote the industrial competitiveness and economic growth of the United States by strengthening the linkages between the laboratories of the Department of Energy and the private sector and by supporting the development and application of technologies critical to the economic, scientific and technological competitiveness of the United States, and for other purposes. Introduced in the House of Representatives, One Hundred Third Congress, First Session, March 2, 1993 and June 24, 1993

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1993-12-31

    The report S. 473 is a bill to promote the industrial competitiveness and economic growth of the United States by strengthening linkages between the laboratories of the Department of Energy (DOE) and the private sector and by supporting the development and application of technologies critical to the economic, scientific and technological competitiveness of the United States. The proposed legislative text is included.

  11. Modeling nurses' attitude toward using automated unit-based medication storage and distribution systems: an extension of the technology acceptance model.

    Science.gov (United States)

    Escobar-Rodríguez, Tomás; Romero-Alonso, María Mercedes

    2013-05-01

    This article analyzes the attitude of nurses toward the use of automated unit-based medication storage and distribution systems and identifies influencing factors. Understanding these factors provides an opportunity to explore actions that might be taken to boost adoption by potential users. The theoretical grounding for this research is the Technology Acceptance Model. The Technology Acceptance Model specifies the causal relationships between perceived usefulness, perceived ease of use, attitude toward using, and actual usage behavior. The research model has six constructs, and nine hypotheses were generated from connections between these six constructs. These constructs include perceived risks, experience level, and training. The findings indicate that these three external variables are related to the perceived ease of use and perceived usefulness of automated unit-based medication storage and distribution systems, and therefore, they have a significant influence on attitude toward the use of these systems.

  12. Hernia Surgical Mesh Implants

    Science.gov (United States)

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

  13. Urogynecologic Surgical Mesh Implants

    Science.gov (United States)

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

  14. American Pediatric Surgical Association

    Science.gov (United States)

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

  15. Optimizing surgical f

    Directory of Open Access Journals (Sweden)

    Sabry Mohamed Amin

    2016-07-01

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

  16. Abortion - surgical - aftercare

    Science.gov (United States)

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

  17. Valoración de la actividad de una Unidad de Dolor Agudo Postoperatorio por los cuidadores del paciente quirúrgico Assessment of the activity of an Acute Postoperative Pain Unit by the staff taking care of surgical patients

    Directory of Open Access Journals (Sweden)

    F. Caba

    2004-12-01

    al 19% de los facultativos; p=0,01. El aspecto mejor valorado de la UDAP fue la mejora en el control del dolor postoperatorio; el peor, la comunicación entre los profesionales y, la sugerencia más referida, la de intentar mejorarla. Conclusiones: El papel de la UDAP es muy bien comprendido en nuestro hospital por los cuidadores del paciente quirúrgico y aunque su actividad es unánimemente percibida como útil y necesaria, existen problemas de integración y comunicación, especialmente con la enfermería de planta. La identificación de situaciones como esta mediante estudios de opinión sobre su actividad, puede ser útil para dirigir mejoras en el funcionamiento de las Unidades de Dolor Agudo con modelos organizativos similares al nuestro.Objective: An Acute Postoperative Pain Unit (APPU staffed by nurses and supervised by the Service of Anesthesiology was created in our center in 2.000. The aim of this study was to assess how the staff taking care of surgical patients perceive its activity. Material and method: The Service of Anesthesiology and Resuscitation and the Post-Anesthetic Recovery Unit (PARU maintain an APPU staffed by nurses that provides planned and protocolized management of postoperative pain to more than 1.000 patients/year undergoing the most aggressive and painful surgical procedures in a second-level hospital. Nurses and doctors taking care of the patients were requested to anonymously and voluntarily answer a written questionnaire with 15 questions (12 close-ended questions grouped in 4 categories and 3 open-ended questions that assessed several aspects of their activity. Results: Out of 168 questionnaires handed out, 87 questionnaires returned were considered (52%, 48 from doctors and 39 from nurses. The role of the APPU was well or very well understood by 97% of the responders and its activity was perceived rather unanimously as useful, effective and necessary by 98, 93 and 97%, respectively. Treatment indications were considered

  18. Heat recovery from UPS units - Analysis of a first unit and technology assessment; Waermerueckgewinnung in USV-Anlagen. Analyse einer Erstanlage und Potentialabschaetzung

    Energy Technology Data Exchange (ETDEWEB)

    Stahl, S.; Schlegel, A.

    2009-11-15

    UPS units (uninterruptible power supply) generate large heat losses, which have to be dissipated with cooling units. awtec has developed a unique UPS system with integrated heat recovery which was installed in 2001 (Building Gretag/SAP in Regensdorf) and which is still running error-free. With this system the waste heat can be recovered and electrical energy for the refrigeration system can be saved likewise. The measured data shows that during the heating season, the unit transfers virtually all heat loss (about 20 MWh/year) to the space heating system. The building's refrigeration system, however, has its own heat recovery system, so the actual annual energy savings can be estimated to be only about 4 MWh of electricity. The prototype shows that awtec built a robust unit which - given an appropriate cooling and heating system - has the potential for high energy savings (without central heat recovery system: 4 MWh electric + 20 MWh thermal) without increased investment. Based on the UPS heat recovery development, previous projects of the Swiss Federal Office of Energy and a market survey, scenarios for the cooling and heat recovery from UPS units were developed. Since the same concepts also apply to the cooling of servers and other IT components, they were also included in the analysis. The scenario analysis shows that a high potential for savings of electric energy and heat exists in this area. In particular, the direct cooling of the IT components with cooling water offers big benefits for heat recovery and free cooling (cooling without the use of the refrigeration system) compared to conventional air cooling. These direct cooling systems are currently mainly used for special applications or as a fallback in case of overheating problems. Passive cooling through geothermal probes, which are now mainly used for buildings with small heat pump systems, provides an interesting approach to the cooling of IT equipment in accordance with the temperature level. It

  19. An overview of pre-surgical evaluation

    Directory of Open Access Journals (Sweden)

    Kurupath Radhakrishnan

    2014-01-01

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

  20. [Surgical education has its price].

    Science.gov (United States)

    Schröder, W; Krones, C J

    2012-04-01

    The radical economisation of the German health-care system has caused an increasing cost awareness. Following this trend, medical education has been identified as a possible expense factor. The theoretical and practical training of young doctors needs time and costs money. However, a detailed cost analysis is still not available, since the complex daily work schedule of young professionals only allows the calculation of single cost factors. Investigations in the USA estimate the costs of surgical training at US$ 80 000 per year and per resident. At present in Germany, surgical training is indirectly financed by the DRG flat rates of the health insurance companies. Possible alternatives include the implementation of a "training fond" which is financed by a percentage fee of the DRG's as well as an on-top funding by the federal government. This "training fond" would support only those surgical units that offer a structured and certified training to surgical residents. However, a systematic cost analysis of such a structured curriculum is necessary for any further discussion.

  1. The push to increase the use of EHR technology by hospitals and physicians in the United States through the HITECH Act and the Medicare incentive program.

    Science.gov (United States)

    Pipersburgh, Jessica

    2011-01-01

    This article reviews key health care spending and electronic health records (EHR) statistics in the United States (Section II); highlights positive and negative aspects of EHR technology (Sections III and IV); briefly reviews the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH) (Section V); discusses the rule passed by the Office of the National Coordinator for Health Information Technology (ONCHIT) and to implement the goals of HITECH (Section VI); discusses the rule passed by the Centers for Medicare & Medicaid Services (CMS) to implement the goals of HITECH and focuses on significant requirements of the Medicare incentive program rule as it applies to hospitals and physicians (Section VII); and finally, concludes by highlighting certain issues that have been raised regarding the goals of HITECH (Section VIII).

  2. 音乐疗法在外科重症监护病房中的应用效果%Effects of Music Treatment in Surgical Intensive Care Unit

    Institute of Scientific and Technical Information of China (English)

    陈宇革; 杨亚平; 朱莉; 商慧兰; 龚蔚

    2011-01-01

    目的 探讨音乐疗法对改善外科重症监护病房患者不良情绪及疼痛的效果.方法 将90例全身麻醉手术后进入外科重症监护室的患者随机分为观察组(44例)和对照组(46例),对照组术后采用专科常规护理,观察组在此基础上采用音乐疗法,比较两组患者术前及术后第1、3、5天的抑郁量表(self-rating depression scale,SDS)评分、视觉模拟评分法(visual analogous scale,VAS)、收缩压和舒张压.结果 治疗前和术后第1天,两组患者的SDS、VAS评分及血压差异无统计学意义(P>0.05);术后第3天和第5天,观察组患者的SDS、VAS评分及舒张压和收缩压均低于对照组,差异有统计学意义(P<0.05或P<0.01).结论 音乐疗法可减轻ICU患者的抑郁情绪,稳定血压,减轻疼痛,增加患者的舒适感.%Objective To evaluate the effect of music treatment in improving negative emotions and pains of patients in surgical intensive care unit(ICU).Methods Ninety surgical ICU patients under general anesthesia were randomly divided into experimental group(n=44)and control group(n=46).All the patients received the specialized routine nursing after operation.Then the patients in the experimental group underwent music treatment.Comparisons were conducted on the scores of self-rating depression scale(SDS), visual analogous scale(VAS),systolic pressure and diastolic pressure before operation and at 1st,3rd and 5th days after operation.Results The two groups had no significant difference on the systolic pressure and the scores of SDS,VAS and at 1st day after operation(P>0.05).The values of SDS, VAS, systolic pressure and diastolic pressure at 3rd and 5th day after operation were significantly lower in the experimental group than in the control group(P<0.01).Systolic pressure and diastolic pressure also had statistics significance (P<0.05 or P<0.05).Conclusion Music treatment can reduce patient's depressed emotion, maintain blood pressure,relieve pain and

  3. Development of AR Surgical Navigation Systems for Multiple Surgical Regions.

    Science.gov (United States)

    Suzuki, Naoki; Hattori, Asaki; Iimura, Jiro; Otori, Nobuyoshi; Onda, Shinji; Okamoto, Tomoyoshi; Yanaga, Katsuhiko

    2014-01-01

    The purpose of our research is to develop surgical navigation systems to enhance surgical safety. Our systems make use of augmented reality technology to superimpose, on the surgery screen on a real time basis, patients' organ models reconstructed in 3D from their X-ray CT data taken before surgery. By doing so, the systems display anatomical risk materials, tumors and blood vessels which surgeons cannot see with their naked eyes. This will in turn lead to surgeons intuitively grasping the inner structures of the operational fields. We so far have been developing navigation systems that can conduct surgeries in various fields. The basic structure of the navigation systems are the same. The navigation systems uses different peripheral equipment and different methods to display navigation images which best meet the demands of each type of surgery. In this thesis, we report on our navigation systems for 2 types of surgery - endoscopic sinus surgery and hepatobilialy-pancreatic surgery.

  4. Surgical Lasers In Gynecology

    Science.gov (United States)

    Schellhas, Helmut F.; Barnes, Alfonso E.

    1982-12-01

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

  5. S. 473: A Bill to promote the industrial competitiveness and economic growth of the United States by strengthening the linkages between the laboratories of the Department of Energy and the private sector and by supporting the development and application of technologies critical to the economic, scientific and technological competitiveness of the United States, and for other purposes. Introduced in the Senate of the United States, One Hundred Third Congress, First Session, March 2, 1993

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1993-12-31

    The report S. 473 is a bill to promote the industrial competitiveness and economic growth of the United States (U.S.) by strengthening the linkages between the laboratories of the Department of Energy and the private sector and by supporting the development and application of technologies critical to the economic, scientific and technological competitiveness of the U.S. The proposed legislative text is included.

  6. CHARACTERIZING COSTS, SAVINGS AND BENEFITS OF A SELECTION OF ENERGY EFFICIENT EMERGING TECHNOLOGIES IN THE UNITED STATES

    Energy Technology Data Exchange (ETDEWEB)

    Xu, T.; Slaa, J.W.; Sathaye, J.

    2010-12-15

    Implementation and adoption of efficient end-use technologies have proven to be one of the key measures for reducing greenhouse gas (GHG) emissions throughout the industries. In many cases, implementing energy efficiency measures is among one of the most cost effective investments that the industry could make in improving efficiency and productivity while reducing CO2 emissions. Over the years, there have been incentives to use resources and energy in a cleaner and more efficient way to create industries that are sustainable and more productive. With the working of energy programs and policies on GHG inventory and regulation, understanding and managing the costs associated with mitigation measures for GHG reductions is very important for the industry and policy makers around the world. Successful implementation of emerging technologies not only can help advance productivities and competitiveness but also can play a significant role in mitigation efforts by saving energy. Providing evaluation and estimation of the costs and energy savings potential of emerging technologies is the focus of our work in this project. The overall goal of the project is to identify and select emerging and under-utilized energy-efficient technologies and practices as they are important to reduce energy consumption in industry while maintaining economic growth. This report contains the results from performing Task 2"Technology evaluation" for the project titled"Research Opportunities in Emerging and Under-Utilized Energy-Efficient Industrial Technologies," which was sponsored by California Energy Commission and managed by CIEE. The project purpose is to analyze market status, market potential, and economic viability of selected technologies applicable to the U.S. In this report, LBNL first performed re-assessments of all of the 33 emerging energy-efficient industrial technologies, including re-evaluation of the 26 technologies that were previously identified by Martin et al. (2000) and

  7. The effectiveness of using the combined-cycle technology in a nuclear power plant unit equipped with an SVBR-100 reactor

    Science.gov (United States)

    Kasilov, V. F.; Dudolin, A. A.; Gospodchenkov, I. V.

    2015-05-01

    The design of a modular SVBR-100 reactor with a lead-bismuth alloy liquid-metal coolant is described. The basic thermal circuit of a power unit built around the SVBR-100 reactor is presented together with the results of its calculation. The gross electrical efficiency of the turbine unit driven by saturated steam at a pressure of 6.7 MPa is estimated at η{el/gr} = 35.5%. Ways for improving the efficiency of this power unit and increasing its power output by applying gas-turbine and combined-cycle technologies are considered. With implementing a combined-cycle power-generating system comprising two GE-6101FA gas-turbine units with a total capacity of 140 MW, it becomes possible to obtain the efficiency of the combined-cycle plant equipped with the SVBR-100 reactor η{el/gr} = 45.39% and its electrical power output equal to 328 MW. The heat-recovery boiler used as part of this power installation generates superheated steam with a temperature of 560°C, due to which there is no need to use a moisture separator/steam reheater in the turbine unit thermal circuit.

  8. A Joint Workshop on Promoting the Development and Deployment of IGCC/Co-Production/CCS Technologies in China and the United States. Workshop report

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Lifeng; Ziao, Yunhan; Gallagher, Kelly Sims

    2009-06-03

    With both China and the United States relying heavily on coal for electricity, senior government officials from both countries have urged immediate action to push forward technology that would reduce carbon dioxide emissions from coal-fired plants. They discussed possible actions at a high-level workshop in April 2009 at the Harvard Kennedy School jointly sponsored by the Belfer Center's Energy Technology Innovation Policy (ETIP) research group, China's Ministry of Science and Technology, and the Chinese Academy of Sciences. The workshop examined issues surrounding Integrated Gasification Combined Cycle (IGCC) coal plants, which turn coal into gas and remove impurities before the coal is combusted, and the related carbon capture and sequestration, in which the carbon dioxide emissions are captured and stored underground to avoid releasing carbon dioxide into the atmosphere. Though promising, advanced coal technologies face steep financial and legal hurdles, and almost certainly will need sustained support from governments to develop the technology and move it to a point where its costs are low enough for widespread use.

  9. Low level technology tool (LLTT) in screening for blindness: test qualities in the outpatients department of a tertiary eye unit using the Snellen chart.

    Science.gov (United States)

    Masanganise, R; Rusakaniko, S; Manjonjori, N

    2010-01-01

    To validate the use of finger counting (low level technology tool) in screening for blindness in the outpatients department of a tertiary eye unit with the view of employing the test for screening illiterate people in hard to reach parts of the country where the conventional visual acuity charts are not available. Aperformance evaluation of counting fingers (LLTT) in screening for blindness against the standard test (Snellen chart). Sekuru Kaguvi Eye Unit, Parirenyatwa Hospital, Zimbabwe. Patients presenting to the Eye Outpatient Department at Sekuru Kaguvi Eye Unit with various eye problems. Sensitivity of low level technology tool (LLTT) in identifying blind people. Sensitivity and specificity of LLTT in detecting blindness in all age groups combined was 100% and 88.5% respectively. Although sensitivity was not affected by patient age, specificity decreased with increasing age. The overall positive predictive value for the test was 53.3% and the prevalence of blindness among outpatient attendees was 11.6%. Finger counting is an effective tool that can be employed in screening for blindness in communities which are hard to reach, have low literacy rate and when conventional methods of testing visual acuity are not available.

  10. Summary of Potassium Nitrate Productive Technology and Unit in China%我国硝酸钾生产工艺及装置概述

    Institute of Scientific and Technical Information of China (English)

    张罡

    2011-01-01

    The potassium nitrate productive technology in China is based mainly on the processes of double decomposition of sodium nitrate and potassium chloride, ion-exchange of ammonium nitrate and potassium chloride, double decomposition of ammonium nitrate and potassium chloride and double decomposition of magnesium nitrate and potassium chloride. The production unit has achieved continuous production on a large scale, the total annual output ranks the third in the world, and the technology and equipment have attained the international advanced level. A brief account is given of the potassium nitrate productive technology and unit in China.%我国硝酸钾生产工艺主要有硝酸钠与氯化钾复分解法、硝酸铵与氯化钾离子交换法、硝酸铵与氯化钾复分解法、硝酸镁与氯化钾复分解法,生产装置均己实现了规模连续化生产,年总产量位居世界第3位,技术与装备达到国际先进水平.简要概述了我国硝酸钾生产工艺及装置情况.

  11. Historical review of surgical simulation--a personal perspective.

    Science.gov (United States)

    Satava, Richard M

    2008-02-01

    Although simulation is relatively new to surgical education, there is a long history in many other disciplines, such as military, aviation, and nuclear power plant operations, among others. In the late 1980s these technologies began to be adapted to the surgical world, along with the new technology of virtual reality. This is a review of the introduction of manikins, computers, and virtual reality into education and training for surgical skills. Two concomitant revolutions occurred: objective assessment of surgical skills and converting training from the apprenticeship model to one of criterion-based training. A personal perspective on these developments adds information not previously published.

  12. Surgical treatment of male infertility in the era of intracytoplasmic sperm injection - new insights

    Directory of Open Access Journals (Sweden)

    Sandro C. Esteves

    2011-01-01

    Full Text Available Assisted reproductive technology is an evolving area, and several adjuvant procedures have been created to increase a couple's chance of conceiving. For male infertility, the current challenges are to properly accommodate old and new techniques that are both cost-effective and evidence-based. In this context, urologists are expected to diagnose, counsel, provide medical or surgical treatment whenever possible and/or correctly refer male patients for assisted conception. Urologists are sometimes part of a multiprofessional team in an assisted reproduction unit and are responsible for the above-cited tasks as well as the surgical retrieval of sperm from either the epididymides or testicles. We present a comprehensive review of the surgical treatment options for infertile males, including the perioperative planning and prognostic aspects, with an emphasis on the role of microsurgery in the optimization of treatment results. This review also discusses current techniques for sperm retrieval that are used in association with assisted reproductive technology and includes sperm retrieval success rates according to the technique and the type of azoospermia. New insights are provided with regard to each surgical treatment option in view of the availability of assisted conception to overcome male infertility.

  13. Technology transfer with system analysis, design, decision making, and impact (Survey-2000) in acute care hospitals in the United States.

    Science.gov (United States)

    Hatcher, M

    2001-10-01

    This paper provides the results of the Survey-2000 measuring technology transfer for management information systems in health care. The relationships with systems approaches, user involvement, usersatisfaction, and decision-making were measured and are presented. The survey also measured the levels Internet and Intranet presents in acute care hospitals, which will be discussed in future articles. The depth of the survey includes e-commerce for both business to business and customers. These results are compared, where appropriate, with results from survey 1997 and changes are discussed. This information will provide benchmarks for hospitals to plan their network technology position and to set goals. This is the first of three articles based upon the results of the Srvey-2000. Readers are referred to a prior article by the author that discusses the survey design and provides a tutorial on technology transfer in acute care hospitals.

  14. Manual of Surgical Instruments

    Directory of Open Access Journals (Sweden)

    Olga Lidia Sánchez Sarría

    2014-10-01

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

  15. The technology of the bearings used in the nuclear power generation system turbine generator units; Technologie des paliers equipant les groupes turbo-alternateurs du parc nucleaire

    Energy Technology Data Exchange (ETDEWEB)

    Vialettes, J.M.; Rossato, M. [Service Ensembles de Production, Departement Machines, Direction des Etudes et Recherches, Electricite de France (EDF), 92 - Clamart (France)

    1997-01-01

    A bearing consists of all the stationary part which allow the relative motion in rotation or in translation, of a shaft line. Inside the bearing there is a journal bearing with a metallic anti-friction coating (the babbitt metal). The high power turbine generator unit rotors are supported by smooth transversal journal bearings fed with oil which fills the empty space and runs along the shaft. The technologies used for the bearings and the thrust bearings of the turbine generator units and the various shaft lines of the French CP0/CP1- and CP2/1300 MW-type nuclear power plants are described. The experience feedback is then discussed in terms of the dynamics of the shaft line, i.e. vibrational problems, the influence of the alignment and the babbitt metal incidents. (author) 4 refs., 11 figs.

  16. DEVELOPMENT OF THEORY AND METHODS OF USE OF INFORMATION AND COMMUNICATION TECHNOLOGIES IN TEACHING MATHEMATICS OF ENGINEERING SPECIALITIES STUDENTS IN THE UNITED STATES

    Directory of Open Access Journals (Sweden)

    Nataliia M. Kiianovska

    2014-10-01

    Full Text Available The article deals with the problems of information and communication technologies (ICT development in teaching mathematics of engineering specialities students in the United States. In the article the nature of trends of convergence of information system in higher technical education and other tendencies in the USA are сharacterized. The main historical stages of development of the theory and methods of ICT use in teaching mathematics of engineering specialities students in the United States are defined. The study of historical sources has been allowed to emphasize six stages, at each stage it is analyzed the use of ICT for teaching mathematics, it is shown the contradictions and the main features of the use of ICT in teaching mathematics of engineering specialities students.

  17. EMERGING TECHNOLOGY BULLETIN: DEVELOPMENT OF A PHOTOTHERMAL DETOXIFICATION UNIT - ENVIRONMENTAL SCIENCE AND ENGINEERING GROUP - UNIVERSITY OF DAYTON RESEARCH INSTITUTE

    Science.gov (United States)

    The University of Dayton Research Institute has developed a novel photochemical process embodied in a device called a Photothermal Detoxification Unit (PDU) which offers an efficient means of destroying hazardous organic wastes. The PDU, which overcomes the problems of slow react...

  18. Report to the President on the Use of Technology to Strengthen K-12 Education in the United States: Findings Related to Research and Evaluation

    Science.gov (United States)

    Shaw, David E.; Becker, Henry J.; Bransford, John D.; Davidson, Jan; Hawkins, Jan; Malcom, Shirley; Molina, Mario; Ride, Sally K.; Sharp, Phillip; Tinker, Robert F.; Vest, Charles; Young, John; Allen, Richard; Bakia, Marianne; Bryson, Rebecca; Chen, C. Samantha; Costello, Caroline M.; Deckel, Garrett M.; Dial, Marjorie R.; Kealey, Edith M.; Lehoczky, Sandor

    1998-06-01

    The Panel on Educational Technology was organized in April 1995 under the auspices of the President's Committee of Advisers on Science and Technology (PCAST) to provide advice to the President on matters related to the application of information technologies to K-12 education in the United States. Its findings and recommendations were set forth in March 1997 in the Report to the President on the Use of Technology to Strengthen K-12 Education in the United States. This report was based on a review of the research literature and on written submissions and oral briefings from a number of academic and industrial researchers, practicing educators, software developers, governmental agencies, and professional and industry organizations involved in various ways with the application of technology to education. Its most important finding is that a large-scale program of rigorous, systematic research on education in general and educational technology in particular will ultimately prove necessary to ensure both the efficacy and cost-effectiveness of technology use within our nation's K-12 schools. Finding that less than 0.1 percent of our nation's expenditures for elementary and secondary education are currently invested to determine which educational techniques actually work, and to find ways to improve them—an extremely low level relative to comparable ratios within the private sector—the Panel recommended that this figure be increased over a period of several years to at least 0.5 percent, and sustained at that level on an ongoing basis. Further, because no one state, municipality, or private firm could hope to capture more than a small fraction of the benefits associated with a significant advance in our understanding of how best to educate K-12 students, the Panel concluded that such funding will have to be provided largely at the federal level in order to avoid a systematic underinvestment (attributable to a classical form of economic externality) relative to the

  19. IEA Wind Task 26. Wind Technology, Cost, and Performance Trends in Denmark, Germany, Ireland, Norway, the European Union, and the United States: 2007–2012

    Energy Technology Data Exchange (ETDEWEB)

    Vitina, Aisma [Ea Energy Analyses, Copenhagen (Denmark); Lüers, Silke [Deutsche WindGuard, Varel (Germany); Wallasch, Anna-Kathrin [Deutsche WindGuard, Varel (Germany); Berkhout, Volker [Fraunhofer IWES, Kassel (Germany); Duffy, Aidan [Dublin Inst. of Technology and Dublin Energy Lab. (Ireland); Cleary, Brendan [Dublin Inst. of Technology and Dublin Energy Lab. (Ireland); Husabø, Lief I. [Norwegian Water Resources and Energy Directorate (NVE), Oslo (Norway); Weir, David E. [Norwegian Water Resources and Energy Directorate (NVE), Oslo (Norway); Lacal-Arántegui, Roberto [European Commission, Ispra (Italy). Joint Research Centre; Hand, Maureen [National Renewable Energy Lab. (NREL), Golden, CO (United States); Lantz, Eric [National Renewable Energy Lab. (NREL), Golden, CO (United States); Belyeu, Kathy [Belyeu Consulting, Takoma Park, MD (United States); Wiser, Ryan H [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Bolinger, Mark [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Hoen, Ben [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2015-06-01

    The International Energy Agency Implementing Agreement for cooperation in Research, Development, and Deployment of Wind Energy Systems (IEA Wind) Task 26—The Cost of Wind Energy represents an international collaboration dedicated to exploring past, present and future cost of wind energy. This report provides an overview of recent trends in wind plant technology, cost, and performance in those countries that are currently represented by participating organizations in IEA Wind Task 26: Denmark, Germany, Ireland, Norway, and the United States as well as the European Union.

  20. CRADA with United Solar Technologies and Pacific Northwest Laboratory (PNL-021): Thin film materialsfor low-cost high performance solar concentrators

    Science.gov (United States)

    Martin, P. M.; Affinito, J. D.; Gross, M. E.; Bennett, W. D.

    1995-03-01

    The objectives of this project were to develop and evaluate promising low-cost dielectric and polymer-protected thin-film reflective metal coatings to be applied to preformed continuously-curved solar reflector panels to enhance their solar reflectance, and to demonstrate protected solar reflective coatings on preformed solar concentrator panels. The opportunity for this project arose from a search by United Solar Technologies (UST) for organizations and facilities capable of applying reflective coatings to large preformed panels. PNL was identified as being uniquely qualified to participate in this collaborative project.

  1. Implementation of a Sage-Based Stirling Model Into a System-Level Numerical Model of the Fission Power System Technology Demonstration Unit

    Science.gov (United States)

    Briggs, Maxwell H.

    2011-01-01

    The Fission Power System (FPS) project is developing a Technology Demonstration Unit (TDU) to verify the performance and functionality of a subscale version of the FPS reference concept in a relevant environment, and to verify component and system models. As hardware is developed for the TDU, component and system models must be refined to include the details of specific component designs. This paper describes the development of a Sage-based pseudo-steady-state Stirling convertor model and its implementation into a system-level model of the TDU.

  2. Advanced stimulation technology deployment program: Unocal Corporation, Dakota and Mesaverde formations, Rincon Unit, San Juan Basin. Topical report, June 1995-February 1996

    Energy Technology Data Exchange (ETDEWEB)

    Wright, C.A.; Weijers, L.; Minner, W.A.

    1996-06-01

    Pinnacle Technologies successfully deployed AST to numerous engineers from Unocal. Unocal estimated an 11% reduction in completion costs after implementing AST on their hydraulic fracture treatments in the Rincon Unit, New Mexico, resulting in a total cost savings of $850,000 on 25 wells. Despite the poorer geology of the newly completed wells, well productivity was equivalent to the older wells with `conventional` fracture treatment designs. Pressure build-up tests also confirmed the improved fracture treatment results: propped fractures of AST-treatments appeared at least twice as long as fractures from conventional treatments, even though completion costs have been reduced.

  3. Dr Kathryn Beers, Assistant Director Physical Sciences and Engineering, Office of Science and Technology Policy Executive Office of the President United States of America visit the CMS experiment at point 5.

    CERN Multimedia

    Maximilien Brice

    2007-01-01

    Dr Kathryn Beers, Assistant Director Physical Sciences and Engineering, Office of Science and Technology Policy Executive Office of the President United States of America visit the CMS experiment at point 5.

  4. 20 January 2014 - Members of the Regional Assemblies and Parliaments United Kingdom of Great Britain and Northern Ireland visiting the LHC tunnel at Point 8 with Technology Department, Vacuum, Surfaces and Coatings Group P. Cruikshank.

    CERN Multimedia

    Pantelia, Anna

    2014-01-01

    20 January 2014 - Members of the Regional Assemblies and Parliaments United Kingdom of Great Britain and Northern Ireland visiting the LHC tunnel at Point 8 with Technology Department, Vacuum, Surfaces and Coatings Group P. Cruikshank.

  5. The Roaring Thirties. Productivity Growth and Technological Change in Great Britain and the United States During the Early Twentieth Century

    NARCIS (Netherlands)

    Woltjer, P.J.

    2013-01-01

    A recent study in American economic history has shown that the 1930s, though scarred by relentless unemployment, mass migration and profound social and cultural change, were far from gloomy in terms of technological and business innovation. In light of these dynamic productivity developments and

  6. Work Addiction and 21st Century Information Technologies in Traditional and Virtual Work Spaces in the United States

    Science.gov (United States)

    Hunka, Patricia L.

    2014-01-01

    This study was completed to understand whether or not work addiction or work addiction intensity could be predicted from mobile technology use. The study further investigated whether or not gender, workspace, income, or education level would moderate the relationship. The sample used was drawn from service industry employees who are not in the…

  7. Surgical ethics and the challenge of surgical innovation.

    Science.gov (United States)

    Angelos, Peter

    2014-12-01

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

  8. Perfecting patient flow in the surgical setting.

    Science.gov (United States)

    Amato-Vealey, Elaine J; Fountain, Patricia; Coppola, Deborah

    2012-07-01

    Reduced surgical efficiency and productivity, delayed patient discharges, and prolonged use of hospital resources are the results of an OR that is unable to move patients to the postanesthesia care unit or other patient units. A primary reason for perioperative patient flow delay is the lack of hospital beds to accommodate surgical patients, which consequently causes backups of patients currently in the surgical suite. In one facility, implementing Six Sigma methodology helped to improve OR patient flow by identifying ways that frontline staff members could work more intelligently and more efficiently, and with less stress to streamline workflow and eliminate redundancy and waste in ways that did not necessitate reducing the number of employees. The results were improved employee morale, job satisfaction and safety, and an enhanced patient experience.

  9. Surgical smoke in dermatologic surgery.

    Science.gov (United States)

    Oganesyan, Gagik; Eimpunth, Sasima; Kim, Silvia Soohyun; Jiang, Shang I Brian

    2014-12-01

    Potential dangers associated with smoke generated during electrosurgery have been described. However, the use of smoke management in dermatology is unknown. There is no objective data showing the amount or the composition of the smoke generated in dermatologic surgeries. To assess the use of smoke management in dermatologic surgery and provide data on the amount and chemical composition of surgical smoke. A total of 997 surveys were sent to dermatologic surgeons across the United States to assess the use of smoke management. Amounts and concentrations of particulates and chemical composition were measured during electrosurgery using a particulate meter and the Environmental Protection Agency-standardized gas chromatography-mass spectrometry analysis. Thirty-two percent of the surgeons responded to the survey, and 77% of the respondents indicated no use of smoke management at all. Only approximately 10% of surgeons reported consistent use of smoke management. Active electrosurgery produced significant amounts of particulates. In addition, surgical smoke contained high concentrations of known carcinogens, such as benzene, butadiene, and acetonitrile. Surgical smoke contains toxic compounds and particulates. Most dermatologic surgeons do not use smoke management within their practices. Raising the awareness of the potential risks can help increase the use of smoke management.

  10. Surgical data science: the new knowledge domain

    Directory of Open Access Journals (Sweden)

    Vedula S. Swaroop

    2017-04-01

    Full Text Available Healthcare in general, and surgery/interventional care in particular, is evolving through rapid advances in technology and increasing complexity of care, with the goal of maximizing the quality and value of care. Whereas innovations in diagnostic and therapeutic technologies have driven past improvements in the quality of surgical care, future transformation in care will be enabled by data. Conventional methodologies, such as registry studies, are limited in their scope for discovery and research, extent and complexity of data, breadth of analytical techniques, and translation or integration of research findings into patient care. We foresee the emergence of surgical/interventional data science (SDS as a key element to addressing these limitations and creating a sustainable path toward evidence-based improvement of interventional healthcare pathways. SDS will create tools to measure, model, and quantify the pathways or processes within the context of patient health states or outcomes and use information gained to inform healthcare decisions, guidelines, best practices, policy, and training, thereby improving the safety and quality of healthcare and its value. Data are pervasive throughout the surgical care pathway; thus, SDS can impact various aspects of care, including prevention, diagnosis, intervention, or postoperative recovery. The existing literature already provides preliminary results, suggesting how a data science approach to surgical decision-making could more accurately predict severe complications using complex data from preoperative, intraoperative, and postoperative contexts, how it could support intraoperative decision-making using both existing knowledge and continuous data streams throughout the surgical care pathway, and how it could enable effective collaboration between human care providers and intelligent technologies. In addition, SDS is poised to play a central role in surgical education, for example, through objective

  11. Surgical data science: The new knowledge domain.

    Science.gov (United States)

    Vedula, S Swaroop; Hager, Gregory D

    2017-04-01

    Healthcare in general, and surgery/interventional care in particular, is evolving through rapid advances in technology and increasing complexity of care with the goal of maximizing quality and value of care. While innovations in diagnostic and therapeutic technologies have driven past improvements in quality of surgical care, future transformation in care will be enabled by data. Conventional methodologies, such as registry studies, are limited in their scope for discovery and research, extent and complexity of data, breadth of analytic techniques, and translation or integration of research findings into patient care. We foresee the emergence of Surgical/Interventional Data Science (SDS) as a key element to addressing these limitations and creating a sustainable path toward evidence-based improvement of interventional healthcare pathways. SDS will create tools to measure, model and quantify the pathways or processes within the context of patient health states or outcomes, and use information gained to inform healthcare decisions, guidelines, best practices, policy, and training, thereby improving the safety and quality of healthcare and its value. Data is pervasive throughout the surgical care pathway; thus, SDS can impact various aspects of care including prevention, diagnosis, intervention, or post-operative recovery. Existing literature already provides preliminary results suggesting how a data science approach to surgical decision-making could more accurately predict severe complications using complex data from pre-, intra-, and post-operative contexts, how it could support intra-operative decision-making using both existing knowledge and continuous data streams throughout the surgical care pathway, and how it could enable effective collaboration between human care providers and intelligent technologies. In addition, SDS is poised to play a central role in surgical education, for example, through objective assessments, automated virtual coaching, and robot

  12. Recognizing surgical patterns

    NARCIS (Netherlands)

    Bouarfa, L.

    2012-01-01

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

  13. Surgical medical record

    DEFF Research Database (Denmark)

    Bulow, S.

    2008-01-01

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

  14. Ethical issues in surgical innovation.

    Science.gov (United States)

    Miller, Megan E; Siegler, Mark; Angelos, Peter

    2014-07-01

    Innovation is responsible for most advances in the field of surgery. Innovative approaches to solving clinical problems have significantly decreased morbidity and mortality for many surgical procedures, and have led to improved patient outcomes. While innovation is motivated by the surgeon's expectation that the new approach will be beneficial to patients, not all innovations are successful or result in improved patient care. The ethical dilemma of surgical innovation lies in the uncertainty of whether a particular innovation will prove to be a "good thing." This uncertainty creates challenges for surgeons, patients, and the healthcare system. By its very nature, innovation introduces a potential risk to patient safety, a risk that may not be fully known, and it simultaneously fosters an optimism bias. These factors increase the complexity of informed consent and shared decision making for the surgeon and the patient. Innovative procedures and their associated technology raise issues of cost and resource distribution in the contemporary, financially conscious, healthcare environment. Surgeons and institutions must identify and address conflicts of interest created by the development and application of an innovation, always preserving the best interest of the patient above the academic or financial rewards of success. Potential strategies to address the challenges inherent in surgical innovation include collecting and reporting objective outcomes data, enhancing the informed consent process, and adhering to the principles of disclosure and professionalism. As surgeons, we must encourage creativity and innovation while maintaining our ethical awareness and responsibility to patients.

  15. Simulation-based surgical education.

    Science.gov (United States)

    Evgeniou, Evgenios; Loizou, Peter

    2013-09-01

    The reduction in time for training at the workplace has created a challenge for the traditional apprenticeship model of training. Simulation offers the opportunity for repeated practice in a safe and controlled environment, focusing on trainees and tailored to their needs. Recent technological advances have led to the development of various simulators, which have already been introduced in surgical training. The complexity and fidelity of the available simulators vary, therefore depending on our recourses we should select the appropriate simulator for the task or skill we want to teach. Educational theory informs us about the importance of context in professional learning. Simulation should therefore recreate the clinical environment and its complexity. Contemporary approaches to simulation have introduced novel ideas for teaching teamwork, communication skills and professionalism. In order for simulation-based training to be successful, simulators have to be validated appropriately and integrated in a training curriculum. Within a surgical curriculum, trainees should have protected time for simulation-based training, under appropriate supervision. Simulation-based surgical education should allow the appropriate practice of technical skills without ignoring the clinical context and must strike an adequate balance between the simulation environment and simulators.

  16. Surgical techniques: past, present and future

    Directory of Open Access Journals (Sweden)

    Karim Qayumi

    2012-04-01

    Full Text Available The aim of this paper is to provide an analytical survey of the information available on the development of past and present surgical techniques, and to make projections for the future. For the purposes of this paper, the Past starts in the Neolithic period and ends in the 1800s. In this context, I have divided the Past into Prehistoric, Ancient and Middle Ages, and this period ends in the second half of the 19th century when the major obstacles to the further development of surgery, such as overcoming pain and infection, were removed. We will discuss the development of surgical techniques, and the obstacles and opportunities prevalent in these periods. In the context of this paper, the Present begins in 1867, when Louis Pasteur discovered microorganisms, and ends in the present day. There have been many important changes in the development of surgical techniques during this period, such as the transfer of surgery from the unsterile operating room to the modern hospital operating theater, the development of advanced and specialized surgical practices, such as transplants and laparoscopy, and minimally invasive surgical methods, robotic and Natural Orifice Transluminal Endoscopic Surgery. It is very difficult to foresee how surgical techniques will develop in the Future because of the unpredictable nature of technological progress. Therefore, in this paper, the forecast for the Future is limited to the next 50- 100 years and is a realistic calculation based on already existing technologies. In this context, the Future is divided into the development of surgical techniques that will develop in the near and distant future. It is anticipated that this overview will shed light on the historical perspective of surgical techniques and stimulate interest in their further development.

  17. Pneumonia associada à ventilação mecânica em Unidade de Terapia Intensiva cirúrgica Ventilator-associated pneumonia in surgical Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Claudia Maria Dantas de Maio Carrilho

    2006-03-01

    -associated pneumonia (VAP is a severe infection that presents multiple causes which can vary depending on the type of intensive care unit, type of patients, emphasizing the needs for vigilance measures with local data. The aim of this study is to describe the incidence, risk factors and mortality of VAP in patients in a surgical ICU. METHODS: Prospective cohort conducted from January 2004 to January 2005. It was included all the patients in mechanical ventilation, followed daily to collect data about demographics, diagnostic, APACHE II and TISS 28 scores, duration of mechanical ventilation, length of stay, incidence of VAP and mortality. RESULTS: 462 patients were studied; age 57.2 ± 16.6 years, 55% men. The mean APACHE II score was 18.3 and the incidence of VAP was 18.8%. The TISS score at admission OR = 1.050 (IC 95%: 1.003-1.050 and the enteral nutrition OR = 5.609 (IC 3.351-9.388 were factors associated with VAP and the prophylactic use of antibiotics was a factor of protection OR = 0.399 (IC95%: 0.177-0.902. The patients with VAP had longer length of stay in ICU (10.3 ± 10.7 vs 4.9 ± 3.3 days, higher median of duration of mechanical ventilation (4 vs 1 days, higher mean of TISS 28 (24.4 ± 4.6 vs 22.8 ± 4.5, and higher crude mortality (46 vs 28.8% when compared with the patients without VAP. CONCLUSIONS: VAP was a frequent infection in surgical patients in mechanical ventilation. Enteral nutrition and admission TISS were risk factors and the previous use of antibiotics was protection factor to develop VAP. In our sample the results demonstrate that VAP is associated with higher duration in mechanical ventilation, longer length of stay and higher mortality.

  18. Mobile Technologies for the Surgical Pathologist.

    Science.gov (United States)

    Hartman, Douglas J

    2015-06-01

    Recent advances in hardware and computing power contained within mobile devices have made it possible to use these devices to improve and enhance pathologist workflow. This article discusses the possible uses ranging from basic functions to intermediate functions to advanced functions. Barriers to implementation are also discussed.

  19. Survey on Robot-Assisted Surgical Techniques Utilization in US Pediatric Surgery Fellowships.

    Science.gov (United States)

    Maizlin, Ilan I; Shroyer, Michelle C; Yu, David C; Martin, Colin A; Chen, Mike K; Russell, Robert T

    2017-02-01

    Robotic technology has transformed both practice and education in many adult surgical specialties; no standardized training guidelines in pediatric surgery currently exist. The purpose of our study was to assess the prevalence of robotic procedures and extent of robotic surgery education in US pediatric surgery fellowships. A deidentified survey measured utilization of the robot, perception on the utility of the robot, and its incorporation in training among the program directors of Accreditation Council for Graduate Medical Education (ACGME) pediatric surgery fellowships in the United States. Forty-one of the 47 fellowship programs (87%) responded to the survey. While 67% of respondents indicated the presence of a robot in their facility, only 26% reported its utilizing in their surgical practice. Among programs not utilizing the robot, most common reasons provided were lack of clear supportive evidence, increased intraoperative time, and incompatibility of instrument size to pediatric patients. While 58% of program directors believe that there is a future role for robotic surgery in children, only 18% indicated that robotic training should play a part in pediatric surgery education. Consequently, while over 66% of survey respondents received training in robot-assisted surgical technique, only 29% of fellows receive robot-assisted training during their fellowship. A majority of fellowships have access to a robot, but few utilize the technology in their current practice or as part of training. Further investigation is required into both the technology's potential benefits in the pediatric population and its role in pediatric surgery training.

  20. Availability of advanced foreign energy conversion and conservation technology for use in the United States. Biennial report

    Energy Technology Data Exchange (ETDEWEB)

    Straus, R W; Thurman, R S; Carsey, J N; Fujishima, C; Hammel, J; Dietrich, P; Pfeil, R; Bottomley, K

    1978-12-01

    The assignment by DOE requested Galaxy to, Review and evaluate all field data and to define areas where foreign work is ready to be implemented by US; areas where US work might be dropped since foreign R and D is more advanced; areas where foreign R and D indicate sufficient promise for the US to initiate work in; areas where cooperative R and D ventures or licensing agreements might prove beneficial, etc. The specific technologies to be investigated by Galaxy were set forth in Tasks I and V of the contract as follows: Task I: (A) waste heat utilization, (B) advanced cycles, (C) component reliability and efficiency, (D) heat transfer, and (E) combustion and materials; Task V: (A) controls and process efficiency; (B) materials and fabrication; (C) components and heat engines; (D) thermodynamics and heat transfer; (E) fuel cells; (F) combustion and alternate fuels; and (G) heat utilization, planning and analysis. The foreign technology is briefly identified within the areas set forth. (WHK)

  1. Exploring the Eastern United States Continental Shelf with the NOAA Cooperative Institute for Ocean Exploration, Research, and Technology

    Science.gov (United States)

    Glickson, D.; Pomponi, S.

    2015-12-01

    The Cooperative Institute for Ocean Exploration, Research, and Technology (CIOERT) serves NOAA priorities in three theme areas: exploring the eastern U.S. continental shelf, improving the understanding of coral and sponge ecosystems, and developing advanced underwater technologies. CIOERT focuses on the exploration and research of ecosystems and habitats along frontier regions of the eastern U.S. continental shelf that are of economic, scientific, or cultural importance or of natural hazards concern. One particular focus is supporting ocean exploration and research through the use of advanced underwater technologies and techniques in order to improve the understanding of vulnerable deep and shallow coral and sponge ecosystems. CIOERT expands the scope and efficiency of exploration and research by developing, testing, and applying new and/or innovative uses of existing technologies to ocean exploration and research activities. In addition, CIOERT is dedicated to expanding ocean literacy and building NOAA's technical and scientific workforce through hands-on, at-sea experiences. A recent CIOERT cruise characterized Gulf of Mexico mesophotic and deepwater reef ecosystems off the west Florida shelf, targeting northern Pulley Ridge. This project created and ground-truthed new sonar maps made with an autonomous underwater vehicle; conducted video and photographic transects of benthic habitat and fish using a remotely operated vehicle; and examined the connectivity of fauna from shallow to deep reef ecosystems. CIOERT was established in 2009 by FAU-Harbor Branch Oceanographic Institute, with University of North Carolina, Wilmington, SRI International, and the University of Miami. The primary NOAA partner is the Office of Oceanic and Atmospheric Research's Office of Ocean Exploration and Research.

  2. Mr. Pat McDonald, Director of "Key Business Technologies", Department of Trade and Industry, United Kingdom

    CERN Document Server

    Maximilien Brice

    2002-01-01

    Photos 01,02: Mr Pat McDonald, Director of "Key Business Technologies", Department of Trade and Industry, UK (third from left, front) in front of the ATLAS End-Cap Toroid vacuum vessel in the ATLAS assembly hall with, from left to right, Fred Wickens, Chris Jones, Peter Fletcher, Ray Browne, Neil Geddes, Jim Fleming, Anne Trefethen, Jim Wilson, Edwin Towndrow, Sharon Bonfield, Guy Rickett, Ken Smith, Peter Jenni. Photo 03: Mr Pat McDonald, Director of "Key Business Technologies", Department of Trade and Industry, UK (fifth from left) visiting ATLAS assembly hall with, from left to right, Jim Wilson, Peter Jenni, Ken Smith, Edwin Towndrow, Ray Brown, Chris Jones, Neil Geddes, Sharon Bonfield, Anne Trefethen, Jim Fleming, Fred Wickens. Photo 04: Mr Pat McDonald, Director of "Key Business Technologies", Department of Trade and Industry, UK (fourth from right) in front of the ATLAS Barrel Toroid coil casing in the ATLAS assembly hall with, from left to right, Peter Jenni, Jim Wilson, Guy Rickett, Anne Trefethen, ...

  3. The role of government in the development and diffusion of renewable energy technologies: Wind power in the United States, California, Denmark and Germany, 1970--2000

    Science.gov (United States)

    Sawin, Janet Laughlin

    2001-07-01

    This dissertation seeks to determine the role of government policy in advancing the development and diffusion of renewable energy technologies, and to determine if specific policies or policy types are more effective than others in achieving these ends. This study analyzes legislation, regulations, research and development (R&D) programs and their impacts on wind energy in California, the rest of the United States, Denmark and Germany, from 1970 through 2000. These countries (and state) were chosen because each has followed a very different path and has adopted wind energy at different rates. Demand for energy, particularly electricity, is rising rapidly worldwide. Renewable energy technologies could meet much of the world's future demand for electricity without the national security, environmental and social costs of conventional technologies. But renewables now play only a minor role in the electric generation systems of most countries. According to conventional economic theory, renewable energy will achieve greater market penetration once it is cost-competitive with conventional generation. This dissertation concludes, however, that government policy is the most significant causal variable in determining the development and diffusion of wind energy technology. Policy is more important for bringing wind energy to maturity than a nation's wind resource potential, wealth, relative differences in electricity prices, or existing infrastructure. Further, policy is essential for enabling a technology to succeed in the marketplace once it is cost-competitive. Policies can affect a technology's perceived, or real, costs; they can reduce risks or increase the availability and affordability of capital; appropriate and consistent policies can eliminate barriers to wind technology. To be adopted on a large scale, renewables require effective, appropriate and, above all, consistent policies that are legislated with a long-term view toward advancing a technology and an

  4. Emergency Preparedness technology support to the Health and Safety Executive (HSE), Nuclear Installations Inspectorate (NII) of the United Kingdom. Appendix A

    Energy Technology Data Exchange (ETDEWEB)

    O`Kula, K.R.

    1994-03-01

    The Nuclear Installations Inspectorate (NII) of the United Kingdom (UK) suggested the use of an accident progression logic model method developed by Westinghouse Savannah River Company (WSRC) and Science Applications International Corporation (SAIC) for K Reactor to predict the magnitude and timing of radioactivity releases (the source term) based on an advanced logic model methodology. Predicted releases are output from the personal computer-based model in a level-of-confidence format. Additional technical discussions eventually led to a request from the NII to develop a proposal for assembling a similar technology to predict source terms for the UK`s advanced gas-cooled reactor (AGR) type. To respond to this request, WSRC is submitting a proposal to provide contractual assistance as specified in the Scope of Work. The work will produce, document, and transfer technology associated with a Decision-Oriented Source Term Estimator for Emergency Preparedness (DOSE-EP) for the NII to apply to AGRs in the United Kingdom. This document, Appendix A is a part of this proposal.

  5. Towards MRI guided surgical manipulator.

    Science.gov (United States)

    Chinzei, K; Miller, K

    2001-01-01

    The advantages of surgical robots and manipulators are well recognized in the clinical and technical community. Precision, accuracy and the potential for telesurgery are the prime motivations in applying advanced robot technology in surgery. In this paper critical interactions between Magnetic Resonance Imaging equipment and mechatronic devices are discussed and a novel Magnetic Resonance compatible surgical robot is described. Experimental results of the effects from several passive (metallic materials) and active (ultrasound motors) mechanical elements are demonstrated. The design principles for Magnetic Resonance compatible robots are established and the compatibility of the proposed robot is assessed by comparing images taken with and without the robot's presence within Signa SP/I GE Medical Systems scanner. The results showed that, in principle, it is possible to construct precision mechatronic devices intended to operate inside MR scanner. Use of such a device will not cause image shift or significant degradation of signal-to-noise-ratio. An MR compatible surgical assist robot was designed and constructed. The robot is not affected by the presence of strong magnetic fields and is able to manoeuvre during imaging without compromising the quality of images. A novel image-guided robot control scheme was proposed. As a part of the control scheme, biomechanics-based organ deformation model was constructed and validated by in-vivo experiment. It has been recognised that for robust control of an image guided surgical robot the precise knowledge of the mechanical properties of soft organs operated on must be known. As an illustration, results in mathematical modelling and computer simulation of brain deformation are given. The novel MR compatible robot was designed to position and direct an axisymmetric tool, such as a laser pointer or a biopsy catheter. New Robot control system based on the prediction of soft organ deformation was proposed.

  6. Mortality profile across our Intensive Care Units: A 5-year database report from a Singapore restructured hospital.

    Science.gov (United States)

    Siddiqui, Shahla

    2015-12-01

    Intensive care remains an area of high acuity and high mortality across the globe. With a rapidly aging population, the disease burden requiring intensive care is growing. The cost of critical care also is rising with new technology becoming available rapidly. We present the all-cause mortality results of 5 years database established in a restructured, large public hospital in Singapore, looking at all three types of Intensive Care Units present in our hospital. These include medical, surgical, and coronary care units.

  7. Development of a Cognitive Robotic System for Simple Surgical Tasks

    Directory of Open Access Journals (Sweden)

    Riccardo Muradore

    2015-04-01

    Full Text Available The introduction of robotic surgery within the operating rooms has significantly improved the quality of many surgical procedures. Recently, the research on medical robotic systems focused on increasing the level of autonomy in order to give them the possibility to carry out simple surgical actions autonomously. This paper reports on the development of technologies for introducing automation within the surgical workflow. The results have been obtained during the ongoing FP7 European funded project Intelligent Surgical Robotics (I-SUR. The main goal of the project is to demonstrate that autonomous robotic surgical systems can carry out simple surgical tasks effectively and without major intervention by surgeons. To fulfil this goal, we have developed innovative solutions (both in terms of technologies and algorithms for the following aspects: fabrication of soft organ models starting from CT images, surgical planning and execution of movement of robot arms in contact with a deformable environment, designing a surgical interface minimizing the cognitive load of the surgeon supervising the actions, intra-operative sensing and reasoning to detect normal transitions and unexpected events. All these technologies have been integrated using a component-based software architecture to control a novel robot designed to perform the surgical actions under study. In this work we provide an overview of our system and report on preliminary results of the automatic execution of needle insertion for the cryoablation of kidney tumours.

  8. Development of a Cognitive Robotic System for Simple Surgical Tasks

    Directory of Open Access Journals (Sweden)

    Riccardo Muradore

    2015-04-01

    Full Text Available The introduction of robotic surgery within the operating rooms has significantly improved the quality of many surgical procedures. Recently, the research on medical robotic systems focused on increasing the level of autonomy in order to give them the possibility to carry out simple surgical actions autonomously. This paper reports on the development of technologies for introducing automation within the surgical workflow. The results have been obtained during the ongoing FP7 European funded project Intelligent Surgical Robotics (I-SUR. The main goal of the project is to demonstrate that autonomous robotic surgical systems can carry out simple surgical tasks effectively and without major intervention by surgeons. To fulfil this goal, we have developed innovative solutions (both in terms of technologies and algorithms for the following aspects: fabrication of soft organ models starting from CT images, surgical planning and execution of movement of robot arms in contact with a deformable environment, designing a surgical interface minimizing the cognitive load of the surgeon supervising the actions, intra-operative sensing and reasoning to detect normal transitions and unexpected events. All these technologies have been integrated using a component-based software architecture to control a novel robot designed to perform the surgical actions under study. In this work we provide an overview of our system and report on preliminary results of the automatic execution of needle insertion for the cryoablation of kidney tumours.

  9. Performance-Based Technology Selection Filter application report for Teledyne Wah Chang Albany Operable Unit Number One. INEL Buried Waste Integrated Demonstration

    Energy Technology Data Exchange (ETDEWEB)

    Richardson, J.G.; Morrison, J.L.; Morneau, R.A.; O`Brien, M.C.; Rudin, M.J.

    1992-05-01

    This report summarizes the application of the Performance-Based Technology Selection Filter (PBTSF) developed for the Idaho National Laboratory`s Buried Waste Integrated Demonstration Program as applied to remediation activities conducted at the Teledyne Wah Chang Albany (TWCA) Superfund Site, Operable Unit One. The remedial action at the TWCA Operable Unit One consisted of solidification, excavation, transportation, and monocell disposal of the contents of two sludge ponds contaminated with various inorganic and organic compounds. Inorganic compounds included low levels of uranium and radium isotopes, as well zirconium, hafnium, chromium, mercury, and nickel. Organic compounds included methylene chloride, 1,1,1-trichloroethane, 1,1-dichloroethane, tetrachloroethane, and hexachlorobenzene. Remediation began in June 1991, and was completed in November 1991. The TWCA Operable Unit One configuration option consisted of 15 functional subelements. Data were gathered on these subelements and end-to-end system operation to calculate numerical values for 28 system performance measures. These were then used to calculate a system performance score. An assessment was made of the availability and definitional clarity of these performance measures, applicability of PBTSF utility functions, and rollup methodology. The PBTSF scoring function worked well, with few problems noted in data gathering, utility function normalization, and scoring calculation. The application of this process to an actual in situ treatment and excavation technical process option clarified the specific terms and bounds of the performance score functions, and identified one problem associated with the definition of system boundary.

  10. Evaluation of technological improvements in bundling units for the collection of eucalyptus logging residues on steep terrain in Spain

    Directory of Open Access Journals (Sweden)

    Sandra Sánchez-García

    2015-08-01

    Full Text Available Aim of the study: The objective of this study was to evaluate recent technological improvements to forest bundlers: a new cutting device with shears and a mechanism which allows the bundling pressure to be changed by the driver. Area of study: eucalyptus plantations in Northern Spain. Material and Methods: Several time studies were performed in order to compare and calculate productivity depending on the machine: John Deere bundler working with the traditional chainsaw and Monra bundler equipped with the technological improvements of shears and adjustable bundling pressure. Research highlights: Significant differences were found between cutting devices (shears and chainsaw and between the Monra working at maximum pressure and at lower pressure. Shears were shown to be a more robust and reliable cutting device, with 1.02 cutting attempts per bundle compared to 1.55 with chain saw. The use of shears made the loading more efficient as it eliminates the need to shake the residues before feeding the bundler. A great advantage of this technological improvement is that it can be incorporated into other machines and thus improve bundling efficiency. In spite of this, working at standard bundling pressure, the productivity of the Monra bundler is only 3.2 per cent higher than that of the John Deere due to the fact that in the latter bundling is faster and it produces bundles with significantly more dry mass. For the Monra bundler, the option of producing lighter bundles further reduced productivity compared to when standard weight bundles are produced. However, it would be of interest to study the effect of the machine working at various pressures in order to optimize the work system. It is possible that working at higher pressures would have advantages in terms of increasing transport efficiency.

  11. The theory of shared communication: how parents of technology-dependent children communicate with nurses on the inpatient unit.

    Science.gov (United States)

    Giambra, Barbara K; Sabourin, Teresa; Broome, Marion E; Buelow, Janice

    2014-01-01

    Care may be compromised for hospitalized technology-dependent children if nurses do not communicate with parents to include their knowledge in the child's plan of care. A qualitative study using grounded theory methodology was undertaken to identify parental perceptions and experiences of communication with nurses. The Theory of Shared Communication was the result of this study and includes questioning, listening, explaining, advocating, verifying understanding and negotiating roles to achieve the outcome of mutual understanding of the child's plan of care. Nurses should be aware of parent perceptions about communication when working with families to optimize the care they provide.

  12. Analysis on the revision of the United States authorizing procedure for the transfer of unclassified nuclear technology

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Sung-ho; Seo, Hana; Lee, Chansuh; Kim, Jong-sook [Korea Institute of Nuclear Nonproliferation and Control, Daejeon (Korea, Republic of)

    2015-10-15

    The DOE (Department Of Energy) has not comprehensively update 10CFR810 since 1986. Since then, the global civil nuclear market has expanded, particularly in China, the Middle East, and Eastern Europe, with vendors from France, Japan, the Republic of Korea, Russia, and Canada. In result, DOE issued revised 810 in respond to comments received from the public and commercial nuclear market changes. This regulation revision improves the efficiency of authorization process to promote national nuclear industry while maintaining nonproliferation control. Even though ROK has initiated a legal basis for Intangible technology transfer (ITT) for nuclear export control, working implementation system is not set up. This research proposes recommendable ITT implementation of the ROK according to the analysis result of the US regulation. In this revision, of 124 countries had been classified as general authorization under 10CFR810, 80 countries reclassified into the specific authorization. By remaining 'fast track' for specific authorization, in particular, time frames for internal DOE and interagency reviews are reduced. This means the US government actively copes with commercial nuclear market expands to promote their industry. Meanwhile, by remaining some of nuclear-weapon states (China, Russia, India) as specific authorization maintaining that the determinations are consistent with current US national security, diplomatic, and trade policy. By benchmarking the US regulation, Korea can improve the efficiency of the technology transfer authorization process easing the regulatory burden by reducing uncertainty and timelines while maintaining the highest level of nonproliferation control.

  13. Application of improved technologies for ensuring high quality in safety, maintenance and operation activities of units 5 and 6 of Kozloduy - a successful project

    Energy Technology Data Exchange (ETDEWEB)

    Naydenov, N. [Kozloduy NPP Units 5 and 6 Modernization Program, Kozloduy (Bulgaria); Hoch, G. [Kozloduy NPP Units 5 and 6 Modernization Program, AREVA NP GmbH, Erlangen (Germany); Krasnocharov, A. [Kozloduy NPP Units 5 and 6 Modernization Program, Dept. Manager, Kozloduy (Bulgaria)

    2007-07-01

    The Units 5 and 6 of Kozloduy Nuclear Power Plant (KNPP) became operative in 1987 and 1991, respectively. These units, consisting of a VVER-1000/320 type reactor, have design characteristics, basically elaborated in accordance with Russian rules and standards in force at the time of the design. In order to reach a full compliance with the international safety standards that evolved over the last two decades KNPP decided to introduce the Kozloduy Units 5 and 6 Modernization Program to upgrade the plant, with the main objective to bring the installation to a safety level compatible with current international practices. The Program comprises 212 individual modifications aimed at enhancing safety, reliability and operational conditions of both units. Some of the measures implemented are as follows: -) the replacement of the thermal insulation of equipment and pipelines in the containment, -) the replacement of the turbine condenser tube bundles with stainless steel tubes, -) the replacement of the in-core monitoring system, -) the implementation of new gas fire extinguishing system for the electronic cabinets, -) the implementation of protective measures and the enhancement of the supports of the main steam and feed water lines, -) the installation of a filtered ventilation system, -) the upgrading of the electrical equipment, and -) the installation of new technologies and equipment for facility status monitoring and preventive detection. The installation of the above mentioned systems is not only a change in design but is a long and complicated process that involves the achievement of thorough analysis of design condition and of the integration on new equipment in existing configuration. The Report draws special attention to the value of the experience gained upon the management and implementation of such large-scale and complex designs in the nuclear field.

  14. Guide to Surgical Specialists

    Science.gov (United States)

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

  15. Surgical Critical Care Initiative

    Data.gov (United States)

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

  16. Ambulatory Surgical Measures - National

    Data.gov (United States)

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

  17. Ambulatory Surgical Measures - Facility

    Data.gov (United States)

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

  18. Surgical site infections

    African Journals Online (AJOL)

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

  19. Office of Electricity Delivery and Energy Reliability (OE) National Energy Technology Laboratory (NETL) American Recovery and Reinvestment Act 2009 United States Department of Energy

    Energy Technology Data Exchange (ETDEWEB)

    Singh, Mohit [Seeo, Incorporated, Hayward, CA (United States); Grape, Ulrik [Seeo, Incorporated, Hayward, CA (United States)

    2014-07-29

    The purpose of this project was for Seeo to deliver the first ever large-scale or grid-scale prototype of a new class of advanced lithium-ion rechargeable batteries. The technology combines unprecedented energy density, lifetime, safety, and cost. The goal was to demonstrate Seeo’s entirely new class of lithium-based batteries based on Seeo’s proprietary nanostructured polymer electrolyte. This technology can enable the widespread deployment in Smart Grid applications and was demonstrated through the development and testing of a 10 kilowatt-hour (kWh) prototype battery system. This development effort, supported by the United States Department of Energy (DOE) enabled Seeo to pursue and validate the transformational performance advantages of its technology for use in grid-tied energy storage applications. The focus of this project and Seeo’s goal as demonstrated through the efforts made under this project is to address the utility market needs for energy storage systems applications, especially for residential and commercial customers tied to solar photovoltaic installations. In addition to grid energy storage opportunities Seeo’s technology has been tested with automotive drive cycles and is seen as equally applicable for battery packs for electric vehicles. The goals of the project were outlined and achieved through a series of specific tasks, which encompassed materials development, scaling up of cells, demonstrating the performance of the cells, designing, building and demonstrating a pack prototype, and providing an economic and environmental assessment. Nearly all of the tasks were achieved over the duration of the program, with only the full demonstration of the battery system and a complete economic and environmental analysis not able to be fully completed. A timeline over the duration of the program is shown in figure 1.

  20. Evaluation of medication errors with implementation of electronic health record technology in the medical intensive care unit

    Directory of Open Access Journals (Sweden)

    Liao TV

    2017-05-01

    Full Text Available T Vivian Liao,1 Marina Rabinovich,2 Prasad Abraham,2 Sebastian Perez,3 Christiana DiPlotti,4 Jenny E Han,5 Greg S Martin,5 Eric Honig5 1Department of Pharmacy Practice, College of Pharmacy, Mercer Health Sciences Center, 2Department of Pharmacy and Clinical Nutrition, Grady Health System, 3Department of Surgery, Emory University, 4Pharmacy, Ingles Markets, 5Department of Medicine, Emory University, Atlanta, GA, USA Purpose: Patients in the intensive care unit (ICU are at an increased risk for medication errors (MEs and adverse drug events from multifactorial causes. ME rate ranges from 1.2 to 947 per 1,000 patient days in the medical ICU (MICU. Studies with the implementation of electronic health records (EHR have concluded that it significantly reduced overall prescribing errors and the number of errors that caused patient harm decreased. However, other types of errors, such as wrong dose and omission of required medications increased after EHR implementation. We sought to compare the number of MEs before and after EHR implementation in the MICU, with additional evaluation of error severity.Patients and methods: Prospective, observational, quality improvement study of all patients admitted to a single MICU service at an academic medical center. Patients were evaluated during four periods over 2 years: August–September 2010 (preimplementation; period I, January–February 2011 (2 months postimplementation; period II, August–September 2012 (21 months postimplementation; period III, and January–February 2013 (25 months postimplementation; period IV. All medication orders and administration records were reviewed by an ICU clinical pharmacist and ME was defined as a deviation from established standards for prescribing, dispensing, administering, or documenting medication. The frequency and classification of MEs were compared between groups by chi square; p<0.05 was considered significant.Results: There was a statistically significant increase

  1. Surgical options for complex craniofacial pain.

    Science.gov (United States)

    Sharma, Mayur; Shaw, Andrew; Deogaonkar, Milind

    2014-10-01

    Complex craniofacial pain can be a challenging condition to manage both medically and surgically, but there is a resurgence of interest in the role of neurostimulation therapy. Surgical options for complex craniofacial pain syndromes include peripheral nerve/field stimulation, ganglion stimulation, spinal cord stimulation, dorsal nerve root entry zone lesioning, motor cortex stimulation, and deep brain stimulation. Peripheral nerve/field stimulation is rapidly being explored and is preferred by both patients and surgeons. Technological advances and improved understanding of the interactions of pain pathways with its affective component will widen the scope of neurostimulation therapy for craniofacial pain syndromes.

  2. Developing an App by Exploiting Web-Based Mobile Technology to Inspect Controlled Substances in Patient Care Units

    Science.gov (United States)

    2017-01-01

    We selected iOS in this study as the App operation system, Objective-C as the programming language, and Oracle as the database to develop an App to inspect controlled substances in patient care units. Using a web-enabled smartphone, pharmacist inspection can be performed on site and the inspection result can be directly recorded into HIS through the Internet, so human error of data translation can be minimized and the work efficiency and data processing can be improved. This system not only is fast and convenient compared to the conventional paperwork, but also provides data security and accuracy. In addition, there are several features to increase inspecting quality: (1) accuracy of drug appearance, (2) foolproof mechanism to avoid input errors or miss, (3) automatic data conversion without human judgments, (4) online alarm of expiry date, and (5) instant inspection result to show not meted items. This study has successfully turned paper-based medication inspection into inspection using a web-based mobile device. PMID:28286761

  3. Developing an App by Exploiting Web-Based Mobile Technology to Inspect Controlled Substances in Patient Care Units

    Directory of Open Access Journals (Sweden)

    Ying-Hao Lu

    2017-01-01

    Full Text Available We selected iOS in this study as the App operation system, Objective-C as the programming language, and Oracle as the database to develop an App to inspect controlled substances in patient care units. Using a web-enabled smartphone, pharmacist inspection can be performed on site and the inspection result can be directly recorded into HIS through the Internet, so human error of data translation can be minimized and the work efficiency and data processing can be improved. This system not only is fast and convenient compared to the conventional paperwork, but also provides data security and accuracy. In addition, there are several features to increase inspecting quality: (1 accuracy of drug appearance, (2 foolproof mechanism to avoid input errors or miss, (3 automatic data conversion without human judgments, (4 online alarm of expiry date, and (5 instant inspection result to show not meted items. This study has successfully turned paper-based medication inspection into inspection using a web-based mobile device.

  4. Pharmaceutics, Drug Delivery and Pharmaceutical Technology: A New Test Unit for Disintegration End-Point Determination of Orodispersible Films.

    Science.gov (United States)

    Low, Ariana; Kok, Si Ling; Khong, Yuetmei; Chan, Sui Yung; Gokhale, Rajeev

    2015-11-01

    No standard time or pharmacopoeia disintegration test method for orodispersible films (ODFs) exists. The USP disintegration test for tablets and capsules poses significant challenges for end-point determination when used for ODFs. We tested a newly developed disintegration test unit (DTU) against the USP disintegration test. The DTU is an accessory to the USP disintegration apparatus. It holds the ODF in a horizontal position, allowing top-view of the ODF during testing. A Gauge R&R study was conducted to assign relative contributions of the total variability from the operator, sample or the experimental set-up. Precision was compared using commercial ODF products in different media. Agreement between the two measurement methods was analysed. The DTU showed improved repeatability and reproducibility compared to the USP disintegration system with tighter standard deviations regardless of operator or medium. There is good agreement between the two methods, with the USP disintegration test giving generally longer disintegration times possibly due to difficulty in end-point determination. The DTU provided clear end-point determination and is suitable for quality control of ODFs during product developmental stage or manufacturing. This may facilitate the development of a standardized methodology for disintegration time determination of ODFs. © 2015 Wiley Periodicals, Inc. and the American Pharmacists Association J Pharm Sci 104:3893-3903, 2015.

  5. E-Procurement System Technology: An Analysis in Electronic Procurement Service Unit (LPSE of Kepulauan Riau Province

    Directory of Open Access Journals (Sweden)

    Rendra Setyadiharja

    2014-12-01

    Full Text Available The practice of corruption always exist in public goods and service procurement in Indonesia. The Government efforts in reducing this case are doing new breakthrough like creating new system of service and goods procurement in an electronic way, usually called E-Procurement. After being instructed by Presidential Regulation number 54, year of 2010, the Local Government must use the E-Procurement System in the process of goods and service procurement, including Kepulauan Riau Province. This Research aims to analyzed the implementation of e-procurement system that had been adopted by Kepulauan Riau Province at year 2008. This research is not just for viewing the implementation of e-procurement system technically, but also to see how the influence of political process to the implementation of e-procurement. The Methodology used in this research is mix-method. This research are conducted in LPSE Kepulauan Riau Province, Procurement Service Unit (ULP and also the vendors that supplies service and goods, that had been using the system. The results of this research are clearly stated that even the system of e-procurement of Kepulauan Riau Province are effective, and the political process is a factor which influencing the implementation of e-procurement.Keywords : E-Procurement, E-Procurement Implementation, Political Process, Principal Influence, Agent Influence. 

  6. Developing an App by Exploiting Web-Based Mobile Technology to Inspect Controlled Substances in Patient Care Units.

    Science.gov (United States)

    Lu, Ying-Hao; Lee, Li-Yao; Chen, Ying-Lan; Cheng, Hsing-I; Tsai, Wen-Tsung; Kuo, Chen-Chun; Chen, Chung-Yu; Huang, Yaw-Bin

    2017-01-01

    We selected iOS in this study as the App operation system, Objective-C as the programming language, and Oracle as the database to develop an App to inspect controlled substances in patient care units. Using a web-enabled smartphone, pharmacist inspection can be performed on site and the inspection result can be directly recorded into HIS through the Internet, so human error of data translation can be minimized and the work efficiency and data processing can be improved. This system not only is fast and convenient compared to the conventional paperwork, but also provides data security and accuracy. In addition, there are several features to increase inspecting quality: (1) accuracy of drug appearance, (2) foolproof mechanism to avoid input errors or miss, (3) automatic data conversion without human judgments, (4) online alarm of expiry date, and (5) instant inspection result to show not meted items. This study has successfully turned paper-based medication inspection into inspection using a web-based mobile device.

  7. 外科重症监护室导管相关性医院感染5年监测资料分析%Catheter-associated nosocomial infection in surgical intensive care unit: a 5 year data analysis

    Institute of Scientific and Technical Information of China (English)

    糜琛蓉; 张祎博; 杨莉; 李文慧; 顾秋莹; 赵煜瑾; 孙芳艳; 李贤华

    2011-01-01

    Objective To realize the status and causes of catheter-associated nosocomial infection (CANI) in surgical intensive care unit (SICU) , so as to decrease the incidence by taking proper measures. Methods Six hundred and fifteen patients with catheters in SICU between 2005 and 2009 were monitored prospectively, including the occurrence of CANI, patients' age, length of hospital stay, invasive procedures, and pathogens. Results One hundred and ninety-seven of 615 patients (32. 03%) developed CANI, and CANI rate was 2. 60%, 12. 85% and 56. 40% in patients with 1 kind, 2 or 3 kinds of catheters simultaneously respectively, there were significant difference among three groups (x2 = 151.55, P<0. 001). The rate of ventilator-associated pneumonia (VAP), catheterassociated urinary tract infection (CA-UTI) , and central venous catheter (CVC)-associated bloodstream infection (CVC-BSI) per 1 000 catheter days was 15. 51, 13. 70 and 5. 79 respectively. The average catheter utilization days before the occurrence of CANI were as follows: ventilator (12. 22 ± 11.29) days, urinary catheter (13. 09 ± 13. 29)days , CVC (20. 64 ± 18. 39) days respectively. The major pathogen in VAP , CA-UTI and CVC-BSI was Acinetobacter spp. ( 18. 80 %), Candida albicans (36. 46 %) and Acinetobacter spp. ( 18. 75 %) respectively. Conclusion Patients with more catheters , long hospital stay and long duration of catheters are prone to develop nosocomial infection. The key to the prevention of emerging of drug-resistant strain and decrease in NI are strengthening of disinfection and isolation, shortening the time of catheter retaining, implementing hand hygiene, and using antimicrobial drug rationally.%目的 了解外科重症监护室(SICU)导管相关性医院感染发生状况及其原因,以采取相应措施降低其发病率.方法 采用前瞻性监测方法,对SICU 2005-2009年间615例留置导管患者的相关医院感染发生状况、年龄、住院天数、侵人性操作

  8. Retrospective analysis of invasive fungal infection in surgical intensive care unit%外科重症治疗病房中侵袭性真菌感染分析

    Institute of Scientific and Technical Information of China (English)

    李纾; 安友仲

    2010-01-01

    目的 分析外科重症治疗病房(SICU)患者侵袭性真菌感染(IFI)的情况.方法 回顾性分析北京大学人民医院SICU 2003年1月至2008年12月间收治的3743例患者真菌感染相关的资料,其中住ICU时间≥48 h的271例患者常规进行了真菌学检查.结果 诊断为院内IFI患者共75例,感染率2.00%(75/3743),真菌血症发生率0.27%(10/3743),死亡37例,病死率49.33%(37/75).各年感染率比较P=0.420,差异无统计学意义;病死率2007年及2008年升高,与以往各年比较差异均有统计学意义(均P<0.05).75例患者中34例为泌尿道感染,37例为肺部感染,10例发现真菌血症,1 例为导管相关真菌感染,2 例为腹腔感染,2 例为胆道感染.11 例患者有2个部位发生真菌感染.检出致病真菌86株,其中白念珠菌40株(46.51%),光滑念珠菌19株(22.09%),热带念珠菌12株(13.95%),近平滑念珠菌7株(8.14%),克柔念珠菌3株(3.49%),毛霉菌4株(4.65%),曲霉菌1株(1.16%).机械通气时间≥3 d、合并细菌感染、使用广谱抗生素或联用3种及以上抗生素是患者发生IFI的高危因素,预防性抗真菌治疗可能有保护作用.结论 我院SICU患者总体IFI发病率较低,真菌血症发生率较低;发生IFI后患者死亡率明显增高;感染部位主要在肺部和泌尿道,致病真菌主要为念珠菌;机械通气、合并细菌感染、抗生素使用是SICU患者发生IFI的重要危险因素.%Objective To conduct a restrospective analysis of the invasive fungal infection (IFI) in surgical intensive care unit (SICU). Methods The IFI data of the patients who were admitted in SICU during January 2003 to December 2008 was retrospectively analyzed. A total of 3743 patients were admitted into SICU. Among them, 271 patient's SICU duration was more than 48 hours, who had fungi examination. Results Seventy-five patients were diagnosed IFI, the morbidity was 2.00% (75/3743), the incidence of fungemia was 0.27% (10/3743), the mortality of IFI

  9. IEA Wind Task 26. Wind Technology, Cost and Performance Trends in Denmark, Germany, Ireland, Norway, the European Union, and the United States. 2007 - 2012

    Energy Technology Data Exchange (ETDEWEB)

    Vitina, Aisma [Ea Energy Analyses, Copenhagen (Denmark); Luers, Silke [Deutsche WindGuard, Varel (Germany); Wallasch, Anna-Kathrin [Deutsche WindGuard, Varel (Germany); Berkhout, Volker [Fraunhofer IWES (Germany); Duffy, Aidan [Dublin Inst. of Technology and Dublin Energy Lab (Ireland); Cleary, Brendan [Dublin Inst. of Technology and Dublin Energy Lab (Ireland); Husabo, Leif I. [Norwegian Water Resources and Energy Directorate (NVE), Oslo (Norway); Weir, David E. [Norwegian Water Resources and Energy Directorate (NVE), Oslo (Norway); Lacal-Arantegui, Roberto [European Commission, Ispra (Italy). Joint Research Centre; Hand, M. Maureen [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Lantz, Eric [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Belyeu, Kathy [Belyeu Consulting, Tacoma Park, MD (United States); Wiser, Ryan [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Bolinger, Mark [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Hoen, Ben [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2015-06-12

    This report builds from a similar previous analysis (Schwabe et al., 2011) exploring the differences in cost of wind energy in 2008 among countries participating in IEA Wind Task 26 at that time. The levelized cost of energy (LCOE) is a widely recognized metric for understanding how technology, capital investment, operations, and financing impact the life-cycle cost of building and operating a wind plant. Schwabe et al. (2011) apply a spreadsheet-based cash flow model developed by the Energy Research Centre of the Netherlands (ECN) to estimate LCOE. This model is a detailed, discounted cash flow model used to represent the various cost structures in each of the participating countries from the perspective of a financial investor in a domestic wind energy project. This model is used for the present analysis as well, and comparisons are made for those countries who contributed to both reports, Denmark, Germany, and the United States.

  10. 美国、加拿大与澳大利亚的卫生技术评估%Health Technology Assessment in United States, Canada and Australia

    Institute of Scientific and Technical Information of China (English)

    徐文煜; 薛迪

    2011-01-01

    以美国、加拿大和澳大利亚为例,回顾了卫生技术评估发展历史、体系结构、参与各方以及对于卫生政策的影响.其对我国卫生技术评估的发展提供了可借鉴的经验.%The United States is historically the first to conduct health technology assessment ( HTA ), and Canada and Australia is the one who performs outstanding HTA in the world. The paper presented the histories of HTA in three countries and their system structures, interest parties and impacts on health policy, which provided inspirations to HTA development in China.

  11. [The design of a family of ultrasonic diagnostic units based on up-to-date computer technologies].

    Science.gov (United States)

    Trukhanov, A I; Nagulin, N E

    1996-01-01

    Small ultrasonic devices are now being used in medical practice. However, the vast majority of them represent designingly completed systems which cannot include additional soft- and hardwares to accumulate measurements and to set up databases, to make additional postprocessing, to transmit measurements along networks and telephone lines, etc. On the other hand, in our and foreign countries, work is under way in designing the systems of archiving and treating ultrasonic images, working places for a physician engaged in radiation diagnosis. But at the same time direct joining of ultrasonic equipment with standard computer facilities is impossible in many practical cases. To design ultrasonic devices by using Multimedia IBM PC technology which may integrate various informational media, such as display, sonic information, and textual data is one of the ways of solving this problem. With this, the hardwares of ultrasonic devices are realized in the construction of standard IBM PC modules. Sonomed ultrasonic devices may be considered to be alternatives of Multimedia IBM PC-based devices.

  12. 抽油机下偏杠铃节能技术应用%Energy Saving Technology Application of Pumping Unit with Biased Downward Barbell

    Institute of Scientific and Technical Information of China (English)

    王增藩

    2011-01-01

    针对目前油田普遍应用常规式游梁抽油机存在的问题;平衡性能相对较差,启动扭矩大,拖动电机功率大,抽油系统效率低和耗能较高等,应用下偏杠铃复合平衡技术对其进行节能技术改造.阐述了该项节能技术改造设计结构及工艺原理,对现场应用效果进行了分析评价,取得以下认识;一是曲柄与下偏杠铃的复合平衡方式,削减了抽油机峰值扭矩,降低了电机消耗功率,有效改善了抽油机平衡效果,平均节电率达到20.53%.二是从现场应用情况看,在不改变原机结构前提下,安装方便,投入成本较低,CYJ10型机改造的节电总体效果高于CYJ6型机.%Aimed at the issue of widely used conventional-style oil pumping beam, such as its balance performance was poor relatively, starting torque and electrical power were bigger, efficiency of pumping unit system was low and the energy consumption was higher. The biased downward barbell is used to balance the gearbox output moment in order to redesign the pumping units. Elaborating this energy-saving technology changes the design structure and process principle, application effect is analyzed and evaluated, and achieved following results. Firstly thecomplex balance of the counterbalance and biased downward barbell, reduces pumping unit peak torque and motor power consumption, improves the moment balance of pumping unit, the average electric saving ratio reaches 20.53%. Secondly from the view of field application, in the premise of unchanging the original pumping unit structure, it is easily installed with lower costs, The overall effect of energy-saving of the redesign CYJ10 style are higher than CYJ6 style.

  13. Ringing in the new physics: The politics and technology of electron colliders in the United States, 1956--1972

    Science.gov (United States)

    Paris, Elizabeth

    The ``November Revolution'' of 1974 and the experiments that followed consolidated the place of the Standard Model in modern particle physics. Much of the evidence on which these conclusions depended was generated by a new type of tool: colliding beam storage rings, which had been considered physically unfeasible twenty years earlier. In 1956 a young experimentalist named Gerry O'Neill dedicated himself to demonstrating that such an apparatus could do useful physics. The storage ring movement encountered numerous obstacles before generating one of the standard machines for high energy research. In fact, it wasn't until 1970 that the U.S. finally broke ground on its first electron-positron collider. Drawing extensively on archival sources and supplementing them with the personal accounts of many of the individuals who took part, Ringing in the New Physics examines this instance of post-World War II techno-science and the new social, political and scientific tensions that characterize it. The motivations are twofold: first, that the chronicle of storage rings may take its place beside mathematical group theory, computer simulations, magnetic spark chambers, and the like as an important contributor to a view of matter and energy which has been the dominant model for the last twenty-five years. In addition, the account provides a case study for the integration of the personal, professional, institutional, and material worlds when examining an episode in the history or sociology of twentieth century science. The story behind the technological development of storage rings holds fascinating insights into the relationship between theory and experiment, collaboration and competition in the physics community, the way scientists obtain funding and their responsibilities to it, and the very nature of what constitutes ``successful'' science in the post- World War II era.

  14. Linear units improve articulation between social and physical constructs: An example from caregiver parameterization for children supported by complex medical technologies

    Science.gov (United States)

    Bezruczko, N.; Stanley, T.; Battle, M.; Latty, C.

    2016-11-01

    Despite broad sweeping pronouncements by international research organizations that social sciences are being integrated into global research programs, little attention has been directed toward obstacles blocking productive collaborations. In particular, social sciences routinely implement nonlinear, ordinal measures, which fundamentally inhibit integration with overarching scientific paradigms. The widely promoted general linear model in contemporary social science methods is largely based on untransformed scores and ratings, which are neither objective nor linear. This issue has historically separated physical and social sciences, which this report now asserts is unnecessary. In this research, nonlinear, subjective caregiver ratings of confidence to care for children supported by complex, medical technologies were transformed to an objective scale defined by logits (N=70). Transparent linear units from this transformation provided foundational insights into measurement properties of a social- humanistic caregiving construct, which clarified physical and social caregiver implications. Parameterized items and ratings were also subjected to multivariate hierarchical analysis, then decomposed to demonstrate theoretical coherence (R2 >.50), which provided further support for convergence of mathematical parameterization, physical expectations, and a social-humanistic construct. These results present substantial support for improving integration of social sciences with contemporary scientific research programs by emphasizing construction of common variables with objective, linear units.

  15. Novel Uses of Video to Accelerate the Surgical Learning Curve.

    Science.gov (United States)

    Ibrahim, Andrew M; Varban, Oliver A; Dimick, Justin B

    2016-04-01

    Surgeons are under enormous pressure to continually improve and learn new surgical skills. Novel uses of surgical video in the preoperative, intraoperative, and postoperative setting are emerging to accelerate the learning curve of surgical skill and minimize harm to patients. In the preoperative setting, social media outlets provide a valuable platform for surgeons to collaborate and plan for difficult operative cases. Live streaming of video has allowed for intraoperative telementoring. Finally, postoperative use of video has provided structure for peer coaching to evaluate and improve surgical skill. Applying these approaches into practice is becoming easier as most of our surgical platforms (e.g., laparoscopic, and endoscopy) now have video recording technology built in and video editing software has become more user friendly. Future applications of video technology are being developed, including possible integration into accreditation and board certification.

  16. 重整预加氢催化剂国内外技术进展%Technology progress of pre-hydrotreating catalyst for reforming unit

    Institute of Scientific and Technical Information of China (English)

    王广胜; 米多; 王伟峰

    2011-01-01

    催化重整预加氢催化剂主要是由载体和金属活性组分组成,最常用的预加氢催化剂的金属组分是Co-Mo、Ni-Mo、Ni-W体系.主要论述了催化重整预加氢催化剂的国内外技术进展,着重论述了国内重整预加氢催化剂的性质、特点及研发单位,提出了重整预加氢催化剂的发展方向,催化重整预加氢催化剂对直馏汽油要有良好的适应性,空速高,反应温度低,活性稳定性好,能够满足工业上长周期运转的需要.%The pre-hydrotreating catalyst for reforming unit are made up of carrier and metal active component,the most commonly used of metal active component for pre-hydrotreating are Co-Mo, Ni-Mo, and Ni-W. The article summarized the technology progress of pre-hydrotreating catalyst for refor-ming unit at home and abroad,emphatically discussed the activity and scientific research situation,put forward the future developing direction of pre-hydrotreating catalyst for reforming unit. The pre-hy-drotreating catalyst should have high space velocity, low reaction temperature,high activity and stabili-ty in distilled gasoline pre-hydrogenation and could meet the need of long running production.

  17. Development of reduced crude processing technology in delayed coking units; Desenvolvimento da tecnologia de processamento de residuo atmosferico em unidade de coqueamento retardado

    Energy Technology Data Exchange (ETDEWEB)

    Soares, Gloria Maria Gomes; Bartros, Francisco Carlos da Costa; Goncalves, Natalie Jorge; Pala, Danielle Marins; Nadolni, Aline Voigt [PETROBRAS, Rio de Janeiro, RJ (Brazil)

    2008-07-01

    Delayed Coking Technology can be described as thermal cracking of low value refinery residual streams into high-value products. This process has been applied in petroleum refining schemes in order to upgrade heavy and ultra-heavy crude oils. The typical feedstock is vacuum residue (VR). When we have an increasing medium distillates demand and refining schemes which have gas oil and VR excess, the simultaneous conversion of these streams becomes economically attractive, due mainly to the increase of diesel production. Thus, the processing of atmospheric residue (AR) in Delayed Coking Units (DCU) has fueled great interest for PETROBRAS. This work presents the results of industrial and pilot plant tests with AR and VR showing the increasing of diesel yields and decreasing of coke yields processing AR as feedstock. When we process all the AR in the DCU with high recycle rate we observe an increasing of 25% on refinery diesel production related to conventional schemes. The refining scheme of the new PETROBRAS refinery at Northeast of Brazil is based on this technology. This refinery will process heavy oils maximizing diesel production with minimum investment. (author)

  18. A Political, Economic, Social, Technology, Legal and Environmental (PESTLE Approach for Risk Identification of the Tidal Industry in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Athanasios Kolios

    2013-09-01

    Full Text Available This paper presents a comprehensive analysis of renewable and especially tidal energy through a political, economic, social, technology, legal and environmental (PESTLE analysis approach and by reviewing the most up to date relevant literature. The study focuses on the United Kingdom given the favourable environmental resources for such technologies; the number of different design concepts that are currently under development as well as the research funding that has been invested over the last few years. Findings of the analysis identify the risks and multiple stakeholders involved at all stages of the tidal energy projects development from the conceptualization of the design, right through to decommissioning. Many of the stakeholders present benefits to the tidal developers through funding, incentives and knowledge sharing, but at the same time they also present potential risks to the future of projects. This is mostly down to different approaches of the most important aspect of tidal energy that needs to be considered, making it hard for technologists and developers to equally address all requirements. From this research it can be concluded that several of these risks can be mitigated early on providing that particular stakeholders are involved at the correct stage of a project.

  19. 3D printing surgical instruments: Are we there yet?

    Science.gov (United States)

    Rankin, Timothy M.; Giovinco, Nicholas A.; Cucher, Daniel J.; Watts, George; Hurwitz, Bonnie; Armstrong, David G.

    2015-01-01

    Background The applications for rapid prototyping have expanded dramatically over the last 20 years. In recent years, additive manufacturing has been intensely investigated for surgical implants, tissue scaffolds, and organs. There is, however, scant literature to date that has investigated the viability of 3D printing of surgical instruments. Materials and Methods Using a fused deposition manufacturing (FDM) printer, an army/ navy surgical retractor was replicated from polylactic acid (PLA) filament. The retractor was sterilized using standard FDA approved glutaraldehyde protocols, tested for bacteria by PCR, and stressed until fracture in order to determine if the printed instrument could tolerate force beyond the demands of an operating room. Results Printing required roughly 90 minutes. The instrument tolerated 13.6 kg of tangential force before failure, both before and after exposure to the sterilant. Freshly extruded PLA from the printer was sterile and produced no PCR product. Each instrument weighed 16g and required only $0.46 of PLA. Conclusions Our estimates place the cost per unit of a 3D printed retractor to be roughly 1/10th the cost of a stainless steel instrument. The PLA Army/ Navy is strong enough for the demands of the operating room. Freshly extruded PLA in a clean environment, such as an OR, would produce a sterile, ready to use instrument. Due to the unprecedented accessibility of 3D printing technology world wide, and the cost efficiency of these instruments, there are far reaching implications for surgery in some underserved and less developed parts of the world. PMID:24721602

  20. 3D Surgical Simulation

    Science.gov (United States)

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

    2009-01-01

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