Thomas, Michael N; Nadalin, Silvio; Schemmer, Peter; Pascher, Andreas; Kaiser, Gernot M; Braun, Felix; Becker, Thomas; Nashan, Björn; Guba, Markus
This manuscript reports the results of a nationwide survey of transplant surgeons in Germany, including the demographics, training, position, individual case loads, center volumes, program structure, professional practice, grade of specialization, workload, work hours, salary, and career expectations. We contacted all 32 German transplant centers that perform liver, kidney, and pancreas transplantation. Surgeons engaged in transplantation were asked to reply to the survey. Eighty-five surgeons responded, with a mean age of 44 ± 8 years, 13% of whom were female. The median transplant frequency per active transplant surgeon was relatively low, with 16 liver transplants, 15 kidney transplants, and three pancreas transplants. The median reported center volumes were 45 liver transplants, 90 kidney transplants, and five pancreas transplants per year. Most of the surgeons reported a primary focus on hepato-pancreato-biliary surgery, and only 10% of effective work time was actually dedicated to perform transplant surgeries. The majority of respondents estimated their weekly work hours to be between 55 and 66 h. When asked about their career satisfaction and expectations, most respondents characterized their salaries as inappropriately low and their career prospects as inadequate. This survey provides a first impression of the transplant surgery work force in Germany. © 2015 Steunstichting ESOT.
Schwalb, W; Shirinzadeh, B; Smith, J
Robotic surgery has seen a rapid increase in popularity in the last few decades because advantages such as increased accuracy and dexterity can be realized. These systems still lack force-feedback, where such a capability is believed to be beneficial to the surgeon and can improve safety. In this paper a force-feedback enabled surgical robotic system is described in which the developed force-sensing surgical tool is discussed in detail. The developed surgical tool makes use of a proximally located force/torque sensor, which, in contrast to a distally located sensor, requires no miniaturization or sterilizability. Experimental results are presented, and indicate high force sensing accuracies with errors <0.09 N. It is shown that developing a force-sensing surgical tool utilizing a proximally located force/torque sensor is feasible, where a tool outer diameter of 12 mm can be achieved. For future work it is desired to decrease the current tool outer diameter to 10 mm. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
The aim of the study – investigate the motivation factors of surgical profile nurses work. The objectives of the study: 1. To investigate of satisfaction with work, to identify the motivation positive factors, emotional exhaustion of nurses, which are working in the surgical profile departments and operating-theaters. 2. To investigate negative factors (emotional exhaustion, salary, nursing load). 3. To give the offers for the main problems solutions. Hypothesis – the nurses m...
Morineau, Thierry; Riffaud, Laurent; Morandi, Xavier; Villain, Jonathan; Jannin, Pierre
Three main approaches can be identified for modelling surgical performance: a competency-based approach, a task-based approach, both largely explored in the literature, and a less known work domain-based approach. The work domain-based approach first describes the work domain properties that constrain the agent's actions and shape the performance. This paper presents a work domain-based approach for modelling performance during cervical spine surgery, based on the idea that anatomical structures delineate the surgical performance. This model was evaluated through an analysis of junior and senior surgeons' actions. Twenty-four cervical spine surgeries performed by two junior and two senior surgeons were recorded in real time by an expert surgeon. According to a work domain-based model describing an optimal progression through anatomical structures, the degree of adjustment of each surgical procedure to a statistical polynomial function was assessed. Each surgical procedure showed a significant suitability with the model and regression coefficient values around 0.9. However, the surgeries performed by senior surgeons fitted this model significantly better than those performed by junior surgeons. Analysis of the relative frequencies of actions on anatomical structures showed that some specific anatomical structures discriminate senior from junior performances. The work domain-based modelling approach can provide an overall statistical indicator of surgical performance, but in particular, it can highlight specific points of interest among anatomical structures that the surgeons dwelled on according to their level of expertise.
Kitagawa, Masaya; Dokko, Daniell; Okamura, Allison M; Yuh, David D
Direct haptic (force or tactile) feedback is not yet available in commercial robotic surgical systems. Previous work by our group and others suggests that haptic feedback might significantly enhance the execution of surgical tasks requiring fine suture manipulation, specifically those encountered in cardiothoracic surgery. We studied the effects of substituting direct haptic feedback with visual and auditory cues to provide the operating surgeon with a representation of the forces he or she is applying with robotic telemanipulators. Using the robotic da Vinci surgical system (Intuitive Surgical, Inc, Sunnyvale, Calif), we compared applied forces during a standardized surgical knot-tying task under 4 different sensory-substitution scenarios: no feedback, auditory feedback, visual feedback, and combined auditory-visual feedback. The forces applied with these sensory-substitution modes more closely approximate suture tensions achieved under ideal haptic conditions (ie, hand ties) than forces applied without such sensory feedback. The consistency of applied forces during robot-assisted suture tying aided by visual feedback or combined auditory-visual feedback sensory substitution is superior to that achieved with hand ties. Robot-assisted ties aided with auditory feedback revealed levels of consistency that were generally equivalent or superior to those attained with hand ties. Visual feedback and auditory feedback improve the consistency of robotically applied forces. Sensory substitution, in the form of visual feedback, auditory feedback, or both, confers quantifiable advantages in applied force accuracy and consistency during the performance of a simple surgical task.
Lakebrink, Joan M.
Asserts that a liberal education and supervised work experience are important to the flexibility needed in the modern workplace. Encourages equitable access to education and employment for all groups. (CH)
C. J. Papachristou
Full Text Available In the literature of Electromagnetism, the electromotive force of a "circuit" is often defined as work done on a unit charge during a complete tour of the latter around the circuit. We explain why this statement cannot be generally regarded as true, although it is indeed true in certain simple cases. Several examples are used to illustrate these points.
Shi, Yunyong; Zhou, Chaozheng; Xie, Le; Chen, Yongjun; Jiang, Jun; Zhang, Zhenfeng; Deng, Ze
Surgical robots lack force feedback, which may lead to operation errors. In order to improve surgical outcomes, this research developed a new master-slave surgical robot, which was designed with an integrated force sensor. The new structure designed for the master-slave robot employs a force feedback mechanism. A six-dimensional force sensor was mounted on the tip of the slave robot's actuator. Sliding model control was adopted to control the slave robot. According to the movement of the master system manipulated by the surgeon, the slave's movement and the force feedback function were validated. The motion was completed, the standard deviation was calculated, and the force data were detected. Hence, force feedback was realized in the experiment. The surgical robot can help surgeons to complete trajectory motions with haptic sensation. Copyright © 2017 John Wiley & Sons, Ltd.
Kelly, B D
BACKGROUND: On the 1 August 2009, the implementation of European Working Time Directive became European law and was implemented in Galway University Hospital (GUH). AIMS: The aim of the study is to ascertain the opinion of the 25 surgical SHOs in GUH on the effect of the implementation of an EWTD compliant roster had on the quality of their training. METHODS: A questionnaire was circulated to all 25 surgical SHOs. RESULTS: Twenty-two (88%) SHOs report a reduction in the quality of their training. 18 (72%) report a reduction in the development of their operative skills. The SHOs believed the EWTD Rotas would encourage Irish graduates to train abroad. CONCLUSIONS: Surgical training faces a challenge with the implementation of EWTD Rotas. Major changes need to be made to the surgical training structure to train surgeons to the highest standard and to retain Irish-trained surgeons in the Irish healthcare system.
In the early 1990s, El Camino Hospital (ECH) streamlined its operations in order to remain competitive. In 1992, the hospital's District Board voted to turn the hospital's management over to a nonprofit company and it became an integrated delivery system (IDS). Hospital employees continued to suffer as their work and work schedules changed in ongoing efforts by the new administration to streamline. Finally, in early 1997, the IDS, Camino Healthcare, was dissolved. The director of radiology and radiation oncology services became aware of increasing employee problems, from high turnover rates and increased absenteeism, to morale and productivity issues. Employees also worried about job redesign, re-engineering and a lack of clear direction and expectations from department leadership. The director of the department created a task force to respond to the needs of staff members. With so much anger directed at department leadership, supervisory staff were not included in the task force. The task force worked first to identify rumors and innuendos and followed with a plan to resolve such issues. The second step was to agree to focus on issues that they could change and to let go of those they couldn't. They selected five priority issues or concerns. The group met weekly and made progress by replacing negative talk and attitudes with positive ones. Meanwhile, the director researched employee satisfaction issues so she would be prepared to discuss such issues and concerns with employees. She focused on a common theme, of having a personal mission or goal for one's self. She encouraged staff members to be aware of their own behavior when communicating with others. Although several informal surveys proved there was still much work to be done, there was positive response--a light at the end of the long tunnel.
Zhao, Baoliang; Nelson, Carl A
Robot-assisted minimally invasive surgery (MIS) has gained popularity due to its high dexterity and reduced invasiveness to the patient; however, due to the loss of direct touch of the surgical site, surgeons may be prone to exert larger forces and cause tissue damage. To quantify tool-tissue interaction forces, researchers have tried to attach different kinds of sensors on the surgical tools. This sensor attachment generally makes the tools bulky and/or unduly expensive and may hinder the normal function of the tools; it is also unlikely that these sensors can survive harsh sterilization processes. This paper investigates an alternative method by estimating tool-tissue interaction forces using driving motors' current, and validates this sensorless force estimation method on a 3-degree-of-freedom (DOF) robotic surgical grasper prototype. The results show that the performance of this method is acceptable with regard to latency and accuracy. With this tool-tissue interaction force estimation method, it is possible to implement force feedback on existing robotic surgical systems without any sensors. This may allow a haptic surgical robot which is compatible with existing sterilization methods and surgical procedures, so that the surgeon can obtain tool-tissue interaction forces in real time, thereby increasing surgical efficiency and safety.
Yancer, D A; Moe, J K
Telecommuters are the work force of the future. The dawning of the information age, with its explosion of telecommunication technology, presents new opportunities for healthcare agencies to extend their borders far beyond traditional physical boundaries. The virtual workplace can become a reality and position healthcare agencies to be geographically dispersed throughout their community. The authors describe a pioneering effort to use telecommunications to retain a valuable employee and create a healthcare agency's first virtual workplace. Strategies for success in telecommuting also are provided from both the telecommuter's and the manager's viewpoints.
O'Grady, Gregory; Harper, Simon; Loveday, Benjamin; Adams, Brandon; Civil, Ian D; Peters, Matthew
The demands of surgical training, learning and service delivery compete with the need to minimize fatigue and maintain an acceptable lifestyle. The optimal balance of working hours is uncertain. This study aimed to define the appropriate hours to meet these requirements according to trainees. All Australian and New Zealand surgical trainees were surveyed. Roster structures, weekly working hours and weekly 'sleep loss hours' (work practices were then correlated with sufficiency of training time, time for study, fatigue and its impacts, and work-life balance preferences. Multivariate and univariate analyses were performed. The response rate was 55.3% with responders representative of the total trainee body. Trainees who worked median 60 h/week (interquartile range: 55-65) considered their work hours to be appropriate for 'technical' and 'non-technical' training needs compared with 55 h/week (interquartile range: 50-60) regarded as appropriate for study/research needs. Working ≥65 h/week, or accruing ≥5.5 weekly 'sleep loss hours', was associated with increased fatigue, reduced ability to study, more frequent dozing while driving and impaired concentration at work. Trainees who considered they had an appropriate work-life balance worked median 55 h/week. Approximately, 60 h/week proved an appropriate balance of working hours for surgical training, although study and lifestyle demands are better met at around 55 h/week. Sleep loss is an important determinant of fatigue and its impacts, and work hours should not be considered in isolation. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.
This report summarizes work force restructuring and community transition activities at all sites. It outlines work force restructuring activity for FY 1997, changing separation patterns, cost savings and separation costs, program assessment, activities to mitigate restructuring impacts, community transition activities, status of displaced workers, lessons learned, and emerging issues in worker and community transition. Work force restructuring and community transition activities for defense nuclear sites are summarized, as are work force restructuring activities at non-defense sites.
Martin, Gail M.
Robots--powerful, versatile, and easily adapted to new operations--may usher in a new industrial age. Workers throughout the labor force could be affected, as well as the nature of the workplace, skill requirements of jobs, and concomitant shifts in vocational education. (SK)
Honeywell, Inc., Minneapolis, Minn.
This publication provides a summary of the Honeywell Working Parent Task Force's recommendations on how to solve problems experienced by working parents. The Task Force consisted of three committees: the Employment Practices Committee (EPC); the Parent Education Committee (PEC); and the Child Care Facilities Committee (CCFC). After examining a…
... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Drug-free work force. 223.570 Section 223.570 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM... TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 223.570 Drug-free work force. ...
Rosen, J; MacFarlane, M; Richards, C; Hannaford, B; Sinanan, M
The best method of training for laparoscopic surgical skills is controversial. Some advocate observation in the operating room, while others promote animal and simulated models or a combination of surgical related tasks. The mode of proficiency evaluation common to all of these methods has been subjective evaluation by a skilled surgeon. In order to define an objective means of evaluating performance, an instrumented laparoscopic grasper was developed measuring the force/torque at the surgeon hand/tool interface. The measured database demonstrated substantial differences between experienced and novice surgeon groups. Analyzing forces and torques combined with the state transition during surgical procedures allows an objective measurement of skill in MIS. Teaching the novice surgeon to limit excessive loads and improve movement efficiency during surgical procedures can potentially result in less injury to soft tissues and less wasted time during laparoscopic surgery. Moreover the force/torque database measured in this study may be used for developing realistic virtual reality simulators and optimization of medical robots performance.
Guo, Shuxiang; Wang, Yuan; Xiao, Nan; Li, Youxiang; Jiang, Yuhua
In robot-assisted catheterization, haptic feedback is important, but is currently lacking. In addition, conventional interventional surgical robotic systems typically employ a master-slave architecture with an open-loop force feedback, which results in inaccurate control. We develop herein a novel real-time master-slave (RTMS) interventional surgical robotic system with a closed-loop force feedback that allows a surgeon to sense the true force during remote operation, provide adequate haptic feedback, and improve control accuracy in robot-assisted catheterization. As part of this system, we also design a unique master control handle that measures the true force felt by a surgeon, providing the basis for the closed-loop control of the entire system. We use theoretical and empirical methods to demonstrate that the proposed RTMS system provides a surgeon (using the master control handle) with a more accurate and realistic force sensation, which subsequently improves the precision of the master-slave manipulation. The experimental results show a substantial increase in the control accuracy of the force feedback and an increase in operational efficiency during surgery.
Ebener, M; Hasselhorn, H M
Working life in Germany is changing. The work force is ageing and the number of people available to the labour market will - from now on - shrink considerably. Prospectively, people will have to work longer; but still today, most people leave employment long before reaching official retirement age. What are the reasons for this? In this report, a conceptual framework and the German lidA Cohort Study are presented. The "lidA conceptual framework on work, age, health and work participation" visualises determinants of employment (11 "domains") in higher working age, e. g., "work", "health", "social status" and "life style". The framework reveals 4 key characteristics of withdrawal from work: leaving working life is the result of an interplay of different domains (complexity); (early) retirement is a process with in part early determinants in the life course (processual character); retirement has a strong individual component (individuality); retirement is embedded in a strong structural frame (structure). On the basis of this framework, the "lidA Cohort Study on work, age, health and work participation" (www.lida-studie.de) investigates long-term effects of work on health and work participation in the ageing work force in Germany. It is the only large study in Germany operationalising the concept of employability in a broad interdisciplinary approach. Employees subject to social security and born in 1959 or in 1965 will be interviewed (CAPI) every 3 years (N[wave 1]=6 585, N[wave 2]=4 244) and their data will be linked (where consented) with social security data covering employment history and with health insurance data. The study design ("Schaie's most efficient design") allows for a tri-factor model that isolates the impact of age, cohort and time. In 2014, the second wave was completed. In the coming years lidA will analyse the association of work, health and work participation, and identify age as well as generation differences. lidA will investigate the
Full Text Available The article analyzes the available ergonomic constructions used for the support of the musculoskeletal system during static, prolonged work performed in forced positions. Possible evaluation methods are presented as well as ergonomic considerations of work performed in inclined positions, where there is no possibility of influencing the working plane. As a result of the presented work, a set of criteria has been proposed and the requirements for methods which can be used to evaluate the technical constructions supporting the worker during tasks performed in forced and static positions.
Kimzey, Reed T.; Prince, Samuel M. O.
The thesis discusses the advantages and disadvantages of one work force scheduling technique--flextime. The authors were interested in determining if a flextime schedule could be put into effect in a governmental organization such as Headquarters Air Force Logistics Command (AFLC). The study objectives were to determine the feasibility,…
Bureau of Labor Statistics (DOL), Washington, DC.
Part of a Special Labor Force Report series, this bulletin on children of working mothers discusses the increase in the number of children with working mothers as of March 1981, and describes major reasons for this growth. The bulletin consists of an article first published February 1982 in the "Monthly Labor Review," additional tables providing…
Quillin, Ralph C; Cortez, Alexander R; Pritts, Timothy A; Hanseman, Dennis J; Edwards, Michael J; Davis, Bradley R
The Accreditation Council for Graduate Medical Education instituted the 80-h workweek for residency programs in 2003. This presented a unique challenge for surgery residents who must acquire a medical and technical knowledge base during training. Therefore, learning should be delivered in an environment congruent with an individual's learning style. In this study, we evaluated the learning styles of general surgery residents to determine how learning styles changed after the implementation to the 80-h workweek. Kolb learning style inventory was taken by general surgery residents at the University of Cincinnati's Department of Surgery, and results from 1999-2012 were analyzed. Statistical analysis was performed using the chi-squared, logistic regression and Wilcoxon rank-sum test. Significance was defined as a P value of learning styles after the institution of the 80-h workweek to converging (43.9%) and accommodating (40.4%, P learning. This change paralleled the transition to a more team-based approach to patient care with the implementation of the 80-h workweek. These findings are important for surgical educators to consider in the development of surgical resident curriculum. Copyright © 2016 Elsevier Inc. All rights reserved.
Courtright P; Miri E
Tackling trachoma is a complex challenge.In order to implement all four components of the SAFE strategy on a national level (surgery for trichiasis, antibiotics, facial cleanliness and environmental change, such as clean water and latrines), there needs to be national coordination, supported by political commitment at the highest level. In each trachoma-endemic country, the body responsible for making this work is the national trachoma task force (NTTF).
Full Text Available Tackling trachoma is a complex challenge.In order to implement all four components of the SAFE strategy on a national level (surgery for trichiasis, antibiotics, facial cleanliness and environmental change, such as clean water and latrines, there needs to be national coordination, supported by political commitment at the highest level. In each trachoma-endemic country, the body responsible for making this work is the national trachoma task force (NTTF.
Brian T. Dent
Full Text Available Background: Maintaining normothermia during porcine surgery is critical in ensuring subject welfare and recovery, reducing the risk of immune system compromise and surgical-site infection that can result from hypothermia. In humans, various methods of patient heating have been demonstrated to be useful, but less evaluation has been performed in techniques to prevent hypothermia perioperatively in pigs. Methods: We compared body temperature regulation during surgery before and after modification of the ambient temperature of the operating laboratories. Three different methods of heating were then compared; a standard circulating water mattress, a resistive fabric blanket, and a forced hot air system. The primary measure was percentage of temperature readings outside a specification range of 36.7–40.0 °C. Results: Tighter control of the ambient temperature while using a circulating water mattress reduced the occurrence of out-of-specification body temperature readings from 20.8% to 5.0%, with most of these the result of hypothermia. Use of a resistive fabric blanket further reduced out-of-specification readings to 1.5%, with a slight increase in the occurrence of hyperthermia. Use of a forced air system reduced out-of-specification readings to less 0.1%. Conclusions: Maintenance of normothermia perioperatively in pig can be improved by tightly controlling ambient temperatures. Use of a resistive blanket or a forced air system can lead to better control than a circulating water mattress, with the forced air system providing a faster response to temperature variations and less chance of hyperthermia.
Donohoe, C L
The forthcoming implementation of the European Working Time Directive (EWTD) for non-consultant hospital doctors (NCHDs) poses a number of challenges in the areas of patient care, training, service provision and quality of life for workers. Surgery, as a craft-based speciality, will face a greater impact on training of future surgeons as operating time could be lost to service provision. The EWTD acts a stimulus for reform of current working practices and re-configuration of services. It will necessitate transformation of the way in which surgeons are trained, if current standards are to be maintained.
Full Text Available The micromanipulator’s force feedback is one of the key research contents of minimally invasive surgical robotic system. Because the micromanipulator is a kind of compact construction which is suitable for valve installation with small space in surgery, especially for the influence of disinfection method, there are major difficulties and limitations to integrate compact sensors in the end of micromanipulator. This article focuses on the 3-degree-of-freedom micromanipulator’s clamping force sensing, and these three joints are actuated by wirerope driving. A clamping force sensing method is proposed based on static tension of wirerope driving, and a static model between the clamping force and wirerope’s static tension is established considering the influence of real friction resistance in the mechanical system. Finally, an equivalent experimental test platform for 3-degree-of-freedom micromanipulator’s clamping force sensing is set up, and then a series of experiments of the clamping force are studied. The frictional resistances of wirerope between the guide plate and guide pulley mechanism are tested, and a calibration and correction method of the experimental clamping force is proposed. The final experiment results show that the total average accuracy of experimental clamping force is about 78.3%, and it can be the basic measurement force to realize micromanipulator’s clamping force feedback of a minimally invasive surgical robot.
Fernández Garrillo, Pablo A.; Grévin, Benjamin; Chevalier, Nicolas; Borowik, Łukasz
We propose and demonstrate the implementation of an alternative work function tip calibration procedure for Kelvin probe force microscopy under ultrahigh vacuum, using monocrystalline metallic materials with known crystallographic orientation as reference samples, instead of the often used highly oriented pyrolytic graphite calibration sample. The implementation of this protocol allows the acquisition of absolute and reproducible work function values, with an improved uncertainty with respect to unprepared highly oriented pyrolytic graphite-based protocols. The developed protocol allows the local investigation of absolute work function values over nanostructured samples and can be implemented in electronic structures and devices characterization as demonstrated over a nanostructured semiconductor sample presenting Al0.7Ga0.3As and GaAs layers with variable thickness. Additionally, using our protocol we find that the work function of annealed highly oriented pyrolytic graphite is equal to 4.6 ± 0.03 eV.
Spiller, Roger [MSF, Stowmarket (United Kingdom)
This paper contrasts the offshore scene of 30 years ago with today, within the limits of inadequate monitoring, then and now. It identifies stress, bullying, change, long working hours and offshore trips and lifestyle as major factors that now have to be addressed if the health of the ageing work force is not to be compromised. Activity external to formal working hours such as travel to and from home and domestic and social relationships are all modified by the nature of offshore work but rarely acknowledged as the responsibility of the employer or operator. The development of a superior lifelong health tracking system is essential for long-term surveillance and epidemiological studies. The acceptance by operators of their long-term responsibilities for staff and the families of offshore workers needs to be better developed. (author)
Katz, Aviva; Mallory, Baird; Gilbert, James C; Bethel, Colin; Hayes-Jordan, Andrea A; Saito, Jacqueline M; Tomita, Sandra S; Walsh, Danielle S; Shin, Cathy E; Wesley, John R; Farmer, Diana
There has been increasing interest and concern raised in the surgical literature regarding changes in the culture of surgical training and practice, and the impact these changes may have on surgeon stress and the appeal of a career in surgery. We surveyed pediatric surgeons and their partners to collect information on career satisfaction and work-family balance. The American Pediatric Surgical Association Task Force on Family Issues developed separate survey instruments for both pediatric surgeons and their partners that requested demographic data and information regarding the impact of surgical training and practice on the surgeon's opportunity to be involved with his/her family. We found that 96% of pediatric surgeons were satisfied with their career choice. Of concern was the lack of balance, with little time available for family, noted by both pediatric surgeons and their partners. The issues of work-family balance and its impact on surgeon stress and burnout should be addressed in both pediatric surgery training and practice. The American Pediatric Surgical Association is positioned to play a leading role in this effort. Copyright © 2010 Elsevier Inc. All rights reserved.
Seabott, Heather; Smith, Ryan K; Alseidi, Adnan; Thirlby, Richard C
The interview process is a pivotal, differentiating component of the residency match. Our bias is toward a working interview, producing better fulfillment of the needs of both parties, and a more informed match selection for the candidates and program. We describe a "candidate-centered" approach for integrating applicant interviews into our daily work schedule. Applicants are informed upon accepting the interview of the working interview model. Our program offers 33 interview days over a 12-week period. A maximum of 5 applicants are hosted per day. Applicants are assigned to 1 of our general, thoracic, vascular, or plastic surgery teams. The interview day begins with the applicant changing into scrubs, attending a morning conference, and taking part in a program overview by a Chief Resident. Applicants join their host team where 4-8 hours are spent observing the operative team, on rounds and sharing lunch. The faculty and senior residents are responsible for interviewing and evaluating applicants though the Electronic Residency Application Service. A total of 13 surgeons are involved in the interview process resulting in broad-based evaluations. Each surgeon interviewed between 3 and 12 applicants. Faculty rate this interview approach highly because it allows them to maintain a rigorous operative schedule while interacting with applicants. Current residents are engaged in welcoming applicants to view the program. Faculty and residents believe cooperating in a real world manner aids their assessment of the applicant. Applicants routinely provide positive feedback, relaying this approach is informative, transparent, and should be the "standard." Applicants believe they are presented a realistic view of the program. Ultimately, this candidate-centered process may be attributable to our resident cohort who exhibit high satisfaction, excellent resident morale, and very low dropout rate. We present a candidate-centered, working interview approach used in the selection of
Guicherit, Onno R
Residents' working hours in the Netherlands were first capped in the early 1990 s. In 2003, European legislation consolidated restrictions to a 48-hour week. No adverse effects were seen on the number of surgical operations performed either in the first or the second decade following these measures. Either the effect on surgical training is minimal, or the number of operations carried out during a residency is not a meaningful indicator of its quality. Personalized modular rotations in both university and teaching hospitals are needed for residents with sub-specializations. Training activities, in combination with more supervision, have to focus on a broader set of competencies beyond simply mastering surgical procedures.
The proposal for a open-quotes New Initiatives Task Forceclose quotes emerged from discussions in the scientific community on how to proceed following the demise of the Burning Plasma Experiment (BPX). In particular, the action of the Secretary of Energy Advisory Board (SEAB), which made the following recommendation in 1991, prompted the initiative: open-quotes Concept exploration should begin to define a new experiment in the $500 million class for the purpose of scientific study of tokomak improvements (e.g., second stability, steady state, bootstrap current) that could suggest new operating modes for ITER and permit the design of more reactor-desirable follow-ons to ITER.close quotes A New Initiative Task force, was chartered by Princeton Plasma Physics Laboratory in October 1991 to provide oversight in the development of a new experimental initiative and to provide guidance to advocate groups in the following areas: programmatic mission and technical objectives, critical issues of physics, engineering, and technology, design criteria, costing, and modes of operation. The guidance was designed to be based on broad community involvement. In addition, the Task Force was asked to identify the preferred options which could proceed to the design stage. Three primary machine designs have emerged from the work of this group, and they are briefly described. 4 refs., 2 figs., 2 tabs
Baur, Heiner; Grebner, Simone; Blasimann, Angela; Hirschmüller, Anja; Kubosch, Eva Johanna; Elfering, Achim
Surgical nurses' work is physically and mentally demanding, possibly leading to work-family conflict (WFC). The current study tests WFC to be a risk factor for neck and lower back pain (LBP). Job influence and social support are tested as resources that could buffer the detrimental impact of WFC. Forty-eight surgical nurses from two university hospitals in Germany and Switzerland were recruited. WFC was assessed with the Work-Family Conflict Scale. Job influence and social support were assessed with the Copenhagen Psychosocial Questionnaire, and back pain was assessed with the North American Spine Society Instrument. Multiple linear regression analyses confirmed WFC as a significant predictor of cervical pain (β = 0.45, p Work-life interventions may have the potential to reduce WFC in surgery nurses.
Freiburg, Carter; James, Ted; Ashikaga, Takamura; Moalem, Jacob; Cherr, Greg
The introduction of duty-hour restrictions has impacted surgical training. Several strategies were introduced by training programs in response to these restrictions. The purpose of this study was to assess the various strategies employed by residency programs to comply with work-hour restrictions with respect to the impact on the quality of surgical education. A national survey was developed and distributed to resident members of the Resident and Associate Society of the American College of Surgeons in all accredited residency programs across North America. Questions in the survey addressed 10 separate accommodation strategies used by training programs to adhere to resident work-hour restrictions. Resident respondents completed a 5-point Likert scale rating each strategy according to its impact on surgical education (detrimental, not very helpful, neutral, somewhat helpful, and very helpful). A total of 599 (9.7%) responses were received from 6186 members of the Resident Associate Society. The use of health information technology (IT), nurse practitioners, and physician assistants were most highly rated. Hiring clinical fellows, establishing nonteaching services, and shift-work scheduling were the three most poorly rated accommodations to work-hour restrictions with respect to resident education. Hospital IT and nonphysician care providers were rated by residents to optimize surgical education in the current work-hour limitation environment. We infer that strategies which lead to increased efficiency and redistribution of resident workload allow surgical trainees to spend more time on activities perceived to have higher educational value. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
More women, including mothers, are part of the work force than ever before. In the workplace, barriers often exist that restrict promotion and advancement of mothers. Mothers often are penalized in attempting to meet the demands of parent and worker roles. Parenting practices have been considered primarily the domain of mothers. However, nurturing may be done effectively by fathers or other motivated adults. Policies of employers must change to accommodate needs of families. Examples of supportive practices may include flexible working hours, parental leave, and on-site child care.
Restrictions in residents' work hours have been in place in Canada for roughly a decade, having been negotiated rather than imposed. The changes in residents' schedules that resulted are roughly equivalent to the limitation of 80 duty hours per week in the United States. When work-hours restrictions began, surgery faculty were worried that residents' experience would be compromised. But these fears have not materialized. Why? The author maintains there are many reasons. (1) Most surgical procedures are now faster, and lengthy inpatient care has diminished, all of which saves time. (2) Formerly difficult or risky procedures are now performed more frequently and safely, which increases residents' education about difficult conditions. (3) A variety of resources (e.g., skills-transfer courses, surgical simulators, etc.) are now available for residents to learn and evolve surgical techniques, and residents take advantage of these resources, being highly motivated to learn the best in the time available to them. (4) There have been positive changes in residents' education that have helped them become more efficient learners than before, with improved resources and skills for faster access to information. The author maintains that in his present surgery residency program, the residents still work extremely hard but are more protected from the unending demands for patient care. They have more time for orderly study and greater opportunities to develop skills other than technical ones. They are in a happier work setting, which the author strongly believes facilitates improved patient care.
Viet - nam ," Military Medicine, Vol. 135, No. 1, 1970, pp. 8-13. St. Clair, N. J., and R. W. Tufte, The PRISM Analysis System, Vector Research, Inc...number not listed) cosmetic lid surgery 96 PLASTIC SURGEON Emergency Procedures emergency surgical control of hemorrhage B5 intubation of airway B6...number not listed) first-assist in surgery perform triage cosmetic lid surgery 108 DERMATOLOGIST Emergency Procedures emergency surgical control of
McGonagle, Alyssa K; Fisher, Gwenith G; Barnes-Farrell, Janet L; Grosch, James W
Perceived work ability refers to a worker's assessment of his or her ability to continue working in his or her job, given characteristics of the job along with his or her resources. Perceived work ability is a critical variable to study in the United States, given an aging workforce, trends to delay retirement, and U.S. policy considerations to delay the age at which full Social Security retirement benefits may be obtained. Based on the job demands-resources model, cognitive appraisal theory of stress, and push/pull factors related to retirement, we proposed and tested a conceptual model of antecedents and outcomes of perceived work ability using 3 independent samples of U.S. working adults. Data regarding workers' job characteristics were from self-report and Occupational Information Network measures. Results from relative importance analysis indicated that health and sense of control were consistently and most strongly related to work ability perceptions relative to other job demands and job and personal resources when perceived work ability was measured concurrently or 2 weeks later in samples with varying occupations. Job demands (along with health and sense of control) were most strongly related to work ability perceptions when perceived work ability was measured in a manufacturing worker sample 1.6 years later. Perceived work ability also predicted lagged labor force outcomes (absence, retirement, and disability leave) while controlling for other known predictors of each. Consistent indirect effects were observed from health status and sense of control to all 3 of these outcomes via perceived work ability. PsycINFO Database Record (c) 2015 APA, all rights reserved.
O'Grady, Gregory; Loveday, Benjamin; Harper, Simon; Adams, Brandon; Civil, Ian D; Peters, Matthew
The working hours of surgical trainees are a subject of international debate. Excessive working hours are fatiguing, and compromise performance, learning and work-life balance. However, reducing hours can impact on continuity of care, training experience and service provision. This study defines the current working hours of Australasian trainees, to inform the working hours debate in our regions. An online survey was conducted of all current Australasian trainees. Questions determined hours spent at work (AW) and off-site on-call (OC) per week, and roster structures were evaluated by training year, specialty and location. The response rate was 55.3%. Trainees averaged 61.4 ± 11.7 h/week AW, with 5% working ≥80 h. OC shifts were worked by 73.5%, for an average of 27.8 ± 14.3 h/week. Trainees of all levels worked similar hours (P= 0.10); however, neurosurgical trainees worked longer hours than most other specialties (P hours (P= 0.01) and rural rotations more OC (P Long days (>12 h) were worked by 86%; median frequency 1:4.4 days; median duration 15 h. OC shifts of 24-h duration were worked by 75%; median frequency 1:4.2 days; median sleep: 5-7 h/shift; median uninterrupted sleep: 3-5 h/shift. This study has quantified the working hours and roster structures of Australasian surgical trainees. By international standards, Australasian trainee working hours are around average. However, some rosters demand long hours and/or induce chronic sleep loss, placing some trainees at risk of fatigue. Ongoing efforts are needed to promote safe rostering practices. © 2010 The Authors. ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons.
Giles, James A
The introduction of European Working Time Directive, limiting doctors' working hours to 48 per week, has caused recent controversy within the profession. The Royal College of Surgeons of England in particular has been one of the loudest critics of the legislation. One of the main concerns is regarding the negative impact on training hours for those embarking on surgical careers. Simulation technology has been suggested as a method to overcome this reduction in hospital training hours, and research suggests that this is a good substitute for operative training in a theatre. However, modern educational theory emphasises the power of informal workplace learning in postgraduate education, and the essential role of experience in training future surgeons. Copyright 2010 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
Churchill, Larry R
Moral virtues are the complement to ethical principles. They constitute the elements of character that drive habits and daily routines. Certain virtues are especially important in surgery, shaping surgical practice even when no big decisions are at hand. Eight virtues are described and the work they do is explored: trustworthiness, equanimity, empathy, advocacy, compassion, courage, humility, and hope. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
"Force20 networks, the pioneer in building and securing reliable networks, today announced that the University of Tennessee physics department has deployed the C300 resilient switch to analyze data form CERN's Large Hadron Collider." (1/2 page)
... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Performance of construction work: Sponsor... Development Projects § 151.51 Performance of construction work: Sponsor force account. (a) Before undertaking any force account construction work, the sponsor (or any public agency acting as agent for the sponsor...
Bonanno, A.; Bozzo, G.; Grandinetti, M.; Sapia, P.
Several studies have showed the subsistence, even in students enrolled in scientific degree courses, of spontaneous ideas regarding the motion of bodies that conflict with Newton's laws. One of the causes is related to the intuitive preconceptions that students have about the role of friction as a force. In fact, in real world novices do not…
A survey was completed by 362 active duty Air Force members in December 2000 regarding their perceptions of schedule predictability, work-family conflict, job satisfaction, organizational commitment...
Podder, Tarun; Clark, Douglas; Sherman, Jason; Fuller, Dave; Messing, Edward; Rubens, Deborah; Strang, John; Brasacchio, Ralph; Liao, Lydia; Ng, W.-S.; Yu Yan
In this paper, we present needle insertion forces and motion trajectories measured during actual brachytherapy needle insertion while implanting radioactive seeds in the prostate glands of 20 different patients. The needle motion was captured using ultrasound images and a 6 degree-of-freedom electromagnetic-based position sensor. Needle velocity was computed from the position information and the corresponding time stamps. From in vivo data we found the maximum needle insertion forces to be about 15.6 and 8.9 N for 17 gauge (1.47 mm) and 18 gauge (1.27 mm) needles, respectively. Part of this difference in insertion forces is due to the needle size difference (17G and 18G) and the other part is due to the difference in tissue properties that are specific to the individual patient. Some transverse forces were observed, which are attributed to several factors such as tissue heterogeneity, organ movement, human factors in surgery, and the interaction between the template and the needle. However, theses insertion forces are significantly responsible for needle deviation from the desired trajectory and target movement. Therefore, a proper selection of needle and modulated velocity (translational and rotational) may reduce the tissue deformation and target movement by reducing insertion forces and thereby improve the seed delivery accuracy. The knowledge gleaned from this study promises to be useful for not only designing mechanical/robotic systems but also developing a predictive deformation model of the prostate and real-time adaptive controlling of the needle
Kim Kwok; Antoinette McCallin; Geoff Dickson
Much has been written about grounded theory and the processes of theory generation. Less is written about managing the problem of preconception, which has the potential to undermine the openness and emergence that are fundamental to classic grounded theory. The purpose of this paper is to discuss the practical realities of managing preconception, and to draw attention to less well recognised factors that contribute to forcing. The topic interest, tactical innovation in rugby, is introduced. R...
Korb, Werner; Geißler, Norman; Strauß, Gero
Engineering a medical technology is a complex process, therefore it is important to include experts from different scientific fields. This is particularly true for the development of surgical technology, where the relevant scientific fields are surgery (medicine) and engineering (electrical engineering, mechanical engineering, computer science, etc.). Furthermore, the scientific field of human factors is important to ensure that a surgical technology is indeed functional, process-oriented, effective, efficient as well as user- and patient-oriented. Working in such trans- and inter-disciplinary teams can be challenging due to different working cultures. The intention of this paper is to propose an innovative cooperative working culture for the interdisciplinary field of computer-assisted surgery (CAS) based on more than ten years of research on the one hand and the interdisciplinary literature on working cultures and various organizational theories on the other hand. In this paper, a retrospective analysis of more than ten years of research work in inter- and trans-disciplinary teams in the field of CAS will be performed. This analysis is based on the documented observations of the authors, the study reports, protocols, lab reports and published publications. To additionally evaluate the scientific experience in an interdisciplinary research team, a literature analysis regarding scientific literature on trans- and inter-disciplinarity was performed. Own research and literature analyses were compared. Both the literature and the scientific experience in an interdisciplinary research team show that consensus finding is not always easy. It is, however, important to start trans- and interdisciplinary projects with a shared mental model and common goals, which include communication and leadership issues within the project teams, i.e. clear and unambiguous information about the individual responsibilities and objectives to attain. This is made necessary due to differing
Al-Shudifat, Abdul Rahman; Kahlon, Babar; Höglund, Peter; Soliman, Ahmed Y; Lindskog, Kristoffer; Siesjo, Peter
The aim of the present study was to identify predictive factors for outcome after surgery of vestibular schwannomas. This is a retrospective study with partially collected prospective data of patients who were surgically treated for vestibular schwannomas at a single institution from 1979 to 2000. Patients with recurrent tumours, NF2 and those incapable of answering questionnaires were excluded from the study. The short form 36 (SF36) questionnaire and a specific questionnaire regarding neurological status, work status and independent life (IL) status were sent to all eligible patients. The questionnaires were sent to 430 eligible patients (out of 537) and 395 (93%) responded. Scores for work capacity (WC) and IL were compared with SF36 scores as outcome estimates. Patients were divided into two groups (group age, gender and tumour diameter were independent predictive factors for postoperative WC in multivariate analysis. A high-risk group was identified in women with age >50 years and tumour diameter >25 mm. In patients ≥64, gender and tumour diameter were significant predictive factors for IL in univariate analysis. Perioperative and postoperative objective factors as length of surgery, blood loss and complications did not predict outcome in the multivariable analysis for any age group. Patients' assessment of change in balance function was the only neurological factor that showed significance both in univariate and multivariable analysis in both age cohorts. While SF36 scores were lower in surgically treated patients in relation to normograms for the general population, they did not correlate significantly to WC and IL. The SF36 questionnaire did not correlate to outcome measures as WC and IL in patients undergoing surgery for vestibular schwannomas. Women and patients above 50 years with larger tumours have a high risk for reduced WC after surgical treatment. These results question the validity of quality of life scores in assessment of outcome after surgery
Hogan, Lyn A.; Erden, James Van; Mower, Eleanor; Patel, Apurva; Mitchell, Steve
This guide is designed to help U.S. businesses successfully hire and retain individuals moving from welfare to work. Section 1 discusses the different circumstances created by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 and how those changes affect business. Section 2 reviews bottom-line benefits realized by…
pertain to the issue of work-family imbalance. That is, despite the high rate of female participation in the paid labour force, women still have...variety of work-related outcomes, including reduced job performance. Work interference with family, on the other hand, was related to absenteeism and
Fitzgerald, J E F; Caesar, B C
The European Working Time Directive (EWTD) 2003/88/EC is a Union Directive laying down minimum health and safety requirements for the organisation of working time. Originally primarily intended as labour law, its progressive introduction up to full implementation for doctors-in-training in August 2009 has substantially reduced duty-hours and caused widespread concern in surgery. Detrimental effects on the continuity of patient care, reduced availability of medical staff with associated rota difficulties, and the reduction in time for training junior doctors have been widely cited. Craft-specialities such as surgery and those providing an acute service have faced particular challenges. This review offers a practical guide for surgical trainees, explaining the European regulations in the context of current terms and conditions of doctor's employment in the UK. Information is provided on protecting training, opting-out, seeking remuneration for this, and ensuring doctors and patients are protected with appropriate medical indemnity cover in place. Copyright © 2012 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
Winsett, Rebecca P; Rottet, Kendra; Schmitt, Abby; Wathen, Ellen; Wilson, Debra
The purpose of the study was to explore the nurse work environment by evaluating the self-report of missed nursing care and the reasons for the missed care. A convenience sample of medical surgical nurses from four hospitals was invited to complete the survey for this descriptive study. The sample included 168 nurses. The MISSCARE survey assessed the frequency and reason of 24 routine nursing care elements. The most frequently reported missed care was ambulation as ordered, medications given within a 30 minute window, and mouth care. Moderate or significant reasons reported for the missed care were: unexpected rise in volume/acuity, heavy admissions/discharges, inadequate assistants, inadequate staff, meds not available when needed, and urgent situations. Identifying missed nursing care and reasons for missed care provides an opportunity for exploring strategies to reduce interruptions, develop unit cohesiveness, improve the nurse work environment, and ultimately leading to improved patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.
Full Text Available Much has been written about grounded theory and the processes of theory generation. Less is written about managing the problem of preconception, which has the potential to undermine the openness and emergence that are fundamental to classic grounded theory. The purpose of this paper is to discuss the practical realities of managing preconception, and to draw attention to less well recognised factors that contribute to forcing. The topic interest, tactical innovation in rugby, is introduced. Researcher motivation and the management of preconception are discussed. The example used is the theory of developing, which explains how rugby coaches in New Zealand manage the problem of winning games. The research demonstrates how the novice grounded theory researcher who is prepared to follow the method and trust the process can produce a rigorous grounded theory that makes a meaningful contribution to rugby coaches, players and their administrators.
Parker, Paul J; Manley, Andrew J; Shand, Ross; O'Hara, John P; Mellor, Adrian
Medical Emergency Response Team (MERT) helicopters fly at altitudes of 3000 m in Afghanistan (9843 ft). Civilian hospitals and disaster-relief surgical teams may have to operate at such altitudes or even higher. Mild hypoxia has been seen to affect the performance of novel tasks at flight levels as low as 5000 ft. Aeromedical teams frequently work in unpressurized environments; it is important to understand the implications of this mild hypoxia and investigate whether supplementary oxygen systems are required for some or all of the team members. Ten UK orthopedic surgeons were recruited and in a double blind randomized experimental protocol, were acutely exposed for 45 min to normobaric hypoxia [fraction of inspired oxygen (FIo2) ∼14.1%, equivalent to 3000 m (10,000 ft)] or normobaric normoxia (sea-level). Basic physiological parameters were recorded. Subjects completed validated tests of verbal working memory capacity (VWMC) and also applied an orthopedic external fixator (Hoffmann® 3, Stryker, UK) to a plastic tibia under test conditions. Significant hypoxia was induced with the reduction of FIo2 to ∼14.1% (Spo2 87% vs. 98%). No effect of hypoxia on VWMC was observed. The pin-divergence score (a measure of frame asymmetry) was significantly greater in hypoxic conditions (4.6 mm) compared to sea level (3.0 mm); there was no significant difference in the penetrance depth (16.9 vs. 17.2 mm). One hypoxic frame would have failed early. We believe that surgery at an altitude of 3000 m, when unacclimated individuals are acutely exposed to atmospheric hypoxia for 45 min, can likely take place without supplemental oxygen use but further work is required.Parker PJ, Manley AJ, Shand R, O'Hara JP, Mellor A. Working memory capacity and surgical performance while exposed to mild hypoxic hypoxemia. Aerosp Med Hum Perform. 2017; 88(10):918-923.
Suttrop, W.; Kinna, D.; Farthing, J.; Hemming, O.; How, J.; Schmidt, V.
The Joint European Torus (JET) fusion experiment is now operated with strong involvement of physicists from outside research laboratories, which often requires remote participation in JET physics experiments. Users' experience with tools for remote collaborative work is reported, including remote computer and data access, remote meetings, shared documentation and various other communication channels
Brown, L J
Both supply and demand influence the ability of the dental work force to adequately and efficiently provide dental care to a U.S. population growing in size and diversity. Major changes are occurring on both sides of the dental care market. Among factors shaping the demand for dental care are changing disease patterns, shifting population demographics, the extent and features of third-party payment, and growth of the economy and the population. The capacity of the dental work force to provide care is influenced by enhancements of productivity and numbers of dental health personnel, as well as their demographic and practice characteristics. The full impact of these changes is difficult to predict. The dentist-to-population ratio does not reflect all the factors that must be considered to develop an effective dental work force policy. Nationally, the dental work force is likely to be adequate for the next several years, but regional work force imbalances appear to exist and may get worse. Against this backdrop of change and uncertainty, future dental work force strategies should strive for short-term responsiveness while avoiding long-term inflexibility. Trends in the work force must be continually monitored. Thorough analysis is required, and action should be taken when necessary.
Summary Current and retrospective data on the fertility control, work-force participation intentions and practice of Melbourne wives are combined in an examination of the causal link between work-force participation and reduced family size. Stress is laid on the analysis of the interaction between work-force participation and fertility over time, taking into account the proportion of married life spent in the work-force, rather than relying exclusively on a measure of current participation, the only option available in the analysis of census-type data. The wide range of information available makes it possible to study the effects of work-force participation on wives of unimpaired fertility, as well as the different consequences of planned and unplanned participation, and of working in a variety of occupations and for a number of distinct reasons. Examination of the future fertility intentions and current contraceptive practice of the younger wives shows that working wives are not, in these respects, markedly different from their house-wife peers. Overall, the balance of the evidence indicates that in the majority of cases fertility influences work-force participation rather than the converse.
What are the barriers to trying to reach, and evaluate the impact of working with, Forces Families? Assessing the effectiveness of Reading Force, a programme to promote shared reading within the Forces community
What are the barriers to trying to reach, and evaluate the impact of working with, Forces Families? Assessing the effectiveness of Reading Force, a programme to promote shared reading within the Forces community
... 3 The President 1 2010-01-01 2010-01-01 false White House Task Force on Middle-Class Working Families Presidential Documents Other Presidential Documents Memorandum of January 30, 2009 White House... times. To these ends, I hereby direct the following: Section 1. White House Task Force on Middle-Class...
Whenever the reaction forces between parts of an electric circuit have to be calculated, as in the design of railguns, a choice has to be made between three available formulae which have evolved during the past 160 years. The first was Ampere's force law for the mechanical interaction between two current elements. Neumann then derived the virtual-work formula from what may be called the Ampere-Neumann electrodynamics. The last to be introduced was the Lorentz force law. This paper investigates whether both the Amperian and the Lorentzian forces are compatible with the virtual-work concept. The conclusion is that only Ampere's formula agrees in all cases with the virtual-work idea, but in special circumstances the Lorentz law will give the same result. After demonstrating how Ampere's law can be derived from the virtual-work formula, it is shown that for two closed circuits the relativistic component of the Lorentz force vanishes under the double integral around the two circuits. The remaining nonvanishing term is also present in the Ampere electrodynamics. This is not the case when considering the reaction forces between two parts of an isolated circuit. The Lorentz force is then, in general, not compatible with the virtual-work concept unless the circuit possesses a high degree of symmetry
When logs of three diameter classes and two specific gravity classes were sheared with a 3/8-inch-thick knife travelling at 2 inches per minute, shearing force and work averaged greatest for dense 13.6-inch logs cut with a knife having a 45o sharpness angle (73,517 pounds; 49,838 foot-pounds). Force and work averaged at least 5.1-inch bolts of...
Carolina Neis Machado
Full Text Available Abstract Introduction: Pilates is a physical exercise method that uses the resistance of springs to modulate the overload from exercises. Objective: To characterize the force versus time curve of the foot work exercise; verify and compare the force applied by the same limb during the foot work exercise against the resistance of two types of springs with different elastic constants, and verify and compare the asymmetry of force applied by right and left lower limbs during the foot work exercise against the resistance of the same type of spring. Methods: Twenty healthy adult individuals familiarized with Pilates were evaluated. Two extensometric force plates adapted to the Reformer apparatus were used. Each participant performed 10 repetitions of the exercise against the resistance of two pairs of springs with different elastic constants. Descriptive and inferential statistics were used with significance levels of p < 0.05. Results: The exercise's standard curve showed that the peak force is reached in the point of maximum hip and knee extension during the execution of the exercise. There were differences between force production by the same limb for different springs (p < 0.001 and between left and right limb when spring with lower elastic constant was used (p = 0.006. No differences were found between right and left limb when spring with higher elastic constant was used (p = 0.108. Conclusion: The knowledge of the force versus time curve and the quantification of unilateral force are important elements in the evaluation and prescription of exercises.
Collins, John P
An international consensus statement has been developed as a reference on the key principles to be considered during discussions on surgical education and training and the delivery of surgical care in an era of restricted hours. Copyright © 2011. Published by Elsevier Ltd.
Boonen, A.; Chorus, A.; Miedema, H.; van der Heijde, D.; Landewé, R.; Schouten, H.; van der Tempel, H.; van der Linden, S.
To investigate withdrawal from the labour force because of inability to work owing to ankylosing spondylitis (AS) and to determine the characteristics of patients with no job because of work disability attributable to AS. A postal questionnaire was sent to 709 patients with AS aged 16-60 years
Joyner, K.H.; Stone, K.R.
The Royal Australian Air Force (RAAF) has long recognised the value of its work force and the need to preserve their health and wellbeing to achieve operational objectives. The Directorate of Air Force Safety (DAFS) is required by the Chief of the Air Staff to take all measures possible to prevent accidents and incidents in the RAAF, under the provisions of the Defence Instruction, 'Air Force Safety and Occupational Health Policy'. Consequently, the RAAF has exercised a pragmatic approach to radiofrequency radiation (RFR) and has always adopted and implemented strict exposure standards. DAFS receives technical advice on RFR from the Directorate of Telecommunications Engineering (DTELENG) and on occupational health from the Directorate General of Air Force Health Services (DGAFHS)
Choi, Sandy Pin-Pin; Pang, Samantha Mei-Che; Cheung, Kin; Wong, Thomas Kwok-Shing
The nursing work environment, which provides the context of care delivery, has been gaining increasing attention in recent years. A growing body of evidence points to an inseparable link between attributes of the nursing work environment and nurse and patient outcomes. While most studies have adopted a survey design to examine the workforce and work environment issues, this study employed a phenomenological approach to provide empirical evidence regarding nurses' perceptions of their work and work environment. The aim of this study was to advance our understanding of the phenomenon of increasing nurse turnover through exploring frontline registered nurses' lived experiences of working in Hong Kong public hospitals. A modified version of Van Kaam's controlled explication method was adopted. Individual semi-structured interviews were conducted with 26 frontline nurses recruited from ten acute regional, district and non-acute public hospitals in Hong Kong. Their perspectives in regard to their work and work environment, such as workload, manpower demand and professional values, were extensively examined, and a hypothetical description relating the nursing work environment with nurses' turnover intention was posited. Contemplation of nurses' experiences revealed the vulnerable aspects of nursing work and six essential constituents of the nursing work environment, namely staffing level, work responsibility, management, co-worker relationships, job, and professional incentives. These essential constituents have contributed to two sets of forces, stabilizing and destabilizing forces, which originate from the attributes of the nursing work environment. Nurses viewed harmonious co-worker relationships, recognition and professional development as the crucial retaining factors. However, nurses working in an unfavorable environment were overwhelmed by destabilizing forces; they expressed frustration and demonstrated an intention to leave their work environment. The nursing
Oh, Jong-Seok; Choi, Seung-Hyun; Choi, Seung-Bok
This paper presents control performances of a new type of four-degrees-of-freedom (4-DOF) haptic master that can be used for robot-assisted minimally invasive surgery (RMIS). By adopting a controllable electrorheological (ER) fluid, the function of the proposed master is realized as a haptic feedback as well as remote manipulation. In order to verify the efficacy of the proposed master and method, an experiment is conducted with deformable objects featuring human organs. Since the use of real human organs is difficult for control due to high cost and moral hazard, an excellent alternative method, the virtual reality environment, is used for control in this work. In order to embody a human organ in the virtual space, the experiment adopts a volumetric deformable object represented by a shape-retaining chain linked (S-chain) model which has salient properties such as fast and realistic deformation of elastic objects. In haptic architecture for RMIS, the desired torque/force and desired position originating from the object of the virtual slave and operator of the haptic master are transferred to each other. In order to achieve the desired torque/force trajectories, a sliding mode controller (SMC) which is known to be robust to uncertainties is designed and empirically implemented. Tracking control performances for various torque/force trajectories from the virtual slave are evaluated and presented in the time domain. (paper)
Oh, Jong-Seok; Choi, Seung-Hyun; Choi, Seung-Bok
This paper presents control performances of a new type of four-degrees-of-freedom (4-DOF) haptic master that can be used for robot-assisted minimally invasive surgery (RMIS). By adopting a controllable electrorheological (ER) fluid, the function of the proposed master is realized as a haptic feedback as well as remote manipulation. In order to verify the efficacy of the proposed master and method, an experiment is conducted with deformable objects featuring human organs. Since the use of real human organs is difficult for control due to high cost and moral hazard, an excellent alternative method, the virtual reality environment, is used for control in this work. In order to embody a human organ in the virtual space, the experiment adopts a volumetric deformable object represented by a shape-retaining chain linked (S-chain) model which has salient properties such as fast and realistic deformation of elastic objects. In haptic architecture for RMIS, the desired torque/force and desired position originating from the object of the virtual slave and operator of the haptic master are transferred to each other. In order to achieve the desired torque/force trajectories, a sliding mode controller (SMC) which is known to be robust to uncertainties is designed and empirically implemented. Tracking control performances for various torque/force trajectories from the virtual slave are evaluated and presented in the time domain.
Wang, Wenru; Kong, Amelia Wai Man; Chair, Sek Ying
The aim of this study is to explore the relationship between job stress and coping strategies of Hong Kong nurses working in an acute surgical unit. This is a descriptive correlational study. Data were collected from 98 Hong Kong surgical nurses using the Nursing Stress Scale and the Jalowiec Coping Scale. Results showed that workload (M = 15.36), lack of support (M = 13.32), and inadequate preparation (M = 12.33) are the most common stressors for Hong Kong surgical nurses. The most frequent strategies used by nurses to cope with stress can be characterized as evasive (M = 19.23), confrontive (M = 17.46), and optimistic (M = 15.81), all of which are also rated as the most effective strategies in reducing stress levels. Only the confrontive, optimistic, supportant, and emotive coping strategies reveal significant correlations (p stress levels of nurses, whereas the evasive, fatalistic, palliative, and self-reliant strategies showed no significant correlation with stress levels (p > .05). Recognizing the impacts of job-related stress and making use of effective coping methods play a vital role in reducing nurse's stress. A change in leadership styles from the managerial level and reallocation of manpower may help reduce job stress. The use of confrontive and optimistic coping strategies in reducing job-related stress for surgical nurses should be advocated and promoted in their daily work. Copyright © 2011 Elsevier Inc. All rights reserved.
Alfredsson, L; Karasek, R; Theorell, T
The project was designed to test the assumption that certain psychosocial characteristics of occupational groups are associated with elevated myocardial infarction risk. All cases of myocardial infarction below the age of 65 in men living in the region of greater Stockholm during the years 1974-1976 were identified (deaths as well as survivals) in the official registries of hospitalizations and deaths. For each case two controls without infarction (in younger ages four) matched for age, area of residence and sex were selected randomly from the parish registries. For each case and control (n = 334 and 882, respectively) information was available regarding occupation. The psychosocial characteristics of each one of the 118 occupations were recorded by means of a nation wide interview survey (3876 working men) in 1977. Relative age-adjusted risks of developing a myocardial infarction were calculated for occupations in which many vs occupations in which few subjects reported a given characteristic (50% with most vs 50% with least). Shift work and monotony were associated with significant excess risk. Hectic work was not associated with excess risk by itself but in combination with variables associated with low decision latitude and/or few possibilities for growth it was associated with significant excess risk.
Hovbrandt, Pia; Håkansson, Carita; Albin, Maria; Carlsson, Gunilla; Nilsson, Kerstin
Reforms are changing pension systems in many European countries, in order to both restrict early retirement and force people to extend their working life. From occupational therapy and occupational science perspectives, studies focusing on aspects of working life that motivate the older worker is urgent. The aim was to describe incentives behind an extended working life among people over age 65. Focus group methodology was used, with participants ages 66-71, from varying work fields: construction and technical companies and the municipal elderly care sector. Work was considered important and valuable to the degree of how challenging work was, the possibilities for inclusion in a team of colleagues and the chances for better personal finances. Amongst all, the participants expressed a feeling of a strengthened identity by being challenged and having the opportunity to manage working tasks. The finding showed the actual reasons behind an extended working life among older workers. However, a risk of rising social inequity may appear with increased working life if older people are forced to extend their working life due to a difficult financial situation as a pensioner. A variety of retirement options and initiatives in order to support older workers are justified.
Aardal, K.I.; Ari, A.
One of the most important problems in the production and inventory planning field, is the scheduling of production and work force in a dynamic environment. Although this problem can be formulated as a linear program, it is often quite difficult to solve directly, due to its large scale. Instead, it
Director of the Air National Guard20 Lt Gen Charles E. Stenner Jr., Chief of the Air Force Reserve21 Specificity about what rebalancing the force...January 2012). Sharp, Travis. Vision Meets Reality: 2010 QDR and 2011 Defense Budget. Center for a New American Security, February 2010. Stenner ...Lt Gen Charles E. Stenner Jr., commander of Air Force Reserve Command (address, Air Force Reserve Senior Leader Conference
Full Text Available Cystic echinococcosis (CE and alveolar echinococcosis (AE are chronic, complex and neglected diseases. Their treatment depends on a number of factors related to the lesion, setting and patient. We performed a literature review of curative or palliative non-surgical, non-chemical interventions in CE and AE. In CE, some of these techniques, like radiofrequency thermal ablation (RFA, were shelved after initial attempts, while others, such as High-Intensity Focused Ultrasound, appear promising but are still in a pre-clinical phase. In AE, RFA has never been tested, however, radiotherapy or heavy-ion therapies have been attempted in experimental models. Still, application to humans is questionable. In CE, although prospective clinical studies are still lacking, therapeutic, non-surgical drainage techniques, such as PAIR (puncture, aspiration, injection, re-aspiration and its derivatives, are now considered a useful option in selected cases. Finally, palliative, non-surgical drainage techniques such as US- or CT-guided percutaneous biliary drainage, centro-parasitic abscesses drainage, or vascular stenting were performed successfully. Recently, endoscopic retrograde cholangiopancreatography (ERCP-associated techniques have become increasingly used to manage biliary fistulas in CE and biliary obstructions in AE. Development of pre-clinical animal models would allow testing for AE techniques developed for other indications, e.g. cancer. Prospective trials are required to determine the best use of PAIR, and associated procedures, and the indications and techniques of palliative drainage.
Alany Bezerra da Rocha Alves
Full Text Available The Surgical Center is a restricted environment of high complexity, where the professionals who work in it deal with exhausting activities, as well as complex and unexpected situations, which are potential physical and psychological stressors, and can interfere in the quality of life. This is an exploratory, descriptive, quantitative qualitative approach, with the objective of analyzing the workload of nursing professionals working at the Surgical Center and the repercussions on the quality of life, submitted and approved by the Research Ethics Committee of the Health Sciences Center of the Federal University of Paraíba (CCS/ UFPB, according to the protocol n° 0156/16, CAAE: 55298616.3.0000.5188. The sample consisted of 15 nurses of both sexes who work in a Philanthropic Hospital located in the municipality of João Pessoa / PB. A questionnaire was applied to characterize the participants' profile, an interview script with data related to work overload and WHOQOL-Bref. It was found that 80% of the participants were women, the average age was 37.8 years. In the sample, 60% were neither satisfied nor dissatisfied with their quality of life, and 33% stated they were dissatisfied with their quality of health. It is concluded that the results obtained provided a more reflective analysis of the workload of nursing professionals working in the surgical center, besides analyzing the repercussions that affect the quality of life of these people, evaluating the association between the variables of the characterization Of the nursing professionals' profile with the domains measured by WOQOL Bref.
Shafiq-ur-Rehman; Mehmood, Sajid; Ahmed, Jamil; Razzaq, Muhammad Haroon; Khan, Shakeeb; Perry, Eugene Phillip
To examine the current practice of handover and to record trainees' assessment of handover process. An audit study. Department of General Surgery, Scarborough General Hospital, Scarborough, United Kingdom, from January to April 2010. A paper-based questionnaire containing instruments pertaining to handover guidelines was disseminated to trainees on surgical on-call rota at the hospital. Trainees' responses regarding handover process including information transferred, designated location, duration, structure, senior supervision, awareness of guidelines, formal training, and rating of current handover practice were analysed. A total of 42 questionnaires were returned (response rate = 100%). The trainees included were; registrars 21% (n=9), core surgical trainees 38 % (n=16), and foundation trainees 41% (n=17). Satisfactory compliance (> 80% handover sessions) to RCS guidelines was observed for only five out of nine components. Ninety-five percent of hand over sessions took place at a designated place and two-third lasted less than 20-minutes. Computer generated handover sheet 57% (n=24) was the most commonly practised method of handover. Specialist registrar 69 % (n=29) remained the supervising person in majority of handover sessions. None of the respondents received formal teaching or training in handover, whereas only half of them 48% (n=20) were aware of handover guidelines. Twenty-one percent of the trainees expressed dissatisfaction with the current practice of handover. Current practice of surgical handover lacks structure despite a fair degree of compliance to RCS handover guidelines. A computerised-sheet based structured handover process, subjected to regular audit, would ensure patient safety and continuity of care.
Garbarino, Sergio; Cuomo, Giovanni; Chiorri, Carlo; Magnavita, Nicola
Law and order enforcement tasks may expose special force police officers to significant psychosocial risk factors. The aim of this work is to investigate the relationship between job stress and the presence of mental health symptoms while controlling sociodemographical, occupational and personality variables in special force police officers. At different time points, 292 of 294 members of the 'VI Reparto Mobile', a special police force engaged exclusively in the enforcement of law and order, responded to our invitation to complete questionnaires for the assessment of personality traits, work-related stress (using the Demand-Control-Support (DCS) and the Effort-Reward-Imbalance (ERI) models) and mental health problems such as depression, anxiety and burnout. Regression analyses showed that lower levels of support and reward and higher levels of effort and overcommitment were associated with higher levels of mental health symptoms. Psychological screening revealed 21 (7.3%) likely cases of mild depression (Beck Depression Inventory, BDI≥10). Officers who had experienced a discrepancy between work effort and rewards showed a marked increase in the risk of depression (OR 7.89, 95% CI 2.32 to 26.82) when compared with their counterparts who did not perceive themselves to be in a condition of distress. The findings of this study suggest that work-related stress may play a role in the development of mental health problems in police officers. The prevalence of mental health symptoms in the cohort investigated here was low, but not negligible in the case of depression. Since special forces police officers have to perform sensitive tasks for which a healthy psychological functioning is needed, the results of this study suggest that steps should be taken to prevent distress and improve the mental well-being of these workers.
Hayward, G.B.; Kinsel, W.
The field of environmental engineering and environmental science is so new that many colleges and universities have only begun the process of bringing academic program, into their areas. Many professional personnel don't need full degree programs but may need only certain courses to enhance their skills in the environmental area. This article discusses the partnership between the Hanford contractors, DOE-RL, and Washington State University in an innovative way in solving a portion of the remediation work force problems
Full Text Available Highly qualified working force is a central element of intensive development model in modern society. The article surveys the experience of countries that managed to transform their economy to the innovative one. Ukrainian economy cannot stand aside processes that dominate the world economy trends, thus we are to use this experience to succeed in future. Today any government of the world is facing challenges that occur due to transformation of the economy into informational one. This type of economy causes its transformation form extensive to intensive one. The main reasons under that is limitation of nature resources, material factors of production. Thus this approach depends much on the quality of working force. Unfortunately in Ukraine there is a misbalance in specialist preparation. This puts additional pressure on the educational sphere also. In order to avoid this pressure we are to conduct reforms in education sphere. Nowadays, in the world views and concepts of governmental role in the social development are changing. This why, even at times of economic recession educational costs are not reduced under the new economical doctrine in the EU. Highly qualified specialists, while creating new products and services play role of engineers in XXI century. They are to lead their industries to world leading positions. From economic point of view, highly qualified specialists benefit society with higher income rates, taxation and thus, increasing the living standards in society. Thus, the majority if modern scientists prove the importance of highly trained working force for more effective economic development.
Eren, B. [Department of Physics, University of Basel, Klingelbergstrasse 82, CH-4056 Basel (Switzerland); Material Sciences Division, Lawrence Berkeley National Laboratory, 1 Cyclotron Road, Berkeley, California 94720 (United States); Gysin, U.; Marot, L., E-mail: Laurent.email@example.com; Glatzel, Th.; Steiner, R.; Meyer, E. [Department of Physics, University of Basel, Klingelbergstrasse 82, CH-4056 Basel (Switzerland)
Few layer graphene and graphite are simultaneously grown on a ∼100 nm thick polycrystalline nickel film. The work function of few layer graphene/Ni is found to be 4.15 eV with a variation of 50 meV by local measurements with Kelvin probe force microscopy. This value is lower than the work function of free standing graphene due to peculiar electronic structure resulting from metal 3d-carbon 2p(π) hybridization.
There is a paucity of trained pediatric surgeons in resource-poor areas, and many children never receive care for debilitating problems that could readily be managed by surgeons with proper training, supplies, and instrumentation. This article, written from the perspective of a surgeon who has been both the recipient of and the provider of volunteer surgical services, is intended to encourage surgeons in technologically advanced locations to volunteer in underserved areas and to assist them in the implementation of such endeavors. Concepts are presented with an emphasis on pediatric surgery, but most are relevant for volunteers in all surgical specialties. Volunteer paradigms include, but are not limited to, the "surgical brigade" model, where a large group of health care professionals take all needed equipment and supplies for the duration of their stint, and the "minimalist" model, where a single volunteer works with local personnel using locally available equipment. For a successful volunteer endeavor the host needs to have a perceived need for the volunteer's services, and the volunteer must be flexible in adapting to meet overwhelming needs with limited resources. It is suggested that appropriate technology, such as the inexpensive anal stimulator presented herein, should be employed whenever possible. With proper planning, realistic expectations, and a cooperative and helpful attitude, volunteer trips can be rewarding experiences for both volunteers and host physicians and lead to lasting relationships that improve children's lives globally.
Gough, Ian R
There is a worldwide trend for reduced working hours for doctors, particularly in the developed western countries. This has been led by the introduction of the European Working Time Directive (EWTD) that has had a significant impact on work patterns and training. Australia currently has a more flexible working environment but this is changing. In New Zealand there is a contract for resident doctors defining a maximum 72 h of rostered work per week. Copyright © 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.
Dyrbye, Liselotte N; Freischlag, Julie; Kaups, Krista L; Oreskovich, Michael R; Satele, Daniel V; Hanks, John B; Sloan, Jeff A; Balch, Charles M; Shanafelt, Tait D
To evaluate factors associated with work-home conflicts (W-HCs) of US surgeons and their potential personal and professional consequences. Cross-sectional study. Members of the American College of Surgeons. Burnout, depression, quality of life, alcohol use, career satisfaction, and career decisions (ie, reduce work hours or leave current practice). Of 7197 participating surgeons, 3754 (52.5%) had experienced a W-HC in the previous 3 weeks. On multivariate analysis, hours worked per week, having children, sex, and work location (Veterans Administration or academic center) were independently associated with an increased risk for W-HC (all P career option to their children (46.0% vs 54.4%; P Work-home conflicts were also independently associated with surgeons reporting a moderate or higher likelihood of planning to reduce clinical work hours (odds ratio, 1.769) and leave their current practice in the next 24 months for a reason other than retirement (odds ratio, 1.706) after controlling for other personal and professional factors. Integrating personal and professional lives is a substantial challenge for US surgeons. Conflict in this balance appears to be a major factor in their decision to reduce work hours and/or move to a new practice, with potential substantive manpower implications for the surgical workforce.
The European Working Time Directive (EWTD) 48 h working week has been law in European countries since 1998. A phased approach to implementation was agreed for doctors in training, which steadily brought down working hours to 58 in 2004, 56 in 2007 and 48 in 2009. Medical trainees can "opt out" to a 54 h working week but this has to be voluntary and rotas cannot be constructed that assume an opt out is taking place. A key component of the working week arrangements is that the maximum period of work for a resident doctor without rest is 13 h. Shorter sessions of work have led to complex rotas, frequent handovers with difficulties maintaining continuity of care with implications for patient safety. Although there has been over 10 years notice of the changes to the working week and progress has up to now been reasonable (helped, in part by a steady increase in consultant numbers) this latest reduction from 56 h to 48 h seems to have been the most difficult to manage. Copyright © 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.
In this report, a basic ERGOMA (Ergonomics in Industrial Management) strategy is proposed as a policy for corporate production and employment in countries where ageing populations and reduced birth rates are imminent, and a strategy related to this is proposed. Specifically, as a strategy at the company level, the results of survey studies aimed at the development of methods for determining job capacity, to enable effective use of the labour of ageing workers, were summarized. A number of the insights gained here are steps in the development of a foundational methodology for practical use, and in actual practice a number of these insights must be subjected to measurements. However, the theory and newly developed methodology described here are thought to represent significant changes from the approaches to job capacity diagnosis and assessment published in the past and from the stance towards utilization of an ageing work-force. The author is confident that this represents new progress in one of the ergonomics approach to dealing with the working environment of ageing workers and an ageing work-force in general.
Nix, Ralph E; Onofrio, Kathleen; Konoske, Paula J; Galarneau, Mike R; Hill, Martin
.... The primary objective of the study was to provide the Air Force with the ability to validate clinical requirements of the MFST assemblage, with the goal of using NHRC's Estimating Supplies Program (ESP...
Peterson, D. J. [Science and Technology Policy Inst., Arlington, VA (United States); LaTourrette, Tom [Science and Technology Policy Inst., Arlington, VA (United States); Bartis, James T. [Science and Technology Policy Inst., Arlington, VA (United States)
RAND has just published a report entitled, "New Forces at Work in Mining: Industry Views of Critical Technologies," by D. J. Peterson, Tom LaTourrette, and James T. Bartis. The report presents the results of a series of in-depth discussions with leading mining industry representatives selected for their prominent position and their ability to think broadly about technology trends. The discussions highlighted the importance of collaborative technology research, development, and implementation strategies and the increasingly critical role of mine personnel in the utilization of new technologies.
Browne, B A
Beliefs about gender discrimination in the work force were investigated among a sample of American (n = 201) and Australian (n = 177) business students. Significant differences between genders in beliefs about the existence of gender discrimination were indicated, with women being more likely than men to affirm its existence, particularly in the area of salary discrimination. In addition, there were differences between genders and between countries in assessment of the factors that might lead to lower participation of women in management and in the assessment of avenues of advancement for women.
Lawthom, Rebecca; Kagan, Carolyn; Burton, Mark; Lo, Sandy; Mok, Lisa; Sham, Sylvia; Baines, Sue; Greenwood, Mark
In this article we seek to reflect critically on some recent research we have carried out, in collaboration with a Chinese welfare NGO, on the experience of forced labor among Chinese migrant workers in the UK. We will (a) locate briefly the wider political context of migrant work (both regular and irregular) in the UK; (b) explore how and why the actual research methods and process of the research deviated in practice from those that were planned; and (c) show the extent to which aspects of the research process reflected a liberation psychology perspective.
The author reflects on his contrasting analytic work with two transsexual patients. He uses three previous psychoanalytic studies (Stoller, Morel and Lemma) to explore whether effective analytic work with the issues driving a person's determined wish for sex reassignment surgery (SRS) is possible. Particular consideration is given to how such work might navigate a path between traumatizing and pathologizing the patient on the one hand and avoiding important analytic material out of fear of so doing on the other. The author proceeds to ask whether it is possible to tell in advance, with any degree of reliability, who is and who is not likely to benefit from surgery. He considers certain diagnostic issues in relation to these questions. Illustrations are given of how, in practice, countertransference anxieties about psychopathologizing transsexual patients can contribute to significant difficulties in working clinically with them. It is argued that the understanding and containment of such anxieties could eventually lead to more effective analytic work, and that such work might be further facilitated by considering the contribution of mind-body dissociation to transsexualism. © 2015, The Society of Analytical Psychology.
PHYSICAL SECURITY: AN ANALYSIS OF THE ROYAL AUSTRALIAN AIR FORCE MILITARY WORKING DOG PROGRAM by Mark W. Powell March 2016 Thesis...AN ANALYSIS OF THE ROYAL AUSTRALIAN AIR FORCE MILITARY WORKING DOG PROGRAM 5. FUNDING NUMBERS 6. AUTHOR(S) Mark W. Powell 7. PERFORMING...increased demand on its physical security elements. Its military working dog (MWD) workforce is required to meet an inventory of 204 by end of year 2023 as
This article uses a socioecological analytical approach to assess the capacity of the public health nutrition work force in Australia as a prelude to work force development strategy planning. It demonstrates how the socioecological model can be used to assess and inform the development of the infrastructure required for effective public health nutrition effort. An interpretive case study method was used involving triangular analysis of quantitative and qualitative data from multiple sources including semistructured interviews with advanced-level practitioners, literature review, a cross-sectional national work force survey, and position description audit and consensus development using a Delphi study. The findings of this analysis indicate that the Australian public health nutrition work force's capacity to effectively address priority nutrition issues is limited by determinants that can be categorized as relating to human resource infrastructure, organizational and policy environments, intelligence access and use, practice improvement and learning systems, and work force preparation. This socioecological analysis supports an intelligence-based focus for work force development effort in Australia and a conceptual framework for work force capacity assessment with potential applications in other countries.
Hansen, Thomas Riisgaard; Bardram, Jakob Eyvind
, and unnecessary stress. To accommodate this situation and to increase the quality of work in operating wards, we have designed a set of pervasive computer systems which supports what we call context-mediated communication and awareness. These systems use large interactive displays, video streaming from key...
Boerjan, Martine; Bluyssen, Simone J M; Bleichrodt, Robert P; van Weel-Baumgarten, Evelyn M; van Goor, Harry
The aim of this cross-sectional study was to investigate the influence of job-related autonomy and social support provided by consultants and colleagues on the stress-related health complaints of surgical residents in the Netherlands. All (n = 400) Dutch residents in training in general surgery were sent validated self-report questionnaires. Odds ratios were calculated predicting health and exposure to long-term stress for gender, number of working hours, type of hospital, level of social support, job-related autonomy and training phase. The interactions between job-related autonomy and level of social support provided by consultants and colleagues, and all variables, were analysed. A total of 254 of 400 (64%) residents returned questionnaires that were eligible for analysis. Residents experienced more health complaints than the average member of the Dutch working population (4.0 versus 2.5; p = 0.000). Male and senior residents were significantly 'healthier' than female and junior residents, respectively. Social support by consultants was a strong predictor of health and social support by colleagues showed a significant interaction with gender. Women and residents in university hospitals experienced less social support by consultants than men and residents in general teaching hospitals. Residents working in university hospitals experienced lower levels of job-related autonomy and less support from colleagues in comparison with those working in general teaching hospitals. A working week of > 60 hours adversely affected health and job-related autonomy. Social support provided by consultants and colleagues, and job control, are important factors that interact with the work-associated, stress-related health of residents in training in general surgery. Residents report a greater number of health complaints than the average member of the working population, especially female and junior residents. General teaching hospitals seem to provide better support at work than
An audit of the Air Force Working Capital Fund financial statements is required by Public Law 101-576, the "Chief Financial Officers Act of 1990," November 15, 1990, as amended by Public Law 103-356...
Full Text Available Nursing is one of the professions where chronic stress is an inseparable characteristic and stems from the very nature of the profession itself. The job of a nurse involves particular mental burdens. The source of these is another person, one who has most often found themselves in an extreme situation. A nurse carries out her/his duties in a state of strong and long-lasting emotional strain. Inappropriate coping with stress and a lack of support from others in difficult situations leads to the development of burnout syndrome. This syndrome not only lowers, to a great extent, the quality of performed work but also prevents nurses from further professional development. Aims : The aim of the following paper is to evaluate the influence of stress connected with the professional work of a nurse on the occurrence of burnout syndrome. Material and methodology : Research was conducted on a group of 103 nurses working at eight hospital wards (surgical and medical treatment at the District Hospital in Lipsko. The research tool was a questionnaire of the author’s own devise, which contained 34 questions. Results : Among the examined nurses, 90% concluded that their professional work has a negative impact on their family life and they pointed to their own occupational burnout. Nurses who carried negative emotions over from work to their homes significantly more often showed a lack of satisfaction from their job and signs of occupational burnout. A substantial percentage of the participants considered shift-work and the professional position held to be a detrimental factor in the process of occupational burnout. Conclusion : The nurses were to a large extent exposed to mental burdens having a negative impact on their work. The vast majority of the respondents felt satisfaction from their job but a significant percentage of the respondents admitted to suffering from symptoms of chronic stress and exhaustion, which may indicate a lack of any support from co
This report presents the results of a survey of the socioeconomic characteristics associated with 11 uranium mine and mill operations in 5 Western States. Comparisons are made with the socioeconomic characteristics of construction and operating crews for coal mines and utility plants in eight Western States. Worker productivity also is compared with that in similar types of coal and uranium mining operations. We found that there existed no significant differences between the socioeconomic characteristics of construction and operating crews and the secondary employment impacts associated with uranium mines and mills when compared with those associated with coal mines and utility plants requiring similar skills at comparable locations. In addition, our survey includes a comparison of several characteristics associated with the households of basic and nonbasic work forces and concludes that significant changes have occurred in the last 5 yr. Accordingly, we recommend additional monitoring and updating of data used in several economic forecasting models to avoid unwarranted delays in achieving national energy goals
Mason, Virginia M; Leslie, Gail; Clark, Kathleen; Lyons, Pat; Walke, Erica; Butler, Christina; Griffin, Martha
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
Full Text Available Dental education aims to produce competent graduates with the ability to provide quality care to the patients and facilitate the smooth integration into professional practice. The objective of this study was to explore the overall preparedness of graduands for integrating into professional practice. The survey was tested for reliability and analysed the career paths, learning preferences, overall knowledge, and confidence amongst graduating dentists in integrating and managing a dental practice on graduation. Sixty-nine students (89.6% in age group of 20–50 years participated in the study. Students indicated a high level of confidence in their skills and ability to work in a team in a practice or collaboratively with other colleagues and specialists but expressed some reservation on their practice management skills (73.1%. Challenges in gaining employment and pressures to repay educational debts are amongst the reasons for graduands preferring a paid job immediately on graduation regardless of demographics. Students indicated that an increase in speciality training and clinical/outreach placements could enhance employability. This study explores the students’ perception of their confidences, knowledge, learning preferences, and practice management skills as a method of evaluating their preparedness to practice on graduation and provides a base line for curriculum structuring to prepare graduands to enter the competitive dental work force.
Krieger, Beate; Kinébanian, Astrid; Prodinger, Birgit; Heigl, Franziska
Research has shown that comparatively few adults with Asperger Syndrome (AS) participate in the competitive work force. The purpose of this study was to gain in-depth knowledge about contextual factors, which contribute to successful labor market participation in some adults with AS. This study was conducted by indepth-interviewing six adults with AS working in the competitive job market in Switzerland. A developmental and hermeneutic narrative approach was used for data collection and analysis. Two in-depth narrative interviews were conducted with each participant. A narrative analysis according to the theories of Paul Ricoeur was performed. Results showed that participants received pre-vocational requisites during their childhood through parents and friends that provided a feeling of security in social contexts. For participants, a supportive school setting resulted in academic achievements. The narratives reveal participants' capacities for understanding and adapting to social norms. Participants' understanding of their own needs was essential to the successful labor market participation. However, disclosure is rare and social stigma is still present. This study showed that successful labor participation of adults with AS can be enhanced through adequate social support already in the early stages of an individual's lifetime.
Legislation launched with the EWTD was born as a "Protection of the clinical personnel against overwork for the benefit of Patients" (consumer protection and safety). It appeared that this legislation is in direct and severe conflict with former EU legislation to train competent surgical specialists. First experiences with the EWTD show far reaching and serious consequences on the training of surgical specialists as well as on medical care. There will be a reduction of about 30-35% of clinical and operative experience acquired during the usual 6 yrs of training, with many other negative aspects (see p. 7). All measures proposed so far to overcome the ensuing problems are unworkable. The training of competent surgical specialists as required by the Directive 93/16 EEC is no longer possible and serious problems with safe patient care will occur in the short term, if no political actions are taken. The surgical specialties, represented in the UEMS, provide a proposal for a working hour model consisting of 48 hrs working time (incl. service duties) plus additional 12 hrs reserved and protected for teaching and training. This model would adhere to the EWTD on the one hand, yet maintain the desired standard of training. This proposed exemption from the EWTD would be limited to the time of specialist training. We ask the responsible politicians to find a solution rapidly to prevent serious negative consequences. This motion is supported by the surgical specialties (neurosurgery, general surgery, orthopaedic surgery, paediatric surgery, cardio-thoracic surgery, vascular surgery, oto-rhino-laryngology, list not complete) of the member states of the EU, representing more than 80,000 surgical specialists.
Haveman, Robert H.; Wolfe, Barbara L.
This paper presents a decision-process model for explaining the growth in transfer recipiency (the receipt by working age people of disability income), the choice of work status, and the reduction in labor force participation of older workers. It is hypothesized that the attractiveness of disability income transfer options has led older male…
Burr, Hermann; Bjorner, Jakob B; Kristensen, Tage S; Tüchsen, Finn; Bach, Elsa
The aims of this study were (i) to describe the trends in the work environment in 1990-2000 among employees in Denmark and (ii) to establish whether these trends were attributable to labor-force changes. The split-panel design of the Danish Work Environment Cohort Study includes interviews with three cross-sections of 6067, 5454, and 5404 employees aged 18-59 years, each representative of the total Danish labor force in 1990, 1995 and 2000. In the cross-sections, the participation rate decreased over the period (90% in 1990, 80% in 1995, 76% in 2000). The relative differences in participation due to gender, age, and region did not change noticeably. Jobs with decreasing prevalence were clerks, cleaners, textile workers, and military personnel. Jobs with increasing prevalence were academics, computer professionals, and managers. Intense computer use, long workhours, and noise exposure increased. Job insecurity, part-time work, kneeling work posture, low job control, and skin contact with cleaning agents decreased. Labor-force changes fully explained the decline in low job control and skin contact to cleaning agents and half of the increase in long workhours, but not the other work environment changes. The work environment of Danish employees improved from 1990 to 2000, except for increases in long workhours and noise exposure. From a specific work environment intervention point of view, the development has been less encouraging because declines in low job control, as well as skin contact to cleaning agents, were explained by labor-force changes.
Gignac, Monique A M; Cao, Xingshan; Lacaille, Diane; Anis, Aslam H; Badley, Elizabeth M
To prospectively examine arthritis-related productivity losses, work changes, and leaving employment, the relationships among these work transitions, and the factors associated with them. Participants with inflammatory arthritis or osteoarthritis were interviewed at 4 time points, 18 months apart, using a structured questionnaire. At baseline (T1), all participants (n = 490; 381 women, 109 men) were employed. At T2, T3, and T4, the sample decreased to 413, 372, and 349 participants, respectively. Respondents were recruited using community advertising and from rheumatology and rehabilitation clinics. Work transitions considered were productivity losses (absenteeism, job disruptions), work changes (reduced hours, changing jobs), and leaving employment. Also measured were demographic, illness, work context, and psychological variables. Generalized estimation equations modeled predictors of work transitions over time. Although 63.1% of respondents remained employed throughout the study, work transitions were common (reported by 76.5% of participants). Productivity losses, especially job disruptions such as being unable to take on extra work, were the most frequently reported. Work transitions were related to subsequently making other work transitions, including leaving employment. Age, sex, education, activity limitations, control, depression, and arthritis-work spillover were also associated with work transitions. This study sheds light on a process of diverse employment changes that may occur in the lives of many individuals with arthritis. It emphasizes the interrelationships among work transitions, as well as other factors in predicting work transitions, and it provides insight into work changes that may signal impending difficulties with remaining employed.
Sanchez-Hucles, J V
African American women in the United States have a long history of employment outside of their homes. Their experiences are unique from other groups of majority and minority men and women due to the interaction of race, gender, and class. Despite long-standing and continuing struggles against discrimination, harassment, low pay, tokenism, and stereotypes, a myth that African American women enjoy a bonus or advantaged status in the work force has developed and persisted. In this article, Black women's work force experiences are examined from a social constructionist framework, misperceptions of Black women are critiqued, explanations are developed that explain the unique status of African American women and recommendations are proposed to eradicate the discrimination and marginal status that Black women have endured in the work force.
The health effects of ionizing radiation recently have been the focus of increased public concern. In response to this concern, in a May 9, 1978, memorandum the White House requested the Secretary of Health, Education, and Welfare to coordinate an interagency program that would, among other things, ensure public awareness and knowledge of the health effects of ionizing radiation. As a result, the Interagency Task Force on Ionizing Radiation was formed. The Information Work Group of the Task Force was asked to outline a public information program to meet the needs of the general public, the health and scientific community, workers, and other persons exposed to low levels of ionizing radiation in the past and at present or who may be exposed in the future. The Work Group is composed of 16 members, each representing an agency participating on the Interagency Task Force on Ionizing Radiation. The Work Group members used the draft Reports of the Science Work Group, the Radiation Exposure Reduction Work Group, the Care and Benefits Work Group, and the Privacy Work Group as a basis for developing the Information Report. In addition, the Information Work Group conducted a preliminary review of existing federal information programs. Meetings were held with representatives of environmental and trade groups, unions, and professional societies to help define the dimensions and priorities of a public information program
Kjærgaard, Jane; Sillesen, Martin; Beier-Holgersen, Randi
Since 2003, United States residents have been limited to an 80-hour workweek. This has prompted concerns of reduced educational quality, especially inadequate operating exposure. In contrast, the Danish surgical specialty-training program mandates a cap on working hours of 37 per week. We hypothesize that there is no direct correlation between work-hours and operative volume achieved during surgical residency. To test the hypothesis, we compare Danish and US operative volumes achieved during surgical residency training. Retrospective comparative study. The data from the US population was extracted from the Accreditation Council for Graduate Medical Education database for General Surgery residents from 2012 to 2013. For Danish residents, a questionnaire with case categories matching the Accreditation Council for Graduate Medical Education categories were sent to all Danish surgeons graduating the national surgical residency program in 2012 or 2013, 54 in total. In all, 30 graduated residents (55%) responded to the Danish survey. We found no significant differences in mean total major procedures (1002.4 vs 976.9, p = 0.28) performed during residency training, but comparing average major procedures per year, the US residents achieve significantly more (132.3 vs 195.4, p work-hours and operative volumes achievable. Factors other than work-hours seem to effect on operative volumes achieved during training. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Full Text Available Measuring working time is not only an important objective of the EU Labour Force Survey (LFS, but also a highly demanding task in terms of methodology. Against the background of a recent debate on the comparability of working time estimates in France and Germany, this article presents a comparative assessment of the measurement of working time in the Labour Force Survey obtained in both countries. It focuses on the measurement of the hours actually worked, the key working-time concept for short-term economic analysis and the National Accounts. The contribution systematically analyses the differences in the measurement approaches used in France and Germany in order to identify the methodological effects that hinder comparability. It comes to the conclusion that the LFS overstates the difference in hours actually worked in France and Germany and identifies question comprehension, rounding, editing effects, as well as certain aspects of the sampling design, as crucial factors of a reliable measurement in particular of absences from work during the reference week. We recommend continuing the work started in the European Statistical System towards the development of a model questionnaire in order to improve cross-national harmonisation of key variables such as hours actually worked.
Zhang, B; Chen, L S; Huang, S L; Liang, L; Gong, X X; Wu, P N; Zhang, S Y; Luo, X N; Zhan, J D; Sheng, X L; Lu, Z M
Objective: To investigate the relationship between Work Ⅱ type of congenital first branchial cleft anomaly (CFBCA) and facial nerve and discuss surgical strategies. Methods: Retrospective analysis of 37 patients with CFBCA who were treated from May 2005 to September 2016. Among 37 cases with CFBCA, 12 males and 25 females; 24 in the left and 13 in the right; the age at diagnosis was from 1 to 76 ( years, with a median age of 20, 24 cases with age of 18 years or less and 13 with age more than 18 years; duration of disease ranged from 1 to 10 years (median of 6 years); 4 cases were recurren after fistula resection. According to the classification of Olsen, all 37 cases were non-cyst (sinus or fistula). External fistula located over the mandibular angle in 28 (75.7%) cases and below the angle in 9 (24.3%) cases. Results: Surgeries were performed successfully in all the 37 cases. It was found that lesions located at anterior of the facial nerve in 13 (35.1%) cases, coursed between the branches in 3 cases (8.1%), and lied in the deep of the facial nerve in 21 (56.8%) cases. CFBCA in female with external fistula below mandibular angle and membranous band was more likely to lie deep of the facial nerve than in male with external fistula over the mandibular angle but without myringeal web. Conclusions: CFBCA in female patients with a external fistula located below the mandibular angle, non-cyst of Olsen or a myringeal web is more likely to lie deep of the facial nerve. Surgeons should particularly take care of the protection of facial nerve in these patients, if necessary, facial nerve monitoring technology can be used during surgery to complete resection of lesions.
Barniol, Pablo; Zavala, Genaro
In this article we compare students' understanding of vector concepts in problems with no physical context, and with three mechanics contexts: force, velocity, and work. Based on our "Test of Understanding of Vectors," a multiple-choice test presented elsewhere, we designed two isomorphic shorter versions of 12 items each: a test with no…
Rachel J. Hill
Full Text Available Large animal models of osteoarthritis are a necessary testing ground for FDA approval of human medicine applications. Sheep models have advantages over other available large animals, but development and progression of osteoarthritis in sheep is exceedingly slow, which handicaps progress in development of potential treatments. We combined oblique angle forced exercise to increase stress on the stifle, with surgical destabilization to hasten the development of osteoarthritis in ewes. Methods for early detection of clinical signs included radiography, urine, and serum biomarker assays and gait analysis and ex vivo we used microcomputed tomography and macroscopic joint analysis. Our model was able to produce clinically detectable signs of osteoarthritis in a relatively short period (14 weeks. Changes in bone were highly correlated between microcomputed tomography and radiographic analysis and changes in cartilage correlated well between urinary glycosaminoglycan levels and serum aggrecanase analyses. Exercise improved the negative effects of destabilization in bone but exacerbated the negative effects of destabilization in cartilage. These observations suggest that we may need to consider treatments for bone and cartilage separately. These results represent an improved large animal model of osteoarthritis with rapid onset of disease and superior detection of bone and soft tissue changes.
... instruction, including: Microbiology Pathophysiology Pharmacology Anatomy and physiology Medical terminology Curriculum . Course content includes: Advanced surgical anatomy Surgical microbiology Surgical pharmacology Anesthesia methods and agents Bioscience Ethical ...
D'Souza, Rennie M; Strazdins, Lyndall; Broom, Dorothy H; Rodgers, Bryan; Berry, Helen L
We investigate one aspect of productivity--sickness absence--and ask whether job insecurity and high work demands are associated with increased sickness absence and, if so, whether mental or physical health mediates this association. We further investigate if having control at work modifies these associations. We used cross-sectional survey data from 2,248 employees aged 40-44 years living in two cities of south-eastern Australia. Logistic regressions were used to compare the associations between job insecurity and demands among those with short (1-3 days) or long-term (> 3 days) sickness absence with those who had no sickness absence in the last four weeks. The mediating effects of mental and physical health were assessed by evaluating changes in the magnitude of the association between these work conditions and sickness absence. High job insecurity (OR = 3.28; 95% CI 1.54-6.95) and high work demands (OR = 1.62; 95% CI 1.13-2.30) were significantly associated with long-term, but not with short-term, sickness absence. These associations were unaffected by job control. Depression and anxiety explained 61% of the association between high work demands and long-term sickness absence and 30% of the association between job insecurity and long-term sickness absence. Difficult working conditions may reduce productivity by contributing to longer absences from work. Reforms intended to improve economic performance should address any potential health costs of insecurity or intensification, which could inadvertently decrease productivity, possibly through their impact on mental health.
van Gameren, Edwin; Velandia Naranjo, Durfari
We analyze factors determining women’s decisions to participate in the labor market and provide elderly care and nonfinancial support to their (grand)children. We use data from the Mexican Health and Aging Study, a survey of people aged 50 and over, applying a three-equation, reduced-form SUR model. Results suggest that care needs are the driving force behind caregiving activities. Traditional roles also appear to be relevant in the labor force participation decision: women with a closer labor market connection when they were young are more likely to work. Simulations of demographic changes illustrate potential effects for future caregiving and participation rates. PMID:26924883
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. ...
loads (for example, carrying meat at the slaughterhouse , carrying of sacks, loading wood by hand) wood cutting in the forest by hand tools, agricultural...8217 factor history. Medical Service Digest (United States Air Force), 27(2), 1976, pp. 14-16. 186 Trimeloni, Col. B.D. The Role of Women in the Air Force...Rahden. Effect of training on maximum oxygen intake and on anaerobic metabolism in man. Int. Z. Angew Physiol., 24(2), 1967, pp. 102-110. 188 Wyndham, C.H
Hiehata, K; Sasahara, A; Onishi, H
Nanometre-sized Pt clusters were prepared on a TiO 2 (110)-(1 x 1) surface, and the lateral distribution of work function was examined by using a Kelvin probe force microscope. Local work function on the Pt clusters was smaller than that on the surrounding TiO 2 surface. Assuming that the dipole moments which perturb the work function are produced by uneven electron distribution, the decrease of the work function indicates electron transfer from the clusters to the TiO 2 surface. After decomposition of pivalate anions on the surfaces by UV irradiation, the work function increased on some Pt clusters. It is known that holes photoexcited in TiO 2 attach to pivalate anions to cause a decomposition reaction. Hence the increase of the observed work function by UV irradiation can be ascribed to the trapping of the accompanying electrons to the Pt clusters
Shafer, Emily Fitzgibbons
Economic theories predict that women are more likely to exit the labor force if their partners' earnings are higher and if their own wage rate is lower. In this article, I use the National Longitudinal Survey of Youth (N = 2,254) and discrete-time event-history analysis to show that wives' relative wages are more predictive of their exit than are…
Kelly, Stacy M.
The present study analyzes four consecutive years of monthly labor force participation rates reported by the Current Population Survey that included nationally representative samples of the general U.S. population and nationally representative samples of the U.S. population with specifically identified disabilities. Visual impairment is one of the…
Besamusca, J.; Tijdens, K.; Keune, M.; Steinmetz, S.
In this article, we investigate the effects of economic conditions, families, education, and gender ideologies on the labor force participation rates of women in eleven age groups in 117 countries. We find that participation rates of young and older women are partly explained by sector sizes and the
Sbaizero, O., E-mail: firstname.lastname@example.org [Department of Engineering and Architecture, University of Trieste (Italy); University of Colorado Cardiovascular Institute, University of Colorado Denver, Aurora (United States); DelFavero, G. [Department of Engineering and Architecture, University of Trieste (Italy); Martinelli, V. [International Center for Genetic Engineering and Biotechnology, Trieste (Italy); Long, C.S.; Mestroni, L. [University of Colorado Cardiovascular Institute, University of Colorado Denver, Aurora (United States)
Atomic force microscopy (AFM) for single-cell force spectroscopy (SCFS) and Poisson statistic were used to analyze the detachment work recorded during the removal of gold-covered microspheres from cardiac fibroblasts. The effect of Cytochalasin D, a disruptor of the actin cytoskeleton, on cell adhesion was also tested. The adhesion work was assessed using a Poisson analysis also derived from single-cell force spectroscopy retracting curves. The use of Poisson analysis to get adhesion work from AFM curves is quite a novel method, and in this case, proved to be effective to study the short-range and long-range contributions to the adhesion work. This method avoids the difficult identification of minor peaks in the AFM retracting curves by creating what can be considered an average adhesion work. Even though the effect of actin depolymerisation is well documented, its use revealed that control cardiac fibroblasts (CT) exhibit a work of adhesion at least 5 times higher than that of the Cytochalasin treated cells. However, our results indicate that in both cells short-range and long-range contributions to the adhesion work are nearly equal and the same heterogeneity index describes both cells. Therefore, we infer that the different adhesion behaviors might be explained by the presence of fewer membrane adhesion molecules available at the AFM tip–cell interface under circumstances where the actin cytoskeleton has been disrupted. - Highlights: • AFM force–deformation curve was used to characterize the cardiac fibroblast adhesion behavior. • The amount and nature of adhesion were assessed using a Poisson analysis applied to the AFM curve. • The work of adhesion for control cells was about four times higher than that of the Cyt-D treated cells. • Short- and long-range contributions to adhesion are nearly equal for both control and treated cells.
Boerjan, M.; Bluyssen, S.J.; Bleichrodt, R.P.; Weel-Baumgarten, E.M. van; Goor, H. van
OBJECTIVES: The aim of this cross-sectional study was to investigate the influence of job-related autonomy and social support provided by consultants and colleagues on the stress-related health complaints of surgical residents in the Netherlands. METHODS: All (n = 400) Dutch residents in training in
Udo, Camilla; Danielson, Ella; Henoch, Ingela; Melin-Johansson, Christina
The aim of this study was to describe surgical nurses' perceived work-related stress in the care of severely ill and dying patients with cancer after participating in an educational intervention on existential issues. This article reports a mixed methods pilot study of an education programme consisting of lectures and supervised discussions conducted in 2009-2010 in three surgical wards in a county hospital in Sweden. The concurrent data collections consisted of repeated interviews with eleven nurses in an educational group, and questionnaires were distributed to 42 nurses on four occasions. Directly after the educational intervention, the nurses described working under high time pressure. They also described being hindered in caring because of discrepancies between their caring intentions and what was possible in the surgical care context. Six months later, the nurses described a change in decision making, and a shift in the caring to make it more in line with their own intentions and patients' needs rather than the organizational structure. They also reported decreased feelings of work-related stress, decreased stress associated with work-load and feeling less disappointed at work. Results indicate that it may be possible to influence nurses' work-related stress through an educational intervention. According to nurses' descriptions, reflecting on their ways of caring for severely ill and dying patients, many of whom had cancer, from an existential perspective, had contributed to enhanced independent decision making in caring. This in turn appears to have decreased their feelings of work-related stress and disappointment at work. Copyright © 2013 Elsevier Ltd. All rights reserved.
...) developed by Michael Miller and David Woehr (Miller & Woehr, 1997; Woehr & Miller, 1997). The MWEP is a multidimensional measure of work ethics based on previous research and literature focusing on work ethic and job performance...
.... There are many potential consequences of these shifts. These changes impact the very nucleus of work and family, and often result in conflict with the organization's culture as attempts are made to provide balance between work and family...
innovative work schedule may cause employee attitudinal changes that are beneficial to employers. For workers, the fundamental feature of flexible working hours is...ipan 0 H 0 1- 150 SELECTED BIBLIOGRAPHY 151 REFERENCES CITED 1. Allenspach, Heinz. Flexible Working Hours . Geneva Switzerland: International Labor...Herman Gadon,and John R. M. Gordon. " Flexible Working Hours : It’s About Time," Har- vard Business Review, January-February 1974, pp. 18-20, 22, 24
Jenna Griebel Rogers
Full Text Available Past work shows religion’s effect on women’s career decisions, particularly when these decisions involve work-family conflict. This study argues that the religious context of a geographic area also influences women’s solutions to work-family conflict through more or less pervasive normative expectations within the community regarding women’s roles and responsibilities to the family. We use the American Community Survey linked with community-level religious proportions to test the relationship between religious contexts and women’s participation in the labor force in the contiguous United States–2054 census geographic areas. Using spatial analysis, we find that community religious concentration is related to the proportion of women who choose not to work. Communities with a higher proportion of the population belonging to conservative religious traditions also have a greater proportion of married women choosing not to work outside the home.
Griffin, Brian; Kilfoil, Maria L.
In the microscopic world of the cell dominated by thermal noise, a cell must be able to successfully segregate its DNA with high fidelity in order to pass its genetic information on to its progeny. In this process of mitosis in eukaryotes, driving forces act on the cytoskeleton-based architecture called the mitotic spindle to promote this division. Our preliminary data demonstrates that the dynamics of this process in yeast cells is universal. Moreover, the dynamics suggest an increasing load as the chromosomes are pulled apart. To investigate this, we use three-dimensional imaging to track the dynamics of the poles of this architecture and the points of attachment to chromosomes simultaneously and with high spatial resolution. We analyze the relative motions of chromosomes as they are organized before segregation and as they are pulled apart, using this data to investigate the force-response behavior of this cytoskeleton-chromosome polymer system.
Jonáš, Alexandr; Zemánek, Pavel
Roč. 29, č. 24 (2008), s. 4813-4851 ISSN 0173-0835 R&D Projects: GA MŠk(CZ) LC06007; GA MŠk OC08034 Institutional research plan: CEZ:AV0Z20650511 Keywords : microfluidics * optical chromatography and sorting * optical force and torque * optical tweezers and micro-manipulation / Optical tweezers and micro-manipulation / Raman microspectroscopy * Raman microspectroscopy Subject RIV: BH - Optics, Masers, Lasers Impact factor: 3.509, year: 2008
Bureau of Labor Statistics (DOL), Washington, DC.
The following are some of the findings based on the results of the annual survey of marital and family characteristics of workers: (1) about 27.6 million of 62.7 million children had mothers in the labor force (over 2 million more than in March 1970); (2) 1.1 million of 6.5 million children under six were in families headed by women (71 percent…
Research scientists studying the health effects of ionizing radiation have expressed the view that their work is sometimes impeded by legal restrictions on access to necessary records. In light of the critical importance of scientifically sound, efficient, and timely epidemiological research to resolve the difficult issues raised by the President's memorandum, the Task Force determined to inquire into the extent of this problem, and to ascertain whether new legislation or regulation was needed to eliminate serious roadblocks
This publication provides an account of educational outcomes assessment activity undertaken by seven assessment teams under the Phase II Charter of the Dean of the Faculty's Educational Outcomes Assessment Working Group...
18:2). A recent survey by the Strategic Air Command (SAC) Mechanical Fquipment Management Evaluation Team ( MEMET ) determined that equipment was...identified by MEMET included Maintenance Action Sheets (MAS) that reported work which was not completed, and other MAS which annotated recurring work...readily apparent. Problem Military. The Deputy Chief of Staff for Engineering and Services, HQ SAC, established the MEMET in 1984 in response to a
Occupational Outlook Quarterly, 2012
The labor force is the number of people ages 16 or older who are either working or looking for work. It does not include active-duty military personnel or the institutionalized population, such as prison inmates. Determining the size of the labor force is a way of determining how big the economy can get. The size of the labor force depends on two…
Raderstorf, Mark; Kurtz, Jennifer
Occupational health nurses must intervene early and validate the conditions and experiences of employees with psychiatric disabilities. Occupational health nurses must ensure employees are receiving appropriate treatment. They must be aware of and prepared to mitigate iatrogenic influences. Occupational health nurses can facilitate resolution of workplace conflicts and issues regarding changing supervisors or departments. They can also facilitate return to work by establishing clear restrictions and coordinating accommodations. compassionate and supportive, yet assertive, approach is key to managing mental health disability. It will, in most cases, facilitate successful return to full-time work.
Gyllensten, Kristina; Andersson, Gunnar; Muller, Helena
Background There is a shortage of registered nurses in the European Union (EU), and job dissatisfaction and perceived high work?family conflict have been identified as causes of nursing staff turnover. Reducing work hours is an organisational intervention that could have a positive effect on nurses? and assistant nurses? job satisfaction, work?life balance, and willingness to stay in the job. An orthopaedic surgery department at a large hospital in Sweden introduced reduced work hours for nur...
Fullerton, Howard N., Jr.; Byrne, James J.
Noting that data from 1970 working life tables indicate that since 1960 worklife expectancy has continued to edge downward for men and to lengthen for women, this report briefly discusses continuing trends in the worklife of men and women from 1900 through 1970. Women's worklife is presented in terms of single women; mothers; widowed, divorced,…
Gyllensten, Kristina; Andersson, Gunnar; Muller, Helena
There is a shortage of registered nurses in the European Union (EU), and job dissatisfaction and perceived high work-family conflict have been identified as causes of nursing staff turnover. Reducing work hours is an organisational intervention that could have a positive effect on nurses' and assistant nurses' job satisfaction, work-life balance, and willingness to stay in the job. An orthopaedic surgery department at a large hospital in Sweden introduced reduced work hours for nurses and assistant nurses in order to improve the working situation. The aim of the study was to investigate the experiences of reduced work hours and no lunch breaks among nurses and assistant nurses at an orthopaedic surgery department at a hospital in Sweden, with a particular focus on recovery and psychosocial working environment. A qualitative design was used in the study. Eleven nurses and assistant nurses working at the particular orthopaedic department took part in the study, and semi-structured interviews were used to collect data. The interviews were analysed by interpretative phenomenological analysis. Four main themes were developed in the analysis of the data: A more sustainable working situation, Improved work-life balance, Consequences of being part of a project, and Improved quality of care. Each theme consisted of subthemes. Overall, reduced work hours appeared to have many, mainly positive, effects for the participants in both work and home life.
Asgeirsdottir, Tinna Laufey
Most studies of the relationship between body weight - as well as its corollary, beauty - and labor-market outcomes have indicated that it is a function of a gender bias, the negative relationship between excess weight or obesity and labor-market outcomes being greater for women than for men. Iceland offers an exceptional opportunity to examine this hypothesis, given that it scores relatively well on an index of gender equality comprising economic, political, educational, labor-market, and health-based criteria. Equipped with an advanced level of educational attainment, on average, women are well represented in Iceland's labor force. When it comes to women's presence in the political sphere, Iceland is out of the ordinary as well; that Icelanders were the first in the world to elect a woman to be president may suggest a relatively gender-blind assessment in the labor market. In the current study, survey data collected by Gallup Iceland in 2002 are used to examine the relationship between weight and employment within this political and social setting. Point estimates indicate that, despite apparently lesser gender discrimination in Iceland than elsewhere, the bias against excess weight and obesity remains gender-based, showing a slightly negative relationship between weight and the employment rate of women, whereas a slightly positive relationship was found for men. Copyright © 2010 Elsevier B.V. All rights reserved.
Full Text Available Urine analysis, serumbiochemical profile and a cortical wedge biopsy for histopathological examination was performed on 42 South African National Defence Force (SANDF dogs from around the country. The only significant finding on urine analysis and serum biochemistry was a relatively large number (16/42 of dogs with elevated serum inorganic phosphate levels. Histopathology revealed that only 9 of the animals had normal kidneys reflected in the wedge biopsy material, with over 50%of them showing signs of glomerular pathology (primarily mesangioproliferative glomerulonephritis. Other conditions detected histopathologically were haemosiderosis (47 % of animals, focal nephrosis (2.4 %, membranoproliferative glomerulonephritis (2.4 %, focal interstitial nephritis (4.7 % and acute tubular nephrosis (4.7 %. The lesions observed were of limited distribution and extent; this histopathological finding may account for the absence of significant abnormalities on urine analysis or serum biochemistry profiles. It appears from these results that a large percentage of the SANDF population would be expected to have mild renal lesions, but that these lesions are not severe enough to lead to clinical signs. The findings of this study are similar to those of randomly selected populations of non-military dogs performed in other areas of the world, which also demonstrated an unexpectedly high incidence of histopathological renal pathology in dogs considered healthy. These lesions may well, however, play a role in later life, and it is recommended that military veterinarians maintain an index of suspicion for renal disease, particularly glomerular disease. The aetiology of the histopathological lesions is unknown.
This paper analyses trends in women?s labour market situations between 1992 and 2005 using data from the European Labour Force Surveys (EU-LFS). These situations are modelled to capture the effects of the presence of a child or children, the age of the youngest child, the mother?s age at first birth and the presence of a spouse on women?s employment and working hours, and to see how they change over time. The trends observed in some countries challenge the geographical breakdown proposed by t...
Kosachev, I D; Gladkikh, P F; Iakovlev, A E
The article is devoted to activities in the period 1941-1945. Krasnoyarsk and Tambov, a professor of surgery Valentine Feliksovich Voyno-Yasenetsky (Archbishop Luka)--doctor of medical sciences, laureate of the State (Stalin) Prize of the USSR, who made a significant contribution to the success of modern surgical science. A brilliant scholar and successor of the ideas of the outstanding scientist and surgeon Nikolai Pirogov, as in the Great Patriotic War surgeon and consultant evacuation hospitals, along with leading surgeons in the Soviet Union had a significant impact on the results of treatment of wounded soldiers and officers, thereby affecting the development of military field surgery. In our country it is rightfully considered the founder of contaminated surgery.
Kawase, Kazumi; Nomura, Kyoko; Tominaga, Ryuji; Iwase, Hirotaka; Ogawa, Tomoko; Shibasaki, Ikuko; Shimada, Mitsuo; Taguchi, Tomoaki; Takeshita, Emiko; Tomizawa, Yasuko; Nomura, Sachiyo; Hanazaki, Kazuhiro; Hanashi, Tomoko; Yamashita, Hiroko; Kokudo, Norihiro; Maeda, Kotaro
To assess the working styles of men and women working as surgeons in Japan. In July, 2014, the Japan Surgical Society invited all their members (n = 29,861), through an internet campaign, to participate in a nationwide survey of surgeons. The items investigated in this descriptive study included demographic information and working styles, based on a questionnaire. In total, 6211 surgeons participated (response rate 20.8%, 5586 men and 625 women). The largest age stratum was 40-49 years for men and 30-39 years for women. Overall, respondents identified their labor contract, including salary and work hours, as the highest priority for improvement. Women with children were more likely to be part-time employees, work fewer hours, and take fewer house calls/on-calls than their male counterparts. Moreover, women of all ages earned a lower annual income than men, irrespective of whether they had children. Perception scores for discrimination related to work and promotion were significantly higher among women than men (p working style was observed between men and women working as surgeons in Japan.
Full Text Available Unlike previous studies on robotization approaching the future based on the cutting-edge technologies and adopting a framework where robotization is considered as an exogenous variable, this study considers that robotization occurs endogenously and uses it as a dependent variable for an objective examination of the effect of robotization on the labor market. To this end, a robotization indicator is created based on the actual number of industrial robots currently deployed in workplaces, and a multiple regression analysis is performed using the robotization indicator and labor variables such as employment, working hours, and wage. The results using the multiple regression considering the triangular relationship of employment–working-hours–wages show that job destruction due to robotization is not too remarkable yet that use. Our results show the complementary relation between employment and robotization, but the substituting relation between working hour and robotization. The results also demonstrate the effects of union, the size of the company and the proportion of production workers and simple labor workers etc. These findings indicate that the degree of robotization may vary with many factors of the labor market. Limitations of this study and implications for future research are also discussed.
The surgical light is an important tool for surgeons to create and maintain good visibility on the surgical task. Chapter 1 gives background to the field of (surgical) lighting and related terminology. Although the surgical light has been developed strongly since its introduction a long time ago,
Cecilia Irina-Răbonţu; Amelia Georgiana Boncea
Even though in Romania there are a few social categories with incomes comparable to those of the Occidentals: enterprisers, notaries, the wage earners working in banks and communications, peasants that sold their lands for millions of Euros, but also enough budgetary people and, as well, all kinds of dodgers, corrupt civil servants or combinatory people. All of them have monthly incomes of at least 2.000 Euros, their wage being the only thing they have in common. However their number is not n...
The spread of teleworkers who commute via telecommunications from their home offices will depend, despite the energy-saving and tax advantages of self-employment, on how fast the social climate accepts teleworking, whether software can be made friendlier, and whether legal issues of database networks are resolved. The societal changes associated with home offices can be either a positive reemphasis on the home or a negative electronic sweatshop and a way to export office work to low-wage areas. The author, who sees a gradual adoption of teleworking while these technological, societal, and marketing barriers are dealt with, develops a scenario for an information society of the future. (DCK)
Lo, Siu-Fai; Spurgeon, Peter
The Accreditation Council for Graduate Medical Education and European working time directive have restricted residents' workweek to 80 and 48 hours, respectively. Impacts on resident's training and health services are under evaluation in western countries. However, relevant studies are deficient in Hong Kong. Surgeons in a regional hospital of Hong Kong were recruited. Opinions were collected by semi-structured questionnaire. Response rate was 82%. Most respondents agreed that residents' work hours should be limited. Seventy-two percent thought that the addition of physician assistants, nurse practitioners and ancillary staff could help decrease the workload of residents. More than 60% thought that residents should have post-call afternoon off. Seventy-two percent worried that the number of operations residents performed would decrease. Only half agreed that long work hours was part of resident training and 56.3% agreed that the training period should be lengthened because of limiting work hours. Ninety-four percent agreed that sleep-deprived residents would create more medical errors; 72% thought that long work hours would impair quality of care. Surprisingly, only 28% thought that limiting work hours would compromise continued patient care. Most respondents opine that resident work hours should be regulated and welcome minor rescheduling of residents' workflow. The impacts on residents' training and patient care require further evaluation.
Conclusion: Most respondents opine that resident work hours should be regulated and welcome minor rescheduling of residents' workflow. The impacts on residents' training and patient care require further evaluation.
Decker, P J; Strader, M K
Most health care managers wonder how to change employee "attitudes" so that their staff will be more accountable for patient satisfaction, cost reduction, and quality of care. Employees were trained to function in an industry where the power players were the physician and the administrator and now it is exceedingly difficult to get them to switch their attention to the patient and the payer in a market-driven economy. For hospital managers, the answer may be right at their fingertips: The Joint Commission on Accreditation of Healthcare Organizations' standards demanding that employee competence be objectively measured, proven, tracked & trended, improved, and age specific. A comprehensive competence assessment system can save the health care manager enormous work in measuring fewer things, focusing performance assessment on the 20 percent of things that are true problems, and helping to specifically define certain competencies such as customer focus and cost consciousness so that coaching, training, and giving performance feedback is easier. Developing a comprehensive competence assessment system is a powerful tool to change the culture of organizations. Consequently, it is important that managers be aware of those possibilities before they embark on developing "competencies" or before their organizations get too carried away on redesigning systems to satisfy standards.
Luksamijarulkul, Pipat; Aiempradit, Natkitta; Vatanasomboon, Pisit
To assess the relationship of bacterial and fungal contamination on used surgical masks worn by the hospital personnel and microbial air quality in their working wards. This is a cross-sectional study of 230 used surgical masks collected from 214 hospital personnel, and 215 indoor air samples collected from their working wards to culture for bacterial and fungal counts. This study was carried out at the hospital in Bangkok. Group or genus of isolated bacteria and fungi were preliminarily identified by Gram's stain and lacto-phenol cotton blue. Data were analyzed using paired t-test and Pearson's correlation coefficient at the significant level of pcontamination on inside area of the used masks were 47 ± 56 and 15 ± 9 cfu/ml/piece, and on outside area were 166 ± 199 and 34 ± 18 cfu/ml/piece, respectively, pcontamination on used masks from hospital personnel working in the male and female medical wards and out-patient department, as well as the bacterial and fungal counts of the indoor air sample collected from the same area were relatively higher than the other wards. The predominant isolated bacteria and fungi contaminated on inside and outside areas of the used masks and air samples were similar (Staphylococcus spp. and Aspergillus spp.; respectively). For its relationship, results found that bacterial and fungal counts in air samples showed significantly positive correlation with the bacterial contamination load on outside area of the used masks, r=0.16, p=0.018 and r=0.21, p=0.003, respectively. High bacterial contamination on outside area of the used masks was demonstrated, and it showed a significant correlation with microbial air quality of working wards.
Full Text Available Objective: To assess the relationship of bacterial and fungal contamination on used surgical masks worn by the hospital personnel and microbial air quality in their working wards. Methods: This is a cross-sectional study of 230 used surgical masks collected from 214 hospital personnel, and 215 indoor air samples collected from their working wards to culture for bacterial and fungal counts. This study was carried out at the hospital in Bangkok. Group or genus of isolated bacteria and fungi were preliminarily identified by Gram’s stain and lacto-phenol cotton blue. Data were analyzed using paired t-test and Pearson’s correlation coefficient at the significant level of p<0.050. Results: Means and standard deviation of bacterial and fungal contamination on inside area of the used masks were 47 ± 56 and 15 ± 9 cfu/ml/piece, and on outside area were 166 ± 199 and 34 ± 18 cfu/ml/piece, respectively, p<0.001. The bacterial and fungal contamination on used masks from hospital personnel working in the male and female medical wards and out-patient department, as well as the bacterial and fungal counts of the indoor air sample collected from the same area were relatively higher than the other wards. The predominant isolated bacteria and fungi contaminated on inside and outside areas of the used masks and air samples were similar (Staphylococcus spp. and Aspergillus spp.; respectively. For its relationship, results found that bacterial and fungal counts in air samples showed significantly positive correlation with the bacterial contamination load on outside area of the used masks, r=0.16, p=0.018 and r=0.21, p=0.003, respectively. Conclusion: High bacterial contamination on outside area of the used masks was demonstrated, and it showed a significant correlation with microbial air quality of working wards.
Department of Labor, Washington, DC.
A four-page synposis of data on women of Hispanic origin in the labor force is presented. Data included are numbers of Hispanic women in the labor force; percentage of Hispanics among women in labor force; percentage of Hispanic women in the labor force; median ages; unemployment rate; education level; income levels; types of jobs occupied…
Using 2004 data of the Philippines' labour force survey, evaluates the hours of work at all jobs, hourly pay among time-rated wage and salary workers, informal employment etc., with the aim to quantify a decent-work situation (i.e. acceptable productive employment, social protection, social dialogue, and rights at work).
Women's Bureau (DOL), Washington, DC.
Data on Hispanic women in the labor force between 1978 and 1988 show the following: (1) 6.5 percent of the women in the work force in 1988 were of Hispanic origin (3.6 million); (2) the median age of Hispanic women was 26.1 years, 2-5 years younger than Black or White women; (3) 66 percent of Hispanic women participate in the labor force, a higher…
Atesok, Kivanc; Mabrey, Jay D; Jazrawi, Laith M; Egol, Kenneth A
Mastering rapidly evolving orthopaedic surgical techniques requires a lengthy period of training. Current work-hour restrictions and cost pressures force trainees to face the challenge of acquiring more complex surgical skills in a shorter amount of time. As a result, alternative methods to improve the surgical skills of orthopaedic trainees outside the operating room have been developed. These methods include hands-on training in a laboratory setting using synthetic bones or cadaver models as well as software tools and computerized simulators that enable trainees to plan and simulate orthopaedic operations in a three-dimensional virtual environment. Laboratory-based training offers potential benefits in the development of basic surgical skills, such as using surgical tools and implants appropriately, achieving competency in procedures that have a steep learning curve, and assessing already acquired skills while minimizing concerns for patient safety, operating room time, and financial constraints. Current evidence supporting the educational advantages of surgical simulation in orthopaedic skills training is limited. Despite this, positive effects on the overall education of orthopaedic residents, and on maintaining the proficiency of practicing orthopaedic surgeons, are anticipated.
Figueroa, Solimar; Bulos, Marlene; Forges, Edwina; Judkins-Cohn, Tanya
The nursing shortage requires new graduate registered nurses (RNs) to work at the bedside, often leading to a shortened orientation period and increased stress. In the Married State Preceptorship Model (MSPM), the preceptor and the preceptee work together as the new graduate RN transitions to the bedside while maintaining safety and quality. This study explored first-year turnover rates of new graduate RNs and new graduate RNs' and preceptors' perceptions of the MSPM in transitioning new graduate RNs to practice. Focus groups and surveys were used with 108 new graduate RNs and 100 preceptors. Four themes emerged for new graduate RNs: partnership, critical thinking, learning, and transition. A statistically significant decrease in turnover rates was seen with MSPM versus traditional precepting. Survey data found that new graduate RNs and preceptors perceived the MSPM as promoting safety and reducing anxiety. The MSPM allows organizations to retain a quality nursing work force focused on safety patient care by transitioning new graduate RNs into the practice setting. Copyright 2013, SLACK Incorporated.
Fan, Joe King-Man; Chan, Fion Siu-Yin; Chu, Kent-Man
Surgical smoke is the gaseous by-product formed during surgical procedures. Most surgeons, operating theatre staff and administrators are unaware of its potential health risks. Surgical smoke is produced by various surgical instruments including those used in electrocautery, lasers, ultrasonic scalpels, high speed drills, burrs and saws. The potential risks include carbon monoxide toxicity to the patient undergoing a laparoscopic operation, pulmonary fibrosis induced by non-viable particles, and transmission of infectious diseases like human papilloma virus. Cytotoxicity and mutagenicity are other concerns. Minimisation of the production of surgical smoke and modification of any evacuation systems are possible solutions. In general, a surgical mask can provide more than 90% protection to exposure to surgical smoke; however, in most circumstances it cannot provide air-tight protection to the user. An at least N95 grade or equivalent respirator offers the best protection against surgical smoke, but whether such protection is necessary is currently unknown.
Lo, Siu-Fai; Spurgeon, Peter
The Accreditation Council for Graduate Medical Education and European working time directive have restricted residents' workweek to 80 and 48 hours, respectively. Impacts on resident's training and health services are under evaluation in western countries. However, relevant studies are deficient in Hong Kong. Methods: Surgeons in a regional hospital of Hong Kong were recruited. Opinions were collected by semi-structured questionnaire. Results: Response rate was 82%. Most respondents agr...
Lavender, Steven A; Sommerich, Carolyn M; Patterson, Emily S; Sanders, Elizabeth B-N; Evans, Kevin D; Park, Sanghyun; Umar, Radin Zaid Radin; Li, Jing
The aim of this study was to learn from a wide range of hospital staff members about how the design of the patient room in which they work adversely affects their ergonomics or hinders their job performance. In addition to providing a healing space for patients, hospital patient rooms need to serve as functional workplaces for the people who provide clinical care, to clean, or to maintain room functions. Therefore, from a design perspective, it is important to understand the needs of all the users of hospital patient rooms with regard to room design. One hundred forty-seven people, representing 23 different occupational stakeholder groups, participated in either focus groups or interviews in which they were asked to identify room design issues that affect the performance of their work tasks. Key issues shared across multiple stakeholder groups included an inability to have eye contact with the patient when entering the room, inadequate space around the bed for the equipment used by stakeholders, the physical demands experienced as stakeholders move furnishings to accomplish their activities or access equipment, and a lack of available horizontal surfaces. Unique issues were also identified for a number of stakeholder groups. There are a number of issues that should be addressed in the next generation of hospital patient rooms, or when refurbishing existing facilities, so that all occupational stakeholder groups can work effectively, efficiently, and without undue physical stress. © The Author(s) 2015.
Hamadani, Fadi T; Deckelbaum, Dan; Sauve, Alexandre; Khwaja, Kosar; Razek, Tarek; Fata, Paola
The implementation of work hour restrictions across North America have resulted in decreased levels of self injury and medical errors for Residents. An arbitration ruling in Quebec has led to further curtailment of work hours beyond that proposed by the ACGME. This may threaten Resident quality of life and in turn decrease the educational quality of surgical residency training. We administered a quality of life questionnaire with an integrated education quality assessment tool to all General Surgery residents training at McGill 6 months after the work hour restrictions. Across several strata respondents reveal a decreased sense of educational quality and quality of life. The arbitration argued that work- hour restrictions would be necessary to improve quality of life for trainees and hence improve patient safety. Results from this study demonstrate the exact opposite in a large majority of respondents, who report a poorer quality of life and a self-reported inability on their part to provide continuous and safe patient care. Copyright © 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Johnson, Paul J; Schmidt, David E; Duvvuri, Umamaheswar
The number of robot-assisted surgeries performed with the da Vinci surgical system has increased significantly over the past decade. The articulating movements of the robotic surgical grasper are controlled by grip controls at the master console. The user interface has been implicated as one contributing factor in surgical grasping errors. The goal of our study was to characterize and evaluate the user interface of the da Vinci surgical system in controlling surgical graspers. An angular manipulator with force sensors was used to increment the grip control angle as grasper output angles were measured. Input force at the grip control was simultaneously measured throughout the range of motion. Pressure film was used to assess the maximum grasping force achievable with the endoscopic grasping tool. The da Vinci robot's grip control angular input has a nonproportional relationship with the grasper instrument output. The grip control mechanism presents an intrinsic resistant force to the surgeon's fingertips and provides no haptic feedback. The da Vinci Maryland graspers are capable of applying up to 5.1 MPa of local pressure. The angular and force input at the grip control of the da Vinci robot's surgical graspers is nonproportional to the grasper instrument's output. Understanding the true relationship of the grip control input to grasper instrument output may help surgeons understand how to better control the surgical graspers and promote fewer grasping errors. Copyright © 2014 Elsevier Inc. All rights reserved.
Occupational Outlook Quarterly, 2010
The labor force is the number of people aged 16 or older who are either working or looking for work. It does not include active-duty military personnel or institutionalized people, such as prison inmates. Quantifying this total supply of labor is a way of determining how big the economy can get. Labor force participation rates vary significantly…
Full Text Available The presented work is an alternative to established measurement systems in surgical navigation. The system is based on camera based tracking of QR code markers. The application uses a single video camera, integrated in a surgical lamp, that captures the QR markers attached to surgical instruments and to the patient.
and character essential for leadership, and the motivation to serve as Air Force career officers. Each cadet graduates with a Bachelor of Science ...and specific national security requirement. RDT&E Major Programs ($ in millions) FY 15 Expenditure Science and Technology $2,282 Long Range Strike...1,243,894 (Less: Earned Revenue) Net Cost before Losses/(Gains) from Actuarial Assumption Changes for Military Retirement Benefits Net Program Costs
The different forces, together with a pictorial analogy of how the exchange of particles works. The table lists the relative strength of the couplings, the quanta associated with the force fields and the bodies or phenomena in which they have a dominant role.
Strohl, Alexis M; Vitkus, Lauren
The article reviews some commonly used orthodontic treatments as well as new strategies to assist in the correction of malocclusion. Many techniques are used in conjunction with surgical intervention and are a necessary compliment to orthognathic surgery. Basic knowledge of these practices will aid in the surgeon's ability to adequately treat the patient. Many orthodontists and surgeons are eliminating presurgical orthodontics to adopt a strategy of 'surgery first' orthodontics in orthognathic surgery. This has the benefit of immediate improvement in facial aesthetics and shorter treatment times. The advent of virtual surgical planning has helped facilitate the development of this new paradigm by making surgical planning faster and easier. Furthermore, using intraoperative surgical navigation is improving overall precision and outcomes. A variety of surgical and nonsurgical treatments may be employed in the treatment of malocclusion. It is important to be familiar with all options available and tailor the patient's treatment plan accordingly. Surgery-first orthodontics, intraoperative surgical navigation, virtual surgical planning, and 3D printing are evolving new techniques that are producing shorter treatment times and subsequently improving patient satisfaction without sacrificing long-term stability.
Our original audit objective was to determine whether the Air Force Consolidated Defense Business Operations Fund financial statements, prepared by the DFAS Denver Center for FY 1993, were presented...
Smith, Thomas J.; Trist, Carolyn
The need for partnerships among deliverers of training in the public and private sectors has reached a critical point if U.S. businesses are to remain competitive. The work force and workplace are being transformed by demographic trends, economic and employment trends, a growing skills mismatch, and concerns over educational effectiveness. Two…
This thesis at the University of Maastricht, defended at May 7, 2004, yields several important and new findings with regard to work related quality of life, participation in the labour force and its determinants of patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS) and juvenile
Galatsch, Michael; Li, Jian; Derycke, Hanne; Müller, Bernd Hans; Hasselhorn, Hans Martin
Previous cross-sectional findings from the European Nurses Early Exit Study (NEXT) show that nurses who were dissatisfied with their work schedule tended to consider leaving the nursing profession. Mediating factors in this decision process may be caused by self-perceived poor work ability and/or health. The aim of this paper is to investigate changes in work ability and general health among nurses in relation to requested, forced and denied change of shift schedule. Longitudinal data from the NEXT Study was used. In total 11,102 nurses from Belgium, Germany, Finland, the Netherlands, Poland, Slovakia, France and Italy completed both the 'basic questionnaire' (t1) and the '12 month follow-up questionnaire' (t2). To examine the time-effect (repeated measures) and the group-effect of five defined groups of nurses on the Work Ability Index (WAI) and general health (SF36), an adjusted 2-way analysis of covariance (ANCOVA) was performed. The nurses who wanted to, but could not change their shifts during the 12 month follow-up had the lowest initial and follow-up scores for WAI (t1: 37.6, t2: 36.6, p work ability and to a lesser comparatively low extent with increased decline in health scores. A forced change of shift against the nurses' will was significantly associated with a deteriorating work ability and health. The findings would suggest that nurses' desire to change their shift patterns may be an indicator for perceived low work ability and/or low health. The results also indicate that fulfilling nurses' wishes with respect to their shift work pattern may improve their personal resources such as work ability and - to somewhat lesser extent - health. Disregarding nurses' preferences, however, bears the risk for further resource deterioration. The findings imply that shift schedule organization may constitute a valuable preventive tool to promote nurses' work ability and - to lesser extent - their perceived health, not least in aging nursing work forces.
Report of the Task Force for Improved Coordination of the DoD Science and Technology Program. Volume 2. Reports of the Working Groups. Working Group A: Strategic Planning. Working Group B: Program Coordination. Working Group C: Advocacy
OperabllY 19 Technolofy Area Summaries 20 Major Technology Thrws 21 Air Force S&T Investment Summary 25 Program Objectives 28 Glcazy 30 1. D-6 TH~E...8217lRI-TAC Advrane Plannzn Sy-i Mulima Radio AWAM3 IRP JSTARS fris MmAvne Anhn ABOCC 37=6 Comb !dftica~ S~ Surance Radar Ewm EAVZ SYNC Media . R~u... Social Sciences 5001 Eisenhower Avenue Alexandria VA 22333-5600 Col. Harry G. Dangerfield Telephone: (301) 663-7443 Executive Assistant to the PEO for
Chmarra, M K; Grimbergen, C A; Dankelman, J
Minimally invasive surgery (e.g. laparoscopy) requires special surgical skills, which should be objectively assessed. Several studies have shown that motion analysis is a valuable assessment tool of basic surgical skills in laparoscopy. However, to use motion analysis as the assessment tool, it is necessary to track and record the motions of laparoscopic instruments. This article describes the state of the art in research on tracking systems for laparoscopy. It gives an overview on existing systems, on how these systems work, their advantages, and their shortcomings. Although various approaches have been used, none of the tracking systems to date comes out as clearly superior. A great number of systems can be used in training environment only, most systems do not allow the use of real laparoscopic instruments, and only a small number of systems provide force feedback.
Pitman, Richard; Fisman, David; Zaric, Gregory S.; Postma, Maarten; Kretzschmar, Mirjam; Edmunds, John; Brisson, Marc
The transmissible nature of communicable diseases is what sets them apart from other diseases modeled by health economists. The probability of a susceptible individual becoming infected at any one point in time (the force of infection) is related to the number of infectious individuals in the
Risk-adjusted morbidity in teaching hospitals correlates with reported levels of communication and collaboration on surgical teams but not with scale measures of teamwork climate, safety climate, or working conditions.
Davenport, Daniel L; Henderson, William G; Mosca, Cecilia L; Khuri, Shukri F; Mentzer, Robert M
Since the Institute of Medicine patient safety reports, a number of survey-based measures of organizational climate safety factors (OCSFs) have been developed. The goal of this study was to measure the impact of OCSFs on risk-adjusted surgical morbidity and mortality. Surveys were administered to staff on general/vascular surgery services during a year. Surveys included multiitem scales measuring OCSFs. Additionally, perceived levels of communication and collaboration with coworkers were assessed. The National Surgical Quality Improvement Program was used to assess risk-adjusted morbidity and mortality. Correlations between outcomes and OCSFs were calculated and between outcomes and communication/collaboration with attending and resident doctors, nurses, and other providers. Fifty-two sites participated in the survey: 44 Veterans Affairs and 8 academic medical centers. A total of 6,083 surveys were returned, for a response rate of 52%. The OCSF measures of teamwork climate, safety climate, working conditions, recognition of stress effects, job satisfaction, and burnout demonstrated internal validity but did not correlate with risk-adjusted outcomes. Reported levels of communication/collaboration with attending and resident doctors correlated with risk-adjusted morbidity. Survey-based teamwork, safety climate, and working conditions scales are not confirmed to measure organizational factors that influence risk-adjusted surgical outcomes. Reported communication/collaboration with attending and resident doctors on surgical services influenced patient morbidity. This suggests the importance of doctors' coordination and decision-making roles on surgical teams in providing high-quality and safe care. We propose risk-adjusted morbidity as an effective measure of surgical patient safety.
Paulsen, Anne Henriette; Lundar, Tryggve; Lindegaard, Karl-Fredrik
Treatment for hydrocephalus has not advanced appreciably since the advent of CSF shunts more than 50 years ago. The outcome for pediatric patients with hydrocephalus has been the object for several studies; however, much uncertainty remains regarding the very long term outcome for these patients. Shunting became the standard treatment for hydrocephalus in Norway during the 1960s, and the first cohorts from this era have now reached middle age. Therefore, the objective of this study was to review surgical outcome, mortality, social outcome, and health-related quality of life in middle-aged patients treated for hydrocephalus during childhood. Data were collected in all patients, age 14 years or less, who required a CSF shunt during the years 1967-1970. Descriptive statistics were assessed regarding patient characteristics, surgical features, social functioning, and work participation. The time and cause of death, if applicable, were also determined. Kaplan-Meier survival estimates were used to determine the overall survival of patients. Information regarding self-perceived health and functional status was assessed using the 36-Item Short Form Health Survey (SF-36) and the Barthel Index score. A total of 128 patients were included in the study, with no patient lost to follow-up. Of the 128 patients in the study, 61 (47.6%) patients died during the 42-45 years of observation. The patients who died belonged to the tumor group (22 patients) and the myelomeningocele group (13 patients). The mortality rate was lowered to 39% if the patients with tumors were excluded. The overall mortality rates at 1, 2, 10, 20, and 40 years from time of initial shunt insertion were 16%, 24%, 31%, 40%, and 48% respectively. The incidence of shunt-related mortality was 8%. The majority of children graduated from a normal school (67%) or from a school specializing in education for physically handicapped children (20%). Self-perceived health was significantly poorer in 6 out of 8 domains
Patil, Nivritti G; Cheng, Stephen W K; Wong, John
Recent high-profile cases have heightened the need for a formal structure to monitor achievement and maintenance of surgical competence. Logbooks, morbidity and mortality meetings, videos and direct observation of operations using a checklist, motion analysis devices, and virtual reality simulators are effective tools for teaching and evaluating surgical skills. As the operating theater is also a place for training, there must be protocols and guidelines, including mandatory standards for supervision, to ensure that patient care is not compromised. Patients appreciate frank communication and honesty from surgeons regarding their expertise and level of competence. To ensure that surgical competence is maintained and keeps pace with technologic advances, professional registration bodies have been promoting programs for recertification. They evaluate performance in practice, professional standing, and commitment to ongoing education.
Azarmehr, Iman; Stokbro, Kasper; Bell, R. Bryan
Purpose: This systematic review investigates the most common indications, treatments, and outcomes of surgical navigation (SN) published from 2010 to 2015. The evolution of SN and its application in oral and maxillofacial surgery have rapidly developed over recent years, and therapeutic indicatio...
Dankelman, J.; Horeman, T.
The present invention relates to a surgical instrument for minimall-invasive surgery, comprising a handle, a shaft and an actuating part, characterised by a gastight cover surrounding the shaft, wherein the cover is provided with a coupler that has a feed- through opening with a loskable seal,
The advancements in fields like robotics and medicine continuously require improvements of sensor devices and more engagement of cooperative sensing technologies. For example, instruments such as tweezers with sensitive force sensory heads could provide the ability to sense a variety of physical quantities in real time, such as the amount and direction of the force applied or the texture of the gripped object. Force sensors with such abilities could be great solutions toward the development of smart surgical tools. In this work, a unique force sensor that can be integrated at the tips of robotic arms or surgical tools is reported. The force sensor consists of a single bioinspired, permanent magnetic and highly elastic nanocomposite cilia integrated on a magnetic field sensing element. The nanocomposite is prepared from permanent magnetic nanowires incorporated into the highly elastic polydimethylsiloxane. We demonstrate the potential of this concept by performing several experiments to show the performance of the force sensor. The developed sensor element has a 200 μm in diameter single cilium with 1:5 aspect ratio and shows a detection range up to 1 mN with a sensitivity of 1.6 Ω/mN and a resolution of 31 μN. The simple fabrication process of the sensor allows easy optimization of the sensor performance to meet the needs of different applications.
Alfadhel, Ahmed; Khan, Mohammed Asadullah; Cardoso, Susana; Kosel, Jü rgen
The advancements in fields like robotics and medicine continuously require improvements of sensor devices and more engagement of cooperative sensing technologies. For example, instruments such as tweezers with sensitive force sensory heads could provide the ability to sense a variety of physical quantities in real time, such as the amount and direction of the force applied or the texture of the gripped object. Force sensors with such abilities could be great solutions toward the development of smart surgical tools. In this work, a unique force sensor that can be integrated at the tips of robotic arms or surgical tools is reported. The force sensor consists of a single bioinspired, permanent magnetic and highly elastic nanocomposite cilia integrated on a magnetic field sensing element. The nanocomposite is prepared from permanent magnetic nanowires incorporated into the highly elastic polydimethylsiloxane. We demonstrate the potential of this concept by performing several experiments to show the performance of the force sensor. The developed sensor element has a 200 μm in diameter single cilium with 1:5 aspect ratio and shows a detection range up to 1 mN with a sensitivity of 1.6 Ω/mN and a resolution of 31 μN. The simple fabrication process of the sensor allows easy optimization of the sensor performance to meet the needs of different applications.
Van Aerden, K.; Moors, G.B.D.; Levecque, K.; Vanroelen, C.
In this article, data from the 2005 European Working Conditions Survey are used to examine the relationship between contemporary employment arrangements and the work-related well-being of European employees. By means of a Latent Class Cluster Analysis, several features of the employment conditions
Arata, Jumpei; Kozuka, Hiroaki; Kim, Hyung Wook; Takesue, Naoyuki; Vladimirov, B; Sakaguchi, Masamichi; Tokuda, Junichi; Hata, Nobuhiko; Chinzei, Kiyoyuki; Fujimoto, Hideo
techniques for this purpose were introduced. Virtual fixture is well known technique as a "force guide" for supporting operators to perform precise manipulation by using a master-slave robot. The virtual fixture for precise and safety surgery was implemented on the system to demonstrate an idea of high-level collaboration between a surgical robot and a navigation system. The extension of virtual fixture is not a part of the Open Core Control system, however, the function such as virtual fixture cannot be realized without a tight collaboration between cutting-edge medical devices. By using the virtual fixture, operators can pre-define an accessible area on the navigation system, and the area information can be transferred to the robot. In this manner, the surgical console generates the reflection force when the operator tries to get out from the pre-defined accessible area during surgery. The Open Core Control software was implemented on a surgical master-slave robot and stable operation was observed in a motion test. The tip of the surgical robot was displayed on a navigation system by connecting the surgical robot with a 3D position sensor through the OpenIGTLink. The accessible area was pre-defined before the operation, and the virtual fixture was displayed as a "force guide" on the surgical console. In addition, the system showed stable performance in a duration test with network disturbance. In this paper, a design of the Open Core Control software for surgical robots and the implementation of virtual fixture were described. The Open Core Control software was implemented on a surgical robot system and showed stable performance in high-level collaboration works. The Open Core Control software is developed to be a widely used platform of surgical robots. Safety issues are essential for control software of these complex medical devices. It is important to follow the global specifications such as a FDA requirement "General Principles of Software Validation" or IEC62304. For
Full Text Available The normative documents, statistic data concerning the people, who are forcedly resettled, are analysed in the article. The aim of the article is to describe the organizational stages of social workers; to determine the features of each stage, to consider the most effective methods and forms of each of the identified stages. Separate facts of creating towns for settlers are studied; information, given in scientific sociological and psychological works, is generalized. The stages of social activity of educators with children of compelled settlers (preparatory, organizational-active and analytical-corrective are determined on the basis of the carried out analysis. The essence of the activity, the methods and forms, the efficiency in realization of work with children, who are forcedly resettled, will be higher upon condition of drawing parents into corresponding forms and kinds of social pedagogical work. The author singles out three stages of work: the preparatory, organizational and activity, analytical and corrective stage. The methods and techniques of social work that shold be applied on each stage are disclosed. The author emphasizes, that not only professionals in the field of education but also representatives of state institutions – organs of executive power, health service, town centers of social service for family, children and youth, public organizations, charity funds and volunteers, which have corresponding specialization or special training, should be drown into realization of proposed stages of work with children-settlers. The author comes to the conclusion that in sprite of existence of already organized work with settlers’ families in Ukraine, more attention should be paid just to work with children because this generation creates the future of our country.
Tomer, Gitit; Xanthakos, Stavra; Kim, Sandra; Rao, Meenakshi; Book, Linda; Litman, Heather J; Fishman, Laurie N
Gender equality in the workplace has not been described in pediatric gastroenterology. An electronic survey that explored perceptions of career parity, work-life balance, and workplace harassment was sent to all members of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Reponses were anonymous. Of the 303 respondents (21%), there was an even distribution across geographic region, age, and gender (54% men). Gender affected perception of salary and promotion; 46% of men but only 9% of women feel that "women earn the same as men" (P work-life balance for either gender. Overall, women are more likely to be dissatisfied with work-life balance than men (P = 0.046). Satisfaction with work-life balance is lower among women versus men pediatric gastroenterologists, but does not correlate with flexibility of spouse's job or caring for young children. Gender-divergent perception of promotion, parity of compensation, and mentoring requires further investigation.
This work plan presents an evaluation of soil vapor extraction (SVE) and bioventing, and describes the SVE pilot scale and bioventing activities to be conducted to extract and treat soil gas at Installation Restoration Program (IRP...
This Bioventing Pilot Test Work Plan presents the scope of an in situ bioventing pilot test and installation of a bioventing system for treatment of petroleum hydrocarbon-contaminated soils at Site...
Umamaheswari S, Jayasree Krishnan
Although retention of employees has become hot topic in this career turbulent era, practically no empirical research is carried out in the fast growing ceramic sector till now and this research fills the gap in the literature. The literatures surveys reported that organization commitment is an important determinant of retention and work environment, supervisor support and training and development are the most relevant antecedents increasing commitment towards organization. This paper examines the impact of the above factors over organization commitment and explores the effects of organization commitment on retention, and verifies the mediating effect of organization commitment on the relationship between proposed factors and retention. Design/methodology/approach: A survey was completed by 416 employees working in five ceramic sanitary ware factories located at different places in India. Questionnaire consisting of items adopted from previous researches were used to collect data. The selection of respondents was based on the simple random sampling. Findings: Findings reveals that organization commitment influences retention and all the above factors enhances it. Moreover organization commitment partially mediates the relationship between proposed factors and retention. However multiple regression analysis indicated that training and development did not have any notable influence on retention. Limitations: This study was conducted in a particular country and also in a particular sector of manufacturing industry, which limits generalization .Possibility of bias towards their organization and assumption that respondents know about their organization are other limitations. Implications: This paper offers recommendations to HR(Human resource) managers that they should extend their support to work environment, supervisor support and training and development in order to generate better relationship with employees and to reduce their likelihood of leaving the company
Full Text Available Purpose: Although retention of employees has become hot topic in this career turbulent era, practically no empirical research is carried out in the fast growing ceramic sector till now and this research fills the gap in the literature. The literatures surveys reported that organization commitment is an important determinant of retention and work environment, supervisor support and training and development are the most relevant antecedents increasing commitment towards organization. This paper examines the impact of the above factors over organization commitment and explores the effects of organization commitment on retention, and verifies the mediating effect of organization commitment on the relationship between proposed factors and retention. Design/methodology/approach: A survey was completed by 416 employees working in five ceramic sanitary ware factories located at different places in India. Questionnaire consisting of items adopted from previous researches were used to collect data. The selection of respondents was based on the simple random sampling. Findings: Findings reveals that organization commitment influences retention and all the above factors enhances it. Moreover organization commitment partially mediates the relationship between proposed factors and retention. However multiple regression analysis indicated that training and development did not have any notable influence on retention. Limitations: This study was conducted in a particular country and also in a particular sector of manufacturing industry, which limits generalization .Possibility of bias towards their organization and assumption that respondents know about their organization are other limitations. Implications: This paper offers recommendations to HR(Human resource managers that they should extend their support to work environment, supervisor support and training and development in order to generate better relationship with employees and to reduce their
Lawson, Katrina J; Rodwell, John J; Noblet, Andrew J
The risk of work-related depression in Australia was estimated based on a survey of 631 police officers. Psychological wellbeing and psychological distress items were mapped onto a measure of depression to identify optimal cutoff points. Based on a sample of police officers, Australian workers, in general, are at risk of depression when general psychological wellbeing is considerably compromised. Large-scale estimation of work-related depression in the broader population of employed persons in Australia is reasonable. The relatively high prevalence of depression among police officers emphasizes the need to examine prevalence rates of depression among Australian employees.
Wells, Ryan S.; Bills, David B.; Devlin, Maura E.
This paper investigates early employment influences on postsecondary expectations and enrolment for working men and women who have recently completed high school in the United States. We find that young workers still have very high expectations for postsecondary education, but that women are more likely to enrol. However, this difference is…
Cook, Alice H.
Women's participation in the workforce is increasing, spurred by inflation, the rising level of consumer aspirations, the increasing number of families headed by women as a consequence of divorce, and the declining birth rate. However, the work women do continues to be segregated from men's and comparatively poorly paid, while women still carry…
Mau, W; Thiele, K; Lamprecht, J
Positive therapeutic effects on the work force participation derived from international clinical trials may not be directly transferable to the community based care in Germany. Therefore recent changes of data regarding sick leave (SL), work disability pension (WDP) and employment from the social insurance and from the national database of the German collaborative arthritis centers were analyzed covering a time period of at least 10 years. Health insurance data showed a steeper decline in the average duration of SL caused by rheumatoid arthritis (RA), ankylosing spondylitis (AS) and systemic lupus erythematosus (SLE) compared with all other diseases. In RA patients from the collaborative arthritis centers the mean duration of SL was much more reduced than the average duration of SL for members of the compulsory health insurance. The proportion of gainfully employed RA patients in collaborative arthritis centers has particularly increased in women. According to data from the pension insurance fund less incident cases of WDP due to RA, AS, and SLE have been observed than WDP caused by all other diseases. Thus different nationwide data show positive changes of the work force participation of individuals suffering from inflammatory rheumatic diseases in Germany.
Full Text Available The paper presents the results of theoretical studies influence of non-uniform temperature distribution along the feedstock length to the unit friction force working on the metal contact surface with the roll change during the round bars 70 mm in diameter continuous rolling process. This value is one of the major factors affecting the grooves wear during the rolling process. The studies were carried out based on the actual engineering data for 160 × 160 mm square cross-section feedstock of steel S355J0. Numerical modelling of the rolling process was performed using Forge2008®, a finite-element based computer program.
Bell, Sharon E.
This report examines the educational and employment characteristics of scientists and engineers who graduated during the years 1972, 1974, 1975, and 1976, with special attention to those whose work involves energy. The characteristics of energy-related graduates are also compared to those of more experienced scientists and engineers involved in energy activities. Information is based on the results of the 1976 and 1978 National Surveys of Recent Science and Engineering Graduates, and the 1976 National Survey of Natural and Social Scientists and Engineers, sponsored by the National Science Foundation and the US Department of Energy. Tabulations are included for the first time on employment involving specific energy sources and activities. Other characteristics discussed include educational level, salary, primary work activity, type of employer, and the proportion of graduates who found employment in their major field.
Guenole, Nigel; Brown, Anna A; Cooper, Andrew J
This article describes an investigation of whether Thurstonian item response modeling is a viable method for assessment of maladaptive traits. Forced-choice responses from 420 working adults to a broad-range personality inventory assessing six maladaptive traits were considered. The Thurstonian item response model's fit to the forced-choice data was adequate, while the fit of a counterpart item response model to responses to the same items but arranged in a single-stimulus design was poor. Monotrait heteromethod correlations indicated corresponding traits in the two formats overlapped substantially, although they did not measure equivalent constructs. A better goodness of fit and higher factor loadings for the Thurstonian item response model, coupled with a clearer conceptual alignment to the theoretical trait definitions, suggested that the single-stimulus item responses were influenced by biases that the independent clusters measurement model did not account for. Researchers may wish to consider forced-choice designs and appropriate item response modeling techniques such as Thurstonian item response modeling for personality questionnaire applications in industrial psychology, especially when assessing maladaptive traits. We recommend further investigation of this approach in actual selection situations and with different assessment instruments.
Disruption in police officers. In recent years there has been a widespread growth in services, available regardless of time or day organization (24/7 service) and a diffuse increase in their use, both in work and private lives, generally ignoring the importance of a regular sleep organization. Police officers - often need to work extended shifts and long hours under highly stressful conditions, which results in reduced levels of safety and operational effectiveness. In numerous studies, perceived stress has been found to correlate with both subjective and objective disturbances in sleep. Consequently, excessive daytime sleepiness is one of the most frequent health and safety hazards that police officers have to deal with. Sleep deprivation affects performance outcomes through a wide range of cognitive domains. Sleepiness and fatigue, caused by sleep loss, extended work and wakefulness, circadian misalignment and sleep disorders are major causes of workplace human errors, incidents, and accidents. Therefore, prevention of sleep loss, high levels of stress and fatigue is a key factor to consider when assessing emergency intervention. In order to combat fatigue and sleepiness, a 30-90 minutes nap before night shift could be a viable option.
Full Text Available Abstract Background The devices used for in vivo examination of muscle contractions assess only pure force contractions and the so-called isokinetic contractions. In isokinetic experiments, the extremity and its muscle are artificially moved with constant velocity by the measuring device, while a tetanic contraction is induced in the muscle, either by electrical stimulation or by maximal voluntary activation. With these systems, experiments cannot be performed at pre-defined, constant muscle length, single contractions cannot be evaluated individually and the separate examination of the isometric and the isotonic components of single contractions is not possible. Methods The myograph presented in our study has two newly developed technical units, i.e. a. a counterforce unit which can load the muscle with an adjustable, but constant force and b. a length-adjusting unit which allows for both the stretching and the contraction length to be infinitely adjustable independently of one another. The two units support the examination of complex types of contraction and store the counterforce and length-adjusting settings, so that these conditions may be accurately reapplied in later sessions. Results The measurement examples presented show that the muscle can be brought to every possible pre-stretching length and that single isotonic or complex isometric-isotonic contractions may be performed at every length. The applied forces act during different phases of contraction, resulting into different pre- and after-loads that can be kept constant – uninfluenced by the contraction. Maximal values for force, shortening, velocity and work may be obtained for individual muscles. This offers the possibility to obtain information on the muscle status and to monitor its changes under non-invasive measurement conditions. Conclusion With the Complex Myograph, the whole spectrum of a muscle's mechanical characteristics may be assessed.
Sandulyak Alexander V.
Full Text Available Due to rapid development of the scientific and applied research in magnetic control and magnetophoresis of ferro- and ferromagnetic disperse fraction of various technological, natural and industry-specific media, the Faraday method is again in high demand as it is mainly aimed at defining magnetic susceptibility of solid and heterogeneous samples of small volumes. Based on the appearing (and then measured ponderomotive force impacting the sample, the method allows accurate determining of single particles magnetic susceptibility by using the data of the sample represented by a conglomerate of the particles of such a fraction. In addition, it is mentioned that to date there is still a great gap in the methodology of the Faraday method as there are no exact recommendations on choosing both the form of the polar pieces of the Faraday balance and the positioning of the sample (the location of the working zone in the interpolar area. Owing to these drawbacks, the well-known and long-time used Faraday method cannot be considered substantiated to a satisfactory degree. Thus, in our point of view, the treatment of the results obtained earlier with the help of the method should be cautious. In our work, we experimentally defined and substantiated an approach to identifying a working (local zone, viz. the zone with stable values of the magnetic force factor – the product of the field intensity and induction by its gradient. The approach features the relative phenomenological analysis and is exemplified by polar pieces of non-traditional spherical form. It has been demonstrated that in order to state the fact of mere existence of this zone (and its location in the interpolar area, the coordinate (usually nonlinear one characteristic of intensity or induction, which is obligatorily obtained in an experiment, should have an inflexion, which guarantees a functionally extreme view of the following coordinate characteristics both of the gradient and that of
City and County of Durham, North Carolina — This thematic map presents the labor force participation rate of working-age people in the United States in 2010. The 2010 Labor Force Participation Rate shows the...
Signature of the CERN GoldenBook at CERN by Peters Higgs British theoretical physicist - He worked on proposals to unify the weak and the electromagnetic forces into a single electroweak theory, The Boson of Higgs.
Signature of the CERN GoldenBook at CERN by Peters Higgs British theoretical physicist - He worked on proposals to unify the weak and the electromagnetic forces into a single electroweak theory, The Boson of Higgs.
Visit of Peters Higgs at Point 2 ALICE Experiment - British theoretical physicist, He worked on proposals to unify the weak and the electromagnetic forces into a single electroweak theory, The Boson of Higgs.
Visit of Peters Higgs at Point 2 ALICE Experiment - British theoretical physicist, He worked on proposals to unify the weak and the electromagnetic forces into a single electroweak theory, The Boson of Higgs.
During the Great War, the French surgeon Alexis Carrel, in collaboration with the English chemist Henry Dakin, devised an antiseptic treatment for infected wounds. This paper focuses on Carrel's attempt to standardise knowledge of infected wounds and their treatment, and looks closely at the vision of surgical skill he espoused and its difference from those associated with the doctrines of scientific management. Examining contemporary claims that the Carrel-Dakin method increased rather than diminished demands on surgical work, this paper further shows how debates about antiseptic wound treatment opened up a critical space for considering the nature of skill as a vital dynamic in surgical innovation and practice.
DeChurch, and Jessica Mesmer- Magnus . 2010. "The Cognitive Underpinnings of Effective Teamwork: A Meta-Analysis." Journal of Applied Psychology 22. Pg.1 19...Mesmer- Magnus . 2010. "The Cognitive Underpinnings of Effective Teamwork: A Meta-Analysis." Journal of Applied Psychology 22. Defense Acquisition...efficiency and effectiveness of joint operations. Thesis Does the Army require unique education, realistic training and organizational agility to
On January 2, 2003, Dr. James G. Roche, the Secretary of the Air Force, received an e-mail directed initially to female cadets, which asserted that there was a significant sexual assault problem at the United States Air Force...
Taverniers, John; Van Ruysseveldt, Joris; Smeets, Tom; von Grumbkow, Jasper
While running a selection procedure, 27 male Belgian Special Forces candidates, with a mean age of 27.4 years (SD = 5.1), were randomly assigned to a no-stress control (n = 14) or a high-intensity stress group (n = 13). Participants in the latter group were exposed to an extremely strenuous mock prisoner of war (POW) exercise. Immediately after stress or control treatment, working memory and visuo-spatial declarative memory performances were measured by the digit span (DS) test and the Rey-Osterrieth complex figure (ROCF), respectively. Concurrently, stress levels were assessed by obtaining salivary cortisol measurements and subjectively by the NASA Task Load Index (TLX). As expected, exposure to high-intensity stress led to both robust cortisol increases and significant differences in TLX scores. Stress induction also significantly impaired DS and ROCF performances. Moreover, delta cortisol increases and ROCF performance in the POW stress group showed a significant negative correlation, while DS performances followed the same tendency. Summarizing, the current findings complement and extend previous work on hormonal stress effects, and the subsequent performance deterioration on two memory tests in a unique high-intensity stress environment.
Hedley-Whyte, John; Milamed, Debra R
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
Full Text Available The numerical calculations results of torsional vibration of the multi-cylinder crankshaft in the serial combustion engine (MC, including a viscous damper (VD, at complex forcing, were shown. In fact, in the MC case the crankshaft rotation forcings spectrum is the sum of harmonic forcing whose amplitude can be compared with the amplitude of the 1st harmonic. A significant impact, in the engine operational velocity, on the vibration damping process of MC, may be the amplitude of the 2nd harmonic of a forcing moment. The calculations results of MC vibration, depending on the amplitude of the 2nd harmonic of the forcing moment, for the first form of the torsional vibration, were shown. Higher forms of torsional vibrations have no practical significance. The calculations assume the optimum damping coefficient VD, when the simple harmonic forcing is equal to the base critical velocity of the MC crankshaft.
Eliyas, S; Vere, J; Ali, Z; Harris, I
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.
Roberts, Kurt E; Bell, Robert L; Duffy, Andrew J
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. PMID:16718842
The autonomous manipulation of the medical robotics is needed to draw up a complete surgical plan in development. The autonomy of the robot comes from the fact that once the plan is drawn up off-line, it is the servo loops, and only these, that control the actions of the robot online, based on instantaneous control signals and measurements provided by the vision or force sensors. Using only these autonomous techniques in medical and surgical robotics remain relatively limited for two main reasons: Predicting complexity of the gestures, and human Safety. Therefore, Modern research in haptic force feedback in medical robotics is aimed to develop medical robots capable of performing remotely, what a surgeon does by himself. These medical robots are supposed to work exactly in the manner that a surgeon does in daily routine. In this paper the master slave tele-robotic system is designed and implemented with accuracy and stability by using 6DOF (Six Degree of Freedom) haptic force feedback devices. The master slave control strategy, haptic devices integration, application software designing using Visual C++ and experimental setup are considered. Finally, results are presented the stability, accuracy and repeatability of the system. (author)
Syed Amjad Ali
Full Text Available The autonomous manipulation of the medical robotics is needed to draw up a complete surgical plan in development. The autonomy of the robot comes from the fact that once the plan is drawn up off-line, it is the servo loops, and only these, that control the actions of the robot online, based on instantaneous control signals and measurements provided by the vision or force sensors. Using only these autonomous techniques in medical and surgical robotics remain relatively limited for two main reasons: Predicting complexity of the gestures, and human Safety. Therefore, Modern research in haptic force feedback in medical robotics is aimed to develop medical robots capable of performing remotely, what a surgeon does by himself. These medical robots are supposed to work exactly in the manner that a surgeon does in daily routine. In this paper the master slave tele-robotic system is designed and implemented with accuracy and stability by using 6DOF (Six Degree of Freedom haptic force feedback devices. The master slave control strategy, haptic devices integration, application software designing using Visual C++ and experimental setup are considered. Finally, results are presented the stability, accuracy and repeatability of the system
Dressler, Dirk; Bhidayasiri, Roongroj; Bohlega, Saeed; Chahidi, Abderrahmane; Chung, Tae Mo; Ebke, Markus; Jacinto, L Jorge; Kaji, Ryuji; Koçer, Serdar; Kanovsky, Petr; Micheli, Federico; Orlova, Olga; Paus, Sebastian; Pirtosek, Zvezdan; Relja, Maja; Rosales, Raymond L; Sagástegui-Rodríguez, José Alberto; Schoenle, Paul W; Shahidi, Gholam Ali; Timerbaeva, Sofia; Walter, Uwe; Saberi, Fereshte Adib
Botulinum toxin (BT) therapy is an established treatment of spasticity due to stroke. For multiple sclerosis (MS) spasticity this is not the case. IAB-Interdisciplinary Working Group for Movement Disorders formed a task force to explore the use of BT therapy for treatment of MS spasticity. A formalised PubMed literature search produced 55 publications (3 randomised controlled trials, 3 interventional studies, 11 observational studies, 2 case studies, 35 reviews, 1 guideline) all unanimously favouring the use of BT therapy for MS spasticity. There is no reason to believe that BT should be less effective and safe in MS spasticity than it is in stroke spasticity. Recommendations include an update of the current prevalence of MS spasticity and its clinical features according to classifications used in movement disorders. Immunological data on MS patients already treated should be analysed with respect to frequencies of MS relapses and BT antibody formation. Registration authorities should expand registration of BT therapy for spasticity regardless of its aetiology. MS specialists should consider BT therapy for symptomatic treatment of spasticity.
The numerical calculations results of torsional vibration of the multi-cylinder crankshaft in the serial combustion engine (MC), including a viscous damper (VD), at complex forcing, were shown. In fact, in the MC case the crankshaft rotation forcings spectrum is the sum of harmonic forcing whose amplitude can be compared with the amplitude of the 1st harmonic. A significant impact, in the engine operational velocity, on the vibration damping process of MC, may be the amplitude of the 2nd harm...
Kamine, Tovy Haber; Barron, Rebecca J; Lesicka, Agnieszka; Galbraith, John D; Millham, Frederick H; Larson, Janet
On July 1, 2011, the Accreditation Council for Graduate Medical Education (ACGME) eliminated 30-hour call in an attempt to improve resident wakefulness. We surveyed interns on the Newton Wellesley Hospital (NWH) surgery service before and after the transition from Q4 overnight call to a night float schedule. For 15 weeks, interns completed weekly surveys including the Epworth Sleepiness Scale (ESS). The service changed to a night float schedule after 3 weeks (ie, first to 3-4 and then to 6 nights in a row). The average ESS score rose from 9.8 ± 5.2 to 14.9 ± 3.1 and 14.4 ± 4.5 (P = .042) on the 3/4 and 6/1 schedules, respectively. Interns were more likely to be abnormally tired on either night float schedule (relative risk = 2.86; 95% confidence interval, 1.17-6.97, P = .029). The new ACGME work hours increased the ESS scores among interns at NWH and caused interns to be more tired than interns on the Q4 schedule. This is likely caused by the multiple nights of poor sleep without a post-call day to make up sleep. Copyright © 2013 Elsevier Inc. All rights reserved.
Inside the atom, particles interact through two forces which are never felt in the everyday world. But they may hold the key to the Universe. These ideas on subatomic forces are discussed with respect to the strong force, the electromagnetic force and the electroweak force. (author)
The work presented in this thesis first addresses the magnitude of the clinical problem of surgically treated tubal pregnancy in The Netherlands. Next, we studied the adherence to recommendations from the Dutch guideline on diagnosis and management of ectopic pregnancy. A systematic review and
Acute abdomen in pregnancy is a disease with a low incidence. The purpose of this work was therefore to create a review of current recommended practice in diagnostics and surgical solution. I also mention surgically relevant physiological and pathological changes specific to pregnancy, differential diagnostics of acute abdomen in pregnancy and impact of the disease and its treatment on the fetus. (author)
Evans, Charity H; Schenarts, Kimberly D
Training competent and professional surgeons efficiently and effectively requires innovation and modernization of educational methods. Today's medical learner is quite adept at using multiple platforms to gain information, providing surgical educators with numerous innovative avenues to promote learning. With the growth of technology, and the restriction of work hours in surgical education, there has been an increase in use of simulation, including virtual reality, robotics, telemedicine, and gaming. The use of simulation has shifted the learning of basic surgical skills to the laboratory, reserving limited time in the operating room for the acquisition of complex surgical skills". Copyright © 2016 Elsevier Inc. All rights reserved.
Xu, Lang; Liu, Qian
This paper discusses a real-time simulation method of inextensible surgical thread based on the Cosserat rod theory using position-based dynamics (PBD). The method realizes stable twining and knotting of surgical thread while including inextensibility, bending, twisting and coupling effects. The Cosserat rod theory is used to model the nonlinear elastic behavior of surgical thread. The surgical thread model is solved with PBD to achieve a real-time, extremely stable simulation. Due to the one-dimensional linear structure of surgical thread, the direct solution of the distance constraint based on tridiagonal matrix algorithm is used to enhance stretching resistance in every constraint projection iteration. In addition, continuous collision detection and collision response guarantee a large time step and high performance. Furthermore, friction is integrated into the constraint projection process to stabilize the twining of multiple threads and complex contact situations. Through comparisons with existing methods, the surgical thread maintains constant length under large deformation after applying the direct distance constraint in our method. The twining and knotting of multiple threads correspond to stable solutions to contact and friction forces. A surgical suture scene is also modeled to demonstrate the practicality and simplicity of our method. Our method achieves stable and fast simulation of inextensible surgical thread. Benefiting from the unified particle framework, the rigid body, elastic rod, and soft body can be simultaneously simulated. The method is appropriate for applications in virtual surgery that require multiple dynamic bodies.
Charboneau, S.; Klos, B.; Heineman, R.; Skeels, B.; Hopkins, A.
's approach to overcome these challengers are described. Many of the challenges to the D and D work at PFP were met with innovative approaches based on new science and/or technology and many were also based on the creativity and motivation of the work force personnel. (authors)
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 / ...
... procedures performed to treat pelvic floor disorders with surgical mesh: Transvaginal mesh to treat POP Transabdominal mesh to treat ... address safety risks Final Order for Reclassification of Surgical Mesh for Transvaginal Pelvic Organ Prolapse Repair Final Order for Effective ...
McDonald, Gavain K
.... By separating 40,000 active duty members, to include 8,000 Company Grade Officers (CGOs), the Air Force intends to balance the skills of its personnel to meet the requirements of the Global War on Terror...
...). Luke AFB is one of several Air Force installations identified as prospective test sites to demonstrate the ICE system with advanced emission controls as part of a low-cost soil vapor extraction (SVE...
Alvarado, Patricio R.; Montalvo, Luis
This is the first book in a five-book physical science series on simple machines. The books are designed for Spanish-speaking junior high school students. This volume defines force and work by suggesting experiments and posing questions concerning drawings in the book which illustrate scientific principles. Answers to the questions are provided;…
The different forces, together with a pictorial analogy of how the exchange of particles works. The table lists the relative strength of the couplings, the quanta associated with the force fields and the bodies of phenomena in which they have a dominant role.
Fischbach, E.; Sudarsky, D.; Szafer, A.; Talmadge, C.; Aronson, S.H.
We review recent experimental and theoretical work dealing with the proposed fifth force. Further analysis of the original Eoetvoes experiments has uncovered no challenges to our original assertion that these data evidence a correlation characteristic of the presence of a new coupling to baryon number or hypercharge. Various models suggest that the proposed fifth force could be accomodated naturally into the existing theoretical framework
Kim, Pyunghwa; Kim, Soomin; Park, Young-Dai; Choi, Seung-Bok
This study proposes a new model to predict the reaction force that occurs in incisions during robot-assisted minimally invasive surgery. The reaction force is fed back to the manipulator by a magneto-rheological fluid (MRF) haptic master, which is featured by a bi-directional clutch actuator. The reaction force feedback provides similar sensations to laparotomy that cannot be provided by a conventional master for surgery. This advantage shortens the training period for robot-assisted minimally invasive surgery and can improve the accuracy of operations. The reaction force modeling of incisions can be utilized in a surgical simulator that provides a virtual reaction force. In this work, in order to model the reaction force during incisions, the energy aspect of the incision process is adopted and analyzed. Each mode of the incision process is classified by the tendency of the energy change, and modeled for realistic real-time application. The reaction force model uses actual reaction force information with three types of actual tissues: hard tissue, medium tissue, and soft tissue. This modeled force is realized by the MRF haptic master through an algorithm based on the position and velocity of a scalpel using two different control methods: an open-loop algorithm and a closed-loop algorithm. The reaction forces obtained from the proposed model are compared with a desired force in time domain.
Currie, Maria E; Talasaz, Ali; Rayman, Reiza; Chu, Michael W A; Kiaii, Bob; Peters, Terry; Trejos, Ana Luisa; Patel, Rajni
The objective of this work was to determine the effect of both direct force feedback and visual force feedback on the amount of force applied to mitral valve tissue during ex vivo robotics-assisted mitral valve annuloplasty. A force feedback-enabled master-slave surgical system was developed to provide both visual and direct force feedback during robotics-assisted cardiac surgery. This system measured the amount of force applied by novice and expert surgeons to cardiac tissue during ex vivo mitral valve annuloplasty repair. The addition of visual (2.16 ± 1.67), direct (1.62 ± 0.86), or both visual and direct force feedback (2.15 ± 1.08) resulted in lower mean maximum force applied to mitral valve tissue while suturing compared with no force feedback (3.34 ± 1.93 N; P forces on cardiac tissue during robotics-assisted mitral valve annuloplasty suturing, force feedback may be required. Copyright © 2016 John Wiley & Sons, Ltd.
Kim, Pyunghwa; Kim, Soomin; Park, Young-Dai; Choi, Seung-Bok
This study proposes a new model to predict the reaction force that occurs in incisions during robot-assisted minimally invasive surgery. The reaction force is fed back to the manipulator by a magneto-rheological fluid (MRF) haptic master, which is featured by a bi-directional clutch actuator. The reaction force feedback provides similar sensations to laparotomy that cannot be provided by a conventional master for surgery. This advantage shortens the training period for robot-assisted minimally invasive surgery and can improve the accuracy of operations. The reaction force modeling of incisions can be utilized in a surgical simulator that provides a virtual reaction force. In this work, in order to model the reaction force during incisions, the energy aspect of the incision process is adopted and analyzed. Each mode of the incision process is classified by the tendency of the energy change, and modeled for realistic real-time application. The reaction force model uses actual reaction force information with three types of actual tissues: hard tissue, medium tissue, and soft tissue. This modeled force is realized by the MRF haptic master through an algorithm based on the position and velocity of a scalpel using two different control methods: an open-loop algorithm and a closed-loop algorithm. The reaction forces obtained from the proposed model are compared with a desired force in time domain. (paper)
Haritoglou, C; Wolf, A
The detachment of the neurosensory retina from the underlying retinal pigment epithelium can be related to breaks of the retina allowing vitreous fluid to gain access to the subretinal space, to exudative changes of the choroid such as tumours or inflammatory diseases or to excessive tractional forces exerted by interactions of the collagenous vitreous and the retina. Tractional retinal detachment is usually treated by vitrectomy and exudative detachment can be addressed by treatment of the underlying condition in many cases. In rhegmatogenous retinal detachment two different surgical procedures, vitrectomy and scleral buckling, can be applied for functional and anatomic rehabilitation of our patients. The choice of the surgical procedure is not really standardised and often depends on the experience of the surgeon and other more ocular factors including lens status, the number of retinal breaks, the extent of the detachment and the amount of preexisting PVR. Using both techniques, anatomic success rates of over 90 % can be achieved. Especially in young phakic patients scleral buckling offers the true advantage to prevent the progression of cataract formation requiring cataract extraction and intraocular lens implantation. Therefore, scleral buckling should be considered in selected cases as an alternative surgical option in spite of the very important technical refinements in modern vitrectomy techniques. Georg Thieme Verlag KG Stuttgart · New York.
Holder, Anna; Lovett, George
identified as a transformative global force of the last decade, most notably in knowledge and information publishing, communication and creation. This paper presents a structured conversation on changing understandings of collaboration, and the realities of collaborative methodology in architectural work...
Kitka, M.; Masek, M.
Fractures of the ribs is the most common thoracic injury after blunt trauma. Chest wall instability (flail chest) is a common occurrence in the presence of multiple ribs fracture. Unilateral or bilateral fractures more ribs anteriorly or posteriorly will produce enough instability that paradoxical respiratory motion results in hypoventilation of an unacceptable degree. Open approach and surgical stabilisation of the chest preserved pulmonary function, improved pain control, minimized posttraumatic deformities and shorter back to work time. (author)
McKinley, Stephen Alan
A new era of robotic surgery is poised to begin when critical patents held by Intuitive Surgical (IS) expire in 2016. IS market dominance for decades has led to an effective monopoly that will be challenged by several commercial enterprises working on next generation general robotic surgery systems. Robotic surgery has the potential to alleviate the skill-gap between experienced and inexperienced surgeons through the automation of sub-tasks within surgicalprocedures.The primary objective of...
Carlsen, C G; Lindorff-Larsen, K; Funch-Jensen, P
PURPOSE: Traditional surgical training is challenged by factors such as patient safety issues, economic considerations and lack of exposure to surgical procedures due to short working hours. A module-based clinical training model promotes rapidly acquired and persistent surgical skills. METHODS...... hernia repair was preferable in both short and long-term compared with standard clinical training. The model will probably be applicable to other surgical training procedures....
Barendregt, Wolmet; Börjesson, Peter; Eriksson, Eva
In this paper, we present the forced collaborative interaction game StringForce. StringForce is developed for a special education context to support training of collaboration skills, using readily available technologies and avoiding the creation of a "mobile bubble". In order to play String......Force two or four physically collocated tablets are required. These tablets are connected to form one large shared game area. The game can only be played by collaborating. StringForce extends previous work, both technologically and regarding social-emotional training. We believe String......Force to be an interesting demo for the IDC community, as it intertwines several relevant research fields, such as mobile interaction and collaborative gaming in the special education context....
Buhmann, Stefan Yoshi
In this book, a modern unified theory of dispersion forces on atoms and bodies is presented which covers a broad range of advanced aspects and scenarios. Macroscopic quantum electrodynamics is shown to provide a powerful framework for dispersion forces which allows for discussing general properties like their non-additivity and the relation between microscopic and macroscopic interactions. It is demonstrated how the general results can be used to obtain dispersion forces on atoms in the presence of bodies of various shapes and materials. Starting with a brief recapitulation of volume I, this volume II deals especially with bodies of irregular shapes, universal scaling laws, dynamical forces on excited atoms, enhanced forces in cavity quantum electrodynamics, non-equilibrium forces in thermal environments and quantum friction. The book gives both the specialist and those new to the field a thorough overview over recent results in the field. It provides a toolbox for studying dispersion forces in various contex...
Burgert, O.; Neumuth, T.; Gessat, M.; Jacobs, S.; Lemke, H. U.
The generation, storage, transfer, and representation of image data in radiology are standardized by DICOM. To cover the needs of image guided surgery or computer assisted surgery in general one needs to handle patient information besides image data. A large number of objects must be defined in DICOM to address the needs of surgery. We propose an analysis process based on Surgical Workflows that helps to identify these objects together with use cases and requirements motivating for their specification. As the first result we confirmed the need for the specification of representation and transfer of geometric models. The analysis of Surgical Workflows has shown that geometric models are widely used to represent planned procedure steps, surgical tools, anatomical structures, or prosthesis in the context of surgical planning, image guided surgery, augmented reality, and simulation. By now, the models are stored and transferred in several file formats bare of contextual information. The standardization of data types including contextual information and specifications for handling of geometric models allows a broader usage of such models. This paper explains the specification process leading to Geometry Mesh Service Object Pair classes. This process can be a template for the definition of further DICOM classes.
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
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...
Isaac-Lowry, Oran Jacob; Okamoto, Steele; Pedram, Sahba Aghajani; Woo, Russell; Berkelman, Peter
To date a variety of teleoperated surgical robotic systems have been developed to improve a surgeon's ability to perform demanding single-port procedures. However typical large systems are bulky, expensive, and afford limited angular motion, while smaller designs suffer complications arising from limited motion range, speed, and force generation. This work was to develop and validate a simple, compact, low cost single site teleoperated laparoendoscopic surgical robotic system, with demonstrated capability to carry out basic surgical procedures. This system builds upon previous work done at the University of Hawaii at Manoa and includes instrument and endoscope manipulators as well as compact articulated instruments designed to overcome single incision geometry complications. A robotic endoscope holder was used for the base, with an added support frame for teleoperated manipulators and instruments fabricated mostly from 3D printed parts. Kinematics and control methods were formulated for the novel manipulator configuration. Trajectory following results from an optical motion tracker and sample task performance results are presented. Results indicate that the system has successfully met the goal of basic surgical functionality while minimizing physical size, complexity, and cost. Copyright © 2017 John Wiley & Sons, Ltd.
Kimura, F T; Pavia Noble, A; Soriano Padilla, F; Soto Miranda, A; Medellín Rodríguez, A
This study presents a statistical review of corrective surgery for cleft palate, based on cases treated at the maxillo-facial surgery units of the Pediatrics Hospital of the Centro Médico Nacional and at Centro Médico La Raza of the National Institute of Social Security of Mexico, over a five-year period. Interdisciplinary management as performed at the Cleft-Palate Clinic, in an integrated approach involving specialists in maxillo-facial surgery, maxillar orthopedics, genetics, social work and mental hygiene, pursuing to reestablish the stomatological and psychological functions of children afflicted by cleft palate, is amply described. The frequency and classification of the various techniques practiced in that service are described, as well as surgical statistics for 188 patients, which include a total of 256 palate surgeries performed from March 1984 to March 1989, applying three different techniques and proposing a combination of them in a single surgical time, in order to avoid complementary surgery.
Full Text Available Vanessa Shifflette,1 Susannah Hambright,2 Joseph Darryl Amos,1 Ernest Dunn,3 Maria Allo4 1Associates in Surgical Acute Care, Methodist Dallas Medical Center, Dallas, TX, USA; 2Methodist Surgical Associates, Methodist Dallas Medical Center, Dallas, TX, USA; 3Graduate Medical Education - General Surgery, Methodist Dallas Medical Center, Dallas, TX, USA; 4Santa Clara Valley Medical Center, San Jose, CA, USA Background: Surgery continues to be an intense, time-consuming residency. Many medical students decide against surgery as a profession due to the long work hours and family strain. The pregnant female surgical resident has an added stress factor compared to her male counterpart. Methods: We distributed an electronic, online 26-question survey to 32 general surgery programs in the southwestern region of the United States. Each program distributed our survey to the female surgical residents who had been pregnant during residency in the last 5 years. Each program was re-contacted 6 weeks after the initial contact. Most questions were in a 5-point Likert scale format. The responses were collected and analyzed using the Survey Monkey website. Results: An unvalidated survey was sent to 32 general surgery programs and 26 programs responded (81%. Each program was asked for the total number of possible responses from female residents that met our criteria (60 female residents. Seven of the programs (27% stated that they have had zero residents pregnant. We had 22 residents respond (37%. Over half of the residents (55% were pregnant during their 2nd or 3rd year of residency, with only 18% pregnant during a research year. Thirty-one percent had a lower American Board of Surgery In-Training Exam (ABSITE score. Ninety percent of the residents were able to take 4 weeks or more for maternity leave. Most of the residents (95% stated that they would do this again during residency given the opportunity, but many of the residents felt that returning back to work
Ansorg, J; Hassan, I; Fendrich, V; Polonius, M J; Rothmund, M; Langer, P
One of the reasons for young doctors to leave the clinical work to go abroad or into non-clinical fields is insufficient quality of training under bad circumstances. Aim of the study was to evaluate the surgical training in Germany from the viewpoint of the residents. A questionnaire was prepared by residents and consultants and approved by the German surgical societies (Deutsche Gesellschaft fur Chirurgie und Berufsverband der Deutschen Chirurgen). It was sent to surgical residents between June 2003 and June 2004, published in "Der Chirurg BDC" and distributed among residents taking part in courses conducted by the BDC. It could be answered anonymously by email, mail or online. The questionnaire was sent back by 584 surgical residents (about 30 % of all). 58 % of the residents declared that they finished the training in the intended time (6 years). Rotation-systems as part of a structured residency program existed for 43 %. Standard surgical procedures were discussed or explained before the procedure in only 46 %. 61 % of the residents were not satisfied with the teaching assistance by their clinical teachers in the OR. Only 33 % had regular talks with the Chief about their progress in surgical training. 18 % of residents felt, that the hospital is interested in their progress in training. Indication-conferences took place in 52 % and mortality-conferences in only 20 % of programs. Regular seminars on recent issues took place in 62 %, and 61 % of residents did not get financial support to attend congresses. 36 % of residents had to use their holidays to attend congresses. Surgical training structures are not well established in about 50 % of the training hospitals from where we got answers to our survey. The training potential of daily surgical work is not used appropriately. It is therefore imperative to develop guidelines for surgical training, the use of log-books and rotation-programs.
This pilot test work plan presents the scope of an in situ enhanced biological degradation, or "bioventing", pilot test for treatment of gasoline- contaminated soils at the Base Exchange Service Station (BXSS...
Vercler, Christian J
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.
Morris, Daniel L J; Bryson, David J; Ollivere, Ben J; Forward, Daren P
English Major Trauma Centres (MTCs) were established in April 2012. Increased case volume and complexity has influenced trauma and orthopaedic (T&O) core surgical training in these centres. To determine if T&O core surgical training in MTCs meets Joint Committee on Surgical Training (JCST) quality indicators including performance of T&O operative procedures and consultant supervised session attendance. An audit cycle assessing the impact of a weekly departmental core surgical trainee rota. The rota included allocated timetabled sessions that optimised clinical and surgical learning opportunities. Intercollegiate Surgical Curriculum Programme (ISCP) records for T&O core surgical trainees at a single MTC were analysed for 8 months pre and post rota introduction. Outcome measures were electronic surgical logbook evidence of leading T&O operative procedures and consultant validated work-based assessments (WBAs). Nine core surgical trainees completed a 4 month MTC placement pre and post introduction of the core surgical trainee rota. Introduction of core surgical trainee rota significantly increased the mean number of T&O operative procedures led by a core surgical trainee during a 4 month MTC placement from 20.2 to 34.0 (pcore surgical trainee during a 4 month MTC placement was significantly increased (0.3 vs 2.4 [p=0.04]). Those of dynamic hip screw fixation (2.3 vs 3.6) and ankle fracture fixation (0.7 vs 1.6) were not. Introduction of a core surgical trainee rota significantly increased the mean number of consultant validated WBAs completed by a core surgical trainee during a 4 month MTC placement from 1.7 to 6.6 (pcore surgical trainee rota utilising a 'problem-based' model can significantly improve T&O core surgical training in MTCs. Copyright © 2016 Elsevier Ltd. All rights reserved.
Full Text Available The article is dedicated to the problem of working-out the methodical theses "The scheme of development and disposal of productive forces of Hanty-mansijsky autonomous district – UGRA" for the perspective period till the year 2020. The necessity of its working-out is caused by the raw materials orientation of the district’s economy, which is simpliciter depending on the condition of mineral and raw material base of the region, already experiencing today the influence of global and national processes on oil and gas market. SWOT-analysis of district’s development and the scheme structure are presented. The Institute of Economy of UrB of RAS along with the other executors took the participation in working-out the scheme structure.
Decrease the inflammatory response Vasodilatation leads to better perfusion and ... Must NOT be allowed to come in contact with brain, meninges, eyes or .... project (SCIP): Evolution of National Quality Measure. Surgical. Infection 2008 ...
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....
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...
Agbo, S. P.
Hemorrhoids are common human afflictions known since the dawn of history. Surgical management of this condition has made tremendous progress from complex ligation and excision procedures in the past to simpler techniques that allow the patient to return to normal life within a short period. Newer techniques try to improve on the post-operative complications of older ones. The surgical options for the management of hemorrhoids today are many. Capturing all in a single article may be difficult if not impossible. The aim of this study therefore is to present in a concise form some of the common surgical options in current literature, highlighting some important post operative complications. Current literature is searched using MEDLINE, EMBASE and the Cochrane library. The conclusion is that even though there are many surgical options in the management of hemorrhoids today, most employ the ligature and excision technique with newer ones having reduced post operative pain and bleeding. PMID:22413048
Surgical site infections (SSIs) are a worldwide problem that has ... deep tissue is found on clinical examination, re-opening, histopathological or radiological investigation ..... Esposito S, Immune system and SSI, Journal of Chemotherapy, 2001.
If these therapies fail, and with a thorough multidisciplinary approach involving carefully ... Generally, surgical pain management is divided into neuro- modulative .... 9 suggested. It is important to be sure that the underlying instability or.
Nabavi, A; Schipper, J
Patient safety during operations hinges on the surgeon's skills and abilities. However, surgical training has come under a variety of restrictions. To acquire dexterity with decreasingly "simple" cases, within the legislative time constraints and increasing expectations for surgical results is the future challenge. Are there alternatives to traditional master-apprentice learning? A literature review and analysis of the development, implementation, and evaluation of surgical simulation are presented. Simulation, using a variety of methods, most important physical and virtual (computer-generated) models, provides a safe environment to practice basic and advanced skills without endangering patients. These environments have specific strengths and weaknesses. Simulations can only serve to decrease the slope of learning curves, but cannot be a substitute for the real situation. Thus, they have to be an integral part of a comprehensive training curriculum. Our surgical societies have to take up that challenge to ensure the training of future generations.
Bailey, John A.
Presents statistics on the changing human resources mix in the labor force, which vocational counselors should be aware of. Trends include higher percentages of women working, and older men and married men leaving the work force. One result is an increasing number of persons are able to retire earlier. (JAC)
Taylor, Frederick L; Levine, Laurence A
The present paper provides a review of the available non-surgical treatments for Peyronie's disease (PD). A review of published literature on oral, intralesional, external energy and iontophoresis therapies for PD was performed, and the published results of available treatment options reviewed. The authors recommendations for appropriate non-surgical management of PD are provided. Although there are many published reports that show the efficacy of non-surgical therapies for PD, there is a lack of large scale, multicenter controlled clinical trials, which makes treatment recommendations difficult. Careful review of the literature does suggest that there are treatment options that make scientific sense and appear to stabilize the disease process, reduce deformity, and improve function. Offering no treatment at all will encourage our patients to pursue alternative treatments, which might do harm, and misses the opportunity to do some good. Clearly further work is necessary to develop safe and effective non-surgical treatments for PD.
Jeffrey B. Driban
Full Text Available We used our voluntary rat model of reaching and grasping to study the effect of performing a high-repetition and high-force (HRHF task for 12 weeks on wrist joints. We also studied the effectiveness of ibuprofen, administered in the last 8 weeks, in attenuating HRHF-induced changes in these joints. With HRHF task performance, ED1+ and COX2+ cells were present in subchondral radius, carpal bones and synovium; IL-1alpha and TNF-alpha increased in distal radius/ulna/carpal bones; chondrocytes stained with Terminal deoxynucleotidyl Transferase- (TDT- mediated dUTP-biotin nick end-labeling (TUNEL increased in wrist articular cartilages; superficial structural changes (e.g., pannus and reduced proteoglycan staining were observed in wrist articular cartilages. These changes were not present in normal controls or ibuprofen treated rats, although IL-1alpha was increased in reach limbs of trained controls. HRHF-induced increases in serum C1,2C (a biomarker of collagen I and II degradation, and the ratio of collagen degradation to synthesis (C1,2C/CPII; the latter a biomarker of collage type II synthesis were also attenuated by ibuprofen. Thus, ibuprofen treatment was effective in attenuating HRHF-induced inflammation and early articular cartilage degeneration.
A retrospective study of post surgical complications was conducted on records of students' Large Animal Surgical Laboratories in the Faculty of Veterinary Medicine (F.V.M.), Ahmadu Bello University (A.B.U), Zaria from 1989 to 1993. Three hundred and eleven surgical complications were recorded from five surgical ...
Full Text Available Helicopter pilots exposed to high intensity noise and other risk factors had increased risk to be noise-induced hearing loss (NIHL. Therefore, it is beneficial to study several risk factors related to NIHL. This study was a nested case-control. Data was extracted from available medical records among helicopter pilots who performed routine aerophysiology training indoctrination (ILA during 1980 through March 2004 at Saryanto Institute for Aviation and Aerospace Medicine (Lakespra, Jakarta. Case was those who had audiogram with a notch of 40 dB or more and of 4000 Hertz on one site or bilateral ears. A case was matched by two controls who free from NIHL up to 2004. All risk factors for cases and controls were counted as of reference date of cases diagnosed. There were 187 medical records available for this study. A number of 32 cases and 64 controls were identified. The final model reveals that NIHL was related to total duration of works, flight hours, and blood pressure. Those who had 500 hours or more than less 500 hours had a moderate increased risk for 2.5 to be NIHL [Adjusted odds ratio (ORa= 2.50; 95% confidence intervals (CI = 0.66-9.29; p = 0.180]. Those who had total duration works 11-24 years had a moderate increased to be NIHL for 2.7 times (ORa = 2.71; 95% CI=0.90-8.10; p = 0.075. Furthermore, prehypertension and hypertension stage 1 subjects than normal blood pressure had moderate trend increased risk to be NIHL. In conclusion total flight hours for 500 hours or more, total duration works 11-24 years, or prehypertension and hypertension stage 1 increased risk NIHL. (Med J Indones 2006; 15:185-90 Keywords: noise induced hearing loss, flight hours, working duration, blood pressure
Connolly, Michael; Seligman, Johnathan; Kastenmeier, Andrew; Goldblatt, Matthew; Gould, Jon C
The clinical application of robotic-assisted surgery (RAS) is rapidly increasing. The da Vinci Surgical System™ is currently the only commercially available RAS system. The skills necessary to perform robotic surgery are unique from those required for open and laparoscopic surgery. A validated laparoscopic surgical skills curriculum (fundamentals of laparoscopic surgery or FLS™) has transformed the way surgeons acquire laparoscopic skills. There is a need for a similar skills training and assessment tool specific for robotic surgery. Based on previously published data and expert opinion, we developed a robotic skills curriculum. We sought to evaluate this curriculum for evidence of construct validity (ability to discriminate between users of different skill levels). Four experienced surgeons (>20 RAS) and 20 novice surgeons (first-year medical students with no surgical or RAS experience) were evaluated. The curriculum comprised five tasks utilizing the da Vinci™ Skills Simulator (Pick and Place, Camera Targeting 2, Peg Board 2, Matchboard 2, and Suture Sponge 3). After an orientation to the robot and a period of acclimation in the simulator, all subjects completed three consecutive repetitions of each task. Computer-derived performance metrics included time, economy of motion, master work space, instrument collisions, excessive force, distance of instruments out of view, drops, missed targets, and overall scores (a composite of all metrics). Experienced surgeons significantly outperformed novice surgeons in most metrics. Statistically significant differences were detected for each task in regards to mean overall scores and mean time (seconds) to completion. The curriculum we propose is a valid method of assessing and distinguishing robotic surgical skill levels on the da Vinci Si™ Surgical System. Further study is needed to establish proficiency levels and to demonstrate that training on the simulator with the proposed curriculum leads to improved robotic
Chaudry, Qaiser; Raza, S. Hussain; Lee, Jeonggyu; Xu, Yan; Wulkan, Mark; Wang, May D.
Medical surgical procedures have not changed much during the past century due to the lack of accurate low-cost workbench for testing any new improvement. The increasingly cheaper and powerful computer technologies have made computer-based surgery planning and training feasible. In our work, we have developed an accurate 3D stomach model, which aims to improve the surgical procedure that treats the infant pediatric and neonatal gastro-esophageal reflux disease (GERD). We generate the 3-D infant stomach model based on in vivo computer tomography (CT) scans of an infant. CT is a widely used clinical imaging modality that is cheap, but with low spatial resolution. To improve the model accuracy, we use the high resolution Visible Human Project (VHP) in model building. Next, we add soft muscle material properties to make the 3D model deformable. Then we use virtual reality techniques such as haptic devices to make the 3D stomach model deform upon touching force. This accurate 3D stomach model provides a workbench for testing new GERD treatment surgical procedures. It has the potential to reduce or eliminate the extensive cost associated with animal testing when improving any surgical procedure, and ultimately, to reduce the risk associated with infant GERD surgery.
De Lorenzo, Danilo; De Momi, Elena; Dyagilev, Ilya; Manganelli, Rudy; Formaglio, Alessandro; Prattichizzo, Domenico; Shoham, Moshe; Ferrigno, Giancarlo
Force feedback in robotic minimally invasive surgery allows the human operator to manipulate tissues as if his/her hands were in contact with the patient organs. A force sensor mounted on the probe raises problems with sterilization of the overall surgical tool. Also, the use of off-axis gauges introduces a moment that increases the friction force on the bearing, which can easily mask off the signal, given the small force to be measured. This work aims at designing and testing two methods for estimating the resistance to the advancement (force) experienced by a standard probe for brain biopsies within a brain-like material. The further goal is to provide a neurosurgeon using a master-slave tele-operated driver with direct feedback on the tissue mechanical characteristics. Two possible sensing methods, in-axis strain gauge force sensor and position-position error (control-based method), were implemented and tested, both aimed at device miniaturization. The analysis carried out was aimed at fulfilment of the psychophysics requirements for force detection and delay tolerance, also taking into account safety, which is directly related to the last two issues. Controller parameters definition is addressed and consideration is given to development of the device with integration of a haptic interface. Results show better performance of the control-based method (RMSE sensors. Force feedback in minimally invasive surgery allows the human operator to manipulate tissues as if his/her hands were in contact with the patient organs. Copyright © 2011 John Wiley & Sons, Ltd.
Cevidanes, Lucia; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael
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
Zhang, Gangqiang; Ren, Tianhui; Lette, Walter; Zeng, Xiangqiong; van der Heide, Emile
Nowadays there is a wide variety of surgical sutures available in the market. Surgical sutures have different sizes, structures, materials and coatings, whereas they are being used for various surgeries. The frictional performances of surgical sutures have been found to play a vital role in their functionality. The high friction force of surgical sutures in the suturing process may cause inflammation and pain to the person, leading to a longer recovery time, and the second trauma of soft or fragile tissue. Thus, the investigation into the frictional performance of surgical suture is essential. Despite the unquestionable fact, little is actually known on the friction performances of surgical suture-tissue due to the lack of appropriate test equipment. This study presents a new penetration friction apparatus (PFA) that allowed for the evaluation of the friction performances of various surgical needles and sutures during the suturing process, under different contact conditions. It considered the deformation of tissue and can realize the puncture force measurements of surgical needles as well as the friction force of surgical sutures. The developed PFA could accurately evaluate and understand the frictional behaviour of surgical suture-tissue in the simulating clinical conditions. The forces measured by the PFA showed the same trend as that reported in literatures. Copyright © 2017 Elsevier Ltd. All rights reserved.
Langebæk, Rikke; Eika, Berit; Jensen, Asger Lundorff
The surgical educational environment is potentially stressful and this can negatively affect students' learning. The aim of this study was to investigate whether veterinary students' level of anxiety is higher in a surgical course than in a non-surgical course and if pre-surgical training...... in a Surgical Skills Lab (SSL) has an anxiety reducing effect. Investigations were carried out as a comparative study and a parallel group study. Potential participants were fourth-year veterinary students who attended a surgical course (Basic Surgical Skills) and a non-surgical course (Clinical Examination...... and 28 students from 2010). Our results show that anxiety levels in veterinary students are significantly higher in a surgical course than in a non-surgical course (p...
Full Text Available Introduction. Surgical tooth extraction is a common procedure in dentistry. However, numerous extraction cases show a high level of difficulty in practice. This difficulty is usually related to inadequate visualization, improper instrumentation, or other factors related to the targeted tooth (e.g., ankyloses or presence of bony undercut. Methods. In this work, the author presents a new technique for surgical tooth extraction based on 3D imaging, computer planning, and a new concept of computer-assisted manufacturing. Results. The outcome of this work is a surgical guide made by 3D printing of plastics and CNC of metals (hybrid outcome. In addition, the conventional surgical cutting tools (surgical burs are modified with a number of stoppers adjusted to avoid any excessive drilling that could harm bone or other vital structures. Conclusion. The present outcome could provide a minimally invasive technique to overcome the routine complications facing dental surgeons in surgical extraction procedures.
Zappella, Luca; Béjar, Benjamín; Hager, Gregory; Vidal, René
Much of the existing work on automatic classification of gestures and skill in robotic surgery is based on dynamic cues (e.g., time to completion, speed, forces, torque) or kinematic data (e.g., robot trajectories and velocities). While videos could be equally or more discriminative (e.g., videos contain semantic information not present in kinematic data), they are typically not used because of the difficulties associated with automatic video interpretation. In this paper, we propose several methods for automatic surgical gesture classification from video data. We assume that the video of a surgical task (e.g., suturing) has been segmented into video clips corresponding to a single gesture (e.g., grabbing the needle, passing the needle) and propose three methods to classify the gesture of each video clip. In the first one, we model each video clip as the output of a linear dynamical system (LDS) and use metrics in the space of LDSs to classify new video clips. In the second one, we use spatio-temporal features extracted from each video clip to learn a dictionary of spatio-temporal words, and use a bag-of-features (BoF) approach to classify new video clips. In the third one, we use multiple kernel learning (MKL) to combine the LDS and BoF approaches. Since the LDS approach is also applicable to kinematic data, we also use MKL to combine both types of data in order to exploit their complementarity. Our experiments on a typical surgical training setup show that methods based on video data perform equally well, if not better, than state-of-the-art approaches based on kinematic data. In turn, the combination of both kinematic and video data outperforms any other algorithm based on one type of data alone. Copyright © 2013 Elsevier B.V. All rights reserved.
P. H. M. Bonai
Full Text Available Nosocomial infection or nosocomial infection (NI is one of the factors that increase the cost of maintaining patients in the health system, even in processes that should safely occur, such as hospital patients and performing simple and routine surgical procedures surgical centers and clinics leading to complications resulting from these infections that prolong hospital stay and promote pain and suffering to the patient, resulting in the defense of the quality of services and influencing negatively the hospitals. Therefore, the aim of this study was to review the factors that result in surgical site infection, with the purpose of better understanding of the subject and the possibility of preventive actions to better treatment outcome of the patient.
Vassilev, Ivaylo; Rogers, Anne; Blickem, Christian; Brooks, Helen; Kapadia, Dharmi; Kennedy, Anne; Sanders, Caroline; Kirk, Sue; Reeves, David
Self-management support forms a central aspect of chronic Illness management nationally and globally. Evidence for the success of self-management support has mainly focussed on individually-centred outcomes of behavioural change. While it is recognised that social network members play an important role there is currently a gap in knowledge regarding who provides what type of support and under what circumstances. This is relevant for understanding the division of labour and the meeting of needs for those living with a long-term condition. We therefore took a network approach to explore self-management support conceptualising it as types of illness ‘work’ undertaken within peoples’ social networks. 300 people from deprived areas and with chronic illnesses took part in a survey conducted in 2010 in the North West of England. A concentric circles diagram was used as a research tool with which participants identified 2,544 network members who contributed to illness management. The results provide an articulation of how social network members are substantially involved in illness management. Whilst partners and close family make the highest contributions there is evidence of inputs from a wide range of relationships. Network member characteristics (type of relationship, proximity, frequency of contact) impact on the amount of illness work undertaken in peoples’ networks. In networks with ‘no partner’ other people tend to contribute more in the way of illness related work than in networks with a partner. This indicates a degree of substitutability between differently constituted networks, and that the level and type of input by different members of a network might change according to circumstances. A network perspective offers an opportunity to redress the balance of an exclusively individual focus on self-management because it addresses the broader set of contributions and resources available to people in need of chronic illness management and support. PMID
In this paper the present status of the meson theory of nuclear forces is reviewed. After some introductory remarks about the relevance of the meson exchange concept in the era of QCD and the empirical features of the NN interaction, the exciting history of nuclear forces is briefly outlined. In the main part, the author gives the basic physical ideas and sketch the derivation of the one-boson-exchange model of the nuclear force, in the Feynman approach. Secondly we describe, in a qualitative way, various necessary extensions, leading to the Bonn model of the N interaction. Finally, points to some interesting pen questions connected with the extended quark structure of the hadrons, which are topics of current research activity
Bell, R.E.; Hartley, D.S.III; Packard, S.L.
This report documents refined requirements for tools to aid the process of force design in Operations Other Than War (OOTWs). It recommends actions for the creation of one tool and work on other tools relating to mission planning. It also identifies the governmental agencies and commands with interests in each tool, from whom should come the user advisory groups overseeing the respective tool development activities. The understanding of OOTWs and their analytical support requirements has matured to the point where action can be taken in three areas: force design, collaborative analysis, and impact analysis. While the nature of the action and the length of time before complete results can be expected depends on the area, in each case the action should begin immediately. Force design for OOTWs is not a technically difficult process. Like force design for combat operations, it is a process of matching the capabilities of forces against the specified and implied tasks of the operation, considering the constraints of logistics, transport and force availabilities. However, there is a critical difference that restricts the usefulness of combat force design tools for OOTWs: the combat tools are built to infer non-combat capability requirements from combat capability requirements and cannot reverse the direction of the inference, as is required for OOTWs. Recently, OOTWs have played a larger role in force assessment, system effectiveness and tradeoff analysis, and concept and doctrine development and analysis. In the first Quadrennial Defense Review (QDR), each of the Services created its own OOTW force design tool. Unfortunately, the tools address different parts of the problem and do not coordinate the use of competing capabilities. These tools satisfied the immediate requirements of the QDR, but do not provide a long-term cost-effective solution.
Koyama, Masashi; Kurono, Kenji; Iida, Akihiko; Suzuki, Hirochika; Hara, Masaki; Mizutani, Hirokazu; Ohba, Satoru; Mizutani, Masaru; Nakajima, Yoichiro.
The CT, US, and MRI findings of confirmed retained surgical sponges were reviewed. The CT examinations in eight lesions demonstrated round or oval masses with heterogeneous internal structures. The US examinations in 5 lesions demonstrated low echogenic masses with high echogenic internal structures, which suggested retained surgical sponges. MR imagings in three lesions showed slightly high intensity comparable to that of muscles on T1-weighted images and high signal intensity on T2-weighted images, suggesting fluid collections of high protein concentration. (author)
Background Swaziland has the highest HIV prevalence in the world – 32% of adults are currently living with HIV — and many Swazis are chronically food insecure — in 2011 one in four Swazis required food aid from the World Food Programme. In southern Africa, food insecurity has been linked to high-risk sexual behaviors, difficulty with antiretroviral therapy (ART) adherence, higher rates of mother-to-child HIV transmission, and more rapid HIV progression. Sex workers in Swaziland are a population that is most at risk of HIV. Little is known about the context and needs of sex workers in Swaziland who are living with HIV, nor how food insecurity may affect these needs. Methods In-depth interviews were conducted with 20 female sex workers who are living with HIV in Swaziland. Interviews took place in four different regions of the country, and were designed to learn about context, experiences, and health service needs of Swazi sex workers. Results Hunger was a major and consistent theme in our informants’ lives. Women cited their own hunger or that of their children as the impetus to begin sex work, and as a primary motivation to continue to sell sex. Informants used good nutrition and the ability to access “healthy” foods as a strategy to manage their HIV infection. Informants discussed difficulty in adhering to ART when faced with the prospect of taking pills on an empty stomach. Across interviews, discussions of CD4 counts and ART adherence intertwined with discussions of poverty, hunger and healthy foods. Some sex workers felt that they had greater trouble accessing food through social networks as result of both their HIV status and profession. Conclusions Informants described a risk cycle of hunger, sex work, and HIV infection. The two latter drive an increased need for ‘healthy foods’ and an alienation from social networks that offer material and emotional support against hunger. Services and interventions for sex workers which address the pathways
Fielding-Miller, Rebecca; Mnisi, Zandile; Adams, Darrin; Baral, Stefan; Kennedy, Caitlin
Swaziland has the highest HIV prevalence in the world - 32% of adults are currently living with HIV - and many Swazis are chronically food insecure - in 2011 one in four Swazis required food aid from the World Food Programme. In southern Africa, food insecurity has been linked to high-risk sexual behaviors, difficulty with antiretroviral therapy (ART) adherence, higher rates of mother-to-child HIV transmission, and more rapid HIV progression. Sex workers in Swaziland are a population that is most at risk of HIV. Little is known about the context and needs of sex workers in Swaziland who are living with HIV, nor how food insecurity may affect these needs. In-depth interviews were conducted with 20 female sex workers who are living with HIV in Swaziland. Interviews took place in four different regions of the country, and were designed to learn about context, experiences, and health service needs of Swazi sex workers. Hunger was a major and consistent theme in our informants' lives. Women cited their own hunger or that of their children as the impetus to begin sex work, and as a primary motivation to continue to sell sex. Informants used good nutrition and the ability to access "healthy" foods as a strategy to manage their HIV infection. Informants discussed difficulty in adhering to ART when faced with the prospect of taking pills on an empty stomach. Across interviews, discussions of CD4 counts and ART adherence intertwined with discussions of poverty, hunger and healthy foods. Some sex workers felt that they had greater trouble accessing food through social networks as result of both their HIV status and profession. Informants described a risk cycle of hunger, sex work, and HIV infection. The two latter drive an increased need for 'healthy foods' and an alienation from social networks that offer material and emotional support against hunger. Services and interventions for sex workers which address the pathways through which food insecurity generates vulnerability
Zens, Martin; Goldschmidtboeing, Frank; Wagner, Ferdinand; Reising, Kilian; Südkamp, Norbert P; Woias, Peter
Several different surgical techniques are used in the treatment of olecranon fractures. Tension band wiring is one of the most preferred options by surgeons worldwide. The concept of this technique is to transform a tensile force into a compression force that adjoins two surfaces of a fractured bone. Currently, little is known about the resulting compression force within a fracture. Sensor devices are needed that directly transduce the compression force into a measurement quality. This allows the comparison of different surgical techniques. Ideally the sensor devices ought to be placed in the gap between the fractured segments. The design, development and characterization of miniaturized pressure sensors fabricated entirely from polydimethylsiloxane (PDMS) for a placement within a fracture is presented. The pressure sensors presented in this work are tested, calibrated and used in an experimental in vitro study. The pressure sensors are highly sensitive with an accuracy of approximately 3 kPa. A flexible fabrication process for various possible applications is described. The first in vitro study shows that using a single-twist or double-twist technique in tension band wiring of the olecranon has no significant effect on the resulting compression forces. The in vitro study shows the feasibility of the proposed measurement technique and the results of a first exemplary study.
Vertut, J.; Marchal, P.; Debrie, G.; Kissel, Ph.
Manipulators of this type manufactured 10-15 years ago were not a success, their widespread introduction having been prevented by their excessive weight, too low capacity, too extensive electronics and high price. The MA 22 system, based on the Virgule device, led to the development of a new technology which combines high reliability with excellent performance, very small electronics and high-torque d.c. motors. The second generation, MA 23, is characterized by a substantially improved mechanism, enabling maximum advantage to be derived from the servo control and making it possible to reproduce, at unlimited distance and with very high slave strength, the dexterity displaced by light master-slave manipulators on the operator side. The authors describe the equipment and indicate the various possibilites for its use in facilities. Long-term development and testing is also being directed towards under-water operation and industrial automatic manipulation. The equipment described opens up a totally new potential for the development of remote-controlled intervention devices, and the authors refer to work on these lines in the Federal Republic of Germany and in France. The research and development effort will also be concerned with penetration into inaccessible parts of facilities. (author)
Full Text Available Temporomandibular joint and the pelvic complex are bidirectionally related. Ankylosing spondylitis (AS is a seronegative arthropathy with the key feature of bony fusion of lumbar vertebrae. A 39 year old known case of AS was presented to private office for left lower impacted third molar surgical removal. Previously, he was rejected to receive oral care for pulpectomy and extraction due to limited mouth opening. Prior to the surgery, lateral neck radiography was obtained to exclude any subluxation of fracture of cervical vertebrae. Neck was supported to insure neck stability during surgical forces. In addition, considering consumption of immunosuppressive medications including corticosteroids, procedure was performed with a great care, with attention to higher possibility of infection and fracture. Access to the surgical site was not desirable, though surgery accomplished without any significant event and the patient discharged with routine analgesic and antibiotics recommendation. Sometimes, impaired access to the oral cavity in patients with AS leads to receive suboptimal or minimal orodental care. Long list of dental implications in these patients may be simplified by considering of careful neck and jaw support, applying at least possible forces and great attention to the infection control rules. It is wised to be performed under patient and skilled hands.
Levi-Mazloum, Niels Donald; Prag, Jørgen Brorson; Jensen, J S
Mycoplasma hominis and Ureaplasma urealyticum are common inhabitants of the human genital tract. Evidence for an aetiological role in pyelonephritis, pelvic inflammatory disease, post-abortion and post-partum fever has been presented. There are sporadic reports of Mycoplasma causing serious...... extragenital infection such as septicemia, septic arthritis, neonatal meningitis and encephalitis. We review 38 cases of surgical infections with Mycoplasma....
Heckmann, A; Leclère, F M; Vogt, P M; Steiert, A
Nowadays surgical intervention is an essential part of the treatment of idiopathic gynecomastia. Choosing the right method is crucial and is based on the current status in the clinical and histological evaluation. Before finalizing the process of choosing a specific method a prior interdisciplinary evaluation of the patient is necessary to ascertain clear indications for a surgical intervention. Liposuction is one of the methods which have become popular in recent years. The advantages are the possible combination with traditional techniques, such as subcutaneous mastectomy or periareolar mastopexy. The main indication is for gynecomastia stage IIa/b and is justifiable due to the reduction in surgical complications and scarring. Furthermore this technique provides an excellent aesthetical outcome for the patient. A total of 162 patients suffering from gynecomastia stages I-III (according to Simon) were surgically treated between 2000 and 2010 and these cases were retrospectively evaluated. The results showed a decline in the use of a T-shaped incision in combination with subcutaneous mastectomy with periareolar tightening compared to an increase in the use of subcutaneous mastectomy in combination with liposuction. The excised tissue should always be sent for histological examination to make sure no malignant cells were present.
Full Text Available Surgical manifestations of filariasis as seen in 150 cases over a period of three years in the department of Surgery, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha are reviewed. The genital manifestations are more common than the elephantiasis in this endemic zone.
Culwick, Caroline; Devine, Chris; Coombs, Catherine
Effective handovers are vital to patient safety and continuity of care, and this is recognised by several national bodies including the GMC. The existing model at Great Western Hospital (GWH) involved three general surgical teams and a urology team placing their printed patient lists, complete with weekend jobs, in a folder for the on-call team to collect at the weekend. We recognised a need to reduce time searching for patients, jobs and reviews, and to streamline weekend ward rounds. A unified weekend list ordering all surgical patients by ward and bed number was introduced. Discrepancies in the layout of each team's weekday list necessitated the design of a new weekday list to match the weekend list to facilitate the easy transfer of information between the two lists. A colour coding system was also used to highlight specific jobs. Prior to this improvement project only 7.1% of those polled were satisfied with the existing system, after a series of interventions satisfaction increased to 85.7%. The significant increase in overall satisfaction with surgical handover following the introduction of the unified weekend list is promising. Locating patients and identifying jobs is easier and weekend ward rounds can conducted in a more logical and timely fashion. It has also helped facilitate the transition to consultant ward rounds of all surgical inpatients at the weekends with promising feedback from a recent consultants meeting.
Ben Ameur, Hazem; Affes, Nejmeddine; Rejab, Haitham; Abid, Bassem; Boujelbene, Salah; Mzali, Rafik; Beyrouti, Mohamed Issam
The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medical or surgical complications. reporting the incidence of surgical complications of colostomies, their therapeutic management and trying to identify risk factors for their occurrence. A retrospective study for a period of 5 years in general surgery department, Habib Bourguiba hospital, Sfax, including all patients operated with confection of a colostomy. Were then studied patients reoperated for stoma complication. Among the 268 patients who have had a colostomy, 19 patients (7%) developed surgical stoma complications. They had a mean age of 59 years, a sex ratio of 5.3 and a 1-ASA score in 42% of cases. It was a prolapse in 9 cases (reconfection of the colostomy: 6 cases, restoration of digestive continuity: 3 cases), a necrosis in 5 cases (reconfection of the colostomy), a plicature in 2 cases (reconfection of the colostomy) a peristomal abscess in 2 cases (reconfection of the colostomy: 1 case, restoration of digestive continuity: 1 case) and a strangulated parastomal hernia in 1 case (herniorrhaphy). The elective incision and the perineal disease were risk factors for the occurrence of prolapse stomial. Surgical complications of colostomies remain a rare event. Prolapse is the most common complication, and it is mainly related to elective approach. Reoperation is often required especially in cases of early complications, with usually uneventful postoperative course.
Tsang, J S
Shortened trainingtimes duetothe European Working Time Directive (EWTD) and increased public scrutiny of surgical competency have led to a move away from the traditional apprenticeship model of training. Virtual reality (VR) simulation is a fascinating innovation allowing surgeons to develop without the need to practice on real patients and it may be a solution to achieve competency within a shortened training period.
Watanabe, Gou; Ishikawa, Norihiro
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.
Wang, Ying; Wang, Zuobin; Liu, Jinyun; Hou, Liwei
This paper presents a method for differential magnetic force microscope imaging based on a two-pass scanning procedure to extract differential magnetic forces and eliminate or significantly reduce background forces with reversed tip magnetization. In the work, the difference of two scanned images with reversed tip magnetization was used to express the local magnetic forces. The magnetic sample was first scanned with a low lift distance between the MFM tip and the sample surface, and the magnetization direction of the probe was then changed after the first scan to perform the second scan. The differential magnetic force image was obtained through the subtraction of the two images from the two scans. The theoretical and experimental results have shown that the proposed method for differential magnetic force microscope imaging is able to reduce the effect of background or environment interference forces, and offers an improved image contrast and signal to noise ratio (SNR). © Wiley Periodicals, Inc.
Diabetic retinopathy is the most common ophthalmic complication of diabetes and the leading cause of blindness among adults, ages 30 to 70. Surgery to remove scar tissue in the eye is the only corrective treatment once the retina is affected. Visual recovery is often hampered by retinal trauma during surgery and by low patient compliance. Our work in this project aimed to improve vitreoretinal surgical methods from information gathered by sensitive surface analysis of pre-retinal tissues found at the vitreoretinal interface. Atomic force microscopy characterization of human retinal tissues revealed that surgically excised inner limiting membrane (ILM) has a heterogeneous surface and is mainly composed of globular and fibrous structures. ILM tissues also show low adhesion for clean unmodified surfaces as opposed to those with functional groups attractive to those on the ILM surface, due to their charge. Based on these observations, layer-by-layer films with embedded gold nanoparticles with a positive outer charge were designed. These modifications increased the adhesion between surgical instruments and ILM by increasing the roughness and tuning the film surface charge. These films proved to be stable under physiological conditions. Finally, the effect of vital dyes on the topographical characteristics of ILMs was characterized and new imaging modes to further reveal ILM topography were utilized. Roughness and adhesion force data suggest that second generation dyes have no effect on the surface nanostructure of ILMs, but increase adhesion at the tip sample interface. This project clearly illustrates that physicochemical information from tissues can be used to rationally re-design surgical procedures, in this case for tissue removal purposes. This rational design method can be applied to other soft tissue excision procedures as is the case of cataract surgery or laparoscopic removal of endometrial tissue.
Lee, Chiwon; Park, Woo Jung; Kim, Myungjoon; Noh, Seungwoo; Yoon, Chiyul; Lee, Choonghee; Kim, Youdan; Kim, Hyeon Hoe; Kim, Hee Chan; Kim, Sungwan
Although minimally invasive surgery (MIS) affords several advantages compared to conventional open surgery, robotic MIS systems still have many limitations. One of the limitations is the non-uniform gripping force due to mechanical strings of the existing systems. To overcome this limitation, a surgical instrument with a pneumatic gripping system consisting of a compressor, catheter balloon, micro motor, and other parts is developed. This study aims to implement a surgical instrument with a pneumatic gripping system and pitching/yawing joints using micro motors and without mechanical strings based on the surgical-operation-by-wire (SOBW) concept. A 6-axis external arm for increasing degrees of freedom (DOFs) is integrated with the surgical instrument using LabVIEW® for laparoscopic procedures. The gripping force is measured over a wide range of pressures and compared with the simulated ideal step function. Furthermore, a kinematic analysis is conducted. To validate and evaluate the system's clinical applicability, a simple peg task experiment and workspace identification experiment are performed with five novice volunteers using the fundamentals of laparoscopic surgery (FLS) board kit. The master interface of the proposed system employs the hands-on-throttle-and-stick (HOTAS) controller used in aerospace engineering. To develop an improved HOTAS (iHOTAS) controller, 6-axis force/torque sensor was integrated in the special housing. The mean gripping force (after 1,000 repetitions) at a pressure of 0.3 MPa was measured to be 5.8 N. The reaction time was found to be 0.4 s, which is almost real-time. All novice volunteers could complete the simple peg task within a mean time of 176 s, and none of them exceeded the 300 s cut-off time. The system's workspace was calculated to be 11,157.0 cm3. The proposed pneumatic gripping system provides a force consistent with that of other robotic MIS systems. It provides near real-time control. It is more durable than the
Georgilas, Ioannis; Dagnino, Giulio; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja
Our group at Bristol Robotics Laboratory has been working on a new robotic system for fracture surgery that has been previously reported . The robotic system is being developed for distal femur fractures and features a robot that manipulates the small fracture fragments through small percutaneous incisions and a robot that re-aligns the long bones. The robots controller design relies on accurate and bounded force and position parameters for which we require real surgical data. This paper reports preliminary findings of forces and torques applied during bone and soft tissue manipulation in typical orthopaedic surgery procedures. Using customised orthopaedic surgical tools we have collected data from a range of orthopaedic surgical procedures at Bristol Royal Infirmary, UK. Maximum forces and torques encountered during fracture manipulation which involved proximal femur and soft tissue distraction around it and reduction of neck of femur fractures have been recorded and further analysed in conjunction with accompanying image recordings. Using this data we are establishing a set of technical requirements for creating safe and dynamically stable minimally invasive robot-assisted fracture surgery (RAFS) systems.
Full Text Available El objetivo principal de este texto es discutir la aplicación de la noción de "fuerza de trabajo secundaria" para caracterizar la fuerza da trabajo femenina en América Latina. Esa caracterización, hecha con frecuencia en forma mecánica por un lado corresponde, cada vez menos a la realidad de los hechos, ya que es creciente la participación femenina en el mercado de trabajo, así como la continuidad de sus trayectorias laborales, el número de horas dedicadas al trabajo remunerado, así como su aporte al ingreso familiar y a la superación de la situación de pobreza de un porcentaje importante de hogares. Por otro lado, el texto argumenta que esa caracterización es uno de los elementos centrales en la estructuración de los patrones de discriminación de género que persisten y se reproducen en el mercado de trabajo latinoamericano.This article aims to discuss the concept of "secondary labor force" to characterize female workforce in Latin America. Such characterization corresponds increasingly less to reality, as women's participation in the labor force and the hours dedicated to their paid work continues to grow, as well as their contribution to household income. The article argues that such characterization is one of the core elements of the gender discriminating patterns that persist in Latin American labor market.
The particles and forces of matter, found in the Universe, are discussed with especial reference to some of the laws which govern behaviour in the sub-atomic world and which determine the way forces work to give matter its various characteristics. The recent history of the search for elementary constituents of matter in this century is outlined and the replacement of the simplicity anticipated in the 1930s by the proliferation of particle states uncovered in the 1950s and 1960s which led to the quark model is examined. (U.K.)
M. Erol Demirseren
Full Text Available Achieving a level of technical skill and confidence in surgical operations is the main goal of plastic surgical training. Operating rooms were accepted as the practical teaching venues of the traditional apprenticeship model. However, increased patient population, time, and ethical and legal considerations made preoperation room practical work a must for plastic surgical training. There are several plastic surgical teaching models and simulators which are very useful in preoperation room practical training and the evaluation of plastic surgery residents. The full thickness skin with its vascular network excised in abdominoplasty procedures is an easily obtainable real human tissue which could be used as a training model in plastic surgery.
Levý, M; Herdegen, P; Sutoris, K; Simša, J
Surgical treatment, despite the rapid development of the numerous modern miniinvasive intervention techniques, remains essential in the treatment of complicated diverticular disease. The aim of this work is to summarize indications for surgical treatment in both acute and elective patients suffering from diverticular disease of the large bowel. Review of the literature and recent findings concerning indications for surgical intervention in patients with diverticulosis of the colon. The article describes indications, types of procedures, techniques and postoperative care in patients undergoing surgical intervention for diverticular disease.
... organized for general surgeons undertaking paediatric surgical emergencies. More paediatric surgeons should be trained and more paediatric surgical units should established in the country. Key Words: Paediatric Abdominal Surgical Emergencies; Paediatric Surgeons, General Surgeons. Journal of College of Medicine ...
Full Text Available The treatment of infections of orthopedic implants is often difficult and complex, although the chances of successful treatment with properly selected diagnostics, surgical and antibiotic treatment protocol have recently increased significantly. Surgical treatment is a key stone factor in the treatment of infections of orthopedic implants and any errors in it often lead to worse clinical outcomes. The most important and frequent surgical errors include: conservative treatment of periprothetic infections with antibiotics only, to-late surgical revision, insufficient debridement during surgical revision, inadequate intraoperative samples for bacteriological and histological analysis. It is important to have and to follow proper treatment algorithm for periprosthetic joint infection. In this work we present the listed surgical and most illustrative key errors.
. The planned visits were advertised locally and in the national media. Screening of the patients was done first by the local medical teams and later by the visiting surgical teams. The surgical teams were comprised of the following personnel:.
.... The author examines how Special Forces and conventional forces worked together in the past in Vietnam, Panama, Somalia, Haiti, Bosnia-Herzegovina, and Operations Desert Storm and Desert Shield...
Culwick, Caroline; Devine, Chris; Coombs, Catherine
Effective handovers are vital to patient safety and continuity of care, and this is recognised by several national bodies including the GMC. The existing model at Great Western Hospital (GWH) involved three general surgical teams and a urology team placing their printed patient lists, complete with weekend jobs, in a folder for the on-call team to collect at the weekend. We recognised a need to reduce time searching for patients, jobs and reviews, and to streamline weekend ward rounds. A unif...
Many topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and evaluation of minimally invasive surgical skills in a training setting and in practice in the operating room. This thesis has led to an enlarged insight in the organization of surgical skills training during residency training of surgical medical specialists.
Steensen, Elmer Fly; Sanchez, Ron
This chapter proposes that organizational strategy formation should be characterized theoretically as a process that is subject to several interacting forces, rather than represented by separate discrete decisionmodels or theoretic perspectives, as is commonly done in the strategic management...... literature. Based on an extensive review of relevant theory and empirical work in strategic decision-making, organizational change theory, cognitive and social psychology, and strategy processes, seven kinds of ''forces'' - rational, imposed, teleological, learning, political, heuristic, and social...... - are identified as interacting in and having significant influence on the strategy formation process. It is further argued that by applying a holistic ''forces-view'' of the significant and interacting influences on strategy formation, we can better understand the dynamics and challenges in managing the process...
Ben-Or, Sharon; Nifong, L Wiley; Chitwood, W Randolph
In July 2000, the da Vinci Surgical System (Intuitive Surgical, Inc) received Food and Drug Administration approval for intracardiac applications, and the first mitral valve repair was done at the East Carolina Heart Institute in May 2000. The system is now approved and used in many surgical specialties. With this disruptive technology and accepted use, surgeons and hospitals are seeking the most efficacious training pathway leading to safe use and responsible credentialing.One of the most important issues related to safe use is assembling the appropriate team of professionals involved with patient care. Moreover, proper patient selection and setting obtainable goals are also important.Creation and maintenance of a successful program are discussed in the article focusing on realistic goals. This begins with a partnership between surgeon leaders, hospital administrators, and industry support. Through this partnership, an appropriate training pathway and clinical pathway for success can be outlined. A timeline can then be created with periods of data analysis and adjustments as necessary. A successful program is attainable by following this pathway and attending to every detail along the journey.
Sadideen, Hazim; Alvand, Abtin; Saadeddin, Munir; Kneebone, Roger
The concept of surgical expertise and the processes involved in its development are topical, and there is a constant drive to identify reliable measures of expert performance in surgery. This review explores the notion of whether surgical experts are "born" or "made", with reference to educational theory and pertinent literature. Peer-reviewed publications, books, and online resources on surgical education, expertise and training were reviewed. Important themes and aspects of expertise acquisition were identified in order to better understand the concept of a surgical expert. The definition of surgical expertise and several important aspects of its development are highlighted. Innate talent plays an important role, but is insufficient on its own to produce a surgical expert. Multiple theories that explore motor skill acquisition and memory are relevant, and Ericsson's theory of the development of competence followed by deliberate self-practice has been especially influential. Psychomotor and non-technical skills are necessary for progression in the current climate in light of our training curricula; surgical experts are adaptive experts who excel in these. The literature suggests that surgical expertise is reached through practice; surgical experts are made, not born. A deeper understanding of the nature of expert performance and its development will ensure that surgical education training programmes are of the highest possible quality. Surgical educators should aim to develop an expertise-based approach, with expert performance as the benchmark. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
The Nigerian Journal of Surgical Research is a publication of the Surgical Research Society with main office in Zaria, Nigeria. Zaria is home to Ahmadu Bello University (ABU), a premier university in Nigeria. The aim of The Nigerian Journal of Surgical Research is to cover developments and advances in the broad field of ...
Rogers, Mary E; Creed, Peter A; Searle, Judy
To identify the reasons why interns would not choose a surgical career. This qualitative study used semi-structured telephone interviews to explore the future career choices of 41 junior doctors (14 men, 27 women). Doctors were asked to identify specialties they would not take up, and state why this was the case. Thirty (73.2%) of the 41 interns nominated surgery as a specialty they would not choose. Themes relating to reasons for not wanting to pursue a surgical career included the lifestyle associated with surgery (66.7%), the culture within the surgical work environment (53.3%), the lack of interest in performing surgical work (36.7%), and the training requirements associated with surgery (33.3%). Both sexes had similar reasons for not wanting to choose a surgical career; but additionally, women referred to the male domination of surgery, and the difficulty and inflexibility of the training program as deterrents. Efforts are needed to promote interest in surgery as a career especially for women, to improve the surgical work environment so that medical students and junior doctors have exposure to positive role models and surgical placements, and to provide a more flexible approach to surgical training.
Arata, Jumpei; Kenmotsu, Hajime; Takagi, Motoki; Hori, Tatsuya; Miyagi, Takahiro; Fujimoto, Hideo; Kajita, Yasukazu; Hayashi, Yuichiro; Chinzei, Kiyoyuki; Hashizume, Makoto
We are currently developing a neurosurgical robotic system that facilitates access to residual tumors and improves brain tumor removal surgical outcomes. The system combines conventional and robotic surgery allowing for a quick conversion between the procedures. This concept requires a new master console that can be positioned at the surgical bedside and be sterilized. The master console was developed using new technologies, such as a parallel mechanism and pneumatic sensors. The parallel mechanism is a purely passive 5-DOF (degrees of freedom) joystick based on the author's haptic research. The parallel mechanism enables motion input of conventional brain tumor removal surgery with a compact, intuitive interface that can be used in a conventional surgical environment. In addition, the pneumatic sensors implemented on the mechanism provide an intuitive interface and electrically isolate the tool parts from the mechanism so they can be easily sterilized. The 5-DOF parallel mechanism is compact (17 cm width, 19cm depth, and 15cm height), provides a 505,050 mm and 90° workspace and is highly backdrivable (0.27N of resistance force representing the surgical motion). The evaluation tests revealed that the pneumatic sensors can properly measure the suction strength, grasping force, and hand contact. In addition, an installability test showed that the master console can be used in a conventional surgical environment. The proposed master console design was shown to be feasible for operative neurosurgery based on comprehensive testing. This master console is currently being tested for master-slave control with a surgical robotic system.
Surgical laboratory in pregraduate students in medicine is beneficial and improves learning processes in cognitive aspects and skills acquisition. It is also an early initiation into scientific research. The laboratory is the introductory pathway into basic concepts of medical science (meaningful learning). It is also where students gain knowledge in procedures and abilities to obtain professional skills, an interactive teacher-student process. Medicine works rapidly to change from an art to a science. This fact compromises all schools and medical faculties to analyze their actual lesson plans. Simulators give students confidence and ability and save time, money and resources, eliminating at the same time the ethical factor of using live animals and the fear of patient safety. Multimedia programs may give a cognitive context evolving logically with an explanation based on written and visual animation followed by a clinical problem and its demonstration in a simulator, all before applying knowledge to the patient.
M.Venkata Krishna Reddy
A common threat Web developers face is a password-guessing attack known as a brute-force attack. A brute-force attack is an attempt to discover a password by systematically trying every possible combination of letters, numbers, and symbols until you discover the one correct combination that works. If your Web site requires user authentication, you are a good target for a brute-force attack. An attacker can always discover a password through a brute-force attack, but the downside is that it co...
Jery, Belgacem; Brennen, Christopher E.; Caughey, Thomas K.; Acosta, Allan
Forces are exerted on a centrifugal pump impeller, due to the asymmetry of the flow caused by the volute of diffuser, and to the motion of the center of the impeller whenever the shaft whirls. Recent work in the measurement of these forces as a function of the whirl speed to shaft speed ratio, and the influence of the volute, is reviewed. These forces may be decomposed into a steady force, a static stiffness matrix, a damping matrix and an inertia matrix. It is shown that for centrifugal p...
Mario R. Romano
Full Text Available Two kinds of forces are active in vitreoretinal traction diseases: tangential and anterior-posterior forces. However, tangential forces are less characterized and classified in literature compared to the anterior-posterior ones. Tangential epiretinal forces are mainly due to anomalous posterior vitreous detachment (PVD, vitreoschisis, vitreopapillary adhesion (VPA, and epiretinal membranes (ERMs. Anomalous PVD plays a key role in the formation of the tangential vectorial forces on the retinal surface as consequence of gel liquefaction (synchysis without sufficient and fast vitreous dehiscence at the vitreoretinal interface. The anomalous and persistent adherence of the posterior hyaloid to the retina can lead to vitreomacular/vitreopapillary adhesion or to a formation of avascular fibrocellular tissue (ERM resulting from the proliferation and transdifferentiation of hyalocytes resident in the cortical vitreous remnants after vitreoschisis. The right interpretation of the forces involved in the epiretinal tangential tractions helps in a better definition of diagnosis, progression, prognosis, and surgical outcomes of vitreomacular interfaces.
Hyundo Choi; Yoan Lim; Junhyung Kim
Haptic feedback is critical for many surgical tasks, and it replicates force reflections at the surgical site. To meet the force reflection requirements, we propose a force sensor with an optical fiber Bragg grating (FBG) for robotic surgery. The force sensor can calculate three directional forces of an instrument from the strain of three FBGs, even under electromagnetic interference. A flexible ring-shape structure connects an instrument tip and fiber strain gages to sense three directional force. And a stopper mechanism is added in the structure to avoid plastic deformation under unexpected large force on the instrument tip. The proposed sensor is experimentally verified to have a sensing range from -12 N to 12 N, and its sensitivity was less than 0.06 N.
Quérat, C; Germain, N; Dumollard, J-M; Estour, B; Peoc'h, M; Prades, J-M
Hyperthyroidism includes several clinical and histopathological situations. Surgery is commonly indicated after failure of medical treatment. The aim of this study was to analyze the indications and complications of surgery as well as endocrine results. Patients operated on for hyperthyroidism between 2004 and 2012 were included in a retrospective study. Total thyroidectomy was performed for Graves' disease, toxic multinodular goiter and amiodarone-associated thyrotoxicosis; patients with toxic nodule underwent hemithyroidectomy. Pathologic analysis assessed surgical specimens; postoperative complications and resolution of hyperthyroidism were noted. Two hundred patients from 15 to 83 years old were included. One hundred and eighty-eight underwent primary surgery and 12 were re-operated for recurrent goiter (6 with subtotal thyroidectomy for multinodular goiter 25 years previously; 6 with hemithyroidectomy for solitary nodule 15 years previously). Eighty-two patients suffered from toxic multinodular goiter, 78 from Graves' disease, 35 from solitary toxic nodules and 5 from amiodarone-associated thyrotoxicosis. Fourteen papillary carcinomas (including 11 papillary microcarcinomas) and 34 healthy parathyroid glands (17%) were identified in the pathological specimens. Postoperative complications comprised 4% permanent recurrent laryngeal nerve palsy (1 year follow-up), 9% hematoma requiring surgical revision, and 3% definitive hypocalcemia. Normalization of thyroid hormone levels was observed in 198 patients. Two recurrences occurred due to incomplete resection (1 case of Graves' disease and 1 intrathoracic toxic goiter that occurred respectively 18 and 5 months after resection). Postoperative complications were more frequent in multinodular goiter (23%) than in Graves' disease (13%) (ns: P>0.05). Surgical management of hyperthyroidism enables good endocrinal control if surgery is complete. Patients need to be fully informed of all possible postoperative complications
Merino, M L; Gómez de Liaño, P; Merino, P; Franco, G
We report 3 cases with a vertical incomitance in upgaze, narrowing of palpebral fissure, and pseudo-overaction of both inferior oblique muscles. Surgery consisted of an elevation of both lateral rectus muscles with an asymmetrical weakening. A satisfactory result was achieved in 2 cases, whereas a Lambda syndrome appeared in the other case. The surgical technique of upper-insertion with a recession of both lateral rectus muscles improved vertical incomitance in 2 of the 3 patients; however, a residual deviation remains in the majority of cases. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.
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.
Youri P. A. Tan
Full Text Available Surgical robots have the potential to provide surgeons with increased capabilities, such as removing physiologic tremor, scaling motion and increasing manual dexterity. Several surgical specialties have subsequently integrated robotic surgery into common clinical practice. Plastic and reconstructive microsurgical procedures have not yet benefitted significantly from technical developments observed over the last two decades. Several studies have successfully demonstrated the feasibility of utilising surgical robots in plastic surgery procedures, yet limited work has been done to identify and analyse current barriers that have prevented wide-scale adaptation of surgical robots for microsurgery. Therefore, a systematic review using PubMed, MEDLINE, Embase and Web of Science databases was performed, in order to evaluate current state of surgical robotics within the field of reconstructive microsurgery and their limitations. Despite the theoretical potential of surgical robots, current commercially available robotic systems are suboptimal for plastic or reconstructive microsurgery. Absence of bespoke microsurgical instruments, increases in operating time, and high costs associated with robotic-assisted provide a barrier to using such systems effectively for reconstructive microsurgery. Consequently, surgical robots provide currently little overall advantage over conventional microsurgery. Nevertheless, if current barriers can be addressed and systems are specifically designed for microsurgery, surgical robots may have the potential of meaningful impact on clinical outcomes within this surgical subspeciality.
Tan, Youri P. A.; Liverneaux, Philippe; Wong, Jason K. F.
Surgical robots have the potential to provide surgeons with increased capabilities, such as removing physiologic tremor, scaling motion and increasing manual dexterity. Several surgical specialties have subsequently integrated robotic surgery into common clinical practice. Plastic and reconstructive microsurgical procedures have not yet benefitted significantly from technical developments observed over the last two decades. Several studies have successfully demonstrated the feasibility of utilising surgical robots in plastic surgery procedures, yet limited work has been done to identify and analyse current barriers that have prevented wide-scale adaptation of surgical robots for microsurgery. Therefore, a systematic review using PubMed, MEDLINE, Embase and Web of Science databases was performed, in order to evaluate current state of surgical robotics within the field of reconstructive microsurgery and their limitations. Despite the theoretical potential of surgical robots, current commercially available robotic systems are suboptimal for plastic or reconstructive microsurgery. Absence of bespoke microsurgical instruments, increases in operating time, and high costs associated with robotic-assisted provide a barrier to using such systems effectively for reconstructive microsurgery. Consequently, surgical robots provide currently little overall advantage over conventional microsurgery. Nevertheless, if current barriers can be addressed and systems are specifically designed for microsurgery, surgical robots may have the potential of meaningful impact on clinical outcomes within this surgical subspeciality. PMID:29740585
Marciuc, Daly; Solschi, Viorel
Understanding the Coriolis effect is essential for explaining the movement of air masses and ocean currents. The lesson we propose aims to familiarize students with the manifestation of the Coriolis effect. Students are guided to build, using the GeoGebra software, a simulation of the motion of a body, related to a rotating reference system. The mathematical expression of the Coriolis force is deduced, for particular cases, and the Foucault's pendulum is presented and explained. Students have the opportunity to deepen the subject, by developing materials related to topics such as: • Global Wind Pattern • Ocean Currents • Coriolis Effect in Long Range Shooting • Finding the latitude with a Foucault Pendulum
Astronomers have compiled evidence that what we always thought of as the actual universe- all the planets, stars, galaxies and matter in space -represents a mere 4% of what's out there. The rest is dark: 23% is called dark matter, 73% dark energy. Scientists have ideas about what dark matter is, but hardly any understanding about dark energy. This has led to rethinking traditional physics and cosmology. Assuming the existence of dark matter and that the law of gravitation is universal, two teams of astrophysicists, from Lawrence Berkeley National Laboratory and the Australian National University, analysed the universe's growth and to their surprise both concluded that the universe expansion is not slowing but speeding up. If the dominant force of evolution isn't gravity what is it?
Patrick J Stokes
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.
Soraya Maria de Medeiros
Full Text Available A articulação entre modo de produção, políticas sociais e práticas de saúde constitui-se o fio condutor desta investigação: trabalho e trabalhadores em saúde. A Terceira Revolução Industrial desencadeou novas articulações de processos econômicos, políticos e sociais, projetos de sociedade, formas de organização de poder e de atores sociais em proporções mundiais. A conformação definida pela nova divisão mundial do trabalho mantém uma relação de força desigual entre o grupo dos países desenvolvidos e em desenvolvimento. O Brasil também vivencia esse processo de transformação e vem implantando políticas sociais com características do modelo neoliberal. Tais políticas têm causado dificuldades, injustiças e instabilidade social, constituindo desafios aos direitos sociais e desencadeando processos que envolvem os âmbitos público e o privado, em termos organizativos e de subjetividade. Este estudo trata de um recorte de periferia do capitalismo tardio, tendo o Brasil como exemplo, e mais especificamente a região Nordeste.The articulation among production mode, social politics and health practices is established as conducting wire of our inquiry press cutting: the work and the workers in health. The Third Industrial Revolution unchained new articulations with the economical, political and social processes in world-wide ratios, the society projects, forms of organization, power and the social actors. This conformation defined by the new world-wide work division keeps a relation of unequal force between developed countries group and developing countries. Brazil lives this transformation process and has been implanting social politics with the neoliberal model characteristics. Such politcs have been motivating difficulties, injustices and social instability, constituting challenges to the question of the social rights and unchaining processes that involve the public and the private of the Brazilian citizens, in their
Nestel, Debra; Harlim, Jennifer; Bryant, Melanie; Rampersad, Rajay; Hunter-Smith, David; Spychal, Bob
The landscape of surgical training is changing. The anticipated increase in the numbers of surgical trainees and the shift to competency-based surgical training places pressures on an already stretched health service. With these pressures in mind, we explored trainers' and trainees' experiences of surgical training in a less traditional rotation, an outer metropolitan hospital. We considered practice-based learning theories to make meaning of surgical training in this setting, in particular Actor-network theory. We adopted a qualitative approach and purposively sampled surgical trainers and trainees to participate in individual interviews and focus groups respectively. Transcripts were made and thematically analysed. Institutional human research ethics approval was obtained. Four surgical trainers and fourteen trainees participated. Almost without exception, participants' report training needs to be well met. Emergent inter-related themes were: learning as social activity; learning and programmatic factors; learning and physical infrastructure; and, learning and organizational structure. This outer metropolitan hospital is suited to the provision of surgical training with the current rotational system for trainees. The setting offers experiences that enable consolidation of learning providing a rich and varied overall surgical training program. Although relational elements of learning were paramount they occurred within a complex environment. Actor-network theory was used to give meaning to emergent themes acknowledging that actors (both people and objects) and their interactions combine to influence training quality, shifting the focus of responsibility for learning away from individuals to the complex interactions in which they work and learn.
Târcoveanu, E; Lupaşcu, C; Vasilescu, A; Moldovanu, R; Ichim, Mihaela; Georgescu, St; Niculescu, D; Dănilă, N; Dimofte, G; Anton, Raluca; Crumpei, Felicia; Florea, Niculina; Ungureanu, Cristina
Gynecomastia describes a benign increase of the mammary gland in men. When medical treatment fails, the surgical procedure is the treatment of choice. There are two main surgical procedures: subdermal mastectomy and liposuction. To evaluate the results after surgical treatment (mastectomy) performed in a general surgery unit. We performed a retrospective study; all the patients operated for gynecomastia were reviewed. The clinical, imaging, biological, intraoperative and histological data were included into a MS Access database and statistical analyzed. From 1990-2007, 114 patients were admitted in the First Surgical Clinic Iaşi for gynecomastia. Only 12.6% from the patients were with bilateral gynecomastia. The mean age was 40.54 +/- 1.83 years old (range 12-84). Mean body mass was 26.72 +/- 0.46 kg/m2 (range 18.5-41), and about 20% from the patients had a BMI of over 30 kg/m2. We also noted that 46.5% were smokers. Simon classification was used for preoperative staging: 2.6% from the cases (N = 3) were included in stage I, 16.7% (N = 19) in stage IIa, 50% (N = 57) in stage IIb and 30.7% in stage III. The patients included in stages IIa and I are younger then the patients included in stage III (p = 0.024). Mastodynia was noted in 46 cases (40.4%). Ultrasound exam was performed in all the cases, and the larger diameter of the nodule measured was 3.75 +/- 0.18 cm (range 0.5-9.7). Only three cases were preoperatively treated with tamoxifen. Most of the cases were operated using general anesthesia (53.5%). Mastectomy was performed by peri-areolar (70.2%), elliptical (28.9%) or radial (0.9%) incisions. The subdermal mastectomy using peri-areolar approach was performed especially for the cases included in stages I, IIa and IIb--p gynecomastia in 6 cases; the other cases presented dilated ducts. We also noted intraductal papillary hyperplasia in 87 cases and chronic inflammation in 35 cases. The histological exam also revealed intraductal papilloma--9 cases, fibro
Hale, Diane F; Sexton, Justin C; Benavides, Linda C; Benavides, Jerry M; Lundy, Jonathan B
The deployment of surgical assets has been driven by mission demands throughout years of military operations in Iraq and Afghanistan. The transition to the highly expeditious Golden Hour Offset Surgical Transport Team (GHOST- T) now offers highly mobile surgical assets in nontraditional operating rooms; the content of the surgical instrument sets has also transformed to accommodate this change. The 102nd Forward Surgical Team (FST) was attached to Special Operations assigned to southern Afghanistan from June 2015 to March 2016. The focus was to decrease overall size and weight of FST instrument sets without decreasing surgical capability of the GHOST-T. Each instrument set was evaluated and modified to include essential instruments to perform damage control surgery. The overall number of main instrument sets was decreased from eight to four; simplified augmentation sets have been added, which expand the capabilities of any main set. The overall size was decreased by 40% and overall weight decreased by 58%. The cardiothoracic, thoracotomy, and emergency thoracotomy trays were condensed to thoracic set. The orthopedic and amputation sets were replaced with an augmentation set of a prepackaged orthopedic external fixator set). An augmentation set to the major or minor basic sets, specifically for vascular injuries, was created. Through the reorganization of conventional FST surgical instrument sets to maintain damage control capabilities and mobility, the 102nd GHOST-T reduced surgical equipment volume and weight, providing a lesson learned for future surgical teams operating in austere environments. 2017.
Working hours The aim of this thesis that I set was a comprehensive analysis of the working hours issue. The main purpose was to summarize this area of labor law while taking into account the Labour Code amendment which came into force on 1st January 2012. The changes in the related legal terms were also included into this thesis because of the mentioned changes. The thesis is composed of three chapters. Chapter One deals briefly with history of Labour Law and regulatory development. Author`s...
Roth, K; Sieber, J P; Schrimm, H; Heeg, P; Buess, G
This paper deals with the requirements for automated processing of endoscopic surgical instruments. After a brief analysis of the current problems, solutions are discussed. Test-procedures have been developed to validate the automated processing, so that the cleaning results are guaranteed and reproducable. Also a device for testing and cleaning was designed together with Netzsch Newamatic and PCI, called TC-MIC, to automate processing and reduce manual work.
Agha, Riaz A.; Fowler, Alexander J.
In the last three decades, simulation has become a key tool in the training of doctors and the maintenance of patient safety. Simulation offers an immersive, realistic way of learning technical skills. Recent changes to the training schemes in many surgical specialities mean that the hours spent working between senior house officer and consultant have been reduced. This, combined with other pressures (such as reduced operating hours), means that surgery has moved away from its traditional app...
Are, C; Berman, R S; Wyld, L; Cummings, C; Lecoq, C; Audisio, R A
The significant global variations in surgical oncology training paradigms can have a detrimental effect on tackling the rising global cancer burden. While some variations in training are essential to account for the differences in types of cancer and biology, the fundamental principles of providing care to a cancer patient remain the same. The development of a global curriculum in surgical oncology with incorporated essential standards could be very useful in building an adequately trained surgical oncology workforce, which in turn could help in tackling the rising global cancer burden. The leaders of the Society of Surgical Oncology and European Society of Surgical Oncology convened a global curriculum committee to develop a global curriculum in surgical oncology. A global curriculum in surgical oncology was developed to incorporate the required domains considered to be essential in training a surgical oncologist. The curriculum was constructed in a modular fashion to permit flexibility to suit the needs of the different regions of the world. Similarly, recognizing the various sociocultural, financial and cultural influences across the world, the proposed curriculum is aspirational and not mandatory in intent. A global curriculum was developed which may be considered as a foundational scaffolding for training surgical oncologists worldwide. It is envisioned that this initial global curriculum will provide a flexible and modular scaffolding that can be tailored by individual countries or regions to train surgical oncologists in a way that is appropriate for practice in their local environment. Copyright © 2016 Society of Surgical Oncology, European Society of Surgical Oncology. Published by Elsevier Ltd.. All rights reserved.
Raghunath, S K; Nagaraja, H; Srivatsa, N
Inguinal lymphadenectomy remains the standard of care for metastatic nodal disease in cases of penile, urethral, vulval and vaginal cancers. Outcomes, including cure rates and overall and progression-free survivals, have progressively improved in these diseases with extending criteria to offer inguinal lymph node dissection for patients 'at-risk' for metastasis or loco-regional recurrence. Hence, despite declining incidence of advanced stages of these cancers, many patients will still need to undergo lymphadenectomy for optimal oncological outcomes. Inguinal node dissection is a morbid procedure with operative morbidity noted in almost two third of the patients. Video endoscopic inguinal lymphadenectomy (VEIL) was described and currently practiced with proven equivalent oncological outcomes. We describe our technique of VEIL using laparoscopic and robotic access as well as various new surgical strategies.
Full Text Available Surgical treatment of craniopharyngiomas is challenging and despite advancements it continues to pose a challenge. Proponents of subtotal resection in conjunction with radiotherapy argue that this less aggressive approach can yield appropriate results with the lower morbidity. On the contrary, other argument is that gross total resection is superior. Though surgical management of craniopharyngioma is challenging due to its location and important surrounding neurovascular structures, optimal surgical results can be expected following radical surgical excision. Radical excision of craniopharyngiomas is associated with excellent long-term recurrence free survival. Radiation induced long-term complications can be altogether avoided by excising these tumors completely.
Basti, Z.; Mayer, A.
Stoma construction is among standard surgical skills and is performed for many indications. Every stoma means huge impact on quality of life for patients even with great improvement in surgical technique and ostomy devices. All patients are very sensitive to complication of stoma and the most frequent complication is parastomal hernia. Incidence reported in literature is very high and unacceptable, it is 30-70%. Surgical approach is very demanding on technical equipment and experiences of surgeon. Authors focus on each surgical approach for treating this complication weather it´s using mesh or laparoscopic or open approach. (author)
The presented work probes the fundamentals of Knudsen forces. Using the direct simulation Monte Carlo (DSMC) method, the flows induced by temperature inhomogeneity within a representative configuration and the Knudsen force acting on a heated microbeam are captured as functions of Knudsen number in the entire flow regime. Both flow strength and Knudsen force peak in the transition regime and negative Knudsen force absent in experimental data is observed. The mechanisms of the thermally induced flows and Knudsen forces are studied. It has been found that thermal edge flow is the main driven source for the formation of the Knudsen force on microbeams and domain configuration plays an important role in the process.
Federspil, Philipp A; Geisthoff, Urban W; Henrich, Dominik; Plinkert, Peter K
In some surgical specialties (eg, orthopedics), robots are already used in the operating room for bony milling work. Otological surgery and otoneurosurgery may also greatly benefit from the enhanced precision of robotics. Experimental study on robotic milling of oak wood and human temporal bone specimen. A standard industrial robot with a six-degrees-of-freedom serial kinematics was used, with force feedback to proportionally control the robot speed. Different milling modes and characteristic path parameters were evaluated to generate milling paths based on computer-aided design (CAD) geometry data of a cochlear implant and an implantable hearing system. The best-suited strategy proved to be the spiral horizontal milling mode with the burr held perpendicular to the temporal bone surface. To reduce groove height, the distance between paths should equal half the radius of the cutting burr head. Because of the vibration of the robot's own motors, a high oscillation of the SD of forces was encountered. This oscillation dropped drastically to nearly 0 Newton (N) when the burr head made contact with the dura mater, because of its damping characteristics. The cutting burr could be kept in contact with the dura mater for an extended period without damaging it, because of the burr's blunt head form. The robot moved the burr smoothly according to the encountered resistances. The study reports the first development of a functional robotic milling procedure for otoneurosurgery with force-based speed control. Future plans include implementation of ultrasound-based local navigation and performance of robotic mastoidectomy.
Mondoñedo, Jarred R; Suki, Béla
Lung volume reduction surgery (LVRS) and bronchoscopic lung volume reduction (bLVR) are palliative treatments aimed at reducing hyperinflation in advanced emphysema. Previous work has evaluated functional improvements and survival advantage for these techniques, although their effects on the micromechanical environment in the lung have yet to be determined. Here, we introduce a computational model to simulate a force-based destruction of elastic networks representing emphysema progression, which we use to track the response to lung volume reduction via LVRS and bLVR. We find that (1) LVRS efficacy can be predicted based on pre-surgical network structure; (2) macroscopic functional improvements following bLVR are related to microscopic changes in mechanical force heterogeneity; and (3) both techniques improve aspects of survival and quality of life influenced by lung compliance, albeit while accelerating disease progression. Our model predictions yield unique insights into the microscopic origins underlying emphysema progression before and after lung volume reduction.
WWC Review of the Report "Meeting the Challenge of Combating Chronic Absenteeism: Impact of the NYC Mayor's Interagency Task Force on Chronic Absenteeism and School Attendance and Its Implications for Other Cities." What Works Clearinghouse Single Study Review
What Works Clearinghouse, 2014
The 2013 study, "Meeting the Challenge of Combating Chronic Absenteeism: Impact of the NYC Mayor's Interagency Task Force on Chronic Absenteeism and School Attendance and Its Implications for Other Cities", examined the impact of the strategies developed by an interagency task force in New York City to combat chronic absenteeism in…
Consistent force fields for carbohydrates were hitherto developed by extensive optimization ofpotential energy function parameters on experimental data and on ab initio results. A wide range of experimental data is used: internal structures obtained from gas phase electron diffraction and from x......-anomeric effects are accounted for without addition of specific terms. The work is done in the framework of the Consistent Force Field which originatedin Israel and was further developed in Denmark. The actual methods and strategies employed havebeen described previously. Extensive testing of the force field...
The ANNALS of AFRICAN SURGERY. January 2016 Volume 13 Issue 1 1. EDITORIAL. Access to Specialized Surgical Care. Saidi H. University of Nairobi. Correspondence to: Prof Hassan Saidi, P.O Box 30196-00100, Nairobi. Email: email@example.com. Ann Afr Surg. 2016;13(1):1-2. The narrative of surgical disease in ...
'To sleep: perchance to dream', is the frequent mantra of the surgical resident. However, unlike. Hamlet, there is no ensuing speculation as to what dreams may come as there are seldom any!! Surgical residency has been both vilified and immortalized, but the fact remains that it is one of the most challenging, provocative ...
Van Goethem, Bart
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
Many topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and evaluation of minimally invasive surgical skills in a training setting and in practice in the operating room.
ESPR uroradiology task force and ESUR Paediatric Work Group--Imaging recommendations in paediatric uroradiology, part VI: childhood renal biopsy and imaging of neonatal and infant genital tract. Minutes from the task force session at the annual ESPR Meeting 2012 in Athens on childhood renal biopsy and imaging neonatal genitalia.
Riccabona, Michael; Lobo, Maria Luisa; Willi, Ulrich; Avni, Fred; Damasio, Beatrice; Ording-Mueller, Lil-Sofie; Blickman, Johan; Darge, Kassa; Papadopoulou, Frederika; Vivier, Pierre-Hugues
The European Society of Paediatric Radiology Uroradiology Task Force and the ESUR Paediatric Work Group jointly publish guidelines for paediatric urogenital imaging. Two yet unaddressed topics involving patient safety and imaging load are addressed in this paper: renal biopsy in childhood and imaging of the neonatal genital tract, particularly in girls. Based on our thorough review of literature and variable practice in multiple centers, procedural recommendations are proposed on how to perform renal biopsy in children and how to approach the genital tract in (female) neonates. These are statements by consensus due to lack of sufficient evidence-based data. The procedural recommendation on renal biopsy in childhood aims at improving patient safety and reducing the number of unsuccessful passes and/or biopsy-related complications. The recommendation for an imaging algorithm in the assessment of the neonatal genital tract focuses on the potential of ultrasonography to reduce the need for more invasive or radiating imaging, however, with additional fluoroscopy or MRI to be used in selected cases. Adherence to these recommendations will allow comparable data and evidence to be generated for future adaptation of imaging strategies in paediatric uroradiology.
The unrivalled conquests of Genghis Khan (CE c.1162-1227) led to the establishment of the Greater Mongolian Empire. By 1279, the Mongol dynasty controlled a vast Empire which, for the first time in history, unified Europe and China via the famous Silk Road. The ensuing century of peace and stability is referred to by historians as the Pax Mongolica, which facilitated Europe's renaissance and remarkably contributed to the rise of modern medicine and surgery. Secondary sources from published literature, primary sources from manuscripts and illustrations courtesy of universities, museum libraries and archives. There is ample evidence detailing the Mongol Empire's power during the thirteenth century and the Silk Road's role as a vehicle of commercial, cultural and scientific exchange. Advances in medical knowledge and surgical skills were made in all parts of the Empire and exchanged from China to Constantinople and back. Prominent medical figures traversed these centres, and no doubt contributed to the spread of surgical science, including Rashid al-Din and Mansur Ibn Ilyas. Their works, it is argued, enriched the practice of surgery and may have indirectly ushered-in the rise of modern surgery in the early medical schools at Salerno, Bologna, Pavia, Oxford, Montpellier and Constantinople to name but a few. The blossoming and diversification of medical and surgical knowledge was an integral part of the great cultural exchange facilitated by the Pax Mongolica. This enhanced surgical practice in China, Persia and Arabia, while coinciding with the renaissance of surgical teaching in Europe. © 2017 Royal Australasian College of Surgeons.
Touzet-Roumazeille, S; Jayyosi, L; Plenier, Y; Guyot, E; Guillard, T; François, C
Children represent a population at risk, because of their short size, their naivety and their attraction to animals. The face and hands are the most specific locations in young children. Wounds are often multiple. In more than half the cases, the child knows the animal, which are dogs and cats by frequency argument. The bite episode occurs mostly when the child is alone with the pet without direct supervision, while playing or stroking the animal. As in all bites, pediatric lesions are infectious, functional and aesthetic emergencies, but the goal of this work was primarily to make a point on principles of surgical management of animal bites in children, highlighting pediatric specificities. Animal bites require psychological, anesthetic and surgical treatment, adapted to the child, in a specialized structure. Hospitalization and general anesthesia are more frequent in children. Any suspicion of mistreatment (and/or abuse) should lead to the child's hospitalization, even if wounds do not justify monitoring in a surgical environment. Emergency surgery is essential to limit functional and aesthetic consequences. The healing capacities of the child and the frequent lack of co-morbidity allow a conservative surgical treatment with suture, repositioning skin flaps and controlled healing in the first place. Immobilization, drainage, and antibiotics will complete the surgery. The healing process, however, leads to a specific management during scar remodeling phase and growth. Psychological care of the child and parents should not be forgotten, and has to start at the same time as surgical treatment at in acute phase. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Full Text Available Surgical treatment of gynecomastia could present unique challenges for the plastic surgeon. Achieving a good balance between effectiveness of the selected approach and the satisfactory aesthetic outcome often is a difficult endeavor. Optimal surgical treatment involves a combination of liposuction and direct excision. In the present study the charts of 11 patients treated with suction-assisted liposuction and direct surgical excision were retrospectively reviewed; a special emphasis is placed on the surgical technique. The mean follow-up period of the patients was 11.6 months. No infection, hematoma, nipple-areola complex necrosis and nipple retraction was encountered in this series. The combined surgical treatment of gynecomastia has shown to be a reliable technique in both small and moderate breast enlargement including those with skin excess.
Zador, Zsolt; Coope, David J; Gnanalingham, Kanna; Lawton, Michael T
Eyebrow craniotomy is a recently described minimally invasive approach for tackling primarily pathology of the anterior skull base. The removal of the orbital bar may further expand the surgical corridor of this exposure, but the extent of benefit is poorly quantified. We assessed the effect of orbital bar removal with regards to surgical access in the eyebrow craniotomy using classic morphometric measurements in cadaver heads. Using surgical phantoms and neuronavigation, we also measured the 'working volume', a new parameter for characterising the volume of surgical access in these approaches. Silicon injected cadaver heads (n = 5) were used for morphometric analysis of the eyebrow craniotomy with and without orbital bar removal. Working depths and 'working areas' of surgical access were measured as defined by key anatomical landmarks. The eyebrow craniotomy with or without orbital bar removal was also simulated using surgical phantoms (n = 3, 90-120 points per trial), calibrated against a frameless neuronavigation system. Working volume was derived from reference coordinates recorded along the anatomical borders of the eyebrow craniotomy using the "α-shape algorithm" in R statistics. In cadaver heads, eyebrow craniotomy with removal of the orbital bar reduced the working depth to the ipsilateral anterior clinoid process (42 ± 2 versus 33 ± 3 mm; p < 0.05), but the working areas as defined by deep neurovascular and bony landmarks was statistically unchanged (total working areas of 418 ± 80 cm(2) versus 334 ± 48 cm(2); p = 0.4). In surgical phantom studies, however, working-volume for the simulated eyebrow craniotomies was increased with orbital bar removal (16 ± 1 cm(3) versus 21 ± 1 cm(3); p < 0.01). In laboratory studies, orbital bar removal in eyebrow craniotomy provides a modest reduction in working depth and increase in the working volume. But this must be weighed up against the added morbidity of the
Luciane Galdino Alberto
Full Text Available O artigo analisa o quadro de trabalhadores do Ministério da Saúde e entidades vinculadas - agências reguladoras da saúde e Fundação Oswaldo Cruz - de 2000 a 2008, relacionando a evolução quantitativa e o perfil dos vínculos dos trabalhadores federais da saúde com os condicionantes históricos e as políticas para o funcionalismo. As estratégias metodológicas da pesquisa foram: revisão bibliográfica, análise documental e de dados primários e secundários. Os resultados sugerem que a partir de 2003 houve uma recomposição parcial de quadros na administração pública federal, por meio de concursos públicos. Tal movimento foi heterogêneo entre áreas, sendo que a saúde apresentou um aumento de servidores ativos inferior à média federal. Observaram-se diferenças na situação do quadro de trabalhadores do Ministério da Saúde e entidades vinculadas. O nível central do Ministério foi pouco beneficiado com a realização de concursos, mantendo baixa proporção de servidores e alta dependência de consultores, terceirizados e contratos temporários. As agências reguladoras da saúde receberam servidores concursados a partir de 2005, mas em 2008 ainda apresentavam trabalhadores com outros tipos de vínculos. Na Fiocruz, observou-se um incremento do número de servidores, porém um aumento maior dos terceirizados. Por fim, discutem-se os desafios de conformação de uma adequada força de trabalho no Ministério da Saúde e entidades vinculadas, visto que no Brasil a esfera federal mantém um papel estratégico para a consolidação do Sistema Único de Saúde.This paper analyzes the work force of the Brazilian Ministry of Health and associated entities -the health regulatory agencies and the Oswaldo Cruz Foundation -from 2000 to 2008, focusing on the quantitative evolution and types of employment relation. The methods involved a bibliographical review, documental analysis and analysis of primary and secondary data. The
Force AOR Travel Info News prevnext Slide show 76,410 pounds of food delivered to Haiti 12th Air Force the French Air Force, Colombian Air Force, Pakistan Air Force, Belgian Air Force, Brazilian Air Force
Dempsey, Kara E; Qureshi, Mahmood M; Ondoma, Solomon M; Dempsey, Robert J
The population of Sub-Saharan Africa suffers from a critical shortage and maldistribution of health care professionals, especially highlighted in surgical subspecialties, such as neurosurgery. In light of The Lancet report and the World Health Organization's directive to provide essential surgical care through the developing world, solutions need to be found to close this training and distribution gap. Methods correcting the situation will only succeed if one understands the geopolitical forces which have shaped the distribution of health care in the region and continue to this day. Solutions have evolved from service to service with education. The partnering organizations, the Foundation of International Education in Neurological Surgery and the World Federation of Neurosurgical Societies, have supported neurosurgical training in the developing world, including curriculum, equipment, facilities, certification, and local acceptance, with a goal of developing a self-sustaining program within the developing country. These ideas heavily rely on partnerships to address classic geopolitical forces, including geography, drought, warfare, ethnic tensions, poverty, and lack of training facilities. Each can be addressed through partnerships, such as development of dyads with programs in developed countries and ongoing programs owned by the countries in question, but partnered with multiple international societies, institutions, and universities. This paper provides both a historic and topical overview of the forces at work which need to be addressed for success in delivering specialized care. This must always result in a self-sustaining program operated by the people of the home country with worldwide support through philanthropy and partnerships. Published by Elsevier Inc.
in epilepsy surgery and working in conjunction with an experienced epileptologist ... memory and the psychological impairment, and prepare the family ... ning that allows visualisation of abnormal activity or active lesions in cases of multiple ...
This paper focuses on the unique aspects of the Fernald Citizens Task Force process that have contributed to a largely successful public participation effort at Fernald. The Fernald Citizens Task Force passed quickly by many procedural issues. Instead, the Task Force concentrated on (a) educating itself about the site, its problems, and possible solutions, and (b) choosing a directed way to approach its mandate: To make recommendations on several open-quotes big pictureclose quotes issues, including future use of the site, cleanup levels, waste disposition, and cleanup priorities. This paper presents the approach used at Fernald for establishing and running a focused site-specific advisory board, the key issues that have been faced, and how these issues were resolved. The success of Fernald in establishing a strong and functioning site-specific advisory board serves as a useful model for other DOE facilities, although the Fernald model is just one of many approaches that can be taken. However, the approach presented here has worked extremely well for Fernald
Cho, J-H; Hwang, H-S; Chang, H-S; Hwang, Y-C
This case report describes the successful autotransplantation of mandibular molars after application of orthodontic forces and discusses the advantages of this technique, that is, pre-application of an orthodontic force for autotransplantation. After clinical and radiographic examination, autotransplantation was planned with the patient's written informed consent. An orthodontic force was applied, and the surgical procedure was performed after tooth mobility had increased. Root canal treatment was performed within 2 weeks of autotransplantation. At the 1-year follow-up, the transplanted teeth revealed asymptomatic and healthy periodontal conditions. Autotransplantation is the surgical movement of a tooth from its original location to another site. The pre-application of orthodontic force technique was recently introduced for autogenous tooth transplantation. Pre-application of an orthodontic force may be a useful treatment option for autotransplantation. © 2012 International Endodontic Journal.
Experience of collaboration between a Dutch surgical team in a Ghanaian Orthopaedic Teaching Hospital. ... medical teams from our hospital were deployed to St. Joseph's Hospital. These teams were completely self-supporting. They were encouraged to work together with the local-staff. Apart from clinical work, effort was
Revised version of quality guidelines for presurgical epilepsy evaluation and surgical epilepsy therapy issued by the Austrian, German, and Swiss working group on presurgical epilepsy diagnosis and operative epilepsy treatment.
Rosenow, Felix; Bast, Thomas; Czech, Thomas; Feucht, Martha; Hans, Volkmar H; Helmstaedter, Christoph; Huppertz, Hans-Jürgen; Noachtar, Soheyl; Oltmanns, Frank; Polster, Tilman; Seeck, Margitta; Trinka, Eugen; Wagner, Kathrin; Strzelczyk, Adam
The definition of minimal standards remains pivotal as a basis for a high standard of care and as a basis for staff allocation or reimbursement. Only limited publications are available regarding the required staffing or methodologic expertise in epilepsy centers. The executive board of the working group (WG) on presurgical epilepsy diagnosis and operative epilepsy treatment published the first guidelines in 2000 for Austria, Germany, and Switzerland. In 2014, revised guidelines were published and the WG decided to publish an unaltered English translation in this report. Because epilepsy surgery is an elective procedure, quality standards are particularly high. As detailed in the first edition of these guidelines, quality control relates to seven different domains: (1) establishing centers with a sufficient number of sufficiently and specifically trained personnel, (2) minimum technical standards and equipment, (3) continuous medical education of employees, (4) surveillance by trained personnel during video electroencephalography (EEG) monitoring (VEM), (5) systematic acquisition of clinical and outcome data, (6) the minimum number of preoperative evaluations and epilepsy surgery procedures, and (7) the cooperation of epilepsy centers. These standards required the certification of the different professions involved and minimum numbers of procedures. In the subsequent decade, quite a number of colleagues were certified by the trinational WG; therefore, the executive board of the WG decided in 2013 to make these standards obligatory. This revised version is particularly relevant given that the German procedure classification explicitly refers to the guidelines of the WG with regard to noninvasive/invasive preoperative video-EEG monitoring and invasive intraoperative diagnostics in epilepsy. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.
Neal, C P; Dennison, A R; Garcea, G
Chronic pancreatitis (CP) is an inflammatory disease of the pancreas which causes chronic pain, as well as exocrine and endocrine failure in the majority of patients, together producing social and domestic upheaval and a very poor quality of life. At least half of patients will require surgical intervention at some stage in their disease, primarily for the treatment of persistent pain. Available data have now confirmed that surgical intervention may produce superior results to conservative and endoscopic treatment. Comprehensive individual patient assessment is crucial to optimal surgical management, however, in order to determine which morphological disease variant (large duct disease, distal stricture with focal disease, expanded head or small duct/minimal change disease) is present in the individual patient, as a wide and differing range of surgical approaches are possible depending upon the specific abnormality within the gland. This review comprehensively assesses the evidence for these differing approaches to surgical intervention in chronic pancreatitis. Surgical drainage procedures should be limited to a small number of patients with a dilated duct and no pancreatic head mass. Similarly, a small population presenting with a focal stricture and tail only disease may be successfully treated by distal pancreatectomy. Long-term results of both of these procedure types are poor, however. More impressive results have been yielded for the surgical treatment of the expanded head, for which a range of surgical options now exist. Evidence from level I studies and a recent meta-analysis suggests that duodenum-preserving resections offer benefits compared to pancreaticoduodenectomy, though the results of the ongoing, multicentre ChroPac trial are awaited to confirm this. Further data are also needed to determine which of the duodenum-preserving procedures provides optimal results. In relation to small duct/minimal change disease total pancreatectomy represents the only
Hechenbleikner, Elizabeth M; Hobson, Deborah B; Bennett, Jennifer L; Wick, Elizabeth C
Surgical site infections are a potentially preventable patient harm. Emerging evidence suggests that the implementation of evidence-based process measures for infection reduction is highly variable. The purpose of this work was to develop an auditing tool to assess compliance with infection-related process measures and establish a system for identifying and addressing defects in measure implementation. This was a retrospective cohort study using electronic medical records. We used the auditing tool to assess compliance with 10 process measures in a sample of colorectal surgery patients with and without postoperative infections at an academic medical center (January 2012 to March 2013). We investigated 59 patients with surgical site infections and 49 patients without surgical site infections. First, overall compliance rates for the 10 process measures were compared between patients with infection vs patients without infection to assess if compliance was lower among patients with surgical site infections. Then, because of the burden of data collection, the tool was used exclusively to evaluate quarterly compliance rates among patients with infection. The results were reviewed, and the key factors contributing to noncompliance were identified and addressed. Ninety percent of process measures had lower compliance rates among patients with infection. Detailed review of infection cases identified many defects that improved following the implementation of system-level changes: correct cefotetan redosing (education of anesthesia personnel), temperature at surgical incision >36.0°C (flags used to identify patients for preoperative warming), and the use of preoperative mechanical bowel preparation with oral antibiotics (laxative solutions and antibiotics distributed in clinic before surgery). Quarterly compliance improved for 80% of process measures by the end of the study period. This study was conducted on a small surgical cohort within a select subspecialty. The
Rangel, Erika L; Smink, Douglas S; Castillo-Angeles, Manuel; Kwakye, Gifty; Changala, Marguerite; Haider, Adil H; Doherty, Gerard M
Although family priorities influence specialty selection and resident attrition, few studies describe resident perspectives on pregnancy during surgical training. To directly assess the resident experience of childbearing during training. A self-administered 74-question survey was electronically distributed in January 2017 to members of the Association of Women Surgeons, to members of the Association of Program Directors in Surgery listserv, and through targeted social media platforms. Surgeons who had 1 or more pregnancies during an Accreditation Council for Graduate Medical Education-accredited US general surgery residency program and completed training in 2007 or later were included. Important themes were identified using focus groups of surgeons who had undergone pregnancy during training in the past 7 years. Additional topics were identified through MEDLINE searches performed from January 2000 to July 2016 combining the keywords pregnancy, resident, attrition, and parenting in any specialty. Descriptive data on perceptions of work schedule during pregnancy, maternity leave policies, lactation and childcare support, and career satisfaction after childbirth. This study included 347 female surgeons (mean [SD] age, 30.5 [2.7] years) with 452 pregnancies. A total of 297 women (85.6%) worked an unmodified schedule until birth, and 220 (63.6%) were concerned that their work schedule adversely affected their health or the health of their unborn child. Residency program maternity leave policies were reported by 121 participants (34.9%). A total of 251 women (78.4%) received maternity leave of 6 weeks or less, and 250 (72.0%) perceived the duration of leave to be inadequate. The American Board of Surgery leave policy was cited as a major barrier to the desired length of leave by 268 of 326 respondents (82.2%). Breastfeeding was important to 329 (95.6%), but 200 (58.1%) stopped earlier than they wished because of poor access to lactation facilities and challenges leaving
Pawlik, Ralph; Krause, David; Bremenour, Frank
The Force Limit System (FLS) was developed to protect test specimens from inadvertent overload. The load limit value is fully adjustable by the operator and works independently of the test system control as a mechanical (non-electrical) device. When a test specimen is loaded via an electromechanical or hydraulic test system, a chance of an overload condition exists. An overload applied to a specimen could result in irreparable damage to the specimen and/or fixturing. The FLS restricts the maximum load that an actuator can apply to a test specimen. When testing limited-run test articles or using very expensive fixtures, the use of such a device is highly recommended. Test setups typically use electronic peak protection, which can be the source of overload due to malfunctioning components or the inability to react quickly enough to load spikes. The FLS works independently of the electronic overload protection.
Jesús M. Gómez-de-Gabriel
Full Text Available Designing surgical instruments for robotic-assisted minimally-invasive surgery (RAMIS is challenging due to constraints on the number and type of sensors imposed by considerations such as space or the need for sterilization. A new method for evaluating the usability of virtual teleoperated surgical instruments based on virtual sensors is presented. This method uses virtual prototyping of the surgical instrument with a dual physical interaction, which allows testing of different sensor configurations in a real environment. Moreover, the proposed approach has been applied to the evaluation of prototypes of a two-finger grasper for lump detection by remote pinching. In this example, the usability of a set of five different sensor configurations, with a different number of force sensors, is evaluated in terms of quantitative and qualitative measures in clinical experiments with 23 volunteers. As a result, the smallest number of force sensors needed in the surgical instrument that ensures the usability of the device can be determined. The details of the experimental setup are also included.
Gómez-de-Gabriel, Jesús M; Harwin, William
Designing surgical instruments for robotic-assisted minimally-invasive surgery (RAMIS) is challenging due to constraints on the number and type of sensors imposed by considerations such as space or the need for sterilization. A new method for evaluating the usability of virtual teleoperated surgical instruments based on virtual sensors is presented. This method uses virtual prototyping of the surgical instrument with a dual physical interaction, which allows testing of different sensor configurations in a real environment. Moreover, the proposed approach has been applied to the evaluation of prototypes of a two-finger grasper for lump detection by remote pinching. In this example, the usability of a set of five different sensor configurations, with a different number of force sensors, is evaluated in terms of quantitative and qualitative measures in clinical experiments with 23 volunteers. As a result, the smallest number of force sensors needed in the surgical instrument that ensures the usability of the device can be determined. The details of the experimental setup are also included.
Gómez-de-Gabriel, Jesús M.; Harwin, William
Designing surgical instruments for robotic-assisted minimally-invasive surgery (RAMIS) is challenging due to constraints on the number and type of sensors imposed by considerations such as space or the need for sterilization. A new method for evaluating the usability of virtual teleoperated surgical instruments based on virtual sensors is presented. This method uses virtual prototyping of the surgical instrument with a dual physical interaction, which allows testing of different sensor configurations in a real environment. Moreover, the proposed approach has been applied to the evaluation of prototypes of a two-finger grasper for lump detection by remote pinching. In this example, the usability of a set of five different sensor configurations, with a different number of force sensors, is evaluated in terms of quantitative and qualitative measures in clinical experiments with 23 volunteers. As a result, the smallest number of force sensors needed in the surgical instrument that ensures the usability of the device can be determined. The details of the experimental setup are also included. PMID:26516863
cooperative control of an AGV and snake robot 2. Advanced our filtering estimation theory to handle highly non- linear spaces using Lie algebra tools 3... linear spaces using Lie algebra tools 3. Investigated novel means by which we can infer or sense force at the tip of the snake robot. We have since...most robots, the surgical snake robot is non- linear . We were, however, able to re-write the Kalman filter estimator in the Lie algebra of the position
Coughlan, Jane; Morar, Sonali S
Educational multimedia has been designed to provide surgical trainees with expert operative information outside of the operating theater. The effectiveness of multimedia (e.g., CD-ROMs) for learning has been a common research topic since the 1990s. To date, however, little discussion has taken place on the mechanisms to evaluate the quality of multimedia-driven teaching. This may be because of a lack of research into the development of appropriate tools for evaluating multimedia, especially for surgical education. This paper reports on a small-scale pilot and exploratory study (n = 12) that developed a tool for surgical multimedia evaluation. The validity of the developed tool was established through adaptation of an existing tool, which was reviewed using experts in surgery, usability, and education. The reliability of the developed tool was tested with surgical trainees who used it to assess a multimedia CD-ROM created for teaching basic surgical skills. The findings contribute to an understanding of surgical trainees' experience of using educational multimedia, in terms of characteristics of the learning material for interface design and content and the process of developing evaluation tools, in terms of inclusion of appropriate assessment criteria. The increasing use of multimedia in medical education necessitates the development of standardized tools for determining the quality of teaching and learning. Little research exists into the development of such tools and so the present work stimulates discussion on how to evaluate surgical training.
Liu, Baoyu; Chen, Wei; Zhu, Cheng
Molecular force spectroscopy has become a powerful tool to study how mechanics regulates biology, especially the mechanical regulation of molecular interactions and its impact on cellular functions. This force-driven methodology has uncovered a wealth of new information of the physical chemistry of molecular bonds for various biological systems. The new concepts, qualitative and quantitative measures describing bond behavior under force, and structural bases underlying these phenomena have substantially advanced our fundamental understanding of the inner workings of biological systems from the nanoscale (molecule) to the microscale (cell), elucidated basic molecular mechanisms of a wide range of important biological processes, and provided opportunities for engineering applications. Here, we review major force spectroscopic assays, conceptual developments of mechanically regulated kinetics of molecular interactions, and their biological relevance. We also present current challenges and highlight future directions.
Stefanescu, Dan Mihai
Part I introduces the basic ""Principles and Methods of Force Measurement"" acording to a classification into a dozen of force transducers types: resistive, inductive, capacitive, piezoelectric, electromagnetic, electrodynamic, magnetoelastic, galvanomagnetic (Hall-effect), vibrating wires, (micro)resonators, acoustic and gyroscopic. Two special chapters refer to force balance techniques and to combined methods in force measurement. Part II discusses the ""(Strain Gauge) Force Transducers Components"", evolving from the classical force transducer to the digital / intelligent one, with the inco
Heleen van Luijn; Saskia Keuzenkamp
More and more people have to combine work and care responsibilities, and work part-time or use daycare and after-school care facilities to help them do so. The Work and Care Act, which came into force on 1 December 2001, combined all the existing schemes - such as parental and maternity leave -
Objective: To review factors influencing the choice of anaesthesia for ophthalmic surgical procedures. ... as risk associated with general anaesthesia (8) they are more .... Wilson ME, Pandey SK, Thakur J. Paediatric cataract blindness in the ...
Mar 23, 2017 ... aDepartamet of Pediatric Surgery, Hospital Teresa Herrera, Complejo Hospitalario. Universitario de A ... Advances in anesthesia, neonatal intensive, surgical, and cardiac care have ... First, these patients are at risk of airway ...
surgical procedure). Arterial cannulation ... Acute retinal necrosis syndrome after epidural corticos- teroid injections ... prevented, or respond to early recognition and treatment. ..... drugs should only be administered if there are no alternatives.
Soler, Luc; Marescaux, Jacques
Technological innovations of the twentieth century have provided medicine and surgery with new tools for education and therapy definition. Thus, by combining Medical Imaging and Virtual Reality, patient-specific applications providing preoperative surgical simulation have become possible.
Takayasu, Kenta; Yoshida, Kenji; Kinoshita, Hidefumi; Yoshimoto, Syunsuke; Oshiro, Osamu; Matsuda, Tadashi
Quantifying surgical skills assists novice surgeons when learning operative techniques. We measured the interaction force at a ligation point and clarified the features of the force pattern among surgeons with different skill levels during laparoscopic knot tying. Forty-four surgeons were divided into three groups based on experience: 13 novice (0-5 years), 16 intermediate (6-15 years), and 15 expert (16-30 years). To assess the tractive force direction and volume during knot tying, we used a sensor that measures six force-torque values (x-axis: Fx, y-axis: Fy, z-axis: Fz, and xy-axis: Fxy) attached to a slit Penrose drain. All participants completed one double knot and five single knot sequences. We recorded completion time, force volume (FV), maximum force (MF), time over 1.5 N, duration of non-zero force, and percentage time when vertical force exceeded horizontal force (PTz). There was a significant difference between groups for completion time (p = 0.007); FV (total: p = 0.002; Fx: p = 0.004, Fy: p = 0.007, Fxy: p = 0.004, Fz: p force (p = 0.029); and PTz (p force pattern at the ligation point during suturing by surgeons with three levels of experience using a force measurement system. We revealed that both force volume and force direction differed depending on surgeons' skill level during knot tying. Copyright © 2017. Published by Elsevier Inc.
Lu, Kim C; Hunt, Steven R
Although medical management can control symptoms in a recurring incurable disease, such as Crohn's disease, surgical management is reserved for disease complications or those problems refractory to medical management. In this article, we cover general principles for the surgical management of Crohn's disease, ranging from skin tags, abscesses, fistulae, and stenoses to small bowel and extraintestinal disease. Copyright © 2013 Elsevier Inc. All rights reserved.
Van Goethem, Bart
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 negative consequences (lengthy placement, impaired wound healing around bulky knots, and the effect of unsightly knots on cosmetics). A study in 9 dogs found that celiotomy closure was easily achiev...
Surgical site infection (SSI) is increasingly recognised as a measure of the quality of patient care by surgeons, infection control practitioners, health planners and the public. There is increasing pressure to compare SSI rates between surgeons, institutions and countries. For this to be meaningful, data must be standardised and must include post-discharge surveillance (PDS) as many superficial SSIs do not present to the original institution. Further work is required to determine the best method of conducting PDS. In 2008 two important documents on SSI were published from the Society for Healthcare Epidemiology of America\\/The Infectious Disease Society of America and the National Institute for Health and Clincal Excellence, UK. Both emphasise key aspects during the preoperative, operative and postoperative phases of patient care. In addition to effective interventions known to be important for some time, e.g. not shaving the surgical site until the day of the procedure, there is increasing emphasis on physiological parameters, e.g. blood glucose concentrations, oxygen tensions and body temperature. Laparoscopic procedures are increasingly associated with reduced SSI rates, and the screening and decontamination of meticillin-resistant Staphylococcus aureus carriers is effective for certain surgical procedures but has to be balanced by cost and the risk of mupirocin resistance. Finally, there is a need to convert theory into practice by the rigorous application of SSI healthcare bundles. Recent studies suggest that, with a multidisciplinary approach, simple measures can be effective in reducing SSI rates.
Lage, Y. E.; Neves, M. M.; Maia, N. M. M.; Tcherniak, D.
It is well-known that when a single-degree-of-freedom (sdof) system is excited by a continuous motion of the foundation, the force transmissibility, relating the force transmitted to the foundation to the applied force, equals the displacement transmissibility. Recent developments in the generalization of the transmissibility to multiple-degree-of-freedom (mdof) systems have shown that similar simple and direct relations between both types of transmissibility do not appear naturally from the definitions, as happens in the sdof case. In this paper, the authors present their studies on the conditions under which it is possible to establish a relation between force transmissibility and displacement transmissibility for mdof systems. As far as the authors are aware, such a relation is not currently found in the literature, which is justified by being based on recent developments in the transmissibility concept for mdof systems. Indeed, it does not appear naturally, but the authors observed that the needed link is present when the displacement transmissibility is obtained between the same coordinates where the applied and reaction forces are considered in the force transmissibility case; this implies that the boundary conditions are not exactly the same and instead follow some rules. This work presents a formal derivation of the explicit relation between the force and displacement transmissibilities for mdof systems, and discusses its potential and limitations. The authors show that it is possible to obtain the displacement transmissibility from measured forces, and the force transmissibility from measured displacements, opening new perspectives, for example, in the identification of applied or transmitted forces. With this novel relation, it becomes possible, for example, to estimate the force transmissibility matrix with the structure off its supports, in free boundary conditions, and without measuring the forces. As far as force identification is concerned, this
Han, So-Eun; Ryoo, Suk-Tae; Lim, So Young; Pyon, Jai-Kyung; Bang, Sa-Ik; Oh, Kap-Sung; Mun, Goo-Hyun
The current trend in minimally invasive surgery is to make a small surgical incision. However, the excessive tensile stress applied by the retractors to the skin surrounding the incision often results in a long wound healing time and extensive scarring. To minimize these types of wound problems, the authors evaluated a simple and cost-effective method to minimize surgical incision scars based on the use of a latex surgical glove. The tunnel-shaped part of a powder-free latex surgical glove was applied to the incision and the dissection plane. It was fixed to the full layer of the dissection plane with sutures. The glove on the skin surface then was sealed with Ioban (3 M Health Care, St. Paul, MN, USA) to prevent movement. The operation proceeded as usual, with the retractor running through the tunnel of the latex glove. It was possible to complete the operation without any disturbance of the visual field by the surgical glove, and the glove was neither torn nor separated by the retractors. The retractors caused traction and friction during the operation, but the extent of damage to the postoperative skin incision margin was remarkably less than when the operation was performed without a glove. This simple and cost-effective method is based on the use of a latex surgical glove to protect the surgical skin incision site and improve the appearance of the postoperative scar. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Full Text Available Abstract Background The aim of this study was to confirm recent results from a previous study focussing on the development of a method to measure the bacterial translocation through puncture holes in surgical gloves under real surgical conditions. Methods An established method was applied to detect bacterial migration from the operating site through the punctured glove. Biogel™ double-gloving surgical gloves were used during visceral surgeries over a 6-month period. A modified Gaschen-bag method was used to retrieve organisms from the inner glove, and thus-obtained bacteria were compared with micro-organisms detected by an intra-operative swab. Results In 20 consecutive procedures, 194 gloves (98 outer gloves, 96 inner gloves were examined. The rate of micro-perforations of the outer surgical glove was 10% with a median wearing time of 100 minutes (range: 20-175 minutes. Perforations occurred in 81% on the non-dominant hand, with the index finger most frequently (25% punctured. In six cases, bacterial migration could be demonstrated microbiologically. In 5% (5/98 of outer gloves and in 1% (1/96 of the inner gloves, bacterial migration through micro-perforations was observed. For gloves with detected micro-perforations (n = 10 outer layers, the calculated migration was 50% (n = 5. The minimum wearing time was 62 minutes, with a calculated median wearing time of 71 minutes. Conclusions This study confirms previous results that bacterial migration through unnoticed micro-perforations in surgical gloves does occur under real practical surgical conditions. Undetected perforation of surgical gloves occurs frequently. Bacterial migration from the patient through micro-perforations on the hand of surgeons was confirmed, limiting the protective barrier function of gloves if worn over longer periods.
Messahel, Farouk M.; AlQahtani, Ali S.
To compare the quality of our services with the World Health Organization (WHO) surgical safety recommendations as a reference, to improve our services if they fall short of that of the WHO, and to publish our additional standards, so that they may be included in future revision of WHO checklist. We conducted this study on 15th July 2008 at the Armed Forces Hospital, Wadi Al-Dawasir, Kingdom of Saudi Arabia. We compared each WHO safety standard item with its corresponding standard in our checklist. There were 4 possibilities for the comparison: that our performance meet, was less than or exceeded the quality-of-care measures in the WHO checklist, or that there are additional safety measures in either checklist that need to be considered by each party. Since its introduction in 1997, our checklist was applied to 11828 patients and resulted in error-free outcomes. Benchmarking proved that our surgical safety performance does not only match the standards of the WHO surgical safety checklist, but also exceeds it in other safety areas (for example measures to prevent perioperative hypothermia and venous thromboembolism). Benchmarking is a continuous quality improvement process aimed at providing the best available at the time in healthcare, and we recommend its adoption by healthcare providers. The WHO surgical safety checklist is a bold step in the right direction towards safer surgical outcomes. Feedback from other medical establishments should be encouraged. (author)
Dolan-Evans, Elliot; Rogers, Gary D
There are some concerns that medical student interest in surgery is suffering. The aims of this project were to investigate the proportion of medical students interested in surgery from years 1 to 4, explore influential attitudinal and demographic factors, and establish baseline data to study the future effects of the Surgical Interest Association. Students were surveyed through an audience response system in year orientation sessions. For a majority of the analyses, respondents were dichotomized based on expressing an interest in surgery or not. There were no significant differences in the interest students had for a surgical career between medical student year levels in a cross-sectional analysis. However, available longitudinal data demonstrated a significant decrease in surgical interest from first years in 2012 to second years in 2013. Lifestyle, working hours and training length concerns had minimal effects as career influences on students interested in surgery, whereas academic interest and career opportunities were motivating factors in choosing this career. The results suggested no difference between levels of interest from first to final year students in surgery as a career, though only 22% of final year students were interested in surgery. This study also suggested that promoting the academic and scientific side of surgery, along with career opportunities available, may be an important avenue to encourage students into surgery. Future research will investigate the changing interests of students in surgery longitudinally throughout the medical school and to analyse the effects of the Surgical Interest Association. © 2014 Royal Australasian College of Surgeons.
Prot, Thomas; Halkic, Nermin; Demartines, Nicolas
Surgery offer the only curative treatment for colorectal hepatic metastasis. Nowadays, five-year survival increases up to 58% in selected cases, due to the improvement and combination of chemotherapy, surgery and ablative treatment like embolisation, radio-frequency or cryoablation. Surgery should be integrated in a multi disciplinary approach and initial work-up must take in account patient general conditions, tumor location, and possible extra hepatic extension. Thus, a surgical resection may be performed immediately or after preparation with chemotherapy or selective portal embolization. Management of liver metastasis should be carried out in oncological hepato-biliary centre.
Bankole, J O; Lawal, O O; Adejuyigbe, O
Audit assures provision of good quality health service at affordable cost. To be complete therefore, surgical practice in the young developing countries, as elsewhere, must incorporate auditing. Peculiarities of the developing countries and insufficient understanding of auditing may be, however, responsible for its been little practised. This article, therefore, reviews the objectives, the commonly evaluated aspects, and the method of audit, and includes a simple model of audit cycle. It is hoped that it will kindle the idea of regular practice of quality assurance by surgeons working in the young developing nations and engender a sustainable interest.
Ashkenaz, David E.; Hall, W. Paige; Haynes, Christy L.; Hicks, Erin M.; McFarland, Adam D.; Sherry, Leif J.; Stuart, Douglas A.; Wheeler, Korin E.; Yonzon, Chanda R.; Zhao, Jing; Godwin, Hilary A.; Van Duyne, Richard P.
In this activity, students use a model created from a coffee cup or cardstock cutout to explore the working principle of an atomic force microscope (AFM). Students manipulate a model of an AFM, using it to examine various objects to retrieve topographic data and then graph and interpret results. The students observe that movement of the AFM…
Hernandez, Rafael; Onar-Thomas, Arzu; Travascio, Francesco; Asfour, Shihab
Laparoscopic training with visual force feedback can lead to immediate improvements in force moderation. However, the long-term retention of this kind of learning and its potential decay are yet unclear. A laparoscopic resection task and force sensing apparatus were designed to assess the benefits of visual force feedback training. Twenty-two male university students with no previous experience in laparoscopy underwent relevant FLS proficiency training. Participants were randomly assigned to either a control or treatment group. Both groups trained on the task for 2 weeks as follows: initial baseline, sixteen training trials, and post-test immediately after. The treatment group had visual force feedback during training, whereas the control group did not. Participants then performed four weekly test trials to assess long-term retention of training. Outcomes recorded were maximum pulling and pushing forces, completion time, and rated task difficulty. Extreme maximum pulling force values were tapered throughout both the training and retention periods. Average maximum pushing forces were significantly lowered towards the end of training and during retention period. No significant decay of applied force learning was found during the 4-week retention period. Completion time and rated task difficulty were higher during training, but results indicate that the difference eventually fades during the retention period. Significant differences in aptitude across participants were found. Visual force feedback training improves on certain aspects of force moderation in a laparoscopic resection task. Results suggest that with enough training there is no significant decay of learning within the first month of the retention period. It is essential to account for differences in aptitude between individuals in this type of longitudinal research. This study shows how an inexpensive force measuring system can be used with an FLS Trainer System after some retrofitting. Surgical
Full Text Available Objetivo: Objetivou-se analisar as compreensões dos enfermeiros do centro cirúrgico a respeito do seu processo de trabalho em uma maternidade de Parnamirim/RN. Método: Trata-se de uma pesquisa qualitativa, descritiva e exploratória que utilizou a entrevista e observação descritiva como instrumentos de coleta de informações. Os dados coletados entre os meses de janeiro e fevereiro de 2010 foram analisados por meio da técnica de análise de conteúdo, modalidade temática. Resultados: Foram classificados em categorias apontam no processo de trabalho da enfermagem: as múltiplas compreensões sobre o processo gerencial; as implicações das relações de poder; a compreensão do mesmo como processo de enfermagem, a educação permanente e a tecnologia dura vista como uma necessidade para o desenvolvimento do referido processo. Conclusão: Diante do exposto, considera-se que há uma compreensão do processo de trabalho da enfermagem de forma pouco aclarada, dispersos e pouco sistematizados dos componentes do mesmo, embora, alguns sejam reconhecidos pelos depoentes.
Weiss, Anna; Lee, Katherine C; Tapia, Viridiana; Chang, David; Freischlag, Julie; Blair, Sarah L; Ramamoorthy, Sonia
Sex disparity in the Program Director role has not been studied. The goal of this study is to evaluate the percentage of women in Chair and Program Director positions. We hypothesize that there is a higher percentage of women in the Program Director role than Chair role. An Internet search identified Chairs, Program Directors, Associate Program Directors, and Division Chiefs. Statistical analysis compared percentages of women in these roles at all institutions, academic/community programs, and regions. There is higher female representation in the Program Director position than Chair position (P = .002) in General Surgery, Otolaryngology, and Orthopedics. More women are Associate Program Directors than Division Chiefs (23.6% vs 9.8%, P ≤ .001). Academic and community programs are no different. In the West, a greater percentage of women are Chairs as compared with the other regions (P ≤ .002). There are higher rates of women in Program Director position than Department Chair position. This discrepancy warrants further investigation. Published by Elsevier Inc.
This brief examines the development of the first Danish Air Force Air Operations Doctrine, which was officially commissioned in October 1997 and remained in effect until 2010. The development of a Danish air power doctrine was heavily influenced by the work of Colonel John Warden (USAF), both...... through his book ”The Air Campaign” and his subsequent planning of the air campaign against Iraq in 1990-1991. Warden’s ideas came to Denmark and the Danish Air Force by way of Danish Air Force students attending the United States Air Force Air University in Alabama, USA. Back in Denmark, graduates from...... the Air University inspired a small number of passionate airmen, who then wrote the Danish Air Operations Doctrine. The process was supported by the Air Force Tactical Command, which found that the work dovetailed perfectly with the transformation process that the Danish Air Force was in the midst...
Full Text Available Craniopharyngiomas are biologically benign lesions (WHO Grade 1 of the sellar and suprasellar region, associated with a serious morbidity. About 50% of these tumors become clinically apparent during childhood. Clinical symptoms include headaches, chiasm syndrome, hydrocephalus, pituitary insufficiencies, and obesity. Growth arrest is a typical symptom in children. The treatment of craniopharyngiomas includes surgery as well as radiotherapy. The goal of surgery varies according to the tumor location and extension and may range from complete resection to biopsy. Surgical complications are well known and cause constant evaluation of surgical strategies. Diencephalic obesity is related to surgical manipulation of hypothalamic tissue. Therefore, a classification system for craniopharyngiomas based on preoperative MRI is suggested by the authors, which may help assess the surgical risk. Recurrences are frequent in craniopharyngiomas, even after complete or gross-total resection. Radiotherapy is therefore recommended to patients with incomplete resections. However, the ideal time for radiotherapy after surgery is under discussion.The treatment of craniopharyngiomas requires an interdisciplinary and multimodal approach. Each patient should receive an individually tailored treatment. Surgically, different approaches as well as different degrees of resection can be considered, depending on tumor location and tumor extension.
Lee, Jae Hyun; Lim, Soo Yeon; Lee, Jang Hyun; Ahn, Hee Chang
Localized scleroderma is characterized by a thickening of the skin from excessive collagen deposits. It is not a fatal disease, but quality of life can be adversely affected due to changes in skin appearance, joint contractures, and, rarely, serious deformities of the face and extremities. We present six cases of localized scleroderma in face from our surgical practice. We reviewed six localized scleroderma cases that were initially treated with medication and then received follow-up surgery between April 2003 and February 2015. Six patients had facial lesions. These cases presented with linear dermal sclerosis on the forehead, oval subcutaneous and dermal depression in the cheek. En coup de sabre (n=4), and oval-shaped lesion of the face (n=2) were successfully treated. Surgical methods included resection with or without Z-plasty (n=3), fat graft (n=1), dermofat graft (n=1), and adipofascial free flap (n=1). Deformities of the affected parts were surgically corrected without reoccurrence. We retrospectively reviewed six cases of localized scleroderma that were successfully treated with surgery. And we propose an algorithm for selecting the best surgical approach for individual localized scleroderma cases. Although our cases were limited in number and long-term follow-up will be necessary, we suggest that surgical management should be considered as an option for treating scleroderma patients.
Cevidanes, Lucia H C; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael
In this article, we discuss the development of methods for computer-aided jaw surgery, which 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 system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3-dimensional surface models from cone-beam computed tomography, dynamic cephalometry, semiautomatic mirroring, interactive cutting of bone, and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intraoperative guidance. The system provides further intraoperative assistance with a computer display showing jaw positions and 3-dimensional positioning guides updated in real time during the surgical procedure. The computer-aided surgery 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 before the surgery. Computer-aided surgery can 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. 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.
focused on reinforcement of personal hygienic practices, social distancing, common contact sur- face decontamination , and wearing of surgical masks... center for febrile respira- tory illness surveillance. Infection control guidance was developed by US Air Force Academy preventive medicine staff and
Migliario, Mario; Rizzi, Manuela; Lucchina, Alberta Greco; Renò, Filippo
The gold standard to arrange impacted teeth in the dental arch is represented by a surgical approach followed by orthodontic traction force application. In the literature, many surgical approaches are proposed to reach such a scope. The aim of the present study is to demonstrate how laser technique could positively assist surgical approaches.Study population was composed by 16 patients undergoing orthodontic treatment of 20 impacted teeth. In 10 patients (population A) surgical exposure of the impacted teeth was performed using a 980 nm diode laser, while in the other 10 patients (population B), surgical incision was performed using a traditional lancet.Only 3 patients of the population A needed local anesthesia for surgical procedure while the remaining 7 patients reported only faint pain during surgery. Two patients referred postsurgical pain (numerical rating scale average value = 2) and needed to take analgesics. None of the patients showed other postsurgical side effects (bleeding, edema).All population B patients needed infiltrative anesthesia and referred postsurgical pain (numerical rating scale average value >4) treated with analgesics. Moreover, in such population, 4 patients referred lips edema while 4 showed bleeding and 6 needed surgical sutures of soft tissues.The lack of side effects of laser surgical approach to expose impacted teeth must persuade dental practitioners to choose such a clinical approach to closed surgical approach every time it is possible.
Azzi, Alain Joe; Shah, Karan; Seely, Andrew; Villeneuve, James Patrick; Sundaresan, Sudhir R; Shamji, Farid M; Maziak, Donna E; Gilbert, Sebastien
Health care resources are costly and should be used judiciously and efficiently. Predicting the duration of surgical procedures is key to optimizing operating room resources. Our objective was to identify factors influencing operative time, particularly surgical team turnover. We performed a single-institution, retrospective review of lobectomy operations. Univariate and multivariate analyses were performed to evaluate the impact of different factors on surgical time (skin-to-skin) and total procedure time. Staff turnover within the nursing component of the surgical team was defined as the number of instances any nurse had to leave the operating room over the total number of nurses involved in the operation. A total of 235 lobectomies were performed by 5 surgeons, most commonly for lung cancer (95%). On multivariate analysis, percent forced expiratory volume in 1 second, surgical approach, and lesion size had a significant effect on surgical time. Nursing turnover was associated with a significant increase in surgical time (53.7 minutes; 95% confidence interval, 6.4-101; P = .026) and total procedure time (83.2 minutes; 95% confidence interval, 30.1-136.2; P = .002). Active management of surgical team turnover may be an opportunity to improve operating room efficiency when the surgical team is engaged in a major pulmonary resection. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
Sawaya, Robin; Bugdadi, Abdulgadir; Azarnoush, Hamed; Winkler-Schwartz, Alexander; Alotaibi, Fahad E; Bajunaid, Khalid; AlZhrani, Gmaan A; Alsideiri, Ghusn; Sabbagh, Abdulrahman J; Del Maestro, Rolando F
The force pyramid is a novel visual representation allowing spatial delineation of instrument force application during surgical procedures. In this study, the force pyramid concept is employed to create and quantify dominant hand, nondominant hand, and bimanual force pyramids during resection of virtual reality brain tumors. To address 4 questions: Do ergonomics and handedness influence force pyramid structure? What are the differences between dominant and nondominant force pyramids? What is the spatial distribution of forces applied in specific tumor quadrants? What differentiates "expert" and "novice" groups regarding their force pyramids? Using a simulated aspirator in the dominant hand and a simulated sucker in the nondominant hand, 6 neurosurgeons and 14 residents resected 8 different tumors using the CAE NeuroVR virtual reality neurosurgical simulation platform (CAE Healthcare, Montréal, Québec and the National Research Council Canada, Boucherville, Québec). Position and force data were used to create force pyramids and quantify tumor quadrant force distribution. Force distribution quantification demonstrates the critical role that handedness and ergonomics play on psychomotor performance during simulated brain tumor resections. Neurosurgeons concentrate their dominant hand forces in a defined crescent in the lower right tumor quadrant. Nondominant force pyramids showed a central peak force application in all groups. Bimanual force pyramids outlined the combined impact of each hand. Distinct force pyramid patterns were seen when tumor stiffness, border complexity, and color were altered. Force pyramids allow delineation of specific tumor regions requiring greater psychomotor ability to resect. This information can focus and improve resident technical skills training. Copyright © 2017 by the Congress of Neurological Surgeons
Atomic Force Microscopy (AFM) can not only image the topography of surfaces at atomic resolution, but can also measure accurately the different interaction forces, like repulsive, adhesive and lateral existing between an AFM tip and the sample surface. Based on AFM, various extended techniques have
Full Text Available Chronic pancreatitis is a progressive inflammatory disease resulting in permanent structural damage of the pancreas. It is mainly characterized by recurring epigastric pain and pancreatic insufficiency. In addition, progression of the disease might lead to additional complications, such as pseudocyst formation or development of pancreatic cancer. The medical and surgical treatment of chronic pancreatitis has changed significantly in the past decades. With regard to surgical management, pancreatic head resection has been shown to be a mainstay in the treatment of severe chronic pancreatitis because the pancreatic head mass is known to trigger the chronic inflammatory process. Over the years, organ-preserving procedures, such as the duodenum-preserving pancreatic head resection and the pylorus-preserving Whipple, have become the surgical standard and have led to major improvements in pain relief, preservation of pancreatic function, and quality of life of patients.
Chirilă, M; Mureşan, R; Cosgarea, M; Tomescu, E
Adduction bilateral vocal fold immobility syndrome may be due by both recurrent laryngeal nerves paralysis--Gerhardt syndrome--and all intrinsic laryngeal muscles paralysis--Riegel syndrome. Etiology of Gerhardt syndrome is thyroid surgery, intubation's maneuver, trauma, neurological disorders, extrala-ryngeal malignancies. The manifestations of Gerhardt syndrome are inspiratory dyspnea and slightly influenced voicing by paramedian vocal folds paralysis with an important narrowing of the airway at the glottic level. The surgical procedures for enlargement of the glottic space can be classified in many ways and their major characteristics are: changes at the glottic level; surgical approach: open neck or endoscopic, with or without opening of the mucosal lining; the need for tracheostomy; the equipment used. The aim of this review is to expound the variety of interventions through the last century marked by the development of the diagnostic methods, the anesthesia and the surgical armament with sophisticated instruments and technologies.
Sade, Robert M; Kavarana, Minoo N
Ethical behavior has always been deeply ingrained in surgical culture, but ethical deliberation has only recently become an important component of cardiac surgical practice. In our earlier review, we covered a range of issues including several related to informed consent, conflict of interest, professional self-regulation and innovation, among many others. This update covers several topics of interest to cardiac surgeons and cardiologists, focusing on controversial issues specific to the practice of cardiothoracic surgery: informed consent, relations with hospitals and euthanasia and physician-assisted suicide. The future holds much uncertainty for cardiac surgical practice, research and culture, and we provide an update on ethical issues to serve as a platform for envisioning what is to come.
This work intends to focus on Galileo's study of what is now called "centrifugal force," within the framework of the Second Day of his Dialogo written in 1632, rather than on the previously published commentaries on the topic. Galileo proposes three geometrical demonstrations in order to prove that gravity will always overcome centrifugalforce, and that the potential rotation of the Earth, whatever its speed, cannot in any case project objects beyond it. Each of these demonstrations must consequently contain an error and it has seemed to us that the first one had not been understood up until now. Our analysis offers an opportunity to return to Galileo's geometrical representation of dynamical questions; actually, we get an insight into the sophistication of Galileo's practices more than into his mistakes. Our second point, concerning the historiography of the problem, shows an evolution from anachronic critics to more contextual considerations, in the course of the second half of the twentieth century.
M.J. Koudstaal (Maarten)
textabstractThe scope of this thesis is to shed more light, from a number of perspectives, on surgically assisted rapid maxillary expansion (SARME). The primary questions this thesis set out to answer were; ‘is there a difference in stability between bone-borne and tooth-borne distraction?’ and ‘can
Langebæk, Rikke; Eika, Berit; Pedersen, Lene Tanggaard
A surgical educational environment is potentially stressful and can negatively affect students' learning. The aim of the present study was to investigate the emotions experienced by veterinary students in relation to their first encounter with live-animal surgery and to identify possible sources...... of positive and negative emotions, respectively. During a Basic Surgical Skills course, 155 veterinary fourth-year students completed a survey. Of these, 26 students additionally participated in individual semi-structured interviews. The results of the study show that students often experienced a combination...
Schiavon, S.; Trenaghi, P.; Nardini, S.; Pagan, V.
A review was made of the chest X-ray features of 120 patients who underwent surgical treatment for mediastinal non-vascular pathologies over the past 12 years in the Mestre Hospital. A method of analysis is proposed which takes into account not only the differences between the immediate post-operative period and the follow-up, but also the anatomotopographic partition and the surgical practice. Normal and pathological patterns for both of the above periods are described. The ''dimness'' of the arial tracheogram is emphasized as a usefull and early sign of mediastinal recurrence
van Melle, Joost P; Wolff, Djoeke; Hörer, Jürgen
by the European Congenital Heart Surgeons Association among 22 member centres. Outcome of surgery to address failing Fontan was collected in 225 patients among which were patients with Fontan takedown (n=38; 17%), Fontan conversion (n=137; 61%) or HTX (n=50; 22%). RESULTS: The most prevalent indication...... for failing Fontan surgery was arrhythmia (43.6%), but indications differed across the surgical groups (p...OBJECTIVE: The objective of this European multicenter study was to report surgical outcomes of Fontan takedown, Fontan conversion and heart transplantation (HTX) for failing Fontan patients in terms of all-cause mortality and (re-)HTX. METHODS: A retrospective international study was conducted...
Clifton, Matthew S; Wulkan, Mark L
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. Copyright © 2015 Elsevier Inc. All rights reserved.
Anna Adolfsen; Saskia Keuzenkamp; m.m.v. Linda Mans
Original title: Uniform uit de kast. This study looks at the attitudes of defence personnel to homosexuality. How do members of the military view homosexual colleagues? Can gays and lesbians working in the armed forces be open about their sexual preferences? Do they regard the armed forces as
Gerkema, T.; Gostiaux, L.
In 1835, Gustave Coriolis derived the expression of a force acting in rotating systems, now known as the Coriolis force. His work was inspired by rotating devices such as waterwheels. However, the onerotating device that has always been with us is the Earth itself. Indeed, the earliest studies on
Qadir, A.; Quamar, J.
Whereas there is no denying the essential contribution of geometrodynamics, it must be admitted that our physical intuition is still firmly based in the Newtonian concept of force. Here we extend some earlier work re-introducing the Newtonian force concept into relativity theory. Some fundamentally new insights into the relativistic effects due to charge and rotation are presented. (author)
Franke, Stefan; Meixensberger, Jürgen; Neumuth, Thomas
Surgical workflow management is expected to enable situation-aware adaptation and intelligent systems behavior in an integrated operating room (OR). The overall aim is to unburden the surgeon and OR staff from both manual maintenance and information seeking tasks. A major step toward intelligent systems behavior is a stable classification of the surgical situation from multiple perspectives based on performed low-level tasks. The present work proposes a method for the classification of surgical situations based on multi-perspective workflow modeling. A model network that interconnects different types of surgical process models is described. Various aspects of a surgical situation description were considered: low-level tasks, high-level tasks, patient status, and the use of medical devices. A study with sixty neurosurgical interventions was conducted to evaluate the performance of our approach and its robustness against incomplete workflow recognition input. A correct classification rate of over 90% was measured for high-level tasks and patient status. The device usage models for navigation and neurophysiology classified over 95% of the situations correctly, whereas the ultrasound usage was more difficult to predict. Overall, the classification rate decreased with an increasing level of input distortion. Autonomous adaptation of medical devices and intelligent systems behavior do not currently depend solely on low-level tasks. Instead, they require a more general type of understanding of the surgical condition. The integration of various surgical process models in a network provided a comprehensive representation of the interventions and allowed for the generation of extensive situation descriptions. Multi-perspective surgical workflow modeling and online situation models will be a significant pre-requisite for reliable and intelligent systems behavior. Hence, they will contribute to a cooperative OR environment. Copyright © 2015 Elsevier Inc. All rights reserved.
Chu, Kathryn M; Ford, Nathan P; Trelles, Miguel
Somalia is one of the most political unstable countries in the world. Ongoing insecurity has forced an inconsistent medical response by the international community, with little data collection. This paper describes the "remote" model of surgical care by Medecins Sans Frontieres, in Guri-El, Somalia. The challenges of providing the necessary prerequisites for safe surgery are discussed as well as the successes and limitations of task shifting in this resource-limited context. In January 2006, MSF opened a project in Guri-El located between Mogadishu and Galcayo. The objectives were to reduce mortality due to complications of pregnancy and childbirth and from violent and non-violent trauma. At the start of the program, expatriate surgeons and anesthesiologists established safe surgical practices and performed surgical procedures. After January 2008, expatriates were evacuated due to insecurity and surgical care has been provided by local Somalian doctors and nurses with periodic supervisory visits from expatriate staff. Between October 2006 and December 2009, 2086 operations were performed on 1602 patients. The majority (1049, 65%) were male and the median age was 22 (interquartile range, 17-30). 1460 (70%) of interventions were emergent. Trauma accounted for 76% (1585) of all surgical pathology; gunshot wounds accounted for 89% (584) of violent injuries. Operative mortality (0.5% of all surgical interventions) was not higher when Somalian staff provided care compared to when expatriate surgeons and anesthesiologists. The delivery of surgical care in any conflict-settings is difficult, but in situations where international support is limited, the challenges are more extreme. In this model, task shifting, or the provision of services by less trained cadres, was utilized and peri-operative mortality remained low demonstrating that safe surgical practices can be accomplished even without the presence of fully trained surgeon and anesthesiologists. If security improves
Schearer, Eric M; Liao, Yu-Wei; Perreault, Eric J; Tresch, Matthew C; Memberg, William D; Kirsch, Robert F; Lynch, Kevin M
We present a method for controlling a neuroprosthesis for a paralyzed human arm using functional electrical stimulation (FES) and characterize the errors of the controller. The subject has surgically implanted electrodes for stimulating muscles in her shoulder and arm. Using input/output data, a model mapping muscle stimulations to isometric endpoint forces measured at the subject's hand was identified. We inverted the model of this redundant and coupled multiple-input multiple-output system by minimizing muscle activations and used this inverse for feedforward control. The magnitude of the total root mean square error over a grid in the volume of achievable isometric endpoint force targets was 11% of the total range of achievable forces. Major sources of error were random error due to trial-to-trial variability and model bias due to nonstationary system properties. Because the muscles working collectively are the actuators of the skeletal system, the quantification of errors in force control guides designs of motion controllers for multi-joint, multi-muscle FES systems that can achieve arbitrary goals.
Mackey, Ryan M.; Kulikov, Igor K.; Smelyanskiy, Vadim; Luchinsky, Dmitry; Orr, Jeb
A document describes work on the origin of Coriolis force and estimating Coriolis force and torque applied to the Ares-1 vehicle during its ascent, based on an internal ballistics model for a multi-segmented solid rocket booster (SRB).
This research work has investigated the contribution of contact force and seepage force to the ... e equilibrium model has deduced an expression for the safe hydraulic head during well ...... Plastic deformation of soils simulation using DEM,.
Schomaker, Peggy K.
Today, school age and preschool children are more likely to have a working mother and to be living with one parent than in the past. Many families headed by women are living in poverty. Much of the teaching in public schools and many work force benefits are geared to the traditional models of the past. (JOW)
Expand Childcare Center hours Dual-military Co-location Policy Maternity , Paternity, and Adoption leave o Women in Service Increase...Distribution unlimited Analysis of Undesignated Work Karan A. Schriver, Edward J. Schmitz, Greggory J. Schell, Hoda Parvin April 2016...designated and undesignated work requirements. Over time, this mix fluctuates, causing changes to the force profile. Undesignated workload has
Full Text Available Building an effective sales force starts with selecting good salespeople, but good salespeople are very difficult to find. The reason for this is that most sales jobs are very demanding and require a great deal from the salesperson. There are many different types of sales jobs. Before it can hire salespeople, each company must do a careful job analysis to see what particular types of selling and other skills are necessary for each sales job. One task of the market planner is to establish clear objectives each year for the entire sales force, for each region, each sales office, and each salesperson. Sales jobs are different from in-house jobs in some significant ways. Nevertheless, each company must continually work on building and maintaining an effective sales force using the following steps: recruitment, selection, training, compensation and evaluation of each salesperson.
Ridgely, Charles T
Many textbooks dealing with general relativity do not demonstrate the derivation of forces in enough detail. The analyses presented herein demonstrate straightforward methods for computing forces by way of general relativity. Covariant divergence of the stress-energy-momentum tensor is used to derive a general expression of the force experienced by an observer in general coordinates. The general force is then applied to the local co-moving coordinate system of a uniformly accelerating observer, leading to an expression of the inertial force experienced by the observer. Next, applying the general force in Schwarzschild coordinates is shown to lead to familiar expressions of the gravitational force. As a more complex demonstration, the general force is applied to an observer in Boyer-Lindquist coordinates near a rotating, Kerr black hole. It is then shown that when the angular momentum of the black hole goes to zero, the force on the observer reduces to the force on an observer held stationary in Schwarzschild coordinates. As a final consideration, the force on an observer moving in rotating coordinates is derived. Expressing the force in terms of Christoffel symbols in rotating coordinates leads to familiar expressions of the centrifugal and Coriolis forces on the observer. It is envisioned that the techniques presented herein will be most useful to graduate level students, as well as those undergraduate students having experience with general relativity and tensor analysis.
Pluchino, F; Broggi, G; Fornari, M; Franzini, A; Solero, C L; Allegranza, A
During a period of 10 years (1977-1986) 40 cases of tumour of the pineal region have been treated at the Istituto Neurologico "C. Besta"-of Milan. Out of these 40 cases, 27 (67.5%) were in the paediatric (10-15 years) or juvenile (15-20 years) age at the time of operation. Since 1983 a specific diagnostic and therapeutic protocol has been adopted and thereafter direct surgical removal of the tumour was performed only when the neuroradiological investigations were highly suggestive of a benign extrinsic lesion. Sixteen cases in this series underwent direct surgical removal; in the remaining 24 cases stereotactic biopsy of the tumour was performed in the first instance. On the basis of the histological diagnosis obtained by this procedure surgical excision of the tumour (9 cases) or radiotherapy (15 cases) was then performed. 25 cases underwent surgical removal of the lesion. In all the cases the infratentorial supracerebellar approach as introduced by Krause and then modified by Stein was adopted. On analysis of the data of this series it was observed that in 25% of the cases completely benign resectable tumours were found; in 25% of the cases astrocytoma (grade I-II) which could be treated at least by partial removal were present; in 30% of the cases radiosensitive lesions were encountered. In the remaining 20% of the cases highly malignant tumours were found which should be treated only by radiotherapy and/or chemotherapy.
Leersum, N.J. van; Snijders, H.S.; Henneman, D.; Kolfschoten, N.E.; Gooiker, G.A.; Berge, M.G. Ten; Eddes, E.H.; Wouters, M.W.; Tollenaar, R.A.E.M.; Bemelman, W.A.; Dam, R.M. van; Elferink, M.A.; Karsten, T.M.; Krieken, J.H. van; Lemmens, V.E.; Rutten, H.J.; Manusama, E.R.; Velde, C.J. van de; Meijerink, W.J.H.J.; Wiggers, T.; Harst, E. van der; Dekker, J.W.T.; Boerma, D.
INTRODUCTION: In 2009, the nationwide Dutch Surgical Colorectal Audit (DSCA) was initiated by the Association of Surgeons of the Netherlands (ASN) to monitor, evaluate and improve colorectal cancer care. The DSCA is currently widely used as a blueprint for the initiation of other audits, coordinated
Lipszyc, E; Pfister, C; Liard, A; Mitrofanoff, P
The buried penis is a rare congenital entity, whose treatment is surgical. There are few publications concerning this matter. The authors report on their experience in 10 cases (1990-1995). In this abnormality, the tip of the glans does not project from the pubic or scrotal skin. It is due to: 1) an excessive development of the penile fascia which retracts the penis; 2) insufficient attachment of the penile skin at the base of the penis; 3) often excessive prepubic fat worsens the appearance of the abnormality but does not by itself totally explain it; 4) a tight phimosis is often present. Surgical treatment is necessary because this aspect tends to persist even after puberty. One cannot indeed count on the development at the age of puberty, neither on the diminution of the fat, nor on the simple cure of the phimosis. One must above all ban circumcision which causes the risk of eliminating the skin necessary for reconstruction. The surgical procedure will comprise: 1) a longitudinal dorsal incision extended circumferentially; 2) resection of the thickened fascia penis; 3) anchoring of the deep face of the dermis to the proximal part of the fascia penis at the base of the penis. This surgical procedure has always brought a significant improvement to the appearance of the penis.
van Leersum, N. J.; Snijders, H. S.; Henneman, D.; Kolfschoten, N. E.; Gooiker, G. A.; ten Berge, M. G.; Eddes, E. H.; Wouters, M. W. J. M.; Tollenaar, R. A. E. M.; Bemelman, W. A.; van Dam, R. M.; Elferink, M. A.; Karsten, Th M.; van Krieken, J. H. J. M.; Lemmens, V. E. P. P.; Rutten, H. J. T.; Manusama, E. R.; van de Velde, C. J. H.; Meijerink, W. J. H. J.; Wiggers, Th; van der Harst, E.; Dekker, J. W. T.; Boerma, D.
In 2009, the nationwide Dutch Surgical Colorectal Audit (DSCA) was initiated by the Association of Surgeons of the Netherlands (ASN) to monitor, evaluate and improve colorectal cancer care. The DSCA is currently widely used as a blueprint for the initiation of other audits, coordinated by the Dutch
Alp, E.; Bijl, D.; Bleichrodt, R.P.; Hansson, B.M.; Voss, A.
Gaseous byproducts produced during electrocautery, laser surgery or the use of ultrasonic scalpels are usually referred to as 'surgical smoke'. This smoke, produced with or without a heating process, contains bio-aerosols with viable and non-viable cellular material that subsequently poses a risk of
Borel-Rinkes, Inne H. M.; Gouma, Dirk J.; Hamming, Jaap F.
Surgical training in the Netherlands has traditionally been characterized by learning on the job under the classic master-trainee doctrine. Over the past decades, it has become regionally organized with intensive structural training courses, and a peer-based quality control system. Recently, the
training at the Addis Ababa University revealed that work-related accidents among surgical trainees were enormous, and there was huge under reporting to the occupational health unit (OHU) of the hospital. The aim of this study was to evaluate ...
Full Text Available This paper analyzes the phenomenon of “forced migration” in Malaysia. It examines the nature of forced migration, the challenges faced by Malaysia, the policy responses and their impact on the country and upon the forced migrants. It considers forced migration as an event hosting multifaceted issues related and relevant to forced migrants and suggests that Malaysia has been preoccupied with the issue of forced migration movements. This is largely seen in various responses invoked from Malaysia due to “south-south forced migration movements.” These responses are, however, inadequate in terms of commitment to the international refugee regime. While Malaysia did respond to economic and migration challenges, the paper asserts that such efforts are futile if she ignores issues critical to forced migrants.
In this paper, the role of three-nucleon forces in ab initio calculations of nuclear systems is investigated. The difference between genuine and induced many-nucleon forces is emphasized. Induced forces arise in the process of solving the nuclear many-body problem as technical intermediaries toward calculationally converged results. Genuine forces make up the Hamiltonian. They represent the chosen underlying dynamics. The hierarchy of contributions arising from genuine two-, three- and many-nucleon forces is discussed. Signals for the need of the inclusion of genuine three-nucleon forces are studied in nuclear systems, technically best under control, especially in three-nucleon and four-nucleon systems. Genuine three-nucleon forces are important for details in the description of some observables. Their contributions to observables are small on the scale set by two-nucleon forces. (author)
.... This runs counter to the popular belief that strategic lift is the limiting constraint. The study begins by highlighting the genesis of the military's current force projection strategy and the resulting importance of rapid force deployments...
Ota, D; Loftin, B; Saito, T; Lea, R; Keller, J
Virtual reality (VR) is an emerging technology that can teach surgeons new procedures and can determine their level of competence before they operate on patients. Also VR allows the trainee to return to the same procedure or task several times later as a refresher course. Laparoscopic surgery is a new operative technique which requires the surgeon to observe the operation on a video-monitor and requires the acquisition of new skills. VR simulation could duplicate the operative field and thereby enhance training and reduce the need for expensive animal training models. Our preliminary experience has shown that we have the technology to model tissues and laparoscopic instruments and to develop in real time a VR learning environment for surgeons. Another basic need is to measure competence. Surgical training is an apprenticeship requiring close supervision and 5-7 years of training. Technical competence is judged by the mentor and has always been subjective. If VR surgical simulators are to play an important role in the future, quantitative measurement of competence would have to be part of the system. Because surgical competence is "vague" and is characterized by such terms as "too long, too short" or "too close, too far," it is possible that the principles of fuzzy logic could be used to measure competence in a VR surgical simulator. Because a surgical procedure consists of a series of tasks and each task is a series of steps, we will plan to create two important tasks in a VR simulator and validate their use. These tasks consist of laparoscopic knot tying and laparoscopic suturing. Our hypothesis is that VR in combination with fuzzy logic can educate surgeons and determine when they are competent to perform these procedures on patients.
Field fluctuations are responsible for an attractive force - the Casimir force - between two parallel (globally neutral) metallic plates separated by a distance d. At high temperature, or equivalently large d, this force is known to exhibit a classical and universal character (independent of the material constitution of the plates). In a recent work, we have displayed the microscopic mechanisms responsible for this universality within a classical model. The plates consist of slabs containing classical charged particles in fluid phase and thermal equilibrium (plasmas). The universality of the force proves to originate from screening sum rules satisfied by the charge correlations. Here we show how this result is altered when the quantum-mechanical nature of the particles is taken into account. It turns out that in addition to the classical result, the asymptotic force for large d comprises a non-universal quantum correction, which is, however, small at high temperature. The method relies on an exact representation of the charge correlations by quantum Mayer graphs, based on the Feynman-Kac path integral formalism. (author)
Hill, Joshua L.
Approved for public release; distribution is unlimited U.S. Army Special Forces (SF) are consistently called upon to work by, with, and through indigenous forces to conduct special warfare. Current SF doctrine reflects an increasing desire for SF operators to be culturally proficient in order to work closely with locals, advise foreign militaries, and build relationships with host-nation counterparts. Despite the doctrinal emphasis on cultural proficiency, SF doctrine offers little concret...
Zia, Aneeq; Essa, Irfan
Manual feedback in basic robot-assisted minimally invasive surgery (RMIS) training can consume a significant amount of time from expert surgeons' schedule and is prone to subjectivity. In this paper, we explore the usage of different holistic features for automated skill assessment using only robot kinematic data and propose a weighted feature fusion technique for improving score prediction performance. Moreover, we also propose a method for generating 'task highlights' which can give surgeons a more directed feedback regarding which segments had the most effect on the final skill score. We perform our experiments on the publicly available JHU-ISI Gesture and Skill Assessment Working Set (JIGSAWS) and evaluate four different types of holistic features from robot kinematic data-sequential motion texture (SMT), discrete Fourier transform (DFT), discrete cosine transform (DCT) and approximate entropy (ApEn). The features are then used for skill classification and exact skill score prediction. Along with using these features individually, we also evaluate the performance using our proposed weighted combination technique. The task highlights are produced using DCT features. Our results demonstrate that these holistic features outperform all previous Hidden Markov Model (HMM)-based state-of-the-art methods for skill classification on the JIGSAWS dataset. Also, our proposed feature fusion strategy significantly improves performance for skill score predictions achieving up to 0.61 average spearman correlation coefficient. Moreover, we provide an analysis on how the proposed task highlights can relate to different surgical gestures within a task. Holistic features capturing global information from robot kinematic data can successfully be used for evaluating surgeon skill in basic surgical tasks on the da Vinci robot. Using the framework presented can potentially allow for real-time score feedback in RMIS training and help surgical trainees have more focused training.
Wagner, J C; Rogers, J E; Baud, R H; Scherrer, J R
A number of compositional Medical Concept Representation systems are being developed. Although these provide for a detailed conceptual representation of the underlying information, they have to be translated back to natural language for used by end-users and applications. The GALEN programme has been developing one such representation and we report here on a tool developed to generate natural language phrases from the GALEN conceptual representations. This tool can be adapted to different source modelling schemes and to different destination languages or sublanguages of a domain. It is based on a multilingual approach to natural language generation, realised through a clean separation of the domain model from the linguistic model and their link by well defined structures. Specific knowledge structures and operations have been developed for bridging between the modelling 'style' of the conceptual representation and natural language. Using the example of the scheme developed for modelling surgical operative procedures within the GALEN-IN-USE project, we show how the generator is adapted to such a scheme. The basic characteristics of the surgical procedures scheme are presented together with the basic principles of the generation tool. Using worked examples, we discuss the transformation operations which change the initial source representation into a form which can more directly be translated to a given natural language. In particular, the linguistic knowledge which has to be introduced--such as definitions of concepts and relationships is described. We explain the overall generator strategy and how particular transformation operations are triggered by language-dependent and conceptual parameters. Results are shown for generated French phrases corresponding to surgical procedures from the urology domain.
In addition to its therapeutic benefits, minimally invasive surgery offers the potential for video recording of the operation. The videos may be archived and used later for reasons such as cognitive training, skills assessment, and workflow analysis. Methods from the major field of video content analysis and representation are increasingly applied in the surgical domain. In this paper, we review recent developments and analyze future directions in the field of content-based video analysis of surgical operations. The review was obtained from PubMed and Google Scholar search on combinations of the following keywords: 'surgery', 'video', 'phase', 'task', 'skills', 'event', 'shot', 'analysis', 'retrieval', 'detection', 'classification', and 'recognition'. The collected articles were categorized and reviewed based on the technical goal sought, type of surgery performed, and structure of the operation. A total of 81 articles were included. The publication activity is constantly increasing; more than 50% of these articles were published in the last 3 years. Significant research has been performed for video task detection and retrieval in eye surgery. In endoscopic surgery, the research activity is more diverse: gesture/task classification, skills assessment, tool type recognition, shot/event detection and retrieval. Recent works employ deep neural networks for phase and tool recognition as well as shot detection. Content-based video analysis of surgical operations is a rapidly expanding field. Several future prospects for research exist including, inter alia, shot boundary detection, keyframe extraction, video summarization, pattern discovery, and video annotation. The development of publicly available benchmark datasets to evaluate and compare task-specific algorithms is essential.
Sengül, A.; Rognini, G.; van Elk, M.; Aspell, J.E.; Bleuler, H.; Blanke, O.
The present study investigated the effects of force feedback in relation to tool use on the multisensory integration of visuo-tactile information. Participants learned to control a robotic tool through a surgical robotic interface. Following tool-use training, participants performed a crossmodal
Sitters, G.; Kamsma, D.; Thalhammer, G.; Ritsch-Marte, M.; Peterman, E.J.G.; Wuite, G.J.L.
Force spectroscopy has become an indispensable tool to unravel the structural and mechanochemical properties of biomolecules. Here we extend the force spectroscopy toolbox with an acoustic manipulation device that can exert forces from subpiconewtons to hundreds of piconewtons on thousands of
A force transducer for measuring lift and drag coefficients for a circular cylinder in turbulent water flow is presented. In addition to describing the actual design and construction of the strain-gauged force- ring based transducer, requirements for obtained valid fluid force test data are discussed, and pertinent flow test experience is related
Ridgely, Charles T.
Many textbooks dealing with general relativity do not demonstrate the derivation of forces in enough detail. The analyses presented herein demonstrate straightforward methods for computing forces by way of general relativity. Covariant divergence of the stress-energy-momentum tensor is used to derive a general expression of the force experienced…
Force TV Radio Week in Photos About Us Air Force Senior Leaders SECAF CSAF CMSAF Biographies Adjunct Professors Senior Mentor Biographies Fact Sheets Commander's Call Topics CCT Archive CSAF Reading List 2017 Media Sites Site Registration Contact Us Search AF.mil: Home > About Us > Air Force Senior Leaders
Contamination and incorporation due to emission of ionizing radiation from radar equipment of the German Federal Armed Forces. A reply to the report of the staff working group Dr. Sommer, presented 21st June 2001. 2. rev. ed.
The document refers to an issue of public debate in Germany, induced by the disclosure of inappropriate occupational safety measures at radar equipment of the German Army and Air Force. In this reply to the official report of investigation, the author gives his own expert opinion, discussing health risks in connection with radar equipment in general, and the specific military radar installations in particular. The author explains his approach to assessing the occupational radiation dose to military personnel and the resulting health risks and effects in that particular case. (orig./CB) [de
Background: Majority of cancer interventions today are performed percutaneously using needle-based procedures, i.e. through the skin and soft tissue. Insufficient accuracy using conventional surgical needles motivated researchers to provide actuation forces to the needle's body for compensating the possible errors of surgeons/physicians. Therefore, active needles were proposed recently where actuation forces provided by shape memory alloys (SMAs) are utilized to assist the maneuverability and accuracy of surgical needles. This work also aims to introduce a novel needle insertion simulation to predict the deflection of a bevel tip needle inside the tissue. Methods: In this work first, the actuation capability of a single SMA wire was studied. The complex response of SMAs was investigated via a MATLAB implementation of the Brinson model and verified via experimental tests. The material characteristics of SMAs were simulated by defining multilinear elastic isothermal stress-strain curves. Rigorous experiments with SMA wires were performed to determine the material properties as well as to show the capability of the code to predict a stabilized SMA transformation behavior with sufficient accuracy. The isothermal stress-strain curves of SMAs were simulated and defined as a material model for the Finite Element Analysis of the active needle. In the second part of this work, a three-dimensional finite element (FE) model of the active steerable needle was developed to demonstrate the feasibility of using SMA wires as actuators to bend the surgical needle. In the FE model, birth and death method of defining boundary conditions, available in ANSYS, was used to achieve the pre-strain condition on SMA wire prior to actuation. This numerical model was validated with needle deflection experiments with developed prototypes of the active needle. The third part of this work describes the design optimization of the active using genetic algorithm aiming for its maximum flexibility
O'Leary, D Peter
Traditionally, surgical education has been confined to operating and lecture theaters. Access to the World Wide Web and services, such as YouTube and iTunes has expanded enormously. Each week throughout Ireland, nonconsultant hospital doctors work hard to create presentations for surgical teaching. Once presented, these valuable presentations are often never used again.
David C Marchant
Full Text Available Research progress assessing the role of attentional focusing instructions on skill acquisition and performance has lead researchers to apply this approach to force production tasks. Initial converging evidence indicates that force production tasks are sensitive to verbal instruction; externally focused instructions (onto movement outcomes, or onto the object force is being exerted against are shown to be more beneficial than internally focused instructions (focusing attention onto the movements being executed. These benefits are observed for maximal and accurate force production, as well as the maintenance of force production in prolonged tasks. A range of mechanisms are identified supporting the proposal that an external focus promotes movement efficiency in line with energy and effort conservation. Future research is required to assess how this developing body of work interacts with the broader understanding of psychological and physiological factors implicated in the effective production, maintenance and limitation of maximal or sub-maximal forces.
Cardenas-Camarena, Lazaro; Dorado, Carlos; Guerrero, Maria Teresa; Nava, Rosa
Aesthetic breast area improvements for gynecomastia and gender dysphoria patients who seek a more masculine appearance have increased recently. We present our clinical experience in breast masculinization and a classification for these patients. From July 2003 to May 2014, 68 patients seeking a more masculine thorax underwent surgery. They were divided into five groups depending on three factors: excess fatty tissue, breast tissue, and skin. A specific surgical treatment was assigned according to each group. The surgical treatments included thoracic liposuction, subcutaneous mastectomy, periareolar skin resection in one or two stages, and mastectomy with a nipple areola complex graft. The evaluation was performed 6 months after surgery to determine the degree of satisfaction and presence of complications. Surgery was performed on a total of 68 patients, 45 male and 22 female, with ages ranging from 18 to 49 years, and an average age of 33 years. Liposuction alone was performed on five patients; subcutaneous mastectomy was performed on eight patients; subcutaneous mastectomy combined with liposuction was performed on 27 patients; periareolar skin resection was performed on 11 patients; and mastectomy with NAC free grafts was performed on 16 patients. The surgical procedure satisfied 94% of the patients, with very few complications. All patients who wish to obtain a masculine breast shape should be treated with only one objective regardless patient's gender: to obtain a masculine thorax. We recommend a simple mammary gland classification for determining the best surgical treatment for these patients LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Boljanovic, S; Axelsson, C K; Elberg, J J
The purpose of the present work has been to evaluate surgical treatment of gynecomastia performed by liposuction combined with subcutaneous mastectomy. It was designed as a prospective consecutive registration of 21 patients (28 breasts) operated in a four month period. Treatment was done in local anaesthesia in the out-patient clinic. Treatment was in one patient complicated with a haematoma. In 86% of cases the patients were satisfied with the postoperative result. Liposuction combined with surgical excision of the gland performed as an out-patient treatment in local anaesthesia is followed by few complications and good cosmetic results.
Casoli, V; Rousvoal, A; Zirak, C; Bakhach, J; Guimberteau, J-C
Microsurgery and human allotransplantation progress as well as the improvement of immunosuppressive drugs actually allow the development of the composite tissue allotransplantation. One of the latest challenges in plastic surgery is to restore the anatomic and functional structures using similar tissues. Composite tissue allotransplantation will probably reach this goal. Our work is to find new surgical techniques for the reconstruction of the osteotendinous apparatus of the long digits. In this paper, we will demonstrate the surgical technique to harvest the allotransplant and its modulation in the reconstruction of various digital defects.
Bialynicki-Birula, I; Cirone, M.A.; Dahl, Jens Peder
We present Heisenberg's equation of motion for the radial variable of a free non-relativistic particle in D dimensions. The resulting radial force consists of three contributions: (i) the quantum fictitious force which is either attractive or repulsive depending on the number of dimensions, (ii......) a singular quantum force located at the origin, and (iii) the centrifugal force associated with non-vanishing angular momentum. Moreover, we use Heisenberg's uncertainty relation to introduce a lower bound for the kinetic energy of an ensemble of neutral particles. This bound is quadratic in the number...... of atoms and can be traced back to the repulsive quantum fictitious potential. All three forces arise for a free particle: "Force without force"....
Derras-Chouk, Amel; Chudnovsky, Eugene M.; Garanin, Dmitry A.; Jaafar, Reem
The stability of graphene cantilever under Casimir attraction to an underlying conductor is investigated. The dependence of the instability threshold on temperature and flexural rigidity is obtained. Analytical work is supplemented by numerical computation of the critical temperature above which the graphene cantilever irreversibly bends down and attaches to the conductor. The geometry of the attachment and exfoliation of the graphene sheet is discussed. It is argued that graphene cantilever can be an excellent tool for precision measurements of the Casimir force.
Oyo-Ita, Angela; Chinnock, Paul; Ikpeme, Ikpeme A
Injury to the abdomen can be blunt or penetrating. Abdominal injury can damage internal organs such as the liver, spleen, kidneys, intestine, and large blood vessels. There are controversies about the best approach to manage abdominal injuries. To assess the effects of surgical and non-surgical interventions in the management of abdominal trauma in a haemodynamically stable and non-peritonitic abdomen. We searched the Cochrane Injuries Group's Specialised Register, The Cochrane Library, Ovid MEDLINE(R), Ovid MEDLINE(R) In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid OLDMEDLINE(R), EMBASE Classic+EMBASE (Ovid), ISI WOS (SCI-EXPANDED, SSCI, CPCI-S & CPSI-SSH), CINAHL Plus (EBSCO), and clinical trials registers, and screened reference lists. We ran the most recent search on 17 September 2015. Randomised controlled trials of surgical interventions and non-surgical interventions involving people with abdominal injury who were haemodynamically stable with no signs of peritonitis. The abdominal injury could be blunt or penetrating. Two review authors independently applied the selection criteria. Data were extracted by two authors using a standard data extraction form, and are reported narratively. Two studies are included, which involved a total of 114 people with penetrating abdominal injuries. Both studies are at moderate risk of bias because the randomisation methods are not fully described, and the original study protocols are no longer available. The studies were undertaken in Finland between 1992 and 2002, by the same two researchers.In one study, 51 people were randomised to surgery or an observation protocol. None of the participants in the study died. Seven people had complications: 5 (18.5%) in the surgical group and 2 (8.3%) in the observation group; the difference was not statistically significant (P = 0.42; Fischer's exact). Among the 27 people who had surgery, 6 (22.2%) surgeries were negative laparotomies, and 15 (55.6%) were non
Strengthscope™ tool was judged by trainees to be crucial to a full understanding of the report and its potential implications. Conclusions Surgical trainees have a wide range of strengths which, if identified and focused upon, could help them to fulfil their greatest potential at work. Strengthscope™ has provided new insights into the range of skills and talents of surgical trainees and has a potential role in providing more advanced educational supervision and mentorship. For these trainees, the assessment and feedback discussion aided their personal and professional development, highlighting where their most significant strengths lay with a view to making their daily working lives more fulfilling and, hopefully, helping them excel.
Besselink, MG; de Bruijn, MT; Rutten, JP; Boermeester, MA; Hofker, HS; Gooszen, HG
Background: This study evaluated the various surgical strategies for treatment of (suspected) infected necrotizing pancreatitis (INP) and patient referrals for this condition in the Netherlands. Methods: This retrospective study included all 106 consecutive patients who had surgical treatment for
Rosenberg, Jacob; Herring, W Joseph; Blobner, Manfred
INTRODUCTION: Sustained deep neuromuscular blockade (NMB) during laparoscopic surgery may facilitate optimal surgical conditions. This exploratory study assessed whether deep NMB improves surgical conditions and, in doing so, allows use of lower insufflation pressures during laparoscopic cholecys...
Are, C; Yanala, U; Malhotra, G; Hall, B; Smith, L; Cummings, C; Lecoq, C; Wyld, L; Audisio, R A; Berman, R S
The ability to provide optimal care to cancer patients depends on awareness of current evidence-based practices emanating from research or involvement in research where circumstances permit. The significant global variations in cancer-related research activity and its correlation to cancer-specific outcomes may have an influence on the care provided to cancer patients and their outcomes. The aim of this project is to develop a global curriculum in research literacy for the surgical oncologist. The leadership of the Society of Surgical Oncology and European Society of Surgical Oncology convened a global curriculum committee to develop a global curriculum in research literacy for the Surgical Oncologist. A global curriculum in research literacy is developed to incorporate the required domains considered to be essential to interpret the published research or become involved in research activity where circumstances permit. The purpose of this curriculum is to promote research literacy for the surgical oncologist, wherever they are based. It does not mandate direct research participation which may not be feasible due to restrictions within the local health-care delivery environment, socio-economic priorities and the educational environment of the individual institution where they work. A global curriculum in research literacy is proposed which may promote research literacy or encourage involvement in research activity where circumstances permit. It is hoped that this will enhance cancer-related research activity, promote awareness of optimal evidence-based practices and improve outcomes for cancer patients globally. Copyright © 2017 Society of Surgical Oncology, European Society of Surgical Oncology. Published by Elsevier Ltd.. All rights reserved.
Davison, Sara; Raison, Nicholas; Khan, Muhammad S; Dasgupta, Prokar; Ahmed, Kamran
Pressures on surgical education from restricted working hours and increasing scrutiny of outcomes have been compounded by the development of highly technical surgical procedures requiring additional specialist training. Mental training (MT), the act of performing motor tasks in the 'mind's eye', offers the potential for training outside the operating room. However, the technique is yet to be formally incorporated in surgical curricula. This study aims to review the available literature to determine the role of MT in surgical education. EMBASE and Medline databases were searched. The primary outcome measure was surgical proficiency following training. Secondary analyses examined training duration, forms of MT and trainees level of experience. Study quality was assessed using Consolidated Standards of Reporting Trials scores or Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group. Fourteen trials with 618 participants met the inclusion criteria, of which 11 were randomized and three longitudinal. Ten studies found MT to be beneficial. Mental rehearsal was the most commonly used form of training. No significant correlation was found between the length of MT and outcomes. MT benefitted expert surgeons more than medical students or novice surgeons. The majority studies demonstrate MT to be beneficial in surgical education especially amongst more experienced surgeons within a well-structured MT programme. However, overall studies were low quality, lacked sufficient methodology and suffered from small sample sizes. For these reasons, further research is required to determine optimal role of MT as a supplementary educational tool within the surgical curriculum. © 2017 Royal Australasian College of Surgeons.
Cook Jonathan A
Full Text Available Abstract Background Randomised trials evaluation of surgical interventions are often designed and analysed as if the outcome of individual patients is independent of the surgeon providing the intervention. There is reason to expect outcomes for patients treated by the same surgeon tend to be more similar than those under the care of another surgeon due to previous experience, individual practice, training, and infrastructure. Such a phenomenon is referred to as the clustering effect and potentially impacts on the design and analysis adopted and thereby the required sample size. The aim of this work was to inform trial design by quantifying clustering effects (at both centre and surgeon level for various outcomes using a database of surgical trials. Methods Intracluster correlation coefficients (ICCs were calculated for outcomes from a set of 10 multicentre surgical trials for a range of outcomes and different time points for clustering at both the centre and surgeon level. Results ICCs were calculated for 198 outcomes across the 10 trials at both centre and surgeon cluster levels. The number of cases varied from 138 to 1370 across the trials. The median (range average cluster size was 32 (9 to 51 and 6 (3 to 30 for centre and surgeon levels respectively. ICC estimates varied substantially between outcome type though uncertainty around individual ICC estimates was substantial, which was reflected in generally wide confidence intervals. Conclusions This database of surgical trials provides trialists with valuable information on how to design surgical trials. Our data suggests clustering of outcome is more of an issue than has been previously acknowledged. We anticipate that over time the addition of ICCs from further surgical trial datasets to our database will further inform the design of surgical trials.
Sepehri, Mitra; Jørgensen, Bo
With a continuing increase in the number of tattoos performed worldwide, the need to treat tattoo complications is growing. Earlier treatments of chronic inflammatory tattoo reactions were dominated by a medical approach, or with no active intervention. In this chapter, we will address modern surgical approaches applied to situations when medical treatment is inefficient and lasers are not applicable. Dermatome shaving is positioned as first-line treatment of allergic tattoo reactions and also indicated in a number of other tattoo reactions, supplemented with excision in selected cases. The methods allow fundamental treatment with removal of the culprit pigment from the dermis. The different instruments, surgical methods, and treatment schedules are reviewed, and a guide to surgeons is presented. Postoperative treatments and the long-term outcomes are described in detail. An algorithm on specialist treatment and follow-up of tattoo reactions, which can be practiced in other countries, is presented. © 2017 S. Karger AG, Basel.
This new edition presents information and knowledge on the field of biomedical devices and surgical tools. The authors look at the interactions between nanotechnology, nanomaterials, design, modeling, and tools for surgical and dental applications, as well as how nanostructured surfaces can be created for the purposes of improving cell adhesion between medical devices and the human body. Each original chapter is revised in this second edition and describes developments in coatings for heart valves, stents, hip and knee joints, cardiovascular devices, orthodontic applications, and regenerative materials such as bone substitutes. There are also 8 new chapters that address: Microvascular anastomoses Inhaler devices used for pulmonary delivery of medical aerosols Surface modification of interference screws Biomechanics of the mandible (a detailed case study) Safety and medical devices The synthesis of nanostructured material Delivery of anticancer molecules using carbon nanotubes Nano and micro coatings for medic...
Portie Felix, Antonio; Navarro Sanchez, Gustavo; Hernandez Solar, Abel; Grass Baldoquin, Jorge Alberto; Domloge Fernandez, Joana
The obesity is the chronic non-communicable disease with a higher rate of growth in past 20 years. It is a risk factor for type 2 diabetes mellitus, high blood pressure, cardiovascular and respiratory affections, infertility, sexual and functional impotence, metabolic syndrome, load joint disorders and some types of cancer (breast, colon, prostate). The metabolic bariatric surgery is the surgical treatment more effective for the morbid obesity at long -and medium- term and not the pharmacologic treatment and the isolated diets. The aim of present historical review of the international literature on the evolution of surgical techniques of the bariatric surgery (malabsorption techniques, gastric restrictive techniques and mixed techniques), is to make available to those interested in this subject, a valuable therapeutic tool to be rationally used. (author)
Flexible work schedules are one response to changes in the composition of the work force, new life-styles, and changes in work attitudes. Types of alternative work schedules are part-time and temporary employment, job sharing, and flextime. Part-time workers are a diverse group--women, the very young, and older near-retirees. Although part-time…
Davies, Jennifer; Khatib, Manaf; Bello, Fernando
Surgical simulation has benefited from a surge in interest over the last decade as a result of the increasing need for a change in the traditional apprentice model of teaching surgery. However, despite the recent interest in surgical simulation as an adjunct to surgical training, most of the literature focuses on laparoscopic, endovascular, and endoscopic surgical simulation with very few studies scrutinizing open surgical simulation and its benefit to surgical trainees. The aim of this review is to summarize the current standard of available open surgical simulators and to review the literature on the benefits of open surgical simulation. Open surgical simulators currently used include live animals, cadavers, bench models, virtual reality, and software-based computer simulators. In the current literature, there are 18 different studies (including 6 randomized controlled trials and 12 cohort studies) investigating the efficacy of open surgical simulation using live animal, bench, and cadaveric models in many surgical specialties including general, cardiac, trauma, vascular, urologic, and gynecologic surgery. The current open surgical simulation studies show, in general, a significant benefit of open surgical simulation in developing the surgical skills of surgical trainees. However, these studies have their limitations including a low number of participants, variable assessment standards, and a focus on short-term results often with no follow-up assessment. The skills needed for open surgical procedures are the essential basis that a surgical trainee needs to grasp before attempting more technical procedures such as laparoscopic procedures. In this current climate of medical practice with reduced hours of surgical exposure for trainees and where the patient's safety and outcome is key, open surgical simulation is a promising adjunct to modern surgical training, filling the void between surgeons being trained in a technique and a surgeon achieving fluency in that
Thurfjell, L; Lundin, A; McLaughlin, J
Surgery simulation is a promising technique for training of surgical procedures. The overall goal for any surgical simulator is to allow for efficient training of the skills required and to improve learning by giving the user proper feedback. This goal is easier achieved if the training is performed in a realistic environment. Therefore functionality such as soft tissue deformation, tearing and cutting, penetration of soft tissue etc. is necessary. Furthermore, a realistic simulator must provide haptic feedback so that all senses match, that is, there should be a correspondence between what you see and what you feel with your hands. In this paper we describe a medical platform that provides all this functionality. It is based on the Reachln Magma API, which has been extended for surgery simulation. We describe the development of the platform and illustrate the use of it for the development of two different types of surgical simulators, both of which represents work in progress.
Keune, Jason D; Kodner, Ira J
The nature of surgical work provides fertile ground in which ethical problems can grow. The concept of what it means to be a "good surgeon" includes the ability to reason and deliberate about how the surgeon's unique technical capabilities integrate with larger society. Ethics education at the resident level is important for several reasons. It can ensure that care is delivered in a socially and ethically responsible manner through global and emergent effects on institutions and traditions. It will prepare residents for leadership positions. It can allow residents to confront issues, such as the scientific underdetermination of surgical practice, the application of new technologies to trusting patients that have been developed by for-profit companies, and a surgical environment that is becoming increasingly institutionalized. Resident ethics education provides the opportunity for a model of collective deliberation to be developed that can be used to make sense of ethical problems as they arise.
Zamora-Valdes, Daniel; Taner, Timucin; Nagorney, David M.
Hepatocellular carcinoma (HCC) is a major cause of cancer-related death worldwide. In select patients, surgical treatment in the form of either resection or transplantation offers a curative option. The aims of this review are to (1) review the current American Association for the Study of Liver Diseases/European Association for the Study of the Liver guidelines on the surgical management of HCC and (2) review the proposed changes to these guidelines and analyze the strength of evidence underlying these proposals. Three authors identified the most relevant publications in the literature on liver resection and transplantation for HCC and analyzed the strength of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification. In the United States, the liver allocation system provides priority for liver transplantation to patients with HCC within the Milan criteria. Current evidence suggests that liver transplantation may also be indicated in certain patient groups beyond Milan criteria, such as pediatric patients with large tumor burden or adult patients who are successfully downstaged. Patients with no underlying liver disease may also benefit from liver transplantation if the HCC is unresectable. In patients with no or minimal (compensated) liver disease and solitary HCC ≥2 cm, liver resection is warranted. If liver transplantation is not available or contraindicated, liver resection can be offered to patients with multinodular HCC, provided that the underlying liver disease is not decompensated. Many patients may benefit from surgical strategies adapted to local resources and policies (hepatitis B prevalence, organ availability, etc). Although current low-quality evidence shows better overall survival with aggressive surgical strategies, this approach is limited to select patients. Larger and well-designed prospective studies are needed to better define the benefits and limits of such approach. PMID:28975836
Sloth, Christoffer; Wisniewski, Rafael
a controller for motion compensation in beating-heart surgery, and prove that it is safe, i.e., the surgical tool is kept within an allowable distance and orientation of the heart. We solve the problem by simultaneously finding a control law and a barrier function. The motion compensation system is simulated...... from several initial conditions to demonstrate that the designed control system is safe for every admissible initial condition....
Loose, D A
Among vascular malformations, the predominantly venous malformations represent the majority of cases. They form a clinical entity and therefore need clear concepts concerning diagnosis and treatment. This paper presents an overview of contemporary classification as well as tactics and techniques of treatment. According to the Hamburg Classification, predominantly venous malformations are categorized into truncular and extratruncular forms, with truncular forms distinguished as obstructions and dilations, and extratruncular forms as limited or infiltrating. The tactics of treatment represent surgical and non-surgical methods or combined techniques. Surgical approaches utilize different tactics and techniques that are adopted based on the pathologic form and type of the malformation: (I) operation to reduce the haemodynamic activity of the malformation; (II) operation to eliminate the malformation; and (III) reconstructive operation. As for (I), a type of a tactic is the operation to derive the venous flow. In (II), the total or partial removal of the venous malformation is demonstrated subdivided into three different techniques. In this way, the infiltrating as well as the limited forms can be treated. An additional technique is dedicated to the treatment of a marginal vein. Approach (III) involves the treatment of venous aneurysms, where a variety of techniques have been successful. Long-term follow-up demonstrates positive results in 91% of the cases. Congenital predominantly venous malformations should be treated according to the principles developed during the past decades in vascular surgery, interventional treatment and multidisciplinary treatment. The days of predominantly conservative treatment should be relegated to the past. Special skills and experiences are necessary to carry out appropriate surgical strategy, and the required operative techniques should be dictated by the location and type of malformation and associated findings.
Maruyama, Izumi; Sato, Gohei; Okaue, Toyotake; Isobe, Yoshinari; Ohtsu, Akira; Sugimoto, Yuzo (Kansai Electric Power Co., Inc., Osaka (Japan))
Severe radiation proctitis was surgically treated in 8 cases. Colostomy was performed in 2 cases, total resection of the rectum in 2 and proctectomy with colostomy in 4. Perineal abscess developed in the 2 cases with total resection of the rectum. Rather than completely resection of the lesion, a procedure leaving no dead space i.e. proctectomy with colostomy, is desirable for radiation proctitis. Complete preoperative examination of the condition of the underlying disease and possible urinary tract complications is important.
O Connor, Paul
BACKGROUND: Surgical checklists has been shown to improve patient safety and teamwork in the operating theatre. However, despite the known benefits of the use of checklists in surgery, in some cases the practical implementation has been found to be less than universal. A questionnaire methodology was used to quantitatively evaluate the attitudes of theatre staff towards a modified version of the World Health Organisation (WHO) surgical checklist with relation to: beliefs about levels of compliance and support, impact on patient safety and teamwork, and barriers to the use of the checklist. METHODS: Using the theory of planned behaviour as a framework, 14 semi-structured interviews were conducted with theatre personnel regarding their attitudes towards, and levels of compliance with, a checklist. Based upon the interviews, a 27-item questionnaire was developed and distribute to all theatre personnel in an Irish hospital. RESULTS: Responses were obtained from 107 theatre staff (42.6% response rate). Particularly for nurses, the overall attitudes towards the effect of the checklist on safety and teamworking were positive. However, there was a lack of rigour with which the checklist was being applied. Nurses were significantly more sensitive to the barriers to the use of the checklist than anaesthetists or surgeons. Moreover, anaesthetists were not as positively disposed to the surgical checklist as surgeons and nurse. This finding was attributed to the tendency for the checklist to be completed during a period of high workload for the anaesthetists, resulting in a lack of engagement with the process. CONCLUSION: In order to improve the rigour with which the surgical checklist is applied, there is a need for: the involvement of all members of the theatre team in the checklist process, demonstrated support for the checklist from senior personnel, on-going education and training, and barriers to the implementation of the checklist to be addressed.
Vigano, A N; Minzioni, G; Graffigna, A; Paganini, F; Salerno, J A
The article deals with the modern approaches to the treatment of supraventricular tachycardia . The authors analyse the results of operations in ectopic atrial tachycardias, the Wolff-Parkinson-White syndrome, modal re-entry tachycardias, and atrial fibrillation . The last-named is of most interest because the authors possess experience in a new operation for isolation of the internodal tracts. In all conditions the authors obtained convincing evidence on the efficacy of modern surgical treatment in supraventricular tachycardias.
Röhl, S.; Bodenstedt, S.; Küderle, C.; Suwelack, S.; Kenngott, H.; Müller-Stich, B. P.; Dillmann, R.; Speidel, S.
Minimally invasive surgery is medically complex and can heavily benefit from computer assistance. One way to help the surgeon is to integrate preoperative planning data into the surgical workflow. This information can be represented as a customized preoperative model of the surgical site. To use it intraoperatively, it has to be updated during the intervention due to the constantly changing environment. Hence, intraoperative sensor data has to be acquired and registered with the preoperative model. Haptic information which could complement the visual sensor data is still not established. In addition, biomechanical modeling of the surgical site can help in reflecting the changes which cannot be captured by intraoperative sensors. We present a setting where a force sensor is integrated into a laparoscopic instrument. In a test scenario using a silicone liver phantom, we register the measured forces with a reconstructed surface model from stereo endoscopic images and a finite element model. The endoscope, the instrument and the liver phantom are tracked with a Polaris optical tracking system. By fusing this information, we can transfer the deformation onto the finite element model. The purpose of this setting is to demonstrate the principles needed and the methods developed for intraoperative sensor data fusion. One emphasis lies on the calibration of the force sensor with the instrument and first experiments with soft tissue. We also present our solution and first results concerning the integration of the force sensor as well as accuracy to the fusion of force measurements, surface reconstruction and biomechanical modeling.
Lee, Marcel H; Ingvertsen, Britt T; Kirpensteijn, Jolle; Jensen, Asger L; Kristensen, Annemarie T
To compare gravimetric and colorimetric methods of quantifying surgical blood loss, and to determine if there is a correlation between preoperative hemostatic tests (buccal mucosa bleeding time [BMBT] and intraoperative blood loss). Prospective clinical study. Dogs (n=15) admitted for cutaneous tumor excision, orthopedic procedure, or exploratory laparotomy. Intraoperative blood loss was quantified by measuring irrigation fluid and weighing surgical sponges used for blood and fluid collection during surgery. Results of gravimetric measurements were then correlated to blood loss quantified using spectrophotometric analysis of hemoglobin (Hb) content. Hemostatic variables including BMBT were measured before surgery and compared with the calculated amount of blood loss. Blood loss quantified by gravimetric measurement showed a significant correlation with colorimetric determination of Hb content in surgical sponges and collected irrigation fluid (r=0.93, P<.0001). BMBT correlated weakly but significantly with intraoperative blood loss (r=0.56, P<.05). Quantifying intraoperative blood loss using spectrophotometric Hb analysis accurately assessed the amount of blood loss; however, it is a time-consuming procedure, primarily applicable as a research tool. Gravimetric evaluation of intraoperative blood loss was found to be an accurate method, which can be recommended for use in a clinical setting. Estimation of blood loss using a gravimetric method is accurate and applicable in the clinical setting and provides surgeons with a simple and objective tool to evaluate intraoperative blood loss.
Andriole, Dorothy A; Jeffe, Donna B; Schechtman, Kenneth B
We sought to determine the extent to which recent increases in levels of gender and racial diversity in the overall resident-physician workforce were evident among core-surgical specialty resident workforces. Chi-square tests for trend assessed the importance of changes from 1996 to 2004 in proportions of women and African Americans in the surgery-resident workforce. Surgery-resident trends were compared with overall resident workforce trends using two-tailed t-tests to compare regression slopes that quantified rates of change over time. Chi-square tests assessed differences between proportions of women and African Americans in the current overall board-certified workforce and their proportions in the surgery board-certified workforce. From 1996 to 2004, proportions of women increased in all seven surgical specialties studied. Compared with the overall trend toward increasing proportions of women in the resident workforce, the trend in one surgical specialty was larger (obstetrics/gynecology, p 0.05), and two were smaller (each p 0.05). Proportions of African Americans decreased in three specialties (each p workforce, except obstetrics/gynecology, remained lower than in the overall board-certified workforce (each p workforces have persisted since 1996 and will likely perpetuate ongoing surgery board-certified workforce disparities.
Full Text Available Abstract Background Electrocautery, laser tissue ablation, and ultrasonic scalpel tissue dissection all generate a 'surgical smoke' containing ultrafine ( Methods To measure the amount of generated particulates in 'surgical smoke' during different surgical procedures and to quantify the particle number concentration for operation room personnel a condensation particle counter (CPC, model 3007, TSI Inc. was applied. Results Electro-cauterization and argon plasma tissue coagulation induced the production of very high number concentration (> 100000 cm-3 of particles in the diameter range of 10 nm to 1 μm. The peak concentration was confined to the immediate local surrounding of the production side. In the presence of a very efficient air conditioning system the increment and decrement of ultrafine particle occurrence was a matter of seconds, with accumulation of lower particle number concentrations in the operation room for only a few minutes. Conclusion Our investigation showed a short term very high exposure to ultrafine particles for surgeons and close assisting operating personnel – alternating with longer periods of low exposure.
Full Text Available Objective. Over the past decade, multiple factors have changed the pattern of neonatal surgical emergencies. An increase in prenatal screenings and the development of neonatal tertiary care centres have changed the clinical approach to these kids. Materials and methods. Between 1995 to 2011 were retrospectively reviewed 34 patients with diagnosis of uncommon rare neonatal surgical emergencies at our institute. We analyzed: sex, gestational age, weight at birth, primary pathology, prenatal diagnosis, associated anomalies, age and weight at surgery, clinical presentation, start of oral feeding and hospitalization. The follow-up was performed at 6,12, 24 and 36 months. Results. There were 21 male and 13 female. The gestational age ranged between 28 and 36 weeks. The weight at birth ranged between 700 and 1400 grams. Oral feeding was started between 4th and 10th postoperative day. The average hospitalization was about 70.47 days. To date, all patients have finished the followup. They are healthy. Conclusion. The outcome of the patients with uncommon surgical emergencies is different based on the etiology. Overall survival is generally good but is influenced by the associated anomalies.
Sakaguchi, Masahiro; Katsumi, Masaharu; Ishimoto, Kiwao; Yamamoto, Shinji; Yukawa, Hirofumi; Koh, Kenzo; Yamaguchi, Kazuya; Ohta, Masataka; Hayashido, Motonori
Radiotherapy for malignant tumors is effective and established. However, there are many complications in radiotherapy. A typical complication is radiation enterocolitis. It is difficult to treat severe histological damage to the irradiated tissues. This paper reports our experience with 26 patients with radiation enterocolitis for whom surgical treatment was given during a period of 16 years in our surgical department. The most frequent original disease requiring irradiation was cancer of the cervix uteri (15 cases) which was followed by cancer of the urinary bladder (7 cases). All of these patients had received external 60 Co irradiation. The ileum was the most frequent site of the lesion, followed by the rectum, sigmoid and descending colon. The period between the end of irradiation and the onset of enterocolitis ranged from 2 months to 10 years, with an average of 28 months. The main symptoms were intestinal obstruction in the ileum, and melena and fistula in the rectum and sigmoid colon. Intestinal resection was performed in 10 patients, a bypass operation in 4, and colostomy in 12. As to types of intestinal suture in these cases, Gambee's single layer method was thought useful from our experience. Colostomy as surgical management of melena and fistula did not yield satisfactory results. (author)
Evgeniou, Evgenios; Loizou, Peter
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. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.
Full Text Available The photokeratoscope has increased the understanding of the aspheric nature of the cornea as well as a better understanding of normal corneal topography. This has significantly affected the development of newer and more predictable models of surgical astigmatic correction. Relaxing incisions effectively flatten the steeper meridian an equivalent amount as they steepen the flatter meridian. The net change in spherical equivalent is, therefore, negligible. Poor predictability is the major limitation of relaxing incisions. Wedge resection can correct large degrees of postkeratoplasty astigmatism, Resection of 0.10 mm of tissue results in approximately 2 diopters of astigmatic correction. Prolonged postoperative rehabilitation and induced irregular astigmatism are limitations of the procedure. Transverse incisions flatten the steeper meridian an equivalent amount as they steepen the flatter meridian. Semiradial incisions result in two times the amount of flattening in the meridian of the incision compared to the meridian 90 degrees away. Combination of transverse incisions with semiradial incisions describes the trapezoidal astigmatic keratotomy. This procedure may correct from 5.5 to 11.0 diopters dependent upon the age of the patient. The use of the surgical keratometer is helpful in assessing a proper endpoint during surgical correction of astigmatism.
Ivanov, P A; Grishin, A V
Results of surgical treatment of 61 patients with injuries of the duodenum are analyzed. The causes of injuries were stab-incised wounds in 24 patients, missile wound -- in 7, closed abdominal trauma -- in 26, trauma of the duodenum during endoscopic papillosphincterotomy -- in 4. All the patients underwent surgery. Complications were seen in 32 (52.5%) patients, 21 patients died, lethality was 34.4%. Within the first 24 hours since the trauma 7 patients died due to severe combined trauma, blood loss, 54 patients survived acute period of trauma, including 28 patients after open trauma, 26 -- after closed and 4 -- after trauma of the duodenum during endoscopic papillosphincterotomy. Diagnostic and surgical policies are discussed. Results of treatment depending on kind and time of surgery are regarded. It is demonstrated that purulent complications due to retroperitoneal phlegmona, traumatic pancreatitis, pneumonia are the causes of significant number of unfavorable outcomes. Therefore, it is important to adequately incise and drainage infected parts of retroperitoneal fat tissue with two-lumen drainages. Decompression through duodenal tube is the effective procedure for prophylaxis of suture insufficiency and traumatic pancreatitis. Suppression of pancreatic and duodenal secretion with octreotid improves significantly surgical treatment results.
Parekh, Dilip; Natarajan, Sathima
Advances over the past decade have indicated that a complex interplay between environmental factors, genetic predisposition, alcohol abuse, and smoking lead towards the development of chronic pancreatitis. Chronic pancreatitis is a complex disorder that causes significant and chronic incapacity in patients and a substantial burden on the society. Major advances have been made in the etiology and pathogenesis of this disease and the role of genetic predisposition is increasingly coming to the fore. Advances in noninvasive diagnostic modalities now allow for better diagnosis of chronic pancreatitis at an early stage of the disease. The impact of these advances on surgical treatment is beginning to emerge, for example, patients with certain genetic predispositions may be better treated with total pancreatectomy versus lesser procedures. Considerable controversy remains with respect to the surgical management of chronic pancreatitis. Modern understanding of the neurobiology of pain in chronic pancreatitis suggests that a window of opportunity exists for effective treatment of the intractable pain after which central sensitization can lead to an irreversible pain syndrome in patients with chronic pancreatitis. Effective surgical procedures exist for chronic pancreatitis; however, the timing of surgery is unclear. For optimal treatment of patients with chronic pancreatitis, close collaboration between a multidisciplinary team including gastroenterologists, surgeons, and pain management physicians is needed.
Matthews, Alexander H; Abdelrahman, Tarig; Powell, Arfon G M T; Lewis, Wyn G
Bibliometric analysis highlights the key topics and publications, which have shaped surgical education. Here, the 100 most cited articles in the arena of surgical education were analyzed. Thomson Reuters Web of Science was interrogated using the keyword search terms "surgery" and ("learning" or "skills" or "competence" or "assessment" or "training" or "procedure-based assessments" or "performance" or "technical skills" or "curriculum" or "education" or "mentoring"] to identify all English language full articles, and the 100 most cited articles were analyzed by topic, journal, author, year, institution, and country of origin. A total of 403,733 eligible articles were returned and the median citation number was 164 (range: 107-1018). The most cited article (by Seymour, Yale University School of Medicine, Annals of Surgery, 1018 citations) focused on the use of virtual reality surgical simulation training. Annals of Surgery published the highest number of articles and received the most citations (n = 16, 3715 citations). The countries with the greatest number of publications were the USA (n = 45), Canada (n = 19), and the UK (n = 18). The commonest topics included simulation (n = 45) and assessment of clinical competence (n = 40). Surgical skill acquisition and assessment was the area of focus of 85% of the most cited contemporary articles, and this study provides the most cited references, serving as a guide as to what makes a citable published work in the field of surgical education. Copyright © 2016 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Verwilghen, Denis; Singh, Ameet
A diverse array of pathogen-related, patient-related, and caretaker-related issues influence risk and prevention of surgical site infections (SSIs). The entire surgical team involved in health care settings in which surgical procedures are performed play a pivotal role in the prevention of SSIs. ...
The aim of Journal of Surgical Technique and Case Report is to advance surgical knowledge and practice by promoting the reporting of innovative and reproducible surgical techniques ... Anterior palatal island advancement flap for bone graft coverage: technical note · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT
Redden, Mark D; Chin, Tze Yang; van Driel, Mieke L
Empyema refers to pus in the pleural space, commonly due to adjacent pneumonia, chest wall injury, or a complication of thoracic surgery. A range of therapeutic options are available for its management, ranging from percutaneous aspiration and intercostal drainage to video-assisted thoracoscopic surgery (VATS) or thoracotomy drainage. Intrapleural fibrinolytics may also be administered following intercostal drain insertion to facilitate pleural drainage. There is currently a lack of consensus regarding optimal treatment. To assess the effectiveness and safety of surgical versus non-surgical treatments for complicated parapneumonic effusion or pleural empyema. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 9), MEDLINE (Ebscohost) (1946 to July week 3 2013, July 2015 to October 2016) and MEDLINE (Ovid) (1 May 2013 to July week 1 2015), Embase (2010 to October 2016), CINAHL (1981 to October 2016) and LILACS (1982 to October 2016) on 20 October 2016. We searched ClinicalTrials.gov and WHO International Clinical Trials Registry Platform for ongoing studies (December 2016). Randomised controlled trials that compared a surgical with a non-surgical method of management for all age groups with pleural empyema. Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked the data for accuracy. We contacted trial authors for additional information. We assessed the quality of the evidence using the GRADE approach. We included eight randomised controlled trials with a total of 391 participants. Six trials focused on children and two on adults. Trials compared tube thoracostomy drainage (non-surgical), with or without intrapleural fibrinolytics, to either VATS or thoracotomy (surgical) for the management of pleural empyema. Assessment of risk of bias for the included studies was generally unclear for selection and blinding but low for attrition and reporting bias. Data analyses compared
Lilia A. Ochoa-Luna
Full Text Available This paper provides a novel algorithm to attain the independent navigation of a colonoscopy surgical endoscope. First, it introduces a brief description of this issue through the scientist advance for medical robotics. It then makes a quickly count of the existent methods and at the end it provides the basis in order to propose a new alternative solution with help from vision-guidance. That means that images will be processed and interpreted with the purpose of maintaining the endoscope always at the intestine center. All this considered will help us to reduce colonoscopy surgeries consequences and the most important advantage of this new method proposed is that surgeons will accomplish their work easier and more efficiently.
Ruiz-Gómez, José Luis; Martín-Parra, José Ignacio; González-Noriega, Mónica; Redondo-Figuero, Carlos Godofredo; Manuel-Palazuelos, José Carlos
Teaching of surgery has been affected by many factors over the last years, such as the reduction of working hours, the optimization of the use of the operating room or patient safety. Traditional teaching methodology fails to reduce the impact of these factors on surgeońs training. Simulation as a teaching model minimizes such impact, and is more effective than traditional teaching methods for integrating knowledge and clinical-surgical skills. Simulation complements clinical assistance with training, creating a safe learning environment where patient safety is not affected, and ethical or legal conflicts are avoided. Simulation uses learning methodologies that allow teaching individualization, adapting it to the learning needs of each student. It also allows training of all kinds of technical, cognitive or behavioural skills. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.
Wang, X. F.; Lv, N.; Mu, H. Z.; Xue, L. J.
During the evolution of the surgical robot, cable plays an important role. It translates motion and force precisely from surgeon’s hand to the tool’s tips. In the paper, the vertical wires, the composition of cable, are mathematically modeled from a geometric point of view. The cable structure and tension are analyzed according to the characteristics of wire screw twist. The structural equations of the wires in different positions are derived for both non-bent cable and bent cable, respectively. The bending moment formula of bent cable is also obtained. This will help researchers find suitable cable and design more matched pulley.
Knop, Luegya Amorim Henriques; Shintcovsk, Ricardo Lima; Gandini, Luiz Gonzaga; Parsekian, Lidia; Pinto, Ary Santos
The aim of this paper is to report two clinical cases, which was performed with surgical exposure and orthodontic traction of a maxillary central incisors. Light forces were used during the orthodontic treatment applied on rigid wires as anchorage. It was noted that teeth presented adequate clinical crown height and gingival contours.
Behrens, Jane; Gräns, Albin; Andersen, Niels Gerner
GER was affected after surgically introducing dummies of a blood-flow biotelemetry system into the abdominal cavity of Atlantic cod. Two days post surgery the cod with implants were, together with a control group, force-fed a standardized meal and the stomach contents recovered 24h later...
Cirone, M.A.; Schleich, W.P.; Straub, F.; Rzazewski, K.; Wheeler, J.A.
In a two-dimensional world, a free quantum particle of vanishing angular momentum experiences an attractive force. This force originates from a modification of the classical centrifugal force due to the wave nature of the particle. For positive energies the quantum anticentrifugal force manifests itself in a bunching of the nodes of the energy wave functions towards the origin. For negative energies this force is sufficient to create a bound state in a two-dimensional δ-function potential. In a counterintuitive way, the attractive force pushes the particle away from the location of the δ-function potential. As a consequence, the particle is localized in a band-shaped domain around the origin
van Geloven, A. A. W.; van Lienden, K. P.; Gouma, D. J.
Objective: Evaluation of diagnostic work-up and treatment of bodypackers. Identification of predictive factors for surgical treatment. Design: Retrospective descriptive study. Setting: Teaching hospital, The Netherlands. Patients: All 40 consecutive patients, admitted during the period 1995-99
Clark, D.; Franklin, J.; Mann, N.
We consider two different forms for a relativistic version of a linear restoring force. The pair comes from taking Hooke's law to be the force appearing on the right-hand side of the relativistic expressions: d"p"/d"t" or d"p"/d["tau"]. Either formulation recovers Hooke's law in the non-relativistic limit. In addition to these two forces, we…
Holmes, C. P.; Kinter, J. L.; Beebe, R. F.; Feigelson, E.; Hurlburt, N. E.; Mentzel, C.; Smith, G.; Tino, C.; Walker, R. J.
Two years ago NASA established the Ad Hoc Big Data Task Force (BDTF - https://science.nasa.gov/science-committee/subcommittees/big-data-task-force), an advisory working group with the NASA Advisory Council system. The scope of the Task Force included all NASA Big Data programs, projects, missions, and activities. The Task Force focused on such topics as exploring the existing and planned evolution of NASA's science data cyber-infrastructure that supports broad access to data repositories for NASA Science Mission Directorate missions; best practices within NASA, other Federal agencies, private industry and research institutions; and Federal initiatives related to big data and data access. The BDTF has completed its two-year term and produced several recommendations plus four white papers for NASA's Science Mission Directorate. This presentation will discuss the activities and results of the TF including summaries of key points from its focused study topics. The paper serves as an introduction to the papers following in this ESSI session.
and a mattress. As such, the paper shows how DR, as an evidence-based method, is established through concrete relations, rather than abstracted and universal principals. It argues that these relations stabilising DR are never enacted once and for all, but require continual work to be held together as a method...... that ‘works’....
Evans, M.S.; Stoughton, R.S.; Kazerooni, H.
This paper presents a theoretical and experimental investigation of a new kind of force sensor which detects forces by measuring an induced pressure change in a material of large Poisson's ratio. In this investigation we develop mathematical expressions for the sensor's sensitivity and bandwidth, and show that its sensitivity can be much larger and its bandwidth is usually smaller than those of existing strain-gage-type sensors. This force sensor is well-suited for measuring large but slowly varying forces. It can be installed in a space smaller than that required by existing sensors
Santosh, Mogurampelly; Maiti, Prabal K
When pulled along the axis, double-strand DNA undergoes a large conformational change and elongates by roughly twice its initial contour length at a pulling force of about 70 pN. The transition to this highly overstretched form of DNA is very cooperative. Applying a force perpendicular to the DNA axis (unzipping), double-strand DNA can also be separated into two single-stranded DNA, this being a fundamental process in DNA replication. We study the DNA overstretching and unzipping transition using fully atomistic molecular dynamics (MD) simulations and argue that the conformational changes of double-strand DNA associated with either of the above mentioned processes can be viewed as force induced DNA melting. As the force at one end of the DNA is increased the DNA starts melting abruptly/smoothly above a critical force depending on the pulling direction. The critical force f m , at which DNA melts completely decreases as the temperature of the system is increased. The melting force in the case of unzipping is smaller compared to the melting force when the DNA is pulled along the helical axis. In the case of melting through unzipping, the double-strand separation has jumps which correspond to the different energy minima arising due to sequence of different base pairs. The fraction of Watson-Crick base pair hydrogen bond breaking as a function of force does not show smooth and continuous behavior and consists of plateaus followed by sharp jumps.
Israelachvili, Jacob N
This reference describes the role of various intermolecular and interparticle forces in determining the properties of simple systems such as gases, liquids and solids, with a special focus on more complex colloidal, polymeric and biological systems. The book provides a thorough foundation in theories and concepts of intermolecular forces, allowing researchers and students to recognize which forces are important in any particular system, as well as how to control these forces. This third edition is expanded into three sections and contains five new chapters over the previous edition.· starts fr
This study uses The Theory Of Constraints (TOC) management methodology and recent military missions to show that RSOI operations are generally the limiting constraint to force deployment operations...
Communications Focal Point Contracting Squadron Force Support Squadron Mortuary Affairs Logistics Readiness Squadron Cadet Logistics Deployment and Distribution Material Management Operations PM Equipment Lab
Zoltan Iosif Korka
Full Text Available Cutting forces are classified among the most important technological parameters in machining process. Cutting forces are the background for the evaluation of the necessary machining power, as well as for dimensioning of the tools. Cutting forces are also having a major influence on the deformation of the work piece machined, its dimensional accuracy, and machining system stability.
Terhune, R.; Van Slyke, D.; Sheppard, T.; Brandrup, M.
The Security Exercise Evaluation System (SEES) is under development for use in planning Force on Force exercises and as an aid in post-exercise evaluation. This study is part of the development cycle where the simulation results are compared to field data to provide guidance for further development of the model. SEES is an event-driven stochastic computer program simulating individual movement and combat within an urban terrain environment. The simulator models the physics of movement, line of sight, and weapon effects. It relies on the controllers to provide all knowledge of security tactics, which are entered by the controllers during the simulation using interactive color graphic workstations. They are able to develop, modify and implement plans promptly as the simulator maintains real time. This paper reports on how SEES will be used to develop an intrusion plan, test the security response tactics and develop observer logistics. A Force on Force field exercise will then be executed to follow the plan with observations recorded. An analysis is made by first comparing the plan and events of the simulation with the field exercise, modifying the simulation plan to match the actual field exercise, and then running the simulation to develop a distribution of possible outcomes
Sprakel, J.H.B.; Besseling, N.A.M.; Leermakers, F.A.M.; Cohen Stuart, M.A.
We present measurements of equilibrium forces resulting from capillary condensation. The results give access to the ultralow interfacial tensions between the capillary bridge and the coexisting bulk phase. We demonstrate this with solutions of associative polymers and an aqueous mixture of gelatin