WorldWideScience

Sample records for systemic venous compliance

  1. Models of the venous system

    DEFF Research Database (Denmark)

    Mehlsen, J

    2000-01-01

    Cardiac output is largely controlled by venous return, the driving force of which is the energy remaining at the postcapillary venous site. This force is influenced by forces acting close to the right atrium, and internally or externally upon the veins along their course. Analogue models of the v......Cardiac output is largely controlled by venous return, the driving force of which is the energy remaining at the postcapillary venous site. This force is influenced by forces acting close to the right atrium, and internally or externally upon the veins along their course. Analogue models...... of the venous system require at least three elements: a resistor, a capacitor and an inductor, with the latter being of more importance in the venous than in the arterial system. Non-linearities must be considered in pressure/flow relations in the small venules, during venous collapse, or low flow conditions...

  2. MRI evidence for altered venous drainage and intracranial compliance in mild traumatic brain injury.

    Directory of Open Access Journals (Sweden)

    Andreas Pomschar

    Full Text Available To compare venous drainage patterns and associated intracranial hydrodynamics between subjects who experienced mild traumatic brain injury (mTBI and age- and gender-matched controls.Thirty adult subjects (15 with mTBI and 15 age- and gender-matched controls were investigated using a 3T MR scanner. Time since trauma was 0.5 to 29 years (mean 11.4 years. A 2D-time-of-flight MR-venography of the upper neck was performed to visualize the cervical venous vasculature. Cerebral venous drainage through primary and secondary channels, and intracranial compliance index and pressure were derived using cine-phase contrast imaging of the cerebral arterial inflow, venous outflow, and the craniospinal CSF flow. The intracranial compliance index is the defined as the ratio of maximal intracranial volume and pressure changes during the cardiac cycle. MR estimated ICP was then obtained through the inverse relationship between compliance and ICP.Compared to the controls, subjects with mTBI demonstrated a significantly smaller percentage of venous outflow through internal jugular veins (60.9±21% vs. controls: 76.8±10%; p = 0.01 compensated by an increased drainage through secondary veins (12.3±10.9% vs. 5.5±3.3%; p<0.03. Mean intracranial compliance index was significantly lower in the mTBI cohort (5.8±1.4 vs. controls 8.4±1.9; p<0.0007. Consequently, MR estimate of intracranial pressure was significantly higher in the mTBI cohort (12.5±2.9 mmHg vs. 8.8±2.0 mmHg; p<0.0007.mTBI is associated with increased venous drainage through secondary pathways. This reflects higher outflow impedance, which may explain the finding of reduced intracranial compliance. These results suggest that hemodynamic and hydrodynamic changes following mTBI persist even in the absence of clinical symptoms and abnormal findings in conventional MR imaging.

  3. Analysis of the vertebral venous system in relation to cerebral venous drainage on MR angiography

    International Nuclear Information System (INIS)

    Baik, Seung Kug; Sohn, Chul Ho; Kim, Gab Chul; Kim, Yong Sun

    2004-01-01

    In the supine position, cerebral venous drainage occurs primarily through the internal jugular veins, as seen on venous phase cerebral angiography. However, in the erect position, the vertebral venous system represents the major alternative pathway of cerebral venous drainage, while outflow through the internal jugular veins is absent or negligible. The purpose of this study is to evaluate the vertebral venous system and its relationship between the surrounding venous structures using magnetic resonance angiography (MRA) in the case of subjects in the supine position. We retrospectively reviewed the results of 65 patients (M:F = 31: 34, mean age 61.6 years) who underwent multi-phase contrast-enhanced carotid MRA. The imaging studies were performed using a 3.0 T MR unit (TR: 5.2, TE: 1.1, FA: 20, 3.8 thickness, EC: 1). We analyzed the appearance and extent of the vertebral venous system (vertebral venous plexus and vertebral artery venous plexus) and the internal jugular vein on the venous phase images. We also evaluated the main drainage pattern of the cerebral venous drainage and the drainage pattern of the vertebral venous system. The visualized vertebral venous system was defined as either poor, vertebral venous plexus dominant, vertebral artery venous plexus dominant or mixed. In the vertebral venous system, the vertebral artery venous plexus was visualized in 54 cases (83%). The appearance of the visualized vertebral artery venous plexus was symmetrical in 39 cases (72%) and asymmetrical in 15 cases (28%). The extent of the visualized vertebral artery venous plexus was partial in 26 cases (48%) and complete in 28 cases (52%). The vertebral venous plexus was visualized in 62 cases (95%). The appearance of the visualized vertebral artery venous plexus was symmetrical in 43 cases (69%) and asymmetrical in 19 cases (31%). The extent of the visualized vertebral artery venous plexus was partial in 35 cases (56%) and complete in 27 cases (44%). The appearance of the

  4. Environmental Compliance Management System

    International Nuclear Information System (INIS)

    Brownson, L.W.; Krsul, T.; Peralta, R.A.; Knudson, D.A.; Rosignolo, C.L.

    1992-01-01

    Argonne National Laboratory (ANL) is developing the Environmental Compliance Management System (ECMS) as a comprehensive, cost-effective tool to ensure (1) that the Laboratory complies with all applicable federal and state environmental laws and regulations, (2) that environmental issues and concerns are recognized and considered in the early phases of projects; and (3) that Laboratory personnel conduct Laboratory operations in the most environmentally acceptable manner. The ECMS is an expert computer system which is designed to allow project engineers to perform an environmental evaluation of their projects. The system includes a Master Program which collects basic project information, provide utility functions, and access the environmental expert modules, environmental expert system modules for each federal and state environmental law which allows the user to obtain specific information on how an individual law may affect his project; and site-specific databases which contain information necessary for effective management of the site under environmental regulations. The ECMS will have the capability to complete and print many of the necessary environmental forms required by federal and state agencies, including the Department of Energy

  5. Effects of Long Duration Spaceflight on Venous and Arterial Compliance in Astronants

    Science.gov (United States)

    Platts, Steven; Ribeiro, L. Christine

    2014-01-01

    1. Project Overview Visual impairment and intracranial pressure (VIIP) is a spaceflight-associated medical condition affecting at least a third of American astronauts who have flown International Space Station (ISS) missions. VIIP is defined primarily by visual acuity deficits and anatomical changes to eye structures. In some astronauts, eye-related changes do not revert back to the preflight state upon return to Earth. Our team will study some of the possible causes for this syndrome. This will be achieved by reviewing previous astronaut data for factors that may predispose astronauts to higher rates of developing this syndrome or greater severity of symptoms. Additionally, we will conduct 3 separate experiments that will characterize vessels in the head and neck and measure the effects of the experimental conditions on ocular structures and function. 2. Technical Summary The primary objective of this study is to determine whether vascular compliance is altered by spaceflight and whether such adaptations are related to the incidence of the VIIP. In particular, we will measure ocular parameters and vascular compliance in vessels of the head and neck in astronauts who have no spaceflight experience (Ground), in astronauts before, during, and after spaceflight (Flight), and in bed rest subjects with conditions similar to spaceflight (Bed Rest). Additionally, we will analyze astronaut data from the Lifetime Surveillance of Astronaut Health (LSAH) archives to determine which factors might be predictive of the development of VIIP (Data Mining). The project will be conducted in four separate, but related parts. Hypothesis The central hypothesis of this proposal is that exposure to the spaceflight environment aboard the ISS may lead to development of the VIIP syndrome (increased intracranial pressure and impaired visual acuity) and that this may be related to alterations in venous and/or arterial compliance in the head and neck. Specific Aims 1. To determine whether

  6. Venous, Arterialized-Venous, or Capillary Glucose Reference Measurements for the Accuracy Assessment of a Continuous Glucose Monitoring System.

    Science.gov (United States)

    Kropff, Jort; van Steen, Sigrid C; deGraaff, Peter; Chan, Man W; van Amstel, Rombout B E; DeVries, J Hans

    2017-11-01

    Different reference methods are used for the accuracy assessment of continuous glucose monitoring (CGM) systems. The effect of using venous, arterialized-venous, or capillary reference measurements on CGM accuracy is unclear. We evaluated 21 individuals with type 1 diabetes using a capillary calibrated CGM system. Venous or arterialized-venous reference glucose samples were taken every 15 min at two separate visits and assessed per YSI 2300 STAT Plus. Arterialization was achieved by heated-hand technique. Capillary samples were collected hourly during the venous reference visit. The investigation sequence (venous or arterialized-venous) was randomized. Effectiveness of arterialization was measured by comparing free venous oxygen pressure (PO2) of both visit days. Primary endpoint was the median absolute relative difference (ARD). Median ARD using arterialized-venous reference samples was not different from venous samples (point estimated difference 0.52%, P = 0.181). When comparing the three reference methods, median ARD was also not different over the full glycemic range (venous 9.0% [n = 681], arterialized-venous 8.3% [n = 684], and capillary 8.1% [n = 205], P = 0.216), nor over the separate glucose ranges. Arterialization was successful (PO2 venous 5.4 kPa vs. arterialized-venous 8.9 kPa, P reference measurements did not significantly impact CGM accuracy. Venous reference seems preferable due to its ease of operation.

  7. ICF's Plant Compliance Assessment System

    International Nuclear Information System (INIS)

    Baker, S.M.

    1989-01-01

    Government and private industrial facilities must manage wastes that are both radioactive and (chemically) hazardous. Until recently, these mixed wastes have been managed under rules established under the Atomic Energy Act (AEA) and the Low-Level Waste Policy At, and rules that derive from environmental legislation have not been applied. Both sets of rules now apply to mixed wastes, creating situations in which significant changes to waste steams must be made in order to bring them into compliance with environmental regulations. The first step in bringing waste streams into compliance is to determine their status with respect to the newly-applicable regulations. This process of compliance assessment is difficult because requirements to minimize human exposure to radiation can conflict with requirements of environmental regulations, many regulations are potentially applicable, the regulations are changing rapidly, and because waste streams designed to operate under AEA rules frequently cannot be easily modified to incorporate the additional regulations. Modern personal computer (PC) tools are being developed to help regulatory analysts manage the large amounts of information required to asses the compliance status of complex process plants. This paper presents the Plant Compliance Assessment System (PCAS), which performs this function by relating a database containing references to regulatory requirements to databases created to describe relevant aspects of the facility to be assessed

  8. Congenital absence of infrarenal IVC and iliac venous system : Unusual collateral Pathways

    International Nuclear Information System (INIS)

    Lee, Jin Joo; Lee, Byung Hee; Kim, Kie Hwan; Do, Young Soo; Chin, Soo Yil

    1994-01-01

    We present a case with congenital absence of the infrarenal portion of inferior vena cava and iliac venous system, showing unusual venous collaterals including the left ovarian venous collateral via parametrial venous complex, and a mesenteric-periureteric venous connection. The venous collateral pathways were demonstrated by computed tomography and venography

  9. Visa Compliance System

    Data.gov (United States)

    US Agency for International Development — A new secure web-based system that tracks the approval process of the DS-2019 applications and participant information. The Office of Education uses VCS to track the...

  10. THE AZYGOS VENOUS SYSTEM AND ITS ANATOMICAL VARIATIONS

    Directory of Open Access Journals (Sweden)

    Madiki Sudhakara Rao

    2016-06-01

    Full Text Available AIMS AND OBJECTIVES Azygos veins are important cavocaval and portacaval junctions, which form a collateral circulation in caval vein occlusion and in portal hypertension, cirrhosis of liver. The unpaired azygos venous system consists of azygos vein, hemiazygos vein and accessory azygos vein. This system of veins, along with its mediastinal, bronchial and oesophageal tributaries drains most of the body wall of trunk, namely posterior abdominal and thoracic wall. Anatomical variations of this unpaired azygos venous system are clinically important. AIMS To study and report the occurrence of anatomical variations of the unpaired azygos venous system in the region of East Godavari District, Andhra Pradesh (India. METHODS The present study was carried out in the Department of Anatomy, KIMS & RF, Amalapuram and G.S.L. Medical College, Rajahmundry over a period of 2 years. The present study was conducted on 60 cadavers (irrespective of age and sex. The entire course of the azygos venous system in these 60 cadavers was carefully observed and documented. RESULTS Anatomical variations were present in 16.66% of cases, out of which three distinct types were identified. 6.6% exhibited two separate azygos venous systems with no communications, 5% with communication between the left brachiocephalic vein and the azygos vein and 5% presence of post-aortic venous channels. CONCLUSION Variations of azygos venous system may be wrongly dubbed as aneurysm, lymphadenopathy or other abnormalities while reporting a CT scan of mediastinum. Venous anomalies are also detected only during surgery. The most troublesome intraoperative hazard is haemorrhage, which is mainly of venous origin. To avoid such situations is to have an awareness and knowledge of the expected venous anomalies.

  11. Use of ultraportable vacuum therapy systems in the treatment of venous leg ulcer.

    Science.gov (United States)

    Cuomo, Roberto; Nisi, Giuseppe; Grimaldi, Luca; Brandi, Cesare; D'Aniello, Carlo

    2017-10-23

    The high incidence of venous leg ulcers and the difficult to give a complete healing involves in an increase of costs for National Health System. Main therapies to obtain a fast healing are compressive bandages, treatment of abnormal venous flow and in-situ-strategies of wound care. Negative pressure therapy does not conventionally used, because these systems not allow the use of compression bandages. Recently the development of ultraportable devices has improved the compliance and the results. Ten patients with venous chronic ulcer on the lower extremities were recruited for this study: all patients had venous leg ulcers from at least one year. We treated the patients with autologous partial thickness skin graft and subsequently we applied NANOVA device included in compressive bandage. We used NANOVA for fourteen days and after we made traditional medications. We submitted a questionnaire to evaluate the impact of dressing and NANOVA device in the quality of life of patients. The device contributed to the formation of granulation tissue and increased the success rate of autologous skin graft without limiting mobility of patient. In addition to this, we have been able to perform compression bandages thanks to small size of this device. Eight ulcers healed within 90 days of medication. We believe that ultraportable negative pressure systems are useful devices for treatment of venous leg ulcers because them allows to realize a compressive bandage without mobility limitations.

  12. Total anomalous systemic venous drainage in left heterotaxy syndrome.

    Science.gov (United States)

    Khandenahally, Ravindranath S; Deora, Surender; Math, Ravi S

    2013-04-01

    Total anomalous systemic venous drainage is an extremely rare congenital heart defect. In this study we describe an 11-year-old girl who presented with a history of fatigue and central cyanosis that she had had since early childhood with unremarkable precordial examination results. Investigations revealed left heterotaxy with all systemic venous drainage to the left-sided atrium with non-compaction of the left ventricle.

  13. ENDOVASCULAR TREATMENT FOR DISORDERS OF THE VENOUS SYSTEM

    Directory of Open Access Journals (Sweden)

    A. G. Osiev

    2015-01-01

    Full Text Available The annual rate of deep vein thrombosis in general population is from 5 to 9 cases per 10 000, whereas for venous thromboembolism (deep vein thrombosis and pulmonary embolism taken together amounts to 14 cases per 10 000. To improve longterm results of therapy for thrombosis of deep veins of the lower extremities, it is important to restore venous function and outflow. Anticoagulant therapy with low weight or non-fractionated heparin preparations remains the most widely used method of management. However, total or partial thrombosis resolution under anticoagulant treatment is achieved only in 4 and 14% of cases, respectively. Thrombolysis allows for early resorption of the thrombus by means of a minimally invasive procedure with lower risk of complication. After the venous flow is restored, the aim of treatment is to prevent damage to the venous valves, venous hypertension and repeated thrombosis with development of the post-thrombotic syndrome. Compared to anticoagulation, systemic thrombolysis has the benefit of more rapid clot resorption and less damage to the venous valve. One of its serious limitations is a high bleeding risk related to higher doses of the drug administered through a peripheral vein catheter. Therefore, selective intra-clot administration of thombolytics (direct catheter thrombolysis has been suggested as an alternative. For more effective therapy with the use of lower doses of thrombolytics, the so called pharmaco-mechanical thrombectomy has been developed. Venous stenosis hindering the venous outflow is frequently seen after direct catheter or pharmaco-mechanical thrombolysis. Angioplasty with stent placement is recommended in the cases with residual venous abnormality after successful thrombolysis and thrombectomy. 

  14. Integrated Compliance Information System (ICIS)

    Data.gov (United States)

    U.S. Environmental Protection Agency — The purpose of ICIS is to meet evolving Enforcement and Compliance business needs for EPA and State users by integrating information into a single integrated data...

  15. Venous, Arterialized-Venous, or Capillary Glucose Reference Measurements for the Accuracy Assessment of a Continuous Glucose Monitoring System

    NARCIS (Netherlands)

    Kropff, Jort; van Steen, Sigrid C.; deGraaff, Peter; Chan, Man W.; van Amstel, Rombout B. E.; DeVries, J. Hans

    2017-01-01

    Background: Different reference methods are used for the accuracy assessment of continuous glucose monitoring (CGM) systems. The effect of using venous, arterialized-venous, or capillary reference measurements on CGM accuracy is unclear. Methods: We evaluated 21 individuals with type 1 diabetes

  16. Basic studies on the estimation of the capacitance of human pulmonary 'venous' system using radionuclide angiocardiography

    International Nuclear Information System (INIS)

    Fujiwara, Hideki; Gotoh, Kohshi; Suzuki, Takahiko; Ohsumi, Yukio; Yagi, Yasuo; Hirakawa, Senri

    1993-01-01

    To establish the methodology to assess the capacitance of human pulmonary 'venous' system, using radionuclide angiocardiography and passive leg elevation, some basic aspects of the method were investigated. The pulmonary 'venous' system consisted of pulmonary veins and the left atrium. A short segment of the volume-pressure curve in human pulmonary 'venous' system was obtained as a line connecting the 2 points. (1) Pulmonary 'venous' volume-mean pulmonary capillary wedge pressure plot (P 'V' V-PCW plot) in supine position, where P 'V' V=0.7 x PBV. Pulmonary blood volume (PBV) was obtained by radionuclide angiocardiography, while mean pulmonary capillary wedge pressure (PCW) was simultaneously recorded by a floating catheter. (2) ΔP 'V' V-ΔPCW relation where ΔP 'V' V=0.8 x ΔPBV. Increment of the pulmonary blood volume (ΔPBV) during passive elevation of legs was measured from the baseline PBV and the percentage increase in the radioactivity over the right anterior chest during the leg elevation, after correction for (a) radioactivity from chest wall origin, and for (b) attenuation of the radioactive beams by the lung and the anterior chest wall. ΔPCW was the increase in PCW during leg elevation. The present study focussed on the details of the two corrections, (a) and (b), using, in parts, mechanical models. The present study also focussed on the reproducibility of the ΔP 'V' V, ΔPCW and Cp'v' (compliance of the pulmonary 'venous' system). The coefficient of variation was ±23% in ΔP 'V' V, ±18% in ΔPCW and ±18% in Cp'v', indicating a fair degree of reproducibility. (author)

  17. Consolidated Audit And Compliance System (CACS)

    Data.gov (United States)

    US Agency for International Development — Consolidated Audit and Compliance System: is an audit findings management and reporting system. CACS is an implementation of the Agency Secure Image and Storage...

  18. Calcification in the portal venous system demonstrated by computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Hadar, H; Sommer, R

    1983-08-01

    The CT appearance of calcification in the portal venous system in a patient with chronic alcoholic cirrhosis is presented. Reported cases of radiologically detectable calcification in the portal system are rare, and most of them have been associated with longstanding portal hypertension. We presume that with CT this diagnosis will be made more frequently. In the presence of calcification in the portal venous system, portal vein thrombosis is highly probable. This information is of obvious importance to the surgeon contemplating a portal decompressive shunt procedure.

  19. Intramedullary Venous Drainage System for Distal Fingertip Replantations.

    Science.gov (United States)

    Purisa, Husrev; Ozturk, Muhammed Besir; Kabakas, Fatih; Mersa, Berkan; Ozcelik, Ismail Bulent; Sezer, Ilker

    2017-08-01

    The number of venous anastomoses performed during fingertip replantation is one of the most important factors affecting the success of replantation. However, because vessel diameters decrease in the zone 1 level, vessel anastomoses, especially vein anastomoses, are technically difficult and, thus, cannot be performed in most cases. Alternative venous drainage methods are crucial when any reliable vein repair is not possible. In the literature, so many artery-only replantation techniques have been defined, such as arteriovenous anastomoses, forming an arteriovenous or venocutaneous fistula, manual milking and massage, puncturing, and external bleeding via a fishmouth incision and using a medical leech. It has been shown that, in distal fingertip replantations, the medullary cavity may also be a good way for venous return. In this study, we introduce an alternative intramedullary venous drainage system we developed to facilitate venous drainage in artery-only fingertip replantations. The results of 24 fingertip replantations distal to the nail fold by using this system are presented with a literature review.

  20. Chlamydia pneumoniae, systemic inflammation and the risk of venous thrombosis.

    NARCIS (Netherlands)

    Maraha, B.; Peeters, M.F.; Aken, B.E. van; Heijer, M. den

    2002-01-01

    Inflammatory mediators are involved in activation of the coagulation system, and elevated plasma concentrations of IL-6 and IL-8 are associated with an increased risk of venous thrombosis. Using serologic and molecular biologic tests, we investigated in a case-control study on patients with

  1. 'Chronic cerebrospinal venous insufficiency' in multiple sclerosis. Is multiple sclerosis a disease of the cerebrospinal venous outflow system?

    International Nuclear Information System (INIS)

    Wattjes, M.P.; Doepp, F.; Bendszus, M.; Fiehler, J.

    2011-01-01

    Chronic impaired venous outflow from the central nervous system has recently been claimed to be associated with multiple sclerosis (MS) pathology. This resulted in the term chronic cerebrospinal venous insufficiency (CCSVI) in MS. The concept of CCSVI is based on sonography studies showing that impaired venous outflow leading to pathological reflux is almost exclusively present in MS patients but not in healthy controls. Based on these findings, a new pathophysiological concept has been introduced suggesting that chronic venous outflow obstruction and venous reflux in the CNS result in pathological iron depositions leading to inflammation and neurodegeneration. The theory of CCSVI in MS has rapidly generated tremendous interest in the media and among patients and the scientific community. In particular, the potential shift in treatment concepts possibly leading to an interventional treatment approach including balloon angioplasty and venous stent placement is currently being debated. However, results from recent studies involving several imaging modalities have raised substantial concerns regarding the CCSVI concept in MS. In this review article, we explain the concept of CCSVI in MS and discuss this hypothesis in the context of MS pathophysiology and imaging studies which have tried to reproduce or refute this theory. In addition, we draw some major conclusions focusing in particular on the crucial question as to whether interventional treatment options are expedient. In conclusion, the present conclusive data confuting the theory of CCSVI in MS should lead to reluctance with respect to the interventional treatment of possible venous anomalies in MS patients. (orig.)

  2. Space Telecommunications Radio System (STRS) Compliance Testing

    Science.gov (United States)

    Handler, Louis M.

    2011-01-01

    The Space Telecommunications Radio System (STRS) defines an open architecture for software defined radios. This document describes the testing methodology to aid in determining the degree of compliance to the STRS architecture. Non-compliances are reported to the software and hardware developers as well as the NASA project manager so that any non-compliances may be fixed or waivers issued. Since the software developers may be divided into those that provide the operating environment including the operating system and STRS infrastructure (OE) and those that supply the waveform applications, the tests are divided accordingly. The static tests are also divided by the availability of an automated tool that determines whether the source code and configuration files contain the appropriate items. Thus, there are six separate step-by-step test procedures described as well as the corresponding requirements that they test. The six types of STRS compliance tests are: STRS application automated testing, STRS infrastructure automated testing, STRS infrastructure testing by compiling WFCCN with the infrastructure, STRS configuration file testing, STRS application manual code testing, and STRS infrastructure manual code testing. Examples of the input and output of the scripts are shown in the appendices as well as more specific information about what to configure and test in WFCCN for non-compliance. In addition, each STRS requirement is listed and the type of testing briefly described. Attached is also a set of guidelines on what to look for in addition to the requirements to aid in the document review process.

  3. Involvement of systemic venous congestion in heart failure.

    Science.gov (United States)

    Rubio Gracia, J; Sánchez Marteles, M; Pérez Calvo, J I

    2017-04-01

    Systemic venous congestion has gained significant importance in the interpretation of the pathophysiology of acute heart failure, especially in the development of renal function impairment during exacerbations. In this study, we review the concept, clinical characterisation and identification of venous congestion. We update current knowledge on its importance in the pathophysiology of acute heart failure and its involvement in the prognosis. We pay special attention to the relationship between abdominal congestion, the pulmonary interstitium as filtering membrane, inflammatory phenomena and renal function impairment in acute heart failure. Lastly, we review decongestion as a new therapeutic objective and the measures available for its assessment. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  4. A new venous infusion pathway monitoring system.

    Science.gov (United States)

    Maki, Hiromichi; Yonezawa, Yoshiharu; Ogawa, Hidekuni; Ninomiya, Ishio; Sata, Koji; Hamada, Shingo; Caldwell, W Morton

    2007-01-01

    A new infusion catheter pathway monitoring system employing linear integrated circuits and a low-power 8-bit single chip microcomputer has been developed for hospital and home use. The sensor consists of coaxial three-layer conductive tapes wrapped around the polyvinyl chloride infusion tube. The inner tape is the main electrode, which records an AC (alternating current) voltage induced on the patient's body by electrostatic coupling from the normal 100 volt, 60 Hz AC power line wiring field in the patient's room. The outside tape layer is a reference electrode to monitor the AC voltage around the main electrode. The center tape layer is connected to system ground and functions as a shield. The microcomputer calculates the ratio of the induced AC voltages recorded by the main and reference electrodes and if the ratio indicates a detached infusion, alerts the nursing station, via the nurse call system or low transmitting power mobile phone.

  5. Management information systems for environmental compliance activities

    Energy Technology Data Exchange (ETDEWEB)

    1990-04-23

    The Department of Energy (DOE) is subject to Federal and state laws designed to protect against threats to public health and the environment. The purpose of this audit was to determine whether the Department had developed adequate information systems for tracking and reporting on the status of its compliance with these laws. Systems used for prioritizing and budgeting for environmental activities are being addressed in a separate review.

  6. A Summation Analysis of Compliance and Complications of Compression Hosiery for Patients with Chronic Venous Disease or Post-thrombotic Syndrome.

    Science.gov (United States)

    Kankam, Hadyn K N; Lim, Chung S; Fiorentino, Francesca; Davies, Alun H; Gohel, Manj S

    2018-03-01

    Compression stockings are commonly prescribed for patients with a range of venous disorders, but are difficult to don and uncomfortable to wear. This study aimed to investigate compliance and complications of compression stockings in patients with chronic venous disease (CVD) and post-thrombotic syndrome (PTS). A literature search of the following databases was carried out: MEDLINE (via PubMed), EMBASE (via OvidSP, 1974 to present), and CINAHL (via EBSCOhost). Studies evaluating the use of compression stockings in patients with CVD (CEAP C2-C5) or for the prevention or treatment of PTS were included. After scrutinising full text articles, compliance with compression and associated complications were assessed. Compliance rates were compared based on study type and degree of compression. Good compliance was defined as patients wearing compression stockings for >50% of the time. From an initial search result of 4303 articles, 58 clinical studies (37 randomised trials and 21 prospective studies) were selected. A total of 10,245 limbs were included, with compression ranging from 15 to 40 mmHg (not stated in 12 studies) and a median follow-up of 12 months (range 1-60 months). In 19 cohorts, compliance was not assessed and in a further nine, compliance was poorly specified. Overall, good compliance with compression was reported for 5371 out of 8104 (66.2%) patients. The mean compliance, weighted by study size, appeared to be greater for compression ≤25 mmHg (77%) versus > 25 mmHg (65%) and greater in the randomised studies (74%) than in prospective observational studies (64%). Complications of stockings were not mentioned in 43 out of 62 cohorts reviewed. Where complications were considered, skin irritation was a common event. In published trials, good compliance with compression is reported in around two thirds of patients, with inferior compliance in those given higher degrees of compression. Further studies are required to identify predictors of non-compliance

  7. Cerebral venous outflow and cerebrospinal fluid dynamics

    Directory of Open Access Journals (Sweden)

    Clive B. Beggs

    2014-12-01

    Full Text Available In this review, the impact of restricted cerebral venous outflow on the biomechanics of the intracranial fluid system is investigated. The cerebral venous drainage system is often viewed simply as a series of collecting vessels channeling blood back to the heart. However there is growing evidence that it plays an important role in regulating the intracranial fluid system. In particular, there appears to be a link between increased cerebrospinal fluid (CSF pulsatility in the Aqueduct of Sylvius and constricted venous outflow. Constricted venous outflow also appears to inhibit absorption of CSF into the superior sagittal sinus. The compliance of the cortical bridging veins appears to be critical to the behaviour of the intracranial fluid system, with abnormalities at this location implicated in normal pressure hydrocephalus. The compliance associated with these vessels appears to be functional in nature and dependent on the free egress of blood out of the cranium via the extracranial venous drainage pathways. Because constricted venous outflow appears to be linked with increased aqueductal CSF pulsatility, it suggests that inhibited venous blood outflow may be altering the compliance of the cortical bridging veins.

  8. Cerebral venous system and anatomical predisposition to high-altitude headache

    NARCIS (Netherlands)

    Wilson, Mark H.; Davagnanam, Indran; Holland, Graeme; Dattani, Raj S.; Tamm, Alexander; Hirani, Shashivadan P.; Kolfschoten, Nicky; Strycharczuk, Lisa; Green, Cathy; Thornton, John S.; Wright, Alex; Edsell, Mark; Kitchen, Neil D.; Sharp, David J.; Ham, Timothy E.; Murray, Andrew; Holloway, Cameron J.; Clarke, Kieran; Grocott, Mike P. W.; Montgomery, Hugh; Imray, Chris; Ahuja, V.; Aref-Adib, G.; Burnham, R.; Chisholm, A.; Clarke, K.; Coates, D.; Coates, M.; Cook, D.; Cox, M.; Dhillon, S.; Dougall, C.; Doyle, P.; Duncan, P.; Edsell, M.; Edwards, L.; Evans, L.; Gardiner, P.; Grocott, M.; Gunning, P.; Hart, N.; Harrington, J.; Harvey, J.; Holloway, C.; Howard, D.; Hurlbut, D.; Imray, C.; Ince, C.; Jonas, M.; van der Kaaij, J.

    2013-01-01

    As inspired oxygen availability falls with ascent to altitude, some individuals develop high-altitude headache (HAH). We postulated that HAH results when hypoxia-associated increases in cerebral blood flow occur in the context of restricted venous drainage, and is worsened when cerebral compliance

  9. Emulsifiers' composition modulates venous irritation of the nanoemulsions as a lipophilic and venous irritant drug delivery system.

    Science.gov (United States)

    Mao, Chengwen; Wan, Jiangling; Chen, Huabing; Xu, Huibi; Yang, Xiangliang

    2009-01-01

    In this study, a nanoemulsion (NE) system was investigated for intravenous delivery of lipophilic and venous irritant drugs. NEs were prepared to deliver diallyl trisulfide (DT) for systemic therapy of bacterial and fungal infection, egg phospholipid was chosen as the main emulsifier, and two co-emulsifiers were also incorporated, including Poloxamer 188 (P188) and Solutol HS 15 (S15). Soybean oil was used as the dispersed phases, forming stable DT NEs with small particle sizes. The venous irritation of DT NEs was evaluated by in vitro human umbilical cord endothelial cells (CRL 1730) compatibility model with the intracellular adenosine triphosphate (ATP) and guanosine triphosphate (GTP) concentrations as the indices. The intracellular ATP and GTP reduction changed with the incorporation of a variety of co-emulsifiers, which varied in a free DT concentration-dependent manner. It was deduced that the free DT concentrations of NEs containing co-emulsifiers were determined by the partition coefficient of DT between oil and surfactant buffer solution. In conclusion, NE was an appropriate delivery system for lipophilic and venous irritant drug, and optimization of the composition of emulsifiers was an effective method to alleviate the venous irritation of DT NEs.

  10. Systemic Venous Inflow to the Liver Allograft to Overcome Diffuse Splanchnic Venous Thrombosis

    Directory of Open Access Journals (Sweden)

    Cristian Lupascu

    2015-01-01

    Full Text Available Diffuse splanchnic venous thrombosis (DSVT, formerly defined as contraindication for liver transplantation (LT, is a serious challenge to the liver transplant surgeon. Portal vein arterialisation, cavoportal hemitransposition and renoportal anastomosis, and finally combined liver and small bowel transplantation are all possible alternatives to deal with this condition. Five patients with preoperatively confirmed extensive splanchnic venous thrombosis were transplanted using cavoportal hemitransposition (4x and renoportal anastomosis (1x. Median follow-up was 58 months (range: 0,5 to 130 months. Two patients with previous radiation-induced peritoneal injury died, respectively, 18 days and 2 months after transplantation. The three other patients had excellent long-term survival, despite the fact that two of them needed a surgical reintervention for severe gastrointestinal bleeding. Extensive splanchnic venous thrombosis is no longer an absolute contraindication to liver transplantation. Although cavoportal hemitransposition and renoportal anastomosis undoubtedly are life-saving procedures allowing for ensuring adequate allograft portal flow, careful follow-up of these patients remains necessary as both methods are unable to completely eliminate the complications of (segmental portal hypertension.

  11. Quantitative estimation of compliance of human systemic veins by occlusion plethysmography with radionuclide

    International Nuclear Information System (INIS)

    Takatsu, Hisato; Gotoh, Kohshi; Suzuki, Takahiko; Ohsumi, Yukio; Yagi, Yasuo; Tsukamoto, Tatsuo; Terashima, Yasushi; Nagashima, Kenshi; Hirakawa, Senri

    1989-01-01

    Volume-pressure relationship and compliance of human systemic veins were estimated quantitatively and noninvasively using radionuclide. The effect of nitroglycerin (NTG) on these parameters was examined. Plethysmography with radionuclide (RN) was performed using the occlusion method on the forearm in 56 patients with various cardiac diseases after RN angiocardiography with 99m Tc-RBC. The RN counts-venous pressure curve was constructed from (1) the changes in radioactivity from region of interest on the forearm that were considered to reflect the changes in the blood volume of the forearm, and (2) the changes in the pressure of the forearm vein (fv) due to venous occlusion. The specific compliance of the forearm veins (Csp.fv; (1/V)·(ΔV/ΔP)) was obtained graphically from this curve at each patient's venous pressure (Pv). Csp.fv was 0.044±0.012 mmHg -1 in class I (mean±SD; n=13), 0.033±0.007 mmHg -1 in class II (n=30), and 0.019±0.007 mmHg -1 in class III (n=13), of the previous NYHA classification of work tolerance. There were significant differences in Csp.fv among the three classes. The systemic venous blood volume (Vsv) was determined by subtracting the central blood volume, measured by RN-angiocardiography, from total blood volume, measured by the indicator dilution method utilizing 131 I-human serum albumin. Systemic venous compliance (Csv) was calculated from Csv=Csp.fv·Vsv. The Csv was 127.2±24.8 ml·mmHg -1 (mean±SD) in class I, 101.1±24.1 ml·mmHg -1 in class II and 62.2±28.1 ml·mmHg -1 in class III. There were significant differences in Csv among the three classes. The class I Csv value was calculated to be 127.2±24.8 ml·mmHg -1 and the Csv/body weight was calculated to be 2.3±0.7 ml·mmHg -1 ·kg -1 of body weight. The administration of NTG increased Csv significantly in all cases. (J.P.N.)

  12. Presence of air in the hepatic portal system in association with umbilical venous catheter malposition

    Directory of Open Access Journals (Sweden)

    Beatriz Regina Alvares

    2014-01-01

    Full Text Available The authors report a case of umbilical venous catheter malposition with air in the portal venous system in a preterm neonate. Initially, the hypothesis of necrotizing enterocolitis was considered, but the newborn progressed with no finding of disease and the air disappeared at follow-up radiography. The differential diagnosis of such a finding can avoid unnecessary clinical treatments.

  13. Visualization of portal venous system by single photon emission CT

    Energy Technology Data Exchange (ETDEWEB)

    Kashiwagi, T; Ikawa, T; Azuma, M; Matsuda, H; Yoshioka, H; Mitsutani, N; Koizumi, T

    1987-03-01

    Single photon emission CT (SPECT) was performed for the intra-abdominal blood pool with /sup 99m/Tc autologous red blood cells (RBC) in 15 patients with liver cirrhosis. Twenty mCi of /sup 99m/Tc-RBC labeled by in vivo technique were administered intravenously and tomographic imaging of the intra-abdominal vascular blood pool was performed as follows. For each subject, 64 views were obtained over 360 deg of elliptic rotation at 30 seconds per view using a high resolution low energy parallel-hole collimator. Portal vein and portosystemic collaterals were clearly observed in coronal images. In 12 of 15 patients, portal vein was delineated. Portosystemic collaterals such as coronary vein, splenorenal shunt and umbilical vein were also shown in 12 patients. These images were consistent with images obtained by scintiphotosplenoportography or arterial portography. Therefore, it is considered that SPECT study for the intra-abdominal blood pool is clinically very useful for the diagnosis of abnormality of portal venous system in portal hypertension.

  14. Microsoft System Center 2012 R2 compliance management cookbook

    CERN Document Server

    Baumgarten, Andreas; Roesner, Susan

    2014-01-01

    Whether you are an IT manager, an administrator, or security professional who wants to learn how Microsoft Security Compliance Manager and Microsoft System Center can help fulfil compliance and security requirements, this is the book for you. Prior knowledge of Microsoft System Center is required.

  15. The Ovine Cerebral Venous System: Comparative Anatomy, Visualization, and Implications for Translational Research

    Science.gov (United States)

    Nitzsche, Björn; Lobsien, Donald; Seeger, Johannes; Schneider, Holm; Boltze, Johannes

    2014-01-01

    Cerebrovascular diseases are significant causes of death and disability in humans. Improvements in diagnostic and therapeutic approaches strongly rely on adequate gyrencephalic, large animal models being demanded for translational research. Ovine stroke models may represent a promising approach but are currently limited by insufficient knowledge regarding the venous system of the cerebral angioarchitecture. The present study was intended to provide a comprehensive anatomical analysis of the intracranial venous system in sheep as a reliable basis for the interpretation of experimental results in such ovine models. We used corrosion casts as well as contrast-enhanced magnetic resonance venography to scrutinize blood drainage from the brain. This combined approach yielded detailed and, to some extent, novel findings. In particular, we provide evidence for chordae Willisii and lateral venous lacunae, and report on connections between the dorsal and ventral sinuses in this species. For the first time, we also describe venous confluences in the deep cerebral venous system and an ‘anterior condylar confluent’ as seen in humans. This report provides a detailed reference for the interpretation of venous diagnostic imaging findings in sheep, including an assessment of structure detectability by in vivo (imaging) versus ex vivo (corrosion cast) visualization methods. Moreover, it features a comprehensive interspecies-comparison of the venous cerebral angioarchitecture in man, rodents, canines and sheep as a relevant large animal model species, and describes possible implications for translational cerebrovascular research. PMID:24736654

  16. Method for determining the schematic presentation for the cortical sulci and venous system

    International Nuclear Information System (INIS)

    Tatemichi, Nobuhiro; Nakano, Hirotake; Inoue, Yoshiharu.

    1994-01-01

    To realize the corticogram of major sulci and venous system, two different image modalities must be superposed with a minimum error : MRI, MRA and X-Ray angiography. The precise schema of cortical sulci have to become possible with the aid of the IR method of MRI that could clearly identify the sulcal system of the outer and internal surface of the hemisphere. The correspondence of the major venous system of MRI with that of angiography was carried out using several skin markers, bone structures and a deep major venous system. This corticogram was used by the neurosurgeons of the hospital for the electrode placement, the topographical identification of the cortical paroxysms and epilepsy surgery. The best argument for the accuracy of sulcal and venous schema could be offered by somato-sensory evoked potential identifying the central sulcus on the corticogram. (author)

  17. New compliance management system of the University Hospital Frankfurt, Germany

    OpenAIRE

    Irmscher, Bettina

    2016-01-01

    The meaning of Corporate Governance is all values and principles guiding or regulating good and responsible business management. Clearly defined roles and responsibilities for managing compliance, risks and checks is the prerequisite for the latter. For that reason, a compliance management system was set up at the University Hospital Frankfurt in 2015.

  18. Abnormal systemic venous connection possibly associated with a persistent right umbilical vein; a case report

    Directory of Open Access Journals (Sweden)

    Smevik Bjarne

    2004-04-01

    Full Text Available Abstract Background Abnormal venous connections involving a persistent right umbilical vein are rare. In a minority of cases the liver is entirely bypassed and the condition is associated with multiple congenital malformations. Case presentation The described case illustrates a systemic venous drainage that was severely abnormal in a newborn girl with a truncus arteriosus type II congenital heart defect. Injection of contrast medium through the umbilical vein catheter revealed a very peculiar venous connection that passed anterio-laterally through the right hemithorax before crossing in an oblique fashion towards the superior vena cava. Conclusions This venous drainage may be the result of a persistent right umbilical vein connecting with the superior vena cava.

  19. Report: ECHO Data Quality Audit – Phase I Results: The Integrated Compliance Information System Needs Security Controls to Protect Significant Non-Compliance Data

    Science.gov (United States)

    Report #09-P-0226, August 31, 2009. End users of the Permit Compliance System and Integrated Compliance Information System National Pollutant Discharge Elimination System can override the Significant Non-Compliance data field without more access controls.

  20. Improving compliance in remote healthcare systems through smartphone battery optimization.

    Science.gov (United States)

    Alshurafa, Nabil; Eastwood, Jo-Ann; Nyamathi, Suneil; Liu, Jason J; Xu, Wenyao; Ghasemzadeh, Hassan; Pourhomayoun, Mohammad; Sarrafzadeh, Majid

    2015-01-01

    Remote health monitoring (RHM) has emerged as a solution to help reduce the cost burden of unhealthy lifestyles and aging populations. Enhancing compliance to prescribed medical regimens is an essential challenge to many systems, even those using smartphone technology. In this paper, we provide a technique to improve smartphone battery consumption and examine the effects of smartphone battery lifetime on compliance, in an attempt to enhance users' adherence to remote monitoring systems. We deploy WANDA-CVD, an RHM system for patients at risk of cardiovascular disease (CVD), using a wearable smartphone for detection of physical activity. We tested the battery optimization technique in an in-lab pilot study and validated its effects on compliance in the Women's Heart Health Study. The battery optimization technique enhanced the battery lifetime by 192% on average, resulting in a 53% increase in compliance in the study. A system like WANDA-CVD can help increase smartphone battery lifetime for RHM systems monitoring physical activity.

  1. The collateral venous system in late pregnancy: A systematic review of the literature.

    Science.gov (United States)

    Humphries, Aimee; Stone, Peter; Mirjalili, S Ali

    2017-11-01

    Recent literature has reported an association between maternal supine sleep position and stillbirth during late pregnancy. In this position the gravid uterus almost completely obstructs the inferior vena cava. A small number of women experience supine hypotension, thought to be due in part to inadequate collateral venous circulation. The aim of this paper is to review the literature describing the anatomy of the collateral venous system and in particular the azygos system, the abdominal portion of which has not been well studied. A systematic review was conducted using the electronic databases: Medline, Embase, Scopus, and Google Scholar. Relevant anatomical and radiological literature concerning the azygos system in particular was reviewed. The search was limited to adult human studies only. The collateral venous system can be divided into superficial, intermediate and deep systems. The azygos system in particular provides immediate collateral venous circulation in the event of acute inferior vena caval obstruction. The abdominal portion of this pathway, including the ascending lumbar vein, has not been well studied and there are certain variations that can render it ineffective. In conclusion, the collateral venous system provides an alternative route for blood to flow back to the systemic circulation when acute occlusion of the inferior vena cava occurs in the supine position during late pregnancy. However, certain anatomical variations can render this pathway ineffective, and this could have implications for the development of supine hypotension and stillbirth in late pregnancy. Clin. Anat. 30:1087-1095, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  2. A prospective case series evaluating the safety and efficacy of the Klox BioPhotonic System in venous leg ulcers

    Directory of Open Access Journals (Sweden)

    Nikolis A

    2016-09-01

    Full Text Available Andreas Nikolis,1 Doria Grimard,2 Yves Pesant,3 Giovanni Scapagnini,4 Denis Vézina5 1Division of Plastic Surgery, Victoria Park Research Centre, Montreal, 2Q&T Research Chicoutimi, Chicoutimi, 3St-Jerome Medical Research Inc., St-Jerome, Quebec, Canada; 4Department of Medicine and Health Sciences, School of Medicine, University of Molise, Campobasso, Italy; 5Klox Technologies, Laval, Quebec, Canada Purpose: To investigate the safety and efficacy of the BioPhotonic System developed by Klox Technologies in a case series of ten patients with venous leg ulcers.Patients and methods: Ten patients with chronic venous leg ulcers, having failed on at least one previous therapy, were enrolled into this case series.Results: Nine patients were evaluable for efficacy. A response (defined as decrease in wound surface area was observed in seven patients (77.8%. Of these, four patients (44.4% achieved wound closure on average 4 months (127.5 days following the beginning of the treatment. Two patients did not respond to the investigational treatment. Quality of life improved over time throughout the study. Compliance was excellent, with 93.2% of visits completed as per protocol. Safety was unremarkable, with only four treatment-emergent-related adverse events, for which no specific intervention was required.Conclusion: The BioPhotonic System was shown to be safe and extremely well tolerated. It also demonstrated potential in terms of wound closure, wound surface area decrease, and wound bed preparation. Keywords: biophotonics, light, photobiomodulation, venous leg ulcers

  3. Systemic treatments for the prevention of venous thrombo-embolic events in paediatric cancer patients with tunnelled central venous catheters

    NARCIS (Netherlands)

    Schoot, Reineke A.; Kremer, Leontien C. M.; van de Wetering, Marianne D.; van Ommen, Cornelia H.

    2013-01-01

    Venous thrombo-embolic events (VTEs) occur in 2.2% to 14% of paediatric cancer patients and cause significant morbidity and mortality. The malignant disease itself, the cancer treatment and the presence of central venous catheters (CVCs) increase the risk of VTE. The primary objective of this review

  4. Compliance Framing - Framing Compliance

    OpenAIRE

    Lutz-Ulrich Haack; Martin C. Reimann

    2012-01-01

    Corporations have to install various organizational measures to comply with legal as well as internal guidelines systematically. Compliance management systems have the challenging task to make use of an internal compliance-marketing approach in order to ensure not only an adequate but also effective compliance-culture. Compliance-literature and findings of persuasive goal-framing-theory give opposite implications for establishing a rather values- versus rule-based compliance-culture respectiv...

  5. Estimation of the compliance of the human capacitance vessels using radionuclide plethysmography

    International Nuclear Information System (INIS)

    Takatsu, Hisato; Gotoh, Kohshi; Suzuki, Takahiko

    1988-01-01

    Radionuclide (RN) plethysmography with Tc-99m RBC was performed in 32 patients with heart disease with the purpose of obtaining compliance of human capacitance vessels. When equilibrium was achieved, RN counts of the region of interest and venous pressure in the forearm were sequentially recorded when the vein of the upper arm was occluded with a cuff inflator. Based on the RN count-venous pressure curve, the specific compliance of the forearm vein and compliance of systemic venous system (SVS) were estimated. In the group of the NYHA functional classification I, which is recognized as hemodynamically ''normal'', the compliance of SVS was 129.8 +- 25.9 ml · mmHg -1 (mean +- SD; n = 9). In comparing the NYHA functional classification and the compliance of SVS, the compliance of SVS was significantly decreased for severer heart failure. Tongue administration of nitroglycerin (0.6 mg) significantly increased the compliance of SVS (p < 0.01). (Namekawa, K.)

  6. Interventional Radiological Management of Prehepatic Obstruction the Splanchnic Venous System

    International Nuclear Information System (INIS)

    Semiz-Oysu, Aslihan; Keussen, Inger; Cwikiel, Wojciech

    2007-01-01

    Purpose. The purpose of this study was to retrospectively evaluate interventional radiological management of patients with symptomatic portal hypertension secondary to obstruction of splanchnic veins. Material and Methods. Twenty-four patients, 15 males and 9 females, 0.75 to 79 years old (mean, 36.4 years), with symptomatic portal hypertension, secondary to splanchnic venous obstruction, were treated by percutaneous methods. Causes and extent of splanchnic venous obstruction and methods are summarized following a retrospective evaluation. Results. Obstructions were localized to the main portal vein (n = 22), intrahepatic portal veins (n = 8), splenic vein (n = 4), and/or mesenteric veins (n = 4). Interventional treatment of 22 (92%) patients included recanalization (n = 19), pharmacological thrombolysis (n = 1), and mechanical thrombectomy (n = 5). Partial embolization of the spleen was done in five patients, in two of them as the only possible treatment. TIPS placement was necessary in 10 patients, while an existing occluded TIPS was revised in two patients. Transhepatic embolization of varices was performed in one patient, and transfemoral embolization of splenorenal shunt was performed in another. Thirty-day mortality was 13.6% (n=3). During the follow-up, ranging between 2 days and 58 months, revision was necessary in five patients. An immediate improvement of presenting symptoms was achieved in 20 patients (83%). Conclusion. We conclude that interventional procedures can be successfully performed in the majority of patients with obstruction of splanchnic veins, with subsequent improvement of symptoms. Treatment should be customized according to the site and nature of obstruction

  7. Effect of Multi-layer Compression Bandage Systems on Leg Ulcers Associated with Chronic Venous Insufficiency

    Directory of Open Access Journals (Sweden)

    Hüseyin Kuplay

    2013-03-01

    Full Text Available Introduction: Venous leg ulcer is a major health problem in terms of high prevalence and high cost for treatment. Multi-layer compression bandage systems for venous leg ulcers are supposed to be the gold standard for the treatment of venous ulcers. The aim of the current study is to investigate the effectiveness of multi-layer compression bandage systems for the treatment of venous leg ulcers.Patients and Methods: Nineteen consecutive patients diagnosed to have leg ulcers were evaluated and four patients were excluded from the study due to the peripheral arterial disease. Fifteen patients, enrolled in the study, were classified according to CEAP classification and belonged to the same class. Betaven® multi-layer compression bandage was applied to patients. Patients were followed-up in terms of wound healing and reduction in wound diameter.Results: Twelve male and three female patients underwent multi-layer bandage system. Mean age of patients was 38.2 ± 4.2 years. Ulcer size was measured planimetrically and baseline ulcer size was 4-10 cm². The location of ulcer was on medial malloelus in seven patients, lateral malleolus in three patients, anterior surface of the leg in four patients and lateral side of the leg in one patient. Patients had chronic venous insuuficiency for a mean of 5.1 ± 2.1 years. CEAP classifications were C6, Ep, As2,3-p18, Pr2,3, 18. Each bandage was changed five days after application along with wound care. Mean duration of treatment was 6 ± 2 weeks. Complete healing of the venous ulcers occurred in all patients except for one. This patient was referred to plastic surgery clinic for reconstruction.Conclusion: Multi-layer compression bandage system is an effective method of treatment for venous leg ulcers associated with chronic venous insufficiency by reducing venous return and increasing intertitial tissue pressure. This effect occurred in the shortrun as well as with a low cost and prevented loss of labor.

  8. Anesthetic implications of total anomalous systemic venous connection to left atrium with left isomerism

    Directory of Open Access Journals (Sweden)

    Parimala Prasanna Simha

    2012-01-01

    Full Text Available Total anomalous systemic venous connection (TASVC to the left atrium (LA is a rare congenital anomaly. An 11-year-old girl presented with complaints of palpitations and cyanosis. TASVC with left isomerism and noncompaction of LV was diagnosed after contrast echocardiogram and computed tomography angiogram. The knowledge of anatomy and pathophysiology is essential for the successful management of these cases. Anesthetic concerns in this case were polycythemia, paradoxical embolism and rhythm abnormalities. The patient was successfully operated by rerouting the systemic venous connection to the right atrium.

  9. Order of draw practices in venous blood sampling at clinical biochemistry departments in the Danish health care system

    DEFF Research Database (Denmark)

    Jacobsen, Katja Kemp; Brandt, Ida; Christensen, Anne Vindahl

    2018-01-01

    the procedures in venous blood sampling among clinical biochemistry departments to assess the uniformity of order of blood draw and adherence to international guidelines in the Danish health care system. METHODS: We collected venous order of draw procedures from 49 clinical biochemistry departments at 22 public...... 15189:2012 accreditation (p = .57). CONCLUSIONS: Venous order of draw procedures is diverse at Danish clinical biochemistry departments and show moderate adherence to international guidelines....

  10. Morpho-functional characterization of the systemic venous pole of the reptile heart

    NARCIS (Netherlands)

    Jensen, Bjarke; Vesterskov, Signe; Boukens, Bastiaan J.; Nielsen, Jan M.; Moorman, Antoon F. M.; Christoffels, Vincent M.; Wang, Tobias

    2017-01-01

    Mammals evolved from reptile-like ancestors, and while the mammalian heart is driven by a distinct sinus node, a sinus node is not apparent in reptiles. We characterized the myocardial systemic venous pole, the sinus venosus, in reptiles to identify the dominant pacemaker and to assess whether the

  11. Venous and autonomic function in formerly pre-eclamptic women and BMI-matched controls.

    Science.gov (United States)

    Heidema, Wieteke M; van Drongelen, Joris; Spaanderman, Marc E A; Scholten, Ralph R

    2018-03-25

    Pre-pregnancy reduced plasma volume increases the risk on subsequent pre-eclamptic pregnancy. Reduced plasma volume is thought to reflect venous reserve capacity, especially when venous vasculature is constricted and sympathetic tone is elevated. As obesity might affect these variables and also relates to pre-eclampsia, increased body weight may underlie these observations. We hypothesized that the relationship between reduced venous reserve and preeclampsia is independent of body mass index (BMI). We compared the non-pregnant venous reserve capacity in 30 formerly pre-eclamptic women, equally divided in 3 BMI-classes (BMI 19.5-24.9, BMI 25-29.9, BMI ≥30) to 30 controls. Cases and controls were matched for BMI, age and parity. The venous reserve capacity was quantified by assessing plasma volume and venous compliance. The autonomic nervous system regulating the venous capacitance was evaluated with heart rate variability analysis in resting supine position and during positive head-up tilt (HUT). Formerly pre-eclamptic women had in supine position lower plasma volume than controls (1339 ± 79 vs 1547 ± 139 ml/m 2 (pBMI-matched controls, reduced venous reserve capacity. This is reflected by lower plasma volume and venous compliance, the autonomic balance is shifted towards sympathetic dominance and lower baroreceptor sensitivity. This suggests that not BMI, but underlying reduced venous reserve relates to pre-eclampsia. This article is protected by copyright. All rights reserved.

  12. The galenic venous system: Surgical anatomy and its angiographic and magnetic resonance venographic correlations

    International Nuclear Information System (INIS)

    Kilic, Tuerker; Ozduman, Koray; Cavdar, Safiye; Oezek, M. Memet; Pamir, M. Necmettin

    2005-01-01

    Objective: This study aims at evaluating the adequacy of digital subtraction angiography and magnetic resonance venography in imaging of the galenic venous system for surgical planning of approaches to the pineal region. Anatomical dissections were carried out in 10 cadavers of several age groups and these were compared to imaging findings in 10 living subjects. Methods: The presence or absence of 10 predetermined veins or vein groupings belonging to the galenic venous system were prospectively analyzed in 10 cadaver dissections and imaging findings of 10 age matched human subjects. The studied vessels were the vein of galen, the internal cerebral veins, both basal vein of Rosenthals, internal occipital vein, occipitotemporal veins, precentral cerebellar veins, tectal veins, pineal veins, superior vermian veins (including superior cerebellar veins (SCVs)) and posterior pericallosal veins. Each of the subjects had both digital subtraction angiography and magnetic resonance venography studies performed. Diagnostic digital subtraction angiography was performed using the transfemoral route and the venous phase was used for the study. Magnetic resonance venography was performed in 1.5 T MRI equipment using the 2D-TOF sequence. All studies were reported to be normal. Results: There was wide variation in the anatomy of the galenic venous system. There were interpersonal, intrapersonal and age related variations. Both the digital subtraction angiography and the magnetic resonance venography were efficient at demonstrating large veins. However, smaller veins were less readily demonstrated in either study. The general sensitivities of the digital subtraction angiography and the magnetic resonance venography for the galenic venous system were 45.5% and 32.5%, respectively. Surgically important veins were missed in most studies. Conclusions: Anatomically, the galenic venous system is highly variable. This variability is caused by interpersonal, intrapersonal and age related

  13. The galenic venous system: Surgical anatomy and its angiographic and magnetic resonance venographic correlations

    Energy Technology Data Exchange (ETDEWEB)

    Kilic, Tuerker [Marmara University, Department of Neurosurgery, PK 53, Maltepe, 81532 Istanbul (Turkey) and Marmara University, Department of Anatomy, Istanbul (Turkey)]. E-mail: turkilic@tnn.net; Ozduman, Koray [Marmara University, Department of Neurosurgery, PK 53, Maltepe, 81532 Istanbul (Turkey); Cavdar, Safiye [Marmara University, Department of Anatomy, Istanbul (Turkey); Oezek, M. Memet [Marmara University, Department of Neurosurgery, PK 53, Maltepe, 81532 Istanbul (Turkey); Pamir, M. Necmettin [Marmara University, Department of Neurosurgery, PK 53, Maltepe, 81532 Istanbul (Turkey)

    2005-11-01

    Objective: This study aims at evaluating the adequacy of digital subtraction angiography and magnetic resonance venography in imaging of the galenic venous system for surgical planning of approaches to the pineal region. Anatomical dissections were carried out in 10 cadavers of several age groups and these were compared to imaging findings in 10 living subjects. Methods: The presence or absence of 10 predetermined veins or vein groupings belonging to the galenic venous system were prospectively analyzed in 10 cadaver dissections and imaging findings of 10 age matched human subjects. The studied vessels were the vein of galen, the internal cerebral veins, both basal vein of Rosenthals, internal occipital vein, occipitotemporal veins, precentral cerebellar veins, tectal veins, pineal veins, superior vermian veins (including superior cerebellar veins (SCVs)) and posterior pericallosal veins. Each of the subjects had both digital subtraction angiography and magnetic resonance venography studies performed. Diagnostic digital subtraction angiography was performed using the transfemoral route and the venous phase was used for the study. Magnetic resonance venography was performed in 1.5 T MRI equipment using the 2D-TOF sequence. All studies were reported to be normal. Results: There was wide variation in the anatomy of the galenic venous system. There were interpersonal, intrapersonal and age related variations. Both the digital subtraction angiography and the magnetic resonance venography were efficient at demonstrating large veins. However, smaller veins were less readily demonstrated in either study. The general sensitivities of the digital subtraction angiography and the magnetic resonance venography for the galenic venous system were 45.5% and 32.5%, respectively. Surgically important veins were missed in most studies. Conclusions: Anatomically, the galenic venous system is highly variable. This variability is caused by interpersonal, intrapersonal and age related

  14. Development of the pulmonary vein and the systemic venous sinus: an interactive 3D overview.

    Directory of Open Access Journals (Sweden)

    Gert van den Berg

    Full Text Available Knowledge of the normal formation of the heart is crucial for the understanding of cardiac pathologies and congenital malformations. The understanding of early cardiac development, however, is complicated because it is inseparably associated with other developmental processes such as embryonic folding, formation of the coelomic cavity, and vascular development. Because of this, it is necessary to integrate morphological and experimental analyses. Morphological insights, however, are limited by the difficulty in communication of complex 3D-processes. Most controversies, in consequence, result from differences in interpretation, rather than observation. An example of such a continuing debate is the development of the pulmonary vein and the systemic venous sinus, or "sinus venosus". To facilitate understanding, we present a 3D study of the developing venous pole in the chicken embryo, showing our results in a novel interactive fashion, which permits the reader to form an independent opinion. We clarify how the pulmonary vein separates from a greater vascular plexus within the splanchnic mesoderm. The systemic venous sinus, in contrast, develops at the junction between the splanchnic and somatic mesoderm. We discuss our model with respect to normal formation of the heart, congenital cardiac malformations, and the phylogeny of the venous tributaries.

  15. The Specification of an Expert System for Building Bylaws Compliance

    Directory of Open Access Journals (Sweden)

    Sania Bhatti

    2012-04-01

    Full Text Available An Expert System is a computer program that simulates the human intelligence and behaviour in specific and limited domains. It is used to solve problems with tricks, shortcuts and heuristics i.e. rules of thumb. Checking a Plan (Map to verify its compliance with building bylaws is a complex task mainly due to various rules and the exceptions to those rules. Humans are prone to make errors in such situations. Due to the problems faced by Building Control Department, HDA ( Hyderabad Development Authority there is a strong need to develop a computerized system. In this research we have developed a prototype named as ESBBC (Expert System for Building Bylaws Compliance for HDA that can help in their building plan checking system. The proposed solution is merging three frameworks, i.e. Java an OOP (Object Oriented Programming language, Prolog- a rule based language and MS Access- for database. The solution is fulfilling the three main requirements of the HDA, i.e. Determination of whether a particular plan is in compliance with predefined building bylaws or not. (2 Offering search facility. (3 Maintaining records of plans which are entered for compliance checking. We have checked plans of 20 properties according to HDA building regulations using ESBBC and presented their results. The results show that ESBBC has capability to identify errors made by humans.

  16. Recommended Guidelines for NERC CIP Compliance for Synchrophasor Systems

    Energy Technology Data Exchange (ETDEWEB)

    Mix, Scott R. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Kirkham, Harold [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Silverstein, Alison [Pacific Northwest National Lab. (PNNL), Richland, WA (United States)

    2017-11-14

    Compliance with the NERC requirements for Critical Infrastructure Protection (CIP) for synchrophasor systems in the Version 5 paradigm seems to be a matter of some uncertainty for those in the synchrophasor user community. This report aims to provide clarification and guidance in the form of case studies based on methods seen in the industry

  17. Imaging of the Coronary Venous System: Validation of Three-Dimensional Rotational Venous Angiography Against Dual-Source Computed Tomography

    International Nuclear Information System (INIS)

    Knackstedt, Christian; Muehlenbruch, Georg; Mischke, Karl; Bruners, Philipp; Schimpf, Thomas; Frechen, Dirk; Schummers, Georg; Mahnken, Andreas H.; Guenther, Rolf W.; Kelm, Malte; Schauerte, Patrick

    2008-01-01

    Information on the anatomy of the cardiac venous system (CVS) is increasingly important for cardiac resynchronization therapy or percutaneous transvenous mitral valve annuloplasty. Three-dimensional (3D) imaging can further improve the understanding of the relationship of cardiac structures. This study was performed to validate the accuracy of rotational coronary sinus angiography (CSA) displaying the 3D anatomy of the CVS compared to ECG-gated, contrast-enhanced, cardiac dual-source computed tomography (DSCT). Five domestic pigs (60 kg) underwent DSCT using a standardized examination protocol. Using a standard C-arm for fluoroscopy, a rotational CSA was obtained and 3D-image reconstructions performed. Side branches were identified using both methods and enumerated. Vessel visibility was estimated for each side branch and great cardiac vein/anterior interventricular vein. Also, vessel diameters were measured at distinct landmarks, i.e., side branching. The amount of contrast medium was determined and the effective radiation exposure of both methods was calculated. There was no significant difference regarding the vessel diameter of the great cardiac vein/anterior interventricular vein or its side branches. Also, estimation of vessel visibility was not different between the two imaging modalities. Estimated radiation exposure and amount of contrast medium were lower for rotational CSA. In conclusion, a 3D reconstruction of rotational CSA images is possible. All parts of the CVS are well depicted, allowing a 3D overview of the CVS anatomy. On-site 3D visualization might improve decision making during cardiac interventions. In contrast to DSCT, rotational CSA does not demonstrate the anatomy of the mitral annulus or the course of the left circumflex artery.

  18. Visualization of the renal venous system by renal arteriography with digital subtraction angiography

    International Nuclear Information System (INIS)

    Nagai, Jun

    1989-01-01

    The purpose of this study was to obtain vivid and precise images of intrarenal venous branching using DSA for renal arteriography. The type of system used was an ADAC DPS-4100C with 70-80 kVp, and 320 mA, 25-50 msec at 6 frames/sec. The duration was 10 sec and the matrix size was 512x512. In order to retain clear subtracted images of intrarenal venous branching with minimal noise the three frames were selected on the time-density curve of DSA: (Fig.3). 1) a frame on which renal arteries disappear (frame X), 2) the frame with highest renal venous density value as (frame Y), 3) the difference of the nephrogram density between X and Y frames in which only the density of the nephrogram decreases (frame Z). The mask image is the image subtracted by the equation of the weighted averaging method on X and Z frame and is subtracted from the image of Y frame in the final step. By this method, 40 kidneys in 36 patients were studied, and the intrarenal venous branches up to the interlobar vein was clearly demonstrated in 28 of these cases (70%). This method is useful to estimate the extent of intrarenal lesions and detect abnormal renal blood flow compared with conventional temporal subtraction method. (author)

  19. Iron oxide contrast media improve MR-imaging of the portal venous system -an experimental study

    International Nuclear Information System (INIS)

    Boeck, J.C.; Knollmann, F.D.; Teltenkoetter, S.; Wlodarcyk, W.; Muehler, A.; Felix, R.

    1997-01-01

    Purpose: The aim was to demonstrate that intravenous superparamagnetic iron oxide contrast agents improve the delineation of the portal venous system. Material and methods: The portal venous system of 8 minipigs was demonstrated by a FLASH 2-D MRA-sequence. Scans were acquired before and after intravenous administration of 10 and 20 μmol/kg of a superparamagnetic iron oxide contrast agent (SHU 555 A). Signal intensities were measured in the portal vein and hepatic parenchym and contrast-to-noise ratios were calculated. Results: Following a cumulative dose of 10 μmol iron oxide, hepatic parenchymal signal intensity decreased to 67±6%, following 20 μmol to 29±4%, and following 40 μmol to 13±2% of control (p [de

  20. Predictive model of portal venous system thrombosis in cirrhotic portal hypertensive patients after splenectomy

    OpenAIRE

    He, Shasha; He, Fangping

    2015-01-01

    Objective: This study is to investigate the risk factors of portal venous system thrombosis (PVT) in patients with cirrhotic portal hypertension after splenectomy and to establish a Logistic regression prediction model. Methods: A total of 119 patients with cirrhotic portal hypertension were enrolled. Their clinical data was retrospectively analyzed. They were divided into PVT group (n = 18) and non-PVT group (n = 101). One-way analysis and multivariate Logistic regression analysis were perfo...

  1. The Anatomical Correlation between the Internal Venous Vertebral System and the Cranial Venae Cavae in Rabbit.

    Science.gov (United States)

    Mazensky, David; Petrovova, Eva; Danko, Jan

    2013-01-01

    The aim of this study was to describe the possible variations in the connection between the internal venous vertebral system and the cranial vena cava in rabbit using corrosion technique. The study was carried out on 40 adult New Zealand white rabbits. The venous system was injected by using Batson's corrosion casting kit number 17. We found the connection between the internal venous vertebral system and the cranial vena cava by means of the vertebral veins and the right azygos vein. The vertebral vein was present as independent tributary in 36 cases (90%). In the rest of the cases, it was found as being double, being triple, or forming a common trunk with other veins. The azygos vein was present as independent tributary of the cranial vena cava in 39 cases (97.5%). We found also a common trunk formed by the junction of the deep cervical vein, the right vertebral vein, and the azygos vein in one case (2.5%). The azygos vein received 6, 7, 8, or 9 pairs of dorsal intercostal veins. Documenting the anatomical variations in the rabbit will aid in the planning of future experimental studies and determining the clinical relevance on such studies.

  2. The Anatomical Correlation between the Internal Venous Vertebral System and the Cranial Venae Cavae in Rabbit

    Directory of Open Access Journals (Sweden)

    David Mazensky

    2013-01-01

    Full Text Available The aim of this study was to describe the possible variations in the connection between the internal venous vertebral system and the cranial vena cava in rabbit using corrosion technique. The study was carried out on 40 adult New Zealand white rabbits. The venous system was injected by using Batson's corrosion casting kit number 17. We found the connection between the internal venous vertebral system and the cranial vena cava by means of the vertebral veins and the right azygos vein. The vertebral vein was present as independent tributary in 36 cases (90%. In the rest of the cases, it was found as being double, being triple, or forming a common trunk with other veins. The azygos vein was present as independent tributary of the cranial vena cava in 39 cases (97.5%. We found also a common trunk formed by the junction of the deep cervical vein, the right vertebral vein, and the azygos vein in one case (2.5%. The azygos vein received 6, 7, 8, or 9 pairs of dorsal intercostal veins. Documenting the anatomical variations in the rabbit will aid in the planning of future experimental studies and determining the clinical relevance on such studies.

  3. Radio-nuclide angiocardiography combined with Swan-Ganz catheter for the estimation of volume-pressure curves of the pulmonary ''venous'' system in man

    International Nuclear Information System (INIS)

    Gotoh, K.; Hirakawa, S.; Suzuki, T.; Fujiwara, H.; Ohsumi, Y.; Yagi, Y.

    1983-01-01

    Short segments of volume-pressure (V-P) curves of the pulmonary ''venous'' (P''V'') system, consisting of the pulmonary veins and left atrium, were estimated in 31 patients. Pulmonary blood volume (PBV) was estimated by our new method, using RN-angiocardiography. Increments in PBV and mean pulmonary artery wedge (PAW) pressure, that occur during passive-elevation of both legs, were clues to the estimation of the compliance (ΔV/ΔP) of this system. Sublingual administration of nitroglycerin (NTG) caused the short segments of V-P curves to shift to the left almost horizontally but slightly downwards, associated with a considerable increase in ΔV/ΔP. It is suggested that NTG causes, among other things, relaxation of the walls of P''V'' system

  4. Importance of the spinal venous system in the formation of metastases

    International Nuclear Information System (INIS)

    Gowin, W.

    1983-01-01

    The vertebral veins and their anastomoses to the other venous vascular regions are presented in their anatomy, physiological and pathophysiological function, with a special reference to the spreading of tumor cells through the veins of the vertebral column. The causes of the accumulation of metastases in the trunk skeleton and brain is pointed out by malignant tumors of the prostata, of the ren, of the lung, of the mamma, of the genital organs and the thyroid gland. The signification of the vertebral venous system as a spread of metastases is emphasized under consideration of the tumor cell kinetics in the blood-flow and the different forms of the metastatic formations, and is verifying by experienced clinical cases and reviews of the literature. (orig.) [de

  5. Porto-systemic collaterals in cirrhosis of the liver. Selective percutaneous transhepatic catheterization of the portal venous system in portal hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Hoevels, J; Lunderquist, A; Tylen, U; Simert, G [Lund Univ. (Sweden)

    1979-01-01

    In 93 patients with cirrhosis of the liver and portal venous hypertension the main tributaries of the portal vein were examined by percutaneous transhepatic catheterization. The appearance and degree of porto-systemic collaterals were analysed. Esophageal varices were demonstrated in 82 patients. No correlation was found between the portal venous pressure and the extent of porto-systemic communications.

  6. Diagnosis of venous disorders

    International Nuclear Information System (INIS)

    Minar, E.

    1993-01-01

    Limited accuracy in the clinic diagnosis of deep vein thrombosis (VT) makes such diagnostic tests such as duplex sonography or venography necessary. Exact information on the age and extent of the thrombus are necessary for the clinician to optimize the therapeutric management. The correct diagnosis of calf vein thrombosis and of recurrent VT in patients with postphlebitis changes also has implications for treatment. After exclusion of thrombosis, the radiologist should evaluate the leg for other possible causes of symptoms besides VT. Investigation of the venous sytem also has a role in the diagnosis in patients with suspected pulmonary embolism. In patients with chronic venous insuffficiency the deep venous system should assessed for patency and venous valve function. The superficial veins should be differentiated in segments with sufficient or insufficient venous valves, and it is also necessary to look for insufficiency of the perforrating veins. In patients with superficial phlebitis there is risk of propagation into the deep venous system. (orig.) [de

  7. Low compliance with a validated system for emergency department triage

    DEFF Research Database (Denmark)

    Christensen, Dorthea; Jensen, Nanna Martin; Maaløe, Rikke

    2011-01-01

    Bispebjerg Hospital has introduced a triage system at the Emergency Department (ED) based on "primary criteria" and a physiological scoring system named the Bispebjerg Early Warning Score (BEWS). A BEWS is calculated on the basis of five vital signs which are accessible bedside. Patients who have...... a "primary criterion" or a BEWS = 5 are presumed to be critically ill or severely injured and should be received by a multidisciplinary team, termed the Emergency Call (EC) and Trauma Call (TC), respectively. The aim of this study was to examine compliance with this triage system at Bispebjerg Hospital....

  8. 75 FR 27182 - Energy Conservation Program: Web-Based Compliance and Certification Management System

    Science.gov (United States)

    2010-05-14

    ... Conservation Program: Web-Based Compliance and Certification Management System AGENCY: Office of Energy... following means: 1. Compliance and Certification Management System (CCMS)--via the Web portal: http... certification reports to the Department of Energy (DOE) through an electronic Web-based tool, the Compliance and...

  9. Comparison of the effectiveness of compression stockings and layer compression systems in venous ulceration treatment

    Science.gov (United States)

    Jawień, Arkadiusz; Cierzniakowska, Katarzyna; Cwajda-Białasik, Justyna; Mościcka, Paulina

    2010-01-01

    Introduction The aim of the research was to compare the dynamics of venous ulcer healing when treated with the use of compression stockings as well as original two- and four-layer bandage systems. Material and methods A group of 46 patients suffering from venous ulcers was studied. This group consisted of 36 (78.3%) women and 10 (21.70%) men aged between 41 and 88 years (the average age was 66.6 years and the median was 67). Patients were randomized into three groups, for treatment with the ProGuide two-layer system, Profore four-layer compression, and with the use of compression stockings class II. In the case of multi-layer compression, compression ensuring 40 mmHg blood pressure at ankle level was used. Results In all patients, independently of the type of compression therapy, a few significant statistical changes of ulceration area in time were observed (Student’s t test for matched pairs, p ulceration area in each of the successive measurements was observed in patients treated with the four-layer system – on average 0.63 cm2/per week. The smallest loss of ulceration area was observed in patients using compression stockings – on average 0.44 cm2/per week. However, the observed differences were not statistically significant (Kruskal-Wallis test H = 4.45, p > 0.05). Conclusions A systematic compression therapy, applied with preliminary blood pressure of 40 mmHg, is an effective method of conservative treatment of venous ulcers. Compression stockings and prepared systems of multi-layer compression were characterized by similar clinical effectiveness. PMID:22419941

  10. Prophylaxis of Venous Thrombosis.

    Science.gov (United States)

    Goldhaber, Samuel Z.

    2001-06-01

    Mechanical measures such as graduated compression stockings and intermittent compression boots are available for venous thrombosis prophylaxis, but compliance may be limited. Plantar venous pneumatic compression devices have attained widespread acceptance by both patients and nurses because of their comfort and compact size, but their track record for efficacy is poor. Inferior vena cava filters prevent pulmonary embolism, but do not halt the thrombotic process or prevent venous thrombosis. Pharmacologic prophylaxis traditionally has relied upon minidose unfractionated heparin; however, re-examination is warranted in the face of increasingly ill and complex patients. My opinion is that small, fixed doses of once-daily low molecular weight heparin will eventually replace minidose unfractionated heparin as the standard pharmacologic prophylaxis regimen for most surgical and medical patients. Prolongation of prophylaxis after hospital discharge should receive increased emphasis. Most patients being transferred to a skilled nursing facility should receive venous thromboembolism prophylaxis. Similarly, most patients undergoing total hip or knee replacement should receive prolonged preventive regimens, with at least 1 month of anticoagulation. Despite advances, certain aspects of venous thrombosis prophylaxis remain problematic. First, a surprisingly high number of hospitalized patients develop venous thrombosis because of failed (rather than omitted) prophylaxis. Second, many patients in intensive care have a combination of peripheral vascular disease and active bleeding (usually gastrointestinal) that precludes mechanical or pharmacologic prophylaxis. Third, neurosurgical patients undergoing craniotomy for brain tumors suffer a high rate of venous thrombosis and major pulmonary embolism despite the routine use of combined mechanical and pharmacologic prophylaxis. My opinion is that these three areas, in addition to the hospital culture of prophylaxis, should receive

  11. A new venous infusion path monitoring system utilizing electrostatic induced potential.

    Science.gov (United States)

    Ogawa, Hidekuni; Yonezawa, Yoshiharu; Maki, Hiromichi; Caldwell, W Morton

    2008-01-01

    A new venous infusion pathway monitoring system has been developed for hospital and home use. The system consists of linear and digital integrated circuits and a low-power 8-bit single chip microcomputer which constantly monitors the infusion pathway intactness. A 330 kHz AC voltage, which is induced on the patient's body by electrostatic coupling from a 330 kHz pulse oscillator, can be recorded by main and reference electrodes wrapped around the infusion polyvinyl chloride tube. If the injection needle or infusion tube becomes detached, then the system detects changes in the induced AC voltages and alerts the nursing station, via the nurse call system or PHS (personal handy phone system).

  12. Criminal Compliance

    Directory of Open Access Journals (Sweden)

    Cristina Antonella Andretta

    2015-10-01

    The article discusses the concepts of both compliance and criminal compliance, its main components and structure as well as the main rules relating to its global application, and finally his emergence in the Ecuadorian legal system.

  13. Renal vein to renal collecting system fistula: An extreme complication from central venous thrombosis secondary to indwelling catheter

    Directory of Open Access Journals (Sweden)

    Aditya Safaya

    2018-04-01

    Full Text Available Central venous catheters are routinely used for resuscitation, chemotherapy and nutrition but are not without risk. Central lines are the most common extrinsic cause of venous thrombosis in neonates and infants. We present an ex-36 week 1800g infant baby girl recovering after a staged repair of gastroschisis with ileostomy and mucous fistula formation. The patient was receiving parenteral nutrition through an indwelling saphenous vein tunneled catheter, with its tip in the inferior vena cava. The patient developed polyuria, with a characteristic odor of the parenteral nutrition and a urine analysis showed glucose and triglyceride levels consistent with the composition of the parenteral nutrition fluid. A fluoroscopic cysto-urogram and an inferior vena-cavogram showed a catheter-associated inferior vena cava thrombosis leading to backpressure changes, diverting all intravenous contrast into the right renal vein and to renal collecting system, thus elucidating the route of the parenteral nutrition fluid reaching the bladder. Our case represents an extreme case of complicated central venous thrombosis. We emphasize the importance of practicing a high index of suspicion for thrombotic complications in severely ill neonates with central venous access. An early diagnosis and aggressive management may prevent progression of the disease towards an overwhelming complication. Keywords: Central venous catheterization complications, Renal vein-collecting system connection, Renal vein- collecting system fistula

  14. Design compliance matrix waste sample container filling system for nested, fixed-depth sampling system

    International Nuclear Information System (INIS)

    BOGER, R.M.

    1999-01-01

    This design compliance matrix document provides specific design related functional characteristics, constraints, and requirements for the container filling system that is part of the nested, fixed-depth sampling system. This document addresses performance, external interfaces, ALARA, Authorization Basis, environmental and design code requirements for the container filling system. The container filling system will interface with the waste stream from the fluidic pumping channels of the nested, fixed-depth sampling system and will fill containers with waste that meet the Resource Conservation and Recovery Act (RCRA) criteria for waste that contains volatile and semi-volatile organic materials. The specifications for the nested, fixed-depth sampling system are described in a Level 2 Specification document (HNF-3483, Rev. 1). The basis for this design compliance matrix document is the Tank Waste Remediation System (TWRS) desk instructions for design Compliance matrix documents (PI-CP-008-00, Rev. 0)

  15. DRUGAS: implantable telemetric system for measuring the portal venous pressure: assembly aspects

    Directory of Open Access Journals (Sweden)

    Fischer Roland

    2017-09-01

    Full Text Available Developing an implantable, telemetric pressure measuring system for venous applications makes a high degree of miniaturization necessary. Thus the influence on the measurement environment is minimized and the risk of thrombosis at small flow blood velocities is decreased. But these systems are limited in terms of accuracy and resolution. The asked system requirements could only be reached by optimising the assembly and encapsulation techniques. To achieve the high degree of miniaturization numerical simulations were performed on the shape and size of the implant and led to the development of a specific metal housing consisting of two main components. A small measuring chamber will be placed into the portal vein and is rigidly fixed to a flat circular part that contains the pressure sensor chip and a transponder board and will be located outside on top of the vein. The main focus of the assembly process was based on a stress-free design and mounting of the components.

  16. Expression of the Components of the Renin-Angiotensin System in Venous Malformation

    Directory of Open Access Journals (Sweden)

    Sam eSiljee

    2016-05-01

    Full Text Available Background Venous malformation (VM is the most common form of vascular malformation, consisting of a network of thin-walled ectatic venous channels with deficient or absent media. This study investigated the expression of the components of the renin-angiotensin system (RAS, namely (prorenin receptor (PRR, angiotensin converting enzyme (ACE, angiotensin II receptor 1 (ATIIR1 and angiotensin II receptor 2 (AIITR2 in subcutaneous (SC and intramuscular (IM VM. Materials and Methods SC (n=7 and IM (n=7 VM were analyzed for the expression of PRR, ACE, ATIIR1, and ATIIR2 using 3,3-diaminobenzidine (DAB and immunofluorescent (IF immunohistochemical (IHC staining and NanoString gene expression analysis. Results IHC staining showed expression of PRR, ACE, ATIIR1 and faint expression of ATIIR2 in the endothelium of SC and IM VM. Furthermore, ATIIR2 was expressed by cells away from the endothelium in both SC and IM VM lesions examined. NanoString analysis demonstrated the presence of PRR, ACE and ATIIR1 but not ATIIR2.Conclusions The presence of PRR, ACE, ATIIR1 and potentially ATIIR2, in both SC and IM VM suggests a role for the RAS in the biology of VM. This novel finding may lead to a mechanism-based therapy for VM.

  17. Decision support systems in clinical practice: The case of venous thromboembolism prevention.

    Science.gov (United States)

    Nazarenko, G I; Kleymenova, E B; Payushik, S A; Otdelenov, V A; Sychev, D A; Yashina, L P

    2015-01-01

    Today medicine is facing a "knowledge crisis" in that explosively expanding medical knowledge encounters limited abilities to disseminate new practices [1]. Clinical practice guidelines (CPGs) are intended to promote high standards of care in specific areas of medicine by summarizing best clinical practice based on careful reviews of current research. However, doctors are often short of time to study these documents and check their updates, have little motivation for strict adherence to them. A systematic review of 11 studies reporting on 29 recommendations has found that median adherence to all recommendations was 34%, suggesting that potential benefits for patients from health research may be lost [2].Clinical decision support systems (CDSS) can serve as a knowledge translation tool, mediator between clinical guidelines and physicians by providing the right information to the right person at the right time. To evaluate the effectiveness of implementation of international and national CPGs for venous thromboembolism (VTE) prevention with the help of CDSS in a general hospital. A multifunctional CDSS based on national and international guidelines on the VTE prevention was developed and implemented in the Medical Center of the Bank of Russia (MC). The system has the following functionalities: 1) it supports the decision on the VTE prevention based on individual risk assessment of thrombosis (scales of Caprini, Rogers and Khorana, Padua Prediction Score, additional risk factors) and bleeding (IMPROVE scale for non-surgical patients, major bleeding scale for surgical patients and major orthopedic surgeries, hemorrhagic complications risk in cancer patients); 2) generates the summary containing the grade of recommendations and the level of evidence, personalized recommendations on regimen and duration of preventive antithrombotic therapy, dose correction according to creatinine clearance; 3) provides an audit form for and statistical analysis of VTE cases; 3

  18. Right-sided superior vena cava draining into the left atrium: a rare anomaly of systemic venous return

    International Nuclear Information System (INIS)

    Aminololama-Shakeri, Shadi; Wootton-Gorges, Sandra L.; Reyes, Melissa; Moore, Elizabeth H.; Pretzlaff, Robert K.

    2007-01-01

    The most commonly encountered systemic thoracic venous anomaly is a persistent left superior vena cava that drains into the right atrium via the coronary sinus. A much rarer systemic venous anomaly is that of isolated anomalous drainage of a normally positioned right superior vena cava (RSVC) into the left atrium (LA). This has been reported in approximately 20 patients with the diagnosis usually being made by cardiac catheterization. We report the case of a toddler with asymptomatic hypoxemia resulting from anomalous drainage of a normal RSVC into his LA. This was diagnosed non-invasively by contrast-enhanced chest CT. (orig.)

  19. Evaluation of the portal venous system using MR angiography in patients with severe liver dysfunction

    International Nuclear Information System (INIS)

    Fukatsu, Hiroshi; Ando, Yoko; Yamakawa, Koji; Ishigaki, Takeo

    1994-01-01

    Fifteen patients of chronic liver dysfunction were examined with 2D TOF MR angiography to assess the portal venous system condition. All of the collateral pathways except esophageal varices were clearly demonstrated in all cases, portal vein thromboses were accurately diagnosed in two cases. Portal vein visualization index were determined as follows: good delineation of the main portal vein only; good delineation of the first tributaries of the intrahepatic portal vein; good delineation of the second or further tributaries. This index showed good correlation with the clinical stage proposed by Japan liver cancer study group. These results suggested that MR angiography has a potential for the evaluation of the portal system in patients with severe liver dysfunction. (author)

  20. Congenital anomalous/aberrant systemic artery to pulmonary venous fistula: Closure with vascular plugs & coil embolization

    Directory of Open Access Journals (Sweden)

    Pankaj Jariwala

    2014-01-01

    Full Text Available A 7-month-old girl with failure to thrive, who, on clinical and diagnostic evaluation [echocardiography & CT angiography] to rule out congenital heart disease, revealed a rare vascular anomaly called systemic artery to pulmonary venous fistula. In our case, there was dual abnormal supply to the entire left lung as1 anomalous supply by normal systemic artery [internal mammary artery]2 and an aberrant feeder vessel from the abdominal aorta. Left Lung had normal bronchial connections and normal pulmonary vasculature. The fistula drained through the pulmonary veins to the left atrium leading to ‘left–left shunt’. Percutaneous intervention in two stages was performed using Amplatzer vascular plugs and coil embolization to close them successfully. The patient gained significant weight in follow up with other normal developmental and mental milestones.

  1. Pure and diluted contrast medium in the evaluation of portal venous system with digital subtraction angiography

    International Nuclear Information System (INIS)

    Gattoni, F.; Baldini, V.; Pozzato, C.; Nessi, R.; Raiteri, R.; Uscenghi, C.; Opocher, E.; Santambrogio, R.

    1990-01-01

    We report the results of intra-arterial digital subtraction angiography (DSA) in 100 patients with portal hypertension. The portal venous system was evaluated; all patients underwent angiography of the celiac and superior mesenteric arteries before surgery. Forty-four of them were also examined after Warren splenorenal shunts. Therefore, a total of 144 exams was evaluated. The authors always employed low-osmolality ionic and non-ionic contrast media (iodine concentration: 300-350 mg/ml). In 70 cases pure contrast medium was injected (20/25 ml): in the extant 74 cases it was diluted with an equal volume of saline solution (osmolality and iodine concentration reduced by 50%). Intra-arterial DSA always visualized portal venous system, collateral circulation, shunt location and postoperative changes. The mayor advantage of intra-arterial DSA is the smaller amount of contrast medium injected, so that local and systemic side effects are rare. According to our experience, it is best to dilute the contrast medium and inject the same amount as in conventional angiography, at the same rate. Other well-known advantages of intra-arterial DSA are quicker execution, less injury to arteries using smaller caliber catheters, and low cost. The major disadvantage of intra-arterial DSA, as it appeared also in our study, is the field size of the intensifier, which in our case was limited to 6-9 inches. This is an insufficient coverage for the whole portal system to be studied, and some contrast medium injections become therefore necessary. An average of 3 injections were given to each patient. This problem reduces the advantage of less contrast medium per injection. At any rate, even though intra-arterial DSA exhibits this limitation, it can nevertheless yield important information in the pre- and postoperative evaluation of patients with portal hypertension

  2. Surgical Management of Renal Cell Carcinoma Extending Into Venous System: A 20-Year Experience.

    Science.gov (United States)

    Xiao, X; Zhang, L; Chen, X; Cui, L; Zhu, H; Pang, D; Yang, Y; Wang, Q; Wang, M; Gao, C

    2017-11-01

    The purpose of this study is to report our 20-year experience with the surgical management of renal cell carcinoma extending into the inferior vena cava using a novel classification system. We retrospectively reviewed the data of 103 patients (69 males, 34 females, mean age: 52.9 ± 12.6 years) with renal cell carcinoma involving the venous system treated between 1993 and 2014. The inferior vena cava tumor thrombus was classified into five levels: 0 (renal vein, n = 12), 1 (infrahepatic, n = 33), 2a (low retrohepatic, n = 26), 2b (high retrohepatic, n = 19), and 3 (supradiaphragmatic, n = 13). Clinical data were summarized, and overall survival, cancer-specific survival, and disease-free survival were examined by Cox regression analysis. All patients underwent radical surgery. Complete resections of the renal tumor and thrombus were achieved in 101 patients (98.1%). Two intraoperative and one postoperative in-hospital deaths (2.9%) occurred. In total, 19 patients (18.8%) had a total of 29 postoperative complications. Mean follow-up time was 46 months (range, 1-239 months). The 5- and 10-year overall survival rates were 62.9% and 56.0%, respectively. Metastasis, rather than thrombus level, was a significant risk factor associated with overall survival (hazard ratio = 4.89, 95% confidence interval: 2.24-10.67, p system can be used to select the optimal surgical approach and method for patients with renal cell carcinoma and venous thrombus. Its use is associated with prolonged survival and relatively few complications. Metastasis is an independent risk factor of overall survival.

  3. Chronic venous disorders

    African Journals Online (AJOL)

    The San Valentino Vascular Screening Project conducted in Italy found a ... developed healthcare systems, the cost of treating advanced venous disease ..... tissue inflammation and necrosis. Sclerosing ... and for its tributaries as an alternative.

  4. Superior vena cava syndrome associated with right-to left shunt through systemic-to-pulmonary venous collaterals

    International Nuclear Information System (INIS)

    Juan, Yu Hsiang; Saboo, Sachin S.; Anand, Vishal; Chatzizisis, Yiannis S.; Steigner, Michael L.; Lin, Yu Ching

    2014-01-01

    Superior vena cava (SVC) obstruction is associated with the gradual development of venous collaterals. We present a rare form of systemic-to-pulmonary subpleural collateral pathway that developed in the bridging subpleural pulmonary veins in a 54-year-old woman with complete SVC obstruction. This uncommon collateral pathway represents a rare form of acquired right-to-left shunt due to previous pleural adhesions with an increased risk of stroke due to right-to-left venous shunting, which requires lifelong anticoagulation.

  5. WIPP shaft seal system parameters recommended to support compliance calculations

    Energy Technology Data Exchange (ETDEWEB)

    Hurtado, L.D.; Knowles, M.K. [Sandia National Labs., Albuquerque, NM (United States); Kelley, V.A.; Jones, T.L.; Ogintz, J.B. [INTERA Inc., Austin, TX (United States); Pfeifle, T.W. [RE/SPEC, Inc., Rapid City, SD (United States)

    1997-12-01

    The US Department of Energy plans to dispose of transuranic waste at the Waste Isolation Pilot Plant (WIPP), which is sited in southeastern New Mexico. The WIPP disposal facility is located approximately 2,150 feet (650 m) below surface in the bedded halite of the Salado Formation. Prior to initiation of disposal activities, the Department of Energy must demonstrate that the WIPP will comply with all regulatory requirements. Applicable regulations require that contaminant releases from the WIPP remain below specified levels for a period of 10,000 years. To demonstrate that the WIPP will comply with these regulations, the Department of Energy has requested that Sandia National Laboratories develop and implement a comprehensive performance assessment of the WIPP repository for the regulatory period. This document presents the conceptual model of the shaft sealing system to be implemented in performance assessment calculations conducted in support of the Compliance Certification Application for the WIPP. The model was developed for use in repository-scale calculations and includes the seal system geometry and materials to be used in grid development as well as all parameters needed to describe the seal materials. These calculations predict the hydrologic behavior of the system. Hence conceptual model development is limited to those processes that could impact the fluid flow through the seal system.

  6. WIPP shaft seal system parameters recommended to support compliance calculations

    International Nuclear Information System (INIS)

    Hurtado, L.D.; Knowles, M.K.; Kelley, V.A.; Jones, T.L.; Ogintz, J.B.; Pfeifle, T.W.

    1997-12-01

    The US Department of Energy plans to dispose of transuranic waste at the Waste Isolation Pilot Plant (WIPP), which is sited in southeastern New Mexico. The WIPP disposal facility is located approximately 2,150 feet (650 m) below surface in the bedded halite of the Salado Formation. Prior to initiation of disposal activities, the Department of Energy must demonstrate that the WIPP will comply with all regulatory requirements. Applicable regulations require that contaminant releases from the WIPP remain below specified levels for a period of 10,000 years. To demonstrate that the WIPP will comply with these regulations, the Department of Energy has requested that Sandia National Laboratories develop and implement a comprehensive performance assessment of the WIPP repository for the regulatory period. This document presents the conceptual model of the shaft sealing system to be implemented in performance assessment calculations conducted in support of the Compliance Certification Application for the WIPP. The model was developed for use in repository-scale calculations and includes the seal system geometry and materials to be used in grid development as well as all parameters needed to describe the seal materials. These calculations predict the hydrologic behavior of the system. Hence conceptual model development is limited to those processes that could impact the fluid flow through the seal system

  7. Extensive tumor thrombus of hepatocellular carcinoma in the entire portal venous system detected on fluorodeoxyglucose positron emission tomography computed tomography

    International Nuclear Information System (INIS)

    Agrawal, Archi; Purandare, Nilendu; Shah, Sneha; Puranik, Ameya; Rangarajan, Venkatesh

    2013-01-01

    Detection of thrombus is usually an incidental finding on fluorodeoxyglucose positron emission tomography/computed tomography studies. Nevertheless this is an important finding in terms of disease prognostication and in planning the treatment strategy. We herein report a case of a 50-years-old male, a diagnosed case of hepatocellular carcinoma with extensive hypermetabolic thrombus involving the entire portal venous system. (author)

  8. Drenaje suplementario del sistema venoso superficial en colgajos pediculados Supplementary drainage of superficial venous system in pedicled flaps

    Directory of Open Access Journals (Sweden)

    A. Fernández García

    2012-06-01

    Full Text Available Los colgajos pediculados pueden sufrir edema y congestión debido a que su drenaje a trevés del sistema venoso superfical es imposible y el flujo hacia el sistema profundo a nivel del pedículo es precario. Esta situación suele evolucionar hacia la necrosis parcial o la pérdida total del colgajo en pocas horas. La apertura del sistema venoso superficial permite el drenaje adecuado de los tejidos transferidos y evita estas complicaciones. Este artículo analiza el papel de las anastomosis microquirúrgicas en el sistema venoso superficial de los colgajos pediculados. Esta técnica permite comunicar el sistema venoso superfical de los tejidos transferidos con el sistema venoso superficial del territorio que rodea al defecto. Presentamos los resultados obtenidos con esta técnica en colgajos de perforante en hélice, colgajos miocutáneos, colgajos neurocutáneos y colgajos fasciograsos volteados.The pedicled flaps can suffer edema and congestion due to the impossibility of drainage toward the superficial venous system and the precarious flow via the deep system at the level of the pedicle. The evolution of this situation is usually partial necrosis or total loss of the flap in a few hours. The opening of the venous superficial system achieves an appropriate drainage of the transfered tissues and avoids these complications. In this article we analyze the role of the microsurgical anastomosis at the level of the superficial venous system of pedicled flaps. This technique allows to communicate the superficial venous system of the transfered tissues with the superficial venous system of the territory around the defect. We report the results with this method in propeller perforator flaps, miocutaneous flaps, neurocutaneous flaps and adipofascial turn over flaps.

  9. 4D flow MR imaging of the portal venous system: a feasibility study in children

    Energy Technology Data Exchange (ETDEWEB)

    Parekh, Keyur; Rose, Michael; Popescu, Andrada; Rigsby, Cynthia K. [Ann and Robert H. Lurie Children' s Hospital of Chicago, Department of Medical Imaging, Chicago, IL (United States); Northwestern University, Department of Radiology, Feinberg School of Medicine, Chicago, IL (United States); Markl, Michael [Northwestern University, Department of Radiology, Feinberg School of Medicine, Chicago, IL (United States); McCormick School of Engineering, Northwestern University, Department of Biomedical Engineering, Chicago, IL (United States); Schnell, Susanne [Northwestern University, Department of Radiology, Feinberg School of Medicine, Chicago, IL (United States)

    2017-02-15

    To determine the feasibility of 4D flow MRI for visualization and quantification of the portal venous haemodynamics in children and young adults. 4D flow was performed in 28 paediatric patients (median age, 8.5 years; interquartile range, 5.2-16.5), 15 with non-operated native portal system and 13 with surgically created portal shunt. Image quality assessment for 3D flow visualization and flow pattern analyses was performed. Regional 4D flow peak velocity and net flow were compared with 2D-cine phase contrast MRI (2D-PC MR) in the post-surgical patients. Mean 3D flow visualization quality score was excellent (mean ± SD, 4.2 ± 0.9) with good inter-rater agreement (κ,0.67). Image quality in children aged >10 years was better than children ≤10 years (p < 0.05). Flow pattern was defined for portal, superior mesenteric, splenic veins and splenic artery in all patients. 4D flow and 2D-PC MR peak velocity and net flow were similar with good correlation (peak velocity: 4D flow 22.2 ± 9.1 cm/s and 2D-PC MR 25.2 ± 11.2 cm/s, p = 0.46; r = 0.92, p < 0.0001; net flow: 4D flow 9.5 ± 7.4 ml/s and 2D-PC MR 10.1 ± 7.3 ml/s, p = 0.65; r = 0.81, p = 0.0007). 4D flow MRI is feasible and holds promise for the comprehensive 3D visualization and quantification of portal venous flow dynamics in children and young adults. (orig.)

  10. 4D flow MR imaging of the portal venous system: a feasibility study in children

    International Nuclear Information System (INIS)

    Parekh, Keyur; Rose, Michael; Popescu, Andrada; Rigsby, Cynthia K.; Markl, Michael; Schnell, Susanne

    2017-01-01

    To determine the feasibility of 4D flow MRI for visualization and quantification of the portal venous haemodynamics in children and young adults. 4D flow was performed in 28 paediatric patients (median age, 8.5 years; interquartile range, 5.2-16.5), 15 with non-operated native portal system and 13 with surgically created portal shunt. Image quality assessment for 3D flow visualization and flow pattern analyses was performed. Regional 4D flow peak velocity and net flow were compared with 2D-cine phase contrast MRI (2D-PC MR) in the post-surgical patients. Mean 3D flow visualization quality score was excellent (mean ± SD, 4.2 ± 0.9) with good inter-rater agreement (κ,0.67). Image quality in children aged >10 years was better than children ≤10 years (p < 0.05). Flow pattern was defined for portal, superior mesenteric, splenic veins and splenic artery in all patients. 4D flow and 2D-PC MR peak velocity and net flow were similar with good correlation (peak velocity: 4D flow 22.2 ± 9.1 cm/s and 2D-PC MR 25.2 ± 11.2 cm/s, p = 0.46; r = 0.92, p < 0.0001; net flow: 4D flow 9.5 ± 7.4 ml/s and 2D-PC MR 10.1 ± 7.3 ml/s, p = 0.65; r = 0.81, p = 0.0007). 4D flow MRI is feasible and holds promise for the comprehensive 3D visualization and quantification of portal venous flow dynamics in children and young adults. (orig.)

  11. Central venous pulse pressure analysis using an R-synchronized pressure measurement system.

    Science.gov (United States)

    Fujita, Yoshihisa; Hayashi, Daisuke; Wada, Shinya; Yoshioka, Naoki; Yasukawa, Takeshi; Pestel, Gunther

    2006-12-01

    The information derived from central venous catheters is underused. We developed an EKG-R synchronization and averaging system to obtained distinct CVP waveforms and analyzed components of these. Twenty-five paralyzed surgical patients undergoing CVP monitoring under mechanical ventilation were studied. CVP and EKG signals were analyzed employing our system, the mean CVP and CVP at end-diastole during expiration were compared, and CVP waveform components were measured using this system. CVP waveforms were clearly visualized in all patients. They showed the a peak to be 1.8+/- 0.7 mmHg, which was the highest of three peaks, and the x trough to be lower than the y trough (-1.6+/- 0.7 mmHg and -0.9+/- 0.5 mmHg, respectively), with a mean pulse pressure of 3.4 mmHg. The difference between the mean CVP and CVP at end-diastole during expiration was 0.58+/- 0.81 mmHg. The mean CVP can be used as an index of right ventricular preload in patients under mechanical ventilation with regular sinus rhythm. Our newly developed system is useful for clinical monitoring and for education in circulatory physiology.

  12. Effect of a system-oriented intervention on compliance problems in schizophrenia

    DEFF Research Database (Denmark)

    Skarsholm, Hanne; Støvring, Henrik; Nielsen, Bent

    2014-01-01

    Background. Numerous studies have been conducted with a view to developing strategies for improvement of medical compliance in patients with schizophrenia. All of the studies conducted so far have had an individual approach to compliance based on the assumption that noncompliance is determined...... individually due to inappropriate behavior in the patient. We conducted a pragmatic controlled trial with a system-oriented approach, to provide a new perspective on compliance and test the efficacy of a multifactorial intervention at the system level in a routine clinical setting, an approach that has...... not previously been used for the improvement of compliance. Methods. 30 patients were allocated to the system-oriented therapy and 40 patients were allocated to the reference intervention, which consisted of individually based compliance therapy. The follow-up period was six months. Primary endpoint...

  13. Venous Ulcers

    Science.gov (United States)

    Caprini, J.A.; Partsch, H.; Simman, R.

    2013-01-01

    Venous leg ulcers are the most frequent form of wounds seen in patients. This article presents an overview on some practical aspects concerning diagnosis, differential diagnosis and treatment. Duplex ultrasound investigations are essential to ascertain the diagnosis of the underlying venous pathology and to treat venous refluxes. Differential diagnosis includes mainly other vascular lesions (arterial, microcirculatory causes), hematologic and metabolic diseases, trauma, infection, malignancies. Patients with superficial venous incompetence may benefit from endovenous or surgical reflux abolition diagnosed by Duplex ultrasound. The most important basic component of the management is compression therapy, for which we prefer materials with low elasticity applied with high initial pressure (short-stretch bandages and Velcro-strap devices). Local treatment should be simple, absorbing and not sticky dressings keeping adequate moisture balance after debridement of necrotic tissue and biofilms are preferred. After the ulcer is healed compression therapy should be continued in order to prevent recurrence. PMID:26236636

  14. Depiction of variants of the portal confluence venous system using multidetector row CT. Analysis of 916 cases

    Energy Technology Data Exchange (ETDEWEB)

    Krumm, P.; Schraml, C.; Bretschneider, C.; Seeger, A.; Klumpp, B.; Kramer, U.; Claussen, C.D.; Miller, S. [Universitaetsklinikum Tuebingen (Germany). Abt. fuer Diagnostische und Interventionelle Radiologie

    2011-12-15

    Purpose: Detailed knowledge of the venous mesenteric system is important for gastrointestinal surgery, particularly for transplantation planning and surgery and for the comprehension of perioperative complications that may influence patient outcome. Data about the mesenteric venous anatomy in the literature varies substantially. The purpose of this study was to categorize venous mesenteric variants and to determine their incidence. Materials and Methods: We included 916 patients requiring diagnostic abdominal CT in the portal venous phase. The mesenteric vein anatomy was categorized as follows: 1. the inferior mesenteric vein (IMV) enters the splenic vein (SV); 2. the IMV enters into the angle of the confluence of the SV and superior mesenteric vein (SMV) forming the portal vein (PV); 3. the IMV enters the SMV; 4. seven rare variants. We measured the diameters of the veins and distances from the confluence to the IMV origins. Results: The frequency of variants was: 1. 37.6 %, 2. 28.8 %; 3. 19.2 %. The rare variants totaled 14.4 %. The average vessel diameters measured in cm: PV 1.48; SV 1.02; SMV 1.2; IMV 0.5. The mean IMV entering distances were 1.66 cm in variant 1 and 0.75 cm in variant 3. Conclusion: The three common variants (1, 2 and 3) are the most relevant ones. 14.4 % of patients had different anatomic variants. The variability of the mesenteric venous system was higher than previously published. Knowledge of rare variants is important to avoid complications in abdominal surgery. (orig.)

  15. Depiction of variants of the portal confluence venous system using multidetector row CT. Analysis of 916 cases

    International Nuclear Information System (INIS)

    Krumm, P.; Schraml, C.; Bretschneider, C.; Seeger, A.; Klumpp, B.; Kramer, U.; Claussen, C.D.; Miller, S.

    2011-01-01

    Purpose: Detailed knowledge of the venous mesenteric system is important for gastrointestinal surgery, particularly for transplantation planning and surgery and for the comprehension of perioperative complications that may influence patient outcome. Data about the mesenteric venous anatomy in the literature varies substantially. The purpose of this study was to categorize venous mesenteric variants and to determine their incidence. Materials and Methods: We included 916 patients requiring diagnostic abdominal CT in the portal venous phase. The mesenteric vein anatomy was categorized as follows: 1. the inferior mesenteric vein (IMV) enters the splenic vein (SV); 2. the IMV enters into the angle of the confluence of the SV and superior mesenteric vein (SMV) forming the portal vein (PV); 3. the IMV enters the SMV; 4. seven rare variants. We measured the diameters of the veins and distances from the confluence to the IMV origins. Results: The frequency of variants was: 1. 37.6 %, 2. 28.8 %; 3. 19.2 %. The rare variants totaled 14.4 %. The average vessel diameters measured in cm: PV 1.48; SV 1.02; SMV 1.2; IMV 0.5. The mean IMV entering distances were 1.66 cm in variant 1 and 0.75 cm in variant 3. Conclusion: The three common variants (1, 2 and 3) are the most relevant ones. 14.4 % of patients had different anatomic variants. The variability of the mesenteric venous system was higher than previously published. Knowledge of rare variants is important to avoid complications in abdominal surgery. (orig.)

  16. Estimation of the compliance of the human capacitance vessels using radionuclide plethysmography. Comparison of the compliance with the NYHA functional classification

    Energy Technology Data Exchange (ETDEWEB)

    Takatsu, Hisato; Gotoh, Kohshi; Suzuki, Takahiko and others

    1988-01-01

    Radionuclide (RN) plethysmography with Tc-99m RBC was performed in 32 patients with heart disease with the purpose of obtaining compliance of human capacitance vessels. When equilibrium was achieved, RN counts of the region of interest and venous pressure in the forearm were sequentially recorded when the vein of the upper arm was occluded with a cuff inflator. Based on the RN count-venous pressure curve, the specific compliance of the forearm vein and compliance of systemic venous system (SVS) were estimated. In the group of the NYHA functional classification I, which is recognized as hemodynamically ''normal'', the compliance of SVS was 129.8 +- 25.9 ml center dot mmHg/sup -1/ (mean +- SD; n = 9). In comparing the NYHA functional classification and the compliance of SVS, the compliance of SVS was significantly decreased for severer heart failure. Tongue administration of nitroglycerin (0.6 mg) significantly increased the compliance of SVS (p < 0.01). (Namekawa, K.).

  17. Process improvement program evolves into compliance program at an integrated delivery system.

    Science.gov (United States)

    Tyk, R C; Hylton, P G

    1998-09-01

    An integrated delivery system discovered questionable practices when it undertook a process-improvement initiative for its revenue-to-cash cycle. These discoveries served as a wake-up call to the organization that it needed to develop a comprehensive corporate compliance program. The organization engaged legal counsel to help it establish such a program. A corporate compliance officer was hired, and a compliance committee was set up. They worked with counsel to develop the structure and substance of the program and establish a corporate code of conduct that became a part of the organization's policies and procedures. Teams were formed in various areas of the organization to review compliance-related activities and suggest improvements. Clinical and nonclinical staff attended mandatory educational sessions about the program. By approaching compliance systematically, the organization has put itself in an excellent position to avoid fraudulent and abusive activities- and the government scrutiny they invite.

  18. Effective Prevention for Portal Venous System Thrombosis After Splenectomy: A Meta-Analysis.

    Science.gov (United States)

    Zhang, Xiao; Wang, Yadong; Yu, Miao; Huang, Jinzhao; Deng, Dongfeng; Xue, Huanzhou

    2017-03-01

    Portal venous system thrombosis (PVST) is a common and potentially life-threatening complication of splenectomy for portal hypertension due to cirrhosis. A meta-analysis was conducted to study the necessity of pharmacologic prophylaxis of PVST after splenectomy and how to select the feasible treatment method. Articles were searched through the PubMed, EMBASE, Cochrane Library databases, and CNKI. Overall, 404 articles were initially identified, and 11 of them were eligible. Among these selected articles, 7 articles were associated with the necessity of anticoagulation for prevention of PVST, while 5 were about the drug selection. We first demonstrated that the incidence of PVST after splenectomy was significantly lower in patients who received the preventive measures than in those who did not (odds ratio [OR]: 0.22, 95% confidence interval [CI]: 0.13-0.39, P splenectomy and devascularization. Preventative use of anticoagulant drugs might decrease the incidence of PVST after splenectomy in patients with portal hypertension, new anticoagulant drugs such as low-molecular-weight heparin should be used, and early or combination use of anticoagulation drugs might lead to lower PVST incidence for patients.

  19. Evaluation of the renal venous system on late arterial and venous phase images with MDCT angiography in potential living laparoscopic renal donors

    International Nuclear Information System (INIS)

    Kawamoto, S.; Lawler, L.P.; Fishman, E.K.

    2005-01-01

    Objective: The objective of our study was to assess whether both renal arteries and renal veins can be evaluated using single-phase MDCT data sets alone to eliminate the need for both arterial and venous phase data sets. Materials and methods: One hundred consecutive potential living renal donors who underwent 4- MDCT were evaluated. CT was performed with 120 mL of IV contrast material at an injection rate of 3 mL/sec. Both late arterial and venous phase acquisitions were obtained at 25 and 55 sec from the start of IV contrast injection, respectively. The number of the right and left renal veins and its anatomic variations were assessed by two reviewers. Late arterial phase images were evaluated initially, and then venous phase images were analyzed to assess opacification of the renal vein and to see whether venous phase data sets changed or added information about the venous anatomy as seen on late arterial phase images. Results: The retroaortic left renal vein was found in two subjects, and the circumaortic left renal vein was detected in three subjects. The renal veins were adequately opacified on late arterial phase images in all subjects. There were six subjects who had a normal left renal vein with a small posterior branch coursing posterior to the aorta and draining into the inferior vena cava, which were difficult to differentiate from the lumbar vein or ascending lumbar vein; in three of these six subjects, the small posterior branch was opacified only on venous phase images. Conclusion: Late arterial phase images obtained at 25 sec after the start of contrast injection can reveal the renal vein anatomy except for a small posterior branch of the left renal vein difficult to differentiate from the lumbar or ascending lumbar vein, as seen in three subjects. The data suggest that venous phase imaging is not necessary for the evaluation of renal vein anatomy. (author)

  20. Evaluation of the renal venous system on late arterial and venous phase images with MDCT angiography in potential living laparoscopic renal donors

    Energy Technology Data Exchange (ETDEWEB)

    Kawamoto, S.; Lawler, L.P.; Fishman, E.K. [Johns Hopkins Hospital, Baltimore, MD (United States). The Russell H. Morgan Department of Radiology and Radiological Science

    2005-03-15

    Objective: The objective of our study was to assess whether both renal arteries and renal veins can be evaluated using single-phase MDCT data sets alone to eliminate the need for both arterial and venous phase data sets. Materials and methods: One hundred consecutive potential living renal donors who underwent 4- MDCT were evaluated. CT was performed with 120 mL of IV contrast material at an injection rate of 3 mL/sec. Both late arterial and venous phase acquisitions were obtained at 25 and 55 sec from the start of IV contrast injection, respectively. The number of the right and left renal veins and its anatomic variations were assessed by two reviewers. Late arterial phase images were evaluated initially, and then venous phase images were analyzed to assess opacification of the renal vein and to see whether venous phase data sets changed or added information about the venous anatomy as seen on late arterial phase images. Results: The retroaortic left renal vein was found in two subjects, and the circumaortic left renal vein was detected in three subjects. The renal veins were adequately opacified on late arterial phase images in all subjects. There were six subjects who had a normal left renal vein with a small posterior branch coursing posterior to the aorta and draining into the inferior vena cava, which were difficult to differentiate from the lumbar vein or ascending lumbar vein; in three of these six subjects, the small posterior branch was opacified only on venous phase images. Conclusion: Late arterial phase images obtained at 25 sec after the start of contrast injection can reveal the renal vein anatomy except for a small posterior branch of the left renal vein difficult to differentiate from the lumbar or ascending lumbar vein, as seen in three subjects. The data suggest that venous phase imaging is not necessary for the evaluation of renal vein anatomy. (author)

  1. An Alternative to EPA Method 9 -- Field Validation of the Digital Opacity Compliance System (DOCS)

    National Research Council Canada - National Science Library

    Rasmussen, Steve L; Stone, Daniel A

    2005-01-01

    The Digital Opacity Compliance System (DOCS) software translates images from a commercial digital camera into visual plume opacity measurements, and is proposed as an alternate reporting method to EPA Method 9...

  2. Medical management of venous ulcers.

    Science.gov (United States)

    Pascarella, Luigi; Shortell, Cynthia K

    2015-03-01

    Venous disease is the most common cause of chronic leg ulceration and represents an advanced clinical manifestation of venous insufficiency. Due to their frequency and chronicity, venous ulcers have a high socioeconomic impact, with treatment costs accounting for 1% of the health care budget in Western countries. The evaluation of patients with venous ulcers should include a thorough medical history for prior deep venous thrombosis, assessment for an hypercoagulable state, and a physical examination. Use of the CEAP (clinical, etiology, anatomy, pathophysiology) Classification System and the revised Venous Clinical Severity Scoring System is strongly recommended to characterize disease severity and assess response to treatment. This venous condition requires lifestyle modification, with affected individuals performing daily intervals of leg elevation to control edema; use of elastic compression garments; and moderate physical activity, such as walking wearing below-knee elastic stockings. Meticulous skin care, treatment of dermatitis, and prompt treatment of cellulitis are important aspects of medical management. The pharmacology of chronic venous insufficiency and venous ulcers include essentially two medications: pentoxifylline and phlebotropic agents. The micronized purified flavonoid fraction is an effective adjunct to compression therapy in patients with large, chronic ulceration. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. Gestational related changes in the deep venous system of the lower limb on light reflection rheography in pregnancy and the puerperium

    Energy Technology Data Exchange (ETDEWEB)

    Calderwood, C.J. [St John' s Hospital, Livingston and Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh (United Kingdom)], E-mail: catherine.calderwood@luht.scot.nhs.uk; Jamieson, R. [Princess Royal Maternity Unit, Glasgow Royal Infirmary, Glasgow (United Kingdom); Greer, I.A. [Hull York Medical School, University of York, York (United Kingdom)

    2007-12-15

    Objective: To assess whether light reflection rheography testing is affected by the changes that occur in the deep venous system of the lower limb in pregnancy and the puerperium. Methods: Twenty five women with a singleton pregnancy were recruited to undergo duplex Doppler ultrasound examinations of the common femoral vein to measure the vessel diameter and the blood flow velocity. Light reflection rheography testing was subsequently performed and the rate of venous emptying in the lower limb calculated. Serial measurements using both techniques were made at 15, 28, 36 weeks, and term gestation and at 2 days and 6 weeks postpartum. Results: Duplex Doppler ultrasound confirmed that there is progressive dilatation of the deep venous system in pregnancy, which reaches a maximum at term and reverses after delivery. There is an accompanying reduction in blood flow velocity, which reaches a nadir at term and increases after delivery. The rate of venous emptying as measured by light reflection rheography decreases with increasing gestation, but did not fall to a level consistent with venous occlusion by a deep venous thrombosis. Conclusions: Light reflection rheography has been shown to provide reliable results in pregnancy and the puerperium. Therefore, it is a potential tool for screening for deep venous thrombosis in this population.

  4. Gestational related changes in the deep venous system of the lower limb on light reflection rheography in pregnancy and the puerperium

    International Nuclear Information System (INIS)

    Calderwood, C.J.; Jamieson, R.; Greer, I.A.

    2007-01-01

    Objective: To assess whether light reflection rheography testing is affected by the changes that occur in the deep venous system of the lower limb in pregnancy and the puerperium. Methods: Twenty five women with a singleton pregnancy were recruited to undergo duplex Doppler ultrasound examinations of the common femoral vein to measure the vessel diameter and the blood flow velocity. Light reflection rheography testing was subsequently performed and the rate of venous emptying in the lower limb calculated. Serial measurements using both techniques were made at 15, 28, 36 weeks, and term gestation and at 2 days and 6 weeks postpartum. Results: Duplex Doppler ultrasound confirmed that there is progressive dilatation of the deep venous system in pregnancy, which reaches a maximum at term and reverses after delivery. There is an accompanying reduction in blood flow velocity, which reaches a nadir at term and increases after delivery. The rate of venous emptying as measured by light reflection rheography decreases with increasing gestation, but did not fall to a level consistent with venous occlusion by a deep venous thrombosis. Conclusions: Light reflection rheography has been shown to provide reliable results in pregnancy and the puerperium. Therefore, it is a potential tool for screening for deep venous thrombosis in this population

  5. An automated hand hygiene training system improves hand hygiene technique but not compliance.

    Science.gov (United States)

    Kwok, Yen Lee Angela; Callard, Michelle; McLaws, Mary-Louise

    2015-08-01

    The hand hygiene technique that the World Health Organization recommends for cleansing hands with soap and water or alcohol-based handrub consists of 7 poses. We used an automated training system to improve clinicians' hand hygiene technique and test whether this affected hospitalwide hand hygiene compliance. Seven hundred eighty-nine medical and nursing staff volunteered to participate in a self-directed training session using the automated training system. The proportion of successful first attempts was reported for each of the 7 poses. Hand hygiene compliance was collected according to the national requirement and rates for 2011-2014 were used to determine the effect of the training system on compliance. The highest pass rate was for pose 1 (palm to palm) at 77% (606 out of 789), whereas pose 6 (clean thumbs) had the lowest pass rate at 27% (216 out of 789). One hundred volunteers provided feedback to 8 items related to satisfaction with the automated training system and most (86%) expressed a high degree of satisfaction and all reported that this method was time-efficient. There was no significant change in compliance rates after the introduction of the automated training system. Observed compliance during the posttraining period declined but increased to 82% in response to other strategies. Technology for training clinicians in the 7 poses played an important education role but did not affect compliance rates. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

  6. An automated hand hygiene compliance system is associated with improved monitoring of hand hygiene.

    Science.gov (United States)

    McCalla, Saungi; Reilly, Maggie; Thomas, Rowena; McSpedon-Rai, Dawn

    2017-05-01

    Consistent hand hygiene is key to reducing health care-associated infections (HAIs) and assessing compliance with hand hygiene protocols is vital for hospital infection control staff. A new automated hand hygiene compliance system (HHCS) was trialed as an alternative to human observers in an intensive care unit and an intensive care stepdown unit at a hospital facility in the northeastern United States. Using a retrospective cohort design, researchers investigated whether implementation of the HHCS resulted in improved hand hygiene compliance and a reduction in common HAI rates. Pearson χ 2 tests were used to assess changes in compliance, and incidence rate ratios were used to test for significant differences in infection rates. During the study period, the HHCS collected many more hand hygiene events compared with human observers (632,404 vs 480) and ensured that the hospital met its compliance goals (95%+). Although decreases in multidrug-resistant organisms, central line-associated bloodstream infections, and catheter-associated urinary tract infection rates were observed, they represented nonsignificant differences. Human hand hygiene observers may not report accurate measures of compliance. The HHCS is a promising new tool for fine-grained assessment of hand hygiene compliance. Further study is needed to examine the association between the HHCS and HAI rate reduction. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  7. Central nervous system decompression sickness and venous gas emboli in hypobaric conditions.

    Science.gov (United States)

    Balldin, Ulf I; Pilmanis, Andrew A; Webb, James T

    2004-11-01

    Altitude decompression sickness (DCS) that involves the central nervous system (CNS) is a rare but potentially serious condition. Identification of early symptoms and signs of this condition might improve treatment. We studied data from 26 protocols carried out in our laboratory over the period 1983-2003; all were designed to provoke DCS in a substantial proportion of subjects. The data set included 2843 cases. We classified subject-exposures that resulted in DCS as: 1) neurological DCS of peripheral and/or central origin (NEURO); 2) a subset of those that involved only the CNS (CNS); and 3) all other cases, i.e., DCS cases that did not have a neurological component (OTHER). For each case, echo imaging data were used to document whether venous gas emboli (VGE) were present, and their level was classified as: 1) any level, i.e., Grade 1 or higher (VGE-1); and 2) high level, Grade 4 (VGE-4). There were 1108 cases of altitude DCS in the database; 218 were classified as NEURO and 49 of those as CNS. VGE-1 were recorded in 83.8% of OTHER compared with 58.7% of NEURO and 55.1% of CNS (both p Hyperbaric oxygen (HBO) was used to treat about half of the CNS cases, while all other cases were treated with 2 h breathing 100% oxygen at ground level. Since only about half of the rare cases of hypobaric CNS DCS cases were accompanied by any level of VGE, echo imaging for bubbles may have limited application for use as a predictor of such cases.

  8. A novel pump-driven veno-venous gas exchange system during extracorporeal CO2-removal.

    Science.gov (United States)

    Hermann, Alexander; Riss, Katharina; Schellongowski, Peter; Bojic, Andja; Wohlfarth, Philipp; Robak, Oliver; Sperr, Wolfgang R; Staudinger, Thomas

    2015-10-01

    Pump-driven veno-venous extracorporeal CO2-removal (ECCO2-R) increasingly takes root in hypercapnic lung failure to minimize ventilation invasiveness or to avoid intubation. A recently developed device (iLA activve(®), Novalung, Germany) allows effective decarboxylation via a 22 French double lumen cannula. To assess determinants of gas exchange, we prospectively evaluated the performance of ECCO2-R in ten patients receiving iLA activve(®) due to hypercapnic respiratory failure. Sweep gas flow was increased in steps from 1 to 14 L/min at constant blood flow (phase 1). Similarly, blood flow was gradually increased at constant sweep gas flow (phase 2). At each step gas transfer via the membrane as well as arterial blood gas samples were analyzed. During phase 1, we observed a significant increase in CO2 transfer together with a decrease in PaCO2 levels from a median of 66 mmHg (range 46-85) to 49 (31-65) mmHg from 1 to 14 L/min sweep gas flow (p gas flow rates. During phase 2, oxygen transfer significantly increased leading to an increase in PaO2 from 67 (49-87) at 0.5 L/min to 117 (66-305) mmHg at 2.0 L/min (p gas flow results in effective CO2-removal, which can be further reinforced by raising blood flow. The clinically relevant oxygenation effect in this setting could broaden the range of indications of the system and help to set up an individually tailored configuration.

  9. Splenectomy Causes 10-Fold Increased Risk of Portal Venous System Thrombosis in Liver Cirrhosis Patients.

    Science.gov (United States)

    Qi, Xingshun; Han, Guohong; Ye, Chun; Zhang, Yongguo; Dai, Junna; Peng, Ying; Deng, Han; Li, Jing; Hou, Feifei; Ning, Zheng; Zhao, Jiancheng; Zhang, Xintong; Wang, Ran; Guo, Xiaozhong

    2016-07-19

    BACKGROUND Portal venous system thrombosis (PVST) is a life-threatening complication of liver cirrhosis. We conducted a retrospective study to comprehensively analyze the prevalence and risk factors of PVST in liver cirrhosis. MATERIAL AND METHODS All cirrhotic patients without malignancy admitted between June 2012 and December 2013 were eligible if they underwent contrast-enhanced CT or MRI scans. Independent predictors of PVST in liver cirrhosis were calculated in multivariate analyses. Subgroup analyses were performed according to the severity of PVST (any PVST, main portal vein [MPV] thrombosis >50%, and clinically significant PVST) and splenectomy. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. RESULTS Overall, 113 cirrhotic patients were enrolled. The prevalence of PVST was 16.8% (19/113). Splenectomy (any PVST: OR=11.494, 95%CI=2.152-61.395; MPV thrombosis >50%: OR=29.987, 95%CI=3.247-276.949; clinically significant PVST: OR=40.415, 95%CI=3.895-419.295) and higher hemoglobin (any PVST: OR=0.974, 95%CI=0.953-0.996; MPV thrombosis >50%: OR=0.936, 95%CI=0.895-0.980; clinically significant PVST: OR=0.935, 95%CI=0.891-0.982) were the independent predictors of PVST. The prevalence of PVST was 13.3% (14/105) after excluding splenectomy. Higher hemoglobin was the only independent predictor of MPV thrombosis >50% (OR=0.952, 95%CI=0.909-0.997). No independent predictors of any PVST or clinically significant PVST were identified in multivariate analyses. Additionally, PVST patients who underwent splenectomy had a significantly higher proportion of clinically significant PVST but lower MELD score than those who did not undergo splenectomy. In all analyses, the in-hospital mortality was not significantly different between cirrhotic patient with and without PVST. CONCLUSIONS Splenectomy may increase by at least 10-fold the risk of PVST in liver cirrhosis independent of severity of liver dysfunction.

  10. Environmental Compliance Assessment System Army National Guard (ECAS- ARNG)

    Science.gov (United States)

    1993-09-01

    Piopory A PucaI Officer (USP&Ro) (6) Stele Sary Odffiar (7) Suace Ahkuteaece MaMnagr (SW!O (9) Comad Lopam Officer (CLO) (00) 0ampoicnai Heaft Nuame...Tment PIM Operators (15) P A O O (20) Hetallmon Respone Teen ( BIO (OSQ (21) Sure Judge Avomw (SIA) (29) S•ate Aviation Officer 2 - 107 COMPLIANCE...eliminate damage to the environment and bio - sphere and stimulate the health and welfare of man (42 USC 4321). Under NEPA, the continuing policy of the

  11. A task management system for compliance with health, safety, and environmental regulations

    International Nuclear Information System (INIS)

    Crump, J.J.; O'Gorman, T.P.

    1992-01-01

    Shell Western E and P Inc. (SWEPI) has developed a new computer system to help it comply with health, safety, and environmental (HS and E) regulations. It is a task management system that functions at the detailed inventory level. It schedules work, instructs operations, and records compliance status. This article discusses design and development of the system

  12. Work performance and tax compliance in flat and progressive tax systems

    NARCIS (Netherlands)

    Pantya, Jozsef; Kovacs, Judit; Kogler, C.; Kirchler, Erich

    2016-01-01

    Different tax systems, and their impact on work motivation and tax compliance are significant issues in contemporary political and economic debates. The proportional feature of a flat tax system is assumed to lead to higher performance, while the fairness of the redistributive progressive tax system

  13. Higher complication risk of totally implantable venous access port systems in patients with advanced cancer - a single institution retrospective analysis.

    Science.gov (United States)

    Chang, Yi-Fang; Lo, An-Chi; Tsai, Chung-Hsin; Lee, Pei-Yi; Sun, Shen; Chang, Te-Hsin; Chen, Chien-Chuan; Chang, Yuan-Shin; Chen, Jen-Ruei

    2013-02-01

    Totally implantable port systems are generally recommended for prolonged central venous access in diverse settings, but their risk of complications remains unclear for patients with advanced cancer. The aim of this study was to assess the risk of port system failure in patients with advanced cancer. We conducted a retrospective cohort study in a comprehensive cancer centre. A detailed chart review was conducted among 566 patients with 573 ports inserted during January-June, 2009 (average 345.3 catheter-days). Cox regression analysis was applied to evaluate factors during insertion and early maintenance that could lead to premature removal of the port systems due to infection or occlusion. Port system-related infection was significantly associated with receiving palliative care immediately after implantation (hazard ratio, HR = 7.3, 95% confidence interval, 95% CI = 1.2-46.0), after adjusting for probable confounders. Primary cancer site also impacted the occurrence of device-related infection. Receiving oncologic/palliative care (HR = 3.0, P = 0.064), advanced cancer stage (HR = 6.5, P = 0.077) and body surface area above 1.71 m(2) (HR = 3.4, P = 0.029) increased the risk of port system occlusion. Our study indicates that totally implantable port systems yield a higher risk of complications in terminally ill patients. Further investigation should be carefully conducted to compare outcomes of various central venous access devices in patients with advanced cancer and to develop preventive strategies against catheter failure.

  14. A Comparison of Clinical Outcomes with Regular- and Low-Profile Totally Implanted Central Venous Port Systems

    International Nuclear Information System (INIS)

    Teichgraeber, Ulf Karl-Martin; Steitparth, Florian; Cho, Chie Hee; Benter, Thomas; Gebauer, Bernhard

    2009-01-01

    The purpose of this study was to evaluate whether low-profile totally implanted central venous port systems can reduce the late complication of skin perforation. Forty patients (age, 57 ± 13 years; 22 females, 18 males) were randomized for the implantation of a low-profile port system, and another 40 patients (age, 61 ± 14 years; 24 females, 16 males) received a regular port system as control group. Indications for port catheter implantation were malignant disease requiring chemotherapy. All port implantations were performed in the angiography suite using sonographically guided central venous puncture and fluoroscopic guidance of the catheter placement. Procedure time, number of complications (procedure-related immediate, early, and late complications), and number of explantations were assessed. Follow-up was performed for 6 months. All port implantations were successfully completed in both study groups. There were two incidents of skin perforation observed in the control group. One skin perforation occurred 13 weeks and the other 16 weeks after port implantation (incidence, 5%) in patients with regular-profile port systems. Two infections were observed, one port infection in each study group. Both infections were characterized as catheter-related infections (infection rate: 0.15 catheter-related infections per 1000 catheter days). In conclusion, low-profile port systems can be placed as safely as traditional chest ports and reduce the risk of developing skin perforations, which occurs when the port system is too tight within the port pocket.

  15. The anterior medullary-anterior pontomesencephalic venous system and its bridging veins communicating to the dural sinuses: normal anatomy and drainage routes from dural arteriovenous fistulas

    International Nuclear Information System (INIS)

    Kiyosue, Hiro; Tanoue, Shuichi; Sagara, Yoshiko; Okahara, Mika; Kashiwagi, Junji; Mori, Hiromu; Hori, Yuzo; Nagatomi, Hirofumi

    2008-01-01

    We evaluated the normal venous anatomy of the anterior medullary/anterior pontomesencephalic venous (AMV/APMV) system and bridging veins connected to the dural sinuses using magnetic resonance (MR) imaging and demonstrated cases of dural arteriovenous fistulas (DAVFs) with bridging venous drainage. MR images obtained using a 3D gradient echo sequence in 70 patients without lesions affecting the deep or posterior venous channels were reviewed to evaluate the normal anatomy of the AMV/APMV system and bridging veins. MR images and digital subtraction angiography in 80 cases with intracranial or craniocervical junction DAVFs were reviewed to evaluate the bridging venous drainage from DAVFs. MR images clearly revealed AMV/APMV in 35 cases. Fifteen cases showed a direct connection between AMV and APMV, while 15 cases showed an indirect communication via the transverse pontine vein or the bridging vein. In the five remaining cases, the AMV and APMV end separately to the bridging vein or the transverse pontine vein. Bridging veins were identified in 34 cases, connecting to the cavernous sinus in 33, to the suboccipital cavernous sinus in 11, and the inferior petrosal sinus in five cases. In 80 DAVF cases, seven of 40 cavernous sinus DAVFs, two craniocervical junction DAVFs, and one inferior petrosal sinus DAVF drained via bridging veins to the brain stem. The AMV/APMV and bridging veins showed various anatomies and frequently showed a connection to the cavernous sinus. Knowledge of the venous anatomy is helpful for the diagnosis and intravascular treatment of DAVFs. (orig.)

  16. Increasing compliance with the World Health Organization Surgical Safety Checklist-A regional health system's experience.

    Science.gov (United States)

    Gitelis, Matthew E; Kaczynski, Adelaide; Shear, Torin; Deshur, Mark; Beig, Mohammad; Sefa, Meredith; Silverstein, Jonathan; Ujiki, Michael

    2017-07-01

    In 2009, NorthShore University HealthSystem adapted the World Health Organization Surgical Safety Checklist (SSC) at each of its 4 hospitals. Despite evidence that SSC reduces intraoperative mistakes and increase patient safety, compliance was found to be low with the paper form. In November 2013, NorthShore integrated the SSC into the electronic health record (EHR). The aim was to increase communication between operating room (OR) personnel and to encourage best practices during the natural workflow of surgeons, anesthesiologists, and nurses. The purpose of this study was to examine the impact of an electronic SSC on compliance and patient safety. An anonymous OR observer selected cases at random and evaluated the compliance rate before the rollout of the electronic SSC. In June 2014, an electronic audit was performed to assess the compliance rate. Random OR observations were also performed throughout the summer in 2014. Perioperative risk events, such as consent issues, incorrect counts, wrong site, and wrong procedure were compared before and after the electronic SSC rollout. A perception survey was also administered to NorthShore OR personnel. Compliance increased from 48% (n = 167) to 92% (n = 1,037; P World Health Organization SSC is a validated tool to increase patient safety and reduce intraoperative complications. The electronic SSC has demonstrated an increased compliance rate, a reduced number of risk events, and most OR personnel believe it will have a positive impact on patient safety. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Year 2000 compliance concerns with the ISA Thermoluminescent Dosimetry Data Processing (TL-DP) software system

    Energy Technology Data Exchange (ETDEWEB)

    Saviz, K.

    1998-05-26

    The year 2000 is rapidly approaching, and there is a good chance that computer systems that utilize two digit year dates will experience problems in retrieval of date information. The ISA Thermoluminescent Dosimetry Data Processing (TL-DP) software and computer system has been reviewed for Year 2000 compliance issues.

  18. Year 2000 compliance concerns with the ISA Thermoluminescent Dosimetry Data Processing (TL-DP) software system

    International Nuclear Information System (INIS)

    Saviz, K.

    1998-01-01

    The year 2000 is rapidly approaching, and there is a good chance that computer systems that utilize two digit year dates will experience problems in retrieval of date information. The ISA Thermoluminescent Dosimetry Data Processing (TL-DP) software and computer system has been reviewed for Year 2000 compliance issues

  19. Combined oral contraceptives: venous thrombosis.

    Science.gov (United States)

    de Bastos, Marcos; Stegeman, Bernardine H; Rosendaal, Frits R; Van Hylckama Vlieg, Astrid; Helmerhorst, Frans M; Stijnen, Theo; Dekkers, Olaf M

    2014-03-03

    , desogestrel, and levonorgestrel, with higher doses being associated with higher thrombosis risk. All combined oral contraceptives investigated in this analysis were associated with an increased risk of venous thrombosis. The effect size depended both on the progestogen used and the dose of ethinylestradiol. Risk of venous thrombosis for combined oral contraceptives with 30-35 μg ethinylestradiol and gestodene, desogestrel, cyproterone acetate and drospirenone were similar, and about 50-80% higher than with levonorgestrel. The combined oral contraceptive with the lowest possible dose of ethinylestradiol and good compliance should be prescribed-that is, 30 μg ethinylestradiol with levonorgestrel.

  20. 9 CFR 205.214 - Litigation as to whether a system is operating in compliance with the Section.

    Science.gov (United States)

    2010-01-01

    ... as to whether a system is operating in compliance with the Section. (a) The requirements for a system... certification, is operating in compliance, thus whether it is a “central filing system” as defined, could be... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Litigation as to whether a system is...

  1. 300 Area dangerous waste tank management system: Compliance plan approach. Final report

    International Nuclear Information System (INIS)

    1996-03-01

    In its Dec. 5, 1989 letter to DOE-Richland (DOE-RL) Operations, the Washington State Dept. of Ecology requested that DOE-RL prepare ''a plant evaluating alternatives for storage and/or treatment of hazardous waste in the 300 Area...''. This document, prepared in response to that letter, presents the proposed approach to compliance of the 300 Area with the federal Resource Conservation and Recovery Act and Washington State's Chapter 173-303 WAC, Dangerous Waste Regulations. It also contains 10 appendices which were developed as bases for preparing the compliance plan approach. It refers to the Radioactive Liquid Waste System facilities and to the radioactive mixed waste

  2. Corporate Average Fuel Economy Compliance and Effects Modeling System Documentation

    Science.gov (United States)

    2009-04-01

    The Volpe National Transportation Systems Center (Volpe Center) of the United States Department of Transportation's Research and Innovative Technology Administration has developed a modeling system to assist the National Highway Traffic Safety Admini...

  3. SPEED COMPLIANCE IN FREEWAY VARIABLE SPEED LIMIT SYSTEM – CASE STUDY OF THE PRAGUE CITY RING

    Directory of Open Access Journals (Sweden)

    Michał MATOWICKI

    2016-03-01

    Full Text Available Many previous studies have confirmed the strong relationship between speed compliance and the frequency and severity of traffic accidents. Variable speed limit (VSL system as a measure to improve traffic safety enables the freeway system to change its posted speed limit based on various traffic and environmental conditions. Such system helps drivers to recognize the upcoming events, to adjust their driving style and in such way to address speed variation of the traffic flow. This is called speed harmonization. Although many studies researching the effect of VSL system on the traffic stream can be found, there are only few addressing its influence on the drivers behavior, particularly focusing on their tolerance limit and compliance, which has crucial meaning for future design of controlling algorithms. This study was prepared to inspect this grey area by studying the data from the VSL system at Prague city ring, describing the influence of the highway management system and its influence on drivers.

  4. Obedience to compliance programs and independence for electricity and natural gas system operators. 2009 report

    International Nuclear Information System (INIS)

    2009-12-01

    In France, system operators belong to groups that also conduct business in the energy sector, in fields governed by competition rules. They could therefore be tempted to use their privileged position to their group's benefit, which would disadvantage end consumers. Non-discriminatory access to electricity and gas transmission and distribution networks is at the core of the market opening to competition approach implemented by the European Union since the end of the 1990's. EU and national enactments in force highlight two tools to ensure nondiscrimination: compliance programmes and independence of system operators with regard to their parent companies. Firstly, compliance programs contain measures taken to ensure that discrimination is completely excluded and that their application is subject to appropriate monitoring. Secondly, system operator independence plays a part in preventing discrimination against competitors with other business activities (generation, supply, etc.) within the same group. In application of these enactments, every electricity or natural gas transmission or distribution system operator serving more than 100,000 customers provided CRE, the Energy Regulatory Commission, with their annual reports on the application of their compliance programs. This document is CRE's 2009 report about compliance programmes and independence of electricity and natural gas system operators. Its content can be summarized as follows: 1 - system operator independence serving consumers: Non-discriminatory access to networks is essential for the development of competitive markets, System operator compliance programs and independence act as a guarantee of nondiscrimination, The legal context in which these issues are addressed is set to change in the near future; 2 - A high level of obedience to compliance programs: The continued efforts of system operators prevent discrimination, CR E has assessed distribution system operators by means of a mystery

  5. Bureau of radiological health compliance testing procedures for cabinet S-ray systems

    International Nuclear Information System (INIS)

    Miller, E.A.; Sprau, D.

    1976-01-01

    A manual has been developed by the Bureau of Radiological Health of the Food and Drug Administration to establish procedures for the routine field testing of cabinet x-ray systems to determine compliance with the Federal Performance Standard for Cabinet X-Ray Systems, 21 CFR 1020.40. The manual provides specific instructions for testing each model of cabinet x-ray system. Results from the inspection are recorded on a data from which is designed to permit automatic data processing

  6. Venous Return and Clinical Hemodynamics: How the Body Works during Acute Hemorrhage

    Science.gov (United States)

    Shen, Tao; Baker, Keith

    2015-01-01

    Venous return is a major determinant of cardiac output. Adjustments within the venous system are critical for maintaining venous pressure during loss in circulating volume. This article reviews two factors that are thought to enable the venous system to compensate during acute hemorrhage: 1) changes in venous elastance and 2) mobilization of…

  7. Air Force IT System Security Compliance with Law and Policy

    Science.gov (United States)

    2016-04-01

    monetary burden on 3 system owners as there is “…a significant cost benefit to building in IA during the development phase” 4 of a system. Current...16 Option 4 : Cloud Computing to Eliminate Policy and Methodology Requirements ....17 Option 4 : Application...Assurance ( IA ) (data integrity) to support mission assurance. To ensure IA and to support the mission, changes need to be made to Air Force IT

  8. Peripheral Insertion of a Central Venous Access Device Under Fluoroscopic Guidance Using a Peripherally Accessed System (PAS) Port in the Forearm

    International Nuclear Information System (INIS)

    Hata, Yasuhiro; Morita, Sojiro; Morita, Yoshitaka; Awatani, Toshihide; Takasaki, Motohiro; Horimi, Tadashi; Ozawa, Zen

    1998-01-01

    Purpose: We describe the technique, efficacy, and complications of fluoroscopy-guided implantation of a central venous access device using a peripherally accessed system (PAS) port via the forearm. Methods: Beginning in July 1994, 105 central venous access devices were implanted in 104 patients for the long-term infusion of antibiotics or antineoplasmic agents, blood products, or parenteral nutrition. The devices was inserted under fluoroscopic guidance with real-time venography from a peripheral route. Results: All ports were successfully implanted. There were no procedure-related complications. No thrombosis or local infection was observed; however, in six patients catheter-related phlebitis occurred. Conclusion: Fluoroscopy-guided implantation of a central venous access device using a PAS port via the forearm is safe and efficacious, and injection of contrast medium through a peripheral IV catheter before introduction of the catheter helps to avoid catheter-related phlebitis

  9. Venous thromboembolism and arterial complications.

    Science.gov (United States)

    Prandoni, Paolo; Piovella, Chiara; Pesavento, Raffaele

    2012-04-01

    An increasing body of evidence suggests the likelihood of a link between venous and arterial thrombosis. The two vascular complications share several risk factors, such as age, obesity, smoking, diabetes mellitus, blood hypertension, hypertriglyceridemia, and metabolic syndrome. Moreover, there are many examples of conditions accounting for both venous and arterial thrombosis, such as the antiphospholipid antibody syndrome, hyperhomocysteinemia, malignancies, infections, and the use of hormonal treatment. Finally, several recent studies have consistently shown that patients with venous thromboembolism are at a higher risk of arterial thrombotic complications than matched control individuals. We, therefore, speculate the two vascular complications are simultaneously triggered by biological stimuli responsible for activating coagulation and inflammatory pathways in both the arterial and the venous system. Future studies are needed to clarify the nature of this association, to assess its extent, and to evaluate its implications for clinical practice. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  10. Venous chest anatomy: clinical implications

    International Nuclear Information System (INIS)

    Chasen, M.H.; Charnsangavej, C.

    1998-01-01

    This article provides a practical approach to the clinical implications and importance of understanding the collateral venous anatomy of the thorax. Routine radiography, conventional venography, computed tomography (CT), and magnetic resonance (MR) imaging studies provide correlative anatomic models for the demonstration of how interconnecting collateral vascular networks within the thorax maintain venous stability at all times. Five major systems comprise the collateral venous network of the thorax ( Fig. 1 ). These include the paravertebral, azygos-hemiazygos, internal mammary, lateral thoracic, and anterior jugular venous systems (AJVS). The five systems are presented in the following sequence: (a) a brief introduction to the importance of catheter position and malposition in understanding access to the thoracic venous system, (b) the anatomy of the azygos-hemiazygos systems and their relationship with the paravertebral plexus, (c) the importance of the AJVS, (d) 'loop' concepts interconnecting the internal mammary and azygos-hemiazygos systems by means of the lateral thoracic and intercostal veins, and (e) the interconnecting venous networks on the thoracic side of the thoracoabdominal junction. Certain aspects of the venous anatomy of the thorax will not be discussed in this chapter and include (a) the intra-abdominal anastomoses between the superior and inferior vena cavae (IVC) via the internal mammary, lateral thoracic, and azygos-hemiazygos systems (beyond the scope of this article), (b) potential collateral vessels involving vertebral, parascapular, thyroidal, thymic, and other smaller veins that might anastomose with the major systems, and (c) anatomic variants and pitfalls that may mimic pathologic conditions (space limitations). (Copyright (c) 1998 Elsevier Science B.V., Amsterdam. All rights reserved.)

  11. Knowledge management and safety compliance in a high-risk distributed organizational system.

    Science.gov (United States)

    Gressgård, Leif Jarle

    2014-06-01

    In a safety perspective, efficient knowledge management is important for learning purposes and thus to prevent errors from occurring repeatedly. The relationship between knowledge exchange among employees and safety behavior may be of particular importance in distributed organizational systems where similar high-risk activities take place at several locations. This study develops and tests hypotheses concerning the relationship between knowledge exchange systems usage, knowledge exchange in the organizational system, and safety compliance. The operational context of the study is petroleum drilling and well operations involving distributed high-risk activities. The hypotheses are tested by use of survey data collected from a large petroleum operator company and eight of its main contractors. The results show that safety compliance is influenced by use of knowledge exchange systems and degree of knowledge exchange in the organizational system, both within and between units. System usage is the most important predictor, and safety compliance seems to be more strongly related to knowledge exchange within units than knowledge exchange between units. Overall, the study shows that knowledge management is central for safety behavior.

  12. Are hepatic portal venous system components distributed equally to the liver? A MDCT study

    International Nuclear Information System (INIS)

    Incedayi, M.; Aribal, S.; Sivrioglu, A.; Sonmez, G.; Ozturk, E.; Yalcin, B.; Basekim, C.

    2012-01-01

    Full text: Objective: We aimed to evaluate the relationships between the splenic index, right and left hepatic lobe volumes, diameters of splenic vein (SV), superior mesenteric vein (SMV) and the portal vein (PV) by Multidetector Computerized Tomography (MDCT). We also investigated indirect signs of portal venous flow pattern using these parameters. Material and method: Following their contrast thoracoabdominal and abdominal 64-MDCT examinations, the images of 100 cases (61 males and 39 females) were evaluated retrospectively. The patients who were included in the study ranged from age 20 to 88 (mean age: 41,78). For each case, the splenic index, total hepatic volume, left and right hepatic volumes were calculated on the post-contrast portal venous phase (50th sec) images. Cases without any known liver and spleen diseases were included in the study. Spearman and Pearson's correlation tests were carried out with the purpose of determining the relationships between the variables. Results: A statistically significant relationship between the splenic index and left hepatic lobe volume and total volume was demonstrated (p=0.001). Positive correlations between the left hepatic lobe volume and splenic index (r=0.55) and between the right hepatic lobe volume and splenic index (r=0.32) were also exhibited. However, the correlation between the left hepatic lobe volume and the splenic index was relatively stronger compared to the correlation between the right hepatic lobe volume and the splenic index (r=0.55 versus r= 0.32). Between the diameter of the SMV and right hepatic lobe volume a statistically significant relation was demonstrated (p<0.0001), and according to Pearson's correlation analysis, a positive correlation of medium strength (r=0.36) was observed. Conclusion: In our study, the MDCT findings revealed statistically significant relations between the splenic index and the left lobe volume and between the diameter of the SMV and the right lobe volume. Information

  13. Veno-venous bypass without systemic heparinization using a centrifugal pump: a blind comparison of a heparin bonded circuit versus a non heparin bonded circuit

    NARCIS (Netherlands)

    van der Hulst, V. P.; Henny, C. P.; Moulijn, A. C.; Engbers, G.; ten Cate, H.; Gründeman, P. F.; Klopper, P. J.

    1989-01-01

    Veno-venous bypass without the use of systemic heparinization has recently become of increasing interest for application during liver transplantation and surgery on the large abdominal veins. However, possible adverse effects on blood components as demonstrated by means of hematologic and hemostatic

  14. Compliance/non-compliance with biosecurity rules specified in the Danish Quality Assurance system (KIK) and Campylobacter-positive broiler flocks 2012 and 2013.

    Science.gov (United States)

    Sandberg, M; Dahl, J; Lindegaard, L L; Pedersen, J R

    2017-01-01

    One source for Campylobacter jejuni infections in humans could be consumption of broiler meat. Transmission of Campylobacter into broiler houses/flocks occurs via many routes. A number of biosecurity rules is specified in the Quality Assurance System in Danish Chicken Production (KIK) - for which the broiler producers annually are audited for compliance with, by bureau Veritas. Multivariable logistic regression models were used to investigated the association between Compliance/non-compliance with biosecurity rules and Campylobacter-positive flocks - on KIK data from 2012 and 2013. Month and before after audit period were also included in the models. KIK rules important to comply with were: no vegetation around houses, closed systems for feed storage and distribution, and division between clean and unclean zones within broiler houses. A Campylobacter-reducing effect was observed of audit visits (in itself), indicating that there is more focus on compliance with KIK at the time of an audit visit, and that adequate daily biosecurity behavior is important. © 2016 Poultry Science Association Inc.

  15. Randomized trial of four-layer and two-layer bandage systems in the management of chronic venous ulceration.

    Science.gov (United States)

    Moffatt, Christine J; McCullagh, Lynn; O'Connor, Theresa; Doherty, Debra C; Hourican, Catherine; Stevens, Julie; Mole, Trevor; Franks, Peter J

    2003-01-01

    To compare a four-layer bandage system with a two-layer system in the management of chronic venous leg ulceration, a prospective randomized open parallel groups trial was undertaken. In total, 112 patients newly presenting to leg ulcer services with chronic leg ulceration, screened to exclude the presence of arterial disease (ankle brachial pressure index ulceration other than venous disease, were entered into the trial. Patients were randomized to receive either four-layer (Profore) or two-layer (Surepress) high-compression elastic bandage systems. In all, 109 out of 112 patients had at least one follow-up. After 24 weeks, 50 out of 57 (88%) patients randomized to the four-layer bandage system with follow-up had ulcer closure (full epithelialization) compared with 40 out of 52 (77%) on the two-layer bandage, hazard ratio = 1.18 (95% confidence interval 0.69-2.02), p = 0.55. After 12 weeks, 40 out of 57 (70%) patients randomized to the four-layer bandage system with follow-up had ulcer closure compared with 30 out of 52 (58%) on the two-layer bandage, odds ratio = 4.23 (95% confidence interval 1.29-13.86), p = 0.02. Withdrawal rates were significantly greater on the two-layer bandage (30 out of 54; 56%) compared with the four-layer bandage system (8 out of 58; 14%), p bandaging system (15 out of 54; 28%) compared with four-layer bandaging (5 out of 54; 9%), p = 0.01. The higher mean cost of treatment in the two-layer bandaging system arm over 24 weeks ($1374 [ pound 916] vs. $1314 [ pound 876]) was explained by the increased mean number of bandage changes (1.5 vs. 1.1 per week) with the two-layer system. In conclusion, the four-layer bandage offers advantages over the two-layer bandage in terms of reduced withdrawal from treatment, fewer adverse incidents, and lower treatment cost.

  16. Flow confirmation study for central venous port in oncologic outpatient undergoing chemotherapy: Evaluation of suspected system-related mechanical complications

    International Nuclear Information System (INIS)

    Sofue, Keitaro; Arai, Yasuaki; Takeuchi, Yoshito; Sugimura, Kazuro

    2013-01-01

    Purpose: To evaluate the efficacy and outcome of a flow confirmation study (FCS) in oncologic outpatients undergoing chemotherapy suspected of a central venous port (CVP) system-related mechanical complication. Materials and methods: A total of 66 patients (27 men, 39 women; mean age, 60 years) received FCS for the following reasons: prolonged infusion time during chemotherapy (n = 32), inability to inject saline fluid (n = 15), lateral neck and/or back pain (n = 6), subcutaneous extravasation of anticancer drug (n = 5), arm swelling (n = 4), and inability to puncture the port (n = 4). FCS consisted of examining the position of CVP, potential secondary shifts or fractures, and integrity of the system using contrast material through the port. Results: Of the 66 patients, 43 had an abnormal finding uncovered by FCS. The most frequent abnormal findings was catheter kinking (n = 22). Explantation and reimplantation of the CVP system was required in 21 of the 66 patients. Remaining 45 patients were able continue using the CVP system after the FCS without any system malfunction. Conclusion: FCS was effective for evaluating CVP system-related mechanical complications and was useful for deciding whether CVP system explantation and reimplantation was required

  17. Flow confirmation study for central venous port in oncologic outpatient undergoing chemotherapy: Evaluation of suspected system-related mechanical complications

    Energy Technology Data Exchange (ETDEWEB)

    Sofue, Keitaro, E-mail: ksofue@ncc.go.jp [Divisions of Diagnostic Radiology, National Cancer Center Hospital (Japan); Department of Radiology, Kobe University, Graduate School of Medicine (Japan); Arai, Yasuaki; Takeuchi, Yoshito [Divisions of Diagnostic Radiology, National Cancer Center Hospital (Japan); Sugimura, Kazuro [Department of Radiology, Kobe University, Graduate School of Medicine (Japan)

    2013-11-01

    Purpose: To evaluate the efficacy and outcome of a flow confirmation study (FCS) in oncologic outpatients undergoing chemotherapy suspected of a central venous port (CVP) system-related mechanical complication. Materials and methods: A total of 66 patients (27 men, 39 women; mean age, 60 years) received FCS for the following reasons: prolonged infusion time during chemotherapy (n = 32), inability to inject saline fluid (n = 15), lateral neck and/or back pain (n = 6), subcutaneous extravasation of anticancer drug (n = 5), arm swelling (n = 4), and inability to puncture the port (n = 4). FCS consisted of examining the position of CVP, potential secondary shifts or fractures, and integrity of the system using contrast material through the port. Results: Of the 66 patients, 43 had an abnormal finding uncovered by FCS. The most frequent abnormal findings was catheter kinking (n = 22). Explantation and reimplantation of the CVP system was required in 21 of the 66 patients. Remaining 45 patients were able continue using the CVP system after the FCS without any system malfunction. Conclusion: FCS was effective for evaluating CVP system-related mechanical complications and was useful for deciding whether CVP system explantation and reimplantation was required.

  18. Principle of accrual and compliance of income and expenses in accounting system

    Directory of Open Access Journals (Sweden)

    V.V. Travin

    2017-12-01

    Full Text Available The introduction of international accounting and financial reporting standards requires the deeper implementation of accounting principles, in particular, the principle of accrual and compliance costs. The current research has shown that its implementation helps to streamline the accounting process by reducing the need to verify the chosen methodology for compliance with other regulatory documents that regulate the peculiarities of accounting in various areas. The categories of «a system», «income» and «expenses» in the accounting system are investigated and their system characteristics are showed. The approach to realization of the principle of accrual and compliance of income and expenses in the accounting system is described and proposed. It involves the possibility of capitalizing costs in the value of stocks, non-current assets, in the form of receivables, or in the form of future periods. The capitalization of costs in value occurs when the costs are not considered as such, and are considered only as an increase in the asset, as an integral part of these or other values. The study takes into account the peculiarities of its influence on the methodology of accounting for financial results of the enterprise.

  19. Project W-420 Ventilation Stack Monitoring System Year 2000 Compliance Assessment Project Plan

    International Nuclear Information System (INIS)

    BUSSELL, J.H.

    1999-01-01

    This document contains a limited assessment of Year 2000 compliance for Project W-420. Additional information is provided as a road map to project documents and other references that may be used to verify Year 2000 compliance. This assessment describes the potential Year 2000 (Y2K) problems and describes the methods for achieving Y2K Compliance for Project W-420, Ventilation Stack Monitoring Systems Upgrades. The purpose of this assessment is to give an overview of the project. This document will not be updated and any dates contained in this document are estimates and may change. The project work scope includes upgrades to ventilation stacks and generic effluent monitoring systems (GEMS) at the 244-A Double Contained Receiver Tank (DCRT), the 244-BX DCRT, the 244-CR Vault, tanks 241-C-105 and 241-C-106, the 244-S DCRT, and the 244-TX DCRT. A detailed description of system dates, functions, interfaces, potential Y2K problems, and date resolutions can not be described since the project is in the definitive design phase, This assessment will describe the methods, protocols, and practices to ensure that equipment and systems do not have Y2K problems

  20. Non-invasive evaluation of the coronary venous system in patients with chronic systolic heart failure by 64-detector computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Cubuk, Rahmi; Tasali, Nuri; Celik, Levent; Guney, Sefik (Dept. of Radiology, Maltepe Univ. School of Medicine, Istanbul (Turkey)), email: rahmicubuk@yahoo.com; Aydin, Alper; Yilmazer, Serdar; Dagdeviren, Bahadir (Dept. of Cardiology, Maltepe Univ. School of Medicine, Istanbul (Turkey))

    2011-05-15

    Background: Imaging coronary venous systems to guide transcatheter cardiac interventions are becoming increasingly important, particularly in heart failure patients who are selected for cardiac resynchronization therapy (CRT). Failure of left ventricular (LV) lead placement during the procedure has been attributed to the inability to insert catheters into the coronary sinus and the lack of suitable side branches. Purpose To comparatively assess the value of a 64-detector MDCT examination in visualizing the cardiac veins and evaluating the morphological characteristics of the coronary venous system in patients with and without chronic systolic heart failure (SHF). Material and Methods A 64-detector MDCT examination of the heart was performed in 26 consecutive patients (five women, 21 men; mean age 57.80 +- 12.05 years; range 27-81 years) with chronic SHF. The morphological characteristics of the coronary venous system, such as the diameter, the distances between the venous tributaries, the angle and the tortuosity, were evaluated. The group was compared with a subgroup of 52 subjects without SHF (LV ejection fraction >40%) matched for age, sex, and the risk factors for coronary artery disease. Results: The coronary sinus (CS), great cardiac vein (GCV), anterior interventricular vein (AIV), and posterior interventricular vein (PIV) were visualized in all 78 individuals. The posterior vein of the left ventricle (PVLV) (63/78), left marginal vein (LMV) (72/78), and the small cardiac vein (SCV) (50/78) were visualized in SHF and control patients (p = NS). The lengths between venous tributaries were higher (p > 0.05) and more dilated (P < 0.001 for CS, GCV, AIV, PVLV, LMV; p = 0.001 for PIV) in the cases with SHF compared with the control population. The angle between the CS-GCV axis and the venous branches was wider (p = 0.02 for LMV and PIV, p = 0.001 for PVLV) and did not have any correlation with the LV diameter in cases with SHF. There was no difference between the

  1. 'Chronic cerebrospinal venous insufficiency' in multiple sclerosis. Is multiple sclerosis a disease of the cerebrospinal venous outflow system?; 'Chronische zerebrospinale venoese Insuffizienz' bei Multipler Sklerose. Ist die Multiple Sklerose eine Erkrankung des zerebrospinalen venoesen Abflusssystems?

    Energy Technology Data Exchange (ETDEWEB)

    Wattjes, M.P. [VU Univ. Medical Center, Amsterdam (Netherlands). Dept. of Radiology; Doepp, F. [Universitaetsklinik Charite, Berlin (Germany). Neurologische Klinik; Bendszus, M. [Heidelberg Univ. (Germany). Abt. fuer Neuroradiologie; Fiehler, J. [Universitaetsklinikum Hamburg-Eppendorf (Germany). Klinik fuer Neuroradiologische Diagnostik und Intervention

    2011-06-15

    Chronic impaired venous outflow from the central nervous system has recently been claimed to be associated with multiple sclerosis (MS) pathology. This resulted in the term chronic cerebrospinal venous insufficiency (CCSVI) in MS. The concept of CCSVI is based on sonography studies showing that impaired venous outflow leading to pathological reflux is almost exclusively present in MS patients but not in healthy controls. Based on these findings, a new pathophysiological concept has been introduced suggesting that chronic venous outflow obstruction and venous reflux in the CNS result in pathological iron depositions leading to inflammation and neurodegeneration. The theory of CCSVI in MS has rapidly generated tremendous interest in the media and among patients and the scientific community. In particular, the potential shift in treatment concepts possibly leading to an interventional treatment approach including balloon angioplasty and venous stent placement is currently being debated. However, results from recent studies involving several imaging modalities have raised substantial concerns regarding the CCSVI concept in MS. In this review article, we explain the concept of CCSVI in MS and discuss this hypothesis in the context of MS pathophysiology and imaging studies which have tried to reproduce or refute this theory. In addition, we draw some major conclusions focusing in particular on the crucial question as to whether interventional treatment options are expedient. In conclusion, the present conclusive data confuting the theory of CCSVI in MS should lead to reluctance with respect to the interventional treatment of possible venous anomalies in MS patients. (orig.)

  2. Risk of infection due to medical interventions via central venous catheters or implantable venous access port systems at the middle port of a three-way cock: luer lock cap vs. luer access split septum system (Q-Syte).

    Science.gov (United States)

    Pohl, Fabian; Hartmann, Werner; Holzmann, Thomas; Gensicke, Sandra; Kölbl, Oliver; Hautmann, Matthias G

    2014-01-25

    Many cancer patients receive a central venous catheter or port system prior to therapy to assure correct drug administration. Even appropriate hygienic intervention maintenance carries the risk of contaminating the middle port (C-port) of a three-way cock (TWC), a risk that increases with the number of medical interventions. Because of the complexity of the cleaning procedure with disconnection and reconnection of the standard luer lock cap (referred as "intervention"), we compared luer lock caps with a "closed access system" consisting of a luer access split septum system with regard to process optimization (work simplification, process time), efficiency (costs) and hygiene (patient safety). For determination of process optimization the workflow of an intervention according to the usual practice and risks was depicted in a process diagram. For determining the actual process costs, we analyzed use of material and time parameters per intervention and used the process parameters for programming the process into a simulation run (n = 1000) to determine the process costs as well as their differences (ACTUAL vs. NOMINAL) within the framework of a discrete event simulation.Additionally cultures were carried out at the TWC C-ports to evaluate possible contamination. With the closed access system, the mean working time of 5.5 minutes could be reduced to 2.97 minutes. The results for average process costs (labour and material costs per use) were 3.92 € for luer lock caps and 2.55 € for the closed access system. The hypothesis test (2-sample t-test, CI 0.95, p-valuerisks (related to material, surroundings, staff handling) could be reduced by 65.38%. In the present research, the closed access system with a divided split septum was superior to conventional luer lock caps. The advantage of the closed access system lies in the simplified handling for staff, which results in a reduced risk of patient infection due to improved clinical hygiene.

  3. Monitoring Student Immunization, Screening, and Training Records for Clinical Compliance: An Innovative Use of the Institutional Learning Management System.

    Science.gov (United States)

    Elting, Julie Kientz

    2017-12-13

    Clinical compliance for nursing students is a complex process mandating them to meet facility employee occupational health requirements for immunization, screening, and training prior to patient contact. Nursing programs monitor clinical compliance with in-house management of student records, either paper or electronic, or by contracting with a vendor specializing in online record tracking. Regardless of method, the nursing program remains fully accountable for student preparation and bears the consequences of errors. This article describes how the institution's own learning management system can be used as an accurate, cost-neutral, user-friendly, and Federal Educational Rights Protection Act-compliant clinical compliance system.

  4. Sonographic detection of portal venous gas

    International Nuclear Information System (INIS)

    Lee, Wang Yul; Lee, S. K.; Cho, O. K.

    1989-01-01

    Portal venous gas suggests underlying bowel disease such as strangulating intestinal obstruction and its demonstration carries with it an important implications with respect to patient management. Radiography has been the gold standard for the detection of portal venous gas. We have experienced two cases of portal venous gas diagnosed by ultrasound. Sonographic findings were floating echoes in the main portal vein and highly echogenic linear or patchy echoes within the hepatic parenchyma. Simple abdominal films of those cases failed to demonstrate gas in the portal venous system

  5. A multi-level model-driven regime for value-added tax compliance in ERP systems

    NARCIS (Netherlands)

    Goossenaerts, J.B.M.; Zegers, A.T.M.; Smits, J.M.

    2009-01-01

    As the economy becomes global and ICT-reliant, approaches practiced in enterprise software product development and enterprise resource planning (ERP) system implementation must cope with increasingly complex situations induced by contemporary supply chain and regulations. Compliance with regulations

  6. DOD Business Systems Modernization: Key Navy Programs' Compliance with DOD's Federated Business Enterprise Architecture Needs to be Adequately Demonstrated

    National Research Council Canada - National Science Library

    Hite, Randolph C; Lakhmani, Neela; Barkakati, Nabajyoti; Doherty, Neil; Glover, Nancy; Longcore, Emily; Holland, Michael; Le, Anh; Leiling, Josh; McCracken, Lee; Srikanth, Sushmita

    2008-01-01

    .... In particular, the programs BEA compliance assessments did not: * Include all relevant architecture products, such as products that specify the technical standards needed to promote interoperability among related systems...

  7. Baseline Design Compliance Matrix for the Rotary Mode Core Sampling System

    International Nuclear Information System (INIS)

    LECHELT, J.A.

    2000-01-01

    The purpose of the design compliance matrix (DCM) is to provide a single-source document of all design requirements associated with the fifteen subsystems that make up the rotary mode core sampling (RMCS) system. It is intended to be the baseline requirement document for the RMCS system and to be used in governing all future design and design verification activities associated with it. This document is the DCM for the RMCS system used on Hanford single-shell radioactive waste storage tanks. This includes the Exhauster System, Rotary Mode Core Sample Trucks, Universal Sampling System, Diesel Generator System, Distribution Trailer, X-Ray Cart System, Breathing Air Compressor, Nitrogen Supply Trailer, Casks and Cask Truck, Service Trailer, Core Sampling Riser Equipment, Core Sampling Support Trucks, Foot Clamp, Ramps and Platforms and Purged Camera System. Excluded items are tools such as light plants and light stands. Other items such as the breather inlet filter are covered by a different design baseline. In this case, the inlet breather filter is covered by the Tank Farms Design Compliance Matrix

  8. Analysis of Emission Effects Related to Drivers’ Compliance Rates for Cooperative Vehicle-Infrastructure System at Signalized Intersections

    Directory of Open Access Journals (Sweden)

    Ruohua Liao

    2018-01-01

    Full Text Available Unknown remaining time of signal phase at a signalized intersection generally results in extra accelerations and decelerations that increase variations of operating conditions and thus emissions. A cooperative vehicle-infrastructure system can reduce unnecessary speed changes by establishing communications between vehicles and the signal infrastructure. However, the environmental benefits largely depend on drivers’ compliance behaviors. To quantify the effects of drivers’ compliance rates on emissions, this study applied VISSIM 5.20 (Planung Transport Verkehr AG, Karlsruhe, Germany to develop a simulation model for a signalized intersection, in which light duty vehicles were equipped with a cooperative vehicle-infrastructure system. A vehicle-specific power (VSP-based model was used to estimate emissions. Based on simulation data, the effects of different compliance rates on VSP distributions, emission factors, and total emissions were analyzed. The results show the higher compliance rate decreases the proportion of VSP bin = 0, which means that the frequencies of braking and idling were lower and light duty vehicles ran more smoothly at the intersection if more light duty vehicles complied with the cooperative vehicle-infrastructure system, and emission factors for light duty vehicles decreased significantly as the compliance rate increased. The case study shows higher total emission reductions were observed with higher compliance rate for all of CO2, NOx, HC, and CO emissions. CO2 was reduced most significantly, decreased by 16% and 22% with compliance rates of 0.3 and 0.7, respectively.

  9. Analysis of Emission Effects Related to Drivers' Compliance Rates for Cooperative Vehicle-Infrastructure System at Signalized Intersections.

    Science.gov (United States)

    Liao, Ruohua; Chen, Xumei; Yu, Lei; Sun, Xiaofei

    2018-01-12

    Unknown remaining time of signal phase at a signalized intersection generally results in extra accelerations and decelerations that increase variations of operating conditions and thus emissions. A cooperative vehicle-infrastructure system can reduce unnecessary speed changes by establishing communications between vehicles and the signal infrastructure. However, the environmental benefits largely depend on drivers' compliance behaviors. To quantify the effects of drivers' compliance rates on emissions, this study applied VISSIM 5.20 (Planung Transport Verkehr AG, Karlsruhe, Germany) to develop a simulation model for a signalized intersection, in which light duty vehicles were equipped with a cooperative vehicle-infrastructure system. A vehicle-specific power (VSP)-based model was used to estimate emissions. Based on simulation data, the effects of different compliance rates on VSP distributions, emission factors, and total emissions were analyzed. The results show the higher compliance rate decreases the proportion of VSP bin = 0, which means that the frequencies of braking and idling were lower and light duty vehicles ran more smoothly at the intersection if more light duty vehicles complied with the cooperative vehicle-infrastructure system, and emission factors for light duty vehicles decreased significantly as the compliance rate increased. The case study shows higher total emission reductions were observed with higher compliance rate for all of CO₂, NO x , HC, and CO emissions. CO₂ was reduced most significantly, decreased by 16% and 22% with compliance rates of 0.3 and 0.7, respectively.

  10. Analysis of Emission Effects Related to Drivers’ Compliance Rates for Cooperative Vehicle-Infrastructure System at Signalized Intersections

    Science.gov (United States)

    Liao, Ruohua; Yu, Lei; Sun, Xiaofei

    2018-01-01

    Unknown remaining time of signal phase at a signalized intersection generally results in extra accelerations and decelerations that increase variations of operating conditions and thus emissions. A cooperative vehicle-infrastructure system can reduce unnecessary speed changes by establishing communications between vehicles and the signal infrastructure. However, the environmental benefits largely depend on drivers’ compliance behaviors. To quantify the effects of drivers’ compliance rates on emissions, this study applied VISSIM 5.20 (Planung Transport Verkehr AG, Karlsruhe, Germany) to develop a simulation model for a signalized intersection, in which light duty vehicles were equipped with a cooperative vehicle-infrastructure system. A vehicle-specific power (VSP)-based model was used to estimate emissions. Based on simulation data, the effects of different compliance rates on VSP distributions, emission factors, and total emissions were analyzed. The results show the higher compliance rate decreases the proportion of VSP bin = 0, which means that the frequencies of braking and idling were lower and light duty vehicles ran more smoothly at the intersection if more light duty vehicles complied with the cooperative vehicle-infrastructure system, and emission factors for light duty vehicles decreased significantly as the compliance rate increased. The case study shows higher total emission reductions were observed with higher compliance rate for all of CO2, NOx, HC, and CO emissions. CO2 was reduced most significantly, decreased by 16% and 22% with compliance rates of 0.3 and 0.7, respectively. PMID:29329214

  11. System dynamics to model the unintended consequences of denying payment for venous thromboembolism after total knee arthroplasty.

    Science.gov (United States)

    Worni, Mathias; Pietrobon, Ricardo; Zammar, Guilherme Roberto; Shah, Jatin; Yoo, Bryan; Maldonato, Mauro; Takemoto, Steven; Vail, Thomas P

    2012-01-01

    The Hospital Acquired Condition Strategy (HACS) denies payment for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The intention is to reduce complications and associated costs, while improving the quality of care by mandating VTE prophylaxis. We applied a system dynamics model to estimate the impact of HACS on VTE rates, and potential unintended consequences such as increased rates of bleeding and infection and decreased access for patients who might benefit from TKA. The system dynamics model uses a series of patient stocks including the number needing TKA, deemed ineligible, receiving TKA, and harmed due to surgical complication. The flow of patients between stocks is determined by a series of causal elements such as rates of exclusion, surgery and complications. The number of patients harmed due to VTE, bleeding or exclusion were modeled by year by comparing patient stocks that results in scenarios with and without HACS. The percentage of TKA patients experiencing VTE decreased approximately 3-fold with HACS. This decrease in VTE was offset by an increased rate of bleeding and infection. Moreover, results from the model suggest HACS could exclude 1.5% or half a million patients who might benefit from knee replacement through 2020. System dynamics modeling indicates HACS will have the intended consequence of reducing VTE rates. However, an unintended consequence of the policy might be increased potential harm resulting from over administration of prophylaxis, as well as exclusion of a large population of patients who might benefit from TKA.

  12. System Dynamics to Model the Unintended Consequences of Denying Payment for Venous Thromboembolism after Total Knee Arthroplasty

    Science.gov (United States)

    Worni, Mathias; Pietrobon, Ricardo; Zammar, Guilherme Roberto; Shah, Jatin; Yoo, Bryan; Maldonato, Mauro; Takemoto, Steven; Vail, Thomas P.

    2012-01-01

    Background The Hospital Acquired Condition Strategy (HACS) denies payment for venous thromboembolism (VTE) after total knee arthroplasty (TKA). The intention is to reduce complications and associated costs, while improving the quality of care by mandating VTE prophylaxis. We applied a system dynamics model to estimate the impact of HACS on VTE rates, and potential unintended consequences such as increased rates of bleeding and infection and decreased access for patients who might benefit from TKA. Methods and Findings The system dynamics model uses a series of patient stocks including the number needing TKA, deemed ineligible, receiving TKA, and harmed due to surgical complication. The flow of patients between stocks is determined by a series of causal elements such as rates of exclusion, surgery and complications. The number of patients harmed due to VTE, bleeding or exclusion were modeled by year by comparing patient stocks that results in scenarios with and without HACS. The percentage of TKA patients experiencing VTE decreased approximately 3-fold with HACS. This decrease in VTE was offset by an increased rate of bleeding and infection. Moreover, results from the model suggest HACS could exclude 1.5% or half a million patients who might benefit from knee replacement through 2020. Conclusion System dynamics modeling indicates HACS will have the intended consequence of reducing VTE rates. However, an unintended consequence of the policy might be increased potential harm resulting from over administration of prophylaxis, as well as exclusion of a large population of patients who might benefit from TKA. PMID:22536313

  13. IAEA preparations for the year 2000 compliance of safeguards equipment systems

    International Nuclear Information System (INIS)

    Aparo, M.; Barnes, B.; Lewis, W.; Hsiung, Sue

    1999-01-01

    The Department of Safeguards, IAEA, has used equipment systems for acquiring relevant data to support safeguards evaluation and verification activities. Typically an equipment system consists of EPROM (embedded system), a connecting personal computer with instrument software for data acquisition, and may include data evaluation software. Complementing the equipment systems is a collection of general evaluation software systems (application software) which support the analysis of the acquired data. In preparing for the year 2000 compliance of all safeguards systems, SGTS (Safeguards Division of Technical Services) in IAEA, must ascertain the equipment systems and the evaluation software authorised for inspection use can properly operate through the passage of year 2000. We present the year 2000 challenge for these systems, the approach we use to tackle the problem, and the status of our year 2000 project. (author)

  14. Implementing an integrated standards-based management system to ensure compliance at Los Alamos National Laboratory

    International Nuclear Information System (INIS)

    Hjeresen, D.; Roybal, S.; Bertino, P.; Gherman, C.; Hosteny, B.

    1995-01-01

    Los Alamos National Laboratory (LANL or the Laboratory) is developing and implementing a comprehensive, Integrated Standards-Based Management System (ISBMS) to enhance environmental, safety, and health (ESH) compliance efforts and streamline management of ESH throughout the Laboratory. The Laboratory recognizes that to be competitive in today's business environment and attractive to potential Partnerships, Laboratory operations must be efficient and cost-effective. The Laboratory also realizes potential growth opportunities for developing ESH as a strength in providing new or improved services to its customers. Overall, the Laboratory desires to establish and build upon an ESH management system which ensures continuous improvement in protecting public health and safety and the environment and which fosters a working relationship with stakeholders. A team of process experts from the LANL Environmental Management (EM) Program Office, worked with management system consultants, and the Department of Energy (DOE) to develop an ESH management systems process to compare current LANL ESH management Systems and programs against leading industry standards. The process enabled the Laboratory to gauge its performance in each of the following areas: Planning and Policy Setting; Systems and Procedures; Implementation and Education; and Monitoring and Reporting. The information gathered on ESH management systems enabled LANL to pinpoint and prioritize opportunities for improvement in the provision of ESH services throughout the Laboratory and ultimately overall ESH compliance

  15. Status after 5 Years of Survival Compliance Testing in the Federal Columbia River Power System (FCRPS)

    Energy Technology Data Exchange (ETDEWEB)

    Skalski, John R.; Weiland, Mark A.; Ham, Kenneth D.; Ploskey, Gene R.; McMichael, Geoffrey A.; Colotelo, Alison H.; Carlson, Thomas J.; Woodley, Christa M.; Eppard, M. Brad; Hockersmith, Eric E.

    2016-06-27

    Survival studies of juvenile salmonids implanted with acoustic tags have been conducted at hydroelectric dams within the Federal Columbia River Power System (FCRPS) in the Columbia and Snake rivers between 2010 and 2014 to assess compliance with dam passage survival standards stipulated in the 2008 Biological Opinion (BiOp). For juvenile salmonids migrating downstream in the spring, dam passage survival defined as survival from the upstream dam face to the tailrace mixing zone must be ≥96% and for summer migrants, ≥93%, and estimated with a standard error ≤1.5% (i.e., 95% confidence interval of ±3%). A total of 29 compliance tests have been conducted at 6 of 8 FCRPS main-stem dams, using over 109,000 acoustic-tagged salmonid smolts. Of these 29 compliance studies, 23 met the survival standards and 26 met the precision requirements. Of the 6 dams evaluated to date, individual survival estimates range from 0.9597 to 0.9868 for yearling Chinook Salmon, 0.9534 to 0.9952 for steelhead, and 0.9076 to 0.9789 for subyearling Chinook Salmon. These investigations suggest the large capital investment over the last 20 years to improve juvenile salmon passage through the FCRPS dams has been beneficial.

  16. Effectiveness of an electronic hand hygiene monitoring system on healthcare workers' compliance to guidelines.

    Science.gov (United States)

    Al Salman, J M; Hani, S; de Marcellis-Warin, N; Isa, Sister Fatima

    2015-01-01

    Hand hygiene is a growing concern among populations and is a crucial element in ensuring patient safety in a healthcare environment. Numerous management efforts have been conducted in that regard, including education, awareness and observations. To better evaluate the possible impact of technology on a healthcare setting, we observed the impact of a particular niche technology developed as an answer to the growing hand hygiene concerns. A study was conducted at Salmaniya Medical Complex (SMC) in Bahrain on a total of 16 Coronary Care Unit (CCU) beds where the system was installed, and the hand hygiene activity of healthcare workers (HCWs) in this area was monitored for a total period of 28 days. Comments, remarks and suggestions were noted, and improvements were made to the technology during the course of the trial. While resistance to change was significant, overall results were satisfactory. Compliance with hand hygiene techniques went from 38-42% to 60% at the beginning of the trial and then increased to an average of 75% at the end of the 28-day trial. In some cases, compliance peaked at 85% or even at 100%. Our case study demonstrates that technology can be used effectively in promoting and improving hand hygiene compliance in hospitals, which is one way to prevent cross-infections, especially in critical care areas. Copyright © 2014 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved.

  17. Abnormalities in the cellular phase of blood fibrinolytic activity in systemic lupus erythematosus and in venous thromboembolism

    International Nuclear Information System (INIS)

    Moroz, L.A.; MacLean, L.D.; Langleben, D.

    1986-01-01

    Fibrinolytic activities of whole blood and plasma were determined by 125 I-fibrin radiometric assay in 16 normal subjects, and in 11 patients with systemic lupus erythematosus (SLE), 14 with progressive systemic sclerosis (PSS), 23 with venous thromboembolic disease, and 20 patients awaiting elective surgery. Mean whole blood and plasma activities for patients with PSS, and for those awaiting elective surgery, were similar to normal values, as was the mean plasma activity in patients with SLE. However, mean whole blood activity in SLE was significantly decreased compared with normals (p less than 0.05), with mean plasma activity accounting for 44% of mean whole blood activity (compared with 17% in normal subjects), representing a 67% decrease in mean calculated cellular phase activity in SLE, when compared with normals. Since the numbers of cells (neutrophils, monocytes) possibly involved in cellular activity were not decreased, the findings suggest a functional defect in fibrinolytic activity of one or more blood cell types in SLE. An additional finding was the participation of the cellular phase as well as the well-known plasma phase of blood in the fibrinolytic response to thromboembolism

  18. A BMPy Road for Venous Development.

    Science.gov (United States)

    Goddard, Lauren M; Kahn, Mark L

    2017-09-11

    Detailed molecular pathways for the specific growth of arteries and lymphatic vessels have been identified, but the mechanisms controlling venous vessel growth have been obscure. Tischfield and colleagues (2017) shed new light on this problem by identifying a role for BMP signaling in development of the cerebral venous system. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Venous leg ulcers

    Science.gov (United States)

    2008-01-01

    Introduction Leg ulcers usually occur secondary to venous reflux or obstruction, but 20% of people with leg ulcers have arterial disease, with or without venous disorders. Between 1.5 and 3.0/1000 people have active leg ulcers. Prevalence increases with age to about 20/1000 in people aged over 80 years. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of standard treatments, adjuvant treatments, and organisational interventions for venous leg ulcers? What are the effects of interventions to prevent recurrence of venous leg ulcers? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 80 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: compression bandages and stockings, cultured allogenic (single or bilayer) skin replacement, debriding agents, dressings (cellulose, collagen, film, foam, hyaluronic acid-derived, semi-occlusive alginate), hydrocolloid (occlusive) dressings in the presence of compression, intermittent pneumatic compression, intravenous prostaglandin E1, larval therapy, laser treatment (low-level), leg ulcer clinics, multilayer elastic system, multilayer elastomeric (or non-elastomeric) high-compression regimens or bandages, oral treatments (aspirin, flavonoids, pentoxifylline, rutosides, stanozolol, sulodexide, thromboxane alpha2 antagonists, zinc), peri

  20. Noninvasive measurement of cerebral venous oxygenation in neonates with a multi-wavelength, fiber-coupled laser diode optoacoustic system

    Science.gov (United States)

    Herrmann, Stephen; Petrov, Irene Y.; Petrov, Yuriy; Fonseca, Rafael A.; Richardson, C. Joan; Shanina, Ekaterina; Prough, Donald S.; Esenaliev, Rinat O.

    2018-03-01

    Noninvasive measurement of cerebral venous oxygenation in neonates could provide critical information for clinicians such as cerebral hypoxia without the risks involved with invasive catheterization. Evaluation of cerebral hypoxia is important in many clinical settings such as hypoxic-ischemic encephalopathy, perfusion monitoring in cardiovascular surgery or in traumatic brain injury. By probing the superior sagittal sinus (SSS), a large central cerebral vein, we can obtain stable signals with our recently developed multi-wavelength, fiber-coupled laser diode optoacoustic system for measurement of SSS blood oxygenation. The neonatal SSS oxygenation was measured in the reflection mode through open anterior and posterior fontanelles without obscuration by the overlying calvarium. In the transmission mode it was measured through the skull in the occipital area. Our device is lightweight, easily maneuverable, and user friendly for physicians. We monitored the SSS oxygenation in neonates admitted to the Neonatal Intensive Care Unit (NICU) of UTMB with varying gestation, birth weight and clinical histories to identify normal range and difference between neonates with and without risk factors for cerebral hypoxia.

  1. Left phrenic nerve anatomy relative to the coronary venous system: Implications for phrenic nerve stimulation during cardiac resynchronization therapy.

    Science.gov (United States)

    Spencer, Julianne H; Goff, Ryan P; Iaizzo, Paul A

    2015-07-01

    The objective of this study was to quantitatively characterize anatomy of the human phrenic nerve in relation to the coronary venous system, to reduce undesired phrenic nerve stimulation during left-sided lead implantations. We obtained CT scans while injecting contrast into coronary veins of 15 perfusion-fixed human heart-lung blocs. A radiopaque wire was glued to the phrenic nerve under CT, then we created three-dimensional models of anatomy and measured anatomical parameters. The left phrenic nerve typically coursed over the basal region of the anterior interventricular vein, mid region of left marginal veins, and apical region of inferior and middle cardiac veins. There was large variation associated with the average angle between nerve and veins. Average angle across all coronary sinus tributaries was fairly consistent (101.3°-111.1°). The phrenic nerve coursed closest to the middle cardiac vein and left marginal veins. The phrenic nerve overlapped a left marginal vein in >50% of specimens. © 2015 Wiley Periodicals, Inc.

  2. Pseudo interruption of the inferior vena cava complicating the device closure of patent ductus arteriosus: Case report and short review of venous system embryology

    Directory of Open Access Journals (Sweden)

    Venkateshwaran Subramanian

    2014-01-01

    Full Text Available A nineteen-month-old girl was taken up for patent ductus arteriosus (PDA device closure. A diagnostic catheter from the right femoral venous access entered the superior vena cava (SVC, through the azygos vein suggesting interruption of inferior vena caval with azygos continuity. Therefore, the PDA device was closed from the right jugular venous access. However, a postprocedure echocardiogram (echo showed a patent inferior vena caval connection into the right atrium. An angiogram from femoral veins showed communication between the iliac veins and the azygos system, in addition to normal drainage into the inferior vena cava (IVC. Congenital communication between the iliac veins and the azygos system can mimic IVC interruption. An attempt to theoretically explain the embryological origin of the communication has been made.

  3. The Compliance Cost of the U.S. Individual Income Tax System

    OpenAIRE

    Joel Slemrod; Nikki Sorum

    1984-01-01

    This paper uses evidence from a survey of Minnesota taxpayers to estimate the magnitude and demographic patterns of the compliance cost of filing federal and state income tax returns. It concludes that in 1982 this cost was between $17 and $27 billion, or from five to seven percent of the revenue raised by the federal and state income tax systems combined. About two billion hours of taxpayer time were spent on filing tax returns, and about $3 billion was spent on professional tax assistance.

  4. An ultrasound study of gestational and postural changes in the deep venous system of the leg in pregnancy.

    Science.gov (United States)

    Macklon, N S; Greer, I A; Bowman, A W

    1997-02-01

    To investigate gestational and postural changes in diameter and blood flow in the proximal deep leg veins during pregnancy. A longitudinal, prospective observational study. The ultrasound department of a teaching maternity hospital. Twenty-four healthy women with uncomplicated singleton pregnancies. Real-time and duplex Doppler ultrasound assessments of the vessel diameter, flow velocity and respiratory flow fluctuation in the proximal deep leg veins of women serially measured from the first trimester of pregnancy to six weeks postnatally. The effects of increasing gestation and the adoption of the left lateral position on the above parameters. An increase in vessel diameter and a fall in flow velocity with increasing gestation was observed. However, no change in venous flow variation was observed. Delivery had reverse effects. Flow velocity was slower in the left than right legs, but on adoption of the left lateral position an increase in flow velocity and venous flow variation was observed in both legs during pregnancy. These data are consistent with the observed increase in incidence and pattern of deep venous thrombosis in pregnancy and may aid interpretation of duplex Doppler ultrasound examinations for deep venous thrombosis in pregnancy. Postural changes should be part of this evaluation. The gravid uterus may not be the sole cause for postural changes in deep venous flow velocity.

  5. Project W-211 initial tank retrieval systems year 2000 compliance assessment project plan

    International Nuclear Information System (INIS)

    BUSSELL, J.H.

    1999-01-01

    This document contains a limited assessment of Year 2000 compliance for Project W-211. Additional information is provided as a road map to project documents and other references that may be used to verify Year 2000 compliance

  6. Project W-151 Tank 101-AZ Waste Retrieval System Year 2000 Compliance Assessment Project Plan

    International Nuclear Information System (INIS)

    BUSSELL, J.H.

    1999-01-01

    This document contains a limited assessment of Year 2000 compliance for Project W-151. Additional information is provided as a road map to project documents and other references that may be used to verify Year 2000 compliance

  7. Compliance of the Savannah River Site D-Area cooling system with environmental regulations

    Energy Technology Data Exchange (ETDEWEB)

    Specht, W.L.; Mackey, H.E.; Paller, M.H.; Wike, L.D.; Wilde, E.W. (eds.)

    1990-08-01

    This document presents information relating to a demonstration under Section 316(a) of the Clean Water Act for the 400-D Area cooling system at the Savannah River Site (SRS) near Aiken, South Carolina. The demonstration was mandated because the National Pollution Discharge Elimination System (NPDES) permit for SRS (SC0000175), granted on January 1, 1984, specified in-stream temperature limits in SRS streams of 32.2{degree}C and a {Delta}T limit of 2.8{degree}C above ambient. To achieve compliance with in-stream temperature limits, the Department of Energy (DOE) and the South Carolina Department of Health and Environmental Control (SCDHEC) entered into a Consent Order (84-4-W) which temporarily superseded the temperature requirements and identified a process for attaining compliance. The preferred option for achieving thermal compliance in Beaver Dam Creek consisted of increased flow, with mixing of the raw water basin overflow with the cooling water discharge during the summer months. Although this action can achieve instream temperatures of less than 32.2{degree}C, {Delta}T's still exceed 2.8{degree}C. Therefore, a 316 (a) Demonstration was initiated to determine whether a balanced indigenous biological community can be supported in the receiving stream with {Delta}T's in excess of 2.8{degree}C. A Biological Monitoring Program for Beaver Dam Creek was approved by SCDHEC in June 1988 and implemented in September 1988. The program monitored the water quality, habitat formers, zooplankton, macroinvertebrates, fish, other vertebrate wildlife and threatened and endangered species in Beaver Dam Creek for an 18-month period (September 1988-February 1990). This document summarizes information collected during the monitoring program and evaluates the data to determine whether Beaver Dam Creek presently supports a balanced indigenous biological community. 97 refs., 32 figs., 51 tabs.

  8. Krsko Nuclear Power Plant's Environmental Management System in Compliance with ISO 14001:2004

    International Nuclear Information System (INIS)

    Kusar, A.; Kavsek, D.

    2010-01-01

    Krsko Nuclear Power Plant (NPP) pays special attention to environmental protection and practices environmental safety in all plant processes and management. In 2008, Krsko NPP introduced the Environmental Management System in compliance with ISO 14001:2004 standard. The plant management announced the Environmental policy which is a part of the business strategy of Krsko NPP which is an eco-friendly company. The Policy is a commitment of the plant management and all staff to act in compliance with requirements of ISO 14001:2004. The standard served as a basis for developing some new documentation such as Environmental Management System Quality Manual, Environmental planning procedures identifying legal and other requirements, Register of environmental aspects, Register of legal and other requirements etc. When establishing the Register of environmental aspects, all possible environmental impacts of the plant were carefully reviewed and estimated. Following the introduction and certification audit in October and December 2008 of Bureau Veritas Certification, Krsko NPP was awarded certificate ISO 14001:2004 attesting conformity of its Environmental Management System with this standard. The Environmental Certificate means that Krsko NPP will promote a positive environmental culture and maintain a safe, healthy and environmentally-sound workplace for all its employees, contractors and visitors.(author).

  9. Project W-420 Ventilation Stack Monitoring System Year 2000 Compliance Assessment Project Plan

    International Nuclear Information System (INIS)

    BUSSELL, J.H.

    1999-01-01

    This assessment describes the potential Year 2000 (Y2K) problems and describes the methods for achieving Y2K Compliance for Project W-420, Ventilation Stack Monitoring Systems Upgrades. The purpose of this assessment is to give an overview of the project. This document will not be updated and any dates contained in this document are estimates and may change. The project work scope includes upgrades to ventilation stacks and generic effluent monitoring systems (GEMS) at the 244-A Double Contained Receiver Tank (DCRT), the 244-BX DCRT, the 244-CR Vault, tanks 241-C-105 and 241-C-106, the 244-S DCRT, and the 244-TX DCRT. A detailed description of system dates, functions, interfaces, potential Y2K problems, and date resolutions can not be described since the project is in the definitive design phase, This assessment will describe the methods, protocols, and practices to ensure that equipment and systems do not have Y2K problems

  10. Computed tomographic manifestations of abdominal and pelvic venous collaterals

    International Nuclear Information System (INIS)

    Pagani, J.J.; Thomas, J.L.; Bernardino, M.E.

    1982-01-01

    Obstruction of blood flow through the inferior vena cava and portal vein may produce venous collaterals. These include the paravertebral venous system and its communications with the ascending lumbar veins and azygous/hemiazygous system; gonadal, periureteric, and other retroperitoneal veins; abdominal wall veins; hemorrhoidal venous plexus; and the portal venous system. The anatomic location of these vessels is discussed. Computed tomography demonstrates them as round or tubular structures that are isodens when compared with other venous structures following contrast material administration. Techniques of examination and methods of differentiation of these vascular structures from other abnormalities, especially lymphadenopathy, are discussed

  11. Splanchnic venous thrombosis and pancreatitis.

    Science.gov (United States)

    Nadkarni, Nikhil A; Khanna, Sahil; Vege, Santhi Swaroop

    2013-08-01

    Pancreatitis is an inflammatory process with local and systemic manifestations. One such local manifestation is thrombosis in splanchnic venous circulation, predominantly of the splenic vein. The literature on this important complication is very sparse. This review offers an overview of mechanism of thrombosis, its pathophysiology, diagnosis, and management in the setting of acute as well as chronic pancreatitis.

  12. Infections Increase Risk of Arterial and Venous Thromboses in Danish Patients with Systemic Lupus Erythematosus

    DEFF Research Database (Denmark)

    Baronaite Hansen, Renata; Jacobsen, Søren

    2014-01-01

    OBJECTIVE: Infections and thromboses are known complications of systemic lupus erythematosus (SLE). We investigated if infectious episodes in patients with SLE were followed by an increased risk of thrombotic events. METHODS: A cohort of 571 patients with prevalent or incident SLE was followed...

  13. A cost-effective peripheral venous port system placed at the bedside.

    Science.gov (United States)

    Finney, R; Albrink, M H; Hart, M B; Rosemurgy, A S

    1992-07-01

    High costs and a paucity of available operating time have led us to seek alternatives to operatively placed vascular access systems. This prospective study is the initial report of a peripheral port system (P.A.S. PORT System, Pharmacia Deltec, Inc.) placed at the bedside. Seventy-nine patients (52 male, 27 female), ages 3-92 years, had ports implanted by surgical residents with attending supervision. Sixty-eight (86%) received the P.A.S. PORT for long-term antibiotics, antifungal, or antiviral therapy; four (5%) for TPN infusion; three (4%) for blood products; two (3%) for chemotherapy; and two (3%) for iv narcotics. Ports were placed in 10 (13%) HIV(+) patients, three (4%) who were fully anticoagulated, and one who was a hemophiliac with a platelet count of zero. Eight patients (10%) developed superficial phlebitis, all of which resolved with nonsteroidal anti-inflammatory agents within 48 hr without port removal. Seven patients (9%) had their port removed due to infection. The average hospital charge to place the P.A.S. PORT System was $1488.00 vs $2811.00 for a tunneled external chest catheter and $3729.00 for the placement of a chest port. Bedside insertion of vascular access devices can be safely performed with acceptable infection rates allowing more efficient use of hospital operating rooms and with substantial cost savings.

  14. Wedge-shaped lesion in the liver seen on postoperative CT. Probable thromboembolic phenomenon in the portal venous system

    International Nuclear Information System (INIS)

    Yoshimitsu, K.; Charnsangavej, C.; Mi Park, J.; Ibukuro, K.

    1996-01-01

    Retrospective review of teaching files in our institution revealed 18 cases showing postoperative WSL in the liver. We also retrospectively reviewed CT images of the liver in 104 patients with a recent history of abdominopelvic surgery performed during a period of 12 months, as well as in 102 patients with no history of surgery during the same period to be used as control. Three additional patients with WSL were found in the postoperative group and none in the control group. Liver CT images from the 21 patients showing WSL, along with their clinical data and follow-up CT where available, were retrospectively analyzed. I.v. contrast-enhanced CT showed homogeneous higher attenuation of WSL than the surrounding liver in all cases; unenhanced CT showed low density in 5 patients, isodensity in 7 patients, and high density in 5 patients as compared with the surrounding liver. Density of unenhanced CT was significantly correlated with the presence or grade of fatty liver. In 5 cases CT demonstrated clots in the portal vein branch within the area of WSL and in 2 cases portal perfusion defects were observed on arterial portal CT, corresponding to the areas of WSL. Follow-up CT examinations were available on 15 patients: WSL became less prominent, or atrophic, or showed no change in 10, 2 and 3 patients respectively. Follow-up CT showed development of liver metastasis in only 3 cases. Only 2 of the 21 patients were clinically symptomatic; one had postoperative ileus and the other obstructive jaundice. Postoperative WSL may represent a thromboembolic phenomenon at the peripheral intrahepatic branch of the portal venous system during or after abdominopelvic surgery, resulting in a compensatory increase in the hepatic arterial flow that appears as wedge-shaped enhancement on CT. (orig./MG)

  15. Extrahepatic portal venous system thrombosis in recurrent acute and chronic alcoholic pancreatitis is caused by local inflammation and not thrombophilia.

    Science.gov (United States)

    Rebours, Vinciane; Boudaoud, Larbi; Vullierme, Marie-Pierre; Vidaud, Dominique; Condat, Bertrand; Hentic, Olivia; Maire, Frédérique; Hammel, Pascal; Ruszniewski, Philippe; Lévy, Philippe

    2012-10-01

    Extrahepatic portal venous system thrombosis (EPVST) occurs in 13% of patients with either recurrent acute (AP) or chronic (CP) alcoholic pancreatitis. The role of thrombophilia has never been assessed in this entity. All consecutive patients with alcoholic AP or CP were included in a prospective study. All patients underwent a computerized tomography (CT) scan of the pancreas to evaluate EPVST as well as thorough testing for thrombophilia (protein C, S, and antithrombin deficiency, factor II, factor V, and JAK2 gene mutations, homocystein, biological antiphospholipid syndrome). A total of 119 patients (male, n=100 (84%); smokers, n=110 (92%)) were included. EPVST was found in 41 patients (35%). The portal, superior mesenteric, or splenic veins were involved in 34%, 24%, and 93% of patients, respectively. Thrombophilia was identified in 18% (n=22), including the biological antiphospholipid syndrome, factor V Leiden mutation, and factor II G20210A gene mutation in 21 (17.6%), 2 (1.6%), and 1 patient (0.8%), respectively. On univariate analysis, the factors associated with EPVST were smoking (RR=1.6 (1.38-1.85), P=0.03), pseudocysts (RR=2.91 (1.29-6.56), P=0.008), a pseudocyst in the pancreatic tail (P=0.03), a high CT severity index for AP (P=0.007), and pancreatic parenchymal necrosis (P=0.02). The presence of hemostatic risk factors was not associated with an increased risk of EPVST. On multivariate analysis, only pseudocysts were associated with EPVST (hazard ratio: 6.402; 95% confidence interval (1.59-26.54), P=0.009). EPVST is found in 35% of patients with acute/chronic alcoholic pancreatitis. Local inflammation appears to be the major predisposing condition. The presence of some form of thrombophilia does not increase the risk of EPVST and should not be systematically searched for in case of EPVST.

  16. Cerebral venous angiomas

    International Nuclear Information System (INIS)

    Agnoli, A.L.; Hildebrandt, G.

    1985-01-01

    Clinical symptoms and radiological signs in 15 patients with cerebral venous malformations are presented and the diagnostic problems discussed. The circulation time in combination with cerebral malformations and angiomas of the scalp are described. CT findings in cases of venous malformations of the brain stem are evaluated. Spot-like enhancement, as well as sharply demarcated round shaped enhancement are characteristic for venous angiomas. Cavernous angiomas usually present as homogenous or inhomogenous round shaped enhanced areas. (Author)

  17. The function regulation of protein C system and novel high risk of venous thrombosis

    International Nuclear Information System (INIS)

    Jin Jian; Tao Yonghui; Zhang Lianfen; Zhang Rongjun; Zhang Manda; Wang Bocheng; He Yang; Bai Xia; Ruan Changgeng

    1999-12-01

    The procedures for isolation and purification of PC, PS, PCI and antithrombin III(ATIII) from human plasma and TM from human urine were developed. Five RIAs were also developed, on the equilibrium method, by raising the antisera in rabbits. 125 I-PC, 125 I-PS and 125 I-ATIII were prepared using the chloramine-T method, 125 I-PCI by Iodogen method and 125 I-TM by Bolton-Hunter method. All of their sensitivities were below 10 μg/L, and the ranges of recovery rates were 94.30% to 105.22%. The cross reactivities of these methods with factor II and thrombin (Th) were negligible. The functional regulation of protein C system with flow cytometry and the five RIAs was investigated. On the basis of the five RIAs. The technique of APC-APTT was developed, which is a simple and reliable method to detect APC-resistance. A PCR was also developed for identification and verification of G1691A transition or point mutation of factor V on homozygotes and heterozygotes. Even though the diagnostic level of APC-APTT were the same as. It is observed that factor V G1691A mutation incidence on Chinese is much lower than on North European. There may be other factors about APC-resistance, such as factor VIII mutation or factor V mutation but not on G1691 A in Chinese

  18. A Novel Stretch Sensor to Measure Venous Hemodynamics

    Directory of Open Access Journals (Sweden)

    Syrpailyne Wankhar

    2018-07-01

    Full Text Available Chronic venous insufficiency is a debilitating condition causing varicose veins and venous ulcers. The pathophysiology includes reflux and venous obstruction. The diagnosis is often made by clinical examination and confirmed by Venous Doppler studies. Plethysmography helps to quantitatively examine the reflux and diagnose the burden of deep venous pathology to better understand venous hemodynamics, which is not elicited by venous duplex examination alone. However, most of these tests are qualitative, expensive, and not easily available. In this paper, we demonstrate the potential use of a novel stretch sensor in the assessment of venous hemodynamics during different maneuvers by measuring the change in calf circumference. We designed the stretch sensor by using semiconductor strain gauges pasted onto a small metal bar to form a load cell. The elastic and Velcro material attached to the load cell form a belt. It converts the change in limb circumference to a proportional tension (force of distension when placed around the calf muscle. We recorded the change in limb circumference from arrays of stretch sensors by using an in-house data acquisition system. We calculated the venous volume (VV, venous filling index (VFI, ejection fraction (EF and residual venous volume (RVV on two normal subjects and on two patients to assess venous hemodynamics. The values (VV > 60 ml, VFI 60%, RVV 2ml/s, EF 35% in patients were comparable to those reported in the literature.

  19. Does Disconformity in State Corporate Income Tax Systems Affect Compliance Cost Burdens?

    OpenAIRE

    Gupta, Sanjay; Mills, Lillian F.

    2003-01-01

    Prior multistate tax research on differences in state tax rules, while investigating the effects on revenue, investment, and tax burden, is silent regarding the effect on compliance costs. We investigate factors that explain state income tax compliance costs for large firms. We find that state compliance costs increase in the number of filing states and entities (or in the number of state tax returns), firm size, and variables proxying for state tax complexity. Our evidence that multistate di...

  20. History of venous leg ulcers.

    Science.gov (United States)

    Gianfaldoni, S; Wollina, U; Lotti, J; Gianfaldoni, R; Lotti, T; Fioranelli, M; Roccia, M G

    To retrieve the history of venous ulcers and of skin lesions in general, we must go back to the appearance of human beings on earth. It is interesting to note that cutaneous injuries evolved parallel to human society. An essential first step in the pathogenesis of ulcers was represented by the transition of the quadruped man to Homo Erectus. This condition was characterized by a greater gravitational pressure on the lower limbs, with consequences on the peripheral venous system. Furthermore, human evolution was characterized by an increased risk of traumatic injuries, secondary to his natural need to create fire and hunt (e.g. stones, iron, fire, animal fighting). Humans then began to fight one another until they came to real wars, with increased frequency of wounds and infectious complications. The situation degraded with the introduction of horse riding, introduced by the Scites, who first tamed animals in the 7th century BC. This condition exhibited iliac veins at compression phenomena, favouring the venous stasis. With time, man continued to evolve until the modern age, which is characterized by increased risk factors for venous wounds such as poor physical activity and dietary errors (1, 2).

  1. Venous thromboembolism in women

    DEFF Research Database (Denmark)

    Group, ESHRE Capri Workshop; Skouby, Sven Olaf

    2013-01-01

    BACKGROUND Venous thromboembolism (VTE) is a specific reproductive health risk for women. METHODS Searches were performed in Medline and other databases. The selection criteria were high-quality studies and studies relevant to clinical reproductive medicine. Summaries were presented and discussed...... is associated with an inherited thrombophilia in men and women. Changes in the coagulation system and in the risk of clinical VTE in women also occur during pregnancy, with the use of reproductive hormones and as a consequence of ovarian stimulation when hyperstimulation syndrome and conception occur together...... therapy (HRT) increases the VTE risk 2- to 4-fold. There is a synergistic effect between thrombophilia and the various reproductive risks. Prevention of VTE during pregnancy should be offered to women with specific risk factors. In women who are at high risk, CHC and HRT should be avoided. CONCLUSIONS...

  2. Implementation of environmental compliance for operating radioactive liquid waste systems at the Oak Ridge National Laboratory

    International Nuclear Information System (INIS)

    Hooyman, J.H.; Robinson, S.M.

    1992-01-01

    This paper addresses methods being implemented at the Oak Ridge National Laboratory (ORNL) to continue operating while achieving compliance with new standards for liquid low level waste (LLLW) underground storage tank systems. The Superfund Amendment and Reauthorization Act (SARA) of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) required that the Department of Energy (DOE) execute a Federal Facility Agreement (FFA) with the Environmental Protection Agency (EPA) within 6 months of listing of the ORNL on the National Priorities List. An FFA for ORNL became effective January 1, 1992 among the EPA, DOE, and the Tennessee Department of Environment and Conservation (TDEC). The agreement ensures that environmental impacts resulting from operations at the Oak Ridge Reservation are investigated and remediated to protect the public health, welfare, and environment

  3. Altered Venous Function during Long-Duration Spaceflights

    Directory of Open Access Journals (Sweden)

    Jacques-Olivier Fortrat

    2017-09-01

    Full Text Available Aims: Venous adaptation to microgravity, associated with cardiovascular deconditioning, may contribute to orthostatic intolerance following spaceflight. The aim of this study was to analyze the main parameters of venous hemodynamics with long-duration spaceflight.Methods: Venous plethysmography was performed on 24 cosmonauts before, during, and after spaceflights aboard the International Space Station. Venous plethysmography assessed venous filling and emptying functions as well as microvascular filtration, in response to different levels of venous occlusion pressure. Calf volume was assessed using calf circumference measurements.Results: Calf volume decreased during spaceflight from 2.3 ± 0.3 to 1.7 ± 0.2 L (p < 0.001, and recovered after it (2.3 ± 0.3 L. Venous compliance, determined as the relationship between occlusion pressure and the change in venous volume, increased during spaceflight from 0.090 ± 0.005 to 0.120 ± 0.007 (p < 0.01 and recovered 8 days after landing (0.071 ± 0.005, arbitrary units. The index of venous emptying rate decreased during spaceflight from −0.004 ± 0.022 to −0.212 ± 0.033 (p < 0.001, arbitrary units. The index of vascular microfiltration increased during spaceflight from 6.1 ± 1.8 to 10.6 ± 7.9 (p < 0.05, arbitrary units.Conclusion: This study demonstrated that overall venous function is changed during spaceflight. In future, venous function should be considered when developing countermeasures to prevent cardiovascular deconditioning and orthostatic intolerance with long-duration spaceflight.

  4. Analysis of the Kinematics and Compliance of a Passive Suspension System using Adams Car

    Directory of Open Access Journals (Sweden)

    N. Ikhsan

    2015-06-01

    Full Text Available The experimental approach is usually used as the way to develop or modify a suspension system to obtain maximum ride comfort and handling characteristics. This approach is a time-consuming process, costly, and may not guarantee the optimum solution. Thus, to avoid this, a virtual vehicle suspension system is necessary. In this paper, a half-car body of an actual suspension system based on the PROTON WRM 44 P0-34 was modeled and simulated. In total, 10 components comprised each front McPherson strut and rear multilink suspension consisting of different joint types and a number of degrees of freedom. The model was developed by defining the location of the hard point or coordinate before specifying the component characteristics and joint type. The completed suspension model was simulated using the vertical parallel and vertical oppose movement test, the same tests conducted with the actual experimental parameter setup. The kinematics and compliance (K&C of the simulation is compared with the experimental data to verify the suspension model. The outcome from the simulation showed a verified virtual suspension system model with a very minimum percentage of error and different characteristics of the static performance of the suspension system when subjected to the test as explained further in the paper.

  5. Implementation of environmental compliance for operating radioactive liquid waste systems at the Oak Ridge National Laboratory

    International Nuclear Information System (INIS)

    Hooyman, J.H.

    1993-01-01

    This paper addresses methods being implemented at the Oak Ridge National Laboratory (ORNL) to continue operating while achieving compliance with new standards for liquid low level waste (LLLW) underground storage tank systems. The Superfund Amendment and Reauthorization Act (SARA) of the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) required that the Department of Energy (DOE) execute a Federal Facility Agreement (FFA) with the Environmental Protection Agency (EPA) within 6 months of listing of the ORNL on the National Priorities List. An FFA for ORNL became effective January 1, 1992 among the EPA, DOE, and the Tennessee Department of Environment and Conservation (TDEC). The objective of the FFA as it relates to these tank systems is to ensure that structural integrity, containment, leak detection capability, and LLLW source control are maintained until final remedial action. The FFA requires that leaking LLLW tank systems be immediately removed from service, and that active tank systems be doubly contained, cathodically protected, and have leak detection capability. LLLW tank systems that do not meet requirements are to be either upgraded or replaced, but can remain in service if they do not leak in the interim

  6. Counteracting negative venous line pressures to avoid arterial air bubbles: an experimental study comparing two different types of miniaturized extracorporeal perfusion systems.

    Science.gov (United States)

    Aboud, Anas; Mederos-Dahms, Hendrikje; Liebing, Kai; Zittermann, Armin; Schubert, Harald; Murray, Edward; Renner, Andre; Gummert, Jan; Börgermann, Jochen

    2015-05-29

    Because of its low rate of clinical complications, miniaturized extracorporeal perfusion systems (MEPS) are frequently used in heart centers worldwide. However, many recent studies refer to the higher probability of gaseous microemboli formation by MEPS, caused by subzero pressure values. This is the main reason why various de-airing devices were developed for today's perfusion systems. In the present study, we investigated the potential benefits of a simple one-way-valve connected to a volume replacement reservoir (OVR) for volume and pressure compensation. In an experimental study on 26 pigs, we compared MEPS (n = 13) with MEPS plus OVR (n = 13). Except OVR, perfusion equipment was identical in both groups. Primary endpoints were pressure values in the venous line and the right atrium as well as the number and volume of air bubbles. Secondary endpoints were biochemical parameters of systemic inflammatory response, ischemia, hemodilution and hemolysis. One animal was lost in the MEPS + OVR group. In the MEPS + OVR group no pressure values below -150 mmHg in the venous line and no values under -100 mmHg in right atrium were noticed. On the contrary, nearly 20% of venous pressure values in the MEPS group were below -150 and approximately 10% of right atrial pressure values were below -100 mmHg. Compared with the MEPS group, the bubble counter device showed lower numbers of arterial air bubbles in the MEPS + OVR group (mean ± SD: 13444 ± 5709 vs. 1 ± 2, respectively; p pressures and to reduce the number and volume of arterial air bubbles. This approach may lead to a lower rate of neurological complications.

  7. Normal venous anatomy and physiology of the lower extremity.

    Science.gov (United States)

    Notowitz, L B

    1993-06-01

    Venous disease of the lower extremities is common but is often misunderstood. It seems that the focus is on the exciting world of arterial anatomy and pathology, while the topic of venous anatomy and pathology comes in second place. However, venous diseases such as chronic venous insufficiency, leg ulcers, and varicose veins affect much of the population and may lead to disability and death. Nurses are often required to answer complex questions from the patients and his or her family about the patient's disease. Patients depend on nurses to provide accurate information in terms they can understand. Therefore it is important to have an understanding of the normal venous system of the legs before one can understand the complexities of venous diseases and treatments. This presents an overview of normal venous anatomy and physiology.

  8. Compliance monitoring system using screen printing technology based on conductive ink.

    Science.gov (United States)

    Hoshi, Kenji; Kawakami, Junko; Aoki, Sorama; Hamada, Kouji; Sato, Kenichi

    2012-01-01

    We developed a compliance monitoring system that electrically detects which drug among the multiple prescribed drugs a patient has taken and the date of drug-taking by a patient to prevent the patient from missing doses and taking drugs incorrectly at home. A conductive pattern is screen printed using conductive ink (silver paste) on the surface of a calendar-type pill organizer containing medications for as long as 1 week (4 times per day × 7 days, 28 doses) to create a sensor for detecting the opening of a pill organizer. Whenever the patient opens the pill organizer and removes a dose of the drug (pill), information about which of the 28 locations is opened and the date of opening are recorded in nonvolatile memory. This system is applicable to patients who take multiple drugs, for whom recording of drug-taking behavior is reportedly difficult. Specific benefits are that the user needs no additional manipulation to use the system: the user can take the drug from the pill organizer according to usual procedures.

  9. Adoption of Farm Management Systems for Cross Compliance - An empirical case in Germany.

    Science.gov (United States)

    Knuth, Ulrike; Amjath-Babu, T S; Knierim, Andrea

    2018-08-15

    In Germany, Farm Management Systems (FMS) have been introduced as a support to farmers' compliance with environmental and other regulations, aiming at the increase of farm level performance and sustainable farming practices. Different kinds of FMS were developed and promulgated with various approaches, determined by each federal state's agricultural advisory system. Knowledge on the FMS' uptake and effectiveness has been lacking so far. The overall aim of this paper is to provide an analysis of the implementation process and selected outcomes of the policy-driven instrumental innovation of FMS. In particular, the objectives are i) to reveal how and with what success the introduction of FMS has been realised in Germany and ii) to analyse and discuss the FMS' adoption in the federal state of Brandenburg. For the first part of the study, we elaborate a situational analysis of the policy implementation through a desk study and expert interviews. In the second part, selected results from a farmers' survey in Brandenburg are presented and a switching regression model is developed to assess the factors responsible for the uptake of FMS and to understand the role of FMS in improving the confidence in complying with Cross Compliance regulations. We found a high degree of diversity among FMS developed in the different federal states. FMS adoption rates varied, but were generally low. Institutional environment seems to have a significant influence as the same FMS had very different adoption rates among federal states. For Brandenburg, our findings show that farmers' confidence to face CC check was increased by the adoption of FMS. However, counterfactual scenario analysis proved that especially farmers who did not adopt FMS would have benefitted most if they had adopted the tool. Our study shows that there is a need for systems supporting farmers in dealing with bureaucratic requirements. Future FMS should be easy to understand, adaptable to individual farmers' needs and be

  10. Peripherally Placed Totally Implantable Venous-access Port Systems of the Forearm: Clinical Experience in 763 Consecutive Patients

    International Nuclear Information System (INIS)

    Goltz, Jan P.; Scholl, Anne; Ritter, Christian O.; Wittenberg, Guenther; Hahn, Dietbert; Kickuth, Ralph

    2010-01-01

    The aim of this study is to evaluate the effectiveness and safety of percutaneously placed totally implantable venous-access ports (TIVAPs) of the forearm. Between January 2006 and October 2008, peripheral TIVAPs were implanted in 763 consecutive patients by ultrasound and fluoroscopic guidance. All catheters were implanted under local anesthesia and were tunneled subcutaneously. Indication, technical success, and complications were retrospectively analyzed according to Society of Interventional Radiology (SIR) criteria. Presence of antibiotic prophylaxis, periprocedurally administered drugs (e.g., sedation), and laboratory results at the time of implantation were analyzed. Maintenance during the service interval was evaluated. In total, 327,499 catheter-days were analyzed. Technical success rate was 99.3%. Reasons for initial failure of implantation were either unexpected thrombosis of the subclavian vein, expanding tumor mass of the mediastinum, or failure of peripheral venous access due to fragile vessels. Mean follow-up was 430 days. There were 115 complications observed (15.1%, 0.03 per 100 catheter-days), of which 33 (4.3%) were classified as early (within 30 days from implantation) and 82 (10.7%) as late. Catheter-related venous thrombosis was found in 65 (8.5%) of 763 (0.02 per 100 catheter-days) TIVAPs. Infections were observed in 41 (5.4%) of 763 (0.01 per 100 catheter-days) devices. Other complications observed included dislocation of the catheter tip (0.8%), occlusion (0.1%), or rupture (0.1%) of the port catheter. Dislocated catheters were corrected during a second interventional procedure. In conclusion, implantation of percutaneously placed peripheral TIVAPs shows a high technical success rate and low risk of early complications when ultrasound and fluoroscopic guidance are used. Late complications are observed three times as often as early complications.

  11. EPA Enforcement and Compliance History Online: Legacy System Clean Air Act Data Set (ZIP)

    Data.gov (United States)

    U.S. Environmental Protection Agency — The Enforcement and Compliance History Online (ECHO) data sets have been compiled for access to larger sets of national data to ensure that ECHO meets your data...

  12. UAS Integration Into the NAS: An Examination of Baseline Compliance in the Current Airspace System

    Science.gov (United States)

    Fern, Lisa; Kenny, Caitlin A.; Shively, Robert J.; Johnson, Walter

    2012-01-01

    As a result of the FAA Modernization and Reform Act of 2012, Unmanned Aerial Systems (UAS) are expected to be integrated into the National Airspace System (NAS) by 2015. Several human factors challenges need to be addressed before UAS can safely and routinely fly in the NAS with manned aircraft. Perhaps the most significant challenge is for the UAS to be non-disruptive to the air traffic management system. Another human factors challenge is how to provide UAS pilots with intuitive traffic information in order to support situation awareness (SA) of their airspace environment as well as a see-and-avoid capability comparable to manned aircraft so that a UAS pilot could safely maneuver the aircraft to maintain separation and collision avoidance if necessary. A simulation experiment was conducted to examine baseline compliance of UAS operations in the current airspace system. Researchers also examined the effects of introducing a Cockpit Situation Display (CSD) into a UAS Ground Control Station (GCS) on UAS pilot performance, workload and situation awareness while flying in a positively controlled sector. Pilots were tasked with conducting a highway patrol police mission with a Medium Altitude Long Endurance (MALE) UAS in L.A. Center airspace with two mission objectives: 1) to reroute the UAS when issued new instructions from their commander, and 2) to communicate with Air Traffic Control (ATC) to negotiate flight plan changes and respond to vectoring and altitude change instructions. Objective aircraft separation data, workload ratings, SA data, and subjective ratings regarding UAS operations in the NAS were collected. Results indicate that UAS pilots were able to comply appropriately with ATC instructions. In addition, the introduction of the CSD improved pilot SA and reduced workload associated with UAS and ATC interactions.

  13. Bilateral anomalous drainage of the posterior divisions of renal veins into the azygos venous system in a 20-year-old woman: a case report.

    Science.gov (United States)

    Pallangyo, Pedro; Lyimo, Frederick; Nicholaus, Paulina; Masatu, Stephano; Janabi, Mohamed

    2016-12-03

    Renal vein anomalies are relatively infrequent and generally asymptomatic. Preoperative knowledge of such variants is, however, of paramount importance in several angiographic and surgical procedures including renal venography, renal vein sampling, spermatic embolization, and renal transplantation. Inadequate knowledge and failure to recognize such anatomic variations may lead to several operative hazards including hemorrhage, nephrectomy, and even death. We report a case of bilateral anomalous drainage of the posterior divisions of renal veins into the azygos venous system in a 20-year-old woman of African descent from Tanzania who presented to us with a 12-year history of recurrent anemia. She had anemia, a positive sickling test, and hemoglobin electrophoresis revealed a sickle cell trait (AS). She underwent computed tomography angiography of her chest and abdomen to rule out the presence of arteriovenous malformations. Aortography findings were normal but venography results revealed features of tortuously dilated azygos and hemiazygos veins each receiving blood from its respective posterior division of renal vein. Although venous anomalies are relatively infrequent and generally lack a clinical significance, a thorough understanding of embryologic development and its associated errors is of immense importance in equipping angiographers and surgeons to select appropriate interventional/operative techniques, anticipate risks, and prevent intervention-related complications.

  14. Assessment of portal venous system patency in the liver transplant candidate: A prospective study comparing ultrasound, microbubble-enhanced colour Doppler ultrasound, with arteriography and surgery

    International Nuclear Information System (INIS)

    Marshall, M.M.; Beese, R.C.; Muiesan, P.; Sarma, D.I.; O'Grady, J.; Sidhu, P.S.

    2002-01-01

    AIM: To determine the role of microbubble-enhanced colour Doppler ultrasound (CDUS) in assessing portal venous patency prior to liver transplantation. MATERIALS AND METHODS: Over a 2-year period, all patients with chronic liver disease undergoing routine pre-transplant CDUS examination in whom the portal venous system was inadequately demonstrated were recruited to the study. CDUS was performed in 368 patients and 33 patients (9%) were recruited. A repeat CDUS examination following an intravenous bolus injection of the microbubble contrast agent Levovist[reg] (Schering Healthcare AG, Berlin, Germany) was performed. Diagnostic confidence was recorded on a free linear analogue scale for both examinations. Findings were compared with indirect portography and surgery. RESULTS: Of the 33 patients with sub-optimal baseline examinations, improvement in portal vein visualization was achieved in 31 patients (94%). Median diagnostic confidence increased from 50% (interquartile range 30-60) to 90% (interquartile range 75-98) (P < 0.001) following administration of Levovist[reg]. Overall accuracy of portal vein assessment using microbubble-enhanced CDUS in 15 patients in whom a definitive diagnosis was made within 2 months was 87%. CONCLUSION: Microbubble-enhanced CDUS is a simple, inexpensive adjunct to standard pre liver transplant screening of the portal vein. It is particularly helpful in patients with end-stage cirrhosis who are at high risk of portal vein thrombosis and in whom the conventional examination is sub-optimal.Marshall, M.M. et al. (2002)

  15. An unusual cause of hydrocephalus: aqueductal developmental venous anomaly

    Energy Technology Data Exchange (ETDEWEB)

    Yagmurlu, Banu; Fitoz, Suat; Atasoy, Cetin; Erden, ilhan [Ankara University School of Medicine, Department of Radiology, Ankara (Turkey); Deda, Gulhis; Unal, Ozlem [Ankara University School of Medicine, Division of Pediatric Neurology, Ankara (Turkey)

    2005-06-01

    Vascular malformations are infrequent causes of aqueductal stenoses, developmental venous anomaly (DVA) being the rarest among them. DVAs, also known as venous angiomas, are congenital in origin and characterized by dilatation of vessels in the superficial and deep venous system. Although they are usually clinically silent, they can be complicated by hemorrhage, seizures and neurologic deficits. Herein, we report MR imaging findings of a 7-year-old girl whose hydrocephalus was due to an abnormal vein coursing through the aqueduct. (orig.)

  16. A newborn liver mass that never existed: a somber reminder of embryonic ties between umbilical vein and portal venous system

    Directory of Open Access Journals (Sweden)

    Haafiz A

    2011-12-01

    Full Text Available Allah Haafiz1, Jonathan L Williams2, Joel M Andres1, Don A Novak11Pediatric Gastroenterology, Hepatology; 2Department of Pediatric Radiology, University of Florida College of Medicine, Gainesville, FL, USAAbstract: A 6-day-old, known to have transposition of the great vessels, received care in the neonatal intensive care unit at a tertiary care center. A computed tomography scan was performed for abdominal distention and upper gastrointestinal bleeding, which revealed a “mass lesion” in the left liver lobe. Analysis of antecedent events and the clinical and laboratory course uncovered an iatrogenic etiology and pathogenesis of the lesion. As the nature of the lesion was clarified, no specific therapy was required. This case is presented to show a serious yet preventable complication of a commonly performed procedure.Keywords: portal vein thrombosis, liver mass, umbilical venous catheter

  17. REDUCING COSTS OF TAX COMPLIANCE AND INVESTMENTS IN PUBLIC SYSTEM OF DIGITAL BOOKKEEPING – SPED – IN BRAZIL

    Directory of Open Access Journals (Sweden)

    Edson Sampaio de Lima

    2016-04-01

    Full Text Available The Public System of Digital Bookkeeping – SPED was developed with the intention of further integration between the tax administrations themselves, then between them and the taxpayers, through the use of technology and, consequently, socioeconomic data standard, in a single environment, raising the tax collection efficiency and reducing the costs of administration and compliance. This article intends to contribute to the analysis of public investments directed to the establishment and maintenance of the project, effectively resulted in a reduction in the costs of tax compliance, temporary and permanent. Survey method was used as a non-random mechanism for data collection, with a developed questionnaire containing 22 questions based on the prediction model regulatory impact developed and applied by the Australian Taxation Office – ATO in your country, adapted to identify cost reduction compliance related to three specific organizational aspects: People, Technology and Procurement of Consulting Services. The questionnaire was emailed to 20 people with executive position or managers directly involved in the project in SPED size businesses and distinct segment. Responded to the survey 20 of the 20 companies. The data collected were analyzed through descriptive and exploratory, in the latter case using the cluster analysis. The survey approach has met both the qualitative and the quantitative research. The results indicate that the SPED caused an increase in compliance costs temporary and permanent, mainly due to the implementation strategy defined and applied solely by the public administration. The analysis also allowed evidence that even if public investments directed to the implementation and maintenance of SPED are not comparatively similar to private investments directed to the same end, it shows a tendency to shift costs of administration for compliance costs for taxpayers.

  18. Brain venous pathologies: MRI findings

    International Nuclear Information System (INIS)

    Salvatico, Rosana; Gonzalez, Alejandro; Yanez, Paulina; Romero, Carlos; Trejo, Mariano; Lambre, Hector

    2006-01-01

    Purpose: To describe MRI findings of the different brain venous pathologies. Material and Methods: Between January 2002 and March 2004, 18 patients were studied 10 males and 8 females between 6 and 63 years old; with different brain venous pathologies. In all cases brain MRI were performed including morphological sequences with and without gadolinium injection and angiographic venous sequences. Results: 10 venous occlusions were found, 6 venous angiomas, and 2 presented varices secondary to arteriovenous dural fistula. Conclusion: Brain venous pathologies can appear in many different clinical contexts, with different prognosis and treatment. In all the cases brain MRI was the best imaging study to disclose typical morphologic abnormalities. (author) [es

  19. REDUCING COSTS OF TAX COMPLIANCE AND INVESTMENTS IN PUBLIC SYSTEM OF DIGITAL BOOKKEEPING – SPED – IN BRAZIL

    OpenAIRE

    Edson Sampaio de Lima; Napoleão Verardi Galegale; Carlos Hideo Arima; Pedro Luiz Côrtes

    2016-01-01

    The Public System of Digital Bookkeeping – SPED was developed with the intention of further integration between the tax administrations themselves, then between them and the taxpayers, through the use of technology and, consequently, socioeconomic data standard, in a single environment, raising the tax collection efficiency and reducing the costs of administration and compliance. This article intends to contribute to the analysis of public investments directed to the establishment and mainten...

  20. Using automated environmental management information systems to enable compliance: Ten questions to answer before selecting a software system

    Energy Technology Data Exchange (ETDEWEB)

    Gilbert, J.B.

    1999-07-01

    As technology invades the arena of environmental information management, hundreds of software packages have become available in the marketplace. How does the already overwhelmed environmental manager or IT professional decide what's right for the organization? Is there a software package that meets the needs of the organization, and is there a successful way to implement the system? Does this require abandoning existing systems with which users are comfortable? Can the system really save time and/or money? This paper discusses three topics: What drives the need for a system; Ten questions to aid in selecting a system that is right for your organization; and enabling technology and software systems available today, and the future application of technology to environmental data management. Motivating factors for EMIS include regulatory, business and IT drivers. Because of the ever-increasing regulatory burden, the need to demonstrate compliance often is the strongest driver. But they cannot ignore business and IT drivers from the discussion, especially with issues such as Enterprise Resource Planning and The Year 2000 impacting many systems projects. Before selecting a system, the organization should address, at a minimum, the following ten issues: (1) Organization objectives; (2) Organization readiness; (3) High-level processes to be automated; (4) Integration and interfaces; (5) User community and needs; (6) Technical requirements; (7) Degree of customization; (8) Project timing; (9) Implementation resource needs; and (10) System justification. Today, there are hundreds of EH and S software packages available too help automate daily business processes. Only a few are multimedia packages, and all require significant implementation efforts. The EMIS market is still evolving, and software vendors continue to enhance product features and usability.

  1. Compliance status

    International Nuclear Information System (INIS)

    Black, D.G.

    1995-01-01

    This section of the 1994 Hanford Site Environmental Report summarizes the activities conducted to ensure that the Hanford Site is in compliance with federal environmental protection statutes and related Washington State and local environmental protection regulations and the status of Hanford's compliance with these requirements. Environmental permits required under the environmental protection regulations are discussed under the applicable statute

  2. Compliance status

    Energy Technology Data Exchange (ETDEWEB)

    Black, D.G.

    1995-06-01

    This section of the 1994 Hanford Site Environmental Report summarizes the activities conducted to ensure that the Hanford Site is in compliance with federal environmental protection statutes and related Washington State and local environmental protection regulations and the status of Hanford`s compliance with these requirements. Environmental permits required under the environmental protection regulations are discussed under the applicable statute.

  3. Performing compliance

    DEFF Research Database (Denmark)

    Wimmelmann, Camilla Lawaetz

    2017-01-01

    the local policy workers front-staged some practices in the implementation process and back-staged others. The local policy workers deliberately performed ‘guideline compliance’ by using information control and impression management techniques. The findings suggest that local guideline compliance should...... be regarded as a staged performance in which deliberate techniques are used to produce and manage certain impressions of compliance....

  4. Determination of respiratory system compliance during pressure support ventilation by small variations of pressure support.

    Science.gov (United States)

    Becher, Tobias; Schädler, Dirk; Rostalski, Philipp; Zick, Günther; Frerichs, Inéz; Weiler, Norbert

    2017-09-22

    In mechanically ventilated patients, measurement of respiratory system compliance (C rs ) is of high clinical interest. Spontaneous breathing activity during pressure support ventilation (PSV) can impede the correct assessment of C rs and also alter the true C rs by inducing lung recruitment. We describe a method for determination of C rs during PSV and assess its accuracy in a study on 20 mechanically ventilated patients. To assess C rs during pressure support ventilation (C rs,PSV ), we performed repeated changes in pressure support level by ± 2 cmH 2 O. C rs,PSV was calculated from the volume change induced by these changes in pressure support level, taking into account the inspiration time and the expiratory time constant. As reference methods, we used C rs , measured during volume controlled ventilation (C rs,VCV ). In a post-hoc analysis, we assessed C rs during the last 20% of the volume-controlled inflation (C rs,VCV20 ). Values were compared by linear regression and Bland-Altman methods comparison. Comparing C rs,PSV to the reference value C rs,VCV , we found a coefficient of determination (r 2 ) of 0.90, but a relatively high bias of - 7 ml/cm H 2 O (95% limits of agreement - 16.7 to + 2.7 ml/cmH 2 O). Comparison with C rs,VCV20 resulted in a negligible bias (- 1.3 ml/cmH 2 O, 95% limits of agreement - 13.9 to + 11.3) and r 2 of 0.81. We conclude that the novel method provides an estimate of end-inspiratory C rs during PSV. Despite its limited accuracy, it might be useful for non-invasive monitoring of C rs in patients undergoing pressure support ventilation.

  5. Beyond compliance using environmental, health and safety management information systems (EMISs) to provide quantified competitive advantages

    Energy Technology Data Exchange (ETDEWEB)

    Schroeder, J.V.; Mayer, G.

    1999-07-01

    In the last 20 years, federal, state and local regulations have provided regulatory incentives for industry to better manage environmental, health and safety (EHS) practices. In order for voluntary EHS management practices to move beyond compliance and continue improving, specific, quantifiable benefits must result. That is, companies must achieve some competitive advantage from implementing EHS improvements that are considered voluntary. Recently, many private companies and public agencies have been giving significant consideration toward the implementation of an EHS management information system (EMIS). Currently considered voluntary, the automation of EHS data collection, storage, retrieval and reporting is subject to the same benefit expectations that other EHS improvements are subject to. The benefits resulting from an EMIS typically result from a reduction in either direct or indirect costs. Direct costs, consisting primarily of labor hours, permit fees, disposal costs, etc., are definable and easily to quantify. Indirect costs, which are comprised of reduced risks and liabilities, are less easily quantifiable. In fact, many have abandoned hope of ever quantifying expected benefits from indirect costs, and simply lump all indirect benefits into a qualitative, catch-all category called intangible benefits. However, by statistically analyzing individual risk events over an expected project life, anticipated benefits can be objectively and accurately quantified. Through the use of a case study, this paper will describe the process of quantifying direct and indirect benefits resulting from the implementation of an EMIS. The paper will describe the application of a statistical model to estimate indirect benefits and will demonstrate how the results of the benefit quantification can be used to make sound, business based decisions based on a required rate of return/return on investment.

  6. Lung volume recruitment acutely increases respiratory system compliance in individuals with severe respiratory muscle weakness

    Directory of Open Access Journals (Sweden)

    Yannick Molgat-Seon

    2017-03-01

    Full Text Available The aim of the present study was to determine whether lung volume recruitment (LVR acutely increases respiratory system compliance (Crs in individuals with severe respiratory muscle weakness (RMW. Individuals with RMW resulting from neuromuscular disease or quadriplegia (n=12 and healthy controls (n=12 underwent pulmonary function testing and the measurement of Crs at baseline, immediately after, 1 h after and 2 h after a single standardised session of LVR. The LVR session involved 10 consecutive supramaximal lung inflations with a manual resuscitation bag to the highest tolerable mouth pressure or a maximum of 50 cmH2O. Each LVR inflation was followed by brief breath-hold and a maximal expiration to residual volume. At baseline, individuals with RMW had lower Crs than controls (37±5 cmH2O versus 109±10 mL·cmH2O−1, p0.05. LVR had no significant effect on measures of pulmonary function at any time point in either group (all p>0.05. During inflations, mean arterial pressure decreased significantly relative to baseline by 10.4±2.8 mmHg and 17.3±3.0 mmHg in individuals with RMW and controls, respectively (both p<0.05. LVR acutely increases Crs in individuals with RMW. However, the high airway pressures during inflations cause reductions in mean arterial pressure that should be considered when applying this technique.

  7. Cerebral venous thrombosis

    International Nuclear Information System (INIS)

    Soralova, T.; Sevcikova, H.; Petersky, D.

    2014-01-01

    We decided to process this theme due to its nonspecific clinical features as they often cause diagnostic problems not only to clinicians but also to diagnostic. It is important to think of this disease mainly in young women who administer hormonal contraception. Imaging methods play the crucial role in diagnostic of cerebral venous sinus thrombosis. The gold standard is a native CT of brain which shows the venous sinus thrombosis as a hyperdense lesion in the locus of the sinus (dense triangle sign), CT venography shows the sinus thrombosis as a defect in a contrast filling of the venous sinus (empty delta sign). Other investigative methods are magnetic resonance imaging or MRA. In short we also mention quite a rare but more serious thrombosis of profound cerebral veins v. cerebri magna-Galeni, vv. cerebri internae). The importance of early diagnostic and non specificity of symptoms is presented in 3 clinical cases that are the part of this work. (author)

  8. Early aggressive intra-venous pulse cyclophosphamide therapy for interstitial lung disease in a patient with systemic sclerosis. A case report.

    LENUS (Irish Health Repository)

    Peshin, R

    2009-06-01

    Interstitial lung disease is an important cause of mortality and morbidity in patients with systemic sclerosis (SSc). There are currently no recommended guidelines for management of these patients. This is probably due to the rarity of this condition, as well as clinical trials with only a small number of cases. There are published case report and case series along with the two main trials, viz. Scleroderma Lung Study and the Fibrosing Alveolitis Study, but again, there is no consensus on treatment protocols. In this report, we present a case of aggressive interstitial lung disease in a patient with SSc, which improved dramatically on treatment with intra-venous cyclophosphamide and high dose prednisolone therapy.

  9. Direct venous thrombolysis and venous angioplasty in the upper extremity

    International Nuclear Information System (INIS)

    Hollmann, J.P.; Guenther, R.W.

    1987-01-01

    Venous thromboses of stenoses in the upper extremity are often the result of a compression syndrome of the shoulder girdle, the Paget-von Schroetter syndrome, vascular surgery, space-occupying lesions in the mediastinum or the result of catheterisation. Direct venous thrombolysis and venous angioplasty were performed successfully in six patients. (orig.) [de

  10. Emergency lighting system for compliance with the IS-30 and further than the foundations of design events

    International Nuclear Information System (INIS)

    Tejeda Sanchez, C.

    2014-01-01

    Autonomy and vulnerability to fire requirements of the emergency lighting systems, established in CSN instruction IS-30, and in commitments to deal with the consequences of events more beyond the bases of design, the design of a new lighting system required of emergency in the Almaraz Nuclear power plant. The design process consists of three phases: study of needs, definition of detailed design and requirements. During these phases is defined distribution and models luminaire lighting studies and specifications. Through the adaptation of the system to the needs of each area of the plant is It achieves compliance with the objectives defined by the CSN. (Author)

  11. Chronic venous disease.

    Science.gov (United States)

    Wolinsky, Claire D; Waldorf, Heidi

    2009-11-01

    Identifying characteristic cutaneous findings is important in determining the appropriate management of certain venous diseases. The health care provider should be familiar with the classic description of patterns and distributions of skin manifestations, such as varicose veins, stasis dermatitis, palpable cord, petechiae, and telangiectasias. In addition to the gross appearance of the skin, a skin biopsy may help elucidate a diagnosis. General treatment and prevention of the underlying venous pathology is essential. Furthermore, specific management of skin findings should include therapy to ameliorate progression of disease and symptomatology when warranted.

  12. Central Venous Access

    International Nuclear Information System (INIS)

    Ganeshan, Arul; Warakaulle, Dinuke R.; Uberoi, Raman

    2007-01-01

    Central venous access plays an important role in the management of an ever-increasing population of patients ranging from those that are critically ill to patients with difficult clinical access. Interventional radiologists are key in delivering this service and should be familiar with the wide range of techniques and catheters now available to them. A comprehensive description of these catheters with regard to indications, technical aspects of catheterization, success rates, and associated early and late complications, as well as a review of various published guidelines on central venous catheter insertion are given in this article

  13. Theory of Compliance: Indicator Checklist Statistical Model and Instrument Based Program Monitoring Information System.

    Science.gov (United States)

    Fiene, Richard J.; Woods, Lawrence

    Two unanswered questions about child care are: (1) Does compliance with state child care regulations have a positive impact on children? and (2) Have predictors of program quality been identified? This paper explores a research study and related model that have had some success in answering these questions. Section I, a general introduction,…

  14. Compliance Determination for Inactivation Requirements of the National Primary Drinking Water Regulations when a Public Water Systems Uses Dichlor and Trichlor for Primary Disinfection

    Science.gov (United States)

    This memorandum has been developed to assist SDWA primacy agencies (EPA Regions, states and territories) when considering inactivation/disinfection compliance requirements for those water systems that choose to use Dichlor or Trichlor.

  15. Venous ulcers -- self-care

    Science.gov (United States)

    ... surgery to improve blood flow through your veins. Prevention If you are at risk for venous ulcers, take the steps listed above under Wound Care. ... weight if you are overweight. Manage your blood pressure and cholesterol levels. ... Venous leg ulcers - self-care; Venous insufficiency ulcers - self-care; Stasis ...

  16. Cerebral venous angioma

    International Nuclear Information System (INIS)

    Inagawa, Tetsuji; Taguchi, Haruyoshi; Kamiya, Kazuko; Yano, Takashi; Nakajima, Reiko

    1984-01-01

    This report presents a 27-year-old male patient who was diagnosed as having cerebral venous angioma in the postero-temporal area by CT scan and cerebral angiography. The patient improved by removing angioma with electrocoagulation of medullary veins. (Namekawa, K.)

  17. Mechanical thrombectomy: an alternative for treating cerebral venous sinus thrombosis.

    Science.gov (United States)

    Izura Gómez, Marta; Misis Del Campo, Maite; Puyalto de Pablo, Paloma; Castaño Duque, Carlos

    2018-01-01

    We report the use of mechanical venous thrombectomy in 2 cases of cerebral venous sinus thrombosis in which the usual first-choice treatment with systemic anticoagulants was contraindicated. Our aim is to present this treatment as an alternative to consider when anticoagulants therapy is too risky or is contraindicated in critically ill patients.

  18. Assistance protocol for venous ulcers patients: validation of contents

    Directory of Open Access Journals (Sweden)

    Daniele Vieira Dantas

    2013-07-01

    Full Text Available Venous ulcers require complex treatment and are responsible for significant morbidity and mortality rates. This study aims at identifying aspects validated by the jury for the preparation of an assistance protocol for venous ulcer sufferers. It is a descriptive and quantitative research, with 39 professionals (30 nurses, 7 doctors and two physiotherapists, held at the Onofre Lopes University Hospital, between April and July/2010. Data collection began through a questionnaire checklist. Analysis was performed through Statistical Package for Social Science 15.0, assessing compliance with guidelines. Results were the compositional aspects of the protocol: assessment of patient and lesion history/documentation, wound care/perilesional skin, dressing suggestion, use of antibiotics and pain treatment, surgical treatment/medication, improving venous return and relapse prevention, patient referral, professional training and referral/counter-referral. It was concluded that to compose the protocol, aspects related to diagnosis, treatment and injury prevention must be considered.

  19. 340 Facility compliance assessment

    International Nuclear Information System (INIS)

    English, S.L.

    1993-10-01

    This study provides an environmental compliance evaluation of the RLWS and the RPS systems of the 340 Facility. The emphasis of the evaluation centers on compliance with WAC requirements for hazardous and mixed waste facilities, federal regulations, and Westinghouse Hanford Company (WHC) requirements pertinent to the operation of the 340 Facility. The 340 Facility is not covered under either an interim status Part A permit or a RCRA Part B permit. The detailed discussion of compliance deficiencies are summarized in Section 2.0. This includes items of significance that require action to ensure facility compliance with WAC, federal regulations, and WHC requirements. Outstanding issues exist for radioactive airborne effluent sampling and monitoring, radioactive liquid effluent sampling and monitoring, non-radioactive liquid effluent sampling and monitoring, less than 90 day waste storage tanks, and requirements for a permitted facility

  20. Introduction of an electronic monitoring system for monitoring compliance with Moments 1 and 4 of the WHO "My 5 Moments for Hand Hygiene" methodology

    Directory of Open Access Journals (Sweden)

    Chan Jasper FW

    2011-05-01

    Full Text Available Abstract Background MedSense is an electronic hand hygiene compliance monitoring system that provides Infection Control Practitioners with continuous access to hand hygiene compliance information by monitoring Moments 1 and 4 of the WHO "My 5 Moments for Hand Hygiene" guidelines. Unlike previous electronic monitoring systems, MedSense operates in open cubicles with multiple beds and does not disrupt existing workflows. Methods This study was conducted in a 6-bed neurosurgical intensive care unit with technical development and evaluation phases. Healthcare workers (HCWs wore an electronic device in the style of an identity badge to detect hand hygiene opportunities and compliance. We compared the compliance determined by the system and an infection control nurse. At the same time, the system assessed compliance by time of day, day of week, work shift, professional category of HCWs, and individual subject, while the workload of HCWs was monitored by measuring the amount of time they spent in patient zones. Results During the three-month evaluation phase, the system identified 13,694 hand hygiene opportunities from 17 nurses, 3 physiotherapists, and 1 healthcare assistant, resulting in an overall compliance of 35.1% for the unit. The per-indication compliance for Moment 1, 4, and simultaneous 1 and 4 were 21.3% (95%CI: 19.0, 23.6, 39.6% (95%CI: 37.3, 41.9, and 49.2% (95%CI: 46.6, 51.8, respectively, and were all statistically significantly different (p Conclusion MedSense provides an unobtrusive and objective measurement of hand hygiene compliance. The information is important for staff training by the infection control team and allocation of manpower by hospital administration.

  1. Introduction of an electronic monitoring system for monitoring compliance with Moments 1 and 4 of the WHO "My 5 Moments for Hand Hygiene" methodology.

    Science.gov (United States)

    Cheng, Vincent C C; Tai, Josepha W M; Ho, Sara K Y; Chan, Jasper F W; Hung, Kwan Ngai; Ho, Pak Leung; Yuen, Kwok Yung

    2011-05-26

    MedSense is an electronic hand hygiene compliance monitoring system that provides Infection Control Practitioners with continuous access to hand hygiene compliance information by monitoring Moments 1 and 4 of the WHO "My 5 Moments for Hand Hygiene" guidelines. Unlike previous electronic monitoring systems, MedSense operates in open cubicles with multiple beds and does not disrupt existing workflows. This study was conducted in a 6-bed neurosurgical intensive care unit with technical development and evaluation phases. Healthcare workers (HCWs) wore an electronic device in the style of an identity badge to detect hand hygiene opportunities and compliance. We compared the compliance determined by the system and an infection control nurse. At the same time, the system assessed compliance by time of day, day of week, work shift, professional category of HCWs, and individual subject, while the workload of HCWs was monitored by measuring the amount of time they spent in patient zones. During the three-month evaluation phase, the system identified 13,694 hand hygiene opportunities from 17 nurses, 3 physiotherapists, and 1 healthcare assistant, resulting in an overall compliance of 35.1% for the unit. The per-indication compliance for Moment 1, 4, and simultaneous 1 and 4 were 21.3% (95%CI: 19.0, 23.6), 39.6% (95%CI: 37.3, 41.9), and 49.2% (95%CI: 46.6, 51.8), respectively, and were all statistically significantly different (p monitored concurrently by the system and infection control nurse, the compliance were 88.9% and 95.6% respectively (p = 0.34), and the activity indices were 11.1 and 12.9 opportunities per hour, respectively. The hours from 12:00 to 14:00 had a notably lower compliance (21.3%, 95%CI: 17.2, 25.3) than nearly three quarters of the other periods of the day (p < 0.001). Nurses who used shared badges had significantly (p < 0.01) lower compliance (23.7%, 95%CI: 17.8, 29.6) than both the registered nurses (36.1%, 95%CI: 34.2, 37.9) and nursing officers (34

  2. Prevalence of venous sinus stenosis in Pseudotumor cerebri (PTC using digital subtraction angiography (DSA

    Directory of Open Access Journals (Sweden)

    Mohamed Hamdy Ibrahim

    2014-06-01

    Conclusion: Studying the intracranial venous system in patients with PTC is an important step in understanding the pathophysiology of the disease. Detection of venous sinus stenosis opens the way to a novel therapeutic option for refractory patients like venous sinus stenting.

  3. A quality improvement project to improve the Medicare and Medicaid Services (CMS) sepsis bundle compliance rate in a large healthcare system.

    Science.gov (United States)

    Raschke, Robert A; Groves, Robert H; Khurana, Hargobind S; Nikhanj, Nidhi; Utter, Ethel; Hartling, Didi; Stoffer, Brenda; Nunn, Kristina; Tryon, Shona; Bruner, Michelle; Calleja, Maria; Curry, Steven C

    2017-01-01

    Sepsis is a leading cause of mortality and morbidity in hospitalised patients. The Centers for Medicare and Medicaid Services (CMS) mandated that US hospitals report sepsis bundle compliance rate as a quality process measure in October 2015. The specific aim of our study was to improve the CMS sepsis bundle compliance rate from 30% to 40% across 20 acute care hospitals in our healthcare system within 1 year. The study included all adult inpatients with sepsis sampled according to CMS specifications from October 2015 to September 2016. The CMS sepsis bundle compliance rate was tracked monthly using statistical process control charting. A baseline rate of 28.5% with 99% control limits was established. We implemented multiple interventions including computerised decision support systems (CDSSs) to increase compliance with the most commonly missing bundle elements. Compliance reached 42% (99% statistical process control limits 18.4%-38.6%) as CDSS was implemented system-wide, but this improvement was not sustained after CMS changed specifications of the outcome measure. Difficulties encountered elucidate shortcomings of our study methodology and of the CMS sepsis bundle compliance rate as a quality process measure.

  4. Problems about the analysis of technical requirements compliance in NPPPCI systems

    International Nuclear Information System (INIS)

    Perello, M.

    1978-01-01

    The display of the problems that the analysis of the technical requirements compliance bring along is presented. In the project of nuclear power plants, above all, the influence of national and international standards in the analysis of the adjustment of requirements established by the governments of nuclear safety of the different countries. In the oral presentation greater emphasis is made on the difficulties that the PSAR evaluation brings when the lack of technical standards in the owner country makes necessary the use of other countries rules. (author)

  5. An alternative approach to continuous compliance monitoring and turbine plant optimization using a PEMS (predictive emission monitoring system)

    International Nuclear Information System (INIS)

    Swanson, B.G.; Lawrence, P.

    2009-01-01

    This paper reviewed the use of a predictive emissions monitoring system (PEMS) at 3 different gas turbine facilities in the United States and highlighted the costs and benefits of using a PEMS for documenting emissions of priority pollutants and greenhouse gases (GHG). The PEMS interfaces directly to the turbine control system and represents a lower cost alternative to the traditional continuous emission monitoring system (CEMS). The PEMS can track combustion efficiency through modeling of the turbine's operation and emissions. Excess emissions can be tracked and the causes of pollution can be determined and mitigated. The PEMS installed at the 3 turbine plants must meet rigorous performance specification criteria and the sites perform ongoing quality assurance tasks such as periodic audits with portable analyzers. The PEMS is much less expensive to install, operate, and maintain compared to the standard CEMS gas analyzer. Empirical PEMS achieves very high accuracy levels and has demonstrated superior reliability over CEMS for various types of continuous process applications under existing air compliance regulations in the United States. Annual accuracy testing at the gas turbine sites have shown that the PEMS predictions are usually within 5 per cent of the reference method. PEMS can be certified as an alternative to gas analyzer based CEMS for nitrogen oxides and carbon dioxide compliance and for GHG trading purposes. 5 refs., 8 figs.

  6. Design of a radioactive gas sampling system for NESHAP compliance measurements of 41Ar

    International Nuclear Information System (INIS)

    Newton, G.J.; McDonald, M.J.; Ghanbari, F.; Hoover, M.D.; Barr, E.B.

    1994-01-01

    United States Department of Energy facilities are required to comply with the U.S. Environmental Protection Agency, National Emission Standard for Hazardous Air Pollutants (NESHAP) 40 CFR, part 61, subpart H. Compliance generally requires confirmatory measurements of emitted radionuclides. Although a number of standard procedures exist for extractive sampling of particle-associated radionuclides, sampling approaches for radioactive gases are less defined. Real-time, flow-through sampling of radioactive gases can be done when concentrations are high compared to interferences from background radiation. Cold traps can be used to collect and concentrate condensible effluents in applications where cryogenic conditions can be established and maintained. Commercially available gas-sampling cylinders can be used to capture grab samples of contaminated air under ambient or compressed conditions, if suitable sampling and control hardware are added to the cylinders. The purpose of the current study was to develop an efficient and compact set of sampling and control hardware for use with commercially available gas-sampling cylinders, and to demonstrate its use in NESHAP compliance testing of 41 Ar at two experimental research reactors

  7. Effects of isokinetic calf muscle exercise program on muscle strength and venous function in patients with chronic venous insufficiency.

    Science.gov (United States)

    Ercan, Sabriye; Çetin, Cem; Yavuz, Turhan; Demir, Hilmi M; Atalay, Yurdagül B

    2018-05-01

    Objective The aim of this study was to observe the change of the ankle joint range of motion, the muscle strength values measured with an isokinetic dynamometer, pain scores, quality of life scale, and venous return time in chronic venous insufficiency diagnosed patients by prospective follow-up after 12-week exercise program including isokinetic exercises. Methods The patient group of this study comprised 27 patients (23 female, 4 male) who were diagnosed with chronic venous insufficiency. An exercise program including isokinetic exercise for the calf muscle was given to patients three days per week for 12 weeks. At the end of 12 weeks, five of the patients left the study due to inadequate compliance with the exercise program. As a result, control data of 22 patients were included. Ankle joint range of active motion, isokinetic muscle strength, pain, quality of life, and photoplethysmography measurements were assessed before starting and after the exercise program. Results Evaluating changes of the starting and control data depending on time showed that all isokinetic muscle strength measurement parameters, range of motion, and overall quality of life values of patients improved. Venous return time values have also increased significantly ( p < 0.05). Conclusion In conclusion, increase in muscle strength has been provided with exercise therapy in patients with chronic venous insufficiency. It has been determined that the increase in muscle strength affected the venous pump and this ensured improvement in venous function and range of motion of the ankle. In addition, it has been detected that pain reduced and quality of life improved after the exercise program.

  8. Georgia Compliance Review Self-Study FY 01.

    Science.gov (United States)

    Georgia State Dept. of Education, Atlanta.

    Intended for evaluation of local compliance with special education federal and state legal requirements, this compliance review document includes both the compliance requirements and the criteria by which compliance is determined during the onsite compliance review of Georgia local school systems and state-operated programs. Each legal requirement…

  9. A comprehensive summary of the ORNL Groundwater Compliance and Surveillance Sampling Results Software System

    International Nuclear Information System (INIS)

    Loffman, R.S.

    1995-01-01

    Groundwater compliance and surveillance activities are conducted at ORNL to fulfill federal and state requirements for environmental monitoring. Information management is an important aspect of this and encompasses many activities which usually have spcific time frames and schedules. In addition to fulfilling these immediate requirements, the results for the monitoring activities are also used to determine the need for environmental remediation. ORNL performs this groundwater results data management and reporting utilizing a group of SAS reg-sign applications and tools which provide the ability to track samples, capture field measurements, verify and validate result data, manage data, and report results in a variety of ways and in a timely manner. This paper provides a comprehensive summary of these applications and tools

  10. Evaluation of hepatic venous pulsatility and portal venous velocity with doppler ultrasonography during the puerperium

    Energy Technology Data Exchange (ETDEWEB)

    Pekindil, Goekhan [Department of Radiology, Trakya University School of Medicine, 22030 Edirne (Turkey); Varol, Fuesun G. [Department of Obstetrics and Gynecology, Trakya University School of Medicine, 22030 Edirne (Turkey); Ali Yuece, M. [Department of Obstetrics and Gynecology, Trakya University School of Medicine, 22030 Edirne (Turkey); Yardim, Turgut [Department of Obstetrics and Gynecology, Trakya University School of Medicine, 22030 Edirne (Turkey)

    1999-03-01

    Objective: The aim of this study is to evaluate pregnancy-induced changes of hepatic venous pulsatility and portal venous velocity in the puerperium and to determine if these changes disappeared by the end of the puerperium. Methods and material: Healthy normal volunteers (90) were examined on the 2nd and 7th days of puerperium and between the 6th and 8th weeks postpartum. Doppler waveform patterns were obtained in the middle hepatic vein and main portal vein. The hepatic venous pulsatility was named as normal, damped or flat. Results: On the 2nd day postpartum, the hepatic vein pulsatility was shown as normal in 8 (26%), damped in 11 (37%) and flat in 11 (37%) cases. On the 7th day postpartum, 15 (50%) cases had normal, 9 (30%) cases had dampened, and 6 (20%) cases had still flat pattern. The majority of the cases (60%) displayed normal hepatic venous pulsatility in the 6th and 8th weeks of puerperium, whereas 23% had still dampened and 17% had flat patterns. There was a trend toward normal pulsatility with increasing puerperal age. The mean portal venous velocity was still higher than the non-pregnant levels and did not showed significant alterations during puerperium. Conclusion: This study emphasised that, since pregnancy-induced alterations in hepatic venous pulsatility and portal venous velocity had not completely returned to normal in most cases until the end of the puerperium, these physiological changes should be considered whenever hepatic and portal systems are interpreted with Doppler sonography during the puerperal period.

  11. Evaluation of hepatic venous pulsatility and portal venous velocity with doppler ultrasonography during the puerperium

    International Nuclear Information System (INIS)

    Pekindil, Goekhan; Varol, Fuesun G.; Ali Yuece, M.; Yardim, Turgut

    1999-01-01

    Objective: The aim of this study is to evaluate pregnancy-induced changes of hepatic venous pulsatility and portal venous velocity in the puerperium and to determine if these changes disappeared by the end of the puerperium. Methods and material: Healthy normal volunteers (90) were examined on the 2nd and 7th days of puerperium and between the 6th and 8th weeks postpartum. Doppler waveform patterns were obtained in the middle hepatic vein and main portal vein. The hepatic venous pulsatility was named as normal, damped or flat. Results: On the 2nd day postpartum, the hepatic vein pulsatility was shown as normal in 8 (26%), damped in 11 (37%) and flat in 11 (37%) cases. On the 7th day postpartum, 15 (50%) cases had normal, 9 (30%) cases had dampened, and 6 (20%) cases had still flat pattern. The majority of the cases (60%) displayed normal hepatic venous pulsatility in the 6th and 8th weeks of puerperium, whereas 23% had still dampened and 17% had flat patterns. There was a trend toward normal pulsatility with increasing puerperal age. The mean portal venous velocity was still higher than the non-pregnant levels and did not showed significant alterations during puerperium. Conclusion: This study emphasised that, since pregnancy-induced alterations in hepatic venous pulsatility and portal venous velocity had not completely returned to normal in most cases until the end of the puerperium, these physiological changes should be considered whenever hepatic and portal systems are interpreted with Doppler sonography during the puerperal period

  12. Evaluation of the induced electric field and compliance procedure for a wireless power transfer system in an electrical vehicle

    International Nuclear Information System (INIS)

    Laakso, Ilkka; Hirata, Akimasa

    2013-01-01

    In this study, an induced electric field in a human body is evaluated for the magnetic field leaked from a wireless power transfer system for charging an electrical vehicle. The magnetic field from the wireless power transfer system is modelled computationally, and its effectiveness is confirmed by comparison with the field measured in a previous study. The induced electric field in a human standing around the vehicle is smaller than the allowable limit prescribed in international guidelines, although the magnetic field strength in the human body is locally higher than the allowable external field strength. Correlation between the external magnetic field and the induced electric field is confirmed to be reasonable at least in the standing posture, which is the case discussed in the international standard. Based on this finding, we discussed and confirmed the applicability of a three-point magnetic field measurement at heights of 0.5, 1.0, and 1.5 m for safety compliance. (paper)

  13. Management of venous thromboembolism.

    Science.gov (United States)

    Parakh, R; Kakkar, V V; Kakkar, A K

    2007-01-01

    Venous Thromboembolism is an important healthcare problem the world over, resulting in significant morbidity, mortality and resource expenditure. The rationale for use of thromboprophylaxis is based on solid principles and scientific evidence. Indian perspective on this topic is lacking due to the non-availability of published Indian data. This document reviews the available International and Indian data and discusses the relevance of recommendations for prevention and management of Venous Thromboembolism (VTE) in the Indian context. Meetings of various specialists from different Indian hospitals in the field of Gastrointestinal Surgery, General and Vascular Surgery, Hematology, Intensive Care, Obstetrics and Gynecology, Oncology and Orthopedics were held in the months of August 2005 to January 2006. The guidelines published by American College of Chest Physicians (ACCP), the International Union of Angiology (IUA), and the Royal College of Obstetricians and Gynecologists (RCOG), were discussed during these meetings. The relevance of these guidelines and the practical implications of following these in a developing country like India were also discussed. Any published data from India was collected from data base searches and the results, along with personal experiences of the participating specialists were discussed. The experiences and impressions of the experts during these meetings have been included in this document. Data from recent sources (International Union of Angiology and the National Comprehensive Cancer Network (NCCN) Practice guidelines in Oncology on Venous thromboembolic disease) was subsequently also included in this document. The suggestions formulated in this document are practical, and would intend to serve as a useful practical reference. A number of unanswered questions remain in the field of thromboprophylaxis, and carefully designed research protocols may help answer some of these. Implementation of the suggestions outlined in the document

  14. 300 area TEDF permit compliance monitoring plan

    International Nuclear Information System (INIS)

    BERNESKI, L.D.

    1998-01-01

    This document presents the permit compliance monitoring plan for the 300 Area Treated Effluent Disposal Facility (TEDF). It addresses the compliance with the National Pollutant Discharge Elimination System (NPDES) permit and Department of Natural Resources Aquatic Lands Sewer Outfall Lease

  15. 300 area TEDF permit compliance monitoring plan

    Energy Technology Data Exchange (ETDEWEB)

    BERNESKI, L.D.

    1998-11-20

    This document presents the permit compliance monitoring plan for the 300 Area Treated Effluent Disposal Facility (TEDF). It addresses the compliance with the National Pollutant Discharge Elimination System (NPDES) permit and Department of Natural Resources Aquatic Lands Sewer Outfall Lease.

  16. Sustained compression and healing of chronic venous ulcers.

    OpenAIRE

    Blair, S. D.; Wright, D. D.; Backhouse, C. M.; Riddle, E.; McCollum, C. N.

    1988-01-01

    STUDY OBJECTIVE--Comparison of four layer bandage system with traditional adhesive plaster bandaging in terms of (a) compression achieved and (b) healing of venous ulcers. DESIGN--Part of larger randomised trial of five different dressings. SETTING--Outpatient venous ulcer clinic in university hospital. PATIENTS--(a) Pressure exerted by both bandage systems was measured in the same 20 patients. (b) Healing with the four layer bandage was assessed in 148 legs in 126 consecutive patients (mean ...

  17. Experimental study on efficacy of compression systems with a high static stiffness index for treatment of venous ulcer patients

    OpenAIRE

    Anneke Andriessen; Martin Abel

    2013-01-01

    The experimental study measured interface pressure and static stiffness index of four different compression systems in fifty-two healthy volunteers. For the study interface pressure (3 cm ø probe was placed at the anatomical B1 point) was recorded on application of the compression systems every 15 min for 4 h, in supine, standing, while sitting and during walking. For this purpose a portable Kikuhime (Harada Corp., Osaka, Japan) device was used. Further static stiffness index (SSI) was...

  18. Experimental study on efficacy of compression systems with a high static stiffness index for treatment of venous ulcer patients

    Directory of Open Access Journals (Sweden)

    Anneke Andriessen

    2013-03-01

    Full Text Available The experimental study measured interface pressure and static stiffness index of four different compression systems in fifty-two healthy volunteers. For the study interface pressure (3 cm ø probe was placed at the anatomical B1 point was recorded on application of the compression systems every 15 min for 4 h, in supine, standing, while sitting and during walking. For this purpose a portable Kikuhime (Harada Corp., Osaka, Japan device was used. Further static stiffness index (SSI was calculated. The evaluated systems were: short stretch bandage system (SSB Rosidal sys (Lohmann & Rauscher, Rengsdorf, Germany, multi-layer bandaging (LSB Profore (Smith & Nephew, Hull, UK, varistretch bandage (VSB Proguide (Smith & Nephew and tubular compression (CS Rosidal mobil (Lohmann & Rauscher. The mean interface pressure of SSB, LSB and VSB was significantly higher (P<0.05 in each position measured over 4 h, compared to CS. In supine VSB showed high-pressure levels, up to 60 mmHg, which remained high. The other systems had more tolerable levels of about 30 mmHg. Interface pressure exerted on limbs is an indicator of their clinical effect. The experimental study results showed different patterns of interface pressure and SSI, which may enable clinicians to predict the frequency of bandage application, supporting an adequate and safe choice of bandage system.

  19. Chronic Venous Disease under pressure

    NARCIS (Netherlands)

    S.W.I. Reeder (Suzan)

    2013-01-01

    textabstractIn chapter 1 we provide a general introduction of this thesis. Chronic venous disease (CVD) is a common medical condition that affects 2-64% of the worldwide population and leads to leg ulcers in 1% of the Western population. Venous leg ulceration (VLU) has an unfavorable prognosis with

  20. A systems approach to improving fleet policy compliance within the US Federal Government

    Energy Technology Data Exchange (ETDEWEB)

    Deason, Kristin S. [The George Washington University, 1776 G St. NW, Washington, DC 20052 (United States); Jefferson, Theresa [Virginia Polytechnic Institute and State University, 1101 King St, Suite 610 Alexandria, VA 22314 (United States)

    2010-06-15

    To reduce dependence on foreign sources of energy, address climate change, and improve environmental quality, the US government has established a goal of reducing petroleum fuel use in its federal agencies. To this end, the government requires its agencies to purchase alternative fuel vehicles, use alternative fuel, and adopt other strategies to reduce petroleum consumption. Compliance with these requirements, while important, creates challenges for federal fleet managers who oversee large, geographically dispersed fleets. In this study, a group of 25 experienced federal fleet managers participated in a pilot study using a structured methodology for developing strategies to comply with fleet requirements while using agency resources as efficiently as possible. Multi-criteria decision making (MCDM) methods were used to identify and quantify agency priorities in combination with a linear programming model to optimize the purchase of fleet vehicles. The method was successful in quantifying tradeoffs and decreasing the amount of time required to develop fleet management strategies. As such, it is recommended to federal agencies as a standard tool for the development of these strategies in the future. (author)

  1. A systems approach to improving fleet policy compliance within the US Federal Government

    International Nuclear Information System (INIS)

    Deason, Kristin S.; Jefferson, Theresa

    2010-01-01

    To reduce dependence on foreign sources of energy, address climate change, and improve environmental quality, the US government has established a goal of reducing petroleum fuel use in its federal agencies. To this end, the government requires its agencies to purchase alternative fuel vehicles, use alternative fuel, and adopt other strategies to reduce petroleum consumption. Compliance with these requirements, while important, creates challenges for federal fleet managers who oversee large, geographically dispersed fleets. In this study, a group of 25 experienced federal fleet managers participated in a pilot study using a structured methodology for developing strategies to comply with fleet requirements while using agency resources as efficiently as possible. Multi-criteria decision making (MCDM) methods were used to identify and quantify agency priorities in combination with a linear programming model to optimize the purchase of fleet vehicles. The method was successful in quantifying tradeoffs and decreasing the amount of time required to develop fleet management strategies. As such, it is recommended to federal agencies as a standard tool for the development of these strategies in the future. (author)

  2. VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

    Directory of Open Access Journals (Sweden)

    Bonno van BELLEN

    2013-09-01

    Full Text Available Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings, type of surgery (open or laparoscopic, abdominal circumference, body mass index (BMI and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%, the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%, but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although

  3. Validating year 2000 compliance

    NARCIS (Netherlands)

    A. van Deursen (Arie); P. Klint (Paul); M.P.A. Sellink

    1997-01-01

    textabstractValidating year 2000 compliance involves the assessment of the correctness and quality of a year 2000 conversion. This entails inspecting both the quality of the conversion emph{process followed, and of the emph{result obtained, i.e., the converted system. This document provides an

  4. Compliance problems of small utility systems with the Powerplant and Industrial Fuel Use Act of 1978: volume II - appendices

    Energy Technology Data Exchange (ETDEWEB)

    None

    1981-01-01

    A study of the problems of compliance with the Powerplant and Industrial Fuel Use Act of 1978 experienced by electric utility systems which have a total generating capacity of less than 2000 MW is presented. This volume presents the following appendices: (A) case studies (Farmington, New Mexico; Lamar, Colorado; Dover, Delaware; Wolverine Electric Cooperative, Michigan; Central Telephone and Utilities, Kansas; Sierra Pacific Power Company, Nevada; Vero Beach, Florida; Lubbock, Texas; Western Farmers Cooperative, Oklahoma; and West Texas Utilities Company, Texas); (B) contacts and responses to study; (C) joint action legislation chart; (D) Texas Municipal Power Agency case study; (E) existing generating units jointly owned with small utilities; (F) future generating units jointly owned with small utilities; (G) Federal Register Notice of April 17, 1980, and letter of inquiry to utilities; (H) small utility responses; and (I) Section 744, PIFUA. (WHK)

  5. Technical complications during veno-venous extracorporeal membrane oxygenation and their relevance predicting a system-exchange--retrospective analysis of 265 cases.

    Directory of Open Access Journals (Sweden)

    Matthias Lubnow

    Full Text Available OBJECTIVES: Technical complications are a known hazard in veno-venous extracorporeal membrane oxygenation (vvECMO. Identifying these complications and predictive factors indicating a developing system-exchange was the goal of the study. METHODS: Retrospective study on prospectively collected data of technical complications including 265 adult patients (Regensburg ECMO Registry, 2009-2013 with acute respiratory failure treated with vvECMO. Alterations in blood flow resistance, gas transfer capability, hemolysis, coagulation and hemostasis parameters were evaluated in conjunction with a system-exchange in all patients with at least one exchange (n = 83. RESULTS: Values presented as median (interquartile range. Patient age was 50(36-60 years, the SOFA score 11(8-14.3 and the Murray lung injury Score 3.33(3.3-3.7. Cumulative ECMO support time 3411 days, 9(6-15 days per patient. Mechanical failure of the blood pump (n = 5, MO (n = 2 or cannula (n = 1 accounted for 10% of the exchanges. Acute clot formation within the pump head (visible clots, increase in plasma free hemoglobin (frHb, serum lactate dehydrogenase (LDH, n = 13 and MO (increase in pressure drop across the MO, n = 16 required an urgent system-exchange, of which nearly 50% could be foreseen by measuring the parameters mentioned below. Reasons for an elective system-exchange were worsening of gas transfer capability (n = 10 and device-related coagulation disorders (n = 32, either local fibrinolysis in the MO due to clot formation (increased D-dimers [DD], decreased platelet count; n = 24, or device-induced hyperfibrinolysis (increased DD, decreased fibrinogen [FG], decreased platelet count, diffuse bleeding tendency; n = 8, which could be reversed after system-exchange. Four MOs were exchanged due to suspicion of infection. CONCLUSIONS: The majority of ECMO system-exchanges could be predicted by regular inspection of the complete ECMO circuit, evaluation of gas exchange, pressure drop

  6. Compliance to antihypertensive drugs, salt restriction, exercise and control of systemic hypertension in hypertensive patients at abbottabad

    International Nuclear Information System (INIS)

    Ahmed, N.; Waqas, A.; Khaliq, M.A.

    2008-01-01

    Hypertension is one of the most important cardiovascular risk factor but its control is still a challenge for physicians all around the world. Control of blood pressure can reduce cardiovascular morbidity and mortality, so the compliance to antihypertensive drugs and life style modification play an important role for the control of hypertension. This analytical (cross-sectional) study was conducted to assess prevalence of control of hypertension among hypertensive patients and to assess the relationship of control of hypertension with factors like compliance to antihypertensive drugs, salt restriction and exercise among the hypertensive patients. This study was conducted at outpatient clinic of medicine at Shahina Jamil Hospital Abbottabad from April 2007 to September 2007. Eighty-nine patients seen in the outpatient clinic of medicine were enrolled in the study. All the patients with age 15 years or above, diagnosed as a case of systemic hypertension were included. Among eighty nine patients, 67 were female and 22 were male with mean age of 55.8+-13.4 years, mean systolic and diastolic blood pressure of 160+-28.6 and 97.8+-14.1 mm Hg respectively, and pulse rate of 85.9+-11.4 per minutes. Out of 89 patients, 25.8% were having controlled hypertension, 48.3% were compliant and 51.7% were not compliant to antihypertensive drugs, 55.1% were having salt restriction and 44.9% were having no salt restriction and 23.6% were used to do physical activity while 76.4% were not used to do physical activity. In group A consisted of patients with controlled hypertension, 95.7% patients were compliant to antihypertensive patients, 95.7% were having salt restriction and 43.5% were used to do physical activity. In group B consisted of patients with uncontrolled hypertension, only 31.8% were compliant to antihypertensive drugs, 40.9% were having salt restriction, 16.7% were used to do physical activity. Hypertension can be controlled if the hypertensive patients have good compliance

  7. Protocol for the realization of venous mapping by chronic venous insufficiency in lower limbs under sonographic guide

    International Nuclear Information System (INIS)

    Blanco Rojas, Diego Jose

    2013-01-01

    The current state of knowledge is reviewed with respect to the realization of lower limbs venous mapping. Venous mapping is obtained by the use of color and spectral Doppler ultrasound. Doppler ultrasound has provided a precise graphical representation of the superficial and deep venous systems. The performance of the venous mapping is considered essential for the correct handling of venous diseases. The anatomical and pathophysiological basic concepts are defined to realize the sonographic assessment of the veins of the lower limbs. The required technical aspects are revised for the realization of sonographic exploration of the patient with venous insufficiency. Sonographic findings are characterized to support the diagnostic of venous insufficiency of the lower limbs. The CEAP (clinical-etiologic-anatomic-pathophysiologic) classification is utilized to differentiate forms and degrees of severity of the disorder, and has allowed an interinstitutional comparison in clinical studies, the evaluation of treatment and monitoring of patients. A proposal is designed to perform reports that have served of guide surgical to vascular surgeons [es

  8. Venous and Arterial Thromboses: Two Sides of the Same Coin?

    Science.gov (United States)

    Lippi, Giuseppe; Favaloro, Emmanuel J

    2018-04-01

    Arterial and venous thromboses are sustained by development of intraluminal thrombi, respectively, within the venous and arterial systems. The composition and structure of arterial and venous thrombi have been historically considered as being very different. Arterial thrombi (conventionally defined as "white") have been traditionally proposed to be composed mainly of fibrin and platelet aggregates, whilst venous thrombi (conventionally defined as "red") have been proposed as mostly being enriched in fibrin and erythrocytes. This archaic dichotomy seems ever more questionable, since it barely reflects the pathophysiology of thrombus formation in vivo. Both types of thrombi are actually composed of a complex fibrin network but, importantly, also contain essentially the same blood-borne cells (i.e., red blood cells, leukocytes, and platelets), and it is only the relative content of these individual elements that differ between venous and arterial clots or, otherwise, between thrombi generated under different conditions of blood flow and shear stress. Convincing evidence now suggests that either white or red intracoronary thrombi may be present in patients with myocardial infarction and, even more importantly, red thrombi may be more prone to distal embolization during percutaneous coronary intervention than those with lower content of erythrocytes. Conversely, it is now accepted that components traditionally considered to be involved "only" in arterial thrombosis are also represented in venous thrombosis. Thus, platelets comprise important components of venous clots, although they may be present in lower amounts here than in arterial thrombi, and von Willebrand factor is also represented in both arterial and venous thrombi. Of importance, such evidence thus supports the concept that adjunctive treatment normally associated to prevention of arterial thrombosis (e.g., aspirin) may have a role also in prevention and treatment of venous thrombosis. Thieme Medical

  9. Assessment of a volume-dependent dynamic respiratory system compliance in ALI/ARDS by pooling breathing cycles

    International Nuclear Information System (INIS)

    Zhao, Zhanqi; Möller, Knut; Guttmann, Josef

    2012-01-01

    New methods were developed to calculate the volume-dependent dynamic respiratory system compliance (C rs ) in mechanically ventilated patients. Due to noise in respiratory signals and different characteristics of the methods, their results can considerably differ. The aim of the study was to establish a practical procedure to validate the estimation of intratidal dynamic C rs . A total of 28 patients from intensive care units of eight German university hospitals with acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) were studied retrospectively. Dynamic volume-dependent C rs was determined during ongoing mechanical ventilation with the SLICE method, dynostatic algorithm and adaptive slice method. Conventional two-point compliance C 2P was calculated for comparison. A number of consecutive breathing cycles were pooled to reduce noise in the respiratory signals. C rs -volume curves produced with different methods converged when the number of pooling cycles increased (n ≥ 7). The mean volume-dependent C rs of 20 breaths was highly correlated with mean C 2P (C 2P,mean = 0.945 × C rs,mean − 0.053, r 2 = 0.968, p < 0.0001). The Bland–Altman analysis indicated that C 2P,mean was lower than C rs,mean (−2.4 ± 6.4 ml cm −1 H 2 O, mean bias ± 2 SD), but not significant according to the paired t-test (p > 0.05). Methods for analyzing dynamic respiratory mechanics are sensitive to noise and will converge to a unique solution when the number of pooled cycles increases. Under steady-state conditions, assessment of the volume-dependent C rs in ALI/ARDS patients can be validated by pooling respiratory data of consecutive breaths regardless of which method is applied. Confidence in dynamic C rs determination may be increased with the proposed pooling. (note)

  10. Quantification of the Hawthorne effect in hand hygiene compliance monitoring using an electronic monitoring system: a retrospective cohort study.

    Science.gov (United States)

    Srigley, Jocelyn A; Furness, Colin D; Baker, G Ross; Gardam, Michael

    2014-12-01

    The Hawthorne effect, or behaviour change due to awareness of being observed, is assumed to inflate hand hygiene compliance rates as measured by direct observation but there are limited data to support this. To determine whether the presence of hand hygiene auditors was associated with an increase in hand hygiene events as measured by a real-time location system (RTLS). The RTLS recorded all uses of alcohol-based hand rub and soap for 8 months in two units in an academic acute care hospital. The RTLS also tracked the movement of hospital hand hygiene auditors. Rates of hand hygiene events per dispenser per hour as measured by the RTLS were compared for dispensers within sight of auditors and those not exposed to auditors. The hand hygiene event rate in dispensers visible to auditors (3.75/dispenser/h) was significantly higher than in dispensers not visible to the auditors at the same time (1.48; p=0.001) and in the same dispensers during the week prior (1.07; pHand hygiene event rates were approximately threefold higher in hallways within eyesight of an auditor compared with when no auditor was visible and the increase occurred after the auditors' arrival. This is consistent with the existence of a Hawthorne effect localised to areas where the auditor is visible and calls into question the accuracy of publicly reported hospital hand hygiene compliance rates. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. The Compliance Cost of the U.S. Individual Income Tax System: A Second Look After Tax Reform

    OpenAIRE

    Blumenthal, Marsha; Slemrod, Joel

    1992-01-01

    Attempts to answer whether or not TRA'86 simplified or complicated taxes by comparing data from surveys of compliance costs conducted in 1982 and 1989. Concludes that tax reform did not reverse the growth in compliance costs in the 1980's.

  12. Usefulness of the Guglielmi detachable coil for embolization of a systemic venous collateral after Fontan operation: A case report.

    Science.gov (United States)

    Sonomura, Tetsuo; Ikoma, Akira; Kawai, Nobuyuki; Suenaga, Tomohiro; Takeuchi, Takashi; Suzuki, Hiroyuki; Uchita, Shunji; Nakai, Motoki; Minamiguchi, Hiroki; Kishi, Kazushi; Sato, Morio

    2012-09-28

    Embolization of collateral veins is often treated with rigid coils (Gianturco and interlocking detachable coils type). However, when dealing with tortuous and dilated collateral veins, there is a high risk for technical failure and coil migration due to inflexibility of the coils. To safely and successfully solve this problem, Guglielmi detachable coils (GDC) can be used for embolization. Their flexibility allows for easy navigation in tortuous veins, low risk of unintended coil release or coil migration, and safe deployment. A 12-year-old girl with a single ventricle had severe cyanosis and a low exercise tolerance 5 years after Fontan procedure. The symptoms were caused by a tortuous and dilated collateral from the left phrenic vein into the left pulmonary vein, forming a right-to-left shunt. The collateral, which had a large diameter and high flow, and therefore a high risk of coil migration, was successfully embolized with 8 GDC. There were no complications such as coil migration or cerebral infarction. Transcatheter embolization increased her systemic oxygen saturation from 81%-84% to 94%-95%, and increased her ability to exercise. The embolization procedure using flexible GDC was low risk compared with other rigid coil embolization techniques when performing embolization of tortuous and dilated collateral veins.

  13. Venous hemodynamic changes in lower limb venous disease

    DEFF Research Database (Denmark)

    Lee, Byung Boong; Nicolaides, Andrew N; Myers, Kenneth

    2016-01-01

    ). Their aim was to confirm or dispel long-held hemodynamic principles and to provide a comprehensive review of venous hemodynamic concepts underlying the pathophysiology of lower limb venous disorders, their usefulness for investigating patients and the relevant hemodynamic changes associated with various...... forms of treatment. Chapter 1 is devoted to basic hemodynamic concepts and normal venous physiology. Chapter 2 presents the mechanism and magnitude of hemodynamic changes in acute deep vein thrombosis indicating their pathophysiological and clinical significance. Chapter 3 describes the hemodynamic...... changes that occur in different classes of chronic venous disease and their relation to the anatomic extent of disease in the macrocirculation and microcirculation. The next four chapters (Chapters 4-7) describe the hemodynamic changes resulting from treatment by compression using different materials...

  14. The hygiene practices of three systems of game meat production in South Africa in terms of animal class and health compliance.

    Science.gov (United States)

    Van der Merwe, Maretha; Hoffman, Louw C; Jooste, Piet J; Calitz, Frikkie Johannes

    2013-05-01

    Three game meat production systems used on game ranches in South Africa are reported on. System one is applied in the game export market and conforms to the hygiene requirements of the European Union (EU). System two and three entail game meat available on the local market not subjected to any regulation. System 2 however, implemented basic meat hygiene values. Measurements of pH, temperature, Aerobic Plate Count (APC), E. coli, Salmonella and S. aureus were subjected to a 3×2 factorial analysis of variance with factors that involve 3 system compliances in 2 classes of game animals in a completely randomised design. The measured bacteriological and quality differences between the three systems do not justify EU standards application on the local market but results indicated a significant compliance×class interaction. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Anatomic variation of the deep venous system and its relationship with deep vein thrombosis found on the lower extremity venograms that were obtained after artificial joint replacements

    International Nuclear Information System (INIS)

    Lee, Min Sun; Lee, Jee Eun; Hwang, Ji Young; Shim, Sung Shine; Yoo, Jeong Hyun; Suh, Jeong Soo; Park, Jae Young

    2006-01-01

    artificial joint replacements. The total number of asymptomatic DVT cases was 43 (23.1%) and DVT was found in the calf in 39 of these cases. Post-operative venograms of the lower extremity showed 7 types of anatomic variation in the deep venous system. The incidence of silent post-operative DVT was not influenced by anatomic variations of the deep vein system, whether there were a small or large number of valves and the operation sites for artificial joint replacement. The most frequent site of DVT after artificial joint replacement was the calf

  16. IAEA preparations for the year 2000 compliance of safeguards information systems

    International Nuclear Information System (INIS)

    Smith, P.M.

    1999-01-01

    The year-2000 (Y2K) problem affects both information systems and equipment systems. This paper describes the work which has been done, and is currently underway, to make the information systems of the Department of Safeguards year-2000 compliant. (author)

  17. Anomlus pulmonary venous return aaccompanied by normal superior pulmonary veins in the left upper lobe: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Eon; Kang, Min Jin; Lee, Ji Hae; Bae, Kyung Eun; Kim, Jae Hyung; Kang, Tae Kyung; Kim, Soung Hee; Kim, Ji Young; Jeong, Myeong Ja; Kim, Soo Hyun [Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2017-08-15

    Partial anomalous pulmonary venous return is a rare congenital pulmonary venous anomaly, in which some of the pulmonary veins drain into the systemic circulation rather than the left atrium. Many variants of partial anomalous pulmonary venous return have been reported. We present a rare type of partial anomalous pulmonary venous return in which the anomalous left upper lobe pulmonary vein drained into the left innominate vein via the vertical vein, accompanying the left upper lobe pulmonary vein in the normal location.

  18. Anomlus pulmonary venous return aaccompanied by normal superior pulmonary veins in the left upper lobe: A case report

    International Nuclear Information System (INIS)

    Kim, Dong Eon; Kang, Min Jin; Lee, Ji Hae; Bae, Kyung Eun; Kim, Jae Hyung; Kang, Tae Kyung; Kim, Soung Hee; Kim, Ji Young; Jeong, Myeong Ja; Kim, Soo Hyun

    2017-01-01

    Partial anomalous pulmonary venous return is a rare congenital pulmonary venous anomaly, in which some of the pulmonary veins drain into the systemic circulation rather than the left atrium. Many variants of partial anomalous pulmonary venous return have been reported. We present a rare type of partial anomalous pulmonary venous return in which the anomalous left upper lobe pulmonary vein drained into the left innominate vein via the vertical vein, accompanying the left upper lobe pulmonary vein in the normal location

  19. Decreased respiratory system compliance on the sixth day of mechanical ventilation is a predictor of death in patients with established acute lung injury

    Directory of Open Access Journals (Sweden)

    Matthay Michael A

    2011-04-01

    Full Text Available Abstract Background Multiple studies have identified single variables or composite scores that help risk stratify patients at the time of acute lung injury (ALI diagnosis. However, few studies have addressed the important question of how changes in pulmonary physiologic variables might predict mortality in patients during the subacute or chronic phases of ALI. We studied pulmonary physiologic variables, including respiratory system compliance, P/F ratio and oxygenation index, in a cohort of patients with ALI who survived more than 6 days of mechanical ventilation to see if changes in these variables were predictive of death and whether they are informative about the pathophysiology of subacute ALI. Methods Ninety-three patients with ALI who were mechanically ventilated for more than 6 days were enrolled in this prospective cohort study. Patients were enrolled at two medical centers in the US, a county hospital and a large academic center. Bivariate analyses were used to identify pulmonary physiologic predictors of death during the first 6 days of mechanical ventilation. Predictors on day 1, day 6 and the changes between day 1 and day 6 were compared in a multivariate logistic regression model. Results The overall mortality was 35%. In multivariate analysis, the PaO2/FiO2 (OR 2.09, p th day of acute lung injury. In addition, a decrease in respiratory system compliance between days 1 and days 6 (OR 2.14, p Conclusions A low respiratory system compliance on day 6 or a decrease in the respiratory system compliance between the 1st and 6th day of mechanical ventilation were associated with increased mortality in multivariate analysis of this cohort of patients with ALI. We suggest that decreased respiratory system compliance may identify a subset of patients who have persistent pulmonary edema, atelectasis or the fibroproliferative sequelae of ALI and thus are less likely to survive their hospitalization.

  20. Deep venous thrombosis and postthrombotic syndrome: invasive management.

    Science.gov (United States)

    Comerota, A J

    2015-03-01

    Invasive management of postthrombotic syndrome encompasses the two ends of the deep vein thrombosis spectrum, patients with acute iliofemoral deep vein thrombosis and those with chronic postthrombotic iliofemoral venous obstruction. Of all patients with acute deep vein thrombosis, those with involvement of the iliofemoral segments have the most severe chronic postthrombotic morbidity. Catheter-based techniques now permit percutaneous treatment to eliminate thrombus, restore patency, potentially maintain valvular function, and improve quality of life. Randomized trial data support an initial treatment strategy of thrombus removal. Failure to eliminate acute thrombus from the iliofemoral system leads to chronic postthrombotic obstruction of venous outflow. Debilitating chronic postthrombotic symptoms of the long-standing obstruction of venous outflow can be reduced by restoring unobstructed venous drainage from the profunda femoris vein to the vena cava. © The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  1. Color-flow Doppler imaging in suspected extremity venous thrombosis

    International Nuclear Information System (INIS)

    Foley, W.D.; Middleton, W.D.; Lawson, T.L.; Hinson, G.W.; Puller, D.R.

    1987-01-01

    Color-flow Doppler imaging (CFDI) (Quanatum, 5 and 7.5 MHz, linear array) has been performed on 23 extremities (nine positive for venous thrombosis, 14 negative) with venographic correlation. CFDI criteria evaluated were venous color-flow respiratory variation, augmentation, compressibility, valve competence, and intraluminal echogenic filling defects. Both CFDI and venography were evaluated independently and prospectively. CFDI and venography agreed in all six cases of femoral vein thrombosis and eight of nine cases of popliteal vein thrombosis. CFDI was negative in one instance of recanalized popliteal vein thrombosis. Recanalized femoral vein thrombosis was documented in three patients by CFDI when the vein was nonopacified on conventional venography. CFDI provides a rapid and accurate assessment of the femoral popliteal venous system and can distinguish an occluded from a recanalized thrombus. Initial experience with auxiliary subclavian venous thrombus has produced equally accurate results

  2. Cooperative advanced Driver assistance Systems - Technological measures for data privacy compliance

    OpenAIRE

    Jäger, Hubert; Schnieder, Lars

    2016-01-01

    Cooperative advanced driver assistance systems (ADAS) will contribute to road traffic safety: Critical situations will be detected, the driver alerted and control of the vehicle interfered with automatically. However, the introduction of such driver assistance systems presupposes that data privacy issues have already been solved in advance. A necessary condition for the driver to accept and trust new Driver assistance systems is that his/her personal and personally identifiable data will be t...

  3. Hydrocephalus in cerebral venous thrombosis

    NARCIS (Netherlands)

    Zuurbier, Susanna M.; van den Berg, René; Troost, Dirk; Majoie, Charles B.; Stam, Jan; Coutinho, Jonathan M.

    2015-01-01

    Increased intracranial pressure is common in cerebral venous thrombosis (CVT), but hydrocephalus is rarely reported in these patients. We examined the frequency, pathophysiology and associated clinical manifestations of hydrocephalus in patients with CVT admitted to our hospital between 2000 and

  4. Total anomalous pulmonary venous return

    Science.gov (United States)

    ... pulmonary venous return, x-ray References Fraser CD, Kane LC. Congenital heart disease. In: Townsend CM Jr, ... 62. Review Date 10/17/2017 Updated by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, ...

  5. Lower extremity arterial and venous ulcers.

    Science.gov (United States)

    Sieggreen, Mary

    2005-06-01

    The prevalence of peripheral arterial disease in the general population is high, but the awareness of primary care providers of the disease process is low. The disease is not recognized by primary care providers. Early recognition and treatment of venous diseases that progress to postphlebotic syndrome, such as after a deep vein thrombosis, will prevent venous ulcers that add considerable expense to the health care system. Vascular assessment, including routine ABI measurement of patients who are in risk categories for vascular disease will identify those patients so that prevention programs can be put into place early. Major contributions to the understanding and management of leg ulcers and wound healing have been made in the last decade. However, there is still confusion as to the exact mechanism behind ulcer development and the best method to manage, cure,and prevent these ulcers has yet to be found.

  6. Venous thromboprophylaxis in general surgery ward admissions: strategies for improvement.

    Science.gov (United States)

    Galante, Mariana; Languasco, Agustín; Gotta, Daniel; Bell, Soledad; Lancelotti, Tomás; Knaze, Viktoria; Saubidet, Cristián Lopez; Grand, Beatriz; Milberg, Matías

    2012-12-01

    To estimate the adherence to institutional venous thromboprophylaxis clinical practice guidelines (CPGs) in general surgery patients and to assess the effectiveness of a multi-strategy improvement intervention. A prospective before-after study. Two teaching hospitals located in the city of Buenos Aires, Argentina. Prescriptions belonging to patients admitted to the general surgery wards were evaluated. A multi-strategy intervention that included (i) simplification of institutional CPGs for venous thromboprophylaxis using a single drug at a single dose, based on the American College of Chest Physicians recommendations, (ii) distribution of pocket cards with an algorithm for the implementation of new recommendations to both, physicians and nurses, working in the general surgery units, (iii) educational talks, (iv) paper-based reminders and (v) audit and feedback. The adherence of the venous thromboprophylaxis prescription to the institutional recommendations. The prescriptions of 100 admitted patients before and 90 after the intervention were included in the analysis. The initial rate of adherence was 31%. After the intervention this rate rose to 71.1% (P< 0.001). The major improvement observed was the reduction in omitted prophylaxis in patients at risk of venous thromboembolism from 45 to 13.3% (P< 0.001). In the adjusted model, prescribing compliance with CPGs was five times more likely during the second stage than during the first stage (OR = 5.60, 95% CI = 2.92-10.74). Simple and economical interventions such as those described in this study can improve general surgeons compliance with the institutional and international guidelines, thus assuring patient safety and quality of health care.

  7. Improving venous leg ulcer management

    OpenAIRE

    Weller, Carolina Dragica

    2017-01-01

    This thesis reports several different methods to develop and evaluate complex interventions designed to improve venous leg ulcer management. Chronic venous leg ulcers (VLU) are the most common chronic wound problem in the community. Its health and economic burden is predicted to increase due to ageing of the community and increase in prevalence of diabetes and obesity. Although many patients seek health care for VLU, most do not receive the most effective management. Patients with this condi...

  8. GHG sustainability compliance of rapeseed-based biofuels produced in a Danish multi-output biorefinery system

    International Nuclear Information System (INIS)

    Boldrin, Alessio; Astrup, Thomas

    2015-01-01

    Biofuels are likely to play an increasingly important role in the transportation sector in the coming decades. To ensure the sustainability of the biofuel chain, regulatory criteria and reduction targets for greenhouse gases (GHG) emissions have been defined in different legislative frameworks (e.g. the European Renewable Energy Directive, RED). The provided calculation methods, however, leave room for interpretation regarding methodological choices, which could significantly affect the resulting emission factors. In this study, GHG reduction factors for a range of biofuels produced in a Danish biorefinery system were determined using five different emission allocation principles. The results show that emission savings ranged from −34 % to 71 %, indicating the need for a better definition of regulatory calculation principles. The calculated emission factors differed significantly from default values provided in the literature, suggesting that case-specific local conditions should be taken into consideration. A more holistic LCA-based approach proved useful in overcoming some of the issues inherent in the regulatory allocation principles. On this basis, indirect land use change (ILUC) emissions were shown to have the same magnitude as the direct emissions, thus indicating that the overall system should be included when assessing biofuel sustainability criteria. - Highlights: • Fulfillment of the GHG compliance criteria may depend on the calculation criteria. • Default factors may not be representative of local conditions. • Zero burden approach should be excluded. • ILUC should not be neglected

  9. Evaluation of the induced electric field and compliance procedure for a wireless power transfer system in an electrical vehicle.

    Science.gov (United States)

    Laakso, Ilkka; Hirata, Akimasa

    2013-11-07

    In this study, an induced electric field in a human body is evaluated for the magnetic field leaked from a wireless power transfer system for charging an electrical vehicle. The magnetic field from the wireless power transfer system is modelled computationally, and its effectiveness is confirmed by comparison with the field measured in a previous study. The induced electric field in a human standing around the vehicle is smaller than the allowable limit prescribed in international guidelines, although the magnetic field strength in the human body is locally higher than the allowable external field strength. Correlation between the external magnetic field and the induced electric field is confirmed to be reasonable at least in the standing posture, which is the case discussed in the international standard. Based on this finding, we discussed and confirmed the applicability of a three-point magnetic field measurement at heights of 0.5, 1.0, and 1.5 m for safety compliance.

  10. Congenital Retinal Macrovessel and the Association of Retinal Venous Malformations With Venous Malformations of the Brain.

    Science.gov (United States)

    Pichi, Francesco; Freund, K Bailey; Ciardella, Antonio; Morara, Mariachiara; Abboud, Emad B; Ghazi, Nicola; Dackiw, Christine; Choudhry, Netan; Souza, Eduardo Cunha; Cunha, Leonardo Provetti; Arevalo, J Fernando; Liu, T Y Alvin; Wenick, Adam; He, Lingmin; Villarreal, Guadalupe; Neri, Piergiorgio; Sarraf, David

    2018-04-01

    Congenital retinal macrovessel (CRM) is a rarely reported venous malformation of the retina that is associated with venous anomalies of the brain. To study the multimodal imaging findings of a series of eyes with congenital retinal macrovessel and describe the systemic associations. In this cross-sectional multicenter study, medical records were retrospectively reviewed from 7 different retina clinics worldwide over a 10-year period (2007-2017). Patients with CRM, defined as an abnormal, large, macular vessel with a vascular distribution above and below the horizontal raphe, were identified. Data were analyzed from December 2016 to August 2017. Clinical information and multimodal retinal imaging findings were collected and studied. Pertinent systemic information, including brain magnetic resonance imaging findings, was also noted if available. Of the 49 included patients, 32 (65%) were female, and the mean (SD) age at onset was 44.0 (20.9) years. A total of 49 eyes from 49 patients were studied. Macrovessel was unilateral in all patients. Color fundus photography illustrated a large aberrant dilated and tortuous retinal vein in all patients. Early-phase frames of fluorescein angiography further confirmed the venous nature of the macrovessel in 40 of 40 eyes. Optical coherence tomography angiography, available in 17 eyes (35%), displayed microvascular capillary abnormalities around the CRM, which were more evident in the deep capillary plexus. Of the 49 patients with CRM, 39 (80%) did not illustrate any evidence of ophthalmic complications. Ten patients (20%) presented with retinal complications, typically an incidental association with CRM. Twelve patients (24%) were noted to have venous malformations of the brain with associated magnetic resonance imaging. Of these, location of the venous anomaly in the brain was ipsilateral to the CRM in 10 patients (83%) and contralateral in 2 patients (17%), mainly located in the frontal lobe in 9 patients (75%). Our study has

  11. Major weapon system environmental life-cycle cost estimating for Conservation, Cleanup, Compliance and Pollution Prevention (C3P2)

    Science.gov (United States)

    Hammond, Wesley; Thurston, Marland; Hood, Christopher

    1995-01-01

    The Titan 4 Space Launch Vehicle Program is one of many major weapon system programs that have modified acquisition plans and operational procedures to meet new, stringent environmental rules and regulations. The Environmental Protection Agency (EPA) and the Department of Defense (DOD) mandate to reduce the use of ozone depleting chemicals (ODC's) is just one of the regulatory changes that has affected the program. In the last few years, public environmental awareness, coupled with stricter environmental regulations, has created the need for DOD to produce environmental life-cycle cost estimates (ELCCE) for every major weapon system acquisition program. The environmental impact of the weapon system must be assessed and budgeted, considering all costs, from cradle to grave. The Office of the Secretary of Defense (OSD) has proposed that organizations consider Conservation, Cleanup, Compliance and Pollution Prevention (C(sup 3)P(sup 2)) issues associated with each acquisition program to assess life-cycle impacts and costs. The Air Force selected the Titan 4 system as the pilot program for estimating life-cycle environmental costs. The estimating task required participants to develop an ELCCE methodology, collect data to test the methodology and produce a credible cost estimate within the DOD C(sup 3)P(sup 2) definition. The estimating methodology included using the Program Office weapon system description and work breakdown structure together with operational site and manufacturing plant visits to identify environmental cost drivers. The results of the Titan IV ELCCE process are discussed and expanded to demonstrate how they can be applied to satisfy any life-cycle environmental cost estimating requirement.

  12. Tailored patient information using a database system: Increasing patient compliance in a day surgery setting

    DEFF Research Database (Denmark)

    Grode, Jesper Nicolai Riis; Grode, Louise; Steinsøe, Ulla

    rehabilitation. The hospital is responsible of providing the patients with accurate information enabling the patient to prepare for surgery. Often patients are overloaded with uncoordinated information, letters and leaflets. The contribution of this project is a database system enabling health professionals...... to empower patients through tailored individualized information. Performing 6500 operations per year at our Day Surgery Centre, health professionals need a computer based system to create individualized information material. Health professionals must be able to adapt the information material quickly...... was established to support these requirements. A relational database system holds all information pieces in a granular, structured form. Each individual piece of information can be joined with other pieces thus supporting the tailoring of information. A web service layer caters for integration with output systems...

  13. Environmental Compliance Mechanisms

    NARCIS (Netherlands)

    Merkouris, Panagiotis; Fitzmaurice, Malgosia

    2017-01-01

    Compliance mechanisms can be found in treaties regulating such diverse issues as human rights, disarmament law, and environmental law. In this bibliography, the focus will be on compliance mechanisms of multilateral environmental agreements (MEAs). Compliance with norms of international

  14. The Strategic Nature of Compliance

    DEFF Research Database (Denmark)

    König, Thomas; Mäder, Lars Kai

    2014-01-01

    by the anticipated enforcement decision of the monitoring agency and whether this agency is responsive to the probability of enforcement success and the potential sanctioning costs produced by noncomplying implementers. Compared to other monitoring systems, the centralized monitoring system of the European Union (EU......This compliance study models correct and timely implementation of policies in a multilevel system as a strategic game between a central monitoring agency and multiple implementers and evaluates statistically the empirical implications of this model. We test whether compliance is determined......) is praised for exemplary effectiveness, but our findings reveal that the monitoring agency refrains from enforcing compliance when the probability of success is low, and the sanctioning costs are high. This results in a compliance deficit, even though the selective enforcement activities of the monitoring...

  15. Avaliação da pressão venosa periférica na esclerose sistêmica Peripheral venous pressure in systemic sclerosis

    Directory of Open Access Journals (Sweden)

    João Potério-Filho

    2004-02-01

    Full Text Available OBJETIVO: Estabelecer a utilidade da medida indireta da pressão venosa periférica (PVP na avaliação de pacientes com esclerose sistêmica (ES, comparando com uma população controle normal. MÉTODOS: Estudo prospectivo avaliando 18 pacientes esclerodérmicas do sexo feminino (sendo oito delas com úlcera cutânea isquêmica submetidas à medida indireta da PVP (por pletismografia. Os dados foram comparados a um grupo controle normal de 18 mulheres hígidas, pareadas para idade. RESULTADOS: Os níveis de pressão arterial foram semelhantes nos dois grupos. Os valores de PVP estavam significativamente diminuídos nos pacientes com ES (58.9 ± 11.6 mmHg no grupo ES e 96.9 ± 7.1 mmHg no grupo controle; p OBJECTIVE: The aim of this prospective study was to establish the usefulness of indirect measurement of peripheral venous pressure (PVP in the evaluation of patients with systemic sclerosis (SSc, comparing them with a normal control population. METHODS: Eighteen female SSc patients (eight patients presenting cutaneous ischemic ulcers were submitted to indirect measurement of the PVP (by plethysmography, and data were compared with a control group of 18 healthy women, paired by age. RESULTS: Arterial pressure levels were similar in both groups. PVP levels were significantly decreased in the SSc patients (58.9 ± 11.6 mmHg in the SSc group and 96.9 ± 7.1 mmHg in the control group; p < 0.0001; in the SSc group, patients with ischemic ulcers presented PVP levels significantly decreased compared with those patients without ulcers (50.6 ± 10.8 mmHg in the ulcer group and 65.5 ± 7.2 mmHg in the group without ulcers; p = 0.006. CONCLUSIONS: It can be concluded that decreased PVP in SSc is associated with a decrease in the blood flow of these patients, predisposing them to cutaneous ischemic ulcers.

  16. Heritability of the dimensions, compliance and distensibility of the human internal jugular vein wall.

    Directory of Open Access Journals (Sweden)

    Adam Domonkos Tarnoki

    Full Text Available The elasticity of the internal jugular vein (IJV is a major determinant of cerebral venous drainage and right atrium venous return. However, the level of genetic determination of IJV dimensions, compliance and distensibility has not been studied yet.170 adult Caucasian twins (43 monozygotic [MZ] and 42 dizygotic [DZ] pairs were involved from the Italian twin registry. Anteroposterior and mediolateral diameters of the IJV were measured bilaterally by ultrasonography. Measurements were made both in the sitting and supine positions, with or without Valsalva maneuver. Univariate quantitative genetic modeling was performed.Genetic factors are responsible for 30-70% of the measured properties of IJV at higher venous pressure even after adjustment for age and gender. The highest level of inheritance was found in the supine position regarding compliance (62% and venous diameter during Valsalva (69%. Environmental and measurement-related factors instead are more important in the sitting position, when the venous pressure is low and the venous lumen is almost collapsed. The range of capacity changes between the lowest and highest intraluminal venous pressure (full distension range are mainly determined by genetic factors (58%.Our study has shown substantial heritability of IJV biomechanics at higher venous pressures even after adjustment for age and gender. These findings yield an important insight to what degree the geometric and elastic properties of the vascular wall are formed by genetic and by environmental factors in humans.

  17. Diagnosis of venous disorders; A challenge for the radiologist. Die radiologische Diagnostik von Venenerkrankungen; Eine Herausforderung

    Energy Technology Data Exchange (ETDEWEB)

    Minar, E. (Abt. Angiologie, Universitaetsklinik fuer Innere Medizin 2, Vienna (Austria))

    1993-09-01

    Limited accuracy in the clinic diagnosis of deep vein thrombosis (VT) makes such diagnostic tests such as duplex sonography or venography necessary. Exact information on the age and extent of the thrombus are necessary for the clinician to optimize the therapeutric management. The correct diagnosis of calf vein thrombosis and of recurrent VT in patients with postphlebitis changes also has implications for treatment. After exclusion of thrombosis, the radiologist should evaluate the leg for other possible causes of symptoms besides VT. Investigation of the venous sytem also has a role in the diagnosis in patients with suspected pulmonary embolism. In patients with chronic venous insuffficiency the deep venous system should assessed for patency and venous valve function. The superficial veins should be differentiated in segments with sufficient or insufficient venous valves, and it is also necessary to look for insufficiency of the perforrating veins. In patients with superficial phlebitis there is risk of propagation into the deep venous system. (orig.)

  18. Cyber Security for the Spaceport Command and Control System: Vulnerability Management and Compliance Analysis

    Science.gov (United States)

    Gunawan, Ryan A.

    2016-01-01

    With the rapid development of the Internet, the number of malicious threats to organizations is continually increasing. In June of 2015, the United States Office of Personnel Management (OPM) had a data breach resulting in the compromise of millions of government employee records. The National Aeronautics and Space Administration (NASA) is not exempt from these attacks. Cyber security is becoming a critical facet to the discussion of moving forward with projects. The Spaceport Command and Control System (SCCS) project at the Kennedy Space Center (KSC) aims to develop the launch control system for the next generation launch vehicle in the coming decades. There are many ways to increase the security of the network it uses, from vulnerability management to ensuring operating system images are compliant with securely configured baselines recommended by the United States Government.

  19. Toward a food service quality management system for compliance with the Mediterranean dietary model.

    Science.gov (United States)

    Grigoroudis, Evangelos; Psaroudaki, Antonia; Diakaki, Christina

    2013-01-01

    The traditional diet of Cretan people in the 1960s is the basis of the Mediterranean dietary model. This article investigates the potential of this model to inspire proposals of meals by food-serving businesses, and suggests a methodology for the development of a quality management system, which will certify the delivery of food service according to this dietary model. The proposed methodology is built upon the principles and structure of the ISO 9001:2008 quality standard to enable integration with other quality, environmental, and food safety management systems.

  20. 40 CFR 141.26 - Monitoring frequency and compliance requirements for radionuclides in community water systems.

    Science.gov (United States)

    2010-07-01

    ... identified in the finished water. (iii) Annual monitoring for strontium-90 and tritium shall be conducted by... requirements for radionuclides in community water systems. 141.26 Section 141.26 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS (CONTINUED) NATIONAL PRIMARY DRINKING WATER...

  1. 75 FR 57191 - Compliance With Interstate Motor Carrier Noise Emission Standards: Exhaust Systems

    Science.gov (United States)

    2010-09-20

    ... 28, 1975, the Federal Highway Administration (FHWA)'s Bureau of Motor Carrier Safety published in the... DEPARTMENT OF TRANSPORTATION Federal Motor Carrier Safety Administration 49 CFR Part 325 [Docket...: Exhaust Systems AGENCY: Federal Motor Carrier Safety Administration, DOT. ACTION: Direct final rule...

  2. The Implications of Integrating Governance, Risk and Compliance in Business Intelligence Systems on Corporate Performance Management

    NARCIS (Netherlands)

    J.J. Madlener (Jos)

    2009-01-01

    textabstractThe last decade organizations have understood more and more the importance of enforcing achievement of the goals defined by their strategy through metrics-driven management. The data warehousing process in Business Intelligence Systems, though supporting bottomup extraction of

  3. Systemic Policy Compliance in a Multi-Jurisdictional Defence Program - Defence Suppliers Perspective

    Science.gov (United States)

    2010-11-01

    Organisation Based Access Control (OrBAC) [4] systems start new grounds in leveraging outcome of social and organisational sciences (and not...and convey these attributes to the resource domain, using a standard identity-federation protocol;  An enterprise directory is used to repose user

  4. NEC Hazardous classification and compliance regarding the surface moisture monitor measurement system

    International Nuclear Information System (INIS)

    Bussell, J.H.

    1996-01-01

    The National Electrical Code, NFPA 70, and National Fire Protection Association requirements for use of Surface Moisture Monitor Systems in classified locations are discussed. The design and configuration of the surface moisture monitor are analyzed with respect to how they comply with requirements of the National Electrical Code requirements, articles 500-504

  5. Media rating systems: do they work? Shop floor compliance with age restrictions in the Netherlands

    NARCIS (Netherlands)

    Gosselt, Jordi Franciscus; van Hoof, Joris Jasper; de Jong, Menno D.T.

    2012-01-01

    Media rating systems have been introduced in many countries to protect minors from being exposed to harmful media content. This study examines whether retailers comply with the guidelines of media ratings in the Netherlands. In a mystery shopping study, minors tried to buy or rent media products for

  6. 32 CFR 806b.30 - Evaluating information systems for Privacy Act compliance.

    Science.gov (United States)

    2010-07-01

    ... privacy issues are unchanged. (d) The depth and content of the Privacy Impact Assessment should be... 32 National Defense 6 2010-07-01 2010-07-01 false Evaluating information systems for Privacy Act... FORCE ADMINISTRATION PRIVACY ACT PROGRAM Privacy Impact Assessments § 806b.30 Evaluating information...

  7. Visualization of coronary venous anatomy by cardiovascular magnetic resonance

    Directory of Open Access Journals (Sweden)

    Crean Andrew

    2009-08-01

    Full Text Available Abstract Background Coronary venous imaging with whole-heart cardiovascular magnetic resonance (CMR angiography has recently been described using developmental pulse sequences and intravascular contrast agents. However, the practical utility of coronary venous imaging will be for patients with heart failure in whom cardiac resynchronisation therapy (CRT is being considered. As such complementary information on ventricular function and myocardial viability will be required. The aim of this study was to determine if the coronary venous anatomy could be depicted as part of a comprehensive CMR protocol and using a standard extracellular contrast agent. Methods and Results Thirty-one 3D whole heart CMR studies, performed after intravenous administration of 0.05 mmol/kg gadolinium DTPA, were reviewed. The cardiac venous system was visualized in all patients. The lateral vein of the left ventricle was present in 74%, the anterior interventricular vein in 65%, and the posterior interventricular vein in 74% of patients. The mean maximum distance of demonstrable cardiac vein on the 3D images was 81.5 mm and was dependent on the quality of the 3D data set. Five patients showed evidence of myocardial infarction on late gadolinium enhancement (LGE images. Conclusion Coronary venous anatomy can be reliably demonstrated using a comprehensive CMR protocol and a standard extracellular contrast agent. The combination of coronary venous imaging, assessment of ventricular function and LGE may be useful in the management of patients with LV dysfunction being considered for CRT.

  8. Endovascular treatment of intracranial venous sinus thrombosis

    International Nuclear Information System (INIS)

    Xu Shubin; Liang Zhihui; Cui Jinguo; Tian Huiqin; Li Liang; Chen Feng

    2009-01-01

    Objective: To evaluate the clinical efficacy and safety of endovascular treatment for intracranial venous sinus thrombosis. Methods: Ten patients with intracranial venous sinus thrombosis, confirmed by CT, MRI, MRV and / or DSA and encountered during the period of Aug. 2005-Aug. 2007, were treated with endovascular management after they failed to respond to anticoagulant therapy. Of ten patients, intravenous thrombolysis and mechanical thrombus maceration were carried out in 6, while intravenous thrombolysis, mechanical thrombus maceration together with intra-arterial thrombolysis were employed in 4. After the treatment, the anticoagulant therapy continued for 6 months. The patients were followed up for 12-29 months (mean 21 months). Results: After the treatment, the clinical symptoms and signs were completely or partially relieved in eight patients, including disappearance of headache (n=6) and relive of headache (n=2). No obvious improvement was found in one patient and linguistic function disturbance was seen in the remaining one. Lumbar puncture showed that the cerebrospinal fluid pressure returned to normal in all patients. Neither recurrence of thrombosis nor new symptom of neuralgic dysfunction was observed. No procedure-related intracranial or systemic hemorrhagic complications occurred both during and after the operation. Conclusion: Endovascular treatment is an effective and safe procedure for the potentially catastrophic intracranial venous thrombosis. (authors)

  9. Wear-Time Compliance with a Dual-Accelerometer System for Capturing 24-h Behavioural Profiles in Children and Adults

    Directory of Open Access Journals (Sweden)

    Scott Duncan

    2018-06-01

    Full Text Available To advance the field of time-use epidemiology, a tool capable of monitoring 24 h movement behaviours including sleep, physical activity, and sedentary behaviour is needed. This study explores compliance with a novel dual-accelerometer system for capturing 24 h movement patterns in two free-living samples of children and adults. A total of 103 children aged 8 years and 83 adults aged 20-60 years were recruited. Using a combination of medical dressing and purpose-built foam pouches, participants were fitted with two Axivity AX3 accelerometers—one to the thigh and the other to the lower back—for seven 24 h periods. AX3 accelerometers contain an inbuilt skin temperature sensor that facilitates wear time estimation. The median (IQR wear time in children was 160 (67 h and 165 (79 h (out of a maximum of 168 h for back and thigh placement, respectively. Wear time was significantly higher and less variable in adults, with a median (IQR for back and thigh placement of 168 (1 and 168 (0 h. A greater proportion of adults (71.6% achieved the maximum number of complete days when compared to children (41.7%. We conclude that a dual-accelerometer protocol using skin attachment methods holds considerable promise for monitoring 24-h movement behaviours in both children and adults.

  10. Organizational performance and regulatory compliance as measured by clinical pertinence indicators before and after implementation of Anesthesia Information Management System (AIMS).

    Science.gov (United States)

    Choi, Clark K; Saberito, Darlene; Tyagaraj, Changa; Tyagaraj, Kalpana

    2014-01-01

    Previous studies have suggested that electronic medical records (EMR) can lead to a greater reduction of medical errors and better adherence to regulatory compliance than paper medical records (PMR). In order to assess the organizational performance and regulatory compliance, we tracked different clinical pertinence indicators (CPI) in our anesthesia information management system (AIMS) for 5 years. These indicators comprised of the protocols from the Surgical Care Improvement Project (SCIP), elements of performance (EP) from The Joint Commission (TJC), and guidelines from the Centers for Medicare and Medicaid Services (CMS). A comprehensive AIMS was initiated and the CPI were collected from October 5, 2009 to December 31, 2010 (EMR period) and from January 1, 2006 to October 4, 2009 (PMR period). Fourteen CPI were found to be common between the EMR and PMR periods. Based on the statistical analysis of the 14 common CPI, there was a significant increase (p < 0.001) in overall compliance after the introduction of EMR compared to the PMR period. The increase in overall compliance was significantly progressive (p = 0.013) from year to year over 2006 and 2010. Of the 14 CPI, Documentation of a) medication doses, and b) monitoring of postoperative physiological status, mental status, and pain scores showed significant improvement (p < 0.001) during the EMR period compared to the PMR period.

  11. Autonomous rehabilitation at stroke patients home for balance and gait: safety, usability and compliance of a virtual reality system.

    Science.gov (United States)

    Held, Jeremia P; Ferrer, Begoña; Mainetti, Renato; Steblin, Alexander; Hertler, Benjamin; Moreno-Conde, Alberto; Dueñas, Alvaro; Pajaro, Marta; L-Parra-Calderón, Carlos; Vargiu, Eloisa; Zarco, Maria J; Barrera, Maria; Echevarria, Carmen; Jódar-Sánchez, Francisco; Luft, Andreas R; Borghese, Nunzio A

    2017-09-25

    New technologies, such as telerehabilitation and gaming devices offer the possibility for patients to train at home. This opens the challenge of safety for the patient as he is called to exercise neither with a therapist on the patients' side nor with a therapist linked remotely to supervise the sessions. To study the safety, usability and patient acceptance of an autonomous telerehabilitation system for balance and gait (the REWIRE platform) in the patients home. Cohort study. Community, in the stroke patients' home. 15 participants with first-ever stroke, with a mild to moderate residual deficit of the lower extremities. Autonomous rehabilitation based on virtual rehabilitation was provided at the participants' home for twelve weeks. The primary outcome was compliance (the ratio between days of actual and scheduled training), analysed with the two-tailed Wilcoxon Mann- Whitney test. Furthermore safety is defined by adverse events. The secondary endpoint was the acceptance of the system measured with the Technology Acceptance Model. Additionally, the cumulative duration of weekly training was analysed. During the study there were no adverse events related to the therapy. Patients performed on average 71% (range 39 to 92%) of the scheduled sessions. The Technology Acceptance Model Questionnaire showed excellent values for stroke patients after the training. The average training duration per week was 99 ±53min. Autonomous telerehabilitation for balance and gait training with the REWIRE-system is safe, feasible and can help to intensive rehabilitative therapy at home. Telerehabilitation enables safe training in home environment and supports of the standard rehabilitation therapy.

  12. Venous pump of the calf: a study of venous and muscular pressures.

    Science.gov (United States)

    Alimi, Y S; Barthelemy, P; Juhan, C

    1994-11-01

    Little data are available concerning the relation between the muscular pumping mechanism and the variation of superficial and deep venous pressure during normal action of the calf pump; therefore we undertook this study to determine the pressure values in three compartments of the calf and in the deep and the superficial venous system and to establish correlation between muscular and venous pressure. Nine healthy young women with a mean age of 23 years (range 19 to 28 years) were examined. In the same calf, a muscular catheter was placed in the deep posterior compartment (DPC), in the superficial posterior compartment (SPC), and in the anterior tibial compartment (ATC), and a vascular catheter was placed in the popliteal vein and in the greater saphenous vein (GSV). The five lines of pressure were simultaneously recorded in the following situations: at rest, during Valsalva maneuver, foot flexion, and foot extension. The situation was studied with the patient in the following positions: decubitus, sitting, standing, and squatting. A final continuous recording was carried out after the patient had been walking for 5 minutes. Mean values with standard errors of muscular and venous pressure were established in each situation. At rest and during Valsalva maneuver, the muscular pressures did not vary, whereas venous pressures increased significantly when the patient was sitting and standing. On the other hand, squatting was associated with a rise in the muscular and vein pressures. Foot flexion entailed a significant increase in the ATC pressure and a rise in the GSV pressure, whereas foot extension caused the DPC pressure to rise without venous pressure modifications. Walking was associated with an alternating increase in the DPC, SPC, GSV and popliteal vein pressures when the foot was compressed to floor followed by a significant decrease when the foot pressure was released. The variations in the deep and superficial venous pressures when the patient is sitting and

  13. Integrated Safeguards Information System for Japan (ISIS-J) - Strengthening SSAC for Enhancing Confidence in Compliance with Safeguards Obligations -

    International Nuclear Information System (INIS)

    Iso, S.; Nishiyama, N.; Kumakura, S.; Takizawa, K.; Yoshida, H.; Kobayashi, I.; Kikuchi, M.; Kimura, N.; Matsubara, T.; Yatsu, S.

    2010-01-01

    IAEA has stated the importance of enhancing cooperation with SSAC. Therefore, Japan has developed the Integrated Safeguards Information System for enhancing confidence in compliance with the national obligation under the safeguards agreement and the additional protocol. Japan already established the National System including national inspections with NDA and DA verification functions and evaluation of data obtained from national inspections and has maintained the National System of safeguards as a SSAC in accordance with the safeguards agreement. Nuclear Material Control Center (NMCC) is engaged in national safeguards activities as designated organization of national inspectorate and information treatment including safeguards data analysis. Recently, purpose of IAEA's safeguards activities may shift to detection of proliferation based on plausible proliferation paths from detection of diversion by certain material accountancy measures. Major safeguards activities of IAEA have changed from quantitative aspects to qualitative them. As supplements for declining the quantitative measures such as the activities based on the safeguards criteria the IAEA would expect the SSAC functions for maintaining the activities of quantitative manners. Japan believes that the State's responsibility for enhancing cooperation between the National System and the IAEA must assure the confidence level of correctness and completeness of the State declarations with accurate and precise accountability as findings from SSAC. Japan has started the development of the strengthened and autonomous national system namely the Integrated safeguards Information System for Japan (ISIS-J) in order to fulfil our responsibility. Japan would seek to improve quality of information including nuclear material accounting data as well as expanded declaration relevant to nuclear activities in Japan, and to increase abilities for explaining safeguards relevant events in Japan. The enhanced findings could include

  14. Anatomical features of venous outflow from rat’s reproductive organs

    Directory of Open Access Journals (Sweden)

    N. A. Nikitin

    2012-01-01

    Full Text Available The venous drainage from reproductive organs of rats is described; new data on peculiarities of the venous drainage are obtained.Objects of study were adult Wistar white rats (20 animals. The animals have passed precision dissection of vessels in order to study anatomic peculiarities of venous drainage from the left spermary in male rats and internal genital organs in female rats in norm. It has been shown that the venous drainage from the left spermary follows the spermatic vein entering into the pampiniform plexus system, which continues into the single venous trunk, which, in its turn, divides into the ascending and descending veins. The descending vein runs into the common left iliac vein, while the ascending vein runs into the renal vein. The venous drainage from female reproductive organs follows through the uterine vein, which, taking the tubal and spermatic veins, runs from the left into the left renal vein and from the right into the caudal vena cava.

  15. Agent Architectures for Compliance

    Science.gov (United States)

    Burgemeestre, Brigitte; Hulstijn, Joris; Tan, Yao-Hua

    A Normative Multi-Agent System consists of autonomous agents who must comply with social norms. Different kinds of norms make different assumptions about the cognitive architecture of the agents. For example, a principle-based norm assumes that agents can reflect upon the consequences of their actions; a rule-based formulation only assumes that agents can avoid violations. In this paper we present several cognitive agent architectures for self-monitoring and compliance. We show how different assumptions about the cognitive architecture lead to different information needs when assessing compliance. The approach is validated with a case study of horizontal monitoring, an approach to corporate tax auditing recently introduced by the Dutch Customs and Tax Authority.

  16. Environmental Cost Analysis System (ECAS) Status and Compliance Requirements for EM Consolidated Business Center Contracts - 13204

    International Nuclear Information System (INIS)

    Sanford, P.C.; Moe, M.A.; Hombach, W.G.; Urdangaray, R.

    2013-01-01

    The Department of Energy (DOE) Office of Environmental Management (EM) has developed a web-accessible database to collect actual cost data from completed EM projects to support cost estimating and analysis. This Environmental Cost Analysis System (ECAS) database was initially deployed in early 2009 containing the cost and parametric data from 77 decommissioning, restoration, and waste management projects completed under the Rocky Flats Closure Project. In subsequent years we have added many more projects to ECAS and now have a total of 280 projects from 8 major DOE sites. This data is now accessible to DOE users through a web-based reporting tool that allows users to tailor report outputs to meet their specific needs. We are using it as a principal resource supporting the EM Consolidated Business Center (EMCBC) and the EM Applied Cost Engineering (ACE) team cost estimating and analysis efforts across the country. The database has received Government Accountability Office review as supporting its recommended improvements in DOE's cost estimating process, as well as review from the DOE Office of Acquisition and Project Management (APM). Moving forward, the EMCBC has developed a Special Contract Requirement clause or 'H-Clause' to be included in all current and future EMCBC procurements identifying the process that contractors will follow to provide DOE their historical project data in a format compatible with ECAS. Changes to DOE O 413.3B implementation are also in progress to capture historical costs as part of the Critical Decision project closeout process. (authors)

  17. RBAC-Matrix-based EMR right management system to improve HIPAA compliance.

    Science.gov (United States)

    Lee, Hung-Chang; Chang, Shih-Hsin

    2012-10-01

    Security control of Electronic Medical Record (EMR) is a mechanism used to manage electronic medical records files and protect sensitive medical records document from information leakage. Researches proposed the Role-Based Access Control(RBAC). However, with the increasing scale of medical institutions, the access control behavior is difficult to have a detailed declaration among roles in RBAC. Furthermore, with the stringent specifications such as the U.S. HIPAA and Canada PIPEDA etc., patients are encouraged to have the right in regulating the access control of his EMR. In response to these problems, we propose an EMR digital rights management system, which is a RBAC-based extension to a matrix organization of medical institutions, known as RBAC-Matrix. With the aim of authorizing the EMR among roles in the organization, RBAC-Matrix also allow patients to be involved in defining access rights of his records. RBAC-Matrix authorizes access control declaration among matrix organizations of medical institutions by using XrML file in association with each EMR. It processes XrML rights declaration file-based authorization of behavior in the two-stage design, called master & servant stage, thus makes the associated EMR to be better protected. RBAC-Matrix will also make medical record file and its associated XrML declaration to two different EMRA(EMR Authorization)roles, namely, the medical records Document Creator (DC) and the medical records Document Right Setting (DRS). Access right setting, determined by the DRS, is cosigned by the patient, thus make the declaration of rights and the use of EMR to comply with HIPAA specifications.

  18. Microbiological Status and Food Safety Compliance of Commercial Basil Production Systems.

    Science.gov (United States)

    de Bruin, Willeke; Otto, Denise; Korsten, Lise

    2016-01-01

    Basil has been implicated in a number of microbe-associated foodborne illnesses across the world, and the source of contamination has often been traced back to the production and/or processing stages of the supply chain. The aim of this study was to evaluate the microbiological quality of fresh basil from the point of production to the retail outlet in the Gauteng and Northwest Provinces of South Africa. A total of 463 samples were collected over a 3-month period from two large-scale commercial herb producing and processing companies and three retail outlets. The microbiological quality of the samples was assessed based on the presence or absence of Escherichia coli O157:H7 and Salmonella Typhimurium and the levels of the indicator bacteria E. coli and total coliforms. Salmonella Typhimurium was detected on four basil samples (0.9%) arriving at the processing facility and at dispatch, but no E. coli O157:H7 was detected throughout the study. Total coliform counts were 0.4 to 4.1 CFU/g for basil, 1.9 to 3.4 log CFU/ml for water, and 0.2 to 1.7 log CFU/cm(2) for contact surfaces, whereas E. coli was detected in the water samples and only once on basil. The Colilert-18 and membrane filter methods were used to analyze water samples, and a comparison of results revealed that the Colilert-18 method was more sensitive. Strong evidence suggests that high numbers of coliforms do not necessarily indicate the presence of Salmonella Typhimurium. The study results highlight the importance of effective implementation of food safety management systems in the fresh produce industry.

  19. Environmental Cost Analysis System (ECAS) Status and Compliance Requirements for EM Consolidated Business Center Contracts - 13204

    Energy Technology Data Exchange (ETDEWEB)

    Sanford, P.C. [Consultant, 11221 E. Cimmarron Dr., Englewood, CO 80111 (United States); Moe, M.A. [EMCBC Office of Cost Estimating and Analysis, United States Department of Energy, 250 E. 5th Street, Suite 500, Cincinnati, OH 45202 (United States); Hombach, W.G. [Team Analysis, Inc., 2 Cardinal Park Drive, Suite 105A, Leesburg, VA 20175 (United States); Urdangaray, R. [Project Performance Corporation, 1760 Old Meadow Road, McLean, VA 22102 (United States)

    2013-07-01

    The Department of Energy (DOE) Office of Environmental Management (EM) has developed a web-accessible database to collect actual cost data from completed EM projects to support cost estimating and analysis. This Environmental Cost Analysis System (ECAS) database was initially deployed in early 2009 containing the cost and parametric data from 77 decommissioning, restoration, and waste management projects completed under the Rocky Flats Closure Project. In subsequent years we have added many more projects to ECAS and now have a total of 280 projects from 8 major DOE sites. This data is now accessible to DOE users through a web-based reporting tool that allows users to tailor report outputs to meet their specific needs. We are using it as a principal resource supporting the EM Consolidated Business Center (EMCBC) and the EM Applied Cost Engineering (ACE) team cost estimating and analysis efforts across the country. The database has received Government Accountability Office review as supporting its recommended improvements in DOE's cost estimating process, as well as review from the DOE Office of Acquisition and Project Management (APM). Moving forward, the EMCBC has developed a Special Contract Requirement clause or 'H-Clause' to be included in all current and future EMCBC procurements identifying the process that contractors will follow to provide DOE their historical project data in a format compatible with ECAS. Changes to DOE O 413.3B implementation are also in progress to capture historical costs as part of the Critical Decision project closeout process. (authors)

  20. Effect of beta-adrenergic blockade on elevated arterial compliance and low systemic vascular resistance in cirrhosis

    DEFF Research Database (Denmark)

    Møller, Søren; Bendtsen, Flemming; Henriksen, Jens Henrik

    2001-01-01

    with beta-blockers, but the effect of this treatment on arterial compliance has not been investigated. The aim of the present study was therefore to assess the effects of propranolol on the arterial compliance of patients with cirrhosis. METHODS: Twenty patients with cirrhosis underwent a haemodynamic......) of 17.8 mmHg, and responded to beta-blocker treatment with a significant reduction in the HVPG (-16%; P beta-adrenergic blockade (1.27 versus 1.29 ml/mmHg, +2%, ns), whereas...... with beta-blockers increases small vessel (arteriolar) vascular tone towards the normal level, but does not affect the elevated compliance of the larger arteries in patients with cirrhosis....

  1. Surgical management of venous malformations.

    Science.gov (United States)

    Loose, D A

    2007-01-01

    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.

  2. ERM 593 Applied Project_Guidance for Reviewing and Approving a Waste Stream Profile in the Waste Compliance and Tracking System_Final_05-05-15

    Energy Technology Data Exchange (ETDEWEB)

    Elicio, Andy U. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-05-05

    My ERM 593 applied project will provide guidance for the Los Alamos National Laboratory Waste Stream Profile reviewer (i.e. RCRA reviewer) in regards to Reviewing and Approving a Waste Stream Profile in the Waste Compliance and Tracking System. The Waste Compliance and Tracking system is called WCATS. WCATS is a web-based application that “supports the generation, characterization, processing and shipment of LANL radioactive, hazardous, and industrial waste.” The LANL generator must characterize their waste via electronically by filling out a waste stream profile (WSP) in WCATS. Once this process is completed, the designated waste management coordinator (WMC) will perform a review of the waste stream profile to ensure the generator has completed their waste stream characterization in accordance with applicable state, federal and LANL directives particularly P930-1, “LANL Waste Acceptance Criteria,” and the “Waste Compliance and Tracking System User's Manual, MAN-5004, R2,” as applicable. My guidance/applied project will describe the purpose, scope, acronyms, definitions, responsibilities, assumptions and guidance for the WSP reviewer as it pertains to each panel and subpanel of a waste stream profile.

  3. Venous abnormalities demonstrated by computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Ishikawa, T; Tsukune, Y; Ashida, H; Tokuda, M; Oyama, Y [St. Marianna Univ., Kawasaki, Kanagawa (Japan). School of Medicine

    1980-05-01

    CT is capable of demonstrating various venous changes. However, little have been described on this subject in the literature. Examples of various venous abnormalities such as obstructed jugular vein, superior and inferior vena cava (IVC), tumor invasion of IVC and renal vein and venous changes in portal hypertension were presented. It was stressed that noninvasive CT is a good tool in diagnosis of some of venous changes and may be able to eliminate angiography in such cases.

  4. Colorectal cancer with venous tumor thrombosis

    OpenAIRE

    Kensuke Otani; Soichiro Ishihara; Keisuke Hata; Koji Murono; Kazuhito Sasaki; Koji Yasuda; Takeshi Nishikawa; Toshiaki Tanaka; Tomomichi Kiyomatsu; Kazushige Kawai; Hiroaki Nozawa; Hironori Yamaguchi; Toshiaki Watanabe

    2018-01-01

    Summary: Colorectal cancer is seldom accompanied by venous tumor thrombosis, and little is known about the features of venous tumor thrombosis in colorectal cancer. However, some reports show that colorectal cancer patients can develop venous tumor thrombosis and warn clinicians not to overlook this complication. In this report, we perform a review of 43 previously reported cases and investigate the characteristics of colorectal cancer accompanied by venous tumor thrombosis. The histological ...

  5. Environmental Compliance Guide. Guidance manual for Department of Energy compliance with the Clean Water Act: National Pollutant Discharge Elimination System (NPDES)

    Energy Technology Data Exchange (ETDEWEB)

    1982-07-01

    This manual provides general guidance for Department of Energy (DOE) officials for complying with Sect. 402 of the Clean Water Act (CWA) of 1977 and amendments. Section 402 authorizes the US Environmental Protection Agency (EPA) or states with EPA approved programs to issue National Pollutant Discharge Elimination System (NPDES) permits for the direct discharge of waste from a point source into waters of the United States. Although the nature of a project dictates the exact information requirements, every project has similar information requirements on the environmental setting, type of discharge(s), characterization of effluent, and description of operations and wastewater treatment. Additional information requirements for projects with ocean discharges, thermal discharges, and cooling water intakes are discussed. Guidance is provided in this manual on general methods for collecting, analyzing, and presenting information for an NPDES permit application. The NPDES program interacts with many sections of the CWA; therefore, background material on pertinent areas such as effluent limitations, water quality standards, toxic substances, and nonpoint source pollutants is included in this manual. Modifications, variances, and extensions applicable to NPDES permits are also discussed.

  6. Year 2000 Compliance of Selected Mission Critical Command, Control, and Communications Systems Managed by The Defense Information Systems Agency

    National Research Council Canada - National Science Library

    1999-01-01

    ...) has adequately planned for and managed year 2000 conversion risks to avoid undue disruption to selected mission critical command, control, and communications systems used in support of Unified...

  7. Racial differences in venous thromboembolism.

    Science.gov (United States)

    Zakai, N A; McClure, L A

    2011-10-01

    The incidence of venous thrombosis (VTE) varies by race, with African-Americans having over 5-fold greater incidence than Asian-ancestry populations, and an intermediate risk for European and Hispanic populations. Known racial differences in genetic polymorphisms associated with thrombosis do not account for this gradient of risk, nor do known racial variations in environmental risk factors. Data on the incidence of and risk factors for VTE outside of Europe and North America and in non-European ancestry populations are sparse. Common genetic polymorphisms in European-Ancestry populations, such as factor V Leiden and prothrombin G20210A, and environmental risk factors, such as obesity, may account for some of the increased risk in European populations, and high factor VIII, high von Willebrand factor and low protein C levels and increased prevalence of obesity may explain some of the increased risk in African-Americans. The low rates in Asian populations may be partially explained by low clinical suspicion in a perceived low-risk population and lack of access to healthcare in other populations. As risk factors for thrombosis, such as surgery and treatment for cancer, are applicable to more people, as obesity increases in prevalence in the developing world, and as surveillance systems for VTE improve, VTE may increase in previously low-risk populations. While differences in VTE by race due to genetic predisposition will probably always be present, understanding the reasons for racial differences in VTE will help providers develop strategies to minimize VTE in all populations. © 2011 International Society on Thrombosis and Haemostasis.

  8. Familial Clustering of Venous Thromboembolism

    DEFF Research Database (Denmark)

    Sindet-Pedersen, Caroline; Oestergaard, Louise Bruun; Gundlund, Anna

    2016-01-01

    BACKGROUND: Identification of risk factors for venous thromboembolism (VTE) is of utmost importance to improve current prophylactic regimes and treatment guidelines. The extent to which a family history contributes to the risk of VTE needs further exploration. OBJECTIVES: To examine the relative ...

  9. Venous thrombosis : a patient's view

    NARCIS (Netherlands)

    Korlaar, Inez van

    2006-01-01

    The studies described in this thesis had two main aims: 1) To study the quality of life of patients with venous thrombosis and to examine the role of illness perceptions in explaining the quality of life of these patients. 2) To assess the psychological consequences of genetic testing for

  10. Cutaneous lupus erythematosus and the risk of deep venous thrombosis and pulmonary embolism

    DEFF Research Database (Denmark)

    Ahlehoff, O; Wu, Jashin J; Raunsø, Jakob

    2017-01-01

    Background Venous thromboembolism (VTE) is a major public health concern. Lupus erythematosus (LE) is a chronic autoimmune disease ranging from localized cutaneous disease (CLE) to systemic involvement (SLE). Patients with SLE have an increased risk of venous thromboembolism (VTE), but little...

  11. Deep venous thrombosis and agenesis of the intrahepatic segment of inferior vena cava

    International Nuclear Information System (INIS)

    Velasco, J.; Fernandez, M.M.; Manzanares, R.; Hernando, A.

    1997-01-01

    We present a case of agenesis of the intrahepatic segment of inferior vena cava (IVC) with drainage through the azygos and hemiazygos systems. The presenting sign was deep venous thrombosis (DVT) in both lower extremities. The different imaging studies led to the diagnosis of both the congenital and acquired venous abnormalities, which are discussed. (Author) 14 refs

  12. 40 CFR 73.35 - Compliance.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 16 2010-07-01 2010-07-01 false Compliance. 73.35 Section 73.35... ALLOWANCE SYSTEM Allowance Tracking System § 73.35 Compliance. (a) Allowance transfer deadline. No allowance... in § 73.34(a) of this part, the Administrator will deduct allowances for each source with excess...

  13. Venous and arterial thrombosis: Two aspects of the same disease?

    Directory of Open Access Journals (Sweden)

    Paolo Prandoni

    2009-01-01

    Full Text Available Paolo PrandoniDepartment of Cardiothoracic and Vascular Sciences, Thromboembolism Unit, University Hospital of Padua Padua, ItalyAbstract: An increasing body of evidence suggests the likelihood of a link between venous and arterial thrombosis. The two vascular complications share several risk factors, such as age, obesity, diabetes mellitus, blood hypertension, hypertriglyceridemia, and metabolic syndrome. Moreover, there are many examples of conditions accounting for both venous and arterial thrombosis, such as the antiphospholipid antibody syndrome, hyperhomocysteinemia, malignancies, infections, and the use of hormonal treatment. Finally, several recent studies have consistently shown that patients with venous thromboembolism are at a higher risk of arterial thrombotic complications than matched control individuals. We, therefore, speculate the two vascular complications are simultaneously triggered by biological stimuli responsible for activating coagulation and inflammatory pathways in both the arterial and the venous system. Future studies are needed to clarify the nature of this association, to assess its extent, and to evaluate its implications for clinical practice.Keywords: venous thromboembolism, deep vein thrombosis, pulmonary embolism, myocardial infarction, ischemic stroke, atherosclerosis

  14. High arterial compliance in cirrhosis is related to low adrenaline and elevated circulating calcitonin gene related peptide but not to activated vasoconstrictor systems

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl; Møller, S; Schifter, S

    2001-01-01

    catecholamines, renin activity, endothelin-1, and calcitonin gene related peptide (CGRP) at baseline and during oxygen inhalation. RESULTS: COMP(art) was significantly increased in cirrhotic patients compared with controls (1.32 v 1.06 ml/mm Hg; padrenaline levels (r=-0.......001) and central circulation time (r=-0.49; padrenaline (-16%; p... to COMP(art) disappeared. The relation of COMP(art) to CGRP and circulatory variables remained unchanged. CONCLUSION: Elevated arterial compliance in cirrhosis is related to low adrenaline, high CGRP, and systemic hyperdynamics but not to indicators of the activated vasoconstrictor systems (noradrenaline...

  15. [An update on the treatment of venous insufficiency in pregnancy].

    Science.gov (United States)

    Rodríguez-Nora, B; Álvarez-Silvares, E

    Chronic venous insufficiency is a long-term pathological condition resulting from anatomical or functional alterations of the venous system. This leads to the appearance of symptoms and physical signs that affect a large part of the population and particularly pregnant women, due to the physiology of pregnancy. The few published studies on the use of pharmacological treatments of venous insufficiency in this group of the population, often makes the management of this condition difficult in routine clinical practice. A review is presented in this article, with all the latest updates in the treatment of this condition during pregnancy. There are numerous general, and some pharmacological, recommendations, that we can safely offer the pregnant patient. Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  16. Endovascular therapy for chronic cerebrospinal venous insufficiency in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Marc A. Lazzaro

    2011-07-01

    Full Text Available Recent reports have emerged suggesting that multiple sclerosis (MS may be due to abnormal venous outflow from the central nervous system, termed Chronic Cerebrospinal Venous Insufficiency (CCSVI. These reports have generated strong interest and controversy over the prospect of a treatable cause of this chronic debilitating disease. This review aims to describe the proposed association between CCSVI and MS, summarize the current data, and discuss the role of endovascular therapy and the need for rigorous randomized clinical trials to evaluate this association and treatment.

  17. Deadline Compliance Status Reports

    Data.gov (United States)

    Department of Housing and Urban Development — These monthly Deadline Compliance Status Reports assist Participating Jurisdictions and HUD Field Offices in monitoring compliance with the 2-year commitment and...

  18. Venous sinus stenting for pseudotumour cerebri with venous sinus stenosis

    International Nuclear Information System (INIS)

    Chen Huairui; Bai Rulin; Wu Xiaojun; Qi Xiangqian; Mei Qiyong; Lu Yicheng

    2011-01-01

    Objective: To explore the relation between venous sinus stenosis and pseduotumour cerebri and to discuss the efficacy and strategy of venous sinus stenting for its treatment. Methods: Venous sinus stenting was performed in a total of 9 patients with pseudotumour cerebri accompanied by dural sinus stenosis. The clinical data, including the clinical presentations, intracranial pressure, angiographic findings, pressure of dural sinus,methods of treatment and the therapeutic results, were retrospectively analyzed. Results: Bilateral disc edema was seen in all patients. The pressure gradient in the lateral sinuses was obviously high before stenting (22.67±7.25)mmHg in all patients and a reduction in intra-sinus pressure and pressure gradient was also found (5.78±3.77)mmHg. The symptoms associated with intracranial hypertension were gradually improved or disappeared in two weeks after the placement of the stent in all cases, and the intracranial pressure dropped evidently (12.78±5.97)cm H 2 O. Vision was improved in 7 cases at three months, whereas it remained poor in 2 cases despite normalized intracranial pressure. There was no other permanent procedure-related morbidity. The patients were followed up for 3 months to 5 years, and no recurrence developed. Conclusion: Lateral sinus stenting is an effective method for the treatment of pseudotumour cerebri with dural sinus stenosis. (authors)

  19. Radiologically-placed venous ports in children under venous anesthesia

    International Nuclear Information System (INIS)

    Jang, Joo Yeon; Jeon, Ung Bae; Choo, Ki Seok; Hwang, Jae Yeon; Kim, Yong Woo; Lee, Yun Jin; Nam, Sang Ool; Lim, Young Tak

    2015-01-01

    To evaluate the efficacy and safety of radiologic venous port placement in children under venous anesthesia. Between April 2009 and July 2011, 44 ports were implanted in 41 children (24 boys, 17 girls). The age of patients ranged from 9 months to 19 years (mean, 6.5 years) and their body weights ranged from 6.8 kg to 56.3 kg (mean, 23.2 kg). Right internal jugular vein access was used in 42 ports, right subclavian vein in 1, and left subclavian in 1. Durability and complications of port implantation were reviewed. The technical success rate was 100%. The catheter life was 10-661 days (mean 246 days). Two patients died during the follow-up period, 21 and 6 ports were removed at the end of treatment or as a result of complications, respectively. One port was removed and replaced by a Hickmann catheter. Three ports were explanted due to port-related sepsis, one due to a catheter kink, and two for unexplained fever or insertion site pain. The overall port-related infection was 3 cases (6.8%, 0.28/1000 catheter days). Venous port placement by interventional radiologists in children under intravenous sedation is relatively safe, with a high rate of technical success and low rate of complications.

  20. Radiologically-placed venous ports in children under venous anesthesia

    Energy Technology Data Exchange (ETDEWEB)

    Jang, Joo Yeon; Jeon, Ung Bae; Choo, Ki Seok; Hwang, Jae Yeon; Kim, Yong Woo; Lee, Yun Jin; Nam, Sang Ool; Lim, Young Tak [Pusan National University School of Medicine, Yangsan (Korea, Republic of)

    2015-02-15

    To evaluate the efficacy and safety of radiologic venous port placement in children under venous anesthesia. Between April 2009 and July 2011, 44 ports were implanted in 41 children (24 boys, 17 girls). The age of patients ranged from 9 months to 19 years (mean, 6.5 years) and their body weights ranged from 6.8 kg to 56.3 kg (mean, 23.2 kg). Right internal jugular vein access was used in 42 ports, right subclavian vein in 1, and left subclavian in 1. Durability and complications of port implantation were reviewed. The technical success rate was 100%. The catheter life was 10-661 days (mean 246 days). Two patients died during the follow-up period, 21 and 6 ports were removed at the end of treatment or as a result of complications, respectively. One port was removed and replaced by a Hickmann catheter. Three ports were explanted due to port-related sepsis, one due to a catheter kink, and two for unexplained fever or insertion site pain. The overall port-related infection was 3 cases (6.8%, 0.28/1000 catheter days). Venous port placement by interventional radiologists in children under intravenous sedation is relatively safe, with a high rate of technical success and low rate of complications.

  1. Mixed Capillary Venous Retroperitoneal Hemangioma

    Directory of Open Access Journals (Sweden)

    Mohit Godar

    2013-01-01

    Full Text Available We report a case of mixed capillary venous hemangioma of the retroperitoneum in a 61-year-old man. Abdominal ultrasonography showed a mass to be hypoechoic with increased flow in color Doppler imaging. Dynamic contrast-enhanced computed tomography revealed a centripetal filling-in of the mass, located anterior to the left psoas muscle at the level of sacroiliac joint. On the basis of imaging features, preoperative diagnosis of hemangioma was considered and the mass was excised by laparoscopic method. Immunohistochemical studies were strongly positive for CD31 and CD34, and negative for calretinin, EMA, WT1, HMB45, Ki67, synaptophysin, and lymphatic endothelial cell marker D2–40. Histologically, the neoplasm was diagnosed as mixed capillary venous hemangioma.

  2. Validating the utilisation of venous bicarbonate as a predictor of ...

    African Journals Online (AJOL)

    Background. Crush injury secondary to sjambok beatings is a well-described phenomenon in southern Africa. Owing to a number of factors, it can result in acute kidney injury (AKI). In 1992, Muckart et al. described a risk stratification system using venous bicarbonate (VB) that can be used in the management of these ...

  3. Compression therapy in patients with venous leg ulcers.

    Science.gov (United States)

    Dissemond, Joachim; Assenheimer, Bernd; Bültemann, Anke; Gerber, Veronika; Gretener, Silvia; Kohler-von Siebenthal, Elisabeth; Koller, Sonja; Kröger, Knut; Kurz, Peter; Läuchli, Severin; Münter, Christian; Panfil, Eva-Maria; Probst, Sebastian; Protz, Kerstin; Riepe, Gunnar; Strohal, Robert; Traber, Jürg; Partsch, Hugo

    2016-11-01

    Wund-D.A.CH. is the umbrella organization of the various wound care societies in German-speaking countries. The present consensus paper on practical aspects pertinent to compression therapy in patients with venous leg ulcers was developed by experts from Germany, Austria, and Switzerland. In Europe, venous leg ulcers rank among the most common causes of chronic wounds. Apart from conservative and interventional wound and vein treatment, compression therapy represents the basis of all other therapeutic strategies. To that end, there are currently a wide variety of materials and systems available. While especially short-stretch bandages or multicomponent systems should be used in the initial decongestion phase, ulcer stocking systems are recommended for the subsequent maintenance phase. Another - to date, far less common - alternative are adaptive Velcro bandage systems. Medical compression stockings have proven particularly beneficial in the prevention of ulcer recurrence. The large number of treatment options currently available enables therapists to develop therapeutic concepts geared towards their patients' individual needs and abilities, thus resulting in good acceptance and adherence. Compression therapy plays a crucial role in the treatment of patients with venous leg ulcers. In recent years, a number of different treatment options have become available, their use and application differing among German-speaking countries. The present expert consensus is therefore meant to outline concrete recommendations for routine implementation of compression therapy in patients with venous leg ulcers. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

  4. MRI in venous thromboembolic disease

    International Nuclear Information System (INIS)

    Sostman, H.D.; Debatin, J.F.; Spritzer, C.E.; Coleman, R.E.; Grist, T.M.; MacFall, J.R.

    1993-01-01

    We evaluated the ability of magnetic resonance (MR) imaging to detect deep venous thrombosis (DVT) and pulmonary embolism (PE). MR venography was performed on 217 patients suspected of having DVT. Cine-MR imaging of the pulmonary arteries was performed in 14 other patients who were thought to have PE based on other imaging studies. In a third group of 5 patients, MR pulmonary angiograms were performed in the sagittal and coronal planes with a multislice fast gradient recalled echo technique. All but one of the 217 MR venograms were technically adequate. In 72 patients with correlative imaging studies (venography and ultrasound) MR venography was 99% sensitive and 95% specific. On the basis of follow-up (mean 8.3 months), no false-negative MR venograms were detected in an additional 64 patients. In 11 other patients MR revealed a diagnosis other than DVT. Cine-MR showed PE in all 14 patients evaluated. MR pulmonary arteriography demonstrated filling defects consistent with acute PE in 2 of 3 patients with acute PE; in the third patient only a questionable filling defect was seen. Coarctations or webs were found in the pulmonary arteries of both patients with chronic PE. These preliminary data suggest that MR imaging may be able to evaluate both the peripheral venous and the pulmonary arterial component of venous thromboembolic disease. Further technical refinement and more extensive clinical experience will be required to establish the role of this method in diagnosing pulmonary embolism, but MR venography is now used routinely in our hospital for the diagnosis of deep venous thrombosis. (orig.)

  5. Significance of venous anastomosis in fingertip replantation.

    Science.gov (United States)

    Hattori, Yasunori; Doi, Kazuteru; Ikeda, Keisuke; Abe, Yukio; Dhawan, Vikas

    2003-03-01

    Adequate venous outflow is the most important factor for successful fingertip replantation. The authors have attempted venous anastomosis in all cases of fingertip replantation to overcome postoperative congestion. In this article, the significance of venous repair for fingertip replantation is described from the authors' results of 64 complete fingertip amputations in 55 consecutive patients, which were replanted from January of 1996 to June of 2001. The overall survival rate was 86 percent. Of the 44 replantations in zone I, 37 survived, and the success rate was 84 percent. Of the 20 replantations in zone II, 18 survived, and the success rate was 90 percent. Venous anastomosis was attempted in all cases, but it was possible in 39 zone I and in all zone II replantations. For arterial repair, vein grafts were necessary in 17 of the 44 zone I and in one of the 20 zone II replantations; for venous repair, they were necessary in six zone I replantations and one zone II replantation. Postoperative vascular complications occurred in 15 replantations. There were five cases of arterial thrombosis and 10 cases of venous congestion. Venous congestion occurred in nine zone I and one zone II replantations. In five of these 10 replantations, venous anastomosis was not possible. In another five replantations, venous outflow was established at the time of surgery, but occlusion occurred subsequently. Except for the five failures resulting from arterial thrombosis, successful venous repair was possible in 49 of 59 replantations (83 percent). Despite the demand for skillful microsurgical technique and longer operation time, the authors' results using venous anastomosis in successful fingertip replantations are encouraging. By performing venous anastomosis, external bleeding can be avoided and a higher survival rate can be achieved. Venous anastomosis for fingertip replantation is a reliable and worthwhile procedure.

  6. Cerebral sino-venous thrombosis

    International Nuclear Information System (INIS)

    Sayama, Ichiro; Kobayashi, Tsunesaburo; Nakajima, Kenji

    1982-01-01

    Three cases of cerebral sino-venous thrombosis were reported. Repeated CT findings were studied and discussed on account of the treatments for those pathologic conditions. Those of studied cases are; a 22-year-old postpartum woman, a 42-year-old woman with irregular vaginal bleeding, and a 26-year-old man with severe reactive emesis after drinking alcohol. They were treated conservatively. Case 1 died in its acute stage. In the remaining ones, each had an uneventful recovery. CT scan findings of them manifested their exact clinical conditions. These findings were devided into two categories, one was direct signs expressed sino-venous occlusion, the other was indirect signs which appeared as a result of these occlusion. Direct signs cannot always get in every cases with sino-venous occlusion, but as for indirect signs, we can get various changes corresponding to the time taken CT photoes, and they are useful to decide appropriate treatments at that time. Considering suitable treatments for this disease, it is necessary to select most suitable ones according to their pathologic conditions, which may be precisely drawn with CT scans. (J.P.N.)

  7. Placement of a Port Catheter Through Collateral Veins in a Patient with Central Venous Occlusion

    International Nuclear Information System (INIS)

    Teichgraeber, Ulf Karl-Martin; Streitparth, Florian; Gebauer, Bernhard; Benter, Thomas

    2010-01-01

    Long-term utilization of central venous catheters (CVCs) for parenteral nutrition has a high incidence of central venous complications including infections, occlusions, and stenosis. We report the case of a 31-year-old woman presenting with a malabsorption caused by short gut syndrome due to congenital aganglionic megacolon. The patient developed a chronic occlusion of all central neck and femoral veins due to long-term use of multiple CVCs over more than 20 years. In patients with central venous occlusion and venous transformation, the implantation of a totally implanted port system by accessing collateral veins is an option to continue long-term parenteral nutrition when required. A 0.014-in. Whisper guidewire (Terumo, Tokyo) with high flexibility and steerability was chosen to maneuver and pass through the collateral veins. We suggest this approach to avoid unfavorable translumbar or transhepatic central venous access and to conserve the anatomically limited number of percutaneous access sites.

  8. Computed tomographic characteristics of collateral venous pathways in dogs with caudal vena cava obstruction.

    Science.gov (United States)

    Specchi, Swan; d'Anjou, Marc-André; Carmel, Eric Norman; Bertolini, Giovanna

    2014-01-01

    Collateral venous pathways develop in dogs with obstruction or increased blood flow resistance at any level of the caudal vena cava in order to maintain venous drainage to the right atrium. The purpose of this retrospective study was to describe the sites, causes of obstruction, and configurations of venous collateral pathways for a group of dogs with caudal vena cava obstruction. Computed tomography databases from two veterinary hospitals were searched for dogs with a diagnosis of caudal vena cava obstruction and multidetector row computed tomographic angiographic (CTA) scans that included the entire caudal vena cava. Images for each included dog were retrieved and collateral venous pathways were characterized using image postprocessing and a classification system previously reported for humans. A total of nine dogs met inclusion criteria and four major collateral venous pathways were identified: deep (n = 2), portal (n = 2), intermediate (n = 7), and superficial (n = 5). More than one collateral venous pathway was present in 5 dogs. An alternative pathway consisting of renal subcapsular collateral veins, arising mainly from the caudal pole of both kidneys, was found in three dogs. In conclusion, findings indicated that collateral venous pathway patterns similar to those described in humans are also present in dogs with caudal vena cava obstruction. These collateral pathways need to be distinguished from other vascular anomalies in dogs. Postprocessing of multidetector-row CTA images allowed delineation of the course of these complicated venous pathways and may be a helpful adjunct for treatment planning in future cases. © 2014 American College of Veterinary Radiology.

  9. Evaluation of hand hygiene compliance and associated factors with a radio-frequency-identification-based real-time continuous automated monitoring system.

    Science.gov (United States)

    Dufour, J-C; Reynier, P; Boudjema, S; Soto Aladro, A; Giorgi, R; Brouqui, P

    2017-04-01

    Hand hygiene is a major means for preventing healthcare-associated infections. One critical point in understanding poor compliance is the lack of relevant markers used to monitor practices systematically. This study analysed hand hygiene compliance and associated factors with a radio-frequency-identification-based real-time continuous automated monitoring system in an infectious disease ward with 17 single bedrooms. Healthcare workers (HCWs) were tracked while performing routine care over 171 days. A multi-level multi-variate logistics model was used for data analysis. The main outcome measures were hand disinfection before entering the bedroom (outside use) and before entering the patient care zone, defined as the zone surrounding the patient's bed (inside/bedside use). Variables analysed included HCWs' characteristics and behaviour, patients, room layouts, path chains and duration of HCWs' paths. In total, 4629 paths with initial hand hygiene opportunities when entering the patient care zone were selected, of which 763 (16.5%), 285 (6.1%) and 3581 (77.4%) were associated with outside use, inside/bedside use and no use, respectively. Hand hygiene is caregiver-dependent. The shorter the duration of the HCW's path, the worse the bedside hand hygiene. Bedside hand hygiene is improved when one or two extra HCWs are present in the room. Hand hygiene compliance at the bedside, as analysed using the continuous monitoring system, depended upon the HCW's occupation and personal behaviour, number of HCWs, time spent in the room and (potentially) dispenser location. Meal tray distribution was a possible factor in the case of failure to disinfect hands. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  10. Compliance als Schutz vor Verbandsverantwortlichkeit?

    Directory of Open Access Journals (Sweden)

    Alexander Tipold

    2016-05-01

    Full Text Available Compliance bedeutet nicht nur Einhaltung und Beachtung von Vorschriften, sondern betrifft auch Maßnahmen, die die Einhaltung der Rechtsnormen absichern sollen und läuft somit auf eine Übererfüllung von Verpflichtungen hinaus. Wenn es keinen klaren Maßstab für Kontroll- und Überwachungspflichten gibt, besteht die Gefahr, dass Strafverfolgungsbehörden die Compliance-Maßnahmen als Maßstab heranziehen und so eine Verschärfung der Pflichten erzeugen. Nach den Regeln des Verbandsverantwortlichkeitsgesetzes schließt im Übrigen das beste Compliance-System nicht zwingend die Verbandsverantwortlichkeit aus, steht aber unter Umständen einem Verfahren gegen den Verband entgegen.

  11. Comparison between radiation exposure levels using an image intensifier and a flat-panel detector-based system in image-guided central venous catheter placement in children weighing less than 10 kg

    Energy Technology Data Exchange (ETDEWEB)

    Miraglia, Roberto; Maruzzelli, Luigi; Cortis, Kelvin; Gerasia, Roberta; Maggio, Simona; Luca, Angelo [Diagnostic and Therapeutic Services, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo (Italy); Piazza, Marcello [Department of Anesthesia, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo (Italy); Tuzzolino, Fabio [Department of Information Technology, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo (Italy)

    2014-09-10

    Ultrasound-guided central venous puncture and fluoroscopic guidance during central venous catheter (CVC) positioning optimizes technical success and lowers the complication rates in children, and is therefore considered standard practice. The purpose of this study was to compare the radiation exposure levels recorded during CVC placement in children weighing less than 10 kg in procedures performed using an image intensifier-based angiographic system (IIDS) to those performed in a flat-panel detector-based interventional suite (FPDS). A retrospective review of 96 image-guided CVC placements, between January 2008 and October 2013, in 49 children weighing less than 10 kg was performed. Mean age was 8.2 ± 4.4 months (range: 1-22 months). Mean weight was 7.1 ± 2.7 kg (range: 2.5-9.8 kg). The procedures were classified into two categories: non-tunneled and tunneled CVC placement. Thirty-five procedures were performed with the IIDS (21 non-tunneled CVC, 14 tunneled CVC); 61 procedures were performed with the FPDS (47 non-tunneled CVC, 14 tunneled CVC). For non-tunneled CVC, mean DAP was 113.5 ± 126.7 cGy cm{sup 2} with the IIDS and 15.9 ± 44.6 cGy . cm{sup 2} with the FPDS (P < 0.001). For tunneled CVC, mean DAP was 84.6 ± 81.2 cGy . cm{sup 2} with the IIDS and 37.1 ± 33.5 cGy cm{sup 2} with the FPDS (P = 0.02). The use of flat-panel angiographic equipment reduces radiation exposure in small children undergoing image-guided CVC placement. (orig.)

  12. Is there a link between the structural impact of thoracic outlet and the development of central venous stenosis?

    Science.gov (United States)

    Kotoda, Atsushi; Akimoto, Tetsu; Sugase, Taro; Yamamoto, Hisashi; Kusano, Eiji

    2013-01-01

    Central venous stenosis (CVS) is a serious complication for chronic hemodialysis (HD) patients. Previous reports of CVS have focused on prior central venous catheterization, because of the higher prevalence and potential for prevention of such an event. However, recent studies have demonstrated that CVS may also develop without a history of central venous catheterization. Although information about the etiological backgrounds regarding the development of CVS without previous central venous catheterization have gradually accumulated, the clinical impact of the chronic compression of the central venous system by the surrounding structures, which may likely determine the central venous susceptibility to CVS, remains poorly understood. This study proposes the hypothesis that the combination of chronic venous compression at the level of thoracic outlet characterized by the natural physique and elevated venous flow induced by the creation of vascular access should be evaluated as a potential factor for the development of CVS, since they may accelerate the development of venous stenosis, presumably through the stimulation of intimal hyperplasia, and thereby the subclavian venous susceptibility to CVS should be determined. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Audit-based compliance control

    NARCIS (Netherlands)

    Cederquist, J.G.; Dimitrakos, T.; Corin, R.J.; Martinelli, F.; Ryan, P.Y.A.; Dekker, M.A.C.; Etalle, Sandro; Schneider, S.; den Hartog, Jeremy; Lenzini, Gabriele

    2007-01-01

    In this paper we introduce a new framework for controlling compliance to discretionary access control policies [Cederquist et al. in Proceedings of the International Workshop on Policies for Distributed Systems and Networks (POLICY), 2005; Corin et al. in Proceedings of the IFIP Workshop on Formal

  14. Context-aware compliance checking

    NARCIS (Netherlands)

    Werf, van der J.M.E.M.; Verbeek, H.M.W.; Aalst, van der W.M.P.; Barros, A.; Gal, A.; Kindler, E.

    2012-01-01

    Organizations face more and more the burden to show that their business is compliant with respect to many different boundaries. The activity of compliance checking is commonly referred to as auditing. As information systems supporting the organization’s business record their usage, process mining

  15. Femoral venous oxygen saturation is no surrogate for central venous oxygen saturation

    NARCIS (Netherlands)

    van Beest, Paul A.; van der Schors, Alice; Liefers, Henriëtte; Coenen, Ludo G. J.; Braam, Richard L.; Habib, Najib; Braber, Annemarije; Scheeren, Thomas W. L.; Kuiper, Michaël A.; Spronk, Peter E.

    2012-01-01

    Objective: The purpose of our study was to determine if central venous oxygen saturation and femoral venous oxygen saturation can be used interchangeably during surgery and in critically ill patients. Design: Prospective observational controlled study. Setting: Nonacademic university-affiliated

  16. Personal experience in the early diagnosis of deep venous thrombosis with the /sup 135/I-fibrinogen test

    Energy Technology Data Exchange (ETDEWEB)

    Diaz, G P; Vicente, A B; Mestre, A P; Iglesias, R S; Irijoa, V; Garcia-Bengochea, J B

    1973-01-01

    The results in the early diagnosis of various surgical patients with a high rate of deep venous thrombosis, using the /sup 125/I Fibrinogen Test are presented. A 22 percent incidence of thrombosis was found, and certain limitations have been noticed which make the test only ideal for the venous system distal to the inguinal area and in legs without recent surgical wounds. The real value of the test, as the earliest method for detecting silent venous thrombosis of the legs is emphasized.

  17. Clinicoroentgenological diagnosis of chronic venous ovarian insufficiency

    International Nuclear Information System (INIS)

    Grakova, L.S.; Galkin, E.V.; Naumova, E.B.

    1989-01-01

    The paper is devoted to clinicoroentgenological correlations of venous renogonadal hemodynamics in 168 women of reproductive age (151 women with infertility, habitual abortion, disordered menstrual function and 17 patients without disorders of the reproductive tract). Clinicolaboratory investigation was followed by visceral and parietal flebography for the detection of a pathological venous reflux into the ovarian pampiniform plexus. Clinicoroentgenological semiotics of chronic venous ovarian insufficiency was analyzed. Infertility was shown to be the main clinical manifestation of ovarian varicocele

  18. The Role of Inflammation in Venous Thromboembolism

    Directory of Open Access Journals (Sweden)

    Brian R. Branchford

    2018-05-01

    Full Text Available Venous thromboembolism (VTE, comprising deep vein thrombosis (DVT, and pulmonary embolism (PE, is becoming increasingly recognized as a cause of morbidity and mortality in pediatrics, particularly among hospitalized children. Furthermore, evidence is accumulating that suggests the inflammatory response may be a cause, as well as consequence, of VTE, but current anticoagulation treatment regimens are not designed to inhibit inflammation. In fact, many established clinical VTE risk factors such as surgery, obesity, cystic fibrosis, sepsis, systemic infection, cancer, inflammatory bowel disease, and lupus likely modulate thrombosis through inflammatory mediators. Unlike other traumatic mechanisms of thrombosis involving vascular transection and subsequent exposure of subendothelial collagen and other procoagulant extracellular matrix materials, inflammation of the vessel wall may initiate thrombosis on an intact vein. Activation of endothelial cells, platelets, and leukocytes with subsequent formation of microparticles can trigger the coagulation system through the induction of tissue factor (TF. Identification of biomarkers to evaluate VTE risk could be of great use to the clinician caring for a patient with inflammatory disease to guide decisions regarding the risk:benefit ratio of various types of potential thromboprophylaxis strategies, or suggest a role for anti-inflammatory therapy. Unfortunately, no such validated inflammatory scoring system yet exists, though research in this area is ongoing. Elevation of C-reactive protein, IL-6, IL-8, and TNF-alpha during a response to systemic inflammation have been associated with increased VTE risk. Consequent platelet activation enhances the prothrombotic state, leading to VTE development, particularly in patients with other risk factors, most notably central venous catheters.

  19. Diagnostic Indication for Venous Echo-Doppler of the Lower Limbs in the Diagnosis of Thromboembolic

    International Nuclear Information System (INIS)

    Bolado, A. G.; Barcena, M. V.; Cura, J. L. del; Gorrno, O.; Grande, D.

    2003-01-01

    To study the effectiveness of Doppler echography in the deep venous system of the lower limbs for deep venous thrombosis detection in patients suspected of having pulmonary thromboembolism. There were received 341 consecutive suspected pulmonary thromboembolism patients, all of whom were emergency room attended. All were submitted to CT pulmonary angiography in order to evaluate thrombus presence in the pulmonary tree. Without knowing the results of the previous exploration, we studied 301 of the patients using Doppler echography in deep venous system of the lower limbs in order to evaluate thrombus presence. In the group of CT-detected pulmonary thromboembolism patients, the percentage of Doppler echography-detected deep venous thrombosis was 46.3%, while in the group of non-detected patients this percentage decreased to 4.7%. Additional deep venous system exploration in clinically suspected pulmonary thiolcarbamate patients is useful, since it can increase the detection rate of venous thromboembolic disease, thereby leading to early treatment and prevention of the disease's manifestation in the lungs. Realization of Doppler echography is especially beneficial in those patients who exhibit no factors which predispose them to thromboembolic disease, as well as in patients who have previously had venous thrombosis. This exploration account for 4.7% of non-detected pulmonary embolism patients being added to the ranks of those with thromboembolic disease, an important percentage when taking into consideration the high pulmonary thromboembolism morbimortality rate. (Author) 30 refs

  20. Sustained compression and healing of chronic venous ulcers.

    Science.gov (United States)

    Blair, S. D.; Wright, D. D.; Backhouse, C. M.; Riddle, E.; McCollum, C. N.

    1988-01-01

    STUDY OBJECTIVE--Comparison of four layer bandage system with traditional adhesive plaster bandaging in terms of (a) compression achieved and (b) healing of venous ulcers. DESIGN--Part of larger randomised trial of five different dressings. SETTING--Outpatient venous ulcer clinic in university hospital. PATIENTS--(a) Pressure exerted by both bandage systems was measured in the same 20 patients. (b) Healing with the four layer bandage was assessed in 148 legs in 126 consecutive patients (mean age 71 (SE 2); range 30-96) with chronic venous ulcers that had resisted treatment with traditional bandaging for a mean of 27.2 (SE 8) months. INTERVENTIONS--(a) Four layer bandage system or traditional adhesive plaster bandaging for pressure studies; (b) four layer bandaging applied weekly for studies of healing. END POINTS--(a) Comparison of pressures achieved at the ankle for up to one week; (b) complete healing within 12 weeks. MEASUREMENTS AND MAIN RESULTS--(a) Four layer bandage produced higher initial pressures at the ankle of 42.5 (SE 1) mm Hg compared with 29.8 (1.8) for the adhesive plaster (p less than 0.001; 95% confidence interval 18.5 to 6.9). Pressure was maintained for one week with the four layer bandage but fell to 10.4 (3.5) mm Hg at 24 hours with adhesive plaster bandaging. (b) After weekly bandaging with the four layer bandage 110 of 48 venous ulcers had healed completely within 12 (mean 6.3 (0.4)) weeks. CONCLUSION--Sustained compression of over 40 mm Hg achieved with a multilayer bandage results in rapid healing of chronic venous ulcers that have failed to heal in many months of compression at lower pressures with more conventional bandages. PMID:3144330

  1. Computed tomography in deep venous thrombosis with limb oedema

    International Nuclear Information System (INIS)

    Seem, E.; Stranden, E.; Stiris, M.G.; Aker Sykehus, Oslo

    1985-01-01

    Computed tomography was used in 12 patients to investigate the distribution of oedema in the soft tissue compartments of lower limbs with deep venous thrombosis. Oedema was evenly distributed throughout the subcutis and the muscular compartments in tomograms obtained 25 cm proximal to the ankle. Significantly less swelling in the muscular compartments was found 10 cm proximal to the ankle. Interstitial fluid hydrostatic pressure was measured in the subcutis, and in anterior and posterior muscular compartments, and was significantly increased in all cases. Except for one case, the recorded pressures were well below 30 mmHg, which is considered the limit above which compartment syndromes occur. Tissue compliance was significantly lower in muscular compartments than in the subcutis. (orig.)

  2. Mapping Tax Compliance

    DEFF Research Database (Denmark)

    Boll, Karen

    2014-01-01

    Tax compliance denotes the act of reporting and paying taxes in accordance with the tax laws. Current social science scholarship on tax compliance can almost entirely be divided into behavioural psychology analyses and critical tax studies. This article, which presents two cases of how tax...... compliance is constructed, challenges the explanatory reaches of today's social science approaches, arguing that an alternative approach to understanding tax compliance is worthwhile exploring. This other choice of approach, inspired by actor–network theory (ANT), adopts a more practice-oriented focus...... that studies tax compliance where it takes place as well as what it is made of. Consequently, this article argues that tax compliance is a socio-material assemblage and that complying is a distributed action. The article concludes by highlighting how an ANT approach contributes to the further theoretical...

  3. Hyperthyroidism and cerebral venous thrombosis.

    Science.gov (United States)

    Mouton, S; Nighoghossian, N; Berruyer, M; Derex, L; Philippeau, F; Cakmak, S; Honnorat, J; Hermier, M; Trouillas, P

    2005-01-01

    The demonstration of an underlying prothrombotic condition in cerebral venous thrombosis (CVT) may have important practical consequences in terms of prevention. Thyrotoxicosis through a hypercoagulable state may be a predisposing factor for CVT. The authors present the cases of 4 patients who developed CVT and hyperthyroidism. At the acute stage, hyperthyroidism was associated with an increase in factor VIII (FVIII). At follow-up, FVIII level remained increased in 2 patients. Hyperthyroidism may have an impact on FVIII level. Accordingly in patients with hyperthyroidism and neurological symptoms, the diagnosis of CVT should be considered and an exhaustive coagulation screening may be appropriate. (c) 2005 S. Karger AG, Basel.

  4. EPA Enforcement and Compliance History Online: ICIS-NPDES Limit

    Data.gov (United States)

    U.S. Environmental Protection Agency — Integrated Compliance Information System (ICIS) National Pollutant Discharge Elimination System (NPDES) Permit Limits data set for Clean Water Act permitted...

  5. Development of Needle Insertion Manipulator for Central Venous Catheterization

    Science.gov (United States)

    Kobayashi, Yo; Hong, Jaesung; Hamano, Ryutaro; Hashizume, Makoto; Okada, Kaoru; Fujie, Masakatsu G.

    Central venous catheterization is a procedure, which a doctor insert a catheter into the patient’s vein for transfusion. Since there are risks of bleeding from arterial puncture or pneumothorax from pleural puncture. Physicians are strictly required to make needle reach up into the vein and to stop the needle in the middle of vein. We proposed a robot system for assisting the venous puncture, which can relieve the difficulties in conventional procedure, and the risks of complication. This paper reports the design structuring and experimental results of needle insertion manipulator. First, we investigated the relationship between insertion force and angle into the vein. The results indicated that the judgment of perforation using the reaction force is possible in case where the needling angle is from 10 to 20 degree. The experiment to evaluate accuracy of the robot also revealed that it has beyond 0.5 mm accuracy. We also evaluated the positioning accuracy in the ultrasound images. The results displays that the accuracy is beyond 1.0 mm and it has enough for venous puncture. We also carried out the venous puncture experiment to the phantom and confirm our manipulator realized to make needle reach up into the vein.

  6. Pulmonary venous abnormalities encountered on pre ...

    African Journals Online (AJOL)

    Multidetector computed tomography (MDCT) elegantly renders pulmonary venous anatomy. With increasing numbers of radiofrequency ablation procedures being performed, there is now a greater emphasis on pre-procedure imaging to delineate this anatomy. Pulmonary venous mapping studies can be performed with or ...

  7. REVIEW ARTICLE Venous thromboembolism associated with ...

    Indian Academy of Sciences (India)

    Navya

    2017-03-24

    Mar 24, 2017 ... Venous thromboembolism associated with protein S deficiency due to ... 2 Institute of Cardiology, Jagiellonian University Medical College, Kraków, Poland ... It has been long recognized that reduced PS activity is a risk factor for venous ... 1988). Sequencing of PROS1 gene intensified studies of genotype-.

  8. Sex-specific aspects of venous thrombosis

    NARCIS (Netherlands)

    Roach, Rachel Elizabeth Jo

    2014-01-01

    Venous thrombosis is a disease that occurs in 1-2 per 1000 people per year. At the time of their first venous thrombosis, approximately 50% of women are exposed to reproductive risk factors (oral contraception, postmenopausal hormone therapy, pregnancy and the puerperium). In this thesis, we showed

  9. Venous Thromboembolism in Patients With Thrombocytopenia

    DEFF Research Database (Denmark)

    Bælum, Jens Kristian; Ellingsen Moe, Espen; Nybo, Mads

    2017-01-01

    BACKGROUND: Venous thromboembolism (VTE) is a frequent and potentially lethal condition. Venous thrombi are mainly constituted of fibrin and red blood cells, but platelets also play an important role in VTE formation. Information about VTE in patients with thrombocytopenia is, however, missing. O...... having thrombocytopenia with VTE seem to be safely treated with anticoagulants without increased occurrence of bleeding....

  10. Risk factors for venous thromboembolism during pregnancy

    DEFF Research Database (Denmark)

    Jensen, Thomas Bo; Gerds, Thomas Alexander; Grøn, Randi

    2013-01-01

    Pregnant women are at an increased risk of venous thromboembolism (VTE). Risk factors for VTE among pregnant women are not sufficiently investigated.......Pregnant women are at an increased risk of venous thromboembolism (VTE). Risk factors for VTE among pregnant women are not sufficiently investigated....

  11. Clinical quality indicators of venous leg ulcers

    DEFF Research Database (Denmark)

    Kjaer, Monica L; Mainz, Jan; Soernsen, Lars T

    2005-01-01

    In the clinical setting, diagnosis and treatment of venous leg ulcers can vary considerably from patient to patient. The first step to reducing this variation is to document venous leg ulcer care through use of quantitative scientific documentation principles. This requires the development of val...

  12. Congenital portosystemic venous connections and other abdominal venous abnormalities in patients with polysplenia and functionally univentricular heart disease: a case series and literature review.

    Science.gov (United States)

    McElhinney, Doff B; Marx, Gerald R; Newburger, Jane W

    2011-01-01

    Published case reports suggest that congenital portosystemic venous connections (PSVC) and other abdominal venous anomalies may be relatively frequent and potentially important in patients with polysplenia syndrome. Our objective was to investigate the frequency and range of portal and other abdominal systemic venous anomalies in patients with polysplenia and inferior vena cava (IVC) interruption who underwent a cavopulmonary anastomosis procedure at our center, and to review the published literature on this topic and the potential clinical importance of such anomalies. Retrospective cohort study and literature review were used. Among 77 patients with heterotaxy, univentricular heart disease, and IVC interruption who underwent a bidirectional Glenn and/or modified Fontan procedure, pulmonary arteriovenous malformations were diagnosed in 33 (43%). Bilateral superior vena cavas were present in 42 patients (55%). Despite inadequate imaging in many patients, a partial PSVC, dual IVCs, and/or renal vein anomalies were detected in 15 patients (19%). A PSVC formed by a tortuous vessel running from the systemic venous system to the extrahepatic portal vein was found in six patients (8%). Abdominal venous anomalies other than PSVC were documented in 13 patients (16%), including nine (12%) with some form of duplicated IVC system, with a large azygous vein continuing to the superior vena cava and a parallel, contralateral IVC of similar or smaller size, and seven with renal vein anomalies. In patients with a partial PSVC or a duplicate IVC that connected to the atrium, the abnormal connection allowed right-to-left shunting. PSVC and other abdominal venous anomalies may be clinically important but under-recognized in patients with IVC interruption and univentricular heart disease. In such patients, preoperative evaluation of the abdominal systemic venous system may be valuable. More data are necessary to determine whether there is a pathophysiologic connection between the

  13. Corporate compliance: framework and implementation.

    Science.gov (United States)

    Fowler, N

    1999-01-01

    The federal government has created numerous programs to combat fraud and abuse. The government now encourages healthcare facilities to have a corporate compliance program (CCP), a plan that reduces the chances that the facility will violate laws or regulations. A CCP is an organization-wide program comprised of a code of conduct and written policies, internal monitoring and auditing standards, employee training, feedback mechanisms and other features, all designed to prevent and detect violations of governmental laws, regulations and policies. It is a system or method ensuring that employees understand and will comply with laws that apply to what they do every day. Seven factors, based on federal sentencing guidelines, provide the framework for developing a CCP. First, a facility must establish rules that are reasonably capable of reducing criminal conduct. Second, high-level personnel must oversee the compliance effort. Third, a facility must use due care in delegating authority in the compliance initiative. Fourth, standards must be communicated effectively to employees, and fifth, a facility must take reasonable steps to achieve compliance. Sixth, standards must be enforced consistently across the organization and last, standards must be modified or changed for reported concerns, to ensure they are not repeated. PROMINA Health System, Inc. in Atlanta, Ga., designed a program to meet federal guidelines. It started with a self-assessment to define its areas or risk. Next, it created the internal structure and assigned organizational responsibility for running the CCP. PROMINA then developed standards of business and professional conduct, established vehicles of communication and trained employees on the standards. Finally, it continues to develop evidence of the program's effectiveness by monitoring and documenting its compliance activities.

  14. Improving patient safety during insertion of peripheral venous catheters: an observational intervention study

    Directory of Open Access Journals (Sweden)

    Kampf, Günter

    2013-11-01

    Full Text Available [english] Background: Peripheral venous catheters are frequently used in hospitalized patients but increase the risk of nosocomial bloodstream infection. Evidence-based guidelines describe specific steps that are known to reduce infection risk. However, the degree of guideline implementation in clinical practice is not known. The aim of this study was to determine the use of specific steps for insertion of peripheral venous catheters in clinical practice and to implement a multimodal intervention aimed at improving both compliance and the optimum order of the steps.Methods: The study was conducted at University Hospital Hamburg. An optimum procedure for inserting a peripheral venous catheter was defined based on three evidence-based guidelines (WHO, CDC, RKI including five steps with 1A or 1B level of evidence: hand disinfection before patient contact, skin antisepsis of the puncture site, no palpation of treated puncture site, hand disinfection before aseptic procedure, and sterile dressing on the puncture site. A research nurse observed and recorded procedures for peripheral venous catheter insertion for healthcare workers in four different departments (endoscopy, central emergency admissions, pediatrics, and dermatology. A multimodal intervention with 5 elements was established (teaching session, dummy training, e-learning tool, tablet and poster, and direct feedback, followed by a second observation period. During the last observation week, participants evaluated the intervention.Results: In the control period, 207 insertions were observed, and 202 in the intervention period. Compliance improved significantly for four of five steps (e.g., from 11.6% to 57.9% for hand disinfection before patient contact; p<0.001, chi-square test. Compliance with skin antisepsis of the puncture site was high before and after intervention (99.5% before and 99.0% after. Performance of specific steps in the correct order also improved (e.g., from 7.7% to 68

  15. Choices that increase compliance

    International Nuclear Information System (INIS)

    Edwards, P.R.

    1991-01-01

    A compliance model is developed and tested using a survey of corporate officials and the regulatory arena of equal employment opportunity. Findings support the economic model of compliance in its conclusion that probability of detection and probable level of sanctions influence compliance decisions. Results also indicate that adjustments to the model that account for bounded rationality are valid. The key outcome, however, is that although all types of investigations play some role in enhancing compliance, those that stress sanctions and thus severity rather than certainty of detection may have the greatest positive influence on compliance. Enforcement programs attempting to operate simply as investigators of small-scale complaints will have less success than those with different types of investigations or a balanced type of single investigation. The results also suggest a more complex cognitive process on the part of regulated individuals than initially theorized. 34 refs., 3 tabs

  16. Can Courts Make Federalism Work? A Game Theory Approach to Court-Induced Compliance and Defection in Federal Systems

    Directory of Open Access Journals (Sweden)

    Gemma Sala

    2014-12-01

    Full Text Available Few studies on federalism analyze the role of courts as safeguards of the federal arrangement, and those that do tend to be too optimistic about what courts can do. This article analyzes the effect of judicial review on the interaction between the central and a regional government in a federation in order to understand the conditions under which courts may or may not enforce compliance with federalism. It argues that politicians of either level of government anticipate the likelihood of a judicial challenge and an eventual veto, and it finds distinct equilibria in the interaction between central and regional governments (imposition, auto-limitation, negotiation and litigation. Only under auto-limitation do courts effectively prevent transgressions to the federal arrangement. In all other scenarios, defection may take place despite the presence of courts. These findings show that as the court’s jurisprudence becomes more solid and defined, the chances for governments to successfully exceed their powers increase. Not only do transgressions take place despite the presence of the court, but because of it.

  17. Evaluation of performance, acceptance, and compliance of an auto-injector in healthy and rheumatoid arthritic subjects measured by a motion capture system.

    Science.gov (United States)

    Xiao, Xiao; Li, Wei; Clawson, Corbin; Karvani, David; Sondag, Perceval; Hahn, James K

    2018-01-01

    The study aimed to develop a motion capture system that can track, visualize, and analyze the entire performance of self-injection with the auto-injector. Each of nine healthy subjects and 29 rheumatoid arthritic (RA) patients with different degrees of hand disability performed two simulated injections into an injection pad while six degrees of freedom (DOF) motions of the auto-injector and the injection pad were captured. We quantitatively measured the performance of the injection by calculating needle displacement from the motion trajectories. The max, mean, and SD of needle displacement were analyzed. Assessments of device acceptance and usability were evaluated by a survey questionnaire and independent observations of compliance with the device instruction for use (IFU). A total of 80 simulated injections were performed. Our results showed a similar level of performance among all the subjects with slightly larger, but not statistically significant, needle displacement in the RA group. In particular, no significant effects regarding previous experience in self-injection, grip method, pain in hand, and Cochin score in the RA group were found to have an impact on the mean needle displacement. Moreover, the analysis of needle displacement for different durations of injections indicated that most of the subjects reached their personal maximum displacement in 15 seconds and remained steady or exhibited a small amount of increase from 15 to 60 seconds. Device acceptance was high for most of the questions (ie, >4; >80%) based on a 0-5-point scale or percentage of acceptance. The overall compliance with the device IFU was high for the first injection (96.05%) and reached 98.02% for the second injection. We demonstrated the feasibility of tracking the motions of injection to measure the performance of simulated self-injection. The comparisons of needle displacement showed that even RA patients with severe hand disability could properly perform self-injection with this

  18. No association of abnormal cranial venous drainage with multiple sclerosis: a magnetic resonance venography and flow-quantification study

    NARCIS (Netherlands)

    Wattjes, M.P.; van Oosten, B.W.; de Graaf, W.L.; Seewann, A.M.; Bot, J.C.J.; van den Berg, R.; Uitdehaag, B.M.J.; Polman, C.H.; Barkhof, F.

    2011-01-01

    Background: Recent studies using colour-coded Doppler sonography showed that chronic impaired venous drainage from the central nervous system is almost exclusively found in multiple sclerosis (MS) patients. This study aimed to investigate the intracranial and extracranial venous anatomy and the

  19. No association of abnormal cranial venous drainage with multiple sclerosis: a magnetic resonance venography and flow-quantification study

    NARCIS (Netherlands)

    Wattjes, Mike P.; van Oosten, Bob W.; de Graaf, Wolter L.; Seewann, Alexandra; Bot, Joseph C. J.; van den Berg, René; Uitdehaag, Bernard M. J.; Polman, Chris H.; Barkhof, Frederik

    2011-01-01

    Recent studies using colour-coded Doppler sonography showed that chronic impaired venous drainage from the central nervous system is almost exclusively found in multiple sclerosis (MS) patients. This study aimed to investigate the intracranial and extracranial venous anatomy and the intracerebral

  20. Implementation of a closed-loop reporting system for critical values and clinical communication in compliance with goals of the joint commission.

    Science.gov (United States)

    Parl, Fritz F; O'Leary, Mandy F; Kaiser, Allen B; Paulett, John M; Statnikova, Kristina; Shultz, Edward K

    2010-03-01

    Current practices of reporting critical laboratory values make it challenging to measure and assess the timeliness of receipt by the treating physician as required by The Joint Commission's 2008 National Patient Safety Goals. A multidisciplinary team of laboratorians, clinicians, and information technology experts developed an electronic ALERTS system that reports critical values via the laboratory and hospital information systems to alphanumeric pagers of clinicians and ensures failsafe notification, instant documentation, automatic tracking, escalation, and reporting of critical value alerts. A method for automated acknowledgment of message receipt was incorporated into the system design. The ALERTS system has been applied to inpatients and eliminated approximately 9000 phone calls a year made by medical technologists. Although a small number of phone calls were still made as a result of pages not acknowledged by clinicians within 10 min, they were made by telephone operators, who either contacted the same physician who was initially paged by the automated system or identified and contacted alternate physicians or the patient's nurse. Overall, documentation of physician acknowledgment of receipt in the electronic medical record increased to 95% of critical values over 9 months, while the median time decreased to communication by developing an electronic system for reporting of critical values that is in compliance with The Joint Commission's goals.

  1. [Venous catheter-related infections].

    Science.gov (United States)

    Ferrer, Carmen; Almirante, Benito

    2014-02-01

    Venous catheter-related infections are a problem of particular importance, due to their frequency, morbidity and mortality, and because they are potentially preventable clinical processes. At present, the majority of hospitalized patients and a considerable number of outpatients are carriers of these devices. There has been a remarkable growth of knowledge of the epidemiology of these infections, the most appropriate methodology for diagnosis, the therapeutic and, in particular, the preventive strategies. Multimodal strategies, including educational programs directed at staff and a bundle of simple measures for implementation, applied to high-risk patients have demonstrated great effectiveness for their prevention. In this review the epidemiology, the diagnosis, and the therapeutic and preventive aspects of these infections are updated. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  2. Variations in gastric compliance induced by acute blood volume changes in anesthetized rats

    Directory of Open Access Journals (Sweden)

    Graça J.R.V.

    2002-01-01

    Full Text Available The impact of acute volume imbalances on gastric volume (GV was studied in anesthetized rats (250-300 g. After cervical and femoral vessel cannulation, a balloon catheter was positioned in the proximal stomach. The opposite end of the catheter was connected to a barostat with an electronic sensor coupled to a plethysmometer. A standard ionic solution was used to fill the balloon (about 3.0 ml and the communicating vessel system, and to raise the reservoir liquid level 4 cm above the animals' xiphoid appendix. Due to constant barostat pressure, GV values were considered to represent the gastric compliance index. All animals were monitored for 90 min. After a basal interval, they were randomly assigned to normovolemic, hypervolemic, hypovolemic or restored protocols. Data were compared by ANOVA followed by Bonferroni's test. Mean arterial pressure (MAP, central venous pressure (CVP and GV values did not change in normovolemic animals (N = 5. Hypervolemic animals (N = 12 were transfused at 0.5 ml/min with a suspension of red blood cells in Ringer-lactate solution with albumin (12.5 ml/kg, which reduced GV values by 11.3% (P0.05. MAP and CVP values increased (P<0.05 after hypervolemia but decreased (P<0.05 with hypovolemia. In conclusion, blood volume level modulates gastric compliance, turning the stomach into an adjustable reservoir, which could be part of the homeostatic process to balance blood volume.

  3. Compliance and Enforcement Actions (CEA) -

    Data.gov (United States)

    Department of Transportation — Compliance and Enforcement Actions application provides process assistance / improvements for conducting investigation and enforcement activities. The Compliance and...

  4. [Evaluation of the Charing Cross Venous Ulcer Questionnaire in patients with chronic venous ulcers in Uruguay].

    Science.gov (United States)

    Tafernaberry, Gabriela; Otero, Gabriela; Agorio, Caroline; Dapueto, Juan J

    2016-01-01

    Chronic venous ulcers (CVU) represent a frequent condition, with difficult therapeutic approaches, that impact on patients’ quality of life, and generate an economic burden to patients and health systems. To perform the cultural adaptation and initial evaluation of the Charing Cross Venous Ulcer Questionnaire (CCVUQ) for Uruguay, and to study the health-related quality of life (HRQL) of patients with CVU. The translated and culturally adapted version of the CCVUQ was applied to a convenience sample of 50 patients. In addition, the PROMIS Global Health Survey was included in the assessment. Both questionnaires showed good internal consistency (Cronbach alfa > 0.70). A statistically significant association was observed between the CCVUQ total scores, its subscales and both dimensions of the PROMIS: Global Physical (GPH) and Global Mental Health (GMH) (rho ≥ 0.40). The CCVUQ mean score was 54.9 ± 42 points while GPH and GMH mean scores were 37.9 ± 29 points, and 43.1 ± 35.1 points respectively. Simple linear regression showed that patients with higher income reported better emotional well-being, while in younger patients, ulcers had a higher impact on Emotional Status and Cosmetics. The translated and adapted version of the CCVUQ was easy to comprehend and apply, showing good psychometric properties. When used in association with the PROMIS Global Health Measure it provides complementary information. HRQL was severely affected in the study sample.

  5. Visualization of venous vessels in cerebral arteriograms in various types of brain strokes

    International Nuclear Information System (INIS)

    Kruszewska, J.; Trzebicki, J.; Binkiewicz, M.

    1982-01-01

    1468 internal carotin angiograms including 945 performed in patients with strokes and 523 with brain tumours were analysed. Three phases were evaluated: arterial, middle and venous, directing attention to brain venous system filling in the arterial phase. Carotid arteriography carried out within 14 days after stroke onset visualizes early filling of the veins and this sign may be helpful in localizing the site brain damage. (author)

  6. Venous intravasation: a potential pitfall of confirmatory hysterosalpingogram following essure hysteroscopic sterilization.

    Science.gov (United States)

    Chang, Michael C; Shim, John J

    2012-09-01

    Indications for hysterosalpingography (HSG) include evaluation of infertility, spontaneous abortions, postoperative evaluation of tubal ligation, pre-myomectomy evaluation, and more recently, evaluation of tubal occlusion after placement of the Essure Permanent Birth Control System. Here we report a case of venous intravasation during a routine post-Essure HSG, a phenomenon in which contrast transits from the uterine cavity, through the myometrium, and directly into draining pelvic veins. Venous intravasation is a potential pitfall in interpretation of HSGs.

  7. Arterial and venous plasma levels of bupivacaine following epidural and intercostal nerve blocks.

    Science.gov (United States)

    Moore, D C; Mather, L E; Bridenbaugh, P O; Bridenbaugh, L D; Balfour, R I; Lysons, D F; Horton, W G

    1976-07-01

    Arterial and peripheral venous plasma levels of bupivacaine were determined in 30 patients following epidural anesthesia using 150 and 225 mg, as well as following intercostal nerve block with 400 mg. Arterial levels were consistently higher than levels in simultaneously sampled venous blood, and the highest levels occurred with bilateral intercostal nerve block. No evidence of systemic toxicity was observed. The results suggest that bupivacaine may have a wider margin of safety in man than is now stated.

  8. Central venous catheters: the role of radiology

    International Nuclear Information System (INIS)

    Tan, P.L.; Gibson, M.

    2006-01-01

    The insertion and management of long-term venous catheters have long been the province of anaesthetists, intensive care physicians and surgeons. Radiologists are taking an increasing role in the insertion of central venous catheters (CVCs) because of their familiarity with the imaging equipment and their ability to manipulate catheters and guide-wires. The radiological management of the complications of CVCs has also expanded as a result. This article reviews the role of radiology in central venous access, covering the detection and management of their complications

  9. Regulatory Enforcement and Compliance

    DEFF Research Database (Denmark)

    May, Peter J.; Winter, Søren

    1999-01-01

    This study of municipal enforcement of agro-environmental regulations in Denmark provides an empirical understanding of how enforcement affects compliance. A key contribution is sorting out the relative influence of inspectors' different styles of enforcement and choices made by enforcement...... agencies. The latter are shown to be more important in bringing about compliance than are inspectors' enforcement styles. Municipal agencies are shown to increase compliance through the use of third parties, more frequent inspection, and setting priorities for inspection of major items. The findings about...

  10. Improving adherence to venous thromoembolism prophylaxis using multiple interventions

    Directory of Open Access Journals (Sweden)

    Al-Tawfiq Jaffar

    2011-01-01

    Full Text Available Objective : In hospital, deep vein thrombosis (DVT increases the morbidity and mortality in patients with acute medical illness. DVT prophylaxis is well known to be effective in preventing venous thromoembolism (VTE. However, its use remains suboptimal. The objective of this study was to evaluate the impact of quality improvement project on adherence with VTE prophylaxis guidelines and on the incidence of hospital-acquired VTEs in medical patients. Methods : The study was conducted at Saudi Aramco Medical Services Organization from June 2008 to August 2009. Quality improvement strategies included education of physicians, the development of a protocol, and weekly monitoring of compliance with the recommendations for VTE prophylaxis as included in the multidisciplinary rounds. A feedback was provided whenever a deviation from the protocol occurs. Results : During the study period, a total of 560 general internal medicine patients met the criteria for VTE prophylaxis. Of those, 513 (91% patients actually received the recommended VTE prophylaxis. The weekly compliance rate in the initial stage of the intervention was 63% (14 of 22 and increased to an overall rate of 100% (39 of 39 (P = 0.002. Hospital-acquired DVT rate was 0.8 per 1000 discharges in the preintervention period and 0.5 per 1000 discharges in the postintervention period, P = 0.51. However, there was a significant increase in the time-free period of the VTE and we had 11 months with no single DVT. Conclusion : In this study, the use of multiple interventions increased VTE prophylaxis compliance rate.

  11. A Predictive Framework to Elucidate Venous Stenosis: CFD & Shape Optimization.

    Science.gov (United States)

    Javid Mahmoudzadeh Akherat, S M; Cassel, Kevin; Boghosian, Michael; Hammes, Mary; Coe, Fredric

    2017-07-01

    The surgical creation of vascular accesses for renal failure patients provides an abnormally high flow rate conduit in the patient's upper arm vasculature that facilitates the hemodialysis treatment. These vascular accesses, however, are very often associated with complications that lead to access failure and thrombotic incidents, mainly due to excessive neointimal hyperplasia (NH) and subsequently stenosis. Development of a framework to monitor and predict the evolution of the venous system post access creation can greatly contribute to maintaining access patency. Computational fluid dynamics (CFD) has been exploited to inspect the non-homeostatic wall shear stress (WSS) distribution that is speculated to trigger NH in the patient cohort under investigation. Thereafter, CFD in liaison with a gradient-free shape optimization method has been employed to analyze the deformation modes of the venous system enduring non-physiological hemodynamics. It is observed that the optimally evolved shapes and their corresponding hemodynamics strive to restore the homeostatic state of the venous system to a normal, pre-surgery condition. It is concluded that a CFD-shape optimization coupling that seeks to regulate the WSS back to a well-defined physiological WSS target range can accurately predict the mode of patient-specific access failure.

  12. 28 CFR 73.4 - Partial compliance not deemed compliance.

    Science.gov (United States)

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Partial compliance not deemed compliance. 73.4 Section 73.4 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) NOTIFICATIONS TO THE ATTORNEY GENERAL BY AGENTS OF FOREIGN GOVERNMENTS § 73.4 Partial compliance not deemed compliance. The fact...

  13. Enforcement and Compliance History Online | US EPA

    Science.gov (United States)

    ECHO, Enforcement and Compliance History Online, provides compliance and enforcement information for approximately 800,000 EPA-regulated facilities nationwide. ECHO includes permit, inspection, violation, enforcement action, and penalty information about facilities regulated under the Clean Air Act (CAA) Stationary Source Program, Clean Water Act (CWA) National Pollutant Elimination Discharge System (NPDES), and/or Resource Conservation and Recovery Act (RCRA). Information also is provided on surrounding demographics when available.

  14. Induced venous pooling and cardiorespiratory responses to exercise after bed rest

    Science.gov (United States)

    Convertino, V. A.; Sandler, H.; Webb, P.; Annis, J. F.

    1982-01-01

    Venous pooling induced by a specially constructed garment is investigated as a possible means for reversing the reduction in maximal oxygen uptake regularly observed following bed rest. Experiments involved a 15-day period of bed rest during which four healthy male subjects, while remaining recumbent in bed, received daily 210-min venous pooling treatments from a reverse gradient garment supplying counterpressure to the torso. Results of exercise testing indicate that while maximal oxygen uptake endurance time and plasma volume were reduced and maximal heart rate increased after bed rest in the control group, those parameters remained essentially unchanged for the group undergoing venous pooling treatment. Results demonstrate the importance of fluid shifts and venous pooling within the cardiovascular system in addition to physical activity to the maintenance of cardiovascular conditioning.

  15. Endovascular Treatment Options in the Management of Lower Limb Deep Venous Thrombosis

    International Nuclear Information System (INIS)

    Nazir, Sarfraz Ahmed; Ganeshan, Arul; Nazir, Sheraz; Uberoi, Raman

    2009-01-01

    Lower limb deep vein thrombosis (DVT) is a common cause of significant morbidity and mortality. Systemic anticoagulation therapy is the mainstay of conventional treatment instituted by most physicians for the management of DVT. This has proven efficacy in the prevention of thrombus extension and reduction in the incidence of pulmonary embolism and rethrombosis. Unfortunately, especially in patients with severe and extensive iliofemoral DVT, standard treatment may not be entirely adequate. This is because a considerable proportion of these patients eventually develops postthrombotic syndrome. This is characterized by chronic extremity pain and trophic skin changes, edema, ulceration, and venous claudication. Recent interest in endovascular technologies has led to the development of an assortment of minimally invasive, catheter-based strategies to deal with venous thrombus. These comprise catheter-directed thrombolysis, percutaneous mechanical thrombectomy devices, adjuvant venous angioplasty and stenting, and inferior vena cava filters. This article reviews these technologies and discusses their current role as percutaneous treatment strategies for venous thrombotic conditions.

  16. Primary Iliac Venous Leiomyosarcoma: A Rare Cause of Deep Vein Thrombosis in a Young Patient

    Directory of Open Access Journals (Sweden)

    Nelson Oliveira

    2011-01-01

    Full Text Available Introduction. Primary venous tumours are a rare cause of deep vein thrombosis. The authors present a case where the definitive diagnosis was delayed by inconclusive complementary imaging. Clinical Case. A thirty-seven-year-old female presented with an iliofemoral venous thrombosis of the right lower limb. The patient had presented with an episode of femoral-popliteal vein thrombosis five months before and was currently under anticoagulation. Phlegmasia alba dolens installed progressively, as thrombus rapidly extended to the inferior vena cava despite systemic thrombolysis and anticoagulation. Diagnostic imaging failed to identify the underlying aetiology of the deep vein thrombosis. The definitive diagnosis of primary venous leiomyosarcoma was reached by a subcutaneous abdominal wall nodule biopsy. Conclusion. Primary venous leiomyosarcoma of the iliac vein is a rare cause of deep vein thrombosis, which must be considered in young patients with recurrent or refractory to treatment deep vein thrombosis.

  17. Environmental Compliance Guide

    International Nuclear Information System (INIS)

    1981-02-01

    The Guide is intended to assist Department of Energy personnel by providing information on the NEPA process, the processes of other environmental statutes that bear on the NEPA process, the timing relationships between the NEPA process and these other processes, as well as timing relationships between the NEPA process and the development process for policies, programs, and projects. This information should be helpful not only in formulating environmental compliance plans but also in achieving compliance with NEPA and various other environmental statutes. The Guide is divided into three parts with related appendices: Part I provides guidance for developing environmental compliance plans for DOE actions; Part II is devoted to NEPA with detailed flowcharts depicting the compliance procedures required by CEQ regulations and Department of Energy NEPA Guidelines; and Part III contains a series of flowcharts for other Federal environmental requirements that may apply to DOE projects

  18. Environmental Compliance Issue Coordination

    Science.gov (United States)

    An order to establish the Department of Energy (DOE) requirements for coordination of significant environmental compliance issues to ensure timely development and consistent application of Departmental environmental policy and guidance

  19. Environmental Compliance Guide

    Energy Technology Data Exchange (ETDEWEB)

    None

    1981-02-01

    The Guide is intended to assist Department of Energy personnel by providing information on the NEPA process, the processes of other environmental statutes that bear on the NEPA process, the timing relationships between the NEPA process and these other processes, as well as timing relationships between the NEPA process and the development process for policies, programs, and projects. This information should be helpful not only in formulating environmental compliance plans but also in achieving compliance with NEPA and various other environmental statutes. The Guide is divided into three parts with related appendices: Part I provides guidance for developing environmental compliance plans for DOE actions; Part II is devoted to NEPA with detailed flowcharts depicting the compliance procedures required by CEQ regulations and Department of Energy NEPA Guidelines; and Part III contains a series of flowcharts for other Federal environmental requirements that may apply to DOE projects.

  20.  Sarbanes-Oxley compliance, internal control and ERP systems: Automation and the case of mySAP ERP

    DEFF Research Database (Denmark)

    Rikhardsson, Pall M.; Best, Peter; Juhl-Christensen, Claus

      The effort to comply with the Sarbanes-Oxley Act (SOX) has focused management attention on the importance of assessing, developing and maintaining an effective and efficient internal control system. ERP systems are a crucial factor in developing such a system. Despite the attention this has att...

  1. Intracranial developmental venous anomaly: is it asymptomatic?

    Science.gov (United States)

    Puente, A Bolívar; de Asís Bravo Rodríguez, F; Bravo Rey, I; Romero, E Roldán

    2018-03-16

    Intracranial developmental venous anomalies are the most common vascular malformation. In the immense majority of cases, these anomalies are asymptomatic and discovered incidentally, and they are considered benign. Very exceptionally, however, they can cause neurological symptoms. In this article, we present three cases of patients with developmental venous anomalies that presented with different symptoms owing to complications derived from altered venous drainage. These anomalies were located in the left insula, right temporal lobe, and cerebellum. The exceptionality of the cases presented as well as of the images associated, which show the mechanism through which the symptoms developed, lies in the low incidence of symptomatic developmental venous anomalies reported in the literature. Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. [Emphysematous gastritis with concomitant portal venous air].

    Science.gov (United States)

    Jeong, Min Yeong; Kim, Jin Il; Kim, Jae Young; Kim, Hyun Ho; Jo, Ik Hyun; Seo, Jae Hyun; Kim, Il Kyu; Cheung, Dae Young

    2015-02-01

    Emphysematous gastritis is a rare form of gastritis caused by infection of the stomach wall by gas forming bacteria. It is a very rare condition that carries a high mortality rate. Portal venous gas shadow represents elevation of intestinal luminal pressure which manifests as emphysematous gastritis or gastric emphysema. Literature reviews show that the mortality rate is especially high when portal venous gas shadow is present on CT scan. Until recently, the treatment of emphysematous gastritis has been immediate surgical intervention. However, there is a recent trend of avoiding surgery because of the frequent occurrence of post-operative complications such as anastomosis leakage. In addition, aggressive surgical treatment has failed to show significant improvement in prognosis. Recently, the authors experienced a case of emphysematous gastritis accompanied by portal venous gas which was treated successfully by conservative treatment without immediate surgical intervention. Herein, we present a case of emphysematous gastritis with concomitant portal venous air along with literature review.

  3. VENOUS THROMBOEMBOLISM PROPHYLAXIS – THE OTHER ...

    African Journals Online (AJOL)

    ABSTRACT. Background: There are no local guidelines for prophylaxis against Venous Thrombo-Embolism (VTE). .... of leg ulceration in the age matched general population. (9.6% to ... number of deaths and its cause amongst these patients.

  4. Imaging of head and neck venous malformations

    International Nuclear Information System (INIS)

    Flis, Christine M.; Connor, Stephen E.

    2005-01-01

    Venous malformations (VMs) are non proliferative lesions that consist of dysplastic venous channels. The aim of imaging is to characterise the lesion and define its anatomic extent. We will describe the plain film, ultrasound (US) (including colour and duplex Doppler), computed tomography (CT), magnetic resonance imaging (MRI), conventional angiographic and direct phlebographic appearances of venous malformations. They will be illustrated at a number of head and neck locations, including orbit, oral cavity, superficial and deep facial space, supraglottic and intramuscular. An understanding of the classification of such vascular anomalies is required to define the correct therapeutic procedure to employ. Image-guided sclerotherapy alone or in combination with surgery is now the first line treatment option in many cases of head and neck venous malformations, so the radiologist is now an integral part of the multidisciplinary management team. (orig.)

  5. [Venous thromboembolic disease: presentation of a case].

    Science.gov (United States)

    Mirpuri-Mirpuri, P G; Álvarez-Cordovés, M M; Pérez-Monje, A

    2013-01-01

    Venous thromboembolic disease in its clinical spectrum includes both deep vein thrombosis and pulmonary thromboembolism, which is usually a complication of deep vein thrombosis. It is a relatively common disease with significant morbidity and requires an accurate diagnosis. They are numerous risk factors for venous thromboembolism, and there is evidence that the risk of thromboembolic disease increases proportionally to the number of predisposing risk factors present. The primary care physician should know the risk factors and suspect the presence of venous thromboembolic disease when there is a compatible clnical picture. The treatment for this pathology is anticoagulation. We report a patient with cardiovascular risk factors who was seen with pain in the right leg and shortness of breath and referred to the hospital with suspected venous thromboembolism, atrial fibrillation and pleural effusion. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  6. Blood flow vs. venous pressure effects on filtration coefficient in oleic acid-injured lung.

    Science.gov (United States)

    Anglade, D; Corboz, M; Menaouar, A; Parker, J C; Sanou, S; Bayat, S; Benchetrit, G; Grimbert, F A

    1998-03-01

    On the basis of changes in capillary filtration coefficient (Kfc) in 24 rabbit lungs, we determined whether elevations in pulmonary venous pressure (Ppv) or blood flow (BF) produced differences in filtration surface area in oleic acid-injured (OA) or control (Con) lungs. Lungs were cyclically ventilated and perfused under zone 3 conditions by using blood and 5% albumin with no pharmacological modulation of vascular tone. Pulmonary arterial, venous, and capillary pressures were measured by using arterial, venous, and double occlusion. Before and during each Kfc-measurement maneuver, microvascular/total vascular compliance was measured by using venous occlusion. Kfc was measured before and 30 min after injury, by using a Ppv elevation of 7 cmH2O or a BF elevation from 1 to 2 l . min-1 . 100 g-1 to obtain a similar double occlusion pressure. Pulmonary arterial pressure increased more with BF than with Ppv in both Con and OA lungs [29 +/- 2 vs. 19 +/- 0.7 (means +/- SE) cmH2O; P Kfc (200 +/- 40 vs. 83 +/- 14%, respectively; P < 0.01) and microvascular/total vascular compliance ratio (86 +/- 4 vs. 68 +/- 5%, respectively; P < 0.01) increased more with BF than with Ppv. In conclusion, for a given OA-induced increase in hydraulic conductivity, BF elevation increased filtration surface area more than did Ppv elevation. The steep pulmonary pressure profile induced by increased BF could result in the recruitment of injured capillaries and could also shift downstream the compression point of blind (zone 1) and open injured vessels (zone 2).

  7. Venous trauma in the Lebanon War--2006.

    Science.gov (United States)

    Nitecki, Samy S; Karram, Tony; Hoffman, Aaron; Bass, Arie

    2007-10-01

    Reports on venous trauma are relatively sparse. Severe venous trauma is manifested by hemorrhage, not ischemia. Bleeding may be internal or external and rarely may lead to hypovolemic shock. Repair of major extremity veins has been a subject of controversy and the current teaching is to avoid venous repair in an unstable or multi-trauma patient. The aim of the current paper is to present our recent experience in major venous trauma during the Lebanon conflict, means of diagnosis and treatment in a level I trauma center. All cases of major venous trauma, either isolated or combined with arterial injury, admitted to the emergency room during the 33-day conflict were reviewed. Out of 511 wounded soldiers and civilians who were admitted to our service over this period, 12 (2.3%) sustained a penetrating venous injury either isolated (5) or combined with arterial injury (7). All injuries were secondary to high velocity penetrating missiles or from multiple pellets stored in long-range missiles. All injuries were accompanied by additional insult to soft tissue, bone and viscera. The mean injury severity score was 15. Severe external bleeding was the presenting symptom in three cases of isolated venous injury (jugular, popliteal and femoral). The diagnosis of a major venous injury was made by a CTA scan in five cases, angiography in one and during surgical exploration in six cases. All injured veins were repaired: three by venous interposition grafts, four by end to end anastomosis, three by lateral suture and two by endovascular techniques. None of the injuries was treated by ligation of a major named vein. Immediate postoperative course was uneventful in all patients and the 30-day follow-up (by clinical assessment and duplex scan) has demonstrated a patent repair with no evidence of thrombosis. Without contradicting the wisdom of ligating major veins in the setup of multi-trauma or an unstable patient, our experience indicates that a routine repair of venous trauma can

  8. Fingertip replantation without venous anastomosis.

    Science.gov (United States)

    Chen, Yi-Chieh; Chan, Fuan Chiang; Hsu, Chung-Chen; Lin, Yu-Te; Chen, Chien-Tzung; Lin, Chih-Hung

    2013-03-01

    Replantation of amputated fingertips is a technical challenge, as many salvage procedures fail because no suitable vein in the fingertip is available for anastomosis. In this study, we examined our experience in fingertip replantation in cases without venous anastomosis with our established fingertip replantation treatment protocol. Between August 2002 and August 2010, a retrospective study examined all patients who had undergone fingertip replantation at Chang-Gung Memorial Hospital. All the patients (n = 24) suffered from complete digital amputations at or distal to the interphalangeal joint of the thumb, or distal to distal interphalangeal joint of the fingers. A total of 30 fingertips that were salvaged by microsurgical anastomosis of the digital arteries but not of digital veins were included in this study. On satisfactory arterial anastomosis, a 2-mm incision was made over the fingertip with a number 11 Scalpel blade, and 0.1 to 0.2 mL heparin (5000 IU/mL) was injected subcutaneously around the incision immediately and once per day thereafter to ensure continuous blood drainage from the replanted fingertip. None of the replanted nail plate was removed, and no medical leeches were used. The perfusion of the replanted digits and patient's hemoglobin level were closely monitored. The wound bleeding was maintained until physiologic venous outflow was restored. Of 30 fingertips, 27 (90%) replanted fingertips survived. The average length needed for maintaining external bleeding by chemical leech was 6.8 days (range, 5-10 days). Twelve patients (including a 2-year-old child) received blood transfusions. The average amount of blood transfusion in the 23 adults was 4.0 units (range, 0-16 units) for each patient or 3.29 units (range, 0-14 units) for each digit. A 2-year-old child received 100 mL blood transfusion or 50 mL for each digit. This study showed that a protocol that promotes controlled bleeding from the fingertip is essential to achieve consistent high

  9. Pathophysiology of spontaneous venous gas embolism

    Science.gov (United States)

    Lambertsen, C. J.; Albertine, K. H.; Pisarello, J. B.; Flores, N. D.

    1991-01-01

    The use of controllable degrees and durations of continuous isobaric counterdiffusion venous gas embolism to investigate effects of venous gas embolism upon blood, cardiovascular, and respiratory gas exchange function, as well as pathological effects upon the lung and its microcirculation is discussed. Use of N2O/He counterdiffusion permitted performance of the pathophysiologic and pulmonary microstructural effects at one ATA without hyperbaric or hypobaric exposures.

  10. Improving venous thromboembolic disease prophylaxis in medical inpatients: a role for education and audit.

    LENUS (Irish Health Repository)

    Kent, B D

    2012-02-01

    BACKGROUND: Venous thromboembolic disease (VTED) prophylaxis is a key strategy in reducing preventable deaths in medical inpatients. We assessed compliance with internationally published guidelines for VTED prophylaxis in at-risk medical patients before and 1 month after an educational intervention to enhance compliance with such guidelines. RESULTS: One hundred and fifty patients were assessed on each occasion. Pre-intervention, VTED prophylaxis was prescribed in only 48% of at-risk cases. Compliance was best among patients under stroke services and worst for those under acute medical teams. Patients within specialist units were more likely to be prescribed prophylaxis than those in general wards (75 vs. 53%; p = 0.0019). Post-intervention, overall compliance improved to 63% (p = 0.041 for comparison). There was a significant improvement among general medical teams (48 vs. 75%; p = 0.001), and in general wards (52 vs. 74%; p = 0.003). CONCLUSIONS: Thromboprophylaxis is under-prescribed in medical inpatients, but compliance with international guidelines can be significantly enhanced with targeted educational intervention.

  11. MR findings of cerebral venous sinus thrombosis

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Myung Kwan; Chang, Kee Hyun; Han, Moon Hee; Choi, Choong Gom [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1994-10-15

    To describe MR findings of cerebral venous sinus thrombosis. We reviewed 11 MR images of six patients with cerebral venous sinus thrombosis. The MR images were retrospectively analyzed in terms of location and signal intensity of the thrombi, parenchymal lesions such as hemorrhage and edema, and changes in follow up study obtained in 4 patients. The thrombus in venous sinus was visualized on MRI in all six patients. The most frequently involved sites were superior sagittal sinus(n=4) and left transverse sinus(n=4). Signal intensity of the thrombus was isointense or hyperintense on both T1- and T2-weighted images with loss of normal signal void of the sinus on all sequences in all patients. Parenchymal lesion was patients in five of six cases, manifested as local hemorrhage in three and edema in three cases(one case overlapped). Local edema seen in three patients was completely resolved on follow up study of seven to 29 days intervals. It is concluded that iso- or high signal intensity with loss of signal void in venous sinus is virtually diagnostic of venous sinus thrombosis. If there are local parenchymal lesions such as hemorrhage and/or edema of unknown causes, cerebral venous sinus thrombosis should be included in differential diagnosis.

  12. Parametric Synthesis of Automatic Control System of Industrial Robot Manipulator in Compliance with Requirements of Robust Quality

    Directory of Open Access Journals (Sweden)

    A. A. Nesenchuk

    2004-01-01

    Full Text Available The paper considers an application of a root-locus method for synthesis of dynamic systems with uncertainty that meet the requirements of pre-set quality. This method is used for parametric synthesis of automatic control system of industrial robot manipulator that is used for transportation of engineering products. The synthesis takes place under conditions of substantial changes in inertia moment of robot load. As a result of investigations it is possible to determine range of values of variable parameter that ensures the required quality of control system operation. A system of computer programs has been developed in order to solve the problem.

  13. Venous catheterization with ultrasound navigation

    International Nuclear Information System (INIS)

    Kasatkin, A. A.; Nigmatullina, A. R.; Urakov, A. L.

    2015-01-01

    By ultrasound scanning it was determined that respiratory movements made by chest of healthy and sick person are accompanied by respiratory chest rise of internal jugular veins. During the exhalation of an individual diameter of his veins increases and during the breath it decreases down to the complete disappearing if their lumen. Change of the diameter of internal jugular veins in different phases can influence significantly the results of vein puncture and cauterization in patients. The purpose of this research is development of the method increasing the efficiency and safety of cannulation of internal jugular veins by the ultrasound visualization. We suggested the method of catheterization of internal jugular veins by the ultrasound navigation during the execution of which the puncture of venous wall by puncture needle and the following conduction of J-guide is carried out at the moment of patient’s exhalation. This method decreases the risk of complications development during catheterization of internal jugular vein due to exclusion of perforating wound of vein and subjacent tissues and anatomical structures

  14. Venous catheterization with ultrasound navigation

    Energy Technology Data Exchange (ETDEWEB)

    Kasatkin, A. A., E-mail: ant-kasatkin@yandex.ru; Nigmatullina, A. R. [Izhevsk State Medical Academy, Kommunarov street, 281, Izhevsk, Russia, 426034 (Russian Federation); Urakov, A. L., E-mail: ant-kasatkin@yandex.ru [Institute of Mechanics Ural Branch of Russian Academy of Sciences, T.Baramzinoy street 34, Izhevsk, Russia, 426067, Izhevsk (Russian Federation); Izhevsk State Medical Academy, Kommunarov street, 281, Izhevsk, Russia, 426034 (Russian Federation)

    2015-11-17

    By ultrasound scanning it was determined that respiratory movements made by chest of healthy and sick person are accompanied by respiratory chest rise of internal jugular veins. During the exhalation of an individual diameter of his veins increases and during the breath it decreases down to the complete disappearing if their lumen. Change of the diameter of internal jugular veins in different phases can influence significantly the results of vein puncture and cauterization in patients. The purpose of this research is development of the method increasing the efficiency and safety of cannulation of internal jugular veins by the ultrasound visualization. We suggested the method of catheterization of internal jugular veins by the ultrasound navigation during the execution of which the puncture of venous wall by puncture needle and the following conduction of J-guide is carried out at the moment of patient’s exhalation. This method decreases the risk of complications development during catheterization of internal jugular vein due to exclusion of perforating wound of vein and subjacent tissues and anatomical structures.

  15. Annual status report on Federal Facility Agreement compliance for the Liquid Low-Level Waste tank systems at Oak Ridge National Laboratory

    International Nuclear Information System (INIS)

    1994-09-01

    This annual report summarizes the status of Federal Facility Agreement (FFA) compliance activities at Oak Ridge National Laboratory (ORNL) and describes the progress made over the past fiscal year. In fiscal 1994, ORNL issued the final submittal of the risk characterization data for the inactive tanks, the secondary containment design demonstration report for Category B piping, and the FFA Implementation Plan. In addition, two new LLLW tanks serving Building 2026 and the Transported Waste Receiving Facility were installed; leak testing was initiated for all active, singly contained tanks and piping; sources of inflow to inactive tanks were investigated and diversion to process waste was begun; and the W-12 tank system was repaired and a request to allow its temporary use was approved by EPA/TDEC. Programmatic improvements were also made during the year: a system for improved communication of FFA plans and activities was implemented in October 1993, a survey was conducted to ensure that all inactive drains are identified and sealed, and two meetings of the ORNL FFA Technical Advisory Group were held

  16. Primary chronic venous insufficiency of the lower extremities: preoperative color duplex Doppler ultrasound study

    International Nuclear Information System (INIS)

    Selfa, S.; Diago, T.; Ricart, M.; Chulia, R.; Martin, F.

    2000-01-01

    To asses the role of color duplex Doppler ultrasound (CDU) in the preoperative study of patients with varicose veins in lower extremities. We employed CDU to examine varicose veins in 342 lower limbs, assessing reflux in saphenous veins (SV), deep venous system (DVS) and perforating veins (PV). We analyzed the relationship between the anatomical extent of the reflux and the clinical findings. Insufficiency of the superficial venous system alone was uncommon, occurring in only 10.8% of the limbs examined. Reflux was observed in SV and PV in 48.2% of the legs. It was detected in all three systems in 29.2% of cases. The presence of reflux in more than one system and more than one value was associated with increased clinical severity. The site of venous reflux in lower extremities with varicose veins varies. Greater clinical severity is observed in the presence of more marked reflux in the DVS and PV. CDU provides anatomic and functional data on the three venous systems of the lower limbs, allowing an individualized therapeutic surgery. Preoperative localization of incompetent PV by means of CDU facilities their ligation. CDU is the technique of choice for the preoperative examination of the venous systems of patients with varicose veins. (Author)

  17. [Sequelae of unilateral deep venous thrombosis in plethysmography of the calf].

    Science.gov (United States)

    Zicot, M; Depairon, M

    1982-01-01

    Twenty four patients suffering from unilateral venous disturbances revealed by Doppler and secondary to a deep venous thrombosis were examined. The calf venous haemodynamics was analyzed by use of a strain-jauge plethysmograph. We determined the increase in venous volume due to the inflation of a thigh pneumatic cuff (pressure at 20, 40 and 60 mm Hg; delta V20, delta V40, delta V60). The maximal venous output (Vout) was measured after a quick release of the 60 mm Hg pressure. The maximal venous drainage (VMM) was assessed during a rhythmic exercise (tiptoeing) while standing; delta V20, delta V40 and delta V60 were nearly constantly reduced on the abnormal side (t of Student respectively 3.49; 6.09 and 5.07). Vout dropped proportionaly to delta V60. Some abnormalities due to valvular insufficiency were frequently present in the beginning of the inflation curve at the level of the abnormal limbs. VMM was nearly always largely decreased on the affected side (t = 5.43). The unilateral flow disturbances displayed by the Doppler were regularly going with abnormalities of the capacitive system, well demonstrated by comparison with the non-affected limbs.

  18. Complication-related removal of totally implantable venous access port systems: Does the interval between placement and first use and the neutropenia-inducing potential of chemotherapy regimens influence their incidence? A four-year prospective study of 4045 patients.

    Science.gov (United States)

    Kakkos, A; Bresson, L; Hudry, D; Cousin, S; Lervat, C; Bogart, E; Meurant, J P; El Bedoui, S; Decanter, G; Hannebicque, K; Regis, C; Hamdani, A; Penel, N; Tresch-Bruneel, E; Narducci, F

    2017-04-01

    Totally implantable venous access port systems are widely used in oncology, with frequent complications that sometimes necessitate device removal. The aim of this study is to investigate the impact of the time interval between port placement and initiation of chemotherapy and the neutropenia-inducing potential of the chemotherapy administered upon complication-related port removal. Between January 2010 and December 2013, 4045 consecutive patients were included in this observational, single-center prospective study. The chemotherapy regimens were classified as having a low (20%) risk for inducing neutropenia. The overall removal rate due to complications was 7.2%. Among them, port-related infection (2.5%) and port expulsion (1%) were the most frequent. The interval between port insertion and its first use was shown to be a predictive factor for complication-related removal rates. A cut-off of 6 days was statistically significant (p = 0.008), as the removal rate for complications was 9.4% when this interval was 0-5 days and 5.7% when it was ≥6 days. Another factor associated with port complication rate was the neutropenia-inducing potential of the chemotherapy regimens used, with removal for complications involved in 5.5% of low-risk regimens versus 9.4% for the intermediate- and high-risk regimens (p = 0.003). An interval of 6 days between placement and first use of the port reduces the removal rate from complications. The intermediate- and high-risk for neutropenia chemotherapy regimens are related to higher port removal rates from complications than low-risk regimens. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  19. Report: EPA Is Taking Steps to Improve State Drinking Water Program Reviews and Public Water Systems Compliance Data

    Science.gov (United States)

    Report #17-P-0326, July 18, 2017. The EPA is taking action to improve oversight tools used to determine whether public water systems are monitoring and reporting drinking water quality in accordance with the Safe Drinking Water Act.

  20. Suggested guidelines for using systemic antimicrobials in bacterial skin infections: part?2? antimicrobial choice, treatment regimens and compliance

    OpenAIRE

    Beco, L.; Guagu?re, E.; M?ndez, C. Lorente; Noli, C.; Nuttall, T.; Vroom, M.

    2013-01-01

    Systemic antimicrobials are critically important in veterinary healthcare, and resistance is a major concern. Antimicrobial stewardship will be important in maintaining clinical efficacy by reducing the development and spread of antimicrobial resistance. Bacterial skin infections are one of the most common reasons for using systemic antimicrobials in dogs and cats. Appropriate management of these infections is, therefore, crucial in any policy for responsible antimicrobial use. The goals of t...

  1. Secondary venous aneurysm following intravenous drug abuse: A case report

    Directory of Open Access Journals (Sweden)

    Marković Miroslav

    2016-01-01

    Full Text Available Introduction. Venous aneurysm (VA is a rare condition that can be presented in both superficial and deep venous system. Secondary VAs as well as pseudoaneurysms are usually caused by external spontaneous or iatrogenic trauma. They are often misdiagnosed and inadequately treated. Complications include thrombosis, phlebitis, eventual pulmonary embolism and rupture. Case report. We presented a case of secondary VA of the great saphenous vein developed in a young addict following chronic intravenous drug application in the groin region. Aneurysm required urgent surgical treatment due to bleeding complication as it was previously misdiagnosed for hematoma (or abscess and punctuated by a general surgeon. Complete resection of VA with successful preservation of continuity of the great saphenous vein was performed. Postoperative course was uneventful. Regular venous flow through the great saphenous vein was confirmed on control ultrasound examination. Conclusion. VAs are uncommon, among them secondary VA being extremely rare. In cases with a significant diameter or threatening complications surgical treatment is recommended. [Projekat Ministarstva nauke Republike Srbije, br. ON175008 i br. III41007

  2. Fingertip Replantation With Palmar Venous Anastomoses in Children.

    Science.gov (United States)

    Wen, Gen; Xu, Jia; Chai, Yi-Min

    2017-06-01

    Fingertip amputation in children is difficult to manage using microsurgical replantation techniques and many salvage procedures have failed owing to the nonavailability of suitable veins for anastomosis in the fingertip. This study reviewed our experience of pediatric fingertip replantation involving palmar venous anastomoses and evaluated the clinical outcomes. From October 2008 to May 2013, 21 pediatric fingertips that had been completely amputated at or distal to the distal interphalangeal joint of the finger, or at or distal to the interphalangeal joint of the thumb were managed using complete replantation. One artery was anastomosed for revascularization with or without nerve repair, and a palmar venous anastomosis was performed to reestablish the outflow system. Twenty (95.2%) of the 21 fingertips survived. One replant involving an avulsion amputation of the left little finger failed, and the patient underwent stump cap-plasty. Excellent restoration of finger motion, pinch strength, and appearance was observed during the mean 39.9-month (range, 18-65 months) follow-up. The mean regained static 2-point discrimination sensation was 3.8 mm (range, 3.2-4.2 mm). All of the children and their families were satisfied with the surgical outcomes. Successful palmar venous anastomosis appears to promote the survival of replanted fingertips in children. Given that the procedure may simplify postoperative care, minimize complications, and achieve a high survival rate, it should be attempted if the technical expertise is available.

  3. Chronic venous leg ulcers – role of topical zinc

    Directory of Open Access Journals (Sweden)

    Maher SF

    2015-06-01

    Full Text Available Sara F Maher Physical Therapy Program, Department of Healthcare Sciences, Wayne State University, Detroit, MI, USA Abstract: Topical zinc has been used in the treatment of wounds for over 3,000 years, and is reported to have antiseptic, astringent, anti-inflammatory, antimicrobial, and wound healing properties. Fourteen studies were identified and reviewed, to assess the efficacy of this treatment modality as either a bandage or skin protectant in the treatment of venous ulcers. The authors of three studies reported improved healing time or success rate in wounds treated with zinc-based products. However, the authors of one study attributed the faster healing rate mainly to the extra compression (that improved venous blood return, delivered by the non-elastic paste bandage, and not by the zinc oxide alone. The quality of evidence is fair, as 50% of the studies were conducted prior to 2000 and 50% of the studies utilized fewer than 45 patients randomized to two or more groups. Other treatments have been reported to be more cost-effective than zinc, including hydrocolloids, four-layer compression systems, and CircAid Thera-boots. Finally, zinc was reported to be less comfortable, less easy to use, and caused increased pain, in comparison to other products on the market. This literature review, therefore, demonstrated that current evidence is insufficient to determine the effectiveness of zinc-based products in the treatment of venous wounds. Future research is needed focusing on larger, high-quality trials with an emphasis on quality of life issues and cost-effectiveness of treatment. Keywords: chronic wounds, leg ulcers, venous insufficiency, topical zinc

  4. Femoral venous oxygen saturation is no surrogate for central venous oxygen saturation

    NARCIS (Netherlands)

    van Beest, Paul A.; van der Schors, Alice; Liefers, Henriette; Coenen, Ludo G. J.; Braam, Richard L.; Habib, Najib; Braber, Annemarije; Scheeren, Thomas W. L.; Kuiper, Michael A.; Spronk, Peter E.

    2012-01-01

    Objective:  The purpose of our study was to determine if central venous oxygen saturation and femoral venous oxygen saturation can be used interchangeably during surgery and in critically ill patients. Design:  Prospective observational controlled study. Setting:  Nonacademic university-affiliated

  5. Prevalence of lower extremity venous duplication

    Directory of Open Access Journals (Sweden)

    Simpson William

    2010-01-01

    Full Text Available Purpose: This retrospective study was performed to determine the prevalence of lower extremity venous duplication using duplex ultrasound in the patient population of a large urban medical center. Materials and Methods: The reports of all lower extremity venous ultrasound examinations performed at our institution between January 1, 2002 and December 31, 2002 were reviewed. Ultrasound examinations that were performed for purposes other than the detection of lower extremity deep vein thrombosis were excluded. The prevalence of duplication and its specific location were recorded. In addition, the prevalence of thrombus and its specific location were also recorded. Results: A total of 3118 exams were performed in 2664 patients. Of the 2664 patients, 2311 had only one examination performed during the study period; 353 patients had more than one examination performed. We found that 10.1% of patients (270/2664 had at least one venous segment duplicated and 5.4% of patients (143/2664 had a thrombus in at least one venous segment. There was a statistically significant difference in the prevalence of both duplication and thrombus with a change in venous segment. Only 0.4% of patients (11/2664 had thrombus within a duplicated segment. Of those who had more than one examination performed, 15.3% (54/353 had the same venous segment(s seen on one examination but not another. Conclusion: Lower extremity venous duplication is a frequent anatomic variant that is seen in 10.1% of patients, but it may not be as common as is generally believed. It can result in a false negative result for deep vein thrombosis.

  6. The impact of a daily smartphone-based feedback system among women with gestational diabetes on compliance, glycemic control, satisfaction, and pregnancy outcome: a randomized controlled trial.

    Science.gov (United States)

    Miremberg, Hadas; Ben-Ari, Tal; Betzer, Tal; Raphaeli, Hagit; Gasnier, Rose; Barda, Giulia; Bar, Jacob; Weiner, Eran

    2018-04-01

    Patient compliance and tight glycemic control have been demonstrated to improve outcome in pregnancies complicated by gestational diabetes mellitus. The use of advanced technological tools, including smartphone-based platforms, to improve medical care and outcomes has been demonstrated in various fields of medicine, but only a few small studies were performed with gestational diabetes mellitus patients. We aimed to study the impact of introducing a smartphone-based daily feedback and communication platform between gestational diabetes mellitus patients and their physicians, on patient compliance, glycemic control, pregnancy outcome, and patient satisfaction. This is a prospective, single-center, randomized controlled trial. Newly diagnosed gestational diabetes mellitus patients presenting to our multidisciplinary diabetes-in-pregnancy clinic were randomized to: (1) routine biweekly prenatal clinic care (control group); or (2) additional daily detailed feedback on their compliance and glycemic control from the clinic team via an application installed on their smartphone (smartphone group). The primary outcome was patient compliance defined as the actual blood glucose measurements/instructed measurements ×100. The secondary outcomes included diabetes-control parameters, pregnancy, and neonatal outcomes. The study was adequately powered to detect a 20% difference in patient compliance, based on a preliminary phase that demonstrated 70% baseline compliance to glucose measurements. A total of 120 newly diagnosed gestational diabetes mellitus patients were analyzed. The 2 groups did not differ in terms of age, parity, education, body mass index, family history, maternal comorbidities, oral glucose tolerance test values, and hemoglobin A1C at randomization. The smartphone group demonstrated higher level of compliance (84 ± 0.16% vs 66 ± 0.28%, P diabetes mellitus patients and the multidisciplinary diabetes-in-pregnancy clinic team improved patient compliance and

  7. Life-threatening Vesicular Bronchial Injury Requiring Veno-venous Extracorporeal Membrane Oxygenation Rescue in an Electronic Nicotine Delivery System User

    Directory of Open Access Journals (Sweden)

    Thomas Carter

    2017-07-01

    Full Text Available The use of electronic nicotine delivery systems (ENDS is increasing across the United States as tobacco bans increase and more people use these devices in an attempt to quit smoking. They are unregulated by the Food and Drug Administration, and there is significant concern that ENDS could produce several toxic byproducts. In this case a 35-year-old female presented to the emergency department with sudden-onset dyspnea. She denied current tobacco smoking, but she was a user of ENDS. When bronchoscopy was performed, an extensive pattern of suspected chemical injury was noted in her airways. She required transfer to a tertiary center where she required extracorporeal membranous oxygenation. Despite public opinion that ENDS are generally safe, or at least safer than tobacco smoking, contrary evidence is mounting. We postulate that her injuries were likely suffered secondary to use of an ENDS.

  8. The common European asylum system and the rights of the child : an exploration of meaning and compliance

    NARCIS (Netherlands)

    Smyth, Ciara Mary

    2013-01-01

    This thesis addresses the question of whether the EU Common European Asylum System (CEAS) complies with the rights of the child. A significant proportion of people seeking asylum in EU countries are children. These children may be totally alone, with people who are not their customary caregivers

  9. Mind the Gap: Accounting Information Systems Curricula Development in Compliance with IFAC Standards in a Developing Country

    Science.gov (United States)

    Aleqab, Mahmoud Mohmad Ahmad; Nurunnabi, Mohammad; Adel, Dalia

    2015-01-01

    The authors examine the consistency between the current practices in designing and teaching accounting information systems (AIS) curricula and the International Federation of Accountants (IFAC) requirements for International Education Practice Statement 2 and International Education Standards 2. Utilizing a survey and interviews data in Jordan,…

  10. Compliance management and corporate governance; Compliance Management und Corporate Governance

    Energy Technology Data Exchange (ETDEWEB)

    Becker, Uwe [Stadt Frankfurt am Main (Germany); Alsheimer, Constantin; Kassebohm, Kristian; Reutler, Susanne [Mainova AG, Frankfurt (Germany)

    2009-08-15

    Starting in the year 2009, numerous changes in the financial system and accountancy a well as in the corporate law come into effect for enterprises. Thereby, the requirements substantially are intensified to their corporate governance. The actual well-known reproaches of bribery, corruption and injuries of data protection intensify the pressure on executive committees and supervisory boards in order to meet normative and ethical requirements. All the more is valid for power suppliers whose reputation can already carry damage out with the first suspicion. Already in 2008, Mainova AG (Frnkfurt/Main, Federal Republic of Germany) implemented a compliance management.

  11. Compliance with physical exercise

    DEFF Research Database (Denmark)

    Gram, Anne Sofie; Bønnelycke, Julie; Rosenkilde Larsen, Mads

    2014-01-01

    Aims: Sixty-one healthy, sedentary, moderately overweight young men participated in a randomised controlled trial to examine the effects of two different doses of endurance exercise on health behaviour and exercise compliance. Methods: Participants were randomised to a sedentary control group......), a post hoc thematic analysis was conducted to connect qualitative and quantitative data in a joint analysis. Results: Of the subjects interviewed, exercise compliance expressed as 95% CI was [96.8; 103%] in the MOD group and [82.9; 99.6%] in the HIGH group. The different doses of daily exercise equally...... or quantitative methodology alone. The preconditions of the TBP were fulfilled, and it represents a methodological model to explain the high degree of compliance and motivation to exercise....

  12. Venous injury in abusive head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Choudhary, Arabinda K. [Nemours A. I. duPont Hospital for Children, Department of Radiology, Wilmington, DE (United States); Bradford, Ray; Thamburaj, K.; Boal, Danielle K.B. [Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Dias, Mark S. [Hershey Medical Center, Department of Neurosurgery, Hershey, PA (United States)

    2015-11-15

    Abusive head trauma (AHT) is an important cause of serious brain injury in infants and young children who have characteristic clinical and imaging findings that are discordant with the clinical history provided. Recent attention has focused on abnormalities of the cranial venous sinuses and cortical veins, both on MRI and at autopsy. Although many have interpreted these to be secondary to the AHT, some have recently argued that these venous abnormalities represent primary cortical sinus and venous thrombosis that leads secondarily to subdural hemorrhage and secondary brain injury. Direct trauma to the veins and sinuses has been reported at autopsy in AHT, but there has been no systematic study of venous abnormalities in cases of AHT. The purpose of this study was to define the incidence and characteristics of venous and sinus abnormalities in AHT. We included all children <36 months of age who were diagnosed with abusive head trauma between 2001 and 2012 and who had MRI and magnetic resonance (MR) venography as part of their diagnostic workup. We analyzed age, gender and clinical findings. MRI and MR venography were analyzed independently by two neuroradiologists with a focus on abnormalities involving the intracranial veins and venous sinuses. A total of 45 children were included. The median age was 3 months (range 15 days to 31 months) and 28 were boys (62%). Clinical findings included retinal hemorrhage in 71% and extracranial fractures in 55%. CT or MRI demonstrated subdural hemorrhage in 41 (91%); none had subdural effusions. In 31 cases (69%) MR venography demonstrated mass effect on the venous sinuses or cortical draining veins, with either displacement or partial or complete effacement of the venous structures from an adjacent subdural hematoma or brain swelling. We also describe the lollipop sign, which represents direct trauma to the cortical bridging veins and was present in 20/45 (44%) children. Evidence of displacement or compression of cortical veins

  13. Venous injury in abusive head trauma

    International Nuclear Information System (INIS)

    Choudhary, Arabinda K.; Bradford, Ray; Thamburaj, K.; Boal, Danielle K.B.; Dias, Mark S.

    2015-01-01

    Abusive head trauma (AHT) is an important cause of serious brain injury in infants and young children who have characteristic clinical and imaging findings that are discordant with the clinical history provided. Recent attention has focused on abnormalities of the cranial venous sinuses and cortical veins, both on MRI and at autopsy. Although many have interpreted these to be secondary to the AHT, some have recently argued that these venous abnormalities represent primary cortical sinus and venous thrombosis that leads secondarily to subdural hemorrhage and secondary brain injury. Direct trauma to the veins and sinuses has been reported at autopsy in AHT, but there has been no systematic study of venous abnormalities in cases of AHT. The purpose of this study was to define the incidence and characteristics of venous and sinus abnormalities in AHT. We included all children <36 months of age who were diagnosed with abusive head trauma between 2001 and 2012 and who had MRI and magnetic resonance (MR) venography as part of their diagnostic workup. We analyzed age, gender and clinical findings. MRI and MR venography were analyzed independently by two neuroradiologists with a focus on abnormalities involving the intracranial veins and venous sinuses. A total of 45 children were included. The median age was 3 months (range 15 days to 31 months) and 28 were boys (62%). Clinical findings included retinal hemorrhage in 71% and extracranial fractures in 55%. CT or MRI demonstrated subdural hemorrhage in 41 (91%); none had subdural effusions. In 31 cases (69%) MR venography demonstrated mass effect on the venous sinuses or cortical draining veins, with either displacement or partial or complete effacement of the venous structures from an adjacent subdural hematoma or brain swelling. We also describe the lollipop sign, which represents direct trauma to the cortical bridging veins and was present in 20/45 (44%) children. Evidence of displacement or compression of cortical veins

  14. THE RELATIONSHIP BETWEEN PERCEPTIONS AND LEVEL OF COMPLIANCE UNDER SELF ASSESSMENT SYSTEM – A STUDY IN THE EAST COAST REGION

    OpenAIRE

    Wan Mohammad Taufik Bin Wan Abdullah; Mohmad Sakarnor Bin Deris; Noriza Binti Mohd Saad; Marziana Bt. Hj. Mohamad; Mahlindayu Binti Tarmidi

    2010-01-01

    Government procurement is a business process within a political system of a government. Failure to properly balance these elements can lead to wasted effort and poor development results within the most important single marketplace in developing countries. Procurement in Malaysia is largely decentralized. The Government Procurement Management Division of the Ministry of Finance sets the procurement policy and rules. The minister of finance or the chief minister for the state procurement boards...

  15. Waste Isolation Pilot Plant shaft sealing system compliance submittal design report. Volume 2 of 2: Appendix E

    International Nuclear Information System (INIS)

    1996-08-01

    This report describes a shaft sealing design for the Waste Isolation Pilot Plant (WIPP), a proposed nuclear waste repository in bedded salt. The system is designed to limit entry of water and release of contaminants through the four existing shafts after the WIPP is decommissioned. The design approach applies redundancy to functional elements and specifies multiple, common, low-permeability materials to reduce uncertainty in performance. The system comprises 13 elements that completely fill the shafts with engineered materials possessing high density and low permeability. Laboratory and field measurements of component properties and performance provide the basis for the design and related evaluations. Hydrologic, mechanical, thermal, and physical features of the system are evaluated in a series of calculations. These evaluations indicate that the design guidance is addressed by effectively limiting transport of fluids within the shafts, thereby limiting transport of hazardous material to regulatory boundaries. Additionally, the use or adaptation of existing technologies for placement of the seal components combined with the use of available, common materials assure that the design can be constructed

  16. FINANCIAL STATEMENTS OF MULTILEVEL SYSTEM OF CONSUMER COOPERATION IN UKRAINE, ITS INFORMATIONAL COMPLIANCE WITH MODERN EUROPEAN REQUIREMENTS

    Directory of Open Access Journals (Sweden)

    Stepan KOSHKAROV

    2016-07-01

    Full Text Available More than 120 countries use the International Financial Reporting Standards (IFRS and the International Accounting Standards (IAS. The Association Agreement between Ukraine and the EU obliges Ukraine to European convergence of accounting. Since 2012, for some entities it has been introduced compulsory, but for others - is that self-application of IFRS and INBO. This trend coincides with the imperative necessity of the consumer cooperation of Ukraine to reform its information system as a key component of its effective management and successful implementation of the controlling. It is proposed to start reforming with the introduction of MSFS and IAS.

  17. Bilateral catheter-directed thrombolysis in a patient with deep venous thrombosis caused by a hypoplastic inferior vena cava

    NARCIS (Netherlands)

    Sloot, S.; Van Nierop, J.; Kootstra, J. J.; Wittens, C.; Fritschy, W. M.

    Introduction Deep venous thrombosis treatment using catheter-directed thrombolysis is advocated over systemic thrombolysis because it reduces bleeding complications. With the development of a catheter that combines ultrasound vibrations and the local delivering of thrombolytics, new and safer

  18. Understanding and managing compliance in the nature conservation context.

    Science.gov (United States)

    Arias, Adrian

    2015-04-15

    Nature conservation relies largely on peoples' rule adherence. However, noncompliance in the conservation context is common: it is one of the largest illegal activities in the world, degrading societies, economies and the environment. Understanding and managing compliance is key for ensuring effective conservation, nevertheless crucial concepts and tools are scattered in a wide array of literature. Here I review and integrate these concepts and tools in an effort to guide compliance management in the conservation context. First, I address the understanding of compliance by breaking it down into five key questions: who?, what?, when?, where? and why?. A special focus is given to 'why?' because the answer to this question explains the reasons for compliance and noncompliance, providing critical information for management interventions. Second, I review compliance management strategies, from voluntary compliance to coerced compliance. Finally, I suggest a system, initially proposed for tax compliance, to balance these multiple compliance management strategies. This paper differs from others by providing a broad yet practical scope on theory and tools for understanding and managing compliance in the nature conservation context. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. GHG sustainability compliance of rapeseed-based biofuels produced in a Danish multi-output biorefinery system

    DEFF Research Database (Denmark)

    Boldrin, Alessio; Astrup, Thomas Fruergaard

    2015-01-01

    .g. the European Renewable Energy Directive, RED). The provided calculation methods, however, leave room for interpretation regarding methodological choices, which could significantly affect the resulting emission factors. In this study, GHG reduction factors for a range of biofuels produced in a Danish...... biorefinery system were determined using five different emission allocation principles. The results show that emission savings ranged from -34 % to 71 %, indicating the need for a better definition of regulatory calculation principles. The calculated emission factors differed significantly from default values...... provided in the literature, suggesting that case-specific local conditions should be taken into consideration. A more holistic LCA-based approach proved useful in overcoming some of the issues inherent in the regulatory allocation principles. On this basis, indirect land use change (ILUC) emissions were...

  20. Long term telemedicine study of compliance in paranoid schizophrenia.

    Science.gov (United States)

    Krzystanek, Marek; Krzeszowski, Dariusz; Jagoda, Karolina; Krysta, Krzysztof

    2015-09-01

    Low compliance is one of the crucial problems of contemporary psychiatry. Relapses, deterioration of cognitive functioning, negative symptoms, neuroleptic resistance are the examples of many consequences of noncompliance in schizophrenia The study was designed to assess the compliance in the 200 patients diagnosed with paranoid schizophrenia, all in the state of symptomatic remission and on the stable neuroleptic treatment. The compliance was assessed using a telepsychiatric system, sending reminders: 1 hour before the planned dose to remind them that drug intake is approaching, and at the moment of intake to check if they took the drug. The confirmed drug intakes were counted by the telepsychiatric system. 158 patients completed the study period. The compliance in the first month of the treatment was 44.6% and decreased over the rest of the period to the level of 33.4%. 50% of the schizophrenic patients were compliant at a level lower than 37%. This group was considered the low compliance group, and in this group the compliance increased after 6 months from 9.3% to 10.3% (p<0.0001). The compliance in the group of schizophrenic patients in remission is very low. The telemedicine system improves the compliance in the patients with the worst compliance.

  1. 12 CFR 268.710 - Compliance procedures.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 3 2010-01-01 2010-01-01 false Compliance procedures. 268.710 Section 268.710 Banks and Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM... Women's Program Manager, the Hispanic Employment Program Coordinator, or the People with Disabilities...

  2. Central venous obstruction in the thorax

    International Nuclear Information System (INIS)

    Collin, G.; Jones, R.G.; Willis, A.P.

    2015-01-01

    Central venous stenosis and occlusion can occur secondary to a spectrum of conditions ranging from aggressive malignancy to benign extrinsic anatomical compression in otherwise healthy individuals. Irrespective of aetiology, significant morbidity in the acute setting and long term can occur unless prompt accurate diagnosis and appropriate management is initiated, the radiologist being central to both. The present review will provide radiologists with a thorough illustration and explanation of the range of central venous conditions in the thorax (including deep vein thrombosis, thoracic outlet syndrome, haemodialysis, and malignancy related causes), the salient imaging findings and interventional management using case examples from the authors' practice. - Highlights: • We show a range of causes of central venous disease in the thorax. • We provide information about different imaging and management strategies. • We show several cases with successes and complications of endovascular management

  3. The Essentials of Parathyroid Hormone Venous Sampling

    Energy Technology Data Exchange (ETDEWEB)

    Taslakian, Bedros, E-mail: btaslakian@gmail.com [NYU Langone Medical Center, Department of Radiology, NYU School of Medicine (United States); Trerotola, Scott O., E-mail: streroto@uphs.upenn.edu [Perelman School of Medicine of the University of Pennsylvania, Department of Radiology (United States); Sacks, Barry, E-mail: bsacks@bidmc.harvard.edu [Beth Israel Deaconess Medical Center, Department of Interventional Radiology (United States); Oklu, Rahmi, E-mail: oklu.rahmi@mayo.edu [Mayo Clinic, Department of Interventional Radiology (United States); Deipolyi, Amy, E-mail: deipolya@mskcc.org [Memorial Sloan Kettering Cancer Center, Department of Radiology (United States)

    2017-01-15

    Hyperparathyroidism is an excess of parathyroid hormone in the blood due to over-activity of one or more parathyroid gland. Localization of abnormal glands with noninvasive imaging modalities, such as technetium sestamibi scan and cross-sectional imaging, has a high success rate. Parathyroid venous sampling is performed for patients with persistent or recurrent disease after previous parathyroid surgery, when repeat noninvasive imaging studies are negative or discordant. The success of invasive localization studies and results interpretation is dependent on the interventional radiologist’s understanding of the normal and ectopic anatomic locations of parathyroid glands, as well as their blood supply and venous drainage. Anatomic and technical considerations for selective parathyroid venous sampling are reviewed.

  4. Cerebral venous sinus thrombosis on MRI: A case series analysis

    Directory of Open Access Journals (Sweden)

    Sanjay M Khaladkar

    2014-01-01

    Full Text Available Background: Cerebral venous sinus thrombosis (CVST is a rare form of stroke seen in young and middle aged group, especially in women due to thrombus of dural venous sinuses and can cause acute neurological deterioration with increased morbidity and mortality if not diagnosed in early stage. Neurological deficit occurs due to focal or diffuse cerebral edema and venous non-hemorrhagic or hemorrhagic infarct. Aim and Objectives: To assess/evaluate the role of Magnetic Resonance Imaging (MRI and Magnetic Resonance Venography (MRV as an imaging modality for early diagnosis of CVST and to study patterns of venous thrombosis, in detecting changes in brain parenchyma and residual effects of CVST using MRI. Materials and Methods: Retrospective descriptive analysis of 40 patients of CVST diagnosed on MRI brain and MRV was done. Results: 29/40 (72.5% were males and 11/40 (27.5% were females. Most of the patients were in the age group of 21-40 years (23/40-57.5%. Most of the patients 16/40 (40% presented within 7 days. No definite cause of CVST was found in 24 (60% patients in spite of detailed history. In 36/40 (90% of cases major sinuses were involved, deep venous system were involved in 7/40 (17.5% cases, superficial cortical vein was involved in 1/40 (2.5% cases. Analysis of stage of thrombus (acute, subacute, chronic was done based on its appearance on T1 and T2WI. 31/40 (77.5% patients showed complete absence of flow on MRV, while 9/40 (22.5% cases showed partial flow on MR venogram. Brain parenchyma was normal in 20/40 (50% patients while 6/40 (15% cases had non-hemorrhagic infarct and 14/40 (35% patients presented with hemorrhagic infarct. Conclusion: Our study concluded that MRI brain with MRV is sensitive in diagnosing both direct signs (evidence of thrombus inside the affected veins and indirect signs (parenchymal changes of CVST and their follow up.

  5. Complications of central venous stenosis due to permanent central venous catheters in children on hemodialysis.

    Science.gov (United States)

    Rinat, Choni; Ben-Shalom, Efrat; Becker-Cohen, Rachel; Feinstein, Sofia; Frishberg, Yaacov

    2014-11-01

    Central venous catheters are frequently used as access for hemodialysis (HD) in children. One of the known complications is central venous stenosis. Although this complication is not rare, it is often asymptomatic and therefore unacknowledged. Superior vena cava (SVC) stenosis is obviously suspected in the presence of upper body edema, but several other signs and symptoms are often unrecognized as being part of this syndrome. We describe four patients with various manifestations of central venous stenosis and SVC syndrome. These sometimes life- or organ-threatening conditions include obstructive sleep apnea, unresolving stridor, increased intracranial pressure, increased intraocular pressure, right-sided pleural effusion, protein-losing enteropathy and lymphadenopathy. The temporal relationship of these complications associated with the use of central venous catheters and documentation of venous stenosis, together with their resolution after alleviation of high venous pressure, points to a causal role. We suggest pathophysiological mechanisms for the formation of each of these complications. In patients with occlusion of the SVC, various unexpected clinical entities can be caused by high central venous pressure. As often the etiology is not obvious, a high index of suspicion is needed as in some cases prompt alleviation of the high pressure is mandatory.

  6. The Amsterdam Hip Protector Study: Compliance and determinants of compliance

    NARCIS (Netherlands)

    van Schoor, N.M.; Asma, G.; Smit, J.H.; Bouter, L.M.; Lips, P.T.A.M.

    2003-01-01

    Hip protectors appear to be effective in reducing the incidence of hip fractures. However, compliance is often poor. Therefore, the objective of this study was to examine the compliance and determinants of compliance with external hip protectors. A prospective study was performed in residents from

  7. [Superficial venous thrombosis. A state of art].

    Science.gov (United States)

    Sándor, Tamás

    2017-01-01

    For a long time superficial thrombophlebitis has been thought to be a rather benign condition. Recently, when duplex ultrasound technique is used for the diagnosis more and more often, the disease is proved to be more dangerous than anticipated. Thrombosis propagates to the deep veins in 6-44% and pulmonary embolism was observed on the patients in 1,5-33%. We can calculate venous thromboembolic complications on every fourth patient. Diagnosis is clinical, but duplex ultrasound examination is mandatory, for estimation of the thrombus extent, for exclusion of the deep venous thrombosis and for follow up. Both legs should be checked with ultrasound, because simultaneous deep venous thrombosis can develop on the contralateral limb. Two different forms can be distinguished: superficial venous thrombosis with, or without varicose veins. In cases of spontaneous, non varicous form, especially when the process is migrating or recurrent, a careful clinical examination is necessery for exclusion of malignant diseases and thrombophilia. The treatment options are summarised on the basis of recent international consensus statements. The American and German guidelines are similar. Compression and mobilisation are cornerstones of the therapy. For a short segment thrombosis non steroidal antiinflammatory drugs are effective. For longer segments low molecular-weight heparins are preferred. Information on the effect of the novel oral anticoagulants for the therapy is lacking but they may appear to be effective in the future for this indication. When thrombus is close to the sapheno-femoral or sapheno-popliteal junction crossectomy (high ligation), or low molecular-weight heparin in therapeutic doses are indicated. The term superficial thrombophlebitis should be discouraged, because inflammation and infection is not the primary pathology. It should be called correctly superficial venous thrombosis in order to avoid the unnecessary administration of antibiotics and the misconception

  8. Rocky Flats Compliance Program

    International Nuclear Information System (INIS)

    1994-02-01

    The Department of Energy (DOE) established the Office of Technology Development (EM-50) (OTD) as an element of Environmental Restoration and Waste Management (EM) in November 1989. The primary objective of the Office of Technology Development, Rocky Flats Compliance Program (RFCP), is to develop altemative treatment technologies for mixed low-level waste (wastes containing both hazardous and radioactive components) to use in bringing the Rocky Flats Plant (RFP) into compliance with Federal and state regulations and agreements. Approximately 48,000 cubic feet of untreated low-level mixed waste, for which treatment has not been specified, are stored at the RFP. The cleanup of the Rocky Flats site is driven by agreements between DOE, the Environmental Protection Agency (EPA), and the Colorado Department of Health (CDH). Under these agreements, a Comprehensive Treatment and Management Plan (CTMP) was drafted to outline the mechanisms by which RFP will achieve compliance with the regulations and agreements. This document describes DOE's strategy to treat low-level mixed waste to meet Land Disposal Restrictions and sets specific milestones related to the regulatory aspects of technology development. These milestones detail schedules for the development of technologies to treat all of the mixed wastes at the RFP. Under the Federal Facilities Compliance Act (FFCA), the CTMP has been incorporated into Rocky Flats Plant Conceptual Site Treatment Plan (CSTP). The CSTP will become the Rocky Flats Plant site Treatment Plan in 1995 and will supersede the CTMP

  9. Environmental compliance and cleanup

    Energy Technology Data Exchange (ETDEWEB)

    Black, D.G.

    1995-06-01

    This section of the 1994 Hanford Site Environmental Report summarizes the roles of the principal agencies, organizations, and public in environmental compliance and cleanup of the Hanford Site. Regulatory oversight, the Federal Facility Agreement and Consent Order, the role of Indian tribes, public participation, and CERCLA Natural Resource Damage Assessment Trustee Activities are all discussed.

  10. Strategisk compliance og regulering

    DEFF Research Database (Denmark)

    Kühn Pedersen, Mogens

    2016-01-01

    Denne artikel introducerer strategisk compliance og påpeger dens samspil med klassiske og nyere former for reguleringer i digital værdiskabelse. Konteksten er den digitale økonomi, som vokser frem imellem den materielle økonomis bærepiller: Virksomheder og markeder, men består af en helt ny...... materialitet, som er det digitale univers og dets modsvarighed i nye krav til compliance. Den nye materialitet stiller nye krav, hvad angår digitale processer og transaktioner. Klassisk regulering, som aktører ikke selv kan ændre, støder på egenregulering, hvor aktørerne selv opsætter regler for at skabe...... digital værdi. Dette kalder på strategisk compliance. Med digitalisering er strategisk compliance sat på dagsordnen i reguleringsdebatten. Vi hævder, at regulering og egenregulering kan komme til at virke komplementært i det post-industrielle, digitaliserede samfund....

  11. Environmental compliance and cleanup

    International Nuclear Information System (INIS)

    Black, D.G.

    1995-01-01

    This section of the 1994 Hanford Site Environmental Report summarizes the roles of the principal agencies, organizations, and public in environmental compliance and cleanup of the Hanford Site. Regulatory oversight, the Federal Facility Agreement and Consent Order, the role of Indian tribes, public participation, and CERCLA Natural Resource Damage Assessment Trustee Activities are all discussed

  12. Financial Markets and Compliance

    NARCIS (Netherlands)

    van de Laar, T.A.H.M.; Bleker, Sylvie; Houben, Raf

    2017-01-01

    This chapter will focus on the goals of financial market regulation through the rules of economics, the strategies financial regulation employs to achieve these goals and the insights this provides for the compliance profession. For an overview of the goals and strategies of financial regulation

  13. Year 2000 compliance issues.

    Science.gov (United States)

    1999-03-01

    This month, we continue our coverage of the year 2000 (Y2K) problem as it affects healthcare facilities and the professionals who work in them. We present the following articles: "Checking PCs for Y2K Compliance"--In this article, we describe the probable sources of Y2K-related errors in PCs and present simple procedures for testing the Y2K compliance of PCs and application software. "Y2K Assessment Equipment Expectations"--In this article, we review the Y2K compliance data from a small sampling of hospitals to help answer the question "What percentage of medical equipment will likely be susceptible to Y2K problems?" "Y2K Labeling of Medical Devices"--In this article, we discuss the pros and cons of instituting a program to label each medical device with its Y2K status. Also in this section, we present an updated list of organizations that support ECRI's Position Statement on the testing of medical devices for Y2K compliance, which we published in the December 1998 issue of Health Devices (27[12]). And we remind readers of the services ECRI can offer to help healthcare institutions cope with the Y2K problem.

  14. Hazard banding in compliance with the new Globally Harmonised System (GHS) for use in control banding tools.

    Science.gov (United States)

    Arnone, Mario; Koppisch, Dorothea; Smola, Thomas; Gabriel, Stefan; Verbist, Koen; Visser, Remco

    2015-10-01

    Many control banding tools use hazard banding in risk assessments for the occupational handling of hazardous substances. The outcome of these assessments can be combined with advice for the required risk management measures (RMMs). The Globally Harmonised System of Classification and Labelling of Chemicals (GHS) has resulted in a change in the hazard communication elements, i.e. Hazard (H) statements instead of Risk-phrases. Hazard banding schemes that depend on the old form of safety information have to be adapted to the new rules. The purpose of this publication is to outline the rationales for the assignment of hazard bands to H statements under the GHS. Based on this, this publication proposes a hazard banding scheme that uses the information from the safety data sheets as the basis for assignment. The assignment of hazard bands tiered according to the severity of the underlying hazards supports the important principle of substitution. Additionally, the set of assignment rules permits an exposure-route-specific assignment of hazard bands, which is necessary for the proposed route-specific RMMs. Ideally, all control banding tools should apply the same assignment rules. This GHS-compliant hazard banding scheme can hopefully help to establish a unified hazard banding strategy in the various control banding tools. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Laboratory analysis of phacoemulsifier compliance and capacity.

    Science.gov (United States)

    Nejad, Mitra; Injev, Valentine P; Miller, Kevin M

    2012-11-01

    To compare the compliance and capacity of 7 fluidics modules used by 6 phacoemulsifiers from 3 manufacturers. Jules Stein Eye Institute, Los Angeles, California, USA. Experimental study. Previous-model and current-model phacoemulsifiers from 3 manufacturers were subjected to laboratory analysis of compliance and capacity. Previous-generation models tested included the Legacy Advantec, Whitestar Sovereign Phacoemulsification System, and Millennium Microsurgical System. Current models tested were the Infiniti Vision System with standard and Intrepid cassettes, Whitestar Signature Phacoemulsification System, and Stellaris Vision Enhancement System. To measure compliance, the aspiration line was connected to an electronic pressure transducer and small volumes of fluid were injected or aspirated. To measure capacity, the space between the distal end of the aspiration line and the pump was filled with methylene blue-dyed fluid. The Legacy was the most compliant phacoemulsifier. The old and new Whitestar systems, Millennium system, and Stellaris system showed similar midrange compliances. The Infiniti Vision System with the Intrepid fluidic management system was the least compliant. The Infiniti cassettes had the greatest capacity, which is a detriment from a surge-control perspective, and Signature cassettes had the least capacity. The Infiniti Intrepid system had the lowest compliance of the 6 units tested, which is optimum from a surge-control perspective. All other things being equal, the Infiniti should have the safest occlusion-break surge response. Mr. Injev is an employee of Alcon Laboratories. Dr. Miller is a consultant to and investigator for Alcon Laboratories. Ms. Nejad has no financial or proprietary interest in any material or method mentioned. Copyright © 2012 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  16. The USAID Environmental Compliance Database

    Data.gov (United States)

    US Agency for International Development — The Environmental Compliance Database is a record of environmental compliance submissions with their outcomes. Documents in the database can be found by visiting the...

  17. Management of Peripheral and Truncal Venous Injuries

    Directory of Open Access Journals (Sweden)

    Triantafillos G. Giannakopoulos

    2017-08-01

    Full Text Available Civilian injuries are increasing according to the World Health Organization, and this is attributed mainly to road traffic accidents and urban interpersonal violence. Vascular injuries are common in these scenarios and are associated with high morbidity and mortality rates. Associated peripheral venous trauma is less likely to lead to death and controversy remains whether ligation or repair should be the primary approach. Conversely, non-compressible truncal venous insult can be lethal due to exsanguination, thus a high index of suspicion is crucial. Operative management is demanding with fair results but recent endovascular adjuncts demonstrate promising results and seem to be the way forward for these serious conditions.

  18. Assessment of Venous Thrombosis in Animal Models.

    Science.gov (United States)

    Grover, Steven P; Evans, Colin E; Patel, Ashish S; Modarai, Bijan; Saha, Prakash; Smith, Alberto

    2016-02-01

    Deep vein thrombosis and common complications, including pulmonary embolism and post-thrombotic syndrome, represent a major source of morbidity and mortality worldwide. Experimental models of venous thrombosis have provided considerable insight into the cellular and molecular mechanisms that regulate thrombus formation and subsequent resolution. Here, we critically appraise the ex vivo and in vivo techniques used to assess venous thrombosis in these models. Particular attention is paid to imaging modalities, including magnetic resonance imaging, micro-computed tomography, and high-frequency ultrasound that facilitate longitudinal assessment of thrombus size and composition. © 2015 American Heart Association, Inc.

  19. Admission Hyperglycemia and Clinical Outcome in Cerebral Venous Thrombosis

    NARCIS (Netherlands)

    Zuurbier, Susanna M.; Hiltunen, Sini; Tatlisumak, Turgut; Peters, Guusje M.; Silvis, Suzanne M.; Haapaniemi, Elena; Kruyt, Nyika D.; Putaala, Jukka; Coutinho, Jonathan M.

    2016-01-01

    Background and Purpose-Admission hyperglycemia is associated with poor clinical outcome in ischemic and hemorrhagic stroke. Admission hyperglycemia has not been investigated in patients with cerebral venous thrombosis. Methods-Consecutive adult patients with cerebral venous thrombosis were included

  20. Human cerebral venous outflow pathway depends on posture and central venous pressure

    DEFF Research Database (Denmark)

    Gisolf, J; van Lieshout, J J; van Heusden, K

    2004-01-01

    Internal jugular veins are the major cerebral venous outflow pathway in supine humans. In upright humans the positioning of these veins above heart level causes them to collapse. An alternative cerebral outflow pathway is the vertebral venous plexus. We set out to determine the effect of posture...... and during a Valsalva manoeuvre in both body positions, correlate highly with model simulation of the jugular cross-sectional area (R(2) = 0.97). The results suggest that the cerebral venous flow distribution depends on posture and CVP: in supine humans the internal jugular veins are the primary pathway...

  1. Comparing and contrasting current guidelines for venous thromboembolism prophylaxis after total hip and total knee arthroplasty.

    Science.gov (United States)

    Lachiewicz, Paul F

    2011-01-01

    Orthopaedic surgeons may be impacted by three different clinical venous thromboembolism guidelines: the American College of Chest Physicians guidelines, the Surgical Care Improvement Project guidelines, and, most recently, the American Academy of Orthopaedic Surgeons (AAOS) guideline. The American College of Chest Physicians guidelines use deep venous thrombosis detected by venography or ultrasonography as their primary outcome measure. High-grade recommendations are based on prospective randomized studies only, usually comparing one pharmacologic agent to another. The Surgical Care Improvement Project guidelines are essentially based on the 2004 American College of Chest Physicians guidelines and seek to determine if surgeons prescribe venous thromboembolism prophylaxis within 24 hours of admission. Compliance with these guidelines may affect the quality rating of a particular hospital. The AAOS guideline was designed with the clinical outcome measures of symptomatic pulmonary embolism, fatal pulmonary embolism, major bleeding, and all-cause mortality. This guideline recommends that surgeons preoperatively evaluate the patient's risks (standard or elevated) for pulmonary embolism and serious bleeding and individualize pharmacologic prophylaxis based on a risk-benefit ratio. The three guidelines all have advantages and disadvantages.

  2. Pneumoperitoneum risk prognosis and correction of venous circulation disturbances in laparoscopic surgery. A pilot study.

    Science.gov (United States)

    Emeljanov, S I; Fedenko, V V; Levite, E M; Panfilov, S A; Bobrinskaya, I G; Fedorov, A V; Matveev, N L; Evdoshenko, V V; Luosev, S V; Bokarev, V V; Musaeva, S R

    1998-10-01

    This study was initiated to find a method of determining the prognosis for possible changes in hemodynamic and respiratory parameters in patients with pneumoperitoneum (PP). We devised a model for a pseudopneumoperitoneum (PPP), which is created by encircling the wide pneumochamber on the entire abdomen and inflating it to a preset pressure. To verify the prognostic possibilities of the proposed model, we studied the pneumotachygraphy parameters, noninvasive and invasive monitoring parameters of PPP after induction of anaesthesia, and venous circulation disturbances, as well as the medical effect of the intermittent sequential compression device. In healthy patients, the restrictive lung syndrome did not approach the risky limit. In patients >/=60 years old, this syndrome was very close to the limit. In a number of patients with serious cardiovascular and pulmonary pathology, the pressure of >10 mmHg was considered to be intolerable. Lung compliance, which was the parameter most sensitive to the increased intraabdominal pressure, was 47 +/- 10 at baseline, and 29 +/- 4 (p > 0.05) at both PPP and real PP (14 mmHg). The PPP model is quite similar to the real PP and can be used for preoperative prognosis in laparoscopic surgery. The elevated intraabdominal pressure results in a significant disturbance of venous blood flow in the lower extremities. The use of the device for peristaltic pneumomassage of the lower limbs is effective in correcting negative changes in venous hemodynamics in laparoscopic surgery.

  3. High-Flow Arterio-Hepatic Venous Shunt in Hepatocellular Carcinoma: Use of Multi-Electrode Radiofrequency for Shunt Obliteration

    Energy Technology Data Exchange (ETDEWEB)

    Pua, Uei, E-mail: druei@yahoo.com [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore)

    2015-10-15

    Intra-tumoral arterio-hepatic venous shunting (AHVS) poses an impediment to transarterial chemoembolization of liver tumors. Not only does it present a potential hazard for systemic shunting and embolization, but also the altered flow dynamics may also result in poor delivery of drug/embolics to the target tumor bed. Current available techniques to overcome AVHS include arterial embolization (particles, coils, glue, etc.) or temporary venous occlusion using balloons. We hereby illustrate the use of radiofrequency ablation to obliterate a complex AHVS consisting of a varix-like venous aneurysm.

  4. Increased arterial compliance in decompensated cirrhosis

    DEFF Research Database (Denmark)

    Henriksen, Jens Henrik Sahl; Møller, Søren; Schifter, S

    1999-01-01

    of the vasodilator, calcitonin gene-related peptide (CGRP) and mean arterial blood pressure (MAP). METHODS: Arterial compliance (COMPart=deltaV/deltaP) was determined as the stroke volume relative to pulse pressure (i.e. systolic minus diastolic blood pressure) during a haemodynamic evaluation of portal hypertension......BACKGROUND/AIMS: In patients with cirrhosis, the systemic circulation is hyperdynamic with low arterial blood pressure and reduced systemic vascular resistance. The present study was undertaken to estimate the compliance of the arterial tree in relation to severity of cirrhosis, circulating level...... of CGRP (r=0.34, parterial compliance in cirrhosis is directly related to the severity of the disease and to the elevated level of circulating vasodilator peptide CGRP, and inversely related...

  5. A workflow for SHPs regulatory compliance in the wholesale market metering system; Workflow para adequacao regulatoria da medicao de faturamento em PCHs

    Energy Technology Data Exchange (ETDEWEB)

    Barbosa, Danilo Ulisses Soares; Vidal, Fernando de Moura; Mariano, Alex [Way2 Servicos de Tecnologia S.A., Florianopolis, SC (Brazil)], E-mail: way2@way2.com.br

    2011-07-15

    CCEE regulatory compliance is a critical and necessary process to the beginning of the commercial operation of generation plants. Even when this stage is completed, the small-team nature of a PCH work crew, their rushed work pace and typical turnover on the matter of their role at the plant make difficult the task of monitoring the demands and processes, which increases the penalty risk. The current article analyses CCEE commercial procedures (PdCs) and ONS Network Procedures, emphasizing activities and workflow which are in compliancy to regulation. Primarily the asset registering process is described in details, from project elaboration and approval until CCEE final validation. After that, the article summarizes all criteria for penalties application regarding wholesale energy metering compliance, missing data and audit channel Unavailability. Besides that, there is a focus on a workflow definition in order to mitigate penalties risk. (author)

  6. Pregnancy-related venous thromboembolism and risk of occult cancer

    DEFF Research Database (Denmark)

    Hansen, Anette Tarp; Veres, Katalin; Horváth-Puhó, Erzsébet

    2017-01-01

    The cancer risk during the first year after a pregnancy-related venous thromboembolism episode is higher than expected. An aggressive search for cancer in women with pregnancy-related venous thromboembolism is probably not warranted, due to low absolute risk.......The cancer risk during the first year after a pregnancy-related venous thromboembolism episode is higher than expected. An aggressive search for cancer in women with pregnancy-related venous thromboembolism is probably not warranted, due to low absolute risk....

  7. Relationship between neighborhood socioeconomic status and venous thromboembolism: results from a population-based study.

    Science.gov (United States)

    Kort, D; van Rein, N; van der Meer, F J M; Vermaas, H W; Wiersma, N; Cannegieter, S C; Lijfering, W M

    2017-12-01

    Essentials Literature on socioeconomic status (SES) and incidence of venous thromboembolism (VTE) is scarce. We assessed neighborhood SES with VTE risk in a population of over 1.4 million inhabitants. Higher neighborhood SES was associated with lower incidence of VTE. These findings are helpful to inform policy and resource allocation in health systems. Background The association between socioeconomic status and arterial cardiovascular disease is well established. However, despite its high burden of disability-adjusted life years, little research has been carried out to determine whether socioeconomic status is associated with venous thromboembolism. Objective To determine if neighborhood socioeconomic status is associated with venous thromboembolism in a population-based study from the Netherlands. Methods We identified all patients aged 15 years and older with a first event of venous thromboembolism from inhabitants who lived in the urban districts of The Hague, Leiden and Utrecht in the Netherlands in 2008-2012. Neighborhood socioeconomic status was based on the status score, which combines educational level, income and unemployment on a four-digit postal code level. Incidence rate ratios of venous thromboembolism were calculated for different levels of neighborhood socioeconomic status, with adjustments for age and sex. Results A total of 7373 patients with a first venous thromboembolism (median age 61 years; 50% deep vein thrombosis) were identified among more than 1.4 million inhabitants. Higher neighborhood SES was associated with lower incidence of VTE. In the two highest status score groups (i.e. the 95-99th and > 99th percentile), the adjusted incidence rate ratios were 0.91 (95% confidence interval [CI], 0.84-1.00) and 0.80 (95% CI, 0.69-0.93), respectively, compared with the reference status score group (i.e. 30-70th percentile). Conclusions High neighborhood socioeconomic status is associated with a lower risk of first venous thromboembolism. © 2017

  8. Mechanochemical endovenous ablation and new frontiers in venous intervention

    NARCIS (Netherlands)

    Boersma, D

    2017-01-01

    Venous insufficiency of the lower extremities is a common condition and related to various symptoms, including venous ulcers. The effect of venous insufficiency on patients’ health-related quality of life is substantial and comparable with other chronic diseases such as arthritis, diabetes, and

  9. Erythrocytes and von Willebrand factor in venous thrombosis

    NARCIS (Netherlands)

    Smeets, M.W.J.

    2018-01-01

    Venous thromboembolism represents the third leading vascular disease after myocardial infarction and stroke. Erythrocytes, the most abundant cells in venous thrombi, were thought to be innocent bystanders that become tangled up in the fibrin mesh of venous thrombi. However, this thesis describes

  10. Contribution of MRI in supracardiac total anomalous pulmonary venous drainage

    International Nuclear Information System (INIS)

    Kastler, B.; Germain, P.; Gangi, A.; Klinkert, A.; Dietemann, J.L.; Wackenheim, A.; Livolsi, A.; Willard, D.

    1992-01-01

    A case of supracardiac total anomalous pulmonary venous drainage (TAPVD) in an infant aged 2 1/2 months is presented. Diagnosis was established non invasively by magnetic resonance image (MRI). Not only did MRI precisely depict the anomalous venous pathway but it moreover securely excluded pulmonary venous obstruction. (orig.)

  11. Diagnostics of defeats of venous collectors of brain

    International Nuclear Information System (INIS)

    Timofeeva, T.V.; Polunina, I.S.; Shcherbakova, E.Ya.; Kuldakova, S.V.

    1997-01-01

    Comparative data of transcranial ultrasonic dopplerography (170 patients) and radionuclidous antroscintigraphy (124), received during diagnostics of defects of venous collectors of brain are analyzed. Five variants of defeats of venous collectors (cross, sigmoid, internal of jugular of jugular vein), but also unpaired sine (direct, confluent) are described. Received results permit to reveal interrelation of infringements of venous outflow and increase of intracranial pressure

  12. Metastatic Carcinoma of Unknown Primary Presenting as Jugular Venous Thrombosis

    Directory of Open Access Journals (Sweden)

    Prince Cheriyan Modayil

    2009-01-01

    Full Text Available Jugular venous thrombosis is unusual and is associated with central venous catheterisation, intravenous drug abuse and head and neck sepsis. It is rarely associated with malignancy. We report a case of metastatic carcinoma of unknown primary in a forty year old female which presented with jugular venous thrombosis. The discussion includes investigation and treatment options for this condition.

  13. QbD-Enabled Development of Novel Stimuli-Responsive Gastroretentive Systems of Acyclovir for Improved Patient Compliance and Biopharmaceutical Performance.

    Science.gov (United States)

    Singh, Bhupinder; Kaur, Anterpreet; Dhiman, Shashi; Garg, Babita; Khurana, Rajneet Kaur; Beg, Sarwar

    2016-04-01

    The current studies entail systematic quality by design (QbD)-based development of stimuli-responsive gastroretentive drug delivery systems (GRDDS) of acyclovir using polysaccharide blends for attaining controlled drug release profile and improved patient compliance. The patient-centric quality target product profile was defined and critical quality attributes (CQAs) earmarked. Risk assessment studies, carried out through Ishikawa fish bone diagram and failure mode, effect, and criticality analysis, helped in identifying the plausible risks or failure modes affecting the quality attributes of the drug product. A face-centered cubic design was employed for systematic development and optimization of the concentration of sodium alginate (X 1) and gellan (X 2) as the critical material attributes (CMAs) in the stimuli-responsive formulations, which were evaluated for CQAs viz. viscosity, gel strength, onset of floatation, and drug release characteristics. Mathematical modeling was carried out for generation of design space, and optimum formulation was embarked upon, exhibiting formulation characteristics marked by excellent floatation and bioadhesion characteristics along with promising drug release control up to 24 h. Drug-excipient compatibility studies through FTIR and DSC revealed absence of any interaction(s) among the formulation excipients. In vivo pharmacokinetic studies in Wistar rats corroborated extension in the drug absorption profile from the optimized stimuli-responsive GR formulations vis-à-vis the marketed suspension (ZOVIRAX®). Establishment of in vitro/in vivo correlation (IVIVC) revealed a high degree of correlation between the in vitro and in vivo data. In a nutshell, the present investigations report the successful development of stimuli-responsive GRDDS of acyclovir, which can be applicable as a platform approach for other drugs too.

  14. 77 FR 24718 - Scientific Information Request on Chronic Venous Ulcers Treatments

    Science.gov (United States)

    2012-04-25

    ... antimicrobial components, what are the benefits and harms of using systemic antibiotics when compared with using.../ . The Key Questions Question 1 For patients with chronic venous leg ulcers, what are the benefits and... clinical signs of cellulitis that are being treated with compression systems, what are the benefits and...

  15. Investigation of cerebral venous outflow in microgravity.

    Science.gov (United States)

    Taibi, A; Gadda, G; Gambaccini, M; Menegatti, E; Sisini, F; Zamboni, P

    2017-10-31

    The gravitational gradient is the major component to face when considering the physiology of venous return, and there is a growing interest in understanding the mechanisms ensuring the heart filling, in the absence of gravity, for astronauts who perform long-term space missions. The purpose of the Drain Brain project was to monitor the cerebral venous outflow of a crew member during an experiment on the International Space Station (ISS), so as to study the compensatory mechanisms that facilitate this essential physiological action in subjects living in a microgravity environment. Such venous function has been characterized by means of a novel application of strain-gauge plethysmography which uses a capacitive sensor. In this contribution, preliminary results of our investigation have been presented. In particular, comparison of plethysmography data confirmed that long duration spaceflights lead to a redistribution of venous blood volume, and showed interesting differences in the amplitude of cardiac oscillations measured at the level of the neck veins. The success of the experiment has also demonstrated that thanks to its easy portability, non-invasiveness, and non-operator dependence, the proposed device can be considered as a novel tool for use aboard the ISS. Further trials are now under way to complete the investigation on the drainage function of the neck veins in microgravity.

  16. Pediatric central venous access devices: nursing interventions

    Directory of Open Access Journals (Sweden)

    Duffy EA

    2017-05-01

    Full Text Available Elizabeth A Duffy, Kathryn N Nelson Department of Health Behavior and Biological Sciences, The University of Michigan School of Nursing, Ann Arbor, MI, USA Abstract: A central venous catheter (CVC is an indwelling catheter that provides permanent or temporary stable venous access for both acute and chronically ill pediatric patients. These catheters provide stable venous access that can be used for a variety of medical purposes including drawing blood, hemodynamic monitoring, infusion of intravenous medications, infusion of intravenous fluids, chemotherapy, blood products, and parenteral nutrition. Each day, nurses access and care for CVCs in infants, children, and adolescents; the precision of this care can prevent life-threatening complications. The purpose of this review and the case study is to highlight the importance and components of evidence-based nursing practice in pediatric CVC care. A historical perspective of CVC care is provided in conjunction with current national initiatives to improve patient outcomes for children with CVCs. Infection prevention, clinical practice guidelines, quality improvement, and evidence-based care bundles are discussed. Keywords: pediatric nursing, central venous catheters, central line-associated bloodstream infection, care bundles, pediatric case study 

  17. Thermodilution-determined Internal Jugular Venous Flow

    DEFF Research Database (Denmark)

    Rasmussen, Peter; Widmer, Mario; Hilty, Matthias P

    2017-01-01

    PURPOSE: Cerebral blood flow (CBF) increases ~20% during whole body exercise although a Kety-Schmidt-determined CBF is reported to remain stable; a discrepancy that could reflect evaluation of arterial vs. internal jugular venous (IJV) flow and/or that CBF is influenced by posture. Here we test...

  18. Global public awareness of venous thromboembolism

    NARCIS (Netherlands)

    Wendelboe, A. M.; McCumber, M.; Hylek, E. M.; Buller, H.; Weitz, J. I.; Raskob, G.; Angchaisuksiri, P.; Blanco, A. N.; Hunt, B. J.; Kakkar, A.; Konstantinides, S. V.; McLintock, C.; Ozaki, Y.

    2015-01-01

    Data on public awareness about thrombosis in general and venous thromboembolism (VTE) in particular are limited. We aimed to measure the global awareness of thrombosis to address this gap. With Ipsos-Reid, from 22 July to 5 August 2014, we surveyed 800 respondents in their native language from each

  19. Central Venous Occlusion in the Hemodialysis Patient.

    Science.gov (United States)

    Krishna, Vinay Narasimha; Eason, Joseph B; Allon, Michael

    2016-11-01

    Central venous stenosis (CVS) is encountered frequently among hemodialysis patients. Prior ipsilateral central venous catheterization and cardiac rhythm device insertions are common risk factors, but CVS can also occur in the absence of this history. Chronic CVS can cause thrombosis with partial or complete occlusion of the central vein at the site of stenosis. CVS is frequently asymptomatic and identified as an incidental finding during imaging studies. Symptomatic CVS presents most commonly as an upper- or lower-extremity edema ipsilateral to the CVS. Previously unsuspected CVS may become symptomatic after placement of an ipsilateral vascular access. The likelihood of symptomatic CVS may be affected by the central venous catheter (CVC) location; CVC side; duration of CVC dependence; type, location, and blood flow of the ipsilateral access; and extent of collateral veins. Venous angiography is the gold standard for diagnosis. Percutaneous transluminal angioplasty and stent placement can improve the stenosis and alleviate symptoms, but CVS typically recurs frequently, requiring repeated interventions. Refractory symptomatic CVS may require ligation of the ipsilateral vascular access. Because no available treatment option is curative, the goal should be to prevent CVS by minimizing catheters and central vein instrumentation in patients with chronic kidney disease and dialysis patients. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  20. Travel and venous thrombosis: a systematic review

    NARCIS (Netherlands)

    Kuipers, S.; Schreijer, A. J. M.; Cannegieter, S. C.; Bueller, H. R.; Rosendaal, F. R.; Middeldorp, S.

    2007-01-01

    In the past decade, numerous publications on the association between venous thrombosis (VT) and travel have been published. Relative and absolute risks of VT after travel, and particularly after travel by air, have been studied in case-control and observational follow-up studies, whereas the effect

  1. Venous thromboembolism: Risk profile and management of ...

    African Journals Online (AJOL)

    Objectives. This study aims to describe the venous thromboembolism (VTE) risk profile of women undergoing elective gynaecological surgery in a tertiary hospital and to audit the VTE prophylaxis prescribed. Methods. One hundred and nine women who underwent elective gynaecological surgery at Kalafong Provincial ...

  2. Urethro-venous intravasation during urethrography

    African Journals Online (AJOL)

    J.M. Ratkal

    Abstract. Retrograde urethrography is a procedure used to evaluate urethral strictures. Urethro-venous intravasation, rarely seen during retrograde urethrography, can result in bacteremia, adverse reactions to contrast agents, renal failure and even pulmonary embolism. We report one such case of a male patient who ...

  3. REVIEW ARTICLE Venous thromboembolism associated with ...

    Indian Academy of Sciences (India)

    Navya

    2017-03-24

    Mar 24, 2017 ... It has been long recognized that reduced PS activity is a risk factor for venous .... individual had PS deficiency type I but was unavailable for DNA .... Influence of PROS1 gene mutations affecting protein S amino-acid 275 on ...

  4. Knowledge, attitude and practice of venous thromboembolism ...

    African Journals Online (AJOL)

    USER

    We aimed to assess the knowledge, attitude and practice of prophylaxis in venous thromboembolism among medical doctors in Usmanu Danfodiyo University Teaching Hospital,. Sokoto, North-West Nigeria. Methodology: The knowledge, attitude and practice of VTE prophylaxis among medical doctors was assessed using ...

  5. Empowerment and BYOx: Towards Improved IS Security Compliance

    DEFF Research Database (Denmark)

    Welck, Maximilian von; Trenz, Manuel; Jensen, Tina Blegind

    2017-01-01

    Non-compliant employees continue to pose a serious threat to information systems security. Most attempts to increase compliant behavior rely on measures that reduce employees’ latitude. However, recent studies suggest that this indeed eventuates in less compliance due to adverse behaviors...... outline how this novel approach to improve IS security compliance can be developed and investigated further....

  6. 30 CFR 772.13 - Coal exploration compliance duties.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Coal exploration compliance duties. 772.13... INTERIOR SURFACE COAL MINING AND RECLAMATION OPERATIONS PERMITS AND COAL EXPLORATION SYSTEMS UNDER REGULATORY PROGRAMS REQUIREMENTS FOR COAL EXPLORATION § 772.13 Coal exploration compliance duties. (a) All...

  7. Venous infraction of developmental venous anomaly: A case report with perfusion imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Youn; Kim, Hye Jeong; Hyun, Su Jeong; Kim, Hee Yeong; Kim, Han Myun; Hwang, Ji Young; Hong, Hye Suk; Woo, Ji Young; Yang, Ik [Dept. of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul (Korea, Republic of); Kim, Eun Soo [Dept. of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang (Korea, Republic of)

    2017-06-15

    Developmental venous anomaly (DVA) is a common congenital venous malformation characterized by dilated medullary veins in caput medusa configuration and a draining vein. Despite the high incidence of DVAs, they are benign anatomic variations and rarely cause symptoms. Here, we report computed tomography and magnetic resonance imaging findings with perfusion images of acute infarction from underlying DVA in a 63-year-old female patient who presented with acute onset of neurologic symptoms and recovered without any neurologic deficit.

  8. Environmental Compliance Assessment System (ECAS).

    Science.gov (United States)

    1993-03-01

    shopping malls, schools, hospitals. reli- gious buildings, factories. workshops, or tourism sites are found within 200 meters (in) of the border of the... Smm (EM&S) (14) W"Wewrm Tmooem Pl~m Svpmwvow (GAM) (16) Ekldbal adl Ca Dýu.oe (DEH) (22) Stdf Jhdle Mvomf 132) Dwoon- of R.scusv. MaUt ut (DRM

  9. Environmental Compliance Assessment System (ECAS)

    Science.gov (United States)

    1994-02-01

    a 1 h average - at ground level, 10 mg/in for an 8 h average. Verify that the concentration of ozone does not exceed 0.12 part per mil- lion ’ppm...research. "* Pest - any imect, rodent, nematode , fungus, or weed; or any other form of terestrial or aquatic plant or animal life or virus, bacterium...524-344 JUDGE 524-314-9779 STALL 524-314-34704 PARTNER 524-403 MOONEY CHEMICALS M-GARD W320 279-3014-9630 . NAUTICAL COATINGS SEA HAWK BIOCOP 44891-6 9

  10. Environmental Compliance Assessment System (ECAS)

    Science.gov (United States)

    1993-09-01

    generators -open burning/open detonation -peak shaving generators -landfills -turbines -surface impoundments -landfarw r- bioremediation Petroleum Product...greater. Methidathion All formu- All uses Restricted Residue effects lations. except on avian species. stock, safflower, and sunflower . All formu...Nursery Unclassified lations. stock. safflower, and sunflower Methomyl As sole Nondomestic Restricted. Residue effects active in- outdoor on mammalian

  11. Automatic Control of Veno-Venous Extracorporeal Lung Assist.

    Science.gov (United States)

    Kopp, Ruedger; Bensberg, Ralf; Stollenwerk, Andre; Arens, Jutta; Grottke, Oliver; Walter, Marian; Rossaint, Rolf

    2016-10-01

    Veno-venous extracorporeal lung assist (ECLA) can provide sufficient gas exchange even in most severe cases of acute respiratory distress syndrome. Commercially available systems are manually controlled, although an automatically controlled ECLA could allow individualized and continuous adaption to clinical requirements. Therefore, we developed a demonstrator with an integrated control algorithm to keep continuously measured peripheral oxygen saturation and partial pressure of carbon dioxide constant by automatically adjusting extracorporeal blood and gas flow. The "SmartECLA" system was tested in six animal experiments with increasing pulmonary hypoventilation and hypoxic inspiratory gas mixture to simulate progressive acute respiratory failure. During a cumulative evaluation time of 32 h for all experiments, automatic ECLA control resulted in a peripheral oxygen saturation ≥90% for 98% of the time with the lowest value of 82% for 15 s. Partial pressure of venous carbon dioxide was between 40 and 49 mm Hg for 97% of the time with no value 49 mm Hg. With decreasing inspiratory oxygen concentration, extracorporeal oxygen uptake increased from 68 ± 25 to 154 ± 34 mL/min (P < 0.05), and reducing respiratory rate resulted in increasing extracorporeal carbon dioxide elimination from 71 ± 37 to 92 ± 37 mL/min (P < 0.05). The "SmartECLA" demonstrator allowed reliable automatic control of the extracorporeal circuit. Proof of concept could be demonstrated for this novel automatically controlled veno-venous ECLA circuit. Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  12. Emergency lighting system for compliance with the IS-30 and further than the foundations of design events; Sistema de Alumbrado de Emergencia para cumplimiento con la IS-30 y sucesos mas alla de las bases de diseno

    Energy Technology Data Exchange (ETDEWEB)

    Tejeda Sanchez, C.

    2014-07-01

    Autonomy and vulnerability to fire requirements of the emergency lighting systems, established in CSN instruction IS-30, and in commitments to deal with the consequences of events more beyond the bases of design, the design of a new lighting system required of emergency in the Almaraz Nuclear power plant. The design process consists of three phases: study of needs, definition of detailed design and requirements. During these phases is defined distribution and models luminaire lighting studies and specifications. Through the adaptation of the system to the needs of each area of the plant is It achieves compliance with the objectives defined by the CSN. (Author)

  13. Mobile Source Emissions Regulatory Compliance Data Inventory

    Science.gov (United States)

    The Mobile Source Emissions Regulatory Compliance Data Inventory data asset contains measured summary compliance information on light-duty, heavy-duty, and non-road engine manufacturers by model, as well as fee payment data required by Title II of the 1990 Amendments to the Clean Air Act, to certify engines for sale in the U.S. and collect compliance certification fees. Data submitted by manufacturers falls into 12 industries: Heavy Duty Compression Ignition, Marine Spark Ignition, Heavy Duty Spark Ignition, Marine Compression Ignition, Snowmobile, Motorcycle & ATV, Non-Road Compression Ignition, Non-Road Small Spark Ignition, Light-Duty, Evaporative Components, Non-Road Large Spark Ignition, and Locomotive. Title II also requires the collection of fees from manufacturers submitting for compliance certification. Manufacturers submit data on an annual basis, to document engine model changes for certification. Manufacturers also submit compliance information on already certified in-use vehicles randomly selected by the EPA (1) year into their life and (4) years into their life to ensure that emissions systems continue to function appropriately over time.The EPA performs targeted confirmatory tests on approximately 15% of vehicles submitted for certification. Confirmatory data on engines is associated with its corresponding submission data to verify the accuracy of manufacturer submission beyond standard business rules.Section 209 of the 1990 Amendments to the Clea

  14. Managing quality and compliance.

    Science.gov (United States)

    McNeil, Alice; Koppel, Carl

    2015-01-01

    Critical care nurses assume vital roles in maintaining patient care quality. There are distinct facets to the process including standard setting, regulatory compliance, and completion of reports associated with these endeavors. Typically, multiple niche software applications are required and user interfaces are varied and complex. Although there are distinct quality indicators that must be tracked as well as a list of serious or sentinel events that must be documented and reported, nurses may not know the precise steps to ensure that information is properly documented and actually reaches the proper authorities for further investigation and follow-up actions. Technology advances have permitted the evolution of a singular software platform, capable of monitoring quality indicators and managing all facets of reporting associated with regulatory compliance.

  15. Central venous recanalization in patients with short gut syndrome: restoration of candidacy for intestinal and multivisceral transplantation.

    Science.gov (United States)

    Lang, Elvira V; Reyes, Jorge; Faintuch, Salomao; Smith, Amy; Abu-Elmagd, Kareem

    2005-09-01

    To assess feasibility and success of venous recanalization in patients with short gut syndrome who have lost their traditional central venous access and required intestinal or multivisceral transplantation. Twelve patients between the ages of 7 and 55 years with short gut syndrome and long-standing total parenteral nutrition (TPN) dependency and/or hypercoagulability were treated. All had extensive chronic central venous occlusions and survival was dependent on restoration of access and planned transplantation. Central venous recanalizations were obtained via sharp needle recanalization techniques, venous reconstructions with stents, and/or extraanatomic access to the central venous system for placement of central venous tunneled catheters. Central venous access was restored in all patients without operative-related mortality. Three major hemodynamic perioperative technical complications were recorded and successfully treated. There were three self-limited early infectious complications. With a mean follow-up of 22 months, eight of the 12 patients were alive with successful small bowel or multivisceral transplantation; six of those became independent of TPN. The remaining four patients died of complications related to TPN (n = 3) or transplantation (n = 1). With a mean follow-up of 20 months, all but two of the recanalized venous accesses were maintained, for a success rate of 83%. Recanalizations of extensive chronic vein occlusions are feasible but associated with high risk. The technique is life-saving for TPN-dependent patients and can restore candidacy for intestinal and multivisceral transplantation. This approach is likely to be increasingly requested because of the current clinical availability of the transplant procedure.

  16. CT findings of posterior fossa venous angiomas

    International Nuclear Information System (INIS)

    Satoh, Toru; Kinugasa, Kazushi; Nishimoto, Akira; Nishimoto, Ken.

    1986-01-01

    Three cases of posterior fossa venous angiomas were reported, with some comments on the CT findings. Case 1: A 53-year-old woman was admitted for the further examination of a viral meningitis which had appeared three months before. Neurological examination revealed no abnormality. Vertebral angiography, however, demonstrated numerous fine medullary veins, with an enlarged intraparenchymal draining vein, in the right cerebellum; they drained into the petrosal vein, which was characteristic of venous angioma. On the plain CT, part of the draining vein was identified as a slightly high-density node. A curvilinear draining vein was demonstrated by the enhanced CT. Case 2: A 29-year-old man was admitted complaining of headache, vomiting, and atxia. Neurological examination disclosed truncal ataxia. The enhanced CT demonstrated two distinct nodules on the anterior border of the hematoma in the deep median cerebellum, probably corresponding to the draining veins. On the angiogram, a venous angioma was found in the bilateral cerebellum; it drained into the precentral cerebellar veins and ultimately joined the straight sinus via the precentro-vermo-rectal vein. Case 3: A 4-year-old boy was admitted suffering from headache, vomiting, and ataxia. Neurological examination disclosed a co-ordination disturbance of the left side. The enhanced CT demonstrated a curvilinear structure inside the hematoma. Angiography showed a venous angioma in the left cerebellum which drained into the petrosal vein. Computerized angiotomography delineated the characteristic venous structure on the angiogram as many fine, high-density lines (medullary veins) converging to a large intraparenchymal linear structure (central medullary vein) and then to a superficial cortical vein. In all cases, large intraparenchymal draining veins were identified by the conventional CT. (J.P.N.)

  17. Anticoagulation period in idiopathic venous thromboembolism

    International Nuclear Information System (INIS)

    Farraj, Rami S.

    2004-01-01

    The period of anticoagulation of a first episode of idiopathic venous thromboembolism has been 6 months. It is unclear if such patients would benefit from longer treatment, as there appears to be an increased risk of recurrence after anticoagulation is stopped. In a randomized prospective study of 64 patients admitted to King Hussein Medical city, Amman, Jordan, who developed a first episode of venous thromboembolism, 32 patients were given warfarin for 24-months, while 32 patients stopped anticoagulation after completion of 6-months of therapy. Our goal was to determine the effects of extended anticoagulation on rates of recurrence of symptomatic venous thromboembolism and bleeding. The patients were followed for 12-months after stopping anticoagulation. After 24-months, 7 of the 32 patients (21%) who had standard anticoagulation for 6-months had a recurrent episode of thromboembolism compared to one of the 32 patients who received anticoagulation for 24 months (3%). Extended warfarin therapy for 24-months has resulted in an absolute risk reduction of 0.1% (p<0.05). This translates into 8 patients having to be treated for 24-months to avoid one recurrence without increasing the risk of major bleeding. Two patients in each group (6%) had major nonfatal bleeding, all 4 bleeding episodes occurring within the first 3-months of anticoagulation. After 36-months of follow up, the recurrence rate of extended warfarin therapy was only 3 patients (9%), which is a 43% relative reduction in recurrence of thromboembolism compared to standard therapy for 6-months. Patients with first episodes of idiopathic venous thromboembolism have an increased risk of recurrent venous thromboembolism and should be treated with oral anticoagulants for longer than 6-months, probably 24-months. (author)

  18. Role of Catheter-directed Thrombolysis in Management of Iliofemoral Deep Venous Thrombosis.

    Science.gov (United States)

    Chen, James X; Sudheendra, Deepak; Stavropoulos, S William; Nadolski, Gregory J

    2016-01-01

    The treatment for iliofemoral deep venous thrombosis (DVT) is challenging, as the use of anticoagulation alone can be insufficient for restoring venous patency and thus lead to prolongation of acute symptoms and an increased risk of chronic complications, including venous insufficiency and postthrombotic syndrome (PTS). In these cases, earlier and more complete thrombus removal can ameliorate acute symptoms and reduce long-term sequelae. Endovascular therapies involving the use of pharmacologic, mechanical, and combined pharmacomechanical modalities have been developed to achieve these goals. The most frequently used of these techniques, catheter-directed thrombolysis (CDT), involves the infusion of a thrombolytic agent through a multiple-side-hole catheter placed within the thrombosed vein to achieve high local doses and thereby break down the clot while minimizing systemic thrombolytic agent exposure. Randomized controlled trial results have indicated decreased PTS rates and improved venous patency rates in patients treated with CDT compared with these rates in patients treated with anticoagulation. The use of newer pharmacomechanical techniques, as compared with conventional CDT, reduces procedural times and thrombolytic agent doses and is the subject of ongoing investigations. Endovascular thrombus removal techniques offer a means to improve venous valvular function and decrease the risk of debilitating long-term complications such as PTS and are a promising option for treating patients with iliofemoral DVT. (©)RSNA, 2016.

  19. Morphologic changes of cerebral veins in hypertensive rats: venous collagenosis is associated with hypertension.

    Science.gov (United States)

    Zhou, Min; Mao, Lijuan; Wang, Ying; Wang, Qian; Yang, Zhiyun; Li, Shurong; Li, Ling

    2015-03-01

    The aims of this study were to determine whether arterial hypertension could affect the venous system of brain and to find out the consequent pathologic changes of cerebral veins. Thirty male Sprague-Dawley rats were divided into 2 groups: a sham-clipped group and a stroke-prone renovascular hypertensive rat group. A 2-kidney 2-clip rat model was used to induce renovascular hypertension in the hypertensive group. Systolic blood pressure was measured by tail cuff once each week. Susceptibility-weighted imaging (SWI) was performed at 12, 16, and 20 weeks after surgery. All the rats were sacrificed after the SWI examination at 20 weeks after surgery. The brains were extracted and embedded in paraffin for histologic examination. Masson trichrome staining was performed to identify venous collagenosis. The sham group demonstrated less prominence of cerebral veins compared with hypertensive groups (P veins on SWI as a sign of venous hypertension and the thickened cerebral venous walls (venous collagenosis), which may play a role in cerebral ischemia and/or infarction, are both consequences of long-term hypertension in hypertensive rats. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  20. Venous malformations: MR imaging features that predict skin burns after percutaneous alcohol embolization procedures

    International Nuclear Information System (INIS)

    Fayad, Laura M.; Hazirolan, Tuncay; Carrino, John A.; Bluemke, David A.; Mitchell, Sally

    2008-01-01

    To examine the value of magnetic resonance (MR) imaging for predicting the occurrence of skin burns in patients with venous malformations who undergo percutaneous alcohol embolization was the objective of the study. Pre-procedural MR imaging at 1.5 T from 40 patients with venous malformations who had undergone percutaneous alcohol embolization was retrospectively reviewed by two observers for these features: anatomic location, definition (well-defined or ill-defined), and the presence of skin, subcutaneous tissue, muscle, tendon, bone, joint, and deep venous system involvement. One observer recorded the length of skin involvement and volume of the malformation. Univariate and multivariate analysis tests were used to determine whether an association between the occurrence of skin burns and MR imaging features existed. The anatomic locations of the venous malformations were the lower extremity (20 out of 40), upper extremity (11 out of 40), trunk (four out of 40), head/neck (three out of 40) and pelvis (two out of 40). Of the 40 subjects, 15% (six out of 40) experienced skin burns. There was a significant association between the absence of muscle involvement (p=0.0198) as well as the length of skin involvement (p=0.027), with the occurrence of skin burns. Malformation size and all other features were not significantly associated with skin burns. Skin burns in patients with venous malformations treated with alcohol embolization are associated with the length of skin involvement and with the absence of deeper tissue involvement, as depicted on MR imaging. (orig.)

  1. The Tobacco Pack Surveillance System: A Protocol for Assessing Health Warning Compliance, Design Features, and Appeals of Tobacco Packs Sold in Low- and Middle-Income Countries.

    Science.gov (United States)

    Smith, Katherine; Washington, Carmen; Brown, Jennifer; Vadnais, Alison; Kroart, Laura; Ferguson, Jacqueline; Cohen, Joanna

    2015-01-01

    Tobacco remains the world's leading preventable cause of death, with the majority of tobacco-caused deaths occurring in low- and middle-income countries. The first global health treaty, the Framework Convention on Tobacco Control (FCTC), outlines a set of policy initiatives that have been demonstrated as effective in reducing tobacco use. Article 11 of the FCTC focuses on using the tobacco package to communicate tobacco-caused harms; it also seeks to restrict the delivery of misleading information about the product on the pack. The objective of this study was to establish a surveillance system for tobacco packs in the 14 low- and middle-income countries with the greatest number of smokers. The Tobacco Pack Surveillance System (TPackSS) monitors whether required health warnings on tobacco packages are being implemented as intended, and identifies pack designs and appeals that might violate or detract from the communication of harm-related information and undermine the impact of a country's tobacco packaging laws. The protocol outlined is intended to be applicable or adaptable for surveillance efforts in other countries. Tobacco packs were collected in 14 countries during 2013. The intention was, to the extent possible, to construct a census of "unique" pack presentations available for purchase in each country. The TPackSS team partnered with in-country field staff to implement a standardized protocol for acquiring packs from 36 diverse neighborhoods across three cities in each country. At the time of purchase, data on price and place of acquisition of each pack was recorded. The field staff, according to a standardized protocol, then photographed packs before they were shipped to the United States for coding and archiving. Each pack was coded for compliance with the country-specific health warning label laws, as well as for key design features of the pack and appeals of the branding elements. The coding protocols were developed based upon prior research, expert

  2. Pattern of magnetic resonance imaging and magnetic resonance venography changes in cerebral venous sinus thrombosis

    International Nuclear Information System (INIS)

    Zafar, A.; Ali, Z.

    2012-01-01

    cerebral venous system is readily picked-up on MRV even if it is missed by CT scan or MRI. (author)

  3. Unicameral bone cyst: radiographic assessment of venous outflow by cystography as a prognostic index.

    Science.gov (United States)

    Ramirez, Ana; Abril, Juan Carlos; Touza, Alberto

    2012-11-01

    percutaneous injections of sclerosing substances. It facilitates the differentiation of cysts that may achieve complete healing (negative venogram) from those that tend to show recurrence (rapid venous outflow). Therapeutic material should be introduced slowly and a second trocar should always be placed to decrease the risk of migration in cysts with communication with the venous system. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

  4. Intrahepatic arterioportal shunting and anomalous venous drainage: understanding the CT features in the liver

    Energy Technology Data Exchange (ETDEWEB)

    Breen, David J.; Rutherford, Elizabeth E.; Stedman, Brian; Lee-Elliott, Catherine; Hacking, C. Nigel [Southampton University Hospitals NHS Trust, Department of Radiology, Southampton, Hampshire (United Kingdom)

    2004-12-01

    The increased use of high-contrast volume, arterial-phase studies of the liver has demonstrated the frequent occurrence of arterioportal shunts within both the cirrhotic and non-cirrhotic liver. This article sets out to explain the underlying microcirculatory mechanisms behind these commonly encountered altered perfusion states. Similarly, well-recognised portal perfusion defects occur around the perifalciform and perihilar liver and are largely caused by anomalous venous drainage via the paraumbilical and parabiliary venous systems. The underlying anatomy will be discussed and illustrated. These vascular anomalies are all caused by or result in diminished portal perfusion and are often manifest in the setting of portal venous thrombosis. The evolving concept of zonal re-perfusion following portal vein thrombosis will be discussed. (orig.)

  5. Two divergent paths: compression vs. non-compression in deep venous thrombosis and post thrombotic syndrome

    Directory of Open Access Journals (Sweden)

    Eduardo Simões Da Matta

    Full Text Available Abstract Use of compression therapy to reduce the incidence of postthrombotic syndrome among patients with deep venous thrombosis is a controversial subject and there is no consensus on use of elastic versus inelastic compression, or on the levels and duration of compression. Inelastic devices with a higher static stiffness index, combine relatively small and comfortable pressure at rest with pressure while standing strong enough to restore the “valve mechanism” generated by plantar flexion and dorsiflexion of the foot. Since the static stiffness index is dependent on the rigidity of the compression system and the muscle strength within the bandaged area, improvement of muscle mass with muscle-strengthening programs and endurance training should be encouraged. Therefore, in the acute phase of deep venous thrombosis events, anticoagulation combined with inelastic compression therapy can reduce the extension of the thrombus. Notwithstanding, prospective studies evaluating the effectiveness of inelastic therapy in deep venous thrombosis and post-thrombotic syndrome are needed.

  6. [Anomalous pulmonary venous return in a pregnant woman identified by cardiac magnetic resonance].

    Science.gov (United States)

    Souto, Fernanda Maria; Andrade, Stephanie Macedo; Barreto, Ana Terra Fonseca; Souto, Maria Júlia Silveira; Russo, Maria Amélia; de Mendonça, José Teles; Oliveira, Joselina Luzia Menezes; Gonçalves, Luiz Flávio Galvão

    2014-06-01

    Anomalous pulmonary venous return (APVR) is a rare cardiac anomaly defined as one or more pulmonary veins draining into a structure other than the left atrium, with venous return directly or indirectly to the right atrium. The most common form is partial APVR, in which one to three pulmonary veins drain into systemic veins or into the right atrium. We report the case of a woman diagnosed with partial APVR by magnetic resonance imaging during pregnancy. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  7. Cerebral venous thrombosis: Pseudoflebitic pattern in the sequence T2 FLAIR

    International Nuclear Information System (INIS)

    Mantilla Martin, Maria Teresa

    2006-01-01

    Cerebral venous thrombosis (CVT) is an infrequent illness, although more than one hundred possible causes have been described. These causes can be divided In two categories: local ones and systemic ones. Magnetic resonance is the most sensitive non invasive method to diagnose CVT. This article presents cases of dural sinus thrombosis, reported in the Clinic Reina Sofia between June of 2003 and June of 2004. Fifteen cases were found. The principle symptoms were: headache, convulsions, and focal neurological deficit. The more frequently affected venous sinus were the transverse and the superior sagittal ones

  8. Cerebral venous thrombosis: Update on clinical manifestations, diagnosis and management

    Directory of Open Access Journals (Sweden)

    Leys Didier

    2008-01-01

    Full Text Available Cerebral venous thrombosis (CVT has a wide spectrum of clinical manifestations that may mimic many other neurological disorders and lead to misdiagnoses. Headache is the most common symptom and may be associated with other symptoms or remain isolated. The other frequent manifestations are focal neurological deficits and diffuse encephalopathies with seizures. The key to the diagnosis is the imaging of the occluded vessel or of the intravascular thrombus, by a combination of magnetic resonance imaging (MRI and magnetic resonance venography (MRV. Causes and risk factors include medical, surgical and obstetrical causes of deep vein thrombosis, genetic and acquired prothrombotic disorders, cancer and hematological disorders, inflammatory systemic disorders, pregnancy and puerperium, infections and local causes such as tumors, arteriovenous malformations, trauma, central nervous system infections and local infections. The breakdown of causes differs in different parts of the world. A meta-analysis of the most recent prospectively collected series showed an overall 15% case-fatality or dependency rate. Heparin therapy is the standard therapy at the acute stage, followed by 3-6 months of oral anticoagulation. Patients with isolated intracranial hypertension may require a lumbar puncture to remove cerebrospinal fluid before starting heparin when they develop a papilloedema that may threaten the visual acuity or decompressive hemicraniectomy. Patients who develop seizures should receive antiepileptic drugs. Cerebral venous thrombosis - even pregnancy-related - should not contraindicate future pregnancies. The efficacy and safety of local thrombolysis and decompressive hemicraniectomy should be tested

  9. Compliance of the Savannah River Plant P-Reactor cooling system with environmental regulations. Demonstrations in accordance with Sections 316(a) and (b) of the Federal Water Pollution Control Act of 1972

    International Nuclear Information System (INIS)

    Wilde, E.W.

    1985-12-01

    This document presents demonstrations under Sections 316(a) and (b) of the Federal Water Pollution Control Act of 1972 for the P-Reactor cooling system at the Savannah River Plant (SRP). The demonstrations were mandated when the National Pollution Discharge Elimination System (NPDES) permit for the SRP was renewed and the compliance point for meeting South Carolina Class B water quality criteria in the P-Reactor cooling system was moved from below Par Pond to the reactor cooling water outfall, No. P-109. Extensive operating, environmental, and biological data, covering most of the current P-Reactor cooling system history from 1958 to the present are discussed. No significant adverse effects were attributed to the thermal effluent discharged to Par Pond or the pumping of cooling water from Par Pond to P Reactor. It was conluded that Par Pond, the principal reservoir in the cooling system for P Reactor, contains balanced indigenous biological communities that meet all criteria commonly used in defining such communities. Par Pond compares favorably with all types of reservoirs in South Carolina and with cooling lakes and reservoirs throughout the southeast in terms of balanced communities of phytoplankton, macrophytes, zooplankton, macroinvertebrates, fish, and other vertebrate wildlife. The report provides the basis for negotiations between the South Carolina Department of Health and Environmental Control (SCDHEC) and the Department of Energy - Savannah River (DOE-SR) to identify a mixing zone which would relocate the present compliance point for Class B water quality criteria for the P-Reactor cooling system

  10. Use of Provider-Level Dashboards and Pay-for-Performance in Venous Thromboembolism Prophylaxis*

    Science.gov (United States)

    Michtalik, Henry J.; Carolan, Howard T.; Haut, Elliott R.; Lau, Brandyn D.; Streiff, Michael B.; Finkelstein, Joseph; Pronovost, Peter J.; Durkin, Nowella; Brotman, Daniel J.

    2014-01-01

    Background Despite safe and cost-effective venous thromboembolism (VTE) prevention measures, VTE prophylaxis rates are often suboptimal. Healthcare reform efforts emphasize transparency through programs to report performance, and payment incentives through programs to pay-for-performance. Objective To sequentially examine an individualized physician dashboard and pay-for-performance program to improve VTE prophylaxis rates amongst hospitalists. Design Retrospective analysis of 3144 inpatient admissions. After a baseline observation period, VTE prophylaxis compliance was compared during both interventions. Setting 1060-bed tertiary care medical center. Participants 38 part- and full-time academic hospitalists. Interventions A Web-based hospitalist dashboard provided VTE prophylaxis feedback. After 6 months of feedback only, a pay-for-performance program was incorporated, with graduated payouts for compliance rates of 80-100%. Measurements Prescription of American College of Chest Physicians guideline-compliant VTE prophylaxis and subsequent pay-for-performance payments. Results Monthly VTE prophylaxis compliance rates were 86% (95% CI: 85, 88), 90% (95% CI: 88, 93), and 94% (95% CI: 93, 96) during the baseline, dashboard, and combined dashboard/pay-for-performance periods, respectively. Compliance significantly improved with the use of the dashboard (p=0.01) and addition of the pay-for-performance program (p=0.01). The highest rate of improvement occurred with the dashboard (1.58%/month; p=0.01). Annual individual physician performance payments ranged from $53 to $1244 (mean $633; SD ±350). Conclusions Direct feedback using dashboards was associated with significantly improved compliance, with further improvement after incorporating an individual physician pay-for-performance program. Real-time dashboards and physician-level incentives may assist hospitals in achieving higher safety and quality benchmarks. PMID:25545690

  11. Ulcer due to chronic venous disease: a sociodemographic study in northeastern Brazil.

    Science.gov (United States)

    de Souza, Edson Marques; Yoshida, Winston Bonetti; de Melo, Valdinaldo Aragão; Aragão, José Aderval; de Oliveira, Luiz Augusto Bitencurt

    2013-07-01

    Venous ulcers account for 70% of chronic leg ulcers and affect about 2-7% of the population, causing much socioeconomic impact and reducing patients' quality of life. In this study we aimed to describe the clinical features of venous ulcers and sociodemographic characteristics of patients with ulcers due to chronic venous disease (CVD). This cross-sectional, observational study was conducted at the Vascular Surgery Service, Universidade Federal de Sergipe, in northeastern Brazil. The study included a consecutive series of 154 patients with active venous ulcers (CEAP C6) in the lower limb due to CVD. Sociodemographic characteristics (age, gender, race, monthly income, education, occupation, and caregiver) and clinical data (affected limb, ulcer site, etiopathogenesis, recurrence, and time elapsed since the first episode of ulcer) were collected. A possible correlation of time elapsed since the first episode of ulcer and number of recurrences with primary or secondary etiology was analyzed by Mann-Whitney U-test. Of the 154 patients analyzed, 79% were female, 94% were ethnically black or brown, 90% had a monthly income less than or equal to minimum wage, 47% were illiterate, 35% had not completed elementary school, 50% had informal jobs, 19.5% were retired, and 18.2% received sick pay from the social security system. The mean age was 53.7 years. Both limbs were affected similarly, and venous ulcers were located predominantly on the medial aspect of the leg (84%). The median time elapsed since the first episode of ulcer was 36 months, being significantly higher in patients with venous ulcers of secondary etiology (P < 0.0003). The prevalence of recurrence was also significantly higher in patients with venous ulcers of secondary etiology (P < 0.001). According to CEAP classification, 65% of ulcers were primary (Ep), 94.1% demonstrated reflux involving the superficial system (As), 92% had incompetent perforators (Ap), 35% demonstrated reflux involving the deep system

  12. Why Chinese farmers obey the law: Pesticide compliance in Hunan Province, China

    NARCIS (Netherlands)

    Yan, H.

    2014-01-01

    While China’s legal system has been increasingly perfected, the implementation of laws in China remains challenging. Simply strengthening law enforcement is not sufficient to improve compliance. It is necessary to bring in a regulatory compliance perspective. This book intends to explore compliance

  13. 48 CFR 252.228-7006 - Compliance with Spanish laws and insurance.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Compliance with Spanish... CLAUSES Text of Provisions And Clauses 252.228-7006 Compliance with Spanish laws and insurance. As prescribed at 228.370(e), use the following clause: Compliance with Spanish Laws and Insurance (DEC 1998) (a...

  14. Compliance. Regulatory policy P-211

    International Nuclear Information System (INIS)

    2001-05-01

    This regulatory policy describes the basic principles and directives for establishing and conducting the Canadian Nuclear Safety Commission (CNSC) Compliance Program. The program is aimed at securing compliance by regulated persons with regulatory requirements made under the Nuclear Safety and Control Act ('the Act'). The policy applies to persons who are regulated by the CNSC through the Act, regulations and licences, as well as by decisions and orders made under the Act. The policy applies to officers and employees of the CNSC, and its authorized representatives or agents, who are involved in developing and carrying out compliance activities. Compliance, in the context of this policy, means conformity by regulated persons with the legally binding requirements of the Act, and the CNSC regulations, licences, decisions, and orders made under the Act. Compliance activities are CNSC measures of promotion, verification and enforcement aimed at securing compliance by regulated person with the applicable legally binding requirements. (author)

  15. EPA Enforcement and Compliance History Online: Water Discharge Monitoring Report Data Sets for FY2010

    Data.gov (United States)

    U.S. Environmental Protection Agency — Integrated Compliance Information System (ICIS) National Pollutant Discharge Elimination System (NPDES) Discharge Monitoring Report (DMR) data sets for Clean Water...

  16. EPA Enforcement and Compliance History Online: Water Discharge Monitoring Report Data Sets for FY2015

    Data.gov (United States)

    U.S. Environmental Protection Agency — Integrated Compliance Information System (ICIS) National Pollutant Discharge Elimination System (NPDES) Discharge Monitoring Report (DMR) data sets for Clean Water...

  17. EPA Enforcement and Compliance History Online: Water Discharge Monitoring Report Data Sets for FY2014

    Data.gov (United States)

    U.S. Environmental Protection Agency — Integrated Compliance Information System (ICIS) National Pollutant Discharge Elimination System (NPDES) Discharge Monitoring Report (DMR) data sets for Clean Water...

  18. EPA Enforcement and Compliance History Online: Water Discharge Monitoring Report Data Sets for FY2009

    Data.gov (United States)

    U.S. Environmental Protection Agency — Integrated Compliance Information System (ICIS) National Pollutant Discharge Elimination System (NPDES) Discharge Monitoring Report (DMR) data sets for Clean Water...

  19. EPA Enforcement and Compliance History Online: Water Discharge Monitoring Report Data Sets for FY2016

    Data.gov (United States)

    U.S. Environmental Protection Agency — Integrated Compliance Information System (ICIS) National Pollutant Discharge Elimination System (NPDES) Discharge Monitoring Report (DMR) data sets for Clean Water...

  20. EPA Enforcement and Compliance History Online: Water Discharge Monitoring Report Data Sets for FY2013

    Data.gov (United States)

    U.S. Environmental Protection Agency — Integrated Compliance Information System (ICIS) National Pollutant Discharge Elimination System (NPDES) Discharge Monitoring Report (DMR) data sets for Clean Water...