Rotating double arm spectrometer to study hard scattering interactions at Serpukhov accelerator

International Nuclear Information System (INIS)

Abramov, V.V.; Baldin, B.Yu.; Buzulutskov, A.F.

1991-01-01

The double arm magnetic spectrometer designed to study high P T particle production with intense proton and pion beams is described. Particle trajectories are measured by the drift and proportional chambers. Particles are identified by Cherenkov ring spectrometer and muon identifier. The spectrometer can be rotated around the target up to 160 mrad. 2 tabs.; 13 figs

Ocean Thermal Energy Conversion Using Double-Stage Rankine Cycle

Directory of Open Access Journals (Sweden)

Yasuyuki Ikegami

2018-03-01

Full Text Available Ocean Thermal Energy Conversion (OTEC using non-azeotropic mixtures such as ammonia/water as working fluid and the multistage cycle has been investigated in order to improve the thermal efficiency of the cycle because of small ocean temperature differences. The performance and effectiveness of the multistage cycle are barely understood. In addition, previous evaluation methods of heat exchange process cannot clearly indicate the influence of the thermophysical characteristics of the working fluid on the power output. Consequently, this study investigated the influence of reduction of the irreversible losses in the heat exchange process on the system performance in double-stage Rankine cycle using pure working fluid. Single Rankine, double-stage Rankine and Kalina cycles were analyzed to ascertain the system characteristics. The simple evaluation method of the temperature difference between the working fluid and the seawater is applied to this analysis. From the results of the parametric performance analysis it can be considered that double-stage Rankine cycle using pure working fluid can reduce the irreversible losses in the heat exchange process as with the Kalina cycle using an ammonia/water mixture. Considering the maximum power efficiency obtained in the study, double-stage Rankine and Kalina cycles can improve the power output by reducing the irreversible losses in the cycle.

Prevalence of inter-arm blood pressure difference among clinical out-patients.

Science.gov (United States)

Sharma, Balkishan; Ramawat, Pramila

2016-04-01

An increased inter-arm blood pressure difference is an easily determined physical finding, may use as an indicator of cardio vascular event and other sever diseases. Authors evaluated 477 patients to determine the prevalence and significance of inter-arm blood pressure difference. 477 routine outdoor patients selected to observe the inter-arm blood pressure difference. Age, height, weight, body mass index, history of disease and blood pressure recorded. The prevalence of ≥10 mmHg systolic inter-arm blood pressure difference was 5.0% was more as compared to 3.8% had diastolic inter-arm blood pressure difference. The prevalence of systolic and diastolic inter-arm difference between 6 to 10 mmHg was 31.4% and 27.9% respectively. Mean systolic inter-arm blood pressure difference was significantly higher among those patients had a multisystem disorder (10.57±0.98 mmHg) and followed by patients with cardiovascular disease (10.22±0.67 mmHg) as compared to healthy patients (2.71±0.96 mmHg). Various diseases highly influenced the increase in blood pressure irrespective of systolic or diastolic was confirmed strongly significant (pdifferent inter arm blood pressure difference levels. This study supports the view of inter-arm blood pressure difference as an alarming stage of increased disease risk that incorporated to investigate potential problems at an early diagnostic stage. A significant mean difference between left and right arm blood pressure recorded for many diseases.

Randomised study on single stage laparo-endoscopic rendezvous (intra-operative ERCP) procedure versus two stage approach (Pre-operative ERCP followed by laparoscopic cholecystectomy) for the management of cholelithiasis with choledocholithiasis.

Science.gov (United States)

Sahoo, Manash Ranjan; Kumar, Anil T; Patnaik, Aashish

2014-07-01

The 'Rendezvous' technique consists of laparoscopic cholecystectomy (LC) standards with intra-operative cholangiography followed by endoscopic sphincterotomy. The sphincterotome is driven across the papilla through a guidewire inserted by the transcystic route. In this study, we intended to compare the two methods in a prospective randomised trial. From 2005 to 2012, we enrolled 83 patients with a diagnosis of cholecysto-choledocolithiasis. They were randomised into two groups. In 'group-A',41 patients were treated with two stages management, first by pre-operative endoscopic retrograde cholangiopancreatography (ERCP) and common bile duct (CBD) clearance and second by LC. In 'group-B', 42 patients were treated with LC and intra-operative cholangiography; and when diagnosis of choledocholithiasis was confirmed, patients had undergone one stage management of by Laparo-endoscopic Rendezvous technique. In arm-A and arm-B groups, complete CBD clearance was achieved in 29 and 38 patients, respectively. Failure of the treatment in arm-A was 29% and in arm-B was 9.5%. In arm-A, selective CBD cannulation was achieved in 33 cases (80.5%) and in arm-B in 39 cases (93%). In arm-Agroup, post-ERCP hyperamylasia was presented in nine patients (22%) and severe pancreatitis in five patients (12%) versus none of the patients (0%) in arm-B group, respectively. Mean post-operative hospital stay in arm-A and arm-B groups are 10.9 and 6.8 days, respectively. One stage laparo-endoscopic rendezvous approach increases selective cannulation of CBD, reduces post-ERCP pancreatitis, reduces days of hospital stay, increases patient's compliance and prevents unnecessary intervention to CBD.

Implementation of double-C-arm synchronous real-time X-ray positioning system computer aided for aspiration biopsy of small lung lesion

International Nuclear Information System (INIS)

Zhu Hong; Wang Dong; Ye Yukun; Zhou Yuan; Lu Jianfeng; Yang Jingyu; Wang Lining

2007-01-01

Objective: To evaluate the feasibility of a new type of real-time three-dimensional X-ray positioning system for aspiration biopsy of small lung lesions. Methods: Using X-ray imaging technology and X-ray collimator technology and combining with double-C-arm X-ray machine, two different synchronous real-time images were obtained from the vertical to the horizontal plane. Then, with the computer image processing and computer vision processing technologies, dynamic tracking for 3D information of a pulmonary lesion and the needle in aspiration, and the relative position of the two, were established. Results: There was no interference while the two imaging perpendicularly X-ray beam met, two synchronous real-time image acquisition and tracking of a lung lesion and a needle could be completed in free respiration. The average positioning system error was about 0.5 mm, the largest positioning error was about 1.0 mm, real-time display rate was 5 screen/sec. Conclusions: the establishment of a new type of double-C-arm synchronous real-time X-ray positioning system is feasible. It is available for the fast and accurate aspiration biopsy of small lung lesions. (authors)

Randomised study on single stage laparo-endoscopic rendezvous (intra-operative ERCP procedure versus two stage approach (Pre-operative ERCP followed by laparoscopic cholecystectomy for the management of cholelithiasis with choledocholithiasis

Directory of Open Access Journals (Sweden)

Manash Ranjan Sahoo

2014-01-01

Full Text Available Introduction : The ′Rendezvous′ technique consists of laparoscopic cholecystectomy (LC standards with intra-operative cholangiography followed by endoscopic sphincterotomy. The sphincterotome is driven across the papilla through a guidewire inserted by the transcystic route. In this study, we intended to compare the two methods in a prospective randomised trial. Materials And Methods: From 2005 to 2012, we enrolled 83 patients with a diagnosis of cholecysto-choledocolithiasis. They were randomised into two groups. In ′group-A′,41 patients were treated with two stages management, first by pre-operative endoscopic retrograde cholangiopancreatography (ERCP and common bile duct (CBD clearance and second by LC. In ′group-B′, 42 patients were treated with LC and intra-operative cholangiography; and when diagnosis of choledocholithiasis was confirmed, patients had undergone one stage management of by Laparo-endoscopic Rendezvous technique. Results: In arm-A and arm-B groups, complete CBD clearance was achieved in 29 and 38 patients, respectively. Failure of the treatment in arm-A was 29% and in arm-B was 9.5%. In arm-A, selective CBD cannulation was achieved in 33 cases (80.5% and in arm-B in 39 cases (93%. In arm-Agroup, post-ERCP hyperamylasia was presented in nine patients (22% and severe pancreatitis in five patients (12% versus none of the patients (0% in arm-B group, respectively. Mean post-operative hospital stay in arm-A and arm-B groups are 10.9 and 6.8 days, respectively. Conclusion: One stage laparo-endoscopic rendezvous approach increases selective cannulation of CBD, reduces post-ERCP pancreatitis, reduces days of hospital stay, increases patient′s compliance and prevents unnecessary intervention to CBD.

The scintillating fiber focal plane detector for the use of Kaos as a double arm spectrometer

Energy Technology Data Exchange (ETDEWEB)

Ayerbe Gayoso, Carlos Antonio

2012-05-25

The upgrade of the Mainz Mikrotron (MAMI) electron accelerator facility in 2007 which raised the beam energy up to 1.5 GeV, gives the opportunity to study strangeness production channels through electromagnetic process. The Kaon Spectrometer (KAOS) managed by the A1 Collaboration, enables the efficient detection of the kaons associated with strangeness electroproduction. Used as a single arm spectrometer, it can be combined with the existing high-resolution spectrometers for exclusive measurements in the kinematic domain accessible to them. For studying hypernuclear production in the {sup A}Z(e,e'K{sup +}){sup A}{sub {lambda}}(Z-1) reaction, the detection of electrons at very forward angles is needed. Therefore, the use of KAOS as a double-arm spectrometer for detection of kaons and the electrons at the same time is mandatory. Thus, the electron arm should be provided with a new detector package, with high counting rate capability and high granularity for a good spatial resolution. To this end, a new state-of-the-art scintillating fiber hodoscope has been developed as an electron detector. The hodoscope is made of two planes with a total of 18432 scintillating double-clad fibers of 0.83 mm diameter. Each plane is formed by 72 modules. Each module is formed from a 60 slanted multi-layer bundle, where 4 fibers of a tilted column are connected to a common read out. The read-out is made with 32 channels of linear array multianode photomultipliers. Signal processing makes use of newly developed double-threshold discriminators. The discriminated signal is sent in parallel to dead-time free time-to-digital modules and to logic modules for triggering purposes. Two fiber modules were tested with a carbon beam at GSI, showing a time resolution of {proportional_to}220 ps (FWHM) and a position resolution of {proportional_to}270 {mu}m (FWHM) with a detection efficiency {epsilon}>99%. The characterization of the spectrometer arm has been achieved through simulations

The scintillating fiber focal plane detector for the use of Kaos as a double arm spectrometer

International Nuclear Information System (INIS)

Ayerbe Gayoso, Carlos Antonio

2012-01-01

The upgrade of the Mainz Mikrotron (MAMI) electron accelerator facility in 2007 which raised the beam energy up to 1.5 GeV, gives the opportunity to study strangeness production channels through electromagnetic process. The Kaon Spectrometer (KAOS) managed by the A1 Collaboration, enables the efficient detection of the kaons associated with strangeness electroproduction. Used as a single arm spectrometer, it can be combined with the existing high-resolution spectrometers for exclusive measurements in the kinematic domain accessible to them. For studying hypernuclear production in the A Z(e,e'K + ) A Λ (Z-1) reaction, the detection of electrons at very forward angles is needed. Therefore, the use of KAOS as a double-arm spectrometer for detection of kaons and the electrons at the same time is mandatory. Thus, the electron arm should be provided with a new detector package, with high counting rate capability and high granularity for a good spatial resolution. To this end, a new state-of-the-art scintillating fiber hodoscope has been developed as an electron detector. The hodoscope is made of two planes with a total of 18432 scintillating double-clad fibers of 0.83 mm diameter. Each plane is formed by 72 modules. Each module is formed from a 60 slanted multi-layer bundle, where 4 fibers of a tilted column are connected to a common read out. The read-out is made with 32 channels of linear array multianode photomultipliers. Signal processing makes use of newly developed double-threshold discriminators. The discriminated signal is sent in parallel to dead-time free time-to-digital modules and to logic modules for triggering purposes. Two fiber modules were tested with a carbon beam at GSI, showing a time resolution of ∝220 ps (FWHM) and a position resolution of ∝270 μm (FWHM) with a detection efficiency ε>99%. The characterization of the spectrometer arm has been achieved through simulations calculating the transfer matrix of track parameters from the fiber

Clinical evaluation of two-stage mandibular wisdom tooth extraction method to avoid mental nerve paresthesia

International Nuclear Information System (INIS)

Nozoe, Etsuro; Nakamura, Yasunori; Okawachi, Takako; Ishihata, Kiyohide; Shinnakasu, Mana; Nakamura, Norifumi

2011-01-01

Clinical courses following two-stage mandibular wisdom tooth extraction (TMWTE) carried out for preventing postoperative mental nerve paresthesia (MNP) were analyzed. When panoramic X-ray showed overlapping of wisdom tooth root on the superior 1/2 or more of the mandibular canal, interruption of the white line of the superior wall of the canal, or diversion of the canal, CT examination was facilitated. In cases where contact between the tooth root and canal was demonstrated in CT examination, TMWTE was then selected after gaining the patient's consent. TMWTE consisted of removing more than a half of the tooth crown and tooth root extraction at the second step after 2-3 months. The clinical features of wisdom teeth extracted and postoperative courses including tooth movement and occurrence of MNP during two-stage MWTE were evaluated. TMWTE was carried out for 40 teeth among 811 wisdom teeth (4.9%) that were extracted from 2007 to 2009. Among them, complete procedures were accomplished in 39 teeth, and crown removal was performed insufficiently at the first-stage operation in one tooth. Tooth movement was detected in 37 of 40 cases (92.5%). No postoperative MNP was observed in cases in which complete two-stage MWTE was carried out, but one case with insufficient crown removal was complicated by postoperative MNP. Seven mild complications (dehiscence, cold sensitivity, etc.) were noted after the first-stage operation. Therefore, we conclude that TMWTE for high-risk cases assessed by X-ray findings is useful to avoid MNP after MWTE. (author)

An adaptive two-stage dose-response design method for establishing proof of concept.

Science.gov (United States)

Franchetti, Yoko; Anderson, Stewart J; Sampson, Allan R

2013-01-01

We propose an adaptive two-stage dose-response design where a prespecified adaptation rule is used to add and/or drop treatment arms between the stages. We extend the multiple comparison procedures-modeling (MCP-Mod) approach into a two-stage design. In each stage, we use the same set of candidate dose-response models and test for a dose-response relationship or proof of concept (PoC) via model-associated statistics. The stage-wise test results are then combined to establish "global" PoC using a conditional error function. Our simulation studies showed good and more robust power in our design method compared to conventional and fixed designs.

The Dubna double-arm time-of-flight spectrometer for heavy-ion reaction products

International Nuclear Information System (INIS)

Schilling, K.D.; Gippner, P.; Seidel, W.; Stary, F.; Will, E.; Heidel, K.; Lukyanov, S.M.; Penionzhkevich, Yu.E.; Salamatin, V.S.; Sodan, H.; Chubarian, G.G.

1986-05-01

The double-arm time-of-flight spectrometer DEMAS designed for the detection and identification of heavy-ion reaction products at incident energies below 10 MeV/amu is presented. Based on the kinematic coincidence method, the relevant physical information is obtained from the measurement of the two correlated velocity vectors of the binary fragments. Construction and performance of the different detector systems applied to measure the time-of-flight values, the position coordinates and the kinetic energies of both fragments are presented in detail. The description of the data acquisition and analysing procedures is followed by the discussion of some experimental examples to demonstrate the spectrometer performance. A mass resolution of typically 4 - 5 amu (fwhm) is routinely achieved. (author)

Two-stage dental implants inserted in a one-stage procedure : a prospective comparative clinical study

NARCIS (Netherlands)

Heijdenrijk, Kees

2002-01-01

The results of this study indicate that dental implants designed for a submerged implantation procedure can be used in a single-stage procedure and may be as predictable as one-stage implants. Although one-stage implant systems and two-stage.

Double-arm time-of-flight mass-spectrometer of nuclear fragments

International Nuclear Information System (INIS)

Ajvazian, G.M.; Astabatyan, R.A.

1995-01-01

A double-arm time-of-flight spectrometer of nuclear fragments for the investigation of heavy nuclei photofission in the intermediate energy range is described. The calibration results and working characteristics of the spectrometer, obtained using 252 Cf as a source of spontaneous fission, are presented. A mass resolution of σ m ∼2-3 a.m.u. was obtained within the registered fragments mass range of 80-160 a.m.u. The spectrometer was tested in the experiment on the investigation of 238 U nuclei fission by Bremsstahlung photons with Eγ max=1.75 GeV

Two-staged management for all types of congenital pouch colon

Directory of Open Access Journals (Sweden)

Rajendra K Ghritlaharey

2013-01-01

Full Text Available Background: The aim of this study was to review our experience with two-staged management for all types of congenital pouch colon (CPC. Patients and Methods: This retrospective study included CPC cases that were managed with two-staged procedures in the Department of Paediatric Surgery, over a period of 12 years from 1 January 2000 to 31 December 2011. Results: CPC comprised of 13.71% (97 of 707 of all anorectal malformations (ARM and 28.19% (97 of 344 of high ARM. Eleven CPC cases (all males were managed with two-staged procedures. Distribution of cases (Narsimha Rao et al.′s classification into types I, II, III, and IV were 1, 2, 6, and 2, respectively. Initial operative procedures performed were window colostomy (n = 6, colostomy proximal to pouch (n = 4, and ligation of colovesical fistula and end colostomy (n = 1. As definitive procedures, pouch excision with abdomino-perineal pull through (APPT of colon in eight, and pouch excision with APPT of ileum in three were performed. The mean age at the time of definitive procedures was 15.6 months (ranges from 3 to 53 months and the mean weight was 7.5 kg (ranges from 4 to 11 kg. Good fecal continence was observed in six and fair in two cases in follow-up periods, while three of our cases lost to follow up. There was no mortality following definitive procedures amongst above 11 cases. Conclusions: Two-staged procedures for all types of CPC can also be performed safely with good results. The most important fact that the definitive procedure is being done without protective stoma and therefore, it avoids stoma closure, stoma-related complications, related cost of stoma closure and hospital stay.

A Two-Stage Approach to Civil Conflict: Contested Incompatibilities and Armed Violence

DEFF Research Database (Denmark)

Bartusevicius, Henrikas; Gleditsch, Kristian Skrede

2017-01-01

conflict origination but have no clear effect on militarization, whereas other features emphasized as shaping the risk of civil war, such as refugee flows and soft state power, strongly influence militarization but not incompatibilities. We posit that a two-stage approach to conflict analysis can help...

Using pilot data to size a two-arm randomized trial to find a nearly optimal personalized treatment strategy.

Science.gov (United States)

Laber, Eric B; Zhao, Ying-Qi; Regh, Todd; Davidian, Marie; Tsiatis, Anastasios; Stanford, Joseph B; Zeng, Donglin; Song, Rui; Kosorok, Michael R

2016-04-15

A personalized treatment strategy formalizes evidence-based treatment selection by mapping patient information to a recommended treatment. Personalized treatment strategies can produce better patient outcomes while reducing cost and treatment burden. Thus, among clinical and intervention scientists, there is a growing interest in conducting randomized clinical trials when one of the primary aims is estimation of a personalized treatment strategy. However, at present, there are no appropriate sample size formulae to assist in the design of such a trial. Furthermore, because the sampling distribution of the estimated outcome under an estimated optimal treatment strategy can be highly sensitive to small perturbations in the underlying generative model, sample size calculations based on standard (uncorrected) asymptotic approximations or computer simulations may not be reliable. We offer a simple and robust method for powering a single stage, two-armed randomized clinical trial when the primary aim is estimating the optimal single stage personalized treatment strategy. The proposed method is based on inverting a plugin projection confidence interval and is thereby regular and robust to small perturbations of the underlying generative model. The proposed method requires elicitation of two clinically meaningful parameters from clinical scientists and uses data from a small pilot study to estimate nuisance parameters, which are not easily elicited. The method performs well in simulated experiments and is illustrated using data from a pilot study of time to conception and fertility awareness. Copyright © 2015 John Wiley & Sons, Ltd.

Two-Armed, Mobile, Sensate Research Robot

Science.gov (United States)

Engelberger, J. F.; Roberts, W. Nelson; Ryan, David J.; Silverthorne, Andrew

2004-01-01

The Anthropomorphic Robotic Testbed (ART) is an experimental prototype of a partly anthropomorphic, humanoid-size, mobile robot. The basic ART design concept provides for a combination of two-armed coordination, tactility, stereoscopic vision, mobility with navigation and avoidance of obstacles, and natural-language communication, so that the ART could emulate humans in many activities. The ART could be developed into a variety of highly capable robotic assistants for general or specific applications. There is especially great potential for the development of ART-based robots as substitutes for live-in health-care aides for home-bound persons who are aged, infirm, or physically handicapped; these robots could greatly reduce the cost of home health care and extend the term of independent living. The ART is a fully autonomous and untethered system. It includes a mobile base on which is mounted an extensible torso topped by a head, shoulders, and two arms. All subsystems of the ART are powered by a rechargeable, removable battery pack. The mobile base is a differentially- driven, nonholonomic vehicle capable of a speed >1 m/s and can handle a payload >100 kg. The base can be controlled manually, in forward/backward and/or simultaneous rotational motion, by use of a joystick. Alternatively, the motion of the base can be controlled autonomously by an onboard navigational computer. By retraction or extension of the torso, the head height of the ART can be adjusted from 5 ft (1.5 m) to 6 1/2 ft (2 m), so that the arms can reach either the floor or high shelves, or some ceilings. The arms are symmetrical. Each arm (including the wrist) has a total of six rotary axes like those of the human shoulder, elbow, and wrist joints. The arms are actuated by electric motors in combination with brakes and gas-spring assists on the shoulder and elbow joints. The arms are operated under closed-loop digital control. A receptacle for an end effector is mounted on the tip of the wrist and

The study on a gas-coupled two-stage stirling-type pulse tube cryocooler

Science.gov (United States)

Wu, X. L.; Chen, L. B.; Zhu, X. S.; Pan, C. Z.; Guo, J.; Wang, J. J.; Zhou, Y.

2017-12-01

A two-stage gas-coupled Stirling-type pulse tube cryocooler (SPTC) driven by a linear dual-opposed compressor has been designed, manufactured and tested. Both of the stages adopted coaxial structure for compactness. The effect of a cold double-inlet at the second stage on the cooling performance was investigated. The test results show that the cold double-inlet will help to achieve a lower cooling temperature, but it is not conducive to achieving a higher cooling capacity. At present, without the cold double-inlet, the second stage has achieved a no-load temperature of 11.28 K and a cooling capacity of 620 mW/20 K with an input electric power of 450 W. With the cold double-inlet, the no-load temperature is lowered to 9.4 K, but the cooling capacity is reduced to 400 mW/20 K. The structure of the developed cryocooler and the influences of charge pressure, operating frequency and hot end temperature will also be introduced in this paper.

Height and Body Composition Determine Arm Propulsive Force in Youth Swimmers Independent of a Maturation Stage

OpenAIRE

Moura, Tatiane; Costa, Manoel; Oliveira, Saulo; Júnior, Marcos Barbosa; Ritti-Dias, Raphael; Santos, Marcos

2014-01-01

The aim of this study was to examine the relationship between anthropometric variables, body composition and propulsive force in swimmers aged 9–17 years. Anthropometric characteristics (body height and mass, sitting height, arm span, arm muscle area and body composition) and the propulsive force of the arm (tethered swimming test) were evaluated in 56 competitive male swimmers. Tanner’s stages of genital maturation (P1–5) were used. The data analysis included correlations and multiple linear...

Eggshell membrane: A possible new natural therapeutic for joint and connective tissue disorders. Results from two open-label human clinical studies

Directory of Open Access Journals (Sweden)

Kevin J Ruff

2009-05-01

Full Text Available Kevin J Ruff1, Dale P DeVore2, Michael D Leu3, Mark A Robinson41ESM Technologies, LLC, Carthage, MO, USA; 2Membrell, LLC, Carthage, MO, USA; 3Private Practice, Jenks, OK, USA; 4Robinson Family Health Center, Carthage, MO, USABackground: Natural Eggshell Membrane (NEM® is a novel dietary supplement that contains naturally occurring glycosaminoglycans and proteins essential for maintaining healthy joint and connective tissues. Two single center, open-label human clinical studies were conducted to evaluate the efficacy and safety of NEM® as a treatment for pain and inflexibility associated with joint and connective tissue disorders. Methods: Eleven (single-arm trial and 28 (double-arm trial patients received oral NEM® 500 mg once daily for four weeks. The primary outcome measure was to evaluate the change in general pain associated with the treatment joints/areas (both studies. In the single-arm trial, range of motion (ROM and related ROM-associated pain was also evaluated. The primary treatment response endpoints were at seven and 30 days. Both clinical assessments were performed on the intent-to-treat (ITT population within each study.Results: Single-arm trial: Supplementation with NEM® produced a significant treatment response at seven days for flexibility (27.8% increase; P = 0.038 and at 30 days for general pain (72.5% reduction; P = 0.007, flexibility (43.7% increase; P = 0.006, and ROM-associated pain (75.9% reduction; P = 0.021. Double-arm trial: Supplementation with NEM® produced a significant treatment response for pain at seven days for both treatment arms (X: 18.4% reduction; P = 0.021. Y: 31.3% reduction; P = 0.014. There was no clinically meaningful difference between treatment arms at seven days, so the Y arm crossed over to the X formulation for the remainder of the study. The significant treatment response continued through 30 days for pain (30.2% reduction; P = 0.0001. There were no adverse events reported during either

Double stage crystallization of bulk Ge20Te80 glass

International Nuclear Information System (INIS)

Parthasarathy, G.; Bandyopadhyay, A.K.; Gopal, E.S.R.; Subbanna, G.N.

1984-01-01

The growing interest of the semiconducting glasses is partly because of their interesting electrical and optical properties. These properties are usually connected with their crystallization. In many glasses, the glass-supercooled liquid transition precedes crystallization. The glass transition temperature (Tsub(g)) is found to exhibit multistage processes for a few systems. In this communication, we report the observation of a double Tsub(g) effect in bulk Ge 20 Te 80 glass and also explain the structural changes taking place in the two stages. (author)

Early stage ovarian cancer: a randomized clinical trial comparing whole abdominal radiotherapy, melphalan, and intraperitoneal chromic phosphate: a National Cancer Institute of Canada Clinical Trials Group report

International Nuclear Information System (INIS)

Klaassen, D.; Shelley, W.; Starreveld, A.

1988-01-01

Two hundred fifty-seven eligible patients with stage I, IIA high risk ovarian carcinoma and IIB, IIIO (disease confined to pelvis), were randomized to either total abdominal radiotherapy (arm A) 2,250 rad in 20 fractions (107 patients), melphalan (arm B) 8 mg/m2/d X 4 every 4 weeks X 18 courses (106 patients), or intraperitoneal chromic phosphate (arm C) 10 to 20 mCi (44 patients). All patients were initially treated with pelvic radiotherapy; arm A, 2,250 rad in ten fractions; and arms B and C, 4,500 rad in 20 fractions. Entry to arm C was discontinued early because of toxicity. In a multifactor analysis using proportional hazards models, no significant difference in survival was observed although there was a marginally significant difference in disease-free survival (P = .015) with arm B being superior to arm A. Stage (P less than .0001), grade (P less than .0001), and histology (P less than .008) were predictors of survival in the multifactor analysis. Performance status, age, and residual disease were significant predictors in the single factor analysis but were not predictive when correction was made for the effects of stage, grade, and histology. Five-year survival rates are 62% for arm A, 61% for arm B, and 66% for arm C. Median duration of follow-up is 8 years. Long-term complications of radiotherapy were seen in 19 patients on arm A, 11 on arm B, and 11 on arm C. Four patients who had received melphalan developed either a myelodysplastic syndrome or acute leukemia. Violations in covering the whole abdominal target volume were correlated with survival

A Double-Blind Placebo-Controlled Randomized Clinical Trial With Magnesium Oxide to Reduce Intrafraction Prostate Motion for Prostate Cancer Radiotherapy

Energy Technology Data Exchange (ETDEWEB)

Lips, Irene M., E-mail: i.m.lips@umcutrecht.nl [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Gils, Carla H. van [Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (Netherlands); Kotte, Alexis N.T.J. [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Leerdam, Monique E. van [Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam (Netherlands); Franken, Stefan P.G.; Heide, Uulke A. van der; Vulpen, Marco van [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands)

2012-06-01

Purpose: To investigate whether magnesium oxide during external-beam radiotherapy for prostate cancer reduces intrafraction prostate motion in a double-blind, placebo-controlled randomized trial. Methods and Materials: At the Department of Radiotherapy, prostate cancer patients scheduled for intensity-modulated radiotherapy (77 Gy in 35 fractions) using fiducial marker-based position verification were randomly assigned to receive magnesium oxide (500 mg twice a day) or placebo during radiotherapy. The primary outcome was the proportion of patients with clinically relevant intrafraction prostate motion, defined as the proportion of patients who demonstrated in {>=}50% of the fractions an intrafraction motion outside a range of 2 mm. Secondary outcome measures included quality of life and acute toxicity. Results: In total, 46 patients per treatment arm were enrolled. The primary endpoint did not show a statistically significant difference between the treatment arms with a percentage of patients with clinically relevant intrafraction motion of 83% in the magnesium oxide arm as compared with 80% in the placebo arm (p = 1.00). Concerning the secondary endpoints, exploratory analyses demonstrated a trend towards worsened quality of life and slightly more toxicity in the magnesium oxide arm than in the placebo arm; however, these differences were not statistically significant. Conclusions: Magnesium oxide is not effective in reducing the intrafraction prostate motion during external-beam radiotherapy, and therefore there is no indication to use it in clinical practice for this purpose.

Phase I (or phase II) dose-ranging clinical trials: proposal of a two-stage Bayesian design.

Science.gov (United States)

Zohar, Sarah; Chevret, Sylvie

2003-02-01

We propose a new design for phase I (or phase II) dose-ranging clinical trials aiming at determining a dose of an experimental treatment to satisfy safety (respectively efficacy) requirements, at treating a sufficiently large number of patients to estimate the toxicity (respectively failure) probability of the dose level with a given reliability, and at stopping the trial early if it is likely that no dose is safe (respectively efficacious). A two-stage design was derived from the Continual Reassessment Method (CRM), with implementation of Bayesian criteria to generate stopping rules. A simulation study was conducted to compare the operating characteristics of the proposed two-stage design to those reached by the traditional CRM. Finally, two applications to real data sets are provided.

Difference in blood pressure measurements between arms: methodological and clinical implications.

Science.gov (United States)

Clark, Christopher E

2015-01-01

Differences in blood pressure measurements between arms are commonly encountered in clinical practice. If such differences are not excluded they can delay the diagnosis of hypertension and can lead to poorer control of blood pressure levels. Differences in blood pressure measurements between arms are associated cross sectionally with other signs of vascular disease such as peripheral arterial disease or cerebrovascular disease. Differences are also associated prospectively with increased cardiovascular mortality and morbidity and all cause mortality. Numbers of publications on inter-arm difference are rising year on year, indicating a growing interest in the phenomenon. The prevalence of an inter-arm difference varies widely between reports, and is correlated with the underlying cardiovascular risk of the population studied. Prevalence is also sensitive to the method of measurement used. This review discusses the prevalence of an inter-arm difference in different populations and addresses current best practice for the detection and the measurement of a difference. The evidence for clinical and for vascular associations of an inter-arm difference is presented in considering the emerging role of an inter-arm blood pressure difference as a novel risk factor for increased cardiovascular morbidity and mortality. Competing aetiological explanations for an inter-arm difference are explored, and gaps in our current understanding of this sign, along with areas in need of further research, are considered.

High precision detector robot arm system

Science.gov (United States)

Shu, Deming; Chu, Yong

2017-01-31

A method and high precision robot arm system are provided, for example, for X-ray nanodiffraction with an X-ray nanoprobe. The robot arm system includes duo-vertical-stages and a kinematic linkage system. A two-dimensional (2D) vertical plane ultra-precision robot arm supporting an X-ray detector provides positioning and manipulating of the X-ray detector. A vertical support for the 2D vertical plane robot arm includes spaced apart rails respectively engaging a first bearing structure and a second bearing structure carried by the 2D vertical plane robot arm.

Sample size determinations for group-based randomized clinical trials with different levels of data hierarchy between experimental and control arms.

Science.gov (United States)

Heo, Moonseong; Litwin, Alain H; Blackstock, Oni; Kim, Namhee; Arnsten, Julia H

2017-02-01

We derived sample size formulae for detecting main effects in group-based randomized clinical trials with different levels of data hierarchy between experimental and control arms. Such designs are necessary when experimental interventions need to be administered to groups of subjects whereas control conditions need to be administered to individual subjects. This type of trial, often referred to as a partially nested or partially clustered design, has been implemented for management of chronic diseases such as diabetes and is beginning to emerge more commonly in wider clinical settings. Depending on the research setting, the level of hierarchy of data structure for the experimental arm can be three or two, whereas that for the control arm is two or one. Such different levels of data hierarchy assume correlation structures of outcomes that are different between arms, regardless of whether research settings require two or three level data structure for the experimental arm. Therefore, the different correlations should be taken into account for statistical modeling and for sample size determinations. To this end, we considered mixed-effects linear models with different correlation structures between experimental and control arms to theoretically derive and empirically validate the sample size formulae with simulation studies.

[Towards the problem of necessity to reduce the medical evacuation stages in conditions of local wars and armed conflicts].

Science.gov (United States)

Gaĭdar, B V; Ivantsov, V A; Sidel'nikov, V O; Rusev, I T; Madaĭ, D Iu; Kokoev, V G; Zinov'ev, E V; Mutalibov, M M

2004-06-01

The article is devoted to the review of modern opinions concerning the experience of military operation medical support in conditions of local wars and military conflicts. On the base of analysis of medical assistance rendered to the wounded and casualties in Republic of Chechnya the advantages and defects of different approaches are discussed. The experience in rendering assistance to the casualties in the Armed Forces of NATO countries during the local wars for the last decades is discussed. It is shown that the optimal variant of organization of treatment-and-evacuation measures during the local armed conflicts and wars is the two-stage scheme of evacuation: the first medical aid--the qualified (specialized) medical aid.

Implications of inaccurate clinical nodal staging in pancreatic adenocarcinoma.

Science.gov (United States)

Swords, Douglas S; Firpo, Matthew A; Johnson, Kirsten M; Boucher, Kenneth M; Scaife, Courtney L; Mulvihill, Sean J

2017-07-01

Many patients with stage I-II pancreatic adenocarcinoma do not undergo resection. We hypothesized that (1) clinical staging underestimates nodal involvement, causing stage IIB to have a greater percent of resected patients and (2) this stage-shift causes discrepancies in observed survival. The Surveillance, Epidemiology, and End Results (SEER) research database was used to evaluate cause-specific survival in patients with pancreatic adenocarcinoma from 2004-2012. Survival was compared using the log-rank test. Single-center data on 105 patients who underwent resection of pancreatic adenocarcinoma without neoadjuvant treatment were used to compare clinical and pathologic nodal staging. In SEER data, medium-term survival in stage IIB was superior to IB and IIA, with median cause-specific survival of 14, 9, and 11 months, respectively (P < .001). Seventy-two percent of stage IIB patients underwent resection vs 28% in IB and 36% in IIA (P < .001). In our institutional data, 12.4% of patients had clinical evidence of nodal involvement vs 69.5% by pathologic staging (P < .001). Among clinical stage IA-IIA patients, 71.6% had nodal involvement by pathologic staging. Both SEER and institutional data support substantial underestimation of nodal involvement by clinical staging. This finding has implications in decisions regarding neoadjuvant therapy and analysis of outcomes in the absence of pathologic staging. Copyright © 2017 Elsevier Inc. All rights reserved.

Two-dimensional myoelectric control of a robotic arm for upper limb amputees

International Nuclear Information System (INIS)

Lopez Celani, Natalia M; Soria, Carlos M; Orosco, Eugenio C; Di Sciascio, Fernando A; Valentinuzzi, Max E

2007-01-01

Rehabilitation engineering and medicine have become integral and significant parts of health care services, particularly and unfortunately in the last three or four decades, because of wars, terrorism and large number of car accidents. Amputees show a high rate of rejection to wear prosthetic devices, often because of lack of an adequate period of adaptation. A robotic arm may appear as a good preliminary stage. To test the hypothesis, myoelectric signals from two upper limb amputees and from four normal volunteers were fed, via adequate electronic conditioning and using MATLAB, to an industrial robotic arm. Proportional strength control was used for two degrees of freedom (x-y plane) by means of eight signal features of control (four traditional statistics plus energy, integral of the absolute value, Willison's amplitude, waveform length and envelope) for comparison purposes, and selecting the best of them as final reference. Patients easily accepted the system and learned in short time how to operate it. Results were encouraging so that valuable training, before prosthesis is implanted, appears as good feedback; besides, these patients can be hired as specialized operators in semi-automatized industry

Two-dimensional myoelectric control of a robotic arm for upper limb amputees

Science.gov (United States)

López Celani, Natalia M.; Soria, Carlos M.; Orosco, Eugenio C.; di Sciascio, Fernando A.; Valentinuzzi, Max E.

2007-11-01

Rehabilitation engineering and medicine have become integral and significant parts of health care services, particularly and unfortunately in the last three or four decades, because of wars, terrorism and large number of car accidents. Amputees show a high rate of rejection to wear prosthetic devices, often because of lack of an adequate period of adaptation. A robotic arm may appear as a good preliminary stage. To test the hypothesis, myoelectric signals from two upper limb amputees and from four normal volunteers were fed, via adequate electronic conditioning and using MATLAB, to an industrial robotic arm. Proportional strength control was used for two degrees of freedom (x-y plane) by means of eight signal features of control (four traditional statistics plus energy, integral of the absolute value, Willison's amplitude, waveform length and envelope) for comparison purposes, and selecting the best of them as final reference. Patients easily accepted the system and learned in short time how to operate it. Results were encouraging so that valuable training, before prosthesis is implanted, appears as good feedback; besides, these patients can be hired as specialized operators in semi-automatized industry.

Novel clinical staging for patients with end-stage gastrointestinal carcinoma.

Science.gov (United States)

Yasuda, Naokuni; Nakashima, Osamu; Ohnaka, Toru; Kamisaka, Koji; Tsunoda, Akira; Kusano, Mitsuo

2006-01-01

We created a new clinical staging system for end-stage gastrointestinal (GI) carcinoma to clarify the therapeutic goals for these patients. Data were obtained from a retrospective review of medical charts. Based on daily clinical observation of 144 patients with end-stage GI carcinoma, we classified the terminal stages as A, B, C, and D. The mean durations of terminal stages A, B, C, and D were 19, 16.6, 6.6, and 1.8 days, respectively, in patients with end-stage gastric cancer and 28.5, 9.1, 5.4, and 1.9 days, respectively, in patients with colorectal cancer. Moreover, 88.0% of patients with gastric carcinoma and 82.6% of patients with colorectal carcinoma passed through terminal stages A, B, C, and D sequentially. The patients in terminal stage B experienced temporary relief of symptoms, but those in terminal stage C did not (P terminal stages can easily be judged by clinical observation and may be an effective new tool with which to manage patients with end-stage GI carcinoma and their families.

Driving pockels cells in multi-arm lasers

International Nuclear Information System (INIS)

Carder, B.M.

1978-01-01

This paper describes the method used to drive Pockels cells on the 20-arm Shiva laser for inertial confinement fusion research at the Lawrence Livermore Laboratory. Shiva became operational last fall, and has just completed a series of 20-arm target shots. It uses two pockels cell gates in each laser arm for suppression of amplified spontaneous emission (ASE) that can damage or destroy the target before the main pulse arrives. Two additional Pockels cells are used in the preamplification stages, so that a total of 42 cells must be driven by the pulser system

Comparative effectiveness of one-stage versus two-stage basilic vein transposition arteriovenous fistulas.

Science.gov (United States)

Ghaffarian, Amir A; Griffin, Claire L; Kraiss, Larry W; Sarfati, Mark R; Brooke, Benjamin S

2018-02-01

Basilic vein transposition (BVT) fistulas may be performed as either a one-stage or two-stage operation, although there is debate as to which technique is superior. This study was designed to evaluate the comparative clinical efficacy and cost-effectiveness of one-stage vs two-stage BVT. We identified all patients at a single large academic hospital who had undergone creation of either a one-stage or two-stage BVT between January 2007 and January 2015. Data evaluated included patient demographics, comorbidities, medication use, reasons for abandonment, and interventions performed to maintain patency. Costs were derived from the literature, and effectiveness was expressed in quality-adjusted life-years (QALYs). We analyzed primary and secondary functional patency outcomes as well as survival during follow-up between one-stage and two-stage BVT procedures using multivariate Cox proportional hazards models and Kaplan-Meier analysis with log-rank tests. The incremental cost-effectiveness ratio was used to determine cost savings. We identified 131 patients in whom 57 (44%) one-stage BVT and 74 (56%) two-stage BVT fistulas were created among 8 different vascular surgeons during the study period that each performed both procedures. There was no significant difference in the mean age, male gender, white race, diabetes, coronary disease, or medication profile among patients undergoing one- vs two-stage BVT. After fistula transposition, the median follow-up time was 8.3 months (interquartile range, 3-21 months). Primary patency rates of one-stage BVT were 56% at 12-month follow-up, whereas primary patency rates of two-stage BVT were 72% at 12-month follow-up. Patients undergoing two-stage BVT also had significantly higher rates of secondary functional patency at 12 months (57% for one-stage BVT vs 80% for two-stage BVT) and 24 months (44% for one-stage BVT vs 73% for two-stage BVT) of follow-up (P < .001 using log-rank test). However, there was no significant difference

Maximally efficient two-stage screening: Determining intellectual disability in Taiwanese military conscripts

Directory of Open Access Journals (Sweden)

Chia-Chang Chien

2009-01-01

Full Text Available Chia-Chang Chien1, Shu-Fen Huang1,2,3,4, For-Wey Lung1,2,3,41Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan; 2Graduate Institute of Behavioral Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan; 4Calo Psychiatric Center, Pingtung County, TaiwanObjective: The purpose of this study was to apply a two-stage screening method for the large-scale intelligence screening of military conscripts.Methods: We collected 99 conscripted soldiers whose educational levels were senior high school level or lower to be the participants. Every participant was required to take the Wisconsin Card Sorting Test (WCST and the Wechsler Adult Intelligence Scale-Revised (WAIS-R assessments.Results: Logistic regression analysis showed the conceptual level responses (CLR index of the WCST was the most significant index for determining intellectual disability (ID; FIQ ≤ 84. We used the receiver operating characteristic curve to determine the optimum cut-off point of CLR. The optimum one cut-off point of CLR was 66; the two cut-off points were 49 and 66. Comparing the two-stage window screening with the two-stage positive screening, the area under the curve and the positive predictive value increased. Moreover, the cost of the two-stage window screening decreased by 59%.Conclusion: The two-stage window screening is more accurate and economical than the two-stage positive screening. Our results provide an example for the use of two-stage screening and the possibility of the WCST to replace WAIS-R in large-scale screenings for ID in the future.Keywords: intellectual disability, intelligence screening, two-stage positive screening, Wisconsin Card Sorting Test, Wechsler Adult Intelligence Scale-Revised

Two-Stage Robust Security-Constrained Unit Commitment with Optimizable Interval of Uncertain Wind Power Output

Directory of Open Access Journals (Sweden)

Dayan Sun

2017-01-01

Full Text Available Because wind power spillage is barely considered, the existing robust unit commitment cannot accurately analyze the impacts of wind power accommodation on on/off schedules and spinning reserve requirements of conventional generators and cannot consider the network security limits. In this regard, a novel double-level robust security-constrained unit commitment formulation with optimizable interval of uncertain wind power output is firstly proposed in this paper to obtain allowable interval solutions for wind power generation and provide the optimal schedules for conventional generators to cope with the uncertainty in wind power generation. The proposed double-level model is difficult to be solved because of the invalid dual transform in solution process caused by the coupling relation between the discrete and continuous variables. Therefore, a two-stage iterative solution method based on Benders Decomposition is also presented. The proposed double-level model is transformed into a single-level and two-stage robust interval unit commitment model by eliminating the coupling relation, and then this two-stage model can be solved by Benders Decomposition iteratively. Simulation studies on a modified IEEE 26-generator reliability test system connected to a wind farm are conducted to verify the effectiveness and advantages of the proposed model and solution method.

Optimal Control of Holding Motion by Nonprehensile Two-Cooperative-Arm Robot

Directory of Open Access Journals (Sweden)

Changan Jiang

2016-01-01

Full Text Available Recently, more researchers have focused on nursing-care assistant robot and placed their hope on it to solve the shortage problem of the caregivers in hospital or nursing home. In this paper, a nonprehensile two-cooperative-arm robot is considered to realize holding motion to keep a two-rigid-link object (regarded as a care-receiver stable on the robot arms. By applying Newton-Euler equations of motion, dynamic model of the object is obtained. In this model, for describing interaction behavior between object and robot arms in the normal direction, a viscoelastic model is employed to represent the normal forces. Considering existence of friction between object and robot arms, LuGre dynamic model is applied to describe the friction. Based on the obtained model, an optimal regulator is designed to control the holding motion of two-cooperative-arm robot. In order to verify the effectiveness of the proposed method, simulation results are shown.

Clinical multiphoton tomography and clinical two-photon microendoscopy

Science.gov (United States)

König, Karsten; Bückle, Rainer; Weinigel, Martin; Elsner, Peter; Kaatz, Martin

2009-02-01

We report on applications of high-resolution clinical multiphoton tomography based on the femtosecond laser system DermaInspectTM with its flexible mirror arm in Australia, Asia, and Europe. Applications include early detection of melanoma, in situ tracing of pharmacological and cosmetical compounds including ZnO nanoparticles in the epidermis and upper dermis, the determination of the skin aging index SAAID as well as the study of the effects of anti-aging products. In addition, first clinical studies with novel rigid high-NA two-photon 1.6 mm GRIN microendoscopes have been conducted to study the effect of wound healing in chronic wounds (ulcus ulcera) as well as to perform intrabody imaging with subcellular resolution in small animals.

A clinical case of single-stage correction of penetration combined orofacial defect with two microsurgical autografts

Directory of Open Access Journals (Sweden)

A. D. Kaprin

2015-01-01

Full Text Available After surgical treatment for locally advanced oral tumors with resection of soft tissues, mucosal membrane, and facial skeletal structures, there are penetration combined defects, removal of which is a challenge for reconstructive surgeons. Mandibular repair is one of the problems in the correction of combined oral defects. Surgeons use different grafts to remove mandibular defects. One-flap transplantation does not always solve all reconstruction problems and ensure the repair of the mucosal membrane, a soft-tissue component, skin integuments, and facial skeleton.The authors describe a clinical case of successful single-stage correction of penetration combined orofacial defect after resection of the tongue, mouth floor, en bloc resection of the lower jaw and mental soft tissues, bilateral cervical supramyochoroidal lymphadenectomy, stage LCL CM mandibular defect formation after J. Boyd, by using two microsurgical autografts (a peroneal skin-muscle-skin autograft and a radial skin-fascia one in a 39-year-old female patient clinically diagnosed with carcinoma of the left mandibular alveolar ridge mucosa, Stage IVA (T4аN0M0.The Department of Microsurgery, P.A. Herzen Moscow Oncology Research Institute, Ministry of Health of Russia, has gained experience in comprehensively correcting extensive combined maxillofacial defects with two or more grafts in 27 patients who underwent autografting with a total of 73 flaps. The most functionally incapacitating and life-incompatible defect was removed at Stage 1 of reconstructive treatment. Delayed reconstruction was made after a complex of specialized antitumor therapy and assessment of treatment results in the absence of progressive growth. A great problem during multi-stage defect correction is presented by the lack of recipient vessels after cervical lymphadenectomy, the presence of soft tissue scar changes, trismus, temporomandibular joint ankylosis, contractures and displacement of the edges of the

Interpreting survival data from clinical trials of surgery versus stereotactic body radiation therapy in operable Stage I non-small cell lung cancer patients.

Science.gov (United States)

Samson, Pamela; Keogan, Kathleen; Crabtree, Traves; Colditz, Graham; Broderick, Stephen; Puri, Varun; Meyers, Bryan

2017-01-01

To identify the variability of short- and long-term survival outcomes among closed Phase III randomized controlled trials with small sample sizes comparing SBRT (stereotactic body radiation therapy) and surgical resection in operable clinical Stage I non-small cell lung cancer (NSCLC) patients. Clinical Stage I NSCLC patients who underwent surgery at our institution meeting the inclusion/exclusion criteria for STARS (Randomized Study to Compare CyberKnife to Surgical Resection in Stage I Non-small Cell Lung Cancer), ROSEL (Trial of Either Surgery or Stereotactic Radiotherapy for Early Stage (IA) Lung Cancer), or both were identified. Bootstrapping analysis provided 10,000 iterations to depict 30-day mortality and three-year overall survival (OS) in cohorts of 16 patients (to simulate the STARS surgical arm), 27 patients (to simulate the pooled surgical arms of STARS and ROSEL), and 515 (to simulate the goal accrual for the surgical arm of STARS). From 2000 to 2012, 749/873 (86%) of clinical Stage I NSCLC patients who underwent resection were eligible for STARS only, ROSEL only, or both studies. When patients eligible for STARS only were repeatedly sampled with a cohort size of 16, the 3-year OS rates ranged from 27 to 100%, and 30-day mortality varied from 0 to 25%. When patients eligible for ROSEL or for both STARS and ROSEL underwent bootstrapping with n=27, the 3-year OS ranged from 46 to 100%, while 30-day mortality varied from 0 to 15%. Finally, when patients eligible for STARS were repeatedly sampled in groups of 515, 3-year OS narrowed to 70-85%, with 30-day mortality varying from 0 to 4%. Short- and long-term survival outcomes from trials with small sample sizes are extremely variable and unreliable for extrapolation. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

One-stage or two-stage revision surgery for prosthetic hip joint infection--the INFORM trial: a study protocol for a randomised controlled trial.

Science.gov (United States)

Strange, Simon; Whitehouse, Michael R; Beswick, Andrew D; Board, Tim; Burston, Amanda; Burston, Ben; Carroll, Fran E; Dieppe, Paul; Garfield, Kirsty; Gooberman-Hill, Rachael; Jones, Stephen; Kunutsor, Setor; Lane, Athene; Lenguerrand, Erik; MacGowan, Alasdair; Moore, Andrew; Noble, Sian; Simon, Joanne; Stockley, Ian; Taylor, Adrian H; Toms, Andrew; Webb, Jason; Whittaker, John-Paul; Wilson, Matthew; Wylde, Vikki; Blom, Ashley W

2016-02-17

Periprosthetic joint infection (PJI) affects approximately 1% of patients following total hip replacement (THR) and often results in severe physical and emotional suffering. Current surgical treatment options are debridement, antibiotics and implant retention; revision THR; excision of the joint and amputation. Revision surgery can be done as either a one-stage or two-stage operation. Both types of surgery are well-established practice in the NHS and result in similar rates of re-infection, but little is known about the impact of these treatments from the patient's perspective. The main aim of this randomised controlled trial is to determine whether there is a difference in patient-reported outcome measures 18 months after randomisation for one-stage or two-stage revision surgery. INFORM (INFection ORthopaedic Management) is an open, two-arm, multi-centre, randomised, superiority trial. We aim to randomise 148 patients with eligible PJI of the hip from approximately seven secondary care NHS orthopaedic units from across England and Wales. Patients will be randomised via a web-based system to receive either a one-stage revision or a two-stage revision THR. Blinding is not possible due to the nature of the intervention. All patients will be followed up for 18 months. The primary outcome is the WOMAC Index, which assesses hip pain, function and stiffness, collected by questionnaire at 18 months. Secondary outcomes include the following: cost-effectiveness, complications, re-infection rates, objective hip function assessment and quality of life. A nested qualitative study will explore patients' and surgeons' experiences, including their views about trial participation and randomisation. INFORM is the first ever randomised trial to compare two widely accepted surgical interventions for the treatment of PJI: one-stage and two-stage revision THR. The results of the trial will benefit patients in the future as the main focus is on patient-reported outcomes: pain, function

Maximally efficient two-stage screening: Determining intellectual disability in Taiwanese military conscripts

OpenAIRE

Chien, Chia-Chang; Huang, Shu-Fen; Lung, For-Wey

2009-01-01

Chia-Chang Chien1, Shu-Fen Huang1,2,3,4, For-Wey Lung1,2,3,41Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan; 2Graduate Institute of Behavioral Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan; 4Calo Psychiatric Center, Pingtung County, TaiwanObjective: The purpose of this study was to apply a two-stage screening method for the large-scale intelligence screening of militar...

Successful Completion of the Pilot Phase of a Randomized Controlled Trial Comparing Sentinel Lymph Node Biopsy to No Further Axillary Staging in Patients with Clinical T1-T2 N0 Breast Cancer and Normal Axillary Ultrasound.

Science.gov (United States)

Cyr, Amy E; Tucker, Natalia; Ademuyiwa, Foluso; Margenthaler, Julie A; Aft, Rebecca L; Eberlein, Timothy J; Appleton, Catherine M; Zoberi, Imran; Thomas, Maria A; Gao, Feng; Gillanders, William E

2016-08-01

Axillary surgery is not considered therapeutic in patients with clinical T1-T2 N0 breast cancer. The importance of axillary staging is eroding in an era in which tumor biology, as defined by biomarker and gene expression profile, is increasingly important in medical decision making. We hypothesized that axillary ultrasound (AUS) is a noninvasive alternative to sentinel lymph node biopsy (SLNB), and AUS could replace SLNB without compromising patient care. Patients with clinical T1-T2 N0 breast cancer and normal AUS were eligible for enrollment. Subjects were randomized to no further axillary staging (arm 1) vs SLNB (arm 2). Descriptive statistics were used to describe the results of the pilot phase of the randomized controlled trial. Sixty-eight subjects were enrolled in the pilot phase of the trial (34 subjects in arm 1, no further staging; 32 subjects in arm 2, SLNB; and 2 subjects voluntarily withdrew from the trial). The median age was 61 years (range 40 to 80 years) in arm 1 and 59 years (range 31 to 81 years) in arm 2, and there were no significant clinical or pathologic differences between the arms. Median follow-up was 17 months (range 1 to 32 months). The negative predictive value (NPV) of AUS for identification of clinically significant axillary disease (>2.0 mm) was 96.9%. No axillary recurrences have been observed in either arm. Successful completion of the pilot phase of the randomized controlled trial confirms the feasibility of the study design, and provides prospective evidence supporting the ability of AUS to exclude clinically significant disease in the axilla. The results provide strong support for a phase 2 randomized controlled trial. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

High-speed double-disc TMP [thermomechanical pulp] from northern and southern softwoods: One or two refining stages

Energy Technology Data Exchange (ETDEWEB)

Sabourin, M.J. (Andritz Sprout-Bauer, Inc., Springfield, OH (United States)); Cort, J.B.; Musselman, R.L. (Andritz Sprout-Bauer, Inc., Muncy, PA (United States))

1994-01-01

Pilot-plant studies were carried out to evaluate one- and two-stage high-speed refining processes for production of thermomechanical pulp (TMP) at minimal energy consumption. Both northern (black spruce/balsam fir) and southern (lobolly pine) wood species were tested. Preliminary results indicate both one- and two-stage high-speed refining are suitable for the production of TMP from spruce and fir. Single-stage, high-speed refining of spruce/fir resulted in over 25% energy savings compared to conventional TMP production. The resulting TMP had improved optical and shive content properties, with slightly reduced pulp strength and long fiber content. Two stages of refining were necessary to optimize pulp quality from the lobolly pine furnish. A 15% energy reduction was obtained when comparing high-speed and conventional TMP pulping of lobolly pine at similar operating conditions. The high-speed pine TMP had comparable bonding strength, shive content, and lower tear than conventional two-stage lobolly pine TMP. 14 refs., 11 figs., 6 tabs.

A study of the free vibration of suspension rod based on four-stage arm mechanism by using computer simulation

Directory of Open Access Journals (Sweden)

Melnychuk S.V.

2016-08-01

Full Text Available We analyze the current state of the prospects and problems of using computer technology to determine the operating parameters of movement of the vehicle. Scientific works related to the study of the properties of the vehicle smooth ride are studied. The following example shows that the modern researches of smooth ride do not pay enough attention to issues associated with the processes that occur in the suspension rod of a vehicle. Scientific works related to the choice of the optimal and simple CAD system for conducting computer simulation tests are overviewed. We developed an animating model of experimental car in SOLIDWORKS environment with the staff suspension rod and the suspension rod based on four-stage arm mechanism, which allows a wide range of tests of components of the vehicle. Methodology and hardware-software complex for testing a car are developed. A test of a vehicle of category N1 is conducted. A computer simulation of the motion of the smooth ride of the car with suspension rod based on four-stage arm mechanism is conducted. The comparative analysis of suspension rod performance based on four-stage arm mechanism is conducted.

Clinical and endorectal ultrasound staging of circumferential rectal cancers

International Nuclear Information System (INIS)

Smith, A.; Farmer, K.C.; Chapple, K.

2008-01-01

Full text: Circumferential rectal cancers present at a more advanced stage than those located in a single quadrant. Although accurate staging is an important aspect of the preoperative management of the patient with a rectal cancer, the clinical and radiological staging of this subgroup of rectal cancer patients has been poorly studied. All patients with a rectal cancer were assessed clinically (by digital rectal examination and rigid sigmoidoscopy) before the radiological assessment by endorectal ultrasound (ERUS). Data collected included tumour height (distance from anal verge in centimetre) and tumour type (circumferential or non-circumferential). Radiological tumour staging was with the TNM system. Fifty-nine subjects (33 men, 26 women; median age 65 years (range 38-86 years)) were identified with a circumferential rectal cancer. Mean height of the cancer was 8 - 0.4 cm (standard error of the mean; range 2-13 cm). Forty-two cancers were palpable, and 17 cancers were impalpable. All cancers assessed clinically as circumferential were confirmed as circumferential on ERUS scanning. Tumour stage as assessed by ERUS was either T3 (n = 57) or T4 (n = 2). Nodal status was NO (n = 29) and N1 (n = 30). All rectal cancers assessed as circumferential on clinical examination have an ERUS stage of T3 or greater.

Twist limits for late twisting double somersaults on trampoline.

Science.gov (United States)

Yeadon, M R; Hiley, M J

2017-06-14

An angle-driven computer simulation model of aerial movement was used to determine the maximum amount of twist that could be produced in the second somersault of a double somersault on trampoline using asymmetrical movements of the arms and hips. Lower bounds were placed on the durations of arm and hip angle changes based on performances of a world trampoline champion whose inertia parameters were used in the simulations. The limiting movements were identified as the largest possible odd number of half twists for forward somersaulting takeoffs and even number of half twists for backward takeoffs. Simulations of these two limiting movements were found using simulated annealing optimisation to produce the required amounts of somersault, tilt and twist at landing after a flight time of 2.0s. Additional optimisations were then run to seek solutions with the arms less adducted during the twisting phase. It was found that 3½ twists could be produced in the second somersault of a forward piked double somersault with arms abducted 8° from full adduction during the twisting phase and that three twists could be produced in the second somersault of a backward straight double somersault with arms fully adducted to the body. These two movements are at the limits of performance for elite trampolinists. Copyright © 2017 Elsevier Ltd. All rights reserved.

A Novel Highly Bioavailable Curcumin Formulation Improves Symptoms and Diagnostic Indicators in Rheumatoid Arthritis Patients: A Randomized, Double-Blind, Placebo-Controlled, Two-Dose, Three-Arm, and Parallel-Group Study.

Science.gov (United States)

Amalraj, Augustine; Varma, Karthik; Jacob, Joby; Divya, Chandradhara; Kunnumakkara, Ajaikumar B; Stohs, Sidney J; Gopi, Sreeraj

2017-10-01

Rheumatoid arthritis (RA) is an autoimmune, chronic systemic inflammatory disorder. The long-term use of currently available drugs for the treatment of RA has many potential side effects. Natural phytonutrients may serve as alternative strategies for the safe and effective treatment of RA, and curcuminoids have been used in Ayurvedic medicine for the treatment of inflammatory conditions for centuries. In this study, a novel, highly bioavailable form of curcumin in a completely natural turmeric matrix was evaluated for its ability to improve the clinical symptoms of RA. A randomized, double-blind, placebo-controlled, three-arm, parallel-group study was conducted to evaluate the comparative efficacy of two different doses of curcumin with that of a placebo in active RA patients. Twelve patients in each group received placebo, 250 or 500 mg of the curcumin product twice daily for 90 days. The responses of the patients were assessed using the American College of Rheumatology (ACR) response, visual analog scale (VAS), C-reactive protein (CRP), Disease Activity Score 28 (DAS28), erythrocyte sedimentation rate (ESR), and rheumatoid factor (RF) values. RA patients who received the curcumin product at both low and high doses reported statistically significant changes in their clinical symptoms at the end of the study. These observations were confirmed by significant changes in ESR, CPR, and RF values in patients receiving the study product compared to baseline and placebo. The results indicate that this novel curcumin in a turmeric matrix acts as an analgesic and anti-inflammatory agent for the management of RA at a dose as low as 250 mg twice daily as evidenced by significant improvement in the ESR, CRP, VAS, RF, DAS28, and ACR responses compared to placebo. Both doses of the study product were well tolerated and without side effects.

iCanADAPT Early protocol: randomised controlled trial (RCT) of clinician supervised transdiagnostic internet-delivered cognitive behaviour therapy (iCBT) for depression and/or anxiety in early stage cancer survivors -vs- treatment as usual

OpenAIRE

Murphy, M. J.; Newby, J. M.; Butow, P.; Kirsten, L.; Allison, K.; Loughnan, S.; Price, M. A.; Shaw, J.; Shepherd, H.; Smith, J.; Andrews, G.

2017-01-01

Background This RCT with two parallel arms will evaluate the efficacy of an internet-delivered transdiagnostic cognitive behavioural therapy (iCBT) intervention for the treatment of clinical depression and/or anxiety in early stage cancer survivors. Methods/design Early stage cancer survivors will be recruited via the research arm of a not-for-profit clinical research unit and randomised to an intervention (iCBT) group or a ?treatment as usual? (TAU) control group. The minimum sample size for...

Simultaneous measurement of thermo-optic and thermal expansion coefficients with a single arm double interferometer.

Science.gov (United States)

Domenegueti, Jose Francisco Miras; Andrade, Acacio A; Pilla, Viviane; Zilio, Sergio Carlos

2017-01-09

A low-cost single arm double interferometer was developed for the concurrent measurement of linear thermal expansion (α) and thermo-optic (dn/dT) coefficients of transparent samples with plane and parallel surfaces. Owing to its common-path optical arrangement, the device is compact and stable, and allows the simultaneous measurement of interferences arising from a low-finesse Fabry-Perot etalon and from a Mach-Zehnder-type interferometer. The method was demonstrated with measurements of solid (silica, BK7, SF6) and liquid (water, ethanol and acetone) samples.

Adding a PECS II block for proximal arm arteriovenous access - a randomised study.

Science.gov (United States)

Quek, K H; Low, E Y; Tan, Y R; Ong, A S C; Tang, T Y; Kam, J W; Kiew, A S C

2018-05-01

Brachial plexus block is often utilised for proximal arm arteriovenous access creation. However, the medial upper arm and axilla are often inadequately anaesthetised, requiring repeated, intraoperative local anaesthetic supplementation, or conversion into general anaesthesia. We hypothesised that the addition of a PECS II block would improve anaesthesia and analgesia for proximal arm arteriovenous access surgery. In this prospective, double-blinded, randomised proof-of-concept study, 36 consenting adults with end-stage renal disease aged between 21 and 90 years received either a combined supraclavicular and PECS II block (Group PECS, n = 18), or combined supraclavicular and sham block (Group SCB, n = 18) for proximal arm arteriovenous access surgery. Primary outcome was whether patients required intraoperative local anaesthetic supplementation by the surgeon. In Group PECS, 33.3% (6/18) needed local anaesthetic supplementation vs. 100% (18/18) in Group SCB. Group SCB had three times (RR 3.0, 95% CI 1.6-5.8; P PECS required lower volume of supplemental local anaesthetic compared to Group SCB (0.0 ml, IQR 0.0-6.3 ml vs. 15.0 ml, IQR 7.4-17.8 ml; P PECS II block to a supraclavicular block improves regional anaesthesia for patients with end-stage renal disease undergoing proximal arm arteriovenous access surgery. © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

The hybrid two stage anticlockwise cycle for ecological energy conversion

Directory of Open Access Journals (Sweden)

Cyklis Piotr

2016-01-01

Full Text Available The anticlockwise cycle is commonly used for refrigeration, air conditioning and heat pumps applications. The application of refrigerant in the compression cycle is within the temperature limits of the triple point and the critical point. New refrigerants such as 1234yf or 1234ze have many disadvantages, therefore natural refrigerants application is favourable. The carbon dioxide and water can be applied only in the hybrid two stages cycle. The possibilities of this solutions are shown for refrigerating applications, as well some experimental results of the adsorption-compression double stages cycle, powered with solar collectors are shown. As a high temperature cycle the adsorption system is applied. The low temperature cycle is the compression stage with carbon dioxide as a working fluid. This allows to achieve relatively high COP for low temperature cycle and for the whole system.

A two-stage Bayesian design with sample size reestimation and subgroup analysis for phase II binary response trials.

Science.gov (United States)

Zhong, Wei; Koopmeiners, Joseph S; Carlin, Bradley P

2013-11-01

Frequentist sample size determination for binary outcome data in a two-arm clinical trial requires initial guesses of the event probabilities for the two treatments. Misspecification of these event rates may lead to a poor estimate of the necessary sample size. In contrast, the Bayesian approach that considers the treatment effect to be random variable having some distribution may offer a better, more flexible approach. The Bayesian sample size proposed by (Whitehead et al., 2008) for exploratory studies on efficacy justifies the acceptable minimum sample size by a "conclusiveness" condition. In this work, we introduce a new two-stage Bayesian design with sample size reestimation at the interim stage. Our design inherits the properties of good interpretation and easy implementation from Whitehead et al. (2008), generalizes their method to a two-sample setting, and uses a fully Bayesian predictive approach to reduce an overly large initial sample size when necessary. Moreover, our design can be extended to allow patient level covariates via logistic regression, now adjusting sample size within each subgroup based on interim analyses. We illustrate the benefits of our approach with a design in non-Hodgkin lymphoma with a simple binary covariate (patient gender), offering an initial step toward within-trial personalized medicine. Copyright © 2013 Elsevier Inc. All rights reserved.

Meta-analysis of Clinical and Radiographic Outcomes After Arthroscopic Single-Row Versus Double-Row Rotator Cuff Repair.

Science.gov (United States)

Perser, Karen; Godfrey, David; Bisson, Leslie

2011-05-01

Double-row rotator cuff repair methods have improved biomechanical performance when compared with single-row repairs. To review clinical outcomes of single-row versus double-row rotator cuff repair with the hypothesis that double-row rotator cuff repair will result in better clinical and radiographic outcomes. Published literature from January 1980 to April 2010. Key terms included rotator cuff, prospective studies, outcomes, and suture techniques. The literature was systematically searched, and 5 level I and II studies were found comparing clinical outcomes of single-row and double-row rotator cuff repair. Coleman methodology scores were calculated for each article. Meta-analysis was performed, with treatment effect between single row and double row for clinical outcomes and with odds ratios for radiographic results. The sample size necessary to detect a given difference in clinical outcome between the 2 methods was calculated. Three level I studies had Coleman scores of 80, 74, and 81, and two level II studies had scores of 78 and 73. There were 156 patients with single-row repairs and 147 patients with double-row repairs, both with an average follow-up of 23 months (range, 12-40 months). Double-row repairs resulted in a greater treatment effect for each validated outcome measure in 4 studies, but the differences were not clinically or statistically significant (range, 0.4-2.2 points; 95% confidence interval, -0.19, 4.68 points). Double-row repairs had better radiographic results, but the differences were also not statistically significant (P = 0.13). Two studies had adequate power to detect a 10-point difference between repair methods using the Constant score, and 1 study had power to detect a 5-point difference using the UCLA (University of California, Los Angeles) score. Double-row rotator cuff repair does not show a statistically significant improvement in clinical outcome or radiographic healing with short-term follow-up.

Improved prediction of bimanual movements by a two-staged (effector-then-trajectory) decoder with epidural ECoG in nonhuman primates

Science.gov (United States)

Choi, Hoseok; Lee, Jeyeon; Park, Jinsick; Lee, Seho; Ahn, Kyoung-ha; Kim, In Young; Lee, Kyoung-Min; Jang, Dong Pyo

2018-02-01

Objective. In arm movement BCIs (brain-computer interfaces), unimanual research has been much more extensively studied than its bimanual counterpart. However, it is well known that the bimanual brain state is different from the unimanual one. Conventional methodology used in unimanual studies does not take the brain stage into consideration, and therefore appears to be insufficient for decoding bimanual movements. In this paper, we propose the use of a two-staged (effector-then-trajectory) decoder, which combines the classification of movement conditions and uses a hand trajectory predicting algorithm for unimanual and bimanual movements, for application in real-world BCIs. Approach. Two micro-electrode patches (32 channels) were inserted over the dura mater of the left and right hemispheres of two rhesus monkeys, covering the motor related cortex for epidural electrocorticograph (ECoG). Six motion sensors (inertial measurement unit) were used to record the movement signals. The monkeys performed three types of arm movement tasks: left unimanual, right unimanual, bimanual. To decode these movements, we used a two-staged decoder, which combines the effector classifier for four states (left unimanual, right unimanual, bimanual movements, and stationary state) and movement predictor using regression. Main results. Using this approach, we successfully decoded both arm positions using the proposed decoder. The results showed that decoding performance for bimanual movements were improved compared to the conventional method, which does not consider the effector, and the decoding performance was significant and stable over a period of four months. In addition, we also demonstrated the feasibility of epidural ECoG signals, which provided an adequate level of decoding accuracy. Significance. These results provide evidence that brain signals are different depending on the movement conditions or effectors. Thus, the two-staged method could be useful if BCIs are used to

The Supraspinatus and the Deltoid - Not just two arm elevators

NARCIS (Netherlands)

de Witte, P.; Werner, S.; ter Braak, L.M.; Veeger, H.E.J.; Nelissen, R.G.H.H.; de Groot, J.H.

2014-01-01

Background: The debate on the clinical and functional role of the Supraspinatus in relation to the Deltoid necessitates experimental assessment of their contributions to arm elevation. Our goal was to evaluate the responses of both muscles to increased elevation moment loading. Methods: Twenty-three

Meta-analysis of Gaussian individual patient data: Two-stage or not two-stage?

Science.gov (United States)

Morris, Tim P; Fisher, David J; Kenward, Michael G; Carpenter, James R

2018-04-30

Quantitative evidence synthesis through meta-analysis is central to evidence-based medicine. For well-documented reasons, the meta-analysis of individual patient data is held in higher regard than aggregate data. With access to individual patient data, the analysis is not restricted to a "two-stage" approach (combining estimates and standard errors) but can estimate parameters of interest by fitting a single model to all of the data, a so-called "one-stage" analysis. There has been debate about the merits of one- and two-stage analysis. Arguments for one-stage analysis have typically noted that a wider range of models can be fitted and overall estimates may be more precise. The two-stage side has emphasised that the models that can be fitted in two stages are sufficient to answer the relevant questions, with less scope for mistakes because there are fewer modelling choices to be made in the two-stage approach. For Gaussian data, we consider the statistical arguments for flexibility and precision in small-sample settings. Regarding flexibility, several of the models that can be fitted only in one stage may not be of serious interest to most meta-analysis practitioners. Regarding precision, we consider fixed- and random-effects meta-analysis and see that, for a model making certain assumptions, the number of stages used to fit this model is irrelevant; the precision will be approximately equal. Meta-analysts should choose modelling assumptions carefully. Sometimes relevant models can only be fitted in one stage. Otherwise, meta-analysts are free to use whichever procedure is most convenient to fit the identified model. © 2018 The Authors. Statistics in Medicine Published by John Wiley & Sons Ltd.

One-stage versus two-stage exchange arthroplasty for infected total knee arthroplasty: a systematic review.

Science.gov (United States)

Nagra, Navraj S; Hamilton, Thomas W; Ganatra, Sameer; Murray, David W; Pandit, Hemant

2016-10-01

Infection complicating total knee arthroplasty (TKA) has serious implications. Traditionally the debate on whether one- or two-stage exchange arthroplasty is the optimum management of infected TKA has favoured two-stage procedures; however, a paradigm shift in opinion is emerging. This study aimed to establish whether current evidence supports one-stage revision for managing infected TKA based on reinfection rates and functional outcomes post-surgery. MEDLINE/PubMed and CENTRAL databases were reviewed for studies that compared one- and two-stage exchange arthroplasty TKA in more than ten patients with a minimum 2-year follow-up. From an initial sample of 796, five cohort studies with a total of 231 patients (46 single-stage/185 two-stage; median patient age 66 years, range 61-71 years) met inclusion criteria. Overall, there were no significant differences in risk of reinfection following one- or two-stage exchange arthroplasty (OR -0.06, 95 % confidence interval -0.13, 0.01). Subgroup analysis revealed that in studies published since 2000, one-stage procedures have a significantly lower reinfection rate. One study investigated functional outcomes and reported that one-stage surgery was associated with superior functional outcomes. Scarcity of data, inconsistent study designs, surgical technique and antibiotic regime disparities limit recommendations that can be made. Recent studies suggest one-stage exchange arthroplasty may provide superior outcomes, including lower reinfection rates and superior function, in select patients. Clinically, for some patients, one-stage exchange arthroplasty may represent optimum treatment; however, patient selection criteria and key components of surgical and post-operative anti-microbial management remain to be defined. III.

Clinical outcomes of arthroscopic single and double row repair in full thickness rotator cuff tears.

Science.gov (United States)

Ji, Jong-Hun; Shafi, Mohamed; Kim, Weon-Yoo; Kim, Young-Yul

2010-07-01

There has been a recent interest in the double row repair method for arthroscopic rotator cuff repair following favourable biomechanical results reported by some studies. The purpose of this study was to compare the clinical results of arthroscopic single row and double row repair methods in the full-thickness rotator cuff tears. 22 patients of arthroscopic single row repair (group I) and 25 patients who underwent double row repair (group II) from March 2003 to March 2005 were retrospectively evaluated and compared for the clinical outcomes. The mean age was 58 years and 56 years respectively for group I and II. The average follow-up in the two groups was 24 months. The evaluation was done by using the University of California Los Angeles (UCLA) rating scale and the shoulder index of the American Shoulder and Elbow Surgeons (ASES). In Group I, the mean ASES score increased from 30.48 to 87.40 and the mean ASES score increased from 32.00 to 91.45 in the Group II. The mean UCLA score increased from the preoperative 12.23 to 30.82 in Group I and from 12.20 to 32.40 in Group II. Each method has shown no statistical clinical differences between two methods, but based on the sub scores of UCLA score, the double row repair method yields better results for the strength, and it gives more satisfaction to the patients than the single row repair method. Comparing the two methods, double row repair group showed better clinical results in recovering strength and gave more satisfaction to the patients but no statistical clinical difference was found between 2 methods.

Prognostic value of baseline metabolic tumor volume in early stage Hodgkin's lymphoma in the standard arm of H10 trial

DEFF Research Database (Denmark)

Cottereau, Anne Ségolène; Versari, Annibale; Loft, Annika

2018-01-01

and compared to baseline characteristics, staging classifications and iPET2. A total of 258 patients were eligible, 101 favorable and 157 unfavorable. The median follow-up was 55 months, with 27 PFS and 12 OS events. TMTV was prognosticator of PFS (p...We tested baseline PET/CT as a measure of total tumor burden in order to better identify high risk patients in early-stage Hodgkin's lymphoma (HL). Stage I-II HL patients enrolled in the standard arm (combined modality treatment) of the H10 trial (NCT00433433) with available baseline PET...... and interim PET (iPET2) after two cycles of doxorubicine, bleomycin, vinblastine, dacarbazine were included. Total metabolic tumor volume (TMTV) was measured on baseline PET. IPET2 findings were reported negative (DS1-3) or positive (DS4-5) with the Deauville scale. The prognostic value of TMTV was evaluated...

A multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention in nursing homes: a two-armed randomized controlled trial.

Science.gov (United States)

Beeckman, Dimitri; Clays, Els; Van Hecke, Ann; Vanderwee, Katrien; Schoonhoven, Lisette; Verhaeghe, Sofie

2013-04-01

Frail older people admitted to nursing homes are at risk of a range of adverse outcomes, including pressure ulcers. Clinical decision support systems are believed to have the potential to improve care and to change the behaviour of healthcare professionals. To determine whether a multi-faceted tailored strategy to implement an electronic clinical decision support system for pressure ulcer prevention improves adherence to recommendations for pressure ulcer prevention in nursing homes. Two-armed randomized controlled trial in a nursing home setting in Belgium. The trial consisted of a 16-week implementation intervention between February and June 2010, including one baseline, four intermediate, and one post-testing measurement. Primary outcome was the adherence to guideline-based care recommendations (in terms of allocating adequate pressure ulcer prevention in residents at risk). Secondary outcomes were the change in resident outcomes (pressure ulcer prevalence) and intermediate outcomes (knowledge and attitudes of healthcare professionals). Random sample of 11 wards (6 experimental; 5 control) in a convenience sample of 4 nursing homes in Belgium. In total, 464 nursing home residents and 118 healthcare professionals participated. The experimental arm was involved in a multi-faceted tailored implementation intervention of a clinical decision support system, including interactive education, reminders, monitoring, feedback and leadership. The control arm received a hard-copy of the pressure ulcer prevention protocol, supported by standardized 30 min group lecture. Patients in the intervention arm were significantly more likely to receive fully adequate pressure ulcer prevention when seated in a chair (F=16.4, P=0.003). No significant improvement was observed on pressure ulcer prevalence and knowledge of the professionals. While baseline attitude scores were comparable between both groups [exp. 74.3% vs. contr. 74.5% (P=0.92)], the mean score after the intervention was

Ground reaction forces produced by two different hockey skating arm swing techniques.

Science.gov (United States)

Hayward-Ellis, Julie; Alexander, Marion J L; Glazebrook, Cheryl M; Leiter, Jeff

2017-10-01

The arm swing in hockey skating can have a positive effect on the forces produced by each skate, and the resulting velocity from each push off. The main purpose of this study was to measure the differences in ground reaction forces (GRFs) produced from an anteroposterior versus a mediolateral style hockey skating arm swing. Twenty-four elite-level female hockey players performed each technique while standing on a ground-mounted force platform, and all trials were filmed using two video cameras. Force data was assessed for peak scaled GRFs in the frontal and sagittal planes, and resultant GRF magnitude and direction. Upper limb kinematics were assessed from the video using Dartfish video analysis software, confirming that the subjects successfully performed two distinct arm swing techniques. The mediolateral arm swing used a mean of 18.38° of glenohumeral flexion/extension and 183.68° of glenohumeral abduction/adduction while the anteroposterior technique used 214.17° and 28.97° respectively. The results of this study confirmed that the mediolateral arm swing produced 37% greater frontal plane and 33% less sagittal plane GRFs than the anteroposterior arm swing. The magnitudes of the resultant GRFs were not significantly different between the two techniques; however, the mediolateral technique produced a resultant GRF with a significantly larger angle from the direction of travel (44.44°) as compared to the anteroposterior technique (31.60°). The results of this study suggest that the direction of GRFs produced by the mediolateral arm swing more closely mimic the direction of lower limb propulsion during the skating stride.

Clinical outcomes of arthroscopic single and double row repair in full thickness rotator cuff tears

Directory of Open Access Journals (Sweden)

Ji Jong-Hun

2010-01-01

Full Text Available Background: There has been a recent interest in the double row repair method for arthroscopic rotator cuff repair following favourable biomechanical results reported by some studies. The purpose of this study was to compare the clinical results of arthroscopic single row and double row repair methods in the full-thickness rotator cuff tears. Materials and Methods: 22 patients of arthroscopic single row repair (group I and 25 patients who underwent double row repair (group II from March 2003 to March 2005 were retrospectively evaluated and compared for the clinical outcomes. The mean age was 58 years and 56 years respectively for group I and II. The average follow-up in the two groups was 24 months. The evaluation was done by using the University of California Los Angeles (UCLA rating scale and the shoulder index of the American Shoulder and Elbow Surgeons (ASES. Results: In Group I, the mean ASES score increased from 30.48 to 87.40 and the mean ASES score increased from 32.00 to 91.45 in the Group II. The mean UCLA score increased from the preoperative 12.23 to 30.82 in Group I and from 12.20 to 32.40 in Group II. Each method has shown no statistical clinical differences between two methods, but based on the sub scores of UCLA score, the double row repair method yields better results for the strength, and it gives more satisfaction to the patients than the single row repair method. Conclusions: Comparing the two methods, double row repair group showed better clinical results in recovering strength and gave more satisfaction to the patients but no statistical clinical difference was found between 2 methods.

One-stage and two-stage penile buccal mucosa urethroplasty

Directory of Open Access Journals (Sweden)

G. Barbagli

2016-03-01

Full Text Available The paper provides the reader with the detailed description of current techniques of one-stage and two-stage penile buccal mucosa urethroplasty. The paper provides the reader with the preoperative patient evaluation paying attention to the use of diagnostic tools. The one-stage penile urethroplasty using buccal mucosa graft with the application of glue is preliminary showed and discussed. Two-stage penile urethroplasty is then reported. A detailed description of first-stage urethroplasty according Johanson technique is reported. A second-stage urethroplasty using buccal mucosa graft and glue is presented. Finally postoperative course and follow-up are addressed.

Double blind clinical trail comparing the safety and efficacy of ...

African Journals Online (AJOL)

Double blind clinical trail comparing the safety and efficacy of nimesulide (100g) and diclofenac in osteoarthrosis of the hip and knee joints. ... A significant proportion of the patients in the diclofenac group (50% vs 17.6%) had break through pain that warranted the use of at least two tablets of 500mg of paracetamol per week ...

Two intercultural performances: Double Nora and Resurrection Day

Directory of Open Access Journals (Sweden)

Mitsuya Mori

2015-02-01

Full Text Available I have so far directed two plays of Ibsen as the intercultural performance, that is, the collaboration of the modern theatre with noh, a traditional Japanese theatre, which was established as an artistic theatre form in the 14th century. The first production was Double Nora, based on A Doll’s House, which premiered at a noh theatre in Tokyo in 2005, and the second was Resurrection Day, based on When We Dead Awaken, performed at the Ibsen Festival in Tokyo in 2010. In both productions, professional noh and modern theatre actors appeared together in their own acting styles. At the Ibsen Conference in Tromsø in June 2012, brief scenes of the two productions were shown. But here in the present article the performances are partly described, and the interactive relationship between different acting styles of noh and modern theatre is examined. A new and difficult experiment of Resurrection Day was to try a conversation between the main noh actor and the modern actress. The experiment was possible because the performance took place not on a noh stage in a unique form but on an ordinary stage in a modern theatre. Thus, some problems involved in the intercultural performance of Ibsen are investigated.

Qtl mapping of wheat doubled haploids for chlorophyll content and chlorophyll fluorescence kinetics under drought stress imposed at anthesis stage

International Nuclear Information System (INIS)

Ilyas, M.; Ilyas, N.; Arshad, M.; Kazi, A.G.

2014-01-01

Drought stress is one of the major environmental constraints to crop plants including wheat worldwide. Synthetic hexaploid can act as a vehicle for improving crop tolerance against biotic and abiotic stresses. Doubled haploid population consisting of one hundred and forty individuals derived from cross of Opata and SH223 was used in the present study to identify genomic regions associated with various quantitative attributes of physiological nature. Doubled haploid mapping population was phenotyped for chlorophyll content and chlorophyll fluorescence kinetics under control and drought stress imposed at anthesis stage. Genotyping of population was accomplished by utilizing two hundred and sixty one polymorphic Gaterslaben wheat microsatellites and Beltsville agriculture research center simple sequence repeats. Linkage map of doubled haploid population comprising of 19 linkage groups and covering map length of two thousands six hundred and twenty six (2626) cM was constructed using map maker software. Major and minor QTLs associated with quantitative traits were identified using QGene software. Major QTL for chlorophyll content (QTc.wwc-1B-S11) of doubled haploid mapping population under anthesis drought stress was mapped on chromosome 1B and explained 10.09 percent of phenotypic variation at LOD score of 5.5. Seven major and minor QTLs for PCFK of doubled haploids were identified on chromosome 1B, 7A and 7D under control and drought stress at anthesis stage. The identified QTLs are of prime importance for high resolution mapping in synthetic hexaploid wheat. Genomic synteny of doubled haploids was observed with rice chromosome 2, 4, 7 and maize chromosome 7 owing to occurrence of orthologous QTLs for chlorophyll content and chlorophyll fluorescence respectively. (author)

Double-continuum wave functions and double-photoionization cross sections of two-electron systems

International Nuclear Information System (INIS)

Tiwary, S.N.

1996-09-01

The present review briefly presents the growing experimental as well as theoretical interests in recent years in the double-continuum wave functions and double-photoionization cross sections of two-electron systems. The validity of existing double-continuum wave functions is analyzed and the importance of electronic correlations in both the initial as well as final states wave functions involved in the transition amplitude for double-photoionization process is demonstrated. At present, we do not have comprehensive and practical double-continuum wave functions which account the full correlation of two-electron in the continuum. Basic difficulties in making accurate theoretical calculations of double ionization by a single high energy photon especially in the vicinity of the threshold, where the correlation plays an important role, are discussed. Illuminating, illustrative and representative examples are presented in order to show the present status and the progress in this field. Future challenges and directions, in high-precision double-photoionization cross sections calculations, have been discussed and suggested. (author). 133 refs, 9 figs

Double Girder Bridge Crane with Double Cycling: Scheduling Strategy and Performance Evaluation

Directory of Open Access Journals (Sweden)

Dandan Wang

2014-01-01

Full Text Available This paper introduces a novel quay crane design, double girder bridge crane (DGBC. DGBC is capable of handling containers of two adjacent bays simultaneously, avoiding crane collisions, saving travelling and reposition cost, and eventually improving terminal efficiency. This problem is formulated as a resource-constrained project scheduling with objective to minimize the maximum completion time. A two-stage heuristic algorithm is proposed in which an operating sequences on each bay is obtained by double cycling, and the integrated timetable for both bays is constructed by solving resource conflicts using the proposed minimum cost strategy. We examine effectiveness and performance of applying DGBC with double cycling. A case study is presented to illustrate how DGBC works with the two-stage method. Three extreme cases with respective conflict types are investigated to develop the performance bounds of DGBC with double cycling. The results show that DGBC can significantly improve terminal productivity, and outperforms single girder crane in both makespan and the lift operation percentage. The highest DGBC efficiency does not require maximum double cycles in two bay schedules; rather the integrated timetable for two bays is the main contribution to the DGBC performance as it yields better cooperation between two spreaders and the driver.

Single-stage Acetabular Revision During Two-stage THA Revision for Infection is Effective in Selected Patients.

Science.gov (United States)

Fink, Bernd; Schlumberger, Michael; Oremek, Damian

2017-08-01

The treatment of periprosthetic infections of hip arthroplasties typically involves use of either a single- or two-stage (with implantation of a temporary spacer) revision surgery. In patients with severe acetabular bone deficiencies, either already present or after component removal, spacers cannot be safely implanted. In such hips where it is impossible to use spacers and yet a two-stage revision of the prosthetic stem is recommended, we have combined a two-stage revision of the stem with a single revision of the cup. To our knowledge, this approach has not been reported before. (1) What proportion of patients treated with single-stage acetabular reconstruction as part of a two-stage revision for an infected THA remain free from infection at 2 or more years? (2) What are the Harris hip scores after the first stage and at 2 years or more after the definitive reimplantation? Between June 2009 and June 2014, we treated all patients undergoing surgical treatment for an infected THA using a single-stage acetabular revision as part of a two-stage THA exchange if the acetabular defect classification was Paprosky Types 2B, 2C, 3A, 3B, or pelvic discontinuity and a two-stage procedure was preferred for the femur. The procedure included removal of all components, joint débridement, definitive acetabular reconstruction (with a cage to bridge the defect, and a cemented socket), and a temporary cemented femoral component at the first stage; the second stage consisted of repeat joint and femoral débridement and exchange of the femoral component to a cementless device. During the period noted, 35 patients met those definitions and were treated with this approach. No patients were lost to followup before 2 years; mean followup was 42 months (range, 24-84 months). The clinical evaluation was performed with the Harris hip scores and resolution of infection was assessed by the absence of clinical signs of infection and a C-reactive protein level less than 10 mg/L. All

Double parton scattering. A tale of two partons

Energy Technology Data Exchange (ETDEWEB)

Kasemets, Tomas

2013-08-15

Double parton scattering in proton-proton collisions can give sizable contributions to final states in parts of phase space. We investigate the correlations between the partons participating in the two hard interactions of double parton scattering. With a detailed calculation of the differential cross section for the double Drell-Yan process we demonstrate how initial state correlations between the partons affect the rate and distribution of final state particles. We present our results with focus on correlations between the polarizations of the partons. In particular transversely polarized quarks lead to a dependence of the cross section on angles between final state particles of the two hard interactions, and thereby on the invariant mass of particle pairs. The size of the spin correlations, and therewith the degree to which the final state particles are correlated, depends on unknown double parton distributions. We derive positivity bounds on the double parton distributions that follow from their interpretation as probability densities, taking into account all possible spin correlations between two partons in an unpolarized proton. We show that the bounds are stable under homogeneous leading-order DGLAP evolution to higher scales. We make direct use of the positivity bounds in numerical investigations on the double DGLAP evolution for two linearly polarized gluons and for two transversely polarized quarks. We find that the linearly polarized gluons are likely to be negligible at high scales but that transversely polarized quarks can still play a significant role. We examine the dependence of the double parton distributions on the transverse distance between the two partons, and therewith between the two hard interactions. We further study the interplay between transverse and longitudinal variables of the distributions, as well as the impact of the differences in integration limits between the evolution equations for single and double parton distributions. (orig.)

Clinical stage T1c prostate cancer: evaluation with endorectal MR imaging and MR spectroscopic imaging.

Science.gov (United States)

Zhang, Jingbo; Hricak, Hedvig; Shukla-Dave, Amita; Akin, Oguz; Ishill, Nicole M; Carlino, Lauren J; Reuter, Victor E; Eastham, James A

2009-11-01

To assess the diagnostic accuracy of endorectal magnetic resonance (MR) imaging and MR spectroscopic imaging for prediction of the pathologic stage of prostate cancer and the presence of clinically nonimportant disease in patients with clinical stage T1c prostate cancer. The institutional review board approved-and waived the informed patient consent requirement for-this HIPAA-compliant study involving 158 patients (median age, 58 years; age range, 40-76 years) who had clinical stage T1c prostate cancer, had not been treated preoperatively, and underwent combined 1.5-T endorectal MR imaging-MR spectroscopic imaging between January 2003 and March 2004 before undergoing radical prostatectomy. On the MR images and combined endorectal MR-MR spectroscopic images, two radiologists retrospectively and independently rated the likelihood of cancer in 12 prostate regions and the likelihoods of extracapsular extension (ECE), seminal vesicle invasion (SVI), and adjacent organ invasion by using a five-point scale, and they determined the probability of clinically nonimportant prostate cancer by using a four-point scale. Whole-mount step-section pathology maps were used for imaging-pathologic analysis correlation. Receiver operating characteristic curves were constructed and areas under the curves (AUCs) were estimated nonparametrically for assessment of reader accuracy. At surgical-pathologic analysis, one (0.6%) patient had no cancer; 124 (78%) patients, organ-confined (stage pT2) disease; 29 (18%) patients, ECE (stage pT3a); two (1%) patients, SVI (stage pT3b); and two (1%) patients, bladder neck invasion (stage pT4). Forty-six (29%) patients had a total tumor volume of less than 0.5 cm(3). With combined MR imaging-MR spectroscopic imaging, the two readers achieved 80% accuracy in disease staging and AUCs of 0.62 and 0.71 for the prediction of clinically nonimportant cancer. Clinical stage T1c prostate cancers are heterogeneous in pathologic stage and volume. MR imaging may

Changes in clinical presentation and staging of lung cancer over two decades.

Science.gov (United States)

Leiro-Fernández, Virginia; Mouronte-Roibás, Cecilia; Ramos-Hernández, Cristina; Botana-Rial, Maribel; González-Piñeiro, Ana; García-Rodríguez, Esmeralda; Represas-Represas, Cristina; Fernández-Villar, Alberto

2014-10-01

Important clinical and epidemiological changes have been observed in lung cancer (LC) in our healthcare area compared to the previous decade. In the last 10 years, specific LC care circuits have been implemented and the active search for cases has been stepped up. The aim of this study was to analyze the progress of these changes over the last 20 years. This is a retrospective study comparing clinical and epidemiological changes between 2 historical cohorts of LC patients (1992-1994 [group 1, 164 patients] and 2004-2006 [group 2, 250 patients]) and a current group from the period 2011-2012 (group 3, 209 patients) Two hundred and nine (209) LC patients were included in group 3 (2011-2012 period). After comparing groups 3 and 2, a non-significant rise in smoking was observed in women (59% vs 41%, p=.25), while the prevalence of adenocarcinoma was unchanged (45% vs 44%, p=.9). The main changes observed were the increase in cases with previous malignancies (23% vs 16%, p=.04), the rise in patients with no associated LC symptoms (33% vs 16%, p<.001), and an increased number of localized NSCLC (non-small cell LC) diagnoses (42% vs 24% in series 2, p<.001 and 14.2% in series 1, p<.001). The number of LC patients diagnosed in localized stages has increased significantly. Furthermore, the number of patients with no symptoms associated with LC and with a history of previous malignancy were significantly increased. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.

Arm Pain

Science.gov (United States)

... be a sign of a heart attack. Seek emergency treatment if you have: Arm, shoulder or back ... http://www.mayoclinic.org/symptoms/arm-pain/basics/definition/SYM-20050870 . Mayo Clinic Footer Legal Conditions and ...

Optics of two-stage photovoltaic concentrators with dielectric second stages

Science.gov (United States)

Ning, Xiaohui; O'Gallagher, Joseph; Winston, Roland

1987-04-01

Two-stage photovoltaic concentrators with Fresnel lenses as primaries and dielectric totally internally reflecting nonimaging concentrators as secondaries are discussed. The general design principles of such two-stage systems are given. Their optical properties are studied and analyzed in detail using computer ray trace procedures. It is found that the two-stage concentrator offers not only a higher concentration or increased acceptance angle, but also a more uniform flux distribution on the photovoltaic cell than the point focusing Fresnel lens alone. Experimental measurements with a two-stage prototype module are presented and compared to the analytical predictions.

Optics of two-stage photovoltaic concentrators with dielectric second stages.

Science.gov (United States)

Ning, X; O'Gallagher, J; Winston, R

1987-04-01

Two-stage photovoltaic concentrators with Fresnel lenses as primaries and dielectric totally internally reflecting nonimaging concentrators as secondaries are discussed. The general design principles of such two-stage systems are given. Their optical properties are studied and analyzed in detail using computer ray trace procedures. It is found that the two-stage concentrator offers not only a higher concentration or increased acceptance angle, but also a more uniform flux distribution on the photovoltaic cell than the point focusing Fresnel lens alone. Experimental measurements with a two-stage prototype module are presented and compared to the analytical predictions.

Homeopathy for Depression - DEP-HOM: study protocol for a randomized, partially double-blind, placebo controlled, four armed study

Science.gov (United States)

2011-01-01

Background Homeopathy is often sought by patients with depression. In classical homeopathy, the treatment consists of two main elements: the case history and the prescription of an individually selected homeopathic remedy. Previous data suggest that individualized homeopathic Q-potencies were not inferior to the antidepressant fluoxetine in a sample of patients with moderate to severe depression. However, the question remains whether individualized homeopathic Q-potencies and/or the type of the homeopathic case history have a specific therapeutical effect in acute depression as this has not yet been investigated. The study aims to assess the two components of individualized homeopathic treatment for acute depression, i.e., to investigate the specific effect of individualized Q-potencies versus placebo and to investigate the effect of different approaches to the homeopathic case history. Methods/Design A randomized, partially double-blind, placebo-controlled, four-armed trial using a 2 × 2 factorial design with a six-week study duration per patient will be performed. 228 patients diagnosed with major depression (moderate episode) by a psychiatrist will be included. The primary endpoint is the total score on the 17-item Hamilton Depression Rating Scale after six weeks. Secondary end points are: Hamilton Depression Rating Scale total score after two and four weeks; response and remission rates, Beck Depression inventory total score, quality of life and safety at two, four and six weeks. Statistical analyses will be by intention-to-treat. The main endpoint will be analysed by a two-factorial analysis of covariance. Within this model generalized estimation equations will be used to estimate differences between verum and placebo, and between both types of case history. Discussion For the first time this study evaluates both the specific effect of homeopathic medicines and of a homeopathic case taking in patients with depression. It is an attempt to deal with the

Clinical effectiveness of decongestive treatments on excess arm volume and patient-centered outcomes in women with early breast cancer-related arm lymphedema: a systematic review

Science.gov (United States)

Jeffs, Eunice; Ream, Emma; Taylor, Cath; Bick, Debra

2018-01-01

ABSTRACT Objective: To identify the effect of decongestive lymphedema treatment on excess arm volume or patient-centered outcomes in women presenting within either 12 months or a mean nine months of developing arm lymphedema following breast cancer treatment. Introduction: Lymphedema is a common consequence of breast cancer treatment requiring life-long treatment to reduce symptoms and prevent complications. Currently, evidence to inform the optimal decongestive lymphedema treatment package is lacking. Inclusion criteria: The review included studies on women who received lymphedema treatment within either 12 months or a mean of nine months of developing unilateral breast cancer-related arm lymphedema. The intervention was any decongestive lymphedema treatment delivered with the purpose of reducing arm lymphedema, compared to another form of lymphedema treatment (whether self or practitioner-administered), placebo or no treatment. The clinical outcome was excess arm volume; patient-centered outcomes were health-related quality of life, arm heaviness, arm function, patient-perceived benefit and satisfaction with treatment. Experimental study designs were eligible, including randomized and non-randomized controlled trials, quasi-experimental, prospective and retrospective before and after studies were considered. Methods: A three-step search strategy was utilized to find published and unpublished studies. The search identified studies published from the inception of each database to July 6, 2016. Reference lists were scanned to identify further eligible studies. Studies were critically appraised using appropriate standardized critical appraisal instruments from the Joanna Briggs Institute. Details describing each study and treatment results regarding outcomes of interest were extracted from papers included in the review using appropriate standardized data extraction tools from the Joanna Briggs Institute. Due to heterogeneity in included studies, results for similar

Single-stage-to-orbit versus two-stage-two-orbit: A cost perspective

Science.gov (United States)

Hamaker, Joseph W.

1996-03-01

This paper considers the possible life-cycle costs of single-stage-to-orbit (SSTO) and two-stage-to-orbit (TSTO) reusable launch vehicles (RLV's). The analysis parametrically addresses the issue such that the preferred economic choice comes down to the relative complexity of the TSTO compared to the SSTO. The analysis defines the boundary complexity conditions at which the two configurations have equal life-cycle costs, and finally, makes a case for the economic preference of SSTO over TSTO.

''VECTON-1'' two-arm spectrometer for rho--meson photoproduction study

International Nuclear Information System (INIS)

Anokhin, M.V.; Kanetsyan, A.R.; Kukarev, V.M.

1977-01-01

A two-arm spectrometer for registering p - mesons according to a charged pion and one of the neutral pion disintegration photons has been designed. The spectrometer arm which registers charged pion comprises a deflecting magnet, dual wide-gap spark chambers and dual scintillation counters. The spectrometer arm for registering the disintegration photon comprises a scintillation counter, a dual wide-gap spark chamber and a shower detector. The principal characteristics of the spectrometer components are listed. The functional diagram of the useful events selection unit is discussed. It is shown that the experimental results obtained with the aid of the ''VEKTON-1'' set-up are in good agreement with the earlier results: P - meson rest energy is 731+-30 MeV, the resonant range width is 195+-58 MeV

A comparative clinical evaluation of arthroscopic single-row versus double-row supraspinatus tendon repair.

Science.gov (United States)

Buess, Eduard; Waibl, Bernhard; Vogel, Roger; Seidner, Robert

2009-10-01

Cadaveric studies and commercial pressure have initiated a strong trend towards double-row repair in arthroscopic cuff surgery. The objective of this study was to evaluate if the biomechanical advantages of a double-row supraspinatus tendon repair would result in superior clinical outcome and higher abduction strength. A retrospective study of two groups of 32 single-row and 33 double-row repairs of small to medium cuff tears was performed. The Simple Shoulder Test (SST) and a visual analog scale for pain were used to evaluate the outcome. The participation rate was 100%. A subset of patients was further investigated with the Constant Score (CS) including electronic strength measurement. The double-row repair patients had significantly more (p = 0.01) yes answers in the SST than the single-row group, and pain reduction was slightly better (p = 0.03). No difference was found for the relative CS (p = 0.86) and abduction strength (p = 0.74). Patient satisfaction was 100% for double-row and 97% for single-row repair. Single- and double-row repairs both achieved excellent clinical results. Evidence of superiority of double-row repair is still scarce and has to be balanced against the added complexity of the procedure and higher costs.

Hydrogen and methane production from household solid waste in the two-stage fermentation process

DEFF Research Database (Denmark)

Lui, D.; Liu, D.; Zeng, Raymond Jianxiong

2006-01-01

A two-stage process combined hydrogen and methane production from household solid waste was demonstrated working successfully. The yield of 43 mL H-2/g volatile solid (VS) added was generated in the first hydrogen production stage and the methane production in the second stage was 500 mL CH4/g VS...... added. This figure was 21% higher than the methane yield from the one-stage process, which was run as control. Sparging of the hydrogen reactor with methane gas resulted in doubling of the hydrogen production. PH was observed as a key factor affecting fermentation pathway in hydrogen production stage....... Furthermore, this study also provided direct evidence in the dynamic fermentation process that, hydrogen production increase was reflected by acetate to butyrate ratio increase in liquid phase. (c) 2006 Elsevier Ltd. All rights reserved....

A two-arm cluster randomized control trial to determine the effectiveness of a pressure ulcer prevention bundle for critically ill patients.

Science.gov (United States)

Tayyib, Nahla; Coyer, Fiona; Lewis, Peter A

2015-05-01

This study tested the effectiveness of a pressure ulcer (PU) prevention bundle in reducing the incidence of PUs in critically ill patients in two Saudi intensive care units (ICUs). A two-arm cluster randomized experimental control trial. Participants in the intervention group received the PU prevention bundle, while the control group received standard skin care as per the local ICU policies. Data collected included demographic variables (age, diagnosis, comorbidities, admission trajectory, length of stay) and clinical variables (Braden Scale score, severity of organ function score, mechanical ventilation, PU presence, and staging). All patients were followed every two days from admission through to discharge, death, or up to a maximum of 28 days. Data were analyzed with descriptive correlation statistics, Kaplan-Meier survival analysis, and Poisson regression. The total number of participants recruited was 140: 70 control participants (with a total of 728 days of observation) and 70 intervention participants (784 days of observation). PU cumulative incidence was significantly lower in the intervention group (7.14%) compared to the control group (32.86%). Poisson regression revealed the likelihood of PU development was 70% lower in the intervention group. The intervention group had significantly less Stage I (p = .002) and Stage II PU development (p = .026). Significant improvements were observed in PU-related outcomes with the implementation of the PU prevention bundle in the ICU; PU incidence, severity, and total number of PUs per patient were reduced. Utilizing a bundle approach and standardized nursing language through skin assessment and translation of the knowledge to practice has the potential to impact positively on the quality of care and patient outcome. © 2015 Sigma Theta Tau International.

The effect of hyoscine butylbromide in shortening the first stage of labor: A double blind, randomized, controlled, clinical trial

Directory of Open Access Journals (Sweden)

Al Qahtani NH

2011-12-01

Full Text Available Nourah H Al Qahtani1 Fatma Al Hajeri21MRCOG, College of Medicine, Department of Obstetrics and Gynecology in King Fahad University Hospital, University of Dammam, Saudi Arabia; 2Department of Obstetrics and Gynecology in King Fahad University Hospital, Saudi ArabiaBackground and objectives: Hyoscine butylbromide (HBB is widely used in labor rooms. There have been many studies on the use of HBB during labor with conflicting results, involving both primiparous and multiparous women. The aim of this trial was to study the efficacy of HBB for shortening the first stage of labor in primiparous women.Methods: The study was a randomized, double blind, controlled trial. Ninety-seven primigravid term pregnant women in spontaneous labor received either hyoscine butylbromide or a placebo intramuscularly once the women entered the active phase of labor. The primary outcome measured was the duration of the first stage of labor. Secondary outcomes were the duration of the second and third stages of labor, blood loss at delivery, rate of cesarean section, and Apgar scores for the neonates.Results: A total of 97 women yielded data for analysis. Of these, 45 women received the placebo and 52 received HBB. The mean duration of the first stage in the control group was 215 minutes, compared with 165 minutes in the study group, representing a decrease of 23.3% (P = 0.001. There were no significant changes in the duration of the second (P = 0.063 or third (P = 0.0418 stages of labor, and no significant differences in blood loss or Apgar scores. There was a slightly higher (but statistically insignificant rate of instrumental delivery in the control group, but no difference in the Cesarean section rate. There was a 60% reduction in opioid analgesic use in the HBB group.Conclusion: HBB is effective in significantly reducing the duration of the first stage of labor, and is not associated with any apparent adverse maternal or neonatal outcomes.Keywords: hyoscine

Percutaneous sacroplasty with the use of C-arm flat-panel detector CT: technical feasibility and clinical outcome

International Nuclear Information System (INIS)

Kang, Sung Eun; Lee, Joon Woo; Kim, Joo Hyung; Kang, Heung Sik; Park, Kun Woo; Yeom, Jin S.

2011-01-01

Sacroplasty for sacral insufficiency fractures (SIFs) has been performed mostly under computed tomography (CT) or fluoroscopy guidance. The purposes of this study are to describe technical tips and clinical outcomes of sacroplasty under C-arm flat panel detector CT (C-arm CT) guidance, and to compare the cement distributions shown on C-arm CT with those on multi-detector CT (MDCT). This study consisted of patients who underwent sacroplasty for SIF using C-arm CT from May 2006 to May 2009. Technical success was assessed in terms of cement filling and leakage. Clinical outcome was assessed at short-term (less than 1 month) and long-term (more than 1 month) follow-up using a four-grade patient satisfaction scale: poor, fair, good, and excellent. After sacroplasty, all patients underwent MDCT and three radiologists compared MDCT images with C-arm CT images in consensus, focusing on the cement distribution and cement leakage. Sacroplasties were performed on both sacral alae in all 8 patients (male:female = 2:6, mean age = 76.9, range = 63-82). The technical success rate was 100%. At short-term follow up, 6 patients (87.5%) reported significant improvement. Five patients (62.5%) were available for long-term follow-up and all 5 patients reported a reduced pain and an improved ability to ambulate. Using MDCT as the standard of reference, the cement distribution was visualized equally well by C-arm CT. Sacroplasty under C-arm CT showed excellent technical success and good clinical outcome. There was an excellent correlation between C-arm CT and MDCT in evaluating cement distribution and cement leakage. (orig.)

Percutaneous sacroplasty with the use of C-arm flat-panel detector CT: technical feasibility and clinical outcome

Energy Technology Data Exchange (ETDEWEB)

Kang, Sung Eun; Lee, Joon Woo; Kim, Joo Hyung; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Gyeonggi-do (Korea, Republic of); Park, Kun Woo; Yeom, Jin S. [Seoul National University Bundang Hospital, Department of Orthopaedic Surgery, Gyeonggi-do (Korea, Republic of)

2011-04-15

Sacroplasty for sacral insufficiency fractures (SIFs) has been performed mostly under computed tomography (CT) or fluoroscopy guidance. The purposes of this study are to describe technical tips and clinical outcomes of sacroplasty under C-arm flat panel detector CT (C-arm CT) guidance, and to compare the cement distributions shown on C-arm CT with those on multi-detector CT (MDCT). This study consisted of patients who underwent sacroplasty for SIF using C-arm CT from May 2006 to May 2009. Technical success was assessed in terms of cement filling and leakage. Clinical outcome was assessed at short-term (less than 1 month) and long-term (more than 1 month) follow-up using a four-grade patient satisfaction scale: poor, fair, good, and excellent. After sacroplasty, all patients underwent MDCT and three radiologists compared MDCT images with C-arm CT images in consensus, focusing on the cement distribution and cement leakage. Sacroplasties were performed on both sacral alae in all 8 patients (male:female = 2:6, mean age = 76.9, range = 63-82). The technical success rate was 100%. At short-term follow up, 6 patients (87.5%) reported significant improvement. Five patients (62.5%) were available for long-term follow-up and all 5 patients reported a reduced pain and an improved ability to ambulate. Using MDCT as the standard of reference, the cement distribution was visualized equally well by C-arm CT. Sacroplasty under C-arm CT showed excellent technical success and good clinical outcome. There was an excellent correlation between C-arm CT and MDCT in evaluating cement distribution and cement leakage. (orig.)

MRI features of patients with heroin spongiform leukoencephalopathy of different clinical stages

International Nuclear Information System (INIS)

Shi Zhu; Pan Suyue; Zhou Liang; Dong Zhao; Lu Bingxun

2007-01-01

Objective: To investigate radiological features of patients with heroin spongiform leukoencephalopathy (HSLE) of different clinical stages and discuss the evolutional characteristics of the disease. Methods: Thirty two patients with HSLE underwent precontrast MRI and postcontrast MRI. The history of addiction, clinical presentations, and brain MRI were analyzed and summarized according to the patient's clinical staging. There are 6 cases in I stage, 21 cases in II stage, 5 cases in III stage. Results: All patients had history of heroin vapor inhalation. Most of the cases developed subacute cerebellar impairment in earlier period. Brain MRI revealed symmetrical lesion within bilateral cerebellum in all patients. Splenium of the corpus callosum, posterior limb of the internal capsule, deep white matter of the occipital and parietal lobes, were gradually involved with progressive deterioration of HSLE. The brain stem and deep white matter of the frontal and temporal lobes were involved in some cases. Conclusions: The history of heated heroin vapor inhalation was the prerequisite for the diagnosis of HSLE. Brain MRI presented the characteristic lesion and its evolution of HSLE. Brain MRI was very important for accurate diagnosis and helpful to judge the clinical stages according to the involved brain region. (authors)

[Arthroscopic double-row reconstruction of high-grade subscapularis tendon tears].

Science.gov (United States)

Plachel, F; Pauly, S; Moroder, P; Scheibel, M

2018-04-01

Reconstruction of tendon integrity to maintain glenohumeral joint centration and hence to restore shoulder functional range of motion and to reduce pain. Isolated or combined full-thickness subscapularis tendon tears (≥upper two-thirds of the tendon) without both substantial soft tissue degeneration and cranialization of the humeral head. Chronic tears of the subscapularis tendon with higher grade muscle atrophy, fatty infiltration, and static decentration of the humeral head. After arthroscopic three-sided subscapularis tendon release, two double-loaded suture anchors are placed medially to the humeral footprint. Next to the suture passage, the suture limbs are tied and secured laterally with up to two knotless anchors creating a transosseous-equivalent repair. The affected arm is placed in a shoulder brace with 20° of abduction and slight internal rotation for 6 weeks postoperatively. Rehabilitation protocol including progressive physical therapy from a maximum protection phase to a minimum protection phase is required. Overhead activities are permitted after 6 months. While previous studies have demonstrated superior biomechanical properties and clinical results after double-row compared to single-row and transosseous fixation techniques, further mid- to long-term clinical investigations are needed to confirm these findings.

Young's double-slit interference with two-color biphotons.

Science.gov (United States)

Zhang, De-Jian; Wu, Shuang; Li, Hong-Guo; Wang, Hai-Bo; Xiong, Jun; Wang, Kaige

2017-12-12

In classical optics, Young's double-slit experiment with colored coherent light gives rise to individual interference fringes for each light frequency, referring to single-photon interference. However, two-photon double-slit interference has been widely studied only for wavelength-degenerate biphoton, known as subwavelength quantum lithography. In this work, we report double-slit interference experiments with two-color biphoton. Different from the degenerate case, the experimental results depend on the measurement methods. From a two-axis coincidence measurement pattern we can extract complete interference information about two colors. The conceptual model provides an intuitional picture of the in-phase and out-of-phase photon correlations and a complete quantum understanding about the which-path information of two colored photons.

Two-stage single-volume exchange transfusion in severe hemolytic disease of the newborn.

Science.gov (United States)

Abbas, Wael; Attia, Nayera I; Hassanein, Sahar M A

2012-07-01

Evaluation of two-stage single-volume exchange transfusion (TSSV-ET) in decreasing the post-exchange rebound increase in serum bilirubin level, with subsequent reduction of the need for repeated exchange transfusions. The study included 104 neonates with hyperbilirubinemia needing exchange transfusion. They were randomly enrolled into two equal groups, each group comprised 52 neonates. TSSV-ET was performed for the 52 neonates and the traditional single-stage double-volume exchange transfusion (SSDV-ET) was performed to 52 neonates. TSSV-ET significantly lowered rebound serum bilirubin level (12.7 ± 1.1 mg/dL), compared to SSDV-ET (17.3 ± 1.7 mg/dL), p < 0.001. Need for repeated exchange transfusions was significantly lower in TSSV-ET group (13.5%), compared to 32.7% in SSDV-ET group, p < 0.05. No significant difference was found between the two groups as regards the morbidity (11.5% and 9.6%, respectively) and the mortality (1.9% for both groups). Two-stage single-volume exchange transfusion proved to be more effective in reducing rebound serum bilirubin level post-exchange and in decreasing the need for repeated exchange transfusions.

Experimental Results of the First Two Stages of an Advanced Transonic Core Compressor Under Isolated and Multi-Stage Conditions

Science.gov (United States)

Prahst, Patricia S.; Kulkarni, Sameer; Sohn, Ki H.

2015-01-01

NASA's Environmentally Responsible Aviation (ERA) Program calls for investigation of the technology barriers associated with improved fuel efficiency of large gas turbine engines. Under ERA the task for a High Pressure Ratio Core Technology program calls for a higher overall pressure ratio of 60 to 70. This mean that the HPC would have to almost double in pressure ratio and keep its high level of efficiency. The challenge is how to match the corrected mass flow rate of the front two supersonic high reaction and high corrected tip speed stages with a total pressure ratio of 3.5. NASA and GE teamed to address this challenge by using the initial geometry of an advanced GE compressor design to meet the requirements of the first 2 stages of the very high pressure ratio core compressor. The rig was configured to run as a 2 stage machine, with Strut and IGV, Rotor 1 and Stator 1 run as independent tests which were then followed by adding the second stage. The goal is to fully understand the stage performances under isolated and multi-stage conditions and fully understand any differences and provide a detailed aerodynamic data set for CFD validation. Full use was made of steady and unsteady measurement methods to isolate fluid dynamics loss source mechanisms due to interaction and endwalls. The paper will present the description of the compressor test article, its predicted performance and operability, and the experimental results for both the single stage and two stage configurations. We focus the detailed measurements on 97 and 100 of design speed at 3 vane setting angles.

Pathogenic and clinical aspects of polyneuropathies, with reference to the hand-arm vibration syndrome.

Science.gov (United States)

Juntunen, J; Taskinen, H

1987-08-01

Along with attacks of white finger, symptoms suggesting peripheral sensorimotor neuropathy, ie, polyneuropathy or entrapment neuropathy, are very important in the hand-arm vibration syndrome. Peripheral neuropathies are probably associated with the occurrence of the syndrome because of a selection mechanism. Polyneuropathy may be a contributing factor in the development of entrapment neuropathies in the upper extremities. It has multiple pathogenic mechanisms and numerous causative factors. However, peripheral nerves can react to pathological stimuli in a limited number of ways. Wallerian degeneration, segmental demyelination, and axonal degeneration are the classical neuropathological types of peripheral neuropathies, of which the first two are possible direct consequences of vibration exposure. The clinical manifestations of polyneuropathy range from sensory to motor types, sometimes with autonomic involvement. Whenever polyneuropathy is encountered in the hand-arm vibration syndrome, its etiologic possibilities should be considered. Regardless of the variable criteria used by different authors, individual diagnosis of the syndrome is always a probability diagnosis, and adequate neurological differential diagnostics have to be employed.

Comparisons of single-stage and two-stage approaches to genomic selection.

Science.gov (United States)

Schulz-Streeck, Torben; Ogutu, Joseph O; Piepho, Hans-Peter

2013-01-01

Genomic selection (GS) is a method for predicting breeding values of plants or animals using many molecular markers that is commonly implemented in two stages. In plant breeding the first stage usually involves computation of adjusted means for genotypes which are then used to predict genomic breeding values in the second stage. We compared two classical stage-wise approaches, which either ignore or approximate correlations among the means by a diagonal matrix, and a new method, to a single-stage analysis for GS using ridge regression best linear unbiased prediction (RR-BLUP). The new stage-wise method rotates (orthogonalizes) the adjusted means from the first stage before submitting them to the second stage. This makes the errors approximately independently and identically normally distributed, which is a prerequisite for many procedures that are potentially useful for GS such as machine learning methods (e.g. boosting) and regularized regression methods (e.g. lasso). This is illustrated in this paper using componentwise boosting. The componentwise boosting method minimizes squared error loss using least squares and iteratively and automatically selects markers that are most predictive of genomic breeding values. Results are compared with those of RR-BLUP using fivefold cross-validation. The new stage-wise approach with rotated means was slightly more similar to the single-stage analysis than the classical two-stage approaches based on non-rotated means for two unbalanced datasets. This suggests that rotation is a worthwhile pre-processing step in GS for the two-stage approaches for unbalanced datasets. Moreover, the predictive accuracy of stage-wise RR-BLUP was higher (5.0-6.1%) than that of componentwise boosting.

Oral paracetamol and/or ibuprofen for treating pain after soft tissue injuries: Single centre double-blind, randomised controlled clinical trial.

Directory of Open Access Journals (Sweden)

Kevin K C Hung

Full Text Available Soft tissue injuries commonly present to the emergency department (ED, often with acute pain. They cause significant suffering and morbidity if not adequately treated. Paracetamol and ibuprofen are commonly used analgesics, but it remains unknown if either one or the combination of both is superior for pain control.To investigate the analgesic effect of paracetamol, ibuprofen and the combination of both in the treatment of soft tissue injury in an ED, and the side effect profile of these drugs.Double-blind, double dummy, placebo-controlled randomised controlled trial. 782 adult patients presenting with soft tissue injury without obvious fractures attending the ED of a university hospital in the New Territories of Hong Kong were recruited. Patients were randomised using a random number table into three parallel arms of paracetamol only, ibuprofen only and a combination of paracetamol and ibuprofen in a 1:1:1 ratio. The primary outcome measure was pain score at rest and on activity in the first 2 hours and first 3 days. Data was analysed on an intention to treat basis.There was no statistically significant difference in pain score in the initial two hours between the three groups, and no clinically significant difference in pain score in the first three days.There was no difference in analgesic effects or side effects observed using oral paracetamol, ibuprofen or a combination of both in patients with mild to moderate pain after soft tissue injuries attending the ED.The study is registered with ClinicalTrials.gov (no. NCT00528658.

Oral paracetamol and/or ibuprofen for treating pain after soft tissue injuries: Single centre double-blind, randomised controlled clinical trial.

Science.gov (United States)

Hung, Kevin K C; Graham, Colin A; Lo, Ronson S L; Leung, Yuk Ki; Leung, Ling Yan; Man, S Y; Woo, W K; Cattermole, Giles N; Rainer, Timothy H

2018-01-01

Soft tissue injuries commonly present to the emergency department (ED), often with acute pain. They cause significant suffering and morbidity if not adequately treated. Paracetamol and ibuprofen are commonly used analgesics, but it remains unknown if either one or the combination of both is superior for pain control. To investigate the analgesic effect of paracetamol, ibuprofen and the combination of both in the treatment of soft tissue injury in an ED, and the side effect profile of these drugs. Double-blind, double dummy, placebo-controlled randomised controlled trial. 782 adult patients presenting with soft tissue injury without obvious fractures attending the ED of a university hospital in the New Territories of Hong Kong were recruited. Patients were randomised using a random number table into three parallel arms of paracetamol only, ibuprofen only and a combination of paracetamol and ibuprofen in a 1:1:1 ratio. The primary outcome measure was pain score at rest and on activity in the first 2 hours and first 3 days. Data was analysed on an intention to treat basis. There was no statistically significant difference in pain score in the initial two hours between the three groups, and no clinically significant difference in pain score in the first three days. There was no difference in analgesic effects or side effects observed using oral paracetamol, ibuprofen or a combination of both in patients with mild to moderate pain after soft tissue injuries attending the ED. The study is registered with ClinicalTrials.gov (no. NCT00528658).

A randomised, double blind, placebo-controlled, multi-centric parallel arm trial to assess the effects of homoeopathic medicines on chronic rhinosinusitis

Directory of Open Access Journals (Sweden)

Raj K Manchanda

2014-01-01

Full Text Available Background: Chronic rhinosinusitis (CRS is one of the most common illnesses interfering with patient′s quality of life and work. Observational studies conducted by the Council indicate positive outcome. This protocol has been developed to ascertain the usefulness of homoeopathic intervention in comparison with control group in a randomised control setting. Objectives: Primary objective is to evaluate the changes in TSS (Total Symptoms Score and SNOT-22 (Sino-nasal Outcome Test-22 within the two groups of the study (Homoeopathy + Placebo. Secondary objective is to evaluate changes in SNOT-22 at end of the trial, changes in Lund and Mackay staging of CT scan, rhinoscopy grading, absolute eosinophil count, global assessment by investigator and patient, and number of acute exacerbations of CRS (for frequency, duration and intensity as per TSS scale compared to placebo. Methods/Design: This is a randomised double blind, placebo-controlled, multi-centric parallel arm trial of 6 months (three months treatment and three months observation period with 14 days run-in period. The primary outcome is a composite of the changes in the TSS and SNOT-22 over 3 months from baseline with area under the curve and changes over 3 months in the Sinus Nasal Outcome Test 22 (SNOT-22 from baseline. Prescription shall be made as per the homoeopathic principles. Efficacy data will be analysed in the intention-to-treat population. Discussion: This trial will help to evaluate the efficacy of homoeopathic individualised treatment using LM-potencies versus placebo in patients suffering from CRS as per the homoeopathic dictum.

Evaluation of the effect of one stage versus two stage full mouth disinfection on C-reactive protein and leucocyte count in patients with chronic periodontitis.

Science.gov (United States)

Pabolu, Chandra Mohan; Mutthineni, Ramesh Babu; Chintala, Srikanth; Naheeda; Mutthineni, Navya

2013-07-01

Conventional non-surgical periodontal therapy is carried out in quadrant basis with 1-2 week interval. This time lag may result in re-infection of instrumented pocket and may impair healing. Therefore, a new approach to full-mouth non-surgical therapy to be completed within two consecutive days with full-mouth disinfection has been suggested. In periodontitis, leukocyte counts and levels of C-reactive protein (CRP) are likely to be slightly elevated, indicating the presence of infection or inflammation. The aim of this study is to compare the efficacy of one stage and two stage non-surgical therapy on clinical parameters along with CRP levels and total white blood cell (TWBC) count. A total of 20 patients were selected and were divided into two groups. Group 1 received one stage full mouth dis-infection and Group 2 received two stages FMD. Plaque index, sulcus bleeding index, probing depth, clinical attachment loss, serum CRP and TWBC count were evaluated for both the groups at baseline and at 1 month post-treatment. The results were analyzed using the Student t-test. Both treatment modalities lead to a significant improvement of the clinical and hematological parameters; however comparison between the two groups showed no significant difference after 1 month. The therapeutic intervention may have a systemic effect on blood count in periodontitis patients. Though one stage FMD had limited benefits over two stages FMD, the therapy can be accomplished in a shorter duration.

Efficacy and predictive value of clinical stage in non-surgical patients with esophageal cancer

International Nuclear Information System (INIS)

Liu Xiao; Wang Guiqi; He Shun

2014-01-01

Objective: To investigate the efficacy and predictive value of clinical stage in non-surgical patients with esophageal cancer (EC). Methods: A retrospective study was conducted in 358 EC patients who underwent radical surgery in our hospital from April 2003 to October 2010 and who had preoperative work-up including endoscopic esophageal ultrasound (EUS), esophagoscopy, thoracic CT scans,and contrast esophagography and had detailed information on postoperative pathological stages. The predictive value of preoperative clinical T/N stage based on EUS + CT for postoperative pathological stage was analyzed. The disease free survival (DFS) and overall survival (OS) were analyzed according to the UICC TNM classification (2002/ 2009) and the clinical stage based on imaging findings. Results: The median follow-up was 47 months.A total of 305 (85.2%) of all patients were analyzed by clinical stage based on EUS + CT.Among them, the predictive value of clinical T stage for pathological T stage was 0-88.6%, highest (88.6%) for T1 stage and lowest for T4 stage. The predictive value of clinical N stage (N 0 /N1) was 62.5-100%. The significant differences in OS and DFS rates based on both 2002 and 2009 UICC TNM classifications were noted (P=0.000 and 0.000). There were significant differences in OS between stage groups, except the comparison between two stage Ⅳ patients and other groups, according to 2002 UICC TNM classification. There were usually insignificant differences in OS between stage groups, according to 2009 UICC TNM classification. For the 305 patients staged clinically based on EUS and CT according to 2002 UICC TNM classification, significant differences in OS and DFS rates were noted (P=0.000 and 0.000). Conclusions: Imaging modalities show good predictive value for N stage (N0/N1),even though they cannot accurately provide the number of metastatic lymph nodes. The clinical stage based on EUS + CT can effectively predict the prognosis of non-surgical EC patients

Scatter correction using a primary modulator on a clinical angiography C-arm CT system.

Science.gov (United States)

Bier, Bastian; Berger, Martin; Maier, Andreas; Kachelrieß, Marc; Ritschl, Ludwig; Müller, Kerstin; Choi, Jang-Hwan; Fahrig, Rebecca

2017-09-01

Cone beam computed tomography (CBCT) suffers from a large amount of scatter, resulting in severe scatter artifacts in the reconstructions. Recently, a new scatter correction approach, called improved primary modulator scatter estimation (iPMSE), was introduced. That approach utilizes a primary modulator that is inserted between the X-ray source and the object. This modulation enables estimation of the scatter in the projection domain by optimizing an objective function with respect to the scatter estimate. Up to now the approach has not been implemented on a clinical angiography C-arm CT system. In our work, the iPMSE method is transferred to a clinical C-arm CBCT. Additional processing steps are added in order to compensate for the C-arm scanner motion and the automatic X-ray tube current modulation. These challenges were overcome by establishing a reference modulator database and a block-matching algorithm. Experiments with phantom and experimental in vivo data were performed to evaluate the method. We show that scatter correction using primary modulation is possible on a clinical C-arm CBCT. Scatter artifacts in the reconstructions are reduced with the newly extended method. Compared to a scan with a narrow collimation, our approach showed superior results with an improvement of the contrast and the contrast-to-noise ratio for the phantom experiments. In vivo data are evaluated by comparing the results with a scan with a narrow collimation and with a constant scatter correction approach. Scatter correction using primary modulation is possible on a clinical CBCT by compensating for the scanner motion and the tube current modulation. Scatter artifacts could be reduced in the reconstructions of phantom scans and in experimental in vivo data. © 2017 American Association of Physicists in Medicine.

A high-dose preparation of lactobacilli and bifidobacteria in the prevention of antibiotic-associated and Clostridium difficile diarrhoea in older people admitted to hospital: a multicentre, randomised, double-blind, placebo-controlled, parallel arm trial (PLACIDE).

Science.gov (United States)

Allen, S J; Wareham, K; Wang, D; Bradley, C; Sewell, B; Hutchings, H; Harris, W; Dhar, A; Brown, H; Foden, A; Gravenor, M B; Mack, D; Phillips, C J

2013-12-01

Antibiotic-associated diarrhoea (AAD) occurs most commonly in older people admitted to hospital and within 12 weeks of exposure to broad-spectrum antibiotics. Although usually a mild and self-limiting illness, the 15-39% of cases caused by Clostridium difficile infection [C. difficile diarrhoea (CDD)] may result in severe diarrhoea and death. Previous research has shown that probiotics, live microbial organisms that, when administered in adequate numbers, are beneficial to health, may be effective in preventing AAD and CDD. To determine the clinical effectiveness and cost-effectiveness of a high-dose, multistrain probiotic in the prevention of AAD and CDD in older people admitted to hospital. A multicentre, randomised, double-blind, placebo-controlled, parallel-arm trial. Medical, surgical and elderly care inpatient wards in five NHS hospitals in the UK. Eligible patients were aged ≥ 65 years, were exposed to one or more oral or parenteral antibiotics and were without pre-existing diarrhoeal disorders, recent CDD or at risk of probiotic adverse effects. Out of 17,420 patients screened, 2981 (17.1%) were recruited. Participants were allocated sequentially according to a computer-generated random allocation sequence; 1493 (50.1%) were allocated to the probiotic and 1488 (49.9%) to the placebo arm. Vegetarian capsules containing two strains of lactobacilli and two strains of bifidobacteria (a total of 6 × 10(10) organisms per day) were taken daily for 21 days. The placebo was inert maltodextrin powder in identical capsules. The occurrence of AAD within 8 weeks and CDD within 12 weeks of recruitment was determined by participant follow-up and checking hospital laboratory records by research nurses who were blind to arm allocation. Analysis based on the treatment allocated included 2941 (98.7%) participants. Potential risk factors for AAD at baseline were similar in the two study arms. Frequency of AAD (including CDD) was similar in the probiotic (159/1470, 10

Design considerations for single-stage and two-stage pneumatic pellet injectors

International Nuclear Information System (INIS)

Gouge, M.J.; Combs, S.K.; Fisher, P.W.; Milora, S.L.

1988-09-01

Performance of single-stage pneumatic pellet injectors is compared with several models for one-dimensional, compressible fluid flow. Agreement is quite good for models that reflect actual breech chamber geometry and incorporate nonideal effects such as gas friction. Several methods of improving the performance of single-stage pneumatic pellet injectors in the near term are outlined. The design and performance of two-stage pneumatic pellet injectors are discussed, and initial data from the two-stage pneumatic pellet injector test facility at Oak Ridge National Laboratory are presented. Finally, a concept for a repeating two-stage pneumatic pellet injector is described. 27 refs., 8 figs., 3 tabs

Esophageal atresia associated with anorectal malformation: Is the outcome better after surgery in two stages in a limited resources scenario?

Directory of Open Access Journals (Sweden)

Sunita Singh

2012-01-01

Full Text Available Aims: To analyze whether outcome of neonates having esophageal atresia with or without tracheoesophageal fistula (EA±TEF associated with anorectal malformation (ARM can be improved by doing surgery in 2 stages. Materials and Methods : A prospective study of neonates having both EA±TEF and ARM from 2004 to 2011. The patients with favorable parameters were operated in a single stage, whereas others underwent first-stage decompression surgery for ARM. Thereafter, once septicemia was under control and ventilator care available, second-stage surgery for EA±TEF was performed. Results: Total 70 neonates (single stage = 20, 2 stages = 30, expired after colostomy = 9, only EA±TEF repair needed = 11 were enrolled. The admission rate for this association was 1 per 290. Forty-one percent (24/70 neonates had VACTERL association and 8.6% (6/70 neonates had multiple gastrointestinal atresias. Sepsis screen was positive in 71.4% (50/70. The survival was 45% (9/20 in neonates operated in a single stage and 53.3% (16/30 when operated in 2 stages (P = 0.04. Data analysis of 50 patients revealed that the survived neonates had significantly better birth weight, better gestational age, negative sepsis screen, no cardiac diseases, no pneumonia, and 2-stage surgery (P value 0.002, 0.003, 0.02, 0.02, 0.04, and 0.04, respectively. The day of presentation and abdominal distension had no significant effect (P value 0.06 and 0.06, respectively. This was further supported by stepwise logistic regression analysis. Conclusions: In a limited resources scenario, the survival rate of babies with this association can be improved by treating ARM first and then for EA±TEF in second stage, once mechanical ventilator care became available and sepsis was under control.

Virtual sine arm kinematic mount system

International Nuclear Information System (INIS)

Xu, Z.; Randall, K.J.

1997-01-01

A novel kinematic mount system for a vertical focusing mirror of the soft x-ray spectroscopy beamline at the Advanced Photon Source is described. The system contains three points in a horizontal plane. Each point consists of two horizontal linear precision stages, a spherical ball bearing, and a vertical precision stage. The horizontal linear stages are aligned orthogonally and are conjoined by a spherical ball bearing, supported by the vertical linear stage at each point. The position of each confined horizontal stage is controlled by a motorized micrometer head by spring-loading the flat tip of the micrometer head onto a tooling ball fixing on the carriage of the stage. A virtual sine arm is formed by tilting the upstream horizontal stage down and the two downstream horizontal stages up by a small angle. The fine pitch motion is achieved by adjusting the upstream stage. This supporting structure is extremely steady due to a relatively large span across the supporting points and yields extremely high resolution on the pitch motion. With a one degree tilt and a microstepping motor, the authors achieved a 0.4 nanoradian resolution on the mirror pitch motion

Meson exchange currents and two neutrino double beta decay

International Nuclear Information System (INIS)

Simkovic, F.

1995-01-01

By using a field theory approach a detailed analysis of the two neutrino double beta decay amplitude has been performed. We have shown that the summation over the intermediate nuclear states in the present two neutrino double beta decay studies corresponds to a summation over a class of meson exchange diagrams. We offer some arguments showing that the two nucleon mechanism considered at present does not provide the main contribution to the two neutrino double beta decay amplitude. A new electron-gamma exchange mechanism for this process is suggested. 31 refs., 1 fig

Study on the Control Algorithm of Two-Stage DC-DC Converter for Electric Vehicles

Directory of Open Access Journals (Sweden)

Changhao Piao

2014-01-01

Full Text Available The fast response, high efficiency, and good reliability are very important characteristics to electric vehicles (EVs dc/dc converters. Two-stage dc-dc converter is a kind of dc-dc topologies that can offer those characteristics to EVs. Presently, nonlinear control is an active area of research in the field of the control algorithm of dc-dc converters. However, very few papers research on two-stage converter for EVs. In this paper, a fixed switching frequency sliding mode (FSFSM controller and double-integral sliding mode (DISM controller for two-stage dc-dc converter are proposed. And a conventional linear control (lag is chosen as the comparison. The performances of the proposed FSFSM controller are compared with those obtained by the lag controller. In consequence, the satisfactory simulation and experiment results show that the FSFSM controller is capable of offering good large-signal operations with fast dynamical responses to the converter. At last, some other simulation results are presented to prove that the DISM controller is a promising method for the converter to eliminate the steady-state error.

Simultaneous 3D–2D image registration and C-arm calibration: Application to endovascular image-guided interventions

Energy Technology Data Exchange (ETDEWEB)

Mitrović, Uroš [Faculty of Electrical Engineering, University of Ljubljana, Tržaška 25, Ljubljana 1000, Slovenia and Cosylab, Control System Laboratory, Teslova ulica 30, Ljubljana 1000 (Slovenia); Pernuš, Franjo [Faculty of Electrical Engineering, University of Ljubljana, Tržaška 25, Ljubljana 1000 (Slovenia); Likar, Boštjan; Špiclin, Žiga, E-mail: ziga.spiclin@fe.uni-lj.si [Faculty of Electrical Engineering, University of Ljubljana, Tržaška 25, Ljubljana 1000, Slovenia and Sensum, Computer Vision Systems, Tehnološki Park 21, Ljubljana 1000 (Slovenia)

2015-11-15

Purpose: Three-dimensional to two-dimensional (3D–2D) image registration is a key to fusion and simultaneous visualization of valuable information contained in 3D pre-interventional and 2D intra-interventional images with the final goal of image guidance of a procedure. In this paper, the authors focus on 3D–2D image registration within the context of intracranial endovascular image-guided interventions (EIGIs), where the 3D and 2D images are generally acquired with the same C-arm system. The accuracy and robustness of any 3D–2D registration method, to be used in a clinical setting, is influenced by (1) the method itself, (2) uncertainty of initial pose of the 3D image from which registration starts, (3) uncertainty of C-arm’s geometry and pose, and (4) the number of 2D intra-interventional images used for registration, which is generally one and at most two. The study of these influences requires rigorous and objective validation of any 3D–2D registration method against a highly accurate reference or “gold standard” registration, performed on clinical image datasets acquired in the context of the intervention. Methods: The registration process is split into two sequential, i.e., initial and final, registration stages. The initial stage is either machine-based or template matching. The latter aims to reduce possibly large in-plane translation errors by matching a projection of the 3D vessel model and 2D image. In the final registration stage, four state-of-the-art intrinsic image-based 3D–2D registration methods, which involve simultaneous refinement of rigid-body and C-arm parameters, are evaluated. For objective validation, the authors acquired an image database of 15 patients undergoing cerebral EIGI, for which accurate gold standard registrations were established by fiducial marker coregistration. Results: Based on target registration error, the obtained success rates of 3D to a single 2D image registration after initial machine-based and

Two-Stage Series-Resonant Inverter

Science.gov (United States)

Stuart, Thomas A.

1994-01-01

Two-stage inverter includes variable-frequency, voltage-regulating first stage and fixed-frequency second stage. Lightweight circuit provides regulated power and is invulnerable to output short circuits. Does not require large capacitor across ac bus, like parallel resonant designs. Particularly suitable for use in ac-power-distribution system of aircraft.

[Impact of microdose clinical trials in the preclinical stage].

Science.gov (United States)

Kim, Soonih

2014-01-01

A microdose clinical trial may be useful as a safe early-phase exploratory study using doses as low as 100 μg or less for determination of the disposition of a candidate compound in humans in a short period of time. This may increase confidence in candidate compounds, especially those for which it is difficult to predict disposition based on the results of in vitro or preclinical studies. In this study, we examined microdose trials performed in the preclinical stage for two first-in-class compounds with a new mechanism of action. These compounds showed species difference in first pass metabolism in the digestive tract and liver, causing uncertainty in prediction of disposition in humans. For this reason, first-in-human microdose clinical trials were performed. The results showed that the two compounds had effective blood concentrations after oral administration at a dose of 100 mg qd. Administration of an extremely small dose of one (14)C-labeled compound permitted identification of major metabolites. No toxic metabolites were detected. The preclinical toxic dose was determined based on prediction of blood exposure at the estimated maximum clinical dose. For the other candidate compound, the findings of the microdose trial indicated a high bioavailability after oral administration and low hepatic clearance after intravenous administration. These results suggested only a small risk of a change in disposition in patients with hepatic disorder. The data obtained for the two compounds suggest that microdose clinical trials can be useful for improving the process of candidate selection in the preclinical stage.

A two-input sliding-mode controller for a planar arm actuated by four pneumatic muscle groups.

Science.gov (United States)

Lilly, John H; Quesada, Peter M

2004-09-01

Multiple-input sliding-mode techniques are applied to a planar arm actuated by four groups of pneumatic muscle (PM) actuators in opposing pair configuration. The control objective is end-effector tracking of a desired path in Cartesian space. The inputs to the system are commanded input pressure differentials for the two opposing PM groups. An existing model for the muscle is incorporated into the arm equations of motion to arrive at a two-input, two-output nonlinear model of the planar arm that is affine in the input and, therefore, suitable for sliding-mode techniques. Relationships between static input pressures are derived for suitable arm behavior in the absence of a control signal. Simulation studies are reported.

Correlation of clinical data, anatomical site and disease stage in ...

African Journals Online (AJOL)

Objective: To evaluate the colorectal cancer clinical data with respect to the anatomical location and stage of disease. Design: Retrospective observational study. Setting: Kenyatta National Hospital (KNH), Nairobi, Kenya. Subjects: Two hundred and fifty three tumours were categorised as right colonic (RCC), left colonic ...

Two-stage anaerobic digestion of cheese whey

Energy Technology Data Exchange (ETDEWEB)

Lo, K V; Liao, P H

1986-01-01

A two-stage digestion of cheese whey was studied using two anaerobic rotating biological contact reactors. The second-stage reactor receiving partially treated effluent from the first-stage reactor could be operated at a hydraulic retention time of one day. The results indicated that two-stage digestion is a feasible alternative for treating whey. 6 references.

Double stage dry-wet-fermentation - start-up of a pilot biogas plant

International Nuclear Information System (INIS)

Buschmann, Jeannette; Busch, Gunter; Burkhardt, Marko

2009-01-01

The Brandenburg University of Technology (BTU) has developed a double stage dry-wet fermentation process for fast and safe anaerobic degradation. Originally designed for treatment of organic wastes, this process allows using a wide variety of solid biodegradable materials. The dividing of hydrolysis and methanation in this process, allows an optimization of the different steps of biogas generation separately. The main advantages of the process are the optimum process control, an extremely stable process operation and a high gas productivity and quality. Compared to conventional processes, the retention times within the percolation stage (hydrolysis) are reduced considerably. In cooperation with the engineering and consulting company GICON, the technology was qualified further to an industrial scale. In 2007 a pilot plant, and, simultaneously, an industrial plant were built by GICON based on this double stage technology. Based on practical experience from the operation of laboratory fermentation plants, the commissioning of the pilot plant was planned, controlled and monitored by our institution. The start-up of a biogas plant of this type focuses mainly on the inoculation the of methane reactor. The growth of microbial populations and generation of a stable biocenosis within the methane reactor is essential and affects the duration of starting period as well as the methanation efficiency a long time afterwards. This paper concerns with start-up of a pilot biogas plant and discusses particular occurrences and effects during this period. (author)

On the robustness of two-stage estimators

KAUST Repository

Zhelonkin, Mikhail

2012-04-01

The aim of this note is to provide a general framework for the analysis of the robustness properties of a broad class of two-stage models. We derive the influence function, the change-of-variance function, and the asymptotic variance of a general two-stage M-estimator, and provide their interpretations. We illustrate our results in the case of the two-stage maximum likelihood estimator and the two-stage least squares estimator. © 2011.

Sensitivity Analysis in Two-Stage DEA

Directory of Open Access Journals (Sweden)

Athena Forghani

2015-07-01

Full Text Available Data envelopment analysis (DEA is a method for measuring the efficiency of peer decision making units (DMUs which uses a set of inputs to produce a set of outputs. In some cases, DMUs have a two-stage structure, in which the first stage utilizes inputs to produce outputs used as the inputs of the second stage to produce final outputs. One important issue in two-stage DEA is the sensitivity of the results of an analysis to perturbations in the data. The current paper looks into combined model for two-stage DEA and applies the sensitivity analysis to DMUs on the entire frontier. In fact, necessary and sufficient conditions for preserving a DMU's efficiency classiffication are developed when various data changes are applied to all DMUs.

Sensitivity Analysis in Two-Stage DEA

Directory of Open Access Journals (Sweden)

Athena Forghani

2015-12-01

Full Text Available Data envelopment analysis (DEA is a method for measuring the efficiency of peer decision making units (DMUs which uses a set of inputs to produce a set of outputs. In some cases, DMUs have a two-stage structure, in which the first stage utilizes inputs to produce outputs used as the inputs of the second stage to produce final outputs. One important issue in two-stage DEA is the sensitivity of the results of an analysis to perturbations in the data. The current paper looks into combined model for two-stage DEA and applies the sensitivity analysis to DMUs on the entire frontier. In fact, necessary and sufficient conditions for preserving a DMU's efficiency classiffication are developed when various data changes are applied to all DMUs.

Two stage-type railgun accelerator

International Nuclear Information System (INIS)

Ogino, Mutsuo; Azuma, Kingo.

1995-01-01

The present invention provides a two stage-type railgun accelerator capable of spiking a flying body (ice pellet) formed by solidifying a gaseous hydrogen isotope as a fuel to a thermonuclear reactor at a higher speed into a central portion of plasmas. Namely, the two stage-type railgun accelerator accelerates the flying body spiked from a initial stage accelerator to a portion between rails by Lorentz force generated when electric current is supplied to the two rails by way of a plasma armature. In this case, two sets of solenoids are disposed for compressing the plasma armature in the longitudinal direction of the rails. The first and the second sets of solenoid coils are previously supplied with electric current. After passing of the flying body, the armature formed into plasmas by a gas laser disposed at the back of the flying body is compressed in the longitudinal direction of the rails by a magnetic force of the first and the second sets of solenoid coils to increase the plasma density. A current density is also increased simultaneously. Then, the first solenoid coil current is turned OFF to accelerate the flying body in two stages by the compressed plasma armature. (I.S.)

Finite difference order doubling in two dimensions

International Nuclear Information System (INIS)

Killingbeck, John P; Jolicard, Georges

2008-01-01

An order doubling process previously used to obtain eighth-order eigenvalues from the fourth-order Numerov method is applied to the perturbed oscillator in two dimensions. A simple method of obtaining high order finite difference operators is reported and an odd parity boundary condition is found to be effective in facilitating the smooth operation of the order doubling process

Preoperative Radiotherapy in Resectable Rectal Cancer: A Prospective Randomized Study of Two Different Approaches

International Nuclear Information System (INIS)

EITTA, M.A.; EL- WAHIDI, G.F.; FOUDA, M.A.; ABO EL-NAGA, E.M.; GAD EL-HAK, N.

2010-01-01

Preoperative radiotherapy in resectable rectal cancer has a number of potential advantages, most importantly reducing local recurrence, increasing survival and down-staging effect. Purpose: This prospective study was designed to compare between two different approaches of preoperative radiotherapy, either short course or long course radiotherapy. The primary endpoint is to evaluate the local recurrence rate, overall survival (OS) and disease free survival (DFS). The secondary endpoint is to evaluate down staging, treatment toxicity and ability to do sphincter sparing procedure (SSP), aiming at helping in the choice of the optimal treatment modality. Patients and Methods: This is a prospective randomized study of patients with resectable rectal cancer who presented to the department of Clinical Oncology and Nuclear Medicine, Mansoura University during the time period between June 2007 and September 2009. These patients received preoperative radiotherapy and were randomized into two arms: Arm 1, short course (SCRT) 25Gy/week/5 fractions followed by surgery within one week, and arm 2, long course preoperative radiotherapy (LCRT) 45Gy/5 weeks/25 fractions followed by surgery after 4-6 weeks. Adjuvant chemotherapy was given 4-6 weeks after surgery according to the postoperative pathology. Results: After a median follow-up of 18 months (range 6 to 28 months), we studied the patterns of recurrence. Three patients experienced local recurrence (LR), two out of 14 (14.2%) in arm 1 and one out of 15 patients (6.7%) in arm 2, (p=0.598). Three patients developed distant metastases [two in arm 1 (14.2%) and one in arm 2 (6.7%), p=0.598]. Two-year OS rate was 64±3% and 66±2%, (p= 0.389), and the 2-year DFS rate was 61±2% and 83±2% for arms 1 and 2, respectively (p=0.83). Tumor (T) downstaging was more achieved in LCRT arm with a statistically significant difference, but did not reach statistical significance in node (N) down-staging. SSP was more available in LCRT but with no

Analysis of the flow field into a two stages and double entry storage pump taking into account two geometries of stator blades

International Nuclear Information System (INIS)

Dunca, G; Isbasoiu, E C; Muntean, S

2010-01-01

The paper presents the 3D numerical analysis of the flow into a hydraulic passage of the two stages and double entry storage pump. One of the reasons for choosing this machinery was that, even from the beginning of its operation, high levels of noise and vibration were recorded. According to the literature, these can be considered as effects of the impeller-stator phenomenon. After only 100 hours of operation, the pump' first stator blades was bend and the second stator blades was broken. As a rehabilitation solution, 100 mm of the chord were cut from the stator blades, near the leading edge. After the rehabilitation, a decrease of the noise and vibration levels during pump operation was observed. In order to analyse the pump behaviour, three measurements campaigns were conducted, after the rehabilitation. Yet, the experimental results were not very conclusive. A more detailed experimental analysis on a real turbo machine is very difficult and expensive. Thus, in order to obtain more detailed information regarding the impeller-stator phenomenon inside the analysed pump, a numerical analysis was realized. The impeller-stator (between the first impeller and first stator as well as between second impeller and second stator) and stator-impeller (between the first stator and second impeller) interactions are taken into account with mixing interface method. The hydrodynamic field from the inlet to the outlet is obtained. As a result, the pressure rise and hydraulic efficiency are computed at best efficiency point. These values are validated against experimental data measured into the storage pump. Comparing the numerical results obtained for the two geometries of the stators, it can be seen that they have different behaviour during the pump's operation. It can be considered that, although the same geometry modification was realized for both the stators, the effects on the flow parameters are different, only for the second stator being possible to observe a net

One-stage vs two-stage cartilage repair: a current review

Directory of Open Access Journals (Sweden)

Daniel Meyerkort

2010-10-01

Full Text Available Daniel Meyerkort, David Wood, Ming-Hao ZhengCenter for Orthopaedic Research, School of Surgery and Pathology, University of Western Australia, Perth, AustraliaIntroduction: Articular cartilage has a poor capacity for regeneration if damaged. Various methods have been used to restore the articular surface, improve pain, function, and slow progression to osteoarthritis.Method: A PubMed review was performed on 18 March, 2010. Search terms included “autologous chondrocyte implantation (ACI” and “microfracture” or “mosaicplasty”. The aim of this review was to determine if 1-stage or 2-stage procedures for cartilage repair produced different functional outcomes.Results: The main procedures currently used are ACI and microfracture. Both first-generation ACI and microfracture result in clinical and functional improvement with no significant differences. A significant increase in functional outcome has been observed in second-generation procedures such as Hyalograft C, matrix-induced ACI, and ChondroCelect compared with microfracture. ACI results in a higher percentage of patients with clinical improvement than mosaicplasty; however, these results may take longer to achieve.Conclusion: Clinical and functional improvements have been demonstrated with ACI, microfracture, mosaicplasty, and synthetic cartilage constructs. Heterogeneous products and lack of good-quality randomized-control trials make product comparison difficult. Future developments involve scaffolds, gene therapy, growth factors, and stem cells to create a single-stage procedure that results in hyaline articular cartilage.Keywords: autologous chondrocyte implantation, microfracture, cartilage repair

Two-stage implant systems.

Science.gov (United States)

Fritz, M E

1999-06-01

Since the advent of osseointegration approximately 20 years ago, there has been a great deal of scientific data developed on two-stage integrated implant systems. Although these implants were originally designed primarily for fixed prostheses in the mandibular arch, they have been used in partially dentate patients, in patients needing overdentures, and in single-tooth restorations. In addition, this implant system has been placed in extraction sites, in bone-grafted areas, and in maxillary sinus elevations. Often, the documentation of these procedures has lagged. In addition, most of the reports use survival criteria to describe results, often providing overly optimistic data. It can be said that the literature describes a true adhesion of the epithelium to the implant similar to adhesion to teeth, that two-stage implants appear to have direct contact somewhere between 50% and 70% of the implant surface, that the microbial flora of the two-stage implant system closely resembles that of the natural tooth, and that the microbiology of periodontitis appears to be closely related to peri-implantitis. In evaluations of the data from implant placement in all of the above-noted situations by means of meta-analysis, it appears that there is a strong case that two-stage dental implants are successful, usually showing a confidence interval of over 90%. It also appears that the mandibular implants are more successful than maxillary implants. Studies also show that overdenture therapy is valid, and that single-tooth implants and implants placed in partially dentate mouths have a success rate that is quite good, although not quite as high as in the fully edentulous dentition. It would also appear that the potential causes of failure in the two-stage dental implant systems are peri-implantitis, placement of implants in poor-quality bone, and improper loading of implants. There are now data addressing modifications of the implant surface to alter the percentage of

One stage revision single-bundle anterior cruciate ligament reconstruction with impacted morselized bone graft following a failed double-bundle reconstruction

Directory of Open Access Journals (Sweden)

Ho Jong Ra

2017-01-01

Full Text Available Although double-bundle anterior cruciate ligament (ACL reconstruction has theoretical benefits such as more accurate reproduction of ACL anatomy, it is technically more demanding surgery. This report describes the case of a one stage revision single-bundle ACL reconstruction after primary double-bundle ACL reconstruction. A professional dancer had an ACL previously reconstructed with a double-bundle technique, but the femoral tunnels were malpositioned resulting in residual laxity and rotational instability. The previous femoral tunnel positions were vertical and widened. The previous vertical tunnels were filled with impacted bone graft and a revision single-bundle ACL reconstruction was performed via the new femoral tunnel with a 2 O'clock position between the previous two tunnels. After 10 months of postoperative rehabilitation, the patient returned to professional dancing with sound bony union and without any residual instability.

[Double Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament at stage I for the treatment of acromioclavicular dislocation with Rockwood type III - V].

Science.gov (United States)

Hu, Wen-yue; Yu, Chong; Huang, Zhong-ming; Han, Lei

2015-06-01

To explore clinical efficacy of double Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament in stage I in treating acromioclavicular dislocation with Rockwood type III - V . From January 2010 to September 2013, 56 patients with Rockwood type III - V acromioclavicular dislocation were treated by operation, including 20 males and 36 femlaes, aged from 32 to 52 years old with an average of 38.5 years old. Twenty-five patients were on the left side and 31 cases on the right side. The time from injury to operation was from 3 to 14 days, averaged 7 days. All patients were diagnosed as acromioclavicular dislocation with Rockwood type III - V, and double Endobutto were used to reconstituting coracoclavicular ligament, line metal anchors were applied for repairing acromioclavicular ligament. Postoperative complications were observed, Karlsson and Constant-Murley evaluation standard were used to evaluate clinical effects. All patients were followed up from 8 to 24 months with average of 11 months. According to Karlsson evaluation standard at 6 months after operation,42 cases were grade A, 13 were grade B and 1 was grade C. Constant-Murley score were improved from (42.80±5.43) before operation to (91.75±4.27) at 6 months after operation. All items at 6 months after operation were better than that of preoperative items. Forty-eight patients got excellent results, 7 were moderate and only 1 with bad result. No shoulder joint adhesion, screw loosening or breakage were occurred during following up. Double Endobutto reconstituting coracoclavicular ligament combined with repairing acromioclavicular ligament in stage I for the treatment of acromioclavicular dislocation with Rockwood type III - V could obtain early staisfied clinical effects, and benefit for early recovery of shoulder joint function.

A double stage dry-wet-fermentation process for a fast and safe digestion of different kinds of organic material

International Nuclear Information System (INIS)

Busch, G.; Sieber, M.; Buschmann, J.; Burkhardat, M.

2009-01-01

The fermentation of organic material is a four-step-process. It is admissible to merge the first two steps (hydrolysis and acidification) to hydrolysis in general and the last two steps (aceto genesis and methano genesis) to methano genesis. The Brandenburg University of Technology in Cottbus has devised a double stage dry-wet-fermentation process for fast and safe anaerobic degradation. Using these processes, it is possible to decompose different kinds of organic material like renewable material (e. g. maize silage), waste (e. g. household-waste) and industrial material (e. g. glycerine). (Author)

Two-step two-stage fission gas release model

International Nuclear Information System (INIS)

Kim, Yong-soo; Lee, Chan-bock

2006-01-01

Based on the recent theoretical model, two-step two-stage model is developed which incorporates two stage diffusion processes, grain lattice and grain boundary diffusion, coupled with the two step burn-up factor in the low and high burn-up regime. FRAPCON-3 code and its in-pile data sets have been used for the benchmarking and validation of this model. Results reveals that its prediction is in better agreement with the experimental measurements than that by any model contained in the FRAPCON-3 code such as ANS 5.4, modified ANS5.4, and Forsberg-Massih model over whole burn-up range up to 70,000 MWd/MTU. (author)

Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers.

Science.gov (United States)

Romanò, C L; Gala, L; Logoluso, N; Romanò, D; Drago, L

2012-12-01

The best method for treating chronic periprosthetic knee infection remains controversial. Randomized, comparative studies on treatment modalities are lacking. This systematic review of the literature compares the infection eradication rate after two-stage versus one-stage revision and static versus articulating spacers in two-stage procedures. We reviewed full-text papers and those with an abstract in English published from 1966 through 2011 that reported the success rate of infection eradication after one-stage or two-stage revision with two different types of spacers. In all, 6 original articles reporting the results after one-stage knee exchange arthoplasty (n = 204) and 38 papers reporting on two-stage revision (n = 1,421) were reviewed. The average success rate in the eradication of infection was 89.8% after a two-stage revision and 81.9% after a one-stage procedure at a mean follow-up of 44.7 and 40.7 months, respectively. The average infection eradication rate after a two-stage procedure was slightly, although significantly, higher when an articulating spacer rather than a static spacer was used (91.2 versus 87%). The methodological limitations of this study and the heterogeneous material in the studies reviewed notwithstanding, this systematic review shows that, on average, a two-stage procedure is associated with a higher rate of eradication of infection than one-stage revision for septic knee prosthesis and that articulating spacers are associated with a lower recurrence of infection than static spacers at a comparable mean duration of follow-up. IV.

Two stages of economic development

OpenAIRE

Gong, Gang

2016-01-01

This study suggests that the development process of a less-developed country can be divided into two stages, which demonstrate significantly different properties in areas such as structural endowments, production modes, income distribution, and the forces that drive economic growth. The two stages of economic development have been indicated in the growth theory of macroeconomics and in the various "turning point" theories in development economics, including Lewis's dual economy theory, Kuznet...

A Comparison between Two Force-Position Controllers with Gravity Compensation Simulated on a Humanoid Arm

Directory of Open Access Journals (Sweden)

Giovanni Gerardo Muscolo

2013-01-01

Full Text Available The authors propose a comparison between two force-position controllers with gravity compensation simulated on the DEXTER bioinspired robotic arm. The two controllers are both constituted by an internal proportional-derivative (PD closed-loop for the position control. The force control of the two systems is composed of an external proportional (P closed-loop for one system (P system and an external proportional-integrative (PI closed-loop for the other system (PI system. The simulation tests performed with the two systems on a planar representation of the DEXTER, an eight-DOF bioinspired arm, showed that by varying the stiffness of the environment, with a correct setting of parameters, both systems ensure the achievement of the desired force regime and with great precision the desired position. The two controllers do not have large differences in performance when interacting with a lower stiffness environment. In case of an environment with greater rigidity, the PI system is more stable. The subsequent implementation of these control systems on the DEXTER robotic bioinspired arm gives guidance on the design and control optimisation of the arms of the humanoid robot named SABIAN.

Exergetic analysis of a double stage LiBr-H2O thermal compressor cooled by air/water and driven by low grade heat

International Nuclear Information System (INIS)

Izquierdo, M.; Venegas, M.; Garcia, N.; Palacios, E.

2005-01-01

In the present paper, an exergetic analysis of a double stage thermal compressor using the lithium bromide-water solution is performed. The double stage system considered allows obtaining evaporation temperatures equal to 5 deg. C using solar heat coming from flat plate collectors and other low grade thermal sources. In this study, ambient air and water are alternatively used as cooling fluids without crystallization problems up to condensation-absorption temperatures equal to 50 deg. C. The results obtained give the entropy generated, the exergy destroyed and the exergetic efficiency of the double stage thermal compressor as a function of the absorption temperature. The conclusions obtained show that the irreversibilities generated by the double stage thermal compressor will tend to increase with the absorption temperature up to 45 deg. C. The maximum value corresponds to 1.35 kJ kg -1 K -1 . The entropy generated and the exergy destroyed by the air cooled system are higher than those by the water cooled one. The difference between the values increases when the absorption temperature increases. For an absorption temperature equal to 50 deg. C, the air cooled mode generates 14% more entropy and destroys 14% more exergy than the water cooled one. Also, the results are compared with those of previous studies for single and double effect air cooled and water cooled thermal compressors. The conclusions show that the double stage system has about 22% less exergetic efficiency than the single effect one and 32% less exergetic efficiency than the double effect one

Method and system for dual resolution translation stage

Science.gov (United States)

Halpin, John Michael

2014-04-22

A dual resolution translation stage includes a stage assembly operable to receive an optical element and a low resolution adjustment device mechanically coupled to the stage assembly. The dual resolution stage also includes an adjustable pivot block mechanically coupled to the stage assembly. The adjustable pivot block includes a pivot shaft. The dual resolution stage further includes a lever arm mechanically coupled to the adjustable pivot block. The lever arm is operable to pivot about the pivot shaft. The dual resolution stage additionally includes a high resolution adjustment device mechanically coupled to the lever arm and the stage assembly.

Anti-kindling induced by two-stage coordinated reset stimulation with weak onset intensity

Directory of Open Access Journals (Sweden)

Magteld eZeitler

2016-05-01

Full Text Available Abnormal neuronal synchrony plays an important role in a number of brain diseases. To specifically counteract abnormal neuronal synchrony by desynchronization, Coordinated Reset (CR stimulation, a spatiotemporally patterned stimulation technique, was designed with computational means. In neuronal networks with spike timing–dependent plasticity CR stimulation causes a decrease of synaptic weights and finally anti-kindling, i.e. unlearning of abnormally strong synaptic connectivity and abnormal neuronal synchrony. Long-lasting desynchronizing aftereffects of CR stimulation have been verified in pre-clinical and clinical proof of concept studies. In general, for different neuromodulation approaches, both invasive and non-invasive, it is desirable to enable effective stimulation at reduced stimulation intensities, thereby avoiding side effects. For the first time, we here present a two-stage CR stimulation protocol, where two qualitatively different types of CR stimulation are delivered one after another, and the first stage comes at a particularly weak stimulation intensity. Numerical simulations show that a two-stage CR stimulation can induce the same degree of anti-kindling as a single-stage CR stimulation with intermediate stimulation intensity. This stimulation approach might be clinically beneficial in patients suffering from brain diseases characterized by abnormal neuronal synchrony where a first treatment stage should be performed at particularly weak stimulation intensities in order to avoid side effects. This might, e.g., be relevant in the context of acoustic CR stimulation in tinnitus patients with hyperacusis or in the case of electrical deep brain CR stimulation with sub-optimally positioned leads or side effects caused by stimulation of the target itself. We discuss how to apply our method in first in man and proof of concept studies.

Performance of an iterative two-stage bayesian technique for population pharmacokinetic analysis of rich data sets

NARCIS (Netherlands)

Proost, Johannes H.; Eleveld, Douglas J.

2006-01-01

Purpose. To test the suitability of an Iterative Two-Stage Bayesian (ITSB) technique for population pharmacokinetic analysis of rich data sets, and to compare ITSB with Standard Two-Stage (STS) analysis and nonlinear Mixed Effect Modeling (MEM). Materials and Methods. Data from a clinical study with

Simultaneous versus sequential pharmacokinetic-pharmacodynamic population analysis using an iterative two-stage Bayesian technique

NARCIS (Netherlands)

Proost, Johannes H.; Schiere, Sjouke; Eleveld, Douglas J.; Wierda, J. Mark K. H.

A method for simultaneous pharmacokinetic-pharmacodynamic (PK-PD) population analysis using an Iterative Two-Stage Bayesian (ITSB) algorithm was developed. The method was evaluated using clinical data and Monte Carlo simulations. Data from a clinical study with rocuronium in nine anesthetized

Are prostate carcinoma clinical stages T1C and T2 similar?

Directory of Open Access Journals (Sweden)

Athanase Billis

2006-04-01

Full Text Available PURPOSE: A recent study has found that PSA recurrence rate for clinical T1c tumors is similar to T2 tumors, indicating a need for further refinement of clinical staging system. To test this finding we compared clinicopathologic characteristics and the time to PSA progression following radical retropubic prostatectomy of patients with clinical stage T1c tumors to those with stage T2, T2a or T2b tumors. MATERIALS AND METHODS: From a total of 186 consecutive patients submitted to prostatectomy, 33.52% had clinical stage T1c tumors, 45.45% stage T2a tumors and 21.02% stage T2b tumors. The variables studied were age, preoperative PSA, prostate weight, Gleason score, tumor extent, positive surgical margins, extraprostatic extension (pT3a, seminal vesicle invasion (pT3b, and time to PSA progression. Tumor extent was evaluated by a point-count method. RESULTS: Patients with clinical stage T1c were younger and had the lowest mean preoperative PSA. In the surgical specimen, they had higher frequency of Gleason score < 7 and more organ confined cancer. In 40.54% of the patients with clinical stage T2b tumors, there was extraprostatic extension (pT3a. During the study period, 54 patients (30.68% developed a biochemical progression. Kaplan-Meier product-limit analysis revealed no significant difference in the time to PSA progression between men with clinical stage T1c versus clinical stage T2 (p = 0.7959, T2a (p = 0.6060 or T2b (p = 0.2941 as well as between men with clinical stage T2a versus stage T2b (p = 0.0994. CONCLUSION: Clinicopathological features are not similar considering clinical stage T1c versus clinical stages T2, T2a or T2b.

Daily blueberry consumption improves blood pressure and arterial stiffness in postmenopausal women with pre- and stage 1-hypertension: a randomized, double-blind, placebo-controlled clinical trial.

Science.gov (United States)

Johnson, Sarah A; Figueroa, Arturo; Navaei, Negin; Wong, Alexei; Kalfon, Roy; Ormsbee, Lauren T; Feresin, Rafaela G; Elam, Marcus L; Hooshmand, Shirin; Payton, Mark E; Arjmandi, Bahram H

2015-03-01

Postmenopausal women have a high prevalence of hypertension and often develop arterial stiffness thereby increasing cardiovascular disease risk. Although antihypertensive drug therapies exist, increasing numbers of people prefer natural therapies. In vivo studies and a limited number of clinical studies have demonstrated the antihypertensive and vascular-protective effects of blueberries. To examine the effects of daily blueberry consumption for 8 weeks on blood pressure and arterial stiffness in postmenopausal women with pre- and stage 1-hypertension. This was an 8-week, randomized, double-blind, placebo-controlled clinical trial. Forty-eight postmenopausal women with pre- and stage 1-hypertension recruited from the greater Tallahassee, FL, area participated. Participants were randomly assigned to receive either 22 g freeze-dried blueberry powder or 22 g control powder. Resting brachial systolic and diastolic blood pressures were evaluated and arterial stiffness was assessed using carotid-femoral pulse wave velocity and brachial-ankle pulse wave velocity. C-reactive protein, nitric oxide, and superoxide dismutase were measured at baseline, 4 weeks, and 8 weeks. Statistical analysis was performed using a split plot model of repeated measures analysis of variance. After 8 weeks, systolic blood pressure and diastolic blood pressure (131±17 mm Hg [Pblueberry powder group, whereas there were no changes in the group receiving the control powder. Nitric oxide levels were greater (15.35±11.16 μmol/L; Pblueberry powder group at 8 weeks compared with baseline values (9.11±7.95 μmol/L), whereas there were no changes in the control group. Daily blueberry consumption may reduce blood pressure and arterial stiffness, which may be due, in part, to increased nitric oxide production. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

A thermal-driven silicon micro xy-stage integrated with piezoresistive sensors for nano-positioning

International Nuclear Information System (INIS)

Choi, Young-Soo; Zhang, Yan; Lee, Dong-Weon

2012-01-01

This paper describes a novel micro xy-stage, driven by double-hot arm horizontal thermal micro-actuators integrated with a piezoresistive sensor (PS) for low-voltage operation and precise control. This micro xy-stage structure is linked with chevron beams and optimized to amplify the displacement generated by the micro-actuators that provide a pull force to the movable platform. The PS employed for in situ displacement detection and feedback control is fabricated at the base of a cold arm, which minimizes the influence of temperature change induced by electro-thermal heating. The micro xy-stage structure is defined through the use of a simple micromachining process, released by backside wet etching with a special tool. For an input power of approximately 44 mW, each chevron actuator provides about 16 µm and the total displacement of the platform is close to 32 µm. The sensitivity of the PS is better than 1 mV µm −1 , obtained from the amplified voltage output of the Wheatstone bridge circuit. The potential applications of the proposed micro xy-stage lie in micro- or nano-manipulation, as well as the positioning of ultra-small objects in nanotechnology. (paper)

[Rotator cuff repair: single- vs double-row. Clinical and biomechanical results].

Science.gov (United States)

Baums, M H; Kostuj, T; Klinger, H-M; Papalia, R

2016-02-01

The goal of rotator cuff repair is a high initial mechanical stability as a requirement for adequate biological recovery of the tendon-to-bone complex. Notwithstanding the significant increase in publications concerning the topic of rotator cuff repair, there are still controversies regarding surgical technique. The aim of this work is to present an overview of the recently published results of biomechanical and clinical studies on rotator cuff repair using single- and double-row techniques. The review is based on a selective literature research of PubMed, Embase, and the Cochrane Database on the subject of the clinical and biomechanical results of single- and double-row repair. In general, neither the biomechanical nor the clinical evidence can recommend the use of a double-row concept for the treatment for every rotator cuff tear. Only tears of more than 3 cm seem to benefit from better results on both imaging and in clinical outcome studies compared with the use of single-row techniques. Despite a significant increase in publications on the surgical treatment of rotator cuff tears in recent years, the clinical results were not significantly improved in the literature so far. Unique information and algorithms, from which the optimal treatment of this entity can be derived, are still inadequate. Because of the cost-effectiveness and the currently vague evidence, the double-row techniques cannot be generally recommended for the repair of all rotator cuff tears.

Accuracy of the One-Stage and Two-Stage Impression Techniques: A Comparative Analysis.

Science.gov (United States)

Jamshidy, Ladan; Mozaffari, Hamid Reza; Faraji, Payam; Sharifi, Roohollah

2016-01-01

Introduction . One of the main steps of impression is the selection and preparation of an appropriate tray. Hence, the present study aimed to analyze and compare the accuracy of one- and two-stage impression techniques. Materials and Methods . A resin laboratory-made model, as the first molar, was prepared by standard method for full crowns with processed preparation finish line of 1 mm depth and convergence angle of 3-4°. Impression was made 20 times with one-stage technique and 20 times with two-stage technique using an appropriate tray. To measure the marginal gap, the distance between the restoration margin and preparation finish line of plaster dies was vertically determined in mid mesial, distal, buccal, and lingual (MDBL) regions by a stereomicroscope using a standard method. Results . The results of independent test showed that the mean value of the marginal gap obtained by one-stage impression technique was higher than that of two-stage impression technique. Further, there was no significant difference between one- and two-stage impression techniques in mid buccal region, but a significant difference was reported between the two impression techniques in MDL regions and in general. Conclusion . The findings of the present study indicated higher accuracy for two-stage impression technique than for the one-stage impression technique.

On nonlinear dynamics and control of a robotic arm with chaos

Directory of Open Access Journals (Sweden)

Felix J. L. P.

2014-01-01

Full Text Available In this paper a robotic arm is modelled by a double pendulum excited in its base by a DC motor of limited power via crank mechanism and elastic connector. In the mathematical model, a chaotic motion was identified, for a wide range of parameters. Controlling of the chaotic behaviour of the system, were implemented using, two control techniques, the nonlinear saturation control (NSC and the optimal linear feedback control (OLFC. The actuator and sensor of the device are allowed in the pivot and joints of the double pendulum. The nonlinear saturation control (NSC is based in the order second differential equations and its action in the pivot/joint of the robotic arm is through of quadratic nonlinearities feedback signals. The optimal linear feedback control (OLFC involves the application of two control signals, a nonlinear feedforward control to maintain the controlled system to a desired periodic orbit, and control a feedback control to bring the trajectory of the system to the desired orbit. Simulation results, including of uncertainties show the feasibility of the both methods, for chaos control of the considered system.

Comparison of single-stage and temperature-phased two-stage anaerobic digestion of oily food waste

International Nuclear Information System (INIS)

Wu, Li-Jie; Kobayashi, Takuro; Li, Yu-You; Xu, Kai-Qin

2015-01-01

Highlights: • A single-stage and two two-stage anaerobic systems were synchronously operated. • Similar methane production 0.44 L/g VS_a_d_d_e_d from oily food waste was achieved. • The first stage of the two-stage process became inefficient due to serious pH drop. • Recycle favored the hythan production in the two-stage digestion. • The conversion of unsaturated fatty acids was enhanced by recycle introduction. - Abstract: Anaerobic digestion is an effective technology to recover energy from oily food waste. A single-stage system and temperature-phased two-stage systems with and without recycle for anaerobic digestion of oily food waste were constructed to compare the operation performances. The synchronous operation indicated the similar ability to produce methane in the three systems, with a methane yield of 0.44 L/g VS_a_d_d_e_d. The pH drop to less than 4.0 in the first stage of two-stage system without recycle resulted in poor hydrolysis, and methane or hydrogen was not produced in this stage. Alkalinity supplement from the second stage of two-stage system with recycle improved pH in the first stage to 5.4. Consequently, 35.3% of the particulate COD in the influent was reduced in the first stage of two-stage system with recycle according to a COD mass balance, and hydrogen was produced with a percentage of 31.7%, accordingly. Similar solids and organic matter were removed in the single-stage system and two-stage system without recycle. More lipid degradation and the conversion of long-chain fatty acids were achieved in the single-stage system. Recycling was proved to be effective in promoting the conversion of unsaturated long-chain fatty acids into saturated fatty acids in the two-stage system.

AN M DWARF COMPANION AND ITS INDUCED SPIRAL ARMS IN THE HD 100453 PROTOPLANETARY DISK

Energy Technology Data Exchange (ETDEWEB)

Dong, Ruobing [Nuclear Science Division, Lawrence Berkeley National Lab, Berkeley, CA 94720 (United States); Zhu, Zhaohuan [Princeton University, Princeton, NJ 08544 (United States); Fung, Jeffrey; Chiang, Eugene [Department of Astronomy, University of California at Berkeley, Berkeley, CA 94720 (United States); Rafikov, Roman [Institute for Advanced Study, Princeton, NJ 08540 (United States); Wagner, Kevin, E-mail: rdong2013@berkeley.edu [Department of Astronomy/Steward Observatory, The University of Arizona, 933 North Cherry Avenue, Tucson, AZ 85721 (United States)

2016-01-01

Recent VLT/SPHERE near-infrared imaging observations revealed two spiral arms with a near m = 2 rotational symmetry in the protoplanetary disk around the ∼1.7 M{sub ⊙} Herbig star HD 100453. A ∼0.3 M{sub ⊙} M dwarf companion, HD 100453 B, was also identified at a projected separation of 120 AU from the primary. In this Letter, we carry out hydrodynamic and radiative transfer simulations to examine the scattered light morphology of the HD 100453 disk as perturbed by the companion on a circular and coplanar orbit. We find that the companion truncates the disk at ∼45 AU in scattered light images, and excites two spiral arms in the remaining (circumprimary) disk with a near m = 2 rotational symmetry. Both the truncated disk size and the morphology of the spirals are in excellent agreement with the SPHERE observations at Y, J, H, and K1-bands, suggesting that the M dwarf companion is indeed responsible for the observed double-spiral-arm pattern. Our model suggests that the disk is close to face on (inclination angle ∼5°), and that the entire disk-companion system rotates counterclockwise on the sky. The HD 100453 observations, along with our modeling work, demonstrate that double spiral arm patterns in near-infrared scattered light images can be generically produced by companions, and support future observations to identify the companions responsible for the arms observed in the MWC 758 and SAO 206462 systems.

Nearly automatic motion capture system for tracking octopus arm movements in 3D space.

Science.gov (United States)

Zelman, Ido; Galun, Meirav; Akselrod-Ballin, Ayelet; Yekutieli, Yoram; Hochner, Binyamin; Flash, Tamar

2009-08-30

Tracking animal movements in 3D space is an essential part of many biomechanical studies. The most popular technique for human motion capture uses markers placed on the skin which are tracked by a dedicated system. However, this technique may be inadequate for tracking animal movements, especially when it is impossible to attach markers to the animal's body either because of its size or shape or because of the environment in which the animal performs its movements. Attaching markers to an animal's body may also alter its behavior. Here we present a nearly automatic markerless motion capture system that overcomes these problems and successfully tracks octopus arm movements in 3D space. The system is based on three successive tracking and processing stages. The first stage uses a recently presented segmentation algorithm to detect the movement in a pair of video sequences recorded by two calibrated cameras. In the second stage, the results of the first stage are processed to produce 2D skeletal representations of the moving arm. Finally, the 2D skeletons are used to reconstruct the octopus arm movement as a sequence of 3D curves varying in time. Motion tracking, segmentation and reconstruction are especially difficult problems in the case of octopus arm movements because of the deformable, non-rigid structure of the octopus arm and the underwater environment in which it moves. Our successful results suggest that the motion-tracking system presented here may be used for tracking other elongated objects.

Analysis of stroke in ATHENA: a placebo-controlled, double-blind, parallel-arm trial to assess the efficacy of dronedarone 400 mg BID for the prevention of cardiovascular hospitalization or death from any cause in patients with atrial fibrillation/atrial flutter

DEFF Research Database (Denmark)

Connolly, Stuart J; Crijns, Harry J G M; Torp-Pedersen, Christian

2009-01-01

, on stroke has been evaluated in a randomized, double-blind clinical trial, ATHENA (A placebo-controlled, double-blind, parallel-arm Trial to assess the efficacy of dronedarone 400 mg BID for the prevention of cardiovascular Hospitalization or death from any cause in patiENts with Atrial fibrillation....../atrial flutter). METHODS AND RESULTS: Patients with persistent or paroxysmal atrial fibrillation and at least 1 risk factor for cardiovascular hospitalization were randomized to receive dronedarone (400 mg BID) or double-blind matching placebo and followed up for a minimum of 1 year to a common termination at 30...... of either oral anticoagulant therapy or antiplatelet agent alone was 60%. Dronedarone reduced the risk of stroke from 1.8% per year to 1.2% per year (hazard ratio 0.66, 95% confidence interval 0.46 to 0.96, P=0.027). The effect of dronedarone was similar whether or not patients were receiving oral...

Exergetic analysis of a double stage LiBr-H{sub 2}O thermal compressor cooled by air/water and driven by low grade heat

Energy Technology Data Exchange (ETDEWEB)

Izquierdo, M. [Instituto C.C. Eduardo Torroja (CSIC), Edificacion y Habitabilidad, Madrid (Spain); Venegas, M.; Garcia, N. [Universidad Carlos III de Madrid (Spain). Departamento de Ingenieria Termica y Fluidos; Palacios, E. [Universidad Politecnica de Madrid (Spain). Departamento de Mecanica Industrial

2005-05-01

In the present paper, an exergetic analysis of a double stage thermal compressor using the lithium bromide-water solution is performed. The double stage system considered allows obtaining evaporation temperatures equal to 5{sup o} C using solar heat coming from flat plate collectors and other low grade thermal sources. In this study, ambient air and water are alternatively used as cooling fluids without crystallization problems up to condensation-absorption temperatures equal to 50 {sup o}C. The results obtained give the entropy generated, the exergy destroyed and the exergetic efficiency of the double stage thermal compressor as a function of the absorption temperature. The conclusions obtained show that the irreversibilities generated by the double stage thermal compressor will tend to increase with the absorption temperature up to 45 {sup o}C. The maximum value corresponds to 1.35 kJ kg{sup -}1{sup K-1}. The entropy generated and the exergy destroyed by the air cooled system are higher than those by the water cooled one. The difference between the values increases when the absorption temperature increases. For an absorption temperature equal to 50 {sup o}C, the air cooled mode generates 14% more entropy and destroys 14% more exergy than the water cooled one. Also, the results are compared with those of previous studies for single and double effect air cooled and water cooled thermal compressors. The conclusions show that the double stage system has about 22% less exergetic efficiency than the single effect one and 32% less exergetic efficiency than the double effect one. (author)

Annual review of advances in lung cancer clinical research: a report for the year 2009.

Science.gov (United States)

Stinchcombe, Thomas E; Bogart, Jeffrey; Wigle, Dennis A; Govindan, Ramaswamy

2010-07-01

The use of positron emission tomography compared with conventional staging increases the detection of extrathoracic metastases and reduces the number futile thoracotomies in patients being evaluated for surgical resection. Long-term follow-up of one of the two adjuvant chemotherapy trials revealed a continued overall survival (OS) benefit to adjuvant chemotherapy. In locally advanced non-small cell lung cancer, a phase III trial of chemoradiotherapy alone and with surgical resection revealed no statistically significant difference in OS between the treatment arms. In advanced stage non-small cell lung cancer, a phase III trial compared gefitinib with carboplatin and paclitaxel in a clinically enriched patient population for epidermal growth factor receptor (EGFR) tyrosine kinase (TK) mutations; among patients with an EGFR TK mutation, patients in gefitinib arm compared with carboplatin and paclitaxel arm experienced a statistically significant superior response rate and progression-free survival, and among patients without EGFR TK mutation patients in the gefitinib arm compared with carboplatin and paclitaxel experienced a statistically significant inferior response rate and progression-free survival. A phase III trial of platinum-based therapy with and without cetuximab in the first-line setting revealed improved OS in the cetuximab arm. A phase III trial of maintenance pemetrexed compared with placebo in patients who had not progressed after initial platinum-based therapy revealed an improvement in OS of patients in the pemetrexed arm with nonsquamous histology. In limited-stage small cell lung cancer, a phase III trial compared standard and high-dose prophylactic cranial irradiation and revealed no significant difference in the rate of brain metastases between the two treatment arms.

Accuracy of the One-Stage and Two-Stage Impression Techniques: A Comparative Analysis

Directory of Open Access Journals (Sweden)

Ladan Jamshidy

2016-01-01

Full Text Available Introduction. One of the main steps of impression is the selection and preparation of an appropriate tray. Hence, the present study aimed to analyze and compare the accuracy of one- and two-stage impression techniques. Materials and Methods. A resin laboratory-made model, as the first molar, was prepared by standard method for full crowns with processed preparation finish line of 1 mm depth and convergence angle of 3-4°. Impression was made 20 times with one-stage technique and 20 times with two-stage technique using an appropriate tray. To measure the marginal gap, the distance between the restoration margin and preparation finish line of plaster dies was vertically determined in mid mesial, distal, buccal, and lingual (MDBL regions by a stereomicroscope using a standard method. Results. The results of independent test showed that the mean value of the marginal gap obtained by one-stage impression technique was higher than that of two-stage impression technique. Further, there was no significant difference between one- and two-stage impression techniques in mid buccal region, but a significant difference was reported between the two impression techniques in MDL regions and in general. Conclusion. The findings of the present study indicated higher accuracy for two-stage impression technique than for the one-stage impression technique.

Two-Stage Centrifugal Fan

Science.gov (United States)

Converse, David

2011-01-01

Fan designs are often constrained by envelope, rotational speed, weight, and power. Aerodynamic performance and motor electrical performance are heavily influenced by rotational speed. The fan used in this work is at a practical limit for rotational speed due to motor performance characteristics, and there is no more space available in the packaging for a larger fan. The pressure rise requirements keep growing. The way to ordinarily accommodate a higher DP is to spin faster or grow the fan rotor diameter. The invention is to put two radially oriented stages on a single disk. Flow enters the first stage from the center; energy is imparted to the flow in the first stage blades, the flow is redirected some amount opposite to the direction of rotation in the fixed stators, and more energy is imparted to the flow in the second- stage blades. Without increasing either rotational speed or disk diameter, it is believed that as much as 50 percent more DP can be achieved with this design than with an ordinary, single-stage centrifugal design. This invention is useful primarily for fans having relatively low flow rates with relatively high pressure rise requirements.

A 45 ps time digitizer with a two-phase clock and dual-edge two-stage interpolation in a field programmable gate array device

Science.gov (United States)

Szplet, R.; Kalisz, J.; Jachna, Z.

2009-02-01

We present a time digitizer having 45 ps resolution, integrated in a field programmable gate array (FPGA) device. The time interval measurement is based on the two-stage interpolation method. A dual-edge two-phase interpolator is driven by the on-chip synthesized 250 MHz clock with precise phase adjustment. An improved dual-edge double synchronizer was developed to control the main counter. The nonlinearity of the digitizer's transfer characteristic is identified and utilized by the dedicated hardware code processor for the on-the-fly correction of the output data. Application of presented ideas has resulted in the measurement uncertainty of the digitizer below 70 ps RMS over the time interval ranging from 0 to 1 s. The use of the two-stage interpolation and a fast FIFO memory has allowed us to obtain the maximum measurement rate of five million measurements per second.

A 45 ps time digitizer with a two-phase clock and dual-edge two-stage interpolation in a field programmable gate array device

International Nuclear Information System (INIS)

Szplet, R; Kalisz, J; Jachna, Z

2009-01-01

We present a time digitizer having 45 ps resolution, integrated in a field programmable gate array (FPGA) device. The time interval measurement is based on the two-stage interpolation method. A dual-edge two-phase interpolator is driven by the on-chip synthesized 250 MHz clock with precise phase adjustment. An improved dual-edge double synchronizer was developed to control the main counter. The nonlinearity of the digitizer's transfer characteristic is identified and utilized by the dedicated hardware code processor for the on-the-fly correction of the output data. Application of presented ideas has resulted in the measurement uncertainty of the digitizer below 70 ps RMS over the time interval ranging from 0 to 1 s. The use of the two-stage interpolation and a fast FIFO memory has allowed us to obtain the maximum measurement rate of five million measurements per second

Estimation of Human Arm Joints Using Two Wireless Sensors in Robotic Rehabilitation Tasks

Directory of Open Access Journals (Sweden)

Arturo Bertomeu-Motos

2015-12-01

Full Text Available This paper presents a novel kinematic reconstruction of the human arm chain with five degrees of freedom and the estimation of the shoulder location during rehabilitation therapy assisted by end-effector robotic devices. This algorithm is based on the pseudoinverse of the Jacobian through the acceleration of the upper arm, measured using an accelerometer, and the orientation of the shoulder, estimated with a magnetic angular rate and gravity (MARG device. The results show a high accuracy in terms of arm joints and shoulder movement with respect to the real arm measured through an optoelectronic system. Furthermore, the range of motion (ROM of 50 healthy subjects is studied from two different trials, one trying to avoid shoulder movements and the second one forcing them. Moreover, the shoulder movement in the second trial is also estimated accurately. Besides the fact that the posture of the patient can be corrected during the exercise, the therapist could use the presented algorithm as an objective assessment tool. In conclusion, the joints’ estimation enables a better adjustment of the therapy, taking into account the needs of the patient, and consequently, the arm motion improves faster.

Single versus double-row repair of the rotator cuff: does double-row repair with improved anatomical and biomechanical characteristics lead to better clinical outcome?

Science.gov (United States)

Pauly, Stephan; Gerhardt, Christian; Chen, Jianhai; Scheibel, Markus

2010-12-01

Several techniques for arthroscopic repair of rotator cuff defects have been introduced over the past years. Besides established techniques such as single-row repairs, new techniques such as double-row reconstructions have gained increasing interest. The present article therefore provides an overview of the currently available literature on both repair techniques with respect to several anatomical, biomechanical, clinical and structural endpoints. Systematic literature review of biomechanical, clinical and radiographic studies investigating or comparing single- and double-row techniques. These results were evaluated and compared to provide an overview on benefits and drawbacks of the respective repair type. Reconstructions of the tendon-to-bone unit for full-thickness tears in either single- or double-row technique differ with respect to several endpoints. Double-row repair techniques provide more anatomical reconstructions of the footprint and superior initial biomechanical characteristics when compared to single-row repair. With regard to clinical results, no significant differences were found while radiological data suggest a better structural tendon integrity following double-row fixation. Presently published clinical studies cannot emphasize a clearly superior technique at this time. Available biomechanical studies are in favour of double-row repair. Radiographic studies suggest a beneficial effect of double-row reconstruction on structural integrity of the reattached tendon or reduced recurrent defect rates, respectively.

A two-site, two-arm, 34-week, double-blind, parallel-group, randomized controlled trial of reduced nicotine cigarettes in smokers with mood and/or anxiety disorders: trial design and protocol

Directory of Open Access Journals (Sweden)

Sophia I. Allen

2017-01-01

Full Text Available Abstract Background The U.S. Food and Drug Administration can set standards for cigarettes that could include reducing their nicotine content. Such a standard should improve public health without causing unintended serious consequences for sub-populations. This study evaluates the effect of progressive nicotine reduction in cigarettes on smoking behavior, toxicant exposure, and psychiatric symptoms in smokers with comorbid mood and/or anxiety disorders using a two-site, two-arm, double-blind, parallel group, randomized controlled trial (RCT in four phases over 34 weeks. Methods Adult smokers (N = 200 of 5 or more cigarettes per day will be randomized across two sites (Penn State and Massachusetts General. Participants must have not had a quit attempt in the prior month, nor be planning to quit in the next 6 months, meet criteria for a current or lifetime unipolar mood and/or anxiety disorder based on the structured Mini-International Neuropsychiatric Interview, and must not have an unstable medical or psychiatric condition. After a week of smoking their own cigarettes, participants receive two weeks of Spectrum research cigarettes with usual nicotine content (11.6 mg. After this baseline period, participants will be randomly assigned to continue smoking Spectrum research cigarettes that contain either (a Usual Nicotine Content (11.6 mg; or (b Reduced Nicotine Content: the nicotine content per cigarette is progressively reduced from approximately 11.6 mg to 0.2 mg in five steps over 18 weeks. At the end of the randomization phase, participants will be offered the choice to either (a quit smoking with assistance, (b continue smoking free research cigarettes, or (c return to purchasing their own cigarettes, for the final 12 weeks of the study. The primary outcome measure is blood cotinine; key secondary outcomes are: exhaled carbon monoxide, urinary total NNAL- 4-(methylnitrosamino-1-(3-pyridyl-1-butanol and 1-hydroxypyrene, oxidative

Optimization of a Two Stage Pulse Tube Refrigerator for the Integrated Current Lead System

Science.gov (United States)

Maekawa, R.; Matsubara, Y.; Okada, A.; Takami, S.; Konno, M.; Tomioka, A.; Imayoshi, T.; Hayashi, H.; Mito, T.

2008-03-01

Implementation of a conventional current lead with a pulse tube refrigerator has been validated to be working as an Integrated Current Lead (ICL) system for the Superconducting Magnetic Energy Storage (SMES). Realization of the system is primarily accounted for the flexibility of a pulse tube refrigerator, which does not posses any mechanical piston and/or displacer. As for an ultimate version of the ICL system, a High Temperature Superconducting (HTS) lead links a superconducting coil with a conventional copper lead. To ensure the minimization of heat loads to the superconducting coil, a pulse tube refrigerator has been upgraded to have a second cooling stage. This arrangement reduces not only the heat loads to the superconducting coil but also the operating cost for a SMES system. A prototype two-stage pulse tube refrigerator, series connected arrangement, was designed and fabricated to satisfy the requirements for the ICL system. Operation of the first stage refrigerator is a four-valve mode, while the second stage utilizes a double inlet configuration to ensure its confined geometry. The paper discusses the optimization of second stage cooling to validate the conceptual design

Instrumented circumferential fusion for tuberculosis of the dorso-lumbar spine. A single or double stage procedure?

Science.gov (United States)

El-Sharkawi, Mohammad Mostafa; Said, Galal Zaki

2012-02-01

The purpose of this study was to present our experience in treating dorso-lumbar tuberculosis by one-stage posterior circumferential fusion and to compare this group with a historical group treated by anterior debridement followed by postero-lateral fusion and stabilization. Between 2003 and 2008, 32 patients with active spinal tuberculosis were treated by one-stage posterior circumferential fusion and prospectively followed for a minimum of two years. Pain severity was measured using Visual Analogue Scale (VAS). Neurological assessment was done using the Frankel scale. The operative data, clinical, radiological, and functional outcomes were also compared to a similar group of 25 patients treated with anterior debridement and fusion, followed 10-14 days later by posterior stabilization and postero-lateral fusion. The mean operative time and duration of hospital stay were significantly longer in the two-stage group. The mean estimated blood loss was also larger, though insignificantly, in the two-stage group. The incidence of complications was significantly lower in the one-stage group. At final follow-up, all 34 patients with pre-operative neurological deficits showed at least one Frankel grade of neurological improvement, all 57 patients showed significant improvement of their VAS back pain score, the mean kyphotic angle has significantly improved, all patients achieved solid fusion and 43 (75.4%) patients returned to their pre-disease activity level or work. Instrumented circumferential fusion, whether in one or two stages, is an effective treatment for dorso-lumbar tuberculosis. One-stage surgery, however, is advantageous because it has lower complication rate, shorter hospital stay, less operative time and blood loss.

Effect of Single and Double Stage Chemically Treated Kenaf Fibers on Mechanical Properties of Polyvinyl Alcohol Film

Directory of Open Access Journals (Sweden)

Md Ershad Ali

2014-12-01

Full Text Available The physico-mechanical properties of lignocellulosic kenaf fiber reinforced polyvinyl alcohol (PVA biocomposite films were investigated. To improve the properties of the biocomposite, kenaf fibers were chemically treated separately in a single stage (with Cr2(SO4312(H2O and double stages (with CrSO4 and NaHCO3 to improve the adhesion and compatibility between the kenaf fiber and PVA matrix. PVA was reinforced with various compositions of chemically treated kenaf fiber by using a solution casting technique. Microstructural analyses and mechanical tests were subsequently conducted. Scanning electron microscopic analysis indicated that chemical treatment improved the uniformity distribution of kenaf fiber within the PVA matrix. FTIR and XRD analyses confirmed the presence of chromium on the fiber surface. The tensile strength of PVA reinforced with chemical treated kenaf fiber was found to be higher than those reinforced with untreated kenaf. The Young’s modulus, flexural strength, and flexural modulus increased with fiber loading for both untreated and treated kenaf fiber reinforced PVA films. The double stage treated kenaf fiber showed better mechanical properties and lower moisture uptake than the single stage treated kenaf fiber.

Deep Arm/Ear-ECG Image Learning for Highly Wearable Biometric Human Identification.

Science.gov (United States)

Zhang, Qingxue; Zhou, Dian

2018-01-01

In this study, to advance smart health applications which have increasing security/privacy requirements, we propose a novel highly wearable ECG-based user identification system, empowered by both non-standard convenient ECG lead configurations and deep learning techniques. Specifically, to achieve a super wearability, we suggest situating all the ECG electrodes on the left upper-arm, or behind the ears, and successfully obtain weak but distinguishable ECG waveforms. Afterwards, to identify individuals from weak ECG, we further present a two-stage framework, including ECG imaging and deep feature learning/identification. In the former stage, the ECG heartbeats are projected to a 2D state space, to reveal heartbeats' trajectory behaviors and produce 2D images by a split-then-hit method. In the second stage, a convolutional neural network is introduced to automatically learn the intricate patterns directly from the ECG image representations without heavy feature engineering, and then perform user identification. Experimental results on two acquired datasets using our wearable prototype, show a promising identification rate of 98.4% (single-arm-ECG) and 91.1% (ear-ECG), respectively. To the best of our knowledge, it is the first study on the feasibility of using single-arm-ECG/ear-ECG for user identification purpose, which is expected to contribute to pervasive ECG-based user identification in smart health applications.

The spiral arms of the Milky Way: The relative location of each different arm tracer within a typical spiral arm width

Energy Technology Data Exchange (ETDEWEB)

Vallée, Jacques P., E-mail: jacques.vallee@nrc-cnrc.gc.ca [National Research Council Canada, National Science Infrastructure portfolio, Herzberg Astronomy and Astrophysics, 5071 West Saanich Road, Victoria, B.C., V9E 2E7 (Canada)

2014-07-01

From the Sun's location in the Galactic disk, different arm tracers (CO, H I, hot dust, etc.) have been employed to locate a tangent to each spiral arm. Using all various and different observed spiral arm tracers (as published elsewhere), we embark on a new goal, namely the statistical analysis of these published data (data mining) to statistically compute the mean location of each spiral arm tracer. We show for a typical arm cross-cut, a separation of 400 pc between the mid-arm and the dust lane (at the inner edge of the arm, toward the Galactic center). Are some arms major and others minor? Separating arms into two sets, as suggested by some, we find the same arm widths between the two sets. Our interpretation is that we live in a multiple (four-arm) spiral (logarithmic) pattern (around a pitch angle of 12°) for the stars and gas in the Milky Way, with a sizable interarm separation (around 3 kpc) at the Sun's location and the same arm width for each arm (near 400 pc from mid-arm to dust lane).

The spiral arms of the Milky Way: The relative location of each different arm tracer within a typical spiral arm width

International Nuclear Information System (INIS)

Vallée, Jacques P.

2014-01-01

From the Sun's location in the Galactic disk, different arm tracers (CO, H I, hot dust, etc.) have been employed to locate a tangent to each spiral arm. Using all various and different observed spiral arm tracers (as published elsewhere), we embark on a new goal, namely the statistical analysis of these published data (data mining) to statistically compute the mean location of each spiral arm tracer. We show for a typical arm cross-cut, a separation of 400 pc between the mid-arm and the dust lane (at the inner edge of the arm, toward the Galactic center). Are some arms major and others minor? Separating arms into two sets, as suggested by some, we find the same arm widths between the two sets. Our interpretation is that we live in a multiple (four-arm) spiral (logarithmic) pattern (around a pitch angle of 12°) for the stars and gas in the Milky Way, with a sizable interarm separation (around 3 kpc) at the Sun's location and the same arm width for each arm (near 400 pc from mid-arm to dust lane).

Analysis on correlation between overall classification on color doppler ultrasound and clinical stages of atherosclerosis obliterans

International Nuclear Information System (INIS)

Zhang Dongmei; Liu Meihan; Shi Weidong; Chen Enqi; Li Xinying; Lin Yu

2010-01-01

Objective: To investigate the correlation and the clinical significance between the overall classification on color Doppler ultrasound and the clinical stages of atherosclerosis obliterans (ASO), and evaluate the extent of arterial lesions comprehensively. Methods: 125 patients of ASO, who were divided into three groups of mild, moderate and severe with Color Doppler ultrasound according to differences of occlusion, quantity, degree of stenosis and collateral number, were analyzed with clinical stages, then their associations were studied with Spearman rank analysis. Results: The clinical manifestations of ASO patients who were divided into three groups of mild, moderate and severe according to overall classification on color Doppler ultrasound were respectively gradually serious, which had positive correlations with the stages of I, II and III according to clinical stages. Spearman rank analysis showed that the correlation coefficients (rs)was 0.797 2 between two groups (P<0.01), there was good consistency between the overall classification on color Doppler ultrasound and the clinical stagesof ASO. Conclusion: The overall classification of ASO on color Doppler ultrasound has considered impact of many other factors on the clinical symptoms,such as the level of the local narrow, narrow scope, segments of occlusion and collateral arteries, which divides the lesions more objectively, shows good consistency with the clinical stages. (authors)

Simple and double two-colour photoionization of rare gas atoms

International Nuclear Information System (INIS)

Guyetand, O.

2008-05-01

The present work deals with simple and double ionization of rare gases by harmonic radiation produced by, and combined with, an intense femtosecond infrared laser. Technical aspects related to the use of harmonic generation and to the detection of ions and electrons in coincidence are exposed. Theoretical background for two colour, few-photon, single and double ionization is detailed. Spectra and angular distributions of the photoelectrons measured in helium are described and compared with TDSE (time-dependent Schroedinger equation) theoretical calculations, for various conditions of the harmonic photons. The shape of the angular distributions can be explained within the frame of two distinct analytic approaches: the perturbation theory and the soft-photon approximation. The double ionization measurements have been performed on xenon, a complex atom characterized by many possible routes leading to double ionization. The analysis of energy and angular correlations of the two photoelectrons proves the feasibility of such experiments that combines harmonic and infrared radiations. It shows that two step processes are dominant in the case of xenon. This work appeals for extending few-photon, double ionization experiments to lighter rare gases. (author)

Evaluation of the 8th AJCC staging system for pathologically versus clinically staged pancreatic adenocarcinoma: A time to revisit a dogma?

Science.gov (United States)

Abdel-Rahman, Omar

2018-02-01

limited. There is clearly a need to have two staging systems for pancreatic adenocarcinoma: pathological and clinical staging systems. Copyright © 2018 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.

Early two-stage double opposing Z-plasty or one-stage push-back palatoplasty?: comparisons in maxillary development and speech outcome at 4 years of age.

Science.gov (United States)

Yamanishi, Tadashi; Nishio, Juntaro; Sako, Michiyo; Kohara, Hiroshi; Hirano, Yoshiko; Yamanishi, Yukiko; Adachi, Tadafumi; Miya, Shigenori; Mukai, Takao

2011-02-01

Determining the optimal timing and procedure of palatal surgery for children with cleft lip and palate has long raised a major controversy. An early two-stage palatoplasty protocol has been a recent trend in an attempt to obtain preferable maxillary growth without compromising adequate speech development. In this study, we aim to address whether the resulting maxillofacial growth and speech development obtained by an early 2-stage palatoplasty protocol are better than those obtained by conventional 1-stage push-back palatoplasty. Seventy-two nonsyndromic children with complete unilateral cleft lip and palate were enrolled in this study. They were divided into 2 groups: 30 children, who were treated with early 2-stage palatoplasty, in which soft palate closure was performed using a modified Furlow's procedure at 12 months of age and hard palate closure was performed at 18 months of age (Early Tow Stage [ETS] group: 22 boys, 8 girls), and 42 children, who underwent 1-stage Wardill-Kilner push-back palatoplasty at 12 months of age (Push Back [PB] group: 31 boys, 11 girls). Cephalometric analysis for maxillofacial growth and assessments of speech development were performed for each child at 4 years of age. The ETS group showed a lager maxillary length than the PB group [anterior nasal spine (ANS)-ptm': ETS, 46.7 ± 2.0 mm; PB, 43.6 ± 2.3 mm]. The ANS in the ETS group was positioned more anteriorly than that in the PB group (N'-ANS: ETS, 2.5 ± 1.8 mm; PB, 0.26 ± 2.5 mm), whereas the posterior edge of the maxilla positioned anteroposteiorly was comparable between the 2 groups. The anterior facial height was significantly greater in the ETS group than in the PB group (N-N': ETS, 43.3 ± 2.9 mm; PB, 40.1 ± 2.3 mm, S-S': ETS, 29.7 ± 3.2 mm; PB, 31.0 ± 3.2 mm). No statistically significant differences were observed in the incidence of either velopharyngeal incompetence or articulation errors between the 2 groups at 4 years of age. Our results show that the early 2

Using ARM Measurements to Understand and Reduce the Double ITCZ Biases in the Community Atmospheric Model

Energy Technology Data Exchange (ETDEWEB)

Zhang, Minghua [Stony Brook Univ., NY (United States)

2016-12-08

that features a spurious double Inter-tropical Convergence Zone (ITCZ) in most models. This work is recently published in Yu et al. (2016). Interannual variation of ITCZ south of the eastern equatorial Pacific: By analyzing data from satellites, field measurements and atmospheric reanalysis, we have characterized the interannual variation of boreal spring precipitation in the eastern tropical Pacific and found the cause of the observed interannual variability. We have shown that ITCZ in this region can occur as a single ITCZ along the Equator, single ITCZ north of the Equator, single ITCZ south of the Equator, and double ITCZ on both sides of the Equator. We have found that convective instability only plays a secondary role in the ITCZ interannual variability. Instead, the remote impact of the Pacific basin-wide SST on the horizontal gradient of surface pressure and wind convergence is the primary driver of this interannual variability. Results point to the need to include moisture convergence in convection schemes to improve the simulation of precipitation in the eastern tropical Pacific. This result has been recently submitted for publication (Yu and Zhang 2016). 2. Improvement of model parameterizations to reduce the double ITCZ bias We analyzed the current status of climate model performance in simulating precipitation in the equatorial Pacific. We have found that the double ITCZ bias has not been reduced in CMIP5 models relative to CMIP4 models. We have characterized the dynamic structure of the common bias by using precipitation, sea surface temperature, surface winds and sea-level. Results are published in Zhang et al. (2015): Since cumulus convection plays a significant role in the double ITCZ behavior in models, we have used measurements from ARM and other sources to carry out a systematic analysis of the roles of shallow and deep convection in the CAM. We found that in both CAM4 and CAM5, when the intensity of deep convection decreases as a result of

[Clinical application of three-dimensional O-arm navigation system in treating patients with dystrophic scoliosis secondary to neurofibromatosis type Ⅰ].

Science.gov (United States)

Liu, Z; Qiu, Y; Li, Y; Zhao, Z H; Wang, B; Zhu, F; Yu, Y; Sun, X; Zhu, Z Z

2017-03-01

Objective: To investigate the clinical outcomes and the accuracy of O-arm-navigation system assisted pedicle screw insertion in dystrophic scoliosis secondary to neurofibromatosis type Ⅰ(NF-1). Methods: A retrospective study was conducted in 41 patients with dystrophic NF-1-associated thoracic scoliosis who were surgically treated at Department of Orthopaedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School between June 2012 and October 2014 with more than 18 months follow-up. The patients were then divided into two groups: 18 patients were under the assistance of O-arm-navigation-based pedicle screw insertion (O-arm group) and the remaining 23 patients' pedicle screws insertion were conducted by free-hand (free-hand group). The X-ray and CT were analyzed to investigate the correction rate and safety of pedicle insertion. t -test was used to analyze measurement data and χ(2) test was used to analyze accuracy of screw insertion between the two groups. Results: The mean coronal Cobb angle was 63.2°±8.7° in the O-arm group and 66.9°±7.4° in the free-hand group ( P >0.05), which was then corrected into 23.1°±6.8° and 30.2°±7.6°( t =2.231, P =0.031) after surgery respectively.Operation time was (265.0±70.3)minutes and estimated blood loss was (1 024±465)ml in the O-arm group. Operation time and estimated blood loss was (243.0±49.6)minutes and (1 228±521)ml respectively in the free-hand group, which had no significant difference between the two groups. However, the implant density was higher in the O-arm group than that in the free-hand group ((64.1±10.8)% vs .(44.3±15.3)%)( t =4.652, P =0.000). The O-arm group comprised 122 screws, of which 72.9% were excellent, 22.1% were good and 4.9% were bad. The free-hand group comprised 136 screws and 48.5% of them were excellent, 33.8% were good and 17.6% were bad.Accuracy of pedicle screw insertion was higher in the O-arm group than that in the free-hand group(χ(2

Development program of two-arm bilateral servomanipulator system for nuclear fuel cycle facilities in PNC

International Nuclear Information System (INIS)

Kashihara, H.; Igarashi, M.; Maeda, M.; Nomizu, T.; Uematsu, K.

1984-01-01

PNC started the development program of a two-arm bilateral servomanipulator to improve remote maintenance in the planning of pilot plants for HLLW vitrification and FBR fuel reprocessing. In this paper, the development program of two-arm bilateral servomanipulators, signal and power transmissions, high performance viewing system, man-machine interface, and transporter system for manipulators will be presented. Also radiation tests for all components used in a hot cell are being performed to aid remote system design

Technology-supported training of arm-hand skills in stroke

NARCIS (Netherlands)

Timmermans, A.A.A.

2010-01-01

Impaired arm-hand performance is a serious consequence of stroke that is associated with reduced self-efficacy and poor quality of life. Task-oriented arm training is a therapy approach that is known to improve skilled arm-hand performance, even in chronic stages after stroke. At the start of this

NxStage dialysis system-associated thrombocytopenia: a report of two cases.

Science.gov (United States)

Sekkarie, Mohamed; Waldron, Michelle; Reynolds, Texas

2016-01-01

Thrombocytopenia in hemodialysis patients has recently been reported to be commonly caused by electron-beam sterilization of dialysis filters. We report the occurrence of thrombocytopenia in the first two patients of a newly established home hemodialysis program. The 2 patients switched from conventional hemodialysis using polysulfone electron-beam sterilized dialyzers to a NxStage system, which uses gamma sterilized polyehersulfone dialyzers incorporated into a drop-in cartridge. The thrombocytopenia resolved after return to conventional dialysis in both patients and recurred upon rechallenge in the patient who opted to retry NxStage. This is the first report of thrombocytopenia with the NxStage system according to the authors’ knowledge. Dialysis-associated thrombocytopenia pathophysiology and clinical significance are not well understood and warrant additional investigations.

The Clinical Usefulness of Simultaneous Placement of Double Endoscopic Nasobiliary Biliary Drainage

Directory of Open Access Journals (Sweden)

Hong Jun Kim

2015-11-01

Full Text Available Background/Aims: To evaluate the technical feasibility and clinical efficacy of double endoscopic nasobiliary drainage (ENBD as a new method of draining multiple bile duct obstructions. Methods: A total of 38 patients who underwent double ENBD between January 2004 and February 2010 at the Asan Medical Center were retrospectively analyzed. We evaluated indications, laboratory results, and the clinical course. Results: Of the 38 patients who underwent double ENBD, 20 (52.6% had Klatskin tumors, 12 (31.6% had hepatocellular carcinoma, 3 (7.9% had strictures at the anastomotic site following liver transplantation, and 3 (7.9% had acute cholecystitis combined with cholangitis. Double ENBD was performed to relieve multiple biliary obstruction in 21 patients (55.1%, drain contrast agent filled during endoscopic retrograde cholangiopancreatography in 4 (10.5%, obtain cholangiography in 4 (10.5%, drain hemobilia in 3 (7.9%, relieve Mirizzi syndrome with cholangitis in 3 (7.9%, and relieve jaundice in 3 (7.9%. Conclusions: Double ENBD may be useful in patients with multiple biliary obstructions.

Unequal-Arms Michelson Interferometers

Science.gov (United States)

Tinto, Massimo; Armstrong, J. W.

2000-01-01

Michelson interferometers allow phase measurements many orders of magnitude below the phase stability of the laser light injected into their two almost equal-length arms. If, however, the two arms are unequal, the laser fluctuations can not be removed by simply recombining the two beams. This is because the laser jitters experience different time delays in the two arms, and therefore can not cancel at the photo detector. We present here a method for achieving exact laser noise cancellation, even in an unequal-arm interferometer. The method presented in this paper requires a separate readout of the relative phase in each arm, made by interfering the returning beam in each arm with a fraction of the outgoing beam. By linearly combining the two data sets with themselves, after they have been properly time shifted, we show that it is possible to construct a new data set that is free of laser fluctuations. An application of this technique to future planned space-based laser interferometer detector3 of gravitational radiation is discussed.

Effect of standard cuff on blood pressure readings in patients with obese arms. How frequent are arms of a 'large circumference'?

Science.gov (United States)

Fonseca-Reyes, Salvador; de Alba-García, Javier García; Parra-Carrillo, José Z; Paczka-Zapata, José Antonio

2003-06-01

To measure the effect on blood pressure readings when a standard cuff is used on patients with arms of a large circumference, and to determine the frequency of arms of a large circumference. Blood pressures were taken in 120 subjects with an arm circumference greater than 33 cm. Also, the arm circumference was determined in 244 patients from a family health unit, and in 216 patients from a hypertension clinic. A mercury sphygmomanometer and two different cuff sizes were used in a random sequence; therefore, 60 patients' blood pressure were first measured with a large cuff, followed by a standard cuff; the opposite sequence was then applied for another 60 patients. With the obtained values and using a regression analysis, the difference in blood pressure overestimation was calculated. Arm circumference measurement percentages were used to determine the frequency of arms of a large circumference. Both systolic and diastolic blood pressures were significantly greater when the standard cuff was used. For every 5 cm increase in arm circumference, starting at 35 cm, a 2-5 mmHg increase in systolic blood pressure, and a 1-3 mmHg increase in diastolic blood pressure was observed. The prevalence of arms with a large circumference in the family medicine unit and hypertension clinic was 42% and 41.8%, respectively. There is an overestimation of blood pressure when a standard cuff is used in obese subjects. The high prevalence of these individuals in our environment, both in the hypertensive and normotensive population, makes it necessary to have on hand different sizes of cuffs for taking blood pressure in order to avoid incorrect decisions.

Chronic infections in hip arthroplasties: comparing risk of reinfection following one-stage and two-stage revision: a systematic review and meta-analysis

Directory of Open Access Journals (Sweden)

Lange J

2012-03-01

Full Text Available Jeppe Lange1,2, Anders Troelsen3, Reimar W Thomsen4, Kjeld Søballe1,51Lundbeck Foundation Centre for Fast-Track Hip and Knee Surgery, Aarhus C, 2Center for Planned Surgery, Silkeborg Regional Hospital, Silkeborg, 3Department of Orthopaedics, Hvidovre Hospital, Hvidovre, 4Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg, 5Department of Orthopaedics, Aarhus University Hospital, Aarhus C, DenmarkBackground: Two-stage revision is regarded by many as the best treatment of chronic infection in hip arthroplasties. Some international reports, however, have advocated one-stage revision. No systematic review or meta-analysis has ever compared the risk of reinfection following one-stage and two-stage revisions for chronic infection in hip arthroplasties.Methods: The review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Relevant studies were identified using PubMed and Embase. We assessed studies that included patients with a chronic infection of a hip arthroplasty treated with either one-stage or two-stage revision and with available data on occurrence of reinfections. We performed a meta-analysis estimating absolute risk of reinfection using a random-effects model.Results: We identified 36 studies eligible for inclusion. None were randomized controlled trials or comparative studies. The patients in these studies had received either one-stage revision (n = 375 or two-stage revision (n = 929. Reinfection occurred with an estimated absolute risk of 13.1% (95% confidence interval: 10.0%–17.1% in the one-stage cohort and 10.4% (95% confidence interval: 8.5%–12.7% in the two-stage cohort. The methodological quality of most included studies was considered low, with insufficient data to evaluate confounding factors.Conclusions: Our results may indicate three additional reinfections per 100 reimplanted patients when performing a one-stage versus two-stage revision. However, the

Nuclear Structure Calculations for Two-Neutrino Double-β Decay

Directory of Open Access Journals (Sweden)

P. Sarriguren

2016-01-01

Full Text Available We study the two-neutrino double-β decay in 76Ge, 116Cd, 128Te, 130Te, and 150Nd, as well as the two Gamow-Teller branches that connect the double-β decay partners with the states in the intermediate nuclei. We use a theoretical microscopic approach based on a deformed self-consistent mean field with Skyrme interactions including pairing and spin-isospin residual forces, which are treated in a proton-neutron quasiparticle random-phase approximation. We compare our results for Gamow-Teller strength distributions with experimental information obtained from charge-exchange reactions. We also compare our results for the two-neutrino double-β decay nuclear matrix elements with those extracted from the measured half-lives. Both single-state and low-lying-state dominance hypotheses are analyzed theoretically and experimentally making use of recent data from charge-exchange reactions and β decay of the intermediate nuclei.

Stability analysis of a high-step-Up DC grid-connected two-stage boost DC-DC converter

Directory of Open Access Journals (Sweden)

El Aroudi A.

2014-01-01

Full Text Available High conversion ratio switching converters are used whenever there is a need to step-up dc source voltage level to a much higher output dc voltage level such as in photovoltaic systems, telecommunications and in some medical applications. A simple solution for achieving this high conversion ratio is by cascading different stages of dc-dc boost converters. The individual converters in such a cascaded system are usually designed separately applying classical design criteria. However these criteria may not be applicable for the complete cascaded system . This paper first presents a glimpse on the bifurcation behavior that a cascade connection of two boost converters can exhibit. It is shown that the desired periodic orbit can undergo period doubling leading to subharmonic oscillations and chaotic regimes. Then, in order to simplify the analysis the second stage is considered as constant current sink and design-oriented analysis is carried out to obtain stability boundaries in the parameter space by taking into account slope interactions between the state variables in the two-different stages.

One-stage exchange with antibacterial hydrogel coated implants provides similar results to two-stage revision, without the coating, for the treatment of peri-prosthetic infection.

Science.gov (United States)

Capuano, Nicola; Logoluso, Nicola; Gallazzi, Enrico; Drago, Lorenzo; Romanò, Carlo Luca

2018-03-16

Aim of this study was to verify the hypothesis that a one-stage exchange procedure, performed with an antibiotic-loaded, fast-resorbable hydrogel coating, provides similar infection recurrence rate than a two-stage procedure without the coating, in patients affected by peri-prosthetic joint infection (PJI). In this two-center case-control, study, 22 patients, treated with a one-stage procedure, using implants coated with an antibiotic-loaded hydrogel [defensive antibacterial coating (DAC)], were compared with 22 retrospective matched controls, treated with a two-stage revision procedure, without the coating. At a mean follow-up of 29.3 ± 5.0 months, two patients (9.1%) in the DAC group showed an infection recurrence, compared to three patients (13.6%) in the two-stage group. Clinical scores were similar between groups, while average hospital stay and antibiotic treatment duration were significantly reduced after one-stage, compared to two-stage (18.9 ± 2.9 versus 35.8 ± 3.4 and 23.5 ± 3.3 versus 53.7 ± 5.6 days, respectively). Although in a relatively limited series of patients, our data shows similar infection recurrence rate after one-stage exchange with DAC-coated implants, compared to two-stage revision without coating, with reduced overall hospitalization time and antibiotic treatment duration. These findings warrant further studies in the possible applications of antibacterial coating technologies to treat implant-related infections. III.

Two-stage free electron laser research

Science.gov (United States)

Segall, S. B.

1984-10-01

KMS Fusion, Inc. began studying the feasibility of two-stage free electron lasers for the Office of Naval Research in June, 1980. At that time, the two-stage FEL was only a concept that had been proposed by Luis Elias. The range of parameters over which such a laser could be successfully operated, attainable power output, and constraints on laser operation were not known. The primary reason for supporting this research at that time was that it had the potential for producing short-wavelength radiation using a relatively low voltage electron beam. One advantage of a low-voltage two-stage FEL would be that shielding requirements would be greatly reduced compared with single-stage short-wavelength FEL's. If the electron energy were kept below about 10 MeV, X-rays, generated by electrons striking the beam line wall, would not excite neutron resonance in atomic nuclei. These resonances cause the emission of neutrons with subsequent induced radioactivity. Therefore, above about 10 MeV, a meter or more of concrete shielding is required for the system, whereas below 10 MeV, a few millimeters of lead would be adequate.

A comparison of entrance skin dose delivered by clinical angiographic c-arms using the real-time dosimeter: the MOSkin

International Nuclear Information System (INIS)

Thorpe, Nathan K.; Cutajar, Dean; Lian, Cheryl; Rosenfeld, Anatoly; Pitney, Mark; Friedman, Daniel; Perevertaylo, Vladimir

2016-01-01

Coronary angiography is a procedure used in the diagnosis and intervention of coronary heart disease. The procedure is often considered one of the highest dose diagnostic procedures in clinical use. Despite this, there is minimal use of dosimeters within angiographic catheterisation laboratories due to challenges resulting from their implementation. The aim of this study was to compare entrance dose delivery across locally commissioned c-arms to assess the need for real-time dosimetry solutions during angiographic procedures. The secondary aim of this study was to establish a calibration method for the MOSkin dosimeter that accurately produces entrance dose values from the clinically sampled beam qualities and energies. The MOSkin is a real-time dosimeter used to measure the skin dose delivered by external radiation beams. The suitability of the MOSkin for measurements in the angiographic catheterisation laboratory was assessed. Measurements were performed using a 30 × 30 × 30cm 3 PMMA phantom positioned at the rotational isocenter of the c-arm gantry. The MOSkin calibration factor was established through comparison of the MOSkin response to EBT2 film response. Irradiation of the dosimeters was performed using several clinical beam qualities ranging in energy from 70 to 105 kVp. A total of four different interventional c-arm machines were surveyed and compared using the MOSkin dosimeter. The phantom was irradiated from a normal angle of incidence using clinically relevant protocols, field sizes and source to image detector distance values. The MOSkin was observed to be radiotranslucent to the c-arm beam in all clinical environments. The MOSkin response was reproducible to within 2 % of the average value across repeated measurements for each beam setting. There were large variations in entrance dose delivery to the phantom between the different c-arm machines with the highest observed cine-acquisition entrance dose rate measuring 326 % higher than the lowest

A Broadly Adaptive Array of Dose-Constraint Templates for Planning of Intensity-Modulated Radiation Therapy for Advanced T-Stage Nasopharyngeal Carcinoma

International Nuclear Information System (INIS)

Chau, R.M.-C.; Leung, S.-F.; Kam, M.K.-M.; Cheung, K.-Y.; Kwan, W.-H.; Yu, K.-H.; Chiu, K.-W.; Cheung, M.L.-M.; Chan, A.T.-C.

2009-01-01

Purpose: To develop and validate adaptive dose-constraint templates in intensity-modulated radiotherapy (IMRT) planning for advanced T-stage nasopharyngeal carcinoma (NPC). Method and Materials: Dose-volume histograms of clinically approved plans for 20 patients with advanced T-stage NPC were analyzed, and the pattern of distribution in relation to the degree of overlap between targets and organs at risk (OARs) was explored. An adaptive dose constraint template (ADCT) was developed based on the degree of overlap. Another set of 10 patients with advanced T-stage NPC was selected for validation. Results of the manual arm optimization protocol and the ADCT optimization protocol were compared with respect to dose optimization time, conformity indices, multiple-dose end points, tumor control probability, and normal tissue complication probability. Results: For the ADCT protocol, average time required to achieve an acceptable plan was 9 minutes, with one optimization compared with 94 minutes with more than two optimizations of the manual arm protocol. Target coverage was similar between the manual arm and ADCT plans. A more desirable dose distribution in the region of overlap between planning target volume and OARs was achieved in the ADCT plan. Dose end points of OARs were similar between the manual arm and ADCT plans. Conclusions: With the developed ADCT, IMRT treatment planning becomes more efficient and less dependent on the planner's experience on dose optimization. The developed ADCT is applicable to a wide range of advanced T-stage NPC treatment and has the potential to be applied in a broader context to IMRT planning for other cancer sites

A stage is a stage is a stage: a direct comparison of two scoring systems.

Science.gov (United States)

Dawson, Theo L

2003-09-01

L. Kohlberg (1969) argued that his moral stages captured a developmental sequence specific to the moral domain. To explore that contention, the author compared stage assignments obtained with the Standard Issue Scoring System (A. Colby & L. Kohlberg, 1987a, 1987b) and those obtained with a generalized content-independent stage-scoring system called the Hierarchical Complexity Scoring System (T. L. Dawson, 2002a), on 637 moral judgment interviews (participants' ages ranged from 5 to 86 years). The correlation between stage scores produced with the 2 systems was .88. Although standard issue scoring and hierarchical complexity scoring often awarded different scores up to Kohlberg's Moral Stage 2/3, from his Moral Stage 3 onward, scores awarded with the two systems predominantly agreed. The author explores the implications for developmental research.

Isometric arm strength and subjective rating of upper limb fatigue in two-handed carrying tasks.

Science.gov (United States)

Li, Kai Way; Chiu, Wen-Sheng

2015-01-01

Sustained carrying could result in muscular fatigue of the upper limb. Ten male and ten female subjects were recruited for measurements of isometric arm strength before and during carrying a load for a period of 4 minutes. Two levels of load of carrying were tested for each of the male and female subjects. Exponential function based predictive equations for the isometric arm strength were established. The mean absolute deviations of these models in predicting the isometric arm strength were in the range of 3.24 to 17.34 N. Regression analyses between the subjective ratings of upper limb fatigue and force change index (FCI) for the carrying were also performed. The results indicated that the subjective rating of muscular fatigue may be estimated by multiplying the FCI with a constant. The FCI may, therefore, be adopted as an index to assess muscular fatigue for two-handed carrying tasks.

The inter-arm diastolic blood pressure difference induced by one arm ischemia: a new approach to assess vascular endothelia function.

Science.gov (United States)

Hu, Weitong; Li, Juxiang; Su, Hai; Wang, Jiwei; Xu, Jinsong; Liu, Yanna; Huang, Ming; Cheng, Xiaoshu

2014-01-01

To evaluate whether inter-arm diastolic blood pressure difference (DBPl-r) induced by one arm ischemia correlates with flow-mediated dilatation (FMD). Bilateral arm BPs were simultaneously measured with two automatic devices and right brachial artery diameter (D) was measured by ultrasound technique in 108 subjects (56 hypertensives and 52 normotensives). Following baseline diameter (D0) and BP measurement, right brachial artery was occluded for 5 minutes. The diameter was measured at 1, 1.5 and 2 min, and bilateral BPs measured at 3, 4 and 5 min after occlusion release. Their averages were recorded as post-D and post-BP, respectively. The difference between post-D and D0 (ΔD) was calculated as the percentage increase of artery diameter (ΔD/D0). The BP difference between left and right arms was calculated as BPl-r, and the difference of post- BPl-r and baseline BPl-r was recorded as the net change of BPl-r (ΔBPl-r). At baseline, bilateral SBPs and DBPs were similar. Right arm ischemia induced significant DBP decline only in the right arm (68.8±12.7 vs 72.6±12.0 mmHg, Parm DBP difference induced by one arm ischemia may be a potential index for clinical evaluation of vascular endothelial function.

Two-stage thermal/nonthermal waste treatment process

International Nuclear Information System (INIS)

Rosocha, L.A.; Anderson, G.K.; Coogan, J.J.; Kang, M.; Tennant, R.A.; Wantuck, P.J.

1993-01-01

An innovative waste treatment technology is being developed in Los Alamos to address the destruction of hazardous organic wastes. The technology described in this report uses two stages: a packed bed reactor (PBR) in the first stage to volatilize and/or combust liquid organics and a silent discharge plasma (SDP) reactor to remove entrained hazardous compounds in the off-gas to even lower levels. We have constructed pre-pilot-scale PBR-SDP apparatus and tested the two stages separately and in combined modes. These tests are described in the report

Concise Arm and Hand Rehabilitation Approach in Stroke (CARAS: A practical and evidence-based framework for clinical rehabilitation management

Directory of Open Access Journals (Sweden)

Johan A. Franck

2015-10-01

Full Text Available The volume of information on new treatment techniques supporting the restoration of arm-hand function (AHF and arm-hand skill performance (ASHP in stroke survivors overwhelms therapists in everyday clinical practice when choosing the appropriate therapy. The Concise Arm and Hand Rehabilitation Approach in Stroke (CARAS is designed for paramedical staff to structure and implement training of AHF and AHSP in stroke survivors. The CARAS is based on four constructs: (a stratification according to the severity of arm–hand impairment (using the Utrecht Arm/Hand -Test [UAT], (b the individual’s rehabilitation goals and concomitant potential rehabilitation outcomes, (c principles of self-efficacy, and (d possibilities to systematically incorporate (new technology and new evidence-based training elements swiftly. The framework encompasses three programs aimed at treating either the severely (UAT 0-1, moderately (UAT 2-3, or mildly (UAT 4-7 impaired arm-hand. Program themes are: taking care of the limb and prevention of complications (Program 1, task-oriented gross motor grip performance (Program 2, and functional AHSP training (Program 3. Each program is preceded and followed by an assessment. Training modularity facilitates rapid interchange/adaptation of sub-elements. Proof-of-principle in clinical rehabilitation has been established. The CARAS facilitates rapid structured design and provision of state-of-the-art AHF and ASHP treatment in stroke patients.

Arm reduced robotic-assisted laparoscopic hysterectomy with transvaginal cuff closure.

Science.gov (United States)

Bodur, Serkan; Dede, Murat; Fidan, Ulas; Firatligil, Burcin F; Ulubay, Mustafa; Ozturk, Mustafa; Yenen, Mufit C

2017-09-01

The use of robotics for benign etiology in gynecology has not proven to be more beneficial when compared to traditional laparoscopy. The major concern regarding robotic hysterectomy stems from its high cost. To evaluate the clinical utility and effectiveness of one-arm reduced robotic-assisted laparoscopic hysterectomy as a cost-effective surgical option for total robotic hysterectomy. A sample population of 54 women who underwent robotic-assisted laparoscopic surgery for benign gynecologic indications was evaluated, and two groups were identified: (1) the two-armed robotic-assisted laparoscopic surgery group (n = 38 patients), and (2) the three-armed robotic-assisted laparoscopic surgery group (n = 16 patients). An increased cost was observed when three-armed robotic surgery was employed for benign gynecologic surgery (p < 0.001). The cost reduction observed in the study group was primarily derived from one robotic arm reduction and vaginal closure of the cuff. This cost reduction was achieved without an increase in complication rates or undesirable postoperative outcomes. An estimated profit between $399.5 and $421.5 was made for each patient depending on the suture material chosen for cuff closure. Two-armed surgery resulted in an 18.6% reduction in procedure-specific costs for robotic hysterectomy. Two-armed robotic-assisted laparoscopic hysterectomy appears to be a cost-effective solution for robotic gynecologic surgery. This surgical solution can be performed as effectively as classical three-armed robotic hysterectomies for benign indications without the risk of increased surgical-related morbidities. This approach has the potential to be a widely preferred surgical approach in medical communities where cost reduction is one of the primary determinants of surgery type.

Comparison of Oone-Stage Free Gracilis Muscle Flap With Two-Stage Method in Chronic Facial Palsy

Directory of Open Access Journals (Sweden)

J Ghaffari

2007-08-01

Full Text Available Background:Rehabilitation of facial paralysis is one of the greatest challenges faced by reconstructive surgeons today. The traditional method for treatment of patients with facial palsy is the two-stage free gracilis flap which has a long latency period of between the two stages of surgery.Methods: In this paper, we prospectively compared the results of the one-stage gracilis flap method with the two -stage technique.Results:Out of 41 patients with facial palsy refered to Hazrat-e-Fatemeh Hospital 31 were selected from whom 22 underwent two- stage and 9 one-stage method treatment. The two groups were identical according to age,sex,intensity of illness, duration, and chronicity of illness. Mean duration of follow up was 37 months. There was no significant relation between the two groups regarding the symmetry of face in repose, smiling, whistling and nasolabial folds. Frequency of complications was equal in both groups. The postoperative surgeons and patients' satisfaction were equal in both groups. There was no significant difference between the mean excursion of muscle flap in one-stage (9.8 mm and two-stage groups (8.9 mm. The ratio of contraction of the affected side compared to the normal side was similar in both groups. The mean time of the initial contraction of the muscle flap in the one-stage group (5.5 months had a significant difference (P=0.001 with the two-stage one (6.5 months.The study revealed a highly significant difference (P=0.0001 between the mean waiting period from the first operation to the beginning of muscle contraction in one-stage(5.5 monthsand two-stage groups(17.1 months.Conclusion:It seems that the results and complication of the two methods are the same,but the one-stage method requires less time for facial reanimation,and is costeffective because it saves time and decreases hospitalization costs.

Design and Analysis of a Split Deswirl Vane in a Two-Stage Refrigeration Centrifugal Compressor

Directory of Open Access Journals (Sweden)

Jeng-Min Huang

2014-09-01

Full Text Available This study numerically investigated the influence of using the second row of a double-row deswirl vane as the inlet guide vane of the second stage on the performance of the first stage in a two-stage refrigeration centrifugal compressor. The working fluid was R134a, and the turbulence model was the Spalart-Allmaras model. The parameters discussed included the cutting position of the deswirl vane, the staggered angle of two rows of vane, and the rotation angle of the second row. The results showed that the performance of staggered angle 7.5° was better than that of 15° or 22.5°. When the staggered angle was 7.5°, the performance of cutting at 1/3 and 1/2 of the original deswirl vane length was slightly different from that of the original vane but obviously better than that of cutting at 2/3. When the staggered angle was 15°, the cutting position influenced the performance slightly. At a low flow rate prone to surge, when the second row at a staggered angle 7.5° cutting at the half of vane rotated 10°, the efficiency was reduced by only about 0.6%, and 10% of the swirl remained as the preswirl of the second stage, which is generally better than other designs.

Oxygen-enhanced MRI vs. quantitatively assessed thin-section CT: Pulmonary functional loss assessment and clinical stage classification of asthmatics

International Nuclear Information System (INIS)

Ohno, Yoshiharu; Koyama, Hisanobu; Matsumoto, Keiko; Onishi, Yumiko; Nogami, Munenobu; Takenaka, Daisuke; Matsumoto, Sumiaki; Sugimura, Kazuro

2011-01-01

Purpose: The purpose of this study was to prospectively compare the efficacy of oxygen-enhanced MR imaging (O 2 -enhanced MRI) and CT for pulmonary functional loss assessment and clinical stage classification of asthmatics. Materials and methods: O 2 -enhanced MRI, CT and %FEV 1 measurement were used 34 consecutive asthmatics classified into four stages ('Mild Intermittent [n = 7]', 'Mild Persistent [n = 8], 'Moderate Persistent [n = 14]' and 'Severe Persistent [n = 5]'). Relative enhancement ratio maps for every subject were generated, and determine mean relative enhancement ratios (MRERs). Mean lung density (MLD) and the airway wall area (WA) corrected by body surface area (WA/BSA) were also measured on CT. To compare the efficacy of the two methods for pulmonary functional loss assessment, all indexes were correlated with %FEV 1 . To determine the efficacy of the two methods for clinical stage classification, all parameters for the four clinical stages were statistically compared. Results: %FEV 1 showed fair or moderate correlation with all parameters (0.15 ≤ r 2 ≤ 0.30, p 2 -enhanced MRI is as effective as CT for pulmonary functional loss assessment and clinical stage classification of asthmatics.

Double-blind, placebo-controlled, randomized study of chlorhexidine prophylaxis for 5-fluorouracil-based chemotherapy-induced oral mucositis with nonblinded randomized comparison to oral cooling (cryotherapy) in gastrointestinal malignancies.

Science.gov (United States)

Sorensen, Jens Benn; Skovsgaard, Torben; Bork, Ellen; Damstrup, Lars; Ingeberg, Sten

2008-04-01

The purpose was to evaluate prevention of oral mucositis (OM) using chlorhexidine compared with placebo and with oral cooling (cryotherapy) during fluorouracil (5-FU)-based chemotherapy in gastrointestinal (GI) cancer. Patients with previously untreated GI cancer receiving bolus 5-FU/leucovorin chemotherapy were randomized to chlorhexidine mouthrinse 3 times a day for 3 weeks (Arm A), double-blind placebo (normal saline) with the same dose and frequency (Arm B), or cryotherapy with crushed ice 45 minutes during chemotherapy (Arm C). Patients self-reported on severity (CTC-grading) and duration of OM. Among 225 patients randomized, 206 answered the questionnaire (70, 64, and 63 patients in Arms A, B, and C, respectively) and were well balanced with respect to diagnoses, stage, age, sex, smoking habits, and performance status. Mucositis grade 3-4 occurred more frequently in Arm B (33%) than in A (13%, Pcryotherapy. The latter is easy and inexpensive but has limited use, as it is drug- and schedule-dependent. The current study is the first double-blind randomized evaluation of prophylactic chlorhexidine in a large adult patient population with solid tumors receiving highly OM-inducing chemotherapy. A role for chlorhexidine in the prevention of OM is suggested, which should be evaluated further.

PSA doubling time of prostate carcinoma managed with watchful observation alone

International Nuclear Information System (INIS)

Choo, Richard; DeBoer, Gerrit; Klotz, Lawrence; Danjoux, Cyril; Morton, Gerard C.; Rakovitch, Eileen; Fleshner, Neil; Bunting, Peter; Kapusta, Linda; Hruby, George

2001-01-01

Purpose: To study prostate-specific antigen (PSA) doubling time of untreated, favorable grade, prostate carcinoma. Methods and Materials: A prospective single-arm cohort study has been in progress to assess the feasibility of a watchful observation protocol with selective delayed intervention using clinical, histologic, or PSA progression as treatment indication in untreated, localized, favorable grade prostate adenocarcinoma (T1b-T2bN0 M0, Gleason Score ≤7, and PSA ≤15 ng/mL). Patients are conservatively managed with watchful observation alone, as long as they do not meet the arbitrarily defined disease progression criteria. Patients are followed regularly and undergo blood tests including PSA at each visit. PSA doubling time (Td) is estimated from a linear regression of ln(PSA) on time, assuming a simple exponential growth model. Results: As of March 2000, 134 patients have been on the study for a minimum of 12 months (median, 24; range, 12-52) and have a median frequency of PSA measurement of 7 times (range, 3-15). Median age is 70 years. Median PSA at enrollment is 6.3 (range, 0.5-14.6). The distribution of Td is as follows: 50 years, 27. The median Td is 5.1 years. In 44 patients (33%), Td is greater than 10 years. There was no correlation between Td and patient age, clinical T stage, Gleason score, or initial PSA level. Conclusion: Td of untreated prostate cancer varies widely. In our cohort, 33% have Td >10 years. Td may be a useful tool to guide treatment intervention for patients managed conservatively with watchful observation alone

The correlation of preoperative CT, MR imaging, and clinical staging (FIGO) with histopathology findings in primary cervical carcinoma

International Nuclear Information System (INIS)

Oezsarlak, Oe.; Schepens, E.; Corthouts, B.; Beeck, B.O. de; Parizel, P.M.; De Schepper, A.M.; Tjalma, W.; Marck, E. van

2003-01-01

The aim of this study was to compare the preoperative findings of abdominal/pelvic CT and MRI with the preoperative clinical International Federation of Obstetrics and Gynecology (FIGO) staging and postoperative pathology report in patients with primary cancer of the cervix. Thirty-six patients with surgical-pathological proven primary cancer of the cervix were retrospectively studied for preoperative staging by clinical examination, CT, and MR imaging. Studied parameters for preoperative staging were the presence of tumor, tumor extension into the parametrial tissue, pelvic wall, adjacent organs, and lymph nodes. The CT was performed in 32 patients and MRI (T1- and T2-weighted images) in 29 patients. The CT and MR staging were based on the FIGO staging system. Results were compared with histological findings. The group is consisted of stage 0 (in situ):1, Ia:1, Ib:8, IIa:2, IIb:12, IIIa:4, IVa:6, and IVb:2 patients. The overall accuracy of staging for clinical examination, CT, and MRI was 47, 53, and 86%, respectively. The MRI incorrectly staged 2 patients and did not visualize only two tumors; one was an in situ (stage-0) and one stage-Ia (microscopic) disease. The MRI is more accurate than CT and they are both superior to clinical examination in evaluating the locoregional extension and preoperative staging of primary cancer of the cervix. (orig.)

Two-stage atlas subset selection in multi-atlas based image segmentation

Energy Technology Data Exchange (ETDEWEB)

Zhao, Tingting, E-mail: tingtingzhao@mednet.ucla.edu; Ruan, Dan, E-mail: druan@mednet.ucla.edu [The Department of Radiation Oncology, University of California, Los Angeles, California 90095 (United States)

2015-06-15

Purpose: Fast growing access to large databases and cloud stored data presents a unique opportunity for multi-atlas based image segmentation and also presents challenges in heterogeneous atlas quality and computation burden. This work aims to develop a novel two-stage method tailored to the special needs in the face of large atlas collection with varied quality, so that high-accuracy segmentation can be achieved with low computational cost. Methods: An atlas subset selection scheme is proposed to substitute a significant portion of the computationally expensive full-fledged registration in the conventional scheme with a low-cost alternative. More specifically, the authors introduce a two-stage atlas subset selection method. In the first stage, an augmented subset is obtained based on a low-cost registration configuration and a preliminary relevance metric; in the second stage, the subset is further narrowed down to a fusion set of desired size, based on full-fledged registration and a refined relevance metric. An inference model is developed to characterize the relationship between the preliminary and refined relevance metrics, and a proper augmented subset size is derived to ensure that the desired atlases survive the preliminary selection with high probability. Results: The performance of the proposed scheme has been assessed with cross validation based on two clinical datasets consisting of manually segmented prostate and brain magnetic resonance images, respectively. The proposed scheme demonstrates comparable end-to-end segmentation performance as the conventional single-stage selection method, but with significant computation reduction. Compared with the alternative computation reduction method, their scheme improves the mean and medium Dice similarity coefficient value from (0.74, 0.78) to (0.83, 0.85) and from (0.82, 0.84) to (0.95, 0.95) for prostate and corpus callosum segmentation, respectively, with statistical significance. Conclusions: The authors

Two-stage atlas subset selection in multi-atlas based image segmentation.

Science.gov (United States)

Zhao, Tingting; Ruan, Dan

2015-06-01

Fast growing access to large databases and cloud stored data presents a unique opportunity for multi-atlas based image segmentation and also presents challenges in heterogeneous atlas quality and computation burden. This work aims to develop a novel two-stage method tailored to the special needs in the face of large atlas collection with varied quality, so that high-accuracy segmentation can be achieved with low computational cost. An atlas subset selection scheme is proposed to substitute a significant portion of the computationally expensive full-fledged registration in the conventional scheme with a low-cost alternative. More specifically, the authors introduce a two-stage atlas subset selection method. In the first stage, an augmented subset is obtained based on a low-cost registration configuration and a preliminary relevance metric; in the second stage, the subset is further narrowed down to a fusion set of desired size, based on full-fledged registration and a refined relevance metric. An inference model is developed to characterize the relationship between the preliminary and refined relevance metrics, and a proper augmented subset size is derived to ensure that the desired atlases survive the preliminary selection with high probability. The performance of the proposed scheme has been assessed with cross validation based on two clinical datasets consisting of manually segmented prostate and brain magnetic resonance images, respectively. The proposed scheme demonstrates comparable end-to-end segmentation performance as the conventional single-stage selection method, but with significant computation reduction. Compared with the alternative computation reduction method, their scheme improves the mean and medium Dice similarity coefficient value from (0.74, 0.78) to (0.83, 0.85) and from (0.82, 0.84) to (0.95, 0.95) for prostate and corpus callosum segmentation, respectively, with statistical significance. The authors have developed a novel two-stage atlas

Two-stage atlas subset selection in multi-atlas based image segmentation

International Nuclear Information System (INIS)

Zhao, Tingting; Ruan, Dan

2015-01-01

Purpose: Fast growing access to large databases and cloud stored data presents a unique opportunity for multi-atlas based image segmentation and also presents challenges in heterogeneous atlas quality and computation burden. This work aims to develop a novel two-stage method tailored to the special needs in the face of large atlas collection with varied quality, so that high-accuracy segmentation can be achieved with low computational cost. Methods: An atlas subset selection scheme is proposed to substitute a significant portion of the computationally expensive full-fledged registration in the conventional scheme with a low-cost alternative. More specifically, the authors introduce a two-stage atlas subset selection method. In the first stage, an augmented subset is obtained based on a low-cost registration configuration and a preliminary relevance metric; in the second stage, the subset is further narrowed down to a fusion set of desired size, based on full-fledged registration and a refined relevance metric. An inference model is developed to characterize the relationship between the preliminary and refined relevance metrics, and a proper augmented subset size is derived to ensure that the desired atlases survive the preliminary selection with high probability. Results: The performance of the proposed scheme has been assessed with cross validation based on two clinical datasets consisting of manually segmented prostate and brain magnetic resonance images, respectively. The proposed scheme demonstrates comparable end-to-end segmentation performance as the conventional single-stage selection method, but with significant computation reduction. Compared with the alternative computation reduction method, their scheme improves the mean and medium Dice similarity coefficient value from (0.74, 0.78) to (0.83, 0.85) and from (0.82, 0.84) to (0.95, 0.95) for prostate and corpus callosum segmentation, respectively, with statistical significance. Conclusions: The authors

Treatment assignment guesses by study participants in a double-blind dose escalation clinical trial of saw palmetto.

Science.gov (United States)

Lee, Jeannette Y; Moore, Page; Kusek, John; Barry, Michael

2014-01-01

This report assesses participant perception of treatment assignment in a randomized, double-blind, placebo-controlled trial of saw palmetto for the treatment of benign prostatic hyperplasia (BCM). Participants randomized to receive saw palmetto were instructed to take one 320 mg gelcap daily for the first 24 weeks, two 320 mg gelcaps daily for the second 24 weeks, and three 320 mg gelcaps daily for the third 24 weeks. Study participants assigned to placebo were instructed to take the same number of matching placebo gelcaps in each time period. At 24, 48, and 72 weeks postrandomization, the American Urological Association Symptom Index (AUA-SI) was administered and participants were asked to guess their treatment assignment. The study was conducted at 11 clinical centers in North America. Study participants were men, 45 years and older, with moderate to low severe BPH symptoms, randomized to saw palmetto (N=151) or placebo (N=155). Treatment arms were compared with respect to the distribution of participant guesses of treatment assignment. For participants assigned to saw palmetto, 22.5%, 24.7%, and 29.8% correctly thought they were taking saw palmetto, and 37.3%, 40.0%, and 44.4% incorrectly thought they were on placebo at 24, 48, and 72 weeks, respectively. For placebo participants, 21.8%, 27.4%, and 25.2% incorrectly thought they were on saw palmetto, and 41.6%, 39.9%, and 42.6% correctly thought they were on placebo at 24, 48, and 72 weeks, respectively. The treatment arms did not vary with respect to the distributions of participants who guessed they were on saw palmetto (p=0.823) or placebo (p=0.893). Participants who experienced an improvement in AUA-SI were 2.16 times more likely to think they were on saw palmetto. Blinding of treatment assignment was successful in this study. Improvement in BPH-related symptoms was associated with the perception that participants were taking saw palmetto.

Simultaneous blood pressure measurement in both arms in hypertensive and nonhypertensive adult patients.

Science.gov (United States)

Fonseca-Reyes, Salvador; Forsyth-MacQuarrie, Avril M; García de Alba-García, Javier Eduardo

2012-08-01

When blood pressure (BP) is taken for the first time, it should be measured in both arms; follow-up measurements should be taken in the arm with the highest BP. However, in clinical practice, this recommendation is rarely followed. Identify the degree of differences in BP between the right and the left arm in individuals with normal and high BP. We measured BP in 111 hypertensive and 80 normotensive patients in both arms at the same time using identical Omron HEM 725 CIC automatic sphygmomanometers. The devices were then switched to the other arm and another set of readings was taken. The absolute and relative difference in BP between arms was calculated from the average of these two readings. We categorized differences as at least 5, at least 10, and at least 20 mmHg for systolic blood pressure/diastolic blood pressure (SBP/DBP). The BP was higher in the right arm, with no statistical significance. The relative differences were also not significant: SBP 1.1±7.1 and DBP 0.21±5.0. However, the absolute differences were significant at an individual level, with a systolic difference of 5.4±4.8 mmHg and a diastolic difference of 3.9 ±3.2 mmHg. The percentages of absolute SBP/DBP differences more than 5 mmHg (21.4%/20.4%) and more than 10 mmHg (15.7%/4.7%) were considerable. The range of arm differences was clinically significant; in hypertensives, the SBP/DBP was -13.2 to +15/-9.2 to +9.6 mmHg and in nonhypertensives it was -12.9 to +15.6/-9.7 to +10.1 mmHg. Although on average there was no clinically significant relative difference between arms, absolute differences at an individual level were often clinically significant. Failure to determine interarm BP differences will lead to erroneous clinical decisions.

The jellyfish and its polyp: a comparative study of gene expression monitored by the protein patterns using two-dimensional gels with double-label autoradiography

International Nuclear Information System (INIS)

Bally, Andreas; Schmid, Volker

1988-01-01

The life cycle of Podocoryne carnea (Coelenterata. Anthomedusae) shows several distinct stages which differ considerably in terms of their ecology, morphology, cellular composition and ultra structure. Using two-dimensional gel electrophoresis and a new method of double-label autoradiography, we show here for the first time for metagenic hydrozoans that only minor differences in gene expression exist between the various life cycle stages. Our results demonstrate the high resolution power of these techniques and show that the different life stages of P. carnea remain rather similar on the protein level (author)

Numerical simulations for the coal/oxidant distribution effects between two-stages for multi opposite burners (MOB) gasifier

International Nuclear Information System (INIS)

Unar, Imran Nazir; Wang, Lijun; Pathan, Abdul Ghani; Mahar, Rasool Bux; Li, Rundong; Uqaili, M. Aslam

2014-01-01

Highlights: • We simulated a double stage 3D entrained flow coal gasifier with multi-opposite burners. • The various reaction mechanisms have evaluated with experimental results. • The effects of coal and oxygen distribution between two stages on the performance of gasifier have investigated. • The local coal to oxygen ratio is affecting the overall efficiency of gasifier. - Abstract: A 3D CFD model for two-stage entrained flow dry feed coal gasifier with multi opposite burners (MOB) has been developed in this paper. At each stage two opposite nozzles are impinging whereas the two other opposite nozzles are slightly tangential. Various numerical simulations were carried out in standard CFD software to investigate the impacts of coal and oxidant distributions between the two stages of the gasifier. Chemical process was described by Finite Rate/Eddy Dissipation model. Heterogeneous and homogeneous reactions were defined using the published kinetic data and realizable k–ε turbulent model was used to solve the turbulence equations. Gas–solid interaction was defined by Euler–Lagrangian frame work. Different reaction mechanism were investigated first for the validation of the model from published experimental results. Then further investigations were made through the validated model for important parameters like species concentrations in syngas, char conversion, maximum inside temperature and syngas exit temperature. The analysis of the results from various simulated cases shows that coal/oxidant distribution between the stages has great influence on the overall performance of gasifier. The maximum char conversion was found 99.79% with coal 60% and oxygen 50% of upper level of injection. The minimum char conversion was observed 95.45% at 30% coal with 40% oxygen at same level. In general with oxygen and coal above or equal to 50% of total at upper injection level has shown an optimized performance

Effect of ammoniacal nitrogen on one-stage and two-stage anaerobic digestion of food waste

International Nuclear Information System (INIS)

Ariunbaatar, Javkhlan; Scotto Di Perta, Ester; Panico, Antonio; Frunzo, Luigi; Esposito, Giovanni; Lens, Piet N.L.; Pirozzi, Francesco

2015-01-01

Highlights: • Almost 100% of the biomethane potential of food waste was recovered during AD in a two-stage CSTR. • Recirculation of the liquid fraction of the digestate provided the necessary buffer in the AD reactors. • A higher OLR (0.9 gVS/L·d) led to higher accumulation of TAN, which caused more toxicity. • A two-stage reactor is more sensitive to elevated concentrations of ammonia. • The IC 50 of TAN for the AD of food waste amounts to 3.8 g/L. - Abstract: This research compares the operation of one-stage and two-stage anaerobic continuously stirred tank reactor (CSTR) systems fed semi-continuously with food waste. The main purpose was to investigate the effects of ammoniacal nitrogen on the anaerobic digestion process. The two-stage system gave more reliable operation compared to one-stage due to: (i) a better pH self-adjusting capacity; (ii) a higher resistance to organic loading shocks; and (iii) a higher conversion rate of organic substrate to biomethane. Also a small amount of biohydrogen was detected from the first stage of the two-stage reactor making this system attractive for biohythane production. As the digestate contains ammoniacal nitrogen, re-circulating it provided the necessary alkalinity in the systems, thus preventing an eventual failure by volatile fatty acids (VFA) accumulation. However, re-circulation also resulted in an ammonium accumulation, yielding a lower biomethane production. Based on the batch experimental results the 50% inhibitory concentration of total ammoniacal nitrogen on the methanogenic activities was calculated as 3.8 g/L, corresponding to 146 mg/L free ammonia for the inoculum used for this research. The two-stage system was affected by the inhibition more than the one-stage system, as it requires less alkalinity and the physically separated methanogens are more sensitive to inhibitory factors, such as ammonium and propionic acid

Staging of gastric adenocarcinoma using two-phase spiral CT: correlation with pathologic staging

International Nuclear Information System (INIS)

Seo, Tae Seok; Lee, Dong Ho; Ko, Young Tae; Lim, Joo Won

1998-01-01

To correlate the preoperative staging of gastric adenocarcinoma using two-phase spiral CT with pathologic staging. One hundred and eighty patients with gastric cancers confirmed during surgery underwent two-phase spiral CT, and were evaluated retrospectively. CT scans were obtained in the prone position after ingestion of water. Scans were performed 35 and 80 seconds after the start of infusion of 120mL of non-ionic contrast material with the speed of 3mL/sec. Five mm collimation, 7mm/sec table feed and 5mm reconstruction interval were used. T-and N-stage were determined using spiral CT images, without knowledge of the pathologic results. Pathologic staging was later compared with CT staging. Pathologic T-stage was T1 in 70 cases(38.9%), T2 in 33(18.3%), T3 in 73(40.6%), and T4 in 4(2.2%). Type-I or IIa elevated lesions accouted for 10 of 70 T1 cases(14.3%) and flat or depressed lesions(type IIb, IIc, or III) for 60(85.7%). Pathologic N-stage was NO in 85 cases(47.2%), N1 in 42(23.3%), N2 in 31(17.2%), and N3 in 22(12,2%). The detection rate of early gastric cancer using two-phase spiral CT was 100.0%(10 of 10 cases) among elevated lesions and 78.3%(47 of 60 cases) among flat or depressed lesions. With regard to T-stage, there was good correlation between CT image and pathology in 86 of 180 cases(47.8%). Overstaging occurred in 23.3%(42 of 180 cases) and understaging in 28.9%(52 of 180 cases). With regard to N-stage, good correlation between CT image and pathology was noted in 94 of 180 cases(52.2%). The rate of understaging(31.7%, 57 of 180 cases) was higher than that of overstaging(16.1%, 29 of 180 cases)(p<0.001). The detection rate of early gastric cancer using two-phase spiral CT was 81.4%, and there was no significant difference in detectability between elevated and depressed lesions. Two-phase spiral CT for determing the T-and N-stage of gastric cancer was not effective;it was accurate in abont 50% of cases understaging tended to occur.=20

Optimal C-arm angulation during transcatheter aortic valve replacement: Accuracy of a rotational C-arm computed tomography based three dimensional heart model.

Science.gov (United States)

Veulemans, Verena; Mollus, Sabine; Saalbach, Axel; Pietsch, Max; Hellhammer, Katharina; Zeus, Tobias; Westenfeld, Ralf; Weese, Jürgen; Kelm, Malte; Balzer, Jan

2016-10-26

To investigate the accuracy of a rotational C-arm CT-based 3D heart model to predict an optimal C-arm configuration during transcatheter aortic valve replacement (TAVR). Rotational C-arm CT (RCT) under rapid ventricular pacing was performed in 57 consecutive patients with severe aortic stenosis as part of the pre-procedural cardiac catheterization. With prototype software each RCT data set was segmented using a 3D heart model. From that the line of perpendicularity curve was obtained that generates a perpendicular view of the aortic annulus according to the right-cusp rule. To evaluate the accuracy of a model-based overlay we compared model- and expert-derived aortic root diameters. For all 57 patients in the RCT cohort diameter measurements were obtained from two independent operators and were compared to the model-based measurements. The inter-observer variability was measured to be in the range of 0°-12.96° of angular C-arm displacement for two independent operators. The model-to-operator agreement was 0°-13.82°. The model-based and expert measurements of aortic root diameters evaluated at the aortic annulus ( r = 0.79, P optimal C-arm configuration, potentially simplifying current clinical workflows before and during TAVR.

Staging in bipolar disorder: from theoretical framework to clinical utility.

Science.gov (United States)

Berk, Michael; Post, Robert; Ratheesh, Aswin; Gliddon, Emma; Singh, Ajeet; Vieta, Eduard; Carvalho, Andre F; Ashton, Melanie M; Berk, Lesley; Cotton, Susan M; McGorry, Patrick D; Fernandes, Brisa S; Yatham, Lakshmi N; Dodd, Seetal

2017-10-01

Illness staging is widely utilized in several medical disciplines to help predict course or prognosis, and optimize treatment. Staging models in psychiatry in general, and bipolar disorder in particular, depend on the premise that psychopathology moves along a predictable path: an at-risk or latency stage, a prodrome progressing to a first clinical threshold episode, and one or more recurrences with the potential to revert or progress to late or end-stage manifestations. The utility and validity of a staging model for bipolar disorder depend on its linking to clinical outcome, treatment response and neurobiological measures. These include progressive biochemical, neuroimaging and cognitive changes, and potentially stage-specific differences in response to pharmacological and psychosocial treatments. Mechanistically, staging models imply the presence of an active disease process that, if not remediated, can lead to neuroprogression, a more malignant disease course and functional deterioration. Biological elements thought to be operative in bipolar disorder include a genetic diathesis, physical and psychic trauma, epigenetic changes, altered neurogenesis and apoptosis, mitochondrial dysfunction, inflammation, and oxidative stress. Many available agents, such as lithium, have effects on these targets. Staging models also suggest the utility of stage-specific treatment approaches that may not only target symptom reduction, but also impede illness neuroprogression. These treatment approaches range from prevention for at-risk individuals, to early intervention strategies for prodromal and newly diagnosed individuals, complex combination therapy for rapidly recurrent illness, and palliative-type approaches for those at chronic, late stages of illness. There is hope that prompt initiation of potentially disease modifying therapies may preclude or attenuate the cognitive and structural changes seen in the later stages of bipolar disorder. The aims of this paper are to: a

Frequency analysis of a two-stage planetary gearbox using two different methodologies

Science.gov (United States)

Feki, Nabih; Karray, Maha; Khabou, Mohamed Tawfik; Chaari, Fakher; Haddar, Mohamed

2017-12-01

This paper is focused on the characterization of the frequency content of vibration signals issued from a two-stage planetary gearbox. To achieve this goal, two different methodologies are adopted: the lumped-parameter modeling approach and the phenomenological modeling approach. The two methodologies aim to describe the complex vibrations generated by a two-stage planetary gearbox. The phenomenological model describes directly the vibrations as measured by a sensor fixed outside the fixed ring gear with respect to an inertial reference frame, while results from a lumped-parameter model are referenced with respect to a rotating frame and then transferred into an inertial reference frame. Two different case studies of the two-stage planetary gear are adopted to describe the vibration and the corresponding spectra using both models. Each case presents a specific geometry and a specific spectral structure.

Kinematics and control of redundant robotic arm based on dielectric elastomer actuators

Science.gov (United States)

Branz, Francesco; Antonello, Andrea; Carron, Andrea; Carli, Ruggero; Francesconi, Alessandro

2015-04-01

Soft robotics is a promising field and its application to space mechanisms could represent a breakthrough in space technologies by enabling new operative scenarios (e.g. soft manipulators, capture systems). Dielectric Elastomers Actuators have been under deep study for a number of years and have shown several advantages that could be of key importance for space applications. Among such advantages the most notable are high conversion efficiency, distributed actuation, self-sensing capability, multi-degree-of-freedom design, light weight and low cost. The big potentialities of double cone actuators have been proven in terms of good performances (i.e. stroke and force/torque), ease of manufacturing and durability. In this work the kinematic, dynamic and control design of a two-joint redundant robotic arm is presented. Two double cone actuators are assembled in series to form a two-link design. Each joint has two degrees of freedom (one rotational and one translational) for a total of four. The arm is designed to move in a 2-D environment (i.e. the horizontal plane) with 4 DoF, consequently having two degrees of redundancy. The redundancy is exploited in order to minimize the joint loads. The kinematic design with redundant Jacobian inversion is presented. The selected control algorithm is described along with the results of a number of dynamic simulations that have been executed for performance verification. Finally, an experimental setup is presented based on a flexible structure that counteracts gravity during testing in order to better emulate future zero-gravity applications.

Laxation of critically ill patients with lactulose or polyethylene glycol : a two-center randomized, double-blind, placebo-controlled trial

NARCIS (Netherlands)

van der Spoel, Johan I; Oudemans-van Straaten, Heleen M; Kuiper, Michael A; van Roon, Eric N; Zandstra, Durk F; van der Voort, Peter H J

2007-01-01

OBJECTIVE: To study whether lactulose or polyethylene glycol is effective to promote defecation in critically ill patients, whether either of the two is superior, and whether the use of enteral laxatives is related to clinical outcome. DESIGN: Double-blind, placebo-controlled, randomized study.

TORPEDO: Prospective, double blind, randomized clinical trial comparing the use of Ketorolac verse placebo during live donor nephrectomy for kidney transplant

Directory of Open Access Journals (Sweden)

Jeffrey Campsen

2017-06-01

Full Text Available The aim of this pilot study was to determine if the use of Ketorolac for donor nephrectomies could decrease the use of narcotics. Methods: This is a prospective, double blind, randomized trial involving patients undergoing nephrectomy for live donor kidney transplantation. Three arms: 1. Ketorolac 30 mg IV×1 in the OR, then ketorolac 15 mg IV every 6 h for 7 doses. 2. Ketorolac 30 mg IV×1 in the OR, then placebo IV every 6 h for 7 doses. 3. Placebo IV×1 in the OR, then placebo IV every 6 h for 7 doses. Outcomes: blood loss, mortality, renal function, cumulative narcotic use, length of hospital stay (LOS, and urinary retention. Results: There were no patient deaths, blood transfusions or renal dysfunction in any study arm. Arm 1 had less narcotic use, reduced length of stay, and reduced urinary retention than Arm 3. Conclusion: There was reduced LOS, less narcotic use and less urinary retention in the Ketorolac group (Arm 1 versus the placebo group (Arm 3. Based on these results we will proceed with a larger study to compare the use of non-opioid analgesics in donor nephrectomies.

Blood pressure measurement method and inter-arm differences: a meta-analysis.

Science.gov (United States)

Verberk, Willem J; Kessels, Alfons G H; Thien, Theo

2011-11-01

Screening for inter-arm difference (IAD) of blood pressure (BP) at each first visit is recommended by numerous guidelines whereas it is unclear whether the method by which IAD is measured has significant influence on the IAD value. A systematic review is made of the studies reporting on double-arm measurements and the association of IAD with procedure characteristics (Medline/PubMed, Embase, and Cochrane Library). The mean absolute IAD was 5.4 ± 1.7 and 3.6 ± 1.2 mm Hg for systolic and diastolic BP, respectively. Of all subjects 14% had a systolic IAD ≥10 mm Hg, 4% a systolic IAD ≥20 mm Hg, and 7% a diastolic IAD ≥10 mm Hg. The relative risk (RR) of obtaining a systolic IAD ≥10 and 20 mm Hg and a diastolic IAD ≥10 mm Hg is higher when measuring sequentially instead of simultaneously (2.2 (95% CI: 1.4-3.6), P arms, with one or two automatic devices and multiple readings should be taken.

Two-Stage Fuzzy Portfolio Selection Problem with Transaction Costs

Directory of Open Access Journals (Sweden)

Yanju Chen

2015-01-01

Full Text Available This paper studies a two-period portfolio selection problem. The problem is formulated as a two-stage fuzzy portfolio selection model with transaction costs, in which the future returns of risky security are characterized by possibility distributions. The objective of the proposed model is to achieve the maximum utility in terms of the expected value and variance of the final wealth. Given the first-stage decision vector and a realization of fuzzy return, the optimal value expression of the second-stage programming problem is derived. As a result, the proposed two-stage model is equivalent to a single-stage model, and the analytical optimal solution of the two-stage model is obtained, which helps us to discuss the properties of the optimal solution. Finally, some numerical experiments are performed to demonstrate the new modeling idea and the effectiveness. The computational results provided by the proposed model show that the more risk-averse investor will invest more wealth in the risk-free security. They also show that the optimal invested amount in risky security increases as the risk-free return decreases and the optimal utility increases as the risk-free return increases, whereas the optimal utility increases as the transaction costs decrease. In most instances the utilities provided by the proposed two-stage model are larger than those provided by the single-stage model.

Wide-bandwidth bilateral control using two-stage actuator system

International Nuclear Information System (INIS)

Kokuryu, Saori; Izutsu, Masaki; Kamamichi, Norihiro; Ishikawa, Jun

2015-01-01

This paper proposes a two-stage actuator system that consists of a coarse actuator driven by a ball screw with an AC motor (the first stage) and a fine actuator driven by a voice coil motor (the second stage). The proposed two-stage actuator system is applied to make a wide-bandwidth bilateral control system without needing expensive high-performance actuators. In the proposed system, the first stage has a wide moving range with a narrow control bandwidth, and the second stage has a narrow moving range with a wide control bandwidth. By consolidating these two inexpensive actuators with different control bandwidths in a complementary manner, a wide bandwidth bilateral control system can be constructed based on a mechanical impedance control. To show the validity of the proposed method, a prototype of the two-stage actuator system has been developed and basic performance was evaluated by experiment. The experimental results showed that a light mechanical impedance with a mass of 10 g and a damping coefficient of 2.5 N/(m/s) that is an important factor to establish good transparency in bilateral control has been successfully achieved and also showed that a better force and position responses between a master and slave is achieved by using the proposed two-stage actuator system compared with a narrow bandwidth case using a single ball screw system. (author)

Two-stage precipitation of neptunium (IV) oxalate

International Nuclear Information System (INIS)

Luerkens, D.W.

1983-07-01

Neptunium (IV) oxalate was precipitated using a two-stage precipitation system. A series of precipitation experiments was used to identify the significant process variables affecting precipitate characteristics. Process variables tested were input concentrations, solubility conditions in the first stage precipitator, precipitation temperatures, and residence time in the first stage precipitator. A procedure has been demonstrated that produces neptunium (IV) oxalate particles that filter well and readily calcine to the oxide

[Clinical efficacy of mouse nerve growth factor in treatment of occupational hand-arm vibration disease].

Science.gov (United States)

Fan, Chunyue; Wang, Yanyan; Zhang, Ying; Lang, Li; Deng, Xiaofeng; Cheng, Ying

2014-12-01

To investigate the efficacy of mouse nerve growth factor (mNGF) in treating occupational hand-arm vibration disease (HAVD). Sixty-four patients with HAVD were equally and randomly divided into treatment group and control group. The control group was given Salvia miltiorrhiza Bunge and deproteinized extract of calf blood to improve circulation, and also given methylcobalamin tablets and vitamin B6 for neurotrophic treatment. In addition to the above treatments for the control group, the treatment group was also given 30 µg/d mNGF by intramuscular injection for two courses (4 weeks for each course) with a 15-day interval. Both the treatment group and the control group showed significant improvements in clinical symptoms and signs (hand numbness and pain, and reduced senses of touch, pain, and vibration), cold water loading test (CWLT), and electroneuromyography (ENMG) after treatments (P hand numbness and pain, reduced senses of touch, pain, and vibration, CWLT, and ENMG, so it has better clinical effect and safety in treating HAVD. Early diagnosis and treatment can improve the outcome of patients with HAVD.

Effect of ammoniacal nitrogen on one-stage and two-stage anaerobic digestion of food waste

Energy Technology Data Exchange (ETDEWEB)

Ariunbaatar, Javkhlan, E-mail: jaka@unicas.it [Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Via Di Biasio 43, 03043 Cassino, FR (Italy); UNESCO-IHE Institute for Water Education, Westvest 7, 2611 AX Delft (Netherlands); Scotto Di Perta, Ester [Department of Civil, Architectural and Environmental Engineering, University of Naples Federico II, Via Claudio 21, 80125 Naples (Italy); Panico, Antonio [Telematic University PEGASO, Piazza Trieste e Trento, 48, 80132 Naples (Italy); Frunzo, Luigi [Department of Mathematics and Applications Renato Caccioppoli, University of Naples Federico II, Via Claudio, 21, 80125 Naples (Italy); Esposito, Giovanni [Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Via Di Biasio 43, 03043 Cassino, FR (Italy); Lens, Piet N.L. [UNESCO-IHE Institute for Water Education, Westvest 7, 2611 AX Delft (Netherlands); Pirozzi, Francesco [Department of Civil, Architectural and Environmental Engineering, University of Naples Federico II, Via Claudio 21, 80125 Naples (Italy)

2015-04-15

Highlights: • Almost 100% of the biomethane potential of food waste was recovered during AD in a two-stage CSTR. • Recirculation of the liquid fraction of the digestate provided the necessary buffer in the AD reactors. • A higher OLR (0.9 gVS/L·d) led to higher accumulation of TAN, which caused more toxicity. • A two-stage reactor is more sensitive to elevated concentrations of ammonia. • The IC{sub 50} of TAN for the AD of food waste amounts to 3.8 g/L. - Abstract: This research compares the operation of one-stage and two-stage anaerobic continuously stirred tank reactor (CSTR) systems fed semi-continuously with food waste. The main purpose was to investigate the effects of ammoniacal nitrogen on the anaerobic digestion process. The two-stage system gave more reliable operation compared to one-stage due to: (i) a better pH self-adjusting capacity; (ii) a higher resistance to organic loading shocks; and (iii) a higher conversion rate of organic substrate to biomethane. Also a small amount of biohydrogen was detected from the first stage of the two-stage reactor making this system attractive for biohythane production. As the digestate contains ammoniacal nitrogen, re-circulating it provided the necessary alkalinity in the systems, thus preventing an eventual failure by volatile fatty acids (VFA) accumulation. However, re-circulation also resulted in an ammonium accumulation, yielding a lower biomethane production. Based on the batch experimental results the 50% inhibitory concentration of total ammoniacal nitrogen on the methanogenic activities was calculated as 3.8 g/L, corresponding to 146 mg/L free ammonia for the inoculum used for this research. The two-stage system was affected by the inhibition more than the one-stage system, as it requires less alkalinity and the physically separated methanogens are more sensitive to inhibitory factors, such as ammonium and propionic acid.

Mixture-based gatekeeping procedures in adaptive clinical trials.

Science.gov (United States)

Kordzakhia, George; Dmitrienko, Alex; Ishida, Eiji

2018-01-01

Clinical trials with data-driven decision rules often pursue multiple clinical objectives such as the evaluation of several endpoints or several doses of an experimental treatment. These complex analysis strategies give rise to "multivariate" multiplicity problems with several components or sources of multiplicity. A general framework for defining gatekeeping procedures in clinical trials with adaptive multistage designs is proposed in this paper. The mixture method is applied to build a gatekeeping procedure at each stage and inferences at each decision point (interim or final analysis) are performed using the combination function approach. An advantage of utilizing the mixture method is that it enables powerful gatekeeping procedures applicable to a broad class of settings with complex logical relationships among the hypotheses of interest. Further, the combination function approach supports flexible data-driven decisions such as a decision to increase the sample size or remove a treatment arm. The paper concludes with a clinical trial example that illustrates the methodology by applying it to develop an adaptive two-stage design with a mixture-based gatekeeping procedure.

Double-Blind Controlled Comparison of Phlebitis Produced by Cephapirin and Cephalothin

Science.gov (United States)

Carrizosa, Jaime; Levison, Matthew E.; Kaye, Donald

1973-01-01

In a double-blind study with each patient as his own control cephapirin and cephalothin were administered to 20 patients in opposite arms for a period of 48 hr each. Neither the incidence of phlebitis nor the degree of phlebitis was significantly different with the two drugs, and there was no difference in the time of onset of pain or phlebitis. PMID:4597719

Changes in arm-hand function and arm-hand skill performance in patients after stroke during and after rehabilitation.

Science.gov (United States)

Franck, Johan Anton; Smeets, Rob Johannes Elise Marie; Seelen, Henk Alexander Maria

2017-01-01

Arm-hand rehabilitation programs applied in stroke rehabilitation frequently target specific populations and thus are less applicable in heterogeneous patient populations. Besides, changes in arm-hand function (AHF) and arm-hand skill performance (AHSP) during and after a specific and well-described rehabilitation treatment are often not well evaluated. This single-armed prospective cohort study featured three subgroups of stroke patients with either a severely, moderately or mildly impaired AHF. Rehabilitation treatment consisted of a Concise_Arm_and_hand_ Rehabilitation_Approach_in_Stroke (CARAS). Measurements at function and activity level were performed at admission, clinical discharge, 3, 6, 9 and 12 months after clinical discharge. Eighty-nine stroke patients (M/F:63/23; mean age:57.6yr (+/-10.6); post-stroke time:29.8 days (+/-20.1)) participated. All patients improved on AHF and arm-hand capacity during and after rehabilitation, except on grip strength in the severely affected subgroup. Largest gains occurred in patients with a moderately affected AHF. As to self-perceived AHSP, on average, all subgroups improved over time. A small percentage of patients declined regarding self-perceived AHSP post-rehabilitation. A majority of stroke patients across the whole arm-hand impairment severity spectrum significantly improved on AHF, arm-hand capacity and self-perceived AHSP. These were maintained up to one year post-rehabilitation. Results may serve as a control condition in future studies.

Considerations Regarding Age at Surgery and Fistula Incidence Using One- and Two-stage Closure for Cleft Palate

Directory of Open Access Journals (Sweden)

Simona Stoicescu

2013-12-01

Full Text Available Introduction: Although cleft lip and palate (CLP is one of the most common congenital malformations, occurring in 1 in 700 live births, there is still no generally accepted treatment protocol. Numerous surgical techniques have been described for cleft palate repair; these techniques can be divided into one-stage (one operation cleft palate repair and two-stage cleft palate closure. The aim of this study is to present our cleft palate team experience in using the two-stage cleft palate closure and the clinical outcomes in terms of oronasal fistula rate. Material and methods: A retrospective analysis was performed on medical records of 80 patients who underwent palate repair over a five-year period, from 2008 to 2012. All cleft palate patients were incorporated. Information on patient’s gender, cleft type, age at repair, one- or two-stage cleft palate repair were collected and analyzed. Results: Fifty-three (66% and twenty-seven (34% patients underwent two-stage and one-stage repair, respectively. According to Veau classification, more than 60% of them were Veau III and IV, associating cleft lip to cleft palate. Fistula occurred in 34% of the two-stage repairs versus 7% of one-stage repairs, with an overall incidence of 24%. Conclusions: Our study has shown that a two-stage cleft palate closure has a higher rate of fistula formation when compared with the one-stage repair. Two-stage repair is the protocol of choice in wide complete cleft lip and palate cases, while one-stage procedure is a good option for cleft palate alone, or some specific cleft lip and palate cases (narrow cleft palate, older age at surgery

Fracture Characteristics Analysis of Double-layer Rock Plates with Both Ends Fixed Condition

Directory of Open Access Journals (Sweden)

S. R. Wang

2014-07-01

Full Text Available In order to research on the fracture and instability characteristics of double-layer rock plates with both ends fixed, the three-dimension computational model of double-layer rock plates under the concentrated load was built by using PFC3D technique (three-dimension particle flow code, and the mechanical parameters of the numerical model were determined based on the physical model tests. The results showed the instability process of the double-layer rock plates had four mechanical response phases: the elastic deformation stage, the brittle fracture of upper thick plate arching stage, two rock-arch bearing stage and two rock-arch failure stage; moreover, with the rock plate particle radius from small to large change, the maximum vertical force of double rock-arch appeared when the particle size was a certain value. The maximum vertical force showed an upward trend with the increase of the rock plate temperature, and in the case of the same thickness the maximum vertical force increased with the increase of the upper rock plate thickness. When the boundary conditions of double-layer rock plates changed from the hinged support to the fixed support, the maximum horizontal force observably decreased, and the maximum vertical force showed small fluctuations and then tended towards stability with the increase of cohesive strength of double-layer rock plates.

Meta-analysis of Clinical and Radiographic Outcomes After Arthroscopic Single-Row Versus Double-Row Rotator Cuff Repair

OpenAIRE

Perser, Karen; Godfrey, David; Bisson, Leslie

2011-01-01

Context: Double-row rotator cuff repair methods have improved biomechanical performance when compared with single-row repairs. Objective: To review clinical outcomes of single-row versus double-row rotator cuff repair with the hypothesis that double-row rotator cuff repair will result in better clinical and radiographic outcomes. Data Sources: Published literature from January 1980 to April 2010. Key terms included rotator cuff, prospective studies, outcomes, and suture techniques. Study Sele...

Implementation of Exhaust Gas Recirculation for Double Stage Waste Heat Recovery System on Large Container Vessel

DEFF Research Database (Denmark)

Andreasen, Morten; Marissal, Matthieu; Sørensen, Kim

2014-01-01

Concerned to push ships to have a lower impact on the environment, the International Maritime Organization are implementing stricter regulation of NOx and SOx emissions, called Tier III, within emission control areas (ECAs). Waste Heat Recovery Systems (WHRS) on container ships consist...... of recovering some of the waste heat from the exhaust gas. This heat is converted into electrical energy used on-board instead of using auxiliary engines. Exhaust Gas Recirculation (EGR) systems, are recirculating a part of the exhaust gas through the engine combustion chamber to reduce emissions. WHRS combined...... with EGR is a potential way to improve system efficiency while reducing emissions. This paper investigates the feasibility of combining the two systems. EGR dilutes the fuel, lowering the combustion temperature and thereby the formation of NOx, to reach Tier III limitation. A double stage WHRS is set up...

Multiple-path Quantum Interference Effects in a Double-Aharonov-Bohm Interferometer

Directory of Open Access Journals (Sweden)

Yang XF

2010-01-01

Full Text Available Abstract We investigate quantum interference effects in a double-Aharonov-Bohm (AB interferometer consisting of five quantum dots sandwiched between two metallic electrodes in the case of symmetric dot-electrode couplings by the use of the Green’s function equation of motion method. The analytical expression for the linear conductance at zero temperature is derived to interpret numerical results. A three-peak structure in the linear conductance spectrum may evolve into a double-peak structure, and two Fano dips (zero conductance points may appear in the quantum system when the energy levels of quantum dots in arms are not aligned with one another. The AB oscillation for the magnetic flux threading the double-AB interferometer is also investigated in this paper. Our results show the period of AB oscillation can be converted from 2π to π by controlling the difference of the magnetic fluxes threading the two quantum rings.

Comparative assessment of single-stage and two-stage anaerobic digestion for the treatment of thin stillage.

Science.gov (United States)

Nasr, Noha; Elbeshbishy, Elsayed; Hafez, Hisham; Nakhla, George; El Naggar, M Hesham

2012-05-01

A comparative evaluation of single-stage and two-stage anaerobic digestion processes for biomethane and biohydrogen production using thin stillage was performed to assess the impact of separating the acidogenic and methanogenic stages on anaerobic digestion. Thin stillage, the main by-product from ethanol production, was characterized by high total chemical oxygen demand (TCOD) of 122 g/L and total volatile fatty acids (TVFAs) of 12 g/L. A maximum methane yield of 0.33 L CH(4)/gCOD(added) (STP) was achieved in the two-stage process while a single-stage process achieved a maximum yield of only 0.26 L CH(4)/gCOD(added) (STP). The separation of acidification stage increased the TVFAs to TCOD ratio from 10% in the raw thin stillage to 54% due to the conversion of carbohydrates into hydrogen and VFAs. Comparison of the two processes based on energy outcome revealed that an increase of 18.5% in the total energy yield was achieved using two-stage anaerobic digestion. Copyright © 2012 Elsevier Ltd. All rights reserved.

Condensate from a two-stage gasifier

DEFF Research Database (Denmark)

Bentzen, Jens Dall; Henriksen, Ulrik Birk; Hindsgaul, Claus

2000-01-01

Condensate, produced when gas from downdraft biomass gasifier is cooled, contains organic compounds that inhibit nitrifiers. Treatment with activated carbon removes most of the organics and makes the condensate far less inhibitory. The condensate from an optimised two-stage gasifier is so clean...... that the organic compounds and the inhibition effect are very low even before treatment with activated carbon. The moderate inhibition effect relates to a high content of ammonia in the condensate. The nitrifiers become tolerant to the condensate after a few weeks of exposure. The level of organic compounds...... and the level of inhibition are so low that condensate from the optimised two-stage gasifier can be led to the public sewer....

Effects of resonant magnetic perturbation on the triggering and the evolution of double-tearing mode

Science.gov (United States)

Wang, L.; Lin, W. B.; Wang, X. Q.

2018-02-01

The effects of resonant magnetic perturbation on the triggering and the evolution of the double-tearing mode are investigated by using nonlinear magnetohydrodynamics simulations in a slab geometry. It is found that the double-tearing mode can be destabilized by boundary magnetic perturbation. Moreover, the mode has three typical development stages before it reaches saturation: the linear stable stage, the linear-growth stage, and the exponential-growth stage. The onset and growth of the double-tearing mode significantly depend on the boundary magnetic perturbations, particularly in the early development stage of the mode. The influences of the magnetic perturbation amplitude on the mode for different separations of the two rational surfaces are also discussed.

Evidence of two-stage melting of Wigner solids

Science.gov (United States)

Knighton, Talbot; Wu, Zhe; Huang, Jian; Serafin, Alessandro; Xia, J. S.; Pfeiffer, L. N.; West, K. W.

2018-02-01

Ultralow carrier concentrations of two-dimensional holes down to p =1 ×109cm-2 are realized. Remarkable insulating states are found below a critical density of pc=4 ×109cm-2 or rs≈40 . Sensitive dc V-I measurement as a function of temperature and electric field reveals a two-stage phase transition supporting the melting of a Wigner solid as a two-stage first-order transition.

Two-stage liquefaction of a Spanish subbituminous coal

Energy Technology Data Exchange (ETDEWEB)

Martinez, M.T.; Fernandez, I.; Benito, A.M.; Cebolla, V.; Miranda, J.L.; Oelert, H.H. (Instituto de Carboquimica, Zaragoza (Spain))

1993-05-01

A Spanish subbituminous coal has been processed in two-stage liquefaction in a non-integrated process. The first-stage coal liquefaction has been carried out in a continuous pilot plant in Germany at Clausthal Technical University at 400[degree]C, 20 MPa hydrogen pressure and anthracene oil as solvent. The second-stage coal liquefaction has been performed in continuous operation in a hydroprocessing unit at the Instituto de Carboquimica at 450[degree]C and 10 MPa hydrogen pressure, with two commercial catalysts: Harshaw HT-400E (Co-Mo/Al[sub 2]O[sub 3]) and HT-500E (Ni-Mo/Al[sub 2]O[sub 3]). The total conversion for the first-stage coal liquefaction was 75.41 wt% (coal d.a.f.), being 3.79 wt% gases, 2.58 wt% primary condensate and 69.04 wt% heavy liquids. The heteroatoms removal for the second-stage liquefaction was 97-99 wt% of S, 85-87 wt% of N and 93-100 wt% of O. The hydroprocessed liquids have about 70% of compounds with boiling point below 350[degree]C, and meet the sulphur and nitrogen specifications for refinery feedstocks. Liquids from two-stage coal liquefaction have been distilled, and the naphtha, kerosene and diesel fractions obtained have been characterized. 39 refs., 3 figs., 8 tabs.

Design and fabrication of uniquely shaped thiol-ene microfibers using a two-stage hydrodynamic focusing design.

Science.gov (United States)

Boyd, Darryl A; Shields, Adam R; Howell, Peter B; Ligler, Frances S

2013-08-07

Microfluidic systems have advantages that are just starting to be realized for materials fabrication. In addition to the more common use for fabrication of particles, hydrodynamic focusing has been used to fabricate continuous polymer fibers. We have previously described such a microfluidics system which has the ability to generate fibers with controlled cross-sectional shapes locked in place by in situ photopolymerization. The previous fiber fabrication studies produced relatively simple round or ribbon shapes, demonstrated the use of a variety of polymers, and described the interaction between sheath-core flow-rate ratios used to control the fiber diameter and the impact on possible shapes. These papers documented the fact that no matter what the intended shape, higher flow-rate ratios produced rounder fibers, even in the absence of interfacial tension between the core and sheath fluids. This work describes how to fabricate the next generation of fibers predesigned to have a much more complex geometry, as exemplified by the "double anchor" shape. Critical to production of the pre-specified fibers with complex features was independent control over both the shape and the size of the fabricated microfibers using a two-stage hydrodynamic focusing system. Design and optimization of the channels was performed using finite element simulations and confocal imaging to characterize each of the two stages theoretically and experimentally. The resulting device design was then used to generate thiol-ene fibers with a unique double anchor shape. Finally, proof-of-principle functional experiments demonstrated the ability of the fibers to transport fluids and to interlock laterally.

Late-stage pharmaceutical R&D and pricing policies under two-stage regulation.

Science.gov (United States)

Jobjörnsson, Sebastian; Forster, Martin; Pertile, Paolo; Burman, Carl-Fredrik

2016-12-01

We present a model combining the two regulatory stages relevant to the approval of a new health technology: the authorisation of its commercialisation and the insurer's decision about whether to reimburse its cost. We show that the degree of uncertainty concerning the true value of the insurer's maximum willingness to pay for a unit increase in effectiveness has a non-monotonic impact on the optimal price of the innovation, the firm's expected profit and the optimal sample size of the clinical trial. A key result is that there exists a range of values of the uncertainty parameter over which a reduction in uncertainty benefits the firm, the insurer and patients. We consider how different policy parameters may be used as incentive mechanisms, and the incentives to invest in R&D for marginal projects such as those targeting rare diseases. The model is calibrated using data on a new treatment for cystic fibrosis. Copyright © 2016 Elsevier B.V. All rights reserved.

Penatalaksanaan Repair Palatoplasty dengan Teknik Furlow Double Opposing Z Plasty

Directory of Open Access Journals (Sweden)

Pingky Krisna Arindra

2015-06-01

metode Furlow double opposing z plasty dengan kombinasi insisi lateral, dan didapatkan hasil menutupnya celah di palatum mole sampai dengan uvula. Telah dilakukan operasi repair palatoplasi dengan metode Furlow double opposing z plasty. Teknik ini dilakukan untuk menghindari insisi yang terlalu luas dikarenakan terdapatnya jaringan fibrous yang tebal pada mukosa palatum pasca operasi sebelumnya. Tujuan studi kasus adalah untuk mengetahui kemampuan teknik Furlow Double Opposing Z Plasty sebagai prosedur repair palatoplasty.   Repair Palatoplasty Management with Furlow Double Opposing Z Plasty Technique. Cases of cleft lip and palate are one of the deformity disorders that often occur. There are variety of clinical appearance ranging from incomplete to complete cases. Clinical appearance with different width requires proper surgical technique. Patients with cleft lip and palate had undergone surgical intervention, so that they needed surgical correction to repair the result or failure of the previous surgery. A Four year old boy complain there was cleft on the soft palate. The patient was diagnosed with labiognatopalatoscisis. The patient had undergone two stages of cleft lip surgery and twice of cleft palate surgery with pushback method and repair with z plasty, however the result was unsatisfactory. Further, the patient underwent repair palatoplasty surgery with Furlow double opposing z plasty method combined with lateral relaxing insicion. The result in the post surgery was the closure of cleft soft palate up to uvula. Repair palataplasty surgery has been done with Furlow double opposing z plasty method. This technique could avoid extended incision due to thick fibrous tissue on the palatum mucosa as the result of serial previous surgery. The aim of this case case study is to determine the technical capabilities of Furlow Double Opposing Z Plasty as palatoplasty repair procedure.

Liposuction for Advanced Lymphedema: A Multidisciplinary Approach for Complete Reduction of Arm and Leg Swelling.

Science.gov (United States)

Boyages, John; Kastanias, Katrina; Koelmeyer, Louise A; Winch, Caleb J; Lam, Thomas C; Sherman, Kerry A; Munnoch, David Alex; Brorson, Håkan; Ngo, Quan D; Heydon-White, Asha; Magnussen, John S; Mackie, Helen

2015-12-01

This research describes and evaluates a liposuction surgery and multidisciplinary rehabilitation approach for advanced lymphedema of the upper and lower extremities. A prospective clinical study was conducted at an Advanced Lymphedema Assessment Clinic (ALAC) comprised of specialists in plastic surgery, rehabilitation, imaging, oncology, and allied health, at Macquarie University, Australia. Between May 2012 and 31 May 2014, a total of 104 patients attended the ALAC. Eligibility criteria for liposuction included (i) unilateral, non-pitting, International Society of Lymphology stage II/III lymphedema; (ii) limb volume difference greater than 25 %; and (iii) previously ineffective conservative therapies. Of 55 eligible patients, 21 underwent liposuction (15 arm, 6 leg) and had at least 3 months postsurgical follow-up (85.7 % cancer-related lymphedema). Liposuction was performed under general anesthesia using a published technique, and compression garments were applied intraoperatively and advised to be worn continuously thereafter. Limb volume differences, bioimpedance spectroscopy (L-Dex), and symptom and functional measurements (using the Patient-Specific Functional Scale) were taken presurgery and 4 weeks postsurgery, and then at 3, 6, 9, and 12 months postsurgery. Mean presurgical limb volume difference was 45.1 % (arm 44.2 %; leg 47.3 %). This difference reduced to 3.8 % (arm 3.6 %; leg 4.3 %) by 6 months postsurgery, a mean percentage volume reduction of 89.6 % (arm 90.2 %; leg 88.2 %) [p multidisciplinary team is essential.

One-stage and two-stage penile buccal mucosa urethroplasty

African Journals Online (AJOL)

G. Barbagli

2015-12-02

Dec 2, 2015 ... there also seems to be a trend of decreasing urethritis and an increase of instrumentation and catheter related strictures in these countries as well [4–6]. The repair of penile urethral strictures may require one- or two- stage urethroplasty [7–10]. Certainly, sexual function can be placed at risk by any surgery ...

Clinical outcome of fresh and vitrified-warmed blastocyst and cleavage-stage embryo transfers in ethnic Chinese ART patients.

Science.gov (United States)

Tong, Guo Qing; Cao, Shan Ren; Wu, Xun; Zhang, Jun Qiang; Cui, Ji; Heng, Boon Chin; Ling, Xiu Feng

2012-10-05

This study sought to evaluate the outcome of fresh and vitrified-warmed cleavage-stage and blastocyst-stage embryo transfers in patients undergoing ART treatment within an ethnic Chinese population. We compared the clinical results of embryo transfer on the 3rd (cleavage stage) or 5th (blastocyst stage) day after oocyte retrieval, including clinical pregnancy rates, implantation rates and multiple pregnancy rates. Our data showed that blastocyst transfer on day 5 did not significantly increase clinical pregnancy rate (41.07% vs 47.08%, p>0.05) and implantation rate (31.8% vs 31.2%, p>0.05) in patients under 35 years of age, in comparison with day 3 cleavage stage embryo transfer. In patients older than 35 years of age, the clinical pregnancy rate after blastocyst transfer was slightly decreased compared with cleavage stage embryo transfer (33.33% vs 42.31%, p>0.05). Unexpectedly, It was found that vitrified-warmed blastocyst transfer resulted in significantly higher clinical pregnancy rate (56.8%) and implantation rate (47%) compared with fresh blastocyst transfer in controlled stimulation cycles (41.07% and 31.8%, respectively). For patients under 35 years of age, the cumulative clinical pregnancy rate combining fresh and vitrified-warmed blastocyst transfer cycles were significantly higher compared to just cleavage-stage embryo transfer (70.1% versus 51.8%, p<0.05). However, the cumulative multiple pregnancy rates showed no significant difference between the two groups. In an ethnic Chinese patient population, fresh blastocyst transfer does not significantly increase clinical pregnancy rate. However, subsequent vitrified-warmed blastocyst transfer in a non-controlled ovarian hyperstimulation cycle dramatically improves clinical outcomes. Therefore, blastocyst culture in tandem with vitrified-warmed blastocyst transfer is recommended as a favourable and promising protocol in human ART treatment, particularly for ethnic Chinese patients.

Effect of Persian Medicine Remedy on Chemotherapy Induced Nausea and Vomiting in Breast Cancer: A Double Blind, Randomized, Crossover Clinical Trial

Science.gov (United States)

Nazari, Mohammad; Taghizadeh, Ali; Bazzaz, Mojtaba Mousavi; Rakhshandeh, Hassan; Shokri, Sadegh

2017-01-01

Background Chemotherapy induced nausea and vomiting (CINV) is a side effect, and has negative effect on quality of life and continuation of chemotherapy. Despite new regimen and drugs, the problems still remain and standard guidelines, effective treatment and supportive care for refractory CINV are still not yet established. Persian medicine, the old Iranian medical school, offer Persumac (prepared from Rhus Coriaria and Bunium Persicum Boiss). Objective The specific objectives were to assess the effect of Persumac on the number and severity of nausea and vomiting in refractory CINV in acute and delayed phase. Methods This randomized, double blind, crossover clinical trial study was carried out on 93 patients with breast cancer and refractory CINV, who received outpatient high emetogenic chemotherapy in Imam Reza hospital, Mashhad, Iran from October 2015 to May 2016. The study has three stages: in stage I patients received a questionaire and completed it after chemotherapy. In stage II they were randomly divided into intervention group with Persumac and control group with placebo (lactose were used). In stage III, wash out and crossover was conducted. Both groups in all stages received standard antiemetic therapy for CINV. The following were set as the inclusion criteria of the study: female, Age ≥18 years, clinical diagnosis of breast cancer, history of refractory CINV, normal blood tests and at least three courses of chemotherapy remaining. Exclusion criteria of this study were: Total or upper abdominal radiation therapy along with chemotherapy, drugs/therapy for nausea and vomiting not prescribed in this study, hypersensitivity to Sumac or Bunium Persicum, use of sumac and Bunium Persicum in seven days prior to the intervention, clinical diagnosis of digestion disorders, non-chemotherapy induced nausea and vomiting, milk allergy, loss of two consecutive or three intermittent doses of Persumac or placebo. Outcomes were gathered by Persian questionnaire. Number

Arm-length stabilisation for interferometric gravitational-wave detectors using frequency-doubled auxiliary lasers

OpenAIRE

Mullavey, Adam J.; Slagmolen, Bram J. J.; Miller, John; Evans, Matthew; Fritschel, Peter; Sigg, Daniel; Waldman, Sam J.; Shaddock, Daniel A.; McClelland, David E.

2011-01-01

Residual motion of the arm cavity mirrors is expected to prove one of the principal impediments to systematic lock acquisition in advanced gravitational-wave interferometers. We present a technique which overcomes this problem by employing auxiliary lasers at twice the fundamental measurement frequency to pre-stabilise the arm cavities’ lengths. Applying this approach, we reduce the apparent length noise of a 1.3 m long, independently suspended Fabry-Perot cavity to 30 pm rms and successfully...

Combining dosimetry and toxicity: analysis of two UK phase III clinical trials

International Nuclear Information System (INIS)

Gulliford, Sarah L

2014-01-01

There are many advantages to performing a clinical trial when implementing a novel radiotherapy technique. The clinical trials framework enables the safety and efficacy of the 'experimental arm' to be tested and ensures practical support, rigorous quality control and data monitoring for participating centres. In addition to the clinical and follow-up data collected from patients within the trial, it is also possible to collect 3-D dosimetric information from the corresponding radiotherapy treatment plans. Analysing the combination of dosimetric, clinical and follow-up data enhances the understanding of the relationship between the dose delivered to both the target and normal tissue structures and reported outcomes and toxicity. Aspects of the collection, collation and analysis of data from two UK multicentre Phase III radiotherapy trials are presented here. MRC-RT01 dose-escalation prostate radiotherapy trial ISRCTN47772397 was one of the first UK multi-centre radiotherapy trials to collect 3-D dosimetric data. A number of different analysis methodologies were implemented to investigate the relationship between the dose distribution to the rectum and specific rectal toxicities. More recently data was collected from the PARSPORT trial (Parotid Sparing IMRT vs conventional head and neck radiotherapy) ISRCTN48243537. In addition to the planned analysis, dosimetric analysis was employed to investigate an unexpected finding that acute fatigue was more prevalent in the IMRT arm of the trial. It can be challenging to collect 3-D dosimetric information from multicentre radiotherapy trials. However, analysing the relationship between dosimetric and toxicity data provides invaluable information which can influence the next generation of radiotherapy techniques.

Two-Stage Variable Sample-Rate Conversion System

Science.gov (United States)

Tkacenko, Andre

2009-01-01

A two-stage variable sample-rate conversion (SRC) system has been pro posed as part of a digital signal-processing system in a digital com munication radio receiver that utilizes a variety of data rates. The proposed system would be used as an interface between (1) an analog- todigital converter used in the front end of the receiver to sample an intermediatefrequency signal at a fixed input rate and (2) digita lly implemented tracking loops in subsequent stages that operate at v arious sample rates that are generally lower than the input sample r ate. This Two-Stage System would be capable of converting from an input sample rate to a desired lower output sample rate that could be var iable and not necessarily a rational fraction of the input rate.

The status of two-arm bilateral servomanipulator system development

International Nuclear Information System (INIS)

Kawatsuma, S.; Fujita, Y.; Maeda, M.; Hayashi, S.; Sasao, N.; Kashihara, H.

1987-01-01

A bilateral servo-manipulator (BSM) has been developed to meet requirements for the new remote maintenance technologies. It will be applied to the Vitrification Plant (V.P.) of high-level liquid waste and FBR Fuel Recycle Pilot Plant (F.R.P.P.). Above mentioned new remote technologies are to perform the maintenance task of all equipments and machines which are installed in the large hot cell, and have several developing items such as BSM, rack, wall-through plug, remote connector and so on. Prototype II model of BSM has been designed and manufactured, adopting some new technologies to concentrate on operability, reliability and maintenability. This paper presents the status of two-arm bilateral servomanipulator system development

Double-Blind Comparison of Phlebitis Produced by Cefazolin Versus Cephalothin

Science.gov (United States)

Shemonsky, Natalie K.; Carrizosa, Jaime; Kaye, Donald; Levison, Matthew E.

1975-01-01

In a double-blind study with each patient as his own control, 1 g of cefazolin and 2 g of cephalothin were administered intravenously every 6 h to 20 patients in opposite arms for a period of 48 h each. The degree of phlebitis was significantly more severe with cephalothin than with cefazolin (P phlebitis nor the time of onset of phlebitis was significantly different between the two drugs. PMID:1147583

Neck and arm pain syndromes

DEFF Research Database (Denmark)

de las Peñas, César Fernández; Cleland, Joshua; Huijbregts, Peter

approaches.It uniquely addresses the expanding role of the various health care professions which require increased knowledge and skills in screening for contra-indications and recognizing the need for medical-surgical referral. Neck and Arm Pain Syndromes also stresses the integration of experiential......The first of its kind, Neck and Arm Pain Syndromes is a comprehensive evidence- and clinical-based book, covering research-based diagnosis, prognosis and management of neuromusculoskeletal pathologies and dysfunctions of the upper quadrant, including joint, muscle, myofascial and neural tissue...... of the most commonly seen pain syndromes in clinical practice over 800 illustrations demonstrating examination procedures and techniques....

DK crush (double-kissing and double-crush) technique for treatment of true coronary bifurcation lesions: illustration and comparison with classic crush.

Science.gov (United States)

Chen, Shaoliang; Zhang, Junjie; Ye, Fei; Zhu, Zhongsheng; Lin, Song; Shan, Shoujie; Kwan, Tak W

2007-04-01

Classic crush has a lower success rate compared to final kissing balloon inflation (FKBI). We previously reported the double-kissing (DK) crush technique that involves double-kissing along with double-crushing for the treatment of true bifurcation coronary lesions in 2005. This is a consecutive, nonrandomized, open-label study. Eighty-eight consecutive patients with single, true coronary bifurcation lesions according to Lefevre Classification2 and side branch diameter >2.0 mm were enrolled. The first 44 patients (from October 2004 to January 2005) were assigned to the classic crush treatment arm and the next 44 patients (from February 2005 to June 2005) were assigned to the DK crush technique arm, respectively. Data within 30 days were analyzed. Patients in the DK crush group, compared to those in classic crush group, were characterized by longer lesion length in the side branch (13.5 +/- 3.4 mm vs 7.8 +/- 3.1 mm; p DK crush group, as well as longer lesion length in the main vessel (24.3 +/- 8.6 mm vs 21.1 +/- 7.3 mm), though without significant differences (p >0.05). Subacute stent thrombosis was detected in 2 patients with failure of FKBI in the classic crush group (4.3%). In addition, patients in the classic crush group were characterized by a smaller minimum lumen diameter (MLD) at the side branch ostium (2.74 +/- 0.12 mm vs 3.01 +/- 0.13 mm; p DK crush has the potential to improve the clinical outcome in patients with coronary bifurcation lesions. Further randomized, prospective, multicenter studies are required to confirm these differences between the classic crush and DK crush techniques.

Double porosity models for the description of water infiltration in wood

DEFF Research Database (Denmark)

Krabbenhøft, Kristian; Damkilde, Lars

2004-01-01

In this paper some of the possibilities of applying double porosity and permeability models to the problem of water infiltration in wood are explored. It is shown that the double porosity model can capture a number of commonly reported anomalies including two-stage infiltration...

The Addition of SPECT/CT Lymphoscintigraphy to Breast Cancer Radiation Planning Spares Lymph Nodes Critical for Arm Drainage

Energy Technology Data Exchange (ETDEWEB)

Cheville, Andrea L., E-mail: Cheville.andrea@mayo.edu [Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota (United States); Brinkmann, Debra H.; Ward, Shelly B. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Durski, Jolanta [Department of Radiology, Nuclear Medicine Program, Mayo Clinic, Rochester, Minnesota (United States); Laack, Nadia N.; Yan, Elizabeth; Schomberg, Paula J.; Garces, Yolanda I. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States); Suman, Vera J. [Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota (United States); Petersen, Ivy A. [Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota (United States)

2013-03-15

Background: This prospective cohort study was designed to determine whether the amount of radiation delivered to the nonpathological lymph nodes (LNs) that drain the arm can be significantly reduced by integrating single-photon emission computed tomography (SPECT)/computed tomography (CT) scans into radiation treatment planning. Methods: SPECT-CT scans were acquired for the 28 patients with stage I or II breast cancer and fused with the routinely obtained radiation oncology planning CT scans. Arm-draining LNs were contoured with 0.5-cm margins automatically using a threshold of 50% maximum intensity. Two treatment plans were generated: 1 per routine clinical practice (standard; STD) and the second (modified; MOD) with treatment fields modified to minimize dose to the arm-draining LNs visible on SPECT/CT images without interfering with the dosage delivered to target tissues. Participants were treated per the MOD plans. Arm volumes were measured prior to radiation and thereafter at least three subsequent 6-month intervals. Results: Sixty-eight level I-III arm-draining LNs were identified, 57% of which were inside the STD plan fields but could be blocked in the MOD plan fields. Sixty-five percent of arm-draining LNs in the STD versus 16% in the MOD plans received a mean of ≥10 Gy, and 26% in the STD versus 4% in the MOD plans received a mean of ≥40 Gy. Mean LN radiation exposure was 23.6 Gy (standard deviation 18.2) with the STD and 7.7 Gy (standard deviation 11.3) with the MOD plans (P<.001). No participant developed lymphedema. Conclusions: The integration of SPECT/CT scans into breast cancer radiation treatment planning reduces unnecessary arm-draining LN radiation exposure and may lessen the risk of lymphedema.

The addition of SPECT/CT lymphoscintigraphy to breast cancer radiation planning spares lymph nodes critical for arm drainage.

Science.gov (United States)

Cheville, Andrea L; Brinkmann, Debra H; Ward, Shelly B; Durski, Jolanta; Laack, Nadia N; Yan, Elizabeth; Schomberg, Paula J; Garces, Yolanda I; Suman, Vera J; Petersen, Ivy A

2013-03-15

This prospective cohort study was designed to determine whether the amount of radiation delivered to the nonpathological lymph nodes (LNs) that drain the arm can be significantly reduced by integrating single-photon emission computed tomography (SPECT)/computed tomography (CT) scans into radiation treatment planning. SPECT-CT scans were acquired for the 28 patients with stage I or II breast cancer and fused with the routinely obtained radiation oncology planning CT scans. Arm-draining LNs were contoured with 0.5-cm margins automatically using a threshold of 50% maximum intensity. Two treatment plans were generated: 1 per routine clinical practice (standard; STD) and the second (modified; MOD) with treatment fields modified to minimize dose to the arm-draining LNs visible on SPECT/CT images without interfering with the dosage delivered to target tissues. Participants were treated per the MOD plans. Arm volumes were measured prior to radiation and thereafter at least three subsequent 6-month intervals. Sixty-eight level I-III arm-draining LNs were identified, 57% of which were inside the STD plan fields but could be blocked in the MOD plan fields. Sixty-five percent of arm-draining LNs in the STD versus 16% in the MOD plans received a mean of ≥10 Gy, and 26% in the STD versus 4% in the MOD plans received a mean of ≥40 Gy. Mean LN radiation exposure was 23.6 Gy (standard deviation 18.2) with the STD and 7.7 Gy (standard deviation 11.3) with the MOD plans (P<.001). No participant developed lymphedema. The integration of SPECT/CT scans into breast cancer radiation treatment planning reduces unnecessary arm-draining LN radiation exposure and may lessen the risk of lymphedema. Copyright © 2013 Elsevier Inc. All rights reserved.

Recommendations for clinical staging (cTNM) of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals

Science.gov (United States)

Rice, Thomas W.; Ishwaran, Hemant; Blackstone, Eugene H.; Hofstetter, Wayne L.; Kelsen, David P.; Apperson-Hansen, Carolyn

2017-01-01

SUMMARY We report analytic and consensus processes that produced recommendations for clinical stage groups (cTNM) of esophageal and esophagogastric junction cancer for the AJCC/UICC cancer staging manuals, 8th edition. The Worldwide Esophageal Cancer Collaboration (WECC) provided data on 22,123 clinically staged patients with epithelial esophageal cancers. Risk-adjusted survival for each patient was developed using random survival forest analysis from which (1) data-driven clinical stage groups were identified wherein survival decreased monotonically and was distinctive between and homogeneous within groups and (2) data-driven anatomic clinical stage groups based only on cTNM. The AJCC Upper GI Task Force, by smoothing, simplifying, expanding, and assessing clinical applicability, produced (3) consensus clinical stage groups. Compared with pTNM, cTNM survival was “pinched,” with poorer survival for early cStage groups and better survival for advanced ones. Histologic grade was distinctive for data-driven grouping of cT2N0M0 squamous cell carcinoma (SCC) and cT1-2N0M0 adenocarcinoma, but consensus removed it. Grouping was different by histopathologic cell type. For SCC, cN0-1 was distinctive for cT3 but not cT1-2, and consensus removed cT4 subclassification and added subgroups 0, IVA, and IVB. For adenocarcinoma, N0-1 was distinctive for cT1-2 but not cT3-4a, cStage II subgrouping was necessary (T1N1M0 [IIA] and T2N0M0 [IIB]), advanced cancers cT3-4aN0-1M0 plus cT2N1M0 comprised cStage III, and consensus added subgroups 0, IVA, and IVB. Treatment decisions require accurate cStage, which differs from pStage. Understaging and overstaging are problematic, and additional factors, such as grade, may facilitate treatment decisions and prognostication until clinical staging techniques are uniformly applied and improved. PMID:27905171

Recommendations for clinical staging (cTNM) of cancer of the esophagus and esophagogastric junction for the 8th edition AJCC/UICC staging manuals.

Science.gov (United States)

Rice, Thomas W; Ishwaran, Hemant; Blackstone, Eugene H; Hofstetter, Wayne L; Kelsen, David P; Apperson-Hansen, Carolyn

2016-11-01

We report analytic and consensus processes that produced recommendations for clinical stage groups (cTNM) of esophageal and esophagogastric junction cancer for the AJCC/UICC cancer staging manuals, 8th edition. The Worldwide Esophageal Cancer Collaboration (WECC) provided data on 22,123 clinically staged patients with epithelial esophageal cancers. Risk-adjusted survival for each patient was developed using random survival forest analysis from which (1) data-driven clinical stage groups were identified wherein survival decreased monotonically and was distinctive between and homogeneous within groups and (2) data-driven anatomic clinical stage groups based only on cTNM. The AJCC Upper GI Task Force, by smoothing, simplifying, expanding, and assessing clinical applicability, produced (3) consensus clinical stage groups. Compared with pTNM, cTNM survival was "pinched," with poorer survival for early cStage groups and better survival for advanced ones. Histologic grade was distinctive for data-driven grouping of cT2N0M0 squamous cell carcinoma (SCC) and cT1-2N0M0 adenocarcinoma, but consensus removed it. Grouping was different by histopathologic cell type. For SCC, cN0-1 was distinctive for cT3 but not cT1-2, and consensus removed cT4 subclassification and added subgroups 0, IVA, and IVB. For adenocarcinoma, N0-1 was distinctive for cT1-2 but not cT3-4a, cStage II subgrouping was necessary (T1N1M0 [IIA] and T2N0M0 [IIB]), advanced cancers cT3-4aN0-1M0 plus cT2N1M0 comprised cStage III, and consensus added subgroups 0, IVA, and IVB. Treatment decisions require accurate cStage, which differs from pStage. Understaging and overstaging are problematic, and additional factors, such as grade, may facilitate treatment decisions and prognostication until clinical staging techniques are uniformly applied and improved. © 2016 International Society for Diseases of the Esophagus.

Advancing early detection of autism spectrum disorder by applying an integrated two-stage screening approach

NARCIS (Netherlands)

Oosterling, Iris J.; Wensing, Michel; Swinkels, Sophie H.; van der Gaag, Rutger Jan; Visser, Janne C.; Woudenberg, Tim; Minderaa, Ruud; Steenhuis, Mark-Peter; Buitelaar, Jan K.

Background: Few field trials exist on the impact of implementing guidelines for the early detection of autism spectrum disorders (ASD). The aims of the present study were to develop and evaluate a clinically relevant integrated early detection programme based on the two-stage screening approach of

Localized chaoticity in two linearly coupled inverted double-well ...

African Journals Online (AJOL)

Two linearly coupled inverted double-well oscillators for a fixed energy and varying coupling strength were studied. The dynamics yielded a chaotic system in which the Poincare surface was characterised by two non-mixing regions, one of regular motion and the other region that became chaotic as the coupling increased.

A virtual reality system for arm and hand rehabilitation

Science.gov (United States)

Luo, Zhiqiang; Lim, Chee Kian; Chen, I.-Ming; Yeo, Song Huat

2011-03-01

This paper presents a virtual reality (VR) system for upper limb rehabilitation. The system incorporates two motion track components, the Arm Suit and the Smart Glove which are composed of a range of the optical linear encoders (OLE) and the inertial measurement units (IMU), and two interactive practice applications designed for driving users to perform the required functional and non-functional motor recovery tasks. We describe the technique details about the two motion track components and the rational to design two practice applications. The experiment results show that, compared with the marker-based tracking system, the Arm Suit can accurately track the elbow and wrist positions. The repeatability of the Smart Glove on measuring the five fingers' movement can be satisfied. Given the low cost, high accuracy and easy installation, the system thus promises to be a valuable complement to conventional therapeutic programs offered in rehabilitation clinics and at home.

Two-year results of vital pulp therapy in permanent molars with irreversible pulpitis: an ongoing multicenter randomized clinical trial.

Science.gov (United States)

Asgary, Saeed; Eghbal, Mohammad Jafar; Ghoddusi, Jamileh

2014-01-01

Oral healthcare expenses are increasing rapidly as a result of the growth of high-cost health technologies worldwide. In many developing/developed countries, low-cost tooth extraction is the alternative treatment option for a high-cost root canal therapy (RCT) for management of human molars with irreversible pulpitis. Vital pulp therapy with calcium-enriched mixture cement (VPT/CEM) as a new alternative treatment option has demonstrated excellent treatment outcomes up to 1 year; if 2-year radiographic/clinical effectiveness as well as cost-effectiveness of the VPT/CEM is also non-inferior compared with RCT, it can serve as a viable treatment for mature molars with irreversible pulpitis. In this prospective, multicenter (n = 23), non-inferiority clinical trial, 407 patients were randomized to either one-visit RCT (n = 202) or VPT/CEM (n = 205) for 27 months. In this part of study, the primary outcome measure was the 2-year clinical and radiographic treatment outcomes. Cost-effectiveness was also analyzed. Mean follow-up times were 24.62 ± 0.72 and 24.61 ± 0.69 months in RCT (n = 166) and VPT/CEM (n = 166) arms, respectively. Clinical success rates in the two study arms were equal (98.19%); however, radiographic success rates were 79.5 and 86.7% in RCT and VPT/CEM arms, respectively, with no statistical difference (P = 0.053). The treatment time span mean was approximately three times greater in the RCT than in the VPT/CEM arm (94.07 vs. 31.09 min; P pulpitis. Vital pulp therapy with CEM is a cost-effective and reliable biological technique for endodontic treatment of permanent molar teeth with irreversible pulpitis and can be recommended for general clinical practice.

Bill project related to the struggle against the proliferation of arms of massive destruction and their vectors; Projet de Loi relatif a la lutte contre la proliferation des armes de destruction massive et de leurs vecteurs

Energy Technology Data Exchange (ETDEWEB)

NONE

2011-07-01

This bill project addresses several issues: the struggle against proliferation of arms of massive destruction (nuclear weapons, nuclear materials, biological weapons, and chemical weapons), the struggle against proliferation of vectors of arms of massive destruction, double-use goods, the use of these weapons and vectors in acts of terrorism

Intraoperative Nerve Blocks Fail to Improve Quality of Recovery after Tissue Expander Breast Reconstruction: A Prospective, Double-Blinded, Randomized, Placebo-Controlled Clinical Trial.

Science.gov (United States)

Lanier, Steven T; Lewis, Kevin C; Kendall, Mark C; Vieira, Brittany L; De Oliveira, Gildasio; Nader, Anthony; Kim, John Y S; Alghoul, Mohammed

2018-03-01

The authors' study represents the first level I evidence to assess whether intraoperative nerve blocks improve the quality of recovery from immediate tissue expander/implant breast reconstruction. A prospective, randomized, double-blinded, placebo-controlled clinical trial was conducted in which patients undergoing immediate tissue expander/implant breast reconstruction were randomized to either (1) intraoperative intercostal and pectoral nerve blocks with 0.25% bupivacaine with 1:200,000 epinephrine and 4 mg of dexamethasone or (2) sham nerve blocks with normal saline. The 40-item Quality of Recovery score, pain score, and opioid use in the postoperative period were compared statistically between groups. Power analysis ensured 80 percent power to detect a 10-point (clinically significant) difference in the 40-item Quality of Recovery score. Forty-seven patients were enrolled. Age, body mass index, laterality, mastectomy type, and lymph node dissection were similar between groups. There were no statistical differences in quality of recovery, pain burden as measured by visual analogue scale, opioid consumption, antiemetic use, or length of hospital stay between groups at 24 hours after surgery. Mean global 40-item Quality of Recovery scores were 169 (range, 155 to 182) for the treatment arm and 165 (range, 143 to 179) for the placebo arm (p = 0.36), indicating a high quality of recovery in both groups. Although intraoperative nerve blocks can be a safe adjunct to a comprehensive postsurgical recovery regimen, the authors' results indicate no effect on overall quality of recovery from tissue expander/implant breast reconstruction. Therapeutic, I.

Effects of age, sex and arm on the precision of arm position sense-left-arm superiority in healthy right-handers.

Science.gov (United States)

Schmidt, Lena; Depper, Lena; Kerkhoff, Georg

2013-01-01

Position sense is an important proprioceptive ability. Disorders of arm position sense (APS) often occur after unilateral stroke, and are associated with a negative functional outcome. In the present study we assessed horizontal APS by measuring angular deviations from a visually defined target separately for each arm in a large group of healthy subjects. We analyzed the accuracy and instability of horizontal APS as a function of age, sex and arm. Subjects were required to specify verbally the position of their unseen arm on a 0-90° circuit by comparing the current position with the target position indicated by a LED lamp, while the arm was passively moved by the examiner. Eighty-seven healthy subjects participated in the study, ranging from 20 to 77 years, subdivided into three age groups. The results revealed that APS was not a function of age or sex, but was significantly better in the non-dominant (left) arm in absolute errors (AE) but not in constant errors (CE) across all age groups of right-handed healthy subjects. This indicates a right-hemisphere superiority for left APS in right-handers and neatly fits to the more frequent and more severe left-sided body-related deficits in patients with unilateral stroke (i.e. impaired APS in left spatial neglect, somatoparaphrenia) or in individuals with abnormalities of the right cerebral hemisphere. These clinical issues will be discussed.

Reconsidering Clinical Staging Model: A Case of Genetic High Risk for Schizophrenia

OpenAIRE

Lee, Tae Young; Kim, Minah; Kim, Sung Nyun; Kwon, Jun Soo

2016-01-01

The clinical staging model is considered a useful and practical method not only in dealing with the early stage of psychosis overcoming the debate about diagnostic boundaries but also in emerging mood disorder. However, its one limitation is that it cannot discriminate the heterogeneity of individuals at clinical high risk for psychosis, but lumps them all together. Even a healthy offspring of schizophrenia can eventually show clinical symptoms and progress to schizophrenia under the influenc...

The effect of regular hemodialysis on the nutritional status of children with end-stage renal disease

Directory of Open Access Journals (Sweden)

Hala M Lotfy

2015-01-01

Full Text Available Growth failure is one of the most common and profound clinical manifestation of chronic kidney disease (CKD in infants, children and adolescents. The aim of this study was to assess the nutritional status of Egyptian children with end-stage renal disease (ESRD on regular hemodialysis (HD. The study included 50 Egyptian children with ESRD on regular HD, following-up at the Pediatric Nephrology unit, Cairo University. History, including dietary history, was taken for all patients and clinical examination was performed on all of them. Body weight, standing height, height or length SD score, the skin fold thickness, mid-arm circumference, mid-arm muscle circumference and mid-arm muscle circumference area were also assessed. The height of the patients was the most affected anthropometric parameter, as 78% of the patients were shorter (height SDS below -3. Body weight is less affected than height, as body weight SDS of 34% of patients was less than -3 SDS. In addition, the body mass index of 16% of the patients was 97 th percentile. Although most ESRD patients received adequate protein and caloric intake, their growth was markedly affected, especially with longer period on HD. We suggest that assessment of growth parameters should be performed at a minimum period of every six months in children with CKD stages 2-3. For children with more advanced CKD (stages 4-5 and 5D, more frequent evaluation may be warranted due to the greater risk of abnormalities.

Immunohistochemical localization of two types of choline acetyltransferase in neurons and sensory cells of the octopus arm.

Science.gov (United States)

Sakaue, Yuko; Bellier, Jean-Pierre; Kimura, Shin; D'Este, Loredana; Takeuchi, Yoshihiro; Kimura, Hiroshi

2014-01-01

Cholinergic structures in the arm of the cephalopod Octopus vulgaris were studied by immunohistochemistry using specific antisera for two types (common and peripheral) of acetylcholine synthetic enzyme choline acetyltransferase (ChAT): antiserum raised against the rat common type ChAT (cChAT), which is cross-reactive with molluscan cChAT, and antiserum raised against the rat peripheral type ChAT (pChAT), which has been used to delineate peripheral cholinergic structures in vertebrates, but not previously in invertebrates. Western blot analysis of octopus extracts revealed a single pChAT-positive band, suggesting that pChAT antiserum is cross-reactive with an octopus counterpart of rat pChAT. In immunohistochemistry, only neuronal structures of the octopus arm were stained by cChAT and pChAT antisera, although the pattern of distribution clearly differed between the two antisera. cChAT-positive varicose nerve fibers were observed in both the cerebrobrachial tract and neuropil of the axial nerve cord, while pChAT-positive varicose fibers were detected only in the neuropil of the axial nerve cord. After epitope retrieval, pChAT-positive neuronal cells and their processes became visible in all ganglia of the arm, including the axial and intramuscular nerve cords, and in ganglia of suckers. Moreover, pChAT-positive structures also became detectable in nerve fibers connecting the different ganglia, in smooth nerve fibers among muscle layers and dermal connective tissues, and in sensory cells of the suckers. These results suggest that the octopus arm has two types of cholinergic nerves: cChAT-positive nerves from brain ganglia and pChAT-positive nerves that are intrinsic to the arm.

The role of the computed tomography in head and neck cancer: Comparison of CT staging with clinical staging in oral cavity, oropharynx and larynx cancer

International Nuclear Information System (INIS)

Chang, Kee Hyun; Lee, Yul; Han, Man Chung

1985-01-01

Thirty-six patients (24 with oral cavity or oropharynx cancers and 12 larynx cancers) were prospectively examined with computed tomography (CT) to determine its value in staging the primary tumor and to compare with the clinical staging. The CT staging agreed with the clinical staging in 50% (12/24) of the oral cavity or oropharynx cancers and in 67% (8/12) of the larynx cancers. The CT upgraded the clinical staging in 29% (7/24) of the oral cavity or oropharynx tumors and in 33% (4/12) of the larynx cancers, whereas the CT downgrade the clinical staging in 21% (5/24) of the oral cavity or oropharynx cancers. There is no downgrade on CT in larynx cancer. The post-surgical confirmation was not made in most of the cases. The possible causes of disagreement between the CT and the clinical staging, and the diagnostic value of the CT in evaluation of the primary tumor in oral cavity, oropharynx and larynx were discussed

The importance of domestic law to international arms control

International Nuclear Information System (INIS)

Lehman, R.F. II.

1993-11-01

Studies of arms control and disarmament tend to focus on political, military, and diplomatic processes. Recently, in the context of the conversion of defense activities to civilian use, the economic aspects of arms control have also received renewed interest. The legal dimension, however, is in need of fresh examination. Both international and domestic law are sailing increasingly in uncharted waters. Recent arms control agreements and related developments in international peacekeeping have expanded the scope of international law and altered how one perceives certain fundamentals, including the principle of national sovereignty. Still, the nation state is largely unchallenged as the primary actor in international affairs. National governments retain near absolute sovereign rights and responsibilities even in an age of trans-national economic integration and codified international norms for human rights, freedom of the press, and the peaceful resolution of disputes. Indeed, the role of domestic law in arms control and disarmament may be more significant now than ever before. A brief review of relationships between arms control and domestic law should illustrate ways in which ones thinking has been underestimating the importance of domestic law. Hopefully, this survey will set the stage properly for the excellent, more detailed case studies by Elinor Hammarskjold and Alan Crawford. Toward that end, this paper will highlight a number of more general, and sometimes provocative, themes. These themes should be kept in mind when those two complementary presentations are considered

The importance of domestic law to international arms control

Energy Technology Data Exchange (ETDEWEB)

Lehman, R.F. II

1993-11-01

Studies of arms control and disarmament tend to focus on political, military, and diplomatic processes. Recently, in the context of the conversion of defense activities to civilian use, the economic aspects of arms control have also received renewed interest. The legal dimension, however, is in need of fresh examination. Both international and domestic law are sailing increasingly in uncharted waters. Recent arms control agreements and related developments in international peacekeeping have expanded the scope of international law and altered how one perceives certain fundamentals, including the principle of national sovereignty. Still, the nation state is largely unchallenged as the primary actor in international affairs. National governments retain near absolute sovereign rights and responsibilities even in an age of trans-national economic integration and codified international norms for human rights, freedom of the press, and the peaceful resolution of disputes. Indeed, the role of domestic law in arms control and disarmament may be more significant now than ever before. A brief review of relationships between arms control and domestic law should illustrate ways in which ones thinking has been underestimating the importance of domestic law. Hopefully, this survey will set the stage properly for the excellent, more detailed case studies by Elinor Hammarskjold and Alan Crawford. Toward that end, this paper will highlight a number of more general, and sometimes provocative, themes. These themes should be kept in mind when those two complementary presentations are considered.

Highly sensitive detection of individual HEAT and ARM repeats with HHpred and COACH.

Science.gov (United States)

Kippert, Fred; Gerloff, Dietlind L

2009-09-24

HEAT and ARM repeats occur in a large number of eukaryotic proteins. As these repeats are often highly diverged, the prediction of HEAT or ARM domains can be challenging. Except for the most clear-cut cases, identification at the individual repeat level is indispensable, in particular for determining domain boundaries. However, methods using single sequence queries do not have the sensitivity required to deal with more divergent repeats and, when applied to proteins with known structures, in some cases failed to detect a single repeat. Testing algorithms which use multiple sequence alignments as queries, we found two of them, HHpred and COACH, to detect HEAT and ARM repeats with greatly enhanced sensitivity. Calibration against experimentally determined structures suggests the use of three score classes with increasing confidence in the prediction, and prediction thresholds for each method. When we applied a new protocol using both HHpred and COACH to these structures, it detected 82% of HEAT repeats and 90% of ARM repeats, with the minimum for a given protein of 57% for HEAT repeats and 60% for ARM repeats. Application to bona fide HEAT and ARM proteins or domains indicated that similar numbers can be expected for the full complement of HEAT/ARM proteins. A systematic screen of the Protein Data Bank for false positive hits revealed their number to be low, in particular for ARM repeats. Double false positive hits for a given protein were rare for HEAT and not at all observed for ARM repeats. In combination with fold prediction and consistency checking (multiple sequence alignments, secondary structure prediction, and position analysis), repeat prediction with the new HHpred/COACH protocol dramatically improves prediction in the twilight zone of fold prediction methods, as well as the delineation of HEAT/ARM domain boundaries. A protocol is presented for the identification of individual HEAT or ARM repeats which is straightforward to implement. It provides high

A Dual-Stage Two-Phase Model of Selective Attention

Science.gov (United States)

Hubner, Ronald; Steinhauser, Marco; Lehle, Carola

2010-01-01

The dual-stage two-phase (DSTP) model is introduced as a formal and general model of selective attention that includes both an early and a late stage of stimulus selection. Whereas at the early stage information is selected by perceptual filters whose selectivity is relatively limited, at the late stage stimuli are selected more efficiently on a…

Clinical outcome and cosmetic results of conservative surgery plus radiation therapy in early stage breast cancer patients

International Nuclear Information System (INIS)

Jin Yening; Wang Yajie; Zhang Xiaoqing; Meng Yan; Li Rongqing; Shi Junyi

2005-01-01

Objective: To evaluate the clinical outcome and cosmetic results in early stage breast cancer patients treated with conservative surgery plus radiation therapy. Methods: From May 1995 to December 2002, 109 such patients were so treated. The post-operative radiotherapy consisted of whole-breast 6 MV linear accelerator irradiation with two tangential half-fields to a total dose of 45-52 Gy (mean 48.6 Gy), followed by a boost irradiation to the tumor bed. Among them, 79 patients received 10-12 Gy (DB) boost by interstitial implantation brachytherapy ( 192 Ir HDR, Nucletron), with single plane implantation for T1 and double plane implantation for T2 tumor. Thirty patients received 15 Gy boost by electron beam. Adjuvant/concurrent chemotherapy (CMF or CEF) and hormonotherapy were also used according to the patients' clinical characteristics. The cosmetic results were scored by both the doctor and the patients. Results: The overall actuarial 5-year survival was 93.8%, with local recurrence of 6.5%. No radiation-induced ulcer was observed in the breast except for acute inflammation at skin pinholes in 5 patients treated by interstitial implant brachytherapy. Among the 75 patients who had had breast examination, cosmetic result scored as good by patient and doctor were 81% and 87%, respectively. The good rate assessed by doctor in brachytherapy boost group and electron beam boost group were 81.2% (39/48) and 85.2% (23/27), There was no significant difference between these two boost techniques (P>0.05). Conclusions: Tumor bed boost irradiation by either brachytherapy or electron beam technique can provide satisfactory local control in early breast cancer treated with conservative surgery plus radiotherapy without increasing the side effects. There is no significant difference in cosmetic result between these two boost techniques. (authors)

Noninvasive lifting of arm, thigh, and knee skin with transcutaneous intense focused ultrasound.

Science.gov (United States)

Alster, Tina S; Tanzi, Elizabeth L

2012-05-01

Transcutaneous intense focused ultrasound is a novel Food and Drug Administration-approved technology for noninvasive skin tightening of the face and neck. No studies have reported on its safety and effectiveness on nonfacial areas. Eighteen paired areas (6 each) on the upper arms, medial thighs, and extensor knees were randomly treated with two different transducers (4.0 MHz, 4.5-mm focal depth and 7.0 MHz, 3.0-mm focal depth). One side was randomly assigned to receive a single pass (single plane) of microthermal coagulation zones over the involved area with the 4.0 MHz, 4.5-mm-depth transducer, and the contralateral side was assigned to receive consecutive single passes (dual plane) using both transducers (4.0 MHz, 4.5-mm depth followed by 7.0 MHz, 3.0-mm depth). Two independent masked assessors determined clinical improvement scores using comparative standardized photographs obtained at baseline and 3 and 6 months after treatment. Subjective assessments of clinical improvement and side effects of treatment were obtained. Global assessment scores revealed significant improvement in all treated areas, with the upper arms and knees demonstrating more skin lifting and tightening than the thighs. Areas receiving dual-plane treatment had slightly better clinical scores than those receiving single-plane treatment in all three sites. Clinical scores from single-plane and dual-plane treated areas continued to improve between 3 and 6 months after treatment. Side effects were mild and transient and included erythema, warmth, and skin tenderness. Rare focal bruising was noted in two patients on the upper arms that resolved within 7 days. No other side effects were reported or observed. Transcutaneous intense focused ultrasound can be safely and effectively used to improve the clinical appearance (texture and contour) of the upper arms, extensor knees, and medial thighs. © 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

Preoperatively Assessable Clinical and Pathological Risk Factors for Parametrial Involvement in Surgically Treated FIGO Stage IB-IIA Cervical Cancer.

Science.gov (United States)

Canaz, Emel; Ozyurek, Eser Sefik; Erdem, Baki; Aldikactioglu Talmac, Merve; Yildiz Ozaydin, Ipek; Akbayir, Ozgur; Numanoglu, Ceyhun; Ulker, Volkan

2017-10-01

Determining the risk factors associated with parametrial involvement (PMI) is of paramount importance to decrease the multimodality treatment in early-stage cervical cancer. We investigated the preoperatively assessable clinical and pathological risk factors associated with PMI in surgically treated stage IB1-IIA2 cervical cancer. A retrospective cohort study of women underwent Querleu-Morrow type C hysterectomy for cervical cancer stage IB1-IIA2 from 2001 to 2015. All patients underwent clinical staging examination under anesthesia by the same gynecological oncologists during the study period. Evaluated variables were age, menopausal status, body mass index, smoking status, FIGO (International Federation of Obstetrics and Gynecology) stage, clinically measured maximal tumor diameter, clinical presentation (exophytic or endophytic tumor), histological type, tumor grade, lymphovascular space invasion, clinical and pathological vaginal invasion, and uterine body involvement. Endophytic clinical presentation was defined for ulcerative tumors and barrel-shaped morphology. Two-dimensional transvaginal ultrasonography was used to measure tumor dimensions. Of 127 eligible women, 37 (29.1%) had PMI. On univariate analysis, endophytic clinical presentation (P = 0.01), larger tumor size (P PMI. In multivariate analysis endophytic clinical presentation (odds ratio, 11.34; 95% confidence interval, 1.34-95.85; P = 0.02) and larger tumor size (odds ratio, 32.31; 95% confidence interval, 2.46-423.83; P = 0.008) were the independent risk factors for PMI. Threshold of 31 mm in tumor size predicted PMI with 71% sensitivity and 75% specificity. We identified 18 patients with tumor size of more than 30 mm and endophytic presentation; 14 (77.7%) of these had PMI. Endophytic clinical presentation and larger clinical tumor size (>3 cm) are independent risk factors for PMI in stage IB-IIA cervical cancer. Approximately 78% of the patients with a tumor size of more than 3 cm and endophytic

[Comparison research on two-stage sequencing batch MBR and one-stage MBR].

Science.gov (United States)

Yuan, Xin-Yan; Shen, Heng-Gen; Sun, Lei; Wang, Lin; Li, Shi-Feng

2011-01-01

Aiming at resolving problems in MBR operation, like low nitrogen and phosphorous removal efficiency, severe membrane fouling and etc, comparison research on two-stage sequencing batch MBR (TSBMBR) and one-stage aerobic MBR has been done in this paper. The results indicated that TSBMBR owned advantages of SBR in removing nitrogen and phosphorous, which could make up the deficiency of traditional one-stage aerobic MBR in nitrogen and phosphorous removal. During steady operation period, effluent average NH4(+) -N, TN and TP concentration is 2.83, 12.20, 0.42 mg/L, which could reach domestic scenic environment use. From membrane fouling control point of view, TSBMBR has lower SMP in supernatant, specific trans-membrane flux deduction rate, membrane fouling resistant than one-stage aerobic MBR. The sedimentation and gel layer resistant of TSBMBR was only 6.5% and 33.12% of one-stage aerobic MBR. Besides high efficiency in removing nitrogen and phosphorous, TSBMBR could effectively reduce sedimentation and gel layer pollution on membrane surface. Comparing with one-stage MBR, TSBMBR could operate with higher trans-membrane flux, lower membrane fouling rate and better pollutants removal effects.

Energy demand in Portuguese manufacturing: a two-stage model

International Nuclear Information System (INIS)

Borges, A.M.; Pereira, A.M.

1992-01-01

We use a two-stage model of factor demand to estimate the parameters determining energy demand in Portuguese manufacturing. In the first stage, a capital-labor-energy-materials framework is used to analyze the substitutability between energy as a whole and other factors of production. In the second stage, total energy demand is decomposed into oil, coal and electricity demands. The two stages are fully integrated since the energy composite used in the first stage and its price are obtained from the second stage energy sub-model. The estimates obtained indicate that energy demand in manufacturing responds significantly to price changes. In addition, estimation results suggest that there are important substitution possibilities among energy forms and between energy and other factors of production. The role of price changes in energy-demand forecasting, as well as in energy policy in general, is clearly established. (author)

Efficacy of polyglucosamine for weight loss?confirmed in a randomized double-blind, placebo-controlled clinical investigation

OpenAIRE

Pokhis, Karina; Bitterlich, Norman; Cornelli, Umberto; Cassano, Giuseppina

2015-01-01

Background The purpose of this clinical study was to ascertain whether low molecular weight chitosan polyglucosamine is able to produce significantly better weight loss than placebo. Method 115 participants were included in the study. We used a two-center randomized, double blind, placebo-controlled design. The participants followed a standard treatment (ST), which included the combination of a low-calorie diet achieved through creating a daily calorie deficit (500 cal) and an increased daily...

Extended Kalman filtering applied to a two-axis robotic arm with flexible links

Energy Technology Data Exchange (ETDEWEB)

Lertpiriyasuwat, V.; Berg, M.C.; Buffinton, K.W.

2000-03-01

An industrial robot today uses measurements of its joint positions and models of its kinematics and dynamics to estimate and control its end-effector position. Substantially better end-effector position estimation and control performance would be obtainable if direct measurements of its end-effector position were also used. The subject of this paper is extended Kalman filtering for precise estimation of the position of the end-effector of a robot using, in addition to the usual measurements of the joint positions, direct measurements of the end-effector position. The estimation performances of extended Kalman filters are compared in applications to a planar two-axis robotic arm with very flexible links. The comparisons shed new light on the dependence of extended Kalman filter estimation performance on the quality of the model of the arm dynamics that the extended Kalman filter operates with.

ARM Airborne Carbon Measurements VI (ARM-ACME VI) Field Campaign Report

Energy Technology Data Exchange (ETDEWEB)

Biraud, Sebastien [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

2017-05-01

From October 1, 2015 through September 30, 2016, AAF deployed a Cessna 206 aircraft over the Southern Great Plains, collecting observations of trace gas mixing ratios over the ARM/SGP Central Facility. The aircraft payload included two Atmospheric Observing Systems (AOS Inc.) analyzers for continuous measurements of CO2, and a 12-flask sampler for analysis of carbon cycle gases (CO2, CO, CH4, N2O, 13CO2). The aircraft payload also includes solar/infrared radiation measurements. This research (supported by DOE ARM and TES programs) builds upon previous ARM-ACME missions. The goal of these measurements is to improve understanding of: (a) the carbon exchange of the ARM region; (b) how CO2 and associated water and energy fluxes influence radiative forcing, convective processes, and CO2 concentrations over the ARM region, and (c) how greenhouse gases are transported on continental scales.

Quantitative Assessment of the Arm/Hand Movements in Parkinson’s Disease Using a Wireless Armband Device

Directory of Open Access Journals (Sweden)

Sofija Spasojević

2017-08-01

Full Text Available We present an approach for quantitative assessment of the arm/hand movements in patients with Parkinson’s disease (PD, from sensor data acquired with a wearable, wireless armband device (Myo sensor. We propose new Movement Performance Indicators that can be adopted by practitioners for the quantitative evaluation of motor performance and support their clinical evaluations. In addition, specific Movement Performance Indicators can indicate the presence of the bradykinesia symptom. The study includes seventeen PD patients and sixteen age-matched controls. A set of representative arm/hand movements is defined under the supervision of movement disorder specialist. In order to assist the evaluations, and for progress monitoring purposes, as well as for assessing the amount of bradykinesia in PD, a total set of 84 Movement Performance Indicators are computed from the sensor readings. Subsequently, we investigate whether wireless armband device, with the use of the proposed Movement Performance Indicators can be utilized: (1 for objective and precise quantitative evaluation of the arm/hand movements of Parkinson’s patients, (2 for assessment of the bradykinesia motor symptom, and (3 as an adequate low-cost alternative for the sensor glove. We conducted extensive analysis of proposed Movement Performance Indicators and results are indicating following clinically relevant characteristics: (i adequate reliability as measured by ICC; (ii high accuracy in discrimination between the patients and controls, and between the disease stages (support to disease diagnosis and progress monitoring, respectively; (iii substantial difference in comparison between the left-hand and the right-hand movements across controls and patients, as well as between disease stage groups; (iv statistically significant correlation with clinical scales (tapping test and UPDRS-III Motor Score; and (v quantitative evaluation of bradykinesia symptom. Results suggest that the proposed

Two-stage reconstruction with the modified Paneva-Holevich technique.

LENUS (Irish Health Repository)

O'Shea, Kieran

2013-05-01

Flexor tendon reconstruction poses both a technical challenge to the hand surgeon and a rehabilitative challenge to the patient and therapist. The modified Paneva-Holevich technique, using a pedicled intra-synovial graft, is a safe and reliable means of staged flexor tendon reconstruction, offering a number of theoretical advantages over classic free-tendon grafting techniques. Clinical outcomes are at the least comparable, if not superior, to those achieved following free-tendon techniques with most authors reporting a low requirement for third stage tenolysis.

[Clinical stages of patients with Alzheimer disease treated in specialist clinics in Spain. The EACE study].

Science.gov (United States)

Alom Poveda, J; Baquero, M; González-Adalid Guerreiro, M

2013-10-01

The diagnostic paradigm of Alzheimer disease (AD) is changing; there is a trend toward diagnosing the disease in its early stages, even before the complete syndrome of dementia is apparent. The clinical stage at which AD is usually diagnosed in our area is unknown. Therefore, the purpose of this study is to describe the clinical stages of AD patients at time of diagnosis. Multicentre, observational and cross-sectional study. Patients with probable AD according to NINCDS-ARDRA criteria, attended in specialist clinics in Spain, were included in the study. We recorded the symptom onset to evaluation and symptom onset to diagnosis intervals and clinical status of AD (based on MMSE, NPI questionnaire, and CDR scale). Participants in this study included 437 specialists representing all of Spain's autonomous communities and a total of 1,707 patients, of whom 1,694 were included in the analysis. Mean MMSE score was 17.6±4.8 (95% CI:17.4-17.9). Moderate cognitive impairment (MMSE between 10 and 20) was detected in 64% of the patients, and severe cognitive impairment (MMSEde Neurología. Published by Elsevier Espana. All rights reserved.

CyARM: Haptic Sensing Device for Spatial Localization on Basis of Exploration by Arms

Directory of Open Access Journals (Sweden)

Junichi Akita

2009-01-01

Full Text Available We introduce a new type of perception aid device based on user's exploration action, which is named as CyARM (acronym of “Cyber Arm”. The user holds this device in her/his arm, the extension of the arm is controlled by tension in wires, which are attached to her/his body according to the distance to the object. This user interface has unique characteristics that give users the illusion of an imaginary arm that extends to existing objects. The implementations of CyARM and our two experiments to investigate the efficiency and effectiveness of CyARM are described. The results show that we could confirm that CyARM can be used to recognize the presence of an object in front of the user and to measure the relative distance to the object.

Renal Replacement Therapy in End-Stage Sickle Cell Nephropathy: Presentation of Two Cases and Literature Review

International Nuclear Information System (INIS)

Al-Mueilo, Samir H.

2005-01-01

Chronic renal failure develops in 4-18% of patients with sickle cell anemia. Hemodialysis and kidney transplant are viable options in the management of end-stage renal disease in patients with sickle cell diseases (SCD). Information on kidney disease among Saudi patients with SCD is non-existing. In this report, the clinical course of two adult males with end-stage sickle cell nephropathy from Eastern Saudi Arabia is described. Literature on renal replacement therapy in sickle cell anemia (SCA) is discussed. (author)

Clinical implications of using the arm motor ability test in stroke rehabilitation.

Science.gov (United States)

O'Dell, Michael W; Kim, Grace; Finnen, Lisa Rivera; Polistena, Caitlin

2011-05-01

To identify all published studies using the Arm Motor Ability Test (AMAT), a standardized, laboratory-based measure for selected upper extremity activities of daily living (ADLs); and to summarize its current uses and provide recommendations for its future use. An Ovid online search was performed using the terms "Arm Motor Ability Test" and "AMAT." The reference lists of all articles obtained were reviewed for additional studies not appearing in the literature search. In addition, the original manual for the use and administration of the AMAT was reviewed. All studies examining the psychometric properties of the AMAT or using the AMAT as an outcome measure were identified. Articles simply mentioning the AMAT without providing data and case reports or abstracts (other than those addressing a specific aspect of the scale of interest) were excluded. Studies were reviewed by the primary author. No formal system of quality review was used. The AMAT has been used as an outcome measure in stroke rehabilitation research examining upper extremity robotics, functional electrical stimulation, and cortical stimulation. The most recent version contains 10 ADL tasks, each of which is composed of 1 to 3 subtasks. Of the 3 domains originally proposed, only the "functional ability" domain is routinely assessed. Psychometric studies have demonstrated good reliability and at least reasonable construct validity. The instrument's sensitivity to change over time is less well established, and no recommendation can be made regarding a minimal clinically important difference. We recommend that the 10-item version of the AMAT and assessment of only the functional ability domain be adopted as standard going forward. Further research should include examination of sensitivity over time, minimal clinically important change, reliability and validity in the mid and lower range of scores, and in neurologic diagnoses other than stroke. Copyright © 2011 American Congress of Rehabilitation Medicine

Oxygen-enhanced MRI vs. quantitatively assessed thin-section CT: Pulmonary functional loss assessment and clinical stage classification of asthmatics

Energy Technology Data Exchange (ETDEWEB)

Ohno, Yoshiharu, E-mail: yosirad@kobe-u.ac.jp [Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017 (Japan); Koyama, Hisanobu [Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017 (Japan); Matsumoto, Keiko [Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017 (Japan); Department of Radiology, University of Yamanashi, 1100, Shimogatou, Chuo, Yamanashi, 409-3898 (Japan); Onishi, Yumiko [Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017 (Japan); Nogami, Munenobu [Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017 (Japan); Division of Image-Based Medicine, Institute of Biomedical Research and Innovation, 2-2 Minatojima Minamimachi Chuo-ku, Kobe, Hyogo, 650-0047 (Japan); Takenaka, Daisuke; Matsumoto, Sumiaki; Sugimura, Kazuro [Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017 (Japan)

2011-01-15

Purpose: The purpose of this study was to prospectively compare the efficacy of oxygen-enhanced MR imaging (O{sub 2}-enhanced MRI) and CT for pulmonary functional loss assessment and clinical stage classification of asthmatics. Materials and methods: O{sub 2}-enhanced MRI, CT and %FEV{sub 1} measurement were used 34 consecutive asthmatics classified into four stages ('Mild Intermittent [n = 7]', 'Mild Persistent [n = 8], 'Moderate Persistent [n = 14]' and 'Severe Persistent [n = 5]'). Relative enhancement ratio maps for every subject were generated, and determine mean relative enhancement ratios (MRERs). Mean lung density (MLD) and the airway wall area (WA) corrected by body surface area (WA/BSA) were also measured on CT. To compare the efficacy of the two methods for pulmonary functional loss assessment, all indexes were correlated with %FEV{sub 1}. To determine the efficacy of the two methods for clinical stage classification, all parameters for the four clinical stages were statistically compared. Results: %FEV{sub 1} showed fair or moderate correlation with all parameters (0.15 {<=} r{sup 2} {<=} 0.30, p < 0.05). WA, WA/BSA and MRER of the 'Severe Persistent' group were significantly larger than those of 'Mild Intermittent' and 'Mild Persistent' groups (p < 0.05), and MRER of the 'Moderate Persistent' group significantly lower than that of the 'Mild Intermittent' group (p < 0.05). Conclusion: O{sub 2}-enhanced MRI is as effective as CT for pulmonary functional loss assessment and clinical stage classification of asthmatics.

Oral Magnesium Supplementation in Chronic Kidney Disease Stages 3 and 4: Efficacy, Safety, and Effect on Serum Calcification Propensity—A Prospective Randomized Double-Blinded Placebo-Controlled Clinical Trial

Directory of Open Access Journals (Sweden)

Iain Bressendorff

2017-05-01

Discussion: Oral Mg supplementation was safe and well tolerated in CKD stages 3 and 4 and improved T50, but did not increase intracellular Mg. Further studies are needed to investigate the long-term effects of Mg supplementation in CKD stage 3 and 4 and whether improvement in calcification propensity is related to clinical endpoints.

A novel hybrid actuation mechanism based XY nanopositioning stage with totally decoupled kinematics

Science.gov (United States)

Zhu, Wu-Le; Zhu, Zhiwei; Guo, Ping; Ju, Bing-Feng

2018-01-01

This paper reports the design, analysis and testing of a parallel two degree-of-freedom piezo-actuated compliant stage for XY nanopositioning by introducing an innovative hybrid actuation mechanism. It mainly features the combination of two Scott-Russell and a half-bridge mechanisms for double-stage displacement amplification as well as moving direction modulation. By adopting the leaf-type double parallelogram (LTDP) structures at both input and output ends of the hybrid mechanism, the lateral stiffness and dynamic characteristics are significantly improved while the parasitic motions are greatly eliminated. The XY nanopositioning stage is constructed with two orthogonally configured hybrid mechanisms along with the LTDP mechanisms for totally decoupled kinematics at both input and output ends. An analytical model was established to describe the complete elastic deformation behavior of the stage, with further verification through the finite element simulation. Finally, experiments were implemented to comprehensively evaluate both the static and dynamic performances of the proposed stage. Closed-loop control of the piezoelectric actuators (PEA) by integrating strain gauges was also conducted to effectively eliminate the nonlinear hysteresis of the stage.

Bill project related to the struggle against the proliferation of arms of massive destruction and their vectors

International Nuclear Information System (INIS)

2011-01-01

This bill project addresses several issues: the struggle against proliferation of arms of massive destruction (nuclear weapons, nuclear materials, biological weapons, and chemical weapons), the struggle against proliferation of vectors of arms of massive destruction, double-use goods, the use of these weapons and vectors in acts of terrorism

Isolated effects of peripheral arm and central body cooling on arm performance.

Science.gov (United States)

Giesbrecht, G G; Wu, M P; White, M D; Johnston, C E; Bristow, G K

1995-10-01

Whole body cooling impairs manual arm performance. The independent contributions of local (peripheral) and/or whole body (central) cooling are not known. Therefore, a protocol was developed in which the arm and the rest of the body could be independently cooled. Biceps temperature (Tmus), at a depth of 20 mm, and esophageal temperature (Tes) were measured. Six subjects were immersed to the clavicles in a tank (body tank) of water under 3 conditions: 1) cold body-cold arm (CB-CA); 2) warm body-cold arm (WB-CA); and 3) cold body-warm arm (CB-WA). In the latter two conditions, subjects placed their dominant arm in a separate (arm) tank. Water temperature (Tw) in each tank was independently controlled. In conditions requiring cold body and/or cold arm, Tw in the appropriate tanks was 8 degrees C. In conditions requiring warm body and/or warm arm, Tw in the appropriate tanks was adjusted between 29 and 38 degrees C to maintain body/arm temperature at baseline values. A battery of 6 tests, requiring fine or gross motor movements, were performed immediately before immersion and after 15, 45, and 70 minutes of immersion. In CB-CA, Tes decreased from an average of 37.2 to 35.6 degrees C and Tmus decreased from 34.6 to 22.0 degrees C. In WB-CA, Tmus decreased to 18.1 degrees C (Tes = 37.1 degrees C), and in CB-WA, Tes decreased to 35.8 degrees C (Tmus = 34.5 degrees C). By the end of immersion, there were significant decrements (43-85%) in the performance of all tests in CB-CA and WB-CA (p body and/or the arm elicits large decrements in finger, hand and arm performance. The decrements are due almost entirely to the local effects of arm tissue cooling.

Pick-up, transport and release of a molecular cargo using a small-molecule robotic arm

Science.gov (United States)

Kassem, Salma; Lee, Alan T. L.; Leigh, David A.; Markevicius, Augustinas; Solà, Jordi

2016-02-01

Modern-day factory assembly lines often feature robots that pick up, reposition and connect components in a programmed manner. The idea of manipulating molecular fragments in a similar way has to date only been explored using biological building blocks (specifically DNA). Here, we report on a wholly artificial small-molecule robotic arm capable of selectively transporting a molecular cargo in either direction between two spatially distinct, chemically similar, sites on a molecular platform. The arm picks up/releases a 3-mercaptopropanehydrazide cargo by formation/breakage of a disulfide bond, while dynamic hydrazone chemistry controls the cargo binding to the platform. Transport is controlled by selectively inducing conformational and configurational changes within an embedded hydrazone rotary switch that steers the robotic arm. In a three-stage operation, 79-85% of 3-mercaptopropanehydrazide molecules are transported in either (chosen) direction between the two platform sites, without the cargo at any time fully dissociating from the machine nor exchanging with other molecules in the bulk.

The newly proposed clinical and post-neoadjuvant treatment staging classifications for gastric adenocarcinoma for the American Joint Committee on Cancer (AJCC) staging.

Science.gov (United States)

In, Haejin; Ravetch, Ethan; Langdon-Embry, Marisa; Palis, Bryan; Ajani, Jaffer A; Hofstetter, Wayne L; Kelsen, David P; Sano, Takeshi

2018-01-01

New stage grouping classifications for clinical (cStage) and post-neoadjuvant treatment (ypStage) stage for gastric adenocarcinoma have been proposed for the eighth edition of the AJCC manual. This article summarizes the analysis for these stages. Gastric adenocarcinoma patients diagnosed in 2004-2009 were identified from the National Cancer Database (NCDB). The cStage cohort included both surgical and nonsurgical cases, and the ypStage cohort included only patients who had chemotherapy or radiation therapy before surgery. Survival differences between the stage groups were determined by the log-rank test and prognostic accuracy was assessed by concordance index. Analysis was performed using SAS 9.4 (SAS, Cary, NC, USA). Five strata for cStage and four strata for ypStage were developed. The 5-year survival rates for cStages were 56.77%, 47.39%, 33.1%, 25.9%, and 5.0% for stages I, IIa, IIb, III, and IV, respectively, and the rates for ypStage were 74.2%, 46.3%, 19.2%, and 11.6% for stages I, II, III, and IV, respectively. The log-rank test showed that survival differences were well stratified and stage groupings were ordered and distinct (p < 0.0001). The proposed cStage and ypStage classification was sensitive and specific and had high prognostic accuracy (cStage: c index = 0.81, 95% CI, 0.79-0.83; ypStage: c index = 0.80, 95% CI, 0.73-0.87). The proposed eighth edition establishes two new staging schemata that provide essential prognostic data for patients before treatment and for patients who have undergone surgery following neoadjuvant therapy. These additions are a significant advance to the AJCC staging manual and will provide critical guidance to clinicians in making informed decisions throughout the treatment course.

Patterns of arm muscle activation involved in octopus reaching movements.

Science.gov (United States)

Gutfreund, Y; Flash, T; Fiorito, G; Hochner, B

1998-08-01

The extreme flexibility of the octopus arm allows it to perform many different movements, yet octopuses reach toward a target in a stereotyped manner using a basic invariant motor structure: a bend traveling from the base of the arm toward the tip (Gutfreund et al., 1996a). To study the neuronal control of these movements, arm muscle activation [electromyogram (EMG)] was measured together with the kinematics of reaching movements. The traveling bend is associated with a propagating wave of muscle activation, with maximal muscle activation slightly preceding the traveling bend. Tonic activation was occasionally maintained afterward. Correlation of the EMG signals with the kinematic variables (velocities and accelerations) reveals that a significant part of the kinematic variability can be explained by the level of muscle activation. Furthermore, the EMG level measured during the initial stages of movement predicts the peak velocity attained toward the end of the reaching movement. These results suggest that feed-forward motor commands play an important role in the control of movement velocity and that simple adjustment of the excitation levels at the initial stages of the movement can set the velocity profile of the whole movement. A simple model of octopus arm extension is proposed in which the driving force is set initially and is then decreased in proportion to arm diameter at the bend. The model qualitatively reproduces the typical velocity profiles of octopus reaching movements, suggesting a simple control mechanism for bend propagation in the octopus arm.

Efficacy and immunogenicity of two or three dose rotavirus-vaccine regimen in South African children over two consecutive rotavirus-seasons: a randomized, double-blind, placebo-controlled trial.

Science.gov (United States)

Madhi, S A; Kirsten, M; Louw, C; Bos, P; Aspinall, S; Bouckenooghe, A; Neuzil, K M; Steele, A D

2012-04-27

Human rotavirus vaccine (HRV; i.e., Rotarix) reduced the incidence of severe rotavirus gastroenteritis (RVGE) by 77% (95% Confidence interval: 56-88%) during the first year of life in South Africa. Persistence of HRV-derived protection against RVGE during subsequent rotavirus seasons, although evident in industrialized settings, remains to be established in African settings. This study reports on the efficacy of HRV against severe RVGE over two consecutive rotavirus seasons in South African children. A prospective, double-blind, placebo controlled multi-centered trial in South Africa and Malawi randomly assigned infants in a 1:1:1 ratio to receive either two (10 and 14 weeks; HRV_2D) or three (6, 10 and 14 weeks; HRV_3D) doses of HRV or placebo. The primary analysis involved pooling of HRV_2D and HRV_3D arms. Episodes of gastroenteritis caused by wild-type rotavirus were identified through active follow-up surveillance and graded by the Vesikari scale. 1339 infants (447 in the HRV_2D group, 447 in the HRV_3D group and 445 in the placebo group) were enrolled in Year 2 of the study, including 1035 (77.3%) who were followed up over two consecutive rotavirus seasons (i.e., Cohort 2 subjects). Rotarix was associated with ongoing protection against severe RVGE, preventing 2.5 episodes per 100 vaccinated children over two consecutive rotavirus seasons; vaccine efficacy: 59% (95% Confidence interval: 1-83%). An exploratory analysis indicated better immunogenicity (among Cohort 1 subjects) and a higher point-efficacy estimate over two seasons in the HRV_3D compared to HRV_2D arms of the study in Cohort 2 subjects. Rotarix is associated with significant reductions in severe gastroenteritis episodes through 2 years of life among South African children. Further research is needed to determine the optimal dosing schedule of Rotarix in providing long-term protection against rotavirus illness in African children. Copyright © 2011 Elsevier Ltd. All rights reserved.

The Anglo-Scandinavian Cardiac Outcomes Trial lipid lowering arm: extended observations 2 years after trial closure

DEFF Research Database (Denmark)

Sever, Peter S; Poulter, Neil R; Dahlof, Bjorn

2008-01-01

Aims To determine the cardiovascular benefits in those originally assigned atorvastatin in the Anglo-Scandinavian Cardiac Outcomes Trial-2.2 years after closure of the lipid-lowering arm of the trial (ASCOT-LLA). Methods and results The Blood Pressure Lowering Arm of the ASCOT trial (ASCOT......-BPLA) compared two different antihypertensive treatment strategies on cardiovascular outcomes. ASCOT-LLA was a double-blind placebo-controlled trial of atorvastatin in those enrolled into ASCOT-BPLA with total cholesterol concentrations at baseline of ... enrolled in ASCOT-BPLA and 10 305 were further assigned either atorvastatin, 10 mg, or placebo. ASCOT-LLA was stopped prematurely after a median 3.3 years follow-up because of substantial cardiovascular benefits in those assigned atorvastatin. Trial physicians were invited to offer atorvastatin to all...

Measure of frequency of alveolar osteitis using two different methods of osteotomy in mandibular third molar impactions: a double-blind randomized clinical trial

International Nuclear Information System (INIS)

Rashid, H.; Amin, M.; Hussain, A.; Azam, K.

2018-01-01

Dento-alveolar surgical procedures involving third molar teeth are the most common surgical procedure in the field of surgery. The objective of this research was to analyse the impact of surgery on the incidence of alveolar osteitis after surgical removal of mandibular third molar and to compare two different bone cutting methods following impacted mandibular third molar surgery. Methods: This double blinded randomized clinical trial was executed at the OPD of Department of Oral and Maxillofacial Surgery, Dow University of Health Sciences, Karachi. The study duration was four months. It was conducted on 60 patients needing unilateral mandibular third molar impaction removal. Patients were randomized to two groups (i.e., physio dispenser group and slow speed handpiece group) before surgery. The surgical procedure was performed under local anaesthesia by using standardized cross infection protocol. The frequency of alveolar osteitis was evaluated on third-day postoperatively. Alveolar osteitis was diagnosed and confirmed by patient's history and clinical evaluation. Post-operative sequelae were observed and recorded objectively. Results: Out of 60 patients', five patients experienced alveolar osteitis, and the incidence rate was 8.3%. A significant p-value of 0.000 was calculated using binomial test for comparison of alveolar osteitis among both groups. Inter-examiner reliability was assessed by kappa and good (62%) agreement, which was found among the examiners, who diagnosed alveolar osteitis clinically. Post-operative sequelae were insignificant in slow speed hand piece group. Conclusion: It was observed that alveolar osteitis was reported in physio-dispenser group; similarly, post-operative complications were also more in this group as compared with slow speed-hand piece group. No surgical complications were observed in slow speed-hand piece group suggesting slow speed hand piece mode of osteotomy to be safer for third molar extraction as compared with

Measure Of Frequency Of Alveolar Osteitis Using Two Different Methods Of Osteotomy In Mandibular Third Molar Impactions: A Double-Blind Randomized Clinical Trial.

Science.gov (United States)

Rashid, Hina; Hussain, Azmina; Sheikh, Abdul Hafeez; Azam, Kehkishan; Malik, Sofia; Amin, Muhammad

2018-01-01

Dento-alveolar surgical procedures involving third molar teeth are the most common surgical procedure in the field of surgery. The objective of this research was to analyse the impact of surgery on the incidence of alveolar osteitis after surgical removal of mandibular third molar and to compare two different bone cutting methods following impacted mandibular third molar surgery.. This double blinded randomized clinical trial was executed at the OPD of Department of Oral and Maxillofacial Surgery, Dow University of Health Sciences, Karachi. The study duration was four months. It was conducted on 60 patients needing unilateral mandibular third molar impaction removal. Patients were randomized to two groups (i.e., physio dispenser group and slow speed handpiece group) before surgery. The surgical procedure was performed under local anaesthesia by using standardized cross infection protocol. The frequency of alveolar osteitis was evaluated on thirdday postoperatively. Alveolar osteitis was diagnosed and confirmed by patient's history and clinical evaluation. Post-operative sequelae were observed and recorded objectively. Out of 60 patients', five patients experienced alveolar osteitis, and the incidence rate was 8.3%. A significant pvalue of 0.000 was calculated using binomial test for comparison of alveolar osteitis among both groups. Inter-examiner reliability was assessed by kappa and good (62%) agreement, which was found among the examiners, who diagnosed alveolar osteitis clinically. Post-operative sequelae were insignificant in slow speed hand piece group. It was observed that alveolar osteitis was reported in physio-dispenser group; similarly, post-operative complications were also more in this group as compared with slow speed-hand piece group. No surgical complications were observed in slow speed-hand piece group suggesting slow speed hand piece mode of osteotomy to be safer for third molar extraction as compared with physio-dispenser.

Improving distress in dialysis (iDiD): a feasibility two-arm parallel randomised controlled trial of an online cognitive behavioural therapy intervention with and without therapist-led telephone support for psychological distress in patients undergoing haemodialysis.

Science.gov (United States)

Hudson, Joanna L; Moss-Morris, Rona; Game, David; Carroll, Amy; McCrone, Paul; Hotopf, Matthew; Yardley, Lucy; Chilcot, Joseph

2016-04-12

Psychological distress is common in end-stage kidney disease (ESKD) and is associated with poorer health outcomes. Cognitive behavioural therapy (CBT) is recommended in UK clinical guidelines for the management of depression in people with long-term conditions. Access to skilled therapists competent in managing the competing mental and physical health demands of ESKD is limited. Online CBT treatments tailored to the needs of the ESKD population offers a pragmatic solution for under-resourced services. This study examines the feasibility and acceptability of implementing a two-arm parallel randomised controlled trial of online CBT with (intervention arm) and without (control arm) therapist support to improve psychological distress in patients undergoing haemodialysis. Patients will be screened for depression and anxiety while attending for their haemodialysis treatments. We aim to recruit 60 adult patients undergoing haemodialysis who meet criteria for mild to moderately severe symptoms of depression and/or anxiety. Patients will be randomised individually (using a 1:1 computerised sequence ratio) to either online CBT with therapist telephone support (intervention arm), or online CBT with no therapist (control arm). Outcomes include feasibility and acceptability descriptive data on rates of recruitment, randomisation, retention and treatment adherence. Self-report outcomes include measures of depression (Patient Health Questionnaire-9), anxiety (Generalised Anxiety Disorder-7), quality of life (Euro-QoL), service use (client service receipt inventory) and illness cognitions (brief illness perception questionnaire). A qualitative process evaluation will also be conducted. The statistician will be blinded to treatment allocation. A National Health Service (NHS) research ethics committee approved the study. Data from this study will provide essential information for the design and testing of further interventions to ameliorate distress in patients undergoing dialysis

WE-EF-207-02: The Rotate-Plus-Shift C-Arm Trajectory: Theory and First Clinical Results

International Nuclear Information System (INIS)

Ritschl, L; Kachelriess, M; Kuntz, J

2015-01-01

Purpose: The proposed method enables the acquisition of a complete dataset for 3D reconstruction of C-Arm data using less than 180° rotation. Methods: Typically a C–arm cone–beam CT scan is performed using a circle–like trajectory around a region of interest. Therefore an angular range of at least 180° plus fan–angle must be covered to ensure a completely sampled data set. This fact defines some constraints on the geometry and technical specifications of a C–arm system, for example a larger C radius or a smaller C opening respectively. This is even more important for mobile C-arm devices which are typically used in surgical applications.To overcome these limitations we propose a new trajectory which requires only 180° minusfan–angle of rotation for a complete data set. The trajectory consists of three parts: A rotation of the C around a defined iso–center and two translational movements parallel to the detector plane at the begin and at the end of the rotation (rotate plus shift trajectory). This enables the acquisition of a completely sampled dataset using only 180° minus fan–angle of rotation. Results: For the evaluation of the method we show simulated and measured data. The results show, that the rotate plus shift scan yields equivalent image quality compared to the short scan which is assumed to be the gold standard for C-arm CT today. Compared to the pure rotational scan over only 165°, the rotate plus shift scan shows strong improvements in image quality. Conclusion: The proposed method makes 3D imaging using C–arms with less than 180° rotation range possible. This enables integrating full 3D functionality into a C- arm device without any loss of handling and usability for 2D imaging

Association of Previous Clinical Breast Examination With Reduced Delays and Earlier-Stage Breast Cancer Diagnosis Among Women in Peru.

Science.gov (United States)

Romanoff, Anya; Constant, Tara Hayes; Johnson, Kay M; Guadiamos, Manuel Cedano; Vega, Ana María Burga; Zunt, Joseph; Anderson, Benjamin O

2017-11-01

Mammographic screening is impractical in most of the world where breast cancers are first identified based on clinical signs and symptoms. Clinical breast examination may improve early diagnosis directly by finding breast cancers at earlier stages or indirectly by heightening women's awareness of breast health concerns. To investigate factors that influence time to presentation and stage at diagnosis among patients with breast cancer to determine whether history of previous clinical breast examination is associated with earlier presentation and/or earlier cancer stage at diagnosis. In this cross-sectional analysis of individual patient interviews using a validated Breast Cancer Delay Questionnaire, 113 (71.1%) of 159 women with breast cancer treated at a federally funded tertiary care referral cancer center in Trujillo, Peru, from February 1 through May 31, 2015, were studied. Method of breast cancer detection and factors that influence time to and stage at diagnosis. Of 113 women with diagnosed cancer (mean [SD] age, 54 [10.8] years; age range, 32-82 years), 105 (92.9%) had self-detected disease. Of the 93 women for whom stage was documented, 45 (48.4%) were diagnosed with early-stage disease (American Joint Committee on Cancer [AJCC] stage 0, I, or II), and 48 (51.6%) were diagnosed with late-stage disease (AJCC stage III or IV). Mean (SD) total delay from symptom onset to initiation of treatment was 407 (665) days because of patient (mean [SD], 198 [449] days) and health care system (mean [SD], 241 [556] days) delay. Fifty-two women (46.0%) had a history of clinical breast examination, and 23 (20.4%) had undergone previous mammography. Women who underwent a previous clinical breast examination were more likely to have shorter delays from symptom development to presentation compared with women who had never undergone a previous clinical breast examination (odds ratio, 2.92; 95% CI, 1.30-6.60; P = .01). Women diagnosed with shorter patient delay were more

The effects of the arm swing on biomechanical and physiological aspects of roller ski skating.

Science.gov (United States)

Hegge, Ann Magdalen; Ettema, Gertjan; de Koning, Jos J; Rognstad, Asgeir Bakken; Hoset, Martin; Sandbakk, Øyvind

2014-08-01

This study analyzed the biomechanical and physiological effects of the arm swing in roller ski skating, and compared leg-skating (i.e. ski skating without poles) using a pronounced arm swing (SWING) with leg-skating using locked arms (LOCKED). Sixteen elite male cross-country skiers performed submaximal stages at 10, 15 and 20kmh(-1) on a 2% inclined treadmill in the two techniques. SWING demonstrated higher peak push-off forces and a higher force impulse at all speeds, but a longer cycle length only at the highest speed (all Pskating increases the ski forces and aerobic energy cost at low and moderate speeds, whereas the greater forces at high speed lead to a longer cycle length and smaller anaerobic contribution. Copyright © 2014 Elsevier B.V. All rights reserved.

Synthesis and Characterization of Well-Defined Regular Star Polyisoprenes with 3, 4, 6 and 8 Arms

KAUST Repository

Ratkanthwar, Kedar R.; Hadjichristidis, Nikolaos; Pudukulathan, Zubaidha

2013-01-01

Three series of regular well-defined star polyisoprenes (PIs) with 3, 4 and 6 arms (each series: same arm molecular weight) have been synthesized by anionic polymerization high vacuum techniques and chlorosilane chemistry. In addition, three linear PIs with practically the double arm molecular weight of the corresponding series (2-arm star PIs) have been synthesized, as well as one 8-arm star PI. All intermediate (arms) and final (stars) products have been characterized by size exclusion chromatography (SEC), SEC-multi-angle laser light scattering (SEC-MALLS) and nuclear magnetic resonance (NMR) spectroscopy. The Tg of the star PIs was determined by differential scanning calorimetry. These model polymeric materials are essential for polymer physics and polymer physical chemistry in order to establish the structure/property relationships.

Final Report on Two-Stage Fast Spectrum Fuel Cycle Options

International Nuclear Information System (INIS)

Yang, Won Sik; Lin, C. S.; Hader, J. S.; Park, T. K.; Deng, P.; Yang, G.; Jung, Y. S.; Kim, T. K.; Stauff, N. E.

2016-01-01

This report presents the performance characteristics of two ''two-stage'' fast spectrum fuel cycle options proposed to enhance uranium resource utilization and to reduce nuclear waste generation. One is a two-stage fast spectrum fuel cycle option of continuous recycle of plutonium (Pu) in a fast reactor (FR) and subsequent burning of minor actinides (MAs) in an accelerator-driven system (ADS). The first stage is a sodium-cooled FR fuel cycle starting with low-enriched uranium (LEU) fuel; at the equilibrium cycle, the FR is operated using the recovered Pu and natural uranium without supporting LEU. Pu and uranium (U) are co-extracted from the discharged fuel and recycled in the first stage, and the recovered MAs are sent to the second stage. The second stage is a sodium-cooled ADS in which MAs are burned in an inert matrix fuel form. The discharged fuel of ADS is reprocessed, and all the recovered heavy metals (HMs) are recycled into the ADS. The other is a two-stage FR/ADS fuel cycle option with MA targets loaded in the FR. The recovered MAs are not directly sent to ADS, but partially incinerated in the FR in order to reduce the amount of MAs to be sent to the ADS. This is a heterogeneous recycling option of transuranic (TRU) elements

Two-stage electrolysis to enrich tritium in environmental water

International Nuclear Information System (INIS)

Shima, Nagayoshi; Muranaka, Takeshi

2007-01-01

We present a two-stage electrolyzing procedure to enrich tritium in environmental waters. Tritium is first enriched rapidly through a commercially-available electrolyser with a large 50A current, and then through a newly-designed electrolyser that avoids the memory effect, with a 6A current. Tritium recovery factor obtained by such a two-stage electrolysis was greater than that obtained when using the commercially-available device solely. Water samples collected in 2006 in lakes and along the Pacific coast of Aomori prefecture, Japan, were electrolyzed using the two-stage method. Tritium concentrations in these samples ranged from 0.2 to 0.9 Bq/L and were half or less, that in samples collected at the same sites in 1992. (author)

Functioning in early and late stages of schizophrenia

Directory of Open Access Journals (Sweden)

Leonardo Gazzi Costa

2014-12-01

Full Text Available INTRODUCTION: Schizophrenia is frequently associated with a debilitating course and prominent impairment in social and occupational functioning. Although the criteria for classification into stages have not been defined in the literature, illness duration and functioning seem to be good candidates.OBJECTIVE:To compare functioning of patients with schizophrenia at different stages of the disease (early vs. late and healthy sex- and age-matched controls.METHODS: This double-blinded, case-controlled study included 79 individuals: 23 patients with schizophrenia diagnosed up to 5 years earlier; 19 patients with schizophrenia diagnosed at least 20 years earlier; and healthy matched controls. Diagnoses were established using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV Axis I Disorder. Functioning was assessed using the Functioning Assessment Short Test (FAST.RESULTS: Patients in the early stage had significantly higher scores than healthy controls in total FAST and in autonomy, occupational functioning, cognitive functioning and interpersonal relationships. Individuals in the late stage had significantly poorer functioning than controls in all domains. The comparison of functioning between the two groups of patients revealed no significant differences, except in occupational functioning, in which late stage patients had a poorer performance.CONCLUSION: Functioning impairment in schizophrenia tends to remain stable despite illness duration. Therefore, functioning should be effectively assessed at an early stage, as illness duration alone may not be the most reliable criterion to stage patients with schizophrenia.

Two-stage nonrecursive filter/decimator

International Nuclear Information System (INIS)

Yoder, J.R.; Richard, B.D.

1980-08-01

A two-stage digital filter/decimator has been designed and implemented to reduce the sampling rate associated with the long-term computer storage of certain digital waveforms. This report describes the design selection and implementation process and serves as documentation for the system actually installed. A filter design with finite-impulse response (nonrecursive) was chosen for implementation via direct convolution. A newly-developed system-test statistic validates the system under different computer-operating environments

Validity, reliability, and feasibility of clinical staging scales in dementia: a systematic review

DEFF Research Database (Denmark)

Rikkert, Marcel G M Olde; Tona, Klodiana Daphne; Janssen, Lieneke

2011-01-01

New staging systems of dementia require adaptation of disease management programs and adequate staging instruments. Therefore, we systematically reviewed the literature on validity and reliability of clinically applicable, multidomain, and dementia staging instruments. A total of 23 articles...

TWO-STAGE REVISION HIP REPLACEMENT PATIENS WITH SEVERE ACETABULUM DEFECT (CASE REPORT

Directory of Open Access Journals (Sweden)

V. V. Pavlov

2017-01-01

Full Text Available Favorable short-term results of arthroplasty are observed in 80–90% of cases, however, over the longer follow up period the percentage of positive outcomes is gradually reduced. Need for revision of the prosthesis or it’s components increases in proportion to time elapsed from the surgery. In addition, such revision is accompanied with a need to substitute the bone defect of the acetabulum. As a solution the authors propose to replace pelvic defects in two stages. During the first stage the defect was filled with bone allograft with platelet-rich fibrin (allografting with the use of PRF technology. After the allograft remodeling during the second stage the revision surgery is performed by implanting standard prostheses. The authors present a clinical case of a female patient with aseptic loosening of acetabular component of prosthesis in the right hip joint, with failed hip function of stage 2, right limb shortening of 2 cm. Treatment results confirm the efficiency and rationality of the proposed bone grafting option. The authors conclude bone allograft in combination with the PRF technology proves to be an alternative to the implantation of massive metal implants in the acetabulum while it reduces the risk of implant-associated infection, of metallosis in surrounding tissues and expands further revision options.

On A Two-Stage Supply Chain Model In The Manufacturing Industry ...

African Journals Online (AJOL)

We model a two-stage supply chain where the upstream stage (stage 2) always meet demand from the downstream stage (stage 1).Demand is stochastic hence shortages will occasionally occur at stage 2. Stage 2 must fill these shortages by expediting using overtime production and/or backordering. We derive optimal ...

The position of the arm during blood pressure measurement in sitting position.

Science.gov (United States)

Adiyaman, Ahmet; Verhoeff, Rutger; Lenders, Jacques W M; Deinum, Jaap; Thien, Theo

2006-12-01

Determining the influence of the position of the arm on blood pressure measurement in the sitting position. Blood pressure of 128 individuals (the majority being treated hypertensive patients) visiting the outpatient clinic was measured simultaneously on both arms with arms in two different positions. First, both arms were placed at the chair support level and blood pressure was measured three times on both arms after 10 min of rest. Subsequently, while still remaining in the same sitting position, five blood pressure measurements were made simultaneously at both arms with one arm placed on the desk and one arm placed and supported at heart level (mid-sternal). The arm placed at heart level served as the reference arm. The choice of which arm was placed at desk level and which arm was placed at heart level was randomized. Both at desk level and at chair support level, mean (+/-SD) systolic and diastolic blood pressures were higher than blood pressure at heart level by 6.1/5.7+/-4.6/3.1 and 9.3/9.4+/-5.4/3.4 mmHg, respectively. The effect of the height differences between the arm positions on the blood pressure readings was smaller than predicted (0.49 mmHg/cm systolic and 0.47 mmHg/cm diastolic). No significant correlation was found between blood pressure difference in the different arm positions (desk and heart level) and age, sex, weight or baseline blood pressure. Different arm positions below heart level have significant effects on blood pressure readings. The leading guidelines about arm position during blood pressure measurement are not in accordance with the arm position used in the Framingham study, the most frequently used study for risk estimations.

CATALOG OF OBSERVED TANGENTS TO THE SPIRAL ARMS IN THE MILKY WAY GALAXY

Energy Technology Data Exchange (ETDEWEB)

Vallée, Jacques P., E-mail: jacques.vallee@nrc-cnrc.gc.ca [Herzberg Astrophysics, National Research Council Canada, National Science Infrastructure portfolio, 5071 West Saanich Road, Victoria, BC, V9E 2E7 (Canada)

2014-11-01

From the Sun's location in the Galactic disk, one can use different arm tracers (CO, H I, thermal or ionized or relativistic electrons, masers, cold and hot dust, etc.) to locate a tangent to each spiral arm in the disk of the Milky Way. We present a master catalog of the astronomically observed tangents to the Galaxy's spiral arms, using different arm tracers from the literature. Some arm tracers can have slightly divergent results from several papers, so a mean value is taken—see the Appendix for CO, H II, and masers. The catalog of means currently consists of 63 mean tracer entries, spread over many arms (Carina, Crux-Centaurus, Norma, Perseus origin, near 3 kpc, Scutum, Sagittarius), stemming from 107 original arm tracer entries. Additionally, we updated and revised a previous statistical analysis of the angular offset and linear separation from the mid-arm for each different mean arm tracer. Given enough arm tracers, and summing and averaging over all four spiral arms, one could determine if arm tracers have separate and parallel lanes in the Milky Way. This statistical analysis allows a cross-cut of a Galactic spiral arm to be made, confirming a recent discovery of a linear separation between arm tracers. Here, from the mid-arm's CO to the inner edge's hot dust, the arm halfwidth is about 340 pc; doubling would yield a full arm width of 680 pc. We briefly compare these observations with the predictions of many spiral arm theories, notably the density wave theory.

CATALOG OF OBSERVED TANGENTS TO THE SPIRAL ARMS IN THE MILKY WAY GALAXY

International Nuclear Information System (INIS)

Vallée, Jacques P.

2014-01-01

From the Sun's location in the Galactic disk, one can use different arm tracers (CO, H I, thermal or ionized or relativistic electrons, masers, cold and hot dust, etc.) to locate a tangent to each spiral arm in the disk of the Milky Way. We present a master catalog of the astronomically observed tangents to the Galaxy's spiral arms, using different arm tracers from the literature. Some arm tracers can have slightly divergent results from several papers, so a mean value is taken—see the Appendix for CO, H II, and masers. The catalog of means currently consists of 63 mean tracer entries, spread over many arms (Carina, Crux-Centaurus, Norma, Perseus origin, near 3 kpc, Scutum, Sagittarius), stemming from 107 original arm tracer entries. Additionally, we updated and revised a previous statistical analysis of the angular offset and linear separation from the mid-arm for each different mean arm tracer. Given enough arm tracers, and summing and averaging over all four spiral arms, one could determine if arm tracers have separate and parallel lanes in the Milky Way. This statistical analysis allows a cross-cut of a Galactic spiral arm to be made, confirming a recent discovery of a linear separation between arm tracers. Here, from the mid-arm's CO to the inner edge's hot dust, the arm halfwidth is about 340 pc; doubling would yield a full arm width of 680 pc. We briefly compare these observations with the predictions of many spiral arm theories, notably the density wave theory

Composite Tissue Transplant of Hand or Arm: A Health Technology Assessment.

Science.gov (United States)

2016-01-01

Injuries to arms and legs following severe trauma can result in the loss of large regions of tissue, disrupting healing and function and sometimes leading to amputation of the damaged limb. People experiencing amputations of the hand or arm could potentially benefit from composite tissue transplant, which is being performed in some countries. Currently, there are no composite tissue transplant programs in Canada. We conducted a systematic review of the literature, with no restriction on study design, examining the effectiveness and cost-effectiveness of hand and arm transplant. We assessed the overall quality of the clinical evidence with GRADE. We developed a Markov decision analytic model to determine the cost-effectiveness of transplant versus standard care for a healthy adult with a hand amputation. Incremental cost-effectiveness ratios (ICERs) were calculated using a 30-year time horizon. We also estimated the impact on provincial health care costs if these transplants were publicly funded in Ontario. Compared to pre-transplant function, patients' post-transplant function was significantly better. For various reasons, 17% of transplanted limbs were amputated, 6.4% of patients died within the first year after the transplant, and 10.6% of patients experienced chronic rejections. GRADE quality of evidence for all outcomes was very low. In the cost-effectiveness analysis, single-hand transplant was dominated by standard care, with increased costs ($735,647 CAD vs. $61,429) and reduced quality-adjusted life-years (QALYs) (10.96 vs. 11.82). Double-hand transplant also had higher costs compared with standard care ($633,780), but it had an increased effectiveness of 0.17 QALYs, translating to an ICER of $3.8 million per QALY gained. In most sensitivity analyses, ICERs for bilateral hand transplant were greater than $1 million per QALY gained. A hand transplant program would lead to an estimated annual budget impact of $0.9 million to $1.2 million in the next 3 years

Double Mesiodentes, Bilateral to Midline: A Report of Two Uncommon Cases

OpenAIRE

Avina Banari

2013-01-01

Background: Spontaneously erupted double mesiodentes, bilateral to midline are extremely rare and can alter both occlusion and appearance by affecting the eruption path, position, inclination and axial rotation of the maxillary permanent incisors. Case Report: Two cases of uncommon occurrence of spontaneously erupted double mesiodentes, bilateral to midline are presented here. The first case report highlights a situation where in treatment has been sought due to esthetic concerns arising,...

Two-stage anatomical repair of “simple” transposition of great arteries in neonates with extracardiac perinatal complications

Directory of Open Access Journals (Sweden)

O. Yu. Kornoukhov

2017-07-01

Full Text Available Aim. This study was designed to analyse the results of two-stage arterial switch operation (ASO of “simple” transposition of great arteries in patients with infection, neurological problems or necrotizing enterocolitis, which preclude neonatal surgery. Methods. Transthoracic echocardiography data and outcomes of surgery were investigated in 19 patients (study group; #1 after two-stage ASO and 67 patients (control group; #2 after a single-stage ASO. Age of patients at the first stage was 27 (8–55 days and at the second stage 172 (92–256 days. Patients in group 2 were 7 (2–53 days old. All of them were followed up for 21 (4–49 months (group 1 and 40 (7–79 months (group 2 after arterial switch operation. Results. There was no operative mortality at both stages in group 1. The duration of ventilation, length of intensive care unit and hospital stay after surgery were considerably lower in group 1. Actuarial sur-vival and freedom from reoperation at 4 years in group 1 accounted for 100%, while in the con-trol group those indicators at 6 years ran to 98.5% and 94%, respectively. The only difference detected by echocardiography was the aortic valve hinge points Z-score (3.9±1.44 vs 3.1±1.27; p=0.025 and sinuses of Valsalva (3.8±1.41 vs 2.8±1.19; p=0.03, which were higher in the 1st group. There was no aortic regurgitation >1 grade in both groups. Conclusion. Two-stage repair of “simple” transposition of great arteries, when it’s necessary to delay arterial switch operation on the clinical grounds, can be performed with excellent clinical outcomes. The tendency of group 1 patients to have a larger neo-aortic root does not appear to bear any clinical significance in mid-term follow-up.Received 21 December 2016. Accepted 8 May 2017.Funding: The study had no sponsorship.Conflict of interest: The authors declare no conflict of interest. Author contributions Study concept and design: Kornoukhov O.Yu., Ilyin V.N.Data collection and

Phase III double-blind evaluation of an aloe vera gel as a prophylactic agent for radiation-induced skin toxicity

International Nuclear Information System (INIS)

Williams, Maureen S.; Burk, Mary; Loprinzi, Charles L.; Hill, Mary; Schomberg, Paula J.; Nearhood, Kim; O'Fallon, Judith R.; Laurie, John A.; Shanahan, Thomas G.; Moore, Randy L.; Urias, Rodolfo E.; Kuske, Robert R.; Engel, Roland E.; Eggleston, William D.

1996-01-01

Purpose: Considerable pilot data and clinical experience suggested that an aloe vera gel might help to prevent radiation therapy-induced dermatitis. Methods and Materials: Two Phase III randomized trials were conducted. The first one was double blinded, utilized a placebo gel, and involved 194 women receiving breast or chest wall irradiation. The second trial randomized 108 such patients to aloe vera gel vs. no treatment. Skin dermatitis was scored weekly during both trials both by patients and by health care providers. Results: Skin dermatitis scores were virtually identical on both treatment arms during both of the trials. The only toxicity from the gel was rare contact dermatitis. Conclusions: This dose and schedule of an aloe vera gel does not protect against radiation therapy-induced dermatitis

Treatment of corn ethanol distillery wastewater using two-stage anaerobic digestion.

Science.gov (United States)

Ráduly, B; Gyenge, L; Szilveszter, Sz; Kedves, A; Crognale, S

In this study the mesophilic two-stage anaerobic digestion (AD) of corn bioethanol distillery wastewater is investigated in laboratory-scale reactors. Two-stage AD technology separates the different sub-processes of the AD in two distinct reactors, enabling the use of optimal conditions for the different microbial consortia involved in the different process phases, and thus allowing for higher applicable organic loading rates (OLRs), shorter hydraulic retention times (HRTs) and better conversion rates of the organic matter, as well as higher methane content of the produced biogas. In our experiments the reactors have been operated in semi-continuous phase-separated mode. A specific methane production of 1,092 mL/(L·d) has been reached at an OLR of 6.5 g TCOD/(L·d) (TCOD: total chemical oxygen demand) and a total HRT of 21 days (5.7 days in the first-stage, and 15.3 days in the second-stage reactor). Nonetheless the methane concentration in the second-stage reactor was very high (78.9%); the two-stage AD outperformed the reference single-stage AD (conducted at the same reactor loading rate and retention time) by only a small margin in terms of volumetric methane production rate. This makes questionable whether the higher methane content of the biogas counterbalances the added complexity of the two-stage digestion.

Nature of galaxy spiral arms

International Nuclear Information System (INIS)

Efremov, Yu.N.

1984-01-01

The nature of galaxy spiral arms is discussed in a popular form. Two approaches in the theory of spiral arms are considered; they are related to the problem of differential galaxy rotation and the spiral structure wave theory. The example of Galaxy M31 is considered to compare the structural peculiarity of its spiral arms with the wave theory predictions. The situation in the central and south-eastern part of arm S4 in Galaxy M31 noted to be completely explained by the wave theory and modern concepts on the origin of massive stars

Rapid Two-stage Versus One-stage Surgical Repair of Interrupted Aortic Arch with Ventricular Septal Defect in Neonates

Directory of Open Access Journals (Sweden)

Meng-Lin Lee

2008-11-01

Conclusion: The outcome of rapid two-stage repair is comparable to that of one-stage repair. Rapid two-stage repair has the advantages of significantly shorter cardiopulmonary bypass duration and AXC time, and avoids deep hypothermic circulatory arrest. LVOTO remains an unresolved issue, and postoperative aortic arch restenosis can be dilated effectively by percutaneous balloon angioplasty.

Placental cord drainage in the third stage of labor: Randomized clinical trial.

Science.gov (United States)

Vasconcelos, Fernanda Barros; Katz, Leila; Coutinho, Isabela; Lins, Vanessa Laranjeiras; de Amorim, Melania Maria

2018-01-01

An open randomized clinical trial was developed at Instituto de Medicina Integral Prof. Fernando Figueira (IMIP) in Recife and at Petronila Campos Municipal Hospital in São Lourenço da Mata, both in Pernambuco, northeastern Brazil, including 226 low-risk pregnant women bearing a single, full-term, live fetus after delayed cord clamping, 113 randomized to placental cord drainage and 113 to a control group not submitted to this procedure. Women incapable of understanding the study objectives and those who went on to have an instrumental or cesarean delivery were excluded. Duration of the third stage of labor did not differ between the two groups (14.2±12.9 versus 13.7±12.1 minutes (mean ± SD), p = 0.66). Likewise, there was no significant difference in mean blood loss (248±254 versus 208±187ml, p = 0.39) or in postpartum hematocrit levels (32.3±4.06 versus 32.8±4.25mg/dl, p = 0.21). Furthermore, no differences were found between the groups for any of the secondary outcomes (postpartum hemorrhage >500 or >1000ml, therapeutic use of oxytocin, third stage >30 or 60 minutes, digital evacuation of the uterus or curettage, symptoms of postpartum anemia and maternal satisfaction). Placental cord drainage had no effect in reducing duration or blood loss during the third stage of labor. ClinicalTrials.gov: www.clinicaltrial.gov, NCT01655576.

Correlative study of the brain CT and clinical features of patients with Down's syndrome in three clinical stages of Alzheimer type dementia

International Nuclear Information System (INIS)

Maruyama, Keiko; Ikeda, Shu-ichi; Yanagisawa, Nobuo.

1995-01-01

Patients with Down's syndrome often develop Alzheimer type neuropathological changes as well as dementia of the Alzheimer type after the age of 40. We studied brain CT findings in relation to three clinical stages of Alzheimer type dementia in 11 patients with Down's syndrome aged from 17 to 55 years. In addition, 123 I-IMP-SPECT was studied in 4 of these patients. Dementia of the Alzheimer type was present in 9 patients; 5 patients were in the early stage, 2 were in the progressive stage, and the other 2 were in the end stage. The earliest CT finding was enlargement of the suprasellar cistern, which indicated atrophy of the medial temporal lobe including the hippocampus and amygdala. This finding was not present in non-demented individuals with Down's syndrome. Moreover, CT scans showed that brain atrophy progressed to the temporal, frontal lobe, and then generalized cerebral cortices, which correlated clinically with the severity of dementia. Studies of 123 I-IMP-SPECT in two patients with mild dementia revealed abnormally decreased isotope uptake in the temporal and posterior parietal regions. We suggest to measure the size of the suprasellar cistern in CT and SPECT scans for early detection and diagnosis of mild dementia of the Alzheimer type in patients with Down's syndrome. (author)

Teaching basic life support with an automated external defibrillator using the two-stage or the four-stage teaching technique.

Science.gov (United States)

Bjørnshave, Katrine; Krogh, Lise Q; Hansen, Svend B; Nebsbjerg, Mette A; Thim, Troels; Løfgren, Bo

2018-02-01

Laypersons often hesitate to perform basic life support (BLS) and use an automated external defibrillator (AED) because of self-perceived lack of knowledge and skills. Training may reduce the barrier to intervene. Reduced training time and costs may allow training of more laypersons. The aim of this study was to compare BLS/AED skills' acquisition and self-evaluated BLS/AED skills after instructor-led training with a two-stage versus a four-stage teaching technique. Laypersons were randomized to either two-stage or four-stage teaching technique courses. Immediately after training, the participants were tested in a simulated cardiac arrest scenario to assess their BLS/AED skills. Skills were assessed using the European Resuscitation Council BLS/AED assessment form. The primary endpoint was passing the test (17 of 17 skills adequately performed). A prespecified noninferiority margin of 20% was used. The two-stage teaching technique (n=72, pass rate 57%) was noninferior to the four-stage technique (n=70, pass rate 59%), with a difference in pass rates of -2%; 95% confidence interval: -18 to 15%. Neither were there significant differences between the two-stage and four-stage groups in the chest compression rate (114±12 vs. 115±14/min), chest compression depth (47±9 vs. 48±9 mm) and number of sufficient rescue breaths between compression cycles (1.7±0.5 vs. 1.6±0.7). In both groups, all participants believed that their training had improved their skills. Teaching laypersons BLS/AED using the two-stage teaching technique was noninferior to the four-stage teaching technique, although the pass rate was -2% (95% confidence interval: -18 to 15%) lower with the two-stage teaching technique.

Validity, reliability, and feasibility of clinical staging scales in dementia: a systematic review

DEFF Research Database (Denmark)

Rikkert, Marcel G M Olde; Tona, Klodiana Daphne; Janssen, Lieneke

2011-01-01

New staging systems of dementia require adaptation of disease management programs and adequate staging instruments. Therefore, we systematically reviewed the literature on validity and reliability of clinically applicable, multidomain, and dementia staging instruments. A total of 23 articles...... describing 12 staging instruments were identified (N = 6109 participants, age 65-87). Reliability was studied in most (91%) of the articles and was judged moderate to good. Approximately 78% of the articles evaluated concurrent validity, which was good to very good, while discriminant validity was assessed...... in only 25%. The scales can be applied in ±15 minutes. Clinical Dementia Rating (CDR), Global Deterioration scale (GDS), and Functional Assessment Staging (FAST) have been monitored on reliability and validity, and the CDR currently is the best-evidenced scale, also studied in international perspective...

Double-Blind Comparison of Phlebitis Produced by Cephalothin Infusions with Buffered and Unbuffered Diluents

Science.gov (United States)

Carrizosa, Jaime; Levison, Matthew E.; Kaye, Donald

1974-01-01

In a double-blind study with each patient as his own control, a buffered and an unbuffered cephalothin solution was administered to 13 patients in opposite arms for a period of 48 h each. Neither the incidence of phlebitis nor the degree of phlebitis was different with the two diluents, and there was no difference in the time of onset of phlebitis. PMID:4840431

Diagnostic criteria and staging of hand-arm vibration syndrome in the United Kingdom.

Science.gov (United States)

McGeoch, Kenneth L; Lawson, Ian J; Burke, Frank; Proud, George; Miles, Jeremy

2005-07-01

In the United Kingdom the diagnosis of Hand-arm Vibration Syndrome varies depending on the purpose of that diagnosis. The criteria differ in three situations. More than 100,000 miners and ex-miners with claims for HAVS have been examined using a Medical Assessment Process which included the use of standardised tests. This contract is unique but it has had significant effects on the two other processes. The Industrial Injuries Disablement Benefit Scheme provides a benefit that can be paid to an employed earner because of an accident or Prescribed Disease. New recommendations have been published to remove the anomalies in the present format for assessing HAVS. If implemented the new scheme will recognise the Stockholm Workshop Scales and workers with neurological problems will also be compensated. The Health and Safety Executive will issue new guidance in the near future on the hazards of hand-arm vibration. Health surveillance in the workplace will be fundamental and the HSE propose a tiered approach with levels 1 to 5. Specialist occupational nurses and doctors with training in the diagnosis and assessment of HAVS will be needed for levels 3 and 4. Only at this level may a diagnosis of HAVS be made. The Medical Assessment Process has demonstrated that it is possible to examine a large number of claimants in a standardised manner. The IIAC and HSE recommendations contain very important improvements on the existing positions in the UK and it must be hoped that they will be implemented in the near future.

Clinical presentation and staging of Hodgkin lymphoma

DEFF Research Database (Denmark)

Gallamini, Andrea; Hutchings, Martin; Ramadan, Safaa

2016-01-01

, sometimes HL is a subtle disease, difficult to diagnose for the paucity of symptoms, the absence of physical findings, or for concomitant immunologic disorders: a compete overview of the common and rare patterns of HL clinical presentation will be also offered. The future perspective of PET scan use......In the present chapter the authors present a brief overview of the diagnostic methods proposed over time for Hodgkin lymphoma (HL) spread detection, moving from surgical procedures, through standard radiological and functional imaging techniques to the present state of the art for HL staging...... tomography (FDG-PET) scan in the armamentarium of staging procedures will be presented and commented, with a special emphasis on the utility of special procedures, such as bone marrow trephine biopsy, which is deemed no longer needed in the PET era. While the HL diagnosis is straightforward in most cases...

Feasibility of pure EFTR using an innovative new endoscopic suturing device: the Double-arm-bar Suturing System (with video).

Science.gov (United States)

Mori, Hirohito; Kobara, Hideki; Fujihara, Shintaro; Nishiyama, Noriko; Rafiq, Kazi; Oryu, Makoto; Fujiwara, Masao; Suzuki, Yasuyuki; Masaki, Tsutomu

2014-02-01

Endoscopic full-thickness resection (EFTR) requires a reliable full-thickness suturing device and an endoscopic counter-traction device to prevent the collapse of the digestive tract. The present study aimed to assess the reliability of newly developed flexible endoscopy suturing devices and the feasibility of pure EFTR. A total of 30 EFTRs were performed and allocated to three groups (N = 10 for each group). The full-thickness sutures were placed using over-the-scope clips (OTSCs), hand-sewn sutures, or the Double-arm-bar Suturing System (DBSS). Air leak tests were conducted in the three groups. The times required for the placement of one OTSC suture and single-stitch simple interrupted sutures (hand-sewn and DBSS sutures, respectively) were also compared. All 30 full-thickness sutures were completely and successfully placed. Regarding the air leak tests, the Mann-Whitney U test showed significant differences between OTSC and hand-sewn sutures (p = 0.003). There was also a significant difference between OTSC and DBSS sutures (p = 0.023). There was no significant difference between hand-sewn and DBSS sutures (p = 0.542). A significant difference was found in the suture time for single-stitch simple interrupted sutures among the OTSC, hand-sewn, and DBSS sutures. The Mann-Whitney U test revealed a significant difference between OTSC and hand-sewn sutures (p = 0.0001). There was no significant difference between OTSC and DBSS sutures (p = 0.533), while a significant difference was found between hand-sewn and DBSS sutures (p = 0.0001). Pure EFTR is feasible if the mechanical counter traction system is used to expand a small operative field and DBSS is used to make full-thickness sutures. The high safety of full-thickness resection and full-thickness suturing allows for clinical applications of this method.

Double Vacuum Bag Process for Resin Matrix Composite Manufacturing

Science.gov (United States)

Hou, Tan-Hung (Inventor); Jensen, Brian J. (Inventor)

2007-01-01

A double vacuum bag molding assembly with improved void management and laminate net shape control which provides a double vacuum enviromnent for use in fabricating composites from prepregs containing air and/or volatiles such as reactive resin matrix composites or composites from solvent containing prepregs with non-reactive resins matrices. By using two vacuum environments during the curing process, a vacuum can be drawn during a B-stage of a two-step cycle without placing the composite under significant relative pressure. During the final cure stage, a significant pressure can be applied by releasing the vacuum in one of the two environments. Inner and outer bags are useful for creating the two vacuum environments with a perforated tool intermediate the two. The composite is placed intermediate a tool plate and a caul plate in the first environment with the inner bag and tool plate defining the first environment. The second environment is characterized by the outer bag which is placed over the inner bag and the tool plate.

Stigma toward psychosis and its formulation process: prejudice and discrimination against early stages of schizophrenia.

Science.gov (United States)

Baba, Yoko; Nemoto, Takahiro; Tsujino, Naohisa; Yamaguchi, Taiju; Katagiri, Naoyuki; Mizuno, Masafumi

2017-02-01

Stigma toward psychosis can prevent social attendance and help-seeking behavior. Early detection and intervention has been shown to improve patient outcome in schizophrenia. The aim of this study was to reveal the characteristics and formulation process of stigma toward each clinical stage of schizophrenia, taking people's backgrounds into consideration. The participants consisted of three groups: general public, patients with mental illness, and psychiatric professionals. We performed a survey examining stigmas toward people with psychotic-like-experiences (PLE), at-risk mental state for psychosis (ARMS), schizophrenia, or depression. Prejudice was measured using a 21-item questionnaire, and discrimination was measured using the Social Distance Scale. The participants consisted of 149 people from the general public, 97 patients, and 119 psychiatric professionals. Generally, a similar pattern was observed among the groups in which prejudice and discrimination against PLE was mildest, followed by that against ARMS and depression, and finally schizophrenia. When the stigma of the general public was compared with that of psychiatric professionals, the prejudice and discrimination against PLE of the general public were both lower than those of the psychiatric professionals. However, the prejudice of the general public was stronger than that of the professionals for ARMS. Furthermore, the discrimination of the general public was stronger than that of the professionals for schizophrenia. The stigmas of mental illness differed according to the clinical stage, although the pattern of severity was similar among the three groups. A formulation process is suggested in which stigma toward schizophrenia develops from an attitudinal property (prejudice) against ARMS and a behavioral property (discrimination) against schizophrenia. Copyright © 2016 Elsevier Inc. All rights reserved.

Clinical aspects of the hand-arm vibration syndrome. A review.

Science.gov (United States)

Pyykkö, I

1986-10-01

At present it seems likely that the different components of the hand-arm vibration syndrome, eg, vibration-induced white finger (VWF), numbing of the hands and arms, muscular fatigue, and occasionally prevalent bone degeneration, may arise independently, and therefore they should be evaluated separately. Evidence of changes caused in the autonomic nervous functions of the body by local vibration is not conclusive. The vascular history should be confirmed objectively with a cold provocation test under laboratory conditions. In individual diagnostics it is useful to record (with modern plethysmographic techniques) the recovery of digital temperature, digital blood pressure, and flow after local cooling. Vibrotactile perception measurement seems to be suitable for group diagnosis. Much of the diagnostic weight for VWF can be obtained from accurate case histories, although, for early changes, the history may be atypical. The lack of simple objective tests for evaluating the hand-arm vibration syndrome makes it difficult to, eg, confirm the history of its different components objectively and estimate the extent of the disability it causes.

A high-gain and high-efficiency X-band triaxial klystron amplifier with two-stage cascaded bunching cavities

Science.gov (United States)

Zhang, Wei; Ju, Jinchuan; Zhang, Jun; Zhong, Huihuang

2017-12-01

To achieve GW-level amplification output radiation at the X-band, a relativistic triaxial klystron amplifier with two-stage cascaded double-gap bunching cavities is investigated. The input cavity is optimized to obtain a high absorption rate of the external injection microwave. The cascaded bunching cavities are optimized to achieve a high depth of the fundamental harmonic current. A double-gap standing wave extractor is designed to improve the beam wave conversion efficiency. Two reflectors with high reflection coefficients both to the asymmetric mode and the TEM mode are employed to suppress the asymmetric mode competition and TEM mode microwave leakage. Particle-in-cell simulation results show that a high power microwave with a power of 2.53 GW and a frequency of 8.4 GHz is generated with a 690 kV, 9.3 kA electron beam excitation and a 25 kW seed microwave injection. Particularly, the achieved power conversion efficiency is about 40%, and the gain is as high as 50 dB. Meanwhile, there is insignificant self-excitation of the parasitic mode in the proposed structure by adopting the reflectors. The relative phase difference between the injected signals and the output microwaves keeps locked after the amplifier becomes saturated.

Dental arch relationship outcomes in one- and two-stage palatoplasty for Japanese patients with complete unilateral cleft lip and palate.

Science.gov (United States)

Mikoya, Tadashi; Shibukawa, Toyoko; Susami, Takafumi; Sato, Yoshiaki; Tengan, Toshimoto; Katashima, Hirotaka; Oyama, Akihiko; Matsuzawa, Yusuke; Ito, Yumi; Funayama, Emi

2015-05-01

To compare dental arch relationship outcomes following one- and two-stage palatal repair. Nonrandomized, clinical trial with concurrent control. Hokkaido University Hospital. Sixty-eight consecutively treated Japanese patients with complete unilateral cleft lip and palate. Thirty-one of the 68 patients underwent two-stage palatoplasty with delayed hard palate closure, and 37 patients underwent one-stage pushback palatoplasty. Dental casts were taken at 4.9 to 6.3 (mean: 5.2) years of age in the two-stage group and at 4.0 to 6.3 (mean: 5.1) years of age in the one-stage group, and dental arch relationships were assessed using the 5-Year-Olds' Index (5-Y) by four raters and the Huddart/Bodenham Index (HB) by two raters. Intrarater and interrater reliabilities evaluated using weighted kappa statistics were good or better for the 5-Y and HB ratings. The mean 5-Y score was 2.94 in the two-stage group and 3.13 in the one-stage group (P value was not significant). However, there was a significant difference in distributions between the groups (P < .05). The HB scores of molars were significantly greater in the two-stage group than in the one-stage group (P < .05). The rank correlation coefficients between the 5-Y and total HB score (ρ = -0.840, P < .01) and between the 5-Y and the score of the incisors in the HB (ρ = -0.814, P < .01) were significantly increased. These results suggest that the anteroposterior relationship was not significantly different between the groups, but the transversal relationship was better in the two-stage group than in the one-stage group.

MEASUREMENT OF GALACTIC LOGARITHMIC SPIRAL ARM PITCH ANGLE USING TWO-DIMENSIONAL FAST FOURIER TRANSFORM DECOMPOSITION

International Nuclear Information System (INIS)

Davis, Benjamin L.; Berrier, Joel C.; Shields, Douglas W.; Kennefick, Julia; Kennefick, Daniel; Seigar, Marc S.; Lacy, Claud H. S.; Puerari, Ivânio

2012-01-01

A logarithmic spiral is a prominent feature appearing in a majority of observed galaxies. This feature has long been associated with the traditional Hubble classification scheme, but historical quotes of pitch angle of spiral galaxies have been almost exclusively qualitative. We have developed a methodology, utilizing two-dimensional fast Fourier transformations of images of spiral galaxies, in order to isolate and measure the pitch angles of their spiral arms. Our technique provides a quantitative way to measure this morphological feature. This will allow comparison of spiral galaxy pitch angle to other galactic parameters and test spiral arm genesis theories. In this work, we detail our image processing and analysis of spiral galaxy images and discuss the robustness of our analysis techniques.

Measurement of Galactic Logarithmic Spiral Arm Pitch Angle Using Two-dimensional Fast Fourier Transform Decomposition

Science.gov (United States)

Davis, Benjamin L.; Berrier, Joel C.; Shields, Douglas W.; Kennefick, Julia; Kennefick, Daniel; Seigar, Marc S.; Lacy, Claud H. S.; Puerari, Ivânio

2012-04-01

A logarithmic spiral is a prominent feature appearing in a majority of observed galaxies. This feature has long been associated with the traditional Hubble classification scheme, but historical quotes of pitch angle of spiral galaxies have been almost exclusively qualitative. We have developed a methodology, utilizing two-dimensional fast Fourier transformations of images of spiral galaxies, in order to isolate and measure the pitch angles of their spiral arms. Our technique provides a quantitative way to measure this morphological feature. This will allow comparison of spiral galaxy pitch angle to other galactic parameters and test spiral arm genesis theories. In this work, we detail our image processing and analysis of spiral galaxy images and discuss the robustness of our analysis techniques.

MEASUREMENT OF GALACTIC LOGARITHMIC SPIRAL ARM PITCH ANGLE USING TWO-DIMENSIONAL FAST FOURIER TRANSFORM DECOMPOSITION

Energy Technology Data Exchange (ETDEWEB)

Davis, Benjamin L.; Berrier, Joel C.; Shields, Douglas W.; Kennefick, Julia; Kennefick, Daniel; Seigar, Marc S.; Lacy, Claud H. S. [Arkansas Center for Space and Planetary Sciences, 202 Field House, University of Arkansas, Fayetteville, AR 72701 (United States); Puerari, Ivanio [Instituto Nacional de Astrofisica, Optica y Electronica, Calle Luis Enrique Erro 1, 72840 Santa Maria Tonantzintla, Puebla (Mexico)

2012-04-01

A logarithmic spiral is a prominent feature appearing in a majority of observed galaxies. This feature has long been associated with the traditional Hubble classification scheme, but historical quotes of pitch angle of spiral galaxies have been almost exclusively qualitative. We have developed a methodology, utilizing two-dimensional fast Fourier transformations of images of spiral galaxies, in order to isolate and measure the pitch angles of their spiral arms. Our technique provides a quantitative way to measure this morphological feature. This will allow comparison of spiral galaxy pitch angle to other galactic parameters and test spiral arm genesis theories. In this work, we detail our image processing and analysis of spiral galaxy images and discuss the robustness of our analysis techniques.

Final Report on Two-Stage Fast Spectrum Fuel Cycle Options

Energy Technology Data Exchange (ETDEWEB)

Yang, Won Sik [Purdue Univ., West Lafayette, IN (United States); Lin, C. S. [Purdue Univ., West Lafayette, IN (United States); Hader, J. S. [Purdue Univ., West Lafayette, IN (United States); Park, T. K. [Purdue Univ., West Lafayette, IN (United States); Deng, P. [Purdue Univ., West Lafayette, IN (United States); Yang, G. [Purdue Univ., West Lafayette, IN (United States); Jung, Y. S. [Purdue Univ., West Lafayette, IN (United States); Kim, T. K. [Argonne National Lab. (ANL), Argonne, IL (United States); Stauff, N. E. [Argonne National Lab. (ANL), Argonne, IL (United States)

2016-01-30

This report presents the performance characteristics of two “two-stage” fast spectrum fuel cycle options proposed to enhance uranium resource utilization and to reduce nuclear waste generation. One is a two-stage fast spectrum fuel cycle option of continuous recycle of plutonium (Pu) in a fast reactor (FR) and subsequent burning of minor actinides (MAs) in an accelerator-driven system (ADS). The first stage is a sodium-cooled FR fuel cycle starting with low-enriched uranium (LEU) fuel; at the equilibrium cycle, the FR is operated using the recovered Pu and natural uranium without supporting LEU. Pu and uranium (U) are co-extracted from the discharged fuel and recycled in the first stage, and the recovered MAs are sent to the second stage. The second stage is a sodium-cooled ADS in which MAs are burned in an inert matrix fuel form. The discharged fuel of ADS is reprocessed, and all the recovered heavy metals (HMs) are recycled into the ADS. The other is a two-stage FR/ADS fuel cycle option with MA targets loaded in the FR. The recovered MAs are not directly sent to ADS, but partially incinerated in the FR in order to reduce the amount of MAs to be sent to the ADS. This is a heterogeneous recycling option of transuranic (TRU) elements

The Clinical Stages of Sporadic Creutzfeldt-Jakob Disease with Met/Met Genotype in Korean Patients.

Science.gov (United States)

Park, So Young; Wang, Min Jeong; Jang, Jae-Won; Park, Young Ho; Lim, Jae-Sung; Youn, Young Chul; Kim, Jungeun; Kim, SangYun

2016-01-01

Clinical diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) is currently based on changes occurring in the late disease stages, which limits early-stage detection. Therefore, we investigated the disease course from the vague symptomatic to the terminal phase. We retrospectively reviewed 36 sCJD patient records, classifying the disease progression into 4 stages based on clinical manifestations: vague symptomatic, possible CJD, probable CJD and chronic vegetative state. We analyzed findings from diffusion-weighted imaging (DWI), electroencephalography (EEG) and cerebrospinal fluid (CSF) 14-3-3 protein testing performed at each stage. In stage 1, the most distinctive feature was DWI hyperintensities in the neocortex, even with negative CSF 14-3-3 protein and EEG results. In stage 2, DWI hyperintensities in the limbic cortex were more remarkable. CSF 14-3-3 protein testing yielded positive results in >80% of patients; EEG showed sensitivity in disease stage-dependent differences in clinical symptoms and laboratory test results will facilitate early and accurate diagnosis. © 2016 S. Karger AG, Basel.

Runway Operations Planning: A Two-Stage Heuristic Algorithm

Science.gov (United States)

Anagnostakis, Ioannis; Clarke, John-Paul

2003-01-01

The airport runway is a scarce resource that must be shared by different runway operations (arrivals, departures and runway crossings). Given the possible sequences of runway events, careful Runway Operations Planning (ROP) is required if runway utilization is to be maximized. From the perspective of departures, ROP solutions are aircraft departure schedules developed by optimally allocating runway time for departures given the time required for arrivals and crossings. In addition to the obvious objective of maximizing throughput, other objectives, such as guaranteeing fairness and minimizing environmental impact, can also be incorporated into the ROP solution subject to constraints introduced by Air Traffic Control (ATC) procedures. This paper introduces a two stage heuristic algorithm for solving the Runway Operations Planning (ROP) problem. In the first stage, sequences of departure class slots and runway crossings slots are generated and ranked based on departure runway throughput under stochastic conditions. In the second stage, the departure class slots are populated with specific flights from the pool of available aircraft, by solving an integer program with a Branch & Bound algorithm implementation. Preliminary results from this implementation of the two-stage algorithm on real-world traffic data are presented.

Intra-operative adjustment of standard planes in C-arm CT image data.

Science.gov (United States)

Brehler, Michael; Görres, Joseph; Franke, Jochen; Barth, Karl; Vetter, Sven Y; Grützner, Paul A; Meinzer, Hans-Peter; Wolf, Ivo; Nabers, Diana

2016-03-01

With the help of an intra-operative mobile C-arm CT, medical interventions can be verified and corrected, avoiding the need for a post-operative CT and a second intervention. An exact adjustment of standard plane positions is necessary for the best possible assessment of the anatomical regions of interest but the mobility of the C-arm causes the need for a time-consuming manual adjustment. In this article, we present an automatic plane adjustment at the example of calcaneal fractures. We developed two feature detection methods (2D and pseudo-3D) based on SURF key points and also transferred the SURF approach to 3D. Combined with an atlas-based registration, our algorithm adjusts the standard planes of the calcaneal C-arm images automatically. The robustness of the algorithms is evaluated using a clinical data set. Additionally, we tested the algorithm's performance for two registration approaches, two resolutions of C-arm images and two methods for metal artifact reduction. For the feature extraction, the novel 3D-SURF approach performs best. As expected, a higher resolution ([Formula: see text] voxel) leads also to more robust feature points and is therefore slightly better than the [Formula: see text] voxel images (standard setting of device). Our comparison of two different artifact reduction methods and the complete removal of metal in the images shows that our approach is highly robust against artifacts and the number and position of metal implants. By introducing our fast algorithmic processing pipeline, we developed the first steps for a fully automatic assistance system for the assessment of C-arm CT images.

Two-step rating-based 'double-faced applicability' test for sensory analysis of spread products as an alternative to descriptive analysis with trained panel.

Science.gov (United States)

Kim, In-Ah; den-Hollander, Elyn; Lee, Hye-Seong

2018-03-01

Descriptive analysis with a trained sensory panel has thus far been the most well defined methodology to characterize various products. However, in practical terms, intensive training in descriptive analysis has been recognized as a serious defect. To overcome this limitation, various novel rapid sensory profiling methodologies have been suggested in the literature. Among these, attribute-based methodologies such as check-all-that-apply (CATA) questions showed results comparable to those of conventional sensory descriptive analysis. Kim, Hopkinson, van Hout, and Lee (2017a, 2017b) have proposed a novel attribute-based methodology termed the two-step rating-based 'double-faced applicability' test with a novel output measure of applicability magnitude (d' A ) for measuring consumers' product usage experience throughout various product usage stages. In this paper, the potential of the two-step rating-based 'double-faced applicability' test with d' A was investigated as an alternative to conventional sensory descriptive analysis in terms of sensory characterization and product discrimination. Twelve commercial spread products were evaluated using both conventional sensory descriptive analysis with a trained sensory panel and two-step rating-based 'double-faced applicability' test with an untrained sensory panel. The results demonstrated that the 'double-faced applicability' test can be used to provide a direct measure of the applicability magnitude of sensory attributes of the samples tested in terms of d' A for sensory characterization of individual samples and multiple sample comparisons. This suggests that when the appropriate list of attributes to be used in the questionnaire is already available, the two-step rating-based 'double-faced applicability' test with d' A can be used as a more efficient alternative to conventional descriptive analysis, without requiring any intensive training process. Copyright © 2017 Elsevier Ltd. All rights reserved.

Two-stage residual inclusion estimation: addressing endogeneity in health econometric modeling.

Science.gov (United States)

Terza, Joseph V; Basu, Anirban; Rathouz, Paul J

2008-05-01

The paper focuses on two estimation methods that have been widely used to address endogeneity in empirical research in health economics and health services research-two-stage predictor substitution (2SPS) and two-stage residual inclusion (2SRI). 2SPS is the rote extension (to nonlinear models) of the popular linear two-stage least squares estimator. The 2SRI estimator is similar except that in the second-stage regression, the endogenous variables are not replaced by first-stage predictors. Instead, first-stage residuals are included as additional regressors. In a generic parametric framework, we show that 2SRI is consistent and 2SPS is not. Results from a simulation study and an illustrative example also recommend against 2SPS and favor 2SRI. Our findings are important given that there are many prominent examples of the application of inconsistent 2SPS in the recent literature. This study can be used as a guide by future researchers in health economics who are confronted with endogeneity in their empirical work.

The inter-arm diastolic blood pressure difference induced by one arm ischemia: a new approach to assess vascular endothelia function.

Directory of Open Access Journals (Sweden)

Weitong Hu

Full Text Available OBJECTIVES: To evaluate whether inter-arm diastolic blood pressure difference (DBPl-r induced by one arm ischemia correlates with flow-mediated dilatation (FMD. METHODS: Bilateral arm BPs were simultaneously measured with two automatic devices and right brachial artery diameter (D was measured by ultrasound technique in 108 subjects (56 hypertensives and 52 normotensives. Following baseline diameter (D0 and BP measurement, right brachial artery was occluded for 5 minutes. The diameter was measured at 1, 1.5 and 2 min, and bilateral BPs measured at 3, 4 and 5 min after occlusion release. Their averages were recorded as post-D and post-BP, respectively. The difference between post-D and D0 (ΔD was calculated as the percentage increase of artery diameter (ΔD/D0. The BP difference between left and right arms was calculated as BPl-r, and the difference of post- BPl-r and baseline BPl-r was recorded as the net change of BPl-r (ΔBPl-r. RESULTS: At baseline, bilateral SBPs and DBPs were similar. Right arm ischemia induced significant DBP decline only in the right arm (68.8±12.7 vs 72.6±12.0 mmHg, P<0.05, which led to an increase of ΔDBPl-r (4.00±3.75 vs 0.78±4.47 mmHg, P<0.05. A positive correlation was seen between ΔD/D0 and ΔDBPl-r (r = 0.744, p<0.001. Furthermore, the correlation between age and ΔDBPl-r (r = -0.358, P<0.01 was similar to that between age and D/D0 (r = -0.398, P<0.01. Meanwhile, both ΔDBPl-r and ΔD/D0 were significantly lower in hypertensive patients than in normotensive patients. CONCLUSION: The inter-arm DBP difference induced by one arm ischemia may be a potential index for clinical evaluation of vascular endothelial function.

Maximally efficient two-stage screening: Determining intellectual disability in Taiwanese military conscripts.

Science.gov (United States)

Chien, Chia-Chang; Huang, Shu-Fen; Lung, For-Wey

2009-01-27

The purpose of this study was to apply a two-stage screening method for the large-scale intelligence screening of military conscripts. We collected 99 conscripted soldiers whose educational levels were senior high school level or lower to be the participants. Every participant was required to take the Wisconsin Card Sorting Test (WCST) and the Wechsler Adult Intelligence Scale-Revised (WAIS-R) assessments. Logistic regression analysis showed the conceptual level responses (CLR) index of the WCST was the most significant index for determining intellectual disability (ID; FIQ ≤ 84). We used the receiver operating characteristic curve to determine the optimum cut-off point of CLR. The optimum one cut-off point of CLR was 66; the two cut-off points were 49 and 66. Comparing the two-stage window screening with the two-stage positive screening, the area under the curve and the positive predictive value increased. Moreover, the cost of the two-stage window screening decreased by 59%. The two-stage window screening is more accurate and economical than the two-stage positive screening. Our results provide an example for the use of two-stage screening and the possibility of the WCST to replace WAIS-R in large-scale screenings for ID in the future.

Perioperative Outcomes and Long-term Survival in Clinically Early-stage Thymic 
Malignancies: Video-assisted Thoracoscopic Thymectomy versus Open Approaches

Directory of Open Access Journals (Sweden)

Hao WANG

2016-07-01

Full Text Available Background and objective Video-assisted thoracoscopic surgery (VATS theoretically offers advantages over open thymectomy for clinically early-stage (Masaoka-Koga stage I and II thymic malignancies. However, longterm outcomes have not been well studied. We compared the postoperative outcomes and survival from a cohort study based on the database of the Chinese Alliance for Research in Thymomas (ChART. Methods Between 1994 and 2012, data of 1,117 patients having surgery for clinically early-stage (Masaoka-Koga stage I and II tumors were enrolled for the study. Among them, 241 cases underwent VATS thymectomy (VATS group, while 876 cases underwent open thymectomy (Open group. Univariate analyses were used to compare the clinical character and perioperative outcomes between the two groups. And multivariate analysis was performed to determine the independent predictive factors for long-term survival. Results Compared with the Open group, the VATS group had higher percentage of total thymectomy (80.5% vs 73.9%, P=0.028, resection rate (98.8% vs 88.7%, P<0.001 and less recurrence (2.9% vs 16.0%, P<0.001. Five-year overall survival was 92% after VATS and 92% after open thymectomy, with no significant difference between the two groups (P=0.15. However, 5-year disease free survival were 92% in VATS group and 83% in Open group (P=0.011. Cox proportional hazards model revealed that WHO classification, Masaoka-Koga stage and adjuvant therapy were independent predictive factors for overall survival, while surgical approach had no significant impact on long-term outcome. Conclusion This study suggests that VATS thymectomy is an effective approach for clinically early-stage thymic malignancies. And it may offer better perioperative outcomes, as well as equal oncological survival.

Skin denervation and its clinical significance in late-stage chronic kidney disease.

Science.gov (United States)

Chao, Chi-Chao; Wu, Vin-Cent; Tan, Chun-Hsiang; Wang, Yi-Mei; Tseng, Ming-Tsung; Wu, Pei-Chen; Lin, Yea-Huey; Lin, Whei-Min; Wu, Kwan-Dun; Hsieh, Sung-Tsang

2011-02-01

To investigate the skin innervation and its clinical significance in late-stage chronic kidney disease (CKD). Case series. National Taiwan University Hospital, Taipei, Taiwan. Forty consecutive nondiabetic patients with late-stage CKD (14 female and 26 male; mean [SD] age, 60.7 [12.3] years), including 2 cases with stage 3 CKD, 6 with stage 4 CKD, and 32 with stage 5 CKD, ie, end-stage kidney disease. Clinical evaluation of neurological deficits, nerve conduction study, autonomic function tests, and a 3-mm-diameter skin biopsy specimen taken from the distal leg. Quantitation of epidermal innervation, parameters of nerve conduction study, R-R interval variability, and sympathetic skin response. Clinically, 21 patients (52.5%) were symptomatic with paresthesia over the limbs or autonomic symptoms. The intraepidermal nerve fiber (IENF) density was markedly reduced in patients with CKD compared with age- and sex-matched controls (mean [SD], 2.8 [2.0] vs 8.6 [2.8] fibers/mm; P Skin denervation was observed in 27 patients (67.5%). Fifteen patients (37.5%) had abnormalities on nerve conduction studies, and 29 patients (72.5%) had abnormal results on autonomic function tests. By analysis with multiple regression models, the IENF density was negatively correlated with the duration of renal disease (P = .02). Additionally, the R-R interval variability at rest was linearly correlated with the IENF density (P = .02) and the absence of sympathetic skin responses at the soles was associated with reduced IENF density (P = .03). Small-fiber sensory and autonomic neuropathies constitute the major form of neuropathy in late-stage CKD. Furthermore, skin denervation was associated with the duration of renal disease.

Lactic-fermented egg white reduced serum cholesterol concentrations in mildly hypercholesterolemic Japanese men: a double-blind, parallel-arm design.

Science.gov (United States)

Matsuoka, Ryosuke; Usuda, Mika; Masuda, Yasunobu; Kunou, Masaaki; Utsunomiya, Kazunori

2017-05-30

Lactic-fermented egg white (LE), produced by lactic acid fermentation of egg white, is an easy-to-consume form of egg white. Here we assessed the effect of daily consumption of LE for 8 weeks on serum total cholesterol (TC) levels. The study followed a double-blind, parallel-arm design and included 88 adult men with mild hypercholesterolemia (mean ± standard error) serum TC levels, 229 ± 1.6 mg/dL; range, 204-259 mg/dL). The subjects were randomly divided into three groups, which consumed LE containing 4, 6, or 8 g of protein daily for 8 weeks. Blood samples were collected before starting LE consumption (baseline) and at 4 and 8 weeks to measure serum TC and low-density lipoprotein cholesterol (LDL-C) levels. After 8 weeks of consumption, serum TC levels in the 8 g group decreased by 11.0 ± 3.7 mg/dL, a significant decrease compared to baseline (p < 0.05) and a significantly greater decrease than for the 4 g group (3.1 ± 3.4 mg/dL; p < 0.05). Serum LDL-C levels in the 8 g group decreased by 13.7 ± 3.1 mg/dL, again a significant decrease compared with baseline (p < 0.05) and a significantly greater decrease than that for the 4 g group (2.1 ± 2.9 mg/dL; p < 0.05). Consumption of LE for 8 weeks at a daily dose of 8 g of proteins reduced serum TC and LDL-C levels in men with mild hypercholesterolemia, suggesting this may be effective in helping to prevent arteriosclerotic diseases. This clinical trial was retrospectively registered with the Japan Medical Association Center for Clinical Trials, (JMA-IIA00279; registered on 13/03/2017; https://dbcentre3.jmacct.med.or.jp/JMACTR/App/JMACTRE02_04/JMACTRE02_04.aspx?kbn=3&seqno=6530 ).

First results from the new double velocity-double energy spectrometer VERDI

Science.gov (United States)

Frégeau, M. O.; Oberstedt, S.; Gamboni, Th.; Geerts, W.; Hambsch, F.-J.; Vidali, M.

2016-05-01

The VERDI spectrometer (VElocity foR Direct mass Identification) is a two arm time-of-flight spectrometer built at the European Commission Joint Research Centre IRMM. It determines fragment masses and kinetic energy distributions produced in nuclear fission by means of the double velocity and double energy (2v-2E) method. The simultaneous measurement of pre- and post neutron fragment characteristics allows studying the share of excitation energy between the two fragments. In particular, the evolution of fission modes and neutron multiplicity may be studied as a function of the available excitation energy. Both topics are of great importance for the development of models used in the evaluation of nuclear data, and also have important implications for the fundamental understanding of the fission process. The development of VERDI focus on maximum geometrical efficiency while striving for highest possible mass resolution. An innovative transmission start detector, using electrons ejected from the target itself, was developed. Stop signal and kinetic energy of both fragments are provided by two arrays of silicon detectors. The present design provides about 200 times higher geometrical efficiency than that of the famous COSI FAN TUTTE spectrometer [Nuclear Instruments and Methods in Physics Research 219 (1984) 569]. We report about a commissioning experiment of the VERDI spectrometer, present first results from a 2v-2E measurement of 252Cf spontaneous fission and discuss the potential of this instrument to contribute to the investigation prompt fission neutron characteristics as a function of fission fragment properties.

Exact positioning of the robotic arm end effector

Science.gov (United States)

Korepanov, Valery; Dudkin, Fedir

2016-07-01

Orbital service becomes a new challenge of space exploration. The necessity to introduce it is connected first of all with an attractive opportunity to prolong the exploitation terms of expensive commercial satellites by, e.g., refilling of fuel or changing batteries. Other application area is a fight with permanently increasing amount of space litter - defunct satellites, burnt-out rocket stages, discarded trash and other debris. Now more than few tens of thousands orbiting objects larger than 5-10 cm (or about 1 million junks larger than 1 cm) are a huge problem for crucial and costly satellites and manned vehicles. For example, in 2014 the International Space Station had to change three times its orbit to avoid collision with space debris. So the development of the concepts and actions related to removal of space debris or non-operational satellites with use of robotic arm of a servicing satellite is very actual. Such a technology is also applicable for unmanned exploratory missions in solar system, for example for collecting a variety of samples from a celestial body surface. Naturally, the robotic arm movements should be controlled with great accuracy at influence of its non-rigidity, thermal and other factors. In these circumstances often the position of the arm end effector has to be controlled with high accuracy. The possibility of coordinate determination for the robotic arm end effector with use of a low frequency active electromagnetic system has been considered in the presented report. The proposed design of such a system consists of a small magnetic dipole source, which is mounted inside of the arm end effector and two or three 3-component magnetic field sensors mounted on a servicing satellite body. The data from this set of 3-component magnetic field sensors, which are fixed relatively to the satellite body, allows use of the mathematical approach for determination of position and orientation of the magnetic dipole source. The theoretical

A four arm, double blind, randomized and placebo controlled study of pregabalin in the management of post-burn pruritus.

Science.gov (United States)

Ahuja, Rajeev B; Gupta, Gaurav K

2013-02-01

Post-burn itch is a distressing symptom in burns rehabilitation and its treatment often proves frustrating for the patient and the multidisciplinary burns team. Traditionally, the mainstay of antipruritic therapy for decades has been antihistamines and massage with emollients. With a better understanding of the neurophysiology of itch emerged a new dimension in the treatment of post-burn pruritus. Gabapentin, a centrally modulating anti-epileptic agent and α2δ ligand, proved in clinical trials to be immensely better in the treatment of post-burn pruritus. Pregabalin is a newer structural analog of gabapentin. It has a much better anxiolytic effect and pharmacokinetic profile as compared to gabapentin. The current study was initiated to specifically study the role of pregabalin in relieving post-burn itch as this has never been investigated before. This double blind, randomized and placebo controlled study had four arms and was carried out on 80 adult patients (20 each). The four arms were: pregabalin, cetirizine with pheniramine maleate, combination of pregabalin, cetirizine and pheniramine maleate, and placebo (vit. B comp.). Massage with coconut oil was integral to all groups. Drug dosage was determined by initial VAS (visual analog scale) scores. All groups matched in demographic data and initial VAS scores. VAS scores were evaluated over next 28 days (days 3, 7, 14, 21 and 28). In patients with mild itch (VAS scores 2-5) or moderate itch (VAS scores 6-8) near complete remission of itch was seen in combination group and pregabalin group where the response was comparable and close to 95%. This was significantly better response than antihistaminic combination or massage alone. However, massage alone was sufficient in decreasing mean scores in mild itch, in a large percentage of patients. Amongst the patients with severe itch (VAS scores 9-10), 3/6 and 6/7 patients dropped out of trial in the antihistaminic and placebo groups, respectively. Combination therapy

Dynamic two-stage mechanism of versatile DNA damage recognition by xeroderma pigmentosum group C protein

Energy Technology Data Exchange (ETDEWEB)

Clement, Flurina C.; Camenisch, Ulrike; Fei, Jia; Kaczmarek, Nina; Mathieu, Nadine [Institute of Pharmacology and Toxicology, University of Zuerich-Vetsuisse, Winterthurerstrasse 260, CH-8057 Zuerich (Switzerland); Naegeli, Hanspeter, E-mail: naegelih@vetpharm.uzh.ch [Institute of Pharmacology and Toxicology, University of Zuerich-Vetsuisse, Winterthurerstrasse 260, CH-8057 Zuerich (Switzerland)

2010-03-01

The recognition and subsequent repair of DNA damage are essential reactions for the maintenance of genome stability. A key general sensor of DNA lesions is xeroderma pigmentosum group C (XPC) protein, which recognizes a wide variety of helix-distorting DNA adducts arising from ultraviolet (UV) radiation, genotoxic chemicals and reactive metabolic byproducts. By detecting damaged DNA sites, this unique molecular sensor initiates the global genome repair (GGR) pathway, which allows for the removal of all the aforementioned lesions by a limited repertoire of excision factors. A faulty GGR activity causes the accumulation of DNA adducts leading to mutagenesis, carcinogenesis, neurological degeneration and other traits of premature aging. Recent findings indicate that XPC protein achieves its extraordinary substrate versatility by an entirely indirect readout strategy implemented in two clearly discernible stages. First, the XPC subunit uses a dynamic sensor interface to monitor the double helix for the presence of non-hydrogen-bonded bases. This initial screening generates a transient nucleoprotein intermediate that subsequently matures into the ultimate recognition complex by trapping undamaged nucleotides in the abnormally oscillating native strand, in a way that no direct contacts are made between XPC protein and the offending lesion itself. It remains to be elucidated how accessory factors like Rad23B, centrin-2 or the UV-damaged DNA-binding complex contribute to this dynamic two-stage quality control process.

Effect of Agaricus sylvaticus supplementation on nutritional status and adverse events of chemotherapy of breast cancer: a randomized, placebo-controlled, double-blind clinical trial.

Science.gov (United States)

Valadares, Fabiana; Garbi Novaes, Maria Rita Carvalho; Cañete, Roberto

2013-01-01

Breast cancer (BC) represents the highest incidence of malignancy in women throughout the world. Medicinal fungi can stimulate the body, reduce side-effects associated with chemotherapy and improve the quality of life in patients with cancer. To evaluate the effects of dietary supplementation of Agaricus sylvaticus on clinical and nutritional parameters in BC patients undergoing chemotherapy. A randomized, placebo-controlled, double-blind, clinical trial was carried out at the Oncology Clinic, Hospital of the Federal District-Brazil from September 2007 to July 2009. Forty six patients with BC, Stage II and III, were randomly assigned to receive either nutritional supplement with A. sylvaticus (2.1 g/day) or placebo. Patients were evaluated during treatment period. Patient supplemented with A. sylvaticus improved in clinical parameters and gastrointestinal functions. Poor appetite decreased by 20% with no changes in bowel functions (92.8%), nausea and vomiting (80%). Dietary supplementation with A. sylvaticus improved nutritional status and reduced abnormal bowel functions, nausea, vomiting, and anorexia in patients with BC receiving chemotherapy.

The Two-Word Stage: Motivated by Linguistic or Cognitive Constraints?

Science.gov (United States)

Berk, Stephanie; Lillo-Martin, Diane

2012-01-01

Child development researchers often discuss a "two-word" stage during language acquisition. However, there is still debate over whether the existence of this stage reflects primarily cognitive or linguistic constraints. Analyses of longitudinal data from two Deaf children, Mei and Cal, not exposed to an accessible first language (American Sign…

A two-stage heating scheme for heat assisted magnetic recording

Science.gov (United States)

Xiong, Shaomin; Kim, Jeongmin; Wang, Yuan; Zhang, Xiang; Bogy, David

2014-05-01

Heat Assisted Magnetic Recording (HAMR) has been proposed to extend the storage areal density beyond 1 Tb/in.2 for the next generation magnetic storage. A near field transducer (NFT) is widely used in HAMR systems to locally heat the magnetic disk during the writing process. However, much of the laser power is absorbed around the NFT, which causes overheating of the NFT and reduces its reliability. In this work, a two-stage heating scheme is proposed to reduce the thermal load by separating the NFT heating process into two individual heating stages from an optical waveguide and a NFT, respectively. As the first stage, the optical waveguide is placed in front of the NFT and delivers part of laser energy directly onto the disk surface to heat it up to a peak temperature somewhat lower than the Curie temperature of the magnetic material. Then, the NFT works as the second heating stage to heat a smaller area inside the waveguide heated area further to reach the Curie point. The energy applied to the NFT in the second heating stage is reduced compared with a typical single stage NFT heating system. With this reduced thermal load to the NFT by the two-stage heating scheme, the lifetime of the NFT can be extended orders longer under the cyclic load condition.

Assessment of liver fibrosis stage influence on clinical course of periodontal diseases in patients with chronic hepatitis C

Directory of Open Access Journals (Sweden)

О. М. Slaba

2017-08-01

Full Text Available The aim. To assess the influence of liver fibrosis stage on the clinical course of periodontal diseases in patients with chronic hepatitis C. Material and Methods. 122 patients with chronic hepatitis C, treated at the 7th department ofLvivRegionalInfectiousDiseasesHospital during 2013 – 2015 were included into dental investigation. The periodontal disease was diagnosed in accordance with the classification of M. F. Danilevsky (1994. The clinical condition of periodontium was assessed by the papillary marginal alveolar index (PMA in the modification ofParma, by the periodontal index – PI (AL Russel, 1956, by the Muhlemann and Son index – the degree of bleeding in the region of the gingival papilla (PBI. The stage of liver fibrosis was determined according to the medical history. The significance of the difference between two or more relative indicators was calculated using the Fisher test with the Metropolis algorithm. The correlation dependence between the clinical condition of periodontal tissues and the stage of liver fibrosis in patients with viral hepatitis C was studied using the Spearman rank correlation coefficient. Results. The highest percentage of patients with stage of liver fibrosis F0 (70.00 ± 15.28 % was registered in patients with healthy periodont, the lowest - in patients with generalized periodontitis of the third stage (7.89 ± 4.37 %. The highest frequency of patients with the stage of liver fibrosis F3 (73.68 ± 7.14 % was also observed in persons suffering from generalized periodontitis stage III (73.68 ± 7.14 %. Conclusions. The distribution of periodontal lesion severity statistically significant (p < 0.001 depended on the stage of liver fibrosis in patients with chronic hepatitis C. Direct (R = 0.70; p < 0.001 strong correlation between the clinical state of periodontal tissues and the stage of liver fibrosis in patients with chronic hepatitis C (using the Spearman rank correlation coefficient has been determined

Radioimmunoimaging in clinical oncology

International Nuclear Information System (INIS)

Kairemo, K.J.A.

1993-01-01

In the thesis radiolabeled antibodies were tested for screening of cancer in patients without previous knowledge of tumour histopathology. They were tested as well targeting known cancer, sometimes in unknown clinical stage. Methods for detection enhancement utilizing double-tracer techniques and alternative routes of administration were also investigated. (385 refs., 11 tabs.)

Efficacy of single-stage and two-stage Fowler–Stephens laparoscopic orchidopexy in the treatment of intraabdominal high testis

Directory of Open Access Journals (Sweden)

Chang-Yuan Wang

2017-11-01

Conclusion: In the case of testis with good collateral circulation, single-stage F-S laparoscopic orchidopexy had the same safety and efficacy as the two-stage F-S procedure. Surgical options should be based on comprehensive consideration of intraoperative testicular location, testicular ischemia test, and collateral circumstances surrounding the testes. Under the appropriate conditions, we propose single-stage F-S laparoscopic orchidopexy be preferred. It may be appropriate to avoid unnecessary application of the two-stage procedure that has a higher cost and causes more pain for patients.

One-photon two-electron processes in helium close to the double ionization threshold

International Nuclear Information System (INIS)

Bouri, C.

2007-04-01

This work presents a study of the 1 P 0 excited states of He that can be reached by absorption of a single photon carrying an energy close to the double ionization threshold (DIT) (79 eV). Above the DIT, these states are the double continuum states; below, they are the double excited states. These two types of states are tightly coupled to the single continuum states with or without excitation of the residual ion He + , owing to their degeneracy in energy. In a one-photon process, these states can only be formed owing to the electronic correlations in the system which must be well described to obtain quantitative good results. Our study is a part of the work which aims at a united description of all these doubly excited, ionized-excited, and double continuum states. We use the Hyperspherical R-Matrix with Semiclassical Outgoing Waves (HRM-SOW) method, initially dedicated to double photoionization studies. We extend it to extract information on the single continuum. This extension allows us to compute cross sections of single photoionization with or without excitation up to n 50 for an excess of 100 meV just above the double ionization threshold. A deep insight into this process is given by a partial waves analysis. The results obtained shed light on the key role of angular and radial correlations. The numerous data we obtain on double and single ionization allow us to establish a continuity relation between these two processes. We show that single ionization with an infinite excitation of the residual ion merges into double photoionization when the excess energy is redistributed between the two electrons. It appears that this relation is valid not only for low but also for high photon energies. Since the HRM-SOW can produce the integrated cross section for double photoionization with high accuracy in the low energy domain, we check the Wannier threshold law. The parameters extracted support strongly this threshold law, and are in good agreement with experimental

Structure of the two-neutrino double-β decay matrix elements within perturbation theory

Science.gov (United States)

Štefánik, Dušan; Šimkovic, Fedor; Faessler, Amand

2015-06-01

The two-neutrino double-β Gamow-Teller and Fermi transitions are studied within an exactly solvable model, which allows a violation of both spin-isospin SU(4) and isospin SU(2) symmetries, and is expressed with generators of the SO(8) group. It is found that this model reproduces the main features of realistic calculation within the quasiparticle random-phase approximation with isospin symmetry restoration concerning the dependence of the two-neutrino double-β decay matrix elements on isovector and isoscalar particle-particle interactions. By using perturbation theory an explicit dependence of the two-neutrino double-β decay matrix elements on the like-nucleon pairing, particle-particle T =0 and T =1 , and particle-hole proton-neutron interactions is obtained. It is found that double-β decay matrix elements do not depend on the mean field part of Hamiltonian and that they are governed by a weak violation of both SU(2) and SU(4) symmetries by the particle-particle interaction of Hamiltonian. It is pointed out that there is a dominance of two-neutrino double-β decay transition through a single state of intermediate nucleus. The energy position of this state relative to energies of initial and final ground states is given by a combination of strengths of residual interactions. Further, energy-weighted Fermi and Gamow-Teller sum rules connecting Δ Z =2 nuclei are discussed. It is proposed that these sum rules can be used to study the residual interactions of the nuclear Hamiltonian, which are relevant for charge-changing nuclear transitions.

Prognostic significance of clinical and pathological stages on locally advanced rectal carcinoma after neoadjuvant chemoradiotherapy

International Nuclear Information System (INIS)

Wen, Bixiu; Zhang, Luning; Wang, Chengtao; Huang, Rong; Peng, Haihua; Zhang, Tian; Dong, Jun; Xiao, Weiwei; Zeng, Zhifan; Liu, Mengzhong; Gao, Yuanhong

2015-01-01

To investigate prognostic significance of clinical and pathological stages in patients with locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy (neo-CRT) and total mesorectal excision. 210 patients with locally advanced rectal carcinoma (cT3-4 or cN+) treated with neo-CRT followed by total mesorectal excision. Treatment outcomes were compared according to clinical and pathological stage. Overall survival (OS), disease free survival (DFS) among patients with different clinical stage and pathological stage after neo-CRT. The median follow-up time was 47 months (range, 14–98 months). Clinical T stage was associated with 5 year OS (p = 0.042) and 5 year DFS (p = 0.014) while clinical N stage was not associated with 5 year OS (p = 0.440), 5 year DFS (p = 0.711). Pathological T stage was associate with 5 year OS (p = 0.001) and 5 year DFS (p = 0.046); and N stage was associated with 5 year OS (p = 0.001), 5 year DFS (p = 0.002). The pathological stage was further classified into three groups: ypT0–2N0 in 91 patients (43.3 %), ypT3–4N0 in 69 patients (32.9 %) and ypT0–4N+ in 50 patients (23.8 %). While pathological stage (ypT0–2 vs ypT3–4N0 vs ypT0–4N+) was associated with 5 year OS (87.9 %, 75.5 %, 56.7 %, p = 0.000), 5 year DFS (74.5 %, 77.4 %, 50.5 %, p = 0.003). Multivariate analysis showed that ypN stage was an independent prognostic factor for patients 5 year DFS. Pathological stage is strongly associated with treatment outcomes in patients with locally advanced rectal carcinoma treated with neo-CRT followed by total mesorectal excision, which may be used as guidance for further individualized treatment

Clinical study of double dose of valsartan combined with tacrolimus in treatment of diabetic nephropathy.

Science.gov (United States)

Jin, H; Zhang, H-N; Hou, X-L; Zhang, B; Wu, J; Zhang, H-B

2016-01-01

To investigate the clinical effect of double dose of valsartan combined with tacrolimus in the treatment of diabetic nephropathy (DN). HA total of 86 cases diagnosed with DN were selected from October 2013 to October 2014 in Zaozhuang Municipal Hospital, China. The study was approved by our hospital Ethics Committee and written consent was obtained from patients and their family members. Patients were randomly divided into three groups according to the sequence of admission, group A (conventional dose of valsartan group, n = 28 cases), group B (double dose of valsartan group, n = 29 cases) and group C (double dose of valsartan combined with tacrolimus group, n = 29). Clinical effects were compared by analyzing the renal function tests after 8 weeks. 24h urine protein, serum creatinine level of patients in group B and group C were significantly lower than that of group A. Those in group C was much lower. The glomerular filtration rates were significantly higher for group B and C than that of group A, and those in group C were much higher. The difference is statistically significant (p valsartan combined with tacrolimus treatment of DN patients can improve clinical symptoms, reducing inflammation, inhibiting or even reversing the interstitial fibrosis, which will improve the curative effect and reduce the recurrence, as to provide a new theoretical basis for the clinical treatment of the disease.

Performance of arm locking in LISA

International Nuclear Information System (INIS)

McKenzie, Kirk; Spero, Robert E.; Shaddock, Daniel A.

2009-01-01

For the Laser Interferometer Space Antenna (LISA) to reach its design sensitivity, the coupling of the free-running laser frequency noise to the signal readout must be reduced by more than 14 orders of magnitude. One technique employed to reduce the laser frequency noise will be arm locking, where the laser frequency is locked to the LISA arm length. In this paper we detail an implementation of arm locking. We investigate orbital effects (changing arm lengths and Doppler frequencies), the impact of errors in the Doppler knowledge that can cause pulling of the laser frequency, and the noise limit of arm locking. Laser frequency pulling is examined in two regimes: at lock acquisition and in steady state. The noise performance of arm locking is calculated with the inclusion of the dominant expected noise sources: ultrastable oscillator (clock) noise, spacecraft motion, and shot noise. We find that clock noise and spacecraft motion limit the performance of dual arm locking in the LISA science band. Studying these issues reveals that although dual arm locking [A. Sutton and D. A. Shaddock, Phys. Rev. D 78, 082001 (2008)] has advantages over single (or common) arm locking in terms of allowing high gain, it has disadvantages in both laser frequency pulling and noise performance. We address this by proposing a modification to the dual arm-locking sensor, a hybrid of common and dual arm-locking sensors. This modified dual arm-locking sensor has the laser frequency pulling characteristics and low-frequency noise coupling of common arm locking, but retains the control system advantages of dual arm locking. We present a detailed design of an arm-locking controller and perform an analysis of the expected performance when used with and without laser prestabilization. We observe that the sensor phase changes beneficially near unity-gain frequencies of the arm-locking controller, allowing a factor of 10 more gain than previously believed, without degrading stability. With a time

Hand-arm vibration syndrome: clinical characteristics, conventional electrophysiology and quantitative sensory testing.

Science.gov (United States)

Rolke, Roman; Rolke, Silke; Vogt, Thomas; Birklein, Frank; Geber, Christian; Treede, Rolf-Detlef; Letzel, Stephan; Voelter-Mahlknecht, Susanne

2013-08-01

Workers exposed to vibrating tools may develop hand-arm vibration syndrome (HAVS). We assessed the somatosensory phenotype using quantitative sensory testing (QST) in comparison to electrophysiology to characterize (1) the most sensitive QST parameter for detecting sensory loss, (2) the correlation of QST and electrophysiology, and (3) the frequency of a carpal tunnel syndrome (CTS) in HAVS. QST, cold provocation tests, fine motor skills, and median nerve neurography were used. QST included thermal and mechanical detection and pain thresholds. Thirty-two patients were examined (54 ± 11 years, 91% men) at the more affected hand compared to 16 matched controls. Vibration detection threshold was the most sensitive parameter to detect sensory loss that was more pronounced in the sensitivity range of Pacinian (150 Hz, x12) than Meissner's corpuscles (20 Hz, x3). QST (84% abnormal) was more sensitive to detect neural dysfunction than conventional electrophysiology (37% abnormal). Motor (34%) and sensory neurography (25%) were abnormal in HAVS. CTS frequency was not increased (9.4%). Findings are consistent with a mechanically-induced, distally pronounced motor and sensory neuropathy independent of CTS. HAVS involves a neuropathy predominantly affecting large fibers with a sensory damage related to resonance frequencies of vibrating tools. Copyright © 2013 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Two-Stage Regularized Linear Discriminant Analysis for 2-D Data.

Science.gov (United States)

Zhao, Jianhua; Shi, Lei; Zhu, Ji

2015-08-01

Fisher linear discriminant analysis (LDA) involves within-class and between-class covariance matrices. For 2-D data such as images, regularized LDA (RLDA) can improve LDA due to the regularized eigenvalues of the estimated within-class matrix. However, it fails to consider the eigenvectors and the estimated between-class matrix. To improve these two matrices simultaneously, we propose in this paper a new two-stage method for 2-D data, namely a bidirectional LDA (BLDA) in the first stage and the RLDA in the second stage, where both BLDA and RLDA are based on the Fisher criterion that tackles correlation. BLDA performs the LDA under special separable covariance constraints that incorporate the row and column correlations inherent in 2-D data. The main novelty is that we propose a simple but effective statistical test to determine the subspace dimensionality in the first stage. As a result, the first stage reduces the dimensionality substantially while keeping the significant discriminant information in the data. This enables the second stage to perform RLDA in a much lower dimensional subspace, and thus improves the two estimated matrices simultaneously. Experiments on a number of 2-D synthetic and real-world data sets show that BLDA+RLDA outperforms several closely related competitors.

Two-stage precipitation of plutonium trifluoride

International Nuclear Information System (INIS)

Luerkens, D.W.

1984-04-01

Plutonium trifluoride was precipitated using a two-stage precipitation system. A series of precipitation experiments identified the significant process variables affecting precipitate characteristics. A mathematical precipitation model was developed which was based on the formation of plutonium fluoride complexes. The precipitation model relates all process variables, in a single equation, to a single parameter that can be used to control particle characteristics

Arm-in-Arm Response Regulator Dimers Promote Intermolecular Signal Transduction

Energy Technology Data Exchange (ETDEWEB)

Baker, Anna W.; Satyshur, Kenneth A.; Morales, Neydis Moreno; Forest, Katrina T. (UW)

2016-02-01

Bacteriophytochrome photoreceptors (BphPs) and their cognate response regulators make up two-component signal transduction systems which direct bacteria to mount phenotypic responses to changes in environmental light quality. Most of these systems utilize single-domain response regulators to transduce signals through unknown pathways and mechanisms. Here we describe the photocycle and autophosphorylation kinetics of RtBphP1, a red light-regulated histidine kinase from the desert bacteriumRamlibacter tataouinensis. RtBphP1 undergoes red to far-red photoconversion with rapid thermal reversion to the dark state. RtBphP1 is autophosphorylated in the dark; this activity is inhibited under red light. The RtBphP1 cognate response regulator, theR. tataouinensisbacteriophytochrome response regulator (RtBRR), and a homolog, AtBRR fromAgrobacterium tumefaciens, crystallize unexpectedly as arm-in-arm dimers, reliant on a conserved hydrophobic motif, hFWAhL (where h is a hydrophobic M, V, L, or I residue). RtBRR and AtBRR dimerize distinctly from four structurally characterized phytochrome response regulators found in photosynthetic organisms and from all other receiver domain homodimers in the Protein Data Bank. A unique cacodylate-zinc-histidine tag metal organic framework yielded single-wavelength anomalous diffraction phases and may be of general interest. Examination of the effect of the BRR stoichiometry on signal transduction showed that phosphorylated RtBRR is accumulated more efficiently than the engineered monomeric RtBRR (RtBRR_mon) in phosphotransfer reactions. Thus, we conclude that arm-in-arm dimers are a relevant signaling intermediate in this class of two-component regulatory systems.

A double-blind placebo-controlled randomized trial of adalimumab in the treatment of hidradenitis suppurativa

DEFF Research Database (Denmark)

Miller, I; Lynggaard, C D; Lophaven, S

2011-01-01

BACKGROUND: Hidradenitis suppurativa (HS) has an impact on patients' quality of life. Treatment of HS is generally unsatisfactory, thus new treatments are needed. OBJECTIVES: To test the efficacy of adalimumab in HS. METHODS: This was a prospective, randomized, double-blinded, placebo-controlled,......BACKGROUND: Hidradenitis suppurativa (HS) has an impact on patients' quality of life. Treatment of HS is generally unsatisfactory, thus new treatments are needed. OBJECTIVES: To test the efficacy of adalimumab in HS. METHODS: This was a prospective, randomized, double-blinded, placebo......-controlled, two-centre clinical trial conducted in Denmark. Inclusion criteria were age above 18 years and a clinical diagnosis of moderate to severe HS defined as Hurley stage II or III for at least 6 months. The patients were randomized 1:2 (placebo/active). Actively treated patients received adalimumab 80 mg...... subcutaneously (s.c.) at baseline followed by 40 mg s.c. every other week for 12 weeks. Placebo-treated patients received identical-looking injections with no active ingredient. The medicine was dispensed in sequentially numbered computer-randomized containers. Participants, care givers and those assessing...

One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies.

Science.gov (United States)

Kunutsor, Setor K; Whitehouse, Michael R; Blom, Ashley W; Board, Tim; Kay, Peter; Wroblewski, B Mike; Zeller, Valérie; Chen, Szu-Yuan; Hsieh, Pang-Hsin; Masri, Bassam A; Herman, Amir; Jenny, Jean-Yves; Schwarzkopf, Ran; Whittaker, John-Paul; Burston, Ben; Huang, Ronald; Restrepo, Camilo; Parvizi, Javad; Rudelli, Sergio; Honda, Emerson; Uip, David E; Bori, Guillem; Muñoz-Mahamud, Ernesto; Darley, Elizabeth; Ribera, Alba; Cañas, Elena; Cabo, Javier; Cordero-Ampuero, José; Redó, Maria Luisa Sorlí; Strange, Simon; Lenguerrand, Erik; Gooberman-Hill, Rachael; Webb, Jason; MacGowan, Alasdair; Dieppe, Paul; Wilson, Matthew; Beswick, Andrew D

2018-04-05

One-stage and two-stage revision strategies are the two main options for treating established chronic peri-prosthetic joint infection (PJI) of the hip; however, there is uncertainty regarding which is the best treatment option. We aimed to compare the risk of re-infection between the two revision strategies using pooled individual participant data (IPD). Observational cohort studies with PJI of the hip treated exclusively by one- or two-stage revision and reporting re-infection outcomes were retrieved by searching MEDLINE, EMBASE, Web of Science, The Cochrane Library, and the WHO International Clinical Trials Registry Platform; as well as email contact with investigators. We analysed IPD of 1856 participants with PJI of the hip from 44 cohorts across four continents. The primary outcome was re-infection (recurrence of infection by the same organism(s) and/or re-infection with a new organism(s)). Hazard ratios (HRs) for re-infection were calculated using Cox proportional frailty hazards models. After a median follow-up of 3.7 years, 222 re-infections were recorded. Re-infection rates per 1000 person-years of follow-up were 16.8 (95% CI 13.6-20.7) and 32.3 (95% CI 27.3-38.3) for one-stage and two-stage strategies respectively. The age- and sex-adjusted HR of re-infection for two-stage revision was 1.70 (0.58-5.00) when compared with one-stage revision. The association remained consistently absent after further adjustment for potential confounders. The HRs did not vary importantly in clinically relevant subgroups. Analysis of pooled individual patient data suggest that a one-stage revision strategy may be as effective as a two-stage revision strategy in treating PJI of the hip.

Single- and double-row repair for rotator cuff tears - biology and mechanics.

Science.gov (United States)

Papalia, Rocco; Franceschi, Francesco; Vasta, Sebastiano; Zampogna, Biagio; Maffulli, Nicola; Denaro, Vincenzo

2012-01-01

We critically review the existing studies comparing the features of single- and double-row repair, and discuss suggestions about the surgical indications for the two repair techniques. All currently available studies comparing the biomechanical, clinical and the biological features of single and double row. Biomechanically, the double-row repair has greater performances in terms of higher initial fixation strength, greater footprint coverage, improved contact area and pressure, decreased gap formation, and higher load to failure. Results of clinical studies demonstrate no significantly better outcomes for double-row compared to single-row repair. Better results are achieved by double-row repair for larger lesions (tear size 2.5-3.5 cm). Considering the lack of statistically significant differences between the two techniques and that the double row is a high cost and a high surgical skill-dependent technique, we suggest using the double-row technique only in strictly selected patients. Copyright © 2012 S. Karger AG, Basel.

Evaluation of magnocellular pathway abnormalities in schizophrenia: a frequency doubling technology study and clinical implications

Directory of Open Access Journals (Sweden)

Fabiana Benites Vaz de Lima

2013-04-01

Full Text Available BACKGROUND: Visual processing deficits have been reported for patients with schizophrenia. Previous studies demonstrated differences in early-stage processing of schizophrenics, although the nature, extent, and localization of the disturbance are unknown. The magnocellular and parvocellular visual pathways are associated with transient and sustained channels, but their respective contributions to schizophrenia-related visual deficits remains controversial. PURPOSE: The aim of this study was to evaluate magnocellular dysfunction in schizophrenia using frequency doubling technology. METHODS: Thirty-one patients with schizophrenia and 34 healthy volunteers were examined. Frequency doubling technology testing was performed in one session, consisting of a 15-minute screening strategy followed by the C-20 program for frequency doubling technology. RESULTS: Schizophrenic patients showed lower global mean sensitivity (30,97 ± 2,25 dB compared with controls (32,17 ± 3,08 dB, p<0.009. Although there was no difference in the delta sensitivity of hemispheres, there was a difference in sensitivity analysis of the fibers crossing the optic chiasm, with lower mean sensitivity in the patient group (28,80 dB versus controls (30,66 dB. The difference was higher in fibers that do not cross the optic chiasm, with lower mean sensitivity in patients (27,61 dB versus controls (30,26 dB, p<0.005. CONCLUSIONS: Our results suggest that there are differences between global sensitivity and fiber sensitivity measured by frequency doubling technology. The different sensitivity of fibers that do not cross the optic chiasm is consistent with most current etiological hypotheses for schizophrenia. The decreased sensitivity responses in the optic radiations may significantly contribute to research assessing early-stage visual processing deficits for patients with schizophrenia.

Vitamin D Supplementation in Chronic Schizophrenia Patients Treated with Clozapine: A Randomized, Double-Blind, Placebo-controlled Clinical Trial.

Science.gov (United States)

Krivoy, Amir; Onn, Roy; Vilner, Yael; Hochman, Eldar; Weizman, Shira; Paz, Amir; Hess, Shmuel; Sagy, Roi; Kimhi-Nesher, Shiri; Kalter, Ehud; Friedman, Tal; Friedman, Zvi; Bormant, Gil; Trommer, Sharon; Valevski, Avi; Weizman, Abraham

2017-12-01

While accumulating evidence suggests that vitamin D deficiency may be involved in the risk to develop schizophrenia and its outcome, there are no studies on vitamin D supplementation in this context. We sought to assess the effect of vitamin D supplementation on psychiatric, cognitive and metabolic parameters in chronic clozapine-treated schizophrenia patients. This eight-week, randomized, double-blind, placebo-controlled clinical trial, recruited schizophrenia patients who had been maintained on clozapine treatment for at least 18weeks and had low levels of vitamin D (70 (to ascertain the presence of residual symptoms). Patients were randomly allocated to either weekly oral drops of vitamin D (14,000IU) or placebo and subsequently assessed at two-week intervals for psychosis severity, mood, cognition and metabolic profile. Twenty four patients were randomly assigned to vitamin D (aged 39.4±9.6years, 75% males) and the other 23 patients to the placebo arm (aged 42.5±11.2years, 60.9% males). After eight weeks, the vitamin D group exhibited a significant increase in vitamin D levels (31.4 vs -0.4nmol/l, pvitamin D on psychotic, depressive or metabolic parameters. However, in the vitamin D group, there was a trend towards improved cognition (effect size=0.17, significance lost following Bonferroni correction). Vitamin D supplementation was associated with a trend towards improved cognition, but did not affect psychosis, mood or metabolic status. It is possible that the robust decrease in the PANSS scores in both groups may have obscured an effect of vitamin D supplementation. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

The extended arm of health professionals?

DEFF Research Database (Denmark)

Norlyk, Annelise; Martinsen, Bente

2013-01-01

responsibility for both the patient's well-being and for the patient's compliance with the daily regimen. Relatives were caught in a conflicting double role. They were the extended arm of the health professionals but also the caring, supporting partner. A tension arose between relatives' desire to help....... Due to the early discharge and the increasing demands on patients for self-care, patients' relatives seem to play a pivotal role in fast-track programmes. However, research is limited into how patients' close relatives are affected by and involved in the postoperative recovery process. Design...

Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy

Energy Technology Data Exchange (ETDEWEB)

Nesvold, Inger-Lise (Dept. of Cancer Rehabilitation-Physiotherapy, Rikshospitalet, Univ. of Oslo, Div. The Norwegian Radium Hospital, Montebello, Oslo (Norway)); Dahl, Alv A.; Fossaa, Sophie D. (Dept. of Clinical Cancer Research, Rikshospitalet, Univ. of Oslo: Division The Norwegian Radiumhospital, Montebello, Oslo (Norway)); Loekkevik, Erik (Dept. of Oncology, Rikshospitalet, Montebello, Oslo (Norway)); Marit Mengshoel, Anne (Inst. of Nursing and Health Sciences, Univ. of Oslo: Medical Faculty, Oslo (Norway))

2008-06-15

Introduction. The objective of this study was to compare the prevalence of late effects in the arm and shoulder in patients with breast cancer stage II who had radical modified mastectomy (RM) or breast-conserving therapy (BCT) followed by loco-regional adjuvant radiotherapy with or without chemotherapy/anti-oestrogen. Material and methods. All patients had axillary lymph node dissection. At a median of 47 months (range 32-87) post-surgery, 263 women (RM: n=186, BCT: n=77) were seen during an outpatient visit and had their arm and shoulder function and the presence of lymphedema assessed by a clinical examination, interview and self-rating. Volume calculation was used to measure lymphedema. Results. In the RM group 20% had developed arm lymphedema versus 8% in the BCT group (p=0.02). In multivariate analysis lymphedema was associated with a higher number of metastatic axillary lymph nodes [OR1.14, p=0.02], RM [OR 2.75, p=0.04] and increasing body mass index (BMI) [OR 1.11, p<0.01]. In the RM group 24% had a restricted range of motion in shoulder flexion compared to 7% in the BCT group (p<0.01). Shoulder pain was reported by 32% in the RM group and by 12% in the BCT group (p=0.001). Increasing observation time, RM, and increasing BMI were significantly associated with impaired arm/shoulder function. Discussion. Arm/shoulder problems including lymphedema were significantly more common after RM compared to BCT in irradiated breast cancer patients who have undergone axillary lymph node dissection. The performance of BCT should be encouraged when appropriate, to ensure a low prevalence of arm/shoulder morbidity including lymphedema

Arm and shoulder morbidity in breast cancer patients after breast-conserving therapy versus mastectomy

International Nuclear Information System (INIS)

Nesvold, Inger-Lise; Dahl, Alv A.; Fossaa, Sophie D.; Loekkevik, Erik; Marit Mengshoel, Anne

2008-01-01

Introduction. The objective of this study was to compare the prevalence of late effects in the arm and shoulder in patients with breast cancer stage II who had radical modified mastectomy (RM) or breast-conserving therapy (BCT) followed by loco-regional adjuvant radiotherapy with or without chemotherapy/anti-oestrogen. Material and methods. All patients had axillary lymph node dissection. At a median of 47 months (range 32-87) post-surgery, 263 women (RM: n=186, BCT: n=77) were seen during an outpatient visit and had their arm and shoulder function and the presence of lymphedema assessed by a clinical examination, interview and self-rating. Volume calculation was used to measure lymphedema. Results. In the RM group 20% had developed arm lymphedema versus 8% in the BCT group (p=0.02). In multivariate analysis lymphedema was associated with a higher number of metastatic axillary lymph nodes [OR1.14, p=0.02], RM [OR 2.75, p=0.04] and increasing body mass index (BMI) [OR 1.11, p<0.01]. In the RM group 24% had a restricted range of motion in shoulder flexion compared to 7% in the BCT group (p<0.01). Shoulder pain was reported by 32% in the RM group and by 12% in the BCT group (p=0.001). Increasing observation time, RM, and increasing BMI were significantly associated with impaired arm/shoulder function. Discussion. Arm/shoulder problems including lymphedema were significantly more common after RM compared to BCT in irradiated breast cancer patients who have undergone axillary lymph node dissection. The performance of BCT should be encouraged when appropriate, to ensure a low prevalence of arm/shoulder morbidity including lymphedema

Arm-to-arm variation when evaluating neuromuscular block: an analysis of the precision and the bias and agreement between arms when using mechanomyography or acceleromyography

DEFF Research Database (Denmark)

Claudius, C; Skovgaard, L T; Viby-Mogensen, J

2010-01-01

Studies comparing acceleromyography and mechanomyography indicate that the two methods cannot be used interchangeably. However, it is uncertain to what extent differences in precision between the methods and the naturally occurring arm-to-arm variation have influenced the results of these studies...

External Fixation versus two-stage Open Reduction Internal Fixation of distal intra-articular Tibia fractures; a Systematic Review

DEFF Research Database (Denmark)

Ladeby Erichsen, Julie; Jensen, Carsten; Damborg, Frank Lindhøj

Internal Fixation (ORIF) or External Fixation (EF). Method : A search was conducted using PUBMED, Embase, Cochrane Central, Open Grey, Orthopaedic Proceedings and WHO International Clinical Trials Registry Platform. Studies with level of evidence I-IV comparing EF with two-stage ORIF of DIATF in patients...

A New Concept of Two-Stage Multi-Element Resonant-/Cyclo-Converter for Two-Phase IM/SM Motor

Directory of Open Access Journals (Sweden)

Mahmud Ali Rzig Abdalmula

2013-01-01

Full Text Available The paper deals with a new concept of power electronic two-phase system with two-stage DC/AC/AC converter and two-phase IM/PMSM motor. The proposed system consisting of two-stage converter comprises: input resonant boost converter with AC output, two-phase half-bridge cyclo-converter commutated by HF AC input voltage, and induction or synchronous motor. Such a system with AC interlink, as a whole unit, has better properties as a 3-phase reference VSI inverter: higher efficiency due to soft switching of both converter stages, higher switching frequency, smaller dimensions and weight with lesser number of power semiconductor switches and better price. In comparison with currently used conventional system configurations the proposed system features a good efficiency of electronic converters and also has a good torque overloading of two-phase AC induction or synchronous motors. Design of two-stage multi-element resonant converter and results of simulation experiments are presented in the paper.

Human arm stiffness and equilibrium-point trajectory during multi-joint movement.

Science.gov (United States)

Gomi, H; Kawato, M

1997-03-01

By using a newly designed high-performance manipulandum and a new estimation algorithm, we measured human multi-joint arm stiffness parameters during multi-joint point-to-point movements on a horizontal plane. This manipulandum allows us to apply a sufficient perturbation to subject's arm within a brief period during movement. Arm stiffness parameters were reliably estimated using a new algorithm, in which all unknown structural parameters could be estimated independent of arm posture (i.e., constant values under any arm posture). Arm stiffness during transverse movement was considerably greater than that during corresponding posture, but not during a longitudinal movement. Although the ratios of elbow, shoulder, and double-joint stiffness were varied in time, the orientation of stiffness ellipses during the movement did not change much. Equilibrium-point trajectories that were predicted from measured stiffness parameters and actual trajectories were slightly sinusoidally curved in Cartesian space and their velocity profiles were quite different from the velocity profiles of actual hand trajectories. This result contradicts the hypothesis that the brain does not take the dynamics into account in movement control depending on the neuromuscular servo mechanism; rather, it implies that the brain needs to acquire some internal models of controlled objects.

Two-Stage Fuzzy Portfolio Selection Problem with Transaction Costs

OpenAIRE

Chen, Yanju; Wang, Ye

2015-01-01

This paper studies a two-period portfolio selection problem. The problem is formulated as a two-stage fuzzy portfolio selection model with transaction costs, in which the future returns of risky security are characterized by possibility distributions. The objective of the proposed model is to achieve the maximum utility in terms of the expected value and variance of the final wealth. Given the first-stage decision vector and a realization of fuzzy return, the optimal value expression of the s...

On the robustness of two-stage estimators

KAUST Repository

Zhelonkin, Mikhail; Genton, Marc G.; Ronchetti, Elvezio

2012-01-01

The aim of this note is to provide a general framework for the analysis of the robustness properties of a broad class of two-stage models. We derive the influence function, the change-of-variance function, and the asymptotic variance of a general

Estimation of treatment preference effects in clinical trials when some participants are indifferent to treatment choice

Directory of Open Access Journals (Sweden)

Stephen D. Walter

2017-02-01

Full Text Available Abstract Background In the two-stage randomised trial design, a randomly sampled subset of study participants are permitted to choose their own treatment, while the remaining participants are randomised to treatment in the usual way. Appropriate analysis of the data from both arms of the study allows investigators to estimate the impact on study outcomes of treatment preferences that patients may have, in addition to evaluating the usual direct effect of treatment. In earlier work, we showed how to optimise this design by making a suitable choice of the proportion of participants who should be assigned to the choice arm of the trial. However, we ignored the possibility of some participants being indifferent to the treatments under study. In this paper, we extend our earlier work to consider the analysis of two-stage randomised trials when some participants have no treatment preference, even if they are assigned to the choice arm and allowed to choose. Methods We compare alternative characterisations of the response profiles of the indifferent or undecided participants, and derive estimates of the treatment and preference effects on study outcomes. We also present corresponding test statistics for these parameters. The methods are illustrated with data from a clinical trial contrasting medical and surgical interventions. Results Expressions are obtained to estimate and test the impact of treatment choices on study outcomes, as well as the impact of the actual treatment received. Contrasts are defined between patients with stated treatment preferences and those with no preference. Alternative assumptions concerning the outcomes of undecided participants are described, and an approach leading to unbiased estimation and testing is identified. Conclusions Use of the two-stage design can provide important insights into determinants of study outcomes that are not identifiable with other designs. The design can remain attractive even in the presence of

Induced membrane technique combined with two-stage internal fixation for the treatment of tibial osteomyelitis defects.

Science.gov (United States)

Luo, Fei; Wang, Xiaohua; Wang, Shulin; Fu, Jingshu; Xie, Zhao

2017-07-01

The purpose of this study was to observe the effects of induced membrane technique combined with two-stage internal fixation in the treatment of tibial osteomyelitis defects. A retrospective analyses for 67 cases of tibialosteomyelitis defects were admitted to our department between September 2012 to February 2015, which were treated with induced membrane technique. At the first stage, implanted with a PMMA cement spacer in the defects after radical debridement and fixed with reconstructive locked plate. Bone grafting and exchanged the plate with intramedullary nail at the second stage. In current study, all patients were followed up for 18-35 months. Sixty-six patients achieved bone union with the average radiographic and clinical healing times of 5.55±2.19 and 7.45±1.69months, respectively. Seven patients required a second debridement before grafting, while four patients experienced a recurrence of infection or a relapse following second stage treatment. Twelve patients experienced either knee or ankle dysfunctions and 2 patients faced delayed wound healing. Donor site complications includes pain and infection were found in 7 and 3 patients, respectively with delayed stress fracture in 1 patient only. Induced membrane technique for the treatment of tibial osteomyelitis defects, seems a reliable method. The use of reconstructive locked plate as a temporary internal fixation at the first stage and exchanged with intramedullary nail at the second stage, potentially achieves good clinical efficacy. Care should be taken to restore the joint function especially in distal tibia. Copyright © 2017 Elsevier Ltd. All rights reserved.

Clinical significance of inter-arm pressure difference and ankle-brachial pressure index in patients with suspected coronary artery disease

International Nuclear Information System (INIS)

Igarashi, Yuko; Chikamori, Taishiro; Tomiyama, Hirofumi; Usui, Yasuhiro; Hida, Satoshi; Tanaka, Hirokazu; Nagao, Tadashi; Yamashina, Akira

2007-01-01

Although measuring blood pressure at the bilateral brachia is common in medical practice, its clinical significance in patients with suspected coronary artery disease (CAD) has not been fully clarified. The method of this study was to define the significance of inter-arm systolic blood pressure difference in patients with suspected CAD, and to assess the relationship between inter-arm pressure difference and CAD, simultaneous brachial and ankle blood pressure measurements and stress myocardial single-photon emission computed tomography (SPECT) were performed in 386 consecutive patients with suspected CAD, excluding those with previous myocardial infarction or coronary revascularization. Subclavian artery stenosis, defined as ≥15 mmHg inter-arm systolic blood pressure difference, was found in 27 patients (7%). Age (65±12 vs 65±11 years), male sex (21/27 vs 244/359), prevalence of hypertension (63% vs 56%), hypercholesterolemia (63% vs 62%), diabetes mellitus (33% vs 38%), cigarette smoking (44% vs 41%) and family history of CAD (15% vs 12%) were similar between patients with subclavian artery stenosis and those without. The incidence of decreased ankle-brachial pressure index (ABI) was higher (37% vs 12%, p=0.001), and percentage ischemic myocardium as assessed by SPECT was greater (9.0±8.5% vs 5.6±6.6%, p=0.05) in patients with subclavian artery stenosis than in those without. Furthermore, significant correlations were observed between inter-arm pressure difference and percentage ischemic myocardium (r=0.13; p=0.01), and ABI (r=-0.26, p<0.0001). Among 386 patients, 283 underwent coronary angiography, and 63% of those who had inter-arm blood pressure difference had CAD. Furthermore, 83% of those CAD patients had multi-vessel CAD, which is regarded as a high-risk subset for subsequent cardiac events. Inter-arm pressure difference is often found in patients with suspected CAD, and is associated with significant CAD and peripheral artery disease. Thus, inter-arm

Training the Unimpaired Arm Improves the Motion of the Impaired Arm and the Sitting Balance in Chronic Stroke Survivors.

Science.gov (United States)

De Luca, Alice; Giannoni, Psiche; Vernetti, Honore; Capra, Cristina; Lentino, Carmelo; Checchia, Giovanni Antonio; Casadio, Maura

2017-07-01

Robot-assisted rehabilitation of stroke survivors mainly focuses on the impaired side of the body while the role of the unimpaired side in the recovery after stroke is still controversial. The goal of this study is to investigate the influence on sitting balance and paretic arm functions of a training protocol based on movements of the unimpaired arm. Sixteen chronic stroke survivors underwent nineteen training sessions, in which they performed active movements with the unimpaired arm supported by a passive exoskeleton. Performance of the trunk and upper limbs was evaluated before treatment, after treatment and at six months follow up with clinical scales and an instrumented evaluation. A reaching test executed with the exoskeleton was used to assess changes in performance of both arms. The treatment based on the unimpaired arm's movements executed with a correct body posture led to benefits in control of the trunk and of both the trained and the untrained arm. The amount of impaired arm improvement in the Fugl-Meyer score was comparable to the outcome of robotic treatments focused directly on this arm. Our results highlight the importance of taking into account all body schema in the rehabilitation robotic program, instead of focusing only on the impaired side of the body.

[Case report: comprehensive treatment of forefoot with double brachymetatarsia in one surgical stage].

Science.gov (United States)

Caldiño-Lozada, I; Gallegos-de la Torre, O; Esperón-Hernández, R

2017-01-01

Brachymetatarsia (shortening of the metatarsal) directly affects the transversal arch of the foot causing severe deformities, such as hallux valgus, divergent toes, overlapping toes, metatarsalgia, all of these alter the biomechanics of the foot and gait. Treatment consists of two main techniques, one-stage lengthening with bone graft or elongation through callotaxis with external fixator; there are variants of both techniques used to minimize the disadvantages of each. The objective of treatment must be to return the structural harmony to the forefoot, improving the biomechanics, resulting in a satisfactory outcome for the patients. This article presents a surgical treatment for feet with closed physis to obtain the appropriate metatarsal formula and to reestablish aesthetics and function. This case was treated by means of one-stage lengthening with bone graft to the affected metatarsal; shortening of the adjacent metatarsals; hallux valgus alignment through the necessary osteotomies and the treatment of deformities of the lesser toes as needed. This surgical technique has as one of its advantages the correction of the entire forefoot at one time, without the need of an external fixator and its required postoperative care. Its main disadvantages are its dependence on structural bone graft and the need of postoperative dressing until healing of the bone has taken place. Satisfactory clinical and radiographical outcomes were obtained in treated patient.