Sample records for ultimately require surgery

  1. 7 CFR 4280.29 - Supplemental financing required for the Ultimate Recipient Project. (United States)


    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Supplemental financing required for the Ultimate Recipient Project. 4280.29 Section 4280.29 Agriculture Regulations of the Department of Agriculture... AND GRANTS Rural Economic Development Loan and Grant Programs § 4280.29 Supplemental financing...

  2. Bariatric surgery insurance requirements independently predict surgery dropout. (United States)

    Love, Kaitlin M; Mehaffey, J Hunter; Safavian, Dana; Schirmer, Bruce; Malin, Steven K; Hallowell, Peter T; Kirby, Jennifer L


    Many insurance companies have considerable prebariatric surgery requirements despite a lack of evidence for improved clinical outcomes. The hypothesis of this study is that insurance-specific requirements will be associated with a decreased progression to surgery and increased delay in time to surgery. Retrospective data collection was performed for patients undergoing bariatric surgery evaluation from 2010-2015. Patients who underwent surgery (SGY; n = 827; mean body mass index [BMI] 49.1) were compared with those who did not (no-SGY; n = 648; mean BMI: 49.4). Univariate and multivariate analysis were performed to identify specific co-morbidity and insurance specific predictors of surgical dropout and time to surgery. A total of 1475 patients using 12 major insurance payors were included. Univariate analysis found insurance requirements associated with surgical drop out included longer median diet duration (no-SGY = 6 mo; SGY = 3 mo; Psurgery dropout. Additionally, surgical patients had an average interval between initial visit and surgery of 5.8±4.6 months with significant weight gain (2.1 kg, Psurgery insurance requirements were associated with lack of patient progression to surgery in this study. In addition, delays in surgery were associated with preoperative weight gain. Although prospective and multicenter studies are needed, these findings have major policy implications suggesting insurance requirements may need to be reconsidered to improve medical care. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  3. Ultrafast Desorption by Impulsive Vibrational Excitation (DIVE). Applications in laser surgery, mass spectrometry and towards ultimate limits in biodiagnosis

    International Nuclear Information System (INIS)

    Ren, Ling


    The prospects for minimally invasive surgery, spatial imaging with mass spectrometry and rapid high throughput biodiagnosis require new means of tissue incision and biomolecule extraction with conserved molecular structure. Towards this aim, a laser ablation process is utilized in this dissertation, which is capable of performing precise tissue incision with minimal collateral damage and extracting intact biological entities with conserved biological functions. The method is based on the recently developed Picosecond Infrared Laser (PIRL) designed to excite selectively the water vibrational modes under the condition of ultrafast Desorption by Impulsive Vibrational Excitation (DIVE). The basic concept is that the selectively excited water molecules act as propellant to ablate whole biological complexes into the plume, faster than any thermal deleterious effect or fragmentation that would mask molecular identities.The PIRL ablation under DIVE condition is applied for the first time to six types of ocular tissues, rendering precise and minimally invasive incisions in a well-controlled and reproducible way. An eminent demonstration is the contact-free and applanation-free corneal trephination with the PIRL. Mass spectrometry and other analytical techniques show that great abundance of proteins with various molecular weights are extracted from the tissue by the PIRL ablation, and that fragmentation or other chemical alternation does not occur to the proteins in the ablation plume. With various microscope imaging and biochemical analysis methods, nano-scale single protein molecules, viruses and cells in the ablation plume are found to be morphologically and functionally identical to their corresponding controls. The PIRL ablation provides a new means to push the frontiers of laser surgery in ophthalmology and can be applied to resolve chemical activities in situ and in vivo. The most important finding is the conserved nature of the extracted biological entities

  4. Ultrafast Desorption by Impulsive Vibrational Excitation (DIVE). Applications in laser surgery, mass spectrometry and towards ultimate limits in biodiagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Ren, Ling


    The prospects for minimally invasive surgery, spatial imaging with mass spectrometry and rapid high throughput biodiagnosis require new means of tissue incision and biomolecule extraction with conserved molecular structure. Towards this aim, a laser ablation process is utilized in this dissertation, which is capable of performing precise tissue incision with minimal collateral damage and extracting intact biological entities with conserved biological functions. The method is based on the recently developed Picosecond Infrared Laser (PIRL) designed to excite selectively the water vibrational modes under the condition of ultrafast Desorption by Impulsive Vibrational Excitation (DIVE). The basic concept is that the selectively excited water molecules act as propellant to ablate whole biological complexes into the plume, faster than any thermal deleterious effect or fragmentation that would mask molecular identities.The PIRL ablation under DIVE condition is applied for the first time to six types of ocular tissues, rendering precise and minimally invasive incisions in a well-controlled and reproducible way. An eminent demonstration is the contact-free and applanation-free corneal trephination with the PIRL. Mass spectrometry and other analytical techniques show that great abundance of proteins with various molecular weights are extracted from the tissue by the PIRL ablation, and that fragmentation or other chemical alternation does not occur to the proteins in the ablation plume. With various microscope imaging and biochemical analysis methods, nano-scale single protein molecules, viruses and cells in the ablation plume are found to be morphologically and functionally identical to their corresponding controls. The PIRL ablation provides a new means to push the frontiers of laser surgery in ophthalmology and can be applied to resolve chemical activities in situ and in vivo. The most important finding is the conserved nature of the extracted biological entities

  5. Ten-year clinical experience of humanitarian cardiothoracic surgery in Rwanda: Building a platform for ultimate sustainability in a resource-limited setting. (United States)

    Swain, JaBaris D; Sinnott, Colleen; Breakey, Suellen; Hasson Charles, Rian; Mody, Gita; Nyirimanzi, Napthal; Patton-Bolman, Ceeya; Come, Patricia; Ganza, Gapira; Rusingiza, Emmanuel; Ruhamya, Nathan; Mucumbitsi, Joseph; Borges, Jorge; Zammert, Martin; Muehlschlegel, Jochen D; Oakes, Robert; Leavitt, Bruce; Bolman, R Morton


    Despite its near complete eradication in resource-rich countries, rheumatic heart disease remains the most common acquired cardiovascular disease in sub-Saharan Africa. With a ratio of physicians/population of 1 per 10,500, including only 4 cardiologists for a population of 11.4 million, Rwanda represents a resource-limited setting lacking the local capacity to detect and treat early cases of strep throat and perform lifesaving operations for advanced rheumatic heart disease. Humanitarian surgical outreach in this region can improve the delivery of cardiovascular care by providing sustainability through mentorship, medical expertise, training, and knowledge transfer, and ultimately the creation of a cardiac center. We describe the experience of consecutive annual visits to Rwanda since 2008 and report the outcomes of a collaborative approach to enable sustainable cardiac surgery in the region. The Ferrans and Powers Quality of Life Index tool's Cardiac Version ( was administered to assess the postoperative quality of life. Ten visits have been completed, performing 149 open procedures, including 200 valve implantations, New York Heart Association class III or IV, with 4.7% 30-day mortality. All procedures were performed with the participation of local Rwandan personnel, expatriate physicians, nurses, residents, and support staff. Early complications included cerebrovascular accident (n = 4), hemorrhage requiring reoperation (n = 6), and death (n = 7). Quality of life was assessed to further understand challenges encountered after cardiac surgery in this resource-limited setting. Four major domains were considered: health and functioning, social and economic, psychologic/spiritual, and family. The mean total quality of life index was 20.79 ± 4.07 on a scale from 0 to 30, for which higher scores indicated higher quality of life. Women had significantly lower "social and economic" subscores (16.81 ± 4.17) than men (18.64 ± 4

  6. Fusion Surgery Required for Recurrent Pediatric Atlantoaxial Rotatory Fixation after Failure of Temporary Fixation with Instrumentation

    Directory of Open Access Journals (Sweden)

    Yoshiyuki Matsuyama


    Full Text Available In cases of chronic irreducible and recurrent unstable atlantoaxial rotatory fixation (AARF, closed reduction and its maintenance are often unsuccessful, requiring surgical treatment. The purpose of the present report is to describe a rare case of pediatric AARF that required multiple treatments. A 6-year-old boy was diagnosed as having type 2 AARF. After conservative treatment, the patient was treated with temporary fixation surgery (C1-C2 Magerl without a bone graft in consideration of motion preservation after screw removal. AARF recurred after the screw removal and required fusion surgery (Magerl–Brooks with an iliac bone graft. Ultimately, bone union was achieved and the screws were removed 11 months after the surgery. We recommend surgeons be cautious when choosing temporary fixation surgery for AARF in small children. Further investigation is needed to determine the optimal time before screw removal.

  7. Transfusion requirements in elective cardiopulmonary bypass surgery patients

    DEFF Research Database (Denmark)

    Sivapalan, Praleene; Bäck, Anne Caroline; Ostrowski, Sisse Rye


    Managing haemostasis in patients undergoing cardiopulmonary bypass (CPB) surgery remains a challenge. There is no established laboratory test to predict transfusion requirements in cardiac surgery. We investigated whether preoperative Thromboelastography (TEG) with Platelet Mapping Assay (PMA......) or Multiple Electrode Aggrometry (MEA) could predict transfusion requirements in patients undergoing elective coronary artery bypass grafting (CABG) or combined CABG with aortic or mitral valve replacement. We prospectively investigated 199 patients undergoing elective CABG or combined procedures. PMA and MEA...

  8. Toward the ultimate goal of tritium self-sufficiency: Technical issues and requirements imposed on ARIES advanced power plants

    International Nuclear Information System (INIS)

    El-Guebaly, Laila A.; Malang, Siegfried


    Due to the lack of external tritium sources, all fusion power plants must demonstrate a closed tritium fuel cycle. The tritium breeding ratio (TBR) must exceed unity by a certain margin. The key question is: how large is this margin and how high should the calculated TBR be? The TBR requirement is design and breeder-dependent and evolves with time. At present, the ARIES requirement is 1.1 for the calculated overall TBR of LiPb systems. The Net TBR during plant operation could be around 1.01. The difference accounts for deficiencies in the design elements (nuclear data evaluation, neutronics code validation, and 3D modeling tools). Such a low Net TBR of 1.01 is potentially achievable in advanced designs employing advanced physics and technology. A dedicated R and D effort will reduce the difference between the calculated TBR and Net TBR. A generic breeding issue encountered in all fusion designs is whether any fusion design will over-breed or under-breed during plant operation. To achieve the required Net TBR with sufficient precision, an online control of tritium breeding is highly recommended for all fusion designs. This can easily be achieved for liquid breeders through online adjustment of Li enrichment.

  9. Mesenteric panniculitis patients requiring emergency surgery: report of three cases. (United States)

    Duman, Mustafa; Koçak, Osman; Fazli, Olgaç; Koçak, Cengiz; Atici, Ali Emre; Duman, Uğur


    Mesenteric panniculitis is a rare, benign disease characterized by a chronic non-specific inflammatory process of mesenteric fat tissue with unknown etiology. The small bowel mesentery is affected mostly. This process rarely involves the large intestine mesentery. Mesenteric panniculitis includes symptoms as abdominal pain, nausea and vomiting, diarrhea, constipation, and fever. In our cases, we had difficulty in the preoperative diagnosis as the clinical changes imitated an obstruction or ischemia of the small bowel. All the cases required emergency abdominal surgery and partial jejunal resection. The aim of this article was to present three cases of mesenteric panniculitis of the small bowel mesentery requiring emergency surgery together with a short review of the literature.

  10. Medical evaluation of the pregnant patient requiring nonobstetric surgery

    International Nuclear Information System (INIS)

    Barron, W.M.


    This article provides a summary of currently available information from a broad range of disciplines aimed at guiding the physician caring for the pregnant patient who requires nonobstetric surgery. An understanding of the anatomic and physiologic alterations that occur during pregnancy will allow such procedures to be accomplished with morbidity and mortality approaching those of nonpregnant surgical patients. The presence of the fetus does impose some restraint; however, this should rarely impair appropriate diagnosis and treatment of maternal disease. This obtains from the broad range of diagnostic and therapeutic alternatives available, and from the fact that what is beneficial for maternal health is generally best for the fetus. 64 references

  11. Flux scaling: Ultimate regime

    Indian Academy of Sciences (India)

    First page Back Continue Last page Overview Graphics. Flux scaling: Ultimate regime. With the Nusselt number and the mixing length scales, we get the Nusselt number and Reynolds number (w'd/ν) scalings: and or. and. scaling expected to occur at extremely high Ra Rayleigh-Benard convection. Get the ultimate regime ...

  12. Robot-Assisted Fracture Surgery: Surgical Requirements and System Design. (United States)

    Georgilas, Ioannis; Dagnino, Giulio; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja


    The design of medical devices is a complex and crucial process to ensure patient safety. It has been shown that improperly designed devices lead to errors and associated accidents and costs. A key element for a successful design is incorporating the views of the primary and secondary stakeholders early in the development process. They provide insights into current practice and point out specific issues with the current processes and equipment in use. This work presents how information from a user-study conducted in the early stages of the RAFS (Robot Assisted Fracture Surgery) project informed the subsequent development and testing of the system. The user needs were captured using qualitative methods and converted to operational, functional, and non-functional requirements based on the methods derived from product design and development. This work presents how the requirements inform a new workflow for intra-articular joint fracture reduction using a robotic system. It is also shown how the various elements of the system are developed to explicitly address one or more of the requirements identified, and how intermediate verification tests are conducted to ensure conformity. Finally, a validation test in the form of a cadaveric trial confirms the ability of the designed system to satisfy the aims set by the original research question and the needs of the users.

  13. What is the Ultimate Fate of Presented Abstracts? Conversion Rates of Presentations to International Publications from the 31st National Congress of Plastic, Reconstructive, and Aesthetic Surgery

    Directory of Open Access Journals (Sweden)

    Burak Ersoy


    Full Text Available Objective: Oral and poster presentations held at national congresses are regarded as important means for sharing of latest scientific data and personal experiences. However, many ideas shared at annual conferences fail to be published. The objective of this study was to examine the publication rate of presentations held at the 31st National Congress of the Turkish Society of Plastic Reconstructive and Aesthetic Surgeons and to analyze various factors associated with publication. Material and Methods: The PubMed database was searched for peer-reviewed publications, corresponding to abstracts presented at the 2009 congress. For all abstracts, parameters including presentation type, topic, institution, author details, publication time, journal name, and impact factor were recorded. Collected data were analyzed using chi-square, Mann–Whitney U, and Kruskal–Wallis tests for statistical significance. Results: In five years 16.8% of 569 proceedings were published in international peer-reviewed journals. The mean time to publication following the congress was 22 months (1–57 months for 75 presentations, whereas 21 proceedings had been published prior to the congress. Compared with posters, the publication rate for oral presentations was significantly greater (30.5% vs. 13.3%; p<0.001. The type of institution had no significant effect on the publication rate. Conclusion: The overall publication rate for the 31st National Plastic Surgery Congress was found to be similar with other Turkish-based studies, but was somewhat lower than that of international counterparts. The significant difference found between the publication rates of oral and poster presentations was interpretted as a positive sign demonstrating a relatively higher level of scientific value and appeal.

  14. The ultimate challenge of pregnancy-associated breast carcinoma

    International Nuclear Information System (INIS)

    Raja, R.; Tahira, A.


    Pregnancy associated breast carcinoma requires making judicious use of all diagnostic modalities and the therapeutic options of surgery, irradiation, chemotherapy and hormonal therapy to enhance survival rates. Individualization of treatment for each patient is the key to success. The effects on future fertility, the time interval before next conception, and whether to breast feed or not are all well-documented. A multidisciplinary coordinated team approach to this ultimate challenge of patient care will prove fruitful. (author)

  15. Excellence and safety in surgery require excellent and safe tutoring. (United States)

    Ferrarese, Alessia; Buccelli, Claudio; Addeo, Giuseppe; Capasso, Emanuele; Conti, Adelaide; Amato, Maurizio; Compagna, Rita; Niola, Massimo; Martino, Valter


    The surgical education in Italy has always been a very important issue. The aim of this article is to bring together the feedback of the definitions of the various components of the learning scheme and to evaluate the importance of the legal point. In March 2016 we performed a literature review. We have also examinated the internet pages of the Italian Department of Education, Health and Medical Order. In Italy the tutor had an unclear role from a legal point of view. He is the person who must be able to perform a specific procedure with expert technical and who must know how to stop the student if this is about to perform a dangerous maneuver. In Italy the ability to work for the trainee is limited in all reality, it depends on several factors including the increase of numbers of medical-legal disputes, the timing, the commitment it requires mentoring and a lack of mentors. In surgery, the problem is greater because of the increasingly of medico-legal implications that we are after surgical procedure. It would be necessary to define a role of the tutor in a regular protocol and a proper assessment of his performance.

  16. Stalking the ultimate particle

    CERN Multimedia


    If you missed the ARTE programme entitled "L'Ultime Particule" broadcast in February, you have another chance to catch it in CERN's Main Auditorium on 13 March. "L'Ultime Particule" is a documentary by the French director Michel Andrieu that seeks to explain particle physics through a contemplative quest for the research physicists of matter of today and yesteryear. Invariably kitted out in a red parka and a soft hat, the programme's investigator scours the planet and the archives in search of the research physicists who are stalking the ultimate particle, the Higgs boson, in their quest to understand the structure of matter. Naturally enough, CERN is an important stage of his journey where Michel Andrieu and his team spent several days last year. Both from the physics and metaphysical points of view, "L'Ultime Particule" is worth seeing. The film's director, Michel Andrieu, will introduce his documentary and answer questions from the audience after the documentary has been shown. L'Ultime Particule by Mic...

  17. The ultimate quotable Einstein

    CERN Document Server


    Here is the definitive new edition of the hugely popular collection of Einstein quotations that has sold tens of thousands of copies worldwide and been translated into twenty-five languages. The Ultimate Quotable Einstein features 400 additional quotes, bringing the total to roughly 1,600 in all. This ultimate edition includes new sections--"On and to Children," "On Race and Prejudice," and "Einstein's Verses: A Small Selection"--as well as a chronology of Einstein's life and accomplishments, Freeman Dyson's authoritative foreword, and new commentary by Alice Calaprice.

  18. Severe Rhabdomyolysis Associated with Staphylococcus aureus Acute Endocarditis Requiring Surgery. (United States)

    Ravry, Céline; Fedou, Anne-Laure; Dubos, Maria; Denes, Éric; Etchecopar, Caroline; Barraud, Olivier; Vignon, Philippe; François, Bruno


    Rhabdomyolysis has multiple etiologies with unclear mechanisms; however, rhabdomyolysis caused by Staphylococcus aureus infection is rare. A case report of severe rhabdomyolysis in a patient who presented with endocarditis caused by methicillin-susceptible S. aureus and review of relevant literature. The patient had a history of cardiac surgery for tetralogy of Fallot. He was admitted to the hospital because of fever and digestive symptoms. Respiratory and hemodynamic status deteriorated rapidly, leading to admission to the intensive care unit (ICU) for mechanical ventilation and vasopressor support. Laboratory tests disclosed severe rhabdomyolysis with a serum concentration of creatine kinase that peaked at 49,068 IU/L; all blood cultures grew methicillin-susceptible S. aureus. Antibiotic therapy was amoxicillin-clavulanic acid, ciprofloxacin, and gentamicin initially and was changed subsequently to oxacillin, clindamycin, and gentamicin. Transesophageal echocardiography showed vegetation on the pulmonary valve, thus confirming the diagnosis of acute endocarditis. Viral testing and computed tomography (CT) scan ruled out any obvious alternative etiology for rhabdomyolysis. Bacterial analysis did not reveal any specificity of the staphylococcal strain. The patient improved with antibiotics and was discharged from the ICU on day 26. He underwent redux surgery for valve replacement on day 53. Staphylococcal endocarditis should be suspected in cases of severe unexplained rhabdomyolysis with acute infectious symptoms.

  19. Quality assessment in pancreatic surgery: what might tomorrow require? (United States)

    Kalish, Brian T; Vollmer, Charles M; Kent, Tara S; Nealon, William H; Tseng, Jennifer F; Callery, Mark P


    The Institute of Medicine (IOM) defines healthcare quality across six domains: safety, timeliness, effectiveness, patient centeredness, efficiency, and equitability. We asked experts in pancreatic surgery (PS) whether improved quality metrics are needed, and how they could align to contemporary IOM healthcare quality domains. We created and distributed a web-based survey to pancreatic surgeons. Respondents ranked 62 proposed PS quality metrics on level of importance (LoI) and aligned each metric to one or more IOM quality domains (multi-domain alignment (MDA)). LoI and MDA scores for a given quality metric were averaged together to render a total quality score (TQS) normalized to a 100-point scale. One hundred six surgeons (21 %) completed the survey. Ninety percent of respondents indicated a definite or probable need for improved quality metrics in PS. Metrics related to mortality, to rates and severity of complications, and to access to multidisciplinary services had the highest TQS. Metrics related to patient satisfaction, costs, and patient demographics had the lowest TQS. The least represented IOM domains were equitability, efficiency, and patient-centeredness. Experts in pancreatic surgery have significant consensus on 12 proposed metrics of quality that they view as both highly important and aligned with more than one IOM healthcare quality domain.

  20. The Ultimate Technology

    DEFF Research Database (Denmark)

    Riis, Søren


    One of the most influential philosophers of the 20th century, Martin Heidegger (1889-1976), died prior to the remarkable cloning of the sheep Dolly and before Dr. Venter started his experiments on creating synthetic life, and he never explicitly discussed living technologies. However, by reinterp......One of the most influential philosophers of the 20th century, Martin Heidegger (1889-1976), died prior to the remarkable cloning of the sheep Dolly and before Dr. Venter started his experiments on creating synthetic life, and he never explicitly discussed living technologies. However......, by reinterpreting his notion of "modern technology," this article shows how it is possible to philosophically assess living technologies and to recognize ways in which Heidegger anticipated this phenomenon with his notion of cybernetics. The interpretation elucidates the fundamental process of technology becoming...... living and simultaneously presents living technology as the ultimate technology. The thesis of this article is that living technology is not just one more technology; rather, it is the perfection of technology as understood by Aristotle. Aristotle's thinking is in this way a key example of a profound...

  1. Intraoperative blood loss and blood transfusion requirements in patients undergoing orthognathic surgery. (United States)

    Faverani, Leonardo Perez; Ramalho-Ferreira, Gabriel; Fabris, André Luis Silva; Polo, Tárik Ocon Braga; Poli, Guilherme Henrique Souza; Pastori, Cláudio Maldonado; Marzola, Clóvis; Assunção, Wirley Gonçalves; Garcia-Júnior, Idelmo Rangel


    Procedures for the surgical correction of dentofacial deformities may produce important complications, whether due to the potential for vascular injury or to prolonged surgery, both of which may lead to severe blood loss. Fluid replacement with crystalloid, colloid, or even blood products may be required. The aim of this study was to assess blood loss and transfusion requirements in 45 patients (18 males and 27 females; mean age 29.29 years, range 16-52 years) undergoing orthognathic surgery, assigned to one of two groups according to procedure type-rapid maxillary expansion or double-jaw orthognathic surgery. Preoperative hemoglobin and hematocrit levels and intraoperative blood loss were measured. There was a substantial individual variation in pre- and postoperative hemoglobin values (10.3-17 and 8.8-15.4 g/dL, respectively; p surgery and follow meticulous protocols to minimize the risks.

  2. Incidence of acute postoperative infections requiring reoperation after arthroscopic shoulder surgery. (United States)

    Yeranosian, Michael G; Arshi, Armin; Terrell, Rodney D; Wang, Jeffrey C; McAllister, David R; Petrigliano, Frank A


    An acute infection after arthroscopic shoulder surgery is a rare but serious complication. Previous studies estimating the incidence of infections after arthroscopic surgery have been conducted, but the majority of these had either relatively small study groups or were not specific to shoulder arthroscopic surgery. To investigate the incidence of acute infections after arthroscopic shoulder surgery and compare infection rates by age group, sex, geographic region, and specific procedures. Case series; Level of evidence, 4. A retrospective review of a large insurance company database was performed for all shoulder arthroscopic surgeries performed in the United States between 2004 and 2009 that required additional surgery for infections within 30 days. The data were stratified by sex, age group, and region. Data were also stratified for specific procedures (capsulorrhaphy, treatment for superior labrum anterior-posterior tears, claviculectomy, decompression, and rotator cuff repair) and used to assess the variation in the incidence of infections across different arthroscopic shoulder procedures. Linear regression was used to determine the significance of differences in the data from year to year. χ(2) analysis was used to assess the statistical significance of variations among all groups. Poisson regression analysis with exposure was used to determine significant differences in a pairwise comparison between 2 groups. The total number of arthroscopic shoulder surgeries performed was 165,820, and the number of infections requiring additional surgery was 450, resulting in an overall infection rate of 0.27%. The incidence of infections varied significantly across age groups (P shoulder procedures was 0.27%. The incidence was highest in elderly patients, in the South, and for rotator cuff repair. The incidence was lowest in young patients, in the Midwest, and for capsulorrhaphy. In general, shoulder arthroscopic surgery in this study population had a low rate of

  3. Outcomes of Tracheostomy in Children Requiring Surgery for Congenital Heart Disease. (United States)

    Ortmann, Laura A; Manimtim, Winston M; Lachica, Charisse I


    Outcomes after discharge in children requiring tracheostomy after cardiac surgery have not been fully described. A retrospective, single-center study was performed on all children tracheostomy and surgery for congenital heart disease from January 2002 to May 2015. Forty-six tracheostomies were placed after surgery and four before. Single-ventricle anatomy was present in 12 (33%) patients. Incidence of tracheostomy after heart surgery increased from 0.8% the first half of the study period to 2% the second half. Median time between cardiac surgery and tracheostomy was 58 days. The most common indication for tracheostomy was multifactorial (30%) followed by airway malacia (22%). Median length to follow-up for survivors was 3.9 years (range 0.4-11.8 years). Survival to hospital discharge was 72%, and intermediate survival was 48%. Survival in those with systemic to pulmonary artery shunts at the time of tracheostomy was 22% compared to 59% for those with biventricular anatomy. Heart failure and multiple indications for tracheostomy were associated with worse outcome. There was no difference in survival for those discharged with a ventilator compared to those that were not. The most common cause of death after discharge was tracheostomy tube dislodgement/obstruction, accounting for 5 of 11 that died. Survival with a tracheostomy after cardiac surgery is poor, and children with systemic to pulmonary artery shunts are at especially high risk of death.

  4. Risk factors for the development of cataract requiring surgery in uveitis associated with juvenile idiopathic arthritis.

    NARCIS (Netherlands)

    Sijssens, K.M.; Rothova, A.; van de Vijver, D.A.M.C.; Stilma, J.S.; de Boer, J.H.


    PURPOSE: To identify the possible risk factors for the development of cataract requiring surgery in children with juvenile idiopathic arthritis (JIA)-associated uveitis. DESIGN: Retrospective cohort study. METHODS: Data of 53 children with JIA-associated uveitis, of whom 27 had undergone cataract

  5. Sevoflurane requirement during elective ankle day surgery: the effects of etirocoxib premedication, a prospective randomised study

    Directory of Open Access Journals (Sweden)

    Jakobsson Jan G


    Full Text Available Abstract Background Anti-inflammatory drugs, NSAIDs, have become an important part of the pain management in day surgery. The aim of the present study was to evaluate the effect of Coxib premedication on the intra-operative anaesthetic requirements in patients undergoing elective ankle surgery in general anaesthesia. Type of study Prospective, randomized study of the intra-operative anaesthetic-sparing effects of etoricoxib premedication as compared to no NSAID preoperatively. Methods The intra-operative requirement of sevoflurane was studied in forty-four ASA 1–2 patients undergoing elective ankle day surgical in balanced general anaesthesia. Primary study endpoint was end-tidal sevoflurane concentration to maintain Cerebral State Index of 40 – 50 during surgery. Results All anaesthesia and surgery was uneventful, no complications or adverse events were noticed. The mean end-tidal sevoflurane concentration intra-operatively was 1.25 (SD 0.2 and 0.91 (SD 0.2 for the pre and post-operative administered group of patients respectively (p Conclusion Coxib premedication before elective day surgery has an anaesthetic sparing potential.

  6. Complications in skin grafts when continuing antithrombotic therapy prior to cutaneous surgery requiring skin grafting

    DEFF Research Database (Denmark)

    Jarjis, Reem Dina; Jørgensen, Lone; Finnerup, Kenneth


    Abstract The risk of postoperative bleeding and wound healing complications in skin grafts among anticoagulated patients undergoing cutaneous surgery has not been firmly established. The objective was to examine the literature and assess the risk of postoperative bleeding or wound healing...... complications in skin grafts among anticoagulated patients, compared with patients who discontinue or patients who are not receiving antithrombotic therapy prior to cutaneous surgery requiring skin grafting. A systematic review examining the effect of antithrombotic therapy on cutaneous surgery was performed...... studies were of prospective and retrospective design. Most of the reviewed studies suggest that the use of antithrombotic therapy can increase the risk of bleeding complications in skin grafts. These complications are only wound threatening and not life threatening. Therefore, this is of concern mostly...

  7. Type of Valvular Heart Disease Requiring Surgery in the 21st Century: Mortality and Length-of-Stay Related to Surgery (United States)

    Boudoulas, Konstantinos Dean; Ravi, Yazhini; Garcia, Daniel; Saini, Uksha; Sofowora, Gbemiga G.; Gumina, Richard J.; Sai-Sudhakar, Chittoor B.


    Aim: While the incidence of rheumatic heart disease has declined dramatically over the last half-century, the number of valve surgeries has not changed. This study was undertaken to define the most common type of valvular heart disease requiring surgery today, and determine in-hospital surgical mortality and length-of-stay (LOS) for isolated aortic or mitral valve surgery in a United States tertiary-care hospital. Methods: Patients with valve surgery between January 2002 to June 2008 at The Ohio State University Medical Center were studied. Patients only with isolated aortic or mitral valve surgery were analyzed. Results: From 915 patients undergoing at least aortic or mitral valve surgery, the majority had concomitant cardiac proce-dures mostly coronary artery bypass grafting (CABG); only 340 patients had isolated aortic (n=204) or mitral (n=136) valve surgery. In-hospital surgical mortality for mitral regurgitation (n=119), aortic stenosis (n=151), aortic insufficiency (n=53) and mitral stenosis (n=17) was 2.5% (replacement 3.4%; repair 1.6%), 3.9%, 5.6% and 5.8%, respectively (p=NS). Median LOS for aortic insufficiency, aortic stenosis, mitral regurgitation, and mitral stenosis was 7, 8, 9 (replacement 11.5; repair 7) and 11 days, respectively (p<0.05 for group). In-hospital surgical mortality for single valve surgery plus CABG was 10.2% (p<0.005 compared to single valve surgery). Conclusions: Aortic stenosis and mitral regurgitation are the most common valvular lesions requiring surgery today. Surgery for isolated aortic or mitral valve disease has low in-hospital mortality with modest LOS. Concomitant CABG with valve surgery increases mortality substantially. Hospital analysis is needed to monitor quality and stimulate improvement among Institutions. PMID:24339838

  8. Blood utilization in neonates and infants undergoing cardiac surgery requiring cardiopulmonary bypass. (United States)

    Wesley, Mark C; Yuki, Koichi; Daaboul, Dima G; Dinardo, James A


    Neonates and infants undergoing cardiac surgery with cardiopulmonary bypass are exposed to multiple blood products from different donors. The volume of the bypass circuit is often as large as the patient's total blood volume and asanguineous bypass primes are unusual. As a result, blood products are required for the cardiopulmonary bypass prime and are often used to treat the postbypass dilutional coagulopathy. We review clot formation and strength, cardiopulmonary bypass prime considerations, assessment of postbypass coagulopathy, component therapy use, ultrafiltration techniques, and use of antifibrinolytic medications. A combined approach including techniques to minimize the prime volume, utilization of ultrafiltration, administration of antifibrinolytics during surgery, and the proper treatment of the dilutional coagulopathy can limit the transfusion requirements.

  9. Shear wall ultimate drift limits

    International Nuclear Information System (INIS)

    Duffey, T.A.; Goldman, A.; Farrar, C.R.


    Drift limits for reinforced-concrete shear walls are investigated by reviewing the open literature for appropriate experimental data. Drift values at ultimate are determined for walls with aspect ratios ranging up to a maximum of 3.53 and undergoing different types of lateral loading (cyclic static, monotonic static, and dynamic). Based on the geometry of actual nuclear power plant structures exclusive of containments and concerns regarding their response during seismic (i.e.,cyclic) loading, data are obtained from pertinent references for which the wall aspect ratio is less than or equal to approximately 1, and for which testing is cyclic in nature (typically displacement controlled). In particular, lateral deflections at ultimate load, and at points in the softening region beyond ultimate for which the load has dropped to 90, 80, 70, 60, and 50 percent of its ultimate value, are obtained and converted to drift information. The statistical nature of the data is also investigated. These data are shown to be lognormally distributed, and an analysis of variance is performed. The use of statistics to estimate Probability of Failure for a shear wall structure is illustrated

  10. A naïve Bayes classifier for planning transfusion requirements in heart surgery. (United States)

    Cevenini, Gabriele; Barbini, Emanuela; Massai, Maria R; Barbini, Paolo


    Transfusion of allogeneic blood products is a key issue in cardiac surgery. Although blood conservation and standard transfusion guidelines have been published by different medical groups, actual transfusion practices after cardiac surgery vary widely among institutions. Models can be a useful support for decision making and may reduce the total cost of care. The objective of this study was to propose and evaluate a procedure to develop a simple locally customized decision-support system. We analysed 3182 consecutive patients undergoing cardiac surgery at the University Hospital of Siena, Italy. Univariate statistical tests were performed to identify a set of preoperative and intraoperative variables as likely independent features for planning transfusion quantities. These features were utilized to design a naïve Bayes classifier. Model performance was evaluated using the leave-one-out cross-validation approach. All computations were done using spss and matlab code. The overall correct classification percentage was not particularly high if several classes of patients were to be identified. Model performance improved appreciably when the patient sample was divided into two classes (transfused and non-transfused patients). In this case the naïve Bayes model correctly classified about three quarters of patients with 71.2% sensitivity and 78.4% specificity, thus providing useful information for recognizing patients with transfusion requirements in the specific scenario considered. Although the classifier is customized to a particular setting and cannot be generalized to other scenarios, the simplicity of its development and the results obtained make it a promising approach for designing a simple model for different heart surgery centres needing a customized decision-support system for planning transfusion requirements in intensive care unit. © 2011 Blackwell Publishing Ltd.

  11. Ultimate disposal of radioactive wastes

    International Nuclear Information System (INIS)

    Roethemeyer, H.


    The activities developed by the Federal Institution of Physical Engineering PTB and by the Federal Office for Radiation Protection (BfS) concentrated, among others, on work to implement ultimate storage facilities for radioactive wastes. The book illuminates this development from site designation to the preliminary evaluation of the Gorleben salt dome, to the preparation of planning documents proving that the Konrad ore mine is suitable for a repository. The paper shows the legal provisions involved; research and development tasks; collection of radioactive wastes ready for ultimate disposal; safety analysis in the commissioning and post-operational stages, and product control. The historical development of waste management in the Federal Republic of Germany and international cooperation in this area are outlined. (DG) [de

  12. Ultimate fate of constrained voters

    International Nuclear Information System (INIS)

    Vazquez, F; Redner, S


    We examine the ultimate fate of individual opinions in a socially interacting population of leftists, centrists and rightists. In an elemental interaction between agents, a centrist and a leftist can both become centrists or both become leftists with equal rates (and similarly for a centrist and a rightist). However leftists and rightists do not interact. This interaction step between pairs of agents is applied repeatedly until the system can no longer evolve. In the mean-field limit, we determine the exact probability that the system reaches consensus (either leftist, rightist or centrist) or a frozen mixture of leftists and rightists as a function of the initial composition of the population. We also determine the mean time until the final state is reached. Some implications of our results for the ultimate fate in a limit of the Axelrod model are discussed

  13. Ultimate fate of constrained voters

    Energy Technology Data Exchange (ETDEWEB)

    Vazquez, F [Department of Physics, Center for BioDynamics, Boston University, Boston, MA 02215 (United States); Redner, S [Department of Physics, Center for Polymer Studies, Boston University, Boston, MA 02215 (United States)


    We examine the ultimate fate of individual opinions in a socially interacting population of leftists, centrists and rightists. In an elemental interaction between agents, a centrist and a leftist can both become centrists or both become leftists with equal rates (and similarly for a centrist and a rightist). However leftists and rightists do not interact. This interaction step between pairs of agents is applied repeatedly until the system can no longer evolve. In the mean-field limit, we determine the exact probability that the system reaches consensus (either leftist, rightist or centrist) or a frozen mixture of leftists and rightists as a function of the initial composition of the population. We also determine the mean time until the final state is reached. Some implications of our results for the ultimate fate in a limit of the Axelrod model are discussed.

  14. Peptic ulcer complications requiring surgery: what has changed in the last 50 years in Turkey. (United States)

    Güzel, Hakan; Kahramanca, Sahin; Şeker, Duray; Özgehan, Gülay; Tunç, Gündüz; Küçükpınar, Tevfik; Kargıcı, Hülagü


    The incidence and prevalence of peptic ulcer disease has decreased in recent years, but it is not so easy to make the same conclusion when complications of peptic ulcer are taken into consideration. The aim of this study is to determine the time trends in complicated peptic ulcer disease and to state the effects of H2 receptor blockers, proton pump inhibitors (PPI), and H. pylori eradication therapies on these complications. This study retrospectively evaluated the patients who were operated on for complications (perforation, bleeding, and obstruction) of peptic ulcer for the last 50 years. Patients were grouped into four groups (G1-G4) according to the dates in which H2 receptor blockers, PPIs, and eradication regimens for H. pylori were introduced The time periods that were studied were: (G1) 1962-1980, (G2) 1981-1990, (G3) 1991-1997, and (G4) 1998-2012. In total, 2953 patients were operated on for complications of peptic ulcer disease, of which 86% of the patients were male. In G1, perforation and obstruction were significantly the most frequent complications (p<0.001), followed by bleeding. In groups G2 and G3, obstruction was still the most frequent complication requiring surgery (p<0.001). In G2 and G3, obstruction was followed by perforation and bleeding, respectively. In G4, perforation was significantly the most frequent complication (p<0.001). From 1962 to 1990 obstruction was the most common complication requiring surgery. In the last decade, perforation became the most common complication. In contrast to reports in the literature, bleeding was the least common complication requiring surgery in Turkey.

  15. Awareness during anaesthesia for surgery requiring evoked potential monitoring: A pilot study

    Directory of Open Access Journals (Sweden)

    Pritish J Korula


    Full Text Available Background: Evoked potential monitoring such as somatosensory-evoked potential (SSEP or motor-evoked potential (MEP monitoring during surgical procedures in proximity to the spinal cord requires minimising the minimum alveolar concentrations (MACs below the anaesthetic concentrations normally required (1 MAC to prevent interference in amplitude and latency of evoked potentials. This could result in awareness. Our primary objective was to determine the incidence of awareness while administering low MAC inhalational anaesthetics for these unique procedures. The secondary objective was to assess the adequacy of our anaesthetic technique from neurophysiologist′s perspective. Methods: In this prospective observational pilot study, 61 American Society of Anesthesiologists 1 and 2 patients undergoing spinal surgery for whom intraoperative evoked potential monitoring was performed were included; during the maintenance phase, 0.7-0.8 MAC of isoflurane was targeted. We evaluated the intraoperative depth of anaesthesia using a bispectral (BIS index monitor as well as the patients response to surgical stimulus (PRST scoring system. Post-operatively, a modified Bruce questionnaire was used to verify awareness. The adequacy of evoked potential readings was also assessed. Results: Of the 61 patients, no patient had explicit awareness. Intraoperatively, 19 of 61 patients had a BIS value of above sixty at least once, during surgery. There was no correlation with PRST scoring and BIS during surgery. Fifty-four out of 61 patient′s evoked potential readings were deemed ′good′ or ′fair′ for the conduct of electrophysiological monitoring. Conclusions: This pilot study demonstrates that administering low MAC inhalational anaesthetics to facilitate evoked potential monitoring does not result in explicit awareness. However, larger studies are needed to verify this. The conduct of SSEP electrophysiological monitoring was satisfactory with the use of this

  16. Experimental investigation of ultimate loads

    Energy Technology Data Exchange (ETDEWEB)

    Petersen, S M; Larsen, G C; Antoniou, I; Lind, S O; Courtney, M [Risoe National Lab., Wind Energy and Atmospheric Physics, Roskilde (Denmark)


    Verification of the structural integrity of a wind turbine involves analysis of fatigue loading as well as ultimate loading. With the trend of persistently growing turbines, the ultimate loading seems to become relatively more important. For wind turbines designed according to the wind conditions prescribed in the IEC-61400 code, the ultimate load is often identified as the leading load parameter. Exemplified by the use of an extensive measurement campaign a procedure for evaluation of the extreme flap-wise bending moments, occurring during normal operating of a wind turbine, is presented. The structural measurements are made on a NEG Micon 650 kW wind turbine erected at a complex high wind site in Oak Creek, California. The turbine is located on the top of a ridge. The prevailing wind direction is perpendicular to the ridge, and the annual mean wind speed is 9.5 m/s. The associated wind field measurement, are taken from two instrumented masts erected less than one rotor diameter in front of the turbine in direction of the prevailing wind direction. Both masts are instrumented at different heights in order to gain insight of the 3D-wind speed structure over the entire rotor plane. Extreme distributions, associated with a recurrence period of 10 minutes, conditioned on the mean wind speed and the turbulence intensity are derived. Combined with the wind climate model proposed in the IEC standard, these distributions are used to predict extreme distributions with recurrence periods equal to one and fifty years, respectively. The synthesis of the conditioned PDF`s and the wind climate model is performed by means of Monte Carlo simulation. (au)

  17. Comparison of time required for traditional versus virtual orthognathic surgery treatment planning. (United States)

    Wrzosek, M K; Peacock, Z S; Laviv, A; Goldwaser, B R; Ortiz, R; Resnick, C M; Troulis, M J; Kaban, L B


    Virtual surgical planning (VSP) is a tool for predicting complex surgical movements in three dimensions and it may reduce preoperative laboratory time. A prospective study to compare the time required for standard preoperative planning versus VSP was conducted at Massachusetts General Hospital from January 2014 through January 2015. Workflow data for bimaxillary cases planned by both standard techniques and VSP were recorded in real time. Time spent was divided into three parts: (1) obtaining impressions, face-bow mounting, and model preparation; (2) occlusal analysis and modification, model surgery, and splint fabrication; (3) online VSP session. Average times were compared between standard treatment planning (sum of parts 1 and 2) and VSP (sum of parts 1 and 3). Of 41 bimaxillary cases included, 20 were simple (symmetric) and 21 were complex (asymmetry and segmental osteotomies). Average times for parts 1, 2, and 3 were 4.43, 3.01, and 0.67h, respectively. The average time required for standard treatment planning was 7.45h and for VSP was 5.10h, a 31% time reduction (Porthognathic surgery cases. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Experience of two trauma-centers with pancreatic injuries requiring immediate surgery. (United States)

    Ouaïssi, Mehdi; Sielezneff, Igor; Chaix, Jean Baptiste; Mardion, Remi Bon; Pirrò, Nicolas; Berdah, Stéphane; Emungania, Olivier; Consentino, Bernard; Cresti, Silvia; Dahan, Laetitia; Orsoni, Pierre; Moutardier, Vincent; Brunet, C; Sastre, Bernard


    Pancreatic injury from blunt trauma is infrequent. The aim of the present study was to evaluate a simplified approach of management of pancreatic trauma injuries requiring immediate surgery consisting of either drainage in complex situation or pancreatectomy in the other cases. From January 1986 to December 2006, 40 pancreatic traumas requiring immediate surgery were performed. Mechanism of trauma, clinical and laboratories findings were noted upon admission, classification of pancreatic injury according to Lucas' classification were considered. Fifteen (100%) drainages were performed for stage I (n=15), 60% splenopancreatectomies and 40% drainage was achieved for stage II (n=18), 3 Pancreaticoduonectomies and 2 exclusion of duodenum with drainage and 2 packing were performed for stage IV (n=7). There were 30 men and 10 women with mean age of 29+/-13 years (15-65). Thirty-eight patients had multiple trauma. Overall, mortality and global morbidity rate were 17% and 65% respectively, and the rates increased with Lucas' pancreatic trauma stage. Distal pancreatectomy is indicated for distal injuries with duct involvement, and complex procedures such as pancreaticoduodenectomy should be performed in hemodynamically stable patients.


    Directory of Open Access Journals (Sweden)

    A. V. Rudakova


    Full Text Available Smoking is a major risk factor in patients with angina pectoris. Interventions that facilitate the rejection of it are an important part of the treatment. Aim. To analyze the cost effectiveness of the partial agonist of nicotinic receptors, varenicline, in patients with angina who require cardiac interventions. Material and methods. The estimation was conducted using a Markov model based on the results of clinical trials and epidemiological studies. The cost of treatment of complications were calculated on the basis of compulsory medical insurance rates for St. Petersburg in 2011. Results. The varenicline therapy in 70-year-old patients before cardiac surgery reduces hospital mortality at an extremely high cost-effectiveness (the cost of preventing one death - 148.8 thousand rubles. The cost/effectiveness ratio in the analysis for the period of survival of patients in this situation was 31.3 thousand rubles for 1 additional year of life. Life expectancy will be increased by an average of 0.147 years. Analysis for the period of survival of 50-year-old patients has shown that in patients after cardiac surgery cost-effectiveness of varenicline is extremely high (in the analysis from the perspective of the health care system the cost/effectiveness ratio was 36.0 thousand rubles for 1 additional year of life, in the analysis, taking into account the social perspective – 17.9 thousand rubles for 1 additional year of life. Increase in the life expectancy of 50 year-old patients will be 0.291 year in average. Conclusion. Varenicline therapy of patients with angina pectoris is the economy before cardiac surgery , and after their execution, and this applies not only young, but older patients. The desirability of varenicline including to federal and regional programs to reduce cardiovascular morbidity and mortality is shown.

  20. Ultimate Explanations of the Universe

    CERN Document Server

    Heller, Michael


    We humans are collectively driven by a powerful - yet not fully explained - instinct to understand. We would like to see everything established, proven, laid bare. The more important an issue, the more we desire to see it clarified, stripped of all secrets, all shades of gray. What could be more important than to understand the Universe and ourselves as a part of it? To find a window onto our origin and our destiny? This book examines how far our modern cosmological theories - with their sometimes audacious models, such as inflation, cyclic histories, quantum creation, parallel universes - can take us towards answering these questions. Can such theories lead us to ultimate truths, leaving nothing unexplained? Last, but not least, Heller addresses the thorny problem of why and whether we should expect to find theories with all-encompassing explicative power.

  1. Ultimate loading of wind turbines

    DEFF Research Database (Denmark)

    Larsen, Gunner Chr.; Ronold, K.; Ejsing Jørgensen, Hans


    An extreme loading study has been conducted comprising a general wind climate analysis as well as a wind turbine reliability study. In the wind climate analysis, the distribution of the (horizontal) turbulence standard deviation, conditioned on the meanwind speed, has been approximated by fitting......, a design turbulence intensity for off-shore application is proposed which, in the IEC code framework, is applicable for extreme as well as for fatigue loaddetermination. In order to establish a rational method to analyse wind turbine components with respect to failure in ultimate loading, and in addition...... a three parameter Weibull distribution to the measured on-shore and off-shore data for wind speed variations. Specific recommendations on off-shore design turbulence intensities are lacking in the presentIEC-code. Based on the present analysis of the off-shore wind climate on two shallow water sites...

  2. Sagittal Alignment As a Predictor of Clinical Adjacent Segment Pathology requiring Surgery after Anterior Cervical Arthrodesis (United States)

    Park, Moon Soo; Kelly, Michael P.; Lee, Dong-Ho; Min, Woo-Kie; Rahman, Ra’Kerry K.; Riew, K. Daniel


    BACKGROUND CONTEXT Postoperative malalignment of the cervical spine may alter cervical spine mechanics, and put patients at risk for clinical adjacent segment pathology requiring surgery. PURPOSE To investigate whether a relationship exists between cervical spine sagittal alignment and clinical adjacent segment pathology requiring surgery (CASP-S) following anterior cervical fusion (ACF). STUDY DESIGN Retrospective matched study. PATIENT SAMPLE One hundred twenty two patients undergoing ACF from 1996 to 2008 were identified, with a minimum of 2 year follow-up. OUTCOME MEASURES Radiographs were reviewed to measure the sagittal alignment using C2 and C7 sagittal plumb lines, distance from the fusion mass plumb line to the C2 and C7 plumb lines, the alignment of the fusion mass, caudally adjacent disc angle, the sagittal slope angle of the superior endplate of the vertebra caudally adjacent to the fusion mass, T1 sagittal angle, overall cervical sagittal alignment, and curve patterns by Katsuura classification. METHODS One hundred twenty two patients undergoing ACF from 1996 to 2008 were identified, with a minimum of 1 year follow-up. Patients were divided into groups according to the development of CASP requiring surgery (Control / CASP-S) and by number/location of levels fused. Radiographs were reviewed to measure the sagittal alignment using C2 and C7 sagittal plumb lines, distance from the fusion mass plumb line to the C2 and C7 plumb lines, the alignment of the fusion mass, caudally adjacent disc angle, the sagittal slope angle of the superior endplate of the vertebra caudally adjacent to the fusion mass, T1 sagittal angle, overall cervical sagittal alignment, and curve patterns by Katsuura classification. Appropriate statistical tests were performed to calculate relationships between the variables and the development of CASP-S. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related

  3. Ultimate explanations and suboptimal choice. (United States)

    Vasconcelos, Marco; Machado, Armando; Pandeirada, Josefa N S


    Researchers have unraveled multiple cases in which behavior deviates from rationality principles. We propose that such deviations are valuable tools to understand the adaptive significance of the underpinning mechanisms. To illustrate, we discuss in detail an experimental protocol in which animals systematically incur substantial foraging losses by preferring a lean but informative option over a rich but non-informative one. To understand how adaptive mechanisms may fail to maximize food intake, we review a model inspired by optimal foraging principles that reconciles sub-optimal choice with the view that current behavioral mechanisms were pruned by the optimizing action of natural selection. To move beyond retrospective speculation, we then review critical tests of the model, regarding both its assumptions and its (sometimes counterintuitive) predictions, all of which have been upheld. The overall contention is that (a) known mechanisms can be used to develop better ultimate accounts and that (b) to understand why mechanisms that generate suboptimal behavior evolved, we need to consider their adaptive value in the animal's characteristic ecology. Copyright © 2018 Elsevier B.V. All rights reserved.

  4. A retrospective study on analgesic requirements for thoracoscopic surgery postoperative pain

    Directory of Open Access Journals (Sweden)

    Kuroda H


    Full Text Available Hiroaki Kuroda,1 Hitomi Mizuno,2 Hitoshi Dejima,1 Kiyoe Watanabe,2 Tatsuya Yoshida,3 Yumiko Naito,2 Yukinori Sakao1 1Department of Thoracic Surgery, 2Department of Nursing, 3Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan Background: Thoracoscopic surgery (TS has been performed as a minimally invasive procedure since the beginning of the 1990s. This has led to a dramatic change in the postoperative condition of these patients, facilitating early ambulation and easier management of postoperative pain. However, empirical evidence on postoperative pain management after TS is limited. The aims of this study were to determine the efficacy and adequacy of postoperative analgesic medications and to simplify the choice of additional drugs based on a numerical rating scale (NRS.Materials and methods: A retrospective study of patients who underwent TS was performed to evaluate postoperative pain, analgesia requirements, and the number of drugs needed during the perioperative period based on the NRS score.Results: Of the 524 patients, mild pain was noted in 87% patients on the day of the operation and in 75.6% patients on ambulation. The mean NRS score was 1.83±1.49 on the day of the operation and 2.73±1.75 on ambulation. An NRS score of 3 on both the day of operation and on ambulation was defined as the necessary condition for improved pain management. Multivariate analysis showed that high surgical stress significantly influenced pain scores. Reduction in pain with an NRS score of ≥1 was significant with the addition of pentazocine hydrochloride (p<0.01 and flurbiprofen (p<0.01. Interestingly, the addition of tramadol was borderline efficacious (p=0.05 in patients with an NRS score of >3 on ambulation.Conclusion: A small number of patients have moderate-to-severe pain after TS. Tramadol demonstrated borderline efficacy in controlling postoperative intense pain with an NRS score of ≥3. Keywords: tramadol, thoracoscopic

  5. The threshold force required for femoral impaction grafting in revision hip surgery.

    LENUS (Irish Health Repository)

    Flannery, Olivia M


    BACKGROUND AND PURPOSE: Femoral impaction grafting requires vigorous impaction to obtain adequate stability without risk of fracture, but the force of impaction has not been determined. We determined this threshold force in a preliminary study using animal femurs. METHODS: Adult sow femurs were used because of their morphological similarity to human femurs in revision hip arthroplasty. 35 sow femurs were impacted with morselized bone chips and an increasing force was applied until the femur fractured. This allowed a threshold force to be established. 5 other femurs were impacted to this force and an Exeter stem was cemented into the neomedullary canal. A 28-mm Exeter head was attached and loaded by direct contact with a hydraulic testing machine. Axial cyclic loading was performed and the position sensor of the hydraulic testing machine measured the prosthetic head subsidence. RESULTS: 29 tests were completed successfully. The threshold force was found to be 4 kN. There was no statistically significant correlation between the load at fracture and the cortex-to-canal ratio or the bone mineral density. Following impaction with a maximum force of 4 kN, the average axial subsidence was 0.28 mm. INTERPRETATION: We achieved a stable construct without fracture. Further studies using human cadaveric femurs should be done to determine the threshold force required for femoral impaction grafting in revision hip surgery.

  6. Age-related postoperative morphine requirements in children following major surgery--an assessment using patient-controlled analgesia (PCA)

    DEFF Research Database (Denmark)

    Hansen, Tom Giedsing; Henneberg, Steen Winther; Hole, P


    To investigate if small children require less morphine for postoperative analgesia than do older children and adolescents we analysed the morphine consumption pattern of 28 consecutive children on intravenous patient-controlled analgesia (PCA) following major surgery. The median age-specific morp......To investigate if small children require less morphine for postoperative analgesia than do older children and adolescents we analysed the morphine consumption pattern of 28 consecutive children on intravenous patient-controlled analgesia (PCA) following major surgery. The median age...

  7. Comparison of Warfarin Requirements in Post-cardiac Surgery Patients: Valve Replacement Versus Non-valve Replacement. (United States)

    Olson, Logan M; Nei, Andrea M; Joyce, David L; Ou, Narith N; Dierkhising, Ross A; Nei, Scott D


    Anticoagulation with warfarin affects approximately 140,000 post-cardiac surgery patients every year, yet there remains limited published data in this patient population. Dosing remains highly variable due to intrinsic risk factors that plague cardiac surgery candidates and a lack of diverse literature that can be applied to those who have undergone a cardiac surgery alternative to heart valve replacement (HVR). In the present study, our aim was to compare the warfarin requirements between HVR and non-HVR patients. This was a single-center, retrospective study of post-cardiac surgery patients initiated on warfarin at Mayo Clinic Hospital, Rochester, from January 1st, 2013 to October 31st, 2016. The primary outcome was the maintenance warfarin dose at the earliest of discharge or warfarin day 10 between patients with HVR and non-HVR cardiac surgeries. A total of 683 patients were assessed during the study period: 408 in the HVR group and 275 in the non-HVR group. The mean warfarin maintenance doses in the HVR and non-HVR groups were 2.55 mg [standard deviation (SD) 1.52] and 2.43 mg (SD 1.21), respectively (adjusted p = 0.65). A multivariable analysis was performed to adjust for gender, age, body mass index and drug interactions. This was the largest study to evaluate warfarin dose requirements in post-cardiac surgery patients and is the first to compare warfarin requirements between HVR and non-HVR patients during the immediate post-operative period. Both groups had similar warfarin requirements, which supports expanding the initial warfarin dosing recommendations of the 9th edition Chest guideline to include non-HVR patients as well as HVR patients.

  8. Cardiac-surgery associated acute kidney injury requiring renal replacement therapy. A Spanish retrospective case-cohort study

    Directory of Open Access Journals (Sweden)

    Garcia-Fernandez Nuria


    Full Text Available Abstract Background Acute kidney injury is among the most serious complications after cardiac surgery and is associated with an impaired outcome. Multiple factors may concur in the development of this disease. Moreover, severe renal failure requiring renal replacement therapy (RRT presents a high mortality rate. Consequently, we studied a Spanish cohort of patients to assess the risk factors for RRT in cardiac surgery-associated acute kidney injury (CSA-AKI. Methods A retrospective case-cohort study in 24 Spanish hospitals. All cases of RRT after cardiac surgery in 2007 were matched in a crude ratio of 1:4 consecutive patients based on age, sex, treated in the same year, at the same hospital and by the same group of surgeons. Results We analyzed the data from 864 patients enrolled in 2007. In multivariate analysis, severe acute kidney injury requiring postoperative RRT was significantly associated with the following variables: lower glomerular filtration rates, less basal haemoglobin, lower left ventricular ejection fraction, diabetes, prior diuretic treatment, urgent surgery, longer aortic cross clamp times, intraoperative administration of aprotinin, and increased number of packed red blood cells (PRBC transfused. When we conducted a propensity analysis using best-matched of 137 available pairs of patients, prior diuretic treatment, longer aortic cross clamp times and number of PRBC transfused were significantly associated with CSA-AKI. Patients requiring RRT needed longer hospital stays, and suffered higher mortality rates. Conclusion Cardiac-surgery associated acute kidney injury requiring RRT is associated with worse outcomes. For this reason, modifiable risk factors should be optimised and higher risk patients for acute kidney injury should be identified before undertaking cardiac surgery.

  9. Experimental assessment of energy requirements and tool tip visibility for photoacoustic-guided endonasal surgery (United States)

    Lediju Bell, Muyinatu A.; Dagle, Alicia B.; Kazanzides, Peter; Boctor, Emad M.


    Endonasal transsphenoidal surgery is an effective approach for pituitary adenoma resection, yet it poses the serious risk of internal carotid artery injury. We propose to visualize these carotid arteries, which are hidden by bone, with an optical fiber attached to a surgical tool and a transcranial ultrasound probe placed on the patient's temple (i.e. intraoperative photoacoustic imaging). To investigate energy requirements for vessel visualization, experiments were conducted with a phantom containing ex vivo sheep brain, ex vivo bovine blood, and 0.5-2.5 mm thick human cadaveric skull specimens. Photoacoustic images were acquired with 1.2-9.3 mJ laser energy, and the resulting vessel contrast was measured at each energy level. The distal vessel boundary was difficult to distinguish at the chosen contrast threshold for visibility (4.5 dB), which was used to determine the minimum energies for vessel visualization. The blood vessel was successfully visualized in the presence of the 0-2.0 mm thick sphenoid and temporal bones with up to 19.2 dB contrast. The minimum energy required ranged from 1.2-5.0 mJ, 4.2-5.9 mJ, and 4.6-5.2 mJ for the 1.0 temporal and 0-1.5 mm sphenoid bones, 1.5 mm temporal and 0-0.5 mm sphenoid bones, and 2.0 mm temporal and 0-0.5 mm sphenoid bones, respectively, which corresponds to a fluence range of 4-21 mJ/cm2. These results hold promise for vessel visualization within safety limits. In a separate experiment, a mock tool tip was placed, providing satisfactory preliminary evidence that surgical tool tips can be visualized simultaneously with blood vessels.

  10. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more ... find out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment ...


    Berkowitz, Aviva C; Ginsburg, Aryeh M; Pesso, Raymond M; Angus, George L D; Kang, Amiee; Ginsburg, Dov B


    Postoperative airway compromise following cervical spine surgery is a potentially serious adverse event. Residual effects of anesthesia and perioperative opioids that can cause both sedation and respiratory depression further increase this risk. Ketamine is an N-methyl-d-aspartate (NMDA) receptor antagonist that provides potent analgesia without noticeable respiratory depression. We investigated whether intraoperative ketamine administration could decrease perioperative opioid requirements in trauma patients undergoing cervical spine surgery. We retrospectively reviewed anesthesia records identifying cervical spine surgeries performed between March 2014 and February 2015. All patients received a balanced anesthetic technique utilizing sevoflurane 0.5 minimum alveolar concentration (MAC) and propofol infusion (50-100 mcg/kg/min). For intraoperative analgesia, one group of patients received ketamine (N=25) and a second group received fentanyl (N=27). Cumulative opioid doses in the recovery room and until 24 hours postoperatively were recorded. Fewer patients in the ketamine group (11/25 [44%] vs. 20/27 [74%], respectively; p = 0.03) required analgesics in the recovery room. Additionally, the total cumulative opioid requirements in the ketamine group decreased postoperatively at both 3 and 6 hours (p = 0.01). Ketamine use during cervical spine surgery decreased opioid requirements in both the recovery room and in the first 6 hours postoperatively. This may have the potential to minimize opioid induced respiratory depression in a population at increased risk of airway complications related to the surgical procedure.

  12. UHS, Ultimate Heat Sink Cooling Pond Analysis

    International Nuclear Information System (INIS)

    Codell, R.; Nuttle, W.K.


    1 - Description of program or function: Three programs model performance of an ultimate heat sink cooling pond. National Weather Service data is read and analyzed to predict periods of lowest cooling performance and highest evaporative loss. The data is compared to local site data for significant differences. Then the maximum pond temperature is predicted. Five programs model performance of an ultimate heat sink spray pond. The cooling performance, evaporative water loss, and drift water loss as a function of wind speed are estimated for a spray field. These estimates are used in conjunction with National Weather Service data to predict periods of lowest cooling performance and highest evaporative loss. This data is compared to local site data for significant differences. Then the maximum pond temperature is predicted. 2 - Method of solution: The transfer of heat and water vapor is modeled using an equilibrium temperature procedure for an UHS cooling pond. The UHS spray pond model considers heat, mass, and momentum transfer from a single water drop with the surrounding air, and modification of the surrounding air resulting from the heat, mass, and momentum transfer from many drops in different parts of a spray field. 3 - Restrictions on the complexity of the problem: The program SPRCO uses RANF, a uniform random number generator which is an intrinsic function on the CDC. All programs except COMET use the NAMELIST statement, which is non standard. Otherwise these programs conform to the ANSI Fortran 77 standard. The meteorological data scanning procedure requires tens of years of recorded data to be effective. The models and methods, provided as useful tool for UHS analyses of cooling ponds and spray ponds, are intended as guidelines only. Use of these methods does not automatically assure NRC approval, nor are they required procedures for nuclear-power-plant licensing

  13. Assessment and characterization of radioactive waste for ultimate storage

    International Nuclear Information System (INIS)

    Brennecke, P.; Warnecke, E.


    The waste specifications determined from site safety analyses define the requirements to be met by waste forms for ultimate storage. Product quality control is the process step ensuring compliance with the conditions to be met for ultimate storage. For this purpose, radionuclide inventory, fixation method, container type, waste form and quantity, and type of waste are the most significant items on the checking list. (DG) [de

  14. The ultimate challenge of cloacal exstrophy. (United States)

    Schober, Justine M; Carmichael, Polly A; Hines, Melissa; Ransley, Philip G


    Our review addresses the various system abnormalities associated with cloacal exstrophy and revisits the question of gender assignment. Gender assignment decisions and psychological aspects of gender issues have become the "ultimate challenge." Exploration of gender identity, gender role behavior and sexual orientation has just begun. A comprehensive literature review was performed with all world literature regarding the current management of cloacal exstrophy. Research focused on management principles, outcomes and documentation of concurrent anomalies. We also describe original research evaluating gender identity in our own series of patients raised as girls to illustrate the challenge of treatment and augment the available literature, which is scant. Abnormalities of the vertebral column ranged from hemivertebra to myelomeningocele. With magnetic resonance imaging, the incidence of spinal dysraphism approached 100% and cord tethering was also more frequently recognized. For children with the short bowel syndrome, advances in antibiotic usage, and parenteral and enteral nutrition have increased the survival rate and reduced morbidity. A neurological component has been recognized for bladder function, bladder neck continence, lower extremity function and erectile capacity. Mitrofanoff-type reconstruction with bladder neck closure and continent catheterizable stoma dramatically increased continence. Diminutive or absent penis has been documented in 30% of males, and no documentation of paternity exists. The majority of females have bicornuate uterus. However, ovaries and tubes were generally normal. No reports of proven fertility exist. The strategy and timing of surgery relating to gender assignment remain controversial. A desperate need exists for research focusing on gender development and quality of life. Until that time, a cautious watchful approach may be most appropriate as our patients with cloacal exstrophy mature into adulthood.

  15. Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery

    Directory of Open Access Journals (Sweden)

    Bates Tom


    Full Text Available Abstract Background The decision on whether to operate on a sick elderly person with an intra-abdominal emergency is one of the most difficult in general surgery. A predictive risk-score would be of great value in this situation. Methods A Medline search was performed to identify those predictive risk-scores relevant to sick elderly patients in whom emergency surgery might be life-saving. Results Many of the risk scores for surgical patients include the operative findings or require tests which are not available in the acute situation. Most of the relevant studies include younger patients and elective surgery. The Glasgow Aneurysm Score and Hardman Index are specific to ruptured aortic aneurysm while the Boey Score and the Hacetteppe Score are specific to perforated peptic ulcer. The Reiss Index and Fitness Score can be used pre-operatively if the elements of the score can be completed in time. The ASA score, which includes a significant element of subjective clinical judgement, can be augmented with factors such as age and urgency of surgery but no test has a negative predictive value sufficient to recommend against surgical intervention without clinical input. Conclusion Risk scores may be helpful in sick elderly patients needing emergency abdominal surgery but an experienced clinical opinion is still essential.

  16. The dream of an ultimate theory

    International Nuclear Information System (INIS)

    Weinberg, S.


    Steven Weinberg describes how the dream of an ultimate theory began when one tried to unify the fundamental laws governing the stars constellations as elementary particles: electromagnetism, weak-electro theory then standard model which gives only one quantity out of its fields, the gravitation. He tries to explain to what an ultimate theory could look like. but the dream of an ultimate theory is not yet realized, there are some elementary particles to find before and then to build superconducting super colliders. The europe made it. the dream of an ultimate theory became an european dream. (N.C.)

  17. Influence of initial imperfections on ultimate strength of spherical shells

    Directory of Open Access Journals (Sweden)

    Chang-Li Yu


    Full Text Available Comprehensive consideration regarding influence mechanisms of initial imperfections on ultimate strength of spherical shells is taken to satisfy requirement of deep-sea structural design. The feasibility of innovative numerical procedure that combines welding simulation and non-linear buckling analysis is verified by a good agreement to experimental and theoretical results. Spherical shells with a series of wall thicknesses to radius ratios are studied. Residual stress and deformations from welding process are investigated separately. Variant influence mechanisms are discovered. Residual stress is demonstrated to be influential to stress field and buckling behavior but not to the ultimate strength. Deformations are proved to have a significant impact on ultimate strength. When central angles are less than critical value, concave magnitudes reduce ultimate strengths linearly. However, deformations with central angles above critical value are of much greater harm. Less imperfection susceptibility is found in spherical shells with larger wall thicknesses to radius ratios.

  18. Information requirements of young women with breast cancer treated with mastectomy or breast conserving surgery: A systematic review. (United States)

    Recio-Saucedo, Alejandra; Gerty, Sue; Foster, Claire; Eccles, Diana; Cutress, Ramsey I


    Young women with breast cancer have poorer prognosis, greater lifetime risk of local recurrence, contralateral recurrence, and distant disease, regardless of surgery received. Here we systematically review published evidence relating to the information requirements and preferences of young women diagnosed with early-stage breast cancer offered a choice between mastectomy and Breast Conservation Surgery (BCS). Findings will inform the development of a surgical decision aid for young women. Eight databases were searched to identify research examining information requirements of young women facing breast oncological surgery treatment decisions (MESH headings). Twelve studies met the inclusion criteria. Data were extracted and summarised in a narrative synthesis. Findings indicate that young women prefer greater and more detailed information regarding treatment side effects, sexuality, and body image. Younger age of diagnosis leads to an increased risk perception of developing a second breast cancer. Young women's choices are influenced by factors associated with family and career. Information is required in a continuum throughout the treatment experience and not only at diagnosis when treatment decisions are made. Young women show differing levels of participation preferences. Young women find decision-making challenging when the characteristics of diagnosis provide a surgical choice between mastectomy and breast conservation surgery. Efforts should be made to provide information regarding sexuality, body image, reconstruction, fertility and likelihood of familial predisposition. Further research is needed to identify the specific level and information requirements of this young-onset group. The low number of studies indicate a need to design studies targeting specifically this age group of breast cancer patients. Copyright © 2015 Elsevier Ltd. All rights reserved.


    Kayalha, Hamid; Mousavi, Zinat; Sadat Barikani, Ameneh; Yaghoobi, Siamak; Khezri, Marzieh Beigom


    Several additives have been suggested to enhance analgesic effect of local anesthetic agents to decrease the adverse effects of them and increase the degree of satisfaction. We designed this randomized double-blind controlled study to evaluate the analgesic efficacy of the neostigmine added to bupivacaine using spinal anesthesia in patients undergoing lower limb orthopedic surgery. Sixty patients 18-80 yr old American Society of Anesthesiologists (ASA) physical status I or II, scheduled for femur surgery under spinal anesthesia, were recruited in a prospective, double-blinded, randomized way. The patients were randomly allocated to one of two groups of 30 each. The neostigmine group (group N) received bupivacaine 20 mg combined with 25 µg neostigmine, and the placebo group (group C) received bupivacaine 20 mg combined with 0.5ml distilled water (intrathecally) 5 minutes prior to surgery. The time to the first analgesic request, analgesic requirement in the first 12 hours after surgery, the duration of sensory and motor blockade, the incidence of adverse effects such as nausea,vomiting,hypotension, ephedrine requirements, bradycardia, and hypoxemia were recorded. Patients receiving neostigmine had a significantly prolonged duration of motor block (C95% CI 30.27 to 87.65; P < 0.001) and sensory block (C95% CI 101.04 to 224.64; P < 0.001) compared to the control group. The difference of the mean time to the first analgesic request was also significantly longer in neostigmine group (C95% CI 83.139 to 208.526; P < 0.001). The total analgesic consumption during the first 12 hours after surgery was devoid of any significant difference between groups N and C (p = 0.41).The two groups were not significantly different in terms of intraoperative and postoperative side effects. Intrathecal neostigmine 25 µg with bupivacaine caused a prolonged time to the first analgesic request and its use was not associated with any side effects.

  20. The effects of aprotinin on blood product transfusion associated with thoracic aortic surgery requiring deep hypothermic circulatory arrest.

    LENUS (Irish Health Repository)

    Seigne, P W


    OBJECTIVE: To compare the effects of aprotinin on blood product use and postoperative complications in patients undergoing thoracic aortic surgery requiring deep hypothermic circulatory arrest. DESIGN: A retrospective study. SETTING: A university hospital. PARTICIPANTS: Nineteen patients who underwent elective or urgent thoracic aortic surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The total number of units of packed red blood cells, fresh frozen plasma, and platelets was significantly less in the group that received aprotinin (p = 0.01, 0.04, and 0.01). The intraoperative transfusion of packed red blood cells and platelets, collection and retransfusion of cell saver, and postoperative transfusion of fresh frozen plasma were also significantly less in the aprotinin group (p = 0.01, 0.02, 0.01, and 0.05). No patient in either group sustained renal dysfunction or a myocardial infarction. Two patients who had not received aprotinin suffered from chronic postoperative seizures, and one patient who had received aprotinin sustained a perioperative stroke. CONCLUSIONS: Low-dose aprotinin administration significantly decreases blood product transfusion requirements in the setting of thoracic aortic surgery requiring deep hypothermic circulatory arrest, and it does not appear to be associated with renal or myocardial dysfunction.

  1. Concussion Prevalence in Competitive Ultimate Frisbee Players (United States)

    Lazar, Damien J.; Lichtenstein, Jonathan D.; Tybor, David J.


    Background: Ultimate Frisbee (ultimate) is a fast-growing, popular sport played nationally by over 4 million athletes. While several studies have examined injury rates in ultimate, no work has investigated the prevalence of concussions specifically or players’ knowledge and management of those injuries. Purpose: To estimate the lifetime prevalence of concussions in ultimate and to assess players’ knowledge of concussions as well as their concussion management behaviors. Study Design: Descriptive epidemiology study. Methods: From June to November 2015, we collected ultimate-related concussion data via an anonymous web-based survey, the Concussion in Ultimate Frisbee Survey, from a convenience sample of 787 male and female ultimate players across the United States. Results: There were 553 male and 234 female respondents included in the analysis; 26.58% of men and 24.79% of women reported that they had sustained at least 1 concussion while playing ultimate, with 45.58% and 43.10% of those men and women, respectively, reporting multiple concussions. A total of 67.81% of men and 78.21% of women stated that they would remove themselves from play after sustaining a given concussion, although 45.99% of men and 37.62% of women indicated that they had returned to play in the same game or practice. Conclusion: Our preliminary data suggest that concussions do commonly occur in competitive ultimate and that better education and management of concussions in ultimate athletes are needed. This study is an important first step in deepening our understanding of these issues. PMID:29552572

  2. Patients with proximal junctional kyphosis requiring revision surgery have higher postoperative lumbar lordosis and larger sagittal balance corrections. (United States)

    Kim, Han Jo; Bridwell, Keith H; Lenke, Lawrence G; Park, Moon Soo; Song, Kwang Sup; Piyaskulkaew, Chaiwat; Chuntarapas, Tapanut


    Case control study. To evaluate risk factors in patients in 3 groups: those without proximal junctional kyphosis (PJK) (N), with PJK but not requiring revision (P), and then those with PJK requiring revision surgery (S). It is becoming clear that some patients maintain stable PJK angles, whereas others progress and develop severe PJK necessitating revision surgery. A total of 206 patients at a single institution from 2002 to 2007 with adult scoliosis with 2-year minimum follow-up (average 3.5 yr) were analyzed. Inclusion criteria were age more than 18 years and primary fusions greater than 5 levels from any thoracic upper instrumented vertebra to any lower instrumented vertebrae. Revisions were excluded. Radiographical assessment included Cobb measurements in the coronal/sagittal plane and measurements of the PJK angle at postoperative time points: 1 to 2 months, 2 years, and final follow-up. PJK was defined as an angle greater than 10°. The prevalence of PJK was 34%. The average age in N was 49.9 vs. 51.3 years in P and 60.1 years in S. Sex, body mass index, and smoking status were not significantly different between groups. Fusions extending to the pelvis were 74%, 85%, and 91% of the cases in groups N, P, and S. Instrumentation type was significantly different between groups N and S, with a higher number of upper instrumented vertebra hooks in group N. Radiographical parameters demonstrated a higher postoperative lumbar lordosis and a larger sagittal balance change, with surgery in those with PJK requiring revision surgery. Scoliosis Research Society postoperative pain scores were inferior in group N vs. P and S, and Oswestry Disability Index scores were similar between all groups. Patients with PJK requiring revision were older, had higher postoperative lumbar lordosis, and larger sagittal balance corrections than patients without PJK. Based on these data, it seems as though older patients with large corrections in their lumbar lordosis and sagittal balance

  3. Physical demands in competitive ultimate frisbee

    DEFF Research Database (Denmark)

    Krustrup, Peter; Mohr, Magni


    The objective was to study game demands in competitive ultimate Frisbee by performing match analysis during a game. Thirteen moderately trained (Yo-Yo intermittent recovery test levels 1 and 2 [Yo-Yo IR1 and IR2] performance: 1790 ± 382 m and 657 ± 225 m, respectively) competitive male ultimate...... = 0.74, p ≤ 0.05). Ultimate Frisbee is an intense intermittent team sport with high cardiovascular loading and clear indications of fatigue toward the end of each half. Yo-Yo IR test performances correlate with physical match performance....

  4. Analysis of ultimate-heat-sink spray ponds. Technical report

    International Nuclear Information System (INIS)

    Codell, R.


    This report develops models which can be utilized in the design of certain types of spray ponds used in ultimate heat sinks at nuclear power plants, and ways in which the models may be employed to determine the design basis required by U.S. Nuclear Regulatory Commission Regulatory Guide 1.27

  5. Flurbiprofen and hypertension but not hydroxyethyl starch are associated with post-craniotomy intracranial haematoma requiring surgery. (United States)

    Jian, M; Li, X; Wang, A; Zhang, L; Han, R; Gelb, A W


    Post-craniotomy intracranial haematoma is one of the most serious complications after neurosurgery. We examined whether post-craniotomy intracranial haematoma requiring surgery is associated with the non-steroidal anti-inflammatory drugs flurbiprofen, hypertension, or hydroxyethyl starch (HES). A case-control study was conducted among 42 359 patients who underwent elective craniotomy procedures at Beijing Tiantan Hospital between January 2006 and December 2011. A one-to-one control group without post-craniotomy intracranial haematoma was selected matched by age, pathologic diagnosis, tumour location, and surgeon. Perioperative blood pressure records up to the diagnosis of haematoma, the use of flurbiprofen and HES were examined. The incidence of post-craniotomy intracranial haematoma and the odds ratios for the risk factors were determined. A total of 202 patients suffered post-craniotomy intracranial haematoma during the study period, for an incidence of 0.48% (95% CI=0.41-0.55). Haematoma requiring surgery was associated with an intraoperative systolic blood pressure of >160 mm Hg (OR=2.618, 95% CI=2.084-2.723, P=0.007), an intraoperative mean blood pressure of >110 mm Hg (OR=2.600, 95% CI=2.312-3.098, P=0.037), a postoperative systolic blood pressure of >160 mm Hg (OR=2.060, 95% CI= 1.763-2.642, P=0.022), a postoperative mean blood pressure of >110 mm Hg (OR=3.600, 95% CI= 3.226-4.057, P=0.001), and the use of flurbiprofen during but not after the surgery (OR=2.256, 95% CI=2.004-2.598, P=0.005). The intraoperative infusion of HES showed no significant difference between patients who had a haematoma and those who did not. Intraoperative and postoperative hypertension and the use of flurbiprofen during surgery are risk factors for post-craniotomy intracranial haematoma requiring surgery. The intraoperative infusion of HES was not associated with a higher incidence of haematoma. © The Author 2014. Published by Oxford University Press on behalf of the British

  6. Ultimate and proximate explanations of strong reciprocity. (United States)

    Vromen, Jack


    Strong reciprocity (SR) has recently been subject to heated debate. In this debate, the "West camp" (West et al. in Evol Hum Behav 32(4):231-262, 2011), which is critical of the case for SR, and the "Laland camp" (Laland et al. in Science, 334(6062):1512-1516, 2011, Biol Philos 28(5):719-745, 2013), which is sympathetic to the case of SR, seem to take diametrically opposed positions. The West camp criticizes advocates of SR for conflating proximate and ultimate causation. SR is said to be a proximate mechanism that is put forward by its advocates as an ultimate explanation of human cooperation. The West camp thus accuses advocates of SR for not heeding Mayr's original distinction between ultimate and proximate causation. The Laland camp praises advocates of SR for revising Mayr's distinction. Advocates of SR are said to replace Mayr's uni-directional view on the relation between ultimate and proximate causes by the bi-directional one of reciprocal causation. The paper argues that both the West camp and the Laland camp misrepresent what advocates of SR are up to. The West camp is right that SR is a proximate cause of human cooperation. But rather than putting forward SR as an ultimate explanation, as the West camp argues, advocates of SR believe that SR itself is in need of ultimate explanation. Advocates of SR tend to take gene-culture co-evolutionary theory as the correct meta-theoretical framework for advancing ultimate explanations of SR. Appearances notwithstanding, gene-culture coevolutionary theory does not imply Laland et al.'s notion of reciprocal causation. "Reciprocal causation" suggests that proximate and ultimate causes interact simultaneously, while advocates of SR assume that they interact sequentially. I end by arguing that the best way to understand the debate is by disambiguating Mayr's ultimate-proximate distinction. I propose to reserve "ultimate" and "proximate" for different sorts of explanations, and to use other terms for distinguishing

  7. Ultimate pressure capacity of CANDU 6 containment structures

    International Nuclear Information System (INIS)

    Radulescu, J.P.; Pradolin, L.; Mamet, J.C.


    This paper summarizes the analytical work carried out and the results obtained when determining the ultimate pressure capacity (UPC) of the containment structures of CANDU 6 nuclear power plants. The purpose of the analysis work was to demonstrate that such containment structures are capable of meeting design requirements under the most severe accident conditions. For this concrete vessel subjected to internal pressure, the UPC was defined as the pressure causing through cracking in the concrete. The present paper deals with the overall behaviour of the containment. The presence of openings, penetrations and the ultimate pressure of the airlocks were considered separately. (author)

  8. ''Project Crystal'' for ultimate storage of highly radioactive waste

    International Nuclear Information System (INIS)



    NAGRA (The National Association for storage of radioactive waste) in Baden has launched in North Switzerland an extensive geological research program. The current research program, under the title of ''Project Crystal'', aims at providing the scientific knowledge which is required for the assessment of the suitability of the crystalline sub-soil of North Switzerland for the ultimate storage of highly radioactive waste. Safety and feasibility of such ultimate storage are in the forefront of preoccupations. Scientific institutes of France, Germany, USA and Canada are cooperating more particularly on boring research and laboratory analyses. Technical data are given on the USA and German installations used. (P.F.K.)

  9. An anaesthetic pre-operative assessment clinic reduces pre-operative inpatient stay in patients requiring major vascular surgery.

    LENUS (Irish Health Repository)

    O'Connor, D B


    BACKGROUND: Patients undergoing major vascular surgery (MVS) require extensive anaesthetic assessment. This can require extended pre-operative stays. AIMS: We investigated whether a newly established anaesthetic pre-operative assessment clinic (PAC) would reduce the pre-operative inpatient stay, avoid unnecessary investigations and facilitate day before surgery (DBS) admissions for patients undergoing MVS. PATIENT AND METHODS: One year following and preceding the establishment of the PAC the records of patients undergoing open or endovascular aortic aneurysm repair, carotid endarterectomy and infra-inguinal bypass were reviewed to measure pre-operative length of stay (LoS). RESULTS: Pre-operative LoS was significantly reduced in the study period (1.85 vs. 4.2 days, respectively, P < 0.0001). Only 12 out of 61 patients in 2007 were admitted on the DBS and this increased to 33 out of 63 patients (P = 0.0002). No procedure was cancelled for medical reasons. CONCLUSION: The PAC has facilitated accurate outpatient anaesthetic assessment for patients requiring MVS. The pre-operative in-patient stay has been significantly reduced.

  10. Ultimate justification: Wittgenstein and medical ethics. (United States)

    Hughes, J


    Decisions must be justified. In medical ethics various grounds are given to justify decisions, but ultimate justification seems illusory and little considered. The philosopher Wittgenstein discusses the problem of ultimate justification in the context of general philosophy. His comments, nevertheless, are pertinent to ethics. From a discussion of Wittgensteinian notions, such as 'bedrock', the idea that 'ultimate' justification is grounded in human nature as such is derived. This discussion is relevant to medical ethics in at least five ways: it shows generally what type of certainty there is in practical ethics; it seems to imply some objective foundation to our ethical judgements; it squares with our experience of making ethical decisions; it shows something of the nature of moral arguments; and, finally, it has implications for teaching medicine and ethics.

  11. Effects of preoperative aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in patients undergoing off-pump coronary artery bypass graft surgery. (United States)

    Shim, Jae Kwang; Choi, Yong Seon; Oh, Young Jun; Bang, Sou Ouk; Yoo, Kyung Jong; Kwak, Young Lan


    Preoperative exposure to clopidogrel and aspirin significantly increases postoperative bleeding in patients undergoing on-pump coronary artery bypass graft surgery. Off-pump coronary bypass grafting has been proposed as an alternative technique to attenuate postoperative bleeding associated with clopidogrel. This study aimed to determine the effects of aspirin and clopidogrel therapy on perioperative blood loss and blood transfusion requirements in off-pump coronary artery bypass grafting. One hundred six patients scheduled for off-pump coronary artery bypass grafting were divided into three groups: aspirin and clopidogrel discontinued more than 6 days before surgery (group 1, n = 35), aspirin and clopidogrel continued until 3 to 5 days before surgery (group 2, n = 51), and both medications continued within 2 days of surgery (group 3, n = 20). Thromboelastographic tracings were analyzed before induction of anesthesia. Routine coagulation profiles were measured before and after surgery. A cell salvage device was used during surgery and salvaged blood was reinfused. Chest tube drainage and blood transfusion requirement were recorded postoperatively. Patient characteristics, operative data, and thromboelastographic tracings were similar among the groups. There were significant decreases in hematocrit level and platelet count and prolongation in prothrombin time postoperatively in all groups without any intergroup differences. The amounts of perioperative blood loss and blood transfusion required were all similar among the groups. Preoperative clopidogrel and aspirin exposure even within 2 days of surgery does not increase perioperative blood loss and blood transfusion requirements in patients undergoing elective off-pump coronary artery bypass grafting.

  12. Radionuclide methods of identifying patients who may require coronary artery bypass surgery

    International Nuclear Information System (INIS)

    Beller, G.A.; Gibson, R.S.; Watson, D.D.


    Myocardial thallium-201 ( 201 Tl) scintigraphy or radionuclide angiography performed in conjunction with exercise stress testing can provide clinically useful information regarding the functional significance of underlying coronary artery stenoses in patients with known or suspected coronary artery disease. Knowledge of type, location, and extent of myocardial 201 Tl perfusion abnormalities or the severity of exercise-induced global and regional dysfunction has prognostic value. Risk stratification can be undertaken with either radionuclide technique by consideration of the magnitude of the ischemic response and may assist in the selection of patients for coronary artery bypass graft surgery (CABG). In patients with coronary artery disease, delayed 201 Tl redistribution observed on exercise or dipyridamole 201 Tl scintigraphy, particularly when present in multiple vascular regions and associated with increased lung 201 Tl uptake, has been shown to be predictive of an adverse outcome, whereas patients with chest pain and a normal exercise 201 Tl scintigram have a good prognosis with medical treatment. Similarly, a marked fall in the radionuclide ejection fraction from rest to exercise has been found to correlate with high-risk anatomic disease. Another important application of radionuclide imaging in patients being considered for CABG (particularly those with a depressed resting left ventricular ejection fraction) is the determination of myocardial viability and potential for improved blood flow and enhanced regional function after revascularization. 69 references

  13. Librarians Are the Ultimate Knowledge Managers? (United States)

    Koina, Cathie


    Librarians are the ultimate knowledge managers. Everyone knows that. After all, haven't they been the custodians of documented knowledge for centuries? Who could possibly do it better than them? Well, then why aren't people knocking down their doors, begging them to be the knowledge managers of the organisation? Are they just ignorant of how…

  14. The Clinical Features, Risk Factors, and Surgical Treatment of Cervicogenic Headache in Patients With Cervical Spine Disorders Requiring Surgery. (United States)

    Shimohata, Keiko; Hasegawa, Kazuhiro; Onodera, Osamu; Nishizawa, Masatoyo; Shimohata, Takayoshi


    To clarify the clinical features and risk factors of cervicogenic headache (CEH; as diagnosed according to the International Classification of Headache Disorders-Third Edition beta) in patients with cervical spine disorders requiring surgery. CEH is caused by cervical spine disorders. The pathogenic mechanism of CEH is hypothesized to involve a convergence of the upper cervical afferents from the C1, C2, and C3 spinal nerves and the trigeminal afferents in the trigeminocervical nucleus of the upper cervical cord. According to this hypothesis, functional convergence of the upper cervical and trigeminal sensory pathways allows the bidirectional (afferent and efferent) referral of pain to the occipital, frontal, temporal, and/or orbital regions. Previous prospective studies have reported an 86-88% prevalence of headache in patients with cervical myelopathy or radiculopathy requiring anterior cervical surgery; however, these studies did not diagnose headache according to the International Classification of Headache Disorders criteria. Therefore, a better understanding of the prevalence rate, clinical features, risk factors, and treatment responsiveness of CEH in patients with cervical spine disorders requiring surgery is necessary. We performed a single hospital-based prospective cross-sectional study and enrolled 70 consecutive patients with cervical spine disorders such as cervical spondylotic myelopathy, ossification of the posterior longitudinal ligament, cervical spondylotic radiculopathy, and cervical spondylotic myeloradiculopathy who had been scheduled to undergo anterior cervical fusion or dorsal cervical laminoplasty between June 2014 and December 2015. Headache was diagnosed preoperatively according to the International Classification of Headache Disorders-Third Edition beta. The Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire, Neck Disability Index, and a 0-100 mm visual analog scale (VAS) were used to evaluate clinical

  15. Liposomal Bupivacaine Use in Transversus Abdominis Plane Blocks Reduces Pain and Postoperative Intravenous Opioid Requirement After Colorectal Surgery. (United States)

    Stokes, Audrey L; Adhikary, Sanjib D; Quintili, Ashley; Puleo, Frances J; Choi, Christine S; Hollenbeak, Christopher S; Messaris, Evangelos


    Enhanced recovery protocols frequently use multimodal postoperative analgesia to improve postoperative outcomes in patients undergoing colorectal surgery. The purpose of this study was to evaluate liposomal bupivacaine use in transversus abdominis plane blocks on postoperative pain scores and opioid use after colorectal surgery. This was a retrospective cohort study comparing outcomes between patients receiving nonliposomal anesthetic (n = 104) and liposomal bupivacaine (n = 303) blocks. The study was conducted at a single tertiary care center. Patients included those identified within an institutional database as inpatients undergoing colorectal procedures between 2013 and 2015 who underwent transversus abdominis plane block for perioperative analgesia. The study measured postoperative pain scores and opioid requirements. Patients receiving liposomal bupivacaine had significantly lower pain scores for the first 24 to 36 postoperative hours. Pain scores were similar after 36 hours. The use of intravenous opioids among the liposomal bupivacaine group decreased by more than one third during the hospitalization (99.1 vs 64.5 mg; p = 0.040). The use of ketorolac was also decreased (49.0 vs 18.3 mg; p bupivacaine group but did not achieve statistical significance. The study was limited by its retrospective, single-center design and heterogeneity of block administration. Attenuated pain scores observed with liposomal bupivacaine use were associated with significantly lower intravenous opioid and ketorolac use, suggesting that liposomal bupivacaine-containing transversus abdominis plane blocks are well aligned with the opioid-reducing goals of many enhanced recovery protocols.

  16. Ultimate gradient in solid-state accelerators

    International Nuclear Information System (INIS)

    Whittum, D.H.


    The authors recall the motivation for research in high-gradient acceleration and the problems posed by a compact collider. They summarize the phenomena known to appear in operation of a solid-state structure with large fields, and research relevant to the question of the ultimate gradient. They take note of new concepts, and examine one in detail, a miniature particle accelerator based on an active millimeter-wave circuit and parallel particle beams

  17. The ultimate disposition of depleted uranium

    Energy Technology Data Exchange (ETDEWEB)

    Lemons, T.R. [Uranium Enrichment Organization, Oak Ridge, TN (United States)


    Depleted uranium (DU) is produced as a by-product of the uranium enrichment process. Over 340,000 MTU of DU in the form of UF{sub 6} have been accumulated at the US government gaseous diffusion plants and the stockpile continues to grow. An overview of issues and objectives associated with the inventory management and the ultimate disposition of this material is presented.

  18. Ultimate Strength of Ship Hulls under Torsion

    DEFF Research Database (Denmark)

    Paik, Jeom Kee; Thayamballi, Anil K.; Pedersen, Preben Terndrup


    For a ship hull with large deck openings such as container vessels and some large bulk carriers, the analysis of warping stresses and hatch opening deformations is an essential part of ship structural analyses. It is thus of importance to better understand the ultimate torsional strength characte......For a ship hull with large deck openings such as container vessels and some large bulk carriers, the analysis of warping stresses and hatch opening deformations is an essential part of ship structural analyses. It is thus of importance to better understand the ultimate torsional strength...... characteristics of ships with large hatch openings. The primary aim of the present study is to investigate the ultimate strength characteristics of ship hulls with large hatch openings under torsion. Axial (warping) as well as shear stresses are normally developed for thin-walled beams with open cross sections...... subjected to torsion. A procedure for calculating these stresses is briefly described. As an illustrative example, the distribution and magnitude of warping and shear stresses for a typical container vessel hull cross section under unit torsion is calculated by the procedure. By theoretical and numerical...

  19. A Giant Brunneroma Causing Gastrointestinal Bleeding and Severe Anemia Requiring Transfusion and Surgery

    Directory of Open Access Journals (Sweden)

    Nicola C. Frenkel


    Full Text Available Brunner’s gland hamartoma, also called hyperplasia, adenoma, and Brunneroma, is an extremely rare benign proliferative lesion of Brunner’s glands in the duodenum. While being mostly small and asymptomatic, they can result in gastrointestinal bleeding and obstruction. We report the case of a 54-year-old man presenting with melena and severe anemia requiring blood transfusion. CT scans showed a large mass of 8 cm in diameter, presumably arising in the duodenum. Endoscopic biopsies were not conclusive. As we were unable to determine the nature of the mass preoperatively and due to the severe symptoms, its size, and the uncertain malignant potential, a classic Whipple procedure was performed. The resected specimen showed extensive proliferation of Brunner’s glands without signs of malignancy.

  20. Ultimate internal pressure capacity of concrete containment structures

    International Nuclear Information System (INIS)

    Krishnaswamy, C.N.; Namperumal, R.; Al-Dabbagh, A.


    Lesson learned from the accident at Three-Mile Island nuclear plant has necessitated the computation of the ultimate internal pressure capacity of containment structures as a licensing requirement in the U.S. In general, a containment structure is designed to be essentially elastic under design accident pressure. However, as the containment pressure builds up beyond the design value due to a more severe postulated accident, the containment response turns nonlinear as it sequentially passes through cracking of concrete, yielding of linear plate, yielding of rebar, and yielding of post-tensioning tendon (if the containment concrete is prestressed). This paper reports on the determination of the ultimate internal pressure capacity and nonlinear behavior of typical reinforced and prestressed concrete BWR containments. The probable modes of failure, the criteria for ultimate pressure capacity, and the most critical sections are described. Simple equations to hand-calculate the ultimate pressure capacity and the nonlinear behavior at membrane sections of the containment shell are presented. A nonlinear finite element analysis performed to determine the nonlinear behavior of the entire shell including nonmembrane sections is briefly discribed. The analysis model consisted of laminated axisymmetric shell finite elements with nonlinear stress-strain properties for each material. Results presented for typical BWR concrete containments include nonlinear response plots of internal pressure versus containment deflection and strains in the liner, rebar, and post-tensioning tendons at the most stressed section in the shell. Leak-tightness of the containment liner and the effect of thermal loads on the ultimate capacity are discussed. (orig.)

  1. The ultimate disposition of depleted uranium

    Energy Technology Data Exchange (ETDEWEB)


    Significant amounts of the depleted uranium (DU) created by past uranium enrichment activities have been sold, disposed of commercially, or utilized by defense programs. In recent years, however, the demand for DU has become quite small compared to quantities available, and within the US Department of Energy (DOE) there is concern for any risks and/or cost liabilities that might be associated with the ever-growing inventory of this material. As a result, Martin Marietta Energy Systems, Inc. (Energy Systems), was asked to review options and to develop a comprehensive plan for inventory management and the ultimate disposition of DU accumulated at the gaseous diffusion plants (GDPs). An Energy Systems task team, under the chairmanship of T. R. Lemons, was formed in late 1989 to provide advice and guidance for this task. This report reviews options and recommends actions and objectives in the management of working inventories of partially depleted feed (PDF) materials and for the ultimate disposition of fully depleted uranium (FDU). Actions that should be considered are as follows. (1) Inspect UF{sub 6} cylinders on a semiannual basis. (2) Upgrade cylinder maintenance and storage yards. (3) Convert FDU to U{sub 3}O{sub 8} for long-term storage or disposal. This will include provisions for partial recovery of costs to offset those associated with DU inventory management and the ultimate disposal of FDU. Another recommendation is to drop the term tails'' in favor of depleted uranium'' or DU'' because the tails'' label implies that it is waste.'' 13 refs.

  2. Landau damping: the mechanics model and its ultimate entropy gain

    International Nuclear Information System (INIS)

    Hannay, J H; Kluge, Michel


    Classical mechanics has only been invoked to account for Landau damping in a rather half-hearted way, alongside plasma perturbation theory. In particular this invocation is essential for the study of the saturation, or post-linear (or 'nonlinear') regime of the damping initiated by Dawson and O'Neill. By embracing mechanics wholeheartedly here, with its attendant phase space, one can access results, old and new, cleanly and directly, and with one fewer numerical integration for the post-linear regime. By using a summation technique familiar in semiclassical quantum mechanics (Poisson summation), the one remaining numerical integration can be much improved in accuracy. Also accessible from mechanics is the ultimate entropy gain. Though zero for any finite time (in the absence of coarse graining), the entropy gain is ultimately non-zero (at infinite time the required coarse graining is zero). It is calculated analytically by using the appropriate asymptotics, hitherto not fully exploited.

  3. Risk of Acute Kidney Injury in Patients Randomized to a Restrictive Versus Liberal Approach to Red Blood Cell Transfusion in Cardiac Surgery: A Substudy Protocol of the Transfusion Requirements in Cardiac Surgery III Noninferiority Trial. (United States)

    Garg, Amit X; Shehata, Nadine; McGuinness, Shay; Whitlock, Richard; Fergusson, Dean; Wald, Ron; Parikh, Chirag; Bagshaw, Sean M; Khanykin, Boris; Gregory, Alex; Syed, Summer; Hare, Gregory M T; Cuerden, Meaghan S; Thorpe, Kevin E; Hall, Judith; Verma, Subodh; Roshanov, Pavel S; Sontrop, Jessica M; Mazer, C David


    When safe to do so, avoiding blood transfusions in cardiac surgery can avoid the risk of transfusion-related infections and other complications while protecting a scarce resource and reducing costs. This protocol describes a kidney substudy of the Transfusion Requirements in Cardiac Surgery III (TRICS-III) trial, a multinational noninferiority randomized controlled trial to determine whether the risk of major clinical outcomes in patients undergoing planned cardiac surgery with cardiopulmonary bypass is no greater with a restrictive versus liberal approach to red blood cell transfusion. The objective of this substudy is to determine whether the risk of acute kidney injury is no greater with a restrictive versus liberal approach to red blood cell transfusion, and whether this holds true in patients with and without preexisting chronic kidney disease. Multinational noninferiority randomized controlled trial conducted in 73 centers in 19 countries (2014-2017). Patients (~4800) undergoing planned cardiac surgery with cardiopulmonary bypass. The primary outcome of this substudy is perioperative acute kidney injury, defined as an acute rise in serum creatinine from the preoperative value (obtained in the 30-day period before surgery), where an acute rise is defined as ≥26.5 μmol/L in the first 48 hours after surgery or ≥50% in the first 7 days after surgery. We will report the absolute risk difference in acute kidney injury and the 95% confidence interval. We will repeat the primary analysis using alternative definitions of acute kidney injury, including staging definitions, and will examine effect modification by preexisting chronic kidney disease (defined as a preoperative estimated glomerular filtration rate [eGFR] blood cell transfusion in the presence of anemia during cardiac surgery done with cardiopulmonary bypass.; clinical trial registration number NCT 02042898.

  4. Ultimately short ballistic vertical graphene Josephson junctions (United States)

    Lee, Gil-Ho; Kim, Sol; Jhi, Seung-Hoon; Lee, Hu-Jong


    Much efforts have been made for the realization of hybrid Josephson junctions incorporating various materials for the fundamental studies of exotic physical phenomena as well as the applications to superconducting quantum devices. Nonetheless, the efforts have been hindered by the diffusive nature of the conducting channels and interfaces. To overcome the obstacles, we vertically sandwiched a cleaved graphene monoatomic layer as the normal-conducting spacer between superconducting electrodes. The atomically thin single-crystalline graphene layer serves as an ultimately short conducting channel, with highly transparent interfaces with superconductors. In particular, we show the strong Josephson coupling reaching the theoretical limit, the convex-shaped temperature dependence of the Josephson critical current and the exceptionally skewed phase dependence of the Josephson current; all demonstrate the bona fide short and ballistic Josephson nature. This vertical stacking scheme for extremely thin transparent spacers would open a new pathway for exploring the exotic coherence phenomena occurring on an atomic scale. PMID:25635386

  5. Ultimate-gradient accelerators physics and prospects

    CERN Document Server

    Skrinsky, Aleksander Nikolayevich


    As introduction, the needs and ways for ultimate acceleration gradients are discussed briefly. The Plasma Wake Field Acceleration is analized in the most important details. The structure of specific plasma oscillations and "high energy driver beam SP-plasma" interaction is presented, including computer simulation of the process. Some pratical ways to introduce the necessary mm-scale bunching in driver beam and to arrange sequential energy multiplication are dicussed. The influence of accelerating beam particle - plasma binary collisions is considered, also. As applications of PWFA, the use of proton super-colliders beams (LHC and Future SC) to drive the "multi particle types" accelerator, and the arrangements for the electron-positron TeV range collider are discussed.

  6. Ultimate load capacities of expansion anchor bolts

    International Nuclear Information System (INIS)

    Czarnecki, R.M.; Manrique, M.A.; Samaddar, S.K.


    A summary of available experimental expansion anchor bolt test data is presented. These data were collected as part of programs by the nuclear industry to address generic issues related to verification of seismic adequacy of equipment in nuclear power plants. Some of the data presented are suitable for use in seismic probabilistic risk assessments. For example, mean values of ultimate strength, along with their standard deviation and coefficients of variation, for a range of most typical expansion anchor bolt sizes are presented. Effects of interaction between shear and tension, edge distance, spacing, and cracking of the concrete are presented in a manner that is more suitable for use in deterministic evaluations. Related industry programs to derive anchor bolt capacities are briefly discussed. Recommendations for areas of further investigation are also presented

  7. Focused ion beam technology and ultimate applications

    International Nuclear Information System (INIS)

    Gierak, Jacques


    In this topical review, the potential of the focused ion beam (FIB) technology and ultimate applications are reviewed. After an introduction to the technology and to the operating principles of liquid metal ion sources (LMIS), of ion optics and instrument architectures, several applications are described and discussed. First, the application of FIB for microcircuit inspection, metrology and failure analysis is presented. Then, we introduce and illustrate some advanced patterning schemes we propose as next generation FIB processing examples. These patterning schemes are (i) local defect injection or smoothing in magnetic thin film direct patterning, (ii) functionalization of graphite substrates to guide organization of clusters, (iii) local and selective epitaxy of III–V semiconductor quantum dots and (iv) FIB patterned solid-state nanopores for biological molecules manipulation and analysis. We conclude this work by giving our vision of the future developments for FIB technology. (topical review)

  8. Transcending matter: physics and ultimate meaning. (United States)

    Paulson, Steve; Frank, Adam; Kaiser, David; Maudlin, Tim; Natarajan, Priyamvada


    From the discovery of new galaxies and nearly undetectable dark energy to the quantum entanglement of particles across the universe, new findings in physics naturally elicit a sense of awe and wonder. For the founders of modern physics-from Einstein and Bohr to Heisenberg, Pauli, and Bohm-a fascination with deeper questions of meaning and ultimate reality led some of them to explore esoteric traditions and metaphysics. More recently, however, physicists have largely shunned such philosophical and spiritual associations. What can contemporary physics offer us in the quest to understand our place in the universe? Has physics in some ways become a religion unto itself that rejects the search for existential meaning? Discussion of these and related questions is presented in this paper. © 2015 New York Academy of Sciences.

  9. Israeli Arabs develop diverticulitis at a younger age and are more likely to require surgery than Jews. (United States)

    Itai, Ghersin; Slijper, Nadav; Sroka, Gideon; Matter, Ibrahim


    Only few studies have examined the impact of racial differences on the age of onset, course and outcomes of diverticulitis. To provide data about the epidemiology of diverticulitis in northern Israel, and to determine whether ethnicity is a predictor of age of onset, complications, and need for surgery. Was conducted a retrospective review of the charts of all patients diagnosed with a first episode of diverticulitis in our hospital between 2005 and 2012. Were found 638 patients with a first episode of acute diverticulitis in the eight year interval. Israeli Arabs developed a first episode of diverticulitis at a younger age compared to Jews (51.2 vs 63.8 years, p<0.01). Arabs living in rural areas developed diverticulitis at a younger age than Arabs living in urban centers (49.4 vs 54.5 years, P=0.03). Jewish and Arabic men developed diverticulitis at younger age compared to their female counterparts (59.9 vs 66.09, p<0.01, and 47.31 vs 56.93, p<0.01, respectively). Arabs were more likely [odds ratio (OR)=1.81 ,95% confidence interval (CI)1.12-2.90, p=0.017] than Jews to require surgical treatment (urgent or elective) for diverticulitis. Israeli Arabs tend to develop diverticulitis at a younger age and are more likely to require surgical treatment for diverticulitis compared to Jews. Arabs living in rural areas develop diverticulitis at a younger age than Arabs living in urban centers. These findings highlight a need to address the root cause for ethnic differences in onset, course and outcome of acute diverticulitis.

  10. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ... out more. Cleft Lip/Palate and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require ...

  11. Prone Accelerated Partial Breast Irradiation After Breast-Conserving Surgery: Compliance to the Dosimetry Requirements of RTOG-0413

    Energy Technology Data Exchange (ETDEWEB)

    Wen Bixiu [Department of Radiation Oncology, New York University Medical Center, New York, New York (United States); Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080 (China); Hsu, Howard; Formenti-Ujlaki, George F.; Lymberis, Stella; Magnolfi, Chiara; Zhao Xuan; Chang Jenghwa; DeWyngaert, J. Keith; Jozsef, Gabor [Department of Radiation Oncology, New York University Medical Center, New York, New York (United States); Formenti, Silvia C., E-mail: [Department of Radiation Oncology, New York University Medical Center, New York, New York (United States)


    Purpose: The dosimetric results from our institution's trials of prone accelerated partial breast irradiation are compared with the dosimetric requirements of RTOG-0413. Methods and Materials: Trial 1 and Trial 2 are 2 consecutive trials of prone-accelerated partial breast irradiation. Eligible for both trials were stage I breast cancer patients with negative margins after breast-conserving surgery. The planning target tumor volume (PTV) was created by extending the surgical cavity 2.0 cm for Trial 1 and 1.5 cm for Trial 2, respectively. Contralateral breast, heart, lungs, and thyroid were contoured. Thirty Gray was delivered in five daily fractions of 6 Gy by a three-dimensional conformal radiation therapy technique in Trial 1 and were by image-guided radiation therapy/intensity-modulated radiation therapy in Trial 2. Dosimetric results from the trials are reported and compared with RTOG 0413 requirements. Results: One hundred forty-six consecutive plans were analyzed: 67 left and 79 right breast cancers. The plans from the trials complied with the required >90% of prescribed dose covering 90% of PTV{sub E}VAL (=generated from the PTV by cropping 0.5 cm from the skin edge and excluding the chest wall): V90% was 98.1 {+-} 3.0% (with V100% and V95%, 89.4 {+-} 12.8%, 96.4 {+-} 5.1%, respectively). No significant difference between laterality was found (Student's t test). The dose constraints criteria of the RTOG-0413 protocol for ipsilateral and contralateral lung (V30 <15% and Dmax <3%), heart (V5 <40%), and thyroid (Dmax <3%) were satisfied because the plans showed an average V5% of 0.6% (range, 0-13.4) for heart, an average V30% of 0.6% (range, 0-9.1%) for ipsilateral lung, and <2% maximum dose to the thyroid. However, our partial breast irradiation plans demonstrated a higher dose to contralateral breast than that defined by RTOG constraints, with a median value of maximum doses of 4.1% (1.2 Gy), possibly as a result of contouring differences

  12. Pituitary magnetic resonance imaging is not required in the postoperative follow-up of acromegalic patients with long-term biochemical cure after transsphenoidal surgery

    NARCIS (Netherlands)

    Zirkzee, E. J. M.; Corssmit, E. P. M.; Biermasz, N. R.; Brouwer, P. A.; Wiggers-de Bruine, F. T.; Kroft, L. J. M.; van Buchem, M. A.; Roelfsema, F.; Pereira, A. M.; Smit, J. W. A.; Romijn, J. A.


    After successful transsphenoidal surgery for acromegaly, life-long follow-up is required, because 10-15% of patients develop recurrence of disease. We assessed whether it is safe to perform postoperative follow-up with only biochemical evaluation in acromegalic patients initially cured by

  13. Wall roughness induces asymptotic ultimate turbulence (United States)

    Zhu, Xiaojue; Verschoof, Ruben A.; Bakhuis, Dennis; Huisman, Sander G.; Verzicco, Roberto; Sun, Chao; Lohse, Detlef


    Turbulence governs the transport of heat, mass and momentum on multiple scales. In real-world applications, wall-bounded turbulence typically involves surfaces that are rough; however, characterizing and understanding the effects of wall roughness on turbulence remains a challenge. Here, by combining extensive experiments and numerical simulations, we examine the paradigmatic Taylor-Couette system, which describes the closed flow between two independently rotating coaxial cylinders. We show how wall roughness greatly enhances the overall transport properties and the corresponding scaling exponents associated with wall-bounded turbulence. We reveal that if only one of the walls is rough, the bulk velocity is slaved to the rough side, due to the much stronger coupling to that wall by the detaching flow structures. If both walls are rough, the viscosity dependence is eliminated, giving rise to asymptotic ultimate turbulence—the upper limit of transport—the existence of which was predicted more than 50 years ago. In this limit, the scaling laws can be extrapolated to arbitrarily large Reynolds numbers.

  14. Is stopping of anticoagulant therapy really required in a minor dental surgery? - How about in an endodontic microsurgery?

    Directory of Open Access Journals (Sweden)

    Yong-Wook Cho


    Full Text Available Nowadays, oral anticoagulants are commonly prescribed to numerous patients for preventing cardiovascular accident such as thromboembolism. An important side effect of anticoagulant is anti-hemostasis. In a major surgery, the oral anticoagulant therapy (OAT regimen must be changed before the surgery for proper post-operative bleeding control. However, in a minor dental surgery and endodontic surgery, the necessity for changing or discontinuing the OAT is open to debate. In this study, risks of the consequences were weighed and analyzed. In patients who stop the OAT, the occurrence of thromboembolic complication is rare but the result is fatal. In patients who continuing the OAT, post-operative bleeding can be controlled well with the local hemostatic measures. In the endodontic surgery, there are almost no studies about this issue. The intra-operative bleeding control is particularly important in the endodontic surgery because of its delicate and sensitive procedures such as inspection of resected root surface using dental microscope and retrograde filling. Further studies are necessary about this issue in the viewpoint of endodontic surgery.

  15. Experts and the ultimate issue rule

    NARCIS (Netherlands)

    Hoving, R.A.; Abels, D.; Bruin, D.; Van der Wilt, H.


    Adjudication of complex criminality requires specific knowledge of a diverse set of complex and technical topics. A judge does not have the required knowledge to interpret and value all the facts in the case properly, nor can he be expected to gain this kind of knowledge. Therefore, opinions of

  16. An investigation on influential factors of patient-controlled epidural analgesic requirement over time for upper abdominal surgeries

    Directory of Open Access Journals (Sweden)

    Ken-Hua Hu


    Conclusion: Our analyses provided valuable information about the factors associated with PCEA consumption over time after upper abdominal surgery. However, the mechanism of how these factors interact over the course of time awaits further investigation.

  17. The prospects of transition metal dichalcogenides for ultimately scaled CMOS (United States)

    Thiele, S.; Kinberger, W.; Granzner, R.; Fiori, G.; Schwierz, F.


    MOSFET gate length scaling has been a main source of progress in digital electronics for decades. Today, researchers still spend considerable efforts on reducing the gate length and on developing ultimately scaled MOSFETs, thereby exploring both new device architectures and alternative channel materials beyond Silicon such as two-dimensional TMDs (transition metal dichalcogenide). On the other hand, the envisaged scaling scenario for the next 15 years has undergone a significant change recently. While the 2013 ITRS edition required a continuation of aggressive gate length scaling for at least another 15 years, the 2015 edition of the ITRS suggests a deceleration and eventually a levelling off of gate length scaling and puts more emphasis on alternative options such as pitch scaling to keep Moore's Law alive. In the present paper, future CMOS scaling is discussed in the light of emerging two-dimensional MOSFET channel, in particular two-dimensional TMDs. To this end, the scaling scenarios of the 2013 and 2015 ITRS editions are considered and the scaling potential of TMD MOSFETs is investigated by means of quantum-mechanical device simulations. It is shown that for ultimately scaled MOSFETs as required in the 2013 ITRS, the heavy carrier effective masses of the Mo- and W-based TMDs are beneficial for the suppression of direct source-drain tunneling, while to meet the significantly relaxed scaling targets of the 2016 ITRS heavy-effective-mass channels are not needed.

  18. LRFD software for design and actual ultimate capacity of confined rectangular columns. (United States)


    The analysis of concrete columns using unconfined concrete models is a well established practice. On the : other hand, prediction of the actual ultimate capacity of confined concrete columns requires specialized nonlinear : analysis. Modern codes and...

  19. Predicting Ultimate Loads for Wind Turbine Design

    International Nuclear Information System (INIS)

    Madsen, P. H.; Pierce, K.; Buhl, M.


    This paper addresses the statistical uncertainty of loads prediction using structural dynamics simulation codes and the requirements for the number and duration of simulations for obtaining robust load estimates

  20. Risk of Acute Kidney Injury in Patients Randomized to a Restrictive Versus Liberal Approach to Red Blood Cell Transfusion in Cardiac Surgery: A Substudy Protocol of the Transfusion Requirements in Cardiac Surgery III Noninferiority Trial

    Directory of Open Access Journals (Sweden)

    Amit X. Garg


    Full Text Available Background: When safe to do so, avoiding blood transfusions in cardiac surgery can avoid the risk of transfusion-related infections and other complications while protecting a scarce resource and reducing costs. This protocol describes a kidney substudy of the Transfusion Requirements in Cardiac Surgery III (TRICS-III trial, a multinational noninferiority randomized controlled trial to determine whether the risk of major clinical outcomes in patients undergoing planned cardiac surgery with cardiopulmonary bypass is no greater with a restrictive versus liberal approach to red blood cell transfusion. Objective: The objective of this substudy is to determine whether the risk of acute kidney injury is no greater with a restrictive versus liberal approach to red blood cell transfusion, and whether this holds true in patients with and without preexisting chronic kidney disease. Design and Setting: Multinational noninferiority randomized controlled trial conducted in 73 centers in 19 countries (2014-2017. Patients: Patients (~4800 undergoing planned cardiac surgery with cardiopulmonary bypass. Measurements: The primary outcome of this substudy is perioperative acute kidney injury, defined as an acute rise in serum creatinine from the preoperative value (obtained in the 30-day period before surgery, where an acute rise is defined as ≥26.5 μmol/L in the first 48 hours after surgery or ≥50% in the first 7 days after surgery. Methods: We will report the absolute risk difference in acute kidney injury and the 95% confidence interval. We will repeat the primary analysis using alternative definitions of acute kidney injury, including staging definitions, and will examine effect modification by preexisting chronic kidney disease (defined as a preoperative estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m 2 . Limitations: It is not possible to blind patients or providers to the intervention; however, objective measures will be used to assess

  1. Towards an Ultimate Battery Thermal Management System

    DEFF Research Database (Denmark)

    Khan, Mohammad Rezwan; Swierczynski, Maciej Jozef; Kær, Søren Knudsen


    The prevailing standards and scientific literature offer a wide range of options for the construction of a battery thermal management system (BTMS). The design of an innovative yet well-functioning BTMS requires strict supervision, quality audit and continuous improvement of the whole process...

  2. Ultimate capacity and influenced factors analysis of nuclear RC containment subjected to internal pressure

    International Nuclear Information System (INIS)

    Song Chenning; Hou Gangling; Zhou Guoliang


    Ultimate compressive bearing capacity, influenced factors and its rules of nuclear RC containment are key problems of safety assessment, accident treatment and structure design, etc. Ultimate compressive bearing capacity of nuclear RC containment is shown by concrete damaged plasticity model and steel double liner model of ABAQUS. The study shows that the concrete of nuclear RC containment cylinder wall becomes plastic when the internal pressure is up to 0.87 MPa, the maximum tensile strain of steel liner exceeds 3000 × 10 6 and nuclear RC containment reaches ultimate status when the internal pressure is up to 1.02 MPa. The result shows that nuclear RC containment is in elastic condition under the design internal pressure and the bearing capacity meets requirement. Prestress and steel liner play key parts in the ultimate internal pressure and failure mode of nuclear RC containment. The study results have value for the analysis of ultimate compressive bearing capacity, structure design and safety assessment. (authors)

  3. A rare case of small bowel volvulus after jenjunoileal bariatric bypass requiring emergency surgery: a case report

    Directory of Open Access Journals (Sweden)

    Patel Pranav H


    Full Text Available Abstract Introduction Bariatric surgery is on the increase throughout the world. Jejunoileal bypass bariatric procedures have fallen out of favor in western surgical centers due to the high rate of associated complications. They are, however, performed routinely in other centers and as a consequence of health tourism, management of complications related to these procedures may still be encountered. Case presentation We describe a rare case of small bowel obstruction in a 45-year-old British Caucasian woman, secondary to a volvulus of the jejunoileal anastomosis following bariatric bypass surgery. The pre-operative diagnosis was confirmed by radiology. We describe a successful surgical technique for this rare complication. Conclusions Bariatric surgery may be complicated by bowel obstruction. Early imaging is vital for diagnosis and effective management. The use of our surgical technique provides a simple and effective approach for the successful management of this bariatric complication.

  4. Ultimate internal pressure capacity assessment of SC structure

    International Nuclear Information System (INIS)

    Park, Hyungkui; Choi, Inkil


    An SC structure applied to a containment building can be quite effective. However, an SC structure cannot be applied to a containment building, because its internal pressure resistance performance has not been verified. The containment building, which undergoes ultimate internal pressure, resists the internal pressure through a pre-stress tendon. It is hard to apply a tendon to an SC structure because of its structural characteristics. Therefore, the internal pressure resistance performance of the SC structure itself should be ensured to apply it to a structure with internal pressure resistance. In this study, the suitability of an SC structure as a substitution for the tendon of a pressure resistant structure was evaluated. A containment structure model was used in this study, because it was representative structures that resistance of ultimate internal pressure be required. In this study, a nonlinear analysis was performed to evaluate and compare the behaviors of tendon model and SC structure model. By comparing the internal pressure-displacement according to the structure type, the stability of SC structure model was assessed

  5. A study on nonlinear behavior of reactor containment structures during ultimate accident condition(I)

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sun Hoon; Kim, Young Jin; Park, Joo Yeon [Youngdong Univ., Yeongdong (Korea, Republic of)] (and others)


    In this study, the following scope and contents are established for first year's study of determining ultimate pressure capacity of CANDU-type reactor containment. State-of-arts on the prediction of the ultimate pressure capacity of prestressed concrete reactor containment. Comparative study on structural characteristics and analysis model of CANDU-type reactor containment. State-of-arts on evaluation method of the ultimate pressure capacity of prestressed concrete reactor containment. Enhancement of evaluation method of the ultimate pressure capacity for PWR containment structure. In order to determine a realistic lower bound of a typical reactor containment structural capacity for internal pressure, modelling techniques and analytical investigation to predict its non-linear behavior up to ultimate capacity are required. Especially, the in-depth evaluation of modeling technique and analysis procedure for determining ultimate pressure capacity of CANDU-type reactor containment is required. Therefore, modelling techniques and analytical investigation to predict its non-linear behavior up to ultimate pressure capacity of CANDU-type reactor containment for internal pressure will be suggested in this study.

  6. A study on nonlinear behavior of reactor containment structures during ultimate accident condition(I)

    International Nuclear Information System (INIS)

    Kim, Sun Hoon; Kim, Young Jin; Park, Joo Yeon


    In this study, the following scope and contents are established for first year's study of determining ultimate pressure capacity of CANDU-type reactor containment. State-of-arts on the prediction of the ultimate pressure capacity of prestressed concrete reactor containment. Comparative study on structural characteristics and analysis model of CANDU-type reactor containment. State-of-arts on evaluation method of the ultimate pressure capacity of prestressed concrete reactor containment. Enhancement of evaluation method of the ultimate pressure capacity for PWR containment structure. In order to determine a realistic lower bound of a typical reactor containment structural capacity for internal pressure, modelling techniques and analytical investigation to predict its non-linear behavior up to ultimate capacity are required. Especially, the in-depth evaluation of modeling technique and analysis procedure for determining ultimate pressure capacity of CANDU-type reactor containment is required. Therefore, modelling techniques and analytical investigation to predict its non-linear behavior up to ultimate pressure capacity of CANDU-type reactor containment for internal pressure will be suggested in this study


    Directory of Open Access Journals (Sweden)

    Amelia Limijaya


    Full Text Available This article aims to analyse the extent to which international accounting standards is applied and whether it is the ultimate goal. Up until the end of 2016, approximately there are 84% of the 149 jurisdictions analysed which require IFRS for all or most domestic publicly accountable entities. This may indicate that we are not that much further from having a single set of globally-accepted accounting standards. However, there is more to financial reporting than just accounting standards alone, such as the political aspect of accounting standard-setting, translation issues surrounding IFRS adoption, the US position and the complexity of financial reporting. Improving financial reporting quality needs more than just having global accounting standards, rather, it is also essential to consider the preparers’ incentives and other institutions surrounding the firm. Stakeholders need to broaden the perspective when viewing financial reporting, so that it will not be focused merely on accounting standards alone.

  8. Ultimate Performance of the ATLAS Superconducting Solenoid

    CERN Document Server

    Ruber, R; Kawai, M; Kondo, Y; Doi, Y; Haruyama, T; Haug, F; Kate, H ten; Kondo, T; Pirotte, O; Metselaar, J; Mizumaki, S; Olesen, G; Sbrissa, E; Yamamoto, A


    A 2 tesla, 7730 ampere, 39 MJ, 45 mm thin superconducting solenoid with a 2.3 meters warm bore and 5.3 meters length, is installed in the center of the ATLAS detector and successfully commissioned. The solenoid shares its cryostat with one of the detector's calorimeters and provides the magnetic field required for the inner detectors to accurately track collision products from the LHC at CERN. After several years of a stepwise construction and test program, the solenoid integration 100 meters underground in the ATLAS cavern is completed. Following the on-surface acceptance test, the solenoid is now operated with its final cryogenic, powering and control system. A re-validation of all essential operating parameters is completed. The performance and test results of underground operation are reported and compared to those previously measured.

  9. Towards an Ultimate Battery Thermal Management System

    DEFF Research Database (Denmark)

    Khan, Mohammad Rezwan; Swierczynski, Maciej Jozef; Kær, Søren Knudsen


    The prevailing standards and scientific literature offer a wide range of options for the construction of a battery thermal management system (BTMS). The design of an innovative yet well-functioning BTMS requires strict supervision, quality audit and continuous improvement of the whole process....... It must address all the current quality and safety (Q&S) standards. In this review article, an effective battery thermal management is sought considering the existing battery Q&S standards and scientific literature. The article contains a broad overview of the current existing standards and literature...... on a generic compliant BTMS. The aim is to assist in the design of a novel compatible BTMS. Additionally, the article delivers a set of recommendations to make an effective BTMS....

  10. Rare Complications of Cervical Spine Surgery: Pseudomeningocoele. (United States)

    Ailon, Tamir; Smith, Justin S; Nassr, Ahmad; Smith, Zachary A; Hsu, Wellington K; Fehlings, Michael G; Fish, David E; Wang, Jeffrey C; Hilibrand, Alan S; Mummaneni, Praveen V; Chou, Dean; Sasso, Rick C; Traynelis, Vincent C; Arnold, Paul M; Mroz, Thomas E; Buser, Zorica; Lord, Elizabeth L; Massicotte, Eric M; Sebastian, Arjun S; Than, Khoi D; Steinmetz, Michael P; Smith, Gabriel A; Pace, Jonathan; Corriveau, Mark; Lee, Sungho; Riew, K Daniel; Shaffrey, Christopher


    This study was a retrospective, multicenter cohort study. Rare complications of cervical spine surgery are inherently difficult to investigate. Pseudomeningocoele (PMC), an abnormal collection of cerebrospinal fluid that communicates with the subarachnoid space, is one such complication. In order to evaluate and better understand the incidence, presentation, treatment, and outcome of PMC following cervical spine surgery, we conducted a multicenter study to pool our collective experience. This study was a retrospective, multicenter cohort study of patients who underwent cervical spine surgery at any level(s) from C2 to C7, inclusive; were over 18 years of age; and experienced a postoperative PMC. Thirteen patients (0.08%) developed a postoperative PMC, 6 (46.2%) of whom were female. They had an average age of 48.2 years and stayed in hospital a mean of 11.2 days. Three patients were current smokers, 3 previous smokers, 5 had never smoked, and 2 had unknown smoking status. The majority, 10 (76.9%), were associated with posterior surgery, whereas 3 (23.1%) occurred after an anterior procedure. Myelopathy was the most common indication for operations that were complicated by PMC (46%). Seven patients (53%) required a surgical procedure to address the PMC, whereas the remaining 6 were treated conservatively. All PMCs ultimately resolved or were successfully treated with no residual effects. PMC is a rare complication of cervical surgery with an incidence of less than 0.1%. They prolong hospital stay. PMCs occurred more frequently in association with posterior approaches. Approximately half of PMCs required surgery and all ultimately resolved without residual neurologic or other long-term effects.

  11. Direct ultimate disposal of spent fuel DEAB. Systems analysis. Ultimate disposal concepts. Final report. Main volume

    International Nuclear Information System (INIS)

    Wahl, A.


    The results elaborated under the project, systems analysis of mixed radwaste disposal concepts and systems analysis of ultimate disposal concepts, provide a comprehensive description and assessment of a radwaste repository, for heat generating wastes and for wastes with negligible heat generation, and thus represent the knowledge basis for forthcoming planning work for a repository in an abandoned salt mine. A fact to be considered is that temperature field calculations have shown that there is room for further optimization with regard to the mine layout. The following aspects have been analysed: (1) safety of operation; (2) technical feasibility and realisation and licensability of the concepts; (3) operational aspects; (4) varieties of utilization of the salt dome for the intended purpose (boreholes for waste emplacement, emplacement in galleries, multi-horizon systems); (5) long-term structural stability of the mine; (6) economic efficiency; (7) nuclear materials safeguards. (orig./HP) [de

  12. Influence of podiatry on orthopedic surgery at a level I trauma center. (United States)

    Jakoi, Andre M; Old, Andrew B; O'Neill, Craig A; Stein, Benjamin E; Stander, Eric P; Rosenblatt, Joseph; Herman, Martin J


    Level I trauma centers frequently see trauma at or below the ankle, which requires consultation with the orthopedic surgery department. However, as podiatry programs begin to firmly establish themselves in more Level I trauma centers, their consultations increase, ultimately taking those once seen by orthopedic surgery. A review of the literature demonstrates that this paradigm shift has yet to be discussed. The purpose of this study was to determine how many, if any, lower extremity fracture consultations a newly developed podiatry program would take from the orthopedic surgery department. A retrospective review was performed of emergency department records from January 2007 to December 2011. Seventeen different emergency department diagnoses were used to search the database. Ultimately, each patient's emergency department course was researched. Several trends were noted. First, if trauma surgery was involved, only the orthopedic surgery department was consulted for any injuries at or below the ankle. Second, the emergency department tended to consult the podiatry program only between the hours of 8 am and 6 pm. Third, as the podiatry program became more established, their number of consultations increased yearly, and, coincidentally, the orthopedic surgery department's consultations decreased. Finally, high-energy traumas involved only the orthopedic surgery department. Whether the orthopedic surgery department or podiatry program is consulted regarding trauma surgery is likely hospital dependent. Copyright 2014, SLACK Incorporated.

  13. Differences in perioperative femoral and radial arterial blood pressure in neonates and infants undergoing cardiac surgery requiring cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Hwa Jin Cho

    Full Text Available Abstract Objective: Several reports claim that blood pressure (BP in the radial artery may underestimate the accurate BP in critically ill patients. Here, the authors evaluated differences in mean blood pressure (MBP between the radial and femoral artery during pediatric cardiac surgery to determine the effectiveness of femoral arterial BP monitoring. Method: The medical records of children under 1 year of age who underwent open-heart surgery between 2007 and 2013 were retrospectively reviewed. Radial and femoral BP were measured simultaneously, and the differences between these values were analyzed at various times: after catheter insertion, after the initiation of cardiopulmonary bypass (CPB-on, after aortic cross clamping (ACC, after the release of ACC, after weaning from CPB, at arrival in the intensive care unit (ICU, and every 6 h during the first day in the ICU. Results: A total of 121 patients who underwent open-heart surgery met the inclusion criteria. During the intraoperative period, from the beginning to the end of CPB, radial MBPs were significantly lower than femoral MBPs at each time-point measured (p 60 min, odds ratio: 7.47 was a risk factor for lower radial pressure. However, discrepancies between these two values disappeared after arrival in the ICU. There was no incidence of ischemic complications associated with the catheterization of both arteries. Conclusion: The authors suggest that femoral arterial pressure monitoring can be safely performed, even in neonates, and provides more accurate BP values during CPB-on periods, and immediately after weaning from CPB, especially when CPB time was greater than 60 min.

  14. Reduced design load basis for ultimate blade loads estimation in multidisciplinary design optimization frameworks

    DEFF Research Database (Denmark)

    Pavese, Christian; Tibaldi, Carlo; Larsen, Torben J.


    The aim is to provide a fast and reliable approach to estimate ultimate blade loads for a multidisciplinary design optimization (MDO) framework. For blade design purposes, the standards require a large amount of computationally expensive simulations, which cannot be efficiently run each cost...... function evaluation of an MDO process. This work describes a method that allows integrating the calculation of the blade load envelopes inside an MDO loop. Ultimate blade load envelopes are calculated for a baseline design and a design obtained after an iteration of an MDO. These envelopes are computed...... for a full standard design load basis (DLB) and a deterministic reduced DLB. Ultimate loads extracted from the two DLBs with the two blade designs each are compared and analyzed. Although the reduced DLB supplies ultimate loads of different magnitude, the shape of the estimated envelopes are similar...

  15. "Right to recommend, wrong to require"- an empirical and philosophical study of the views among physicians and the general public on smoking cessation as a condition for surgery. (United States)

    Björk, Joar; Juth, Niklas; Lynøe, Niels


    cessation prior to surgery rather than a "requirement strategy". The normative reasons speak in favour of the "recommendation strategy".

  16. Medical student surgery elective in rural Haiti: a novel approach to satisfying clerkship requirements while providing surgical care to an underserved population. (United States)

    Chin-Quee, Anthony; White, Laura; Leeds, Ira; MacLeod, Jana; Master, Viraj A


    The addition of global health programs to medical school training results in graduates with enhanced clinical skills and increased sensitivity to cost issues. Funding from U.S. medical schools has been unable to meet student demand, and therefore it is often a critical limiting factor to the lack of development of these programs. We describe an alternative approach for global health surgical training for medical students. Emory University medical students and faculty, in collaboration with Project Medishare for Haiti, planned, raised funds, and executed a successful short-term surgical camp to supplement available surgical services in rural Haiti. Learning objectives that satisfied Emory University School of Medicine surgery clerkship requirements were crafted, and third-year students received medical school credit for the trip. In the absence of house staff and placed in an under-resourced, foreign clinical environment, the surgical elective described here succeeded in meeting learning objectives for a typical third-year surgical clerkship. Objectives were met through a determined effort to ensure that home institution requirements were aligned properly with learning activities while students were abroad and through a close collaboration between medical students, faculty members, and the administration. Emory University's international surgery elective for medical students demonstrates that opportunities for supervised, independent student-learning and global health service can be integrated into a traditional surgical clerkship. These opportunities can be organized to meet the requirements and expectations for third-year surgery clerkships at other medical colleges. This work also identifies how such trips can be planned and executed in a manner that does not burden strained academic budgets with further demands on resources.

  17. Ultrasound-Assisted Thoracic Paravertebral Block Reduces Intraoperative Opioid Requirement and Improves Analgesia after Breast Cancer Surgery: A Randomized, Controlled, Single-Center Trial.

    Directory of Open Access Journals (Sweden)

    Lijian Pei

    Full Text Available The contribution of ultrasound-assisted thoracic paravertebral block to postoperative analgesia remains unclear. We compared the effect of a combination of ultrasound assisted-thoracic paravertebral block and propofol general anesthesia with opioid and sevoflurane general anesthesia on volatile anesthetic, propofol and opioid consumption, and postoperative pain in patients having breast cancer surgery.Patients undergoing breast cancer surgery were randomly assigned to ultrasound-assisted paravertebral block with propofol general anesthesia (PPA group, n = 121 or fentanyl with sevoflurane general anesthesia (GA group, n = 126. Volatile anesthetic, propofol and opioid consumption, and postoperative pain intensity were compared between the groups using noninferiority and superiority tests.Patients in the PPA group required less sevoflurane than those in the GA group (median [interquartile range] of 0 [0, 0] vs. 0.4 [0.3, 0.6] minimum alveolar concentration [MAC]-hours, less intraoperative fentanyl requirements (100 [50, 100] vs. 250 [200, 300]μg,, less intense postoperative pain (median visual analog scale score 2 [1, 3.5] vs. 3 [2, 4.5], but more propofol (median 529 [424, 672] vs. 100 [100, 130] mg. Noninferiority was detected for all four outcomes; one-tailed superiority tests for each outcome were highly significant at P<0.001 in the expected directions.The combination of propofol anesthesia with ultrasound-assisted paravertebral block reduces intraoperative volatile anesthetic and opioid requirements, and results in less post operative pain in patients undergoing breast cancer NCT00418457.

  18. Ultimate Educational Aims, Overridingness, and Personal Well-Being (United States)

    Haji, Ishtiyaque; Cuypers, Stefaan E.


    Discussion regarding education's aims, especially its ultimate aims, is a key topic in the philosophy of education. These aims or values play a pivotal role in regulating and structuring moral and other types of normative education. We outline two plausible strategies to identify and justify education's ultimate aims. The first associates these…

  19. Sensitivity analysis on ultimate strength of aluminium stiffened panels

    DEFF Research Database (Denmark)

    Rigo, P.; Sarghiuta, R.; Estefen, S.


    This paper presents the results of an extensive sensitivity analysis carried out by the Committee III.1 "Ultimate Strength" of ISSC?2003 in the framework of a benchmark on the ultimate strength of aluminium stiffened panels. Previously, different benchmarks were presented by ISSC committees on ul...

  20. The Use of a 3D Printer in Pre-operative Planning for a Patient Requiring Acetabular Reconstructive Surgery. (United States)

    Duncan, James M; Nahas, Samuel; Akhtar, Kashif; Daurka, Jasvinder


    Surgical management of acetabular fractures is often highly complex, and a successful outcome depends upon an appreciation of the fracture pattern and the most appropriate approach to reduce and hold it. Currently, computed tomography (CT) images are used in conjunction with plain x-rays to identify the main fracture components and their spatial relationship to one another, and as such surgeons still have to make decisions based upon their ability to visualise the fracture from the images available. 3D printers have now become widely available and inexpensive, and can be used to rapidly produce life-size models based on CT scans of an individual patient. The availability of patient specific, accurate and detailed models of complex acetabular fractures can aid planning of surgical management on a patient specific basis. This report describes the use of a 3D printer to create a life-size model reconstruction of the pelvis of a 48 year old male patient who sustained a left sided associated both column acetabular fracture following a motorbike accident in the Sahara Desert. The model allowed visualisation of the multiple fracture fragments and their relative displacements. The tactile feedback allowed assessment of the different fracture fragments. The relative displacement of the quadrilateral plate and posterior column fragments could be assessed and the surgeon felt that these would be amenable to reduction from an ilioinguinal approach. An anatomic reduction was achieved and was held with the application of a pelvic brim plate with 2 screws lagging the posterior column/quadrilateral plate fragment. There are previous examples of 3D models being used in orthopaedic surgery through the use of rapid prototyping, however this method is usually expensive and time consuming. Advances in 3D printer technology offer surgeons a number of advantages when treating these complex fractures. With the ever-increasing economy, ease of use and speed of additive processing, the

  1. Does a thrombin-based topical haemostatic agent reduce blood loss and transfusion requirements after total knee revision surgery? A randomized, controlled trial. (United States)

    Romanò, Carlo L; Monti, Lorenzo; Logoluso, Nicola; Romanò, Delia; Drago, Lorenzo


    The aim of the present study was to assess the efficacy of a thrombin-based topical haemostatic in reducing blood requirements after total knee replacement (TKR) revision surgery. This prospective, randomized, controlled study was designed to evaluate the haemostatic efficacy and safety of a thrombin-based topical haemostatic (Floseal) versus standard treatment in patients receiving total knee revision arthroplasty. The decrease in haemoglobin values postsurgery and the blood units transfused were recorded. The decision to transfuse was made by a surgeon blinded to the patient's group allocation. Forty-eight patients were enroled in the study; twenty-four patients each were randomized to the treatment and control groups, respectively. The median decrease in haemoglobin concentration on the first postoperative day was 2.2 g/dL in the treatment group and 2.7 g/dL in the control group. A significant reduction in units of blood transfused was also observed in the treatment group compared with the control group [1.1 ± 1.13 (range 0-4) vs. 1.9 ± 1.41 (range 0-5) blood units; P = 0.04]. No major treatment-related adverse events were recorded in the study. This study shows that a thrombin-based topical haemostatic reduces the need for blood transfusion in TKR revision surgery. A thrombin-based topical haemostatic agent can be an appropriate solution to enhance haemostasis and vessel sealing at the operative site in TKR revision surgery, in order to reduce the need for blood transfusion after surgery. II.

  2. Pre-prosthetic surgery: Mandible

    Directory of Open Access Journals (Sweden)

    Veeramalai Naidu Devaki


    Full Text Available Pre-prosthetic surgery is that part of oral and maxillofacial surgery which restores oral function and facial form. This is concerned with surgical modification of the alveolar process and its surrounding structures to enable the fabrication of a well-fitting, comfortable, and esthetic dental prosthesis. The ultimate goal of pre-prosthetic surgery is to prepare a mouth to receive a dental prosthesis by redesigning and smoothening bony edges.

  3. Construction of a Urologic Robotic Surgery Training Curriculum: How Many Simulator Sessions Are Required for Residents to Achieve Proficiency? (United States)

    Wiener, Scott; Haddock, Peter; Shichman, Steven; Dorin, Ryan


    To define the time needed by urology residents to attain proficiency in computer-aided robotic surgery to aid in the refinement of a robotic surgery simulation curriculum. We undertook a retrospective review of robotic skills training data acquired during January 2012 to December 2014 from junior (postgraduate year [PGY] 2-3) and senior (PGY4-5) urology residents using the da Vinci Skills Simulator. We determined the number of training sessions attended and the level of proficiency achieved by junior and senior residents in attempting 11 basic or 6 advanced tasks, respectively. Junior residents successfully completed 9.9 ± 1.8 tasks, with 62.5% completing all 11 basic tasks. The maximal cumulative success rate of junior residents completing basic tasks was 89.8%, which was achieved within 7.0 ± 1.5 hours of training. Of senior residents, 75% successfully completed all six advanced tasks. Senior residents attended 6.3 ± 3.5 hours of training during which 5.1 ± 1.6 tasks were completed. The maximal cumulative success rate of senior residents completing advanced tasks was 85.4%. When designing and implementing an effective robotic surgical training curriculum, an allocation of 10 hours of training may be optimal to allow junior and senior residents to achieve an acceptable level of surgical proficiency in basic and advanced robotic surgical skills, respectively. These data help guide the design and scheduling of a residents training curriculum within the time constraints of a resident's workload.

  4. Intestinal Surgery. (United States)

    Desrochers, André; Anderson, David E


    A wide variety of disorders affecting the intestinal tract in cattle may require surgery. Among those disorders the more common are: intestinal volvulus, jejunal hemorrhage syndrome and more recently the duodenal sigmoid flexure volvulus. Although general principles of intestinal surgery can be applied, cattle has anatomical and behavior particularities that must be known before invading the abdomen. This article focuses on surgical techniques used to optimize outcomes and discusses specific disorders of small intestine. Diagnoses and surgical techniques presented can be applied in field conditions. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Thermal performance measurements on ultimate heat sinks--cooling ponds

    International Nuclear Information System (INIS)

    Hadlock, R.K.; Abbey, O.B.


    The primary objective of the studies described is to obtain the requisite data, with respect to modeling requirements, to characterize thermal performance of heat sinks for nuclear facilities existing at elevated water temperatures in result of experiencing a genuinely large heat load and responding to meteorological influence. The data should reflect thermal performance for combinations leading to worst-case meteorological influence. A geothermal water retention basin has been chosen as the site for the first measurement program and data have been obtained in the first of several experiments scheduled to be performed there. These data illustrate the thermal and water budgets during episodes of cooling from an initially high pond water bulk temperature. Monitoring proceeded while the pond experienced only meteorological and seepage influence. The data are discussed and are presented as a data volume which may be used for calculation purposes. Suggestions for future measurement programs are stated with the intent to maintain and improve relevance to nuclear ultimate heat sinks while continuing to examine the performance of the analog geothermal pond. It is further suggested that the geothermal pond, with some modification, may be a suitable site for spray pond measurements

  6. Ultimate Lateral Capacity of Rigid Pile in c- φ Soil (United States)

    Zhang, Wei-min


    To date no analytical solution of the pile ultimate lateral capacity for the general c- φ soil has been obtained. In the present study, a new dimensionless embedded ratio was proposed and the analytical solutions of ultimate lateral capacity and rotation center of rigid pile in c- φ soils were obtained. The results showed that both the dimensionless ultimate lateral capacity and dimensionless rotation center were the univariate functions of the embedded ratio. Also, the ultimate lateral capacity in the c- φ soil was the combination of the ultimate lateral capacity ( f c ) in the clay, and the ultimate lateral capacity ( f φ ) in the sand. Therefore, the Broms chart for clay, solution for clay ( φ=0) put forward by Poulos and Davis, solution for sand ( c=0) obtained by Petrasovits and Awad, and Kondner's ultimate bending moment were all proven to be the special cases of the general solution in the present study. A comparison of the field and laboratory tests in 93 cases showed that the average ratios of the theoretical values to the experimental value ranged from 0.85 to 1.15. Also, the theoretical values displayed a good agreement with the test values.

  7. Overview of robotic colorectal surgery: Current and future practical developments (United States)

    Roy, Sudipta; Evans, Charles


    Minimal access surgery has revolutionised colorectal surgery by offering reduced morbidity and mortality over open surgery, while maintaining oncological and functional outcomes with the disadvantage of additional practical challenges. Robotic surgery aids the surgeon in overcoming these challenges. Uptake of robotic assistance has been relatively slow, mainly because of the high initial and ongoing costs of equipment but also because of limited evidence of improved patient outcomes. Advances in robotic colorectal surgery will aim to widen the scope of minimal access surgery to allow larger and more complex surgery through smaller access and natural orifices and also to make the technology more economical, allowing wider dispersal and uptake of robotic technology. Advances in robotic endoscopy will yield self-advancing endoscopes and a widening role for capsule endoscopy including the development of motile and steerable capsules able to deliver localised drug therapy and insufflation as well as being recharged from an extracorporeal power source to allow great longevity. Ultimately robotic technology may advance to the point where many conventional surgical interventions are no longer required. With respect to nanotechnology, surgery may eventually become obsolete. PMID:26981188

  8. Effect of intravenous paracetamol on postoperative morphine requirements in neonates and infants undergoing major noncardiac surgery: a randomized controlled trial

    NARCIS (Netherlands)

    Ceelie, Ilse; de Wildt, Saskia N.; van Dijk, Monique; van den Berg, Margreeth M. J.; van den Bosch, Gerbrich E.; Duivenvoorden, Hugo J.; de Leeuw, Tom G.; Mathôt, Ron; Knibbe, Catherijne A. J.; Tibboel, Dick


    Continuous morphine infusion as standard postoperative analgesic therapy in young infants is associated with unwanted adverse effects such as respiratory depression. To determine whether intravenous paracetamol (acetaminophen) would significantly (>30%) reduce morphine requirements in neonates and

  9. Identifying the Infection Control Areas Requiring Modifications in Thoracic Surgery Units: Results of a Two-Year Surveillance of Surgical Site Infections in Hospitals in Southern Poland. (United States)

    Dubiel, Grzegorz; Rogoziński, Paweł; Żaloudik, Elżbieta; Bruliński, Krzysztof; Różańska, Anna; Wójkowska-Mach, Jadwiga


    Surgical site infection (SSI) is considered to be a priority in infection control. The objective of this study is the analysis of results of active targeted surveillance conducted over a two-year period in the Department of Thoracic Surgery at the Pulmonology and Thoracic Surgery Center in Bystra, in southern Poland. The retrospective analysis was carried out on the basis of results of active monitoring of SSI in the 45-bed Department of Thoracic Surgery at the Pulmonology and Thoracic Surgery Center in Bystra between April 1, 2014 and April 30, 2016. Surgical site infections were identified based on the definitions of the European Centre for Disease Prevention and Control (ECDC) taking into account the time of symptom onset, specifically, whether the symptoms occurred within 30 d after the surgical procedure. Detection of SSI relied on daily inspection of incisions by a trained nurse, analysis of medical and nursing entries in the computer system, and analysis of all results of microbiologic tests taken in the unit and in the operating room. In the study period, data were collected regarding 1,387 treatment procedures meeting the registration criteria. Forty cases of SSI were detected yielding an incidence rate of 3%. Most cases (55%) were found in the course of hospitalization and 45% were detected after the patient's discharge. The SSIs were classified as follows: superficial, 37.5%; deep infections, 7.5%; and organ/space infection, 55%. Among patients who were diagnosed with SSI, most were male (77.5%). For patients with an American Society of Anesthesiologists (ASA) score I-II the incidence rate was 2%; ASA score III or more, 3.7%. The incidence rate varied from 0.3% in clean surgical site to 6.5% in clean-contaminated site. The study validated the usefulness of targeted surveillance in monitoring SSIs in patients hospitalized in thoracic surgery departments. Surgical site infection surveillance identified areas of care requiring modifications, namely

  10. [Treatment-refractory-dental-extraction-associated pyothorax involving infection by 2 species of oral originated bacteria requires surgical debridement by video assisted thoracoscopic surgery (VATS)]. (United States)

    Rai, Kammei; Matsuo, Kiyoshi; Yonei, Toshiro; Sato, Toshio


    Cases of septic pulmonary embolism (SPE) diagnosed clinically by CT after dental extraction rarely include verification of bacteria from the local infection site. We report the case of a 70-year-old man without background disease suffering severe pyothrax after dental extraction. We detected two species of oral bacteria from his pleural effusion. Treatment was so difficult that it required surgical debridement by video assisted thoracoscopic surgery (VATS), even after the appropriate administration of antibiotics. According to the American Heart Association (AHA) prophylaxis guidelines for preventing infective endocarditis indicate that it is uncommon to prescribe antibiotics to patients without background disease after dental extraction. No appropriate Japanese guidelines exist considering the prevention of SPE causing severe pyothorax as in our case. The hematogenous spread of bacteria such as SPE caused by sepsis after tooth extraction thus requires more attended careful consideration in clinical practice if patients are to be properly protected against potentially serious complications.

  11. Ultimate guide to YouTube for business

    CERN Document Server


    Ultimate Guide to YouTube for Business helps small business owners create marketing videos to help promote their products, share their story, build a community around their brand without spending a fortune-all the while making money.

  12. Ultimate Opening Combined with Area Stability Applied to Urban Scenes


    Marcotegui , Beatriz; Serna , Andrés; Hernández , Jorge


    International audience; This paper explores the use of ultimate opening in urban analysis context. It demonstrates the efficiency of this approach for street level elevation images, derived from 3D point clouds acquired by terrestrial mobile mapping systems. An area-stability term is introduced in the residual definition, reducing the over-segmentation of the vegetation while preserving small significant regions. We compare two possible combinations of the Ultimate Opening and the Area Stabil...

  13. Direct ultimate disposal - state of investigations and prospects

    International Nuclear Information System (INIS)

    Gasterstaedt, N.


    Based on a decision adopted by the Prime Ministers on 25/10/90, the principles governing preventive waste management of nuclear power plants are reviewed. Increasing importance is attached to the direct ultimate disposal alternative. The legal and political framework, the technology involved, the state of developments, future activities under the R and D programme as well as a cost estimate of direct ultimate disposal are presented. (orig.) [de

  14. Differences in perioperative femoral and radial arterial blood pressure in neonates and infants undergoing cardiac surgery requiring cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Hwa Jin Cho


    Full Text Available Objective: Several reports claim that blood pressure (BP in the radial artery may underestimate the accurate BP in critically ill patients. Here, the authors evaluated differences in mean blood pressure (MBP between the radial and femoral artery during pediatric cardiac surgery to determine the effectiveness of femoral arterial BP monitoring. Method: The medical records of children under 1 year of age who underwent open-heart surgery between 2007 and 2013 were retrospectively reviewed. Radial and femoral BP were measured simultaneously, and the differences between these values were analyzed at various times: after catheter insertion, after the initiation of cardiopulmonary bypass (CPB-on, after aortic cross clamping (ACC, after the release of ACC, after weaning from CPB, at arrival in the intensive care unit (ICU, and every 6 h during the first day in the ICU. Results: A total of 121 patients who underwent open-heart surgery met the inclusion criteria. During the intraoperative period, from the beginning to the end of CPB, radial MBPs were significantly lower than femoral MBPs at each time-point measured (p 60 min, odds ratio: 7.47 was a risk factor for lower radial pressure. However, discrepancies between these two values disappeared after arrival in the ICU. There was no incidence of ischemic complications associated with the catheterization of both arteries. Conclusion: The authors suggest that femoral arterial pressure monitoring can be safely performed, even in neonates, and provides more accurate BP values during CPB-on periods, and immediately after weaning from CPB, especially when CPB time was greater than 60 min. Resumo: Objetivo: Diversos relatos alegam que a pressão arterial (PA na artéria radial poderá subestimar a PA precisa em pacientes gravemente doentes. Aqui, avaliamos diferenças na pressão arterial média (PAM entre a artéria radial e femoral durante cirurgia cardíaca pediátrica para determinar a eficácia do

  15. Conception of electron beam-driven subcritical molten salt ultimate safety reactor

    Energy Technology Data Exchange (ETDEWEB)

    Abalin, S.S.; Alekseev, P.N.; Ignat`ev, V.V. [Kurchatov Institute, Moscow (Russian Federation)] [and others


    This paper is a preliminary sketch of a conception to develop the {open_quotes}ultimate safety reactor{close_quotes} using modern reactor and accelerator technologies. This approach would not require a long-range R&D program. The ultimate safety reactor could produce heat and electric energy, expand the production of fuel, or be used for the transmutation of long-lived wastes. The use of the combined double molten salt reactor system allows adequate neutron multiplication to permit using an electron accelerator for the initial neutron flux. The general parameters of such a system are discussed in this paper.

  16. Ultimate - a new generation of gasoline and diesel fuels; Ultimate - eine neue Generation von Otto- und Dieselkraftstoffen

    Energy Technology Data Exchange (ETDEWEB)

    Strempel, G. [Aral Forschung/Global Fuels Technology, Bochum (Germany); Beckwith, P. [BP Fuels Management Group, Pangbourne (United Kingdom); Froehling, J. [Aral Forschung, Bochum (Germany). Labor/Analytik; Baron, U. [Aral Forschung, Bochum (Germany). Motor- und Fahrzeuglaboratorium; Sauermann, P.; Balfanz, U. [Aral Forschung, Bochum (Germany). Produktentwicklung; Doermer, W. [Aral Forschung, Bochum (Germany). Produktqualitaet


    With the launch of Ultimate 100 gasoline and Ultimate Diesel, motorists in Germany now have the opportunity to choose new advanced performance fuels designed to get the very best from their engines. This article gives details of the technical development behind these fuels, their wide range of benefits, and how it is possible to manufacture fuels which meet the considerable technical challenge of achieving both more performance and less pollution. (orig.)


    Directory of Open Access Journals (Sweden)

    Mladen Hudec


    Full Text Available The most questionable are the values of pressures between rock and support resulting from common deformations on the contact area between rock and support. Therefore the modelling and design of the tunnel support is not reliable, if it is based on active rock pressure resulting from this common deformations. The inversion of the design procedure is proposed. Instead of the active extreme pressure of the rock on support, the influence of ultimate reaction of the support on the rock has to be analysed. This procedure can be performed using the ultimate load principle, as proposed by Eurocodc 7 (Geotechnies. Normally, the rock has the tendency to increase the common conver¬gence until the support reaches its ultimate state. So, loading of profile boundary with the ultimate possible reaction of the support is very plausible. The reactive support pressures have to be probable and itself in equilibrium. The ultimate reactive load has to be reduced by Euro-code safety factor for structural elements and applied on the rock with given properties, or alternatively (as proposed by Eurocode 7 the soil or rock properties have to be diminished and calculated with full ultimate support pressures. If the rock with given (or proposed pro¬perties and loaded with ultimate reactive pressures resulting from supposed support, satisfy its failure criterion, then is the compound system support-rock verificatcd. By this procedure, the number of relevant material properties is reduce to the primary stress ratio and the constants defining the failure criterion. The verification can be performed by any of numerical methods, but we prefer here used boundary elements method (the paper is published in Croatian.

  18. Hematopoietic Stem Cell Transplantation From Unrelated Donors in 2 Cases of Interleukin-10 Receptor Deficiency: Is Surgery Not a Requirement? (United States)

    Kocacik Uygun, Dilara F; Uygun, Vedat; Daloğlu, Hayriye; Öztürkmen, Seda; Karasu, Gülsün; Reisli, İsmail; Sayar, Ersin; Yüksekkaya, Hasan A; Glocker, Erik-Oliver; Boztuğ, Kaan; Yeşilipek, Akif


    Mutations in interleukin-10 and its receptors cause infantile inflammatory bowel disease (IBD), a hyperinflammatory disorder characterized by severe, treatment-refractory colitis, multiple abscesses, and enterocutaneous fistulas. Patients with infantile IBD often require several surgical interventions, including complete colectomy, and hematopoietic stem cell transplantation is currently the only known medical therapy. Traditionally, operative management has been preferred before stem cell transplantation because of the latter's increased susceptibility to procedural complications; however, surgical intervention could be delayed, and possibly reconsidered, because our 2 patients with infantile IBD demonstrated a rapid response to treatment via engraftment.

  19. A comparison of international criteria for the ultimate storage of radioactive wastes

    International Nuclear Information System (INIS)

    Mielke, H.


    In countries other than the Federal Republic of Germany and internationally there are no comprehensive codes referring to criteria and safety requirements except those of the IAEA and USA. In other countries there exist safety goals for the ultimate storage or for purely geological criteria. The degree of detailing regulations differs widely abroad and internationally. Safety goals abroad and internationally as well as measures for their realisation in the ultimate storage of radioactive wastes in deep geological formations are in line with the German safety goals. The IAEA refers to general aspects of geological, waste technology and ultimate storage technology criteria. In the USA, ultimate storage technology criteria have been quantified in part. The quantitative geological criteria existing in Great Britain and in the Netherlands are only relevant in as much as safety analyses must be performed for a specific site to provide evidence for the safety of this site. The comparison shows that most requirements pronounced abroad are also made for the Federal Republic of Germany. Some requirements are more specified in the Federal Republic of Germany, some are more detailed abroad. (orig./HP) [de

  20. Ultimate load capacity assessment of reinforced concrete shell structures

    International Nuclear Information System (INIS)

    Gupta, Amita; Singh, R.K.; Kushwaha, H.S.; Mahajan, S.C.; Kakodkar, A.


    The objective of this study is to develop capability for prediction of ultimate load capacity of reinforced concrete shell structures. The present finite element code ULCA (Ultimate Load Capacity Assessment) adopts a degenerate concept of formulating general isoparametric shell element with a layered approach in the thickness direction. Different failure modes such as crushing, tensile cracking and reinforcement yielding are recognised for various problems. The structure fails by crushing of concrete when the concrete strain/stress reaches the ultimate stress or strain of concrete. Material nonlinearities as a result of tension cracking, tension stiffening between reinforcement and concrete in cracked region and yielding of reinforcement are considered along with geometric nonlinearity. Thus with this code it is possible to predict the pressure at which the first cracking, first through thickness cracking, first yielding of reinforcement occurs. After validating the code with few bench mark problems for different failure modes a reinforced concrete nuclear containment is analysed for its ultimate capacity and the results are matched with the published results. Further the ultimate load capacity of outer containment wall of Narora Atomic Power Station is predicted. It is observed that containment fails in membrane region and has a sufficient margin against design pressure. (author). 9 refs., 56 figs., 3 tabs., 1 appendix with 4 tabs

  1. Do instability markers predict satisfactory reduction and requirement for later surgery in emergency department patients with wrist fracture? (United States)

    Winayak, Amar; Gossat, Alyza; Cooper, Jenny; Ritchie, Peter; Lim, Wei; Klim, Sharon; Kelly, Anne-Maree


    Research suggests that the presence of instability markers in patients with displaced distal radial fractures is associated with poorer outcome. Our aims were to determine whether the presence of previously defined instability markers could predict the likelihood of successful ED reduction and requirement for a secondary procedure after ED reduction. Retrospective cohort study performed by medical record review. Adult ED patients coded as having an isolated wrist fracture and having fracture reduction in ED were eligible for inclusion. Data collected included demographics, history of osteoporosis, mechanism of injury, radiological features on X-rays and performance of a secondary procedure. Outcomes of interest were the rate of successful fracture reduction in ED (against defined radiological criteria), the rate of secondary procedures and the association between the number of defined instability risk factors and successful reduction and performance of a secondary surgical procedure. Analysis was by χ 2 test, receiver operating characteristic curve, logistic regression analyses. Three hundred and nineteen patients were studied; median age 62 years, 77% female. Sixty-five per cent of patients had satisfactory fracture reduction in ED (95% CI 59%-70%). Eighty-six patients underwent a secondary procedure to reduce/stabilise their fracture (28%, 95% CI 23%-33%). Younger age, lack of satisfactory ED reduction and increased number of instability factors were independently predictive of the performance of a secondary procedure. Instability risk factors are common in patients with wrist fractures requiring reduction in ED. The number of instability factors is not a strong predictor of the performance of secondary procedures. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  2. Ductility and Ultimate Capacity of Prestressed Steel Reinforced Concrete Beams

    Directory of Open Access Journals (Sweden)

    Chengquan Wang


    Full Text Available Nonlinear numerical analysis of the structural behaviour of prestressed steel reinforced concrete (PSRC beams was carried out by using finite element analysis software ABAQUS. By comparing the load-deformation curves, the rationality and reliability of the finite element model have been confirmed; moreover, the changes of the beam stiffness and stress in the forcing process and the ultimate bearing capacity of the beam were analyzed. Based on the model, the effect of prestressed force, and H-steel to the stiffness, the ultimate bearing capacity and ductility of beam were also analyzed.

  3. Ultimate load model test for Sizewell 'B' primary containment

    International Nuclear Information System (INIS)

    Crowder, R.


    This paper considers the factors influencing the adoption of an ultimate load factor for the Sizewell 'B' PWR primary containment structure. As part of the validation process for the ultimate load analysis method, a proposal has been made by Nuclear Design Associates to build and test a 1/10th scale model of the containment structure, which would proceed following the granting of section 2 consent for Sizewell 'B'. The modelling principles, construction method and test proposals are examined in some detail. The proposal is currently being considered by the CEGB's Project Management Team. (author)

  4. Trump er gældsøkonomiens ultimative illusionist

    DEFF Research Database (Denmark)

    Nielsen, Peter


    Trump giver ikke kun gevaldige skattelettelser og nærer en illusion om, at vækst vil løse alle problemer. Han fortrænger også gældsøkonomiens ultimative bundlinje i form af klimaforandringerne.......Trump giver ikke kun gevaldige skattelettelser og nærer en illusion om, at vækst vil løse alle problemer. Han fortrænger også gældsøkonomiens ultimative bundlinje i form af klimaforandringerne....

  5. Ultimate deformation capacity of reinforced concrete slabs underblast load

    NARCIS (Netherlands)

    Doormaal, J.C.A.M. van; Weerheijm, J.


    In this paper a test method to determine the deformation capacity and the resistance-deformation curve of blast-loaded slabs is described. This method was developed at TNO-PML. The method has been used to determine the ultimate deformation capacity of some simply supported reinforced concrete slabs

  6. 49 Stories That Make an Ultimate STEM Lesson Plan (United States)

    Mehta, Swati; Mehta, Rohit; Berzina-Pitcher, Inese; Seals, Christopher; Mishra, Punya


    In this paper we reviewed what 49 large urban public school district STEM teachers enrolled in a year-long graduate certificate and fellowship program at a large Midwestern university considered as their amazing teaching moments. They were asked to share their amazing teaching moments that would make an Ultimate Lesson Plan in STEM. In smaller…

  7. Ultimate capabilities of soft x-ray optics

    International Nuclear Information System (INIS)

    Vinogradov, A.V.; Zorev, N.N.; Kozhevnikov, I.V.


    Nonimaging soft X-ray optics is examined. The ultimate capabilities of a number of X-ray optical components designed for concentration and collimation of radiation from point sources are determined. The applications of X-ray optics are discussed together with the properties of materials in the X-ray range

  8. Safety related aspects of ultimate disposal of radioactive wastes

    International Nuclear Information System (INIS)

    Goemmel, R.


    Solutions and questions related to nuclear waste management are presented. In particular, long-term safety of repositories in Germany and Sweden is considered, with special attention being paid to methods of detection, geotechnical barriers and post-operational phase of salt dome repositories, and conditioning of wastes to make them fit for ultimate disposal. (DG) [de

  9. Changes in heparin dose response slope during cardiac surgery: possible result in inaccuracy in predicting heparin bolus dose requirement to achieve target ACT. (United States)

    Ichikawa, Junko; Mori, Tetsu; Kodaka, Mitsuharu; Nishiyama, Keiko; Ozaki, Makoto; Komori, Makiko


    The substantial interpatient variability in heparin requirement has led to the use of a heparin dose response (HDR) technique. The accuracy of Hepcon-based heparin administration in achieving a target activated clotting time (ACT) using an HDR slope remains controversial. We prospectively studied 86 adult patients scheduled for cardiac surgery requiring cardiopulmonary bypass. The total dose of calculated heparin required for patient and pump priming was administered simultaneously to achieve a target ACT of 450 s for HDR on the Hepcon HMS system. Blood samples were obtained after the induction of anesthesia, at 3 min after heparin administration and after the initiation of CPB to measure kaolin ACT, HDR slope, whole-blood heparin concentration based on the HDR slope and anti-Xa heparin concentration, antithrombin and complete blood count. The target ACT of 450 s was not achieved in 68.6% of patients. Compared with patients who achieved the target ACT, those who failed to achieve their target ACT had a significantly higher platelet count at baseline. Correlation between the HDR slope and heparin sensitivity was poor. Projected heparin concentration and anti-Xa heparin concentration are not interchangeable based on the Bland-Altman analysis. It can be hypothesized that the wide discrepancy in HDR slope versus heparin sensitivity may be explained by an inaccurate prediction of the plasma heparin level and/or the change in HDR of individual patients, depending on in vivo factors such as extravascular sequestration of heparin, decreased intrinsic antithrombin activity level and platelet count and/or activity.

  10. Ambulatory cleft lip surgery: A value analysis. (United States)

    Arneja, Jugpal S; Mitton, Craig


    Socialized health systems face fiscal constraints due to a limited supply of resources and few reliable ways to control patient demand. Some form of prioritization must occur as to what services to offer and which programs to fund. A data-driven approach to decision making that incorporates outcomes, including safety and quality, in the setting of fiscal prudence is required. A value model championed by Michael Porter encompasses these parameters, in which value is defined as outcomes divided by cost. To assess ambulatory cleft lip surgery from a quality and safety perspective, and to assess the costs associated with ambulatory cleft lip surgery in North America. Conclusions will be drawn as to how the overall value of cleft lip surgery may be enhanced. A value analysis of published articles related to ambulatory cleft lip repair over the past 30 years was performed to determine what percentage of patients would be candidates for ambulatory cleft lip repair from a quality and safety perspective. An economic model was constructed based on costs associated with the inpatient stay related to cleft lip repair. On analysis of the published reports in the literature, a minority (28%) of patients are currently discharged in an ambulatory fashion following cleft lip repair. Further analysis suggests that 88.9% of patients would be safe candidates for same-day discharge. From an economic perspective, the mean cost per patient for the overnight admission component of ambulatory cleft surgery to the health care system in the United States was USD$2,390 and $1,800 in Canada. The present analysis reviewed germane publications over a 30-year period, ultimately suggesting that ambulatory cleft lip surgery results in preservation of quality and safety metrics for most patients. The financial model illustrates a potential cost saving through the adoption of such a practice change. For appropriately selected patients, ambulatory cleft surgery enhances overall health care value.

  11. Turbinate surgery (United States)

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...

  12. Bariatric Surgery (United States)

    ... often. Each type of surgery has advantages and disadvantages. Bariatric Surgery Benefits Bariatric surgery can improve many ... Grants & Grant History Research Resources Research at NIDDK Technology Advancement & Transfer Meetings & Workshops Health Information Diabetes Digestive ...

  13. Lung surgery (United States)

    ... are thoracotomy and video-assisted thoracoscopic surgery (VATS). Robotic surgery may also be used. Lung surgery using ... Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, ...

  14. Plastic Surgery (United States)

    ... Staying Safe Videos for Educators Search English Español Plastic Surgery KidsHealth / For Teens / Plastic Surgery What's in ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ...

  15. Cable tray ultimate strength test employing a large shaker table

    Energy Technology Data Exchange (ETDEWEB)

    Komatsu, K.; Myojin, K.; Imai, K. [The Kansai Electric Power Co., Osaka (Japan); Fuyama, H. [Mitsubishi Heavy Industries Ltd, Takasago (Japan); Kokubo, E. [Mitsubishi Heavy Industdries Ltd, Kobe (Japan)


    Ultimate behaviors of cable trays, used in nuclear plants, have not been well studied since cable trays are designed based on conservative design criteria. In this study, by employing a large shaker table, an ultimate strength test was conducted for cable trays used in nuclear power plants. This report describes the results of shaker table test. The following results were obtained. First, in an S{sub 2} earthquake, the damping ratio was so large - more than 30% due to the rubbing of cables - that a large response was not present and the strains in the support were within the elastic limits. Secondly, the support was strong enough to sustain the cable trays even when the strain in the support was 20 times larger than the elastic limit. (authors)

  16. Utilization of metal scrap for the production of waste drums for ultimate disposal

    International Nuclear Information System (INIS)

    Janberg, K.; Rittscher, D.


    The contribution reviews the history of development of the techniques for treatment of decommissioning scrap from the beginning of the 1980's onwards (decommissioning of the Niederaichbach and Gundremmingen nuclear power stations), together with the radiological measuring methods required for regulatory purposes. The advantages of the recycling of the metal scrap by means of melting, and of materials utilization for production of waste containers for ultimate storage are discussed together with product quality assurance criteria. (RB) [de

  17. Management and ultimate storage of wastes from nuclear power generation

    International Nuclear Information System (INIS)


    The annotation on R and D prorgam 86 parts I-II have been brought together in the present report part I, together with some general viewpoints, and been classified according to subject. Part II of the present report comprises viewpoints of 'Research Program 1987-1992' and part III of 'Alternative methods of ultimate storage'. Swedish and French viewpoints are presented in Swedish, the remaining foreign material in English. The comments are grouped in subject catergories. (O.S.)

  18. Ultimate Gradient Limitation in Niobium Superconducting Accelerating Cavities

    Energy Technology Data Exchange (ETDEWEB)

    Checchin, Mattia [Illinois Inst. of Technology, Chicago, IL (United States); Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Grassellino, Anna [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Martinello, Martina [Illinois Inst. of Technology, Chicago, IL (United States); Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Posen, Sam [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Romanenko, Alexander [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Zasadzinski, John [Illinois Inst. of Technology, Chicago, IL (United States)


    The present study is addressed to the theoretical description of the ultimate gradient limitation in SRF cavities. Our intent is to exploit experimental data to confirm models which provide feed-backs on how to improve the current state-of-art. New theoretical insight on the cavities limiting factor can be suitable to improve the quench field of N-doped cavities, and therefore to take advantage of high Q0 at high gradients.

  19. Ultimate capacity of piles penetrating in weak soil layers

    Directory of Open Access Journals (Sweden)

    Al-Obaidi Ahmed


    Full Text Available A pile foundation is one of the most popular forms of deep foundations. They are routinely employed to transfer axial structure loads through the soft soil to stronger bearing strata. Piles generally used to increase the load carrying capacity of the foundation and reduce the settlement of the foundation. On the other hand, many cases in practice where piles pass through different layers of soil that contain weak layers located at different depths and extension, also some time cavities with a different shape, size, and depth are found. In this study, a total of 96 cases is considered and simulated in PLAXIS 2D program aiming to understand the influence of weak soil on the ultimate pile capacity. The piles embedded in the dense sand with a layer of weak soil at different extension and location. The cross section of the geometry used in this study was designed as an axisymmetric model with the 15-node element; the boundary condition recommended at least 5D in the horizontal direction, and (L+5D in the vertical direction where D and L are the diameter and length of pile, respectively. The soil is modeled as Mohr-Coulomb, with five input parameters and the behavior of pile material represented by the linear elastic model. The results of the above cases are compared with the results found in a pile embedded in dense soil without weak layers or cavities. The results indicated that the existence of weak soil layer within the surrounding soil around the pile decreases the ultimate capacity. Furthermore, it has been found that increase in the weak soil width (extension leads to reduction in the ultimate capacity of the pile. This phenomenon is applicable to all depth of weak soil. The influence of weak layer extension on the ultimate capacity is less when it is presentin the upper soil layers.

  20. Ultimate survival in anomalous ψ(2S) decays

    International Nuclear Information System (INIS)

    Gérard, Jean-Marc; Martini, Antony


    The hierarchy among the radiative γ(π 0 ,η,η ′ ) decay channels for the ψ ′ looks quite different from the J/ψ one. The fate of charm, namely an ultimate survival of on-shell cc ¯ intermediate states, might give us the clue for this new puzzle in exclusive charmonium decays. A similar self-preservation has already been invoked in the past to solve the so-called ρπ puzzle.

  1. Hydrogeological problems in the ultimate storage of radioactive wastes

    International Nuclear Information System (INIS)

    Uerpmann, E.P.


    The following work shows how one can achieve the safe closure of ultimate-stored radioactive wastes by connecting a series of various barriers to the biosphere. The propagation of radionuclides by ground water is considered to be the most important long-term transport mechanism. Salt occurences in the Federal Republic of Germany are considered to be the best form suitable for end storage formations for known reasons. When not observing mining and hydrogeological knowledge, the danger of uncontrollable water flow in the end storage can arise from the water solubility of the salt rocks. Therefore the filling of salt mines and the subsequent procedures are dealt with in detail. The leading of radioactive nuclides is influenced by the properties of the ultimately stored wastes and by the quality of the remaining filling of the caves. These problems are dealt with in detail. A series of barriers to the closure of the underground caves are suggested and discussed. The most important barriers consist of the stability of the corresponding selected end storage structure. Possible arrangements of the storage cave are given which even after storage must maintain a high stability. Proposals are made on how the ultimately stored wastes can protect themselves against contact with free water or salt solutions. (orig.) [de

  2. Ultimate concerns in late modernity: Archer, Bourdieu and reflexivity. (United States)

    Farrugia, David; Woodman, Dan


    Through a critique of Margaret Archer's theory of reflexivity, this paper explores the theoretical contribution of a Bourdieusian sociology of the subject for understanding social change. Archer's theory of reflexivity holds that conscious 'internal conversations' are the motor of society, central both to human subjectivity and to the 'reflexive imperative' of late modernity. This is established through critiques of Bourdieu, who is held to erase creativity and meaningful personal investments from subjectivity, and late modernity is depicted as a time when a 'situational logic of opportunity' renders embodied dispositions and the reproduction of symbolic advantages obsolete. Maintaining Archer's focus on 'ultimate concerns' in a context of social change, this paper argues that her theory of reflexivity is established through a narrow misreading and rejection of Bourdieu's work, which ultimately creates problems for her own approach. Archer's rejection of any pre-reflexive dimensions to subjectivity and social action leaves her unable to sociologically explain the genesis of 'ultimate concerns', and creates an empirically dubious narrative of the consequences of social change. Through a focus on Archer's concept of 'fractured reflexivity', the paper explores the theoretical necessity of habitus and illusio for understanding the social changes that Archer is grappling with. In late modernity, reflexivity is valorized just as the conditions for its successful operation are increasingly foreclosed, creating 'fractured reflexivity' emblematic of the complex contemporary interaction between habitus, illusio, and accelerating social change. © London School of Economics and Political Science 2015.

  3. Skill qualifications in pediatric minimally invasive surgery. (United States)

    Iwanaka, Tadashi; Morikawa, Yasuhide; Yamataka, Atsuyuki; Nio, Masaki; Segawa, Osamu; Kawashima, Hiroshi; Sato, Masahito; Terakura, Hirotsugu; Take, Hiroshi; Hirose, Ryuichiro; Yagi, Makoto


    In 2006, The Japanese Society of Pediatric Endoscopic Surgeons devised a plan to develop a pediatric endoscopic surgical skill qualification (ESSQ) system. This system is controlled by The Japan Society for Endoscopic Surgery. The standard requirement for skills qualification is the ability of each applicant to complete common types of laparoscopic surgery. The main goal of the system is to decrease complications of laparoscopic surgery by evaluating the surgical skills of each applicant and subsequently certify surgeons with adequate skills to perform laparoscopic operations safely. A committee of pediatric ESSQ created a checklist to assess the applicant's laparoscopic surgical skills. Skills are assessed in a double-blinded fashion by evaluating an unedited video recording of a fundoplication for pediatric gastroesophageal reflux disease. The initial pediatric ESSQ system was started in 2008. In 2008 and 2009, respectively, 9 out of 17 (53%) and 6 out of 12 (50%) applicants were certified as expert pediatric laparoscopic surgeons. Our ultimate goal is to provide safe and appropriate pediatric minimally invasive procedures and to avoid severe complications. To prove the predictive validity of this system, a survey of the outcomes of operations performed by certified pediatric surgeons is required.



    Krishna; Chandrashekar; Anuroopa; Senthil; Syed; Sandeep S; Kumuda; Ashwini


    The efficacy of periodontal surgery in the treatment of periodontal diseases not yet been systematically evaluated. The objective of this review was to systematically evaluate the efficacy of periodontal surgical procedures in the various treatment modalities. Periodontal disease is multifaceted in nature and scope. The problems created due to this inflammatory condition are different eg. gingival enlargement, osseous deformities, mucogingival problem which ultimately may ...

  5. About Hand Surgery (United States)

    ... Find a hand surgeon near you. © 2009 American Society for Surgery of the Hand. Definition developed by ASSH Council. Other Links CME Mission Statement and Disclaimer Policies and Technical Requirements Exhibits and Partners ASSH 822 W. Washington Blvd. ... 2018 by American Society for Surgery of the Hand × Search Tips Tip ...

  6. Hand Surgery: Anesthesia (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Hand Surgery Anesthesia Email to a friend * required ...

  7. Rapid population growth and environmental degradation: ultimate versus proximate factors. (United States)

    Shaw, R P


    This philosophical review of 2 arguments about responsibility for and solutions to environmental degradation concludes that both sides are correct: the ultimate and the proximal causes. Ultimate causes of pollution are defined as the technology responsible for a given type of pollution, such as burning fossil fuel; proximate causes are defined as situation-specific factors confounding the problem, such as population density or rate of growth. Commoner and others argue that developed countries with low or negative population growth rates are responsible for 80% of world pollution, primarily in polluting technologies such as automobiles, power generation, plastics, pesticides, toxic wastes, garbage, warfaring, and nuclear weapons wastes. Distortionary policies also contribute; examples are agricultural trade protection, land mismanagement, urban bias in expenditures, and institutional rigidity., Poor nations are responsible for very little pollution because poverty allows little waste or expenditures for polluting, synthetic technologies. The proximal causes of pollution include numbers and rate of growth of populations responsible for the pollution. Since change in the ultimate cause of pollution remains out of reach, altering the numbers of polluters can make a difference. Predictions are made for proportions of the world's total waste production, assuming current 1.6 tons/capita for developed countries and 0.17 tons/capita for developing countries. If developing countries grow at current rates and become more wealthy, they will be emitting half the world's waste by 2025. ON the other hand, unsustainable population growth goes along with inadequate investment in human capital: education, health, employment, infrastructure. The solution is to improve farming technologies in the 117 non-self-sufficient countries, fund development in the most unsustainable enclaves of growing countries, break institutionalized socio-political rigidity in these enclaves, and focus on

  8. Methodology for predicting ultimate pressure capacity of the ACR-1000 containment structure

    International Nuclear Information System (INIS)

    Saudy, A.M.; Awad, A.; Elgohary, M.


    The Advanced CANDU Reactor or the ACR-1000 is developed by Atomic Energy of Canada Limited (AECL) to be the next step in the evolution of the CANDU product line. It is based on the proven CANDU technology and incorporates advanced design technologies. The ACR containment structure is an essential element of the overall defense in depth approach to reactor safety, and is a physical barrier against the release of radioactive material to the environment. Therefore, it is important to provide a robust design with an adequate margin of safety. One of the key design requirements of the ACR containment structure is to have an ultimate pressure capacity that is at least twice the design pressure Using standard design codes, the containment structure is expected to behave elastically at least up to 1.5 times the design pressure. Beyond this pressure level, the concrete containment structure with reinforcements and post-tension tendons behaves in a highly non-linear manner and exhibits a complex response when cracks initiate and propagate. To predict the structural non-linear responses, at least two critical features are involved. These are: the structural idealization by the geometry and material property models, and the adopted solution algorithm. Therefore, detailed idealization of the concrete structure is needed in order to accurately predict its ultimate pressure capacity. This paper summarizes the analysis methodology to be carried out to establish the ultimate pressure capacity of the ACR containment structure and to confirm that the structure meets the specified design requirements. (author)

  9. Adobe Photoshop CS5 for Photographers The Ultimate Workshop

    CERN Document Server

    Evening, Martin


    If you already have a good knowledge of Adobe Photoshop and are looking to advance your skills, Adobe Photoshop CS5 for Photographers: The Ultimate Workshop is the book you've been waiting for.  Renowned photographers Martin Evening and Jeff Schewe impart their Photoshop tips and workflow, showing you how to use a vast array of rarely seen advanced Photoshop techniques.  Whether the subject is serious retouching work, weird and wonderful compositions, or planning a shoot before you've even picked up a camera, you can be sure that the advice is based on years of practical experience.

  10. Ultimate survival in anomalous ψ(2S) decays

    Energy Technology Data Exchange (ETDEWEB)

    Gérard, Jean-Marc; Martini, Antony


    The hierarchy among the radiative γ(π{sup 0},η,η{sup ′}) decay channels for the ψ{sup ′} looks quite different from the J/ψ one. The fate of charm, namely an ultimate survival of on-shell cc{sup ¯} intermediate states, might give us the clue for this new puzzle in exclusive charmonium decays. A similar self-preservation has already been invoked in the past to solve the so-called ρπ puzzle.

  11. Determination of Ultimate Torque for Multiply Connected Cross Section Rod

    Directory of Open Access Journals (Sweden)

    V. L. Danilov


    Full Text Available The aim of this work is to determine load-carrying capability of the multiply cross-section rod. This calculation is based on the model of the ideal plasticity of the material, so that the desired ultimate torque is a torque at which the entire cross section goes into a plastic state.The article discusses the cylindrical multiply cross-section rod. To satisfy the equilibrium equation and the condition of plasticity simultaneously, two stress function Ф and φ are introduced. By mathematical transformations it has been proved that Ф is constant along the path, and a formula to find its values on the contours has been obtained. The paper also presents the rationale of the line of stress discontinuity and obtained relationships, which allow us to derive the equations break lines for simple interaction of neighboring circuits, such as two lines, straight lines and circles, circles and a different sign of the curvature.After substitution into the boundary condition at the end of the stress function Ф and mathematical transformations a formula is obtained to determine the ultimate torque for the multiply cross-section rod.Using the doubly connected cross-section and three-connected cross-section rods as an example the application of the formula of ultimate torque is studied.For doubly connected cross-section rod, the paper offers a formula of the torque versus the radius of the rod, the aperture radius and the distance between their centers. It also clearly demonstrates the torque dependence both on the ratio of the radii and on the displacement of hole. It is shown that the value of the torque is more influenced by the displacement of hole, rather than by the ratio of the radii.For the three-connected cross-section rod the paper shows the integration feature that consists in selection of a coordinate system. As an example, the ultimate torque is found by two methods: analytical one and 3D modeling. The method of 3D modeling is based on the Nadai

  12. Classification of radioactive waste and determination of waste specifications as well as conditions of acceptance for ultimate storage

    International Nuclear Information System (INIS)

    Merz, E.


    The determination of waste specification and conditions of acceptance must follow a certain scheme, the basics of which will be presented. First the types of waste and the ultimate storage facilities will be characterized. The various categories of waste will be listed in a universally valid system, and the preliminary conditioning options will be determined. Based on the results of safety analysis taking into account the whole system - geological circumstances, ultimate store mines, types and forms of waste - specifications for the various ultimate store products are to be derived following iterative methods. Suggestions though not of a binding nature and probably subject to eventual revisions in part will be presented. To ensure the safety goals, i.e. the exclusion of radioactivity from the human biosphere, appropriate quality control is required concerning the production and the acceptance at the ultimate store. The guiding principles to be heeded will be discussed in brief. (orig./HP) [de

  13. Ultimate Limit State Model Basis for Assessment of Offshore Wind Energy Converters

    DEFF Research Database (Denmark)

    Thöns, Sebastian; Faber, M. H.; Rücker, W.


    then in combina-tion with the ultimate limit state requirements leads to the specific constitutive relations. As a result finite element models based on shell elements incorporating a structural and a loading model are introduced and described in detail. Applying these models the ultimate capacity of the support...... on the basis of literature review and measurement data from a prototype Multibrid M5000 support structure. In combination with the developed structural and loading models, sensitivity analyses in regard to the responses are peiformed to enhance the understanding and to refine the developed models. To this end...... variables on the responses including nonlinearity the refinement of the model is performed on a quantitative basis....

  14. 75 FR 60133 - Agency Information Collection Activities: Declaration of Ultimate Consignee That Articles Were... (United States)


    ... Activities: Declaration of Ultimate Consignee That Articles Were Exported for Temporary Scientific or... the Declaration of Ultimate Consignee That Articles Were Exported for Temporary Scientific or...: Title: Declaration of Ultimate Consignee That Articles Were Exported for Temporary Scientific or...

  15. The ultimate security bounds of quantum key distribution protocols

    International Nuclear Information System (INIS)

    Nikolopoulos, G.M.; Alber, G.


    Full text: Quantum key distribution (QKD) protocols exploit quantum correlations in order to establish a secure key between two legitimate users. Recent work on QKD has revealed a remarkable link between quantum and secret correlations. In this talk we report on recent results concerning the ultimate upper security bounds of various QKD schemes (i.e., the maximal disturbance up to which the two legitimate users share quantum correlations) under the assumption of general coherent attacks. In particular, we derive an analytic expression for the ultimate upper security bound of QKD schemes that use two mutually unbiased bases. As long as the two legitimate users focus on the sifted key and treat each pair of data independently during the post processing, our results are valid for arbitrary dimensions of the information carriers. The bound we have derived is well below the predictions of optimal cloning machines. The possibility of extraction of a secret key beyond entanglement distillation is also discussed. In the case of qutrits we argue that any eavesdropping strategy is equivalent to a symmetric one. For higher dimensions, however, such equivalence is generally no longer valid. (author)

  16. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... surgery. It is important to understand that your treatment, which will probably include orthodontics before and after ... to realistically estimate the time required for your treatment. Correction of Common Dentofacial Deformities ​ ​ The information provided ...

  17. Aids and Surgery

    African Journals Online (AJOL)



    Dec 2, 2004 ... HIV/AIDS patients require surgery sometimes during their illness. The objective of the ... risks to surgical equipes and analysing preventive strategies to HIV ... of Atlanta, and after an assessment of the performance status and ...

  18. Laparoscopic Spine Surgery (United States)

    ... the frontal approach takes advantage of normal tissue planes and does not require removal of any bone. ... to the “open” procedure may include: Obesity A history of prior abdominal surgery causing dense scar tissue ...

  19. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  20. Review and evaluation of information on the thermal performance of ultimate heat sinks: spray ponds and cooling ponds

    International Nuclear Information System (INIS)

    Drake, R.L.


    A report is presented which identifies and evaluates available information and data useful in validating and improving existing models for the thermal performance of ultimate heat sinks. Included are discussions of the thermal elements of cooling ponds and spray ponds, the available information and data pertinent to the problem, and the requirements and needs for further research and performance data. An outline is presented of the necessary elements required for a performance test of an ultimate heat sink before the system is thermally approved. (auth)

  1. On the ultimate uncertainty of the top quark pole mass

    Energy Technology Data Exchange (ETDEWEB)

    Beneke, M. [Technische Univ. Muenchen, Garching (Germany). Physik-Department; Marquard, P. [Deutsches Elektronen-Synchrotron (DESY), Zeuthen (Germany); Nason, P. [INFN, Sezione di Milano Bicocca (Italy); Steinhauser, M. [Karlsruher Institut fuer Technologie (Germany). Inst. fuer Theoretische Teilchenphysik


    We combine the known asymptotic behaviour of the QCD perturbation series expansion, which relates the pole mass of a heavy quark to the MS mass, with the exact series coefficients up to the four-loop order to determine the ultimate uncertainty of the top-quark pole mass due to the renormalon divergence. We perform extensive tests of our procedure by varying the number of colours and flavours, as well as the scale of the strong coupling and the MS mass, and conclude that this uncertainty is around 70 MeV. We further estimate the additional contribution to the mass relation from the five-loop correction and beyond to be 250 MeV.

  2. On the ultimate uncertainty of the top quark pole mass

    International Nuclear Information System (INIS)

    Beneke, M.; Nason, P.; Steinhauser, M.


    We combine the known asymptotic behaviour of the QCD perturbation series expansion, which relates the pole mass of a heavy quark to the MS mass, with the exact series coefficients up to the four-loop order to determine the ultimate uncertainty of the top-quark pole mass due to the renormalon divergence. We perform extensive tests of our procedure by varying the number of colours and flavours, as well as the scale of the strong coupling and the MS mass, and conclude that this uncertainty is around 70 MeV. We further estimate the additional contribution to the mass relation from the five-loop correction and beyond to be 250 MeV.

  3. On the ultimate uncertainty of the top quark pole mass (United States)

    Beneke, M.; Marquard, P.; Nason, P.; Steinhauser, M.


    We combine the known asymptotic behaviour of the QCD perturbation series expansion, which relates the pole mass of a heavy quark to the MS ‾ mass, with the exact series coefficients up to the four-loop order to determine the ultimate uncertainty of the top-quark pole mass due to the renormalon divergence. We perform extensive tests of our procedure by varying the number of colours and flavours, as well as the scale of the strong coupling and the MS ‾ mass. Including an estimate of the internal bottom and charm quark mass effect, we conclude that this uncertainty is around 110 MeV. We further estimate the additional contribution to the mass relation from the five-loop correction and beyond to be around 300 MeV.

  4. Multiple (Two) Met Bel 601 In Series Ultimate Vacuum Testing

    Energy Technology Data Exchange (ETDEWEB)

    Restivo, M. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)


    SRNL Environmental and Chemical Process Technology (E&CPT) was requested to perform testing of vacuum pumps per a verbal request from the Customer, SRNL Hydrogen Processing Technology. Tritium Operations is currently having difficulties procuring the Normetex™® Model 15 m3/hr (9 CFM) vacuum pump (formerly Normetex Pompes, now EumecaSARL). One possible solution proposed by Hydrogen Processing Technology personnel is to use two Senior Aerospace Metal Bellows MB-601 vacuum pumps piped with the heads in series, and the pumps in series (Figure 1 below). This memorandum documents the ultimate vacuum testing that was performed to determine if this concept was a viable alternate vacuum pump strategy. This testing dovetails with previous pump evaluations documented in references 1 and 2.

  5. Ultimate Drivers and Proximate Correlates of Polyandry in Predatory Mites.

    Directory of Open Access Journals (Sweden)

    Peter Schausberger

    Full Text Available Polyandry is more widespread than anticipated from Bateman's principle but its ultimate (evolutionary causes and proximate (mechanistic correlates are more difficult to pinpoint than those of polygyny. Here, we combined mating experiments, quantification of reproductive traits and microsatellite genotyping to determine the fitness implications of polyandry in two predatory mite species, where males are highly polygynous (up to 45 fertilized females during life, whereas females range from monandry to various polyandry levels. The medium-level polyandrous (up to eight male mates possible Neoseiulus californicus received clear direct and indirect benefits: multiply mated females produced more offspring with higher survival chances over longer times than singly mated females. In contrast, singly and multiply mated females of the low-level polyandrous (commonly two male mates at maximum Phytoseiulus persimilis produced similar numbers of offspring having similar survival chances. In both species, multiple mating resulted in mixed offspring paternities, opening the chance for indirect fitness benefits such as enhanced genetic compatibility, complementarity and/or variability. However, the female re-mating likelihood and the paternity chance of non-first male mates were lower in P. persimilis than in N. californicus. Regarding proximate factors, in both species first mating duration and female re-mating likelihood were negatively correlated. Based on occasional fertilization failure of first male mates in P. persimilis, and mixed offspring paternities in both species, we argue that fertilization assurance and the chance to gain indirect fitness benefits are the ultimate drivers of polyandry in P. persimilis, whereas those of N. californicus are higher offspring numbers coupled with enhanced offspring viability and possibly other indirect fitness benefits. Overall, the adaptive significance and proximate events well reflected the polyandry levels. Our

  6. Ultimate Drivers and Proximate Correlates of Polyandry in Predatory Mites. (United States)

    Schausberger, Peter; Patiño-Ruiz, J David; Osakabe, Masahiro; Murata, Yasumasa; Sugimoto, Naoya; Uesugi, Ryuji; Walzer, Andreas


    Polyandry is more widespread than anticipated from Bateman's principle but its ultimate (evolutionary) causes and proximate (mechanistic) correlates are more difficult to pinpoint than those of polygyny. Here, we combined mating experiments, quantification of reproductive traits and microsatellite genotyping to determine the fitness implications of polyandry in two predatory mite species, where males are highly polygynous (up to 45 fertilized females during life), whereas females range from monandry to various polyandry levels. The medium-level polyandrous (up to eight male mates possible) Neoseiulus californicus received clear direct and indirect benefits: multiply mated females produced more offspring with higher survival chances over longer times than singly mated females. In contrast, singly and multiply mated females of the low-level polyandrous (commonly two male mates at maximum) Phytoseiulus persimilis produced similar numbers of offspring having similar survival chances. In both species, multiple mating resulted in mixed offspring paternities, opening the chance for indirect fitness benefits such as enhanced genetic compatibility, complementarity and/or variability. However, the female re-mating likelihood and the paternity chance of non-first male mates were lower in P. persimilis than in N. californicus. Regarding proximate factors, in both species first mating duration and female re-mating likelihood were negatively correlated. Based on occasional fertilization failure of first male mates in P. persimilis, and mixed offspring paternities in both species, we argue that fertilization assurance and the chance to gain indirect fitness benefits are the ultimate drivers of polyandry in P. persimilis, whereas those of N. californicus are higher offspring numbers coupled with enhanced offspring viability and possibly other indirect fitness benefits. Overall, the adaptive significance and proximate events well reflected the polyandry levels. Our study provides a

  7. Chapter 12: Surgery for sinonasal disease. (United States)

    Higgins, Thomas S; Lane, Andrew P


    Surgery for chronic rhinosinusitis is an effective complement to a well-designed medical regimen. Functional endoscopic sinus surgery is among the most common surgeries performed for sinonasal disease refractory to maximal medical therapy. Nasal surgery techniques, such as septoplasty and inferior turbinate surgery, may assist in both relieving the symptom of nasal obstruction and providing access for sinus surgery. Although rare, open sinus techniques are occasionally required.

  8. Robotic surgery (United States)

    ... with this type of surgery give it some advantages over standard endoscopic techniques. The surgeon can make ... Elsevier Saunders; 2015:chap 87. Muller CL, Fried GM. Emerging technology in surgery: Informatics, electronics, robotics. In: ...

  9. Nose Surgery (United States)

    ... Patient Health Home Copyright © 2018 American Academy of Otolaryngology–Head and Neck Surgery. Reproduction or republication strictly ... Terms of Use © Copyright 2018. American Academy of Otolaryngology — Head and Neck Surgery 1650 Diagonal Rd Alexandria, ...

  10. After Surgery (United States)

    ... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

  11. Thyroid Surgery (United States)

    ... Hypothyroidism in Children and Adolescents Pediatric Differentiated Thyroid Cancer Thyroid Nodules in Children and Adolescents Thyroid Surgery Resources Thyroid Surgery Brochure PDF Thyroid Surgery FAQs PDF En Español Cirugia De La Tiroides El folleto de Cirugia De La Tiroides Search Thyroid ...

  12. Future Synchrotron Light Sources Based on Ultimate Storage Rings

    International Nuclear Information System (INIS)

    Cai, Yunhai


    The main purpose of this talk is to describe how far one might push the state of the art in storage ring design. The talk will start with an overview of the latest developments and advances in the design of synchrotron light sources based on the concept of an 'ultimate' storage ring. The review will establish how bright a ring based light source might be, where the frontier of technological challenges are, and what the limits of accelerator physics are. Emphasis will be given to possible improvements in accelerator design and developments in technology toward the goal of achieving an ultimate storage ring. An ultimate storage ring (USR), defined as an electron ring-based light source having an emittance in both transverse planes at the diffraction limit for the range of X-ray wavelengths of interest for a scientific community, would provide very high brightness photons having high transverse coherence that would extend the capabilities of X-ray imaging and probe techniques beyond today's performance. It would be a cost-effective, high-coherence 4th generation light source, competitive with one based on energy recovery linac (ERL) technology, serving a large number of users studying material, chemical, and biological sciences. Furthermore, because of the experience accumulated over many decades of ring operation, it would have the great advantage of stability and reliability. In this paper we consider the design of an USR having 10-pm-rad emittance. It is a tremendous challenge to design a storage ring having such an extremely low emittance, a factor of 100 smaller than those in existing light sources, especially such that it has adequate dynamic aperture and beam lifetime. In many ultra-low emittance designs, the injection acceptances are not large enough for accumulation of the electron beam, necessitating on-axis injection where stored electron bunches are completely replaced with newly injected ones. Recently, starting with the MAX-IV 7-bend achromatic cell, we

  13. Future Synchrotron Light Sources Based on Ultimate Storage Rings

    Energy Technology Data Exchange (ETDEWEB)

    Cai, Yunhai; /SLAC


    The main purpose of this talk is to describe how far one might push the state of the art in storage ring design. The talk will start with an overview of the latest developments and advances in the design of synchrotron light sources based on the concept of an 'ultimate' storage ring. The review will establish how bright a ring based light source might be, where the frontier of technological challenges are, and what the limits of accelerator physics are. Emphasis will be given to possible improvements in accelerator design and developments in technology toward the goal of achieving an ultimate storage ring. An ultimate storage ring (USR), defined as an electron ring-based light source having an emittance in both transverse planes at the diffraction limit for the range of X-ray wavelengths of interest for a scientific community, would provide very high brightness photons having high transverse coherence that would extend the capabilities of X-ray imaging and probe techniques beyond today's performance. It would be a cost-effective, high-coherence 4th generation light source, competitive with one based on energy recovery linac (ERL) technology, serving a large number of users studying material, chemical, and biological sciences. Furthermore, because of the experience accumulated over many decades of ring operation, it would have the great advantage of stability and reliability. In this paper we consider the design of an USR having 10-pm-rad emittance. It is a tremendous challenge to design a storage ring having such an extremely low emittance, a factor of 100 smaller than those in existing light sources, especially such that it has adequate dynamic aperture and beam lifetime. In many ultra-low emittance designs, the injection acceptances are not large enough for accumulation of the electron beam, necessitating on-axis injection where stored electron bunches are completely replaced with newly injected ones. Recently, starting with the MAX-IV 7-bend

  14. Concept for an ultimate storage facility for heat-generating radioactive waste in clay stone in Germany

    International Nuclear Information System (INIS)

    Bollingerfehr, Wilhelm; Poehler, Matthias


    According to the German reference ultimate storage concept heat-generating radioactive waste from the operation of nuclear power stations should be stored permanently maintenance-free and in a non-recoverable manner in a salt formation. Within the framework of investigations into the utilisation of alternative host rocks a concept for an ultimate storage facility in clay stone was developed in an R and D project. For this purpose all important aspects of the design, development, operation and shutdown were taken into account for a model region in northern Germany. It was established that storage in 50 m deep vertical boreholes in a mine at a depth of about 350 m appears to be the most practical solution for an ultimate storage facility in clay stone. Compared to the reference concept in salt an ultimate storage facility in clay stone requires solid support of all mine openings with steel arches or shotcrete. Because of the lower maximum permissible temperature in the backfilling material (bentonite) the area required for the ultimate storage facility is about five times larger. A period of more than 100 years is estimated from survey to shutdown. (orig.)

  15. Efficiency Of Different Teaching Models In Teaching Of Frisbee Ultimate

    Directory of Open Access Journals (Sweden)

    Žuffová Zuzana


    Full Text Available The aim of the study was to verify the efficiency of two frisbee ultimate teaching models at 8-year grammar schools relative to age. In the experimental group was used a game based model (Teaching Games for Understanding and in the control group the traditional model based on teaching techniques. 6 groups of female students took part in experiment: experimental group 1 (n=10, age=11.6, experimental group 2 (n=12, age=13.8, experimental group 3 (n=14, age =15.8, control group 1 (n=11, age =11.7, control group 2 (n=10, age =13.8 and control group 3 (n=9, age =15.8. Efficiency of the teaching models was evaluated based of game performance and special knowledge results. Game performance was evaluated by the method of game performance assessment based on GPAI (Game Performance Assessment Instrument through video record. To verify level of knowledge, we used a knowledge test, which consisted of questions related to the rules and tactics knowledge of frisbee ultimate. To perform statistical evaluation Mann-Whitney U-test was used. Game performance assessment and knowledge level indicated higher efficiency of TGfU in general, but mostly statistically insignificant. Experimental groups 1 and 2 were significantly better in the indicator that evaluates tactical aspect of game performance - decision making (p<0.05. Experimental group 3 was better in the indicator that evaluates skill execution - disc catching. The results showed that the students of the classes taught by game based model reached partially better game performance in general. Experimental groups achieved from 79.17 % to 80 % of correct answers relating to the rules and from 75 % to 87.5 % of correct answers relating to the tactical knowledge in the knowledge test. Control groups achieved from 57.69 % to 72.22 % of correct answers relating to the rules and from 51.92 % to 72.22 % of correct answers relating to the tactical knowledge in the knowledge test.

  16. Process Inherent Ultimate Safety (PIUS) reactor evaluation study: Final report

    International Nuclear Information System (INIS)


    This report presents the results of an independent study by United Engineers and Constructors (UNITED) of the SECURE-P Process Inherent Ultimate Safety (PIUS) Reactor Concept which is presently under development by the Swedish light water reactor vendor ASEA-ATOM of Vasteras, Sweden. This study was performed to investigate whether there is any realistic basis for believing that the PIUS reactor could be a viable competitor in the US energy market in the future. Assessments were limited to the technical, economic and licensing aspects of PIUS. Socio-political issues, while certainly important in answering this question, are so broad and elusive that it was considered that addressing them with the limited perspective of one small group from one company would be of questionable value and likely be misleading. Socio-political issues aside, the key issue is economics. For this reason, the specific objectives of this study were to determine if the estimated PIUS plant cost will be competitive in the US market and to identify and evaluate the technical and licensing risks that might make PIUS uneconomical or otherwise unacceptable

  17. ZIO: The Ultimate Linux I/O Framework

    CERN Document Server

    Gonzalez Cobas, J D; Rubini, A; Nellaga, S; Vaga, F


    ZIO (with Z standing for “The Ultimate I/O” Framework) was developed for CERN with the specific needs of physics labs in mind, which are poorly addressed in the mainstream Linux kernel. ZIO provides a framework for industrial, high-bandwith, high-channel count I/O device drivers (digitizers, function generators, timing devices like TDCs) with performance, generality and scalability as design goals. Among its features, it offers abstractions for • both input and output channels, and channel sets • run-time selection of trigger types • run-time selection of buffer types • sysfs-based configuration • char devices for data and metadata • a socket interface (PF ZIO) as alternative to char devices In this paper, we discuss the design and implementation of ZIO, and describe representative cases of driver development for typical and exotic applications: drivers for the FMC (FPGAMezzanine Card, see [1]) boards developed at CERN like the FMC ADC 100Msps digitizer, FMC TDC timestamp counter, and FMC DEL ...

  18. Episodic foresight and anxiety: Proximate and ultimate perspectives. (United States)

    Miloyan, Beyon; Bulley, Adam; Suddendorf, Thomas


    In this paper, we examine the relationship between episodic foresight and anxiety from an evolutionary perspective, proposing that together they confer an advantage for modifying present moment decision-making and behaviour in the light of potential future threats to fitness. We review the body of literature on the role of episodic foresight in anxiety, from both proximate and ultimate perspectives. We propose that anxious feelings associated with episodic simulation of possible threat-related future events serve to imbue these simulations with motivational currency. Episodic and semantic details of a future threat may be insufficient for motivating its avoidance, but anxiety associated with a simulation can provoke adaptive threat management. As such, we detail how anxiety triggered by a self-generated, threat-related future simulation prepares the individual to manage that threat (in terms of its likelihood and/or consequences) over greater temporal distances than observed in other animals. We then outline how anxiety subtypes may represent specific mechanisms for predicting and managing particular classes of fitness threats. This approach offers an inroad for understanding the nature of characteristic future thinking patterns in anxiety disorders and serves to illustrate the adaptive function of the mechanism from which clinical anxiety deviates. © 2015 The British Psychological Society.

  19. Yield, utilization, storage and ultimate storage of depleted uranium

    International Nuclear Information System (INIS)

    Aumueller, L.; Hermann, J.


    More than 80% of the uranium leaving uranium enrichment plants is depleted to a residual content of about 0,25% U 235. Due to the present ineconomical further depletion to the technically possible residual content of 0,1% U 235, the so-called 'tails' are first of all stored. The quantity of stored depleted uranium in the FRG should be about 100.000 t by the year 2000. It represents a strategic reserve for future energy supply regardless of profitableness. The study analysis the conceivable possible uses for the tails quantity considered. These are, besides further depletion whose profitableness is considered, also the use as breeder material in breeder reactors and the use in the non-nuclear field. The main part of the study deals with the various storage possibilities of the depleted uranium in oxidic or fluoride form. A comparison of costs of alternative storage concepts showed a clear advantage for the storage of UF 6 in 48 inch containers already in use. The conceivable accidents in storing are analyzed and measures to reduce the consequences are discussed. Finally, the problems of ultimate storage for the remaining waste after further depletion or use are investigated and the costs arising here are also estimated. (RB) [de

  20. Optimized molten salt receivers for ultimate trough solar fields (United States)

    Riffelmann, Klaus-J.; Richert, Timo; Kuckelkorn, Thomas


    Today parabolic trough collectors are the most successful concentrating solar power (CSP) technology. For the next development step new systems with increased operation temperature and new heat transfer fluids (HTF) are currently developed. Although the first power tower projects have successfully been realized, up to now there is no evidence of an all-dominant economic or technical advantage of power tower or parabolic trough. The development of parabolic trough technology towards higher performance and significant cost reduction have led to significant improvements in competitiveness. The use of molten salt instead of synthetic oil as heat transfer fluid will bring down the levelized costs of electricity (LCOE) even further while providing dispatchable energy with high capacity factors. FLABEG has developed the Ultimate TroughTM (UT) collector, jointly with sbp Sonne GmbH and supported by public funds. Due to its validated high optical accuracy, the collector is very suitable to operate efficiently at elevated temperatures up to 550 °C. SCHOTT will drive the key-innovations by introducing the 4th generation solar receiver that addresses the most significant performance and cost improvement measures. The new receivers have been completely redesigned to provide a product platform that is ready for high temperature operation up to 550 °C. Moreover distinct product features have been introduced to reduce costs and risks in solar field assembly and installation. The increased material and design challenges incurred with the high temperature operation have been reflected in sophisticated qualification and validation procedures.

  1. Accounting conservatism,ultimate ownership and investment efficiency

    Institute of Scientific and Technical Information of China (English)

    Xiaodong Xu; Xia Wang; Nina Han


    Purpose-The purpose of this paper is to analyze and examine the role of accounting conservatism on firm investment behavior in China.Design/methodology/approach-By combining a developed theoretical framework and empirical study,this paper examines the impacts of accounting conservatism on firm investment.The sample and data are all collected from Wind and CAMAR databases.Findings-The paper finds that the association between accounting conservatism and capital expenditure is significantly positive when inside capital is not enough to use for investment,suggesting that conservatism can expend the level of investment by decreasing information asymmetry and cost of capital;however,the association between accounting conservatism and capital expenditure is significantly negative when inside capital is enough to use for investment,suggesting that conservatism can curtail the level of investment by mitigating the interest conflicts between management and outside shareholders and decreasing agency costs.Additionally,the paper finds that the severity of information asymmetry and agency problem affects the role of accounting conservatism on firm investment behaviour,and the association between accounting conservatism and capital expenditure is weaker for firms with ultimate ownership controller as local government or individuals.Originality/value-This is the first paper to analyze and examine the impacts of accounting conservatism on firm investment in China directly.The findings are also useful to explain the awkward predicament found by prior literature.

  2. Ultimate storage of radioactive wastes annual report, 1973

    International Nuclear Information System (INIS)

    The present report is a cooperative effort by the Company for Radiation and Environmental Research, Munich, and the Company for Nuclear Research, Karlsruhe, and provides a survey of work carried out during 1973 in the area of ultimate storage of radioactive wastes. Mining and construction works which were carried out in the Asse Salt Mine near Remlingen both underground as well as above the ground and which were used for repair, maintenance and expansion of the operation consistent with its future tasks are reported. The storage of low-level wastes at the 750 m level and also the test-oriented storage of medium-level waste materials at the 490 m level were carried out within the reporting period. Shielded storage casks S7V developed by the GfK were used for the first time in September for transporting 200 l iron-hooped drums filled with medium-level radioactive wastes to Asse, each shipment always containing seven drums. With two round-trips a week taking place between the Nuclear Research Center, Karlsruhe and the Asse II shaft installation, 14 drums were brought each week so that, by the end of the year, the quantity in storage amounted to a total of 233 drums. Further information is provided concerning the present status of research work in the fields of oromechanics, geology and hydrology as well as other findings. Further, storage techniques are discussed which are presently in the planning stage

  3. Exploring Ultimate Water Capillary Evaporation in Nanoscale Conduits. (United States)

    Li, Yinxiao; Alibakhshi, Mohammad Amin; Zhao, Yihong; Duan, Chuanhua


    Capillary evaporation in nanoscale conduits is an efficient heat/mass transfer strategy that has been widely utilized by both nature and mankind. Despite its broad impact, the ultimate transport limits of capillary evaporation in nanoscale conduits, governed by the evaporation/condensation kinetics at the liquid-vapor interface, have remained poorly understood. Here we report experimental study of the kinetic limits of water capillary evaporation in two dimensional nanochannels using a novel hybrid channel design. Our results show that the kinetic-limited evaporation fluxes break down the limits predicated by the classical Hertz-Knudsen equation by an order of magnitude, reaching values up to 37.5 mm/s with corresponding heat fluxes up to 8500 W/cm 2 . The measured evaporation flux increases with decreasing channel height and relative humidity but decreases as the channel temperature decreases. Our findings have implications for further understanding evaporation at the nanoscale and developing capillary evaporation-based technologies for both energy- and bio-related applications.

  4. Robotics in reproductive surgery: strengths and limitations. (United States)

    Catenacci, M; Flyckt, R L; Falcone, T


    Minimally invasive surgical techniques are becoming increasingly common in gynecologic surgery. However, traditional laparoscopy can be challenging. A robotic surgical system gives several advantages over traditional laparoscopy and has been incorporated into reproductive gynecological surgeries. The objective of this article is to review recent publications on robotically-assisted laparoscopy for reproductive surgery. Recent clinical research supports robotic surgery as resulting in less post-operative pain, shorter hospital stays, faster return to normal activities, and decreased blood loss. Reproductive outcomes appear similar to alternative approaches. Drawbacks of robotic surgery include longer operating room times, the need for specialized training, and increased cost. Larger prospective studies comparing robotic approaches with laparoscopy and conventional open surgery have been initiated and information regarding long-term outcomes after robotic surgery will be important in determining the ultimate utility of these procedures. Copyright © 2011 Elsevier Ltd. All rights reserved.

  5. [Quality of publications in plastic surgery]. (United States)

    Mornet, O; Grolleau, J-L; Garrido, I; Bekara, F; Herlin, C; Chaput, B


    The objective of this study is to describe plastic surgery publications in terms of methodology, level of evidence, approval by institutional review board, method of consent, and subspecialty. The 8 top-ranked plastic surgery journals were selected. We manually reviewed the last 40 original articles in each plastic surgery journal, to represent more than 2 months of publications for all journals (range: 3-17 months). Only clinical original articles on human subjects were included. Each article was read at least twice by two different reviewers to ensure accurate data transcription, and then graded by written criteria. One of the senior authors was asked to make a final decision in case of doubt. Among the articles reviewed, 320 were analyzed. The geographical origin of these publications were Asia (32.5%), Europe (30%), US (28.4%), South America (5.6%), Africa (2.5%), and finally Oceania (1%). Reconstructive surgery remains the specialty area most represented in the journals with almost half of the publications, followed by breast surgery (24%) and plastic surgery (19%). A total of 75.6% were retrospective studies. Nearly 80% of the studies were of low level of evidence. Only 3.5% were randomized trials. Less than 40% of the publications mentioned approval by an institutional committee, and 22.6% a patient's informed consent. This study aimed to analyze the quality of plastic surgery publications, taking into account the criteria of Evidence Based Medicine. This work showed that more than half of the studies did not mention an institutional review board approval (Ethics Committee), and that three quarter of the studies did not indicate the presence of patient's informed consent. Ultimately, over 80% of the studies were of low level of evidence. The top-ranked journals have already imposed guidelines corresponding to the methodology requirements to publish clinical studies in their pages, such as EQUATOR criteria for the PRS journal. Efforts are therefore to be done

  6. Assessing Fatigue and Ultimate Load Uncertainty in Floating Offshore Wind Turbines Due to Varying Simulation Length

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, G.; Lackner, M.; Haid, L.; Matha, D.; Jonkman, J.; Robertson, A.


    With the push towards siting wind turbines farther offshore due to higher wind quality and less visibility, floating offshore wind turbines, which can be located in deep water, are becoming an economically attractive option. The International Electrotechnical Commission's (IEC) 61400-3 design standard covers fixed-bottom offshore wind turbines, but there are a number of new research questions that need to be answered to modify these standards so that they are applicable to floating wind turbines. One issue is the appropriate simulation length needed for floating turbines. This paper will discuss the results from a study assessing the impact of simulation length on the ultimate and fatigue loads of the structure, and will address uncertainties associated with changing the simulation length for the analyzed floating platform. Recommendations of required simulation length based on load uncertainty will be made and compared to current simulation length requirements.

  7. Ultimate strength of a large wind turbine blade

    Energy Technology Data Exchange (ETDEWEB)

    Moelholt Jensen, Find


    of the profile, also called 'local deformations', to verify a more complex response than that of a Bernoulli-Euler Beam. A large number of mechanical displacement sensors and strain gauges were mounted inside and outside the structure. These measurements further proved highly useful when validating Finite Element based analysis and failure mechanisms should be decided. Finally, comparisons of the ultimate failure loads observed in the full-scale tests are presented and conclusions are drawn based on the mechanisms found. (au)

  8. Ultimate resistance of a reinforced concrete foundation under impulsive loading

    International Nuclear Information System (INIS)

    Aquaro, D.; Forasassi, G.; Marconi, M.


    The impact of a spent nuclear fuel cask against a reinforced concrete slab of a temporary repository for spent nuclear fuel is numerically analysed. The analysis considers accidental events in which a spent nuclear fuel cask would drop against the floor of a repository during lifting operations. Two types of solutions have been taken into account: a simple reinforced concrete structure and a structure provided with a 40 mm thick steel liner on the impacted surface, connected to a 1600 mm thick concrete bed. The model is assumed to be axisymmetric and positioned on an elastic ground (Winkler model). The concrete has been simulated as: elastic perfectly plastic under compressive stresses limited by a crushing strain; elastic linear under tensile stresses until a cracking stress value and a following decrease of stress characterized by a constant or variable softening modulus; limited ability to resist at shear stresses after cracking characterized by a shear retention factor. The steel of the reinforcement bars and of the cask has been simulated as an elastic perfectly plastic material. Several numerical simulations have been performed in order to determine the influence, on the ultimate resistance of the structure under examination, of the steel liner, of some characteristic parameters of concrete (as the softening module and the shear retention factor) and of the Winkler coefficient values, simulating the elastic behaviour of the ground. The obtained results demonstrate that a steel liner produces a lower stress in the concrete as well as in the reinforcement but the bed is still subjected to the cracking phenomenon throughout its entire width although the crushing is localized to only a few elements near the impact zone. The use of a more complex constitutive equation for the concrete considering the shear retention factor and the softening module has given results which do not differ greatly from those related to a more simplified model. A different degree of

  9. Parametric Study on Ultimate Failure Criteria of Elbow Piping Components in Seismically Isolated NPP

    Energy Technology Data Exchange (ETDEWEB)

    Hahm, Dae Gi; Ki, Min Kyu [KAERI, Daejeon (Korea, Republic of); Jeon, Bub Gyu; Kim, Nam Sik [Pusan National University, Busan (Korea, Republic of)


    It is well known that the interface pipes between isolated and non-isolated structures will become the most critical in the seismically isolated NPPs. Therefore, seismic performance of such interface pipes should be evaluated comprehensively especially in terms of the seismic fragility capacity. To evaluate the seismic capacity of interface pipes in the isolated NPP, firstly, we should define the failure mode and failure criteria of critical pipe components. Hence, in this study, we performed the dynamic tests of elbow components which were installed in a seismically isolated NPP, and evaluated the ultimate failure mode and failure criteria by using the test results. To do this, we manufactured 25 critical elbow component specimens and performed cyclic loading tests under the internal pressure condition. The failure mode and failure criteria of a pipe component will be varied by the design parameters such as the internal pressure, pipe diameter, loading type, and loading amplitude. From the tests, we assessed the effects of the variation parameters onto the failure criteria. For the tests, we generated the seismic input protocol of relative displacement between the ends of elbow component. In this paper, elbow in piping system was defined as a fragile element and numerical model was updated by component test. Failure mode of piping component under seismic load was defined by the dynamic tests of ultimate pipe capacity. For the interface piping system, the seismic capacity should be carefully estimated since that the required displacement absorption capacity will be increased significantly by the adoption of the seismic isolation system. In this study, the dynamic tests were performed for the elbow components which were installed in an actual NPPs, and the ultimate failure mode and failure criteria were also evaluated by using the test results.

  10. Ultimate storage of radioactive waste - geotechnical challenge or routine task?

    International Nuclear Information System (INIS)

    Alheid, H.J.


    Construction, operation and decommissioning of nuclear waste repositories require sophisticated design, high-tech technical implementation and reliable performance assessment studies. Geotechnical methods have been applied in many research projects and tailored to the high standards of nuclear waste disposal. Exemplary the development of methods for the characterization of excavation damaged zones (EDZ) is discussed in this paper. Well known geotechnical and geophysical methods have been adapted to fulfil the requirements of essential high resolution in space and the necessity of long term observations. The achieved improvements in measurement techniques and data processing allow to describe the properties of the EDZ in detail. Scientist have accepted the challenge and fulfilled the special requirements of measuring, monitoring and modelling in the field of nuclear waste disposal. The newly developed methods should be checked for their applicability to other geotechnical problems in order to achieve more detailed results than with standard methods. (orig.)

  11. Clinical implications of medulloblastoma subgroups: incidence of CSF diversion surgery. (United States)

    Schneider, Christian; Ramaswamy, Vijay; Kulkarni, Abhaya V; Rutka, James T; Remke, Marc; Tabori, Uri; Hawkins, Cynthia; Bouffet, Eric; Taylor, Michael D


    While medulloblastoma was initially thought to comprise a single homogeneous entity, it is now accepted that it in fact comprises 4 discrete subgroups, each with its own distinct demographics, clinical presentation, transcriptomics, genetics, and outcome. Hydrocephalus is a common complication of medulloblastoma and not infrequently requires CSF diversion. The authors report the incidence of CSF diversion surgery in each of the subgroups of medulloblastoma (Wnt, Shh, Group 3, and Group 4). The medical and imaging records for patients who underwent surgery for medulloblastoma at The Hospital for Sick Children were retrospectively reviewed. The primary outcome was the requirement for CSF diversion surgery either before or within 60 days of tumor resection. The modified Canadian Preoperative Prediction Rule for Hydrocephalus (mCPPRH) was compared among subgroups. Of 143 medulloblastoma patients, treated from 1991 to 2013, sufficient data were available for 130 patients (15 with Wnt, 30 with Shh, 30 with Group 3, and 55 with Group 4 medulloblastomas). Of these, 28 patients (22%) ultimately underwent CSF diversion surgery: 0% with Wnt, 29% with Shh, 29% with Group 3, and 43% with Group 4 tumors. Patients in the Wnt subgroup had a lower incidence of CSF diversion than all other patients combined (p = 0.04). Wnt patients had a lower mCPPRH score (lower risk of CSF diversion, p = 0.045), were older, had smaller ventricles at diagnosis, and had no leptomeningeal metastases. The overall rate of CSF diversion surgery for Shh, Group 3, and Group 4 medulloblastomas is around 30%, but no patients in the present series with a Wnt medulloblastoma required shunting. The low incidence of hydrocephalus in patients with Wnt medulloblastoma likely reflects both host factors (age) and disease factors (lack of metastases). The absence of hydrocephalus in patients with Wnt medulloblastomas likely contributes to their excellent rate of survival and may also contribute to a higher quality

  12. Patient Selection in Plastic Surgery: Recognizing Body Dysmorphic Disorder

    Directory of Open Access Journals (Sweden)

    Cihan Sahin


    Full Text Available Plastic surgery is a branch of medicine that provides significant improvements to the people with positive changes. But first of all, this branch has a characteristic which requires analysing patients' psychological situation very carefully. Plastic surgeons are often confronted by patients with mental disorders seeking aesthetic surgery. It is imperative for surgeons to recognize possible underlying psychiatric illnesses. Common psychiatric conditions seen in cosmetic surgery patients include body dysmorphic disorder (BDD, narcissistic personality disorder and histrionic personality disorders. BDD is of particular importance to plastic surgeons. Because outrageous dissatisfaction with one's appearance may conceal psychopathologic traits that are not always easily recognizable, and which, if neglected, may result in serious iatrogenic and medicolegal consequences, we hope that this paper will help plastic surgeons in ultimately preventing patient and surgeon dissatisfaction within the population of patients with psychiatric disorders, and should recognize the diagnostic features of body dysmorphic disorder and screen psychologically unstable patients who may never be satisfied with surgery. [Arch Clin Exp Surg 2013; 2(2.000: 109-115

  13. Sustainable production. The ultimate result of a continuous improvement

    NARCIS (Netherlands)

    Ron, de A.J.


    To fulfil market requirements, companies have introduced cost awareness, quality programs and techniques to become flexible. These items should be handled as a continuous process of improvement. The cost awareness implies that e.g. material waste is avoided during production, the quality programs

  14. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ...

  15. Application of risk-informed design methods to select the PSACS ultimate heat sink

    International Nuclear Information System (INIS)

    Elliott, Michael A.; Apostolakis, George E.


    In the early phases of advanced system design, information is scarce. The technologies, components and processes to be used have not been specified adequately or are not well understood and uncertainties are very large. Yet, it is during these early phases that design teams and other stakeholders are required to make critical decisions to guide the development of the system. To aid in this decision making, a formal process is proposed based on the Analytic-Deliberative Decision-Making Process (ADP) that allows stakeholders to synthesize rationally their knowledge and experience and facilitate learning and sharing of best practices. The ADP identifies and prioritizes attributes relevant to a decision problem and supports the formulation of metrics to measure the performance of different design options. This paper reports on an application of the ADP to the selection of an ultimate heat sink for the Flexible Conversion Ratio (FCR) reactor's Passive Secondary Auxiliary Cooling System (PSACS). Two ultimate heat sink options are identified and evaluated, air and water.


    African Journals Online (AJOL)

    in the endoscopy room. GENERAL SURGERY. T du Toit, O C Buchel, S J A Smit. Department of Surgery, University of the Free State, Bloemfontein, ... The lack of video instrumentation in developing countries: Redundant fibre-optic instruments (the old. “eye scope”) are still being used. This instrument brings endoscopists ...


    African Journals Online (AJOL)

    mean time to first surgery post burn was 11.5 days with a median volume of 0.73 mls/kg/% ..... Mode. Mean (SD). Upper limit. 95% CI. Lower limit. 95% CI. Mode. Elective surgery .... evaluating single-unit red blood cell transfusions in reducing.

  18. 78 FR 69101 - Agency Information Collection Activities: Declaration of the Ultimate Consignee That Articles... (United States)


    ... Activities: Declaration of the Ultimate Consignee That Articles Were Exported for Temporary Scientific or... the Declaration of the Ultimate Consignee that Articles were Exported for Temporary Scientific or...: Title: Declaration of the Ultimate Consignee that Articles were Exported for Temporary Scientific or...

  19. Art and Plastic Surgery. (United States)

    Fernandes, Julio Wilson; Metka, Susanne


    The roots of science and art of plastic surgery are very antique. Anatomy, drawing, painting, and sculpting have been very important to the surgery and medicine development over the centuries. Artistic skills besides shape, volume, and lines perception can be a practical aid to the plastic surgeons' daily work. An overview about the interactions between art and plastic surgery is presented, with a few applications to rhinoplasty, cleft lip, and other reconstructive plastic surgeries. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors

  20. Choosing surgery

    DEFF Research Database (Denmark)

    Thorstensson, Carina; Lohmander, L; Frobell, Richard


    -depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed......ABSTRACT: BACKGROUND: The objective was to understand patients' views of treatment after acute anterior cruciate ligament (ACL) injury, and their reasons for deciding to request surgery despite consenting to participate in a randomised controlled trial (to 'cross-over'). METHODS: Thirty-four in...... before surgery, and 11 were interviewed at least 6 months after surgery. To provide additional information, 12 patients were interviewed before randomisation. Interviews were audio-recorded, transcribed and analysed using the Framework approach. RESULTS: Strong preference for surgery was commonplace...

  1. Art and epilepsy surgery. (United States)

    Ladino, Lady Diana; Hunter, Gary; Téllez-Zenteno, José Francisco


    The impact of health and disease has led many artists to depict these themes for thousands of years. Specifically, epilepsy has been the subject of many famous works, likely because of the dramatic and misunderstood nature of the clinical presentation. It often evokes religious and even mythical processes. Epilepsy surgical treatment has revolutionized the care of selected patients and is a relatively recent advance. Epilepsy surgery has been depicted in very few artistic works. The first portrait showing a potential surgical treatment for patients with epilepsy was painted in the 12th century. During the Renaissance, Bosch famously provided artistic commentary on traditional beliefs in "The stone of madness". Several of these works demonstrate a surgeon extracting a stone from a patient's head, at one time believed to be the source of all "folly", including epileptic seizures, psychosis, intellectual disability, depression, and a variety of other illnesses. There are some contemporary art pieces including themes around epilepsy surgery, all of them depicting ancient Inca Empire procedures such as trepanning. This article reviews the most relevant artistic works related with epilepsy surgery and also its historical context at the time the work was produced. We also present a painting from the Mexican artist Eduardo Urbano Merino that represents the patient's journey through refractory epilepsy, investigations, and ultimately recovery. Through this work, the artist intends to communicate hope and reassurance to patients going through this difficult process. © 2013.

  2. BOOK REVIEW: Seeking Ultimates. An Intuitive Guide to Physics (United States)

    Brown, Neil


    Physics has the reputation of being a difficult and dry subject. Many books have been written in attempts to show that the difficulties are not insurmountable, even for the layman, and to convey some of the fascination it provides for those within it. In Seeking Ultimates Peter Landsberg avoids mathematics, the source of so many difficulties, entirely, and seeks to make physics comprehensible by what he terms intuition. He also emphasizes that there is almost no part of science that is completely understood; there are always areas of incompleteness and uncertainty, capable of providing exciting new results, and examples of this are highlighted throughout the book. After an introduction Landsberg starts with macroscopic phenomena for ease of understanding, though one might question whether the chosen topic of thermodynamics is ever going to be easy. Next he looks at microscopic effects, from atomic structure to the fundamental particles of the standard model and their interactions. There follow chapters on time and entropy, on chaos theory, on quantum mechanics and then cosmology. The final chapters look at physical constants (including the anthropic principle), whether physics has room for a creator God (the conclusion is that this is not the province of science), and some thoughts on science as a human activity. The chosen topics are those which have been important in the late twentieth century and remain important. Each chapter cites an eminent scientist as a `hero', though little is made of this. There are occasional historical notes, set in boxes, and a few short poems to leaven the text. What the book achieves is difficult to assess. Removing mathematics and adding a glossary of technical terms do not necessarily allow non-scientists to enjoy the text, as the publisher's note on the back cover suggests. The concepts can baffle the layman even more than the mathematics, and one of the most difficult of all physical concepts permeates so much of this book

  3. PSA Update Procedures, an Ultimate Need for Living PSA

    International Nuclear Information System (INIS)

    Hegedus, D.


    Nuclear facilities by their complex nature, change with time. These changes can be both physical (plant modification, etc.), operational (enhanced procedures, etc.) and organizational. In addition, there are also changes in our understanding of the plant, due to operational experience, data collection, technology enhancements, etc. Therefore, it is imperative that PSA model must be frequently up-dated or modified to reflect these changes. Over the last ten years. these has been a remarkable growth of the use of Probabilistic Safety Assessments (PSAs). The most rapidly growing area of the PSA Applications is their use to support operational decision-making. Many of these applications are characterized by the potential for not only improving the safety level but also for providing guidance on the optimal use of resources and reducing regulatory burden. To enable a wider use of the PSA model as a tool for safety activities it is essential to maintain the model in a controlled state. Moreover, to fulfill requirements for L iving PSA , the PSA model has to be constantly updated and/or monitored to reflect the current plant configuration. It should be noted that the PSA model should not only represent the plant design but should also represent the operational and emergency procedures. To keep the PSA model up-to-date several issues should be clearly defined including: - Responsibility should be divided among the PSA group, - Procedures for implementing changes should be established, and - QA requirements/program should be established to assure documentation and reporting. (author)

  4. Aging characteristics of containment building and sensitivity on ultimate pressure capacity

    International Nuclear Information System (INIS)

    Seo, Jeong Moon; Choun, Young Sun; Choi, In Kil; Ha, Jae Joo


    For the reliable safety assessment of the containment building, structural and material conditions can be investigated in detail and pertinent assessment technologies have to be established. Also, an understanding on the aging-related degradations for the construction materials is required to predict long-term structural safety of the containment building. For the development of reliable aging prediction models, an extensive data base system related to aging properties of the containment building has to be prepared. The objectives of this research are to develop aging models representing long-term degradation of materials and a structural performance assessment program for containment building considering aging-related degradation. According to the results of sensitivity analysis, as the mechanical properties of the constituent materials degrade, the ultimate pressure capacity of containment building may decrease and severe damage may occur around the mid-level of the containment wall. (author). 28 refs., 11 tabs., 36 figs

  5. Patient dose rate: An ultimate limit for spatial and density resolution of scanning systems

    International Nuclear Information System (INIS)

    Kowalski, G.; Wagner, W.


    In X-ray scanning systems, picture quality of the reconstructed slices is limited to a maximum spatial as well as density resolution by the applied radiation dose. Density resolution can be improved in proportion to the root of the patient dose, whereas a doubled spatial resolving power requires an eight times higher patient dose, assuming a fixed slice thickness. Only a careful trade-off between the applied patient dose, density resolution and spatial resolution yields a maximal diagnostic value for the physician. Specifications of a scanning system have to take into account these ultimate restrictions, so that picture quality really is limited by the patient's dose rather than by technical constraints. In addition a method is given by which the applied dose can be reduced by focusing the main intensity onto the region of interest, in case that region is known a priori. (orig.) [de

  6. SoundScapes - Beyond Interaction... in search of the ultimate human-centred interface

    DEFF Research Database (Denmark)

    Brooks, Tony


    that can also benefit communication. To achieve this a new generation of intuitive natural interfaces will be required and SoundScapes (see below) is a step toward this goal to discover the ultimate interface for matching the human experience to technology. Emergent hypothesis that have developed...... as a result of the SoundScapes research will be discussed. Introduction to SoundScapes SoundScapes is a contemporary art concept that has become widely known as an interdisciplinary platform for knowledge exchange, innovative product creation of creative and scientific work that uses non-invasive sensor...... Resonance. The multimedia content is adaptable so that the environment is tailored for each participant according to a user profile. This full body movement or the smallest of gesture results in human data input to SoundScapes. The same technology that enables this empowerment is used for performance art...

  7. Review of ultimate pressure capacity test of containment structure and scale model design techniques

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Jeong Moon; Choi, In Kil [Korea Atomic Energy Research Institute, Taejeon (Korea)


    This study was performed to obtain the basic knowledge of the scaled model test through the review of experimental studies conducted in foreign countries. The results of this study will be used for the wall segment test planed in next year. It was concluded from the previous studies that the larger the model, the greater the trust of the community in the obtained results. It is recommended that a scale model 1/4 - 1/6 be suitable considering the characteristics of concrete, reinforcement, liner and tendon. Such a large scale model test require large amounts of time and budget. Because of these reasons, it is concluded that the containment wall segment test with analytical studies is efficient for the verification of the ultimate pressure capacity of the containment structures. 57 refs., 46 figs., 11 tabs. (Author)

  8. The DREAM project-Towards the ultimate in calorimetry

    International Nuclear Information System (INIS)

    Wigmans, Richard


    High-precision jet spectroscopy will be increasingly important in future high-energy accelerator experiments, particularly at a linear e + e - collider. The dual-readout technique makes it possible to meet and exceed the requirements on calorimeter performance in experiments at such a collider. The DREAM Collaboration is exploring the limits of the possibilities offered by this technique, by systematically eliminating the limiting factors, one after the other. Powerful tools in this context are the simultaneous measurement of scintillation light and Cherenkov light generated in the shower development process, and a detailed measurement of the time structure of the signals. In this talk, the latest results of this generic detector R and D project are presented. In particular, I report on the first tests of a hybrid dual-readout calorimeter system, in which a BGO crystal matrix served as the electromagnetic section.

  9. The efficacy of preventive parasternal single injection of bupivacaine on intubation time, blood gas parameters, narcotic requirement, and pain relief after open heart surgery: A randomized clinical trial study

    Directory of Open Access Journals (Sweden)

    Mahmoud Saeidi


    Full Text Available Background: Postsurgical pain usually results in some complications in the patients. This study has tried to investigate the effects of parasternal single injection of bupivacaine on postoperative pulmonary and pain consequences in patients after open heart surgery. Methods: : In a prospective double blind clinical study, 100 consenting patients undergoing elective open heart surgery were randomized into two groups. In case group, bupivacaine was injected at both sides of sternum, immediately before sternal closure. In the control group, no intervention was performed. Then, the patients were investigated regarding intubation period, length of ICU stay, arterial blood gas (ABG parameters, morphine requirement, and their severity of postoperative pain using a visual analogue scale (VAS device. Results: No differences were found between the two groups regarding to age, sex, pump time, operation time, and body mass index and preoperative cardiac ejection fraction. Mean intubation length in case group was much shorter than that in control group. Mean PaO 2 in case group was lower in different checking times in postoperative period. The patients in the case group needed less morphine compared to those in the control group during the 24-hour observation period in the ICU. Finally, mean VAS scores of pain in case group were significantly lower than those in control group at 6, 12, and 24 hours postoperatively. Conclusions: Patients′ pain relief by parasternal single injection of bupivacaine in early postoperative period can facilitate earlier ventilator weaning and tracheal extubation after open heart surgery as well as achieving lower pain scores and narcotic requirements.

  10. Cataract Surgery (United States)

    ... Oncology Oculoplastics/Orbit Refractive Management/Intervention Retina/Vitreous Uveitis Focus On Pediatric Ophthalmology ... Are Cataracts? Pediatric Cataracts Cataract Diagnosis and Treatment Cataract Surgery IOL Implants: Lens Replacement After Cataracts ...

  11. Brain surgery (United States)

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... cut depends on where the problem in the brain is located. The surgeon creates a hole in ...

  12. Foot Surgery (United States)

    ... coding trends along with compliance guidelines and practice marketing materials, APMA has you covered whether you are ... crutches after the surgery or in a cast. Fusions: Fusions are usually performed to treat arthritic or ...

  13. Hemorrhoid surgery (United States)

    ... this page: // Hemorrhoid surgery To use the sharing features on this page, please enable JavaScript. Hemorrhoids are swollen veins around the anus. They may ...


    African Journals Online (AJOL)

    Department of Plastic and Reconstructive Surgery Sefako Makgatho Health Science University, ... We report on a pilot study on the use of a circumareolar excision and the use of .... and 1 gynecomastia patient) requested reduction in NAC size.


    African Journals Online (AJOL)

    influence medical students in pursuing a career in surgery. ... training, females reported significantly higher levels of agreement that surgical training would be better overseas when ..... mentoring surgical research or educational lectures and.


    African Journals Online (AJOL)

    1 Department of Surgery, Nelson R Mandela School of Medicine, University of ... in 51 reports. Four reports were illegible; one was conducted by a junior consultant, two by a fourth year trainee specialist ... The study period was 12 months from.

  17. Sinus Surgery (United States)

    ... sinus computed tomography (CT) scan (without contrast), nasal physiology (rhinomanometry and nasal cytology), smell testing, and selected ... altered anatomical landmarks, or where a patient’s sinus anatomy is very unusual, making typical surgery difficult. Image ...

  18. Ultimate response time of high electron mobility transistors

    International Nuclear Information System (INIS)

    Rudin, Sergey; Rupper, Greg; Shur, Michael


    We present theoretical studies of the response time of the two-dimensional gated electron gas to femtosecond pulses. Our hydrodynamic simulations show that the device response to a short pulse or a step-function signal is either smooth or oscillating time-decay at low and high mobility, μ, values, respectively. At small gate voltage swings, U 0  = U g  − U th , where U g is the gate voltage and U th is the threshold voltage, such that μU 0 /L < v s , where L is the channel length and v s is the effective electron saturation velocity, the decay time in the low mobility samples is on the order of L 2 /(μU 0 ), in agreement with the analytical drift model. However, the decay is preceded by a delay time on the order of L/s, where s is the plasma wave velocity. This delay is the ballistic transport signature in collision-dominated devices, which becomes important during very short time periods. In the high mobility devices, the period of the decaying oscillations is on the order of the plasma wave velocity transit time. Our analysis shows that short channel field effect transistors operating in the plasmonic regime can meet the requirements for applications as terahertz detectors, mixers, delay lines, and phase shifters in ultra high-speed wireless communication circuits

  19. Austrian Economics - The Ultimate Achievement of an Intellectual Journey

    Directory of Open Access Journals (Sweden)

    Pascal Salin


    Full Text Available In this lecture delivered November 2008 on the occasion of the presentation of the Mises Institute’s Gary G. Schlarbaum Prize for lifetime achievement in the cause of liberty, Professor Salin discusses his discovery of Austrian economics and his involvement in “the world of individual liberty,” and draws various lessons from his intellectual journey. The coherence of Austrian economics appealed to Salin—it is not a patchwork of partial theories, but a logical process of thought founded on realistic assumptions about individual action. Salin also discusses differences between the Chicago and Austrian approaches, and his views about monetary systems.The financial crisis beginning in late 2008 is not a crisis of capitalism, but of state intervention, caused by the expansionary monetary policy of the Fed. Capitalism is the solution, not the cause. There is no need to create money. There is never any balance of payments problem. What is required is tax systems more friendly to capital accumulation, a decrease in the role of the state, the end of monetary policy and, if possible, the disappearing of central banks and the IMF.

  20. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N


    National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures...... undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...

  1. The ultimately accountable job: leading today's sales organization. (United States)

    Colletti, Jerome A; Fiss, Mary S


    In recent years, sales leaders have had to devote considerable time and energy to establishing and maintaining disciplined processes. The thing is, many of them stop there--and they can't afford to, because the business environment has changed. Customers have gained power and gone global, channels have proliferated, more product companies are selling services, and many suppliers have begun providing a single point of contact for customers. Such changes require today's sales leaders to fill various new roles: Company leader. The best sales chiefs actively help formulate and execute company strategy, and they collaborate with all functions of the business to deliver value to customers. Customer champion. Customers want C-level relationships with suppliers in order to understand product strategy, look at offerings in advance, and participate in decisions made about future products--and sales leaders are in the best position to offer that kind of contact. Process guru. Although sales chiefs must look beyond the sales and customer processes they have honed over the past decade, they can't abandon them. The focus on process has become only more important as many organizations have begun bundling products and services to meet important customers' individual needs. Organization architect. Good sales leaders spend a lot of time evaluating and occasionally redesigning the sales organization's structure to ensure that it supports corporate strategy. Often, this involves finding the right balance between specialized and generalized sales roles. Course corrector. Sales leaders must watch the horizon, but they can't take their hands off the levers or forget about the dials. If they do, they might fail to respond when quick adjustments in priorities are needed.

  2. Metabolic engineering: the ultimate paradigm for continuous pharmaceutical manufacturing. (United States)

    Yadav, Vikramaditya G; Stephanopoulos, Gregory


    Research and development (R&D) expenditures by pharmaceutical companies doubled over the past decade, yet candidate attrition rates and development times rose markedly during this period. Understandably, companies have begun downsizing their pipelines and diverting investments away from R&D in favor of manufacturing. It is estimated that transitioning to continuous manufacturing could enable companies to compete for a share in emerging markets. Accordingly, the model for continuous manufacturing that has emerged commences with the conversion of late-stage intermediates into the active pharmaceutical ingredient (API) in a series of continuous flow reactors, followed by continuous solid processing to form finished tablets. The use of flow reactions for API synthesis will certainly generate purer products at higher yields in shorter times compared to equivalent batch reactions. However, transitioning from batch to flow configuration simply alleviates transport limitations within the reaction milieu. As the catalogue of reactions used in flow syntheses is a subset of batch-based chemistries, molecules such as natural products will continue to evade drug prospectors. Also, it is uncertain whether flow synthesis can deliver improvements in the atom and energy economies of API production at the scales that would achieve the levels of revenue growth targeted by companies. Instead, it is argued that implementing metabolic engineering for the production of oxidized scaffolds as gateway molecules for flow-based addition of electrophiles is a more effective and scalable strategy for accessing natural product chemical space. This new paradigm for manufacturing, with metabolic engineering as its engine, would also permit rapid optimization of production variables and allow facile scale-up from gram to ton scale to meet material requirements for clinical trials, thus recasting manufacturing as a tool for discovery. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  3. Incompatible type A plasma transfusion in patients requiring massive transfusion protocol: Outcomes of an Eastern Association for the Surgery of Trauma multicenter study. (United States)

    Stevens, W Tait; Morse, Bryan C; Bernard, Andrew; Davenport, Daniel L; Sams, Valerie G; Goodman, Michael D; Dumire, Russell; Carrick, Matthew M; McCarthy, Patrick; Stubbs, James R; Pritts, Timothy A; Dente, Christopher J; Luo-Owen, Xian; Gregory, Jason A; Turay, David; Gomaa, Dina; Quispe, Juan C; Fitzgerald, Caitlin A; Haddad, Nadeem N; Choudhry, Asad; Quesada, Jose F; Zielinski, Martin D


    With a relative shortage of type AB plasma, many centers have converted to type A plasma for resuscitation of patients whose blood type is unknown. The goal of this study is to determine outcomes for trauma patients who received incompatible plasma transfusions as part of a massive transfusion protocol (MTP). As part of an Eastern Association for the Surgery of Trauma multi-institutional trial, registry and blood bank data were collected from eight trauma centers for trauma patients (age, ≥ 15 years) receiving emergency release plasma transfusions as part of MTPs from January 2012 to August 2016. Incompatible type A plasma was defined as transfusion to patient blood type B or type AB. Of the 1,536 patients identified, 92% received compatible plasma transfusions and 8% received incompatible type A plasma. Patient characteristics were similar except for greater penetrating injuries (48% vs 36%; p = 0.01) in the incompatible group. In the incompatible group, patients were transfused more plasma units at 4 hours (median, 9 vs. 5; p plasma to patients with blood groups B and AB as part of a MTP does not appear to be associated with significant increases in morbidity or mortality. Therapeutic study, level IV.

  4. TMJ surgery following orthognathic surgery: A case series

    Directory of Open Access Journals (Sweden)

    C. Politis


    Full Text Available Orthognathic surgery may affect or cause temporomandibular joint (TMJ complaints. This study evaluated the need for TMJ surgery after orthognathic surgery.A retrospective cohort study was carried out on 630 consecutive patients undergoing at least a Le Fort I or bilateral sagittal split osteotomy (BSSO. The mean follow-up time was 2,3 years. Clinical, surgical and radiographic findings were collected.Ten of the 630 patients (1.6% had additional arthroscopic TMJ-surgery in one (9 or in both (1 joints because of internal derangement, resistant to conventional therapy. Only 4/10 patients had successful outcomes following arthroscopic surgery. One patient with unsuccessful outcome required multiple additional open TMJ-surgeries, all remaining ineffective to relieve pain and restricted mouth opening. If arthroscopy failed to relieve symptoms (5/10 patients, further conservative management was opted. Arthroscopy seemed effective mainly in patients without pre-existing TMJ complaints.A further five of the 630 patients (0.8% required more treatment because of bilateral postoperative condylar resorption, but none of them required TMJ-surgery.In contrast to patients with bilateral condylar resorption where the skeletal relapse remained the issue of concern, patients with internal derangement/osteoarthrosis exhibited major occlusal changes in one patient only (1/10, leaving the TMJ complaints as the main concern. Keywords: Sagittal split osteotomy, Le Fort I osteotomy, Orthognathic surgery, Condylar remodelling, Condylar resorption, Osteoarthrosis, Internal derangement, Relapse, Arthroscopy

  5. Tennis elbow surgery (United States)

    Lateral epicondylitis - surgery; Lateral tendinosis - surgery; Lateral tennis elbow - surgery ... Surgery to repair tennis elbow is often an outpatient surgery. This means you will not stay in the hospital overnight. You will be given ...

  6. Mohs micrographic surgery (United States)

    Skin cancer - Mohs surgery; Basal cell skin cancer - Mohs surgery; Squamous cell skin cancer - Mohs surgery ... Mohs surgery usually takes place in the doctor's office. The surgery is started early in the morning and is ...

  7. Health care quality, access, cost, workforce, and surgical education: the ultimate perfect storm. (United States)

    Schwartz, Marshall Z


    The discussions on health care reform over the past two years have focused on cost containment while trying to maintain quality of care. Focusing on just cost and quality unfortunately does not address other very important factors that impact on our health care delivery system. Availability of a well-trained workforce, maintaining the sophisticated medical/surgical education system, and ultimately access to quality care by the public are critical to maintaining and enhancing our health care delivery system. Unfortunately, all five of these components are under at risk. Thus, we have evolving the ultimate perfect storm affecting our health care delivery system. Although not ideal and given the uniqueness of our population and their expectations, our current delivery system is excellent compared to other countries. However, the cost of our current system is rising at an alarming rate. Currently, health care consumes 17% of our gross domestic product. If our system is not revised this will continue to rise and by 2025 it will consume 48%. The dilemma, given the current state of our overall economy and rising debt, is how to address this major problem. Unfortunately, the Affordable Care Act, which is now law, does not address most of the issues and the cost was initially grossly under estimated. Furthermore, the law does not address the issues of workforce, maintaining our medical education system or ultimately, access. A major revision of our system will be necessary to truly create a system that protects and enhances all five of the components of our health care delivery system. To effectively accomplish this will require addressing those issues that lead to wasteful spending and diversion of our health care dollars to profit instead of care. Improved and efficient delivery systems that reduce complications, reduction of duplication of tertiary and quaternary programs or services within the same markets (i.e. regionalization of care), health insurance reform, and

  8. Assessment of the Pre-operative Nutritional Status of Patients who were Scheduled for Elective Surgery and Determination of Nutritional Support Requirements

    Directory of Open Access Journals (Sweden)

    Bahri Özer


    Full Text Available Aim: We aimed to evaluate the nutritional status with clinical, antropometric and laboratory methods in patients who were scheduled for elective surgery. Methods: Retrospective evaluation of 90 patients in a period of 4 years was performed. Patients with tumors (group 1 were compared with controls (group 2 in regard to nutritional status. Student t-test, Mann-Whitney U test and chi-square test were used for statistical analysis. Results: The mean age of patients in group 1 (3 males, 8 females and group 2 (35 males, 44 females was 62.8±11.0 and 47.7±16.2 years, respectively. The mean body mass index (BMI was 30.1±6.6. Triceps thickness and circumference of the upper mid-arm were 2.2±0.8 and 28.6±4.2 cm, respectively. All patients had a Subjective Global Assessment (SGA score A, but two patients were classified as having moderate nutritional risk according to Nutritional Risk Screening (NRS 2002. The mean length of hospital stay was 2.6±2.4 days. Complications were observed in four patients of group 2 and in two patients of group 1. Gender, SGA score, albumin, prealbumin, BMI, triceps thickness, circumference of the upper mid-arm and complication rates were statistically similar between the groups. There was a statistically significant difference in age, NRS 2002, gastrointestinal system findings, length of hospital stay, sedimentation and fasting blood glucose levels between the groups. Conclusion: Patients with nutritional risk can be detected using the NRS 2002. Nutritional support was necessary in 2% of all cases and in 18% of group 1 patients. However, advantages of antropometric measurements, biochemical tests, BMI and SGA could not be shown.

  9. Orthognathic Surgery

    DEFF Research Database (Denmark)

    Kjærgaard Larsen, Marie; Thygesen, Torben Henrik


    The literature shows that the indications for orthognathic surgery (OS) are often functional problems and unsatisfactory facial esthetics. This study investigated the esthetic outcomes and overall satisfaction following OS. Somatosensory change is a relatively common complication and its influence...... on the level of satisfaction was studied. The social-networking web site Facebook was used to identify the study population. An online questionnaire was performed using the website SurveyMonkey. In all, 105 (9%) respondents from the Danish Facebook group about OS, called Kaebeoperation (jaw surgery), were...... in beauty than women (P = 0.030). Sixty-four percent replied that their attractiveness had been increased after OS. Eighty-six percent were happy with the results and 89% would recommend the surgery to others in need. No significant differences in esthetic results and satisfaction were seen with regard...

  10. Ultimate intra-wafer critical dimension uniformity control by using lithography and etch tool corrections (United States)

    Kubis, Michael; Wise, Rich; Reijnen, Liesbeth; Viatkina, Katja; Jaenen, Patrick; Luca, Melisa; Mernier, Guillaume; Chahine, Charlotte; Hellin, David; Kam, Benjamin; Sobieski, Daniel; Vertommen, Johan; Mulkens, Jan; Dusa, Mircea; Dixit, Girish; Shamma, Nader; Leray, Philippe


    With shrinking design rules, the overall patterning requirements are getting aggressively tighter. For the 7-nm node and below, allowable CD uniformity variations are entering the Angstrom region (ref [1]). Optimizing inter- and intra-field CD uniformity of the final pattern requires a holistic tuning of all process steps. In previous work, CD control with either litho cluster or etch tool corrections has been discussed. Today, we present a holistic CD control approach, combining the correction capability of the etch tool with the correction capability of the exposure tool. The study is done on 10-nm logic node wafers, processed with a test vehicle stack patterning sequence. We include wafer-to-wafer and lot-to-lot variation and apply optical scatterometry to characterize the fingerprints. Making use of all available correction capabilities (lithography and etch), we investigated single application of exposure tool corrections and of etch tool corrections as well as combinations of both to reach the lowest CD uniformity. Results of the final pattern uniformity based on single and combined corrections are shown. We conclude on the application of this holistic lithography and etch optimization to 7nm High-Volume manufacturing, paving the way to ultimate within-wafer CD uniformity control.

  11. Obesity-related cardiorenal disease: the benefits of bariatric surgery. (United States)

    Fenske, Wiebke; Athanasiou, Thanos; Harling, Leanne; Drechsler, Christiane; Darzi, Ara; Ashrafian, Hutan


    The inexorable increase in the prevalence of obesity is a global health concern, which will result in a concomitant escalation in health-care costs. Obesity-related metabolic syndrome affects approximately 25% of adults and is associated with cardiovascular and renal disease. The heart and kidneys are physiologically interdependent, and the pathological effects of obesity can lead to cardiorenal syndrome and, ultimately, kidney and heart failure. Weight loss can prevent or ameliorate obesity-related cardiorenal syndrome, but long-term maintenance of a healthy weight has been difficult to achieve through lifestyle changes or pharmacotherapy. Bariatric surgery offers both sustained weight loss and favourable metabolic changes, including dramatic improvements in glycaemic control and symptoms of type 2 diabetes mellitus. Procedures such as Roux-en-Y gastric bypass offer immediate multisystemic benefits, including bile flow alteration, reduced gastric size, anatomical gut rearrangement and altered flow of nutrients, vagal manipulation and enteric hormone modulation. In patients with cardiorenal syndrome, bariatric surgery also offers renoprotection and cardioprotection, and attenuates both kidney and heart failure by improving organ perfusion and reversing metabolic dysfunction. However, further research is required to understand how bariatric surgery acts on the cardiorenal axis, and its pioneering role in novel treatments and interventions for cardiorenal disease.

  12. Ultimate architecture

    CERN Multimedia

    Jencks, Charles


    "European physics hothouse CERN recently unveiled Atlas, the world's most powerful particle detector, which it will use to search for the fundamental building blocks of nature from May next year. Charles Jencks describes the experience of getting up clsoe to the engineering marvel that could en up creating a mini-black hole."(5 pages with photos).

  13. Ultimate energy

    International Nuclear Information System (INIS)


    An explanation is given of the complexity faced by the scientific researcher in an effort to achieve fusion power. Outlines the theory and current experiments being pursued in this complex project, including visits to five major fusion research laboratories, and interviews with physicists

  14. Bleb incarceration following Ahmed valve surgery

    Directory of Open Access Journals (Sweden)

    Gross FJ


    Full Text Available Fredric J Gross, Giovanni DiSandro Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, VA, USA Abstract: Globe luxation is a painful and potentially vision-threatening condition in which the globe becomes trapped behind the eyelids requiring physician intervention in the emergency department or eye clinic. On presentation, the patient typically complains of an inability to close their eye, severe foreign body sensation, decreased vision, and significant eye pain. Although most visual symptoms are reversible and primarily result from exposure keratopathy, optic nerve damage, and permanent vision loss can occur from repeat or prolonged episodes of globe luxation. Risk factors include any congenital or acquired conditions that displace the globe anteriorly in the orbit and increased eyelid laxity that allows the globe to prolapse through the lid aperture. Typically, the precipitating event involves eyelid retraction during ophthalmic examination or an event that increases intraorbital pressure such as coughing or sneezing. Once the globe has luxated, the condition is typically worsened by blepharospasm and patients’ attempts to close the eye that worsen the entrapment. In the current case, the patient had a large superotemporal filtering bleb following Ahmed valve surgery for uncontrolled glaucoma. While instilling her glaucoma medication, she retracted her eyelids sufficiently to pull the upper lid over her filtering bleb where it became entrapped causing a similar presentation to globe luxation. Traditional methods of repositioning the globe were unsuccessful. Bleb needling was ultimately required to return the globe to a normal position. Keywords: luxation, globe, glaucoma

  15. Pediatric endocrine surgery development

    Directory of Open Access Journals (Sweden)

    Ivan I. Dedov


    Full Text Available Department of pediatric surgery at the Endocrinology Research Centre has been around for nearly two years. During operation, surgical treatment has received more than 500 patients with various endocrine disorders. The article discusses modern diagnostic approaches and surgical options for diseases included in the new direction of pediatric surgery – endocrine surgery in children. There are discussions about options for radical treatment of Graves disease in children, positive and negative aspects of surgical and radioactive iodine treatment. Is own stats of postoperative hyperparathyroidism. Is proposed to optimize the algorithm of actions in identifying thyroid nodules in children. In primary hyperparathyroidism, the emphasis is on the complexity of the postoperative management of patients related to the feature of children’s age in determining the severity of the reactions on the water-electrolyte disorders. Separately reviewed the literature of the adrenal glands diseases in children, demonstrating their own clinical cases which required surgical intervention. The authors describe the possibilities of modern neurosurgical equipment in the Endocrinology Research Centre in operations on the pituitary gland in children. Patients of different age groups performed transnasal transsphenoidal removal of tumors of the chiasm-sellar region using endoscopic assistance. The article also cited research data of pancreas diseases and their surgical treatment. Much attention is paid to the gender section of endocrine surgery in children. Discusses the tactics in disorders of sex development, gonadal tumors in children, diseases of the breast. In conclusion outlines the prospects for the development of endocrine surgery in children.


    African Journals Online (AJOL)

    surgery. Since the first laparoscopic treatment of hydatid disease was described in 1992,14 there has been a steady growth in reports of the laparoscopic treatment of hydatid cysts of liver. Although early reported laparoscopic treatment of liver hydatid disease was confined to simple drainage, more advanced laparoscopic ...


    African Journals Online (AJOL)

    Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town,. South Africa ... included all district, regional and tertiary hospitals in the nine provinces. Clinics and so-called ..... large contingency of senior general surgeons from countries such as Cuba, who have ...


    African Journals Online (AJOL)

    meet the criteria for damage control surgery, and ligation of the AVC is a .... There were two vertebral body fractures, one penetrating brain injury from a gunshot wound to the head, one ... two hand fractures, three haemothoraces, one pelvic fracture, .... One patient with an intimal flap injury to his left common iliac artery ...


    African Journals Online (AJOL)

    Schwab , using a three-phase approach.5 In 1998, Moore et al. extended the concept and described the five-stage approach.6. The aim of damage control surgery is to prevent severely injured patients from developing the “lethal triad” of hypothermia, coagulopathy and worsening acidosis, as this confers a dismal prognosis ...

  20. Rodding Surgery (United States)

    ... Physical activity prior to surgery,  Length of the operation; anesthesia issues,  Reason for the choice of rod,  Time in the hospital,  Length of recovery time at home,  Pain management including control of muscle spasms,  The rehabilitation plan. ...

  1. 75 FR 76746 - Agency Information Collection Activities: Declaration of Ultimate Consignee That Articles Were... (United States)


    ... Activities: Declaration of Ultimate Consignee That Articles Were Exported for Temporary Scientific or... That Articles Were Exported for Temporary Scientific or Educational Purposes. This is a proposed... forms of information. Title: Declaration of Ultimate Consignee That Articles Were Exported for Temporary...

  2. 7 CFR 4280.21 - Eligible REDG Ultimate Recipients and Projects. (United States)


    ... care providers; (5) Projects that utilize Advanced Telecommunications or computer networks to... 7 Agriculture 15 2010-01-01 2010-01-01 false Eligible REDG Ultimate Recipients and Projects. 4280... Economic Development Loan and Grant Programs § 4280.21 Eligible REDG Ultimate Recipients and Projects. The...

  3. 78 FR 55117 - Ultimate Heat Sink for Nuclear Power Plants; Draft Regulatory Guide (United States)


    ... NUCLEAR REGULATORY COMMISSION [NRC-2013-0203] Ultimate Heat Sink for Nuclear Power Plants; Draft... (DG), DG-1275, ``Ultimate Heat Sink for Nuclear Power Plants.'' This regulatory guide (RG) describes methods and procedures acceptable to the NRC staff that nuclear power plant facility licensees and...

  4. Errors and complications in laparoscopic surgery


    Liviu Drăghici; Mircea Lițescu; Rubin Munteanu; Constantin Pătru; Carmen L. Gorgan; Radu Mirică; Isabela Drăghici


    Background. In laparoscopic surgery errors are unavoidable and require proper acknowledgment to reduce the risk of intraoperative and accurately assess the appropriate therapeutic approach. Fortunately, their frequency is low and cannot overshadow the benefits of laparoscopic surgery. Materials and Methods. We made an epidemiological investigation in General Surgery Department of Emergency Clinical Hospital "St. John" Bucharest, analyzing 20 years of experience in laparoscopic surgery, during...

  5. Influence of cracks and pitting corrosion on residual ultimate strength of stiffened plates

    Directory of Open Access Journals (Sweden)

    ZHANG Jing


    Full Text Available [Objectives] Ships and offshore platforms serve in the harsh sea environment for a long time. Cracks and pitting corrosion will occur in such a structure and the damage will affect its ultimate strength.[Methods] To investigate the influence of cracks and pitting corrosion on ultimate bearing capacity, the ultimate strength of a structure under axial compression is studied by using a nonlinear finite element. The mesh size of a stiffened plate with cracks and pitting corrosion is first discussed. Then the influence of the relative positions of cracks and pitting corrosion, number of corrosion points and crack length impact on the residual ultimate strength of damaged stiffened plates is discussed via a series of calculations.[Results] The results indicate that the increase in crack length and pitting corrosion significantly decreases the ultimate strength of a stiffened plate. [Conclusions] This provides a useful reference for designing and maintaining ships and offshore structures in their life cycles.

  6. Carotid artery surgery (United States)

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  7. Patch in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alireza Alizadeh Ghavidel


    Full Text Available Introduction: Excessive bleeding presents a risk for the patient in cardiovascular surgery. Local haemostatic agents are of great value to reduce bleeding and related complications. TachoSil (Nycomed, Linz, Austria is a sterile, haemostatic agent that consists of an equine collagen patchcoated with human fibrinogen and thrombin. This study evaluated the safety and efficacy of TachoSil compared to conventional technique.Methods: Forty-two patients scheduled for open heart surgeries, were entered to this study from August 2010 to May 2011. After primary haemostatic measures, patients divided in two groups based on surgeon’s judgment. Group A: 20 patients for whom TachoSil was applied and group B: 22 patients that conventional method using Surgicel (13 patients or wait and see method (9 cases, were performed in order to control the bleeding. In group A, 10 patients were male with mean age of 56.95±15.67 years and in group B, 9 cases were male with mean age of 49.95±14.41 years. In case group 70% (14/20 of the surgeries were redo surgeries versus 100% (22/22 in control group.Results: Baseline characteristics were similar in both groups. In TachoSil group 75% of patients required transfusion versus 90.90% in group B (P=0.03.Most transfusions consisted of packed red blood cell; 2±1.13 units in group A versus 3.11±1.44 in group B (P=0.01, however there were no significant differences between two groups regarding the mean total volume of intra and post-operative bleeding. Re-exploration was required in 10% in group A versus 13.63% in group B (P=0.67.Conclusion: TachoSil may act as a superior alternative in different types of cardiac surgery in order to control the bleeding and therefore reducing transfusion requirement.

  8. Risk of wound infection and safety profile of amoxicillin in healthy patients which required third molar surgery: a systematic review and meta-analysis. (United States)

    Isiordia-Espinoza, M A; Aragon-Martinez, O H; Martínez-Morales, J F; Zapata-Morales, J R


    The aim of this systematic review and meta-analysis was to assess the risk of surgical wound infection and the adverse effects of amoxicillin in healthy patients who required excision of third molars. We identified eligible reports from searches of PubMed, Medline®, the Cochrane Library, Imbiomed, LILACS, and Google Scholar. Studies that met our minimum requirements were evaluated using inclusion and exclusion criteria and the Oxford Quality Scale. Those with a score of 3 or more on this Scale were included and their data were extracted and analysed. For evaluation of the risk of infection the absolute risk reduction, number needed to treat, and 95% CI were calculated. For evaluation of the risk of an adverse effect the absolute risk increase, number needed to harm, and 95% CI were calculated using the Risk Reduction Calculator. Each meta-analysis was made with the help of the Mantel-Haenszel random effects model, and estimates of risk (OR) and 95% CI were calculated using the Review Manager 5.3, from the Cochrane Library. A significant risk was assumed when the lower limit of the 95% CI was greater than 1. Probabilities of less than 0.05 were accepted as significant. The results showed that there was no reduction in the risk of infection when amoxicillin was given before or after operation compared with an untreated group or placebo. In conclusion, this study suggests that amoxicillin given prophylactically or postoperatively does not reduce the risk of infection in healthy patients having their third molars extracted. Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  9. Comparison of Plastic Surgery Residency Training in United States and China. (United States)

    Zheng, Jianmin; Zhang, Boheng; Yin, Yiqing; Fang, Taolin; Wei, Ning; Lineaweaver, William C; Zhang, Feng


    Residency training is internationally recognized as the only way for the physicians to be qualified to practice independently. China has instituted a new residency training program for the specialty of plastic surgery. Meanwhile, plastic surgery residency training programs in the United States are presently in a transition because of restricted work hours. The purpose of this study is to compare the current characteristics of plastic surgery residency training in 2 countries. Flow path, structure, curriculum, operative experience, research, and evaluation of training in 2 countries were measured. The number of required cases was compared quantitatively whereas other aspects were compared qualitatively. Plastic surgery residency training programs in 2 countries differ regarding specific characteristics. Requirements to become a plastic surgery resident in the United States are more rigorous. Ownership structure of the regulatory agency for residency training in 2 countries is diverse. Training duration in the United States is more flexible. Clinical and research training is more practical and the method of evaluation of residency training is more reasonable in the United States. The job opportunities after residency differ substantially between 2 countries. Not every resident has a chance to be an independent surgeon and would require much more training time in China than it does in the United States. Plastic surgery residency training programs in the United States and China have their unique characteristics. The training programs in the United States are more standardized. Both the United States and China may complement each other to create training programs that will ultimately provide high-quality care for all people.

  10. How to introduce a program of Enhanced Recovery after Surgery? The experience of the CAPIO group. (United States)

    Verrier, J-F; Paget, C; Perlier, F; Demesmay, F


    The traditional model of hospital care has been challenged by the development of a care-management process that allows early patient autonomy (outpatient surgery, Enhanced Recovery after Surgery). Hospitalization has been transformed in response to this development, based on innovative medical and organizational strategies. Within a surgical service, the deployment of these processes requires the creation of a support structure, with re-organization of existing structures, analysis of potential obstacles, implementation of management tools, and ongoing follow-up of organizational function, clinical results, organizational and patient satisfaction. These will ultimately assess adaptation of structures within these new organizations. In this article, we share our insights based on experience gained over the past six years by surgical teams of the CAPIO group. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  11. [Requirements for final year medical studies in the era of generation Y - implementation for general and visceral surgery at the Ludwig Maximilians University of Munich]. (United States)

    Albertsmeier, M; Pratschke, S; Raes, P; Werner, J; Angele, M K


    The revision of the medical licensing regulations in 2012 has changed the underlying conditions for the practical year (PY), especially in the sense of markedly more flexibility for the medical students. The driving force for these and future changes, however, is not the legislature but rather the students themselves who are explicitly demanding that their training be adapted to their requirements and wishes. Time for the realisation of personal aims, planning of leisure time activities, for the family and social contacts as well as an altogether balanced work-life balance have replaced the wish for professional advancement as premise for the lifestyle of generation Y. Many hospitals, especially the privately-supported, attract students with special offers - university hospitals are called upon to defend their position in the competition for newly qualified students. The present article describes the changes of 2012 as part of a programme for a sustainable increase in the attractivity of the surgical PY at the Ludwig-Maximilian University (LMU) in Munich. Georg Thieme Verlag KG Stuttgart · New York.

  12. The CRISPR-Cas9 technology: Closer to the ultimate toolkit for targeted genome editing. (United States)

    Quétier, Francis


    The first period of plant genome editing was based on Agrobacterium; chemical mutagenesis by EMS (ethyl methanesulfonate) and ionizing radiations; each of these technologies led to randomly distributed genome modifications. The second period is associated with the discoveries of homing and meganuclease enzymes during the 80s and 90s, which were then engineered to provide efficient tools for targeted editing. From 2006 to 2012, a few crop plants were successfully and precisely modified using zinc-finger nucleases. A third wave of improvement in genome editing, which led to a dramatic decrease in off-target events, was achieved in 2009-2011 with the TALEN technology. The latest revolution surfaced in 2013 with the CRISPR-Cas9 system, whose high efficiency and technical ease of use is really impressive; scientists can use in-house kits or commercially available kits; the only two requirements are to carefully choose the location of the DNA double strand breaks to be induced and then to order an oligonucleotide. While this close-to- ultimate toolkit for targeted editing of genomes represents dramatic scientific progress which allows the development of more complex useful agronomic traits through synthetic biology, the social acceptance of genome editing remains regularly questioned by anti-GMO citizens and organizations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. The ultimate emergency measures to secure a NPP under an accidental condition with no designed power or water supply

    Energy Technology Data Exchange (ETDEWEB)

    Liang, K.S., E-mail: [Institute of Nuclear Engineering and Science, National Tsing Hua University, 101 Sec. 2, Kuang-Fu Road, Hsinchu 30013, Taiwan (China); School of Nuclear Science and Engineering, Shanghai Jiao Tong University, 800 Dong-Chuan Road, Shanghai (China); Chiang, S.C. [Department of Nuclear Safety, Taiwan Power Company, 242 Sec. 3, Roosevelt Road, Taipei 10016, Taiwan (China); Hsu, Y.F.; Young, H.J.; Pei, B.S. [Institute of Nuclear Engineering and Science, National Tsing Hua University, 101 Sec. 2, Kuang-Fu Road, Hsinchu 30013, Taiwan (China); Wang, L.C. [Department of Nuclear Safety, Taiwan Power Company, 242 Sec. 3, Roosevelt Road, Taipei 10016, Taiwan (China)


    Highlights: Black-Right-Pointing-Pointer An ultimate measure to secure core was developed, if power or water supply cannot be restored in time. Black-Right-Pointing-Pointer This ultimate measure was simulated by RELAP5-3D to verify the concept of this emergency plan. Black-Right-Pointing-Pointer Quantification of the required raw water injection rate was performed for NPPS in Taiwan Black-Right-Pointing-Pointer Reactor controlled depressurization within the 1st hour is essential to reduce the required raw water injection rate. Black-Right-Pointing-Pointer For PWR, even heat sink can be developed, RCP seal leak might eventually cause core uncover 10 h after seal leak occurs. - Abstract: In the recent nuclear catastrophe which occurred in Japan on March 11, 2011, several units of Fukushima conventional BWR experienced a total loss of power and water supply triggered by a heavy earthquake and a following Tsunami beyond design basis. In Fukushima accident it was observed that sea water was injected into reactors only after hydrogen explosion took place and it was considered a little too late to prevent core from damage. With regard to this fact, the Taiwan power company develops an ultimate measure to prevent reactor from encountering core damage, if either designed AC power or reactor water supply cannot be restored in time. This ultimate measure was named as DIVing plan, abbreviated from system depressurization, water injection and containment venting. Once any designed AC power or reactor water supply is made available, this DIVing plan will be activated to (1) depressurize reactor first, (2) inject any available water into reactor by any available power supply if this critical status cannot be restored in time, and (3) vent the containment if necessary to maintain containment integrity. In this paper the DIVing plan was simulated by RELAP5-3D to verify the concept of it and also to quantify the required raw water injection rate to prevent core from damage for both

  14. The ultimate emergency measures to secure a NPP under an accidental condition with no designed power or water supply

    International Nuclear Information System (INIS)

    Liang, K.S.; Chiang, S.C.; Hsu, Y.F.; Young, H.J.; Pei, B.S.; Wang, L.C.


    Highlights: ► An ultimate measure to secure core was developed, if power or water supply cannot be restored in time. ► This ultimate measure was simulated by RELAP5-3D to verify the concept of this emergency plan. ► Quantification of the required raw water injection rate was performed for NPPS in Taiwan ► Reactor controlled depressurization within the 1st hour is essential to reduce the required raw water injection rate. ► For PWR, even heat sink can be developed, RCP seal leak might eventually cause core uncover 10 h after seal leak occurs. - Abstract: In the recent nuclear catastrophe which occurred in Japan on March 11, 2011, several units of Fukushima conventional BWR experienced a total loss of power and water supply triggered by a heavy earthquake and a following Tsunami beyond design basis. In Fukushima accident it was observed that sea water was injected into reactors only after hydrogen explosion took place and it was considered a little too late to prevent core from damage. With regard to this fact, the Taiwan power company develops an ultimate measure to prevent reactor from encountering core damage, if either designed AC power or reactor water supply cannot be restored in time. This ultimate measure was named as DIVing plan, abbreviated from system depressurization, water injection and containment venting. Once any designed AC power or reactor water supply is made available, this DIVing plan will be activated to (1) depressurize reactor first, (2) inject any available water into reactor by any available power supply if this critical status cannot be restored in time, and (3) vent the containment if necessary to maintain containment integrity. In this paper the DIVing plan was simulated by RELAP5-3D to verify the concept of it and also to quantify the required raw water injection rate to prevent core from damage for both PWR and BWR plants in Taiwan, after the loss of passive cooling mechanism. Provided the passive cooling mechanism is lost

  15. Metabolic Surgery

    DEFF Research Database (Denmark)

    Pareek, Manan; Schauer, Philip R; Kaplan, Lee M


    The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus. Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individuals with obesity. Randomized trials have recently shown...... the superiority of surgery over medical treatment alone in achieving improved glycemic control, as well as a reduction in cardiovascular risk factors. The mechanisms seem to extend beyond the magnitude of weight loss alone and include improvements in incretin profiles, insulin secretion, and insulin sensitivity....... Moreover, observational data suggest that the reduction in cardiovascular risk factors translates to better patient outcomes. This review describes commonly used metabolic surgical procedures and their current indications and summarizes the evidence related to weight loss and glycemic outcomes. It further...

  16. Preparing for Surgery (United States)

    ... Events Advocacy For Patients About ACOG Preparing for Surgery Home For Patients Search FAQs Preparing for Surgery ... Surgery FAQ080, August 2011 PDF Format Preparing for Surgery Gynecologic Problems What is the difference between outpatient ...

  17. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ...

  18. Corrective Jaw Surgery (United States)

    ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ...

  19. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  20. Facial Cosmetic Surgery (United States)

    ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  1. Heart bypass surgery (United States)

    Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Bypass surgery - heart; CABG; Coronary artery bypass graft; Coronary artery bypass surgery; Coronary bypass surgery; Coronary artery disease - CABG; CAD - CABG; Angina - ...

  2. NEOCE: a new external occulting coronagraph experiment for ultimate observations of the chromosphere, corona and interface (United States)

    Damé, Luc; Fineschi, Silvano; Kuzin, Sergey; Von Fay-Siebenburgen, Erdélyi Robert

    Several ground facilities and space missions are currently dedicated to the study of the Sun at high resolution and of the solar corona in particular. However, and despite significant progress with the advent of space missions and UV, EUV and XUV direct observations of the hot chromosphere and million-degrees coronal plasma, much is yet to be achieved in the understanding of these high temperatures, fine dynamic dissipative structures and of the coronal heating in general. Recent missions have shown the definite role of a wide range of waves and of the magnetic field deep in the inner corona, at the chromosphere-corona interface, where dramatic and physically fundamental changes occur. The dynamics of the chromosphere and corona is controlled and governed by the emerging magnetic field. Accordingly, the direct measurement of the chromospheric and coronal magnetic fields is of prime importance. The solar corona consists of many localised loop-like structures or threads with the plasmas brightening and fading independently. The plasma evolution in each thread is believed to be related to the formation of filaments, each one being dynamic, in a non-equilibrium state. The mechanism sustaining this dynamics, oscillations or waves (Alfvén or other magneto-plasma waves), requires both very high-cadence, multi-spectral observations, and high resolution and coronal magnetometry. This is foreseen in the future Space Mission NEOCE (New External Occulting Coronagraph Experiment), the ultimate new generation high-resolution coronagraphic heliospheric mission, to be proposed for ESA M4. NEOCE, an evolution of the HiRISE mission, is ideally placed at the L5 Lagrangian point (for a better follow-up of CMEs), and provides FUV imaging and spectro-imaging, EUV and XUV imaging and spectroscopy, and ultimate coronagraphy by a remote external occulter (two satellites in formation flying 375 m apart minimizing scattered light) allowing to characterize temperature, densities and

  3. Surgery of the Trachea

    Directory of Open Access Journals (Sweden)

    Mark S. Allen


    Full Text Available Surgical procedures on the trachea have only been undertaken within the past 50 years. Knowing the unique blood supply of the trachea and how to reduce tension on any anastomosis are key to a successful outcome. Tracheal conditions requiring surgery usually present with shortness of breath on exertion, and preoperative evaluation involves computed tomography and rigid bronchoscopy. Tracheal resection and reconstruction can be safely performed with excellent outcomes by following a well-described technique.

  4. Seismic shear wall ISP NUPEC's seismic ultimate dynamic response test. Comparison report

    International Nuclear Information System (INIS)


    In the seismic design of a nuclear power plant, evaluation of the ultimate strength of the nuclear reactor building is an important subject for assessment of seismic reliability of the plant. In order to carry out the evaluation, the response characteristics of reinforced concrete seismic shear walls up to their ultimate state have to be understood. For this purpose, there is a need to develop reliable non-linear response analysis methods which enables the reliable ultimate strength evaluation of nuclear reactor buildings. Along with this need, many computer codes have been developed. These computer codes are compared. (K.A.)

  5. Epilepsy surgery: Recommendations for India

    Directory of Open Access Journals (Sweden)

    Chandra P


    Full Text Available The following article recommends guidelines for epilepsy surgery for India. This article reviews the indications, the various surgical options available and the outcome of surgery for drug resistant epilepsy based on current evidence. Epilepsy surgery is a well-established option for patients who have been diagnosed to have drug resistant epilepsy (DRE (on at least two appropriate, adequate anti-epileptic drugs (AEDs (either in monotherapy or in combination with continuing seizures, where the presurgical work-up has shown concordance of structural imaging (magnetic resonance imaging and electrical mapping data (electroencephalography (EEG, video EEG. There may be a requirement of functional imaging techniques in a certain number of DRE like positron emission tomography (PET, single photon emission tomography, (SPECT. Invasive monitoring should be restricted to a few when all noninvasive investigations are inconclusive, there is a dual pathology or there is a discordance of noninvasive data. The types of surgery could be curative (resective surgeries: amygdalo hippocampectomy, lesionectomy and multilobar resections; functional surgeries: hemispherotomy and palliative (multiple subpial transaction, corpus callosotomy, vagal nerve stimulation. Epilepsy surgery in indicated cases has a success range from 50 to 86% in achieving seizure freedom as compared with < 5% success rate with AEDs only in persons with DRE. Centers performing surgery should be categorized into Level I and Level II.

  6. [Risk management for endoscopic surgery]. (United States)

    Kimura, Taizo


    The number of medical accidents in endoscopic surgery has recently increased. Surgical complications caused by inadequate preparation or immature technique or those resulting in serious adverse outcomes may be referred to as medical accidents. The Nationwide Survey of Endoscopic Surgery showed that bile duct injury and uncontrollable bleeding were seen in 0.68% and in 0.58%, respectively, of cholecystectomy patients; interoperative and postoperative complications in 0.84% and in 3.8%, respectively, of gastric cancer surgery patients; and operative complications in 6.74% of bowel surgery patients. Some required open repair, and 49 patients died. The characteristic causes of complications in endoscopic surgery are a misunderstanding of anatomy, handling of organs outside the visual field, burn by electrocautery, and injuries caused by forceps. Bleeding that requires a laparotomy for hemostasis is also a complication. Furthermore, since the surgery is usually videorecorded, immature techniques resulting in complications are easily discovered. To decrease the frequency of accidents, education through textbooks and seminars, training using training boxes, simulators, or animals, proper selection of the surgeon depending on the difficulty of the procedure, a low threshold for conversion to laparotomy, and use of the best optical equipment and surgical instruments are important. To avoid malpractice lawsuits, informed consent obtained before surgery and proper communication after accidents are necessary.

  7. Surgery with cooperative robots. (United States)

    Lehman, Amy C; Berg, Kyle A; Dumpert, Jason; Wood, Nathan A; Visty, Abigail Q; Rentschler, Mark E; Platt, Stephen R; Farritor, Shane M; Oleynikov, Dmitry


    Advances in endoscopic techniques for abdominal procedures continue to reduce the invasiveness of surgery. Gaining access to the peritoneal cavity through small incisions prompted the first significant shift in general surgery. The complete elimination of external incisions through natural orifice access is potentially the next step in reducing patient trauma. While minimally invasive techniques offer significant patient advantages, the procedures are surgically challenging. Robotic surgical systems are being developed that address the visualization and manipulation limitations, but many of these systems remain constrained by the entry incisions. Alternatively, miniature in vivo robots are being developed that are completely inserted into the peritoneal cavity for laparoscopic and natural orifice procedures. These robots can provide vision and task assistance without the constraints of the entry incision, and can reduce the number of incisions required for laparoscopic procedures. In this study, a series of minimally invasive animal-model surgeries were performed using multiple miniature in vivo robots in cooperation with existing laparoscopy and endoscopy tools as well as the da Vinci Surgical System. These procedures demonstrate that miniature in vivo robots can address the visualization constraints of minimally invasive surgery by providing video feedback and task assistance from arbitrary orientations within the peritoneal cavity.

  8. Ultimate Bound of a 3D Chaotic System and Its Application in Chaos Synchronization

    Directory of Open Access Journals (Sweden)

    Jiezhi Wang


    Full Text Available Two ellipsoidal ultimate boundary regions of a special three-dimensional (3D chaotic system are proposed. To this chaotic system, the linear coefficient of the ith state variable in the ith state equation has the same sign; it also has two one-order terms and one quadratic cross-product term in each equation. A numerical solution and an analytical expression of the ultimate bounds are received. To get the analytical expression of the ultimate boundary region, a new result of one maximum optimization question is proved. The corresponding ultimate boundary regions are demonstrated through numerical simulations. Utilizing the bounds obtained, a linear controller is proposed to achieve the complete chaos synchronization. Numerical simulation exhibits the feasibility of the designed scheme.

  9. [Deniss Hanovs, Valdis Tēraudkalns: Ultimate Freedom - no choice] / Olaf Mertelsmann

    Index Scriptorium Estoniae

    Mertelsmann, Olaf, 1969-


    Arvustus: Deniss Hanovs, Valdis Tēraudkalns: Ultimate Freedom - no choice. The culture of authoritarianism in Latvia, 1934-1940. (Central and Eastern Europe. Reginal perspectives in global context, Bd. 2.) Brill. Leiden-Boston 2013

  10. Gastrointestinal Surgery of Neuroendocrine Neoplasms

    DEFF Research Database (Denmark)

    Hansen, Carsten Palnæs; Olsen, Ingrid Marie Holst; Knigge, Ulrich


    Surgery is the only treatment that may cure the patient with gastroenteropancreatic (GEP) neuroendocrine neoplasms (NENs) and should always be considered as the first-line treatment if radical resection can be achieved. Even in cases where radical surgery is not possible, palliative resection may...... be performed to reduce local or hormone-induced symptoms and to improve quality of life. The surgical procedures for GEP-NENs are accordingly described below. In most patients life-long follow-up is required, even following radical surgery, as recurrence may occur several years later....

  11. Sources of medical error in refractive surgery. (United States)

    Moshirfar, Majid; Simpson, Rachel G; Dave, Sonal B; Christiansen, Steven M; Edmonds, Jason N; Culbertson, William W; Pascucci, Stephen E; Sher, Neal A; Cano, David B; Trattler, William B


    To evaluate the causes of laser programming errors in refractive surgery and outcomes in these cases. In this multicenter, retrospective chart review, 22 eyes of 18 patients who had incorrect data entered into the refractive laser computer system at the time of treatment were evaluated. Cases were analyzed to uncover the etiology of these errors, patient follow-up treatments, and final outcomes. The results were used to identify potential methods to avoid similar errors in the future. Every patient experienced compromised uncorrected visual acuity requiring additional intervention, and 7 of 22 eyes (32%) lost corrected distance visual acuity (CDVA) of at least one line. Sixteen patients were suitable candidates for additional surgical correction to address these residual visual symptoms and six were not. Thirteen of 22 eyes (59%) received surgical follow-up treatment; nine eyes were treated with contact lenses. After follow-up treatment, six patients (27%) still had a loss of one line or more of CDVA. Three significant sources of error were identified: errors of cylinder conversion, data entry, and patient identification error. Twenty-seven percent of eyes with laser programming errors ultimately lost one or more lines of CDVA. Patients who underwent surgical revision had better outcomes than those who did not. Many of the mistakes identified were likely avoidable had preventive measures been taken, such as strict adherence to patient verification protocol or rigorous rechecking of treatment parameters. Copyright 2013, SLACK Incorporated.

  12. Recommendation for basis for decision on a Danish ultimate storage for low and intermediate radioactive wastes

    International Nuclear Information System (INIS)


    In 2003 the Danish Parliament consented to let the government start the preparation of a basis for decision on a Danish ultimate storage for low and intermediate radioactive wastes. The present report is the result of the preparation process, and it describes the fundamental safety and environmental principles for establishing an ultimate storage, including determining the principles for the site selection, storage construction, and safety analyses. (LN)

  13. A Technique for Temperature and Ultimate Load Calculations of Thin Targets in a Pulsed Electron Beam

    DEFF Research Database (Denmark)

    Hansen, Jørgen-Walther; Lundsager, Per


    A technique is presented for the calculation of transient temperature distributions and ultimate load of rotationally symmetric thin membranes with uniform lateral load and exposed to a pulsed electron beam from a linear accelerator. Heat transfer by conduction is considered the only transfer...... mechanism. The ultimate load is calculated on the basis of large plastic strain analysis. Analysis of one aluminum and one titanium membrane is shown....

  14. Educational attainment and ultimate fertility among Swedish women born in 1955-59

    Directory of Open Access Journals (Sweden)

    Gerda Neyer


    Full Text Available This is the second of two companion papers addressing the association between educational attainment and fertility for some sixty educational groups of Swedish women, defined according to field of education as well as level of education. The first paper is about childlessness and education, the present one about the mean number of children ever born. We find that ultimate fertility decreases somewhat with an increasing educational level, but its dependence on the field of education is much more impressive. In general, educational groups with relatively little childlessness also have relatively high ultimate fertility, and educational groups with much childlessness have relatively low ultimate fertility. In particular, women educated for the teaching or health-care professions have less childlessness and a higher ultimate fertility than others. Conversely, women with an education for esthetic or (non-teacher humanist occupations have unusually high fractions childless and low ultimate fertility. Women with religious educations stand out by having very high fractions childless but quite ordinary mean ultimate fertility nevertheless; such women have very little childbearing outside of marriage. Women with research degrees have remarkably ordinary childbearing behavior; they do not forego motherhood to the extent that some theories would predict.

  15. Excess glycogen does not resolve high ultimate pH of oxidative muscle. (United States)

    England, Eric M; Matarneh, Sulaiman K; Oliver, Emily M; Apaoblaza, Ariel; Scheffler, Tracy L; Shi, Hao; Gerrard, David E


    Skeletal muscle glycogen content can impact the extent of postmortem pH decline. Compared to glycolytic muscles, oxidative muscles contain lower glycogen levels antemortem which may contribute to the higher ultimate pH. In an effort to explore further the participation of glycogen in postmortem metabolism, we postulated that increasing the availability of glycogen would drive additional pH decline in oxidative muscles to equivalent pH values similar to the ultimate pH of glycolytic muscles. Glycolysis and pH declines were compared in porcine longissimus lumborum (glycolytic) and masseter (oxidative) muscles using an in vitro system in the presence of excess glycogen. The ultimate pH of the system containing longissimus lumborum reached a value similar to that observed in intact muscle. The pH decline of the system containing masseter samples stopped prematurely resulting in a higher ultimate pH which was similar to that of intact masseter muscle. To investigate further, we titrated powdered longissimus lumborum and masseter samples in the reaction buffer. As the percentage of glycolytic sample increased, the ultimate pH decreased. These data show that oxidative muscle produces meat with a high ultimate pH regardless of glycogen content and suggest that inherent muscle factors associated with glycolytic muscle control the extent of pH decline in pig muscles. Copyright © 2015 Elsevier Ltd. All rights reserved.

  16. Assessment on Ultimate Load of Cold-formed Steel Channel (CFSC Stub Column

    Directory of Open Access Journals (Sweden)

    Mohd Sani Mohd Syahrul Hisyam


    Full Text Available Cold-formed steel is used as the non-structural and structural material in civil engineering work and building. Cold-formed steel channel is selected and cut into 100 mm, 200 mm, 300 mm, 400 mm and 500 mm. The slenderness ratio is calculated and noted as a stub or short column because below 40. The column is tested by using Universal Testing Machine to determine the ultimate load of the stub column. Besides, the CFSC is determined the material properties of CFSC for checking it’s the originality of steel based material. The experimental data are tested and compared with the Direct Strength Method (DSM. It showed that the CFSC1 with a height of 100 mm is reported to have a higher value of ultimate load when compared with other samples. When the height of the stub column increased, the ultimate load of the sample is decreased. Then, the CFSC1 also showed a higher in initial stiffness when compared with other samples. All samples are shown having a higher data in ultimate load when compared with the Direct Strength Method prediction. The ultimate load of experimental and DSM all gave a ratio below 1.03. Finally, all samples can further recommend determining the relation between the ultimate loads with variations of height of the column.

  17. Advanced Applications of Robotics in Digestive Surgery (United States)

    Patriti, Alberto; Addeo, Pietro; Buchs, Nicolas; Casciola, Luciano; Morel, Philippe


    Laparoscopy is widely recognized as feasible and safe approach to many oncologic and benign digestive conditions and is associated with an improved early outcome. Robotic surgery promises to overcome intrinsic limitations of laparoscopic surgery by a three-dimensional view and wristed instruments widening indications for a minimally invasive approach. To date, the more interesting applications of robotic surgery are those operations restricted to one abdominal quadrant and requiring a fine dissection and digestive reconstruction. While robot-assisted rectal and gastric surgery are becoming well-accepted options among the surgical community, applications of robotics in hepato-biliary and pancreatic surgery are still debated. PMID:23905029

  18. Emergency surgery for Crohn's disease. (United States)

    Smida, Malek; Miloudi, Nizar; Hefaiedh, Rania; Zaibi, Rabaa


    Surgery has played an essential role in the treatment of Crohn's disease. Emergency can reveal previously unknown complications whose treatment affects prognosis. Indicate the incidence of indications in emergent surgery for Crohn's disease. Specify the types of procedures performed in these cases and assess the Results of emergency surgery for Crohn's disease postoperatively,  in short , medium and long term. Retrospective analysis of collected data of 38 patients, who underwent surgical resection for Crohn's disease during a period of 19 years from 1992 to 2011 at the department of surgery in MONGI SLIM Hospital, and among them 17 patients underwent emergency surgery for Crohn's disease. In addition to socio-demographic characteristics and clinical presentations of our study population, we evaluated the indications, the type of intervention, duration of evolution preoperative and postoperative complications and overall prognosis of the disease. Of the 38 patients with Crohn's disease requiring surgical intervention, 17/38 patients underwent emergency surgery. Crohn's disease was inaugurated by the complications requiring emergency surgery in 11 patients. The mean duration of symptoms prior to surgery was 1.5 year. The most common indication for emergency surgery was acute intestinal obstruction (n=6) followed by perforation and peritonitis (n=5). A misdiagnosis of appendicitis was found in 4 patients and a complicated severe acute colitis for undiagnosed Crohn's disease was found in 2 cases. The open conventional surgery was performed for 15 patients. Ileocolic resection was the most used intervention. There was one perioperative mortality and 5 postoperative morbidities. The mean of postoperative hospital stay was 14 days (range 4-60 days). Six patients required a second operation during the follow-up period. The incidence of emergency surgery for Crohn's disease in our experience was high (17/38 patients), and is not as rare as the published estimates

  19. The Ultimate Pile Bearing Capacity from Conventional and Spectral Analysis of Surface Wave (SASW) Measurements (United States)

    Faizah Bawadi, Nor; Anuar, Shamilah; Rahim, Mustaqqim A.; Mansor, A. Faizal


    A conventional and seismic method for determining the ultimate pile bearing capacity was proposed and compared. The Spectral Analysis of Surface Wave (SASW) method is one of the non-destructive seismic techniques that do not require drilling and sampling of soils, was used in the determination of shear wave velocity (Vs) and damping (D) profile of soil. The soil strength was found to be directly proportional to the Vs and its value has been successfully applied to obtain shallow bearing capacity empirically. A method is proposed in this study to determine the pile bearing capacity using Vs and D measurements for the design of pile and also as an alternative method to verify the bearing capacity from the other conventional methods of evaluation. The objectives of this study are to determine Vs and D profile through frequency response data from SASW measurements and to compare pile bearing capacities obtained from the method carried out and conventional methods. All SASW test arrays were conducted near the borehole and location of conventional pile load tests. In obtaining skin and end bearing pile resistance, the Hardin and Drnevich equation has been used with reference strains obtained from the method proposed by Abbiss. Back analysis results of pile bearing capacities from SASW were found to be 18981 kN and 4947 kN compared to 18014 kN and 4633 kN of IPLT with differences of 5% and 6% for Damansara and Kuala Lumpur test sites, respectively. The results of this study indicate that the seismic method proposed in this study has the potential to be used in estimating the pile bearing capacity.

  20. Different Ultimate Factors Define Timing of Breeding in Two Related Species.

    Directory of Open Access Journals (Sweden)

    Veli-Matti Pakanen

    Full Text Available Correct reproductive timing is crucial for fitness. Breeding phenology even in similar species can differ due to different selective pressures on the timing of reproduction. These selection pressures define species' responses to warming springs. The temporal match-mismatch hypothesis suggests that timing of breeding in animals is selected to match with food availability (synchrony. Alternatively, time-dependent breeding success (the date hypothesis can result from other seasonally deteriorating ecological conditions such as intra- or interspecific competition or predation. We studied the effects of two ultimate factors on the timing of breeding, synchrony and other time-dependent factors (time-dependence, in sympatric populations of two related forest-dwelling passerine species, the great tit (Parus major and the willow tit (Poecile montanus by modelling recruitment with long-term capture-recapture data. We hypothesized that these two factors have different relevance for fitness in these species. We found that local recruitment in both species showed quadratic relationships with both time-dependence and synchrony. However, the importance of these factors was markedly different between the studied species. Caterpillar food played a predominant role in predicting the timing of breeding of the great tit. In contrast, for the willow tit time-dependence modelled as timing in relation to conspecifics was more important for local recruitment than synchrony. High caterpillar biomass experienced during the pre- and post-fledging periods increased local recruitment of both species. These contrasting results confirm that these species experience different selective pressures upon the timing of breeding, and hence responses to climate change may differ. Detailed information about life-history strategies is required to understand the effects of climate change, even in closely related taxa. The temporal match-mismatch hypothesis should be extended to consider

  1. Assessment of cooling tower (ultimate heat sink) performance in the Byron individual plant examination

    International Nuclear Information System (INIS)

    Campbell, H.D.; Hawley, J.T.; Klopp, G.T.; Thelen, W.A.


    A time-dependent model of the Byron Nuclear Generation Station safety-related cooling towers has been developed for use with the Byron PRA (IPE). The model can either be run in a stand-alone program with externally supplied heat loads, or can be directly coupled into MAAP (Modular Accident Analysis Program). The primary feature of the model is a careful tracking of the basin temperature through the progression of different severe accidents. Heat removal rates from containment, both from containment fan-coolers and the residual heat removal system, are determined by the feed-back of this time-varying return temperature. Also, the inventory of the basin is tracked in time, and this is controlled by make-up, evaporative losses due to the heat load supplied to the towers, and the possibility of unsecured blowdown. The model has been used to determine the overall capabilities and vulnerabilities of the Byron Ultimate Heat Sink (UHS). It was determined that the UHS is very reliable with respect to maintaining acceptably low basin temperatures, requiring only at most two of eight operating cooling tower fans. Further, when the two units have their Essential Service Water (ESW) systems cross-tied, one of four ESW operating pumps is sufficient to handle the loads from the accident unit with the other unit proceeding to an orderly shutdown. The major vulnerability of the Byron UHS is shown to be the ability to maintain inventory, although the time-scales for basin dry-out are relatively long, being eight to twenty-one hours, depending upon when blowdown is secured. (author)

  2. Robotic surgery update. (United States)

    Jacobsen, G; Elli, F; Horgan, S


    Minimally invasive surgical techniques have revolutionized the field of surgery. Telesurgical manipulators (robots) and new information technologies strive to improve upon currently available minimally invasive techniques and create new possibilities. A retrospective review of all robotic cases at a single academic medical center from August 2000 until November 2002 was conducted. A comprehensive literature evaluation on robotic surgical technology was also performed. Robotic technology is safely and effectively being applied at our institution. Robotic and information technologies have improved upon minimally invasive surgical techniques and created new opportunities not attainable in open surgery. Robotic technology offers many benefits over traditional minimal access techniques and has been proven safe and effective. Further research is needed to better define the optimal application of this technology. Credentialing and educational requirements also need to be delineated.

  3. Abdominal aortic aneurysm surgery

    DEFF Research Database (Denmark)

    Gefke, K; Schroeder, T V; Thisted, B


    The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553...... patients, 51 (9%) of whom died within the first 48 hours. Of the 502 patients who survived for more than 48 hours, 109 required ICU therapy for more than 48 hours, whereas 393 patients were in the ICU for less than 48 hours. The incidence of preoperative risk factors was similar for the two groups...... combined failed to permit identification of patients in whom the perioperative survival rate was 0%. Even 20% of patients with multiorgan failure survived for 6 months. Of those patients who needed ICU therapy for more than 48 hours, 41 (38%) were alive at the end of 1988. In response to a questionnaire...

  4. Approach to Rectal Cancer Surgery

    Directory of Open Access Journals (Sweden)

    Terence C. Chua


    Full Text Available Rectal cancer is a distinct subset of colorectal cancer where specialized disease-specific management of the primary tumor is required. There have been significant developments in rectal cancer surgery at all stages of disease in particular the introduction of local excision strategies for preinvasive and early cancers, standardized total mesorectal excision for resectable cancers incorporating preoperative short- or long-course chemoradiation to the multimodality sequencing of treatment. Laparoscopic surgery is also increasingly being adopted as the standard rectal cancer surgery approach following expertise of colorectal surgeons in minimally invasive surgery gained from laparoscopic colon resections. In locally advanced and metastatic disease, combining chemoradiation with radical surgery may achieve total eradication of disease and disease control in the pelvis. Evidence for resection of metastases to the liver and lung have been extensively reported in the literature. The role of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal metastases is showing promise in achieving locoregional control of peritoneal dissemination. This paper summarizes the recent developments in approaches to rectal cancer surgery at all these time points of the disease natural history.

  5. Training for single port video assisted thoracoscopic surgery lung resections. (United States)

    McElnay, Philip J; Lim, Eric


    With many surgical training programmes providing less time for training it can be challenging for trainees to acquire the necessary surgical skills to perform complex video assisted thoracoscopic surgery (VATS) lung resections. Indeed as the utilization of single port operations increases the need to approach the operating theatre with already-existing excellent hand-eye coordination skills increases. We suggest that there are a number of ways that trainees can begin to develop these necessary skills. Firstly, using computer games that involve changing horizons and orientations. Secondly, utilizing box-trainers to practice using the thoracoscopic instruments. Thirdly, learning how essential tools such as the stapler work. Trainees will then be able to progress to meaningfully assisting in theatre and indeed learning how to perform the operation themselves. At this stage is useful to observe expert surgeons whilst they operate-to watch both their technical and non-technical skills. Ultimately, surgery is a learned skill and requires implementation of these techniques over a sustained period of time.

  6. Robotic surgery for rectal cancer: current immediate clinical and oncological outcomes. (United States)

    Araujo, Sergio Eduardo Alonso; Seid, Victor Edmond; Klajner, Sidney


    associated to reduced conversion rates. Other short-term outcomes are comparable to conventional laparoscopy techniques, if not better. Ultimately, pathological data evaluation suggests that oncologic safety may be preserved after robotic total mesorectal excision. However, further studies are required to evaluate oncologic safety and functional results.

  7. Ultimate dynamics of the Kirschner-Panetta model: Tumor eradication and related problems (United States)

    Starkov, Konstantin E.; Krishchenko, Alexander P.


    In this paper we consider the ultimate dynamics of the Kirschner-Panetta model which was created for studying the immune response to tumors under special types of immunotherapy. New ultimate upper bounds for compact invariant sets of this model are given, as well as sufficient conditions for the existence of a positively invariant polytope. We establish three types of conditions for the nonexistence of compact invariant sets in the domain of the tumor-cell population. Our main results are two types of conditions for global tumor elimination depending on the ratio between the proliferation rate of the immune cells and their mortality rate. These conditions are described in terms of simple algebraic inequalities imposed on model parameters and treatment parameters. Our theoretical studies of ultimate dynamics are complemented by numerical simulation results.

  8. Revisiting perceptions of quality of hospice care: managing for the ultimate referral. (United States)

    Churchman, Richard; York, Grady S; Woodard, Beth; Wainright, Charles; Rau-Foster, Mary


    Hospice services provided in the final months of life are delivered through complex interpersonal relationships between caregivers, patients, and families. Often, service value and quality are defined by these interpersonal interactions. This understanding provides hospice leaders with an enormous opportunity to create processes that provide the optimal level of care during the last months of life. The authors argue that the ultimate referral is attained when a family member observes the care of a loved one, and the family member conveys a desire to receive the same quality of services their loved one received at that facility. The point of this article is to provide evidence that supports the methods to ultimately enhance the patient's and family's experience and increase the potential for the ultimate referral. © The Author(s) 2013.

  9. Ultimate Owner and Firm Performance - Evidence from Romanian Mining and Quarrying Listed Firms

    Directory of Open Access Journals (Sweden)

    Cosmin MIHAI


    Full Text Available The main objectives of this paper are to describe the necessary steps to identify the ultimate owner and to investigate the relation between the ultimate ownership and the financial performance of Romanian mining and quarrying listed firms. The study was conducted for the companies listed on Bucharest Stock Exchange, in both regulated and non-regulated segments. The final sample included 17 companies of mining and quarrying. Return on Equity was used for measuring the financial performance of the firms. The ultimate ownership was measured by the percentage of voting rights held by a shareholder. Econometric tools like multiple linear regression analysis were used for analysis. The results of the study suggest that there is a significant negative link between financial performance and divergence between voting rights and cash-flow rights.

  10. The importance of mines for ultimate storage at Deilmann-Haniel Shaft Sinking

    International Nuclear Information System (INIS)

    Greinacher, Jochen; Oellers, Thomas; Ahlbrecht, Thomas


    Deilmann-Haniel Shaft Sinking GmbH and its predecessor and associate companies have been involved in projects for underground ultimate storage in Germany, Europe and America for over 45 years. The field of activities previously comprised surveying, planning and sinking of shafts, repair and conversion work, design of underground sealing structures, planning of conveyors and support of the BfS in planning approval procedures. Following discontinuation of activities in the German coal mining industry the use of mines for ultimate storage is an important support for German specialist mining companies. The use of mines for ultimate storage ensures that the existing mining know how in Germany is maintained, because training of the younger generation on the commercial and engineering side of the companies is made possible by the imminent major projects.

  11. Assessment of Ultimate Load Capacity for Pre-Stressed Concrete Containment Vessel Model of PWR Design With BARC Code ULCA

    International Nuclear Information System (INIS)

    Basha, S.M.; Singh, R.K.; Patnaik, R.; Ramanujam, S.; Kushwaha, H.S.; Venkat Raj, V.


    Ultimate load capacity assessment of nuclear containments has been a thrust research area for Indian Pressurised Heavy Water Reactor (PHWR) power programme. For containment safety assessment of Indian PHWRs a finite element code ULCA was developed at BARC, Trombay. This code has been extensively benchmarked with experimental results. The present paper highlights the analysis results for Prestressed Concrete Containment Vessel (PCCV) tested at Sandia National Labs, USA in a Round Robin analysis activity co-sponsored by Nuclear Power Engineering Corporation (NUPEC), Japan and the U.S Nuclear Regulatory Commission (NRC). Three levels of failure pressure predictions namely the upper bound, the most probable and the lower bound (all with 90% confidence) were made as per the requirements of the round robin analysis activity. The most likely failure pressure is predicted to be in the range of 2.95 Pd to 3.15 Pd (Pd= design pressure of 0.39 MPa for the PCCV model) depending on the type of liners used in the construction of the PCCV model. The lower bound value of the ultimate pressure of 2.80 Pd and the upper bound of the ultimate pressure of 3.45 Pd are also predicted from the analysis. These limiting values depend on the assumptions of the analysis for simulating the concrete-tendon interaction and the strain hardening characteristics of the steel members. The experimental test has been recently concluded at Sandia Laboratory and the peak pressure reached during the test is 3.3 Pd that is enveloped by our upper bound prediction of 3.45 Pd and is close to the predicted most likely pressure of 3.15 Pd. (authors)

  12. Abdominal surgery in neonatal foals. (United States)

    Bryant, James E; Gaughan, Earl M


    Abdominal surgery in foals under 30 days old has become more common with improved neonatal care. Early recognition of a foal at risk and better nursing care have increased the survival rates of foals that require neonatal care. The success of improved neonatal care also has increased the need for accurate diagnosis and treatment of gastrointestinal, umbilical, and bladder disorders in these foals. This chapter focuses on the early and accurate diagnosis of specific disorders that require abdominal exploratory surgery and the specific treatment considerations and prognosis for these disorders.

  13. On the decrease of ultimate elongation of gum elastomer by irradiation

    International Nuclear Information System (INIS)

    Ito, Masayuki


    The reason why the ultimate elongation of gum elastomer decreases by irradiation was studied. The sample used is tetrafluoroethylenepropylene copolymer vulcanized which is a heat resistant elastomer. The sample was irradiated by a electron beam at room temperature. Cross-linking predominate in the operation. (Case 1) Scission predominant condition (Case 2) was given by irradiation of Co-60 γ ray at 100 deg C. Alternative irradiation of γ ray and electron beam under above condition can keep the original cross-linking density by the appropriate choice of each of the doses. (Case 3) The three cases mentioned above involve all of the cases of radiation induced aging of elastomers. Therefor, the following explanation for three cases shows the reason why the ultimate elongation of gum elastomer decreases by irradiation. Case 1. Cross-linking predominant condition. Ultimate elongation is proportional to -0.5 power of the dose. This fact can be explicable by the model of Buche, i.e. the breaking of a short chain causes another to break and that so on throughout the whole sample. Case 2. Chain scission predominant condition. Ultimate elongation increases by irradiation for a certain dose. This fact can understand by the model of Buche. But from a certain dose ultimate elongation does not increase. In the period the structure of the sample turned to be the same structure as the low molecular weight amorphose polymer vulcanized. Case 3. Rate of cross-linking and scission is the same. The average chain length does not chainge in the condition. But the distribution of chain length became wider and wider by irradiation. The increase of short chain result the decrease in ultimate elongation. (author)

  14. The Plastic Surgery Hand Curriculum. (United States)

    Silvestre, Jason; Levin, L Scott; Serletti, Joseph M; Chang, Benjamin


    Designing an effective hand rotation for plastic surgery residents is difficult. The authors address this limitation by elucidating the critical components of the hand curriculum during plastic surgery residency. Hand questions on the Plastic Surgery In-Service Training Exam for six consecutive years (2008 to 2013) were characterized by presence of imaging, vignette setting, question taxonomy, answer domain, anatomy, and topic. Answer references were quantified by source and year of publication. Two hundred sixty-six questions were related to hand surgery (22.7 percent of all questions; 44.3 per year) and 61 were accompanied by an image (22.9 percent). Vignettes tended to be clinic- (50.0 percent) and emergency room-based (35.3 percent) (p < 0.001). Questions required decision-making (60.5 percent) over interpretation (25.9 percent) and recall skills (13.5 percent) (p < 0.001). Answers focused on interventions (57.5 percent) over anatomy/pathology (25.2 percent) and diagnoses (17.3 percent) (p < 0.001). Nearly half of the questions focused on the digits. The highest yield topics were trauma (35.3 percent), reconstruction (24.4 percent), and aesthetic and functional problems (14.2 percent). The Journal of Hand Surgery (American volume) (20.5 percent) and Plastic and Reconstructive Surgery (18.0 percent) were the most-cited journals, and the median publication lag was 7 years. Green's Operative Hand Surgery was the most-referenced textbook (41.8 percent). These results will enable trainees to study hand surgery topics with greater efficiency. Faculty can use these results to ensure that tested topics are covered during residency training. Thus, a benchmark is established to improve didactic, clinical, and operative experiences in hand surgery.

  15. Ultimate strength and ductility of steel reinforced concrete beam-columns

    International Nuclear Information System (INIS)

    Shohara, Ryoichi


    The ultimate strength and ductility of SRC beam-columns are investigated using the data gathered in Architectural Institute of Japan. Though the simple superposed strength formula in AIJ standard underestimates the strength of SRC beam-column failed in flexure, the generalized superposed strength formula estimates it satisfactory. The strength formula in AIJ standard does not good agreement with test data. The SRC beam-column failed in shear has almost equalductility with that failed in flexure owing to the encased steel. Author presents the formulas which estimate the ultimate deformation angle for SRC beam-columns. (author)

  16. Maintained ship hull girder ultimate strength reliability considering corrosion and fatigue

    DEFF Research Database (Denmark)

    Hu, Yong; Cui, W.; Pedersen, Preben Terndrup


    The prupose of this paper is to propose a methodology to assess the time-variant ultimate strength of ship hull girder under the degradations of corrosion and fatigue. The effects of fatigue cracks on the tensile and compressive residual ultimate strength of stiffened panels and unstiffened plates......, webs and flanges, respectively. The effects of inspections and repair are taken into account. A minimum net thickness rule is used to determine repair policies. A procedure is proposed to determine the maximum allowable corrosion thickness of different parts of the hull cross section. The procedure...

  17. Behaviour of concrete nuclear containment structures upto ultimate failure with special reference to MAPP-1 containment

    International Nuclear Information System (INIS)

    Appa Rao, T.V.S.R.


    Theoretical and experimental methods for investigating the behaviour of concrete secondary containment structures subjected to loads upto their ultimate failure have been discussed in the paper. Need for inelastic nonlinear analysis of containments has been emphasized. Different contitutive models of concrete that can be employed in the nonlinear analysis of concrete structures were briefly reviewed. Based on the experimental results obtained in a 1:12 scale model test conducted at the Structural Engineering Research (Regional) Centre, Madras, behaviour of the MAPP-1 containment to internal pressure loading upto its ultimate failure has been discussed. (author)

  18. Decision basis for a Danish ultimate storage for low and intermediate radioactive wastes

    International Nuclear Information System (INIS)


    In 2003 the Danish Parliament consented to let the government start the preparation of a basis for decision on a Danish ultimate storage for low and intermediate radioactive wastes. The present report was prepared by a working group and it presents the final proposal for such a decision basis. The report describes the fundamental safety and environmental principles for establishing an ultimate storage, including determining the principles for site selection, storage construction, and safety analysis. In an appendix, the amount, types, and activity level of the Danish radioactive wastes are presented. (ln)

  19. Cochlear implant revision surgeries in children. (United States)

    Amaral, Maria Stella Arantes do; Reis, Ana Cláudia Mirândola B; Massuda, Eduardo T; Hyppolito, Miguel Angelo


    The surgery during which the cochlear implant internal device is implanted is not entirely free of risks and may produce problems that will require revision surgeries. To verify the indications for cochlear implantation revision surgery for the cochlear implant internal device, its effectiveness and its correlation with certain variables related to language and hearing. A retrospective study of patients under 18 years submitted to cochlear implant Surgery from 2004 to 2015 in a public hospital in Brazil. Data collected were: age at the time of implantation, gender, etiology of the hearing loss, audiological and oral language characteristics of each patient before and after Cochlear Implant surgery and any need for surgical revision and the reason for it. Two hundred and sixty-five surgeries were performed in 236 patients. Eight patients received a bilateral cochlear implant and 10 patients required revision surgery. Thirty-two surgeries were necessary for these 10 children (1 bilateral cochlear implant), of which 21 were revision surgeries. In 2 children, cochlear implant removal was necessary, without reimplantation, one with cochlear malformation due to incomplete partition type I and another due to trauma. With respect to the cause for revision surgery, of the 8 children who were successfully reimplanted, four had cochlear calcification following meningitis, one followed trauma, one exhibited a facial nerve malformation, one experienced a failure of the cochlear implant internal device and one revision surgery was necessary because the electrode was twisted. The incidence of the cochlear implant revision surgery was 4.23%. The period following the revision surgeries revealed an improvement in the subject's hearing and language performance, indicating that these surgeries are valid in most cases. Copyright © 2018 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  20. Tennis elbow surgery - discharge (United States)

    ... epicondylitis surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... long as you are told. This helps ensure tennis elbow will not return. You may be prescribed a ...

  1. Lung surgery - discharge (United States)

    ... Lung biopsy - discharge; Thoracoscopy - discharge; Video-assisted thoracoscopic surgery - discharge; VATS - discharge ... milk) for 2 weeks after video-assisted thoracoscopic surgery and 6 to 8 weeks after open surgery. ...

  2. Gastric Sleeve Surgery (United States)

    ... Videos for Educators Search English Español Gastric Sleeve Surgery KidsHealth / For Teens / Gastric Sleeve Surgery What's in ... or buying healthy food ) Preparing for Gastric Sleeve Surgery Preparing for this major operation takes months of ...

  3. Hip Replacement Surgery (United States)

    ... Outreach Initiative Breadcrumb Home Health Topics English Español Hip Replacement Surgery Basics In-Depth Download Download EPUB ... PDF What is it? Points To Remember About Hip Replacement Surgery Hip replacement surgery removes damaged or ...

  4. Dental Implant Surgery (United States)

    ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, ... to find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring ...

  5. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, ... to find out more. Wisdom Teeth Management Wisdom Teeth Management An impacted wisdom tooth can damage neighboring ...

  6. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Oral Surgeries Facial Cosmetic Surgery Facial Injury / Trauma Surgery Obstructive Sleep Apnea (OSA) Oral, Head and Neck Pathology TMJ and Facial Pain Wisdom Teeth Management Procedures Anesthesia Anesthesia Oral and maxillofacial surgeons are ...

  7. Simplified Model Surgery Technique for Segmental Maxillary Surgeries

    Directory of Open Access Journals (Sweden)

    Namit Nagar


    Full Text Available Model surgery is the dental cast version of cephalometric prediction of surgical results. Patients having vertical maxillary excess with prognathism invariably require Lefort I osteotomy with maxillary segmentation and maxillary first premolar extractions during surgery. Traditionally, model surgeries in these cases have been done by sawing the model through the first premolar interproximal area and removing that segment. This clinical innovation employed the use of X-ray film strips as separators in maxillary first premolar interproximal area. The method advocated is a time-saving procedure where no special clinical or laboratory tools, such as plaster saw (with accompanying plaster dust, were required and reusable separators were made from old and discarded X-ray films.


    African Journals Online (AJOL)

    presentation.2 Promptly and accurately diagnosing and treating appendicitis has its complexities. ... and lower gastrointestinal bleeding, pancreatitis, appendicitis, burns wounds and basic chronic vascular pathology. Patients requiring care ...


    African Journals Online (AJOL)

    establish the incidence, causes, intervention required and outcome. Methods: All ... Pancreatic fistula was classified according to the International Study. Group of ... necrosis. Conclusion: Severe PPH is associated with substantial morbidity.

  10. Advantages of robotics in benign gynecologic surgery. (United States)

    Truong, Mireille; Kim, Jin Hee; Scheib, Stacey; Patzkowsky, Kristin


    gynecologic surgery. Conclusions on the benefits and risks of robotic surgery should be made with caution given limited data, especially when compared with other routes. Route of surgery selection should take into consideration the surgeons' skill and comfort level that allows for the highest level of safety and efficiency. Ultimately, the robotic device is an additional minimally invasive surgical tool that can further the goal of minimizing laparotomy in gynecology.

  11. Revisional Bariatric Surgery. (United States)

    Switzer, Noah J; Karmali, Shahzeer; Gill, Richdeep S; Sherman, Vadim


    Revisional bariatric procedures are increasingly common. With more primary procedures being performed to manage severe obesity and its complications, 5% to 8% of these procedures will fail, requiring revisional operation. Reasons for revisional bariatric surgery are either primary inadequate weight loss, defined as less than 25% excess body weight loss, or weight recidivism, defined as a gain of more than 10 kg based on the nadir weight; however, each procedure also has inherit specific complications that can also be indications for revision. This article reviews the history of each primary bariatric procedure, indications for revision, surgical options, and subsequent outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Breast Reduction Surgery (United States)

    ... considering breast reduction surgery, consult a board-certified plastic surgeon. It's important to understand what breast reduction surgery entails — including possible risks and complications — as ...

  13. Prediction of Local Ultimate Strain and Toughness of Trabecular Bone Tissue by Raman Material Composition Analysis

    Directory of Open Access Journals (Sweden)

    Roberto Carretta


    Full Text Available Clinical studies indicate that bone mineral density correlates with fracture risk at the population level but does not correlate with individual fracture risk well. Current research aims to better understand the failure mechanism of bone and to identify key determinants of bone quality, thus improving fracture risk prediction. To get a better understanding of bone strength, it is important to analyze tissue-level properties not influenced by macro- or microarchitectural factors. The aim of this pilot study was to identify whether and to what extent material properties are correlated with mechanical properties at the tissue level. The influence of macro- or microarchitectural factors was excluded by testing individual trabeculae. Previously reported data of mechanical parameters measured in single trabeculae under tension and bending and its compositional properties measured by Raman spectroscopy was evaluated. Linear and multivariate regressions show that bone matrix quality but not quantity was significantly and independently correlated with the tissue-level ultimate strain and postyield work (r=0.65–0.94. Principal component analysis extracted three independent components explaining 86% of the total variance, representing elastic, yield, and ultimate components according to the included mechanical parameters. Some matrix parameters were both included in the ultimate component, indicating that the variation in ultimate strain and postyield work could be largely explained by Raman-derived compositional parameters.

  14. Molar mass of poly(ethylene terephthalate) (PET) during ultimate uniaxial drawing

    NARCIS (Netherlands)

    Göschel, U.; Cools, P.J.C.H.


    The changes of the average molar mass Mw, Mn, Mz, and molar mass distributions during multistep uniaxial drawing of poly(ethylene terephthalate) (PET) to achieve ultimate mechanical properties have been studied in detail by means of size exclusion chromatography (SEC) with triple detection:

  15. Molar-Mass of Poly(Ethylene-Terephthalate) (PET) During Ultimate Uniaxial Drawing

    NARCIS (Netherlands)

    Göschel, A.G.P.U.; Cools, P.J.C.H.


    The changes of the average molar mass Mw, Mn, Mz, and molar mass distributions during multistep uniaxial drawing of poly(ethylene terephthalate) (PET) to achieve ultimate mechanical properties have been studied in detail by means of size exclusion chromatography (SEC) with triple detection:

  16. Prisoner Fasting as Symbolic Speech: The Ultimate Speech-Action Test. (United States)

    Sneed, Don; Stonecipher, Harry W.

    The ultimate test of the speech-action dichotomy, as it relates to symbolic speech to be considered by the courts, may be the fasting of prison inmates who use hunger strikes to protest the conditions of their confinement or to make political statements. While hunger strikes have been utilized by prisoners for years as a means of protest, it was…

  17. Reliability analysis of production ships with emphasis on load combination and ultimate strength

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Xiaozhi


    This thesis deals with ultimate strength and reliability analysis of offshore production ships, accounting for stochastic load combinations, using a typical North Sea production ship for reference. A review of methods for structural reliability analysis is presented. Probabilistic methods are established for the still water and vertical wave bending moments. Linear stress analysis of a midships transverse frame is carried out, four different finite element models are assessed. Upon verification of the general finite element code ABAQUS with a typical ship transverse girder example, for which test results are available, ultimate strength analysis of the reference transverse frame is made to obtain the ultimate load factors associated with the specified pressure loads in Det norske Veritas Classification rules for ships and rules for production vessels. Reliability analysis is performed to develop appropriate design criteria for the transverse structure. It is found that the transverse frame failure mode does not seem to contribute to the system collapse. Ultimate strength analysis of the longitudinally stiffened panels is performed, accounting for the combined biaxial and lateral loading. Reliability based design of the longitudinally stiffened bottom and deck panels is accomplished regarding the collapse mode under combined biaxial and lateral loads. 107 refs., 76 refs., 37 tabs.

  18. Magnetic surfaces, particle orbits and neutral injection in conventional and ultimate torsatrons

    International Nuclear Information System (INIS)

    Anderson, D.T.; Derr, J.A.; Kruckewitt, T.; Shohet, J.L.; Rehker, S.; Tataronis, J.A.


    Capabilities in fully non-axisymmetric numerical methods have resulted in a parametric study of various conventional and ultimate torsatron configurations. No superbananas are found in torsatrons without local magnetic wells. Neutral injection calculations show that, if the vacuum magnetic surfaces are well defined, tangential injection is very efficient

  19. Study of ultimate heat sink to Angra-1,2 and 3 Nuclear Power Plants

    International Nuclear Information System (INIS)

    Moreira, R.M.; Pinto, A.M.F.


    This report presents the premises, results and conclusion of study done to ultimate heat sink of Angra 1,2 and 3 units, with base in postulated accidents that generate transient heat discharges to environment. It's explicitily presumed the eventuality of discharging heat water recirculation. (C.M.) [pt

  20. Method for ultimate disposition of borate containing radioactive wastes by vitrification

    International Nuclear Information System (INIS)

    Bege, D.; Faust, H.J.; Puthawala, A.; Stunkel, H.


    Method for the ultimate disposition of radioactive wastes by vitrification, in which weak to medium radioactive waste concentrates from borate-containing radioactive liquids are mixed with added glass-forming materials, maximally in a ratio of 1:3, and the mixture heated to obtain a glass-forming melt

  1. 26 CFR 48.6427-10 - Kerosene; claims by registered ultimate vendors (blocked pumps). (United States)


    ... (blocked pumps). 48.6427-10 Section 48.6427-10 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE...; claims by registered ultimate vendors (blocked pumps). (a) Overview. This section provides rules under... allowed by section 6427(l)(5)(B)(i). These claims relate to kerosene sold from a blocked pump. Claims...

  2. Discussion of the Method to Determine the Ultimate Bearing Capacity of Soil Foundation (United States)

    Du, Peng; Liu, Xiaoling; Zhang, Yangfu


    Combining literature examples, this paper has carried out Contrastive analysis of the theoretical formula method and finite element method about the ultimate bearing capacity of foundation, To verify rationality and superiority of the incremental load method in finite element ABAQUS in solving the bearing capacity of foundation soil. The study can provide certain reference for practical engineering calculation and analysis of foundation bearing capacity.

  3. Too many journals? Towards a theory of repeated rejections and ultimate acceptance

    NARCIS (Netherlands)

    Oosterhaven, Jan

    Under a set of reasonable assumptions, it is shown that all manuscripts submitted to any journal will ultimately be published, either by the first journal or by one of the following journals to which a manuscript is resubmitted. This suggests that low quality manuscripts may also be published, which

  4. proximate and ultimate analysis of fuel pellets from oil palm residues

    African Journals Online (AJOL)


    Keywords: Oil Palm Residues, Fuel Pellets, Proximate Analysis, Ultimate Analysis. 1. INTRODUCTION ... Pelletizing of this biomass resources into pellets is a way of ensuring a ... demand for pellets [3], and alternative feed-stocks such as palm kernel ... agro-residues, selection of the best pellets has to be made based on ...

  5. Factors influencing career choice after initial training in surgery.

    LENUS (Irish Health Repository)

    McHugh, Seamus


    Irish general surgery faces a recruitment crisis with only 87 of 145 (60%) basic surgical training (BST) places filled in 2009. We assessed basic surgical trainees to identify objective, and potentially modifiable, factors that influence ultimate recruitment into a general surgical career.

  6. Bone Metabolism after Bariatric Surgery (United States)

    Yu, Elaine W.


    Bariatric surgery is a popular and effective treatment for severe obesity, but may have negative effects on the skeleton. This review summarizes changes in bone density and bone metabolism from animal and clinical studies of bariatric surgery, with specific attention to Roux-en-Y gastric bypass (RYGB), adjustable gastric banding (AGB), and sleeve gastrectomy (SG). Skeletal imaging artifacts from obesity and weight loss are also considered. Despite challenges in bone density imaging, the preponderance of evidence suggests that bariatric surgery procedures have negative skeletal effects that persist beyond the first year of surgery, and that these effects vary by surgical type. The long-term clinical implications and current clinical recommendations are presented. Further study is required to determine mechanisms of bone loss after bariatric surgery. Although early studies focused on calcium/vitamin D metabolism and mechanical unloading of the skeleton, it seems likely that surgically-induced changes in the hormonal and metabolic profile may be responsible for the skeletal phenotypes observed after bariatric surgery. PMID:24677277

  7. Factors Influencing American Plastic Surgery Residents Toward an Academic Career. (United States)

    Chetta, Matthew D; Sugg, Kristoffer B; Diaz-Garcia, Rafael J; Kasten, Steven J


    Plastic surgery residency program directors have an interest in recruiting applicants who show an interest in an academic practice. Medical school achievements (ie, United States Medical Licensing Examination® scores, publications, and Alpha Omega Alpha status) are metrics assessed to grade applicants but may not correlate with ultimately choosing an academic career. This study was designed to investigate factors influencing residents' choices for or against academic careers. A 25-item online questionnaire was designed to measure baseline interest in academic plastic surgery and factors that influence decisions to continue on or abandon that career path. This questionnaire was disseminated to the integrated/combined plastic surgery residents during the 2013 to 2014 academic year. One hundred twenty-five respondents indicated that they were currently interested in pursuing academic practice (n = 78) or had lost interest in academic practice (n = 47). Among all respondents, 92.8% (n = 116) stated they were interested in academic careers at the time of residency application, but one-third (n = 41) subsequently lost interest. Those residents who retained interest in academic careers indicated resident/medical student educational opportunities (57%) and complexity of patients (52%) as reasons. Those who lost interest cited a lack of autonomy (43%), publishing requirements (32%), and income discrepancy (26%) as reasons. Many residents report losing interest in academics during residency. Traditional metrics valued in the recruitment process may not serve as positive predictors of an academic career path. Reasons why residents lose interest are not easily correctable, but mentorship, adequate career counseling, and research opportunities during training remain factors that can be addressed across all residency programs.

  8. The alcohol patient and surgery

    DEFF Research Database (Denmark)

    Tønnesen, H


    Alcohol abusers have a threefold increased risk of post-operative morbidity after surgery. The most frequent complications are infections, cardiopulmonary insufficiency, and bleeding episodes. Pathogenesis is suppressed immune capacity, subclinical cardiac dysfunction, and haemostatic imbalance....... The economic implications of alcohol abuse in surgical patients are tremendous. Interventional studies are required to reduce future increases in post-operative morbidity....

  9. Conventional surgery in breast cancer

    International Nuclear Information System (INIS)

    Tapia Herrera, Andres


    General aspects of breast cancer were described from the epidemiological point of view, clinical and pathological, as well as its impact at global and national levels. Parenchyma conservative surgery and/or breast skin was analyzed exhaustively as a cancer treatment analyzed exhaustively, to your specifications, requirements, technical aspects, risks, benefits, degree of oncological safety and benefits for patients [es

  10. Achalasia: Dilation, Injection or Surgery?


    Peracchia, Alberto; Bonavina, Luigi


    Achalasia results from irreversible alterations of the esophageal myenteric plexus. The target of treatment in this setting is to reduce lower esophageal sphincter resistance to passage of the bolus. Definitive treatment of the disease requires pneumatic dilation or Heller myotomy. Although no controlled studies comparing modern endoscopic and surgical techniques are available, laparoscopic surgery is emerging as the initial intervention of choice.

  11. Use of an integrated containment and ultimate heat sink (UHS) response approach to evaluate nuclear power plant modifications

    International Nuclear Information System (INIS)

    Wetzel, M.C.; Vieira, A.T.; Patton, D.C.


    Detailed containment and Ultimate Heat Sink (UHS) performance evaluations often are required to support major plant modifications, such as power up-rates and steam generator replacements. These UHS and containment pressure and temperature response evaluations are interrelated. Not only is the containment heat load to the UHS a factor in these evaluations, but other heat loads, such as those from the spent fuel pool, may change as a result of the plant modification and impact containment or UHS response. Our experience is that if an integrated containment/UHS response model is developed prior to the feasibility evaluations for such plant modifications, significant savings in engineering hours can be achieved. This paper presents an overview of such a front-end engineering tool that has been developed and used to support engineering evaluations. 3 refs., 2 figs

  12. Surgery for achalasia: 1998. (United States)

    Shiino, Y; Filipi, C J; Awad, Z T; Tomonaga, T; Marsh, R E


    Technical controversies abound regarding the surgical treatment of achalasia. To determine the value of a concomitant antireflux procedure, the best antireflux procedure, the correct length for gastric myotomy, the optimal surgical approach (thoracic or abdominal), and the equivalency of minimally invasive surgery, a literature review was carried out. The review is based on 23 articles on open transabdominal or transthoracic myotomy, 14 articles on laparoscopic myotomy, and four articles on thoracoscopic myotomy. Postoperative results of traditional open thoracic or transabdominal myotomy as determined by symptomatology were better with fundoplication than without fundoplication. The incidence of postoperative reflux as proved by pH monitoring was high in patients who had an open transabdominal myotomy without fundoplication. The type of antireflux procedure used and the length of gastric myotomy had little effect on results. The results of transthoracic Heller myotomy do not require a concomitant fundoplication. Laparoscopic and thoracoscopic myotomy had excellent results at short-term follow-up. A fundoplication must be added if the myotomy is performed transabdominally. A randomized prospective study is required to determine the best fundoplication and the extent of gastric myotomy. Although minimally invasive surgery for achalasia has excellent initial results, longer follow-up in a larger population of patients is needed.

  13. Efficacy of the Danish epilepsy surgery programme

    DEFF Research Database (Denmark)

    Holm, E; Foged, M T; Beniczky, S


    lobe after ICR were free of disabling seizures. 12% of MTLE patients developed de novo depression after epilepsy surgery despite good surgical outcome. Three patients required rehabilitation due to post-operative hemiplegia. CONCLUSION: The outcomes of the Danish epilepsy surgery programme align...... epilepsy surgery programme from 2009 to 2014. MATERIAL AND METHODS: A total of 169 consecutive patients, operated at Rigshospitalet, were included. Information was gathered from digital patient records. Before 1-year follow-up, two patients were lost to follow-up and three were referred to new surgery...

  14. Importance of Functional Airway Surgery in Orthognathic Surgery Performed Patients

    Directory of Open Access Journals (Sweden)

    Erkan Yüce


    Full Text Available Le Fort I osteotomy is usually combined with mandibular ramus procedures (sagittal split in order to correct dentofacial deformities that cause malocclusion. Patients who have dentofacial anomalies involving the maxilla carry a higher risk of difficulty in breathing due to septal deviation and inferior turbinate hypertrophy. If these conditions are ignored preoperatively, severe airway problems may come up after orthognathic surgery. A detailed examination regarding nasal airway should be conducted in such patients, and they should be informed about their condition which may require an additional intervention during or after their main surgery.

  15. Hernia inguinal laparoscopic surgery

    International Nuclear Information System (INIS)

    Morelli Brum, R. . E mail:


    The purpose of this paper is to enhance treatment of inguinal hernia through a bibliographic study of its main complications and the analysis of a retrospective series of laparoscopic restorations performed by the author in the same private medical care center. From December 1994 through July 2003, ninety-nine patients were operated in 108 procedures.The technique employed was trans-abdominal peritoneal (TAPP)Follow-up covered over 2 years in 80% of patients with a relapse of 2.8%. Main morbidity was neuralgia due to a nerve being trapped, which fact required re-intervention.There was no mortality.The conclusion arrived at is that it is and excellent technique which requires a long learning curve and its main indication would be relapse of conventional surgery, bilateralism, coexistence with another laparoscopic abdominal pathology and doubts concerning contra lateral hernia

  16. Cost-Benefit Performance Simulation of Robot-Assisted Thoracic Surgery As Required for Financial Viability under the 2016 Revised Reimbursement Paradigm of the Japanese National Health Insurance System. (United States)

    Kajiwara, Naohiro; Kato, Yasufumi; Hagiwara, Masaru; Kakihana, Masatoshi; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko


    To discuss the cost-benefit performance (CBP) and establish a medical fee system for robotic-assisted thoracic surgery (RATS) under the Japanese National Health Insurance System (JNHIS), which is a system not yet firmly established. All management steps for RATS are identical, such as preoperative and postoperative management. This study examines the CBP based on medical fees of RATS under the JNHIS introduced in 2016. Robotic-assisted laparoscopic prostatectomy (RALP) and robotic-assisted partial nephrectomy (RAPN) now receive insurance reimbursement under the category of use of support devices for endoscopic surgery ($5420 and $3485, respectively). If the same standard amount were to be applied to RATS, institutions would need to perform at least 150 or 300 procedures thoracic operation per year to show a positive CBP ($317 per procedure as same of RALP and $130 per procedure as same of RAPN, respectively). Robotic surgery in some areas receives insurance reimbursement for its "supportive" use for endoscopic surgery as for RALP and RAPN. However, at present, it is necessary to perform da Vinci Surgical System Si (dVSi) surgery at least 150-300 times in a year in a given institution to prevent a deficit in income.

  17. Ultimate uniaxial compressive strength of stiffened panel with opening under lateral pressure

    Directory of Open Access Journals (Sweden)

    Chang-Li Yu


    Full Text Available This paper concentrated on the ultimate uniaxial compressive strength of stiffened panel with opening under lateral load and also studied the design-oriented formulae. For this purpose, three series of well executed experiments on longitudinal stiffened panel with rectangular opening subjected to the combined load have been selected as test models. The finite element analysis package, ABAQUS, is used for simulation with considering the large elasticplastic deflection behavior of stiffened panels. The feasibility of the numerical procedure is verified by a good agreement of experimental results and numerical results. More cases studies are executed employing nonlinear finite element method to analyze the influence of design variables on the ultimate strength of stiffened panel with opening under combined pressure. Based on data, two design formulae corresponding to different opening types are fitted, and accuracy of them is illustrated to demonstrate that they could be applied to basic design of practical engineering structure.

  18. The Assessment of the Ultimate Hull Girder Strength of RO-RO Ship after Damages (United States)

    Zubair Muis Alie, Muhammad; Sitepu, Ganding; Izaak Latumahin, Samuel


    Many accidents of Ro-Ro ships happen in Indonesia such as collision and grounding. When the collision or grounding takes place on the Ro-Ro ship, the ultimate strength of hull structure after damage becomes decrease. Car and passenger decks are critical location since collision and/or grounding occur. In the present study, the assessment of the ultimate hull girder strength is conducted. The cross section of Ro-Ro ship is taken to be analyzed. The collision and grounding damages are assumed to be palced on the side and bottom area, respectively. The damages are created by removing the element from the side shell and bottom part. Finally, the result obtained is compared with one another.

  19. Accelerator physics and technology limitations to ultimate energy and luminosity in very large hadron colliders

    Energy Technology Data Exchange (ETDEWEB)

    P. Bauer et al.


    The following presents a study of the accelerator physics and technology limitations to ultimate energy and luminosity in very large hadron colliders (VLHCs). The main accelerator physics limitations to ultimate energy and luminosity in future energy frontier hadron colliders are synchrotron radiation (SR) power, proton-collision debris power in the interaction regions (IR), number of events-per-crossing, stored energy per beam and beam-stability [1]. Quantitative estimates of these limits were made and translated into scaling laws that could be inscribed into the particle energy versus machine size plane to delimit the boundaries for possible VLHCs. Eventually, accelerator simulations were performed to obtain the maximum achievable luminosities within these boundaries. Although this study aimed at investigating a general VLHC, it was unavoidable to refer in some instances to the recently studied, [2], 200 TeV center-of-mass energy VLHC stage-2 design (VLHC-2). A more thorough rendering of this work can be found in [3].

  20. Evaluation of time-accelerated irradiation method of elastomer by modulus-ultimate elongation profile

    International Nuclear Information System (INIS)

    Ito, Masayuki; Oka, Toshitaka; Hama, Yosimasa


    'Generalized modulus-ultimate elongation profile' was induced from the relationship between the modulus and the ultimate elongation of an elastomer that was quantitatively added crosslinking and scission. This profile can be used to evaluate the time-accelerated irradiation methods of ethylene-propylene-diene elastomer. The irradiation under low dose rate (0.33 kGy/h) at room temperature was the reference condition. The short-time irradiation condition was 4.2 kGy/h in 0.5 MPa oxygen at room temperature and 5.0 kGy/h in air at 70 o C. The former tended to bring about the higher ratio of scission than the reference condition; the latter tended to bring about the higher ratio of crosslinking.

  1. Out-of-plane ultimate shear strength of RC mat-slab foundations

    International Nuclear Information System (INIS)

    Kumagai, Hitoshi; Nukui, Yasushi; Imamura, Akira; Terayama, Takeshi; Hagiwara, Tetsuya; Kojima, Isao


    There have been few studies on the out-of-plane shear in RC mat-slab foundations, and the reasonable method has been demanded to estimate ultimate shear strength of RC mat-slab foundations in the nuclear facilities. In the previous study, the out-of-plane loading tests on the 20 square slab specimens had been performed to collect the fundamental data. In this study, the test results were successfully predicted by 3D non-linear Finite Element Analysis. It has been confirmed that the ultimate shear stress in the slab specimen can be estimated by the Arakawa's formula, which is commonly used to estimate the shear strength of RC beams. (author)

  2. Ultimate analysis of PWR prestressed concrete containment subjected to internal pressure

    International Nuclear Information System (INIS)

    Hu, H.-T.; Lin, Y.-H.


    Numerical analyses are carried out by using the ABAQUS finite element program to predict the ultimate pressure capacity and the failure mode of the PWR prestressed concrete containment at Maanshan nuclear power plant. Material nonlinearity such as concrete cracking, tension stiffening, shear retention, concrete plasticity, yielding of prestressing tendon, yielding of steel reinforcing bar and degradation of material properties due to high temperature are all simulated with proper constitutive models. Geometric nonlinearity due to finite deformation has also been considered. The results of the analysis show that when the prestressed concrete containment fails, extensive cracks take place at the apex of the dome, the junction of the dome and cylinder, and the bottom of the cylinder connecting to the base slab. In addition, the ultimate pressure capacity of the containment is higher than the design pressure by 86%

  3. Nonlinear finite element analysis of nuclear reinforced prestressed concrete containments up to ultimate load capacity

    International Nuclear Information System (INIS)

    Gupta, A.; Singh, R.K.; Kushwaha, H.S.; Mahajan, S.C.; Kakodkar, A.


    For safety evaluation of nuclear structures a finite element code ULCA (Ultimate Load Capacity Assessment) has been developed. Eight/nine noded isoparametric quadrilateral plate/shell element with reinforcement as a through thickness discrete but integral smeared layer of the element is presented to analyze reinforced and prestressed concrete structures. Various constitutive models such as crushing, cracking in tension, tension stiffening and rebar yielding are studied and effect of these parameters on the reserve strength of structures is brought out through a number of benchmark tests. A global model is used to analyze the prestressed concrete containment wall of a typical 220 MWe Pressurized Heavy Water Reactor (PHWR) up to its ultimate capacity. This demonstrates the adequacy of Indian PHWR containment design to withstand severe accident loads

  4. Qualtum cosmics-and-chaotics--the ultimate tortoise in physics and modern medicine.

    Directory of Open Access Journals (Sweden)

    Kothari M


    Full Text Available Qualtum cosmics is the qualitative opposite of quantum mechanics. The flip-side of qualtum cosmics is qualtum chaotics, the two governing much of what is seen as inscrutable in medicine. The Ultimate (Last Tortoise is close to Einsteinean idea of a Unified Theory, a single concept that can explain whatsoever there is in physics, (and in medicine, or what have you.

  5. The Influence of Wagon Structure Part Shape Optimization on Ultimate Fatigue Strength


    Milovanović, Vladimir; Živković, Miroslav; Jovičić, Gordana; Živković, Jelena; Kozak, Dražan


    This study investigates how shape optimisation affects the ultimate fatigue strength of a mechanical part. The mechanical part chosen for this investigation is an axle guard of running gear elements of the Hccrrs 2x2 axle car-carrying wagon. The static and fatigue strength analysis procedure according to the UIC 517 standard and numerical methods have been applied. Material properties were determined experimentally and the necessary numerical calculations were performed by using the finite el...

  6. The ultimate safe (US) Reactor: A concept for the third millenium

    International Nuclear Information System (INIS)

    Gat, U.


    The Ultimate Safe (U.S.) Reactor is based on a novel safety concept. Fission products in the reactor are allowed to accumulate only to a level at which they would constitute a harmless source term. Removal of fission products also removes the decay heat - the driving force for the source term. The reactor has no excess criticality and is controlled by the reactivity temperature coefficient. Safety is inherent and passive. Waste is removed from the site promptly

  7. Modeling and simulation of loss of the ultimate heat sink in a typical material testing reactor

    International Nuclear Information System (INIS)

    El-Khatib, Hisham; El-Morshedy, Salah El-Din; Higazy, Maher G.; El-Shazly, Karam


    Highlights: ► A thermal–hydraulic model has been developed to simulate loss of the ultimate heat sink in MTR. ► The model involves three coupled sub-models for core, heat exchanger and cooling tower. ► The model is validated against PARET for steady-state and verified by operation data for transients. ► The model is used to simulate the behavior of the reactor under a loss of the ultimate heat sink. ► The model results are analyzed and discussed. -- Abstract: A thermal–hydraulic model has been developed to simulate loss of the ultimate heat sink in a typical material testing reactor (MTR). The model involves three interactively coupled sub-models for reactor core, heat exchanger and cooling tower. The model is validated against PARET code for steady-state operation and verified by the reactor operation records for transients. Then, the model is used to simulate the thermal–hydraulic behavior of the reactor under a loss of the ultimate heat sink event. The simulation is performed for two operation regimes: regime I representing 11 MW power and three cooling tower cells operated, and regime II representing 22 MW power and six cooling tower cells operated. In regime I, the simulation is performed for 1, 2 and 3 cooling tower cells failed while in regime II, it is performed for 1, 2, 3, 4, 5 and 6 cooling tower cells failed. The simulation is performed under protected conditions where the safety action called power reduction is triggered by reactor protection system to decrease the reactor power by 20% when the coolant inlet temperature to the core reaches 43 °C and scram is triggered if the core inlet temperature reaches 44 °C. The model results are analyzed and discussed.

  8. Tasks of radiation protection in the centralized collection and ultimate disposal of radioactive waste

    International Nuclear Information System (INIS)

    Boerst, F.M.; Fasten, C.; Koerner, W.; Oppermann, U.; Werner, H.J.; Zappe, D.


    In the GDR, the ERAM (Endlager fuer radioaktive Abfaelle, Morsleben), an operating unit of Volkseigenes Kombinat Kernkraftwerke 'Bruno Leuschner' in Greifswald, is responsible for the central collection and ultimate disposal of radioactive waste. From the licensing body's point of view an assessment is given of the legislation for radioactive wastes, especially as to their collection, transport to and handling in the final repository. As a result, some conclusions are drawn concerning future work in this field. 9 tabs., 34 refs. (author)

  9. Effects of urbanization on animal behaviour : patterns, underlying mechanisms and ultimate causes


    Miranda, Ana Catarina Sequeira Nunes Coutinho de


    Human-altered environmental conditions affect many species at the global scale. An extreme form of anthropogenic alteration is the existence and rapid increase of urban areas. A key question is how animals cope with urbanization. In order to live in cities, animals have to adjust their behaviour and life histories to the urban novel environment.The main objectives of this thesis were to investigate (i) the existence of behavioural changes related to the urbanization process, (ii) the ultimate...

  10. Dual characteristics of yield and ultimate strength as applied to two grades of beryllium

    International Nuclear Information System (INIS)

    Priddy, T.G.; Benzley, S.E.; Johnson, R.L.


    Published yield and ultimate biaxial strength data for two grades of beryllium are correlated with the use of a macroscopic failure model. Cross sections of the resulting surfaces in three-dimensional stress space are drawn to illustrate the expected transition from ductile to brittle fracture for triaxial tension states of stress. The usefulness of these models to the prediction of fracture in ductile materials is discussed. 5 tables, 8 figures, 11 references

  11. Numerical Study on Ultimate Behaviour of Bolted End-Plate Steel Connections

    Directory of Open Access Journals (Sweden)

    R.E.S. Ismail

    Full Text Available Abstract Bolted end-plate steel connections have become more popular due to ease of fabrication. This paper presents a three dimension Finite Element Model (FEM, using the multi-purpose software ABAQUS, to study the effect of different geometrical parameters on the ultimate behavior of the connection. The proposed model takes into account material and geometrical non-linearities, initial imperfection, contact between adjacent surfaces and the pretension force in the bolts. The Finite Element results are calibrated with published experimental results ''briefly reviewed in this paper'' and verified that the numerical model can simulate and analyze the overall and detailed behavior of different types of bolted end-plate steel connections. Using verified FEM, parametric study is then carried out to study the ultimate behavior with variations in: bolt diameter, end-plate thickness, length of column stiffener, angle of rib stiffener. The results are examined with respect to the failure modes, the evolution of the resistance, the initial stiffness, and the rotation capacity. Finally, the ultimate behavior of the bolted end-plate steel connection is discussed in detail, and recommendations for the design purpose are made.

  12. Transition to the Ultimate Regime in Two-Dimensional Rayleigh-Bénard Convection (United States)

    Zhu, Xiaojue; Mathai, Varghese; Stevens, Richard J. A. M.; Verzicco, Roberto; Lohse, Detlef


    The possible transition to the so-called ultimate regime, wherein both the bulk and the boundary layers are turbulent, has been an outstanding issue in thermal convection, since the seminal work by Kraichnan [Phys. Fluids 5, 1374 (1962), 10.1063/1.1706533]. Yet, when this transition takes place and how the local flow induces it is not fully understood. Here, by performing two-dimensional simulations of Rayleigh-Bénard turbulence covering six decades in Rayleigh number Ra up to 1 014 for Prandtl number Pr =1 , for the first time in numerical simulations we find the transition to the ultimate regime, namely, at Ra*=1013 . We reveal how the emission of thermal plumes enhances the global heat transport, leading to a steeper increase of the Nusselt number than the classical Malkus scaling Nu ˜Ra1 /3 [Proc. R. Soc. A 225, 196 (1954), 10.1098/rspa.1954.0197]. Beyond the transition, the mean velocity profiles are logarithmic throughout, indicating turbulent boundary layers. In contrast, the temperature profiles are only locally logarithmic, namely, within the regions where plumes are emitted, and where the local Nusselt number has an effective scaling Nu ˜Ra0.38 , corresponding to the effective scaling in the ultimate regime.

  13. Ultimate strength analysis of ring-stiffened cylinders subjected to hydrostatic pressure

    International Nuclear Information System (INIS)

    Park, Chi Mo


    In this study, ultimate strength analysis of ring-stiffened cylinders have been performed, considering the elasto-plastic large deflection. In the elasto-plastic analysis, von Mises yield criteria, the plastic flow theory and the layered approach have been adopted. In order to take into account the follower force effect of the hydrostatic pressure, the incremental load components have been updated at every loading step. As collapse modes, axisymmetric yielding, interframe shell buckling and general buckling are considered, while local buckling of ring-stiffener is not considered. Initial shape imperfection is assumed to be the elastic buckling mode to obtain the lower bound of the ultimate strength. Results of numerical analysis are compared with the experimental results to show the validity of the present approach. It has been drawn that the present numerical results are closely correlated with the experimental results. On the other hand, the effects of initial shape imperfection and condition on the ultimate strength have been investigated. (Author)

  14. Ultimate load design and testing of a cylindrical prestressed concrete vessel

    International Nuclear Information System (INIS)

    Stefanou, G.D.


    The object of this research was to design, construct and test to failure a prestressed concrete pressure vessel model that could be used to investigate the behavior of a full scale structure underworking and ultimate load. The properties and the design of the model was based generally on full scale vessels already constructed to house the nuclear reactors used in atomic power stations. To design the model the ultimate load approach was adopted throughout. All load factors associated with the prestressing have been defined and kept to a minimum in order that the vessel's behavior may be predicted. The tests on the vessel were carried out first on the elastic range to observe its behavior at working load and then at the ultimate range to observe the modes of failure and compare the actual results in both cases with the predicted values. Although full agreement between observed results and predicted values was not obtained, the conclusions drawn from the study were useful for the design of full scale vessels. (author)

  15. Sex reassignment surgery

    Directory of Open Access Journals (Sweden)

    Bižić Marta


    Full Text Available Transsexualism, or gender incongruence, presents a state in which a person's assigned sex at birth conflicts with their psychological gender. It is classified in International Classification of Diseases as F64. Treating these persons require multidisciplinary approach, including psychiatrist, endocrinologist, gynecologist, urologist, plastic and reconstructive surgeon. Genital reconstruction is the final step in transition, and can be performed when all other conditions required by World Professional Association for Transgender Health (WPATH are accomplished. Female to male sex reassignment surgery Several surgical procedures can be done in female to male transsexuals, including mastectomy, removal of female genitalia, metoidioplasty, scrotoplasty with implantation of testicular implants, as well as total phalloplasty. The current operative technique of metoidioplasty comprise the following steps: vaginal removal, the release of the ventral chordee and clitoral ligaments, straightening and lengthening of the clitoris, urethroplasty by combining buccal mucosa graft and genital flaps and scrotoplasty with insertion of testicle prostheses. The goal is to perform all these procedures in one stage, and that makes our team famous worldwide. Metoidioplasty results in excellent cosmetic outcome with completely preserved sensitivity and sexual arousal, enables voiding while standing, but without ability to penetrate due to small size of the neophallus. Considering these advantages, including low complication rate, patients often choose this option. For those who require bigger phallus which enables implantation of penile prosthesis, several surgical techniques have been reported using either available local vascularized tissue or microvascular tissue transfer. However, none of them satisfy all the goals of modern penile construction, i.e. reproducibility, tactile and erogenous sensation, a competent neourethra with a meatus at the top of the neophallus

  16. Reevaluation of needlescopic surgery. (United States)

    Tagaya, Nobumi; Kubota, Keiichi


    Although the use of single-incision laparoscopic surgery (SILS) has spread rapidly, most procedures employ additional needlescopic instruments to ensure safety and shorten the operation time. Therefore, on the basis of results obtained in our department, the present study was conducted to reevaluate the current state of needlescopic surgery (NS) to improve the cosmetic results and postoperative quality of life of patients and to reduce cost and degree of stress on surgeons. Between May 1998 and February 2011, we performed NS in 202 patients. The diagnoses included gallbladder diseases in 151 patients, spontaneous pneumothorax in 11, thyroid tumor and axillary lymph node metastases in 10 patients each, splenic cyst and appendicitis in 4 patients each, idiopathic thrombocytopenic purpura and postoperative abdominal wall hernia in 3 patients each, primary aldosteronism and hepatic cyst in 2 patients each, and adhesional bowel obstruction and gastric stromal tumor in 1 patient each. Under general anesthesia, one 12-mm and tow or three 2- or 3-mm ports were introduced into the operative field. The specimen was retrieved via the 12-mm wound using a plastic bag. The operations were completed in all patients without the need to convert to an open procedure. In 8 (5.3%) of the 151 cholecystectomies, a change to 5-mm instruments was required. There were no perioperative complications. Pertinent technical points included avoidance of direct organ mobilization to minimize injury, rotation of the operating table and utilization of organ gravity to create a better operative field, minimum use of needlescope to ensure safe maneuvering, and improvement of the bi-hand technique. NS is a safe and feasible procedure that allows experienced surgeons to achieve minimally invasive surgery with low morbidity, without the need to convert to a conventional or open procedure.

  17. Minimally invasive single-site surgery for the digestive system: A technological review

    Directory of Open Access Journals (Sweden)

    Dhumane Parag


    Full Text Available Minimally Invasive Single Site (MISS surgery is a better terminology to explain the novel concept of scarless surgery, which is increasingly making its way into clinical practice. But, there are some difficulties. We review the existing technologies for MISS surgery with regards to single-port devices, endoscope and camera, instruments, retractors and also the future perspectives for the evolution of MISS surgery. While we need to move ahead cautiously and wait for the development of appropriate technology, we believe that the "Ultimate form of Minimally Invasive Surgery" will be a hybrid form of MISS surgery and Natural Orifice Transluminal Endoscopic Surgery, complimented by technological innovations from the fields of robotics and computer-assisted surgery.

  18. Total hip and knee replacement surgery results in changes in leukocyte and endothelial markers

    Directory of Open Access Journals (Sweden)

    Maclean Kirsty M


    Full Text Available Abstract Background It is estimated that over 8 million people in the United Kingdom suffer from osteoarthritis. These patients may require orthopaedic surgical intervention to help alleviate their clinical condition. Investigations presented here was to test the hypothesis that total hip replacement (THR and total knee replacement (TKR orthopaedic surgery result in changes to leukocyte and endothelial markers thus increasing inflammatory reactions postoperatively. Methods During this 'pilot study', ten test subjects were all scheduled for THR or TKR elective surgery due to osteoarthritis. Leukocyte concentrations were measured using an automated full blood count analyser. Leukocyte CD11b (Mac-1 and CD62L cell surface expression, intracellular production of H2O2 and elastase were measured as markers of leukocyte function. Von Willebrand factor (vWF and soluble intercellular adhesion molecule-1 (sICAM-1 were measured as markers of endothelial activation. Results The results obtained during this study demonstrate that THR and TKR orthopaedic surgery result in similar changes of leukocyte and endothelial markers, suggestive of increased inflammatory reactions postoperatively. Specifically, THR and TKR surgery resulted in a leukocytosis, this being demonstrated by an increase in the total leukocyte concentration following surgery. Evidence of leukocyte activation was demonstrated by a decrease in CD62L expression and an increase in CD11b expression by neutrophils and monocytes respectively. An increase in the intracellular H2O2 production by neutrophils and monocytes and in the leukocyte elastase concentrations was also evident of leukocyte activation following orthopaedic surgery. With respect to endothelial activation, increases in vWF and sICAM-1 concentrations were demonstrated following surgery. Conclusion In general it appeared that most of the leukocyte and endothelial markers measured during these studies peaked between days 1

  19. 15 CFR Supplement No. 3 to Part 748 - BIS-711, Statement by Ultimate Consignee and Purchaser Instructions (United States)


    ...” include: contractual, franchise, distributor, wholesaler, continuing and regular individual business, etc... persons, other than employees of the ultimate consignee or purchaser, who assisted in the preparation of...

  20. Restoration of the jawline and the neck after bariatric surgery. (United States)

    Sclafani, Anthony P


    Bariatric surgery can result in massive, rapid weight loss. Patients who undergo this surgery can be left with significant facial and neck skin redundancy and may request restorative facial plastic surgery. Optimal results require a thorough understanding of the unique physiologic, metabolic, and anatomic findings in these patients. Modifications of standard rhytidectomy techniques are necessary to suit the specific features of the patient after bariatric surgery.

  1. [Thoracic surgery for patients with bronchial asthma]. (United States)

    Iyoda, A; Satoh, Y


    Thoracic surgery poses a risk for complications in the respiratory system. In particular, for patients with bronchial asthma, we need to care for perioperative complications because it is well known that these patients frequently have respiratory complications after surgery, and they may have bronchial spasms during surgery. If we can get good control of their bronchial asthma, we can usually perform surgery for these patients without limitations. For safe postoperative care, it is desirable that these patients have stable asthma conditions that are well-controlled before surgery, as thoracic surgery requires intrabronchial intubation for anesthesia and sometimes bronchial resection. These stimulations to the bronchus do not provide for good conditions because of the risk of bronchial spasm. Therefore, we should use the same agents that are used to control bronchial asthma if it is already well controlled. If it is not, we have to administer a β₂ stimulator, aminophylline, or steroidal agents for good control. Isoflurane or sevoflurane are effective for the safe control of anesthesia during surgery, and we should use a β₂ stimulator, with or without inhalation, or steroidal agents after surgery. It is important to understand that we can perform thoracic surgery for asthma patients if we can provide perioperative control of bronchial asthma, although these patients still have severe risks.

  2. Ultimate Electrical Means for Severe Accident and Multi Unit Event Management

    International Nuclear Information System (INIS)

    Guisez, Xavier


    Following the Multi Unit Severe Accident that occurred at Fukushima as a result of the tsunami on 11 March 2011, the European Council decided to submit its Nuclear Power Plants to a Stress Test. In Belgium, this Stress Test, named BEST (Belgian Stress Test), was successfully concluded at the end of 2011. Nevertheless, Electrabel decided, in agreement with the Authorities, to start a beyond design basis action plan, with the goal to mitigate the consequences of a Beyond Design Basis Accident and a Multi Unit Event. Consequently, this has led to an improvement of the robustness of its Nuclear Power Plants. Considering the importance of electrical power supply to a nuclear power plant, a significant part of this action plan consisted of setting up a mobile, 'plug and play' method for the electrical power supply to some major safety systems. In order to install this ultimate power supply, three factors were retained as essential. First, important reactor monitoring instrumentation is preserved. Second, core cooling is provided at all times. Finally, systems are easily made operational within a very short delay of time. During normal operation and Design Basis Events, core cooling is provided by High Voltage equipment. However, during high stress circumstances, it is too complex to realize connections on this equipment. Therefore, analysis was performed to realize core cooling with, easier to handle, Low Voltage equipment. These systems are powered by several GenSets, especially designed and manufactured for this application. The outcome of this project are easy to use, ultimate means, that supply electric power to important safety systems in order to drastically reduce the risk of core damage, during a beyond design basis event. Additionally, for all ultimate means, procedures and training modules were developed for the operators. (authors)

  3. [Thymus surgery in a general surgery department]. (United States)

    Mega, Raquel; Coelho, Fátima; Pimentel, Teresa; Ribero, Rui; Matos, Novo de; Araújo, António


    Evaluation of thymectomy cases between 1990-2003, in a General Surgery Department. Evaluation of the therapeutic efficacy in Miastenia Gravis patients. Retrospective study based on evaluation of data from Serviço de Cirurgia, Neurologia and Consult de Neurology processes, between 1990-2003, of 15 patients submitted to total thymectomy. 15 patients, aged 17 to 72, 11 female and 4 male. Miastenia Gravis was the main indication for surgery, for uncontrollable symptoms or suspicion of thymoma. In patients with myasthenia, surgery was accomplish after compensation of symptoms. There weren't post-surgery complications. Pathology were divided in thymic hyperplasia and thymoma. Miastenia patients have there symptoms diminished or stable with reduction or cessation of medical therapy. Miastenia was the most frequent indication for thymectomy. Surgery was good results, with low morbimortality, as long as the protocols are respected.

  4. Ultimate pressures achieved in TiZrV sputter-coated vacuum chambers

    CERN Document Server

    Benvenuti, Cristoforo; Ruzinov, V


    Two metre long, cylindrical vacuum chambers of diameter ranging from 34 to 100 mm, coated with TiZrV getter films by sputtering, have been baked for about 24 h at temperatures from 120 to 250 degrees C. The ultimate pressures achieved after bakeout were found to correspond to the ratio of the pressure gauge degassing to the effective pumping speed provided by the chamber at the location of the gauge. The results covering a pressure range from 10/sup -11/ Torr down to 10 /sup -13/ Torr are presented and discussed. (6 refs).

  5. DHC in Helsinki - The Ultimate Heating and Cooling Solution for a Large Urban Area

    Energy Technology Data Exchange (ETDEWEB)

    Wirgentius, Niko; Riipinen, Marko


    Since the 1950s there has been successful district energy business in Helsinki. It has been the main factor for superior energy efficiency and low CO2 emissions both in heating and cooling as well as providing clean air for the metropolitan area. The system has been grown by commercial basis based on customers' own willingness to select district energy solution. It also provided a profitable energy business to local energy company, Helsinki Energy. Helsinki DHC system is a good example of ultimate urban energy solution that provides benefits for the customer, energy company, metropolitan area and for the whole society as well.

  6. Investigations on the ultimate compressive strength of composite plates with geometrical imperfections

    DEFF Research Database (Denmark)

    Misirlis, K.; Downes, J.; Dow, R.S.


    with initial geometric imperfections. This paper presents the validation of finite element models against a series of plate tests that were performed within this framework and parametric studies that were carried out to identify the effects of geometric imperfections on the ultimate compressive strength......A series of studies has been performed within the MARSTRUCT Network of Excellence on Marine Structures in order to investigate the buckling response of glass fibre reinforced polymer plates. These studies include the fabrication, testing and finite element analysis of a large number of plates...

  7. Lava ultimate resin nano ceramic for CAD/ CAM: customization case study. (United States)

    Koller, M; Arnetzl, G V; Holly, L; Arnetzl, G


    Lava Ultimate Resin Nano Ceramic (RNC) blocks are innovative new CAD/CAM materials that make it possible to achieve superior esthetic results in easy steps. The blocks are made of nano ceramic particles embedded in a highly cured resin matrix. Therefore, composite materials can be used to characterize and adjust resin nano ceramic restorations after milling. The milled RNC restorations can be individualized intra-orally or extra-orally, either before or after insertion. Unlike conventional ceramic restorations, customization and glaze firing is neither necessary nor possible with RNC restorations. This opens up the opportunity for intraoral individualization and adaptation of the restorations.

  8. Reflecting on impact, changes and continuities: restructuring workplace cultures: the ultimate work-family challenge.


    Lewis, Suzan


    Purpose – The purpose of this paper is to reflect on the paper “Restructuring workplace cultures: the ultimate work-family challenge?” is published in Women in Management Review, Vol. 16 No. 1, 2001, pp. 21-9. \\ud \\ud Design/methodology/approach – The impact of the paper is considered within a framework that takes account of national discursive and political contexts in the UK in 2001 and in the present and uses a gendered organisation lens. \\ud \\ud Findings – The 2001 paper demonstrates that...

  9. The legal ensurance of underground ultimate storage of radioactive wastes without risk

    International Nuclear Information System (INIS)

    Prasse, R.


    1. The legal position towards the property owner: a) with a view to the freedom of property claim, b) in the light of the influence of the property owner. 2. The legal position towards the neighbouring property owners: a) resistance rights of the body corporate responsible for the ultimate storage, b) resistance rights of the neighbouring property owner. 3. The legal position towards those authorized to mine: a) mining free minerals, b) mining minerals reserved for the state. 4. The legal position towards prospectors. (orig./HP) [de

  10. Seismic proving test of ultimate piping strength (current status of preliminary tests)

    International Nuclear Information System (INIS)

    Suzuki, K.; Namita, Y.; Abe, H.; Ichihashi, I.; Suzuki, K.; Ishiwata, M.; Fujiwaka, T.; Yokota, H.


    In 1998 Fiscal Year, the 6 year program of piping tests was initiated with the following objectives: i) to clarify the elasto-plastic response and ultimate strength of nuclear piping, ii) to ascertain the seismic safety margin of the current seismic design code for piping, and iii) to assess new allowable stress rules. In order to resolve extensive technical issues before proceeding on to the seismic proving test of a large-scale piping system, a series of preliminary tests of materials, piping components and simplified piping systems is intended. In this paper, the current status of the material tests and the piping component tests is reported. (author)

  11. A New Algorithm for Determining Ultimate Pit Limits Based on Network Optimization


    Ali Asghar Khodayari


    One of the main concerns of the mining industry is to determine ultimate pit limits. Final pit is a collection of blocks, which can be removed with maximum profit while following restrictions on the slope of the mine’s walls. The size, location and final shape of an open-pit are very important in designing the location of waste dumps, stockpiles, processing plants, access roads and other surface facilities as well as in developing a production program. There are numerous methods for designing...

  12. Nutrition Following Pancreatic Surgery (United States)

    ... BACK Contact Us DONATE NOW GENERAL DONATION PURPLESTRIDE Nutrition Following Pancreatic Surgery Home Facing Pancreatic Cancer Living with Pancreatic Cancer Diet and Nutrition Nutrition Following Pancreatic Surgery Ver esta página en ...

  13. Blood donation before surgery (United States)

    ... page: // Blood donation before surgery To use the sharing features on ... team. Related MedlinePlus Health Topics Blood Transfusion and Donation Surgery Browse the Encyclopedia A.D.A.M., ...

  14. Cosmetic ear surgery (United States)

    Otoplasty; Ear pinning; Ear surgery - cosmetic; Ear reshaping; Pinnaplasty ... Cosmetic ear surgery may be done in the surgeon's office, an outpatient clinic, or a hospital. It can be performed under ...

  15. Open heart surgery (United States)

    ... this page: // Open heart surgery To use the sharing features on this ... large arteries connected to the heart. The term "open heart surgery" means that you are connected to a ...

  16. Pediatric heart surgery - discharge (United States)

    ... discharge; Heart valve surgery - children - discharge; Heart surgery - pediatric - discharge; Heart transplant - pediatric - discharge ... Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics . 20th ed. Philadelphia, PA: Elsevier; 2016:chap 434. ...

  17. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... misalignment of jaws and teeth. Surgery can improve chewing, speaking and breathing. While the patient's appearance may ... indicate the need for corrective jaw surgery: Difficulty chewing, or biting food Difficulty swallowing Chronic jaw or ...

  18. Refractive corneal surgery - discharge (United States)

    ... surgery. Avoid contact sports (such as boxing and football) for the first 4 weeks after surgery. DO ... herein should not be used during any medical emergency or for the diagnosis or treatment of any ...

  19. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. ... more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...

  20. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ...

  1. Surgery for pancreatic cancer (United States)

    ... laparoscopically (using a tiny video camera) or using robotic surgery depends on: The extent of the surgery ... by URAC, also known as the American Accreditation HealthCare Commission ( URAC's accreditation program is ...

  2. Anti-reflux surgery (United States)

    ... surgery. You may need another surgery in the future if you develop new reflux symptoms or swallowing ... Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: ...

  3. Blepharoplasty (Eyelid Surgery) (United States)

    ... Blepharoplasty (BLEF-uh-roe-plas-tee) is a type of surgery that repairs droopy eyelids and may involve ... tobacco and drugs. Your expectations. An honest discussion of your hopes and motivation for surgery will help set the stage for ...

  4. Smoking and surgery (United States)

    Surgery - quitting smoking; Surgery - quitting tobacco; Wound healing - smoking ... Tar, nicotine, and other chemicals from smoking can increase your risk of many health problems. These include heart and blood vessel problems, such as: Blood clots and aneurysms in ...

  5. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Jaw Surgery Download Download the ebook for further information Corrective jaw, or orthognathic surgery is performed by ... your treatment. Correction of Common Dentofacial Deformities ​ ​ The information provided here is not intended as a substitute ...

  6. Cosmetic breast surgery - discharge (United States)

    ... this page: // Cosmetic breast surgery - discharge To use the sharing features on this page, please enable JavaScript. You had cosmetic breast surgery to change the size or shape ...

  7. Shoulder surgery - discharge (United States)

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  8. Weight Loss Surgery (United States)

    Weight loss surgery helps people with extreme obesity to lose weight. It may be an option if you cannot lose weight ... obesity. There are different types of weight loss surgery. They often limit the amount of food you ...

  9. Robotic liver surgery (United States)

    Leung, Universe


    Robotic surgery is an evolving technology that has been successfully applied to a number of surgical specialties, but its use in liver surgery has so far been limited. In this review article we discuss the challenges of minimally invasive liver surgery, the pros and cons of robotics, the evolution of medical robots, and the potentials in applying this technology to liver surgery. The current data in the literature are also presented. PMID:25392840

  10. Breast Cancer Surgery (United States)

    FACTS FOR LIFE Breast Cancer Surgery The goal of breast cancer surgery is to remove the whole tumor from the breast. Some lymph nodes ... might still be in the body. Types of breast cancer surgery There are two types of breast cancer ...

  11. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... their surgery, orthognathic surgery is performed to correct functional problems. Jaw Surgery can have a dramatic effect on many aspects of life. Following are some of the conditions that may ... front, or side Facial injury Birth defects Receding lower jaw and ...

  12. Pediatric heart surgery (United States)

    Heart surgery - pediatric; Heart surgery for children; Acquired heart disease; Heart valve surgery - children ... There are many kinds of heart defects. Some are minor, and others are more serious. Defects can occur inside the heart or in the large blood vessels ...

  13. The theoretical ultimate magnetoelectric coefficients of magnetoelectric composites by optimization design

    International Nuclear Information System (INIS)

    Wang, H.-L.; Liu, B.


    This paper investigates what is the largest magnetoelectric (ME) coefficient of ME composites, and how to realize it. From the standpoint of energy conservation, a theoretical analysis is carried out on an imaginary lever structure consisting of a magnetostrictive phase, a piezoelectric phase, and a rigid lever. This structure is a generalization of various composite layouts for optimization on ME effect. The predicted theoretical ultimate ME coefficient plays a similar role as the efficiency of ideal heat engine in thermodynamics, and is used to evaluate the existing typical ME layouts, such as the parallel sandwiched layout and the serial layout. These two typical layouts exhibit ME coefficient much lower than the theoretical largest values, because in the general analysis the stress amplification ratio and the volume ratio can be optimized independently and freely, but in typical layouts they are dependent or fixed. To overcome this shortcoming and achieve the theoretical largest ME coefficient, a new design is presented. In addition, it is found that the most commonly used electric field ME coefficient can be designed to be infinitely large. We doubt the validity of this coefficient as a reasonable ME effect index and consider three more ME coefficients, namely the electric charge ME coefficient, the voltage ME coefficient, and the static electric energy ME coefficient. We note that the theoretical ultimate value of the static electric energy ME coefficient is finite and might be a more proper measure of ME effect

  14. Experimental study on ultimate strength and strain behavior of concrete under biaxial compressive stresses

    International Nuclear Information System (INIS)

    Onuma, Hiroshi; Aoyagi, Yukio


    The purpose of this investigation was to study the ultimate strength failure mode and deformation behavior of concrete under short-term biaxial compressive stresses, as an aid to design and analyze the concrete structures subjected to multiaxial compression such as prestressed or reinforced concrete vessel structures. The experimental work on biaxial compression was carried out on the specimens of three mix proportions and different ages with 10cm x 10cm x 10cm cubic shape in a room controlled at 20 0 C. The results are summarized as follows. (1) To minimize the surface friction between specimens and loading platens, the pads of teflon sheets coated with silicone grease were used. The coefficient of friction was measured and was 3 percent on the average. (2) The test data showed that the strength of the concrete subjected to biaxial compression increased as compared to uniaxial compressive strength, and that the biaxial strength increase was mainly dependent on the ratio of principal stresses, and it was hardly affected by mix proportions and ages. (3) The maximum increase of strength, which occurred at the stress ratio of approximately sigma 2 /sigma 1 = 0.6, was about 27 percent higher than the uniaxial strength of concrete. (4) The ultimate strength in case of biaxial compression could be approximated by the parabolic equation. (Kako, I.)

  15. Secondary Moments due to Prestressing with Different Bond at the Ultimate Limit State

    Directory of Open Access Journals (Sweden)

    Halvoník Jaroslav


    Full Text Available Secondary effects of prestressing develop in statically indeterminate structures (e.g., continuous beams due to the restraint of deformations imposed by hyperstatic restraints. These effects may significantly influence internal forces and stresses in prestressed structures. Secondary effects are influenced by the redundancy of a structural system, which raises the question of whether they will remain constant after a change in the structural system, e.g., due to the development of plastic hinge(s in a critical cross-section(s or after the development of a kinematic mechanism, or if they will disappear when the structure changes into a sequence of simply supported beams. The paper deals with an investigation of the behavior of continuous post-tensioned beams subjected to an ultimate load with significant secondary effects from prestressing. A total of 6 two-span beams prestressed by tendons with different bonds were tested in a laboratory with a load that changed their structural system into a kinematic mechanism. The internal forces and secondary effects of the prestressing were controlled through measurements of the reactions in all the supports. The results revealed that the secondary effects remained as a permanent part of the action on the experimental beams, even after the development of the kinematic mechanism. The results obtained confirmed that secondary effects should be included in all combinations of actions for verifications of ultimate limit states (ULS.

  16. Secondary Moments due to Prestressing with Different Bond at the Ultimate Limit State (United States)

    Halvoník, Jaroslav; Pažma, Peter; Vida, Radoslav


    Secondary effects of prestressing develop in statically indeterminate structures (e.g., continuous beams) due to the restraint of deformations imposed by hyperstatic restraints. These effects may significantly influence internal forces and stresses in prestressed structures. Secondary effects are influenced by the redundancy of a structural system, which raises the question of whether they will remain constant after a change in the structural system, e.g., due to the development of plastic hinge(s) in a critical cross-section(s) or after the development of a kinematic mechanism, or if they will disappear when the structure changes into a sequence of simply supported beams. The paper deals with an investigation of the behavior of continuous post-tensioned beams subjected to an ultimate load with significant secondary effects from prestressing. A total of 6 two-span beams prestressed by tendons with different bonds were tested in a laboratory with a load that changed their structural system into a kinematic mechanism. The internal forces and secondary effects of the prestressing were controlled through measurements of the reactions in all the supports. The results revealed that the secondary effects remained as a permanent part of the action on the experimental beams, even after the development of the kinematic mechanism. The results obtained confirmed that secondary effects should be included in all combinations of actions for verifications of ultimate limit states (ULS).

  17. Bootstrap calculation of ultimate strength temperature maxima for neutron irradiated ferritic/martensitic steels (United States)

    Obraztsov, S. M.; Konobeev, Yu. V.; Birzhevoy, G. A.; Rachkov, V. I.


    The dependence of mechanical properties of ferritic/martensitic (F/M) steels on irradiation temperature is of interest because these steels are used as structural materials for fast, fusion reactors and accelerator driven systems. Experimental data demonstrating temperature peaks in physical and mechanical properties of neutron irradiated pure iron, nickel, vanadium, and austenitic stainless steels are available in the literature. A lack of such an information for F/M steels forces one to apply a computational mathematical-statistical modeling methods. The bootstrap procedure is one of such methods that allows us to obtain the necessary statistical characteristics using only a sample of limited size. In the present work this procedure is used for modeling the frequency distribution histograms of ultimate strength temperature peaks in pure iron and Russian F/M steels EP-450 and EP-823. Results of fitting the sums of Lorentz or Gauss functions to the calculated distributions are presented. It is concluded that there are two temperature (at 360 and 390 °C) peaks of the ultimate strength in EP-450 steel and single peak at 390 °C in EP-823.

  18. Plasticity and constraints on social evolution in African mole-rats: ultimate and proximate factors. (United States)

    Faulkes, Chris G; Bennett, Nigel C


    Here, we review comparative studies of African mole-rats (family Bathyergidae) to explain how constraints acting at the ultimate (environmental) and proximate (organismal) levels have led to convergent gains and losses of sociality within this extensive adaptive radiation of subterranean rodents endemic to sub-Saharan Africa. At the ultimate level, living in environments that range from mesic through to arid has led to both variation and flexibility in social organization among species, culminating in the pinnacle of social evolution in the eusocial naked and Damaraland mole-rats (Heterocephalus glaber and Fukomys damarensis). The common mole-rat (Cryptomys hottentotus) provides a model example of how plasticity in social traits exists within a single species inhabiting areas with different ecological constraint. At the proximate level, reproductive strategies and cooperative breeding may be constrained by the correlated evolution of a suite of traits including physiological suppression of reproduction, the development of physiological and morphological castes, and the mode of ovulatory control and seasonality in breeding. Furthermore, recent neurobiological advances indicate that differential patterns of neurotransmitter expression within the forebrain may underpin (and limit) either a solitary or group living/cooperative lifestyle not only in mole-rats, but also more widely among disparate mammalian taxa.

  19. Evaluation of the ultimate pressure capacity of rectangular HVAC ducts for nuclear pwoer plants

    International Nuclear Information System (INIS)

    Wedellsborg, B.W.


    Typical Category I HVAC ducts in a nuclear plant must be designed for loads and load combinations including positive and negative pressure loads which are generated due to the normal operation and postulated accident conditions. These pressure loads most often govern the design of the HVAC ducts. Structural design criteria are presently based on the AISI Code which limits the duct panel width-to-thickness ratio to a maximum of 500 and the maximum height-to-thickness ratio to 200, unless it can be shown by structural tests that larger ratios can be used. Test Programs performed on rectangular HVAC ducts subjected to vacumm loads have substantiated the use of ducts having panel width to thickness ratios of up to 1600. The results of the test programs were subsequently incorporated into the design through a more rational analytical design method which was developed from and correlates well with the test results. The purpose of this paper is to present the analytical design method and its correlation with the test results. Simple formulae for the design of rectangular HVAC ducts are presented. Lower bound values of duct sheet, and stiffener ultimate loads are derived, and correlated with recent test results. Analytically predicted ultimate pressures are also compared with other available duct test data

  20. ULtiMATE system for rapid assembly of customized TAL effectors.

    Directory of Open Access Journals (Sweden)

    Junjiao Yang

    Full Text Available Engineered TAL-effector nucleases (TALENs and TALE-based constructs have become powerful tools for eukaryotic genome editing. Although many methods have been reported, it remains a challenge for the assembly of designer-based TALE repeats in a fast, precise and cost-effective manner. We present an ULtiMATE (USER-based Ligation Mediated Assembly of TAL Effector system for speedy and accurate assembly of customized TALE constructs. This method takes advantage of uracil-specific excision reagent (USER to create multiple distinct sticky ends between any neighboring DNA fragments for specific ligation. With pre-assembled templates, multiple TALE DNA-binding domains could be efficiently assembled in order within hours with minimal manual operation. This system has been demonstrated to produce both functional TALENs for effective gene knockout and TALE-mediated gene-specific transcription activation (TALE-TA. The feature of both ease-of-operation and high efficiency of ULtiMATE system makes it not only an ideal method for biologic labs, but also an approach well suited for large-scale assembly of TALENs and any other TALE-based constructions.

  1. Ultimate shearing strength of aseismatic walls with many small holes for reactor buildings

    International Nuclear Information System (INIS)

    Yoshizaki, Seiji; Ezaki, Tetsuro; Korenaga, Takeyoshi; Sotomura, Kentaro.


    The aseismatic walls for reactor buildings have complicated forms, and are characterized by large wall thickness and high reinforcement ratio as compared with ordinary aseismatic walls. The forms are mainly box, cylinder or irregular polygonal prism and their combination. The design of the walls with many small holes has been performed on the basis of the reinforced concrete structure calculation standard of the Architectural Institute of Japan, following the case with large opening. When there are many small holes, the arrangement of reinforcement for the openings becomes complex, and the construction is difficult. It is necessary to rationalize the design and to simplify the reinforcement work. Under the background like this, the experiment to examine the shearing property in bending of the aseismatic walls with many small holes for reactor buildings was carried out, and horizontal loading test was performed on 43 specimens. The method of calculating the ultimate shearing strength of a wall without opening was proposed, and the method of applying it to a wall with many small holes is shown. The experimental method and the results, the examination of the experimental results, and the ultimate shearing strength of the aseismatic walls are reported. (Kako, I.)

  2. Ultimate strength performance of tankers associated with industry corrosion addition practices

    Directory of Open Access Journals (Sweden)

    Kim Do Kyun


    Full Text Available In the ship and offshore structure design, age-related problems such as corrosion damage, local denting, and fatigue damage are important factors to be considered in building a reliable structure as they have a significant influence on the residual structural capacity. In shipping, corrosion addition methods are widely adopted in structural design to prevent structural capacity degradation. The present study focuses on the historical trend of corrosion addition rules for ship structural design and investigates their effects on the ultimate strength performance such as hull girder and stiffened panel of double hull oil tankers. Three types of rules based on corrosion addition models, namely historic corrosion rules (pre-CSR, Common Structural Rules (CSR, and harmonised Common Structural Rules (CSRH are considered and compared with two other corrosion models namely UGS model, suggested by the Union of Greek Shipowners (UGS, and Time-Dependent Corrosion Wastage Model (TDCWM. To identify the general trend in the effects of corrosion damage on the ultimate longitudinal strength performance, the corrosion addition rules are applied to four representative sizes of double hull oil tankers namely Panamax, Aframax, Suezmax, and VLCC. The results are helpful in understanding the trend of corrosion additions for tanker structures

  3. Ultimate strength performance of tankers associated with industry corrosion addition practices

    Directory of Open Access Journals (Sweden)

    Do Kyun Kim


    Full Text Available In the ship and offshore structure design, age-related problems such as corrosion damage, local denting, and fatigue damage are important factors to be considered in building a reliable structure as they have a significant influence on the residual structural capacity. In shipping, corrosion addition methods are widely adopted in structural design to prevent structural capacity degradation. The present study focuses on the historical trend of corrosion addition rules for ship structural design and investigates their effects on the ultimate strength performance such as hull girder and stiffened panel of double hull oil tankers. Three types of rules based on corrosion addition models, namely historic corrosion rules (pre-CSR, Common Structural Rules (CSR, and harmonised Common Structural Rules (CSRH are considered and compared with two other corrosion models namely UGS model, suggested by the Union of Greek Shipowners (UGS, and Time-Dependent Corrosion Wastage Model (TDCWM. To identify the general trend in the effects of corrosion damage on the ultimate longitudinal strength performance, the corrosion addition rules are applied to four representative sizes of double hull oil tankers namely Panamax, Aframax, Suezmax, and VLCC. The results are helpful in understanding the trend of corrosion additions for tanker structures.

  4. A New Algorithm for Determining Ultimate Pit Limits Based on Network Optimization

    Directory of Open Access Journals (Sweden)

    Ali Asghar Khodayari


    Full Text Available One of the main concerns of the mining industry is to determine ultimate pit limits. Final pit is a collection of blocks, which can be removed with maximum profit while following restrictions on the slope of the mine’s walls. The size, location and final shape of an open-pit are very important in designing the location of waste dumps, stockpiles, processing plants, access roads and other surface facilities as well as in developing a production program. There are numerous methods for designing ultimate pit limits. Some of these methods, such as floating cone algorithm, are heuristic and do not guarantee to generate optimum pit limits. Other methods, like Lerchs–Grossmann algorithm, are rigorous and always generate the true optimum pit limits. In this paper, a new rigorous algorithm is introduced. The main logic in this method is that only positive blocks, which can pay costs of their overlying non-positive blocks, are able to appear in the final pit. Those costs may be paid either by positive block itself or jointly with other positive blocks, which have the same overlying negative blocks. This logic is formulated using a network model as a Linear Programming (LP problem. This algorithm can be applied to two- and three-dimension block models. Since there are many commercial programs available for solving LP problems, pit limits in large block models can be determined easily by using this method.

  5. Minimal invasive gastric surgery: A systematic review

    Directory of Open Access Journals (Sweden)

    Kirti Bushan


    Full Text Available Background: As an alternate to open surgery, laparoscopic gastrectomy (LG is currently being performed in many centers, and has gained a wide clinical acceptance. The aim of this review article is to compare oncologic adequacy and safety of LG with open surgery for gastric adenocarcinomas with respect to lymphadenectomy, short-term outcomes (postoperative morbidity and mortality and long-term outcome (5 years overall survival and disease-free survival. Materials and Methods: PubMed was searched using query “LG” for literature published in English from January 2000 to April 2014. A total of 875 entries were retrieved. These articles were screened and 59 manuscripts ultimately formed the basis of current review. Results: There is high-quality evidence to support short-term efficacy, safety and feasibility of LG for gastric adenocarcinomas, although accounts on long-term survivals are still infrequent.

  6. Antifibrinolytics in liver surgery

    Directory of Open Access Journals (Sweden)

    Jalpa Makwana


    Full Text Available Hyperfibrinolysis, a known complication of liver surgery and orthotopic liver transplantation (OLT, plays a significant role in blood loss. This fact justifies the use of antifibrinolytic drugs during these procedures. Two groups of drug namely lysine analogues [epsilon aminocaproic acid (EACA and tranexamic acid (TA] and serine-protease-inhibitors (aprotinin are frequently used for this purpose. But uniform data or guidelines on the type of antifibrinolytic drugs to be used, their indications and correct dose, is still insufficient. Antifibrinolytics behave like a double-edged sword. On one hand, there are benefits of less transfusion requirements but on the other hand there is potential complication like thromboembolism, which has been reported in several studies. We performed a systematic search in PubMed and Cochrane Library, and we included studies wherein antifibrinolytic drugs (EACA, TA, or aprotinin were compared with each other or with controls/placebo. We analysed factors like intraoperative red blood cell and fresh frozen plasma requirements, the perioperative incidence of hepatic artery thrombosis, venous thromboembolic events and mortality. Among the three drugs, EACA is least studied. Use of extensively studied drug like aprotinin has been restricted because of its side effects. Haemostatic effect of aprotinin and tranexamic acid has been comparable. However, proper patient selection and individualized treatment for each of them is required. Purpose of this review is to study various clinical trials on antifibrinolytic drugs and address the related issues like benefits claimed and associated potential complications.

  7. Long-term experience in salt mining and experience in salt mine decommissioning - a chance for ultimate storage?

    International Nuclear Information System (INIS)

    Sitz, P.; Rauche, H.


    The author discusses similarities between salt mining and ultimate storage and the possibility of using abandoned salt mines as ultimate storage site. He states that with all the numeric prediction tools now available, expert knowledge of mining engineers is still indispensable [de

  8. Anaesthetic Management of Conjoined Twins′ Separation Surgery

    Directory of Open Access Journals (Sweden)

    Kolli S Chalam


    Full Text Available Anaesthesia for conjoined twins, either for separation surgery, or for MRI or other evaluation procedures is an enormous challenge to the paediatric anaesthesiologist. This is an extra challenging surgery because we the anaesthesiologists need to care for two patients at the same time instead of just one. Anaesthesia for conjoined twins ′separation surgery mainly centered on the following concerns: 1.Conjoined Twins′ physiology like crossed circulation. distribution of blood volume and organ sharing with their anaesthetic implications. 2.Long marathon surgery with massive fluid shifts and loss of blood & blood components and their rapid replenishment. 3.Meticulous planning for organized management of long hours of anaesthetic administration in two paediatric subjects simultaneously with multi surgical specialties involvement and their unique requirements.We report the anaesthetic and intensive care management of one pair of Pygopagus separation surgery and also the review of literature and world statistics.

  9. Using your shoulder after surgery (United States)

    Shoulder surgery - using your shoulder; Shoulder surgery - after ... rotator cuff surgery or other ligament or labral surgery, you need to be careful with your shoulder. Ask the surgeon what arm movements are safe ...

  10. Achalasia: Dilation, Injection or Surgery?

    Directory of Open Access Journals (Sweden)

    Alberto Peracchia


    Full Text Available Achalasia results from irreversible alterations of the esophageal myenteric plexus. The target of treatment in this setting is to reduce lower esophageal sphincter resistance to passage of the bolus. Definitive treatment of the disease requires pneumatic dilation or Heller myotomy. Although no controlled studies comparing modern endoscopic and surgical techniques are available, laparoscopic surgery is emerging as the initial intervention of choice.

  11. Delayed Tension Pneumothorax During Surgery

    Directory of Open Access Journals (Sweden)

    Ying-Lun Chen


    Full Text Available Tension pneumothorax is a life-threatening emergency that rapidly results in cardiopulmonary arrest. It requires prompt diagnosis and treatment. We present 2 cases from our practice, 1 caused by blunt chest trauma and the other resulting from laparoscopic surgery. Both were successfully treated by insertion of a chest tube. The diagnosis and treatment of intraoperative pneumothorax is discussed together with a review of the literature.

  12. Application and development of non contact angle-wide viewing system in vitreous retinal surgery

    Directory of Open Access Journals (Sweden)

    Rong-Hua He


    Full Text Available Wide-angle viewing system as an important auxiliary device can clearly observe the whole fundus field of vision in vitreous surgery, which enable vitreoretinal surgery more efficient, safer and more effective. So it has very high application value in ophthalmologic operation. In this paper, we studied the development and application of wide-angle viewing system in vitreoretinal surgery in recent years, from which we summed up the advantage of non-contact wide-angle viewing system in clinical field, and pointed out the shortcomings. The ultimate goal is to make the non-contact wide-angle viewing system better applied in vitreous surgery.

  13. Introducing the International Confederation of Plastic Surgery Societies: ICOPLAST. (United States)

    Rakhorst, Hinne A; Badran, Hassan; Clarke, Howard M; Cooter, Rodney; Evans, Gregory R D; Kirschbaum, Julio Daniel; Koh, Kyung Suk; Lazier, Carol; Murphy, Robert X; Nakatsuka, Takashi; Piccolo, Nelson Sarto; Perks, Graeme


    This article describes the formation of the International Confederation of Plastic Surgery Societies (ICOPLAST) as a novel, transparent, dynamic, and proactive confederation of national plastic surgery societies. ICOPLAST aspires to provide a voice for the entire international community of plastic surgeons. ICOPLAST has been designed to benefit the patient, plastic surgery as a profession, and each individual plastic surgeon. Its principal objective is to enhance international communication, education, and advocacy processes to ultimately improve patient outcomes for plastic surgery patients globally. The new ICOPLAST's focus is to add true value for patients. ICOPLAST's evolution, philosophy, governance, and bylaws are explained and all societies worldwide are encouraged and cordially invited to join. An open and warm invitation is provided. Additional information is found at

  14. Ultimate Limit State Design Of Sheet Pile Walls By Finite Elements And Nonlinear Programming

    DEFF Research Database (Denmark)

    Krabbenhøft, Kristian; Damkilde, Lars; Krabbenhøft, Sven


    Limit analysis has been used for decades in civil and mechanical engineering practice as a means of analyzing structures of materials which with reasonable accuracy can be described as being rigid-perfectly plastic. Such materials include steel, concrete and soils. Traditionally, most attention has...... been given to the problem which consists of determining the ultimate magnitude of a given set of loads acting on a structure with a given geometry. This problem is relevant when determining e.g. the necessary extrusion pressure in metal forming problems, when evaluating the bearing capacity...... is the load intensity. In the paper we consider the latter of these problems with particular reference to the design of sheet pile walls....

  15. Methodological Challenges of Identifying Ultimate Land Use Changes Caused by Biofuel Production

    DEFF Research Database (Denmark)

    Wenzel, Henrik; Kløverpris, Jesper; Nielsen, Per Henning


    that is only poorly dealt with by LCA methods. Even though the use of land, or change of land cover and its eco-systems, is acknowledged to be a very important impact of human activities, a methodology for assessing this impact category has not yet  been properly developed within LCA. Some LCA scientists have...... looked into methods for assessing the impacts of given changes of land use, i.e. the impact assessment component of the LCA, but very few have looked into how to actually do the inventory modelling, i.e. how to identify which land is ultimately affected by the decision and system under study. State...... in the systems being studied. The aims of this paper is to analyse the mechanisms influencing the long-term land use consequences of changes in crop demand and propose a methodological framework for identifying these consequences within a global scope. The outset of the paper is the principles of consequential...

  16. An experimental investigation on the ultimate strength of epoxy repaired braced partial infilled RC frames (United States)

    Dubey, Shailendra Kumar Damodar; Kute, Sunil


    Due to earthquake, buildings are damaged partially or completely. Particularly structures with soft storey are mostly affected. In general, such damaged structures are repaired and reused. In this regard, an experimental investigation was planned and conducted on models of single-bay, single-storey of partial concrete infilled reinforced concrete (RC) frames up to collapse with corner, central and diagonal steel bracings. Such collapsed frames were repaired with epoxy resin and retested. The initiative was to identify the behaviour, extent of restored ultimate strength and deflection of epoxy-retrofitted frames in comparison to the braced RC frames. The performance of such frames has been considered only for lateral loads. In comparison to bare RC frames, epoxy repaired partial infilled frames have significant increase in the lateral load capacity. Central bracing is more effective than corner and diagonal bracing. For the same load, epoxy repaired frames have comparable deflection than similar braced frames.

  17. Silicon coupled-ring resonator structures for slow light applications: potential, impairments and ultimate limits

    International Nuclear Information System (INIS)

    Canciamilla, A; Torregiani, M; Ferrari, C; Morichetti, F; Melloni, A; De La Rue, R M; Samarelli, A; Sorel, M


    Coupled-ring resonator-based slow light structures are reported and discussed. By combining the advantages of high index contrast silicon-on-insulator technology with an efficient thermo-optical activation, they provide an on-chip solution with a bandwidth of up to 100 GHz and a slowdown factor of up to 16, as well as a continuous reconfiguration scheme and a fine tunability. The performance of these devices is investigated in detail for both static and dynamic operation, in order to evaluate their potential in optical signal processing applications at high bit rate. The main impairments imposed by fabrication imperfections are also discussed in relation to the slowdown factor. In particular, the analysis of the impact of backscatter, disorder and two-photon absorption on the device transfer function reveals the ultimate limits of these structures and provides valuable design rules for their optimization

  18. Process for extracting residual heat and device for the ultimate absorption of heat for nuclear reactors

    International Nuclear Information System (INIS)

    Bernard, Lawrence Jr.


    This invention concerns a 'heat sink' or device for the ultimate absorption of heat for electric power stations using the most widespread thermal neutron nuclear reactors, namely 'light water' reactors such as boiling or pressurized water reactors. The residual heat given off by these reactors can be safely extracted with this method by using dry cooling. However, the invention does not concern the problems arising from the cooling of the steam used for actuating the steam turbine nor the cooling of the steam exhausted by the turbine or coming from it, but it does concern the 'safety' part of the nuclear power station in which the residual heat discharged in the reactor is controlled and dissipated [fr

  19. Design proposal for ultimate shear strength of tapered steel plate girders

    Directory of Open Access Journals (Sweden)

    A. Bedynek


    Full Text Available Numerous experimental and numerical studies on prismatic plate girders subjected to shear can be found in the literature. However, the real structures are frequently designed as non-uniform structural elements. The main objective of the research is the development of a new proposal for the calculation of the ultimate shear resistance of tapered steel plate girders taking into account the specific behaviour of such members. A new mechanical model is presented in the paper and it is used to show the differences between the behaviour of uniform and tapered web panels subjected to shear. EN 1993-1-5 design specifications for the determination of the shear strength for rectangular plates are improved in order to assess the shear strength of tapered elements. Numerical studies carried out on tapered steel plate girders subjected to shear lead to confirm the suitability of the mechanical model and the proposed design expression.

  20. Determination of the ultimate load in concrete slabs by the yield line finite element method

    International Nuclear Information System (INIS)

    Vaz, L.E.; Feijo, B.; Martha, L.F.R.; Lopes, M.M.


    A method for calculating the ultimate load in reinforced concrete slabs is proposed. The method follows the finite element aproach representating the continuum slab as an assembly of rigid triangular plates connected along their sides through yield line elements. This approach leads to the definition of the displacement configuration of the plate only as a function of the transversal displacement at the nodes of the mesh (1 DOF per node) reducing significantly the number of DOF's in relation to the conventional formulation by means of the finite element method (minimum of 3 DOF per node). Nonlinear behaviour of the reinforced concrete section is considered in the definition of the moment rotation curve of the yield lines. The effect of the in plane forces acting in the middle surface of the plate is also taken into account. The validity of the model is verified comparing the numerical solutions with the results of the classical yield line theory. (Author) [pt

  1. Fuzzy stochastic analysis of serviceability and ultimate limit states of two-span pedestrian steel bridge (United States)

    Kala, Zdeněk; Sandovič, GiedrÄ--


    The paper deals with non-linear analysis of ultimate and serviceability limit states of two-span pedestrian steel bridge. The effects of random material and geometrical characteristics on limit states are analyzed. The Monte Carlo method was applied to stochastic analysis. For the serviceability limit state, also influence of fuzzy uncertainty of the limit deflection value on random characteristics of load capacity of variable action was studied. The results prove that, for the type of structure studied, the serviceability limit state is decisive from the point of view of design. The present paper opens a discussion on the use of stochastic analysis to verify the limit deflections given in the standards EUROCODES.

  2. Assessment of Wind Parameter Sensitivity on Ultimate and Fatigue Wind Turbine Loads: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Robertson, Amy N [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Sethuraman, Latha [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Jonkman, Jason [National Renewable Energy Laboratory (NREL), Golden, CO (United States); Quick, Julian [National Renewable Energy Laboratory (NREL), Golden, CO (United States)


    Wind turbines are designed using a set of simulations to ascertain the structural loads that the turbine could encounter. While mean hub-height wind speed is considered to vary, other wind parameters such as turbulence spectra, sheer, veer, spatial coherence, and component correlation are fixed or conditional values that, in reality, could have different characteristics at different sites and have a significant effect on the resulting loads. This paper therefore seeks to assess the sensitivity of different wind parameters on the resulting ultimate and fatigue loads on the turbine during normal operational conditions. Eighteen different wind parameters are screened using an Elementary Effects approach with radial points. As expected, the results show a high sensitivity of the loads to the turbulence standard deviation in the primary wind direction, but the sensitivity to wind shear is often much greater. To a lesser extent, other wind parameters that drive loads include the coherence in the primary wind direction and veer.

  3. Ultimate Pressure Capacity of Prestressed Concrete Containment Vessels with Steel Fibers

    Energy Technology Data Exchange (ETDEWEB)

    Hahm, Dae Gi; Choun, Young Sun; Choi, In Kil [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)


    The ultimate pressure capacity (UPC) of the prestressed concrete containment vessel (PCCV) is very important since the PCCV are final protection to prevent the massive leakage of a radioactive contaminant caused by the severe accident of nuclear power plants (NPPs). The tensile behavior of a concrete is an important factor which influence to the UPC of PCCVs. Hence, nowadays, it is interested that the application of the steel fiber to the PCCVs since that the concrete with steel fiber shows an improved performance in the tensile behavior compared to reinforced concrete (RC). In this study, we performed the UPC analysis of PCCVs with steel fibers corresponding to the different volume ratio of fibers to verify the effectiveness of steel fibers on PCCVs

  4. La simplexité, ultime avatar de la complexité ?


    Demongeot, Jacques; Amor, Hedi Ben; Hazgui, Hana; Lontos, Athanasios


    1. Introduction La simplexité peut être considérée comme l’émergence de nouvelles fonctionnalités, issues des interactions entre sous-systèmes (ou modules) d’un système complexe : elle apparaît ainsi comme l’ultime avatar de la complexité, ce qui permet de la définir, sans rupture épistémologique avec le courant scientifique des systèmes complexes, comme la tendance qu’a la nature de sélectionner les fonctions vitales des êtres vivants, en particulier celles les plus utiles à la spécificité e...

  5. International surgery: definition, principles and Canadian practice (United States)

    Lett, Ronald


    This article is dedicated to the Canadian international surgeon, Norman Bethune (1890–1939). International surgery is defined as a humanitarian branch of medicine concerned with the treatment of bodily injuries or disorders by incision or manipulations, emphasizing cooperation and understanding among nations and involving education, research, development and advocacy. In this article I review the colonial past, the dark ages following the Declaration of Alma-Ata, the progress made and the present challenges in international surgery. I present a definition of international surgery that recognizes the current era of surgical humanitarianism, validates a global understanding of surgical issues and promotes cooperation among nations. Included are the principles of international surgery: education, research, infrastructure development and advocacy. International surgical projects are classified according to type (clinical, relief, developmental) and integration strategy (vertical or horizontal). Also reviewed are the Canadian practice of international surgery by nongovernmental, professional and academic organizations and the requirements of international and Canadian funding agencies, the development concepts basic to all projects, including results-based management and the cross-cutting themes of gender equity, environmental protection and human safety. I recommend formalizing international surgery into a discipline as a means of promoting surgical care in low-income countries. If international surgery is to be sustained in Canada, infrastructure and support from Canadian surgeons is particularly important. An understanding of the history, definition and classification of international surgery should promote surgical care in low-income countries. PMID:14577711

  6. Enhanced recovery after surgery in gastric resections. (United States)

    Bruna Esteban, Marcos; Vorwald, Peter; Ortega Lucea, Sonia; Ramírez Rodríguez, Jose Manuel


    Enhanced recovery after surgery is a modality of perioperative management with the purpose of improving results and providing a faster recovery of patients. This kind of protocol has been applied frequently in colorectal surgery, presenting less available experience and evidence in gastric surgery. According to the RICA guidelines published in 2015, a review of the bibliography and the consensus established in a multidisciplinary meeting in Zaragoza on the 9th of October 2015, we present a protocol that contains the basic procedures of fast-track for resective gastric surgery. The measures to be applied are divided in a preoperative, perioperative and postoperative stage. This document provides recommendations concerning the appropriate information, limited fasting and administration of carbohydrate drinks 2hours before surgery, specialized anesthetic strategies, minimal invasive surgery, no routine use of drainages and tubes, mobilization and early oral tolerance during the immediate postoperative period, as well as criteria for discharge. The application of a protocol of enhanced recovery after surgery in resective gastric surgery can improve and accelerate the functional recovery of our patients, requiring an appropriate multidisciplinary coordination, the evaluation of obtained results with the application of these measures and the investigation of controversial topics about which we currently have limited evidence. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Surgery for atrial fibrillation. (United States)

    Viganò, M; Graffigna, A; Ressia, L; Minzioni, G; Pagani, F; Aiello, M; Gazzoli, F


    The mechanisms of atrial fibrillation arc multiple reentry circuits spinning around the atrial surface, and these baffle any attempt to direct surgical interruption. The purpose of this article is to report the surgical experience in the treatment of isolated and concomitant atrial fibrillation at the Cardiac Surgical Institute of the University of Pavia. In cases of atrial fibrillation secondary to mitral/valve disease, surgical isolation of the left atrium at the time of mitral valve surgery can prevent atrial fibrillation from involving the right atrium, which can exert its diastolic pump function on the right ventricle. Left atrial isolation was performed on 205 patients at the time of mitral valve surgery. Atrial partitioning ("maze operation") creates straight and blind atrial alleys so that non-recentry circuits can take place. Five patients underwent this procedure. In eight-cases of atrial fibrillation secondary to atrial septal defect, the adult patients with atrial septal defect and chronic or paroxysmal atrial fibrillation underwent surgical isolation of the right atrium associated which surgical correction of the defect, in order to let sinus rhythm govern the left atrium and the ventricles. "Lone" atrial fibrillation occurs in hearts with no detectable organic disease. Bi-atrial isolation with creation of an atrial septal internodal "corridor" was performed on 14 patients. In cases of atrial fibrillation secondary to mitral valve disease, left atrial isolation was performed on 205 patients at the time of mitral valve surgery with an overall sinus rhythm recovery of 44%. In the same period, sinus rhythm was recovered and persisted in only 19% of 252 patients who underwent mitral valve replacement along (P < 0.001). Sinus rhythm was less likely to recover in patients with right atriomegaly requiring tricuspid valve annuloplasty: 59% vs 84% (P < 0.001). Restoration of the right atrial function raised the cardiac index from 2.25 +/- 0.55 1/min per m2

  8. Stapledon's Interplanetary Man: A Commonwealth of Worlds and the Ultimate Purpose of Space Colonisation (United States)

    Crawford, Ian A.

    In his 1948 lecture to the British Interplanetary Society Stapledon considered the ultimate purpose of colonising other worlds. Having examined the possible motivations arising from improved scientific knowledge and access to extraterrestrial raw materials, he concludes that the ultimate benefits of space colonisation will be the increased opportunities for developing human (and post-human) diversity, intellectual and aesthetic potential and, especially, `spirituality'. By the latter concept he meant a striving for ``sensitive and intelligent awareness of things in the universe (including persons), and of the universe as a whole.'' A key insight articulated by Stapledon in this lecture was that this should be the aspiration of all human development anyway, with or without space colonisation, but that the latter would greatly increase the scope for such developments. Another key aspect of his vision was the development of a diverse, but connected, `Commonwealth of Worlds' extending throughout the Solar System, and eventually beyond, within which human potential would be maximised. In this paper I analyse Stapledon's vision of space colonisation, and will conclude that his overall conclusions remain sound. However, I will also argue that he was overly utopian in believing that human social and political unity are prerequisites for space exploration (while agreeing that they are desirable objectives in their own right), and that he unnecessarily downplayed the more prosaic scientific and economic motivations which are likely to be key drivers for space exploration (if not colonisation) in the shorter term. Finally, I draw attention to some recent developments in international space policy which, although probably not influenced by Stapledon's work, are nevertheless congruent with his overarching philosophy as outlined in `Interplanetary Man?'.

  9. Ultimate internal pressure capacity of a reinforced concrete Mark III containment

    International Nuclear Information System (INIS)

    McGaughy, J.P. Jr.; Lin, F.T.; Sen, S.K.


    The static ultimate capacity of a Mark III BWR pressure suppression type containment has been investigated with a view to determine its capability to withstand the internal pressure associated with a postulated hydrogen burn. The reinforced concrete containment consists of a right circular cylinder covered by a hemispherical dome and supported on a flat circular foundation mat. A 1/4'' thick welded steel liner plate covers the inside surface of the containment shell. The cylinder is a 3.5 ft. thick shell with an inside radius of 62.0 feet. The thickness of the dome is 3.5 feet. Reinforcement in the shell is comprised of multi-layers of circumferential, meridional and diagonal rebars. Major containment penetrations consists of a circular equipment hatch and two personnel airlock assemblies. The containment ultimate capacity is determined by performing a non-linear analysis using the proprietary finite element computer code 'FINEL'. The code has the capability of modelling concrete cracking in tension and redistribution forces and moments to account for such phenomenon. For analysis purposes, the finite element model included the containment dome and the upper portion of the containment cylinder with appropriate boundary conditions applied at the model cut off region. This portion of the containment structure is selected because the segment of the cylinder that is included in the model has the least amount of hopp reinforcement, and when the general yield state is reached, the hoop reinforcement will be the limiting element. The containment structure has been treated as an axisymmetric shell using axisymmetric quadrilateral finite elements in the radial plane to model the liner plate and concrete. The reinforcing steel have been idealized by finite elements with unidirectional stiffness. (orig./RW)

  10. Ultimate refrigerating conditions, behavior turning and a thermodynamic analysis for absorption–compression hybrid refrigeration cycle

    International Nuclear Information System (INIS)

    Zheng Danxing; Meng Xuelin


    Highlights: ► Two novel fundamental concepts of the absorption refrigeration cycle were proposed. ► The interaction mechanism of compressor pressure increasing with other key-parameters was investigated. ► A set of optimal operating condition of hybrid refrigeration cycle was found. ► A simulation and investigation for R134a-DMF hybrid refrigeration cycle was performed. - Abstract: The absorption–compression hybrid refrigeration cycle has been considered as an effective approach to reduce the mechanical work consumption by using low-grade heat, such as solar energy. This work aims at studying the thermodynamic mechanism of the hybrid refrigeration cycle. Two fundamental concepts have been proposed, which are the ultimate refrigerating temperature (or the ultimate temperature lift) and the behavior turning. On the basis of that, the interaction mechanism of compressor pressure increasing with other key-parameters and the impact of compressor pressure increasing on the cycle performance have been investigated. The key-parameters include the concentration difference, the circulation ratio of working fluid, etc. The work points out that the hybrid refrigeration cycle performance varies with the change of compressor outlet pressure and depends on which one achieves dominance in the hybrid refrigeration cycle, the absorption sub-system or the compression sub-system. The behavior turning point during parameters changing corresponds to a maximum value of the heat powered coefficient of performance. In this case, the hybrid refrigeration cycle performance is optimal because the low-grade heat utilization is the most effective. In addition, to validate the theoretical analysis, a solar hybrid refrigeration cycle with R134a–DMF as working pair was simulated. The Peng–Robinson equation of state was adopted to calculate thermophysical properties when the reliability assessment of the prediction models on the available literature data of R134a–DMF system had been

  11. Experience with day stay surgery. (United States)

    Cohen, D; Keneally, J; Black, A; Gaffney, S; Johnson, A


    Potential advantages of day stay surgery are cost saving, improved utilization of staff and hospital facilities, and reduction of stress for the paediatric patient and his family. The successful program requires careful case selection, full operating and anesthetic facilities and good follow-up. Day stay surgery was initiated at Royal Alexandra Hospital for Children in 1974. Experience is reviewed in relation to the total number and nature of surgical admissions and the daily utilisation of the facility. Utilization has markedly increased in the past 2 yr. Current practice is reviewed with regard to initial assessment, preparation for surgery and overall management during the day admission. Parental attitudes towards day stay surgery were evaluated indicating both the advantages and the problems encountered. These related mainly to insufficient information, transport difficulties and afternoon operations. Recommendations for improving the day stay service are discussed with special reference to: (1) communication with the parents as to adequate pre-operative explanation, revision of the day stay information pamphlet and improved distribution, and clear postoperative instructions, (2) the timing of operations, and (3) transport and parking facilities.

  12. Orthognathic surgery in cleft patients. (United States)

    Phillips, John H; Nish, Iain; Daskalogiannakis, John


    After studying this article, the participant should be able to: 1. Identify the skeletal changes in the cleft patient that necessitate surgery. 2. Describe the orthodontic principles that precede surgical treatment. 3. Demonstrate the surgical principles involved in cleft orthognathic surgery and how to avoid common pitfalls particular to cleft orthognathic surgery. 4. Anticipate when dentoalveolar distraction can help in the treatment of problems not easily treated with conventional orthognathic techniques. This CME article covers the basic multidisciplinary approach to the treatment of patients requiring a combined orthodontic orthognathic approach to their skeletally based malocclusion. The dentoskeletal abnormalities are described for these patients, as are the fundamental orthodontic principles in the presurgical treatment of these patients. The basic surgical principles are discussed in general, and the reader is provided with advice on avoiding common pitfalls. Specific attention is given to the more recent advances in dentoalveolar distraction in cases of large defects that would have been difficult to treat using conventional orthognathic surgery. Videos are provided to illustrate the general principles in treating the cleft orthognathic patient and to illustrate the treatment of large defects using dentoalveolar distraction.

  13. Macroeconomic landscape of refractive surgery in the United States. (United States)

    Corcoran, Kevin J


    This review examines the economic history of refractive surgery and the decline of laser-assisted in-situ keratomileusis (LASIK) in the USA, and the emergence of refractive cataract surgery as an area of growth. Since it peaked in 2007 at 1.4 million procedures per year, LASIK has declined 50% in the USA, whereas refractive cataract surgery, including presbyopia-correcting intraocular lenses (IOLs), astigmatism-correcting IOLs, and femtosecond laser-assisted cataract surgery, has grown to 350 000 procedures per year, beginning in 2003. Patients are price-sensitive and responsive to publicity (good or bad) about refractive surgery and refractive cataract surgery. LASIK's decline has been partially offset by the emergence of refractive cataract surgery. About 11% of all cataract surgery in the USA involves presbyopia-correcting IOLs, astigmatism-correcting IOLs, or a femtosecond laser. From the surgeon's perspective, there are high barriers to entry into the marketplace for refractive surgery and refractive cataract surgery due to the high capital cost of excimer and femtosecond lasers, the high skill level required to deliver spectacular results to demanding patients who pay out of pocket, and the necessity to perform a high volume of surgeries to satisfy both of these requirements. Probably, less than 7% of US cataract surgeons can readily meet all of these requirements.

  14. The Utility of Outcome Studies in Plastic Surgery

    Directory of Open Access Journals (Sweden)

    Hani Sinno, MD, MEng


    Full Text Available Summary: Outcome studies help provide the evidence-based science rationalizing treatment end results that factor the experience of patients and the impact on society. They improve the recognition of the shortcoming in clinical practice and provide the foundation for the development of gold standard care. With such evidence, health care practitioners can develop evidence-based justification for treatments and offer patients with superior informed consent for their treatment options. Furthermore, health care and insurance agencies can recognize improved cost-benefit options in the purpose of disease prevention and alleviation of its impact on the patient and society. Health care outcomes are ultimately measured by the treatment of disease, the reduction of symptoms, the normalization of laboratory results and physical measures, saving a life, and patient satisfaction. In this review, we outline the tools available to measure outcomes in plastic surgery and subsequently allow the objective measurements of plastic surgical conditions. Six major outcome categories are discussed: (1 functional measures; (2 preference-based measures and utility outcome scores; (3 patient satisfaction; (4 health outcomes and time; (5 other tools: patient-reported outcome measurement information system, BREAST-Q, and Tracking Operations and Outcomes for Plastic Surgeons; and (6 cost-effectiveness analysis. We use breast hypertrophy requiring breast reduction as an example throughout this review as a representative plastic surgical condition with multiple treatments available.

  15. Virtual Reality and Augmented Reality in Plastic Surgery: A Review. (United States)

    Kim, Youngjun; Kim, Hannah; Kim, Yong Oock


    Recently, virtual reality (VR) and augmented reality (AR) have received increasing attention, with the development of VR/AR devices such as head-mounted displays, haptic devices, and AR glasses. Medicine is considered to be one of the most effective applications of VR/AR. In this article, we describe a systematic literature review conducted to investigate the state-of-the-art VR/AR technology relevant to plastic surgery. The 35 studies that were ultimately selected were categorized into 3 representative topics: VR/AR-based preoperative planning, navigation, and training. In addition, future trends of VR/AR technology associated with plastic surgery and related fields are discussed.


    Pećanac, Marija Đ


    Plastic surgery is a medical specialty dealing with corrections of defects, improvements in appearance and restoration of lost function. Ancient times. The first recorded account of reconstructive plastic surgery was found in ancient Indian Sanskrit texts, which described reconstructive surgeries of the nose and ears. In ancient Greece and Rome, many medicine men performed simple plastic cosmetic surgeries to repair damaged parts of the body caused by war mutilation, punishment or humiliation. In the Middle Ages, the development of all medical braches, including plastic surgery was hindered. New age. The interest in surgical reconstruction of mutilated body parts was renewed in the XVIII century by a great number of enthusiastic and charismatic surgeons, who mastered surgical disciplines and became true artists that created new forms. Modern era. In the XX century, plastic surgery developed as a modern branch in medicine including many types of reconstructive surgery, hand, head and neck surgery, microsurgery and replantation, treatment of burns and their sequelae, and esthetic surgery. Contemporary and future plastic surgery will continue to evolve and improve with regenerative medicine and tissue engineering resulting in a lot of benefits to be gained by patients in reconstruction after body trauma, oncology amputation, and for congenital disfigurement and dysfunction.

  17. On a definition of the appropriate timing for surgical intervention in orthognathic surgery. (United States)

    Hernández-Alfaro, F; Guijarro-Martínez, R


    Together with the introduction of new orthodontic techniques and minimally invasive surgery protocols, the emergence of modern patient prototypes has given way to novel timing schemes for the handling of dento-maxillofacial deformities. The aim of this study was to define, justify, and systematize the appropriate timing for orthognathic surgery. A retrospective analysis of orthognathic surgery procedures carried out over a 3-year period was performed. Six timing schemes were defined: 'surgery first', 'surgery early', 'surgery late', 'surgery last', 'surgery only', and 'surgery never'. Gender, age at surgery, main motivation for treatment, orthodontic treatment length, and number of orthodontic appointments were evaluated. A total of 362 orthognathic procedures were evaluated. The most common approach was 'surgery late'. While aesthetic improvement was the leading treatment motivation in 'surgery first', 'surgery early', and 'surgery last' cases, occlusal optimization was the chief aim of 'surgery late'. Sleep-disordered breathing was the main indication for treatment in 'surgery only'. Compared to 'surgery late', orthodontic treatment was substantially shorter in 'surgery early' and 'surgery first' cases, but the number of orthodontic appointments was similar. In conclusion, the skilful management of dento-maxillofacial deformities requires a comprehensive analysis of patient-, orthodontist-, and surgeon-specific variables. Each timing approach has well-defined indications, treatment planning considerations, and orthodontic and surgical peculiarities. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Cerebral monitoring during neonatal surgery for non-cardiac congenital anomalies: a first step to improve outcome?

    NARCIS (Netherlands)

    Stolwijk, L.J.


    Monitoring the newborn brain during surgery Cerebral monitoring in newborns, who require surgery in the first month of life, is important to protect the brain. The newborn brain is vulnerable during neonatal surgery. Newborn babies with a congenital anomaly requiring surgery in the first month of

  19. Failed epilepsy surgery deserves a second chance. (United States)

    Reed, Chrystal M; Dewar, Sandra; Fried, Itzhak; Engel, Jerome; Eliashiv, Dawn


    Resective epilepsy surgery has been shown to have up to 70-80% success rates in patients with intractable seizure disorder. Around 20-30% of patients with Engel Classification III and IV will require reevaluation for further surgery. Common reasons for first surgery failures include incomplete resection of seizure focus, incorrect identification of seizure focus and recurrence of tumor. Clinical chart review of seventeen patients from a single adult comprehensive epilepsy program who underwent reoperation from 2007 to 2014 was performed. High resolution Brain MRI, FDG-PET, Neuropsychometric testing were completed in all cases in both the original surgery and the second procedure. Postoperative outcomes were confirmed by prospective telephone follow up and verified by review of the patient's electronic medical records. Outcomes were classified according to the modified Engel classification system: Engel classes I and II are considered good outcomes. A total of seventeen patients (involving 10 females) were included in the study. The average age of patients at second surgery was 42 (range 23-64 years). Reasons for reoperation included: incomplete first resection (n=13) and recurrence of tumor (n=4). Median time between the first and second surgery was 60 months. After the second surgery, ten of the seventeen patients (58.8%) achieved seizure freedom (Engel Class I), in agreement with other published reports. Of the ten patients who were Engel Class I, seven required extension of the previous resection margins, while three had surgery for recurrence of previously partially resected tumor. We conclude that since the risk of complications from reoperation is low and the outcome, for some, is excellent, consideration of repeat surgery is justified. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Ergonomics in laparoscopic surgery

    Directory of Open Access Journals (Sweden)

    Supe Avinash


    Full Text Available Laparoscopic surgery provides patients with less painful surgery but is more demanding for the surgeon. The increased technological complexity and sometimes poorly adapted equipment have led to increased complaints of surgeon fatigue and discomfort during laparoscopic surgery. Ergonomic integration and suitable laparoscopic operating room environment are essential to improve efficiency, safety, and comfort for the operating team. Understanding ergonomics can not only make life of surgeon comfortable in the operating room but also reduce physical strains on surgeon.

  1. Gastric and intestinal surgery. (United States)

    Fossum, Theresa W; Hedlund, Cheryl S


    Gastric surgery is commonly performed to remove foreign bodies and correct gastric dilatation-volvulus and is less commonly performed to treat gastric ulceration or erosion, neoplasia, and benign gastric outflow obstruction. Intestinal surgery, although commonly performed by veterinarians, should never be considered routine. The most common procedures of the small intestinal tract performed in dogs and cats include enterotomy and resection/anastomosis. Surgery of the large intestine is indicated for lesions causing obstruction, perforations, colonic inertia, or chronic inflammation.

  2. Laparoendoscopic single-site surgery in gynaecology: A new frontier in minimally invasive surgery

    Directory of Open Access Journals (Sweden)

    Fader Amanda


    Full Text Available Review Objective: To review the recent developments and published literature on laparoendoscopic single-site (LESS surgery in gynaecology. Recent Findings: Minimally invasive surgery has become a standard of care for the treatment of many benign and malignant gynaecological conditions. Recent advances in conventional laparoscopy and robotic-assisted surgery have favorably impacted the entire spectrum of gynaecological surgery. With the goal of improving morbidity and cosmesis, continued efforts towards refinement of laparoscopic techniques have lead to minimization of size and number of ports required for these procedures. LESS surgery is a recently proposed surgical term used to describe various techniques that aim at performing laparoscopic surgery through a single, small-skin incision concealed within the umbilicus. In the last 5 years, there has been a surge in the developments in surgical technology and techniques for LESS surgery, which have resulted in a significant increase in utilisation of LESS across many surgical subspecialties. Recently published outcomes data demonstrate feasibility, safety and reproducibility for LESS in gynaecology. The contemporary LESS literature, extent of gynaecological procedures utilising these techniques and limitations of current technology will be reviewed in this manuscript. Conclusions: LESS surgery represents the newest frontier in minimally invasive surgery. Comparative data and prospective trials are necessary in order to determine the clinical impact of LESS in treatment of gynaecological conditions.

  3. History of shoulder instability surgery. (United States)

    Randelli, Pietro; Cucchi, Davide; Butt, Usman


    The surgical management of shoulder instability is an expanding and increasingly complex area of study within orthopaedics. This article describes the history and evolution of shoulder instability surgery, examining the development of its key principles, the currently accepted concepts and available surgical interventions. A comprehensive review of the available literature was performed using PubMed. The reference lists of reviewed articles were also scrutinised to ensure relevant information was included. The various types of shoulder instability including anterior, posterior and multidirectional instability are discussed, focussing on the history of surgical management of these topics, the current concepts and the results of available surgical interventions. The last century has seen important advancements in the understanding and treatment of shoulder instability. The transition from open to arthroscopic surgery has allowed the discovery of previously unrecognised pathologic entities and facilitated techniques to treat these. Nevertheless, open surgery still produces comparable results in the treatment of many instability-related conditions and is often required in complex or revision cases, particularly in the presence of bone loss. More high-quality research is required to better understand and characterise this spectrum of conditions so that successful evidence-based management algorithms can be developed. IV.

  4. Anesthesia for ambulatory anorectal surgery. (United States)

    Gudaityte, Jūrate; Marchertiene, Irena; Pavalkis, Dainius


    The prevalence of minor anorectal diseases is 4-5% of adult Western population. Operations are performed on ambulatory or 24-hour stay basis. Requirements for ambulatory anesthesia are: rapid onset and recovery, ability to provide quick adjustments during maintenance, lack of intraoperative and postoperative side effects, and cost-effectiveness. Anorectal surgery requires deep levels of anesthesia. The aim is achieved with 1) regional blocks alone or in combination with monitored anesthesia care or 2) deep general anesthesia, usually with muscle relaxants and tracheal intubation. Modern general anesthetics provide smooth, quickly adjustable anesthesia and are a good choice for ambulatory surgery. Popular regional methods are: spinal anesthesia, caudal blockade, posterior perineal blockade and local anesthesia. The trend in regional anesthesia is lowering the dose of local anesthetic, providing selective segmental block. Adjuvants potentiating analgesia are recommended. Postoperative period may be complicated by: 1) severe pain, 2) urinary retention due to common nerve supply, and 3) surgical bleeding. Complications may lead to hospital admission. In conclusion, novel general anesthetics are recommended for ambulatory anorectal surgery. Further studies to determine an optimal dose and method are needed in the group of regional anesthesia.

  5. "Oriental anthropometry" in plastic surgery

    Directory of Open Access Journals (Sweden)

    Senna-Fernandes Vasco


    Full Text Available Background : According to Chinese medicine, the acupuncture-points′ (acupoints locations are proportionally and symmetrically distributed in well-defined compartment zones on the human body surface Oriental Anthropometry" (OA. Acupoints, if considered as aesthetic-loci, might be useful as reference guides in plastic surgery (PS. Aim: This study aimed to use aesthetic-loci as anatomical reference in surgical marking of Aesthetic Plastic Surgery. Method: This was an observational study based on aesthetic surgeries performed in private clinic. This study was based on 106 cases, comprising of 102 women and 4 men, with ages varying from 07 to 73 years, and with heights of between 1.34 m and 1.80 m. Patients were submitted to aesthetic surgical planning by relating aesthetic-loci to conventional surgical marking, including breast surgeries, abdominoplasty, rhytidoplasty, blepharoplasty, and hair implant. The aesthetic-surgical-outcome (ASO of the patients was assessed by a team of plastic surgeons (who were not involved in the surgical procedures over a follow-up period of one year by using a numeric-rating-scale in percentage (% terms. A four-point-verbal-rating-scale was used to record the patients′ opinion of therapeutic-satisfaction (TS. Results: ASO was 75.3 ± 9.4% and TS indicated that most patients (58.5% obtained "good" results. Of the remainder, 38.7% found the results "excellent", and 2.8% found them "fair". Discussion and Conclusion : The data suggested that the use of aesthetic-loci may be a useful tool for PS as an anatomical reference for surgical marking. However, further investigation is required to assess the efficacy of the OA by providing the patients more reliable balance and harmony in facial and body contours surgeries.

  6. Nontrauma emergency surgery: optimal case mix for general surgery and acute care surgery training. (United States)

    Cherry-Bukowiec, Jill R; Miller, Barbra S; Doherty, Gerard M; Brunsvold, Melissa E; Hemmila, Mark R; Park, Pauline K; Raghavendran, Krishnan; Sihler, Kristen C; Wahl, Wendy L; Wang, Stewart C; Napolitano, Lena M


    To examine the case mix and patient characteristics and outcomes of the nontrauma emergency (NTE) service in an academic Division of Acute Care Surgery. An NTE service (attending, chief resident, postgraduate year-3 and postgraduate year-2 residents, and two physician assistants) was created in July 2005 for all urgent and emergent inpatient and emergency department general surgery patient consults and admissions. An NTE database was created with prospective data collection of all NTE admissions initiated from November 1, 2007. Prospective data were collected by a dedicated trauma registrar and Acute Physiology and Chronic Health Evaluation-intensive care unit (ICU) coordinator daily. NTE case mix and ICU characteristics were reviewed for the 2-year time period January 1, 2008, through December 31, 2009. During the same time period, trauma operative cases and procedures were examined and compared with the NTE case mix. Thousand seven hundred eight patients were admitted to the NTE service during this time period (789 in 2008 and 910 in 2009). Surgical intervention was required in 70% of patients admitted to the NTE service. Exploratory laparotomy or laparoscopy was performed in 449 NTE patients, comprising 37% of all surgical procedures. In comparison, only 118 trauma patients (5.9% of admissions) required a major laparotomy or thoracotomy during the same time period. Acuity of illness of NTE patients was high, with a significant portion (13%) of NTE patients requiring ICU admission. NTE patients had higher admission Acute Physiology and Chronic Health Evaluation III scores [61.2 vs. 58.8 (2008); 58.2 vs. 55.8 (2009)], increased mortality [(9.71% vs. 4.89% (2008); 6.78% vs. 5.16% (2009)], and increased readmission rates (15.5% vs. 7.4%) compared with the total surgical ICU (SICU) admissions. In an era of declining operative caseload in trauma, the NTE service provides ample opportunity for complex general surgery decision making and operative procedures for

  7. Treatment of the loss of ultimate heat sink initiating events in the IRSN level 1 PSA

    International Nuclear Information System (INIS)

    Dupuy, Patricia; Georgescu, Gabriel; Corenwinder, Francois


    The total loss of the ultimate heat sink is an initiating event which, even it is mainly of external origin, has been considered in the frame of internal events Level 1 PSA by IRSN. The on-going actions on the development of external hazards PSA and the recent incident of loss of the heat sink induced by the ingress of vegetable matter that occurred in France in 2009 have pointed out the need to improve the modeling of the loss of the heat sink initiating event and sequences to better take into account the fact that this loss may be induced by external hazards and thus affect all the site units. The paper presents the historical steps of the modeling of the total loss of the heat sink, the safety stakes of this modeling, the main assumptions used by IRSN in the associated PSA for the 900 MWe reactors and the results obtained. The total loss of the heat sink was not initially addressed in the safety demonstration of French NPPs. On the basis of the insights of the first probabilistic assessments performed in the 80's, the risks associated to this 'multiple failure situation' turned out to be very significant and design and organisational improvements were implemented on the plants. Reviews of the characterization of external hazards and of their consequences on the installations and French operating feedback have revealed that extreme hazards may induce a total loss of the heat sink. Moreover, the accident that occurred at Fukushima in 2011 has pointed out the risk of such a loss of long duration at all site units in case of extreme hazards. In this context, it seems relevant to further improve the modelling of the total loss of the heat sink by considering the external hazards that may cause this loss. In a first step, IRSN has improved the assumptions and data used in the loss of the heat sink PSA model, in particular by considering that such a loss may affect all the site units. The next challenge will be the deeper analysis of the impact of external hazards on

  8. Surgery: a risky business. (United States)

    Vats, Amit; Nagpal, Kamal; Moorthy, Krishna


    The advancement of surgical technology has made surgery an increasingly suitable management option for an increasing number of medical conditions. Yet there is also a growing concern about the number of patients coming to harm as a result of surgery. Studies show that this harm can be prevented by better teamwork and communication in operating theatres. This article discusses the extent of adverse events in surgery and how effective teamwork and communication can improve patient safety. It also highlights the role checklists and briefing in improving teamwork and reducing human error in surgery.

  9. Heart valve surgery (United States)

    ... replacement; Valve repair; Heart valve prosthesis; Mechanical valves; Prosthetic valves ... surgery. Your heart valve has been damaged by infection ( endocarditis ). You have received a new heart valve ...

  10. Kansas Department of Transportation column expert : ultimate shear capacity of circular columns using the simplified modified compression field theory. (United States)


    The importance of the analysis of circular columns to accurately predict their ultimate confined : capacity under shear-flexure-axial force interaction domain is recognized in light of the extreme load event : imposed by the current American Associat...

  11. Medical tourism and bariatric surgery: who pays? (United States)

    Sheppard, Caroline E; Lester, Erica L W; Chuck, Anderson W; Kim, David H; Karmali, Shahzeer; de Gara, Christopher J; Birch, Daniel W


    The objective of this study was to determine the short-term cost impact that medical tourism for bariatric surgery has on a public healthcare system. Due to long wait times for bariatric surgery services, Canadians are venturing to private clinics in other provinces/countries. Postoperative care in this population not only burdens the provincial health system with intervention costs required for complicated patients, but may also impact resources allotted to patients in the public clinic. A chart review was performed from January 2009 to June 2013, which identified 62 medical tourists requiring costly interventions related to bariatric surgery. Secondarily, a survey was conducted to estimate the frequency of bariatric medical tourists presenting to general surgeons in Alberta, necessary interventions, and associated costs. A threshold analysis was used to compare costs of medical tourism to those from our institution. A conservative cost estimate of $1.8 million CAD was calculated for all interventions in 62 medical tourists. The survey established that 25 Albertan general surgeons consulted 59 medical tourists per year: a cost of approximately $1 million CAD. Medical tourism was calculated to require a complication rate ≤ 28% (average intervention cost of $37,000 per patient) to equate the cost of locally conducted surgery: a rate less than the current supported evidence. Conducting 250 primary bariatric surgeries in Alberta is approximately $1.9 million less than the modeled cost of treating 250 medical tourists returning to Alberta. Medical tourism has a substantial impact on healthcare costs in Alberta. When compared to bariatric medical tourists, the complication rate for locally conducted surgery is less, and the cost of managing the complications is also much less. Therefore, we conclude that it is a better use of resources to conduct bariatric surgery for Albertan residents in Alberta than to fund patients to seek surgery out of province/country.

  12. Pregnancy and the Plastic Surgery Resident. (United States)

    Garza, Rebecca M; Weston, Jane S; Furnas, Heather J


    Combining pregnancy with plastic surgery residency has historically been difficult. Two decades ago, 36 percent of plastic surgery program directors surveyed actively discouraged pregnancy among residents, and 33 percent of women plastic surgeons suffered from infertility. Most alarmingly, 26 percent of plastic surgery trainees had had an elective abortion during residency. With increasing numbers of women training in plastic surgery, this historical lack of support for pregnancy deserves further attention. To explore the current accommodations made for the pregnant plastic surgery resident, an electronic survey was sent to 88 plastic surgery program directors in the United States. Fifty-four responded, for a response rate of 61.36 percent. On average, a director trained a total of 7.91 women among 17.28 residents trained over 8.19 years. Of the women residents, 1.43 were pregnant during a director's tenure, with 1.35 of those residents taking maternity leave. An average 1.75 male residents took paternity leave. Approximately one-third of programs had a formal maternity/paternity leave policy (36.54 percent) which, in most cases, was limited to defining allowed weeks of leave, time required to fulfill program requirements, and remuneration during leave. This survey of plastic surgery directors is a first step in defining the challenges training programs face in supporting the pregnant resident. Directors provided comments describing their challenges accommodating an absent resident in a small program and complying with the American Board of Plastic Surgery's required weeks of training per year. A discussion of these challenges is followed by suggested solutions.

  13. Infection management following ambulatory surgery

    Directory of Open Access Journals (Sweden)

    Chin AB


    Full Text Available Anne B Chin, Elizabeth C Wick Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Surgical site infections (SSIs are frequent postoperative complications that are linked to measures of surgical quality and payment determinations. As surgical procedures are increasingly performed in the ambulatory setting, management of SSIs must transition with this trend. Prevention of SSIs should include optimization of patient comorbidities, aggressive infection control policies including appropriate skin decontamination, maintenance of normothermia, and appropriate antibiotic prophylaxis. Systems must also be set in place to provide adequate surveillance for identification of SSIs when they do occur as well as provide direct feedback to surgeons regarding SSI rates. This may require utilization of claims-based surveillance. Patient education and close follow-up with the clinical team are essential for early identification and management of SSIs. Therapy should remain focused on source control and appropriate antibiotic therapy. Keywords: ambulatory surgery, SSI, infection

  14. Less extensive surgery compared to extensive surgery

    DEFF Research Database (Denmark)

    Lauszus, Finn F; Petersen, Astrid C; Neumann, Gudrun


    -up by hospital data files, general practitioner, death certificate, and autopsy report. Revision of histopathology by a single pathologist. Main outcome measures: Survival and relapse by clinical data, stage, and type of surgery. RESULTS: The incidence of AGCT was 1.37 per year per 100,000 women (95% CI: 1.08, 1.......68). The median follow-up time was 15 years and for the 79 surviving women 22 years. Stage I was found in 94% of cases. Relapse occurred in 24% of women in stage I and 100% of the other stages. Survival in stage I was 95%, 89% and 84% after 5, 10 and 20 years respectively. Increased survival of stage I......: The survival of women was better in AGCT than in epithelial ovarian tumor. Age and type of surgery, besides stage, influenced survival. Total abdominal hysterectomy and bilateral salpingo-oophorectomy is the recommended treatment with advancing age. At younger age less extensive surgery was associated...

  15. A probabilistics safety assessment of ultimate response guidelines of Maanshan Nuclear Power Plant

    Energy Technology Data Exchange (ETDEWEB)

    Wang, P-Y.; Lee, M. [National Tsing Hua Univ., Hsinchu, Taiwan (China); Chao, C-C. [Inst. of Nuclear Energy Research, Taoyuan, Taiwan (China)


    Ultimate Response Guidelines (URGs) was proposed to mitigate the so called 'Fukushima type accident' of nuclear power plants (NPPs). As specified in URGs, if it is necessary, operators will depressurize the secondary side of steam generators (SGs) to bring in the low pressure water. The injection damages the economic value of the plant. However, the injection prevents the cladding temperature from rising above 1500 F (1089 K), which is the temperature that release of volatile fission products from gap is initiated. In the present study, the impact of URGs on the Core Damage Frequency (CDF) in a SBO (Station Blackout) accident of a Pressurized Water Reactor (PWR) designed by Westinghouse and adopts large dry containment is quantified. In the Base Case analysis of the study, the actions in the URGs are not considered. The CDF of SBO in the base case calculation is 2.49x10{sup -7} year. The actions specified in URGs can reduce CDF by 62%. The strategies in URGs are very effective in enhancing the reliability of decay heat removal via SG secondary side. Therefore, the implementation of these strategies can reduce the CDF of sequences involving late failure of AFWS. After the incorporation URGs, the dominant sequences of SBO are the sequences with seal failure. (author)

  16. Ultimate pressure capacity assessment of R FRC PCCV based on the tension stiffening tests

    International Nuclear Information System (INIS)

    Hahm, Dae Gi; Choun, Young Sun


    The use of fibers in concrete or cement composites can enhance the performance of structural elements. Fibers have been used for a cement mixture to increase the toughness and tensile strength, and to improve the cracking and deformation characteristics. The addition of fibers into concrete can improve the ductility and increase the tensile resistance of concrete structures. Recently, the application of fibers to prestressed concrete containment vessels (PCCVs) has been a major research topic. However, the tensile stiffening behavior of reinforced - fiber reinforced concrete (RFRC) is not fully developed yet especially for specimens using large diameter re bars. In nuclear power plant (NPP) PCCVs, large diameter re bars are applied. Therefore, the tensile stiffening behavior model should be developed to assess ultimate pressure capacity (UPC) of R FRC PCCVs. In this study, we modeled the tensile stiffening behavior of R FRC PCCVs by using recently developed model, and assessed the UPC of R FRC PCCVs. To do this, we performed tension stiffening test of R FRC with large diameter re bar

  17. Ultimate disposal of radioactive waste in the FRG - current progress of projects and perspectives

    International Nuclear Information System (INIS)

    Roesel, H.


    In the Federal Republic of Germany, the state is responsible for providing for the ultimate disposal of radioactive waste, whereas the cost is borne by the waste producing establishments. The Federal Ministry for the Environment, Nature Conservation and Reactor Safety, (BMU), as the competent state authority has delegated its responsibilities in this matter to the Physikalisch-Technische Bundesanstalt (PTB). The PTB is allowed to have work done by third parties. For this purpose, the Deutsche Gesellschaft zum Bau und Betrieb von Endlagern fuer Abfallstoffe mbH (DBE) has been founded, which since 1979 is investigating the Gorleben salt dome for suitability to serve as a repository for all type of solid, radioactive waste. The final decisions on site approval can be taken after completion of the underground exploration work, which according to current schedules is expected to be achieved at the end of the 1990s. The other candidate site, the Konrad mine, has been investigated by the GSF in the years 1976 to 1982, and on August 31, 1982 the PTB has filed an application to institute the plan approval procedure for the Konrad mine to be prepared to serve as a waste repository. The plan is expected to be laid open in the first half of 1989, and hearings possibly be held in the second half. In case of plan approval, the site preparation will probably take 3 years, so that the Konrad mine will be ready to receive radioactive waste by the year 1993. (orig.) [de

  18. An Experimental Investigation on the Ultimate Strength of Partially Infilled: Braced Steel Frames (United States)

    Dubey, Shailendra Kumar Damodar; Kute, Sunil Y.


    Infilled walls are usually, considered as non-structural elements. However, these walls are effective in carrying lateral loads. In this regard, an experimental investigation was planned and conducted to study the effect of braced and partially infilled steel frames with cement mortar and concrete in comparison to the bare frames. All these frames were tested up to collapse and subjected only to horizontal loads to obtain an effective and possible solution for soft storey which are generally not infilled. In comparison to bare steel frames, partially infilled frames have an increase of lateral load capacity by 45-60%. Central bracing is more effective than that of the corner bracing. For the same load partially infilled frames have significantly less deflection than that of the bare frames. A reduced load factor is suggested for the design of soft storey columns with the partial infills. A mathematical model has been proposed to calculate the theoretical ultimate load for the braced, cement mortar and concrete partial infilled frames.

  19. Hierarchical nanoporous metals as a path toward the ultimate three-dimensional functionality. (United States)

    Fujita, Takeshi


    Nanoporous metals prepared via dealloying or selective leaching of solid solution alloys and compounds represent an emerging class of materials. They possess a three-dimensional (3D) structure of randomly interpenetrating ligaments/nanopores with sizes between 5 nm and several tens of micrometers, which can be tuned by varying their preparation conditions (such as dealloying time and temperature) or additional thermal coarsening. As compared to other nanostructured materials, nanoporous metals have many advantages, including their bicontinuous structure, tunable pore sizes, bulk form, good electrical conductivity, and high structural stability. Therefore, nanoporous metals represent ideal 3D materials with versatile functionality, which can be utilized in various fields. In this review, we describe the recent applications of nanoporous metals in molecular detection, catalysis, 3D graphene synthesis, hierarchical pore formation, and additive manufacturing (3D printing) together with our own achievements in these areas. Finally, we discuss possible ways of realizing the ultimate 3D functionality beyond the scope of nanoporous metals.


    Delcourt, Johann; Bode, Nikolai W F; Denoël, Mathieu


    Ant mill, caterpillar circle, bat doughnut, amphibian vortex, duck swirl, and fish torus are different names for rotating circular animal formations, where individuals turn around a common center. These "collective vortex behaviors" occur at different group sizes from pairs to several million individuals and have been reported in a large number of organisms, from bacteria to vertebrates, including humans. However, to date, no comprehensive review and synthesis of the literature on vortex behaviors has been conducted. Here, we review the state of the art of the proximate and ultimate causes of vortex behaviors. The ubiquity of this behavioral phenomenon could suggest common causes or fundamental underlying principles across contexts. However, we find that a variety of proximate mechanisms give rise to vortex behaviors. We highlight the potential benefits of collective vortex behaviors to individuals involved in them. For example, in some species, vortices increase feeding efficiency and could give protection against predators. It has also been argued that vortices could improve collective decision-making and information transfer. We highlight gaps in our understanding of these ubiquitous behavioral phenomena and discuss future directions for research in vortex studies.

  1. Measurement of ultimate tensile strength and Young modulus in LYSO scintillating crystals

    Energy Technology Data Exchange (ETDEWEB)

    Scalise, Lorenzo, E-mail: [Dipartimento di Meccanica, Universita Politecnica delle Marche, Via Brecce Bianche, 60131 Ancona (Italy); Rinaldi, Daniele [Dipartimento di Fisica e Ingegneria dei Materiali e del Territorio, Universita Politecnica delle Marche, Via Brecce Bianche, 60131 Ancona (Italy); Istituto Nazionale di Fisica Nucleare, Section of Perugia (Italy); Davi, Fabrizio [Dipartimento di Architettura Costruzioni e Strutture, Universita Politecnica delle Marche, Via Brecce Bianche, 60131 Ancona (Italy); Paone, Nicola [Dipartimento di Meccanica, Universita Politecnica delle Marche, Via Brecce Bianche, 60131 Ancona (Italy)


    Scintillating crystals are employed in high energy physics, in medical imaging, diagnostic and security. Two mechanical properties of lutetium-yttrium oxyorthosilicate cerium-doped Lu{sub 2(1-x)}Y{sub 2x}SiO{sub 5}:Ce with x=0.1 (LYSO) crystals have been measured: the ultimate tensile stress ({sigma}{sub UTS}) and the Young elastic modulus (E). Measurements are made by means of a 4-points loading device and the experimental results account for an elastic-brittle stress-strain relation, which depends heavily on the specimen preparation and the material defects. {sigma}{sub UTS} along the [0 1 0] tensile direction ranges within 68.14 and 115.61 MPa, which, in the lowest case, is more than twice with respect to those measured for PbWO{sub 4} (PWO), exhibiting a marked difference between the annealed and the not-annealed samples. The mean elastic modulus (E), along the same direction, is E=1.80x10{sup 11} ({+-}2.15x10{sup 10}) N/m{sup 2}, with lower dispersion respect to UTS data. This type of analysis and study can be included into quality control procedures of crystals, based on samples taken out of production; such procedures can be established for industrial processing of crystals aimed to the high energy physics (calorimeters) and medical imaging (PET, etc.) applications.

  2. PEP-X: An Ultimate Storage Ring Based on Fourth-Order Geometric Achromats

    Energy Technology Data Exchange (ETDEWEB)

    Cai, Yunhai; Bane, Karl; Hettel, Robert; Nosochkov, Yuri; Wang, Min-Huey; /SLAC


    We have designed an 'ultimate' storage ring for the PEP-X light source that achieves the diffraction limited emittances (at 1.5 {angstrom}) of 12 pm-rad in both horizontal and vertical planes with a 4.5-GeV beam. These emittances include the contribution of intrabeam scattering at a nominal current of 200 mA in 3300 bunches. This quality beam in conjunction with a conventional 4-m undulator in a straight section can generate synchrotron radiation having a spectral brightness above 10{sup 22} [photons/s/mm{sup 2}/mrad{sup 2}/0.1% BW] at a 10 keV photon energy. The high coherence at the diffraction limit makes PEP-X competitive with 4th generation light sources based on an energy recovery linac. In addition, the beam lifetime is several hours and the dynamic aperture is large enough to allow off-axis injection. The alignment and stability tolerances, though challenging, are achievable. A ring with all these properties is only possible because of several major advances in mitigating the effects of nonlinear resonances.

  3. A new approach to the modeling of ultimate heat sink cooling ponds

    International Nuclear Information System (INIS)

    Policastro, A.J.; Wastag, M.; Paul, J.; Carhart, R.A.


    Ultimate heat sink (UHS) cooling pond thermal performance is analyzed by a new method in which zero, one, and three-dimensional models are used in combination. A typical UHS pond has an irregular shape covering 20 hectares at an average depth of 4 m with a heavy thermal load of 40 MWt (megawatts thermal) per hectare. The resulting flow field can be one, two or three dimensional. A three-dimensional numerical model (Paul 1983) is modified and used to determine the effective dimensionality of the pond under accident conditions. The model's surface heat transfer formulas and its predictions of thermal hydraulics are verified using laboratory and field data. The Paul model shows that, unlike normal cooling ponds, a typical UHS pond is vertically-mixed with only a longitudinal temperature variation. Buoyancy-driven circulations, strong discharge-to-intake flow, and rapid surface heat removal break down the usual vertical stratification. Predictions of the one-dimensional MITEMP model are shown to agree with Paul model predictions for a typical UHS pond at the Catawba Nuclear Power Plant

  4. Test research and analysis for ultimate capacity of Qinshan NPP PCCV

    International Nuclear Information System (INIS)

    Zufeng, X.


    This paper introduces design and research for containment of Qinshan NPP which is the first PWR in CHINA designed and constructed by ourselves. The PCCV design is basically in conformity to ASME code. To verify the structural integrity capacity of Qinshan NPP containment, we fulfilled SIT and ILRT successfully in June, 1991. The special attention of the paper is focused on the ultimate capacity of the PCCV under severe accidents and earthquake. A study comprised of five different independent parts has been performed for the development of containment model test and corresponding nonlinear analysis. There are two prestressed concrete containment models with equipment hatch. One is 1/15 scale with steel liner tested on shake table and then moved out loaded with atmospheric pressure. The other is 1/10 scale without steel liner loaded with water pressure until destruction. From different methods including model test and nonlinear analysis, all obtained unanimous conclusion. The capacity under internal pressure and earthquake is reliable. The safety margin is enough. Consequently, in the second phase of Qinshan NPP and other PWR NPP under design, PCCV should be a better selection in China since it's more economic, rational and safe. (author)

  5. Ultimate methane yield from beef cattle manure: effect of temperature, ration constituents, antibiotics and manure age

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, A G; Varel, V H; Chen, Y R


    The effects of temperature, ration constituents, antibiotics and manure age on the ultimate methane yield (Bo, litre CH4/g volatile solids fed (VSf)) were investigated using 4-litre batch fermenters. The average Bo for fermenters maintained at 30-60 degrees Celcius (at 5 degrees Celcius intervals) was 0.328 litre CH4/g VSf. The Bo at 65 degrees Celcius averaged 0.118 litre CH4g VSf, but this low yield was attributed to unstable fermentation rather than decreased substrate availability at that temperature. These results agreed well with Bo values estimated from daily-fed fermenters. Chlortetracycline and monensin did not affect Bo; however, monensin did delay the start of active fermentation in batch fermenters. The average Bo of manure from cattle fed 91.5, 40 and 7% corn silage were 0.173, 0.232 and 0.290 litre CH4/g VSf, respectively. The average Bo for 6-8 week old manure from a dirt feedlot was 0.210 litre CH4/g VSf. (Refs. 14).

  6. Ultimate disposition of aluminum clad spent nuclear fuel in the United States

    International Nuclear Information System (INIS)

    Messick, C.E.; Clark, W.D.; Clapper, M.; Mustin, T.P.


    Treatment and disposition of spent nuclear fuel (SNF) in the United States has changed significantly over the last decade due to change in world climate associated with nuclear material. Chemical processing of aluminum based SNF is ending and alternate disposition paths are being developed that will allow for the ultimate disposition of the enriched uranium in this SNF. Existing inventories of aluminum based SNF are currently being stored primarily in water-filled basins at the Savannah River Site (SRS) while these alternate disposition paths are being developed and implemented. Nuclear nonproliferation continues to be a worldwide concern and it is causing a significant influence on the development of management alternatives for SNF. SRS recently completed an environmental impact statement for the management of aluminum clad SNF that selects alternatives for all of the fuels in inventory. The U.S. Department of Energy and SRS are now implementing a dual strategy of processing small quantities of 'problematic' SNF while developing an alternative technology to dispose of the remaining aluminum clad SNF in the proposed monitored geologic repository. (author)

  7. Structural Phenomenon of Cement-Based Composite Elements in Ultimate Limit State

    Directory of Open Access Journals (Sweden)

    I. Iskhakov


    Full Text Available Cement-based composite materials have minimum of two components, one of which has higher strength compared to the other. Such materials include concrete, reinforced concrete (RC, and ferrocement, applied in single- or two-layer RC elements. This paper discusses experimental and theoretical results, obtained by the authors in the recent three decades. The authors have payed attention to a structural phenomenon that many design features (parameters, properties, etc. at ultimate limit state (ULS of a structure are twice higher (or lower than at initial loading state. This phenomenon is evident at material properties, structures (or their elements, and static and/or dynamic structural response. The phenomenon is based on two ideas that were developed by first author: quasi-isotropic state of a structure at ULS and minimax principle. This phenomenon is supported by experimental and theoretical results, obtained for various structures, like beams, frames, spatial structures, and structural joints under static or/and dynamic loadings. This study provides valuable indicators for experiments’ planning and estimation of structural state. The phenomenon provides additional equation(s for calculating parameters that are usually obtained experimentally and can lead to developing design concepts and RC theory, in which the number of empirical design coefficients will be minimal.

  8. Thermal performance experiments on ultimate heat sinks, spray ponds, and cooling ponds

    International Nuclear Information System (INIS)

    Hadlock, R.K.


    A program of measurement on a Battelle-Northwest (BNW) spray pond has been completed to prove an integrated instrumentation system for application in future field experiments. The measurement programs in the field will produce data of relevance to the design and understanding of performance for ultimate heat sinks as components of emergency core cooling systems. In the absence of active emergency cooling systems, the data will be obtained on analog systems--prime candidates among these are the naturally-occurring hot ponds at Yellowstone National Park and man-made hot cooling ponds at Savannah River National Laboratory as well as spray ponds at various industrial facilities. The proof experiment has provided data that not only illustrate the effectiveness of the instrumentation system but also display interesting site-specific heat transfer processes. The data to be obtained in the field will also be site specific but must be of generic applicability in modeling for design and performance purposes. The integrated instrumentation system will evolve, through modest modifications and substantial supplementation, to provide the requisite data for the more demanding situation of work in and about hot water

  9. Genotyping by sequencing (GBS, an ultimate marker-assisted selection (MAS tool to accelerate plant breeding

    Directory of Open Access Journals (Sweden)

    Jiangfeng eHe


    Full Text Available Marker-assisted selection (MAS refers to the use of molecular markers to assist phenotypic selections in crop improvement. Several types of molecular markers, such as single nucleotide polymorphism (SNP, have been identified and effectively used in plant breeding. The application of next-generation sequencing (NGS technologies has led to remarkable advances in whole genome sequencing, which provides ultra-throughput sequences to revolutionize plant genotyping and breeding. To further broaden NGS usages to large crop genomes such as maize and wheat, genotyping by sequencing (GBS has been developed and applied in sequencing multiplexed samples that combine molecular marker discovery and genotyping. GBS is a novel application of NGS protocols for discovering and genotyping SNPs in crop genomes and populations. The GBS approach includes the digestion of genomic DNA with restriction enzymes followed by the ligation of barcode adapter, PCR amplification and sequencing of the amplified DNA pool on a single lane of flow cells. Bioinformatic pipelines are needed to analyze and interpret GBS datasets. As an ultimate MAS tool and a cost-effective technique, GBS has been successfully used in implementing genome-wide association study (GWAS, genomic diversity study, genetic linkage analysis, molecular marker discovery and genomic selection (GS under a large scale of plant breeding programs.

  10. Ultimate pressure capacity assessment of R FRC PCCV based on the tension stiffening tests

    Energy Technology Data Exchange (ETDEWEB)

    Hahm, Dae Gi; Choun, Young Sun [KAERI, Daejeon (Korea, Republic of)


    The use of fibers in concrete or cement composites can enhance the performance of structural elements. Fibers have been used for a cement mixture to increase the toughness and tensile strength, and to improve the cracking and deformation characteristics. The addition of fibers into concrete can improve the ductility and increase the tensile resistance of concrete structures. Recently, the application of fibers to prestressed concrete containment vessels (PCCVs) has been a major research topic. However, the tensile stiffening behavior of reinforced - fiber reinforced concrete (RFRC) is not fully developed yet especially for specimens using large diameter re bars. In nuclear power plant (NPP) PCCVs, large diameter re bars are applied. Therefore, the tensile stiffening behavior model should be developed to assess ultimate pressure capacity (UPC) of R FRC PCCVs. In this study, we modeled the tensile stiffening behavior of R FRC PCCVs by using recently developed model, and assessed the UPC of R FRC PCCVs. To do this, we performed tension stiffening test of R FRC with large diameter re bar.

  11. Design Dependent Cutoff Frequency of Nanotransistors Near the Ultimate Performance Limit (United States)

    Kordrostami, Zoheir; Sheikhi, M. Hossein; Zarifkar, Abbas


    We have studied the effect of different structural designs of double gate MOSFETs (DG-MOSFETs) and carbon nanotube field effect transistors (CNTFETs) on the cutoff frequency (fT). The effects of metallic contacts with Schottky barriers, gate work function, dual material gate (DMG), halo doped channel and lightly doped drain and source (LDDS) architectures on the fT have been investigated for DG-MOSFETs and CNTFETs and the design dependent fT for both types of transistors has been studied for the first time. The simulations are based on the Schrödinger-Poisson solvers developed for each nanotransistor separately. The ballistic limit has been studied as the ultimate performance limit of the DG-MOSFETs and CNTFETs. The results of this paper, for the first time, show how some designations used for modification of short channel effects or current-voltage characteristics affect the fT. The results revealed that the cutoff frequencies of both types of the transistors exhibit the same behavior with changing design parameters. We have shown that the Schottky barriers, parasitic capacitances and halo doping reduce the fT and have proposed the DMG and LDDS artchitectures as ways to increase the fT for DG-MOSFETs and CNTFETs for the first time.

  12. Pareto-Optimal Evaluation of Ultimate Limit States in Offshore Wind Turbine Structural Analysis

    Directory of Open Access Journals (Sweden)

    Michael Muskulus


    Full Text Available The ultimate capacity of support structures is checked with extreme loads. This is straightforward when the limit state equations depend on a single load component, and it has become common to report maxima for each load component. However, if more than one load component is influential, e.g., both axial force and bending moments, it is not straightforward how to define an extreme load. The combination of univariate maxima can be too conservative, and many different combinations of load components can result in the worst value of the limit state equations. The use of contemporaneous load vectors is typically non-conservative. Therefore, in practice, limit state checks are done for each possible load vector, from each time step of a simulation. This is not feasible when performing reliability assessments and structural optimization, where additional, time-consuming computations are involved for each load vector. We therefore propose to use Pareto-optimal loads, which are a small set of loads that together represent all possible worst case scenarios. Simulations with two reference wind turbines show that this approach can be very useful for jacket structures, whereas the design of monopiles is often governed by the bending moment only. Even in this case, the approach might be useful when approaching the structural limits during optimization.

  13. Performance Indicators in Spine Surgery. (United States)

    St-Pierre, Godefroy Hardy; Yang, Michael H; Bourget-Murray, Jonathan; Thomas, Ken C; Hurlbert, Robin John; Matthes, Nikolas


    Systematic review. To elucidate how performance indicators are currently used in spine surgery. The Patient Protection and Affordable Care Act has given significant traction to the idea that healthcare must provide value to the patient through the introduction of hospital value-based purchasing. The key to implementing this new paradigm is to measure this value notably through performance indicators. MEDLINE, CINAHL Plus, EMBASE, and Google Scholar were searched for studies reporting the use of performance indicators specific to spine surgery. We followed the Prisma-P methodology for a systematic review for entries from January 1980 to July 2016. All full text articles were then reviewed to identify any measure of performance published within the article. This measure was then examined as per the three criteria of established standard, exclusion/risk adjustment, and benchmarking to determine if it constituted a performance indicator. The initial search yielded 85 results among which two relevant studies were identified. The extended search gave a total of 865 citations across databases among which 15 new articles were identified. The grey literature search provided five additional reports which in turn led to six additional articles. A total of 27 full text articles and reports were retrieved and reviewed. We were unable to identify performance indicators. The articles presenting a measure of performance were organized based on how many criteria they lacked. We further examined the next steps to be taken to craft the first performance indicator in spine surgery. The science of performance measurement applied to spine surgery is still in its infancy. Current outcome metrics used in clinical settings require refinement to become performance indicators. Current registry work is providing the necessary foundation, but requires benchmarking to truly measure performance. 1.

  14. Laboratory reptile surgery: principles and techniques. (United States)

    Alworth, Leanne C; Hernandez, Sonia M; Divers, Stephen J


    Reptiles used for research and instruction may require surgical procedures, including biopsy, coelomic device implantation, ovariectomy, orchidectomy, and esophogostomy tube placement, to accomplish research goals. Providing veterinary care for unanticipated clinical problems may require surgical techniques such as amputation, bone or shell fracture repair, and coeliotomy. Although many principles of surgery are common between mammals and reptiles, important differences in anatomy and physiology exist. Veterinarians who provide care for these species should be aware of these differences. Most reptiles undergoing surgery are small and require specific instrumentation and positioning. In addition, because of the wide variety of unique physiologic and anatomic characteristics among snakes, chelonians, and lizards, different techniques may be necessary for different reptiles. This overview describes many common reptile surgery techniques and their application for research purposes or to provide medical care to research subjects.

  15. Legal and ethical issues in robotic surgery. (United States)

    Mavroforou, A; Michalodimitrakis, E; Hatzitheo-Filou, C; Giannoukas, A


    With the rapid introduction of revolutionary technologies in surgical practice, such as computer-enhanced robotic surgery, the complexity in various aspects, including medical, legal and ethical, will increase exponentially. Our aim was to highlight important legal and ethical implications emerged from the application of robotic surgery. Search of the pertinent medical and legal literature. Robotic surgery may open new avenues in the near future in surgical practice. However, in robotic surgery, special training and experience along with high quality assessment are required in order to provide normal conscientious care and state-of-the-art treatment. While the legal basis for professional liability remains exactly the same, litigation with the use of robotic surgery may be complex. In case of an undesirable outcome, in addition to physician and hospital, the manufacturer of the robotic system may be sued. In respect to ethical issues in robotic surgery, equipment safety and reliability, provision of adequate information, and maintenance of confidentiality are all of paramount importance. Also, the cost of robotic surgery and the lack of such systems in most of the public hospitals may restrict the majority from the benefits offered by the new technology. While surgical robotics will have a significant impact on surgical practice, it presents challenges so much in the realm of law and ethics as of medicine and health care.

  16. New trends in minimally invasive urological surgery

    Directory of Open Access Journals (Sweden)

    Prabhakar Rajan


    Full Text Available Purpose: The perceived benefits of minimally-invasive surgery include less postoperative pain, shorter hospitalization, reduced morbidity and better cosmesis while maintaining diagnostic accuracy and therapeutic outcome. We review the new trends in minimally-invasive urological surgery. Materials and method: We reviewed the English language literature using the National Library of Medicine database to identify the latest technological advances in minimally-invasive surgery with particular reference to urology. Results: Amongst other advances, studies incorporating needlescopic surgery, laparoendoscopic single-site surgery , magnetic anchoring and guidance systems, natural orifice transluminal endoscopic surgery and flexible robots were considered of interest. The results from initial animal and human studies are also outlined. Conclusion: Minimally-invasive surgery continues to evolve to meet the demands of the operators and patients. Many novel technologies are still in the testing phase, whilst others have entered clinical practice. Further evaluation is required to confirm the safety and efficacy of these techniques and validate the published reports.

  17. Laser assisted robotic surgery in cornea transplantation (United States)

    Rossi, Francesca; Micheletti, Filippo; Magni, Giada; Pini, Roberto; Menabuoni, Luca; Leoni, Fabio; Magnani, Bernardo


    Robotic surgery is a reality in several surgical fields, such as in gastrointestinal surgery. In ophthalmic surgery the required high spatial precision is limiting the application of robotic system, and even if several attempts have been designed in the last 10 years, only some application in retinal surgery were tested in animal models. The combination of photonics and robotics can really open new frontiers in minimally invasive surgery, improving the precision, reducing tremor, amplifying scale of motion, and automating the procedure. In this manuscript we present the preliminary results in developing a vision guided robotic platform for laser-assisted anterior eye surgery. The robotic console is composed by a robotic arm equipped with an "end effector" designed to deliver laser light to the anterior corneal surface. The main intended application is for laser welding of corneal tissue in laser assisted penetrating keratoplasty and endothelial keratoplasty. The console is equipped with an integrated vision system. The experiment originates from a clear medical demand in order to improve the efficacy of different surgical procedures: when the prototype will be optimized, other surgical areas will be included in its application, such as neurosurgery, urology and spinal surgery.

  18. Multimodality treatment of a complex series of parallel pathologies in a 16-year-old male that ultimately leads to bilateral hip arthroplasty surgery: A case report.

    LENUS (Irish Health Repository)

    Cullen, Emmet


    Femoral head osteonecrosis is associated with significant sequelae for the patient in the long-term. A combination of factors are thought to contribute to the pathophysiology behind this debilitating disease process.

  19. Gamified Requirements Engineering: Model and Experimentation

    NARCIS (Netherlands)

    Lombriser, Philipp; Dalpiaz, Fabiano; Lucassen, Garm; Brinkkemper, Sjaak


    [Context & Motivation] Engaging stakeholders in requirements engineering (RE) influences the quality of the requirements and ultimately of the system to-be. Unfortunately, stakeholder engagement is often insufficient, leading to too few, low-quality requirements. [Question/problem] We aim to

  20. Augmented reality in surgery. (United States)

    Shuhaiber, Jeffrey H


    To evaluate the history and current knowledge of computer-augmented reality in the field of surgery and its potential goals in education, surgeon training, and patient treatment. National Library of Medicine's database and additional library searches. Only articles suited to surgical sciences with a well-defined aim of study, methodology, and precise description of outcome were included. Augmented reality is an effective tool in executing surgical procedures requiring low-performance surgical dexterity; it remains a science determined mainly by stereotactic registration and ergonomics. Strong evidence was found that it is an effective teaching tool for training residents. Weaker evidence was found to suggest a significant influence on surgical outcome, both morbidity and mortality. No evidence of cost-effectiveness was found. Augmented reality is a new approach in executing detailed surgical operations. Although its application is in a preliminary stage, further research is needed to evaluate its long-term clinical impact on patients, surgeons, and hospital administrators. Its widespread use and the universal transfer of such technology remains limited until there is a better understanding of registration and ergonomics.