Occupancy estimation and the closure assumption

Science.gov (United States)

Rota, Christopher T.; Fletcher, Robert J.; Dorazio, Robert M.; Betts, Matthew G.

2009-01-01

1. Recent advances in occupancy estimation that adjust for imperfect detection have provided substantial improvements over traditional approaches and are receiving considerable use in applied ecology. To estimate and adjust for detectability, occupancy modelling requires multiple surveys at a site and requires the assumption of 'closure' between surveys, i.e. no changes in occupancy between surveys. Violations of this assumption could bias parameter estimates; however, little work has assessed model sensitivity to violations of this assumption or how commonly such violations occur in nature. 2. We apply a modelling procedure that can test for closure to two avian point-count data sets in Montana and New Hampshire, USA, that exemplify time-scales at which closure is often assumed. These data sets illustrate different sampling designs that allow testing for closure but are currently rarely employed in field investigations. Using a simulation study, we then evaluate the sensitivity of parameter estimates to changes in site occupancy and evaluate a power analysis developed for sampling designs that is aimed at limiting the likelihood of closure. 3. Application of our approach to point-count data indicates that habitats may frequently be open to changes in site occupancy at time-scales typical of many occupancy investigations, with 71% and 100% of species investigated in Montana and New Hampshire respectively, showing violation of closure across time periods of 3 weeks and 8 days respectively. 4. Simulations suggest that models assuming closure are sensitive to changes in occupancy. Power analyses further suggest that the modelling procedure we apply can effectively test for closure. 5. Synthesis and applications. Our demonstration that sites may be open to changes in site occupancy over time-scales typical of many occupancy investigations, combined with the sensitivity of models to violations of the closure assumption, highlights the importance of properly addressing

CIRSE Vascular Closure Device Registry

International Nuclear Information System (INIS)

Reekers, Jim A.; Müller-Hülsbeck, Stefan; Libicher, Martin; Atar, Eli; Trentmann, Jens; Goffette, Pierre; Borggrefe, Jan; Zeleňák, Kamil; Hooijboer, Pieter; Belli, Anna-Maria

2011-01-01

Purpose: Vascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology. Methods: The CIRSE registry of closure devices with an anchor and a plug started in January 2009 and ended in August 2009. A total of 1,107 patients were included in the registry. Results: Deployment success was 97.2%. Deployment failure specified to access type was 8.8% [95% confidence interval (95% CI) 5.0–14.5] for antegrade access and 1.8% (95% CI 1.1–2.9) for retrograde access (P = 0.001). There was no difference in deployment failure related to local PVD at the access site. Calcification was a reason for deployment failure in only 5.9 cm, and two vessel occlusions. Conclusion: The conclusion of this registry of closure devices with an anchor and a plug is that the use of this device in interventional radiology procedures is safe, with a low incidence of serious access site complications. There seems to be no difference in complications between antegrade and retrograde access and other parameters.

Comparison between primary closure with karydakis's technique versus open procedure in treatment of pilonidal sinus in terms of frequency of postoperative wound infection

International Nuclear Information System (INIS)

Nafees, A.U.A.; Ahmed, M.

2013-01-01

Objective: The purpose of this study is to compare between primary closure with Karydakis's technique versus open procedure in treatment of pilonidal sinus in terms of frequency of postoperative wound infection. Study Design: Randomized Clinical Trials (RCT). Place and Duration of Study: This study was carried out at Department of Surgery, CMH, Kharian over a period of 2 years from Sept 2010 to Oct 2012. Patients and Methods: Sixty patients were selected out of which 30 patients underwent open excision and secondary healing and 30 patients underwent Karydakis procedure. Post operatively these patients were observed for wound infection on date of discharge and weeks 1, 2 and 3. Results of both groups were compared for wound infection by applying chi-square test. Results: There was no statistically significant difference in the frequency of infection between the two groups when calculated during the complete course of study. Conclusion: Primary closure with Karydakis's technique and open procedure are satisfactory surgical procedures for pilonidal sinus disease in terms of post-operative wound infection. (author)

Catheter-based closure of the patent ductus arteriosus in lower weight infants.

Science.gov (United States)

Pavlek, Leeann R; Slaughter, Jonathan L; Berman, Darren P; Backes, Carl H

2018-06-13

Risks associated with drug therapy and surgical ligation have led health care providers to consider alternative strategies for patent ductus arteriosus (PDA) closure. Catheter-based PDA closure is the procedure of choice for ductal closure in adults, children, and infants ≥6kg. Given evidence among older counterparts, interest in catheter-based closure of the PDA in lower weight (closure devices; (3) review the technical success (feasibility); (4) review the risks (safety profile); (5) discuss the quality of evidence on procedural efficacy; (6) consider areas for future research. The review provided herein suggests that catheter-based PDA closure is technically feasible, but the lack of comparative trials precludes determination of the optimal strategy for ductal closure in this subgroup of infants. Copyright © 2018 Elsevier Inc. All rights reserved.

CIRSE Vascular Closure Device Registry

Science.gov (United States)

Müller-Hülsbeck, Stefan; Libicher, Martin; Atar, Eli; Trentmann, Jens; Goffette, Pierre; Borggrefe, Jan; Zeleňák, Kamil; Hooijboer, Pieter; Belli, Anna-Maria

2010-01-01

Purpose Vascular closure devices are routinely used after many vascular interventional radiology procedures. However, there have been no major multicenter studies to assess the safety and effectiveness of the routine use of closure devices in interventional radiology. Methods The CIRSE registry of closure devices with an anchor and a plug started in January 2009 and ended in August 2009. A total of 1,107 patients were included in the registry. Results Deployment success was 97.2%. Deployment failure specified to access type was 8.8% [95% confidence interval (95% CI) 5.0–14.5] for antegrade access and 1.8% (95% CI 1.1–2.9) for retrograde access (P = 0.001). There was no difference in deployment failure related to local PVD at the access site. Calcification was a reason for deployment failure in only 5.9 cm, and two vessel occlusions. Conclusion The conclusion of this registry of closure devices with an anchor and a plug is that the use of this device in interventional radiology procedures is safe, with a low incidence of serious access site complications. There seems to be no difference in complications between antegrade and retrograde access and other parameters. PMID:20981425

Impact of Different Standard Type A7A Drum Closure-Ring Practices on Gasket Contraction and Bolt Closure Distance– 15621

Energy Technology Data Exchange (ETDEWEB)

Ketusky, Edward [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Blanton, Paul [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL); Bobbitt, John H. [Savannah River Site (SRS), Aiken, SC (United States). Savannah River National Lab. (SRNL)

2015-03-11

The Department of Energy, the Savannah River National Laboratory, several manufacturers of specification drums, and the United States Department of Transportation (DOT) are collaborating in the development of a guidance document for DOE contractors and vendors who wish to qualify containers to DOT 7A Type A requirements. Currently, the effort is focused on DOT 7A Type A 208-liter (55-gallons) drums with a standard 12-gauge bolted closure ring. The U.S. requirements, contained in Title 49, Part 178.350 “Specification 7A; general packaging, Type A specifies a competent authority review of the packaging is not required for the transport of (Class 7) radioactive material containing less than Type A quantities of radioactive material. For Type AF drums, a 4 ft. regulatory free drop must be performed, such that the drum “suffers maximum damage.” Although the actual orientation is not defined by the specification, recent studies suggest that maximum damage would result from a shallow angle top impact, where kinetic energy is transferred to the lid, ultimately causing heavy damage to the lid, or even worse, causing the lid to come off. Since each vendor develops closure recommendations/procedures for the drums they manufacture, key parameters applied to drums during closing vary based on vendor. As part of the initial phase of the collaboration, the impact of the closure variants on the ability of the drum to suffer maximum damage is investigated. Specifically, closure testing is performed varying: 1) the amount of torque applied to the closure ring bolt; and, 2) stress relief protocol, including: a) weight of hammer; and, b) orientation that the hammer hits the closure ring. After closure, the amount of drum lid gasket contraction and the distance that the closure bolt moves through the closure ring is measured.

Treatment of severe refractory epistaxis in hereditary hemorrhagic telangiectasia using a two-flap nasal closure method

Science.gov (United States)

Timmins, Benjamin H.; Hunter, Benjamin N.; Wilson, Kevin F.; Ward, P. Daniel

2016-01-01

Background Nasal closure has been shown to effectively manage severe epistaxis refractory to other treatments in patients with hereditary hemorrhagic telangiectasia (HHT). The nasal closure procedure may be underutilized due to its surgical complexity and flap breakdown. Methods Retrospective review of thirteen HHT patients treated for severe epistaxis with nasal closure between 2005 and 2013. Operating room (OR) time, need for revision surgery, pre- and post-procedure epistaxis severity score (ESS), complete blood count values, and Glasgow Benefit Inventory (GBI) questionnaire results were collected for each patient. The technique is described. We characterize a typical nasal closure patient and compare outcomes based on our experience with the traditional three-flap closure and a simplified two-flap nasal closure procedure. Results The average candidate for nasal closure in this series had an ESS of 7.88, Hgb of 8.3 g/dL, and received multiple transfusions, iron therapy, and cautery/coagulation procedures. Average ESS subsequent to nasal closure using the two flap method is 0.92 and mean GBI score is 56.3. Comparison of five patients who underwent the traditional three-flap nasal closure procedure and eight patients receiving the two flap nasal closure showed no significant difference in post-op ESS or GBI metrics. Mean operating room times of the traditional and simplified methods were 3.12 hours and 1.44 hours (p=0.0001). Mean time to first revision for eight nasal closure patients is 21.5 months. Conclusion In short-term follow-up, the two-flap procedure has shown comparable effectiveness with significantly reduced complexity and operative time compared to the traditional nasal closure method. PMID:26751606

Vein Patch Closure Using Below the Knee Greater Saphenous Vein for Femoral Endarterectomy Procedures is Not Always a Safe Choice

Directory of Open Access Journals (Sweden)

M. Berner

Full Text Available : Background: The complication of vein patch rupture is well described after carotid patch angioplasty; however, there is a paucity of data about the safety of vein patch closure in the setting of femoral endarterectomy. Methods/results: From May 2012 to May 2015, 115 femoral endarterectomies with patch closure were performed. A patch rupture occurred in three cases (2.6% with a mortality rate of 66% (2/3. In all cases the greater saphenous vein below the knee was used as patch material. Discussion/conclusion: Vein patches, particularly from small calibre veins, should be excluded in femoral endarterectomy procedures as they pose a substantial risk of rupture. Keywords: Angioplasty, Patch rupture, Femoral artery, Patch, Great saphenous vein

Use of the Boomerang catalyst advantage closure device to facilitate complex multistaged percutaneous revascularization procedures for the treatment of critical limb ischemia.

Science.gov (United States)

Garcia, Joel A; Casserly, Ivan P

2009-07-01

An increasing spectrum of complex peripheral arterial disease may be successfully treated using percutaneous revascularization techniques. A pair of challenging peripheral revascularization procedures in patients with critical limb ischemia is presented, where an array of interventional tools and techniques were required, and the off-label use of the Boomerang catalyst system closure device was important in managing a variety of complex arterial access issues and ultimately allowing procedural success. Copyright 2009 Wiley-Liss, Inc.

Management of intermittent angle closure glaucoma with Nd: yag laser iridotomy as a primary procedure

International Nuclear Information System (INIS)

Ahmed, M.

2006-01-01

To assess the efficacy and complications of Nd: YAG laser iridotomy in patients with intermittent (sub-acute) angle closure glaucoma. Twenty-five eyes of twenty-three patients with periodic (intermittent) angle closure, selected in outpatient department, were kept on pilocarpine until YAG laser iridotomy was performed. After YAG laser iridotomy oral acetazolamide and topical dexamethasone was used to control post laser rise of IOP and inflammation respectively. Patency of iridotomy was confirmed and intra-ocular pressure was measured one hour after the procedure. Immediate complication, if any, was noted. Follow-up was done for six months. Prophylactic laser iridotomy was done in fellow eye with occludable angle. Levene's test for equality of variance and t-test for equality of means were used for statistical analysis. This study revealed a significant difference in IOP before and after YAG laser iridotomy (p = .002). Complete follow-up of 6 months was possible in 25 eyes of 23 subjects. After YAG Laser iridotomy, 21 (84%) eyes showed negative provocative test, intraocular pressure below 19mm Hg without medication and anterior chamber angle no more occludable and were labeled successful. Iridotomy remained patent in 96% of eyes. Iridotomy failed to reduce IOP in 4 (16%) eyes. The complications were minimal and transient. (author)

Technique of Antireflux Procedure without Creating Submucosal Tunnel for Surgical Correction of Vesicoureteric Reflux during Bladder Closure in Exstrophy.

Science.gov (United States)

Sunil, Kanoujia; Gupta, Archika; Chaubey, Digamber; Pandey, Anand; Kureel, Shiv Narain; Verma, Ajay Kumar

2018-01-01

To report the clinical application of the new surgical technique of antireflux procedure without creating submucosal tunnel for surgical correction of vesicoureteric reflux during bladder closure in exstrophy. Based on the report of published experimental technique, the procedure was clinically executed in seven patients of classic exstrophy bladder with small bladder plate with polyps, where the creation of submucosal tunnel was not possible, in last 18 months. Ureters were mobilized. A rectangular patch of bladder mucosa at trigone was removed exposing the detrusor. Mobilized urteres were advanced, crossed and anchored to exposed detrusor parallel to each other. Reconstruction included bladder and epispadias repair with abdominal wall closure. The outcome was measured with the assessment of complications, abolition of reflux on cystogram and upper tract status. At 3-month follow-up cystogram, reflux was absent in all. Follow-up ultrasound revealed mild dilatation of pelvis and ureter in one. The technique of extra-mucosal ureteric reimplantation without the creation of submucosal tunnel is simple to execute without risk and complications and effectively provides an antireflux mechanism for the preservation of upper tract in bladder exstrophy. With the use of this technique, reflux can be prevented since the very beginning of exstrophy reconstruction.

ASD Closure in Structural Heart Disease.

Science.gov (United States)

Wiktor, Dominik M; Carroll, John D

2018-04-17

While the safety and efficacy of percutaneous ASD closure has been established, new data have recently emerged regarding the negative impact of residual iatrogenic ASD (iASD) following left heart structural interventions. Additionally, new devices with potential advantages have recently been studied. We will review here the potential indications for closure of iASD along with new generation closure devices and potential late complications requiring long-term follow-up. With the expansion of left-heart structural interventions and large-bore transseptal access, there has been growing experience gained with management of residual iASD. Some recently published reports have implicated residual iASD after these procedures as a potential source of diminished clinical outcomes and mortality. Additionally, recent trials investigating new generation closure devices as well as expanding knowledge regarding late complications of percutaneous ASD closure have been published. While percutaneous ASD closure is no longer a novel approach to managing septal defects, there are several contemporary issues related to residual iASD following large-bore transseptal access and new generation devices which serve as an impetus for this review. Ongoing attention to potential late complications and decreasing their incidence with ongoing study is clearly needed.

Interim status of closure/post-closure plan for 183-H solar evaporation basins

International Nuclear Information System (INIS)

1988-03-01

This report describes a plan for decommissioning several solar evaporation basins on the Hanford reservation. The document describes procedures for sampling during decommissioning and a plan for certification of the resulting completed landfill. Additional plans deal with the training, security of the site, and post-closure monitoring

Early Closure of a Temporary Ileostomy in Patients With Rectal Cancer

DEFF Research Database (Denmark)

Danielsen, Anne K; Park, Jennifer; Jansen, Jens E

2017-01-01

OBJECTIVE: The objective was to study morbidity and mortality associated with early closure (8-13 days) of a temporary stoma compared with standard procedure (closure after > 12 weeks) after rectal resection for cancer. BACKGROUND: A temporary ileostomy may reduce the risk of pelvic sepsis after .......0001. CONCLUSIONS: It is safe to close a temporary ileostomy 8 to 13 days after rectal resection and anastomosis for rectal cancer in selected patients without clinical or radiological signs of anastomotic leakage.......OBJECTIVE: The objective was to study morbidity and mortality associated with early closure (8-13 days) of a temporary stoma compared with standard procedure (closure after > 12 weeks) after rectal resection for cancer. BACKGROUND: A temporary ileostomy may reduce the risk of pelvic sepsis after...... creation) of a temporary ileostomy was compared with late closure (>12 weeks) in a multicenter randomized controlled trial, EASY (www.clinicaltrials.gov, NCT01287637) including patients undergoing rectal resection for cancer. Patients with a temporary ileostomy without signs of postoperative complications...

Effectiveness of percutaneous closure of patent foramen ovale for hypoxemia.

Science.gov (United States)

Fenster, Brett E; Nguyen, Bryant H; Buckner, J Kern; Freeman, Andrew M; Carroll, John D

2013-10-15

The aim of this study was to evaluate the ability of percutaneous patent foramen ovale (PFO) closure to improve systemic hypoxemia. Although PFO-mediated right-to-left shunt (RTLS) is associated with hypoxemia, the ability of percutaneous closure to ameliorate hypoxemia is unknown. Between 2004 and 2009, 97 patients who underwent PFO closure for systemic hypoxemia and dyspnea that was disproportionate to underlying lung disease were included for evaluation. All patients exhibited PFO-mediated RTLS as determined by agitated saline echocardiography. Procedural success was defined as implantation of a device without major complications and mild or no residual shunt at 6 months. Clinical success was defined as a composite of an improvement in New York Heart Association (NYHA) functional class, reduction of dyspnea symptoms, or decreased oxygen requirement. Procedural success was achieved in 96 of 97 (99%), and clinical success was achieved in 68 of 97 (70%). The presence of any moderate or severe interatrial shunt by agitated saline study (odds ratio [OR] = 4.7; p gender (OR = 0.30; p <0.017) decreased the likelihood of success. In conclusion, based on the largest single-center experience of patients referred for PFO closure for systemic hypoxemia, PFO closure was a mechanically effective procedure with an associated improvement in echocardiographic evidence of RTLS, NYHA functional class, and oxygen requirement. Copyright © 2013 Elsevier Inc. All rights reserved.

Comparison of cost-effectiveness and postoperative outcome of device closure and open surgery closure techniques for treatment of patent ductus arteriosus

Directory of Open Access Journals (Sweden)

Alireza Ahmadi

2014-01-01

Full Text Available BACKGROUND: Various devices have been recently employed for percutaneous closure of the patent ductus arteriosus (PDA. Although the high effectiveness of device closure techniques has been clearly determined, a few studies have focused on the cost-effectiveness and also postoperative complications of these procedures in comparison with open surgery. The present study aimed to evaluate the clinical outcome and cost-effectiveness of PDA occlusion by Amplatzer and coil device in comparisong with open surgery. METHODS: In this cross-sectional study, a randomized sample of 201 patients aged 1 month to 16 years (105 patients with device closure and 96 patients with surgical closure was selected. The ratio of total pulmonary blood flow to total systemic blood flow, the Qp/Qs ratio, was measured using a pulmonary artery catheter. The cost analysis included direct medical care costs associated with device implantation and open surgery, as well as professional fees. All costs were calculated in Iranian Rials and then converted to US dollars. RESULTS: There was no statistical difference in mean Qp/Qs ratio before the procedure between the device closure group and the open surgery group (2.1 ± 0.7 versus 1.7 ± 0.6, P = 0.090. The mean measured costs were overall higher in the device closure group than in open closure group (948.87 ± 548.76 US$ versus 743.70 ± 696.91 US$, P < 0.001. This difference remained significant after adjustment for age and gender (Standardized Beta = 0.160, P = 0.031. PDA closure with the Amplatzer ductal occluder (1053.05 ± 525.73 US$ or with Nit-Occlud coils (PFM (912.73 ± 565.94 US$, P < 0.001 was more expensive than that via open surgery. However, the Cook detachable spring coils device closure (605.65 ± 194.62 US$, P = 0.650 had a non-significant cost difference with open surgery. No event was observed in the device closure group regarding in-hospital mortality or morbidity; however, in another group, 2 in-hospital deaths

Comparison of cost-effectiveness and postoperative outcome of device closure and open surgery closure techniques for treatment of patent ductus arteriosus.

Science.gov (United States)

Ahmadi, Alireza; Sabri, Mohammadreza; Bigdelian, Hamid; Dehghan, Bahar; Gharipour, Mojgan

2014-01-01

Various devices have been recently employed for percutaneous closure of the patent ductus arteriosus (PDA). Although the high effectiveness of device closure techniques has been clearly determined, a few studies have focused on the cost-effectiveness and also postoperative complications of these procedures in comparison with open surgery. The present study aimed to evaluate the clinical outcome and cost-effectiveness of PDA occlusion by Amplatzer and coil device in comparisong with open surgery. In this cross-sectional study, a randomized sample of 201 patients aged 1 month to 16 years (105 patients with device closure and 96 patients with surgical closure) was selected. The ratio of total pulmonary blood flow to total systemic blood flow, the Qp/Qs ratio, was measured using a pulmonary artery catheter. The cost analysis included direct medical care costs associated with device implantation and open surgery, as well as professional fees. All costs were calculated in Iranian Rials and then converted to US dollars. There was no statistical difference in mean Qp/Qs ratio before the procedure between the device closure group and the open surgery group (2.1 ± 0.7 versus 1.7 ± 0.6, P = 0.090). The mean measured costs were overall higher in the device closure group than in open closure group (948.87 ± 548.76 US$ versus 743.70 ± 696.91 US$, P gender (Standardized Beta = 0.160, P = 0.031). PDA closure with the Amplatzer ductal occluder (1053.05 ± 525.73 US$) or with Nit-Occlud coils (PFM) (912.73 ± 565.94 US$, P < 0.001) was more expensive than that via open surgery. However, the Cook detachable spring coils device closure (605.65 ± 194.62 US$, P = 0.650) had a non-significant cost difference with open surgery. No event was observed in the device closure group regarding in-hospital mortality or morbidity; however, in another group, 2 in-hospital deaths occurred, two patients experienced pneumonia and seizure, and one suffered electrolyte abnormalities including

Closure and Sealing Design Calculation

International Nuclear Information System (INIS)

T. Lahnalampi; J. Case

2005-01-01

The purpose of the ''Closure and Sealing Design Calculation'' is to illustrate closure and sealing methods for sealing shafts, ramps, and identify boreholes that require sealing in order to limit the potential of water infiltration. In addition, this calculation will provide a description of the magma that can reduce the consequences of an igneous event intersecting the repository. This calculation will also include a listing of the project requirements related to closure and sealing. The scope of this calculation is to: summarize applicable project requirements and codes relating to backfilling nonemplacement openings, removal of uncommitted materials from the subsurface, installation of drip shields, and erecting monuments; compile an inventory of boreholes that are found in the area of the subsurface repository; describe the magma bulkhead feature and location; and include figures for the proposed shaft and ramp seals. The objective of this calculation is to: categorize the boreholes for sealing by depth and proximity to the subsurface repository; develop drawing figures which show the location and geometry for the magma bulkhead; include the shaft seal figures and a proposed construction sequence; and include the ramp seal figure and a proposed construction sequence. The intent of this closure and sealing calculation is to support the License Application by providing a description of the closure and sealing methods for the Safety Analysis Report. The closure and sealing calculation will also provide input for Post Closure Activities by describing the location of the magma bulkhead. This calculation is limited to describing the final configuration of the sealing and backfill systems for the underground area. The methods and procedures used to place the backfill and remove uncommitted materials (such as concrete) from the repository and detailed design of the magma bulkhead will be the subject of separate analyses or calculations. Post-closure monitoring will not

A regenerative approach towards mucosal fenestration closure

Science.gov (United States)

Gandi, Padma; Anumala, Naveen; Reddy, Amarender; Viswa Chandra, Rampalli

2013-01-01

Mucosal fenestration is an opening or an interstice through the oral mucosa. A lesion which occurs with greater frequency than generally realised, its occurrence is attributed to a myriad of causes. Mucogingival procedures including connective tissue grafts, free gingival grafts and lateral pedicle grafts are generally considered to be the treatment of choice in the closure of a mucosal fenestration. More often, these procedures are performed in conjunction with other procedures such as periradicular surgery and with bone grafts. However, the concomitant use of gingival grafts and bone grafts in mucosal fenestrations secondary to infections in sites exhibiting severe bone loss is highly debatable. In this article, we report two cases of mucosal fenestrations secondary to trauma and their management by regenerative periodontal surgery with the placement of guided tissue regeneration membrane and bone graft. The final outcome was a complete closure of the fenestration in both the cases. PMID:23749826

Safety and Efficacy of Transcatheter Closure of Patent Ductus Arteriosus With Severe Mitral Regurgitation in Adults.

Science.gov (United States)

Wang, Zhongkai; Chen, Tao; Chen, Liang; Qin, Yongwen; Zhao, Xianxian

2016-01-01

Transcatheter closure is the usual treatment for patent ductus arteriosus (PDA), but its safety and efficacy have not been reported in adult PDA patients with severe mitral regurgitation. A retrospective study on 27 consecutive patients diagnosed with PDA and severe mitral regurgitation and treated using transcatheter closure between September 2010 and September 2012 at the Department of Cardiology of Changhai Hospital in Changhai, China. Left ventricular (LV) diastolic volume and function, pulmonary artery pressure, and instantaneous reverse-flow volume were examined by echocardiography before PDA closure, immediately after closure, and 1 year after closure. After the procedure, the LV diastolic volume (P.05). Pulmonary arterial systolic pressure was unchanged 1 year after closure (from 46.41 ± 19.92 mm Hg to 45.43 ± 13.64 mm Hg; P=.58). All procedures were uneventful and only mild complications occurred (hemolysis in 2 cases, subcutaneous hematoma in 4 cases, and fever in 2 cases). Transcatheter closure can decrease the LV volume and instantaneous reverse-flow volume in adult PDA patients with severe mitral regurgitation. This procedure is effective and has a good safety profile.

Reliability in maintenance and design of elastomer sealed closures

International Nuclear Information System (INIS)

Lake, W.H.

1978-01-01

The methods of reliability are considered for maintenance and design of elastomer sealed containment closures. Component reliability is used to establish a replacement schedule for system maintenance. Reliability data on elastomer seals is used to evaluate the common practice of annual replacement, and to calculate component reliability values for several typical shipment time periods. System reliability methods are used to examine the relative merits of typical closure designs. These include single component and redundant seal closure, with and without closure verification testing. The paper presents a general method of quantifying the merits of closure designs through the use of reliability analysis, which is a probabilistic technique. The reference list offers a general source of information in the field of reliability, and should offer the opportunity to extend the procedures discussed in this paper to other design safety applications

Closure of hazardous and mixed radioactive waste management units at DOE facilities

International Nuclear Information System (INIS)

1990-06-01

This is document addresses the Federal regulations governing the closure of hazardous and mixed waste units subject to Resource Conservation and Recovery Act (RCRA) requirements. It provides a brief overview of the RCRA permitting program and the extensive RCRA facility design and operating standards. It provides detailed guidance on the procedural requirements for closure and post-closure care of hazardous and mixed waste management units, including guidance on the preparation of closure and post-closure plans that must be submitted with facility permit applications. This document also provides guidance on technical activities that must be conducted both during and after closure of each of the following hazardous waste management units regulated under RCRA

Cyanoacrylate for Intraoral Wound Closure: A Possibility?

Directory of Open Access Journals (Sweden)

Parimala Sagar

2015-01-01

Full Text Available Wound closure is a part of any surgical procedure and the objective of laceration repair or incision closure is to approximate the edges of a wound so that natural healing process may occur. Over the years new biomaterials have been discovered as an alternate to conventional suture materials. Cyanoacrylate bioadhesives are one among them. They carry the advantages of rapid application, patient comfort, resistance to infection, hemostatic properties, and no suture removal anxiety. Hence this study was undertaken to study the effect of long chain cyanoacrylate as an adhesive for intraoral wound closure and also to explore its hemostatic and antibacterial effects. Isoamyl-2-cyanoacrylate (AMCRYLATE was used as the adhesive in the study. In conclusion isoamyl cyanoacrylate can be used for intraoral wound closure, as an alternative to sutures for gluing the mucoperiosteum to bone, for example, after impaction removal, periapical surgeries, and cleft repair. Its hemostatic and antibacterial activity has to be further evaluated.

Transcatheter closure of re-canalized patent ductus arteriosus after surgical ligation

International Nuclear Information System (INIS)

Zhang Qingqiao; Jiang Shiliang; Huang Lianjun; Zhao Shihua; Zheng Hong; Ling Jian; Jin Jinglin; Xu Zhongying; Xie Ruolan; Dai Ruping

2002-01-01

Objective: To evaluate the effectiveness of transcatheter closure of re-canalized patent ductus arteriosus (PDA) after surgical ligation. Methods: Between June 1995 and November 2000, 14 patients (5 male, 9 female) with re-canalized PDA after surgical ligation underwent transcatheter closure, their median age was 13 years (range 4 to 48 years). The time between surgical ligation and the interventional procedure ranged from one month to twenty-two years. Implantations of Amplatzer duct occluder and Rashkind occluder were performed trans-venously. Cook coil occlusions was performed trans-arterially. Follow-up with X-ray radiograph and echocardiography was made 24 hours, 1, 3, 6 months, and more than 1 year after the procedure. Results: Twelve PDAs were of funnel shape, and the remaining two PDAs were of tubular shape. The median minimum diameter of re-canalized PDA after ligation was 4 mm (range 1 to 8 mm). Aortograms ten minutes after closure showed complete closure and trivial residual shunt in 11 and 3 patients, respectively. The technical success rate was 100%, and there were no complications. Echocardiography showed complete closure in all patients within 24 hours. All patients were discharged in one to two days after the procedure. At a follow-up of one to eighteen months in ten patients, there were no migration of devices and residual PDA. Conclusion: Transcatheter closure using Amplatzer duct occluder, coil (Cook company or Pfm company) and Rashkind occluder was an effective method for patients with re-canalized PDA after surgical ligation. It may be an alternative to second surgery owing to its safety, reliability, min-invasiveness, and short hospitalization

Transcatheter closure of re-canalized patent ductus arteriosus after surgical ligation

Energy Technology Data Exchange (ETDEWEB)

Qingqiao, Zhang; Shiliang, Jiang; Lianjun, Huang; Shihua, Zhao; Hong, Zheng; Jian, Ling; Jinglin, Jin; Zhongying, Xu; Ruolan, Xie; Ruping, Dai [Chinese Academy of Medical Science, Beijing Union Medical College, Beijing (China). Cardiovascular Inst. and Fuwai Hospital, Dept. of Radiology

2002-02-01

Objective: To evaluate the effectiveness of transcatheter closure of re-canalized patent ductus arteriosus (PDA) after surgical ligation. Methods: Between June 1995 and November 2000, 14 patients (5 male, 9 female) with re-canalized PDA after surgical ligation underwent transcatheter closure, their median age was 13 years (range 4 to 48 years). The time between surgical ligation and the interventional procedure ranged from one month to twenty-two years. Implantations of Amplatzer duct occluder and Rashkind occluder were performed trans-venously. Cook coil occlusions was performed trans-arterially. Follow-up with X-ray radiograph and echocardiography was made 24 hours, 1, 3, 6 months, and more than 1 year after the procedure. Results: Twelve PDAs were of funnel shape, and the remaining two PDAs were of tubular shape. The median minimum diameter of re-canalized PDA after ligation was 4 mm (range 1 to 8 mm). Aortograms ten minutes after closure showed complete closure and trivial residual shunt in 11 and 3 patients, respectively. The technical success rate was 100%, and there were no complications. Echocardiography showed complete closure in all patients within 24 hours. All patients were discharged in one to two days after the procedure. At a follow-up of one to eighteen months in ten patients, there were no migration of devices and residual PDA. Conclusion: Transcatheter closure using Amplatzer duct occluder, coil (Cook company or Pfm company) and Rashkind occluder was an effective method for patients with re-canalized PDA after surgical ligation. It may be an alternative to second surgery owing to its safety, reliability, min-invasiveness, and short hospitalization.

Sizing of patent ductus arteriosus in adults for transcatheter closure using the balloon pull-through technique.

Science.gov (United States)

Shafi, Nabil A; Singh, Gagan D; Smith, Thomas W; Rogers, Jason H

2018-05-01

To describe a novel balloon sizing technique used during adult transcatheter patent ductus arteriosus (PDA) closure. In addition, to determine the clinical and procedural outcomes in six patients who underwent PDA balloon sizing with subsequent deployment of a PDA occluder device. Transcatheter PDA closure in adults has excellent safety and procedural outcomes. However, PDA sizing in adults can be challenging due to variable defect size, high flow state, or anatomical complexity. We describe a series of six cases where the balloon- pull through technique was successfully performed for PDA sizing prior to transcatheter closure. Consecutive adult patients undergoing adult PDA closure at our institution were studied retrospectively. A partially inflated sizing balloon was pulled through the defect from the aorta into the pulmonary artery and the balloon waist diameter was measured. Procedural success and clinical outcomes were obtained. Six adult patients underwent successful balloon pull-through technique for PDA sizing during transcatheter PDA closure, since conventional angiography often gave suboptimal opacification of the defect. All PDAs were treated with closure devices based on balloon PDA sizing with complete closure and no complications. In three patients that underwent preprocedure computed tomography, the balloon size matched the CT derived measurements. The balloon pull-through technique for PDA sizing is a safe and accurate sizing modality in adults undergoing transcatheter PDA closure. © 2017 Wiley Periodicals, Inc.

Comparison of efficacy of procedures in the treatment of acute angle-closure glaucoma

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Lian-Rong Su

2013-06-01

Full Text Available AIM: To observe the clinical effects of 3 different surgery treatments for acute angle-closure glaucoma. METHODS: Totally 60 cases of acute angle-closure glaucoma were randomly divided into 3 groups. Iris root excision or laser iridotomy was applied to group A, cataract phacoemulsification with artificial lens implantation and goniosynechialysis for group B, crabeculectomy for group C. The changes of vision, intraocular pressure, chamber angle, anterior chamber depth before and after operation were observed, while the postoperative complications and following operations were analyzed. The period of follow-up was one week, one month, three months and six months.RESULTS: No statistical significance was found for treatments of group A and C(P>0.05. For group C the treatment was statistically significant(PPPCONCLUSION: Cataract phacoemulsification with artificial lens implantation and goniosynechialysis is a safe and effective surgery for treatment of acute angle-closure glaucoma, which can effectively improve vision, decrease intraocular pressure, open anterior chamber angle.

Special closures for steel drum shipping containers

International Nuclear Information System (INIS)

Bonzon, L.L.; Otts, J.V.

1976-01-01

The objective of this program was to develop special lid closures for typical, steel drum, radioactive material shipping containers. Previous experience and testing had shown that the existing container was adequate to withstand the required environmental tests for certification, but that the lid and closure were just marginally effective. Specifically, the lid closure failed to consistently maintain a tight seal between the container and the lid after drop tests, thus causing the package contents to be vulnerable in the subsequent fire test. Recognizing the deficiency, the United States Energy Research and Development Administration requested the development of new closure(s) which would: (1) be as strong and resistant to a drop as the bottom of the container; (2) have minimal economic impact on the overall container cost; (3) maximize the use of existing container designs; (4) consider crush loads; and (5) result in less dependence on personnel and loading procedures. Several techniques were evaluated and found to be more effective than the standard closure mechanism. Of these, three new closure techniques were designed, fabricated, and proven to be structurally adequate to provide containment when a 454-kg drum was drop tested from 9.14-m onto an unyielding surface. The three designs were: (1) a 152-mm long lid extension or skirt welded to the standard drum lid, (2) a separate inner lid, with 152-mm long skirt and (3) C-clamps used at the container-lid interface. Based upon structural integrity, economic impact, and minimal design change, the lid extension is the recommended special closure

[Periprocedural and late complications after percutaneous closure of patent foramen ovale: a single centre experience].

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Węglarz, Przemysław; Konarska Kuszewska, Ewa; Spisak Borowska, Katarzyna; Machowski, Jerzy; Drzewiecka-Gerber, Agnieszka; Kuszewski, Piotr; Jackson, Christopher L; Opala, Grzegorz; Trusz Gluza, Maria

2012-01-01

Patent foramen ovale (PFO) is a potential risk factor for ischaemic stroke in young individuals. An interventional method of secondary stroke prevention in PFO patients is its percutaneous closure. To assess safety and effectiveness (i.e. lack of residual shunt) of percutaneous PFO closure in patients with history of cryptogenic cerebrovascular event. 149 patients (56 men/93 women), aged 39 ± 12 years, underwent percutaneous PFO closure. The implantation was performed under local anaesthesia, guided by trans-oesophageal echocardiography (TEE) and fluoroscopy. Follow-up trans-thoracic echocardiography (TTE) was performed at 1 month and follow-up TEE at 6-months. In cases of residual shunt, additional TEE was performed after ensuing 6 months. Effective PFO closure (no residual shunt) was achieved in 91.3% patients at 6 months and 95.3% patients at 12 months. In 2 patients transient atrial fibrillation was observed during the procedure. In 2 patients, a puncture site haematoma developed and in 1 patient superficial thrombophlebitis was noted. In 1 patient a small pericardial effusion was observed, which resolved at day 3 post-procedurally, after administration of non-steroidal anti-inflammatory drugs. Percutaneous PFO closure seems to be a safe procedure when performed in a centre with adequate expertise with regard to these procedures.

304 Concretion facility closure plan

International Nuclear Information System (INIS)

1990-04-01

The Hanford Site, located northwest of Richland, Washington, houses reactors, chemical-separation systems, and related facilities used for the production of special nuclear materials. The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. Recyclable scrap uranium Zircaloy-2 and copper silicon alloy, uranium-titanium alloy, beryllium/Zircaloy-2 alloy, and Zircaloy-2 chips and fines were secured in concrete billets in the 304 Concretion Facility, located in the 300 Area. The beryllium/Zircaloy-2 alloy and Zircaloy-2 chips and fines are designated as low-level radioactive mixed waste (LLRMW) with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 304 Concretion Facility is now undergoing closure as defined in the Resource Conservation and Recovery Act of 1976 (RCRA). This closure plan presents a description of the facility, the history of materials and wastes managed, and the procedures that will be followed to close the 304 Concretion Facility (304 Facility). Clean closure of the 304 Facility is the proposed method for closure of the facility. Justification for this proposal is presented. 15 refs., 22 figs., 4 tabs

Transcatheter closure of patent ductus arteriosus: 11 years of clinical experience in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

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Djer, Mulyadi M; Saputro, Dimas Dwi; Putra, Sukman Tulus; Idris, Nikmah Salamia

2015-06-01

Transcatheter closure of patent ductus arteriosus (PDA) has been suggested to be the standard treatment of PDA. Although, in general, the procedure shows a high successful rate, outcomes may vary among pediatric cardiology centers. To evaluate the effectiveness of transcatheter closure of PDA in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, this was a retrospective study on patients who underwent transcatheter closure of PDA in Cipto Mangunkusumo Hospital during the period of 2002-2013. Hospital registry was reviewed and data about patients' characteristics, PDA severity, procedure, and outcomes were retrieved. There were 298 patients, of whom 90 were males, who underwent transcatheter closure of PDA during the study period. Median age was 3.4 years (1 months-18 years), and median body weight was 12 (3.6-59) kg. The diameter of PDA ranged from 1.1 to 15.4 mm with a median of 3.7 mm. Device could be deployed in all patients, in which most were the Amplatzer ductal occluder (69.8 %) and the remainders were coils. Median fluoroscopy time was 15.4 (1.5-87) min, and procedure time was 76 (30-200) min. Complete closure was achieved in most patients (97.3 %), whereas device migration occurred in a minority (0.3 %) of patients. No major complication occurred during or after the procedure. Transient anemia and bradycardia were found in 3.7 and 1.3 % patients, respectively. Most patients were discharged from the hospital at 1 day after the procedure. Transcatheter closure method is a safe and effective procedure to close PDA.

Monitoring calculation of closure change of Extradosed Cable-stayed Bridge

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Shi, Jing Xian; Ran, Zhi Hong

2018-06-01

During the construction of extradosed cable-stayed bridge in Yunnan province, China, the construction unit has made certain changes in the construction process of the closure section due to environmental restrictions: remove the hanging basket after the closure, the sling shall not be provided in closure section, the function of the sling is realized by the hanging basket on the 16th beam. In case of this change, the bridge has been constructed to section 15th. In order to ensure the smooth and orderly progress of each stage in the closure phase, this article is arranged according to the construction plan, appropriate adjustment of related procedures, checking the bridge safety at all stages of construction, the stress and force of the main girder are compared to ensure the safety of the construction after closure changes. Adjust the height of the beam of the 16th and 17th to adapt the new construction plan, and the bridge closure smoothly.

Transcatheter closure of patent ductus arteriosus: past, present and future.

Science.gov (United States)

Baruteau, Alban-Elouen; Hascoët, Sébastien; Baruteau, Julien; Boudjemline, Younes; Lambert, Virginie; Angel, Claude-Yves; Belli, Emre; Petit, Jérôme; Pass, Robert

2014-02-01

This review aims to describe the past history, present techniques and future directions in transcatheter treatment of patent ductus arteriosus (PDA). Transcatheter PDA closure is the standard of care in most cases and PDA closure is indicated in any patient with signs of left ventricular volume overload due to a ductus. In cases of left-to-right PDA with severe pulmonary arterial hypertension, closure may be performed under specific conditions. The management of clinically silent or very tiny PDAs remains highly controversial. Techniques have evolved and the transcatheter approach to PDA closure is now feasible and safe with current devices. Coils and the Amplatzer Duct Occluder are used most frequently for PDA closure worldwide, with a high occlusion rate and few complications. Transcatheter PDA closure in preterm or low-bodyweight infants remains a highly challenging procedure and further device and catheter design development is indicated before transcatheter closure is the treatment of choice in this delicate patient population. The evolution of transcatheter PDA closure from just 40 years ago with 18F sheaths to device delivery via a 3F sheath is remarkable and it is anticipated that further improvements will result in better safety and efficacy of transcatheter PDA closure techniques. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Stress analysis of closure bolts for shipping casks

International Nuclear Information System (INIS)

Mok, G.C.; Fischer, L.E.; Hsu, S.T.

1993-01-01

This report specifies the requirements and criteria for stress analysis of closure bolts for shipping casks containing nuclear spent fuels or high level radioactive materials. The specification is based on existing information conceming the structural behavior, analysis, and design of bolted joints. The approach taken was to extend the ASME Boiler and Pressure Vessel Code requirements and criteria for bolting analysis of nuclear piping and pressure vessels to include the appropriate design and load characteristics of the shipping cask. The characteristics considered are large, flat, closure lids with metal-to-metal contact within the bolted joint; significant temperature and impact loads; and possible prying and bending effects. Specific formulas and procedures developed apply to the bolt stress analysis of a circular, flat, bolted closure. The report also includes critical load cases and desirable design practices for the bolted closure, an in-depth review of the structural behavior of bolted joints, and a comprehensive bibliography of current information on bolted joints

Improvement of tricuspid regurgitation after transcatheter ASD closure in older patients.

Science.gov (United States)

Chen, L; Shen, J; Shan, X; Wang, F; Kan, T; Tang, X; Zhao, X; Qin, Y

2017-07-19

Adult patients with undiagnosed atrial septal defect (ASD) may have right heart cavity enlargement and functional tricuspid valve insufficiency. Moderate or more severe tricuspid regurgitation has been associated with a worse prognosis, and more serious complications are typically seen in older patients. This study aimed to evaluate the improvement in functional tricuspid regurgitation and heart geometry after transcatheter ASD closure in older patients. The data of 111 patients over 60 years of age with moderate or severe tricuspid regurgitation before ASD closure were analyzed. At the 1‑month and 6‑month follow-up after closure, both tricuspid regurgitation jet area and right atrial volume decreased significantly. Right ventricular volume decreased 1 month after closure, showing a further decrease at the end of the 6‑month follow-up. However, 24 patients (21.6%) still had persistent severe tricuspid regurgitation after the procedure. Multivariate analysis revealed that patient age at ASD closure and pulmonary artery systolic pressure determined by echocardiography before closure were predictors of persistent tricuspid regurgitation after closure. Transcatheter ASD closure in older patients could significantly decrease tricuspid regurgitation and improve right heart geometry.

Safety of Percutaneous Patent Ductus Arteriosus Closure: An Unselected Multicenter Population Experience

Science.gov (United States)

El‐Said, Howaida G.; Bratincsak, Andras; Foerster, Susan R.; Murphy, Joshua J.; Vincent, Julie; Holzer, Ralf; Porras, Diego; Moore, John; Bergersen, Lisa

2013-01-01

Background The technique and safety of transcatheter patent ductus arteriosus (PDA) closure have evolved during the past 20 years. We sought to report a multicenter experience of PDA closure with a focus on the rate of adverse events (AE) and a review of institutional practice differences. Methods and Results Outcome data on transcatheter PDA closure were collected at 8 centers prospectively using a multicenter registry (Congenital Cardiac Catheterization Project on Outcome Registry). Between February 2007 and June 2010, 496 PDA closures were recorded using a device in 338 (68%) or coils in 158 (32%). Most patients had an isolated PDA (90%). Fifty percent of patients were between 6 months and 3 years old, with only 40 patients (8%) closure and 1 mm (range 0.5 to 6 mm; IQR 1 to 2 mm) for coil closure (P2 mm (all P1.5 mm. In 9% of cases (n=46), an AE occurred; however, only 11 (2%) were classified as high severity. Younger age was associated with a higher AE rate. Coil‐related AEs were more common than device‐related AEs (10% versus 2%, Pclosure in the present era has a very low rate of complications, although these are higher in younger children. Technical intervention‐related events were more common in coil procedures compared with device procedures. For PDAs ≤2.5 mm in diameter, institutional differences in preference for device versus coil exist. PMID:24284214

Printing tattoo effect after use of Dermabond®Prineo® Skin closure system

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Shabeer Ahmad Wani

2017-03-01

Full Text Available Abdominoplasty is a very common procedure in the plastic surgery practice and may lead to a variety of unfavorable results including incision site complications. The surgical adhesives system, which entered into daily practice to replace the need for subcuticular closure for skin, saves time and may have better wound appearance. Dermabond® Prineo® Skin Closure System (Ethicon Inc., Somerville, NJ, USA has two major components: 2–Octyl cyanoacrylate glue and a flexible, self-adhesive polyester mesh. It can be used with or without sutures, and has the added benefit of waterproofing, and microbial resistance. It also saves time. This case describes a male patient who experienced a “printing tattoo” effect following an elective procedure of abdominoplasty and the results after this closure system was used.

Comparison of a continuous suture pattern with a simple interrupted pattern for enteric closure in dogs and cats: 83 cases (1991-1997).

Science.gov (United States)

Weisman, D L; Smeak, D D; Birchard, S J; Zweigart, S L

1999-05-15

To describe and compare a simple continuous suture pattern with a simple interrupted pattern for enterotomy closure or end-to-end intestinal anastomosis. Retrospective study. 58 dogs and 25 cats that underwent enterotomy or intestinal resection and anastomosis. Signalment, surgical procedure, suture pattern, suture material, confirmation of dehiscence, and follow-up were reviewed. Groups were compared by procedure (anastomosis or enterotomy) and by suture pattern. 57 animals underwent continuous closure; 26 had interrupted closure. Only polydioxanone or polypropylene suture materials were used. Overall, 81 (98%) animals had no signs of intestinal dehiscence and survived > 2 weeks. Two animals had confirmed dehiscence after foreign body removal, 1 of 57 (2%) after continuous closure, and 1 of 26 (4%) after interrupted closure. The simple continuous closure pattern is an acceptable alternative to simple interrupted closure for small intestinal anastomosis or enterotomy closure.

Manufacturing and properties of closure head forging integrated with flange for PWR reactor pressure vessel

International Nuclear Information System (INIS)

Tomoharu Sasaki; Iku Kurihara; Etsuo Murai; Yasuhiko Tanaka; Koumei Suzuki

2003-01-01

Closure head forging (SA508, Gr.3 Cl.1) integrated with flange for PWR reactor pressure vessel has been developed. This is intended to enhance structural integrity of closure head resulted in elimination of ISI, by eliminating weld joint between closure head and flange in the conventional design. Manufacturing procedures have been established so that homogeneity and isotropy of the material properties can be assured in the closure head forging integrated with flange. Acceptance tensile and impact test specimens are taken and tested regarding the closure head forging integrated with flange as very thick and complex forgings. This paper describes the manufacturing technologies and material properties of the closure head forging integrated with flange. (orig.)

Transcatheter Closure of Patent Foramen Ovale: A Single Center Experience

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Ivan Milev

2016-10-01

CONCLUSIONS: Percutaneous transcatheter closure of PFO is a safe and effective procedure showing mid-term relief of neurological symptoms in patients as well as significant reduction of migraine symptoms.

Transcatheter closure of a large patent ductus arteriosus using jugular access in an infant.

Science.gov (United States)

Fernandes, Precylia; Assaidi, Anass; Baruteau, Alban-Elouen; Fraisse, Alain

2018-03-01

Trans-catheter device closure of patent ductus arteriosus (PDA) via femoral route is the commonly used, safe and effective procedure. Trans-jugular approach has been successfully used in older children with interrupted inferior vena cava. We report a case of successful occlusion of PDA using Amplatzer duct occluder (ADO) via trans-jugular approach following difficulties encountered in gaining femoral venous access. A 6-month-old male infant, weighing 8 kg was admitted for percutaneous catheter closure of PDA. Echocardiogram showed a 4.5 mm duct and left heart dilatation. Femoral venous access was not possible; therefore, we decided to use a trans-jugular approach. The duct was occluded using 8/6 mm ADO. Successful closure of the duct was confirmed with an aortogram. Post procedure echocardiogram showed no residual shunt across the duct. We highlight that trans-catheter closure of PDA using jugular venous access is safe and effective even in infants.

Safe disposal of radioactive waste. Post-closure safety assessment of permanent repository in Novi han

International Nuclear Information System (INIS)

Mateeva, M.

2007-01-01

A presented material is the third part of the monograph with title 'Safe disposal of radioactive waste. Post-closure safety assessment of the permanent repository in Novi Han'. This part deals with review of the scenario selection procedure. The process system of permanent repository for radioactive waste is describing in details for different levels. Preliminary screening process of features, events and processes is presented here. Interaction matrixes for basic disposal system components are constructed. Final selection and grouping between the included features, events and processes is done. Selected and defined scenarios for post-closure safety assessment are presented too. Key words: post-closure safety assessment, scenario generation procedure, process system, process influence diagram, and interaction matrix

Closure of the patent ductus arteriosus with the Amplatzer Duct Occluder II: a clinical experience.

Science.gov (United States)

Karagöz, Tevfik; Akin, Alper; Ertuğrul, Ilker; Aykan, Hayrettin Hakan; Alehan, Dursun; Ozer, Sema; Ozkutlu, Süheyla

2012-12-01

The aim of our study was to share our clinical experience on cases with patent ductus arteriosus treated with the Amplatzer Duct Occluder II. Between 2008 and 2012, 26 of 31 patients with patent ductus arteriosus underwent successful transcatheter closure of patent ductus arteriosus using the Amplatzer Duct Occluder II. Mean age was 3.3 years and mean weight was 15.7 kilograms. The presence of a residual shunt, left pulmonary artery or aortic obstruction was explored by administering contrast material during the procedure. The patients were discharged 24 hours after the procedure. The procedure was successful in 26 of 31 patients and failed in five patients. According to the Krichenko classification, 26 patients had type A, one patient had type B and 4 patients had type C ductus. The mean narrowest ductus diameter was 3.2 mm and the mean ductus length was 6.7 mm. Complete angiographic occlusion occurred immediately after the procedure in 22 out of 26 patients in whom the ductus was closed successfully with the Amplatzer Duct Occluder II. Complete occlusion was achieved in the remaining patients with residual shunt one month after the procedure. The procedure was preceded by closure with an Amplatzer Duct Occluder I in two patients and an Amplatzer Vascular Plug I in one patient. Amplatzer Duct Occluder II is highly effective in transcatheter closure of patent ductus arteriosus. We think that an alternative closure device and alternative techniques can be attempted in patients with type C ductus. The success rate could increase with accumulating experience.

Contemporary outcomes of percutaneous closure of patent ductus arteriosus in adolescents and adults.

Science.gov (United States)

P, Sudhakar; Jose, John; George, Oommen K

Catheter based treatment has gained wide acceptance for management of patent ductus arteriosus (PDA) ever since its introduction. Percutaneous closure in adults can be challenging because of anatomical factors including large sizes, associated pulmonary arterial hypertension (PAH) and co-morbidities. This study aimed to provide comprehensive contemporary data on the safety and efficacy of percutaneous device closure of PDA in adult and adolescent population at a large referral center. This single-center retrospective analysis included 70 patients (33 adolescents and 37 adults) who underwent successful percutaneous device closure of PDA between January 2011 and February 2017.Baseline patient demographics, clinical characteristics, procedural and device related variables, and immediate outcomes during hospital stay were recorded. Patients were followed up for residual shunt and complications. Of 70 PDA device closure cases, 71.4% were females; the mean age was 23 years (range:10-58years). Devices used were 4-Cook's detachable coils, 64-occluders (ADO-I and II, Lifetech, Cardi-O-Fix), 1-vascular plug and 1-ventricular septal occluder device. Device success was achieved in all including those with very large PDAs. At 24-h post-procedure, the success rate of transcatheter intervention was 95.7%. At 6-months follow up, complete closure was observed in all (mean follow up duration-531days). In patients with severe PAH, significant immediate and sustained reduction of the mean pulmonary pressure was observed(77mmHg to 33mmHg;P=0.014). No procedure-related complications including death, device embolization and stenosis of aorta or pulmonary artery occurred. In contemporary practice, percutaneous device closure is an effective and safe treatment option for adolescent and adult PDA patients. Copyright © 2017. Published by Elsevier B.V.

Contemporary outcomes of percutaneous closure of patent ductus arteriosus in adolescents and adults

Directory of Open Access Journals (Sweden)

Sudhakar P

2018-03-01

Full Text Available Background: Catheter based treatment has gained wide acceptance for management of patent ductus arteriosus (PDA ever since its introduction. Percutaneous closure in adults can be challenging because of anatomical factors including large sizes, associated pulmonary arterial hypertension (PAH and co-morbidities. This study aimed to provide comprehensive contemporary data on the safety and efficacy of percutaneous device closure of PDA in adult and adolescent population at a large referral center. Methods: This single-center retrospective analysis included 70 patients (33 adolescents and 37 adults who underwent successful percutaneous device closure of PDA between January 2011 and February 2017.Baseline patient demographics, clinical characteristics, procedural and device related variables, and immediate outcomes during hospital stay were recorded. Patients were followed up for residual shunt and complications. Results: Of 70 PDA device closure cases, 71.4% were females; the mean age was 23 years (range:10-58years. Devices used were 4-Cook’s detachable coils, 64-occluders (ADO-I and II, Lifetech, Cardi-O-Fix, 1-vascular plug and 1-ventricular septal occluder device. Device success was achieved in all including those with very large PDAs. At 24-h post-procedure, the success rate of transcatheter intervention was 95.7%. At 6-months follow up, complete closure was observed in all (mean follow up duration-531 days. In patients with severe PAH, significant immediate and sustained reduction of the mean pulmonary pressure was observed(77 mmHg to 33 mmHg;P = 0.014. No procedure-related complications including death, device embolization and stenosis of aorta or pulmonary artery occurred. Conclusions: In contemporary practice, percutaneous device closure is an effective and safe treatment option for adolescent and adult PDA patients. Keywords: Patent ductus arteriosus, Amplatzer duct occluder, Lifetech duct occluder, Cera device, Residual shunt

Transcatheter closure of patent ductus arteriosus using the angled duct occluder

Energy Technology Data Exchange (ETDEWEB)

Yongwen, Qin; Xianxian, Zhao; Hong, Wu; Xing, Zheng; Jijun, Ding; Jianqiang, Hu [Second Military Medical Univ., Shanghai (China). Changhai Hospital, Dept. of Cardiology

2004-04-01

Objective: To assess the immediate efficacy of transcatheter closure of patent ductus arteriosus(PDA) using the angled duct occluder (ADO). Methods: 9 patients (1 male, 8 female) underwent transcatheter closure of PDA using the ADO. The mean PDA diameter at its narrowest segment was (5.8 {+-} 1.9) mm, ranging 3 to 10 mm. A 6 - 9F long sheath was used for the delivery of ADO. Results: The devices were deployed successfully in all patients. Angiographies showed no shunt across the device 15 min after the implantation of ADO. Within 1 week, echocardiography revealed complete closure in all patients. There were no complications. Conclusions: The transcatheter closure of PDA using ADO is an effective and safe procedure. The device matches with the shape of aortic cavity much more precisely than Amplatzer duct occluder. (authors)

Fontan fenestration closure and event-free survival.

Science.gov (United States)

Imielski, Bartlomiej R; Woods, Ronald K; Mussatto, Kathleen A; Cao, Yumei; Simpson, Pippa M; Tweddell, James S

2013-01-01

The purpose of the present study was to evaluate the association of open and closed Fontan fenestration status with event-free survival. All patients who underwent a fenestrated Fontan procedure at our institution from January 1994 through June 2007 were reviewed. Patient information was obtained from the medical records. The patients were assigned to 1 of 2 study groups, open or closed, according to their most recent fenestration status. Clinically relevant morbid events were tabulated, and Kaplan-Meier event analysis was used to create event-free probability curves with log-rank comparisons. A total of 161 patients were classified as open and 51 as closed. The median interval to an event was 1.1 years (interquartile range, 0.1-3.3 years) after the Fontan procedure. The median interval to closure was 1.2 years (interquartile range, 0.7-3.3 years). The median interval to an event was 1.5 years (interquartile range, 0.1-4.6 years) in the closed group and 1.1 years (interquartile range, 0.1-3.3 years) in the open group. Event-free probability analysis revealed no significant difference between the 2 groups (P = .15). The median follow-up arterial oxygen saturation was greater in the closed group (96.0%; interquartile range, 94.0%-97.0%) than in the open group (91.0%; interquartile range, 86.0%-95.0%; P < .0001). Fenestration closure was associated with greater arterial oxygen saturation but not greater event-free survival. The interval to an event was slightly less than the interval to fenestration closure, suggesting potential merit in the evaluation of earlier fenestration closure. Adoption of specific fenestration management guidelines might help improve the overall outcomes and enhance the quality of future studies. Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Catheter closure of patent foramen ovale in patients with cryptogenic cerebrovascular accidents: initial experiences in Japan.

Science.gov (United States)

Kijima, Yasufumi; Akagi, Teiji; Nakagawa, Koji; Taniguchi, Manabu; Ueoka, Akira; Deguchi, Kentaro; Toh, Norihisa; Oe, Hiroki; Kusano, Kengo; Sano, Shunji; Ito, Hiroshi

2014-01-01

Although numerous studies have shown an association between a patent foramen ovale (PFO) and cryptogenic cerebrovascular accidents (CVA), there has been no definitive control study that demonstrated the benefit of percutaneous device closure of a PFO compared to medical therapy in patients with CVA. Additionally, few clinical data exist for Japanese patients in this field. We demonstrate the initial experiences in catheter closure of a PFO as secondary prevention of CVA in Japan. Catheter closure of a PFO was attempted in 7 patients who were diagnosed with cryptogenic CVA. Mean age at the procedure was 54 ± 19 years. The presence of spontaneous interatrial right-to-left shunts was demonstrated by transesophageal contrast echocardiography without Valsalva maneuver in all of the patients. Amplatzer Cribriform device (n = 4) or Amplatzer PFO Occluder (n = 3) was used for the procedure and was successfully deployed. Device-related complications were not observed at the time of the procedure or during the follow-up period (mean period of 16 ± 9 months). Catheter closure of a PFO could be safely performed with Amplatzer Cribriform or Amplatzer PFO Occluder. This procedure may contribute to prevention of recurrent cryptogenic CVA in Japanese patients.

Summative Mass Analysis of Algal Biomass - Integration of Analytical Procedures: Laboratory Analytical Procedure (LAP)

Energy Technology Data Exchange (ETDEWEB)

Laurens, Lieve M. L.

2016-01-13

This procedure guides the integration of laboratory analytical procedures to measure algal biomass constituents in an unambiguous manner and ultimately achieve mass balance closure for algal biomass samples. Many of these methods build on years of research in algal biomass analysis.

[Safety and efficacy of percutaneous patent ductus arteriosus closure solely under thoracic echocardiography guidance].

Science.gov (United States)

Pan, Xiangbin; Ouyang, Wenbin; Li, Shoujun; Guo, Gaili; Liu, Yao; Zhang, Dawei; Zhang, Fengwen; Pang, Kunjing; Fang, Nengxin; Hu, Shengshou

2015-01-01

To avoid the radiation injuries and use of contrast agent, we assessed the safety and efficacy of percutaneous patent ductus arteriosus closure solely under thoracic echocardiography guidance. From June 2013 to June 2014, thirty patients (mean age: (6.3 ± 2.5) years, mean body weight:(22.5 ± 7.3) kg) with pure patent ductus arteriosus were continuously included in this study. The mean diameter of patent ductus arteriosus was (3.8 ± 0.9) mm. Patients were all treated by percutaneous patent ductus arteriosus closure via right femoral artery solely under thoracic echocardiography guidance. The efficacy of the procedure was evaluated by thoracic echocardiography. Follow-up was performed at one month after procedure. All 30 cases were successfully treated with percutaneous patent ductus arteriosus closure solely under thracic echocardiography guidance. The procedural time was (32.8 ± 5.7) minutes. The mean diameter of Amplatzer ADO II was (4.9 ± 1.0) mm. Postoperative trivial residual shunt occurred in six patients immediately after the procedure. All patients survived without peripheral vascular injury or complications such as cardiac perforation. Hospitalization time was (3.4 ± 0.7) days. At one-month follow-up, no complications such as residual shunt or pericardial effusion were observed. Echocardiography guided percutaneous patent ductus arteriosus closure by femoral artery approach is safe and effective, and can avoid X-ray and the use of contrast agents.

Closure requirements

International Nuclear Information System (INIS)

Hutchinson, I.P.G.; Ellison, R.D.

1992-01-01

Closure of a waste management unit can be either permanent or temporary. Permanent closure may be due to: economic factors which make it uneconomical to mine the remaining minerals; depletion of mineral resources; physical site constraints that preclude further mining and beneficiation; environmental, regulatory or other requirements that make it uneconomical to continue to develop the resources. Temporary closure can occur for a period of several months to several years, and may be caused by factors such as: periods of high rainfall or snowfall which prevent mining and waste disposal; economic circumstances which temporarily make it uneconomical to mine the target mineral; labor problems requiring a cessation of operations for a period of time; construction activities that are required to upgrade project components such as the process facilities and waste management units; and mine or process plant failures that require extensive repairs. Permanent closure of a mine waste management unit involves the provision of durable surface containment features to protect the waters of the State in the long-term. Temporary closure may involve activities that range from ongoing maintenance of the existing facilities to the installation of several permanent closure features in order to reduce ongoing maintenance. This paper deals with the permanent closure features

304 Concretion Facility Closure Plan

International Nuclear Information System (INIS)

1991-10-01

The Hanford Site, located northwest of Richland, Washington, houses reactors, chemical-separation systems, and related facilities used for the production of special nuclear materials. The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. Recyclable scrap uranium with Zircaloy-2 and copper silicon allo , uranium-titanium alloy, beryllium/Zircaloy-2 alloy, and Zircaloy-2 chips and fines were secured in concrete billets (7.5-gal containers) in the 304 Concretion Facility (304 Facility), located in the 300 Area. The beryllium/Zircaloy-2 alloy and Zircaloy-2 chips and fines are designated as low-level radioactive mixed waste (LLRMW) with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 304 Concretion Facility is now undergoing closure as defined in the Resource Conservation and Recovery Act of 1976 (RCRA) and the Washington Administrative Code (WAC) Dangerous Waste Regulations, WAC 173-303-040 (Ecology 1991). This closure plan presents a description of the facility, the history of materials and wastes managed, and the procedures that will be followed to close the 304 Facility. The strategy for closure of the 304 Facility is presented in Section 6.0

Closure and ratio correlation analysis of lunar chemical and grain size data

Science.gov (United States)

Butler, J. C.

1976-01-01

Major element and major element plus trace element analyses were selected from the lunar data base for Apollo 11, 12 and 15 basalt and regolith samples. Summary statistics for each of the six data sets were compiled, and the effects of closure on the Pearson product moment correlation coefficient were investigated using the Chayes and Kruskal approximation procedure. In general, there are two types of closure effects evident in these data sets: negative correlations of intermediate size which are solely the result of closure, and correlations of small absolute value which depart significantly from their expected closure correlations which are of intermediate size. It is shown that a positive closure correlation will arise only when the product of the coefficients of variation is very small (less than 0.01 for most data sets) and, in general, trace elements in the lunar data sets exhibit relatively large coefficients of variation.

Rash with DERMABOND PRINEO Skin Closure System Use in Bilateral Reduction Mammoplasty: A Case Series

OpenAIRE

R. W. Knackstedt; J. A. Dixon; P. J. O’Neill; F. A. Herrera

2015-01-01

Background. Bilateral reduction mammoplasty is a common plastic surgery procedure that can be complicated by unfavorable scar formation along incision sites. Surgical adhesives can be utilized as an alternative or as an adjunct to conventional suture closures to help achieve good wound tension and provide an adequate barrier with excellent cosmesis. The recently introduced DERMABOND PRINEO Skin Closure System Skin Closure System combines the skin adhesive 2-octyl cyanoacrylate with a self-ad...

Transcatheter closure of atrial septal defect in a patient with Noonan syndrome after corrective surgery

Directory of Open Access Journals (Sweden)

Mangovski Ljupčo

2015-01-01

Full Text Available Introduction. Transcatheter atrial septal defect (ASD closure is considered to be a gold standard for patients with the suitable anatomy as compared to cardiac surgery. Reocurrence of ASD after surgical closure is a very rare late complication which can be successfully managed with transcatheter procedure. Case report. We reported a female patient with Noonan syndrome who presented with hemodinamically significant ASD 37 years after the corrective cardiac surgery. Due to numerous comorbidities which included severe kyphoscoliosis, pectus excavatum and multiple surgeries we decided to perform transcatheter closure of ASD. The procedure itself was very challenging due to the patient’s short stature and heart’s orientation in the chest, but was performed successfully. The subsequent follow-up was uneventful and the patient reported improvement in the symptoms. Conclusion. Transcatheter closure of ASD in a patient with Noonan syndrome with the history of surgically corrected ASD can be performed successfully, despite challenging chest anatomy.

European Hernia Society guidelines on the closure of abdominal wall incisions

DEFF Research Database (Denmark)

Muysoms, F E; Antoniou, S A; Bury, K

2015-01-01

using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and methodological guidance was taken from Scottish Intercollegiate Guidelines Network (SIGN). The literature search included publications up to April 2014. The guidelines were written using the AGREE II...... of rapidly absorbable sutures. It is suggested using a slowly absorbable monofilament suture in a single layer aponeurotic closure technique without separate closure of the peritoneum. A small bites technique with a suture to wound length (SL/WL) ratio at least 4/1 is the current recommended method......, it is suggested using the smallest trocar size adequate for the procedure and closure of the fascial defect if trocars larger or equal to 10 mm are used. For single incision laparoscopic surgery, we suggest meticulous closure of the fascial incision to avoid an increased risk of incisional hernias....

Transcatheter closure of patent ductus arteriosus using the angled duct occluder

International Nuclear Information System (INIS)

Qin Yongwen; Zhao Xianxian; Wu Hong; Zheng Xing; Ding Jijun; Hu Jianqiang

2004-01-01

Objective: To assess the immediate efficacy of transcatheter closure of patent ductus arteriosus(PDA) using the angled duct occluder (ADO). Methods: 9 patients (1 male, 8 female) underwent transcatheter closure of PDA using the ADO. The mean PDA diameter at its narrowest segment was (5.8 ± 1.9) mm, ranging 3 to 10 mm. A 6 - 9F long sheath was used for the delivery of ADO. Results: The devices were deployed successfully in all patients. Angiographies showed no shunt across the device 15 min after the implantation of ADO. Within 1 week, echocardiography revealed complete closure in all patients. There were no complications. Conclusions: The transcatheter closure of PDA using ADO is an effective and safe procedure. The device matches with the shape of aortic cavity much more precisely than Amplatzer duct occluder. (authors)

Transcatheter closure of patent ductus arteriosus using Flipper coil and Amplatzer Duct Occluder: Ten-year experience from a single center

Directory of Open Access Journals (Sweden)

Đukić Milan

2017-01-01

Full Text Available Introduction/Objective. Transcatheter closure is a well-established procedure for treatment of patent ductus arteriosus (PDA. We aimed to make a comparison between transcatheter PDA occlusion with Flipper coil and Amplatzer Duct Occluder (ADO and to determine the incidence and significance of procedural complications. Methods. Between November 2004 and October 2014, 148 patients were eligible for transcatheter PDA closure at the University Children’s Hospital in Belgrade, Serbia. The median age was 5.9 years (the range of 0.9 years to 17.3 years and the median weight was 21 kg (the range of 8.8 kg to 94 kg. Follow-up evaluations with Doppler echocardiogram were performed at one day, three months, and one and two years after the PDA occlusion. Results. Median narrowest PDA diameter was 1.5 mm (the range of 0.5 mm to 5.6 mm. Flipper coil was used for PDA closure in 84 (59.2% and ADO in 58 patients (40.8%. There was no significant difference in the rate of immediate complete closure between the coil and the ADO group (86.9% vs. 75.9%, p = 0.089, but a significantly higher rate of complete closure was achieved with ADO at one day (83.3% vs. 98.3%, p = 0.004, three months (85.7% vs. 100%, p = 0.002, and both one and two years after the implantation (91.7% vs. 100%, p = 0.041. In total, 12 complications occurred during the procedure, seven of which with coil and five with ADO occlusion of PDA. Conclusion. Transcatheter closure of PDA using both coils and ADOs is a very safe and effective procedure. ADO proved superior to coil in terms of complete closure rate as early as one day after the procedure.

Current perspectives in percutaneous atrial septal defect closure devices

Directory of Open Access Journals (Sweden)

Bissessor N

2015-07-01

Full Text Available N Bissessor1–4 1Department of Cardiology, The Epworth Hospital, Melbourne, VIC, Australia; 2Division of Interventional Cardiology, The Alfred Hospital, Melbourne, VIC, Australia; 3Department of Clinical Science, Charles Sturt University Albury Campus, NSW, Australia; 4Heart Foundation, Griffith University, QLD, Australia Abstract: In the last decade, percutaneous atrial septal defect (ASD closure has become the treatment of choice in most clinical presentations of ASD. Percutaneous ASD closure has established procedural safety through operator experience and improved device structure and deliverability. There have also been advances in diagnostic capabilities. Devices have evolved from large bulky meshes to repositionable, minimal residual mesh content that easily endothelializes and conforms well to surrounding structures. Biodegradable technology has been introduced and will be closely watched as a future option. The evolution of ASD closure device usage in the last four decades incorporates development that minimizes a wide range of serious side effects that have been reported over the years. Complications reported in the literature include thrombus formation, air embolization, device embolization, erosions, residual shunts, and nickel hypersensitivity. Modern devices have intermediate to long term data with outcomes that have been favorable. Devices are available in multiple sizes with improved delivery mechanisms to recapture, reposition, and safely close simple and complex ASDs amenable to percutaneous closure. In this review, commonly used devices and deployment procedures are discussed together with a look at devices that show promise for the future. Keywords: ASD, congenital, Amplatzer, Gore Helex, Biostar, Figulla

The predictors of dislodgement and outcomes of transcatheter closure of complex atrial septal defects in adolescents and adults

Directory of Open Access Journals (Sweden)

Wei-Chieh Lee

2015-11-01

Conclusion: Eroded and floppy IAS or aneurysm formation post ASO implantation and peri-procedure arrhythmia could predict ASO dislodgement in complex ASD closure. Transcatheter closure of ASDs under TEE guidance is feasible in complex cases.

Transcatheter device closure of secundum atrial septal defect (ASD) in young children

International Nuclear Information System (INIS)

Sadiq, N.; Ullah, M.; Sultan, M.; Akhtar, K.; Akbar, H.

2014-01-01

To analyze the safety and efficacy of device closure of secundum atrial septal defect in children = 5 years of age. Study Design: Quasi-experimental study. Place and Duration of Study: The study was conducted at Armed Forces Institute of Cardiology / National Institute of Heart Diseases Rawalpindi, Pakistan from Dec 2010 - Dec 2012. Patients and Method: Forty eight patients = 5 years of age underwent transcatheter closure of secundum ASD during two years. All patients were evaluated with 2-D echocardiography before the procedure. The sizing balloon was used in 6% and general anaesthesia was given in 83% (n=40) of patients. Results: Ninety seven point nine percent (47/48) had successful closure of ASD. The mean age was 4.1 +- 6.8 years (range 2.5-5 years) and 58.4% (28/48) were females. The defect size and occluders used were between 5-20 mm (mean 12 +-- 3.5) and 8-22 mm (mean 15 +- 3.9) respectively, three patients had simultaneous procedures including pulmonary valvuloplasty in two and percutaneous transmitral commissurotomy (PTMC) in one. The major complications remained 2% (1/48) which included device embolization just after release of device while minor complication rate was 12.5%. The median procedure time was 30 min (15-100 min) and median fluoroscopic time was 6 min (1.50-45 min). There was no emergency surgical exploration or death during this period. Conclusion: Transcatheter device closure of suitable secundum atrial septal defect is effective and safe in young children in skilled and professional hands. (author)

INTEC CPP-603 Basin Water Treatment System Closure: Process Design

Energy Technology Data Exchange (ETDEWEB)

Kimmitt, Raymond Rodney; Faultersack, Wendell Gale; Foster, Jonathan Kay; Berry, Stephen Michael

2002-09-01

This document describes the engineering activities that have been completed in support of the closure plan for the Idaho Nuclear Technology and Engineering Center (INTEC) CPP-603 Basin Water Treatment System. This effort includes detailed assessments of methods and equipment for performing work in four areas: 1. A cold (nonradioactive) mockup system for testing equipment and procedures for vessel cleanout and vessel demolition. 2. Cleanout of process vessels to meet standards identified in the closure plan. 3. Dismantlement and removal of vessels, should it not be possible to clean them to required standards in the closure plan. 4. Cleanout or removal of pipelines and pumps associated with the CPP-603 basin water treatment system. Cleanout standards for the pipes will be the same as those used for the process vessels.

CT based 3D printing is superior to transesophageal echocardiography for pre-procedure planning in left atrial appendage device closure.

Science.gov (United States)

Obasare, Edinrin; Mainigi, Sumeet K; Morris, D Lynn; Slipczuk, Leandro; Goykhman, Igor; Friend, Evan; Ziccardi, Mary Rodriguez; Pressman, Gregg S

2018-05-01

Accurate assessment of the left atrial appendage (LAA) is important for pre-procedure planning when utilizing device closure for stroke reduction. Sizing is traditionally done with transesophageal echocardiography (TEE) but this is not always precise. Three-dimensional (3D) printing of the LAA may be more accurate. 24 patients underwent Watchman device (WD) implantation (71 ± 11 years, 42% female). All had complete 2-dimensional TEE. Fourteen also had cardiac computed tomography (CCT) with 3D printing to produce a latex model of the LAA for pre-procedure planning. Device implantation was unsuccessful in 2 cases (one with and one without a 3D model). The model correlated perfectly with implanted device size (R 2  = 1; p < 0.001), while TEE-predicted size showed inferior correlation (R 2  = 0.34; 95% CI 0.23-0.98, p = 0.03). Fisher's exact test showed the model better predicted final WD size than TEE (100 vs. 60%, p = 0.02). Use of the model was associated with reduced procedure time (70 ± 20 vs. 107 ± 53 min, p = 0.03), anesthesia time (134 ± 31 vs. 182 ± 61 min, p = 0.03), and fluoroscopy time (11 ± 4 vs. 20 ± 13 min, p = 0.02). Absence of peri-device leak was also more likely when the model was used (92 vs. 56%, p = 0.04). There were trends towards reduced trans-septal puncture to catheter removal time (50 ± 20 vs. 73 ± 36 min, p = 0.07), number of device deployments (1.3 ± 0.5 vs. 2.0 ± 1.2, p = 0.08), and number of devices used (1.3 ± 0.5 vs. 1.9 ± 0.9, p = 0.07). Patient specific models of the LAA improve precision in closure device sizing. Use of the printed model allowed rapid and intuitive location of the best landing zone for the device.

Influence of Closure & Non-Closure of the Visceral and Parietal Peritoneum on Post Cesarean Morbidity

Directory of Open Access Journals (Sweden)

Tabasi Z.

2010-01-01

Full Text Available AbstractBackground and Objectives: One of the most important issues in promoting mother and child health is reducing the morbidity rate after cesarean section. The aim of this study was to investigate the influence of closure and non-closure of the visceral and parietal peritoneum on post cesarean morbidity in women attending Shabihkhani Maternity Hospital in Kashan, Iran.Methods: This study was conducted with a single blind randomized clinical trial method on 100 parturient women that underwent emergency or elective cesarean section. Patients with previous cesarean section and or abdominal surgery, diseases such as hypertension, diabetes mellitus and premature rupture of membrane and pre operative bleeding, were excluded from this study. Then, the participants were randomly divided into two groups: in one group both peritoneal layers were closed while in the other group, they were not closed. Post operative morbidity including fever, bleeding, post operative pain, analgesic consumption and time of operation were assessed. Data were analyzed with t-tests, and χ2 and a P<0.05 were considered significant.Results: In this study, there were no significant differences between the two groups with respect to age, gestational age, the reason for caesarean section and gravidity, nor were there any differences with respect to the incidence of fever or bleeding and was similar between the two groups, but there was a significant difference between the two groups regarding to feeling of severe pain (P=0.0003, analgesic consumption (P=0.0003 and time of operation (P=0.004. In the non-closure group, dose of analgesic drugs, pain severity and time of operation were less than those of the other group.Conclusion: The Findings showed that non-closure of peritoneal layers as a shorter and simpler procedure has no influence on increasing post cesarean morbidity. Therefore, due to maternal health promotion and early neonatal breastfeeding, non closure of peritoneal

Clinical trial comparing excision and primary closure with modified ...

African Journals Online (AJOL)

The aim of this study was to compare modified Limberg flap procedure with excision and primary closure in the treatment of uncomplicated pilonidal disease. Methods: This study was conducted on 120 patients with uncomplicated sacrococcygeal pilonidal disease that were randomly allocated into two groups: group I ...

First clinical experience with Celt ACD(®) : a femoral arterial puncture closure device.

LENUS (Irish Health Repository)

Jan, Aftab

2013-08-01

This prospective nonrandomized study compared the safety and efficacy of a novel arterial closure device (ACD) in common femoral artery procedures to that of the FDA submitted historical manual pressure control group, who underwent either a diagnostic angiogram (DA) or a percutaneous coronary intervention (PCI) procedure.

How Slow Can We Go? 4 Frames Per Second (fps) Versus 7.5 fps Fluoroscopy for Atrial Septal Defects (ASDs) Device Closure.

Science.gov (United States)

Hiremath, Gurumurthy; Meadows, Jeffery; Moore, Phillip

2015-06-01

Radiation exposure remains a significant concern for ASD device closure. In an effort to reduce radiation exposure, the default fluoroscopy frame rate in our Siemens biplane pediatric catheterization laboratory was reduced to 4 fps in November 2013 from an earlier 7.5 fps fluoro rate. This study aims to evaluate the components contributing to total radiation exposure and compare the procedural success and radiation exposure during ASD device closure using 4 versus 7.5 fps fluoroscopy rates. Twenty ASD device closures performed using 4 fps fluoro rate were weight-matched to 20 ASD closure procedures using 7.5 fps fluoro rate. Baseline characteristics, procedure times and case times were similar in the two groups. Device closure was successful in all but one case in the 4 fps group. The dose area product (DAP), normalized DAP to body weight, total radiation time and fluoro time were lower in the 4 fps group but not statistically different than the 7.5 fps. The number of cine images and cine times were identical in both groups. Fluoroscopy and cineangiography contributed equally to radiation exposure. Fluoroscopy at 4 fps can be safe and effective for ASD device closure in children and adults. There was no increase in procedure time, cine time, fluoro time or complications at this slow fluoro rate. There was a trend toward decreased radiation exposure as measured by indexed DAP although not statistically significant in this small study. Further study with multiple operators using 4 fps fluoroscopy for simple interventional procedures is recommended.

16. Optimal guidance of percutaneous device closure of PDA by transthoracic echocardiography

Directory of Open Access Journals (Sweden)

M. Alobaidan

2016-07-01

Full Text Available Patent ductus arteriosus (PDA is common congenital cardiac lesion and the most accepted way of management is transcatheter occlusion by device which is usually done under fluoroscopy guidance. Transoesophageal echo cardiography and transaortic imaging were used in adult to guide the procedure which is with certain applications in pediatric age group transthoracic echocardiography (TTE in pediatric population provides excellent images for PDA and may replace the use of fluoroscopy to guide PDA closure at least in special situations. To highlight the feasibility of device closure under guidance of TTE to be applied in sick patients who are not suitable for transfer to cardiac catheter laboratory or those with contraindication to contrast and or radiation application. 18 patients from July 2013 to May 2015 underwent TTE guidance device closure of PDA, 1 patient was excluded after device embolization which necessitate retrieval under fluoroscopy (fluoro.. Conscious sedation was used in 17 patients except 1 who was sick and already ventilated in ICU, there were 11 female and 7 male, antegrade approach was used in 10 patients with partial fluoro and retrograde approach in 8 patients without fluoro. Median age is 7 months, median weight is 8 kg (3.2–11 kg, 2 patients with renal impairment, 2 with Leukemia, median procedure time is 35 min, median fluoro. is 2.2 min, PDA size were small in 13 patients and moderate in 5, immediate closure is achieved in all. The devices were ADOI, ADOS, ADOII, Occlutech, and AVP2. Device embolization in 1 with successful retrieval and second device was used with complete closure percutaneous PDA closure under TTE guidance is feasible, safe and recommended in selected patients with certain situation.

Emergency evacuation/transportation plan update: Traffic model development and evaluation of early closure procedures. Final report

Energy Technology Data Exchange (ETDEWEB)

NONE

1993-10-28

Prolonged delays in traffic experienced by Laboratory personnel during a recent early dismissal in inclement weather, coupled with reconstruction efforts along NM 502 east of the White Rock Wye for the next 1 to 2 years, has prompted Los Alamos National Laboratory (LANL) to re-evaluate and improve the present transportation plan and its integration with contingency plans maintained in other organizations. Facilities planners and emergency operations staff need to evaluate the transportation system`s capability to inefficiently and safely evacuate LANL under different low-level emergency conditions. A variety of potential procedures governing the release of employees from the different technical areas (TAs) requires evaluation, perhaps with regard to multiple emergency-condition scenarios, with one or more optimal procedures ultimately presented for adoption by Lab Management. The work undertaken in this project will hopefully lay a foundation for an on-going, progressive transportation system analysis capability. It utilizes microscale simulation techniques to affirm, reassess and validate the Laboratory`s Early Dismissal/Closure/Delayed Opening Plan. The Laboratory is required by Federal guidelines, and compelled by prudent practice and conscientious regard for the welfare of employees and nearby residents, to maintain plans and operating procedures for evacuation if the need arises. The tools developed during this process can be used outside of contingency planning. It is anticipated that the traffic models developed will allow site planners to evaluate changes to the traffic network which could better serve the normal traffic levels. Changes in roadway configuration, control strategies (signalization and signing), response strategies to traffic accidents, and patterns of demand can be modelled using the analysis tools developed during this project. Such scenarios typically are important considerations in master planning and facilities programming.

An approach for the design of closure bolts of spent fuel elements transportation packages

International Nuclear Information System (INIS)

Mattar Neto, Miguel; Miranda, Carlos A.J.; Fainer, Gerson

2009-01-01

The spent fuel elements transportation packages must be designed for severe conditions including significant fire and impact loads corresponding to hypothetical accident conditions. In general, these packages have large flat lids connected to cylindrical bodies by closure bolts that can be the weak link in the containment system. The bolted closure design depends on the geometrical characteristics of the flat lid and the cylindrical body, including their flanges, on the type of the gaskets and their dimensions, and on the number, strength, and tightness of the bolts. There are well established procedures for the closure bolts design used in pressure vessels and piping. They can not be used directly in the bolts design applied to transportation packages. Prior to the use of these procedures, it is necessary consider the differences in the main loads (pressure for the pressure vessels and piping and impact loads for the transportation packages) and in the geometry (large flat lids are not used in pressure vessels and piping). So, this paper presents an approach for the design of the closure bolts of spent fuel elements transportation packages considering the impact loads and the typical geometrical configuration of the transportation packages. (author)

Application of statistical dynamical turbulence closures to data assimilation

International Nuclear Information System (INIS)

O'Kane, Terence J; Frederiksen, Jorgen S

2010-01-01

We describe the development of an accurate yet computationally tractable statistical dynamical closure theory for general inhomogeneous turbulent flows, coined the quasi-diagonal direct interaction approximation closure (QDIA), and its application to problems in data assimilation. The QDIA provides prognostic equations for evolving mean fields, covariances and higher-order non-Gaussian terms, all of which are also required in the formulation of data assimilation schemes for nonlinear geophysical flows. The QDIA is a generalization of the class of direct interaction approximation theories, initially developed by Kraichnan (1959 J. Fluid Mech. 5 497) for isotropic turbulence, to fully inhomogeneous flows and has been further generalized to allow for both inhomogeneous and non-Gaussian initial conditions and long integrations. A regularization procedure or empirical vertex renormalization that ensures correct inertial range spectra is also described. The aim of this paper is to provide a coherent mathematical description of the QDIA turbulence closure and closure-based data assimilation scheme we have labeled the statistical dynamical Kalman filter. The mathematical formalism presented has been synthesized from recent works of the authors with some additional material and is presented in sufficient detail that the paper is of a pedagogical nature.

Transcatheter Closure of Patent Ductus Arteriosus in Adolescents and Adults: A Case Series

Directory of Open Access Journals (Sweden)

Sukman Tulus Putra

2017-02-01

Full Text Available During 11 years period from January 2005 to December 2015 there were 18 adolescent and adult patients  who underwent transcatheter closure of PDA using PDA Amplatzer Duct Occluder (ADO. There were 9 cases with age of 14 to 18 years and 9 cases with age of more than 18 years where the oldest case was 46 years old. Two cases were male and 16 cases were female. Prior to procedures, clinical assessment, ECG, chest x-ray and transthoracic echocardiography (TTE were performed to confirm the diagnosis of PDA. The procedures of device implantation was performed under conscious sedation in adults and using general anesthesia in adolescents.The size of PDA ranged from 1.6 mm to 11.1 mm. Based on Kritchenko classification, the type of PDA were 15 type A1 and 3type A2. Flow ratio between pulmonary to systemic circulation was between 1.1 and 5.9. The procedure time ranged from 60-189 minutes and the fluoroscopic time 7.1-77.3 minutes. The PA pressure ranged from 22 to 63 mmHg. Immediate results after procedures as seen in angiography showed complete closure in 14 cases and smoky residual shunt or minimal residual shunts in 4 cases, which probably due to the temporary leaking through the devices. In 24 hours, complete closure was achieved in all cases (100% and continued until 1months. At 6 month follow up, there was no residual shunts detected and also there was no significant complications, such as device embolization or recanalization. This case series suggest that transcatheter closure of PDA in adolescents and adults using Amplatzer duct occluder (ADO is effective and has excellent resultswithout significant complication. However, long-term follow up is required to assess long term efficacy and safety.

Road Closures

Data.gov (United States)

Montgomery County of Maryland — This is an up to date map of current road closures in Montgomery County.This dataset is updated every few minutes from the Department of Transportation road closure...

Recurrent Stroke after Transcatheter PFO Closure in Cryptogenic Stroke or Tia: Long-Term Follow-Up

Directory of Open Access Journals (Sweden)

Elisabetta Mariucci

2017-01-01

Full Text Available Background. There are few data on the mechanism of recurrent neurological events after transcatheter closure of patent foramen ovale (PFO in cryptogenic stroke or TIA. Methods. We retrospectively reviewed PFO closure procedures for the secondary prevention of cryptogenic stroke/TIA performed between 1999 and 2014 in Bologna, Italy. Results. Written questionnaires were completed by 402 patients. Mean follow-up was 7 ± 3 years. Stroke recurred in 3.2% (0.5/100 patients-year and TIA in 2.7% (0.4/100 patients-year. Ninety-two percent of recurrent strokes were not cryptogenic. Recurrent stroke was noncardioembolic in 69% of patients, AF related in 15% of patients, device related in 1 patient, and cryptogenic in 1 patient. AF was diagnosed after the procedure in 21 patients (5.2%. Multivariate Cox’s proportion hazard model identified age ≥ 55 years at the time of closure (OR 3.16, p=0.007 and RoPE score < 7 (OR 3.21, p=0.03 as predictors of recurrent neurological events. Conclusion. Recurrent neurological events after PFO closure are rare, usually noncryptogenic and associated with conventional vascular risk factors or AF related. Patients older than 55 years of age and those with a RoPE score < 7 are likely to get less benefit from PFO closure. After transcatheter PFO closure, lifelong strict vascular risk factor control is warranted.

Nasalance Scores of Children with Repaired Cleft Palate Who Exhibit Normal Velopharyngeal Closure during Aerodynamic Testing

Science.gov (United States)

Zajac, David J.

2013-01-01

Purpose: To determine if children with repaired cleft palate and normal velopharyngeal (VP) closure as determined by aerodynamic testing exhibit greater acoustic nasalance than control children without cleft palate. Method: Pressure-flow procedures were used to identify 2 groups of children based on VP closure during the production of /p/ in the…

Predicting Peri-Device Leakage of Left Atrial Appendage Device Closure Using Novel Three-Dimensional Geometric CT Analysis.

Science.gov (United States)

Chung, Hyemoon; Jeon, Byunghwan; Chang, Hyuk-Jae; Han, Dongjin; Shim, Hackjoon; Cho, In Jeong; Shim, Chi Young; Hong, Geu-Ru; Kim, Jung-Sun; Jang, Yangsoo; Chung, Namsik

2015-12-01

After left atrial appendage (LAA) device closure, peri-device leakage into the LAA persists due to incomplete occlusion. We hypothesized that pre-procedural three-dimensional (3D) geometric analysis of the interatrial septum (IAS) and LAA orifice can predict this leakage. We investigated the predictive parameters of LAA device closure obtained from baseline cardiac computerized tomography (CT) using a novel 3D analysis system. We conducted a retrospective study of 22 patients who underwent LAA device closure. We defined peri-device leakage as the presence of a Doppler signal inside the LAA after device deployment (group 2, n = 5) compared with patients without peri-device leakage (group 1, n = 17). Conventional parameters were measured by cardiac CT. Angles θ and φ were defined between the IAS plane and the line, linking the LAA orifice center and foramen ovale. Group 2 exhibited significantly better left atrial (LA) function than group 1 (p = 0.031). Pre-procedural θ was also larger in this group (41.9° vs. 52.3°, p = 0.019). The LAA cauliflower-type morphology was more common in group 2. Overall, the patients' LA reserve significantly decreased after the procedure (21.7 mm(3) vs. 17.8 mm(3), p = 0.035). However, we observed no significant interval changes in pre- and post-procedural values of θ and φ in either group (all p > 0.05). Angles between the IAS and LAA orifice might be a novel anatomical parameter for predicting peri-device leakage after LAA device closure. In addition, 3D CT analysis of the LA and LAA orifice could be used to identify clinically favorable candidates for LAA device closure.

Deep venous thrombosis after saphenous endovenous radiofrequency ablation: is it predictable?

Science.gov (United States)

Jacobs, Chad E; Pinzon, Maria Mora; Orozco, Jennifer; Hunt, Peter J B; Rivera, Aksim; McCarthy, Walter J

2014-04-01

Endovenous radiofrequency ablation (RFA) is a safe and effective treatment for varicose veins caused by saphenous reflux. Deep venous thrombosis (DVT) is a known complication of this procedure. The purpose of this study is to describe the frequency of DVT after RFA and the associated predisposing factors. A retrospective analysis was performed using prospectively collected data from December 2008 to December 2011; a total of 277 consecutive office-based RFA procedures were performed at a single institution using the VNUS ClosureFast catheter (VNUS Medical Technologies, San Jose, CA). Duplex ultrasonography scans were completed 2 weeks postprocedure in all patients. Risk factors assessed for the development of DVT included: great versus small saphenous vein (SSV) treated, right versus left side treated, number of radiofrequency cycles used, hypercoagulable state, history of DVT, tobacco use, medications (i.e., oral contraceptives, aspirin, warfarin, and clopidogrel), and vein diameter at the junction of the superficial and deep systems. Seventy-two percent of the patients were women, 56% were treated on the right side, and 86% were performed on the great saphenous vein (GSV). The mean age was 54 ± 14 years (range: 23-88 years). Three percent of patients had a preprocedure diagnosis of hypercoagulable state, and 8% had a history of previous DVT. On postprocedural ultrasound, thrombus protrusion into the deep system without occlusion (endovenous heat-induced thrombosis) was present in 11 patients (4%). DVT, as defined by thrombus protrusion with complete occlusion of the femoral or popliteal vein, was identified in 2 patients (0.7%). Previous DVT was the only factor associated with postprocedural DVT (P = 0.018). Although not statistically significant, there was a trend toward a higher risk of DVT in SSV-treated patients. Factors associated with endovascular heat-induced thrombosis alone were male sex (P = 0.02), SSV treatment (P = 0.05), aspirin use (P = 0.008), and

Space closure using the Hycon device. A case report.

Science.gov (United States)

Kachiwala, Viral A; Kalha, Anmol S; Vigneshwaran, J

2007-05-01

Space closure can be a difficult and uncomfortable procedure. Appliances able to be activated by the patient may reduce the number of visits for adjustment. To describe the closure of spaces with the Hycon device, an intra-oral screw that can be activated by the patient. Sliding mechanics were used to retract the upper and lower anterior teeth following extraction of the first premolars in a patient with bimaxillary protrusion. The active force for retraction was derived from the Hycon device activated twice a week by the patient. The rate of space closure achieved was of the order of 1.9 mm/month. The extraction spaces were closed by distal movement of the anterior teeth and mesial movement of the posterior teeth. The Hycon device proved to be an effective means of retracting the anterior teeth and protracting the posterior teeth. Because the device can be activated by the patient fewer visits for adjustment may be required.

Safety evaluation for the inner canister closure station

International Nuclear Information System (INIS)

Glasscock, J.R.

1987-01-01

The Inner Canister Closure Station (ICCS), built by Remote Technology Corporation, will be operability tested. The ICCS is used to remotely leak test Inner Canister Closures (ICC's) and replace ICC's that are not water tight. After operability testing, the ICCS will be inspected and sent to the 717-F mock-up shop for remotability demonstration and dimensional checks, then installed in the Vitrification Building, 221-S. An analysis of potential safety hazards, equipment safety features, and procedural controls indicates that the ICCS can be operated without undue hazard to employees or to the public. A safety inspection and a new equipment inspection will be held before operation to verify that the ICCS meets Savannah River Site safety requirements. 4 refs., 6 figs

Transcatheter closure of membranous ventricular septal defects with home-made nitinol occluder

Energy Technology Data Exchange (ETDEWEB)

Yongwen, Qin; Xianxian, Zhao; Xing, Zheng; Jijun, Ding; Jiang, Cao [Second Military Medical Univ., Shanghai (China). Changhai Hospital, Dept. of Cardiology

2004-04-01

Objective: To evaluate the feasibility and efficacy of transcatheter perimembranous ventricular septal defects (VSD) occlusion with home-made nitinol occluder. Methods: Transcatheter closure was attempted in 196 patients with perimembranous VSD. The diameter of VSD measured by echocardiography was 3 to 15 mm, mean (4.94 {+-} 2.23) mm. The angiographic diameter of the VSD was 3 to 6 mm, mean (3.92 {+-} 1.44) mm. A 7-10 F delivery sheath was advanced across the perimembranous VSD over a wire from femoral vein to deploy the occluder with the guidance of echocardiography and fluoroscopy. The device diameter selected was from 4 to 20 mm, mean (6.68 {+-} 2.76) mm. Left ventriculography and transthoracic echocardiography were repeated to assess the closure of the defects 15 min after the procedure. Continuous electrocardiogram monitoring lasted for 5 days. The echocardiography and electrocardiogram examination were scheduled for 1, 6 and 12 months of follow-up. Results: The occluders were successfully deployed in 191 patients. There were five procedural failures, two with device-related aortic insufficiency, and three of inability to pass through VSD. After deployment of the devices, there were no residual shunt in 180 of 191 patients, 11 patients with a trivial residual shunt that disappeared in 8 patients after one month of follow up. 3 patients developed mild tricuspid insufficiency. 12 developed transient complete right bundle branch block, and 5 transient complete left bundle branch block, and 2 transient complete atrioventricular block. There were repetitive nonparoxysmal ventricular tachycardia in 4 patients 1 week after the procedure. One patient had a detached device embolized into the left pulmonary artery but with a successful catheter retrieval by snare and transcatheter closure. The devices were similarly applied to patients with VSD associated with patent ductus arteriosus, and 4 patients with VSD complicated by atrial septal defects. The fluoroscopy time

Effectiveness of Closure of Public Places with Time Delay in Disease Control

Directory of Open Access Journals (Sweden)

Wang Zhenggang

2008-06-01

Full Text Available A theoretical basis for the evaluation of the effciency of quarantine measure is developed in a SIR model with time delay. In this model, the effectiveness of the closure of public places such as schools in disease control, modeled as a high degree node in a social network, is evaluated by considering the effect of the time delay in the identification of the infected. In the context of the SIR model, the relation between the number of infectious individuals who are identified with time delay and then quarantined and those who are not identified and continue spreading the virus are investigated numerically. The social network for the simulation is modeled by a scale free network. Closure measures are applied to those infected nodes with high degrees. The effectiveness of the measure can be controlled by the present value of the critical degree KC: only those nodes with degree higher than KC will be quarantined. The cost CQ incurred for the closure measure is assumed to be proportional to the total links rendered inactive as a result of the measure, and generally decreases with KC, while the medical cost CQ incurred for virus spreading increases with KC. The total social cost (CM + CQ will have a minimum at a critical KC, which depends on the ratio of medical cost coeffcient αM and closure cost coeffcient αQ. Our simulation results demonstrate a mathematical procedure to evaluate the effciency of quarantine measure. Although the numerical work is based on a scale free network, the procedure can be readily generalized and applied to a more realistic social network to determine the proper closure measure in future epidemics.

Colostomy closure: how to avoid complications

Science.gov (United States)

Levitt, Marc A.; Lawal, Taiwo A.; Peña, Alberto

2010-01-01

Purpose Colostomy is an operation frequently performed in pediatric surgery. Despite its benefits, it can produce significant morbidity. In a previous publication we presented our experience with the errors and complications that occurred during cases of colostomy creation. We now have focused in the morbidity related to the colostomy closure. The technical details that might have contributed to the minimal morbidity we experienced are described. Methods The medical records of 649 patients who underwent colostomy closure over a 28-year period were retrospectively reviewed looking for complications following these procedures. Our perioperative protocol for colostomy closure consisted in: clear fluids by mouth and repeated proximal stoma irrigations 24 h prior to the operation. Administration of IV antibiotics during anesthesia induction and continued for 48 h. Meticulous surgical technique that included: packing of the proximal stoma, plastic drape to immobilize the surgical field, careful hemostasis, emphasis in avoiding contamination, cleaning the edge of the stomas to allow a good 2-layer, end-to-end anastomosis with separated long-term absorbable sutures, generous irrigation of the peritoneal cavity and subsequent layers with saline solution, closure by layers to avoid dead space, and avoidance of hematomas. No drains and no nasogastric tubes were used. Oral fluids were started the day after surgery and patients were discharged 48–72 h after the operation. Results The original diagnoses of the patients were: anorectal malformation (583), Hirschsprung’s disease (53), and others (13). 10 patients (1.5%) had complications: 6 had intestinal obstruction (5 due to small bowel adhesions, 1 had temporary delay of the function of the anastomosis due to a severe size discrepancy between proximal and distal stoma with a distal microcolon) and 4 incisional hernias. There were no anastomotic dehiscences or wound infection. There was no bleeding, no anastomotic

Colostomy closure: how to avoid complications.

Science.gov (United States)

Bischoff, Andrea; Levitt, Marc A; Lawal, Taiwo A; Peña, Alberto

2010-11-01

Colostomy is an operation frequently performed in pediatric surgery. Despite its benefits, it can produce significant morbidity. In a previous publication we presented our experience with the errors and complications that occurred during cases of colostomy creation. We now have focused in the morbidity related to the colostomy closure. The technical details that might have contributed to the minimal morbidity we experienced are described. The medical records of 649 patients who underwent colostomy closure over a 28-year period were retrospectively reviewed looking for complications following these procedures. Our perioperative protocol for colostomy closure consisted in: clear fluids by mouth and repeated proximal stoma irrigations 24 h prior to the operation. Administration of IV antibiotics during anesthesia induction and continued for 48 h. Meticulous surgical technique that included: packing of the proximal stoma, plastic drape to immobilize the surgical field, careful hemostasis, emphasis in avoiding contamination, cleaning the edge of the stomas to allow a good 2-layer, end-to-end anastomosis with separated long-term absorbable sutures, generous irrigation of the peritoneal cavity and subsequent layers with saline solution, closure by layers to avoid dead space, and avoidance of hematomas. No drains and no nasogastric tubes were used. Oral fluids were started the day after surgery and patients were discharged 48-72 h after the operation. The original diagnoses of the patients were: anorectal malformation (583), Hirschsprung's disease (53), and others (13). 10 patients (1.5%) had complications: 6 had intestinal obstruction (5 due to small bowel adhesions, 1 had temporary delay of the function of the anastomosis due to a severe size discrepancy between proximal and distal stoma with a distal microcolon) and 4 incisional hernias. There were no anastomotic dehiscences or wound infection. There was no bleeding, no anastomotic stricture and no mortality. Based on

Closure The Definitive Guide

CERN Document Server

Bolin, Michael

2010-01-01

If you're ready to use Closure to build rich web applications with JavaScript, this hands-on guide has precisely what you need to learn this suite of tools in depth. Closure makes it easy for experienced JavaScript developers to write and maintain large and complex codebases -- as Google has demonstrated by using Closure with Gmail, Google Docs, and Google Maps. Author and Closure contributor Michael Bolin has included numerous code examples and best practices, as well as valuable information not available publicly until now. You'll learn all about Closure's Library, Compiler, Templates, tes

Influence of Closure & Non-Closure of the Visceral and Parietal Peritoneum on Post Cesarean Morbidity

Directory of Open Access Journals (Sweden)

Z Tabasi

2012-05-01

>Findings showed that non-closure of peritoneal layers as a shorter and simpler procedure has no influence on increasing post cesarean morbidity. Therefore, due to maternal health promotion and early neonatal breastfeeding, non closure of peritoneal layers is recommended

Acute limb ischemia caused by incorrect deployment of a clip-based arterial closure device

Directory of Open Access Journals (Sweden)

Łukasz Dzieciuchowicz

2016-04-01

Full Text Available Failure of a vascular closure device most commonly results in a hemorrhage or pseudoaneurysm formation. In this paper a rare case of severe acute limb ischemia following incorrect deployment of a clip-based closure device (Starclose SE, Abbott Vascular in a 31-year-old woman is presented. Symptoms of acute limb ischemia occurred at the start of the ambulation, 6 h after completion of the procedure. Because of the severity of ischemia the patient was treated surgically, and limb perfusion was successfully restored. An attempt of closure of an inadvertently punctured narrow superficial femoral artery was identified as the cause of this complication.

Closure of Myelomeningocele Defects Using a Limberg Flap or Direct Repair

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Jung-Hwan Shim

2016-01-01

Full Text Available BackgroundThe global prevalence of myelomeningocele has been reported to be 0.8–1 per 1,000 live births. Early closure of the defect is considered to be the standard of care. Various surgical methods have been reported, such as primary skin closure, local skin flaps, musculocutaneous flaps, and skin grafts. The aim of this study was to describe the clinical characteristics of myelomeningocele defects and present the surgical outcomes of recent cases of myelomeningocele at our institution.MethodsPatients who underwent surgical closure of myelomeningocele at our institution from January 2004 to December 2013 were included in this study. A retrospective chart review of their medical records was performed, and comorbidities, defect size, location, surgical procedures, complications, and the final results were analyzed.ResultsA total of 14 patients underwent surgical closure for myelomeningocele defects. Twelve cases were closed with direct skin repair, while two cases required local skin flaps to cover the skin defects. Three cases of infection occurred, requiring incision and either drainage or removal of allogenic materials. One case of partial flap necrosis occurred, requiring secondary revision using a rotational flap and a full-thickness skin graft. Despite these complications, all wounds eventually healed completely.ConclusionsMost myelomeningocele defects can be managed by direct skin repair alone. In cases of large defects, in which direct repair is not possible, local flaps may be used to cover the defect. Complications such as wound dehiscence and partial flap necrosis occurred in this study; however, all such complications were successfully managed with simple ancillary procedures.

Transcatheter Closure of Patent Ductus Arteriosus in Children with the Occlutech Duct Occluder.

Science.gov (United States)

Bilici, Meki; Demir, Fikri; Akın, Alper; Türe, Mehmet; Balık, Hasan; Kuyumcu, Mahir

2017-12-01

The aim of this study was to evaluate the feasibility, efficacy and safety of transcatheter closure of patent ductus arteriosus (PDA) with the Occlutech duct occluder (ODO) in children. We reviewed the clinical records of 71 patients who underwent percutaneous closure of PDA with an ODO between September 2014 and August 2016. The Occlutech duct occluder was applied to 71 patients during the study period (September 2014-August 2016), and the results were analyzed in this study. Forty-two of the patients were female and 29 male. The median age was 20.5 months (range, 6-194 months) and median weight was 16 kg (range, 6-68 kg). The PDA was classified as type A in 54 patients (76.1%), type E in 14 (19.7%), type C in 2 (2.8%) and type B in 1 (1.4%) based on the Krichenko classification. A standard ODO device was used for the transcatheter closure procedure in 66 patients and the long-shank ODO device in 5. In the echocardiographic measurement of PDA, the median smallest diameter was 2.7 mm (range, 1.5-7.0 mm), and in the angiographic measurement, the median smallest diameter was 2.5 mm (range, 1.5-6.5 mm). All 71 patients underwent successful PDA closure with the ODO. Angiography following the procedure showed complete closure in 47 patients (66.2%), mild residual shunt in 13 patients (18.3%) and a trivial shunt in 11 patients (15.5%). Color flow Doppler echocardiogpaphy at 24 h post-implantation showed that complete closure was achieved in 65 patients (91.5%), and 6 patients (8.5%) had mild residual shunt. All patients (100%) had complete closure at 30 days of follow-up. The results of this study showed that the Occlutech PDA occluder device is safe and effective in the closure of PDA. As the pulmonary artery side of the device is wider than the aortic side, protrusion toward the aortic side and embolization are prevented, but there is residual shunt in the early period, although this residual shunt disappeared after a few months.

Compilation of current literature on seals, closures, and leakage for radioactive material packagings

International Nuclear Information System (INIS)

Warrant, M.M.; Ottinger, C.A.

1989-01-01

This report presents an overview of the features that affect the sealing capability of radioactive material packagings currently certified by the US Nuclear Regulatory Commission. The report is based on a review of current literature on seals, closures, and leakage for radioactive material packagings. Federal regulations that relate to the sealing capability of radioactive material packagings, as well as basic equations for leakage calculations and some of the available leakage test procedures are presented. The factors which affect the sealing capability of a closure, including the properties of the sealing surfaces, the gasket material, the closure method and the contents are discussed in qualitative terms. Information on the general properties of both elastomer and metal gasket materials and some specific designs are presented. A summary of the seal material, closure method, and leakage tests for currently certified packagings with large diameter seals is provided. 18 figs., 9 tabs

Cost comparison of transcatheter and operative closures of ostium secundum atrial septal defects

Science.gov (United States)

O’Byrne, Michael L.; Gillespie, Matthew J.; Shinohara, Russell T.; Dori, Yoav; Rome, Jonathan J.; Glatz, Andrew C.

2015-01-01

Background Clinical outcomes for transcatheter and operative closures of atrial septal defects (ASDs) are similar. Economic cost for each method has not been well described. Methods A single-center retrospective cohort study of children and adults cost of operative and transcatheter closures of ASD. A propensity score weight-adjusted multivariate regression model was used in an intention-to-treat analysis. Costs for reintervention and crossover admissions were included in primary analysis. Results A total of 244 subjects were included in the study (64% transcatheter and 36% operative), of which 2% (n = 5) were ≥18 years. Crossover rate from transcatheter to operative group was 3%. Risk of reintervention (P = .66) and 30-day mortality (P = .37) were not significantly different. In a multivariate model, adjusted cost of operative closure was 2012 US $60,992 versus 2012 US $55,841 for transcatheter closure (P cost favoring transcatheter closure were length of stay, medications, and follow-up radiologic and laboratory testing, overcoming higher costs of procedure and echocardiography. Professional costs did not differ. The rate of 30-day readmission was greater in the operative cohort, further increasing the cost advantage of transcatheter closure. Sensitivity analyses demonstrated that costs of follow-up visits influenced relative cost but that device closure remained favorable over a broad range of crossover and reintervention rates. Conclusion For single secundum ASD, cost comparison analysis favors transcatheter closure over the short term. The cost of follow-up regimens influences the cost advantage of transcatheter closure. PMID:25965721

Intraoperative closure of infant multiple muscular ventricular septal defects with Amplatzer occluder

International Nuclear Information System (INIS)

Liu Jinfen; Gao Wei; Zhu Zhongqun; Chen Huiwen; Zhang Yuqi

2005-01-01

Objective: To report the preliminary experience of intraoperative hybrid therapy for closure of multiple muscular ventricular septal defects (VSD) in a small infant. Methods: After median sternotomy, a AGA Amplatzer occluder was introduced through right ventricular surface to close 2 muscular ventricular septal defects under transesophageal echocardiographic guidance. Results: The infant survived after the treatment without residual shunting, and rehabilitated rapidly. Conclusions: Intraoperative hybrid therapy with combined surgical technique and interventional procedure for closure of multiple muscular VSD in small infant is a safe and effective method. (authors)

Comparative Study Between Coaptive Film Versus Suture For Wound Closure After Long Bone Fracture Fixation

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IM Anuar Ramdhan

2013-03-01

Full Text Available INTRODUCTION: Coaptive film (i.e., Steri-StripsTM is an adhesive tape used to replace sutures in wound closure. The use of coaptive film for wound closure after long bone fracture fixation has not been well documented in the literature. METHODS: The aim of this prospective, randomized controlled trial comparing coaptive film with sutures for wound closure after long bone fracture fixation was skin closure time, incidence of wound complications and scar width at 12 week follow-up. Forty-five patients underwent femur fracture fixation (22 patients’ wound closed with sutures, 23 with coaptive film. RESULTS: The mean time for skin closure using coaptive film was 171.13 seconds compared to 437.27 seconds using suture. The mean wound lengths in the coaptive film group and suture group were 187.65 mm and 196.73 mm, respectively. One patient in each group had wound complications. CONCLUSION: Coaptive film is a time-saving procedure for skin closure following long bone fracture fixation. There is no difference in the incidence of wound complications and scar width between these two methods of skin closure.

Effectiveness of closure of public places with time delay in disease control.

Science.gov (United States)

Wang, Zhenggang; Szeto, Kwok Yip; Leung, Frederick Chi-Ching

2008-08-25

A theoretical basis for the evaluation of the effciency of quarantine measure is developed in a SIR model with time delay. In this model, the effectiveness of the closure of public places such as schools in disease control, modeled as a high degree node in a social network, is evaluated by considering the effect of the time delay in the identification of the infected. In the context of the SIR model, the relation between the number of infectious individuals who are identified with time delay and then quarantined and those who are not identified and continue spreading the virus are investigated numerically. The social network for the simulation is modeled by a scale free network. Closure measures are applied to those infected nodes with high degrees. The effectiveness of the measure can be controlled by the present value of the critical degree K(C): only those nodes with degree higher than K(C) will be quarantined. The cost C(Q) incurred for the closure measure is assumed to be proportional to the total links rendered inactive as a result of the measure, and generally decreases with K(C), while the medical cost C(Q) incurred for virus spreading increases with K(C). The total social cost (C(M) + C(Q)) will have a minimum at a critical K(*), which depends on the ratio of medical cost coeffcient alpha(M) and closure cost coeffcient alpha(Q). Our simulation results demonstrate a mathematical procedure to evaluate the effciency of quarantine measure. Although the numerical work is based on a scale free network, the procedure can be readily generalized and applied to a more realistic social network to determine the proper closure measure in future epidemics.

Transcatheter closure of patent ductus arteriosus with special conformation

International Nuclear Information System (INIS)

Zhang Yigang; Li Shijie; Fu Qiang

2009-01-01

Objective: To discuss the technique of transcatheter closure for the treatment of patent ductus arteriosus (PDA) with special conformation so as to improve the technical success rate and clinical safety. Methods: Transcatheter closure was performed in 23 patients with PDA of special types by using different devices according to the angiocardiographic conformation and the clinical manifestation. The therapeutic results were evaluated by transthoracic color Doppler echocardiography at 24 hours, one, three and six months after the operation. Results: Different occluders were successfully implanted in all patients. PDA of special types was found in 23 patients, which included: (1) special conformation (n=12), consisting of small type (n=5), huge type (n=3), aneurismal type (n=2) and displayed on special exposure position (n=2), (2) accompanied by other malformations (n=2), containing dextroaortic arch (n=1) and dextrocardia (n=1), (3) associated with severe pulmonary hypertension (n=8) and (4) recanalization after surgery (n=1). Conclusion: For PDA with special conformation, therapeutic strategy should be individually formulated in order to smoothly bring the closure procedure to success. (authors)

Professional Closure Beyond State Authorization

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Gitte Sommer Harrits

2014-03-01

Full Text Available For decades, the Weberian approach to the study of professions has been strong, emphasizing state authorization and market monopolies as constituting what is considered a profession. Originally, however, the Weberian conception of closure, or the ways in which a profession is constituted and made separate, was broader. This article suggests a revision of the closure concept, integrating insights from Pierre Bourdieu, and conceptualizing professional closure as the intersection of social, symbolic and legal closure. Based on this revision, this article demonstrates how to apply such a concept in empirical studies. This is done by exploring social, symbolic and legal closure across sixteen professional degree programs. The analyses show a tendency for some overlap between different forms of closure, with a somewhat divergent pattern for legal closure. Results support the argument that we need to study these processes as an intersection of different sources of closure, including capital, lifestyles and discourse

Efficacy and Safety of Transthoracic Echocardiography Alone in Transcatheter Closure of Secundum-Type Atrial Septal Defects in Adults.

Science.gov (United States)

Ding, Cheng; Chang, Jia-Kan; Lin, Chang-Chyi; Wu, Yong-Jian; Hsieh, Kai-Sheng

2016-04-01

On-site transthoracic echocardiography (TTE) to guide the transcutaneous closure of secundum-type atrial septal defects (ASDs) in the catheterization laboratory remains unclear, especially in adults. Between 2005 and 2012, a total of 82 adults underwent transcutaneous closure of ASDs. The initial 15 cases underwent the procedure with both on-site transesophageal echocardiography (TEE) and TTE monitoring. Since January 2008, a total of 67 patients underwent on-site TTE alone to guide the procedure. Among the 82 adult patients who underwent a transcutaneous closure of the secundum-type ASD procedure, all had successful closure of the defects, and no periprocedural adverse complications occurred. No statistical significance was observed in the successful complete shunt closure rate between the TEE plus TTE and TTE groups during sequential follow-up (postprocedure 24 hour [87% vs. 92%],1 month [93% vs. 95%], 3 month [93% vs. 97%], and 12 month [93% vs. 97%], P > 0.05, respectively) nor was a significant difference observed between the two groups, including decreased right ventricular dimension (29.5 ± 3.3 vs. 32.0 ± 4.9 mm, 26.5 ± 3.0 vs. 28.7 ± 4.6 mm, 26.2 ± 3.1 vs. 28.2 ± 4.8 mm, and 25.6 ± 2.8 vs. 27.7 ± 4.7 mm, P > 0.05, respectively) or increased left ventricular end-diastolic dimension (41.1 ± 2.0 vs. 42.6 ± 3.0 mm, 44.3 ± 2.7 vs. 45.5 ± 3.1 mm, 44.2 ± 2.8 vs. 45.4 ± 3.1 mm, 44.9 ± 2.7 vs. 45.8 ± 2.6 mm, P > 0.05, respectively) before the procedure, and at the 3-, 6-, and 12-month follow-up evaluations. This study showed that TTE guidance alone may be considered efficacious and safe as TEE during a transcutaneous ASD occlusion procedure in select adults. © 2015, Wiley Periodicals, Inc.

Tight closure and vanishing theorems

International Nuclear Information System (INIS)

Smith, K.E.

2001-01-01

Tight closure has become a thriving branch of commutative algebra since it was first introduced by Mel Hochster and Craig Huneke in 1986. Over the past few years, it has become increasingly clear that tight closure has deep connections with complex algebraic geometry as well, especially with those areas of algebraic geometry where vanishing theorems play a starring role. The purpose of these lectures is to introduce tight closure and to explain some of these connections with algebraic geometry. Tight closure is basically a technique for harnessing the power of the Frobenius map. The use of the Frobenius map to prove theorems about complex algebraic varieties is a familiar technique in algebraic geometry, so it should perhaps come as no surprise that tight closure is applicable to algebraic geometry. On the other hand, it seems that so far we are only seeing the tip of a large and very beautiful iceberg in terms of tight closure's interpretation and applications to algebraic geometry. Interestingly, although tight closure is a 'characteristic p' tool, many of the problems where tight closure has proved useful have also yielded to analytic (L2) techniques. Despite some striking parallels, there had been no specific result directly linking tight closure and L∼ techniques. Recently, however, the equivalence of an ideal central to the theory of tight closure was shown to be equivalent to a certain 'multiplier ideal' first defined using L2 methods. Presumably, deeper connections will continue to emerge. There are two main types of problems for which tight closure has been helpful: in identifying nice structure and in establishing uniform behavior. The original algebraic applications of tight closure include, for example, a quick proof of the Hochster-Roberts theorem on the Cohen-Macaulayness of rings of invariants, and also a refined version of the Brianqon-Skoda theorem on the uniform behaviour of integral closures of powers of ideals. More recent, geometric

40 CFR 264.228 - Closure and post-closure care.

Science.gov (United States)

2010-07-01

... remaining wastes to a bearing capacity sufficient to support final cover; and (iii) Cover the surface....112 must include both a plan for complying with paragraph (a)(1) of this section and a contingent plan... practicably removed at closure; and (ii) The owner or operator must prepare a contingent post-closure plan...

RCRA corrective action and closure

International Nuclear Information System (INIS)

1995-02-01

This information brief explains how RCRA corrective action and closure processes affect one another. It examines the similarities and differences between corrective action and closure, regulators' interests in RCRA facilities undergoing closure, and how the need to perform corrective action affects the closure of DOE's permitted facilities and interim status facilities

Primary closure after carotid endarterectomy is not inferior to other closure techniques.

Science.gov (United States)

Avgerinos, Efthymios D; Chaer, Rabih A; Naddaf, Abdallah; El-Shazly, Omar M; Marone, Luke; Makaroun, Michel S

2016-09-01

Primary closure after carotid endarterectomy (CEA) has been much maligned as an inferior technique with worse outcomes than in patch closure. Our purpose was to compare perioperative and long-term results of different CEA closure techniques in a large institutional experience. A consecutive cohort of CEAs between January 1, 2000, and December 31, 2010, was retrospectively analyzed. Closure technique was used to divide patients into three groups: primary longitudinal arteriotomy closure (PRC), patch closure (PAC), and eversion closure (EVC). End points were perioperative events, long-term strokes, and restenosis ≥70%. Multivariate regression models were used to assess the effect of baseline predictors. There were 1737 CEA cases (bilateral, 143; mean age, 71.4 ± 9.3 years; 56.2% men; 35.3% symptomatic) performed during the study period with a mean clinical follow-up of 49.8 ± 36.4 months (range, 0-155 months). More men had primary closure, but other demographic and baseline symptoms were similar between groups. Half the patients had PAC, with the rest evenly distributed between PRC and EVC. The rate of nerve injury was 2.7%, the rate of reintervention for hematoma was 1.5%, and the length of hospital stay was 2.4 ± 3.0 days, with no significant differences among groups. The combined stroke and death rate was 2.5% overall and 3.9% and 1.7% in the symptomatic and asymptomatic cohort, respectively. Stroke and death rates were similar between groups: PRC, 11 (2.7%); PAC, 19 (2.2%); EVC, 13 (2.9%). Multivariate analysis showed baseline symptomatic disease (odds ratio, 2.4; P = .007) and heart failure (odds ratio, 3.1; P = .003) as predictors of perioperative stroke and death, but not the type of closure. Cox regression analysis demonstrated, among other risk factors, no statin use (hazard ratio, 2.1; P = .008) as a predictor of ipsilateral stroke and severe (glomerular filtration rate <30 mL/min/1.73 m(2)) renal insufficiency (hazard ratio, 2.6; P�

Criticality assessment of LLRWDF closure

International Nuclear Information System (INIS)

Sarrack, A.G.; Weber, J.H.; Woody, N.D.

1992-01-01

During the operation of the Low Level Radioactive Waste Disposal Facility (LLRWDF), large amounts (greater than 100 kg) of enriched uranium (EU) were buried. This EU came primarily from the closing and decontamination of the Naval Fuels Facility in the time period from 1987--1989. Waste Management Operations (WMO) procedures were used to keep the EU boxes separated to prevent possible criticality during normal operation. Closure of the LLRWDF is currently being planned, and waste stabilization by Dynamic Compaction (DC) is proposed. Dynamic compaction will crush the containers in the LLRWDF and result in changes in their geometry. Research of the LLRWDF operations and record keeping practices have shown that the EU contents of trenches are known, but details of the arrangement of the contents cannot be proven. Reviews of the trench contents, combined with analysis of potential critical configurations, revealed that some portions of the LLRWDF can be expected to be free of criticality concerns while other sections have credible probabilities for the assembly of a critical mass, even in the uncompacted configuration. This will have an impact on the closure options and which trenches can be compacted

Transcatheter closure of secundum atrial septal defect with cardio SEAL septal occluder. A preliminary result of clinical application

International Nuclear Information System (INIS)

Zhang Gejun; Dai Ruping; Liu Yanling; Jiang Shiliang; Zeng Zheng; Huang Lianjun; Xie Ruolan

2001-01-01

Objective: To evaluate the efficiency and preliminary results of transcatheter closure of secundum atrial septal defect (ASD) with CardioSEAL septal occluder. Methods: There were 12 patients in this study. Trans-esophageal echocardiography (TEE) before the interventions confirmed the ASDs with a mean diameter of *13.14 +- 3.48) mm (ranging from 8 to 20 mm). There were 11 isolated ASDs and 1 multi-defects ASD in the group. Each ASD was occluded with CardioSEAL septal occluder through the percutaneous procedure. The closure procedure was guided by fluoroscopy and trans-esophageal echocardiography. The TEE was done immediately after the procedure to find whether there was residual shunt. Trans-thoracic-echocardiography (TTE), ECG, and X-ray examination were done 24 hours, 1 month, 3 months, and 1 year after the procedures as follow-up to evaluate the efficiency. Results: The placements of the occluders were successful in 11 cases. There were no mortality and no emergent surgery during the procedures. TEE confirmed that there were trivial and small residual shunts in 3 cases immediately after the procedures. TTE confirmed small residual shunts in 2 cases 24 hour after the procedures, and in 1 case 1 month, 3 month, and 1 year after the procedures. Conclusion: Transcatheter closure of secundum ASD with CardioSEAL septal occluder was an efficient nonsurgical method. It could be the method of choice in treating the ASDs with special anatomic variations. It had a high successful rate of device placement and satisfied preliminary results, but the long-term follow-up was needed

Transcatheter closure of membranous ventricular septal defects with home-made nitinol occluder

International Nuclear Information System (INIS)

Qin Yongwen; Zhao Xianxian; Zheng Xing; Ding Jijun; Cao Jiang

2004-01-01

Objective: To evaluate the feasibility and efficacy of transcatheter perimembranous ventricular septal defects (VSD) occlusion with home-made nitinol occluder. Methods: Transcatheter closure was attempted in 196 patients with perimembranous VSD. The diameter of VSD measured by echocardiography was 3 to 15 mm, mean (4.94 ± 2.23) mm. The angiographic diameter of the VSD was 3 to 6 mm, mean (3.92 ± 1.44) mm. A 7-10 F delivery sheath was advanced across the perimembranous VSD over a wire from femoral vein to deploy the occluder with the guidance of echocardiography and fluoroscopy. The device diameter selected was from 4 to 20 mm, mean (6.68 ± 2.76) mm. Left ventriculography and transthoracic echocardiography were repeated to assess the closure of the defects 15 min after the procedure. Continuous electrocardiogram monitoring lasted for 5 days. The echocardiography and electrocardiogram examination were scheduled for 1, 6 and 12 months of follow-up. Results: The occluders were successfully deployed in 191 patients. There were five procedural failures, two with device-related aortic insufficiency, and three of inability to pass through VSD. After deployment of the devices, there were no residual shunt in 180 of 191 patients, 11 patients with a trivial residual shunt that disappeared in 8 patients after one month of follow up. 3 patients developed mild tricuspid insufficiency. 12 developed transient complete right bundle branch block, and 5 transient complete left bundle branch block, and 2 transient complete atrioventricular block. There were repetitive nonparoxysmal ventricular tachycardia in 4 patients 1 week after the procedure. One patient had a detached device embolized into the left pulmonary artery but with a successful catheter retrieval by snare and transcatheter closure. The devices were similarly applied to patients with VSD associated with patent ductus arteriosus, and 4 patients with VSD complicated by atrial septal defects. The fluoroscopy time for the

Follow-up of P dispersion after transcatheter closure of an atrial septal defect in children

International Nuclear Information System (INIS)

Baspinar, O.; Kervancioglu, M.; Kilinc, M.; Irdem, A.; Koruk, S.

2014-01-01

Objectives: To determine in paediatric patients with atrial septal defects whether differences in P wave dispersion occurred with transcatheter closures using the Amplatzer septal occluder. Method: A total of 31 children who had undergone transcathater closures were evaluated. P maximum, P minimum, and P dispersion were measured with 12-lead surface electrocardiography, before the procedure and one week, one month, three months, six months and one year following the procedure. SPSS 10 was used for statistical analysis. Results: There were 23 (74.2%) females and 8 (25.8%) males with an overall mean age of 7.5+-4.1 years and mean weight of 26.2+-16.9kg. The P maximum and P minimum measurements differed between patients during the follow-up period. Both measurements decreased with time. However, P dispersion was not significantly different throughout the follow-up period (before the procedure P maximum 95.4+-15.6 ms, P minimum 64.5+-15.4 ms, and P dispersion 30.8+-11.4ms; one year later, P maximum 76.1+-14.6 ms, P minimum 47.1+-12.1 ms, and P dispersion 29.1+-9.1ms). Conclusion: Over time, there are no P dispersion differences in transcatheter closures using the Amplatzer septal occluder. (author)

Vacuum-assisted closure therapy in the management of lung abscess.

Science.gov (United States)

Sziklavari, Zsolt; Ried, Michael; Hofmann, Hans-Stefan

2014-09-06

Despite significant advances in the treatment of thoracic infections, complex lung abscess remains a problem in modern thoracic surgery. We describe the novel application of vacuum-assisted closure for the treatment of a lung abscess. The technical details and preliminary results are reported. After the initial failed conservative treatment of an abscess, minimally invasive surgical intervention was performed with vacuum-assisted closure. The vacuum sponges were inserted in the abscess cavity at the most proximal point to the pleural surface. The intercostal space of the chest wall above the entering place was secured by a soft tissue retractor. The level of suction was initially set to 100 mm Hg, with a maximum suction of 125 mm Hg. The sponge was changed once on the 3rd postoperative day. The abscess cavity was rapidly cleaned and decreased in size. The mini-thoracotomy could be closed on the 9th postoperative day. Closure of the cavity was simple, without any short- or long-term treatment failure. This technique reduced the trauma associated with the procedure. The patient was discharged on the 11th postoperative day. Vacuum-assisted closure systems should be considered for widespread use as an alternative option for the treatment of complicated pulmonary abscess in elderly, debilitated, immunocompromised patients after failed conservative treatment.

A new technique for the closure of the lens capsule by laser welding.

Science.gov (United States)

Pini, Roberto; Rossi, Francesca; Menabuoni, Luca; Lenzetti, Ivo; Yoo, Sonia; Parel, Jean-Marie

2008-01-01

A new method is presented for the closure of the lens capsule based on laser welding of suitably prepared patches of anterior capsular tissue. Experiments were performed in freshly enucleated porcine eyes. The patches were previously stained with a solution of indocyanine green in sterile water and then welded on the recipient capsule by means of diode laser radiation at 810 nm. The welded tissue revealed mechanical properties comparable to those of healthy tissue. This technique is proposed to repair capsular breaks and to provide the closure of the capsulorhexis in lens refilling procedures.

A multicenter randomized controlled trial comparing absorbable barbed sutures versus conventional absorbable sutures for dermal closure in open surgical procedures.

Science.gov (United States)

Rubin, J Peter; Hunstad, Joseph P; Polynice, Alain; Gusenoff, Jeffrey A; Schoeller, Thomas; Dunn, Raymond; Walgenbach, Klaus J; Hansen, Juliana E

2014-02-01

Barbed sutures were developed to reduce operative time and improve security of wound closure. The authors compare absorbable barbed sutures (V-Loc, Covidien, Mansfield, Massachusetts) with conventional (smooth) absorbable sutures for soft tissue approximation. A prospective multicenter randomized study comparing barbed sutures with smooth sutures was undertaken between August 13, 2009, and January 31, 2010, in 241 patients undergoing abdominoplasty, mastopexy, and reduction mammaplasty. Each patient received barbed sutures on 1 side of the body, with deep dermal sutures eliminated or reduced. Smooth sutures with deep dermal and subcuticular closure were used on the other side as a control. The primary endpoint was dermal closure time. Safety was assessed through adverse event reporting through a 12-week follow-up. A total of 229 patients were ultimately treated (115 with slow-absorbing polymer and 114 with rapid-absorbing polymer). Mean dermal closure time was significantly quicker with the barbed suture compared with the smooth suture (12.0 vs 19.2 minutes; P<.001), primarily due to the need for fewer deep dermal sutures. The rapid-absorbing barbed suture showed a complication profile equivalent to the smooth suture, while the slow-absorbing barbed suture had a higher incidence of minor suture extrusion. Barbed sutures enabled faster dermal closure quicker than smooth sutures, with a comparable complication profile. 1.

Patient Satisfaction After Femoral Arterial Access Site Closure Using the ExoSeal® Vascular Closure Device Compared to Manual Compression: A Prospective Intra-individual Comparative Study

International Nuclear Information System (INIS)

Pieper, Claus Christian; Thomas, Daniel; Nadal, Jennifer; Willinek, Winfried A.; Schild, Hans Heinz; Meyer, Carsten

2016-01-01

PurposeTo intra-individually compare discomfort levels and patient satisfaction after arterial access closure using the ExoSeal ® vascular closure device (VCD) and manual compression (MC) in a prospective study design.MethodsPatients undergoing two planned interventions from 07/2013 to 09/2014 could participate in the study. Access closure was performed with an ExoSeal ® -VCD in one and MC in the other intervention. Patients were clinically and sonographically examined and were given questionnaires 1 day after intervention [groin- and back-pain during bedrest (100-point visual analog scale; 0: no pain); comfortability of bedrest (10-point Likert scale, 1: comfortable), satisfaction with closure (10-point Likert scale, 1: very satisfied)]. Results were analyzed in a cross-over design.Results48 patients (29 male, median age 62.5 (32–88) years) were included. An ExoSeal ® -VCD was used first in 25 cases. As four of these subsequently refused MC as second intervention, data from 44 patients could be analyzed. All closures were technically successful (successful device deployment) without major complications. Groin- and back-pain after VCD-use/MC was 0 (0–15) vs. 10 (0–80) and 0 (0–75) vs. 25 (0–90), respectively (p < 0.0001). Bedrest after VCD-use was more comfortable than after MC [1 (range 1–7) vs. 6 (2–10); p < 0.0001]. Satisfaction with the closure procedure and with the intervention in general was higher after VCD-use compared to MC [1 (1–3) vs. 5 (2–10) and 1 (1–2) vs. 2 (1–4), respectively; p < 0.0001].ConclusionIntra-individual comparison showed pain levels and discomfort to be significantly lower after ExoSeal ® use compared to MC. VCD closure was associated with higher satisfaction both with the closure itself and with the intervention in general

Numerical approach of memory effect on crack closure phenomenon

International Nuclear Information System (INIS)

Billardon, R.; Brunet, M.; Lemaitre, J.

1981-01-01

In the case of variable amplitude loading, it is necessary to introduce in the fatigue crack propagation law a parameter accounting for the threshold value of strain energy release rate. In order to relate this threshold to crack closure or crack opening, a finite element procedure has been developed based upon anisotropic elastoplastic constitutive equations (Marquis). This finite element procedure is used for the cyclic elastoplastic analysis of fatigue bending crack tests carried on 2024 aluminium alloy, 2 millimeters thick. The influence of the hardening rule used is studied for the case of one single overload on constant amplitude (0, +) loading. (orig./HP)

Rash with DERMABOND PRINEO Skin Closure System Use in Bilateral Reduction Mammoplasty: A Case Series.

Science.gov (United States)

Knackstedt, R W; Dixon, J A; O'Neill, P J; Herrera, F A

2015-01-01

Background. Bilateral reduction mammoplasty is a common plastic surgery procedure that can be complicated by unfavorable scar formation along incision sites. Surgical adhesives can be utilized as an alternative or as an adjunct to conventional suture closures to help achieve good wound tension and provide an adequate barrier with excellent cosmesis. The recently introduced DERMABOND PRINEO Skin Closure System Skin Closure System combines the skin adhesive 2-octyl cyanoacrylate with a self-adhering polyester-based mesh. Proposed benefits of wound closure with DERMABOND PRINEO Skin Closure System, used with or without sutures, include its watertight seal, easy removal, microbial barrier, even distribution of tension, and reduction in wound closure time. Although allergic reactions to 2-octyl cyanoacrylate have been reported, few allergic reactions to DERMABOND PRINEO Skin Closure System have been noted in the literature. This case series describes three patients who experienced an allergic reaction to DERMABOND PRINEO Skin Closure System after undergoing elective bilateral reduction mammoplasties at our institution to further explore this topic. Methods. Retrospective chart review of bilateral reduction mammoplasty patients who received DERMABOND PRINEO Skin Closure System dressing at our institution was performed. Results. Three patients were identified as having a rash in reaction to DERMABOND PRINEO Skin Closure System after bilateral reduction mammoplasty. All three patients required systemic steroid treatment to resolve the rash. One patient was identified as having a prior adhesive reaction. Conclusions. DERMABOND PRINEO Skin Closure System has demonstrated its efficacy in optimizing scar healing and appearance. However, as we demonstrate these three allergic reactions to DERMABOND PRINEO Skin Closure System, caution must be utilized in its usage, namely, in patients with a prior adhesive allergy and in sites where moisture or friction may be apparent.

Rash with DERMABOND PRINEO Skin Closure System Use in Bilateral Reduction Mammoplasty: A Case Series

Directory of Open Access Journals (Sweden)

R. W. Knackstedt

2015-01-01

Full Text Available Background. Bilateral reduction mammoplasty is a common plastic surgery procedure that can be complicated by unfavorable scar formation along incision sites. Surgical adhesives can be utilized as an alternative or as an adjunct to conventional suture closures to help achieve good wound tension and provide an adequate barrier with excellent cosmesis. The recently introduced DERMABOND PRINEO Skin Closure System Skin Closure System combines the skin adhesive 2-octyl cyanoacrylate with a self-adhering polyester-based mesh. Proposed benefits of wound closure with DERMABOND PRINEO Skin Closure System, used with or without sutures, include its watertight seal, easy removal, microbial barrier, even distribution of tension, and reduction in wound closure time. Although allergic reactions to 2-octyl cyanoacrylate have been reported, few allergic reactions to DERMABOND PRINEO Skin Closure System have been noted in the literature. This case series describes three patients who experienced an allergic reaction to DERMABOND PRINEO Skin Closure System after undergoing elective bilateral reduction mammoplasties at our institution to further explore this topic. Methods. Retrospective chart review of bilateral reduction mammoplasty patients who received DERMABOND PRINEO Skin Closure System dressing at our institution was performed. Results. Three patients were identified as having a rash in reaction to DERMABOND PRINEO Skin Closure System after bilateral reduction mammoplasty. All three patients required systemic steroid treatment to resolve the rash. One patient was identified as having a prior adhesive reaction. Conclusions. DERMABOND PRINEO Skin Closure System has demonstrated its efficacy in optimizing scar healing and appearance. However, as we demonstrate these three allergic reactions to DERMABOND PRINEO Skin Closure System, caution must be utilized in its usage, namely, in patients with a prior adhesive allergy and in sites where moisture or friction may

Ring closure in actin polymers

Energy Technology Data Exchange (ETDEWEB)

Sinha, Supurna, E-mail: supurna@rri.res.in [Raman Research Institute, Bangalore 560080 (India); Chattopadhyay, Sebanti [Doon University, Dehradun 248001 (India)

2017-03-18

We present an analysis for the ring closure probability of semiflexible polymers within the pure bend Worm Like Chain (WLC) model. The ring closure probability predicted from our analysis can be tested against fluorescent actin cyclization experiments. We also discuss the effect of ring closure on bend angle fluctuations in actin polymers. - Highlights: • Ring closure of biopolymers. • Worm like chain model. • Predictions for experiments.

Sternocleidomastoid flap augmentation of the pharyngeal closure after total laryngectomy.

Science.gov (United States)

Ibrahim, Sherif Gabr; Wahba, Basim Metwally; Elbatawi, Ahmed Mahmoud; Eltelety, Ahmad Mohamed

2017-08-01

The objective of the study was to evaluate the effect of sternocleidomastoid (SCM) flap augmentation of the pharyngeal closure after total laryngectomy on the incidence of pharyngocutaneous fistula (PCF). Thirty patients with T4a laryngeal carcinoma and none of them receiving primary radiotherapy previously were divided into two equal groups. Group A patients had SCM flap augmentation of the pharyngeal closure after total laryngectomy. Group B patients had the standard pharyngeal closure without augmentation. Both groups were followed up for 30 days postoperatively for the development of PCF. The use of the SCM added about extra 15 min to the surgical procedure in all patients (p laryngectomy. Three patients in each group developed PCF either early (10 days or less postoperatively) or late (more than 10 days but less than 30 days postoperatively). There was no statistically significant difference in the length of hospital stay between the two groups. The use of SCM flap did not reduce the incidence of PCF after total laryngectomy.

[Percutaneous closure of the patent ductus arteriosus in children with the Amplatzer Duct Occluder II].

Science.gov (United States)

Parra-Bravo, José Rafael; Osuna-Izaguirre, Manuel Alfredo; Beirana-Palencia, Luisa; Gálvez-Cancino, Franco; Martínez-Monterrosas, Christian; Lazo-Cárdenas, César; Reyes-Vargas, César

2014-01-01

In the last decades, several devices have been used for the percutaneous closure of patent ductus arteriosus, with its own limitations and risks. The Amplatzer Duct Occluder II has been designed to overcome those limitations and reduce risks. We described our initial series of patients who underwent percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder II, emphasis on the technical aspects of the procedure. We reviewed the clinical records of 9 patients with patent ductus arteriosus who underwent percutaneous closure with the Amplatzer Duct Occluder II. Median age was 24 months (range 8-51 months) and the median weight was 10.7kg (range 6-16.3kg). The minimal ductus arteriosus diameter was 2.7mm (1-5mm). Implantation was successful in all cases. The devices most commonly used (33.3%) were the dimensions 4-4mm (3 patients), in 2 patients were used 3-4mm and in the rest of the patients were employed occluder other sizes. Four cases showed slight residual flow immediately after implantation. Total closure was achieved in 24h in 8 of 9 patients (89%). There was no embolization of the occluder or deaths during the procedure and we only observed one minor complication. The Amplatzer Duct Occluder II in this series was effective in 89% of the patients at 24hs after the procedure and 100% follow-up. The implantation was safe and no major complications were observed. The occlusion rate is comparable to those reported for the Amplatzer Duct Occluder I. Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

Tubular closure device

International Nuclear Information System (INIS)

Klahn, F.C.; Nolan, J.H.; Wills, C.

1982-01-01

This invention relates to a closure mechanism for closing openings such as the bore of a conduit and for releasably securing members within the bore. More particularly, this invention relates to a closure mechanism for tubular irradiation surveillance specimen assembly holders used in nuclear reactors

Loop Ileostomy Closure as an Overnight Procedure: Institutional Comparison With the National Surgical Quality Improvement Project Data Set.

Science.gov (United States)

Berger, Nicholas G; Chou, Raymond; Toy, Elliot S; Ludwig, Kirk A; Ridolfi, Timothy J; Peterson, Carrie Y

2017-08-01

Enhanced recovery pathways have decreased length of stay after colorectal surgery. Loop ileostomy closure remains a challenge, because patients experience high readmission rates, and validation of enhanced recovery pathways has not been demonstrated. This study examined a protocol whereby patients were discharged on the first postoperative day and instructed to advance their diet at home with close telephone follow-up. The hypothesis was that patients can be safely discharged the day after loop closure, leading to shorter length of stay without increased rates of readmission or complications. Patients undergoing loop ileostomy closure were queried from the American College of Surgeons National Surgical Quality Improvement Project and compared with a single institution (2012-2015). Length of stay, 30-day readmission, and 30-day morbidity data were analyzed. The study was conducted at a tertiary university department. The study includes 1602 patients: 1517 from the National Surgical Quality Improvement Project database and 85 from a single institution. Length of stay and readmission rates were measured. Median length of stay was less at the single institution compared with control (2 vs 4 d; p < 0.001). Thirty-day readmission (15.3% vs 10.4%; p = 0.15) and overall 30-day complications (15.3% vs 16.7%; p = 0.73) were similar between cohorts. Estimated adjusted length of stay was less in the single institution (2.93 vs 5.58 d; p < 0.0001). There was no difference in the odds of readmission (p = 0.22). The main limitations of this study include its retrospective nature and limitations of the National Surgical Quality Improvement Program database. Next-day discharge with protocoled diet advancement and telephone follow-up is acceptable after loop ileostomy closure. Patients can benefit from decreased length of stay without an increase in readmission or complications. This has the potential to change the practice of postoperative management of loop ileostomy closure, as

Patient Satisfaction After Femoral Arterial Access Site Closure Using the ExoSeal{sup ®} Vascular Closure Device Compared to Manual Compression: A Prospective Intra-individual Comparative Study

Energy Technology Data Exchange (ETDEWEB)

Pieper, Claus Christian, E-mail: claus.christian.pieper@ukb.uni-bonn.de; Thomas, Daniel, E-mail: daniel.thomas@ukb.uni-bonn.de [University of Bonn, Department of Radiology (Germany); Nadal, Jennifer, E-mail: jennifer.nadal@ukb.uni-bonn.de [University of Bonn, Institute for Medical Biometry, Informatics and Epidemiology (Germany); Willinek, Winfried A., E-mail: w.willinek@bk-trier.de; Schild, Hans Heinz, E-mail: hans.schild@ukb.uni-bonn.de; Meyer, Carsten, E-mail: carsten.meyer@ukb.uni-bonn.de [University of Bonn, Department of Radiology (Germany)

2016-01-15

PurposeTo intra-individually compare discomfort levels and patient satisfaction after arterial access closure using the ExoSeal{sup ®} vascular closure device (VCD) and manual compression (MC) in a prospective study design.MethodsPatients undergoing two planned interventions from 07/2013 to 09/2014 could participate in the study. Access closure was performed with an ExoSeal{sup ®}-VCD in one and MC in the other intervention. Patients were clinically and sonographically examined and were given questionnaires 1 day after intervention [groin- and back-pain during bedrest (100-point visual analog scale; 0: no pain); comfortability of bedrest (10-point Likert scale, 1: comfortable), satisfaction with closure (10-point Likert scale, 1: very satisfied)]. Results were analyzed in a cross-over design.Results48 patients (29 male, median age 62.5 (32–88) years) were included. An ExoSeal{sup ®}-VCD was used first in 25 cases. As four of these subsequently refused MC as second intervention, data from 44 patients could be analyzed. All closures were technically successful (successful device deployment) without major complications. Groin- and back-pain after VCD-use/MC was 0 (0–15) vs. 10 (0–80) and 0 (0–75) vs. 25 (0–90), respectively (p < 0.0001). Bedrest after VCD-use was more comfortable than after MC [1 (range 1–7) vs. 6 (2–10); p < 0.0001]. Satisfaction with the closure procedure and with the intervention in general was higher after VCD-use compared to MC [1 (1–3) vs. 5 (2–10) and 1 (1–2) vs. 2 (1–4), respectively; p < 0.0001].ConclusionIntra-individual comparison showed pain levels and discomfort to be significantly lower after ExoSeal{sup ®} use compared to MC. VCD closure was associated with higher satisfaction both with the closure itself and with the intervention in general.

Anesthetic management of Amplatzer atrial septal defect closure device embolization to right ventricular outflow tract

Directory of Open Access Journals (Sweden)

S Das

2016-01-01

Full Text Available Percutaneous device closure of atrial septal defect (ASD is an alternative treatment to surgery with advantages of avoidance of surgery, short procedure time, early discharge from hospital, and lower rates of complications. However, percutaneous device closure is associated with infrequent life-threatening complications such as device embolization. We report a case device embolization of the ASD occlude device into right ventricular outflow tract resulting progressive hypoxia. The role of anesthesiologist as a team leader in managing such emergency is discussed.

Changes in Serum Natriuretic Peptide Levels after Percutaneous Closure of Small to Moderate Ventricular Septal Defects

Directory of Open Access Journals (Sweden)

Yuksel Kaya

2012-01-01

Full Text Available Background. B-type natriuretic peptide has been shown to be a very sensitive and specific marker of heart failure. In this study, we aimed to investigate the effect of percutaneous closure of ventricular septal defects with Amplatzer septal occluders on brain natriuretic peptide levels. Methods. Between 2008 and 2011, 23 patients underwent successfully percutaneous ventricular septal defect closure in 4 cardiology centers. Brain natriuretic peptide levels were measured in nine patients (4 male, mean ages were 25.3±14.3 who underwent percutaneous closure with Amplatzer occluders for membranous or muscular ventricular septal defects were enrolled in the study. Brain natriuretic peptide levels were measured one day before and one month after the closure. Patients were evaluated clinically and by echocardiography one month after the procedure. Results. Percutaneous closures of ventricular septal defects were successfully performed in all patients. There was not any significant adverse event in patients group during followup. Decrease in brain natriuretic peptide levels after closure were statistically significant (97.3±78.6 versus 26.8±15.6, =0.013. Conclusion. Brain Natriuretic Peptide levels are elevated in patients with ventricular septal defects as compared to controls. Percutaneous closure of Ventricular Septal Defect with Amplatzer occluders decreases the BNP levels.

Composite three-layer closure of oral antral communication with 10 months follow-up-a case study.

Science.gov (United States)

Weinstock, Robert J; Nikoyan, Levon; Dym, Harry

2014-02-01

We propose a 3-layer composite closure technique for an oral antral communication (OAC) while avoiding secondary donor site morbidity. A patient had developed a 1-cm OAC after extraction of right maxillary first molar. The patient subsequently developed acute maxillary sinusitis. The patient was taken to the operating room, and a Caldwell-Luc procedure was performed. The bony window from the Caldwell-Luc was "press fit" over the bony OAC defect. Soft tissue closure was then achieved with a buccal fat pad flap and a buccal mucosal advancement flap. The patient was examined on postoperative day 5 and 1, 2, 3, 6, and 10 months postoperatively. The acute sinusitis had resolved. The soft tissue closure was successful. The bone graft remained intact, prevented sinus pneumatization, and restored continuity to the floor of the maxillary sinus. The presented technique for 3-layer closure of OACs allows for the stability of a double-layer closure of OAC with the added benefit of bone grafting from single operative site, achieving stable oral antral closure, bone grafting, and the avoidance of secondary donor site morbidity. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Transcatheter closure of patent ductus arteriosus using the AMPLATZER™ duct occluder II (ADO II).

Science.gov (United States)

Gruenstein, Daniel H; Ebeid, Makram; Radtke, Wolfgang; Moore, Phillip; Holzer, Ralf; Justino, Henri

2017-05-01

The study purpose is to evaluate the safety and efficacy of the ADO II device for closure of patent ductus arteriosus (PDA) in children. Transcatheter treatment of PDA has been evolving for 40+ years and is the treatment of choice. The AMPLATZER™ Duct Occluder (ADO) device was developed for larger diameter ducts and is not ideal in all PDAs. ADO II was developed for small to moderate-sized ducts. This is a single-arm, multicenter study evaluating safety and efficacy of the ADO II device. Patients closure in 98% of successful implantations. In this prospective study, the ADO II was safe and effective for closure of small to moderate PDAs. Implantation is simple and the ability for retrograde aortic delivery reduces procedure-related radiation exposure. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Closure of giant omphaloceles by the abdominal wall component separation technique in infants.

NARCIS (Netherlands)

Eijck, F.C. van; Blaauw, I. de; Bleichrodt, R.P.; Rieu, P.N.M.A.; Staak, F.H.J.M. van der; Wijnen, M.H.W.A.; Wijnen, R.M.H.

2008-01-01

BACKGROUND/PURPOSE: Several techniques have been described to repair giant omphaloceles. There is no procedure considered to be the criterion standard worldwide. The aim of the present prospective study was to analyze the early and late results of secondary closure of giant omphaloceles using the

Early experience with the Occlutech PLD occluder for mitral paravalvar leak closure through a hybrid transapical approach.

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Bedair, Radwa; Morgan, Gareth J; Bapat, Vinayak; Kapetanakis, Stamatis; Goreczny, Sebastian; Simpson, John; Qureshi, Shakeel A

2016-12-10

We sought to evaluate the feasibility and efficacy of hybrid transapical closure of paravalvar mitral leaks using a new Occlutech PLD occluder in patients with heart failure and/or haemolytic anaemia. Retrospective analysis of clinical and procedural data was undertaken for patients who had attempted closure of paravalvar mitral leaks via a hybrid transapical approach with the Occlutech PLD occluder. Eight patients (four males, median age 69 years) underwent closure of 10 mitral paravalvar leaks using eight Occlutech PLD occluders and two AMPLATZER Vascular Plugs (AVP II). Successful deployment, with significant reduction of the paravalvar leak was achieved in seven patients with short procedure (median 131 min) and fluoroscopy times (median 22 min). One patient had mechanical interference with prosthetic valve function, requiring surgery. Another patient with a high EuroSCORE (48.8%) died of multi-organ failure two days after the procedure. Clinical improvement in either heart failure or haemolysis was seen in all discharged patients. In our series of patients with challenging anatomy, the Occlutech PLD occluders performed well when implanted via a hybrid transapical approach. Further work is needed to assess this methodology fully for a wider population and to assess other deployment approaches for this promising new occluder.

Safety and effectiveness of repeat arterial closure using the AngioSeal device in patients with hepatic malignancy.

Science.gov (United States)

Hieb, Robert A; Neisen, Melissa J; Hohenwalter, Eric J; Molnar, Jim A; Rilling, William S

2008-12-01

To retrospectively evaluate the safety and effectiveness of the use of the AngioSeal device for repeat arterial closure in patients with hepatic malignancy. A retrospective analysis of patients with hepatic malignancy who had undergone repeated arterial closure with the AngioSeal device was performed. All charts for patients undergoing transarterial chemoembolization or TheraSphere radioembolization were reviewed for the method of hemostasis and the number of arterial closures. A total of 53 patients (58.5% men, 41.5% women; mean age, 58.7 years) had repeat AngioSeal arterial puncture closure after chemoembolization or TheraSphere treatment. Percutaneous closure of the common femoral artery with the AngioSeal device was performed in accordance with the manufacturer's recommendations. The patients were examined for complications on follow-up. Effectiveness was defined by the ability to obtain satisfactory hemostasis. Safety was assessed by the absence of groin complications and by vessel patency on follow-up angiograms of the puncture site obtained at subsequent liver-directed therapy sessions. Fifty-three patients in this study group had a total of 203 common femoral artery punctures. There were a total of 161 closures with the AngioSeal device (79.3%): 58 (36%) single closures and 103 (64.0%) repeat closures. Of the 161 attempts at AngioSeal closure, there was one closure failure in the single-puncture group, yielding a success rate of 98.3%; and one closure failure in the repeat-puncture group, yielding a success rate of 99%. In these two patients, hemostasis was achieved with traditional manual compression without the need for any other device, and no complications were noted. The overall success rate of AngioSeal device closure was 98.7%. The repeat use of the AngioSeal closure device is safe and effective in patients with hepatic malignancy undergoing regional oncologic interventional procedures.

A COMPARATIVE STUDY OF SINGLE VERSUS DOUBLE LAYER CLOSURE ON LOWER SEGMENT CAESAREAN SCAR

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Kirtirekha Mohapatra

2016-10-01

Full Text Available BACKGROUND There are few issues in modern obstetrics that have been as controversial as management of a woman with a prior caesarean delivery. Hence, it is required to have evidence based correct practice of this surgical procedure. Healing of the uterine incision and the strength of the scar should be the most important consideration. The aim of the study is to compare the effect of technique of uterine closure (Single Layer vs. Double Layer on subsequent pregnancies and to find out, which technique has a better maternal and neonatal outcome by strengthening the scar. MATERIALS AND METHODS 500 cases of previous caesarean section pregnancies were taken, 250 from single layer closure group and 250 from double layer closure group. The mode of delivery during present pregnancy was noted. Integrity of scar, thickness of scar, presence of adhesion were documented. The neonates were observed. Results were compared so as to draw an inference about the better method. RESULTS Mean age between the two groups were similar. Majority did not have history of premature rupture of membrane during previous pregnancy. Postoperative complications were more when double layer closure of uterine scar was done in index surgery. Interpregnancy gap of <3 years was more commonly present in double layer closure group (52.8% in double layer versus 34.8% in single layer. Single layer had more scar tenderness (21.2%, thinned out scars (34.6%, incomplete ruptures (7.1% and complete ruptures (2.8% than double layer closure group. Neonatal outcomes were not statistically different in both the groups. CONCLUSION Double layer uterine closure seems to have better impact on scar integrity as compared to single layer uterine closure.

Observations on early and delayed colostomy closure.

Science.gov (United States)

Tade, A O; Salami, B A; Ayoade, B A

2011-06-01

Traditional treatment of a variety of colorectal pathologies had included a diverting colostomy that was closed eight or more weeks later during a readmission. The aim of this retrospective study was to determine the outcomes of early colostomy closure and delayed colostomy closure in patients with temporary colostomies following traumatic and non-traumatic colorectal pathologies. In this study early colostomy closure was the closure of a colostomy within three weeks of its construction, while delayed colostomy closure referred to closure after 3 weeks. Complete records of the 37 adult patients who had temporary colostomy constructed and closed between Jan. 1997 December 2003 for various colorectal pathologies were studied. Fourteen patients had early colostomy closure while 23 had delayed closure. In the early colostomy closure group there were 10 men and 4 women. The mean age of the patients was 28yr with a range of 18-65yr. Colostomies were closed 9-18 days after initial colostomy construction. There was no mortality. Morbidity rate 28.6% (4 out of 14). There were two faecal fistulas (14.3%). Twenty-three patients had delayed colostomy closure 8 weeks to 18 months after initial colostomy construction. These were patients unfit for early surgery after initial colostomy construction because of carcinoma, significant weight loss, or sepsis. There was no mortality. Morbidity rate was 26.1%. There were 3 faecal fistulas (13.2%). Outcomes following early colostomy closure and delayed closure were comparable. Patients fit for surgery should have early closure whilst patients who may have compromised health should have delayed closure.

Sternal exploration or closure

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VAC - vacuum-assisted closure - sternal wound; Sternal dehiscence; Sternal infection ... in the wound to look for signs of infection Remove dead or infected ... use a VAC (vacuum-assisted closure) dressing. It is a negative ...

Resection and Primary Closure of Edematous Glossoepiglottic Mucosa in a Dog Causing Laryngeal Obstruction.

Science.gov (United States)

Schabbing, Kevin J; Seaman, Jeffrey A

An approximately 22 mo old male neutered English bulldog was evaluated for acute onset of dyspnea with suspected brachycephalic obstructive airway syndrome (BOAS). Laryngoscopic exam revealed diffuse, severe edema and static displacement of redundant glossoepiglottic (GE) mucosa causing complete obstruction of the larynx and epiglottic entrapment. Static displacement of the GE mucosa was observed and determined to be the overriding component of dyspnea in this patient with BOAS. Resection and primary closure with two separate, simple continuous sutures of the GE mucosa were performed. Resection and primary closure of the GE mucosa resolved the acute onset of dyspnea in this patient. Surgical correction of the stenotic nares, elongated soft palate, and everted laryngeal saccules were performed under the same anesthetic procedure. Static displacement of the GE mucosa may occur in patients with BOAS. Surgical resection and closure of the GE mucosa resolved this patient's dyspnea and is recommended in airway obstruction. It remains to be determined if primary closure and subsequent tensioning or scar tissue of the GE mucosa results in further complications related to restricted epiglottic movement.

Remote automatic plasma arc-closure welding of a dry-storage canister for spent nuclear fuel and high-level radioactive waste

International Nuclear Information System (INIS)

Sprecace, R.P.; Blankenship, W.P.

1982-01-01

A carbon steel storage canister has been designed for the dry encapsulation of spent nuclear fuel assemblies or of logs of vitrified high level radioactive waste. The canister design is in conformance with the requirements of the ASME Code, Section III, Division 1 for a Class 3 vessel. The canisters will be loaded and sealed as part of a completely remote process sequence to be performed in the hot bay of an experimental encapsulation facility at the Nevada Test Site. The final closure to be made is a full penetration butt weld between the canister body, a 12.75-in O.D. x 0.25-in wall pipe, and a mating semiellipsoidal closure lid. Due to a combination of design, application and facility constraints, the closure weld must be made in the 2G position (canister vertical). The plasma arc welding system is described, and the final welding procedure is described and discussed in detail. Several aspects and results of the procedure development activity, which are of both specific and general interest, are highlighted; these include: The critical welding torch features which must be exactly controlled to permit reproducible energy input to, and gas stream interaction with, the weld puddle. A comparison of results using automatic arc voltage control with those obtained using a mechanically fixed initial arc gap. The optimization of a keyhole initiation procedure. A comparison of results using an autogenous keyhole closure procedure with those obtained using a filler metal addition. The sensitivity of the welding process and procedure to variations in joint configuration and dimensions and to variations in base metal chemistry. Finally, the advantages and disadvantages of the plasma arc process for this application are summarized from the current viewpoint, and the applicability of this process to other similar applications is briefly indicated

Comparison of long-term clinical outcome between transcatheter Amplatzer occlusion and surgical closure of isolated patent ductus arteriosus.

Science.gov (United States)

Chen, Zhao-yang; Wu, Li-ming; Luo, Yu-kun; Lin, Chao-gui; Peng, Ya-fei; Zhen, Xing-chun; Chen, Liang-long

2009-05-20

Transcatheter Amplatzer occlusion of patent ductus artertiosus (PDA) has emerged as a minimally invasive alternative to surgical closure. The goal of this study was to compare long-term clinical outcomes between two procedures, especially on chronic residual shunt, late or very late procedure-related complications, and regression of pulmonary hypertension and left ventricular dilation. A total 255 patients having isolated PDA with a minimal diameter of >or= 4 mm treated from January 2000 to July 2003 were included in this study and have been followed up until July 2008. The patients were assigned to either the device or surgical closure group according to the patients' and/or their parents' preference. Baseline physical exams, chest roentgenography, electrocardiography, and echocardiography were performed preprocedure and at each follow-up. Seventy-two patients accepted the transcatheter procedure (Group-TC) and 183 underwent surgical operation (Group-SO) for PDA closure, both groups were similar in their demographics and preoperative clinical characteristics. There were no cardiac deaths and late complications such as infectious endocarditis and Amplatzer duct occluder (ADO) dislodge in either group. More acute procedure-related complications were recorded in Group-SO (13.7%) compared with Group-TC (1.4%) (P = 0.004). The recovery time was (8.7 +/- 2.3) days for the Group-SO and (1.3 +/- 0.5) days for the Group-TC (P ventricular dilation; neither survival freedom from pulmonary hypertension nor abnormal left ventricular end-diastolic volume index were significantly different between the surgical group and the Amplatzer group. Our study confirmed the long-term safety and efficacy of transcatheter Amplatzer occlusion. In comparison to the time-proven surgical closure, transcatheter Amplatzer occlusion was less invasive and associated with fewer complications and residual shunt, and as effective in the regression of pulmonary hypertension and left ventricular

Full closure strategic analysis.

Science.gov (United States)

2014-07-01

The full closure strategic analysis was conducted to create a decision process whereby full roadway : closures for construction and maintenance activities can be evaluated and approved or denied by CDOT : Traffic personnel. The study reviewed current...

Crack closure, a literature study

Science.gov (United States)

Holmgren, M.

1993-08-01

In this report crack closure is treated. The state of the art is reviewed. Different empirical formulas for determining the crack closure are compared with each other, and their benefits are discussed. Experimental techniques for determining the crack closure stress are discussed, and some results from fatigue tests are also reported. Experimental data from the literature are reported.

Quality Assurance Project Plan for the HWMA/RCRA Closure Certification of the TRA-731 Caustic and Acid Storage Tank System - 1997 Notice of Violation Consent Order; TOPICAL

International Nuclear Information System (INIS)

Evans, S.K.

2002-01-01

This Quality Assurance Project Plan for the HWMA/RCRA Closure Certification of the TRA- 731 Caustic and Acid Storage Tank System is one of two documents that comprise the Sampling and Analysis Plan for the HWMA/RCRA closure certification of the TRA-731 caustic and acid storage tank system at the Idaho National Engineering and Environmental Laboratory. This plan, which provides information about the project description, project organization, and quality assurance and quality control procedures, is to be used in conjunction with the Field Sampling Plan for the HWMA/RCRA Closure Certification of the TRA-731 Caustic and Acid Storage Tank System. This Quality Assurance Project Plan specifies the procedures for obtaining the data of known quality required by the closure activities for the TRA-731 caustic and acid storage tank system

Revisit to Grad's Closure and Development of Physically Motivated Closure for Phenomenological High-Order Moment Model

International Nuclear Information System (INIS)

Myong, R. S.; Nagdewe, S. P.

2011-01-01

The Grad's closure for the high-order moment equation is revisited and, by extending his theory, a physically motivated closure is developed for the one-dimensional velocity shear gas flow. The closure is based on the physical argument of the relative importance of various terms appearing in the moment equation. Also, the closure is derived such that the resulting theory may be inclusive of the well established linear theory (Navier-Stokes-Fourier) as limiting case near local thermal equilibrium.

Durability of central aortic valve closure in patients with continuous flow left ventricular assist devices.

Science.gov (United States)

McKellar, Stephen H; Deo, Salil; Daly, Richard C; Durham, Lucian A; Joyce, Lyle D; Stulak, John M; Park, Soon J

2014-01-01

A competent aortic valve is essential to providing effective left ventricular assist device support. We have adopted a practice of central aortic valve closure by placing a simple coaptation stitch at left ventricular assist device implantation in patients with significant aortic insufficiency. We conducted a follow-up study to evaluate the efficacy and durability of this procedure. The study included patients who had undergone continuous flow left ventricular assist device implantation. The patients were divided into 2 groups, those who did not require any aortic procedure because the valve was competent and those who underwent central aortic valve closure for mild or greater aortic regurgitation. The clinical endpoints were mortality, progression or recurrence of aortic insufficiency, and reoperation for aortic valve pathologic features. Aortic insufficiency was measured qualitatively from mild to severe on a scale of 0 to 5. A total of 123 patients received continuous flow left ventricular assist devices from February 2007 to August 2011. Of those, 18 (15%) underwent central aortic valve closure at left ventricular assist device implantation because of significant aortic insufficiency (1.8 ± 1.4) and 105 who did not (competent aortic valve, 0.15 ± 0.43; P assist device-supported patients, with follow-up extending into 2 years. Although aortic insufficiency progressed over time in those with minimal native valve regurgitation initially, no such progression was noted in those with central aortic valve closure. Additional investigation is needed to evaluate whether prophylactic central aortic valve closure should be performed at left ventricular assist device implantation to avoid problematic aortic regurgitation developing over time, in particular in patients undergoing left ventricular assist device implantation for life-long (destination therapy) support. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights

Spontaneous closure of midline diastema following frenectomy

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Koora Kiran

2007-03-01

Full Text Available Maxillary midline diastema is a common aesthetic problem in mixed and early permanent dentitions. The space can occur either as a transient malocclusion or created by developmental, pathological or iatrogenical factors. Many innovative therapies varying from restorative procedures such as composite build-up to surgery (frenectomies and orthodontics are available. Although literature says every frenectomy procedure should be preceded by orthodontic treatment, we opted for frenectomy technique without any orthodontic intervention. Presented herewith is a case report of a 9-year-old girl with a high frenal attachment that had caused spacing of the maxillary central incisors. A spontaneous closure of the midline diastema was noted within 2 months following frenectomy. The patient was followed up for 4 months after which the space remained closed and there was no necessity for an orthodontic treatment at a later stage.

Multidisciplinary Assessment in Optimising Results of Percutaneous Patent Foramen Ovale Closure.

Science.gov (United States)

Davies, Allan; Ekmejian, Avedis; Collins, Nicholas; Bhagwandeen, Rohan

2017-03-01

Amplatzer device used in 83 cases (74.1%). Early residual shunting was visible in seven patients (6.3%), however on follow-up agitated saline study only two patients had residual shunt (1.8%). The annual risk of recurrent stroke or TIA was 0.21%. Percutaneous patent foramen ovale closure can be performed safely and effectively in patients with paradoxical embolism. In selected patients, following appropriate multidisciplinary specialist pre-procedural assessment, excellent long-term results with low incidence of recurrent events may be achieved. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Underground storage tank 431-D1U1, Closure Plan

Energy Technology Data Exchange (ETDEWEB)

Mancieri, S.

1993-09-01

This document contains information about the decommissioning of Tank 431-D1U1. This tank was installed in 1965 for diesel fuel storage. This tank will remain in active usage until closure procedures begin. Soils and ground water around the tank will be sampled to check for leakage. Appendices include; proof of proper training for workers, health and safety briefing record, task hazard analysis summary, and emergency plans.

Evaluation of a novel trocar-site closure and comparison with a standard Carter-Thomason closure device.

Science.gov (United States)

del Junco, Michael; Okhunov, Zhamshid; Juncal, Samuel; Yoon, Renai; Landman, Jaime

2014-07-01

The aim of this study was to evaluate and compare a novel trocars-site closure device, the WECK EFx™ Endo Fascial Closure System (EFx) with the Carter-Thomason CloseSure System® (CT) for the closure of laparoscopic trocar site defects created by a 12-mm dilating trocar. We created standardized laparoscopic trocars-site abdominal wall defects in cadaver models using a standard 12-mm laparoscopic dilating trocar. Trocar defects were closed in a randomized fashion using one of the two closure systems. We recorded time and number of attempts needed for complete defect closure. In addition, we recorded the ability to maintain pneumoperitoneum, endoscopic visualization, safety, security, and facility based on the surgeon's subjective evaluations. We compared outcomes for the EFx and CT closure systems. We created 72 standardized laparoscopic trocars-site abdominal wall defects. The mean time needed for complete defect closure was 98.53 seconds (±28.9) for the EFx compared with 133.61 seconds (±54.61) for the CT (Psafety were 2.92 for EFx vs 2.19 for CT (Pvs 1.83 for EFx and CT, respectively (Pvs 2.33 for CT (P=0.022). No significant difference was observed between the EFx and the CT systems for endoscopic visualization (2.28 vs 2.50, P=0.080). In this in vitro cadaver trial, the EFx was superior in terms of time needed to complete defect closure, safety, and facility. CT was superior in terms of maintenance of pneumoperitoneum. Both systems were equal in the number of attempts needed to complete the defect closure and endoscopic visualization.

Endoscopic closure of duodenal perforations by using an over-the-scope clip: a randomized, controlled porcine study.

Science.gov (United States)

von Renteln, Daniel; Rudolph, Hans-Ulrich; Schmidt, Arthur; Vassiliou, Melina C; Caca, Karel

2010-01-01

Duodenal perforations during diagnostic upper endoscopy are rare; however, when therapeutic techniques are performed, the reported incidence is as great as 2.8%. Surgical repair is usually mandated, but it is associated with significant morbidity and mortality. To compare closure of duodenal perforations by using an over-the-scope clip (OTSC) with a surgical closure. Randomized, controlled animal study. Animal facility laboratory. Domestic pigs (24 females). Large (10-mm) duodenal perforations were created by using an endoscopic needle-knife. The animals were randomly assigned to either open surgical repair (n=12) or endoscopic closure by using the OTSC system (n=12). Pressurized leak tests were performed during necropsy. One major bleed occurred because of a liver injury during creation of the duodenotomy. Mean time for endoscopic closure was 5 minutes (range, 3-8 min; SD +/- 2). No complications occurred during any of the closure procedures. At necropsy, all OTSC and surgical closures demonstrated complete sealing of duodenotomy sites. Pressurized leak tests demonstrated a mean burst pressure of 166 mm Hg (range, 80-260; SD +/- 65) for OTSC closures and 143 mm Hg (range, 30-300, SD +/- 83) for surgical sutures. Ex vivo intact duodenal specimens exhibited a mean burst pressure of 247 mm Hg (range, 200-300; SD +/- 35), which was significantly higher compared with in vivo OTSC and surgical closures (P < .01). There were no significant differences between burst pressures of OTSC and surgical closures (P = .461). Nonsurvival setting. Endoscopic closure of duodenal perforations by using the OTSC system is comparable with surgical closure in a nonsurvival porcine model. This technique is easy to perform and seems suitable for repairing duodenal perforations. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Retrospective analysis of a VACM (vacuum-assisted closure and mesh-mediated fascial traction treatment manual for temporary abdominal wall closure – results of 58 consecutive patients

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Beltzer, Christian

2016-07-01

Full Text Available Introduction: The optimal treatment concept for temporary abdominal closure (TAC in critically ill visceral surgery patients with open abdomen (OA continues to be unclear. The VACM (vacuum-assisted closure and mesh-mediated fascial traction therapy seems to permit higher delayed primary fascial closure rates (FCR than other TAC procedures. Material and methods: Patients of our clinic (n=58 who were treated by application of a VAC/VACM treatment manual in the period from 2005 to 2008 were retrospectively analysed. Results: The overall FCR of all patients was 48.3% (95% confidence interval: 34.95–61.78. An FCR of 61.3% was achieved in patients who had a vicryl mesh implanted at the fascial level (VACM therapy in the course of treatment. Mortality among patients treated with VACM therapy was 45.2% (95% CI: 27.32–63.97.Conclusions: The results of our own study confirm the results of previous studies which showed an acceptable FCR among non-trauma patients who were treated with VACM therapy. VACM therapy currently appears to be the treatment regime of choice for patients with OA requiring TAC.

Eyelid closure at death

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A D Macleod

2009-01-01

Full Text Available Aim: To observe the incidence of full or partial eyelid closure at death. Materials and Methods: The presence of ptosis was recorded in 100 consecutive hospice patient deaths. Results: Majority (63% of the patients died with their eyes fully closed, however, 37% had bilateral ptosis at death, with incomplete eye closure. In this study, central nervous system tumor involvement and/or acute hepatic encephalopathy appeared to be pre-mortem risk factors of bilateral ptosis at death. Conclusion: Organicity and not psychogenicity is, therefore, the likely etiology of failure of full eyelid closure at death.

Scope and closures

CERN Document Server

Simpson, Kyle

2014-01-01

No matter how much experience you have with JavaScript, odds are you don’t fully understand the language. This concise yet in-depth guide takes you inside scope and closures, two core concepts you need to know to become a more efficient and effective JavaScript programmer. You’ll learn how and why they work, and how an understanding of closures can be a powerful part of your development skillset.

Transseptal Guidewire Stabilization for Device Closure of a Large Pulmonary Arteriovenous Malformation

International Nuclear Information System (INIS)

Joseph, George; Kunwar, Brajesh Kumar

2013-01-01

A 46-year-old man presenting with massive hemoptysis was found to have a large pulmonary arteriovenous malformation (PAVM) in the right lung. Closure of the PAVM with an Amplatzer-type duct occluder was hampered by inability to advance the device delivery sheath into the PAVM due to vessel tortuosity and inadequate guidewire support. Atrial septal puncture was performed and a femorofemoral arteriovenous guidewire loop through the right pulmonary artery, PAVM, and left atrium was created. Traction on both ends of the guidewire loop allowed advancement of the device delivery sheath into the PAVM and successful completion of the procedure. Transseptal guidewire stabilization can be a valuable option during device closure of large PAVMs when advancement, stability, or kinking of the device delivery sheath is an issue.

Meconium Ileus–Is a Single Surgical Procedure Adequate?

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Hagith Nagar

2006-07-01

Full Text Available Meconium ileus is one of the gastrointestinal manifestations of cystic fibrosis (CF, and affects 15% of neonates. The condition results from the accumulation of sticky inspissated meconium. Both nonoperative and operative therapies may be effective in relieving obstruction. The treatment of choice for uncomplicated meconium ileus is the use of enteral N-acetylcysteine or Gastrografin enemata. Once such therapy fails, surgery is indicated. A number of operative procedures are in use, including Bishop-Koop enterostomy, T-tube irrigation, resection and primary anastomosis, and enterotomy with irrigation and primary closure. During the period 1991-2003, five newborns required surgical intervention for uncomplicated meconium ileus. None responded to conservative management. All were males, including one set of twins. All underwent laparotomy, enterotomy, appendectomy, irrigation and closure of enterotomy. None required a second surgical procedure. CF was confirmed in all, and in each case, both parents were found to be genetic carriers of a mutational form of CF. A single surgical intervention is preferable in these patients, in view of the high rate of pulmonary involvement in CF patients. Enterotomy, irrigation and primary closure are the treatment of choice for uncomplicated meconium ileus.

100-D Ponds closure plan. Revision 1

International Nuclear Information System (INIS)

Petersen, S.W.

1997-09-01

The 100-D Ponds is a Treatment, Storage, and Disposal (TSD) unit on the Hanford Facility that received both dangerous and nonregulated waste. This Closure Plan (Rev. 1) for the 100-D Ponds TSD unit consists of a RCRA Part A Dangerous Waste Permit Application (Rev. 3), a RCRA Closure Plan, and supporting information contained in the appendices to the plan. The closure plan consists of eight chapters containing facility description, process information, waste characteristics, and groundwater monitoring data. There are also chapters containing the closure strategy and performance standards. The strategy for the closure of the 100-D Ponds TSD unit is clean closure. Appendices A and B of the closure plan demonstrate that soil and groundwater beneath 100-D Ponds are below cleanup limits. All dangerous wastes or dangerous waste constituents or residues associated with the operation of the ponds have been removed, therefore, human health and the environment are protected. Discharges to the 100-D Ponds, which are located in the 100-DR-1 operable unit, were discontinued in June 1994. Contaminated sediment was removed from the ponds in August 1996. Subsequent sampling and analysis demonstrated that there is no contamination remaining in the ponds, therefore, this closure plan is a demonstration of clean closure

Closure for spent-fuel transport and storage containers

International Nuclear Information System (INIS)

Ahner, S.; Knackstedt, H.G.; Srostlik, P.

1980-01-01

The container has a transport closure and a shielding closure. This shielding closure consists of two pieces (double closure system), which can be fartened to one another like a bayonet fixing. A central motion of rotation is enough to open the closure. It can be done remote-controlled as well as manually. (DG) [de

Echocardiographic predictors of coil vs device closure in patients undergoing percutaneous patent ductus arteriosus closure.

Science.gov (United States)

Roushdy, Alaa; Abd El Razek, Yasmeen; Mamdouh Tawfik, Ahmed

2018-01-01

To determine anatomic and hemodynamic echocardiographic predictors for patent ductus arteriosus (PDA) device vs coil closure. Seventy-six patients who were referred for elective transcatheter PDA closure were enrolled in the study. All patients underwent full echocardiogram including measurement of the PDA pulmonary end diameter, color flow width and extent, peak and end-diastolic Doppler gradients across the duct, diastolic flow reversal, left atrial dimensions and volume, left ventricular sphericity index, and volumes. The study group was subdivided into 2 subgroups based on the mode of PDA closure whether by coil (n = 42) or device (n = 34). Using univariate analysis there was a highly significant difference between the 2 groups as regard the pulmonary end diameter measured in both the suprasternal and parasternal short-axis views as well as the color flow width and color flow extent (P closure group had statistically significant higher end-systolic and end-diastolic volumes indexed, left atrial volume, and diastolic flow reversal. Receiver operating characteristic curve analysis showed a pulmonary end diameter cutoff point from the suprasternal view > 2.5 mm and from parasternal short-axis view > 2.61 mm to have the highest balanced sensitivity and specificity to predict the likelihood for device closure (AUC 0.971 and 0.979 respectively). The pulmonary end diameter measured from the suprasternal view was the most independent predictor of device closure. The selection between PDA coil or device closure can be done on the basis of multiple anatomic and hemodynamic echocardiographic variables. © 2017 Wiley Periodicals, Inc.

The exploration of the closure of patent ductus arteriosus with Amplatzer occluder through single venous approach under ultrasound monitoring

International Nuclear Information System (INIS)

Luo Guoxin; He Jianxin; Li Guoying; Gong Zhihua; Wen Yanfei

2011-01-01

Objective: To explore the feasibility and effectiveness of transcatheter closure of patent ductus arteriosus (PDA) with Amplatzer occluder by using single venous approach method under ultrasound monitoring. Methods: During the period from May 2003 to April 2010, transcatheter closure of PDA were performed in 123 cases. Of the 123 patients, the procedure was accomplished by using arteriovenous dual approach method in 46 and by using single venous approach method in 77. All the procedures were monitored by ultrasound. The shape, size of PDA and immediate therapeutic results were checked with angiography in arteriovenous dual approach method or with ultrasonography in single venous approach method. The size of Amplatzer occluder was individually selected according to the smallest diameter of PDA. Echocardiography was performed at 3 days, one, 6 and 12 months after the procedure to evaluate the results. Results: Successful device placement with the initially selected occluder was obtained in 118 cases. In 4 cases the procedure was eventually completed after a bigger occluder was employed to replace the initial one, while in one case a smaller occluder had to use to replace the first one. The technical success rate was 100%. Conclusion: The transcatheter closure of PDA with Amplatzer occluder under ultrasound monitoring by single venous approach method is clinically effective and feasible. Being technically simple and time-saving, this single venous approach method is of great value in clinical practice. (authors)

Comparison of Outcomes between Early Fascial Closure and Delayed Abdominal Closure in Patients with Open Abdomen: A Systematic Review and Meta-Analysis

Directory of Open Access Journals (Sweden)

Yu Chen

2014-01-01

Full Text Available Up to the present, the optimal time to close an open abdomen remains controversial. This study was designed to evaluate whether early fascial abdominal closure had advantages over delayed approach for open abdomen populations. Medline, Embase, and Cochrane Library were searched until April 2013. Search terms included “open abdomen,” “abdominal compartment syndrome,” “laparostomy,” “celiotomy,” “abdominal closure,” “primary,” “delayed,” “permanent,” “fascial closure,” and “definitive closure.” Open abdomen was defined as “fail to close abdominal fascia after a laparotomy.” Mortality, complications, and length of stay were compared between early and delayed fascial closure. In total, 3125 patients were included for final analysis, and 1942 (62% patients successfully achieved early fascial closure. Vacuum assisted fascial closure had no impact on pooled fascial closure rate. Compared with delayed abdominal closure, early fascial closure significantly reduced mortality (12.3% versus 24.8%, RR, 0.53, P<0.0001 and complication incidence (RR, 0.68, P<0.0001. The mean interval from open abdomen to definitive closure ranged from 2.2 to 14.6 days in early fascial closure groups, but from 32.5 to 300 days in delayed closure groups. This study confirmed clinical advantages of early fascial closure over delayed approach in treatment of patients with open abdomen.

Tools for Closure Project and Contract Management: Development of the Rocky Flats Integrated Closure Project Baseline

International Nuclear Information System (INIS)

Gelles, C. M.; Sheppard, F. R.

2002-01-01

This paper details the development of the Rocky Flats Integrated Closure Project Baseline - an innovative project management effort undertaken to ensure proactive management of the Rocky Flats Closure Contract in support of the Department's goal for achieving the safe closure of the Rocky Flats Environmental Technology Site (RFETS) in December 2006. The accelerated closure of RFETS is one of the most prominent projects within the Department of Energy (DOE) Environmental Management program. As the first major former weapons plant to be remediated and closed, it is a first-of-kind effort requiring the resolution of multiple complex technical and institutional challenges. Most significantly, the closure of RFETS is dependent upon the shipment of all special nuclear material and wastes to other DOE sites. The Department is actively working to strengthen project management across programs, and there is increasing external interest in this progress. The development of the Rocky Flats Integrated Closure Project Baseline represents a groundbreaking and cooperative effort to formalize the management of such a complex project across multiple sites and organizations. It is original in both scope and process, however it provides a useful precedent for the other ongoing project management efforts within the Environmental Management program

50 CFR 648.161 - Closures.

Science.gov (United States)

2010-10-01

... Bluefish Fishery § 648.161 Closures. (a) EEZ closure. NMFS shall close the EEZ to fishing for bluefish by... dealer permit holders that no commercial quota is available for landing bluefish in that state. ...

Closure of tubular patent ductus arteriosus with the Amplatzer Vascular Plug IV: feasibility and safety.

Science.gov (United States)

Baruteau, Alban-Elouen; Lambert, Virginie; Riou, Jean-Yves; Angel, Claude-Yves; Belli, Emre; Petit, Jérôme

2015-01-01

Closure of tubular patent ductus arteriosus remains a challenging procedure. Anecdotal use of Amplatzer Vascular Plug IV for tubular ductus closure has been reported but feasibility and safety in a consecutive patients' series remain unknown. We performed a monocenter prospective study at the Marie Lannelongue Hospital in Paris, France. From 2009 to 2014, a total of 47 patients (39 infants, 3 children, and 5 adults) underwent ductus closure with the Plug IV. Ductus morphology was a type E in 34 (72.3%) patients and a type C in 13 (27.7%) patients. Ductus closure occurred in 39 (83.0%) infants at a median age of seven months (range: 3-23 months) and a median weight of 6.9 kg (range: 4.1-17.0 kg). A past history of prematurity and very low birth weight was found in 33 (70.2%) of them. Twelve (25.5%) patients had pulmonary hypertension. Mean Plug IV diameter was 1.9 ± 0.1 mm larger than the mean maximal ductus diameter. Early complete closure of the ductus was obtained in all patients. Early migration of an undersized Plug IV occurred in one (2.1%) patient and was suitable for percutaneous device retrieval. After a mean follow-up of 3.4 ± 1.4 years, all patients are alive and asymptomatic, no late complication occurred. Transcatheter closure of tubular ductus with the Amplatzer Vascular Plug IV can be safe and effective, with a 100% early occlusion rate. This device, suitable for a 4F sheath, is a new alternative for tubular ductus closure in low-body-weight infants. © The Author(s) 2014.

Open abdomen in gastrointestinal surgery: Which technique is the best for temporary closure during damage control?

Science.gov (United States)

Ribeiro Junior, Marcelo A F; Barros, Emily Alves; de Carvalho, Sabrina Marques; Nascimento, Vinicius Pereira; Cruvinel Neto, José; Fonseca, Alexandre Zanchenko

2016-01-01

AIM To compare the 3 main techniques of temporary closure of the abdominal cavity, vacuum assisted closure (vacuum-assisted closure therapy - VAC), Bogota bag and Barker technique, in damage control surgery. METHODS After systematic review of the literature, 33 articles were selected to compare the efficiency of the three procedures. Criteria such as cost, infections, capacity of reconstruction of the abdominal wall, diseases associated with the technique, among others were analyzed. RESULTS The Bogota bag and Barker techniques present as advantage the availability of material and low cost, what is not observed in the VAC procedure. The VAC technique is the most efficient, not only because it reduces the tension on the boarders of the lesion, but also removes stagnant fluids and debris and acts at cellular level increasing cell proliferation and division. Bogota bag presents the higher rates of skin laceration and evisceration, greater need for a stent for draining fluids and wash-ups, higher rates of intestinal adhesion to the abdominal wall. The Barker technique presents lack of efficiency in closing the abdominal wall and difficulty on maintaining pressure on the dressing. The VAC dressing can generate irritation and dermatitis when the drape is applied, in addition to pain, infection and bleeding, as well as toxic shock syndrome, anaerobic sepsis and thrombosis. CONCLUSION The VAC technique, showed to be superior allowing a better control of liquid on the third space, avoiding complications such as fistula with small mortality, low infection rate, and easier capability on primary closure of the abdominal cavity. PMID:27648164

Results of coil closure of patent ductus arteriosus using a tapered tip catheter for enhanced control.

Science.gov (United States)

Devanagondi, Rajiv; Latson, Larry; Bradley-Skelton, Sharon; Prieto, Lourdes

2016-08-01

This article describes the efficacy and embolization rates of coil delivery via modified vertebral catheter (MVC) for patent ductus arteriosus (PDA) closure. Various techniques have been devised to enhance coil control and prevent embolization during PDA closure. Since 1995, they have delivered coils via tapered vertebral catheters for improved coil control. Catheterization reports, angiograms, and echocardiograms were reviewed for patients with PDA occlusion via MVC from 2001 to 2014. Residual shunting was determined by angiography and echocardiogram within 24 hr post-procedure. Procedural success was defined as ≤ trivial angiographic and echocardiographic shunt, and no aortic nor LPA obstruction, after final coil delivery. About 125 coil occlusions were attempted in 103 patients. Minimal PDA diameter was 2 (0.6-6) mm. Four coils were removed with a snare/bioptome due to aortic/LPA obstruction following release. Seven were malpositioned while still held by the MVC of which three embolized while attempting withdrawal. Five embolized after full release from the MVC. The embolization rate was 6.4%. Embolizations were more likely in PDAs ≥ 2.5 mm (P closure with lower embolization rates, coil occlusion by MVC should still be considered for small PDAs, especially in resource limited regions. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Comparison of fasciotomy wound closures using traditional dressing changes and the vacuum-assisted closure device.

Science.gov (United States)

Zannis, John; Angobaldo, Jeff; Marks, Malcolm; DeFranzo, Anthony; David, Lisa; Molnar, Joseph; Argenta, Louis

2009-04-01

Fasciotomy wounds can be a major contributor to length of stay for patients as well as a difficult reconstructive challenge. Once the compartment pressure has been relieved and stabilized, the wound should be closed as quickly and early as possible to avoid later complications. Skin grafting can lead to morbidity and scarring at both the donor and fasciotomy site. Primary closure results in a more functional and esthetic outcome with less morbidity for the patient, but can often be difficult to achieve secondary to edema, skin retraction, and skin edge necrosis. Our objective was to examine fasciotomy wound outcomes, including time to definitive closure, comparing traditional wet-to-dry dressings, and the vacuum-assisted closure (VAC) device. This retrospective chart review included a consecutive series of patients over a 10-year period. This series included 458 patients who underwent 804 fasciotomies. Of these fasciotomy wounds, 438 received exclusively VAC. dressings, 270 received only normal saline wet-to-dry dressings, and 96 were treated with a combination of both. Of the sample, 408 patients were treated with exclusively VAC therapy or wet-to-dry dressings and 50 patients were treated with a combination of both. In comparing all wounds, there was a statistically significant higher rate of primary closure using the VAC versus traditional wet-to-dry dressings (P lower extremities and P extremities). The time to primary closure of wounds was shorter in the VAC. group in comparison with the non-VAC group. This study has shown that the use of the VAC for fasciotomy wound closure results in a higher rate of primary closure versus traditional wet-to-dry dressings. In addition, the time to primary closure of wounds or time to skin grafting is shorter when the VAC was employed. The VAC used in the described settings decreases hospitalization time, allows for earlier rehabilitation, and ultimately leads to increased patient satisfaction.

Design Procedure on Stud Bolt for Reactor Vessel Assembly

International Nuclear Information System (INIS)

Kim, Jong-Wook; Lee, Gyu-Mahn; Jeoung, Kyeong-Hoon; Kim, Tae-Wan; Park, Keun-Bae; Kim, Keung-Koo

2008-10-01

The reactor pressure vessel flange is welded to the upper part of reactor pressure vessel, and there are stud holes to mount the closure head with stud bolts. The surface mating the closure head is compressed with O-ring, which acts as a sealing gasket to prevent coolant leakage. Bolted flange connections perform a very important structural role in the design of a reactor pressure vessel. Their importance stems from two important functions: (a) maintenance of the structural integrity of the connection itself, and (b) prevention of leakage through the O-ring preloaded by stud bolts. In the present study, an evaluation procedure for the design of stud bolt is developed to meet ASME code requirements. The developed design procedure could provide typical references in the development of advanced reactor design in the future

Prevalence of patent foramen ovale and usefulness of percutaneous closure device in carcinoid heart disease.

Science.gov (United States)

Mansencal, Nicolas; Mitry, Emmanuel; Pillière, Rémy; Lepère, Céline; Gérardin, Benoît; Petit, Jérôme; Gandjbakhch, Iradj; Rougier, Philippe; Dubourg, Olivier

2008-04-01

The aim of this study was to assess (1) the incidence of patent foramen ovale (PFO) in carcinoid syndrome (CS) and (2) the feasibility of percutaneous closure procedure in selected patients with CS. One hundred eight patients were prospectively studied: 54 with CS and an age- and gender-matched control group. All patients underwent conventional and contrast echocardiography. Patients with clinical signs of dyspnea (New York Heart Association class > or =III), cyanosis, carcinoid heart disease (CHD), and severe PFO were referred for the percutaneous closure of PFO. The prevalence of PFO was 41% in patients with CS and 22% in the control group (p = 0.03) and was significantly higher in patients with CHD (59%, p = 0.009). Four patients (14% of those with CHD) were referred for the percutaneous closure of PFO, and 3 patients ultimately underwent PFO closure (using Amplatzer septal occluders). At 6-month follow-up, New York Heart Association class was improved in all patients, as well as arterial blood gas results (p = 0.04) and 6-minute walking distance (p = 0.03), but all patients presented residual right-to-left shunts. In conclusion, this prospective study demonstrates that in patients with CHD, the prevalence of PFO is high and that percutaneous closure of PFO is feasible, with a reduction in symptoms but with residual shunting.

Hanford Patrol Academy Demolition Sites Closure Plan

International Nuclear Information System (INIS)

1992-11-01

From 1975 to 1991 the Hanford Patrol Academy Demolition Sites (HPADS) were used for demolition events. These demolition events were a form of thermal treatment for spent or abandoned chemical waste. Because the HPADS will no longer be used for this thermal activity, the sites will be closed. Closure will be conducted pursuant to the requirements of the Washington State Department of Ecology (Ecology) Dangerous Waste Regulations, Washington Administrative Code (WAC) 173-303-610 and 40 CFR 270.1. Closure also will satisfy closure requirements of WAC 173-303-680 and for the thermal treatment closure requirements of 40 CFR 265.381. This closure plan presents a description of the HPADS, the history of the waste treated, and the approach that will be followed to close the HPADS. Because dangerous waste does not include the source, special nuclear, and by-product material components of mixed waste, radionuclides are not within the scope of WAC 173-303 or of this closure plan. The information on radionuclides is provided only for general knowledge where appropriate. Only dangerous constituents derived from HPADS operations will be addressed in this closure plan in accordance with WAC 173-303-610(2)(b)(i). The HPADS are actually two distinct soil closure areas within the Hanford Patrol Academy training area

Initial experience with the 3.3 Fr Mongoose® pigtail catheter for aortic angiography during patent ductus arteriosus closure in small patients.

Science.gov (United States)

Hena, Zachary; Sutton, Nicole J; Gates, Gregory J; Taragin, Benjamin H; Pass, Robert H

2017-01-01

Smaller femoral arterial sheaths may be associated with fewer vascular complications. The 3.3 Fr Mongoose ® Pediavascular pigtail catheter is a catheter that allows higher flow rates, potentially resulting in improved angiographic quality. We reviewed our experience with this small catheter during patent ductus arteriosus (PDA) closure. Review of patients ≤20 kg in whom the Mongoose ® catheter was used during PDA closure from 12/13 to 4/15. Angiographic efficacy and procedural details were compared to ten 4 Fr catheter cases. Comparisons were performed using Mann-Whitney U-test; P closure in small children.

One-stage closure of isolated cleft palate with the Veau-Wardill-Kilner V to Y pushback procedure or the Cronin modification. I. Comparison of operative results.

Science.gov (United States)

Heliövaara, A; Rintala, A; Ranta, R

1993-01-01

The long term operative results of one-stage closure of isolated cleft palate with either the Veau-Wardill-Kilner V to Y pushback procedure or the Cronin modification were evaluated and compared retrospectively. A total of 116 consecutive patients with isolated cleft palate who had been operated on at the age of 18-24 months were followed up until 17-20 years of age. Twenty-four of the patients needed one or more additional operations on the palate, mainly pharyngeal flaps (20%) and repair of fistulas (10%). There was no significant difference in the number of patients who needed further operations, either between the two different operations or between the sexes, but the patients who presented with the most extensive clefts required the most operations.

32 CFR 989.25 - Base closure and realignment.

Science.gov (United States)

2010-07-01

... 32 National Defense 6 2010-07-01 2010-07-01 false Base closure and realignment. 989.25 Section 989... PROTECTION ENVIRONMENTAL IMPACT ANALYSIS PROCESS (EIAP) § 989.25 Base closure and realignment. Base closure or realignment may entail special requirements for environmental analysis. The permanent base closure...

Patent ductus arteriosus closure using an Amplatzer™ ventricular septal defect closure device

Science.gov (United States)

Fernando, Rajeev; Koranne, Ketan; Loyalka, Pranav; Kar, Biswajit; Gregoric, Igor

2013-01-01

The ductus arteriosus originates from the persistence of the distal portion of the left sixth aortic arch. It connects the descending aorta (immediately distal to the left subclavian artery) to the roof of the main pulmonary artery, near the origin of the left pulmonary artery. Persistence of the duct beyond 48 h after birth is abnormal and results in patent ductus arteriosus (PDA). PDA is rare in adults because it is usually discovered and treated in childhood. Mechanical closure remains the definitive therapy because the patency of ductus arteriosus may lead to multiple complications, depending on the size and flow through the ductus. PDA closure is indicated in patients with symptoms and evidence of left heart enlargement, and in patients with elevated pulmonary pressures when reversal is possible. Transcatheter closure is the preferred technique in adults because it avoids sternotomy, reduces the length of hospital stay and is associated with fewer complications compared with surgery. First demonstrated in 1967, both the technique and the occluder devices used have since evolved. However, designing an ideal PDA occluder has been a challenge due to the variability in size, shape and orientation of PDAs. The present article describes a case involving a 35-year-old woman who presented to the Center for Advanced Heart Failure (Houston, USA) with congestive heart failure due to a large PDA, which was successfully occluded using an Amplatzer (St Jude Medical, USA) muscular ventricular septal defect closure device. The wider waist and dual-retention discs of these ventricular septal defect closure devices may be important factors to consider in the future development of devices for the occlusion of large PDAs. PMID:24294051

Evaluation of the Momentum Closure Schemes in MPAS-Ocean

Science.gov (United States)

Zhao, Shimei; Liu, Yudi; Liu, Wei

2018-04-01

In order to compare and evaluate the performances of the Laplacian viscosity closure, the biharmonic viscosity closure, and the Leith closure momentum schemes in the MPAS-Ocean model, a variety of physical quantities, such as the relative reference potential energy (RPE) change, the RPE time change rate (RPETCR), the grid Reynolds number, the root mean square (RMS) of kinetic energy, and the spectra of kinetic energy and enstrophy, are calculated on the basis of results of a 3D baroclinic periodic channel. Results indicate that: 1) The RPETCR demonstrates a saturation phenomenon in baroclinic eddy tests. The critical grid Reynolds number corresponding to RPETCR saturation differs between the three closures: the largest value is in the biharmonic viscosity closure, followed by that in the Laplacian viscosity closure, and that in the Leith closure is the smallest. 2) All three closures can effectively suppress spurious dianeutral mixing by reducing the grid Reynolds number under sub-saturation conditions of the RPETCR, but they can also damage certain physical processes. Generally, the damage to the rotation process is greater than that to the advection process. 3) The dissipation in the biharmonic viscosity closure is strongly dependent on scales. Most dissipation concentrates on small scales, and the energy of small-scale eddies is often transferred to large-scale kinetic energy. The viscous dissipation in the Laplacian viscosity closure is the strongest on various scales, followed by that in the Leith closure. Note that part of the small-scale kinetic energy is also transferred to large-scale kinetic energy in the Leith closure. 4) The characteristic length scale L and the dimensionless parameter D in the Leith closure are inherently coupled. The RPETCR is inversely proportional to the product of D and L. When the product of D and L is constant, both the simulated RPETCR and the inhibition of spurious dianeutral mixing are the same in all tests using the Leith

Percutaneous patent foramen ovale closure: the Paradoxical Cerebral Embolism Prevention Registry.

Science.gov (United States)

Paiva, Luís; Dinis, Paulo; Providência, Rui; Costa, Marco; Margalho, Susana; Goncalves, Lino

2015-03-01

The natural history and therapeutic interventions for secondary prevention after a cerebrovascular event in patients with patent foramen ovale (PFO) are not yet established. This study aims to assess the safety and efficacy of percutaneous PFO closure in a population of patients with ischemic cerebrovascular disease of unknown etiology. This prospective observational study included patients with a history of cryptogenic transient ischemic attack (TIA) or stroke who underwent percutaneous PFO closure. The effectiveness of the device for the secondary prevention of TIA or stroke was assessed by comparing observed events in the sample with expected events for this clinical setting. The sample included 193 cases of percutaneous PFO closure (age 46.4 ± 13.1 years, 62.2% female) with a mean follow-up of 4.3 ± 2.2 years, corresponding to a total exposure to ischemic events of 542 patient-years. The high-risk characteristics of the PFO were assessed prior to device implantation. There were seven primary endpoint events during follow-up (1.3 per 100 patient-years), corresponding to a relative risk reduction of 68.2% in recurrent TIA or stroke compared to medical therapy alone. The procedure was associated with a low rate of device- or intervention-related complications (1.5%). In this long-term registry, percutaneous PFO closure was shown to be a safe and effective therapy for the secondary prevention of cryptogenic stroke or TIA. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

Transcatheter device closure of ruptured sinus of Valsalva: Immediate results and short term follow up

Directory of Open Access Journals (Sweden)

Sen Supratim

2009-01-01

Full Text Available This is a retrospective, observational study comprising of eight patients with isolated rupture of the sinus of Valsalva (RSOV who underwent transcatheter device closure. The mean age of presentation was 32.8 ± 10.0 years. New York Heart Association (NYHA class at the time of presentation was II (six patients and III (two patients. The RSOVs were all closed using a patent ductus arteriosus device. The mean procedural time was 42.3 ± 5.4 minutes, while the fluoroscopic time was 24.5 ± 6.9 minutes. All had complete closure of the shunt. The average hospital stay was 2.9 ± 1.1 days. There were no major complications. The patients were followed up for a mean of 11.3 ± 4.1 months. At the time of the last follow up all the patients were in NYHA class I. We conclude that in the short term, transcatheter closure of isolated RSOV is a viable alternative to surgical repair.

Long-term efficacy of transcatheter closure of patent ductus arteriosus with the Rashkind double umbrella

International Nuclear Information System (INIS)

Zhang Qingqiao; Jiang Shiliang; Huang Lianjun; Zhao Shihua; Zheng Hong; Ling Jian; Xu Zhongying; Zhang Gejun; Xie Ruolan; Dai Ruping

2003-01-01

Objective: To evaluate the long-term efficacy of transcatheter patent ductus arteriosus (PDA) closure with the Rashkind double umbrella. Methods: Between July 1994 and December 1998, forty nine patients (12 male, 37 female) at a mean age of (21 ± 13) years (range 2.4 to 54 years) underwent attempted transcatheter closure of a PDA using the Rashkind double umbrella. The Rashkind double umbrella was implanted through femoral venous route. Aortography was performed to check any residual shunt presence, 10 to 30 minutes after the closure, and at 6-month intervals thereafter. Results: Forty seven of the 49 patients had successful device placement. Two patients underwent surgical therapy. The prevalence of trace, mild, moderate, and large residual shunt was 12.8% (6/47), 27.7%(13/47), 25.5%(12/47), and 14.8% (7/47), respectively, and the prevalence of complete closure was 19.2%(9/47) 10 to 30 minutes after the procedure. Of the 49 patients, 36 completed short-term (≤3 months) follow-up, the prevalence of residual shunt was 44.4%(16/36) at 3 months. 30 patients completed medium-term (>3 months and ≤36 months) follow-up, the prevalence of residual shunt was 13.3% (4/30) at 36 months. For the long-term (>36 months) follow-up (38-96 months, mean 60±12 months) in 25 patients, there were 4 patients with residual shunt across PDA. Two patients with residual shunt at 46 and 48 months, respectively, had complete closure after reocclusion using the Amplatzer duct occluder. Conclusions: The long-term residual shunt after closure of PDA with the Rashkind double umbrella can not disappear spontaneously, thus a second device is sometimes needed to achieve complete closure

Long-term efficacy of transcatheter closure of patent ductus arteriosus with the Rashkind double umbrella

Energy Technology Data Exchange (ETDEWEB)

Qingqiao, Zhang; Shiliang, Jiang; Lianjun, Huang; Shihua, Zhao; Hong, Zheng; Jian, Ling; Zhongying, Xu; Gejun, Zhang; Ruolan, Xie; Ruping, Dai [Chinese academy of Medical Science and Beijing Union Medical College, Beijing (China). Cardiovascular Institute and Fuwai Hospital, Dept. of Radiology

2003-10-01

Objective: To evaluate the long-term efficacy of transcatheter patent ductus arteriosus (PDA) closure with the Rashkind double umbrella. Methods: Between July 1994 and December 1998, forty nine patients (12 male, 37 female) at a mean age of (21 {+-} 13) years (range 2.4 to 54 years) underwent attempted transcatheter closure of a PDA using the Rashkind double umbrella. The Rashkind double umbrella was implanted through femoral venous route. Aortography was performed to check any residual shunt presence, 10 to 30 minutes after the closure, and at 6-month intervals thereafter. Results: Forty seven of the 49 patients had successful device placement. Two patients underwent surgical therapy. The prevalence of trace, mild, moderate, and large residual shunt was 12.8% (6/47), 27.7%(13/47), 25.5%(12/47), and 14.8% (7/47), respectively, and the prevalence of complete closure was 19.2%(9/47) 10 to 30 minutes after the procedure. Of the 49 patients, 36 completed short-term ({<=}3 months) follow-up, the prevalence of residual shunt was 44.4%(16/36) at 3 months. 30 patients completed medium-term (>3 months and {<=}36 months) follow-up, the prevalence of residual shunt was 13.3% (4/30) at 36 months. For the long-term (>36 months) follow-up (38-96 months, mean 60{+-}12 months) in 25 patients, there were 4 patients with residual shunt across PDA. Two patients with residual shunt at 46 and 48 months, respectively, had complete closure after reocclusion using the Amplatzer duct occluder. Conclusions: The long-term residual shunt after closure of PDA with the Rashkind double umbrella can not disappear spontaneously, thus a second device is sometimes needed to achieve complete closure.

Phacoemulsification with intraocular lens implantation in primary angle-closure suspect, primary angle-closure and primary angle-closure glaucoma with cataract

Directory of Open Access Journals (Sweden)

Kun Zeng

2013-08-01

Full Text Available AIM: To evaluate the features and clinical outcomes of cataract extraction by phacoemulsification with intraocular lens implantation in primary angle-closure suspect(PACS, primary angle-closure(PACand primary angle-closure glaucoma(PACGwith cataract.METHODS:Phacoemulsification with intraocular lens implantation was performed on 86 cases(86 eyesdiagnosed as PACS, PAC and PACG co-existing cataract from January to December 2012. All cases were followed up for 3 months to 1 year. Pre-operative and post-operative visual acuity, intraocular pressure(IOP, gonioscopy, ultrasound biomicroscopy(UBM, visual field and usage of anti-glaucomaous eye drops were recorded.RESULTS:Zonular dialysis existed in 19 eyes(22%. The post-operative visual acuity improved in 84 eyes(98%. The post-operative visual acuity was CONCLUSION: PACS, PAC and PACG co-existing zonular dialysis is common. Phacoemulsification with IOL implantation can reduce IOP, deepen anterior chamber and open angle.

40 CFR 264.178 - Closure.

Science.gov (United States)

2010-07-01

... Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Use and Management of Containers § 264.178 Closure. At closure, all hazardous waste and hazardous waste residues must be removed...

Closure report for N Reactor

International Nuclear Information System (INIS)

1994-01-01

This report has been prepared to satisfy Section 3156(b) of Public Law 101-189 (Reports in Connection with Permanent Closures of Department of Energy Defense Nuclear Facilities), which requires submittal of a Closure Report to Congress by the Secretary of Energy upon the permanent cessation of production operations at a US Department of Energy (DOE) defense nuclear facility (Watkins 1991). This closure report provides: (1) A complete survey of the environmental problems at the facility; (2) Budget quality data indicating the cost of environmental restoration and other remediation and cleanup efforts at the facility; (3) A proposed cleanup schedule

Closure report for N Reactor

Energy Technology Data Exchange (ETDEWEB)

1994-01-01

This report has been prepared to satisfy Section 3156(b) of Public Law 101-189 (Reports in Connection with Permanent Closures of Department of Energy Defense Nuclear Facilities), which requires submittal of a Closure Report to Congress by the Secretary of Energy upon the permanent cessation of production operations at a US Department of Energy (DOE) defense nuclear facility (Watkins 1991). This closure report provides: (1) A complete survey of the environmental problems at the facility; (2) Budget quality data indicating the cost of environmental restoration and other remediation and cleanup efforts at the facility; (3) A proposed cleanup schedule.

Long-Term Results of Transcatheter Closure of Patent Ductus Arteriosus in Infants Using Amplatzer Duct Occluder

Science.gov (United States)

Behjati-Ardakani, Mostafa; Behjati-Ardakani, Mohammad-Amin; Hosseini, Seyed-Habibolla; Noori, Noormohammad

2013-01-01

Objective Patent ductus arteriosus (PDA) is one of the most frequently seen congenital heart diseases. Its closure is recommended because of the risk of infective endocardis, as well as morbidity and mortality in the long. The aim of this study was to assess the long term results of the transcatheter closure of PDA in infants using amplatzer duct occlude (ADO). Methods From May 2004 to September 2011, forty eight infants underwent transcatheter closure of PDA. A lateral or right anterior oblique view aortogram was done to locate PDA and to measure its size. Before discharge, repeat aortogram was performed to evaluate eventual residual shunt and to confirm the appropriate deployment of the ADO. Follow up evaluations were done with transthoracic echocardiography at discharge, 1 month, 6 months, 12 months and yearly thereafter. Findings The mean age of patients at procedure was 9.18±2.32 (range 3 to 12) months, mean weight 6.73±1.16 (range 4.5 to 10.1) kg. The PDA occluded completely in 20 out of the 48 patients. Twenty four patients had trivial or mild shunt and two patients had moderate residual shunt which disappeared in one patient within 24 hours and other patient with moderate shunt in 1 month. One patient (age 8 months) had mild LPA stenosis. The device emobolization occurred in two patients, immediately after the procedure in one and during night in the other patient Conclusion The long term results suggested that transcatheter closure of PDA using Amplatzer duct occluder is a safe and effective treatment in infants less than 1 year of age with minimal complications. PMID:24427494

Femoral Artery Stenosis Following Percutaneous Closure Using a Starclose Closure Device

International Nuclear Information System (INIS)

Bent, Clare Louise; Kyriakides, Constantinos; Matson, Matthew

2008-01-01

Starclose (Abbott Vascular Devices, Redwood City, CA) is a new arterial closure device that seals a femoral puncture site with an extravascular star-shaped nitinol clip. The clip projects small tines into the arterial wall which fold inward, causing the arterial wall to pucker, producing a purse-string-like seal closing the puncture site. The case history is that of a 76-year-old female patient who underwent day-case percutaneous diagnostic coronary angiography. A Starclose femoral artery closure device was used to achieve hemostasis with subsequent femoral artery stenosis.

Therapy of spinal wound infections using vacuum-assisted wound closure: risk factors leading to resistance to treatment.

Science.gov (United States)

Ploumis, Avraam; Mehbod, Amir A; Dressel, Thomas D; Dykes, Daryll C; Transfeldt, Ensor E; Lonstein, John E

2008-07-01

This study retrospectively reviewed spine surgical procedures complicated by wound infection and managed by a protocol including the use of vacuum-assisted wound closure (VAC). To define factors influencing the number of debridements needed before the final wound closure by applying VAC for patients with postoperative spinal wound infections. VAC has been suggested as a safe and probably effective method for the treatment of spinal wound infections. The risk factors for infection resistance and need for debridement revisions after VAC placement are unknown. Seventy-three consecutive patients with 79 wound infections after undergoing spine surgery were studied (6 of them had recurrence of infection). All patients were taken to the operating room for irrigation and debridement under general anesthesia followed by placement of the VAC with subsequent delayed closure of the wound. Linear regression and t test were used to identify if the following variables were risk factors for the resistance of infection to VAC treatment: timing of clinical appearance of infection, depth of infection (deep or superficial), presence of instrumentation, positive culture for methicillin-resistant Staphylococcus aureus (MRSA) or more than 1 microorganism, age of the patient, and presence of other comorbidities. There were 34 males and 39 females with an average age of 58.4 years (21 to 82). Once the VAC was initiated, there was an average of 1.4 procedures until and including closure of the wound. The wound was closed an average of 7 days (range 5 to 14) after the placement of the initial VAC on the wound. The average follow-up was 14 months (range 12 to 28). All of the patients but 2 achieved a clean, closed wound without removal of instrumentation at a minimum follow-up of 1 year. Sixty patients had implants (instrumentation or allograft) within the site of wound infection. Thirteen patients had a decompression with exposed dura. Sixty-four infections (81%) presented with a draining

9 CFR 318.301 - Containers and closures.

Science.gov (United States)

2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Containers and closures. 318.301... Canning and Canned Products § 318.301 Containers and closures. (a) Examination and cleaning of empty containers. (1) Empty containers, closures, and flexible pouch roll stock shall be evaluated by the...

75 FR 29322 - Base Closure and Realignment

Science.gov (United States)

2010-05-25

... DEPARTMENT OF DEFENSE Office of the Secretary Base Closure and Realignment AGENCY: Office of...)(ii) of the Defense Base Closure and Realignment Act of 1990. It provides a partial list of military installations closing or realigning pursuant to the 2005 Base Closure and Realignment (BRAC) Report. It also...

76 FR 4373 - Notice of Temporary Closure of Caves With Significant Bat Resources on Public Lands in New Mexico

Science.gov (United States)

2011-01-25

... identified for closure would be: (1) Signed and posted in the local BLM office having jurisdiction over the... mining laws. At a minimum, the BLM offices will require decontamination procedures to be followed by all...

Nasal closure for the treatment of epistaxis secondary to hereditary hemorrhagic telangiectasia.

Science.gov (United States)

Sena Esteves, Sara; Cardoso, Carla; Silva, Ana; Abrunhosa, José; Almeida E Sousa, Cecília

Hereditary hemorrhagic telangiectasia (HHT), also known by the eponym Osler-Weber-Rendu syndrome, is an autosomal dominant disorder characterised by the presence of multiple arteriovenous malformations (AVMs) affecting multiple organs. Many procedures have been used for epistaxis control in patients with this disorder. The objective of this study was to report the treatment of severe HHT-related epistaxiswith the modified Young's procedure. We describe the treatment of 4 patients with severe blood-transfusion-dependent epistaxis who underwent a modified Young's procedure in a tertiary hospital. The nasal closure was bilateral and complete in all cases. All patients were followed for 12 months or longer. The procedure was well tolerated and complete cessation of bleeding was achieved in all the patients. Young's technique is a safe surgical procedure, well tolerated by patients with severe epistaxis and HHT. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

Percutaneous closure of patent foramen ovale in patients with presumed paradoxical embolism: periprocedural results and midterm risk of recurrent neurologic events.

Science.gov (United States)

Balbi, Manrico; Casalino, Laura; Gnecco, Giovanni; Bezante, Gian Paolo; Pongiglione, Giacomo; Marasini, Maurizio; Del Sette, Massimo; Barsotti, Antonio

2008-08-01

To report our data on selected patients with previous paradoxical embolism who underwent transcatheter patent foramen ovale (PFO) closure. Between July 2001 and July 2007, percutaneous PFO closure was performed on 128 patients (65 women, mean age: 46 +/- 12.8 years). Patent foramen ovale closure was recommended for secondary prevention in patients with previous transient ischemic attacks (52.5%), stroke (46%), or peripheral embolism (1.5%). Implantation was successful in all patients, and at the end of intervention, complete PFO closure was achieved in 70.3% of them. There were no "major" complications (ie, deaths, device embolization or thrombosis, need for cardiac surgery). The overall incidence of complications (mostly hemorrhagic) was 7%. The mean follow-up period was 32 months. Complete closure had been achieved in 78.4% and in 82.5% of patients at the third month of transesophageal echocardiography examination and at the sixth month of transcranial Doppler examination, respectively. There were no recurrent thromboembolic events during the follow-up period. Percutaneous closure of PFO is a feasible procedure, but it is not a risk-free technique. However, in correctly selected patients (ie, large PFO and those at risk for neurologic relapse), nearly complete PFO closure seems to provide protection from future neurologic ischaemic events at midterm follow-up.

Hybrid approach for transcatheter paravalvular leak closure of mitral prosthesis in high-risk patients through transapical access.

Science.gov (United States)

Davidavicius, Giedrius; Rucinskas, Kestutis; Drasutiene, Agne; Samalavicius, Robertas; Bilkis, Valdas; Zakarkaite, Diana; Aidietis, Audrius

2014-11-01

To report "hybrid" procedure feasibility and the clinical success of transcatheter paravalvular leak closure through apical access. Seven patients (73.6±6.1 years; 4 men) with severe mitral prosthesis paravalvular leak were selected. All patients were at high risk for open surgery because of severe comorbidities and heart failure (New York Heart Association class III-IV). The defect size was 25±7.8 mm in the long axis and 9.3±2 mm in the short axis. Two defects were detected in 2 patients. The transapical procedure was performed in a "hybrid" surgery room using minithoracotomy and general anesthesia. Three-dimensional transesophageal echocardiography and fluoroscopy were used for imaging. A total of 19 Amplatzer Vascular Plug III devices (St Jude Medical) were implanted in 7 patients, 2.7/patient and 1 to 3/fistula. The procedure time was 150.7±66.8 minutes. In 6 of 7 patients (85.7%), the paravalvular leak was successfully closed, resulting in no or mild residual regurgitation. One patient had moderate regurgitation despite deployment of 3 Amplatzer Vascular Plug III devices. Two patients required blood transfusion related to procedural blood loss. The patients were discharged at 15.3±6.5 days and followed up at 215.7±138.6 days. All but 1 patient reported symptomatic improvement by ≥1 New York Heart Association class at follow-up. One patient died 216 days postoperatively. A "hybrid approach" for transcatheter paravalvular leak closure of mitral prosthesis from the apical route is effective in reducing the regurgitation grade and improving functional capacity in high-risk patients. Complete closure of the defect was maintained at follow-up in most patients. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Fenestrated Transcatheter ASD Closure in Adults with Diastolic Dysfunction and/or Pulmonary Hypertension: Case Series and Review of the Literature.

Science.gov (United States)

Abdelkarim, Ayman; Levi, Daniel S; Tran, Bao; Ghobrial, Joanna; Aboulhosn, Jamil

2016-12-01

This study aims to evaluate the safety and efficacy of transcatheter fenestrated ASD closure and to summarize the literature regarding the published techniques and outcomes of transcatheter partial ASD closure. Patients with left ventricular diastolic dysfunction (LVDD) or right ventricular (RV) dysfunction and/or pulmonary hypertension (PHT) may suffer untoward consequences of complete closure of an ostium secundum atrial septal defect (ASD). Therefore, for patients that fall under these categories we suggest partial occlusion of the defect, which may be better tolerated than complete defect closure. After obtaining IRB approval, a search for patients that have undergone percutaneous ASD closure was performed in the Ahmanson/UCLA Adult Congenital Heart Disease Center database to identify which patients received a fenestrated ASD closure device. Eight consecutive patients ranging between 22 and 83 years of age (mean 48 years) with PHT and/or LVDD or RV dysfunction who underwent fenestrated transcatheter ASD closure at UCLA were identified. None of the subjects experienced complications related to the procedure. Postprocedure clinical evaluation showed improvement in symptoms and exercise capacity. Available follow-up transthoracic echocardiography data (mean 4 months, range 0-20 months) demonstrated patent fenestrations in four of eight patients. None of the patients had thromboembolic or infectious complications and there were no device migrations, erosions or embolizations. Partial ASD occlusion in patients with diastolic dysfunction or RV dysfunction and/or PHT is safe and may be better tolerated than complete ASD closure in selected patients. © 2016 Wiley Periodicals, Inc.

Closure Welding of Plutonium Bearing Storage Containers

International Nuclear Information System (INIS)

Cannell, G.R.

2002-01-01

A key element in the Department of Energy (DOE) strategy for the stabilization, packaging and storage of plutonium-bearing materials involves closure welding of DOE-STD-3013 Outer Containers (3013 container). The 3013 container provides the primary barrier and pressure boundary preventing release of plutonium-bearing materials to the environment. The final closure (closure weld) of the 3013 container must be leaktight, structurally sound and meet DOE STD 3013 specified criteria. This paper focuses on the development, qualification and demonstration of the welding process for the closure welding of Hanford PFP 3013 outer containers

9 CFR 355.25 - Canning with heat processing and hermetically sealed containers; closures; code marking; heat...

Science.gov (United States)

2010-01-01

... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Canning with heat processing and hermetically sealed containers; closures; code marking; heat processing; incubation. 355.25 Section 355.25... IDENTIFICATION AS TO CLASS, QUALITY, QUANTITY, AND CONDITION Inspection Procedure § 355.25 Canning with heat...

Fuel channel closure and adapter

International Nuclear Information System (INIS)

Cashen, W.S.

1985-01-01

This invention provides a mechanical closure/actuating ram combination particularly suited for use in sealing the ends of the pressure tubes when a CANDU-type reactor is refueled. It provides a cluster that may be inserted into a fuel channel end fitting to provide at least partial closing off of a pressure tube while permitting the disengagement of the fueling machine and its withdrawal from the closure for other purposes. The invention also provides a ram/closure combination wherein the application of loading force to a deformable sealing disk is regulated by a massive load bar component forming part of the fueling machine and being therefore accessible for maintenance or replacement

Experience with Vacuum-assisted closure of sternal wound infections following cardiac surgery and evaluation of chronic complications associated with its use.

Science.gov (United States)

Bapat, Vinayak; El-Muttardi, Naguib; Young, Christopher; Venn, Graham; Roxburgh, James

2008-01-01

We report our experience in use of Vacuum-assisted closure therapy (VAC) in the treatment of poststernotomy wound infection with emphasis on recurrent wound-related problems after use of VAC and their treatment. Between July 2000 and June 2003, 2706 patients underwent various cardiac procedures via median sternotomy. Forty-nine patients with postoperative sternal wound infection (1.9%) were managed with VAC. Wounds were classified as either superficial sternal wound infection (28 patients) or deep sternal wound infection (21 patients). In the superficial sternal wound infection group, 23 patients had VAC as definitive treatment (GroupA), while five patients (Group B) had VAC followed by surgical closure. Similarly, in the deep sternal wound infection group, 12 patients had VAC as definitive treatment (Group C), while nine patients had VAC followed by surgical closure (Group D). Patients were discharged after satisfactory wound closure. Upon discharge patients were followed up at interval of three to six months. Recurrent sternal problems when identified were investigated and additional surgical procedures were carried out when necessary. There were nine deaths, all due to unrelated causes except in one patient who died of right ventricular rupture (Group C). Nine patients in Group A had recurrent wound problems of which six had VAC system for > 21 days. Three patients underwent extensive debridement due to sternal osteomyelitis. All eight patients in Group B presented with chronic wound-related problems and underwent multiple debridements. Four patients had laparoscopic omental flaps. In contrast 14 patients (Group B and D) who were treated with shorter duration of VAC followed by either a flap or direct surgical closure, did not present with recurrent problems. VAC therapy is a safe and reliable option in the treatment of sternal wound infection. However, prolonged use of VAC system as a replacement for surgical closure of sternal wound appears to be associated

Restaurant closures

CERN Document Server

Novae Restauration

2012-01-01

Christmas Restaurant closures Please note that the Restaurant 1 and Restaurant 3 will be closed from Friday, 21 December at 5 p.m. to Sunday, 6 January, inclusive. They will reopen on Monday, 7 January 2013.   Restaurant 2 closure for renovation To meet greater demand and to modernize its infrastructure, Restaurant 2 will be closed from Monday, 17 December. On Monday, 14 January 2013, Sophie Vuetaz’s team will welcome you to a renovated self-service area on the 1st floor. The selections on the ground floor will also be expanded to include pasta and pizza, as well as snacks to eat in or take away. To ensure a continuity of service, we suggest you take your break at Restaurant 1 or Restaurant 3 (Prévessin).

Anterior Segment Imaging Predicts Incident Gonioscopic Angle Closure.

Science.gov (United States)

Baskaran, Mani; Iyer, Jayant V; Narayanaswamy, Arun K; He, Yingke; Sakata, Lisandro M; Wu, Renyi; Liu, Dianna; Nongpiur, Monisha E; Friedman, David S; Aung, Tin

2015-12-01

To investigate the incidence of gonioscopic angle closure after 4 years in subjects with gonioscopically open angles but varying degrees of angle closure detected on anterior segment optical coherence tomography (AS OCT; Visante; Carl Zeiss Meditec, Dublin, CA) at baseline. Prospective, observational study. Three hundred forty-two subjects, mostly Chinese, 50 years of age or older, were recruited, of whom 65 were controls with open angles on gonioscopy and AS OCT at baseline, and 277 were cases with baseline open angles on gonioscopy but closed angles (1-4 quadrants) on AS OCT scans. All subjects underwent gonioscopy and AS OCT at baseline (horizontal and vertical single scans) and after 4 years. The examiner performing gonioscopy was masked to the baseline and AS OCT data. Angle closure in a quadrant was defined as nonvisibility of the posterior trabecular meshwork by gonioscopy and visible iridotrabecular contact beyond the scleral spur in AS OCT scans. Gonioscopic angle closure in 2 or 3 quadrants after 4 years. There were no statistically significant differences in age, ethnicity, or gender between cases and controls. None of the control subjects demonstrated gonioscopic angle closure after 4 years. Forty-eight of the 277 subjects (17.3%; 95% confidence interval [CI], 12.8-23; P < 0.0001) with at least 1 quadrant of angle closure on AS OCT at baseline demonstrated gonioscopic angle closure in 2 or more quadrants, whereas 28 subjects (10.1%; 95% CI, 6.7-14.6; P < 0.004) demonstrated gonioscopic angle closure in 3 or more quadrants after 4 years. Individuals with more quadrants of angle closure on baseline AS OCT scans had a greater likelihood of gonioscopic angle closure developing after 4 years (P < 0.0001, chi-square test for trend for both definitions of angle closure). Anterior segment OCT imaging at baseline predicts incident gonioscopic angle closure after 4 years among subjects who have gonioscopically open angles and iridotrabecular contact on AS OCT at

Cardi-O-Fix duct occluder versus Amplatzer duct occluder for closure of patent ductus arteriosus.

Science.gov (United States)

Celebi, Ahmet; Demir, Ibrahim Halil; Saritaş, Türkay; Dedeoğlu, Reyhan; Yucel, Ilker Kemal; Demir, Fadli; Erdem, Abdullah

2013-11-15

We sought to investigate the safety, efficacy, and follow-up results of percutaneous patent ductus arteriosus (PDA) closure using the novel Cardi-O-Fix duct occluder (CDO), a device similar to but less expensive than the Amplatzer duct occluder (ADO). We also aimed to compare these two devices in terms of results. Between March 2005 and May 2012, 167 patients diagnosed with moderate-to-large PDA underwent transcatheter closure. ADO was used in 56 (33.5%) patients with a mean age of 8.1 ± 11.9 years (3.6 months-56 years), whereas CDO was used in 111 (66.5%) patients with a mean age of 12.6 ± 14.6 years (4.8 months-63 years). The narrowest PDA diameter, the used device diameter, procedure time, fluoroscopy time, and residual shunt rates were similar between the two groups. Procedural success rate was 100% in both groups. Although the residual shunt rate was higher in the CDO group immediately after the procedure, the difference was not statistically significant (12.6 vs. 8.9%; P = 0.3). There was no statistically significant difference between groups at discharge and during follow-up. No deaths occurred in any of the groups, and there were no differences in complication rates during the short- and mid-term follow-up periods (CDO 7/111 vs. ADO 5/56; P = 0.5 π). The CDO can be used for PDA closure because of its safety, effectiveness, and simplicity in use. It is available in bigger sizes and can be used in patients with large defects. According to our short- and mid-term findings, the results it yields are similar to those of the ADO; thus, it may be the preferred choice owing to its low cost and large size variability. Copyright © 2013 Wiley Periodicals, Inc.

Randomized clinical trial of intestinal ostomy takedown comparing pursestring wound closure vs conventional closure to eliminate the risk of wound infection.

Science.gov (United States)

Camacho-Mauries, Daniel; Rodriguez-Díaz, José Luis; Salgado-Nesme, Noel; González, Quintín H; Vergara-Fernández, Omar

2013-02-01

The use of temporary stomas has been demonstrated to reduce septic complications, especially in high-risk anastomosis; therefore, it is necessary to reduce the number of complications secondary to ostomy takedowns, namely wound infection, anastomotic leaks, and intestinal obstruction. To compare the rates of superficial wound infection and patient satisfaction after pursestring closure of ostomy wound vs conventional linear closure. Patients undergoing colostomy or ileostomy closure between January 2010 and February 2011 were randomly assigned to linear closure (n = 30) or pursestring closure (n = 31) of their ostomy wound. Wound infection within 30 days of surgery was defined as the presence of purulent discharge, pain, erythema, warmth, or positive culture for bacteria. Patient satisfaction, healing time, difficulty managing the wound, and limitation of activities were analyzed with the Likert questionnaire. The infection rate for the control group was 36.6% (n = 11) vs 0% in the pursestring closure group (p ostomy wound closure (shorter healing time and improved patient satisfaction).

Are patients with severe epistaxis caused by hereditary hemorrhagic telangiectasia satisfied with nostril closure surgery?

Science.gov (United States)

Ichimura, Keiichi; Kikuchi, Hisashi; Imayoshi, Shoichiro; Yamauchi, Tomohiko; Ishikawa, Kotaro

2012-02-01

Recurrent epistaxis as a manifestation of hereditary hemorrhagic telangiectasia (HHT) is usually difficult to control. Although no treatment is regarded to be completely efficacious, nostril closure is considered a modality of choice for the most severe cases. The cessation of airflow resulting from this procedure can stop bleeding by minimizing risk factors. However, loss of nasal functions is a disadvantage of nostril closure. We conducted a questionnaire survey of patients who underwent nostril closure surgery, regarding the effects and disadvantages of the operation. Seven patients were asked questions on issues including frequency and severity of epistaxis pre- and post-operatively, satisfaction of treatment, and impairment in daily living activities. Most patients reported complete cessation of bleeding. Some still had bleeding, but the frequency and severity were far lower. No transfusions were required in any of the cases. Patients reported some disadvantages, for example, respiratory, olfactory, and phonatory issues. Six out of seven patients were very satisfied with the outcome of surgery. Nostril closure surgery can remarkably reduce frequency and volume of epistaxis. Our survey indicated that satisfactory results were achieved. However, difficulties caused by complete nasal obstruction varied. Thus, individualized coping strategies are required. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Patent ductus arteriosus closure using an Amplatzer(™) ventricular septal defect closure device.

Science.gov (United States)

Fernando, Rajeev; Koranne, Ketan; Loyalka, Pranav; Kar, Biswajit; Gregoric, Igor

2013-01-01

The ductus arteriosus originates from the persistence of the distal portion of the left sixth aortic arch. It connects the descending aorta (immediately distal to the left subclavian artery) to the roof of the main pulmonary artery, near the origin of the left pulmonary artery. Persistence of the duct beyond 48 h after birth is abnormal and results in patent ductus arteriosus (PDA). PDA is rare in adults because it is usually discovered and treated in childhood. Mechanical closure remains the definitive therapy because the patency of ductus arteriosus may lead to multiple complications, depending on the size and flow through the ductus. PDA closure is indicated in patients with symptoms and evidence of left heart enlargement, and in patients with elevated pulmonary pressures when reversal is possible. Transcatheter closure is the preferred technique in adults because it avoids sternotomy, reduces the length of hospital stay and is associated with fewer complications compared with surgery. First demonstrated in 1967, both the technique and the occluder devices used have since evolved. However, designing an ideal PDA occluder has been a challenge due to the variability in size, shape and orientation of PDAs. The present article describes a case involving a 35-year-old woman who presented to the Center for Advanced Heart Failure (Houston, USA) with congestive heart failure due to a large PDA, which was successfully occluded using an Amplatzer (St Jude Medical, USA) muscular ventricular septal defect closure device. The wider waist and dual-retention discs of these ventricular septal defect closure devices may be important factors to consider in the future development of devices for the occlusion of large PDAs.

Temporary Closure of the Open Abdomen: A Systematic Review on Delayed Primary Fascial Closure in Patients with an Open Abdomen

NARCIS (Netherlands)

Boele van Hensbroek, Pieter; Wind, Jan; Dijkgraaf, Marcel G. W.; Busch, Olivier R. C.; Goslings, J. Carel

2009-01-01

Background This study was designed to systematically review the literature to assess which temporary abdominal closure (TAC) technique is associated with the highest delayed primary fascial closure (FC) rate. In some cases of abdominal trauma or infection, edema or packing precludes fascial closure

Catheter Closure Through a Venous Approach of Patent Ductus Arteriosus in Small Pediatric Patients Using Combined Angiographic and Echocardiographic Guidance.

Science.gov (United States)

Thanopoulos, Basil Vasilios D; Ninios, Vlassis; Dardas, Petros; Giannopoulos, Andreas; Deleanou, Dan; Iancovici, Silvia

2016-11-15

The standard technique of catheter closure of patent ductus arteriosus (PDA) may be associated with arterial complications particularly in small pediatric patients. The aim of this study was to evaluate whether catheter closure of PDA in small children using an exclusive venous approach is a safe and effective alternative to closure with the standard technique. One hundred-twelve patients, aged 2 to 24 months, were randomly assigned in a 1:1 ratio to catheter closure of PDA using the standard technique (group 1) and an exclusive venous approach (group 2), respectively. In group 2, the procedure was guided using hand injections of contrast media through the delivery sheath and 2-dimensional and color Doppler echocardiography. Group 1: the PDA diameter ranged from 2 to 5.5 mm and the device diameter ranged from 4 to 8 mm. The PDA occluders were permanently implanted in all patients. Five losses of the arterial pulses that were restored with intravenous infusion of heparin and recombinant tissue plasminogen activator (rtPA), and 4 groin hematomas were the main complications of the procedure. Group 2: the mean PDA diameter ranged from 2.5 to 6 mm and the device diameter ranged from 3 to 8 mm. The PDA occluders were permanently implanted in all but 2 patients. There were no complications. Complete echocardiographic closure of PDA at 1-month follow-up was observed in all 110 patients. Exclusive transvenous PDA occlusion is an effective and safe technique that prevents the arterial complications of the standard approach in small children. Copyright © 2016 Elsevier Inc. All rights reserved.

[Bath Plug Closure Method for Cerebrospinal Fluid Leakage by Endoscopic Endonasal Approach:Cooperative Treatment by Neurosurgeons and Otolaryngologists].

Science.gov (United States)

Kawaguchi, Tomohiro; Arakawa, Kazuya; Nomura, Kazuhiro; Ogawa, Yoshikazu; Katori, Yukio; Tominaga, Teiji

2017-12-01

Endoscopic endonasal surgery, an innovative surgical technique, is used to approach sinus lesions, lesions of the skull base, and intradural tumors. The cooperation of experienced otolaryngologists and neurosurgeons is important to achieve safe and reliable surgical results. The bath plug closure method is a treatment option for patients with cerebrospinal fluid(CSF)leakage. Although it includes dural and/or intradural procedures, surgery tends to be performed by otolaryngologists because its indications, detailed maneuvers, and pitfalls are not well recognized by neurosurgeons. We reviewed the cases of patients with CSF leakage treated by using the bath plug closure method with an endoscopic endonasal approach at our institution. Three patients were treated using the bath plug closure method. CSF leakage was caused by a meningocele in two cases and trauma in one case. No postoperative intracranial complications or recurrence of CSF leakage were observed. The bath plug closure method is an effective treatment strategy and allows neurosurgeons to gain in-depth knowledge of the treatment options for CSF leakage by using an endoscopic endonasal approach.

Some Recent Developments in Turbulence Closure Modeling

Science.gov (United States)

Durbin, Paul A.

2018-01-01

Turbulence closure models are central to a good deal of applied computational fluid dynamical analysis. Closure modeling endures as a productive area of research. This review covers recent developments in elliptic relaxation and elliptic blending models, unified rotation and curvature corrections, transition prediction, hybrid simulation, and data-driven methods. The focus is on closure models in which transport equations are solved for scalar variables, such as the turbulent kinetic energy, a timescale, or a measure of anisotropy. Algebraic constitutive representations are reviewed for their role in relating scalar closures to the Reynolds stress tensor. Seamless and nonzonal methods, which invoke a single closure model, are reviewed, especially detached eddy simulation (DES) and adaptive DES. Other topics surveyed include data-driven modeling and intermittency and laminar fluctuation models for transition prediction. The review concludes with an outlook.

HWMA/RCRA Closure Plan for the Basin Facility Basin Water Treatment System - Voluntary Consent Order NEW-CPP-016 Action Plan

International Nuclear Information System (INIS)

Evans, S. K.

2007-01-01

This Hazardous Waste Management Act/Resource Conservation and Recovery Act closure plan for the Basin Water Treatment System located in the Basin Facility (CPP-603), Idaho Nuclear Technology and Engineering Center (INTEC), Idaho National Laboratory Site, was developed to meet future milestones established under the Voluntary Consent Order. The system to be closed includes units and associated ancillary equipment included in the Voluntary Consent Order NEW-CPP-016 Action Plan and Voluntary Consent Order SITE-TANK-005 Tank Systems INTEC-077 and INTEC-078 that were determined to have managed hazardous waste. The Basin Water Treatment System will be closed in accordance with the requirements of the Hazardous Waste Management Act/Resource Conservation and Recovery Act, as implemented by the Idaho Administrative Procedures Act 58.01.05.009 and 40 Code of Federal Regulations 265, to achieve 'clean closure' of the tank system. This closure plan presents the closure performance standards and methods of achieving those standards for the Basin Water Treatment Systems

HWMA/RCRA Closure Plan for the Basin Facility Basin Water Treatment System - Voluntary Consent Order NEW-CPP-016 Action Plan

Energy Technology Data Exchange (ETDEWEB)

Evans, S. K.

2007-11-07

This Hazardous Waste Management Act/Resource Conservation and Recovery Act closure plan for the Basin Water Treatment System located in the Basin Facility (CPP-603), Idaho Nuclear Technology and Engineering Center (INTEC), Idaho National Laboratory Site, was developed to meet future milestones established under the Voluntary Consent Order. The system to be closed includes units and associated ancillary equipment included in the Voluntary Consent Order NEW-CPP-016 Action Plan and Voluntary Consent Order SITE-TANK-005 Tank Systems INTEC-077 and INTEC-078 that were determined to have managed hazardous waste. The Basin Water Treatment System will be closed in accordance with the requirements of the Hazardous Waste Management Act/Resource Conservation and Recovery Act, as implemented by the Idaho Administrative Procedures Act 58.01.05.009 and 40 Code of Federal Regulations 265, to achieve "clean closure" of the tank system. This closure plan presents the closure performance standards and methods of achieving those standards for the Basin Water Treatment Systems.

Percutaneous closure of patent ductus arteriosus in small infants with significant lung disease may offer faster recovery of respiratory function when compared to surgical ligation.

Science.gov (United States)

Abu Hazeem, Anas A; Gillespie, Matthew J; Thun, Haley; Munson, David; Schwartz, Matthew C; Dori, Yoav; Rome, Jonathan J; Glatz, Andrew C

2013-10-01

To describe our experience with percutaneous closure of patent ductus arteriosus (PDA) in small infants and compare outcomes to matched surgical patients. Ligation via thoracotomy has been used to close PDAs in small infants, but has been associated with respiratory and hemodynamic compromise. We hypothesized that percutaneous closure would offer faster recovery of respiratory function. Patients closure between January 2000 and April 2012 were reviewed and matched to contemporary surgical patients on gestational age (GA), birth weight (BW), procedure weight (WT), and ventilation mode. Patients returned to baseline respiratory status when the product of mean airway pressure and FiO2 returned to pre-procedural levels. Eight matched pairs were included. Median BW, GA, and WT were 1.43 kg (0.52-2.97), 29.8 weeks (24-39), and 2.8 kg (2.2-3.9) for catheter patients and 1.55 kg (0.48-3.04), 29 weeks (23-37), and 2.75 kg (2.3-4.2) for surgical patients. Complete PDA closure occurred in all. The median time to return to baseline respiratory status was significantly shorter in the percutaneous group (17 hr (range 0-113) vs. 53 hr (range 13-219), P closure of PDA in small infants on respiratory support is equivalent in safety and efficacy and may offer shorter recovery time than surgical ligation. Copyright © 2013 Wiley Periodicals, Inc.

Analysis of Mining-induced Valley Closure Movements

Science.gov (United States)

Zhang, C.; Mitra, R.; Oh, J.; Hebblewhite, B.

2016-05-01

Valley closure movements have been observed for decades in Australia and overseas when underground mining occurred beneath or in close proximity to valleys and other forms of irregular topographies. Valley closure is defined as the inward movements of the valley sides towards the valley centreline. Due to the complexity of the local geology and the interplay between several geological, topographical and mining factors, the underlying mechanisms that actually cause this behaviour are not completely understood. A comprehensive programme of numerical modelling investigations has been carried out to further evaluate and quantify the influence of a number of these mining and geological factors and their inter-relationships. The factors investigated in this paper include longwall positional factors, horizontal stress, panel width, depth of cover and geological structures around the valley. It is found that mining in a series passing beneath the valley dramatically increases valley closure, and mining parallel to valley induces much more closure than other mining orientations. The redistribution of horizontal stress and influence of mining activity have also been recognised as important factors promoting valley closure, and the effect of geological structure around the valley is found to be relatively small. This paper provides further insight into both the valley closure mechanisms and how these mechanisms should be considered in valley closure prediction models.

Three dimensional transesophageal echocardiography guided transcatheter closure of mitral paraprosthesis regurgitation – A case report

Directory of Open Access Journals (Sweden)

Vinay Kumar Sharma

2013-05-01

Full Text Available The last two decades have witnessed vast advances in the field of cardiac intervention, particularly with regard to nonsurgical closure of structural heart diseases including para prosthetic valvular leaks. The use of imaging techniques to guide even well-established procedures enhances the efficiency and safety of these procedures. The present case report aims to highlight the role of three dimensional transesophageal echocardiography in pre, intra and post operative management of patients with mitral para prosthetic valvular regurgitation.

Experience with the vacuum assisted closure negative pressure technique in the treatment of non-healing diabetic and dysvascular wounds.

Science.gov (United States)

Clare, Michael P; Fitzgibbons, Timothy C; McMullen, Scott T; Stice, R Colleen; Hayes, Dennis F; Henkel, Loree

2002-10-01

The purpose of this study is to report our experience with the Vacuum Assisted Closure (VAC) negative pressure technique in patients with non-healing wounds of the foot, ankle, and lower limb. We retrospectively reviewed 17 patients with non-healing wounds of the lower extremity who underwent treatment using the Vacuum Assisted Closure (VAC) device. Thirteen of 17 (76%) had diabetes mellitus, nine of whom were insulin-dependent, and 10 of whom had associated peripheral neuropathy. Eight of 17 (47%) had severe peripheral vascular disease. All had failed previous management with serial wound debridements and dressing changes; 15 of 17 (88%) had previously completed at least one course of oral antibiotics. Thirteen of 17 (76%) had previously undergone operative irrigation and debridement of the wounds; six of 17 (35%) had previously undergone revascularization procedures of the involved extremity. Five of 17 (29%) had wounds necessitating an amputation procedure prior to the present treatment; seven of 17 (41%) had failed treatment with local growth factors prior to the present treatment. Average length of treatment with the VAC device was 8.2 weeks. Fourteen of 17 (82%) wounds successfully healed; four underwent split-thickness skin grafting for wound closure; four were briefly treated with local growth factors; six were treated with only dressing changes following VAC treatment. Three of 17 (18%) wounds failed VAC treatment; all three patients had diabetes and had wounds located in the midfoot or forefoot; two of three had severe peripheral vascular disease. Our results indicate that the Vacuum Assisted Closure negative pressure technique is emerging as an acceptable option for wound care of the lower extremity. Not all patients are candidates for such treatment; those patients with severe peripheral vascular disease or smaller forefoot wounds may be best treated by other modalities. Larger wounds seem to be better suited for skin grafting or two-stage primary

Biomechanics Strategies for Space Closure in Deep Overbite

Directory of Open Access Journals (Sweden)

Harryanto Wijaya

2013-07-01

Full Text Available Space closure is an interesting aspect of orthodontic treatment related to principles of biomechanics. It should be tailored individually based on patient’s diagnosis and treatment plan. Understanding the space closure biomechanics basis leads to achieve the desired treatment objective. Overbite deepening and losing posterior anchorage are the two most common unwanted side effects in space closure. Conventionally, correction of overbite must be done before space closure resulted in longer treatment. Application of proper space closure biomechanics strategies is necessary to achieve the desired treatment outcome. This cases report aimed to show the space closure biomechanics strategies that effectively control the overbite as well as posterior anchorage in deep overbite patients without increasing treatment time. Two patients who presented with class II division 1 malocclusion were treated with fixed orthodontic appliance. The primary strategies included extraction space closure on segmented arch that employed two-step space closure, namely single canine retraction simultaneously with incisors intrusion followed by enmasse retraction of four incisors by using differential moment concept. These strategies successfully closed the space, corrected deep overbite and controlled posterior anchorage simultaneously so that the treatment time was shortened. Biomechanics strategies that utilized were effective to achieve the desired treatment outcome.

Magnetisable container closure and means for its removal

International Nuclear Information System (INIS)

Barrett, W.I.

1984-01-01

A container has a closed lower end and an open upper end, is made of a non-magnetic material such as aluminium, and has a peripheral groove spaced from the open end. A disc-like closure is of magnetic material such as ferritic steel, has a pair of spring jaws joined to the disc by a joining member such that when the disc of the closure is in position closing the open end of the container, the jaws engage in groove and hold the closure in position. To remove the closure, it is engaged by magnetic means mounted for example on a wall and having a step such that when the container is moved laterally away the closure is retained by the magnetic means aided by the step and thereby the closure becomes removed from the container. (author)

Urethrovaginal fistula closure.

Science.gov (United States)

Clifton, Marisa M; Goldman, Howard B

2017-01-01

In the developed world, urethrovaginal fistulas are most the likely the result of iatrogenic injury. These fistulas are quite rare. Proper surgical repair requires careful dissection and tension-free closure. The objective of this video is to demonstrate the identification and surgical correction of an urethrovaginal fistula. The case presented is of a 59-year-old woman with a history of pelvic organ prolapse and symptomatic stress urinary incontinence who underwent vaginal hysterectomy, anterior colporrhaphy, posterior colporrhaphy, and synthetic sling placement. Postoperatively, she developed a mesh extrusion and underwent sling excision. After removal of her synthetic sling, she began to experience continuous urinary incontinence. Physical examination and cystourethroscopy demonstrated an urethrovaginal fistula at the midurethra. Options were discussed and the patient wished to undergo transvaginal fistula repair. The urethrovaginal fistula was intubated with a Foley catheter. The fistula tract was isolated and removed. The urethra was then closed with multiple tension-free layers. This video demonstrates several techniques for identifying and subsequently repairing an urethrovaginal fistula. Additionally, it demonstrates the importance of tension-free closure. Urethrovaginal fistulas are rare. They should be repaired with careful dissection and tension-free closure.

Percutaneous Closure of Patent Foramen Ovale in Patients With Migraine: The PREMIUM Trial.

Science.gov (United States)

Tobis, Jonathan M; Charles, Andrew; Silberstein, Stephen D; Sorensen, Sherman; Maini, Brijeshwar; Horwitz, Phillip A; Gurley, John C

2017-12-05

Migraine is a prevalent and disabling disorder. Patent foramen ovale (PFO) has been associated with migraine, but its role in the disorder remains poorly understood. This study examined the efficacy of percutaneous PFO closure as a therapy for migraine with or without aura. The PREMIUM (Prospective, Randomized Investigation to Evaluate Incidence of Headache Reduction in Subjects With Migraine and PFO Using the AMPLATZER PFO Occluder to Medical Management) was a double-blind study investigating migraine characteristics over 1 year in subjects randomized to medical therapy with a sham procedure (right heart catheterization) versus medical therapy and PFO closure with the Amplatzer PFO Occluder device (St. Jude Medical, St. Paul, Minnesota). Subjects had 6 to 14 days of migraine per month, had failed at least 3 migraine preventive medications, and had significant right-to-left shunt defined by transcranial Doppler. Primary endpoints were responder rate defined as 50% reduction in migraine attacks and adverse events. Secondary endpoints included reduction in migraine days and efficacy in patients with versus without aura. Of 1,653 subjects consented, 230 were enrolled. There was no difference in responder rate in the PFO closure (45 of 117) versus control (33 of 103) groups. One serious adverse event (transient atrial fibrillation) occurred in 205 subjects who underwent PFO closure. Subjects in the PFO closure group had a significantly greater reduction in headache days (-3.4 vs. -2.0 days/month, p = 0.025). Complete migraine remission for 1 year occurred in 10 patients (8.5%) in the treatment group versus 1 (1%) in the control group (p = 0.01). PFO closure did not meet the primary endpoint of reduction in responder rate in patients with frequent migraine. (Prospective, Randomized Investigation to Evaluate Incidence of Headache Reduction in Subjects With Migraine and PFO Using the AMPLATZER PFO Occluder to Medical Management [PREMIUM]; NCT00355056). Copyright

SRS tank closure. Innovative technology summary report

International Nuclear Information System (INIS)

1999-08-01

High-level waste (HLW) tank closure technology is designed to stabilize any remaining radionuclides and hazardous constituents left in a tank after bulk waste removal. Two Savannah River Site (SRS) HLW tanks were closed after cleansing and then filling each tank with three layers of grout. The first layer consists of a chemically reducing grout. The fill material has chemical properties that retard the movement of some radionuclides and chemical constituents. A layer of controlled low-strength material (CLSM), a self-leveling fill material, is placed on top of the reducing grout. CLSM provides sufficient strength to support the overbearing weight. The final layer is a free-flowing, strong grout similar to normal concrete. After the main tank cavity is filled, risers are filled with grout, and all waste transfer piping connected to the tank is isolated. The tank ventilation system is dismantled, and the remaining systems are isolated. Equipment that remains with the tank is filled with grout. The tank and ancillary systems are left in a state requiring only limited surveillance. Administrative procedures are in place to control land use and access. DOE eventually plans to remove all of its HLW storage tanks from service. These tanks are located at SRS, Hanford, and Idaho National Engineering and Environmental Laboratory. Low-activity waste storage tanks at Oak Ridge Reservation are also scheduled for closure

Closure of shallow underground injection wells

International Nuclear Information System (INIS)

Veil, J.A.; Grunewald, B.

1993-01-01

Shallow injection wells have long been used for disposing liquid wastes. Some of these wells have received hazardous or radioactive wastes. According to US Environmental Protection Agency (EPA) regulations, Class IV wells are those injection wells through which hazardous or radioactive wastes are injected into or above an underground source of drinking water (USDW). These wells must be closed. Generally Class V wells are injection wells through which fluids that do not contain hazardous or radioactive wastes are injected into or above a USDW. Class V wells that are responsible for violations of drinking water regulations or that pose a threat to human health must also be closed. Although EPA regulations require closure of certain types of shallow injection wells, they do not provide specific details on the closure process. This paper describes the regulatory background, DOE requirements, and the steps in a shallow injection well closure process: Identification of wells needing closure; monitoring and disposal of accumulated substances; filling and sealing of wells; and remediation. In addition, the paper describes a major national EPA shallow injection well enforcement initiative, including closure plan guidance for wells used to dispose of wastes from service station operations

Reliability assessment of underground shaft closure

International Nuclear Information System (INIS)

Fossum, A.F.; Munson, D.E.

1994-01-01

The intent of the WIPP, being constructed in the bedded geologic salt deposits of Southeastern New Mexico, is to provide the technological basis for the safe disposal of radioactive Transuranic (TRU) wastes generated by the defense programs of the United States. In determining this technological basis, advanced reliability and structural analysis techniques are used to determine the probability of time-to-closure of a hypothetical underground shaft located in an argillaceous salt formation and filled with compacted crushed salt. Before being filled with crushed salt for sealing, the shaft provides access to an underground facility. Reliable closure of the shaft depends upon the sealing of the shaft through creep closure and recompaction of crushed backfill. Appropriate methods are demonstrated to calculate cumulative distribution functions of the closure based on laboratory determined random variable uncertainty in salt creep properties

303-K Radioactive Mixed-Waste Storage Facility closure plan

International Nuclear Information System (INIS)

1991-11-01

The Hanford Site, located northwest of Richland, Washington, houses reactors chemical-separation systems, and related facilities used for the production o special nuclear materials. The 300 Area of the Hanford Site contains reactor fuel manufacturing facilities and several research and development laboratories. The 303-K Radioactive Mixed-Waste Storage Facility (303-K Facility) has been used since 1943 to store various radioactive,and dangerous process materials and wastes generated by the fuel manufacturing processes in the 300 Area. The mixed wastes are stored in US Department of Transportation (DOT)-specification containers (DOT 1988). The north end of the building was used for storage of containers of liquid waste and the outside storage areas were used for containers of solid waste. Because only the north end of the building was used, this plan does not include the southern end of the building. This closure plan presents a description of the facility, the history of materials and wastes managed, and a description of the procedures that will be followed to chose the 303-K Facility as a greater than 90-day storage facility. The strategy for closure of the 303-K Facility is presented in Chapter 6.0

Field Sampling Plan for the HWMA/RCRA Closure Certification of the TRA-731 Caustic and Acid Storage Tank System - 1997 Notice of Violation Consent Order

International Nuclear Information System (INIS)

Evans, S.K.

2002-01-01

This Field Sampling Plan for the HWMA/RCRA Closure Certification of the TRA-731 Caustic and Acid Storage Tank System is one of two documents that comprise the Sampling and Analysis Plan for the HWMA/RCRA closure certification of the TRA-731 caustic and acid storage tank system at the Idaho National Engineering and Environmental Laboratory. This plan, which provides information about sampling design, required analyses, and sample collection and handling procedures, is to be used in conjunction with the Quality Assurance Project Plan for the HWMA/RCRA Closure Certification of the TRA-731 Caustic and Acid Storage Tank System

Numerical approximation of the Boltzmann equation : moment closure

NARCIS (Netherlands)

Abdel Malik, M.R.A.; Brummelen, van E.H.

2012-01-01

This work applies the moment method onto a generic form of kinetic equations to simplify kinetic models of particle systems. This leads to the moment closure problem which is addressed using entropy-based moment closure techniques utilizing entropy minimization. The resulting moment closure system

WASTE PACKAGE OPERATIONS FY99 CLOSURE METHODS REPORT

Energy Technology Data Exchange (ETDEWEB)

M. C. Knapp

1999-09-23

The waste package (WP) closure weld development task is part of a larger engineering development program to develop waste package designs. The purpose of the larger waste package engineering development program is to develop nuclear waste package fabrication and closure methods that the Nuclear Regulatory Commission will find acceptable and will license for disposal of spent nuclear fuel (SNF), non-fuel components, and vitrified high-level waste within a Monitored Geologic Repository (MGR). Within the WP closure development program are several major development tasks, which, in turn, are divided into subtasks. The major tasks include: WP fabrication development, WP closure weld development, nondestructive examination (NDE) development, and remote in-service inspection development. The purpose of this report is to present the objectives, technical information, and work scope relating to the WP closure weld development.and NDE tasks and subtasks and to report results of the closure weld and NDE development programs for fiscal year 1999 (FY-99). The objective of the FY-99 WP closure weld development task was to develop requirements for closure weld surface and volumetric NDE performance demonstrations, investigate alternative NDE inspection techniques, and develop specifications for welding, NDE, and handling system integration. In addition, objectives included fabricating several flat plate mock-ups that could be used for NDE development, stress relief peening, corrosion testing, and residual stress testing.

WASTE PACKAGE OPERATIONS FY-99 CLOSURE METHODS REPORT

International Nuclear Information System (INIS)

M. C. Knapp

1999-01-01

The waste package (WP) closure weld development task is part of a larger engineering development program to develop waste package designs. The purpose of the larger waste package engineering development program is to develop nuclear waste package fabrication and closure methods that the Nuclear Regulatory Commission will find acceptable and will license for disposal of spent nuclear fuel (SNF), non-fuel components, and vitrified high-level waste within a Monitored Geologic Repository (MGR). Within the WP closure development program are several major development tasks, which, in turn, are divided into subtasks. The major tasks include: WP fabrication development, WP closure weld development, nondestructive examination (NDE) development, and remote in-service inspection development. The purpose of this report is to present the objectives, technical information, and work scope relating to the WP closure weld development.and NDE tasks and subtasks and to report results of the closure weld and NDE development programs for fiscal year 1999 (FY-99). The objective of the FY-99 WP closure weld development task was to develop requirements for closure weld surface and volumetric NDE performance demonstrations, investigate alternative NDE inspection techniques, and develop specifications for welding, NDE, and handling system integration. In addition, objectives included fabricating several flat plate mock-ups that could be used for NDE development, stress relief peening, corrosion testing, and residual stress testing

T-tube vs Primary Common Bile Duct Closure

Directory of Open Access Journals (Sweden)

M R Joshi

2010-09-01

Full Text Available INTRODUCTION: Closure of the common bile duct over T-tube after exploration is a widely practiced traditional method. However, its use may give rise to many complications. We do primary closure of common bile duct after exploration. Aim of the study is to see the efficacy and safety of the primary closure. METHODS: Study was carried out to compare the results of both the techniques from 2006 to 2009 in the cases proven to have common bile duct stone with or without the features of obstructive jaundice. Post operative hospital stay and morbidities related to both the groups were recorded and analyzed. RESULTS: There were total 71 cases included in the study. Thirty one in T-tube group and 40 in primary closure group. T-tube was removed in most of the cases after three weeks where as average time of drain removal in primary closure group is 5.79 +/-1.79 days. Incidence of retained stone was equal in each group. Major complication in T-tube group is biliary peritonitis in four patients at the time of T-tube removal whereas none of the patient from primary closure group suffered from such major complication. CONCLUSIONS: Primary closure after the common bile duct exploration is safe and it helps to avoid the morbidities related to T-tube. Keywords: Choledocholithiasis, Primary closure, retained stone, T-tube, Ureterorenoscope.

Improved results of the vacuum assisted closure and Nitinol clips sternal closure after postoperative deep sternal wound infection.

Science.gov (United States)

Tocco, Maria Pia; Costantino, Alberto; Ballardini, Milva; D'Andrea, Claudio; Masala, Marcello; Merico, Eusebio; Mosillo, Luigi; Sordini, Paolo

2009-05-01

Postoperative deep sternal wound infection is a severe complication of cardiac surgery, with a high mortality rate and a high morbidity rate. The objective of this prospective study is to report our experience with the vacuum assisted closure (VAC) system for the management of deep wound infection. We also devised an innovative closure technique post VAC therapy using thermo reactive clips. The advantage of this technique is that the posterior face of the sternum does not have to be separated from the mediastinal structures thus minimising the risk of damage. From October 2006 to October 2008, we prospectively evaluated 21 patients affected by mediastinitis after sternotomy. Nineteen patients had sternotomy for coronary artery bypass grafting (CABG), one patient for aortic valve replacement (AVR) and another one for ascending aortic replacement (AAR). All patients were treated with the VAC system at the time of infection diagnosis. When the wound tissue appeared viable and the microbiological cultures were negative, the chest was closed using the most suitable procedure for the patient in question; nine patients were closed using pectoralis flaps, nine patients using Nitinol clips, one patient with a combined technique (use of Nitinol clips and muscle flap), one patient with a direct wound closure and another patient, who needed AAR with a homograft performed in another institution, was closed using sternal wires. We had no mortality; wound healing was successfully achieved in all patients. In more than 50% of the patients, the VAC therapy allowed direct sternal resynthesis. The average duration of the vacuum therapy was 26 days (range 14-37 days). VAC is a safe and effective option in the treatment of post-sternotomy mediastinitis, with excellent survival and immediate improvement of local wound conditions; furthermore, the use of Nitinol clips after VAC therapy demonstrated to be a safe and non-invasive option for sternal resynthesis. After VAC therapy, a

Techniques for Abdominal Wall Closure after Damage Control Laparotomy: From Temporary Abdominal Closure to Early/Delayed Fascial Closure—A Review

Directory of Open Access Journals (Sweden)

Qian Huang

2016-01-01

Full Text Available Open abdomen (OA has been an effective treatment for abdominal catastrophes in traumatic and general surgery. However, management of patients with OA remains a formidable task for surgeons. The central goal of OA is closure of fascial defect as early as is clinically feasible without precipitating abdominal compartment syndrome. Historically, techniques such as packing, mesh, and vacuum-assisted closure have been developed to assist temporary abdominal closure, and techniques such as components separation, mesh-mediated traction, bridging fascial defect with permanent synthetic mesh, or biologic mesh have also been attempted to achieve early primary fascial closure, either alone or in combined use. The objective of this review is to present the challenges of these techniques for OA with a goal of early primary fascial closure, when the patient’s physiological condition allows.

Uncertainty Quantification of Multi-Phase Closures

Energy Technology Data Exchange (ETDEWEB)

Nadiga, Balasubramanya T. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States); Baglietto, Emilio [Massachusetts Inst. of Technology (MIT), Cambridge, MA (United States)

2017-10-27

In the ensemble-averaged dispersed phase formulation used for CFD of multiphase ows in nuclear reactor thermohydraulics, closures of interphase transfer of mass, momentum, and energy constitute, by far, the biggest source of error and uncertainty. Reliable estimators of this source of error and uncertainty are currently non-existent. Here, we report on how modern Validation and Uncertainty Quanti cation (VUQ) techniques can be leveraged to not only quantify such errors and uncertainties, but also to uncover (unintended) interactions between closures of di erent phenomena. As such this approach serves as a valuable aide in the research and development of multiphase closures. The joint modeling of lift, drag, wall lubrication, and turbulent dispersion|forces that lead to tranfer of momentum between the liquid and gas phases|is examined in the frame- work of validation of the adiabatic but turbulent experiments of Liu and Banko , 1993. An extensive calibration study is undertaken with a popular combination of closure relations and the popular k-ϵ turbulence model in a Bayesian framework. When a wide range of super cial liquid and gas velocities and void fractions is considered, it is found that this set of closures can be validated against the experimental data only by allowing large variations in the coe cients associated with the closures. We argue that such an extent of variation is a measure of uncertainty induced by the chosen set of closures. We also nd that while mean uid velocity and void fraction pro les are properly t, uctuating uid velocity may or may not be properly t. This aspect needs to be investigated further. The popular set of closures considered contains ad-hoc components and are undesirable from a predictive modeling point of view. Consequently, we next consider improvements that are being developed by the MIT group under CASL and which remove the ad-hoc elements. We use non-intrusive methodologies for sensitivity analysis and calibration (using

Factors affecting closure of a temporary stoma.

Science.gov (United States)

Taylor, Claire; Varma, Sarah

2012-01-01

The purpose of the study was to examine time to reversal of a temporary ostomy, reasons for delayed closure, and patient satisfaction with the scheduling of their closure and related hospital care. Cross-sectional, descriptive study. The target population comprised patients who underwent creation of a temporary ostomy and reversal surgery within one National Health System Hospital Trust in the United Kingdom. The population served by this Trust are ethnically and socioeconomically diverse, predominantly living in urban areas around Greater London. Sixty-one persons who met inclusion criteria were identified. A two-step analytical process was undertaken. First, a literature review examining incidence and causes of delayed stoma closure was undertaken. Second, a postal survey of all patients who had had their stoma closed in 2009 was conducted. Respondents were allowed 2 weeks to complete and return the questionnaire. The survey instrument was developed locally and subjected to content validation using ostomy patients, surgical and nursing colleagues. It consisted of 9 questions querying time from original surgery to closure, reasons for delaying closure surgery beyond 12 weeks, and satisfaction with care. Twenty-seven patients returned their questionnaires, indicating they consented to participate; a response rate of 44%. Half of the respondents (n = 14 [52%]) underwent closure surgery within 6 months of stoma formation; the remaining 48% waited more than 6 months (median: 6.5 months, range: 1.5-26 months). Thirteen patients (48%) reported a delay in receiving their stoma closure; the main reason cited was the need for a course of adjuvant postoperative chemotherapy. Three quarters of respondents (22 [74%]) were satisfied with the overall care they received. Findings from this study suggest that stoma closure may be associated with fewest complications if performed before 12 weeks.

Transcatheter device closure of perimembranous ventricular septal defect in children treated with prophylactic oral steroids: acute and mid-term results of a single-centre, prospective, observational study.

Science.gov (United States)

Thakkar, Bhavesh; Patel, Nehal; Bohora, Shomu; Bhalodiya, Dharmin; Singh, Tarandeep; Madan, Tarun; Shah, Saurin; Poptani, Vishal; Shukla, Anand

2016-04-01

Background and Objective Although transcatheter closure of perimembranous ventricular septal defect is emerging as an accepted, viable alternative, conduction disturbances still remain a major concern. Although steroid treatment has shown encouraging results with complete recovery, efficacy of prophylactic use of steroids is still speculative. We aim to study the mid-term outcome of perimembranous ventricular septal defect closure in children who received prophylactic oral steroids. Materials and methods A prospective study was designed and antegrade device closure was attempted in eligible children who met the following inclusion criteria: age 3-18 years and weight >10 kg, defect diameter ⩽12 mm, and symptomatic, haemodynamic changes or history of infective endocarditis. Prophylactic steroid protocol consisted of 2 weeks oral prednisolone (1 mg/kg/day) initiated immediately after the procedure, and in the event of bradyarrhythmia it was escalated to 2 mg/kg. Patients were regularly followed-up at 1, 6, and 12 months and then annually. Patients with post-procedure heart block underwent Holter monitoring after a minimum of 1 year interval. Between May, 2007 and August, 2012, successful device closure was accomplished in 290/297 patients. Mean age and weight were 9±3.12 years and 21±8.27 kg, respectively. The defect measured 5±1.38 mm on echocardiography. Mean fluoroscopy time was 12.98±8.64 minutes. Eight patients with major complications included one each with device embolisation, haemolysis, severe aortic regurgitation, and five with bradyarrhythmias, including complete atrioventricular block in three, Mobitz II in one, and bifascicular block in one. Patients with complete atrioventricular block responded to high-dose steroid and temporary pacemaker. Minor complications included post-procedure heart block (n=22) and blood loss (n=2). At 18.23±13.15 months follow-up, 8/27 (five major, 22 minor) with arrhythmia had persistent post-procedure heart block of no

40 CFR 267.143 - Financial assurance for closure.

Science.gov (United States)

2010-07-01

...), utilizing the certificate of insurance for closure specified at 40 CFR 264.151(e). (f) Corporate financial... 40 Protection of Environment 26 2010-07-01 2010-07-01 false Financial assurance for closure. 267... PERMIT Financial Requirements § 267.143 Financial assurance for closure. The owner or operator must...

Tubular closure mechanism

International Nuclear Information System (INIS)

Kalen, D.D.; Mitchem, J.W.

1982-01-01

This invention relates to a closure mechanism for tubular irradiation surveillance specimen assembly holder used in nuclear reactors. The closure mechanism is composed of a latching member which includes a generally circular chamber with a plurality of elongated latches depending therefrom. The latching member circumscribes part of an actuator member which is disposed within the latching member so as to be axially movable. The axial movement of the actuator actuates positioning of the latches between positions in which the latches are locked and secured within the actuator member. Means, capable of being remotely manipulated, are provided to move the actuator in order to position the latches and load the articles within the tube

40 CFR 265.280 - Closure and post-closure.

Science.gov (United States)

2010-07-01

... contaminants caused by wind erosion; and (4) Compliance with § 265.276 concerning the growth of food-chain... and post-closure care objectives of paragraph (a) of this section: (1) Type and amount of hazardous..., including amount, frequency, and pH of precipitation; (5) Geological and soil profiles and surface and...

Airport Movement Area Closure Planner, Phase I

Data.gov (United States)

National Aeronautics and Space Administration — This SBIR research develops an automation tool improving temporary and permanent runway closure management. The Movement Area Closure Planner (MACP) provides airport...

The 4843 Alkali Metal Storage Facility Closure Plan

International Nuclear Information System (INIS)

1991-06-01

The 4843 AMSF has been used primarily to provide a centralized building to receive and store dangerous and mixed alkali metal waste, including sodium and lithium, which has been generated at the Fast Flux Test Facility and at various other Hanford Site operations that used alkali metals. Most of the dangerous and mixed alkali metal waste received consists of retired equipment from liquid sodium processes. The unit continues to store material. In general, only solid alkali metal waste that is water reactive is stored at the 4843 AMSF. The 4843 AMSF will be closed in a manner consistent with Ecology guidelines and regulations (WAC 173-303-610). The general closure procedure is detailed as follows

Left ventricular remodeling and change of systolic function after closure of patent ductus arteriosus in adults: device and surgical closure.

Science.gov (United States)

Jeong, Young-Hoon; Yun, Tae-Jin; Song, Jong-Min; Park, Jung-Jun; Seo, Dong-Man; Koh, Jae-Kon; Lee, Se-Whan; Kim, Mi-Jeong; Kang, Duk-Hyun; Song, Jae-Kwan

2007-09-01

Left ventricular (LV) remodeling and predictors of LV systolic function late after closure of patent ductus arteriosus (PDA) in adults remain to be clearly demonstrated. In 45 patients with PDA, including 28 patients who received successful occlusion using the Amplatzer device (AD group) (AGA, Golden Valley, MN) and 17 patients who received surgical closure (OP group), echocardiography studies were performed before closure and 1 day (AD group) or within 7 days (OP group) after closure, and then were repeated at > or = 6 months (17 +/- 13 months). In both groups, LV ejection fraction (EF) and end-diastolic volume index were significantly decreased immediately after closure, whereas end-systolic volume index did not change. During the long-term follow-up period, end-systolic as well as end-diastolic volume indices decreased significantly in both groups and LV EF recovered compared to the immediate postclosure state. However, LV EF remained low compared to the preclosure state. Five patients (11.1%) including 3 patients in the AD group and 2 patients in the OP group showed persistent late LV systolic dysfunction (EF or = 62% had a sensitivity of 72% and a specificity of 83% for predicting late normal LV EF after closure. Left ventricular EF remains low late after PDA closure compared with preclosure state in adults. Preclosure LV EF is the best index to predict late postclosure LV EF.

Significant skin-tightening by closure of fractional ablative laser holes.

Science.gov (United States)

Russe, Elisabeth; Purschke, Martin; Limpiangkanan, Wikunda; Farinelli, William A; Wang, Ying; Doukas, Apostolos G; Sakamoto, Fernanda H; Wechselberger, Gottfried; Anderson, Richard Rox

2018-01-01

Ablative fractional laser treatment uses thousands of very small laser beam wounds to damage a fraction of the skin, which stimulates tissue remodeling. Each open micro-wound heals without scarring, but the amount of skin tightening achieved is limited. This animal study was performed to test the hypothesis that immediate temporary closure of fractional laser wounds could increase skin tightening after fractional ablative laser treatment. Four adult swine were used for the study; 98 square test sites (3 × 3 cm) were tattooed on the abdomen and flanks of each pig. An ablative fractional Erbium:YAG laser (Sciton Profile, Sciton Inc, Palo Alto, CA) was used to treat the test areas. A laser micro-spot fluence of 375 J/cm 2 was delivered in 150-250 microseconds pulses, resulting in an array of ablation channels extending 1.5 mm deep into the skin, with a spot size of 250 µm, with 10% treatment density. Immediately following laser exposure the resulting holes were closed using a stretched elastic adhesive dressing, which, when applied, recoiled and compressed the diameter of the ablation holes. The compressive dressings were removed after 7 days. This procedure was compared to removing the same amount of skin (10%) mechanically by specially designed 19 gauge coring needles, as well as to the same laser and coring methods without compression closure. Area and shape of test sites were measured by digital photography before and 28 days after treatment. Data analysis included compensation for animal growth, as measured by increase in the area of the untreated control sites. All treated and control sites healed within a week, without scarring evident at 28 days. Laser treatment combined with compressive wound closure caused significant shrinkage at 28 days compared with untreated control sites. The treated skin area was reduced by 11.5% (P = 0.0001). Needle coring with wound closure produced similar, significant shrinkage (8%, P < 0.0021), whereas laser

The influence of percutaneous closure of patent ductus arteriosus on left ventricular size and function: a prospective study using two- and three-dimensional echocardiography and measurements of serum natriuretic peptides.

Science.gov (United States)

Eerola, Anneli; Jokinen, Eero; Boldt, Talvikki; Pihkala, Jaana

2006-03-07

We aimed to evaluate the effect of percutaneous closure of patent ductus arteriosus (PDA) on left ventricular (LV) hemodynamics. Today, most PDAs are closed percutaneously. Little is known, however, about hemodynamic changes after the procedure. Of 37 children (ages 0.6 to 10.6 years) taken to the catheterization laboratory for percutaneous PDA closure, the PDA was closed in 33. Left ventricular diastolic and systolic dimensions, volumes, and function were examined by two-dimensional (2D) and three-dimensional (3D) echocardiography and serum concentrations of natriuretic peptides measured before PDA closure, on the following day, and 6 months thereafter. Control subjects comprised 36 healthy children of comparable ages. At baseline, LV diastolic diameter measured >+2 SD in 5 of 33 patients. In 3D echocardiography, a median LV diastolic volume measured 54.0 ml/m2 in the control subjects and 58.4 ml/m2 (p closure and 57.2 ml/m2 (p = NS) 6 months after closure. A median N-terminal brain natriuretic peptide (pro-BNP) concentration measured 72 ng/l in the control group and 141 ng/l in the PDA group before closure (p = 0.001) and 78.5 ng/l (p = NS) 6 months after closure. Patients differed from control subjects in indices of LV systolic and diastolic function at baseline. By the end of follow-up, all these differences had disappeared. Even in the subgroup of patients with normal-sized LV at baseline, the LV diastolic volume decreased significantly during follow-up. Changes in LV volume and function caused by PDA disappear by 6 months after percutaneous closure. Even the children with normal-sized LV benefit from the procedure.

Single-site neural tube closure in human embryos revisited.

Science.gov (United States)

de Bakker, Bernadette S; Driessen, Stan; Boukens, Bastiaan J D; van den Hoff, Maurice J B; Oostra, Roelof-Jan

2017-10-01

Since the multi-site closure theory was first proposed in 1991 as explanation for the preferential localizations of neural tube defects, the closure of the neural tube has been debated. Although the multi-site closure theory is much cited in clinical literature, single-site closure is most apparent in literature concerning embryology. Inspired by Victor Hamburgers (1900-2001) statement that "our real teacher has been and still is the embryo, who is, incidentally, the only teacher who is always right", we decided to critically review both theories of neural tube closure. To verify the theories of closure, we studied serial histological sections of 10 mouse embryos between 8.5 and 9.5 days of gestation and 18 human embryos of the Carnegie collection between Carnegie stage 9 (19-21 days) and 13 (28-32 days). Neural tube closure was histologically defined by the neuroepithelial remodeling of the two adjoining neural fold tips in the midline. We did not observe multiple fusion sites in neither mouse nor human embryos. A meta-analysis of case reports on neural tube defects showed that defects can occur at any level of the neural axis. Our data indicate that the human neural tube fuses at a single site and, therefore, we propose to reinstate the single-site closure theory for neural tube closure. We showed that neural tube defects are not restricted to a specific location, thereby refuting the reasoning underlying the multi-site closure theory. Clin. Anat. 30:988-999, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

Novel deployment of a covered duodenal stent in open surgery to facilitate closure of a malignant duodenal perforation

Directory of Open Access Journals (Sweden)

Psaila Josephine

2009-10-01

Full Text Available Abstract Background Its a dilemma to attempt a palliative procedure to debulk the tumour and/or prevent future obstructive complications in a locally advanced intra abdominal malignancy. Case presentation A 38 year old Vietnamese man presented with a carcinoma of the colon which had invaded the gallbladder and duodenum with a sealed perforation of the second part of the duodenum. Following surgical exploration, it was evident that primary closure of the perforated duodenum was not possible due to the presence of unresectable residual tumour. Conclusion We describe a novel technique using a covered duodenal stent deployed at open surgery to aid closure of a malignant duodenal perforation.

Intraoperative three-dimensional transesophageal echocardiography for assessing the defect geometries of mitral prosthetic paravalvular leak during transcatheter closure

Directory of Open Access Journals (Sweden)

Jeng Wei

2015-03-01

Conclusion: RT 3D TEE can clearly delineate the geometries of defects in their entirety, including shape, size, and location of the defect and track canal. It would also appear that RT 3D TEE is superior to 2D TEE in the process of guiding the wire through the difficult canal anatomy, facilitating the overall procedure. The small mitral PVLs can be completely occluded, but subsequent complications occurred with large defect closures because of embolization or releak. Therefore, transcatheter closure of PVLs seems to be an attractive alternative for these patients, but newer occluder designs that better conform to leak geometry will be required to improve outcomes.

303-K Storage Facility closure plan

International Nuclear Information System (INIS)

1993-01-01

Recyclable scrap uranium with zircaloy-2 and copper silicon alloy, uranium-titanium alloy, beryllium/zircaloy-2 alloy, and zircaloy-2 chips and fines were secured in concrete billets (7.5-gallon containers) in the 303-K Storage Facility, located in the 300 Area. The beryllium/zircaloy-2 alloy and zircaloy-2 chips and fines are designated as mixed waste with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 303-K Storage Facility is now undergoing closure as defined in the Resource Conservation and Recovery Act (RCRA) of 1976 and the Washington Administrative Code (WAC) Dangerous Waste Regulations, WAC 173-303-040. This closure plan presents a description of the 303-K Storage Facility, the history of materials and waste managed, and the procedures that will be followed to close the 303-K Storage Facility. The 303-K Storage Facility is located within the 300-FF-3 (source) and 300-FF-5 (groundwater) operable units, as designated in the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) (Ecology et al. 1992). Contamination in the operable units 300-FF-3 and 300-FF-5 is scheduled to be addressed through the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980 remedial action process. Therefore, all soil remedial action at the 304 Facility will be conducted as part of the CERCLA remedial action of operable units 300-FF-3 and 300-FF-5

Mass extraction container closure integrity physical testing method development for parenteral container closure systems.

Science.gov (United States)

Yoon, Seung-Yil; Sagi, Hemi; Goldhammer, Craig; Li, Lei

2012-01-01

Container closure integrity (CCI) is a critical factor to ensure that product sterility is maintained over its entire shelf life. Assuring the CCI during container closure (C/C) system qualification, routine manufacturing and stability is important. FDA guidance also encourages industry to develop a CCI physical testing method in lieu of sterility testing in a stability program. A mass extraction system has been developed to check CCI for a variety of container closure systems such as vials, syringes, and cartridges. Various types of defects (e.g., glass micropipette, laser drill, wire) were created and used to demonstrate a detection limit. Leakage, detected as mass flow in this study, changes as a function of defect length and diameter. Therefore, the morphology of defects has been examined in detail with fluid theories. This study demonstrated that a mass extraction system was able to distinguish between intact samples and samples with 2 μm defects reliably when the defect was exposed to air, water, placebo, or drug product (3 mg/mL concentration) solution. Also, it has been verified that the method was robust, and capable of determining the acceptance limit using 3σ for syringes and 6σ for vials. Sterile products must maintain their sterility over their entire shelf life. Container closure systems such as those found in syringes and vials provide a seal between rubber and glass containers. This seal must be ensured to maintain product sterility. A mass extraction system has been developed to check container closure integrity for a variety of container closure systems such as vials, syringes, and cartridges. In order to demonstrate the method's capability, various types of defects (e.g., glass micropipette, laser drill, wire) were created in syringes and vials and were tested. This study demonstrated that a mass extraction system was able to distinguish between intact samples and samples with 2 μm defects reliably when the defect was exposed to air, water

105-DR Large Sodium Fire Facility closure activities evaluation report

International Nuclear Information System (INIS)

Adler, J.G.

1996-01-01

This report evaluates the closure activities at the 105-DR Large Sodium Fire Facility. The closure activities discussed include: the closure activities for the structures, equipment, soil, and gravel scrubber; decontamination methods; materials made available for recycling or reuse; and waste management. The evaluation compares these activities to the regulatory requirements and closure plan requirements. The report concludes that the areas identified in the closure plan can be clean closed

Storage shaft definitive closure plug and method

International Nuclear Information System (INIS)

Dardaine, M.

1992-01-01

A definitive closure plug system for radioactive waste storage at any deepness, is presented. The inherent weight of the closure materials is used to set in the plug: these materials display an inclined sliding surface in such a way that when the closure material rests on a stable surface of the shaft storage materials, the relative sliding of the different materials tends to spread them towards the shaft internal wall so as to completely occlude the shaft

Effectiveness of a new gelatin sealant system for dural closure.

Science.gov (United States)

Kawai, Hisashi; Nakagawa, Ichiro; Nishimura, Fumihiko; Motoyama, Yasushi; Park, Young-Su; Nakamura, Mitsutoshi; Nakase, Hiroyuki; Suzuki, Shuko; Ikada, Yoshito

2014-10-01

Watertight dural closure is imperative after neurosurgical procedures because inadequately treated leakage of cerebrospinal fluid (CSF) can have serious consequences. In this study, the authors test the use of a new gelatin glue as a dural sealant in in vitro and in vivo canine models of transdural CSF leakage. The in vitro model was sutured semicircles of canine dura mater and artificial dural substitute. The sutures were sealed with gelatin glue (n  =  20), fibrin glue (n  =  20), or a polyethylene glycol (PEG)-based hydrogel sealant (n  =  20). Each sample was set in a device to measure water pressure, and pressure was increased until leakage occurred. Bonding strength was subjectively evaluated. The in vivo model was dogs who underwent dural excision and received either no sealant (control group; n  =  5) or gelatin glue sealant (n  =  5) before dural closure. Twenty-eight days post-surgery, the maximum intracranial pressure was measured at the cisterna magna using Valsalva maneuver and tissue adhesion was evaluated. The water pressure at which leakage occurred in the in vitro model was higher with gelatin glue (76·5 ± 39·8 mmHg) than with fibrin glue (38·3 ± 27·4 mmHg, P control group (13·8 ± 4·0 mmHg, P control group (P  =  0·005). The new gelatin glue provides an effective watertight closure when used as an adjunct to sutured dural repair.

Atrial septum defect closure device in a beating heart, from the perspective of a researcher in artificial organs.

Science.gov (United States)

Tomizawa, Yasuko

2012-12-01

Transcatheter closure of atrial septum defect (ASD) with a closure device is increasing, but the history of clinical use of this procedure is still short, and the efficacy and long-term safety remain unproved. The total number of closure devices implanted throughout the world has not been counted accurately. Therefore, the probability of complications occurring after implantation is uncertain. Device-related complications that occur suddenly late after implantation are life-threatening, and quite often necessitate emergency surgical intervention. In Japanese medical journals, authors reporting closure devices have mentioned no complications and problems in their facilities. Detailed studies of device-related complications and device removal have not been reported in Japan. In fact, this literature search found an unexpectedly large number of reports of various adverse events from many overseas countries. When follow-up duration is short and the number of patients is small, the incidence of complications cannot be determined. Rare complications may emerge in a large series with a long observation period. Consequently, the actual number of incidents related to ASD closure devices is possibly several times higher than the number reported. Guidelines for long-term patient management for patients with an implanted closure device are necessary and post-marketing surveillance is appropriate. Development of a national database, a worldwide registration system, and continuous information disclosure will improve the quality of treatment. The devices currently available are not ideal in view of reports of late complications requiring urgent surgery and the need for life-long follow-up. An ideal device should be free from complications during life, and reliability is indispensable.

[New technology for prevention of embolic events in atrial fibrillation: a systematic review on percutaneous endovascular left atrial appendage closure].

Science.gov (United States)

Danna, Paolo; Sagone, Antonio; Proietti, Riccardo; Arensi, Andrea; Viecca, Maurizio; Santangeli, Pasquale; Di Biase, Luigi; Natale, Andrea

2012-09-01

Atrial fibrillation (AF) is the most common cardiac arrhythmia. The mortality rate of patients with AF is doubled as compared to non-fibrillating controls. The most relevant complication of AF is a major increase in the risk of stroke. The gold standard in reducing cerebrovascular events in AF is warfarin therapy, which is not free from contraindications and limitations. The left atrial appendage (LAA) is the main source of emboli causing stroke in AF. LAA closure is a seducing approach to stroke risk reduction in AF without anticoagulation. Since 1949, heart surgeons have performed LAA closure or amputation in patients with AF. Percutaneous endovascular LAA closure is a new, less invasive, technique to reach the goal. Several devices have been used to perform this intervention, and the results of published trials are encouraging in terms of effectiveness and relative safety of this attractive technique. In this review we examine the published trials and data on percutaneous LAA closure, with particular attention to the risks and benefits of this procedure.

Laser peripheral iridoplasty for angle-closure.

Science.gov (United States)

Ng, Wai Siene; Ang, Ghee Soon; Azuara-Blanco, Augusto

2012-02-15

Angle-closure glaucoma is a leading cause of irreversible blindness in the world. Treatment is aimed at opening the anterior chamber angle and lowering the IOP with medical and/or surgical treatment (e.g. trabeculectomy, lens extraction). Laser iridotomy works by eliminating pupillary block and widens the anterior chamber angle in the majority of patients. When laser iridotomy fails to open the anterior chamber angle, laser iridoplasty may be recommended as one of the options in current standard treatment for angle-closure. Laser peripheral iridoplasty works by shrinking and pulling the peripheral iris tissue away from the trabecular meshwork. Laser peripheral iridoplasty can be used for crisis of acute angle-closure and also in non-acute situations.   To assess the effectiveness of laser peripheral iridoplasty in the treatment of narrow angles (i.e. primary angle-closure suspect), primary angle-closure (PAC) or primary angle-closure glaucoma (PACG) in non-acute situations when compared with any other intervention. In this review, angle-closure will refer to patients with narrow angles (PACs), PAC and PACG. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 12), MEDLINE (January 1950 to January 2012), EMBASE (January 1980 to January 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to January 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 5 January 2012. We included only randomised controlled trials (RCTs) in this review. Patients with narrow angles, PAC or PACG were eligible. We excluded studies that included only patients with acute presentations

Feasibility analysis of loop colostomy closure in patients under local anesthesia

Directory of Open Access Journals (Sweden)

Abreu Rone Antônio Alves de

2006-01-01

Full Text Available PURPOSE: To verify prospectively the practicability of performing loop colostomy closure under local anesthesia and sedation. METHODS: In this study, 21 patients underwent this operation. Lidocaine 2% and bupivacaine 0.5% were utilized. Pain was evaluated during the operation, on the first postoperative day and at hospital discharge. Intraoperative events, postoperative complications and the acceptability of this procedure were analyzed. RESULTS: The mean duration of the operation was 133 minutes (range: 85 to 290 minutes. The mean postoperative hospitalization was four days (range: one to twelve days. No patients died. Complications occurred in two patients (9.4%: abdominal wall hematoma and operative wound infection. With regard to pain severity, scores of less than or equal to three were indicated in the intraoperative evaluation by 80% of the patients (17/21 and on the first postoperative day by 85% (18/21. At hospital discharge, 95.2% of the patients (20/21 said they were in favor of the local anesthesia technique. CONCLUSION: Loop colostomy closure under local anesthesia and sedation is feasible, safe and acceptable to patients.

Percutaneous closure of postoperative ventricular septal residual left-to-right shunt with the China made device

International Nuclear Information System (INIS)

Qin Yongwen; Zhao Xianxian; Wu Hong; Ding Jijun; Cao Jiang; Zheng Xin

2007-01-01

Objective: To evaluate the feasibility and efficacy of percutaneous transcatheter closure of residual ventricular septal defect (VSD)after surgical closure using China made-nitinol VSD device. Methods: Transcatheter closure was attempted in 11 patients (5 males, 6 females)with a residual VSD following surgical closure. The mean residual VSD narrowest diameter was(5.82 ± 2.09) mm (range from 3 to 9 mm)by echocardiography. A 6 F-9 F delivery sheath was advanced across the residual VSD over a guidewire from femoral vein to deploy the occluder under guidance of left ventriculography and transthoracic echocardiography. Results: The left ventriculography showed membranous part aneurism-like residual VSD in 8 patients and funnel type in 3 cases. There were multiple outlet in 5 cases and one outlets in 6 cases, with mean residual VSD narrowest diameter of (6.09 ± 1.58) mm (range from 3 to 9 mm)measured by left ventriculography. The diameter of occluder was (9.18 ± 2.79) mm (range from 8 to 12 mm). Complete closure of the defect was obtained in 10 cases, and another small residual shunt still remained in one case who had four outlets been treated by 2 occluders. No aortic valvular regurgitation occured in all patients except 1 patient presented complete atrioventricular block within 3 days after the procedure and recovered 2 weeks later with intravenous steroids therapy; and no other complications occured. The fluoroscopy time was(16.91 ± 4.23) min (range from 8 to 30 min). During follow-up from 1 m - 4 y, only 1 case showed residual shunt, and the other had no episodes of endocarditis, thromboembolism, hemolysis, infectious endocarditis, displacement of the occluder and aortic valvular regurgitation. Conclusion: Transcatheter closure of postoperative ventricular septal residual left-to-right shunt with China made-nitinol occluder is safe and effective. (authors)

The potential migration effect of rural hospital closures

DEFF Research Database (Denmark)

Sørensen, Jens Fyhn Lykke

2008-01-01

to out-migration, although the hypothetical way of questioning leaves uncertainty about the actual scale of out-migration. Child families appear to be the most likely out-migrants. Elderly people may be hardest hit by a hospital closure, being most reliant on health care and least inclined to move away.......Rural hospital closures are high on the current health care agenda in Denmark. One raised concern is that rural hospital closures may further decrease population numbers in rural areas, as closures may induce some residents to move away from affected areas, i.e. closer to health care services...

200 West Ash Pit Demolition Site closure plan

International Nuclear Information System (INIS)

1992-11-01

The Hanford Facility is owned by the US Government and operated by the US Department of Energy, Richland Field Office. Dangerous waste and mixed waste (containing both radioactive and dangerous components) are managed and produced on the Hanford Facility. Westinghouse Hanford Company is a major contractor to the US Department of Energy, Richland Field Office and serves as cooperator of the 200 West Ash Pit Demolition Site, the unit addressed in this closure plan. The 200 West Ash Pit Demolition Site Closure Plan consists of a Part A Permit Application (Revision 3) and a closure plan. An explanation of the Part A Permit Application revision is provided at the beginning of the Part A section. The closure plan consists of nine chapters and three appendices. This 200 West Ash Pit Demolition Site Closure Plan submittal contains information current as of October 15, 1992

Assessment of consistent two-equation closure for forest flows

DEFF Research Database (Denmark)

Sogachev, Andrey; Cavar, Dalibor; Bechmann, Andreas

of grid turbulence and wall-bounded flow, the closure suggested is also valid for homogeneous shear flows commonly observed inside tall vegetative canopies. The present work assess the plant drag closure by comparing results of two different CFD models against observations derived over the forested area...... and can be applied for any twoequation closure. Results derived by different CFD models with k-epsilon and k-omega closure are similar and in good comparison with observations. Overall, numerical results show that the closure performs well, opening new possibilities for application to tasks related...... to the atmospheric boundary layer—where it is important to adequately account for the influences of vegetation....

A successful environmental remediation program closure and post-closure activities (CAPCA) Y-12 Plant, Oak Ridge, Tennessee

International Nuclear Information System (INIS)

Bowers, M.H.

1991-01-01

The Resource Conservation and Recovery Act (RCRA) closure of eleven waste management units at the Department of Energy's (DOE's) Oak Ridge Y-12 Plant is nearing completion. The Oak Ridge Y-12 Plant is managed by Martin Marietta Energy Systems, Inc. for the US Department of Energy under Contract DE-AC05-84OR21400. The Closure and Post Closure Program (CAPCA) has been accomplished on an accelerated schedule through the efforts of a dedicated team from several organizations. This paper relates experience gained from the program that can be of benefit on other DOE environmental remediation projects. Technical design and construction aspects, as well as project management considerations, are discussed

Evaluation of Container Closure System Integrity for Frozen Storage Drug Products.

Science.gov (United States)

Nieto, Alejandra; Roehl, Holger; Brown, Helen; Nikoloff, Jonas; Adler, Michael; Mahler, Hanns-Christian

2016-01-01

Sometimes, drug product for parenteral administration is stored in a frozen state (e.g., -20 °C or -80 °C), particularly during early stages of development of some biotech molecules in order to provide sufficient stability. Shipment of frozen product could potentially be performed in the frozen state, yet possibly at different temperatures, for example, using dry ice (-80 °C). Container closure systems of drug products usually consist of a glass vial, rubber stopper, and an aluminum crimped cap. In the frozen state, the glass transition temperature (Tg) of commonly used rubber stoppers is between -55 and -65 °C. Below their Tg, rubber stoppers are known to lose their elastic properties and become brittle, and thus potentially fail to maintain container closure integrity in the frozen state. Leaks during frozen temperature storage and transportation are likely to be transient, yet, can possibly risk container closure integrity and lead to microbial contamination. After thawing, the rubber stopper is supposed to re-seal the container closure system. Given the transient nature of the possible impact on container closure integrity in the frozen state, typical container closure integrity testing methods (used at room temperature conditions) are unable to evaluate and thus confirm container closure integrity in the frozen state. Here we present the development of a novel method (thermal physical container closure integrity) for direct assessment of container closure integrity by a physical method (physical container closure integrity) at frozen conditions, using a modified He leakage test. In this study, different container closure systems were evaluated with regard to physical container closure integrity in the frozen state to assess the suitability of vial/stopper combinations and were compared to a gas headspace method. In summary, the thermal physical container closure integrity He leakage method was more sensitive in detecting physical container closure

Transcatheter closure of patent ductus arteriosus: Evaluating the effect of the learning curve on the outcome

Directory of Open Access Journals (Sweden)

Azhar Ahmad

2009-01-01

Full Text Available Background and Objectives : Initial experience with transcatheter closure of patent ductus arteriosus (PDA using detachable coils and Amplatzer duct occluder devices is reported. We evaluated the outcome, complications, and influence of the learning curve, and also assessed the need of surgical backup for such interventional procedures. Methods: From January 2000 to December 2004, 121 patients underwent transcatheter closure of PDA. Aortic angiogram was performed to evaluate the size, position, and shape of the duct for appropriately choosing the occluder device type and size. A second aortic angiogram was performed 10 minutes after device deployment. Echocardiography was repeated at intervals of 24 hours, then at 1, 3, and 6 months after the procedure to assess complications. Stepwise multiple regression analysis was used to assess the role of experience in improving the outcome of the procedure. Results: Of 121 cases, four patients had pulmonary artery embolization of the occluder device which was successfully retrieved in the catheterization laboratory, while two others had embolization that required surgical intervention. Four patients had temporary residual leak, nine had protrusion of the device into the aorta without significant Doppler pressure gradient or hemolysis on follow-up, and five had partial hemodynamically insignificant obstruction to the left pulmonary artery. Statistical analysis showed that the effect of the learning curve and experience was responsible for 93% improvement in the procedural outcome over the five-year study period. Conclusion: Transcatheter occlusion of PDA is safe and effective alternative to surgery. Complications occurred in those with unfavorable duct anatomy and with the use of multiple coils. Surgical backup was important for such interventional procedures. Experience played a major role in the proper choice of device type and size which greatly influenced the outcome of the procedure.

Considerations for closure of low-level radioactive waste engineered disposal facilities

International Nuclear Information System (INIS)

1992-01-01

Proper stabilization and closure of low-level radioactive waste disposal facilities require detailed planning during the early stages of facility development. This report provides considerations for host States, compact regions, and unaffiliated States on stabilization and closure of engineered low-level radioactive waste and mixed waste disposal facilities. A time line for planning closure activities, which identifies closure considerations to be addressed during various stages of a facility's development, is presented. Current Federal regulatory requirements and guidance for closure and post-closure are outlined. Significant differences between host State and Federal closure requirements are identified. Design features used as stabilization measures that support closure, such as waste forms and containers, backfill materials, engineered barrier systems, and site drainage systems, are described. These design features are identified and evaluated in terms of how they promote long-term site stability by minimizing water infiltration, controlling subsidence and surface erosion, and deterring intrusion. Design and construction features critical to successful closure are presented for covers and site drainage. General considerations for stabilization and closure operations are introduced. The role of performance and environmental monitoring during closure is described

Tank closure reducing grout

International Nuclear Information System (INIS)

Caldwell, T.B.

1997-01-01

A reducing grout has been developed for closing high level waste tanks at the Savannah River Site in Aiken, South Carolina. The grout has a low redox potential, which minimizes the mobility of Sr 90 , the radionuclide with the highest dose potential after closure. The grout also has a high pH which reduces the solubility of the plutonium isotopes. The grout has a high compressive strength and low permeability, which enhances its ability to limit the migration of contaminants after closure. The grout was designed and tested by Construction Technology Laboratories, Inc. Placement methods were developed by the Savannah River Site personnel

The Jejunal Serosal Patch Procedure: A Successful Technique for ...

African Journals Online (AJOL)

Background: The selection of the most appropriate technique for the repair of peptic ulcer perforations, especially when the initial attempt of closure has failed have been the concern of many surgeons. Since the experimental report regarding the jejunal serosal patch procedure by Koboldin in 1963, authors have reported its ...

A kinematic view of loop closure.

Science.gov (United States)

Coutsias, Evangelos A; Seok, Chaok; Jacobson, Matthew P; Dill, Ken A

2004-03-01

We consider the problem of loop closure, i.e., of finding the ensemble of possible backbone structures of a chain segment of a protein molecule that is geometrically consistent with preceding and following parts of the chain whose structures are given. We reduce this problem of determining the loop conformations of six torsions to finding the real roots of a 16th degree polynomial in one variable, based on the robotics literature on the kinematics of the equivalent rotator linkage in the most general case of oblique rotators. We provide a simple intuitive view and derivation of the polynomial for the case in which each of the three pair of torsional axes has a common point. Our method generalizes previous work on analytical loop closure in that the torsion angles need not be consecutive, and any rigid intervening segments are allowed between the free torsions. Our approach also allows for a small degree of flexibility in the bond angles and the peptide torsion angles; this substantially enlarges the space of solvable configurations as is demonstrated by an application of the method to the modeling of cyclic pentapeptides. We give further applications to two important problems. First, we show that this analytical loop closure algorithm can be efficiently combined with an existing loop-construction algorithm to sample loops longer than three residues. Second, we show that Monte Carlo minimization is made severalfold more efficient by employing the local moves generated by the loop closure algorithm, when applied to the global minimization of an eight-residue loop. Our loop closure algorithm is freely available at http://dillgroup. ucsf.edu/loop_closure/. Copyright 2004 Wiley Periodicals, Inc. J Comput Chem 25: 510-528, 2004

Socket sclerosis--an obstacle for orthodontic space closure?

Science.gov (United States)

Baumgaertel, Sebastian

2009-07-01

Socket sclerosis is a rare reaction to tooth extraction resulting in high-density bone in the center of the alveolar process, where, under normal circumstances, cancellous bone is to be expected. In an adult orthodontic patient, routine extractions of the mandibular first permanent bicuspids were performed, resulting in socket sclerosis and unsuccessful orthodontic space closure. Orthodontic mini-implants were inserted to augment anchorage and aid in space closure. In the presence of socket sclerosis, conventional orthodontic mechanics failed to close the extraction spaces. However, with absolute anchorage in place, space closure occurred at a nearly normal rate. After treatment, no signs of socket sclerosis were discernible on the periapical radiographs. Socket sclerosis can be an obstacle for orthodontic space closure if traditional mechanics are employed. However, mini-implant-reinforced anchorage can lead to successful space closure, resulting in complete resolution of the sclerotic sites.

Transcatheter closure of moderate-to-large patent ductus arteriosus in infants using Amplatzer duct occluder.

Science.gov (United States)

Wang, Jou-Kou; Wu, Mei-Hwan; Lin, Ming-Tai; Chiu, Shuenn-Nan; Chen, Chun-An; Chiu, Hsin-Hui

2010-02-01

There are difficulties in transcatheter closure of patent ductus arteriosus (PDA) in infants. The 46 infants (mean age 6.2+/-2.7 months; mean body weight 6.3+/-1.6 kg) who underwent PDA closure using the Amplatzer duct occluder (ADO). The indication for using an ADO was a ductus diameter > or =2.5 or 3 mm. Device diameter selected was 1-3 mm larger than ductal diameter. The mean systolic pulmonary artery pressure was 40.9+/-18.2 mmHg. The mean Qp/Qs ratio was 3.1+/-1.2. The mean ductus diameter was 3.3+/-0.8 mm. ADO was successfully deployed in 45 patients. Failure occurred in 1 case. The mean diameter of device used was 5.4+/-1.1 mm. No severe complications occurred. At the 1-month echocardiographic follow-up, a small residual shunt was present in 4 of 45 patients and had disappeared in all 4 patients at the 3-month follow-up. One patient developed a moderate degree of left ventricular outflow tract obstruction 2.3 years after the procedure. Transcatheter closure of PDA in infants using the ADO is a safe and effective method.

State Environmental Policy Act (SEPA) Checklist for the 105-DR Large Sodium Fire Facility Closure Plan

Energy Technology Data Exchange (ETDEWEB)

1990-09-01

The Hanford Site, located northwest of the city of Richland, Washington, houses reactors, chemical-separation systems, and related facilities used for the production of special nuclear materials, as well as for activities associated with nuclear energy development. The 105-DR Large Sodium Fire Facility (LSFF), which was in operation from about 1972 to 1986, was a research laboratory that occupied the former ventilation supply room on the southwest side of the 105-DR Reactor facility. The LSFF was established to provide means of investigating fire and safety aspects associated with large sodium or other metal alkali fires in the liquid metal fast breeder reactor (LMFBR) facilities. The 105-DR Reactor facility was designed and built in the 1950's and is located in the 100-D Area of the Hanford Site. The building housed the DR defense reactor, which was shut down in 1964. The LSFF is subject to the regulatory requirements for the storage and treatment of dangerous wastes. Clean closure is the proposed method of closure for the LSFF. Closure will be conducted pursuant to the requirements of the Washington Administrative Code (WAC) 173-303-610 (Ecology 1989). This closure plan presents a description of the facility, the history of wastes managed, and the procedures that will be followed to close the LSFF as an Alkali Metal Treatment Facility. No future use of the LSFF is expected.

Primary closure of equine laryngotomy incisions

DEFF Research Database (Denmark)

Lindegaard, C.; Karlsson, L.; Ekstrøm, Claus Thorn

2016-01-01

incision between January 1995 and June 2012 were reviewed. Horses with a laryngotomy incision closed in three layers for primary healing were included. Descriptive data on healing characteristics and complications of laryngotomy wounds were collected from the medical records and via follow......The objective was to report healing characteristics and complications after primary closure of equine laryngotomies and analyse factors potentially associated with complications. This retrospective case series of the medical records of horses (n = 180) undergoing laryngoplasty and laryngotomy...... after primary closure of equine laryngotomy incisions are infrequent and considered of minimal severity and can be performed safely when paying careful attention to the closure of the cricothyroid membrane....

Detailed design report for an operational phase panel-closure system

International Nuclear Information System (INIS)

1996-01-01

Under contract to Westinghouse Electric Corporation (Westinghouse), Waste Isolation Division (WID), IT Corporation has prepared a detailed design of a panel-closure system for the Waste Isolation Pilot Plant (WIPP). Preparation of this detailed design of an operational-phase closure system is required to support a Resource Conservation and Recovery Act (RCRA) Part B permit application and a non-migration variance petition. This report describes the detailed design for a panel-closure system specific to the WIPP site. The recommended panel-closure system will adequately isolate the waste-emplacement panels for at least 35 years. This report provides detailed design and material engineering specifications for the construction, emplacement, and interface-grouting associated with a panel-closure system at the WIPP repository, which would ensure that an effective panel-closure system is in place for at least 35 years. The panel-closure system provides assurance that the limit for the migration of volatile organic compounds (VOC) will be met at the point of compliance, the WIPP site boundary. This assurance is obtained through the inherent flexibility of the panel-closure system

3718-F Alkali Metal Treatment and Storage Facility Closure Plan

International Nuclear Information System (INIS)

1991-12-01

Since 1987, Westinghouse Hanford Company has been a major contractor to the U.S. Department of Energy-Richland Operations Office and has served as co-operator of the 3718-F Alkali Metal Treatment and Storage Facility, the waste management unit addressed in this closure plan. The closure plan consists of a Part A Dangerous waste Permit Application and a RCRA Closure Plan. An explanation of the Part A Revision (Revision 1) submitted with this document is provided at the beginning of the Part A section. The closure plan consists of 9 chapters and 5 appendices. The chapters cover: introduction; facility description; process information; waste characteristics; groundwater; closure strategy and performance standards; closure activities; postclosure; and references

3718-F Alkali Metal Treatment and Storage Facility Closure Plan

Energy Technology Data Exchange (ETDEWEB)

None

1991-12-01

Since 1987, Westinghouse Hanford Company has been a major contractor to the U.S. Department of Energy-Richland Operations Office and has served as co-operator of the 3718-F Alkali Metal Treatment and Storage Facility, the waste management unit addressed in this closure plan. The closure plan consists of a Part A Dangerous waste Permit Application and a RCRA Closure Plan. An explanation of the Part A Revision (Revision 1) submitted with this document is provided at the beginning of the Part A section. The closure plan consists of 9 chapters and 5 appendices. The chapters cover: introduction; facility description; process information; waste characteristics; groundwater; closure strategy and performance standards; closure activities; postclosure; and references.

ASSESSMENT OF LENS THICKNESS IN ANGLE CLOSURE DISEASE

Directory of Open Access Journals (Sweden)

Nishat Sultana Khayoom

2016-08-01

Full Text Available BACKGROUND Anterior chamber depth and lens thickness have been considered as important biometric determinants in primary angle-closure glaucoma. Patients with primary narrow angle may be classified as a primary angle closure suspect (PACS, or as having primary angle closure (PAC or primary angle closure glaucoma (PACG. 23.9% of patients with primary angle closure disease are in India, which highlights the importance of understanding the disease, its natural history, and its underlying pathophysiology, so that we may try to establish effective methods of treatment and preventative measures to delay, or even arrest, disease progression, thereby reducing visual morbidity. AIM To determine the lens thickness using A-scan biometry and its significance in various stages of angle closure disease. MATERIALS AND METHODS Patients attending outpatient department at Minto Ophthalmic Hospital between October 2013 to May 2015 were screened for angle closure disease and subsequently evaluated at glaucoma department. In our study, lens thickness showed a direct correlation with shallowing of the anterior chamber by determining the LT/ ACD ratio. A decrease in anterior chamber depth is proportional to the narrowing of the angle which contributes to the progression of the angle closure disease from just apposition to occlusion enhancing the risk for optic nerve damage and visual field loss. Hence, if the lens thickness values are assessed earlier in the disease process, appropriate intervention can be planned. CONCLUSION Determination of lens changes along with anterior chamber depth and axial length morphometrically can aid in early detection of angle closure. The role of lens extraction for PACG is a subject of increased interest. Lens extraction promotes the benefits of anatomical opening of the angle, IOP reduction and improved vision. This potential intervention may be one among the armamentarium of approaches for PACG. Among the current treatment modalities

Patent foramen ovale closure using a bioabsorbable closure device: safety and efficacy at 6-month follow-up.

Science.gov (United States)

Van den Branden, Ben J; Post, Martijn C; Plokker, Herbert W; ten Berg, Jurriën M; Suttorp, Maarten J

2010-09-01

The aim of this study was to assess the mid-term safety and efficacy of percutaneous patent foramen ovale (PFO) closure using a bioabsorbable device (BioSTAR, NMT Medical, Boston, Massachusetts). Closure of PFO in patients with cryptogenic stroke has proven to be safe and effective using different types of permanent devices. All consecutive patients who underwent percutaneous PFO closure with the bioabsorbable closure device between November 2007 and January 2009 were included. Residual shunt was assessed using contrast transthoracic echocardiography. Sixty-two patients (55% women, mean age 47.7 ± 11.8 years) underwent PFO closure. The in-hospital complications were a surgical device retrieval in 2 patients (3.2%), device reposition in 1 (1.6%), and a minimal groin hematoma in 6 patients (9.7%). The short-term complications at 1-month follow-up (n = 60) were a transient ischemic attack in the presence of a residual shunt in 1 patient and new supraventricular tachycardia in 7 patients (11.3%). At 6-month follow-up (n = 60), 1 patient without residual shunt developed a transient ischemic attack and 1 developed atrial fibrillation. A mild or moderate residual shunt was noted in 51.7%, 33.9%, and 23.7% after 1-day, 1-month, and 6-month follow-up, respectively. A large shunt was present in 8.3%, 3.4%, and 0% after 1-day, 1-month, and 6-month follow-up. Closure of PFO using the bioabsorbable device is associated with a low complication rate and a low recurrence rate of embolic events. However, a relatively high percentage of mild or moderate residual shunting is still present at 6-month follow-up. Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Emergent properties during dorsal closure in Drosophila morphogenesis

International Nuclear Information System (INIS)

Peralta, X G; Toyama, Y; Edwards, G S; Kiehart, D P

2008-01-01

Dorsal closure is an essential stage of Drosophila development that is a model system for research in morphogenesis and biological physics. Dorsal closure involves an orchestrated interplay between gene expression and cell activities that produce shape changes, exert forces and mediate tissue dynamics. We investigate the dynamics of dorsal closure based on confocal microscopic measurements of cell shortening in living embryos. During the mid-stages of dorsal closure we find that there are fluctuations in the width of the leading edge cells but the time-averaged analysis of measurements indicate that there is essentially no net shortening of cells in the bulk of the leading edge, that contraction predominantly occurs at the canthi as part of the process for zipping together the two leading edges of epidermis and that the rate constant for zipping correlates with the rate of movement of the leading edges. We characterize emergent properties that regulate dorsal closure, i.e., a velocity governor and the coordination and synchronization of tissue dynamics

Prevalence of Pressure Ulcer and Nutritional Factors Affecting Wound Closure Success in Thailand.

Science.gov (United States)

Auiwattanakul, Supakrit; Ungpinitpong, Winai; Yutthakasemsunt, Surakrant; Buranapin, Supawan; Chittawatanarat, Kaweesak

2017-09-01

The authors aimed to estimate the prevalence of pressure ulcers and to explore the nutritional effects of the prognostic factors on successful pressure ulcer closure in a public tertiary care hospital in Thailand. The study was a retrospective cohort analysis of seven-year census (2008 - 2014) at Surin hospital in Thailand. There were 424 of total 240,826 patients aged over than 15 years admitted to surgery, orthopedics and medicine wards during the study period with documented pressure ulcers (ICD 10TM). We analyzed four hundred and ten patients after excluding 14 patients with non-pressure ulcers (due to burning/ diabetic/ ischemic neuropathic ulcers, and less than 24 hours of admission) and loss medical record. We selected independent factors from demographic data, nutritional factors, pressure ulcer characteristics, and management data. The outcome of interest was successful pressure ulcer closure. The analysis method was the semi-parametric Cox regression model and reported as Hazard Ratios (HR) with 95% confidence interval (95% CI). The total hospital admission was 240,826 patients between 2008 - 2014. 410 patients were developing pressure ulcers, of these, 7% (28/410) success in ulcer closure, and 77% (314/410) failure in closure requiring for additional procedures (excisional debridement). The rest of patients (16%, 68/410) was non-operative care. The prevalence of pressure ulcers was 1.7 per 1,000 person-year. The multivariable model found that only the Nottingham Hospital Screening Tool (NS) score was a statistically significant nutritional variable, and additional subgroup analysis of two models of sepsis and spinal cord co-morbidities was also significant. Adjusted hazard ratios (HR) for NS score = 0.355 (95% CI: 0.187, 0.674), p=0.002), for sepsis = 0.312 (95% CI: 0.140, 0.695), p=0.004), and for spinal cord co-morbidity = 0.420 (95% CI: 0.184, 0.958), p=0.039). The annual prevalence was 1.7 per 1,000 persons. NS score was strongly associated with

Aesthetic Closure of Maxillary and Mandibular Anterior Spaces Using Direct Composite Resin Build-Ups: A Case Report

Directory of Open Access Journals (Sweden)

Schick Simona-Georgiana

2016-07-01

Full Text Available The presence of multiple spaces in the anterior aesthetic zone can produce discomfort for patients and its treatment can be difficult for dental professionals. A variety of treatment options are available and these include orthodontic movement, prosthetic indirect restorations or direct composite resin build-ups. Among these, the closure of interdental spaces using composite build-ups combined with orthodontic treatment is considered to be most conservative. This type of treatment has several advantages like the maximum preservation of tooth substance (no tooth preparation, no need for anesthesia, no multiple time-consuming visits, no provisional restorations and also comparably low costs. Clinical Consideration: This case report describes the clinical restorative procedure of direct composite resin build-ups for the closure of multiple anterior spaces.

Economic evaluation of closure cap barrier materials study

Energy Technology Data Exchange (ETDEWEB)

Serrato, M.G.; Bhutani, J.S.; Mead, S.M.

1993-09-01

Volume II of the Economic Evaluation of the Closure Cap Barrier Materials, Revision I contains detailed cost estimates for closure cap barrier materials. The cost estimates incorporate the life cycle costs for a generic hazardous waste seepage basin closure cap under the RCRA Post Closure Period of thirty years. The economic evaluation assessed six barrier material categories. Each of these categories consists of several composite cover system configurations, which were used to develop individual cost estimates. The information contained in this report is not intended to be used as a cost estimating manual. This information provides the decision makers with the ability to screen barrier materials, cover system configurations, and identify cost-effective materials for further consideration.

Economic evaluation of closure cap barrier materials study

International Nuclear Information System (INIS)

Serrato, M.G.; Bhutani, J.S.; Mead, S.M.

1993-09-01

Volume II of the Economic Evaluation of the Closure Cap Barrier Materials, Revision I contains detailed cost estimates for closure cap barrier materials. The cost estimates incorporate the life cycle costs for a generic hazardous waste seepage basin closure cap under the RCRA Post Closure Period of thirty years. The economic evaluation assessed six barrier material categories. Each of these categories consists of several composite cover system configurations, which were used to develop individual cost estimates. The information contained in this report is not intended to be used as a cost estimating manual. This information provides the decision makers with the ability to screen barrier materials, cover system configurations, and identify cost-effective materials for further consideration

Key financial ratios can foretell hospital closures.

Science.gov (United States)

Lynn, M L; Wertheim, P

1993-11-01

An analysis of various financial ratios sampled from open and closed hospitals shows that certain leverage, liquidity, capital efficiency, and resource availability ratios can predict hospital closure up to two years in advance of the closure with an accuracy of nearly 75 percent.

Successful transcatheter closure of coronary artery fistula in a child with single coronary artery: a heavy load and a long road.

Science.gov (United States)

Phasalkar, Manjunath; Thakkar, Bhavesh; Poptani, Vishal

2013-07-01

Single coronary artery is an uncommon variation of the coronary circulation. After transposition of great arteries, coronary artery fistulas are the most common associated cardiac anomalies in these patients. Transcatheter closure of coronary artery fistula (CAF) involving single coronary artery is a challenging intervention. In the absence of contralateral coronary artery, a complex anatomy of the CAF and a large myocardial perfusion territory of the dominant circulation pose an additional risk during interventional procedure. We report our experience of a successful transcatheter closure of a coronary artery fistula in a patient with single coronary artery. Copyright © 2013 Wiley Periodicals, Inc.

Hospital closure: Phoenix, Hydra or Titanic?

Science.gov (United States)

Dunne, T; Davis, S

1996-01-01

Very little has been published about the effects of hospital closure in terms of the service, financial or management issues of the process. Attempts through a case-study format to redress the balance and as such represents the reflections of practitioners who have recently undergone the experience of hospital closure and the often neglected issues arising both during and after the process.

Simulating school closure policies for cost effective pandemic decision making

Directory of Open Access Journals (Sweden)

Araz Ozgur M

2012-06-01

Full Text Available Abstract Background Around the globe, school closures were used sporadically to mitigate the 2009 H1N1 influenza pandemic. However, such closures can detrimentally impact economic and social life. Methods Here, we couple a decision analytic approach with a mathematical model of influenza transmission to estimate the impact of school closures in terms of epidemiological and cost effectiveness. Our method assumes that the transmissibility and the severity of the disease are uncertain, and evaluates several closure and reopening strategies that cover a range of thresholds in school-aged prevalence (SAP and closure durations. Results Assuming a willingness to pay per quality adjusted life-year (QALY threshold equal to the US per capita GDP ($46,000, we found that the cost effectiveness of these strategies is highly dependent on the severity and on a willingness to pay per QALY. For severe pandemics, the preferred strategy couples the earliest closure trigger (0.5% SAP with the longest duration closure (24 weeks considered. For milder pandemics, the preferred strategies also involve the earliest closure trigger, but are shorter duration (12 weeks for low transmission rates and variable length for high transmission rates. Conclusions These findings highlight the importance of obtaining early estimates of pandemic severity and provide guidance to public health decision-makers for effectively tailoring school closures strategies in response to a newly emergent influenza pandemic.

Potential socio-economic consequences of mine closure

Directory of Open Access Journals (Sweden)

Marietjie Ackermann

2018-01-01

Full Text Available Background: Mine closures generally reveal negligence on the part of mining houses, not only in terms of the environment, but also the surrounding mining communities. Aim: This article reflects on the findings of research into the socio-economic consequences of mine closure. The research specifically explored how mineworkers’ dependency on their employment at a mine affects their ability to sustain their livelihood. Setting: The research was conducted at the Orkney Mine and the Grootvlei Mine (Springs. Methods: The research was conducted within a naturalistic domain, guided by a relativist orientation, a constructivist ontology and an interpretivist epistemology. Data were collected by means of document analysis, semi-structured interviews, focus group discussion and unstructured observation. Results: From the research findings, it is evident that mine closures, in general, have a devastating effect on the surrounding mining communities as well as on the employees. Mine closures in the case studies gradually depleted the mining communities’ livelihood assets and resulted in the collapse of their coping strategies and livelihood outcomes. It generally affected the communities’ nutrition, health, education, food security, water, shelter, levels of community participation and personal safety. Conclusion: If not managed efficiently and effectively, mine closures may pose significant challenges to the mining industry, government, the environment, national and local economic prosperity and communities in the peripheral areas of mines. This truly amplifies that mine closure, whether temporary or permanent, is an issue that needs to be addressed with responsibility towards all stakeholders, including the mining community and the labour force.

Top closure for control rod drive for nuclear reactor

International Nuclear Information System (INIS)

Raas, J.H.; Schwartz, J.I.

1978-01-01

A removable top closure and venting assembly for the tubular housing of a control rod drive includes a mounting ring threadably inserted in the upper end of the housing, a fluid-sealing closure member beneath the mounting ring and which is mounted in and coupled to the mounting ring by means of a ball and socket joint, a gas vent defined by interconnecting passages extending through the closure and through the ball and socket joint, and a vent valve accessible from the top of the closure assembly. 3 claims, 2 figures

Transcatheter closure of ventricular septal defect with Occlutech Duct Occluder.

Science.gov (United States)

Atik-Ugan, Sezen; Saltik, Irfan Levent

2018-04-01

Patent ductus arteriosus occluders are used for transcatheter closure of ventricular septal defects, as well as for closure of patent ductus arteriosus. The Occlutech Duct Occluder is a newly introduced device for transcatheter closure of patent ductus arteriosus. Here, we present a case in which the Occlutech Duct Occluder was successfully used on a patient for the closure of a perimembraneous ventricular septal defect.

Seven-year follow-up of percutaneous closure of patent foramen ovale.

Science.gov (United States)

Mirzada, Naqibullah; Ladenvall, Per; Hansson, Per-Olof; Johansson, Magnus Carl; Furenäs, Eva; Eriksson, Peter; Dellborg, Mikael

2013-12-01

Observational studies favor percutaneous closure of patent foramen ovale (PFO) over medical treatment to reduce recurrent stroke while randomized trials fail to demonstrate significant superiority of percutaneous PFO closure. Few long-term studies are available post PFO closure. This study reports long-term clinical outcomes after percutaneous PFO closure. Between 1997 and 2006, 86 consecutive eligible patients with cerebrovascular events, presumably related to PFO, underwent percutaneous PFO closure. All 86 patients were invited to a long-term follow-up, which was carried out during 2011 and 2012. Percutaneous PFO closure was successfully performed in 85 of 86 patients. The follow-up rate was 100%. No cardiovascular or cerebrovascular deaths occurred. Two patients (both women) died from lung cancer during follow-up. Follow-up visits were conducted for 64 patients and the remaining 20 patients were followed up by phone. The mean follow-up time was 7.3 years (5 to 12.4 years). Mean age at PFO closure was 49 years. One patient had a minor stroke one month after PFO closure and a transient ischemic attack (TIA) two years afterwards. One other patient suffered from a TIA six years after closure. No long-term device-related complications were observed. Percutaneous PFO closure was associated with very low risk of recurrent stroke and is suitable in most patients. We observed no mortality and no long-term device-related complications related to PFO closure, indicating that percutaneous PFO closure is a safe and efficient treatment even in the long term.

Permanent Closure of the TAN-664 Underground Storage Tank

Energy Technology Data Exchange (ETDEWEB)

Bradley K. Griffith

2011-12-01

This closure package documents the site assessment and permanent closure of the TAN-664 gasoline underground storage tank in accordance with the regulatory requirements established in 40 CFR 280.71, 'Technical Standards and Corrective Action Requirements for Owners and Operators of Underground Storage Tanks: Out-of-Service UST Systems and Closure.'

Single-shell tank closure work plan. Revision A

Energy Technology Data Exchange (ETDEWEB)

NONE

1995-06-01

In January 1994, the Hanford Federal Facility Agreement and Conset Order (Tri-Party Agreement) was amended to reflect a revised strategy for remediation of radioactive waste in underground storage tanks. These amendments include milestones for closure of the single-shell tank (SST) operable units, to be initiated by March 2012 and completed by September 2024. This SST-CWP has been prepared to address the principal topical areas identified in Tri-Party Agreement Milestone M-45-06 (i.e., regulatory pathway, operable unit characterization, waste retrieval, technology development, and a strategy for achieving closure). Chapter 2.0 of this SST-CWP provides a brief description of the environmental setting, SST System, the origin and characteristics of SST waste, and ancillary equipment that will be remediated as part of SST operable unit closure. Appendix 2A provides a description of the hydrogeology of the Hanford Site, including information on the unsaturated sediments (vadose zone) beneath the 200 Areas Plateau. Chapter 3.0 provides a discussion of the laws and regulations applicable to closure of the SST farm operable units. Chapter 4.0 provides a summary description of the ongoing characterization activities that best align with the proposed regulatory pathway for closure. Chapter 5.0 describes aspects of the SST waste retrieval program, including retrieval strategy, technology, and sequence, potential tank leakage during retrieval, and considerations of deployment of subsurface barriers. Chapter 6.0 outlines a proposed strategy for closure. Chapter 7.0 provides a summary of the programs underway or planned to develop technologies to support closure. Ca. 325 refs.

Single-shell tank closure work plan. Revision A

International Nuclear Information System (INIS)

1995-06-01

In January 1994, the Hanford Federal Facility Agreement and Conset Order (Tri-Party Agreement) was amended to reflect a revised strategy for remediation of radioactive waste in underground storage tanks. These amendments include milestones for closure of the single-shell tank (SST) operable units, to be initiated by March 2012 and completed by September 2024. This SST-CWP has been prepared to address the principal topical areas identified in Tri-Party Agreement Milestone M-45-06 (i.e., regulatory pathway, operable unit characterization, waste retrieval, technology development, and a strategy for achieving closure). Chapter 2.0 of this SST-CWP provides a brief description of the environmental setting, SST System, the origin and characteristics of SST waste, and ancillary equipment that will be remediated as part of SST operable unit closure. Appendix 2A provides a description of the hydrogeology of the Hanford Site, including information on the unsaturated sediments (vadose zone) beneath the 200 Areas Plateau. Chapter 3.0 provides a discussion of the laws and regulations applicable to closure of the SST farm operable units. Chapter 4.0 provides a summary description of the ongoing characterization activities that best align with the proposed regulatory pathway for closure. Chapter 5.0 describes aspects of the SST waste retrieval program, including retrieval strategy, technology, and sequence, potential tank leakage during retrieval, and considerations of deployment of subsurface barriers. Chapter 6.0 outlines a proposed strategy for closure. Chapter 7.0 provides a summary of the programs underway or planned to develop technologies to support closure. Ca. 325 refs

Social and macro economic impact of closure

International Nuclear Information System (INIS)

Medeliene, D.

1999-01-01

The social consequences of closure of Ignalina NPP will largely depend on the actions the Government takes. If it puts in place the conditions which enable the International Financial Institutions to assist Lithuania, both in providing loans and grants for decommissioning and (in the case of the EU) providing Structural Adjustment Funds for the regional economic development of the Visaginas area, then solutions to the problems of closure can be found. But if the Government delays putting into place the necessary conditions, then Lithuania will be left to solve the problems of - inter alia necessary - closure of Ignalina NPP on its own. (author)

Angle closure glaucoma in congenital ectropion uvea

Directory of Open Access Journals (Sweden)

Grace M. Wang

2018-06-01

Full Text Available Purpose: Congenital ectropion uvea is a rare anomaly, which is associated with open, but dysplastic iridocorneal angles that cause childhood glaucoma. Herein, we present 3 cases of angle-closure glaucoma in children with congenital ectropion uvea. Observations: Three children were initially diagnosed with unilateral glaucoma secondary to congenital ectropion uvea at 7, 8 and 13 years of age. The three cases showed 360° of ectropion uvea and iris stromal atrophy in the affected eye. In one case, we have photographic documentation of progression to complete angle closure, which necessitated placement of a glaucoma drainage device 3 years after combined trabeculotomy and trabeculectomy. The 2 other cases, which presented as complete angle closure, also underwent glaucoma drainage device implantation. All three cases had early glaucoma drainage device encapsulation (within 4 months and required additional surgery (cycloablation or trabeculectomy. Conclusions and importance: Congenital ectropion uvea can be associated with angle-closure glaucoma, and placement of glaucoma drainage devices in all 3 of our cases showed early failure due to plate encapsulation. Glaucoma in congenital ectropion uvea requires attention to angle configuration and often requires multiple surgeries to obtain intraocular pressure control. Keywords: Congenital ectropion uvea, Juvenile glaucoma, Angle-closure glaucoma, Glaucoma drainage device

Strategic Planning for Hot Cell Closure

International Nuclear Information System (INIS)

LANGSTAFF, D.C.

2001-01-01

The United States Department of Energy (DOE) and its contractor were remediating a large hot cell complex to mitigate the radiological hazard. A Resource Conservation and Recovery Act (RCRA) closure unit was determined to be located within the complex. The regulator established a challenge to develop an acceptable closure plan on a short schedule (four months). The scope of the plan was to remove all excess equipment and mixed waste from the closure unit, establish the requirements of the legally binding Closure Plan and develop an acceptable schedule. The complex has several highly radioactive tanks, tank vaults, piping, and large hot cells containing complex chemical processing equipment. Driven by a strong need to develop an effective strategy to meet cleanup commitments, three principles were followed to develop an acceptable plan: (1) Use a team approach, (2) Establish a buffer zone to support closure, and (3) Use good practice when planning the work sequence. The team was composed of DOE, contractor, and Washington State Department of Ecology (Regulator) staff. The team approach utilized member expertise and fostered member involvement and communication. The buffer zone established an area between the unregulated parts of the building and the areas that were allegedly not in compliance with environmental standards. Introduction of the buffer zone provided simplicity, clarity, and flexibility into the process. Using good practice means using the DOE Integrated Safety Management Core Functions for planning and implementing work safely. Paying adequate attention to detail when the situation required contributed to the process credibility and a successful plan

Proposed modifications to the RCRA post-closure permit for the Bear Creek Hydrogeologic Regime at the US Department of Energy Y-12 Plant, Oak Ridge, Tennessee

International Nuclear Information System (INIS)

1997-05-01

This report presents proposed modifications to several conditions of the Resource Conservation and Recovery Act (RCRA) Post-Closure Permit (PCP) for the Bear Creek Hydrogeologic Regime (BCHR). These permit conditions define the requirements for RCRA post-closure corrective action groundwater monitoring at the S-3 Ponds, the Oil Landfarm, and the Bear Creek Burial Grounds (units A, C-West, and Walk-in Pits). Modification of these PCP conditions is requested to: (1) clarify the planned integration of RCRA post-closure corrective action groundwater monitoring with the monitoring program to be established in the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) Record of Decision (ROD) for the Bear Creek Valley (BCV) Watershed, (2) revise several of the current technical requirements for groundwater monitoring based on implementation of the RCRA post-closure corrective action monitoring program during 1996, and (3) update applicable technical procedures with revised versions recently issued by the Y-12 Plant Groundwater Protection Program (GWPP). With these modifications, the Y-12 Plant will continue to meet the full intent of all regulatory obligations for post-closure care of these facilities. Section 2.0 provides the technical justification for each proposed permit modification. The proposed changes to permit language are provided in Section 3.0 (S-3 Ponds), Section 4.0 (Oil Landfarm), and Section 5.0 (Bear Creek Burial Grounds). Sections 6.0 and 7.0 reference updated and revised procedures for groundwater sampling, and monitoring well plugging and abandonment, respectively. Appendix A includes all proposed revisions to the PCP Attachments

Proposed modifications to the RCRA post-closure permit for the Bear Creek Hydrogeologic Regime at the US Department of Energy Y-12 Plant, Oak Ridge, Tennessee

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-05-01

This report presents proposed modifications to several conditions of the Resource Conservation and Recovery Act (RCRA) Post-Closure Permit (PCP) for the Bear Creek Hydrogeologic Regime (BCHR). These permit conditions define the requirements for RCRA post-closure corrective action groundwater monitoring at the S-3 Ponds, the Oil Landfarm, and the Bear Creek Burial Grounds (units A, C-West, and Walk-in Pits). Modification of these PCP conditions is requested to: (1) clarify the planned integration of RCRA post-closure corrective action groundwater monitoring with the monitoring program to be established in the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) Record of Decision (ROD) for the Bear Creek Valley (BCV) Watershed, (2) revise several of the current technical requirements for groundwater monitoring based on implementation of the RCRA post-closure corrective action monitoring program during 1996, and (3) update applicable technical procedures with revised versions recently issued by the Y-12 Plant Groundwater Protection Program (GWPP). With these modifications, the Y-12 Plant will continue to meet the full intent of all regulatory obligations for post-closure care of these facilities. Section 2.0 provides the technical justification for each proposed permit modification. The proposed changes to permit language are provided in Section 3.0 (S-3 Ponds), Section 4.0 (Oil Landfarm), and Section 5.0 (Bear Creek Burial Grounds). Sections 6.0 and 7.0 reference updated and revised procedures for groundwater sampling, and monitoring well plugging and abandonment, respectively. Appendix A includes all proposed revisions to the PCP Attachments.

Subcostal closure technique for prevention of postthoracotomy pain syndrome.

Science.gov (United States)

Hong, Kipyo; Bae, Mikyung; Han, Sora

2016-09-01

The purpose of this study was to evaluate the efficacy of our subcostal closure technique in prevention of postthoracotomy pain syndrome. From July 2012 to March 2015, 29 patients in whom a lobectomy was indicated underwent a thoracotomy. The thoracotomy wounds were closed using a subcostal closure technique (subcostal closure group) and outcomes were compared with 31 patients who underwent video-assisted thoracoscopic surgery (thoracoscopy group). The duration of oral opioid consumption was evaluated from medical records, and postoperative pain was evaluated by telephone interview conducted by a trained nurse practitioner who was unaware of the patient's group. Pain scores were higher in the thoracoscopy group compared to the subcostal closure group, reaching statistical significance (Numeric Rating Scale 0.55 ± 0.948 in the subcostal closure group vs. 1.84 ± 1.614 in the thoracoscopy group; p Pain Scale 0.24 ± 0.435 in the subcostal closure group vs. 0.81 ± 0.703 in the thoracoscopy group; p pain syndrome. © The Author(s) 2016.

Comparing over-the-scope clip versus endoloop and clips (KING closure) for access site closure: a randomized experimental study

Czech Academy of Sciences Publication Activity Database

Martínek, J.; Ryska, O.; Tučková, I.; Filípková, T.; Doležel, R.; Juhás, Štefan; Motlík, Jan; Zavoral, M.; Ryska, M.

2013-01-01

Roč. 27, č. 4 (2013), s. 1203-1210 ISSN 0930-2794 R&D Projects: GA MZd NS9994 Institutional research plan: CEZ:AV0Z50450515 Keywords : NOTES * gastrotomy closure * rectotomy closure Subject RIV: FJ - Surgery incl. Transplants Impact factor: 3.313, year: 2013

Hexone Storage and Treatment Facility closure plan

International Nuclear Information System (INIS)

1992-11-01

The HSTF is a storage and treatment unit subject to the requirements for the storage and treatment of dangerous waste. Closure is being conducted under interim status and will be completed pursuant to the requirements of Washington State Department of Ecology (Ecology) Dangerous Waste Regulations, Washington Administrative Code (WAC) 173-303-610 and WAC 173-303-640. Because dangerous waste does not include the source, special nuclear, and by-product material components of mixed waste, radionuclides are not within the scope of WAC 173-303 or of this closure plan. The information on radionuclides is provided only for general knowledge where appropriate. The known hazardous/dangerous waste remaining at the site before commencing other closure activities consists of the still vessels, a tarry sludge in the storage tanks, and residual contamination in equipment, piping, filters, etc. The treatment and removal of waste at the HSTF are closure activities as defined in the Resource Conservation and Recovery Act (RCRA) of 1976 and WAC 173-303

Long-term follow up after transcatheter closure of atrial septal defect and patent foramen ovale in adults

Directory of Open Access Journals (Sweden)

Jure Dolenc

2014-01-01

Full Text Available Background: The aim of our study was to define long-term electrocardiographic and echocardiographic changes and complications after transcatheter closure of atrial septal defect and patent foramen ovale in adults.Methods: The clinical, electrocardiographic and echocardiographic follow-up of 137 consecutive patients that underwent transcatheter closure of atrial septal defect (51 patients or patent foramen ovale (86 patients in a 10-year period was analyzed retrospectively.Results: In the patent foramen ovale group, we observed no significant postprocedural changes. There were no changes in heart rate, heart rhythm and PR or QRS duration in both groups. In the atrial septal defect group, we observed a leftward shift in the heart axis (p = 0.017, a decrease in the estimated systolic pulmonary artery pressure (p = 0.024, decreased tricuspid early diastolic flow velocity (p = 0.002, a decrease in the right chamber dimensions (p = 0.0004 and interventricular septal movement normalization (p < 0.0001. Most of the complications were mild and occurred early after the procedure. Three early serious complications were documented.Conclusions: No electrocardiographic or echocardiographic changes occurred after patent foramen ovale closure. Atrial septal defect closure is related to significant early morphological and hemodynamic improvement. Postprocedural complications are usually early and mild but serious late complications can occur. For that reason, long-term follow up is recommended in these patients.

Project Management Approach to Transition of the Miamisburg Closure Project From Environmental Cleanup to Post-Closure Operations

International Nuclear Information System (INIS)

Carpenter, C.P.; Marks, M.L.; Smiley, S.L.; Gallaher, D.M.; Williams, K.D.

2006-01-01

The U.S. Department of Energy (DOE) used a project management approach to transition the Miamisburg Closure Project from cleanup by the Office of Environmental Management (EM) to post-closure operations by the Office of Legacy Management (LM). Two primary DOE orders were used to guide the site transition: DOE Order 430.1B, Real Property Asset Management, for assessment and disposition of real property assets and DOE Order 413.3, Program and Project Management for Acquisition of Capital Assets, for project closeout of environmental cleanup activities and project transition of post-closure activities. To effectively manage these multiple policy requirements, DOE chose to manage the Miamisburg Closure Project as a project under a cross-member transitional team using representatives from four principal organizations: DOE-LM, the LM contractor S.M. Stoller Corporation, DOE-EM, and the EM contractor CH2M Hill Mound Inc. The mission of LM is to manage the Department's post-transition responsibilities and long-term care of legacy liabilities and to ensure the future protection of human health and the environment for cleanup sites after the EM has completed its cleanup activities. (authors)

Influence of timing of delayed hard palate closure on articulation skills in 3-year-old Danish children with unilateral cleft lip and palate

DEFF Research Database (Denmark)

Willadsen, Elisabeth; Boers, Maria; Schöps, Antje

2017-01-01

Background Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. Aims To assess the influence of different timing of hard palate closure in a two-stage procedure on articu......Background Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. Aims To assess the influence of different timing of hard palate closure in a two-stage procedure...... on articulation skills in 3-year-olds born with unilateral cleft lip and palate (UCLP). Secondary aims were to compare results with peers without CP, and to investigate if there are gender differences in articulation skills. Furthermore, burden of treatment was to be estimated in terms of secondary surgery...

Design, production and initial state of the closure

International Nuclear Information System (INIS)

2010-12-01

The report is included in a set of Production reports, presenting how the KBS-3 repository is designed, produced and inspected. The production reports are included in the safety report for the KBS-3 repository and repository facility. The report provides input on the initial state of the closure and plugs in underground openings other than deposition tunnels for the assessment of the long-term safety, SR-Site. The initial state refers to the properties of the engineered barriers once they have been finally placed in the KBS-3 repository and will not be further handled within the repository facility. In addition, the report provides some input to the operational safety report, SR-Operation, on how the closure and plugs shall be handled and installed. The report presents the design premises and reference designs of the closure and plugs and verifies their conformity to the design premises. It also briefly deals with the production of the closure and plugs. Finally, the initial state of the closure and plugs and their conformity to the reference designs and design premises are presented

Design, production and initial state of the closure

Energy Technology Data Exchange (ETDEWEB)

2010-12-15

The report is included in a set of Production reports, presenting how the KBS-3 repository is designed, produced and inspected. The production reports are included in the safety report for the KBS-3 repository and repository facility. The report provides input on the initial state of the closure and plugs in underground openings other than deposition tunnels for the assessment of the long-term safety, SR-Site. The initial state refers to the properties of the engineered barriers once they have been finally placed in the KBS-3 repository and will not be further handled within the repository facility. In addition, the report provides some input to the operational safety report, SR-Operation, on how the closure and plugs shall be handled and installed. The report presents the design premises and reference designs of the closure and plugs and verifies their conformity to the design premises. It also briefly deals with the production of the closure and plugs. Finally, the initial state of the closure and plugs and their conformity to the reference designs and design premises are presented

Digital signal processing of data from borehole creep closure

International Nuclear Information System (INIS)

Chakrabarti, S.; Patrick, W.C.; Duplancic, N.

1987-01-01

Digital signal processing, a technique commonly used in the fields of electrical engineering and communication technology, has been successfully used to analyze creep closure data obtained from a 0.91 m diameter by 5.13 deep borehole in bedded salt. By filtering the ''noise'' component of the closure data from a test borehole, important data trends were made more evident and average creep closure rates were able to be calculated. This process provided accurate estimates of closure rates that are used in the design of lined boreholes in which heat-generating transuranic nuclear wastes are emplaced at the Waste Isolation Pilot Plant

40 CFR 264.119 - Post-closure notices.

Science.gov (United States)

2010-07-01

...) STANDARDS FOR OWNERS AND OPERATORS OF HAZARDOUS WASTE TREATMENT, STORAGE, AND DISPOSAL FACILITIES Closure... closure of each hazardous waste disposal unit, the owner or operator must submit to the local zoning... disposal unit of the facility. For hazardous wastes disposed of before January 12, 1981, the owner or...

A closure test for time-specific capture-recapture data

Science.gov (United States)

Stanley, T.R.; Burnham, K.P.

1999-01-01

The assumption of demographic closure in the analysis of capture-recapture data under closed-population models is of fundamental importance. Yet, little progress has been made in the development of omnibus tests of the closure assumption. We present a closure test for time-specific data that, in principle, tests the null hypothesis of closed-population model M(t) against the open-population Jolly-Seber model as a specific alternative. This test is chi-square, and can be decomposed into informative components that can be interpreted to determine the nature of closure violations. The test is most sensitive to permanent emigration and least sensitive to temporary emigration, and is of intermediate sensitivity to permanent or temporary immigration. This test is a versatile tool for testing the assumption of demographic closure in the analysis of capture-recapture data.

RELAP-7 Closure Correlations

Energy Technology Data Exchange (ETDEWEB)

Zou, Ling [Idaho National Lab. (INL), Idaho Falls, ID (United States); Berry, R. A. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Martineau, R. C. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Andrs, D. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Zhang, H. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Hansel, J. E. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Sharpe, J. P. [Idaho National Lab. (INL), Idaho Falls, ID (United States); Johns, Russell C. [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

2017-04-01

The RELAP-7 code is the next generation nuclear reactor system safety analysis code being developed at the Idaho National Laboratory (INL). The code is based on the INL’s modern scientific software development framework, MOOSE (Multi-Physics Object Oriented Simulation Environment). The overall design goal of RELAP-7 is to take advantage of the previous thirty years of advancements in computer architecture, software design, numerical integration methods, and physical models. The end result will be a reactor systems analysis capability that retains and improves upon RELAP5’s and TRACE’s capabilities and extends their analysis capabilities for all reactor system simulation scenarios. The RELAP-7 code utilizes the well-posed 7-equation two-phase flow model for compressible two-phase flow. Closure models used in the TRACE code has been reviewed and selected to reflect the progress made during the past decades and provide a basis for the colure correlations implemented in the RELAP-7 code. This document provides a summary on the closure correlations that are currently implemented in the RELAP-7 code. The closure correlations include sub-grid models that describe interactions between the fluids and the flow channel, and interactions between the two phases.

The effectiveness of eye-closure in repeated interviews

OpenAIRE

Vredeveldt, A.; Baddeley, A.D.; Hitch, G.J.

2014-01-01

Purpose Closing the eyes during recall can help witnesses remember more about a witnessed event. This study examined the effectiveness of eye-closure in a repeated recall paradigm with immediate free recall followed 1 week later by both free and cued recall. We examined whether eye-closure was more or less effective during the second free-recall attempt compared with the first, whether eye-closure during the first recall attempt had an impact on subsequent free- and cued-recall performance, a...

Transcatheter Closure of Patent Ductus Arteriosus in Extremely Premature Newborns: Early Results and Midterm Follow-Up.

Science.gov (United States)

Zahn, Evan M; Peck, Daniel; Phillips, Alistair; Nevin, Phillip; Basaker, Kaylan; Simmons, Charles; McRae, Marion E; Early, Tracy; Garg, Ruchira

2016-12-12

The goal of this study was to describe early and midterm outcomes of extremely premature newborns (EPNs) who underwent transcatheter echocardiographically guided patent ductus arteriosus (PDA) closure. Surgical ligation of PDA in EPNs confers significant risk for procedural morbidity and adverse long-term outcomes. The Amplatzer Vascular Plug II was used in all cases. Post-ligation syndrome was defined using previously published parameters. Patients were followed at pre-specified intervals, and prospectively collected data were reviewed. Transcatheter closure was attempted in 24 EPNs (mean procedural age 30 days [range 5 to 80 days], mean procedural weight 1,249 g [range 755 to 2,380 g]) and was successful in 88%. The 3 procedural failures were related to the development of left pulmonary artery (LPA) stenosis caused by the device, and all devices were removed uneventfully. Complications included 2 instances of device malposition, resolved with device repositioning, and 1 instance of LPA stenosis, requiring an LPA stent. There were no procedural deaths, cases of post-ligation syndrome, residual PDA, or device embolization. Survival to discharge was 96% (23 of 24), with a single late death unrelated to the procedure. After a median follow-up period of 11.1 months, all patients were alive and well, with no residual PDA or evidence of LPA or aortic coarctation. This newly described technique can be performed safely with a high success rate and minimal procedural morbidity in EPNs. Early and midterm follow-up is encouraging. Future efforts should be directed toward developing specific devices for this unique application. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Closure of the squared Zakharov--Shabat eigenstates

International Nuclear Information System (INIS)

Kaup, D.J.

1976-01-01

By solution of the inverse scattering problem for a third-order (degenerate) eigenvalue problem, the closure of the squared eigenfunctions of the Zakharov--Shabat equations is found. The question of the completeness of squared eigenstates occurs in many aspects of ''inverse scattering transforms'' (solving nonlinear evolution equations exactly by inverse scattering techniques), as well as in various aspects of the inverse scattering problem. The method used here is quite suggestive as to how one might find the closure of the squared eigenfunctions of other eigenvalue equations, and the strong analogy between these results and the problem of finding the closure of the eigenvectors of a nonself-adjoint matrix is pointed out

Cost-effectiveness analysis of different devices used for the closure of small-to-medium-sized patent ductus arteriosus in pediatric patients

Science.gov (United States)

El-Saiedi, Sonia A; El Sisi, Amal M; Mandour, Rodina Sobhy; Abdel-Aziz, Doaa M; Attia, Wael A

2017-01-01

Aims: In this study, we examined the differences in cost and effectiveness of various devices used for the closure of small to medium sized patent ductus arteriosus (PDA). Setting and Design: We retrospectively studied 116 patients who underwent closure of small PDAs between January 2010 and January 2015. Subjects and Methods: Three types of devices were used: the Amplatzer duct occluder (ADO) II, the cook detachable coil and the Nit Occlud coil (NOC). Immediate and late complications were recorded and patients were followed up for 3 months after the procedure. Statistical Methods: All statistical calculations were performed using Statistical Package for the Social Science software. P closure of small-to medium-sized PDAs. Calculations of the incremental cost-effectiveness. (ICE) revealed that the Cook detachable coil had less ICE than the ADO II and NOC. The NOC was more effective with fewer complications. PMID:28566822

Comparison of surgical time and complication rate of subcutaneous and skin closure using barbed suture or traditional knotted suture in dogs.

Science.gov (United States)

Nutt, Laura K; Wilson, Megan L; Sakals, Sherisse

2017-12-01

This prospective study evaluated the handling, intraoperative and postoperative complication rates of a barbed knotless suture for closure of subcutaneous tissue and skin in 17 client-owned dogs (group A) following a tibial plateau leveling osteotomy procedure. Clinical characteristics, surgical time, and complication rates were compared to a control group of 17 client-owned dogs (group B) with subcutaneous tissue and skin closure using traditional suture material. Signalment was not significantly different between groups and did not have an effect on complication rates. Surgical times were not significantly different for subcutaneous tissue or skin closure between the 2 groups. There were significantly more intraoperative complications in the barbed suture group (A: 4/17; B: 0/17; P = 0.033) but no difference in minor or major postoperative complication rates (minor A: 2/16; B: 1/14; P = 0.626, major A: 2/16; B: 0/14; P = 0.171).

The Office of Site Closure: Progress in the Face of Challenges

International Nuclear Information System (INIS)

Fiore, J. J.; Murphie, W. E.; Meador, S. W.

2002-01-01

The Office of Site Closure (OSC) was formed in November 1999 when the Department of Energy's (DOE's) Office of Environmental Management (EM) reorganized to focus specifically on site cleanup and closure. OSC's objective is to achieve safe and cost-effective cleanups and closures that are protective of our workers, the public, and the environment, now and in the future. Since its inception, OSC has focused on implementing a culture of safe closure, with emphasis in three primary areas: complete our responsibility for the Closure Sites Rocky Flats, Mound, Fernald, Ashtabula, and Weldon Spring; complete our responsibility for cleanup at sites where the DOE mission has been completed (examples include Battelle King Avenue and Battelle West Jefferson in Columbus, and General Atomics) or where other Departmental organizations have an ongoing mission (examples include the Brookhaven, Livermore, or Los Alamos National Laboratories, and the Nevada Test Site); and create a framework a nd develop specific business closure tools that will help sites close, such as guidance for and decisions on post-contract benefit liabilities, records retention, and Federal employee incentives for site closure. This paper discusses OSC's 2001 progress in achieving site cleanups, moving towards site closure, and developing specific business closure tools to support site closure. It describes the tools used to achieve progress towards cleanup and closure, such as the application of new technologies, changes in contracting approaches, and the development of agreements between sites and with host states. The paper also identifies upcoming challenges and explores options for how Headquarters and the sites can work together to address these challenges. Finally, it articulates OSC's new focus on oversight of Field Offices to ensure they have the systems in place to oversee contractor activities resulting in site cleanups and closures

Stomal Closure: Strategies to Prevent Incisional Hernia

Science.gov (United States)

Harries, Rhiannon L.; Torkington, Jared

2018-01-01

Incisional hernias following ostomy reversal occur frequently. Incisional hernias at the site of a previous stoma closure can cause significant morbidity, impaired quality of life, lead to life-threatening hernia incarceration or strangulation and result in a significant financial burden on health care systems Despite this, the evidence base on the subject is limited. Many recognised risk factors for the development of incisional hernia following ostomy reversal are related to patient factors such as age, malignancy, diabetes, COPD, hypertension and obesity, and are not easily correctable. There is a limited amount of evidence to suggest that prophylactic mesh reinforcement may be of benefit to reduce the post stoma closure incisional hernia rate but a further large scale randomised controlled trial is due to report in the near future. There appears to be weak evidence to suggest that surgeons should favour circular, or “purse-string” closure of the skin following stoma closure in order to reduce the risk of SSI, which in turn may reduce incisional hernia formation. There remains the need for further evidence in relation to suture technique, skin closure techniques, mechanical bowel preparation and oral antibiotic prescription focusing on incisional hernia development as an outcome measure. Within this review, we discuss in detail the evidence base for the risk factors for the development of, and the strategies to prevent ostomy reversal site incisional hernias. PMID:29670882

Stomal Closure: Strategies to Prevent Incisional Hernia

Directory of Open Access Journals (Sweden)

Rhiannon L. Harries

2018-04-01

Full Text Available Incisional hernias following ostomy reversal occur frequently. Incisional hernias at the site of a previous stoma closure can cause significant morbidity, impaired quality of life, lead to life-threatening hernia incarceration or strangulation and result in a significant financial burden on health care systems Despite this, the evidence base on the subject is limited. Many recognised risk factors for the development of incisional hernia following ostomy reversal are related to patient factors such as age, malignancy, diabetes, COPD, hypertension and obesity, and are not easily correctable. There is a limited amount of evidence to suggest that prophylactic mesh reinforcement may be of benefit to reduce the post stoma closure incisional hernia rate but a further large scale randomised controlled trial is due to report in the near future. There appears to be weak evidence to suggest that surgeons should favour circular, or “purse-string” closure of the skin following stoma closure in order to reduce the risk of SSI, which in turn may reduce incisional hernia formation. There remains the need for further evidence in relation to suture technique, skin closure techniques, mechanical bowel preparation and oral antibiotic prescription focusing on incisional hernia development as an outcome measure. Within this review, we discuss in detail the evidence base for the risk factors for the development of, and the strategies to prevent ostomy reversal site incisional hernias.

Case Report: Rapid staged abdominal closure using Gore-Tex® mesh as a bridge to primary omphalocele sac closure

Directory of Open Access Journals (Sweden)

William C. Kethman

2016-06-01

Full Text Available Omphaloceles present an ongoing challenge due to significant variations in presentation and associated co-morbidities. Diverse management strategies have been described to tackle many of the fundamental challenges of closure and reconstruction of the abdominal wall – this fact demonstrates a need for increasingly individualized management options for this complex disease. We describe a novel method of rapid staged abdominal wall closure using Gore-Tex® mesh as a bridge to primary omphalocele closure in an infant with partial Pentalogy of Cantrell and giant ruptured omphalocele. This strategy can be used in management of some of the most complex abdominal wall defects.

Bidirectional Barbed Sutures for Wound Closure: Evolution and Applications

Science.gov (United States)

Paul, Malcolm D.

2009-01-01

Traditionally, wound closure sutures have in common the need to tie knots with the inherent risk of extrusion, palpability, microinfarcts, breakage, and slippage. Bidirectional barbed sutures have barbs arrayed in a helical fashion in opposing directions on either side of an unbarbed midsegment. This suture is inserted at the midpoint of a wound and pulled through till resistance is encountered from the opposing barbs; each half of the suture is then advanced to the lateral ends of the wound. This design provides a method of evenly distributing tension along the incision line, a faster suture placement and closure time with no need to tie knots, and the possibility of improved cosmesis. Bidirectional barbed sutures, which are available in both absorbable and nonabsorbable forms, can be used for simple closures, multilayered closures, and closure of high-tension wounds in a variety of surgical settings. PMID:24527114

Primary angle closure glaucoma in a myopic kinship.

Science.gov (United States)

Hagan, J C; Lederer, C M

1985-03-01

Three related myopic individuals with primary angle closure glaucoma are reported. They had true myopia and not pseudomyopia secondary to increased lenticular index of refraction. We believe one of these individuals (-8.62 spherical equivalent) to have the most myopic case of primary angle closure glaucoma reported in the literature. Although myopia is associated with anatomical factors that offer considerable protection from primary angle closure glaucoma, its presence does not eliminate the possibility of this disease. Laser iridectomy was effective in the treatment of these patients.

Closure of a mixed waste landfill: Lessons learned

International Nuclear Information System (INIS)

Phifer, M.A.

1990-01-01

Much experience has been gained during the closure of the Mixed Waste Management Facility (MWMF) at the Savannah River Site (SRS) and many lessons were learned. This knowledge was applied to other closures at SRS yielding decreased costs, schedule enhancement, and increased overall project efficiency. The next major area of experience to be gained at SRS in the field of waste site closures will be in the upkeep, maintenance, and monitoring of clay caps. Further test programs will be required to address these requirements

Hamiltonian closures in fluid models for plasmas

Science.gov (United States)

Tassi, Emanuele

2017-11-01

This article reviews recent activity on the Hamiltonian formulation of fluid models for plasmas in the non-dissipative limit, with emphasis on the relations between the fluid closures adopted for the different models and the Hamiltonian structures. The review focuses on results obtained during the last decade, but a few classical results are also described, in order to illustrate connections with the most recent developments. With the hope of making the review accessible not only to specialists in the field, an introduction to the mathematical tools applied in the Hamiltonian formalism for continuum models is provided. Subsequently, we review the Hamiltonian formulation of models based on the magnetohydrodynamics description, including those based on the adiabatic and double adiabatic closure. It is shown how Dirac's theory of constrained Hamiltonian systems can be applied to impose the incompressibility closure on a magnetohydrodynamic model and how an extended version of barotropic magnetohydrodynamics, accounting for two-fluid effects, is amenable to a Hamiltonian formulation. Hamiltonian reduced fluid models, valid in the presence of a strong magnetic field, are also reviewed. In particular, reduced magnetohydrodynamics and models assuming cold ions and different closures for the electron fluid are discussed. Hamiltonian models relaxing the cold-ion assumption are then introduced. These include models where finite Larmor radius effects are added by means of the gyromap technique, and gyrofluid models. Numerical simulations of Hamiltonian reduced fluid models investigating the phenomenon of magnetic reconnection are illustrated. The last part of the review concerns recent results based on the derivation of closures preserving a Hamiltonian structure, based on the Hamiltonian structure of parent kinetic models. Identification of such closures for fluid models derived from kinetic systems based on the Vlasov and drift-kinetic equations are presented, and

A Challenging Case of Patent Ductus Arteriosus Device Closure in an Adult with Unconventional Views and Catheters

Science.gov (United States)

Garg, Naveen; Raja, Deep Chandh; Khanna, Roopali; Kumar, Sudeep

2018-01-01

Abnormally oriented patent ductus arteriosus is expected in adults, which can lead to difficulties while attempting a device closure. Alternate angiographic views like the “right anterior oblique view,” “retrograde approach” and in rare cases, as elicited in the following case scenario, special catheters like the “Tiger® catheter” can aid in crossing the lesion and completion of the procedure successfully. PMID:29876027

MNC Subsidiary Closures

DEFF Research Database (Denmark)

Sofka, Wolfgang; Torres Preto, Miguel; de Faria, Pedro

2014-01-01

We investigate the consequences of MNC subsidiary closures for employees who lose their jobs. In particular, we examine the extent to which the human capital that these employees acquired while employed by the MNC influences the wages they receive in their new jobs. We propose an employee...

2727-S Nonradioactive Dangerous Waste Storage Facility clean closure evaluation report

International Nuclear Information System (INIS)

Luke, S.N.

1994-01-01

This report presents the analytical results of 2727-S NRDWS facility closure verification soil sampling and compares these results to clean closure criteria. The results of this comparison will determine if clean closure of the unit is regulatorily achievable. This report also serves to notify regulators that concentrations of some analytes at the site exceed sitewide background threshold levels (DOE-RL 1993b) and/or the limits of quantitation (LOQ). This report also presents a Model Toxics Control Act Cleanup (MTCA) (WAC 173-340) regulation health-based closure standard under which the unit can clean close in lieu of closure to background levels or LOQ in accordance with WAC 173-303-610. The health-based clean closure standard will be closure to MTCA Method B residential cleanup levels. This report reconciles all analyte concentrations reported above background or LOQ to this health-based cleanup standard. Regulator acceptance of the findings presented in this report will qualify the TSD unit for clean closure in accordance with WAC 173-303-610 without further TSD unit soil sampling, or soil removal and/or decontamination. Nondetected analytes require no further evaluation

Waste Dump Closure and Cost Estimates at AngloGold Ashanti ...

African Journals Online (AJOL)

Michael

2017-12-02

Dec 2, 2017 ... 2University of Mines and Technology, P.O. Box 237, Tarkwa, Ghana ... The mine has closure plans for the waste dumps and the closure activity ... incur additional cost, it was advised that the mine should execute the closure and reclamation plan without delay. .... Progressively rehabilitate the project area.

A short summary on finite element modelling of fatigue crack closure

Energy Technology Data Exchange (ETDEWEB)

Singh, Konjengbam Darunkumar [Indian Institute of Technology, Guwahati (India); Parry, Matthew Roger [Airbus Operations Ltd, Bristol(United Kingdom); Sinclair, Ian [University of Southampton, Southampton (United Kingdom)

2011-12-15

This paper presents a short summary pertaining to the finite element modelling of fatigue crack closure. Several key issues related to finite element modelling of fatigue crack closure are highlighted: element type, mesh refinement, stabilization of crack closure, crack-tip node release scheme, constitutive model, specimen geometry, stress-states (i.e., plane stress, plane strain), crack closure monitoring. Reviews are presented for both straight and deflected cracks.

Staged closure of a giant omphalocele with amnion preservation, modified technique

Directory of Open Access Journals (Sweden)

Akram H. Aljahdali

2017-04-01

Full Text Available Closure of a giant omphalocele can be challenging. Preservation of the amnion in staged closure is not commonly practiced. Here, we describe 2 cases of giant omphalocele treated with a modified amnion preservation, staged closure technique. This paper demonstrates the feasibility and safety of this technique, and the versatility of amnion to adapt to an escharization strategy if closure is not achievable.

Vacuum-assisted closure device for the management of infected postpneumonectomy chest cavities.

Science.gov (United States)

Perentes, Jean Yannis; Abdelnour-Berchtold, Etienne; Blatter, Jeannine; Lovis, Alban; Ris, Hans-Beat; Krueger, Thorsten; Gonzalez, Michel

2015-03-01

Infected postpneumonectomy chest cavities may be related to chronic postpneumonectomy empyema or arise in rare situations of necrotizing pneumonia with complete lung destruction where pneumonectomy and pleural debridement are required. We evaluated the safety and efficacy of an intrathoracic vacuum-assisted closure device (VAC) for the treatment of infected postpneumonectomy chest cavities. A retrospective single institution review of all patients with infected postpneumonectomy chest cavities treated by VAC between 2005 and 2013. Patients underwent surgical debridement of the thoracic cavity, muscle flap closure of the bronchial stump when a fistula was present, and repeated intrathoracic VAC dressings until granulation tissue covered the entire chest cavity. After this, the cavity was obliterated by a Clagett procedure and closed. Twenty-one patients (14 men and 7 women) underwent VAC treatment of their infected postpneumonectomy chest cavity. Twelve patients presented with a chronic postpneumonectomy empyema (10 of them with a bronchopleural fistula) and 9 patients with an empyema occurring in the context of necrotizing pneumonia treated by pneumonectomy. In-hospital mortality was 23%. The median duration of VAC therapy was 23 days (range, 4-61 days) and the median number of VAC changes per patient was 6 (range, 2-14 days). Infection control and successful chest cavity closure was achieved in all surviving patients. One adverse VAC treatment-related event was identified (5%). The intrathoracic VAC application is a safe and efficient treatment of infected postpneumonectomy chest cavities and allows the preservation of chest wall integrity. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Intracardiac echocardiography: use during transcatheter device closure of a patent ductus arteriosus in a dog.

Science.gov (United States)

Chetboul, V; Damoiseaux, C; Behr, L; Morlet, A; Moise, N S; Gouni, V; Lavennes, M; Pouchelon, J-L; Laborde, F; Borenstein, N

2017-06-01

Intracardiac echocardiography (ICE) is used in humans for percutaneous interventional procedures, such as transcatheter device closures. Intracardiac echocardiography provides high-resolution imaging of cardiac structures with two-dimensional, M-mode, Doppler, and also three-dimensional modalities. The present report describes application of ICE during transcatheter occlusion of patent ductus arteriosus using a canine ductal occluder in a dog for which transesophageal echocardiography could not provide an optimal acoustic window. Copyright © 2017 Elsevier B.V. All rights reserved.

Transcatheter closure of large atrial septal defects with deficient aortic or posterior rims using the "Greek maneuver". A multicenter study.

Science.gov (United States)

Thanopoulos, Basil D; Dardas, Petros; Ninios, Vlasis; Eleftherakis, Nicholaos; Karanasios, Evangelos

2013-10-09

We report a modification ("Greek maneuver") of the standard atrial septal defect (ASD) closure technique using the Amplatzer septal occluder (ASO) to facilitate closure of large ASDs with deficient aortic or posterior rims. 185 patients (median 10.8, range 3 to 52 years) with large ASDs (mean diameter 26±7 mm, range 20-40 mm) with a deficient aortic (134 patients) or posterior (51 patients) rim underwent catheter closure with the ASO using the "Greek maneuver" under transesophageal guidance. The Greek maneuver is applied when protrusion of the aortic edge of the deployed left disk of the device in to the right atrium is detected by echo. To circumvent this left disk is recaptured and the whole delivery system is pushed inward and leftward into the left atrium where the left disk and the 2/3 of right disk are simultaneously released. This maneuver forces the left disk to become parallel to the septum preventing the protrusion of the device into the right atrium. The ASO was successfully implanted and was associated with complete closure in 175/185 (95%) of the patients. There were no early or late complications related to the procedure during a follow-up period ranging from 6 months to 7 years. The "Greek maneuver" is a simple quite useful trick that facilitates closure of large ASDs associated with or without deficient aortic or posterior rims. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Transcatheter closure of patent ductus arteriosus in children weighing 10 kg or less: Initial experience at Sohag University Hospital.

Science.gov (United States)

Ali, Safaa; El Sisi, Amel

2016-04-01

To assess the challenges, feasibility, and efficacy of device closure of patent ductus arteriosus (PDA) in small children weighing ⩽10 kg for different types of devices used in an initial experience at Sohag University hospital. Between March 2011 and September 2014, 91 patients with PDA underwent transcatheter closure in our institute, among whom 54 weighed ⩽10 kg. All of these patients underwent transcatheter closure of PDA using either a Cook Detachable Coil, PFM Nit-Occlud, or Amplatzer duct occluder. A retrospective review of the treatment results and adverse events was performed. Successful device placement was achieved in 53/54 small children (98.1%). The median minimum PDA diameter was 2.4 mm [interquartile range (IQR, 1.8-3.5 mm), median weight 8 kg (IQR, 7-10 kg), and median age 10 months (IQR, 8-17 months)]. Mild aortic obstruction occurred in one case (1.9%), as the device became displaced towards the aorta after release. The device embolized in one case (1.9%) and no retrieval attempt was made. Five cases (9.3%) had minor vascular complications. With the current availability of devices for PDA closure, transcatheter closure of PDA is considered safe and efficacious in small children weighing ⩽10 kg with good mid-term outcome. The procedure had a low rate of high-severity adverse events even with the initial experience of the catheterization laboratory.

DESIGN OF A WELDING AND INSPECTION SYSTEM FOR WASTE STORAGE CLOSURE

International Nuclear Information System (INIS)

H.B. Smartt; A.D. Watkins; D.P. Pace; R.J. Bitsoi; E.D. Larsen T.R. McJunkin; C.R. Tolle

2005-01-01

This work reported here was done to provide a conceptual design for a robotic welding and inspection system for the Yucca Mountain Repository waste package closure system. The welding and inspection system is intended to make the various closure welds that seal and/or structurally join the lids to the waste package vessels. The welding and inspection system will also perform surface and volumetric inspections of the various closure welds and has the means to repair closure welds, if required. The system is designed to perform these various activities remotely, without the necessity of having personnel in the closure cell

Friction or Closure

DEFF Research Database (Denmark)

Lundahl, Mikela

2014-01-01

Heritage is a discourse that aims at closure. It fixates the narrative of the past through the celebration of specific material (or sometimes immaterial non-) ob-jects. It organizes temporality and construct events and freezes time. How does this unfold in the case of the UNESCO World Heritage si...

Multipass mining sequence room closures: In situ data report

International Nuclear Information System (INIS)

Munson, D.E.; Jones, R.L.; Northrop-Salazar, C.L.; Woerner, S.J.

1992-12-01

During the construction of the Thermal/Structural In Situ Test Rooms at the Waste Isolation Pilot Plant (WIPP) facility, measurements of the salt displacements were obtained at very early times, essentially concurrent with the mining activity. This was accomplished by emplacing manually read closure gage stations directly at the mining face, actually between the face and the mining machine, immediately upon mining of the intended gage location. Typically, these mining sequence closure measurements were taken within one hour of mining of the location and within one meter of the mining face. Readings were taken at these gage stations as the multipass mining continued, with the gage station reestablished as each successive mining pass destroyed the earlier gage points. Data reduction yields the displacement history during the mining operation. These early mining sequence closure data, when combined with the later data of the permanently emplaced closure gages, gives the total time-dependent closure displacements of the test rooms. This complete closure history is an essential part of assuring that the in situ test databases will provide an adequate basis for validation of the predictive technology of salt creep behavior, as required by the WIPP technology development program for disposal of radioactive waste in bedded salt

Closure Plan for Active Low Level Burial Grounds

Energy Technology Data Exchange (ETDEWEB)

SKELLY, W.A.

2000-11-16

This plan has been prepared in response to direction from the U.S. Department of Energy. The purpose of the plan is to define approaches that will be implemented to ensure protection of the public and the environment when active Low-Level Burial Grounds (LLBGs) at the Hanford Site are closed. Performance assessments for active burial grounds in the 200 East and West 200 Areas provide current estimates of potential environmental contamination and doses to the ''maximum exposed individual'' from burial ground operation and closure and compare dose estimates to performance objective dose limits for the facilities. This is an Operational Closure Plan. The intent of the guidance in DOE Order 435.1 is that this plan will be a living document, like the facility performance assessments, and will be revised periodically through the operational life of the LLBGs to reflect updated information on waste inventory. management practices, facility transition planning, schedule dates, assessments of post-closure performance, and environmental consequences. Out year dates identified in this plan are tentative. A Final Closure Plan will be prepared in the future when the timing and extent of closure-related activities for LLBGs can be established with greater certainty. After current operations at the LLBGs are concluded, this plan proposes transitioning of these facilities to the Environmental Restoration Program. This action will enable the Environmental Restoration Program to design and implement consistent and coordinated final remedial actions for active and inactive LLBGs. Active and inactive burial grounds in the 200 West and 200 East Areas are commingled. This plan describes approaches that will be implemented during Interim Closure, Final Closure, and Institutional Control Periods to prepare LLBGs for surface barriers, and the construction of barriers, as well as the scope of inspection, monitoring and maintenance practices that will be performed during

Locally advanced rectal cancer: a cooperative surgical approach to a complex surgical procedure.

LENUS (Irish Health Repository)

Owens, P

2015-01-01

Single stage en bloc abdominoperineal resection and sacrectomy, with a myocutaneous flap closure is a relatively uncommon procedure. Our case study of a 77 year old man with a locally invasive rectal adenocarcinoma highlights the complex intraoperative management of such a patient.

Regional neural tube closure defined by the Grainy head-like transcription factors.

Science.gov (United States)

Rifat, Yeliz; Parekh, Vishwas; Wilanowski, Tomasz; Hislop, Nikki R; Auden, Alana; Ting, Stephen B; Cunningham, John M; Jane, Stephen M

2010-09-15

Primary neurulation in mammals has been defined by distinct anatomical closure sites, at the hindbrain/cervical spine (closure 1), forebrain/midbrain boundary (closure 2), and rostral end of the forebrain (closure 3). Zones of neurulation have also been characterized by morphologic differences in neural fold elevation, with non-neural ectoderm-induced formation of paired dorso-lateral hinge points (DLHP) essential for neural tube closure in the cranial and lower spinal cord regions, and notochord-induced bending at the median hinge point (MHP) sufficient for closure in the upper spinal region. Here we identify a unifying molecular basis for these observations based on the function of the non-neural ectoderm-specific Grainy head-like genes in mice. Using a gene-targeting approach we show that deletion of Grhl2 results in failed closure 3, with mutants exhibiting a split-face malformation and exencephaly, associated with failure of neuro-epithelial folding at the DLHP. Loss of Grhl3 alone defines a distinct lower spinal closure defect, also with defective DLHP formation. The two genes contribute equally to closure 2, where only Grhl gene dosage is limiting. Combined deletion of Grhl2 and Grhl3 induces severe rostral and caudal neural tube defects, but DLHP-independent closure 1 proceeds normally in the upper spinal region. These findings provide a molecular basis for non-neural ectoderm mediated formation of the DLHP that is critical for complete neuraxis closure. (c) 2010 Elsevier Inc. All rights reserved.

300 Area waste acid treatment system closure plan

International Nuclear Information System (INIS)

LUKE, S.N.

1999-01-01

The Hanford Facility Dangerous Waste Permit Application is considered to be a single application organized into a General Information Portion (document number DOERL-91-28) and a Unit-Specific Portion. The scope of the Unit-Specific Portion includes closure plan documentation submitted for individual, treatment, storage, and/or disposal units undergoing closure, such as the 300 Area Waste Acid Treatment System. Documentation contained in the General Information Portion is broader in nature and could be used by multiple treatment, storage, and/or disposal units (e.g., the glossary provided in the General Information Portion). Whenever appropriate, 300 Area Waste Acid Treatment System documentation makes cross-reference to the General Information Portion, rather than duplicating text. This 300 Area Waste Acid Treatment System Closure Plan (Revision 2) includes a Hanford Facility Dangerous Waste Permit Application, Part A, Form 3. Information provided in this closure plan is current as of April 1999

300 Area waste acid treatment system closure plan

Energy Technology Data Exchange (ETDEWEB)

LUKE, S.N.

1999-05-17

The Hanford Facility Dangerous Waste Permit Application is considered to be a single application organized into a General Information Portion (document number DOERL-91-28) and a Unit-Specific Portion. The scope of the Unit-Specific Portion includes closure plan documentation submitted for individual, treatment, storage, and/or disposal units undergoing closure, such as the 300 Area Waste Acid Treatment System. Documentation contained in the General Information Portion is broader in nature and could be used by multiple treatment, storage, and/or disposal units (e.g., the glossary provided in the General Information Portion). Whenever appropriate, 300 Area Waste Acid Treatment System documentation makes cross-reference to the General Information Portion, rather than duplicating text. This 300 Area Waste Acid Treatment System Closure Plan (Revision 2) includes a Hanford Facility Dangerous Waste Permit Application, Part A, Form 3. Information provided in this closure plan is current as of April 1999.

Intraoperative three-dimensional transesophageal echocardiography for assessing the defect geometries of mitral prosthetic paravalvular leak during transcatheter closure.

Science.gov (United States)

Wei, Jeng; Yin, Wei-Hsian; Lee, Yung-Tsai; Hsiung, Ming C; Tsai, Shen-Kou; Chuang, Yi Cheng; Ou, Ching-Huei; Chou, Yi-Pen

2015-03-01

Paravalvular leaks (PVLs) are a common complication of prosthetic valve replacement. Use of the transcatheter intervention technique is a suitable alternative in high-risk patients who may not tolerate repeat surgery. Common reasons for failure of this demanding intervention include poor imaging quality and unsuitable anatomy. The purpose of this study was to assess the usefulness and the incremental value of real-time three-dimensional (RT 3D) transesophageal echocardiography (TEE) over two-dimensional (2D) TEE findings in the evaluation of the geometry and track of mitral PVLs during transcatheter closure. Five patients with six mitral PVLs at high risk for repeat surgery underwent transcatheter leak closure. Intraoperative RT 3DTEE was used to assess the location, shape, number, and size of the defects. Transapical approaches were used in all cases with fluoroscopic and RT 3D TEE guidance of the wire and catheter, device positioning, and assessment of residual leak after the procedure. In all of the cases, defects with irregular crescent shapes and distorted tracks were clearly delineated by RT 3D TEE. This was compared to those results obtained through 2D TEE, which was unable to characterize the defects. Three cases showed small leaks, which were completely occluded with a patent ductus arteriosus (PDA) device in two cases, and a muscular ventricular septal defect (mVSD) occluder combined with coil devices in one case. One case involved a large leak and early device embolization of the muscular VSD occluder, which was removed surgically, and demonstrated a crescent-shaped defect. One patient had two releaks 2 months subsequent to the procedure due to two new extended leaks at the tails of the crescent-shaped defect. RT 3D TEE can clearly delineate the geometries of defects in their entirety, including shape, size, and location of the defect and track canal. It would also appear that RT 3D TEE is superior to 2D TEE in the process of guiding the wire through the

Predictors of successful closure of patent ductus arteriosus with indomethacin.

Science.gov (United States)

Ahamed, M F; Verma, P; Lee, S; Vega, M; Wang, D; Kim, M; Fuloria, M

2015-09-01

To determine whether platelet counts can predict the likelihood of successful closure of patent ductus arteriosus (PDA) with indomethacin. This was a retrospective cohort study of infants closure with indomethacin and those who failed were compared. Multivariable logistic regression was used to identify predictors of successful ductal closure. In infants with hemodynamically significant PDA, older GA (odds ratio=1.54; 95% confidence interval: 1.12 to 2.13), male gender (odds ratio=3.02; 95% confidence interval: 1.08 to 8.49) and higher platelet count (odds ratio=1.5; 95% confidence interval: 1.04 to 2.17) prior to indomethacin treatment were associated with successful ductal closure with indomethacin. Older GA, male gender and higher platelet count at time of treatment of hemodynamically significant PDA are predictors of successful ductal closure with indomethacin.

300 Area Process Trenches Closure Plan

International Nuclear Information System (INIS)

Luke, S.N.

1994-01-01

Since 1987, Westinghouse Hanford Company has been a major contractor to the US Department of Energy, Richland Operations Office and has served as co-operator of the 300 Area Process Trenches, the waste management unit addressed in this closure plan. For the purposes of the Resource Conservation and Recovery Act, Westinghouse Hanford Company is identified as ''co-operator.'' The 300 Area Process Trenches Closure Plan (Revision 0) consists of a Resource Conservation and Recovery Act Part A Dangerous Waste Permit Application, Form 3 and a Resource Conservation and Recovery Act Closure Plan. An explanation of the Part A Permit Application, Form 3 submitted with this document is provided at the beginning of the Part A Section. The closure plan consists of nine chapters and six appendices. The 300 Area Process Trenches received dangerous waste discharges from research and development laboratories in the 300 Area and from fuels fabrication processes. This waste consisted of state-only toxic (WT02), corrosive (D002), chromium (D007), spent halogenated solvents (F001, F002, and F003), and spent nonhalogented solvent (F005). Accurate records are unavailable concerning the amount of dangerous waste discharged to the trenches. The estimated annual quantity of waste (item IV.B) reflects the total quantity of both regulated and nonregulated waste water that was discharged to the unit

Oral Paracetamol for Patent Ductus Arteriosus Rescue Closure.

Science.gov (United States)

Pharande, Pramod; Watson, Hadley; Tan, Kenneth; Sehgal, Arvind

2018-01-01

The objective of this study was to ascertain the efficacy of oral paracetamol in closing a symptomatic patent ductus arteriosus (PDA) when used as 'rescue' option. After obtaining ethics approval, a retrospective appraisal of the data from April 2014 to July 2015 was performed. Infants who were administered oral paracetamol either after unsuccessful therapy with ibuprofen or where it was considered contraindicated were included. A previously published echocardiographic scoring schema to stratify for ductal disease severity was used. Using univariate analysis, characteristics of infants with successful closure were compared with partial (a priori reduction in composite score by ≥ 50% of pretreatment) or no closure. Twenty infants with gestation age and birthweight of 25.7 ± 1.5 weeks and 724.1 ± 143 g, respectively, were studied. Complete closure was noted in 10 (50%) infants with additional four infants showing a significant reduction in haemodynamic shunting. Gestational age at birth and at therapy, chronological age at therapy, birthweight and total fluid intake were comparable between the two groups. The pre-therapy composite score had a significant association with successful closure (the higher the echocardiographic score, the lesser the closure). Concomitant furosemide therapy and late-onset sepsis had a high likelihood ratio of unsuccessful closure (11.01 [2-tailed, p = 0.005] and 5.3 [2-tailed, p = 0.07]), respectively. Oral paracetamol may be a possible therapeutic option in premature infants where therapy with first-line agents is unsuccessful or contraindicated. Concomitant sepsis and furosemide administration may affect successful therapy.

Patent Foramen Ovale Closure for Secondary Prevention of Cryptogenic Stroke: Updated Meta-Analysis of Randomized Clinical Trials.

Science.gov (United States)

Vaduganathan, Muthiah; Qamar, Arman; Gupta, Ankur; Bajaj, Navkaranbir; Golwala, Harsh B; Pandey, Ambarish; Bhatt, Deepak L

2018-05-01

Patent foramen ovale closure represents a potential secondary prevention strategy for cryptogenic stroke, but available trials have varied by size, device studied, and follow-up. We conducted a systematic search of published randomized clinical trials evaluating patent foramen ovale closure versus medical therapy in patients with recent stroke or transient ischemic attack using PubMED, EMBASE, and Cochrane through September 2017. Weighting was by random effects models. Of 480 studies screened, we included 5 randomized clinical trials in the meta-analysis in which 3440 patients were randomized to patent foramen ovale closure (n = 1829) or medical therapy (n = 1611) and followed for an average of 2.0 to 5.9 years. Index stroke/transient ischemic attack occurred within 6 to 9 months of randomization. The primary end point was composite stroke/transient ischemic attack and death (in 3 trials) or stroke alone (in 2 trials). Patent foramen ovale closure reduced the primary end point (0.70 vs 1.48 events per 100 patient-years; risk ratio [RR], 0.52 [0.29-0.91]; I 2  = 55.0%) and stroke/transient ischemic attack (1.04 vs 2.00 events per 100 patient-years; RR, 0.55 [0.37-0.82]; I 2  = 42.2%) with modest heterogeneity compared with medical therapy. Procedural bleeding was not different between study arms (1.8% vs 1.8%; RR, 0.94 [0.49-1.83]; I 2  = 29.2%), but new-onset atrial fibrillation/flutter was increased with patent foramen ovale closure (6.6% vs 0.7%; RR, 4.69 [2.17-10.12]; I 2  = 29.3%). In patients with recent cryptogenic stroke, patent foramen ovale closure reduces recurrent stroke/transient ischemic attack compared with medical therapy, but is associated with a higher risk of new-onset atrial fibrillation/flutter. Copyright © 2018 Elsevier Inc. All rights reserved.

Hanford Patrol Academy demolition sites closure plan

Energy Technology Data Exchange (ETDEWEB)

1993-09-30

The Hanford Site is owned by the U.S. Government and operated by the U.S. Department of Energy, Richland Operations Office. Westinghouse Hanford Company is a major contractor to the U.S. Department of Energy, Richland Operations Office and serves as co-operator of the Hanford Patrol Academy Demolition Sites, the unit addressed in this paper. This document consists of a Hanford Facility Dangerous Waste Part A Permit Application, Form 3 (Revision 4), and a closure plan for the site. An explanation of the Part A Form 3 submitted with this closure plan is provided at the beginning of the Part A section. This Hanford Patrol Academy Demolition Sites Closure Plan submittal contains information current as of December 15, 1994.

Impact of Vial Capping on Residual Seal Force and Container Closure Integrity.

Science.gov (United States)

Mathaes, Roman; Mahler, Hanns-Christian; Roggo, Yves; Ovadia, Robert; Lam, Philippe; Stauch, Oliver; Vogt, Martin; Roehl, Holger; Huwyler, Joerg; Mohl, Silke; Streubel, Alexander

2016-01-01

The vial capping process is a critical unit operation during drug product manufacturing, as it could possibly generate cosmetic defects or even affect container closure integrity. Yet there is significant variability in capping equipment and processes, and their relation to potential defects or container closure integrity has not been thoroughly studied. In this study we applied several methods-residual seal force tester, a self-developed system of a piezo force sensor measurement, and computed tomography-to characterize different container closure system combinations that had been sealed using different capping process parameter settings. Additionally, container closure integrity of these samples was measured using helium leakage (physical container closure integrity) and compared to characterization data. The different capping equipment settings lead to residual seal force values from 7 to 115 N. High residual seal force values were achieved with high capping pre-compression force and a short distance between the capping plate and plunge. The choice of container closure system influenced the obtained residual seal force values. The residual seal force tester and piezoelectric measurements showed similar trends. All vials passed physical container closure integrity testing, and no stopper rupture was seen with any of the settings applied, suggesting that container closure integrity was warranted for the studied container closure system with the chosen capping setting ranges. The vial capping process is a critical unit operation during drug product manufacturing, as it could possibly generate cosmetic defects or even affect container closure integrity. Yet there is significant variability in capping equipment and processes, and their relation to potential defects or container closure integrity has not been thoroughly studied. In this study we applied several methods-residual seal force tester, a self-developed system of a piezo force sensor measurement, and

Military Base Closures: Updated Status of Prior Base Realignments and Closures

Science.gov (United States)

As the Department of Defense (DOD) prepares for the 2005 base realignment and closure (BRAC) round, questions continue to be raised about the transfer and environmental cleanup of unneeded property arising from the prior four BRAC rounds and their impact on cost and savings and on local economies.

Transuranic Storage Area (TSA)-2 container storage unit RCRA closure plan

International Nuclear Information System (INIS)

Lodman, D.W.; Spry, M.J.; Nolte, E.P.; Barry, G.A.

1992-11-01

This document describes the proposed plans for closure of the Transuranic Storage Area (TSA)-2 container storage unit at the Idaho National Engineering Laboratory in accordance with the Resource Conservation and Recovery Act closure requirements. The location, size, capacity, history, and current status of the unit are described. Future plans for the unit include incorporating the earthen-covered portion of the TSA-2 pad into a TSA retrieval enclosure along with the TSA-1 and TSAR pads, and closure of the portion of the TSA-2 pad under the Air Support Weather Shield (ASWS-2). This plan addresses closure of the ASWS-2 by decontaminating structures and equipment that may have contacted the waste. Sufficient sampling and documentation of all closure activities will be performed to demonstrate clean closure. A tentative schedule is provided in the form of a milestone chart

Phenomenology of convection-parameterization closure

Directory of Open Access Journals (Sweden)

J.-I. Yano

2013-04-01

Full Text Available Closure is a problem of defining the convective intensity in a given parameterization. In spite of many years of efforts and progress, it is still considered an overall unresolved problem. The present article reviews this problem from phenomenological perspectives. The physical variables that may contribute in defining the convective intensity are listed, and their statistical significances identified by observational data analyses are reviewed. A possibility is discussed for identifying a correct closure hypothesis by performing a linear stability analysis of tropical convectively coupled waves with various different closure hypotheses. Various individual theoretical issues are considered from various different perspectives. The review also emphasizes that the dominant physical factors controlling convection differ between the tropics and extra-tropics, as well as between oceanic and land areas. Both observational as well as theoretical analyses, often focused on the tropics, do not necessarily lead to conclusions consistent with our operational experiences focused on midlatitudes. Though we emphasize the importance of the interplays between these observational, theoretical and operational perspectives, we also face challenges for establishing a solid research framework that is universally applicable. An energy cycle framework is suggested as such a candidate.

Crack closure and sequential effects in fatigue: A literature survey

Science.gov (United States)

Holmgren, M.

A literature survey of the phenomenon of crack closure is reported here. The state of the art is reviewed and several empirical formulas for determining the crack closure are compared with each other. Their properties, advantages and disadvantages are briefly discussed. Experimental techniques for determining the crack closure stress are presented and experimental data from the literature are reported.

303-K Storage Facility: Report on FY98 closure activities

International Nuclear Information System (INIS)

Adler, J.G.

1998-01-01

This report summarizes and evaluates the decontamination activities, sampling activities, and sample analysis performed in support of the closure of the 303-K Storage Facility. The evaluation is based on the validated data included in the data validation package (98-EAP-346) for the 303-K Storage Facility. The results of this evaluation will be used for assessing contamination for the purpose of closing the 303-K Storage Facility as described in the 303-K Storage Facility Closure Plan, DOE/RL-90-04. The closure strategy for the 303-K Storage Facility is to decontaminate the interior of the north half of the 303-K Building to remove known or suspected dangerous waste contamination, to sample the interior concrete and exterior soils for the constituents of concern, and then to perform data analysis, with an evaluation to determine if the closure activities and data meet the closure criteria. The closure criteria for the 303-K Storage Facility is that the concentrations of constituents of concern are not present above the cleanup levels. Based on the evaluation of the decontamination activities, sampling activities, and sample data, determination has been made that the soils at the 303-K Storage Facility meet the cleanup performance standards (WMH 1997) and can be clean closed. The evaluation determined that the 303-K Building cannot be clean closed without additional closure activities. An additional evaluation will be needed to determine the specific activities required to clean close the 303-K Storage Facility. The radiological contamination at the 303-K Storage Facility is not addressed by the closure strategy

Hamiltonian fluid closures of the Vlasov-Ampère equations: From water-bags to N moment models

Energy Technology Data Exchange (ETDEWEB)

Perin, M.; Chandre, C.; Tassi, E. [Aix-Marseille Université, Université de Toulon, CNRS, CPT UMR 7332, 13288 Marseille (France); Morrison, P. J. [Department of Physics and Institute for Fusion Studies, The University of Texas at Austin, Austin, Texas 78712-1060 (United States)

2015-09-15

Moment closures of the Vlasov-Ampère system, whereby higher moments are represented as functions of lower moments with the constraint that the resulting fluid system remains Hamiltonian, are investigated by using water-bag theory. The link between the water-bag formalism and fluid models that involve density, fluid velocity, pressure and higher moments is established by introducing suitable thermodynamic variables. The cases of one, two, and three water-bags are treated and their Hamiltonian structures are provided. In each case, we give the associated fluid closures and we discuss their Casimir invariants. We show how the method can be extended to an arbitrary number of fields, i.e., an arbitrary number of water-bags and associated moments. The thermodynamic interpretation of the resulting models is discussed. Finally, a general procedure to derive Hamiltonian N-field fluid models is proposed.

Percutaneous Patent Ductus Arteriosus (PDA) Closure in Very Preterm Infants: Feasibility and Complications.

Science.gov (United States)

Backes, Carl H; Cheatham, Sharon L; Deyo, Grace M; Leopold, Scott; Ball, Molly K; Smith, Charles V; Garg, Vidu; Holzer, Ralf J; Cheatham, John P; Berman, Darren P

2016-02-12

Percutaneous closure of patent ductus arteriosus (PDA) in term neonates is established, but data regarding outcomes in infants born very preterm (closure at weights closure. Twenty-five percent (13/52) of infants were closure. Compared to precatheterization trends, percutaneous PDA closure resulted in improved respiratory status, including less exposure to mechanical ventilation (mixed effects logistic model, Pclosure at weights closure versus alternative (surgical ligation) management strategies. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Angle closure glaucoma in congenital ectropion uvea.

Science.gov (United States)

Wang, Grace M; Thuente, Daniel; Bohnsack, Brenda L

2018-06-01

Congenital ectropion uvea is a rare anomaly, which is associated with open, but dysplastic iridocorneal angles that cause childhood glaucoma. Herein, we present 3 cases of angle-closure glaucoma in children with congenital ectropion uvea. Three children were initially diagnosed with unilateral glaucoma secondary to congenital ectropion uvea at 7, 8 and 13 years of age. The three cases showed 360° of ectropion uvea and iris stromal atrophy in the affected eye. In one case, we have photographic documentation of progression to complete angle closure, which necessitated placement of a glaucoma drainage device 3 years after combined trabeculotomy and trabeculectomy. The 2 other cases, which presented as complete angle closure, also underwent glaucoma drainage device implantation. All three cases had early glaucoma drainage device encapsulation (within 4 months) and required additional surgery (cycloablation or trabeculectomy). Congenital ectropion uvea can be associated with angle-closure glaucoma, and placement of glaucoma drainage devices in all 3 of our cases showed early failure due to plate encapsulation. Glaucoma in congenital ectropion uvea requires attention to angle configuration and often requires multiple surgeries to obtain intraocular pressure control.

Mixed Waste Management Facility closure at the Savannah River Site

International Nuclear Information System (INIS)

Bittner, M.F.

1991-08-01

The Mixed Waste Management Facility of the Savannah River Plant received hazardous and solid low level radioactive wastes from 1972 until 1986. Because this facility did not have a permit to receive hazardous wastes, a Resource Conservation and Recovery Act closure was performed between 1987 and 1990. This closure consisted of dynamic compaction of the waste trenches and placement of a 3-foot clay cap, a 2-foot soil cover, and a vegetative layer. Operations of the waste disposal facility, tests performed to complete the closure design, and the construction of the closure cap are discussed herein

Cystic Duct Closure by Sealing With Bipolar Electrocoagulation

Science.gov (United States)

Damgaard, B.; Jorgensen, L. N.; Larsen, S. S.; Kristiansen, V. B.

2010-01-01

Background: Cystic duct leakage after cholecystectomy is not uncommon and is a potentially serious complication. The aim of this study was to assess a bipolar sealing system (LigaSure®) for closure of the cystic duct. Methods: The records from consecutive laparoscopic cholecystectomies performed in 2 hospitals with closure of the cystic duct with LigaSure after informed consent were recorded and complications and morbidity registered. The records were compared with those of patients undergoing laparoscopic cholecystectomy with closure of the cystic duct with clips during the same period. Results: During the study period, 218 laparoscopic cholecystectomies were performed; 102 of these were performed with the LigaSure. One patient was excluded due to violation of the protocol. We experienced no cases of cystic duct leakage, but in one patient, bile leakage from the gallbladder bed was observed probably due to a small aberrant duct. Conclusion: The LigaSure system was safe and effective for closure and division of the cystic duct in laparoscopic cholecystectomy. PMID:20412641

LLNL/YMP Waste Container Fabrication and Closure Project

International Nuclear Information System (INIS)

1990-10-01

The Department of Energy's Office of Civilian Radioactive Waste Management (OCRWM) Program is studying Yucca Mountain, Nevada as a suitable site for the first US high-level nuclear waste repository. Lawrence Livermore National Laboratory (LLNL) has the responsibility for designing and developing the waste package for the permanent storage of high-level nuclear waste. This report is a summary of the technical activities for the LLNL/YMP Nuclear Waste Disposal Container Fabrication and Closure Development Project. Candidate welding closure processes were identified in the Phase 1 report. This report discusses Phase 2. Phase 2 of this effort involved laboratory studies to determine the optimum fabrication and closure processes. Because of budget limitations, LLNL narrowed the materials for evaluation in Phase 2 from the original six to four: Alloy 825, CDA 715, CDA 102 (or CDA 122) and CDA 952. Phase 2 studies focused on evaluation of candidate material in conjunction with fabrication and closure processes

Complex bladder-exstrophy-epispadias management: Causes of failure of initial bladder closure

Directory of Open Access Journals (Sweden)

Kouame Dibi Bertin

2014-01-01

Full Text Available The success of the initial closure of the complex bladder-exstrophy remains a challenge in pediatric surgery. This study describes a personal experience of the causes of failure of the initial closure and operative morbidity during the surgical treatment of bladder-exstrophy complex. From April 2000 to March 2014, four patients aged 16 days to 7 years and 5 months underwent complex exstrophy-epispadias repair with pelvic osteotomies. There were three males and one female. Three of them had posterior pelvic osteotomy, one had anterior innominate osteotomy. Bladder Closure: Bladder closure was performed in three layers. Our first patient had initial bladder closure with polyglactin 4/0 (Vicryl ® 4/0, concerning the last three patients, initial bladder closure was performed with polydioxanone 4/0 (PDS ® 4/0. The bladder was repaired leaving the urethral stent and ureteral stents for full urinary drainage for three patients. In one case, only urethral stent was left, ureteral drainage was not possible, because stents sizes were more important than the ureteral diameter. Out of a total of four patients, initial bladder closure was completely achieved for three patients. At the immediate postoperative follow-up, two patients presented a complete disunion of the abdominal wall and bladder despite an appropriate postoperative care. The absorbable braided silk (polyglactin used for the bladder closure was considered as the main factor in the failure of the bladder closure. The second cause of failure of the initial bladder closure was the incomplete urine drainage, ureteral catheterisation was not possible because the catheters sizes were too large compared with the diameters of the ureters. The failure of the initial bladder-exstrophy closure may be reduced by a closure with an absorbable monofilament silk and efficient urine drainage via ureteral catheterisation.

Understanding the Risk Factors of Trauma Center Closures

Science.gov (United States)

Shen, Yu-Chu; Hsia, Renee Y.; Kuzma, Kristen

2011-01-01

Objectives We analyze whether hazard rates of shutting down trauma centers are higher due to financial pressures or in areas with vulnerable populations (such as minorities or the poor). Materials and Methods This is a retrospective study of all hospitals with trauma center services in urban areas in the continental US between 1990 and 2005, identified from the American Hospital Association Annual Surveys. These data were linked with Medicare cost reports, and supplemented with other sources, including the Area Resource File. We analyze the hazard rates of trauma center closures among several dimensions of risk factors using discrete-time proportional hazard models. Results The number of trauma center closures increased from 1990 to 2005, with a total of 339 during this period. The hazard rate of closing trauma centers in hospitals with a negative profit margin is 1.38 times higher than those hospitals without the negative profit margin (P lower hazard of shutting down trauma centers (ratio: 0.58, P penetration face a higher hazard of trauma center closure (ratio: 2.06, P < 0.01). Finally, hospitals in areas with higher shares of minorities face a higher risk of trauma center closure (ratio: 1.69, P < 0.01). Medicaid load and uninsured populations, however, are not risk factors for higher rates of closure after we control for other financial and community characteristics. Conclusions Our findings give an indication on how the current proposals to cut public spending could exacerbate the trauma closure particularly among areas with high shares of minorities. In addition, given the negative effect of health maintenance organizations on trauma center survival, the growth of Medicaid managed care population should be monitored. Finally, high shares of Medicaid or uninsurance by themselves are not independent risk factors for higher closure as long as financial pressures are mitigated. Targeted policy interventions and further research on the causes, are needed to

The Rising Rate of Rural Hospital Closures.

Science.gov (United States)

Kaufman, Brystana G; Thomas, Sharita R; Randolph, Randy K; Perry, Julie R; Thompson, Kristie W; Holmes, George M; Pink, George H

2016-01-01

Since 2010, the rate of rural hospital closures has increased significantly. This study is a preliminary look at recent closures and a formative step in research to understand the causes and the impact on rural communities. The 2009 financial performance and market characteristics of rural hospitals that closed from 2010 through 2014 were compared to rural hospitals that remained open during the same period, stratified by critical access hospitals (CAHs) and other rural hospitals (ORHs). Differences were tested using Pearson's chi-square (categorical variables) and Wilcoxon rank test of medians. The relationships between negative operating margin and (1) market factors and (2) utilization/staffing factors were explored using logistic regression. In 2009, CAHs that subsequently closed from 2010 through 2014 had, in general, lower levels of profitability, liquidity, equity, patient volume, and staffing. In addition, ORHs that closed had smaller market shares and operated in markets with smaller populations compared to ORHs that remained open. Odds of unprofitability were associated with both market and utilization factors. Although half of the closed hospitals ceased providing health services altogether, the remainder have since converted to an alternative health care delivery model. Financial and market characteristics appear to be associated with closure of rural hospitals from 2010 through 2014, suggesting that it is possible to identify hospitals at risk of closure. As closure rates show no sign of abating, it is important to study the drivers of distress in rural hospitals, as well as the potential for alternative health care delivery models. © 2015 National Rural Health Association.

303-K Storage Facility closure plan. Revision 2

Energy Technology Data Exchange (ETDEWEB)

1993-12-15

Recyclable scrap uranium with zircaloy-2 and copper silicon alloy, uranium-titanium alloy, beryllium/zircaloy-2 alloy, and zircaloy-2 chips and fines were secured in concrete billets (7.5-gallon containers) in the 303-K Storage Facility, located in the 300 Area. The beryllium/zircaloy-2 alloy and zircaloy-2 chips and fines are designated as mixed waste with the characteristic of ignitability. The concretion process reduced the ignitability of the fines and chips for safe storage and shipment. This process has been discontinued and the 303-K Storage Facility is now undergoing closure as defined in the Resource Conservation and Recovery Act (RCRA) of 1976 and the Washington Administrative Code (WAC) Dangerous Waste Regulations, WAC 173-303-040. This closure plan presents a description of the 303-K Storage Facility, the history of materials and waste managed, and the procedures that will be followed to close the 303-K Storage Facility. The 303-K Storage Facility is located within the 300-FF-3 (source) and 300-FF-5 (groundwater) operable units, as designated in the Hanford Federal Facility Agreement and Consent Order (Tri-Party Agreement) (Ecology et al. 1992). Contamination in the operable units 300-FF-3 and 300-FF-5 is scheduled to be addressed through the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) of 1980 remedial action process. Therefore, all soil remedial action at the 304 Facility will be conducted as part of the CERCLA remedial action of operable units 300-FF-3 and 300-FF-5.

Environmental considerations in mine closure planning

International Nuclear Information System (INIS)

Ricks, G.

1997-01-01

Mine closure planning considers the best ways to plan and manage the environmental changes and socio-economic effects associated with the closing of mines. While the criteria for judging successful closures may vary, it is particularly important for physical, chemical and biological stability to be achieved and for final land use to be appropriate. Trust funds are increasingly favoured as a practical means of fulfilling the requirement for a financial surety and of ensuring that financial provision is available at the end of the mine's life. (author)

Special closure for radioactive shipping container

International Nuclear Information System (INIS)

Otts, J.V.

1976-03-01

The objective of this program was to develop a special lid closure for radioactive material shipping containers, typically steel drums. Three closure techniques were designed, fabricated, and proven to be structurally adequate to protect 1000 lb when dropped 30 ft. The three designs were (1) a 6-in. lid extension (skirt), (2) a 6-in. inner lid, and (3) c-clamps used at the container/lid interface. Based upon structural integrity, economic impact, and minimal design change, the 6-in. lid extension is recommended

Association of iris crypts with acute primary angle closure.

Science.gov (United States)

Koh, Victor; Chua, Jacqueline; Shi, Yuan; Thakku, Sri Gowtham; Lee, Ryan; Nongpiur, Monisha E; Baskaran, Mani; Kumar, Rajesh S; Perera, Shamira; Aung, Tin; Cheng, Ching-Yu

2017-10-01

To determine the relationship between iris surface features and acute primary angle closure (APAC) in eyes with angle closure. Case-control study involving Asian patients diagnosed with previous APAC, primary angle closure suspect (PACS), primary angle closure (PAC) and primary angle closure glaucoma (PACG) at an eye centre in Singapore between August 2012 and January 2015. Participants underwent ophthalmic examination and digital slit-lamp iris photography. Iris surface features were graded based on crypts, furrows and colour. Fellow eyes of APAC were compared with PACS and PAC/PACG eyes with regard to their iris surface features. Occurrence of APAC. A total of 309 patients (71 APAC, 139 PACS, 47 PAC and 52 PACG) were included (mean age: 67.7±7.2 years and 36.6% male). Compared with PACS, higher crypt grade was significantly associated with lower odds of APAC (OR=0.58 for one grade higher in crypt grade; p=0.027, adjusted for age, gender, ethnicity and pupil diameter). The results remained similar when compared with PAC/PACG group (OR=0.58 for one grade higher in crypt grade; p=0.043). We did not observe any significant associations between iris furrows or colour with presence of APAC. Our study comprising Asian eyes with angle closure suggests that the presence of a higher crypt grading may be protective for APAC. As such, assessing iris surface architecture for crypts could be a new measure for risk stratification of developing APAC in eyes with angle closure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

PFO closuRE and CryptogenIc StrokE (PRECISE) registry

DEFF Research Database (Denmark)

Wöhrle, Jochen; Bertrand, Bernard; Søndergaard, Lars

2012-01-01

The Premere™ PFO closure device has a special design for closure of patent foramen ovale (PFO) including a flexible distance and angulation between the right and left disc providing minimal septal distortion. The primary objective of the study was to determine the degree of risk for stroke or tra...... or transient ischemic attack (TIA) in patients after Premere™ PFO closure device implantation....

The effectiveness of eye-closure in repeated interviews

NARCIS (Netherlands)

Vredeveldt, A.; Baddeley, A.D.; Hitch, G.J.

2014-01-01

Purpose Closing the eyes during recall can help witnesses remember more about a witnessed event. This study examined the effectiveness of eye-closure in a repeated recall paradigm with immediate free recall followed 1 week later by both free and cued recall. We examined whether eye-closure was more

Percutaneous closure of patent foramen ovale in cryptogenic embolism.

Science.gov (United States)

Meier, Bernhard; Kalesan, Bindu; Mattle, Heinrich P; Khattab, Ahmed A; Hildick-Smith, David; Dudek, Dariusz; Andersen, Grethe; Ibrahim, Reda; Schuler, Gerhard; Walton, Antony S; Wahl, Andreas; Windecker, Stephan; Jüni, Peter

2013-03-21

The options for secondary prevention of cryptogenic embolism in patients with patent foramen ovale are administration of antithrombotic medications or percutaneous closure of the patent foramen ovale. We investigated whether closure is superior to medical therapy. We performed a multicenter, superiority trial in 29 centers in Europe, Canada, Brazil, and Australia in which the assessors of end points were unaware of the study-group assignments. Patients with a patent foramen ovale and ischemic stroke, transient ischemic attack (TIA), or a peripheral thromboembolic event were randomly assigned to undergo closure of the patent foramen ovale with the Amplatzer PFO Occluder or to receive medical therapy. The primary end point was a composite of death, nonfatal stroke, TIA, or peripheral embolism. Analysis was performed on data for the intention-to-treat population. The mean duration of follow-up was 4.1 years in the closure group and 4.0 years in the medical-therapy group. The primary end point occurred in 7 of the 204 patients (3.4%) in the closure group and in 11 of the 210 patients (5.2%) in the medical-therapy group (hazard ratio for closure vs. medical therapy, 0.63; 95% confidence interval [CI], 0.24 to 1.62; P=0.34). Nonfatal stroke occurred in 1 patient (0.5%) in the closure group and 5 patients (2.4%) in the medical-therapy group (hazard ratio, 0.20; 95% CI, 0.02 to 1.72; P=0.14), and TIA occurred in 5 patients (2.5%) and 7 patients (3.3%), respectively (hazard ratio, 0.71; 95% CI, 0.23 to 2.24; P=0.56). Closure of a patent foramen ovale for secondary prevention of cryptogenic embolism did not result in a significant reduction in the risk of recurrent embolic events or death as compared with medical therapy. (Funded by St. Jude Medical; ClinicalTrials.gov number, NCT00166257.).

Biological constraints do not entail cognitive closure.

Science.gov (United States)

Vlerick, Michael

2014-12-01

From the premise that our biology imposes cognitive constraints on our epistemic activities, a series of prominent authors--most notably Fodor, Chomsky and McGinn--have argued that we are cognitively closed to certain aspects and properties of the world. Cognitive constraints, they argue, entail cognitive closure. I argue that this is not the case. More precisely, I detect two unwarranted conflations at the core of arguments deriving closure from constraints. The first is a conflation of what I will refer to as 'representation' and 'object of representation'. The second confuses the cognitive scope of the assisted mind for that of the unassisted mind. Cognitive closure, I conclude, cannot be established from pointing out the (uncontroversial) existence of cognitive constraints. Copyright © 2014 Elsevier Ltd. All rights reserved.

Transcatheter closure of ventricular septal defects with nitinol wire occluders of type patent ductus arteriosus.

Science.gov (United States)

Wierzyk, Arkadiusz; Szkutnik, Małgorzata; Fiszer, Roland; Banaszak, Paweł; Pawlak, Szymon; Białkowski, Jacek

2014-01-01

Ventricular septal defects closure (VSD) depending on the anatomy and clinical setting can be performed surgically or by a hybrid and transcatheter approach. Two cases of children with VSD will be presented. Patients' defects were closed with various types of occluders made of nitinol wire mesh occluder, patent ductus arteriosus (PDA) type. The first case was a 2.5-year-old boy after cardiosurgical correction of tetralogy of Fallot (TOF). After the procedure, a significant haemodynamic residual VSD was observed, which was not successfully closed during the subsequent reoperation. Despite pharmacological treatment, symptoms of heart failure were observed in this patient. In echocardiographic images the residual VSD was presented as a tunnel-like dissection of the ventricular septum (length 6 mm and diameter 3.4 mm). The defect was closed via arterial access with an Amplatzer Duct Occluder II (ADO II). The procedure was successfully performed without any medical complications. In this child, a significant shunt reduction and a noticeable improvement in the patient's clinical status and diminished symptoms of heart failure were noticed. The second patient was a 4-year-old girl suffering from a multi-perforated perimembranous VSD accompanied by a ventricular septal defect with aneurysm. The defect was closed by a venous approach with a PDA Cardio-O-Fix occluder (very similar to ADO I). No short-term or long-term complications were visible during or after the procedure. Only a mild residual shunt through the VSD was observed 6 months afterwards. Transcatheter VSD closure with a proper morphology, with occluders of type Amplatzer Duct Occluder ADO I or ADO II, constitutes a safe and effective therapeutic alternative.

Exceptional closure of UNIQA office at CERN

CERN Multimedia

HR Department

2009-01-01

The UNIQA office at CERN will be closed from Wednesday 18 February to Friday 20 February due to painting work. During this closure, the Headquarters of UNIQA in Geneva will remain at the disposal of the members. See details https://cern.ch/chis/UNIQA_Offices.asp The CERN office will re-open on Monday 23 February according to the normal schedule. We apologise for any inconvenience caused by this closure.

Transcatheter closure of hemodynamic significant patent ductus arteriosus in 32 premature infants by amplatzer ductal occluder additional size-ADOIIAS.

Science.gov (United States)

Morville, Patrice; Akhavi, Ahmad

2017-10-01

The advent of Amplatzer Duct Occluder II additional Size (ADOIIAS) provided the potential to close hemodynamic significant patent ductus arteriosus (HSPDA) and to analyze the feasibility, safety and efficacy of the device. Treatment of a patent ductus arteriosus (PDA) in very premature neonates is still a dilemma for the neonatalogist who has to consider its significance and has to choose among different treatment options. Because surgical ligation and medical therapy both have their drawbacks, interventional catheterization might provide an alternative means of closing HSPDA. Between September 2013 and June 2015, 32 premature infants with complications related to HSPDA defined by ultrasound (US) underwent transcatheter closure. The procedure was performed in the catheterization laboratory by venous cannulation without angiography. The position of the occluder was directed by X-ray and US. In particular we looked at procedural details, device size selection, complications, and short and mid-term outcomes. Thirty two premature infants, all of whom had clinical complications related to HSPDA, born at gestational ages ranging between 23.6 and 36 weeks (mean ± standard deviation 28 ± 3 weeks) underwent attempted transcatheter PDA closure using the ADOIIAS. Their mean age and weight at the time of procedure was 25 days (range 8-70 days) and 1373 g (range 680-2480 g), respectively. Ten infants weighed ≤1,000g. All ducts were tubular. The mean PDA and device waist diameters were 3.2 ± 0.6mm (range 2.2-4) and 4.4 ± 0.6 mm, respectively, and the mean PDA and device lengths 5.2 ± 2.0 mm (range 2-10) and 3.4 ± 1.3 mm. Median fluoroscopy and procedural times were 11 min (range 3-24) and 28 min (range 10-90), respectively. Complete closure was achieved in all but one patient. There was no device migration. A left pulmonary artery (LPA) obstruction developed in one patient. Five infants died. Four deaths were related to complications of

Closure of large patent ductus arteriosus using the Amplatzer Septal Occluder.

Science.gov (United States)

García-Montes, José A; Camacho-Castro, Anahí; Sandoval-Jones, Juan P; Buendía-Hernández, Alfonso; Calderón-Colmenero, Juan; Patiño-Bahena, Emilia; Zabal, Carlos

2015-03-01

Percutaneous closure of patent ductus arteriosus has become the treatment of choice in many centres. In patients with large ducts and pulmonary hypertension, transcatheter closure has been achieved with success using the Amplatzer Duct Occluder or even the Amplatzer Muscular Ventricular Septal Defect Occluder. We present a series of 17 patients with large and hypertensive ductus arteriosus who were treated with an Amplatzer Septal Occluder. The group had 11 female patients (64.7%) and a mean age of 18.6±12.1 years. The haemodynamic and anatomical data are as follows: pulmonary artery systolic pressure 71.3±31.8 mmHg, pulmonary to systemic flow ratio 3.14±1.36, ductal diameter at the pulmonary end 12.5±3.8 mm, and at the aortic end 20.2±7.7 mm; 14 cases (82.3%) had type A ducts. In 11 patients, we began the procedure using a different device - six with duct occluder and five with ventricular septal occluder - and it was changed because of device embolisation in six (35.3%). All septal occluders were delivered successfully. Residual shunt was moderate in six patients (35.3%), mild in eight (47%), trivial in two (11.8%), and no shunt in one (5.9%). Pulmonary systolic pressure decreased to 48.9±10.8 mmHg after occlusion (p=0.0015). Follow-up in 15 patients (88.2%) for 28.4±14.4 months showed complete closure in all cases but one, and continuous decrease of the pulmonary systolic pressure to 31.4±10.5 mmHg. No complications at follow-up have been reported. The Amplatzer Septal Occluder is a good alternative to percutaneously treat large and hypertensive ductus arteriosus.

Is transcatheter closure better than medical therapy for cryptogenic stroke with patent foramen ovale? A meta-analysis of randomised trials.

Science.gov (United States)

Nagaraja, Vinayak; Raval, Jwalant; Eslick, Guy D; Burgess, David; Denniss, A Robert

2013-11-01

The prevalence of patent foramen ovale among patients with cryptogenic stroke is higher than that in the general population. Closure with a percutaneous device is often recommended in such patients, but it is not known whether this intervention reduces the risk of recurrent stroke. A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane library, Google Scholar, Science Direct, and Web of Science. Original data were abstracted from each study and used to calculate a pooled event rate (ER), odd ratio (OR) and 95% confidence interval (95% CI). Only three randomised trials comprising 2303 patients met full criteria for analysis. Procedural success (ER: 94.20%, 95% CI: 87.6-97.4%) and effective closure (ER: 92.70%, 95% CI: 85.9-96.4%) of closure therapy were good. The odds ratio for stroke (OR: 0.654, 95% CI: 0.358-1.193) and transient ischaemic attack (OR: 0.768, 95% CI: 0.413-1.429) did not confer a benefit of PFO closure over medical therapy. Age {45 years (OR: 0.707, 95% CI: 0.27-1.856)}, gender {males (OR: 0.498, 95% CI: 0.247-1.004), females (OR: 1.16, 95% CI: 0.597-2.255)}, substantial shunt size (OR: 0.354, 95% CI: 0.089-1.406) and the presence of atrial septal aneurysm (OR: 0.7, 95% CI: 0.21-2.33) did not influence the treatment effect of PFO closure. However, the adverse events like major vascular complication (OR: 10.905, 95% CI: 1.997-59.562) and atrial fibrillation (OR: 3.297, 95% CI: 0.874-12.432) were significantly higher in the closure group. In patients with cryptogenic stroke or TIA who had a patent foramen ovale, closure with a device does not confer an advantage over medical therapy and is associated with adverse events like major vascular complication and atrial fibrillation. Copyright © 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.

Data-driven non-Markovian closure models

Science.gov (United States)

Kondrashov, Dmitri; Chekroun, Mickaël D.; Ghil, Michael

2015-03-01

This paper has two interrelated foci: (i) obtaining stable and efficient data-driven closure models by using a multivariate time series of partial observations from a large-dimensional system; and (ii) comparing these closure models with the optimal closures predicted by the Mori-Zwanzig (MZ) formalism of statistical physics. Multilayer stochastic models (MSMs) are introduced as both a generalization and a time-continuous limit of existing multilevel, regression-based approaches to closure in a data-driven setting; these approaches include empirical model reduction (EMR), as well as more recent multi-layer modeling. It is shown that the multilayer structure of MSMs can provide a natural Markov approximation to the generalized Langevin equation (GLE) of the MZ formalism. A simple correlation-based stopping criterion for an EMR-MSM model is derived to assess how well it approximates the GLE solution. Sufficient conditions are derived on the structure of the nonlinear cross-interactions between the constitutive layers of a given MSM to guarantee the existence of a global random attractor. This existence ensures that no blow-up can occur for a broad class of MSM applications, a class that includes non-polynomial predictors and nonlinearities that do not necessarily preserve quadratic energy invariants. The EMR-MSM methodology is first applied to a conceptual, nonlinear, stochastic climate model of coupled slow and fast variables, in which only slow variables are observed. It is shown that the resulting closure model with energy-conserving nonlinearities efficiently captures the main statistical features of the slow variables, even when there is no formal scale separation and the fast variables are quite energetic. Second, an MSM is shown to successfully reproduce the statistics of a partially observed, generalized Lotka-Volterra model of population dynamics in its chaotic regime. The challenges here include the rarity of strange attractors in the model's parameter

Autonomic Closure for Turbulent Flows Using Approximate Bayesian Computation

Science.gov (United States)

Doronina, Olga; Christopher, Jason; Hamlington, Peter; Dahm, Werner

2017-11-01

Autonomic closure is a new technique for achieving fully adaptive and physically accurate closure of coarse-grained turbulent flow governing equations, such as those solved in large eddy simulations (LES). Although autonomic closure has been shown in recent a priori tests to more accurately represent unclosed terms than do dynamic versions of traditional LES models, the computational cost of the approach makes it challenging to implement for simulations of practical turbulent flows at realistically high Reynolds numbers. The optimization step used in the approach introduces large matrices that must be inverted and is highly memory intensive. In order to reduce memory requirements, here we propose to use approximate Bayesian computation (ABC) in place of the optimization step, thereby yielding a computationally-efficient implementation of autonomic closure that trades memory-intensive for processor-intensive computations. The latter challenge can be overcome as co-processors such as general purpose graphical processing units become increasingly available on current generation petascale and exascale supercomputers. In this work, we outline the formulation of ABC-enabled autonomic closure and present initial results demonstrating the accuracy and computational cost of the approach.

Lower limb revascularisation preceding surgical wound coverage - an interdisciplinary algorithm for chronic wound closure.

Science.gov (United States)

Aust, M C; Spies, M; Guggenheim, M; Gohritz, A; Kall, S; Rosenthal, H; Pichlmaier, M; Oehlert, G; Vogt, P M

2008-08-01

Chronic wounds may occur or persist due to arterial insufficiency. Despite the high prevalence of arterial occlusive disease, a search of the literature has yielded a paucity of data on the benefit of interventions to recanalise lower extremity arteries prior to surgical closure of chronic wounds. To investigate the correlation of simple clinical examinations and apparative diagnostics for the detection of arterial occlusive disease of the lower extremity in patients with chronic wounds, and to evaluate the benefit of vascular procedures to optimise wound perfusion before surgical closure. During a 6-year period, 150 patients with chronic lower extremity wounds (no healing for more than 30 days) were included into this prospective study. All patients underwent palpation of foot pulses, Doppler sonography and measurement of occlusive pressures. Positive clinical findings were re-evaluated by angiography. All patients with peripheral extremity vessel occlusions underwent vascular interventions (percutaneous transluminal angioplasty with stenting, open thrombectomy or vascular bypass surgery) prior to surgical wound closure. In all 34 patients (21%) with missing foot pulses, suspicious Doppler signals or pathological occlusive pressure measurements, the clinical diagnosis of arterial occlusion was confirmed by angiography. An arterial pathology had previously been diagnosed in merely two of those patients. Nineteen patients underwent percutaneous transluminal angioplasty and 21 stents were implanted; in 10 cases, open thrombectomy or vascular bypasses were performed. In all 34 patients, sufficient peripheral recanalisation and improved wound perfusion were successfully achieved. For definitive wound closure, microsurgical tissue transplantation was performed in 15 patients. Angiography was performed prior to surgery. In 11 patients, regional or local flaps were used. Six patients received split skin grafting only; two wounds healed conservatively following vascular

Development of an arid site closure plan

International Nuclear Information System (INIS)

Nyhan, J.W.; Barnes, F.J.

1987-01-01

This document describes the development of a prototype plan for the effective closure and stabilization of an arid low-level waste disposal site. This plan will provide demonstrated closure techniques for a trench in a disposal site at Los Alamos. The accuracy of modeling soil water storage by two hydrologic models, CREAMS and HELP, was tested by comparing simulation results with field measurements of soil moisture in eight experimental landfill cover systems having a range of well-defined soil profiles and vegetative covers. Regression analysis showed that CREAMS generally represented soil moisture more accurately than HELP simulations. Precautions for determining parameter values for model input and for interpreting simulation results are discussed. A specific example is presented showing how the field-validated hydrologic models can be used to develop a final prototype closure plan. 15 refs., 13 figs., 3 tabs

Bilateral Acute Angle-closure after Intraocular Surgery.

Science.gov (United States)

Hoskens, Kirsten; Pinto, Luis Abegão; Vandewalle, Evelien; Verdonk, Nancy; Stalmans, Ingeborg

2014-01-01

We report the case of a 75-year-old woman who developed an acute bilateral angle-closure associated with choroidal effusion a day after an uneventful cataract surgery. The same patient had undergone a similarly uneventful cataract surgery two weeks before, under the same protocol, with no postoperative complication in the other eye. Medical treatment, including the use of oral sulfamide-related drugs (acetazolamide), topical beta-blockers and steroids led to a gradual decrease in intraocular pressure (IOP) and choroidal effusion. Despite initial reports suggesting a link between sulfamide-exposure and these rare forms of angle-closure, our report would suggest a more complex pathophysiology behind this intriguing phenomenon. How to cite this article: Hoskens K, Pinto LA, Vandewalle E, Verdonk N, Stalmans I. Bilateral Acute Angle-closure after Intraocular Surgery. J Curr Glaucoma Pract 2014;8(3):113-114.

200 West Area Ash Pit Demolition Site closure plan. Revision 1

International Nuclear Information System (INIS)

Ruck, F.R.

1994-01-01

The Ash Pit Demolition Site had two known demolition events, the first occurred in November of 1984, and the second occurred in June of 1986. These demolition events were a form of thermal treatment for discarded explosive chemical products. Because the Ash Pit Demolition Site will no longer be used for this thermal activity, the site will be closed. Closure will be conducted pursuant to the requirements of the Washington State Department of Ecology (Ecology) ''Dangerous Waste Regulations'', Washington Administrative Code (WAC) 173-303-610 and 40 Code of Federal Regulations (CFR) 270.1. The 200 West Area Ash Pit Demolition Site Closure Plan consists of a Part A, Form 3, Dangerous Waste Permit Application (Revision 4) and a closure plan. An explanation of the Part A, Form 3, submitted with this closure plan is provided at the beginning of the Part A Section. The closure plan consists of nine chapters and five appendices. This closure plan presents a description of the Ash,Pit Demolition Site, the history of the waste treated, and the approach that will be followed to close the Ash Pit Demolition Site. Because there were no radioactively contaminated chemicals involved in the demolitions, the information on radionuclides is provided for ''information only''. Remediation of any radioactive contamination is not within the scope of this closure plan. Only dangerous constituents derived from Ash Pit Demolition Site operations will be addressed in this closure plan in accordance with WAC 173-303-610(2)(b)(i)

Household responses to school closure resulting from outbreak of influenza B, North Carolina.

Science.gov (United States)

Johnson, April J; Moore, Zack S; Edelson, Paul J; Kinnane, Lynda; Davies, Megan; Shay, David K; Balish, Amanda; McCarron, Meg; Blanton, Lenee; Finelli, Lyn; Averhoff, Francisco; Bresee, Joseph; Engel, Jeffrey; Fiore, Anthony

2008-07-01

School closure is a proposed strategy for reducing influenza transmission during a pandemic. Few studies have assessed how families respond to closures, or whether other interactions during closure could reduce this strategy's effect. Questionnaires were administered to 220 households (438 adults and 355 children) with school-age children in a North Carolina county during an influenza B virus outbreak that resulted in school closure. Closure was considered appropriate by 201 (91%) households. No adults missed work to solely provide childcare, and only 22 (10%) households required special childcare arrangements; 2 households incurred additional costs. Eighty-nine percent of children visited at least 1 public location during the closure despite county recommendations to avoid large gatherings. Although behavior and attitudes might differ during a pandemic, these results suggest short-term closure did not cause substantial hardship for parents. Pandemic planning guidance should address the potential for transmission in public areas during school closure.

[Epidemiologic and economic effectiveness of school closure during influenza epidemics and pandemics].

Science.gov (United States)

Gendon, Iu Z; Vasil'ev, Iu M

2012-01-01

Epidemiologic and economic effectiveness of school closure during influenza epidemics and pandemics is discussed. Optimal effect of school closure is observed when this measure is taken at the start of the epidemic or pandemic and for a sufficiently long time. School closure during high morbidity among schoolchildren, in the middle (at the peak) and by the end of epidemic or pandemic does not influence significantly the spread of influenza or morbidity. Significant economic losses and other negative consequences of school closure are noted. School closure may be the most appropriate during the emergence of influenza pandemic when the pandemic vaccine is not yet available, however timely mass immunization of schoolchildren against influenza may be a more appropriate measure than school closure for the reduction of influenza morbidity and spread during seasonal influenza epidemics.

Endoscopic full-thickness resection and defect closure in the colon.

Science.gov (United States)

von Renteln, Daniel; Schmidt, Arthur; Vassiliou, Melina C; Rudolph, Hans-Ulrich; Caca, Karel

2010-06-01

Endoscopic full-thickness resection (eFTR) is a minimally invasive method for en bloc resection of GI lesions. The aim of this pilot study was to evaluate the feasibility of a grasp-and-snare technique for eFTR combined with an over-the-scope clip (OTSC) for defect closure. Nonsurvival animal study. Animal laboratory. Fourteen female domestic pigs. The eFTR was performed in porcine colons using a novel tissue anchor in combination with a standard monofilament snare and 14 mm OTSC. In the first group (n = 20), closure of the colonic defects with OTSC was attempted after the resection. In the second group (n = 8), an endoloop was used to secure the resection base before eFTR was performed. In the first group (n = 20), eFTR specimens ranged from 2.4 to 5.5 cm in diameter. Successful closure was achieved in 9 out of 20 cases. Mean burst pressure for OTSC closure was 29.2 mm Hg (range, 2-90; SD, 29.92). Injury to adjacent organs occurred in 3 cases. Lumen obstruction due to the OTSC closure occurred in 3 cases. In the second group (n = 8), the diameter of specimens ranged from 1.2 to 2.2 cm. Complete closure was achieved in all cases, with a mean burst pressure of 76.6 mm Hg (range, 35-120; SD, 31). Lumen obstruction due to the endoloop closure occurred in one case. No other complications or injuries were observed in the second group. Nonsurvival setting. Colonic eFTR using the grasp-and-snare technique is feasible in an animal model. Ligation of the resection base with an endoloop before eFTR seems to reduce complication rates and improve closure success and leak test results despite yielding smaller specimens. Copyright 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

The Finishing Touch: Anatomy of Expert Lesson Closures

Science.gov (United States)

Webster, Collin A.; Connolly, Graeme; Schempp, Paul G.

2009-01-01

Background: Based on the idea that students remember best what is presented last, the lesson closure is commonly identified as an important component of effective teaching and has recently surfaced as a routine practice of expert teachers in sport. Despite its link to both effective and expert instruction, the lesson closure has seen scarce…

Tracheocutaneous Fistula Closure with Turnover Flap and Polydioxanone Plate

Directory of Open Access Journals (Sweden)

Justin R. Bryant, DO, MBA

2017-10-01

Full Text Available Summary:. An alternative surgical treatment is proposed for closure of tracheocutaneous fistulas. The authors present a new technique for reconstruction of persistent tracheocutaneous fistula resultant from temporary tracheostomy. The single-stage closure under local anesthesia involves a fistulous tract turnover flap with a perforated 0.15 mm polydioxanone plate between the flap and the subcutaneous closure. This article presents 3 cases of persistent tracheocutaneous fistula treated by this method. At follow-up examination after follow-up, no recurrent fistula formation had occurred, and no respiratory deformity was present.

Clad vent set cup closure-weld-zone grinding evaluation

International Nuclear Information System (INIS)

Ulrich, G.B.; Woods, A.T.; Ohriner, E.K.

1996-04-01

Clad vent set (CVS) cups were ground in the closure-weld zone to reduce the wall-thickness variation created by the cup deep-drawing process. A significantly more uniform wall thickness would be beneficial for the CVS closure-weld operation. The goal was to reduce the average within-cup wall-thickness variation (defined as the range of wall thicknesses in the closure-weld zone) approximately 50% from the Cassini production value of 42 microm. This goal was shown to be achievable but, unfortunately, not with the existing blank and formed cup thicknesses

Yucca Mountain project container fabrication, closure and non-destructive evaluation development activities

International Nuclear Information System (INIS)

Russell, E.W.; Nelson, T.A.

1989-06-01

In this presentation, container fabrication, closure, and non-destructive evaluation (NDE) process development activities are described. All of these activities are interrelated, and will contribute to the metal barrier selection activity. The plan is to use a corrosion-resistant material in the form of a cylinder with a wall thickness of ∼1cm (2cm for pure copper.) The materials under consideration include the three austenitic alloys: stainless steel-304L, stainless steel-316L and alloy 825, as well as the three copper alloys: CDA 102, CDA 613, and CDA 715. This document reviews the recommended procedures and processes for fabricating, closing and evaluating each of the candidate materials

A standardized perioperative surgical site infection care process among children with stoma closure: a before-after study.

Science.gov (United States)

Porras-Hernandez, Juan; Bracho-Blanchet, Eduardo; Tovilla-Mercado, Jose; Vilar-Compte, Diana; Nieto-Zermeño, Jaime; Davila-Perez, Roberto; Teyssier-Morales, Gustavo; Lule-Dominguez, Martha

2008-10-01

We report on the effectiveness of a standardized perioperative care process for lowering surgical site infection (SSI) rates among children with stoma closure at a tertiary-care public pediatric teaching hospital in Mexico City. All consecutive children with stoma closure operated on between November 2003 and October 2005 were prospectively followed for 30 days postoperatively. We conducted a before-after study to evaluate standardized perioperative bowel- and abdominal-wall care process results on SSI rates. Seventy-one patients were operated on, and all completed follow-up. SSI rates declined from 42.8% (12/28) before to 13.9% (6/43) after the standardization procedure (relative risk (RR) = 3.1; 95% confidence interval (CI) = 1.3-7.2; p = 0.006). SSI independently associated risk factors comprised peristomal skin inflammation >3 mm (odds ratio (OR) = 9.6; 95% CI = 1.8-49.6; p = 0.007) and intraoperative complications (OR = 13.3; 95% CI = 1.4-127.2; p = 0.02). Being operated on during the after-study period was shown to be a protective factor against SSI (OR = 0.2; 95% CI = 0.4-0.97; p = 0.04). Standardization was able to reduce SSI rates threefold in children with stoma closure in a short period of time.

[Lung perfusion studies after percutaneous closure of patent ductus arteriosus using the Amplatzer Duct Occluder in children].

Science.gov (United States)

Parra-Bravo, José Rafael; Apolonio-Martínez, Adriana; Estrada-Loza, María de Jesús; Beirana-Palencia, Luisa Gracia; Ramírez-Portillo, César Iván

2015-01-01

The closure of patent ductus arteriosus with multiple devices has been associated with a reduction in lung perfusion. We evaluated the pulmonary perfusion after percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder device using perfusion lung scan. Thirty patients underwent successful percutaneous patent ductus arteriosus occlusions using the Amplatzer Duct Occluder device were included in this study. Lung perfusion scans were preformed 6 months after the procedure. Peak flow velocities and protrusion of the device were analyzed by Doppler echocardiography. A left lung perfusionductus arteriosus and the minimum and maximum diameter/length of the ductus arteriosus ratio were statistically significant in patients with abnormalities of lung perfusion. It was observed protrusion the device in 6 patients with a higher maximum flow rate in the left pulmonary artery. The left lung perfusion may be compromised after percutaneous closure of patent ductus arteriosus with the Amplatzer Duct Occluder. The increased flow velocity in the origin of the left pulmonary artery can be a poor indicator of reduction in pulmonary perfusion and can occur in the absence of protrusion of the device. Copyright © 2014 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

Sustainable closure of construction materials quarries in Cuba

Directory of Open Access Journals (Sweden)

Julio Montero-Matos

2017-10-01

Full Text Available The inclusion of effective mine closure plans in the exploitation project is the way to compensate for the harmful effect of this activity. Based on a diagnosis carried out in 11 sites in operation, belonging to the company Canteras, a methodology was designed with a systemic and integral approach that consists of five stages and allows the execution of quarry closures in a sustainable manner. The Delphi method was applied to select the criteria that directly affect the sustainable closure of quarries in such a way that it considers the essential postulates of the Cuban Economic Model (MEC. The proposed methodology represents a contribution to the planning and design of the mining closure in Cuban non-metallic deposits to guarantee the reduction of the environmental impacts caused during its operation and the reduction, to the lesser extent possible, of negative socio-economic effects for the workers and the community located in the area of influence of the quarries. Currently applied in the quarry of San José, in Mayabeque province.

Review on improved seismic imaging with closure phase

KAUST Repository

Schuster, Gerard T.

2014-08-13

The timing and amplitudes of arrivals recorded in seismic traces are influenced by velocity variations all along the associated raypaths. Consequently, velocity errors far from the target can lead to blurred imaging of the target body. To partly remedy this problem, we comprehensively reviewed inverting differential traveltimes that satisfied the closure-phase condition. The result is that the source and receiver statics are completely eliminated in the data and velocities far from the target do not need to be known. We successfully used the phase closure equation for traveltime tomography, refraction statics, migration, refraction tomography, and earthquake location, all of which demonstrated the higher resolution achievable by processing data with differential traveltimes rather than absolute traveltimes. More generally, the stationary version of the closure-phase equation is equivalent to Fermat’s principle and can be derived from the equations of seismic interferometry. In summary, the general closure-phase equation is the mathematical foundation for approximately redatuming sources and/or receivers to the target of interest without the need to accurately know the statics or the velocity model away from the target.

GCFR 1/20-scale PCRV central core cavity closure model test

International Nuclear Information System (INIS)

Robinson, G.C.; Dougan, J.R.

1981-06-01

Oak Ridge National Laboratory has been conducting structural response tests of the prestressed concrete reactor vessel (PCRV) closures for the 300-MW(e) gas-cooled fast reactor demonstration power plant. This report describes the third in a series of tests of small-scale closure plug models. The model represents a redesign of the central core cavity closure plug. The primary objective was to demonstrate structural performance and ultimate load capacity of the closure plug. Secondary objectives included obtaining data on crack development and propagation and on mode of failure of the composite structure

Cleft Palate Fistula Closure Utilizing Acellular Dermal Matrix

Directory of Open Access Journals (Sweden)

Omri Emodi, DMD

2018-03-01

Full Text Available Summary:. Fistulas represent failure of cleft palate repair. Secondary and tertiary fistula repair is challenging, with high recurrence rates. In the present retrospective study, we review the efficacy of using acellular dermal matrix as an interposition layer for cleft palate fistula closure in 20 consecutive patients between 2013 and 2016. Complete fistula closure was obtained in 16 patients; 1 patient had asymptomatic recurrent fistula; 2 patients had partial closure with reduction of fistula size and minimal nasal regurgitation; 1 patient developed a recurrent fistula without changes in symptoms (success rate of 85%. We conclude that utilizing acellular dermal matrix for cleft palate fistula repair is safe and simple with a high success rate.

Cleft Palate Fistula Closure Utilizing Acellular Dermal Matrix.

Science.gov (United States)

Emodi, Omri; Ginini, Jiriys George; van Aalst, John A; Shilo, Dekel; Naddaf, Raja; Aizenbud, Dror; Rachmiel, Adi

2018-03-01

Fistulas represent failure of cleft palate repair. Secondary and tertiary fistula repair is challenging, with high recurrence rates. In the present retrospective study, we review the efficacy of using acellular dermal matrix as an interposition layer for cleft palate fistula closure in 20 consecutive patients between 2013 and 2016. Complete fistula closure was obtained in 16 patients; 1 patient had asymptomatic recurrent fistula; 2 patients had partial closure with reduction of fistula size and minimal nasal regurgitation; 1 patient developed a recurrent fistula without changes in symptoms (success rate of 85%). We conclude that utilizing acellular dermal matrix for cleft palate fistula repair is safe and simple with a high success rate.

Stationary neutrino radiation transport by maximum entropy closure

International Nuclear Information System (INIS)

Bludman, S.A.

1994-11-01

The authors obtain the angular distributions that maximize the entropy functional for Maxwell-Boltzmann (classical), Bose-Einstein, and Fermi-Dirac radiation. In the low and high occupancy limits, the maximum entropy closure is bounded by previously known variable Eddington factors that depend only on the flux. For intermediate occupancy, the maximum entropy closure depends on both the occupation density and the flux. The Fermi-Dirac maximum entropy variable Eddington factor shows a scale invariance, which leads to a simple, exact analytic closure for fermions. This two-dimensional variable Eddington factor gives results that agree well with exact (Monte Carlo) neutrino transport calculations out of a collapse residue during early phases of hydrostatic neutron star formation

An Elongated Leading Edge Facilitates Rotation Flap Closure: In Vivo Demonstration.

Science.gov (United States)

Lichon, Vanessa; Barbosa, Naiara; Gomez, Doug; Goldman, Glenn

2016-01-01

Variation in the design of a rotation flap may affect wound closure tension. Lengthening the leading edge of a rotation flap has been a method of reducing the tension of closure in the primary motion. An in vitro study negating this tenant has been published. The authors set out to design an in vivo experiment to determine if lengthening the leading edge of a rotation flap has the effect of reducing closure tension in the primary motion of the repair. An animal study approved by Institutional Animal Care and Use Committee was undertaken in a pig model. A tension-measuring apparatus was designed using Teflon-coated wires and digital tensiometers. Rotation flaps of a standard design and with elongated leading edges were incised on the flanks of pigs under general anesthesia. Flap closure tensions were measured at points along the leading edge of the flap and in the secondary motion. Elongating the leading edge of a flap led to a statistically significant reduction in closure tension in the primary motion of the flap and at the flap tip. The secondary motion closure tensions were essentially unaffected. The authors confirm that elongating the leading edge of a standard rotation flap will reduce closure tension in the primary flap motion.

Systematic review and meta-analysis of published randomized controlled trials comparing purse-string vs conventional linear closure of the wound following ileostomy (stoma) closure.

Science.gov (United States)

Sajid, Muhammad Shafique; Bhatti, Muhammad I; Miles, William Fa

2015-05-01

The objective of this article is to systematically analyse the randomized, controlled trials comparing the effectiveness of purse-string closure (PSC) of an ileostomy wound with conventional linear closure (CLC). Randomized, controlled trials comparing the effectiveness of purse-string closure vs conventional linear closure (CLC) of ileostomy wound in patients undergoing ileostomy closure were analysed using RevMan®, and the combined outcomes were expressed as risk ratio (RR) and standardized mean difference (SMD). Three randomized, controlled trials, recruiting 206 patients, were retrieved from medical electronic databases. There were 105 patients in the PSC group and 101 patients in the CLC group. There was no heterogeneity among included trials. Duration of operation (SMD: -0.18; 95% CI: -0.45, 0.09; z = 1.28; P SMD: 0.01; 95% CI: -0.26, 0.28; z = 0.07; P infection (OR, 0.10; 95% CI: 0.03, 0.33; z = 3.78; P infection apparently without influencing the duration of operation and length of hospital stay. © The Author(s) 2014. Published by Oxford University Press and the Digestive Science Publishing Co. Limited.

Decommissioning licensing procedure

International Nuclear Information System (INIS)

Perello, M.

1979-01-01

Decommissioning or closure of a nuclear power plant, defined as the fact that takes place from the moment that the plant stops producing for the purpose it was built, is causing preocupation. So this specialist meeting on Regulatory Review seems to be the right place for presenting and discusing the need of considering the decommissioning in the safety analysis report. The main goal of this paper related to the licensing procedure is to suggest the need of a new chapter in the Preliminary Safety Analysis Report (P.S.A.R.) dealing with the decommissioning of the nuclear power plant. Therefore, after a brief introduction the problem is exposed from the point of view of nuclear safety and finally a format of the new chapter is proposed. (author)

Proposed modifications to the RCRA post-closure permit for the Chestnut Ridge Hydrogeologic Regime at the U.S. Department of Energy Y-12 Plant, Oak Ridge, Tennessee

International Nuclear Information System (INIS)

1997-05-01

This report presents proposed modifications to several conditions of the Resource Conservation and Recovery Act (RCRA) Post-Closure Permit (PCP) for the Chestnut Ridge Hydrogeologic Regime (CRHR) (permit number TNHW-088, EPA ID No. TN3 89 009 0001). These permit conditions define the requirements for RCRA post-closure detection groundwater monitoring at the Chestnut Ridge Sediment Disposal Basin (CRSDB) and Kerr Hollow Quarry (KHQ), and RCRA post-closure corrective action groundwater monitoring at the Chestnut Ridge Security Pits (CRSPs). Modification of these PCP conditions is requested to: (1) clarify the planned integration of RCRA post-closure corrective action groundwater monitoring at the CRSPs with the monitoring program to be established in the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) record of decision (ROD), (2) revise several of the current technical requirements for groundwater monitoring based on implementation of the RCRA monitoring programs during 1996, (3) replace several of the technical procedures included in the PCP with updated versions recently issued by the Y-12 Plant Groundwater Protection Program (GWPP), and (4) correct inaccurate regulatory citations and references to permit conditions and permit attachments. With these modifications, the Y- 12 Plant will continue to meet the full intent of all regulatory obligations for post-closure care of these facilities. Section 2 provides the technical justification for each proposed permit modification. Section 3.0 contains proposed changes to Section II of the PCP. Modifications to site-specific permit conditions are presented in Section 4.0 (CRSDB), Section 5.0 (CRSPs), and Section 6.0 (KHQ). Sections 7.0 and 8.0 reference updated and revised procedures for groundwater sampling, and monitoring well plugging and abandonment, respectively. Appendix A includes all proposed revisions to the permit attachments

Proposed modifications to the RCRA post-closure permit for the Chestnut Ridge Hydrogeologic Regime at the U.S. Department of Energy Y-12 Plant, Oak Ridge, Tennessee

Energy Technology Data Exchange (ETDEWEB)

NONE

1997-05-01

This report presents proposed modifications to several conditions of the Resource Conservation and Recovery Act (RCRA) Post-Closure Permit (PCP) for the Chestnut Ridge Hydrogeologic Regime (CRHR) (permit number TNHW-088, EPA ID No. TN3 89 009 0001). These permit conditions define the requirements for RCRA post-closure detection groundwater monitoring at the Chestnut Ridge Sediment Disposal Basin (CRSDB) and Kerr Hollow Quarry (KHQ), and RCRA post-closure corrective action groundwater monitoring at the Chestnut Ridge Security Pits (CRSPs). Modification of these PCP conditions is requested to: (1) clarify the planned integration of RCRA post-closure corrective action groundwater monitoring at the CRSPs with the monitoring program to be established in the Comprehensive Environmental Response, Compensation, and Liability Act (CERCLA) record of decision (ROD), (2) revise several of the current technical requirements for groundwater monitoring based on implementation of the RCRA monitoring programs during 1996, (3) replace several of the technical procedures included in the PCP with updated versions recently issued by the Y-12 Plant Groundwater Protection Program (GWPP), and (4) correct inaccurate regulatory citations and references to permit conditions and permit attachments. With these modifications, the Y- 12 Plant will continue to meet the full intent of all regulatory obligations for post-closure care of these facilities. Section 2 provides the technical justification for each proposed permit modification. Section 3.0 contains proposed changes to Section II of the PCP. Modifications to site-specific permit conditions are presented in Section 4.0 (CRSDB), Section 5.0 (CRSPs), and Section 6.0 (KHQ). Sections 7.0 and 8.0 reference updated and revised procedures for groundwater sampling, and monitoring well plugging and abandonment, respectively. Appendix A includes all proposed revisions to the permit attachments.

Variation in practice patterns in device closure of atrial septal defects and patent ductus arteriosus: An analysis of data from the IMproving Pediatric and Adult Congenital Treatment (IMPACT) registry.

Science.gov (United States)

O'Byrne, Michael L; Kennedy, Kevin F; Rome, Jonathan J; Glatz, Andrew C

2018-02-01

Practice variation is a potentially important measure of healthcare quality. The IMPACT registry provides a representative national sample with which to study practice variation in trans-catheter interventions for congenital heart disease. We studied cases for closure of atrial septal defect (ASD) and patent ductus arteriosus (PDA) in IMPACT between January 1, 2011, and September 30, 2015, using hierarchical multivariate models studying (1) the distribution of indications for closure and (2) in patients whose indication for closure was left (LVVO) or right ventricular volume overload (RVVO), the factors influencing probability of closure of a small defect (either in size or in terms of the magnitude of shunt). Over the study period, 5233 PDA and 4459 ASD cases were performed at 77 hospitals. The indications for ASD closure were RVVO in 84% and stroke prevention in 13%. Indications for PDA closure were LVVO in 57%, endocarditis prevention in 36%, and pulmonary hypertension in 7%. There was statistically significant variability in indications between hospitals for PDA and ASD procedures (median rate ratio (MRR): 1.3 and 1.1; both Pclosure of PDA and ASD. Further research is necessary to study whether this affects outcomes or resource utilization. Copyright © 2017 Elsevier Inc. All rights reserved.

Autocracy bias in informal groups under need for closure.

Science.gov (United States)

Pierro, Antonio; Mannetti, Lucia; De Grada, Eraldo; Livi, Stefano; Kruglanski, Arie W

2003-03-01

Two experiments investigated the tendency of groups with members under high (vs. low) need for cognitive closure to develop an autocratic leadership structure in which some members dominate the discussion, constitute the "hubs" of communication, and influence the group more than other members. The first experiment found that high (vs. low) need for closure groups, as assessed via dispositional measure of the need for closure, manifested greater asymmetry of conversational floor control, such that members with autocratic interactional style were more conversationally dominant and influential than less autocratic members. The second experiment manipulated the need for closure via time pressure and utilized a social network analysis. Consistent with expectation, groups under time pressure (vs. no pressure) showed a greater asymmetry of participation, of centrality, and of prestige among the group members, such that the more focal members were perceived to exert the greater influence over the groups' decisions.

Closure properties of Watson-Crick grammars

Science.gov (United States)

Zulkufli, Nurul Liyana binti Mohamad; Turaev, Sherzod; Tamrin, Mohd Izzuddin Mohd; Azeddine, Messikh

2015-12-01

In this paper, we define Watson-Crick context-free grammars, as an extension of Watson-Crick regular grammars and Watson-Crick linear grammars with context-free grammar rules. We show the relation of Watson-Crick (regular and linear) grammars to the sticker systems, and study some of the important closure properties of the Watson-Crick grammars. We establish that the Watson-Crick regular grammars are closed under almost all of the main closure operations, while the differences between other Watson-Crick grammars with their corresponding Chomsky grammars depend on the computational power of the Watson-Crick grammars which still need to be studied.

Permanent Closure of MFC Biodiesel Underground Storage Tank 99ANL00013

Energy Technology Data Exchange (ETDEWEB)

Kerry L. Nisson

2012-10-01

This closure package documents the site assessment and permanent closure of the Materials and Fuels Complex biodiesel underground storage tank 99ANL00013 in accordance with the regulatory requirements established in 40 CFR 280.71, “Technical Standards and Corrective Action Requirements for Owners and Operators of Underground Storage Tanks: Out-of-Service UST Systems and Closure.”

The Availability of Judicial Review Regarding Military Base Closures and Realignments

Science.gov (United States)

2005-06-30

held that the President is not subject to the APA, due to separation of powers principles.37 Base Closure Act Claims The Dalton Court distinguished...that the 1988 Base Closure Act violated the non-delegation doctrine and the separation of powers doctrine.53 However, the Base Closure Act has not yet been held unconstitutional by any federal appellate courts.

218-E-8 Borrow Pit Demolition Site closure plan. Revision 1

International Nuclear Information System (INIS)

Ruck, F.R.

1994-01-01

The 218-E-8 Demolition Site was the site of a single demolition event in November of 1984. This demolition event was a form of thermal treatment for discarded explosive chemical products. Because the 218-E-8 Demolition Site will no longer be used for this thermal activity, the site will be closed. Closure will be conducted pursuant to the requirements of the Washington State Department of Ecology (Ecology) ''Dangerous Waste Regulations,'' Washington Administrative Code (WAC) 173-303-610 and 40 Code of Federal Regulations (CFR) 270.1. The 218-E-8 Borrow Pit Demolition Site Closure Plan consists of a Hanford Facility Dangerous Waste Part A Permit Application, Form 3, Revision 4, and a closure plan. An explanation of the Part A Form 3, submitted with this closure plan is provided at the beginning of the Part A Section. The closure plan consists of nine chapters and five appendices. This closure plan presents a description of the 218-E-8 Demolition Site, the history of the waste treated, and the approach that will be followed to close the 218-E-8 Demolition Site. Because there were no radioactively contaminated chemicals involved in t he demolitions at the 218-E-8 Borrow Pit site, the information on radionuclides is provided for ''information only.'' Remediation of any radioactive contamination is not within the scope of this closure plan. Only dangerous constituents derived from 218-E-8 Demolition Site operations will be addressed in this closure plan in accordance with WAC 173-303-610(2)(b)(i)

Transcatheter closure of large patent ductus arteriosus with severe pulmonary arterial hypertension in adults: immediate and two-year follow-up results.

Science.gov (United States)

Zhang, Cao-Jin; Huang, Yi-Gao; Huang, Xin-Sheng; Huang, Tao; Huang, Wen-Hui; Xia, Chun-Li; Mo, Yu-Jing

2012-11-01

Transcatheter closure of patent ductus arteriosus (PDA) is a well established procedure and an accepted treatment modality for small to moderate-sized PDA. This study aimed to evaluate the immediate and follow-up results of transcatheter closure of large PDAs with severe pulmonary arterial hypertension (PAH) in adults. After a complete hemodynamic evaluation differentiating from the reversibility of severe PAH, transcatheter closure of PDA was performed. Patients were followed up clinically and echocardiographically at 24 hours, 1 month, 3 months, 6 months, 12 months and 24 months after occlusion. Twenty-nine patients had successful occlusion, pulmonary artery pressure (PAP), left ventricular ejection fraction (LVEF) and fractional shortening (FS) significantly decreased immediately after occlusion ((106 ± 25) mmHg vs. (50 ± 14) mmHg, P closure, the signs and symptoms improved markedly in all 29 patients, and PDAs were completely closed and remained closed during the follow-up. Eighteen patients having different degrees of dyspnea were treated with angiotensin converting enzyme inhibitor (ACEI) and/or digoxin after occlusion. Nine patients whose pulmonary vascular resistence (PVR) > 6 Wood units accepted targeted PAH therapy. After 1 to 3 months of peroral drug therapy, their exercise tolerance improved from New York Heart Association (NYHA) class III-IV to NYHA class I. During follow-up, no latent arrhythmias were found, the left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular mass index (LVMI) and pulmonary artery systolic pressure (PASP) decreased significantly (P closure of large PDA with severe PAH is feasible, effective, and safe in adults. Significant left ventricular systolic changes may occur after closure of large PDA, and left ventricular function usually recovers within a few months.

A simple novel technique [PUIT] for closure of urethrocutaneous fistula after hypospadias repair: Preliminary results

Directory of Open Access Journals (Sweden)

Awad M

2005-01-01

Full Text Available Urethrocutaneous fistula is a common complication of urethroplasty for severe hypospadias, even when a microsurgical technique is applied, the closure of the fistula is a challenging problem. We present a simple surgical procedure, posterior urethral incision technique [PUIT] to close the fistula in our department. Between February 2001 and December 2004 we prospectively evaluated 32 patients, 26 patients with initial hypospadias fistulas and 6 with recurrent fistulas who underwent closure of urethrocutaneous fistula after hypospadias repair. The mean age of patients was 5 years, the operation consisted of trimming the fistula edge after mobilization of the skin all-around then a midline posterior urethral incision was done 2 mm above and 2 mm below the fistula opening then re-approximation of the urethral edges using 6/0 vicryl sutures with loop magnification. The timing of fistula repair was between 6 and 13 months after it was formed, all of these were effectively closed except three cases with stricture and fistula. Of these, two were completely relieved after repeated urethral dilatation, three times a week for 2 weeks. The third failed case will need another sitting after 6 months. The posterior midline urethral incision gives a good opportunity for repair without tension with a good cosmetic outcome. This may be done under local anesthesia in adults. The procedure is considered simple rapid and easy to be done for variable fistulas types whatever of its site and the age.

Vascularized fibular graft combined with vacuum assisted closure in ...

African Journals Online (AJOL)

The flowthrough fibular graft combined with Vacuum Assisted Closure (VAC) controlled the infection, shortened the course of treatment, and effectively restored limb function when applied to the treatment of tibial defects. Keywords: Tibial defect, Flow-through fibular graft, Vacuum Assisted Closure, Chronic Osteomyelitis ...

Hand-suture versus stapling for closure of loop ileostomy: HASTA-Trial: a study rationale and design for a randomized controlled trial

Directory of Open Access Journals (Sweden)

Krüger Matthias

2011-02-01

Full Text Available Abstract Background Colorectal cancer is the second most common tumor in developed countries, with a lifetime prevalence of 5%. About one third of these tumors are located in the rectum. Surgery in terms of low anterior resection with mesorectal excision is the central element in the treatment of rectal cancer being the only option for definite cure. Creating a protective diverting stoma prevents complications like anastomotic failure and meanwhile is the standard procedure. Bowel obstruction is one of the main and the clinically and economically most relevant complication following closure of loop ileostomy. The best surgical technique for closure of loop ileostomy has not been defined yet. Methods/Design A study protocol was developed on the basis of the only randomized controlled mono-center trial to solve clinical equipoise concerning the optimal surgical technique for closure of loop ileostomy after low anterior resection due to rectal cancer. The HASTA trial is a multi-center pragmatic randomized controlled surgical trial with two parallel groups to compare hand-suture versus stapling for closure of loop ileostomy. It will include 334 randomized patients undergoing closure of loop ileostomy after low anterior resection with protective ileostomy due to rectal cancer in approximately 20 centers consisting of German hospitals of all level of health care. The primary endpoint is the rate of bowel obstruction within 30 days after ileostomy closure. In addition, a set of surgical and general variables including quality of life will be analyzed with a follow-up of 12 months. An investigators meeting with a practical session will help to minimize performance bias and enforce protocol adherence. Centers are monitored centrally as well as on-site before and during recruitment phase to assure inclusion, treatment and follow up according to the protocol. Discussion Aim of the HASTA trial is to evaluate the efficacy of hand-suture versus stapling for

105-DR Large Sodium Fire Facility closure plan

International Nuclear Information System (INIS)

1993-05-01

The Hanford Site, located northwest of the city of Richland, Washington, houses reactors, chemical-separation systems, and related facilities used for the production of special nuclear materials, and activities associated with nuclear energy development. The 105-DR Large Sodium Fire Facility (LSFF), which was in operation from about 1972 to 1986, was a research laboratory that occupied the former ventilation supply room on the southwest side of the 105-DR Reactor facility. The LSFF was established to provide a means of investigating fire and safety aspects associated with large sodium or other metal alkali fires in the liquid metal fast breeder reactor (LMFBR) facilities. The 105-DR Reactor facility was designed and built in the 1950's and is located in the 100-D Area of the Hanford Site. The building housed the 105-DR defense reactor, which was shut down in 1964. The LSFF was initially used only for engineering-scale alkali metal reaction studies. In addition, the Fusion Safety Support Studies program sponsored intermediate-size safety reaction tests in the LSFF with lithium and lithium lead compounds. The facility has also been used to store and treat alkali metal waste, therefore the LSFF is subject to the regulatory requirements for the storage and treatment of dangerous waste. Closure will be conducted pursuant to the requirements of the Washington Administrative Code (WAC) 173-303-610. This closure plan presents a description of the facility, the history of waste managed, and the procedures that will be followed to close the LSFF as an Alkali Metal Treatment Facility. No future use of the LSFF is expected

Structural analysis of closure bolts for shipping casks

International Nuclear Information System (INIS)

Mok, G.C.; Fischer, L.E.

1993-04-01

This paper identifies the active forces and moments in a closure bolt of a shipping cask. It examines the interactions of these forces/moments and suggest simplified methods for their analysis. The paper also evaluates the role that the forces and moments play in the structure integrity of the closure bolt and recommends stress limits and desirable practices to ensure its integrity

Influence of timing of delayed hard palate closure on articulation skills in 3-year-old Danish children with unilateral cleft lip and palate.

Science.gov (United States)

Willadsen, Elisabeth; Boers, Maria; Schöps, Antje; Kisling-Møller, Mia; Nielsen, Joan Bogh; Jørgensen, Line Dahl; Andersen, Mikael; Bolund, Stig; Andersen, Helene Søgaard

2018-01-01

Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. To assess the influence of different timing of hard palate closure in a two-stage procedure on articulation skills in 3-year-olds born with unilateral cleft lip and palate (UCLP). Secondary aims were to compare results with peers without CP, and to investigate if there are gender differences in articulation skills. Furthermore, burden of treatment was to be estimated in terms of secondary surgery, hearing and speech therapy. A randomized controlled trial (RCT). Early hard palate closure (EHPC) at 12 months versus late hard palate closure (LHPC) at 36 months in a two-stage procedure was tested in a cohort of 126 Danish-speaking children born with non-syndromic UCLP. All participants had the lip and soft palate closed around 4 months of age. Audio and video recordings of a naming test were available from 113 children (32 girls and 81 boys) and were transcribed phonetically. Recordings were obtained prior to hard palate closure in the LHPC group. The main outcome measures were percentage consonants correct adjusted (PCC-A) and consonant errors from blinded assessments. Results from 36 Danish-speaking children without CP obtained previously by Willadsen in 2012 were used for comparison. Children with EHPC produced significantly more target consonants correctly (83%) than children with LHPC (48%; p < .001). In addition, children with LHPC produced significantly more active cleft speech characteristics than children with EHPC (p < .001). Boys achieved significantly lower PCC-A scores than girls (p = .04) and produced significantly more consonant errors than girls (p = .02). No significant differences were found between groups regarding burden of treatment. The control group performed significantly better than the EHPC and LHPC groups on all compared variables. © 2017 Royal College of Speech

Multicenter Off-Label Use of Nit-Occlud Coil in Retrograde Closure of Small Patent Ductus Arteriosus.

Science.gov (United States)

Zanjani, Keyhan Sayadpour; Sobhy, Rodina; El-Kaffas, Rania; El-Sisi, Amal

2017-04-01

We studied the safety and efficacy of closing patent ductus arteriosus by Nit-Occlud coils via retrograde approach. This is a retrospective study of 46 attempts to close ducts by this method in two hospitals in Egypt and Iran. Ductus arteriosus was crossed by left or right Judkins or endhole catheters. The coil was delivered via the same catheter or the provided endhole catheter after exchange. The procedure was successful in 42 out of 46 attempts. Fluoroscopy and procedural times were significantly shorter when the catheter was not exchanged. This method is effective and safe for the closure of small ducts. Crossing the duct and delivering the coil by a left Judkins catheter is the easiest and fastest way to perform this method.

[Velopharyngeal closure pattern and speech performance among submucous cleft palate patients].

Science.gov (United States)

Heng, Yin; Chunli, Guo; Bing, Shi; Yang, Li; Jingtao, Li

2017-06-01

To characterize the velopharyngeal closure patterns and speech performance among submucous cleft palate patients. Patients with submucous cleft palate visiting the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University between 2008 and 2016 were reviewed. Outcomes of subjective speech evaluation including velopharyngeal function, consonant articulation, and objective nasopharyngeal endoscopy including the mobility of soft palate, pharyngeal walls were retrospectively analyzed. A total of 353 cases were retrieved in this study, among which 138 (39.09%) demonstrated velopharyngeal competence, 176 (49.86%) velopharyngeal incompetence, and 39 (11.05%) marginal velopharyngeal incompetence. A total of 268 cases were subjected to nasopharyngeal endoscopy examination, where 167 (62.31%) demonstrated circular closure pattern, 89 (33.21%) coronal pattern, and 12 (4.48%) sagittal pattern. Passavant's ridge existed in 45.51% (76/167) patients with circular closure and 13.48% (12/89) patients with coronal closure. Among the 353 patients included in this study, 137 (38.81%) presented normal articulation, 124 (35.13%) consonant elimination, 51 (14.45%) compensatory articulation, 36 (10.20%) consonant weakening, 25 (7.08%) consonant replacement, and 36 (10.20%) multiple articulation errors. Circular closure was the most prevalent velopharyngeal closure pattern among patients with submucous cleft palate, and high-pressure consonant deletion was the most common articulation abnormality. Articulation error occurred more frequently among patients with a low velopharyngeal closure rate.

Transcatheter closure of post-operative residual ventricular septal defect using a patent ductus arteriosus closure device in an adult: a case report.

Science.gov (United States)

Djer, Mulyadi M; Idris, Nikmah S; Alwi, Idrus; Wijaya, Ika P

2014-07-01

Transcatheter closure of perimembranous and muscular ventricular septal defect (VSD) has been performed widely and it has more advantages compare to surgery. However, transcatheter closure of residual VSD post operation of complex congenital heart disease is still challenging because of the complexity of anatomy and concern about device stability, so the operator should meticulously choose the most appropriate technique and device. We would like to report a case of transcatheter closure of residual VSD post Rastelli operation in a patient with double outlet right ventricle (DORV), sub-aortic VSD, severe infundibulum pulmonary stenosis (PS) and single coronary artery. The patient had undergone operations for four times, but he still had intractable heart failure that did not response to medications. On the first attempt. we closed the VSD using a VSD occluder, unfortunately the device embolized into the descending aorta, but fortunately we was able to snare it out. Then we decided to close the VSD using a patent ductus arteriosus (PDA occluder). On transesophageal echocardiography (TEE) and angiography evaluation, the device position was stable. Post transcatheter VSD closure, the patient clinical condition improved significantly and he could finally be discharged after a long post-surgery hospitalization. Based on this experience we concluded that the transcatheter closure of residual VSD in complex CHD using PDA occluder could be an effective alternative treatment.

Influence of Timing of Delayed Hard Palate Closure on Articulation Skills in 3-Year-Old Danish Children with Unilateral Cleft Lip and Palate

Science.gov (United States)

Willadsen, Elisabeth; Boers, Maria; Schöps, Antje; Kisling-Møller, Mia; Nielsen, Joan Bogh; Jørgensen, Line Dahl; Andersen, Mikael; Bolund, Stig; Andersen, Helene Søgaard

2018-01-01

Background: Differing results regarding articulation skills in young children with cleft palate (CP) have been reported and often interpreted as a consequence of different surgical protocols. Aims: To assess the influence of different timing of hard palate closure in a two-stage procedure on articulation skills in 3-year-olds born with unilateral…

The open abdomen and temporary abdominal closure systems--historical evolution and systematic review.

Science.gov (United States)

Quyn, A J; Johnston, C; Hall, D; Chambers, A; Arapova, N; Ogston, S; Amin, A I

2012-08-01

Several techniques for temporary abdominal closure have been developed. We systematically review the literature on temporary abdominal closure to ascertain whether the method can be tailored to the indication. Medline, Embase, the Cochrane Central Register of Controlled Trials and relevant meeting abstracts until December 2009 were searched using the following headings: open abdomen, laparostomy, VAC (vacuum assisted closure), TNP (topical negative pressure), fascial closure, temporary abdominal closure, fascial dehiscence and deep wound dehiscence. The data were analysed by closure technique and aetiology. The primary end-points included delayed fascial closure and in-hospital mortality. The secondary end-points were intra-abdominal complications. The search identified 106 papers for inclusion. The techniques described were VAC (38 series), mesh/sheet (30 series), packing (15 series), Wittmann patch (eight series), Bogotá bag (six series), dynamic retention sutures (three series), zipper (15 series), skin only and locking device (one series each). The highest facial closure rates were seen with the Wittmann patch (78%), dynamic retention sutures (71%) and VAC (61%). Temporary abdominal closure has evolved from simple packing to VAC based systems. In the absence of sepsis Wittmann patch and VAC offered the best outcome. In its presence VAC had the highest delayed primary closure and the lowest mortality rates. However, due to data heterogeneity only limited conclusions can be drawn from this analysis. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

Transcatheter closure of paravalvular leaks using a paravalvular leak device – a prospective Polish registry

Directory of Open Access Journals (Sweden)

Grzegorz Smolka

2016-05-01

Full Text Available Introduction : Transcatheter paravalvular leak closure (TPVLC has become an established treatment option but is mostly performed with off-label use of different non-dedicated occluders. The first one specifically designed for TPVLC is the paravalvular leak device (PLD – Occlutech. Aim : We present initial short-term results of a prospective registry intended to assess the safety and efficacy of TPVLC with PLD. Material and methods : We screened patients with paravalvular leak (PVL after surgical valve replacement (SVR. Heart failure symptoms and/or hemolytic anemia were indications for TPVLC. Patients were selected according to PVL anatomy by RT 3D TEE. Only those considered appropriate for closure with a single PLD were enrolled. The procedures were performed via transvascular or transapical access using type W (waist PLDs only. Results : Thirty patients with 34 PVLs (18 aortic, 16 mitral were included. We implanted 35 PLDs with a total device success rate of 94.3% (100% for aortic, 88.2% for mitral. The procedural success rate, encompassing device success without in-hospital complications, was 94.1% (100% for aortic, 93.8% for mitral. During the follow-up period we recorded an increase of hemoglobin concentration (3.9 to 4.1 g/dl, red blood count (11.6 to 12.2 M/mm3 and functional improvement by NYHA class. Conclusions : Paravalvular leak device type W is a promising TPVLC device, but meticulous preselection of patients based on imaging of PVL anatomy is a prerequisite. A PLD should only be chosen for channels shorter than 5 mm. Size of the device should match the PVL cross-sectional area without any oversizing. Such an approach facilitates high device and procedural success rates.

Eigenspace perturbations for structural uncertainty estimation of turbulence closure models

Science.gov (United States)

Jofre, Lluis; Mishra, Aashwin; Iaccarino, Gianluca

2017-11-01

With the present state of computational resources, a purely numerical resolution of turbulent flows encountered in engineering applications is not viable. Consequently, investigations into turbulence rely on various degrees of modeling. Archetypal amongst these variable resolution approaches would be RANS models in two-equation closures, and subgrid-scale models in LES. However, owing to the simplifications introduced during model formulation, the fidelity of all such models is limited, and therefore the explicit quantification of the predictive uncertainty is essential. In such scenario, the ideal uncertainty estimation procedure must be agnostic to modeling resolution, methodology, and the nature or level of the model filter. The procedure should be able to give reliable prediction intervals for different Quantities of Interest, over varied flows and flow conditions, and at diametric levels of modeling resolution. In this talk, we present and substantiate the Eigenspace perturbation framework as an uncertainty estimation paradigm that meets these criteria. Commencing from a broad overview, we outline the details of this framework at different modeling resolution. Thence, using benchmark flows, along with engineering problems, the efficacy of this procedure is established. This research was partially supported by NNSA under the Predictive Science Academic Alliance Program (PSAAP) II, and by DARPA under the Enabling Quantification of Uncertainty in Physical Systems (EQUiPS) project (technical monitor: Dr Fariba Fahroo).

Acceptable results of early closure of loop ileostomy to protect low rectal anastomosis

DEFF Research Database (Denmark)

Perdawid, Sharafaden Karim; Andersen, Ole Bjørn; Perdawood, Sharaf

2011-01-01

INTRODUCTION: This was a pilot project performed prior to full implementation of early loop ileostomy closure (within two weeks) following low anterior resection of the rectum in a group of patients selected according to previously recommended criteria for safe, early ileostomy closure. MATERIAL......, closure operation, the postoperative closure period and follow-up. RESULTS: Eleven patients were included (men, n = 4) with a median age of 58 years (range 47-79 years). Ileostomy closure was performed at a median of ten days (range 8-13 days) following rectum resection. The median hospital stay was 16...

Guidance for closure of existing DOE LLW disposal sites

International Nuclear Information System (INIS)

Blanchfield, L.

1987-01-01

During FY 1986, a closure guidance document was developed. The purpose of this document is to provide guidance in support of DOE Order 5820.2 to site operating contractors for the stabilization and closure of existing low-level waste (LLW) shallow land disposal sites at US Department of Energy (DOE) facilities. Guidance is provided to aid operators in placing existing LLW sites in a closed conditions, i.e., a condition in which a nonoperational site meets postclosure performance requirements and can be shown, within a high degree of confidence, to perform as anticipated in the future, under the most cost-effective maintenance approach. Guidance is based on the philosophy that closure should be planned and performed using a systems approach. Plans for FY 1987 call for revision of the document to incorporate more information on closure of LLW sites also containing radioactive mixed waste and/or transuranic waste. 4 references, 3 figures, 2 tables

Repository Closure and Sealing Approach

International Nuclear Information System (INIS)

A.T. Watkins

2000-01-01

The scope of this analysis will be to develop the conceptual design of the closure seals and their locations in the Subsurface Facilities. The design will be based on the recently established program requirements for transitioning to the Site Recommendation (SR) design as outlined by ''Approach to Implementing the Site Recommendation Baseline'' (Stroupe 2000) and the ''Monitored Geologic Repository Project Description Document'' (CRWMS M andO 1999b). The objective of this analysis will be to assist in providing a description for the Subsurface Facilities System Description Document, Section 2 and finally to document any conclusions reached in order to contribute and provide support to the SR. This analysis is at a conceptual level and is considered adequate to support the SR design. The final closure barriers and seals for the ventilation shafts, and the north and south ramps will require these openings to be permanently sealed to limit excessive air and water inflows and prevent human intrusion. The major tasks identified with closure in this analysis are: (1) Developing the overall subsurface seal layout and identifying design and operational interfaces for the Subsurface Facilities. (2) Summarizing the general site conditions and general rock characteristic with respect to seal location and describing the seal selected. (3) Identify seal construction materials, methodology of construction and strategic locations including design of the seal and plugs. (4) Discussing methods to prevent human intrusion

Hormonal regulation of floret closure of rice (Oryza sativa.

Directory of Open Access Journals (Sweden)

Youming Huang

Full Text Available Plant hormones play important roles in regulating every aspect of growth, development, and metabolism of plants. We are interested in understanding hormonal regulation of floret opening and closure in plants. This is a particularly important problem for hybrid rice because regulation of flowering time is vitally important in hybrid rice seed production. However, little was known about the effects of plant hormones on rice flowering. We have shown that jasmonate and methyl jasmonate play significant roles in promoting rice floret opening. In this study, we investigated the effects of auxins including indole-3-acidic acid (IAA, indole-3-butyric acid (IBA, 1-naphthalene-acetic acid (NAA, 2,4-dichlorophenoxy acetic acid (2,4-D and 3,6-dichloro-2-methoxybenzoic acid (DIC and abscisic acid (ABA on floret closure of four fertile and three sterile varieties of rice. The results from field studies in three growing seasons in 2013-2015 showed that the percentages of closed florets were significantly lower in plants treated with IAA, IBA, 2,4-D, DIC and NAA and that the durations of floret opening were significantly longer in plants treated with the same auxins. The auxins exhibited time- and concentration-dependant effects on floret closure. ABA displayed opposite effects of auxins because it increased the percentages of floret closure and decreased the length of floret opening of rice varieties. The degree of auxin-inhibiting and ABA-promoting effects on floret closure was varied somewhat but not significantly different among the rice varieties. Endogenous IAA levels were the highest in florets collected shortly before opening followed by a sharp decline in florets with maximal angles of opening and a significant jump of IAA levels shortly after floret closure in both fertile and sterile rice plants. ABA levels showed an opposite trend in the same samples. Our results showed that auxins delayed but ABA promoted the closure of rice floret regardless of

Hormonal regulation of floret closure of rice (Oryza sativa)

Science.gov (United States)

Huang, Youming; Zeng, Xiaochun

2018-01-01

Plant hormones play important roles in regulating every aspect of growth, development, and metabolism of plants. We are interested in understanding hormonal regulation of floret opening and closure in plants. This is a particularly important problem for hybrid rice because regulation of flowering time is vitally important in hybrid rice seed production. However, little was known about the effects of plant hormones on rice flowering. We have shown that jasmonate and methyl jasmonate play significant roles in promoting rice floret opening. In this study, we investigated the effects of auxins including indole-3-acidic acid (IAA), indole-3-butyric acid (IBA), 1-naphthalene-acetic acid (NAA), 2,4-dichlorophenoxy acetic acid (2,4-D) and 3,6-dichloro-2-methoxybenzoic acid (DIC) and abscisic acid (ABA) on floret closure of four fertile and three sterile varieties of rice. The results from field studies in three growing seasons in 2013–2015 showed that the percentages of closed florets were significantly lower in plants treated with IAA, IBA, 2,4-D, DIC and NAA and that the durations of floret opening were significantly longer in plants treated with the same auxins. The auxins exhibited time- and concentration-dependant effects on floret closure. ABA displayed opposite effects of auxins because it increased the percentages of floret closure and decreased the length of floret opening of rice varieties. The degree of auxin-inhibiting and ABA-promoting effects on floret closure was varied somewhat but not significantly different among the rice varieties. Endogenous IAA levels were the highest in florets collected shortly before opening followed by a sharp decline in florets with maximal angles of opening and a significant jump of IAA levels shortly after floret closure in both fertile and sterile rice plants. ABA levels showed an opposite trend in the same samples. Our results showed that auxins delayed but ABA promoted the closure of rice floret regardless of the varieties

Comparison of different moment-closure approximations for stochastic chemical kinetics

Energy Technology Data Exchange (ETDEWEB)

Schnoerr, David [School of Biological Sciences, University of Edinburgh, Edinburgh (United Kingdom); School of Informatics, University of Edinburgh, Edinburgh (United Kingdom); Sanguinetti, Guido [School of Informatics, University of Edinburgh, Edinburgh (United Kingdom); Grima, Ramon [School of Biological Sciences, University of Edinburgh, Edinburgh (United Kingdom)

2015-11-14

In recent years, moment-closure approximations (MAs) of the chemical master equation have become a popular method for the study of stochastic effects in chemical reaction systems. Several different MA methods have been proposed and applied in the literature, but it remains unclear how they perform with respect to each other. In this paper, we study the normal, Poisson, log-normal, and central-moment-neglect MAs by applying them to understand the stochastic properties of chemical systems whose deterministic rate equations show the properties of bistability, ultrasensitivity, and oscillatory behaviour. Our results suggest that the normal MA is favourable over the other studied MAs. In particular, we found that (i) the size of the region of parameter space where a closure gives physically meaningful results, e.g., positive mean and variance, is considerably larger for the normal closure than for the other three closures, (ii) the accuracy of the predictions of the four closures (relative to simulations using the stochastic simulation algorithm) is comparable in those regions of parameter space where all closures give physically meaningful results, and (iii) the Poisson and log-normal MAs are not uniquely defined for systems involving conservation laws in molecule numbers. We also describe the new software package MOCA which enables the automated numerical analysis of various MA methods in a graphical user interface and which was used to perform the comparative analysis presented in this paper. MOCA allows the user to develop novel closure methods and can treat polynomial, non-polynomial, as well as time-dependent propensity functions, thus being applicable to virtually any chemical reaction system.

Prediction of left ventricular dysfunction after device closure of patent ductus arteriosus: proposal for a new functional classification.

Science.gov (United States)

Kiran, Viralam S; Tiwari, Ashish

2018-04-06

The aims of this study were to determine the incidence and correlates of left ventricular (LV) dysfunction amongst percutaneous patent ductus arteriosus (PDA) device closure patients, and to propose an indexed parameter for predicting LV dysfunction. In a retrospective cross-sectional analysis of 30 months duration, 447 patients who underwent PDA device closure were studied. The diameter of the PDA at the pulmonary artery end was measured in the angiograms in all patients and was indexed for their body surface area. The indexed PDA size was categorised into group A (1-2.9 mm/m², 35/447), B (3-5.9 mm/m², 254/447), C (6-8.9 mm/m², 66/447) and D (>9 mm/m², 35/447). Systolic LV function was evaluated using echocardiography at frequent intervals. Overall, 62.63% of the patients were female (280/447). At baseline, all 447 patients had normal LV function. LV dysfunction was seen in 102/447 (22.8%) patients with 2.8% in category A (1/35), 10.6% in category B (27/254), 34.1% in category C (42/123) and 91.4% in category D (32/35) after PDA device closure. Correlation of indexed PDA size and LV dysfunction was statistically significant (pclosures. Indexed PDA size correlates well with post-procedural LV dysfunction. The authors propose a new classification of PDA utilising this accurate, reproducible and easy to perform parameter, which does not involve any extra cost, for risk stratification and early management in device closure of PDA.

Closure behavior of spherical void in slab during hot rolling process

Science.gov (United States)

Cheng, Rong; Zhang, Jiongming; Wang, Bo

2018-04-01

The mechanical properties of steels are heavily deteriorated by voids. The influence of voids on the product quality should be eliminated through rolling processes. The study on the void closure during hot rolling processes is necessary. In present work, the closure behavior of voids at the center of a slab at 800 °C during hot rolling processes has been simulated with a 3D finite element model. The shape of the void and the plastic strain distribution of the slab are obtained by this model. The void decreases along the slab thickness direction and spreads along the rolling direction but hardly changes along the strip width direction. The relationship between closure behavior of voids and the plastic strain at the center of the slab is analyzed. The effects of rolling reduction, slab thickness and roller diameter on the closure behavior of voids are discussed. The larger reduction, thinner slab and larger roller diameter all improve the closure of voids during hot rolling processes. Experimental results of the closure behavior of a void in the slab during hot rolling process mostly agree with the simulation results..

Security option file - After closure (DOS-AF)

International Nuclear Information System (INIS)

2016-01-01

A first volume presents the context and scope of the Cigeo project, and the scope of this document. It proposes a general presentation of Cigeo, the regulatory framework and standards. It describes the different aspects and components of the security strategy: principles, security functions after closure, objectives of protection, global approach. It proposes a security assessment: objectives, consistency with international practices, assessment steps, scenarios, scenario quantitative assessment. The next part addresses security management. The second volume contains a description of the storage system: site characteristics, types of stored parcels, the future of the installation after its closure. The third volume proposes a security assessment. It addresses the management of risks and uncertainties, describes a scenario of normal evolution and also scenarios of altered evolutions, scenarios of unintentional human intrusion, and what-if type scenarios. The fourth volume reports lessons at the current stage of the project, and gives an overview of important activities from storage design to storage closure

Mail Office annual closure

CERN Multimedia

2013-01-01

On the occasion of the annual closure of CERN, there will be no mail distributed on Friday 20 December 2013 but mail will be collected in the morning. Nevertheless, you will still be able to bring your outgoing mail to Building 555-R-002 until 12 noon.  

Closure certification report: TA-35 TSL-125 surface impoundment

International Nuclear Information System (INIS)

1991-01-01

This closure report documents closure activities for the TA-35 TSL-125 surface impoundment and associated structures at Los Alamos National Laboratory (the Laboratory). Prior to formal approval of the closure plan, the decision was made to proceed with closure activities to prevent any further releases from the site following informal discussions with New Mexico Environment Department (NMED) personnel. The closure plan is a revision of the previously submitted draft dated July 1988. Clean closure of the TSL-125 site was accomplished through: Removal and proper disposal of all wastes contained within the surface impoundment system; Decontamination and/or removal and proper disposal of the surface impoundment, its associated structures, and contaminated soil underlying the impoundment area; Sampling and analysis of soil to determine the presence and concentrations of any hazardous constituents remaining in the soil at the TSL-125 site; and Demonstration through a risk assessment that any constituents remaining in the soil at the TSL-125 site pose no threat to human health and the environment. All remaining soil concentrations of hazardous constituents were below health-based action levels. Analytical results indicated that benzidine, n-nitrosodimethylamine, and n-nitrosodi-n-propylamine were not detected at or above their limits of quantitation and beryllium was not present at or above its laboratory detection limit. However, the limits of quantitation and detection for these constituents were greater than their calculated health-based action levels. To demonstrate that these constituents were not present, historical data was researched and it was determined that the constituents were not utilized at the Building 125 site. 4 refs., 8 figs., 1 tab

Stochastic particle acceleration and statistical closures

International Nuclear Information System (INIS)

Dimits, A.M.; Krommes, J.A.

1985-10-01

In a recent paper, Maasjost and Elsasser (ME) concluded, from the results of numerical experiments and heuristic arguments, that the Bourret and the direct-interaction approximation (DIA) are ''of no use in connection with the stochastic acceleration problem'' because (1) their predictions were equivalent to that of the simpler Fokker-Planck (FP) theory, and (2) either all or none of the closures were in good agreement with the data. Here some analytically tractable cases are studied and used to test the accuracy of these closures. The cause of the discrepancy (2) is found to be the highly non-Gaussian nature of the force used by ME, a point not stressed by them. For the case where the force is a position-independent Ornstein-Uhlenbeck (i.e., Gaussian) process, an effective Kubo number K can be defined. For K << 1 an FP description is adequate, and conclusion (1) of ME follows; however, for K greater than or equal to 1 the DIA behaves much better qualitatively than the other two closures. For the non-Gaussian stochastic force used by ME, all common approximations fail, in agreement with (2)

Non-pupillary block angle-closure mechanisms: a comprehensive analysis of their prevalence and treatment outcomes

Directory of Open Access Journals (Sweden)

Daniela L. M. Junqueira

2014-12-01

Full Text Available Purpose: To assess the prevalence and treatment outcomes of angle-closure mechanisms other than pupillary block in a population of Brazilian patients. Methods: A retrospective chart review was conducted to evaluate patients who had undergone laser peripheral iridotomy (LPI due to occludable angles at a single institution between July 2009 and April 2012. An occludable angle was defined as an eye in which the posterior trabecular meshwork was not visible for ≥180° on dark-room gonioscopy. Key exclusion criteria were any form of secondary glaucoma and the presence of >90° of peripheral anterior synechiae. Collected data were age, race, gender, angle-closure mechanism (based on indentation goniocopy and ultrasound biomicroscopy, intraocular pressure (IOP, number of antiglaucoma medications and subsequent management during follow-up. If both eyes were eligible, the right eye was arbitrarily selected for analysis. Results: A total of 196 eyes of 196 consecutive patients (mean age 58.3 ± 11.6 years who underwent LPI were included. In most of the patients [86% (169 patients; 133 women and 36 men], LPI sucessfully opened the angle. Mean IOP was reduced from 18.3 ± 6.4 mmHg to 15.4 ± 4.5 mmHg after LPI (p<0.01. Among the 27 patients with persistent occludable angles, the most common underlying mechanisms were plateau iris (56% and lens-induced component (34%. Most of these patients (85% were treated with argon laser peripheral iridoplasty (ALPI; approximately 90% showed non-occludable angles following the laser procedure (mean IOP reduction of 18.9%, with no significant differences between patients with plateau iris and lens-induced components (p=0.34; mean follow-up of 11.4 ± 3.6 months. Conclusion: Our findings suggest that, in this population of Brazilian patients, several eyes with angle closure were not completely treated with LPI. In the present large case series involving middle-age patients, plateau iris was the leading cause of

Primary closure in colon trauma.

Science.gov (United States)

Salinas-Aragón, Luis Enrique; Guevara-Torres, Lorenzo; Vaca-Pérez, Enrique; Belmares-Taboada, Jaime Arístides; Ortiz-Castillo, Fátima de Guadalupe; Sánchez-Aguilar, Martín

2009-01-01

Primary repair of colon injuries is an accepted therapeutic option; however, controversy persists regarding its safety. Our objective was to report the evolution and presence of complications in patients with colon injury who underwent primary closure and to determine if the time interval (>6 h), degree of injury, contamination, anatomic site injured, PATI (Penetrating Abdominal Trauma Index) >25, and the presence of other injuries in colon trauma are associated with increased morbidity and mortality. This was a prospective, observational, longitudinal and descriptive study conducted at the Central Hospital "Dr. Ignacio Morones Prieto," San Luis Potosí, Mexico, from January 1, 2003 to December 31, 2007. We included patients with abdominal trauma with colon injury subjected to surgical treatment. chi(2) was used for basic statistical analysis. There were 481 patients with abdominal trauma who underwent surgery; 77(16.1%) had colon injury. Ninety percent (n = 69) were treated in the first 6 h; 91% (n = 70) were due to penetrating injuries, and gunshot wound accounted for 48% (n = 37). Transverse colon was the most frequently injured (38%) (n = 29). Grade I and II injuries accounted for 75.3% (n = 58). Procedures included primary repair (76.66 %) (n = 46); resection with anastomosis (8.3%) (n = 5); and colostomy (15%) (n = 9). Associated injuries were present in 76.6% (n = 59). There was some degree of contamination in 85.7% (n = 66); 82.8% (58) had PATI colon injury. Primary repair is a safe procedure for treatment of colon injuries. Patients with primary repair had lower morbidity (p <0.009). Surgery during the first 6 h (p <0.006) and in hemodynamically stable patients (p <0.014) had a lower risk of complications.

Straight line closure of congenital macrostomia

Directory of Open Access Journals (Sweden)

Schwarz Richard

2004-01-01

Full Text Available The results of patients operated on by Nepal Cleft Lip and Palate Association (NECLAPA surgeons for congenital macrostomia were prospectively studied between January 2000 and December 2002. There were four males and three females with a median age of 10 years. Three had an associated branchial arch syndrome. In all patients an overlapping repair of orbicularis oris was done. Six patients had a straight line closure with excellent cosmetic results and one a Z-plasty with a more obvious scar. All had a normal appearing commissure. Overlapping orbicularis repair with straight line skin closure for this rare congenital anomaly is recommended.

Vacuum-assisted closure versus closure without vacuum assistance for preventing surgical site infections and infections of chronic wounds: a meta-analysis of randomized controlled trials.

Science.gov (United States)

Tansarli, Giannoula S; Vardakas, Konstantinos Z; Stratoulias, Constantinos; Peppas, George; Kapaskelis, Anastasios; Falagas, Matthew E

2014-08-01

We sought to examine whether vacuum-assisted closure (VAC) is associated with fewer surgical site infections (SSIs) or infections of chronic wounds than other management procedures for surgical wounds. The PubMed and Scopus databases were searched systematically. Randomized controlled trials (RCTs) comparing the development of SSIs or infections of chronic wounds between patients treated with VAC for acute or chronic wounds and those whose wounds were treated without VAC were considered eligible for inclusion in the study. Eight RCTs met the inclusion criteria for the study. Four of the studies included chronic or diabetic lower extremity wounds and four included fractures. In three of four studies reporting on fractures, the wounds were not closed post-operatively, whereas in one study primary closure of the wound was performed. With regard to wounds left open after the stabilization of fractures, patients whose wounds were treated with VAC developed fewer SSIs than those whose wounds were treated without VAC ([367 patients (196 with VAC; 171 without VAC) relative risk [RR], 0.47; 95% CI 0.28-0.81]). On the contrary, no difference in the development of SSIs occurred among patients with chronic or diabetic lower-extremity wounds treated with VAC and those whose wounds were treated without VAC ([638 patients (320 with VAC; 318 without VAC) RR 1.67; 95% CI: 0.71-3.94]). The available evidence suggests that the development of infections in wounds treated with VAC depends on the type of wound being treated.

A randomized clinical trial to compare three methods of orthodontic space closure.

Science.gov (United States)

Dixon, V; Read, M J F; O'Brien, K D; Worthington, H V; Mandall, N A

2002-03-01

To compare the rates of orthodontic space closure for: Active ligatures, polyurethane powerchain (Rocky Mountain Orthodontics, RMO Europe, Parc d'Innovation, Rue Geiler de Kaysersberg, 67400 Illkirch-Graffenstaden, Strasbourg, France) and nickel titanium springs. Patients entering the space closure phase of fixed orthodontic treatment attending six orthodontic providers. Twelve patients received active ligatures (48 quadrants), 10 patients received powerchain (40 quadrants) and 11 patients, nickel-titanium springs (44 quadrants). Patients were randomly allocated for treatment with active ligatures, powerchain or nickel titanium springs. Upper and lower study models were collected at the start of space closure (T(o)) and 4 months later (T(1)). We recorded whether the patient wore Class II or Class III elastics. Space present in all four quadrants was measured, by a calibrated examiner, using Vernier callipers at T(o) and T(1.) The rate of space closure, in millimetres per month (4 weeks) and a 4-monthly rate, was then calculated. Examiner reliability was assessed at least 2 weeks later. Mean rates of space closure were 0.35 mm/month for active ligatures, 0.58 mm/month for powerchain, and 0.81 mm/month for NiTi springs. No statistically significant differences were found between any methods with the exception of NiTi springs showing more rapid space closure than active ligatures (P space closure. NiTi springs gave the most rapid rate of space closure and may be considered the treatment of choice. However, powerchain provides a cheaper treatment option that is as effective. The use of inter-arch elastics does not appear to influence rate of space closure.

Reactor vessel closure head replacements in 1997

International Nuclear Information System (INIS)

Anon.

1997-01-01

The Framatome-Jeumont Industrie consortium have completed in 1997 28 reactor vessel (RV) closure head replacements, including five on 1300 MWe class PWR units. Framatome manages the operations and handles removal and reinstallation of equipment (not including the control rod drive mechanisms (CRDM)) and the requalification tests, while JI, which manufactures the CRDMs, is involved in the CRDM cutting, re-machining and welding operations, using tools of original design, in order to optimize the RV closure head operation in terms of costs, schedule and dosage

Estimating the costs of school closure for mitigating an influenza pandemic

Directory of Open Access Journals (Sweden)

Adams Elisabeth J

2008-04-01

Full Text Available Abstract Background School closure is a key component of many countries' plans to mitigate the effect of an influenza pandemic. Although a number of studies have suggested that such a policy might reduce the incidence, there are no published studies of the cost of such policies. This study attempts to fill this knowledge gap Methods School closure is expected to lead to significant work absenteeism of working parents who are likely to be the main care givers to their dependent children at home. The cost of absenteeism due to school closure is calculated as the paid productivity loss of parental absenteeism during the period of school closure. The cost is estimated from societal perspective using a nationally representative survey. Results The results show that overall about 16% of the workforce is likely to be the main caregiver for dependent children and therefore likely to take absenteeism. This rises to 30% in the health and social care sector, as a large proportion of the workforce are women. The estimated costs of school closure are significant, at £0.2 bn – £1.2 bn per week. School closure is likely to significantly exacerbate the pressures on the health system through staff absenteeism. Conclusion The estimates of school closure associated absenteeism and the projected cost would be useful for pandemic planning for business continuity, and for cost effectiveness evaluation of different pandemic influenza mitigation strategies.

Early closure of postinfarction ventricular septal defects.

Science.gov (United States)

Martinelli, Luigi; Dottori, Vincenzo; Caputo, Enrico; Graffigna, Angelo; Pederzolli, Carlo

2003-05-01

According to the guidelines of the American College of Cardiology/American Heart Association early closure of postinfarction septal defects is now a class I indication although it still carries a relevant morbidity and mortality. The operative risk is related both to the critical hemodynamic conditions of the patient and to the technical difficulties posed by the friable tissue of the infarcted area. The most recent techniques involving the use of pericardial patches reinforced by acrylic glue have significantly reduced the hospital mortality. The aim of this study was to discuss the reliability of an aggressive, tissue-sparing surgical approach to this complication. We present a consecutive series of 12 patients operated upon between January 1998 and October 2001 within 12 hours of the onset of clinical evidence of postinfarction septal rupture. Repair was achieved with minimal septal debridement and the use of a large pericardial patch reinforced by a biological glue. Three cases of dehiscence required early reoperation with no hospital mortality. This procedure is technically feasible and allows early aggressive treatment of postinfarction septal rupture with satisfactory results.

Preoperative Botulinum toxin A enabling defect closure and laparoscopic repair of complex ventral hernia.

Science.gov (United States)

Rodriguez-Acevedo, Omar; Elstner, Kristen E; Jacombs, Anita S W; Read, John W; Martins, Rodrigo Tomazini; Arduini, Fernando; Wehrhahm, Michael; Craft, Colette; Cosman, Peter H; Dardano, Anthony N; Ibrahim, Nabeel

2018-02-01

Operative management of complex ventral hernia still remains a significant challenge for surgeons. Closure of large defects in the unprepared abdomen has serious pathophysiological consequences due to chronic contraction and retraction of the lateral abdominal wall muscles. We report outcomes of 56 consecutive patients who had preoperative Botulinum toxin A (BTA) abdominal wall relaxation facilitating closure and repair. This was a prospective observational study of 56 patients who underwent ultrasound-guided BTA into the lateral abdominal oblique muscles prior to elective ventral hernia repair between November 2012 and January 2017. Serial non-contrast abdominal CT imaging was performed to evaluate changes in lateral oblique muscle length and thickness. All hernias were repaired laparoscopically, or laparoscopic-open-laparoscopic (LOL) using intraperitoneal onlay mesh. 56 patients received BTA injections at predetermined sites to the lateral oblique muscles, which were well tolerated. Mean patient age was 59.7 years, and mean BMI was 30.9 kg/m 2 (range 21.8-54.0). Maximum defect size was 24 × 27 cm. A subset of 18 patients underwent preoperative pneumoperitoneum as an adjunct procedure. A comparison of pre-BTA to post-BTA imaging demonstrated an increase in mean lateral abdominal wall length from 16.1 cm to 20.1 cm per side, a mean gain of 4.0 cm/side (range 1.0-11.7 cm/side) (p LOL primary closure was achieved in all cases, with no clinical evidence of raised intra-abdominal pressures. One patient presented with a new fascial defect 26 months post-operative. Preoperative BTA to the lateral abdominal wall muscles is a safe and effective technique for the preparation of patients prior to operative management of complex ventral hernias. BTA temporary flaccid paralysis relaxes, elongates and thins the chronically contracted abdominal musculature. This in turn reduces lateral traction forces facilitating laparoscopic repair and fascial closure of large

CLOSURE REPORT FOR CORRECTIVE ACTION UNIT 528: POLYCHLORINATED BIPHENYLS CONTAMINATION NEVADA TEST SITE, NEVADA

Energy Technology Data Exchange (ETDEWEB)

BECHTEL NEVADA

2006-09-01

This Closure Report (CR) describes the closure activities performed at CAU 528, Polychlorinated Biphenyls Contamination, as presented in the Nevada Division of Environmental Protection (NDEP)-approved Corrective Action Plan (CAP) (US. Department of Energy, National Nuclear Security Administration Nevada Site Office [NNSAINSO], 2005). The approved closure alternative was closure in place with administrative controls. This CR provides a summary of the completed closure activities, documentation of waste disposal, and analytical data to confirm that the remediation goals were met.

Resource Conservation and Recovery Act Closure Plan for the Y-12 9409-5 Tank Storage Facility

International Nuclear Information System (INIS)

1995-02-01

This document presents information on the closure of the Y-12 9409-5 Tank Storage Facility. Topics discussed include: facility description; closure history; closure performance standard; partial closure; maximum waste inventory; closure activities; schedule; and postclosure care

Does velopharyngeal closure pattern affect the success of pharyngeal flap pharyngoplasty?

Science.gov (United States)

Armour, Alexis; Fischbach, Simone; Klaiman, Paula; Fisher, David M

2005-01-01

Historically at The Hospital for Sick Children in Toronto, pharyngeal flap pharyngoplasty has been the treatment of choice for treatment of velopharyngeal insufficiency, regardless of velopharyngeal closure pattern. The authors hypothesize that pharyngeal flap pharyngoplasty is more effective in treating velopharyngeal insufficiency in patients with circular or sagittal velopharyngeal closure and less effective in treating the coronal closure pattern. Ninety-three patients who underwent superiorly based pharyngeal flap surgery for velopharyngeal insufficiency were evaluated in a retrospective chart review. Closure pattern was determined preoperatively by nasopharyngoscopy or multiview videofluoroscopy. Nasalance was assessed preoperatively and at 6 weeks and 1 year postoperatively. Nasalance during nonnasal speech was decreased on average, for all closure patterns, postoperatively. However, a significantly higher percentage of patients were corrected to normal nasalance scores in thenoncoronal group than in the coronal group (57 percent versus 35 percent, respectively) at 1 year postoperatively (p approach to the management of velopharyngeal insufficiency and are more inclined to treat coronal pattern velopharyngeal insufficiency with sphincter pharyngoplasty.

Automated analysis of angle closure from anterior chamber angle images.

Science.gov (United States)

Baskaran, Mani; Cheng, Jun; Perera, Shamira A; Tun, Tin A; Liu, Jiang; Aung, Tin

2014-10-21

To evaluate a novel software capable of automatically grading angle closure on EyeCam angle images in comparison with manual grading of images, with gonioscopy as the reference standard. In this hospital-based, prospective study, subjects underwent gonioscopy by a single observer, and EyeCam imaging by a different operator. The anterior chamber angle in a quadrant was classified as closed if the posterior trabecular meshwork could not be seen. An eye was classified as having angle closure if there were two or more quadrants of closure. Automated grading of the angle images was performed using customized software. Agreement between the methods was ascertained by κ statistic and comparison of area under receiver operating characteristic curves (AUC). One hundred forty subjects (140 eyes) were included, most of whom were Chinese (102/140, 72.9%) and women (72/140, 51.5%). Angle closure was detected in 61 eyes (43.6%) with gonioscopy in comparison with 59 eyes (42.1%, P = 0.73) using manual grading, and 67 eyes (47.9%, P = 0.24) with automated grading of EyeCam images. The agreement for angle closure diagnosis between gonioscopy and both manual (κ = 0.88; 95% confidence interval [CI), 0.81-0.96) and automated grading of EyeCam images was good (κ = 0.74; 95% CI, 0.63-0.85). The AUC for detecting eyes with gonioscopic angle closure was comparable for manual and automated grading (AUC 0.974 vs. 0.954, P = 0.31) of EyeCam images. Customized software for automated grading of EyeCam angle images was found to have good agreement with gonioscopy. Human observation of the EyeCam images may still be needed to avoid gross misclassification, especially in eyes with extensive angle closure. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

Design Alternative Evaluation No. 3: Post-Closure Ventilation

International Nuclear Information System (INIS)

Logan, R.C.

1999-01-01

The objective of this study is to provide input to the Enhanced Design Alternatives (EDA) for License Application Design Selection (LADS). Its purpose is to develop and evaluate conceptual designs for post-closure ventilation alternatives that enhance repository performance. Post-closure ventilation is expected to enhance repository performance by limiting the amount of water contacting the waste packages. Limiting the amount of water contacting the waste packages will reduce corrosion

Transcatheter Device Closure of Patent Ductus Arteriosus

International Nuclear Information System (INIS)

Sultan, M.; Ullah, M.; Sadiq, N.; Akhtar, K.; Akbar, H.

2014-01-01

Objective: To determine the efficacy, safety and immediate complications encountered during percutaneous device closure of patent ductus arteriosus (PDA). Study Design: Case series. Place and Duration of Study: Department of Paediatric Cardiology, AFIC/NIHD, Rawalpindi, from January 2005 to December 2010. Methodology: Consecutive 500 patients who underwent attempted transcatheter PDA device closure were included in the study. Device type position, success of closure and complications were described as frequency percentage. Results: In 491 cases (98.2%), PDA was successfully occluded including 4 cases (0.8%) where devices were dislodged but retrieved and redeployed in Cath laboratory. PDA occluder devices used in 448 cases (91%) while coils (single or multiple) were used in 42 cases (8.5%) and in one case (0.2%) ASD occluder device was used to occlude the PDA. There were 09 (1.8%) unsuccessful cases, 06 (1.2%) were abandoned as ducts were considered unsuitable for device closure, 02 (0.4%) devices dislodged and needed surgical retrieval and one case (0.2%) was abandoned due to faulty equipment. The narrowest PDA diameter ranged from 0.5 - 14 mm with mean of 4.5 +- 2.4 mm. There was a single (0.2%) mortality. Conclusion: Transcatheter occlusion of PDA by coil or occluder device is an effective therapeutic option with high success rate. Complication rate is low in the hands of skilled operators yet paediatric cardiac surgical back-up cover is mandatory. (author)

Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke

DEFF Research Database (Denmark)

Søndergaard, Lars; Kasner, Scott E; Rhodes, John F

2017-01-01

BACKGROUND: The efficacy of closure of a patent foramen ovale (PFO) in the prevention of recurrent stroke after cryptogenic stroke is uncertain. We investigated the effect of PFO closure combined with antiplatelet therapy versus antiplatelet therapy alone on the risks of recurrent stroke and new...... brain infarctions. METHODS: In this multinational trial involving patients with a PFO who had had a cryptogenic stroke, we randomly assigned patients, in a 2:1 ratio, to undergo PFO closure plus antiplatelet therapy (PFO closure group) or to receive antiplatelet therapy alone (antiplatelet-only group......). Imaging of the brain was performed at the baseline screening and at 24 months. The coprimary end points were freedom from clinical evidence of ischemic stroke (reported here as the percentage of patients who had a recurrence of stroke) through at least 24 months after randomization and the 24-month...

Environmental assessment: Closure of the Waste Calcining Facility (CPP-633), Idaho National Engineering Laboratory

International Nuclear Information System (INIS)

1996-07-01

The U.S. Department of Energy (DOE) proposes to close the Waste Calcining Facility (WCF). The WCF is a surplus DOE facility located at the Idaho Chemical Processing Plant (ICPP) on the Idaho National Engineering Laboratory (INEL). Six facility components in the WCF have been identified as Resource Conservation and Recovery Ace (RCRA)-units in the INEL RCRA Part A application. The WCF is an interim status facility. Consequently, the proposed WCF closure must comply with Idaho Rules and Standards for Hazardous Waste contained in the Idaho Administrative Procedures Act (IDAPA) Section 16.01.05. These state regulations, in addition to prescribing other requirements, incorporate by reference the federal regulations, found at 40 CFR Part 265, that prescribe the requirements for facilities granted interim status pursuant to the RCRA. The purpose of the proposed action is to reduce the risk of radioactive exposure and release of hazardous constituents and eliminate the need for extensive long-term surveillance and maintenance. DOE has determined that the closure is needed to reduce potential risks to human health and the environment, and to comply with the Idaho Hazardous Waste Management Act (HWMA) requirements

The value of vacuum-assisted closure in septic patients treated with laparostomy.

Science.gov (United States)

Pliakos, Ioannis; Papavramidis, Theodossis S; Michalopoulos, Nick; Deligiannidis, Nickolaos; Kesisoglou, Isaak; Sapalidis, Konstantinos; Papavramidis, Spiros

2012-09-01

The ideal method of temporary abdominal closure (TAC) should allow rapid closure, easy maintenance, and wound repair with minimal tissue damage. The aim of this retrospective study is to compare open abdomen outcomes between patients managed with vacuum-assisted closure (VAC), and patients managed with other methods of TAC, when septic abdomen is present. Two groups of patients with septic open abdomen: 27 treated with VAC versus 31 treated with other techniques of TAC. We studied open abdomen duration, number of dressing changes, re-exploration rate, successful abdominal closure rate, overall mortality, and development of enteroatmospheric fistulas. The VAC device demonstrated its superiority concerning open abdomen duration (P advantages concerning clinical feasibility. The high rates of direct fascia closure with an acceptable rate of ventral hernias are further benefits of this technique.

Model-Based Comprehensive Analysis of School Closure Policies for Mitigating Influenza Epidemics and Pandemics.

Science.gov (United States)

Fumanelli, Laura; Ajelli, Marco; Merler, Stefano; Ferguson, Neil M; Cauchemez, Simon

2016-01-01

School closure policies are among the non-pharmaceutical measures taken into consideration to mitigate influenza epidemics and pandemics spread. However, a systematic review of the effectiveness of alternative closure policies has yet to emerge. Here we perform a model-based analysis of four types of school closure, ranging from the nationwide closure of all schools at the same time to reactive gradual closure, starting from class-by-class, then grades and finally the whole school. We consider policies based on triggers that are feasible to monitor, such as school absenteeism and national ILI surveillance system. We found that, under specific constraints on the average number of weeks lost per student, reactive school-by-school, gradual, and county-wide closure give comparable outcomes in terms of optimal infection attack rate reduction, peak incidence reduction or peak delay. Optimal implementations generally require short closures of one week each; this duration is long enough to break the transmission chain without leading to unnecessarily long periods of class interruption. Moreover, we found that gradual and county closures may be slightly more easily applicable in practice as they are less sensitive to the value of the excess absenteeism threshold triggering the start of the intervention. These findings suggest that policy makers could consider school closure policies more diffusely as response strategy to influenza epidemics and pandemics, and the fact that some countries already have some experience of gradual or regional closures for seasonal influenza outbreaks demonstrates that logistic and feasibility challenges of school closure strategies can be to some extent overcome.

Influence of fatigue crack wake length and state of stress on crack closure

Science.gov (United States)

Telesman, Jack; Fisher, Douglas M.

1988-01-01

The location of crack closure with respect to crack wake and specimen thickness under different loading conditions was determined. The rate of increase of K sub CL in the crack wake was found to be significantly higher for plasticity induced closure in comparison to roughness induced closure. Roughness induced closure was uniform throughout the thickness of the specimen while plasticity induced closure levels were 50 percent higher in the near surface region than in the midthickness. The influence of state of stress on low-high load interaction effects was also examined. Load interaction effects differed depending upon the state of stress and were explained in terms of delta K sub eff.