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Sample records for vnus closure procedure

  1. Procedures adopted by orthodontists for space closure and anchorage control

    Directory of Open Access Journals (Sweden)

    André da Costa Monini

    2013-12-01

    Full Text Available OBJECTIVE: The aim of this study was to identify the procedures adopted by Brazilian orthodontists in the following situations: extraction space closure, anchorage control in case of necessary anchorage for group A and frequency of skeletal anchorage use, especially in the upper jaw. METHOD: A questionnaire was sent to the e-mail address of all dentists registered in the Brazilian Federal Council of Dentistry. RESULTS: The results showed that most Brazilian orthodontists usually perform extraction space closure by means of sliding mechanics. The use of palatal bar, inclusion of second molars in the archwire and space closure performed in two phases are the most used techniques for anchorage control in the upper jaw. The skeletal anchorage is referenced by 36.5% of specialists as a routine practice for the upper jaw anchorage. CONCLUSIONS: There is a wide variety of procedures adopted by Brazilian orthodontists for orthodontic space closure and anchorage control.

  2. Abdominal wall closure after a stomal reversal procedure.

    Science.gov (United States)

    López-Cano, Manuel; Pereira, José Antonio; Villanueva, Borja; Vallribera, Francesc; Espin, Eloy; Armengol Carrasco, Manuel; Arbós Vía, María Antonia; Feliu, Xavier; Morales-Conde, Salvador

    2014-01-01

    The closure of a temporary stoma involves 2 different surgical procedures: the stoma reversal procedure and the abdominal wall reconstruction of the stoma site. The management of the abdominal wall has different areas that should be analyzed such us how to avoid surgical site infection (SSI), the technique to be used in case of a concomitant hernia at the stoma site or to prevent an incisional hernia in the future, how to deal with the incision when the stoma reversal procedure is performed by laparoscopy and how to close the skin at the stoma site. The aim of this paper is to analyze these aspects in relation to abdominal wall reconstruction during a stoma reversal procedure.

  3. Closure

    NARCIS (Netherlands)

    Stigter, C.J.

    1988-01-01

    At least an easier task than I have carried out the previous hour when we discussed the preliminary conclusions and recommendations has, as a compensation I guess, been given to me as well. To say a few words as a closure of this symposium. The beginning of such a series of closing statements is mos

  4. Hemodynamic effects of closure of residual arteriovenous fistulae during in situ graft procedures

    DEFF Research Database (Denmark)

    Laustsen, Jesper; Nielsen, Henriette Svarre; Pedersen, Erik Morre

    2011-01-01

    The objective was to study the intraoperative hemodynamic effects of closure of residual arteriovenous fistulae during in situ saphenous vein graft procedures. Data on 60 residual arteriovenous fistulae in nine patients (five men) with a median age of 74 years (range 64-83 years) with critical...... lower limb ischemia were obtained. Direct measurements of proximal and distal blood pressures in the graft were taken and simultaneous determinations of volume blood flow proximally and distally in the graft with ultrasound transit time technique before and after closure of residual fistulae were made....... Closure of a fistula with blood flow around or below 100 mL/min did not increase distal outflow, whereas closure of fistulae with higher blood flow resulted in unpredictable changes in distal outflow. Only fistulae with a blood flow above approximately 100 mL/min may be of hemodynamic significance....

  5. Cardiac procedures to prevent stroke: patent foramen ovale closure/left atrial appendage occlusion.

    Science.gov (United States)

    Freixa, Xavier; Arzamendi, Dabit; Tzikas, Apostolos; Noble, Stephane; Basmadjian, Arsene; Garceau, Patrick; Ibrahim, Réda

    2014-01-01

    Stroke is a major contributor to population morbidity and mortality. Cardiac thromboembolic sources are an important potential cause of stroke. Left atrial appendage (LAA) thromboembolism in association with atrial fibrillation is a major contributor to stroke occurrence, particularly in elderly individuals. Patent foramen ovale (PFO) acts as a potential conduit from the right-sided circulation to the brain, and has been suggested to be an important factor in cryptogenic stroke in the young patients. Advances in interventional cardiology have made it possible to deal with these potential stroke sources (LAA and PFO), but the available methods have intrinsic limitations that must be recognized. Furthermore, the potential value of LAA and PFO closure depends on our ability to identify when the target structure is importantly involved in stroke risk; this is particularly challenging for PFO. This article addresses the clinical use of PFO and LAA closure in stroke prevention. We discuss technical aspects of closure devices and methods, questions of patient selection, and clinical trials evidence. We conclude that for PFO closure, the clinical trials evidence is thus far negative in the broad cryptogenic stroke population, but closure might nevertheless be indicated for selected high-risk patients. LAA closure has an acceptable balance between safety and efficacy for atrial fibrillation patients with high stroke risk and important contraindications to oral anticoagulation. Much more work needs to be done to optimize the devices and techniques, and better define patient selection for these potentially valuable procedures.

  6. Percutaneous suture-mediated closure of femoral access sites deployed through the procedure sheath: initial clinical experience with a novel vascular closure device.

    Science.gov (United States)

    Eggebrecht, Holger; Naber, Christoph; Woertgen, Uta; Ringe, Sonia; Konorza, Thomas F M; Schmermund, Axel; von Birgelen, Clemens; Haude, Michael; Kroeger, Knut; Erbel, Raimund; Baumgart, Dietrich

    2003-03-01

    The objective of this study was to assess the initial safety and feasibility of a novel suture-mediated device for closure of femoral access sites immediately after diagnostic or interventional cardiac catheterization. In a prospective study, 150 patients (mean age, 61.5 years; 109 male) underwent femoral access closure with a novel suture closure device (Superstitch, Sutura) immediately after diagnostic (n = 106) or interventional (n = 44) catheterization procedures, independently of the coagulation status. All patients were monitored for 24 hr after the procedure. The closure device was successfully deployed in 92% of patients. Immediate hemostasis was achieved in 77% of patients with no differences between patients undergoing diagnostic catheterization or coronary interventions (79% vs. 73%; P = 0.659). After 2 min of additional light manual compression, hemostasis was achieved in 92% of patients. There was one major complication requiring vascular surgery (0.7%). The novel suture closure device is a safe and effective device that allows for immediate closure of femoral puncture sites after both diagnostic and interventional procedures with a low rate of major complications.

  7. Complications of radical soft-tissue mobilization procedure as a primary closure of exstrophy.

    Science.gov (United States)

    Purves, J Todd; Gearhart, John P

    2008-02-01

    The radical soft-tissue mobilization procedure was developed as a component of the staged closure of classical bladder exstrophy to improve continency rates without having to perform pelvic osteotomies. The authors describe complications following this procedure and discuss possible etiologies and subsequent management. We extracted from an institutionally approved exstrophy database the records of patients evaluated for complications following radical soft-tissue mobilization repair from 1999 to 2002. Four patients were referred to our institution following closure of exstrophy with the radical soft-tissue mobilization technique; two boys and two girls. Complications included ischemic penile injuries in both males, failed exstrophy closure in one female, incontinence with need for bladder neck transection and diversion in two patients, and upper tract deterioration in two patients of whom one required cystectomy and incontinent diversion. Omission of osteotomies when employing the radical soft-tissue mobilization repair appears to result in complications that could otherwise be prevented. Additionally, the complex dissection of the pelvic musculature, innervation and vasculature performed during radical mobilization has great potential to injure the pelvic structures and genitalia, as has been seen with the cases presented herein.

  8. Left atrial appendage closure: patient, device and post-procedure drug selection.

    Science.gov (United States)

    Tzikas, Apostolos; Bergmann, Martin W

    2016-05-17

    Left atrial appendage closure (LAAC), a device-based therapy for stroke prevention in patients with atrial fibrillation, is considered an alternative to oral anticoagulation therapy, particularly for patients at high risk of bleeding. Proof of concept has been demonstrated by the PROTECT AF and PREVAIL trials which evaluated the WATCHMAN device (Boston Scientific, Marlborough, MA, USA) versus warfarin, showing favourable outcome for the device group. The most commonly used devices for LAAC are the WATCHMAN and its successor, the WATCHMAN FLX (Boston Scientific) and the AMPLATZER Cardiac Plug and more recently the AMPLATZER Amulet device (both St. Jude Medical, St. Paul, MN, USA). The procedure is typically performed via a transseptal puncture under fluoroscopic and echocardiographic guidance. Technically, it is considered quite demanding due to the anatomic variability and fragility of the appendage. Careful material manipulation, adequate operator training, and good cardiac imaging and device sizing allow a safe, uneventful procedure. Post-procedure antithrombotic drug selection is based on the patient's history, indication and quality of LAAC.

  9. Percutaneous left atrial appendage closure: procedural techniques and outcomes.

    Science.gov (United States)

    Saw, Jacqueline; Lempereur, Mathieu

    2014-11-01

    Percutaneous left atrial appendage closure technology for stroke prevention in patients with atrial fibrillation has significantly advanced in the past 2 decades. Several devices are under clinical investigation, and a few have already received Conformité Européene (CE)-mark approval and are available in many countries. The WATCHMAN device (Boston Scientific, Natick, Massachusetts) has the most supportive data and is under evaluation by the U.S. Food and Drug Administration for warfarin-eligible patients. The Amplatzer Cardiac Plug (St. Jude Medical, Plymouth, Minnesota) has a large real-world experience over the past 5 years, and a randomized trial comparing Amplatzer Cardiac Plug with the WATCHMAN device is anticipated in the near future. The Lariat procedure (SentreHEART Inc., Redwood City, California) has also gained interest lately, but early studies were concerning for high rates of serious pericardial effusion and major bleeding. The current real-world experience predominantly involves patients who are not long-term anticoagulation candidates or who are perceived to have high bleeding risks. This pattern of practice is expected to change when the U.S. Food and Drug Administration approves the WATCHMAN device for warfarin-eligible patients. This paper reviews in depth the procedural techniques, safety, and outcomes of the current leading devices. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  10. Efficacy of femoral vascular closure devices in patients treated with anticoagulant, abciximab or thrombolytics during percutaneous endovascular procedures

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ha Young; Choo, Sung Wook [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Roh, Hong Gee [Konkuk University School of Medicine, Seoul (Korea, Republic of)] (and others)

    2006-03-15

    This study assessed the outcomes of using vascular closure devices following percutaneous transfemoral endovascular procedures in the patients who were treated with heparin, abciximab thrombolytics (urokinase or t-PA) during the procedures. From March 28, 2003 to August 31, 2004, we conducted a prospective and randomized study in which 1,676 cases of 1.180 patients were treated with one of the two different closure devices (the collagen plug device was Angio-Seal{sup TM.}, the suture-mediated closure device was The Closer S{sup TM}) at the femoral access site after instituting percutaneous endovascular procedures. Among the 1,676 cases, 108 cases (the drug group) were treated with heparin only (n=94), thrombolytics only (n=10), heparin and thrombolytics (n=3), or abciximab and thrombolytics (n=1) during the procedures; 1,568 cases (the no-drug group) were treated without any medication. We compared the efficacy and complications between the two groups. Of the drug group, 42 cases underwent arterial closures with the collagen plug devices and 66 cases underwent arterial closures with the suture-mediated closure devices. We also compared the efficacy and complications between these two group. The immediate hemostasis rates were 92.9% (1,456/1,568) in the no drug group and 91.7% (99/108) in the drug group. Early complications occurred in four cases of the drug group. These included two episodes of rebleeding with using the Closer S, which required manual compression for at least 10 minutes, and two episodes of minor oozing with using one Angio-Seal and one Closer S, which required two hours of additional bed rest. There was no late complication. So, the total success rates were 90.8% (1,423/1,568) in the no-drug group and 88.0% (95/108) in the drug group. These results were not significantly different between the two groups ({rho}=0.34). In the drug group, the difference of the successful hemostasis rate between the collagen plug devices and the suture

  11. Intra-procedural imaging of the left atrial appendage: implications for closure with the Amplatzer™ cardiac plug.

    Science.gov (United States)

    Sobrino, Ayax; Tzikas, Apostolos; Freixa, Xavier; Pulido, Alicia; Chan, Jason; Garceau, Patrick; Ibrahim, Reda; Basmadjian, Arsène J

    2014-01-01

    To evaluate intra-procedural imaging with transesophageal echocardiography and angiography during left atrial appendage occlusion using the Amplatzer™ Cardiac Plug with regard to sizing and final device shape. Left atrial appendage ostium dimensions and diameter at a depth of 10mm from the ostium were measured by transesophageal echocardiography (0-180°) and angiography (RAO 30° - Cranial 20°) in consecutive patients undergoing left atrial appendage occlusion using the ACP with an oversizing strategy of 10-20% relative to the baseline measurements. After delivery, ACP dimensions were measured and device shape was assessed. Twenty-seven consecutive patients underwent successful uncomplicated left atrial appendage closure with Amplatzer™ Cardiac Plug. We found a significant difference between the largest and smallest left atrial appendage diameter measured with transesophageal echocardiography (22.3±4.2 vs. 18.1±4.1mm, p<0.001). By the end of the procedure (by angiography), ACP had an optimal shape in 17 patients (63%), a strawberry-like shape in 7 patients (26%), and a square-like shape in 3 patients (11%). ACP was oversized on average by 1.5±2.7 and 3.3±2.3mm compared to transesophageal echocardiography and angiography, respectively. The final shape of the device was not significantly associated with the degree of oversizing. We found a considerable variability in the assessment of the left atrial appendage, using transesophageal echocardiography and angiography. The degree of Amplatzer™ Cardiac Plug expansion within the left atrial appendage and the final shape of the device were not associated with the degree of oversizing. Copyright © 2013 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  12. Day-case peripheral angioplasty using nurse-led admission, discharge, and follow-up procedures: arterial closure devices are not necessary

    Energy Technology Data Exchange (ETDEWEB)

    Kasthuri, R.; Karunaratne, D.; Andrew, H.; Sumner, J. [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL (United Kingdom); Chalmers, N. [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL (United Kingdom)], E-mail: nicholas.chalmers@cmmc.nhs.uk

    2007-12-15

    Aim: To audit the safety of day-case peripheral arterial intervention without the use of arterial-closure devices using nurse-led admission, discharge, and follow-up procedures. Materials and methods: Patients referred for elective, peripheral vascular intervention were selected for day-case care according to pre-determined criteria using telephone triage. Post-procedure haemostasis was achieved using manual compression. After 3 h bed-rest, patients were mobilized and discharged at 5 h. Patients were contacted by telephone next working day to audit complications. Results: One hundred and eighty-three elective day-case peripheral interventions were performed over 2 years, predominantly using 6 F sheaths. No closure devices were used. Five patients (2%) returned to the department because of persistent groin symptoms the next day. One of these had a false aneurysm. Four required no further treatment. A single patient returned at day 6 with a delayed false aneurysm. Conclusion: Day-case peripheral vascular intervention can be safely performed in appropriately selected patients without the use of arterial closure devices. Specialist radiology nurses have a major role in the counselling, care, and follow-up of these patients.

  13. Radiofrequency ablation of the great saphenous vein with the ClosureFAST™ procedure: mid-term experience on 400 patients from a single centre.

    Science.gov (United States)

    Tolva, Valerio S; Cireni, Lea V; Bianchi, Paolo G; Lombardo, Almarosa; Keller, Guido C; Casana, Renato M

    2013-07-01

    Endovascular obliteration of the great saphenous vein (GSV) has been proposed as an alternative to conventional extirpative treatment of varicose veins. This report reviewed the initial experience with the ClosureFAST™ procedure in 407 legs over a one-year period. Occlusion of the GSV was seen on 98 % of completion scans and in all patients within 1 week of the procedure. Persistent occlusion was documented in all cases. One had paresthesias and one had skin pigmentation. Three patients had transient superficial thrombophlebitis in a treated segment of a superficial collateral of the GSV. One patient was found to have extension of an asymptomatic, nonocclusive thrombus into the common femoral vein 1 week after the procedure. Radiofrequency ablation of the GSV appears to be a safe alternative to conventional stripping and ligation. Randomised clinical trials and longer follow-up periods are required to establish the overall superiority of the procedure in comparison to conventional stripping.

  14. Procedural success and intra-hospital outcome related to left atrial appendage morphology in patients that receive an interventional left atrial appendage closure.

    Science.gov (United States)

    Fastner, Christian; Behnes, Michael; Sartorius, Benjamin; Wenke, Annika; El-Battrawy, Ibrahim; Ansari, Uzair; Gill, Ishar-Singh; Borggrefe, Martin; Akin, Ibrahim

    2017-08-01

    The interventional left atrial appendage (LAA) closure represents an emerging alternative to oral anticoagulation for stroke prevention in certain atrial fibrillation patients. Preliminary results have suggested high procedural success rates and fewer peri-interventional complications; however, there persists an insufficient understanding of the role of many underlying confounding variables (e.g., anatomical characteristics). It was investigated whether varying LAA morphologies influence procedural success as well as in-hospital outcome. Sixty-seven patients ineligible for long-term oral anticoagulation were included in this single-center, prospective, observational registry spanning from the years 2014 to 2016. Interventions were performed with the Watchman occluder (Boston Scientific, Natick, MA) or the Amplatzer Amulet (St. Jude Medical, St. Paul, MN), at the operator's discretion. Results derived from the data describing procedural success, fluoroscopy, and peri-interventional safety events were classified according to the presenting LAA morphology (cauliflower, cactus, windsock, and chicken wing). Rates of successful implantation were high across all groups (≥98%; P = 0.326). Surrogate parameters underlining procedural complexity like median total duration (P = 0.415), median fluoroscopy time (P = 0.459), median dose area product (P = 0.698), and the median amount of contrast agent (P = 0.076) demonstrated similar results across all groups. Likewise, the periprocedural complication rate was not significantly different and was mainly restricted to minor bleeding events. Irrespective of the varying morphological presentation of the LAA, the procedural success rates, interventional characteristics, and safety events did not significantly differ among patients receiving an interventional LAA closure. © 2017 Wiley Periodicals, Inc.

  15. Novel dural incision and closure procedure for preventing postoperative cerebrospinal fluid leakage during the surgical removal of dumbbell-shaped spinal tumors: technical note.

    Science.gov (United States)

    Ito, Kiyoshi; Aoyama, Tatsuro; Nakamura, Takuya; Hanaoka, Yoshiki; Horiuchi, Tetsuyoshi; Hongo, Kazuhiro

    2016-11-01

    The authors report on a new method for removing dumbbell-shaped spinal tumors that avoids the risk of postoperative cerebrospinal fluid (CSF) leakage. Adequate visualization of the intra- and extradural components of the tumor is achieved with the use of separate dural incisions. First, the dura mater is opened along the dural theca to provide adequate visualization of the intradural portion of the mass; then, a second incision is made along the nerve root to remove the extradural component. Meticulous suturing is essential in intradural lesion cases; however, the dura mater is usually thin and fragile in such cases. During suturing with a needle and thread, the dura mater can become lacerated proximal to the needle holes and result in CSF leakage. In the authors' technique, instead of using a needle and thread, nonpenetrating vascular clips were used to close the dural incisions. When operating on dumbbell-shaped spinal tumors, the authors found that the "separate-dural-incision method" was preferable to the conventional T-shaped dural incision method because no dural defects occurred after the intradural procedure and meticulous dural closure with vascular clips was achieved. The authors conclude that the novel separate-dural-incision method for removing dumbbell-shaped tumors and the use of nonpenetrating vascular clips permits reliable dural closure, prevents postoperative CSF leakage, and promises good postoperative clinical results.

  16. Standardization procedure for the nasal nitric oxide measurement method using Niox MINO® and the tidal-breathing technique with velum-closure.

    Science.gov (United States)

    Gelardi, M; Abbattista, G; Quaranta, V N; Quaranta, N; Seccia, V; Buttafava, S; Frati, F; Ciprandi, G

    2016-01-01

    Nitric oxide (NO) is a molecule that performs many functions in the human body. The entire respiratory tract can produce NO, but the highest production occurs in the upper respiratory tract, in the paranasal sinuses in particular. The aim of the present study was to assess a new nasal NO (nNO) measurement method using the Niox MINO Nasal® device (Aerocrine AB, Solna, Sweden) and a special procedure, in order to compare the nNO values obtained in 32 healthy subjects with the values found in the international literature. The measured normal nNO values were equal to 426.76±143.27 ppb, with a 95% confidence interval [160.22-733.30]. Males had an average nNO value equal to 446.76±133.63 [178.64 – 714.02], whereas in females the average value was 403.80±154.90 [94.00-713.60]. This study allows us to confirm that we have been able to establish the normal range of nitric oxide quantity produced in the nasal/sinus cavities of healthy individuals using the Niox MINO Nasal® device and tidal-breathing with velum-closure manoeuvre.

  17. FINAL CLOSURE PLAN SURFACE IMPOUNDMENTS CLOSURE, SITE 300

    Energy Technology Data Exchange (ETDEWEB)

    Lane, J E; Scott, J E; Mathews, S E

    2004-09-29

    Lawrence Livermore National Laboratory of the University of California (LLNL) operates two Class II surface impoundments that store wastewater that is discharged from a number of buildings located on the Site 300 Facility (Site 300). The wastewater is the by-product of explosives processing. Reduction in the volume of water discharged from these buildings over the past several years has significantly reduced the wastewater storage needs. In addition, the impoundments were constructed in 1984, and the high-density polyethylene (HDPE) geomembrane liners are nearing the end of their service life. The purpose of this project is to clean close the surface impoundments and provide new wastewater storage using portable, above ground storage tanks at six locations. The tanks will be installed prior to closure of the impoundments and will include heaters for allowing evaporation during relatively cool weather. Golder Associates (Golder) has prepared this Final Closure Plan (Closure Plan) on behalf of LLNL to address construction associated with the clean closure of the impoundments. This Closure Plan complies with State Water Resources Control Board (SWRCB) Section 21400 of the California Code of Regulations Title 27 (27 CCR {section}21400). As required by these regulations and guidance, this Plan provides the following information: (1) A site characterization, including the site location, history, current operations, and geology and hydrogeology; (2) The regulatory requirements relevant to clean closure of the impoundments; (3) The closure procedures; and, (4) The procedures for validation and documentation of clean closure.

  18. Assessment of the effect on blood loss and transfusion requirements when adding a polyethylene glycol sealant to the anastomotic closure of aortic procedures: a case–control analysis of 102 patients undergoing Bentall procedures

    Directory of Open Access Journals (Sweden)

    Natour Ehsan

    2012-10-01

    Full Text Available Abstract Background The use of CoSeal®, a polyethylene glycol sealant, in cardiac and vascular surgery for prevention of anastomotic bleeding has been subject to prior investigations. We analysed our perioperative data to determine the clinical benefit of using polyethylene glycol sealant to inhibit suture line bleeding in aortic surgery. Methods From January 2004 to June 2006, 124 patients underwent aortic surgical procedures such as full root replacements, reconstruction and/or replacement of ascending aorta and aortic arch procedures. A Bentall procedure was employed in 102 of these patients. In 48 of these, a polyethylene glycol sealant was added to the anastomotic closure of the aortic procedure (sealant group and the other 54 patients did not have this additive treatment to the suture line (control group. Results There were no significant between-group differences in the demographic characteristics of the patients undergoing Bentall procedures. Mean EuroSCORES (European System for Cardiac Operative Risk Evaluation were 13.7 ± 7.7 (sealant group and 14.4 ± 6.2 (control group, p = NS. The polyethylene glycol sealant group had reduced intraoperative and postoperative transfusion requirements (red blood cells: 761 ± 863 versus 1248 ± 1206 ml, p = 0.02; fresh frozen plasma: 413 ± 532 versus 779 ± 834 ml, p = 0.009; and less postoperative drainage loss (985 ± 972 versus 1709 ± 1302 ml, p = 0.002. A trend towards a lower rate of rethoracotomy was observed in the sealant group (1/48 versus 6/54, p = 0.07 and there was significantly less time spent in the intensive care unit or hospital (both p = 0.03. Based on hypothesis-generating calculations, the resulting economic benefit conferred by shorter intensive care unit and hospital stays, reduced transfusion requirements and a potentially lower rethoracotomy rate is estimated at €1,943 per patient in this data analysis

  19. Restaurant closures

    CERN Multimedia

    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).

  20. Design of closure works

    NARCIS (Netherlands)

    Verhagen, H.J.

    2007-01-01

    This chapter discusses the design aspects of estuary and river closures and those of reservoir dams and certain other hydraulic structures. The focus of this chapter is on closures, not on the situation after the closure has been completed.

  1. Closure and Sealing Design Calculation

    Energy Technology Data Exchange (ETDEWEB)

    T. Lahnalampi; J. Case

    2005-08-26

    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

  2. Closure Issues with Families.

    Science.gov (United States)

    Craig, Steven E.; Bischof, Gary H.

    Closure of the counseling relationship constitutes both an ending and a beginning. Although closure signifies the ending of the present counseling relationship, many family counselors conceptualize closure as the start of a working relationship between counselor and family that may be summoned in future times of crisis or during a difficult life…

  3. 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

  4. [Percutaneous closure of patent ductus arteriosus: results and costs compared to surgical closure].

    Science.gov (United States)

    Vieu, T; Beaurain, S; Angel, C; Leriche, H; Petit, J; Conso, J F; Planché, C; Losay, J

    1995-10-01

    The comparison of the clinical results and costs of the two methods of closure of patient ductus arteriosus was undertaken in two comparable groups of 40 patients treated in the same period in the same hospital. After transcatheter closure there was a 9% residual shunt rate at 3 years, the 2 patients with a residual continuous murmur being operated secondarily. The only complication was severe haemolysis which regressed after transcatheter ablation of the prosthesis. After surgical closure, there were no residual shunt. Some postoperative complications were observed in 20% of cases, usually benign (ventilatory problems, dysphonia or urinary infection), but occasionally more serious (peroperative lesion of the pulmonary artery). Morbidity, inherent to the technique of closure, was very different and much less in catheter closure. The average cost (daily cost x average length of hospital stay) was much less with transcatheter closure 38,558 francs versus 11,240 francs. On the other hand, the direct cost of transcatheter closure was greater than that of surgery: 32,798 francs versus 20,903 francs, the difference being related to the actual price of the prosthesis. The authors conclude that the 3 year results of transcatheter closure of patent ductus arterious make this technique a reasonable therapeutic alternative to surgery. From the safety point of view, the two techniques are comparable bu patient confort is greater with transcatheter closure for an increase in cost of the initial procedure which should decrease in relation to the types and prices of the prosthesis used.

  5. Closure Operators and Closure Systems on Quantaloid-Enriched Categories

    Institute of Scientific and Technical Information of China (English)

    Min LIU; Bin ZHAO

    2013-01-01

    In this paper,we introduce the fundamental notions of closure operator and closure system in the framework of quantaloid-enriched category.We mainly discuss the relationship between closure operators and adjunctions and establish the one-to-one correspondence between closure operators and closure systems on quantaloid-enriched categories.

  6. Entropy production and collisionless fluid closure

    Energy Technology Data Exchange (ETDEWEB)

    Sarazin, Y; Zarzoso, D; Garbet, X; Ghendrih, Ph; Grandgirard, V [CEA, IRFM, F-13108 Saint-Paul-lez-Durance (France); Dif-Pradalier, G, E-mail: yanick.sarazin@cea.f [Center for Astrophysics and Space Science, U.C.S.D., La Jolla, CA 92093 (United States)

    2009-11-15

    A novel method is proposed to construct collisionless fluid closures accounting for some kinetic properties. The idea consists in optimizing the agreement between the fluid and kinetic quasi-linear entropy production rates, so as to constrain the closure coefficients. This procedure is applied to the slab branch of the ion temperature gradient driven instability. Focusing on the kinetic regime characterized by slow waves, the closure proposed by Hammett and Perkins (Hammett and Perkins 1990 Phys. Rev. Lett. 64 3019) naturally emerges from the systematic identification of the kinetic and fluid entropy production rates. This closure is revealed to be extremely powerful well beyond the kinetic regime. Besides, it reconciles the fluid and kinetic linear stability diagrams in the two-dimensional space of the density and temperature gradient lengths. Such a method is systematic and generic. As such, it is applicable to other models and classes of instabilities.

  7. Entropy production and collisionless fluid closure

    Science.gov (United States)

    Sarazin, Y.; Dif-Pradalier, G.; Zarzoso, D.; Garbet, X.; Ghendrih, Ph; Grandgirard, V.

    2009-11-01

    A novel method is proposed to construct collisionless fluid closures accounting for some kinetic properties. The idea consists in optimizing the agreement between the fluid and kinetic quasi-linear entropy production rates, so as to constrain the closure coefficients. This procedure is applied to the slab branch of the ion temperature gradient driven instability. Focusing on the kinetic regime characterized by slow waves, the closure proposed by Hammett and Perkins (Hammett and Perkins 1990 Phys. Rev. Lett. 64 3019) naturally emerges from the systematic identification of the kinetic and fluid entropy production rates. This closure is revealed to be extremely powerful well beyond the kinetic regime. Besides, it reconciles the fluid and kinetic linear stability diagrams in the two-dimensional space of the density and temperature gradient lengths. Such a method is systematic and generic. As such, it is applicable to other models and classes of instabilities.

  8. Testing turbulent closure models with convection simulations

    CERN Document Server

    Snellman, J E; Mantere, M J; Rheinhardt, M; Dintrans, B

    2012-01-01

    Aims: To compare simple analytical closure models of turbulent Boussinesq convection for stellar applications with direct three-dimensional simulations both in homogeneous and inhomogeneous (bounded) setups. Methods: We use simple analytical closure models to compute the fluxes of angular momentum and heat as a function of rotation rate measured by the Taylor number. We also investigate cases with varying angles between the angular velocity and gravity vectors, corresponding to locating the computational domain at different latitudes ranging from the pole to the equator of the star. We perform three-dimensional numerical simulations in the same parameter regimes for comparison. The free parameters appearing in the closure models are calibrated by two fit methods using simulation data. Unique determination of the closure parameters is possible only in the non-rotating case and when the system is placed at the pole. In the other cases the fit procedures yield somewhat differing results. The quality of the closu...

  9. 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.

  10. COMPARATIVE STUDY OF LAPAROSCOPIC CLOSURE OPEN PEPTIC PERFORATION CLOSURE

    Directory of Open Access Journals (Sweden)

    Vivek

    2015-10-01

    Full Text Available Laparoscopic closure of perforated duodenal ulcer was first performed in the year 1990 . Due to its advantage of better view of the peritoneal cavity an opportunity for thorough lavage and avoidance of upper abdominal incision, with its related complication, especially in high – ri sk patients, this procedure has gained popularity all over the world. Approximately 10 - 20% of patients suffering from peptic ulcer develop perforation of stomach or duodenum in which, chemical peritonitis develop initially from gastric secretion and duoden al secretion the condition is life threatening. Early diagnosis and treatment is extremely important. Mortality will increase up if perforation exists more than 24 to 48 hours. Usually surgical intervention of simple closure with omental patch of the perforation is required. this study aims at evaluating efficacy , safety and outcome of laparoscopic surgery for perforated duodenal ulcer patients admitted during period Jan 2009 to Dec 2012 at tertiary hospital in north Karnataka A total of 61cases diagnosed as peritonitis secondary to duodenal ulcer perforation were involved in the study 30underwent open perforation closure and 31 cases underwent lap closure. Peptic ulcers are focal defects in the gastric or duodenal mucosa which extend into the sub mucosa or deeper. they may be acute or chronic and ultimately are caused by on imbalance between the action of peptic acid and mucosal defenses peptic ulcer remains a common outpatient diagnosis, but the number of elective operations for peptic ul cer disease have decreased dramatically over the past 30 decades due to the advent of H2 blockers However the incidence of emergency surgeries, and death rate associated with peptic ulcer are same

  11. Median sternotomy closure: review and update research

    Institute of Scientific and Technical Information of China (English)

    Hua Kun; Yang Xiubin

    2009-01-01

    Cardiac surgery is a very common operation nowadays all over the world. Median stemotomy is a routine procedure required for cardiac access during open heart surgery. The complications of this procedure after the cardiac surgery range from 0.7% to 1.5% of all cases, and bear a high mortality rate if they occur. Every individual surgeon must pay great attention on every detail during the sternal closure. This article shows the details as to conventional information and updated progress on median sternotomy closure. The update contents involve in biomechanics, number of wires twists, biomaterial and so on.According to our experience, we recommend four peristernal single/double steel wires for sternal closure as our optimal choice.

  12. Primary closure for postoperative mediastinitis in children.

    Science.gov (United States)

    Ohye, Richard G; Maniker, Robert B; Graves, Holly L; Devaney, Eric J; Bove, Edward L

    2004-09-01

    Mediastinitis affects approximately 1% of children undergoing median sternotomy. Conventional therapy involves debridement followed by open wound care with delayed closure, days to weeks of closed suction or antimicrobial irrigation, and vacuum-assisted closure or muscle flap closure. We hypothesized that primary closure without prolonged suction or irrigation is an effective, less traumatic treatment for mediastinitis in children. From January 1986 to July 2002, 6705 procedures involving median sternotomy were performed at the C. S. Mott Children's Hospital, resulting in 57 cases of mediastinitis (0.85%). Cases were divided into 2 groups, with 42 cases treated with primary closure and 15 cases treated with delayed or muscle flap closure. The 42 cases of primary closure comprised the primary study group of this institutional review board-approved, retrospective analysis. Patient demographics, surgical variables, mediastinitis-related parameters, and outcomes were evaluated. One patient had recurrent mediastinitis for an overall infection eradication rate of 97% (40/41). Three patients (7%) required re-exploration for suspected ongoing infection. Of these re-explorations, 1 patient had evidence of continued mediastinitis. The remaining 2 patients with sepsis of unclear cause had no clinical or culture evidence of recurrent infection. One of these patients ultimately died of sepsis without active mediastinitis for a hospital survival of 97% (41/42). No significant differences could be detected between the treatment successes and failures in this small cohort of patients. Simple primary closure is an effective means to treat selected cases of postoperative mediastinitis in children. The results compare favorably with other more lengthy or debilitating treatments.

  13. Eyelid closure at death

    Directory of Open Access Journals (Sweden)

    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.

  14. Final Clean Closure Report Site 300 Surface Impoundments Closure Lawrence Livermore National Laboratory Livermore, California

    Energy Technology Data Exchange (ETDEWEB)

    Haskell, K

    2006-02-14

    Lawrence Livermore National Laboratory operated two Class II surface impoundments that stored wastewater that was discharged from a number of buildings located on the Site 300 Facility (Site 300). The wastewater was the by-product of explosives processing. Reduction in the volume of water discharged from these buildings over the past several years significantly reduced the wastewater storage needs. In addition, the impoundments were constructed in 1984, and the high-density polyethylene (HDPE) geomembrane liners were nearing the end of their service life. The purpose of this project was to clean close the surface impoundments and provide new wastewater storage using above ground storage tanks at six locations. The tanks were installed and put into service prior to closure of the impoundments. This Clean Closure Report (Closure Report) complies with State Water Resources Control Board (SWRCB) Section 21400 of the California Code of Regulations Title 27 (27 CCR section 21400). As required by these regulations and guidance, this Closure Report provides the following information: (1) a brief site description; (2) the regulatory requirements relevant to clean closure of the impoundments; (3) the closure procedures; and (4) the findings and documentation of clean closure.

  15. Suitability of Exoseal Vascular Closure Device for Antegrade Femoral Artery Puncture Site Closure

    Energy Technology Data Exchange (ETDEWEB)

    Schmelter, Christopher, E-mail: christopher.schmelter@klinikum-ingolstadt.de; Liebl, Andrea; Poullos, Nektarios [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany); Ruppert, Volker [Klinikum Ingolstadt, Department of Vascular Surgery (Germany); Vorwerk, Dierk [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany)

    2013-06-15

    Purpose. To assess the efficacy and safety of the Exoseal vascular closure device for antegrade puncture of the femoral artery. Methods. In a prospective study from February 2011 to January 2012, a total of 93 consecutive patients received a total of 100 interventional procedures via an antegrade puncture of the femoral artery. An Exoseal vascular closure device (6F) was used for closure in all cases. Puncture technique, duration of manual compression, and use of compression bandages were documented. All patients were monitored by vascular ultrasound and color-coded duplex sonography of their respective femoral artery puncture site within 12 to 36 h after angiography to check for vascular complications. Results. In 100 antegrade interventional procedures, the Exoseal vascular closure device was applied successfully for closure of the femoral artery puncture site in 96 cases (96 of 100, 96.0 %). The vascular closure device could not be deployed in one case as a result of kinking of the vascular sheath introducer and in three cases because the bioabsorbable plug was not properly delivered to the extravascular space adjacent to the arterial puncture site, but instead fully removed with the delivery system (4.0 %). Twelve to 36 h after the procedure, vascular ultrasound revealed no complications at the femoral artery puncture site in 93 cases (93.0 %). Minor vascular complications were found in seven cases (7.0 %), with four cases (4.0 %) of pseudoaneurysm and three cases (3.0 %) of significant late bleeding, none of which required surgery. Conclusion. The Exoseal vascular closure device was safely used for antegrade puncture of the femoral artery, with a high rate of procedural success (96.0 %), a low rate of minor vascular complications (7.0 %), and no major adverse events.

  16. Coblation-assisted closure of persistent tracheocutaneous fistulae.

    Science.gov (United States)

    Walner, David L; Mularczyk, Chris; Kakodkar, Kedar

    2016-06-01

    Persistent tracheocutaneous fistulae (PTCFs) are sequelae of long-term tracheostomy tube use, and while many procedures exist to correct this issue, several are invasive and incur risk to the patient. This case study discusses a minimally invasive approach to closure of small PFTFs with a coblator device that may reduce the risks associated with other closure procedures. We demonstrated successful tracheocutaneous fistulae closure after coblation in all 4 patients that the operation was performed. We believe this technique can be considered for patients under select circumstances and can be part of a surgeon's armamentarium for the treatment of small PTCFs.

  17. A regenerative approach towards mucosal fenestration closure.

    Science.gov (United States)

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

    2013-06-06

    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.

  18. 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.

  19. The myth of closure.

    Science.gov (United States)

    Boss, Pauline; Carnes, Donna

    2012-12-01

    Therapies for grief and loss have traditionally focused on the work of grieving. The goal was to reach an endpoint, now popularly called closure. There are, however, many people who, through no fault of their own, find a loss so unclear that there can be no end to grief. They have not failed in the work of grieving, but rather have suffered ambiguous loss, a type of loss that is inherently open ended. Instead of closure, the therapeutic goal is to help people find meaning despite the lack of definitive information and finality. Hope lies in increasing a family's tolerance for ambiguity, but first, professionals must increase their own comfort with unanswered questions. In this article, the authors, one a poet, the other a family therapist and theorist, offer a unique blending of theory, reflection, and poetry to experientially deepen the process of self-reflection about a kind of loss that defies closure. © FPI, Inc.

  20. Achieving closure at Fernald

    Energy Technology Data Exchange (ETDEWEB)

    Bradburne, John; Patton, Tisha C.

    2001-02-25

    When Fluor Fernald took over the management of the Fernald Environmental Management Project in 1992, the estimated closure date of the site was more than 25 years into the future. Fluor Fernald, in conjunction with DOE-Fernald, introduced the Accelerated Cleanup Plan, which was designed to substantially shorten that schedule and save taxpayers more than $3 billion. The management of Fluor Fernald believes there are three fundamental concerns that must be addressed by any contractor hoping to achieve closure of a site within the DOE complex. They are relationship management, resource management and contract management. Relationship management refers to the interaction between the site and local residents, regulators, union leadership, the workforce at large, the media, and any other interested stakeholder groups. Resource management is of course related to the effective administration of the site knowledge base and the skills of the workforce, the attraction and retention of qualified a nd competent technical personnel, and the best recognition and use of appropriate new technologies. Perhaps most importantly, resource management must also include a plan for survival in a flat-funding environment. Lastly, creative and disciplined contract management will be essential to effecting the closure of any DOE site. Fluor Fernald, together with DOE-Fernald, is breaking new ground in the closure arena, and ''business as usual'' has become a thing of the past. How Fluor Fernald has managed its work at the site over the last eight years, and how it will manage the new site closure contract in the future, will be an integral part of achieving successful closure at Fernald.

  1. Tank closure reducing grout

    Energy Technology Data Exchange (ETDEWEB)

    Caldwell, T.B.

    1997-04-18

    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{sup 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.

  2. 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.  

  3. MNC Subsidiary Closure

    DEFF Research Database (Denmark)

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

    2013-01-01

    We investigate the consequences of MNC subsidiary closures for employees who lose their jobs. We ask to what degree the foreign knowledge that they were exposed to is valued in their new job. We argue theoretically that this foreign knowledge is both valuable and not readily available in the host...

  4. MNC Subsidiary Closure

    DEFF Research Database (Denmark)

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

    We investigate the consequences of MNC subsidiary closures for employees who lose their jobs. We ask to what degree the foreign knowledge that they were exposed to is valued in their new job. We argue theoretically that this foreign knowledge is both valuable and not readily available in the host...

  5. Ring closure in actin polymers

    Science.gov (United States)

    Sinha, Supurna; Chattopadhyay, Sebanti

    2017-03-01

    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.

  6. Use of bipedicular advancement flaps for intrauterine closure of myeloschisis.

    Science.gov (United States)

    Mangels, K J; Tulipan, N; Bruner, J P; Nickolaus, D

    2000-01-01

    Several groups have begun to explore the feasibility and utility of intrauterine closure of myelomeningocele. A subset of these fetuses have defects which fall into the category of myeloschisis, and therefore have inadequate skin to enable primary closure. After considerable discussion, it was decided to utilize bipedicular flaps to close these lesions. The procedure is described, and representative examples are shown. To date, 13 of 56 fetuses have required this approach for closure in utero. While this technique generally provides adequate coverage of the dural sac, the cosmetic results have been less than optimal.

  7. A case against closure

    Directory of Open Access Journals (Sweden)

    Olin, Doris

    2005-01-01

    Full Text Available Este artigo examina a objeção ao fechamento [dedutivo] que surge no contexto de certos paradoxos epistêmicos, paradoxos cuja conclusão é que a crença justificada pode ser inconsistente. É universalmente aceito que, se essa conclusão é correta, o fechamento deve ser rejeitado, para que se evite a crença justificada em enunciados contraditórios (P, ~P. Mas, mesmo que os argumentos desses paradoxos - o paradoxo da falibilidade (do prefácio e o paradoxo da loteria - seja mal sucedidos, eles, ainda assim, sugerem a existência de evidência independente para uma objeção mais direta contra o fechamento. O exame do argumento da falibilidade revela uma exigência de modéstia epistêmica que viola o fechamento a partir de múltiplas premissas. A reflexão sobre o paradoxo da loteria nos confronta com um dilema em que cada alternativa fornece um contra-exemplo ao fechamento a partir de uma única premissa. Seja ou não possível a inconsistência racional, há uma objeção contra o fechamento. This paper examines the case against closure that arises in the context of certain epistemic paradoxes, paradoxes whose conclusion is that it is possible for justified belief to be inconsistent. It is generally agreed that if this conclusion is correct, closure must be rejected in order to avoid justified belief in contradictory statements (P, ~P. But even if the arguments of these paradoxes – the fallibility (preface paradox and the lottery paradox – are unsuccessful, they nonetheless suggest independent grounds for a more direct case against closure. Examination of the fallibility argument reveals a requirement of epistemic modesty that violates multiple premise closure. Reflection on the lottery paradox presents us with a dilemma in which each alternative provides a counterexample to single premise closure. Whether or not rational inconsistency is possible, there is a case against closure.

  8. Closure versus non-closure of the peritoneum at caesarean section: short- and long-term outcomes

    OpenAIRE

    Bamigboye, Anthony A; Hofmeyr, G Justus

    2014-01-01

    Background Caesarean section is a very common surgical procedure worldwide. Suturing the peritoneal layers at caesarean section may or may not confer benefit, hence the need to evaluate whether this step should be omitted or routinely performed. Objectives The objective of this review was to assess the effects of non-closure as an alternative to closure of the peritoneum at caesarean section on intraoperative and immediate- and long-term postoperative outcomes. Search methods We searched the ...

  9. Summer season | Cafeteria closures

    CERN Multimedia

    2013-01-01

    Please note the following cafeteria closures over the summer season: Bldg. 54 closed from 29/07/2013 to 06/09/2013. Bldg. 13: closed from 13/07/2013 to 06/09/2013. Restaurant No. 2, table service (brasserie and restaurant): closed from 01/08/2013 to 06/09/2013. Bldg. 864: closed from 29/07/2013 to 06/09/2013. Bldg. 865: closed from 29/07/2013 to 06/09/2013.

  10. Summer season | Cafeteria closures

    CERN Multimedia

    2013-01-01

    Please note the following cafeteria closures over the summer season: Bldg. 54 closed from 29/07/2013 to 06/09/2013. Bldg. 13: closed from 13/07/2013 to 06/09/2013. Restaurant No. 2, table service (brasserie and restaurant): closed from 01/08/2013 to 06/09/2013. Bldg. 864: closed from 29/07/2013 to 06/09/2013. Bldg. 865: closed from 29/07/2013 to 06/09/2013.

  11. 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.

  12. Tracheocutaneous fistula closure using a Cartilo-musculo-cutaneous bilobed flap.

    Science.gov (United States)

    Petersen, Wiebke; Amr, Amro; Held, Manuel; Werner, Jan-Ole; Schaller, Hans-Eberhard; Rahmanian-Schwarz, Afshin

    2014-03-01

    In general, the development of a tracheocutaneous fistula (TCF) after tracheotomy is a seldom but recurrent clinical problem in long-term ventilated patients. In cases of prolonged wound healing with no spontaneous wound closure or insufficient later closure by secondary suture, different surgical procedures have been previously described for the closure of TCFs. Nonetheless, each procedure has its individually associated complications so that definite closure of TCFs still remains a challenge. The purpose of this case report is to present a unique case of a patient with a persistent TCF that was successfully closed using a local cartilo-musculo-cutaneous bilobed flap.

  13. Maximum-entropy closure of hydrodynamic moment hierarchies including correlations.

    Science.gov (United States)

    Hughes, Keith H; Burghardt, Irene

    2012-06-07

    Generalized hydrodynamic moment hierarchies are derived which explicitly include nonequilibrium two-particle and higher-order correlations. The approach is adapted to strongly correlated media and nonequilibrium processes on short time scales which necessitate an explicit treatment of time-evolving correlations. Closure conditions for the extended moment hierarchies are formulated by a maximum-entropy approach, generalizing related closure procedures for kinetic equations. A self-consistent set of nonperturbative dynamical equations are thus obtained for a chosen set of single-particle and two-particle (and possibly higher-order) moments. Analytical results are derived for generalized Gaussian closures including the dynamic pair distribution function and a two-particle correction to the current density. The maximum-entropy closure conditions are found to involve the Kirkwood superposition approximation.

  14. Hamiltonian closures for fluid models with four moments by dimensional analysis

    CERN Document Server

    Perin, M; Morrison, P J; Tassi, E

    2015-01-01

    Fluid reductions of the Vlasov-Amp{\\`e}re equations that preserve the Hamiltonian structure of the parent kinetic model are investigated. Hamiltonian closures using the first four moments of the Vlasov distribution are obtained, and all closures provided by a dimensional analysis procedure for satisfying the Jacobi identity are identified. Two Hamiltonian models emerge, for which the explicit closures are given, along with their Poisson brackets and Casimir invariants.

  15. 40 CFR 265.280 - Closure and post-closure.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Closure and post-closure. 265.280 Section 265.280 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES... location, topography, and surrounding land use, with respect to the potential effects of pollutant...

  16. Planning for integrated mine closure

    Energy Technology Data Exchange (ETDEWEB)

    Linda Starke (ed.)

    2008-07-01

    This document presents an Integrated Mine Closure Planning Toolkit for the mining and metals sector. The toolkit is intended to be used to promote a more disciplined approach to integrated closure planning and to increase the uniformity of good practices across the sector. The concepts apply equally well to both large and small companies. The document is not intended to be prescriptive; it provides a suite of tools that can be brought to bear in formulating well-considered decisions when planning for closure. It uses a risk and opportunity based process to guide the practitioner through the iterative process of preparing for planned closure. The first section, with head office and mine management personnel as the primary audience, describes the participants of effective closure planning. Sections 2 and 3 provide the frameworks for a conceptual closure plan and a detailed plan. The key audiences for these two sections are mine management and head office personnel, financial modellers and estimators, governments, academics and non-governmental organizations. The forth section addresses decommissioning and post closure planning, and Section 5 draws together the conclusions and outlines several unresolved issues. The five narrative sections are followed by Section 6 which outlines 13 tools, some of which are already available in earlier ICMM publications, member practices and other sector-affiliated publications. Others have been developed to cover identified gaps. These tools provide the practitioner with practical work processes, examples and contexts within which to apply closure planning discipline.

  17. A New Surgical Technique for Closure of Pilonidal Sinus Defects: Triangular Closure Technique

    Science.gov (United States)

    Mutaf, Mehmet; Temel, Metin; Koç, Mustafa Nihat

    2017-01-01

    Background We present a clinical experience with a new local flap procedure, namely the triangular closure technique, for reconstruction of sacrococcygeal skin defects resulting from excision of the pilonidal sinus. Material/Methods In this technique, the defect is surgically converted to a triangle in shape. Then, the triangular defect is closed by transposition of 2 skin flaps designed in an unequal z-plasty manner. Over 6 years, this technique has been used for closure of defects of chronic pilonidal sinus disease in 27 patients (6 females, 21 males). The size of the defect ranged between 3.5 cm and 12 cm in dimension. Results A tension-free defect closure was obtained in all patients. All flaps except one healed with no complications. A mean follow-up of 3.62±1.77 months revealed aesthetically and functionally acceptable results with the obliteration of the natal cleft in all patients. No recurrence was observed in the follow-up period. Conclusions The triangular closure technique was found to be a useful technique for the treatment of pilonidal sinus with favorable results regarding the time before return to work. PMID:28238003

  18. Closure of Oroantral Communications Using Biodegradable Polyurethane Foam : A Long Term Study in Rabbits

    NARCIS (Netherlands)

    Visscher, Susan H.; van Minnen, Baucke; van Leeuwen, M. Barbara M.; van Kooten, Theo G.; Bos, Rudolf R. M.

    2009-01-01

    An oroantral communication (OAC) is an open connection between the oral cavity and maxillary sinus. Closure of OACs is commonly performed with a surgical procedure using a mucoperiosteal nap. An alternative technique using synthetic biodegradable polyurethane (PU) foam for closure of OACs is present

  19. 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…

  20. 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 ...

  1. Percutaneous closure of a very large left atrial appendage using the Amplatzer amulet.

    Science.gov (United States)

    Freixa, Xavier; Kwai Chan, Jason Leung; Tzikas, Apostolos; Garceau, Patrick; Basmadjian, Arsène; Ibrahim, Réda

    2013-10-01

    Although percutaneous left atrial appendage (LAA) closure is becoming a common procedure worldwide, there are still some anatomic limitations. The size of the LAA is one of the current limitations as the most popular devices do not allow the closure of very large LAAs. The new Amplatzer Cardiac Plug 2, also called "Amulet," has been redesigned not only to improve delivery and safety but also to allow the closure of larger LAAs. The present report describes the successful closure of a very large LAA using the Amulet.

  2. Primary fascial closure with laparoscopic ventral hernia repair: systematic review.

    Science.gov (United States)

    Nguyen, Duyen H; Nguyen, Mylan T; Askenasy, Erik P; Kao, Lillian S; Liang, Mike K

    2014-12-01

    Laparoscopic ventral hernia repair (LVHR) has grown in popularity. Typically, this procedure is performed with a mesh bridge technique that results in high rates of seroma, eventration (bulging), and patient dissatisfaction. In an effort to avoid these complications, there is growing interest in the role of laparoscopic primary fascial closure with intraperitoneal mesh placement. This systematic review evaluated the outcomes of closure of the central defect during LVHR. A literature search of PubMed, Cochrane databases, and Embase was conducted using PRISMA guidelines. MINORS was used to assess the methodologic quality. Primary outcome was hernia recurrence. Secondary outcomes were surgical-site infection, seroma formation, bulging, and patient-centered items (satisfaction, chronic pain, functional status). Eleven studies were identified, eight of which were case series (level 4 data). Three comparative studies examined the difference between closure and nonclosure of the fascial defect during laparoscopic ventral incisional hernia repairs (level 3 and 4 data). These studies suggested that primary fascial closure (n = 138) compared to nonclosure (n = 255) resulted in lower recurrence rates (0-5.7 vs. 4.8-16.7 %) and seroma formation rates (5.6-11.4 vs. 4.3-27.8 %). Follow-up periods for both groups were similar (1-108 months). Only one study evaluated patient function and clinical bulging. It showed better outcomes with primary fascial closure. Closure of the central defect during LVHR resulted in less recurrence, bulging, and seroma than nonclosure. Patients with closure were more satisfied with the results and had better functional status. The quality of the data was poor, however. A randomized controlled trial to evaluate the role of closure of the central defect during LVHR is warranted.

  3. Closure of hazardous and mixed radioactive waste management units at DOE facilities. [Contains glossary

    Energy Technology Data Exchange (ETDEWEB)

    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.

  4. 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.

  5. Relevant closure: a new form of defeasible reasoning for description logics

    CSIR Research Space (South Africa)

    Casini, G

    2014-09-01

    Full Text Available Among the various proposals for defeasible reasoning for description logics, Rational Closure, a procedure originally defined for propositional logic, turns out to have a number of desirable properties. Not only it is computationally feasible...

  6. Angle closure glaucoma following a combined blepharoplasty and ectropion repair.

    Science.gov (United States)

    Gayton, J L; Ledford, J K

    1992-01-01

    This paper reports an occurrence of angle closure glaucoma following a combined blepharoplasty and ectropion repair. We are unaware of any previous reports of such an incident. Specific to this case was the coexistence of a cataract that contributed to the narrowing of the anterior chamber. This condition, along with pupil dilation secondary to the anesthetic, precipitated a phacomorphic angle closure glaucoma attack, necessitating emergency cataract surgery. Because other procedures involve pupillary dilation as a potential side effect, we recommend an increased awareness of this potential postoperative complication.

  7. Entropy production rate as a constraint for collisionless fluid closures

    Science.gov (United States)

    Fleurence, E.; Sarazin, Y.; Garbet, X.; Dif-Pradalier, G.; Ghendrih, Ph.; Grandgirard, V.; Ottaviani, M.

    2006-11-01

    A novel method is proposed to construct collisionless fluid closures accounting for some kinetic properties. The first dropped fluid moment is assumed to be a linear function of the lower order ones. Optimizing the agreement between the fluid and kinetic entropy production rates is used to constrain the coefficients of the linear development. This procedure is applied to a reduced version of the interchange instability. The closure, involving the absolute value of the wave vector, is non-local in real space. In this case, the linear instability thresholds are the same, and the linear growth rates exhibit similar characteristics. Such a method is applicable to other models and classes of instabilities.

  8. Spontaneous closure of midline diastema following frenectomy

    Directory of Open Access Journals (Sweden)

    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.

  9. Spontaneous closure of midline diastema following frenectomy.

    Science.gov (United States)

    Koora, Kiran; Muthu, M S; Rathna, Prabhu V

    2007-03-01

    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.

  10. Transcatheter closure of patent foramen ovale using the internal jugular venous approach.

    Science.gov (United States)

    Węglarz, Przemysław; Konarska-Kuszewska, Ewa; Zębik, Tadeusz; Kuszewski, Piotr; Drzewiecka-Gerber, Agnieszka; Motyka, Marek; Ludyga, Tomasz; Bajor, Grzegorz

    2014-01-01

    Transcatheter closure of patent foramen ovale is routinely performed using the transfemoral approach, which is safe and technically easy. Our case represents the rare situation where the procedure needs to be performed using the right internal jugular venous approach. According to our best knowledge this is the first report of a patent foramen ovale closure procedure with access through the internal jugular with necessity to advance the guide wire and transseptal sheath into the left ventricle. Developing alternative techniques of transcatheter patent foramen ovale closure seems to be especially important in rare cases where transfemoral access is unavailable.

  11. Percutaneous repair of iatrogenic subclavian artery injury by suture-mediated closure device

    Directory of Open Access Journals (Sweden)

    Rahul S Chivate

    2016-01-01

    Full Text Available Central venous catheterization through internal jugular vein is done routinely in intensive care units. It is generally safe, more so when the procedure is performed under ultrasound guidance. However, there could be inadvertent puncture of other vessels in the neck when the procedure is not performed under real-time sonographic guidance. Closure of this vessel opening can pose a challenge if it is an artery, in a location difficult to compress, and is further complicated by deranged coagulation profile. Here, we discuss the removal of an inadvertently placed catheter from subclavian artery with closure of arteriotomy percutaneously using arterial suture-mediated closure device.

  12. RCRA closure of mixed waste impoundments

    Energy Technology Data Exchange (ETDEWEB)

    Blaha, F.J. [Doty and Associates (United States); Greengard, T.C.; Arndt, M.B. [Rockwell International (United States)

    1989-11-01

    A case study of a RCRA closure action at the Rocky Flats Plant is presented. Closure of the solar evaporation ponds involves removal and immobilization of a mixed hazardous/radioactive sludge, treatment of impounded water, groundwater monitoring, plume delineation, and collection and treatment of contaminated groundwater. The site closure is described within the context of regulatory negotiations, project schedules, risk assessment, clean versus dirty closure, cleanup levels, and approval of closure plans and reports. Lessons learned at Rocky Flats are summarized.

  13. Transcatheter Closure of Congenital Coronary Artery Fistulas with a Giant Coronary Artery Aneurysm in Children: Experiences from a Single Center

    Science.gov (United States)

    Li, Yi-Fan; Zhang, Zhi-Wei; Wang, Shu-Shui; Xie, Zhao-Feng; Zhang, Xu; Li, Yu-Fen

    2017-01-01

    Background: Transcatheter closure of congenital coronary artery fistulas (CCAFs) is an alternative therapy to surgery; however, data regarding transcatheter closure for CCAF with a giant coronary artery aneurysm (CAA) in pediatric patients are still limited due to the rarity of the disease. We aimed to evaluate the efficacy and safety of transcatheter closure for CCAF with a giant CAA in a pediatric population at a single center. Methods: Medical records of pediatric patients (aneurysm dilation after the second intervention. One patient experienced thrombus formation within the CAA after the procedure. Among those with closure at the entry point of the CAA, a mild-to-moderate residual shunt was detected in three patients. Conclusions: Transcatheter closure appears to be a safe and effective alternative therapy for CCAF with a giant CAA in the pediatric population. Closure at the entry point of the CAA, and closure at both the entry and exit points when feasible, may reduce the risk of postinterventional complications. PMID:28776543

  14. Overlay Technique for Transcatheter Left Atrial Appendage Closure.

    Science.gov (United States)

    Li, Shuang; Zhu, Mengyun; Lu, Yunlan; Tang, Kai; Zhao, Dongdong; Chen, Wei; Xu, Yawei

    2015-08-01

    The Overlay technique is popular in peripheral artery interventions, but not in coronary or cardiac structural procedures. We present an initial experience using three-episode overlays during a transcatheter left atrial appendage closure. The first overlay was applied to facilitate advancement of the delivery sheath into left atrium. The second overlay was used to navigate the advancement of prepped delivery system containing the compressed occluder into its optimal position in the left atrium. The third overlay facilitated the real-time deployment of the closure device. This case report demonstrates the effectiveness of the overlay technique in facilitating each step of the transcatheter left atrial appendage closure. Copyright © 2015 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.

  15. 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.

  16. Compressible turbulence transport equations for generalized second order closure

    Energy Technology Data Exchange (ETDEWEB)

    Cloutman, L D

    1999-05-01

    Progress on the theory of second order closure in turbulence models of various types requires knowledge of the transport equations for various turbulence correlations. This report documents a procedure that provides such equations for a wide variety of turbulence averages for compressible flows of a multicomponent fluid. Generalizing some work by Germano for incompressible flows, we introduce an appropriate extension of his generalized second order correlations and use a generalized mass-weighted averaging procedure to derive transport equations for the correlations. The averaging procedure includes all of the commonly used averages as special cases. The resulting equations provide an internally consistent starting point for future work in developing single-point statistical turbulence transport models for fluid flows. The form invariance of the in-compressible equations also holds for the compressible case, and we discuss some of the closure issues and frequently ignored complications of statistical turbulence models of compressible flows.

  17. Facilitating memory with hypnosis, focused meditation, and eye closure.

    Science.gov (United States)

    Wagstaff, Graham F; Brunas-Wagstaff, Jo; Cole, Jon; Knapton, Luke; Winterbottom, James; Crean, Vicki; Wheatcroft, Jacqueline

    2004-10-01

    Three experiments examined some features of hypnotic induction that might be useful in the development of brief memory-facilitation procedures. The first involved a hypnosis procedure designed to facilitate face identification; the second employed a brief, focused-meditation (FM) procedure, with and without eye closure, designed to facilitate memory for an emotional event. The third experiment was a check for simple motivation and expectancy effects. Limited facilitation effects were found for hypnosis, but these were accompanied by increased confidence in incorrect responses. However, eye closure and FM were effective in facilitating free recall of an event without an increase in errors. FM reduced phonemic fluency, suggesting that the effectiveness of FM was not due to simple changes in expectancy or motivation.

  18. Echocardiographic guidance and monitoring of left atrial appendage closure with AtriClip during open-chest cardiac surgery.

    Science.gov (United States)

    Contri, Rachele; Clivio, Sara; Torre, Tiziano; Cassina, Tiziano

    2017-09-12

    Left atrial appendage (LAA) closure prevents thromboembolic risk and avoids lifelong anticoagulation due to atrial fibrillation (AF). Nowadays, AtriClip, a modern epicardial device approved in June 2010, allows external and safe closure of LAA in patients undergoing cardiac surgery during other open-chest cardiac surgical procedures. Such a surgical approach and its epicardial deployment differentiates LAA closure with AtriClip from percutaneous closure techniques such as Watchman (Boston Scientific, Marlborough, MA, USA), Lariat (SentreHEART Inc., Redwood City, CA, USA), and Amplatzer Amulet (St. Jude Medical, St. Paul, MN, USA) device procedures. AtriClip positioning must consider perioperative transesophageal echocardiography (TEE) to confirm LAA anatomical features, to explore the links with neighboring structures, and finally to assess its successful closure. We report a sequence of images to document the role of intraoperative TEE during an elective aortic valve replacement and LAA external closure with AtriClip. © 2017, Wiley Periodicals, Inc.

  19. Effectiveness and Safety of Transcatheter Patent Foramen Ovale Closure for Migraine (EASTFORM) Trial

    Science.gov (United States)

    Xing, Ying-qi; Guo, Yu-Zhu; Gao, Yong-Sheng; Guo, Zhen-Ni; Niu, Peng-Peng; Yang, Yi

    2016-01-01

    We evaluated the safety and effectiveness of transcatheter patent foramen ovale (PFO) closure for the treatment of migraine in a Chinese population. This non-randomized clinical trial enrolled 258 consecutive substantial or severe migraineurs with a right-to-left shunt (RLS) (grade II–IV) and grouped subjects according to their election or refusal of PFO closure. Migraine was diagnosed according to the International Classification of Headache Disorders III-beta and evaluated using the Headache Impact Test-6 (HIT-6). In total, 241 participants (125 in the transcatheter closure group and 116 in the control group) were included in the study. In general, the PFO closure procedure was found to be safe. At 1 month after closure, 76.1% of patients returned for c-TCD evaluation; of these, 85.7% were downgraded to negative status or a grade-I shunt. Residual shunts and placebo effects were thought to resolve by 12 months post-procedure, when migraine impact was reported to decrease by 73.6%. Transcatheter PFO closure was demonstrated to be effective for the treatment of migraine by comparing HIT-6 scores between the transcatheter closure and control groups (p < 0.001). Our results suggest that transcatheter PFO closure is a safe and effective approach for the treatment of migraine in the Chinese population, especially in females with constant RLS. Clinical trial no. NCT02127294 (registered on April 29, 2014). PMID:27966652

  20. Transcatheter Closure of Patent Foramen Ovale: A Single Center Experience

    Science.gov (United States)

    Milev, Ivan; Zafirovska, Planinka; Zimbakov, Zan; Idrizi, Shpend; Ampova-Sokolov, Vilma; Gorgieva, Emilija; Ilievska, Liljana; Tosheski, Goce; Hristov, Nikola; Georgievska-Ismail, Ljubica; Anguseva, Tanja; Mitrev, Zan

    2016-01-01

    BACKGROUND: Percutaneous transcatheter closure (PTC) of patent foramen ovale (PFO) is implicated in cryptogenic stroke, transitional ischemic attack (TIA) and treatment of a migraine. AIM: Our goal was to present our experience in the interventional treatment of PFO, as well as to evaluate the short and mid-term results in patients with closed PFO. MATERIAL AND METHODS: Transcatheter closure of PFO was performed in 52 patients (67.3% women, mean age 40.7 ± 11.7 years). Patients were interviewed for subjective grading of the intensity of headaches before and after the PFO closure. RESULTS: During 2 years of follow-up, there was no incidence of new stroke, TIA and/or syncope. Follow-up TCD performed in 35 patients showed complete PFO closure in 20 patients (57.1%). Out of 35 patients, 22 (62.9%) reported having a migraine before the procedure with an intensity of headaches at 8.1 ± 1.9 on a scale from 1 to 10. During 2 years of follow-up, symptoms of a migraine disappeared in 4 (18.2%) and the remaining 18 patients reported the significant decrease in intensity 4.8 ± 2.04 (p = 0.0001). In addition, following PFO closure the incidence of the headaches decreased significantly (p = 0.0001). 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. PMID:28028400

  1. Transcatheter Closure of Patent Ductus Arteriosus: The Penang Hospital's Experience.

    Science.gov (United States)

    Amir Hamzah, A R; Tiow, C A; Koh, G T; Sharifah, A M

    2011-03-01

    Transcatheter closure of small and moderate sizes of Patent Ductus Arteriosus (PDA) is a standard and well accepted form of treatment. The aim of this study is to describe the experience of transcatheter closure of PDA in Penang Hospital. All patients who underwent transcatheter closure of PDA at our institution between 20th January 2006 and 27th June 2008 were retrospectively identified and studied. There were a total of 66 patients who had undergone transcatheter closure of PDA during this period which comprised of 24 male and 42 female. The PDA was closed by Amplatzer Duct Occluder (ADO) in 31 patients, Gianturco coil in 29 patients and other types of devices in 6 patients. There were 4 patients (6%) who had developed acute complication during the procedure (3 of them developed coil embolization and 1 had bleeding from puncture site). The PDA was successfully close in 95.5% of the study population without any residual PDA shunting. All the patients were alive but 5 of them (4.5%) have some abnormalities (2 has mild left pulmonary stenosis, 3 has small residual). Comparison between ADO and Gianturco coil revealed no significant difference in the outcome. Transcatheter closure of PDA has proven to be safe and effective with good midterm outcome. There was no significant difference between Amplatzer Ductal Occluder and Gianturco coil in term of the outcome.

  2. Endobronchial closure of bronchopleural fistulas with Amplatzer vascular plug.

    Science.gov (United States)

    Fruchter, Oren; Bruckheimer, Elchanan; Raviv, Yael; Rosengarten, Dror; Saute, Milton; Kramer, Mordechai R

    2012-01-01

    Bronchopulmonary fistula (BPF) is a severe complication following lobectomy or pneumonectomy and is associated with a high rate of morbidity and mortality. We have developed a novel minimally invasive method of central BPF closure using Amplatzer vascular plug (AVP) device that was originally designed for the transcatheter closure of vascular structures in patients with small BPF. Patients with BPFs were treated under conscious sedation by bronchoscopic closure of BPFs using AVP. After locating the fistula using bronchography, the self-expanding nitinol made AVP occluder to be delivered under direct bronchoscopic guidance over a loader wire into the fistula followed by bronchography to assure correct device positioning and sealing of the BPF. Six AVPs were placed in five patients, four males and one female, with a mean age of 62.3 years (range: 51-82 years). The underlying disorders and etiologies for BPF development were lobectomy (two patients), pneumonectomy for lung cancer (one patient), lobectomy due to necrotizing pneumonia (one patient), and post-tracheostomy tracheo-pleural fistula (one patient). In all the patients, the bronchoscopic procedure was successful and symptoms related to BPF disappeared following closure by the AVP. The results were maintained over a median follow-up of 9 months (range: 5-34 months). Endobronchial closure using the AVP is a safe and effective method for treatment of small postoperative BPF. The ease of their implantation by bronchoscopy under conscious sedation adds this novel technique to the armatorium of minimally invasive modalities for the treatment of small BPF.

  3. Experimental Investigation on the Pressure Characteristics of Cavity Closure Region

    Institute of Scientific and Technical Information of China (English)

    Yadong Wang; Xulong Yuan; Yuwen Zhang

    2012-01-01

    The most complicated component in cavitating flow and pressure distribution is the flow in the cavity closure line.The cavitating flow and pressure distribution provide critical aspects of flow field details in the region.The integral of pressure results of the hydrodynamic forces,indicate domination in the design of a supercavitating vehicle.An experiment was performed in a water tunnel to investigate the pressure characteristics of the cavity closure region.Ventilation methods were employed to generate artificial cavity,and the ventilation rate was adjusted accordingly to obtain the desired cavity length.An array of pressure transducers was laid down the cavity closure line to capture pressure distribution in this region.The experimental results show that there is a pressure peak in the cavity closure region,and the rise rate of pressure in space tends to be higher in the upwind side when the flow is non-axisymmetric.The transient pressure variations during the cavity formation procedure were also present.The method of measurement in this paper can be referenced by engineers.The result helps to study the flow pattern of cavity closure region,and it can also be used to analyze the formation of supercavitating vehicle hydrodynamics.

  4. Congenital Abdominal Wall Defects: Staged closure by Dual Mesh.

    Science.gov (United States)

    Risby, Kirsten; Jakobsen, Marianne Skytte; Qvist, Niels

    2016-01-01

    To evaluate the clinical utility of GORE® DUALMESH (GDM) in the staged closure of large congenital abdominal wall defects. Data of patients with congenital abdominal wall defects managed with GDM was analyzed for outcome regarding complete fascial closure; mesh related complications; and post-discharge gastrointestinal surgery. GDM was placed in 34 (gastroschisis=27, omphalocele=7) patients during the study period. Complete closure of the fascia was obtained in one patient with omphalocele and in 22 patients with gastroschisis. Mesh related surgical complications were seen in five (15%) children: four had detachment of the mesh and one patient developed abdominal compartment syndrome. Mesh related clinical infection was observed in five children. In hospital mortality occurred in four cases (2 gastroschisis and 2 omphalocele) and was not procedure-related. Of the 30 children discharged, 28 (82%) were still alive. At follow-up, three patients (10%) were operated for a minor ventral hernia and 4 children were operated (laparotomy and adhesionolysis) for adhesive intestinal obstruction. Staged closure with GDM is a safe alternative when primary fascial closure is difficult.

  5. 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

  6. The archaeology of uncommon interventions: Articulating the rationale for transcatheter closure of congenital coronary artery fistulas in asymptomatic children.

    Science.gov (United States)

    McElhinney, Doff B

    2016-02-15

    Transcatheter closure of coronary artery fistulas can be executed successfully in infants and children with few serious procedural complications. Indications for and long-term outcomes of closure of coronary artery fistulas remain poorly defined. Registries may offer the best opportunity for advancing our knowledge about uncommon interventions such as coil or device closure of coronary artery fistulas, but to do so, they must include sufficient data and evaluate factors potentially associated with salutary or adverse outcome.

  7. 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

  8. Percutaneous closure of catheter enterotomy: feasibility determination in vivo.

    Science.gov (United States)

    Roy, Sumit; Hol, Per Kristian

    2014-01-01

    To determine whether a catheter enterotomy can be percutaneously sealed with a commercially available vascular closure implant. The study was performed using a porcine model of small intestinal obstruction. Preliminary experiments were performed to allow an informed choice between two of the most promising commercially available alternatives: A multipronged metal clip (StarClose®) and a resorbable anchored polymer plate (FemoSeal®). Thereafter closure of seven enterotomies was attempted with the most suitable implant. The deployment procedure was subjectively analyzed. The sealed enterotomies were visually evaluated and hydrostatically tested. StarClose was rejected for formal assessment because it was both difficult to deploy and could not ensure a watertight seal. The conventional method for deploying FemoSeal was found to be inappropriate for percutaneously closing enterotomies. However an improvised accessory allowed all seven enterotomies to be successfully sealed with the implant using a modified procedure that involved only one additional step. After closure, six of the seven enterotomies tolerated intraluminal pressure up to 65 mm Hg. FemoSeal has the potential to serve as an implant for percutaneous closure of catheter enterotomies if the deployment tool can be appropriately modified.

  9. Percutaneous left atrial appendage closure for stroke prevention

    DEFF Research Database (Denmark)

    De Backer, Ole; Loupis, Anastasia M; Ihlemann, Nikolaj

    2014-01-01

    INTRODUCTION: In atrial fibrillation (AF) patients with an increased stroke risk, oral anticoagulation (OAC) is the standard treatment for stroke prevention. However, this therapy carries a high risk of major bleeding. Percutaneous closure of the left atrial appendage (LAA) is suggested as an alt......INTRODUCTION: In atrial fibrillation (AF) patients with an increased stroke risk, oral anticoagulation (OAC) is the standard treatment for stroke prevention. However, this therapy carries a high risk of major bleeding. Percutaneous closure of the left atrial appendage (LAA) is suggested...... as an alternative option for stroke prevention in AF patients with contraindication(s) for OAC treatment. MATERIAL AND METHODS: A total of 42 patients underwent percutaneous LAA closure. In this report, we describe our experience with this procedure. RESULTS: The patients treated were AF patients with a high stroke...... risk (CHADS-VASc 4.5±1.4) and contra-indication(s) for OAC and/or a high bleeding risk (HAS-BLED 3.7±0.9). A history of intracerebral bleeding was the most common reason for LAA closure. Successful implantation was obtained in 41 of 42 patients. One major peri-procedural complication occurred; a major...

  10. 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 <0.024), NYHA class at referral (OR = 2.9; p <0.0087), and 10-year increase in age (OR = 1.8; p <0.0017) increased likelihood of clinical success. In contrast, a pulmonary comorbidity (OR = 0.18; p <0.005) and male 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.

  11. [Laparotomy closure in advanced peritonitis].

    Science.gov (United States)

    Bensman, V M; Savchenko, Yu P; Shcherba, S N; Golikov, I V; Triandafilov, K V; Chaykin, V V; Pyatakov, S N; Saakyan, A S; Saakyan, E A

    to improve the results of advanced peritonitis management. 743 patients with advanced peritonitis were studied. Patients were divided into 2 groups depending on treatment strategy. Programmed relaparotomy combined with removable draining musculoaponeurotic seams during laparotomy closure decreased mortality from 47.8±2.7% to 24.1±2.3% (pperitonitis management. Laparotomy closure with only cutaneous seams is indicated in case of persistent abdominal hypertension. Large eventration always requires abdominal wall repair. APACHE-III scale scores have significant prognostic value in patients with advanced peritonitis.

  12. Closure phase and lucky imaging.

    Science.gov (United States)

    Rhodes, William T

    2009-01-01

    Since its introduction by Jennison in 1958, the closure-phase method for removing the effects of electrical path-length errors in radio astronomy and of atmospheric turbulence in optical astronomy has been based on the non-redundant-spacing triple interferometer. It is shown that through application of lucky imaging concepts it is possible to relax this condition, making closure-phase methods possible with redundantly spaced interferometer configurations and thereby widening their range of application. In particular, a quadruple-interferometer can, under lucky imaging conditions, be treated as though it were a triple interferometer. The slit-annulus aperture is investigated as a special case.

  13. Homogeneous orbit closures and applications

    CERN Document Server

    Lindenstrauss, Elon

    2011-01-01

    We give new classes of examples of orbits of the diagonal group in the space of unit volume lattices in R^d for d > 2 with nice (homogeneous) orbit closures, as well as examples of orbits with explicitly computable but irregular orbit closures. We give Diophantine applications to the former, for instance we show that if x is the cubic root of 2 then for any y,z in R liminf |n|=0 (as |n| goes to infinity), where denotes the distance of a real number c to the integers.

  14. Post Closure Safety of the Morsleben Repository

    Energy Technology Data Exchange (ETDEWEB)

    Preuss, J.; Eilers, G.; Mauke, R.; Moeller-Hoeppe, N.; Engelhardt, H.-J.; Kreienmeyer, M.; Lerch, C.; Schrimpf, C.

    2002-02-26

    After the completion of detailed studies of the suitability the twin-mine Bartensleben-Marie, situated in the Federal State of Saxony-Anhalt (Germany), was chosen in 1970 for the disposal of low and medium level radioactive waste. The waste emplacement started in 1978 in rock cavities at the mine's fourth level, some 500 m below the surface. Until the end of the operational phase in 1998 in total about 36,800 m{sup 3} of radioactive waste was disposed of. The Morsleben LLW/ILW repository (ERAM) is now under licensing for closure. After completing the licensing procedure the repository will be sealed and backfilled to exclude any undue future impact onto man or the environment. The main safety objective is to protect the biosphere from the harmful effects of the disposed radionuclides. Furthermore, classical or conventional requirements call for ruling out or minimizing other unfavorable environmental effects. The ERAM is an abandoned rock salt and potash mine. As a consequence it has a big void volume, however small parts of the cavities are backfilled with crushed salt rocks. Other goals of the closure concept are therefore a long-term stabilization of the cavities to prevent a dipping or buckling of the ground surface. In addition, groundwater protection shall be assured. For the sealing of the repository a closure concept was developed to ensure compliance with the safety protection objectives. The concept anticipates the backfilling of the cavities with hydraulically setting backfill materials (salt concretes). The reduction of the remaining void volume in the mine causes in the case of brine intrusions a limitation of the leaching processes of the exposed potash seams. However, during the setting process the hydration heat of the concrete will lead to an increase of the temperature and hence to thermally induced stresses of the concrete and the surrounding rocks. Therefore, the influence of these stresses and deformations on the stability of the salt body

  15. Telephone switchboard closure | 19 December

    CERN Multimedia

    2014-01-01

    Exceptionally, the telephone switchboard will close at 4 p.m. on Friday, 19 December, instead of the usual time of 6 p.m., to allow time for closing all systems properly before the annual closure. Therefore, switchboard operator assistance to transfer calls from/to external lines will stop. All other phone services will run as usual.

  16. Abdominal wound closure: current perspectives

    Directory of Open Access Journals (Sweden)

    Williams ZF

    2015-12-01

    Full Text Available Zachary F Williams, William W Hope Department of Surgery, South East Area Health Education Center, New Hanover Regional Medical Center, Wilmington, NC, USA Abstract: This review examines both early and late wound complications following laparotomy closure, with particular emphasis on technical aspects that reduce hernia formation. Abdominal fascial closure is an area of considerable variation within the field of general surgery. The formation of hernias following abdominal wall incisions continues to be a challenging problem. Ventral hernia repairs are among the most common surgeries performed by general surgeons, and despite many technical advances in the field, incisional hernia rates remain high. Much attention and research has been directed to the surgical management of hernias. Less focus has been placed on prevention of hernia formation despite its obvious importance. This review examines the effects of factors such as the type of incision, suture type and size, closure method, patient risk factors, and the use of prophylactic mesh. Keywords: incisional, abdominal, hernia, prevention, wound closure techniques 

  17. Vacuum assisted closure in coloproctology

    NARCIS (Netherlands)

    Bemelman, W.A.

    2009-01-01

    Vacuum-assisted closure has earned its indications in coloproctology. It has been described with variable results in the treatment of large perineal defects after abdominoperineal excision, in the treatment of stoma dehiscence and perirectal abscesses. The most promising indication for

  18. 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.

  19. MANTA, a novel plug-based vascular closure device for large bore arteriotomies: technical report.

    Science.gov (United States)

    van Gils, Lennart; Daemen, Joost; Walters, Greg; Sorzano, Todd; Grintz, Todd; Nardone, Sam; Lenzen, Mattie; De Jaegere, Peter P T; Roubin, Gary; Van Mieghem, Nicolas M

    2016-09-18

    Catheter-based interventions have become a less invasive alternative to conventional surgical techniques for a wide array of cardiovascular diseases but often create large arteriotomies. A completely percutaneous technique is attractive as it may reduce the overall complication rate and procedure time. Currently, large bore arteriotomy closure relies on suture-based techniques. Access-site complications are not uncommon and often seem related to closure device failure. The MANTA VCD is a novel collagen-based closure device that specifically targets arteriotomies between 10 and 22 Fr. This technical report discusses the MANTA design concept, practical instructions for use and preliminary clinical experience.

  20. Vacuum with mesh is a feasible temporary closure device after fascial dehiscence

    DEFF Research Database (Denmark)

    Bjørsum-Meyer, Thomas; Skarbye, Mona; Jensen, Kenneth Højsgaard

    2013-01-01

    fascial dehiscence focusing on fascial closure rate, mortality and procedure-related complications. MATERIAL AND METHODS: We performed a retrospective study on 18 patients treated with VAWCM after fascial dehiscence who were consecutively admitted to the Department of Surgery, Slagelse Hospital, between...... with a planned ventral hernia. We performed a retrospective follow-up with a median duration of 21 months 21% developed an incisional hernia. Two patients died within 60 days after closure of the abdomen. CONCLUSION: We found and that VAWCM is a safe and useful technique for delayed primary closure of the open...

  1. 40 CFR 265.112 - Closure plan; amendment of plan.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Closure plan; amendment of plan. 265... DISPOSAL FACILITIES Closure and Post-Closure § 265.112 Closure plan; amendment of plan. (a) Written plan... have a written closure plan. Until final closure is completed and certified in accordance with §...

  2. 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.

  3. Generalized Convective Quasi-Equilibrium Closure

    Science.gov (United States)

    Yano, Jun-Ichi; Plant, Robert

    2016-04-01

    Arakawa and Schubert proposed convective quasi-equilibrium as a basic principle for closing their spectrum mass-flux convection parameterization. In deriving this principle, they show that the cloud work function is a key variable that controls the growth of convection. Thus, this closure hypothesis imposes a steadiness of the cloud work function tendency. This presentation shows how this principle can be generalized so that it can also encompasses both the CAPE and the moisture-convergence closures. Note that the majority of the current mass-flux convection parameterization invokes a CAPE closure, whereas the moisture-convergence closure was extremely popular historically. This generalization, in turn, includes both closures as special cases of convective quasi-equilibrium. This generalization further suggests wide range of alternative possibilities for convective closure. In general, a vertical integral of any function depending on both large-scale and convective-scale variables can be adopted as an alternative closure variables, leading to an analogous formulation as Arakawa and Schubert's convective quasi-equilibrium formulation. Among those, probably the most fascinating possibility is to take a vertical integral of the convective-scale moisture for the closure. Use of a convective-scale variable for closure has a particular appeal by not suffering from a loss of predictability of any large-scale variables. That is a main problem with any of the current convective closures, not only for the moisture-convergence based closure as often asserted.

  4. Closure constraints for hyperbolic tetrahedra

    CERN Document Server

    Charles, Christoph

    2015-01-01

    We investigate the generalization of loop gravity's twisted geometries to a q-deformed gauge group. In the standard undeformed case, loop gravity is a formulation of general relativity as a diffeomorphism-invariant SU(2) gauge theory. Its classical states are graphs provided with algebraic data. In particular closure constraints at every node of the graph ensure their interpretation as twisted geometries. Dual to each node, one has a polyhedron embedded in flat space R^3. One then glues them allowing for both curvature and torsion. It was recently conjectured that q-deforming the gauge group SU(2) would allow to account for a non-vanishing cosmological constant Lambda, and in particular that deforming the loop gravity phase space with real parameter q>0 would lead to a generalization of twisted geometries to a hyperbolic curvature. Following this insight, we look for generalization of the closure constraints to the hyperbolic case. In particular, we introduce two new closure constraints for hyperbolic tetrahe...

  5. The Gore-Tex Suture in Periareolar Closure: A Modified Closure Technique.

    Science.gov (United States)

    Chapman, Jade; Ingram, Scott

    2016-12-01

    In breast reduction and mastopexy procedures, the periareolar closure forms a vital component of the surgery. Periareolar closures completed with an absorbable suture may be prone to significant widening, hypertrophy and/or areolar distortion. In an effort to avoid this, some surgeons use a non-absorbable/permanent suture material [Franco (Arch Plast Surg 41 (6): 728-733, 2014)]. Hammond (Plast Reconstr Surg 119 (3):804-809, 2007) recommends the use of a Gore-Tex® suture for this purpose in view of the supple, pliable nature of the material; however, there remain at least occasional instances of infection and extrusion of the knot used to tie off the Gore-Tex "purse-string" [Franco (Arch Plast Surg 41 (6): 728-733, 2014); Salgarello (Aesthet Plast Surg 37 (5):1061-1062, 2013)]. We describe a method of securing the suture ends, which avoids the creation of a bulky knot, thus minimising the risk of infection and suture extrusion. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  6. 静脉腔内射频闭合治疗下肢静脉曲张和深静脉瓣膜功能不全%Endovenous radiofrequecy obliteration for chronic venous insufficiency

    Institute of Scientific and Technical Information of China (English)

    何春水; 刘勇; 曾宏; 曾德春; 聂利霞; 何延政

    2006-01-01

    静脉内激光治疗下肢静脉曲张取得较大进展,但仍存在某些不足。我科于2004年引进美国“维纳斯”数控射频闭合仪(VNUS Closure System,VNUS Medical Technologies Inc,San Joes,Calif,USA)治疗原发性下肢静脉曲张和下肢深静脉瓣膜功能不全,现将临床资料总结如下。

  7. Novel use of the medtronic micro vascular plug for PDA closure in preterm infants.

    Science.gov (United States)

    Wang-Giuffre, Elizabeth W; Breinholt, John P

    2017-05-01

    To describe a single institution experience with a new endovascular occlusion device used for transcatheter patent ductus arteriosus (PDA) closure in preterm infants. The PDA is a defect largely treated via cardiac catheterization except for the smallest patients. Medical records and catheterization reports of all premature neonates who underwent PDA device closure with the Medtronic Micro Vascular Plug (MVP) (Medtronic, Minneapolis, MN) between September 2015 and June 2016 were reviewed. Procedural details, complications, and short term outcomes were recorded. Eight premature neonates born at a median gestational age of 28 weeks (23 to 35 weeks) underwent PDA closure with a Medtronic MVP. All devices were deployed via a 4F angled Glide catheter in prograde fashion without arterial access. Median age and weight was 52 days (15-112 days) and 2,550 g (1,800-3,500 g), respectively. Fluoroscopy and echocardiography were utilized for the procedure. Complete closure was achieved in all patients with no procedural complications, pulmonary artery or aortic obstruction or death. One device embolized 9 days after deployment and was successfully retrieved. This study describes transcatheter PDA closure with the Medtronic MVP. The major advantage is the ability to deliver the device via a standard catheter in prograde fashion, and avoid the hemodynamic instability produced by rigid delivery sheaths. It also further validates the ability to close the PDA without arterial access, providing improved access to this procedure to smaller and more vulnerable children. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  8. 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.

  9. Percutaneous closure of atrial septal defects leads to normalisation of atrial and ventricular volumes

    Directory of Open Access Journals (Sweden)

    Worthley Matthew I

    2008-12-01

    Full Text Available Abstract Background Percutaneous closure of atrial septal defects (ASDs should potentially reduce right heart volumes by removing left-to-right shunting. Due to ventricular interdependence, this may be associated with impaired left ventricular filling and potentially function. Furthermore, atrial changes post-ASD closure have been poorly understood and may be important for understanding risk of atrial arrhythmia post-ASD closure. Cardiovascular magnetic resonance (CMR is an accurate and reproducible imaging modality for the assessment of cardiac function and volumes. We assessed cardiac volumes pre- and post-percutaneous ASD closure using CMR. Methods Consecutive patients (n = 23 underwent CMR pre- and 6 months post-ASD closure. Steady state free precession cine CMR was performed using contiguous slices in both short and long axis views through the ASD. Data was collected for assessment of left and right atrial, ventricular end diastolic volumes (EDV and end systolic volumes (ESV. Data is presented as mean ± SD, volumes as mL, and paired t-testing performed between groups. Statistical significance was taken as p Results There was a significant reduction in right ventricular volumes at 6 months post-ASD closure (RVEDV: 208.7 ± 76.7 vs. 140.6 ± 60.4 mL, p Conclusion ASD closure leads to normalisation of ventricular volumes and also a reduction in right atrial volume. Further follow-up is required to assess how this predicts outcomes such as risk of atrial arrhythmias after such procedures.

  10. Watertight dural closure! An in vitro study to explore the myth

    Directory of Open Access Journals (Sweden)

    Sudipkumar Sengupta

    2013-01-01

    Full Text Available Aim: The watertight closure of the dura mater is fundamental to intracranial supratentorial procedures in neurosurgery. Controversies exist claiming the superiority of one closure technique over another. But is ′Water-tight′ dural closure really achievable ? An in vitro study system was developed to test the pressures at which dural incisions, closed with sutures, leaked. Materials and Methods: Bovine dura was secured to the lower end of an open ended calibrated plastic cylinder. Multiple interrupted stitches were applied over a two 2 cm length of the dura without any incision. Similarly a 2 cm incision was made and closed with interrupted and continuous stitches. Cylinder was filled with colored saline gradually. Height of the water column at which sutured dura leaked was recorded. The tests were conducted with the dura both in lax and tense conditions. Inlay closure technique was also tested on the same model using a dural substitute. Results: Even without an incision, needle puncture sites over a dura, leak, at a very low hydrostatic pressure (30 < mm of H2O, though a continuous interlocking suture performs slightly better than an interrupted suture technique. If the needle puncture sites are closed with glue, both the suture techniques can achieve a watertight closure against a hydrostatic pressure of 240 mm of H2O. Conclusion : In the experimental model described, ′Water-tight′ dural closure appears to be impossible with suture closure of a dural defect.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  12. Closure constraints for hyperbolic tetrahedra

    Science.gov (United States)

    Charles, Christoph; Livine, Etera R.

    2015-07-01

    We investigate the generalization of loop gravity's twisted geometries to a q-deformed gauge group. In the standard undeformed case, loop gravity is a formulation of general relativity as a diffeomorphism-invariant SU(2) gauge theory. Its classical states are graphs provided with algebraic data. In particular, closure constraints at every node of the graph ensure their interpretation as twisted geometries. Dual to each node, one has a polyhedron embedded in flat space {{{R}}3}. One then glues them, allowing for both curvature and torsion. It was recently conjectured that q-deforming the gauge group SU(2) would allow us to account for a non-vanishing cosmological constant Λ \

  13. 100-D Ponds closure plan. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    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.

  14. 40 CFR 264.112 - Closure plan; amendment of plan.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Closure plan; amendment of plan. 264... Closure and Post-Closure § 264.112 Closure plan; amendment of plan. (a) Written plan. (1) The owner or operator of a hazardous waste management facility must have a written closure plan. In addition,...

  15. Usefulness of early diastolic mitral annular velocity to predict plasma levels of brain natriuretic peptide and transient heart failure development after device closure of atrial septal defect.

    Science.gov (United States)

    Masutani, Satoshi; Taketazu, Mio; Mihara, Chihiro; Mimura, Yuko; Ishido, Hirotaka; Matsunaga, Tamotsu; Kobayashi, Toshiki; Senzaki, Hideaki

    2009-12-15

    Device closure of atrial septal defect (ASD) is sometimes followed by elevation of plasma brain natriuretic peptide (BNP), a marker of heart failure, and progression to heart failure. This study tested the hypothesis that the underlying diastolic dysfunction, assessed on tissue Doppler images (TDI) before device closure, can predict BNP level after ASD closure. The study subjects were 39 consecutive patients (age 27.5 +/- 16.3 years, range 5 to 63) who underwent device closure for ASD. Echocardiographic evaluation using TDI and 2-dimensional and pulse wave Doppler were performed, together with plasma BNP measurement 1 day before and 2 days after ASD closure. Before ASD closure, an age-dependent decrease was noted in left ventricular relaxation, assessed by early diastolic mitral annular velocity. ASD closure resulted in a decrease in early diastolic mitral annular velocity (from 14.7 to 12.3 cm/s, p linear regression identified early diastolic mitral annular velocity before ASD closure and age as independent predictors of BNP levels after ASD closure (p annular velocity developed exertional dyspnea after the procedure. In conclusion, our results indicate that TDI measurements could be useful to detect underlying diastolic dysfunction that can potentially cause heart failure after ASD closure and emphasize the importance of ASD closure at a young age before impairment of left ventricular relaxation.

  16. Structural determinants of hospital closure.

    Science.gov (United States)

    Longo, D R; Chase, G A

    1984-05-01

    In a retrospective case-control study, structural characteristics of hospitals that closed during the years 1976-1980 were contrasted with three comparison groups: hospitals that were acquired in a merger; hospitals that joined a multihospital system; and hospitals that remained autonomously opened, to investigate these characteristics as predictors of closure. Characteristics investigated included environmental, structural, and process variables. The independent variables were measured 5 years prior to outcome. Findings indicate that closed hospitals resemble hospitals acquired in a merger ("failure"), and likewise autonomous hospitals resemble hospitals that join a multihospital system ("success"). The most important predictors of hospital failure were the physician-to-population ratio, the East North Central and West North Central census regions, the level of diversification, low occupancy rate, location in a standard metropolitan statistical area, the chief executive officer's lack of affiliation in the American College of Hospital Administrators, profit status, bed size of less than 50, and presence in a state with a rate-setting agency. Surprisingly, this study shows the bed-to-population ratio to be unrelated to closure. In addition, the findings strongly support the open-system perspective, which, unlike the closed-system perspective, is concerned with the vulnerability of the organization to the uncontrollable and often unpredictable influences of the environment.

  17. PERCUTANEOUS CLOSURE OF SECUNDUM-TYPE ATRIAL SEPTAL DEFECTS USING AMPLATZER SEPTAL OCCLUDERS

    Directory of Open Access Journals (Sweden)

    Uroš Mazić

    2003-01-01

    Full Text Available Background. Percutaneous closure of secundumtype atrial septal defect (ASD II. is becoming an increasingly widespread alternative to surgical closure. We report our initial clinical experience with the percutaneous closure of ASD II. using Amplatzer Septal Occluders (ASO in Slovenia.Patients and methods. Fifty consecutive patients with ASD II. were evaluated for transcatheter closure with ASO using both transthoracic (TTE and transesophageal echocardiography (TEE. Transcatheter closure was performed under general endotracheal anesthesia with simultaneous fluoroscopy and TEE guidance. The stretch defect diameter was measured using an Amplatzer sizing balloon catheter. The ASO having a 2–4 mm larger diameter than the stretched defect diameter was selected for defect closure. Follow-up was scheduled 10 min, 24 hours, 1 month, 3 months, 6 months, 1 year and then annually after the procedure.Results. Eight patients (16% with deficiency of the posterior, inferior anterior, or inferior posterior rim were not deemed suitable for transcatheter closure and were referred for surgery. Fourteen patients (28% had centrally positioned defects, 23 patients (46% defects with a deficient superior anterior rim, 3 patients had multiple defects, while 2 patients presented with atrial septal aneurysm: 1 associated with a single perforation and 1 with multiple perforations. So far, cardiac catheterization has been performed in 24 patients, while the remaining 12 patients are waiting cardiac catheterization. During cardiac catheterization, 1 additional patient was excluded from percutaneous closure due to an additional defect unsuitable for percutaneous closure. Therefore, percutaneous closure was attempted in 23 patients. In a single patient we retrieved an inadequately positioned occluder and referred the patient for elective surgical closure. A large Eustachian valve caused this single failure of occluder positioning in our series. In the remaining 22 patients

  18. Thromboembolism Prevention via Transcatheter Left Atrial Appendage Closure with Transeosophageal Echocardiography Guidance

    Directory of Open Access Journals (Sweden)

    John Palios

    2014-01-01

    Full Text Available Atrial fibrillation (AF is an independent risk factor for stroke. Anticoagulation therapy has a risk of intracerebral hemorrhage. The use of percutaneous left atrial appendage (LAA closure devices is an alternative to anticoagulation therapy. Echocardiography has a leading role in LAA closure procedure in patient selection, during the procedure and during followup. A comprehensive echocardiography study is necessary preprocedural in order to identify all the lobes of the LAA, evaluate the size of the LAA ostium, look for thrombus or spontaneous echo contrast, and evaluate atrial anatomy, including atrial septal defect and patent foramen ovale. Echocardiography is used to identify potential cardiac sources of embolism, such as atrial septal aneurysm, mitral valve disease, and aortic debris. During the LAA occlusion procedure transeosophageal echocardiography provides guidance for the transeptal puncture and monitoring during the release of the closure device. Procedure-related complications can be evaluated and acceptable device release criteria such as proper position and seating of the occluder in the LAA, compression, and stability can be assessed. Postprocedural echocardiography is used for followup to assess the closure of the LAA ostium. This overview paper describes the emerging role of LAA occlusion procedure with transeosophageal echocardiography guidance as an alternative to anticoagulation therapy in patients with AF.

  19. 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...

  20. 40 CFR 264.351 - 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 Incinerators § 264.351 Closure. At closure the owner or operator must remove all hazardous waste and hazardous waste...

  1. 50 CFR 665.666 - Closures.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false Closures. 665.666 Section 665.666 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC ADMINISTRATION... § 665.666 Closures. (a) If the Regional Administrator determines that the harvest quota for any...

  2. 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.

  3. Spontaneous closure of traumatic tympanic membrane perforations

    DEFF Research Database (Denmark)

    Jellinge, Marlene Ersgaard; Kristensen, S.; Larsen, K

    2015-01-01

    BACKGROUND: The treatment of traumatic tympanic membrane perforations varies in different investigations, ranging from observation to early surgical repair. The present study aimed to focus on the closure rate and the closure time in a group of patients treated with a watchful waiting policy. MET...

  4. Acute angle closure glaucoma following ileostomy surgery

    Directory of Open Access Journals (Sweden)

    Mariana Meirelles Lopes

    2015-02-01

    Full Text Available Angle-closure glaucoma can be induced by drugs that may cause pupillary dilatation. We report a case of a patient that developed bilateral angle closure glaucoma after an ileostomy surgery because of systemic atropine injection. This case report highlights the importance of a fast ophthalmologic evaluation in diseases with ocular involvement in order to make accurate diagnoses and appropriate treatments.

  5. Comparison of 2 techniques of tracheocutaneous fistula closure: analysis of outcomes and health care use.

    Science.gov (United States)

    Wine, Todd M; Simons, Jeffrey P; Mehta, Deepak K

    2014-03-01

    Tracheocutaneous fistula (TCF) can be repaired using various techniques. This research is an outcomes and health care use comparative analysis of 2 commonly used techniques to repair TCF. To compare outcomes and health care use for 2 techniques of TCF repair. Retrospective cohort study at a tertiary care children's hospital. The study population comprised 50 consecutive patients aged 11 to 216 months who underwent surgical treatment for persistent TCF between January 2007 and August 2012. Tracheocutaneous fistula closure was achieved using excision of the TCF alone and healing by secondary intent or excision of the TCF plus primary closure over a drain. Differences in perioperative and postoperative outcomes. In total, 30 patients underwent excision of a TCF plus primary closure over a drain (closure group), and 20 patients underwent excision of a TCF alone and healing by secondary intent (excision group). Statistically, the closure and excision groups were not significantly different regarding gestational age, age at tracheotomy, duration between decannulation and TCF repair, and duration of tracheostomy. The mean (SD) procedure durations were 9.7 (3.7) minutes for the excision group and 37.4 (25.1) minutes for the closure group (P < .001). The mean (SD) lengths of hospital stay were 0.3 (0.5) day for the excision group and 1.1 (0.9) days for the closure group (P = .001). The mean (SD) lengths of intensive care unit stay were 0.0 (0.0) day for the excision group and 1.0 (1.5) day for the closure group (P = .001). Closure success rates were 20 of 22 for the excision group and 30 of 30 for the closure group (P = .17). Complication rates were 0 of 22 for the excision group and 2 of 30 for the closure group (P = .50). The rates of success and complications were not significantly different between TCF closure and excision groups. Excision of a TCF alone with healing by secondary intent requires less operating room time and shorter hospital stay

  6. Intermittent acute angle closure glaucoma and chronic angle closure following topiramate use with plateau iris configuration

    Directory of Open Access Journals (Sweden)

    Rajjoub LZ

    2014-07-01

    Full Text Available Lamise Z Rajjoub, Nisha Chadha, David A Belyea Department of Ophthalmology, The George Washington University, Washington, DC, USA Abstract: This is a case report describing recurrent intermittent acute angle closure episodes in the setting of topiramate use in a female suffering from migraines. Despite laser peripheral iridotomy placement for the pupillary block component, and the discontinuation of topiramate, the acute angle closure did not resolve in the left eye with chronic angle closure and the patient required urgent trabeculectomy. The right eye responded to laser peripheral iridotomy immediately and further improved after the cessation of topiramate. While secondary angle closure glaucoma due to topiramate use has been widely reported, its effects in patients with underlying primary angle closure glaucoma have not been discussed. Our report highlights the importance of recognizing the often multifactorial etiology of angle closure glaucoma to help guide clinical management. Keywords: angle closure glaucoma, plateau iris, topiramate, secondary glaucoma, drug-induced glaucoma

  7. Closure of fascial defect at trocar sites after laparoscopic surgery.

    Science.gov (United States)

    Sahin, Mustafa; Eryilmaz, Ramazan; Okan, Ismail

    2006-01-01

    As laparoscopic surgery evolves, a growing number of different abdominal operations can now be performed. This necessitates the use of multiple large trocars. Herniation through the fascial defect created by trocar entry in laparoscopic interventions has been reported at a rate of 1-6%. We describe a simple closure technique for fascial defects at trocar sites after laparoscopic surgery. To facilitate the closure of the fascial defects of > or = 10 mm trocar entry sites, the surgeon places the upper end of a dissecting forceps through the fascial defect and tilts it so that the abdominal of the peritoneum comes into contact with its flat surface. The assistant retracts the skin and subcutaneous tissue and the "J" needle with the appropriate suture material is then used to take a stitch through the fascia under direct vision. The sharp end of the needle is prevented from coming into contact with any deeper structure as it slides on the flat surface of the dissecting forceps. The stitch is then pulled up to lift the edge of the fascia and the needle is passed from the opposite edge of the fascia in the same manner and then the suture is ligated. The aforementioned technique is easy to perform and facilitates the closure of the fascial defect at trocar sites, and there is no extra cost for the procedure.

  8. The appendiceal stump closure during laparoscopy: historical, surgical, and future perspectives.

    Science.gov (United States)

    Gomes, Carlos Augusto; Nunes, Tarcizo Afonso; Soares, Cleber; Gomes, Camila Couto

    2012-02-01

    During a laparoscopic appendectomy, the closure of the appendiceal stump is an important step because of postoperative complications from its inappropriate management. The development of life-threatening events such as stercoral fistulas, postoperative peritonitis, and sepsis is feared and unwanted. The tactical modification of the appendiceal stump closure with a single endoligature, replacing the invaginating suture, adjusted very well to laparoscopic appendectomy, and nowadays is the procedure of choice, whenever possible. Among the alternatives that do not make use of an invaginating suture, studies advocate the use of an endostapler, endoligature (endo-loop), metal clips, bipolar endocoagulation, and polymeric clips. All alternatives have advantages and disadvantages against the different clinical stages of acute appendicitis, and it should be noted that the different forms of appendiceal stump closure have never been assessed in prospective randomized studies. Knowledge about and appropriate use of all of them are important for a safe and more cost-effective procedure.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. Closure of Microcosm for refurbishment

    CERN Multimedia

    2014-01-01

    Since 1994, the Microcosm exhibition has given the opportunity to visitors of all ages and backgrounds to have a first glimpse into the secrets of physics.   To ensure that Microcosm can continue fulfilling its educational aims at the same level of quality for many years to come, it is closing for renovation work on 8 December 2014 and is expected to reopen during Summer 2015. During the closure, the “Fun with Physics” workshop will not take place, but the Universe of Particles exhibition in the Globe and the Passport to the Big Bang circuit will remain accessible to the public, free of charge and with no need to book in advance.  Guided tours of CERN are also available (advance booking required via this page).

  11. Closure for milliliter scale bioreactor

    Science.gov (United States)

    Klein, David L.; Laidlaw, Robert D.; Andronaco, Gregory; Boyer, Stephen G.

    2010-12-14

    A closure for a microreactor includes a cap that is configured to be inserted into a well of the microreactor. The cap, or at least a portion of the cap, is compliant so as to form a seal with the well when the cap is inserted. The cap includes an aperture that provides an airway between the inside of the well to the external environment when the cap is inserted into the well. A porous plug is inserted in the aperture, e.g., either directly or in tube that extends through the aperture. The porous plug permits gas within the well to pass through the aperture while preventing liquids from passing through to reduce evaporation and preventing microbes from passing through to provide a sterile environment. A one-way valve may also be used to help control the environment in the well.

  12. 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.

  13. Safety of labour and delivery following closures of obstetric services in small community hospitals.

    Science.gov (United States)

    Hutcheon, Jennifer A; Riddell, Corinne A; Strumpf, Erin C; Lee, Lily; Harper, Sam

    2017-03-20

    In recent decades, many smaller hospitals in British Columbia, Canada, have stopped providing planned obstetric services. We examined the effect of these service closures on the labour and delivery outcomes of pregnant women living in affected communities. We used maternal postal codes to identify delivery records (1998-2014) of women residing in a community affected by service closure. The records were obtained from the British Columbia Perinatal Data Registry. We examined the effect of the closures using a within-communities fixed-effects framework and included similar-sized communities without service closures to control for underlying time trends. The primary outcome was a previously published composite measure of labour and delivery safety, the Adverse Outcome Index, which includes adverse events such as birth injury and unanticipated operative procedures, and includes weights for severity of adverse events. Secondary outcomes included maternal or newborn transfer, and use of obstetric interventions. We found little evidence that closure of planned obstetric services affected the risk of composite adverse maternal-newborn outcome (-0.4 excess adverse events per 100 deliveries, 95% confidence interval [CI] -2.0 to 1.1), or most other secondary outcomes. The severity of composite outcome events decreased following the closures (rate ratio 0.58, 95% CI 0.36 to 0.89). Closures were associated with increases in use of epidural analgesia (3.4 excess events per 100 deliveries, 95% CI 0.4 to 6.3) and length of antepartum stay (0.6 h, 95% CI 0.1 to 1.0 h). Closure of planned obstetric services in low-volume hospitals was not associated with an increase or decrease in frequency of adverse events during labour and delivery. © 2017 Canadian Medical Association or its licensors.

  14. Subsidence crack closure: rate, magnitude and sequence

    Energy Technology Data Exchange (ETDEWEB)

    De Graff, J.V.; Romesburg, H.C.

    1981-06-01

    Tension cracks are a major surface disturbance resulting from subsidence and differential settlement above underground coal mines. Recent engineering studies of subsidence indicate that cracks may close where tensile stresses causing the cracks are reduced or relaxed. This stress reduction occurs as mining in the area is completed. Crack closure was confirmed by a study in the Wasatch Plateau coal field of central Utah. Cracks occurred in both exposed bedrock and regolith in an area with maximum subsidence of 3 m. Mean closure rate was 0.3 cm per week with individual crack closure rates between 0.2 cm and 1.0 cm per week. The mean crack closure magnitude was 80% with closure magnitudes varying between 31% and 100%. Actual magnitude values ranged from 0.6 cm to 6.5 cm with a mean value of 3.8 cm. Statistical analysis compared width change status among cracks over time. It was found that: 1) a 41% probability existed that a crack would exhibit decreasing width per weekly measurement, 2) closure state sequences seem random over time, and 3) real differences in closure state sequence existed among different cracks. (6 refs.) (In English)

  15. Analytic closures for M1 neutrino transport

    Science.gov (United States)

    Murchikova, E. M.; Abdikamalov, E.; Urbatsch, T.

    2017-08-01

    Carefully accounting for neutrino transport is an essential component of many astrophysical studies. Solving the full transport equation is too expensive for most realistic applications, especially those involving multiple spatial dimensions. For such cases, resorting to approximations is often the only viable option for obtaining solutions. One such approximation, which recently became popular, is the M1 method. It utilizes the system of the lowest two moments of the transport equation and closes the system with an ad hoc closure relation. The accuracy of the M1 solution depends on the quality of the closure. Several closures have been proposed in the literature and have been used in various studies. We carry out an extensive study of these closures by comparing the results of M1 calculations with precise Monte Carlo calculations of the radiation field around spherically symmetric protoneutron star models. We find that no closure performs consistently better or worse than others in all cases. The level of accuracy that a given closure yields depends on the matter configuration, neutrino type and neutrino energy. Given this limitation, the maximum entropy closure by Minerbo on average yields relatively accurate results in the broadest set of cases considered in this work.

  16. Comparison of Closure of Gastric Perforation Ulcers With Biodegradable Lactide-Glycolide-Caprolactone or Omental Patches

    NARCIS (Netherlands)

    Bertleff, Marietta J. O. E.; Stegmann, Toon; Liem, Robert S. B.; Kors, Geert; Robinson, Peter H.; Nicolai, Jean Philippe; Lange, Johan F.

    2009-01-01

    Background: The current treatment of perforated peptic ulcers is primary closure, supported by the application of an omental patch. It is difficult and time consuming to perform this procedure by laparoscopic surgery, largely because of the required suturing. It was our aim to develop and test a new

  17. Live/Real Time Three-Dimensional Trans Esophageal Echocardiographic Findings in Amplatzer ASD Closure Devices in Adults

    Directory of Open Access Journals (Sweden)

    Fatemeh Nabavizadeh

    2012-09-01

    Full Text Available Six female patients aged from 19 to 73 years, with ostium secundum atrial septal defect underwent closure procedure with Amplatzer septal occluder device. Three-dimensional Echocardiography (3D-TEE was done during the procedure or one day after the procedure. 3D-TEE provides incremental value over Two- dimensional trans-esophageal echocardiography in measuring Amplatzer septal occluder disc sizes and correlates well with manufacture device size. 3D-TEE will surely prove to increase the technical efficiency and it will become an important tool for the interventionists for periprocedural evaluation of device closures.

  18. Acute fulminant pseudomembranous colitis which developed after ileostomy closure and required emergent total colectomy: a case report

    OpenAIRE

    2012-01-01

    Abstract Introduction Pseudomembranous colitis is known to be caused by Clostridium difficile; and, in 3% to 8% of patients, it lapses into an aggressive clinical course that is described as fulminant. We present here a case of extremely rapid and fatal fulminant pseudomembranous colitis that developed after ileostomy closure, a minor surgical procedure. To the best of our knowledge, this is the first case report of fatal fulminant pseudomembranous colitis after closure of a diversion ileosto...

  19. Endobronchial closure of bronchopleural fistulae using amplatzer devices: our experience and literature review.

    Science.gov (United States)

    Fruchter, Oren; Kramer, Mordechai R; Dagan, Tamir; Raviv, Yael; Abdel-Rahman, Nader; Saute, Milton; Bruckheimer, Elchanan

    2011-03-01

    Bronchopulmonary fistulae (BPFs) are a severe complication of lobectomy and pneumonectomy and are associated with high rates of morbidity and mortality. We have developed a novel, minimally invasive method of central BPF closure using Amplatzer devices (ADs) that were originally designed for the transcatheter closure of cardiac defects. Ten patients with 11 BPFs (eight men and two women, aged 66.3±10.1 years [mean±SD]) were treated under conscious sedation with bronchoscopic closure of the BPFs using ADs. A nitinol double-disk occluder device was delivered under direct bronchoscopic guidance over a guidewire into the fistula. By extruding a disk on either side of the BPF, the fistula was occluded. Bronchography was performed by injecting contrast medium through the delivery sheath following the procedure to ensure correct device positioning. In nine patients, the procedure was successful and symptoms related to the BPF disappeared following closure by the AD. The results were maintained over a median follow-up period of 9 months. Therefore, we state that endobronchial closure using an AD is a safe and effective method for treatment of a postoperative BPF.

  20. Yucca Mountain Waste Package Closure System

    Energy Technology Data Exchange (ETDEWEB)

    shelton-davis; Colleen Shelton-Davis; Greg Housley

    2005-10-01

    The current disposal path for high-level waste is to place the material into secure waste packages that are inserted into a repository. The Idaho National Laboratory has been tasked with the development, design, and demonstration of the waste package closure system for the repository project. The closure system design includes welding three lids and a purge port cap, four methods of nondestructive examination, and evacuation and backfill of the waste package, all performed in a remote environment. A demonstration of the closure system will be performed with a full-scale waste package.

  1. Yucca Mountain Waste Package Closure System

    Energy Technology Data Exchange (ETDEWEB)

    Herschel Smartt; Arthur Watkins; David Pace; Rodney Bitsoi; Eric Larsen; Timothy McJunkin; Charles Tolle

    2006-04-01

    The current disposal path for high-level waste is to place the material into secure waste packages that are inserted into a repository. The Idaho National Laboratory has been tasked with the development, design, and demonstration of the waste package closure system for the repository project. The closure system design includes welding three lids and a purge port cap, four methods of nondestructive examination, and evacuation and backfill of the waste package, all performed in a remote environment. A demonstration of the closure system will be performed with a full-scale waste package.

  2. Percutaneous closure of secundum atrial septal defects: Experience of a tertiary referral center

    Directory of Open Access Journals (Sweden)

    Ali Hikmet Kırdök

    2012-03-01

    Full Text Available Objectives: This study was aimed to evaluate our clinical experiences and investigate results of percutaneous closure of secundum atrial septal defects (ASD in our clinic.Results: We retrospectively included 70 patients (19 male, 51 female undergoing percutaneous ASD closure procedure with mean age of 36±14.8 (17-75 in our clinic between March 2008 and January 2010. Defect diameter measured by transesophageal echocardiography was 19.7±6.3 mm (6-32 mm. Device size used for percutaneous closure of ASD was 23.7±6.2 (12-36. Devices used for percutaneous closure were nitinol-based devices including Amplatzer (64.7%, Cardiofix (26.7% and biodegredable BioStar (8.6%. The percutaneous closure procedure was successful at 68 of 70 (97% patients. In 2 patients procedure failed. Failure reason was device embolization in one patient and device strut fracture in other; so these 2 patients referred to surgery. During follow up 2 more patients also referred to surgery because of device embolization in first day control. In 3 patients (4.2% supraventricular arrythmias that are converted to sinus by cardioversion are observed. Mean follow up interval was 18.6±9.6 months (1-44 and during this period peripheral vascular complications, cerebrovascular accidents, thrombus on devices, device erosion or death is not observed.Conclusion: Percutaneous closure of secundum ASD which started to replace surgical treatment of ASD in last decades is safe and effective method in short to mid-term period. However because of potentially serious complication risks it should be performed in special centers by operators who are experienced in treating structural heart diseases.

  3. Systematization of a set of closure techniques.

    Science.gov (United States)

    Hausken, Kjell; Moxnes, John F

    2011-11-01

    Approximations in population dynamics are gaining popularity since stochastic models in large populations are time consuming even on a computer. Stochastic modeling causes an infinite set of ordinary differential equations for the moments. Closure models are useful since they recast this infinite set into a finite set of ordinary differential equations. This paper systematizes a set of closure approximations. We develop a system, which we call a power p closure of n moments, where 0≤p≤n. Keeling's (2000a,b) approximation with third order moments is shown to be an instantiation of this system which we call a power 3 closure of 3 moments. We present an epidemiological example and evaluate the system for third and fourth moments compared with Monte Carlo simulations.

  4. Reliability assessment of underground shaft closure

    Energy Technology Data Exchange (ETDEWEB)

    Fossum, A.F. [RE/SPEC, Inc., Rapid City, SD (United States); Munson, D.E. [Sandia National Labs., Albuquerque, NM (United States)

    1994-12-31

    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.

  5. One-stage closure of the entire primary palate.

    Science.gov (United States)

    Lehman, J A; Douglas, B K; Ho, W C; Husami, T W

    1990-10-01

    Timing of the closure of the anterior palate and alveolus is a subject of debate. Late repair of this defect is complicated by high fistula formation and subjects the patient to the problems of palate fistula for extended periods of time. We have utilized a single procedure performed when the child is 3 months of age that completely closes the anterior hard palate and alveolus along with the cleft lip. Our series consisted of 61 consecutive patients with unilateral clefts of the primary and secondary palate. Mucosal turnover flaps from the vomer along with lateral nasal mucosal flaps provide the nasal lining. A buccal sulcus flap with a Veau flap completes the oral repair. Ninety-five percent (58 of 61) of the patients had complete and stable closure of their anterior palate and alveolus after 1 year. The incidence of fistula formation in our series (3 of 61) is much lower than that reported with the utilization of other protocols. Excellent exposure of the anterior palate and alveolar defect during lip repair, early restoration of anatomic relationships, establishment of a good nostril floor and sill, and very low fistula formation are among the benefits of this procedure. The increase in operative time is considered minimal in light of aforementioned advantages.

  6. Microwave Tissue Soldering for Immediate Wound Closure

    Science.gov (United States)

    Arndt, G. Dickey; Ngo, Phong H.; Phan, Chau T.; Byerly, Diane; Dusl, John; Sognier, Marguerite A.; Carl, James

    2011-01-01

    A novel approach for the immediate sealing of traumatic wounds is under development. A portable microwave generator and handheld antenna are used to seal wounds, binding the edges of the wound together using a biodegradable protein sealant or solder. This method could be used for repairing wounds in emergency settings by restoring the wound surface to its original strength within minutes. This technique could also be utilized for surgical purposes involving solid visceral organs (i.e., liver, spleen, and kidney) that currently do not respond well to ordinary surgical procedures. A miniaturized microwave generator and a handheld antenna are used to deliver microwave energy to the protein solder, which is applied to the wound. The antenna can be of several alternative designs optimized for placement either in contact with or in proximity to the protein solder covering the wound. In either case, optimization of the design includes the matching of impedances to maximize the energy delivered to the protein solder and wound at a chosen frequency. For certain applications, an antenna could be designed that would emit power only when it is in direct contact with the wound. The optimum frequency or frequencies for a specific application would depend on the required depth of penetration of the microwave energy. In fact, a computational simulation for each specific application could be performed, which would then match the characteristics of the antenna with the protein solder and tissue to best effect wound closure. An additional area of interest with potential benefit that remains to be validated is whether microwave energy can effectively kill bacteria in and around the wound. Thus, this may be an efficient method for simultaneously sterilizing and closing wounds.

  7. 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.

  8. Minimally invasive retrieval of patent foramen ovale closure device after device migration to the descending aorta.

    Science.gov (United States)

    Basoor, Abhijeet S; Cotant, John F; Halabi, Abdul R; DeGregorio, Michele; Chughtai, Haroon; Patel, Kiritkumar C

    2012-01-01

    Percutaneous treatment of patent foramen ovale with a septal closure device has become a common procedure, but it is associated with various complications. Migration of the device is uncommon, and migration through the aortic valve into the aorta is rare. Managing the migration of a patent foramen ovale occluder can be challenging; it usually requires surgical retrieval of the foreign body. We report a rare case in which a patient experienced migration of a large patent foramen ovale closure device to the descending aorta. Rarer still was its successful percutaneous management.

  9. [Percutaneous closure of patent foramen ovale: a wise approach].

    Science.gov (United States)

    Gaspardone, Achille; Iani, Cesare; Papa, Marco

    2008-09-01

    support transcatheter PFO closure for prevention of cryptogenic stroke recurrence as well as for migraine therapy, and considering that the procedure is not riskless (major complications occurring in 1.5-2% of patients whose PFO was closed), a very prudent and wise approach is imperative in individual patients when this therapeutic strategy is carried out.

  10. Effects of transcatheter closure of Fontan fenestration on exercise tolerance. kidecho@yahoo.com.

    Science.gov (United States)

    Momenah, Tarek S; Eltayb, Haifa; Oakley, Reida El; Qethamy, Howeida Al; Faraidi, Yahya Al

    2008-05-01

    Baffle fenestration is associated with a significantly better outcome in standard and high-risk patients undergoing completion of Fontan. We report the effects of subsequent transcatheter closure of fenestration on exercise capacity and oxygen saturation. Sixteen patients with a mean age of 10.3 years underwent Amplatzer septal occluder (ASO) device transcatheter closure of Fontan fenestration. All had a fenestrated Fontan operation 6 month to 8 years prior to the procedure. A stress test was performed before and after device closure of fenestration in 14 patients (2 patients did not tolerate stress test before the procedure). The fenestrations in all patients were successfully occluded with the use of the Amplatzer device occluder. No complications occurred during or after the procedure. O2 saturation increased from a mean 85.1 +/- 7.89% to 94.5 +/- 3.63% (p < 0.01) at rest and from 66.2 +/- 12.86% to 87.2 +/- 8.64% (p < 0.01) following exercise. Exercise duration has also increased from 8.22 +/- 2.74 min to 10.29 +/- 1.91 min (p < 0.05). Transcatheter closure of Fontan fenestration increases the duration of exercise capacity and increases O2 saturation at rest and after exercise.

  11. 105-DR Large Sodium Fire Facility closure activities evaluation report

    Energy Technology Data Exchange (ETDEWEB)

    Adler, J.G.

    1996-04-22

    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.

  12. NPAR- products, applications and closure

    Energy Technology Data Exchange (ETDEWEB)

    Vora, J.P.

    1995-04-01

    Almost a decade ago the Office of Nuclear Regulatory Research (RES) developed and implemented a comprehensive research program (NUREG-1144) widely known as NPAR or Nuclear Plant Aging Research. The NPAR program is a structured research program specifically oriented to understanding significant age-related degradation mechanisms and their long term effects on properties and performance of important components and systems and ways to mitigate detrimental effects of aging. It provided a road map and a phased approach to research that is applicable to any structure, system, or component of interest. This hardware-oriented engineering research program led the industry worldwide and communicated a need to understand and manage age-related degradation effects in selected but important structures and components. At the conclusion (1995) of the NPAR program, 22 electrical and mechanical components, 13 safety-related systems, and 10 special topics will have been studied and results summarized in 160 technical reports. This reference library of information listed and summarized in NUREG-1377, Rev. No. 4 provides a foundation upon which individual programs can be built for the specific needs of a utility, a regulator, or equipment manufacturers. During the life of the NPAR program, it has provided technical bases and support for license renewal, codes and standards, resolution of generic safety issues, information notices, regulatory guides and the standard Review Plan, as well as the Office of Nuclear Reactor Regulation and The NRC Regions. All ongoing NPAR activities will either be completed or terminated by the end of 1995. No new initiative will be undertaken. This paper summarizes NPAR products and accomplishments, application of the research results, and its status and closure.

  13. Accelerating cleanup: Paths to closure

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-06-01

    This report describes the status of Environmental Management`s (EM`s) cleanup program and a direction forward to complete achievement of the 2006 vision. Achieving the 2006 vision results in significant benefits related to accomplishing EM program objectives. As DOE sites accelerate cleanup activities, risks to public health, the environment, and worker safety and health are all reduced. Finding more efficient ways to conduct work can result in making compliance with applicable environmental requirements easier to achieve. Finally, as cleanup activities at sites are completed, the EM program can focus attention and resources on the small number of sites with more complex cleanup challenges. Chapter 1 describes the process by which this report has been developed and what it hopes to accomplish, its relationship to the EM decision-making process, and a general background of the EM mission and program. Chapter 2 describes how the site-by-site projections were constructed, and summarizes, for each of DOE`s 11 Operations/Field Offices, the projected costs and schedules for completing the cleanup mission. Chapter 3 presents summaries of the detailed cleanup projections from three of the 11 Operations/Field Offices: Rocky Flats (Colorado), Richland (Washington), and Savannah River (South Carolina). The remaining eight Operations/Field Office summaries are in Appendix E. Chapter 4 reviews the cost drivers, budgetary constraints, and performance enhancements underlying the detailed analysis of the 353 projects that comprise EM`s accelerated cleanup and closure effort. Chapter 5 describes a management system to support the EM program. Chapter 6 provides responses to the general comments received on the February draft of this document.

  14. 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.

  15. An eddy closure for potential vorticity

    Energy Technology Data Exchange (ETDEWEB)

    Ringler, Todd D [Los Alamos National Laboratory

    2009-01-01

    The Gent-McWilliams (GM) parameterization is extended to include a direct influence in the momentum equation. The extension is carried out in two stages; an analysis of the inviscid system is followed by an analysis of the viscous system. In the inviscid analysis the momentum equation is modified such that potential vorticity is conserved along particle trajectories following a transport velocity that includes the Bolus velocity in a manner exactly analogous to the continuity and tracer equations. In addition (and in contrast to traditional GM closures), the new formulation of the inviscid momentum equation results in a conservative exchange between potential and kinetic forms of energy. The inviscid form of the eddy closure conserves total energy to within an error proportional to the time derivative of the Bolus velocity. The hypothesis that the viscous term in the momentum equation should give rise to potential vorticity being diffused along isopycnals in a manner analogous to other tracers is examined in detail. While the form of the momentum closure that follows from a strict adherence to this hypothesis is not immediately interpretable within the constructs of traditional momentum closures, three approximations to this hypothesis results in a form of dissipation that is consistent with traditional Laplacian diffusion. The first two approximations are that relative vorticity, not potential vorticity, is diffused along isopyncals and that the flow is in approximate geostrophic balance. An additional approximation to the Jacobian term is required when the dissipation coefficient varies in space. More importantly, the critique of this hypothesis results in the conclusion that the viscosity parameter in the momentum equation should be identical to the tradition GM closure parameter {Kappa}. Overall, we deem the viscous form of the eddy closure for potential vorticity as a viable closure for use in ocean circulation models.

  16. Interventional Closure of Patent Foramen Ovale (PFO with Amplatzer PFO Occluder in Patients with Paradoxical Cerebral Embolism

    Directory of Open Access Journals (Sweden)

    Ali Mohammad Haji Zeinali

    2006-08-01

    Full Text Available Background: Percutaneous transcatheter closure has been proposed as an alternative to surgical closure or long-term anticoagulation in patients with presumed paradoxical embolism and patent foramen ovale (PFO. Methods: There were two symptomatic patients (29 and 47 years old who underwent percutaneous transcatheter closure of PFO after at least two events of cerebral ischemia; one embolic event had occurred under anti-platelet therapy. For both patients, Amplatzer PFO occluder measuring 25 mm in diameter were used. In both cases, complete occlusion by color Doppler and transesophageal contrast echocardiography investigation was achieved after the procedure and lasted at least up to 3 months after implantation as determined by our follow up. Mean fluoroscopy time was 16.7 minutes. Results: Percutaneous transcatheter closure was technically successful in both patients (100%. No residual shunt was seen at the end of the procedure or in follow-ups. In-hospital follow-up was uneventful. At a mean follow-up of 3 months, no recurrent embolic neurological events were observed. Conclusion: Transcatheter closure of PFO with Amplatzer PFO occluder devices is a safe and effective therapy for patients with previous paradoxical embolism PFO. Percutaneous closure is associated with a high success rate, low incidence of hospital complications, and freedom of cerebral ischemic events.

  17. Percutaneous atrial shunt closure using the novel Occlutech Figulla device: 6-month efficacy and safety.

    Science.gov (United States)

    Van Den Branden, Ben J L; Post, Martijn C; Plokker, Herbert W M; Ten Berg, Jurriën M; Suttorp, Maarten J

    2011-06-01

    The Occlutech Figulla Occluder is a new innovative device for percutaneous closure of a patent foramen ovale (PFO) and an atrial septum defect (ASD). We describe the safety and efficacy of this new device at 6-month follow-up. All 82 consecutive patients (51% female, mean age 49.0 ± 13.6 years) who underwent percutaneous PFO (n = 48) or ASD (n = 34) closure between October 2008 and October 2009 were included. Implantation success was 100%. The in-hospital complications were two new onset supraventricular tachycardia (SVT) (2.4%, both ASD patients), nine minimal groin hematoma's (11.0%, 4 PFO and 5 ASD patients), and one transient ST elevation during the procedure (1.2%, ASD patient). During 6 months follow-up (n = 79), no major complications or reoccurrences of cerebral thrombo-embolic events did occur. Seven patients (8.9%, 6 PFO and 1 ASD patient) experienced a new SVT. One patient developed a recurrent cerebral hemorrhage 5 months after ASD closure, which appeared not to be related to the procedure. Using contrast transthoracic echocardiography 6 months after PFO closure (n = 45), a residual shunt was present in 30.2% of the patients (small 25.6%, moderate 4.6%, severe 0%). In the ASD group (n = 34), a residual shunt was observed in 32.5% (small 17.7%, moderate 14.7%, severe 2.9%). The Occlutech Figulla Occluder appears to be easy to use, effective, and safe for percutaneous closure of PFO and ASD. We report a low complication rate but a relative high percentage of small residual shunts 6 months after closure. ©2010, Wiley Periodicals, Inc.

  18. Preliminary experience using transthoracic echocardiography guiding percutaneous closure of ruptured right sinus of Valsalva aneurysm

    Institute of Scientific and Technical Information of China (English)

    LI Yue; WANG Guang-yi; WANG Zhi-feng; GUO Liang

    2011-01-01

    Background In the 21st century, minimally invasive treatment is one of the main developmental directions of medical sciences. It is well known that the echocardiography plays an important role during interventional treatments of some structural heart diseases. Because the ruptured right sinus of the Valsalva aneurysm (RRSVA) is a rare disease, there were few reports about percutaneous catheter closure of RRSVA. This study aimed to sum up our experience with transthoracic echocardiography (TTE) during percutaneous catheter closure of RRSVA.Methods Five RRSVA cases were treated with percutaneous catheter closure. The whole procedure was guided and monitored by TTE and fluoroscopy. The maximum diameter of the RRSVA was measured by TTE before and after the catheter passed through the rupture site. A duct occluder 2 mm larger than the maximum diameter was chosen. The closure effects were evaluated with TTE and fluoroscopy immediately after the occluding device was deployed. All patients were followed up by TTE for 8 to 30 months.Results Before the catheter passed through the rupture site the maximum diameter of the RRSVA measured with TTE and aortography were (7.9 ±2.1) mm and (7.8 ± 1.8) mm. After the catheter passed through the rupture site the maximum diameter measured with TTE was (11.2 ± 3.2) mm, which was significantly larger than before the procedure (P <0.05). The percutaneous catheter closure was successful in four cases and failed in one. Compared to the aortography the TTE was better at distinguishing residual shunts from aortic valve regurgitation immediately after the occluding device was deployed. There were no complications during 8 to 30 months of follow-up.Conclusion Transthoracic echocardiography can play an important role during percutaneous catheter closure of RRSVA,especially for estimating the size of the RRSVA after the catheter passes through the rupture site, and differentiating residual shunt from aortic valve regurgitation immediately

  19. 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.

  20. Increased postoperative complications after protective ileostomy closure delay: An institutional study

    Institute of Scientific and Technical Information of China (English)

    Ines; Rubio-Perez; Miguel; Leon; Daniel; Pastor; Joaquin; Diaz; Dominguez; Ramon; Cantero

    2014-01-01

    AIM: To study the morbidity and complications as-sociated to ileostomy reversal in colorectal surgery pa-tients, and if these are related to the time of closure. METHODS: A retrospective analysis of 93 patients, who had undergone elective ileostomy closure between 2009 and 2013 was performed. Demographic, clinical and surgical variables were reviewed for analysis. All complications were recorded, and classified according to the Clavien-Dindo Classification. Statistical univariate and multivariate analysis was performed, setting a P value of 0.05 for significance.RESULTS: The patients had a mean age of 60.3 years, 58% male. The main procedure for ileostomy cre-ation was rectal cancer(56%), and 37% had received preoperative chemo-radiotherapy. The average delay from creation to closure of the ileostomy was 10.3 mo. Postoperative complications occurred in 40% of the pa-tients, with 1% mortality. The most frequent were ileus(13%) and wound infection(13%). Pseudomembra-nous colitis appeared in 4%. Increased postoperative complications were associated with delay in ileostomyclosure(P = 0.041). Male patients had more complica-tions(P = 0.042), mainly wound infections(P = 0.007). Pseudomembranous colitis was also associated with the delay in ileostomy closure(P = 0.003). End-to-end in-testinal anastomosis without resection was significantly associated with postoperative ileus(P = 0.037). CONCLUSION: Although closure of a protective il-eostomy is a fairly common surgical procedure, it has a high rate of complications, and this must be taken into account when the indication is made. The delay in stoma closure can increase the rate of complications in general, and specifically wound infections and colitis.

  1. Skin closure in vascular neurosurgery: A prospective study on absorbable intradermal suture versus nonabsorbable suture.

    Science.gov (United States)

    Pereira, Julio Leonardo Barbosa; Vieira, Gerival; de Albuquerque, Lucas Alverne Freitas; Mendes, George de Albuquerque Cavalcanti; Salles, Ludmila Rezende; de Souza, André Felipe Ferreira; Dellaretti, Marcos; de Sousa, Atos Alves

    2012-01-01

    The craniotomy performed with minimal hair removal and closure with intradermal suture alone is an option in neurosurgical procedures, which can help faster psychological recovery of the patient, as it allows a better cosmetic result. This study is aimed at evaluating if such method is safe and effective, compared with continuous skin sutures with 2-0 nylon. We analyzed the sutures in 117 patients undergoing craniotomies for cerebral aneurysm clipping. In the case group (n = 49), closure of the scalp was performed only with intradermal absorbable sutures using wire Monocryl(®) 2-0. In the control group (n = 68), closure was performed with continuous suture using 2-0 nylon. The case group was composed of 49 patients in whom just intradermal suture was performed. One (2.2%) patient developed wound infection and was given proper medical treatment. No cases of dehiscence or cerebrospinal fluid leaks were observed. The control group was composed of 68 patients in whom the skin was closed with 2-0 nylon continuous suture. Three (5.3%) patients developed wound infection and were given proper medical treatment. There were no cases of wound dehiscence. The overall infection rate in the control group was 4%. There was no statistically significant difference in the number of wound infections between the two groups (P = 0.73). The closure with intradermal suture alone in craniotomies is as safe as the traditional skin closure with nylon sutures, besides eliminating the need for suture removal and providing a cosmetic advantage.

  2. Delayed Closure of Giant Omphaloceles in West Africa: Report of Five Cases

    Science.gov (United States)

    El Ezzi, Oumama; Bossou, Raymond; Reinberg, Olivier; Maurer, Sabine Vasseur; Roessingh, Anthony de Buys

    2017-01-01

    Giant omphalocele (GO) management is controversial and not easy. Conservative management at birth and delayed surgical closure is usually mandatory. Postponed surgery may be challenging and carry the risk of intensive care treatment. We report on five children who were treated in our department for GO between 2000 and 2010. Initially, the patients were managed conservatively in West Africa. Delayed closure of the ventral hernia was performed in Switzerland after patient transfer through a nongovernmental organization. Fascial closure was performed at the median age of 23 months. Median diameter of the hernias was 10 × 10 cm ranging from 10 × 8 cm to 24 × 15 cm. Four (80%) patients had associated anomalies. Three children needed mechanical ventilation in the intensive care unit after surgery. Median hospitalization was 19 days. Complications were seen in two patients. The follow-up showed no recurrence of ventral hernia. There was no mortality. This report shows that conservative management of a GO at birth with delayed closure of the ventral hernia after transferring the patients to a European center is a safe approach for West African children and avoids life-threatening procedures. Delayed closure of a GO may be nevertheless challenging everywhere.

  3. PHASE CLOSURE NULLING: THEORY AND PRACTICE

    Directory of Open Access Journals (Sweden)

    A. Chelli

    2009-01-01

    Full Text Available We provide a complete theory of the phase closure of a binary system in which a small, feeble, and unresolved companion acts as a perturbing parameter on the spatial frequency spectrum of a dominant, bright, resolved source. We demonstrate that the in uence of the companion can be measured with precision by measuring the phase closure of the system near the nulls of the primary visibility function. In these regions of phase closure nulling, frequency intervals always exist where the phase closure signature of the companion is larger than any systematic error and can thus be measured. We show that this technique allows retrieval of many astrophysically relevant properties of faint and close companions such as ux, position, and in favorable cases, spectrum. As a proof of concept, using the AMBER/VLTI instrument with 3 auxiliary telescopes of 1.8 m and only 15 minutes of on-sky integration, we detected the ve magnitudes fainter companion of HD 59717 at only 3.5 stellar radii distance from the primary. This is one of the highest contrast detected by interferometry between a companion and its parent star. We conclude by a rapid study of the potentialities of phase closure nulling observations with current interferometers and explore the requirements for a new type of dedicated instrument.

  4. Space Station evolution study oxygen loop closure

    Science.gov (United States)

    Wood, M. G.; Delong, D.

    1993-01-01

    In the current Space Station Freedom (SSF) Permanently Manned Configuration (PMC), physical scars for closing the oxygen loop by the addition of oxygen generation and carbon dioxide reduction hardware are not included. During station restructuring, the capability for oxygen loop closure was deferred to the B-modules. As such, the ability to close the oxygen loop in the U.S. Laboratory module (LAB A) and the Habitation A module (HAB A) is contingent on the presence of the B modules. To base oxygen loop closure of SSF on the funding of the B-modules may not be desirable. Therefore, this study was requested to evaluate the necessary hooks and scars in the A-modules to facilitate closure of the oxygen loop at or subsequent to PMC. The study defines the scars for oxygen loop closure with impacts to cost, weight and volume and assesses the effects of byproduct venting. In addition, the recommended scenarios for closure with regard to topology and packaging are presented.

  5. 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.

  6. 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.

  7. Adapting MARSSIM for FUSRAP site closure.

    Science.gov (United States)

    Johnson, Robert; Durham, L; Rieman, C

    2003-06-01

    The Multi-Agency Radiation Survey and Site Investigation Manual (MARSSIM) provides a coherent, technically defensible process for establishing that exposed surfaces satisfy site cleanup requirements. Unfortunately, many sites have complications that challenge a direct application of MARSSIM. Example complications include Record of Decision (ROD) requirements that are not MARSSIM-friendly, the potential for subsurface contamination, and incomplete characterization information. These types of complications are typically the rule, rather than the exception, for sites undergoing radiologically-driven remediation and closure. One such site is the Formerly Utilized Sites Remedial Action Program (FUSRAP) Linde site in Tonawanda, New York. Cleanup of the site is currently underway. The Linde site presented a number of challenges to designing and implementing a closure strategy consistent with MARSSIM. This paper discusses some of the closure issues confronted by the U.S. Army Corps of Engineers Buffalo District at the Linde site and describes how MARSSIM protocols were adapted to address these issues.

  8. Procedural method for the development of scenarios in the operational phase following closure of final repositories in deep geological formations. Report on the working package 1. Development of the international status of science and technology concerning methods and tools for operational and long-term safety cases; Vorgehensweise bei der Szenarienentwicklung in der Nachverschlussphase von Endlagern in tiefen geologieschen Formationen. Bericht zum Arbeitspaket 1. Weiterentwicklung des internationalen Stands von Wissenschaft und Technik zu Methoden und Werkzeugen fuer Betriebs- und Langzeitsicherheitsnachweise

    Energy Technology Data Exchange (ETDEWEB)

    Uhlmann, Stephan

    2016-09-15

    For the disposal of high-level radioactive wastes the disposal in deep geological formations is internationally favored. The safety cases include the scientific, technical, administrative and operational safety analyses and arguments, including the management system. According to IAEA the safety case includes site qualification, the design of the facility, construction and operation including an accident analysis, the closure phase and the post-closure phase. The safety case includes the evaluation of radiological risks for several scenarios. The report covers the methodology of scenario assumption in the post-closure phase of repositories in deep geological formations.

  9. Transcatheter closure of the patent foramen ovale in children: intermediate-term follow-up results.

    Science.gov (United States)

    Sel, Kutay; Aykan, Hakan H; Duman, Derya; Aypar, Ebru; Özkutlu, Süheyla; Alehan, Dursun; Karagöz, Tevfik

    2017-10-01

    The patent foramen ovale is almost a normal anatomical hole between the atria with ~30% incidence in the general population. It has been suggested that the patent foramen ovale is the cause of some neurological events, which is explained by paradoxical embolism. Transcatheter closure of the patent foramen ovale is a common procedure in adult patients with cerebral ischaemic events, but there are limited data investigating the results in children. Between January, 2005 and February, 2014, 17 patients' patent foramen ovales were closed by the transcatheter approach in our department. The indications for closure were transient ischaemic attack in 10 patients, stroke in four patients, and migraine in three patients. The mean age and mean weight at the time of the procedure were 11.1±3.7 years and 42.1±15.4 kg, respectively. We asked our patients whether their previous ailments continued. All patients responded to the study survey. In 15 patients, ailments did not continue after patent foramen ovale closure and they significantly decreased in two of them. We suggest that under the right conditions device closure of the patent foramen ovale is a safe solution for these cryptogenic ischaemic events and migraine.

  10. Immediate and mid-term clinical course after percutaneous closure of paravalvular leakage.

    Science.gov (United States)

    Sánchez-Recalde, Angel; Moreno, Raúl; Galeote, Guillermo; Jimenez-Valero, Santiago; Calvo, Luis; Sevillano, Joel Hernández; Arroyo-Ucar, Eduardo; López, Teresa; Mesa, José M; López-Sendón, José L

    2014-08-01

    Percutaneous closure of paravalvular leakage is an alternative to surgery in high-risk patients, but its use has been limited by a lack of specific devices. More appropriate devices-like the Amplatzer Vascular Plug III-have recently been developed, but information about their efficacy and safety is still scarce. The objective of the present study was to assess the mid-term results of paravalvular leakage closure with this device. We analyzed the clinical and echocardiographic course both in-hospital and mid-term (13 [9] months) in a series of 20 consecutive patients (age, 68 years; logistic EuroSCORE, 29) with paravalvular leakage and attempted percutaneous closure. Closure was attempted for 23 leaks (17 mitral and 6 aortic) during 22 procedures in 20 patients. Implantation was successful in 87% of the leaks and the procedure was successful in 83%-with success being defined as a reduction in regurgitation of ≥ 1 degree. Survival at 1 year was 64.7% and survival free of the composite event of death/surgery was 58.8%. The degree of residual regurgitation was not associated with mortality but was associated with functional status. Survivors showed significant improvement in functional class. Percutaneous closure of leakage with the Amplatzer Vascular Plug III is safe and efficient in the mid-term. However, mortality among high-risk patients is high independently of the degree of residual regurgitation, indicating that these procedures are performed when heart disease has reached an advanced stage. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  11. 2401-W Waste storage building closure plan

    Energy Technology Data Exchange (ETDEWEB)

    LUKE, S.M.

    1999-07-15

    This plan describes the performance standards met and closure activities conducted to achieve clean closure of the 2401-W Waste Storage Building (2401-W) (Figure I). In August 1998, after the last waste container was removed from 2401-W, the U.S. Department of Energy, Richland Operations Office (DOE-RL) notified Washington State Department of Ecology (Ecology) in writing that the 2401-W would no longer receive waste and would be closed as a Resource Conservation and Recovery Act (RCRA) of 1976 treatment, storage, and/or disposal (TSD) unit (98-EAP-475). Pursuant to this notification, closure activities were conducted, as described in this plan, in accordance with Washington Administrative Code (WAC) 173-303-610 and completed on February 9, 1999. Ecology witnessed the closure activities. Consistent with clean closure, no postclosure activities will be necessary. Because 2401-W is a portion of the Central Waste Complex (CWC), these closure activities become the basis for removing this building from the CWC TSD unit boundary. The 2401-W is a pre-engineered steel building with a sealed concrete floor and a 15.2-centimeter concrete curb around the perimeter of the floor. This building operated from April 1988 until August 1998 storing non-liquid containerized mixed waste. All waste storage occurred indoors. No potential existed for 2401-W operations to have impacted soil. A review of operating records and interviews with cognizant operations personnel indicated that no waste spills occurred in this building (Appendix A). After all waste containers were removed, a radiation survey of the 2401-W floor for radiological release of the building was performed December 17, 1998, which identified no radiological contamination (Appendix B).

  12. 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.

  13. The effect of plant closure on crime

    OpenAIRE

    Rege, Mari; Skarðhamar, Torbjørn; Telle, Kjetil; Votruba, Mark

    2009-01-01

    We estimate the effect of exposure to plant closure on crime using an individual-level panel data set containing criminal charges for all unmarried and employed Norwegian men below the age of 40. Men originally employed in plants that subsequently closed are 14 percent more likely to be charged of a crime than comparable men in stable plants. There is no difference in charge rates prior to closure, supporting a causal interpretation of our result. Within crime categories, we find no effect of...

  14. 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.

  15. Surgical conditions and requested procedures for ruminants and ...

    African Journals Online (AJOL)

    cal conditions and requested procedures cattle, sheep, goat, dog and cat, accounted ... pattern of surgical diseases and requested procedures among ruminants and ..... or primary closure. 10 (18.18%). -. 10(7.51%). Dental caries tooth extraction. 1(1.81 ... Third eyelid prolapse .... To facilitate the healing process of traumatic.

  16. The 4843 Alkali Metal Storage Facility Closure Plan

    Energy Technology Data Exchange (ETDEWEB)

    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.

  17. 78 FR 20625 - Extension of Hearing Record Closure Date

    Science.gov (United States)

    2013-04-05

    ... From the Federal Register Online via the Government Publishing Office DEFENSE NUCLEAR FACILITIES SAFETY BOARD Extension of Hearing Record Closure Date AGENCY: Defense Nuclear Facilities Safety Board. ACTION: Extension of hearing record closure date. SUMMARY: The Defense Nuclear Facilities Safety...

  18. 77 FR 65871 - Extension of Hearing Record Closure Date

    Science.gov (United States)

    2012-10-31

    ... From the Federal Register Online via the Government Publishing Office DEFENSE NUCLEAR FACILITIES SAFETY BOARD Extension of Hearing Record Closure Date AGENCY: Defense Nuclear Facilities Safety Board. ACTION: Extension of hearing record closure date. SUMMARY: The Defense Nuclear Facilities Safety...

  19. 33 CFR 154.520 - Closure devices.

    Science.gov (United States)

    2010-07-01

    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Closure devices. 154.520 Section 154.520 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED... devices. (a) Except as provided in paragraph (b) of this section, each facility to which this part...

  20. Rural Primary School Closures in England.

    Science.gov (United States)

    Whitfield, Richard C.

    A three-phase interdisciplinary effort between educators and environmental planners is focusing on the social effects of rural primary school reorganization now occuring in England as a result of a declining birth rate and the resulting need for school closure. A questionnaire mailed nationally to rural Local Education Authorities, cross-community…

  1. The Story of a Charter School Closure.

    Science.gov (United States)

    Flynn, Susan L.; Arguelles, Lourdes

    2001-01-01

    The story of a charter school closure is told from the perspectives of students, parents, teachers, and community members, who felt that the sponsoring district revoked the charter for political reasons despite broad local support. The experience underscores the necessity of publicly subjecting the relationship of the public school system and the…

  2. Parallel hierarchical evaluation of transitive closure queries

    NARCIS (Netherlands)

    Houtsma, M.A.W.; Cacace, F.; Ceri, S.

    1991-01-01

    Presents a new approach to parallel computation of transitive closure queries using a semantic data fragmentation. Tuples of a large base relation denote edges in a graph, which models a transportation network. A fragmentation algorithm is proposed which produces a partitioning of the base relation

  3. End-of-year closure - Mail Office

    CERN Multimedia

    GS Department

    2010-01-01

    On the occasion of the annual closure of CERN, there will be no mail distributed on Tuesday 21 December 2010, but mail will be collected in the morning. Nevertheless, it will be possible for you to bring your mail for the departure until 12:00 at building 555-R-002. Mail Office

  4. The Triangle Closure is a Polyhedron

    CERN Document Server

    Basu, Amitabh; Köppe, Matthias

    2011-01-01

    Recently, cutting planes derived from maximal lattice-free convex sets have been studied intensively by the integer programming community. An important question in this research area has been to decide whether the closures associated with certain families of lattice-free sets are polyhedra. For a long time, the only result known was the celebrated theorem of Cook, Kannan and Schrijver who showed that the split closure is a polyhedron. Although some fairly general results were obtained by Andersen, Louveaux and Weismantel [An analysis of mixed integer linear sets based on lattice point free convex sets, Math. Oper. Res. 35, (2010) pp. 233--256], some basic questions have remained unresolved. For example, maximal lattice-free triangles are the natural family to study beyond the family of splits and it has been a standing open problem to decide whether the triangle closure is a polyhedron. In this paper, we resolve this by showing that the triangle closure is indeed a polyhedron, and its number of facets can be ...

  5. 300 Area Process Trenches Closure Plan

    Energy Technology Data Exchange (ETDEWEB)

    Luke, S.N.

    1994-08-15

    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.

  6. Opening up closure. Semiotics across scales

    Science.gov (United States)

    Lemke

    2000-01-01

    The dynamic emergence of new levels of organization in complex systems is related to the semiotic reorganization of discrete/continuous variety at the level below as continuous/discrete meaning for the level above. In this view both the semiotic and the dynamic closure of system levels is reopened to allow the development and evolution of greater complexity.

  7. Individual Consequences of Plant Closures and Cutbacks

    DEFF Research Database (Denmark)

    Andersen, Steen

    1991-01-01

    This thesis describes the segment of unemployment which has its origin in major closures and cutbacks. The argument for this is to make it possible to describe and to analyse a flow into and a flow out of a population of unemployed. Given a major dismissal the following questions are to be answer...

  8. Primary closure of equine laryngotomy incisions

    DEFF Research Database (Denmark)

    Lindegaard, C.; Karlsson, L.; Ekstrøm, C. T.;

    2016-01-01

    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 inc...

  9. Parallel hierarchical evaluation of transitive closure queries

    NARCIS (Netherlands)

    Houtsma, M.A.W.; Houtsma, M.A.W.; Cacace, F.; Ceri, S.

    1991-01-01

    Presents a new approach to parallel computation of transitive closure queries using a semantic data fragmentation. Tuples of a large base relation denote edges in a graph, which models a transportation network. A fragmentation algorithm is proposed which produces a partitioning of the base relation

  10. 50 CFR 648.141 - Closure.

    Science.gov (United States)

    2010-10-01

    ... 50 Wildlife and Fisheries 8 2010-10-01 2010-10-01 false Closure. 648.141 Section 648.141 Wildlife... inaction of one or more states will cause the applicable target exploitation rate specified in § 648.140(a... state has been remedied by that state without causing the applicable specified target exploitation...

  11. Synthesis of azaphenanthridines via anionic ring closure

    DEFF Research Database (Denmark)

    Hansen, Henriette Møller; Lysén, M.; Begtrup, M.;

    2005-01-01

    A new and convergent synthesis of azaphenanthridines via an anionic ring closure is reported. Ortho-lithiation/in situ borylation of cyanopyridines produces the corresponding cyanopyridylboronic esters, which undergo a Suzuki-Miyaura cross-coupling to give the key intermediates. Addition of lithium...

  12. 50 CFR 635.28 - Closures.

    Science.gov (United States)

    2010-10-01

    ... for the shark species or complexes specified in § 635.27(b)(1) will remain open. (2) When NMFS..., provided the harvesting vessel does no fishing after the closure in the Atlantic Ocean north of 5 N. lat., and reports positions with a vessel monitoring system, as specified in § 635.69. Additionally,...

  13. [The transcatheter closure of patent ductus arteriosus. The initial experience].

    Science.gov (United States)

    Vázquez-Antona, C A; Rijlaarsdam, M; Gaspar, J; Gil Moreno, M; Buendía Hernández, A; Martínez Ríos, M A; Attie, F

    1993-01-01

    Percutaneous closure of the patent ductus arteriosus (PDA) has been recently reported to be an effective alternative in the treatment of patients with ductal shunting. We report the initial experience and results during follow-up of percutaneous ductal occlusion with the Rashkind occluder (USCI) in six patients with isolated PDA. Ages ranged from 3 to 23 years. Diagnosis was corroborated with two dimensional and Doppler echocardiography in all patients. During cardiac catheterization systolic pulmonary artery pressure oscillated between 22 and 64 mmHg and Qp/Qs ratio between 1.3 and 4.1. In two patients prosthesis of 12 mm were used and in the remaining prosthesis of 17 mm. Only one patient demonstrated total occlusion during immediate control aortography, the other patients presented central residual shunting over the occluder. In the three patients occlusion with balloon-catheter was added to the procedure, resulting in total occlusion in two and significant reduction of the shunt magnitude in one. Two technical problems were resolved satisfactorily. None of the cases presented device embolization. Mean follow-up was 23.8 months with control echocardiograms at 24 hours, 1, 4, 12 and 24 months. In all patients immediate reduction of the left atrial dimension was demonstrated. Three patients presented residual shunts in the first 24 hours. In two of them total occlusion had occurred after one month and the other patient persisted with a small residual shunt until one year after the procedure. In conclusion, in this small study group good results were obtained with percutaneous ductal closure.

  14. Outcomes of Clinical Application of Boomerang Closure Wire System

    Institute of Scientific and Technical Information of China (English)

    Jian-sheng WU; Wen-bin WEI; Yu-jia WANG; Xin-xia ZHANG; Xue-song HU

    2009-01-01

    Objectives To evaluate the efficacy and safety of clinical application of a novel type of vascular closure device named Boomerang closure wire system (BCWS). Methods BCWSs were used in 288 patients (BCWSs group) for hemostasis after transfernoral coronary angiography (CAG) or percutaneous coronary intervention (PCI). Device suc-cess rate, hemostasis success rate, manual compression time, recumbent time, minor peripheral complication rate, se-vere peripheral complication rate and hospital staying time after procedure were analyzed. Results were compared to those from 300 patients (control group) who received manual compression in our hospital during the same period. Results In BCWS group, device success rate was 97.2 %, hemostasis success rate was 95.1%. Manual compression time in CAG subgroup and PCI subgroup was 7.8 min and 11.2 min, respectively. Recumbent time was 136. 3 min in CAG subgroup, 284.6 min in PCI subgroup. Minor peripheral complication rate was 4.5 %, severe peripheral compli-cation rate was 2.4 %. Hospital-staying time after procedure in CAG group and PCI group was 1.8 d and 6.6 d, re-spectively. Compared to control group, manual compression time, recumbent time and hospital-staying time of BCWSs group had statistical significance; hemostasis success rate, minor peripheral complication rate and severe peripheral complication rate of BCWSs group bad no statistical difference. Conclusions BCWS provides satisfied haemostatic effect. Compared to routine manual compression, BCWS shortens manual compression time, recumbent time and hos-pital staying time.

  15. 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.

  16. Complications and mid-term outcome after percutaneous patent foramen ovale closure in patients with cryptogenic stroke

    Science.gov (United States)

    Luermans, J.G.L.M.; Post, M.C.; Plokker, H.W.M.; ten Berg, J.M.; Suttorp, M.J.

    2008-01-01

    Background: Percutaneous patent foramen ovale (PFO) closure seems to reduce the risk of recurrent thromboembolism. We report the safety and efficacy of percutaneous PFO closure in our centre. Methods: All patients, >16 years of age, who underwent a percutaneous PFO closure in our centre were included. Reoccurrence of stroke, transient ischaemic attack (TIA) and peripheral thromboembolism were assessed. Periprocedural and midterm complications are reported. Results: Eighty-three consecutive patients (mean age 49±13 years) were included. Indications for PFO closure were cryptogenic stroke (59.0%), TIA (33.7%), peripheral embolism (2.4%) and other (4.8%). For PFO closure, a Cardioseal/Starflex device was used in 63 patients and an Amplatzer PFO occluder device in 20 patients. Stroke recurred in 1.2%, TIA in 3.6%, peripheral embolism in 0% during a mean follow-up of 1.9±1.2 years. Major periprocedural complications occurred in 1.2%. The mid-term complication rate was 2.4% and only consisted of minor complications. During follow-up, a residual right-to-left shunt was present in 5.7% of the patients. No significant difference in outcome, complications or residual shunting could be documented between the two device types. Conclusion: In our centre, the percutaneous closure of a PFO seems to be a safe and effective procedure to prevent recurrence of paradoxical thrombo-embolic events. (Neth Heart J 2008;16:332-6.) PMID:18958256

  17. Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis.

    Science.gov (United States)

    Roberge, Stéphanie; Demers, Suzanne; Berghella, Vincenzo; Chaillet, Nils; Moore, Lynne; Bujold, Emmanuel

    2014-11-01

    A systematic review and metaanalysis were performed through electronic database searches to estimate the effect of uterine closure at cesarean on the risk of adverse maternal outcome and on uterine scar evaluated by ultrasound. Randomized controlled trials, which compared single vs double layers and locking vs unlocking sutures for uterine closure of low transverse cesarean, were included. Outcomes were short-term complications (endometritis, wound infection, maternal infectious morbidity, blood transfusion, duration of surgical procedure, length of hospital stay, mean blood loss), uterine rupture or dehiscence at next pregnancy, and uterine scar evaluation by ultrasound. Twenty of 1278 citations were included in the analysis. We found that all types of closure were comparable for short-term maternal outcomes, except for single-layer closure, which had shorter operative time (-6.1 minutes; 95% confidence interval [CI], -8.7 to -3.4; P type of uterine closure for optimal maternal outcomes and is insufficient to conclude about the risk of uterine rupture. Single-layer closure and locked first layer are possibly coupled with thinner residual myometrium thickness.

  18. 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.'

  19. 25 CFR 573.6 - Order of temporary closure.

    Science.gov (United States)

    2010-04-01

    ... or a customer. (7) A management contractor operates for business without a contract that the Chairman... 25 Indians 2 2010-04-01 2010-04-01 false Order of temporary closure. 573.6 Section 573.6 Indians... ENFORCEMENT § 573.6 Order of temporary closure. (a) When an order of temporary closure may issue...

  20. Pulmonary edema following transcatheter closure of atrial septal defect

    Directory of Open Access Journals (Sweden)

    Singhi Anil

    2010-01-01

    Full Text Available Pulmonary edema after device closure of atrial septal defect (ASD is a rare complication. We present illustrative images of a case of pulmonary edema after device closure of ASD in a 53 year old adult. Older patients undergoing ASD closure can benefit from their left atrial and left ventricular end diastolic pressures measurement before and after temporary balloon occlusion of ASD.

  1. A Simple Method for Thoracotomy Closure Avoiding Intercostal Nerve Damage

    Directory of Open Access Journals (Sweden)

    Ufuk Cagirici

    2016-09-01

    Full Text Available It is well known that intercostal nerve damage during thoracotomy closure causes severe postoperative pain. A simple closure technique is proposed for intercostal nerve-sparing during thoracotomy opening and closure. We think that this maneuver may avoid intercostal nerve compression.

  2. 27 CFR 28.102 - Bottles to have closures affixed.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Bottles to have closures... Transportation to a Manufacturing Bonded Warehouse § 28.102 Bottles to have closures affixed. Every bottle containing distilled spirits to be withdrawn under the provisions of this subpart shall have a closure...

  3. 78 FR 1206 - Second Extension of Hearing Record Closure Date

    Science.gov (United States)

    2013-01-08

    ... SAFETY BOARD Second Extension of Hearing Record Closure Date AGENCY: Defense Nuclear Facilities Safety Board. ACTION: Second extension of hearing record closure date. SUMMARY: The Defense Nuclear Facilities... closure date to January 2, 2013 (77 FR 65871). Extension of Time: The Board now extends the period of...

  4. 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

    Energy Technology Data Exchange (ETDEWEB)

    Evans, Susan Kay; Orchard, B. J.

    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.

  5. 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

    Energy Technology Data Exchange (ETDEWEB)

    Evans, S.K.

    2002-01-31

    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.

  6. Skin closure in vascular neurosurgery: A prospective study on absorbable intradermal suture versus nonabsorbable suture

    OpenAIRE

    Pereira, Julio Leonardo Barbosa; Vieira,Gerival; de Albuquerque, Lucas Alverne Freitas; Mendes, George de Albuquerque Cavalcanti; Salles, Ludmila Rezende; de Souza, André Felipe Ferreira; Dellaretti, Marcos; Sousa,Atos Alves de

    2012-01-01

    Background: The craniotomy performed with minimal hair removal and closure with intradermal suture alone is an option in neurosurgical procedures, which can help faster psychological recovery of the patient, as it allows a better cosmetic result. This study is aimed at evaluating if such method is safe and effective, compared with continuous skin sutures with 2-0 nylon. Methods: We analyzed the sutures in 117 patients undergoing craniotomies for cerebral aneurysm clipping. In the case group (...

  7. Elastic suture (shoelace technique) for fasciotomy closure after treatment of compartmental syndrome associated to tibial fracture.

    Science.gov (United States)

    Branco, Paulo Sergio Martins Castelo; Cardoso Junior, Mauricio; Rotbande, Isaac; Ciraudo, José Antonio Fraga; Silva, Celso Ricardo Correa de Melo; Leal, Paulo Cesar Dos Santos

    2017-01-01

    This article reports the use of elastic suture as an adjuvant in surgical wound closure caused by decompressive fasciotomy after compartment syndrome associated with a compound fracture of the tibia. Widely used in other medico-surgical specialties, this technique is unusual in orthopedics surgery, but the simplicity of the procedure and the successful outcome observed in this case allows for its consideration as indicated for situations similar to that presented in this study.

  8. The hybrid perventricular closure of apical muscular ventricular septal defect with Amplatzer duct occluder

    Directory of Open Access Journals (Sweden)

    Soo Jin Kim

    2013-04-01

    Full Text Available &lt;b&gt;Purpose:&lt;/b&gt; Apical muscular ventricular septal defects (MVSDs, especially in small infants, can be difficult to manage using surgical and percutaneous closure. An intraoperative perventricular procedure is a good option for closing apical MVSDs in small children with or without associated cardiac anomalies.We evaluated the results of hybrid perventricular closure of apical MVSDs performed using an Amplatzer duct occluder (ADO. &lt;b&gt;Methods:&lt;/b&gt; We retrospectively reviewed the medical records of 5 patients who underwent hybrid perventricular closure of MVSDs with ADOs, from March 2006 to May 2011. The median patient age at the time of the procedure was 12 months (range, 25 days to 25 months, and the median body weight was 9.1 kg (range, 4.3 to 15 kg. Two patients had multiple ventricular septal defects (VSDs; additional perimembranous VSD in 1 patient and multiple MVSDs in the other and 3 patients had associated cardiac anomalies; complete transposition of the great arteries in 1 patient and an atrial septal defect in 2 patients. All the procedures were performed on beating hearts, exception in 1 case. The ADO selected for the aortic side was at least 1 to 2 mm larger than the largest VSD in the left ventricle side. &lt;b&gt;Results:&lt;/b&gt; The procedure was successful in all patients and each device was well positioned. During the median follow-up of 2.4 years, a small residual VSD was noted in 2 patients who had multiple VSDs and no leakage was seen in the other 3 patients. &lt;b&gt;Conclusion:&lt;/b&gt; Perventricular closure of MVSD with an ADO is a good option for patients with apical MVSD. However, careful manipulation is important, especially in the case of small infants.

  9. 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.

  10. Ultrasonographic features of vascular closure devices: initial and 6-month follow-up results

    OpenAIRE

    Hye Jung Choo; Hae Woong Jeong; Jin Young Park; Sung-Chul Jin; Sung Tae Kim; Jung Hwa Seo; Sun Joo Lee; Young Mi Park

    2014-01-01

    Purpose:

    This study aimed to evaluate the ultrasonographic findings for various types of vascular closure devices (VCDs) immediately after the angiographic procedure and at 6-month follow-up.

    Methods:

    We included 18 VCDs including Angio-Seal (n=4), FemoSeal (n=8), ExoSeal (n=3), Perclose (n=...

  11. First-in-man Percutaneous LAA Closure With an Amplatzer Amulet and TriGuard Embolic Protection Device in a Patient With LAA Thrombus.

    Science.gov (United States)

    Del Furia, Francesca; Ancona, Marco B; Giannini, Francesco; Jabbour, Richard J; Regazzoli, Damiano; Mangieri, Antonio; Latib, Azeem; Colombo, Antonio; Montorfano, Matteo

    2017-04-01

    Percutaneous left atrial appendage (LAA) closure is currently utilized for the prophylaxis of thromboembolic cerebrovascular accidents in patients with non-valvular atrial fibrillation. The presence of LAA thrombus is usually considered a contraindication for the procedure, since there is a high risk of thrombus embolization. While reports in the literature have shown the feasibility of LAA closure in the presence of LAA thrombus with certain cerebral embolic protection devices, we present the first-in-man LAA closure of a patient with LAA thrombus using the TriGuard Embolic Protection Device.

  12. Transesophageal echocardiography for incremental value of Amplatezer cribriform septal occluder for percutaneous transcatheter closure of complex septal defects: Case series

    Directory of Open Access Journals (Sweden)

    Shen Kou Tsai

    2017-06-01

    Conclusion: Our patients with complex septal defects were successfully treated by transcatheter closure using an Amplazter cribriform septal occluder device with careful planning based on patient presentation and close interdisciplinary collaboration. RT 3D color Doppler TEE provided precise information for the selection of the appropriate occluder device and facilitated the procedure by guiding the catheter through the often challenging patient anatomy.

  13. Conscious sedation using dexmedetomidine for percutaneous transcatheter closure of atrial septal defects: A single center experience

    Directory of Open Access Journals (Sweden)

    Pushkar Mahendra Desai

    2016-01-01

    Full Text Available Objective: The aim of this study is to determine safety and feasibility of conscious sedation using dexmedetomidine for transcatheter atrial septal defect (ASD device closure. Material and Methods: A retrospective institutional review of transcatheter ASD device closure without endotracheal intubation over 18 months. The protocol included topical oropharyngeal anesthesia using lignocaine followed by dexmedetomidine bolus 1 μg/kg intravenously over 10 min and maintenance dose 0.2-0.7 μg/kg/h. Ramsay sedation score 2-3 was maintained. Patients were analyzed regarding demographic profile, device size, procedure time, anesthesia time, recovery time, hospital stay, and any hemodynamic or procedural complications. Results: A total of 43 patients with mean age 31.56 ± 13.74 years (range: 12-56 years were analyzed. Mean anesthesia duration was 71.75 + 21.08 min. Mean recovery time was 7.6 ± 3.01 min. 16 females and one male patient required additional propofol with a mean dose of 30.8 ± 10.49 mg. No hemodynamic instability was noted. No patient required general anesthesia with endotracheal intubation. The procedure was successful in 93.02% of patients. Four patients developed atrial fibrillation. All patients were satisfied. Conclusion: Conscious sedation using dexmedetomidine is a safe and effective anesthetic technique for percutaneous ASD closure.

  14. 77 FR 75186 - Notice of Closure, Target Shooting Public Safety Closure on the Lake Mountains in Utah County, UT

    Science.gov (United States)

    2012-12-19

    ... Bureau of Land Management Notice of Closure, Target Shooting Public Safety Closure on the Lake Mountains... approximately 900 acres of public land on the Lake Mountains in Utah County, Utah, to recreational target... Lake Mountains area. DATES: This target shooting closure within the described area will remain in...

  15. 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, P.; Wind, J.; Dijkgraaf, M.G.W.; Busch, O.R.C.; Goslings, J.C.

    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

  16. 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, P.; Wind, J.; Dijkgraaf, M.G.W.; Busch, O.R.C.; Goslings, J.C.

    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

  17. Roles of real-time three-dimensional transesophageal echocardiography in peri-operation of transcatheter left atrial appendage closure

    Science.gov (United States)

    Zhou, Qing; Song, Hongning; Zhang, Lan; Deng, Qing; Chen, Jinling; Hu, Bo; Wang, Yijia; Guo, Ruiqiang

    2017-01-01

    Abstract Left atrial appendage (LAA) closure is a new treatment option for the prevention of stroke in patients with nonvalvular atrial fibrillation (AF). Conventional 2-dimensional transesophageal echocardiography (2D TEE) has some limitations in the imaging assessment of LAA closure. Real-time 3-dimensional transesophageal echocardiography (RT-3D TEE) allows for detailed morphologic assessment of the LAA. In this study, we aim to determine the clinical values of RT-3D TEE in the periprocedure of LAA closure. Thirty-eight persistent or paroxysmal AF patients with indications for LAA closure were enrolled in this study. RT-3D TEE full volume data of the LAA were recorded before operation to evaluate the anatomic feature, the landing zone dimension, and the depth of the LAA. On this basis, selection of LAA closure device was carried out. During the procedure, RT-3D TEE was applied to guide the interatrial septal puncture, device operation, and evaluate the occlusion effects. The patients were follow-up 1 month and 3 months postclosure. Twenty-eight (73.7%) patients with AF received placement of LAA occlusion device under RT-3D TEE. Eleven cases with single-lobe LAAs were identified using RT-3D TEE, among which 4 showed limited depth. Seventeen cases showed bilobed or multilobed LAA. Seven cases received LAA closure using Lefort and 21 using LAmbre based on the 3D TEE and radiography. The landing zone dimension of the LAA measured by RT-3D TEE Flexi Slice mode was better correlated with the device size used for occlusion (r = 0.90) than 2D TEE (r = 0.88). The interatial septal puncture, the exchange of the sheath, as well as the release of the device were executed under the guidance of RT-3D TEE during the procedure. The average number of closure devices utilized for optimal plugging was (1.11 ± 0.31). There were no clinically unacceptable residual shunts, pericardial effusion, or tamponade right after occlusion. All the patients had the device well

  18. Percutaneous closure of secundum type atrial septal defects:More than 5-year follow-up

    Institute of Scientific and Technical Information of China (English)

    Roel; JR; Snijder; Maarten; J; Suttorp; Jurri?n; M; Ten; Berg; Martijn; C; Post

    2015-01-01

    AIM: To investigate long-term efficacy of two different devices more than five years after percutaneous atrial septal defect(ASD) closure in adults.METHODS: All patients who underwent percutaneous closure of an ASD in the St. Antonius Hospital, Nieuwegein, The Netherlands, between February 1998 and December 2006 were included. Percutaneous closure took place under general anaesthesia and transesophageal echocardiographic moni toring. Transthoracic echocardiography(TTE) was performed 24 h post-procedure to visualize the device position and to look for residual shunting using color Doppler. All complications were registered. All patients were invited for an outpatient visit and contrast TTE more than 5-years after closure. Efficacy was based on the presence of a residual right-to-left shunt(RLS), graded as minimal, moderate or severe. The presence of a residual left-to-right shunt(LRS) was diagnosed using color Doppler, and was not graded. Descriptive statistics were used for patients’ characteristics. Univariate analysis was used to identify predictors for residual shunting.RESULTS: In total, 104 patients(mean age 45.5 ± 17.1 years) underwent percutaneous ASD closure using an Amplatzer device(ASO) in 76 patients and a Cardioseal/Starflex device(CS/SF) in 28 patients. The mean follow-up was 6.4 ± 3.4 years. Device migration occurred in 4 patients of whom two cases occurred during the index hospitalization(1 ASO, 1 CS/SF). The other 2 cases of device migration occurred during the first 6 mo of follow-up(2 CS/SF). The recurrent thrombo-embolic event rate was similar in both groups: 0.4% per follow-up year. More than 12 mo post-ASD closure and latest follow-up, new-onset supraventricular tachyarrhythmia’s occurred in 3.9% and 0% for the ASO and CS/SF group, respectively. The RLS rate at latest follow-up was 17.4%(minimal 10.9%, moderate 2.2%, severe 4.3%) and 45.5%(minimal 27.3%, moderate 18.2%, severe 0%) for the ASO- and CS/SF groups, respectively. There was no

  19. 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.

  20. The proposal of the closure element pipe

    Directory of Open Access Journals (Sweden)

    Fojtášek Kamil

    2017-01-01

    Full Text Available The present paper summarizes the basic equations describing the behavior of butterfly valves during the fluid flow. Butterfly valves are used as a safety element in the energy industry, petrochemical industry, in steam lines etc. The paper describes the theoretical determination of the control torque on the closure element, the torque causes the opening and closing of butterfly valve. Determination of this torque depends on many factors, geometry of the closure element, misalignment to the axis of fluid flow, control method of valve, method of imposition of the moving member and of course on the operating parameters. Correct determination of the torque affects the proper design butterfly valves and ensure its functionality, which can prevent damage to other elements of the monitoring system.

  1. The proposal of the closure element pipe

    Science.gov (United States)

    Fojtášek, Kamil; Krutil, Jaroslav; Dvořák, Lukáš

    The present paper summarizes the basic equations describing the behavior of butterfly valves during the fluid flow. Butterfly valves are used as a safety element in the energy industry, petrochemical industry, in steam lines etc. The paper describes the theoretical determination of the control torque on the closure element, the torque causes the opening and closing of butterfly valve. Determination of this torque depends on many factors, geometry of the closure element, misalignment to the axis of fluid flow, control method of valve, method of imposition of the moving member and of course on the operating parameters. Correct determination of the torque affects the proper design butterfly valves and ensure its functionality, which can prevent damage to other elements of the monitoring system.

  2. The Galois closure of Drinfeld modular towers

    DEFF Research Database (Denmark)

    Bassa, Alp; Beelen, Peter

    2011-01-01

    In this article we study Drinfeld modular curves X0(pn) associated to congruence subgroups Γ0(pn) of GL(2,Fq[T]) where p is a prime of Fq[T]. For n>r>0 we compute the extension degrees and investigate the structure of the Galois closures of the covers X0(pn)→X0(pr) and some of their variations. T...

  3. Notice of car park and road closures

    CERN Multimedia

    2006-01-01

    The arrival of one of the end caps of the CMS Tracker in Building 186 will result in the temporary closure of the following car parks: Building186: south entrance Building 613 Building 28 Building181: south entrance Building 600 Building 31 Route Oppenheimer The car parks concerned will be closed from Monday 30 October until the evening of Tuesday 31 October. Thank you for your cooperation. PH-CMT Group Tel. 164569

  4. Notice of car park and road closures

    CERN Multimedia

    2006-01-01

    The arrival of one of the end caps of the CMS Tracker in Building 186 will result in the temporary closure of the following car parks: Building186: south entrance Building 613 Building 28 Building181: south entrance Building 600 Building 31 Route Oppenheimer The car parks concerned will be closed from Sunday 22 October until the evening of Monday 23 October. Thank you for your cooperation. PH-CMT Group Tel. 164569

  5. Calcined solids storage facility closure study

    Energy Technology Data Exchange (ETDEWEB)

    Dahlmeir, M.M.; Tuott, L.C.; Spaulding, B.C. [and others

    1998-02-01

    The disposal of radioactive wastes now stored at the Idaho National Engineering and Environmental Laboratory is currently mandated under a {open_quotes}Settlement Agreement{close_quotes} (or {open_quotes}Batt Agreement{close_quotes}) between the Department of Energy and the State of Idaho. Under this agreement, all high-level waste must be treated as necessary to meet the disposal criteria and disposed of or made road ready to ship from the INEEL by 2035. In order to comply with this agreement, all calcined waste produced in the New Waste Calcining Facility and stored in the Calcined Solids Facility must be treated and disposed of by 2035. Several treatment options for the calcined waste have been studied in support of the High-Level Waste Environmental Impact Statement. Two treatment methods studied, referred to as the TRU Waste Separations Options, involve the separation of the high-level waste (calcine) into TRU waste and low-level waste (Class A or Class C). Following treatment, the TRU waste would be sent to the Waste Isolation Pilot Plant (WIPP) for final storage. It has been proposed that the low-level waste be disposed of in the Tank Farm Facility and/or the Calcined Solids Storage Facility following Resource Conservation and Recovery Act closure. In order to use the seven Bin Sets making up the Calcined Solids Storage Facility as a low-level waste landfill, the facility must first be closed to Resource Conservation and Recovery Act (RCRA) standards. This study identifies and discusses two basic methods available to close the Calcined Solids Storage Facility under the RCRA - Risk-Based Clean Closure and Closure to Landfill Standards. In addition to the closure methods, the regulatory requirements and issues associated with turning the Calcined Solids Storage Facility into an NRC low-level waste landfill or filling the bin voids with clean grout are discussed.

  6. Left Atrial Appendage Closure Guided by Integrated Echocardiography and Fluoroscopy Imaging Reduces Radiation Exposure.

    Directory of Open Access Journals (Sweden)

    Christiane Jungen

    Full Text Available To investigate whether percutaneous left atrial appendage (LAA closure guided by automated real-time integration of 2D-/3D-transesophageal echocardiography (TEE and fluoroscopy imaging results in decreased radiation exposure.In this open-label single-center study LAA closure (AmplatzerTM Cardiac Plug was performed in 34 consecutive patients (8 women; 73.1±8.5 years with (n = 17, EN+ or without (n = 17, EN- integrated echocardiography/fluoroscopy imaging guidance (EchoNavigator® [EN]; Philips Healthcare. There were no significant differences in baseline characteristics between both groups. Successful LAA closure was documented in all patients. Radiation dose was reduced in the EN+ group about 52% (EN+: 48.5±30.7 vs. EN-: 93.9±64.4 Gy/cm2; p = 0.01. Corresponding to the radiation dose fluoroscopy time was reduced (EN+: 16.7±7 vs. EN-: 24.0±11.4 min; p = 0.035. These advantages were not at the cost of increased procedure time (89.6±28.8 vs. 90.1±30.2 min; p = 0.96 or periprocedural complications. Contrast media amount was comparable between both groups (172.3±92.7 vs. 197.5±127.8 ml; p = 0.53. During short-term follow-up of at least 3 months (mean: 8.1±5.9 months no device-related events occurred.Automated real-time integration of echocardiography and fluoroscopy can be incorporated into procedural work-flow of percutaneous left atrial appendage closure without prolonging procedure time. This approach results in a relevant reduction of radiation exposure.ClinicalTrials.gov NCT01262508.

  7. A Quadratic Closure for Compressible Turbulence

    Energy Technology Data Exchange (ETDEWEB)

    Futterman, J A

    2008-09-16

    We have investigated a one-point closure model for compressible turbulence based on third- and higher order cumulant discard for systems undergoing rapid deformation, such as might occur downstream of a shock or other discontinuity. In so doing, we find the lowest order contributions of turbulence to the mean flow, which lead to criteria for Adaptive Mesh Refinement. Rapid distortion theory (RDT) as originally applied by Herring closes the turbulence hierarchy of moment equations by discarding third order and higher cumulants. This is similar to the fourth-order cumulant discard hypothesis of Millionshchikov, except that the Millionshchikov hypothesis was taken to apply to incompressible homogeneous isotropic turbulence generally, whereas RDT is applied only to fluids undergoing a distortion that is 'rapid' in the sense that the interaction of the mean flow with the turbulence overwhelms the interaction of the turbulence with itself. It is also similar to Gaussian closure, in which both second and fourth-order cumulants are retained. Motivated by RDT, we develop a quadratic one-point closure for rapidly distorting compressible turbulence, without regard to homogeneity or isotropy, and make contact with two equation turbulence models, especially the K-{var_epsilon} and K-L models, and with linear instability growth. In the end, we arrive at criteria for Adaptive Mesh Refinement in Finite Volume simulations.

  8. Stochastic particle acceleration and statistical closures

    Energy Technology Data Exchange (ETDEWEB)

    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).

  9. Creativity & Cognitive Closure (Creatividad y cierre cognitivo

    Directory of Open Access Journals (Sweden)

    Melike Hazir

    2015-02-01

    Full Text Available Abstract The aim of this paper is to present the relationship between the need for cognitive closure (NFC and creativity. In light of previous research, a theoretical foundation is established for the term creativity. Next the social-cognitive phenomenon of the need for cognitive closure is explained based on the theory of Kruglanski and Webster, and considering the tendencies of urgency and permanency. Conclusion: The role of creativity is to control cognitive closure in order to solve problems that arise during the learning process and usually during the life. Resumen El objetivo de este trabajo es presentar la relación entre la necesidad de cierre cognitivo (NCC y la creatividad. A la luz de las investigaciones realizadas, se establece la base teórica para el término de creatividad y la explica del fenómeno socio-cognitivo de necesidad de cierre cognitivo en base a la teoría de Kruglanski y Webster, teniendo en cuenta las tendencias de urgencia y permanencia. Conclusión: La creatividad tiene un papel importante de control del cierre cognitivo con el fin de resolver los problemas que surjan durante el proceso de aprendizaje y en general durante la vida.

  10. Endonasal endoscopic closure of cerebrospinal fluid rhinorrhea.

    Science.gov (United States)

    Schmerber, S; Righini, C; Lavielle, J P; Passagia, J G; Reyt, E

    2001-02-01

    The authors review their experience with endoscopic repair of skull base defects associated with cerebrospinal fluid (CSF) rhinorrhea involving the paranasal sinuses. A total of 22 patients was treated endoscopically between 1992 and 1998. The repair method consisted of closure of the CSF fistula with a free autologous abdominal fat graft and fibrin glue, supported with a sheet of silastic. The primary closure rate was 82% (18/22), and the overall closure rate was 95.5% (21/22) without recurrence or complications within an average follow-up of 5 years (14-83 months). A single patient still complains of cerebrospinal rhinorrhea, although this was never proved by any clinical, endoscopic, or biological (beta(2)-transferrin) examination. The repair of ethmoidal-sphenoidal cerebrospinal fluid fistulae by endonasal endoscopic surgery is an excellent technique, both safe and effective. Fat is a material of choice, as it is tight and resists infection well. The technique and indications for endoscopic management of cerebrospinal fluid leaks are discussed.

  11. VR closure rates for two vocational models.

    Science.gov (United States)

    Fraser, Virginia V; Jones, Amanda M; Frounfelker, Rochelle; Harding, Brian; Hardin, Teresa; Bond, Gary R

    2008-01-01

    The Individual Placement and Support (IPS) model of supported employment is an evidence-based practice for individuals with psychiatric disabilities. To be financially viable, IPS programs require funding from the state-federal vocational rehabilitation (VR) system. However, some observers have questioned the compatibility of IPS and the VR system. Using a randomized controlled trial comparing IPS to a well-established vocational program called the Diversified Placement Approach (DPA), we examined rates of VR sponsorship and successful VR closures. We also describe the establishment of an active collaboration between a psychiatric rehabilitation agency and the state VR system to facilitate rapid VR sponsorship for IPS clients. Both IPS and DPA achieved a 44% rate of VR Status 26 closure when considering all clients entering the study. IPS and DPA averaged similar amount of time to achieve VR sponsorship. Time from vocational program entry to Status 26 was 51 days longer on average for IPS. Even though several IPS principles seem to run counter to VR practices, such as zero exclusion and rapid job search, we found IPS closure rates comparable to those for DPA, a vocational model that screens for readiness, provides prevocational preparation, and extensively uses agency-run businesses.

  12. TRANSCATHETER CLOSURE OF PATENT DUCTUS ARTERIOSUS

    Institute of Scientific and Technical Information of China (English)

    高伟; 周爱卿; 余志庆; 李奋; 王荣发; 黄美蓉

    2002-01-01

    Objective To explore the efficacy of transcatheter closure of patent ductus arteriosus (PDA) with detachable coil and Amplatzer duct occluder (ADO). Methods Transcatheter colsure of PDA was performed in 160 cases, aged 4.56±2.67 years, of whom 3 had residual shunt after surgical ligation, 2 had pulmomary stenosis (PS), 1 had coarctation of aorta (COA), 1 had right aortic arch, and 2 had atrial septal defect (ASD). Results Detachable coils (Duct Occlude pfm or Cook Inc) were successfully used in 51 patients with a smallest PDA diameter of 1.86±0.78mm. Amplatzer duct occluders were also successfully performed in other 109 with a moderate to large PDA diameter of 3.89±1.32mm, of whom 3 with PS or COA were performed balloon dilation firstly, and 2 with ASD were performed PDA occlusion firstly; 1 month to 4.8years follow-up coil or Amplatzer device closure of PDA showed that neither residual shunt nor any complication. Conclusion It is suggested that the detachable coil and Amplatzer duct occluder are simple and safe for the catheter closure from small to large sized PDA.

  13. Folate receptors and neural tube closure.

    Science.gov (United States)

    Saitsu, Hirotomo

    2017-02-28

    Neural tube defects (NTD) are among the most common human congenital malformations, affecting 0.5-8/1000 of live births. Human clinical trials have shown that periconceptional folate supplementation significantly decreases the occurrence of NTD in offspring. However, the mechanism by which folate acts on NTD remains largely unknown. Folate receptor (Folr) is one of the three membrane proteins that mediate cellular uptake of folates. Recent studies suggest that mouse Folr1 (formerly referred to as Fbp1) is essential for neural tube closure. Therefore, we examined spatial and temporal expression patterns of Folr1 in developing mouse embryos, showing a close association between Folr1 and anterior neural tube closure. Transient transgenic analysis was performed using lacZ as a reporter; we identified a 1.1-kb enhancer that directs lacZ expression in the neural tube and optic vesicle in a manner that is similar to endogenous Folr1. The 1.1-kb enhancer sequences were highly conserved between humans and mice, suggesting that human FOLR1 is associated with anterior neural tube closure in humans. Several experimental studies in mice and human epidemiological and genetics studies have suggested that folate receptor abnormalities are involved in a portion of human NTDs, although the solo defect of FOLR1 did not cause NTD.

  14. Hospital admissions before and after shipyard closure.

    Science.gov (United States)

    Bartley, M; Fagin, L

    1990-03-01

    "To determine the effect of job loss on health an investigation was made of admissions to hospitals in 887 men five years before and three years after the closure of a Danish shipyard. The control group comprised 441 men from another shipyard. The information on hospital admissions was obtained from the Danish national register of patients. The relative risk of admission in the control group dropped significantly in terms of the number of men admitted from the study group from 1.29 four to five years before closure to 0.74 in the three years after closure. This was especially true of admissions due to accidents (1.33 to 0.46) and diseases of the digestive system (4.53 to 1.03). For diseases of the circulatory system, particularly cardiovascular diseases, the relative risk increased from 0.8 to 1.60, and from 1.0 to 2.6 respectively. These changes in risk of illness after redundancy are probably a consequence of a change from the effects of a high risk work environment to the effects of psychosocial stresses such as job insecurity and unemployment."

  15. 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.

  16. Outcomes After Paravalvular Leak Closure: Transcatheter Versus Surgical Approaches.

    Science.gov (United States)

    Wells, John A; Condado, Jose F; Kamioka, Norihiko; Dong, Andy; Ritter, Andrew; Lerakis, Stamatios; Clements, Stephen; Stewart, James; Leshnower, Bradley; Guyton, Robert; Forcillo, Jessica; Patel, Ateet; Thourani, Vinod H; Block, Peter C; Babaliaros, Vasilis

    2017-03-13

    The aim of this study was to compare outcomes of transcatheter intervention (TI) versus surgical intervention (SI) for paravalvular leak (PVL). Data comparing the treatment of PVL with TI and SI are limited. A retrospective cohort study was conducted comparing baseline characteristics, procedural details, and 1-year survival in consecutive patients who underwent TI or SI for moderate or greater PVL from 2007 to 2016. The primary outcome was a composite of death, reintervention for PVL, or readmission for congestive heart failure-related symptoms at 1 year. Of 114 patients, 56 underwent TI and 58 underwent SI. PVL locations were mitral, aortic, and pulmonary in 69 (60.5%), 39 (34.2%), and 6 (5.3%) patients, respectively. At baseline, TI patients were older (age 71 vs. 62 years; p = 0.010) and had fewer cases of active endocarditis (0.0% vs. 25.9%, p < 0.001) than SI patients. The TI group had a shorter post-operative stay (4 vs. 8 days; p < 0.001), a shorter intensive care unit stay (0 vs. 3 days; p < 0.001), and fewer readmissions at 30 days (8.9% vs. 25.9%; p = 0.017). There were no differences in the primary endpoint (TI 33.9% vs. SI 39.7%; p = 0.526) or 1-year survival (TI 83.9% vs. SI 75.9%; p = 0.283) between groups. In this study, TI for PVL closure had comparable 1-year clinical outcomes with SI, even after adjusting for differences in baseline characteristics, with less in-hospital morbidity and 30-day rehospitalization. Although further study is needed, these findings support the increased implementation of TI for PVL closure at experienced institutions. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  17. 105-DR Large Sodium Fire Facility closure plan. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    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.

  18. 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.

  19. Percutaneous closure of atrial septal defects without balloon sizing in adults: Experience of a tertiary referral center

    Directory of Open Access Journals (Sweden)

    Hasan Kaya

    2013-03-01

    Full Text Available Objective: We aimed to evaluate our clinical experienceand short-term results of percutaneous closure of secundumtype atrial septal defects (ASD in adults.Methods: We studied 71 patients (49 female, 22 male,mean age 35±14 years undergoing percutaneous closureof ASD between January 2010-October 2012 in ourclinic. All procedures were performed under sedoanalgesiawithout balloon sizing. Clinical characteristics of patients,properties of percutaneous closure intervention,complications and short-term results are evaluated.Results: Defect diameter measured by transesophagealechocardiographic examination was 19.8±6.4 mm. Devicesize used for percutaneous closure was 24.7±6.7mm. Procedure was successfully performed in 67 patients(94%. Four patients were referred for surgery because ofprocedural failure. During procedure, a patient developedtransient 2nd degree AV block, and another developeddevice thrombosis. Residual shunt was detected in threepatients at first day control echocardiographic examination.In the follow-up of 13±8 months, no residual shunt,embolic or arrhythmic complications were observed.Conclusion: Percutaneous closure of secundum ASD isa safe and effective method with high success and lowcomplication rates in experienced centers. J Clin Exp Invest2013; 4 (1: 67-72Key words: Secundum atrial septal defect, percutaneousclosure, sedoanalgesia, transesophageal echocardiography

  20. Total fistulectomy, sphincteroplasty and closure of the residual cavity for trans-sphincteric perianal fistula in the elderly patient.

    Science.gov (United States)

    Mascagni, Domenico; Pironi, Daniele; Pontone, Stefano; Tonda, Maya; Eberspacher, Chiara; Panarese, Alessandra; Miscusi, Giandomenico; Grimaldi, Gianmarco; Catania, Antonio; Santoro, Alberto; Filippini, Angelo; Sorrenti, Salvatore

    2017-02-01

    Perianal fistula is a complex and frequent disease. At present, no treatment nor technique has shown an absolute superiority in terms of efficacy and recurrence rate. The technique has to be chosen considering the balance between faecal continence preservation and disease eradication. Rarely concomitant perianal abscess and fistula are treated at the same time, and often time to complete recovery is long. The aim of this study was to evaluate the possibility of treating the abscess and the fistula tract in one procedure with total fistulectomy, sphincteroplasty and an almost complete closure of the residual cavity, thus reducing the healing time in older patients. A non-randomized single-centre series of 86 patients from 2007 to 2012 with low-medium trans-sphincteric perianal fistula (fistulectomy, sphincteroplasty and closure of the residual cavity technique. Success rate was 97.7% with a healing time of 4 weeks; overall morbidity was 16.2%; recurrence rate was 2.3%; no major alterations of continence were observed. Fistulectomy, sphincteroplasty and closure of the residual cavity are associated with a low rate of recurrence and good faecal continence preservation in older patients. This technique can be safely used even with a concomitant perianal abscess, with reduction in healing time and in the number of surgical procedures needed. Total fistulectomy with sphincteroplasty and partial closure of the residual cavity, as described, is a safe procedure but has to be performed by dedicated colorectal surgeons.

  1. 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

    Directory of Open Access Journals (Sweden)

    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.

  2. Use of StarClose for brachial artery closure after percutaneous endovascular interventions.

    Science.gov (United States)

    Puggioni, Alessandra; Boesmans, Evelyne; Deloose, Koen; Peeters, Patrick; Bosiers, Marc

    2008-01-01

    The objective of this study was to evaluate a percutaneous extravascular closure device (StarClose, Abbott Vascular, Redwood City, CA) after brachial endovascular approach. From 2004 to 2006, 29 patients received StarClose for brachial closure. Primary endpoints were successful deployment and absence of procedure-related morbidity, secondary endpoints were brachial artery patency on duplex and absence of late (> 30 days) complications. The device was successfully deployed in all patients. In two patients (6.8%) local complications occurred: one patient developed a large hematoma successfully treated with prolonged compression and a second patient presented with brachial artery occlusion requiring operative intervention. After a mean follow-up of 7.5+/-7.2 months, all patients had a palpable brachial/radial pulse; none had signs of infection, distal embolization or neurological deficits. On ultrasound b-mode imaging, the clip was visible as a 4 mm echolucent area at the outer anterior wall of the artery. Based on the peak systolic velocity ratios between the site of StarClose and proximal brachial artery (mean 1.08+/-0.2), none of the studied patients had a significant stenosis at the site of closure. StarClose is safe and effective in providing hemostasis following interventional procedures through the brachial artery; further advantages include patients comfort and early discharge.

  3. Rectal perforations and fistulae secondary to a glycerin enema: closure by over-the-scope-clip.

    Science.gov (United States)

    Mori, Hirohito; Kobara, Hideki; Fujihara, Shintaro; Nishiyama, Noriko; Kobayashi, Mitsuyoshi; Masaki, Tsutomu; Izuishi, Kunihiko; Suzuki, Yasuyuki

    2012-06-28

    Rectal perforations due to glycerin enemas (GE) typically occur when the patient is in a seated or lordotic standing position. Once the perforation occurs and peritonitis results, death is usually inevitable. We describe two cases of rectal perforation and fistula caused by a GE. An 88-year-old woman presented with a large rectal perforation and a fistula just after receiving a GE. Her case was further complicated by an abscess in the right rectal wall. The second patient was a 78-year-old woman who suffered from a rectovesical fistula after a GE. In both cases, we performed direct endoscopic abscess lavage with a saline solution and closed the fistula using an over-the-scope-clip (OTSC) procedure. These procedures resulted in dramatic improvement in both patients. Direct endoscopic lavage and OTSC closure are very useful for pararectal abscess lavage and fistula closure, respectively, in elderly patients who are in poor general condition. Our two cases are the first reports of the successful endoscopic closure of fistulae using double OTSCs after endoscopic lavage of the debris and an abscess of the rectum secondary to a GE.

  4. Rectal perforations and fistulae secondary to a glycerin enema: Closure by over-the-scope-clip

    Institute of Scientific and Technical Information of China (English)

    Hirohito Mori; Hideki Kobara; Shintaro Fujihara; Noriko Nishiyama; Mitsuyoshi Kobayashi; Tsutomu Masaki; Kunihiko Izuishi; Yasuyuki Suzuki

    2012-01-01

    Rectal perforations due to glycerin enemas (GE) typically occur when the patient is in a seated or lordotic standing position.Once the perforation occurs and peritonitis results,death is usually inevitable.We describe two cases of rectal perforation and fistula caused by a GE.An 88-year-old woman presented with a large rectal perforation and a fistula just after receiving a GE.Her case was further complicated by an abscess in the right rectal wall.The second patient was a 78-year-old woman who suffered from a rectovesical fistula after a GE.In both cases,we performed direct endoscopic abscess lavage with a saline solution and closed the fistula using an over-the-scope-clip (OTSC) procedure.These procedures resulted in dramatic improvement in both patients.Direct endoscopic lavage and OTSC closure are very useful for pararectal abscess lavage and fistula closure,respectively,in elderly patients who are in poor general condition.Our two cases are the first reports of the successful endoscopic closure of fistulae using double OTSCs after endoscopic lavage of the debris and an abscess of the rectum secondary to a GE.

  5. Report for the HWMA/RCRA Post Closure Permit for the INTEC Waste Calcining Facility at the INL Site

    Energy Technology Data Exchange (ETDEWEB)

    Idaho Cleanup Project

    2006-06-01

    The Waste Calcining Facility (WCF) is located at the Idaho Nuclear Technology and Engineering Center. In 1998, the WCF was closed under an approved Hazardous Waste Management Act/Resource Conservation and Recovery Act (HWMA/RCRA) Closure Plan. Vessels and spaces were grouted and then covered with a concrete cap. The Idaho Department of Environmental Quality issued a final HWMA/RCRA post-closure permit on September 15, 2003, with an effective date of October 16, 2003. This permit sets forth procedural requirements for groundwater characterization and monitoring, maintenance, and inspections of the WCF to ensure continued protection of human health and the environment. The post-closure permit also includes semiannual reporting requirements under Permit Conditions III.H. and I.U. These reporting requirements have been combined into this single semiannual report.

  6. Bronchopleural fistula after pneumonectomy: interdisciplinary surgical closure by an ipsilateral pedicled latissimus dorsi flap supported by video-assisted thoracoscopy.

    Science.gov (United States)

    Wolter, A; Scholz, T; Diedrichson, J; Arens-Landwehr, A; Schroeder-Finckh, R; Liebau, J

    2013-11-01

    Post-pneumonectomy bronchopleural fistula (BPF) remains a rare but often life-threatening complication and therapeutic challenge. Traditional surgical procedures include chronic open drainage, attempts at direct stump closure, thoracoplasty with or without chest wall muscle transposition and trans-sternal bronchial closure. We describe a case with successful closure of a chronic BPF after pneumonectomy by intrathoracic transposition of a pedicled latissimus dorsi muscle flap circumferentially fixed on the surrounding pleural tissue under continuous video-assisted thoracoscopic overview. The postoperative course was without complications; no tumour, empyema or fistula re-occurred. In this article we want to present the potential advantages of video-assisted thoracoscopic support and interdisciplinary teamwork to improve the outcome of patients with BPFs after pneumonectomy.

  7. Free Flap Procedures for Reconstruction After Head and Neck Cancer.

    Science.gov (United States)

    Kini, Erin

    2015-12-01

    Patients with head and neck cancer are seeking improved surgical procedures to avoid severe defects that result from head and neck cancer resection. Free flap reconstruction provides vascularized tissue that has been transferred from a distant donor site on a patient's body to a recipient site, markedly improving wound closure and protecting structures of the head and neck. This article discusses free flap procedures for reconstruction after head and neck cancer resection, including the following procedure phases: airway protection and neck dissections, tumor resection, flap harvest, microvascular anastomosis of the flap, and reconstruction and closure. The article also explains specific risk factors for patients undergoing free flap procedures that have been identified in the literature and include procedure length, hypothermia, and pressure injuries. Each of these factors is discussed regarding its specific effect on this patient population, and the nursing interventions to reduce these risks are identified.

  8. Cardiac Arrest after Connecting Negative Pressure to the Subgaleal Drain during Craniotomy Closure

    Directory of Open Access Journals (Sweden)

    Monu Yadav

    2014-01-01

    Full Text Available A one-year-old child operated on for arachnoid cyst in right frontoparietotemporal region had sudden bradycardia followed by cardiac arrest leading to death after connecting negative pressure to the subgaleal drain during craniotomy closure. The surgical procedure was uneventful. It is a common practice to place epidural or subgaleal drains connected to a vacuum system towards the end of craniotomy to prevent accumulation of intracranial and extracranial blood. The phenomenon of bradycardia with hypotension is known to occur following negative pressure application to the epidural, epicranial, or subgaleal space after craniotomy closure. However cardiac arrest as a complication of negative pressure suction drain in neurosurgical patients is not described in the literature.

  9. Percutaneous left atrial appendage closure: Technical aspects and prevention of periprocedural complications with the watchman device

    Institute of Scientific and Technical Information of China (English)

    Sven; M?bius-Winkler; Nicolas; Majunke; Marcus; Sandri; Norman; Mangner; Axel; Linke; Gregg; W; Stone; Ingo; D?hnert; Gerhard; Schuler; Peter; B; Sick

    2015-01-01

    Transcatheter closure of the left atrial appendage has been developed as an alternative to chronic oral anticoagulation for stroke prevention in patients with atrial fibrillation, and as a primary therapy for patients with contraindications to chronic oral anticoagulation. The promise of this new intervention compared with warfarin has been supported by several, small studies and two pivotal randomized trial with the Watchman Device. The results regarding risk reduction for stroke have been favourable although acute complications were not infrequent. Procedural complications, which are mainly related to transseptal puncture and device implantation, include air embolism, pericardial effusions/tamponade and device embolization. Knowledge of nature, management and prevention of complications should minimize the risk of complications and allow transcatheter left atrial appendage closure to emerge as a therapeutic option for patients with atrial fibrillation at risk for cardioembolic stroke.

  10. Laser-assisted multidisciplinary approach for closure and prevention of relapse of midline diastema

    Directory of Open Access Journals (Sweden)

    Amol Kamble

    2017-01-01

    Full Text Available Midline diastema, which occurs as spacing between the upper central incisors, is a common occurrence seen in the pediatric population. In the ugly duckling stage of development; no treatment is generally advocated as the diastema is a transient one. When diastemas occur due to other pathologies, they pose several problems in relation to esthetics and speech in a growing child. With the advent of time, patient's demand for esthetics has greatly increased. Along with this, a less time-consuming treatment option is a favorite. Proper diagnosis of the diastema, unfolding its etiology, helps in devising an adequate treatment plan. This eventually will lead to stability of the final result. The present case report presents a different and unique approach for the esthetic closure of midline diastema following frenectomy procedure. The approach proves to be a quick and simple option for closure of midline diastemas in cases with concomitant incisal edge irregularities.

  11. 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.

  12. Towards closure relations in the Representative Elementary Watershed (REW) framework containing observable parameters: Relations for Hortonian overland flow

    Science.gov (United States)

    Vannametee, E.; Karssenberg, D.; Bierkens, M. F. P.

    2012-07-01

    This study presents the derivation procedure of an integrated closure relation for infiltration and Hortonian overland flow in the Representative Elementary Watershed (REW) framework that contains directly-observable parameters. A physically-based high resolution model is used to simulate the infiltration flux and discharge for 6 × 105 set of synthetic REWs and rainstorms scenarios. This synthetic data set serves as a surrogate of real-world data to deduce the closure relation. The closure relation performance is evaluated against the results from the high resolution model. The results show that the closure relation is capable of predicting accurate hydrological responses for an independent set of synthetic REWs and rainstroms in terms of the Nash-Sutcliffe index, errors in total discharge volume, and peak discharge, especially in cases where a relatively large amount of runoff is produced with fast responses. For the estimation of parameters in the closure relation, a local method using inverse distance weighted interpolation in the parameter space is superior to the global method based on the multiple regression, resulting in a better reproduction of runoff characteristics.

  13. Mechanism and Etiology of Primary Chronic Angle Closure Glaucoma

    Institute of Scientific and Technical Information of China (English)

    1994-01-01

    The ocular anatomic features, pupil-blocking force, status of angle synechiae closure and positivity of provocative tests were compared between the primary chronic angle closure glaucoma (PCACG) and primary a-cute angle closure glaucoma (PAACG) by using ultrasonic biometry, computerized anterior ocular segment image processing technique, gonioscopy and provocative tests. The studies showed that the anterior chamber depth of PAACG was shallower than that of PCACG; the pupil-blocking force of PAACG was st...

  14. Echocardiographic assessment and percutaneous closure of multiple atrial septal defects

    Directory of Open Access Journals (Sweden)

    Timperley Jonathan

    2004-07-01

    Full Text Available Abstract Atrial septal defect closure is now routinely performed using a percutaneous approach under echocardiographic guidance. Centrally located, secundum defects are ideal for device closure but there is considerable morphological variation in size and location of the defects. A small proportion of atrial septal defects may have multiple fenestrations and these are often considered unsuitable for device closure. We report three cases of multiple atrial septal defects successfully closed with two Amplatzer septal occluders.

  15. Rural pharmacy closures: implications for rural communities.

    Science.gov (United States)

    Todd, Kelli; Ullrich, Fred; Mueller, Keith

    2013-01-01

    Retail pharmacies provide essential services to residents of rural areas and serve many communities as the sole provider of pharmacist services. Losing the only retail pharmacy within a rural community (census designated city), and within a 10 mile radius based on driving distance ("sole community pharmacy"), may affect access to prescription and over-the-counter drugs and, in some cases, leave the community without proximate access to any clinical provider. This policy brief documents the closure of local retail pharmacies in which the pharmacist was the only clinical provider available in the community at the time the pharmacy closed. Characteristics of the community and the retail pharmacy are described. The findings may suggest future policy actions to minimize the risk or mitigate the negative consequences of pharmacy closures. Key Findings. (1) Between May 1, 2006, and October 31, 2010, 119 sole community pharmacies closed. (2) Of those 119 pharmacies, 31 were located in rural communities with no other health professionals or clinical providers. (3) In 16 states, at least 1 community lost a sole community retail pharmacy, and there was no other pharmacy within 10 miles (actual driving distance). (4) Of the 31 pharmacy closures in communities with no other providers, 17% were located in remote rural areas designated with a Rural-Urban Commuting Area (RUCA) score of 10 or higher. Such a score means that, on average, 60 minutes of travel time is required to reach an urbanized area, and 40 minutes is required to reach a large urban cluster of 20,000 population or more.

  16. Prevention of recurrent cryptogenic stroke with percutaneous closure of patent foramen ovale; one year follow-up study with magnetic resonance imaging and Holter monitoring.

    Science.gov (United States)

    Ateş, Ahmet Hakan; Sunman, Hamza; Aytemir, Kudret; Yorgun, Hikmet; Canpolat, Uğur; Topcuoğlu, Mehmet Akif; Karlı Oğuz, Kader; Şahiner, Levent; Kaya, Ergün Barış; Tokgözoğlu, Lale; Kabakçı, Giray; Oto, Ali

    2015-01-01

    In this study, we aimed to evaluate the effect of percutaneous closure of patent foramen ovale (PFO) on the recurrence of stroke and new cardiac arrhythmia using magnetic resonance imaging (MRI) and Holter monitoring. Patients with PFO had >1 previous stroke or transient ischemic attack documented with MRI in the first event. PFO with right to left shunt was detected by transesophageal echocardiography (TEE) and transcranial Doppler ultrasound. MRI examinations were performed on patients before and one year after PFO closure was applied. A twenty-four hour Holter monitoring was performed in all patients within 1 month before and 6 months after the procedure. Percutaneous PFO closure was performed on 47 patients (25 female, mean age: 38.7 years) who had cerebral ischemic events detected by MRI. A year after the procedure, TEE showed that there was no residual interatrial right-to-left shunting. After a 14 month follow-up, no new cerebrovascular event and no new lesion on MRI were recorded. The incidence of arrhythmia did not increase significantly after the procedure on Holter monitoring (p=0.917). One-year clinical and MRI follow-up study of patients with cerebral ischemic events and percutaneous closure of PFO showed no recurrent event and no significant complication associated with the procedure. In addition, Holter monitorization demonstrated that the procedure did not increase the incidence of arrhythmias compared with pre-procedural monitoring.

  17. PFO closure with only fluoroscopic guidance: 7 years real-world single centre experience.

    Science.gov (United States)

    Mangieri, Antonio; Godino, Cosmo; Montorfano, Matteo; Arioli, Francesco; Rosa, Isabella; Ajello, Silvia; Piraino, Daniela; Monello, Alberto; Pavon, Anna Giulia; Viani, Giacomo; Magni, Valeria; Cappelletti, Alberto; Margonato, Alberto; Colombo, Antonio

    2015-07-01

    To evaluate the safety and the efficacy of fluoroscopy-guided only (Fluo-G) and of echocardiography-guided (Echo-G; trans-esophageal echocardiography-TEE-or intracardiac echocardiography-ICE) percutaneous closure of patent foramen ovale (PFO). Single center retrospective registry enrolling 368 consecutive patients (mean age 50.5 years) who underwent PFO closure between June 2004 and December 2011. Most patients had prior cryptogenic stroke (n = 126; 34.2%), TIA (n = 218; 51.1%); some of these had recurrent neurological events [multiple strokes n = 28 (7.8%); multiple TIAs n = 72 (18.6%)]. All the patients underwent a preprocedure TEE. PFO closure was performed with Echo-G in 187 patients (50.8%) (TEE n = 69, 36.8% and ICE n = 124, 66.3%). In Fluo-G cases, PFO with atrial septal aneurysm (ASA) was significantly less present (P Fluo-G group (P Fluo-G vs. 98.3% Echo-G) and RtL-shunt at follow-up (11.7% Fluo-G vs. 7.6% Echo-G). The rate of conversion from Fluoro-G to Echo-G procedure was 4.4% (n = 8). At a median follow-up of 4 years, freedom from recurrent embolic events rate was similar between the two groups (Echo-G 94.5 vs. Fluo-G 95.7%). In our experience Fluoro-G PFO closure was performed mainly in cases of simple anatomy, with similar results in terms of safety and efficacy compared to Echo-G cases. Both fluoroscopy and total procedural times were lower in the Fluo-G cases. © 2015 Wiley Periodicals, Inc.

  18. 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

  19. Narrative Intelligibility and Closure in Interactive Systems

    DEFF Research Database (Denmark)

    Bruni, Luis Emilio; Baceviciute, Sarune

    2013-01-01

    ), which in turn can be seen as a function of Narrative Intelligibility. AAD can also be influenced by the intended or unintended level of abstractedness or didascalicity (i.e. figurativeness) of a given narrative. We define narrative intelligibility in complementarity with the related notion of Narrative...... Closure. We also make a distinction between the goals of the system and the goals of the narrative that it mediates, and consider the proposed parameters at two interrelated levels of analysis: the system level and the embedded narrative level, as the normative values and goals of these two levels should...

  20. 100-N Area underground storage tank closures

    Energy Technology Data Exchange (ETDEWEB)

    Rowley, C.A.

    1993-08-01

    This report describes the removal/characterization actions concerning underground storage tanks (UST) at the 100-N Area. Included are 105-N-LFT, 182-N-1-DT, 182-N-2-DT, 182-N-3-DT, 100-N-SS-27, and 100-N-SS-28. The text of this report gives a summary of remedial activities. In addition, correspondence relating to UST closures can be found in Appendix B. Appendix C contains copies of Unusual Occurrence Reports, and validated sampling data results comprise Appendix D.

  1. Defense Base Closure and Realignment Commission

    Science.gov (United States)

    1993-01-01

    international responsibilities with more limited resources. ýeS~ectfully yours , im Courter k,"Chairman CAPT Peter 𔃽owman, USN (Ret) C mBeverly Byr bea Cox...sub tania and, the forc tr- a clear decline in the period 1995-1999. Thus, turc plan and fial criteria and, therefore, theas te wrk clnes theexcss...restoration (cleanup) costs in the cost of closure, on the status of this request to the 1995 since DoD is obligated to clean up bases Commission. regardless

  2. Multiple coil closure of isolated aortopulmonary collateral

    Directory of Open Access Journals (Sweden)

    Padhi Sumanta

    2010-01-01

    Full Text Available A 7-month-old girl was diagnosed to have large aortopulmonary collateral during evaluation for congestive heart failure. There was no other evidence of cardiopulmonary disease. The collateral was successfully closed with multiple coils delivered sequentially. We describe the issues associated during closure of the aortopulmonary collateral in this case. To the best of our knowledge, this is the first reported case of large aortopulmonary collateral presenting with heart failure in an otherwise structurally normal heart that was closed successfully with multiple coils delivered sequentially.

  3. U.S. Small Business HUBZone Base Closure Areas

    Data.gov (United States)

    Small Business Administration — HUBZone Qualitified Base Closure Areas - the lands within the boundaries of a military installation that was closed through a privatization process under the Federal...

  4. Effect of crack surface geometry on fatigue crack closure

    Energy Technology Data Exchange (ETDEWEB)

    Drury, W.J. [P and L Technologies, Inc., Atlanta, GA (United States); Gokhale, A.M. [Georgia Inst. of Tech., Atlanta, GA (United States). School of Materials Science and Engineering; Antolovich, S.D. [Washington State Univ., Pullman, WA (United States). School of Mechanical and Materials Engineering

    1995-10-01

    The geometry of crack faces often plays a critical role in reducing crack extension forces when crack closure occurs during fatigue crack growth. Most previous studies of fatigue crack closure are concerned with mechanical measure of closure as related to the crack growth rate; very little attention has been given to the geometry of the crack surfaces. The objective is to identify those aspects of crack surface geometry that are important in the closure process, to develop quantitative fractographic techniques to estimate such attributes in a statistically significant and robust manner, and to correlate them to the physical process of crack closure. For this purpose, fatigue crack propagation experiments were performed on a Ni-base superalloy and crack growth rates and crack closure loads were measured. Digital image profilometry and software-based analysis techniques were used for statistically reliable and detailed quantitative characterization of fatigue crack profiles. It is shown that the dimensionless, scale-independent attributes, such a height-to-width ratio of asperities, fractal dimensions, dimensionless roughness parameters, etc., do not represent the aspects of crack geometry that are of primary importance in the crack closure phenomena. Furthermore, it is shown that the scale-dependent characteristics, such as average asperity height, do represent the aspects of crack geometry that play an interactive role in the closure process. These observations have implications concerning the validity of geometry-dependent, closure-based models for fatigue crack growth.

  5. Comparison of outcome and complications using different types of devices for percutaneous closure of a secundum atrial septal defect in adults: a single-center experience.

    Science.gov (United States)

    Post, Martijn C; Suttorp, Maarten J; Jaarsma, Wybren; Plokker, H W Thijs

    2006-03-01

    The objective of this study was to find differences in outcome and complications using three different types of devices for percutaneous atrial septal defect (ASD) closure in adults. Percutaneous closure of a secundum-type ASD is increasingly performed in adult patients. All adult patients who underwent a percutaneous closure of a secundum-type ASD in our center between November 1996 and November 2004 were included. Failure was defined as dislocation or embolization of the device, which required surgical intervention. Periprocedural and mid-term complications were registered. Sixty-five patients, mean age 45.7+/-18.1 years (18 men, 47 women), underwent a percutaneous closure of an ASD with an ASDOS in 3, an Amplatzer in 36, and a Cardioseal/Starflex closure device in 26 patients. During an overall median follow-up of 1.2 years (range, 0.1-6.7 years), the failure occurred in four patients, all Cardioseal/Starflex (P=0.04). Within the Cardioseal/Starflex subgroup, the ASD and device diameters were significantly higher in those patients in whom the primary endpoint occurred compared to the others, 18.8+/-3.8 vs. 13.0+/-3.8 mm for ASD diameter (P=0.01) and 40 (range, 40-43) vs. 33 mm (range, 20-40) for device diameter (P=0.008). Overall complications were transient arrhythmias in 15.4%, pericardial effusion in 1.5%, and transient ischemic attack in 1.5%. Complete closure 6 months after the procedure occurred in 79.6%, without difference between the devices. Percutaneous ASD closure seems to be a relatively safe and effective procedure. However, using the larger Cardioseal/Starflex devices for closure seems to be related to a higher rate of device dislocation and embolization. Copyright (c) 2006 Wiley-Liss, Inc.

  6. Vascular Closure Devices in Interventional Radiology Practice.

    Science.gov (United States)

    Patel, Rafiuddin; Muller-Hulsbeck, Stefan; Morgan, Robert; Uberoi, Raman

    2015-08-01

    Manual compression (MC) is a well-established technique for haemostasis following percutaneous arterial intervention. However, MC is labour and time intensive with potential limitations, particularly for patients who are coagulopathic, unable to comply with bed rest or obese and when large sheaths or anti-coagulants are used. There are a variety of vascular closure devices (VCDs) available to overcome these limitations. This review gives an overview of current VCDs, their mechanism of action, individual strengths and weaknesses, evidence base and utility in interventional radiology (IR) practice. The majority of the published evidence on VCDs is derived from patients undergoing cardiac interventions, which should be borne in mind when considering the applicability and transfer of this data for general IR practice. Overall, the evidence suggests that most VCDs are effective in achieving haemostasis with a similar rate of complications to MC although the complication profile associated with VCDs is distinct to that of MC. There is insufficient evidence to comparatively analyse the different types of VCDs currently available or reliably judge their cost-effectiveness. The interventional radiologist should have a thorough understanding of the available techniques for haemostasis and be able to identify and utilise the most appropriate strategy and closure technique for the individual patient.

  7. Distributed Programming via Safe Closure Passing

    Directory of Open Access Journals (Sweden)

    Philipp Haller

    2016-02-01

    Full Text Available Programming systems incorporating aspects of functional programming, e.g., higher-order functions, are becoming increasingly popular for large-scale distributed programming. New frameworks such as Apache Spark leverage functional techniques to provide high-level, declarative APIs for in-memory data analytics, often outperforming traditional "big data" frameworks like Hadoop MapReduce. However, widely-used programming models remain rather ad-hoc; aspects such as implementation trade-offs, static typing, and semantics are not yet well-understood. We present a new asynchronous programming model that has at its core several principles facilitating functional processing of distributed data. The emphasis of our model is on simplicity, performance, and expressiveness. The primary means of communication is by passing functions (closures to distributed, immutable data. To ensure safe and efficient distribution of closures, our model leverages both syntactic and type-based restrictions. We report on a prototype implementation in Scala. Finally, we present preliminary experimental results evaluating the performance impact of a static, type-based optimization of serialization.

  8. IT SERVICES AVAILABILITY DURING CERN ANNUAL CLOSURE

    CERN Multimedia

    2002-01-01

    Mail, NICE 2000, Web, EDMS (in collaboration with EST Division), General purpose databases, lxbatch, lxplus, Automated tape devices, Castor, Backups, Campus Network, Remedy, Security and VPN services will be available during the CERN annual closure. Problems developing on these services should be addressed within about half a day except on Christmas and New Year evenings, December 25, 2002 and January 1st, 2003. All other services will be left running mostly unattended. No interruptions are scheduled but restoration of the service in case of failure cannot be guaranteed. It should be noted that the Helpdesk will be closed, that no file restores from backups will be possible and damaged tapes will not be processed. An operator service will be maintained and can be reached at extension 75011 or by email to computer.operations@cern.ch. Please remember to shutdown and power off any equipment in your office which is not foreseen to be used during the annual closure before you leave for the holiday.

  9. Vascular Closure Devices in Interventional Radiology Practice

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Rafiuddin, E-mail: rafiuddin.patel@ouh.nhs.uk [John Radcliffe Hospital, Department of Radiology (United Kingdom); Muller-Hulsbeck, Stefan, E-mail: muehue@diako.de [Diakonissen Hospital, Diagnostic and Interventional Radiology/Neuroradiology (Germany); Morgan, Robert, E-mail: robert.morgan@stgeorges.nhs.uk [St George’s Hospital, Department of Radiology (United Kingdom); Uberoi, Raman, E-mail: raman.uberoi@orh.nhs.uk [John Radcliffe Hospital, Department of Radiology (United Kingdom)

    2015-08-15

    Manual compression (MC) is a well-established technique for haemostasis following percutaneous arterial intervention. However, MC is labour and time intensive with potential limitations, particularly for patients who are coagulopathic, unable to comply with bed rest or obese and when large sheaths or anti-coagulants are used. There are a variety of vascular closure devices (VCDs) available to overcome these limitations. This review gives an overview of current VCDs, their mechanism of action, individual strengths and weaknesses, evidence base and utility in interventional radiology (IR) practice. The majority of the published evidence on VCDs is derived from patients undergoing cardiac interventions, which should be borne in mind when considering the applicability and transfer of this data for general IR practice. Overall, the evidence suggests that most VCDs are effective in achieving haemostasis with a similar rate of complications to MC although the complication profile associated with VCDs is distinct to that of MC. There is insufficient evidence to comparatively analyse the different types of VCDs currently available or reliably judge their cost-effectiveness. The interventional radiologist should have a thorough understanding of the available techniques for haemostasis and be able to identify and utilise the most appropriate strategy and closure technique for the individual patient.

  10. On closure parameter estimation in chaotic systems

    Directory of Open Access Journals (Sweden)

    J. Hakkarainen

    2012-02-01

    Full Text Available Many dynamical models, such as numerical weather prediction and climate models, contain so called closure parameters. These parameters usually appear in physical parameterizations of sub-grid scale processes, and they act as "tuning handles" of the models. Currently, the values of these parameters are specified mostly manually, but the increasing complexity of the models calls for more algorithmic ways to perform the tuning. Traditionally, parameters of dynamical systems are estimated by directly comparing the model simulations to observed data using, for instance, a least squares approach. However, if the models are chaotic, the classical approach can be ineffective, since small errors in the initial conditions can lead to large, unpredictable deviations from the observations. In this paper, we study numerical methods available for estimating closure parameters in chaotic models. We discuss three techniques: off-line likelihood calculations using filtering methods, the state augmentation method, and the approach that utilizes summary statistics from long model simulations. The properties of the methods are studied using a modified version of the Lorenz 95 system, where the effect of fast variables are described using a simple parameterization.

  11. Transcatheter Closure of Atrial Septal Defects Improves Cardiac Remodeling and Function of Adult Patients with Permanent Atrial Fibrillation

    Institute of Scientific and Technical Information of China (English)

    Liang Chen; Yuan Bai; Fei-Yu Wang; Zhi-Gang Zhang; Xing-Hua Shan; Tao Chen; Xian-Xian Zhao

    2015-01-01

    Background:Permanent atrial fibrillation (AF) is the most common form of dysrhythmia associated with atrial septal defects (ASDs) in patients older than 40 years.However,little is known about cardiac remodeling after transcatheter closure in patients with permanent AF.This study was designed to compare cardiac events and remodeling effects after transcatheter closure in such patients.Methods:Clinical data of 289 adult patients older than 40 years who underwent ASD closure at our center were analyzed retrospectively.Of them,63 patients with permanent AF were assigned to the case group,and the other 226 patients without permanent AF were assigned to the control group.Cardiac events and changes in left and right cardiac cavity dimensions before the procedure and 6 months after the procedure were compared between the two groups.Results:Patients in the case group were significantly older than those in the control group.The right ventricular (RV) volume and right atrial (RA) volume were decreased significantly in both the groups during a median follow-up period of 6 months after closure (P < 0.001).The left atrial dimensions,left ventricular end-systolic dimensions,left ventricular end-diastolic dimensions and left ventricular ejection fraction showed no significant change before and after the procedure in both the groups.Changes of the RV volume and RA volume in the case group were significantly smaller than those in the control group (P =0.005 and P < 0.001).The New York Heart Association cardiac function was improved in both the groups during the 6 months follow-up period.Conclusions:The transcatheter closure of ASD can improve the cardiac remodeling and cardiac function in patients with or without AF.

  12. Transcatheter Closure of Atrial Septal Defects Improves Cardiac Remodeling and Function of Adult Patients with Permanent Atrial Fibrillation

    Directory of Open Access Journals (Sweden)

    Liang Chen

    2015-01-01

    Full Text Available Background: Permanent atrial fibrillation (AF is the most common form of dysrhythmia associated with atrial septal defects (ASDs in patients older than 40 years. However, little is known about cardiac remodeling after transcatheter closure in patients with permanent AF. This study was designed to compare cardiac events and remodeling effects after transcatheter closure in such patients. Methods: Clinical data of 289 adult patients older than 40 years who underwent ASD closure at our center were analyzed retrospectively. Of them, 63 patients with permanent AF were assigned to the case group, and the other 226 patients without permanent AF were assigned to the control group. Cardiac events and changes in left and right cardiac cavity dimensions before the procedure and 6 months after the procedure were compared between the two groups. Results: Patients in the case group were significantly older than those in the control group. The right ventricular (RV volume and right atrial (RA volume were decreased significantly in both the groups during a median follow-up period of 6 months after closure (P < 0.001. The left atrial dimensions, left ventricular end-systolic dimensions, left ventricular end-diastolic dimensions and left ventricular ejection fraction showed no significant change before and after the procedure in both the groups. Changes of the RV volume and RA volume in the case group were significantly smaller than those in the control group (P = 0.005 and P < 0.001. The New York Heart Association cardiac function was improved in both the groups during the 6 months follow-up period. Conclusions: The transcatheter closure of ASD can improve the cardiac remodeling and cardiac function in patients with or without AF.

  13. The StarClose Vascular Closure System: interventional results from the CLIP study.

    Science.gov (United States)

    Hermiller, J B; Simonton, C; Hinohara, T; Lee, D; Cannon, L; Mooney, M; O'Shaughnessy, C; Carlson, H; Fortuna, R; Zapien, M; Fletcher, D R; DiDonato, K; Chou, T M

    2006-11-01

    The StarClose Vascular Closure System is a femoral access site closure technology that uses a flexible nitinol clip to complete a circumferential, extravascular arteriotomy close. The Clip CLosure In Percutaneous Procedures study was initiated to study the safety and efficacy of the StarClose device in subjects undergoing diagnostic and interventional catheterization procedures. A total of 17 U.S. sites enrolled 596 subjects, with 483 subjects randomized at a 2:1 ratio to receive StarClose or standard compression of the arteriotomy after the percutaneous procedure. The study included roll-in (n = 113), diagnostic (n = 208), and interventional (n = 275) arms with a primary safety endpoint of major vascular complications through 30 days and a primary efficacy endpoint of postprocedure time to hemostasis. The results of the diagnostic StarClose cohort have been reported separately. Results for the interventional arm revealed major vascular complications occurring in 1.1% of StarClose subjects (2/184) and 1.1% in manual compression subjects (1/91; P = 1.00). No infections were seen in either cohort. Minor complications in the StarClose interventional group occurred at a rate of 4.3% (8/184) and with compression at 9.9% (9/91; P = 0.107). Pseudoaneurysm or arteriovenous fistula was not seen with StarClose. With StarClose, procedural success was 100% (136/136) for the diagnostic group and 98.9% (181/183) in the interventional group. Device success for the treatment group was 86.8%. In the interventional cohort, 87.3% (158/181) of StarClose subjects reported a pain scale of 0-3 compared with 93.3% (84/90) in the compression group, which was not statistically different. The clinical results of this study demonstrate that the StarClose Vascular Closure System is noninferior to manual compression with respect to the primary safety endpoint of major vascular events in subjects who undergo percutaneous interventional procedures. StarClose significantly reduced time to

  14. Left Atrial Appendage Closure for Atrial Fibrillation Is Safe and Effective After Intracranial or Intraocular Hemorrhage.

    Science.gov (United States)

    Fahmy, Peter; Spencer, Ryan; Tsang, Michael; Gooderham, Peter; Saw, Jacqueline

    2016-03-01

    Atrial fibrillation (AF) affects 1%-2% of the general population and 13% of individuals older than 80 years of age. Anticoagulation has been the mainstay therapy to reduce stroke risk. Patients with previous intracranial hemorrhage (ICH) or intraocular hemorrhage (IOH) are at increased risk of recurrence if anticoagulation is continued or initiated. Left atrial appendage (LAA) closure may obviate the need for long-term anticoagulation in these patients. We report our consecutive series of patients with nonvalvular AF with previous ICH or IOH who underwent LAA closure with the AMPLATZER Cardiac Plug (ACP; St Jude Medical, St Paul, MN), AMPLATZER Amulet, or WATCHMAN (Boston Scientific, Natick, MA) device. Demographics, clinical status, procedural outcomes, and complications were collected at baseline, during the procedure, at 3 months, at 1 year, and annually thereafter. Twenty-six patients with previous ICH (n = 24) or IOH (n = 2) underwent LAA closure (9 with the ACP, 3 with the Amulet, and 7 with the WATCHMAN). The mean age was 76 ± 7 years, and 61.5% were men with a mean CHADS2 (Congestive Heart Failure, Hypertension, Age, Diabetes, Stroke/Transient Ischemic Attack) score of 3.2 ± 1.4 and CHA2DS2-VASc (Congestive Heart Failure, Hypertension, Age [≥ 75 years], Diabetes, Stroke/Transient Ischemic Attack, Vascular Disease, Age [65-74 years], Sex [Female] score) of 4.9 ± 1.7. No procedure-related complications occurred. Mean follow-up was 11.9 ± 13.3 months. One patient died at 13 months (this death was not related to the procedure), and 1 patient had a transient ischemic attack at 20.6 months after the procedure. No ischemic stroke, haemorrhagic stroke, or bleeding problems occurred during follow-up. In our consecutive series, LAA closure was found to be safe and effective in patients with AF and a history of ICH or IOH. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  15. Dental Procedures.

    Science.gov (United States)

    Ramponi, Denise R

    2016-01-01

    Dental problems are a common complaint in emergency departments in the United States. There are a wide variety of dental issues addressed in emergency department visits such as dental caries, loose teeth, dental trauma, gingival infections, and dry socket syndrome. Review of the most common dental blocks and dental procedures will allow the practitioner the opportunity to make the patient more comfortable and reduce the amount of analgesia the patient will need upon discharge. Familiarity with the dental equipment, tooth, and mouth anatomy will help prepare the practitioner for to perform these dental procedures.

  16. Surgical closure of postlaryngectomy pharyngocutaneous fistula: a defect based approach.

    Science.gov (United States)

    Magdy, Emad A

    2008-01-01

    Surgical repair of postlaryngectomy pharyngocutaneous fistula (PCF) can be challenging. Although several studies describe separate reconstruction methods, only few address the variability in defect characteristics and hence flap selection. The current clinical study presents a retrospective review of 19 patients who underwent surgical repair of persistent PCFs, over a 4-year period in a tertiary referral institute by a single primary surgeon. All but one patient were men with a mean age of 61 +/- 10 years. Nine patients had previous unsuccessful attempts for surgical closure. Previous neck irradiation was the most common comorbid condition encountered (52.6%), followed by low hemoglobin level (47.4%), hepatic disease (36.8%) and diabetes mellitus (31.6%). According to defect characteristics, six patients received a local cervical skin procedure, ten patients had reconstructions using the pectoralis major musculocutaneous flap and three patients required a radial forearm free flap repair. All PCFs were eventually successfully closed with no major complications. Patients were followed-up for an average of 19.7 months (range, 5-38 months). Acceptable oral swallowing results were achieved in all but one patient. In conclusion, successful results are achievable in difficult persistent PCF cases with a defect based reconstruction approach kept in mind.

  17. Designing Flaps for Closure of Circular and Semicircular Skin Defects.

    Science.gov (United States)

    Alvarado, Alfredo

    2016-01-01

    Removing skin lesions from the human body is a simple procedure, but closing the resulting defect may prove a difficult task. The surgeon quite often encounters a problem when the lesion is located in a confined anatomical area where the elasticity of the skin is limited or when the lesion is large. To obviate these difficulties, I present 4 new incisions for closure of circular and semicircular skin defects on difficult parts of the human body such as the scalp, face, axilla, back, and sacrococcygeal areas. This article describes a working model made of white bond paper that can be enlarged or reduced in size using a regular copying machine that can be prepared in advance of surgery to make sure that it adapts to a particular anatomical location. Also, it describes a geometrical analysis in order to determine the distortion of the minimal tension lines of the skin, skin wastage, and length of the suture lines. In summary, it is possible to use a variety of skin incisions, taking advantage of the minimal tension lines of the skin and also taking into consideration the anatomical characteristics of the region involved.

  18. 77 FR 55895 - Permanent Closure of Cincinnati Blue Ash Airport

    Science.gov (United States)

    2012-09-11

    ... Federal Aviation Administration Permanent Closure of Cincinnati Blue Ash Airport AGENCY: Federal Aviation Administration (FAA), DOT. ACTION: Notice of permanent closure of Cincinnati Blue Ash Airport (ISZ). SUMMARY: The... Cincinnati advising that on August 29, 2012, it was permanently closing Cincinnati Blue Ash Airport...

  19. The use of paper tape in wound closures.

    Science.gov (United States)

    Danto, L A; Albertazzi, V J; Elliott, T E; Love, F G

    1986-12-01

    The techniques described using paper tape in wound closure have been found to be cosmetically equal to or better than other forms of wound closure. Paper tape provides better support, is more versatile and care free, while being easier to use and less expensive than Steri Strips.

  20. Incomplete RV Remodeling After Transcatheter ASD Closure in Pediatric Age.

    Science.gov (United States)

    Agha, Hala M; El-Saiedi, Sonia A; Shaltout, Mohamed F; Hamza, Hala S; Nassar, Hayat H; Abdel-Aziz, Doaa M; Tantawy, Amira Esmat El

    2015-10-01

    Published data showing the intermediate effect of transcatheter device closure of atrial septal defect (ASD) in the pediatric age-group are scarce. The objective of the study was to assess the effects of transcatheter ASD closure on right and left ventricular functions by tissue Doppler imaging (TDI). The study included 37 consecutive patients diagnosed as ASD secundum by transthoracic echocardiography and TEE and referred for transcatheter closure at Cairo University Specialized Pediatric Hospital, Egypt, from October 2010 to July 2013. Thirty-seven age- and sex-matched controls were selected. TDI was obtained using the pulsed Doppler mode, interrogating the right cardiac border (the tricuspid annulus) and lateral mitral annulus, and myocardial performance index (MPI) was calculated at 1-, 3-, 6- and 12-month post-device closure. Transcatheter closure of ASD and echocardiographic examinations were successfully performed in all patients. There were no significant differences between two groups as regards the age, gender, weight or BSA. TDI showed that patients with ASD had significantly prolonged isovolumetric contraction, relaxation time and MPI compared with control group. Decreased tissue Doppler velocities of RV and LV began at one-month post-closure compared with the controls. Improvement in RVMPI and LVMPI began at 1-month post-closure, but they are still prolonged till 1 year. Reverse remodeling of right and left ventricles began 1 month after transcatheter ASD closure, but did not completely normalize even after 1 year of follow-up by tissue Doppler imaging.

  1. Managing waste exports when closure risks are endogenous

    OpenAIRE

    Stähler, Frank; Michaelis, Peter

    1993-01-01

    This paper provides a rationale for taxing waste exports when closure risks are endogenous in that they depend on the importing country's accumulated stock of waste. The paper shows that the optimal time path of waste exports requires a progressively increasing tax rate which even surmounts a Hotelling tax which tackles the problem by evaluating the expected closure stock.

  2. 30 CFR 57.4603 - Closure of valves.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Closure of valves. 57.4603 Section 57.4603... Control Welding/cutting/compressed Gases § 57.4603 Closure of valves. To prevent accidental release of... or manifold system valves shall be closed when— (a) The cylinders are moved; (b) The torch and...

  3. 30 CFR 56.4603 - Closure of valves.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Closure of valves. 56.4603 Section 56.4603... Control Welding/cutting/compressed Gases § 56.4603 Closure of valves. To prevent accidental release of... or manifold system valves shall be closed when— (a) The cylinders are moved; (b) The torch and...

  4. On the normality of orbit closures which are hypersurfaces

    Indian Academy of Sciences (India)

    Nguyen Quang Loc

    2016-02-01

    Let be a quiver representation with non-zero admissible annihilator. In this paper, we prove the normality of the orbit closure $\\bar{\\mathcal{O}}_{N}$ when it is a hypersurface. The result thus gives new examples of normal orbit closures of quiver representations.

  5. 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.

  6. Localization of Tight Closure in Two-Dimensional Rings

    Indian Academy of Sciences (India)

    Kamran Divaani-Aazar; Massoud Tousi

    2005-02-01

    It is shown that tight closure commutes with localization in any two-dimensional ring of prime characteristic if either is a Nagata ring or possesses a weak test element. Moreover, it is proved that tight closure commutes with localization at height one prime ideals in any ring of prime characteristic.

  7. 40 CFR 267.142 - Cost estimate for closure.

    Science.gov (United States)

    2010-07-01

    ... dollars, or by using an inflation factor derived from the most recent Implicit Price Deflator for Gross... active life of the facility, the owner or operator must adjust the closure cost estimate for inflation... closure cost estimate must be updated for inflation within 30 days after the close of the firm's fiscal...

  8. 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.

  9. Guinea pig ductus arteriosus. II - Irreversible closure after birth.

    Science.gov (United States)

    Fay, F. S.; Cooke, P. H.

    1972-01-01

    To investigate the mechanism underlying irreversibility of ductal closure after birth, studies were undertaken to determine the exact time course for the onset of irreversible closure of the guinea pig ductus arteriosus. Parallel studies of the reactivity of ductal smooth muscle to oxygen and studies of the postpartum cellular changes within the vessel were also carried out.

  10. Fatigue Crack Closure Analysis Using Digital Image Correlation

    Science.gov (United States)

    Leser, William P.; Newman, John A.; Johnston, William M.

    2010-01-01

    Fatigue crack closure during crack growth testing is analyzed in order to evaluate the critieria of ASTM Standard E647 for measurement of fatigue crack growth rates. Of specific concern is remote closure, which occurs away from the crack tip and is a product of the load history during crack-driving-force-reduction fatigue crack growth testing. Crack closure behavior is characterized using relative displacements determined from a series of high-magnification digital images acquired as the crack is loaded. Changes in the relative displacements of features on opposite sides of the crack are used to generate crack closure data as a function of crack wake position. For the results presented in this paper, remote closure did not affect fatigue crack growth rate measurements when ASTM Standard E647 was strictly followed and only became a problem when testing parameters (e.g., load shed rate, initial crack driving force, etc.) greatly exceeded the guidelines of the accepted standard.

  11. Endoscopic closure of large septal perforations with bilateral Hadad-Bassagasteguy flaps.

    Science.gov (United States)

    Morera Serna, Eduardo; Ferrán de la Cierva, Luis; Fernández, Meritxell Tomás; Canut, Santiago Quer; Mesquida, Jacoba Alba; Purriños, Francisco José García

    2017-03-01

    Surgical closure of nasal septal perforations is one of the most challenging procedures in nasal surgery. Defects greater than 2 cm are especially difficult to repair with the traditional approaches due to the challenges of mobilizing enough mucosa to close big gaps, and avoiding airway stenosis in the process. We present a new technique to endoscopically close major septal perforations using bilateral Hadad-Bassagasteguy flaps. Four consecutive patients with septal perforations greater than 2 cm were operated at our institution. Bilateral Hadad-Bassagasteguy flaps were endoscopically raised, one of them above the defect and the other one below it, and rotated to partially cover the defect on each side. A deep temporalis fascia graft was sandwiched between the two flaps to provide a scaffold for schneiderian mucosa growth. Both flaps were covered with a silicone sheet for 3 weeks. A complete closure of the defect was accomplished in three of the four patients; partial closure was achieved in the other. Nasal crusting, epistaxis, and nasal breathing improved in all patients. Large defects of the nasal septum may be closed in selected cases by rotation of bilateral pedicled septal mucosal flaps partially covering the defect area, followed by secondary healing of the nasal mucosa over an autologous graft acting as an epithelial scaffold.

  12. 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.

  13. Comparison of voice outcomes after radial forearm free flap reconstruction versus primary closure after laryngectomy.

    Science.gov (United States)

    Alam, Daniel S; Vivek, Prashant P; Kmiecik, Joann

    2008-08-01

    Laryngectomy with primary closure and tracheoesophageal prosthesis (TEP) voice rehabilitation has been the mainstay of the management of patients with advanced laryngeal malignancy. When adequate mucosal tissue is not available, pharyngeal reconstruction with free flaps can be utilized. The speech outcomes of these patients have been traditionally considered inferior based on the findings of a limited number of studies. We report the results of a review of our experience with radial forearm free flap (RFFF) reconstruction of extensive laryngopharyngectomy defects vs our institutional outcomes seen with primary closure. Retrospective review. All patients treated with laryngectomy procedures with either primary closure (28 patients) or RFFF (20 patients) reconstructions at the Cleveland Clinic from 2002 through 2007 were included. Blinded evaluation with statistical analysis of standard speech outcomes measures (maximal sustained phonation, fluent count) as well as qualitative variables are reported. Based on our data collection, the two groups are statistically indistinguishable. These findings support the utility and effectiveness of the RFFF in pharyngeal reconstruction in achieving good voice outcomes.

  14. Using field inversion to quantify functional errors in turbulence closures

    Science.gov (United States)

    Singh, Anand Pratap; Duraisamy, Karthik

    2016-04-01

    A data-informed approach is presented with the objective of quantifying errors and uncertainties in the functional forms of turbulence closure models. The approach creates modeling information from higher-fidelity simulations and experimental data. Specifically, a Bayesian formalism is adopted to infer discrepancies in the source terms of transport equations. A key enabling idea is the transformation of the functional inversion procedure (which is inherently infinite-dimensional) into a finite-dimensional problem in which the distribution of the unknown function is estimated at discrete mesh locations in the computational domain. This allows for the use of an efficient adjoint-driven inversion procedure. The output of the inversion is a full-field of discrepancy that provides hitherto inaccessible modeling information. The utility of the approach is demonstrated by applying it to a number of problems including channel flow, shock-boundary layer interactions, and flows with curvature and separation. In all these cases, the posterior model correlates well with the data. Furthermore, it is shown that even if limited data (such as surface pressures) are used, the accuracy of the inferred solution is improved over the entire computational domain. The results suggest that, by directly addressing the connection between physical data and model discrepancies, the field inversion approach materially enhances the value of computational and experimental data for model improvement. The resulting information can be used by the modeler as a guiding tool to design more accurate model forms, or serve as input to machine learning algorithms to directly replace deficient modeling terms.

  15. On Conservation Equation Combinations and Closure Relations

    Directory of Open Access Journals (Sweden)

    William G. Gray

    2014-07-01

    Full Text Available Fundamental conservation equations for mass, momentum and energy of chemical species can be combined with thermodynamic relations to obtain secondary forms, such as conservation equations for phases, an internal energy balance and a mechanical energy balance. In fact, the forms of secondary equations are infinite and depend on the criteria used in determining which species-based equations to employ and how to combine them. If one uses these secondary forms in developing an entropy inequality to be used in formulating closure relations, care must be employed to ensure that the appropriate equations are used, or problematic results can develop for multispecies systems. We show here that the use of the fundamental forms minimizes the chance of an erroneous formulation in terms of secondary forms and also provides guidance as to which secondary forms should be used if one uses them as a starting point.

  16. Occupational closure in nursing work reconsidered

    DEFF Research Database (Denmark)

    Traynor, Michael; Nissen, Nina; Lincoln, Carol

    2015-01-01

    In healthcare, occupational groups have adopted tactics to maintain autonomy and control over their areas of work. Witz described a credentialist approach to occupational closure adopted by nursing in the United Kingdom during the 19th and early 20th centuries. However, the recent advancement...... = 59). The aim was to examine how these workers positioned themselves as professionals and accounted for professional boundaries. A thematic analysis revealed a complex situation in which participants were divided between articulating an acceptance of a subordinate role within traditional occupational......, while nurses abandon it for largely administrative roles. We conclude that the participants are the not unwilling agents of a managerially led project to reshape the workforce that cuts across existing occupational boundaries....

  17. Asymptotic Behavior of Integral Closures in Modules

    Institute of Scientific and Technical Information of China (English)

    R.Naghipour; P.Schenzel

    2007-01-01

    Let R be a commutative Noetherian Nagata ring,let M be a non-zero finitely generated R-module,and let I be an ideal of R such that height M I > O.In this paper,there is a definition of the integral closure Na for any submodule N of M extending Rees'definition for the case of a domain.As the main results,it is shown that the operation N →Na on the set of submodules N of M is a semi-prime operation,and for any submodule Nof M,the sequences Ass R M/(InN)a and hssR(InM)a/(InN)a (n=1,2,...) of associated prime ideals are increasing and ultimately constant for large n.

  18. Notice of car park and road closures

    CERN Multimedia

    2006-01-01

    The transfer of the two HF CMS detectors between Hall 186 and Point 5 (a convoy measuring 64 metres in length and weighing 440 tonnes) will result in the temporary closure of the following car parks: Building186: south entrance Building 613 Building 28 Building181 south entrance Building 600 Building 31 Route OPPENHEIMER The car parks concerned will be closed from Sunday 2 July until the evening of Tuesday 4 July and from Sunday 9 July until the evening of Tuesday 11 July 2006. Route FEYNMAN is also expected to be closed to traffic from mid-morning on Monday 3 July until the evening of Tuesday 4 July and from mid-morning on Monday 10 July until the evening of Tuesday 11 July (possible deviation via route FERMI and route RUTHERFORD). Thank you for your cooperation. TS-IC Group Tel. 163380 - 164043

  19. Notice of car park and road closures

    CERN Multimedia

    2006-01-01

    The transfer of the two HF CMS detectors between Hall 186 and Point 5 (a convoy measuring 64 metres in length and weighing 440 tonnes) will result in the temporary closure of the following car parks: Building186: south entrance Building 613 Building 28 Building181 south entrance Building 600 Building 31 Route OPPENHEIMER The car parks concerned will be closed from Sunday 2 July until the evening of Tuesday 4 July and from Sunday 9 July until the evening of Tuesday 11 July 2006.Route FEYNMAN is also expected to be closed to traffic from mid-morning on Monday 3 July until the evening of Tuesday 4 July and from mid-morning on Monday 10 July until the evening of Tuesday 11 July (possible deviation via route FERMI and route RUTHERFORD).Thank you for your cooperation. TS-IC GroupTel. 163380 - 164043

  20. Dynamics of electrochemical flows 3 Closure models

    CERN Document Server

    Xu, Chengjun

    2013-01-01

    The electrolyte (comprising of solute ions and solvents) flow-through the porous media is frequently encountered in nature or in many engineering applications, such as the electrochemical systems, manufacturing of composites, oil production, geothermal engineering, nuclear thermal disposal, soil pollution. Our previous work derived the interfacial interaction terms between the solid and the fluid, which can be used to investigate the details of transports of mass, heat, electric flied, potential, or momentum in the process of the electrochemical flows-through porous electrode. In this work, we establish the closure models for these interfacial interaction terms to close the governing equations from mathematical algebra. The interfacial interaction terms regard to the electric field, potential and electric force are firstly revealed. Our new theory provides a new approach to describe the electrochemical flows-through porous media.

  1. Device closure of post-myocardial infarction ventricular septal defect three weeks after coronary angioplasty

    Science.gov (United States)

    Patnaik, A. N.; Barik, Ramachandra; Kumari, N. Rama; Gulati, A. S.

    2012-01-01

    Percutaneus device closure appears to be safe and effective in patients treated for a residual shunt after initial surgical closure, as well as after two to three weeks of index myocardial infarction. The index case presented with a ventricular septal defect on second of acute myocardial infarction thrombolysed with streptokinase. The general condition of the patient was fairly stable. Cardiac catheterization and coronary angiography showed significant left to right shunt and there was 90 % proximal stenosis of left anterior descending coronary artery. Other coronary arteries were normal. Angioplasty and stenting to the coronary artery lesion was done using drug eluting stent (DES) with very good angiographic result. Patient was discharged after four days in stable condtion. After 3 weeks his ventricular septal defect was closed percutaneusly using cardio -O-fix device with tiny residual shunt. The procedure was uneventful and of brief duration. He was discharged after 5 days of the post procedure in very stable condition with minimal residual shunt. A staged procedure is a better option if the condition of the patient allows strengthening ventricular septal defect border. PMID:22629038

  2. Decommissioning and Closure of the Morsleben Deep Geological Repository - The Final Step

    Energy Technology Data Exchange (ETDEWEB)

    Ripkens, M.; Biurrun, E.

    2002-02-26

    In Germany, a deep geologic repository for low and intermediate-level waste has been in operation since 1971. This repository, which is located in the territory of former Eastern Germany, became a Federal Facility in the wake of German reunification in 1990. Since then, waste from all of Germany was disposed of until a stop ordered by BfS in 1998. The site is now in the process of being decommissioned and later closed down. This process includes updating the concept for guaranteeing appropriate waste isolation for as long as the waste remains a hazard. During the licensing procedure being currently conducted, in line with German requirements for repository sites, the site operator must provide convincing proof of the facility's long-term safety. Thereafter, implementation of the decommissioning and closure concept will follow. It is estimated that the licensing procedure will take until the year 2006. The decommissioning and closure process itself will require about 10 years. Reliable costs estimates are not yet available. This paper briefly covers the history of the Morsleben radioactive waste repository and provides a draft update on the status of the licensing procedure.

  3. 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.

  4. ICPP tank farm closure study. Volume 1

    Energy Technology Data Exchange (ETDEWEB)

    Spaulding, B.C.; Gavalya, R.A.; Dahlmeir, M.M. [and others

    1998-02-01

    The disposition of INEEL radioactive wastes is now under a Settlement Agreement between the DOE and the State of Idaho. The Settlement Agreement requires that existing liquid sodium bearing waste (SBW), and other liquid waste inventories be treated by December 31, 2012. This agreement also requires that all HLW, including calcined waste, be disposed or made road ready to ship from the INEEL by 2035. Sodium bearing waste (SBW) is produced from decontamination operations and HLW from reprocessing of SNF. SBW and HLW are radioactive and hazardous mixed waste; the radioactive constituents are regulated by DOE and the hazardous constituents are regulated by the Resource Conservation and Recovery Act (RCRA). Calcined waste, a dry granular material, is produced in the New Waste Calcining Facility (NWCF). Two primary waste tank storage locations exist at the ICPP: Tank Farm Facility (TFF) and the Calcined Solids Storage Facility (CSSF). The TFF has the following underground storage tanks: four 18,400-gallon tanks (WM 100-102, WL 101); four 30,000-gallon tanks (WM 103-106); and eleven 300,000+ gallon tanks. This includes nine 300,000-gallon tanks (WM 182-190) and two 318,000 gallon tanks (WM 180-181). This study analyzes the closure and subsequent use of the eleven 300,000+ gallon tanks. The 18,400 and 30,000-gallon tanks were not included in the work scope and will be closed as a separate activity. This study was conducted to support the HLW Environmental Impact Statement (EIS) waste separations options and addresses closure of the 300,000-gallon liquid waste storage tanks and subsequent tank void uses. A figure provides a diagram estimating how the TFF could be used as part of the separations options. Other possible TFF uses are also discussed in this study.

  5. 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.

  6. Perventricular device closure of residual muscular ventricular septal defects after repair of complex congenital heart defects in pediatric patients.

    Science.gov (United States)

    Zhu, Da; Tao, Kaiyu; An, Qi; Luo, Shuhua; Gan, Changping; Lin, Ke

    2013-01-01

    Residual muscular ventricular septal defects are surgical challenges, especially after the repair of complex congenital heart defects. We investigated perventricular device closure as a salvage technique in pediatric patients who had postoperative residual muscular ventricular septal defects. From February 2009 through June 2011, 14 pediatric patients at our hospital had residual muscular ventricular septal defects after undergoing surgical repair of complex congenital heart defects. Ten patients met our criteria for perventricular device closure of the residual defects: significant left-to-right shunting (Qp/Qs >1.5) or substantial hemodynamic instability (a defect ≥2 mm in size). The patients' mean age was 20.4 ± 13.5 months, and their mean body weight was 10 ± 3.1 kg. The median diameter of the residual defects was 4.2 mm (range, 2.5-5.1 mm). We deployed a total of 11 SQFDQ-II Muscular VSD Occluders (Shanghai Shape Memory Alloy Co., Ltd.; Shanghai, China) in the 10 patients, in accord with conventional techniques of perventricular device closure. The mean procedural duration was 31.1 ±9.1 min. We recorded the closure and complication rates perioperatively and during a 12-month follow-up period. Complete closure was achieved in 8 patients; 2 patients had persistent trivial residual shunts. No deaths, conduction block, device embolism, or other complications occurred throughout the study period. We conclude that perventricular device closure is a safe, effective salvage treatment for postoperative residual muscular ventricular septal defects in pediatric patients. Long-term studies with larger cohorts might further confirm this method's feasibility.

  7. Simple excision and closure of a distal limb of loop colostomy prolapse by stapler device.

    Science.gov (United States)

    Masumori, K; Maeda, K; Koide, Y; Hanai, T; Sato, H; Matsuoka, H; Katsuno, H; Noro, T

    2012-04-01

    Stomal prolapse is one of the common complications in transverse colostomy and can be managed conservatively in most cases; however, laparotomy and reconstruction of the stoma may sometimes be required, especially in case of irreducible colostomy prolapse. We have reported a simple local repair with reconstruction of the loop colostomy. We herein report a new more simple technique to avoid laparotomy and allow excision of the irreducible colostomy prolapse and complete closure of the distal limb of loop colostomy when no decompression is required in the distal limb of the stoma. In this procedure, the number of stapler and the time with blood loss for the operation can be saved.

  8. 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.

  9. A COMPARATIVE STUDY OF OVERLAY AND UNDERLAY MYRINGOPLASTY CONSIDERING CLOSURE OF PERFORATION AND HEARING RESULTS: OUR EXPERIENCE

    OpenAIRE

    Arumugam; Kannappan; Rizwan Rafeeque

    2016-01-01

    BACKGROUND Myringoplasty is an established procedure for closure of tympanic membrane perforations. The quest is on to improve the results further by studying various technique. METHODS In the present randomized prospective study of one-year duration, 103 patients having a dry large or a subtotal perforation were subjected to myringoplasty by overlay (51 cases) and underlay (52 cases) techniques. RESULTS The underlay technique resulted in a 94.2% (49 cases) success rat...

  10. Mid-term Follow-up of the Transcatheter Closure of Perimembranous Ventricular Septal Defects in Children Using the Amplatzer

    Directory of Open Access Journals (Sweden)

    Mehdi Ghaderian

    2016-03-01

    Full Text Available Background: The ventricular septal defect (VSD is the most common form of congenital heart defects. The purpose of this study was to evaluate the results of the early complications and mid-term follow-up of the transcatheter closure of the VSD using the Amplatzer VSD Occluder.Methods: Between April 2012 and October 2013, 110 patients underwent the percutaneous closure of the perimembranous VSD. During the procedure, the size and type of the VSD were obtained via ventriculography. A device at least 2 mm larger than the VSD diameter measured via ventriculography was deployed. The size of the VSD, size of the Amplatzer, and device-size to VSD-size ratio were calculated. After the confirmation of the suitable position of the device via echocardiography and left ventriculography, the device was released. Follow-up evaluations were done at discharge as well as at 1, 6, and 12 months and yearly thereafter for the VSD occlusion and complete heart block.Results: The study population comprised 62 females and 48 males. The mean age and weight of the patients at procedure were 4.3 ± 5.6 years (range: 2 to 14 and 14.9 ± 10.8 kg (range: 10 to 43. The average device size was 7.0 ± 2.5 mm (range: 4 to 14. The VSD occlusion rate was 72.8% at the completion of the procedure and rose up to 99.0% during the follow-up. The most serious significant complication was complete atrioventricular block, which was seen in 2 patients. The mean follow-up duration was 10.9 ± 3.6 months.Conclusion: The transcatheter closure of the perimembranous VSD was a safe and effective treatment with excellent closure rates in our study population. This procedure had neither mortality nor serious complications. 

  11. Incomplete left atrial appendage occlusion and thrombus formation after Watchman implantation treated with anticoagulation followed by further transcatheter closure with a second-generation Amplatzer Cardiac Plug (Amulet device).

    Science.gov (United States)

    Lam, Simon Cheung Chi; Bertog, Stefan; Sievert, Horst

    2015-02-01

    We report a case of incomplete left atrial appendage (LAA) closure after Watchman device (Atritech, Boston Scientific, Natrick, MA) implantation which subsequently developed a thrombus 3 years after the initial procedure. The thrombus resolved after a short period of anticoagulation with warfarin, and the LAA was successfully occluded with a second-generation Amplatzer Cardiac Plug (Amulet device, AGA, St Jude Medical, Minneapolis, MN). Incomplete LAA closure may be associated with increased risk of thrombus formation and further closure with a second device after a course of anticoagulation may be a reasonable and feasible strategy. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

  12. 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.

  13. Lip interactions and closure duration in labial consonants

    Science.gov (United States)

    Lofqvist, Anders

    2003-04-01

    This study examines interactions between the upper and lower lips in labial consonants where the duration of the oral closure is varied for linguistic purposes. Earlier work has shown that such interactions occur and that their magnitude is partly related to the duration of the oral closure. Lip movements were recorded in native Japanese speakers using a magnetometer system. Results show a positive correlation between the vertical positions of the upper and lower, when both are measured at the point in time where the lower lip reached its peak position during the oral closure. Since the peak vertical position of the lower lip increased with closure duration, the upper lip also had a higher vertical position at the same point in time for long than for short consonants. During the oral closure, the lower lip continued to move upward with a larger movement for long than for short consonants. Due to the mechanical interaction between the lips, the upper lip reversed its downward movement at the onset of the oral closure and also moved upward during the closure, again with a larger movement for long than for short consonants. [Work supported by NIH.

  14. Contraceptive procedures.

    Science.gov (United States)

    Beasley, Anitra; Schutt-Ainé, Ann

    2013-12-01

    Although most women desire to control the size and spacing of their family, the rate of unintended pregnancy in the United States remains high, with approximately half of all pregnancies being unintended. Reducing unintended pregnancy is a national public health goal, and the increased use of long-acting reversible contraceptives (LARCs) (intrauterine devices and implants) can help meet this goal. LARCs are among the most effective forms of contraception available. There are few contraindications to their use, and insertion and removal are straightforward procedures that are well tolerated in the outpatient office setting. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Potential uselessness and futility of left atrial appendage occlusion and patent foramen ovale closure in cardioembolic stroke.

    Science.gov (United States)

    Nicolosi, Gian L

    2017-02-16

    International guidelines indicate that interventional closure of left atrial appendage and patent foramen ovale may be considered in selected patients for stroke prevention. These procedures appear, however, from the published literature, at high risk of uselessness and futility in the single case, if not even capable to induce harm and adverse events. In fact, all reported systematic reviews and meta-analyses have not shown in a convincing manner the superiority of these procedures in stroke prevention, taking into account the occurrence of possible complications also, as compared with alternative medical treatment. On the basis of these considerations, it becomes very difficult to define always and unequivocally how adequate and complete was the information when given to each single candidate patient before the procedure by the Heart Team, the left atrial appendage occlusion Team or patent foramen ovale closure Team, potentially involved in conflict of interest. Before indicating these procedures, a complete diagnostic work-up should then be planned for each single patient to identify and treat not only one, but all concomitant risk factors and potential different cardioembolic sources. It could also be suggested to have, for each single candidate patient, a second independent opinion from physicians not involved in the procedure and possibly not operating in the same institution. This prudential approach could reduce in each single case the risk of uselessness, futility and even potential harm and adverse events of those procedures.

  16. Use of Amplatzer device for endobronchial closure of bronchopleural fistulas.

    Science.gov (United States)

    Kramer, Mordechai R; Peled, Nir; Shitrit, David; Atar, Eli; Saute, Milton; Shlomi, Dekel; Amital, Anat; Bruckheimer, Elchanan

    2008-06-01

    Bronchopulmonary fistula (BPF) is associated with high morbidity and mortality. It occurs as an uncommon but often severe complication of pneumonectomy. BPF may be treated by a range of surgical and medical techniques, including chest drain, Eloesser muscle flap, omental flap, transsternal bronchial closure, thoracoplasty, and prolonged therapy with antibiotic regimens. The use of bronchoscopy has been reported for the delivery of biological glue, coils, covered stents, and sealants. In this work, we describe a novel method of BPF closure using the Amplatzer device, which is commonly used for transcatheter closure of atrial septal defects.

  17. History of Sandia National Laboratories` auxiliary closure mechanisms

    Energy Technology Data Exchange (ETDEWEB)

    Weydert, J.C. [Sandia National Labs., Albuquerque, NM (United States); Ponder, G.M. [Geo-Centers, Inc., Albuquerque, NM (United States)

    1993-12-01

    An essential component of a horizontal, underground nuclear test setup at the Nevada Test Site is the auxiliary closure system. The massive gates that slam shut immediately after a device has been detonated allow the prompt radiation to pass, but block debris and hot gases from continuing down the tunnel. Thus, the gates protect experiments located in the horizontal line-of-sight steel pipe. Sandia National Laboratories has been the major designer and developer of these closure systems. This report records the history of SNL`s participation in and contributions to the technology of auxiliary closure systems used in horizontal tunnel tests in the underground test program.

  18. PRECL: A new method for interferometry imaging from closure phase

    CERN Document Server

    Ikeda, Shiro; Akiyama, Kazunori; Hada, Kazuhiro; Honma, Mareki

    2016-01-01

    For short-wavelength VLBI observations, it is difficult to measure the phase of the visibility function accurately. The closure phases are reliable measurements under this situation, though it is not sufficient to retrieve all of the phase information. We propose a new method, Phase Retrieval from Closure Phase (PRECL). PRECL estimates all the visibility phases only from the closure phases. Combining PRECL with a sparse modeling method we have already proposed, imaging process of VLBI does not rely on dirty image nor self-calibration. The proposed method is tested numerically and the results are promising.

  19. Spurious Shell Closures in the Relativistic Mean Field Model

    CERN Document Server

    Geng, L S; Toki, H; Long, W H; Shen, G

    2006-01-01

    Following a systematic theoretical study of the ground-state properties of over 7000 nuclei from the proton drip line to the neutron drip line in the relativistic mean field model [Prog. Theor. Phys. 113 (2005) 785], which is in fair agreement with existing experimental data, we observe a few spurious shell closures, i.e. proton shell closures at Z=58 and Z=92. These spurious shell closures are found to persist in all the effective forces of the relativistic mean field model, e.g. TMA, NL3, PKDD and DD-ME2.

  20. 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.

  1. Clinical experience with a circumferential clip-based vascular closure device in diagnostic catheterization.

    Science.gov (United States)

    Hermiller, James; Simonton, Charles; Hinohara, Tom; Lee, Daniel; Cannon, Louis; Mooney, Michael; O'Shaughnessy, Charles; Carlson, Harold; Fortuna, Richard; Yarbrough, Carol Anne; Zapien, Michael; Chou, Tony

    2005-10-01

    The StarClose Vascular Closure System (Abbott Vascular Devices, Redwood City, California) utilizes a small, flexible nitinol clip to complete a circumferential, extravascular closure of the femoral arteriotomy site. The StarClose is an investigational device in the United States, limited by Federal law to investigational use. The StarClose is CE Mark approved. The CLIP study was a prospective, randomized, multicenter trial utilizing a noninferiority design to compare the rate of major vascular complications and time-to-hemostasis using the StarClose system versus manual compression. A total of 596 subjects were enrolled, 208 of whom underwent diagnostic angiography. This diagnostic subset is the focus of this report. The primary safety endpoint was major vascular complications and the primary efficacy endpoint was time-to-hemostasis. All patients were followed at 30 days with a clinical exam. Subjects were randomized 2:1 to the StarClose (n = 136) or manual compression (n = 72). There were no major vascular complications in either group. Minor vascular complications occurred in 3 StarClose patients (2.2%), and 1 manual compression patient (1.4%) (p = 1.00). Use of the StarClose device reduced mean time-to-hemostasis from 15.47 +/- 11.4 to 1.46 +/- 4.5 minutes (p manual compression, and reduced the average time-to-ambulation from 269 +/- 135 to 163 +/- 105 minutes (p < or = 0.001). Device success was 94.1% (127/135), and procedural success was 100% (136/136). The clinical results of this study concluded that the StarClose Vascular Closure System is noninferior to standard compression with respect to the the primary safety endpoint of closing arteriotomies in patients who undergo percutaneous diagnostic procedures.

  2. Internal inguinal ring closure by laparoscopy using homologous pericardium grafts in horses

    Directory of Open Access Journals (Sweden)

    Julio David Spagnolo

    2016-02-01

    Full Text Available ABSTRACT: The occlusion of inguinal ring is the treatment to avoid the inguinal hernia in horses. The aim of this study is evaluate the efficacy of homologous pericardium grafts for internal inguinal ring closure in horses, comparing mechanical or manual laparoscopic suture. Cross over study, using six healthy intact male Mangalarga breed horses aged between 3 and 12 years. Horses were operated under general anesthesia in 25º Trendelenburg position. Five laparoscopic portals were employed. Pericardium grafts measuring 4x5cm were anchored covering the left and right internal inguinal rings using either manual intracorporeal suture or laparoscopic stapler. Horses were followed-up during 11 weeks when were submitted to a laparoscopic control. Surgical time, trans and postoperative complications and effectiveness of internal inguinal closure were evaluated and statistically analyzed. The level of significance was set at 5% P<0.05. The procedures were realized without complications and the mean time required for manual and mechanical suture procedures differed significantly (67.8±15.3 and 14.1±2.1 min respectively; P<0.05. All manually sutured grafts remained in place and partial suture dehiscence with incomplete occlusion of the internal inguinal ring was observed in two stapled grafts. Non-severe complications were observed trans or postoperatively. One synechiae and three omental adhesions were observed by laparoscopic control on day 77, but without clinical relevance in the evaluated period. The use of homologous pericardium grafts was effectiveness to internal inguinal ring closure by laparoscopy. Mechanical suture was faster to perform than manual, but provided less satisfactory results concerning safety of graft fixation.

  3. Spontaneous closure of midline diastema following frenectomy

    OpenAIRE

    Koora Kiran; Muthu M; Rathna Prabhu

    2007-01-01

    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...

  4. Total fistulectomy with simple closure of the internal opening in the management of complex cryptoglandular fistulas: long-term results and functional outcome.

    Science.gov (United States)

    Tobisch, Alexander; Stelzner, Sigmar; Hellmich, Gunter; Jackisch, Thomas; Witzigmann, Helmut

    2012-07-01

    Total fistulectomy with simple closure of the internal opening has been used for the management of complex anal fistulas. This approach involves complete removal of the fistula tract and closure of the internal opening with sutures. This study aimed to report long-term outcomes in patients with complex cryptoglandular fistulas who undergo this procedure. This is a retrospective review of a prospectively collected consecutive series. This study was conducted at a community-based hospital with a specialized colorectal unit. : Patients included in this study had cryptoglandular fistulas and underwent total fistulectomy with simple closure of the internal opening between 1997 and 2007. The main outcome measures were success rate and postoperative continence (Cleveland Clinic Florida Fecal Incontinence Scale). Treatment was considered successful if the external opening was closed and no drainage was present at the last follow-up. Success was achieved in 187 (74%) patients with a median follow-up time of 70 (range, 14-141) months. Patients with posterior transsphincteric or suprasphincteric fistulas had a higher success rate than those with other types of fistulas (82% vs 67%;p = 0.014), and patients for whom the procedure failed were significantly younger than those for whom the procedure was a success (mean, 45 vs 50 years; p = 0.010). Of 160 patients with success who had no previous surgery, 89 (56%) had normal continence postoperatively (CCF-FI score = 0). The limitations of this study include its retrospective nature, the potential for selection bias, and the lack of preoperative continence scores. Total fistulectomy with simple closure of the internal opening is effective for the long-term closure of complex cryptoglandular fistulas.However, this procedure may affect continence despite its sphincter-sparing quality. Nonetheless, the high success rate in patients with posterior transsphincteric or suprasphincteric fistulas renders this procedure a reasonable option

  5. 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.

  6. Don’t call it a closure!

    CERN Multimedia

    Rosaria Marraffino

    2015-01-01

    During the Laboratory’s annual closure, some members of the personnel joined their families, others seized the chance to travel the world. The Restaurants were closed, the corridors were dark and the heating was turned off in most of the buildings. However, a lot of people spent the Christmas break working on site and the Bulletin would like to dedicate this first article of the new year to them all!   In the CERN Control Centre (CCC), each shift had two people in position to guarantee regular 24/7 service and to intervene in case of need. Gildas Langlois and Rodolphe Maillet, CCC operators from the Beams Department, spent Christmas Eve there and celebrated it with a cake. “I volunteered to work during the holidays in order to allow colleagues to stay with their families,” says Maillet. On New Year’s Eve, it was Julien Pache and Jean-Michel Nonglaton’s turn to spend the night at work. They had a nice dinner with a CCC-made fondue and some desse...

  7. Friction or Closure: Heritage as Loss

    Directory of Open Access Journals (Sweden)

    Mikela Lundahl

    2014-12-01

    Full Text Available 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- objects. It organizes temporality and construct events and freezes time. How does this unfold in the case of the UNESCO World Heritage site of Stone Town, Zanzibar? It is a place of beauty and violence, of trade, slavery and tourism, and the World Heritage narrative does not accommodate all its significant historical facts and lived memories. In this article I will discuss some of these conflicting or competing historical facts. The anthropologist Anna Tsing has developed the concept-metaphor friction as a way to discuss the energy created when various actors narrate 'the same' event(s in different ways, and see the other participants' accounts as fantasies or even fabrications. I will use my position as researcher and my relations to different sources: informants, authorities and texts, and discuss how different accounts relate to and partly construct each other; and how I, in my own process as an analyst and listener, negotiate these conflicting stories, what I identify as valid and non valid accounts. The case in this article is Stone Town in Zanzibar and the development and dissolution going on under the shadow of the UNESCO World Heritage flag; a growing tourism; a global and local increase in islamisation; and the political tension within the Tanzanian union. My main focus is narratives of the identity of Zanzibar since heritagization constructs identity.

  8. IT Services availability during CERN annual closure

    CERN Multimedia

    2003-01-01

    Mail, Cern Windows (NICE ),  Web services,  LXPLUS, LXBATCH, Automated tape devices, Castor, Backups, software license servers, Sundev, CVS and Print Servers, CDS and Agenda-Maker, EDMS (in collaboration with EST Division), CMS disc servers, Campus Network,  Remedy, Security and VPN services will be available during the CERN annual closure. The physics database cluster, replication location service as well as accdb, cerndb and admsdb are the only databases available, CCDB will be closed for public access. Problems developing on scheduled services should be addressed within about half a day except around  Christmas Eve and Christmas Day ( 24 and 25th December ) and New Year's Eve and New Years Day (31st December and 1st Janauary. All other services will be left running mostly unattended. No interruptions are scheduled but restoration of the service in case of failure cannot be guaranteed. Please note that the Helpdesk will be closed, that no file restores from backups will be possible and damaged tapes wi...

  9. IT Services availability during CERN annual closure

    CERN Multimedia

    2003-01-01

    Mail, Cern Windows (NICE ),  Web services,  LXPLUS, LXBATCH, Automated tape devices, Castor, Backups, software license servers, Sundev, CVS and Print Servers, CDS and Agenda-Maker, EDMS (in collaboration with EST Division), CMS disc servers, Campus Network,  Remedy, Security and VPN services will be available during the CERN annual closure. The physics database cluster, replication location service as well as accdb, cerndb and admsdb are the only databases available, CCDB will be closed for public access. Problems developing on scheduled services should be addressed within about half a day except around  Christmas Eve and Christmas Day ( 24 and 25th December ) and New Year's Eve and New Years Day (31st December and 1st Janauary. All other services will be left running mostly unattended. No interruptions are scheduled but restoration of the service in case of failure cannot be guaranteed. Please note that the Helpdesk will be closed, that no file restores from backups will be possible and damaged tapes wi...

  10. 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.

  11. Simultaneous oroantral communication closure, sinus‑lifting, and ...

    African Journals Online (AJOL)

    2015-10-10

    Oct 10, 2015 ... revealed healthy and functional implants in the teeth area. Key words: .... the development of several alternative treatment modalities by some ... 1. Lee BK. One‑stage operation of large oroantral fistula closure, sinus lifting,.

  12. Optical closure of parameterized bio-optical relationships

    Science.gov (United States)

    He, Shuangyan; Fischer, Jürgen; Schaale, Michael; He, Ming-xia

    2014-03-01

    An optical closure study on bio-optical relationships was carried out using radiative transfer model matrix operator method developed by Freie Universität Berlin. As a case study, the optical closure of bio-optical relationships empirically parameterized with in situ data for the East China Sea was examined. Remote-sensing reflectance ( R rs) was computed from the inherent optical properties predicted by these biooptical relationships and compared with published in situ data. It was found that the simulated R rs was overestimated for turbid water. To achieve optical closure, bio-optical relationships for absorption and scattering coefficients for suspended particulate matter were adjusted. Furthermore, the results show that the Fournier and Forand phase functions obtained from the adjusted relationships perform better than the Petzold phase function. Therefore, before bio-optical relationships are used for a local sea area, the optical closure should be examined.

  13. 40 CFR 264.119 - Post-closure notices.

    Science.gov (United States)

    2010-07-01

    ... disposal unit is located wishes to remove hazardous wastes and hazardous waste residues, the liner, if any, or contaminated soils, he must request a modification to the post-closure permit in accordance...

  14. 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.

  15. EPIDERMAL DELETION OF HIF-2α STIMULATES WOUND CLOSURE

    Science.gov (United States)

    Cowburn, Andrew S.; Crotty Alexander, Laura E.; Southwood, Mark; Nizet, Victor; Chilvers, Edwin R.; Johnson, Randall S.

    2013-01-01

    Wound closure requires a complex series of micro-environmentally influenced events. A key aspect of wound closure is the migration of keratinocytes across the open wound. It has been found previously that the response to hypoxia via the HIF-1α transcription factor is a key feature of wound closure. The need for hypoxic response is likely due to interrupted wound vasculature as well as infection, and in this work, we investigated the need for a highly related hypoxic response transcription factor, HIF-2α. This factor was deleted tissue-specifically in mice, and the resulting mice were found to have an accelerated rate of wound closure. This is correlated with a reduced bacterial load and inflammatory response in these mice. This indicates that manipulating or reducing the HIF-2α response in keratinocytes could be a useful means to accelerate wound healing and tissue repair. PMID:24037341

  16. Nonlinear closures for scale separation in supersonic magnetohydrodynamic turbulence

    CERN Document Server

    Grete, Philipp; Schmidt, Wolfram; Schleicher, Dominik R G; Federrath, Christoph

    2015-01-01

    Turbulence in compressible plasma plays a key role in many areas of astrophysics and engineering. The extreme plasma parameters in these environments, e.g. high Reynolds numbers, supersonic and super-Alfvenic flows, however, make direct numerical simulations computationally intractable even for the simplest treatment -- magnetohydrodynamics (MHD). To overcome this problem one can use subgrid-scale (SGS) closures -- models for the influence of unresolved, subgrid-scales on the resolved ones. In this work we propose and validate a set of constant coefficient closures for the resolved, compressible, ideal MHD equations. The subgrid-scale energies are modeled by Smagorinsky-like equilibrium closures. The turbulent stresses and the electromotive force (EMF) are described by expressions that are nonlinear in terms of large scale velocity and magnetic field gradients. To verify the closures we conduct a priori tests over 137 simulation snapshots from two different codes with varying ratios of thermal to magnetic pre...

  17. Neural tube closure: cellular, molecular and biomechanical mechanisms.

    Science.gov (United States)

    Nikolopoulou, Evanthia; Galea, Gabriel L; Rolo, Ana; Greene, Nicholas D E; Copp, Andrew J

    2017-02-15

    Neural tube closure has been studied for many decades, across a range of vertebrates, as a paradigm of embryonic morphogenesis. Neurulation is of particular interest in view of the severe congenital malformations - 'neural tube defects' - that result when closure fails. The process of neural tube closure is complex and involves cellular events such as convergent extension, apical constriction and interkinetic nuclear migration, as well as precise molecular control via the non-canonical Wnt/planar cell polarity pathway, Shh/BMP signalling, and the transcription factors Grhl2/3, Pax3, Cdx2 and Zic2. More recently, biomechanical inputs into neural tube morphogenesis have also been identified. Here, we review these cellular, molecular and biomechanical mechanisms involved in neural tube closure, based on studies of various vertebrate species, focusing on the most recent advances in the field.

  18. Approximate maximum-entropy moment closures for gas dynamics

    Science.gov (United States)

    McDonald, James G.

    2016-11-01

    Accurate prediction of flows that exist between the traditional continuum regime and the free-molecular regime have proven difficult to obtain. Current methods are either inaccurate in this regime or prohibitively expensive for practical problems. Moment closures have long held the promise of providing new, affordable, accurate methods in this regime. The maximum-entropy hierarchy of closures seems to offer particularly attractive physical and mathematical properties. Unfortunately, several difficulties render the practical implementation of maximum-entropy closures very difficult. This work examines the use of simple approximations to these maximum-entropy closures and shows that physical accuracy that is vastly improved over continuum methods can be obtained without a significant increase in computational cost. Initially the technique is demonstrated for a simple one-dimensional gas. It is then extended to the full three-dimensional setting. The resulting moment equations are used for the numerical solution of shock-wave profiles with promising results.

  19. 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...

  20. Threats and opportunities for post-closure development in dolomitic ...

    African Journals Online (AJOL)

    Threats and opportunities for post-closure development in dolomitic ... in the form of sinkholes and widespread radioactive pollution exacerbate such fears. ... developments such as aquaculture, agriculture and different forms of tourism relating ...

  1. 300 Area waste acid treatment system closure plan. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-03-01

    This section provides a description of the Hanford Site, identifies the proposed method of 300 Area Waste Acid Treatment System (WATS) closure, and briefly summarizes the contents of each chapter of this plan.

  2. 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.

  3. Transcatheter Closure of Patent Ductus Arteriosus and Atrial Septal Defects Using the Amplatzer Occluder

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Objective:To evalte the efficiency,safety and complications of transcatheter closure of patent ductus arteriosus (PDA) or secundum atrial septal defects (ASD)using the Amplatzer occluder device.Methods:30 patients underwent transcatheter closure of PDA or ASD with the Amplatzer occluder.The lateral descending aortographies were performed to evaluate immediate results in the 20 patients of PDA.Hemodynamics was studied before and after the procedure.X-ray and echocardiography were performed in order to detect residual shunt and recanalization.Results:The device was successfully implanted in 28 patients.There was on clinical evidence of hemolysis andon incidence of device emboliszation.The median operation time waw 56min and median fluoroscopy time was 11min .The devices'positions were optmal and on residual shunt was found 24h and 1month after the procedure No complicatios were observed during the 3-month follow-up in 25 patients.Conclusions:The Amplatzer occluder device is a highly efficient prosthesis that can be safely applied in most patients with PDA or ASD.

  4. Single trans-septal access technique for left atrial intracardiac echocardiography to guide left atrial appendage closure.

    Science.gov (United States)

    Aguirre, Daniel; Pincetti, Christian; Perez, Luis; Deck, Carlos; Alfaro, Mario; Vergara, Maria Jesus; Maluenda, Gabriel

    2017-08-24

    This registry aimed to describe the safety and feasibility of a single trans-septal (TS) access technique for left intracardiac echocardiography (ICE) guidance of left-atrial appendage (LAA) closure procedure. LAA closure is currently accepted as an alternative to oral anticoagulation (OAC) in patients with non-valvular atrial fibrillation (NVAF) who are at high-risk for bleeding. Currently, LAA closure procedure is typically performed under trans-esophageal echocardiogram (TEE) guidance. Although, ICE has the advantage of not requiring profound sedation/anesthesia, ICE-LAA imaging quality is often limited from the right atrium requiring double TS access. Twenty-two patients with NVAF underwent LAA closure using the Amplatzer Amulet™ device (St Jude Medical) under ICE guidance from the left atrium. The ICE AcuNav catheter (Biosense Webster) and the Amulet delivery sheath were advanced into the LA through single TS puncture technique. The population was predominately male (59.1%) with a mean age of 74 ± 9.3 years, at high-risk for stroke (mean CHADS2 score of 3.8 ± 1.1) and bleeding (mean HAS BLED score of 3.5 ± 1.3). The Amplatzer Amulet(TM) device was successfully implanted in all patients. No procedural related complications including device embolization were noted. No major cardiovascular events occurred and all patients were discharged alive. At 30-day follow-up all patients remained alive, free of ischemic stroke and with no residual leak or device thrombus on TEE. This initial experience suggests that LAA occlusion with the Amplatzer Amulet device using ICE guidance from the left atrium via a single trans-septal technique is feasible and safe. © 2017 Wiley Periodicals, Inc.

  5. Left atrial appendage closure using the Amulet device: an initial experience with the second generation amplatzer cardiac plug.

    Science.gov (United States)

    Lam, Simon Cheung Chi; Bertog, Stefan; Gafoor, Sameer; Vaskelyte, Laura; Boehm, Patrick; Ho, Raymond Wei Jian; Franke, Jennifer; Hofmann, Ilona; Sievert, Horst

    2015-02-01

    Aim of this study was to demonstrate the feasibility, safety, and short-term outcome of left atrial appendage (LAA) closure with a new generation LAA closure device. The Amulet device (AGA, St Jude Medical, Minneapolis, MN) is a new generation of the amplatzer cardiac plug (ACP), specifically designed for LAA closure. This new version is designed to facilitate the implantation process and minimize procedural or device-related complications. The device was implanted in 17 patients with nonvalvular atrial fibrillation (AF). Clinical data were obtained at baseline, during the procedure, at discharge, at 30 and 90 days. All devices were implanted successfully. Device sizes ranged from 20 mm to 31 mm. A 12 French (Fr) or 14 Fr delivery sheath was used depending on the selected device size. Full and partial recapture was performed in 1 case and 3 cases, respectively. There was 1 procedure-related pericardial effusion successfully managed with pericardiocentesis. There was no device embolization. The mean length of stay was 2.1 ± 0.3 days. At 90 days, there were no deaths, strokes, systemic thromboembolism, or bleeding complications. There was no device-related thrombus or pericardial effusion at 90-day TEE. In 2 of the 17 patients minimal peridevice flow (smaller than 2 mm) was present. The Amulet device, which has new novel features as compared with the first generation ACP, is a feasible option for LAA closure. From our initial experience, implantation of the Amulet is associated with high success rate and good short-term outcome. © 2014 Wiley Periodicals, Inc.

  6. A closure relation to molecular theory of solvation for macromolecules

    Science.gov (United States)

    Kobryn, Alexander E.; Gusarov, Sergey; Kovalenko, Andriy

    2016-10-01

    We propose a closure to the integral equations of molecular theory of solvation, particularly suitable for polar and charged macromolecules in electrolyte solution. This includes such systems as oligomeric polyelectrolytes at a finite concentration in aqueous and various non-aqueous solutions, as well as drug-like compounds in solution. The new closure by Kobryn, Gusarov, and Kovalenko (KGK closure) imposes the mean spherical approximation (MSA) almost everywhere in the solvation shell but levels out the density distribution function to zero (with the continuity at joint boundaries) inside the repulsive core and in the spatial regions of strong density depletion emerging due to molecular associative interactions. Similarly to MSA, the KGK closure reduces the problem to a linear equation for the direct correlation function which is predefined analytically on most of the solvation shells and has to be determined numerically on a relatively small (three-dimensional) domain of strong depletion, typically within the repulsive core. The KGK closure leads to the solvation free energy in the form of the Gaussian fluctuation (GF) functional. We first test the performance of the KGK closure coupled to the reference interaction site model (RISM) integral equations on the examples of Lennard-Jones liquids, polar and nonpolar molecular solvents, including water, and aqueous solutions of simple ions. The solvation structure, solvation chemical potential, and compressibility obtained from RISM with the KGK closure favorably compare to the results of the hypernetted chain (HNC) and Kovalenko-Hirata (KH) closures, including their combination with the GF solvation free energy. We then use the KGK closure coupled to RISM to obtain the solvation structure and thermodynamics of oligomeric polyelectrolytes and drug-like compounds at a finite concentration in electrolyte solution, for which no convergence is obtained with other closures. For comparison, we calculate their solvation

  7. Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke.

    Science.gov (United States)

    Søndergaard, Lars; Kasner, Scott E; Rhodes, John F; Andersen, Grethe; Iversen, Helle K; Nielsen-Kudsk, Jens E; Settergren, Magnus; Sjöstrand, Christina; Roine, Risto O; Hildick-Smith, David; Spence, J David; Thomassen, Lars

    2017-09-14

    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. 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 incidence of new brain infarction, which was a composite of clinical ischemic stroke or silent brain infarction detected on imaging. We enrolled 664 patients (mean age, 45.2 years), of whom 81% had moderate or large interatrial shunts. During a median follow-up of 3.2 years, clinical ischemic stroke occurred in 6 of 441 patients (1.4%) in the PFO closure group and in 12 of 223 patients (5.4%) in the antiplatelet-only group (hazard ratio, 0.23; 95% confidence interval [CI], 0.09 to 0.62; P=0.002). The incidence of new brain infarctions was significantly lower in the PFO closure group than in the antiplatelet-only group (22 patients [5.7%] vs. 20 patients [11.3%]; relative risk, 0.51; 95% CI, 0.29 to 0.91; P=0.04), but the incidence of silent brain infarction did not differ significantly between the study groups (P=0.97). Serious adverse events occurred in 23.1% of the patients in the PFO closure group and in 27.8% of the patients in the antiplatelet-only group (P=0.22). Serious device-related adverse events occurred in 6 patients (1.4%) in the PFO closure group, and atrial fibrillation occurred in 29

  8. Remedial Action Work Plan Amchitka Island Mud Pit Closures

    Energy Technology Data Exchange (ETDEWEB)

    DOE/NV

    2001-04-05

    This remedial action work plan presents the project organization and construction procedures developed for the performance of the remedial actions at U.S. Department of Energy (DOE's) sites on Amchitka Island, Alaska. During the late1960s and early 1970s, the U.S. Department of Defense and the U.S. Atomic Energy Commission (the predecessor agency to DOE) used Amchitka Island as a site for underground nuclear tests. A total of nine sites on the Island were considered for nuclear testing; however, tests were only conducted at three sites (i.e., Long Shot in 1965, Milrow in 1969, and Cannikin in 1971). In addition to these three sites, large diameter emplacement holes were drilled in two other locations (Sites D and F) and an exploratory hole was in a third location (Site E). It was estimated that approximately 195 acres were disturbed by drilling or preparation for drilling in conjunction with these activities. The disturbed areas include access roads, spoil-disposal areas, mud pits which have impacted the environment, and an underground storage tank at the hot mix plant which was used to support asphalt-paving operations on the island. The remedial action objective for Amchitka Island is to eliminate human and ecological exposure to contaminants by capping drilling mud pits, removing the tank contents, and closing the tank in place. The remedial actions will meet State of Alaska regulations, U.S. Fish and Wildlife Service refuge management goals, address stakeholder concerns, and address the cultural beliefs and practices of the native people. The U.S. Department of Energy, Nevada Operations Office will conduct work on Amchitka Island under the authority of the Comprehensive Emergency Response, Compensation, and Liability Act. Field activities are scheduled to take place May through September 2001. The results of these activities will be presented in a subsequent Closure Report.

  9. 303-K Storage Facility report on FY98 closure activities

    Energy Technology Data Exchange (ETDEWEB)

    Adler, J.G.

    1998-07-17

    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.

  10. Synthesis of Pyridoacridines through Anionic Cascade Ring Closure

    DEFF Research Database (Denmark)

    Petersen, I.N.; Kristensen, Jesper Langgaard

    2014-01-01

    A new synthesis of 13-deazaascididemin (AK-37) based on a recently developed anionic cascade ring closure is presented. Although the isolated yields are modest, the approach provides ready access to new substituted derivatives of 13-deazaascididemin. © Georg Thieme Verlag.......A new synthesis of 13-deazaascididemin (AK-37) based on a recently developed anionic cascade ring closure is presented. Although the isolated yields are modest, the approach provides ready access to new substituted derivatives of 13-deazaascididemin. © Georg Thieme Verlag....

  11. Techniques and materials for skin closure in caesarean section

    DEFF Research Database (Denmark)

    Mackeen, A Dhanya; Berghella, Vincenzo; Larsen, Mie-Louise

    2012-01-01

    Caesarean section is a common operation with no agreed upon standard regarding certain operative techniques or materials to use. With regard to skin closure, the skin incision can be re-approximated by a subcuticular suture immediately below the skin layer, by an interrupted suture, or by staples....... A great variety of materials and techniques are used for skin closure after caesarean section and there is a need to identify which provide the best outcomes for women....

  12. Apoptosis is not required for mammalian neural tube closure.

    Science.gov (United States)

    Massa, Valentina; Savery, Dawn; Ybot-Gonzalez, Patricia; Ferraro, Elisabetta; Rongvaux, Anthony; Cecconi, Francesco; Flavell, Richard; Greene, Nicholas D E; Copp, Andrew J

    2009-05-19

    Apoptotic cell death occurs in many tissues during embryonic development and appears to be essential for processes including digit formation and cardiac outflow tract remodeling. Studies in the chick suggest a requirement for apoptosis during neurulation, because inhibition of caspase activity was found to prevent neural tube closure. In mice, excessive apoptosis occurs in association with failure of neural tube closure in several genetic mutants, but whether regulated apoptosis is also necessary for neural tube closure in mammals is unknown. Here we investigate the possible role of apoptotic cell death during mouse neural tube closure. We confirm the presence of apoptosis in the neural tube before and during closure, and identify a correlation with 3 main events: bending and fusion of the neural folds, postfusion remodeling of the dorsal neural tube and surface ectoderm, and emigration of neural crest cells. Both Casp3 and Apaf1 null embryos exhibit severely reduced apoptosis, yet neurulation proceeds normally in the forebrain and spine. In contrast, the mutant embryos fail to complete neural tube closure in the midbrain and hindbrain. Application of the apoptosis inhibitors z-Vad-fmk and pifithrin-alpha to neurulation-stage embryos in culture suppresses apoptosis but does not prevent initiation or progression of neural tube closure along the entire neuraxis, including the midbrain and hindbrain. Remodeling of the surface ectoderm to cover the closed tube, as well as delamination and migration of neural crest cells, also appear to be normal in the apoptosis-suppressed embryos. We conclude that apoptosis is not required for neural tube closure in the mouse embryo.

  13. Early Canadian Multicenter Experience With WATCHMAN for Percutaneous Left Atrial Appendage Closure.

    Science.gov (United States)

    Saw, Jacqueline; Fahmy, Peter; Azzalini, Lorenzo; Marquis, Jean-Francois; Hibbert, Benjamin; Morillo, Carlos; Carrizo, Aldo; Ibrahim, Reda

    2017-04-01

    There are limited data with WATCHMAN (Boston Scientific Corporation, Natick, MA, USA) for left atrial appendage (LAA) closure in patients with nonvalvular atrial fibrillation (AF) and contraindications to anticoagulation. The purpose of this study was to evaluate the safety and efficacy of WATCHMAN in our early Canadian experience. We report our pooled consecutive series of patients who underwent WATCHMAN implantation at four major Canadian centers. Indications for LAA closure were CHADS2 ≥ 1 or CHA2 DS2 -VASc ≥ 2, and contraindication/intolerance to or failure on anticoagulation. Follow-up imaging was typically performed 1-6 months postprocedure. One hundred and six patients underwent LAA closure with WATCHMAN from May 2013 to October 2015. The mean age was 74.8 ± 7.7, mean CHADS2 score was 2.8 ± 1.2, CHA2 DS2 -VASc score was 4.3 ± 1.5, and HASBLED score was 3.2 ± 1.2. Permanent AF was present in 67.9% and paroxysmal AF in 32.1%. Indications for LAA closure were prior bleeding 89.6% (87 major bleeding and 8 minor bleeding), 9.4% were deemed high risk for bleeding, and 0.9% with recurrent strokes on warfarin. Procedural success was 97.2% (103 of 106), with one device embolization (snared percutaneously), one implant failure due to inadequate LAA depth, and one cardiac perforation requiring surgical repair before WATCHMAN implantation. The composite major safety event-rate was 1.9% (1 death and 1 device embolization). Mean hospital stay was 1.8 ± 4.7 days. Antithrombotic therapy postimplant included dual antiplatelet therapy in 76 of 103 (73.8%). Mean follow-up was 210 ± 182 days; there were two transient ischemic attacks, with estimated 66% reduction in thromboembolic events relative to CHADS2 predicted risk. In our early Canadian experience, WATCHMAN for LAA closure in patients contraindicated to anticoagulation appeared safe and effective. © 2017 Wiley Periodicals, Inc.

  14. HERA Mock Observations: Looking for Closure HERA Memorandum Number 13

    CERN Document Server

    Carilli, C L

    2016-01-01

    We investigate the use of closure phase as a method to detect the HI 21cm signal from the neutral IGM during cosmic reionzation. Closure quantities have the unique advantage of being independent of antenna-based calibration terms. We employ realistic, large area sky models from Sims et al. (2016). These include an estimate of the HI 21cm signal generated using 21cm FAST, plus continuum models of both the diffuse Galactic synchrotron emission and the extragalactic point sources. We employ the CASA simulator and adopt the Dillon-Parsons HERA configuration to generate a uv measurement set. We then use AIPS to calculate the closure phases as a function of frequency ('closure spectra'), and python scripts for subsequent analysis. We find that the closure spectra for the HI signal show dramatic structure in frequency, and based on thermal noise alone, the redundant HERA-331 array should detect these fluctuations easily. Comparatively, the frequency structure in the continuum closure spectra is much smoother than th...

  15. OCULAR BIOMETRY IN ANGLE CLOSURE GLAUCOMA AND SENILE CATARACT

    Institute of Scientific and Technical Information of China (English)

    WANG Yu-lan; SHENG Yao-hua; YE Xiang-yu

    2008-01-01

    Objective To compare ocular biometric values in angle closure glaucoma and cataract in senile population.Methods Ocular biometry was performed in eyes classified to have angle closure glaucoma (29 eyes) and senile cataract (31 eyes). Ocular biometry readings between two groups were compared and analyzed statistically. Intraocular pressure was also recorded before and after lens extraction.Results Anterior chamber depth was shallower in patients with angle closure glaucoma group [(1.79±0.56) mm] compared with senile cataract group [(2.69±0.40) mm] (P<0.01). Lens thickness was greater in angle closure glaucoma group [(5.30±0.61) mm] than that in senile cataract group [(3.84±0.61) mm] (P<0.01). Phacoemusification was performed in 5 patients with persistent acute attack of angle closure glaucoma. IOPs were controlled in all five cases after lens extraction.Conclusion Eyes with angle closure glaucoma seems to have significantly shallow anterior chamber and greater lens thickness compared to senile cataract eyes in the same age. Lens extraction might be effective in those cases with such anatomy features.

  16. Levels of control and closure in complex semiotic systems

    Science.gov (United States)

    Joslyn

    2000-01-01

    It is natural to advance closures as atomic processes of universal evolution, and to analyze this concept specifically. Real complex systems like organisms and complex mechanisms cannot exist at either extreme of complete closure or lack of closure, nevertheless we should consider the properties of closures in general, the introduction of boundaries, a corresponding stability, the establishment of system autonomy and identity, and thereby the introduction of emergent new system of potentially new types. Our focus should move from simple physical closure of common objects and classical self-organizing systems to semiotically closed systems that maintain cyclic relations of perception, interpretation, decision, and action with their environments. Thus, issues arise concerning the use and interpretation of symbols, representations, and/or internal models (whether explicit or implicit) by the system; and the syntactic, semantic, and pragmatic relations among the sign tokens, their interpretations, and their use or function for the systems in question. Primitive semiotic closures are hypothesized as equivalent to simple control systems, and in turn equivalent to simple organisms. This leads us directly to the grand hierarchical control theories of Turchin, Powers, and Albus, which provide an explicit mechanism for the formation of new levels within complex semiotically closed systems.

  17. 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.

  18. 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.

  19. Revascularization procedure induced maturogenesis of upper permanent incisor.

    Science.gov (United States)

    Abduljabbar, F; Bakhsh, A; Abed, H

    2014-09-01

    Treatment of carious or traumatized teeth with open apex is usually a challenge to a dentist. Recently, some case reports have shown that revascularization process induced maturogenesis of immature non-vital teeth. This case report describes the successful revascularization process of an immature central incisor. The upper left central incisor of 14-year-old boy was treated by revascularization process induced maturogenesis procedures. The tooth was symptomatic and caused a mucogingival swelling before the treatment. 3 years follow-up radiographs show a root elongation and an apical closure in the tooth treated with revascularization process. Revascularization procedure induced maturogenesis have several advantages over conventional apexification procedure.

  20. 216-B-3 expansion ponds closure plan

    Energy Technology Data Exchange (ETDEWEB)

    1994-10-01

    This document describes the activities for clean closure under the Resource Conservation and Recovery Act of 1976 (RCRA) of the 216-B-3 Expansion Ponds. The 216-B-3 Expansion Ponds are operated by the US Department of Energy, Richland Operations Office (DOE-RL) and co-operated by Westinghouse Hanford Company (Westinghouse Hanford). The 216-B-3 Expansion Ponds consists of a series of three earthen, unlined, interconnected ponds that receive waste water from various 200 East Area operating facilities. The 3A, 3B, and 3C ponds are referred to as Expansion Ponds because they expanded the capability of the B Pond System. Waste water (primarily cooling water, steam condensate, and sanitary water) from various 200 East Area facilities is discharged to the Bypass pipe (Project X-009). Water discharged to the Bypass pipe flows directly into the 216-B-3C Pond. The ponds were operated in a cascade mode, where the Main Pond overflowed into the 3A Pond and the 3A Pond overflowed into the 3C Pond. The 3B Pond has not received waste water since May 1985; however, when in operation, the 3B Pond received overflow from the 3A Pond. In the past, waste water discharges to the Expansion Ponds had the potential to have contained mixed waste (radioactive waste and dangerous waste). The radioactive portion of mixed waste has been interpreted by the US Department of Energy (DOE) to be regulated under the Atomic Energy Act of 1954; the dangerous waste portion of mixed waste is regulated under RCRA.

  1. Patent foramen ovale closure following cryptogenic stroke or transient ischaemic attack: Long-term follow-up of 301 cases.

    Science.gov (United States)

    Mirzaali, Mikaeil; Dooley, Maureen; Wynne, Dylan; Cooter, Nina; Lee, Lorraine; Haworth, Peter; Saha, Romi; Gainsborough, Nicola; Hildick-Smith, David

    2015-11-15

    Patent foramen ovale has been identified as a conduit for paradoxical embolism resulting in cryptogenic stroke or transient ischemic attack (TIA). We aimed to establish rates of death, recurrent stroke or TIA among patients undergoing PFO closure for stroke or TIA at our unit. A retrospective analysis of all PFO closure patients was performed between May 2004 and January 2013. Follow up was performed by mortality tracing using the Medical Research Information Service of the Office of National Statistics. With regard to stroke or TIA recurrence, written consent forms and questionnaires were mailed with follow up telephone calls. Medical notes and imaging records were consulted where adverse events were noted. 301 patients aged 48.6 ± 11.0 years, 54.4% male, with ≥1 thromboembolic neurovascular event had percutaneous PFO closure with one of eight devices, with successful implantation in 99% of cases. Follow-up duration was 40.2 ± 26.2 months (range 1.3-105.3); complete in 301 patients for mortality (100%) and 283 patients (94.0%) for neurovascular events. Two patients died during follow-up (respiratory failure n = 1; road traffic accident n = 1). Recurrent stroke (MRI or CT confirmed) was observed in five patients (0.5%; 0.55 per 100 person-years) and TIA in 9 (1.1%; 0.98 per 100 person-years). Atrial fibrillation requiring treatment was documented in 14 patients (1.7%). Percutaneous PFO closure in patients with cryptogenic stroke or TIA is a safe treatment with a low incidence of procedural complications and recurrent neurovascular events. Registry data like these may help to demonstrate the utility of PFO closure in stroke.

  2. Fracture mechanics analyses of partial crack closure in shell structures

    Science.gov (United States)

    Zhao, Jun

    2007-12-01

    This thesis presents the theoretical and finite element analyses of crack-face closure behavior in shells and its effect on the stress intensity factor under a bending load condition. Various shell geometries, such as spherical shell, cylindrical shell containing an axial crack, cylindrical shell containing a circumferential crack and shell with double curvatures, are all studied. In addition, the influence of material orthotropy on the crack closure effect in shells is also considered. The theoretical formulation is developed based on the shallow shell theory of Delale and Erdogan, incorporating the effect of crack-face closure at the compressive edges. The line-contact assumption, simulating the crack-face closure at the compressive edges, is employed so that the contact force at the closure edges is introduced, which can be translated to the mid-plane of the shell, accompanied by an additional distributed bending moment. The unknown contact force is computed by solving a mixed-boundary value problem iteratively, that is, along the crack length, either the normal displacement of the crack face at the compressive edges is equal to zero or the contact pressure is equal to zero. It is found that due to the curvature effects crack closure may not always occur on the entire length of the crack, depending on the direction of the bending load and the geometry of the shell. The crack-face closure influences significantly the magnitude of the stress intensity factors; it increases the membrane component but decreases the bending component. The maximum stress intensity factor is reduced by the crack-face closure. The significant influence of geometry and material orthotropy on rack closure behavior in shells is also predicted based on the analytical solutions. Three-dimensional FEA is performed to validate the theoretical solutions. It demonstrates that the crack face closure occurs actually over an area, not on a line, but the theoretical solutions of the stress intensity

  3. The final stage of the laparoscopic procedure: exploring final steps

    Directory of Open Access Journals (Sweden)

    Ricardo A. Natalin

    2012-02-01

    Full Text Available Despite significant advances in laparoscopic technique and technologies, laparoscopic Urologic surgery remains technically demanding regarding various surgical steps including the challenge of specimen retrieval and extraction, whether to install a drainage system and the best option for wound closure. Laparoscopic specimen entrapment and extraction occurs at what is falsely considered the "end of the procedure". During open surgery, after the specimen has been mobilized, the specimen is simply lifted out of the larger incision which has been made to achieve the surgical objectives. In contrast, significant laparoscopic skill is required to entrap and safely extract laparoscopic specimens. Indeed, the Urologist and surgical team which are transitioning from open surgery may disregard this important part of the procedure which may lead to significant morbidity. As such, it is imperative that during laparoscopic procedures, the "end of the procedure" be strictly defined as the termination of skin closure and dressing placement. Taking a few minutes to focus on safe specimen entrapment and extraction will substantially reduce major morbidity. The following review focus on the technology and technique of specimen entrapment and extraction, on the matter of whether to install a drainage system of the abdominal cavity and the options for adequate closure of trocar site wounds. This article's primary objectives are to focus on how to minimize morbidity while maintain the advantages of a minimally invasive surgical approach.

  4. HWMA/RCRA Closure Plan for the TRA/MTR Warm Waste System Voluntary Consent Order SITE-TANK-005 Tank System TRA-007

    Energy Technology Data Exchange (ETDEWEB)

    K. Winterholler

    2007-01-30

    This Hazardous Waste Management Act/Resource Conservation and Recovery Act Closure Plan was developed for portions of the Test Reactor Area/Materials Test Reactor Warm Waste System located in the Materials Test Reactor Building (TRA-603) at the Reactor Technology Complex, Idaho National Laboratory Site, to meet a further milestone established under Voluntary Consent Order Action Plan SITE-TANK-005 for the Tank System TRA-007. The reactor drain tank and canal sump to be closed are included in the Test Reactor Area/Materials Test Reactor Warm Waste System. The reactor drain tank and the canal sump will be closed in accordance with the interim status 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 Code of Federal Regulations 265. This closure plan presents the closure performance standards and methods for achieving those standards.

  5. 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.

  6. Epithelial gap closure governed by forces and geometry

    Science.gov (United States)

    Ladoux, Benoit

    The closure of gaps within epithelia is crucial to maintain the integrity and the homeostasis of the tissue during wound healing or cell extrusion processes. Cells mediate gap closure through either the assembly of multicellular actin-based contractile cables (purse-string contraction) or the protrusive activity of border cells into the gap (cell crawling). I will present experimental data and numerical modeling that show how these mechanisms can mutually interact to promote efficient epithelial gap closure and how mechanical constraints can regulate these mechanisms. I will first present how geometrical constraints dictate mechanisms of epithelial gap closure. We determine the importance of tissue shape during closure and the role of curvature of cell boundaries in this process. An essential difference between the two closure mechanisms is that cell crawling always pulls the edge of the tissue forward (i.e. towards the gap) while purse string pulls the edge forward or backwards depending on the local geometry. Our study demonstrates how the interplay between these two mechanisms is crucial for closing gaps and wounds, which naturally come in arbitrary shapes. Then I will focus on epithelial closure mechanism during cell extrusion. Within confluent cell layers, cellular motions coupled between neighbors are tightly regulated by the packing density of the epithelium inducing drastic changes in the dynamics of these tissues. I will show how cell density and tissue mechanics regulate the extrusion of cells within a confluent epithelial cell sheet, simultaneously measuring collective movements and traction forces. Epithelial packing and collective cell dynamics dictate the modes of cellular extrusions from lamellipodia crawling of the neighboring cells at low densities to coordinated actin-based contractile purse-string mechanism at higher density.

  7. Towards an efficient multiscale modeling of low-dimensional reactive systems: study of numerical closure procedures

    CERN Document Server

    Mazzi, Giacomo; Samaey, Giovanni

    2012-01-01

    In this paper, we present a study on how to develop an efficient multiscale simulation strategy for the dynamics of chemically active systems on low-dimensional supports. Such reactions are encountered in a wide variety of situations, ranging from heterogeneous catalysis to electrochemical or (membrane) biological processes, to cite a few. We analyzed in this context different techniques within the framework of an important multiscale approach known as the equation free method (EFM), which "bridges the multiscale gap" by building microscopic configurations using macroscopic-level information only. We hereby considered two simple reactive processes on a one-dimensional lattice, the simplicity of which allowed for an in-depth understanding of the parameters controlling the efficiency of this approach. We demonstrate in particular that it is not enough to base the EFM on the time evolution of the average concentrations of particles on the lattice, but that the time evolution of clusters of particles has to be in...

  8. The Observation on Efficacy of Angio-seal Closure Device in the Femoral Arterial Puncture Site after PCI

    Institute of Scientific and Technical Information of China (English)

    Zhang Bin; Jin Lijun; Wei Shuishen; Fang Xianhong; Wu Handong; Dong Taiming; Yan hong; Liao Hongtao

    2006-01-01

    Objective To evaluatereliability and safety of Angio-seal hemostasis device applied to the femoral arterial puncture site after percutaneous coronary intervention (PCI). Methods In 40 patients after PCI in our institute during the period between May 2002 and December 2003, Angioseal device were used to seal the femoral arterial puncture site. Results All the Angioseal devices were successfully deployed in 40 patients (successful rate:100%); the mean time to hemostasis was 45±12 sec;the mean time to ambulate after angioseal closure was 1.9±0.5 hours. No major groin and systemic complication was observed. There was minor groin oozing in 2 cases and small hemotoma in 1 patient.Conclusions Angio-seal closure device of the femoral artery puncture site after a percutaneous coronary procedure is safe. It can shorten the time to hemostasis,leads to early mobilization, and reduce groin complication. The disadvantage is relatively expensive.

  9. Hamiltonian fluid closures of the Vlasov-Amp{\\`e}re equations: from water-bags to N moment models

    CERN Document Server

    Perin, M; Morrison, P J; Tassi, E

    2015-01-01

    Moment closures of the Vlasov-Amp{\\`e}re 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.

  10. Ease of Using a Dedicated Percutaneous Closure Device after Inadvertent Cannulation of the Subclavian Artery: Case Report

    Directory of Open Access Journals (Sweden)

    Arnaud Devriendt

    2009-01-01

    Full Text Available Inadvertent puncture of the subclavian artery is a relatively frequent and potentially disastrous complication of attempted central venous access. Due to its noncompressible location, accidental subclavian arterial cannulation may result in hemorrhage as the sheath is removed. We report a new case of successful percutaneous closure of the subclavian artery which had been inadvertently cannulated, using a closure device based on a collagen plug (Angio-Seal, St. Jude Medical. This was performed in a patient who had received maximal antiplatelet and anticoagulation therapies because of prior coronary stenting in the context of cardiogenic shock. There was no prior angiographic assessment, as arterial puncture was presumed to have been distal to the right common artery and vertebral arteries. No complications were observed in this high-risk patient, suggesting that this technique could be used once the procedure has been evaluated prospectively.

  11. A novel impermeable adhesive membrane to reinforce dural closure: a preliminary retrospective study on 119 consecutive high-risk patients.

    Science.gov (United States)

    Ferroli, Paolo; Acerbi, Francesco; Broggi, Morgan; Schiariti, Marco; Albanese, Erminia; Tringali, Giovanni; Franzini, Angelo; Broggi, Giovanni

    2013-01-01

    Postoperative cerebrospinal fluid (CSF) leak in neurosurgery remains a significant source of morbidity. TissuePatchDural (TPD), a novel impermeable adhesive membrane, can be used to reinforce dural closure in cases considered at high risk to develop postoperative CSF leak. A retrospective, single-center, clinical investigation was conducted on 119 patients who underwent elective neurosurgical procedures between January and June 2010. Inclusion criteria included adult patients undergoing clean elective surgeries where a primary watertight closure was not possible. Three groups of patients were considered: 1) infratentorial, 67 cases; 2) supratentorial, 34 cases; and 3) spinal, 18 cases. All these patients received TPD to reinforce dural closure. Preoperative (long-term corticosteroid therapy, previous surgery and radiotherapy), intraoperative (site of procedures and size of dural gap), and postoperative (early and late hydrocephalus) conditions were analyzed as possible risk factors associated with CSF leakage. The mean follow-up was 7.14 months (range 6-12 months). CSF leak was detected in 11 of 119 cases (9.2%). The presence of pre- and postoperative risk factors was associated with a higher percentage of CSF leakage: 8 of 22 cases (36.3%) vs. 3 of 97 cases (3.1%) (P < 0.0001). All leaks could be conservatively treated and no patient required readmission or second surgery. No TPD-related adverse or allergic effects were observed. TPD seems to be a safe tool to be used to reinforce dural closure in patients with a high risk of developing CSF leaks. Copyright © 2013 Elsevier Inc. All rights reserved.

  12. Long-Term Follow-up of Patent Ductus Arteriosus Closure with the Amplatzer Duct Occluder in Children

    Directory of Open Access Journals (Sweden)

    Mostafa Behjati-Ardakani

    2015-10-01

    Full Text Available Background: Transcatheter closure of patent ductus arteriosus (PDA has become an alternative treatment to surgery. We evaluated the long-term results of the transcatheter closure of PDA with the Amplatzer Duct Occluder (ADO in children.Methods: Between May 2004 and October 2012, 138 children with PDA (43 males and 95 females underwent transcatheter PDA closure. Clinical, electrocardiographic, echocardiographic, and hemodynamic data were assessed pre and postprocedurally and at follow-up.Results: The mean age of the patients at procedure was 3.53 ± 2.43 years (range = 1.1 to 9.5 years, mean weight was11.9±4.6 kg (range = 6 to 29 kg, median pulmonary end diameter of the PDA was 5 mm (range = 4 to 15 mm, and median diameter of the ADO was 8 mm (range = 6 to 16 mm. The mean follow-up time was 43.4 ± 23.5 months (range = 13.5 to98 months.The devices were successfully deployed in 136 (98.5% patients. Device embolization occurred in 2 patients, immediately in one patient and during the first postprocedural night in the other patient. The first patient had percutaneous device retrieval, followed by implantation of a larger device. The second patient had surgical device removal and PDA ligation. Immediately after device implantation, trivial to mild residual shunts were detected in 112 (80% patients; all the shunts, however, disappeared 24 hours after the procedure. One patient had left pulmonary artery stenosis with a gradient of 25 mm Hg at 24 hours', 40 mmHg at one month's, and 64 mmHg at 6 months' follow-up. There were no cases of late embolization, aortic obstruction, late hemolysis, infective endocarditis, or death.Conclusion: Transcatheter PDA closure with the ADO was safe and effective, with a high success rate at long-term follow-up.

  13. Two-Year Follow Up After Surgical Versus Percutaneous Paravalvular Leak Closure: A Non-Randomized Analysis.

    Science.gov (United States)

    Angulo-Llanos, Rocío; Sarnago-Cebada, Fernando; Rivera, Allan R; Elízaga Corrales, Jaime; Cuerpo, Gregorio; Solis, Jorge; Gutierrez-Ibañes, Enrique; Sanz-Ruiz, Ricardo; Vázquez Álvarez, M E; Fernandez-Avilés, Francisco

    2016-10-01

    Percutaneous closure of paravalvular leak (PVL) has emerged as an alternative treatment. Predictors of survival and procedural success are unknown. To review our experience in the treatment of PVL and evaluate efficacy, mortality, predictors of success, and outcomes. Retrospective review of percutaneous PVL procedures between years 2008 and 2014. Survival and results were compared with a control cohort of surgical patients. Percutaneous closure was attempted in 51 patients. The surgical group had 36 patients. Defects were perimitral in 67 patients (77%). Mean follow-up (FU) was 784.5 days. After propensity score analysis in-hospital mortality was higher in the surgical group (30.6% vs. 9.8%, OR 6, P 0.01). Clinical improvement was higher in the percutaneous group (71.4% vs. 36.4%, P 0.002). Multivariate analysis showed normal creatinine (OR 15, P < 0.001) as independent predictor of clinical improvement. For the composite end-point of all-cause mortality or readmission, older age (OR 10.7, P 0.001), renal failure, (OR 18, P < 0.01), poor functional class and the absence of clinical improvement (OR 3.9, P < 0.001) were related with a higher risk. There were no differences in survival free from the composite end-point according to the treatment received (surgical or percutaneous). Percutaneous PVL closure has a reasonable rate of success and low complication rates, and results compare favorably with surgical treatment. Older patients and those with poor functional class or renal failure (RF) showed a worse prognosis even after a successful closure. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  14. Long-term cavity closure in non-linear rocks

    Science.gov (United States)

    Cornet, Jan; Dabrowski, Marcin; Schmid, Daniel Walter

    2017-08-01

    The time dependent closure of pressurized cavities in viscous rocks due to far-field loads is a problem encountered in many applications like drilling, cavity abandonment and porosity closure. The non-linear nature of the flow of rocks prevents the use of simple solutions for hole closure and calls for the development of appropriate expressions reproducing all the dependencies observed in nature. An approximate solution is presented for the closure velocity of a pressurized cylindrical cavity in a non-linear viscous medium subjected to a combined pressure and shear stress load in the far field. The embedding medium is treated as homogeneous, isotropic, and incompressible and follows a Carreau viscosity model. We derive analytical solutions for the end-member cases of the pressure and shear loads. The exact analytical solution for pressure loads shows that the closure velocity vR is given by the implicit expression {Δ p}/{2{μ _0D_{II}^*}} = - 1/2B( {{v_R^2}/{RD_{II^* + v_R^2}};1/2, - 1/{2n}} ), where Δp is the pressure load, R is the hole radius, B is the incomplete beta function, and μ0, D_{II}^*, n are, respectively, the threshold viscosity, transition rate and stress exponent of the Carreau model. The closure velocity is dominated by the linear mechanism under pressure loads smaller than 1.8{μ _0}D_{II}^* and by the non-linear one under large pressure loads. In the non-linear regime, pressure variations support an increasing part of the load with increasing degree of non-linearity. The decay of the stress perturbation in the non-linear zone varies as r- 2/n where r is the radial distance to the hole. A solution for the maximum closure velocity at the cavity rim vRmax under far-field shear is given: v_{R\\max} = ( 1 + {\\overline {M_s}} ^{-1/2})R\\overline D_{II}, where \\overline {M_s} = (1 + {\\overline {D_{II}} }^2 \\big/ {nD{_{II}^*}^2}) \\big/ ( 1 + {\\overline {D_{II}}^2} \\big/ D{_{II}^*}^2) and \\overline {D_{II}} is the second invariant of the far

  15. Intrauterine closure of myelomeningocele: an update.

    Science.gov (United States)

    Tulipan, Noel

    2004-02-15

    Preliminary evidence suggests that intrauterine myelomeningocele repair may benefit patients by reducing the both incidence of hydrocephalus and the severity of the Chiari malformation; however, this benefit remains unproved. Furthermore, the procedure entails substantial risks not associated with conventional therapy. A randomized controlled trial of intrauterine and conventional therapies is underway. This study should definitively establish the procedure related risks and benefits. Regardless of the outcome, it is clear that the risks of intrauterine intervention need to be reduced before myelomeningocele, or other congenital malformations, can be effectively treated prior to birth. To that end, studies are being conducted to assess the potential advantages of applying state-of-the-art endoscopic techniques to intrauterine therapy. If benefit can be proven and risks reduced, intrauterine myelomeningocele repair has the potential to become the preferred therapy for patients suffering from this debilitating disease.

  16. Fatigue testing of three peristernal median sternotomy closure techniques

    Directory of Open Access Journals (Sweden)

    Griffin Lanny V

    2008-09-01

    Full Text Available Abstract Background Failure of a sternotomy closure because of closure system fatigue is a complication that may result in dehiscence and put the individual at risk for serious complications. The purpose of this study was to assess the fatigue performance of three peristernal median sternotomy closure techniques (figure-of-eight stainless-steel wires, figure-of-eight stainless-steel cables, or Pectofix Dynamic Sternal Fixation [DSF] stainless-steel plates in order to quantify the potential risk of fatigue failure of these devices when subject to cyclic loads in physiologically relevant loading directions. Study Design All tests were conducted on polyurethane foam sternal models. A cardiothoracic surgeon divided each sternal model longitudinally and repaired it with a closure device. Tests were performed using a materials testing system that applied cyclic loading in a uniaxial direction until the test model catastrophically broke or data run-out occurred. For each loading direction (lateral distraction and longitudinal shear, five trials of each closure technique were tested. Life data and location of device failure (if present were evaluated. Statistical analysis was performed using regression with life data allowed for correlation between life data and the various closure techniques to develop risk assessment curves for each device. Results The data show that the figure-of-eight stainless-steel cable and the DSF plate systems are considerably less likely to fail under both lateral distraction and longitudinal shear cyclic loading conditions as compared to the figure-of-eight stainless-steel wire system. Moreover, the figure-of-eight stainless-steel cable system is the most resistant to failure, particularly for high cycle counts. Conclusion This study in addition to Cohen and Griffin's earlier published biomechanical comparison of the ultimate strength of these same three closure techniques provide extensive experimental evidence regarding the

  17. Cost-effectiveness analysis on spinal anesthesia versus local anesthesia plus sedation for loop colostomy closure.

    Science.gov (United States)

    Vaz, Filinto Aníbal Alagia; Abreu, Rone Antônio Alves; Soárez, Patrícia Coelho de; Speranzini, Manlio Basílio; Fernandes, Luís Cesar; Matos, Delcio

    2010-01-01

    Studies in the area of health economics are still poorly explored and it is known that the cost savings in this area is becoming more necessary, provided that strict criteria. To perform a cost-effectiveness analysis of spinal anesthesia versus local anesthesia plus sedation for loop colostomy closure. This was a randomized clinical trial with 50 patients undergoing loop colostomy closure either under spinal anesthesia (n = 25) or under local anesthesia plus sedation (n = 25). The duration of the operation, time spent in the post-anesthesia recovery room, pain, postoperative complications, length of hospital stay, laboratory and imaging examinations and need for rehospitalization and reoperation were analyzed. The direct medical costs were analyzed. A decision tree model was constructed. The outcome measures were mean cost and cost per local and systemic postoperative complications avoided. Incremental cost-effectiveness ratios were presented. Duration of operation: 146 +/- 111.5 min. vs 105 +/- 23.6 min. (P = 0.012); mean time spent in post-anesthesia recovery room: 145 +/- 110.8 min. vs 36.8 +/- 34.6 min. (Pplus sedation (Pplus sedation (P = 0.209). Hospitalization + rehospitalization: 4.5 +/- 4.1 days vs 2.9 +/- 2.2 days (Pcost-effectiveness ratio: R$ -474.78, indicating that the strategy with local anesthesia plus sedation is cost saving. In the present investigation, loop colostomy closure under local anesthesia plus sedation was effective and appeared to be a dominant strategy, compared with the same surgical procedure under spinal anesthesia.

  18. Cutaneous wound closure materials: an overview and update.

    Science.gov (United States)

    Al-Mubarak, Luluah; Al-Haddab, Mohammed

    2013-10-01

    On a daily basis, dermasurgeons are faced with different kinds of wounds that have to be closed. With a plethora of skin closure materials currently available, choosing a solution that combines excellent and rapid cosmetic results with practicality and cost-effectiveness can be difficult, if not tricky. We aimed to review the available skin closure materials over the past 20 years and the scientific claims behind their effectiveness in repairing various kinds of wounds. The two authors independently searched and scrutinised the literature. The search was performed electronically using Pub Med, the Cochrane Database, Google Scholar and Ovid as search engines to find articles concerning skin closure materials written since 1990. Many factors are involved in the choice of skin closure material, including the type and place of the wound, available materials, physician expertise and preferences, and patient age and health. Evidence-based main uses of different skin closure materials are provided to help surgeons choose the appropriate material for different wounds.

  19. 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

  20. Cutaneous wound closure materials: An overview and update

    Directory of Open Access Journals (Sweden)

    Luluah Al-Mubarak

    2013-01-01

    Full Text Available Introduction: On a daily basis, dermasurgeons are faced with different kinds of wounds that have to be closed. With a plethora of skin closure materials currently available, choosing a solution that combines excellent and rapid cosmetic results with practicality and cost-effectiveness can be difficult, if not tricky. Objectives: We aimed to review the available skin closure materials over the past 20 years and the scientific claims behind their effectiveness in repairing various kinds of wounds. Materials and Methods: The two authors independently searched and scrutinised the literature. The search was performed electronically using Pub Med, the Cochrane Database, Google Scholar and Ovid as search engines to find articles concerning skin closure materials written since 1990. Conclusion: Many factors are involved in the choice of skin closure material, including the type and place of the wound, available materials, physician expertise and preferences, and patient age and health. Evidence-based main uses of different skin closure materials are provided to help surgeons choose the appropriate material for different wounds.

  1. Leaf Closure in the Venus Flytrap: An Acid Growth Response

    Science.gov (United States)

    Williams, Stephen E.; Bennett, Alan B.

    1982-12-01

    The rapid closure of leaves in the Venus flytrap (Dionaea muscipula) involves irreversible cell enlargement, which can be initiated by acidifying the cell walls to pH 4.50 and below. Leaves infiltrated with neutral buffers that keep the pH above 4.50 to 4.75 will not close in response to stimulation of their trigger hairs even though the action potentials that ordinarily cause closure are produced. During the 1 to 3 seconds required for closure about 29 percent of the cellular adenosine triphosphate is lost. It is likely that this adenosine triphosphate is used in very rapid transport of hydrogen ions from the motor cells and that the movement is due to a mechanism of ``acid growth.''

  2. A computable expression of closure to efficient causation.

    Science.gov (United States)

    Mossio, Matteo; Longo, Giuseppe; Stewart, John

    2009-04-07

    In this paper, we propose a mathematical expression of closure to efficient causation in terms of lambda-calculus; we argue that this opens up the perspective of developing principled computer simulations of systems closed to efficient causation in an appropriate programming language. An important implication of our formulation is that, by exhibiting an expression in lambda-calculus, which is a paradigmatic formalism for computability and programming, we show that there are no conceptual or principled problems in realizing a computer simulation or model of closure to efficient causation. We conclude with a brief discussion of the question whether closure to efficient causation captures all relevant properties of living systems. We suggest that it might not be the case, and that more complex definitions could indeed create crucial some obstacles to computability.

  3. Phase closure nulling: results from the 2009 campaign

    Science.gov (United States)

    Duvert, Gilles; Malbet, Fabien; Chelli, Alain; Millan-Gabet, Rafael; Monnier, John D.; Schaefer, Gail H.

    2010-07-01

    We present here a new observational technique, Phase Closure Nulling (PCN), which has the potential to obtain very high contrast detection and spectroscopy of faint companions to bright stars. PCN consists in measuring closure phases of fully resolved objects with a baseline triplet where one of the baselines crosses a null of the object visibility function. For scenes dominated by the presence of a stellar disk, the correlated flux of the star around nulls is essentially canceled out, and in these regions the signature of fainter, unresolved, scene object(s) dominates the imaginary part of the visibility in particular the closure phase. We present here the basics of the PCN method, the initial proof-of-concept observation, the envisioned science cases and report about the first observing campaign made on VLTI/AMBER and CHARA/MIRC using this technique.

  4. Phase Closure Nulling: results from the 2009 campaign

    CERN Document Server

    Duvert, Gilles; Chelli, Alain; Millan-Gabet, Rafael; Monnier, John D; Schaefer, Gail H

    2010-01-01

    We present here a new observational technique, Phase Closure Nulling (PCN), which has the potential to obtain very high contrast detection and spectroscopy of faint companions to bright stars. PCN consists in measuring closure phases of fully resolved objects with a baseline triplet where one of the baselines crosses a null of the object visibility function. For scenes dominated by the presence of a stellar disk, the correlated flux of the star around nulls is essentially canceled out, and in these regions the signature of fainter, unresolved, scene object(s) dominates the imaginary part of the visibility in particular the closure phase. We present here the basics of the PCN method, the initial proof-of-concept observation, the envisioned science cases and report about the first observing campaign made on VLTI/AMBER and CHARA/MIRC using this technique.

  5. Infering and Calibrating Triadic Closure in a Dynamic Network

    Science.gov (United States)

    Mantzaris, Alexander V.; Higham, Desmond J.

    In the social sciences, the hypothesis of triadic closure contends that new links in a social contact network arise preferentially between those who currently share neighbours. Here, in a proof-of-principle study, we show how to calibrate a recently proposed evolving network model to time-dependent connectivity data. The probabilistic edge birth rate in the model contains a triadic closure term, so we are also able to assess statistically the evidence for this effect. The approach is shown to work on data generated synthetically from the model. We then apply this methodology to some real, large-scale data that records the build up of connections in a business-related social networking site, and find evidence for triadic closure.

  6. Self-Energy Closure for Inhomogeneous Turbulent Flows and Subgrid Modeling

    Directory of Open Access Journals (Sweden)

    Jorgen S. Frederiksen

    2012-04-01

    Full Text Available A new statistical dynamical closure theory for general inhomogeneous turbulent flows and subgrid modeling is presented. This Self-Energy (SE closure represents all eddy interactions through nonlinear dissipation or forcing ‘self-energy’ terms in the mean-field, covariance and response function equations. This makes the renormalization of the bare dissipation and forcing, and the subgrid modeling problem, transparent. The SE closure generalizes the quasi-diagonal direct interaction closure to allow for more complex interactions. The SE closure is applicable to flows in different geometries, is exact near maximum entropy states corresponding to canonical equilibrium, and provides a framework for deriving simpler realizable closures.

  7. Immediate and short-term outcomes after percutaneous atrial septal defect closure using the new nit-occlud ASD-R device.

    Science.gov (United States)

    Peirone, Alejandro; Contreras, Alejandro; Ferrero, Adolfo; da Costa, Rodrigo Nieckel; Pedra, Simone Fontes; Pedra, Carlos A C

    2014-09-01

    To evaluate the feasibility, safety, and efficacy of implantation of the new Nit Occlud ASD-R® (NOASD-R) device for percutaneous closure of ostium secundum atrial septal defects (ASD-OS). Device catheter implantation has become the method of choice for most patients with ASD-OS. No single device has proven to be ideal for this type of procedure. The NOASD-R has a distinct design that may help to overcome limitations of other devices. A prospective, single arm, observational study including all consecutive patients receiving the NOASD-R device for ASD-OS closure between October 2011 and September 2013 was performed. Patient selection, device design, deployment technique, complications, and procedural outcomes were evaluated. Seventy-four patients underwent attempted transcatheter ASD-OS closure using the NOASD-R device. Implantation of the occluder was successful in 73 patients (98.6%). The majority of patients were female (79.5%) with a median age of 17.2 years (range: 2-74). A 2-D transthoracic color-Doppler echocardiogram (TTE) obtained at the 3 or 6 month follow-up visit showed complete occlusion of the ASD-OS in 72/73 patients (98.6%). At a mean follow-up interval of 11.4 ± 6.8 months there have been no episodes of late device embolization, cardiac perforation or erosion, endocarditis, thromboembolism, wire fracture, embolic neurologic events, or death. We report the first worldwide clinical experience using the NOASD-R device for ASD-OS closure. The procedure was feasible, with a high rate of successful implantations, and safe. High ASD-OS closure rates and no complications were encountered during short-term follow-up. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

  8. Triadic closure as a basic generating mechanism of communities in complex networks

    Science.gov (United States)

    Bianconi, Ginestra; Darst, Richard K.; Iacovacci, Jacopo; Fortunato, Santo

    2014-10-01

    Most of the complex social, technological, and biological networks have a significant community structure. Therefore the community structure of complex networks has to be considered as a universal property, together with the much explored small-world and scale-free properties of these networks. Despite the large interest in characterizing the community structures of real networks, not enough attention has been devoted to the detection of universal mechanisms able to spontaneously generate networks with communities. Triadic closure is a natural mechanism to make new connections, especially in social networks. Here we show that models of network growth based on simple triadic closure naturally lead to the emergence of community structure, together with fat-tailed distributions of node degree and high clustering coefficients. Communities emerge from the initial stochastic heterogeneity in the concentration of links, followed by a cycle of growth and fragmentation. Communities are the more pronounced, the sparser the graph, and disappear for high values of link density and randomness in the attachment procedure. By introducing a fitness-based link attractivity for the nodes, we find a phase transition where communities disappear for high heterogeneity of the fitness distribution, but a different mesoscopic organization of the nodes emerges, with groups of nodes being shared between just a few superhubs, which attract most of the links of the system.

  9. Environmental assessment: Closure of the Waste Calcining Facility (CPP-633), Idaho National Engineering Laboratory

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    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.

  10. Transcatheter closure of perimembranous ventricular septal defects: single centre experience in China

    Institute of Scientific and Technical Information of China (English)

    LI Tian-chang; HU Da-yi; BIAN Hong; WANG Guo-hong; WANG Xian; ZHU Zheng-yan; XU Yu-yun

    2005-01-01

    @@ Ventricular septal defect (VSD) is one of the most common congenital heart malformation. As an isolated lesion, it accounts for 20%-30% of patients with congenital heart disease.1 Eighty percent of these defects are perimembranous involving the membranous septum and the adjacent area of muscular septum. At least 80% of these defects are small and close spontaneously,2,3 the larger defects often persist to cause significant shunt and right ventricular hypertension. Although conventional surgical repair of perimembranous ventricular septal defects (PMVSDs) is a safe, widely accepted procedure with negligible mortality. It is associated with morbidity, discomfort and a thoracotomy scar.1 As an alternative to surgery, a variety of devices for transcatheter closure of VSD have been developed. However, these devices were not specifically designed for this purpose and none has gained wide acceptance. Large delivery sheaths, inability to recapture and reposition, structural failure, dislodgement and embolization of the device, interference with the aortic valve resulting in aortic insufficiency and a high rate of residual shunting are the major limitations of the previously described techniques.2,3 The initial experiences with transcatheter closure of PMVSDs in patients with a new device that was especially designed for non-surgical occlusion of these defects, the Amplatzer asymmetric VSD occluder (AAVSDO, AGA Medical Co., USA) were encouraging.4-6 But the long-term results are not known.

  11. Transumbilical endoscopic technique for complete closure of inguinal hernias in female pediatric patients

    Science.gov (United States)

    Zhou, Xuewu; Qi, Xi; Jiang, Bing; Sha, Yongliang; Song, Daiqiang

    2017-01-01

    Laparoscopic percutaneous extraperitoneal closure of inguinal hernia with variable devices as an effective technique in minimal-access surgery for pediatric inguinal hernias in children was investigated in the present study. A Veress needle was inserted into the abdomen. Trocars, laparoscope and needle holder were placed through the umbilical incision. Under laparoscopic monitoring, a round needle was introduced into the peritoneal cavity through the anterior abdominal wall. The end of the suture inside the peritoneal cavity was left outside the peritoneal cavity in favor of ligation. The needle was passed through the peritoneum to place an extraperitoneal purse-string suture around the internal inguinal ring, counterclockwise on the left and clockwise on the right. The needle was then passed back into the peritoneal cavity and out through the abdominal wall, and the needle ends of the stitch were cut. The ends of the suture were tied. We described a technique used for transumbilical endoscopic closure of pediatric inguinal hernias in girls. This technique is simple and can be performed quickly. The cosmetic result is excellent because the two umbilical incisions are only 5-mm long, which make it possible to perform surgery without a visible scar. We performed this procedure in over 96 patients and have had no recurrences. Thus, this method may become the laparoscopic repair of choice for females with inguinal hernias. PMID:28123465

  12. 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.

  13. Modern approaches in primary exstrophy closure.

    Science.gov (United States)

    Purves, J Todd

    2011-05-01

    Until the 1970s, bladder exstrophy was a frequently fatal birth defect that, at the very least, conferred a shortened life span with devastating consequences for afflicted patients. Beginning with the modern era of surgical management, survival has become routine, and now the focus is on optimizing a near-normal return to function and cosmesis while limiting the frequency and morbidity of reconstructive procedures. Here we discuss the most frequently used strategies, their principles, and most recent outcomes for the management of exstrophy worldwide. Advantages and disadvantages of each approach are discussed in broad terms with the understanding that one universally accepted technique for managing bladder exstrophy has yet to be developed.

  14. System Dynamics and Modified Cumulant Neglect Closure Schemes

    DEFF Research Database (Denmark)

    Köylüoglu, H. Ugur; Nielsen, Søren R.K.

    Dealing with multipeaked problems, the goal of the paper is to improve the quality of the approximations for the expectations appearing in the differential equations written for the statistical moments of the state vector, guided by insight in the system dynamics. For systems with polynomial non......-linearities, modifications in the cumulant neglect closure scheme are suggested. The methodology is illustrated using the two wells oscillator. An error analysis is performed to compare the modified and ordinary cumulant neglect closure schemes applied at the second and fourth order levels with the exact results available....

  15. The Criteria for and Effects of Base Closures

    Science.gov (United States)

    1989-12-01

    determine how to improve federal government incentive programs designed to help overcome the sometimes adverse effect of base closures on the local...appoint an independent commission to study realignment or have the Department of Defense designate all bases as candidates for closure and begin appropriate...TV( CeO."t G,", Com Sovnqs Fbote, 33 tn LAct Dinon b Doia 1.11 TV X L Rle: Wesit IleiA 1913 566 K0 300 Fl laviot State Roth MC. CEF Stenv:ee

  16. 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

  17. Generative Power and Closure Properties of Watson-Crick Grammars

    Directory of Open Access Journals (Sweden)

    Nurul Liyana Mohamad Zulkufli

    2016-01-01

    Full Text Available We define WK linear grammars, as an extension of WK regular grammars with linear grammar rules, and WK context-free grammars, thus investigating their computational power and closure properties. We show that WK linear grammars can generate some context-sensitive languages. Moreover, we demonstrate that the family of WK regular languages is the proper subset of the family of WK linear languages, but it is not comparable with the family of linear languages. We also establish that the Watson-Crick regular grammars are closed under almost all of the main closure operations.

  18. A PDF closure model for compressible turbulent chemically reacting flows

    Science.gov (United States)

    Kollmann, W.

    1992-01-01

    The objective of the proposed research project was the analysis of single point closures based on probability density function (pdf) and characteristic functions and the development of a prediction method for the joint velocity-scalar pdf in turbulent reacting flows. Turbulent flows of boundary layer type and stagnation point flows with and without chemical reactions were be calculated as principal applications. Pdf methods for compressible reacting flows were developed and tested in comparison with available experimental data. The research work carried in this project was concentrated on the closure of pdf equations for incompressible and compressible turbulent flows with and without chemical reactions.

  19. Newborn exstrophy closure without osteotomy: Is there a role?

    Science.gov (United States)

    Inouye, Brian M; Lue, Kathy; Abdelwahab, Mahmoud; Di Carlo, Heather N; Young, Ezekiel E; Tourchi, Ali; Grewal, Mehnaj; Hesh, Christopher; Sponseller, Paul D; Gearhart, John P

    2016-02-01

    Recent articles document successful classic bladder exstrophy (CBE) closure without osteotomy. Still, many patients require osteotomy if they have a large bladder template and pubic diastasis, or non-malleable pelvis. To understand the indications and outcomes of bladder closure with and without pelvic osteotomy in patients younger than 1 month of age. An institutional database of 1217 exstrophy-epispadias patients was reviewed for CBE patients closed at the authors' institution within the first month of life. Patient demographics, closure history, pubic diastasis distance, bladder capacity, and outcomes were recorded and compared using chi-square tests between osteotomy and non-osteotomy patients. Failure was defined as bladder dehiscence, prolapse, vesicocutaneous fistula, or bladder outlet obstruction requiring reoperation. Bladder capacity >100 mL was deemed sufficient for bladder neck reconstruction (BNR). One hundred CBE patients were included for analysis: 38 closed with osteotomy (26 male, 12 female), and 62 closed without osteotomy (42 male, 20 female). There were four failed closures in the osteotomy group (2 dehiscence, 2 prolapse) and four failed closures in the non-osteotomy group (2 dehiscence, 2 prolapse). This corresponded to statistically equivalent rates of failure between the osteotomy and non-osteotomy groups (10.5% vs. 6.5%, p = 0.466). There was no statistically significant difference between the groups' ability to achieve bladder capacity sufficient for BNR (82% vs. 71%, p = 0.234). A successful primary bladder closure, regardless of the use of osteotomy, has been shown to be the single most important predictor of eventual continence. Because of the complexity of exstrophy manifestations, a multidisciplinary team approach is of the utmost importance. Based on our institutional experience, closure without osteotomy is considered when patients are osteotomy in patients considered suitable for closure by both the pediatric urologist and

  20. Weak* sequential closures in Banach space theory and their applications

    OpenAIRE

    Ostrovskii, M. I.

    2002-01-01

    Let X be a Banach space. Given a subset A of the dual space X* denote by $A_{(1)}$ the weak* sequential closure of A, i.e., the set of all limits of weak*-convergent sequences in A. The study of weak* sequential closures of linear subspaces of the duals of separable Banach spaces was initiated by S.Banach. The first results of this study were presented in the appendix to his book "Theorie des operations lineaires" (1932). It is natural to suppose that the reason for studying weak* sequential ...

  1. Hybrid closure of atrial septal defect: A modified approach

    Directory of Open Access Journals (Sweden)

    Kshitij Sheth

    2015-01-01

    Full Text Available A 3.5-year-old girl underwent transcatheter closure of patent ductus arteriosus in early infancy during which time her secundum atrial septal defect (ASD was left alone. When she came for elective closure of ASD, she was found to have bilaterally blocked femoral veins. The defect was successfully closed with an Amplatzer septal occluder (ASO; St. Jude Medical, Plymouth, MN, USA using a hybrid approach via a sub-mammary mini-thoracotomy incision without using cardiopulmonary bypass. At the end of 1-year follow-up, the child is asymptomatic with device in a stable position without any residual shunt.

  2. Pulmonary edema following transcatheter closure of atrial septal defect

    Directory of Open Access Journals (Sweden)

    Keerthi Chigurupati

    2015-01-01

    Full Text Available We describe an incident of development of acute pulmonary edema after the device closure of a secundum atrial septal defect in a 52-year-old lady, which was treated with inotropes, diuretics and artificial ventilation. Possibility of acute left ventricular dysfunction should be considered after the defect closure in the middle-aged patients as the left ventricular compliance may be reduced due to increased elastic stiffness and diastolic dysfunction. Baseline left atrial pressure may be > 10 mmHg in these patients. Associated risk factors for the left ventricular dysfunction are a large Qp:Qs ratio, systemic hypertension, severe pulmonary hypertension and paroxysmal atrial fibrillation.

  3. Pulmonary edema following transcatheter closure of atrial septal defect

    Science.gov (United States)

    Chigurupati, Keerthi; Reshmi, Liza Jose; Gadhinglajkar, Shrinivas; Venkateshwaran, S.; Sreedhar, Rupa

    2015-01-01

    We describe an incident of development of acute pulmonary edema after the device closure of a secundum atrial septal defect in a 52-year-old lady, which was treated with inotropes, diuretics and artificial ventilation. Possibility of acute left ventricular dysfunction should be considered after the defect closure in the middle-aged patients as the left ventricular compliance may be reduced due to increased elastic stiffness and diastolic dysfunction. Baseline left atrial pressure may be > 10 mmHg in these patients. Associated risk factors for the left ventricular dysfunction are a large Qp:Qs ratio, systemic hypertension, severe pulmonary hypertension and paroxysmal atrial fibrillation. PMID:26139760

  4. Sutures versus staples for wound closure in orthopaedic surgery: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Shantz Jesse A

    2012-06-01

    Full Text Available Abstract Background A recently published meta-analysis comparing metallic staples to sutures in orthopaedic procedures revealed three fold increase in risk for infection in stapled wounds. The studies included in the meta-analysis are at risk of bias due to experimental design limitations. A large randomized controlled trial is proposed to direct orthopaedic surgeons in their choice of wound closure material. Methods/Design A parallel group randomized controlled trial with institutional review board approval will be conducted. Patients will be randomized intraoperatively to have skin wounds closed with sutures or staples. Dressings will be used to maintain blinding outcome assessors. The primary outcome measure will be a composite all-cause wound complication outcome measure composed of: infection, wound drainage, wound necrosis, blistering, dehiscence, suture abscess and material sensitivity reaction. An independent review board blinded to treatment assignment will adjudicate suspected complications based on clinical data. All deceased patients will also be reviewed. An interim analysis of complications will take place after half of the patients have been recruited. All data will be analyzed by a blinded statistician. Dichotomous primary and secondary outcome measures will be analyzed using the Chi-squared statistic. Continuous outcome measures will be analyzed using Student's t-test. Subgroup analysis will compare infection rates using sutures versus staples in each anatomic area (upper extremity, pelvis/acetabulum, hip/femur, knee, ankle. A further subgroup analysis will be conducted comparing trauma patients to elective surgery patients. Non-infected revision surgery will also be compared to primary surgery. Discussion Wound closure material is an afterthought for many orthopaedic surgeons. The combined results of several comparative trials suggests that the choice of wound closure materials may have an impact on the rate of surgical site

  5. TRA Closure Plan REV 0-9-20-06 HWMA/RCRA Closure Plan for the TRA/MTR Warm Waste System Voluntary Consent Order SITE-TANK-005 Tank System TRA-007

    Energy Technology Data Exchange (ETDEWEB)

    Winterholler, K.

    2007-01-31

    This Hazardous Waste Management Act/Resource Conservation and Recovery Act closure plan was developed for portions of the Test Reactor Area/Materials Test Reactor Warm Waste System located in the Materials Test Reactor Building (TRA-603) at the Reactor Technology Complex, Idaho National Laboratory Site, to meet a further milestone established under Voluntary Consent Order Action Plan SITE-TANK-005 for Tank System TRA-007. The reactor drain tank and canal sump to be closed are included in the Test Reactor Area/Materials Test Reactor Warm Waste System. The reactor drain tank and the canal sump were characterized as having managed hazardous waste. The reactor drain tank and canal sump will be closed in accordance with the interim status 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. This closure plan presents the closure performance standards and methods for achieving those standards.

  6. 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.

  7. FREE VASTUS LATERALIS MUSCLE FLAP FOR CLOSURE OF RECURRENT ORONASAL FISTULA: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Prakash Kumar

    2015-06-01

    Full Text Available Recurrent oronasal fistulas after cleft palate repair present a difficult problem for the cleft surgeon. Repeated surgeries to close the fistula results in increased scar formation with associated soft tissue contracture and a resultant increase in fistula size. Although locally available flaps ha s been the standard procedure for closure of small fistulae, Large fistulas requires regional flaps like tongue flaps requiring multistage transfer, with resultant intra oral scarring, to avoid the problems associated with loco regional flaps and recent in crease in success rates of free tissue transfers make them a viable, one - stage means of closing these defects. In this case report we present our clinical experience with recurren t palatal fistula and highlight the effective use of the free vastuslateralis mus cle flap as a means of repair.

  8. Successful closure of feline axillary wounds by reconstruction of the elbow skin fold.

    Science.gov (United States)

    Brinkley, C H

    2007-02-01

    This report describes the successful closure of five chronic feline axillary wounds. The aetiology was known to be forelimb entrapment in a neck collar in three cases and was suspected in the others. Each cat underwent a single surgical procedure during which the wound was debrided, the normal structure of the elbow skin fold was restored and the remaining skin defect was closed primarily. None of the cats had undergone any previous reconstruction attempts. No postoperative complications were observed and the wounds healed uneventfully. Cats have well-developed elbow skin folds, allowing a wide range of limb motion to occur. Having a forelimb trapped in a neck collar not only creates a wound in the axilla but also disrupts the normal anatomy of the skin fold. This report demonstrates that restoring the elbow skin fold before closing the wound may improve the chances of a successful reconstruction at the first surgical intervention.

  9. Development of high shrinkage polyethylene terephthalate (PET) shape memory polymer tendons for concrete crack closure

    Science.gov (United States)

    Teall, Oliver; Pilegis, Martins; Sweeney, John; Gough, Tim; Thompson, Glen; Jefferson, Anthony; Lark, Robert; Gardner, Diane

    2017-04-01

    The shrinkage force exerted by restrained shape memory polymers (SMPs) can potentially be used to close cracks in structural concrete. This paper describes the physical processing and experimental work undertaken to develop high shrinkage die-drawn polyethylene terephthalate (PET) SMP tendons for use within a crack closure system. The extrusion and die-drawing procedure used to manufacture a series of PET tendon samples is described. The results from a set of restrained shrinkage tests, undertaken at differing activation temperatures, are also presented along with the mechanical properties of the most promising samples. The stress developed within the tendons is found to be related to the activation temperature, the cross-sectional area and to the draw rate used during manufacture. Comparisons with commercially-available PET strip samples used in previous research are made, demonstrating an increase in restrained shrinkage stress by a factor of two for manufactured PET filament samples.

  10. Containment closure time following loss of cooling under shutdown conditions of YGN units 3 and 4

    Energy Technology Data Exchange (ETDEWEB)

    Seul, Kwang Won; Bang, Young Seok; Kim, Se Won; Kim, Hho Jung [Korea Institute of Nuclear Safety, Taejon (Korea, Republic of)

    1998-12-31

    The YGN Units 3 and 4 plant conditions during shutdown operation were reviewed to identify the possible event scenarios following the loss of shutdown cooling. The thermal hydraulic analyses were performed for the five cases of RCS configurations under the worst event scenario, unavailable secondary cooling and no RCS inventory makeup, using the RELAP5/MOD3.2 code to investigate the plant behavior. From the analyses results, times to boil, times to core uncovery and times to core heat up were estimated to determine the containment closure time to prevent the uncontrolled release of fission products to atmosphere. These data provide useful information to the abnormal procedure to cope with the event. 6 refs., 7 figs., 2 tabs. (Author)

  11. Endoscopic closure instead of surgery to close an ileal pouch fistula with the over-the-scope clip system

    Science.gov (United States)

    Wei, Yao; Gong, Jian-Feng; Zhu, Wei-Ming

    2017-01-01

    An ileal pouch fistula is an uncommon complication after an ileal pouch anal anastomosis. Most patients who suffer from an ileal pouch fistula will need surgical intervention. However, the surgery can be invasive and has a high risk compared to endoscopic treatment. The over-the-scope clip (OTSC) system was initially developed for hemostasis and leakage closure in the gastrointestinal tract during flexible endoscopy. There have been many successes in using this approach to apply perforations to the upper gastrointestinal tract. However, this approach has not been used for ileal pouch fistulas until currently. In this report, we describe one patient who suffered a leak from the tip of the “J” pouch and was successfully treated with endoscopic closure via the OTSC system. A 26-year-old male patient had an intestinal fistula at the tip of the “J” pouch after an ileal pouch anal anastomosis procedure. He received endoscopic treatment via OTSC under intravenous anesthesia, and the leak was closed successfully. Endoscopic closure of a pouch fistula could be a simpler alternative to surgery and could help avoid surgery-related complications. PMID:28250903

  12. close: Closure of patent foramen ovale, oral anticoagulants or antiplatelet therapy to prevent stroke recurrence: Study design.

    Science.gov (United States)

    Mas, Jean-Louis; Derumeaux, Geneviève; Amarenco, Pierre; Arquizan, Caroline; Aubry, Pierre; Barthelet, Martine; Bertrand, Bernard; Brochet, Eric; Cabanes, Laure; Donal, Erwan; Dubois-Randé, Jean-Luc; Durand-Zaleski, Isabelle; Ernande, Laura; Finet, Gérard; Fraisse, Alain; Giroud, Maurice; Guérin, Patrice; Habib, Gilbert; Juliard, Jean-Michel; Leys, Didier; Lièvre, Michel; Lusson, Jean-René; Marcon, François; Michel, Patrick; Moulin, Thierry; Mounier-Vehier, François; Pierard, Luc; Piot, Christophe; Rey, Christian; Rodier, Gilles; Roudaut, Raymond; Schleich, Jean-Marc; Teiger, Emmanuel; Turc, Guillaume; Vuillier, Fabrice; Weimar, Christian; Woimant, France; Chatellier, Gilles

    2016-08-01

    Currently available data do not provide definitive evidence on the comparative benefits of closure of patent foramen ovale, oral anticoagulants and antiplatelet therapy in patients with patent foramen ovale-associated cryptogenic stroke To assess whether transcatheter patent foramen ovale closure plus antiplatelet therapy is superior to antiplatelet therapy alone and whether oral anticoagulant therapy is superior to antiplatelet therapy, for secondary stroke prevention in patients aged 16 to 60 years with a large patent foramen ovale or a patent foramen ovale associated with an atrial septal aneurysm, and an otherwise unexplained ischaemic stroke or retinal ischaemia. Six hundred and sixty-four patients were included in the study. CLOSE is an academic-driven, multicentre, randomized, open-label, three-group, superiority trial with blinded adjudication of outcome events. The trial has been registered with Clinical Trials Register (Clinicaltrials.gov, NCT00562289). Patient recruitment started in December 2007. Patient follow-up will continue until December 2016. Expected mean follow-up = 5.6 years. The primary efficacy outcome is the occurrence of fatal or nonfatal stroke. Safety outcomes include fatal, life-threatening or major procedure- or device-related complications and fatal, life-threatening or major haemorrhagic complications. CLOSE is the first specifically designed trial to assess the superiority of patent foramen ovale closure over antiplatelet therapy alone and the superiority of oral anticoagulants over antiplatelet therapy to prevent stroke recurrence in patients with patent foramen ovale-associated cryptogenic stroke. © 2016 World Stroke Organization.

  13. Acute left ventricular failure after transcatheter closure of a secundum atrial septal defect in a patient with hypertrophic cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    ZHANG Cao-jin; HUANG Yi-gao; HUANG Xin-sheng

    2011-01-01

    We report a case of acute left ventricular failure at one hour after transcatheter closure of a secundum atrial septal defect (ASD) in a 28-year-old man with hypertrophic cardiomyopathy. Afforded noninvasive mechanical ventilation and the administration of intravenous morphine and high doses of furosemide, the patient exhibited improvement of his clinical condition, redtion of pulmonary congestion at chest X-ray, and satisfactory blood gas analyses in twelve hours. Twentyfour hours later, the patient received oral administration of furosemide and metoprolol. After 7 days the patient was discharged in good clinical condition. At follow-up at 12 months, the patient had remained symptomatically improved from NYHA Class Ⅲ symptoms before the procedure to Class Ⅱ symptoms. There was no latent arrhythmia at the follow-up examination. Follow-up transthoracic echocardiography estimated an improvement of the left ventricular function. So,transcatheter closure of a secundum ASD in a patient with hypertrophic cardiomyopathy is feasible, and a thorough understanding of the hemodynamic condition of ASD and hypertrophic cardiomyopathy will reduce the complication of ASD closure.

  14. 24h and 30 day outcome of Perclose Proglide suture mediated vascular closure device: An Indian experience.

    Science.gov (United States)

    Vinayakumar, Desabandhu; Kayakkal, Shajudeen; Rajasekharan, Sandeep; Thottian, Julian Johny; Sankaran, Prasanth; Bastian, Cicy

    Advantages of vascular closure device over manual compression include patient comfort, early mobilisation and discharge, avoidance of interruption of anticoagulation, avoidance of local compression and its sequelae and less time constraint on staff. No published Indian data exist regarding Perclose Proglide suture mediated vascular closure device (SMC). To study the 24h and 30 day outcome of Perclose Proglide SMC retrospectively. Retrospective observational study conducted in the Department of Cardiology, Government Medical College, Calicut, Kerala from June 2013 to June 2015. All consecutive patients with Perclose Proglide SMC deployment done by a single operator for achieving access site haemostasis where 24h and 30 day post-procedure data were available were included. Major and minor complications, procedure success, device failure were predefined. 323 patients were analysed. Procedure success rate was 99.7% (322/323). Transient oozing occurred in 44 patients (13.6%), minor and major complications occurred in 2% and 1.5% of patients respectively. Major complication included one case of retroperitoneal bleed, one access site infection, one pseudo aneurysm formation and two access site arterial stenosis. There was no death or complication requiring limb amputation. "Preclose" technique was used successfully in six patients. Primary device failure occurred in 12 cases which were tackled successfully with second Proglide in all except one. Perclose Proglide SMC is a safe and effective method to achieve haemostasis up to 22F with less complication rate. Copyright © 2016. Published by Elsevier B.V.

  15. Factors influencing ring closure through olefin metathesis - A perspective

    Indian Academy of Sciences (India)

    Subrata Ghosh; Sarita Ghosh; Niladri Sarkar

    2006-05-01

    Success of ring closure reactions of substrates having two terminal alkenes through olefin metathesis depends on a number of factors such as catalysts, nature and size of the rings to be formed and the substituents/functional groups present on the alkenes as well as at the allylic position. This article presents an overview of these influencing factors with illustrative examples.

  16. Department of Defense Base Closure and Realignment Report

    Science.gov (United States)

    1993-03-01

    Fayetteville, Arkansas Fort Smith, Arkansas Pacific Grove, California Macon, Georgia Terre Haute, Indiana Hutchinson, Kansas Monroe, Louisiana New Bedford...the body of this report. 233 Table 1. - ASE CLOSURE AND R&EALIGNMENT RECAP Bumox lam 8mmm Rqm (4m5US& M~ 10 ~MOM ed pomm ") Cbmuk APE. L Phlk Naval Hmp

  17. 12 CFR 604.430 - Closure of meetings.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Closure of meetings. 604.430 Section 604.430 Banks and Banking FARM CREDIT ADMINISTRATION ADMINISTRATIVE PROVISIONS FARM CREDIT ADMINISTRATION BOARD... meeting to close such meeting or such exempt portion, and the General Counsel, Farm Credit...

  18. 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.

  19. REFLEX CLOSURE OF THE OESOPHAGEAL GROOVE AND ITS ...

    African Journals Online (AJOL)

    and that tIus was the main route for passage of solid matter from the rumen to ... closure of swallowing and states: "I gave milk via the. ,mouth and the .... which might suffer as a result of rumen fermentation, and some .... microbial protein produced as a result of rumen fermen- tation. .... The total lactase activity in the small in-.

  20. Planar cell polarity genes and neural tube closure.

    Science.gov (United States)

    Ueno, Naoto; Greene, Nicholas D E

    2003-11-01

    Closure of the neural tube is essential for normal development of the brain and spinal cord. Failure of closure results in neural tube defects (NTDs), common and clinically severe congenital malformations whose molecular mechanisms remain poorly understood. On the other hand, it is increasingly well established that common molecular mechanisms are employed to regulate morphogenesis of multicellular organisms. For example, signaling triggered by polypeptide growth factors is highly conserved among species and utilized in multiple developmental processes. Recent studies have revealed that the Drosophila planar cell polarity (PCP) pathway, which directs position and direction of wing hairs on the surface of the fly wing, is well conserved, and orthologs of several genes encoding components of the pathway are also found in vertebrates. Interestingly, in vertebrates, this signaling pathway appears to be co-opted to regulate "convergent extension" cell movements during gastrulation. Disruption of vertebrate PCP genes in Xenopus laevis or zebrafish causes severe gastrulation defects or the shortening of the trunk, as well as mediolateral expansion of somites. In Xenopus, in which the neural tube closes by elevation and fusion of neural folds, inhibition of convergent extension can also prevent neural tube closure causing a "spina bifida-like" appearance. Furthermore, several of the genes involved in the PCP pathway have recently been shown to be required for neural tube closure in the mouse, since mutation of these genes causes NTDs. Therefore, understanding the mechanisms underlying the establishment of cell polarity in Drosophila may provide important clues to the molecular basis of NTDs.

  1. Descending mediastinitis managed by sternotomy, taurolidine and delayed closure.

    Science.gov (United States)

    Iyer, Anand P; Kugathasan, Gana; Prabha, Ramesh; Malik, Paras; Kuteyi, Opeyemi; Larbalestier, Robert

    2013-10-01

    Descending necrotizing mediastinitis is a rare complication of upper respiratory infections. A quick diagnosis and prompt and complete surgical drainage is important for a successful outcome. A 74-year-old man with descending necrotizing mediastinitis needed a sternotomy, multiple washouts, and delayed sternal closure.

  2. Reduced heating level during the end-of-year closure

    CERN Multimedia

    2003-01-01

    To save on energy costs, the heating will once again be operating at a reduced level during the end-of-year closure of the Laboratory. We would ask all those in charge of premises where normal temperature have to be maintained to let us know by 18 December 2003 at the latest (tel. 74195 or 72201). ST/CV - ST/FM Groups

  3. REDUCED HEATING LEVEL DURING THE END-OF-YEAR CLOSURE

    CERN Multimedia

    ST/CV - ST/FM Groups

    2002-01-01

    To save on energy costs, the heating will once again be operating at a reduced level during the end-of-year closure of the Laboratory. We would ask all those in charge of premises where normal temperature have to be maintained to let us know by 19 December 2002 at the latest (tel. 74195 or 72201). ST/CV - ST/FM Groups

  4. REDUCED HEATING LEVEL DURING THE END-OF-YEAR CLOSURE

    CERN Document Server

    ST/CV - ST/TFM Groups

    2001-01-01

    To save on energy costs, the heating will once again be operating at a reduced level during the end-of-year closure of the Laboratory. We would ask all those in charge of premises where normal temperature have to be maintained to let us know by 20 December 2001 at the latest (tel.74195 or 72201).

  5. A Political Analysis of Community Influence over School Closure

    Science.gov (United States)

    Finnigan, Kara S.; Lavner, Mark

    2012-01-01

    This study seeks to understand community member participation in and influence over an urban school district's school closure process. Data from interviews with School Board members, district administrators, and community members, as well as district documents and newspaper articles suggest that district administrators limited participation…

  6. Interpretation and Closure in the Historical Geology Laboratory.

    Science.gov (United States)

    King, Hobart M.

    1997-01-01

    Presents an activity that convinces students that rock records do contain many types of "readable" evidence and gives students insight into the methods of historical geology. Describes a closure assignment that requires students to reflect upon what they have learned, organize their knowledge, and write a capstone essay on the history of the…

  7. Multivariate moment closure techniques for stochastic kinetic models

    Science.gov (United States)

    Lakatos, Eszter; Ale, Angelique; Kirk, Paul D. W.; Stumpf, Michael P. H.

    2015-09-01

    Stochastic effects dominate many chemical and biochemical processes. Their analysis, however, can be computationally prohibitively expensive and a range of approximation schemes have been proposed to lighten the computational burden. These, notably the increasingly popular linear noise approximation and the more general moment expansion methods, perform well for many dynamical regimes, especially linear systems. At higher levels of nonlinearity, it comes to an interplay between the nonlinearities and the stochastic dynamics, which is much harder to capture correctly by such approximations to the true stochastic processes. Moment-closure approaches promise to address this problem by capturing higher-order terms of the temporally evolving probability distribution. Here, we develop a set of multivariate moment-closures that allows us to describe the stochastic dynamics of nonlinear systems. Multivariate closure captures the way that correlations between different molecular species, induced by the reaction dynamics, interact with stochastic effects. We use multivariate Gaussian, gamma, and lognormal closure and illustrate their use in the context of two models that have proved challenging to the previous attempts at approximating stochastic dynamics: oscillations in p53 and Hes1. In addition, we consider a larger system, Erk-mediated mitogen-activated protein kinases signalling, where conventional stochastic simulation approaches incur unacceptably high computational costs.

  8. Multivariate moment closure techniques for stochastic kinetic models

    Energy Technology Data Exchange (ETDEWEB)

    Lakatos, Eszter, E-mail: e.lakatos13@imperial.ac.uk; Ale, Angelique; Kirk, Paul D. W.; Stumpf, Michael P. H., E-mail: m.stumpf@imperial.ac.uk [Department of Life Sciences, Centre for Integrative Systems Biology and Bioinformatics, Imperial College London, London SW7 2AZ (United Kingdom)

    2015-09-07

    Stochastic effects dominate many chemical and biochemical processes. Their analysis, however, can be computationally prohibitively expensive and a range of approximation schemes have been proposed to lighten the computational burden. These, notably the increasingly popular linear noise approximation and the more general moment expansion methods, perform well for many dynamical regimes, especially linear systems. At higher levels of nonlinearity, it comes to an interplay between the nonlinearities and the stochastic dynamics, which is much harder to capture correctly by such approximations to the true stochastic processes. Moment-closure approaches promise to address this problem by capturing higher-order terms of the temporally evolving probability distribution. Here, we develop a set of multivariate moment-closures that allows us to describe the stochastic dynamics of nonlinear systems. Multivariate closure captures the way that correlations between different molecular species, induced by the reaction dynamics, interact with stochastic effects. We use multivariate Gaussian, gamma, and lognormal closure and illustrate their use in the context of two models that have proved challenging to the previous attempts at approximating stochastic dynamics: oscillations in p53 and Hes1. In addition, we consider a larger system, Erk-mediated mitogen-activated protein kinases signalling, where conventional stochastic simulation approaches incur unacceptably high computational costs.

  9. Device Closure of Small Ventricular Septal Defects: When and Why?

    Directory of Open Access Journals (Sweden)

    IB Vijayalakshmi

    2014-10-01

    Full Text Available Ventricular septal defect (VSD accounts for approximately 20-30 % of all forms of congenital heart disease (CHD. They were traditionally closed surgically in the past. The surgery though safe carries the risk of morbidity, complete heart block, wound infection and thoracotomy scar on the chest. On weighing the risk and benefit, the small VSDs were not submitted to surgery in the past. So for many years it has been taught that the small VSDs are to be left alone and surgery is not recommended. Many clinicians believed in spontaneous closure of VSDs. Hence they advised the parents to wait for spontaneous closure till the child is 9 years old. But what if the VSD does not close by 10 years is the question. Are they normal as grown up congenital heart (GUCH. The Jane Somerville GUCH unit showed that spontaneous closure occurred only in 10% between the age of 17 and 45 (mean - 27 years in small VSDs in adults. What is worth noting is about 25% had serious complications: infective endocarditis (11%, progressive aortic regurgitation (5%, age-related symptomatic arrhythmias (8.5% like atrial fibrillation. This means that asymptomatic small VSDs in childhood is not necessarily benign during adult life. This raises the question, when we have a safe non-surgical device closure available to close the small VSDs, should we put the future lives of the young in danger by not giving the benefit of technology to them?

  10. Closure of open wellbores in creeping salt sheets

    NARCIS (Netherlands)

    Weijermars, R.; Jackson, M.P.A.; Van Harmelen, A.

    2013-01-01

    Safe exploration and production of pre-salt (or subsalt) hydrocarbons require that drilling operations be optimized. We introduce analytical models of wellbore closure, accounting for variations in both the wellbore net pressure and far-field flow rate of an autochthonous or allochthonous salt sheet

  11. 40 CFR 265.143 - Financial assurance for closure.

    Science.gov (United States)

    2010-07-01

    ....143 Section 265.143 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SOLID WASTES... operator must compare the new estimate with the trustee's most recent annual valuation of the trust fund... trust agreement (see § 264.151(a)) to show current closure cost estimates; (C) Annual valuations...

  12. Uterine Closure in Cesarean Delivery: A New Technique

    Directory of Open Access Journals (Sweden)

    K M Babu

    2012-01-01

    Full Text Available Fear of scar rupture is one of risks involved in a post caesarean pregnancy. This had led to an increased rate of repeat cesarean delivery in today′s times. Closure of the uterine incision is a key step in cesarean section, and it is imperative that an optimal surgical technique be employed for closing a uterine scar. This technique should be able to withstand the stress of subsequent labor. In the existing techniques of uterine closure, single or double layer, correct approximation of the cut margins, that is, decidua-to-decidua, myometrium to myometrium, serosa to serosa is not guaranteed. Also, there are high chances of inter surgeon variability. It was felt that if a suturing technique which ensures correct approximation of all the layers mentioned above with nil or minimal possibility of inter operator variability existed, there will not be any thinning of lower segment caesarean section (LSCS. Further, a scarred uterus repaired in this manner will be able to withstand the stress of labor in future. We hereby report a new technique for uterine closure devised by us, which incorporates a continuous modified mattress suture technique as a modification of the existing surgical technique of uterine closure.

  13. Primary Closure versus Gastric Resection for Perforated Gastric ...

    African Journals Online (AJOL)

    Surgical Scales: Primary Closure versus Gastric Resection for. Perforated Gastric ... best choice? Minor or ... current practice is reserved mostly for Johnson Type I and IV ulcers .... if gastrectomy is indicated and even if the patient is fit for major ...

  14. 31. Left ventricular dysfunction after patent ductus arteriosus (PDA closure

    Directory of Open Access Journals (Sweden)

    Rihab Agouba

    2015-10-01

    Conclusions: Depressed LV-SFx may occur after PDA closure with higher incidence after catheter PDA device occlusion. All of preterm babies had surgical PDA occlusion and none of them presented with depressed LV-SFx in the post-operative follow-up. Further prospective studies are needed to investigate these observations.

  15. Mechanics of epithelial closure over non-adherent environments

    Science.gov (United States)

    Vedula, Sri Ram Krishna; Peyret, Grégoire; Cheddadi, Ibrahim; Chen, Tianchi; Brugués, Agustí; Hirata, Hiroaki; Lopez-Menendez, Horacio; Toyama, Yusuke; Neves de Almeida, Luís; Trepat, Xavier; Lim, Chwee Teck; Ladoux, Benoit

    2015-01-01

    The closure of gaps within epithelia is crucial to maintain its integrity during biological processes such as wound healing and gastrulation. Depending on the distribution of extracellular matrix, gap closure occurs through assembly of multicellular actin-based contractile cables or protrusive activity of border cells into the gap. Here we show that the supracellular actomyosin contractility of cells near the gap edge exerts sufficient tension on the surrounding tissue to promote closure of non-adherent gaps. Using traction force microscopy, we observe that cell-generated forces on the substrate at the gap edge first point away from the centre of the gap and then increase in the radial direction pointing into the gap as closure proceeds. Combining with numerical simulations, we show that the increase in force relies less on localized purse-string contractility and more on large-scale remodelling of the suspended tissue around the gap. Our results provide a framework for understanding the assembly and the mechanics of cellular contractility at the tissue level.

  16. Fetal endoscopic myelomeningocele closure preserves segmental neurological function

    NARCIS (Netherlands)

    Verbeek, Renate J.; Heep, Axel; Maurits, Natalia M.; Cremer, Reinhold; Hoving, Eelco W.; Brouwer, Oebele F.; Van der Hoeven, Johannes H.; Sival, Deborah A.

    2012-01-01

    AIM:   Our aim was to compare the effect of prenatal endoscopic with postnatal myelomeningocele closure (fetally operated spina bifida aperta [fSBA]) versus neonatally operated spina bifida aperta [nSBA]) on segmental neurological leg condition. METHOD:   Between 2003 and 2009, the fetal surgical te

  17. Patent Foramen Ovale and Closure Technique with the Amplatzer Occluder

    Directory of Open Access Journals (Sweden)

    Bernhard Meier

    2014-01-01

    Full Text Available Proof that percutaneous closure of the patent foramen ovale (PFO is superior to medical treatment is still incomplete. Paradoxical embolism is a rare event occurring over decades rather than years. None of the 4 randomized trials published carried enough patients or was followed up for long enough to reach superiority endpoints. All data, however, point to a benefit of PFO closure. Free wall erosion (exceedingly rare and triggering of atrial fibrillation (in about 1% of patients are the only noteworthy complications. They are outweighed by the supposedly prevented events of paradoxical embolisms, such as stroke, transient ischemic attacks, myocardial infarctions, or other systemic embolisms. Medical treatment with perhaps the exception of lifelong oral anticoagulation provides less protection. During a 10-year follow-up of a comparative study the annual mortality was significantly lower in the patients with PFO closure (0.4% than in those with medical treatment (1.1%, P<0.03. PFO closure can be accomplished in less than 1 hour with immediate resumption of physical activity. It represents thus a kind of mechanical vaccination.

  18. Cystic duct closure by sealing with bipolar electrocoagulation

    DEFF Research Database (Denmark)

    Schulze, S; Damgaard, B; Jørgensen, Lars Nannestad;

    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 i...

  19. Vacuum-assisted closure : indications and clinical experience

    NARCIS (Netherlands)

    Schasfoort, RA; Obdeijn, MC; Nicolai, JPA; van der Werf, J.F.A.; de Lange, M.

    2000-01-01

    The use of subatmospheric pressure to promote wound healing has gradually found support in the past few years. The vacuum-assisted closure system uses a pump providing a continuous negative pressure of preferably 125 mmHg, which is distributed over the wound surface by an airtight covered foam. The

  20. Non-perturbative closure calculation for fluids and plasmas

    Science.gov (United States)

    Tang, Xianzhu; McDevitt, Chris; Guo, Zehua

    2015-11-01

    Closure calculation of the Chapman-Enskog type is based on a perturbative expansion in the small parameter of Knudsen number, which is defined as the ratio of the thermal particle mean-free-path and the system gradient length scale. The error in the analysis can be locally measured in phase space using the local Knudsen number, which for the energy squared dependence of the mean-free-path, is much larger for high energy particles. Such breakdown, if occurs at sufficiently high energy, has small impact on closure results, but in cases of strong spatial gradients, can have large effect and invalidate the perturbative calculation. Here we show a non-perturbative closure formulation and its application in calculating standard closure quantitities such as heat flux. This approach applies as long as the thermal bulk is close to a Maxwellian, where a perturbative analysis can be matched onto a non-perturbative treatment of the tail population. Work supported by DOE via LANL-LDRD.

  1. Energy balance closure for the LITFASS-2003 experiment

    NARCIS (Netherlands)

    Foken, T.; Mauder, M.; Liebethal, C.; Wimmer, F.; Beyrich, F.; Leps, J.P.; Raasch, S.; Debruin, H.A.R.; Meijninger, W.M.L.; Bange, J.

    2010-01-01

    In the first part, this paper synthesises the main results from a series of previous studies on the closure of the local energy balance at low-vegetation sites during the LITFASS-2003 experiment. A residual of up to 25% of the available energy has been found which cannot be fully explained either by

  2. Phase Closure at 691 GHz using the Submillimeter Array

    CERN Document Server

    Hunter, T R; Peck, A B; Christensen, R D; Blundell, R; Camacho, A; Patt, F; Sakamoto, K; Young, K H

    2007-01-01

    Phase closure at 682 GHz and 691 GHz was first achieved using three antennas of the Submillimeter Array (SMA) interferometer located on Mauna Kea, Hawaii. Initially, phase closure was demonstrated at 682.5 GHz on Sept. 19, 2002 using an artificial ground-based "beacon" signal. Subsequently, astronomical detections of both Saturn and Uranus were made at the frequency of the CO(6-5) transition (691.473 GHz) on all three baselines on Sept. 22, 2002. While the larger planets such as Saturn are heavily resolved even on these short baselines (25.2m, 25.2m and 16.4m), phase closure was achieved on Uranus and Callisto. This was the first successful experiment to obtain phase closure in this frequency band. The CO(6-5) line was also detected towards Orion BN/KL and other Galactic sources, as was the vibrationally-excited 658 GHz water maser line toward evolved stars. We present these historic detections, as well as the first arcsecond-scale images obtained in this frequency band.

  3. Budget cuts force early closure of Stanford collider

    CERN Multimedia

    2008-01-01

    in Brief Stanford's B-meson work is coming to an early end.SLACIn early March, California's Stanford Linear Accelerator Center (SLAC) will shut down a collider that produces B mesons. The closure means that the lab's commitment to BaBar - an international collaboration studying the differences between matter and antimatter - will now end seven months early.

  4. Underground storage tank 511-D1U1 closure plan

    Energy Technology Data Exchange (ETDEWEB)

    Mancieri, S.; Giuntoli, N.

    1993-09-01

    This document contains the closure plan for diesel fuel underground storage tank 511-D1U1 and appendices containing supplemental information such as staff training certification and task summaries. Precision tank test data, a site health and safety plan, and material safety data sheets are also included.

  5. Multivariate moment closure techniques for stochastic kinetic models.

    Science.gov (United States)

    Lakatos, Eszter; Ale, Angelique; Kirk, Paul D W; Stumpf, Michael P H

    2015-09-07

    Stochastic effects dominate many chemical and biochemical processes. Their analysis, however, can be computationally prohibitively expensive and a range of approximation schemes have been proposed to lighten the computational burden. These, notably the increasingly popular linear noise approximation and the more general moment expansion methods, perform well for many dynamical regimes, especially linear systems. At higher levels of nonlinearity, it comes to an interplay between the nonlinearities and the stochastic dynamics, which is much harder to capture correctly by such approximations to the true stochastic processes. Moment-closure approaches promise to address this problem by capturing higher-order terms of the temporally evolving probability distribution. Here, we develop a set of multivariate moment-closures that allows us to describe the stochastic dynamics of nonlinear systems. Multivariate closure captures the way that correlations between different molecular species, induced by the reaction dynamics, interact with stochastic effects. We use multivariate Gaussian, gamma, and lognormal closure and illustrate their use in the context of two models that have proved challenging to the previous attempts at approximating stochastic dynamics: oscillations in p53 and Hes1. In addition, we consider a larger system, Erk-mediated mitogen-activated protein kinases signalling, where conventional stochastic simulation approaches incur unacceptably high computational costs.

  6. Optimal Technique for Abdominal Fascial Closure in Liver Transplant Patients

    Directory of Open Access Journals (Sweden)

    Unal Aydin

    2010-01-01

    Conclusion: Our results indicate that the novel technique used in this study contributed to overcoming early and late postoperative complications associated with closure of the abdominal fascia in liver transplant patients. In addition, this new technique has proven to be easily applicable, faster, safer and efficient in these patients; it is also potentially useful for conventional surgery.

  7. Burdock fructooligosaccharide induces stomatal closure in Pisum sativum.

    Science.gov (United States)

    Guo, Yanling; Guo, Moran; Zhao, Wenlu; Chen, Kaoshan; Zhang, Pengying

    2013-09-12

    Burdock fructooligosaccharide (BFO) isolated from the root tissue of Arctium lappa is a reserve carbohydrate that can induce resistance against a number of plant diseases. Stomatal closure is a part of plant innate immune response to restrict bacterial invasion. In this study, the effects of BFO on stomata movement in Pisum sativum and the possible mechanisms were studied with abscisic acid (ABA) as a positive control. The results showed that BFO could induce stomatal closure accompanied by ROS and NO production, as is the case with ABA. BFO-induced stomatal closure was inhibited by pre-treatment with L-NAME (N(G)-nitro-L-arginine methyl ester, hydrochloride; nitric oxide synthase inhibitor) and catalase (hydrogen peroxide scavenger). Exogenous catalase completely restricted BFO-induced production of ROS and NO in guard cells. In contrast, L-NAME prevented the rise in NO levels but only partially restricted the ROS production. These results indicate that BFO-induced stomatal closure is mediated by ROS and ROS-dependent NO production.

  8. Security and biomechanical strength of three end-pass configurations for the terminal end of intradermal closures performed with unidirectional barbed suture material in dogs.

    Science.gov (United States)

    Regier, Penny J; Smeak, Daniel D; McGilvray, Kirk C

    2016-12-01

    OBJECTIVE To compare security of continuous intradermal suture lines closed by use of barbed suture with 3 end-pass configurations or without an end-pass configuration. SAMPLE 40 full-thickness, 4-cm-long, parasagittal wounds in canine cadavers. PROCEDURES Each continuous intradermal closure was terminated with 1 of 3 end-pass techniques or without an end-pass configuration (control group). A servohydraulic machine applied tensile load perpendicular to the long axis of the suture line. A load-displacement curve was generated for each sample; maximum load, displacement, stiffness, mode of construct failure, and load at first suture slippage at termination (ie, terminal end of the suture line) were recorded. RESULTS Values for maximum load, displacement, and stiffness did not differ significantly among the 3 end-pass techniques, and load at first suture slippage at termination was not significantly different among the 4 groups. A 1-pass technique slipped in 5 of 9 samples; 3 of these 5 slips caused failure of wound closure. A 2-pass technique slipped in 3 of 9 samples, none of which caused failure of wound closure. Another 2-pass technique slipped in 4 of 10 samples; 2 of these 4 slips caused failure of wound closure. The control group had slippage in 10 of 10 samples; 9 of 10 slips caused failure of wound closure CONCLUSIONS AND CLINICAL RELEVANCE An end-pass anchor was necessary to terminate a continuous intradermal suture line, and all 3 end-pass anchor techniques were suitable to prevent wound disruption. The 2-pass technique for which none of the suture slippages caused wound closure failure provided the most reliable configuration.

  9. 77 FR 74119 - Snapper-Grouper Fishery of the South Atlantic; 2012 Commercial Accountability Measure and Closure...

    Science.gov (United States)

    2012-12-13

    ... the South Atlantic; 2012 Commercial Accountability Measure and Closure for South Atlantic Snowy... (NOAA), Commerce. ACTION: Temporary rule; closure. SUMMARY: NMFS implements accountability measures...

  10. Left atrial appendage closure device implantation and pulmonary vein isolation as a comprehensive treatment for atrial fibrillation

    Directory of Open Access Journals (Sweden)

    А. А. Якубов

    2016-01-01

    Full Text Available Objective. This randomized clinical trial was designed to assess the impact of pulmonary vein isolation (PVI combined with LAA occlusion on patients with high-risk AF. Methods. Patients with a history of symptomatic paroxysmal (P AF and/or persistent (Pers AF and CHA2DS2-VASc score ≥2 and HAS-BLED score ≥3 were randomized in groups with PVI only (n = 44 and PVI combined with LAA occlusion (n = 45. All patients were followed during 24 months in order to evaluate the safety of thromboembolic complications and to monitor the heart rhythm conducted by means of an implantable cardiac monitor. Results. 6 patients from the PVI with LAA occlusion group were transferred to the PVI only group because of a failure to implant a LAA closure device. Based on ILR data, by the end of the follow-up 33 (66% out of 50 patients in the PVI only group and 23 (59% out of 39 patients in the PVI with LAA closure device implantation group were free from atrial fibrillation and flutter without antiarrhythmic drugs (p = 0.34. In the blanking period, AF% was significantly higher in the PVI with LAA closure group than that in the PVI-only group, 9.7±10.8 and 4.2±4.1% respectively (p = 0.004. After the blanking period, the AF% was similar in both groups. During the entire follow-up, no AF/intervention-related complications were observed. Conclusion. The combination of LAA closure device implantation with PVI seems to be a safe procedure. However, it does not improve the efficacy of PVI in patients with symptomatic refractory AF. But in the blanking period LAA occlusion increases AF %.

  11. Safety and efficacy of the Perclose suture-mediated closure device following carotid artery stenting under clopidogrel platelet blockade

    Energy Technology Data Exchange (ETDEWEB)

    Zorger, Niels; Finkenzeller, Thomas; Lenhart, Markus; Hamer, Okka; Paetzel, Christian; Borisch, Inghita; Toepel, Ingolf; Feuerbach, Stefan; Link, Johann [University of Regensburg Klinikum, Franz-Josef-Strauss-Allee 11, 93042, Regensburg (Germany)

    2004-04-01

    The aim of this study was evaluation of a closure device (Perclose, Menlo Park, Calif.) for closure of the femoral artery access site in patients undergoing aggressive anticoagulation and platelet blockade after carotid stenting. Fifty-five patients who received clopidogrel in addition to aspirin and heparin as medication for carotid stenting were included for suture of the femoral access site after using 7- or 8-F guide catheters. The technical success, the time for suture, the clotting parameters, and complications were examined. Follow-up investigations, including ultrasound and clinical examinations, were performed. The groin was checked for possible hematoma, pseudoaneurysm, arteriovenous fistula, and local infection. Technical success was obtained in 51 of 54 patients (94%) after a mean procedure time of 6 min (range 5-10 min). The suture device was not used in one patient (2%) for anatomical reasons and failed to obtain hemostasis in 3 of 54 (6%) patients. In 4 of 54 patients (7%) bleeding was observed at the punctured site 4-6 h after intervention which was treated by a compression bandage. The mean dedicated activated clotting time was 137 s (range 29-287 s) before intervention and 349 s (150-958 s) just before deploying the Perclose device. During follow-up after 2 days (range 2-6 days) and 6 months no further complications of the puncture site were observed except for two large groin hematomas. No major complications occurred. Closure of the femoral access site after carotid stenting using a Perclose closure device is safe and effective even in patients receiving an aggressive anticoagulation and antiplatelet therapy. (orig.)

  12. Transcatheter Closure of Atrial Septal Defect with Amplatzer Septal Occluder in Adults: Immediate, Short, and Intermediate-Term Results

    Directory of Open Access Journals (Sweden)

    Majid Dehghani

    2011-05-01

    Full Text Available Background: The transcatheter closure of the atrial septal defect (ASD has become an alternative technique to surgical procedures. The aim of this study was to assess the immediate, short, and intermediate-term results of the transcatheter closure of the secundum ASD with the Amplatzer Septal Occluder (ASO in adult Iranian patients.Methods: Between December 2004 and July 2008, the transcatheter closure of the ASD using the ASO was attempted in 58consecutive, adult patients. The mean age of the patients was 37.1 ± 12.7 years (range = 19 - 75 years.All the procedures were performed under local anesthesia with transthoracic or transesophageal echocardiography and fluoroscopic guidance. The stretched diameter of the ASD was determined with a balloon sizing catheter, and device selection was based on and matched to the stretched diameter of the septal defect.Transthoracic echocardiography was performed immediately after the release of the device and before discharge.Further follow-up at one month, six months, and yearly thereafter included physical examination, electrocardiography, andtransthoracic echocardiography.Results: The mean ASD diameter, as measured by esophageal echocardiography, was 24.8 ± 5.4 mm (range = 13 - 34 mm.The mean stretched diameter, as measured by the balloon catheter, was 27.1 ± 6.4 mm (range = 12.5 - 39 mm. Deploymentof the ASO was successful in 52 (89.6% patients and failed in 6 (10.4%. Four patients experienced severe complications,1 had tamponade requiring drainage, 2 had device embolization to the left atrium and right ventricular outflow tract, and 1 had late wire fracture (surgical removal and repair of the ASD. The position of two large devices (34 mm and 36 mm was considered unsuitable and unstable after implantation and resulted in the removal of these devices.Minor complications included transient complete atrioventricular block in 1 patient, paroxysmal supra tachycardia in 3 patients, atrial flutter in 1 patient

  13. ICPP tank farm closure study. Volume 2: Engineering design files

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-02-01

    Volume 2 contains the following topical sections: Tank farm heel flushing/pH adjustment; Grouting experiments for immobilization of tank farm heel; Savannah River high level waste tank 20 closure; Tank farm closure information; Clean closure of tank farm; Remediation issues; Remote demolition techniques; Decision concerning EIS for debris treatment facility; CERCLA/RCRA issues; Area of contamination determination; Containment building of debris treatment facility; Double containment issues; Characterization costs; Packaging and disposal options for the waste resulting from the total removal of the tank farm; Take-off calculations for the total removal of soils and structures at the tank farm; Vessel off-gas systems; Jet-grouted polymer and subsurface walls; Exposure calculations for total removal of tank farm; Recommended instrumentation during retrieval operations; High level waste tank concrete encasement evaluation; Recommended heavy equipment and sizing equipment for total removal activities; Tank buoyancy constraints; Grout and concrete formulas for tank heel solidification; Tank heel pH requirements; Tank cooling water; Evaluation of conservatism of vehicle loading on vaults; Typical vault dimensions and approximately tank and vault void volumes; Radiological concerns for temporary vessel off-gas system; Flushing calculations for tank heels; Grout lift depth analysis; Decontamination solution for waste transfer piping; Grout lift determination for filling tank and vault voids; sprung structure vendor data; Grout flow properties through a 2--4 inch pipe; Tank farm load limitations; NRC low level waste grout; Project data sheet calculations; Dose rates for tank farm closure tasks; Exposure and shielding calculations for grout lines; TFF radionuclide release rates; Documentation of the clean closure of a system with listed waste discharge; and Documentation of the ORNL method of radionuclide concentrations in tanks.

  14. Middle Miocene closure of the Central American Seaway

    Science.gov (United States)

    Montes, C.; Cardona, A.

    2014-12-01

    The final closure of the Panama Isthmus and permanent separation of Caribbean and Pacific waters is thought to have modified their salinity, faunistic assemblages, and ultimately, ocean circulation patterns and global climate. The Great American Biotic Interchange (GABI) is thought to have been the result of Plio-Pleistocene closure of the Isthmus that allowed land animals to massively cross the Isthmus. Similarly, the separation of Caribbean and Pacific waters by a rising Isthmus is thougth to be a prime example of vicariance. The role of Isthmus closure on global changes, however, remains controversial due in part to the difficulty of establishing a precise chronology of seaway closure. While timing of glaciation is well established, new data on the chronology of Isthmus emergence suggests that the process of closure is more complex, long, and old than previously thought. We sampled fluvial and shallow marine strata in northwesternmost South America to recover zircon grains for provenance analyses in the immediate vicinity of the docking site. Because the ages of magmatic provinces in northwestern South America and the Panama Isthmus are mutually exclusive, detrital zircon analyses provides a tool to evaluate land connections. We found that an uniquely Panamanian, 40-45 Ma (early Lutetian) detrital zircon fingerprint is abundant in middle Miocene strata, but absent in underlying lower Miocene and Oligocene strata of the northern Andes. This fingerprint represents the beginning of fluvial detrital exchange between the Panama arc and South America, and therefore marks the time of docking and the end of deep-water, and probably shallow-water connections by middle Miocene times.

  15. Factors Influencing School Closure and Dismissal Decisions: Influenza A (H1N1), Michigan 2009

    Science.gov (United States)

    Dooyema, Carrie A.; Copeland, Daphne; Sinclair, Julie R.; Shi, Jianrong; Wilkins, Melinda; Wells, Eden; Collins, Jim

    2014-01-01

    Background: In fall 2009, many US communities experienced school closures during the influenza A H1N1 pandemic (pH1N1) and the state of Michigan reported 567 closures. We conducted an investigation in Michigan to describe pH1N1-related school policies, practices, and identify factors related to school closures. Methods: We distributed an online…

  16. 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.”

  17. An evaluation of mass flux closures for diurnal cycles of shallow cumulus

    NARCIS (Netherlands)

    Neggers, R.A.J.; Siebesma, A.P.; Lenderink, G.; Holtslag, A.A.M.

    2004-01-01

    Three closure methods for the mass flux at cloud base in shallow cumulus convection are critically examined for the difficult case of a diurnal cycle over land. The closure methods are first evaluated against large-eddy simulations (LESs) by diagnosing all parameters appearing in the closure equatio

  18. Prophylactic plastic surgery closure of neurosurgical scalp incisions reduces the incidence of wound complications in previously-operated patients treated with bevacizumab (Avastin®) and radiation.

    Science.gov (United States)

    Golas, Alyssa Reiffel; Boyko, Tatiana; Schwartz, Theodore H; Stieg, Philip E; Boockvar, John A; Spector, Jason A

    2014-09-01

    Neurosurgical craniotomy, craniectomy, or other trans-galeal interventions are performed for a variety of indications, including the resection of benign or malignant tumors, hematoma evacuation, and for the management of intractable seizure disorders. Despite an overall low complication rate of intervention, wound healing complications such as dehiscence, surgical site infection, and cerebrospinal fluid leak are not uncommon. A retrospective review was performed of all patients who underwent scalp incision closure at a single institution by a single plastic surgeon between 2006 and 2013. Sixty patients (83 procedures) were included in the study. Fifty-seven patients (95.0 %) underwent previous craniotomy, craniectomy, or other trans-galeal procedure. Of the total 60 patients, 35 patients received preoperative radiation. Sixteen patients received bevacizumab prior to their index case, while 12 received bevacizumab postoperatively. Ten patients (16.7 %) required additional plastic surgical intervention for wound complications after their index plastic surgery procedure. Plastic surgery was consulted prophylactically in 34 patients (38 procedures). When plastic surgery was consulted prophylactically, 4 patients (11.8 %) required further wound revision. None of the 14 patients who underwent prophylactic plastic surgery closure for previous scalp incision, preoperative bevacizumab, and XRT administration required re-intervention. Plastic surgery closure of complex scalp incisions reduces the incidence of wound complications among patients who underwent previous neurosurgical intervention, XRT administration, and preoperative bevacizumab administration. This is particularly true when plastic surgery closure is performed "prophylactically." Further collaboration between the neurosurgical and plastic surgery teams is therefore warranted, particularly in the setting of these high-risk cases.

  19. ABDOMINAL CLOSURE WITH ANTI BACTERIAL COATED SUTURE MATERIALS AND ITS RELATION TO THE INCIDENCE OF POST OPERATIVE SUPERFICIAL SURGICAL SITE INFECTION RATES

    OpenAIRE

    Josephine Pudumai Selvi; Celine Foustina Mary; Karthikeyan Rajashekar

    2017-01-01

    BACKGROUND Surgical site infection (SSI) is an immense burden on healthcare resources even in the modern era of immaculate sterilization approaches and highly effective antibiotics. An estimated 234 million various surgical procedures, involving skin incisions requiring various types of wound closure techniques, are performed in the world, with the majority resulting in a wound healing by primary intention. Triclosan (5-chloro-2-(2, 4-dichlorophenoxy) phenol) is a broad-spectrum b...

  20. A time-series study of percutaneous closure of patent foramen ovale: premature adoption?

    Science.gov (United States)

    Lew, Kian Nian; Angelini, Gianni D; Hollingworth, William

    2016-01-01

    To evaluate the impact of National Institute for Health and Care Excellence (NICE) guidance in January 2005 and subsequent trial evidence on the adoption of percutaneous closure of patent foramen ovale (PCPFO). A retrospective time series study was conducted using the Inpatient Hospital Episode Statistics (HES) England. A total of 3801 patients, aged ≥18 and ≤60 years, who had PCPFO from 1 April 2006 to 31 March 2012 in England. Percentage change annualised (PCA) in PCPFO procedure rates between initial NICE guidance and publication of trial results was analysed. Between Quarter 2, 2006 and Quarter 4, 2009, 2163 PCPFO procedures were performed, with an increasing PCA of 48.4%. The procedure rate peaked before the presentation of equivocal results from the first randomised controlled trial (RCT) in late 2010, and declined between Quarter 4, 2009 and Quarter 4, 2011 (PCA=-15.3%). Of more than 2300 patients recruited to three RCTs, only 71 were recruited in English hospitals. PCPFO was rapidly adopted after the publication of initial NICE guidance despite the absence of RCT evidence of efficacy. Very few English patients participated in international RCTs of PCPFO, suggesting that NICE recommendations also failed to encourage the generation of RCT evidence.

  1. 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.

  2. Postprocedural Outcomes and Risk Factors for Arrhythmias Following Transcatheter Closure of Congenital Perimembranous Ventricular Septal Defect: A Single-center Retrospective Study

    Science.gov (United States)

    Zhao, Li-Jian; Han, Bo; Zhang, Jian-Jun; Yi, Ying-Chun; Jiang, Dian-Dong; Lyu, Jian-Li

    2017-01-01

    Background: Currently, transcatheter closure of perimembranous ventricular septal defect (pmVSD) is a widely accepted therapeutic modality. However, arrhythmias, especially postprocedural heart blocks, are a concern and outcomes are not very clear. This study explored the outcomes and risk factors of arrhythmias associated with transcatheter device closure of pmVSD. Methods: A total of 395 patients diagnosed with pmVSD who successfully underwent transcatheter intervention between January 2010 and December 2015 in our center were retrospectively reviewed. Electrocardiographic data before and after the procedure were collected and analyzed. We first evaluated the potential risk factors including gender, age, weight, inlet and outlet diameters of defect, subaortic rim length, occluder size, corrected occluder size into body surface area, fluoroscopy time, presence of aneurysm, and deployment position. We compared the potential risk factors between arrhythmia and nonarrhythmia groups using univariate analysis, followed by logistic analysis for independent risk factors. Results: Various arrhythmias were detected in 95 cases (24.1%) following transcatheter closure procedure. Logistic regression analysis revealed that eccentric (odds ratio [OR] 2.9, 95% confidence interval [CI]: 1.2–7.2) and large occluders (OR 2.0, 95% CI: 1.6–2.5), as well as long fluoroscopy time (OR 1.1, 95% CI: 1.1–1.2), were correlated with postprocedural arrhythmia. During 35.5 months (range: 9–80 months) of follow-up, most of the patients (74 out of 95) reverted to normal heart rhythm. Conclusions: The mid-term outcome of patients with arrhythmias after transcatheter closure of pmVSD was satisfactory as most of the patients recovered normal rhythm. Eccentric, large device and long fluoroscopy time increase the risk of arrhythmias after transcatheter closure of pmVSD. PMID:28229981

  3. 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.

  4. Bariatric Surgery Procedures

    Science.gov (United States)

    ... Center Access to Care Toolkit EHB Access Toolkit Bariatric Surgery Procedures Bariatric surgical procedures cause weight loss by ... Bariatric procedures also often cause hormonal changes. Most weight loss surgeries today are performed using minimally invasive techniques (laparoscopic ...

  5. Bariatric Surgery Procedures

    Science.gov (United States)

    ... Center Access to Care Toolkit EHB Access Toolkit Bariatric Surgery Procedures Bariatric surgical procedures cause weight loss by restricting the ... Online Education Directory Search Patient Learning Center Bariatric Surgery ... Surgery Procedures BMI Calculator Childhood and Adolescent Obesity ...

  6. Complete closure of artificial gastric ulcer after endoscopic submucosal dissection by combined use of a single over-the-scope clip and through-the-scope clips (with videos).

    Science.gov (United States)

    Maekawa, Satoshi; Nomura, Ryosuke; Murase, Takayuki; Ann, Yasuyoshi; Harada, Masaru

    2015-02-01

    A 5-7 day hospital stay is usually needed after endoscopic submucosal dissection (ESD) of gastric tumor because of the possibility of delayed perforation or bleeding. The aim of this study was to evaluate the efficacy of combined use of a single over-the-scope clip (OTSC) and through-the-scope clips (TTSCs) to achieve complete closure of artificial gastric ulcer after ESD. We prospectively studied 12 patients with early gastric cancer or gastric adenoma. We performed complete closure of post-ESD artificial gastric ulcer using a combination of a single OTSC and TTSCs. Mean size of post-ESD artificial ulcer was 54.6 mm. The mean operating time for the closure procedure was 15.2 min., and the success rate was 91.7 % (11/12). Patients who underwent complete closure of post-ESD artificial gastric ulcer could be discharged the day after ESD and the closing procedure. Complete closure of post-ESD artificial gastric ulcer using a combination of a single OTSC and TTSCs is useful for shortening the period of hospitalization and reducing treatment cost.

  7. Results of Sauve-kapandji procedure.

    Science.gov (United States)

    Low, C K; Chew, W Y C

    2002-03-01

    Sauve-Kapandji procedure is used to treat distal radioulnar joint disorder. Sixteen patients with distal radioulnar joint (DRUJ) disease treated with Sauve-Kapandji procedure between 1996 and 1998 were available for review at an average follow up period of 32.8 months,ranging from 24 to 48 months. The patients were young and the average age at the time of procedure was 33.6 years. There were eight cases of post-traumatic DRUJ arthritis, two cases of dislocation of DRUJ with malunion of radial fractures and six cases of rheumatoid patients with destruction of DRUJ. The distal end of ulnar shaft was stabilised with a sling created using radial 1/2 slip of extensor carpi ulnaris (ECU) tendon. Functional results were evaluated with Mayo wrist score. Fusion of DRUJ was achieved in all cases by two months. Excellent results were achieved in eight cases, good in six, fair in one and poor in one. All except one case gained increase range of forearm rotation. Complications included one case of closure of pseudoarthrosis and required excision of the ulna head to restore forearm rotation. Sauve-Kapandji procedure is recommended in young patients with distal radioulnar joint disorder.

  8. Use of Adipose-Derived Stem Cells to Support Topical Skin Adhesive for Wound Closure: A Preliminary Report from Animal In Vivo Study

    Directory of Open Access Journals (Sweden)

    Maciej Nowacki

    2016-01-01

    Full Text Available The aim of this study was to determine the local and systemic effects of adipose-derived stem cells (ADSCs as a component of topical skin adhesive in an animal artificial wound closure model. In presented study the cosmetic effects, histological analysis, mechanical properties, and cell migration have been assessed to evaluate the usefulness of ADSCs as supporting factor for octyl blend cyanoacrylate adhesive. The total of 40 rats were used and divided into six groups. In the Study Group, ADSCs were administered by multipoint injection of the six surrounding intrawound areas with additional freely leaving procedure of the cells between the skin flaps just before applying adhesive to close the wound. Five control groups without using ADSCs, utilizing different types of standard wound closure, were created in order to check efficiency of experimental stem cell therapy. In our study, we proved that ADSCs could be used effectively also as a supportive tool in topical skin adhesive for wound closure. However we did not achieve any spectacular differences related to such aspects as better mechanical properties or special biological breakthroughs in wound healing properties. The use of stem cells, especially ADSCs for wound closure can provide an inspiring development in plastic and dermatologic surgery.

  9. Transcatheter closure of ventricular septal defect in patients with aortic valve prolapse and mild aortic regurgitation:feasibility and preliminary outcome

    Institute of Scientific and Technical Information of China (English)

    Guan-Liang Chen; Hai-Tao Li; Hai-Rong Li; Zhi-Wei Zhang

    2015-01-01

    Objective: To evaluate the feasibility, safety and efficacy of transcatheter closure of ventricular septal defect (VSD) in patients with aortic valve prolapse (AVP) and mild aortic regurgitation (AR). Methods: Between January 2008 and July 2014, transcatheter closure of VSD was attempted in 65 patients. Results: The total intermediate closure successful rate in all subjects was 96.9%. During the perioperative period, no death, major bleeding, pericardial tamponade, occluder dislodgement, residual shunt or hemolysis occurred. Two procedures had been forced to suspend due to significant aggregation of device related aortic regurgitation, three cases of transient complete left bundle branch block occurred but did not sustain. At 1-year follow-up, no patients had residual shunts and complications. Furthermore, grade of residual AR were relieved in 61.9% (39/63) cases and degree of AVP were ameliorated in 36.5% (23/63) patients; Conclusions: Transcatheter closure VSD in selected patients with AVP and mild AR is technically feasible and highly effective. Long term safety and efficacy needs to be assessed.

  10. Gravity Affects the Closure of the Traps in Dionaea muscipula

    Directory of Open Access Journals (Sweden)

    Camilla Pandolfi

    2014-01-01

    Full Text Available Venus flytrap (Dionaea muscipula Ellis is a carnivorous plant known for its ability to capture insects thanks to the fast snapping of its traps. This fast movement has been long studied and it is triggered by the mechanical stimulation of hairs, located in the middle of the leaves. Here we present detailed experiments on the effect of microgravity on trap closure recorded for the first time during a parabolic flight campaign. Our results suggest that gravity has an impact on trap responsiveness and on the kinetics of trap closure. The possible role of the alterations of membrane permeability induced by microgravity on trap movement is discussed. Finally we show how the Venus flytrap could be an easy and effective model plant to perform studies on ion channels and aquaporin activities, as well as on electrical activity in vivo on board of parabolic flights and large diameter centrifuges.

  11. Gravity affects the closure of the traps in Dionaea muscipula.

    Science.gov (United States)

    Pandolfi, Camilla; Masi, Elisa; Voigt, Boris; Mugnai, Sergio; Volkmann, Dieter; Mancuso, Stefano

    2014-01-01

    Venus flytrap (Dionaea muscipula Ellis) is a carnivorous plant known for its ability to capture insects thanks to the fast snapping of its traps. This fast movement has been long studied and it is triggered by the mechanical stimulation of hairs, located in the middle of the leaves. Here we present detailed experiments on the effect of microgravity on trap closure recorded for the first time during a parabolic flight campaign. Our results suggest that gravity has an impact on trap responsiveness and on the kinetics of trap closure. The possible role of the alterations of membrane permeability induced by microgravity on trap movement is discussed. Finally we show how the Venus flytrap could be an easy and effective model plant to perform studies on ion channels and aquaporin activities, as well as on electrical activity in vivo on board of parabolic flights and large diameter centrifuges.

  12. Assistant pullback technique for main span closure of Sutong Bridge

    Institute of Scientific and Technical Information of China (English)

    Chen Ming; Luo Chengbin; Wu Qihe; Zhang Yongtao; You Xinpeng

    2009-01-01

    Sutong Bridge is a cable-stayed steel box girder bridge with a main span of 1 088 m. The erection of upper structure adopts geometry control method and requires no change to the unit's size and the structure's none-stress geometry. Before main span closure, the cantilever of girder reaches 540.8 m, the structure state is noticeably influenced by external circumstances, the main span closure face great difficulty. By abstracting the advantage of the pullback method abroad and the domestic temperature-cutting method, a new assistant pullback method have put forward and bring into practice actually. In this paper, the analysis key point of practice conditions, key parameter of practice, main measures of the method and the performance is introduced.

  13. CERN Services Availability during the CERN Annual Closure 2011

    CERN Multimedia

    IT & GS Departments

    2011-01-01

    General Services: Most of the services provided by the GS Department that do not depend on continuous human presence will remain available during the CERN annual closure. Support levels are reduced during this period, in general the target reaction time for problems will be ½ day. Apart from the heating system, no interruptions are scheduled. In case of failure, the reaction time for restoration of services depends on the arrangements that have been made on a service by service level. Incidents will be documented at http://gssb.web.cern.ch/ For more detailed information please consult the service-portal (http://cern.ch/service-portal). Computing Services Most of the services provided by the IT Department - including WLCG production services - will remain available during the CERN annual closure. No interruptions are scheduled but in case of failure, the restoration of services cannot be guaranteed. Problems will be dealt with on a best effort basis only. However, please note: Experts shoul...

  14. Economic returns to occupational closure in the German skilled trades.

    Science.gov (United States)

    Bol, Thijs

    2014-07-01

    Recent sociological studies argue that wage differentials between occupations are partly attributable to occupational closure. Occupations set up barriers which restrict the supply of occupational labor, thereby generating an economic rent. In this article we study occupational closure in the skilled trades of Germany, where the Trade and Crafts code restricts self-employment in 41 occupations to those who are master craftsmen. Newly gathered occupational data about the Trade and Crafts code is mapped on micro data from the German Microcensus of 2006. The central finding of our empirical analyses is that self-employed workers with comparable levels of human capital and demographic characteristics earn structurally more in closed occupations. We argue that this earnings premium is a rent, obtained by self-employed because of the entry restriction that is laid down by the Trade and Crafts code. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Jam proof closure assembly for lidded pressure vessels

    Science.gov (United States)

    Cioletti, Olisse C.

    1992-01-01

    An expendable closure assembly is provided for use (in multiple units) with a lockable pressure vessel cover along its rim, such as of an autoclave. This assembly is suited to variable compressive contact and locking with the vessel lid sealing gasket. The closure assembly consists of a thick walled sleeve insert for retention in the under bores fabricated in the cover periphery and the sleeve is provided with internal threading only. A snap serves as a retainer on the underside of the sleeve, locking it into an under bore retention channel. Finally, a standard elongate externally threaded bolt is sized for mating cooperation with the so positioned sleeve, whereby the location of the bolt shaft in the cover bore hole determines its compressive contact on the underlying gasket.

  16. Genetic, epigenetic, and environmental contributions to neural tube closure.

    Science.gov (United States)

    Wilde, Jonathan J; Petersen, Juliette R; Niswander, Lee

    2014-01-01

    The formation of the embryonic brain and spinal cord begins as the neural plate bends to form the neural folds, which meet and adhere to close the neural tube. The neural ectoderm and surrounding tissues also coordinate proliferation, differentiation, and patterning. This highly orchestrated process is susceptible to disruption, leading to neural tube defects (NTDs), a common birth defect. Here, we highlight genetic and epigenetic contributions to neural tube closure. We describe an online database we created as a resource for researchers, geneticists, and clinicians. Neural tube closure is sensitive to environmental influences, and we discuss disruptive causes, preventative measures, and possible mechanisms. New technologies will move beyond candidate genes in small cohort studies toward unbiased discoveries in sporadic NTD cases. This will uncover the genetic complexity of NTDs and critical gene-gene interactions. Animal models can reveal the causative nature of genetic variants, the genetic interrelationships, and the mechanisms underlying environmental influences.

  17. Closure of oroantral fistula with rotational palatal flap technique

    Directory of Open Access Journals (Sweden)

    David B. Kamadjaja

    2007-03-01

    Full Text Available Oroantral fistula is one of the common complications following dentoalveolar surgeries in the maxilla. Closure of oroantral fistula should be done as early as possible to eliminate the risk of infection of the antrum. Palatal flap is one of the commonly used methods in the closure of oroantral fistula. A case is reported of a male patient who had two oroantral communication after having his two dental implants removed. Buccal flap was used to close the defects, but one of them remained open and resulted in oroantral fistula. Second correction was performed to close the defect using buccal fat pad, but the fistula still persisted. Finally, palatal rotational flap was used to close up the fistula. The result was good, as the defect was successfully closed and the donor site healed uneventfully.

  18. Effective closure temperature in leaky and/or saturating thermochronometers

    DEFF Research Database (Denmark)

    Guralnik, Benny; Jain, Mayank; Herman, Frédéric

    2013-01-01

    that can be stored (termed ‘saturating’). While all conservative results can be easily reproduced, an extended use of our formulation provides meaningful effective closure temperatures even when the standard calculation schemes fail. For a first-order loss radiometric system governed by K...... approximation for a broad range of cooling functions in systems where closure occurs close to the systemʼs initial/final thermal boundary conditions. We clarify the use and the meaning of TC(T0,TP) by drawing a comparison between (i) a hypothetical application of apatite U–Pb dating (TC≈450°C) on Venus (mean...... surface temperature of 450 °C, leaky behaviour), and (ii) the recently introduced thermochronometric application of optically stimulated luminescence (OSL) dating on Earth (both leaky and saturating behaviour)....

  19. Is spontaneous closure of a patent arterial duct common?

    Science.gov (United States)

    Hoffman, Julien I E

    2017-01-01

    As closing a patent arterial duct is relatively simple, safe, and successful, most children with a patent arterial duct have it closed soon after diagnosis. The larger ducts are closed to prevent congestive heart failure, pulmonary vascular disease, or aneurysmal dilatation of the ductus, and smaller ducts are closed to prevent infective endocarditis. Consequently, there is no opportunity to determine whether spontaneous closure or diminution in size of the patent arterial duct is common. If the duct does become smaller, flow through it may be so low that no murmur is produced - the silent ductus. The frequency and best management of the silent patent arterial duct are unknown, and we do not know whether these tiny ducts are the last stage before spontaneous closure.

  20. Inertial-particle accelerations in turbulence: a Lagrangian closure

    CERN Document Server

    Vajedi, S; Mehlig, B; Biferale, L

    2016-01-01

    The distribution of particle accelerations in turbulence is intermittent, with non-Gaussian tails that are quite different for light and heavy particles. In this article we analyse a closure scheme for the acceleration fluctuations of light and heavy inertial particles in turbulence, formulated in terms of Lagrangian correlation functions of fluid tracers. We compute the variance and the flatness of inertial particle accelerations and we discuss their dependency on the Stokes number. The closure incorporates effects induced by the Lagrangian correlations along the trajectories of fluid tracers, and its predictions agree well with results of direct numerical simulations of inertial particles in turbulence, provided that the effects induced by the inertial preferential sampling of heavy/light particles outside/inside vortices are negligible. In particular, the scheme predicts the correct functional behaviour of the acceleration variance, as a function of Stokes, as well as the presence of a minimum/maximum for ...

  1. Evaluation of explicit and implicit LES closures for Burgers turbulence

    CERN Document Server

    Maulik, Romit

    2016-01-01

    In this work, we perform an aposteriori error analysis on implicit and explicit large eddy simulation closure models for solving the Burgers turbulence problem. Our closure modeling efforts include both functional and structural models equipped with various low-pass filters. We introduce discrete binomial smoothing filters and an enhanced version of the Van Cittert algorithm to accelerate the convergence of approximate deconvolution processes including regularization and relaxation filtering approaches. Our implicit modeling efforts consist of various high-order schemes including compact and non-compact fifth-order upwind schemes as well as weighted essential non-oscillatory (WENO) and compact reconstructed WENO (CRWENO) schemes, and the resulting schemes are shown to effectively converge to the direct numerical simulation (DNS) for increasing resolutions. Comparing with DNS and underresolved DNS computations, our numerical assessments illustrate the ability of these methods to capture the energy content near...

  2. Teaching advanced wound closure techniques using cattle digits.

    Science.gov (United States)

    Khalil, Philipe N; Kanz, Karl-Georg; Siebeck, Matthias; Mutschler, Wolf

    2011-03-01

    To evaluate a model used to impart advanced wound closure skills because available models do not meet the necessary requirements to a substantial degree. Seventy-one residents were asked to evaluate a 75-minute-long skills course using cadaveric cattle digits to learn Z-plasty, V-Y-plasty, and oval-shaped rotational flaps. A short film and the course instructor demonstrated each technique first. A Likert rating scale ranging from 1 to 6 was used for questions in the survey given to the residents. There was strong agreement among residents (1.65 ± 1.17 years of experience) that advanced wound closure training courses are necessary (5.73 ± 0.73), which corresponded to the residents' low level of knowledge and self-assessment of practical skills and present experience (2.84 ± 1.01). The course was evaluated with high acceptance, even though it was found to be demanding for the trainees (5.84 ± 0.40). This might also be related to the high rating of the model itself, which was found to be a suitable method for teaching advanced wound closure techniques (5.50 ± 0.71) that was easily comprehensible (5.73 ± 0.53). Skills training courses for young trainees are warranted to impart advanced wound closure techniques. The curriculum using cattle digits presented here is recommended. The authors have indicated no significant interest with commercial supporters. © 2011 by the American Society for Dermatologic Surgery, Inc.

  3. Ozone mediators effect on "in vitro" scratch wound closure.

    Science.gov (United States)

    Valacchi, Giuseppe; Sticozzi, Claudia; Zanardi, Iacopo; Belmonte, Giuseppe; Cervellati, Franco; Bocci, Velio; Travagli, Valter

    2016-09-01

    The beneficial effect of low doses of ozone on wound healing has been well documented and attributed mainly to its bactericidal and pro-oxidant properties. Because ozone itself does not penetrate the cells but immediately reacts with polyunsaturated fatty acids, its effects are the results of oxidative mediators. Among the molecule produces by the interaction of ozone with biological systems, there are HNE and H2O2. At today, the cellular mechanisms accounting for the positive effects of mild ozonization on wound closure are still largely unexplored. The aim of the present study was to evaluate the effect of different non-toxic doses of ozonated saline ranging from 2 to 300 μM, in an in vitro wound scratch model by the use of human keratinocytes. The results showed that ozonated saline is able to improve in vitro wound healing by stimulating cell proliferation as measured by BrdU assay and PCNA protein levels. In order to better elucidate the molecules that play the main role in the beneficial effect of ozonated saline in wound healing, HNE and H2O2 were used alone or in combination to mimic ozonated saline effect. Surprisingly, keratinocytes treated with different doses of HNE and H2O2 did not significantly improve the wound closure, while the combination of the two compounds was able to improve wound closure. In addition, Nrf2 pathways were also activated as determined by its translocation to the nucleus and the increased HO1 gene expression. The present work suggests that ozonated saline effect on wound closure is the results of the combination of more molecules among which HNE and H2O2 play a key role.

  4. Reduced heating level during the end-of-year closure

    CERN Document Server

    2004-01-01

    To save on energy costs, the heating will once again be operating at a reduced level during the end-of-year closure of the Laboratory. We would ask all those in charge of premises where normal temperature have to be maintained to let us know by 16 December 2004 at the latest (tel. 72201 or 77777 or e-mail fm.support@cern.ch.). TS/CV - TS/FM Groups

  5. Reduced heating level during the end-of-year closure

    CERN Multimedia

    ST Department

    2007-01-01

    To save on energy costs, the heating will once again be operating at a reduced level during the end-of-year closure of the Laboratory. We would ask all those in charge of premises where normal temperatures have to be maintained to let us know by 14 December 2007 at the latest (tel. 72201 or 77777 or e-mail fm.support@cern.ch). TS/CV - TS/FM Groups

  6. Reduced heating level during the end-of-year closure

    CERN Document Server

    TS/CV-TS/FM Group

    2004-01-01

    To save on energy costs, the heating will once again be operating at a reduced level during the end-of-year closure of the Laboratory. We would ask all those in charge of premises where normal temperature have to be maintained to let us know by 16 December 2004 at the latest (tel. 72201 or 77777 or e-mail fm.support@cern.ch.).

  7. Reduced heating level during the end-of-year closure

    CERN Document Server

    2007-01-01

    To save on energy costs, the heating will once again be operating at a reduced level during the end-of-year closure of the Laboratory. We would ask all those in charge of premises where normal temperature have to be maintained to let us know by 14 December 2007 at the latest (tel. 72201 or 77777 or e-mail mailto:fm.support@cern.ch). TS/CV - TS/FM Groups

  8. Moment closure in a Moran model with recombination

    CERN Document Server

    Baake, Ellen

    2011-01-01

    We extend the Moran model with single-crossover recombination to include general recombination and mutation. We show that, in the case without resampling, the expectations of products of marginal processes defined via partitions of sites form a closed hierarchy, which is exhaustively described by a finite system of differential equations. One thus has the exceptional situation of moment closure in a nonlinear system. Surprisingly, this property is lost when resampling (i.e., genetic drift) is included.

  9. A Birmingham psychogeography: continuity and closure (Volume 2)

    OpenAIRE

    2015-01-01

    There has been some sociological interest in MG Rover’s decline and widespread deindustrialisation in Birmingham. However, little research has considered the proximity of Rover’s closure in 2005 to another seminal event for the city – the opening of the Bullring shopping centre in 2003. These events appear indicative of Daniel Bell’s conception of ‘postindustrialism’. This thesis uses the tradition of ‘psychogeography’ to critique postindustrialism in Birmingham, examining the city’s co...

  10. Bilateral acute angle-closure glaucoma after dexfenfluramine treatment.

    Science.gov (United States)

    Denis, P; Charpentier, D; Berros, P; Touameur, S

    1995-01-01

    We report the case of a patient with narrow angles who had an attack of bilateral acute angle-closure glaucoma precipitated by dexfenfluramine, a serotoninergic drug developed for appetite suppression. Although the exact mechanism remains uncertain, the pupillary block observed in our case may be the result of the serotoninergic or indirect parasympatholytic properties of the drug on the iris sphincter muscle. Serotonergic psychoactive drugs should be prescribed cautiously in patients with known narrow angles and should be monitored by an ophthalmologist.

  11. Modified Transverse Thoracosternotomy and Cost-Effective Reinforced Sternal Closure.

    Science.gov (United States)

    Costa, Joseph; Sonett, Joshua R; D'Ovidio, Frank

    2015-12-01

    The bilateral transverse thoracosternotomy clamshell incision provides excellent exposure to the mediastinal structures in double lung transplantation. The use of a modified transverse sternotomy and a figure of 8 configuration with one monofilament metal wire, along with two longitudinal wires across the sternal division, results in greater stability and equally distributed oblique tension. Our described technique was more cost effective and resulted in no incidence of dehiscence. We present our experience using a modified transverse sternotomy and reinforced sternal closure method.

  12. Gastrotomy closure using bioabsorbable plugs in a canine model.

    Science.gov (United States)

    Cios, Theodore J; Reavis, Kevin M; Renton, David R; Hazey, Jeffrey W; Mikami, Dean J; Narula, Vimal K; Allemang, Matthew T; Davis, S Scott; Melvin, W Scott

    2008-04-01

    The repair of gastric perforation commonly involves simple suture closure using an open or laparoscopic approach. An endolumenal approach using prosthetic materials may be beneficial. The role of bioprosthetics in this instance has not been thoroughly investigated, thus the authors evaluated the feasibility of gastric perforation repair using a bioabsorbable device and quantified gross and histological changes at the injury site. Twelve canines were anesthetized and underwent open gastrotomy. A 1-cm-diameter perforation was created in the anterior wall of the stomach and plugged with a bioabsorbable device. Intralumenal pH was recorded. Canines were sacrificed at one, four, six, eight, and 12 weeks. The stomach was explanted followed by gross and histological examination. The injury site was examined. The relative ability of the device to seal the perforation was recorded, as were postoperative changes. Tissue samples were analyzed for gross and microscopic tissue growth and compared to normal gastric tissue in the same animal as an internal control. A scoring system of -2 to +2 was used to measure injury site healing (-2= leak, -1= no leak and minimal ingrowth, 0= physiologic healing, +1= mild hypertrophic tissue, +2= severe hypertrophic tissue). In all canines, the bioprosthesis successfully sealed the perforation without leak under ex vivo insufflation. At one week, the device maintained its integrity but there was no tissue ingrowth. Histological healing score was -1. At 4-12 weeks, gross examination revealed a healed injury site in all animals. The lumenal portion of the plug was completely absorbed. The gross and histological healing score ranged from -1 to +1. The application of a bioabsorbable device results in durable closure of gastric perforation with physiologic healing of the injury site. This method of gastrotomy closure may aid in the evolution of advanced endoscopic approaches to perforation closure of hollow viscera.

  13. Effectiveness of Recombinant Human Growth Hormone for Pharyngocutaneous Fistula Closure

    OpenAIRE

    Kucuk, Nurten; Sari, Murat; Midi, Ahmet; Yumusakhuylu, Ali Cemal; Findik, Ozan; Binnetoglu, Adem

    2015-01-01

    Objectives In laryngeal cancer, which comprises 25% of head and neck cancer, chemotherapy has come into prominence with the increase in organ-protective treatments. With such treatment, salvage surgery has increased following recurrence; the incidence of pharyngocutaneous fistula has also increased in both respiratory and digestive system surgery. We investigated the effects of recombinant human growth hormone on pharyngocutaneous fistula closure in Sprague-Dawley rats, based on an increase i...

  14. End-of-year closure 2011/2012

    CERN Multimedia

    Human Resouces Department

    2011-01-01

    (Application of Articles R II 4.38 and R II 4.39 of the Staff Regulations) Annual closure of the site of the Organization during the Christmas holidays and days of special leave granted by the Director-General : The Laboratory will be closed from Thursday 22 December 2011 to Wednesday 4 January 2012 inclusive (without deduction of annual leave). The first working day in the New Year will be Thursday 5 January 2012. Tel. 73903

  15. 2010 River Corridor Closure Contractor Revegetation and Mitigation Monitoring Report

    Energy Technology Data Exchange (ETDEWEB)

    C. T. Lindsey, A. L. Johnson

    2010-09-30

    This report documents eh status of revegetation projects and natural resources mitigation efforts conducted for remediated waste sites and other activities associated with CERLA cleanup of National Priorities List waste sites at Hanford. This report contains vegetation monitoring data that were collected in the spring and summer of 2010 from the River Corridor Closure Contract’s revegetation and mitigation areas on the Hanford Site.

  16. Reduced heating level during the end-of-year closure

    CERN Multimedia

    TS Department

    2008-01-01

    To save on energy costs, the heating will once again be operating at a reduced level during the end-of-year closure of the Laboratory. We would ask all those in charge of premises where normal temperature have to be maintained to let us know by 12 December 2008 at the latest (tel. 72201 or 77777 or e-mail mailto:fm.support@cern.ch). TS/CV - TS/FM Groups

  17. The Synthesis of Force Closure Grasps in the Plane.

    Science.gov (United States)

    1985-09-01

    TASK U Artificial Inteligence Laboratory AREA A WORK UN IT "NMUIERS ~( 545 Technology Square Cambridge, MA 02139 SI. CONTROLLING OFICE NAME ANO... ARTIFICIAL INThLLIX’ ENCE LABORATORY A. 1. Memo 861 September, 1985 The Synthesis of Force-Closure Grasps In the Plane DTIC ’VeL% ,#ECTE 1 VnDcNguyenU Abstract... Artificial In- telligenmcc Liabomatory of thle Massachuset Is hInsttute of Teclhnolog3 . Support for the Lahoratot * s Artificial Intelligence research is

  18. Anterior ischemic optic neuropathy precipitated by acute primary angle closure

    Directory of Open Access Journals (Sweden)

    Choudhari Nikhil

    2010-01-01

    Full Text Available A 59-year-old man with a history of longstanding systemic hypotension developed asymmetric non-arteritic anterior ischemic optic neuropathy (NAION apparently precipitated by bilateral sequential acute primary angle closure. NAION is very rarely reported in association with raised intraocular pressure. In contrast to optical coherence tomography, the failure of scanning laser polarimetry to detect axonal swelling was another interesting finding. Possible reasoning for these observations is discussed.

  19. 2011 River Corridor Closure Contractor Revegetation and Mitigation Monitoring Report

    Energy Technology Data Exchange (ETDEWEB)

    West, W. J.; Lucas, J. G.; Gano, K. A.

    2011-11-14

    This report documents the status of revegetation projects and natural resources mitigation efforts conducted for remediated waste sites and other activities associated with the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 cleanup of National Priorities List waste sites at Hanford. This report contains the vegetation monitoring data that was collected in the spring and summer of 2011 from the River Corridor Closure Contractor’s revegetation and mitigation areas on the Hanford Site.

  20. AX Tank farm closure settlement estimates and soil testing

    Energy Technology Data Exchange (ETDEWEB)

    BECKER, D.L.

    1999-03-25

    This study provides a conservative three-dimensional settlement study of the AX Tank Farm closure with fill materials and a surface barrier. The finite element settlement model constructed included the interaction of four tanks and the surface barrier with the site soil and bedrock. Also addressed are current soil testing techniques suitable for the site soil with recommendations applicable to the AX Tank Farm and the planned cone penetration testing.