WorldWideScience

Sample records for volume replacement procedures

  1. Volume of Requests for Internet Medicare Replacement Cards

    Data.gov (United States)

    Social Security Administration — This dataset provides monthly volumes at the national level from federal fiscal year 2008 onwards for Internet Medicare Replacement Card. The dataset includes only...

  2. Pollutant Assessments Group procedures manual: Volume 2, Technical procedures

    Energy Technology Data Exchange (ETDEWEB)

    1992-03-01

    This is volume 2 of the manuals that describes the technical procedures currently in use by the Pollution Assessments Group. This manual incorporates new developments in hazardous waste assessment technology and administrative policy. Descriptions of the equipment, procedures and operations of such things as radiation detection, soil sampling, radionuclide monitoring, and equipment decontamination are included in this manual. (MB)

  3. Counseling patients on facial volume replacement and adherence with posttreatment instructions

    Directory of Open Access Journals (Sweden)

    Doris Day

    2010-07-01

    Full Text Available Doris DayDay Dermatology and Aesthetics New York, USAAbstract: Use of injectable volume replacement products has increased dramatically in the US in recent years. An optimal outcome with volume replacement depends on a thorough ­knowledge of the products on the part of the dermatologic/aesthetic physician specialist, identification of patients with a likelihood of benefiting from volume replacement procedures, selection of an appropriate product for the individual patient, and effective patient counseling to ensure adherence to posttreatment care instructions. Adherence to physician instructions in the field of dermatology appears limited, and there is very little published information on adherence to physician instructions following facial volume replacement procedures. The purpose of this review is to provide strategies for understanding and overcoming the barriers to adherence with the widely used dermal fillers. Strategies include using patient-centered techniques, such as a motivational interview encouraging the patient to follow postprocedure care instructions, eg, massage. In this case, demonstrating massage techniques while the patient is still in the office, with patient participation and detailed feedback, also contributes to good adherence with posttreatment care instructions. Telephone counseling, reminder postcards, and text messages may help improve clinic attendance for follow-up. Motivated patients who demonstrate good ­adherence to physician instructions generally respond well to volume replacement treatments, and usually experience fewer adverse events than patients who do not follow instructions. Although promoting adherence to pretreatment and posttreatment protocols remains a challenge, patient counseling throughout the treatment process can lead to successful results.Keywords: improving adherence, injectable volume replacement, product selection, ­rejuvenation procedure, soft tissue augmentation

  4. Provider volume and outcomes for oncological procedures.

    LENUS (Irish Health Repository)

    Killeen, S D

    2012-02-03

    BACKGROUND: Oncological procedures may have better outcomes if performed by high-volume providers. METHODS: A review of the English language literature incorporating searches of the Medline, Embase and Cochrane collaboration databases was performed. Studies were included if they involved a patient cohort from 1984 onwards, were community or population based, and assessed health outcome as a dependent variable and volume as an independent variable. The studies were also scored quantifiably to assess generalizability with respect to any observed volume-outcome relationship and analysed according to organ system; numbers needed to treat were estimated where possible. RESULTS: Sixty-eight relevant studies were identified and a total of 41 were included, of which 13 were based on clinical data. All showed either an inverse relationship, of variable magnitude, between provider volume and mortality, or no volume-outcome effect. All but two clinical reports revealed a statistically significant positive relationship between volume and outcome; none demonstrated the opposite. CONCLUSION: High-volume providers have a significantly better outcome for complex cancer surgery, specifically for pancreatectomy, oesphagectomy, gastrectomy and rectal resection.

  5. 23 CFR 650.411 - Procedures for bridge replacement and rehabilitation projects.

    Science.gov (United States)

    2010-04-01

    ... 23 Highways 1 2010-04-01 2010-04-01 false Procedures for bridge replacement and rehabilitation... ENGINEERING AND TRAFFIC OPERATIONS BRIDGES, STRUCTURES, AND HYDRAULICS Highway Bridge Replacement and Rehabilitation Program § 650.411 Procedures for bridge replacement and rehabilitation projects. (a) Consideration...

  6. Acceptance test procedure for SY Tank Farm replacement exhauster unit

    Energy Technology Data Exchange (ETDEWEB)

    Becken, G.W.

    1994-12-16

    The proper functioning of a new 241-SY Tank Farm replacement exhauster will be acceptance tested, to establish operability and to provide an operational baseline for the equipment. During this test, a verification of all of the alarm and control circuits associated with the exhaust, which provide operating controls and/or signals to local and remote alarm/annunciator panels, shall be performed. Test signals for sensors that provide alarms, warnings, and/or interlocks will be applied to verify that alarm, warning, and interlock setpoints are correct. Alarm and warning lights, controls, and local and remote readouts for the exhauster will be verified to be adequate for proper operation of the exhauster. Testing per this procedure shall be conducted in two phases. The first phase of testing, to verify alarm, warning, and interlock setpoints primarily, will be performed in the MO-566 Fab Shop. The second phase of testing, to verify proper operation and acceptable interface with other tank farm systems, will be conducted after the exhauster and all associated support and monitoring equipment have been installed in the SY Tank Farm. The exhauster, which is mounted on a skid and which will eventually be located in the SY tank farm, receives input signals from a variety of sensors mounted on the skid and associated equipment. These sensors provide information such as: exhauster system inlet vacuum pressure; prefilter and HEPA filter differential pressures; exhaust stack sampler status; exhaust fan status; system status (running/shut down); and radiation monitoring systems status. The output of these sensors is transmitted to the exhauster annunciator panel where the signals are displayed and monitored for out-of-specification conditions.

  7. Update on Nonsurgical Lung Volume Reduction Procedures

    Directory of Open Access Journals (Sweden)

    J. Alberto Neder

    2016-01-01

    Full Text Available There has been a surge of interest in endoscopic lung volume reduction (ELVR strategies for advanced COPD. Valve implants, coil implants, biological LVR (BioLVR, bronchial thermal vapour ablation, and airway stents are used to induce lung deflation with the ultimate goal of improving respiratory mechanics and chronic dyspnea. Patients presenting with severe air trapping (e.g., inspiratory capacity/total lung capacity (TLC 225% predicted and thoracic hyperinflation (TLC > 150% predicted have the greatest potential to derive benefit from ELVR procedures. Pre-LVRS or ELVR assessment should ideally include cardiological evaluation, high resolution CT scan, ventilation and perfusion scintigraphy, full pulmonary function tests, and cardiopulmonary exercise testing. ELVR procedures are currently available in selected Canadian research centers as part of ethically approved clinical trials. If a decision is made to offer an ELVR procedure, one-way valves are the first option in the presence of complete lobar exclusion and no significant collateral ventilation. When the fissure is not complete, when collateral ventilation is evident in heterogeneous emphysema or when emphysema is homogeneous, coil implants or BioLVR (in that order are the next logical alternatives.

  8. Nursing procedures during continuous renal replacement therapies: a national survey.

    Science.gov (United States)

    Ricci, Zaccaria; Benelli, Sonia; Barbarigo, Fabio; Cocozza, Giulia; Pettinelli, Noemi; Di Luca, Emanuela; Mettifogo, Mariangela; Toniolo, Andrea; Ronco, Claudio

    2015-01-01

    The current role of nurses in the management of critically ill patients needing continuous renal replacement therapies is clearly fundamental. The care of these complex patients is typically shared by critical care and dialysis nurses: their precise duties may vary from country to country. To clarify this issue we conducted a national-level survey at a recent Italian course on nursing practices during continuous renal replacement therapies. A total of 119 questionnaires were analysed. The participants, who were equally divided between critical care and dialysis nurses, came from 44 different hospitals and 35 Italian cities. Overall, 23% of participants answered that "the dialysis staff" were responsible for continuous renal replacement therapies in the Intensive Care Unit, while 39% answered "the critical care nurse", and 38% "a shared organization". Interestingly, less than the half of participants claimed specific continuous renal replacement therapies training was provided to employees before handling an acute dialysis machine. Finally, about 60% of participants had experience of extra-corporeal membrane oxygenation machines used in conjunction with continuous renal replacement therapies. Workload coordination and management of critically ill patients undergoing continuous renal replacement therapies in Italy is not standardized. At present, the duties of critical care and dialysis nurses vary significantly across the country. They frequently overlap or leave gaps in the assistance received by patients. The role of nurses involved in the care of continuous renal replacement therapies patients in Italy currently requires better organization, possibly starting with intensive standardized training and educational programs.

  9. Latest-Generation Transcatheter Aortic Valve Replacement Devices and Procedures.

    Science.gov (United States)

    Chamandi, Chekrallah; Puri, Rishi; Rodriguez-Gabella, Tania; Rodés-Cabau, Josep

    2017-09-01

    Transcatheter aortic valve replacement (TAVR) is a well-established treatment for patients with severe symptomatic aortic stenosis who are at high or prohibitive surgical risk. More recently, TAVR has emerged as a valid alternative to surgical aortic valve replacement for treating intermediate-risk patients, and several studies are currently evaluating the role of TAVR in low-risk patients. Transcatheter heart valve (THV) technologies have evolved considerably over time, and important iterations have been implemented in many of the latest-generation devices to (1) reduce the size and improve delivery system properties; (2) improve valve deployment, repositioning, and retrievability; and (3) reduce paravalvular leaks. This article reviews the main characteristics of, and clinical results associated with, the newer-generation THVs while providing an overview of novel TAVR indications. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  10. Operational test procedure for SY tank farm replacement exhauster unit

    International Nuclear Information System (INIS)

    McClees, J.

    1995-01-01

    This operational test procedure will verify that the remaining functions not tested per WHC-SD-WM-ATP-080, or components disturbed during final installation, as well as interfaces with other tank farm equipment and remote monitoring stations are operating correctly

  11. Diagnostic imaging procedure volume in the United States

    International Nuclear Information System (INIS)

    Johnson, J.L.; Abernathy, D.L.

    1983-01-01

    Comprehensive data on 1979 and 1980 diagnostic imaging procedure volume were collected from a stratified random sample of U.S. short-term general-care hospitals and private practices of radiologists, cardiologists, obstetricians/gynecologists, orthopedic surgeons, and neurologists/neurosurgeons. Approximately 181 million imaging procedures (within the study scope) were performed in 1980. Despite the rapidly increasing use of newer imaging methods, plain film radiography (140.3 million procedures) and contrast studies (22.9 million procedures) continue to comprise the vast majority of diagnostic imaging volume. Ultrasound, computed tomography, nuclear medicine, and special procedures make up less than 10% of total diagnostic imaging procedures. Comparison of the data from this study with data from an earlier study indicates that imaging procedure volume in hospitals expanded at an annual growth rate of almost 8% from 1973 to 1980

  12. Transcatheter Pulmonary Valve Replacement for Right Ventricular Outflow Tract Conduit Dysfunction After the Ross Procedure

    DEFF Research Database (Denmark)

    Gillespie, Matthew J; McElhinney, Doff B; Kreutzer, Jacqueline

    2015-01-01

    BACKGROUND: Right ventricular outflow tract (RVOT) conduit dysfunction is a limitation of the Ross procedure. Transcatheter pulmonary valve replacement (TPVR) could alter the impact of conduit dysfunction and the risk-benefit balance for the Ross procedure. METHODS: Retrospective review of databa......BACKGROUND: Right ventricular outflow tract (RVOT) conduit dysfunction is a limitation of the Ross procedure. Transcatheter pulmonary valve replacement (TPVR) could alter the impact of conduit dysfunction and the risk-benefit balance for the Ross procedure. METHODS: Retrospective review....... Of these, 56 (84%) received a Melody valve; in 5 of the 11 patients who did not, the implant was aborted due to concern for coronary artery compression, and 1 implanted patient required emergent surgery for left coronary compression. The RVOT gradient decreased from a median 38 mm Hg to 13.5 mm Hg (p

  13. Integration technique of digital I and C replacement and its Critical Digital Review procedure

    International Nuclear Information System (INIS)

    Huang, Hui-Wen; Yang, Wen-Long

    2013-01-01

    Highlights: ► A digital I and C replacement integration technique have been developed. ► Establishment of Nuclear Power Plant Digital Replacement Integration Guideline. ► Preliminary Investigation on I and C System Digitalization. ► Evaluation on I and C System Digitalization. ► Establishment of I and C System Digitalization Architectures. -- Abstract: Institute of Nuclear Energy Research (INER) developed a digital Instrumentation and Control (I and C) replacement integration technique on the basis of requirement of the three existing nuclear power plants (NPPs), which are Chin–Shan (CS) NPP, Kuo–Sheng (KS) NPP, and Maanshan (MS) NPP, in Taiwan, and also developed the related Critical Digital Review (CDR) procedure. The digital I and C replacement integration technique includes: (1) Establishment of Nuclear Power Plant Digital Replacement Integration Guideline, (2) Preliminary Investigation on I and C System Digitalization, (3) Evaluation on I and C System Digitalization, and (4) Establishment of I and C System Digitalization Architectures. These works can be a reference for performing I and C system digital replacement integration of the three existing NPPs of Taiwan Power Company (TPC). A CDR is the review for a critical system digital I and C replacement. The major reference of this procedure is EPRI TR-1011710 (2005) “Handbook for Evaluating Critical Digital Equipment and Systems” which was published by the Electric Power Research Institute (EPRI). With this document, INER developed a TPC-specific CDR procedure. Currently, CDR becomes one of the policies for digital I and C replacement in TPC. The contents of this CDR procedure include: Scope, Responsibility, Operation Procedure, Operation Flow Chart, CDR review items. The CDR review items include the comparison of the design change, Software Verification and Validation (SV and V), Failure Mode and Effects Analysis (FMEA), Evaluation of Diversity and Defense-in-depth (D3), Evaluation of

  14. The relationship of hospital charges and volume to surgical site infection after total hip replacement.

    Science.gov (United States)

    Boas, Rebecca; Ensor, Kelsey; Qian, Edward; Hutzler, Lorraine; Slover, James; Bosco, Joseph

    2015-05-01

    The purpose of this study was to analyze the effect of hospital volume and charges on the rate of surgical site infections for total hip replacements (THRs) in New York State (NYS). In NYS, higher volume hospitals have higher charges after THR. The study team analyzed 93,620 hip replacements performed in NYS between 2008 and 2011. Hospital charges increased significantly from $43,713 in 2008 to $50,652 in 2011 (P<.01). Compared with lower volume hospitals, patients who underwent THR at the highest volume hospitals had significantly lower surgical site infection rates (P=.003) and higher total hospital charges (P<.0001). The study team found that in the highest volume hospitals, preventing one surgical site infection was associated with $1.6 million dollars in increased charges. © 2014 by the American College of Medical Quality.

  15. Valve-sparing root replacement for freestanding pulmonary autograft aneurysm after the Ross procedure.

    Science.gov (United States)

    Ratschiller, Thomas; Eva, Sames-Dolzer; Schimetta, Wolfgang; Paulus, Patrick; Müller, Hannes; Zierer, Andreas; Mair, Rudolf

    2018-02-20

    Autograft dilatation is the main long-term complication following the Ross procedure using the freestanding root replacement technique. We reviewed our 25-year experience with the Ross procedure with a special emphasis on valve-sparing reoperations. From 1991 to 2016, 153 patients (29.6 ± 16.6 years; 29.4% pediatric) underwent a Ross operation at our institution with implantation of the autograft as freestanding root replacement. The follow-up is 98.7% complete with a mean of 12.2 ± 5.5 years. Mortality at 30-days was 2.0%. Echocardiography documented no or trivial aortic regurgitation in 99.3% of the patients at discharge. Survival probability at 20 years was 85.4%. No case of autograft endocarditis occurred. Autograft deterioration rate was 2.01% per patient-year, and freedom from autograft reoperation was 75.3% at 15 years. A reoperation for autograft aneurysm was required in 35 patients (22.9%) at a mean interval of 11.1 ± 4.6 years after the Ross procedure. A valve-sparing root replacement was performed in 77% of patients, including 10 David and 17 Yacoub procedures with no early mortality. Three patients required prosthetic valve replacement within 2 years after a Yacoub operation. At latest follow-up, 92% of all surviving patients still carry the pulmonary autograft valve. Freedom from autograft valve replacement was 92.1% at 15 years. Using the David or Yacoub techniques, the autograft valve can be preserved in the majority of patients with root aneurysms after the Ross procedure. Reoperations can be performed with no early mortality, a good functional midterm result, and an acceptable reintervention rate. Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  16. Replacement

    Directory of Open Access Journals (Sweden)

    S. Radhakrishnan

    2014-03-01

    Full Text Available The fishmeal replaced with Spirulina platensis, Chlorella vulgaris and Azolla pinnata and the formulated diet fed to Macrobrachium rosenbergii postlarvae to assess the enhancement ability of non-enzymatic antioxidants (vitamin C and E, enzymatic antioxidants (superoxide dismutase (SOD and catalase (CAT and lipid peroxidation (LPx were analysed. In the present study, the S. platensis, C. vulgaris and A. pinnata inclusion diet fed groups had significant (P < 0.05 improvement in the levels of vitamins C and E in the hepatopancreas and muscle tissue. Among all the diets, the replacement materials in 50% incorporated feed fed groups showed better performance when compared with the control group in non-enzymatic antioxidant activity. The 50% fishmeal replacement (best performance diet fed groups taken for enzymatic antioxidant study, in SOD, CAT and LPx showed no significant increases when compared with the control group. Hence, the present results revealed that the formulated feed enhanced the vitamins C and E, the result of decreased level of enzymatic antioxidants (SOD, CAT and LPx revealed that these feeds are non-toxic and do not produce any stress to postlarvae. These ingredients can be used as an alternative protein source for sustainable Macrobrachium culture.

  17. Procedural Experience for Transcatheter Aortic Valve Replacement and Relation to Outcomes: The STS/ACC TVT Registry.

    Science.gov (United States)

    Carroll, John D; Vemulapalli, Sreekanth; Dai, Dadi; Matsouaka, Roland; Blackstone, Eugene; Edwards, Fred; Masoudi, Frederick A; Mack, Michael; Peterson, Eric D; Holmes, David; Rumsfeld, John S; Tuzcu, E Murat; Grover, Frederick

    2017-07-04

    Transcatheter aortic valve replacement (TAVR) has been introduced into U.S. clinical practice with efforts to optimize outcomes and minimize the learning curve. The goal of this study was to assess the degree to which increasing experience during the introduction of this procedure, separated from other outcome determinants including patient and procedural characteristics, is associated with outcomes. The authors evaluated the association of hospital TAVR volume and patient outcomes for TAVR by using data from 42,988 commercial procedures conducted at 395 hospitals submitting to the Transcatheter Valve Therapy Registry from 2011 through 2015. Outcomes assessed included adjusted and unadjusted in-hospital major adverse events. Increasing site volume was associated with lower in-hospital risk-adjusted outcomes, including mortality (p < 0.02), vascular complications (p < 0.003), and bleeding (p < 0.001) but was not associated with stroke (p = 0.14). From the first case to the 400th case in the volume-outcome model, risk-adjusted adverse outcomes declined, including mortality (3.57% to 2.15%), bleeding (9.56% to 5.08%), vascular complications (6.11% to 4.20%), and stroke (2.03% to 1.66%). Vascular and bleeding volume-outcome associations were nonlinear with a higher risk of adverse outcomes in the first 100 cases. An association of procedure volume with risk-adjusted outcomes was also seen in the subgroup having transfemoral access. The initial adoption of TAVR into practice in the United States showed that increasing experience was associated with better outcomes. This association, whether deemed a prolonged learning curve or a manifestation of a volume-outcome relationship, suggested that concentrating experience in higher volume heart valve centers might be a means of improving outcomes. (STS/ACC Transcatheter Valve Therapy Registry [TVT Registry]; NCT01737528). Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All

  18. Preferential effects of low volume versus high volume replacement with crystalloid fluid in a hemorrhagic shock model in pigs.

    Science.gov (United States)

    Ponschab, Martin; Schöchl, Herbert; Keibl, Claudia; Fischer, Henrik; Redl, Heinz; Schlimp, Christoph J

    2015-10-06

    Fluid resuscitation is a core stone of hemorrhagic shock therapy, and crystalloid fluids seem to be associated with lower mortality compared to colloids. However, as redistribution starts within minutes, it has been suggested to replace blood loss with a minimum of a three-fold amount of crystalloids. The hypothesis was that in comparison to high volume (HV), a lower crystalloid volume (LV) achieves a favorable coagulation profile and exerts sufficient haemodynamics in the acute phase of resuscitation. In 24 anaesthetized pigs, controlled arterial blood loss of 50 % of the estimated blood volume was either (n = 12) replaced with a LV (one-fold) or a HV (three-fold) volume of a balanced, acetated crystalloid solution at room temperature. Hemodynamic parameters, dilution effects and coagulation profile by standard coagulation tests and thromboelastometry at baseline and after resuscitation were determined in both groups. LV resuscitation increased MAP significantly less compared to the HV, 61 ± 7 vs. 82 ± 14 mmHg (p controlled blood loss, a one fold LV crystalloid replacement strategy is sufficient to adequately raise blood pressure up to a mean arterial pressure >50 mm Hg. The concept of damage control resuscitation (DCR) with permissive hypotension may be better met by using LV as compared to a three fold HV resuscitation strategy. High volume administration of an acetated balanced crystalloid does not lead to hyperchloraemic acidosis, but may negatively influence clinical parameters, such as higher blood pressure, lower body temperature and impaired coagulation parameters, which could potentially increase bleeding after trauma. Replacement of acute blood loss with just an equal amount of an acetated balanced crystalloid appears to be the preferential treatment strategy in the acute phase after controlled bleeding.

  19. Proposal of organisation and ALARA procedures for maintenance site: application to replacement of steam generator

    International Nuclear Information System (INIS)

    Lochard, J.; Lefaure, C.

    1989-08-01

    This report proposes generic organization and ALARA procedures for preparing a maintenance site at a NPP. After a short description of the ALARA principle, it describes the proposition for French sites. They are grouped according to the following: motivation, organisation, means. They are illustrated by the example of steam generator replacement. Three special points concerning preparation of the site are developed: education; training of operators; review of the project

  20. Pacemaker replacement in nonagenarians: Procedural safety and long-term follow-up.

    Science.gov (United States)

    Loirat, Aurélie; Fénéon, Damien; Behaghel, Albin; Behar, Nathalie; Le Helloco, Alain; Mabo, Philippe; Daubert, Jean-Claude; Leclercq, Christophe; Martins, Raphaël P

    2015-01-01

    The rate of pacemaker implantation is rising. Given that the life expectancy of the population is projected to increase, a large number of elderly patients are likely to be implanted in the future. As pacemaker batteries can last for 8-10years, an increasing number of pacemaker recipients will require replacement of their devices when they become nonagenarians. To analyse the short- and long-term outcomes after device replacement in nonagenarians. Patients aged≥90years referred to a tertiary centre for pacemaker replacement from January 2004 to July 2014 were included retrospectively. Clinical follow-up data were obtained from clinical visits or telephone interviews with patients or their families. The primary clinical endpoint was total mortality. Secondary endpoints included early and delayed procedure-related complications and predictive risk factors for total mortality. Sixty-two patients were included (mean age 93.3±2.9years at time of pacemaker replacement). Mean procedure duration was 35.7±17.2minutes. Mean hospital stay was 2.2±1.1days. One patient died from a perioperative complication. Thirty-seven patients (59.7%) died during a median follow-up of 22.1months (interquartile range, 11.8-39.8months). Survival rates were 84.2% (95% confidence interval [CI] 71.8-91.5%) at 1year, 66.9% (95% CI 51.8-78.2%) at 2years and 22.7% (95% CI 10.6-37.7%) at 5years. Atrial fibrillation (hazard ratio 2.47, 95% CI 1.1-5.6) and non-physiological pacing (i.e. VVI pacing in patients in sinus rhythm) (hazard ratio 2.20, 95% CI 1.0-4.9) were predictors of mortality. Pacemaker replacement in nonagenarians is a safe and straightforward procedure. These data suggest that procedures can be performed securely in this old and frail population, with patients living for a median of 30months afterwards. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  1. Onco plastic volume replacement with latissimus dorsi myocutaneous flap in patients with large ptotic breasts. Is it feasible?

    International Nuclear Information System (INIS)

    El-Marakby, H.H.; Kotb, M.H.

    2011-01-01

    Onco plastic breast conservative surgery has evolved as a safe alternative to the standard mastectomy in the treatment of early breast cancer. The procedure involves tumour resection with an adequate safety margin and either breast reshaping with volume displacement procedures (large or pt otic breasts) or volume replacement with latissimus dorsi myocutaneous flap (LDF) (small to medium sized non-ptotic breasts). A contra lateral mastopexy procedure is usually necessary with the volume displacement Onco plastic surgery, a procedure that is often rejected by a significant number of patients. This limits the choice of the reconstruction of breast defects in such patients to autologous tissues i.e. LDF. Aim: Aim is to evaluate the feasibility of volume replacement onco plastic breast conservative surgery with lemmatise dorsi myocutaneous flaps for patients with large ptotic breasts. This involves testing the oncologic safety in terms of adequate safety margin, the complications rate and the final cosmetic outcome. The loco regional recurrence rate will be recorded and compared with oncoplastic volume displacement for similar sized breast defects. Patients and methods: A group of 50 female patients with early breast cancers (T2) who presented to the department of surgery at the National Cancer Institute, Cairo, Egypt in the period between carried out in all patient groups and was used to annually follow up the patients. All patients were detected with T2 NO breast cancer by both clinical and radiological examinations. All patients underwent partial mastectomy was and reconstruction with LDFs. Results: The average age at presentation was 46.5 ± 9 years and the range was 26-65 years. Most of the patients were subjected to partial mastectomy in 30 patients (60%), excision of a single quadrant from the four major quadrants was carried out in 15 patients (30%) where skin sparing wide local excision was carried out in only five patients (10%). The safety margin ranged from

  2. Mixed reality simulation of rasping procedure in artificial cervical disc replacement (ACDR) surgery.

    Science.gov (United States)

    Halic, Tansel; Kockara, Sinan; Bayrak, Coskun; Rowe, Richard

    2010-10-07

    Until quite recently spinal disorder problems in the U.S. have been operated by fusing cervical vertebrae instead of replacement of the cervical disc with an artificial disc. Cervical disc replacement is a recently approved procedure in the U.S. It is one of the most challenging surgical procedures in the medical field due to the deficiencies in available diagnostic tools and insufficient number of surgical practices For physicians and surgical instrument developers, it is critical to understand how to successfully deploy the new artificial disc replacement systems. Without proper understanding and practice of the deployment procedure, it is possible to injure the vertebral body. Mixed reality (MR) and virtual reality (VR) surgical simulators are becoming an indispensable part of physicians' training, since they offer a risk free training environment. In this study, MR simulation framework and intricacies involved in the development of a MR simulator for the rasping procedure in artificial cervical disc replacement (ACDR) surgery are investigated. The major components that make up the MR surgical simulator with motion tracking system are addressed. A mixed reality surgical simulator that targets rasping procedure in the artificial cervical disc replacement surgery with a VICON motion tracking system was developed. There were several challenges in the development of MR surgical simulator. First, the assembly of different hardware components for surgical simulation development that involves knowledge and application of interdisciplinary fields such as signal processing, computer vision and graphics, along with the design and placements of sensors etc . Second challenge was the creation of a physically correct model of the rasping procedure in order to attain critical forces. This challenge was handled with finite element modeling. The third challenge was minimization of error in mapping movements of an actor in real model to a virtual model in a process called

  3. Complications of Percutaneous Nephrostomy, Percutaneous Insertion of Ureteral Endoprosthesis, and Replacement Procedures

    International Nuclear Information System (INIS)

    Kaskarelis, Ioannis S.; Papadaki, Marina G.; Malliaraki, Niki E.; Robotis, Epaminondas D.; Malagari, Katerina S.; Piperopoulos, Ploutarchos N.

    2001-01-01

    Purpose: The aim of the present study was to record and identify the frequency of complications following percutaneous nephrostomy, replacement of nephrostomy drains and percutaneous insertion of ureteral endoprostheses.Methods: During a 10-year period 341 patients were referred to our department with indications for percutaneous nephrostomy and/or percutaneous insertion of a ureteral endoprosthesis, and a total of 1036 interventional procedures were performed (nephrostomy, catheter change, stenting).Results: There were three major complications (0.29%): two patients died during the first 30 days after the procedure, due to aggravation of their condition caused by the procedure, and one patient had retroperitoneal bleeding requiring surgery. There were 76 complications of intermediate severity (7.33%): catheter or stent displacement (n = 37, 3.57%) catheter occlusion (n = 18, 1.73%), hematuria (n = 12, 1.16%), and urinary tract infection (n = 9, 0.87%). The 55 minor complications (5.3%) comprised inflammation of the skin at the site of insertion of the percutaneous catheter.Conclusion: The small number of complications observed during acts of interventional uroradiology prove transcutaneous manipulations to be safe medical procedures

  4. Load research manual. Volume 1. Load research procedures

    Energy Technology Data Exchange (ETDEWEB)

    Brandenburg, L.; Clarkson, G.; Grund, Jr., C.; Leo, J.; Asbury, J.; Brandon-Brown, F.; Derderian, H.; Mueller, R.; Swaroop, R.

    1980-11-01

    This three-volume manual presents technical guidelines for electric utility load research. Special attention is given to issues raised by the load data reporting requirements of the Public Utility Regulatory Policies Act of 1978 and to problems faced by smaller utilities that are initiating load research programs. In Volumes 1 and 2, procedures are suggested for determining data requirements for load research, establishing the size and customer composition of a load survey sample, selecting and using equipment to record customer electricity usage, processing data tapes from the recording equipment, and analyzing the data. Statistical techniques used in customer sampling are discussed in detail. The costs of load research also are estimated, and ongoing load research programs at three utilities are described. The manual includes guides to load research literature and glossaries of load research and statistical terms.

  5. David I reimplantation procedure for aortic root replacement in Marfan patients: medium-term outcome.

    Science.gov (United States)

    Kari, Fabian A; Beyersdorf, Friedhelm; Rylski, Bartosz; Stephens, Elizabeth H; Russe, Maximilian; Siepe, Matthias

    2014-11-01

    Technical variations of the David reimplantation valve-sparing aortic root replacement (V-SARR) procedure have been proposed to be advantageous in patients with connective tissue disease, such as the Marfan syndrome (MFS). We report results of a Marfan cohort treated exclusively with the non-modified David I procedure. Forty-eight Marfan patients (25 males, mean age 33 ± 12 years, range 15-62 years) underwent the original variant of the David V-SARR (David I) between 1997 and 2013. Forty-two operations (88%) were performed as elective procedures for aortic root aneurysms and six for acute dissections (12%). Seventeen had aortic regurgitation (AR) grades ≥2+ preoperatively, and 3 had AR >2+. No patients with severe AR (4+) were selected for V-SARR. Three full or hemi-arch replacements were performed. Patients who were operated on using a variation of the David I or David II procedure were excluded. Mean prosthesis size was 28 ± 3 mm (18-30 mm). Mean clinical and echocardiographic follow-up (98% complete) was 3.8 ± 3.7 years with a cumulative follow-up of 178 patient-years. The early mortality rate was 2% (one hospital death). The survival rate was 98% (95% confidence 84-99%) at 4 years and 90% (57-98%) at 8 years with 5 patients at risk at 10 years. The rate of freedom from root or valve reoperation was 97% (79-99%) and 97% (79-99%) at 4 and 8 years, respectively. Only one patient required mechanical aortic valve replacement for progression of AR. Despite potential theoretical drawbacks of the David I V-SARR technique without neo-sinuses or a neo-sinotubular junction, it results in a favourable mid-term outcome in Marfan patients and compares well with reported results of different modifications of David V-SARR. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  6. User's operating procedures. Volume 3: Projects directorate information programs

    Science.gov (United States)

    Haris, C. G.; Harris, D. K.

    1985-01-01

    A review of the user's operating procedures for the scout project automatic data system, called SPADS is presented. SPADS is the results of the past seven years of software development on a prime mini-computer. SPADS was developed as a single entry, multiple cross-reference data management and information retrieval system for the automation of Project office tasks, including engineering, financial, managerial, and clerical support. This volume, three of three, provides the instructions to operate the projects directorate information programs in data retrieval and file maintenance via the user friendly menu drivers.

  7. User's operating procedures. Volume 2: Scout project financial analysis program

    Science.gov (United States)

    Harris, C. G.; Haris, D. K.

    1985-01-01

    A review is presented of the user's operating procedures for the Scout Project Automatic Data system, called SPADS. SPADS is the result of the past seven years of software development on a Prime mini-computer located at the Scout Project Office, NASA Langley Research Center, Hampton, Virginia. SPADS was developed as a single entry, multiple cross-reference data management and information retrieval system for the automation of Project office tasks, including engineering, financial, managerial, and clerical support. This volume, two (2) of three (3), provides the instructions to operate the Scout Project Financial Analysis program in data retrieval and file maintenance via the user friendly menu drivers.

  8. New experimental procedure for measuring volume magnetostriction on powder samples

    International Nuclear Information System (INIS)

    Rivero, G.; Multigner, M.; Valdes, J.; Crespo, P.; Martinez, A.; Hernando, A.

    2005-01-01

    Conventional techniques used for volume magnetostriction measurements, as strain gauge or cantilever method, are very useful for ribbons or thin films but cannot be applied when the samples are in powder form. To overcome this problem a new experimental procedure has been developed. In this work, the experimental set-up is described, together with the results obtained in amorphous FeCuZr powders, which exhibit a strong dependence of the magnetization on the strength of the applied magnetic field. The magnetostriction measurements presented in this work point out that this dependence is related to a magnetovolume effect

  9. Reoperative Aortic Root Replacement in Patients with Previous Aortic Root or Aortic Valve Procedures

    Directory of Open Access Journals (Sweden)

    Byung Kwon Chong

    2016-08-01

    Full Text Available Background: Generalization of standardized surgical techniques to treat aortic valve (AV and aortic root diseases has benefited large numbers of patients. As a consequence of the proliferation of patients receiving aortic root surgeries, surgeons are more frequently challenged by reoperative aortic root procedures. The aim of this study was to evaluate the outcomes of redo-aortic root replacement (ARR. Methods: We retrospectively reviewed 66 patients (36 male; mean age, 44.5±9.5 years who underwent redo-ARR following AV or aortic root procedures between April 1995 and June 2015. Results: Emergency surgeries comprised 43.9% (n=29. Indications for the redo-ARR were aneurysm (n=12, pseudoaneurysm (n=1, or dissection (n=6 of the residual native aortic sinus in 19 patients (28.8%, native AV dysfunction in 8 patients (12.1%, structural dysfunction of an implanted bioprosthetic AV in 19 patients (28.8%, and infection of previously replaced AV or proximal aortic grafts in 30 patients (45.5%. There were 3 early deaths (4.5%. During follow- up (median, 54.65 months; quartile 1–3, 17.93 to 95.71 months, there were 14 late deaths (21.2%, and 9 valve-related complications including reoperation of the aortic root in 1 patient, infective endocarditis in 3 patients, and hemorrhagic events in 5 patients. Overall survival and event-free survival rates at 5 years were 81.5%±5.1% and 76.4%±5.4%, respectively. Conclusion: Despite technical challenges and a high rate of emergency conditions in patients requiring redo-ARR, early and late outcomes were acceptable in these patients.

  10. 3D printed cardiac phantom for procedural planning of a transcatheter native mitral valve replacement

    Science.gov (United States)

    Izzo, Richard L.; O'Hara, Ryan P.; Iyer, Vijay; Hansen, Rose; Meess, Karen M.; Nagesh, S. V. Setlur; Rudin, Stephen; Siddiqui, Adnan H.; Springer, Michael; Ionita, Ciprian N.

    2016-03-01

    3D printing an anatomically accurate, functional flow loop phantom of a patient's cardiac vasculature was used to assist in the surgical planning of one of the first native transcatheter mitral valve replacement (TMVR) procedures. CTA scans were acquired from a patient about to undergo the first minimally-invasive native TMVR procedure at the Gates Vascular Institute in Buffalo, NY. A python scripting library, the Vascular Modeling Toolkit (VMTK), was used to segment the 3D geometry of the patient's cardiac chambers and mitral valve with severe stenosis, calcific in nature. A stereolithographic (STL) mesh was generated and AutoDesk Meshmixer was used to transform the vascular surface into a functioning closed flow loop. A Stratasys Objet 500 Connex3 multi-material printer was used to fabricate the phantom with distinguishable material features of the vasculature and calcified valve. The interventional team performed a mock procedure on the phantom, embedding valve cages in the model and imaging the phantom with a Toshiba Infinix INFX-8000V 5-axis Carm bi-Plane angiography system. Results: After performing the mock-procedure on the cardiac phantom, the cardiologists optimized their transapical surgical approach. The mitral valve stenosis and calcification were clearly visible. The phantom was used to inform the sizing of the valve to be implanted. Conclusion: With advances in image processing and 3D printing technology, it is possible to create realistic patientspecific phantoms which can act as a guide for the interventional team. Using 3D printed phantoms as a valve sizing method shows potential as a more informative technique than typical CTA reconstruction alone.

  11. Film replacement by digital x-ray detectors - the correct procedure and equipment

    International Nuclear Information System (INIS)

    Ewert, U.; Zscherpel, U.; Bavendiek, K.

    2004-01-01

    New digital detectors were developed for medical applications, which have the potential to substitute the X-ray film and revolutionise the radiological technique. Digital Detector Arrays (DDA: Flat Panel Detectors, Line Detectors) and Imaging Plates (Computed Radiography) allow a fast detection of radiographic images in a shorter time and with higher dynamic than film applications. Companies report about a reduction of exposure time down to 5 - 25% in comparison to NDT film exposures. This provides together with the reduction of consumables economical (and also ecological) benefits and short amortisation periods. But this does not always provide the same image quality as NDT film. The requirements of the European and USA standards for film radiography are analysed to derive correct requirements for the digital image quality and procedures for prediction and measurement of image quality. Basically the USA standards seem to be more tolerant for these new innovative technologies. New standard proposals use signal/noise ratio and unsharpness as dominant parameters for image quality. Specialised measurement procedures are described. The properties of the new detectors can be controlled by electronics and exposure conditions. New names appear in literature like 'direct radiography' and 'film replacement techniques'. The basic advantage of the new digital techniques is the possibility to use numeric procedures for image interpretation. Industrial radiology can be optimised for crack detection as well as for analysis of flaw depth and shape measurement. Automated flaw detection, measurement of part dimensions and detection of completeness are used for serial part inspection devices. Parallel to the development of DDA's, an extraordinary increase of Computed Tomography (CT) applications can be observed. (author)

  12. Value of the regurgitant volume to end diastolic volume ratio to predict the regression of left ventricular dimensions after valve replacement in aortic insufficiency

    NARCIS (Netherlands)

    P.M. Fioretti (Paolo); C. Tirtaman; E. Bos (Egbert); P.W.J.C. Serruys (Patrick); J.R.T.C. Roelandt (Jos)

    1987-01-01

    textabstractThe aim of this study was to assess the value of regurgitant stroke volume (RSV) to end-diastolic volume (EDV) ratio to predict the regression of left ventricular (LV) dimensions after uncomplicated valve replacement in 34 patients with severe pure aortic insufficiency. The RSV/EDV ratio

  13. The Ross procedure offers excellent survival compared with mechanical aortic valve replacement in a real-world setting.

    Science.gov (United States)

    Andreas, Martin; Wiedemann, Dominik; Seebacher, Gernot; Rath, Claus; Aref, Tandis; Rosenhek, Raphael; Heinze, Georg; Eigenbauer, Ernst; Simon, Paul; Ruetzler, Kurt; Hiesmayr, Joerg-Michael; Moritz, Anton; Laufer, Guenther; Kocher, Alfred

    2014-09-01

    The ideal prosthesis for young patients requiring aortic valve replacement has not been defined to date. Although the Ross procedure provides excellent survival, its application is still limited. We compared the long-term survival after the Ross procedure with mechanical aortic valve replacement. All consecutive Ross procedures and mechanical aortic valve replacements performed between 1991 and 2008 at a single centre were analysed. Only adult patients between 18 and 50 years of age were included in the study. Survival and valve-related complications were evaluated. Furthermore, survival was compared with the age- and sex-matched Austrian population. A total of 159 Ross patients and 173 mechanical valve patients were included. The cumulative survival for the Ross procedure was significantly better, with survival rates of 96, 94 and 93% at 5, 10 and 15 years, respectively, in comparison to 90, 84 and 75% (P Ross group but was significantly reduced in the mechanical valve group. In a real-world setting, the Ross procedure is associated with a long-term survival benefit in young adults in comparison to mechanical aortic valve replacement. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  14. Pertinent anatomy and analysis for midface volumizing procedures.

    Science.gov (United States)

    Surek, Christopher C; Beut, Javier; Stephens, Robert; Jelks, Glenn; Lamb, Jerome

    2015-05-01

    The study was conducted to construct an anatomically inspired midfacial analysis facilitating safe, accurate, and dynamic nonsurgical rejuvenation. Emphasis is placed on determining injection target areas and adverse event zones. Twelve hemifacial fresh cadavers were dissected in a layered fashion. Dimensional measurements between the midfacial fat compartments, prezygomatic space, mimetic muscles, and neurovascular bundles were used to develop a topographic analysis for clinical injections. A longitudinal line from the base of the alar crease to the medial edge of the levator anguli oris muscle (1.9 cm), lateral edge of the levator anguli oris muscle (2.6 cm), and zygomaticus major muscle (4.6 cm) partitions the cheek into two aesthetic regions. A six-step facial analysis outlines three target zones and two adverse event zones and triangulates the point of maximum cheek projection. The lower adverse event zone yields an anatomical explanation to inadvertent jowling during anterior cheek injection. The upper adverse event zone localizes the palpebral branch of the infraorbital artery. The medial malar target area isolates quadrants for anterior cheek projection and tear trough effacement. The middle malar target area addresses lid-cheek blending and superficial compartment turgor. The lateral malar target area highlights lateral cheek projection and locates the prezygomatic space. This stepwise analysis illustrates target areas and adverse event zones to achieve midfacial support, contour, and profile in the repose position and simultaneous molding of a natural shape during animation. This reproducible method can be used both procedurally and in record-keeping for midface volumizing procedures.

  15. Usefulness of Oncoplastic Volume Replacement Techniques after Breast Conserving Surgery in Small to Moderate-sized Breasts

    Directory of Open Access Journals (Sweden)

    Jung Dug Yang

    2012-09-01

    Full Text Available BackgroundIn Korean women, many of whom have small to moderate-sized breasts, it is difficult to cover a partial breast defect using oncoplastic volume displacement techniques after removal of an adequate volume of tissue during oncologic surgery. In such cases, oncoplastic volume replacement techniques are more useful.MethodsFrom January 2007 to December 2011, 104 women underwent a total of 107 breast-conserving surgeries with various kinds of oncoplastic volume replacement techniques. We used latissimus dorsi (LD myocutaneous flap for cases in which the resection mass was greater than 150 g. In case with a resection mass less than 150 g, we used regional flaps such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps such as an intercostal artery perforator (ICAP flap or a thoracodorsal artery perforator (TDAP flap.ResultsThe mean age was 46.1 years, and the average follow-up interval was 10.3 months. The patients underwent oncoplastic volume replacement techniques with a lateral thoracodorsal flap (n=9, thoracoepigastric flap (n=7, ICAP flap (n=25, TDAP flap (n=12, and LD flap (n=54. There was one case of congestion in an LD flap, and two cases of fat necrosis in an ICAP flap. Most of the patients were satisfied with the cosmetic results.ConclusionsOncoplastic volume replacement techniques can be reliable and useful for the correction of breast deformity after breast-conserving surgery, especially in patients with small to moderate-sized breasts.

  16. Partical replacement of the rooting procedure of Chrysanthenum merifolium cuttings by pre-rooting storage in the dark.

    NARCIS (Netherlands)

    Pol, van de P.A.

    1988-01-01

    Part of the rooting procedure of Chrysanthemum morifolium 'Pink Boston' and 'Refour' cuttings can be replaced by pre-rooting storage in the dark. Pre-rooting storage of 7 days at temperatures between 9° and 21°C was adequate. Longer periods of dark storage resulted in increase of root growth but

  17. A finite volume procedure for fluid flow, heat transfer and solid-body stress analysis

    KAUST Repository

    Jagad, P. I.; Puranik, B. P.; Date, A. W.

    2018-01-01

    A unified cell-centered unstructured mesh finite volume procedure is presented for fluid flow, heat transfer and solid-body stress analysis. An in-house procedure (A. W. Date, Solution of Transport Equations on Unstructured Meshes with Cell

  18. Esophageal Replacement in Children: Presentation of 18 Cases and Results of Their Surgical Procedure

    Directory of Open Access Journals (Sweden)

    S. Delshad

    2007-11-01

    Full Text Available Background:Esophageal replacement is indicated in certain circumstances including long gap esophageal atresia,severe strictures due to gastro-esophageal reflux (GER and caustic burns. We analyzed our results of 18 patients who underwent esophageal replacement in our university hospital. Methods:We reviewed esophageal replacements carried out in our department between June 1996 and August 2004.We report 18 patients(4 girls and 14 boys with ages ranging from 3.5 until 30 months.Fifteen patients had long gap atresia,two had strictures due to GER,and one case had caustic burn. Esophageal replacement was performed through an abdominal midline incision by one of three methods, namely: colon transposition in 15, gastric replacement in 2, and gastric tube in 1 case. Results: Leakage and stricture were the most common complications of esophageal replacement.Most deaths were due to aspiration pneumonia and congenital cardiac disease.Conclusion:Esophageal replacement has limited indications.It allows a good functional result,with adequate oral feeding and normal growth.

  19. How to achieve synergy between volume replacement and filling products for global facial rejuvenation.

    Science.gov (United States)

    Raspaldo, Hervé; Aziza, Richard; Belhaouari, Lakhdar; Berros, Philippe; Body, Sylvie; Galatoire, Olivier; Le Louarn, Claude; Michaud, Thierry; Niforos, François; Rousseaux, Isabelle; Runge, Marc; Taieb, Maryna

    2011-04-01

    The objective of this paper is to provide an expert consensus regarding facial rejuvenation using a combination of volume replacement (Juvéderm(®) VOLUMA(®)), filling products (Juvéderm(®) Ultra product line) and botulinum toxin. The Juvéderm product line exploits innovative 3-D technology, producing a range of cohesive, homogenous gels that produce predictable, long-lasting and natural results. The products are easy to use by practitioners and are well-tolerated by patients, and used in combination can provide additional benefits not achieved with one product alone. An assessment of facial anatomy and consideration of the aging process, as well as available treatment options, are also addressed in determining the best combination of products to use. Outcomes from a questionnaire and workshop sessions focusing on specific aspects of use of the Juvéderm product line and botulinum toxin in daily clinical practice are discussed, and recommendations for product use following debate amongst the experts are provided.

  20. Merrill's Atlas of radiographic positions and radiologic procedures. Volumes 1-3. Sixth edition

    International Nuclear Information System (INIS)

    Ballinger, P.W.

    1985-01-01

    Merrill's Atlas describes and explains the routine and specialized radiologic procedures for all body systems. This edition thoroughly reorganized, updated and expanded. Volumes one and two describe all routine and flouroscopic procedures; and volume three describes more specialized areas in the profession

  1. Improved Survival After the Ross Procedure Compared With Mechanical Aortic Valve Replacement.

    Science.gov (United States)

    Buratto, Edward; Shi, William Y; Wynne, Rochelle; Poh, Chin L; Larobina, Marco; O'Keefe, Michael; Goldblatt, John; Tatoulis, James; Skillington, Peter D

    2018-03-27

    It is unclear whether the Ross procedure offers superior survival compared with mechanical aortic valve replacement (AVR). This study evaluated experience and compared long-term survival between the Ross procedure and mechanical AVR. Between 1992 and 2016, a total of 392 Ross procedures were performed. These were compared with 1,928 isolated mechanical AVRs performed during the same time period as identified using the University of Melbourne and Australia and New Zealand Society of Cardiac and Thoracic Surgeons' Cardiac Surgery Databases. Only patients between 18 and 65 years of age were included. Propensity-score matching was performed for risk adjustment. Ross procedure patients were younger, and had fewer cardiovascular risk factors. The Ross procedure was associated with longer cardiopulmonary bypass and aortic cross-clamp times. Thirty-day mortality was similar (Ross, 0.3%; mechanical, 0.8%; p = 0.5). Ross procedure patients experienced superior unadjusted long-term survival at 20 years (Ross, 95%; mechanical, 68%; p mechanical, 84%; p = 0.018). In this Australian, propensity-score matched study, the Ross procedure was associated with better long-term survival compared with mechanical AVR. In younger patients, with a long life expectancy, the Ross procedure should be considered in centers with sufficient expertise. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

  2. Is the Ross procedure a riskier operation? Perioperative outcome comparison with mechanical aortic valve replacement in a propensity-matched cohort.

    Science.gov (United States)

    Bouhout, Ismail; Noly, Pierre-Emmanuel; Ghoneim, Aly; Stevens, Louis-Mathieu; Cartier, Raymond; Poirier, Nancy; Bouchard, Denis; Demers, Philippe; El-Hamamsy, Ismail

    2017-01-01

    The aim of this study was to compare perioperative outcomes in young adults following isolated Ross procedure versus mechanical aortic valve replacement (AVR) in a high-volume centre. From 2007 to 2015, 337 elective isolated mechanical AVRs and 137 Ross procedures were performed in young adults (Ross cohort versus six (9%) in the mechanical AVR cohort (P = 0.49). A significant increase in serum creatinine (>2-fold increase) was more commonly observed after the Ross procedure (11 vs 1%; P = 0.03), but there was no significant difference in the rate of temporary dialysis. Twenty-seven patients (39%) required ≥1 blood product transfusion in the Ross group, whereas 21 patients (31%) did so in the mechanical AVR group (P = 0.47). Median hospital length of stay was similar in both the groups (6 days). There are no differences in mortality or major perioperative outcomes in adults undergoing an isolated Ross procedure or mechanical AVR. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  3. Hemodynamic outcomes of the Ross procedure versus other aortic valve replacement: a systematic review and meta-analysis.

    Science.gov (United States)

    Um, Kevin J; McCLURE, Graham R; Belley-Cote, Emilie P; Gupta, Saurabh; Bouhout, Ismail; Lortie, Hugo; Alraddadi, Hatim; Alsagheir, Ali; Bossard, Matthias; McINTYRE, William F; Lengyel, Alexandra; Eikelboom, John W; Ouzounian, Maral; Chu, Michael W; Parry, Dominic; El-Hamamsy, Ismail; Whitlock, Richard P

    2018-01-09

    Life expectancy in young adults undergoing mechanical or bioprosthetic aortic valve replacement (AVR) may be reduced by up to 20 years compared to age matched controls. The Ross procedure is a durable, anticoagulation-sparing alternative. We performed a systematic review and meta-analysis to compare the valve hemodynamics of the Ross procedure versus other AVR. We searched Cochrane CENTRAL, MEDLINE and EMBASE from inception to February 2017 for randomized controlled trials (RCTs) and observational studies (n≥10 Ross). Independently and in duplicate, we performed title and abstract screening, full-text eligibility assessment, and data collection. We evaluated the risk of bias with the Cochrane and CLARITY tools, and the quality of evidence with the GRADE framework. We identified 2 RCTs and 13 observational studies that met eligibility criteria (n=1,412). In observational studies, the Ross procedure was associated with a lower mean aortic gradient at discharge (MD -9 mmHg, 95% CI [-13, -5], pRoss procedure was associated with a lower mean gradient at latest follow-up (MD -15 mmHg, 95% CI [-32, 2], p=0.08, I2=99%). The mean pulmonic gradient for the Ross procedure was 18.0 mmHg (95% CI [16, 20], pRoss procedure was associated with better aortic valve hemodynamics. Future studies should evaluate the impact of the Ross procedure on exercise capacity and quality of life.

  4. Cerebral Embolic Protection During Transcatheter Aortic Valve Replacement Significantly Reduces Death and Stroke Compared With Unprotected Procedures.

    Science.gov (United States)

    Seeger, Julia; Gonska, Birgid; Otto, Markus; Rottbauer, Wolfgang; Wöhrle, Jochen

    2017-11-27

    The aim of this study was to evaluate the impact of cerebral embolic protection on stroke-free survival in patients undergoing transcatheter aortic valve replacement (TAVR). Imaging data on cerebral embolic protection devices have demonstrated a significant reduction in number and volume of cerebral lesions. A total of 802 consecutive patients were enrolled. The Sentinel cerebral embolic protection device (Claret Medical Inc., Santa Rosa, California) was used in 34.9% (n = 280) of consecutive patients. In 65.1% (n = 522) of patients TAVR was performed in the identical setting except without cerebral embolic protection. Neurological follow-up was done within 7 days post-procedure. The primary endpoint was a composite of all-cause mortality or all-stroke according to Valve Academic Research Consortium-2 criteria within 7 days. Propensity score matching was performed to account for possible confounders. Both filters of the device were successfully positioned in 280 of 305 (91.8%) consecutive patients. With use of cerebral embolic protection rate of disabling and nondisabling stroke was significantly reduced from 4.6% to 1.4% (p = 0.03; odds ratio: 0.29, 95% confidence interval: 0.10 to 0.93) in the propensity-matched population (n = 560). The primary endpoint occurred significantly less frequently, with 2.1% (n = 6 of 280) in the protected group compared with 6.8% (n = 19 of 280) in the control group (p = 0.01; odds ratio: 0.30; 95% confidence interval: 0.12 to 0.77). In multivariable analysis Society of Thoracic Surgeons score for mortality (p = 0.02) and TAVR without protection (p = 0.02) were independent predictors for the primary endpoint. In patients undergoing TAVR use of a cerebral embolic protection device demonstrated a significant higher rate of stroke-free survival compared with unprotected TAVR. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  5. Nuclear fuel technology - Tank calibration and volume determination for nuclear materials accountancy - Part 1: Procedural overview

    International Nuclear Information System (INIS)

    2007-01-01

    Accurate determinations of volume are a fundamental component of any measurement-based system of control and accountability in a facility that processes or stores nuclear materials in liquid form. Volume determinations are typically made with the aid of a calibration or volume measurement equation that relates the response of the tank's measurement system to some independent measure of tank volume. The ultimate purpose of the calibration exercise is to estimate the tank's volume measurement equation (the inverse of the calibration equation), which relates tank volume to measurement system response. The steps carried out to acquire data for estimating the tank's calibration or volume measurement equation are collectively described as the process of tank calibration. This part of ISO 18213 describes procedures for tank calibration and volume determination for nuclear process tanks equipped with pressure-measurement systems for determining liquid content. Specifically, overall guidance is provided for planning a calibration exercise undertaken to obtain the data required for the measurement equation to estimate a tank's volume. The key steps in the procedure are also presented for subsequently using the estimated volume-measurement equation to determine tank liquid volumes. The procedures presented apply specifically to tanks equipped with bubbler probe systems for measuring liquid content. Moreover, these procedures produce reliable results only for clear (i.e. without suspended solids), homogeneous liquids that are at both thermal and static equilibrium. The paper elaborates on scope, physical principles involved, the calibration model, equipment required, a typical tank calibration procedure, calibration planning and pre-calibration activities, and volume determination. A bibliography is provided

  6. The influence of a balanced volume replacement concept on inflammation, endothelial activation, and kidney integrity in elderly cardiac surgery patients.

    Science.gov (United States)

    Boldt, Joachim; Suttner, Stephan; Brosch, Christian; Lehmann, Andreas; Röhm, Kerstin; Mengistu, Andinet

    2009-03-01

    A balanced fluid replacement strategy appears to be promising for correcting hypovolemia. The benefits of a balanced fluid replacement regimen were studied in elderly cardiac surgery patients. In a randomized clinical trial, 50 patients aged >75 years undergoing cardiac surgery received a balanced 6% HES 130/0.42 plus a balanced crystalloid solution (n = 25) or a non-balanced HES in saline plus saline solution (n = 25) to keep pulmonary capillary wedge pressure/central venous pressure between 12-14 mmHg. Acid-base status, inflammation, endothelial activation (soluble intercellular adhesion molecule-1, kidney integrity (kidney-specific proteins glutathione transferase-alpha; neutrophil gelatinase-associated lipocalin) were studied after induction of anesthesia, 5 h after surgery, 1 and 2 days thereafter. Serum creatinine (sCr) was measured approximately 60 days after discharge. A total of 2,750 +/- 640 mL of balanced and 2,820 +/- 550 mL of unbalanced HES were given until the second POD. Base excess (BE) was significantly reduced in the unbalanced (from +1.21 +/- 0.3 to -4.39 +/- 1.0 mmol L(-1) 5 h after surgery; P volume replacement strategy including a balanced HES and a balanced crystalloid solution resulted in moderate beneficial effects on acid-base status, inflammation, endothelial activation, and kidney integrity compared to a conventional unbalanced volume replacement regimen.

  7. Patient Recall of Informed Consent at 4 Weeks After Total Hip Replacement With Standardized Versus Procedure-Specific Consent Forms.

    Science.gov (United States)

    Pomeroy, Eoghan; Shaarani, Shahril; Kenyon, Robert; Cashman, James

    2017-08-25

    Informed consent plays a pivotal role in the operative process, and surgeons have an ethical and legal obligation to provide patients with information to allow for shared decision-making. Unfortunately, patient recall after the consent process is frequently poor. This study aims to evaluate the effect of procedure-specific consent forms on patient's recall four weeks after total hip replacement (THR). This is a prospective study using a posttest-only control group design. Sixty adult patients undergoing total hip replacement were allocated to be consented using either the generic or the surgery-specific consent form. Four weeks after surgery, a phone interview was conducted to assess patient's recall of risk of surgical complications. Patient demographic characteristics and educational attainment were similar in both groups. There was a statistically significant increase in the mean number of risks recalled in the study group at 1.43 compared with 0.67 in the control group (P = 0.0131). Consent is a complex process, and obtaining informed consent is far from straightforward. A statistically significant improvement in patient's recall with the use of procedure-specific consent forms was identified, and based on this, we would advocate their use. However, overall patient recall in both groups was poor. We believe that improving the quality of informed consent may require the sum of small gains, and the use of procedure-specific consent forms may aid in this regard.

  8. Provider volume and outcomes for abdominal aortic aneurysm repair, carotid endarterectomy, and lower extremity revascularization procedures.

    LENUS (Irish Health Repository)

    Killeen, Shane D

    2012-02-03

    BACKGROUND: Intuitively, vascular procedures performed by high-volume vascular subspecialists working at high-volume institutions should be associated with improved patient outcome. Although a large number of studies assess the relationship between volume and outcome, a single contemporary compilation of such studies is lacking. METHODS: A review of the English language literature was performed incorporating searches of the Medline, EMBASE, and Cochrane collaboration databases for abdominal aortic aneurysm repair (elective and emergent), carotid endarterectomy, and arterial lower limb procedures for any volume outcome relationship. Studies were included if they involved a patient cohort from 1980 onwards, were community or population based, and assessed health outcomes (mortality and morbidity) as a dependent variable and volume as an independent variable. RESULTS: We identified 74 relevant studies, and 54 were included. All showed either an inverse relationship of variable magnitude between provider volume and mortality, or no volume-outcome effect. The reduction in the risk-adjusted mortality rate (RAMR) for high-volume providers was 3% to 11% for elective abdominal aortic aneurysm (AAA) repair, 2.5 to 5% for emergent AAA repair, 0.7% to 4.7% carotid endarterectomy, and 0.3% to 0.9% for lower limb arterial bypass procedures. Subspeciality training also conferred a considerable morbidity and mortality benefit for emergent AAA repair, carotid endarterectomy, and lower limb arterial procedures. CONCLUSION: High-volume providers have significantly better outcomes for vascular procedures both in the elective and emergent setting. Subspeciality training also has a considerable impact. These data provide further evidence for the specialization of vascular services, whereby vascular procedures should generally be preformed by high-volume, speciality trained providers.

  9. Hanford tank waste operation simulator operational waste volume projection verification and validation procedure

    International Nuclear Information System (INIS)

    HARMSEN, R.W.

    1999-01-01

    The Hanford Tank Waste Operation Simulator is tested to determine if it can replace the FORTRAN-based Operational Waste Volume Projection computer simulation that has traditionally served to project double-shell tank utilization. Three Test Cases are used to compare the results of the two simulators; one incorporates the cleanup schedule of the Tri Party Agreement

  10. Recreation of architectural structures using procedural modeling based on volumes

    Directory of Open Access Journals (Sweden)

    Santiago Barroso Juan

    2013-11-01

    Full Text Available While the procedural modeling of buildings and other architectural structures has evolved very significantly in recent years, there is noticeable absence of high-level tools that allow a designer, an artist or an historian, creating important buildings or architectonic structures in a particular city. In this paper we present a tool for creating buildings in a simple and clear, following rules that use the language and methodology of creating their own buildings, and hiding the user the algorithmic details of the creation of the model.

  11. User's operating procedures. Volume 1: Scout project information programs

    Science.gov (United States)

    Harris, C. G.; Harris, D. K.

    1985-01-01

    A review of the user's operating procedures for the Scout Project Automatic Data System, called SPADS is given. SPADS is the result of the past seven years of software development on a Prime minicomputer located at the Scout Project Office. SPADS was developed as a single entry, multiple cross reference data management and information retrieval system for the automation of Project office tasks, including engineering, financial, managerial, and clerical support. The instructions to operate the Scout Project Information programs in data retrieval and file maintenance via the user friendly menu drivers is presented.

  12. MR imaging of right ventricular function after the Ross procedure for aortic valve replacement: initial experience

    NARCIS (Netherlands)

    Grotenhuis, Heynric B.; de Roos, Albert; Ottenkamp, Jaap; Schoof, Paul H.; Vliegen, Hubert W.; Kroft, Lucia J. M.

    2008-01-01

    PURPOSE: To prospectively assess right ventricular (RV) function after the Ross procedure by using magnetic resonance (MR) imaging. MATERIALS AND METHODS: The local ethics committee approved the study and informed consent was obtained from all participants prior to enrollment in the study. Seventeen

  13. Long-Term Outcomes of the Ross Procedure Versus Mechanical Aortic Valve Replacement: Propensity-Matched Cohort Study.

    Science.gov (United States)

    Mazine, Amine; David, Tirone E; Rao, Vivek; Hickey, Edward J; Christie, Shakira; Manlhiot, Cedric; Ouzounian, Maral

    2016-08-23

    The ideal aortic valve substitute in young and middle-aged adults remains unknown. We sought to compare the long-term outcomes of patients undergoing the Ross procedure and those receiving a mechanical aortic valve replacement (AVR). From 1990 to 2014, 258 patients underwent a Ross procedure and 1444 had a mechanical AVR at a single institution. Patients were matched into 208 pairs through the use of a propensity score. Mean age was 37.2±10.2 years, and 63% were male. Mean follow-up was 14.2±6.5 years. Overall survival was equivalent (Ross versus AVR: hazard ratio, 0.91, 95% confidence interval, 0.38-2.16; P=0.83), although freedom from cardiac- and valve-related mortality was improved in the Ross group (Ross versus AVR: hazard ratio, 0.22; 95% confidence interval, 0.034-0.86; P=0.03). Freedom from reintervention was equivalent after both procedures (Ross versus AVR: hazard ratio, 1.86; 95% confidence interval, 0.76-4.94; P=0.18). Long-term freedom from stroke or major bleeding was superior after the Ross procedure (Ross versus AVR: hazard ratio, 0.09; 95% confidence interval, 0.02-0.31; PRoss procedure and mechanical AVR. However, the Ross procedure was associated with improved freedom from cardiac- and valve-related mortality and a significant reduction in the incidence of stroke and major bleeding. In specialized centers, the Ross procedure represents an excellent option and should be considered for young and middle-aged adults undergoing AVR. © 2016 American Heart Association, Inc.

  14. 99mTc-albumin can replace 125I-albumin to determine plasma volume repeatedly

    DEFF Research Database (Denmark)

    Bonfils, Peter K; Damgaard, Morten; Stokholm, Knud H

    2012-01-01

    OBJECTIVE: Plasma volume assessment may be of importance in several disorders. The purpose of the present study was to compare the reliability of plasma volume measurements by technetium-labeled human serum albumin ((99m)Tc-HSA) with a simultaneously performed plasma volume determination...... with iodine-labeled human serum albumin ((125)I-HSA). MATERIALS AND METHODS: In 15 healthy volunteers, simultaneous plasma volume measurements with (99m)Tc-HSA and (125)I-HSA were performed after ½ hour in the supine position. Blood samples were obtained 10, 15, 20, and 30 minutes after the injection...... for accurate retropolation from the plasma counts to time zero to correct for leakage of the isotopes from the circulation. RESULTS: The mean difference (bias) between plasma volume measured with (125)I-albumin and (99m)Tc-albumin was 8 ml (0.1 ml/kg) with limits of agreement (bias ±1.96 SD) ranging from -181...

  15. Three-dimensional prototyping for procedural simulation of transcatheter mitral valve replacement in patients with mitral annular calcification.

    Science.gov (United States)

    El Sabbagh, Abdallah; Eleid, Mackram F; Matsumoto, Jane M; Anavekar, Nandan S; Al-Hijji, Mohammed A; Said, Sameh M; Nkomo, Vuyisile T; Holmes, David R; Rihal, Charanjit S; Foley, Thomas A

    2018-01-23

    Three-dimensional (3D) prototyping is a novel technology which can be used to plan and guide complex procedures such as transcatheter mitral valve replacement (TMVR). Eight patients with severe mitral annular calcification (MAC) underwent TMVR. 3D digital models with digital balloon expandable valves were created from pre-procedure CT scans using dedicated software. Five models were printed. These models were used to assess prosthesis sizing, anchoring, expansion, paravalvular gaps, left ventricular outflow tract (LVOT) obstruction, and other potential procedure pitfalls. Results of 3D prototyping were then compared to post procedural imaging to determine how closely the achieved procedural result mirrored the 3D modeled result. 3D prototyping simulated LVOT obstruction in one patient who developed it and in another patient who underwent alcohol septal ablation prior to TMVR. Valve sizing correlated with actual placed valve size in six out of the eight patients and more than mild paravalvular leak (PVL) was simulated in two of the three patients who had it. Patients who had mismatch between their modeled valve size and post-procedural imaging were the ones that had anterior leaflet resection which could have altered valve sizing and PVL simulation. 3D printed model of one of the latter patients allowed modification of anterior leaflet to simulate surgical resection and was able to estimate the size and location of the PVL after inserting a valve stent into the physical model. 3D prototyping in TMVR for severe MAC is feasible for simulating valve sizing, apposition, expansion, PVL, and LVOT obstruction. © 2018 Wiley Periodicals, Inc.

  16. [Cox/maze III procedure combined with mitral valve replacement in treatment of rheumatic mitral valve disease with atrial fibrilation].

    Science.gov (United States)

    Chen, Rukun; Wang, Yongqing; Chen, Yongbing; Chen, Suocheng

    2002-06-25

    To compare the curative effect of Cox/maze III procedure combined with mitral replacement and that of mitral valve replacement (MVR). Fifty-six patients suffering from rheumatic heart disease with atrial fibrillation (AF) were treated by Cox/maze III procedure combined with MVR (maze group). Another 56 age, sex, and heart function-matched patients with the same diagnosis underwent MVR alone during the same period. Warfarin was administered after operation in both groups. Comparison of operative complication and curative effects was made. The aortic cross-clamp time and cardio pulmonary bypass time (CPB) were longer in maze group than in MVT group (75 +/- 22 min vs 41 +/- 11 min, P Atrial contractility was restored in all patients with sinus rhythm. One year after operation, 98.18% patients' cardiac function changed to grade and 1.82% changed to grade II. In MVR group AF disappeared after operation temporarily for 24 hours in 7 patients and re-appeared, and AF disappeared in one patients for 2 years so far. One year after operation, the cardiac function of 94.6% patients in MVR group changed to grade I, of 3.6% patients to grade II, and of 1.8% patients to grade III. No serious hemorrhage relate d to anticoagulant therapy happened. One patient in MVR group suffered from hemiplegia due to cerebral embolism. The late mortality was 1.8% on maze group amd 3.6% in MVR group. Cox/maze III procedure combined with NVR is safe and effective in treating rheumatic heart disease with AF.

  17. The effect of economic downturn on the volume of surgical procedures: A systematic review.

    Science.gov (United States)

    Fujihara, Nasa; Lark, Meghan E; Fujihara, Yuki; Chung, Kevin C

    2017-08-01

    Economic downturn can have a wide range of effects on medicine at both individual and national levels. We aim to describe these effects in relation to surgical volume to guide future planning for physician specialization, patient expectations in the face of economic crises, or estimating healthcare expenditure. We hypothesized that because of high out-of-pocket costs, cosmetic procedure volumes would be most affected by economic decline. A systematic review was conducted using MEDLINE, Embase, and ABI/INFORMS. The main search terms were "economic recession" and "surgical procedures, operative". Studies were included if surgical volumes were measured and economic indicators were used as predictors of economic conditions. Twelve studies were included, and the most common subject was cosmetic (n = 5), followed by orthopedic (n = 2) and cardiac surgeries (n = 2). The majority of studies found that in periods of economic downturn, surgical volume decreased. Among the eight studies using Pearson's correlation analysis, there were no significant differences between cosmetic procedures and other elective procedures, indicating that cosmetic procedures may display trends similar to those of non-cosmetic elective procedures in periods of economic downturn. Surgical volume generally decreased when economic indicators declined, observed for both elective and non-elective surgery fields. However, a few specific procedure volumes such as vasectomy and caesarean section for male babies increased during the economic downturn. Knowledge of these trends can be useful for future surgical planning and distribution of healthcare resources. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  18. Processed bottom ash for replacing fine aggregate in making high-volume fly ash concrete

    OpenAIRE

    Antoni; Sulistio Aldi Vincent; Wahjudi Samuel; Hardjito Djwantoro; Hardjito Djwantoro

    2017-01-01

    Bottom ash is a coal plant by-product that is abundant and underutilized. There is the potential use of bottom ash as a fine aggregate replacement in concrete mixtures; however, the problems of water absorption and uniformity of quality of the material need to be overcome first. In this study, bottom ash was treated by sieve separation and pounding to smaller particle size for use as a sand substitute. The physical and chemical characteristics of bottom ash were tested after treatment includi...

  19. Processed bottom ash for replacing fine aggregate in making high-volume fly ash concrete

    Directory of Open Access Journals (Sweden)

    Antoni

    2017-01-01

    Full Text Available Bottom ash is a coal plant by-product that is abundant and underutilized. There is the potential use of bottom ash as a fine aggregate replacement in concrete mixtures; however, the problems of water absorption and uniformity of quality of the material need to be overcome first. In this study, bottom ash was treated by sieve separation and pounding to smaller particle size for use as a sand substitute. The physical and chemical characteristics of bottom ash were tested after treatment including water absorption, sieve analysis, and fineness modulus. Highvolume fly ash (HVFA mortar specimens were made and the compressive strength and flowability test using bottom ash after treatment are compared with that of the sand specimen. Low water to cementitious ratio was used to ensure higher strength from the cementitious paste and superplasticizer demand was determined for each treatment. The result showed that bottom ash can be used as fine aggregate replacement material. Sieve separation of the bottom ash could produce 75% of the compressive strength compared with the control sand specimen, whereas pounded bottom ash could have up to 96% of the compressive strength of the control specimen. A 28-day compressive strength of 45 MPa was achievable with 100% replacement of fine aggregate with bottom ash.

  20. Rejecting escape events in large volume Ge detectors by a pulse shape selection procedure

    International Nuclear Information System (INIS)

    Del Zoppo, A.; Agodi, C.; Alba, R.; Bellia, G.; Coniglione, R.; Loukachine, K.; Maiolino, C.; Migneco, E.; Piattelli, P.; Santonocito, D.; Sapienza, P.

    1993-01-01

    The dependence of the response to γ-rays of a large volume Ge detector on the interval width of a selected initial rise pulse slope is investigated. The number of escape events associated with a small pulse slope is found to be greater than the corresponding number of full energy events. An escape event rejection procedure based on the observed correlation between energy deposition and pulse shape is discussed. Such a procedure seems particularly suited for the design of highly granular large volume Ge detector arrays. (orig.)

  1. Effect of Copolymer Latexes on Physicomechanical Properties of Mortar Containing High Volume Fly Ash as a Replacement Material of Cement

    Directory of Open Access Journals (Sweden)

    El-Sayed Negim

    2014-01-01

    Full Text Available This paper investigates the physicomechanical properties of mortar containing high volume of fly ash (FA as partial replacement of cement in presence of copolymer latexes. Portland cement (PC was partially replaced with 0, 10, 20, 30 50, and 60% FA. Copolymer latexes were used based on 2-hydroxyethyl acrylate (2-HEA and 2-hydroxymethylacrylate (2-HEMA. Testing included workability, setting time, absorption, chemically combined water content, compressive strength, and scanning electron microscopy (SEM. The addition of FA to mortar as replacement of PC affected the physicomechanical properties of mortar. As the content of FA in the concrete increased, the setting times (initial and final were elongated. The results obtained at 28 days of curing indicate that the maximum properties of mortar occur at around 30% FA. Beyond 30% FA the properties of mortar reduce and at 60% FA the properties of mortar are lower than those of the reference mortar without FA. However, the addition of polymer latexes into mortar containing FA improved most of the physicomechanical properties of mortar at all curing times. Compressive strength, combined water, and workability of mortar containing FA premixed with latexes are higher than those of mortar containing FA without latexes.

  2. Effect of copolymer latexes on physicomechanical properties of mortar containing high volume fly ash as a replacement material of cement.

    Science.gov (United States)

    Negim, El-Sayed; Kozhamzharova, Latipa; Gulzhakhan, Yeligbayeva; Khatib, Jamal; Bekbayeva, Lyazzat; Williams, Craig

    2014-01-01

    This paper investigates the physicomechanical properties of mortar containing high volume of fly ash (FA) as partial replacement of cement in presence of copolymer latexes. Portland cement (PC) was partially replaced with 0, 10, 20, 30 50, and 60% FA. Copolymer latexes were used based on 2-hydroxyethyl acrylate (2-HEA) and 2-hydroxymethylacrylate (2-HEMA). Testing included workability, setting time, absorption, chemically combined water content, compressive strength, and scanning electron microscopy (SEM). The addition of FA to mortar as replacement of PC affected the physicomechanical properties of mortar. As the content of FA in the concrete increased, the setting times (initial and final) were elongated. The results obtained at 28 days of curing indicate that the maximum properties of mortar occur at around 30% FA. Beyond 30% FA the properties of mortar reduce and at 60% FA the properties of mortar are lower than those of the reference mortar without FA. However, the addition of polymer latexes into mortar containing FA improved most of the physicomechanical properties of mortar at all curing times. Compressive strength, combined water, and workability of mortar containing FA premixed with latexes are higher than those of mortar containing FA without latexes.

  3. Sutureless versus Conventional Aortic Valve Replacement: Outcomes in 70 High-Risk Patients Undergoing Concomitant Cardiac Procedures.

    Science.gov (United States)

    Hanedan, Muhammet Onur; Yuruk, Mehmet Ali; Parlar, Ali Ihsan; Ziyrek, Ugur; Arslan, Ali Kemal; Sayar, Ufuk; Mataraci, Ilker

    2018-02-01

    In elderly, high-risk surgical patients, sutureless aortic valve replacement (AVR) can often be an alternative to conventional AVR; shorter aortic cross-clamp and cardiopulmonary bypass times are the chief advantages. We compared the outcomes of sutureless AVR with those of conventional AVR in 70 elderly patients who underwent concomitant cardiac surgical procedures. We retrospectively analyzed the cases of 42 men and 28 women (mean age, 70.4 ± 10.3 yr; range, 34-93 yr) who underwent cardiac operations plus AVR with either a sutureless valve (group 1, n=38) or a conventional bioprosthetic or mechanical valve (group 2, n=32). Baseline patient characteristics were similar except for worse New York Heart Association functional status and the prevalence of diabetes mellitus in group 1. In group 1, the operative, cross-clamp, and cardiopulmonary bypass times were shorter (all P =0.001), postoperative drainage amounts were lower ( P =0.009), hospital stays were shorter ( P =0.004), and less red blood cell transfusion was needed ( P =0.037). Echocardiograms before patients' discharge from the hospital showed lower peak and mean aortic gradients in group 1 (mean transvalvular gradient, 8.4 ± 2.8 vs 12.2 ± 5.2 mmHg; P =0.012). We found that elderly, high-risk patients who underwent multiple cardiac surgical procedures and sutureless AVR had better hemodynamic outcomes and shorter ischemic times than did patients who underwent conventional AVR.

  4. Replacement Nuclear Research Reactor. Supplement to Draft Environmental Impact Statement. Volume 3

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-01-01

    The Draft Environmental Impact Statement for a replacement research reactor at Lucas Heights, was available for public examination and comment for some three months during 1998. A Supplement to the Draft Environmental Impact Statement (Draft EIS) has been completed and was lodged with Environment Australia on 18 January 1999. The Supplement is an important step in the overall environmental assessment process. It reviews submissions received and provides the proponent`s response to issues raised in the public review period. General issues extracted from submissions and addressed in the Supplement include concern over liability issues, Chernobyl type accidents, the ozone layer and health issues. Further studies, relating to issues raised in the public submission process, were undertaken for the Supplementary EIS. These studies confirm, in ANSTO`s view, the findings of the Draft EIS and hence the findings of the Final EIS are unchanged from the Draft EIS

  5. Replacement Nuclear Research Reactor. Supplement to Draft Environmental Impact Statement. Volume 3

    International Nuclear Information System (INIS)

    1999-01-01

    The Draft Environmental Impact Statement for a replacement research reactor at Lucas Heights, was available for public examination and comment for some three months during 1998. A Supplement to the Draft Environmental Impact Statement (Draft EIS) has been completed and was lodged with Environment Australia on 18 January 1999. The Supplement is an important step in the overall environmental assessment process. It reviews submissions received and provides the proponent's response to issues raised in the public review period. General issues extracted from submissions and addressed in the Supplement include concern over liability issues, Chernobyl type accidents, the ozone layer and health issues. Further studies, relating to issues raised in the public submission process, were undertaken for the Supplementary EIS. These studies confirm, in ANSTO's view, the findings of the Draft EIS and hence the findings of the Final EIS are unchanged from the Draft EIS

  6. Field Operations and Enforcement Manual for Air Pollution Control. Volume III: Inspection Procedures for Specific Industries.

    Science.gov (United States)

    Weisburd, Melvin I.

    The Field Operations and Enforcement Manual for Air Pollution Control, Volume III, explains in detail the following: inspection procedures for specific sources, kraft pulp mills, animal rendering, steel mill furnaces, coking operations, petroleum refineries, chemical plants, non-ferrous smelting and refining, foundries, cement plants, aluminum…

  7. Procedural volume, cost, and reimbursement of outpatient incisional hernia repair: implications for payers and providers.

    Science.gov (United States)

    Song, Chao; Liu, Emelline; Tackett, Scott; Shi, Lizheng; Marcus, Daniel

    2017-06-01

    This analysis aimed to evaluate trends in volumes and costs of primary elective incisional ventral hernia repairs (IVHRs) and investigated potential cost implications of moving procedures from inpatient to outpatient settings. A time series study was conducted using the Premier Hospital Perspective ® Database (Premier database) for elective IVHR identified by International Classification of Diseases, Ninth revision, Clinical Modification codes. IVHR procedure volumes and costs were determined for inpatient, outpatient, minimally invasive surgery (MIS), and open procedures from January 2008-June 2015. Initial visit costs were inflation-adjusted to 2015 US dollars. Median costs were used to analyze variation by site of care and payer. Quantile regression on median costs was conducted in covariate-adjusted models. Cost impact of potential outpatient migration was estimated from a Medicare perspective. During the study period, the trend for outpatient procedures in obese and non-obese populations increased. Inpatient and outpatient MIS procedures experienced a steady growth in adoption over their open counterparts. Overall median costs increased over time, and inpatient costs were often double outpatient costs. An economic model demonstrated that a 5% shift of inpatient procedures to outpatient MIS procedures can have a cost surplus of ∼ US $1.8 million for provider or a cost-saving impact of US $1.7 million from the Centers for Medicare & Medicaid Services perspective. The study was limited by information in the Premier database. No data were available for IVHR cases performed in free-standing ambulatory surgery centers or federal healthcare facilities. Volumes and costs of outpatient IVHRs and MIS procedures increased from January 2008-June 2015. Median costs were significantly higher for inpatients than outpatients, and the difference was particularly evident for obese patients. A substantial cost difference between inpatient and outpatient MIS cases

  8. Investigation of Causal Relationship between Stock Prices and Trading Volume using Toda and Yamamoto Procedure

    Directory of Open Access Journals (Sweden)

    Sushil BAJAJ

    2014-11-01

    Full Text Available The present study probes the relationship between the stock prices and trading volume. For achieving this purpose, daily data of adjusted closing stock prices, trading volume of 39 individual securities and S&P CNX Nifty from January 1, 1998 to May 31, 2013 have been used. In this study, instead of applying ordinary Granger causality test to investigate the relationship between stock prices and trading volume, Toda and Yamamoto (1995 procedure has been applied for analyzing the data. Lag length chosen by AIC and FPE criterion has been insured by running Lagrange Multiplier (LM test and causality determined by Toda and Yamamoto test has also been confirmed by using VAR methodology. Although, Toda and Yamamoto and VAR test produced little dissimilar results, nevertheless, the empirical analysis provides sufficient grounds to declare the presence of interaction between stock prices and trading volume.

  9. General least-squares fitting procedures to minimize the volume of a hyperellipsoid

    International Nuclear Information System (INIS)

    Wadlinger, E.A.

    1979-01-01

    Several methods for determining the shape parameters, which in two dimensions are the Courant-Snyder parameters, and the volume of an ellipse or hyperellipse that represent a set of phase-space points in a two or more dimensional hyperspace are presented. The ellipse parameters are useful for matching a beam to an accelerating or transport system and in studies of emittance growth. The fitting procedure minimizes the total volume of a hyperellipse by adjusting the ellipse shape parameters. The total volume is the sum of the individual particle volumes defined by the hyperellipse that passes through the phase-space point of a particle. A two-dimensional space is considered first; the results are then generalized to higher dimensions. Computer programs using these techniques were written. 1 figure

  10. Graded changes in enamel component volumes resulted from a short tooth bleaching procedure.

    Science.gov (United States)

    Ferreira, Artemisa Fernanda Moura; Perez, Flávia Maria de Moraes Ramos; Limeira Júnior, Francisco de Assis; de Moura, Mirella de Fátima Liberato; de Sousa, Frederico Barbosa

    2016-05-01

    To test the hypothesis that changes in enamel component volumes (mineral, organic, and water volumes, and permeability) are graded from outer to inner enamel after a short bleaching procedure. Extracted unerupted human third molars had half of their crowns bleached (single bleaching session, 3 × 15 min), and tooth shade changes in bleached parts were analyzed with a spectrophotometer. Ground sections were prepared, component volumes and permeability were quantified at histological points located at varying distances from the enamel surface (n=10 points/location), representing conditions before and after bleaching. Tooth shade changes were significant (pbleaching, except at the outer layers. Multiple analysis of covariances revealed that most of the variance of the change in enamel composition after bleaching was explained by the combination of the set of types of component volume (in decreasing order of relevance: mineral loss, organic gain, water gain, and decrease in permeability) with the set of distances from the enamel surface (graded from the enamel surface inward) (canonical R(2)=0.97; p99%). Changes in enamel composition after a short bleaching procedure followed a gradient within component volumes (mineral loss>organic gain>water gain>decrease in permeability) and decreased from the enamel surface inward. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Evaluation of aesthetics of implant-supported single-tooth replacements using different bone augmentation procedures : A prospective randomized clinical study

    NARCIS (Netherlands)

    Meijndert, Leo; Meijer, Henny J. A.; Stellingsma, Kees; Stegenga, Boudewijn; Raghoebar, Gerry M.

    2007-01-01

    Objectives: The aim of this study was to evaluate the aesthetics of implant-supported single-tooth replacements using different augmentation procedures in a prospective study with the use of an objective rating index and with a subjective patient questionnaire, and to compare the results with each

  12. The effects of contrast media volume on acute kidney injury after transcatheter aortic valve replacement: a systematic review and meta-analysis.

    Science.gov (United States)

    Thongprayoon, Charat; Cheungpasitporn, Wisit; Podboy, Alexander J; Gillaspie, Erin A; Greason, Kevin L; Kashani, Kianoush B

    2016-11-01

    The goal of this systematic review was to assess the effects of contrast media volume on transcatheter aortic valve replacement-related acute kidney injury. A literature search was performed using Medline, EMbase, the Cochrane Database of Systematic Reviews, and clinicaltrials.gov from the inception of these databases through December 2015. Studies that reported relative risk, odds ratio, or hazard ratio comparing the risks of acute kidney injury following transcatheter aortic valve replacement in patients who received high contrast media volume were included. Pooled risk ratio (RR) and 95% confidence intervals (95% CI) were calculated using a random-effect, generic inverse variance method. Four cohort studies composed of 891 patients were included in the analyses to assess the risk of acute kidney injury after transcatheter aortic valve replacement in patients who received high contrast media volume. The pooled RR of acute kidney injury after transcatheter aortic valve replacement in patients who received a large volume of contrast media was 1.41 (95% CI, 0.87 to 2.28) compared with low contrast media volume. The meta-analysis was limited to studies using standard acute kidney injury definitions, and the pooled RR of acute kidney injury in patients who received high contrast media volume is 1.12 (95% CI, 0.78 to 1.62). Our meta-analysis shows no significant association between contrast media volume and risk of acute kidney injury after transcatheter aortic valve replacement. © 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

  13. A finite volume procedure for fluid flow, heat transfer and solid-body stress analysis

    KAUST Repository

    Jagad, P. I.

    2018-04-12

    A unified cell-centered unstructured mesh finite volume procedure is presented for fluid flow, heat transfer and solid-body stress analysis. An in-house procedure (A. W. Date, Solution of Transport Equations on Unstructured Meshes with Cell-Centered Colocated Variables. Part I: Discretization, International Journal of Heat and Mass Transfer, vol. 48 (6), 1117-1127, 2005) is extended to include the solid-body stress analysis. The transport terms for a cell-face are evaluated in a structured grid-like manner. The Cartesian gradients at the center of each cell-face are evaluated using the coordinate transformation relations. The accuracy of the procedure is demonstrated by solving several benchmark problems involving different boundary conditions, source terms, and types of loading.

  14. Stereotactic ultrasound for target volume definition in a patient with prostate cancer and bilateral total hip replacement.

    Science.gov (United States)

    Boda-Heggemann, Judit; Haneder, Stefan; Ehmann, Michael; Sihono, Dwi Seno Kuncoro; Wertz, Hansjörg; Mai, Sabine; Kegel, Stefan; Heitmann, Sigrun; von Swietochowski, Sandra; Lohr, Frank; Wenz, Frederik

    2015-01-01

    Target-volume definition for prostate cancer in patients with bilateral metal total hip replacements (THRs) is a challenge because of metal artifacts in the planning computed tomography (CT) scans. Magnetic resonance imaging (MRI) can be used for matching and prostate delineation; however, at a spatial and temporal distance from the planning CT, identical rectal and vesical filling is difficult to achieve. In addition, MRI may also be impaired by metal artifacts, even resulting in spatial image distortion. Here, we present a method to define prostate target volumes based on ultrasound images acquired during CT simulation and online-matched to the CT data set directly at the planning CT. A 78-year-old patient with cT2cNxM0 prostate cancer with bilateral metal THRs was referred to external beam radiation therapy. T2-weighted MRI was performed on the day of the planning CT with preparation according to a protocol for reproducible bladder and rectal filling. The planning CT was obtained with the immediate acquisition of a 3-dimensional ultrasound data set with a dedicated stereotactic ultrasound system for online intermodality image matching referenced to the isocenter by ceiling-mounted infrared cameras. MRI (offline) and ultrasound images (online) were thus both matched to the CT images for planning. Daily image guided radiation therapy (IGRT) was performed with transabdominal ultrasound and compared with cone beam CT. Because of variations in bladder and rectal filling and metal-induced image distortion in MRI, soft-tissue-based matching of the MRI to CT was not sufficient for unequivocal prostate target definition. Ultrasound-based images could be matched, and prostate, seminal vesicles, and target volumes were reliably defined. Daily IGRT could be successfully completed with transabdominal ultrasound with good accordance between cone beam CT and ultrasound. For prostate cancer patients with bilateral THRs causing artifacts in planning CTs, ultrasound referenced to

  15. The impact of surgeon volume on colostomy reversal outcomes after Hartmann's procedure for diverticulitis.

    Science.gov (United States)

    Aquina, Christopher T; Probst, Christian P; Becerra, Adan Z; Hensley, Bradley J; Iannuzzi, James C; Noyes, Katia; Monson, John R T; Fleming, Fergal J

    2016-11-01

    Colostomy reversal after Hartmann's procedure for diverticulitis is a morbid procedure, and studies investigating factors associated with outcomes are lacking. This study identifies patient, surgeon, and hospital-level factors associated with perioperative outcomes after stoma reversal. The Statewide Planning and Research Cooperative System was queried for urgent/emergency Hartmann's procedures for diverticulitis between 2000-2012 in New York State and subsequent colostomy reversal within 1 year of the procedure. Surgeon and hospital volume were categorized into tertiles based on the annual number of colorectal resections performed each year. Bivariate and mixed-effects analyses were used to assess the association between patient, surgeon, and hospital-level factors and perioperative outcomes after colostomy reversal, including a laparoscopic approach; duration of stay; intensive care unit admission; complications; mortality; and 30-day, unscheduled readmission. Among 10,487 patients who underwent Hartmann's procedure and survived to discharge, 63% had the colostomy reversed within 1 year. After controlling for patient, surgeon, and hospital-level factors, high-volume surgeons (≥40 colorectal resections/yr) were independently associated with higher odds of a laparoscopic approach (unadjusted rates: 14% vs 7.6%; adjusted odds ratio = 1.84, 95% confidence interval = 1.12, 3.00), shorter duration of stay (median: 6 versus 7 days; adjusted incidence rate ratio = 0.87, 95% confidence interval = 0.81, 0.95), and lower odds of 90-day mortality (unadjusted rates: 0.4% vs 1.0%; adjusted odds ratio = 0.30, 95% confidence interval = 0.10, 0.88) compared with low-volume surgeons (1-15 colorectal resections/yr). High-volume surgeons are associated with better perioperative outcomes and lower health care utilization after Hartmann's reversal for diverticulitis. These findings support referral to high-volume surgeons for colostomy reversal. Copyright © 2016

  16. Optimisation of Forensic Genetics Procedures Used in Disputed Paternity Testing: Adjustment of the PCR Reaction Volume

    Directory of Open Access Journals (Sweden)

    Damir Marjanović

    2006-05-01

    Full Text Available Standard molecular techniques, with only a slight modification, are very useful in obtaining and interpreting the final results in the field of forensic genetic. Data obtained through such analysis are highly reliable and can be used as a very powerful tool that produces valuable results. However, success and swiftness of DNA typing of biological evidence either that found at a crime scene or used in disputed paternity testing, depends on the optimization of numerous factors. One of the most important and critical phases that ensures reliability of the whole procedure is the choice of the most suitable volume for the amplification protocol. Buccal swabs were collected from volunteers. DNA was extracted by Qiagen Dnaeasy Tissue Kit. PowerPlex 16 kit was used to simultaneously amplify 15 STR loci by PCR. Amplification was carried out as described previously. The tested total working reaction volumes were 5, 10 and 25 microl. The PCR amplification was carried out in PE Gene Amp PCR System Thermal Cycler (ABI, Foster City, CA. Amplification products were analyzed on an ABI PRISM 377 instrument (ABI, Foster City, CA in 5% bis-acrilamide gel. Amplification was generally successful for all the tested reaction volumes. Lower partial to complete DNA profiles ratio, the quality of obtained STR profiles, significantly reduced amount of reaction's components give advantage to 5 microl reaction volume over other two tested volumes in this case.

  17. Low contrast medium-volume third-generation dual-source computed tomography angiography for transcatheter aortic valve replacement planning

    Energy Technology Data Exchange (ETDEWEB)

    Felmly, Lloyd M. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiothoracic Surgery, Department of Surgery, Charleston, SC (United States); De Cecco, Carlo N.; Varga-Szemes, Akos; McQuiston, Andrew D. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Schoepf, U.J.; Litwin, Sheldon E.; Bayer, Richard R. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); Medical University of South Carolina, Division of Cardiology, Department of Medicine, Charleston, SC (United States); Mangold, Stefanie [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); University Hospital of Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen (Germany); Vogl, Thomas J. [University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Wichmann, Julian L. [Medical University of South Carolina, Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Charleston, SC (United States); University Hospital Frankfurt, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany)

    2017-05-15

    To investigate feasibility, image quality and safety of low-tube-voltage, low-contrast-volume comprehensive cardiac and aortoiliac CT angiography (CTA) for planning transcatheter aortic valve replacement (TAVR). Forty consecutive TAVR candidates prospectively underwent combined CTA of the aortic root and vascular access route (270 mgI/ml iodixanol). Patients were assigned to group A (second-generation dual-source CT [DSCT], 100 kV, 60 ml contrast, 4.0 ml/s flow rate) or group B (third-generation DSCT, 70 kV, 40 ml contrast, 2.5 ml/s flow rate). Vascular attenuation, noise, signal-to-noise (SNR) and contrast-to-noise ratios (CNR) were compared. Subjective image quality was assessed by two observers. Estimated glomerular filtration (eGFR) at CTA and follow-up were measured. Besides a higher body-mass-index in group B (24.8±3.8 kg/m{sup 2} vs. 28.1±5.4 kg/m{sup 2}, P=0.0339), patient characteristics between groups were similar (P≥0.0922). Aortoiliac SNR (P=0.0003) was higher in group B. Cardiac SNR (P=0.0003) and CNR (P=0.0181) were higher in group A. Subjective image quality was similar (P≥0.213) except for aortoiliac image noise (4.42 vs. 4.12, P=0.0374). TAVR-planning measurements were successfully obtained in all patients. There were no significant changes in eGFR among and between groups during follow-up (P≥0.302). TAVR candidates can be safely and effectively evaluated by a comprehensive CTA protocol with low contrast volume using low-tube-voltage acquisition. (orig.)

  18. Low contrast medium-volume third-generation dual-source computed tomography angiography for transcatheter aortic valve replacement planning

    International Nuclear Information System (INIS)

    Felmly, Lloyd M.; De Cecco, Carlo N.; Varga-Szemes, Akos; McQuiston, Andrew D.; Schoepf, U.J.; Litwin, Sheldon E.; Bayer, Richard R.; Mangold, Stefanie; Vogl, Thomas J.; Wichmann, Julian L.

    2017-01-01

    To investigate feasibility, image quality and safety of low-tube-voltage, low-contrast-volume comprehensive cardiac and aortoiliac CT angiography (CTA) for planning transcatheter aortic valve replacement (TAVR). Forty consecutive TAVR candidates prospectively underwent combined CTA of the aortic root and vascular access route (270 mgI/ml iodixanol). Patients were assigned to group A (second-generation dual-source CT [DSCT], 100 kV, 60 ml contrast, 4.0 ml/s flow rate) or group B (third-generation DSCT, 70 kV, 40 ml contrast, 2.5 ml/s flow rate). Vascular attenuation, noise, signal-to-noise (SNR) and contrast-to-noise ratios (CNR) were compared. Subjective image quality was assessed by two observers. Estimated glomerular filtration (eGFR) at CTA and follow-up were measured. Besides a higher body-mass-index in group B (24.8±3.8 kg/m 2 vs. 28.1±5.4 kg/m 2 , P=0.0339), patient characteristics between groups were similar (P≥0.0922). Aortoiliac SNR (P=0.0003) was higher in group B. Cardiac SNR (P=0.0003) and CNR (P=0.0181) were higher in group A. Subjective image quality was similar (P≥0.213) except for aortoiliac image noise (4.42 vs. 4.12, P=0.0374). TAVR-planning measurements were successfully obtained in all patients. There were no significant changes in eGFR among and between groups during follow-up (P≥0.302). TAVR candidates can be safely and effectively evaluated by a comprehensive CTA protocol with low contrast volume using low-tube-voltage acquisition. (orig.)

  19. Load research manual. Volume 2. Fundamentals of implementing load research procedures

    Energy Technology Data Exchange (ETDEWEB)

    Brandenburg, L.; Clarkson, G.; Grund, Jr., C.; Leo, J.; Asbury, J.; Brandon-Brown, F.; Derderian, H.; Mueller, R.; Swaroop, R.

    1980-11-01

    This three-volume manual presents technical guidelines for electric utility load research. Special attention is given to issues raised by the load data reporting requirements of the Public Utility Regulatory Policies Act of 1978 and to problems faced by smaller utilities that are initiating load research programs. In Volumes 1 and 2, procedures are suggested for determining data requirements for load research, establishing the size and customer composition of a load survey sample, selecting and using equipment to record customer electricity usage, processing data tapes from the recording equipment, and analyzing the data. Statistical techniques used in customer sampling are discussed in detail. The costs of load research also are estimated, and ongoing load research programs at three utilities are described. The manual includes guides to load research literature and glossaries of load research and statistical terms.

  20. Radiation dose to procedural personnel and patients from an X-ray volume imaging system

    International Nuclear Information System (INIS)

    Paul, Jijo; Mbalisike, Emmanuel C.; Vogl, Thomas J.

    2013-01-01

    To evaluate the radiation dose received by procedural personnel and patients from an X-ray volume imaging (XVI) system during interventional procedures. Forty patients were examined using catheter angiography (group A), digital subtraction angiography (group B) and cone-beam CT (CBCT, group C). Doses to procedural personnel (using thermo-luminescent dosimeters, TLDs) and patients were estimated. Image quality and lesion delineation were assessed using objective and subjective methods. Shapiro-Wilk, two-sided Student's t and Wilcoxon matched-pairs tests were used to test statistical significance. Doses (milligrays) measured in the hands and left knee of the interventionist were higher than those in an assistant physician (P < 0.05). Doses (dose-area product and skin entry dose) were lower in group A and higher in C compared with other groups; moreover, comparison among the groups were significant (all P = 0.0001). Subjective and objective lesion delineation showed significant results (all P < 0.05) among the tumour types considered. Image quality estimation showed the opposite results for objective and subjective analysis. More doses were obtained for hands of the procedural personnel compared to other anatomical regions measured. Catheter angiography showed lower dose compared with other imaging groups examined. Lesion delineation was clearly possible using CBCT. Objective and subjective analysis showed the opposite results regarding image quality because of higher noise levels and artefacts. (orig.)

  1. Proposal of organisation and ALARA procedure for preparation, follow-up and experience gained from maintenance: application to replacement of pressure vessel

    International Nuclear Information System (INIS)

    Lochard, Jacques; Lefaure, Christian

    1990-01-01

    This report proposes the organisation and ALARA procedures for preparation, follow-up and analysis of the lessons learned during maintenance works at a nuclear power plant. After a brief description of the ALARA principle in the first chapter, the following chapters describe proposals for establishing and start-up of a maintenance building site. The proposals are illustrated by the replacement of the pressure vessel as an example

  2. Proposal of organisation and ALARA procedure for preparation, follow-up and experience gained from maintenance: application to replacement of pressure vessel

    International Nuclear Information System (INIS)

    Lochard, Jacques; Lefaure, Christian

    1989-12-01

    This report proposes the organisation and ALARA procedures for preparation, follow-up and analysis of the lessons learned during maintenance works at a nuclear power plant. After a brief description of the ALARA principle in the first chapter, the following chapters describe proposals for establishing and start-up of a maintenance building site. The proposals are illustrated by the replacement of the pressure vessel as an example

  3. [Evaluation of selected parameters of blood coagulation and fibrinolysis system in patients undergoing total hip replacement surgery with normovolemic hemodilution procedure and standard enoxaparine prophylaxis].

    Science.gov (United States)

    Piecuch, Wiesław; Sokołowska, Bozena; Dmoszyńska, Anna; Furmanik, Franciszek

    2003-01-01

    The aim of the study was to evaluate selected blood coagulation and fibrinolysis parameters in patients undergoing total hip replacement surgery with normovolemic hemodilution and standard enoksaparine profilaxis. The study included 66 patients undergoing hip replacement surgery. The group consisted of 51 women and 15 men, within the age range of 47-78, the mean age was 64. In 32 (subgroup II) patients the surgery was performed with the use of normovolemic hemodilution, in 34 (subgroup I) the hemodilution procedure was not applied. The enoksaparine as prophylaxis started 12 hours prior to surgery and continued during hospitalisation. The examination of the coagulation system was performed: on the day of the operation in the morning, on the day of the operation in the evening and on the first day after operation. We determined the concentrations of TAT and PAP complexes, prothrombin fragments 1 + 2 (F1 + 2) and d-dimers (DD). 1) during total hip replacement surgery and particularly in the period of the first 12 hours after the procedure marked activation of coagulation and fibrinolysis occurRed; 2) the application of the hemodilution procedure does not influence significantly the degree of coagulation and fibrinolysis disorders in the perioperative period, but could reduced incidence of thromboembolic complications in the postoperative period.

  4. Analysis of excimer laser radiant exposure effect toward corneal ablation volume at LASIK procedure

    Science.gov (United States)

    Adiati, Rima Fitria; Rini Rizki, Artha Bona; Kusumawardhani, Apriani; Setijono, Heru; Rahmadiansah, Andi

    2016-11-01

    LASIK (Laser Asissted In Situ Interlamelar Keratomilieusis) is a technique for correcting refractive disorders of the eye such as myopia and astigmatism using an excimer laser. This procedure use photoablation technique to decompose corneal tissues. Although preferred due to its efficiency, permanency, and accuracy, the inappropriate amount radiant exposure often cause side effects like under-over correction, irregular astigmatism and problems on surrounding tissues. In this study, the radiant exposure effect toward corneal ablation volume has been modelled through several processes. Data collecting results is laser data specifications with 193 nm wavelength, beam diameter of 0.065 - 0.65 cm, and fluence of 160 mJ/cm2. For the medical data, the myopia-astigmatism value, cornea size, corneal ablation thickness, and flap data are taken. The first modelling step is determining the laser diameter between 0.065 - 0.65 cm with 0.45 cm increment. The energy, power, and intensity of laser determined from laser beam area. Number of pulse and total energy is calculated before the radiant exposure of laser is obtained. Next is to determine the parameters influence the ablation volume. Regression method used to create the equation, and then the spot size is substituted to the model. The validation used is statistic correlation method to both experimental data and theory. By the model created, it is expected that any potential complications can be prevented during LASIK procedures. The recommendations can give the users clearer picture to determine the appropriate amount of radiant exposure with the corneal ablation volume necessary.

  5. Dosimetric impact of the variation of the prostate volume and shape between pretreatment planning and treatment procedure

    International Nuclear Information System (INIS)

    Beaulieu, Luc; Aubin, Sylviane; Taschereau, Richard; Pouliot, Jean; Vigneault, Eric

    2002-01-01

    Purpose: The goal of this study is to evaluate the dosimetric impact on a pretreatment planning of prostatic volume and shape variations occurring between the moment of the volume study (preplanning) and just before a transperineal permanent seed implant procedure. Such variations could be an obvious source of misplacement of the seeds relative to the prostate gland and organs at risk. Other sources of dosimetric uncertainties, such as misplacement due to the procedure itself or edema, are eliminated by looking at these variations before the implant procedure. Methods and Materials: For 35 clinical cases, prostate contours were taken at preplanning time as well as in the operating room (OR) minutes before the procedure. Comparison of shape and volume between the two sets was made. The impact on V100 was evaluated by placing the seeds in their planned positions in the new volume (clinical situation) and also by performing a new plan with the second set of contours to simulate an intraoperative approach. Results: The volume taken in the OR remained unchanged compared to the pretreatment planning volume in only 37% of the cases. While on average the dose coverage loss from pretreatment planning due to a combination of variations of volume and shape was small at 5.7%, a V100 degradation of up to 20.9% was observed in extreme cases. Even in cases in which no changes in volume were observed, changes in shape occurred and strongly affected implant dosimetry. Conclusions: Variations of volume and shape between pretreatment planning and the implant procedure can have a strong impact on the dosimetry if the planning and the implant procedure are not performed on the same day. This is an argument in favor of performing implant dosimetry in the OR

  6. Survival comparison of the Ross procedure and mechanical valve replacement with optimal self-management anticoagulation therapy: propensity-matched cohort study.

    Science.gov (United States)

    Mokhles, M Mostafa; Körtke, Heinrich; Stierle, Ulrich; Wagner, Otto; Charitos, Efstratios I; Bogers, Ad J J C; Gummert, Jan; Sievers, Hans-Hinrich; Takkenberg, Johanna J M

    2011-01-04

    It is suggested that in young adults the Ross procedure results in better late patient survival compared with mechanical prosthesis implantation. We performed a propensity score-matched study that assessed late survival in young adult patients after a Ross procedure versus that after mechanical aortic valve replacement with optimal self-management anticoagulation therapy. We selected 918 Ross patients and 406 mechanical valve patients 18 to 60 years of age without dissection, aneurysm, or mitral valve replacement who survived an elective procedure (1994 to 2008). With the use of propensity score matching, late survival was compared between the 2 groups. Two hundred fifty-three patients with a mechanical valve (mean follow-up, 6.3 years) could be propensity matched to a Ross patient (mean follow-up, 5.1 years). Mean age of the matched cohort was 47.3 years in the Ross procedure group and 48.0 years in the mechanical valve group (P=0.17); the ratio of male to female patients was 3.2 in the Ross procedure group and 2.7 in the mechanical valve group (P=0.46). Linearized all-cause mortality rate was 0.53% per patient-year in the Ross procedure group compared with 0.30% per patient-year in the mechanical valve group (matched hazard ratio, 1.86; 95% confidence interval, 0.58 to 5.91; P=0.32). Late survival was comparable to that of the general German population. In comparable patients, there is no late survival difference in the first postoperative decade between the Ross procedure and mechanical aortic valve implantation with optimal anticoagulation self-management. Survival in these selected young adult patients closely resembles that of the general population, possibly as a result of highly specialized anticoagulation self-management, better timing of surgery, and improved patient selection in recent years.

  7. Efficient Procedure to Compute the Microcanonical Volume of Initial Conditions that Lead to Escape Trajectories from a Multidimensional Potential Well

    NARCIS (Netherlands)

    Waalkens, Holger; Burbanks, Andrew; Wiggins, Stephen

    2005-01-01

    A procedure is presented for computing the phase space volume of initial conditions for trajectories that escape or ‘‘react’’ from a multidimensional potential well. The procedure combines a phase space transition state theory, which allows one to construct dividing surfaces that are free of local

  8. Sampling procedures for inventory of commercial volume tree species in Amazon Forest.

    Science.gov (United States)

    Netto, Sylvio P; Pelissari, Allan L; Cysneiros, Vinicius C; Bonazza, Marcelo; Sanquetta, Carlos R

    2017-01-01

    The spatial distribution of tropical tree species can affect the consistency of the estimators in commercial forest inventories, therefore, appropriate sampling procedures are required to survey species with different spatial patterns in the Amazon Forest. For this, the present study aims to evaluate the conventional sampling procedures and introduce the adaptive cluster sampling for volumetric inventories of Amazonian tree species, considering the hypotheses that the density, the spatial distribution and the zero-plots affect the consistency of the estimators, and that the adaptive cluster sampling allows to obtain more accurate volumetric estimation. We use data from a census carried out in Jamari National Forest, Brazil, where trees with diameters equal to or higher than 40 cm were measured in 1,355 plots. Species with different spatial patterns were selected and sampled with simple random sampling, systematic sampling, linear cluster sampling and adaptive cluster sampling, whereby the accuracy of the volumetric estimation and presence of zero-plots were evaluated. The sampling procedures applied to species were affected by the low density of trees and the large number of zero-plots, wherein the adaptive clusters allowed concentrating the sampling effort in plots with trees and, thus, agglutinating more representative samples to estimate the commercial volume.

  9. A Quantitative Analysis of the Relationship between Medicare Payment and Service Volume for Glaucoma Procedures from 2005 through 2009.

    Science.gov (United States)

    Gong, Dan; Jun, Lin; Tsai, James C

    2015-05-01

    To calculate the association between Medicare payment and service volume for 6 commonly performed glaucoma procedures. Retrospective, longitudinal database study. A 100% dataset of all glaucoma procedures performed on Medicare Part B beneficiaries within the United States from 2005 to 2009. Fixed-effects regression model using Medicare Part B carrier data for all 50 states and the District of Columbia, controlling for time-invariant carrier-specific characteristics, national trends in glaucoma service volume, Medicare beneficiary population, number of ophthalmologists, and income per capita. Payment-volume elasticities, defined as the percent change in service volume per 1% change in Medicare payment, for laser trabeculoplasty (Current Procedural Terminology [CPT] code 65855), trabeculectomy without previous surgery (CPT code 66170), trabeculectomy with previous surgery (CPT code 66172), aqueous shunt to reservoir (CPT code 66180), laser iridotomy (CPT code 66761), and scleral reinforcement with graft (CPT code 67255). The payment-volume elasticity was nonsignificant for 4 of 6 procedures studied: laser trabeculoplasty (elasticity, -0.27; 95% confidence interval [CI], -1.31 to 0.77; P = 0.61), trabeculectomy without previous surgery (elasticity, -0.42; 95% CI, -0.85 to 0.01; P = 0.053), trabeculectomy with previous surgery (elasticity, -0.28; 95% CI, -0.83 to 0.28; P = 0.32), and aqueous shunt to reservoir (elasticity, -0.47; 95% CI, -3.32 to 2.37; P = 0.74). Two procedures yielded significant associations between Medicare payment and service volume. For laser iridotomy, the payment-volume elasticity was -1.06 (95% CI, -1.39 to -0.72; P payment, laser iridotomy service volume increased by 1.06%. For scleral reinforcement with graft, the payment-volume elasticity was -2.92 (95% CI, -5.72 to -0.12; P = 0.041): for every 1% decrease in CPT code 67255 payment, scleral reinforcement with graft service volume increased by 2.92%. This study calculated the association

  10. Proposal of organisation and ALARA procedures for maintenance site: application to replacement of steam generator; Propositions d'organisation et procedures ALARA pour la preparation des chantiers de maintenance: application au RGV

    Energy Technology Data Exchange (ETDEWEB)

    Lochard, J; Lefaure, C

    1989-08-01

    This report proposes generic organization and ALARA procedures for preparing a maintenance site at a NPP. After a short description of the ALARA principle, it describes the proposition for French sites. They are grouped according to the following: motivation, organisation, means. They are illustrated by the example of steam generator replacement. Three special points concerning preparation of the site are developed: education; training of operators; review of the project.

  11. Effects of 1-year growth hormone replacement therapy on thyroid volume and function of the children and adolescents with idiopathic growth hormone deficiency.

    Science.gov (United States)

    Keskin, Meliksah; Bayramoglu, Elvan; Aycan, Zehra

    2017-10-26

    There are different opinions about the effects of growth hormone replacement therapy (GHRT) on thyroid function and volume. This study aimed to assess the effects of GHRT on thyroid volume and function in the children and adolescents with growth hormone (GH) deficiency. A total of 29 patients diagnosed with GH deficiency were enrolled in the study. The control group consisted of 29 cases matched for age, gender and pubertal period with the patients. Thyroid function tests and insulin-like growth factor levels were measured, simultaneously thyroid volumes were assessed by ultrasonography at the initiation period and at the end of GHRT. Thyroid volumes of the patient group was -0.55±1.1 standard deviations (SDs) initially; whereas at the end of 1 year it was found to be -0.29±1.29 SDs and both SDs of thyroid volumes did not differ significantly. The SDs of thyroid volume of the control group was -0.85±1.03 SDs initially and -0.72±0.85 SDs at the end of 1 year; and they did not differ significantly. On the other hand, after GHRT of 1 year, thyroid stimulating hormone (TSH) and free thyroxine (T4) levels decreased. It was observed that SDs of thyroid gland volumes did not change in GH deficient children and adolescents after GHRT.

  12. Valve-Sparing Root Replacement Compared With Composite Valve Graft Procedures in Patients With Aortic Root Dilation.

    Science.gov (United States)

    Ouzounian, Maral; Rao, Vivek; Manlhiot, Cedric; Abraham, Nachum; David, Carolyn; Feindel, Christopher M; David, Tirone E

    2016-10-25

    Although aortic valve-sparing (AVS) operations are established alternatives to composite valve graft (CVG) procedures for patients with aortic root aneurysms, comparative long-term outcomes are lacking. This study sought to compare the results of patients undergoing AVS procedures with those undergoing CVG operations. From 1990 to 2010, a total of 616 patients age Marfan syndrome and lower rates of bicuspid aortic valve than those undergoing bio-CVG or m-CVG procedures. In-hospital mortality (0.3%) and stroke rate (1.3%) were similar among groups. After adjusting for clinical covariates, both bio-CVG and m-CVG procedures were associated with increased long-term major adverse valve-related events compared with patients undergoing AVS (hazard ratio [HR]: 3.4, p = 0.005; and HR: 5.2, p valve-related complications when compared with bio-CVG and m-CVG. AVS is the treatment of choice for young patients with aortic root aneurysm and normal or near-normal aortic cusps. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  13. Probabilistic safety analysis procedures guide, Sections 8-12. Volume 2, Rev. 1

    International Nuclear Information System (INIS)

    McCann, M.; Reed, J.; Ruger, C.; Shiu, K.; Teichmann, T.; Unione, A.; Youngblood, R.

    1985-08-01

    A procedures guide for the performance of probabilistic safety assessment has been prepared for interim use in the Nuclear Regulatory Commission programs. It will be revised as comments are received, and as experience is gained from its use. The probabilistic safety assessment studies performed are intended to produce probabilistic predictive models that can be used and extended by the utilities and by NRC to sharpen the focus of inquiries into a range of issues affecting reactor safety. The first volume of the guide describes the determination of the probability (per year) of core damage resulting from accident initiators internal to the plant (i.e., intrinsic to plant operation) and from loss of off-site electric power. The scope includes human reliability analysis, a determination of the importance of various core damage accident sequences, and an explicit treatment and display of uncertainties for key accident sequences. This second volume deals with the treatment of the so-called external events including seismic disturbances, fires, floods, etc. Ultimately, the guide will be augmented to include the plant-specific analysis of in-plant processes (i.e., containment performance). This guide provides the structure of a probabilistic safety study to be performed, and indicates what products of the study are valuable for regulatory decision making. For internal events, methodology is treated in the guide only to the extent necessary to indicate the range of methods which is acceptable; ample reference is given to alternative methodologies which may be utilized in the performance of the study. For external events, more explicit guidance is given

  14. Probabilistic safety analysis procedures guide. Sections 1-7 and appendices. Volume 1, Revision 1

    International Nuclear Information System (INIS)

    Bari, R.A.; Buslik, A.J.; Cho, N.Z.

    1985-08-01

    A procedures guide for the performance of probabilistic safety assessment has been prepared for interim use in the Nuclear Regulatory Commission programs. It will be revised as comments are received, and as experience is gained from its use. The probabilistic safety assessment studies performed are intended to produce probabilistic predictive models that can be used and extended by the utilities and by NRC to sharpen the focus of inquiries into a range of issues affecting reactor safety. This first volume of the guide describes the determination of the probability (per year) of core damage resulting from accident initiators internal to the plant (i.e., intrinsic to plant operation) and from loss of off-site electric power. The scope includes human reliability analysis, a determination of the importance of various core damage accident sequences, and an explicit treatment and display of uncertainties for key accident sequences. The second volume deals with the treatment of the so-called external events including seismic disturbances, fires, floods, etc. Ultimately, the guide will be augmented to include the plant-specific analysis of in-plant processes (i.e., containment performance). This guide provides the structure of a probabilistic safety study to be performed, and indicates what products of the study are valuable for regulatory decision making. For internal events, methodology is treated in the guide only to the extent necessary to indicate the range of methods which is acceptable; ample reference is given to alternative methodologies which may be utilized in the performance of the study. For external events, more explicit guidance is given

  15. "Pulmonary valve replacement diminishes the presence of restrictive physiology and reduces atrial volumes": a prospective study in Tetralogy of Fallot patients.

    Science.gov (United States)

    Pijuan-Domenech, Antonia; Pineda, Victor; Castro, Miguel Angel; Sureda-Barbosa, Carlos; Ribera, Aida; Cruz, Luz M; Ferreira-Gonzalez, Ignacio; Dos-Subirà, Laura; Subirana-Domènech, Teresa; Garcia-Dorado, David; Casaldàliga-Ferrer, Jaume

    2014-11-15

    Pulmonary valve replacement (PVR) reduces right ventricular (RV) volumes in the setting of long-term pulmonary regurgitation after Tetralogy of Fallot (ToF) repair; however, little is known of its effect on RV diastolic function. Right atrial volumes may reflect the burden of RV diastolic dysfunction. The objective of this paper is to evaluate the clinical, echocardiographic, biochemical and cardiac magnetic resonance (CMR) variables, focusing particularly on right atrial response and right ventricular diastolic function prior to and after elective PVR in adult patients with ToF. This prospective study was conducted from January 2009 to April 2013 in consecutive patients > 18 years of age who had undergone ToF repair in childhood and were accepted for elective PVR. Twenty patients (mean age: 35 years; 70% men) agreed to enter the study. PVR was performed with a bioporcine prosthesis. Concomitant RV reduction was performed in all cases when technically possible. Pulmonary end-diastolic forward flow (EDFF) decreased significantly from 5.4 ml/m(2) to 0.3 ml/m(2) (p volumes by 25% (p = 0.0024): mean indexed diastolic/systolic atrial volumes prior to surgery were 43 ml/m(2) (SD+/-4.6)/63 ml/m(2) (SD+/-5.5), and dropped to 33 ml/m(2) (SD+/-3)/46 ml/m(2) (SD+/-2.55) post-surgery. All patients presented right ventricular diastolic and systolic volume reductions, with a mean volume reduction of 35% (p volumes in keeping with the known reduction in RV volumes, after PVR. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  16. A safe procedure for connecting a continuous renal replacement therapy device into an extracorporeal membrane oxygenation circuit.

    Science.gov (United States)

    Suga, Natsumi; Matsumura, Yosuke; Abe, Ryuzo; Hattori, Noriyuki; Nakada, Taka-Aki; Oda, Shigeto

    2017-06-01

    Patients receiving extracorporeal membrane oxygenation (ECMO) often require continuous renal replacement therapy (CRRT). The intra-circuit pressure of adult ECMO usually deviates from the physiological range. We investigated the use of CRRT connected to an ECMO circuit with physiological intra-circuit pressures (0-150 mmHg, defined as the "safety range") using an in vitro experiment involving a water-filled ECMO circuit. The intra-circuit pressure pre-pump, post-pump, and post-oxygenator were measured while varying the height of the pump or ECMO flow. The bypass conduit pressure and distance from the post-oxygenator port were measured to find the "safety point", where the bypass pressure remained within the safety range. Both drainage and return limbs of the CRRT machine were connected to the safety point and the inlet and outlet pressures of the hemofilter were recorded while varying the ECMO and CRRT flow. The pre-pump pressure only remained within the safety range for heights >75 cm (ECMO flow = 4 L/min) or ECMO flow machine safely under physiological pressures in adult patients receiving ECMO.

  17. Technical procedures for water resources: Volume 4, Deaf Smith County site, Texas: Environmental Field Program: Final draft

    International Nuclear Information System (INIS)

    1987-08-01

    This volume contains Technical Procedures pursuant to the water Resources Site Study Plan: including Collection, Preservation, and Shipment of Ground-Water Samples; Inventory Current Water Use and Estimating Projected Water Use; Estimation of Precipitation Depth, Duration, Frequence; Estimation of Probable Maximum Precipitation; Calculation of Floodplains

  18. Technical procedures for water resources, Deaf Smith County site, Texas: Volume 1: Environmental Field Program: Final draft

    International Nuclear Information System (INIS)

    1987-08-01

    This volume contains Technical Procedures pursuant to the Water Resources Site Study Plan including, determination of basin topographic characteristics, determination of channel and playa lake characteristics, operation of a stream gaging station, operation of a playa lake stage gaging system, and processing of data from a playa lake stage gaging system

  19. Outcomes of PCI in Relation to Procedural Characteristics and Operator Volumes in the United States.

    Science.gov (United States)

    Fanaroff, Alexander C; Zakroysky, Pearl; Dai, David; Wojdyla, Daniel; Sherwood, Matthew W; Roe, Matthew T; Wang, Tracy Y; Peterson, Eric D; Gurm, Hitinder S; Cohen, Mauricio G; Messenger, John C; Rao, Sunil V

    2017-06-20

    Professional guidelines have reduced the recommended minimum number to an average of 50 percutaneous coronary intervention (PCI) procedures performed annually by each operator. Operator volume patterns and associated outcomes since this change are unknown. The authors describe herein PCI operator procedure volumes; characteristics of low-, intermediate-, and high-volume operators; and the relationship between operator volume and clinical outcomes in a large, contemporary, nationwide sample. Using data from the National Cardiovascular Data Registry collected between July 1, 2009, and March 31, 2015, we examined operator annual PCI volume. We divided operators into low- (100 PCIs per year) volume groups, and determined the adjusted association between annual PCI volume and in-hospital outcomes, including mortality. The median annual number of procedures performed per operator was 59; 44% of operators performed PCI procedures per year. Low-volume operators more frequently performed emergency and primary PCI procedures and practiced at hospitals with lower annual PCI volumes. Unadjusted in-hospital mortality was 1.86% for low-volume operators, 1.73% for intermediate-volume operators, and 1.48% for high-volume operators. The adjusted risk of in-hospital mortality was higher for PCI procedures performed by low- and intermediate-volume operators compared with those performed by high-volume operators (adjusted odds ratio: 1.16 for low versus high; adjusted odds ratio: 1.05 for intermediate vs. high volume) as was the risk for new dialysis post PCI. No volume relationship was observed for post-PCI bleeding. Many PCI operators in the United States are performing fewer than the recommended number of PCI procedures annually. Although absolute risk differences are small and may be partially explained by unmeasured differences in case mix between operators, there remains an inverse relationship between PCI operator volume and in-hospital mortality that persisted in risk

  20. Surveillance of Vittaforma corneae in hot springs by a small-volume procedure.

    Science.gov (United States)

    Chen, Jung-Sheng; Hsu, Tsui-Kang; Hsu, Bing-Mu; Huang, Tung-Yi; Huang, Yu-Li; Shaio, Men-Fang; Ji, Dar-Der

    2017-07-01

    supporting the need for proper control and regulations at hot spring recreational waters in order to avoid health risks from this pathogen. Finally, we have developed a small volume procedure for detecting V. corneae in water samples and this has proved to be very useful. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. The economics of plastic surgery practices: trends in income, procedure mix, and volume.

    Science.gov (United States)

    Krieger, Lloyd M; Lee, Gordon K

    2004-07-01

    Anecdotally, plastic surgeons have complained of working harder for the same or less income in recent years. They also complain of falling fees for reconstructive surgery and increasing competition for cosmetic surgery. This study examined these notions using the best available data. To gain a better understanding of the current plastic surgery market, plastic surgeon incomes, fees, volume, and relative mix of cosmetic and reconstructive surgery were analyzed between the years 1992 and 2002. To gain a broader perspective, plastic surgeon income trends were then compared with those of other medical specialties and of nonmedical professions. The data show that in real dollars, plastic surgeon incomes have remained essentially steady in recent years, despite plastic surgeons increasing their surgery load by an average of 41 percent over the past 10 years. The overall income trend is similar to that of members of other medical specialties and other nonmedical professionals. The average practice percentage of cosmetic surgery was calculated and found to have increased from 27 percent in 1992 to 58 percent in 2002. This most likely can be explained by the findings that real dollar fees collected for cosmetic surgery have decreased very slightly, whereas those for reconstructive procedures have experienced sharp declines. This study demonstrates that plastic surgeons have adjusted their practice profiles in recent years. They have increased their case loads and shifted their practices toward cosmetic surgery, most likely with the goal of maintaining their incomes. The strategy appears to have been successful in the short term. However, with increasing competition and falling prices for cosmetic surgery, it may represent a temporary bulwark for plastic surgeon incomes unless other steps are taken.

  2. Replacement energy costs for nuclear electricity-generating units in the United States: 1997--2001. Volume 4

    International Nuclear Information System (INIS)

    VanKuiken, J.C.; Guziel, K.A.; Tompkins, M.M.; Buehring, W.A.

    1997-09-01

    This report updates previous estimates of replacement energy costs for potential short-term shutdowns of 109 US nuclear electricity-generating units. This information was developed to assist the US Nuclear Regulatory Commission (NRC) in its regulatory impact analyses, specifically those that examine the impacts of proposed regulations requiring retrofitting of or safety modifications to nuclear reactors. Such actions might necessitate shutdowns of nuclear power plants while these changes are being implemented. The change in energy cost represents one factor that the NRC must consider when deciding to require a particular modification. Cost estimates were derived from probabilistic production cost simulations of pooled utility system operations. Factors affecting replacement energy costs, such as random unit failures, maintenance and refueling requirements, and load variations, are treated in the analysis. This report describes an abbreviated analytical approach as it was adopted to update the cost estimates published in NUREG/CR-4012, Vol. 3. The updates were made to extend the time frame of cost estimates and to account for recent changes in utility system conditions, such as change in fuel prices, construction and retirement schedules, and system demand projects

  3. Acid-base and electrolyte status during normovolemic hemodilution with succinylated gelatin or HES-containing volume replacement solutions in rats.

    Directory of Open Access Journals (Sweden)

    Johanna K Teloh

    Full Text Available BACKGROUND: In the past, several studies have compared different colloidal replacement solutions, whereby the focus was usually on the respective colloid. We therefore systematically studied the influence of the carrier solution's composition of five approved colloidal volume replacement solutions (Gelafundin, Gelafusal, Geloplasma, Voluven and Volulyte on acid-base as well as electrolyte status during and following acute severe normovolemic hemodilution. The solutions differed in the colloid used (succinylated gelatin vs. HES and in the presence and concentration of metabolizable anions as well as in their electrolyte composition. METHODS: Anesthetized Wistar rats were subjected to a stepwise normovolemic hemodilution with one of the solutions until a final hematocrit of 10%. Subsequent to dilution (162 min, animals were observed for an additional period (150 min. During dilution and observation time blood gas analyses were performed eight times in total. Additionally, in the Voluven and Volulyte groups as well as in 6 Gelafundin animals, electrolyte concentrations, glucose, pH and succinylated gelatin were measured in urine and histopathological evaluation of the kidney was performed. RESULTS: All animals survived without any indications of injury. Although the employed solutions differed in their respective composition, comparable results in all plasma acid-base and electrolyte parameters studied were obtained. Plasma pH increased from approximately 7.28 to 7.39, the plasma K(+ concentration decreased from circa 5.20 mM to 4.80-3.90 mM and the plasma Cl(- concentration rose from approximately 105 mM to 111-120 mM. Urinary analysis revealed increased excretion of K(+, H(+ and Cl(-. CONCLUSIONS: The present data suggest that the carrier solution's composition with regard to metabolizable anions as well as K(+, Ca(2+ only has a minor impact on acid-base and electrolyte status after application of succinylated gelatin or HES-containing colloidal

  4. Department of Defense Financial Management Regulation. Volume 13. Nonappropriated Funds Policy and Procedures

    National Research Council Canada - National Science Library

    1994-01-01

    .... In addition, it directs statutory and regulatory financial reporting requirements. This Volume prescribes standard accounting principles and practices for all DoD nonappropriated fund instrumentalities (NAFIs...

  5. Thalamic volume deficit contributes to procedural and explicit memory impairment in HIV infection with primary alcoholism comorbidity.

    Science.gov (United States)

    Fama, Rosemary; Rosenbloom, Margaret J; Sassoon, Stephanie A; Rohlfing, Torsten; Pfefferbaum, Adolf; Sullivan, Edith V

    2014-12-01

    Component cognitive and motor processes contributing to diminished visuomotor procedural learning in HIV infection with comorbid chronic alcoholism (HIV+ALC) include problems with attention and explicit memory processes. The neural correlates associated with this constellation of cognitive and motor processes in HIV infection and alcoholism have yet to be delineated. Frontostriatal regions are affected in HIV infection, frontothalamocerebellar regions are affected in chronic alcoholism, and frontolimbic regions are likely affected in both; all three of these systems have the potential of contributing to both visuomotor procedural learning and explicit memory processes. Here, we examined the neural correlates of implicit memory, explicit memory, attention, and motor tests in 26 HIV+ALC (5 with comorbidity for nonalcohol drug abuse/dependence) and 19 age-range matched healthy control men. Parcellated brain volumes, including cortical, subcortical, and allocortical regions, as well as cortical sulci and ventricles, were derived using the SRI24 brain atlas. Results indicated that smaller thalamic volumes were associated with poorer performance on tests of explicit (immediate and delayed) and implicit (visuomotor procedural) memory in HIV+ALC. By contrast, smaller hippocampal volumes were associated with lower scores on explicit, but not implicit memory. Multiple regression analyses revealed that volumes of both the thalamus and the hippocampus were each unique independent predictors of explicit memory scores. This study provides evidence of a dissociation between implicit and explicit memory tasks in HIV+ALC, with selective relationships observed between hippocampal volume and explicit but not implicit memory, and highlights the relevance of the thalamus to mnemonic processes.

  6. Thalamic Volume Deficit Contributes to Procedural and Explicit Memory Impairment in HIV Infection with Primary Alcoholism Comorbidity

    Science.gov (United States)

    Fama, Rosemary; Rosenbloom, Margaret J.; Sassoon, Stephanie A.; Rohlfing, Torsten; Pfefferbaum, Adolf; Sullivan, Edith V.

    2014-01-01

    Component cognitive and motor processes contributing to diminished visuomotor procedural learning in HIV infection with comorbid chronic alcoholism (HIV+ALC) include problems with attention and explicit memory processes. The neural correlates associated with this constellation of cognitive and motor processes in HIV infection and alcoholism have yet to be delineated. Frontostriatal regions are affected in HIV infection, frontothalamocerebellar regions are affected in chronic alcoholism, and frontolimbic regions are likely affected in both; all three of these systems have the potential of contributing to both visuomotor procedural learning and explicit memory processes. Here, we examined the neural correlates of implicit memory, explicit memory, attention, and motor tests in 26 HIV+ALC (5 with comorbidity for nonalcohol drug abuse/dependence) and 19 age-range matched healthy control men. Parcellated brain volumes, including cortical, subcortical, and allocortical regions, as well as cortical sulci and ventricles, were derived using the SRI24 brain atlas. Results indicated that smaller thalamic volumes were associated with poorer performance on tests of explicit (immediate and delayed) and implicit (visuomotor procedural) memory in HIV+ALC. By contrast, smaller hippocampal volumes were associated with lower scores on explicit, but not implicit memory. Multiple regression analyses revealed that volumes of both the thalamus and the hippocampus were each unique independent predictors of explicit memory scores. This study provides evidence of a dissociation between implicit and explicit memory tasks in HIV+ALC, with selective relationships observed between hippocampal volume and explicit but not implicit memory, and highlights the relevance of the thalamus to mnemonic processes. PMID:24421067

  7. Automated and Semiautomated Segmentation of Rectal Tumor Volumes on Diffusion-Weighted MRI: Can It Replace Manual Volumetry?

    International Nuclear Information System (INIS)

    Heeswijk, Miriam M. van; Lambregts, Doenja M.J.; Griethuysen, Joost J.M. van; Oei, Stanley; Rao, Sheng-Xiang; Graaff, Carla A.M. de; Vliegen, Roy F.A.; Beets, Geerard L.; Papanikolaou, Nikos; Beets-Tan, Regina G.H.

    2016-01-01

    Purpose: Diffusion-weighted imaging (DWI) tumor volumetry is promising for rectal cancer response assessment, but an important drawback is that manual per-slice tumor delineation can be highly time consuming. This study investigated whether manual DWI-volumetry can be reproduced using a (semi)automated segmentation approach. Methods and Materials: Seventy-nine patients underwent magnetic resonance imaging (MRI) that included DWI (highest b value [b1000 or b1100]) before and after chemoradiation therapy (CRT). Tumor volumes were assessed on b1000 (or b1100) DWI before and after CRT by means of (1) automated segmentation (by 2 inexperienced readers), (2) semiautomated segmentation (manual adjustment of the volumes obtained by method 1 by 2 radiologists), and (3) manual segmentation (by 2 radiologists); this last assessment served as the reference standard. Intraclass correlation coefficients (ICC) and Dice similarity indices (DSI) were calculated to evaluate agreement between different methods and observers. Measurement times (from a radiologist's perspective) were recorded for each method. Results: Tumor volumes were not significantly different among the 3 methods, either before or after CRT (P=.08 to .92). ICCs compared to manual segmentation were 0.80 to 0.91 and 0.53 to 0.66 before and after CRT, respectively, for the automated segmentation and 0.91 to 0.97 and 0.61 to 0.75, respectively, for the semiautomated method. Interobserver agreement (ICC) pre and post CRT was 0.82 and 0.59 for automated segmentation, 0.91 and 0.73 for semiautomated segmentation, and 0.91 and 0.75 for manual segmentation, respectively. Mean DSI between the automated and semiautomated method were 0.83 and 0.58 pre-CRT and post-CRT, respectively; DSI between the automated and manual segmentation were 0.68 and 0.42 and 0.70 and 0.41 between the semiautomated and manual segmentation, respectively. Median measurement time for the radiologists was 0 seconds (pre- and post-CRT) for the

  8. Automated and Semiautomated Segmentation of Rectal Tumor Volumes on Diffusion-Weighted MRI: Can It Replace Manual Volumetry?

    Energy Technology Data Exchange (ETDEWEB)

    Heeswijk, Miriam M. van [Department of Radiology, Maastricht University Medical Centre, Maastricht (Netherlands); Department of Surgery, Maastricht University Medical Centre, Maastricht (Netherlands); Lambregts, Doenja M.J., E-mail: d.lambregts@nki.nl [Department of Radiology, Maastricht University Medical Centre, Maastricht (Netherlands); Department of Radiology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Griethuysen, Joost J.M. van [GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht (Netherlands); Department of Radiology, The Netherlands Cancer Institute, Amsterdam (Netherlands); Oei, Stanley [Department of Radiology, Maastricht University Medical Centre, Maastricht (Netherlands); Rao, Sheng-Xiang [Department of Radiology, Maastricht University Medical Centre, Maastricht (Netherlands); Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai (China); Graaff, Carla A.M. de [Department of Radiology, Maastricht University Medical Centre, Maastricht (Netherlands); Vliegen, Roy F.A. [Atrium Medical Centre Parkstad/Zuyderland Medical Centre, Heerlen (Netherlands); Beets, Geerard L. [GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht (Netherlands); Department of Surgery, The Netherlands Cancer Institute, Amsterdam (Netherlands); Papanikolaou, Nikos [Laboratory of Computational Medicine, Institute of Computer Science, FORTH, Heraklion, Crete (Greece); Beets-Tan, Regina G.H. [GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht (Netherlands); Department of Radiology, The Netherlands Cancer Institute, Amsterdam (Netherlands)

    2016-03-15

    Purpose: Diffusion-weighted imaging (DWI) tumor volumetry is promising for rectal cancer response assessment, but an important drawback is that manual per-slice tumor delineation can be highly time consuming. This study investigated whether manual DWI-volumetry can be reproduced using a (semi)automated segmentation approach. Methods and Materials: Seventy-nine patients underwent magnetic resonance imaging (MRI) that included DWI (highest b value [b1000 or b1100]) before and after chemoradiation therapy (CRT). Tumor volumes were assessed on b1000 (or b1100) DWI before and after CRT by means of (1) automated segmentation (by 2 inexperienced readers), (2) semiautomated segmentation (manual adjustment of the volumes obtained by method 1 by 2 radiologists), and (3) manual segmentation (by 2 radiologists); this last assessment served as the reference standard. Intraclass correlation coefficients (ICC) and Dice similarity indices (DSI) were calculated to evaluate agreement between different methods and observers. Measurement times (from a radiologist's perspective) were recorded for each method. Results: Tumor volumes were not significantly different among the 3 methods, either before or after CRT (P=.08 to .92). ICCs compared to manual segmentation were 0.80 to 0.91 and 0.53 to 0.66 before and after CRT, respectively, for the automated segmentation and 0.91 to 0.97 and 0.61 to 0.75, respectively, for the semiautomated method. Interobserver agreement (ICC) pre and post CRT was 0.82 and 0.59 for automated segmentation, 0.91 and 0.73 for semiautomated segmentation, and 0.91 and 0.75 for manual segmentation, respectively. Mean DSI between the automated and semiautomated method were 0.83 and 0.58 pre-CRT and post-CRT, respectively; DSI between the automated and manual segmentation were 0.68 and 0.42 and 0.70 and 0.41 between the semiautomated and manual segmentation, respectively. Median measurement time for the radiologists was 0 seconds (pre- and post-CRT) for the

  9. Automated and Semiautomated Segmentation of Rectal Tumor Volumes on Diffusion-Weighted MRI: Can It Replace Manual Volumetry?

    Science.gov (United States)

    van Heeswijk, Miriam M; Lambregts, Doenja M J; van Griethuysen, Joost J M; Oei, Stanley; Rao, Sheng-Xiang; de Graaff, Carla A M; Vliegen, Roy F A; Beets, Geerard L; Papanikolaou, Nikos; Beets-Tan, Regina G H

    2016-03-15

    Diffusion-weighted imaging (DWI) tumor volumetry is promising for rectal cancer response assessment, but an important drawback is that manual per-slice tumor delineation can be highly time consuming. This study investigated whether manual DWI-volumetry can be reproduced using a (semi)automated segmentation approach. Seventy-nine patients underwent magnetic resonance imaging (MRI) that included DWI (highest b value [b1000 or b1100]) before and after chemoradiation therapy (CRT). Tumor volumes were assessed on b1000 (or b1100) DWI before and after CRT by means of (1) automated segmentation (by 2 inexperienced readers), (2) semiautomated segmentation (manual adjustment of the volumes obtained by method 1 by 2 radiologists), and (3) manual segmentation (by 2 radiologists); this last assessment served as the reference standard. Intraclass correlation coefficients (ICC) and Dice similarity indices (DSI) were calculated to evaluate agreement between different methods and observers. Measurement times (from a radiologist's perspective) were recorded for each method. Tumor volumes were not significantly different among the 3 methods, either before or after CRT (P=.08 to .92). ICCs compared to manual segmentation were 0.80 to 0.91 and 0.53 to 0.66 before and after CRT, respectively, for the automated segmentation and 0.91 to 0.97 and 0.61 to 0.75, respectively, for the semiautomated method. Interobserver agreement (ICC) pre and post CRT was 0.82 and 0.59 for automated segmentation, 0.91 and 0.73 for semiautomated segmentation, and 0.91 and 0.75 for manual segmentation, respectively. Mean DSI between the automated and semiautomated method were 0.83 and 0.58 pre-CRT and post-CRT, respectively; DSI between the automated and manual segmentation were 0.68 and 0.42 and 0.70 and 0.41 between the semiautomated and manual segmentation, respectively. Median measurement time for the radiologists was 0 seconds (pre- and post-CRT) for the automated method, 41 to 69 seconds (pre-CRT) and

  10. High procedure volume is strongly associated with improved survival after lung cancer surgery

    DEFF Research Database (Denmark)

    Lüchtenborg, Margreet; Riaz, Sharma P; Coupland, Victoria H

    2013-01-01

    Studies have reported an association between hospital volume and survival for non-small-cell lung cancer (NSCLC). We explored this association in England, accounting for case mix and propensity to resect....

  11. High-volume natural volcanic pozzolan and limestone powder as partial replacements for portland cement in self-compacting and sustainable concrete

    KAUST Repository

    Celik, Kemal; Jackson, Marie D.; Mancio, Mauricio; Meral, Cagla; Emwas, Abdul-Hamid M.; Mehta, P. Kumar; Monteiro, Paulo José Meleragno

    2014-01-01

    A laboratory study demonstrates that high volume, 45% by mass replacement of portland cement (OPC) with 30% finely-ground basaltic ash from Saudi Arabia (NP) and 15% limestone powder (LS) produces concrete with good workability, high 28-day compressive strength (39 MPa), excellent one year strength (57 MPa), and very high resistance to chloride penetration. Conventional OPC is produced by intergrinding 95% portland clinker and 5% gypsum, and its clinker factor (CF) thus equals 0.95. With 30% NP and 15% LS portland clinker replacement, the CF of the blended ternary PC equals 0.52 so that 48% CO2 emissions could be avoided, while enhancing strength development and durability in the resulting self-compacting concrete (SCC). Petrographic and scanning electron microscopy (SEM) investigations of the crushed NP and finely-ground NP in the concretes provide new insights into the heterogeneous fine-scale cementitious hydration products associated with basaltic ash-portland cement reactions. © 2013 Published by Elsevier Ltd.

  12. Ankle replacement

    Science.gov (United States)

    Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery ... Ankle replacement surgery is most often done while you are under general anesthesia. This means you will ...

  13. 40 CFR 86.1838-01 - Small volume manufacturer certification procedures.

    Science.gov (United States)

    2010-07-01

    ...-Duty Vehicles, Light-Duty Trucks, and Complete Otto-Cycle Heavy-Duty Vehicles § 86.1838-01 Small volume... companies; (iv) Vehicles and/or engines imported or distributed by all firms where the vehicles and/or...-use verification testing to have a minimum odometer mileage of 75 percent of the full useful life...

  14. CONTROL PROCEDURES OF VOLUME OF ESTIMATED AND HARVESTED WOOD IN A PLANTATION OF Pinus spp. IN PARANÁ STATE

    Directory of Open Access Journals (Sweden)

    Silvane Vatraz

    2014-06-01

    Full Text Available http://dx.doi.org/10.5902/1980509814585The objective of this research was to improve the operating procedures of control of the volume of timber estimated by the forest inventory and the effectively harvested volume in order to reduce inconsistencies in the forest planning practiced in a forestry plantation of Pinus spp. in Paraná state. Accordingly, we used the tools of quality: storming and PDCA Cycle through an exploratory research project to study together. The study showed an inconsistency initial volume – 24,73% of the volume estimated by the inventory and the effectively harvested wood. This inconsistency was composed of operational failures in the activities of Forest Inventory (+13,84%, Forest Harvesting (+15,62% and Expedition Wood (-3,08%. The application of quality tools helped in the identification of inconsistency, as well as the revelation of operational failures, which suggested some routine monitoring and checking each of the activities involved in managing operational forestry.  

  15. Procedures for treating common cause failures in safety and reliability studies: Volume 2, Analytic background and techniques: Final report

    International Nuclear Information System (INIS)

    Mosleh, A.; Fleming, K.N.; Parry, G.W.; Paula, H.M.; Worledge, D.H.; Rasmuson, D.M.

    1988-12-01

    This report presents a framework for the inclusion of the impact of common cause failures in risk and reliability evaluations. Common cause failures are defined as that subset of dependent failures for which causes are not explicitly included in the logic model as basic events. The emphasis here is on providing procedures for a practical, systematic approach that can be used to perform and clearly document the analysis. The framework and the methods discussed for performing the different stages of the analysis integrate insights obtained from engineering assessments of the system and the historical evidence from multiple failure events into a systematic, reproducible, and defensible analysis. This document, Volume 2, contains a series of appendices that provide additional background and methodological detail on several important topics discussed in Volume 1

  16. The procedures manual of the Environmental Measurements Laboratory. Volume 1, 28. edition

    Energy Technology Data Exchange (ETDEWEB)

    Chieco, N.A. [ed.

    1997-02-01

    This manual covers procedures and technology currently in use at the Environmental Measurements Laboratory. An attempt is made to be sure that all work carried out will be of the highest quality. Attention is focused on the following areas: quality assurance; sampling; radiation measurements; analytical chemistry; radionuclide data; special facilities; and specifications.

  17. The procedures manual of the Environmental Measurements Laboratory. Volume 1, 28. edition

    International Nuclear Information System (INIS)

    Chieco, N.A.

    1997-02-01

    This manual covers procedures and technology currently in use at the Environmental Measurements Laboratory. An attempt is made to be sure that all work carried out will be of the highest quality. Attention is focused on the following areas: quality assurance; sampling; radiation measurements; analytical chemistry; radionuclide data; special facilities; and specifications

  18. The procedures manual of the Environmental Measurements Laboratory. Volume 2, 28. edition

    Energy Technology Data Exchange (ETDEWEB)

    Chieco, N.A. [ed.

    1997-02-01

    This report contains environmental sampling and analytical chemistry procedures that are performed by the Environmental Measurements Laboratory. The purpose of environmental sampling and analysis is to obtain data that describe a particular site at a specific point in time from which an evaluation can be made as a basis for possible action.

  19. Enzyme Replacement Therapy and/or Hematopoietic Stem Cell Transplantation at diagnosis in patients with Mucopolysaccharidosis type I: results of a European consensus procedure

    LENUS (Irish Health Repository)

    de Ru, Minke H

    2011-08-10

    Abstract Background Mucopolysaccharidosis type I (MPS I) is a lysosomal storage disorder that results in the accumulation of glycosaminoglycans causing progressive multi-organ dysfunction. Its clinical spectrum is very broad and varies from the severe Hurler phenotype (MPS I-H) which is characterized by early and progressive central nervous system (CNS) involvement to the attenuated Scheie phenotype (MPS I-S) with no CNS involvement. Indication, optimal timing, safety and efficacy of the two available treatment options for MPS I, enzyme replacement therapy (ERT) and hematopoietic stem cell transplantation (HSCT), are subject to continuing debate. A European consensus procedure was organized to reach consensus about the use of these two treatment strategies. Methods A panel of specialists, including 8 specialists for metabolic disorders and 7 bone marrow transplant physicians, all with acknowledged expertise in MPS I, participated in a modified Delphi process to develop consensus-based statements on MPS I treatment. Fifteen MPS I case histories were used to initiate the discussion and to anchor decisions around either treatment mode. Before and at the meeting all experts gave their opinion on the cases (YES\\/NO transplantation) and reasons for their decisions were collected. A set of draft statements on MPS I treatment options composed by a planning committee were discussed and revised during the meeting until full consensus. Results Full consensus was reached on several important issues, including the following: 1) The preferred treatment for patients with MPS I-H diagnosed before age 2.5 yrs is HSCT; 2) In individual patients with an intermediate phenotype HSCT may be considered if there is a suitable donor. However, there are no data on efficacy of HSCT in patients with this phenotype; 3) All MPS I patients including those who have not been transplanted or whose graft has failed may benefit significantly from ERT; 4) ERT should be started at diagnosis and may be

  20. Recommended procedures for performance testing of radiobioassay laboratories: Volume 2, In vitro samples

    International Nuclear Information System (INIS)

    Fenrick, H.W.; MacLellan, J.A.

    1988-11-01

    Draft American National Standards Institute (ANSI) Standard N13.30 (Performance Criteria for Radiobioassay) was developed for the US Department of Energy and the US Nuclear Regulatory Commission to help ensure that bioassay laboratories provide accurate and consistent results. The draft standard specifies the criteria for defining the procedures necessary to establish a bioassay performance-testing laboratory and program. The bioassay testing laboratory will conduct tests to evaluate the performance of service laboratories. Pacific Northwest Laboratory helped develop testing procedures as part of an effort to evaluate the performance criteria by testing the existing measurement capabilities of various bioassay laboratories. This report recommends guidelines for the preparation, handling, storage, distribution, shipping, and documentation of in vitro test samples (artificial urine and fecal matter) for indirect bioassay. The data base and recommended records system for documenting radiobioassay performance at the service laboratories are also presented. 8 refs., 3 tabs

  1. Recommended procedures for performance testing of radiobioassay laboratories: Volume 3, In vivo test phantoms

    International Nuclear Information System (INIS)

    MacLellan, J.A.; Traub, R.J.

    1988-11-01

    Draft American National Standards Institute (ANSI) Standard N13.30 (Performance Criteria for Radiobioassay) was developed for the US Department of Energy and the US Nuclear Regulatory Commission to help ensure that bioassay laboratories provide accurate and consistent results. The draft standard describes the procedures necessary to establish a bioassay performance-testing laboratory and program. The bioassay performance-testing laboratory will conduct tests to evaluate the performance of service laboratories. Pacific Northwest Laboratory helped develop testing procedures as part of an effort to evaluate the draft ANSI N13.30 performance criteria by testing the existing measurement capabilities of various bioassay laboratories. This report recommends guidelines for the preparation, handling, storage, distribution, shipping, and documentation of test phantoms used for calibration of measurement systems for direct bioassay. The data base and recommended records system for documenting radiobioassay performance at the service laboratories are also presented

  2. Library Operations Policies and Procedures, Volume 2. Central Archive for Reusable Defense Software (CARDS)

    Science.gov (United States)

    1994-02-28

    use and customize those policies and procedures applicable to the implementor’s situation. It is not the intent of this manual to restrict the library...improvements. Pare 10 ka•- V •DkI U Release Manager The Release Manager provides franchisees with media copies of existing libraries, as needed. Security...implementors, and potential library franchisees . Security Team The Security Team assists the Security Officer with security analysis. Team members are

  3. Technical procedures for water resources, Deaf Smith County site, Texas: Volume 2: Environmental Field Program: Final draft

    International Nuclear Information System (INIS)

    1987-08-01

    This volume contains the following Technical Procedures pursuant to the Water Resources Site Study Plan operation of a Playa Lake conductivity monitoring station and processing of data from a Playa Lake conductivity monitoring station. This procedure defines steps and methods for the installation, operation, and maintenance of the Playa Lake conductivity monitoring stations. Conductivity measurements will be taken at six playa lakes in the site study area to record changes in total dissolved solids as a function of stage. Playa lake conductivity and stage (volume) measurements will be used, in conjunction with other water quality data collected at the Playa Lake and precipitation stations, to determine the mass of dissolved solids entering and leaving the playas. This baseline information on the pollutant mass balance of the playas will be used to assess potential changes in playa lake water quality and the magnitude of those changes due to site development. The pollutant mass balances will also be used on determining the source of pollutants. 2 refs., 5 figs

  4. Development of SRC-I product analysis. Volume 3. Documentation of procedures

    Energy Technology Data Exchange (ETDEWEB)

    Schweighardt, F.K.; Kingsley, I.S.; Cooper, F.E.; Kamzelski, A.Z.; Parees, D.M.

    1983-09-01

    This section documents the BASIC computer program written to simulate Wilsonville's GC-simulated distillation (GCSD) results at APCI-CRSD Trexlertown. The GC conditions used at APCI for the Wilsonville GCSD analysis of coal-derived liquid samples were described in the SRC-I Quarterly Technical Report, April-June 1981. The approach used to simulate the Wilsonville GCSD results is also from an SRC-I Quarterly Technical Report and is reproduced in Appendix VII-A. The BASIC computer program is described in the attached Appendix VII-B. Analysis of gases produced during coal liquefaction generates key information needed to determine product yields for material balance and process control. Gas samples from the coal process development unit (CPDU) and tubing bombs are the primary samples analyzed. A Carle gas chromatographic system was used to analyze coal liquefaction gas samples. A BASIC computer program was written to calculate the gas chromatographic peak area results into mole percent results. ICRC has employed several analytical workup procedures to determine the amount of distillate, oils, asphaltenes, preasphaltenes, and residue in SRC-I process streams. The ASE procedure was developed using Conoco's liquid column fractionation (LC/F) method as a model. In developing the ASE procedure, ICRC was able to eliminate distillation, and therefore quantify the oils fraction in one extraction step. ASE results were shown to be reproducible within +- 2 wt %, and to yield acceptable material balances. Finally, the ASE method proved to be the least affected by sample composition.

  5. Knee Replacement

    Science.gov (United States)

    Knee replacement is surgery for people with severe knee damage. Knee replacement can relieve pain and allow you to ... Your doctor may recommend it if you have knee pain and medicine and other treatments are not ...

  6. Human factors evaluation of teletherapy: Human-system interfaces and procedures. Volume 3

    International Nuclear Information System (INIS)

    Kaye, R.D.; Henriksen, K.; Jones, R.; Morisseau, D.S.; Serig, D.I.

    1995-07-01

    A series of human factors evaluations was undertaken to better understand the contributing factors to human error in the teletherapy environment. Teletherapy is a multidisciplinary methodology for treating cancerous tissue through selective exposure to an external beam of ionizing radiation. The principal sources of radiation are a radioactive isotope, typically cobalt60 (Co-60), or a linear accelerator device capable of producing very high energy x-ray and electron beams. A team of human factors specialists conducted site visits to radiation oncology departments at community hospitals, university centers, and free-standing clinics. In addition, a panel of radiation oncologists, medical physicists, and radiation technologists served as subject matter experts. A function and task analysis was initially performed to guide subsequent evaluations in the areas of user-system interfaces, procedures, training and qualifications, and organizational policies and practices. The present report focuses on an evaluation of the human-system interfaces in relation to the treatment machines and supporting equipment (e.g., simulators, treatment planning computers, control consoles, patient charts) found in the teletherapy environment. The report also evaluates operating, maintenance and emergency procedures and practices involved in teletherapy. The evaluations are based on the function and task analysis and established human engineering guidelines, where applicable

  7. Recommended procedures for performance testing of radiobioassay laboratories: Volume 1, Quality assurance

    International Nuclear Information System (INIS)

    Fenrick, H.W.; MacLellan, J.A.

    1988-11-01

    Draft American National Standards Institute (ANSI) Standard N13.30 (Performance Criteria for Radiobioassay) was developed in response to a concern expressed by the US Department of Energy and US Nuclear Regulatory Commission to help ensure that bioassay laboratories provide accurate and consistent results. The draft standard specifies the criteria for defining the procedures necessary to establish a bioassay performance-testing laboratory and program. The testing laboratory will conduct tests to evaluate the performance of service laboratories. Pacific Northwest Laboratory helped define responsibilities and develop procedures as part of an effort to evaluate the draft ANSI N13.30 performance criteria for quality assurance at bioassay laboratories. This report recommends elements of quality assurance and quality control responsibilities for the bioassay performance-testing laboratory program, including the qualification and performance of personnel and the calibration, certification, and performance of equipment. The data base and recommended records system for documenting radiobioassay performance at the service laboratories are also presented. 15 refs

  8. Human factors evaluation of teletherapy: Human-system interfaces and procedures. Volume 3

    Energy Technology Data Exchange (ETDEWEB)

    Kaye, R.D.; Henriksen, K.; Jones, R. [Hughes Training, Inc., Falls Church, VA (United States); Morisseau, D.S.; Serig, D.I. [Nuclear Regulatory Commission, Washington, DC (United States). Div. of Systems Technology

    1995-07-01

    A series of human factors evaluations was undertaken to better understand the contributing factors to human error in the teletherapy environment. Teletherapy is a multidisciplinary methodology for treating cancerous tissue through selective exposure to an external beam of ionizing radiation. The principal sources of radiation are a radioactive isotope, typically cobalt60 (Co-60), or a linear accelerator device capable of producing very high energy x-ray and electron beams. A team of human factors specialists conducted site visits to radiation oncology departments at community hospitals, university centers, and free-standing clinics. In addition, a panel of radiation oncologists, medical physicists, and radiation technologists served as subject matter experts. A function and task analysis was initially performed to guide subsequent evaluations in the areas of user-system interfaces, procedures, training and qualifications, and organizational policies and practices. The present report focuses on an evaluation of the human-system interfaces in relation to the treatment machines and supporting equipment (e.g., simulators, treatment planning computers, control consoles, patient charts) found in the teletherapy environment. The report also evaluates operating, maintenance and emergency procedures and practices involved in teletherapy. The evaluations are based on the function and task analysis and established human engineering guidelines, where applicable.

  9. Utility of Volume Assessment Using Bioelectrical Impedance Analysis in Critically Ill Patients Receiving Continuous Renal Replacement Therapy: A Prospective Observational Study

    Directory of Open Access Journals (Sweden)

    Ki Hyun Park

    2017-08-01

    Full Text Available Background Fluid overload prior to continuous renal replacement therapy (CRRT is an important prognostic factor. Thus, precise evaluation of fluid status is necessary to treat such patients. In this study, we investigated whether fluid assessment using bioelectrical impedance analysis (BIA can predict outcomes in critically ill patients requiring CRRT. Methods A prospective observational study was performed in patients who were admitted to the intensive care unit and who required CRRT. BIA was conducted before CRRT; then, the ratio of extracellular water to total body water (ECW/TBW was derived to estimate volume status. Results A total of 31 patients treated with CRRT were included. There were 18 men (58.1%, and the median age was 67 years (interquartile range, 51 to 78 years. Fourteen patients (45.2% died within 28 days after CRRT initiation. Patients were divided into 16 with ECW/TBW ≥0.41 and 15 with ECW/TBW <0.41. Survival rate within 28 days was different between the two groups (P = 0.044. Cox regression analysis revealed a relationship between ECW/TBW ≥0.41 and 28-day mortality, but it was not statistically significant (hazard ratio, 3.0; 95% confidence interval, 0.9 to 9.8; P = 0.061. Lastly, the area under the curve of ECW/TBW for 28-day mortality was analyzed. The area under the curve of ECW/TBW was 0.73 (95% confidence interval, 0.54 to 0.92, and this was significant (P = 0.037. Conclusions Fluid status can be assessed using BIA in critically ill patients requiring CRRT, and BIA can predict mortality. Further large trials are needed to confirm the usefulness of BIA in critically ill patients.

  10. [Falling Short of Minimum Volume Standards, Exemptions and Their Consequences from 2018 Onwards. Complex Procedures on Oesophagus and Pancreas in German Hospitals from 2006 to 2014].

    Science.gov (United States)

    de Cruppé, Werner; Geraedts, Max

    2018-03-16

    The minimum volume standards for hospitals in Germany, in force since 2004, provide four exemptions for non-complying hospitals. This study investigates the extent and importance of these exemptions for complex procedures on the oesophagus and pancreas for all non-complying hospitals and for the revised minimum volume regulations in force since the beginning of 2018. Longitudinal, descriptive analyses of data on minimum volume standards and their exemptions for complex procedures on the oesophagus and pancreas, as presented by the hospital quality report cards of the reporting years from 2006 to 2014. For each year and both procedures, about 120 hospitals with some 500 cases report non-compliance with the minimum volume standards. Of these a third report no exemptions (with 180 procedures), a third state emergencies (110), and another third report exemptions due to internal hospital restructuring (210). Ensuring geographical access to care as an exemption is of no importance. After the three year exemption period for installation of a new service line, 20% of the hospitals with procedures on the oesophagus and 30% on the pancreas complied with the minimum volume standards. After the two-year period for staff realignment, the figures were 40 and 50%, respectively. Exemptions do not entirely explain all procedures performed by hospitals not complying with the minimum volume standards. The revised minimum volume regulations' restructuring of exemptions to "emergencies" and "new or renewed service lines" with a two year exemption period, are concordant with the empirical findings of this study. Georg Thieme Verlag KG Stuttgart · New York.

  11. Volume Replacement Therapy during Hip Arthroplasty using Hydroxyethyl Starch (130/0.4 Compared to Lactated Ringer Decreases Allogeneic Blood Transfusion and Postoperative Infection

    Directory of Open Access Journals (Sweden)

    Adilson Hamaji

    2013-01-01

    Full Text Available Background and objectives: Hydroxyethyl starch (HES 130/0.4 is considered an effective plasma expander when compared to crystalloids. There is controversy around its superiority regarding hemodynamic optimization and about possible detrimental effects on coagulation. The aim of this study was to compare the effects of HES 130/0.4 to lactated Ringer solution during hip arthroplasty in adult patients under spinal anesthesia regarding intraoperative bleeding, hemodynamic parameters, coagulation profile, transfusion requirements and clinical outcomes. Methods: In this randomized, controlled trial, 48 patients scheduled for hip arthroplasty with spinal anesthesia were randomized into two groups: 24 patients were allocated to receive a preload of 15 mL.kg-1 of HES 130/0.4 and 24 patients received a preload of 30 mL.kg-1 lactated Ringer solution before surgery. Hemodynamic measurements, hemoglobin concentrations, biochemical parameters and coagulation tests were evaluated in three periods during surgical procedure. Patients received medical follow-up during their hospital stay and up to postoperative 30 days. Primary outcome was the requirement of red blood cell transfusion between groups during hospital stay. Secondary outcome were hemodynamic parameters, length of hospital stay, mortality and occurrence of clinical postoperative complications. Results: Red blood cell transfusion was required in 17% of patients in the HES group and in 46% in the Ringer group (p = .029. Postoperative infections were more frequently observed in the Ringer group (17% compared to the HES group (0, p = .037. There were no significant differences between groups in mortality, hospital length of stay and clinical complications other than infection. Conclusions: During hip arthroplasty, patients treated with hypervolemic hemodilution with hydroxyethyl starch 130/0.4 required less transfusion and presented lower infection rate compared to patients who received lactated

  12. Comparison of different application systems and CT- assisted treatment planning procedures in primary endometrium cancer: Is it technically possible to include the whole uterus volume in the volume treated by brachytherapy

    International Nuclear Information System (INIS)

    Mock, U.; Knocke, Th.; Fellner, C.; Poetter, R.

    1996-01-01

    Purpose: Brachytherapy is regarded as the definitive component of treatment for inoperable patients with endometrium cancer. In published series the whole uterus has been claimed to represent the target volume independently of the individual tumor spread. The purpose of this work is to compare different planning and application procedures and to analyze the target volumes (whole uterus), treatment volumes and their respective relation for the given various conditions. Material and Methods: In ten patients with primary endometrium cancer the correlation between target- and treatment volume was analysed based on standard one-channel applicators or individual Heyman applicators. A comparative analysis of target volumes resulting from two different planning procedures of Heyman applications was performed. CT was carried out after insertion of the Heyman ovoids. Target volume was estimated by measuring the uterus size at different cross sections of the CT images. Dose calculation was performed with (PLATO-system) or without (NPS-system) transferring these data directly to the planning system. We report on the differences in treatment volumes resulting from the two application and planning systems. Results: The mean value of the uterus volume was 180 ccm (range 57 ccm to 316 ccm). Four out of 10 patients had an asymmetric uterus configuration with a side-difference (in longitudinal or transversal direction) of more than 1 cm. On average 70% (range 48-95%) of the uterus volume was included by the treatment volume when Heymann applicators were used compared to 45 % (range 25-89%) when standard one channel applicators were used. This represents an improvement of 25% (range from 11%-35%). By utilizing the more sophisticated way of treatment planning a more adequate coverage of the uterus volume was achieved in five out of ten patients. The treated volume increased on the average by 20 % (range 11 %-32%). In three cases changes in the irradiation volume were less than 5%. In

  13. Prospective observational study for perioperative volume replacement with 6% HES 130/0,42, 4% gelatin and 6% HES 200/0,5 in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Winterhalter M

    2010-09-01

    Full Text Available Abstract Background The constantly growing amount of different kinds of colloid fluids necessitates comparative investigations with regards to the safety and effectivity in clinical use of these preparations. Hence we compared three colloid fluids in an observational study. The objective was the exploration of the influence of these three colloids on blood coagulation, hemodynamics and renal function of the cardiac surgical patient. Methods We included 90 patients undergoing an elective open-heart surgery with the use of the heart-lung machine and observed them consecutively. Group 1 [gelatin 4% (n = 30], Group 2 [HES 200/0,5 (n = 30] and Group 3 [HES 130/0,42 (n = 30]. We measured the perioperative volume replacement, the administration of blood- and coagulation-products, the application of catecholamines, the renal function, blood gas and the platelet aggregation using multiplate electrode analyzer (Multiplate®, Dynabyte medical, Munich, Germany. Results The gelatin-group needed significantly more norepinephrine than the HES 130/0.42 group. The responsible surgeon considered the blood coagulation in the HES 200/0.5 group most frequently as impaired. Furthermore we saw a significant decrease in platelet function in the HES 200/0.5 group when performing the multiplate®-analysis (ADP-and COL-test. HES 130/0.4 as well as gelatin 4% showed no significant change in platelet function. The gelatin-group and the HES 200/0.5 needed significantly more aprotinine than the HES 130/0.4 group. We saw no significant difference with regards to administration of blood and coagulation products between the three groups. The urinary excretion during the intervention was significantly higher in the HES 200/0.5 group and in the gelatin group than in the HES 130/0.4 group. Conclusions Our results confirm the lower stabilizing effect of gelatin on circulation during fluid resuscitation. The blood coagulation was mostly impaired due to HES 200/0.5 confirmed by the

  14. Combined mitral valve replacement associated with the Bentall procedure, diaphragmatic hernia repair and reconstruction of the pectus excavatum in a 26-year-old patient with Marfan syndrome.

    Science.gov (United States)

    Stępiński, Piotr; Stankowski, Tomasz; Aboul-Hassan, Sleiman Sebastian; Szymańska, Anna; Marczak, Jakub; Cichoń, Romuald

    2016-06-01

    A 26-year-old man with Marfan syndrome was admitted as an emergency patient with ascending aorta aneurysm, severe mitral and aortic regurgitation, diaphragmatic hernia and pectus excavatum. After completion of diagnostics a combined surgical procedure was performed.

  15. Combined mitral valve replacement associated with the Bentall procedure, diaphragmatic hernia repair and reconstruction of the pectus excavatum in a 26-year-old patient with Marfan syndrome

    OpenAIRE

    St?pi?ski, Piotr; Stankowski, Tomasz; Aboul-Hassan, Sleiman Sebastian; Szyma?ska, Anna; Marczak, Jakub; Cicho?, Romuald

    2016-01-01

    A 26-year-old man with Marfan syndrome was admitted as an emergency patient with ascending aorta aneurysm, severe mitral and aortic regurgitation, diaphragmatic hernia and pectus excavatum. After completion of diagnostics a combined surgical procedure was performed.

  16. Replacing penalties

    Directory of Open Access Journals (Sweden)

    Vitaly Stepashin

    2017-01-01

    Full Text Available УДК 343.24The subject. The article deals with the problem of the use of "substitute" penalties.The purpose of the article is to identify criminal and legal criteria for: selecting the replacement punishment; proportionality replacement leave punishment to others (the formalization of replacement; actually increasing the punishment (worsening of legal situation of the convicted.Methodology.The author uses the method of analysis and synthesis, formal legal method.Results. Replacing the punishment more severe as a result of malicious evasion from serving accused designated penalty requires the optimization of the following areas: 1 the selection of a substitute punishment; 2 replacement of proportionality is serving a sentence other (formalization of replacement; 3 ensuring the actual toughening penalties (deterioration of the legal status of the convict. It is important that the first two requirements pro-vide savings of repression in the implementation of the replacement of one form of punishment to others.Replacement of punishment on their own do not have any specifics. However, it is necessary to compare them with the contents of the punishment, which the convict from serving maliciously evaded. First, substitute the punishment should assume a more significant range of restrictions and deprivation of certain rights of the convict. Second, the perfor-mance characteristics of order substitute the punishment should assume guarantee imple-mentation of the new measures.With regard to replacing all forms of punishment are set significant limitations in the application that, in some cases, eliminates the possibility of replacement of the sentence, from serving where there has been willful evasion, a stricter measure of state coercion. It is important in the context of the topic and the possibility of a sentence of imprisonment as a substitute punishment in cases where the original purpose of the strict measures excluded. It is noteworthy that the

  17. Using Time-Driven Activity-Based Costing as a Key Component of the Value Platform: A Pilot Analysis of Colonoscopy, Aortic Valve Replacement and Carpal Tunnel Release Procedures.

    Science.gov (United States)

    Martin, Jacob A; Mayhew, Christopher R; Morris, Amanda J; Bader, Angela M; Tsai, Mitchell H; Urman, Richard D

    2018-04-01

    Time-driven activity-based costing (TDABC) is a methodology that calculates the costs of healthcare resources consumed as a patient moves along a care process. Limited data exist on the application of TDABC from the perspective of an anesthesia provider. We describe the use of TDABC, a bottom-up costing strategy and financial outcomes for three different medical-surgical procedures. In each case, a multi-disciplinary team created process maps describing the care delivery cycle for a patient encounter using the TDABC methodology. Each step in a process map delineated an activity required for delivery of patient care. The resources (personnel, equipment and supplies) associated with each step were identified. A per minute cost for each resource expended was generated, known as the capacity cost rate, and multiplied by its time requirement. The total cost for an episode of care was obtained by adding the cost of each individual resource consumed as the patient moved along a clinical pathway. We built process maps for colonoscopy in the gastroenterology suite, calculated costs of an aortic valve replacement by comparing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR) techniques, and determined the cost of carpal tunnel release in an operating room versus an ambulatory procedure room. TDABC is central to the value-based healthcare platform. Application of TDABC provides a framework to identify process improvements for health care delivery. The first case demonstrates cost-savings and improved wait times by shifting some of the colonoscopies scheduled with an anesthesiologist from the main hospital to the ambulatory facility. In the second case, we show that the deployment of an aortic valve via the transcatheter route front loads the costs compared to traditional, surgical replacement. The last case demonstrates significant cost savings to the healthcare system associated with re-organization of staff required to execute a

  18. Using Time-Driven Activity-Based Costing as a Key Component of the Value Platform: A Pilot Analysis of Colonoscopy, Aortic Valve Replacement and Carpal Tunnel Release Procedures

    Science.gov (United States)

    Martin, Jacob A.; Mayhew, Christopher R.; Morris, Amanda J.; Bader, Angela M.; Tsai, Mitchell H.; Urman, Richard D.

    2018-01-01

    Background Time-driven activity-based costing (TDABC) is a methodology that calculates the costs of healthcare resources consumed as a patient moves along a care process. Limited data exist on the application of TDABC from the perspective of an anesthesia provider. We describe the use of TDABC, a bottom-up costing strategy and financial outcomes for three different medical-surgical procedures. Methods In each case, a multi-disciplinary team created process maps describing the care delivery cycle for a patient encounter using the TDABC methodology. Each step in a process map delineated an activity required for delivery of patient care. The resources (personnel, equipment and supplies) associated with each step were identified. A per minute cost for each resource expended was generated, known as the capacity cost rate, and multiplied by its time requirement. The total cost for an episode of care was obtained by adding the cost of each individual resource consumed as the patient moved along a clinical pathway. Results We built process maps for colonoscopy in the gastroenterology suite, calculated costs of an aortic valve replacement by comparing surgical aortic valve replacement (SAVR) versus transcatheter aortic valve replacement (TAVR) techniques, and determined the cost of carpal tunnel release in an operating room versus an ambulatory procedure room. Conclusions TDABC is central to the value-based healthcare platform. Application of TDABC provides a framework to identify process improvements for health care delivery. The first case demonstrates cost-savings and improved wait times by shifting some of the colonoscopies scheduled with an anesthesiologist from the main hospital to the ambulatory facility. In the second case, we show that the deployment of an aortic valve via the transcatheter route front loads the costs compared to traditional, surgical replacement. The last case demonstrates significant cost savings to the healthcare system associated with re

  19. Design of Training Systems, Phase II Report, Volume III; Model Program Descriptions and Operating Procedures. TAEG Report No. 12-2.

    Science.gov (United States)

    Naval Training Equipment Center, Orlando, FL. Training Analysis and Evaluation Group.

    The Design of Training Systems (DOTS) project was initiated by the Department of Defense (DOD) to develop tools for the effective management of military training organizations. Volume 3 contains the model and data base program descriptions and operating procedures designed for phase 2 of the project. Flow charts and program listings for the…

  20. Percutaneous closure of patent foramen ovale and atrial septal defect in adults: the impact of clinical variables and hospital procedure volume on in-hospital adverse events.

    Science.gov (United States)

    Opotowsky, Alexander R; Landzberg, Michael J; Kimmel, Stephen E; Webb, Gary D

    2009-05-01

    Percutaneous closure of patent foramen ovale/atrial septal defect (PFO/ASD) is an increasingly common procedure perceived as having minimal risk. There are no population-based estimates of in-hospital adverse event rates of percutaneous PFO/ASD closure. We used nationally representative data from the 2001-2005 Nationwide Inpatient Sample to identify patients >or-=20 years old admitted to an acute care hospital with an International Classification of Diseases, Ninth Revision code designating percutaneous PFO/ASD closure on the first or second hospital day. Variables analyzed included age, sex, number of comorbidities, year, same-day use of intracardiac or other echocardiography, same-day left heart catheterization, hospital size and teaching status, PFO/ASD procedural volume, and coronary intervention volume. Outcomes of interest included length of stay, charges, and adverse events. The study included 2,555 (weighted to United States population: 12,544 +/- 1,987) PFO/ASD closure procedures. Mean age was 52.0 +/- 0.4 years, and 57.3% +/- 1.0% were women. Annual hospital volume averaged 40.8 +/- 7.7 procedures (range, 1-114). Overall, 8.2 +/- 0.8% of admissions involved an adverse event. Older patients and those with comorbidities were more likely to sustain adverse events. Use of intracardiac echocardiography was associated with fewer adverse events. The risk of adverse events was inversely proportional to annual hospital volume (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.86-0.96, per 10 procedures), even after limiting the analysis to hospitals performing >or=10 procedures annually (OR 0.91, 95% CI 0.85-0.98). Adverse events were more frequent at hospitals in the lowest volume quintile as compared with the highest volume quintile (13.3% vs 5.4%, OR 2.42, 95% CI 1.55-3.78). The risk of adverse events of percutaneous PFO/ASD closure is inversely correlated with hospital volume. This relationship applies even to hospitals meeting the current guidelines

  1. The Impact of use of Double Set-up on Infection Rates in Revision Total Knee Replacement and Limb Salvage Procedures

    Directory of Open Access Journals (Sweden)

    Jennifer Waterman

    2015-03-01

    Full Text Available A retrospective analysis was performed to determine the impact of utilizing a double set-up procedure on reducing infection rates revision total knee and limb salvage procedures in patients with known joint infection.  Eighteen cases fit selection criteria.  The recurrence rate of infection was 5.5% which is less than reported recent literature review.   This suggests the use of a double set-up in combination with other infection reducing protocols may help further reduce recurrent infection.  Keywords: double set-up, infection, revision total knee arthroplasty, limb-salvage

  2. Association between hospital procedure volume and early complications after pacemaker implantation: results from a large, unselected, contemporary cohort of the German nationwide obligatory external quality assurance programme.

    Science.gov (United States)

    Nowak, Bernd; Tasche, Karl; Barnewold, Linda; Heller, Günther; Schmidt, Boris; Bordignon, Stefano; Chun, K R Julian; Fürnkranz, Alexander; Mehta, Rajendra H

    2015-05-01

    Several studies demonstrated an inverse relationship between cardioverter-defibrillator implantation volume and complication rates, suggesting better outcomes for higher volume centres. However, the association of institutional procedural volume with patient outcomes for permanent pacemaker (PPM) implantation remains less known, especially in decentralized implantation systems. We performed retrospective examination of data on patients undergoing PPM from the German obligatory quality assurance programme (2007-12) to evaluate the relationship of hospital PPM volume (categorized into quintiles of their mean annual volume) with risk-adjusted in-hospital surgical complications (composite of pneumothorax, haemothorax, pericardial effusion, or pocket haematoma, all requiring intervention, or device infection) and pacemaker lead dislocation. Overall 430 416 PPM implantations were documented in 1226 hospitals. Systems included dual (72.8%) and single (25.8%) chamber PPM and cardiac resynchronization therapy (CRT) devices (1.1%). Complications included surgical (0.92%), and ventricular (0.99%), and atrial (1.22%) lead dislocation. Despite an increase in relatively complex procedures (dual chamber, CRT), there was a significant decrease in the procedural and fluoroscopy times and complications from lowest to highest implantation volume quintiles (P for trend <0.0001). The greatest difference was observed between the lowest (1-50 implantations/year-reference group) and the second-lowest (51-90 implantations/year) quintile: surgical complications [odds ratio (OR) 0.69; confidence interval (CI) 0.60-0.78], atrial lead dislocations (OR 0.69; CI 0.59-0.80), and ventricular lead dislocations (OR 0.73; CI 0.63-0.84). Hospital annual PPM volume was directly related to indication-based implantation of relatively more complex PPM and yet inversely with procedural times and rates of early surgical complications and lead dislocations. Thus, our data suggest better performance and lower

  3. Knee Replacement

    Science.gov (United States)

    ... days. Medications prescribed by your doctor should help control pain. During the hospital stay, you'll be encouraged to move your ... exercise your new knee. After you leave the hospital, you'll continue physical ... mobility and a better quality of life. And most knee replacements can be ...

  4. Proposal of organisation and ALARA procedure for preparation, follow-up and experience gained from maintenance: application to replacement of pressure vessel; Proposition d'organisation et procedure ALARA pour la preparation le suivi et le retour d'experience des chantiers de maintenance: application au RGV

    Energy Technology Data Exchange (ETDEWEB)

    Lochard, Jacques; Lefaure, Christian

    1990-01-01

    This report proposes the organisation and ALARA procedures for preparation, follow-up and analysis of the lessons learned during maintenance works at a nuclear power plant. After a brief description of the ALARA principle in the first chapter, the following chapters describe proposals for establishing and start-up of a maintenance building site. The proposals are illustrated by the replacement of the pressure vessel as an example.

  5. Proposal of organisation and ALARA procedure for preparation, follow-up and experience gained from maintenance: application to replacement of pressure vessel; Proposition d'organisation et procedure ALARA pour le suivi et le retour d'experience des chantiers de maintenance: application au RGV

    Energy Technology Data Exchange (ETDEWEB)

    Lochard, Jacques; Lefaure, Christian

    1989-12-01

    This report proposes the organisation and ALARA procedures for preparation, follow-up and analysis of the lessons learned during maintenance works at a nuclear power plant. After a brief description of the ALARA principle in the first chapter, the following chapters describe proposals for establishing and start-up of a maintenance building site. The proposals are illustrated by the replacement of the pressure vessel as an example.

  6. Glaucoma after corneal replacement.

    Science.gov (United States)

    Baltaziak, Monika; Chew, Hall F; Podbielski, Dominik W; Ahmed, Iqbal Ike K

    Glaucoma is a well-known complication after corneal transplantation surgery. Traditional corneal transplantation surgery, specifically penetrating keratoplasty, has been slowly replaced by the advent of new corneal transplantation procedures: primarily lamellar keratoplasties. There has also been an emergence of keratoprosthesis implants for eyes that are high risk of failure with penetrating keratoplasty. Consequently, there are different rates of glaucoma, pathogenesis, and potential treatment in the form of medical, laser, or surgical therapy. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Economic appraisal of the angioplasty procedures performed in 2004 in a high-volume diagnostic and interventional cardiology unit.

    Science.gov (United States)

    Manari, Antonio; Costa, Elena; Scivales, Alessandro; Ponzi, Patrizia; Di Stasi, Francesca; Guiducci, Vincenzo; Pignatelli, Gianluca; Giacometti, Paola

    2007-10-01

    Growing interest in the use of drug-eluting stents (DESs) in coronary angioplasty has prompted the Healthcare Agency of the Emilia Romagna Region to draw up recommendations for their appropriate clinical use in high-risk patients. Since the adoption of any new technology necessitates economic appraisal, we analysed the resource consumption of the various types of angioplasty procedures and the impact on the budget of a cardiology department. A retrospective economic appraisal was carried out on the coronary angioplasty procedures performed in 2004 in the Department of Interventional Cardiology of Reggio Emilia. On the basis of the principles of activity-based costing, detailed hospital costs were estimated for each procedure and compared with the relevant diagnosis-related group (DRG) reimbursement. In 2004, the Reggio Emilia hospital performed 806 angioplasty procedures for a total expenditure of euro 5,176,268. These were 93 plain old balloon angioplasty procedures (euro 487,329), 401 procedures with bare-metal stents (euro 2,380,071), 249 procedures with DESs (euro 1,827,386) and 63 mixed procedures (euro 481,480). Reimbursements amounted to euro 5,816,748 (11% from plain old balloon angioplasty, 50% from bare-metal stent, 31% from DES and 8% from mixed procedures) with a positive margin of about euro 680,480 between costs incurred and reimbursements obtained, even if the reimbursement for DES and mixed procedures was not covering all the incurred costs. Analysis of the case-mix of procedures revealed that an overall positive margin between costs and DRG reimbursements was achieved. It therefore emerges that adherence to the indications of the Healthcare Agency of the Emilia Romagna Region for the appropriate clinical use of DESs is economically sustainable from the hospital enterprise point of view, although the DRG reimbursements are not able to differentiate among resource consumptions owing to the adoption of innovative technologies.

  8. Replacement rod

    International Nuclear Information System (INIS)

    Hatfield, S.C.

    1989-01-01

    This patent describes in an elongated replacement rod for use with fuel assemblies of the type having two end fittings connected by guide tubes with a plurality of rod and guide tube cell defining spacer grids containing rod support features and mixing vanes. The grids secured to the guide tubes in register between the end fittings at spaced intervals. The fuel rod comprising: an asymmetrically beveled tip; a shank portion having a straight centerline; and a permanently diverging portion between the tip and the shank portion

  9. Virtual Whipple: preoperative surgical planning with volume-rendered MDCT images to identify arterial variants relevant to the Whipple procedure.

    Science.gov (United States)

    Brennan, Darren D; Zamboni, Giulia; Sosna, Jacob; Callery, Mark P; Vollmer, Charles M V; Raptopoulos, Vassilios D; Kruskal, Jonathan B

    2007-05-01

    The purposes of this study were to combine a thorough understanding of the technical aspects of the Whipple procedure with advanced rendering techniques by introducing a virtual Whipple procedure and to evaluate the utility of this new rendering technique in prediction of the arterial variants that cross the anticipated surgical resection plane. The virtual Whipple is a novel technique that follows the complex surgical steps in a Whipple procedure. Three-dimensional reconstructed angiographic images are used to identify arterial variants for the surgeon as part of the preoperative radiologic assessment of pancreatic and ampullary tumors.

  10. Federal Logistics Information System (FLIS) Procedures Manual. Volume 3. Development and Maintenance of Item Logistics Data Tools.

    Science.gov (United States)

    1995-01-01

    Ammunition for cannon with illu- to fight fires minating projectile started by Ammunition for cannon with incen- explosion. diary projectile...OSNABURG Ozu Aya JEAN 146 DoD 4100.39-M Volume 3 APPENDIX 3-3-B SAMPLE OF NEW CONCEPT FIIG FIIG SAMPLE INC 00000 APPENDIX C Table 32 Palm Beach PLAIN

  11. Shoulder replacement - discharge

    Science.gov (United States)

    Total shoulder arthroplasty - discharge; Endoprosthetic shoulder replacement - discharge; Partial shoulder replacement - discharge; Partial shoulder arthroplasty - discharge; Replacement - shoulder - discharge; Arthroplasty - shoulder - discharge

  12. (99m) Tc-labelled human serum albumin cannot replace (125) I-labelled human serum albumin to determine plasma volume in patients with liver disease

    DEFF Research Database (Denmark)

    Henriksen, Ulrik Lütken; Henriksen, Jens H; Bendtsen, Flemming

    2013-01-01

    Summary Background and aims Determination of plasma volume (PV) is important in several clinical situations. Thus, patients with liver disease often have augmented PV as part of their sodium–water retention. This study was undertaken to compare PV determination by two indicators: technetium......-labelled human serum albumin (99mTc-HSA) and iodine-labelled human serum albumin (125I-HSA), as the former may have advantages at repeated measurements and the latter is the classical gold standard. Study population and methods In 88 patients, (64 with liver disease, mainly cirrhosis, and 24 patients without...... In all patients, a close correlation was present between PV determined by the two indicators (r = 0·89, Pdetermined with 99mTc-HSA exceeded PV determined with 125I-HSA by 367 ml (5·2 ml kg...

  13. Transitioning to the direct anterior approach in total hip arthroplasty. Is it a true muscle sparing approach when performed by a low volume hip replacement surgeon?

    Science.gov (United States)

    Nistor, Dan-Viorel; Caterev, Sergiu; Bolboacă, Sorana-Daniela; Cosma, Dan; Lucaciu, Dan Osvald Gheorghe; Todor, Adrian

    2017-11-01

    We conducted this study to establish if the transition from a lateral approach (LA) to the direct anterior approach (DAA) for a low volume hip arthroplasty surgeon during the steep learning curve can be performed maintaining the muscle sparing approach of the DAA without increasing the complication rates. In this controlled, prospective, randomized clinical study we investigated 70 patients (35 DAA, 35 LA) with similar demographics that underwent a total hip arthroplasty. Assessment of the two approaches consisted of determining the invasiveness through serum markers for muscle damage (i.e. myoglobin, creatine kinase and lactate dehydrogenase), the operative parameters such as post-operative pain and rescue medication consumption, the component positioning and complication rates. Post-operative myoglobin levels were higher (p < 0.001) in the LA group (326.42 ± 84.91 ng/mL) as compared to the DAA group (242.80 ± 71.03 ng/mL), but with no differences regarding other biomarkers for muscle damage. Pain levels were overall lower in the DAA group, with a statistical and clinical difference during surgery day (p < 0.001) associated with lower (p < 0.001) rescue medication consumption (median 1 (1; 3) mg morphine vs. 3 (2; 4) mg morphine). Most patients in the LA group reported chronic post-operative pain throughout all three evaluated months, while the majority of patients in the DAA group reported no pain after week six. Component positioning did not differ significantly between groups and neither did complication rates. The DAA can be transitioned from the LA safely, without higher complication rates while maintaining its muscle spearing advantages when performed by a low volume hip arthroplasty surgeon.

  14. Minimally invasive aortic valve replacement

    DEFF Research Database (Denmark)

    Foghsgaard, Signe; Schmidt, Thomas Andersen; Kjaergard, Henrik K

    2009-01-01

    In this descriptive prospective study, we evaluate the outcomes of surgery in 98 patients who were scheduled to undergo minimally invasive aortic valve replacement. These patients were compared with a group of 50 patients who underwent scheduled aortic valve replacement through a full sternotomy...... operations were completed as mini-sternotomies, 4 died later of noncardiac causes. The aortic cross-clamp and perfusion times were significantly different across all groups (P replacement...... is an excellent operation in selected patients, but its true advantages over conventional aortic valve replacement (other than a smaller scar) await evaluation by means of randomized clinical trial. The "extended mini-aortic valve replacement" operation, on the other hand, is a risky procedure that should...

  15. Federal Logistics Information System (FLIS) Procedures Manual. Volume 8. Document Identifier Code Input/Output Formats (Fixed Length)

    Science.gov (United States)

    1994-07-01

    REQUIRED MIX OF SEGMENTS OR INDIVIDUAL DATA ELEMENTS TO BE EXTRACTED. IN SEGMENT R ON AN INTERROGATION TRANSACTION (LTI), DATA RECORD NUMBER (DRN 0950) ONLY...and zation and Marketing input DICs. insert the Continuation Indicator Code (DRN 8555) in position 80 of this record. Maximum of OF The assigned NSN...for Procurement KFR, File Data Minus Security Classified Characteristics Data KFC 8.5-2 DoD 4100.39-M Volume 8 CHAPTER 5 ALPHABETIC INDEX OF DIC

  16. Permanent Quadriplegia Following Replacement of Voice Prosthesis.

    Science.gov (United States)

    Ozturk, Kayhan; Erdur, Omer; Kibar, Ertugrul

    2016-11-01

    The authors presented a patient with quadriplegia caused by cervical spine abscess following voice prosthesis replacement. The authors present the first reported permanent quadriplegia patient caused by voice prosthesis replacement. The authors wanted to emphasize that life-threatening complications may be faced during the replacement of voice prosthesis. Care should be taken during the replacement of voice prosthesis and if some problems have been faced during the procedure patients must be followed closely.

  17. Differentiation between focal malignant marrow-replacing lesions and benign red marrow deposition of the spine with T2*-corrected fat-signal fraction map using a three -echo volume interpolated breath-hold gradient echo dixon sequence

    International Nuclear Information System (INIS)

    Kim, Yong Pyo; Kim, Sung Jun; Chung, Tae Sub; Yoo, Yeon Hwa; Yoon, Choon Sik; Kanneengiesser, Stephan; Paek, Moon Young; Song, Ho Taek; Lee, Young Han; Suh, Jin Suck

    2014-01-01

    To assess the feasibility of T2 * -corrected fat-signal fraction (FF) map by using the three-echo volume interpolated breath-hold gradient echo (VIBE) Dixon sequence to differentiate between malignant marrow-replacing lesions and benign red marrow deposition of vertebrae. We assessed 32 lesions from 32 patients who underwent magnetic resonance imaging after being referred for assessment of a known or possible vertebral marrow abnormality. The lesions were divided into 21 malignant marrow-replacing lesions and 11 benign red marrow depositions. Three sequences for the parameter measurements were obtained by using a 1.5-T MR imaging scanner as follows: three-echo VIBE Dixon sequence for FF; conventional T1-weighted imaging for the lesion-disc ratio (LDR); pre- and post-gadolinium enhanced fat-suppressed T1-weighted images for the contrast-enhancement ratio (CER). A region of interest was drawn for each lesion for parameter measurements. The areas under the curve (AUC) of the parameters and their sensitivities and specificities at the most ideal cutoff values from receiver operating characteristic curve analysis were obtained. AUC, sensitivity, and specificity were respectively compared between FF and CER. The AUCs of FF, LDR, and CER were 0.96, 0.80, and 0.72, respectively. In the comparison of diagnostic performance between the FF and CER, the FF showed a significantly larger AUC as compared to the CER (p = 0.030), although the difference of sensitivity (p = 0.157) and specificity (p = 0.157) were not significant. Fat-signal fraction measurement using T2 * -corrected three-echo VIBE Dixon sequence is feasible and has a more accurate diagnostic performance, than the CER, in distinguishing benign red marrow deposition from malignant bone marrow-replacing lesions.

  18. Correlation between left ventricular diastolic function before and after valve replacement surgery and myocardial ultrastructural changes in patients with left ventricular volume-overloaded valvular heart diseases

    International Nuclear Information System (INIS)

    Okada, Tomiro

    1993-01-01

    Left ventricular (LV) diastolic functions in 23 patients with aortic regurgitation (AR) and 22 patients with mitral regurgitation (MR) were evaluated by gated blood pool scintigraphy. LV myocardial biopsy was performed during open heart surgery, and LV myocardial ultrastructural changes were evaluated by electron microscope. Correlation between LV diastolic function and myocardial ultrastructural changes was examined. It was suggested that preoperative LV diastolic dysfunction occurred earlier than LV systolic dysfunction in patients with AR and MR. LV early diastolic dysfunction was especially significant in patients with AR. LV systolic function was significantly improved postoperatively compared with LV diastolic function in patients with AR and MR. It was suggested that LV interstitial fibrosis caused LV diastolic dysfunction in patients with AR and MR, and insufficiency of myocardial thickening as compensation in patients with MR. It was presumed that LV diastolic dysfunction was irreversible in patients with AR and MR in the distant postoperative period due to persistence of the preoperative myocardial ultrastructural change, e.g., interstitial fibrosis. These LV diastolic indices measured by gated pool scintigraphy were useful in predicting LV ultrastructural changes and postoperative LV dysfunction in patients with LV volume-overloaded valvular heart disease. (author)

  19. Hip joint replacement

    Science.gov (United States)

    Hip arthroplasty; Total hip replacement; Hip hemiarthroplasty; Arthritis - hip replacement; Osteoarthritis - hip replacement ... Your hip joint is made up of 2 major parts. One or both parts may be replaced during surgery: ...

  20. Technical procedures for water resources: Volume 3, Environmental Field Program, Deaf Smith County Site, Texas: Final draft

    International Nuclear Information System (INIS)

    1987-08-01

    To ensure that the environmental field program comprehensively addresses the issues and requirements of the project, a site study plan (SSP) has been prepared for Water Resources (ONWI, 1987). This technical procedure (TP) has been developed to implement the field program described in the Water Resources Site Study Plan. This procedure provides the general method for the field collection of water and sediment samples from playa lakes using an Alpha horizontal type sampler or equivalent or a peristaltic pump for water and a KB-coring devise or ponar grab for sediments. The samples will be preserved and then shipped to a laboratory for analysis. The water quality and sediment samples will be collected as part of the surface-water quality field study described in the Site Plan for Water Resources. 15 refs., 5 figs., 3 tabs

  1. Lung Volume Reduction in Chronic Obstructive Pulmonary Disease (COPD AND#8211; An Updated Review of Surgical and Endoscopic Procedures

    Directory of Open Access Journals (Sweden)

    Ramakant Dixit

    2012-08-01

    Full Text Available The conventional medical management of emphysema using bronchodilators and anti-inflammatory agents has a limited benefit in patients having advanced hyperinflation of lungs due to destruction of elastic tissue. The natural course of Chronic Obstructive Pulmonary Disease (COPD has been shown to be altered by only smoking cessation and oxygen therapy so far. The lung volume reduction surgery is viewed as another modality to change the natural history of emphysema in recent years. For patients with more generalized emphysema, resection of lung parenchyma improves elastic recoil and chest wall mechanics. An extensive literature search has demonstrated that carefully selected patients of emphysema (i.e. upper lobe predominant disease, low exercise capacity and Forced Expiratory Volume in First Second (FEV1 and DLco and #8804; 20% of predicted receive benefits in terms of symptomatic improvement and physiologic response following Lung Volume Reduction Surgery (LVRS. The resurgent interest in LVRS and National Emphysema Treatment Trial findings for emphysema have stimulated a range of innovative methods, to improve the outcome and reduce complications associated with current LVRS techniques. These novel approaches include surgical resection with compression/banding devices, endobronchial blockers, sealants, obstructing devices and valves and endobronchial bronchial bypass approaches. Experimental data and preliminary results are becoming available for some of these approaches. Most of the published studies so far have been uncontrolled and unblinded. Overall, extensive research in the near future will help to determine the potential clinical applicability of these new approaches to the treatment of emphysema symptoms. [Arch Clin Exp Surg 2012; 1(4.000: 249-257

  2. Practical determination of aortic valve calcium volume score on contrast-enhanced computed tomography prior to transcatheter aortic valve replacement and impact on paravalvular regurgitation: Elucidating optimal threshold cutoffs.

    Science.gov (United States)

    Bettinger, Nicolas; Khalique, Omar K; Krepp, Joseph M; Hamid, Nadira B; Bae, David J; Pulerwitz, Todd C; Liao, Ming; Hahn, Rebecca T; Vahl, Torsten P; Nazif, Tamim M; George, Isaac; Leon, Martin B; Einstein, Andrew J; Kodali, Susheel K

    The threshold for the optimal computed tomography (CT) number in Hounsfield Units (HU) to quantify aortic valvular calcium on contrast-enhanced scans has not been standardized. Our aim was to find the most accurate threshold to predict paravalvular regurgitation (PVR) after transcatheter aortic valve replacement (TAVR). 104 patients who underwent TAVR with the CoreValve prosthesis were studied retrospectively. Luminal attenuation (LA) in HU was measured at the level of the aortic annulus. Calcium volume score for the aortic valvular complex was measured using 6 threshold cutoffs (650 HU, 850 HU, LA × 1.25, LA × 1.5, LA+50, LA+100). Receiver-operating characteristic (ROC) analysis was performed to assess the predictive value for > mild PVR (n = 16). Multivariable analysis was performed to determine the accuracy to predict > mild PVR after adjustment for depth and perimeter oversizing. ROC analysis showed lower area under the curve (AUC) values for fixed threshold cutoffs (650 or 850 HU) compared to thresholds relative to LA. The LA+100 threshold had the highest AUC (0.81), and AUC was higher than all studied protocols, other than the LA x 1.25 and LA + 50 protocols, where the difference approached statistical significance (p = 0.05, and 0.068, respectively). Multivariable analysis showed calcium volume determined by the LAx1.25, LAx1.5, LA+50, and LA+ 100 HU protocols to independently predict PVR. Calcium volume scoring thresholds which are relative to LA are more predictive of PVR post-TAVR than those which use fixed cutoffs. A threshold of LA+100 HU had the highest predictive value. Copyright © 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  3. On developing an optimal design procedure for a bimorph piezoelectric cantilever energy harvester under a predefined volume

    Science.gov (United States)

    Aboulfotoh, Noha; Twiefel, Jens

    2018-06-01

    A typical vibration harvester is tuned to operate at resonance in order to maximize the power output. There are many design parameter sets for tuning the harvester to a specific frequency, even for simple geometries. This work studies the impact of the geometrical parameters on the harvested power while keeping the resonance frequency constant in order to find the combination of the parameters that optimizes the power under a predefined volume. A bimorph piezoelectric cantilever is considered for the study. It consists of two piezoelectric layers and a middle non-piezoelectric layer and holds a tip mass. A theoretical model was derived to obtain the system parameters and the power as functions of the design parameters. Formulas for the optimal load resistance that provide maximum power capability at resonance and anti-resonance frequency were derived. The influence of the width on the power is studied, considering a constant mass ratio (between the tip mass and the mass of the beam). This keeps the resonance frequency constant while changing the width. The influence of the ratio between the thickness of the middle layer and that of the piezoelectric layer is also studied. It is assumed that the total thickness of the cantilever is constant and the middle layer has the same mechanical properties (elasticity and density) as the piezoelectric layer. This keeps the resonance frequency constant while changing the ratio between the thicknesses. Finally, the influence of increasing the free length as well as of increasing the mass ratio on the power is investigated. This is done by first, increasing each of them individually and secondly, by increasing each of them simultaneously while increasing the total thickness under the condition of maintaining a constant resonance frequency. Based on the analysis of these influences, recommendations as to how to maximize the geometrical parameters within the available volume and mass are presented.

  4. Guidelines for the verification and validation of expert system software and conventional software: Volume 5, Rationale and description of verification and validation guideline packages and procedures. Final report

    International Nuclear Information System (INIS)

    Miller, L.A.; Hayes, J.E.; Mirsky, S.M.

    1995-05-01

    This report is the fifth volume in a series of reports describing the results of the Expert System Verification and Validation (V ampersand V) project which is jointly funded by US NRC and EPRI toward formulating guidelines for V ampersand V of expert systems for use in nuclear power applications. This report provides the rationale for and description of those guidelines. The actual guidelines themselves (and the accompanying 11 step by step Procedures) are presented in Volume 7, User's Manual. Three factors determine what V ampersand V is needed: (1) the stage, of the development life cycle (requirements, design, or implementation), (2) whether the overall system or a specialized component needs be tested (knowledge base component, inference engine or other highly reusable element, or a component involving conventional software), and (3) the stringency of V ampersand V that is needed (as judged from an assessment of the system's complexity and the requirement for its integrity to form three Classes). A V ampersand V guideline package is provided for each of the combinations of these three variables. The package specifies the V ampersand V methods recommended and the order in which they should be administered, the assurances each method provides, the qualifications needed by the V ampersand V team to employ each Particular method, the degree to which the methods should be applied, the performance measures that should be taken, and the decision criteria for accepting, conditionally accepting, or rejecting an evaluated system. In addition to the guideline packages, highly detailed step-by-step procedures are provided for 11 of the more important methods, to ensure that they Can be implemented correctly. The guidelines can apply to conventional procedural software systems as well as all kinds of AI systems

  5. 76 FR 62092 - Filing Procedures

    Science.gov (United States)

    2011-10-06

    ... INTERNATIONAL TRADE COMMISSION Filing Procedures AGENCY: International Trade Commission. ACTION: Notice of issuance of Handbook on Filing Procedures. SUMMARY: The United States International Trade Commission (``Commission'') is issuing a Handbook on Filing Procedures to replace its Handbook on Electronic...

  6. Prolonged Intermittent Renal Replacement Therapy.

    Science.gov (United States)

    Edrees, Fahad; Li, Tingting; Vijayan, Anitha

    2016-05-01

    Prolonged intermittent renal replacement therapy (PIRRT) is becoming an increasingly popular alternative to continuous renal replacement therapy in critically ill patients with acute kidney injury. There are significant practice variations in the provision of PIRRT across institutions, with respect to prescription, technology, and delivery of therapy. Clinical trials have generally demonstrated that PIRRT is non-inferior to continuous renal replacement therapy regarding patient outcomes. PIRRT offers cost-effective renal replacement therapy along with other advantages such as early patient mobilization and decreased nursing time. However, due to lack of standardization of the procedure, PIRRT still poses significant challenges, especially pertaining to appropriate drug dosing. Future guidelines and clinical trials should work toward developing consensus definitions for PIRRT and ensure optimal delivery of therapy. Copyright © 2016 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  7. Liver Resections in a High-Volume Center: Form Standard Procedures to Extreme Surgery and Ultrasound-guided Resections.

    Science.gov (United States)

    Botea, Florin; Ionescu, Mihnea; Braşoveanu, Vladislav; Hrehoreţ, Doina; Alexandrescu, Sorin; Grigorie, Mihai; Stanciulea, Oana; Nicolaescu, Diana; Tomescu, Dana; Droc, Gabriela; Ungureanu, Daniela; Fota, Ruxandra; Croitoru, Adina; Gheorghe, Liana; Gheorghe, Cristian; Lupescu, Ioana; Grasu, Mugur; Boroş, Mirela; Dumitru, Radu; Toma, Mihai; Herlea, Vlad; Popescu, Irinel

    2017-01-01

    Background: Liver resection (LR) is the treatment of choice for most benign and malignant focal liver lesions, as well as in selected patients with liver trauma. Few other therapies can compete with LR in selected cases, such as liver transplantation in hepatocellular carcinoma (HCC) and ablative therapies in small HCCs or liver metastases. The present paper analyses a single center experience in LR, reviewing the indications of LR, the operative techniques and their short-term results. Between January 2000 and December 2016, in "œDan Setlacec" Center of General Surgery and Liver Transplantation were performed 3165 LRs in 3016 patients, for pathologic conditions of the liver. In the present series, liver resections for living-donor liver transplantation were excluded. The median age of the patients was 56 years (mean 58 years; range 1-88), with male/female ratio 1524/1492 and adult/pediatric patient ratio 2973/43. Results: Malignant lesions were the main indication for LR (2372 LRs; 74.9%). Among these, colorectal liver metastases were the most frequent indication (952 LRs; 30.1%), followed by hepatocellular carcinoma (575 patients, 18.2%). The highest number of resected tumors per patient was 21, and the median diameter of the largest tumor was 40 mm (mean 51 mm; range 3-250). Major resections rate was 18.6% (588 LRs) and anatomical LRs were performed in 789 patients (24.9%). The median operative time was 180 minutes (mean 204 minutes; range 45-920). The median blood loss was 500 ml (mean 850 ml; range 500-9500), with a transfusion rate of 41.6% (1316 LRs). The morbidity rate was 40.1% (1270 LRs) and the rate of major complications (Dindo-Clavien IIIa or more) was 13.2% (418 LRs). Mortality rate was 4.2% (127 pts). LRs should be performed in specialized high-volume centers to achieve the best results (low morbidity and mortality rates). Celsius.

  8. Guidelines for the verification and validation of expert system software and conventional software: Rationale and description of V ampersand V guideline packages and procedures. Volume 5

    International Nuclear Information System (INIS)

    Mirsky, S.M.; Hayes, J.E.; Miller, L.A.

    1995-03-01

    This report is the fifth volume in a series of reports describing the results of the Expert System Verification C, and Validation (V ampersand V) project which is jointly funded by the U.S. Nuclear Regulatory Commission and the Electric Power Research Institute toward the objective of formulating Guidelines for the V ampersand V of expert systems for use in nuclear power applications. This report provides the rationale for and description of those guidelines. The actual guidelines themselves are presented in Volume 7, open-quotes User's Manual.close quotes Three factors determine what V ampersand V is needed: (1) the stage of the development life cycle (requirements, design, or implementation); (2) whether the overall system or a specialized component needs to be tested (knowledge base component, inference engine or other highly reusable element, or a component involving conventional software); and (3) the stringency of V ampersand V that is needed (as judged from an assessment of the system's complexity and the requirement for its integrity to form three Classes). A V ampersand V Guideline package is provided for each of the combinations of these three variables. The package specifies the V ampersand V methods recommended and the order in which they should be administered, the assurances each method provides, the qualifications needed by the V ampersand V team to employ each particular method, the degree to which the methods should be applied, the performance measures that should be taken, and the decision criteria for accepting, conditionally accepting, or rejecting an evaluated system. In addition to the Guideline packages, highly detailed step-by-step procedures are provided for 11 of the more important methods, to ensure that they can be implemented correctly. The Guidelines can apply to conventional procedural software systems as well as all kinds of Al systems

  9. Comparison between automated breast volume scanner (ABVS) versus hand-held ultrasound as a second look procedure after magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Girometti, Rossano; Zanotel, Martina; Londero, Viviana; Bazzocchi, Massimo; Zuiani, Chiara [University of Udine, Azienda Ospedaliero-Universitaria, ' S. Maria della Misericordia' , Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, Udine (Italy)

    2017-09-15

    To evaluate the agreement between automated breast volume scanner (ABVS) and conventional ultrasound (US) as a second-look (SL) tool for assessing additional findings found on MRI. Over a 7-month period, we prospectively assigned to SL-US and SL-ABVS all patients undergoing 1.5 T breast MRI in whom additional findings were found. Five experienced breast radiologists independently interpreted SL-US and SL-ABVS in blinded sessions to evaluate the detection rate of MRI findings and assign them to BI-RADS categories. We calculated the agreement between the two methods in assessing MRI findings as significant (BI-RADS 3-5) versus not significant (BI-RADS 1-2), as well as their cancer detection rate. In a population of 131 patients, SL-ABVS and SL-US showed a comparable detection rate of MRI findings (69.3 vs. 71.5%) (p > 0.05; McNemar test), with an almost perfect agreement in assessing them as significant or not (k = 0.94). This translated into a comparably high cancer detection rate (83.8% for SL-ABVS vs. 87.0% for SL-US). Only 1/31 cancers was missed by SL-ABVS. SL-ABVS and SL-US are nearly equivalent in assessing the significance of MRI findings, leading to a comparable cancer detection rate. SL-ABVS has the potential to replace SL-US in the SL scenario. (orig.)

  10. Comparison between automated breast volume scanner (ABVS) versus hand-held ultrasound as a second look procedure after magnetic resonance imaging

    International Nuclear Information System (INIS)

    Girometti, Rossano; Zanotel, Martina; Londero, Viviana; Bazzocchi, Massimo; Zuiani, Chiara

    2017-01-01

    To evaluate the agreement between automated breast volume scanner (ABVS) and conventional ultrasound (US) as a second-look (SL) tool for assessing additional findings found on MRI. Over a 7-month period, we prospectively assigned to SL-US and SL-ABVS all patients undergoing 1.5 T breast MRI in whom additional findings were found. Five experienced breast radiologists independently interpreted SL-US and SL-ABVS in blinded sessions to evaluate the detection rate of MRI findings and assign them to BI-RADS categories. We calculated the agreement between the two methods in assessing MRI findings as significant (BI-RADS 3-5) versus not significant (BI-RADS 1-2), as well as their cancer detection rate. In a population of 131 patients, SL-ABVS and SL-US showed a comparable detection rate of MRI findings (69.3 vs. 71.5%) (p > 0.05; McNemar test), with an almost perfect agreement in assessing them as significant or not (k = 0.94). This translated into a comparably high cancer detection rate (83.8% for SL-ABVS vs. 87.0% for SL-US). Only 1/31 cancers was missed by SL-ABVS. SL-ABVS and SL-US are nearly equivalent in assessing the significance of MRI findings, leading to a comparable cancer detection rate. SL-ABVS has the potential to replace SL-US in the SL scenario. (orig.)

  11. Transcatheter aortic valve replacement

    Science.gov (United States)

    ... gov/ency/article/007684.htm Transcatheter aortic valve replacement To use the sharing features on this page, please enable JavaScript. Transcatheter aortic valve replacement (TAVR) is surgery to replace the aortic valve. ...

  12. Hip Replacement Surgery

    Science.gov (United States)

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

  13. Nicotine replacement therapy

    Science.gov (United States)

    Smoking cessation - nicotine replacement; Tobacco - nicotine replacement therapy ... Before you start using a nicotine replacement product, here are some things to know: The more cigarettes you smoke, the higher the dose you may need to ...

  14. Prevalence of Total Hip and Knee Replacement in the United States.

    Science.gov (United States)

    Maradit Kremers, Hilal; Larson, Dirk R; Crowson, Cynthia S; Kremers, Walter K; Washington, Raynard E; Steiner, Claudia A; Jiranek, William A; Berry, Daniel J

    2015-09-02

    Descriptive epidemiology of total joint replacement procedures is limited to annual procedure volumes (incidence). The prevalence of the growing number of individuals living with a total hip or total knee replacement is currently unknown. Our objective was to estimate the prevalence of total hip and total knee replacement in the United States. Prevalence was estimated using the counting method by combining historical incidence data from the National Hospital Discharge Survey and the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from 1969 to 2010 with general population census and mortality counts. We accounted for relative differences in mortality rates between those who have had total hip or knee replacement and the general population. The 2010 prevalence of total hip and total knee replacement in the total U.S. population was 0.83% and 1.52%, respectively. Prevalence was higher among women than among men and increased with age, reaching 5.26% for total hip replacement and 10.38% for total knee replacement at eighty years. These estimates corresponded to 2.5 million individuals (1.4 million women and 1.1 million men) with total hip replacement and 4.7 million individuals (3.0 million women and 1.7 million men) with total knee replacement in 2010. Secular trends indicated a substantial rise in prevalence over time and a shift to younger ages. Around 7 million Americans are living with a hip or knee replacement, and consequently, in most cases, are mobile, despite advanced arthritis. These numbers underscore the substantial public health impact of total hip and knee arthroplasties. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  15. The effect of major adverse renal cardiovascular event (MARCE) incidence, procedure volume, and unit cost on the hospital savings resulting from contrast media use in inpatient angioplasty.

    Science.gov (United States)

    Keuffel, Eric; McCullough, Peter A; Todoran, Thomas M; Brilakis, Emmanouil S; Palli, Swetha R; Ryan, Michael P; Gunnarsson, Candace

    2018-04-01

    To determine the net economic impact of switching from low-osmolar contrast media (LOCM) to iso-osmolar contrast media (IOCM; iodixanol) in patients undergoing inpatient coronary or peripheral angioplasty in the United States (US). A budget impact model (BIM) was developed from a hospital perspective. Nationally representative procedural and contrast media prevalence rates, along with MARCE (major adverse renal cardiovascular event) incidence and episode-related cost data were derived from Premier Hospital Data (October 2014 to September 2015). A previously estimated relative risk reduction in MARCE associated with IOCM usage (9.3%) was applied. The higher cost of IOCM was included when calculating the net impact estimates at the aggregate, hospital type, and per hospital levels. One-way (±25%) and probabilistic sensitivity analyses identified the model's most important inputs. Based on weighted analysis, 513,882 US inpatient angioplasties and 35,610 MARCE cases were estimated annually. Switching to an "IOCM only" strategy from a "LOCM only" strategy increases contrast media cost, but prevents 2,900 MARCE events. The annual budget impact was an estimated saving of $30.71 million, aggregated across all US hospitals, $6,316 per hospital, or $60 per procedure. Net savings were maintained across all univariate sensitivity analyses. While MARCE/event-free cost differential was the most important factor driving total net savings for hospitals in the Northeast and West, procedural volume was important in the Midwest and rural locations. Switching to an "IOCM only" strategy from a "LOCM only" approach yields substantial net global savings to hospitals, both at the national level and within hospital sub-groups. Hospital administrators should maintain awareness of the factors that are likely to be more influential for their hospital and recognize that purchasing on the basis of lower contrast media cost may result in higher overall costs for patients undergoing inpatient

  16. Total ankle joint replacement.

    Science.gov (United States)

    2016-02-01

    Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability. For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction. Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  17. Feeder replacement tooling and processes

    International Nuclear Information System (INIS)

    Mallozzi, R.; Goslin, R.; Pink, D.; Askari, A.

    2008-01-01

    Primary heat transport system feeder integrity has become a concern at some CANDU nuclear plants as a result of thinning caused by flow accelerated corrosion (FAC). Feeder inspections are indicating that life-limiting wall thinning can occur in the region between the Grayloc hub weld and second elbow of some outlet feeders. In some cases it has become necessary to replace thinned sections of affected feeders to restore feeder integrity to planned end of life. Atomic Energy of Canada Limited (AECL) and Babcock and Wilcox Canada Ltd. (B and W) have developed a new capability for replacement of single feeders at any location on the reactor face without impacting or interrupting operation of neighbouring feeders. This new capability consists of deploying trained crews with specialized tools and procedures for feeder replacements during planned outages. As may be expected, performing single feeder replacement in the congested working environment of an operational CANDU reactor face involves overcoming many challenges with respect to access to feeders, available clearances for tooling, and tooling operation and performance. This paper describes some of the challenges encountered during single feeder replacements and actions being taken by AECL and B and W to promote continuous improvement of feeder replacement tooling and processes and ensure well-executed outages. (author)

  18. Defining line replaceable units

    NARCIS (Netherlands)

    Parada Puig, J. E.; Basten, R. J I

    2015-01-01

    Defective capital assets may be quickly restored to their operational condition by replacing the item that has failed. The item that is replaced is called the Line Replaceable Unit (LRU), and the so-called LRU definition problem is the problem of deciding on which item to replace upon each type of

  19. Natural look in volume restoration.

    Science.gov (United States)

    Lupo, Mary P

    2008-09-01

    Filling and volumizing injection procedures are currently widely used for facial augmentation and re-establishing a youthful appearance. Aesthetic physicians have advanced from the practice of treating single lines and wrinkles towards filling large facial areas to globally restore natural facial contours and meet patient demand for nonsurgical rejuvenation. This review describes the different categories of fillers and volumizers based on their duration of action and ability to create a natural looking effect; they can be broadly classified as temporary or long-lasting biodegradable agents, or permanent nonbiodegradable agents. Temporary fillers are effective to correct lines and wrinkles, but may not adequately meet the need for global facial rejuvenation and volume replacement in a long-term, cost-efficient manner. Permanent fillers for global restoration pose the issue of long-term safety, and may not be compatible with changes in facial architecture with continued aging. Longer lasting volumizers provide patients with a durable, effective option for the restoration of facial volume and the re-establishment of youthful facial contours. Temporary fillers and volumizers may also be used in combination to provide a wide source of options for the global restoration and rejuvenation of the face.

  20. Ankle replacement - discharge

    Science.gov (United States)

    ... total - discharge; Total ankle arthroplasty - discharge; Endoprosthetic ankle replacement - discharge; Osteoarthritis - ankle ... You had an ankle replacement. Your surgeon removed and reshaped ... an artificial ankle joint. You received pain medicine and were ...

  1. Artificial Disc Replacement

    Science.gov (United States)

    ... Spondylolisthesis BLOG FIND A SPECIALIST Treatments Artificial Disc Replacement (ADR) Patient Education Committee Jamie Baisden The disc ... Disc An artificial disc (also called a disc replacement, disc prosthesis or spine arthroplasty device) is a ...

  2. Partial knee replacement - slideshow

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/presentations/100225.htm Partial knee replacement - series—Normal anatomy To use the sharing ... A.M. Editorial team. Related MedlinePlus Health Topics Knee Replacement A.D.A.M., Inc. is accredited ...

  3. Petroleum supply annual, 1997. Volume 2

    International Nuclear Information System (INIS)

    1998-06-01

    The Petroleum Supply Annual (PSA) contains information on the supply and disposition of crude oil and petroleum products. The publication reflects data that were collected from the petroleum industry during 1997 through monthly surveys. The PSA is divided into two volumes. The first volume contains three sections: Summary Statistics, Detailed Statistics, and Refinery Statistics; each with final annual data. The second volume contains final statistics for each month of 1997, and replaces data previously published in the Petroleum Supply Monthly (PSM). The tables in Volumes 1 and 2 are similarly numbered to facilitate comparison between them. Explanatory Notes, located at the end of this publication, present information describing data collection, sources, estimation methodology, data quality control procedures, modifications to reporting requirements and interpretation of tables. Industry terminology and product definitions are listed alphabetically in the Glossary. 35 tabs

  4. Petroleum supply annual 1996: Volume 2

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1997-06-01

    The Petroleum Supply Annual (PSA) contains information on the supply and disposition of crude oil and petroleum products. The publication reflects data that were collected from the petroleum industry during 1996 through monthly surveys. The PSA is divided into two volumes. The first volume contains three sections: Summary Statistics, Detailed Statistics, and Refinery Capacity; each with final annual data. The second volume contains final statistics for each month of 1996, and replaces data previously published in the Petroleum Supply Monthly (PSM). The tables in Volumes 1 and 2 are similarly numbered to facilitate comparison between them. Explanatory Notes, located at the end of this publication, present information describing data collection, sources, estimation methodology, data quality control procedures, modifications to reporting requirements and interpretation of tables. Industry terminology and product definitions are listed alphabetically in the Glossary. 35 tabs.

  5. Petroleum supply annual, 1997. Volume 2

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-06-01

    The Petroleum Supply Annual (PSA) contains information on the supply and disposition of crude oil and petroleum products. The publication reflects data that were collected from the petroleum industry during 1997 through monthly surveys. The PSA is divided into two volumes. The first volume contains three sections: Summary Statistics, Detailed Statistics, and Refinery Statistics; each with final annual data. The second volume contains final statistics for each month of 1997, and replaces data previously published in the Petroleum Supply Monthly (PSM). The tables in Volumes 1 and 2 are similarly numbered to facilitate comparison between them. Explanatory Notes, located at the end of this publication, present information describing data collection, sources, estimation methodology, data quality control procedures, modifications to reporting requirements and interpretation of tables. Industry terminology and product definitions are listed alphabetically in the Glossary. 35 tabs.

  6. Petroleum supply annual 1998: Volume 2

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-06-01

    The Petroleum Supply Annual (PSA) contains information on the supply and disposition of crude oil and petroleum products. The publication reflects data that were collected from the petroleum industry during 1998 through monthly surveys. The PSA is divided into two volumes. The first volume contains three sections: Summary Statistics, Detailed Statistics, and Refinery Statistics; each with final annual data. This second volume contains final statistics for each month of 1998, and replaces data previously published in the Petroleum Supply Monthly (PSM). The tables in Volumes 1 and 2 are similarly numbered to facilitate comparison between them. Explanatory Notes, located at the end of this publication, present information describing data collection, sources, estimation methodology, data quality control procedures, modifications to reporting requirements and interpretation of tables. Industry terminology and product definitions are listed alphabetically in the Glossary. 35 tabs.

  7. Petroleum supply annual 1994, Volume 2

    International Nuclear Information System (INIS)

    1995-06-01

    The Petroleum Supply Annual (PSA) contains information on the supply and disposition of crude oil and petroleum products. The publication reflects data that were collected from the petroleum industry during 1994 through annual and monthly surveys. The PSA is divided into two volumes. This first volume contains four sections: Summary Statistics, Detailed Statistics, Refinery Capacity, and Oxygenate Capacity each with final annual data. The second volume contains final statistics for each month of 1994, and replaces data previously published in the Petroleum Supply Monthly (PSM). The tables in Volumes 1 and 2 are similarly numbered to facilitate comparison between them. Explanatory Notes, located at the end of this publication, present information describing data collection, sources, estimation methodology, data quality control procedures, modifications to reporting requirements and interpretation of tables. Industry terminology and product definitions are listed alphabetically in the Glossary

  8. Petroleum supply annual 1996: Volume 2

    International Nuclear Information System (INIS)

    1997-06-01

    The Petroleum Supply Annual (PSA) contains information on the supply and disposition of crude oil and petroleum products. The publication reflects data that were collected from the petroleum industry during 1996 through monthly surveys. The PSA is divided into two volumes. The first volume contains three sections: Summary Statistics, Detailed Statistics, and Refinery Capacity; each with final annual data. The second volume contains final statistics for each month of 1996, and replaces data previously published in the Petroleum Supply Monthly (PSM). The tables in Volumes 1 and 2 are similarly numbered to facilitate comparison between them. Explanatory Notes, located at the end of this publication, present information describing data collection, sources, estimation methodology, data quality control procedures, modifications to reporting requirements and interpretation of tables. Industry terminology and product definitions are listed alphabetically in the Glossary. 35 tabs

  9. Petroleum supply annual 1995: Volume 2

    International Nuclear Information System (INIS)

    1996-06-01

    The Petroleum Supply Annual (PSA) contains information on the supply and disposition of crude oil and petroleum products. The publication reflects data that were collected from the petroleum industry during 1995 through monthly surveys. The PSA is divided into two volumes. This first volume contains three sections: Summary Statistics, Detailed Statistics, and selected Refinery Statistics each with final annual data. The second volume contains final statistics for each month of 1995, and replaces data previously published in the Petroleum Supply Monthly (PSM). The tables in Volumes 1 and 2 are similarly numbered to facilitate comparison between them. Explanatory Notes, located at the end of this publication, present information describing data collection, sources, estimation methodology, data quality control procedures, modifications to reporting requirements and interpretation of tables. Industry terminology and product definitions are listed alphabetically in the Glossary

  10. Petroleum supply annual 1998. Volume 2

    International Nuclear Information System (INIS)

    1999-06-01

    The Petroleum Supply Annual (PSA) contains information on the supply and disposition of crude oil and petroleum products. The publication reflects data that were collected from the petroleum industry during 1998 through monthly surveys. The PSA is divided into two volumes. The first volume contains three sections: Summary Statistics, Detailed Statistics, and Refinery Statistics; each with final annual data. This second volume contains final statistics for each month of 1998, and replaces data previously published in the Petroleum Supply Monthly (PSM). The tables in Volumes 1 and 2 are similarly numbered to facilitate comparison between them. Explanatory Notes, located at the end of this publication, present information describing data collection, sources, estimation methodology, data quality control procedures, modifications to reporting requirements and interpretation of tables. Industry terminology and product definitions are listed alphabetically in the Glossary. 35 tabs

  11. Flued head replacement alternatives

    International Nuclear Information System (INIS)

    Smetters, J.L.

    1987-01-01

    This paper discusses flued head replacement options. Section 2 discusses complete flued head replacement with a design that eliminates the inaccessible welds. Section 3 discusses alternate flued head support designs that can drastically reduce flued head installation costs. Section 4 describes partial flued head replacement designs. Finally, Section 5 discusses flued head analysis methods. (orig./GL)

  12. Capital Equipment Replacement Decisions

    OpenAIRE

    Batterham, Robert L.; Fraser, K.I.

    1995-01-01

    This paper reviews the literature on the optimal replacement of capital equipment, especially farm machinery. It also considers the influence of taxation and capital rationing on replacement decisions. It concludes that special taxation provisions such as accelerated depreciation and investment allowances are unlikely to greatly influence farmers' capital equipment replacement decisions in Australia.

  13. Implementing Replacement Cost Accounting

    Science.gov (United States)

    1976-12-01

    cost accounting Clickener, John Ross Monterey, California. Naval Postgraduate School http://hdl.handle.net/10945/17810 Downloaded from NPS Archive...Calhoun IMPLEMENTING REPLACEMENT COST ACCOUNTING John Ross CHckener NAVAL POSTGRADUATE SCHOOL Monterey, California THESIS IMPLEMENTING REPLACEMENT COST ...Implementing Replacement Cost Accounting 7. AUTHORS John Ross Clickener READ INSTRUCTIONS BEFORE COMPLETING FORM 3. RECIPIENT’S CATALOG NUMBER 9. TYRE OF

  14. Combination of Mean Platelet Volume/Platelet Count Ratio and the APACHE II Score Better Predicts the Short-Term Outcome in Patients with Acute Kidney Injury Receiving Continuous Renal Replacement Therapy.

    Science.gov (United States)

    Li, Junhui; Li, Yingchuan; Sheng, Xiaohua; Wang, Feng; Cheng, Dongsheng; Jian, Guihua; Li, Yongguang; Feng, Liang; Wang, Niansong

    2018-03-29

    Both the Acute physiology and Chronic Health Evaluation (APACHE II) score and mean platelet volume/platelet count Ratio (MPR) can independently predict adverse outcomes in critically ill patients. This study was aimed to investigate whether the combination of them could have a better performance in predicting prognosis of patients with acute kidney injury (AKI) who received continuous renal replacement therapy (CRRT). Two hundred twenty-three patients with AKI who underwent CRRT between January 2009 and December 2014 in a Chinese university hospital were enrolled. They were divided into survivals group and non-survivals group based on the situation at discharge. Receiver Operating Characteristic (ROC) curve was used for MPR and APACHE II score, and to determine the optimal cut-off value of MPR for in-hospital mortality. Factors associated with mortality were identified by univariate and multivariate logistic regression analysis. The mean age of the patients was 61.4 years, and the overall in-hospital mortality was 48.4%. Acute cardiorenal syndrome (ACRS) was the most common cause of AKI. The optimal cut-off value of MPR for mortality was 0.099 with an area under the ROC curve (AUC) of 0.636. The AUC increased to 0.851 with the addition of the APACHE II score. The mortality of patients with of MPR > 0.099 was 56.4%, which was significantly higher than that of the control group with of ≤ 0.099 (39.6%, P= 0.012). Logistic regression analysis showed that average number of organ failure (OR = 2.372), APACHE II score (OR = 1.187), age (OR = 1.028) and vasopressors administration (OR = 38.130) were significantly associated with poor prognosis. Severity of illness was significantly associated with prognosis of patients with AKI. The combination of MPR and APACHE II score may be helpful in predicting the short-term outcome of AKI. © 2018 The Author(s). Published by S. Karger AG, Basel.

  15. Combination of Mean Platelet Volume/Platelet Count Ratio and the APACHE II Score Better Predicts the Short-Term Outcome in Patients with Acute Kidney Injury Receiving Continuous Renal Replacement Therapy

    Directory of Open Access Journals (Sweden)

    Junhui Li

    2018-03-01

    Full Text Available Background/Aims: Both the Acute physiology and Chronic Health Evaluation (APACHE II score and mean platelet volume/platelet count Ratio (MPR can independently predict adverse outcomes in critically ill patients. This study was aimed to investigate whether the combination of them could have a better performance in predicting prognosis of patients with acute kidney injury (AKI who received continuous renal replacement therapy (CRRT. Methods: Two hundred twenty-three patients with AKI who underwent CRRT between January 2009 and December 2014 in a Chinese university hospital were enrolled. They were divided into survivals group and non-survivals group based on the situation at discharge. Receiver Operating Characteristic (ROC curve was used for MPR and APACHE II score, and to determine the optimal cut-off value of MPR for in-hospital mortality. Factors associated with mortality were identified by univariate and multivariate logistic regression analysis. Results: The mean age of the patients was 61.4 years, and the overall in-hospital mortality was 48.4%. Acute cardiorenal syndrome (ACRS was the most common cause of AKI. The optimal cut-off value of MPR for mortality was 0.099 with an area under the ROC curve (AUC of 0.636. The AUC increased to 0.851 with the addition of the APACHE II score. The mortality of patients with of MPR > 0.099 was 56.4%, which was significantly higher than that of the control group with of ≤ 0.099 (39.6%, P= 0.012. Logistic regression analysis showed that average number of organ failure (OR = 2.372, APACHE II score (OR = 1.187, age (OR = 1.028 and vasopressors administration (OR = 38.130 were significantly associated with poor prognosis. Conclusion: Severity of illness was significantly associated with prognosis of patients with AKI. The combination of MPR and APACHE II score may be helpful in predicting the short-term outcome of AKI.

  16. Property Assessment of Sponge Cake Added with Egg Replacer

    OpenAIRE

    Yaqiang He; Linlin Wang; Qian Lu

    2015-01-01

    Chicken egg which is always used in sponge cake production is likely to deteriorate during storage or transportation. This weakness prevents the wide use of chicken egg in sponge cake making. In order to solve this problem, egg replacer has been developed. In this study, effect of egg replacer on the property of sponge cake was analyzed. The result indicated egg replacer could improve the yield rate and specific volume of sponge cake. However, high content of egg replacer would negatively imp...

  17. 14 CFR 21.9 - Replacement and modification articles.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 1 2010-01-01 2010-01-01 false Replacement and modification articles. 21.9... CERTIFICATION PROCEDURES FOR PRODUCTS AND PARTS General § 21.9 Replacement and modification articles. (a) If a person knows, or should know, that a replacement or modification article is reasonably likely to be...

  18. A low-volume polyethylene glycol solution was associated with an increased suboptimal bowel preparation rate but had similar recommendations for an early repeat colonoscopy, procedure times, and adenoma detection rates.

    Directory of Open Access Journals (Sweden)

    Sam C Hankins

    Full Text Available Low-volume polyethylene glycol (PEG bowel preparations are better tolerated by patients than high-volume preparations and may achieve similar preparation quality. However, there is little data comparing their effects on a recommendation for an early repeat colonoscopy (because of a suboptimal preparation, procedure times, adenoma detection rate (ADR, and advanced adenoma detection rate (AADR.This is a retrospective cohort study of outpatient colonoscopies performed during a one-year period at a single academic medical center in which low-volume MoviPrep® (n = 1841 or high-volume Colyte® (n = 1337 was used. All preparations were split-dosed. Appropriate covariates were included in regression models assessing suboptimal preparation quality (fair, poor, or inadequate, procedure times, recommendation for an early repeat colonoscopy, ADR, and AADR.MoviPrep® was associated with an increase in having a suboptimal bowel preparation (OR 1.36; 95% CI: 1.06-1.76, but it was not associated with differences in insertion (p = 0.43, withdrawal (p = 0.22, or total procedure times (p = 0.10. The adjusted percentage with a suboptimal preparation was 11.7% for patients using MoviPrep® and 8.8% for patients using Colyte®. MoviPrep® was not associated with a significant difference in overall ADR (OR 0.93; 95% CI: 0.78-1.11, AADR (OR 1.18; 95% CI: 0.87-1.62, or recommendation for early repeat colonoscopy (OR 1.16; 95% CI: 0.72-1.88.MoviPrep® was associated with a small absolute increase in having a suboptimal preparation, but did not affect recommendations for an early repeat colonoscopy, procedure times, or adenoma detection rates. Mechanisms to reduce financial barriers limiting low-volume preparations should be considered because of their favorable tolerability profile.

  19. Esophageal Replacement for Long-Gap Esophageal Atresia in a ...

    African Journals Online (AJOL)

    humility to know when to consider a replacement procedure (3). To replace the esophagus of a baby is a major decision in many pediatric surgical units world over. Fortunately, the need for this procedure has decreased in the recent years due to the increase in the variety of techniques of lengthening the upper esophageal ...

  20. Report on the behalf of the special commission for the examination of the bill project, after activation of the accelerated procedure, related to energy transition for a green growth (nr 2188) - Nr 2230. Volume I, Volume II - comparative table, Volume III - hearings, impact study

    International Nuclear Information System (INIS)

    Bareigts, Ericka; Battistel, Marie-Noelle; Buis, Sabine; Baupin, Denis; Plisson, Philippe

    2014-01-01

    The first volume of this huge report reports the general discussion and the detailed examination, discussion and modifications of the French bill project on energy transition. The addressed topics are: the definition of common objectives for a successful energy transition, for a strengthening of France energy independence and for the struggle against global warming; a better renovation of buildings to save energy, to reduce prices and to create jobs; the development of clean transports to improve air quality and to protect health; the struggle against wastage and the promotion of circular economy from product design to product recycling; the promotion of renewable energies to diversify our energies and valorise territorial resources; the strengthening of nuclear safety and citizen information; the simplification and clarification of procedures for efficiency and competitiveness gains; the empowerment of citizen, enterprises, territories and State to act together. The second volume proposes a table which gives a comparative overview between the bill project text and the text modified and adopted by the commission. The third volume reports hearings of the minister and of several representatives of professional, public, and consumer organisations and bodies. It also contains the report of an impact study performed on all the different arrangements and measures contained by the bill project

  1. Aeronautical Information System Replacement -

    Data.gov (United States)

    Department of Transportation — Aeronautical Information System Replacement is a web-enabled, automation means for the collection and distribution of Service B messages, weather information, flight...

  2. How to replace a reactor pressure vessel

    International Nuclear Information System (INIS)

    Huber, R.

    1996-01-01

    A potential life extending procedure for a nuclear reactor after, say, 40 years of service life, might in some circumstances be the replacement of the reactor pressure vessel. Neutron induced degradation of the vessel might make replacement by one of a different material composition desirable, for example. Although the replacement of heavy components, such as steam generators, has been possible for many years, the pressure vessel presents a much more demanding task if only because it is highly irradiated. Some preliminary feasibility studies by Siemens are reported for the two removal strategies that might be considered. These are removal of the entire pressure vessel in one piece and dismantling it into sections. (UK)

  3. High lung cancer surgical procedure volume is associated with shorter length of stay and lower risks of re-admission and death

    DEFF Research Database (Denmark)

    Møller, Henrik; Riaz, Sharma P; Holmberg, Lars

    2016-01-01

    It is debated whether treating cancer patients in high-volume surgical centres can lead to improvement in outcomes, such as shorter length of hospital stay, decreased frequency and severity of post-operative complications, decreased re-admission, and decreased mortality. The dataset for this anal......It is debated whether treating cancer patients in high-volume surgical centres can lead to improvement in outcomes, such as shorter length of hospital stay, decreased frequency and severity of post-operative complications, decreased re-admission, and decreased mortality. The dataset...... to their geographical population. Higher volume hospitals had shorter length of stay and the odds of re-admission were 15% lower in the highest hospital volume quintile compared with the lowest quintile. Mortality risks were 1% after 30 d and 3% after 90 d. Patients from hospitals in the highest volume quintile had...

  4. Radiation Source Replacement Workshop

    Energy Technology Data Exchange (ETDEWEB)

    Griffin, Jeffrey W.; Moran, Traci L.; Bond, Leonard J.

    2010-12-01

    This report summarizes a Radiation Source Replacement Workshop in Houston Texas on October 27-28, 2010, which provided a forum for industry and researchers to exchange information and to discuss the issues relating to replacement of AmBe, and potentially other isotope sources used in well logging.

  5. Novel Amalgams for In-Space Fabrication of Replacement Parts

    Science.gov (United States)

    Cochran, Calvin T.; Van Hoose, James R.; Grugel, R. N.

    2012-01-01

    Being able to fabricate replacement parts during extended space flight missions precludes the weight, storage volume, and speculation necessary to accommodate spares. Amalgams, widely used in dentistry, are potential candidates for fabricating parts in microgravity environments as they are moldable, do not require energy for melting, and do not pose fluid handling problems. Unfortunately, amalgams have poor tensile strength and the room temperature liquid component is mercury. To possibly resolve these issues a gallium-indium alloy was substituted for mercury and small steel fibers were mixed in with the commercial alloy powder. Subsequent microscopic examination of the novel amalgam revealed complete bonding of the components, and mechanical testing of comparable samples showed those containing steel fibers to have a significant improvement in strength. Experimental procedures, microstructures, and test results are presented and discussed in view of further improving properties.

  6. The caudal septum replacement graft.

    Science.gov (United States)

    Foda, Hossam M T

    2008-01-01

    To describe a technique for reconstructing the lost tip support in cases involving caudal septal and premaxillary deficiencies. The study included 120 patients with aesthetic and functional nasal problems resulting from the loss of caudal septal and premaxillary support. An external rhinoplasty approach was performed to reconstruct the lost support using a cartilaginous caudal septum replacement graft and premaxillary augmentation with Mersilene mesh. The majority of cases (75%) involved revisions in patients who had previously undergone 1 or more nasal surgical procedures. A caudal septum replacement graft was combined with premaxillary augmentation in 93 patients (77.5%). The mean follow-up period was 3 years (range, 1-12 years). The technique succeeded in correcting the external nasal deformities in all patients and resulted in a significant improvement in breathing in 74 patients (86%) with preoperative nasal obstruction. There were no cases of infection, displacement, or extrusion. The caudal septum replacement graft proved to be very effective in restoring the lost tip support in patients with caudal septal deficiency. Combining the graft with premaxillary augmentation using Mersilene mesh helped increase support and stability over long-term follow-up.

  7. [Experimental evaluation of the role of the coronary sinus pressure in the regulation of coronary return volume via the coronary sinus. Surgical considerations in atrio-pulmonary diversion procedures].

    Science.gov (United States)

    Fantidis, P; Fernández Ruiz, M A; Madero Jarabo, R; Moreno Granados, F; Cordovilla Zurdo, G; Sanz Galeote, E

    1990-11-01

    In order to find out the validity of the vascular waterfall mechanism in coronary venous circulation, the role of coronary sinus pressure in the regulation of coronary return volume via the coronary sinus is studied in healthy animals. An experimental model of pressure regulation in the coronary sinus was prepared, and aortic pressure, EKG and the cardiac output (measured by thermodilution) were recorded. The return volume via the coronary sinus was measured at coronary sinus pressure of 10 or less, 15, 20, and 25 mmHg or more, for a total of 36 determinations. Increased coronary sinus pressure did not produce significant changes in aortic pressure, heart rate, cardiac index or coronary return volume via coronary sinus. When coronary sinus pressure was 25 mmHg or more, there was a significant decline in the average of coronary return volume via coronary sinus. Nevertheless, stepwise variant regression showed that the coronary sinus pressure per se does not condition the volume of coronary return via the coronary sinus. Our results suggest that in the healthy animals, the vascular waterfall mechanism in coronary venous circulation is not valid. Our results suggest that in the correction of congenital cardiac malformations using atriopulmonary anastomosis procedures, employing techniques that ensure coronary sinus drainage into the left atrium, in order to avoid the hemodynamic repercussions attributable to the vascular waterfall mechanism, is not justified.

  8. Could wind replace nuclear?

    International Nuclear Information System (INIS)

    2017-01-01

    This article aims at assessing the situation produced by a total replacement of nuclear energy by wind energy, while facing consumption demand at any moment, notably in December. The authors indicate the evolution of the French energy mix during December 2016, and the evolution of the rate between wind energy production and the sum of nuclear and wind energy production during the same month, and then give briefly some elements regarding necessary investments in wind energy to wholly replace nuclear energy. According to them, such a replacement would be ruinous

  9. Emergency procedures

    International Nuclear Information System (INIS)

    Abd Nasir Ibrahim; Azali Muhammad; Ab Razak Hamzah; Abd Aziz Mohamed; Mohammad Pauzi Ismail

    2004-01-01

    The following subjects are discussed - Emergency Procedures: emergency equipment, emergency procedures; emergency procedure involving X-Ray equipment; emergency procedure involving radioactive sources

  10. Evolution of high tooth replacement rates in sauropod dinosaurs.

    Science.gov (United States)

    D'Emic, Michael D; Whitlock, John A; Smith, Kathlyn M; Fisher, Daniel C; Wilson, Jeffrey A

    2013-01-01

    Tooth replacement rate can be calculated in extinct animals by counting incremental lines of deposition in tooth dentin. Calculating this rate in several taxa allows for the study of the evolution of tooth replacement rate. Sauropod dinosaurs, the largest terrestrial animals that ever evolved, exhibited a diversity of tooth sizes and shapes, but little is known about their tooth replacement rates. We present tooth replacement rate, formation time, crown volume, total dentition volume, and enamel thickness for two coexisting but distantly related and morphologically disparate sauropod dinosaurs Camarasaurus and Diplodocus. Individual tooth formation time was determined by counting daily incremental lines in dentin. Tooth replacement rate is calculated as the difference between the number of days recorded in successive replacement teeth. Each tooth family in Camarasaurus has a maximum of three replacement teeth, whereas each Diplodocus tooth family has up to five. Tooth formation times are about 1.7 times longer in Camarasaurus than in Diplodocus (315 vs. 185 days). Average tooth replacement rate in Camarasaurus is about one tooth every 62 days versus about one tooth every 35 days in Diplodocus. Despite slower tooth replacement rates in Camarasaurus, the volumetric rate of Camarasaurus tooth replacement is 10 times faster than in Diplodocus because of its substantially greater tooth volumes. A novel method to estimate replacement rate was developed and applied to several other sauropodomorphs that we were not able to thin section. Differences in tooth replacement rate among sauropodomorphs likely reflect disparate feeding strategies and/or food choices, which would have facilitated the coexistence of these gigantic herbivores in one ecosystem. Early neosauropods are characterized by high tooth replacement rates (despite their large tooth size), and derived titanosaurs and diplodocoids independently evolved the highest known tooth replacement rates among archosaurs.

  11. Evolution of high tooth replacement rates in sauropod dinosaurs.

    Directory of Open Access Journals (Sweden)

    Michael D D'Emic

    Full Text Available BACKGROUND: Tooth replacement rate can be calculated in extinct animals by counting incremental lines of deposition in tooth dentin. Calculating this rate in several taxa allows for the study of the evolution of tooth replacement rate. Sauropod dinosaurs, the largest terrestrial animals that ever evolved, exhibited a diversity of tooth sizes and shapes, but little is known about their tooth replacement rates. METHODOLOGY/PRINCIPAL FINDINGS: We present tooth replacement rate, formation time, crown volume, total dentition volume, and enamel thickness for two coexisting but distantly related and morphologically disparate sauropod dinosaurs Camarasaurus and Diplodocus. Individual tooth formation time was determined by counting daily incremental lines in dentin. Tooth replacement rate is calculated as the difference between the number of days recorded in successive replacement teeth. Each tooth family in Camarasaurus has a maximum of three replacement teeth, whereas each Diplodocus tooth family has up to five. Tooth formation times are about 1.7 times longer in Camarasaurus than in Diplodocus (315 vs. 185 days. Average tooth replacement rate in Camarasaurus is about one tooth every 62 days versus about one tooth every 35 days in Diplodocus. Despite slower tooth replacement rates in Camarasaurus, the volumetric rate of Camarasaurus tooth replacement is 10 times faster than in Diplodocus because of its substantially greater tooth volumes. A novel method to estimate replacement rate was developed and applied to several other sauropodomorphs that we were not able to thin section. CONCLUSIONS/SIGNIFICANCE: Differences in tooth replacement rate among sauropodomorphs likely reflect disparate feeding strategies and/or food choices, which would have facilitated the coexistence of these gigantic herbivores in one ecosystem. Early neosauropods are characterized by high tooth replacement rates (despite their large tooth size, and derived titanosaurs and

  12. Slab replacement maturity guidelines.

    Science.gov (United States)

    2014-04-01

    This study investigated the use of maturity method to determine early age strength of concrete in slab : replacement application. Specific objectives were (1) to evaluate effects of various factors on the compressive : maturity-strength relationship ...

  13. Partial knee replacement

    Science.gov (United States)

    ... good range of motion in your knee. The ligaments in your knee are stable. However, most people with knee arthritis have a surgery called a total knee arthroplasty (TKA). Knee replacement is most often done in people age 60 ...

  14. Carbohydrates as Fat Replacers.

    Science.gov (United States)

    Peng, Xingyun; Yao, Yuan

    2017-02-28

    The overconsumption of dietary fat contributes to various chronic diseases, which encourages attempts to develop and consume low-fat foods. Simple fat reduction causes quality losses that impede the acceptance of foods. Fat replacers are utilized to minimize the quality deterioration after fat reduction or removal to achieve low-calorie, low-fat claims. In this review, the forms of fats and their functions in contributing to food textural and sensory qualities are discussed in various food systems. The connections between fat reduction and quality loss are described in order to clarify the rationales of fat replacement. Carbohydrate fat replacers usually have low calorie density and provide gelling, thickening, stabilizing, and other texture-modifying properties. In this review, carbohydrates, including starches, maltodextrins, polydextrose, gums, and fibers, are discussed with regard to their interactions with other components in foods as well as their performances as fat replacers in various systems.

  15. Hip joint replacement - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100006.htm Hip joint replacement - series—Normal anatomy To use the ... to slide 5 out of 5 Overview The hip joint is made up of two major parts: ...

  16. Tool Inventory and Replacement

    Science.gov (United States)

    Bear, W. Forrest

    1976-01-01

    Vocational agriculture teachers are encouraged to evaluate curriculum offerings, the new trends in business and industry, and develop a master tool purchase and replacement plan over a 3- to 5-year period. (HD)

  17. Knee joint replacement

    Science.gov (United States)

    ... to make everyday tasks easier. Practice using a cane, walker , crutches , or a wheelchair correctly. On the ... ask your doctor Knee joint replacement - discharge Preventing falls Preventing falls - what to ask your doctor Surgical ...

  18. Product Platform Replacements

    DEFF Research Database (Denmark)

    Sköld, Martin; Karlsson, Christer

    2012-01-01

    . To shed light on this unexplored and growing managerial concern, the purpose of this explorative study is to identify operational challenges to management when product platforms are replaced. Design/methodology/approach – The study uses a longitudinal field-study approach. Two companies, Gamma and Omega...... replacement was chosen in each company. Findings – The study shows that platform replacements primarily challenge managers' existing knowledge about platform architectures. A distinction can be made between “width” and “height” in platform replacements, and it is crucial that managers observe this in order...... to challenge their existing knowledge about platform architectures. Issues on technologies, architectures, components and processes as well as on segments, applications and functions are identified. Practical implications – Practical implications are summarized and discussed in relation to a framework...

  19. The replacement research reactor

    International Nuclear Information System (INIS)

    Cameron, R.

    1999-01-01

    As a consequences of the government decision in September 1997. ANSTO established a replacement research reactor project to manage the procurement of the replacement reactor through the necessary approval, tendering and contract management stages This paper provides an update of the status of the project including the completion of the Environmental Impact Statement. Prequalification and Public Works Committee processes. The aims of the project, management organisation, reactor type and expected capabilities are also described

  20. Pseudoaneurysm of the facial artery following bilateral temporomandibular joint replacement: A case report

    Directory of Open Access Journals (Sweden)

    Lanit Anand

    2017-03-01

    Case report: A 59-year-old male presented to our department with bony ankylosis of his temporomandibular joints bilaterally as a result of previous osteomyelitis. He underwent bilateral temperomandibular joint replacements in a two-stage procedure. Six weeks post discharge he presented to the emergency department in haemorrhagic shock, having lost significant blood volume from a pulsatile lesion over his right mandible. Computed tomography angiography revealed a pseudoaneurysm of the right facial artery. He proceeded to emergent embolisation with resolution of the pseudoaneurysm.

  1. Delirium After Transcatheter Aortic Valve Replacement.

    Science.gov (United States)

    Giuseffi, Jennifer L; Borges, Nyal E; Boehm, Leanne M; Wang, Li; McPherson, John A; Fredi, Joseph L; Ahmad, Rashid M; Ely, E Wesley; Pandharipande, Pratik P

    2017-07-01

    Postoperative delirium is associated with increased mortality. Patients undergoing transcatheter aortic valve replacement are at risk for delirium because of comorbid conditions. To compare the incidence, odds, and mortality implications of delirium between patients undergoing transcatheter replacement and patients undergoing surgical replacement. The Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the Intensive Care Unit were used to assess arousal level and delirium prospectively in all patients with severe aortic stenosis who had transcatheter or surgical aortic valve replacement at an academic medical center. Multivariable logistic regression was used to determine the relationship between procedure type and occurrence of delirium. Cox regression was used to assess the association between postoperative delirium and 6-month mortality. A total of 105 patients had transcatheter replacement and 121 had surgical replacement. Patients in the transcatheter group were older (median age, 81 vs 68 years; P replacement. Delirium is less likely to develop in the transcatheter group but is associated with higher mortality in both groups. ©2017 American Association of Critical-Care Nurses.

  2. 3. Procedures and Recursion

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 1; Issue 6. Algorithms Procedures and Recursion. R K Shyamasundar. Series Article Volume 1 ... Author Affiliations. R K Shyamasundar1. Computer Science Group, Tata Institute of Fundamental Research, Homi Bhabha Road Mumbai 400 005, India.

  3. Preoperative volume calculation of the hepatic venous draining areas with multi-detector row CT in adult living donor liver transplantation: impact on surgical procedure

    International Nuclear Information System (INIS)

    Frericks, Bernd B.J.; Kirchhoff, Timm D.; Shin, Hoen-Oh; Stamm, Georg; Merkesdal, Sonja; Abe, Takehiko; Galanski, Michael; Schenk, Andrea; Peitgen, Heinz-Otto; Klempnauer, Juergen; Nashan, Bjoern

    2006-01-01

    The purpose was to assess the volumes of the different hepatic territories and especially the drainage of the right paramedian sector in adult living donor liver transplantation (ALDLT). CT was performed in 40 potential donors of whom 28 underwent partial living donation. Data sets of all potential donors were postprocessed using dedicated software for segmentation, volumetric analysis and visualization of liver territories. During an initial period, volumes and shapes of liver parts were calculated based on the individual portal venous perfusion areas. After partial hepatic congestion occurring in three grafts, drainage territories with special regard to MHV tributaries from the right paramedian sector, and the IRHV were calculated additionally. Results were visualized three-dimensionally and compared to the intraoperative findings. Calculated graft volumes based on hepatic venous drainage and graft weights correlated significantly (r=0.86,P<0.001). Mean virtual graft volume was 930 ml and drained as follows: RHV: 680 ml, IRHV: 170 ml (n=11); segment 5 MHV tributaries: 100 ml (n=16); segment 8 MHV tributaries: 110 ml (n=20). When present, the mean aberrant venous drainage fraction of the right liver lobe was 28%. The evaluated protocol allowed a reliable calculation of the hepatic venous draining areas and led to a change in the hepatic venous reconstruction strategy at our institution. (orig.)

  4. Nuclear materials management procedures

    International Nuclear Information System (INIS)

    Veevers, K.; Silver, J.M.; Quealy, K.J.; Steege, E. van der.

    1987-10-01

    This manual describes the procedures for the management of nuclear materials and associated materials at the Lucas Heights Research Laboratories. The procedures are designed to comply with Australia's nuclear non-proliferation obligations to the International Atomic Energy Agency (IAEA), bilateral agreements with other countries and ANSTO's responsibilities under the Nuclear Non-Proliferation (Safeguards) Act, 1987. The manual replaces those issued by the Australian Atomic Energy Commission in 1959, 1960 and 1969

  5. Design verification for reactor head replacement

    International Nuclear Information System (INIS)

    Dwivedy, K.K.; Whitt, M.S.; Lee, R.

    2005-01-01

    This paper outlines the challenges of design verification for reactor head replacement for PWR plants and the program for qualification from the prospective of the utility design engineering group. This paper is based on the experience with the design confirmation of four reactor head replacements for two plants, and their interfacing components, parts, appurtenances, and support structures. The reactor head replacement falls under the jurisdiction of the applicable edition of the ASME Section XI code, with particular reference to repair/replacement activities. Under any repair/replacement activities, demands may be encountered in the development of program and plan for replacement due to the vintage of the original design/construction Code and the design reports governing the component qualifications. Because of the obvious importance of the reactor vessel, these challenges take on an added significance. Additional complexities are introduced to the project, when the replacement components are fabricated by vendors different from the original vendor. Specific attention is needed with respect to compatibility with the original design and construction of the part and interfacing components. The program for reactor head replacement requires evaluation of welding procedures, applicable examination, test, and acceptance criteria for material, welds, and the components. Also, the design needs to take into consideration the life of the replacement components with respect to the extended period of operation of the plant after license renewal and other plant improvements. Thus, the verification of acceptability of reactor head replacement provides challenges for development and maintenance of a program and plan, design specification, design report, manufacturer's data report and material certification, and a report of reconciliation. The technical need may also be compounded by other challenges such as widely scattered global activities and organizational barriers, which

  6. Magnetic resonance imaging as a diagnostic method for assessing function. New procedures for the non-invasive quantification of cerebral blood volume and blood flow

    International Nuclear Information System (INIS)

    Gueckel, F.; Rempp, K.; Becker, G.; Koepke, J.; Loose, R.; Brix, G.

    1994-01-01

    This paper presents a brief introduction to the current status of cerebral blood volume and blood flow imaging with magnetic resonance imaging (MRI) techniques. A new method for the quantitative assessment of regional cerebral blood volume (rCBV) and regional cerebral blood flow (rCBF) on the basis of the indicator dilution theory is described and preliminary quantitative results from healthy volunteers are presented. The mean values for the rCBV are 8,27±1,85 ml/100 g for grey matter and 3,78±1,34 ml/100 g for white matter. The mean values for the rCBF are 44,8±11,29 ml/min/100 g for the grey matter and 20,88±8,42 ml/min/100 g for the white matter. These results are in good agreement with PET results from the literature. (orig.) [de

  7. Mechanical Aortic Valve Replacement in Octogenarian

    Directory of Open Access Journals (Sweden)

    Irfan Tasoglu

    2013-10-01

    Full Text Available Aim: This study analyzes the long-term outcomes of mechanical aortic valve replacement in octogenarian patients. Material and Method: A retrospective review was performed on 23 octogenarian patients who underwent mechanical aortic valve replacement. Hospital mortality, postoperative intensive care unit stay, hospital stay and long-term results was examined. Estimates of the cumulative event mortality rate were calculated by the Kaplan-Meier method. Results: The mean age of all patients was 82.9±2.3 years and most were men (65.22%. The median ejection fraction was 45%. 73.91% of patients were in New York Heart Association class III-IV. Thirteen patients (56.52% in this study underwent combined procedure, the remaining 10 (43.48% patients underwent isolated aortic valve replacement. The most common valve size was 23 mm. The mean intensive care unit stay was 1.76±1.14 days. The mean hospital stay was 9.33±5.06 days. No complications were observed in 56.52% patients during their hospital stay. The overall hospital mortality was 8.7%. Follow-up was completed for all 23 patients. Median follow-up time was 33 months (1-108 months. Actuarial survival among discharged from hospital was 59% at 5 years. Discussion: Mechanical aortic valve replacement is a safe procedure in octogenarian patients and can be performed safely even in combined procedure.

  8. Water quality of storm runoff and comparison of procedures for estimating storm-runoff loads, volume, event-mean concentrations, and the mean load for a storm for selected properties and constituents for Colorado Springs, southeastern Colorado, 1992

    Science.gov (United States)

    Von Guerard, Paul; Weiss, W.B.

    1995-01-01

    The U.S. Environmental Protection Agency requires that municipalities that have a population of 100,000 or greater obtain National Pollutant Discharge Elimination System permits to characterize the quality of their storm runoff. In 1992, the U.S. Geological Survey, in cooperation with the Colorado Springs City Engineering Division, began a study to characterize the water quality of storm runoff and to evaluate procedures for the estimation of storm-runoff loads, volume and event-mean concentrations for selected properties and constituents. Precipitation, streamflow, and water-quality data were collected during 1992 at five sites in Colorado Springs. Thirty-five samples were collected, seven at each of the five sites. At each site, three samples were collected for permitting purposes; two of the samples were collected during rainfall runoff, and one sample was collected during snowmelt runoff. Four additional samples were collected at each site to obtain a large enough sample size to estimate storm-runoff loads, volume, and event-mean concentrations for selected properties and constituents using linear-regression procedures developed using data from the Nationwide Urban Runoff Program (NURP). Storm-water samples were analyzed for as many as 186 properties and constituents. The constituents measured include total-recoverable metals, vola-tile-organic compounds, acid-base/neutral organic compounds, and pesticides. Storm runoff sampled had large concentrations of chemical oxygen demand and 5-day biochemical oxygen demand. Chemical oxygen demand ranged from 100 to 830 milligrams per liter, and 5.-day biochemical oxygen demand ranged from 14 to 260 milligrams per liter. Total-organic carbon concentrations ranged from 18 to 240 milligrams per liter. The total-recoverable metals lead and zinc had the largest concentrations of the total-recoverable metals analyzed. Concentrations of lead ranged from 23 to 350 micrograms per liter, and concentrations of zinc ranged from 110

  9. PRA Procedures Guide: a guide to the performance of probabilistic risk assessments for nuclear power plants. Final report, Volume 1 - Chapters 1-8

    International Nuclear Information System (INIS)

    1983-01-01

    This document, the Probabilistic Risk Assessment (PRA) Procedures Guide, is intended to provide an overview of the risk-assessment field as it exists today and to identify acceptable techniques for the systematic assessment of the risk from nuclear power plants. Topics discussed include: organization of PRA; accident-sequence definition and system modeling; human-reliability analysis; data-base development; accident-sequence quantification; physical processes of core-melt accidents; and radionuclide release and transport

  10. Criteria for the replacement of restorations

    DEFF Research Database (Denmark)

    Wilson, Nairn; Lynch, Christopher; Brunton, Paul Brunton

    2016-01-01

    The replacement of a restoration is one of the most common procedures in dentistry. However, the criteria for such intervention, excluding catastrophic failure and persistent discomfort and pain, continue to be the subject of considerable debate. The decision-making process remains subjective...... on the part of the treating clinician, while the evidence base for refurbishment and repair rather than replacement for the management of defective and failing restorations continues to grow and strengthen. This article, prepared as an Academy of Operative Dentistry European Section consensus publication...

  11. Pretreatment procedures

    International Nuclear Information System (INIS)

    Anon.

    1989-01-01

    It is frequently in the patient's best interest that radiation treatments are initiated soon after the decision to treat is made. However, it is essential to good radiation therapy that the patient's treatment course be planned and beam-modifying devices be fabricated with utmost care prior to treatment. The objectives of the treatment, along with the treatment parameters and techniques necessary to achieve these objectives, must be discussed prior to initiating planning procedures. Determination of the target volume is made by the radiation oncologist; this is based on knowledge of the history of the tumor, the patterns of spread of the disease, and on diagnostic findings during the work-up of each patient. It is then necessary to obtain several measurements of the patient and also to identify the position of the target volume and of adjacent normal organs with respect to known external skin marks before the actual treatment planning is begun. Such localization can be done through several methods. The two most commonly used methods are radiographic and computed tomography (CT), both of which are discussed in this chapter. The measurements often include contours of the patient's external surface, usually in the axial plane of the central axis of the beam, and often in multiple levels within the region to be treated. Three dimensional localization and treatment planning requires thorough understanding of geometry as well as of patient positioning and immobilization. This chapter attempts to clarify some of these complicated but essential preparations for treatment

  12. Development of an approach to facilitate optimal equipment replacement.

    Science.gov (United States)

    1999-10-01

    The principle objective of this study was to develop a procedure using available departmental data on operation, maintenance and replacement costs to provide the Louisiana Department of Transportation and Development with guidelines for the identific...

  13. Equal Pay for Equal Work: Medicare Procedure Volume and Reimbursement for Male and Female Surgeons Performing Total Knee and Total Hip Arthroplasty.

    Science.gov (United States)

    Holliday, Emma B; Brady, Christina; Pipkin, William C; Somerson, Jeremy S

    2018-02-21

    The observed sex gap in physician salary has been the topic of much recent debate in the United States, but it has not been well-described among orthopaedic surgeons. The objective of this study was to evaluate for sex differences in Medicare claim volume and reimbursement among orthopaedic surgeons. The Medicare Provider Utilization and Payment Public Use File was used to compare claim volume and reimbursement between female and male orthopaedic surgeons in 2013. Data were extracted for each billing code per orthopaedic surgeon in the year 2013 for total claims, surgical claims, total knee arthroplasty (TKA) claims, and total hip arthroplasty (THA) claims. A total of 20,546 orthopaedic surgeons who treated traditional Medicare patients were included in the initial analysis. Claim volume and reimbursement received were approximately twofold higher for all claims and more than threefold higher for surgical claims for male surgeons when compared with female surgeons (p 10 TKAs and THAs, respectively, in 2013 for Medicare patients and were included in the subset analyses. Although male surgeons performed a higher mean number of TKAs than female surgeons (mean and standard deviation, 37 ± 33 compared with 26 ± 17, respectively, p men and women for TKA or THA ($1,135 ± $228 compared with $1,137 ± $184 for TKA, respectively, p = 0.380; $1,049 ± $226 compared with $1,043 ± $266 for THA, respectively, p = 0.310). Female surgeons had a lower number of total claims and reimbursements compared with male surgeons. However, among surgeons who performed >10 THAs and TKAs, there were no sex differences in the mean reimbursement payment per surgeon. The number of women in orthopaedics is rising, and there is much interest in how their productivity and compensation compare with their male counterparts.

  14. Prioritizing equipment for replacement.

    Science.gov (United States)

    Capuano, Mike

    2010-01-01

    It is suggested that clinical engineers take the lead in formulating evaluation processes to recommend equipment replacement. Their skill, knowledge, and experience, combined with access to equipment databases, make them a logical choice. Based on ideas from Fennigkoh's scheme, elements such as age, vendor support, accumulated maintenance cost, and function/risk were used.6 Other more subjective criteria such as cost benefits and efficacy of newer technology were not used. The element of downtime was also omitted due to the data element not being available. The resulting Periop Master Equipment List and its rationale was presented to the Perioperative Services Program Council. They deemed the criteria to be robust and provided overwhelming acceptance of the list. It was quickly put to use to estimate required capital funding, justify items already thought to need replacement, and identify high-priority ranked items for replacement. Incorporating prioritization criteria into an existing equipment database would be ideal. Some commercially available systems do have the basic elements of this. Maintaining replacement data can be labor-intensive regardless of the method used. There is usually little time to perform the tasks necessary for prioritizing equipment. However, where appropriate, a clinical engineering department might be able to conduct such an exercise as shown in the following case study.

  15. Thyroid hormone replacement therapy

    NARCIS (Netherlands)

    Wiersinga, W. M.

    2001-01-01

    Thyroid hormone replacement has been used for more than 100 years in the treatment of hypothyroidism, and there is no doubt about its overall efficacy. Desiccated thyroid contains both thyroxine (T(4)) and triiodothyronine (T(3)); serum T(3) frequently rises to supranormal values in the absorption

  16. Can photovoltaic replace nuclear?

    International Nuclear Information System (INIS)

    2017-01-01

    As the French law on energy transition for a green growth predicts that one third of nuclear energy production is to be replaced by renewable energies (wind and solar) by 2025, and while the ADEME proposes a 100 per cent renewable scenario for 2050, this paper proposes a brief analysis of the replacement of nuclear energy by solar photovoltaic energy. It presents and discusses some characteristics of photovoltaic production: production level during a typical day for each month (a noticeable lower production in December), evolution of monthly production during a year, evolution of the rate between nuclear and photovoltaic production. A cost assessment is then proposed for energy storage and for energy production, and a minimum cost of replacement of nuclear by photovoltaic is assessed. The seasonal effect is outlined, as well as the latitude effect. Finally, the authors outline the huge cost of such a replacement, and consider that public support to new photovoltaic installations without an at least daily storage mean should be cancelled

  17. Fluorescent Lamp Replacement Study

    Science.gov (United States)

    2017-07-01

    not be cited for purposes of advertisement. DISPOSITION INSTRUCTIONS: Destroy this document when no longer needed. Do not return to the... recycling , and can be disposed safely in a landfill. (2) LEDs offer reduced maintenance costs and fewer bulb replacements, significantly reducing... recycling . Several fixtures, ballasts and energy efficient fluorescent bulbs that were determined to be in pristine condition were returned to ATC

  18. Replacing Recipe Realism

    OpenAIRE

    Saatsi, J

    2017-01-01

    Many realist writings exemplify the spirit of ‘recipe realism’. Here I characterise recipe realism, challenge it, and propose replacing it with ‘exemplar realism’. This alternative understanding of realism is more piecemeal, robust, and better in tune with scientists’ own attitude towards their best theories, and thus to be preferred.

  19. Personalised external aortic root support (PEARS) in Marfan syndrome: analysis of 1-9 year outcomes by intention-to-treat in a cohort of the first 30 consecutive patients to receive a novel tissue and valve-conserving procedure, compared with the published results of aortic root replacement.

    Science.gov (United States)

    Treasure, Tom; Takkenberg, Johanna J M; Golesworthy, Tal; Rega, Filip; Petrou, Mario; Rosendahl, Ulrich; Mohiaddin, Raad; Rubens, Michael; Thornton, Warren; Lees, Belinda; Pepper, John

    2014-06-01

    Among people with Marfan syndrome who have a typical aortic root aneurysm, dissection is a characteristic cause of premature death. To pre-empt Type A dissection, composite root replacement with a mechanical valve became the standard of care in the 1980s and 1990s. This is being superseded by valve-sparing aortic root replacement to avoid lifelong anticoagulation. In 2004, a total root and valve-sparing procedure, personalised external aortic support, was introduced. We report here results among the first 30 recipients. From cross-sectional digital images, the patient's own aorta is modelled by computer aided design and a replica is made in thermoplastic by rapid prototyping. On this, a personalised support of a macroporous polymer mesh is manufactured. The mesh is positioned around the aorta, closely applied from the aortoventricular junction to beyond the brachiocephalic artery. The operation is performed with a beating heart and usually without cardiopulmonary bypass. Between 2004 and 2011, 30 patients, median age 28 years (IQR 20-44) had this operation and have been prospectively followed for 1.4-8.8 years by February 2013. During a total of 133 patient-years there were no deaths or cerebrovascular, aortic or valve-related events. These early outcomes are better than published results for the more radical extirpative root replacement operations. The aortic valve, the root architecture, and the blood/endothelia interface are conserved. The perioperative burden is less and there has been freedom from aortic and valvular events. A prospective comparative study is planned. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  20. Personalised external aortic root support (PEARS) in Marfan syndrome: analysis of 1–9 year outcomes by intention-to-treat in a cohort of the first 30 consecutive patients to receive a novel tissue and valve-conserving procedure, compared with the published results of aortic root replacement

    Science.gov (United States)

    Treasure, Tom; Takkenberg, Johanna J M; Golesworthy, Tal; Rega, Filip; Petrou, Mario; Rosendahl, Ulrich; Mohiaddin, Raad; Rubens, Michael; Thornton, Warren; Lees, Belinda; Pepper, John

    2014-01-01

    Objective Among people with Marfan syndrome who have a typical aortic root aneurysm, dissection is a characteristic cause of premature death. To pre-empt Type A dissection, composite root replacement with a mechanical valve became the standard of care in the 1980s and 1990s. This is being superseded by valve-sparing aortic root replacement to avoid lifelong anticoagulation. In 2004, a total root and valve-sparing procedure, personalised external aortic support, was introduced. We report here results among the first 30 recipients. Methods From cross-sectional digital images, the patient's own aorta is modelled by computer aided design and a replica is made in thermoplastic by rapid prototyping. On this, a personalised support of a macroporous polymer mesh is manufactured. The mesh is positioned around the aorta, closely applied from the aortoventricular junction to beyond the brachiocephalic artery. The operation is performed with a beating heart and usually without cardiopulmonary bypass. Results Between 2004 and 2011, 30 patients, median age 28 years (IQR 20–44) had this operation and have been prospectively followed for 1.4–8.8 years by February 2013. During a total of 133 patient-years there were no deaths or cerebrovascular, aortic or valve-related events. These early outcomes are better than published results for the more radical extirpative root replacement operations. Conclusions The aortic valve, the root architecture, and the blood/endothelia interface are conserved. The perioperative burden is less and there has been freedom from aortic and valvular events. A prospective comparative study is planned. PMID:24395977

  1. Imaging techniques in transcatheter aortic valve replacement

    Directory of Open Access Journals (Sweden)

    Quaife RA

    2013-11-01

    Full Text Available Robert A Quaife, Jennifer Dorosz, John C Messenger, Ernesto E Salcedo Division of Cardiology, University of Colorado, Aurora, CO, USA Abstract: Calcific aortic stenosis is now understood as a complex valvular degenerative process sharing many risk factors with atherosclerosis. Once patients develop symptomatic calcific aortic stenosis, the only effective treatment is aortic valve replacement. In the past decade, transcatheter aortic valve replacement (TAVR has been developed as an alternative to surgery to treat severe calcific aortic stenosis. Cardiac imaging plays a pivotal role in the contemporary management of patients with calcific aortic stenosis, and particularly in patients being considered for TAVR, who demand detailed imaging of the aortic valve apparatus. In this review, we highlight the role of cardiac imaging for patient selection, procedural guidance, and evaluation of results of TAVR. Keywords: aortic stenosis, cardiovascular imaging, transcutaneous aortic valve replacement

  2. The replacement research reactor

    International Nuclear Information System (INIS)

    Cameron, R.; Horlock, K.

    2001-01-01

    The contract for the design, construction and commissioning of the Replacement Research Reactor was signed in July 2000. This was followed by the completion of the detailed design and an application for a construction licence was made in May 2001. This paper will describe the main elements of the design and their relation to the proposed applications of the reactor. The future stages in the project leading to full operation are also described

  3. Apparatus for fuel replacement

    International Nuclear Information System (INIS)

    Imada, Takahiko.

    1974-01-01

    Object: To support a telescope mast such that no deforming load is applied to it even during massive vibration, it is held fixed at the time of fuel replacement to permit satisfactory remote control operation by automatic operation. Structure: The body of the fuel replacement apparatus is provided with telescope mast fixing means comprising a slide base supported for reciprocal movement with respect to a telescope mast, an operating arm pivoted at the slide base, a wrist member mounted on the free end of the operating arm and an engagement member for restricting the slide base and operating arm at the time of loading and unloading the fuel. When loading and unloading the fuel, the slide base and operating arm are restrained by the engagement member to reliably restrict the vibration of the telescope mast. When the fuel replacement apparatus is moved, the means provided on the operating arm is smoothly displaced to follow the swing (vibration) of the telescope mast to prevent the deforming load from being applied to the support portion or other areas. The wrist member supports the telescope mast such that it can be rotated while restraining movement in the axial direction, and it is provided with revolution drive means for rotating the telescope mast under remote control. (Kamimura, M.)

  4. Redesigning a joint replacement program using Lean Six Sigma in a Veterans Affairs hospital.

    Science.gov (United States)

    Gayed, Benjamin; Black, Stephen; Daggy, Joanne; Munshi, Imtiaz A

    2013-11-01

    In April 2009, an analysis of joint replacement surgical procedures at the Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, revealed that total hip and knee replacements incurred $1.4 million in non-Veterans Affairs (VA) care costs with an average length of stay of 6.1 days during fiscal year 2008. The Joint Replacement Program system redesign project was initiated following the Vision-Analysis-Team-Aim-Map-Measure-Change-Sustain (VA-TAMMCS) model to increase efficiency, decrease length of stay, and reduce non-VA care costs. To determine the effectiveness of Lean Six Sigma process improvement methods applied in a VA hospital. Perioperative processes for patients undergoing total joint replacement were redesigned following the VA-TAMMCS model--the VA's official, branded method of Lean Six Sigma process improvement. A multidisciplinary team including the orthopedic surgeons, frontline staff, and executive management identified waste in the current processes and initiated changes to reduce waste and increase efficiency. Data collection included a 1-year baseline period and a 20-month sustainment period. The primary endpoint was length of stay; a secondary analysis considered non-VA care cost reductions. Length of stay decreased 36% overall, decreasing from 5.3 days during the preproject period to 3.4 days during the 20-month sustainment period (P Lean and Six Sigma process improvement initiatives in a surgical practice, producing a 36% sustained reduction in length of stay and completely eliminating non-VA care for total hip and knee replacements while increasing total joint replacement volume at this medical center.

  5. Human factors evaluation of remote afterloading brachytherapy. Supporting analyses of human-system interfaces, procedures and practices, training and organizational practices and policies. Volume 3

    International Nuclear Information System (INIS)

    Callan, J.R.; Kelly, R.T.; Quinn, M.L.

    1995-07-01

    A human factors project on the use of nuclear by-product material to treat cancer using remotely operated afterloaders was undertaken by the Nuclear Regulatory Commission. The purpose of the project was to identify factors that contribute to human error in the system for remote afterloading brachytherapy (RAB). This report documents the findings from the second, third, fourth, and fifth phases of the project, which involved detailed analyses of four major aspects of the RAB system linked to human error: human-system interfaces; procedures and practices; training practices and policies; and organizational practices and policies, respectively. Findings based on these analyses provided factual and conceptual support for the final phase of this project, which identified factors leading to human error in RAB. The impact of those factors on RAB performance was then evaluated and prioritized in terms of safety significance, and alternative approaches for resolving safety significant problems were identified and evaluated

  6. Human factors evaluation of remote afterloading brachytherapy. Supporting analyses of human-system interfaces, procedures and practices, training and organizational practices and policies. Volume 3

    Energy Technology Data Exchange (ETDEWEB)

    Callan, J.R.; Kelly, R.T.; Quinn, M.L. [Pacific Science & Engineering Group, San Diego, CA (United States)] [and others

    1995-07-01

    A human factors project on the use of nuclear by-product material to treat cancer using remotely operated afterloaders was undertaken by the Nuclear Regulatory Commission. The purpose of the project was to identify factors that contribute to human error in the system for remote afterloading brachytherapy (RAB). This report documents the findings from the second, third, fourth, and fifth phases of the project, which involved detailed analyses of four major aspects of the RAB system linked to human error: human-system interfaces; procedures and practices; training practices and policies; and organizational practices and policies, respectively. Findings based on these analyses provided factual and conceptual support for the final phase of this project, which identified factors leading to human error in RAB. The impact of those factors on RAB performance was then evaluated and prioritized in terms of safety significance, and alternative approaches for resolving safety significant problems were identified and evaluated.

  7. CANDU-PHW fuel channel replacement experience

    International Nuclear Information System (INIS)

    Dunn, J.T.; Kakaria, B.K.

    1982-09-01

    One of the main characteristics of the CANDU pressurized heavy water reactor is the use of pressure tubes rather than one large pressure vessel to contain the fuel and coolant. This provides an inherent design capability to permit their replacement in an expeditious manner, without seriously affecting the high capacity factors of the reactor units. Of th eight Ontario Hydro commercial nuclear generating units, the lifetime performance places seven of them (including two that have had some of their fuel channels replaced), in the top ten positions in the world's large nuclear-electric unit performance ranking. Pressure tube cracks in the rolled joint region have resulted in 70 fuel channels being replaced in three reactor units, the latest being at the Bruce Nuclear Generating Station 'A', Unit 2 in February 1982. The rolled joint design and rolling procedures have been modified to eliminate this problem on CANDU units subsequent to Bruce 'A'. This paper describes the CANDU pressure tube performance history and expectations, and the tooling and procedures used to carry out the fuel channel replacement

  8. Ridge augmentation with soft tissue procedures in aesthetic dentistry: pre- and postoperative volume measurements with a new kind of moire technique

    Science.gov (United States)

    Studer, Stephan P.; Mueller, Ernst; Bucher, Alfred

    1993-09-01

    The aim of this paper was to measure the volume differences of operated alveolar ridge defects before and until 3 months post-surgically. Ten patients with ten localized alveolar ridge defects were operated on. Five alveolar ridge defects were corrected by using the full thickness onlay graft technique and the other five defects were operated by the subepithelial connective tissue graft technique. A strict standardized operation protocol was followed and all alveolar ridge defects were operated on by the same dental surgeon. Before as well as 1, 2, and 3 months after surgery the corrected defect was photographed and an impression was made by using an A-silicon material to produce a gypsum-cast model. The form of all these cast models was then measured using the moire technique. The three months result of ten cases shows that the form of the operated alveolar ridge defects, which were corrected by the subepithelial connective tissue graft technique are more stable compared to those which were operated on by the full thickness onlay graft technique. Localized alveolar ridge defects using the latter method does not show a form stability after 3 months post-surgically.

  9. Selection and delineation of lymph node target volumes in head and neck conformal radiotherapy. proposal for standardizing terminology and procedure based on the surgical experience

    International Nuclear Information System (INIS)

    Gregoire, V.; Coche, E.; Cosnard, G.; Hamoir, M.; Reychler, H.

    2000-01-01

    The increasing use of 3D treatment planning in head and neck radiation oncology has created an urgent need for new guidelines for the selection and the delineation of the neck node areas to be included in the clinical target volume. Surgical literature has provided us with valuable information on the extent of pathological nodal involvement in the neck as a function of the primary tumor site. In addition, few clinical series have also reported information on radiological nodal involvement in those areas not commonly included in radical neck dissection. Taking all these data together, guidelines for the selection of the node levels to be irradiated for the major head and neck sites could be proposed. To fill the missing link between these Guidelines and the 3D treatment planning, recommendations for the delineation of these node levels (levels I-VI and retropharyngeal) on CT (or MRI) slices have been proposed using the guidelines outlined by the Committee for Head and Neck Surgery and Oncology of the American Academy for Otolarynology-Head and Neck Surgery. These guidelines were adapted to take into account specific radiological landmarks more easily identified on CT or MRI slices than in the operating field. (author)

  10. Toleration, Synthesis or Replacement?

    DEFF Research Database (Denmark)

    Holtermann, Jakob v. H.; Madsen, Mikael Rask

    2016-01-01

    , in order to answer is not yet another partisan suggestion, but rather an attempt at making intelligible both the oppositions and the possibilities of synthesis between normative and empirical approaches to law. Based on our assessment and rational reconstruction of current arguments and positions, we...... therefore outline a taxonomy consisting of the following three basic, ideal-types in terms of the epistemological understanding of the interface of law and empirical studies: toleration, synthesis and replacement. This tripartite model proves useful with a view to teasing out and better articulating...

  11. Upgrade, rebuild or replace?

    International Nuclear Information System (INIS)

    Forbes, C.A.

    1990-01-01

    Ageing reactor simulators present some tough decisions for utility managers. Although most utilities have chosen the cheaper, upgrading solution as the best compromise between costs and outage length, some US utilities have found that for them, replacement represents the best option. Simulators may be less than ten years old, but they have limited instructor systems, older low fidelity models that cannot reproduce important training scenarios, and out of date, difficult to maintain computers that do not permit much expansion of the models anyway. Perhaps worse than this is the possibility that the simulator may no longer be a faithful reproduction of the referenced plant, or have poor (or non-existent) documentation. (author)

  12. Correlation between left ventricular diastolic function before and after valve replacement surgery and myocardial ultrastructural changes in patients with left ventricular volume-overloaded valvular heart diseases; Evaluation with gated blood pool scintigraphy using [sup 99m]Tc

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Tomiro (Okayama Univ. (Japan). School of Medicine)

    1993-06-01

    Left ventricular (LV) diastolic functions in 23 patients with aortic regurgitation (AR) and 22 patients with mitral regurgitation (MR) were evaluated by gated blood pool scintigraphy. LV myocardial biopsy was performed during open heart surgery, and LV myocardial ultrastructural changes were evaluated by electron microscope. Correlation between LV diastolic function and myocardial ultrastructural changes was examined. It was suggested that preoperative LV diastolic dysfunction occurred earlier than LV systolic dysfunction in patients with AR and MR. LV early diastolic dysfunction was especially significant in patients with AR. LV systolic function was significantly improved postoperatively compared with LV diastolic function in patients with AR and MR. It was suggested that LV interstitial fibrosis caused LV diastolic dysfunction in patients with AR and MR, and insufficiency of myocardial thickening as compensation in patients with MR. It was presumed that LV diastolic dysfunction was irreversible in patients with AR and MR in the distant postoperative period due to persistence of the preoperative myocardial ultrastructural change, e.g., interstitial fibrosis. These LV diastolic indices measured by gated pool scintigraphy were useful in predicting LV ultrastructural changes and postoperative LV dysfunction in patients with LV volume-overloaded valvular heart disease. (author).

  13. THE REPLACEMENT-RENEWAL OF INDUSTRIAL EQUIPMENTS. THE MAPI FORMULAS

    Directory of Open Access Journals (Sweden)

    Meo Colombo Carlotta

    2010-07-01

    Full Text Available Since the production has been found to be an economical means for satisfying human wants, this process requires a complex industrial organization together with a large investment in equipments, plants and productive systems. These productive systems are employed to alter the physical environment and create consumer goods. As a result, they are consumed or become obsolete, inadequate, or otherwise candidates for replacement. When replacement is being considered, two assets must be evaluated: the present asset, the defender and its potential replacement, the challenger. Since the success of an industrial organization depends upon profit, replacement should generally occur if an economic advantage will result. Whatever the reason leading to the consideration of replacement, the analysis and decisions must be based upon estimates of what will occur in the future. In this paper we present the Mapi algorithm as a procedure for evaluating investments or for analyzing replacement opportunities.

  14. The need for unique risk adjustment for surgical site infections at a high-volume, tertiary care center with inherent high-risk colorectal procedures.

    Science.gov (United States)

    Gorgun, E; Benlice, C; Hammel, J; Hull, T; Stocchi, L

    2017-08-01

    The aim of the present study was to create a unique risk adjustment model for surgical site infection (SSI) in patients who underwent colorectal surgery (CRS) at the Cleveland Clinic (CC) with inherent high risk factors by using a nationwide database. The American College of Surgeons National Surgical Quality Improvement Program database was queried to identify patients who underwent CRS between 2005 and 2010. Initially, CC cases were identified from all NSQIP data according to case identifier and separated from the other NSQIP centers. Demographics, comorbidities, and outcomes were compared. Logistic regression analyses were used to assess the association between SSI and center-related factors. A total of 70,536 patients met the inclusion criteria and underwent CRS, 1090 patients (1.5%) at the CC and 69,446 patients (98.5%) at other centers. Male gender, work-relative value unit, diagnosis of inflammatory bowel disease, pouch formation, open surgery, steroid use, and preoperative radiotherapy rates were significantly higher in the CC cases. Overall morbidity and individual postoperative complication rates were found to be similar in the CC and other centers except for the following: organ-space SSI and sepsis rates (higher in the CC cases); and pneumonia and ventilator dependency rates (higher in the other centers). After covariate adjustment, the estimated degree of difference between the CC and other institutions with respect to organ-space SSI was reduced (OR 1.38, 95% CI 1.08-1.77). The unique risk adjustment strategy may provide center-specific comprehensive analysis, especially for hospitals that perform inherently high-risk procedures. Higher surgical complexity may be the reason for increased SSI rates in the NSQIP at tertiary care centers.

  15. Power Plant Replacement Study

    Energy Technology Data Exchange (ETDEWEB)

    Reed, Gary

    2010-09-30

    This report represents the final report for the Eastern Illinois University power plant replacement study. It contains all related documentation from consideration of possible solutions to the final recommended option. Included are the economic justifications associated with the chosen solution along with application for environmental permitting for the selected project for construction. This final report will summarize the results of execution of an EPC (energy performance contract) investment grade audit (IGA) which lead to an energy services agreement (ESA). The project includes scope of work to design and install energy conservation measures which are guaranteed by the contractor to be self-funding over its twenty year contract duration. The cost recovery is derived from systems performance improvements leading to energy savings. The prime focus of this EPC effort is to provide a replacement solution for Eastern Illinois University's aging and failing circa 1925 central steam production plant. Twenty-three ECMs were considered viable whose net impact will provide sufficient savings to successfully support the overall project objectives.

  16. Cadmium plating replacements

    Energy Technology Data Exchange (ETDEWEB)

    Nelson, M.J.; Groshart, E.C.

    1995-03-01

    The Boeing Company has been searching for replacements to cadmium plate. Two alloy plating systems seem close to meeting the needs of a cadmium replacement. The two alloys, zinc-nickel and tin-zinc are from alloy plating baths; both baths are neutral pH. The alloys meet the requirements for salt fog corrosion resistance, and both alloys excel as a paint base. Currently, tests are being performed on standard fasteners to compare zinc-nickel and tin-zinc on threaded hardware where cadmium is heavily used. The Hydrogen embrittlement propensity of the zinc-nickel bath has been tested, and just beginning for the tin-zinc bath. Another area of interest is the electrical properties on aluminum for tin-zinc and will be discussed. The zinc-nickel alloy plating bath is in production in Boeing Commercial Airplane Group for non-critical low strength steels. The outlook is promising that these two coatings will help The Boeing Company significantly reduce its dependence on cadmium plating.

  17. REPLACEMENT OF FRENCH CARDS

    CERN Multimedia

    Human Resources Division

    2001-01-01

    The French Ministry of Foreign Affairs has informed the Organization that it is shortly to replace all diplomatic cards, special cards and employment permits ('attestations de fonctions') now held by members of the personnel and their families. Between 2 July and 31 December 2001, these cards are to be replaced by secure, computerized equivalents. A 'personnel office' stamped photocopy of the old cards may continue to be used until 31 December 2001. For the purposes of the handover, members of the personnel must go personally to the cards office (33/1-015), between 8:30 and 12:30, in order to fill a 'fiche individuelle' form (in black ink only), which has to be personally signed by themselves and another separately signed by members of their family, taking the following documents for themselves and members of their families already in possession of a French card : A recent identity photograph in 4.5 cm x 3.5 cm format (signed on the back) The French card in their possession an A4 photocopy of the same Fre...

  18. Power Plant Replacement Study

    Energy Technology Data Exchange (ETDEWEB)

    Reed, Gary

    2010-09-30

    This report represents the final report for the Eastern Illinois University power plant replacement study. It contains all related documentation from consideration of possible solutions to the final recommended option. Included are the economic justifications associated with the chosen solution along with application for environmental permitting for the selected project for construction. This final report will summarize the results of execution of an EPC (energy performance contract) investment grade audit (IGA) which lead to an energy services agreement (ESA). The project includes scope of work to design and install energy conservation measures which are guaranteed by the contractor to be self-funding over its twenty year contract duration. The cost recovery is derived from systems performance improvements leading to energy savings. The prime focus of this EPC effort is to provide a replacement solution for Eastern Illinois University’s aging and failing circa 1925 central steam production plant. Twenty-three ECMs were considered viable whose net impact will provide sufficient savings to successfully support the overall project objectives.

  19. Steam generator replacement from ALARA aspects

    International Nuclear Information System (INIS)

    Terry, I.; Breznik, B.

    2003-01-01

    This paper is going to consider radiological related parameters important for steam generator replacement (SGR) implementation. These parameters are identified as ALARA related parameters, owner-contractor relationship, planning, health physics with logistic services, and time required for the replacement. ALARA related parameters such as source or initial dose rate and plant system configuration define the initial conditions for the planning. There is room to optimise work planning. managerial procedures and also the staff during the implementation phase. The overview of these general considerations is based on the following background: using internationally available data and the experience of one of the vendors, i.e. Siemens-Framatome, and management experience of SG replacement which took place at Krsko NPP in the spring of 2000. Generally plant decisions on maintenance or repair procedures under radiation conditions take into account ALARA considerations. But in the main it is difficult to adjudge the results of an ALARA study, usually in the form of a collective dose estimate, because a comparison standard is missing. That is, very often the planned work is of a one-off nature so comparisons are not possible or the scopes are not the same. In such a case the collective doses for other types of work are looked at and a qualitative evaluation is made. In the case of steam generator replacement this is not the case. Over years of steam generator replacements world-wide a standard has been developed gradually. The first part of the following displays an overview of SGR and sets the Krsko SGR in perspective by applying dose analysis. The second part concentrates on the Krsko SGR itself and its ALARA aspects. (authors)

  20. ISP-27 OECD/NEA/CSNI International Standard Problem n.27. Bethsy experiment 9.1 B. 2. cold leg break without HPSI and with delayed ultimate procedure. Comparison report. Volume 1 + 2

    International Nuclear Information System (INIS)

    1992-11-01

    This report is the final comparison report for ISP-27, a blind problem which is based on the BETHSY test 9.1b performed in december 1989 at the Nuclear Research Center in Grenoble (France). The BETHSY integral test facility is a scaled down model of a 3 loop 900 e MW FRAMATOME PWR; the overall scaling factor applied to every volume, mass flowrate and power level is close to 1/100, while elevations are 1/1 in order to preserve the gravitational heads. The cold leg break is combined with the High Pressure Injection System (HPIS) failure. In that case, the state oriented approach requires operators to start an Ultimate Procedure, which consists in fully opening the Steam Generator (SG) atmospheric dumps as soon as they are informed of the unavailability of the HPIS. The presently studied scenario assumes a delayed application of this procedure, which is started only when the core outlet temperature rises significantly higher than the saturation temperature. The BETHSY Test 9.1b addresses, besides typical problems relevant to Small Break Loss Of Coolant Accidents (SBLOCA) such as critical 2-phase flow, loop seal clearing, heat-transfer during boil-off or accumulator injection, specific aspects related to the fast depressurization (primary to secondary and structural heat transfer), uncovered core behavior when intense condensation takes place in the SG, and primary side refilling by the Low Pressure Injection System (LPIS)

  1. Changing of the guard: reducing infection when replacing neural pacemakers.

    Science.gov (United States)

    Pepper, Joshua; Meliak, Lara; Akram, Harith; Hyam, Jonathan; Milabo, Catherine; Candelario, Joseph; Foltynie, Thomas; Limousin, Patricia; Curtis, Carmel; Hariz, Marwan; Zrinzo, Ludvic

    2017-04-01

    OBJECTIVE Infection of deep brain stimulation (DBS) hardware has a significant impact on patient morbidity. Previous experience suggests that infection rates appear to be higher after implantable pulse generator (IPG) replacement surgery than after the de novo DBS procedure. In this study the authors examine the effect of a change in practice during DBS IPG replacements at their institution. METHODS Starting in January 2012, patient screening for methicillin-resistant Staphylococcus aureus (MRSA) and, and where necessary, eradication was performed prior to elective DBS IPG change. Moreover, topical vancomycin was placed in the IPG pocket during surgery. The authors then prospectively examined the infection rate in patients undergoing DBS IPG replacement at their center over a 3-year period with at least 9 months of follow-up. RESULTS The total incidence of infection in this prospective consecutive series of 101 IPG replacement procedures was 0%, with a mean follow-up duration of 24 ± 11 months. This was significantly lower than the authors' previously published historical control group, prior to implementing the change in practice, where the infection rate for IPG replacement was 8.5% (8/94 procedures; p = 0.003). CONCLUSIONS This study suggests that a change in clinical practice can significantly lower infection rates in patients undergoing DBS IPG replacement. These simple measures can minimize unnecessary surgery, loss of benefit from chronic stimulation, and costly hardware replacement, further improving the cost efficacy of DBS therapies.

  2. Replace with abstract title

    Science.gov (United States)

    Coho, Aleksander; Kioussis, Nicholas

    2003-03-01

    We use the semidiscrete variational generelized Peierls-Nabarro model to study the effect of Cu alloying on the dislocation properties of Al. First-principles density functional theory (DFT) is used to calculate the generalized-stacking-fault (GSF) energy surface when a plane, on which one in four Al atoms has been replaced with a Cu atom, slips over a pure Al plane. Various dislocation core properties (core width, energy, Peierls stress, dissociation tendency) are investigated and compared with the pure Al case. Cu alloying lowers the intrinsic stacking fault (ISF) energy, which makes dislocations more likely to dissociate into partials. We also try to understand the lowering of ISF energy in terms of Al-Cu and Al-Al bond formation and braking during shearing along the direction. From the above we draw conclusions about the effects of Cu alloying on the mechanical properties of Al.

  3. Iron replacement therapy

    DEFF Research Database (Denmark)

    Nielsen, Ole Haagen; Coskun, Mehmet; Weiss, Günter

    2016-01-01

    PURPOSE OF REVIEW: Approximately, one-third of the world's population suffers from anemia, and at least half of these cases are because of iron deficiency. With the introduction of new intravenous iron preparations over the last decade, uncertainty has arisen when these compounds should...... be administered and under which circumstances oral therapy is still an appropriate and effective treatment. RECENT FINDINGS: Numerous guidelines are available, but none go into detail about therapeutic start and end points or how iron-deficiency anemia should be best treated depending on the underlying cause...... of iron deficiency or in regard to concomitant underlying or additional diseases. SUMMARY: The study points to major issues to be considered in revisions of future guidelines for the true optimal iron replacement therapy, including how to assess the need for treatment, when to start and when to stop...

  4. Central alarm system replacement in NPP Krsko

    International Nuclear Information System (INIS)

    Cicvaric, D.; Susnic, M.; Djetelic, N.

    2004-01-01

    Current NPP Krsko central alarm system consists of three main segments. Main Control Board alarm system (BETA 1000), Ventilation Control Board alarm system (BETA 1000) and Electrical Control Board alarm system (BETA 1100). All sections are equipped with specific BetaTone audible alarms and silence, acknowledge as well as test push buttons. The main reason for central alarm system replacement is system obsolescence and problems with maintenance, due to lack of spare parts. Other issue is lack of system redundancy, which could lead to loss of several Alarm Light Boxes in the event of particular power supply failure. Current central alarm system does not provide means of alarm optimization, grouping or prioritization. There are three main options for central alarm system replacement: Conventional annunciator system, hybrid annunciator system and advanced alarm system. Advanced alarm system implementation requires Main Control Board upgrade, integration of process instrumentation and plant process computer as well as long time for replacement. NPP Krsko has decided to implement hybrid alarm system with patchwork approach. The new central alarm system will be stand alone, digital, with advanced filtering and alarm grouping options. Sequence of event recorder will be linked with plant process computer and time synchronized with redundant GPS signal. Advanced functions such as link to plant procedures will be implemented with plant process computer upgrade in outage 2006. Central alarm system replacement is due in outage 2004.(author)

  5. Reoperative aortic root replacement: Outcome in a contemporary series.

    Science.gov (United States)

    Esaki, Jiro; Leshnower, Bradley G; Binongo, Jose N; Lasanajak, Yi; McPherson, LaRonica; Thourani, Vinod H; Chen, Edward P

    2017-09-01

    Reoperative aortic root replacement is a challenging procedure associated with significant mortality and morbidity. The purpose of this study was to investigate the outcomes of reoperative aortic root replacement when performed in a number of complex clinical settings and to identify risk factors for operative mortality and long-term survival. From 2006 to 2015, 280 consecutive patients at an academic center underwent reoperative aortic root replacement after a variety of previous aortic or cardiac operations. Logistic regression and extended Cox proportional hazards regression analyses were used to determine risk factors for operative mortality and long-term survival, respectively. The mean age of patients was 52.5 ± 14.1 years. Prior operations included proximal aortic replacement in 113 patients, valve surgery in 162 patients, and coronary artery bypass grafting in 46 patients. Concomitant procedures included arch replacement in 135 patients, coronary artery bypass grafting in 68 patients, and mitral valve repair/replacement in 18 patients. Operative mortality was 14.3%. Five-year survival was 74.0%. Univariable analysis did not find previous root replacement, prior proximal aortic surgery, and concomitant arch replacement to be risk factors for operative mortality. In the multivariable analysis, chronic lung disease, prior myocardial infarction, and concomitant mitral valve surgery were risk factors for operative mortality. Age, peripheral artery disease, emergency, and concomitant mitral valve surgery were risk factors for mortality in the late phase. Reoperative aortic root replacement represents complex procedures carrying significant morbidity and mortality. Chronic lung disease, prior myocardial infarction, and concomitant mitral valve surgery were risk factors for operative mortality. Age, peripheral artery disease, emergency, and concomitant mitral valve surgery were risk factors for long-term mortality. Copyright © 2017 The American Association for

  6. Quantization Procedures

    International Nuclear Information System (INIS)

    Cabrera, J. A.; Martin, R.

    1976-01-01

    We present in this work a review of the conventional quantization procedure, the proposed by I.E. Segal and a new quantization procedure similar to this one for use in non linear problems. We apply this quantization procedures to different potentials and we obtain the appropriate equations of motion. It is shown that for the linear case the three procedures exposed are equivalent but for the non linear cases we obtain different equations of motion and different energy spectra. (Author) 16 refs

  7. Service water system repair/replacement guidelines: Planning and implementation

    International Nuclear Information System (INIS)

    Frederick, G.J.; Gandy, D.W.; Peterson, A.G. Jr.; Findlan, S.J.

    1993-11-01

    Service water system failures have prompted concerns related to extended power plant operating life and plant availability. Selection and procurement of materials for repair or replacement of piping and components may be the most important factors in improving service water system reliability. The authors examined factors that contribute to reduced SWS reliability. The factors include material selection inadequacies, water treatment problems, operational/maintenance practices, fabrication procedures, environmental degradation mechanisms, and coating problems. The authors investigated material selection for replacement and repair, taking into account fabrication practices, environmental concerns, and cost comparisons of materials. They examined specific components such as piping, pumps, valves, and heat exchangers with regard to material selection and fabrication practice. Although proper material selection is essential in upgrading and maintaining the designed functions of a SWS, it is critical to address SWS repair/replacement activities with a systemwide approach. Degradation of materials in SWS applications are plant specific, depending on factors unique to each site such as geographic location, existing materials, operating procedures, and environment. All these characteristics must be addressed in making repair/replacement decisions. Criteria that must be integrated for successful long-term operation of SWS include the following: Materials selection (upgrade or in-kind replacement), Evaluation of root cause or nature of the failure mechanism, Scope of the repair/replacement activities, Material compatibility of the existing materials, Operational and maintenance procedures, Code or jurisdictional requirements, Economic considerations, Water treatment programs, System design improvements or modifications

  8. Antenna Controller Replacement Software

    Science.gov (United States)

    Chao, Roger Y.; Morgan, Scott C.; Strain, Martha M.; Rockwell, Stephen T.; Shimizu, Kenneth J.; Tehrani, Barzia J.; Kwok, Jaclyn H.; Tuazon-Wong, Michelle; Valtier, Henry; Nalbandi, Reza; hide

    2010-01-01

    The Antenna Controller Replacement (ACR) software accurately points and monitors the Deep Space Network (DSN) 70-m and 34-m high-efficiency (HEF) ground-based antennas that are used to track primarily spacecraft and, periodically, celestial targets. To track a spacecraft, or other targets, the antenna must be accurately pointed at the spacecraft, which can be very far away with very weak signals. ACR s conical scanning capability collects the signal in a circular pattern around the target, calculates the location of the strongest signal, and adjusts the antenna pointing to point directly at the spacecraft. A real-time, closed-loop servo control algorithm performed every 0.02 second allows accurate positioning of the antenna in order to track these distant spacecraft. Additionally, this advanced servo control algorithm provides better antenna pointing performance in windy conditions. The ACR software provides high-level commands that provide a very easy user interface for the DSN operator. The operator only needs to enter two commands to start the antenna and subreflector, and Master Equatorial tracking. The most accurate antenna pointing is accomplished by aligning the antenna to the Master Equatorial, which because of its small size and sheltered location, has the most stable pointing. The antenna has hundreds of digital and analog monitor points. The ACR software provides compact displays to summarize the status of the antenna, subreflector, and the Master Equatorial. The ACR software has two major functions. First, it performs all of the steps required to accurately point the antenna (and subreflector and Master Equatorial) at the spacecraft (or celestial target). This involves controlling the antenna/ subreflector/Master-Equatorial hardware, initiating and monitoring the correct sequence of operations, calculating the position of the spacecraft relative to the antenna, executing the real-time servo control algorithm to maintain the correct position, and

  9. Aortic valve replacement in octogenarians

    Directory of Open Access Journals (Sweden)

    Dark John H

    2007-07-01

    Full Text Available Abstract Background and Aims As our population ages and life expectancy increases the number of people aged over 80 and more referred for cardiac surgery is growing. This study sought to identify the outcome of aortic valve replacement (AVR in octogenarians. Methods 68 patients aged 80 years or more underwent AVR at the Freeman Hospital, between April 2001 and April 2004. A retrospective review of the notes and outcomes from the patients' GP and the NHS strategic tracking service was performed. 54% (37 underwent isolated AVR whilst 46% (31 underwent combined AVR and CABG. Results Follow up was 100% complete. The mean age was 83.1 ± s.d. 2.9 years, a mean gradient of 83 ± s.d. 31 mmHg and mean AVA of 0.56 cm2. The mean additive EuroSCORE was 8.6 ± s.d. 1.2, the logistic EuroSCORE mean 12.0 ± s.d. 5.9. In hospital 30 day mortality was 13 %. Survival was 80% at 1 year and 78% at 2 years. Median follow up was for 712 days. Stepwise logistic regression identified chronic obstructive airways disease as an independent predictor of mortality (p Conclusion Our study demonstrates that the operative mortality for AVR in the over eighties is good, whilst the mid to long term outcome is excellent There is a very low attrition rate with those undergoing the procedure living as long than their age matched population. This study confirms AVR is a safe, acceptable treatment for octogenarians with excellent mid term outcomes.

  10. Hip Replacement: MedlinePlus Health Topic

    Science.gov (United States)

    ... invasive hip replacement (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Hip Replacement updates ... replacement - precautions Minimally invasive hip replacement Related Health Topics Hip Injuries and Disorders National Institutes of Health ...

  11. The replacement of technically obsolete equipments

    International Nuclear Information System (INIS)

    Anglaret, Ph.; Patouillaud, M.

    1987-01-01

    The paper covers the analysis of procedures for replacement of technically obsolete but still operational equipments in use in a nuclear power plant. The Three Mile Island accident showed that operators in the control room reqire additional information at their disposal. In 1986 CGEE Alsthom received two orders for improvements to control systems, for the South African nuclear power plant Koeberg and the Dutch nuclear power plant Borssele. The new systems will provide support to normal operation and offer additional help in accident situations. 4 figs

  12. Educating My Replacement

    Science.gov (United States)

    Tarter, Jill

    , in partnership with the dedicated teachers out there, I think I can help promote the critical thinking skills and scientific literacy of the next generation of voters. Hopefully, I can also help train my replacement to be a better scientist, capable of seizing all the opportunities generated by advances in technology and our improved understanding of the universe to craft search strategies with greater probability of success than those I have initiated.

  13. Stereoscopy in diagnostic radiology and procedure planning: does stereoscopic assessment of volume-rendered CT angiograms lead to more accurate characterisation of cerebral aneurysms compared with traditional monoscopic viewing?

    International Nuclear Information System (INIS)

    Stewart, Nikolas; Lock, Gregory; Coucher, John; Hopcraft, Anthony

    2014-01-01

    Stereoscopic vision is a critical part of the human visual system, conveying more information than two-dimensional, monoscopic observation alone. This study aimed to quantify the contribution of stereoscopy in assessment of radiographic data, using widely available three-dimensional (3D)-capable display monitors by assessing whether stereoscopic viewing improved the characterisation of cerebral aneurysms. Nine radiology registrars were shown 40 different volume-rendered (VR) models of cerebral computed tomography angiograms (CTAs), each in both monoscopic and stereoscopic format and then asked to record aneurysm characteristics on short multiple-choice answer sheets. The monitor used was a current model commercially available 3D television. Responses were marked against a gold standard of assessments made by a consultant radiologist, using the original CT planar images on a diagnostic radiology computer workstation. The participants' results were fairly homogenous, with most showing no difference in diagnosis using stereoscopic VR models. One participant performed better on the monoscopic VR models. On average, monoscopic VRs achieved a slightly better diagnosis by 2.0%. Stereoscopy has a long history, but it has only recently become technically feasible for stored cross-sectional data to be adequately reformatted and displayed in this format. Scant literature exists to quantify the technology's possible contribution to medical imaging - this study attempts to build on this limited knowledge base and promote discussion within the field. Stereoscopic viewing of images should be further investigated and may well eventually find a permanent place in procedural and diagnostic medical imaging.

  14. Halocarbons as Halon Replacements. Volume 1. Technology Review and Initiation

    Science.gov (United States)

    1991-03-01

    Gas Phase Reaction Rate Theory, Ronald Press, New York, p. 339, 1966. 73. Gaffney , J. S., and Levine, S. Z., "Predicting Gas Phase Organic Molecule...Technologies for the Control of Hazardous Wastes, Noyes Data Corporation, Park Ridge , New Jersey, 1983. 107. Bonner, T., Desai, B., Fullenkamp, J...Hughes, T., Kennedy, E., McCormick, R., Peters, J., and Zanders, D., Hazardous Waste Incineration EngineerinS, Noyes Data Corporation, Park Ridge , New

  15. Transforming Normal Programs by Replacement

    NARCIS (Netherlands)

    Bossi, Annalisa; Pettorossi, A.; Cocco, Nicoletta; Etalle, Sandro

    1992-01-01

    The replacement transformation operation, already defined in [28], is studied wrt normal programs. We give applicability conditions able to ensure the correctness of the operation wrt Fitting's and Kunen's semantics. We show how replacement can mimic other transformation operations such as thinning,

  16. Replaceable liquid nitrogen piping

    International Nuclear Information System (INIS)

    Yasujima, Yasuo; Sato, Kiyoshi; Sato, Masataka; Hongo, Toshio

    1982-01-01

    This liquid nitrogen piping with total length of about 50 m was made and installed to supply the liquid nitrogen for heat insulating shield to three superconducting magnets for deflection and large super-conducting magnet for detection in the π-meson beam line used for high energy physics experiment in the National Laboratory for High Energy Physics. The points considered in the design and manufacture stages are reported. In order to minimize the consumption of liquid nitrogen during transport, vacuum heat insulation method was adopted. The construction period and cost were reduced by the standardization of the components, the improvement of welding works and the elimination of ineffective works. For simplifying the maintenance, spare parts are always prepared. The construction and the procedure of assembling of the liquid nitrogen piping are described. The piping is of double-walled construction, and its low temperature part was made of SUS 316L. The super-insulation by aluminum vacuum evaporation and active carbon were attached on the external surface of the internal pipe. The final leak test and the heating degassing were performed. The tests on evacuation, transport capacity and heat entry are reported. By making the internal pipe into smaller size, the piping may be more efficient. (Kako, I.)

  17. Soil Overconsolidation Changes Caused by Dynamic Replacement

    Science.gov (United States)

    Piotr, Kanty; Sławomir, Kwiecień; Jerzy, Sękowski

    2017-10-01

    In the dynamic replacement method (DR) the soil is improved by initially dropping a large weight (typically 8-20 t) pounder from a significant height up to 25 m. The created crater is filled with a stronger material (gravel, rubble, stone aggregate, debris), and the pounder is dropped once or multiple times again. The construction of dynamic replacement pillars influences the parameters of the adjacent soil. It results from the energy generated by dropping a pounder into the soil. In the current practice, these changes are not taken into the account during the design. This paper focuses on the changes of overconsolidation ratio (OCR) and in situ coefficient of lateral earth pressure (K) values estimated base on cone penetration test (CPTU) and Dilatometric test (DMT) performed at a test site. A single column was constructed and the ground around the column was examined using CPTU and DMT, performed at different distances from the column centre (2, 3, 4 and 6 m) and at different time intervals (during construction and 1, 8, 30 days later). The column was constructed in so-called transition soils (between cohesive and non-cohesive). While interpreting the results of the research, the authors addressed the matter of choosing the procedure of OCR and K indication for transition soils (in this case described as silts and/or sandy silts). Overconsolidation changes may differ depending on the chosen analysis procedure (for cohesive or non-cohesive soils). On the basis of the analysis presented in the paper and the observation of soil (acknowledged as cohesive according to macroscopic observations) during column excavation, it was decided that for more detailed analyses methods dedicated to cohesive soils should be applied. Generally, it can be stated that although the changes were complex, DR pillar formation process resulted in the increase of these parameters. The average increases of OCR and K values were 25% and 10% respectively. The post installation values are not

  18. Patients Unicondylar Knee Replacement vs. Total Knee Replacement

    OpenAIRE

    Hedra Eskander

    2017-01-01

    The aim of this review article is to analyse the clinical effectiveness of total knee replacement (TKR) compared to unicondylar knee replacement (UKR) on patients. In terms of survival rates, revision rates and postoperative complications. The keywords used were: knee arthroplasty. Nearly three thousand articles were found on 25 August 2016. Of those, only twenty-five were selected and reviewed because they were strictly focused on the topic of this article. Compared with those who have TKR, ...

  19. Steam generator replacement at Surry Power Station

    International Nuclear Information System (INIS)

    McKay, H.S.

    1982-01-01

    The purposes of the steam generator repair program at Surry Power Station were to repair the tube degradation caused by corrosion-related phenomena and to restore the integrity of the steam generators to a level equivalent to new equipment. The repair program consisted of (1) replacing the existing lower-shell assemblies with new ones and (2) adding new moisture separation equipment to the upper-shell assemblies. These tasks required that several pieces of reactor coolant piping, feedwater piping, main steam piping, and the steam generator be cut and refurbished for reinstallation after the new lower shell was in place. The safety implications and other potential effects of the repair program both during the repair work and after the unit was returned to power were part of the design basis of the repair program. The repair program has been completed on Unit 2 without any adverse effects on the health and safety of the general public or to the personnel engaged in the repair work. Before the Unit 1 repair program began, a review of work procedures and field changes for the Unit 2 repair was conducted. Several major changes were made to avoid recurrence of problems and to streamline procedures. Steam generator replacements was completed on June 1, 1981, and the unit is presently in the startup phase of the outrage

  20. Managing infection in the revision total hip replacement patient.

    Science.gov (United States)

    Halley, D K

    1993-01-01

    Deep infection is one of the most devastating complications in total hip replacement. This dreaded complication is presented in considerable detail with special emphasis on prevention, diagnosis, and various methods of surgical and antibiotic treatment. Basic fundamentals of antibiotic therapy are reviewed. In addition, guidelines are given for the indications of surgical intervention, the type and staging of operative procedures, with detailed techniques of the various operative procedures used to treat the infected total hip implant patient.

  1. Nuclear reactor fuel replacement system

    International Nuclear Information System (INIS)

    Kayano, Hiroyuki; Joge, Toshio.

    1976-01-01

    Object: To permit the direction in which a fuel replacement unit is moving to be monitored by the operator. Structure: When a fuel replacement unit approaches an intermediate goal position preset in the path of movement, renewal of data display on a goal position indicator is made every time the goal position is changed. With this renewal, the prevailing direction of movement of the fuel replacement unit can be monitored by the operator. When the control of movement is initiated, the co-ordinates of the intermediate goal point A are displayed on a goal position indicator. When the replacement unit reaches point A, the co-ordinates of the next intermediate point B are displayed, and upon reaching point B the co-ordinates of the (last) goal point C are displayed. (Nakamura, S.)

  2. Slab replacement maturity guidelines : [summary].

    Science.gov (United States)

    2014-04-01

    Concrete sets in hours at moderate temperatures, : but the bonds that make concrete strong continue : to mature over days to years. However, for : replacement concrete slabs on highways, it is : crucial that concrete develop enough strength : within ...

  3. Dutasteride reduces prostate size and prostate specific antigen in older hypogonadal men with benign prostatic hyperplasia undergoing testosterone replacement therapy.

    Science.gov (United States)

    Page, Stephanie T; Hirano, Lianne; Gilchriest, Janet; Dighe, Manjiri; Amory, John K; Marck, Brett T; Matsumoto, Alvin M

    2011-07-01

    Benign prostatic hyperplasia and hypogonadism are common disorders in aging men. There is concern that androgen replacement in older men may increase prostate size and symptoms of benign prostatic hyperplasia. We examined whether combining dutasteride, which inhibits testosterone to dihydrotestosterone conversion, with testosterone treatment in older hypogonadal men with benign prostatic hyperplasia reduces androgenic stimulation of the prostate compared to testosterone alone. We conducted a double-blind, placebo controlled trial of 53 men 51 to 82 years old with symptomatic benign prostatic hyperplasia, prostate volume 30 cc or greater and serum total testosterone less than 280 ng/dl (less than 9.7 nmol/l). Subjects were randomized to daily transdermal 1% T gel plus oral placebo or dutasteride for 6 months. Testosterone dosing was adjusted to a serum testosterone of 500 to 1,000 ng/dl. The primary outcomes were prostate volume measured by magnetic resonance imaging, serum prostate specific antigen and androgen levels. A total of 46 subjects completed all procedures. Serum testosterone increased similarly into the mid-normal range in both groups. Serum dihydrotestosterone increased in the testosterone only but decreased in the testosterone plus dutasteride group. In the testosterone plus dutasteride group prostate volume and prostate specific antigen (mean ± SEM) decreased 12% ± 2.5% and 35% ± 5%, respectively, compared to the testosterone only group in which prostate volume and prostate specific antigen increased 7.5% ± 3.3% and 19% ± 7% (p = 0.03 and p = 0.008), respectively, after 6 months of treatment. Prostate symptom scores improved in both groups. Combined treatment with testosterone plus dutasteride reduces prostate volume and prostate specific antigen compared to testosterone only. Coadministration of a 5α-reductase inhibitor with testosterone appears to spare the prostate from androgenic stimulation during testosterone replacement in older

  4. 3D Model of Surfactant Replacement Therapy

    Science.gov (United States)

    Grotberg, James; Tai, Cheng-Feng; Filoche, Marcel

    2015-11-01

    Surfactant Replacement Therapy (SRT) involves instillation of a liquid-surfactant mixture directly into the lung airway tree. Though successful in neonatal applications, its use in adults had early success followed by failure. We present the first mathematical model of 3D SRT where a liquid plug propagates through the tree from forced inspiration. In two separate modeling steps, the plug first deposits a coating film on the airway wall which subtracts from its volume, a ``coating cost''. Then the plug splits unevenly at the airway bifurcation due to gravity. The steps are repeated until a plug ruptures or reaches the tree endpoint alveoli/acinus. The model generates 3D images of the resulting acinar distribution and calculates two global indexes, efficiency and homogeneity. Simulating published literature, the earlier successful adult SRT studies show comparatively good index values, while the later failed studies do not. Those unsuccessful studies used smaller dose volumes with higher concentration mixtures, apparently assuming a well mixed compartment. The model shows that adult lungs are not well mixed in SRT due to the coating cost and gravity effects. Returning to the higher dose volume protocols could save many thousands of lives annually in the US. Supported by NIH Grants HL85156, HL84370 and Agence Nationale de la Recherche, ANR no. 2010-BLAN-1119-05.

  5. Replacement of sub-systems

    International Nuclear Information System (INIS)

    Rosen, S.E.

    1992-01-01

    This paper describes a number of quality aspects related to replacement of important systems or components in a nuclear power station. Reference is given to the steam generator replacement and power uprating performed at Ringhals 2 in Sweden in 1989. Since quality is a wide concept there has been put special emphasis in this paper to the important aspects that traditionally are not connected to quality. (author) 1 fig

  6. Current topics in the radiology of joint replacement surgery

    International Nuclear Information System (INIS)

    Weissman, B.N.

    1990-01-01

    Several methods of total hip joint replacement are currently used. Radiographic appearances after cemented, bone ingrowth, press-fit, and bipolar hip prostheses are reviewed. The roles of nuclear medicine and arthrographic procedures for identifying complications are discussed. Total knee prostheses and, in particular, complications related to the patellar component are described.115 references

  7. Total hip replacements at Kikuyu Hospital, Kenya | Kingori | East ...

    African Journals Online (AJOL)

    Background: Total joint arthroplasty is a highly effective procedure that is frequently performed in elderly patients. This is not so in the third world and is not frequently performed. Total hip replacement (THR) relieves the pain and functional disability experienced by patients with moderate to severe arthritis of the hip, ...

  8. Spine imaging after lumbar disc replacement: pitfalls and current recommendations

    OpenAIRE

    Robinson, Yohan; Sand?n, Bengt

    2009-01-01

    Abstract Background Most lumbar artificial discs are still composed of stainless steel alloys, which prevents adequate postoperative diagnostic imaging of the operated region when using magnetic resonance imaging (MRI). Thus patients with postoperative radicular symptoms or claudication after stainless steel implants often require alternative diagnostic procedures. Methods Possible complications of lumbar total disc replacement (TDR) are reviewed from the available literature and imaging reco...

  9. Optimal selection of Orbital Replacement Unit on-orbit spares - A Space Station system availability model

    Science.gov (United States)

    Schwaab, Douglas G.

    1991-01-01

    A mathematical programing model is presented to optimize the selection of Orbital Replacement Unit on-orbit spares for the Space Station. The model maximizes system availability under the constraints of logistics resupply-cargo weight and volume allocations.

  10. Ethamsylate and blood loss in total hip replacement.

    Science.gov (United States)

    Keith, I

    1979-01-01

    Nineteen consecutive patients undergoing total hip replacement under epidural anaesthesia were randomly divided into two groups. The treatment group received 1000 mg of ethamsylate intravenously before induction of anaesthesia. Blood lost during surgery was measured by a colorimetric technique. Closed suction drains were used and all blood lost after operation collected for measurement. Ethamsylate did not decrease the average volumes of blood lost during or after the operation. Neither did it reduce the requirements for blood transfusion. Although there were no side-effects attributable to ethamyslate, there seems to be no indication for its use in total hip replacement under epidural anaesthesia.

  11. Prioritization methodology for chemical replacement

    Science.gov (United States)

    Cruit, Wendy; Goldberg, Ben; Schutzenhofer, Scott

    1995-01-01

    Since United States of America federal legislation has required ozone depleting chemicals (class 1 & 2) to be banned from production, The National Aeronautics and Space Administration (NASA) and industry have been required to find other chemicals and methods to replace these target chemicals. This project was initiated as a development of a prioritization methodology suitable for assessing and ranking existing processes for replacement 'urgency.' The methodology was produced in the form of a workbook (NASA Technical Paper 3421). The final workbook contains two tools, one for evaluation and one for prioritization. The two tools are interconnected in that they were developed from one central theme - chemical replacement due to imposed laws and regulations. This workbook provides matrices, detailed explanations of how to use them, and a detailed methodology for prioritization of replacement technology. The main objective is to provide a GUIDELINE to help direct the research for replacement technology. The approach for prioritization called for a system which would result in a numerical rating for the chemicals and processes being assessed. A Quality Function Deployment (QFD) technique was used in order to determine numerical values which would correspond to the concerns raised and their respective importance to the process. This workbook defines the approach and the application of the QFD matrix. This technique: (1) provides a standard database for technology that can be easily reviewed, and (2) provides a standard format for information when requesting resources for further research for chemical replacement technology. Originally, this workbook was to be used for Class 1 and Class 2 chemicals, but it was specifically designed to be flexible enough to be used for any chemical used in a process (if the chemical and/or process needs to be replaced). The methodology consists of comparison matrices (and the smaller comparison components) which allow replacement technology

  12. Extended replacement of the thoracic aorta.

    Science.gov (United States)

    Hino, Yutaka; Okada, Kenji; Oka, Takanori; Inoue, Takeshi; Tanaka, Akiko; Omura, Atsushi; Kano, Hiroya; Okita, Yutaka

    2013-01-01

    We present our experience of total aortic arch replacement. Twenty-nine patients (21 males and 8 females; mean age 63.3 ± 13.3 years) with extended thoracic aortic aneurysms underwent graft replacement. The pathology of the diseased aorta was non-dissecting aneurysm in 11 patients, including one aortitis and aortic dissection in 18 patients (acute type A: one, chronic type A: 11, chronic type B: six). Five patients had Marfan syndrome. In their previous operation, two patients had undergone the Bentall procedure, three had endovascular stenting, one had aortic root replacement with valve sparing and 12 had hemi-arch replacement for acute type A dissection. Approaches to the aneurysm were as follows: posterolateral thoracotomy with rib-cross incision in 16, posterolateral thoracotomy extended to the retroperitoneal abdominal aorta in seven, mid-sternotomy and left pleurotomy in three, anterolateral thoracotomy with partial lower sternotomy in two and clam-shell incision in one patient. Extension of aortic replacement was performed from the aortic root to the descending aorta in 4, from the ascending aorta to the descending aorta in 17 and from the ascending to the abdominal aorta in eight patients. Arterial inflow for cardiopulmonary bypass consisted of the femoral artery in 15 patients, ascending aorta and femoral artery in seven, descending or abdominal aorta in five and ascending aorta in two. Venous drainage site was the femoral vein in 10, pulmonary artery in eight, right atrium in five, femoral artery with right atrium/pulmonary artery in four and pulmonary artery with right atrium in two patients. The operative mortality, 30-day mortality and hospital mortality was one (cardiac arrest due to aneurysm rupture), one (rupture of infected aneurysm) and one (brain contusion), respectively. Late mortality occurred in three patients due to pneumonia, ruptured residual aneurysm and intracranial bleeding. Actuarial survival at 5 years after the operations was 80.6

  13. Optimization of station battery replacement

    International Nuclear Information System (INIS)

    Jancauskas, J.R.; Shook, D.A.

    1994-01-01

    During a loss of ac power at a nuclear generating station (including diesel generators), batteries provide the source of power which is required to operate safety-related components. Because traditional lead-acid batteries have a qualified life of 20 years, the batteries must be replaced a minimum of once during a station's lifetime, twice if license extension is pursued, and more often depending on actual in-service dates and the results of surveillance tests. Replacement of batteries often occurs prior to 20 years as a result of systems changes caused by factors such as Station Blackout Regulations, control system upgrades, incremental load growth, and changes in the operating times of existing equipment. Many of these replacement decisions are based on the predictive capabilities of manual design basis calculations. The inherent conservatism of manual calculations may result in battery replacements occurring before actually required. Computerized analysis of batteries can aid in optimizing the timing of replacements as well as in interpreting service test data. Computerized analysis also provides large benefits in maintaining the as-configured load profile and corresponding design margins, while also providing the capability of quickly analyze proposed modifications and response to internal and external audits

  14. Medicare Program; Comprehensive Care for Joint Replacement Payment Model for Acute Care Hospitals Furnishing Lower Extremity Joint Replacement Services. Final rule.

    Science.gov (United States)

    2015-11-24

    This final rule implements a new Medicare Part A and B payment model under section 1115A of the Social Security Act, called the Comprehensive Care for Joint Replacement (CJR) model, in which acute care hospitals in certain selected geographic areas will receive retrospective bundled payments for episodes of care for lower extremity joint replacement (LEJR) or reattachment of a lower extremity. All related care within 90 days of hospital discharge from the joint replacement procedure will be included in the episode of care. We believe this model will further our goals in improving the efficiency and quality of care for Medicare beneficiaries with these common medical procedures.

  15. Quantification of in vivo implant wear in total knee replacement from dynamic single plane radiography

    Science.gov (United States)

    Teeter, Matthew G.; Seslija, Petar; Milner, Jaques S.; Nikolov, Hristo N.; Yuan, Xunhua; Naudie, Douglas D. R.; Holdsworth, David W.

    2013-05-01

    An in vivo method to measure wear in total knee replacements was developed using dynamic single-plane fluoroscopy. A dynamic, anthropomorphic total knee replacement phantom with interchangeable, custom-fabricated components of known wear volume was created, and dynamic imaging was performed. For each frame of the fluoroscopy data, the relative location of the femoral and tibial components were determined, and the apparent intersection of the femoral component with the tibial insert was used to calculate wear volume, wear depth, and frequency of intersection. No difference was found between the measured and true wear volumes. The precision of the measurements was ±39.7 mm3 for volume and ±0.126 mm for wear depth. The results suggest the system is capable of tracking wear volume changes across multiple time points in patients. As a dynamic technique, this method can provide both kinematic and wear measurements that may be useful for evaluating new implant designs for total knee replacements.

  16. Acute normovolaemic haemodilution decreases postoperative allogeneic blood transfusion after total knee replacement.

    Science.gov (United States)

    Olsfanger, D; Fredman, B; Goldstein, B; Shapiro, A; Jedeikin, R

    1997-09-01

    We hypothesized that the success of postoperative blood conservation after acute normovolaemic haemodilution (NVHD) is influenced by the extent of intraoperative bleeding and surgical trauma, and the timing of autologous blood transfusion. As total knee replacement is associated with minimal intraoperative but extensive postoperative blood loss, this procedure is ideally suited to acute NVHD. Therefore, to test our hypothesis, 30 patients undergoing elective total knee replacement were enrolled in a prospective, randomized, controlled study. In groups NVHD-2 and NVHD-6, before induction of anaesthesia patients were bled to a target packed cell volume (PCV) of 28-30%, and in the post-anaesthesia care unit autologous blood was transfused over a 2-h period terminating after operation at 2 and 6 h, respectively. In the control group, NVHD was not performed. After operation, platelets, fibrinogen, prothrombin and partial thromboplastin time, and liver function, urea and electrolytes were measured and compared with preoperative baseline values. Significantly (P conservation strategy. However, there was no difference in allogeneic blood administration between the two NVHD groups. Coagulation and liver function, and urea and electrolyte concentrations were unaffected by treatment.

  17. Replacement research reactor for Australia

    International Nuclear Information System (INIS)

    Miller, Ross

    1998-01-01

    In 1992, the Australian Government commissioned a review into the need for a replacement research reactor. That review concluded that in about years, if certain conditions were met, the Government could make a decision in favour of a replacement reactor. A major milestone was achieved when, on 3 September 1997, the Australian Government announced the construction of a replacement research reactor at the site of Australia's existing research reactor HIFAR, subject to the satisfactory outcome of an environmental assessment process. The reactor will be have the dual purpose of providing a first class facility for neutron beam research as well as providing irradiation facilities for both medical isotope production and commercial irradiations. The project is scheduled for completion before the end of 2005. (author)

  18. Joint replacement in Zambia: A review of Hip & Knee Replacement ...

    African Journals Online (AJOL)

    Methods: Data captured by the different variables entered into the Joint Register covering the pre-op, intra-op and post-op period of all total hip and knee replacement surgery done at the ZIOH from 1998 to 2010 was entered into a spreadsheet after verification with individual patient medical records. This was then imported ...

  19. Environmental Measurements Laboratory (EML) procedures manual

    International Nuclear Information System (INIS)

    Chieco, N.A.; Bogen, D.C.; Knutson, E.O.

    1990-11-01

    Volume 1 of this manual documents the procedures and existing technology that are currently used by the Environmental Measurements Laboratory. A section devoted to quality assurance has been included. These procedures have been updated and revised and new procedures have been added. They include: sampling; radiation measurements; analytical chemistry; radionuclide data; special facilities; and specifications. 228 refs., 62 figs., 37 tabs. (FL)

  20. HST Replacement Battery Initial Performance

    Science.gov (United States)

    Krol, Stan; Waldo, Greg; Hollandsworth, Roger

    2009-01-01

    The Hubble Space Telescope (HST) original Nickel-Hydrogen (NiH2) batteries were replaced during the Servicing Mission 4 (SM4) after 19 years and one month on orbit.The purpose of this presentation is to highlight the findings from the assessment of the initial sm4 replacement battery performance. The batteries are described, the 0 C capacity is reviewed, descriptions, charts and tables reviewing the State Of Charge (SOC) Performance, the Battery Voltage Performance, the battery impedance, the minimum voltage performance, the thermal performance, the battery current, and the battery system recharge ratio,

  1. Insurance for replacement power costs

    International Nuclear Information System (INIS)

    Cleaver, A.

    1980-01-01

    Although careful consideration is given to insurance against physical damage to plant and equipment, little thought is given to the costs that will be incurred in replacing the power that is lost while a relatively efficient system is out of action. The results of an investigation carried out for a generating authority with an installed capacity of about 3000 MW is given. Replacement power costs for different cases of severity of damage range from Pound1.17m per month for damage to central services taking out all four units. (author)

  2. Replacing fuel alignment in Germany

    International Nuclear Information System (INIS)

    Poetz, F.; Kalthoff, W.

    1991-01-01

    Up to the end of 1989 varying numbers of broken fuel alignment pins were detected in several German PWRs (80 broken pins in all). The distribution of these broken pins over the core cross-section was more or less random. The problem was due to the stress corrosion cracking of the pin material and was restricted to individual pins. It was concluded that all fuel alignment pins made of Inconel X-750 should be replaced. The development of a new pin, more resistant to intergranular stress corrosion, and the replacement technique are outlined. (author)

  3. Aortic Root Replacement for Children With Loeys-Dietz Syndrome.

    Science.gov (United States)

    Patel, Nishant D; Alejo, Diane; Crawford, Todd; Hibino, Narutoshi; Dietz, Harry C; Cameron, Duke E; Vricella, Luca A

    2017-05-01

    Loeys-Dietz syndrome (LDS) is an aggressive aortopathy with a proclivity for aortic aneurysm rupture and dissection at smaller diameters than other connective tissue disorders. We reviewed our surgical experience of children with LDS to validate our guidelines for prophylactic aortic root replacement (ARR). We reviewed all children (younger than 18 years) with a diagnosis of LDS who underwent ARR at our institution. The primary endpoint was mortality, and secondary endpoints included complications and the need for further interventions. Thirty-four children with LDS underwent ARR. Mean age at operation was 10 years, and 15 (44%) were female. Mean preoperative root diameter was 4 cm. Three children (9%) had composite ARR with a mechanical prosthesis, and 31 (91%) underwent valve-sparing ARR. Concomitant procedures included arch replacement in 2 (6%), aortic valve repair in 1 (3%), and patent foramen ovale closure in 16 (47%). There was no operative mortality. Two children (6%) required late replacement of the ascending aorta, 5 (15%) required arch replacement, 1 (3%) required mitral valve replacement, and 2 (6%) had coronary button aneurysms/pseudoaneurysms requiring repair. Three children required redo valve-sparing ARR after a Florida sleeve procedure, and 2 had progressive aortic insufficiency requiring aortic valve replacement after a valve-sparing procedure. There were 2 late deaths (6%). These data confirm the aggressive aortopathy of LDS. Valve-sparing ARR should be performed when feasible to avoid the risks of prostheses. Serial imaging of the arterial tree is critical, given the rate of subsequent intervention. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Electronic Procedures for Medical Operations

    Science.gov (United States)

    2015-01-01

    Electronic procedures are replacing text-based documents for recording the steps in performing medical operations aboard the International Space Station. S&K Aerospace, LLC, has developed a content-based electronic system-based on the Extensible Markup Language (XML) standard-that separates text from formatting standards and tags items contained in procedures so they can be recognized by other electronic systems. For example, to change a standard format, electronic procedures are changed in a single batch process, and the entire body of procedures will have the new format. Procedures can be quickly searched to determine which are affected by software and hardware changes. Similarly, procedures are easily shared with other electronic systems. The system also enables real-time data capture and automatic bookmarking of current procedure steps. In Phase II of the project, S&K Aerospace developed a Procedure Representation Language (PRL) and tools to support the creation and maintenance of electronic procedures for medical operations. The goal is to develop these tools in such a way that new advances can be inserted easily, leading to an eventual medical decision support system.

  5. Radiological difficulty in identifying unicompartmental knee replacement dislocation

    Directory of Open Access Journals (Sweden)

    Mr Oruaro Adebayo Onibere, MBBS, MRCS

    2017-09-01

    Full Text Available Unicondylar knee replacement is a relatively common elective orthopedic procedure but is not often seen in the Emergency Department setting. Familiarity with normal clinical and radiological appearances is difficult to gain. Dislocation of the mobile bearing component “spacer” is a known complication of unicondylar knee replacements, and these patients will initially present to the accident and Emergency Department. In this setting, an accurate and prompt diagnosis is necessary to appropriately manage the patient's condition. There is normally a radiological challenge in identifying dislocated mobile bearings on plain radiographs. These patients may need to have further imaging, such as a computer tomographic scan to identify the dislocated mobile bearing.

  6. Synthetic ossicular replacements: Normal and abnormal CT appearance

    International Nuclear Information System (INIS)

    Swartz, J.D.; Zwillenberg, S.; Berger, A.S.; Granoff, D.W.; Popky, G.L.

    1986-01-01

    Numerous synthetic ossicular replacements are currently in use. The TORP conducts sound from the newly formed tympanic membrane to the oval window; the PORP is used when the stapes superstructure is maintained, being interposed between the tympanic membrane and the stapes capitulum. In 12 patients the surgical results of ossicular replacement procedures were good, which gave the author the opportunity to study the normal CT appearance. In an additional 10 patients CT was performed before surgical revision. Using CT, they have been able to diagnose subluxation and fibrous tissue fixation. In two patients the CT appearance was unremarkable, but at surgery lateralization of the graft was found, with a nonfunctioning interface

  7. Adjacent level effects of bi level disc replacement, bi level fusion and disc replacement plus fusion in cervical spine--a finite element based study.

    Science.gov (United States)

    Faizan, Ahmad; Goel, Vijay K; Biyani, Ashok; Garfin, Steven R; Bono, Christopher M

    2012-03-01

    Studies delineating the adjacent level effect of single level disc replacement systems have been reported in literature. The aim of this study was to compare the adjacent level biomechanics of bi-level disc replacement, bi-level fusion and a construct having adjoining level disc replacement and fusion system. In total, biomechanics of four models- intact, bi level disc replacement, bi level fusion and fusion plus disc replacement at adjoining levels- was studied to gain insight into the effects of various instrumentation systems on cranial and caudal adjacent levels using finite element analysis (73.6N+varying moment). The bi-level fusion models are more than twice as stiff as compared to the intact model during flexion-extension, lateral bending and axial rotation. Bi-level disc replacement model required moments lower than intact model (1.5Nm). Fusion plus disc replacement model required moment 10-25% more than intact model, except in extension. Adjacent level motions, facet loads and endplate stresses increased substantially in the bi-level fusion model. On the other hand, adjacent level motions, facet loads and endplate stresses were similar to intact for the bi-level disc replacement model. For the fusion plus disc replacement model, adjacent level motions, facet loads and endplate stresses were closer to intact model rather than the bi-level fusion model, except in extension. Based on our finite element analysis, fusion plus disc replacement procedure has less severe biomechanical effects on adjacent levels when compared to bi-level fusion procedure. Bi-level disc replacement procedure did not have any adverse mechanical effects on adjacent levels. Copyright © 2011 Elsevier Ltd. All rights reserved.

  8. Understanding Total Hip Replacement Recovery towards the Design of a Context-Aware Systems

    NARCIS (Netherlands)

    Jimenez Garcia, Juan

    2011-01-01

    Total Hip Replacement (THR) is a common procedure to improve the mobility of elderly with osteoarthritis. Presently information about the recovery process after discharge is unclear. As consequence patients and physiotherapists face uncertainties to follow an adequate trajectory for recovery.

  9. Environmental procedures

    International Nuclear Information System (INIS)

    1992-01-01

    The European Bank has pledged in its Agreement to place environmental management at the forefront of its operations to promote sustainable economic development in central and eastern Europe. The Bank's environmental policy is set out in the document titled, Environmental Management: The Bank's Policy Approach. This document, Environmental Procedures, presents the procedures which the European Bank has adopted to implement this policy approach with respect to its operations. The environmental procedures aim to: ensure that throughout the project approval process, those in positions of responsibility for approving projects are aware of the environmental implications of the project, and can take these into account when making decisions; avoid potential liabilities that could undermine the success of a project for its sponsors and the Bank; ensure that environmental costs are estimated along with other costs and liabilities; and identify opportunities for environmental enhancement associated with projects. The review of environmental aspects of projects is conducted by many Bank staff members throughout the project's life. This document defines the responsibilities of the people and groups involved in implementing the environmental procedures. Annexes contain Environmental Management: The Bank's Policy Approach, examples of environmental documentation for the project file and other ancillary information

  10. Testing of Replacement Bag Material

    International Nuclear Information System (INIS)

    Laurinat, J.E.

    1998-01-01

    Recently, the FB-Line bagout material was changed to simplify the processing of sand, slag, and crucible.The results of the strength tests and the outgassing measurements and calculations demonstrate that the proposed replacement nylon bag materials (HRMP and orange anti-static material) are acceptable substitutes for LDPE and the original nylon with respect to mechanical properties

  11. Electrocatalysts Prepared by Galvanic Replacement

    Directory of Open Access Journals (Sweden)

    Athanasios Papaderakis

    2017-03-01

    Full Text Available Galvanic replacement is the spontaneous replacement of surface layers of a metal, M, by a more noble metal, Mnoble, when the former is treated with a solution containing the latter in ionic form, according to the general replacement reaction: nM + mMnoblen+ → nMm+ + mMnoble. The reaction is driven by the difference in the equilibrium potential of the two metal/metal ion redox couples and, to avoid parasitic cathodic processes such as oxygen reduction and (in some cases hydrogen evolution too, both oxygen levels and the pH must be optimized. The resulting bimetallic material can in principle have a Mnoble-rich shell and M-rich core (denoted as Mnoble(M leading to a possible decrease in noble metal loading and the modification of its properties by the underlying metal M. This paper reviews a number of bimetallic or ternary electrocatalytic materials prepared by galvanic replacement for fuel cell, electrolysis and electrosynthesis reactions. These include oxygen reduction, methanol, formic acid and ethanol oxidation, hydrogen evolution and oxidation, oxygen evolution, borohydride oxidation, and halide reduction. Methods for depositing the precursor metal M on the support material (electrodeposition, electroless deposition, photodeposition as well as the various options for the support are also reviewed.

  12. Testosterone replacement in male hypogonadism

    OpenAIRE

    Kalra, Sanjay; Agrawal, Navneet; Kumar, Satish; Sharma, Amit

    2010-01-01

    Sanjay Kalra1, Navneet Agrawal2, Satish Kumar3, Amit Sharma11Department of Endocrinology, Bharti Hospital, Karnal, India; 2Dept of Medicine, GR Medical College, Gwalior, India; 3Clinical Research, EXCEL Life Sciences, NOIDA, IndiaAbstract: This article contains a review of the clinical aspects of testosterone replacement in androgen deficiency of the aging male.Keywords: testosterone, supplementation, hypogonadism, ADAM

  13. [Valve-sparing Replacement in Patients with Aortic Root Dilatation].

    Science.gov (United States)

    Yamazaki, Kazuhiro; Minatoya, Kenji; Ueda, Ryoma; Takehara, Masato; Sakamoto, Kazuhisa; Ide, Yujiro; Kanemitsu, Hideo; Ueyama, Koji; Ikeda, Tadashi

    2018-01-01

    Valve-sparing root replacement is increasingly used to overcome drawbacks associated with valvular prostheses. In our institution, 7 patients underwent valve-sparing root replacement from August 2016 to July 2017. The mean age was 45 years (range, 14~69 years). Three patients had Marfan syndrome and 1 had Loeys-Dietz syndrome with acute aortic dissection. All patients underwent surgery with reimplantation technique using a Valsalva graft. Two patients required repair of aortic valve leaflet prolapse. All patients had an excellent clinical course, with mild or no aortic regurgitation and a decrease in end-diastolic volume on echocardiography. These results support the continued use of valve-sparing root replacement in selected patients.

  14. Noninvasive Hemodynamic Measurements During Neurosurgical Procedures in Sitting Position.

    Science.gov (United States)

    Schramm, Patrick; Tzanova, Irene; Gööck, Tilman; Hagen, Frank; Schmidtmann, Irene; Engelhard, Kristin; Pestel, Gunther

    2017-07-01

    Neurosurgical procedures in sitting position need advanced cardiovascular monitoring. Transesophageal echocardiography (TEE) to measure cardiac output (CO)/cardiac index (CI) and stroke volume (SV), and invasive arterial blood pressure measurements for systolic (ABPsys), diastolic (ABPdiast) and mean arterial pressure (MAP) are established monitoring technologies for these kind of procedures. A noninvasive device for continuous monitoring of blood pressure and CO based on a modified Penaz technique (volume-clamp method) was introduced recently. In the present study the noninvasive blood pressure measurements were compared with invasive arterial blood pressure monitoring, and the noninvasive CO monitoring to TEE measurements. Measurements of blood pressure and CO were performed in 35 patients before/after giving a fluid bolus and a change from supine to sitting position, start of surgery, and repositioning from sitting to supine at the end of surgery. Data pairs from the noninvasive device (Nexfin HD) versus arterial line measurements (ABPsys, ABPdiast, MAP) and versus TEE (CO, CI, SV) were compared using Bland-Altman analysis and percentage error. All parameters compared (CO, CI, SV, ABPsys, ABPdiast, MAP) showed a large bias and wide limits of agreement. Percentage error was above 30% for all parameters except ABPsys. The noninvasive device based on a modified Penaz technique cannot replace arterial blood pressure monitoring or TEE in anesthetized patients undergoing neurosurgery in sitting position.

  15. Replacement of the C-terminal tetrapeptide ( 314 PAPV 317 to 314 ...

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Biosciences; Volume 35; Issue 4. Replacement of the C-terminal tetrapeptide (314PAPV317 to 314SSSM317) in interferon regulatory factor-2 alters its N-terminal DNA-binding activity. Krishna Prakash Pramod C Rath. Articles Volume 35 Issue 4 December 2010 pp 547-556 ...

  16. The use of transcatheter aortic valve replacement vs surgical aortic valve replacement for the treatment of aortic stenosis

    Directory of Open Access Journals (Sweden)

    Jensen HA

    2015-08-01

    Full Text Available Hanna A Jensen, Lillian L Tsai, Vinod H Thourani Division of Cardiothoracic Surgery, Joseph B Whitehead Department of Surgery, Structural Heart and Valve Center, Emory University School of Medicine, Atlanta, GA, USA Abstract: Severe aortic stenosis (AS is associated with considerable morbidity and mortality and is increasing in prevalence as the global population increases. Since AS primarily affects the elderly, many of these patients have comorbidities that make them poor candidates for the gold standard treatment for AS, surgical aortic valve replacement. Transcatheter aortic valve replacement has emerged as a novel technology for the management of AS in higher risk patients over the past decade. Randomized trials have established the safety and efficacy of transcatheter aortic valve replacement, and the medical community has rallied to identify the patients who are most suitable for this transformative treatment. This review focuses on outlining the key procedural differences, describing the unique challenges of both operations, and finally assessing and comparing outcomes both on a general level and in challenging patient subgroups. Keywords: aortic valve replacement, transcatheter aortic valve replacement, surgical aortic valve replacement 

  17. 25 CFR 700.53 - Dwelling, replacement.

    Science.gov (United States)

    2010-04-01

    ... 25 Indians 2 2010-04-01 2010-04-01 false Dwelling, replacement. 700.53 Section 700.53 Indians THE... Policies and Instructions Definitions § 700.53 Dwelling, replacement. The term replacement dwelling means a dwelling selected by the head of a household as a replacement dwelling that meets the criteria of this...

  18. 24 CFR 880.602 - Replacement reserve.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Replacement reserve. 880.602... Replacement reserve. (a) A replacement reserve must be established and maintained in an interest-bearing account to aid in funding extraordinary maintenance and repair and replacement of capital items. (1) Part...

  19. 24 CFR 891.405 - Replacement reserve.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Replacement reserve. 891.405....405 Replacement reserve. (a) Establishment of reserve. The Owner shall establish and maintain a replacement reserve to aid in funding extraordinary maintenance and repair and replacement of capital items...

  20. 24 CFR 891.855 - Replacement reserves.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Replacement reserves. 891.855... § 891.855 Replacement reserves. (a) The mixed-finance owner shall establish and maintain a replacement... the funds will be used to pay for capital replacement costs for the Section 202 or 811 supportive...

  1. A Bayesian perspective on some replacement strategies

    International Nuclear Information System (INIS)

    Mazzuchi, Thomas A.; Soyer, Refik

    1996-01-01

    In this paper we present a Bayesian decision theoretic approach for determining optimal replacement strategies. This approach enables us to formally incorporate, express, and update our uncertainty when determining optimal replacement strategies. We develop relevant expressions for both the block replacement protocol with minimal repair and the age replacement protocol and illustrate the use of our approach with real data

  2. Radiochemical procedures

    International Nuclear Information System (INIS)

    Lyon, W.S.

    1982-01-01

    The modern counting instrumentation has largely obviated the need for separation processes in the radiochemical analysis but problems in low-level radioactivity measurement, environmental-type analyses, and special situations caused in the last years a renaissance of the need for separation techniques. Most of the radiochemical procedures, based on the classic works of the Manhattan Project chemists of the 1940's, were published in the National Nuclear Energy Series (NNES). Improvements such as new solvent extraction and ion exchange separations have been added to these methods throughout the years. Recently the Los Alamos Group have reissued their collected Radiochemical Procedures containing a short summary and review of basic inorganic chemistry - 'Chemistry of the Elements on the Basis of Electronic Configuration'. (A.L.)

  3. Personalised external aortic root support (PEARS) in Marfan syndrome: Analysis of 1-9 year outcomes by intention-to-treat in a cohort of the first 30 consecutive patients to receive a novel tissue and valve-conserving procedure, compared with the published results of aortic root replacement

    NARCIS (Netherlands)

    T. Treasure (Tom); J.J.M. Takkenberg (Hanneke); T. Golesworthy (Tal); F. Rega (Filip); M. Petrou (Mario); U. Rosendahl (Ulrich); R. Mohiaddin (Raad); M. Rubens (Michael); W. Thornton (Warren); B. Lees (Belinda); J. Pepper (John)

    2014-01-01

    textabstractObjective: Among people with Marfan syndrome who have a typical aortic root aneurysm, dissection is a characteristic cause of premature death. To pre-empt Type A dissection, composite root replacement with a mechanical valve became the standard of care in the 1980s and 1990s. This is

  4. Replacement strategy for obsolete plant computers

    International Nuclear Information System (INIS)

    Schaefer, J.P.

    1985-01-01

    The plant computers of the first generation of larger nuclear power plants are reaching the end of their useful life time with respect to the hardware. The software would be no reason for a system exchange but new tasks for the supervisory computer system, availability questions of maintenance personnel and spare parts and the demand for improved operating procedures for the computer users have stimulated the considerations on how to exchange a computer system in a nuclear power plant without extending plant outage times due to exchange works. In the Federal Republic of Germany the planning phase of such backfitting projects is well under way, some projects are about to be implemented. The base for these backfitting projects is a modular supervisory computer concept which has been designated for the new line of KWU PWR's. The main characteristic of this computer system is the splitting of the system into a data acquisition level and a data processing level. This principle allows an extension of the processing level or even repeated replacements of the processing computers. With the existing computer system still in operation the new system can be installed in a step-by-step procedure. As soon as the first of the redundant process computers of the data processing level is in operation and the data link to the data acquisition computers is established the old computer system can be taken out of service. Then the back-up processing computer can be commissioned to complete the new system. (author)

  5. Modifications to Replacement Costs System

    International Nuclear Information System (INIS)

    Godec, M.

    1989-01-01

    The purpose of this memorandum is to document the improvements and modifications made to the Replacement Costs of Crude Oil (REPCO) Supply Analysis System. While some of this work was performed under our previous support contract to DOE/ASFE, we are presenting all modifications and improvements are presented here for completeness. The memo primarily documents revisions made to the Lower-48 Onshore Model. Revisions and modifications made to other components and models in the REPCO system which are documented elsewhere are only highlighted in this memo. Generally, the modifications made to the Lower-48 Onshore Model reflect changes that have occurred in domestic drilling, oil field costs, and reserves since 1982, the date of the most recent available data used for the original Replacement Costs report, published in 1985

  6. Petroleum supply annual 1994. Volume 1

    International Nuclear Information System (INIS)

    1995-01-01

    The Petroleum Supply Annual (PSA) contains information on the supply and disposition of crude oil and petroleum products. The publication reflects data that were collected from the petroleum industry during 1994 through annual and monthly surveys. The PSA is divided into two volumes. This first volume contains four sections: Summary Statistics, Detailed Statistics, Refinery Capacity, and Oxygenate Capacity each with final annual data. The second volume contains final statistics for each month of 1994, and replaces data previously published in the Petroleum Supply Monthly (PSM). The tables in Volumes 1 and 2 are similarly numbered to facilitate comparison between them. Below is a description of each section in Volume 1 of the PSA

  7. Results of Austin Moore replacement.

    Directory of Open Access Journals (Sweden)

    Jadhav A

    1996-04-01

    Full Text Available Forty cases of Austin Moore Replacement done for transcervical fractures of the femur in patients were reviewed after a period of 12 to 48 months postoperatively (mean 26 mth. 30 cases (75% had mild to severe pain of non-infective origin, starting as early as 6 months postoperatively. This was irrespective of the make, size or position (varus/valgus of the prosthesis. Though the Aufranc and Sweet clinical scoring was satisfactory in 65% cases, radiological evidence of complications like sinking, protrusion, etc. were seen in majority of the cases. Calcar resorption was seen in 34 cases (85% as early as 4 months postoperatively. Results of THR and bipolar replacement done for transcervical fractures in recent literature show 85% pain-free cases at 5 years. We feel that Austin Moore Replacement should be reserved for patients more than 65 years of age and those who are less active or debilitated because of other factors, because of increased acetabular wear with time in the younger individual. This is corroborated by unsatisfactory results in patients less than 65 years of age (p < 0.05.

  8. BWR control blade replacement strategies

    Energy Technology Data Exchange (ETDEWEB)

    Kennard, M W [Stoller Nuclear Fuel, NAC International, Pleasantville, NY (United States); Harbottle, J E [Stoller Nuclear Fuel, NAC International, Thornbury, Bristol (United Kingdom)

    2000-02-01

    The reactivity control elements in a BWR, the control blades, perform three significant functions: provide shutdown margin during normal and accident operating conditions; provide overall core reactivity control; and provide axial power shaping control. As such, the blades are exposed to the core's neutron flux, resulting in irradiation of blade structural and absorber materials. Since the absorber depletes with time (if B{sub 4}C is used, it also swells) and the structural components undergo various degradation mechanisms (e.g., embrittlement, corrosion), the blades have limits on their operational lifetimes. Consequently, BWR utilities have implemented strategies that aim to maximize blade lifetimes while balancing operational costs, such as extending a refuelling outage to shuffle high exposure blades. This paper examines the blade replacement strategies used by BWR utilities operating in US, Europe and Asia by assembling information related to: the utility's specific blade replacement strategy; the impact the newer blade designs and changes in core operating mode were having on those strategies; the mechanical and nuclear limits that determined those strategies; the methods employed to ensure that lifetime limits were not exceeded during operation; and blade designs used (current and replacement blades). (author)

  9. BWR control blade replacement strategies

    International Nuclear Information System (INIS)

    Kennard, M.W.; Harbottle, J.E.

    2000-01-01

    The reactivity control elements in a BWR, the control blades, perform three significant functions: provide shutdown margin during normal and accident operating conditions; provide overall core reactivity control; and provide axial power shaping control. As such, the blades are exposed to the core's neutron flux, resulting in irradiation of blade structural and absorber materials. Since the absorber depletes with time (if B 4 C is used, it also swells) and the structural components undergo various degradation mechanisms (e.g., embrittlement, corrosion), the blades have limits on their operational lifetimes. Consequently, BWR utilities have implemented strategies that aim to maximize blade lifetimes while balancing operational costs, such as extending a refuelling outage to shuffle high exposure blades. This paper examines the blade replacement strategies used by BWR utilities operating in US, Europe and Asia by assembling information related to: the utility's specific blade replacement strategy; the impact the newer blade designs and changes in core operating mode were having on those strategies; the mechanical and nuclear limits that determined those strategies; the methods employed to ensure that lifetime limits were not exceeded during operation; and blade designs used (current and replacement blades). (author)

  10. The reciprocal iso-inhibition volume concept: A procedure for the evaluation in effect-directed analysis with thin-layer chromatography - using the thin-layer chromatography-luminescent bacteria assay as an example.

    Science.gov (United States)

    Schulz, Wolfgang; Weiss, Stefan C; Weber, Walter H; Winzenbacher, Rudi

    2017-10-13

    In effect-directed analysis (EDA) with high-performance thin-layer chromatography (HPTLC), the effect is often detected using images. Thus, an approach to create inhibition chromatograms from these images was developed using the example of the HPTLC- bioluminescence inhibition test. A comparison between the cuvette test and the HPTLC test shows that the test on the plate is significantly more sensitive. To describe the strength of the effect, the EC 50 value is determined from the dose-response relationship. However, the inhibiting compounds are generally unknown and thus their concentrations are also unknown. Therefore, instead of the concentration, the known application volumes are used. This enables the calculation of the application volume necessary to achieve 50% inhibition. Since the volume is inversely proportional to the concentration, the reciprocal value of the calculated volume is indicated and is referred to as the reciprocal iso-inhibition volume (RIV). Using this RIV-concept, it is now possible to compare inhibition bands within and between plates. The entire evaluation is described by the means of two samples from a contaminated site using the bioluminescence inhibition. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. [Environmental investigation of ground water contamination at Wright-Patterson Air Force Base, Ohio]. Volume 3, Appendix A, Draft standard operating procedures and elements: Sampling and Analysis Plan (SAP): Phase 1, Task 4, Field Investigation, Draft

    Energy Technology Data Exchange (ETDEWEB)

    1991-10-01

    This report presents information concerning field procedures employed during the monitoring, well construction, well purging, sampling, and well logging at the Wright-Patterson Air Force Base. Activities were conducted in an effort to evaluate ground water contamination.

  12. In-core monitor housing replacement at Fukushima Daiichi Unit No.4

    International Nuclear Information System (INIS)

    Arai, Tomoyuki

    1999-01-01

    The in-core monitor (ICM) housing replacement of a Boiling Water Reactor (BWR) has been completed at Fukushima-Daiichi Unit No. 4 (1F4) of the Tokyo Electric Power Company (TEPCO) in Japan. Since cracking of the inside surface of an ICM housing was found in this unit, the ICM housing was replaced with one made of low-carbon stainless steel (SS) to improve Intergranular Stress Corrosion Cracking (IGSCC) resistance. This project is the first application of the replacement procedure for the ICM housing and employs various advanced technologies. The outline of the ICM housing replacement project and applied technologies are discussed in this paper. (author)

  13. Acceptance test for 900 MWe PWR unit replacement steam generators

    International Nuclear Information System (INIS)

    Gourguechon, B.

    1993-01-01

    During the first half of 1994, the Gravelines 1 steam generators will be replaced (SG replacement procedure). The new SG's differ from the former components notably by the alloy used for the tube bundle, in this case, the high chromium content Inconel 690. So, from this standpoint, they are to be considered as PWR 900 replacement SG first models and their thermal efficiency has consequently to be assessed. This will provide an opportunity of ensuring that the performance of the components delivered is in compliance with requirements and of making the necessary provisions if significant deviations are observed. The EFMT branch, which has been in charge of the instrumentation and acceptance of the different SG first models since the first PWR plants were commissioned, will be responsible for the acceptance tests and the ultimate validation of a performance assessment procedure applicable to the future replacement steam generators. The methods and tests proposed for SG expert appraisal are based on consideration of the importance of primary measurement quality for satisfactory SG assessment and of the new test facilities with which the 900 and 1 300 PWR plants are gradually being equipped. These facilities provide an on-site computer environment for tests compatible with the tools (PATTERN, etc.) used at EFMT and in other departments. This test is the first of this kind performed by EFMT and the test facility of a nuclear power plant. (author). 6 figs

  14. The use of synthetic ligaments in the design of an enhanced stability total knee joint replacement.

    Science.gov (United States)

    Stokes, Michael D; Greene, Brendan C; Pietrykowski, Luke W; Gambon, Taylor M; Bales, Caroline E; DesJardins, John D

    2018-03-01

    Current total knee replacement designs work to address clinically desired knee stability and range of motion through a balance of retained anatomy and added implant geometry. However, simplified implant geometries such as bearing surfaces, posts, and cams are often used to replace complex ligamentous constraints that are sacrificed during most total knee replacement procedures. This article evaluates a novel total knee replacement design that incorporates synthetic ligaments to enhance the stability of the total knee replacement system. It was hypothesized that by incorporating artificial cruciate ligaments into a total knee replacement design at specific locations and lengths, the stability of the total knee replacement could be significantly altered while maintaining active ranges of motion. The ligament attachment mechanisms used in the design were evaluated using a tensile test, and determined to have a safety factor of three with respect to expected ligamentous loading in vivo. Following initial computational modeling of possible ligament orientations, a physical prototype was constructed to verify the function of the design by performing anterior/posterior drawer tests under physiologic load. Synthetic ligament configurations were found to increase total knee replacement stability up to 94% compared to the no-ligament case, while maintaining total knee replacement flexion range of motion between 0° and 120°, indicating that a total knee replacement that incorporates synthetic ligaments with calibrated location and lengths should be able to significantly enhance and control the kinematic performance of a total knee replacement system.

  15. The influence of carbohydrate-based fat replacers with and without emulsifiers on the quality characteristics of lowfat cake.

    Science.gov (United States)

    Khalil, A H

    1998-01-01

    Physical and sensory characteristics of cakes prepared with either the carbohydrate-based fat replacers N-Flate, Paselli MD 10 and Litesse (0, 25, 50 and 75% of fat weight) or fat replacers plus emulsifier (mono- and diglycerides; 0 and 3% of flour weight) were studied. Specific gravity of the batter was significantly (p Cakes prepared with fat replacers at the 25 and 50% levels had higher volumes, specific volume and standing heights than those of the control. Cakes prepared with fat replacers at the 25, 50 and 75% levels were more compressible than the control. Cakes prepared with Paselli MD 10 had the highest volumes, specific volume, standing heights and compressibilities. Incorporation of emulsifier with fat replacers improved cake volumes, standing heights and compressibilities. Cakes prepared with fat replacers exhibited higher crust and crumb color values compared to the control. Cakes prepared with 25 or 50% fat replacers had higher mean scores for flavor, softness and eating quality than the control. Incorporation of emulsifier with fat replacers did not affect the crust color, crumb color and flavor, but significantly (p < or = 0.05) improved softness and eating quality.

  16. Experimental replacement of esophagus with a short segment of trachea.

    Science.gov (United States)

    Abbasidezfouli, Azizollah; Ansari, Damoon; Sheikhy, Kambiz; Abarkar, Mohammad; Sadeghbeigi, Farahnaz; Abbasidezfouli, Sepehr; Sharifi, Davood

    2016-03-01

    Segmental resection of esophagus with primary anastomosis is prohibited because of the risk of dehiscence. We previously have shown that replacement of a segment of cervical esophagus with a tracheal segment of the same length could successfully be performed in a canine model. In this study, we sought to assess the feasibility of replacement of the esophageal defect with a shorter segment of trachea. In five mongrel dogs weighting 20-30 kg, under general anesthesia and after a cervical incision, 8 cm of the cervical esophagus was resected and replaced by a 4-cm segment of the adjacent trachea. The animals were evaluated clinically for signs and symptoms of stenosis and dehiscence and then euthanized after 2 mo of follow-up. All dogs recovered from surgery and started regular diet on the seventh postoperative day. No clinical or endoscopic sign of stenosis or voice change was seen. Squamous metaplasia and atrophy of mucosal glands and cartilage were detected in the histopathologic examination of the replaced segments. Replacement of a cervical esophageal defect with a shorter segment of trachea can be performed successfully in dogs. This procedure can be potentially used for the treatment of cervical esophageal lesions in humans. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Analytical Chemistry Laboratory (ACL) procedure compendium

    International Nuclear Information System (INIS)

    1993-01-01

    This volume contains the interim change notice for the safety operation procedure for hot cell. It covers the master-slave manipulators, dry waste removal, cell transfers, hoists, cask handling, liquid waste system, and physical characterization of fluids

  18. ReplacementMatrix: a web server for maximum-likelihood estimation of amino acid replacement rate matrices.

    Science.gov (United States)

    Dang, Cuong Cao; Lefort, Vincent; Le, Vinh Sy; Le, Quang Si; Gascuel, Olivier

    2011-10-01

    Amino acid replacement rate matrices are an essential basis of protein studies (e.g. in phylogenetics and alignment). A number of general purpose matrices have been proposed (e.g. JTT, WAG, LG) since the seminal work of Margaret Dayhoff and co-workers. However, it has been shown that matrices specific to certain protein groups (e.g. mitochondrial) or life domains (e.g. viruses) differ significantly from general average matrices, and thus perform better when applied to the data to which they are dedicated. This Web server implements the maximum-likelihood estimation procedure that was used to estimate LG, and provides a number of tools and facilities. Users upload a set of multiple protein alignments from their domain of interest and receive the resulting matrix by email, along with statistics and comparisons with other matrices. A non-parametric bootstrap is performed optionally to assess the variability of replacement rate estimates. Maximum-likelihood trees, inferred using the estimated rate matrix, are also computed optionally for each input alignment. Finely tuned procedures and up-to-date ML software (PhyML 3.0, XRATE) are combined to perform all these heavy calculations on our clusters. http://www.atgc-montpellier.fr/ReplacementMatrix/ olivier.gascuel@lirmm.fr Supplementary data are available at http://www.atgc-montpellier.fr/ReplacementMatrix/

  19. Beta-Cell Replacement: Pancreas and Islet Cell Transplantation.

    Science.gov (United States)

    Niclauss, Nadja; Meier, Raphael; Bédat, Benoît; Berishvili, Ekaterine; Berney, Thierry

    2016-01-01

    Pancreas and islet transplantation are 2 types of beta-cell replacement therapies for type 1 diabetes mellitus. Since 1966, when pancreas transplantation was first performed, it has evolved to become a highly efficient procedure with high success rates, thanks to advances in surgical technique and immunosuppression. Pancreas transplantation is mostly performed as simultaneous pancreas-kidney transplantation in patients with end-stage nephropathy secondary to diabetes. In spite of its efficiency, pancreas transplantation is still a major surgical procedure burdened by high morbidity, which called for the development of less invasive and hazardous ways of replacing beta-cell function in the past. Islet transplantation was developed in the 1970s as a minimally invasive procedure with initially poor outcomes. However, since the report of the 'Edmonton protocol' in 2000, the functional results of islet transplantation have substantially and constantly improved and are about to match those of whole pancreas transplantation. Islet transplantation is primarily performed alone in nonuremic patients with severe hypoglycemia. Both pancreas transplantation and islet transplantation are able to abolish hypoglycemia and to prevent or slow down the development of secondary complications of diabetes. Pancreas transplantation and islet transplantation should be seen as two complementary, rather than competing, therapeutic approaches for beta-cell replacement that are able to optimize organ donor use and patient care. © 2016 S. Karger AG, Basel.

  20. A prospective study on the risk of glove fingertip contamination during draping in joint replacement surgery.

    Science.gov (United States)

    Makki, D; Deierl, K; Pandit, A; Trakru, S

    2014-09-01

    The aim of this prospective study was to investigate the risk of contamination of surgical gloves during preparation and draping in joint replacement surgery. During 46 hip and knee replacement procedures, the gloves of orthopaedic consultants (n=5) and registrars (n=3) were assessed for contamination immediately after draping by impression of gloved fingers on blood agar. Contamination was evaluated by the surgeon's grade, the type of procedure, the role of the assistant and the dominance of the hand. A total of 125 pairs of top gloves were examined (79 pairs from registrars and 46 pairs from consultants). Bacterial contamination was isolated on 19 pairs (15.2%) (16 pairs from registrars and 3 pairs from consultants, p=0.04). Coagulase negative staphylococci were the main isolates and contamination was considered low in all cases (1-5 colonies). Contamination was seen more on the dominant hand (16 gloves from dominant hands and 6 from non-dominant hands, p=0.04), on the index finger and thumb. More contaminated gloves were seen in hip arthroplasty procedures (16 pairs from total hip replacements vs 3 pairs from total knee replacements, p=0.02). Contamination of glove fingertips during draping in joint replacement procedures is more likely to occur among junior surgeons, in hip rather than knee arthroplasty procedures and on the dominant hand. It is therefore essential that surgeons of different grades replace gloves used in draping to avoid exposing patients to the risk of infection.

  1. Outcome of the TURP-TUVP sandwich procedure for minimally invasive surgical treatment of benign prostatic hyperplasia with volume larger than 40cc over a 4-year period in Nigeria

    Directory of Open Access Journals (Sweden)

    O.I. Aisuodionoe-Shadrach

    2013-03-01

    Conclusions: The sandwich combination of TURP and TUVP for the surgical treatment of BPH with volume larger than 40cc had satisfactory patient safety profile and resulted in significant improvement in IPSS, Qmax and PVR on follow-up at 3 months.

  2. Gentilly 2 divider plate replacement

    International Nuclear Information System (INIS)

    Forest, J.; Klisel, E.; McClellan, G.; Schnelder, W.

    1995-01-01

    The steam generators at the Gentilly 2 Nuclear Plant in operation since 1983 were built with primary divider plates of a bolted panel configuration. During a routine outage inspection, it was noted that two bolts had dislodged from the divider and were located lying in the primary head. Subsequent inspections revealed erosion damage to a substantial number of divider plate bolts and to a lesser extent, to the divider plate itself. After further inspection and repair the units were returned to operation, however, it was determined that a permanent replacement of the primary divider plates was going to be necessary. After evaluation of various options, it was decided that the panel type dividers would be replaced with a single piece floating design. The divider itself was to be of a one piece all-welded arrangement to be constructed from individual panels to be brought in through the manways. In view of the strength limitations of the bolted attachment of the upper seat bar to the tubesheet, a new welded seat bar was provided. To counteract erosion concerns, the new divider is fitted with erosion resistant inserts or weld buildup and with improved sealing features in order to minimize leakage and erosion. At an advanced stage in the design and manufacture of the components, the issue of divider strength during LOCA conditions came into focus. Analysis was performed to determine the strength and/or failure characteristics of the divider to a variety of small and large LOCA conditions. The paper describes the diagnosis of the original divider plates and the design, manufacture, field mobilization, installation and subsequent operation of the replacement divider plates. (author)

  3. In Defense of Artificial Replacement.

    Science.gov (United States)

    Shiller, Derek

    2017-06-01

    If it is within our power to provide a significantly better world for future generations at a comparatively small cost to ourselves, we have a strong moral reason to do so. One way of providing a significantly better world may involve replacing our species with something better. It is plausible that in the not-too-distant future, we will be able to create artificially intelligent creatures with whatever physical and psychological traits we choose. Granted this assumption, it is argued that we should engineer our extinction so that our planet's resources can be devoted to making artificial creatures with better lives. © 2017 John Wiley & Sons Ltd.

  4. [A re-operative case of bentall operation and aortic arch replacement using a stent graft for a Marfan syndrome, post sternum turnover and post mitral valve replacement].

    Science.gov (United States)

    Sasaki, H; Aomi, S; Noji, S; Uwabe, K; Kihara, S; Kurihara, H; Koyanagi, H

    2001-09-01

    A 36-year-old male with Marfan syndrome succesfully underwent Bentall operation and aortic arch replacement using a stent graft as an elephant trunk. He had received MVR with sternum turn over 14 years previously. Median sternotomy was performed. Under circulatory arrest with rertograde cerebral perfusion we performed Bentall operation and aortic arch replacement using a stent graft. The sternum was cured well. Retractive breathing was not detected. This surgical procedure was effective for cardiovascular disease with Marfan syndrome.

  5. Regulations and Procedures Manual

    Energy Technology Data Exchange (ETDEWEB)

    Young, Lydia J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2011-07-25

    The purpose of the Regulations and Procedures Manual (RPM) is to provide LBNL personnel with a reference to University and Lawrence Berkeley National Laboratory (LBNL or Laboratory) policies and regulations by outlining normal practices and answering most policy questions that arise in the day-to-day operations of Laboratory organizations. Much of the information in this manual has been condensed from detail provided in LBNL procedure manuals, Department of Energy (DOE) directives, and Contract DE-AC02-05CH11231. This manual is not intended, however, to replace any of those documents. RPM sections on personnel apply only to employees who are not represented by unions. Personnel policies pertaining to employees represented by unions may be found in their labor agreements. Questions concerning policy interpretation should be directed to the LBNL organization responsible for the particular policy. A link to the Managers Responsible for RPM Sections is available on the RPM home page. If it is not clear which organization is responsible for a policy, please contact Requirements Manager Lydia Young or the RPM Editor.

  6. Regulations and Procedures Manual

    Energy Technology Data Exchange (ETDEWEB)

    Young, Lydia [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2010-09-30

    The purpose of the Regulations and Procedures Manual (RPM) is to provide Laboratory personnel with a reference to University and Lawrence Berkeley National Laboratory policies and regulations by outlining the normal practices and answering most policy questions that arise in the day-to-day operations of Laboratory departments. Much of the information in this manual has been condensed from detail provided in Laboratory procedure manuals, Department of Energy (DOE) directives, and Contract DE-AC02-05CH11231. This manual is not intended, however, to replace any of those documents. The sections on personnel apply only to employees who are not represented by unions. Personnel policies pertaining to employees represented by unions may be found in their labor agreements. Questions concerning policy interpretation should be directed to the department responsible for the particular policy. A link to the Managers Responsible for RPM Sections is available on the RPM home page. If it is not clear which department should be called, please contact the Associate Laboratory Director of Operations.

  7. Blood banking and regulation: procedures, problems, and alternatives

    National Research Council Canada - National Science Library

    Dauer, Edward A

    This volume examines regulatory and policymaking procedures in blood banking, regulatory enforcement and compliance, innovations and alternatives in regulation, congressional oversight and regulatory...

  8. Hormone Replacement Therapy and Your Heart

    Science.gov (United States)

    Hormone replacement therapy and your heart Are you taking — or considering — hormone therapy to treat bothersome menopausal symptoms? Understand ... you. By Mayo Clinic Staff Long-term hormone replacement therapy used to be routinely prescribed for postmenopausal ...

  9. Skilled nursing facilities after joint replacement

    Science.gov (United States)

    ... care providers in the weeks before your joint replacement. They can advise you about whether going directly ... of many people who have had a joint replacement? Can they tell you how many? A good ...

  10. Risks of hip and knee replacement

    Science.gov (United States)

    ... is normal to lose blood during and after hip or knee replacement surgery. Some people need a ... clot form are higher during and soon after hip or knee replacement surgery. Sitting or lying down ...

  11. Fleet replacement modeling : final report, July 2009.

    Science.gov (United States)

    2009-07-01

    This project focused on two interrelated areas in equipment replacement modeling for fleets. The first area was research-oriented and addressed a fundamental assumption in engineering economic replacement modeling that all assets providing a similar ...

  12. Long-life slab replacement concrete : [summary].

    Science.gov (United States)

    2015-04-01

    Concrete slab replacement projects in Florida have demonstrated a high incidence of : replacement slab cracking. Causes of cracking have not been reliably determined. University of South Florida researchers : sought to identify the factors or : param...

  13. Long-life slab replacement concrete.

    Science.gov (United States)

    2015-03-01

    This research was initiated following reports of high incidence of cracking on FDOT concrete pavement replacement : slab projects. Field slabs were instrumented for data acquisition from high-early-strength concrete pavement : replacement slabs place...

  14. B Plant process piping replacement feasibility study

    International Nuclear Information System (INIS)

    Howden, G.F.

    1996-01-01

    Reports on the feasibility of replacing existing embedded process piping with new more corrosion resistant piping between cells and between cells and a hot pipe trench of a Hanford Site style canyon facility. Provides concepts for replacement piping installation, and use of robotics to replace the use of the canyon crane as the primary means of performing/supporting facility modifications (eg, cell lining, pipe replacement, equipment reinstallation) and operational maintenenace

  15. 24 CFR 970.31 - Replacement units.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Replacement units. 970.31 Section... PUBLIC HOUSING PROGRAM-DEMOLITION OR DISPOSITION OF PUBLIC HOUSING PROJECTS § 970.31 Replacement units. Notwithstanding any other provision of law, replacement public housing units may be built on the original public...

  16. Diagenetic replacement of Micas by Carbonates

    NARCIS (Netherlands)

    Oele, E.

    1961-01-01

    In the Ordovician sandstones of the Cantabrian Mountains a replacement of the micas by carbonate minerals could be observed. The absence of metamorphic minerals suggests a diagenetic replacement. This is supported by the finding of the same type of replacement in some undisturbed Pliocene sediments

  17. 47 CFR 13.17 - Replacement license.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 1 2010-10-01 2010-10-01 false Replacement license. 13.17 Section 13.17 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL RADIO OPERATORS General § 13.17 Replacement... request a replacement. The application must be accompanied by the required fee and submitted to the...

  18. 24 CFR 891.605 - Replacement reserve.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Replacement reserve. 891.605... 8 Assistance § 891.605 Replacement reserve. (a) Establishment of reserve. The Borrower shall establish and maintain a replacement reserve to aid in funding extraordinary maintenance, and repair and...

  19. 24 CFR 891.745 - Replacement reserve.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Replacement reserve. 891.745... and Individuals-Section 162 Assistance § 891.745 Replacement reserve. The general requirements for the replacement reserve are provided in § 891.605. For projects funded under §§ 891.655 through 891.790, the...

  20. 24 CFR 572.125 - Replacement reserves.

    Science.gov (United States)

    2010-04-01

    ...) Homeownership Program Requirements-Implementation Grants § 572.125 Replacement reserves. (a) Purpose. A single replacement reserve may be established for the homeownership program only if HUD determines it is necessary to... 24 Housing and Urban Development 3 2010-04-01 2010-04-01 false Replacement reserves. 572.125...

  1. Development of Procedures for Assessing the Impact of Vocational Education Research and Development on Vocational Education (Project IMPACT). Volume 8--A Field Study of Predicting Impact of Research and Development Projects in Vocational and Technical Education.

    Science.gov (United States)

    Malhorta, Man Mohanlal

    As part of Project IMPACT's effort to identify and develop procedures for complying with the impact requirements of Public Law 94-482, a field study was conducted to identify and validate variables and their order of importance in predicting and evaluating impact of research and development (R&D) projects in vocational and technical education.…

  2. Molecular replacement then and now

    International Nuclear Information System (INIS)

    Scapin, Giovanna

    2013-01-01

    A brief overview, with examples, of the evolution of molecular-replacement methods and models over the past few years is presented. The ‘phase problem’ in crystallography results from the inability to directly measure the phases of individual diffracted X-ray waves. While intensities are directly measured during data collection, phases must be obtained by other means. Several phasing methods are available (MIR, SAR, MAD, SAD and MR) and they all rely on the premise that phase information can be obtained if the positions of marker atoms in the unknown crystal structure are known. This paper is dedicated to the most popular phasing method, molecular replacement (MR), and represents a personal overview of the development, use and requirements of the methodology. The first description of noncrystallographic symmetry as a tool for structure determination was explained by Rossmann and Blow [Rossmann & Blow (1962 ▶), Acta Cryst.15, 24–31]. The term ‘molecular replacement’ was introduced as the name of a book in which the early papers were collected and briefly reviewed [Rossmann (1972 ▶), The Molecular Replacement Method. New York: Gordon & Breach]. Several programs have evolved from the original concept to allow faster and more sophisticated searches, including six-dimensional searches and brute-force approaches. While careful selection of the resolution range for the search and the quality of the data will greatly influence the outcome, the correct choice of the search model is probably still the main criterion to guarantee success in solving a structure using MR. Two of the main parameters used to define the ‘best’ search model are sequence identity (25% or more) and structural similarity. Another parameter that may often be undervalued is the quality of the probe: there is clearly a relationship between the quality and the correctness of the chosen probe and its usefulness as a search model. Efforts should be made by all structural biologists to

  3. Correct coding for laboratory procedures during assisted reproductive technology cycles.

    Science.gov (United States)

    2016-04-01

    This document provides updated coding information for services related to assisted reproductive technology procedures. This document replaces the 2012 ASRM document of the same name. Copyright © 2016 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  4. 40 CFR Appendix F to Part 60 - Quality Assurance Procedures

    Science.gov (United States)

    2010-07-01

    ... owner or operator must revise the current written procedures or modify or replace the CEMS to correct..., exponential, and power). If the expanded data base and revised correlation meet PS-11 statistical criteria...

  5. Aortic root replacement after previous surgical intervention on the aortic valve, aortic root, or ascending aorta.

    Science.gov (United States)

    Kirsch, E W Matthias; Radu, N Costin; Mekontso-Dessap, Armand; Hillion, Marie-Line; Loisance, Daniel

    2006-03-01

    Aortic root replacement after a previous operation on the aortic valve, aortic root, or ascending aorta remains a major challenge. Records of 56 consecutive patients (44 men; mean age, 56.4 +/- 13.6 years) undergoing reoperative aortic root replacement between June 1994 and June 2005 were reviewed retrospectively. Reoperation was performed 9.4 +/- 6.7 years after the last cardiac operation. Indications for reoperation were true aneurysm (n = 14 [25%]), false aneurysm (n = 10 [18%]), dissection or redissection (n = 9 [16%]), structural or nonstructural valve dysfunction (n = 10 [18%]), prosthetic valve-graft infection (n = 12 [21%]), and miscellaneous (n = 1 [2%]). Procedures performed were aortic root replacement (n = 47 [84%]), aortic root replacement plus mitral valve procedure (n = 5 [9%]), and aortic root replacement plus arch replacement (n = 4 [7%]). In 14 (25%) patients coronary artery bypass grafting had to be performed unexpectedly during the same procedure or immediately after the procedure to re-establish coronary perfusion. Hospital mortality reached 17.9% (n = 10). Multivariate logistic regression analysis revealed the need for unplanned perioperative coronary artery bypass grafting as the sole independent risk factor for hospital death (P = .005). Actuarial survival was 83.8% +/- 4.9% at 1 month, 73.0% +/- 6.3% at 1 year, and 65.7% +/- 9.0% at 5 years after the operation. One patient had recurrence of endocarditis 6.7 months after the operation and required repeated homograft aortic root replacement. Reoperative aortic root replacement remains associated with a high postoperative mortality. The need to perform unplanned coronary artery bypass grafting during reoperative aortic root replacement is a major risk factor for hospital death. The optimal technique for coronary reconstruction in this setting remains to be debated.

  6. Online doctor reviews: do they track surgeon volume, a proxy for quality of care?

    Science.gov (United States)

    Segal, Jeffrey; Sacopulos, Michael; Sheets, Virgil; Thurston, Irish; Brooks, Kendra; Puccia, Ryan

    2012-04-10

    Increasingly, consumers are accessing the Internet seeking health information. Consumers are also using online doctor review websites to help select their physician. Such websites tally numerical ratings and comments from past patients. To our knowledge, no study has previously analyzed whether doctors with positive online reputations on doctor review websites actually deliver higher quality of care typically associated with better clinical outcomes and better safety records. For a number of procedures, surgeons who perform more procedures have better clinical outcomes and safety records than those who perform fewer procedures. Our objective was to determine if surgeon volume, as a proxy for clinical outcomes and patient safety, correlates with online reputation. We investigated the numerical ratings and comments on 9 online review websites for high- and low-volume surgeons for three procedures: lumbar surgery, total knee replacement, and bariatric surgery. High-volume surgeons were randomly selected from the group within the highest quartile of claims submitted for reimbursement using the procedures' relevant current procedural terminology (CPT) codes. Low-volume surgeons were randomly selected from the lowest quartile of submitted claims for the procedures' relevant CPT codes. Claims were collated within the Normative Health Information Database, covering multiple payers for more than 25 million insured patients. Numerical ratings were found for the majority of physicians in our sample (547/600, 91.2%) and comments were found for 385/600 (64.2%) of the physicians. We found that high-volume (HV) surgeons could be differentiated from low-volume (LV) surgeons independently by analyzing: (1) the total number of numerical ratings per website (HV: mean = 5.85; LV: mean = 4.87, Pcustomer service (HV: mean = 0.24; LV: mean = 0.22, P=.52); and (3) proportion of scathing criticism/total comments about customer service (HV: mean = 0.19; LV: mean = 0.21, P=.48). Online

  7. Controversies in hormone replacement therapy

    Directory of Open Access Journals (Sweden)

    A. Baziad

    2001-09-01

    Full Text Available Deficiency of estrogen hormone will result in either long-term or short-term health problems which may reduce the quality of life. There are numerous methods by which the quality of female life can be achieved. Since the problems occuring are due to the deficiency of estrogen hormone, the appropriate method to tackle the problem is by administration of estrogen hormone. The administration of hormone replacement therapy (HRT with estrogen may eliminate climacteric complaints, prevent osteoporosis, coronary heart disease, dementia, and colon cancer. Although HRT has a great deal of advantage, its use is still low and may result in controversies. These controversies are due to fact that both doctor and patient still hold on to the old, outmoded views which are not supported by numerous studies. Currently, the use of HRT is not only based on experience, or temporary observation, but more on evidence based medicine. (Med J Indones 2001; 10: 182-6Keywords: controversies, HRT

  8. Tracheal replacement by autogenous aorta

    Directory of Open Access Journals (Sweden)

    Anoosh Farhad

    2009-06-01

    Full Text Available Abstract Background Tracheal defects may occur after trauma or prolonged intubation. Resection of tracheal tumors also poses a major challenge for substitution. In an effort to solve this problem, different techniques have been tried with little success. We report on a new animal model which showed acceptable results with fewer complications. Methods We replaced 5 cm of cervical trachea in 10 dogs with harvested infra-renal aorta and repaired the aortic defect with Dacron graft. Results Necropsy of the grafted aorta and anastomotic site revealed well healed anastomosis in all animals together with ciliated columnar epithelium coverage of grafted aorta and neovascularization of aortic wall. Conclusion Aortic graft is preferable to other substitutes because of less antigenicity, less vascularity, and no mucous secretions or peristalsis

  9. Tracheal replacement by autogenous aorta.

    Science.gov (United States)

    Anoosh, Farhad; Hodjati, Hossain; Dehghani, Seifollah; Tanideh, Nader; Kumar, Perikala V

    2009-06-09

    Tracheal defects may occur after trauma or prolonged intubation. Resection of tracheal tumors also poses a major challenge for substitution. In an effort to solve this problem, different techniques have been tried with little success. We report on a new animal model which showed acceptable results with fewer complications. We replaced 5 cm of cervical trachea in 10 dogs with harvested infra-renal aorta and repaired the aortic defect with Dacron graft. Necropsy of the grafted aorta and anastomotic site revealed well healed anastomosis in all animals together with ciliated columnar epithelium coverage of grafted aorta and neovascularization of aortic wall. Aortic graft is preferable to other substitutes because of less antigenicity, less vascularity, and no mucous secretions or peristalsis.

  10. Renal replacement therapy in Europe

    DEFF Research Database (Denmark)

    Pippias, Maria; Stel, Vianda S; Abad Diez, José Maria

    2015-01-01

    BACKGROUND: This article summarizes the 2012 European Renal Association-European Dialysis and Transplant Association Registry Annual Report (available at www.era-edta-reg.org) with a specific focus on older patients (defined as ≥65 years). METHODS: Data provided by 45 national or regional renal...... disease (ESRD) receiving renal replacement therapy (RRT) and renal transplantation rates for 2012 are presented. RESULTS: In 2012, the overall unadjusted incidence rate of patients with ESRD receiving RRT was 109.6 per million population (pmp) (n = 69 035), ranging from 219.9 pmp in Portugal to 24.2 pmp...... to 32% between countries. The overall renal transplantation rate in 2012 was 28.3 pmp (n = 15 673), with the highest rate seen in the Spanish region of Catalonia. The proportion of patients ≥65 years receiving a transplant ranged from 0 to 35%. Five-year adjusted survival for all RRT patients was 59...

  11. Computer simulation of replacement sequences in copper

    International Nuclear Information System (INIS)

    Schiffgens, J.O.; Schwartz, D.W.; Ariyasu, R.G.; Cascadden, S.E.

    1978-01-01

    Results of computer simulations of , , and replacement sequences in copper are presented, including displacement thresholds, focusing energies, energy losses per replacement, and replacement sequence lengths. These parameters are tabulated for six interatomic potentials and shown to vary in a systematic way with potential stiffness and range. Comparisons of results from calculations made with ADDES, a quasi-dynamical code, and COMENT, a dynamical code, show excellent agreement, demonstrating that the former can be calibrated and used satisfactorily in the analysis of low energy displacement cascades. Upper limits on , , and replacement sequences were found to be approximately 10, approximately 30, and approximately 14 replacements, respectively. (author)

  12. Cost justification of chiller replacement

    International Nuclear Information System (INIS)

    Baker, T.J.; Baumer, R.A.

    1993-01-01

    We often hear of products with paybacks that are too good to be true. Just a few weeks ago,a client received a recommendation from a national service company's local office. In the letter the company recommended that open-quotes due to the age and condition of the boiler ... that the school consider replacing the boiler... The cost for the new boiler can usually be recovered by lower fuel bills in 2 to 3 yearsclose quotes. This was for an installation in Southeast Texas where the boiler is only used 4 to 5 months per year. Analysis show the above claims to be nonsense. A new boiler would cost about $47,000 installed. Current total gas bills for the facility are $15,630 per year. They would have to shutoff the gas to the facility to have a three year payback. In fact, only two-thirds of the gas is used to heat the facility so we have only $10, 000 to write off against the new boiler. How much will the greater efficiency save? A 30% savings due to greater efficiency produces $3,000 per year in gas savings to offset the $47,000 cost, a 16 year payback. And much of the efficiency savings can be realized by adjusting the existing boiler. In another care a client wanted to investigate replacement of a twenty year old chiller plant with more efficient equipment. We investigated the project and determined that the payback would be greater than ten years. They did not operate the equipment during the summer and at less than 50% of capacity the balance of the year

  13. Petroleum supply annual 1998: Volume 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-06-01

    The ``Petroleum Supply Annual`` (PSA) contains information on the supply and disposition of crude oil and petroleum products. The publication reflects data that were collected from the petroleum industry during 1998 through annual and monthly surveys. The PSA is divided into two volumes. This first volume contains three sections: Summary Statistics, Detailed Statistics, and Refinery Statistics; each with final annual data. The second volume contains final statistics for each month of 1998, and replaces data previously published in the PSA. The tables in Volumes 1 and 2 are similarly numbered to facilitate comparison between them. 16 figs., 59 tabs.

  14. Petroleum supply annual, 1997. Volume 1

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-06-01

    The Petroleum Supply Annual (PSA) contains information on the supply and disposition of crude oil and petroleum products. The publication reflects data that were collected from the petroleum industry during 1997 through annual and monthly surveys. The PSA is divided into two volumes. This first volume contains three sections: Summary Statistics, Detailed Statistics, and Refinery Statistics; each with final annual data. The second volume contains final statistics for each month of 1997, and replaces data previously published in the Petroleum Supply Monthly (PSM). The tables in Volumes 1 and 2 are similarly numbered to facilitate comparison between them. 16 figs., 48 tabs.

  15. Petroleum supply annual 1992: Volume 1

    International Nuclear Information System (INIS)

    1993-01-01

    The Petroleum Supply Annual (PSA) contains information on the supply and disposition of crude oil and petroleum products. The publication reflects data that were collected from the petroleum industry during 1992 through annual and monthly surveys. The PSA is divided into two volumes. This first volume contains four sections: Summary Statistics, Detailed Statistics, Refinery Capacity and Oxygenate Capacity each with final annual data. The second volume contains final statistics for each month of 1992, and replaces data previously published in the Petroleum Supply Monthly (PSM). The tables in Volumes 1 and 2 are similarly numbered to facilitate comparison between them

  16. Petroleum supply annual 1998: Volume 1

    International Nuclear Information System (INIS)

    1999-06-01

    The ''Petroleum Supply Annual'' (PSA) contains information on the supply and disposition of crude oil and petroleum products. The publication reflects data that were collected from the petroleum industry during 1998 through annual and monthly surveys. The PSA is divided into two volumes. This first volume contains three sections: Summary Statistics, Detailed Statistics, and Refinery Statistics; each with final annual data. The second volume contains final statistics for each month of 1998, and replaces data previously published in the PSA. The tables in Volumes 1 and 2 are similarly numbered to facilitate comparison between them. 16 figs., 59 tabs

  17. Petroleum supply annual, 1997. Volume 1

    International Nuclear Information System (INIS)

    1998-06-01

    The Petroleum Supply Annual (PSA) contains information on the supply and disposition of crude oil and petroleum products. The publication reflects data that were collected from the petroleum industry during 1997 through annual and monthly surveys. The PSA is divided into two volumes. This first volume contains three sections: Summary Statistics, Detailed Statistics, and Refinery Statistics; each with final annual data. The second volume contains final statistics for each month of 1997, and replaces data previously published in the Petroleum Supply Monthly (PSM). The tables in Volumes 1 and 2 are similarly numbered to facilitate comparison between them. 16 figs., 48 tabs

  18. Mechanical versus bioprosthetic aortic valve replacement.

    Science.gov (United States)

    Head, Stuart J; Çelik, Mevlüt; Kappetein, A Pieter

    2017-07-21

    Mechanical valves used for aortic valve replacement (AVR) continue to be associated with bleeding risks because of anticoagulation therapy, while bioprosthetic valves are at risk of structural valve deterioration requiring reoperation. This risk/benefit ratio of mechanical and bioprosthetic valves has led American and European guidelines on valvular heart disease to be consistent in recommending the use of mechanical prostheses in patients younger than 60 years of age. Despite these recommendations, the use of bioprosthetic valves has significantly increased over the last decades in all age groups. A systematic review of manuscripts applying propensity-matching or multivariable analysis to compare the usage of mechanical vs. bioprosthetic valves found either similar outcomes between the two types of valves or favourable outcomes with mechanical prostheses, particularly in younger patients. The risk/benefit ratio and choice of valves will be impacted by developments in valve designs, anticoagulation therapy, reducing the required international normalized ratio, and transcatheter and minimally invasive procedures. However, there is currently no evidence to support lowering the age threshold for implanting a bioprosthesis. Physicians in the Heart Team and patients should be cautious in pursuing more bioprosthetic valve use until its benefit is clearly proven in middle-aged patients. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  19. The importance of the mean platelet volume in the diagnosis of ...

    African Journals Online (AJOL)

    EB

    2013-09-03

    Sep 3, 2013 ... The importance of the mean platelet volume in the diagnosis of ... terms of the focus of the study, hemoglobin, neutrophil count, mean cell volume (MCV), red cell distribution .... hormone replacement therapy and some drugs,.

  20. Optimization on replacement period of plant equipment

    International Nuclear Information System (INIS)

    Kasai, Masao; Asano, Hiromi

    2002-01-01

    Optimization of the replacement period of plant equipment is one of the main items to rationalize the activities on plant maintenance. There are several models to replace the equipment and the formulations for optimizing the replacement period are different among these models. In this study, we calculated the optimum replacement periods for some equipment parts based on the replacement models and found that the optimum solutions are not so largely differ from the replacement models as far as the replacement period is not so large. So we will be able to use the most usable model especially in the early phase of rationalization on plant maintenance, since there are large uncertainties in data for optimization. (author)

  1. Continuous quality improvement program for hip and knee replacement.

    Science.gov (United States)

    Marshall, Deborah A; Christiansen, Tanya; Smith, Christopher; Squire Howden, Jane; Werle, Jason; Faris, Peter; Frank, Cy

    2015-01-01

    Improving quality of care and maximizing efficiency are priorities in hip and knee replacement, where surgical demand and costs increase as the population ages. The authors describe the integrated structure and processes from the Continuous Quality Improvement (CQI) Program for Hip and Knee Replacement Surgical Care and summarize lessons learned from implementation. The Triple Aim framework and 6 dimensions of quality care are overarching constructs of the CQI program. A validated, evidence-based clinical pathway that measures quality across the continuum of care was adopted. Working collaboratively, multidisciplinary experts embedded the CQI program into everyday practices in clinics across Alberta. Currently, 83% of surgeons participate in the CQI program, representing 95% of the total volume of hip and knee surgeries. Biannual reports provide feedback to improve care processes, infrastructure planning, and patient outcomes. CQI programs evaluating health care services inform choices to optimize care and improve efficiencies through continuous knowledge translation. © The Author(s) 2014.

  2. Robotic vascular resections during Whipple procedure.

    Science.gov (United States)

    Allan, Bassan J; Novak, Stephanie M; Hogg, Melissa E; Zeh, Herbert J

    2018-01-01

    Indications for resection of pancreatic cancers have evolved to include selected patients with involvement of peri-pancreatic vascular structures. Open Whipple procedures have been the standard approach for patients requiring reconstruction of the portal vein (PV) or superior mesenteric vein (SMV). Recently, high-volume centers are performing minimally invasive Whipple procedures with portovenous resections. Our institution has performed seventy robotic Whipple procedures with concomitant vascular resections. This report outlines our technique.

  3. Robotic vascular resections during Whipple procedure

    OpenAIRE

    Allan, Bassan J.; Novak, Stephanie M.; Hogg, Melissa E.; Zeh, Herbert J.

    2018-01-01

    Indications for resection of pancreatic cancers have evolved to include selected patients with involvement of peri-pancreatic vascular structures. Open Whipple procedures have been the standard approach for patients requiring reconstruction of the portal vein (PV) or superior mesenteric vein (SMV). Recently, high-volume centers are performing minimally invasive Whipple procedures with portovenous resections. Our institution has performed seventy robotic Whipple procedures with concomitant vas...

  4. The use of ileocolic segment for esophageal replacement in children

    Directory of Open Access Journals (Sweden)

    Harshjeet Singh Bal

    2016-01-01

    Full Text Available Aims: To evaluate and describe the procedure and outcome of ileocolic replacement of esophagus. Materials and Methods: We review 7 children with esophageal injuries, who underwent esophageal replacement using ileocolic segment in Christian Medical College, Vellore, India between 2006 and 2014. Results: The ileocolic segment was used in 7 children with scarred or inadequate esophagus. There were 4 girls and 3 boys, who underwent esophageal replacement using isoperistaltic ileocolic segment in this period. Age at presentation varied from 1 month to 14 years with an average of 4.6 years. The indications for ileocolic replacements were corrosive strictures in 5, failed esophageal atresia repair in one and gastric volvulus related esophageal stricture in another. The average follow-up duration was 37 months. One child with corrosive stricture lost to follow-up and died 2 years later in another center. Other 6 children were free of dysphagia till the last follow-up. Conclusions: Although the ileocolic segment is not commonly used for esophageal substitution, it can be useful in special situations where the substitution needs to reach the high cervical esophagus and also where the stomach is scarred and not suitable for gastric pull-up.

  5. Australia's replacement research reactor project

    International Nuclear Information System (INIS)

    Harris, K.J.

    1999-01-01

    HIFAR, a 10 MW tank type DIDO Class reactor has operated at the Lucas Heights Science and Technology Centre for 43 years. HIFAR and the 10 kW Argonaut reactor 'Moata' which is in the Care and Maintenance phase of decommissioning are Australia's only nuclear reactors. The initial purpose for HIFAR was for materials testing to support a nuclear power program. Changing community attitude through the 1970's and a Government decision not to proceed with a planned nuclear power reactor resulted in a reduction of materials testing activities and a greater emphasis being placed on neutron beam research and the production of radioisotopes, particularly for medical purposes. HIFAR is not fully capable of satisfying the expected increase in demand for medical radiopharmaceuticals beyond the next 5 years and the radial configuration of the beam tubes severely restricts the scope and efficiency of neutron beam research. In 1997 the Australian Government decided that a replacement research reactor should be built by the Australian Nuclear Science and Technology Organisation at Lucas Heights subject to favourable results of an Environmental Impact Study. The Ei identified no reasons on the grounds of safety, health, hazard or risk to prevent construction on the preferred site and it was decided in May 1999 that there were no environmental reasons why construction of the facility should not proceed. In recent years ANSTO has been reviewing the operation of HIFAR and observing international developments in reactor technology. Limitations in the flexibility and efficiency achievable in operation of a tank type reactor and the higher intrinsic safety sought in fundamental design resulted in an early decision that the replacement reactor must be a pool type having cleaner and higher intensity tangential neutron beams of wider energy range than those available from HIFAR. ANSTO has chosen to use it's own resources supported by specialised external knowledge and experience to identify

  6. The Ross Procedure in Pediatric Patients: A 20-Year Experience of Ross Procedure in a Single Institution.

    Science.gov (United States)

    Yoon, Dong Woog; Yang, Ji-Hyuk; Jun, Tae-Gook; Park, Pyo Won

    2017-08-01

    The Ross/Ross-Konno procedure is considered a good option for irreparable aortic valve disease in pediatric patients because of its hemodynamic performance and potential for growth of the pulmonary autograft. This study is a review of the long-term results of our 20-year experience with the Ross and Ross-Konno operations in a single institution. Between June 1995 and January 2016, 16 consecutive patients (mean age, 6.0±5.9 years; range, 16 days to 17.4 years) underwent either a Ross operation (n=9) or a Ross-Konno operation (n=7). The study included 12 males and 4 females, with a median follow-up period of 47 months (range, 6 to 256 months). There were no cases of in-hospital or late mortality. Six reoperations were performed in 5 patients. Four patients underwent right ventricular-pulmonary artery (RV-PA) conduit replacement. Two patients underwent concomitant replacement of the pulmonary autograft and RV-PA conduit 10 years and 8 years after the Ross operation, respectively. The rate of freedom from adverse outcomes of the pulmonary autograft was 88% and 70% at 5 and 10 years, respectively. The rate of freedom from valve-related reoperations was 79% and 63% at 5 and 10 years, respectively. Pulmonary autografts demonstrated good durability with low mortality. The Ross/Ross-Konno procedure is a good option that can be performed safely in pediatric patients with aortic valve disease, even in a small-volume center.

  7. Surfactant replacement therapy--economic impact.

    Science.gov (United States)

    Pejaver, R K; al Hifzi, I; Aldussari, S

    2001-06-01

    Surfactant replacement is an effective treatment for neonatal respiratory distress syndrome. (RDS). As widespread use of surfactant is becoming a reality, it is important to assess the economic implications of this new form of therapy. A comparison study was carried out at the Neonatal Intensive Care Unit (NICU) of Northwest Armed Forces Hospital, Saudi Arabia. Among 75 infants who received surfactant for RDS and similar number who were managed during time period just before the surfactant was available, but by set criteria would have made them eligible for surfactant. All other management modalities except surfactant were the same for all these babies. Based on the intensity of monitoring and nursing care required by the baby, the level of care was divided as: Level IIIA, IIIB, Level II, Level I. The cost per day per bed for each level was calculated, taking into account the use of hospital immovable equipment, personal salaries of nursing, medical, ancillary staff, overheads and maintenance, depreciation and replacement costs. Medications used, procedures done, TPN, oxygen, were all added to individual patient's total expenditure. 75 infants in the Surfactant group had 62 survivors. They spent a total of 4300 days in hospital. (av 69.35) Out of which 970 d (av 15.65 per patient) were ventilated days. There were 56 survivors in the non-surfactant group of 75. They had spent a total of 5023 days in the hospital (av 89.69/patient) out of which 1490 were ventilated days (av 26.60 d). Including the cost of surfactant (two doses), cost of hospital stay for each infant taking the average figures of stay would be SR 118, 009.75 per surfactant treated baby and SR 164, 070.70 per non-surfactant treated baby. The difference of 46,061 SR is 39.03% more in non-surfactant group. One Saudi rial = 8 Rs (approx at the time study was carried out.) Medical care cost varies from place to place. However, it is definitely cost-effective where surfactant is concerned. Quality adjusted

  8. New procedures in nuclear medicine

    International Nuclear Information System (INIS)

    Spencer, R.P.

    1989-01-01

    The authors review the recent emergence of functional studies in nuclear medicine in this critical and informative text. The new procedures are presented in terms of their underlying physiology, indications, contraindications, methodology, results, interpretation and relationship to other evaluations. The volume includes discussions on the central nervous system, interventional studies, cardiac studies, bone densitometry, plus radiolabeled antibodies, radiolabeling of blood elements and flow and distribution

  9. Visual Image Sensor Organ Replacement

    Science.gov (United States)

    Maluf, David A.

    2014-01-01

    This innovation is a system that augments human vision through a technique called "Sensing Super-position" using a Visual Instrument Sensory Organ Replacement (VISOR) device. The VISOR device translates visual and other sensors (i.e., thermal) into sounds to enable very difficult sensing tasks. Three-dimensional spatial brightness and multi-spectral maps of a sensed image are processed using real-time image processing techniques (e.g. histogram normalization) and transformed into a two-dimensional map of an audio signal as a function of frequency and time. Because the human hearing system is capable of learning to process and interpret extremely complicated and rapidly changing auditory patterns, the translation of images into sounds reduces the risk of accidentally filtering out important clues. The VISOR device was developed to augment the current state-of-the-art head-mounted (helmet) display systems. It provides the ability to sense beyond the human visible light range, to increase human sensing resolution, to use wider angle visual perception, and to improve the ability to sense distances. It also allows compensation for movement by the human or changes in the scene being viewed.

  10. Gene replacement in Penicillium roqueforti.

    Science.gov (United States)

    Goarin, Anne; Silar, Philippe; Malagnac, Fabienne

    2015-05-01

    Most cheese-making filamentous fungi lack suitable molecular tools to improve their biotechnology potential. Penicillium roqueforti, a species of high industrial importance, would benefit from functional data yielded by molecular genetic approaches. This work provides the first example of gene replacement by homologous recombination in P. roqueforti, demonstrating that knockout experiments can be performed in this fungus. To do so, we improved the existing transformation method to integrate transgenes into P. roqueforti genome. In the meantime, we cloned the PrNiaD gene, which encodes a NADPH-dependent nitrate reductase that reduces nitrate to nitrite. Then, we performed a deletion of the PrNiaD gene from P. roqueforti strain AGO. The ΔPrNiaD mutant strain is more resistant to chlorate-containing medium than the wild-type strain, but did not grow on nitrate-containing medium. Because genomic data are now available, we believe that generating selective deletions of candidate genes will be a key step to open the way for a comprehensive exploration of gene function in P. roqueforti.

  11. Confronting hip resurfacing and big femoral head replacement gait analysis

    Directory of Open Access Journals (Sweden)

    Panagiotis K. Karampinas

    2014-03-01

    Full Text Available Improved hip kinematics and bone preservation have been reported after resurfacing total hip replacement (THRS. On the other hand, hip kinematics with standard total hip replacement (THR is optimized with large diameter femoral heads (BFH-THR. The purpose of this study is to evaluate the functional outcomes of THRS and BFH-THR and correlate these results to bone preservation or the large femoral heads. Thirty-one patients were included in the study. Gait speed, postural balance, proprioception and overall performance. Our results demonstrated a non-statistically significant improvement in gait, postural balance and proprioception in the THRS confronting to BFH-THR group. THRS provide identical outcomes to traditional BFH-THR. The THRS choice as bone preserving procedure in younger patients is still to be evaluated.

  12. Total hip and knee joint replacement: perioperative clinical aspects

    Directory of Open Access Journals (Sweden)

    Luciana Pereira Almeida de Piano

    2010-09-01

    Full Text Available Objective: To understand the profile of patients undergoing hip and knee replacement during two years, and to compare the data obtained with the literature. Methods: A total of 323 medical records were reviewed to analyze the perioperative data of patients submitted to hip and knee replacement. Results: Osteoarthritis was the main indication for both procedures and male patients were heavier than females (p < 0.05. Hypertension was the prevalent disease among patients. Blood loss was more frequent in knee surgery than in the hip. Conclusions: The profile of patients undergoing total arthroplasty improved substantially over the past decade due to shorter hospital stay, lower risk of thromboembolic events and no infection as compared to previous reports.

  13. Financial Analysis for Replacement of Construction Equipment in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Ali Shash

    2012-11-01

    Full Text Available This study report results of a survey conducted in the EasternProvince of Saudi Arabia to explore the procedures and financialtechniques that large-size contractors utilise in replacingequipment. The results indicated that contractors set severalreplacement alternatives that they evaluate by using a set ofvarious qualitative and quantitative factors. The contractors’business objectives, employee safety and morale, and, contractors’image in the industry were found to be the most influentialqualitative factors affecting the decision of equipment replacement.Inflation, downtime, obsolescence, salvage value, and depreciationare among the top quantitative factors that contractors considerwhile making a decision to replace equipment. Because of theirsimplicity and practicality, the net present value, payback period,and the economic life are the most popular techniques that areutilised for analysing the financial issues of proposed replacementalternatives.

  14. Expandable Total Humeral Replacement in a Child with Osteosarcoma

    Directory of Open Access Journals (Sweden)

    Eric R. Henderson

    2015-01-01

    Full Text Available Case. A right-handed 8-year-old female patient presented with a conventional, high-grade osteosarcoma involving her right humerus; through-shoulder amputation was recommended. After consultation, total humerus resection with expandable, total humeral endoprosthesis reconstruction was performed with a sleeve to encourage soft-tissue ingrowth. At three-year follow-up she has received one lengthening procedure and her functional scores are excellent. Conclusion. Total humeral resection and replacement in the pediatric population are rare and although early reports of expandable total humeral endoprosthesis outcomes demonstrate high failure rates, this patient’s success indicates that expandable total humeral replacement is a viable option.

  15. Surface neuromuscular electrical stimulation for quadriceps strengthening pre and post total knee replacement.

    LENUS (Irish Health Repository)

    Monaghan, Brenda

    2010-01-01

    Total knee replacement has been demonstrated to be one of the most successful procedures in the treatment of osteoarthritis. However quadriceps weakness and reductions in function are commonly reported following surgery. Recently Neuromuscular Electrical Stimulation (NMES) has been used as an adjunct to traditional strengthening programmes. This review considers the effectiveness of NMES as a means of increasing quadriceps strength in patients before and after total knee replacement.

  16. Preventative Valve-Sparing Aortic Root Replacement and Pregnancy Outcome in Marfan Syndrome

    OpenAIRE

    Sokol, Vesna; Zlopaša, Gordan; Herman, Mislav; Planinić, Pavao; Micevska, Ana

    2012-01-01

    In Marfan syndrome, with dilatation of the aortic root secondary to an underlying connective tissue defect, pregnancy can cause hemodynamic stress leading to the development of an aortic aneurysm and even a fatal aortic dissection. In the presence of existing aortic root enlargement and a family history of aortic dissection, preventative elective surgery is suggested. Aortic root replacement with or without a valve-sparing procedure is superior to total aortic root replacement with ...

  17. Aorta-atria-septum combined incision for aortic valve re-replacement

    Science.gov (United States)

    Xu, Yiwei; Ye, Xiaofeng; Li, Zhaolong

    2018-01-01

    This case report illustrates a patient who underwent supra-annular mechanical aortic valve replacement then suffered from prosthesis dysfunction, increasing pressure gradient with aortic valve. She was successfully underwent aortic valve re-replacement, sub-annular pannus removing and aortic annulus enlargement procedures through combined cardiac incision passing through aortic root, right atrium (RA), and upper atrial septum. This incision provides optimal visual operative field and simplifies dissection. PMID:29850170

  18. Case Study of a physiotherapy treatment of a patient after total hip replacement

    OpenAIRE

    Havlíčková, Barbora

    2013-01-01

    The bachelor's thesis consists of two parts. The general part includes anatomy and kinesiology of the hip joint and also the topic of coxarthrosis as the most common reason for the total hip replacement surgery. An integral part of this part is the elaboration of a rehabilitation plan for patients undergoing such procedure. The practical part of the thesis is conceived a case study of a patient after total hip replacement because of coxarthrosis. Finally, the thesis includes the therapeutic o...

  19. The design and analysis of salmonid tagging studies in the Columbia River. Volume 7: Monte-Carlo comparison of confidence internal procedures for estimating survival in a release-recapture study, with applications to Snake River salmonids

    International Nuclear Information System (INIS)

    Lowther, A.B.; Skalski, J.

    1996-06-01

    Confidence intervals for survival probabilities between hydroelectric facilities of migrating juvenile salmonids can be computed from the output of the SURPH software developed at the Center for Quantitative Science at the University of Washington. These intervals have been constructed using the estimate of the survival probability, its associated standard error, and assuming the estimate is normally distributed. In order to test the validity and performance of this procedure, two additional confidence interval procedures for estimating survival probabilities were tested and compared using simulated mark-recapture data. Intervals were constructed using normal probability theory, using a percentile-based empirical bootstrap algorithm, and using the profile likelihood concept. Performance of each method was assessed for a variety of initial conditions (release sizes, survival probabilities, detection probabilities). These initial conditions were chosen to encompass the range of parameter values seen in the 1993 and 1994 Snake River juvenile salmonid survival studies. The comparisons among the three estimation methods included average interval width, interval symmetry, and interval coverage

  20. Terminal Procedures Publication/Airport Diagrams - Aeronautical Information Services Digital Products

    Data.gov (United States)

    Department of Transportation — The U.S. Terminal Procedure Publications (TPPs) is a 26 volume set of printed paper books containing Instrument Approach Procedure charts (IAP), Departure Procedure...

  1. Comparative analysis of pain in patients who underwent total knee replacement regarding the tourniquet pressure

    Directory of Open Access Journals (Sweden)

    Marcos George de Souza Leão

    Full Text Available ABSTRACT OBJECTIVES: To evaluate through the visual analog scale (VAS the pain in patients undergoing total knee replacement (TKR with different pressures of the pneumatic tourniquet. METHODS: An observational, randomized, descriptive study on an analytical basis, with 60 patients who underwent TKR, divided into two groups, which were matched: a group where TKR was performed with tourniquet pressures of 350 mmHg (standard and the other with systolic blood pressure plus 100 mmHg (P + 100. These patients had their pain assessed by VAS at 48 h, and at the 5th and 15th days after procedure. Secondarily, the following were also measured: range of motion (ROM, complications, and blood drainage volume in each group; the data were subjected to statistical analysis. RESULTS: After data analysis, there was no statistical difference regarding the incidence of complications (p = 0.612, ROM (p = 0.202, bleeding after 24 and 48 h (p = 0.432 and p = 0.254 or in relation to VAS. No correlation was observed between time of ischemia compared to VAS and bleeding. CONCLUSIONS: The use of the pneumatic tourniquet pressure at 350 mmHg or systolic blood pressure plus 100 mmHg did not influence the pain, blood loss, ROM, and complications. Therefore the pressures at these levels are safe and do not change the surgery outcomes; the time of ischemia must be closely observed to avoid major complications.

  2. Incidence of Renal Failure Requiring Hemodialysis Following Transcatheter Aortic Valve Replacement.

    Science.gov (United States)

    Ladia, Vatsal; Panchal, Hemang B; O׳Neil, Terrence J; Sitwala, Puja; Bhatheja, Samit; Patel, Rakeshkumar; Ramu, Vijay; Mukherjee, Debabrata; Mahmud, Ehtisham; Paul, Timir K

    2016-09-01

    Studies have shown that iodinated radiocontrast use is associated with acute renal failure especially in the presence of chronic kidney disease and multiple factors modulate this risk. The purpose of this meta-analysis is to compare the incidence of renal failure requiring hemodialysis between transfemoral (TF) and transapical (TA) transcatheter aortic valve replacement using the Edwards valve. The PubMed database was searched from January 2000 through December 2014. A total of 10 studies (n = 2,459) comparing TF (n = 1,268) and TA (n = 1,191) TAVR procedures using the Edwards valve were included. Variables of interest were baseline logistic EuroSCORE, prevalence of diabetes mellitus, hypertension, peripheral arterial disease, chronic kidney disease and amount of contrast used. The primary endpoint was incidence of renal failure requiring hemodialysis. The odds ratio and 95% CI were computed and P renal failure requiring hemodialysis was higher with the Edwards valve. This suggests that the incidence of renal failure requiring hemodialysis after TAVR is associated with baseline comorbidities in the TA-TAVR group rather than the volume of contrast used. Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  3. Valve-sparing aortic root replacement in Marfan syndrome.

    Science.gov (United States)

    Cameron, Duke E; Vricella, Luca A

    2005-01-01

    Marfan syndrome is the most common inherited connective tissue disorder, affecting approximately 1 in 10,000 live births. The cardinal features of Marfan syndrome are the abnormalities of the skeleton (tall stature, arachnodactyly, and joint hyperelasticity), eye (lens subluxation), and aorta (root aneurysm with proclivity toward rupture and dissection). Aortic catastrophe accounts for most of the premature mortality among Marfan patients, a risk that climbs steeply during adolescence and results in death of half of Marfan patients by the age of 40 years. Most of the improvement in life expectancy that has been achieved in Marfan syndrome is attributable to early recognition of aortic root aneurysms and prophylactic replacement with composite grafts (mechanical valve prostheses within Dacron conduits) before rupture or dissection occurs. Despite the excellent early and late results with composite grafts, there has been growing interest in operative procedures that replace the sinuses but preserve the aortic valve leaflets, to avoid anticoagulation and minimize the risk of prosthesis-related endocarditis. These procedures are still in evolution and late results are not yet known, but as with mitral repair in the setting of myxomatous disease, valve-sparing procedures in Marfan syndrome have weathered a storm of initial criticism and skepticism and are steadily gaining acceptance.

  4. Pediatric procedural sedation and analgesia

    Directory of Open Access Journals (Sweden)

    Meredith James

    2008-01-01

    Full Text Available Procedural sedation and analgesia (PSA is an evolving field in pediatric emergency medicine. As new drugs breach the boundaries of anesthesia in the Pediatric Emergency Department, parents, patients, and physicians are finding new and more satisfactory methods of sedation. Short acting, rapid onset agents with little or no lingering effects and improved safety profiles are replacing archaic regimens. This article discusses the warning signs and areas of a patient′s medical history that are particularly pertinent to procedural sedation and the drugs used. The necessary equipment is detailed to provide the groundwork for implementing safe sedation in children. It is important for practitioners to familiarize themselves with a select few of the PSA drugs, rather than the entire list of sedatives. Those agents most relevant to PSA in the pediatric emergency department are presented.

  5. Opportunistic replacement of fusion power system parts

    International Nuclear Information System (INIS)

    Day, J.A.; George, L.L.

    1981-01-01

    This paper describes a maintenance problem in a fusion power plant. The problem is to specify which life limited parts should be replaced when there is an opportunity. The objective is to minimize the cost rate of replacement parts and of maintenance actions while satisfying a power plant availability constraint. The maintenance policy is to look ahead and replace all parts that will reach their life limits within a time called a screen. Longer screens yield greater system availabilities because more parts are replaced prior to their life limits

  6. Menopause and hormone replacement therapy

    Directory of Open Access Journals (Sweden)

    Ali Baziad

    2001-12-01

    Full Text Available The global population in the 21st century has reached 6.2 billion people, by the year 2025 it is to be around 8.3-8.5 billion, and will increase further. Elderly people are expected to grow rapidly than other groups. The fastest increase in the elderly population will take place in Asia. Life expectancy is increasing steadily throughout developed and developing countries. For many  menopausal women, increased life expectancy will accompanied by many health problems. The consequences of estrogen deficiency are the menopausal symptoms. The treatment of menopause related complaints and diseases became an  important socioeconomic and medical issue. Long term symptoms, such as the increase in osteoporosis fractures, cardio and cerebrovascular disesses and dementia, created a large financial burden on individuals and society. All these health problems can be lreated or prevented by hormone replacement therapy (HRT. Natural HRT is usually prefened. Synthetic  estrogen in oral contraceptives (oc are not recommended for HRT. Many contra-indications for oc, but now it is widely usedfor HRT. The main reasons for discontinuing HRT are unwanted bleeding, fear of cancer, and negative side effects. Until now there are sill debates about the rebrtonship between HRT and the incidence of breast cancer. Many data showed that there were no clear relationship between the use of HRT and breast cancer. ThereÎore, nwny experts advocate the use of HRTfrom the first sign of climacteric complaints until death. (Med J Indones 2001;10: 242-51Keywords: estrogen deficiency, climacteric phases, tibolone.

  7. Replacing Fortran Namelists with JSON

    Science.gov (United States)

    Robinson, T. E., Jr.

    2017-12-01

    Maintaining a log of input parameters for a climate model is very important to understanding potential causes for answer changes during the development stages. Additionally, since modern Fortran is now interoperable with C, a more modern approach to software infrastructure to include code written in C is necessary. Merging these two separate facets of climate modeling requires a quality control for monitoring changes to input parameters and model defaults that can work with both Fortran and C. JSON will soon replace namelists as the preferred key/value pair input in the GFDL model. By adding a JSON parser written in C into the model, the input can be used by all functions and subroutines in the model, errors can be handled by the model instead of by the internal namelist parser, and the values can be output into a single file that is easily parsable by readily available tools. Input JSON files can handle all of the functionality of a namelist while being portable between C and Fortran. Fortran wrappers using unlimited polymorphism are crucial to allow for simple and compact code which avoids the need for many subroutines contained in an interface. Errors can be handled with more detail by providing information about location of syntax errors or typos. The output JSON provides a ground truth for values that the model actually uses by providing not only the values loaded through the input JSON, but also any default values that were not included. This kind of quality control on model input is crucial for maintaining reproducibility and understanding any answer changes resulting from changes in the input.

  8. TOTAL JOINT REPLACEMENT OF THE LOWER EXTREMITY IN PATIENTS WITH JUVENILE IDIOPATHIC ARTHRITIS

    Directory of Open Access Journals (Sweden)

    Стюарт Б. Гудмэн

    2014-03-01

    Full Text Available Joint replacement of the lower extremity in Juvenile Idiopathic Arthritis (JIA is becoming more commonly performed worldwide. These young adults experience severe pain and disability from end-stage arthritis, and require joint replacement of the hip or knee to alleviate pain, and restore ambulation and function. These procedures are very challenging from the anesthesia and surgical point of view, due to small overall proportions, numerous bony and other deformities and soft tissue contractures. Joint replacement operations for JIA are best performed by experienced teams, where pre-operative and peri-operative care, and post-operative rehabilitation can be optimized in a collaborative, patient-centered environment.

  9. Efficiency of performing pulmonary procedures in a shared endoscopy unit: procedure time, turnaround time, delays, and procedure waiting time.

    Science.gov (United States)

    Verma, Akash; Lee, Mui Yok; Wang, Chunhong; Hussein, Nurmalah B M; Selvi, Kalai; Tee, Augustine

    2014-04-01

    The purpose of this study was to assess the efficiency of performing pulmonary procedures in the endoscopy unit in a large teaching hospital. A prospective study from May 20 to July 19, 2013, was designed. The main outcome measures were procedure delays and their reasons, duration of procedural steps starting from patient's arrival to endoscopy unit, turnaround time, total case durations, and procedure wait time. A total of 65 procedures were observed. The most common procedure was BAL (61%) followed by TBLB (31%). Overall procedures for 35 (53.8%) of 65 patients were delayed by ≥ 30 minutes, 21/35 (60%) because of "spillover" of the gastrointestinal and surgical cases into the time block of pulmonary procedure. Time elapsed between end of pulmonary procedure and start of the next procedure was ≥ 30 minutes in 8/51 (16%) of cases. In 18/51 (35%) patients there was no next case in the room after completion of the pulmonary procedure. The average idle time of the room after the end of pulmonary procedure and start of next case or end of shift at 5:00 PM if no next case was 58 ± 53 minutes. In 17/51 (33%) patients the room's idle time was >60 minutes. A total of 52.3% of patients had the wait time >2 days and 11% had it ≥ 6 days, reason in 15/21 (71%) being unavailability of the slot. Most pulmonary procedures were delayed due to spillover of the gastrointestinal and surgical cases into the block time allocated to pulmonary procedures. The most common reason for difficulty encountered in scheduling the pulmonary procedure was slot unavailability. This caused increased procedure waiting time. The strategies to reduce procedure delays and turnaround times, along with improved scheduling methods, may have a favorable impact on the volume of procedures performed in the unit thereby optimizing the existing resources.

  10. Model morphing and sequence assignment after molecular replacement

    Energy Technology Data Exchange (ETDEWEB)

    Terwilliger, Thomas C., E-mail: terwilliger@lanl.gov [Los Alamos National Laboratory, Mail Stop M888, Los Alamos, NM 87545 (United States); Read, Randy J. [University of Cambridge, Cambridge Institute for Medical Research, Cambridge CB2 0XY (United Kingdom); Adams, Paul D. [Lawrence Berkeley National Laboratory, One Cyclotron Road, Bldg 64R0121, Berkeley, CA 94720 (United States); Brunger, Axel T. [Stanford University, 318 Campus Drive West, Stanford, CA 94305 (United States); Afonine, Pavel V. [Lawrence Berkeley National Laboratory, One Cyclotron Road, Bldg 64R0121, Berkeley, CA 94720 (United States); Hung, Li-Wei [Los Alamos National Laboratory, Mail Stop M888, Los Alamos, NM 87545 (United States)

    2013-11-01

    A procedure for model building is described that combines morphing a model to match a density map, trimming the morphed model and aligning the model to a sequence. A procedure termed ‘morphing’ for improving a model after it has been placed in the crystallographic cell by molecular replacement has recently been developed. Morphing consists of applying a smooth deformation to a model to make it match an electron-density map more closely. Morphing does not change the identities of the residues in the chain, only their coordinates. Consequently, if the true structure differs from the working model by containing different residues, these differences cannot be corrected by morphing. Here, a procedure that helps to address this limitation is described. The goal of the procedure is to obtain a relatively complete model that has accurate main-chain atomic positions and residues that are correctly assigned to the sequence. Residues in a morphed model that do not match the electron-density map are removed. Each segment of the resulting trimmed morphed model is then assigned to the sequence of the molecule using information about the connectivity of the chains from the working model and from connections that can be identified from the electron-density map. The procedure was tested by application to a recently determined structure at a resolution of 3.2 Å and was found to increase the number of correctly identified residues in this structure from the 88 obtained using phenix.resolve sequence assignment alone (Terwilliger, 2003 ▶) to 247 of a possible 359. Additionally, the procedure was tested by application to a series of templates with sequence identities to a target structure ranging between 7 and 36%. The mean fraction of correctly identified residues in these cases was increased from 33% using phenix.resolve sequence assignment to 47% using the current procedure. The procedure is simple to apply and is available in the Phenix software package.

  11. Model morphing and sequence assignment after molecular replacement

    International Nuclear Information System (INIS)

    Terwilliger, Thomas C.; Read, Randy J.; Adams, Paul D.; Brunger, Axel T.; Afonine, Pavel V.; Hung, Li-Wei

    2013-01-01

    A procedure for model building is described that combines morphing a model to match a density map, trimming the morphed model and aligning the model to a sequence. A procedure termed ‘morphing’ for improving a model after it has been placed in the crystallographic cell by molecular replacement has recently been developed. Morphing consists of applying a smooth deformation to a model to make it match an electron-density map more closely. Morphing does not change the identities of the residues in the chain, only their coordinates. Consequently, if the true structure differs from the working model by containing different residues, these differences cannot be corrected by morphing. Here, a procedure that helps to address this limitation is described. The goal of the procedure is to obtain a relatively complete model that has accurate main-chain atomic positions and residues that are correctly assigned to the sequence. Residues in a morphed model that do not match the electron-density map are removed. Each segment of the resulting trimmed morphed model is then assigned to the sequence of the molecule using information about the connectivity of the chains from the working model and from connections that can be identified from the electron-density map. The procedure was tested by application to a recently determined structure at a resolution of 3.2 Å and was found to increase the number of correctly identified residues in this structure from the 88 obtained using phenix.resolve sequence assignment alone (Terwilliger, 2003 ▶) to 247 of a possible 359. Additionally, the procedure was tested by application to a series of templates with sequence identities to a target structure ranging between 7 and 36%. The mean fraction of correctly identified residues in these cases was increased from 33% using phenix.resolve sequence assignment to 47% using the current procedure. The procedure is simple to apply and is available in the Phenix software package

  12. Why Lumbar Artificial Disk Replacements (LADRs) Fail.

    Science.gov (United States)

    Pettine, Kenneth; Ryu, Robert; Techy, Fernando

    2017-07-01

    A retrospective review of prospectively collected data. To determine why artificial disk replacements (ADRs) fail by examining results of 91 patients in FDA studies performed at a single investigational device exemption (IDE) site with minimum 2-year follow-up. Patients following lumbar ADR generally achieve their 24-month follow-up results at 3 months postoperatively. Every patient undergoing ADR at 1 IDE site by 2 surgeons was evaluated for clinical success. Failure was defined as <50% improvement in ODI and VAS or any additional surgery at index or adjacent spine motion segment. Three ADRs were evaluated: Maverick, 25 patients; Charité, 31 patients; and Kineflex, 35 patients. All procedures were 1-level operations performed at L4-L5 or L5-S1. Demographics and inclusion/exclusion criteria were similar and will be discussed. Overall clinical failure occurred in 26% (24 of 91 patients) at 2-year follow-up. Clinical failure occurred in: 28% (Maverick) (7 of 25 patients), 39% (Charité) (12 of 31 patients), and 14% (Kineflex) (5 of 35 patients). Causes of failure included facet pathology, 50% of failure patients (12 of 24). Implant complications occurred in 5% of total patients and 21% of failure patients (5 of 24). Only 5 patients went from a success to failure after 3 months. Only 1 patient went from a failure to success after a facet rhizotomy 1 year after ADR. Seventy-four percent of patients after ADR met strict clinical success after 2-year follow-up. The clinical success versus failure rate did not change from their 3-month follow-up in 85 of the 91 patients (93%). Overall clinical success may be improved most by patient selection and implant type.

  13. Can Clouds replace Grids? Will Clouds replace Grids?

    International Nuclear Information System (INIS)

    Shiers, J D

    2010-01-01

    The world's largest scientific machine - comprising dual 27km circular proton accelerators cooled to 1.9 o K and located some 100m underground - currently relies on major production Grid infrastructures for the offline computing needs of the 4 main experiments that will take data at this facility. After many years of sometimes difficult preparation the computing service has been declared 'open' and ready to meet the challenges that will come shortly when the machine restarts in 2009. But the service is not without its problems: reliability - as seen by the experiments, as opposed to that measured by the official tools - still needs to be significantly improved. Prolonged downtimes or degradations of major services or even complete sites are still too common and the operational and coordination effort to keep the overall service running is probably not sustainable at this level. Recently 'Cloud Computing' - in terms of pay-per-use fabric provisioning - has emerged as a potentially viable alternative but with rather different strengths and no doubt weaknesses too. Based on the concrete needs of the LHC experiments - where the total data volume that will be acquired over the full lifetime of the project, including the additional data copies that are required by the Computing Models of the experiments, approaches 1 Exabyte - we analyze the pros and cons of Grids versus Clouds. This analysis covers not only technical issues - such as those related to demanding database and data management needs - but also sociological aspects, which cannot be ignored, neither in terms of funding nor in the wider context of the essential but often overlooked role of science in society, education and economy.

  14. Can Clouds replace Grids? Will Clouds replace Grids?

    Energy Technology Data Exchange (ETDEWEB)

    Shiers, J D, E-mail: Jamie.Shiers@cern.c [CERN, 1211 Geneva 23 (Switzerland)

    2010-04-01

    The world's largest scientific machine - comprising dual 27km circular proton accelerators cooled to 1.9{sup o}K and located some 100m underground - currently relies on major production Grid infrastructures for the offline computing needs of the 4 main experiments that will take data at this facility. After many years of sometimes difficult preparation the computing service has been declared 'open' and ready to meet the challenges that will come shortly when the machine restarts in 2009. But the service is not without its problems: reliability - as seen by the experiments, as opposed to that measured by the official tools - still needs to be significantly improved. Prolonged downtimes or degradations of major services or even complete sites are still too common and the operational and coordination effort to keep the overall service running is probably not sustainable at this level. Recently 'Cloud Computing' - in terms of pay-per-use fabric provisioning - has emerged as a potentially viable alternative but with rather different strengths and no doubt weaknesses too. Based on the concrete needs of the LHC experiments - where the total data volume that will be acquired over the full lifetime of the project, including the additional data copies that are required by the Computing Models of the experiments, approaches 1 Exabyte - we analyze the pros and cons of Grids versus Clouds. This analysis covers not only technical issues - such as those related to demanding database and data management needs - but also sociological aspects, which cannot be ignored, neither in terms of funding nor in the wider context of the essential but often overlooked role of science in society, education and economy.

  15. Can Clouds replace Grids? Will Clouds replace Grids?

    Science.gov (United States)

    Shiers, J. D.

    2010-04-01

    The world's largest scientific machine - comprising dual 27km circular proton accelerators cooled to 1.9oK and located some 100m underground - currently relies on major production Grid infrastructures for the offline computing needs of the 4 main experiments that will take data at this facility. After many years of sometimes difficult preparation the computing service has been declared "open" and ready to meet the challenges that will come shortly when the machine restarts in 2009. But the service is not without its problems: reliability - as seen by the experiments, as opposed to that measured by the official tools - still needs to be significantly improved. Prolonged downtimes or degradations of major services or even complete sites are still too common and the operational and coordination effort to keep the overall service running is probably not sustainable at this level. Recently "Cloud Computing" - in terms of pay-per-use fabric provisioning - has emerged as a potentially viable alternative but with rather different strengths and no doubt weaknesses too. Based on the concrete needs of the LHC experiments - where the total data volume that will be acquired over the full lifetime of the project, including the additional data copies that are required by the Computing Models of the experiments, approaches 1 Exabyte - we analyze the pros and cons of Grids versus Clouds. This analysis covers not only technical issues - such as those related to demanding database and data management needs - but also sociological aspects, which cannot be ignored, neither in terms of funding nor in the wider context of the essential but often overlooked role of science in society, education and economy.

  16. Enzyme replacement and substrate reduction therapy for Gaucher disease.

    Science.gov (United States)

    Shemesh, Elad; Deroma, Laura; Bembi, Bruno; Deegan, Patrick; Hollak, Carla; Weinreb, Neal J; Cox, Timothy M

    2015-03-27

    Gaucher disease, a rare disorder, is caused by inherited deficiency of the enzyme glucocerebrosidase. It is unique among the ultra-orphan disorders in that four treatments are currently approved by various regulatory authorities for use in routine clinical practice. Hitherto, because of the relatively few people affected worldwide, many of whom started therapy during a prolonged period when there were essentially no alternatives to imiglucerase, these treatments have not been systematically evaluated in studies such as randomized controlled trials now considered necessary to generate the highest level of clinical evidence. To summarize all available randomized controlled study data on the efficacy and safety of enzyme replacement therapies and substrate reduction therapy for treating Gaucher disease. We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Inborn Errors of Metabolism Trials Register. Additional searches were conducted on ClinicalTrials.gov for any ongoing studies with potential interim results, and through PubMed. We also searched the reference lists of relevant articles and reviews.Date of last search: 07 August 2014. All randomized and quasi-randomized controlled studies (including open-label studies and cross-over studies) assessing enzyme replacement therapy or substrate reduction therapy, or both, in all types of Gaucher disease were included. Two authors independently assessed the risk of bias in the included studies, and extracted relevant data. Of the 488 studies retrieved by the electronic searches, eight met the inclusion criteria and were analysed (300 participants). Response parameters were restricted to haemoglobin concentration, platelet count, spleen and liver volume and serum biomarkers (chitotriosidase and CCL18). Only one publication reported a 'low risk of bias' score in all parameters assessed, and all studies included were randomized.Four studies reported the responses to enzyme replacement therapy of previously

  17. 46 CFR 67.171 - Deletion; requirement and procedure.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 2 2010-10-01 2010-10-01 false Deletion; requirement and procedure. 67.171 Section 67...; Requirement for Exchange, Replacement, Deletion, Cancellation § 67.171 Deletion; requirement and procedure. (a... provided in § 67.161, and the vessel is subject to deletion from the roll of actively documented vessels...

  18. 30 CFR 57.19122 - Replacement parts.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Replacement parts. 57.19122 Section 57.19122 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE... Inspection and Maintenance § 57.19122 Replacement parts. Parts used to repair hoists shall have properties...

  19. Transcatheter Aortic Valve Replacement in Europe

    DEFF Research Database (Denmark)

    Mylotte, Darren; Osnabrugge, Ruben L J; Windecker, Stephan

    2013-01-01

    The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy.......The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy....

  20. 30 CFR 56.19122 - Replacement parts.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Replacement parts. 56.19122 Section 56.19122 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE... Inspection and Maintenance § 56.19122 Replacement parts. Parts used to repair hoists shall have properties...

  1. An abstract machine for module replacement

    OpenAIRE

    Walton, Chris; Krl, Dilsun; Gilmore, Stephen

    1998-01-01

    In this paper we define an abstract machine model for the mλ typed intermediate language. This abstract machine is used to give a formal description of the operation of run-time module replacement from the programming language Dynamic ML. The essential technical device which we employ for module replacement is a modification of two-space copying garbage collection.

  2. Temelin NPP - IandC replacement

    International Nuclear Information System (INIS)

    Spalenka, I.

    1997-01-01

    The original instrumentation and control system of the Temelin nuclear power plant is being upgraded and replaced by a modern Westinghouse-supplied system which meets the requirements imposed on current nuclear power plant designs. The history and purpose of the IandC system replacement is given, and the design of the new system is described in some detail. (A.K.)

  3. Replacement Value of fermented millet ( Pennisetum americanum ...

    African Journals Online (AJOL)

    The replacement value of fermented millet for maize in the diets of Clarias gariepinus fingerlings reared in a recirculation system was determined. Five isonitrogenous diets were formulated to contain graded levels of fermented millet meal replacing 0, 20, 40, 60 and 80% of maize and fed to triplicate groups of fingerlings ...

  4. 30 CFR 823.14 - Soil replacement.

    Science.gov (United States)

    2010-07-01

    ... 30 Mineral Resources 3 2010-07-01 2010-07-01 false Soil replacement. 823.14 Section 823.14 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR PERMANENT PROGRAM PERFORMANCE STANDARDS SPECIAL PERMANENT PROGRAM PERFORMANCE STANDARDS-OPERATIONS ON PRIME FARMLAND § 823.14 Soil replacement. (a) Soil...

  5. A useful framework for optimal replacement models

    International Nuclear Information System (INIS)

    Aven, Terje; Dekker, Rommert

    1997-01-01

    In this note we present a general framework for optimization of replacement times. It covers a number of models, including various age and block replacement models, and allows a uniform analysis for all these models. A relation to the marginal cost concept is described

  6. 7 CFR 1944.659 - Replacement housing.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 13 2010-01-01 2009-01-01 true Replacement housing. 1944.659 Section 1944.659 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS...) PROGRAM REGULATIONS (CONTINUED) HOUSING Housing Preservation Grants § 1944.659 Replacement housing...

  7. Infection after total knee replacement: diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Lucio Honorio de Carvalho Junior

    2013-09-01

    Full Text Available Infection after total knee replacement (IATJ is a rare complication. It is associated with increased morbidity and mortality increasing the final costs. Gram positive coccus and Staphylococcus coagulase-negative and Staphylococcus aureus are the most common isolated germs (>50% of the cases. Conditions related to the patient, to the surgical procedure and even to the post op have been identified as risk factors to IATJ. Many complementary methods together with clinical symptoms are useful to a proper diagnosis. Treatment for IATJ must be individualized but generally is a combination of systemic antibiotic therapy and surgical treatment. Prosthesis exchange in one or two stages is the first choice procedure. Debridement with prosthesis retention is an option in acute cases with stable implants and antibiotic sensible germs.

  8. Analysis of Mitral Valve Replacement Outcomes is Enhanced by Meaningful Clinical Use of Electronic Health Records

    Science.gov (United States)

    Chen, John C; Pfeffer, Thomas; Johnstone, Shelley; Chen, Yuexin; Kiley, Mary-Lou; Richter, Richard; Lee, Hon

    2013-01-01

    Objective: Cardiac surgical mortality has improved during the last decade despite the aging of the population. An integrated US health plan developed a heart valve registry to track outcomes and complications of heart valve operations. This database was used for longitudinal evaluation of mitral valve (MV) outcomes from 1999 to 2008 at four affiliated hospitals. Methods: We identified 3130 patients in the Apollo database who underwent 3180 initial MV procedures. Internal administrative and Social Security Administration databases were merged to determine survival rates. Electronic health records were searched to ascertain demographics, comorbidities, and postoperative complications. Cox regression was used to evaluate mean survival and identify risk factors. Results: The procedures included 1160 mechanical valve replacements, 1159 tissue valve replacements, and 861 annuloplasties. The mean age of patients undergoing these procedures was 58 ± 11 years, 69 ± 12 years, and 62 ± 12 years, respectively. Mean survival was 8.9 ± 0.1 years for mechanical valve replacement, 7.0 ± 0.1 years for tissue valve replacement, and 7.7 ± 0.1 years for annuloplasty. Early in the study, there was a preference for implanting mechanical MVs. Beginning in 2003, more patients received tissue valve replacements rather than mechanical valves. Over time, there was an increasing trend of annuloplasty. Cox regression analysis identified the following risk factors for increased ten-year mortality: tissue valve implantation; advanced age; female sex; nonelective, nonisolated procedure; diabetes; postoperative use of banked blood products; previous cardiovascular intervention; dialysis; and longer perfusion time. Hospital location, reoperation, preoperative anticoagulation, and cardiogenic shock were not statistically significant risk factors. Conclusions: When controlling for other risk factors, we observed a lower long-term survival rate for tissue valve replacement compared with

  9. Replacing lactose from calf milk replacers : effects on digestion and post-absorptive metabolism

    NARCIS (Netherlands)

    Gilbert, M.S.

    2015-01-01

    Summary PhD thesis Myrthe S. Gilbert

    Replacing lactose from calf milk replacers – Effects on digestion and post-absorptive metabolism

    Veal calves are fed milk replacer (MR) and solid feed. The largest part of the energy provided to veal calves

  10. Pipe replacement in a water supply network: coordinated versus uncoordinated replacement and budget effects

    NARCIS (Netherlands)

    Dijk, van D.; Hendrix, E.M.T.

    2016-01-01

    Operators of underground water supply networks are challenged with pipe replacement
    decisions, because pipes are subject to increased failure rates as they age and financial resources
    are often limited.We study the optimal replacement time and optimal number of pipe replacements
    such

  11. Volume and outcome of organ transplantation

    NARCIS (Netherlands)

    Banta, H.D.; Engel, G.L.; Schersten, T.

    1992-01-01

    In general, technically demanding medical procedures are associated with better outcomes when they are carried out in institutions and by physicians with higher volumes of practice. This paper examines the evidence for a volume-outcome relationship in the case of organ transplantation. Although few

  12. Model morphing and sequence assignment after molecular replacement.

    Science.gov (United States)

    Terwilliger, Thomas C; Read, Randy J; Adams, Paul D; Brunger, Axel T; Afonine, Pavel V; Hung, Li-Wei

    2013-11-01

    A procedure termed `morphing' for improving a model after it has been placed in the crystallographic cell by molecular replacement has recently been developed. Morphing consists of applying a smooth deformation to a model to make it match an electron-density map more closely. Morphing does not change the identities of the residues in the chain, only their coordinates. Consequently, if the true structure differs from the working model by containing different residues, these differences cannot be corrected by morphing. Here, a procedure that helps to address this limitation is described. The goal of the procedure is to obtain a relatively complete model that has accurate main-chain atomic positions and residues that are correctly assigned to the sequence. Residues in a morphed model that do not match the electron-density map are removed. Each segment of the resulting trimmed morphed model is then assigned to the sequence of the molecule using information about the connectivity of the chains from the working model and from connections that can be identified from the electron-density map. The procedure was tested by application to a recently determined structure at a resolution of 3.2 Å and was found to increase the number of correctly identified residues in this structure from the 88 obtained using phenix.resolve sequence assignment alone (Terwilliger, 2003) to 247 of a possible 359. Additionally, the procedure was tested by application to a series of templates with sequence identities to a target structure ranging between 7 and 36%. The mean fraction of correctly identified residues in these cases was increased from 33% using phenix.resolve sequence assignment to 47% using the current procedure. The procedure is simple to apply and is available in the Phenix software package.

  13. Trends in Medicare Reimbursement for Orthopedic Procedures: 2000 to 2016.

    Science.gov (United States)

    Eltorai, Adam E M; Durand, Wesley M; Haglin, Jack M; Rubin, Lee E; Weiss, Arnold-Peter C; Daniels, Alan H

    2018-03-01

    Understanding trends in reimbursement is critical to the financial sustainability of orthopedic practices. Little research has examined physician fee trends over time for orthopedic procedures. This study evaluated trends in Medicare reimbursements for orthopedic surgical procedures. The Medicare Physician Fee Schedule was examined for Current Procedural Terminology code values for the most common orthopedic and nonorthopedic procedures between 2000 and 2016. Prices were adjusted for inflation to 2016-dollar values. To assess mean growth rate for each procedure and subspecialty, compound annual growth rates were calculated. Year-to-year dollar amount changes were calculated for each procedure and subspecialty. Reimbursement trends for individual procedures and across subspecialties were compared. Between 2000 and 2016, annual reimbursements decreased for all orthopedic procedures examined except removal of orthopedic implant. The orthopedic procedures with the greatest mean annual decreases in reimbursement were shoulder arthroscopy/decompression, total knee replacement, and total hip replacement. The orthopedic procedures with the least annual reimbursement decreases were carpal tunnel release and repair of ankle fracture. Rate of Medicare procedure reimbursement change varied between subspecialties. Trauma had the smallest decrease in annual change compared with spine, sports, and hand. Annual reimbursement decreased at a significantly greater rate for adult reconstruction procedures than for any of the other subspecialties. These findings indicate that reimbursement for procedures has steadily decreased, with the most rapid decrease seen in adult reconstruction. [Orthopedics. 2018; 41(2):95-102.]. Copyright 2018, SLACK Incorporated.

  14. Capillary gas chromatographic analysis of nerve agents using large volume injections. Final report

    Energy Technology Data Exchange (ETDEWEB)

    Deinum, T.; Nieuwenhuy, C.

    1994-11-01

    The procedure developed at TNO-Prins Maurits Laboratory (TNO-PML) for the verification of intact organophosphorus chemical warfare agents in water samples was improved. The last step in this procedure, the laborious and non-reproducible transfer of an ethyl acetate extract onto a Tenax-adsorption tube followed by thermal desorption of the Tenax-tube, was replaced by large volume injection of the extract onto a capillary gas chromatographic system. The parameters controlling the injection of a large volume of an extract (200 ul) were investigated and optimized. As ethyl acetate caused severe problems, potential new solvents were evaluated. With the improved procedure, the nerve agents sarin, tabun, soman, diisopropyl fluorophosphate (DFP) and VX could be determined in freshly prepared water samples at pg/ml (ppt) levels. The fate of the nerve agents under study in water at two pH`s (4.8 and 6) was investigated. For VX, the pH should be adjusted before extraction. Moreover, it is worthwhile to acidify water samples to diminish hydrolysis.

  15. Optimal composition of fluid-replacement beverages.

    Science.gov (United States)

    Baker, Lindsay B; Jeukendrup, Asker E

    2014-04-01

    The objective of this article is to provide a review of the fundamental aspects of body fluid balance and the physiological consequences of water imbalances, as well as discuss considerations for the optimal composition of a fluid replacement beverage across a broad range of applications. Early pioneering research involving fluid replacement in persons suffering from diarrheal disease and in military, occupational, and athlete populations incurring exercise- and/or heat-induced sweat losses has provided much of the insight regarding basic principles on beverage palatability, voluntary fluid intake, fluid absorption, and fluid retention. We review this work and also discuss more recent advances in the understanding of fluid replacement as it applies to various populations (military, athletes, occupational, men, women, children, and older adults) and situations (pathophysiological factors, spaceflight, bed rest, long plane flights, heat stress, altitude/cold exposure, and recreational exercise). We discuss how beverage carbohydrate and electrolytes impact fluid replacement. We also discuss nutrients and compounds that are often included in fluid-replacement beverages to augment physiological functions unrelated to hydration, such as the provision of energy. The optimal composition of a fluid-replacement beverage depends upon the source of the fluid loss, whether from sweat, urine, respiration, or diarrhea/vomiting. It is also apparent that the optimal fluid-replacement beverage is one that is customized according to specific physiological needs, environmental conditions, desired benefits, and individual characteristics and taste preferences.

  16. Optimum body size of Holstein replacement heifers.

    Science.gov (United States)

    Hoffman, P C

    1997-03-01

    Criteria that define optimum body size of replacement heifers are required by commercial dairy producers to evaluate replacement heifer management programs. Historically recommended body size criteria have been based on live BW measurements. Numerous research studies have observed a positive relationship between BW at first calving and first lactation milk yield, which has served as the impetus for using live BW to define body size of replacement heifers. Live BW is, however, not the only available measurement to define body size. Skeletal measurements such as wither height, length, and pelvic area have been demonstrated to be related to first lactation performance and (or) dystocia. Live BW measurements also do not define differences in body composition. Differences in body composition of replacement heifers at first calving are also related to key performance variables. An updated research data base is available for the modern Holstein genotype to incorporate measures of skeletal growth and body composition with BW when defining body size. These research projects also lend insight into the relative importance of measurements that define body size of replacement heifers. Incorporation of these measurements from current research into present BW recommendations should aid commercial dairy producers to better define replacement heifer growth and management practices. This article proposes enhancements in defining optimum body size and growth characteristics of Holstein replacement heifers.

  17. Sparse PDF Volumes for Consistent Multi-Resolution Volume Rendering

    KAUST Repository

    Sicat, Ronell Barrera

    2014-12-31

    This paper presents a new multi-resolution volume representation called sparse pdf volumes, which enables consistent multi-resolution volume rendering based on probability density functions (pdfs) of voxel neighborhoods. These pdfs are defined in the 4D domain jointly comprising the 3D volume and its 1D intensity range. Crucially, the computation of sparse pdf volumes exploits data coherence in 4D, resulting in a sparse representation with surprisingly low storage requirements. At run time, we dynamically apply transfer functions to the pdfs using simple and fast convolutions. Whereas standard low-pass filtering and down-sampling incur visible differences between resolution levels, the use of pdfs facilitates consistent results independent of the resolution level used. We describe the efficient out-of-core computation of large-scale sparse pdf volumes, using a novel iterative simplification procedure of a mixture of 4D Gaussians. Finally, our data structure is optimized to facilitate interactive multi-resolution volume rendering on GPUs.

  18. Quantification of in vivo implant wear in total knee replacement from dynamic single plane radiography

    International Nuclear Information System (INIS)

    Teeter, Matthew G; Naudie, Douglas D R; Holdsworth, David W; Seslija, Petar; Milner, Jaques S; Nikolov, Hristo N; Yuan Xunhua

    2013-01-01

    An in vivo method to measure wear in total knee replacements was developed using dynamic single-plane fluoroscopy. A dynamic, anthropomorphic total knee replacement phantom with interchangeable, custom-fabricated components of known wear volume was created, and dynamic imaging was performed. For each frame of the fluoroscopy data, the relative location of the femoral and tibial components were determined, and the apparent intersection of the femoral component with the tibial insert was used to calculate wear volume, wear depth, and frequency of intersection. No difference was found between the measured and true wear volumes. The precision of the measurements was ±39.7 mm 3 for volume and ±0.126 mm for wear depth. The results suggest the system is capable of tracking wear volume changes across multiple time points in patients. As a dynamic technique, this method can provide both kinematic and wear measurements that may be useful for evaluating new implant designs for total knee replacements. (paper)

  19. Solving structures of protein complexes by molecular replacement with Phaser

    International Nuclear Information System (INIS)

    McCoy, Airlie J.

    2006-01-01

    Four case studies in using maximum-likelihood molecular replacement, as implemented in the program Phaser, to solve structures of protein complexes are described. Molecular replacement (MR) generally becomes more difficult as the number of components in the asymmetric unit requiring separate MR models (i.e. the dimensionality of the search) increases. When the proportion of the total scattering contributed by each search component is small, the signal in the search for each component in isolation is weak or non-existent. Maximum-likelihood MR functions enable complex asymmetric units to be built up from individual components with a ‘tree search with pruning’ approach. This method, as implemented in the automated search procedure of the program Phaser, has been very successful in solving many previously intractable MR problems. However, there are a number of cases in which the automated search procedure of Phaser is suboptimal or encounters difficulties. These include cases where there are a large number of copies of the same component in the asymmetric unit or where the components of the asymmetric unit have greatly varying B factors. Two case studies are presented to illustrate how Phaser can be used to best advantage in the standard ‘automated MR’ mode and two case studies are used to show how to modify the automated search strategy for problematic cases

  20. Conceptual Design Plan SM-43 Replacement Project

    Energy Technology Data Exchange (ETDEWEB)

    University of California, Los Alamos National Laboratory, SCC Project Office

    2000-11-01

    The Los Alamos National Laboratory Conceptual Design Plan for the SM-43 Replacement Project outlines plans for replacing the SM-43 Administration Building. Topics include the reasons that replacement is considered a necessity; the roles of the various project sponsors; and descriptions of the proposed site and facilities. Also covered in this proposal is preliminary information on the project schedule, cost estimates, acquisition strategy, risk assessment, NEPA strategy, safety strategy, and safeguards and security. Spreadsheets provide further detail on space requirements, project schedules, and cost estimates.

  1. Valve-sparing and valve-replacing techniques for aortic root replacement in patients with Marfan syndrome: Analysis of early outcome.

    Science.gov (United States)

    Volguina, Irina V; Miller, D Craig; LeMaire, Scott A; Palmero, Laura C; Wang, Xing Li; Connolly, Heidi M; Sundt, Thoralf M; Bavaria, Joseph E; Dietz, Harry C; Milewicz, Dianna M; Coselli, Joseph S

    2009-05-01

    A prospective, international registry study was initiated to provide contemporary comparative data on short-term clinical outcomes after aortic valve-sparing and aortic valve-replacing root operations in patients with Marfan syndrome. The purpose of this initial report is to describe the study design and to compare early outcomes in the first 151 enrolled patients. We assessed 30-day outcomes in 151 patients who met strict Ghent diagnostic criteria for Marfan syndrome and underwent aortic root replacement with either valve-replacing (n = 46) or valve-sparing techniques (n = 105) at one of 18 participating centers. In the valve replacement group, a mechanical composite valve graft was used in 39 (85%) patients and a bioprosthetic valve in 7 (15%). In the valve-sparing group, David V procedures were performed in 57 (54%) patients, David I in 38 (36%), David IV in 8 (8%), Florida sleeve in 1 (1%), and Yacoub remodeling in 1 (1%). No in-hospital or 30-day deaths occurred. Despite longer crossclamp and cardiopulmonary bypass times in the valve-sparing group, there were no significant between-group differences in postoperative complications. Thirty-day valve-related complications occurred in 2 (4%) patients undergoing valve replacement and in 3 (3%) undergoing valve-sparing procedures (P = .6). The analysis of early outcomes revealed that valve-sparing techniques were the most common approach to root replacement in patients with Marfan syndrome in these centers. The complexity of valve-sparing root replacement did not translate into any demonstrable adverse early outcomes. Subsequent analysis will compare the 3-year durability of these two surgical approaches.

  2. Autologous blood transfusion in total knee replacement surgery.

    Science.gov (United States)

    Sarkanović, Mirka Lukić; Gvozdenović, Ljiljana; Savić, Dragan; Ilić, Miroslav P; Jovanović, Gordana

    2013-03-01

    Total knee replacement (TKR) surgery is one of the most frequent and the most extensive procedures in orthopedic surgery, accompanied with some serious complications. Perioperative blood loss is one of the most serious losses, so it is vital to recognize and treat such losses properly. Autologous blood transfusion is the only true alternative for the allogeneic blood. The aim of this study was to to examine if autologous blood transfusion reduces usage of allogenic blood in total knee replacement surgery, as well as to examine possible effect of autologous blood transfusion on postoperative complications, recovery and hospital stay of patients after total knee replacement surgery. During the controlled, prospective, randomised study we compared two groups of patients (n = 112) with total prosthesis implanted in their knee. The group I consisted of the patients who received the transfusion of other people's (allogeneic) blood (n = 57) and the group II of the patients whose blood was collected postoperatively and then given them [their own (autologous) blood] (n = 55). The transfusion trigger for both groups was hemoglobin level of 85 g/L. In the group of patients whose blood was collected perioperatively only 9 (0.9%) of the patients received transfusion of allogeneic blood, as opposed to the control group in which 98.24% of the patients received the transfusion of allogeneic blood (p blood was collected stayed in hospital for 6.18 days, while the patients of the control group stayed 7.67 days (p blood transfusion is a very effective method for reducing consumption of allogenic blood and thus, indirectly for reducing all complications related to allogenic blood transfusion. There is also a positive influence on postoperative recovery after total knee replacement surgery due to the reduction of hospital stay, and indirectly on the reduction of hospital costs.

  3. HASL procedures manual

    International Nuclear Information System (INIS)

    Harley, J.H.

    1977-08-01

    Additions and corrections to the following sections of the HASL Procedures Manual are provided: General, Sampling, Field Measurements; General Analytical Chemistry, Chemical Procedures, Data Section, and Specifications

  4. Replacement Saltwell Pumping System Document Bibliography

    International Nuclear Information System (INIS)

    BELLOMY, J.R.

    2000-01-01

    This document bibliography is prepared to identify engineering documentation developed during the design of the Replacement Saltwell Pumping System. The bibliography includes all engineering supporting documents and correspondence prepared prior to the deployment of the system in the field. All documents referenced are available electronically through the Records Management Information System (RMIS). Major components of the Replacement Saltwell Pumping System include the Sundyne Canned Motor Pump, the Water Filter Skid, the Injection Water Skid and the Backflow Preventer Assembly. Drawing H-14-104498 provides an index of drawings (fabrication details, PandIDs, etc.) prepared to support development of the Replacement Saltwell Pumping System. Specific information pertaining to new equipment can be found in Certified Vendor Information (CVI) File 50124. This CVI file has been established specifically for new equipment associated with the Replacement Saltwell Pumping System

  5. The future of rapid bridge deck replacement.

    Science.gov (United States)

    2015-06-01

    Replacing aging, deteriorated infrastructure often requires road closures and traffic detours which impose : inconvenience and delay on commerce and members of the motoring public. Accelerated bridge construction : techniques often use precast member...

  6. Proper Installation of Replacement Windows | Efficient Windows

    Science.gov (United States)

    Collaborative Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring

  7. Assessing Window Replacement Options | Efficient Windows Collaborative

    Science.gov (United States)

    Foundry Foundry New Construction Windows Window Selection Tool Selection Process Design Guidance Installation Replacement Windows Window Selection Tool Assessing Options Selection Process Design Guidance Installation Understanding Windows Benefits Design Considerations Measuring Performance Performance Standards

  8. Logistic Vehicle System Replacement Cost Estimate

    National Research Council Canada - National Science Library

    Stinson, Margaret

    1998-01-01

    The Logistics Vehicle System (LVS) was originally fielded from 1985-1989. Most of the LVS fleet will reach end-of-service life in 2005, therefore the goal of the Logistics Vehicle System Replacement (LVSR...

  9. Steam-generator replacement sets new marks

    International Nuclear Information System (INIS)

    Beck, R.L.

    1995-01-01

    This article describes how, in one of the most successful steam-generator replacement experiences at PWRs worldwide, the V C Summer retrofit exceeded plant goals for critical-path duration, radiation, exposure, and radwaste generation. Intensive planning and teamwork, combined with the firm support of station management and the use of mockups to prepare the work crews for activity in a radiological environment, were key factors in the record performance achieved by South Carolina Electric and Gas Co (SCE and G) in replacing three steam generators at V C Summer nuclear station. The 97-day, two-hour breaker-to-breaker replacement outage -- including an eight-day delay for repair of leak in a small-bore seal-injection line of a reactor coolant pump (unrelated to the replacement activities) -- surpassed the project goal by over one day. Moreover, the outage was only 13 hours shy of the world record held by Virginia Power Co's North Anna Unit 1

  10. Nuclear facilities: repair and replacement technologies

    International Nuclear Information System (INIS)

    2005-01-01

    The oldest operating reactors are more than 35 years old and are now facing major maintenance operations. The first replacement of a pressurizer took place in autumn 2005 at the St-Lucie plant (Usa) while steam generators have been currently replaced since 1983. Nuclear industry has to adapt to this new market by proposing innovative technological solutions in the reactor maintenance field. This document gathers the 9 papers presented at the conference. The main improvements concern repair works on internal components of PWR-type reactors, the replacement of major components of the primary coolant circuit and surface treatments to limit the propagation of damages. The first paper shows that adequate design and feedback experience are good assets to manage the ageing of a nuclear unit. Another paper shows that a new repair method of a relief valve can avoid its replacement. (A.C.)

  11. Guide to optimized replacement of equipment seals

    International Nuclear Information System (INIS)

    Gleason, J.F.

    1990-03-01

    A reevaluation of current scheduled replacement intervals of polymeric seals in plant equipment can achieve significant benefits. Information is provided which has the potential for increasing replacement intervals based on better information on how seals have performed through unique nuclear industry tests to qualify equipment, improved elastomers and increased knowledge of the failure mechanisms and related performance. The research was performed by reviewing applications of elastomeric seals in nuclear plants and practice associated with defining seal replacement intervals in the nuclear power and other industries. Performance indicators and how they predict degradation of seals were evaluated. Guidelines and a flow chart for reevaluating seal replacement intervals are provided. 29 refs., 38 figs., 8 tabs

  12. [Reoperative valve replacement in patients undergoing cardiac reoperation: a report of 104 cases].

    Science.gov (United States)

    Zou, Liang-jian; Xu, Zhi-yun; Wang, Zhi-nong; Lang, Xi-long; Han, Lin; Lu, Fang-lin; Xu, Ji-bin; Tang, Hao; Ji, Guang-yu; Wang, Er-song; Wang, Jun; Qu, Yi

    2010-08-15

    To review the experience of reoperative valve replacement for 104 patients. From January 2002 to December 2009, 104 patients underwent heart valve replacement in reoperations, accounting for 2.92% of the total patient population (3557 cases) who had valve replacement during this period. In this group, 53 male and 51 female patients were included with a median age of 46 years (ranged from 13 to 72 years). The reasons of reoperation included 28 cases suffered from another valve lesion after valve replacement, 10 cases suffered from valve lesion after mitral valvuloplasty, 19 cases suffered from perivalvular leakage after valve replacement, 18 cases suffered from valve lesion after previous correction of congenital heart defect, 7 cases suffered from bioprosthetic valve decline, 10 cases suffered from prosthetic valve endocarditis, 9 cases suffered from dysfunction of machine valve, and 3 cases suffered from other causes. The re-operations were mitral and aortic valve replacement in 2 cases, mitral valve replacement in 59 cases, aortic valve replacement in 24 cases, tricuspid valve replacement in 16 cases, and Bentall's operation in 3 cases. The interval from first operation to next operation was 1 month-19 years. There were 8 early deaths from heart failure, renal failure and multiple organ failure (early mortality 7.69%). Major complications were intraoperative hemorrhage in 2 cases, re-exploration for mediastinal bleeding in 2 cases and sternotomy surgical site infection in 1 case. Complete follow-up (3 months-7 years and 2 months) was available for all patients. Two patients died, one patient died of intracranial hemorrhage, and another cause was unknown. Satisfactory short-term and long-term results can be obtained in reoperative valve replacement with appropriate timing of operation control, satisfactory myocardial protection, accurate surgical procedure and suitable perioperative treatment.

  13. Machine replacement, Network Externalities and Investment Cycles

    OpenAIRE

    Juan Ruiz

    2003-01-01

    This paper presents a model where agents decide on the timing of replacement of ageing machines. The optimal replacement policy for an agent is influenced by other agents' decisions because the productivity of a particular vintage displays network externalities that set in with a lag. In equilibrium, agents follow innovation cycles with a frequency that is lower than optimal, so there is too much delay. One extreme case is the possibility of inefficient collapse: for some parameters there is ...

  14. Equipment Replacement Decision Making: Opportunities and Challenges

    OpenAIRE

    Fan, Wei (David); Gemar, Mason D.; Machemehl, Randy

    2012-01-01

    The primary function of equipment managers is to replace the right equipment at the right time and at the lowest overall cost. In this paper, the opportunities and challenges associated with equipment replacement optimization (ERO) are discussed in detail. First, a comprehensive review of the state-of-the art and state-of-the practice literature for the ERO problem is conducted. Second, a dynamic programming (DP) based optimization solution methodology is presented to solve the ERO problem. T...

  15. Does Online Marketing Truly Replace Traditional Marketing?

    OpenAIRE

    Gunawan, Emilia Margareth

    2013-01-01

    This review explains the way how online marketing has been replacing traditional marketing in terms of marketing mix. This replacement might happen, because online marketing can give advantages, i.e., offering on-time delivery, increasing effectiveness of two way interactions between buyer and seller, and creating online communities (Szmigin, et al, 2005). The transition of atoms to bits format reflects that tangible products in traditional marketing is being digitalized. The marketing strate...

  16. Infective endocarditis following percutaneous pulmonary valve replacement

    DEFF Research Database (Denmark)

    Cheung, Gary; Vejlstrup, Niels; Ihlemann, Nikolaj

    2013-01-01

    Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult.......Infective endocarditis (IE) following percutaneous pulmonary valve replacement (PPVR) with the Melody valve is rarely reported. Furthermore, there are challenges in this diagnosis; especially echocardiographic evidence of vegetation within the prosthesis may be difficult....

  17. Geometric procedures for civil engineers

    CERN Document Server

    Tonias, Elias C

    2016-01-01

    This book provides a multitude of geometric constructions usually encountered in civil engineering and surveying practice.  A detailed geometric solution is provided to each construction as well as a step-by-step set of programming instructions for incorporation into a computing system. The volume is comprised of 12 chapters and appendices that may be grouped in three major parts: the first is intended for those who love geometry for its own sake and its evolution through the ages, in general, and, more specifically, with the introduction of the computer. The second section addresses geometric features used in the book and provides support procedures used by the constructions presented. The remaining chapters and the appendices contain the various constructions. The volume is ideal for engineering practitioners in civil and construction engineering and allied areas.

  18. Two-stage multilevel en bloc spondylectomy with resection and replacement of the aorta.

    Science.gov (United States)

    Gösling, Thomas; Pichlmaier, Maximilian A; Länger, Florian; Krettek, Christian; Hüfner, Tobias

    2013-05-01

    We report a case of multilevel spondylectomy in which resection and replacement of the adjacent aorta were done. Although spondylectomy is nowadays an established technique, no report on a combined aortic resection and replacement has been reported so far. The case of a 43-year-old man with a primary chondrosarcoma of the thoracic spine is presented. The local pathology necessitated resection of the aorta. We did a two-stage procedure with resection and replacement of the aorta using a heart-lung machine followed by secondary tumor resection and spinal reconstruction. The procedure was successful. A tumor-free margin was achieved. The patient is free of disease 48 months after surgery. En bloc spondylectomy in combination with aortic resection is feasible and might expand the possibility of producing tumor-free margins in special situations.

  19. Optimal timing of joint replacement using mathematical programming and stochastic programming models.

    Science.gov (United States)

    Keren, Baruch; Pliskin, Joseph S

    2011-12-01

    The optimal timing for performing radical medical procedures as joint (e.g., hip) replacement must be seriously considered. In this paper we show that under deterministic assumptions the optimal timing for joint replacement is a solution of a mathematical programming problem, and under stochastic assumptions the optimal timing can be formulated as a stochastic programming problem. We formulate deterministic and stochastic models that can serve as decision support tools. The results show that the benefit from joint replacement surgery is heavily dependent on timing. Moreover, for a special case where the patient's remaining life is normally distributed along with a normally distributed survival of the new joint, the expected benefit function from surgery is completely solved. This enables practitioners to draw the expected benefit graph, to find the optimal timing, to evaluate the benefit for each patient, to set priorities among patients and to decide if joint replacement should be performed and when.

  20. Systematic review of the outcome of aortic valve replacement in patients with aortic stenosis

    NARCIS (Netherlands)

    Sharma, Umesh C.; Barenbrug, Paul; Pokharel, Saraswati; Dassen, Willem R. M.; Pinto, Yigal M.; Maessen, Jos G.

    2004-01-01

    BACKGROUND: After the establishment of aortic valve replacement procedure for aortic stenosis, there are heterogeneous studies and varying reports on outcome. An analysis that compares individual studies to summarize the overall effect is still lacking. This study systematically analyzes the change

  1. 78 FR 679 - Revisions to the Auxiliary Installations, Replacement Facilities, and Siting and Maintenance...

    Science.gov (United States)

    2013-01-04

    ... process, see the Comment Procedures Section of this document. FOR FURTHER INFORMATION CONTACT: Katherine... existing facilities.\\14\\ The Commission reasoned that section 2.55(b) replacements ``should only involve... when an installation can qualify for section 157.203(b) automatic authorization). Further, to alleviate...

  2. Some Direct and Generalized Effects of Replacing an Autistic Man's Echolalia with Correct Responses to Questions.

    Science.gov (United States)

    McMorrow, Martin J.; Foxx, R. M.

    1986-01-01

    The use of operant procedures was extended to decrease immediate echolalia and increase appropriate responding to questions of a 21-year-old autistic man. Multiple baseline designs demonstrated that echolalia was rapidly replaced with correct stimulus-specific responses. A variety of generalized improvements were observed in verbal responses to…

  3. 9 CFR 442.3 - Scale requirements for accurate weights, repairs, adjustments, and replacements after inspection.

    Science.gov (United States)

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Scale requirements for accurate... PROCEDURES AND REQUIREMENTS FOR ACCURATE WEIGHTS § 442.3 Scale requirements for accurate weights, repairs, adjustments, and replacements after inspection. (a) All scales used to determine the net weight of meat and...

  4. Essential Specification Elements for Heat Exchanger Replacement

    Energy Technology Data Exchange (ETDEWEB)

    Bower, L.

    2015-07-01

    Performance upgrade and equipment degradation are the primary impetuses for a nuclear power plant to engage in the large capital cost project of heat exchanger replacement. Along with attention to these issues, consideration of heat exchanger Codes and Standards, material improvements, thermal redesign, and configuration are essential for developing User’s Design Specifications for successful replacement projects. The User’s Design Specification is the central document in procuring ASME heat exchangers. Properly stated objectives for the heat exchanger replacement are essential for obtaining the materials, configurations and thermal designs best suited for the nuclear power plant. Additionally, the code of construction required and the applied manufacturing standard (TEMA or HEI) affects how the heat exchanger may be designed or configured to meet the replacement goals. Knowledge of how Codes and Standards affect design and configuration details will aid in writing the User’s Design Specification. Joseph Oat Corporation has designed and fabricated many replacement heat exchangers for the nuclear power industry. These heat exchangers have been constructed per ASME Section III to various Code-Years or ASME Section VIII-1 to the current Code-Year also in accordance with TEMA and HEI. These heat exchangers have been a range of like-for-like replacement to complete thermal, material and configuration redesigns. Several examples of these heat exchangers with their Code, Standard and specification implications are presented. (Author.

  5. Strategic vehicle fleet management - the replacement problem

    Directory of Open Access Journals (Sweden)

    Adam Redmer

    2016-03-01

    Full Text Available Background: Fleets constitute the most important production means in transportation. Their appropriate management is crucial for all companies having transportation duties. The paper is the third one of a series of three papers that the author dedicates to the strategic vehicle fleet management topic. Material and methods: The paper discusses ways of building replacement strategies for companies' fleets of vehicles. It means deciding for how long to exploit particular vehicles in a fleet (the fleet replacement problem - FR. The essence of this problem lies in the minimization of vehicle / fleet exploitation costs by balancing ownership and utilization costs and taking into account budget limitations. In the paper an original mathematical model (an optimization method allowing for the FR analysis is proposed. Results: An application of the proposed optimization method in a real-life decision situation (the case study within the Polish environment and the obtained solution are presented. The solution shows that there exist optimal exploitation periods of particular vehicles in a fleet. However, combination of them gives a replacement plan for an entire fleet violating budget constraints. But it is possible to adjust individual age to replacement of particular vehicles to fulfill budget constraints without losing economical optimality of a developed replacement plan for an entire fleet. Conclusions: The paper is the last one of a series of three papers that the author dedicated to the strategic vehicle fleet management topic including the following managerial decision problems: MAKE-or-BUY, sizing / composition and replacement.

  6. International examples of steam generator replacement

    International Nuclear Information System (INIS)

    Wiechmann, K.

    1993-01-01

    Since 1979-1980 a total of twelve nuclear power plants world-wide have had their steam generators replaced. The replacement of the Combustion steam generators in the Millstone-2 plant in the United States was completed very recently. Steam generator replacement activities are going on at present in four plants. In North Anna, the steam generators have been under replacement since January 1990. In Japan, preparations have been started for Genkai-1. Since January 1992, the two projects in Beznau-1, Switzerland, and Doel-3, Belgium, have bee planned and executed in parallel. Why steam generator replacement? There are a number of defect mechanisms which give rise to the need for early steam generator replacement. One of the main reasons is the use of Inconel-600 as material for the heating tubes. Steam generator heating tubes made of Inconel-600 have been known to exhibit their first defects due to stress corrosion cracking after less than one year of operation. (orig.) [de

  7. A replaceable reflective film for solar concentrators

    Energy Technology Data Exchange (ETDEWEB)

    1991-09-01

    The 3M Company manufactures a silvered acrylic film called ECP-305 that is regarded as the preferred reflective film for use on stretched-membrane heliostats. However, ECP-305 will degrade in time, due to both corrosion of the silver layer and delamination at the film's silver-to-acrylic interface, and will eventually need to be replaced. 3M uses a very aggressive adhesive on this film, and once it is laminated, replacement is very difficult. The purpose of this investigation was the development of a replaceable reflector, a reflective film that can be easily removed and replaced. A replaceable reflector was successfully configured by laminating ECP-305 to the top surface of a smooth, dimensionally stable polymer film, with a removable adhesive applied to the underside of the polymer film. Several stages of screening and testing led to the selection of a 0.010-inch thick polycarbonate (GE 8030) as the best polymer film and a medium tack tape (3M Y-9425) was selected as the best removable adhesive. To demonstrate the feasibility of the replaceable reflector concept and to provide a real-time field test, the chosen construction was successfully applied to the 50-m{sup 2} SKI heliostat at the Central Receiver Test Facility at Sandia National Laboratories in Albuquerque. 4 refs., 13 figs., 7 tabs.

  8. Waste segregation procedures and benefits

    International Nuclear Information System (INIS)

    Fish, J.D.; Massey, C.D.; Ward, S.J.

    1990-01-01

    Segregation is a critical first step in handling hazardous and radioactive materials to minimize the generation of regulated wastes. In addition, segregation can significantly reduce the complexity and the total cost of managing waste. Procedures at Sandia National Laboratories, Albuquerque require that wastes be segregated, first, by waste type (acids, solvents, low level radioactive, mixed, classified, etc.). Higher level segregation requirements, currently under development, are aimed at enhancing the possibilities for recovery, recycle and reapplication; reducing waste volumes; reducing waste disposal costs, and facilitating packaging storage, shipping and disposal. 2 tabs

  9. Two-fold sustainability – Adobe with sawdust as partial sand replacement

    Science.gov (United States)

    Jokhio, Gul A.; Syed Mohsin, Sharifah M.; Gul, Yasmeen

    2018-04-01

    Adobe is a material that is economic, environment friendly, and provides better indoor air quality. The material required for the preparation of adobe include clay, sand, and sometimes straw or other organic materials. These materials do not require industrial processing or transportation, however, sand mining has been recently posing a threat to the environment. Therefore, to enhance the existing sustainability of adobe, sand can be partially or fully replaced by other waste materials. This approach will not only solve the problem of excessive sand mining, it will also address the issue of waste management. Sawdust is one such waste material that can be used to partially replace sand in Adobe. This paper presents the results of compressive and flexural test carried out on Adobe samples with partial sand replacement by sawdust. The results show that about 4% sand replacement by volume produces higher compressive strength, whereas the flexural strength reduces with the use of sawdust. However, since flexural strength is not a critical property for adobe, it is concluded that replacing sand with sawdust by about 4% of volume will be beneficial.

  10. Efficacy of a Meal-Replacement Program for Promoting Blood Lipid Changes and Weight and Body Fat Loss in US Army Soldiers

    Science.gov (United States)

    2010-02-01

    meal-replace- ent program (Slim-Fast Plan, Unilever , Englewood Cliffs, J) and were provided with all meal-replacement products nd snack bars (Slim-Fast...Optima, Unilever ). This group ill be referred to as “meal replacers” throughout the arti- le. Meal replacers were provided with calorie-controlled eal...snack bars (Slim-Fast Optima, Unilever , Englewood Cliffs, NJ).eficiencies in recording, including incomplete item de- t 70 February 2010 Volume 110 Number

  11. Computer assisted procedure maintenance

    International Nuclear Information System (INIS)

    Bisio, R.; Hulsund, J. E.; Nilsen, S.

    2004-04-01

    The maintenance of operating procedures in a NPP is a tedious and complicated task. Through the whole life cycle of the procedures they will be dynamic, 'living' documents. Several aspects of the procedure must be considered in a revision process. Pertinent details and attributes of the procedure must be checked. An organizational structure must be created and responsibilities allotted for drafting, revising, reviewing and publishing procedures. Available powerful computer technology provides solutions within document management and computerisation of procedures. These solutions can also support the maintenance of procedures. Not all parts of the procedure life cycle are equally amenable to computerized support. This report looks at the procedure life cycle in todays NPPs and discusses the possibilities associated with introduction of computer technology to assist the maintenance of procedures. (Author)

  12. Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support

    Science.gov (United States)

    2011-01-01

    Surgical management of tetralogy of Fallot (TOF) results in anatomic and functional abnormalities in the majority of patients. Although right ventricular volume load due to severe pulmonary regurgitation can be tolerated for many years, there is now evidence that the compensatory mechanisms of the right ventricular myocardium ultimately fail and that if the volume load is not eliminated or reduced by pulmonary valve replacement the dysfunction might be irreversible. Cardiovascular magnetic resonance (CMR) has evolved during the last 2 decades as the reference standard imaging modality to assess the anatomic and functional sequelae in patients with repaired TOF. This article reviews the pathophysiology of chronic right ventricular volume load after TOF repair and the risks and benefits of pulmonary valve replacement. The CMR techniques used to comprehensively evaluate the patient with repaired TOF are reviewed and the role of CMR in supporting clinical decisions regarding pulmonary valve replacement is discussed. PMID:21251297

  13. Evaluation of slurry preparation procedures for the determination of mercury by axial view inductively coupled plasma optical emission spectrometry using on-line cold vapor generation

    International Nuclear Information System (INIS)

    Santos, Eder Jose dos; Herrmann, Amanda Beatriz; Antunes Vieira, Mariana; Azzolin Frescura, Vera Lucia; Curtius, Adilson Jose

    2005-01-01

    Five different slurry preparation procedures were tested, after grinding the solid samples to a particle size ≤53 μm: (1) using aqua regia plus HF, 30 min of sonication, standing time of 24 h followed by another 30 min of sonication; (2) same as the previous one, except that the standing time and the second ultrasound treatment were omitted; (3) same as the previous one, except that HF was not used; (4) same as the previous one, except that the aqua regia was replaced by nitric acid; (5) same as the previous one, except that the acid nitric was replaced by tetramethylammonium hydroxide (TMAH). The Hg vapor was generated on-line, and the emission signal intensity measured at 253.652 nm by axial view inductively coupled plasma optical emission spectrometry. Initially, four experimental conditions were optimized using a multivariate factorial analysis: the concentrations of HCl and of the reducing agent, NaBH 4 , used in the cold vapor generation, and two instrumental parameters, the plasma radiofrequency power and the carrier gas flow rate. The radiofrequency power was statistically significant, but limited to 1.2 kW for practical reasons. The procedures were applied to 11 biological and environmental materials. Both, the slurries and the filtrates were analyzed, using calibration solutions in the same medium as in the slurries. The first three procedures produced results in agreement with the certified values. The two last procedures, using nitric acid or TMHA could not be used for quantitative analysis. For practical reasons, Procedure 3, with a detection limit (3s, n=10) of 0.06 μg g -1 for a sample mass of 20 mg in a final volume of 15 mL is recommended. The relative standard deviations for mercury in the investigated materials, using the recommended procedure, were lower than 12.5%, indicating a good precision for slurry sampling. The recommended procedure is simple, rapid and robust

  14. Quality and Safety in Health Care, Part XXXII: Additional Outcome Predictors for Transcatheter Aortic Valve Replacement.

    Science.gov (United States)

    Harolds, Jay A

    2018-02-01

    Mortality 12 months after a transcatheter aortic valve replacement (TAVR) is partly due to a number of reasons in addition to the usual preprocedural medical patient risk factors. In patients who need a permanent pacemaker placed after the procedure, the mortality risk goes up. The death rate following a TAVR varies considerably at different institutions, and the past death rate of TAVR patients at an institution is predictive of the mortality rate of new patients having this procedure. In addition, the quality of life of the individual before the procedure is predictive of the 12-month mortality outcome after the TAVR is done.

  15. Aortic valve replacement with the Biocor PSB stentless xenograft.

    Science.gov (United States)

    Bertolini, P; Luciani, G B; Vecchi, B; Pugliese, P; Mazzucco, A

    1998-08-01

    The midterm clinical results after aortic valve replacement with the Biocor PSB stentless xenograft on all patients operated between October 1992 and October 1996 were reviewed. One hundred six patients, aged 70+/-6 years, had aortic valve replacement for aortic stenosis (67%), regurgitation (11%), or both (22%). Associated procedures were done in 49 patients (46%), including coronary artery bypass in 30 patients, mitral valve repair/replacement in 16, and ascending aorta replacement in 5 patients. Aortic cross-clamp and cardiopulmonary bypass times were 96+/-24 and 129+/-31 minutes, respectively. There were 3 (3%) early deaths due to low output (2 patients) and cerebrovascular accident (1 patient). Follow-up of survivors ranged from 6 to 66 months (mean, 39+/-14 months). Survival was 94%+/-2% and 90%+/-3% at 1 and 5 years. There were 5 late deaths due to cardiac cause (2), cancer (2), and pulmonary embolism (1 patient). No patient had structural valve deterioration, whereas 100% and 95%+/-3% were free from valve-related events at 1 and 5 years. There were two reoperations due to narrowing of the left coronary ostium and endocarditis, with an actuarial freedom from reoperation of 99%+/-1% and 98+/-1% at 1 and 5 years, respectively. Functional results demonstrated a mean peak transprosthetic gradient of 16+/-12 mm Hg, with only 1 patient (1%) with a 55 mm Hg gradient. No cases of valve regurgitation greater than mild were recorded at follow-up. Assessment of New York Heart Association functional class demonstrated a significant improvement (2.9+/-0.6 versus 1.4+/-0.7; p=0.01). All patients were free from anticoagulation. Aortic valve replacement using the Biocor PSB stentless xenograft offers excellent midterm survival, negligible valve deterioration, and a very low rate of valve-related events, which are comparable to estimates reported with other models of stentless xenografts and currently available stented xenografts. Hemodynamic performance is favorable and

  16. Structural considerations in steam generator replacement

    International Nuclear Information System (INIS)

    Bertheau, S.R.; Gazda, P.A.

    1991-01-01

    Corrosion of the tubes and tube-support structures inside pressurized water reactor (PWR) steam generators has led many utilities to consider a replacement of the generators. Such a project is a major undertaking for a utility and must be well planned to ensure an efficient and cost-effective effort. This paper discusses various structural aspects of replacement options, such as total or partial generator replacement, along with their associated pipe cuts; major structural aspects associated with removal paths through the equipment hatch or through an opening in the containment wall, along with the related removal processes; onsite movement and storage of the generators; and the advantages and disadvantages of the removal alternatives. This paper addresses the major structural considerations associated with a steam generator replacement project. Other important considerations (e.g., licensing, radiological concerns, electrical requirements, facilities for management and onsite administrative activities, storage and fabrication activities, and offsite transportation) are not discussed in this paper, but should be carefully considered when undertaking a replacement project

  17. Hip or knee replacement - in the hospital after

    Science.gov (United States)

    Hip replacement surgery - after - self-care; Knee replacement surgery - after - self-care ... taking walks in the hallways with help. After knee replacement, some surgeons recommend using a continuous passive ...

  18. The Effect on Long-Term Survivorship of Surgeon Preference for Posterior-Stabilized or Minimally Stabilized Total Knee Replacement: An Analysis of 63,416 Prostheses from the Australian Orthopaedic Association National Joint Replacement Registry.

    Science.gov (United States)

    Vertullo, Christopher J; Lewis, Peter L; Lorimer, Michelle; Graves, Stephen E

    2017-07-05

    Controversy still exists as to the optimum management of the posterior cruciate ligament (PCL) in total knee arthroplasty. Surgeons can choose to kinematically substitute the PCL with a posterior-stabilized total knee replacement or alternatively to utilize a cruciate-retaining, also known as minimally stabilized, total knee replacement. Proponents of posterior-stabilized total knee replacement propose that the reported lower survivorship in registries when directly compared with minimally stabilized total knee replacement is due to confounders such as selection bias because of the preferential usage of posterior-stabilized total knee replacement in more complex or severe cases. In this study, we aimed to eliminate these possible confounders by performing an instrumental variable analysis based on surgeon preference to choose either posterior-stabilized or minimally stabilized total knee replacement, rather than the actual prosthesis received. Cumulative percent revision, hazard ratio (HR), and revision diagnosis data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry from September 1, 1999, to December 31, 2014, for 2 cohorts of patients, those treated by high-volume surgeons who preferred minimally stabilized replacements and those treated by high-volume surgeons who preferred posterior-stabilized replacements. All patients had a diagnosis of osteoarthritis and underwent fixed-bearing total knee replacement with patellar resurfacing. At 13 years, the cumulative percent revision was 5.0% (95% confidence interval [CI], 4.0% to 6.2%) for the surgeons who preferred the minimally stabilized replacements compared with 6.0% (95% CI, 4.2% to 8.5%) for the surgeons who preferred the posterior-stabilized replacements. The revision risk for the surgeons who preferred posterior-stabilized replacements was significantly higher for all causes (HR = 1.45 [95% CI, 1.30 to 1.63]; p total knee replacement compared with the patients of

  19. Can Geothermal Power Replace Fossil Fuels?

    Science.gov (United States)

    Klenner, R.; Gosnold, W. D.

    2009-12-01

    Development of geothermal energy in any capacity is a positive step toward a sustainable energy future. The resource is enormous and has the capacity to supply most future demand for electrical power if technology can meet some substantial challenges. Electrical power from geothermal energy has several compelling characteristics: a small footprint, low emissions, continuous availability, and sustainability. However, a common perception of geothermal energy is that it is available only in a few isolated localities and thus cannot contribute significantly to future electrical power needs. This perception neglects the stored thermal energy available everywhere in the upper 10 km of Earth’s crust. We are investigating the potential for power production in oil-producing sedimentary basins where subsurface temperatures are sufficient for intermediate geothermal resources (90 °C -150 °C) at depths greater than 3 km. Existing estimates of geothermal energy stored at depth in sedimentary formations in the U.S. have been based only on a few aquifers and have not included the greater volume of fluids in oil-bearing formations. We reevaluated the accessible geothermal resource base for the north central US and found that including geothermal fluids in oil-producing formations increased the resource estimate by a factor of eight. Preliminary analysis of other basins indicates that the current estimate of thermal energy in the U.S. (100,000 EJ) may be of the order of 400,000 EJ. This is particularly significant due to recent technological advances leading to commercialization of scalable organic Rankine cycle (ORC) engines. Until recently, ORC systems were available only on an at large scale, i.e., 10s of MW, and had efficiencies of about 10 percent. Currently there are at least five manufacturers making scalable ORC systems in the 50 kW to 1 MW range, and at least one system has an efficiency of about 17 percent and is expected to attain an efficiency in the low 20s as it

  20. Safety and performance of a novel embolic deflection device in patients undergoing transcatheter aortic valve replacement: results from the DEFLECT I study.

    Science.gov (United States)

    Baumbach, Andreas; Mullen, Michael; Brickman, Adam M; Aggarwal, Suneil K; Pietras, Cody G; Forrest, John K; Hildick-Smith, David; Meller, Stephanie M; Gambone, Louise; den Heijer, Peter; Margolis, Pauliina; Voros, Szilard; Lansky, Alexandra J

    2015-05-01

    This study aimed to evaluate the safety and performance of the TriGuard™ Embolic Deflection Device (EDD), a nitinol mesh filter positioned in the aortic arch across all three major cerebral artery take-offs to deflect emboli away from the cerebral circulation, in patients undergoing transcatheter aortic valve replacement (TAVR). The prospective, multicentre DEFLECT I study (NCT01448421) enrolled 37 consecutive subjects undergoing TAVR with the TriGuard EDD. Subjects underwent clinical and cognitive follow-up to 30 days; cerebral diffusion-weighted magnetic resonance imaging (DW-MRI) was performed pre-procedure and at 4±2 days post procedure. The device performed as intended with successful cerebral coverage in 80% (28/35) of cases. The primary safety endpoint (in-hospital EDD device- or EDD procedure-related cardiovascular mortality, major stroke disability, life-threatening bleeding, distal embolisation, major vascular complications, or need for acute cardiac surgery) occurred in 8.1% of subjects (VARC-defined two life-threatening bleeds and one vascular complication). The presence of new cerebral ischaemic lesions on post-procedure DW-MRI (n=28) was similar to historical controls (82% vs. 76%, p=NS). However, an exploratory analysis found that per-patient total lesion volume was 34% lower than reported historical data (0.2 vs. 0.3 cm3), and 89% lower in patients with complete (n=17) versus incomplete (n=10) cerebral vessel coverage (0.05 vs. 0.45 cm3, p=0.016). Use of the first-generation TriGuard EDD during TAVR is safe, and device performance was successful in 80% of cases during the highest embolic-risk portions of the TAVR procedure. The potential of the TriGuard EDD to reduce total cerebral ischaemic burden merits further randomised investigation.

  1. Three Steam Generator Replacement Projects in 1995

    International Nuclear Information System (INIS)

    Holz, R.; Clavier, G.

    1996-01-01

    Since the companies Siemens AG and Framatome S. A. joined their experience and efforts in the field of steam generator replacements and formed a consortium in 1991, the following projects were performed in 1995: Ringhals 3, Tihange 3 and Asco 1. Further projects will follow in 1996, i. e., Doel 4 and Asco 2. Currently, this European consortium is bidding for the contract to replace the steam generators at the Krsko NPP and hopes to be awarded in 1996. An overview of the way the Consortium Siemens and Framatome approaches SG replacement projects is given based on the projects performed in 1995. Various aspects of project planning, management, licensing, personnel qualification and techniques used on site will be discussed. (author)

  2. REPLACEMENT IN RABBIT HERDS: A REVIEW

    Directory of Open Access Journals (Sweden)

    Ibrahim F.M. Marai

    2010-08-01

    Full Text Available Doe rabbit's replacement constitutes the annual renewal rate of new breeders that must be incorporated into the production stock. Criterion for culling non-productive animals differs significantly among fryer production colonies, foundation stocks and a colony with continuous enzootic disease or continuous malnourishment. In commercial rabbit production, good management improves the health and productivity of the entire herd, by reducing the all-time high replacement rates and improving economic viability. In the present article, a comprehensive review of numerous experiences in the rabbit production field of different countries, was presented. Basic recommendations for professional breeders were highlighted, covering critical issues such as the need for continuously upgrading the health status of the colony, the positive effect of   genetic selection and the nutritional conditioning and special treatment of young does being groomed as future replacements.

  3. Optimal timing for intravascular administration set replacement.

    Science.gov (United States)

    Ullman, Amanda J; Cooke, Marie L; Gillies, Donna; Marsh, Nicole M; Daud, Azlina; McGrail, Matthew R; O'Riordan, Elizabeth; Rickard, Claire M

    2013-09-15

    The tubing (administration set) attached to both venous and arterial catheters may contribute to bacteraemia and other infections. The rate of infection may be increased or decreased by routine replacement of administration sets. This review was originally published in 2005 and was updated in 2012. The objective of this review was to identify any relationship between the frequency with which administration sets are replaced and rates of microbial colonization, infection and death. We searched The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 6), MEDLINE (1950 to June 2012), CINAHL (1982 to June 2012), EMBASE (1980 to June 2012), reference lists of identified trials and bibliographies of published reviews. The original search was performed in February 2004. We also contacted researchers in the field. We applied no language restriction. We included all randomized or controlled clinical trials on the frequency of venous or arterial catheter administration set replacement in hospitalized participants. Two review authors assessed all potentially relevant studies. We resolved disagreements between the two review authors by discussion with a third review author. We collected data for seven outcomes: catheter-related infection; infusate-related infection; infusate microbial colonization; catheter microbial colonization; all-cause bloodstream infection; mortality; and cost. We pooled results from studies that compared different frequencies of administration set replacement, for instance, we pooled studies that compared replacement ≥ every 96 hours versus every 72 hours with studies that compared replacement ≥ every 48 hours versus every 24 hours. We identified 26 studies for this updated review, 10 of which we excluded; six did not fulfil the inclusion criteria and four did not report usable data. We extracted data from the remaining 18 references (16 studies) with 5001 participants: study designs included neonate and adult

  4. Replacement of the JRR-3 computer system

    Energy Technology Data Exchange (ETDEWEB)

    Kato, Tomoaki; Kobayashi, Kenichi; Suwa, Masayuki; Mineshima, Hiromi; Sato, Mitsugu [Japan Atomic Energy Research Inst., Tokai, Ibaraki (Japan). Tokai Research Establishment

    2000-10-01

    The JRR-3 computer system contributes to stable operation of JRR-3 since 1990. But now about 10 years have passed since it was designed and some problems have occurred. Under these situations, we should replace the old computer system for safe and stable operation. In this replacement, the system is improved as regards man-machine interface and efficiency about maintenance. The new system consists of three functions, which are 'the function of management for operation information' (renewal function), 'the function of management for facility information' (new function) and the function of management for information publication' (new function). By this replacement, New JRR-3 computer system can contribute to safe and stable operation. (author)

  5. Testosterone Replacement, Muscle Strength, and Physical Function

    Directory of Open Access Journals (Sweden)

    You-Seon Nam

    2018-05-01

    Full Text Available Muscle strength and physical function decrease in older men, as do testosterone levels. Nonetheless, the effects of testosterone replacement therapy on muscle strength and physical function remain inconclusive and equivocal. We conducted a rapid systematic review, the results of which showed that testosterone replacement does not affect muscle strength (measured by hand grip strength and leg muscle strength, although it may increase physical function (measured by the 6-minute walk test, Physical Activity Scale for the Elderly score, and other physical performance tests. However, most of the studies were conducted in the United States or Europe and did not include participants from Asian or other ethnic backgrounds; therefore, further studies are needed to evaluate the effects of testosterone replacement in a broader population.

  6. Dead pixel replacement in LWIR microgrid polarimeters.

    Science.gov (United States)

    Ratliff, Bradley M; Tyo, J Scott; Boger, James K; Black, Wiley T; Bowers, David L; Fetrow, Matthew P

    2007-06-11

    LWIR imaging arrays are often affected by nonresponsive pixels, or "dead pixels." These dead pixels can severely degrade the quality of imagery and often have to be replaced before subsequent image processing and display of the imagery data. For LWIR arrays that are integrated with arrays of micropolarizers, the problem of dead pixels is amplified. Conventional dead pixel replacement (DPR) strategies cannot be employed since neighboring pixels are of different polarizations. In this paper we present two DPR schemes. The first is a modified nearest-neighbor replacement method. The second is a method based on redundancy in the polarization measurements.We find that the redundancy-based DPR scheme provides an order-of-magnitude better performance for typical LWIR polarimetric data.

  7. Replacement of the JRR-3 computer system

    International Nuclear Information System (INIS)

    Kato, Tomoaki; Kobayashi, Kenichi; Suwa, Masayuki; Mineshima, Hiromi; Sato, Mitsugu

    2000-01-01

    The JRR-3 computer system contributes to stable operation of JRR-3 since 1990. But now about 10 years have passed since it was designed and some problems have occurred. Under these situations, we should replace the old computer system for safe and stable operation. In this replacement, the system is improved as regards man-machine interface and efficiency about maintenance. The new system consists of three functions, which are 'the function of management for operation information' (renewal function), 'the function of management for facility information' (new function) and the function of management for information publication' (new function). By this replacement, New JRR-3 computer system can contribute to safe and stable operation. (author)

  8. Postmenopausal hormone replacement therapy--clinical implications

    DEFF Research Database (Denmark)

    Ravn, S H; Rosenberg, J; Bostofte, E

    1994-01-01

    The menopause is defined as cessation of menstruation, ending the fertile period. The hormonal changes are a decrease in progesterone level, followed by a marked decrease in estrogen production. Symptoms associated with these hormonal changes may advocate for hormonal replacement therapy....... This review is based on the English-language literature on the effect of estrogen therapy and estrogen plus progestin therapy on postmenopausal women. The advantages of hormone replacement therapy are regulation of dysfunctional uterine bleeding, relief of hot flushes, and prevention of atrophic changes...... in the urogenital tract. Women at risk of osteoporosis will benefit from hormone replacement therapy. The treatment should start as soon after menopause as possible and it is possible that it should be maintained for life. The treatment may be supplemented with extra calcium intake, vitamin D, and maybe calcitonin...

  9. Severe Heterotopic Ossification following Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Alexander L. Dodds

    2014-01-01

    Full Text Available Although the incidence of minor heterotopic ossification is probably higher than what is usually expected, severe heterotopic ossification (HO is an extremely rare event following total knee replacement surgery. We present the case of a 66-year-old woman who initially had achieved an excellent range of motion following bilateral uncemented rotating platform total knee replacement, before presenting with pain and loss of range of motion at 2 months after surgery. Severe HO was diagnosed on X-rays. Treatment consisted of nonoperative measures only, including physiotherapy with hydrotherapy and anti-inflammatories. She eventually regained her range of motion when seen at 8 months after operation. This case illustrates that nonoperative treatment without the use of radiotherapy or surgery can be used to safely resolve stiffness caused by HO after total knee replacement.

  10. Ranking hospitals for outcomes in total hip replacement - administrative data with or without patient surveys? - Part 2: Patient survey and administrative data

    Directory of Open Access Journals (Sweden)

    Schäfer, Thomas

    2007-03-01

    Full Text Available Background: Many hospital rankings rely on the frequency of adverse outcomes and are based on administrative data. In the study presented here, we tried to find out, to what extent available administrative data of German Sickness Funds allow for an adequate hospital ranking and compared this with rankings based on additional information derived from a patient survey. Total hip replacement was chosen as an example procedure. In part II of the publication, we present the results of the approach based on administrative and patient-derived data. Methods: We used administrative data from a large health insurance (AOK-Lower Saxony of the year 2002 and from a patient survey. The study population comprised mainly beneficiaries, who received primary total hip replacement in the year 2002, were mailed a survey 6 month post-operatively and participated in the survey. Performance indicators used where “Revision”, “Complications” and “Change of functional impairment”. Hospitals were ranked if they performed at least 20 procedures on AOK-beneficiaries. Multivariate modelling (logistic regression and generalized linear models was used to estimate the performance indicators by case-mix variables (a.o. age, sex, co-morbidity, medical history and hospital characteristics (hospital size, surgical volume. The actual ranking was based on these multivariate models, excluding hospital variables and adding dummy-variables for each hospital. Hospitals were ranked by their case-mix adjusted odds ratio or Standardized Difference (SDR with respect to a pre-selected reference hospital. The resulting rankings were compared with each other and with regard to the impact of case-mix variables. Results: 4089 beneficiaries received primary total hip replacement in 2002. 3293 patients participated in the survey (80.5%. The ranking included 60 hospitals. The agreement of rankings based on different performance indicators in the same year was low to high (a correlation

  11. Renal replacement therapy in healthy adult horses.

    Science.gov (United States)

    Wong, D M; Witty, D; Alcott, C J; Sponseller, B A; Wang, C; Hepworth, K

    2013-01-01

    Renal replacement therapy (RRT) has been implemented extensively in people to facilitate recovery from acute renal failure (ARF). RRT has not been explored in horses, but might provide a further treatment option in horses with ARF. To investigate efficacy and safety of RRT in horses. Five healthy adult horses. A prospective study was performed on horses restrained in stocks and intravenously connected to a commercial RRT machine to allow continuous venovenous hemodiafiltration to be performed for 6 hours. The RRT machine was set at the following flow rates: blood flow rate 250 mL/min; dialysate rate 3,000 mL/h; prefilter replacement pump 3,000 mL/h; and postfilter replacement pump rate 2,000 mL/h. Balanced electrolyte solution was used as dialysate and replacement fluid. Heart rate, respiratory rate, body temperature, direct arterial blood pressure, urine output, and various clinicopathologic parameters were measured over the study period. Renal replacement therapy was successfully performed in horses, resulting in a mean creatinine clearance of 0.127 mL/kg/min (68.9 mL/min) and urea reduction ratio of 24%. No adverse effects were detected although a significant decrease in rectal temperature was observed (P ≤ .007). A significant increase in serum phosphorus (P ≤ .001) and decrease in BUN (P replacement therapy can safely and effectively be used in adult horses. Copyright © 2013 by the American College of Veterinary Internal Medicine.

  12. Computerized procedures system

    Science.gov (United States)

    Lipner, Melvin H.; Mundy, Roger A.; Franusich, Michael D.

    2010-10-12

    An online data driven computerized procedures system that guides an operator through a complex process facility's operating procedures. The system monitors plant data, processes the data and then, based upon this processing, presents the status of the current procedure step and/or substep to the operator. The system supports multiple users and a single procedure definition supports several interface formats that can be tailored to the individual user. Layered security controls access privileges and revisions are version controlled. The procedures run on a server that is platform independent of the user workstations that the server interfaces with and the user interface supports diverse procedural views.

  13. MILSTAMP: Military Standard Transportation and Movement Procedures. Volume 1

    Science.gov (United States)

    1987-03-15

    GUATEMALA AREA: DE3 QUEPOS DB1 SAN JOSE DE4 GOLFITO DB2 PUERTO QUETZAL HONDURAS AREA: EL SALVADOR AREA: DFI SAN LORENZO DC1 LA UNION DF2 FUERZA DC2 LA...DB2 PUERTO QUETZAL DE1 PUNTARENAS DB3 SANTO THOMAS, GUATEMALA DE2 CALDERA DE3 QUEPOS DE4 GOLFITO F21-10 CH 6 DoD 4500.32-R Vol. I HONDURAS AREA: DF2...012 PUERTO QUETZAL DE1 PUNTARENAS DB3 SANTO THOMAS, GUATEMALA DE2 CALDERA DE3 QUEPOS DE4 GOLFITO F21 -10 CH 6 DoD 4500.32-R Vol. I HONDURAS AREA

  14. Financial Management Regulation. Volume 15. Security Assistance Policy and Procedures

    Science.gov (United States)

    1993-03-01

    as follows: (3). (5). (6). (7). (I). Qty, (4). SC/MOS/ Ofr Del Itm (2). Unit of Costs TA or Rel Trm Nbr Item Descriction issue (a) Unit (b) Total...the period rubber stamp or computer printing to: ended followed by an alphabetic management code assigned by SAAC. The management code 1. Notify the...EDIT DTC (1) 22 --- Validated it TBC is invalid. See TBC va’idation TYPE-ASST(1) 23 --- NO EDIT DOC- NBR -LST-8(8) 󈧜-27 --- NO EDIT DT-RQSN(4) DOC-SERIAL

  15. Precision Measurement and Calibration. Volume 1. Statistical Concepts and Procedures

    Science.gov (United States)

    1969-02-01

    1950. When Both Variables are Subject to 11. R. D. Stiehler, G. G. Richey, and J. Man- Error," Biometrics , Vol. 5, No. 3, pp. del, "Measurement of...34Analysis of extreme values," Ann. Math. Stat., 21 (1950), 488-506. 3. W. J. DixoN, "Processing data for outliers," Biometrics , 9 (1953), 74-89. 4...standards written by John Perry-" and Figure 1-- hematic Riepesentatitl of Hierarhies ml lftarRalph W. Smith ( ’. Staldards Laberatorles Using

  16. Military Standard Transportation and Movement Procedures. Volume 1. Change 5

    Science.gov (United States)

    1994-08-12

    ANATA AMT JUNEAU JNU ANNAROO ANY KETCHIKAN INTL AIRPORT KTN ANDAMOOKA ADO KING SALMON AKN ANGUS DOWNS ANZ KODIAK ADQ ARARAT ARY KOTZEBUE OTZ ARGYLE DOWNS...ARX ASBURY PARK, NJ AUA ARUBA, ARUBA ARY ARARAT , AUSTRALIA AUB ITAUBA, BRAZIL ARZ N’ZETO, ANGOLA AUC ARAUCA, COLOMBIA F4-22 C5 DoD 4500.32-R Vol. I...CAYMAN, WEST INDIES MCI KANSAS CITY, MISSOURI-INTL. USA LYC LYCKSELE, SWEDEN MCK MCCOOK, NEBRASKA, USA LYE LYNEHAM, UNITED KINGDOM M04 MONTE CARLO

  17. Analytical Chemistry Laboratory (ACL) procedure compendium. Volume 1, Administrative

    Energy Technology Data Exchange (ETDEWEB)

    1992-06-01

    Covered are: analytical laboratory operations (ALO) sample receipt and control, ALO data report/package preparation review and control, single shell tank (PST) project sample tracking system, sample receiving, analytical balances, duties and responsibilities of sample custodian, sample refrigerator temperature monitoring, security, assignment of staff responsibilities, sample storage, data reporting, and general requirements for glassware.

  18. Analytical Chemistry Laboratory (ACL) procedure compendium. Volume 4, Organic methods

    Energy Technology Data Exchange (ETDEWEB)

    1993-08-01

    This interim notice covers the following: extractable organic halides in solids, total organic halides, analysis by gas chromatography/Fourier transform-infrared spectroscopy, hexadecane extracts for volatile organic compounds, GC/MS analysis of VOCs, GC/MS analysis of methanol extracts of cryogenic vapor samples, screening of semivolatile organic extracts, GPC cleanup for semivolatiles, sample preparation for GC/MS for semi-VOCs, analysis for pesticides/PCBs by GC with electron capture detection, sample preparation for pesticides/PCBs in water and soil sediment, report preparation, Florisil column cleanup for pesticide/PCBs, silica gel and acid-base partition cleanup of samples for semi-VOCs, concentrate acid wash cleanup, carbon determination in solids using Coulometrics` CO{sub 2} coulometer, determination of total carbon/total organic carbon/total inorganic carbon in radioactive liquids/soils/sludges by hot persulfate method, analysis of solids for carbonates using Coulometrics` Model 5011 coulometer, and soxhlet extraction.

  19. Radiological evaluation of failed total hip replacement

    International Nuclear Information System (INIS)

    Raspa, V.; Aldrovandi, S.; Pompei, G.

    1988-01-01

    The retrospective study of 50 operated cases of cemented total hip replacement and a review of the literature enabled the authors to define the radiological features of the above-mentioned condition. These features include one or more of the following signs: calcar reabsorption, lacunar erosions, modified relatioships between the prosthesis components, sepsis and loosening, periarticular calcifications dislocation and fracture of prosthesis components. Careful evaluation of these radiological features is extremely important for both an early diagnosis of failed total hip replacement and the choice of an adequate surgical treatment

  20. Fuzzy logic application for extruders replacement problem

    Directory of Open Access Journals (Sweden)

    Edison Conde Perez dos Santos

    2017-03-01

    Full Text Available In a scenario of uncertainty and imprecision, before taking the replacement analysis, a manager needs to consider the uncertain reality of a problem. In this scenario, the fuzzy logic makes an excellent option. Therefore, it is necessary to make a decision based on the fuzzy model. This study is based on the comparison of two methodologies used in the problem of asset replacement. The study, thus, was based on a comparison between two extruders for polypropylene yarn bibliopegy, comparing mainly the costs involved in maintaining the equipment.