Art concept of Magellan spacecraft and inertial upper stage (IUS) deployment

NASA Technical Reports Server (NTRS)

1988-01-01

Magellan spacecraft mounted on inertial upper stage drifts above Atlantis, Orbiter Vehicle (OV) 104, after its deployment during mission STS-30 in this artist concept. Solar panels are deployed and in OV-104's open payload bay (PLB) the airborne support equipment (ASE) is visible. Both spacecraft are orbiting the Earth. Magellan, named after the 16th century Portuguese explorer, will orbit Venus about once every three hours, acquiring radar data for 37 minutes of each orbit when it is closest to the surface. Using an advanced instrument called a synthetic aperture radar (SAR), it will map more than 90 per cent of the surface with resolution ten times better than the best from prior spacecraft. Magellan is managed by the Jet Propulsion Laboratory (JPL); Martin Marietta Aerospace is developing the spacecraft and Hughes Aircraft Company, the advanced imaging radar.

NASA Ares I Crew Launch Vehicle Upper Stage Avionics and Software Overview

NASA Technical Reports Server (NTRS)

Nola, Charles L.; Blue, Lisa

2008-01-01

Building on the heritage of the Saturn and Space Shuttle Programs for the Design, Development, Test, and Evaluation (DDT and E) of avionics and software for NASA's Ares I Crew Launch Vehicle (CLV), the Ares I Upper Stage Element is a vital part of the Constellation Program's transportation system. The Upper Stage Element's Avionics Subsystem is actively proceeding toward its objective of delivering a flight-certified Upper Stage Avionics System for the Ares I CLV.

Ares I Upper Stage Update

NASA Technical Reports Server (NTRS)

Davis, Daniel J.

2010-01-01

These presentation slides review the progress in the development of the Ares I upper stage. The development includes development of a manufacturing and processing assembly that will reduce the time required over 100 days, development of a weld tool that is a robotic tool that is the largest welder of its kind in the United States, development of avionics and software, and development of logisitics and operations systems.

Study of a High-Energy Upper Stage for Future Shuttle Missions

NASA Technical Reports Server (NTRS)

Dressler, Gordon A.; Matuszak, Leo W.; Stephenson, David D.

2003-01-01

Space Shuttle Orbiters are likely to remain in service to 2020 or beyond for servicing the International Space Station and for launching very high value spacecraft. There is a need for a new STS-deployable upper stage that can boost certain Orbiter payloads to higher energy orbits, up to and including Earth-escape trajectories. The inventory of solid rocket motor Inertial Upper Stages has been depleted, and it is unlikely that a LOX/LH2-fueled upper stage can fly on Shuttle due to safety concerns. This paper summarizes the results of a study that investigated a low cost, low risk approach to quickly developing a new large upper stage optimized to fly on the existing Shuttle fleet. Two design reference missions (DRMs) were specified: the James Webb Space Telescope (JWST) and the Space Interferometry Mission (SIM). Two categories of upper stage propellants were examined in detail: a storable liquid propellant and a storable gel propellant. Stage subsystems 'other than propulsion were based largely on heritage hardware to minimize cost, risk and development schedule span. The paper presents the ground rules and guidelines for conducting the study, the preliminary conceptual designs margins, assessments of technology readiness/risk, potential synergy with other programs, and preliminary estimates of development and production costs and schedule spans. Although the Orbiter Columbia was baselined for the study, discussion is provided to show how the results apply to the remaining STS Orbiter fleet.

Electric Propulsion Upper-Stage for Launch Vehicle Capability Enhancement

NASA Technical Reports Server (NTRS)

Kemp, Gregory E.; Dankanich, John W.; Woodcock, Gordon R.; Wingo, Dennis R.

2007-01-01

The NASA In-Space Propulsion Technology Project Office initiated a preliminary study to evaluate the performance benefits of a solar electric propulsion (SEP) upper-stage with existing and near-term small launch vehicles. The analysis included circular and elliptical Low Earth Orbit (LEO) to Geosynchronous Earth Orbit (GEO) transfers, and LEO to Low Lunar Orbit (LLO) applications. SEP subsystem options included state-of-the-art and near-term solar arrays and electric thrusters. In-depth evaluations of the Aerojet BPT-4000 Hall thruster and NEXT gridded ion engine were conducted to compare performance, cost and revenue potential. Preliminary results indicate that Hall thruster technology is favored for low-cost, low power SEP stages, while gridded-ion engines are favored for higher power SEP systems unfettered by transfer time constraints. A low-cost point design is presented that details one possible stage configuration and outlines system limitations, in particular fairing volume constraints. The results demonstrate mission enhancements to large and medium class launch vehicles, and mission enabling performance when SEP system upper stages are mounted to low-cost launchers such as the Minotaur and Falcon 1. Study results indicate the potential use of SEP upper stages to double GEO payload mass capability and to possibly enable launch on demand capability for GEO assets. Transition from government to commercial applications, with associated cost/benefit analysis, has also been assessed. The sensitivity of system performance to specific impulse, array power, thruster size, and component costs are also discussed.

Upper Stage Engine Composite Nozzle Extensions

NASA Technical Reports Server (NTRS)

Valentine, Peter G.; Allen, Lee R.; Gradl, Paul R.; Greene, Sandra E.; Sullivan, Brian J.; Weller, Leslie J.; Koenig, John R.; Cuneo, Jacques C.; Thompson, James; Brown, Aaron;

Modeling and Test Data Analysis of a Tank Rapid Chill and Fill System for the Advanced Shuttle Upper Stage (ASUS) Concept

NASA Technical Reports Server (NTRS)

Flachbart, Robin; Hedayat, Ali; Holt, Kimberly A.; Cruit, Wendy (Technical Monitor)

2001-01-01

The Advanced Shuttle Upper Stage (ASUS) concept addresses safety concerns associated .with cryogenic stages by launching empty, and filling on ascent. The ASUS employs a rapid chill and fill concept. A spray bar is used to completely chill the tank before fill, allowing the vent valve to be closed during the fill process. The first tests of this concept, using a flight size (not flight weight) tank. were conducted at Marshall Space Flight Center (MSFC) during the summer of 2000. The objectives of the testing were to: 1) demonstrate that a flight size tank could be filled in roughly 5 minutes to accommodate the shuttle ascent window, and 2) demonstrate a no-vent fill of the tank. A total of 12 tests were conducted. Models of the test facility fill and vent systems, as well as the tank, were constructed. The objective of achieving tank fill in 5 minutes was met during the test series. However, liquid began to accumulate in the tank before it was chilled. Since the tank was not chilled until the end of each test, vent valve closure during fill was not possible. Even though the chill and fill process did not occur as expected, reasonable model correlation with the test data was achieved.

NASA Ares 1 Crew Launch Vehicle Upper Stage Configuration Selection Process

NASA Technical Reports Server (NTRS)

Cook, Jerry R.

2006-01-01

The Upper Stage Element of NASA s Ares I Crew Launch Vehicle (CLV) is a "clean-sheet" approach that is being designed and developed in-house, with Element management at MSFC. The USE concept is a self-supporting cylindrical structure, approximately 115 long and 216" in diameter. While the Reusable Solid Rocket Booster (RSRB) design has changed since the CLV inception, the Upper Stage Element design has remained essentially a clean-sheet approach. Although a clean-sheet upper stage design inherently carries more risk than a modified design, it does offer many advantages: a design for increased reliability; built-in extensibility to allow for commonality/growth without major redesign; and incorporation of state-of-the-art materials, hardware, and design, fabrication, and test techniques and processes to facilitate a potentially better, more reliable system.

Inertial Upper Stage (IUS) software analysis

NASA Technical Reports Server (NTRS)

Grayson, W. L.; Nickel, C. E.; Rose, P. L.; Singh, R. P.

1979-01-01

The Inertial Upper Stage (IUS) System, an extension of the Space Transportation System (STS) operating regime to include higher orbits, orbital plane changes, geosynchronous orbits, and interplanetary trajectories is presented. The IUS software design, the IUS software interfaces with other systems, and the cost effectiveness in software verification are described. Tasks of the IUS discussed include: (1) design analysis; (2) validation requirements analysis; (3) interface analysis; and (4) requirements analysis.

Crew Launch Vehicle (CLV) Upper Stage Configuration Selection Process

NASA Technical Reports Server (NTRS)

Davis, Daniel J.; Coook, Jerry R.

2006-01-01

The Crew Launch Vehicle (CLV), a key component of NASA's blueprint for the next generation of spacecraft to take humans back to the moon, is being designed and built by engineers at NASA s Marshall Space Flight Center (MSFC). The vehicle s design is based on the results of NASA's 2005 Exploration Systems Architecture Study (ESAS), which called for development of a crew-launch system to reduce the gap between Shuttle retirement and Crew Exploration Vehicle (CEV) Initial Operating Capability, identification of key technologies required to enable and significantly enhance these reference exploration systems, and a reprioritization of near- and far-term technology investments. The Upper Stage Element (USE) of the CLV is a clean-sheet approach that is being designed and developed in-house, with element management at MSFC. The USE concept is a self-supporting cylindrical structure, approximately 115' long and 216" in diameter, consisting of the following subsystems: Primary Structures (LOX Tank, LH2 Tank, Intertank, Thrust Structure, Spacecraft Payload Adaptor, Interstage, Forward and Aft Skirts), Secondary Structures (Systems Tunnel), Avionics and Software, Main Propulsion System, Reaction Control System, Thrust Vector Control, Auxiliary Power Unit, and Hydraulic Systems. The ESAS originally recommended a CEV to be launched atop a four-segment Space Shuttle Main Engine (SSME) CLV, utilizing an RS-25 engine-powered upper stage. However, Agency decisions to utilize fewer CLV development steps to lunar missions, reduce the overall risk for the lunar program, and provide a more balanced engine production rate requirement prompted engineers to switch to a five-segment design with a single Saturn-derived J-2X engine. This approach provides for single upper stage engine development for the CLV and an Earth Departure Stage, single Reusable Solid Rocket Booster (RSRB) development for the CLV and a Cargo Launch Vehicle, and single core SSME development. While the RSRB design has

Reusable Agena study. Volume 1: Executive summary. [space shuttle Agena upper stage tug concept

NASA Technical Reports Server (NTRS)

1974-01-01

The shuttle Agena upper stage interim tug concept is based on a building block approach. These building block concepts are extensions of existing ascent Agena configurations. Several current improvements, have been used in developing the shuttle/Agena upper stage concepts. High-density acid is used as the Agena upper stage oxidizer. The baffled injector is used in the main engine. The DF-224 is a fourth generation computer currently in development and will be flight proven in the near future. The Agena upper stage building block concept uses the current Agena as a baseline, adds an 8.5-inch (21.6 cm) extension to the fuel tank for optimum mixture ratio, uses monomethyl hydrazine as fuel, exchanges a 150:1 nozzle extension for the existing 45:1, exchanges an Autonetics DF-224 for the existing Honeywell computer, and adds a star sensor for guidance update. These modifications to the current Agena provide a 5-foot (1.52m) diameter shuttle/Agena upper stage that will fly all Vandenberg Air Force Base missions in the reusable mode without resorting to a kick motor. The delta V velocity of the Agena is increased by use of a strap-on propellant tank option. This option provides a shuttle/Agena upper stage with the capability to place almost 3900 pounds (1769 kg) into geosynchronous orbit (24 hour period) without the aid of kick motors.

SLS Block 1-B and Exploration Upper Stage Navigation System Design

NASA Technical Reports Server (NTRS)

Oliver, T. Emerson; Park, Thomas B.; Smith, Austin; Anzalone, Evan; Bernard, Bill; Strickland, Dennis; Geohagan, Kevin; Green, Melissa; Leggett, Jarred

2018-01-01

The SLS Block 1B vehicle is planned to extend NASA's heavy lift capability beyond the initial SLS Block 1 vehicle. The most noticeable change for this vehicle from SLS Block 1 is the swapping of the upper stage from the Interim Cryogenic Propulsion stage (ICPS), a modified Delta IV upper stage, to the more capable Exploration Upper Stage (EUS). As the vehicle evolves to provide greater lift capability and execute more demanding missions so must the SLS Integrated Navigation System to support those missions. The SLS Block 1 vehicle carries two independent navigation systems. The responsibility of the two systems is delineated between ascent and upper stage flight. The Block 1 navigation system is responsible for the phase of flight between the launch pad and insertion into Low-Earth Orbit (LEO). The upper stage system assumes the mission from LEO to payload separation. For the Block 1B vehicle, the two functions are combined into a single system intended to navigate from ground to payload insertion. Both are responsible for self-disposal once payload delivery is achieved. The evolution of the navigation hardware and algorithms from an inertial-only navigation system for Block 1 ascent flight to a tightly coupled GPS-aided inertial navigation system for Block 1-B is described. The Block 1 GN&C system has been designed to meet a LEO insertion target with a specified accuracy. The Block 1-B vehicle navigation system is designed to support the Block 1 LEO target accuracy as well as trans-lunar or trans-planetary injection accuracy. This is measured in terms of payload impact and stage disposal requirements. Additionally, the Block 1-B vehicle is designed to support human exploration and thus is designed to minimize the probability of Loss of Crew (LOC) through high-quality inertial instruments and Fault Detection, Isolation, and Recovery (FDIR) logic. The preliminary Block 1B integrated navigation system design is presented along with the challenges associated with

Advances in upper extremity prosthetics.

PubMed

Zlotolow, Dan A; Kozin, Scott H

2012-11-01

Until recently, upper extremity prostheses had changed little since World War II. In 2006, the Defense Advanced Research Projects Agency responded to an increasing number of military amputees with the Revolutionizing Prosthetics program. The program has yielded several breakthroughs both in the engineering of new prosthetic arms and in the control of those arms. Direct brain-wave control of a limb with 22° of freedom may be within reach. In the meantime, advances such as individually powered digits have opened the door to multifunctional full and partial hand prostheses. Restoring sensation to the prosthetic limb remains a major challenge to full integration of the limb into a patient's self-image. Copyright © 2012 Elsevier Inc. All rights reserved.

Genomic Biomarkers for the Prediction of Stage and Prognosis of Upper Tract Urothelial Carcinoma.

PubMed

Bagrodia, Aditya; Cha, Eugene K; Sfakianos, John P; Zabor, Emily C; Bochner, Bernard H; Al-Ahmadie, Hikmat A; Solit, David B; Coleman, Jonathan A; Iyer, Gopa; Scott, Sasinya N; Shah, Ronak; Ostrovnaya, Irina; Lee, Byron; Desai, Neil B; Ren, Qinghu; Rosenberg, Jonathan E; Dalbagni, Guido; Bajorin, Dean F; Reuter, Victor E; Berger, Michael F

2016-06-01

Genomic characterization of radical nephroureterectomy specimens in patients with upper tract urothelial carcinoma may allow for thoughtful integration of systemic and targeted therapies. We sought to determine whether genomic alterations in upper tract urothelial carcinoma are associated with adverse pathological and clinical outcomes. Next generation exon capture sequencing of 300 cancer associated genes was performed in 83 patients with upper tract urothelial carcinoma. Genomic alterations were assessed individually and also grouped into core signal transduction pathways or canonical cell functions for association with clinicopathological outcomes. Binary outcomes, including grade (high vs low), T stage (pTa/T1/T2 vs pT3/T4) and organ confined status (pT2 or less and N0/Nx vs greater than pT2 or N+) were assessed with the Kruskal-Wallis and Fisher exact tests as appropriate. Associations between alterations and survival were estimated using the Kaplan-Meier method and Cox regression. Of the 24 most commonly altered genes in 9 pathways TP53/MDM2 alterations and FGFR3 mutations were the only 2 alterations uniformly associated with high grade, advanced stage, nonorgan confined disease, and recurrence-free and cancer specific survival. TP53/MDM2 alterations were associated with adverse clinicopathological outcomes whereas FGFR3 mutations were associated with favorable outcomes. We created a risk score using TP53/MDM2 and FGFR3 status that was able to discriminate between adverse pathological and clinical outcomes, including in the subset of patients with high grade disease. The study is limited by small numbers and lack of validation. Our data indicate that specific genomic alterations in radical nephroureterectomy specimens correlate with tumor grade, stage and cancer specific survival outcomes. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Simulink Model of the Ares I Upper Stage Main Propulsion System

NASA Technical Reports Server (NTRS)

Burchett, Bradley T.

2008-01-01

A numerical model of the Ares I upper stage main propulsion system is formulated based on first principles. Equation's are written as non-linear ordinary differential equations. The GASP fortran code is used to compute thermophysical properties of the working fluids. Complicated algebraic constraints are numerically solved. The model is implemented in Simulink and provides a rudimentary simulation of the time history of important pressures and temperatures during re-pressurization, boost and upper stage firing. The model is validated against an existing reliable code, and typical results are shown.

Maturation of enabling technologies for the next generation reignitable cryogenic upper stage

NASA Astrophysics Data System (ADS)

Mueller, Mark

Following the ESA decision in November 2008, a pre-development phase (Phase 1) of a future evolution of the Ariane 5 launcher (named Ariane 5 Midlife Evolution, A5ME) was started under Astrium Prime leadership. This upgraded version of the Ariane 5 launcher is based on an enhanced performance Upper Stage including the cryogenic re-ignitable VINCI engine. Thanks to this reignition capability, this new Upper Stage shall be "versatile" in the sense that it shall fulfil customer needs on a broader spectrum of orbits than the "standard" orbits (i.e. Geosynchronous Transfer Orbits, GTO) typically used for commercial telecommunications satellites. In order to meet the challenges of versatility, new technologies are currently being investigated. These technologies are mainly related -but not limited-to propellant management during the extended coasting phases with the related heat transfer into the tanks and the required multiple engine re-ignitions. Within the frame of the ESA Future Launchers Preparatory Programme (Period 2 Slice 1), the Cryogenic Upper Stage Technology project (CUST) aims to mature critical technologies to such a Technology Readiness Level (TRL) that they can be integrated into the baseline A5ME Upper Stage development schedule. In addition to A5ME application, these technologies can also be used on the future next generation European launcher. This paper shows the down-selection process implemented to identify the most crucial enabling technologies for a future versatile Upper Stage and gives a description of each technology finally selected for maturation in the frame of CUST. These include -amongst others-a Sandwich Common Bulkhead for the propellant tank, an external thermal insulation kit and various propellant management devices for the coasting phase. The paper also gives an overview on the related development and maturation plan including the tests to be conducted, as well as first results of the maturation activities themselves.

Advanced space engine preliminary design. [liquid hydrogen/liquid oxygen upper stage engine for space tug application

NASA Technical Reports Server (NTRS)

Zachary, A. T.

1973-01-01

Analysis and design of an optimum LO2/LH2, combustion topping cycle, 88,964 Newtons (20,000-pound) thrust, liquid rocket engine was conducted. The design selected is well suited to high-energy, upper-stage engine applications such as the Space Tug and embodies features directed toward optimization of vehicle performance. A configuration selection was conducted based on prior Air Force Contracts, and additional criteria for optimum stage performance. Following configuration selection, analyses and design of the major components and engine systems were conducted to sufficient depth to provide layout drawings suitable for subsequent detailing. In addition, engine packaging to a common interface and a retractable nozzle concept were defined. Alternative development plans and related costs were also established. The design embodies high-performance, low-weight, low NPSH requirements (saturated propellant inlet conditions at start), idle-mode operation, and autogenous pressurization. The design is the result of the significant past and current LO2/LH2 technology efforts of the NASA centers and the Air Force, as well as company-funded programs.

Aerodynamic characteristics of the upper stages of a launch vehicle in low-density regime

NASA Astrophysics Data System (ADS)

Oh, Bum Seok; Lee, Joon Ho

2016-11-01

Aerodynamic characteristics of the orbital block (remaining configuration after separation of nose fairing and 1st and 2nd stages of the launch vehicle) and the upper 2-3stage (configuration after separation of 1st stage) of the 3 stages launch vehicle (KSLV-II, Korea Space Launch Vehicle) at high altitude of low-density regime are analyzed by SMILE code which is based on DSMC (Direct Simulation Monte-Carlo) method. To validating of the SMILE code, coefficients of axial force and normal forces of Apollo capsule are also calculated and the results agree very well with the data predicted by others. For the additional validations and applications of the DSMC code, aerodynamic calculation results of simple shapes of plate and wedge in low-density regime are also introduced. Generally, aerodynamic characteristics in low-density regime differ from those of continuum regime. To understand those kinds of differences, aerodynamic coefficients of the upper stages (including upper 2-3 stage and the orbital block) of the launch vehicle in low-density regime are analyzed as a function of Mach numbers and altitudes. The predicted axial force coefficients of the upper stages of the launch vehicle are very high compared to those in continuum regime. In case of the orbital block which flies at very high altitude (higher than 250km), all aerodynamic coefficients are more dependent on velocity variations than altitude variations. In case of the upper 2-3 stage which flies at high altitude (80km-150km), while the axial force coefficients and the locations of center of pressure are less changed with the variations of Knudsen numbers (altitudes), the normal force coefficients and pitching moment coefficients are more affected by variations of Knudsen numbers (altitude).

Analytical Approach for Estimating Preliminary Mass of ARES I Crew Launch Vehicle Upper Stage Structural Components

NASA Technical Reports Server (NTRS)

Aggarwal, Pravin

2007-01-01

electrical power functions to other Elements of the CLV, is included as secondary structure. The MSFC has an overall responsibility for the integrated US element as well as structural design an thermal control of the fuel tanks, intertank, interstage, avionics, main propulsion system, Reaction Control System (RCS) for both the Upper Stage and the First Stage. MSFC's Spacecraft and Vehicle Department, Structural and Analysis Design Division is developing a set of predicted mass of these elements. This paper details the methodology, criterion and tools used for the preliminary mass predictions of the upper stage structural assembly components. In general, weight of the cylindrical barrel sections are estimated using the commercial code Hypersizer, whereas, weight of the domes are developed using classical solutions. HyperSizer is software that performs automated structural analysis and sizing optimization based on aerospace methods for strength, stability, and stiffness. Analysis methods range from closed form, traditional hand calculations repeated every day in industry to more advanced panel buckling algorithms. Margin-of-safety reporting for every potential failure provides the engineer with a powerful insight into the structural problem. Optimization capabilities include finding minimum weight panel or beam concepts, material selections, cross sectional dimensions, thicknesses, and lay-ups from a library of 40 different stiffened and sandwich designs and a database of composite, metallic, honeycomb, and foam materials. Multiple different concepts (orthogrid, isogrid, and skin stiffener) were run for multiple loading combinations of ascent design load with and with out tank pressure as well as proof pressure condition. Subsequently, selected optimized concept obtained from Hypersizer runs was translated into a computer aid design (CAD) model to account for the wall thickness tolerance, weld land etc for developing the most probable weight of the components. The flow diram

Orbit decay analysis of STS upper stage boosters

NASA Technical Reports Server (NTRS)

Graf, O. F., Jr.; Mueller, A. C.

1979-01-01

An orbit decay analysis of the space transportation system upper stage boosters is presented. An overview of the computer trajectory programs, DSTROB, algorithm is presented. Atmospheric drag and perturbation models are described. The development of launch windows, such that the transfer orbit will decay within two years, is discussed. A study of the lifetimes of geosynchronous transfer orbits is presented.

Modeling and Simulation of the ARES UPPER STAGE Transportation, Lifting, Stacking and Mating Operations Within the Vehicle Assembly Building at KSC

NASA Technical Reports Server (NTRS)

Kromis, Phillip A.

2010-01-01

This viewgraph presentation describes the modeling and simulation of the Ares Upper Stage Transportation, lifting, stacking, and mating operations within the Vehicle Assembly Building (VAB) at Kennedy Space Center (KSC). An aerial view of KSC Launch Shuttle Complex, two views of the Delmia process control layout, and an upper stage move subroutine and breakdown are shown. An overhead image of the VAB and the turning basin along with the Pegasus barge at the turning basin are also shown. This viewgraph presentation also shows the actual design and the removal of the mid-section spring tensioners, the removal of the AFT rear and forward tensioners tie downs, and removing the AFT hold down post and mount. US leaving the Pegasus Barge, the upper stage arriving at transfer aisle, upper stage receiving/inspection in transfer aisle, and an overhead view of upper stage receiving/inspection in transfer aisle are depicted. Five views of the actual connection of the cabling to the upper stage aft lifting hardware are shown. The upper stage transporter forward connector, two views of the rotation horizontal to vertical, the disconnection of the rear bolt ring cabling, the lowering of the upper stage to the inspection stand, disconnection of the rear bolt ring from the upper stage, the lifting of the upper stage and inspection of AFT fange, and the transfer of upper stage in an integrated stack are shown. Six views of the mating of the upper stage to the first stage are depicted. The preparation, inspection, and removal of the forward dome are shown. The upper stage mated on the integrated stack and crawler is also shown. This presentation concludes with A Rapid Upper Limb Assessment (RULA) utilizing male and female models for assessing risk factors to the upper extremities of human beings in an actual physical environment.

The advanced-stage therapy group.

PubMed

Berman, A; Weinberg, H

1998-10-01

Many authors describe a stage of maturity in the development of groups, but each highlights a different dimension. This article describes the characteristics of the advanced stage and the main axes along which it develops (internalization and containment, symbolization, self and self-other development, differentiation and individuation). It also offers a conceptual explanation for these developments and attempts to identify the conditions necessary for the emergence of this stage of maturity. An understanding of this stage and the conditions required for its development can be used by the group leader as a compass to help him or her navigate the group toward this objective.

NASA Ares I Crew Launch Vehicle Upper Stage Overview

NASA Technical Reports Server (NTRS)

Davis, Daniel J.

2008-01-01

By incorporating rigorous engineering practices, innovative manufacturing processes and test techniques, a unique multi-center government/contractor partnership, and a clean-sheet design developed around the primary requirements for the International Space Station (ISS) and Lunar missions, the Upper Stage Element of NASA's Crew Launch Vehicle (CLV), the "Ares I," is a vital part of the Constellation Program's transportation system. Constellation's exploration missions will include Ares I and Ares V launch vehicles required to place crew and cargo in low-Earth orbit (LEO), crew and cargo transportation systems required for human space travel, and transportation systems and scientific equipment required for human exploration of the Moon and Mars. Early Ares I configurations will support ISS re-supply missions. A self-supporting cylindrical structure, the Ares I Upper Stage will be approximately 84' long and 18' in diameter. The Upper Stage Element is being designed for increased supportability and increased reliability to meet human-rating requirements imposed by NASA standards. The design also incorporates state-of-the-art materials, hardware, design, and integrated logistics planning, thus facilitating a supportable, reliable, and operable system. With NASA retiring the Space Shuttle fleet in 2010, the success of the Ares I Project is essential to America's continued leadership in space. The first Ares I test flight, called Ares 1-X, is scheduled for 2009. Subsequent test flights will continue thereafter, with the first crewed flight of the Crew Exploration Vehicle (CEV), "Orion," planned for no later than 2015. Crew transportation to the ISS will follow within the same decade, and the first Lunar excursion is scheduled for the 2020 timeframe.

NASA Ares I Crew Launch Vehicle Upper Stage Overview

NASA Technical Reports Server (NTRS)

McArthur, J. Craig

2008-01-01

By incorporating rigorous engineering practices, innovative manufacturing processes and test techniques, a unique multi-center government/contractor partnership, and a clean-sheet design developed around the primary requirements for the International Space Station (ISS) and Lunar missions, the Upper Stage Element of NASA's Crew Launch Vehicle (CLV), the "Ares I," is a vital part of the Constellation Program's transportation system. Constellation's exploration missions will include Ares I and Ares V launch vehicles required to place crew and cargo in low-Earth orbit (LEO), crew and cargo transportation systems required for human space travel, and transportation systems and scientific equipment required for human exploration of the Moon and Mars. Early Ares I configurations will support ISS re-supply missions. A self-supporting cylindrical structure, the Ares I Upper Stage will be approximately 84' long and 18' in diameter. The Upper Stage Element is being designed for increased supportability and increased reliability to meet human-rating requirements imposed by NASA standards. The design also incorporates state-of-the-art materials, hardware, design, and integrated logistics planning, thus facilitating a supportable, reliable, and operable system. With NASA retiring the Space Shuttle fleet in 2010, the success of the Ares I Project is essential to America's continued leadership in space. The first Ares I test flight, called Ares I-X, is scheduled for 2009. Subsequent test flights will continue thereafter, with the first crewed flight of the Crew Exploration Vehicle (CEV), "Orion," planned for no later than 2015. Crew transportation to the ISS will follow within the same decade, and the first Lunar excursion is scheduled for the 2020 timeframe.

Upper Airway Collapsibility (Pcrit) and Pharyngeal Dilator Muscle Activity are Sleep Stage Dependent

PubMed Central

Carberry, Jayne C.; Jordan, Amy S.; White, David P.; Wellman, Andrew; Eckert, Danny J.

2016-01-01

Study Objectives: An anatomically narrow/highly collapsible upper airway is the main cause of obstructive sleep apnea (OSA). Upper airway muscle activity contributes to airway patency and, like apnea severity, can be sleep stage dependent. Conversely, existing data derived from a small number of participants suggest that upper airway collapsibility, measured by the passive pharyngeal critical closing pressure (Pcrit) technique, is not sleep stage dependent. This study aimed to determine the effect of sleep stage on Pcrit and upper airway muscle activity in a larger cohort than previously tested. Methods: Pcrit and/or muscle data were obtained from 72 adults aged 20–64 y with and without OSA.Pcrit was determined via transient reductions in continuous positive airway pressure (CPAP) during N2, slow wave sleep (SWS) and rapid eye movement (REM) sleep. Genioglossus and tensor palatini muscle activities were measured: (1) awake with and without CPAP, (2) during stable sleep on CPAP, and (3) in response to the CPAP reductions used to quantify Pcrit. Results: Pcrit was 4.9 ± 1.4 cmH2O higher (more collapsible) during REM versus SWS (P = 0.012), 2.3 ± 0.6 cmH2O higher during REM versus N2 (P < 0.001), and 1.6 ± 0.7 cmH2O higher in N2 versus SWS (P = 0.048). Muscle activity decreased from wakefulness to sleep and from SWS to N2 to REM sleep for genioglossus but not for tensor palatini. Pharyngeal muscle activity increased by ∼50% by breath 5 following CPAP reductions. Conclusions: Upper airway collapsibility measured via the Pcrit technique and genioglossus muscle activity vary with sleep stage. These findings should be taken into account when performing and interpreting “passive” Pcrit measurements. Citation: Carberry JC, Jordan AS, White DP, Wellman A, Eckert DJ. Upper airway collapsibility (Pcrit) and pharyngeal dilator muscle activity are sleep stage dependent. SLEEP 2016;39(3):511–521. PMID:26612386

EGFR mutations in early-stage and advanced-stage lung adenocarcinoma: Analysis based on large-scale data from China.

PubMed

Pi, Can; Xu, Chong-Rui; Zhang, Ming-Feng; Peng, Xiao-Xiao; Wei, Xue-Wu; Gao, Xing; Yan, Hong-Hong; Zhou, Qing

2018-05-02

EGFR-tyrosine kinase inhibitors play an important role in the treatment of advanced non-small cell lung cancer (NSCLC). EGFR mutations in advanced NSCLC occur in approximately 35% of Asian patients and 60% of patients with adenocarcinoma. However, the frequency and type of EGFR mutations in early-stage lung adenocarcinoma remain unclear. We retrospectively collected data on patients diagnosed with lung adenocarcinoma tested for EGFR mutation. Early stage was defined as pathological stage IA-IIIA after radical lung cancer surgery, and advanced stage was defined as clinical stage IIIB without the opportunity for curative treatment or stage IV according to the American Joint Committee on Cancer Staging Manual, 7th edition. A total of 1699 patients were enrolled in this study from May 2014 to May 2016; 750 were assigned to the early-stage and 949 to the advanced-stage group. Baseline characteristics of the two groups were balanced, except that there were more smokers in the advanced-stage group (P < 0.001). The total EGFR mutation rate in the early-stage group was similar to that in the advanced-stage group (53.6% vs. 51.4%, respectively; P = 0.379). There was no significant difference in EGFR mutation type between the two groups. In subgroup analysis of smoking history, there was no difference in EGFR mutation frequency or type between the early-stage and advanced-stage groups. Early-stage and advanced-stage groups exhibited the same EGFR mutation frequencies and types. © 2018 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

Multiple Removal of Spent Rocket Upper Stages with an Ion Beam Shepherd

NASA Astrophysics Data System (ADS)

Bombardelli, C.; Herrera-Montojo, J.; Gonzalo, J. L.

2013-08-01

Among the many advantages of the recently proposed ion beam shepherd (IBS) debris removal technique is the capability to deal with multiple targets in a single mission. A preliminary analysis is here conducted in order to estimate the cost in terms of spacecraft mass and total mission time to remove multiple large-size upper stages of the Zenit family. Zenit-2 upper stages are clustered at 71 degrees inclination around 850 km altitude in low Earth orbit. It is found that a removal of two targets per year is feasible with a modest size spacecraft. The most favorable combinations of targets are outlined.

Physics Identity Development: A Snapshot of the Stages of Development of Upper-Level Physics Students

ERIC Educational Resources Information Center

Irving, Paul W.; Sayre, Eleanor C.

2013-01-01

As part of a longitudinal study into identity development in upper-level physics students a phenomenographic research method is employed to assess the stages of identity development of a group of upper-level students. Three categories of description were discovered which indicate the three different stages of identity development for this group…

Stir Friction Welding Used in Ares I Upper Stage Fabrication

NASA Technical Reports Server (NTRS)

2007-01-01

Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. This HD video image depicts friction stir welding used in manufacturing aluminum panels that will fabricate the Ares I upper stage barrel. The panels are subjected to confidence tests in which the bent aluminum is stressed to breaking point and thoroughly examined. The panels are manufactured by AMRO Manufacturing located in El Monte, California. (Highest resolution available)

Stir Friction Welding Used in Ares I Upper Stage Fabrication

NASA Technical Reports Server (NTRS)

2007-01-01

Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. This HD video image depicts friction stir welding used in manufacturing aluminum panels that will fabricate the Ares I upper stage barrel. The aluminum panels are subjected to confidence panel tests during which the bent aluminum is stressed to breaking point and thoroughly examined. The panels are manufactured by AMRO Manufacturing located in El Monte, California. (Highest resolution available)

Ares First Stage "Systemology" - Combining Advanced Systems Engineering and Planning Tools to Assure Mission Success

NASA Technical Reports Server (NTRS)

Seiler, James; Brasfield, Fred; Cannon, Scott

2008-01-01

Ares is an integral part of NASA s Constellation architecture that will provide crew and cargo access to the International Space Station as well as low earth orbit support for lunar missions. Ares replaces the Space Shuttle in the post 2010 time frame. Ares I is an in-line, two-stage rocket topped by the Orion Crew Exploration Vehicle, its service module, and a launch abort system. The Ares I first stage is a single, five-segment reusable solid rocket booster derived from the Space Shuttle Program's reusable solid rocket motor. The Ares second or upper stage is propelled by a J-2X main engine fueled with liquid oxygen and liquid hydrogen. This paper describes the advanced systems engineering and planning tools being utilized for the design, test, and qualification of the Ares I first stage element. Included are descriptions of the current first stage design, the milestone schedule requirements, and the marriage of systems engineering, detailed planning efforts, and roadmapping employed to achieve these goals.

The Inertial Upper Stage - Flight experience and capabilities

NASA Astrophysics Data System (ADS)

Kuhns, Randall H.; Maricich, Peter L.; Bangsund, Edward L.; Friske, Stephen A.; Hallman, Wayne P.; Goldstein, Allen E.

1993-10-01

The Inertial Upper Stage (IUS) is a two-stage rocket designed to place a variety of payloads in high earth orbit or on interplanetary trajectories, which has been boosted to date, together with its payloads, from the earth's surface to low altitude park orbits by the USAF Titan launcher and the NASA Space Shuttle. This paper discusses the IUS redundancy and presents data on the value of the IST's redundant design and the past uses of the vehicle's redundant capability to achieve mission success. The value of IUS's redundancy has been confirmed on several flights. The paper presents block diagrams of the IUS redundancy architecture and of the redundancy hardware switching and commands.

Lessons Learned from Ares I Upper Stage Structures and Thermal Design

NASA Technical Reports Server (NTRS)

Ahmed, Rafiq

2012-01-01

The Ares 1 Upper Stage was part of the vehicle intended to succeed the Space Shuttle as the United States manned spaceflight vehicle. Although the Upper Stage project was cancelled, there were many lessons learned that are applicable to future vehicle design. Lessons learned that are briefly detailed in this Technical Memorandum are for specific technical areas such as tank design, common bulkhead design, thrust oscillation, control of flight and slosh loads, purge and hazardous gas system. In addition, lessons learned from a systems engineering and vehicle integration perspective are also included, such as computer aided design and engineering, scheduling, and data management. The need for detailed systems engineering in the early stages of a project is emphasized throughout this report. The intent is that future projects will be able to apply these lessons learned to keep costs down, schedules brief, and deliver products that perform to the expectations of their customers.

Ares I-X Upper Stage Simulator Residual Stress Analysis

NASA Technical Reports Server (NTRS)

Raju, Ivatury S.; Brust, Frederick W.; Phillips, Dawn R.; Cheston, Derrick

2008-01-01

The structural analyses described in the present report were performed in support of the NASA Engineering and Safety Center (NESC) Critical Initial Flaw Size (CIFS) assessment for the Ares I-X Upper Stage Simulator (USS) common shell segment. An independent assessment was conducted to determine the critical initial flaw size (CIFS) for the flange-to-skin weld in the Ares I-X Upper Stage Simulator (USS). The Ares system of space launch vehicles is the US National Aeronautics and Space Administration s plan for replacement of the aging space shuttle. The new Ares space launch system is somewhat of a combination of the space shuttle system and the Saturn launch vehicles used prior to the shuttle. Here, a series of weld analyses are performed to determine the residual stresses in a critical region of the USS. Weld residual stresses both increase constraint and mean stress thereby having an important effect on fatigue and fracture life. The results of this effort served as one of the critical load inputs required to perform a CIFS assessment of the same segment.

The Malemute development program. [rocket upper stage engine design

NASA Technical Reports Server (NTRS)

Bolster, W. J.; Hoekstra, P. W.

1976-01-01

The Malemute vehicle systems are two-stage systems based on utilizing a new high performance upper stage motor with two existing military boosters. The Malmute development program is described relative to program structure, preliminary design, vehicle subsystems, and the Malemute motor. Two vehicle systems, the Nike-Malemute and Terrier-Malemute, were developed which are capable of transporting comparatively large diameter (16 in.) 200-lb payloads to altitudes of 500 and 700 km, respectively. These vehicles provide relatively low-cost transportation with two-stage reliability and launch simplicity. Flight tests of both vehicle systems revealed their performance capabilities, with the Terrier-Malemute system involving a unique Malemute motor spin sensitivity problem. It is suggested that the vehicles can be successfully flown by lowering the burnout spin rate.

Integrated Solar Upper Stage Technical Support

NASA Technical Reports Server (NTRS)

Jaworske, Donald A.

1998-01-01

NASA Lewis Research Center is participating in the Integrated Solar Upper Stage (ISUS) program. This program is a ground-based demonstration of an upper stage concept that will be used to generate both solar propulsion and solar power. Solar energy collected by a primary concentrator is directed into the aperture of a secondary concentrator and further concentrated into the aperture of a heat receiver. The energy stored in the receiver-absorber-converter is used to heat hydrogen gas to provide propulsion during the orbital transfer portion of the mission. During the balance of the mission, electric power is generated by thermionic diodes. Several materials issues were addressed as part of the technical support portion of the ISUS program, including: 1) Evaluation of primary concentrator coupons; 2) Evaluation of secondary concentrator coupons; 3) Evaluation of receiver-absorber-converter coupons; 4) Evaluation of in-test witness coupons. Two different types of primary concentrator coupons were evaluated from two different contractors-replicated coupons made from graphite-epoxy composite and coupons made from microsheet glass. Specular reflectivity measurements identified the replicated graphite-epoxy composite coupons as the primary concentrator material of choice. Several different secondary concentrator materials were evaluated, including a variety of silver and rhodium reflectors. The specular reflectivity of these materials was evaluated under vacuum at temperatures up to 800 C. The optical properties of several coupons of rhenium on graphite were evaluated to predict the thermal performance of the receiver-absorber-converter. Finally, during the ground test demonstration, witness coupons placed in strategic locations throughout the thermal vacuum facility were evaluated for contaminants. All testing for the ISUS program was completed successfully in 1997. Investigations related to materials issues have proven helpful in understanding the operation of the test

ADVANCED MANUFACTURING TEAM

NASA Image and Video Library

2014-01-16

ZACK JONES AND JIM LYDON OF MSFC’S ADVANCED MANUFACTURING TEAM, WITH MSFC’S M2 SELECTIVE LASER MELTING SYSTEM. THE M2 IS CURRENTLY DEDICATED TO ADVANCED COPPER MATERIAL DEVELOPMENT FOR THE LOW COST UPPER STAGE PROGRAM.

Upper Stage Flight Experiment 10K Engine Design and Test Results

NASA Technical Reports Server (NTRS)

Ross, R.; Morgan, D.; Crockett, D.; Martinez, L.; Anderson, W.; McNeal, C.

2000-01-01

A 10,000 lbf thrust chamber was developed for the Upper Stage Flight Experiment (USFE). This thrust chamber uses hydrogen peroxide/JP-8 oxidizer/fuel combination. The thrust chamber comprises an oxidizer dome and manifold, catalyst bed assembly, fuel injector, and chamber/nozzle assembly. Testing of the engine was done at NASA's Stennis Space Center (SSC) to verify its performance and life for future upper stage or Reusable Launch Vehicle applications. Various combinations of silver screen catalyst beds, fuel injectors, and combustion chambers were tested. Results of the tests showed high C* efficiencies (97% - 100%) and vacuum specific impulses of 275 - 298 seconds. With fuel film cooling, heating rates were low enough that the silica/quartz phenolic throat experienced minimal erosion. Mission derived requirements were met, along with a perfect safety record.

NASA Ares I Crew Launch Vehicle Upper Stage Overview

NASA Technical Reports Server (NTRS)

Davusm Daniel J.; McArthur, J. Craig

2008-01-01

By incorporating rigorous engineering practices, innovative manufacturing processes and test techniques, a unique multi-center government/contractor partnership, and a clean-sheet design developed around the primary requirements for the International Space Station (ISS) and Lunar missions, the Upper Stage Element of NASA's Crew Launch Vehicle (CLV), the "Ares I," is a vital part of the Constellation Program's transportation system.

ADVANCED MANUFACTURING TEAM

NASA Image and Video Library

2014-01-16

QUINCY BEAN, JIM LYDON, AND ZACK JONES OF MSFC’S ADVANCED MANUFACTURING TEAM, WITH MSFC’S M2 SELECTIVE LASER MELTING SYSTEM. THE M2 IS CURRENTLY DEDICATED TO ADVANCED COPPER MATERIAL DEVELOPMENT FOR THE LOW COST UPPER STAGE PROGRAM.

Stir Friction Welding Used in Ares I Upper Stage Fabrication

NASA Technical Reports Server (NTRS)

2007-01-01

Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. This HD video image depicts the preparation and placement of a confidence ring for friction stir welding used in manufacturing aluminum panels that will fabricate the Ares I upper stage barrel. The aluminum panels are manufactured and subjected to confidence tests during which the bent aluminum is stressed to breaking point and thoroughly examined. The panels are manufactured by AMRO Manufacturing located in El Monte, California. (Highest resolution available)

Large Scale Testing of a Foam/Multilayer Insulation Thermal Control System (TCS) for Cryogenic Upper Stages

NASA Technical Reports Server (NTRS)

Hastings, Leon; Martin, James

1998-01-01

The development of high energy cryogenic upper stages is essential for the efficient delivery of large payloads to various destinations envisioned in future programs. A key element in such upper stages is cryogenic fluid management (CFM) advanced development/technology. Due to the cost of and limited opportunities for orbital experiments, ground testing must be employed to the fullest extent possible. Therefore, a system level test bed termed the Multipurpose Hydrogen Test Bed (MHTB), which is representative in size and shape (3 meter diameter by 3 meter long with a volume of 18 cubic meters) of a fully integrated space transportation vehicle liquid hydrogen propellant tank has been established. To date, upper stage studies have often baselined the foam/multilayer insulation (FMLI) combination concept; however, hardware experience with the concept is minimal and was therefore selected for the MHTB. The foam element (isofoam SS-1 171 with an average thickness of 3.5 centimeters) is designed to protect against ground hold/ascent flight environments, and allows for the use of a dry nitrogen purge as opposed to the more complex/heavy helium purge subsystem normally required with MLI in cryogenic applications. The MLI (45 layers of Double Aluminized Mylar with Dacron spacers) provides protection in the vacuum environment of space and is designed for an on-orbit storage period of 45 days. Several unique features were incorporated in the MLI concept and included: variable density MLI (reduces weight and radiation losses by changing the layer density), larger but fewer DAM perforations for venting during ascent to orbit (reduces radiation losses), and roll wrap installation of the MLI with a commercially established process to lower assembly man-hours and reduce seam heat leak. Thermal performance testing of the MHTB TCS was conducted during three test series conducted between September 1995 and May 1996. Results for the ground hold portion of the tests were as expected

Comparative evaluation of existing expendable upper stages for space shuttle

NASA Technical Reports Server (NTRS)

Weyers, V. J.; Sagerman, G. D.; Borsody, J.; Lubick, R. J.

1974-01-01

The use of existing expendable upper stages in the space shuttle during its early years of operation is evaluated. The Burner 2, Scout, Delta, Agena, Transtage, and Centaur were each studied under contract by their respective manufacturers to determine the extent and cost of the minimum modifications necessary to integrate the stage with the shuttle orbiter. A comparative economic analysis of thirty-five different families of these stages is discussed. Results show that the overall transportation system cost differences between many of the families are quite small. However, by considering several factors in addition to cost, it is possible to select one family as being representative of the capability of the minimum modification existing stage approach. The selected family meets all of the specified mission requirements during the early years of shuttle operation.

Subsystem Hazard Analysis Methodology for the Ares I Upper Stage Source Controlled Items

NASA Technical Reports Server (NTRS)

Mitchell, Michael S.; Winner, David R.

2010-01-01

This article describes processes involved in developing subsystem hazard analyses for Source Controlled Items (SCI), specific components, sub-assemblies, and/or piece parts, of the NASA ARES I Upper Stage (US) project. SCIs will be designed, developed and /or procured by Boeing as an end item or an off-the-shelf item. Objectives include explaining the methodology, tools, stakeholders and products involved in development of these hazard analyses. Progress made and further challenges in identifying potential subsystem hazards are also provided in an effort to assist the System Safety community in understanding one part of the ARES I Upper Stage project.

Propellant Management in Booster and Upper Stage Propulsion Systems

NASA Technical Reports Server (NTRS)

Fisher, Mark F.

1997-01-01

A summary review of some of the technical issues which surround the design of the propulsion systems for Booster and Upper Stage systems are presented. The work focuses on Propellant Geyser, Slosh, and Orientation. A brief description of the concern is given with graphics which help the reader to understand the physics of the situation. The most common solutions to these problems are given with there respective advantages and disadvantages.

Effect of hydronephrosis on survival in advanced stage cervical cancer.

PubMed

Goklu, Mehmet Rıfat; Seckin, Kerem Doga; Togrul, Cihan; Goklu, Yasemin; Tahaoglu, Ali Emre; Oz, Murat; Ertas, Ibrahim Egemen

2015-01-01

Hydronephrosis is frequently encountered in advanced stage cervical cancers, and may be associated with mortality. In the present study, we aimed to demonstrate the effect of hydronephrosis on survival in patients with inoperable advanced stage cervical cancer. The study data were acquired by retrospective analysis of the patient records belonging to 165 women with FIGO (International Federation of Gynecology and Obstetrics) stage-IIIB or more advanced cervical cancer, which were not surgical candidates. Parameters including patient age, pathological diagnosis, disease stage, pelvic sidewall extension, presence of hydronephrosis and administration of chemoradiation were analyzed. Further, the effects of these variables on survival were assessed. P values less than 0.05 were considered statistically significant. The distribution of the study patients according to disease stage was as follows: 131 (79.4%) had stage-IIIB, 18 (10.9%) had stage-IVB and 16 (% 9.7) patients had stage-IVA disease. Hydronephrosis was not evident in 91 (55.2%) of these patients, whereas 41 (24.8%) had unilateral and 33 (20%) patients had bilateral hydronephrosis. When compared to mean survival in patients who did not have hydronephrosis, survival was significantly shortened in patients who had bilateral and unilateral hydronephrosis (p<0.05). There was no significant survival difference between patients with unilateral and bilateral hydronephrosis (p>0.05). Although patient age, pathological type, pelvic involvement, and chemotherapy treatment rates were similar (p>0.05), radiotherapy requirement rate and disease stage were significantly different among the study groups (p<0.05). Hydronephrosis was found to be a significant predictor of poor survival in patients with advanced stage cervical cancer, irrespective of unilateral or bilateral involvement.While waiting for future studies with larger sample sizes, we believe that the FIGO stages in advanced cervical cancer could further be

Is uniportal thoracoscopic surgery a feasible approach for advanced stages of non-small cell lung cancer?

PubMed Central

Fieira, Eva; Delgado, Maria; Mendez, Lucía; Fernandez, Ricardo; de la Torre, Mercedes

2014-01-01

Objectives Conventional video-assisted thoracoscopic (VATS) lobectomy for advanced lung cancer is a feasible and safe surgery in experienced centers. The aim of this study is to assess the feasibility of uniportal VATS approach in the treatment of advanced non-small cell lung cancer (NSCLC) and compare the perioperative outcomes and survival with those in early-stage tumors operated through the uniportal approach. Methods From June 2010 to December 2012, we performed 163 uniportal VATS major pulmonary resections. Only NSCLC cases were included in this study (130 cases). Patients were divided into two groups: (A) early stage and (B) advanced cases (>5 cm, T3 or T4, or tumors requiring neoadjuvant treatment). A descriptive and retrospective study was performed, comparing perioperative outcomes and survival obtained in both groups. A survival analysis was performed with Kaplan-Meier curves and the log-rank test was used to compare survival between patients with early and advanced stages. Results A total of 130 cases were included in the study: 87 (A) vs. 43 (B) patients (conversion rate 1.1 vs. 6.5%, P=0.119). Mean global age was 64.9 years and 73.8% were men. The patient demographic data was similar in both groups. Upper lobectomies (A, 52 vs. B, 21 patients) and anatomic segmentectomies (A, 4 vs. B, 0) were more frequent in group A while pneumonectomy was more frequent in B (A, 1 vs. B, 6 patients). Surgical time was longer (144.9±41.3 vs. 183.2±48.9, P<0.001), and median number of lymph nodes (14 vs. 16, P=0.004) were statistically higher in advanced cases. Median number of nodal stations (5 vs. 5, P=0.165), days of chest tube (2 vs. 2, P=0.098), HOS (3 vs. 3, P=0.072), and rate of complications (17.2% vs. 14%, P=0.075) were similar in both groups. One patient died on the 58th postoperative day. The 30-month survival rate was 90% for the early stage group and 74% for advanced cases Conclusions Uniportal VATS lobectomy for advanced cases of NSCLC is a safe and

Development and Testing of Carbon-Carbon Nozzle Extensions for Upper Stage Liquid Rocket Engines

NASA Technical Reports Server (NTRS)

Valentine, Peter G.; Gradl, Paul R.; Greene, Sandra E.

2017-01-01

Carbon-carbon (C-C) composite nozzle extensions are of interest for use on a variety of launch vehicle upper stage engines and in-space propulsion systems. The C-C nozzle extension technology and test capabilities being developed are intended to support National Aeronautics and Space Administration (NASA) and Department of Defense (DOD) requirements, as well as those of the broader Commercial Space industry. For NASA, C-C nozzle extension technology development primarily supports the NASA Space Launch System (SLS) and NASA's Commercial Space partners. Marshall Space Flight Center (MSFC) efforts are aimed at both (a) further developing the technology and databases needed to enable the use of composite nozzle extensions on cryogenic upper stage engines, and (b) developing and demonstrating low-cost capabilities for testing and qualifying composite nozzle extensions. Recent, on-going, and potential future work supporting NASA, DOD, and Commercial Space needs will be discussed. Information to be presented will include (a) recent and on-going mechanical, thermal, and hot-fire testing, as well as (b) potential future efforts to further develop and qualify domestic C-C nozzle extension solutions for the various upper stage engines under development.

Tumor angiogenesis in advanced stage ovarian carcinoma.

PubMed

Hollingsworth, H C; Kohn, E C; Steinberg, S M; Rothenberg, M L; Merino, M J

1995-07-01

Tumor angiogenesis has been found to have prognostic significance in many tumor types for predicting an increased risk of metastasis. We assessed tumor vascularity in 43 cases of advanced stage (International Federation of Gynecologists and Obstetricians stages III and IV) ovarian cancer by using the highly specific endothelial cell marker CD34. Microvessel counts and stage were associated with disease-free survival and with overall survival by Kaplan-Meier analysis. The plots show that higher stage, higher average vessel count at 200x (200x avg) and 400x (400x avg) magnification and highest vessel count at 400x (400x high) magnification confer a worse prognosis for disease-free survival. Average vessel count of less than 16 (400x avg, P2 = 0.01) and less than 45 (200x avg, P2 = 0.026) suggested a better survival. Similarly, a high vessel count of less than 20 (400x high, P2 = 0.019) conferred a better survival as well. The plots suggest that higher stage, higher average vessel count at 200x and 400x, and highest vessel count at 200x and 400x show a trend to worse overall survival as well. With the Cox proportional hazards model, stage was the best predictor of overall survival, however, the average microvessel count at 400x was found to be the best predictor of disease-free survival. These results suggest that analysis of neovascularization in advanced stage ovarian cancer may be a useful prognostic factor.

Waterhammer Testing and Modeling of the Ares I Upper Stage Reaction Control System

NASA Technical Reports Server (NTRS)

Williams, J. Hunter; Holt, Kimberly A.

2010-01-01

NASA's Ares I rocket is the agency's first step in completing the goals of the Constellation Program, which plans to deliver a new generation of space explorers into low earth orbit for future missions to the International Space Station, the moon, and other destinations within the solar system. Ares I is a two-stage rocket topped by the Orion crew capsule and its service module. The launch vehicle's First Stage is a single, five-segment reusable solid rocket booster (RSRB), derived from the Space Shuttle Program's four segment RSRB. The vehicle's Upper Stage, being designed at Marshall Space Flight Center (MSFC), is propelled by a single J-2X Main Engine fueled with liquid oxygen and liquid hydrogen. During active Upper Stage flight of the Ares I launch vehicle, the Upper Stage Reaction Control System (US ReCS) will perform attitude control operations for the vehicle. The US ReCS will provide three-axis attitude control capability (roll, pitch, and yaw) for the Upper Stage while the J-2X is not firing and roll control capability while the engine is firing. Because of the requirements imposed upon the system, the design must accommodate rapid pulsing of multiple thrusters simultaneously to maintain attitude control. In support of these design activities and in preparation for Critical Design Review, analytical models of the US ReCS propellant feed system have been developed using the Thermal Hydraulic Library of MSC.EASY5 v.2008, herein referred to as EASY5. EASY5 is a commercially available fluid system modeling package with significant history of modeling space propulsion systems. In Fall 2009, a series of development tests were conducted at MSFC on a cold-flow test article for the US ReCS, herein referred to as System Development Test Article (SDTA). A subset of those tests performed were aimed at examining the effects of waterhammer on a flight-representative system and to ensure that those effects could be quantified with analytical models and incorporated into

Materials, Processes and Manufacturing in Ares 1 Upper Stage: Integration with Systems Design and Development

NASA Technical Reports Server (NTRS)

Bhat, Biliyar N.

2008-01-01

Ares I Crew Launch Vehicle Upper Stage is designed and developed based on sound systems engineering principles. Systems Engineering starts with Concept of Operations and Mission requirements, which in turn determine the launch system architecture and its performance requirements. The Ares I-Upper Stage is designed and developed to meet these requirements. Designers depend on the support from materials, processes and manufacturing during the design, development and verification of subsystems and components. The requirements relative to reliability, safety, operability and availability are also dependent on materials availability, characterization, process maturation and vendor support. This paper discusses the roles and responsibilities of materials and manufacturing engineering during the various phases of Ares IUS development, including design and analysis, hardware development, test and verification. Emphasis is placed how materials, processes and manufacturing support is integrated over the Upper Stage Project, both horizontally and vertically. In addition, the paper describes the approach used to ensure compliance with materials, processes, and manufacturing requirements during the project cycle, with focus on hardware systems design and development.

Waterhammer Modeling for the Ares I Upper Stage Reaction Control System Cold Flow Development Test Article

NASA Technical Reports Server (NTRS)

Williams, Jonathan H.

2010-01-01

The Upper Stage Reaction Control System provides three-axis attitude control for the Ares I launch vehicle during active Upper Stage flight. The system design must accommodate rapid thruster firing to maintain the proper launch trajectory and thus allow for the possibility to pulse multiple thrusters simultaneously. Rapid thruster valve closure creates an increase in static pressure, known as waterhammer, which propagates throughout the propellant system at pressures exceeding nominal design values. A series of development tests conducted in the fall of 2009 at Marshall Space Flight Center were performed using a water-flow test article to better understand fluid performance characteristics of the Upper Stage Reaction Control System. A subset of the tests examined waterhammer along with the subsequent pressure and frequency response in the flight-representative system and provided data to anchor numerical models. This thesis presents a comparison of waterhammer test results with numerical model and analytical results. An overview of the flight system, test article, modeling and analysis are also provided.

Waterhammer modeling for the Ares I Upper Stage Reaction Control System cold flow development test article

NASA Astrophysics Data System (ADS)

Williams, Jonathan Hunter

The Upper Stage Reaction Control System provides in-flight three-axis attitude control for the Ares I Upper Stage. The system design must accommodate rapid thruster firing to maintain proper launch trajectory and thus allow for the possibility to pulse multiple thrusters simultaneously. Rapid thruster valve closure creates an increase in static pressure, known as waterhammer, which propagates throughout the propellant system at pressures exceeding nominal design values. A series of development tests conducted at Marshall Space Flight Center in 2009 were performed using a water-flow test article to better understand fluid characteristics of the Upper Stage Reaction Control System. A subset of the tests examined the waterhammer pressure and frequency response in the flight-representative system and provided data to anchor numerical models. This thesis presents a comparison of waterhammer test results with numerical model and analytical results. An overview of the flight system, test article, modeling and analysis are also provided.

Staging laparoscopy improves treatment decision-making for advanced gastric cancer.

PubMed

Hu, Yan-Feng; Deng, Zhen-Wei; Liu, Hao; Mou, Ting-Yu; Chen, Tao; Lu, Xin; Wang, Da; Yu, Jiang; Li, Guo-Xin

2016-02-07

To evaluate the clinical value of staging laparoscopy in treatment decision-making for advanced gastric cancer (GC). Clinical data of 582 patients with advanced GC were retrospectively analyzed. All patients underwent staging laparoscopy. The strength of agreement between computed tomography (CT) stage, endoscopic ultrasound (EUS) stage, laparoscopic stage, and final stage were determined by weighted Kappa statistic (Kw). The number of patients with treatment decision-changes was counted. A χ(2) test was used to analyze the correlation between peritoneal metastasis or positive cytology and clinical characteristics. Among the 582 patients, the distributions of pathological T classifications were T2/3 (153, 26.3%), T4a (262, 45.0%), and T4b (167, 28.7%). Treatment plans for 211 (36.3%) patients were changed after staging laparoscopy was performed. Two (10.5%) of 19 patients in M1 regained the opportunity for potential radical resection by staging laparoscopy. Unnecessary laparotomy was avoided in 71 (12.2%) patients. The strength of agreement between preoperative T stage and final T stage was in almost perfect agreement (Kw = 0.838; 95% confidence interval (CI): 0.803-0.872; P < 0.05) for staging laparoscopy; compared with CT and EUS, which was in fair agreement. The strength of agreement between preoperative M stage and final M stage was in almost perfect agreement (Kw = 0.990; 95% CI: 0.977-1.000; P < 0.05) for staging laparoscopy; compared with CT, which was in slight agreement. Multivariate analysis revealed that tumor size (≥ 40 mm), depth of tumor invasion (T4b), and Borrmann type (III or IV) were significantly correlated with either peritoneal metastasis or positive cytology. The best performance in diagnosing P-positive was obtained when two or three risk factors existed. Staging laparoscopy can improve treatment decision-making for advanced GC and decrease unnecessary exploratory laparotomy.

Assessment and Verification of SLS Block 1-B Exploration Upper Stage and Stage Disposal Performance

NASA Technical Reports Server (NTRS)

Patrick, Sean; Oliver, T. Emerson; Anzalone, Evan J.

2018-01-01

Delta-v allocation to correct for insertion errors caused by state uncertainty is one of the key performance requirements imposed on the SLS Navigation System. Additionally, SLS mission requirements include the need for the Exploration Up-per Stage (EUS) to be disposed of successfully. To assess these requirements, the SLS navigation team has developed and implemented a series of analysis methods. Here the authors detail the Delta-Delta-V approach to assessing delta-v allocation as well as the EUS disposal optimization approach.

Advanced Hepatocellular Carcinoma: Which Staging Systems Best Predict Prognosis?

PubMed Central

Huitzil-Melendez, Fidel-David; Capanu, Marinela; O'Reilly, Eileen M.; Duffy, Austin; Gansukh, Bolorsukh; Saltz, Leonard L.; Abou-Alfa, Ghassan K.

2010-01-01

Purpose The purpose of cancer staging systems is to accurately predict patient prognosis. The outcome of advanced hepatocellular carcinoma (HCC) depends on both the cancer stage and the extent of liver dysfunction. Many staging systems that include both aspects have been developed. It remains unknown, however, which of these systems is optimal for predicting patient survival. Patients and Methods Patients with advanced HCC treated over a 5-year period at Memorial Sloan-Kettering Cancer Center were identified from an electronic medical record database. Patients with sufficient data for utilization in all staging systems were included. TNM sixth edition, Okuda, Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), Chinese University Prognostic Index (CUPI), Japan Integrated Staging (JIS), and Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire (GETCH) systems were ranked on the basis of their accuracy at predicting survival by using concordance index (c-index). Other independent prognostic variables were also identified. Results Overall, 187 eligible patients were identified and were staged by using the seven staging systems. CLIP, CUPI, and GETCH were the three top-ranking staging systems. BCLC and TNM sixth edition lacked any meaningful prognostic discrimination. Performance status, AST, abdominal pain, and esophageal varices improved the discriminatory ability of CLIP. Conclusion In our selected patient population, CLIP, CUPI, and GETCH were the most informative staging systems in predicting survival in patients with advanced HCC. Prospective validation is required to determine if they can be accurately used to stratify patients in clinical trials and to direct the appropriate need for systemic therapy versus best supportive care. BCLC and TNM sixth edition were not helpful in predicting survival outcome, and their use is not supported by our data. PMID:20458042

The J-2X Upper Stage Engine: From Heritage to Hardware

NASA Technical Reports Server (NTRS)

Byrd, THomas

2008-01-01

NASA's Global Exploration Strategy requires safe, reliable, robust, efficient transportation to support sustainable operations from Earth to orbit and into the far reaches of the solar system. NASA selected the Ares I crew launch vehicle and the Ares V cargo launch vehicle to provide that transportation. Guiding principles in creating the architecture represented by the Ares vehicles were the maximum use of heritage hardware and legacy knowledge, particularly Space Shuttle assets, and commonality between the Ares vehicles where possible to streamline the hardware development approach and reduce programmatic, technical, and budget risks. The J-2X exemplifies those goals. It was selected by the Exploration Systems Architecture Study (ESAS) as the upper stage propulsion for the Ares I Upper Stage and the Ares V Earth Departure Stage (EDS). The J-2X is an evolved version ofthe historic J-2 engine that successfully powered the second stage of the Saturn I launch vehicle and the second and third stages of the Saturn V launch vehicle. The Constellation architecture, however, requires performance greater than its predecessor. The new architecture calls for larger payloads delivered to the Moon and demands greater loss of mission reliability and numerous other requirements associated with human rating that were not applied to the original J-2. As a result, the J-2X must operate at much higher temperatures, pressures, and flow rates than the heritage J-2, making it one of the highest performing gas generator cycle engines ever built, approaching the efficiency of more complex stage combustion engines. Development is focused on early risk mitigation, component and subassembly test, and engine system test. The development plans include testing engine components, including the subscale injector, main igniter, powerpack assembly (turbopumps, gas generator and associated ducting and structural mounts), full-scale gas generator, valves, and control software with hardware

Testing of Selective Laser Melting Turbomachinery Applicable to Exploration Upper Stage

NASA Technical Reports Server (NTRS)

Calvert, Marty; Turpin, Jason; Nettles, Mindy

2015-01-01

This task is to design, fabricate, and spin test to failure a Ti6-4 hydrogen turbopump impeller that was built using the selective laser melting (SLM) fabrication process (fig. 1). The impeller is sized around upper stage engine requirements. In addition to the spin burst test, material testing will be performed on coupons that are built with the impeller.

FDG-PET/CT Limited to the Thorax and Upper Abdomen for Staging and Management of Lung Cancer.

PubMed

Arens, Anne I J; Postema, Jan W A; Schreurs, Wendy M J; Lafeber, Albert; Hendrickx, Baudewijn W; Oyen, Wim J G; Vogel, Wouter V

2016-01-01

This study evaluates the diagnostic accuracy of [F-18]-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) of the chest/upper abdomen compared to the generally performed scan from head to upper thighs, for staging and management of (suspected) lung cancer in patients with no history of malignancy or complaints outside the thorax. FDG-PET/CT scans of 1059 patients with suspected or recently proven lung cancer, with no history of malignancy or complaints outside the thorax, were analysed in a retrospective multi-centre trial. Suspect FDG-avid lesions in the chest and upper abdomen, the head and neck area above the shoulder line and in the abdomen and pelvis below the caudal tip of the liver were noted. The impact of lesions detected in the head and neck area and abdomen and pelvis on additional diagnostic procedures, staging and treatment decisions was evaluated. The head and neck area revealed additional suspect lesions in 7.2%, and the abdomen and pelvis in 15.8% of patients. Imaging of the head and neck area and the abdomen and pelvic area showed additional lesions in 19.5%, inducing additional diagnostic procedures in 7.8%. This resulted in discovery of additional lesions considered malignant in 10.7%, changing patient management for lung cancer in 1.2%. In (suspected) lung cancer, PET/CT limited to the chest and upper abdomen resulted in correct staging in 98.7% of patients, which led to the identical management as full field of view PET in 98.8% of patients. High value of FDG-PET/CT for staging and correct patient management is already achieved with chest and upper abdomen. Findings in head and neck area and abdomen and pelvis generally induce investigations with limited or no impact on staging and treatment of NSCLC, and can be interpreted accordingly.

Dinoflagellates: Fossil motile-stage tests from the upper cretaceous of the Northern New Jersey coastal plain

USGS Publications Warehouse

May, F.E.

1976-01-01

Fossil dinoflagellate tests have been considered to represent encysted, nonmotile stages. The discovery of flagellar porelike structures and probable trichocyst pores in the Upper Cretaceous genus Dinogymnium suggests that motile stage tests are also preserved as acid-resistant, organic-walled microfossils.

Characterization of the 2012-044C BRIZ-M Upper Stage Breakup

NASA Astrophysics Data System (ADS)

Matney, M. J.; Hamilton, J.; Horstman, M.; Papanyan, V.

2013-08-01

On 6 August 2012, Russia launched two commercial satellites aboard a Proton rocket, and attempted to place them in geosynchronous orbit using a Briz-M upper stage (2012-044C, SSN 38746). Unfortunately, the upper stage failed early in its burn and was left stranded in an elliptical orbit with a perigee in low Earth orbit (LEO). Because the stage failed with much of its fuel on board, it was deemed a significant breakup risk. These fears were confirmed when it broke up 16 October, creating a large cloud of debris with perigees below that of the International Space Station. The debris cloud was tracked by the U.S. Space Surveillance Network (SSN), which can reliably detect and track objects down to about 10 cm in size. Because of the unusual geometry of the breakup, there was an opportunity for the NASA Orbital Debris Program Office to use specialized radar assets to characterize the extent of the debris cloud in sizes smaller than the standard debris tracked by the SSN. This paper describes the observation campaign to measure the small particle distributions of this cloud and presents the results of the data analysis. We shall compare the data to the modelled size distribution, number, and shape of the cloud, and what implications this may have for future breakup debris models. We shall conclude the paper with a discussion about how this measurement process can be improved for future breakups.

Characterization of the 2012-044C Briz-M Upper Stage Breakup

NASA Technical Reports Server (NTRS)

Matney, M. J.; Hamilton, J.; Horstman, M.; Papanyan, V.

2013-01-01

On 6 August, 2012, Russia launched two commercial satellites aboard a Proton rocket, and attempted to place them in geosynchronous orbit using a Briz-M upper stage (2012-044C, SSN 38746). Unfortunately, the upper stage failed early in its burn and was left stranded in an elliptical orbit with a perigee in low Earth orbit (LEO). Because the stage failed with much of its fuel on board, it was deemed a significant breakup risk. These fears were confirmed when it broke up 16 October, creating a large cloud of debris with perigees below that of the International Space Station. The debris cloud was tracked by the US Space Surveillance Network (SSN), which can reliably detect and track objects down to about 10 cm in size. Because of the unusual geometry of the breakup, there was an opportunity for NASA Orbital Debris Program Office to use specialized radar assets to characterize the extent of the debris cloud in sizes smaller than the standard debris tracked by the SSN. This paper will describe the observation campaign to measure the small particle distributions of this cloud, and presents the results of the analysis of the data. We shall compare the data to the modelled size distribution, number, and shape of the cloud, and what implications this may have for future breakup debris models. We shall conclude the paper with a discussion how this measurement process can be improved for future breakups.

Characterization of the 2012-044c Briz-M Upper Stage Breakup

NASA Technical Reports Server (NTRS)

Matney, M. J.; Hamilton, Joseph; Papanyan, Valen

2013-01-01

On 6 August, 2012, Russia launched two commercial satellites aboard a Proton rocket, and attempted to place them in geosynchronous orbit using a Briz-M upper stage (2012-044C, SSN 38746). Unfortunately, the upper stage failed early in its burn and was left stranded in an elliptical orbit with a perigee in low Earth orbit (LEO). Because the stage failed with much of its fuel on board, it was deemed a significant breakup risk. These fears were confirmed when it broke up 16 October, creating a large cloud of debris with perigees below that of the International Space Station. The debris cloud was tracked by the US Space Surveillance Network (SSN), which can reliably detect and track objects down to about 10 cm in size. Because of the unusual geometry of the breakup, there was an opportunity for NASA Orbital Debris Program Office to request radar assets to characterize the extent of the debris cloud in sizes smaller than the standard debris tracked by the SSN. This paper will describe the observation campaign to measure the small particle distributions of this cloud, and presents the results of the analysis of the data. We shall compare the data to the modelled size distribution, number, and shape of the cloud, and what implications this may have for future breakup debris models. We shall conclude the paper with a discussion how this measurement process can be improved for future breakups.

Growing a Training System and Culture for the Ares I Upper Stage Project

NASA Technical Reports Server (NTRS)

Scott, David W.

2009-01-01

In roughly two years time, Marshall Space Flight Center s (MSFC) Mission Operations Laboratory (MOL) has incubated a personnel training and certification program for about 1000 learners and multiple phases of the Ares I Upper Stage (US) project. Previous MOL-developed training programs focused on about 100 learners with a focus on operations, and had enough full-time training staff to develop courseware and provide training administration. This paper discusses 1) the basics of MOL's training philosophy, 2) how creation of a broad, structured training program unfolded as feedback from more narrowly defined tasks, 3) how training philosophy, development methods, and administration are being simplified and tailored so that many Upper Stage organizations can "grow their own" training yet maintain consistency, accountability, and traceability across the project, 4) interfacing with the production contractor's training system and staff, and 5) reaping training value from existing materials and events.

Shuttle/IUS performance for planetary missions. [Interim Upper Stage

NASA Technical Reports Server (NTRS)

Cork, M. J.; Driver, J. M.; Wright, J. L.

1975-01-01

Potential requirements for planetary missions in the 1980s, capabilities of the Interim Upper Stage (IUS) candidates to perform those missions, and Shuttle/IUS mission profile options for performance enhancement are examined. The most demanding planetary missions are the Pioneer Saturn/Uranus/Titan Probe and the Mariner-class orbiters of Mercury, Jupiter, and Saturn. Options available to designers of these missions will depend on the specific IUS selected for development and the programmatic phasing of the IUS and the NASA Tug. Use of Shuttle elliptic orbits as initial conditions for IUS ignition offers significant performance improvements; specific values are mission dependent.

Space Launch System Upper Stage Technology Assessment

NASA Technical Reports Server (NTRS)

Holladay, Jon; Hampton, Bryan; Monk, Timothy

2014-01-01

The Space Launch System (SLS) is envisioned as a heavy-lift vehicle that will provide the foundation for future beyond low-Earth orbit (LEO) exploration missions. Previous studies have been performed to determine the optimal configuration for the SLS and the applicability of commercial off-the-shelf in-space stages for Earth departure. Currently NASA is analyzing the concept of a Dual Use Upper Stage (DUUS) that will provide LEO insertion and Earth departure burns. This paper will explore candidate in-space stages based on the DUUS design for a wide range of beyond LEO missions. Mission payloads will range from small robotic systems up to human systems with deep space habitats and landers. Mission destinations will include cislunar space, Mars, Jupiter, and Saturn. Given these wide-ranging mission objectives, a vehicle-sizing tool has been developed to determine the size of an Earth departure stage based on the mission objectives. The tool calculates masses for all the major subsystems of the vehicle including propellant loads, avionics, power, engines, main propulsion system components, tanks, pressurization system and gases, primary structural elements, and secondary structural elements. The tool uses an iterative sizing algorithm to determine the resulting mass of the stage. Any input into one of the subsystem sizing routines or the mission parameters can be treated as a parametric sweep or as a distribution for use in Monte Carlo analysis. Taking these factors together allows for multi-variable, coupled analysis runs. To increase confidence in the tool, the results have been verified against two point-of-departure designs of the DUUS. The tool has also been verified against Apollo moon mission elements and other manned space systems. This paper will focus on trading key propulsion technologies including chemical, Nuclear Thermal Propulsion (NTP), and Solar Electric Propulsion (SEP). All of the key performance inputs and relationships will be presented and

Glacial stages and post-glacial environmental evolution in the Upper Garonne valley, Central Pyrenees.

PubMed

Fernandes, M; Oliva, M; Palma, P; Ruiz-Fernández, J; Lopes, L

2017-04-15

The maximum glacial extent in the Central Pyrenees during the Last Glaciation is known to have occurred before the global Last Glacial Maximum, but the succession of cold events afterwards and their impact on the landscape are still relatively unknown. This study focuses on the environmental evolution in the upper valley of the Garonne River since the Last Glaciation. Geomorphological mapping allows analysis of the spatial distribution of inherited and current processes and landforms in the study area. The distribution of glacial records (moraines, till, erratic boulders, glacial thresholds) suggests the existence of four glacial stages, from the maximum expansion to the end of the glaciation. GIS modeling allows quantification of the Equilibrium Line Altitude, extent, thickness and volume of ice in each glacial stage. During the first stage, the Garonne glacier reached 460m in the Loures-Barousse-Barbazan basin, where it formed a piedmont glacier 88km from the head and extended over 960km 2 . At a second stage of glacier stabilization during the deglaciation process, the valley glaciers were 12-23km from the head until elevations of 1000-1850m, covering an area of 157km 2 . Glaciers during stage three remained isolated in the upper parts of the valley, at heights of 2050-2200m and 2.6-4.5km from the head, with a glacial surface of 16km 2 . In stage four, cirque glaciers were formed between 2260m and 2590m, with a length of 0.4-2km and a glacial area of 5.7km 2 . Also, the wide range of periglacial, slope, nival and alluvial landforms existing in the formerly glaciated environments allows reconstruction of the post-glacial environmental dynamics in the upper Garonne basin. Today, the highest lands are organized following three elevation belts: subnival (1500-1900m), nival (1900-2300m) and periglacial/cryonival (2300-2800m). Copyright © 2017 Elsevier B.V. All rights reserved.

J-2X Upper Stage Engine: Hardware and Testing 2009

NASA Technical Reports Server (NTRS)

Buzzell, James C.

2009-01-01

Mission: Common upper stage engine for Ares I and Ares V. Challenge: Use proven technology from Saturn X-33, RS-68 to develop the highest Isp GG cycle engine in history for 2 missions in record time . Key Features: LOX/LH2 GG cycle, series turbines (2), HIP-bonded MCC, pneumatic ball-sector valves, on-board engine controller, tube-wall regen nozzle/large passively-cooled nozzle extension, TEG boost/cooling . Development Philosophy: proven hardware, aggressive schedule, early risk reduction, requirements-driven.

[Prognostic factors of advanced stage non-small-cell lung cancer].

PubMed

Kwas, H; Guermazi, E; Khattab, A; Hrizi, C; Zendah, I; Ghédira, H

2017-09-01

Primary lung cancer is the leading cause of cancer death in men in the world. Although the introduction of new drugs, new therapeutic strategies and despite therapeutic advances, the prognosis is relatively improved during the last years. To evaluate the prognosis of patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) and to identify prognostic factors at these stages. A retrospective study, including 140 cases of locally advanced or metastatic NSCLC diagnosed in our department between 2003 and 2013. The average age was 61±10 years (35 to 90 years). Sex ratio was 18. The delays management were 80±25 days for presentation, 45±20 days for the diagnostic, while the treatment delay was 8±2.33 days. The cancer was at stage IIIA in 14%, IIIB in 27% and IV in 59%. Six months and one-year survival was between 50 and 74% and between 9 and 25%, respectively. Better survival was observed in patients with NSCLC on stage III, having better performance status, having comorbid conditions, with prolonged delays management, a short therapeutic delay and patients who received specific antitumor treatment. The prognostic factors in locally advanced and metastatic NSCLC in our patients were: stage of cancer, performance status, comorbid conditions, delay of management and specific antitumoral treatment. These factors should be considered in the management of patients with advanced NSCLC. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Upper Stage Tank Thermodynamic Modeling Using SINDA/FLUINT

NASA Technical Reports Server (NTRS)

Schallhorn, Paul; Campbell, D. Michael; Chase, Sukhdeep; Piquero, Jorge; Fortenberry, Cindy; Li, Xiaoyi; Grob, Lisa

2006-01-01

Modeling to predict the condition of cryogenic propellants in an upper stage of a launch vehicle is necessary for mission planning and successful execution. Traditionally, this effort was performed using custom, in-house proprietary codes, limiting accessibility and application. Phenomena responsible for influencing the thermodynamic state of the propellant have been characterized as distinct events whose sequence defines a mission. These events include thermal stratification, passive thermal control roll (rotation), slosh, and engine firing. This paper demonstrates the use of an off the shelf, commercially available, thermal/fluid-network code to predict the thermodynamic state of propellant during the coast phase between engine firings, i.e. the first three of the above identified events. Results of this effort will also be presented.

Inertial upper stage - Upgrading a stopgap proves difficult

NASA Astrophysics Data System (ADS)

Geddes, J. P.

The technological and project management difficulties associated with the Inertial Upper Stage's (IUS) development and performance to date are assessed, with a view to future prospects for this system. The IUS was designed for use both on the interim Titan 34D booster and the Space Shuttle Orbiter. The IUS malfunctions and cost overruns reported are substantially due to the system's reliance on novel propulsion and avionics technology. Its two solid rocket motors, which were selected on the basis of their inherent safety for use on the Space Shuttle, have the longest burn time extant. A three-dimensional carbon/carbon nozzle throat had to be developed to sustain this long burn, as were lightweight composite wound cases and shirts, insulation, igniters, and electromechanical thrust vector control.

A Supersonic/Hypersonic Aerodynamic Investigation of the Saturn 1B/Apollo Upper Stage

NASA Technical Reports Server (NTRS)

1966-01-01

The static stability and axial force characteristics of an upper stage Saturn 1B/Apollo model were investigated in a series of wind tunnel tests at Mach numbers between 1. 93 and 8. 05. This report presents and analyzes the results of these small-scale studies. Test procedures and models are described, and consideration of boundary layer characteristics and violated modeling rules yields an assessment of the validity of the data. Four basic models provided evaluation of the basic launch vehicle characteristics, as well as the effects of two modes of mission abort and jettison of the launch escape system. The launch configuration experienced sudden, strong changes in stability derivatives and axial force coefficients near Mach 5. No similar changes were observed on the other configurations. Effects of Reynolds number, Mach number and boundary layer trips were obtained for each shape. The faired curves are believed to be valid for full-scale flight of the Saturn 1B/Apollo upper stage.

Operations analysis (study 2.1). Contingency analysis. [of failure modes anticipated during space shuttle upper stage planning

NASA Technical Reports Server (NTRS)

1974-01-01

Future operational concepts for the space transportation system were studied in terms of space shuttle upper stage failure contingencies possible during deployment, retrieval, or space servicing of automated satellite programs. Problems anticipated during mission planning were isolated using a modified 'fault tree' technique, normally used in safety analyses. A comprehensive space servicing hazard analysis is presented which classifies possible failure modes under the catagories of catastrophic collision, failure to rendezvous and dock, servicing failure, and failure to undock. The failure contingencies defined are to be taken into account during design of the upper stage.

[Staging gastritis with the OLGA system: prevalence of advanced stages of gastric atrophy in Mexican patients].

PubMed

Ramírez-Mendoza, P; Ruiz-Castillo, S A; Maroun-Marun, C; Trujillo-Benavides, O; Baltazar-Montúfar, P; Méndez del Monte, R; Angeles-Garay, U

2011-01-01

Gastric adenocarcinoma of intestinal type is preceded by inflammation, which produces mucosal atrophy and intestinal metaplasia, progressing eventually to dysplasia and invasive cancer. Recently an international group, the Operative Link on Gastritis Assessment (OLGA) proponed a staging system for gastric biopsies. To recognize the distribution of advanced stages of gastric mucosal atrophy in Mexican patients with dyspepsia according to the OLGA system. We apply the OLGA system for cancer risk (Stages 0 to IV) to 322 gastric biopsies from consecutive patients with dyspepsia. Using the Sydney protocol, we recorded the presence of atrophy, dysplasia and the relationship with ulcer disease. We report the stage of atrophy for each region and the Helicobacter pylori infection status. We documented 72 (22.4%) cases with atrophy, 50 of them (69.4%) were metaplastic-type. Overall, nine biopsies (2.78%) were stage III (all of them with metaplastic-type atrophy) and there was not stage IV cases. We did not find high-grade dysplasia or intramucosal carcinoma. In 8 of subjects with stage III, we observed low-grade dysplasia. We documented gastric ulcer in 5 patients with stage II, 60% of them with associated low-grade dysplasia. Five patients with duodenal ulcer were found in stages 0 and I. We found low prevalence of advanced stages of mucosal gastric atrophy among patients with dyspepsia. However we recognized 9 patients with stage III according to OLGA system worthy of follow-up because the high risk for developing gastric cancer.

LOX/LH2 propulsion system for launch vehicle upper stage, test results

NASA Technical Reports Server (NTRS)

Ikeda, T.; Imachi, U.; Yuzawa, Y.; Kondo, Y.; Miyoshi, K.; Higashino, K.

1984-01-01

The test results of small LOX/LH2 engines for two propulsion systems, a pump fed system and a pressure fed system are reported. The pump fed system has the advantages of higher performances and higher mass fraction. The pressure fed system has the advantages of higher reliability and relative simplicity. Adoption of these cryogenic propulsion systems for upper stage of launch vehicle increases the payload capability with low cost. The 1,000 kg thrust class engine was selected for this cryogenic stage. A thrust chamber assembly for the pressure fed propulsion system was tested. It is indicated that it has good performance to meet system requirements.

Assessment and Verification of SLS Block 1-B Exploration Upper Stage State and Stage Disposal Performance

NASA Technical Reports Server (NTRS)

Patrick, Sean; Oliver, Emerson

2018-01-01

One of the SLS Navigation System's key performance requirements is a constraint on the payload system's delta-v allocation to correct for insertion errors due to vehicle state uncertainty at payload separation. The SLS navigation team has developed a Delta-Delta-V analysis approach to assess the effect on trajectory correction maneuver (TCM) design needed to correct for navigation errors. This approach differs from traditional covariance analysis based methods and makes no assumptions with regard to the propagation of the state dynamics. This allows for consideration of non-linearity in the propagation of state uncertainties. The Delta-Delta-V analysis approach re-optimizes perturbed SLS mission trajectories by varying key mission states in accordance with an assumed state error. The state error is developed from detailed vehicle 6-DOF Monte Carlo analysis or generated using covariance analysis. These perturbed trajectories are compared to a nominal trajectory to determine necessary TCM design. To implement this analysis approach, a tool set was developed which combines the functionality of a 3-DOF trajectory optimization tool, Copernicus, and a detailed 6-DOF vehicle simulation tool, Marshall Aerospace Vehicle Representation in C (MAVERIC). In addition to delta-v allocation constraints on SLS navigation performance, SLS mission requirement dictate successful upper stage disposal. Due to engine and propellant constraints, the SLS Exploration Upper Stage (EUS) must dispose into heliocentric space by means of a lunar fly-by maneuver. As with payload delta-v allocation, upper stage disposal maneuvers must place the EUS on a trajectory that maximizes the probability of achieving a heliocentric orbit post Lunar fly-by considering all sources of vehicle state uncertainty prior to the maneuver. To ensure disposal, the SLS navigation team has developed an analysis approach to derive optimal disposal guidance targets. This approach maximizes the state error covariance prior

Testing for the J-2X Upper Stage Engine

NASA Technical Reports Server (NTRS)

Buzzell, James C.

2010-01-01

NASA selected the J-2X Upper Stage Engine in 2006 to power the upper stages of the Ares I crew launch vehicle and the Ares V cargo launch vehicle. Based on the proven Saturn J-2 engine, this new engine will provide 294,000 pounds of thrust and a specific impulse of 448 seconds, making it the most efficient gas generator cycle engine in history. The engine's guiding philosophy emerged from the Exploration Systems Architecture Study (ESAS) in 2005. Goals established then called for vehicles and components based, where feasible, on proven hardware from the Space Shuttle, commercial, and other programs, to perform the mission and provide an order of magnitude greater safety. Since that time, the team has made unprecedented progress. Ahead of the other elements of the Constellation Program architecture, the team has progressed through System Requirements Review (SRR), System Design Review (SDR), Preliminary Design Review (PDR), and Critical Design Review (CDR). As of February 2010, more than 100,000 development engine parts have been ordered and more than 18,000 delivered. Approximately 1,300 of more than 1,600 engine drawings were released for manufacturing. A major factor in the J-2X development approach to this point is testing operations of heritage J-2 engine hardware and new J-2X components to understand heritage performance, validate computer modeling of development components, mitigate risk early in development, and inform design trades. This testing has been performed both by NASA and its J-2X prime contractor, Pratt & Whitney Rocketdyne (PWR). This body of work increases the likelihood of success as the team prepares for testing the J-2X powerpack and first development engine in calendar 2011. This paper will provide highlights of J-2X testing operations, engine test facilities, development hardware, and plans.

Upper gastrointestinal symptoms in patients with advanced cancer: relationship to nutritional and performance status.

PubMed

Bovio, G; Montagna, G; Bariani, C; Baiardi, P

2009-10-01

The goals of the study were to determine the relationship of upper gastrointestinal symptoms with nutritional status and to assess their association with performance status in patients with advanced cancer. We studied 143 patients (50 F, 93 M, mean age 68 +/- 11 years, mean body mass index 22.39 +/- 4.3 kg/m(2)). Assessed symptoms were the following: anorexia, nausea, vomiting, dysphagia for solids, dysphagia for liquids, xerostomia, hypogeusia, dysgeusia, hiccup and chewing disturbances. We determined anthropometric parameters, daily energy intake and serum albumin, prealbumin and transferrin. The most common upper gastrointestinal symptoms were xerostomia (73%), anorexia (49%) and chewing disturbances (40%). Fifty-four percent of patients had weight loss greater than 10%. Seventy-three patients (51%) had daily energy intake lower than their resting energy expenditure. Mean serum prealbumin, albumin and transferrin were below normal range. Mean Eastern Cooperative Oncology Group performance status scale was 3.1 +/- 0.49. Symptoms were often strongly correlated, and usually, patients experienced at least three upper gastrointestinal symptoms at the same time. Anorexia, nausea and vomiting were the symptoms mostly correlated with other symptoms. A correlation was found between vomiting and hiccup. Energy intake (EI) was the nutritional parameter mostly affected by upper gastrointestinal symptoms; moreover, EI is the most predictive factor of upper gastrointestinal symptoms, particularly xerostomia, anorexia and dysphagia for solids. Upper gastrointestinal symptoms are linked to nutritional parameters: In particular, energy intake represents the most predictive variable of symptom occurrence. The performance status is not affected by upper gastrointestinal symptoms. A rigorous nutritional assessment and the managing of upper gastrointestinal symptoms are crucial in patients with advanced cancer.

Experience of curing serious obstruction of advanced-stage upper digestive tract tumor using laser under endoscope

NASA Astrophysics Data System (ADS)

Mu, Hai-Bin; Zhang, Man-Ling; Zhang, Xiao-Qiang; Zhang, Feng-Qiu; Kong, De-Jia; Tang, Li-Bin

1998-11-01

The patients who suffer from upper digestive tract tumor, such as cancer of esophagus, cancer of cardia, all have serious obstruction and fail to get nutrition and can not bear the strike of the radiotherapy and chemotherapy. In order to reduce the obstruction symptom and suffering of the patients and to prolong their life time, since 1989, our hospital used the laser to cure the upper digestive tract tumor 11 cases with serious obstruction and got remarkable curative effect.

Infusing Training into the Documentation and Culture of Ares I Upper Stage Design and Manufacturing

NASA Technical Reports Server (NTRS)

Scott, David W.

2009-01-01

In roughly two years time, Marshall Space Flight Center's (MSFC) Mission Operations Laboratory (MOL) has incubated a personnel training and certification program for about 1000 learners and multiple phases of the Ares I Upper Stage (US) project. Previous MOL-developed training programs focused on about 100 learners with a focus on operations, and had enough full-time training staff to develop courseware and provide training administration. This paper discusses 1) how creation of a broad, structured training program unfolded as feedback from more narrowly defined tasks, 2) how training philosophy, development methods, and administration are being simplified and tailored so that many Upper Stage organizations can grow their own training yet maintain consistency, accountability, and traceability across the project, and 3) possibilities for interfacing with the production contractor's training system and staff.

Taming Liquid Hydrogen: The Centaur Upper Stage Rocket, 1958-2002

NASA Technical Reports Server (NTRS)

Dawson, Virginia P.; Bowles, Mark D.

2004-01-01

During its maiden voyage in May 1962, a Centaur upper stage rocket, mated to an Atlas booster, exploded 54 seconds after launch, engulfing the rocket in a huge fireball. Investigation revealed that Centaur's light, stainless-steel tank had split open, spilling its liquid-hydrogen fuel down its sides, where the flame of the rocket exhaust immediately ignited it. Coming less than a year after President Kennedy had made landing human beings on the Moon a national priority, the loss of Centaur was regarded as a serious setback for the National Aeronautics and Space Administration (NASA). During the failure investigation, Homer Newell, Director of Space Sciences, ruefully declared: "Taming liquid hydrogen to the point where expensive operational space missions can be committed to it has turned out to be more difficult than anyone supposed at the outset." After this failure, Centaur critics, led by Wernher von Braun, mounted a campaign to cancel the program. In addition to the unknowns associated with liquid hydrogen, he objected to the unusual design of Centaur. Like the Atlas rocket, Centaur depended on pressure to keep its paper-thin, stainless-steel shell from collapsing. It was literally inflated with its propellants like a football or balloon and needed no internal structure to give it added strength and stability. The so-called "pressure-stabilized structure" of Centaur, coupled with the light weight of its high- energy cryogenic propellants, made Centaur lighter and more powerful than upper stages that used conventional fuel. But, the critics argued, it would never become the reliable rocket that the United States needed.

Upper thermal tolerances of early life stages of freshwater mussels

USGS Publications Warehouse

Pandolfo, Tamara J.; Cope, W. Gregory; Arellano, Consuelo; Bringolf, Robert B.; Barnhart, M. Christopher; Hammer, E

2010-01-01

Freshwater mussels (order Unioniformes) fulfill an essential role in benthic aquatic communities, but also are among the most sensitive and rapidly declining faunal groups in North America. Rising water temperatures, caused by global climate change, industrial discharges, drought, or land development, could further challenge imperiled unionid communities. The aim of our study was to determine the upper thermal tolerances of the larval (glochidia) and juvenile life stages of freshwater mussels. Glochidia of 8 species of mussels were tested: Lampsilis siliquoidea, Potamilus alatus, Ligumia recta, Ellipsaria lineolata,Lasmigona complanata, Megalonaias nervosa, Alasmidonta varicosa, and Villosa delumbis. Seven of these species also were tested as juveniles. Survival trends were monitored while mussels held at 3 acclimation temperatures (17, 22, and 27°C) were exposed to a range of common and extreme water temperatures (20–42°C) in standard acute laboratory tests. The average median lethal temperature (LT50) among species in 24-h tests with glochidia was 31.6°C and ranged from 21.4 to 42.7°C. The mean LT50 in 96-h juvenile tests was 34.7°C and ranged from 32.5 to 38.8°C. Based on comparisons of LT50s, thermal tolerances differed among species for glochidia, but not for juveniles. Acclimation temperature did not affect thermal tolerance for either life stage. Our results indicate that freshwater mussels already might be living close to their upper thermal tolerances in some systems and, thus, might be at risk from rising environmental temperatures.

Lifetime Estimation of the Upper Stage of GSAT-14 in Geostationary Transfer Orbit.

PubMed

Jeyakodi David, Jim Fletcher; Sharma, Ram Krishan

2014-01-01

The combination of atmospheric drag and lunar and solar perturbations in addition to Earth's oblateness influences the orbital lifetime of an upper stage in geostationary transfer orbit (GTO). These high eccentric orbits undergo fluctuations in both perturbations and velocity and are very sensitive to the initial conditions. The main objective of this paper is to predict the reentry time of the upper stage of the Indian geosynchronous satellite launch vehicle, GSLV-D5, which inserted the satellite GSAT-14 into a GTO on January 05, 2014, with mean perigee and apogee altitudes of 170 km and 35975 km. Four intervals of near linear variation of the mean apogee altitude observed were used in predicting the orbital lifetime. For these four intervals, optimal values of the initial osculating eccentricity and ballistic coefficient for matching the mean apogee altitudes were estimated with the response surface methodology using a genetic algorithm. It was found that the orbital lifetime from these four time spans was between 144 and 148 days.

Lifetime Estimation of the Upper Stage of GSAT-14 in Geostationary Transfer Orbit

PubMed Central

Jeyakodi David, Jim Fletcher; Sharma, Ram Krishan

2014-01-01

The combination of atmospheric drag and lunar and solar perturbations in addition to Earth's oblateness influences the orbital lifetime of an upper stage in geostationary transfer orbit (GTO). These high eccentric orbits undergo fluctuations in both perturbations and velocity and are very sensitive to the initial conditions. The main objective of this paper is to predict the reentry time of the upper stage of the Indian geosynchronous satellite launch vehicle, GSLV-D5, which inserted the satellite GSAT-14 into a GTO on January 05, 2014, with mean perigee and apogee altitudes of 170 km and 35975 km. Four intervals of near linear variation of the mean apogee altitude observed were used in predicting the orbital lifetime. For these four intervals, optimal values of the initial osculating eccentricity and ballistic coefficient for matching the mean apogee altitudes were estimated with the response surface methodology using a genetic algorithm. It was found that the orbital lifetime from these four time spans was between 144 and 148 days. PMID:27437491

Advanced titration to treat a floppy epiglottis in selective upper airway stimulation.

PubMed

Heiser, Clemens

2016-09-01

The following report presents a case of a patient with high residual apnea-hypopnea index at 6 months following implantation of an upper airway stimulation device who improved significantly after advanced titration via drug-induced sedated endoscopy by changing the electrode configuration for stimulation from bipolar to monopolar. This case demonstrates the utility of postsurgical advanced titration to optimize programming settings for improved clinical outcomes. Laryngoscope, 126:S22-S24, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Solar thermal upper stage: Economic advantage and development status

NASA Technical Reports Server (NTRS)

Adams, Alan M.

1995-01-01

A solar thermal upper stage (STUS) is envisioned as a propulsive concept for the future. The STUS will be used for low Earth orbit (LEO) to geostationary-Earth orbit (GEO) transfer and for planetary exploration missions. The STUS offers significant performance gains over conventional chemical propulsion systems. These performance gains translate into a more economical, more efficient method of placing useful payloads in space and maximizing the benefits derived from space activity. This paper will discuss the economical advantages of an STUS compared to conventional chemical propulsion systems, the potential market for an STUS, and the recent activity in the development of an STUS. The results of this assessment combined with the performance gains, will provide a strong justification for the development of an STUS.

Initial Assessment of the Ares I-X Launch Vehicle Upper Stage to Vibroacoustic Flight Environments

NASA Technical Reports Server (NTRS)

Larko, Jeffrey M.; Hughes, William O.

2008-01-01

The Ares I launch vehicle will be NASA s first new launch vehicle since 1981. Currently in design, it will replace the Space Shuttle in taking astronauts to the International Space Station, and will eventually play a major role in humankind s return to the Moon and eventually to Mars. Prior to any manned flight of this vehicle, unmanned test readiness flights will be flown. The first of these readiness flights, named Ares I-X, is scheduled to be launched in April 2009. The NASA Glenn Research Center is responsible for the design, manufacture, test and analysis of the Ares I-X upper stage simulator (USS) element. As part of the design effort, the structural dynamic response of the Ares I-X launch vehicle to its vibroacoustic flight environments must be analyzed. The launch vehicle will be exposed to extremely high acoustic pressures during its lift-off and aerodynamic stages of flight. This in turn will cause high levels of random vibration on the vehicle's outer surface that will be transmitted to its interior. Critical flight equipment, such as its avionics and flight guidance components are susceptible to damage from this excitation. This study addresses the modelling, analysis and predictions from examining the structural dynamic response of the Ares I-X upper stage to its vibroacoustic excitations. A statistical energy analysis (SEA) model was used to predict the high frequency response of the vehicle at locations of interest. Key to this study was the definition of the excitation fields corresponding to lift off acoustics and the unsteady aerodynamic pressure fluctuations during flight. The predicted results will be used by the Ares I-X Project to verify the flight qualification status of the Ares I-X upper stage components.

ESC-B: The Cryogenic Upper Stage for Europe's Heavy Lift Launcher Ariane 5ECB

NASA Astrophysics Data System (ADS)

Juhls, A.

2002-01-01

-A. Juhls, Astrium GmbH -M. Lepelletier, Snecma Moteurs -JM. Bahu, CNES -C. Poincheval, CNES. In the year 1998 the European ministerial council decided to initiate the Ariane 5 Plus programme in order to upgrade the European heavy lift launcher Ariane 5. The market was changing more rapidly than predicted showing steadily growing satellite mass and the demand for flexible missions while strong competitors were intensifying their preparations to enter the commercial business. The answer was to improve the Ariane 5 launcher by modifying the cryogenic first (or lower ?) stage and the solid boosters and by introducing two cryogenic upper stages in two steps: In order to cope with the short term need of a significant growth of GTO lift capacity up to 10 t the first denoted ESC-A shall enter commercial service in 2002. Four years later a more powerful second version shall take over enabling a GTO performance of 12 t and providing versatile mission capability. The paper will focus on this new cryogenic upper stage denoted ESC-B giving first a general description of main characteristics and constituents. The article will highlight different challenging aspects of the ESC-B development: Ambitious economical conditions regarding both limited development budgets and the strong need to reduce production cost require improved working methods and an adjustment of the conventional development logic, in particular regarding new verification methods. Furthermore Europe is now facing the complex combination of versatile mission capability together with a powerful cryogenic upper stage. The paper will present the approach to define reasonable mission scenarios in order to cover customer demands while avoiding too stringent system requirements. Along with VINCI, Europe's first expander cycle type engine featuring an extendable nozzle dedicated subsystems will be described which allow 4 re-ignitions and 6 hours of ballistic flight. The paper concludes with the summary of the

Taming Liquid Hydrogen: The Centaur Upper Stage Rocket

NASA Technical Reports Server (NTRS)

Dawson, Virginia P.; Bowles, Mark D.

2004-01-01

The Centaur is one of the most powerful rockets in the world. As an upper-stage rocket for the Atlas and Titan boosters it has been a reliable workhorse for NASA for over forty years and has played an essential role in many of NASA's adventures into space. In this CD-ROM you will be able to explore the Centaur's history in various rooms to this virtual museum. Visit the "Movie Theater" to enjoy several video documentaries on the Centaur. Enter the "Interview Booth" to hear and read interviews with scientists and engineers closely responsible for building and operating the rocket. Go to the "Photo Gallery" to look at numerous photos of the rocket throughout its history. Wander into the "Centaur Library" to read various primary documents of the Centaur program. Finally, stop by the "Observation Deck" to watch a virtual Centaur in flight.

Operations analysis (study 2.1): Shuttle upper stage software requirements

NASA Technical Reports Server (NTRS)

Wolfe, R. R.

1974-01-01

An investigation of software costs related to space shuttle upper stage operations with emphasis on the additional costs attributable to space servicing was conducted. The questions and problem areas include the following: (1) the key parameters involved with software costs; (2) historical data for extrapolation of future costs; (3) elements of the basic software development effort that are applicable to servicing functions; (4) effect of multiple servicing on complexity of the operation; and (5) are recurring software costs significant. The results address these questions and provide a foundation for estimating software costs based on the costs of similar programs and a series of empirical factors.

Rectosigmoidian Involvement in Advanced-stage Ovarian Cancer - Intraoperative Decisions.

PubMed

Bacalbasa, Nicolae; Balescu, Irina; Dima, Simona

2017-01-01

Ovarian cancer remains one of the most commonly encountered malignancies affecting women worldwide, that is unfortunately commonly diagnosed in advanced stages of the disease. In these stages, the tumoral process usually involves the surrounding viscera throughout contiguity or induces the apparition of distant metastases via peritoneal, lymphatic or hematogenous spread, multiple resections being needed in order to achieve a good control of the disease. In the present study, we present a case series of 12 patients in whom various surgical procedures on the rectosigmoidian loop were performed in order to achieve debulking surgery to no residual disease. Digestive tract resections consisted of rectosigmoidian resection with left colostomy in three cases, low rectosigmoidian resections with anastomosis in eight cases and a stripping procedure of the peritoneal layer in one case. Due to the close proximity of the digestive and gynecological tract, advanced-stage ovarian tumors frequently involve the rectosigmoidian loop, imposing association of digestive tract surgical procedures. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Development of an innovative sandwich common bulkhead for cryogenic upper stage propellant tank

NASA Astrophysics Data System (ADS)

Szelinski, B.; Lange, H.; Röttger, C.; Sacher, H.; Weiland, S.; Zell, D.

2012-12-01

In the frame of the Future Launcher Preparatory Program (FLPP) investigating advancing technologies for the Next Generation of Launchers (NGL) a number of novel key technologies are presently under development for significantly improving vehicle performance in terms of payload capacity and mission versatility. As a respective ESA guided technology development program, Cryogenic Upper Stage Technologies (CUST) has been launched within FLPP that hosts among others the development of a common bulkhead to separate liquid hydrogen from the liquid oxygen compartment. In this context, MT Aerospace proposed an advanced sandwich design concept which is currently in the development phase reaching for TRL4 under MT Aerospace responsibility. Key components of this sandwich common bulkhead are a specific core material, situated in-between two thin aluminum face sheets, and an innovative thermal decoupling element at the equatorial region. The combination of these elements provides excellent thermal insulation capabilities and mechanical performance at a minimum weight, since mechanical and thermal functions are merged in the same component. This improvement is expressed by substantial performance figures of the proposed concept that include high resistance against reverse pressure, an optimized heat leak and minimized mass, involving the sandwich dome structure and the adjacent interface rings. The development of single sub-technologies, all contributing to maturate the sandwich common bulkhead towards the desired technology readiness level (TRL), is described in the context of the given design constraints as well as technical, functional and programmatic requirements, issued from the stage level. This includes the thermal and mechanical characterization of core materials, manufacturing issues as well as non-destructive testing and the thermal and structural analyses and dimensioning of the complete common bulkhead system. Dedicated TRL assessments in the Ariane 5 Mid

Appropriateness of advanced upper limb prosthesis prescription for a patient with cognitive impairment: a case report.

PubMed

Barredo, Jennifer; Acluche, Frantzy; Disla, Roxanne; Fantini, Christopher; Fishelis, Leah; Sasson, Nicole; Resnik, Linda

2017-08-01

To describe a participant with scapulo-thoracic amputation and cognitive impairment trained to use the DEKA Arm and discuss factors relevant to the determination that he was not an appropriate candidate for independent home use of the device. The participant underwent 40 h of in-laboratory training with the DEKA Arm Advanced Upper Limb Prosthesis. Pre-training neuropsychological measures of cognition were collected. Qualitative and quantitative data related to functional performance, quality of life and pain were collected after 10 h of training, and at the conclusion of training. Using a constant comparative approach, data were binned into major themes; elements within each theme were identified. Six themes were relevant to the determination that the participant was inappropriate for home use of the DEKA Arm: physical and mental health; learning, memory and cognition; adult role function; functional performance; user safety and judgement and capacity for independent device use. Issues contraindicating unsupervised device use included: uncontrolled health symptoms, poor knowledge application, safety concerns, absenteeism and performance degradation under stress. The findings have implications for training with and prescription of the DEKA Arm and other complex upper limb prostheses. Further research is needed to develop a model to guide prescription of technologically complex upper limb prostheses. Implications for Rehabilitation Advanced upper limb prostheses, like the DEKA Arm, promise greater functionality, but also may be cognitively demanding, raising questions of when, and if, prescription is appropriate for patients with cognitive impairment. At this time, no formal criteria exist to guide prescription of advanced upper limb prostheses. Each clinical team applies their own informal standards in decision-making. In this case report, we described six factors that were considered in determining whether or not a research participant, with scapulo

Racial/Ethnic, socioeconomic, and geographic disparities of cervical cancer advanced-stage diagnosis in Texas.

PubMed

Zhan, F Benjamin; Lin, Yan

2014-01-01

Advanced-stage diagnosis is among the primary causes of mortality among cervical cancer patients. With the wide use of Pap smear screening, cervical cancer advanced-stage diagnosis rates have decreased. However, disparities of advanced-stage diagnosis persist among different population groups. A challenging task in cervical cancer disparity reduction is to identify where underserved population groups are. Based on cervical cancer incidence data between 1995 and 2008, this study investigated advanced-stage cervical cancer disparities in Texas from three social domains: Race/ethnicity, socioeconomic status (SES), and geographic location. Effects of individual and contextual factors, including age, tumor grade, race/ethnicity, as well as contextual SES, spatial access to health care, sociocultural factors, percentage of African Americans, and insurance expenditures, on these disparities were examined using multilevel logistic regressions. Significant variations by race/ethnicity and SES were found in cervical cancer advanced-stage diagnosis. We also found a decline in racial/ethnic disparities of advanced cervical cancer diagnosis rate from 1995 to 2008. However, the progress was slower among African Americans than Hispanics. Geographic disparities could be explained by age, race/ethnicity, SES, and the percentage of African Americans in a census tract. Our findings have important implications for developing effective cervical cancer screening and control programs. We identified the location of underserved populations who need the most assistance with cervical cancer screening. Cervical cancer intervention programs should target Hispanics and African Americans, as well as individuals from communities with lower SES in geographic areas where higher advanced-stage diagnosis rates were identified in this study. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Risk Assessment Challenges in the Ares I Upper Stage

NASA Technical Reports Server (NTRS)

Stott, James E.; Ring, Robert W.; Elrada, Hassan A.; Hark, Frank

2007-01-01

NASA Marshall Space Flight Center (MSFC) is currently at work developing hardware and systems for the Ares I rocket that will send future astronauts into orbit. Built on cutting-edge launch technologies, evolved powerful Apollo and Space Shuttle propulsion elements, and decades of NASA spaceflight experience, Ares I is the essential core of a safe, reliable, cost-effective space transportation system -- one that will carry crewed missions back to the moon, on to Mars and out into the solar system. Ares I is an in-line, two-stage rocket configuration topped by the Orion crew vehicle and its launch abort system. In addition to the vehicle's primary mission -carrying crews of four to six astronauts to Earth orbit --Ares I may also use its 25-ton payload capacity to deliver resources and supplies to the International Space Station, or to "park" payloads in orbit for retrieval by other spacecraft bound for the moon or other destinations. Crew transportation to the International Space Station is planned to begin no later than 2014. The first lunar excursion is scheduled for the 2020 timeframe. This paper presents the challenges in designing the Ares I upper stage for reliability and safety while minimizing weight and maximizing performance.

Rectosigmoidian Involvement in Advanced-stage Ovarian Cancer – Intraoperative Decisions

PubMed Central

BACALBASA, NICOLAE; BALESCU, IRINA; DIMA, SIMONA

2017-01-01

Background/Aim: Ovarian cancer remains one of the most commonly encountered malignancies affecting women worldwide, that is unfortunately commonly diagnosed in advanced stages of the disease. In these stages, the tumoral process usually involves the surrounding viscera throughout contiguity or induces the apparition of distant metastases via peritoneal, lymphatic or hematogenous spread, multiple resections being needed in order to achieve a good control of the disease. Patients and Methods: In the present study, we present a case series of 12 patients in whom various surgical procedures on the rectosigmoidian loop were performed in order to achieve debulking surgery to no residual disease. Results: Digestive tract resections consisted of rectosigmoidian resection with left colostomy in three cases, low rectosigmoidian resections with anastomosis in eight cases and a stripping procedure of the peritoneal layer in one case. Conclusion: Due to the close proximity of the digestive and gynecological tract, advanced-stage ovarian tumors frequently involve the rectosigmoidian loop, imposing association of digestive tract surgical procedures. PMID:28882968

[Clinical Advanced in Early-stage ALK-positive Non-small Cell Lung Cancer Patients].

PubMed

Gao, Qiongqiong; Jiang, Xiangli; Huang, Chun

2017-02-20

Lung cancer is the leading cause of cancer death in China. Non-small cell lung cancer (NSCLC) accounts for 85% of lung cancer cases, with the majority of the cases diagnosed at the advanced stage. Molecular targeted therapy is becoming the focus attention for advanced NSCLC. Echinoderm microtubule-associated protein-like 4 gene and the anaplastic lymphoma kinase gene (EML4-ALK) is among the most common molecular targets of NSCLC; its specific small-molecule tyrosine kinase inhibitors (TKIs) are approved for use in advanced NSCLC cases of ALK-positive. However, the influence of EML4-ALK fusion gene on the outcome of early-stage NSCLC cases and the necessity of application of TKIs for early-stage ALK-positive NSCLC patients are still uncertain. In this paper, we summarized the progression of testing methods for ALK-positive NSCLC patients as well as clinicopathological implication, outcome, and necessity of application of TKIs for early-stage ALK-positive NSCLC patients.

Migration and winter distributions of canvasbacks staging on the Upper Mississippi River

USGS Publications Warehouse

Serie, J.R.; Trauger, D.L.; Sharp, D.E.

1983-01-01

Fall and winter distribution patterns of canvasbacks (Aythya valisineria) staging on the upper Mississippi River near LaCrosse, Wisconsin (navigational Pools 7 and 8) and Keokuk, Iowa (Pool 19) were studied during 1973-77. Sightings and recoveries obtained from 1,488 color-marked males during 1973-75 and 3,789 banded males and females during 1973-77 suggested 2 principal migration corridors: 1 extending eastward from Pools 7 and 8 to the eastern Great Lakes and southeast to the Mid-Atlantic Region and another southward from Pools 7 and 8 to the lower Mississippi Valley, Gulf Coast, and east Texas regions. These discrete populations stage concurrently on Pools 7 and 8 during the fall, but winter in different areas of the Atlantic, Mississippi, and Central flyways. Populations staging on Pool 19 were not discrete from those staging on Pools 7 and 8. A continual turnover of birds passing through these staging areas was indicated. Canvasbacks wintering in the Mississippi and Central flyways were widely dispersed among a variety of habitats, whereas canvasbacks wintering in the Atlantic Flyway were concentrated in a few traditional habitats. Canvasbacks exhibited strong fidelity to wintering areas. Distribution patterns and population attributes of canvasbacks during fall and winter may be explained by the predictability of natural foods and their ability to exploit these foods.

Research on advanced transportation systems

NASA Astrophysics Data System (ADS)

Nagai, Hirokazu; Hashimoto, Ryouhei; Nosaka, Masataka; Koyari, Yukio; Yamada, Yoshio; Noda, Keiichirou; Shinohara, Suetsugu; Itou, Tetsuichi; Etou, Takao; Kaneko, Yutaka

1992-08-01

An overview of the researches on advanced space transportation systems is presented. Conceptual study is conducted on fly back boosters with expendable upper stage rocket systems assuming a launch capacity of 30 tons and returning to the launch site by the boosters, and prospect of their feasibility is obtained. Reviews are conducted on subjects as follows: (1) trial production of 10 tons sub scale engines for the purpose of acquiring hardware data and picking up technical problems for full scale 100 tons thrust engines using hydrocarbon fuels; (2) development techniques for advanced liquid propulsion systems from the aspects of development schedule, cost; (3) review of conventional technologies, and common use of component; (4) oxidant switching propulsion systems focusing on feasibility of Liquefied Air Cycle Engine (LACE) and Compressed Air Cycle Engine (CACE); (5) present status of slosh hydrogen manufacturing, storage, and handling; (6) construction of small high speed dynamometer for promoting research on mini pump development; (7) hybrid solid boosters under research all over the world as low-cost and clean propulsion systems; and (8) high performance solid propellant for upper stage and lower stage propulsion systems.

Overview of the Main Propulsion System for the NASA Ares I Upper Stage

NASA Technical Reports Server (NTRS)

Quinn, Jason E.; Swanson, Luke A.

2009-01-01

A functional overview of the Main Propulsion System (MPS) of the NASA Ares I Upper Stage is provided. In addition to a simple overview of the key MPS functions and design philosophies, major lessons learned are discussed. The intent is to provide a technical overview with enough detail to allow engineers outside of the MPS Integrated Product Team (IPT) to develop a rough understanding of MPS operations, components, design philosophy, and lessons learned.

Solar Thermal Upper Stage Cryogen System Engineering Checkout Test

NASA Technical Reports Server (NTRS)

Olsen, A. D; Cady, E. C.; Jenkins, D. S.

1999-01-01

The Solar Thermal Upper Stage technology (STUSTD) program is a solar thermal propulsion technology program cooperatively sponsored by a Boeing led team and by NASA MSFC. A key element of its technology program is development of a liquid hydrogen (LH2) storage and supply system which employs multi-layer insulation, liquid acquisition devices, active and passive thermodynamic vent systems, and variable 40W tank heaters to reliably provide near constant pressure H2 to a solar thermal engine in the low-gravity of space operation. The LH2 storage and supply system is designed to operate as a passive, pressure fed supply system at a constant pressure of about 45 psia. During operation of the solar thermal engine over a small portion of the orbit the LH2 storage and supply system propulsively vents through the enjoy at a controlled flowrate. During the long coast portion of the orbit, the LH2 tank is locked up (unvented). Thus, all of the vented H2 flow is used in the engine for thrust and none is wastefully vented overboard. The key to managing the tank pressure and therefore the H2 flow to the engine is to manage and balance the energy flow into the LH2 tank with the MLI and tank heaters with the energy flow out of the LH2 tank through the vented H2 flow. A moderate scale (71 cu ft) LH2 storage and supply system was installed and insulated at the NASA MSFC Test Area 300. The operation of the system is described in this paper. The test program for the LH2 system consisted of two parts: 1) a series of engineering tests to characterize the performance of the various components in the system: and 2) a 30-day simulation of a complete LEO and GEO transfer mission. This paper describes the results of the engineering tests, and correlates these results with analytical models used to design future advanced Solar Orbit Transfer Vehicles.

Upper airway changes in syndromic craniosynostosis patients following midface or monobloc advancement: correlation between volume changes and respiratory outcome.

PubMed

Nout, Erik; Bannink, Natalja; Koudstaal, Maarten J; Veenland, Jifke F; Joosten, Koen F M; Poublon, Rene M L; van der Wal, Karel G H; Mathijssen, Irene M J; Wolvius, Eppo B

2012-04-01

In syndromic craniosynostosis patients, respiratory insufficiency may be a pressing indication to surgically increase the patency of the upper airway by midface or monobloc advancement. In this study the volume changes of the upper airway and the respiratory outcome following midface (Le Fort I or III) or monobloc advancement in ten syndromic craniosynostosis patients are evaluated. Pre- and postoperatively, the airway volume was measured using a semi-automatic region growing method. Respiratory data were correlated to the volume measurements. In nine patients the outcome of upper airway volume measurements correlated well to the respiratory outcome. Three of these patients showed a minimal airway volume gain or even volume loss, and no respiratory improvement was found. In one monobloc patient improvement of the respiratory outcome without an evident volume gain of the upper airway was found. The majority of patients with Le Fort III advancement showed respiratory improvement, which for the greater part correlated to the results of the volume analysis. In monobloc patients the respiratory outcomes and volume measurements were less obvious. Preoperative endoscopy of the upper airway is advocated to identify the level of obstruction in patients with residual obstructive sleep apnoea. Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Subscale Carbon-Carbon Nozzle Extension Development and Hot Fire Testing in Support of Upper Stage Liquid Rocket Engines

NASA Technical Reports Server (NTRS)

Gradl, Paul; Valentine, Peter; Crisanti, Matthew; Greene, Sandy Elam

2016-01-01

Upper stage and in-space liquid rocket engines are optimized for performance through the use of high area ratio nozzles to fully expand combustion gases to low exit pressures increasing exhaust velocities. Due to the large size of such nozzles and the related engine performance requirements, carbon-carbon (C/C) composite nozzle extensions are being considered for use in order to reduce weight impacts. NASA and industry partner Carbon-Carbon Advanced Technologies (C-CAT) are working towards advancing the technology readiness level of large-scale, domestically-fabricated, C/C nozzle extensions. These C/C extensions have the ability to reduce the overall costs of extensions relative to heritage metallic and composite extensions and to decrease weight by 50%. Material process and coating developments have advanced over the last several years, but hot fire testing to fully evaluate C/C nozzle extensions in relevant environments has been very limited. NASA and C-CAT have designed, fabricated and hot fire tested multiple subscale nozzle extension test articles of various C/C material systems, with the goal of assessing and advancing the manufacturability of these domestically producible materials as well as characterizing their performance when subjected to the typical environments found in a variety of liquid rocket and scramjet engines. Testing at the MSFC Test Stand 115 evaluated heritage and state-of-the-art C/C materials and coatings, demonstrating the capabilities of the high temperature materials and their fabrication methods. This paper discusses the design and fabrication of the 1.2k-lbf sized carbon-carbon nozzle extensions, provides an overview of the test campaign, presents results of the hot fire testing, and discusses potential follow-on development work.

Post-operative radiation therapy for advanced-stage oropharyngeal cancer.

PubMed

Hansen, Eric; Panwala, Kathryn; Holland, John

2002-11-01

Between 1985 and 1999, 43 patients with locally-advanced, resectable oropharyngeal cancer were treated with combined surgery and post-operative radiation therapy (RT) at Oregon Health and Science University. Five patients (12 per cent) had Stage III disease and 38 patients (88 per cent) had Stage IV disease. All patients had gross total resections of the primary tumour. Thirty-seven patients had neck dissections for regional disease. RT consisted of a mean tumour-bed dose of 63.0 Gy delivered in 1.8-2.0 Gy fractions over a mean of 49 days. At three- and five-years, the actuarial local control was 96 per cent and the actuarial local/regional control was 80 per cent. The three- and five-year actuarial rates of distant metastases were 41 per cent and 46 per cent, respectively. The actuarial overall survival at three- and five-years was 41 per cent and 34 per cent, respectively. The actuarial rates of progression-free survival were 49 per cent at three-years and 45 per cent at five years. Combined surgery and post-operative RT for advanced-stage oropharyngeal cancer results in excellent local/regional control. This particular group of patients experienced a high-rate of developing distant metastases.

Safety and Mission Assurance for In-House Design Lessons Learned from Ares I Upper Stage

NASA Technical Reports Server (NTRS)

Anderson, Joel M.

2011-01-01

This viewgraph presentation identifies lessons learned in the course of the Ares I Upper Stage design and in-house development effort. The contents include: 1) Constellation Organization; 2) Upper Stage Organization; 3) Presentation Structure; 4) Lesson-Importance of Systems Engineering/Integration; 5) Lesson-Importance of Early S&MA Involvement; 6) Lesson-Importance of Appropriate Staffing Levels; 7) Lesson-Importance S&MA Team Deployment; 8) Lesson-Understanding of S&MA In-Line Engineering versus Assurance; 9) Lesson-Importance of Close Coordination between Supportability and Reliability/Maintainability; 10) Lesson-Importance of Engineering Data Systems; 11) Lesson-Importance of Early Development of Supporting Databases; 12) Lesson-Importance of Coordination with Safety Assessment/Review Panels; 13) Lesson-Implementation of Software Reliability; 14) Lesson-Implementation of S&MA Technical Authority/Chief S&MA Officer; 15) Lesson-Importance of S&MA Evaluation of Project Risks; 16) Lesson-Implementation of Critical Items List and Government Mandatory Inspections; 17) Lesson-Implementation of Critical Items List Mandatory Inspections; 18) Lesson-Implementation of Test Article Safety Analysis; and 19) Lesson-Importance of Procurement Quality.

Reduced upper obstructions in N3 and increased lower obstructions in REM sleep stage detected with manometry.

PubMed

Wirth, Markus; Schramm, Juliane; Bautz, Maximilian; Hofauer, Benedikt; Edenharter, Günther; Ott, Armin; Heiser, Clemens

2018-01-01

In obstructive sleep apnea (OSA), airway obstruction occurs at different anatomic levels. The frequency and location of obstructions play a crucial role in the planning of surgical treatment. The aim of this study was to evaluate the pharyngeal obstruction levels in different sleep stages with manometry in OSA patients. In addition, the manometry results were compared with drug-induced sleep endoscopy (DISE). Forty-one patients with OSA received manometry measurements during one night of sleep. All patients were simultaneously evaluated with polysomnography. The frequency of obstructions in different sleep stages was assessed. Twenty patients were additionally studied with DISE. Obstruction levels detected with manometry were compared with DISE. The frequency of upper and to a lesser extent lower obstructions decreased in sleep stage N3. In rapid eye movement (REM) sleep, lower obstructions increased. The overall proportion of upper and lower obstructions detected with manometry corresponded with DISE in 13 of 20 cases. A significant change in the obstruction levels was detected with manometry in N3 and REM sleep. The reduction of both upper and to a lesser extent lower obstructions in N3 suggests more stable airways in slow-wave sleep. Relevant lower obstructions were not detected in DISE compared to manometry in 5 out of 20 examinations. This could be a potential reason for treatment failure of site-specific surgical OSA treatment when only performing DISE preoperatively. Therefore, manometry could be a useful complementary tool in the preoperative evaluation for OSA.

Fertility-sparing surgery in advanced stage malignant ovarian germ cell tumor: a case report.

PubMed

Ghalleb, Montassar; Bouzaiene, Hatem; Slim, Skander; Hadiji, Achraf; Hechiche, Monia; Ben Hassouna, Jamel; Rahal, Khaled

2017-12-17

Malignant ovarian germ cell tumor is a rare type of disease, which generally has a good prognosis due to the high chemosensitivity of this type of tumor. Fertility preservation is an important issue because malignant ovarian germ cell tumor commonly affects young women. Although conservation is the standard for early stage, it becomes more debatable as the disease progresses to more advanced stages. Report the case of a patient with an International Federation of Gynecology and Obstetrics Stage IIIc malignant ovarian germ cell tumor, who had conservative surgery and chemotherapy with a good fertility outcome. A 23-year-old North African woman with a left malignant ovarian germ cell tumor stage IIIc was treated by left adnexectomy and omentectomy followed by chemotherapy. A 15-year follow-up showed no signs of relapse, and she completed three full-term natural pregnancies. Malignant ovarian germ cell tumor is a rare ovarian tumor with a good prognosis. It is usually associated with a good fertility outcome in early stages. However, due to the rarity of the disease in advanced stages, the fertility outcome for this group of patients is not clear. This lack of data surrounding advanced stages points to the need for a meta-analysis of all published cases.

Pilot study of psilocybin treatment for anxiety in patients with advanced-stage cancer.

PubMed

Grob, Charles S; Danforth, Alicia L; Chopra, Gurpreet S; Hagerty, Marycie; McKay, Charles R; Halberstadt, Adam L; Greer, George R

2011-01-01

Researchers conducted extensive investigations of hallucinogens in the 1950s and 1960s. By the early 1970s, however, political and cultural pressures forced the cessation of all projects. This investigation reexamines a potentially promising clinical application of hallucinogens in the treatment of anxiety reactive to advanced-stage cancer. To explore the safety and efficacy of psilocybin in patients with advanced-stage cancer and reactive anxiety. A double-blind, placebo-controlled study of patients with advanced-stage cancer and anxiety, with subjects acting as their own control, using a moderate dose (0.2 mg/kg) of psilocybin. A clinical research unit within a large public sector academic medical center. Twelve adults with advanced-stage cancer and anxiety. In addition to monitoring safety and subjective experience before and during experimental treatment sessions, follow-up data including results from the Beck Depression Inventory, Profile of Mood States, and State-Trait Anxiety Inventory were collected unblinded for 6 months after treatment. Safe physiological and psychological responses were documented during treatment sessions. There were no clinically significant adverse events with psilocybin. The State-Trait Anxiety Inventory trait anxiety subscale demonstrated a significant reduction in anxiety at 1 and 3 months after treatment. The Beck Depression Inventory revealed an improvement of mood that reached significance at 6 months; the Profile of Mood States identified mood improvement after treatment with psilocybin that approached but did not reach significance. This study established the feasibility and safety of administering moderate doses of psilocybin to patients with advanced-stage cancer and anxiety. Some of the data revealed a positive trend toward improved mood and anxiety. These results support the need for more research in this long-neglected field. clinicaltrials.gov Identifier: NCT00302744.

Development of the arterial pattern in the upper limb of staged human embryos: normal development and anatomic variations

PubMed Central

RODRÍGUEZ-NIEDENFÜHR, M.; BURTON, G. J.; DEU, J.; SAÑUDO, J. R.

2001-01-01

A total of 112 human embryos (224 upper limbs) between stages 12 and 23 of development were examined. It was observed that formation of the arterial system in the upper limb takes place as a dual process. An initial capillary plexus appears from the dorsal aorta during stage 12 and develops at the same rate as the limb. At stage 13, the capillary plexus begins a maturation process involving the enlargement and differentiation of selected parts. This remodelling process starts in the aorta and continues in a proximal to distal sequence. By stage 15 the differentiation has reached the subclavian and axillary arteries, by stage 17 it has reached the brachial artery as far as the elbow, by stage 18 it has reached the forearm arteries except for the distal part of the radial, and finally by stage 21 the whole arterial pattern is present in its definitive morphology. This differentiation process parallels the development of the skeletal system chronologically. A number of arterial variations were observed, and classified as follows: superficial brachial (7.7%), accessory brachial (0.6%), brachioradial (14%), superficial brachioulnar (4.7%), superficial brachioulnoradial (0.7%), palmar pattern of the median (18.7%) and superficial brachiomedian (0.7%) arteries. They were observed in embryos belonging to stages 17–23 and were not related to a specific stage of development. Statistical comparison with the rates of variations reported in adults did not show significant differences. It is suggested that the variations arise through the persistence, enlargement and differentiation of parts of the initial network which would normally remain as capillaries or even regress. PMID:11693301

Effects of virtual reality training with modified constraint-induced movement therapy on upper extremity function in acute stage stroke: a preliminary study.

PubMed

Ji, Eun-Kyu; Lee, Sang-Heon

2016-11-01

[Purpose] The purpose of this study was to investigate the effects of virtual reality training combined with modified constraint-induced movement therapy on upper extremity motor function recovery in acute stage stroke patients. [Subjects and Methods] Four acute stage stroke patients participated in the study. A multiple baseline single subject experimental design was utilized. Modified constraint-induced movement therapy was used according to the EXplaining PLastICITy after stroke protocol during baseline sessions. Virtual reality training with modified constraint-induced movement therapy was applied during treatment sessions. The Manual Function Test and the Box and Block Test were used to measure upper extremity function before every session. [Results] The subjects' upper extremity function improved during the intervention period. [Conclusion] Virtual reality training combined with modified constraint-induced movement is effective for upper extremity function recovery in acute stroke patients.

Hot-Fire Test of Liquid Oxygen/Hydrogen Space Launch Mission Injector Applicable to Exploration Upper Stage

NASA Technical Reports Server (NTRS)

Barnett, Greg; Turpin, Jason; Nettles, Mindy

2015-01-01

This task is to hot-fire test an existing Space Launch Mission (SLM) injector that is applicable for all expander cycle engines being considered for the exploration upper stage. The work leverages investment made in FY 2013 that was used to additively manufacture three injectors (fig. 1) all by different vendors..

Advanced Low-Noise Research Fan Stage Design

NASA Technical Reports Server (NTRS)

Neubert, Robert; Bock, Larry; Malmborg, Eric; Owen-Peer, William

1997-01-01

This report describes the design of the Advanced Low-Noise Research Fan stage. The fan is a variable pitch design, which is designed at the cruise pitch condition. Relative to the cruise setting, the blade is closed at takeoff and opened for reverse thrust operation. The fan stage is a split flow design with fan exit guide vanes (FEGVs) and core stators. The fan stage design is combined with a nacelle and engine core duct to form a powered fan/nacelle subscale model. This model is intended for use in combined aerodynamic, acoustic, and structural testing in a wind tunnel. The fan has an outer diameter of 22 in. and a hub-to-tip of 0.426 in., which allows the use of existing NASA fan and cowl force balance and rig drive systems. The design parameters were selected to permit valid acoustic and aerodynamic comparisons with the Pratt & Whitney (P&W) 17- and 22-in. rigs previously tested under NASA contract. The fan stage design is described in detail. The results of the design axisymmetric and Navier-Stokes aerodynamic analysis are presented at the critical design conditions. The structural analysis of the fan rotor and attachment is included. The blade and attachment are predicted to have adequate low-cycle fatigue life and an acceptable operating range without resonant stress or flutter. The stage was acoustically designed with airfoil counts in the FEGV and core stator to minimize noise. A fan/FEGV tone analysis developed separately under NASA contract was used to determine the optimum airfoil counts. The fan stage was matched to the existing nacelle, designed under the previous P&W low-noise contract, to form a fan/nacelle model for wind tunnel testing. It is an axisymmetric nacelle for convenience in testing and analysis. Previous testing confirmed that the nacelle performed as required at various aircraft operating conditions.

Palliative management of malignant upper urinary tract obstruction

PubMed Central

Sountoulides, P; Mykoniatis, I; Dimasis, N

2014-01-01

Malignancies of the genitourinary tract are diagnosed with increased frequency compared to the past. Currently prostate and bladder cancer account for the majority of urological malignancies. While for prostate cancer recent developments in the management of local and metastatic disease are likely to lead the majority of patients to either cure from the disease or to longer survival time, for bladder cancer advanced disease will unfortunately lead to death within months. However, the common clinical scenario in both prostate and bladder cancer includes, in high incidence, upper urinary tract obstruction in the advanced stages of these malignancies. This coupled with the fact that average life expectancy in the western world is increasing, will result in a significant patient population with either advanced, non-curable disease or with problems related to the received therapeutic surgical or medical interventions. There is no doubt that in both circumstances the room and role of palliation therapy is increasing. The care of patients with advanced urologic malignancies requires a multi-disciplinary effort from physicians of many specialties under the guiding role of the treating urologist. This review focuses on currently available palliative therapeutic options for upper urinary tract obstruction in the setting of patients with advanced malignancies of the urinary tract, as recently significant advancements have been witnessed in this field. PMID:26052193

Palliative management of malignant upper urinary tract obstruction.

PubMed

Sountoulides, P; Mykoniatis, I; Dimasis, N

2014-01-01

Malignancies of the genitourinary tract are diagnosed with increased frequency compared to the past. Currently prostate and bladder cancer account for the majority of urological malignancies. While for prostate cancer recent developments in the management of local and metastatic disease are likely to lead the majority of patients to either cure from the disease or to longer survival time, for bladder cancer advanced disease will unfortunately lead to death within months. However, the common clinical scenario in both prostate and bladder cancer includes, in high incidence, upper urinary tract obstruction in the advanced stages of these malignancies. This coupled with the fact that average life expectancy in the western world is increasing, will result in a significant patient population with either advanced, non-curable disease or with problems related to the received therapeutic surgical or medical interventions. There is no doubt that in both circumstances the room and role of palliation therapy is increasing. The care of patients with advanced urologic malignancies requires a multi-disciplinary effort from physicians of many specialties under the guiding role of the treating urologist. This review focuses on currently available palliative therapeutic options for upper urinary tract obstruction in the setting of patients with advanced malignancies of the urinary tract, as recently significant advancements have been witnessed in this field.

Epistaxis in end stage liver disease masquerading as severe upper gastrointestinal hemorrhage.

PubMed

Camus, Marine; Jensen, Dennis M; Matthews, Jason D; Ohning, Gordon V; Kovacs, Thomas O; Jutabha, Rome; Ghassemi, Kevin A; Machicado, Gustavo A; Dulai, Gareth S

2014-10-14

To describe the prevalence, diagnosis, treatment, and outcomes of end stage liver disease (ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage (UGIH). This observational single center study included all consecutive patients with ESLD and epistaxis identified from consecutive subjects hospitalized with suspected UGIH and prospectively enrolled in our databases of severe UGIH between 1998 and 2011. A total of 1249 patients were registered for severe UGIH in the data basis, 461 (36.9%) were cirrhotics. Epistaxis rather than UGIH was the bleeding source in 20 patients. All patients had severe coagulopathy. Epistaxis was initially controlled in all cases. Fifteen (75%) subjects required posterior nasal packing and 2 (10%) embolization in addition to correction of coagulopathy. Five (25%) patients died in the hospital, 12 (60%) received orthotopic liver transplantation (OLT), and 3 (15%) were discharged without OLT. The mortality rate was 63% in patients without OLT. Severe epistaxis in patients with ESLD is (1) a diagnosis of exclusion that requires upper endoscopy to exclude severe UGIH; and (2) associated with a high mortality rate in patients not receiving OLT.

Preliminary Performance of Lithium-ion Cell Designs for Ares I Upper Stage Applications

NASA Technical Reports Server (NTRS)

Miller, Thomas B.; Reid, Concha M.; Kussmaul, Michael T.

2011-01-01

NASA's Ares I Crew Launch Vehicle (CLV) baselined lithium-ion technology for the Upper Stage (US). Under this effort, the NASA Glenn Research Center investigated three different aerospace lithium-ion cell suppliers to assess the performance of the various lithium-ion cell designs under acceptance and characterization testing. This paper describes the overall testing approaches associated with lithium-ion cells, their ampere-hour capacity as a function of temperature and discharge rates, as well as their performance limitations for use on the Ares I US vehicle.

Advanced expander test bed engine

NASA Technical Reports Server (NTRS)

Mitchell, J. P.

1992-01-01

The Advanced Expander Test Bed (AETB) is a key element in NASA's Space Chemical Engine Technology Program for development and demonstration of expander cycle oxygen/hydrogen engine and advanced component technologies applicable to space engines as well as launch vehicle upper stage engines. The AETB will be used to validate the high pressure expander cycle concept, study system interactions, and conduct studies of advanced mission focused components and new health monitoring techniques in an engine system environment. The split expander cycle AETB will operate at combustion chamber pressures up to 1200 psia with propellant flow rates equivalent to 20,000 lbf vacuum thrust.

Ares I Upper Stage Pressure Tests in Wind Tunnel

NASA Technical Reports Server (NTRS)

2007-01-01

Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. In this HD video image, the first stage reentry 1/2% model is undergoing pressure measurements inside the wind tunnel testing facility at MSFC. (Highest resolution available)

Cognitive predictors of skilled performance with an advanced upper limb multifunction prosthesis: a preliminary analysis.

PubMed

Hancock, Laura; Correia, Stephen; Ahern, David; Barredo, Jennifer; Resnik, Linda

2017-07-01

Purpose The objectives were to 1) identify major cognitive domains involved in learning to use the DEKA Arm; 2) specify cognitive domain-specific skills associated with basic versus advanced users; and 3) examine whether baseline memory and executive function predicted learning. Method Sample included 35 persons with upper limb amputation. Subjects were administered a brief neuropsychological test battery prior to start of DEKA Arm training, as well as physical performance measures at the onset of, and following training. Multiple regression models controlling for age and including neuropsychological tests were developed to predict physical performance scores. Prosthetic performance scores were divided into quartiles and independent samples t-tests compared neuropsychological test scores of advanced scorers and basic scorers. Baseline neuropsychological test scores were used to predict change in scores on physical performance measures across time. Results Cognitive domains of attention and processing speed were statistically significantly related to proficiency of DEKA Arm use and predicted level of proficiency. Conclusions Results support use of neuropsychological tests to predict learning and use of a multifunctional prosthesis. Assessment of cognitive status at the outset of training may help set expectations for the duration and outcomes of treatment. Implications for Rehabilitation Cognitive domains of attention and processing speed were significantly related to level of proficiencyof an advanced multifunctional prosthesis (the DEKA Arm) after training. Results provide initial support for the use of neuropsychological tests to predict advanced learningand use of a multifunctional prosthesis in upper-limb amputees. Results suggest that assessment of patients' cognitive status at the outset of upper limb prosthetictraining may, in the future, help patients, their families and therapists set expectations for theduration and intensity of training and may help set

Design and Analysis of a Turbopump for a Conceptual Expander Cycle Upper-Stage Engine

NASA Technical Reports Server (NTRS)

Dorney, Daniel J.; Rothermel, Jeffry; Griffin, Lisa W.; Thornton, Randall J.; Forbes, John C.; Skelly, Stephen E.; Huber, Frank W.

2006-01-01

As part of the development of technologies for rocket engines that will power spacecraft to the Moon and Mars, a program was initiated to develop a conceptual upper stage engine with wide flow range capability. The resulting expander cycle engine design employs a radial turbine to allow higher pump speeds and efficiencies. In this paper, the design and analysis of the pump section of the engine are discussed. One-dimensional meanline analyses and three-dimensional unsteady computational fluid dynamics simulations were performed for the pump stage. Configurations with both vaneless and vaned diffusers were investigated. Both the meanline analysis and computational predictions show that the pump will meet the performance objectives. Additional details describing the development of a water flow facility test are also presented.

Incentivizing advanced mathematics study at upper secondary level: the case of bonus points in Ireland

NASA Astrophysics Data System (ADS)

Treacy, Páraic Thomas

2018-04-01

Secondary level mathematics education in Ireland has recently experienced a period of significant change with the introduction of new curricula and the addition of an incentive to study upper secondary mathematics at the most advanced level (Higher Level). This incentive, typically referred to as 'bonus points', appears to have aided a significant increase in the number of students studying upper secondary mathematics at Higher Level. However, thematic analysis of interviews with experienced upper secondary mathematics examiners and exploration of mathematics diagnostic test data outlined in this paper suggest that the difficulty of the Higher Level upper secondary mathematics final examination in Ireland has reduced since the introduction of the bonus points initiative. The sharp increase in students attempting this examination coupled with a policy of maintaining a consistent proportion of students achieving passing grades was identified as a key reason for this possible reduction in standards.

Clinical and Cost Implications of Universal Versus Locally Advanced-Stage and Advanced-Stage-Only Molecular Testing for Epidermal Growth Factor Receptor Mutations and Anaplastic Lymphoma Kinase Rearrangements in Non-Small Cell Lung Carcinoma: A Tertiary Academic Institution Experience.

PubMed

Sauter, Jennifer L; Butnor, Kelly J

2016-04-01

Although epidermal growth factor receptor (EGFR)- and anaplastic lymphoma kinase (ALK)-directed therapies are not approved for patients with early-stage non-small cell lung carcinoma (NSCLC), many institutions perform EGFR and ALK testing for all patients with NSCLC at the time of initial diagnosis. Current consensus guidelines recommend EGFR testing and suggest ALK testing at the time of initial diagnosis for patients with advanced disease. To examine the cost and clinical impact of EGFR and ALK testing of patients with early-stage NSCLC. Records from all patients with a diagnosis of NSCLC made on a nonresection specimen at our institution during a single calendar year (2012) were reviewed, and a cost analysis was performed. Of 133 total patients, 47 (35%) had early-stage (stage I or II) disease and 86 (65%) had locally advanced (stage III) or advanced (stage IV) disease at presentation. Eight of 47 patients with early-stage disease (17%) had progression/recurrence during 18 to 30 months of follow-up, 6 of 8 (75%) of whom had pathologic confirmation of progression/recurrence. The estimated additional cost of EGFR and ALK testing for all newly diagnosed patients with NSCLC at our institution is $75,200 per year, compared to testing only patients with locally advanced and advanced-stage disease. The cost of universal molecular testing of NSCLC is substantial. EGFR and ALK testing of patients with early-stage disease appears to have negligible clinical impact, as most patients do not have disease recurrence/progression. Those whose disease recurs/progresses typically undergo rebiopsy. Our findings do not support the practice of universal EGFR and ALK testing in NSCLC at the time of initial diagnosis.

Epistaxis in end stage liver disease masquerading as severe upper gastrointestinal hemorrhage

PubMed Central

Camus, Marine; Jensen, Dennis M; Matthews, Jason D; Ohning, Gordon V; Kovacs, Thomas O; Jutabha, Rome; Ghassemi, Kevin A; Machicado, Gustavo A; Dulai, Gareth S

2014-01-01

AIM: To describe the prevalence, diagnosis, treatment, and outcomes of end stage liver disease (ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage (UGIH). METHODS: This observational single center study included all consecutive patients with ESLD and epistaxis identified from consecutive subjects hospitalized with suspected UGIH and prospectively enrolled in our databases of severe UGIH between 1998 and 2011. RESULTS: A total of 1249 patients were registered for severe UGIH in the data basis, 461 (36.9%) were cirrhotics. Epistaxis rather than UGIH was the bleeding source in 20 patients. All patients had severe coagulopathy. Epistaxis was initially controlled in all cases. Fifteen (75%) subjects required posterior nasal packing and 2 (10%) embolization in addition to correction of coagulopathy. Five (25%) patients died in the hospital, 12 (60%) received orthotopic liver transplantation (OLT), and 3 (15%) were discharged without OLT. The mortality rate was 63% in patients without OLT. CONCLUSION: Severe epistaxis in patients with ESLD is (1) a diagnosis of exclusion that requires upper endoscopy to exclude severe UGIH; and (2) associated with a high mortality rate in patients not receiving OLT. PMID:25320538

Advanced transportation system studies technical area 3: Alternate propulsion subsystem concepts, volume 3

NASA Technical Reports Server (NTRS)

Levak, Daniel

1993-01-01

The objective of this contract was to provide definition of alternate propulsion systems for both earth-to-orbit (ETO) and in-space vehicles (upper stages and space transfer vehicles). For such propulsion systems, technical data to describe performance, weight, dimensions, etc. was provided along with programmatic information such as cost, schedule, needed facilities, etc. Advanced technology and advanced development needs were determined and provided. This volume separately presents the various program cost estimates that were generated under three tasks: the F-1A Restart Task, the J-2S Restart Task, and the SSME Upper Stage Use Task. The conclusions, technical results, and the program cost estimates are described in more detail in Volume 1 - Executive Summary and in individual Final Task Reports.

Ares I-X Upper Stage Simulator Compartment Pressure Comparisons During Ascent

NASA Technical Reports Server (NTRS)

Downs. William J.; Kirchner, Robert D.; McLachlan, Blair G.; Hand, Lawrence A.; Nelson, Stuart L.

2011-01-01

Predictions of internal compartment pressures are necessary in the design of interstage regions, systems tunnels, and protuberance covers of launch vehicles to assess potential burst and crush loading of the structure. History has proven that unexpected differential pressure loads can lead to catastrophic failure. Pressures measured in the Upper Stage Simulator (USS) compartment of Ares I-X during flight were compared to post-flight analytical predictions using the CHCHVENT chamber-to-chamber venting analysis computer program. The measured pressures were enveloped by the analytical predictions for most of the first minute of flight but were outside of the predictions thereafter. This paper summarizes the venting system for the USS, discusses the probable reasons for the discrepancies between the measured and predicted pressures, and provides recommendations for future flight vehicles.

Nomogram for suboptimal cytoreduction at primary surgery for advanced stage ovarian cancer.

PubMed

Gerestein, Cornelis G; Eijkemans, Marinus J; Bakker, Jeanette; Elgersma, Otto E; van der Burg, Maria E L; Kooi, Geertruida S; Burger, Curt W

2011-11-01

Maximal cytoreduction to minimal residual tumor is the most important determinant of prognosis in patients with advanced stage epithelial ovarian cancer (EOC). Preoperative prediction of suboptimal cytoreduction, defined as residual tumor >1 cm, could guide treatment decisions and improve counseling. The objective of this study was to identify predictive computed tomographic (CT) scan and clinical parameters for suboptimal cytoreduction at primary cytoreductive surgery for advanced stage EOC and to generate a nomogram with the identified parameters, which would be easy to use in daily clinical practice. Between October 2005 and December 2008, all patients with primary surgery for suspected advanced stage EOC at six participating teaching hospitals in the South Western part of the Netherlands entered the study protocol. To investigate independent predictors of suboptimal cytoreduction, a Cox proportional hazard model with backward stepwise elimination was utilized. One hundred and fifteen patients with FIGO stage III/IV EOC entered the study protocol. Optimal cytoreduction was achieved in 52 (45%) patients. A suboptimal cytoreduction was predicted by preoperative blood platelet count (p=0.1990; odds ratio (OR)=1.002), diffuse peritoneal thickening (DPT) (p=0.0074; OR=3.021), and presence of ascites on at least two thirds of CT scan slices (p=0.0385; OR=2.294) with a for-optimism corrected c-statistic of 0.67. Suboptimal cytoreduction was predicted by preoperative platelet count, DPT and presence of ascites. The generated nomogram can, after external validation, be used to estimate surgical outcome and to identify those patients, who might benefit from alternative treatment approaches.

Pretreatment tables predicting pathologic stage of locally advanced prostate cancer.

PubMed

Joniau, Steven; Spahn, Martin; Briganti, Alberto; Gandaglia, Giorgio; Tombal, Bertrand; Tosco, Lorenzo; Marchioro, Giansilvio; Hsu, Chao-Yu; Walz, Jochen; Kneitz, Burkhard; Bader, Pia; Frohneberg, Detlef; Tizzani, Alessandro; Graefen, Markus; van Cangh, Paul; Karnes, R Jeffrey; Montorsi, Francesco; van Poppel, Hein; Gontero, Paolo

2015-02-01

Pretreatment tables for the prediction of pathologic stage have been published and validated for localized prostate cancer (PCa). No such tables are available for locally advanced (cT3a) PCa. To construct tables predicting pathologic outcome after radical prostatectomy (RP) for patients with cT3a PCa with the aim to help guide treatment decisions in clinical practice. This was a multicenter retrospective cohort study including 759 consecutive patients with cT3a PCa treated with RP between 1987 and 2010. Retropubic RP and pelvic lymphadenectomy. Patients were divided into pretreatment prostate-specific antigen (PSA) and biopsy Gleason score (GS) subgroups. These parameters were used to construct tables predicting pathologic outcome and the presence of positive lymph nodes (LNs) after RP for cT3a PCa using ordinal logistic regression. In the model predicting pathologic outcome, the main effects of biopsy GS and pretreatment PSA were significant. A higher GS and/or higher PSA level was associated with a more unfavorable pathologic outcome. The validation procedure, using a repeated split-sample method, showed good predictive ability. Regression analysis also showed an increasing probability of positive LNs with increasing PSA levels and/or higher GS. Limitations of the study are the retrospective design and the long study period. These novel tables predict pathologic stage after RP for patients with cT3a PCa based on pretreatment PSA level and biopsy GS. They can be used to guide decision making in men with locally advanced PCa. Our study might provide physicians with a useful tool to predict pathologic stage in locally advanced prostate cancer that might help select patients who may need multimodal treatment. Copyright © 2014 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Nomogram for 30-day morbidity after primary cytoreductive surgery for advanced stage ovarian cancer.

PubMed

Nieuwenhuyzen-de Boer, G M; Gerestein, C G; Eijkemans, M J C; Burger, C W; Kooi, G S

2016-01-01

Extensive surgical procedures to achieve maximal cytoreduction in patients with advanced stage epithelial ovarian cancer (EOC) are inevitably associated with postoperative morbidity and mortality. This study aimed to identify preoperative predictors of 30-day morbidity after primary cytoreductive surgery for advanced stage EOC and to develop a nomogram for individual risk assessment. Patients in The Netherlands who underwent primary cytoreductive surgery for advanced stage EOC between January 2004 and December 2007. All peri- and postoperative complications within 30 days after surgery were registered and classified. To investigate predictors of 30-day morbidity, a Cox proportional hazard model with backward stepwise elimination was utilized. The identified predictors were entered into a nomogram. The main outcome was to identify parameters that predict operative risk. 293 patients entered the study protocol. Optimal cytoreduction was achieved in 136 (46%) patients. Thirty-day morbidity was seen in 99 (34%) patients. Morbidity could be predicted by age (p = 0.033; OR 1.024), preoperative hemoglobin (p = 0.194; OR 0.843), and WHO performance status (p = 0.015; OR 1.821) with a optimism-corrected c-statistic of 0.62. Determinants co-morbidity status, serum CA125 level, platelet count, and presence of ascites were comparable in both groups. Thirty-day morbidity after primary cytoreductive surgery for advanced stage EOC could be predicted by age, hemoglobin, and WHO performance status. The generated nomogram could be valuable for predicting operative risk in the individual patient.

SPIRIT advance care planning intervention in early stage dementias: An NIH stage I behavioral intervention development trial.

PubMed

Song, Mi-Kyung; Ward, Sandra E; Hepburn, Kenneth; Paul, Sudeshna; Shah, Raj C; Morhardt, Darby J

2018-06-02

People in the early stages of Alzheimer's disease and related dementias (ADRD) are encouraged to engage in advance care planning (ACP) while they are still competent to appoint a surrogate decision maker and meaningfully participate in ACP discussions with the surrogate. In this NIH Stage I behavioral intervention development trial, we will adapt and test an efficacious ACP intervention, SPIRIT (Sharing Patient's Illness Representation to Increase Trust), with people with mild dementia and their surrogates to promote open, honest discussions while such discussions about end-of-life care are possible. We will first adapt SPIRIT (in person) to target people with mild dementia and their surrogates through a process of modification-pretesting-refinement using stakeholders (persons with mild dementia, family caregivers, and clinicians) and experts, including adapting the delivery mode to interactive web-based videoconference format (SPIRIT-remote). Then in a 3-group RCT with 120 patient-surrogate dyads, we will evaluate the feasibility and acceptability of SPIRIT in-person and SPIRIT remote, and preliminary efficacy of SPIRIT compared to usual care on preparedness outcomes for end-of-life decision making (dyad congruence on goals of care, patient decisional conflict, and surrogate decision-making confidence) shortly after the intervention. This Stage I research of SPIRIT will generate valuable insights regarding how to improve ACP for people with mild dementia who will progress to an advanced stage of the disease in the foreseeable future. ClinicalTrials.gov NCT03311711, Registered 10/12/2017. Copyright © 2018. Published by Elsevier Inc.

BH3-only protein Bim predicts advanced stage of cutaneous melanoma.

PubMed

Gambichler, T; Rooms, I; Scholl, L; Stockfleth, E; Stücker, M; Sand, M

2016-11-01

Bim having strong pro-apoptotic effects belongs to the BH3-only proteins of the Bcl-2 protein family and contributes to survival pathways in cancer cells. We aimed to investigate Bim protein expression in cutaneous melanoma (CM). Bim protein expression was assessed by immunohistochemistry in primary and metastatic melanomas and correlated with clinical and histopathological features. The Bim immunoreactivity score of the primary melanomas investigated (4.6 ± 1.5) was significantly (P < 0.0001) higher than that observed in metastases (2.8 ± 1.1). Low Bim expression was significantly associated with primary nodular melanoma type (P = 0.005). Moreover, Bim expression was significantly inversely correlated with tumour thickness (r = -0.36; P = 0.0035), advanced stage of disease (stage III and IV; r = -0.60; P < 0.0001), disease relapse (r = -0.18; P = 0.034) and disease-related death (r = -0.19; P = 0.026). Advanced stage of disease was independently predicted by low Bim expression (P = 0.0010, odds ratio: 0.22, 95% CI: 0.10-0.56) on multivariate analysis; however, Bim was not shown to be an independent predictor for disease relapse (P = 0.40) and disease-related death (P = 0.77). Our data demonstrate that Bim protein expression is significantly inversely correlated with melanoma features that are associated with worse prognosis. We have shown that Bim protein expression in CM is an independent predictor for advanced disease confirming that this pro-apoptotic BH3-only protein might be a potent biomarker and promising therapeutic target. © 2016 European Academy of Dermatology and Venereology.

Incentivizing Advanced Mathematics Study at Upper Secondary Level: The Case of Bonus Points in Ireland

ERIC Educational Resources Information Center

Treacy, Páraic Thomas

2018-01-01

Secondary level mathematics education in Ireland has recently experienced a period of significant change with the introduction of new curricula and the addition of an incentive to study upper secondary mathematics at the most advanced level (Higher Level). This incentive, typically referred to as 'bonus points', appears to have aided a significant…

Seal Joint Analysis and Design for the Ares-I Upper Stage LOX Tank

NASA Technical Reports Server (NTRS)

Phillips, Dawn R.; Wingate, Robert J.

2011-01-01

The sealing capability of the Ares-I Upper Stage liquid oxygen tank-to-sump joint is assessed by analyzing the deflections of the joint components. Analyses are performed using three-dimensional symmetric wedge finite element models and the ABAQUS commercial finite element software. For the pressure loads and feedline interface loads, the analyses employ a mixed factor of safety approach to comply with the Constellation Program factor of safety requirements. Naflex pressure-assisted seals are considered first because they have been used successfully in similar seal joints in the Space Shuttle External Tank. For the baseline sump seal joint configuration with a Naflex seal, the predicted joint opening greatly exceeds the seal design specification. Three redesign options of the joint that maintain the use of a Naflex seal are studied. The joint openings for the redesigned seal joints show improvement over the baseline configuration; however, these joint openings still exceed the seal design specification. RACO pressure-assisted seals are considered next because they are known to also be used on the Space Shuttle External Tank, and the joint opening allowable is much larger than the specification for the Naflex seals. The finite element models for the RACO seal analyses are created by modifying the models that were used for the Naflex seal analyses. The analyses show that the RACO seal may provide sufficient sealing capability for the sump seal joint. The results provide reasonable data to recommend the design change and plan a testing program to determine the capability of RACO seals in the Ares-I Upper Stage liquid oxygen tank sump seal joint.

Upper gastrointestinal bleeding in patients with CKD.

PubMed

Liang, Chih-Chia; Wang, Su-Ming; Kuo, Huey-Liang; Chang, Chiz-Tzung; Liu, Jiung-Hsiun; Lin, Hsin-Hung; Wang, I-Kuan; Yang, Ya-Fei; Lu, Yueh-Ju; Chou, Che-Yi; Huang, Chiu-Ching

2014-08-07

Patients with CKD receiving maintenance dialysis are at risk for upper gastrointestinal bleeding. However, the risk of upper gastrointestinal bleeding in patients with early CKD who are not receiving dialysis is unknown. The hypothesis was that their risk of upper gastrointestinal bleeding is negatively linked to renal function. To test this hypothesis, the association between eGFR and risk of upper gastrointestinal bleeding in patients with stages 3-5 CKD who were not receiving dialysis was analyzed. Patients with stages 3-5 CKD in the CKD program from 2003 to 2009 were enrolled and prospectively followed until December of 2012 to monitor the development of upper gastrointestinal bleeding. The risk of upper gastrointestinal bleeding was analyzed using competing-risks regression with time-varying covariates. In total, 2968 patients with stages 3-5 CKD who were not receiving dialysis were followed for a median of 1.9 years. The incidence of upper gastrointestinal bleeding per 100 patient-years was 3.7 (95% confidence interval, 3.5 to 3.9) in patients with stage 3 CKD, 5.0 (95% confidence interval, 4.8 to 5.3) in patients with stage 4 CKD, and 13.9 (95% confidence interval, 13.1 to 14.8) in patients with stage 5 CKD. Higher eGFR was associated with a lower risk of upper gastrointestinal bleeding (P=0.03), with a subdistribution hazard ratio of 0.93 (95% confidence interval, 0.87 to 0.99) for every 5 ml/min per 1.73 m(2) higher eGFR. A history of upper gastrointestinal bleeding (P<0.001) and lower serum albumin (P=0.004) were independently associated with higher upper gastrointestinal bleeding risk. In patients with CKD who are not receiving dialysis, lower renal function is associated with higher risk for upper gastrointestinal bleeding. The risk is higher in patients with previous upper gastrointestinal bleeding history and low serum albumin. Copyright © 2014 by the American Society of Nephrology.

Camera Layout Design for the Upper Stage Thrust Cone

NASA Technical Reports Server (NTRS)

Wooten, Tevin; Fowler, Bart

2010-01-01

Engineers in the Integrated Design and Analysis Division (EV30) use a variety of different tools to aid in the design and analysis of the Ares I vehicle. One primary tool in use is Pro-Engineer. Pro-Engineer is a computer-aided design (CAD) software that allows designers to create computer generated structural models of vehicle structures. For the Upper State thrust cone, Pro-Engineer was used to assist in the design of a layout for two camera housings. These cameras observe the separation between the first and second stage of the Ares I vehicle. For the Ares I-X, one standard speed camera was used. The Ares I design calls for two separate housings, three cameras, and a lighting system. With previous design concepts and verification strategies in mind, a new layout for the two camera design concept was developed with members of the EV32 team. With the new design, Pro-Engineer was used to draw the layout to observe how the two camera housings fit with the thrust cone assembly. Future analysis of the camera housing design will verify the stability and clearance of the camera with other hardware present on the thrust cone.

Solar Thermal Upper Stage Liquid Hydrogen Pressure Control Testing and Analytical Modeling

NASA Technical Reports Server (NTRS)

Olsen, A. D.; Cady, E. C.; Jenkins, D. S.; Chandler, F. O.; Grayson, G. D.; Lopez, A.; Hastings, L. J.; Flachbart, R. H.; Pedersen, K. W.

2012-01-01

The demonstration of a unique liquid hydrogen (LH2) storage and feed system concept for solar thermal upper stage was cooperatively accomplished by a Boeing/NASA Marshall Space Flight Center team. The strategy was to balance thermodynamic venting with the engine thrusting timeline during a representative 30-day mission, thereby, assuring no vent losses. Using a 2 cubic m (71 cubic ft) LH2 tank, proof-of-concept testing consisted of an engineering checkout followed by a 30-day mission simulation. The data were used to anchor a combination of standard analyses and computational fluid dynamics (CFD) modeling. Dependence on orbital testing has been incrementally reduced as CFD codes, combined with standard modeling, continue to be challenged with test data such as this.

Variation in advanced stage at diagnosis of lung and female breast cancer in an English region 2006-2009.

PubMed

Lyratzopoulos, G; Abel, G A; Barbiere, J M; Brown, C H; Rous, B A; Greenberg, D C

2012-03-13

Understanding variation in stage at diagnosis can inform interventions to improve the timeliness of diagnosis for patients with different cancers and characteristics. We analysed population-based data on 17,836 and 13,286 East of England residents diagnosed with (female) breast and lung cancer during 2006-2009, with stage information on 16,460 (92%) and 10,435 (79%) patients, respectively. Odds ratios (ORs) of advanced stage at diagnosis adjusted for patient and tumour characteristics were derived using logistic regression. We present adjusted ORs of diagnosis in stages III/IV compared with diagnosis in stages I/II. For breast cancer, the frequency of advanced stage at diagnosis increased stepwise among old women (ORs: 1.21, 1.46, 1.68 and 1.78 for women aged 70-74, 75-79, 80-84 and ≥85, respectively, compared with those aged 65-69 , P<0.001). In contrast, for lung cancer advanced stage at diagnosis was less frequent in old patients (ORs: 0.82, 0.74, 0.73 and 0.66, P<0.001). Advanced stage at diagnosis was more frequent in more deprived women with breast cancer (OR: 1.23 for most compared with least deprived, P=0.002), and in men with lung cancer (OR: 1.14, P=0.011). The observed patterns were robust to sensitivity analyses approaches for handling missing stage data under different assumptions. Interventions to help improve the timeliness of diagnosis of different cancers should be targeted at specific age groups.

Systematic genomic identification of colorectal cancer genes delineating advanced from early clinical stage and metastasis

PubMed Central

2013-01-01

Background Colorectal cancer is the third leading cause of cancer deaths in the United States. The initial assessment of colorectal cancer involves clinical staging that takes into account the extent of primary tumor invasion, determining the number of lymph nodes with metastatic cancer and the identification of metastatic sites in other organs. Advanced clinical stage indicates metastatic cancer, either in regional lymph nodes or in distant organs. While the genomic and genetic basis of colorectal cancer has been elucidated to some degree, less is known about the identity of specific cancer genes that are associated with advanced clinical stage and metastasis. Methods We compiled multiple genomic data types (mutations, copy number alterations, gene expression and methylation status) as well as clinical meta-data from The Cancer Genome Atlas (TCGA). We used an elastic-net regularized regression method on the combined genomic data to identify genetic aberrations and their associated cancer genes that are indicators of clinical stage. We ranked candidate genes by their regression coefficient and level of support from multiple assay modalities. Results A fit of the elastic-net regularized regression to 197 samples and integrated analysis of four genomic platforms identified the set of top gene predictors of advanced clinical stage, including: WRN, SYK, DDX5 and ADRA2C. These genetic features were identified robustly in bootstrap resampling analysis. Conclusions We conducted an analysis integrating multiple genomic features including mutations, copy number alterations, gene expression and methylation. This integrated approach in which one considers all of these genomic features performs better than any individual genomic assay. We identified multiple genes that robustly delineate advanced clinical stage, suggesting their possible role in colorectal cancer metastatic progression. PMID:24308539

Solid rocket technology advancements for space tug and IUS applications

NASA Technical Reports Server (NTRS)

Ascher, W.; Bailey, R. L.; Behm, J. W.; Gin, W.

1975-01-01

In order for the shuttle tug or interim upper stage (IUS) to capture all the missions in the current mission model for the tug and the IUS, an auxiliary or kick stage, using a solid propellant rocket motor, is required. Two solid propellant rocket motor technology concepts are described. One concept, called the 'advanced propulsion module' motor, is an 1800-kg, high-mass-fraction motor, which is single-burn and contains Class 2 propellent. The other concept, called the high energy upper stage restartable solid, is a two-burn (stop-restartable on command) motor which at present contains 1400 kg of Class 7 propellant. The details and status of the motor design and component and motor test results to date are presented, along with the schedule for future work.

Black breast cancer survivors experience greater upper extremity disability.

PubMed

Dean, Lorraine T; DeMichele, Angela; LeBlanc, Mously; Stephens-Shields, Alisa; Li, Susan Q; Colameco, Chris; Coursey, Morgan; Mao, Jun J

2015-11-01

Over one-third of breast cancer survivors experience upper extremity disability. Black women present with factors associated with greater upper extremity disability, including: increased body mass index (BMI), more advanced disease stage at diagnosis, and varying treatment type compared with Whites. No prior research has evaluated the relationship between race and upper extremity disability using validated tools and controlling for these factors. Data were drawn from a survey study among 610 women with stage I-III hormone receptor positive breast cancer. The disabilities of the arm, shoulder and hand (QuickDASH) is an 11-item self-administered questionnaire that has been validated for breast cancer survivors to assess global upper extremity function over the past 7 days. Linear regression and mediation analysis estimated the relationships between race, BMI and QuickDASH score, adjusting for demographics and treatment types. Black women (n = 98) had 7.3 points higher average QuickDASH scores than White (n = 512) women (p < 0.001). After adjusting for BMI, age, education, cancer treatment, months since diagnosis, and aromatase inhibitor status, Black women had an average 4-point (95 % confidence interval 0.18-8.01) higher QuickDASH score (p = 0.04) than White women. Mediation analysis suggested that BMI attenuated the association between race and disability by 40 %. Even several years post-treatment, Black breast cancer survivors had greater upper extremity disability, which was partially mediated by higher BMIs. Close monitoring of high BMI Black women may be an important step in reducing disparities in cancer survivorship. More research is needed on the relationship between race, BMI, and upper extremity disability.

Carbon-Carbon Nozzle Extension Development in Support of In-Space and Upper-Stage Liquid Rocket Engines

NASA Technical Reports Server (NTRS)

Gradl, Paul R.; Valentine, Peter G.

2017-01-01

Upper stage and in-space liquid rocket engines are optimized for performance through the use of high area ratio nozzles to fully expand combustion gases to low exit pressures, increasing exhaust velocities. Due to the large size of such nozzles, and the related engine performance requirements, carbon-carbon (C-C) composite nozzle extensions are being considered to reduce weight impacts. Currently, the state-of-the-art is represented by the metallic and foreign composite nozzle extensions limited to approximately 2000 degrees F. used on the Atlas V, Delta IV, Falcon 9, and Ariane 5 launch vehicles. NASA and industry partners are working towards advancing the domestic supply chain for C-C composite nozzle extensions. These development efforts are primarily being conducted through the NASA Small Business Innovation Research (SBIR) program in addition to other low level internal research efforts. This has allowed for the initial material development and characterization, subscale hardware fabrication, and completion of hot-fire testing in relevant environments. NASA and industry partners have designed, fabricated and hot-fire tested several subscale domestically produced C-C extensions to advance the material and coatings fabrication technology for use with a variety of liquid rocket and scramjet engines. Testing at NASA's Marshall Space Flight Center (MSFC) evaluated heritage and state-of-the-art C-C materials and coatings, demonstrating the initial capabilities of the high temperature materials and their fabrication methods. This paper discusses the initial material development, design and fabrication of the subscale carbon-carbon nozzle extensions, provides an overview of the test campaign, presents results of the hot fire testing, and discusses potential follow-on development work. The follow on work includes the fabrication of ultra-high temperature materials, larger C-C nozzle extensions, material characterization, sub-element testing and hot-fire testing at

Expression signatures of early-stage and advanced medaka melanomas.

PubMed

Klotz, Barbara; Kneitz, Susanne; Regensburger, Martina; Hahn, Lena; Dannemann, Michael; Kelso, Janet; Nickel, Birgit; Lu, Yuan; Boswell, William; Postlethwait, John; Warren, Wesley; Kunz, Manfred; Walter, Ronald B; Schartl, Manfred

2018-06-01

Melanoma is one of the most aggressive tumors with a very low survival rate once metastasized. The incidence of newly detected cases increases every year suggesting the necessity of development and application of innovative treatment strategies. Human melanoma develops from melanocytes localized in the epidermis of the skin to malignant tumors because of deregulated effectors influencing several molecular pathways. Despite many advances in describing the molecular changes accompanying melanoma formation, many critical and clinically relevant molecular features of the transformed pigment cells and the underlying mechanisms are largely unknown. To contribute to a better understanding of the molecular processes of melanoma formation, we use a transgenic medaka melanoma model that is well suited for the investigation of melanoma tumor development because fish and human melanocytes are both localized in the epidermis. The purpose of our study was to gain insights into melanoma development from the first steps of tumor formation up to melanoma progression and to identify gene expression patterns that will be useful for monitoring treatment effects in drug screening approaches. Comparing transcriptomes from juvenile fish at the tumor initiating stage with nevi and advanced melanoma of adults, we identified stage specific expression signatures and pathways that are characteristic for the development of medaka melanoma, and are also found in human malignancies. Copyright © 2017 Elsevier Inc. All rights reserved.

Retinopathy of prematurity: mutations in the Norrie disease gene and the risk of progression to advanced stages.

PubMed

Haider, M Z; Devarajan, L V; Al-Essa, M; Srivastva, B S; Kumar, H; Azad, R; Rashwan, N

2001-04-01

Retinopathy of prematurity (ROP) is a retinal vascular disease that occurs in infants with short gestational age and low birth weight and may lead to retinal detachment and blindness. Missense mutations in the Norrie disease (ND) gene have been associated with the risk of progression to advanced stages in cases of ROP from the US and also in clinically similar ND and familial exudative vitreoretinopathy. We have screened two ND gene mutations, namely A105T and Val60Glu, by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and allele-specific PCR methods, respectively, in 210 Kuwaiti premature newborns to replicate these findings in a different ethnic group. In the Kuwaiti premature newborn cohort, 115 of 210 babies had no eye problems and served as controls, while 95 were cases of ROP. In 71 of 95 ROP cases, the disease regressed spontaneously on or before stage 3, while in 24 of 95 ROP cases the disease progressed to advanced stages 4 and 5. In case of missense mutation (A105T), the AA genotype was detected in 96% of controls compared with 87% of ROP cases (NS); similarly no significant difference was found between spontaneously regressed ROP cases and those who progressed to advanced stages. For the Val60Glu mutation, no significant association was detected between the genotype and progression of ROP to advanced stages. Unlike data from the US, our findings from a Kuwaiti cohort of ROP cases and controls suggest a lack of association between the two ND gene mutations (A105T and Val60Glu) and ROP and the risk of progression of the disease to advanced stages.

Advanced Transportation System Studies. Technical Area 3: Alternate Propulsion Subsystems Concepts. Volume 3; Program Cost Estimates

NASA Technical Reports Server (NTRS)

Levack, Daniel J. H.

2000-01-01

The objective of this contract was to provide definition of alternate propulsion systems for both earth-to-orbit (ETO) and in-space vehicles (upper stages and space transfer vehicles). For such propulsion systems, technical data to describe performance, weight, dimensions, etc. was provided along with programmatic information such as cost, schedule, needed facilities, etc. Advanced technology and advanced development needs were determined and provided. This volume separately presents the various program cost estimates that were generated under three tasks: the F- IA Restart Task, the J-2S Restart Task, and the SSME Upper Stage Use Task. The conclusions, technical results , and the program cost estimates are described in more detail in Volume I - Executive Summary and in individual Final Task Reports.

Physical activity in patients with advanced-stage cancer: a systematic review of the literature.

PubMed

Albrecht, Tara A; Taylor, Ann Gill

2012-06-01

The importance of physical activity for chronic disease prevention and management has become generally well accepted. The number of research interventions and publications examining the benefits of physical activity for patients with cancer has been rising steadily. However, much of that research has focused on the impact of physical activity either prior to or early in the cancer diagnosis, treatment, and survivorship process. Research focusing on the effects of physical activity, specifically for patients with advanced-stage cancer and poorer prognostic outcomes, has been addressed only recently. The purpose of this article is to examine the state of the science for physical activity in the advanced-stage disease subset of the cancer population. Exercise in a variety of intensities and forms, including yoga, walking, biking, and swimming, has many health benefits for people, including those diagnosed with cancer. Research has shown that, for people with cancer (including advanced-stage cancer), exercise can decrease anxiety, stress, and depression while improving levels of pain, fatigue, shortness of breath, constipation, and insomnia. People diagnosed with cancer should discuss with their oncologist safe, easy ways they can incorporate exercise into their daily lives.

Reflections on Centaur Upper Stage Integration by the NASA Lewis (Glenn) Research Center

NASA Technical Reports Server (NTRS)

Graham, Scott R.

2015-01-01

The NASA Glenn (then Lewis) Research Center (GRC) led several expendable launch vehicle (ELV) projects from 1963 to 1998, most notably the Centaur upper stage. These major, comprehensive projects included system management, system development, integration (both payload and stage), and launch operations. The integration role that GRC pioneered was truly unique and highly successful. Its philosophy, scope, and content were not just invaluable to the missions and vehicles it supported, but also had significant Agency-wide benefits. An overview of the NASA Lewis Research Center (now the NASA Glenn Research Center) philosophy on ELV integration is provided, focusing on Atlas/Centaur, Titan/Centaur, and Shuttle/Centaur vehicles and programs. The necessity of having a stable, highly technically competent in-house staff is discussed. Significant depth of technical penetration of contractor work is another critical component. Functioning as a cohesive team was more than a concept: GRC senior management, NASA Headquarters, contractors, payload users, and all staff worked together. The scope, content, and history of launch vehicle integration at GRC are broadly discussed. Payload integration is compared to stage development integration in terms of engineering and organization. Finally, the transition from buying launch vehicles to buying launch services is discussed, and thoughts on future possibilities of employing the successful GRC experience in integrating ELV systems like Centaur are explored.

Reflections on Centaur Upper Stage Integration by the NASA Lewis (Glenn) Research Center

NASA Technical Reports Server (NTRS)

Graham, Scott R.

2014-01-01

The NASA Glenn (then Lewis) Research Center (GRC) led several expendable launch vehicle (ELV) projects from 1963 to 1998, most notably the Centaur upper stage. These major, comprehensive projects included system management, system development, integration (both payload and stage), and launch operations. The integration role that GRC pioneered was truly unique and highly successful. Its philosophy, scope, and content were not just invaluable to the missions and vehicles it supported, but also had significant Agencywide benefits. An overview of the NASA Lewis Research Center (now the NASA Glenn Research Center) philosophy on ELV integration is provided, focusing on Atlas/Centaur, Titan/Centaur, and Shuttle/Centaur vehicles and programs. The necessity of having a stable, highly technically competent in-house staff is discussed. Significant depth of technical penetration of contractor work is another critical component. Functioning as a cohesive team was more than a concept: GRC senior management, NASA Headquarters, contractors, payload users, and all staff worked together. The scope, content, and history of launch vehicle integration at GRC are broadly discussed. Payload integration is compared to stage development integration in terms of engineering and organization. Finally, the transition from buying launch vehicles to buying launch services is discussed, and thoughts on future possibilities of employing the successful GRC experience in integrating ELV systems like Centaur are explored.

Pair-wise comparison analysis of differential expression of mRNAs in early and advanced stage primary colorectal adenocarcinomas

PubMed Central

Lau, Tze Pheng; Roslani, April Camilla; Lian, Lay Hoong; Chai, Hwa Chia; Lee, Ping Chin; Hilmi, Ida; Goh, Khean Lee; Chua, Kek Heng

2014-01-01

Objectives To characterise the mRNA expression patterns of early and advanced stage colorectal adenocarcinomas of Malaysian patients. Design Comparative expression analysis. Setting and participants We performed a combination of annealing control primer (ACP)-based PCR and reverse transcription-quantitative real-time PCR for the identification of differentially expressed genes (DEGs) associated with early and advanced stage primary colorectal tumours. We recruited four paired samples from patients with colorectal cancer (CRC) of Dukes’ A and B for the preliminary differential expression study, and a total of 27 paired samples, ranging from CRC stages I to IV, for subsequent confirmatory test. The tumouric samples were obtained from the patients with CRC undergoing curative surgical resection without preoperative chemoradiotherapy. The recruited patients with CRC were newly diagnosed with CRC, and were not associated with any hereditary syndromes, previously diagnosed cancer or positive family history of CRC. The paired non-cancerous tissue specimens were excised from macroscopically normal colonic mucosa distally located from the colorectal tumours. Primary and secondary outcome measures The differential mRNA expression patterns of early and advanced stage colorectal adenocarcinomas compared with macroscopically normal colonic mucosa were characterised by ACP-based PCR and reverse transcription-quantitative real-time PCR. Results The RPL35, RPS23 and TIMP1 genes were found to be overexpressed in both early and advanced stage colorectal adenocarcinomas (p<0.05). However, the ARPC2 gene was significantly underexpressed in early colorectal adenocarcinomas, while the advanced stage primary colorectal tumours exhibited an additional overexpression of the C6orf173 gene (p<0.05). Conclusions We characterised two distinctive gene expression patterns to aid in the stratification of primary colorectal neoplasms among Malaysian patients with CRC. Further work can be done to

Two-stage, low noise advanced technology fan. 5: Acoustic final report

NASA Technical Reports Server (NTRS)

Sofrin, T. G.; Riloff, N., Jr.

1975-01-01

The NASA Q2S(quiet two-stage) fan is a 0.836m (32.9 in.) diameter model of the STF 433 engine fan, selected in a 1972 study for an Advanced Technology Transport (ATT) airplane. Noise-control features include: low tip speed, moderate stage pressure rise, large blade-vane spacings, no inlet guide vanes, and optimum blade and vane numbers. Tests were run on the baseline Q2S fan with standard inlet and discharge ducts. Further tests were made of a translating centerbody sonic inlet device and treated discharge ducts. Results were scaled to JT8D and JT3D engine fan size for comparison with current two-stage fans, and were also scaled to STF 433 fan size to compare calculated ATT flyover noise with FAR 36 limits. Baseline Q2S results scaled to JT8D and JT3D engine fan sizes showed substantial noise reductions. Calculated unsuppressed baseline ATT flyovers averaged about 2.5 EPNdB below FAR 36 limits. Using measured sonic inlet results, scaled baseline Q2S fan results, and calculated attenuations for a 1975 technology duct liner, projected flyover noise calculations for the ATT averaged about FAR 36 limits minus 10 EPNdB. Advances in suppression technology required to meet the 1985 goal of FAR 36 limits minus 20 EPNdB are discussed.

Preventing Accidental Ignition of Upper-Stage Rocket Motors

NASA Technical Reports Server (NTRS)

Hickman, John; Morgan, Herbert; Cooper, Michael; Murbach, Marcus

2005-01-01

A report presents a proposal to reduce the risk of accidental ignition of certain upper-stage rocket motors or other high energy hazardous systems. At present, mechanically in-line initiators are used for initiation of many rocket motors and/or other high-energy hazardous systems. Electrical shorts and/or mechanical barriers, which are the basic safety devices in such systems, are typically removed as part of final arming or pad preparations while personnel are present. At this time, static discharge, test equipment malfunction, or incorrect arming techniques can cause premature firing. The proposal calls for a modular out-of-line ignition system incorporating detonating-cord elements, identified as the donor and the acceptor, separated by an air gap. In the safe configuration, the gap would be sealed with two shields, which would prevent an accidental firing of the donor from igniting the system. The shields would be removed to enable normal firing, in which shrapnel generated by the donor would reliably ignite the acceptor to continue the ordnance train. The acceptor would then ignite a through bulkhead initiator (or other similar device), which would ignite the motor or high-energy system. One shield would be remotely operated and would be moved to the armed position when a launch was imminent or conversely returned to the safe position if the launch were postponed. In the event of failure of the remotely operated shield, the other shield could be inserted manually to safe the system.

The Advanced Labs Website: resources for upper-level laboratories

NASA Astrophysics Data System (ADS)

Torres-Isea, Ramon

2012-03-01

The Advanced Labs web resource collection is an effort to create a central, comprehensive information base for college/university faculty who teach upper-level undergraduate laboratories. The website is produced by the American Association of Physics Teachers (AAPT). It is a part of ComPADRE, the online collection of resources in physics and astronomy education, which itself is a part of the National Science Foundation-funded National Science Digital Library (NSDL). After a brief review of its history, we will discuss the current status of the website while describing the various types of resources available at the site and presenting examples of each. We will detail a step-by-step procedure for submitting resources to the website. The resource collection is designed to be a community effort and thus welcomes input and contributions from its users. We will also present plans, and will seek audience feedback, for additional website services and features. The constraints, roadblocks, and rewards of this project will also be addressed.

Aluminum 2195 T8 Gore Development for Space Launch System Core and Upper Stage

NASA Technical Reports Server (NTRS)

Volz, Martin

2015-01-01

Gores are pie-shaped panels that are welded together to form the dome ends of rocket fuel tanks as shown in figure 1. Replacing aluminum alloy 2219 with aluminum (Al)-lithium (Li) alloy 2195 as the Space Launch System (SLS) cryogenic tank material would save enormous amounts of weight. In fact, it has been calculated that simply replacing Al 2219 gores with Al 2195 gores on the SLS core stage domes could save approximately 3,800 pound-mass. This is because the Al-Li 2195 alloy exhibits both higher mechanical properties and lower density than the SLS baseline Al 2219 alloy. Indeed, the known advantages of Al 2195 led to its use as a replacement for Al 2219 in the shuttle external tank program. The required thicknesses of Al 2195 gores for either SLS core stage tanks or upper stage tanks will depend on the specific design configurations. The required thicknesses or widths may exceed the current experience base in the manufacture of such gores by the stretch-forming process. Accordingly, the primary objective of this project was to enhance the formability of Al 2195 by optimizing the heat treatment and stretch-forming process for gore thicknesses up to 0.75 inches, which envelop the maximum expected gore thicknesses for SLS tank configurations.

Active Space Debris Removal using European Modified Launch Vehicle Upper Stages Equipped with Electrodynamic Tethers

NASA Astrophysics Data System (ADS)

Nasseri, Ali S.; Emanuelli, Matteo; Raval, Siddharth; Turconi, Andrea; Becker, Cristoph

2013-08-01

During the past few years, several research programs have assessed the current state and future evolution of the Low Earth Orbit region. These studies indicate that space debris density could reach a critical level such that there will be a continuous increase in the number of debris objects, primarily driven by debris-debris collision activity known as the Kessler effect. This cascade effect can be even more significant when intact objects as dismissed rocket bodies are involved in the collision. The majority of the studies until now have highlighted the urgency for active debris removal in the next years. An Active Debris Removal System (ADRS) is a system capable of approaching the debris object through a close-range rendezvous, establishing physical connection, stabilizing its attitude and finally de-orbiting the debris object using a type of propulsion system in a controlled manoeuvre. In its previous work, this group showed that a modified Fregat (Soyuz FG's 4th stage) or Breeze-M upper stage (Proton-M) launched from Plesetsk (Russian Federation) and equipped with an electro-dynamic tether (EDT) system can be used, after an opportune inclination's change, to de-orbit a Kosmos-3M second stage rocket body while also delivering an acceptable payload to orbit. In this paper, we continue our work on the aforementioned concept, presented at the 2012 Beijing Space Sustainability Conference, by comparing its performance to ADR missions using only chemical propulsion from the upper stage for the far approach and the de-orbiting phase. We will also update the EDT model used in our previous work and highlight some of the methods for creating physical contact with the object. Moreover, we will assess this concept also with European launch vehicles (Vega and Soyuz 2-1A) to remove space debris from space. In addition, the paper will cover some economic aspects, like the cost for the launches' operator in term of payload mass' loss at the launch. The entire debris removal

Dental Age Estimation (DAE): Data management for tooth development stages including the third molar. Appropriate censoring of Stage H, the final stage of tooth development.

PubMed

Roberts, Graham J; McDonald, Fraser; Andiappan, Manoharan; Lucas, Victoria S

2015-11-01

The final stage of dental development of third molars is usually helpful to indicate whether or not a subject is aged over 18 years. A complexity is that the final stage of development is unlimited in its upper border. Investigators usually select an inappropriate upper age limit or censor point for this tooth development stage. The literature was searched for appropriate data sets for dental age estimation and those that provided the count (n), the mean (x¯), and the standard deviation (sd) for each of the tooth development stages. The Demirjian G and Demirjian H were used for this study. Upper and lower limits of the Stage G and Stage H data were calculated limiting the data to plus or minus three standard deviations from the mean. The upper border of Stage H was limited by appropriate censoring at the maximum value for Stage G. The maximum age at attainment from published data, for Stage H, ranged from 22.60 years to 34.50 years. These data were explored to demonstrate how censoring provides an estimate for the correct maximum age for the final stage of Stage H as 21.64 years for UK Caucasians. This study shows that confining the data array of individual tooth developments stages to ± 3sd provides a reliable and logical way of censoring the data for tooth development stages with a Normal distribution of data. For Stage H this is inappropriate as it is unbounded in its upper limit. The use of a censored data array for Stage H using Percentile values is appropriate. This increases the reliability of using third molar Stage H alone to determine whether or not an individual is over 18 years old. For Stage H, individual ancestral groups should be censored using the same technique. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

Ares I and Ares I-X Stage Separation Aerodynamic Testing

NASA Technical Reports Server (NTRS)

Pinier, Jeremy T.; Niskey, Charles J.

2011-01-01

The aerodynamics of the Ares I crew launch vehicle (CLV) and Ares I-X flight test vehicle (FTV) during stage separation was characterized by testing 1%-scale models at the Arnold Engineering Development Center s (AEDC) von Karman Gas Dynamics Facility (VKF) Tunnel A at Mach numbers of 4.5 and 5.5. To fill a large matrix of data points in an efficient manner, an injection system supported the upper stage and a captive trajectory system (CTS) was utilized as a support system for the first stage located downstream of the upper stage. In an overall extremely successful test, this complex experimental setup associated with advanced postprocessing of the wind tunnel data has enabled the construction of a multi-dimensional aerodynamic database for the analysis and simulation of the critical phase of stage separation at high supersonic Mach numbers. Additionally, an extensive set of data from repeated wind tunnel runs was gathered purposefully to ensure that the experimental uncertainty would be accurately quantified in this type of flow where few historical data is available for comparison on this type of vehicle and where Reynolds-averaged Navier-Stokes (RANS) computational simulations remain far from being a reliable source of static aerodynamic data.

Upper limits on the rates of BNS and NSBH mergers from Advanced LIGO's first observing run

NASA Astrophysics Data System (ADS)

Lackey, Benjamin; LIGO Collaboration

2017-01-01

Last year the Advanced LIGO detectors finished their first observing run and detected two binary black hole mergers with high significance but no binary neutron star (BNS) or neutron-star-black-hole (NSBH) mergers. We present upper limits on the rates of BNS and NSBH mergers in the universe based on their non-detection with two modeled searches. With zero detections, the upper limits depend on the choice of prior, but we find 90% upper limits using a conservative prior of 12 , 000 / Gpc3 / yr for BNS mergers and 1 , 000 - 3 , 000 / Gpc3 / yr for NSBH mergers depending on the black hole mass. Comparing these upper limits to several rates predictions in the literature, we find our upper limits are close to the more optimistic rates estimates. Further non-detections in the second and third observing runs should be able to rule out several rates predictions. Using the observed rate of short gamma ray bursts (GRBs), we can also place lower limits on the average beaming angle of short GRBs. Assuming all short GRBs come from BNS mergers, we find a 90% lower limit of 1-4 degrees on the GRB beaming angle, with the range coming from the uncertainty in short GRB rates.

The experience of living with advanced-stage cancer: a thematic synthesis of the literature.

PubMed

García-Rueda, N; Carvajal Valcárcel, A; Saracíbar-Razquin, M; Arantzamendi Solabarrieta, M

2016-07-01

The aim of the study was to understand the experience of people living with advanced-stage cancer through literature. The search included The Cochrane Library, PubMed, PsycInfo, CINAHL and Cuiden. Thirteen studies were included. A qualitative meta-synthesis was conducted. One thread emerged from the thematic synthesis: the desire to live as normally as possible, despite being aware of the proximity of death. Three themes also emerged: "a process that is unique" with its four sub-themes; "support network" and "health context," each of them having two sub-themes. This study concludes that living with advanced-stage cancer is a unique and complex process which has both positive and negative aspects. The review provides a comprehensive view of the experience, which considers the importance of the support network and the health context in which the person lives. In this study, "normalcy" is the adjustment to the new reality and living as closely as possible to the way one lived before the disease, while developing a new relationship with being finite and death. A better understanding of the experience of living with advanced-stage cancer will help health professionals to identify the needs of the patients in order to plan individual, high-quality care. © 2016 John Wiley & Sons Ltd.

Environmental protection requirements for scout/shuttle auxiliary stages

NASA Technical Reports Server (NTRS)

Qualls, G. L.; Kress, S. S.; Storey, W. W.; Ransdell, P. N.

1980-01-01

The requirements for enabling the Scout upper stages to endure the expected temperature, mechanical shock, acoustical and mechanical vibration environments during a specified shuttle mission were determined. The study consisted of: determining a shuttle mission trajectory for a 545 kilogram (1200 pound) Scout payload; compilation of shuttle environmental conditions; determining of Scout upper stages environments in shuttle missions; compilation of Scout upper stages environmental qualification criteria and comparison to shuttle mission expected environments; and recommendations for enabling Scout upper stages to endure the exptected shuttle mission environments.

Combined treatment of advanced stages of recurrent skin cancer of the head.

PubMed

Pompucci, Angelo; Rea, Giancarla; Farallo, Eugenio; Salgarello, Marzia; Campanella, Antonino; Fernandez, Eduardo

2004-04-01

The authors investigated whether skull base resection and primary free-flap reconstruction in a single-stage surgery is oncologically effective for treating advanced stages of recurrent skin cancer (RSC) of the head. Eighteen consecutive patients were surgically treated. Twelve of them underwent an anterolateral skull base resection, which was performed using a pterional craniotomy combined with an orbitozygomatic osteotomy. Six patients underwent a posterolateral skull base resection, which was performed using an asterional craniotomy combined with a retrolabyrinthine petrosectomy. The wide postoperative defects were covered with muscular or myocutaneous free flaps. The main factor influencing survival was the extent of the resection: patients with no or minimal residual disease showed a statistically significant longer survival time than those with consistent residual disease. Basal cell carcinoma had a better prognosis than squamous cell carcinoma. A trend toward improved survival was observed in patients classified as T4M0 with negative lymph nodes (N0), but this trend was not statistically significant. Adjuvant radiotherapy significantly influenced both survival time and the rate of local recurrence. The surgical morbidity rate was 27.8%; there were two transient cerebrospinal fluid leaks and three seventh cranial nerve injuries. Late complications included radionecrosis in one patient and skin erosion requiring a second surgery in another patient. No deaths occurred during a 30-day postoperative period. Advances in skull base surgery and free-flap reconstruction allowed the authors to treat patients with advanced-stage RSC of the head in a rather satisfactory manner. Only when it is impossible to achieve no or minimal residual disease should aggressive treatment be considered.

Development of Weld Inspection of the Ares I Crew Launch Vehicle Upper Stage

NASA Technical Reports Server (NTRS)

Russell, Sam; Ezell, David

2010-01-01

NASA is designing a new crewed launch vehicle called Ares I to replace the Space Shuttle after its scheduled retirement in 2010. This new launch vehicle will build on the Shuttle technology in many ways including using a first stage based upon the Space Shuttle Solid Rocket Booster, advanced aluminum alloys for the second stage tanks, and friction stir welding to assemble the second stage. Friction stir welding uses a spinning pin that is inserted in the joint between two panels that are to be welded. The pin mechanically mixes the metal together below the melting temperature to form the weld. Friction stir welding allows high strength joints in metals that would otherwise lose much of their strength as they are melted during the fusion welding process. One significant change from the Space Shuttle that impacts NDE is the implementation of self-reacting friction stir welding for non-linear welds on the primary metallic structure. The self-reacting technique differs from the conventional technique because the load of the pin tool pressing down on the metal being joined is reacted by a nut on the end of the tool rather than an anvil behind the part. No spacecraft has ever flown with a self-reacting friction stir weld, so this is a major advancement in the manufacturing process, bringing with it a whole new set of challenges for NDE to overcome. The metal microstructure and possible defects are different from other weld processes. Friction plug welds will be used to close out the hole remaining in the radial welds when friction stir welded. This plug welding also has unique challenges in inspection. The current state of development of these inspections will be presented, along with other information pertinent to NDE of the Ares I.

Impact of paranasal sinus invasion on advanced nasopharyngeal carcinoma treated with intensity-modulated radiation therapy: the validity of advanced T stage of AJCC/UICC eighth edition staging system.

PubMed

Wang, Ying; Zhao, Jie; Zhao, Yajie; Yang, Zhen; Lei, Mingjun; Li, Zhanzhan; Wei, Rui; Chen, Dengming; He, Yuxiang; Shen, Liangfang

2018-05-01

The aim of this study was to clarify the prognostic role of paranasal sinus invasion in advanced NPC patients. Data of patients (n = 295) with advanced NPC (T3/T4N0-3 M0) treated with intensity-modulated radiation therapy were retrospectively analyzed. Staging was according to the AJCC/UICC eighth edition staging system. Overall survival (OS), local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) were calculated, and differences were compared between patients with and without paranasal sinus invasion. Multivariate analysis was used to identify the independent predictors of different survival parameters. Paranasal sinus invasion was present in 126 of 295 (42.7%) patients. Sphenoid, ethmoid, maxillary, and frontal sinus involvements were present in 123 of 295 (41.7%), 95 of 295 (32.2%), 45 of 295 (15.3%), and 0 of 295 (0%), respectively. All survival parameters were significantly better in patients without paranasal sinus invasion. When paranasal sinus invasion was reclassified as T4 instead of T3, all survival rates, other than LRFS (P = 0.156), were significantly better in the new T3 patients, and differences in all survival parameters remained nonsignificant between T3 with paranasal sinus invasion and T4 without paranasal sinus invasion patients (all P > 0.05). In multivariate analysis, paranasal sinus invasion was found to be an independent negative prognostic factor for OS, DFS, and DMFS (P = 0.016, P = 0.004, and P = 0.006, respectively), but not for LRFS (P = 0.068). Paranasal sinus invasion has prognostic value in advanced NPC. It may be reasonable to classify paranasal sinus invasion as T4 stage. © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

A Novel Therapeutic Modality for Advanced Stage Prostate Cancer Treatment

DTIC Science & Technology

2017-10-01

Unlimited The views, opinions and/or findings contained in this report are those of the author(s) and should not be construed as an official Department of...PrCa are non-selective and provide only limited response rate Thus, novel treatment modalities are needed to treat advanced stage PrCa. In this...of ORM on MTA1 protein. Considering effective therapeutic index of ORM, we are also making more potent analogues of ORM. These findings suggest that

Advanced expander test bed program

NASA Technical Reports Server (NTRS)

Riccardi, D. P.; Mitchell, J. C.

1993-01-01

The Advanced Expander Test Bed (AETB) is a key element in NASA's Space Chemical Engine Technology Program for development and demonstration of expander cycle oxygen/hydrogen engine and advanced component technologies applicable to space engines as well as launch vehicle upper stage engines. The AETB will be used to validate the high-pressure expander cycle concept, investigate system interactions, and conduct investigations of advanced mission focused components and new health monitoring techniques in an engine system environment. The split expander cycle AETB will operate at combustion chamber pressures up to 1200 psia with propellant flow rates equivalent to 20,000 lbf vacuum thrust. Contract work began 27 Apr. 1990. During 1992, a major milestone was achieved with the review of the final design of the oxidizer turbopump in Sep. 1992.

GOES-S Atlas V Centaur Stage OVI

NASA Image and Video Library

2018-02-08

At the Vertical Integration Facility at Space Launch Complex 41 at Cape Canaveral Air Force Station in Florida, a Centaur upper stage is mated to a United Launch Alliance Atlas V rocket that will boost NOAA's Geostationary Operational Environmental Satellite-S, or GOES-S, to orbit. GOES-S is the second in a series of four advanced geostationary weather satellites that will significantly improve the detection and observation of environmental phenomena that directly affect public safety, protection of property and the nation's economic health and prosperity. GOES-S is slated to launch March 1, 2018.

Advanced two-stage compressor program design of inlet stage

NASA Technical Reports Server (NTRS)

Bryce, C. A.; Paine, C. J.; Mccutcheon, A. R. S.; Tu, R. K.; Perrone, G. L.

1973-01-01

The aerodynamic design of an inlet stage for a two-stage, 10/1 pressure ratio, 2 lb/sec flow rate compressor is discussed. Initially a performance comparison was conducted for an axial, mixed flow and centrifugal second stage. A modified mixed flow configuration with tandem rotors and tandem stators was selected for the inlet stage. The term conical flow compressor was coined to describe a particular type of mixed flow compressor configuration which utilizes axial flow type blading and an increase in radius to increase the work input potential. Design details of the conical flow compressor are described.

Experiences of family of patient with newly diagnosed advanced terminal stage hepatocellular cancer.

PubMed

Shih, Whei-Mei Jean; Hsiao, Ping-Ju; Chen, Min-Li; Lin, Mei-Hsiang

2013-01-01

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the third leading cause of cancer-related death worldwide due to its generally poor prognosis. Caregiver burden for liver cancer cases is higher than with other cancer and needs especial attention. To explore the experiences of families of patients with newly diagnosed advanced terminal stage hepatocellular cancer by interview. Nine participants were recruited in this study. Content analysis of the interviews revealed four themes: blaming oneself, disrupting the pace of life, searching all possible regimens, and not letting go. This study provides new insight into the needs and support of family members especially when they are facing loved ones with newly diagnosed advanced terminal stage HCC. These results will inform future supportive care service development and intervention research aimed at providing assistance in reducing unmet supportive care needs and psychological distress of these family members.

Recent advances in endovascular techniques for management of acute nonvariceal upper gastrointestinal bleeding

PubMed Central

Loffroy, Romaric F; Abualsaud, Basem A; Lin, Ming D; Rao, Pramod P

2011-01-01

Over the past two decades, transcatheter arterial embolization has become the first-line therapy for the management of upper gastrointestinal bleeding that is refractory to endoscopic hemostasis. Advances in catheter-based techniques and newer embolic agents, as well as recognition of the effectiveness of minimally invasive treatment options, have expanded the role of interventional radiology in the management of hemorrhage for a variety of indications, such as peptic ulcer bleeding, malignant disease, hemorrhagic Dieulafoy lesions and iatrogenic or trauma bleeding. Transcatheter interventions include the following: selective embolization of the feeding artery, sandwich coil occlusion of the gastroduodenal artery, blind or empiric embolization of the supposed bleeding vessel based on endoscopic findings and coil pseudoaneurysm or aneurysm embolization by three-dimensional sac packing with preservation of the parent artery. Transcatheter embolization is a fast, safe and effective, minimally invasive alternative to surgery when endoscopic treatment fails to control bleeding from the upper gastrointestinal tract. This article reviews the various transcatheter endovascular techniques and devices that are used in a variety of clinical scenarios for the management of hemorrhagic gastrointestinal emergencies. PMID:21860697

Racial disparities in advanced stage colorectal cancer survival

PubMed Central

Wallace, Kristin; Hill, Elizabeth G.; Lewin, David N.; Williamson, Grace; Oppenheimer, Stephanie; Ford, Marvella E.; Wargovich, Michael J.; Berger, Franklin G.; Bolick, Susan W.; Thomas, Melanie B.; Alberg, Anthony J.

2013-01-01

Purpose African Americans (AA) have a higher incidence and lower survival from colorectal cancer (CRC) compared to European Americans (EA). In the present study, statewide, population-based data from South Carolina Central Cancer Registry (SCCCR) is used to investigate the relationship between race and age on advanced stage CRC survival. Methods The study population was comprised of 3865 advanced pathologically documented colon and rectal adenocarcinoma cases diagnosed between 01 January 1996 and 31 December 2006: 2673 (69%) EA and 1192 (31%) AA. Kaplan-Meier methods were used to generate median survival time and corresponding 95% confidence intervals (CI) by race, age, and gender. Factors associated with survival were evaluated by fitting Cox proportional hazards (CPH) regression models to generate Hazard Ratios (HR) and 95% CI. Results We observed a significant interaction between race and age on CRC survival (p = 0.04). Among younger patients (< 50 years), AA race was associated with a 1.34 (95% CI 1.06-1.71) higher risk of death compared to EA. Among older patients, we observed a modest increase risk of death among AA men compared to EA (HR 1.16 (95% CI 1.01-1.32) but no difference by race among women (HR 0.94 (95% CI 0.82-1.08)). Moreover, we observed that the disparity in survival has worsened over the past 15 years. Conclusions Future studies that integrate clinical, molecular, and treatment-related data are needed for advancing understanding of the racial disparity in CRC survival, especially for those < 50 years old. PMID:23296454

Two stage turbine for rockets

NASA Technical Reports Server (NTRS)

Veres, Joseph P.

1993-01-01

The aerodynamic design and rig test evaluation of a small counter-rotating turbine system is described. The advanced turbine airfoils were designed and tested by Pratt & Whitney. The technology represented by this turbine is being developed for a turbopump to be used in an advanced upper stage rocket engine. The advanced engine will use a hydrogen expander cycle and achieve high performance through efficient combustion of hydrogen/oxygen propellants, high combustion pressure, and high area ratio exhaust nozzle expansion. Engine performance goals require that the turbopump drive turbines achieve high efficiency at low gas flow rates. The low mass flow rates and high operating pressures result in very small airfoil heights and diameters. The high efficiency and small size requirements present a challenging turbine design problem. The shrouded axial turbine blades are 50 percent reaction with a maximum thickness to chord ratio near 1. At 6 deg from the tangential direction, the nozzle and blade exit flow angles are well below the traditional design minimum limits. The blade turning angle of 160 deg also exceeds the maximum limits used in traditional turbine designs.

Low Cost Upper Stage-Class Propulsion (LCUSP)

NASA Technical Reports Server (NTRS)

Vickers, John

2015-01-01

NASA is making space exploration more affordable and viable by developing and utilizing innovative manufacturing technologies. Technology development efforts at NASA in propulsion are committed to continuous innovation of design and manufacturing technologies for rocket engines in order to reduce the cost of NASA's journey to Mars. The Low Cost Upper Stage-Class Propulsion (LCUSP) effort will develop and utilize emerging Additive Manufacturing (AM) to significantly reduce the development time and cost for complex rocket propulsion hardware. Benefit of Additive Manufacturing (3-D Printing) Current rocket propulsion manufacturing techniques are costly and have lengthy development times. In order to fabricate rocket engines, numerous complex parts made of different materials are assembled in a way that allow the propellant to collect heat at the right places to drive the turbopump and simultaneously keep the thrust chamber from melting. The heat conditioned fuel and oxidizer come together and burn inside the combustion chamber to provide thrust. The efforts to make multiple parts precisely fit together and not leak after experiencing cryogenic temperatures on one-side and combustion temperatures on the other is quite challenging. Additive manufacturing has the potential to significantly reduce the time and cost of making rocket parts like the copper liner and Nickel-alloy jackets found in rocket combustion chambers where super-cold cryogenic propellants are heated and mixed to the extreme temperatures needed to propel rockets in space. The Selective Laser Melting (SLM) machine fuses 8,255 layers of copper powder to make a section of the chamber in 10 days. Machining an equivalent part and assembling it with welding and brazing techniques could take months to accomplish with potential failures or leaks that could require fixes. The design process is also enhanced since it does not require the 3D model to be converted to 2-D drawings. The design and fabrication process

Two-Stage Technique Used to Manage Severe Upper Airway Obstruction and Avoid Surgical Tracheostomy: A Case Report.

PubMed

Onwochei, Desire N; El-Boghdadly, Kariem; Ahmad, Imran

2018-03-01

Severe upper airway obstruction is commonly managed with surgical tracheostomy under local anesthesia. We present a 49-year-old woman with postradiotherapy laryngeal fixation and transglottic stenosis for dilation of a pharyngeal stricture who refused elective tracheostomy. A 2-stage technique was used, which involved an awake fiberoptic intubation, followed by the transtracheal insertion of a Cricath needle and ventilation using an ejector-based Ventrain device. We discuss management aspects of this clinical scenario and the principles by which the Ventrain works.

Para-aortic lymphadenectomy in advanced stage cervical cancer, a protocol for comparing safety, feasibility and diagnostic accuracy of surgical staging versus PET-CT; PALDISC trial.

PubMed

Tax, Casper; Abbink, Karin; Rovers, Maroeska M; Bekkers, Ruud L M; Zusterzeel, Petra L M

2018-01-01

Currently, a PET-CT is used to assess the need for extended field radiotherapy of para-aortic lymph nodes (PALN) in International Federation of Gynaecology and Obstetrics (FIGO) stage IB2, IIA2-IVA (locally advanced stage) cervical cancer. A small study established a sensitivity and specificity estimate for PALN metastases of 50% (95% CI; 7-93%) and 83% (95% CI; 52-98%), respectively. Surgical staging of PALN may lead to a higher diagnostic accuracy. However, surgical staging of para-aortic lymph nodes in locally advanced stage cervical cancer is not common practice. Therefore, a phase 2 randomised controlled trial is needed to assess its safety and feasibility. In addition to standard imaging (MRI or CT scan) with PET-CT, 30 adult women with FIGO stage IB2, IIA2-IVA cervical cancer will be randomised to receive either surgical staging or usual PET-CT staging. Administering extended field radiotherapy will be based on lymphadenectomy results for the intervention group and on the PET-CT results for the control group. Follow-up visits at 0, 3, 6, 9 and 12 months will assess health-related quality of life and progression-free survival.Primary safety and feasibility outcomes of surgical staging will be assessed by calculating means with 95% confidence intervals for duration of surgery, number of complications, blood loss, nodal yield after para-aortic lymphadenectomy and treatment delay due to surgical staging. Secondary patient-centred outcomes on quality of life and first year survival will be documented and compared between the two groups. Estimates of sensitivity, specificity and negative and positive predictive values of MRI, PET-CT and surgical staging will be presented with 95% CI.. All analysis will be performed according to the intention to treat principle. This study will assess safety and feasibility, expressed as the number and severity of complications, effect on quality of life and the treatment delay due to surgically staging para-aortic lymph nodes in

Simulated dynamic response of a multi-stage compressor with variable molecular weight flow medium

NASA Technical Reports Server (NTRS)

Babcock, Dale A.

1995-01-01

A mathematical model of a multi-stage compressor with variable molecular weight flow medium is derived. The modeled system consists of a five stage, six cylinder, double acting, piston type compressor. Each stage is followed by a water cooled heat exchanger which serves to transfer the heat of compression from the gas. A high molecular weight gas (CFC-12) mixed with air in varying proportions is introduced to the suction of the compressor. Condensation of the heavy gas may occur in the upper stage heat exchangers. The state equations for the system are integrated using the Advanced Continuous Simulation Language (ACSL) for determining the system's dynamic and steady state characteristics under varying operating conditions.

Active Debris Removal Using Modified Launch Vehicle Upper Stages

NASA Astrophysics Data System (ADS)

Nasseri, S. Ali; Emanuelli, Matteo; Raval, Siddharth; Turconi, Andrea

2013-09-01

During the past few years, several research programs have assessed the current state and future evolution of space debris in the Low Earth Orbit region. These studies indicate that space debris density could reach a critical level such that there will be a continuous increase in the number of debris objects, primarily driven by debris-debris collision activity known as the Kessler effect. These studies also highlight the urgency for active debris removal.An Active Debris Removal System (ADRS) is capable of approaching the debris object through a close-range rendezvous, stabilizing its attitude, establishing physical contact, and finally de-orbiting the debris object. The de-orbiting phase could be powered by propulsion systems such as chemical rockets or electrodynamic tether (EDT) systems.The aim of this project is to model and evaluate a debris removal mission in which an adapted rocket upper stage, equipped with an electrodynamic tether (EDT) system, is employed for de-orbiting a debris object. This ADRS package is installed initially as part of a launch vehicle on a normal satellite deployment mission, and a far-approach manoeuvre will be required to align the ADRS' orbit with that of the target debris. We begin by selecting a suitable target debris and launch vehicle, and then proceed with modelling the entire debris removal mission from launch to de-orbiting of the target debris object using Analytical Graphic Inc.'s Systems Tool Kit (STK).

Solar thermal upper stage technology demonstrator liquid hydrogen storage and feed system test program

NASA Astrophysics Data System (ADS)

Cady, E. C.

1997-01-01

The Solar Thermal Upper Stage Technology Demonstrator (STUSTD) Liquid Hydrogen Storage and Feed System (LHSFS) Test Program is described. The test program consists of two principal phases. First, an engineering characterization phase includes tests performed to demonstrate and understand the expected tank performance. This includes fill and drain; baseline heat leak; active Thermodynamic Vent System (TVS); and flow tests. After the LHSFS performance is understood and performance characteristics are determined, a 30 day mission simulation test will be conducted. This test will simulate a 30 day transfer mission from low earth orbit (LEO) to geosynchronous equatorial orbit (GEO). Mission performance predictions, based on the results of the engineering characterization tests, will be used to correlate the results of the 30 day mission simulation.

IUS/TUG orbital operations and mission support study. Volume 2: Interim upper stage operations

NASA Technical Reports Server (NTRS)

1975-01-01

Background data and study results are presented for the interim upper stage (IUS) operations phase of the IUS/tug orbital operations study. The study was conducted to develop IUS operational concepts and an IUS baseline operations plan, and to provide cost estimates for IUS operations. The approach used was to compile and evaluate baseline concepts, definitions, and system, and to use that data as a basis for the IUS operations phase definition, analysis, and costing analysis. Both expendable and reusable IUS configurations were analyzed and two autonomy levels were specified for each configuration. Topics discussed include on-orbit operations and interfaces with the orbiter, the tracking and data relay satellites and ground station support capability analysis, and flight control center sizing to support the IUS operations.

Using virtual reality environment to facilitate training with advanced upper-limb prosthesis.

PubMed

Resnik, Linda; Etter, Katherine; Klinger, Shana Lieberman; Kambe, Charles

2011-01-01

Technological advances in upper-limb prosthetic design offer dramatically increased possibilities for powered movement. The DEKA Arm system allows users 10 powered degrees of movement. Learning to control these movements by utilizing a set of motions that, in most instances, differ from those used to obtain the desired action prior to amputation is a challenge for users. In the Department of Veterans Affairs "Study to Optimize the DEKA Arm," we attempted to facilitate motor learning by using a virtual reality environment (VRE) program. This VRE program allows users to practice controlling an avatar using the controls designed to operate the DEKA Arm in the real world. In this article, we provide highlights from our experiences implementing VRE in training amputees to use the full DEKA Arm. This article discusses the use of VRE in amputee rehabilitation, describes the VRE system used with the DEKA Arm, describes VRE training, provides qualitative data from a case study of a subject, and provides recommendations for future research and implementation of VRE in amputee rehabilitation. Our experience has led us to believe that training with VRE is particularly valuable for upper-limb amputees who must master a large number of controls and for those amputees who need a structured learning environment because of cognitive deficits.

Flight results of attitude matching between Space Shuttle and Inertial Upper Stage (IUS) navigation systems

NASA Astrophysics Data System (ADS)

Treder, Alfred J.; Meldahl, Keith L.

The recorded histories of Shuttle/Orbiter attitude and Inertial Upper Stage (IUS) attitude have been analyzed for all joint flights of the IUS in the Orbiter. This database was studied to determine the behavior of relative alignment between the IUS and Shuttle navigation systems. It is found that the overall accuracy of physical alignment has a Shuttle Orbiter bias component less than 5 arcmin/axis and a short-term stability upper bound of 0.5 arcmin/axis, both at 1 sigma. Summaries of the experienced physical and inertial alginment offsets are shown in this paper, together with alignment variation data, illustrated with some flight histories. Also included is a table of candidate values for some error source groups in an Orbiter/IUS attitude errror model. Experience indicates that the Shuttle is much more accurate and stable as an orbiting launch platform than has so far been advertised. This information will be valuable for future Shuttle payloads, especially those (such as the Aeroassisted Flight Experiment) which carry their own inertial navigation systems, and which could update or initialize their attitude determination systems using the Shuttle as the reference.

Space Launch System Advanced Development Office, FY 2013 Annual Report

NASA Technical Reports Server (NTRS)

Crumbly, C. M.; Bickley, F. P.; Hueter, U.

2013-01-01

The Advanced Development Office (ADO), part of the Space Launch System (SLS) program, provides SLS with the advanced development needed to evolve the vehicle from an initial Block 1 payload capability of 70 metric tons (t) to an eventual capability Block 2 of 130 t, with intermediary evolution options possible. ADO takes existing technologies and matures them to the point that insertion into the mainline program minimizes risk. The ADO portfolio of tasks covers a broad range of technical developmental activities. The ADO portfolio supports the development of advanced boosters, upper stages, and other advanced development activities benefiting the SLS program. A total of 34 separate tasks were funded by ADO in FY 2013.

Advanced space program studies. Overall executive summary

NASA Technical Reports Server (NTRS)

Wolfe, M. G.

1977-01-01

NASA and DoD requirements and planning data were used in multidiscipline advanced planning investigations of space operations and associated elements (including man), identification of potential low cost approaches, vehicle design, cost synthesis techniques, technology forecasting and opportunities for DoD technology transfer, and the development near-, mid-, and far-term space initiatives and development plans with emphasis on domestic and military commonality. An overview of objectives and results are presented for the following studies: advanced space planning and conceptual analysis, shuttle users, technology assessment and new opportunities, standardization and program practice, integrated STS operations planning, solid spinning upper stage, and integrated planning support functions.

Advances in water resources research in the Upper Blue Nile basin and the way forward: A review

NASA Astrophysics Data System (ADS)

Dile, Yihun Taddele; Tekleab, Sirak; Ayana, Essayas K.; Gebrehiwot, Solomon G.; Worqlul, Abeyou W.; Bayabil, Haimanote K.; Yimam, Yohannes T.; Tilahun, Seifu A.; Daggupati, Prasad; Karlberg, Louise; Srinivasan, Raghavan

2018-05-01

The Upper Blue Nile basin is considered as the lifeline for ∼250 million people and contributes ∼50 Gm3/year of water to the Nile River. Poor land management practices in the Ethiopian highlands have caused a significant amount of soil erosion, thereby threatening the productivity of the Ethiopian agricultural system, degrading the health of the aquatic ecosystem, and shortening the life of downstream reservoirs. The Upper Blue Nile basin, because of limited research and availability of data, has been considered as the "great unknown." In the recent past, however, more research has been published. Nonetheless, there is no state-of-the-art review that presents research achievements, gaps and future directions. Hence, this paper aims to bridge this gap by reviewing the advances in water resources research in the basin while highlighting research needs and future directions. We report that there have been several research projects that try to understand the biogeochemical processes by collecting information on runoff, groundwater recharge, sediment transport, and tracers. Different types of hydrological models have been applied. Most of the earlier research used simple conceptual and statistical approaches for trend analysis and water balance estimations, mainly using rainfall and evapotranspiration data. More recent research has been using advanced semi-physically/physically based distributed hydrological models using high-resolution temporal and spatial data for diverse applications. We identified several research gaps and provided recommendations to address them. While we have witnessed advances in water resources research in the basin, we also foresee opportunities for further advancement. Incorporating the research findings into policy and practice will significantly benefit the development and transformation agenda of the Ethiopian government.

GOES-S Atlas V Centaur Stage OVI

NASA Image and Video Library

2018-02-08

At the Vertical Integration Facility at Space Launch Complex 41 at Cape Canaveral Air Force Station in Florida, technicians and engineers monitor progress as a Centaur upper stage is mated to a United Launch Alliance Atlas V rocket that will boost NOAA's Geostationary Operational Environmental Satellite-S, or GOES-S, to orbit. GOES-S is the second in a series of four advanced geostationary weather satellites that will significantly improve the detection and observation of environmental phenomena that directly affect public safety, protection of property and the nation's economic health and prosperity. GOES-S is slated to launch March 1, 2018.

GOES-S Atlas V Centaur Stage OVI

NASA Image and Video Library

2018-02-08

At the Vertical Integration Facility at Space Launch Complex 41 at Cape Canaveral Air Force Station in Florida, a crane lifts a Centaur upper stage for mating to a United Launch Alliance Atlas V rocket that will boost NOAA's Geostationary Operational Environmental Satellite-S, or GOES-S, to orbit. GOES-S is the second in a series of four advanced geostationary weather satellites that will significantly improve the detection and observation of environmental phenomena that directly affect public safety, protection of property and the nation's economic health and prosperity. GOES-S is slated to launch March 1, 2018.

Racial disparities in advanced-stage colorectal cancer survival.

PubMed

Wallace, Kristin; Hill, Elizabeth G; Lewin, David N; Williamson, Grace; Oppenheimer, Stephanie; Ford, Marvella E; Wargovich, Michael J; Berger, Franklin G; Bolick, Susan W; Thomas, Melanie B; Alberg, Anthony J

2013-03-01

African-Americans (AA) have a higher incidence of and lower survival from colorectal cancer (CRC) compared with European Americans (EA). In the present study, statewide, population-based data from South Carolina Central Cancer Registry are used to investigate the relationship between race and age on advanced-stage CRC survival. The study population was comprised of 3,865 advanced pathologically documented colon and rectal adenocarcinoma cases diagnosed between 01 January 1996 and 31 December 2006: 2,673 (69 %) EA and 1,192 (31 %) AA. Kaplan-Meier methods were used to generate median survival time and corresponding 95 % confidence intervals (CI) by race, age, and gender. Factors associated with survival were evaluated by fitting Cox proportional hazards regression models to generate hazard ratios (HR) and 95 % CI. We observed a significant interaction between race and age on CRC survival (p = 0.04). Among younger patients (<50 years), AA race was associated with a 1.34 times (95 % CI 1.06-1.71) higher risk of death compared with EA. Among older patients, we observed a modest increase in risk of death among AA men compared with EA [HR 1.16 (95 % CI 1.01-1.32)] but no difference by race between women [HR 0.94 (95 % CI 0.82-1.08)]. Moreover, we observed that the disparity in survival has worsened over the past 15 years. Future studies that integrate clinical, molecular, and treatment-related data are needed for advancing understanding of the racial disparity in CRC survival, especially for those <50 years old.

Tracking an upper limit of the "Carnian Crisis" and/or Carnian stage in the Western Carpathians (Slovakia)

NASA Astrophysics Data System (ADS)

Kohút, Milan; Hofmann, Mandy; Havrila, Milan; Linnemann, Ulf; Havrila, Jakub

2018-01-01

The Late Triassic timescale, especially the Carnian-Norian boundary, is poorly constrained mainly due to a paucity of high-precision radio-isotopic ages that can be related accurately to contradictions between the biostratigraphic and magnetostratigraphic correlations. LA ICP-MS dating of detrital zircons from five samples of the Lunz Formation—the Upper Triassic siliciclastic sediments from the Western Carpathians (Slovakia)—provided a wide spectrum of ages that vary from Late Archaean (ca. 2582 Ma) to Triassic (ca. 216 Ma). These marine delta sediments represent a typical product of the "Carnian Crisis"—a major climate change and biotic turnover that occurred during the Carnian stage in the Tethys Ocean within the carbonate shelf and intrashelf basins in the Northern Calcareous Alps and the Western Carpathians. The supply of clastic material in the studied Lunz Formation was derived from several sources, especially: (i) from the recycled Variscan orogen; (ii) from the remote East European Platform; and (iii) from the contemporaneous Triassic volcanic sources. Syn-sedimentary volcanic zircons with a concordia age of 221.2 ± 1.6 Ma (calculated from 12 single analyses) represent the maximum age of deposition of the Lunz Formation, and demonstrate that the upper limit of the "Carnian Crisis" and/or the Carnian stage in the Alpine-Carpathians realm is younger than the current age of the Carnian-Norian boundary at ca. 227 Ma listed on the International Chronostratigraphic Chart (International Commission on Stratigraphy 2016/12 Edition).

Evaluation of PET and laparoscopy in STagIng advanced gastric cancer: a multicenter prospective study (PLASTIC-study).

PubMed

Brenkman, H J F; Gertsen, E C; Vegt, E; van Hillegersberg, R; van Berge Henegouwen, M I; Gisbertz, S S; Luyer, M D P; Nieuwenhuijzen, G A P; van Lanschot, J J B; Lagarde, S M; de Steur, W O; Hartgrink, H H; Stoot, J H M B; Hulsewe, K W E; Spillenaar Bilgen, E J; van Det, M J; Kouwenhoven, E A; van der Peet, D L; Daams, F; van Sandick, J W; van Grieken, N C T; Heisterkamp, J; van Etten, B; Haveman, J W; Pierie, J P; Jonker, F; Thijssen, A Y; Belt, E J T; van Duijvendijk, P; Wassenaar, E; van Laarhoven, H W M; Wessels, F J; Haj Mohammad, N; van Stel, H F; Frederix, G W J; Siersema, P D; Ruurda, J P

2018-04-20

Initial staging of gastric cancer consists of computed tomography (CT) and gastroscopy. In locally advanced (cT3-4) gastric cancer, fluorodeoxyglucose positron emission tomography with CT (FDG-PET/CT or PET) and staging laparoscopy (SL) may have a role in staging, but evidence is scarce. The aim of this study is to evaluate the impact and cost-effectiveness of PET and SL in addition to initial staging in patients with locally advanced gastric cancer. This prospective observational cohort study will include all patients with a surgically resectable, advanced gastric adenocarcinoma (cT3-4b, N0-3, M0), that are scheduled for treatment with curative intent after initial staging with gastroscopy and CT. The modalities to be investigated in this study is the addition of PET and SL. The primary outcome of this study is the proportion of patients in whom the PET or SL lead to a change in treatment strategy. Secondary outcome parameters are: diagnostic performance, morbidity and mortality, quality of life, and cost-effectiveness of these additional diagnostic modalities. The study recently started in August 2017 with a duration of 36 months. At least 239 patients need to be included in this study to demonstrate that the diagnostic modalities are break-even. Based on the annual number of gastrectomies in the participating centers, it is estimated that approximately 543 patients are included in this study. In this study, it is hypothesized that performing PET and SL for locally advanced gastric adenocarcinomas results in a change of treatment strategy in 27% of patients and an annual cost-reduction in the Netherlands of €916.438 in this patient group by reducing futile treatment. The results of this study may be applicable to all countries with comparable treatment algorithms and health care systems. NCT03208621 . This trial was registered prospectively on June 30, 2017.

Assembly of 5.5-Meter Diameter Developmental Barrel Segments for the Ares I Upper Stage

NASA Technical Reports Server (NTRS)

Carter, Robert W.

2011-01-01

Full scale assembly welding of Ares I Upper Stage 5.5-Meter diameter cryogenic tank barrel segments has been performed at the Marshall Space Flight Center (MSFC). One full-scale developmental article produced under the Ares 1 Upper Stage project is the Manufacturing Demonstration Article (MDA) Barrel. This presentation will focus on the welded assembly of this barrel section, and associated lessons learned. Among the MDA articles planned on the Ares 1 Program, the Barrel was the first to be completed, primarily because the process of manufacture from piece parts (barrel panels) utilized the most mature friction stir process planned for use on the Ares US program: Conventional fixed pin Friction Stir Welding (FSW). This process is in use on other space launch systems, including the Shuttle s External Tank, the Delta IV common booster core, the Delta II, and the Atlas V rockets. The goals for the MDA Barrel development were several fold: 1) to prove out Marshall Space Flight Center s new Vertical Weld Tool for use in manufacture of cylindrical barrel sections, 2) to serve as a first run for weld qualification to a new weld specification, and 3) to provide a full size cylindrical section for downstream use in precision cleaning and Spray-on Foam Insulation development. The progression leading into the welding of the full size barrel included sub scale panel welding, subscale cylinder welding, a full length confidence weld, and finally, the 3 seamed MDA barrel processing. Lessons learned on this MDA program have been carried forward into the production tooling for the Ares 1 US Program, and in the use of the MSFC VWT in processing other large scale hardware, including two 8.4 meter diameter Shuttle External Tank barrel sections that are currently being used in structural analysis to validate shell buckling models.

Treatment with DAV for advanced-stage hemangiosarcoma in dogs.

PubMed

Dervisis, Nikolaos G; Dominguez, Pedro A; Newman, Rebecca G; Cadile, Casey D; Kitchell, Barbara E

2011-01-01

Hemangiosarcoma (HSA) is an aggressive disease that is fairly common in the dog. The authors evaluated a doxorubicin, dacarbazine, and vincristine (DAV) combination protocol in dogs with nonresectable stage II and stage III HSA. Twenty-four dogs were enrolled in this prospective, phase 2 study. Doxorubicin and dacarbazine were administered on day 1 while vincristine was administered on days 8 and 15. The protocol was repeated every 21 days for a maximum of six cycles or until disease progression. Toxicity and efficacy were assessed by clinical and laboratory evaluation and by questionnaires completed by the owners. Of the 24 included dogs, 19 were evaluable for response. The response rate (including five complete responses and four partial responses) was 47.4%. Median time to tumor progression was 101 days and median overall survival was 125 days. Significant toxicities were noted, including 41 high-grade hematologic and 12 high-grade gastrointestinal toxic events. Five dogs discontinued treatment due to chemotherapy-related toxicities, but no treatment-related deaths occurred. Multivariate analysis identified patient age (relative risk [RR], 2.3, P=0.049) to be negatively associated with time to progression whereas dacarbazine dose reductions (RR, 0.06, P=0.031) were positively associated with time to progression. Dacarbazine dose reduction was the sole factor positively associated with overall survival (RR, 0.28, P=0.015). In conclusion, the DAV combination appears to offer clinical responses and may prolong survival in dogs with advanced-stage HSA.

Long-Term Results of Concurrent Chemoradiotherapy for Advanced N2-3 Stage Nasopharyngeal Carcinoma

PubMed Central

Wang, Xue; Chen, Meng; Wu, Jing; Xu, Jian-Hua; Qian, Pu-Dong; Guo, Wen-Jie; Jiang, Xue-Song; Zhu, Huan-Feng; Gu, Jia-Jia; Wu, Jian-Feng; Zhang, Ye-wei; He, Xia

2015-01-01

Background N-stage is related to distant metastasis in nasopharyngeal carcinoma (NPC) patients. The purpose of this study was to evaluate the efficacy and toxicity of different nedaplatin-based chemotherapy regimens in advanced N2-3 stage NPC patients treated with intensity modulated radiation therapy (IMRT). Patients and Methods Between April 2005 and December 2009, a total of 128 patients with N2-3 advanced NPC were retrospectively analyzed. Patients were treated with IMRT concurrent with 2 cycles of chemotherapy consisting of either nedaplatin plus paclitaxel (NP group, n = 67) or nedaplatin plus fluorouracil and paclitaxel (NFP group, n = 61). Two to four cycles of adjuvant chemotherapy were then administered every 21 days following concurrent chemoradiotherapy. Results With a median follow-up of 60 months, the 5-year overall survival (OS), progression-free survival (PFS), local-regional recurrence-free survival (LRRFS), and distant metastasis-free survival (DMFS) for all patients were 81.4%, 71.5%, 87.8% and 82.0%, respectively. No significant difference in PFS (66.6% vs. 76.7%, P = 0.212) and LRRFS rates (89.0% vs. 86.3%, P = 0.664) was observed between the NP and NFP groups. The 5-year OS (75.4% vs. 88.5%, P = 0.046) and DMFS (75.1% vs. 89.0%, P = 0.042) rate were superior in the NFP group compared with the NP group. The NFP group had a higher incidence of grade 3–4 acute toxicities including bone marrow suppression (leukopenia: χ2 = 3.935, P = 0.047; anemia: χ2 = 9.760, P = 0.002; thrombocytopenia: χ2 = 8.821, P = 0.003), and both liver and renal dysfunction (χ2 = 5.206, P = 0.023) compared with the NP group. Late toxicities were moderate and no difference was observed between the two groups. Conclusion IMRT concurrent with nedaplatin-based chemotherapy is an advocated regimen for patients with advanced N2-3 stage NPC. Patients with advanced N2-3 stage may be better candidates for the NFP regimen although this regimen was associated with a high acute

Liquid biopsy: A potential and promising diagnostic tool for advanced stage non-small cell lung cancer patients.

PubMed

Doval, D C; Deshpande, R; Dhabhar, B; Babu, K G; Prabhash, K; Chopra, R; Sripada, P V; Deshmukh, C; Suryavanshi, M

2017-12-01

More than 50% of non-small cell lung cancer (NSCLC) cases harbor an actionable mutation, and molecular testing at different intervals can help in personalized and targeted treatment. Core tissue biopsy and needle biopsy done at the time of diagnosis/disease progression are interventional, time-consuming and can affect the patients adversely. Noninterventional biomarker testing by liquid biopsy promises to revolutionize advanced stage cancer screening. The present report was formulated based on an expert panel meeting of renowned oncologists who gave their opinions for minimally invasive liquid biopsy to detect targetable molecular biomarkers in advanced NSCLC cases. An exhaustive literature search was done to support their recommendations. Clinical utility of minimally invasive liquid biopsy, for detection of molecular biomarkers in advanced stage NSCLC patients, was broadly discussed by the key opinion leaders.

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

NASA Technical Reports Server (NTRS)

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

2015-01-01

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

The Status of National Values in the Books of Social Studies for the Grades of the Upper Primary Stage in Jordan

ERIC Educational Resources Information Center

Subheyyin, Eid H.; Mawajdeh, Baker S.; Talhouni, Mansour H.; Rfou', Mohammad O.

2017-01-01

This study aimed at determining the most important national values that should be included in the textbooks of social studies for the upper-primary stage grades in Jordan; and then identifying the degree of their inclusion in those books. The study used a descriptive-analytical approach. A study tool which includes twelve national values was…

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

NASA Technical Reports Server (NTRS)

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

2015-01-01

NASA's Environmentally Responsible Aviation (ERA) Program calls for investigation of the technology barriers associated with improved fuel efficiency for large gas turbine engines. Under ERA, the highly loaded core compressor technology program attempts to realize the fuel burn reduction goal by increasing overall pressure ratio of the compressor to increase thermal efficiency of the engine. Study engines with overall pressure ratio of 60 to 70 are now being investigated. This means that the high pressure compressor would have to almost double in pressure ratio while keeping a high level of efficiency. NASA and GE teamed to address this challenge by testing the first two stages of an advanced GE compressor designed to meet the requirements of a very high pressure ratio core compressor. Previous test experience of a compressor which included these front two stages indicated a performance deficit relative to design intent. Therefore, the current rig was designed to run in 1-stage and 2-stage configurations in two separate tests to assess whether the bow shock of the second rotor interacting with the upstream stage contributed to the unpredicted performance deficit, or if the culprit was due to interaction of rotor 1 and stator 1. Thus, the goal was to fully understand the stage 1 performance under isolated and multi-stage conditions, and additionally to provide a detailed aerodynamic data set for CFD validation. Full use was made of steady and unsteady measurement methods to understand fluid dynamics loss source mechanisms due to rotor shock interaction and endwall losses. This paper will present the description of the compressor test article and its measured performance and operability, for both the single stage and two stage configurations. We focus the paper on measurements at 97% corrected speed with design intent vane setting angles.

Biologic lung volume reduction in advanced upper lobe emphysema: phase 2 results.

PubMed

Criner, Gerard J; Pinto-Plata, Victor; Strange, Charlie; Dransfield, Mark; Gotfried, Mark; Leeds, William; McLennan, Geoffrey; Refaely, Yael; Tewari, Sanjiv; Krasna, Mark; Celli, Bartolome

2009-05-01

Biologic lung volume reduction (BioLVR) is a new endobronchial treatment for advanced emphysema that reduces lung volume through tissue remodeling. Assess the safety and therapeutic dose of BioLVR hydrogel in upper lobe predominant emphysema. Open-labeled, multicenter phase 2 dose-ranging studies were performed with BioLVR hydrogel administered to eight subsegmental sites (four in each upper lobe) involving: (1) low-dose treatment (n = 28) with 10 ml per site (LD); and (2) high-dose treatment (n = 22) with 20 ml per site (HD). Safety was assessed by the incidence of serious medical complications. Efficacy was assessed by change from baseline in pulmonary function tests, dyspnea score, 6-minute walk distance, and health-related quality of life. After treatment there were no deaths and four serious treatment-related complications. A reduction in residual volume to TLC ratio at 12 weeks (primary efficacy outcome) was achieved with both LD (-6.4 +/- 9.3%; P = 0.002) and HD (-5.5 +/- 9.4%; P = 0.028) treatments. Improvements in pulmonary function in HD (6 mo: DeltaFEV(1) = +15.6%; P = 0.002; DeltaFVC = +9.1%; P = 0.034) were greater than in LD patients (6 mo: DeltaFEV(1) = +6.7%; P = 0.021; DeltaFVC = +5.1%; P = 0.139). LD- and HD-treated groups both demonstrated improved symptom scores and health-related quality of life. BioLVR improves physiology and functional outcomes up to 6 months with an acceptable safety profile in upper lobe predominant emphysema. Overall improvement was greater and responses more durable with 20 ml per site than 10 ml per site dosing. Clinical trial registered with www.clinicaltrials.gov (NCT 00435253 and NCT 00515164).

Additive Manufacturing of Low Cost Upper Stage Propulsion Components

NASA Technical Reports Server (NTRS)

Protz, Christopher; Bowman, Randy; Cooper, Ken; Fikes, John; Taminger, Karen; Wright, Belinda

2014-01-01

NASA is currently developing Additive Manufacturing (AM) technologies and design tools aimed at reducing the costs and manufacturing time of regeneratively cooled rocket engine components. These Low Cost Upper Stage Propulsion (LCUSP) tasks are funded through NASA's Game Changing Development Program in the Space Technology Mission Directorate. The LCUSP project will develop a copper alloy additive manufacturing design process and develop and optimize the Electron Beam Freeform Fabrication (EBF3) manufacturing process to direct deposit a nickel alloy structural jacket and manifolds onto an SLM manufactured GRCop chamber and Ni-alloy nozzle. In order to develop these processes, the project will characterize both the microstructural and mechanical properties of the SLMproduced GRCop-84, and will explore and document novel design techniques specific to AM combustion devices components. These manufacturing technologies will be used to build a 25K-class regenerative chamber and nozzle (to be used with tested DMLS injectors) that will be tested individually and as a system in hot fire tests to demonstrate the applicability of the technologies. These tasks are expected to bring costs and manufacturing time down as spacecraft propulsion systems typically comprise more than 70% of the total vehicle cost and account for a significant portion of the development schedule. Additionally, high pressure/high temperature combustion chambers and nozzles must be regeneratively cooled to survive their operating environment, causing their design to be time consuming and costly to build. LCUSP presents an opportunity to develop and demonstrate a process that can infuse these technologies into industry, build competition, and drive down costs of future engines.

Multiband mucosectomy for advanced dysplastic lesions in the upper digestive tract

PubMed Central

Espinel, Jesús; Pinedo, Eugenia; Ojeda, Vanesa; del Rio, Maria Guerra

2015-01-01

Endoscopic resection (ER) is at present an accepted treatment for superficial gastrointestinal neoplasia. ER provides similar efficacy to surgery; however, it is minimally invasive and less expensive. Endoscopic mucosal resection (EMR) is superior to biopsy for diagnosing advanced dysplasia and can change the diagnostic grade and the management. Several EMR techniques have been described that are alternatively used dependent upon the endoscopist personal experience, the anatomic conditions and the endoscopic appearance of the lesion to be resected. The literature suggests that EMR offers comparable outcomes to surgery for selected indications. EMR techniques using a cap fitted endoscope and EMR using a ligation device [multiband mucosectomy (MBM)] are the most frequently use. MBM technique does not require submucosal injection as with the endoscopic resection-cap technique, multiple resections can be performed with the same snare, pre-looping the endoscopic resection-snare in the ridge of the cap is not necessary, MBM does not require withdrawal of the endoscope between resections and up to six consecutive resections can be performed. This reduces the time and cost required for the procedure, while also reducing patient discomfort. Despite the increasing popularity of MBM, data on the safety and efficacy of this technique in upper gastrointestinal lesions with advanced dysplasia, defined as those lesions that have high-grade dysplasia or early cancer, is limited. PMID:25901216

Application of GPS to Enable Launch Vehicle Upper Stage Heliocentric Disposal

NASA Technical Reports Server (NTRS)

Anzalone, Evan J.; Oliver, T. Emerson

2017-01-01

To properly dispose of the upper stage of the Space Launch System, the vehicle must perform a burn in Earth orbit to perform a close flyby of the Lunar surface to gain adequate energy to enter into heliocentric space. This architecture was selected to meet NASA requirements to limit orbital debris in the Earth-Moon system. The choice of a flyby for heliocentric disposal was driven by mission and vehicle constraints. This paper describes the SLS mission for Exploration Mission -1, a high level overview of the Block 1 vehicle, and the various disposal options considered. The research focuses on this analysis in terms of the mission design and navigation problem, focusing on the vehicle-level requirements that enable a successful mission. An inertial-only system is shown to be insufficient for heliocentric flyby due to large inertial integration errors from launch through disposal maneuver while on a trans-lunar trajectory. The various options for aiding the navigation system are presented and details are provided on the use of GPS to bound the state errors in orbit to improve the capability for stage disposal. The state estimation algorithm used is described as well as its capability in determination of the vehicle state at the start of the planned maneuver. This data, both dispersions on state and on errors, is then used to develop orbital targets to use for meeting the required Lunar flyby for entering onto a heliocentric trajectory. The effect of guidance and navigation errors on this capability is described as well as the identified constraints for achieving the disposal requirements. Additionally, discussion is provided on continued analysis and identification of system considerations that can drive the ability to integrate onto a vehicle intended for deep space.

Management of untreated advanced stage follicular lymphoma: Role of patient discernment.

PubMed

Umakanthan, Jayadev Manikkam; Lunning, Mathew A

2018-03-01

Follicular lymphoma is the most common indolent non-Hodgkin lymphoma. Advanced stage disease is common at diagnosis. The timing of treatment for follicular lymphoma is best approached by considering the combination of presence or absence of symptoms along with estimation of tumor burden. Upfront treatment strategies should take into initial presentation variables, pace of disease progression and goals of care after discussion with the patient. Treatment approaches remain diverse and patient discernment is paramount. Copyright © 2017 Elsevier Ltd. All rights reserved.

Three-dimensional changes to the upper airway after maxillomandibular advancement with counterclockwise rotation: a systematic review and meta-analysis.

PubMed

Louro, R S; Calasans-Maia, J A; Mattos, C T; Masterson, D; Calasans-Maia, M D; Maia, L C

2018-05-01

The aim of this study was to evaluate the effect of counterclockwise (CCW) rotation and maxillomandibular advancement (MMA) on the upper airway space using three-dimensional images. An electronic search was performed in the PubMed, Cochrane Library, Scopus, Virtual Health Library, Web of Science, and OpenGrey databases (end date July 2016); a hand-search of primary study reference lists was also conducted. The inclusion criteria encompassed computed tomography evaluations of the upper airway spaces of adult patients undergoing orthognathic surgery with CCW rotation and MMA. The articles were evaluated for risk of bias with a tool for before-and-after studies. A meta-analysis was performed with the mean differences using a random-effects model. Heterogeneity was assessed with the Q-test and the I 2 index. The meta-analysis revealed significant (P<0.001) increases in both the total airway volume (effect size of 6832mm 3 and confidence interval of 5554-8109mm 3 ) and the minimum axial area (effect size of 92mm 2 and confidence interval of 70-113mm 2 ). The heterogeneity was low in both comparisons (I 2 =38% and 7%, respectively). The technique of mandibular advancement with CCW rotation produced significant increases in the volumes and areas of the upper airway spaces. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Behavioral variant frontotemporal dementia: advanced disease stages and death. A step to palliative care.

PubMed

Diehl-Schmid, J; Richard-Devantoy, S; Grimmer, T; Förstl, H; Jox, R

2017-08-01

The aim of the present study was to gain insight into the living and care situation in advanced behavioral variant frontotemporal dementia (bvFTD), to describe symptoms and findings in advanced bvFTD, and to evaluate somatic comorbidities and circumstances of death. Standardized interviews were conducted with family caregivers of 83 patients with bvFTD. Forty-four percent of the patients were already deceased at the time of the interview. At the time of the interview or death, respectively, 47% of the patients lived in a nursing home. The median time between symptom onset and nursing home admission was 5.0 ± 5.5 years. In moderate and severe dementia stages almost all patients suffered from severe disabilities including impairment of language, gait, swallowing, and of the ability to care for themselves. Sixteen percent of the patients had got enteral tube feeding. Comorbid somatic diseases were diagnosed in 46% of the patients. Twenty-three percent of the deceased patients had been admitted into a hospital before death. Cardiovascular disease and respiratory disease, mostly pneumonia, were the most frequent causes of death. Advanced bvFTD is characterized by severe cognitive impairment and physical disabilities. BvFTD leads to a premature death. Our findings stress the importance of strategies that maximize patient comfort in advanced disease stages and allow for a peaceful death. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Weight optimal design of lateral wing upper covers made of composite materials

NASA Astrophysics Data System (ADS)

Barkanov, Evgeny; Eglītis, Edgars; Almeida, Filipe; Bowering, Mark C.; Watson, Glenn

2016-09-01

The present investigation is devoted to the development of a new optimal design of lateral wing upper covers made of advanced composite materials, with special emphasis on closer conformity of the developed finite element analysis and operational requirements for aircraft wing panels. In the first stage, 24 weight optimization problems based on linear buckling analysis were solved for the laminated composite panels with three types of stiffener, two stiffener pitches and four load levels, taking into account manufacturing, reparability and damage tolerance requirements. In the second stage, a composite panel with the best weight/design performance from the previous study was verified by nonlinear buckling analysis and optimization to investigate the effect of shear and fuel pressure on the performance of stiffened panels, and their behaviour under skin post-buckling. Three rib-bay laminated composite panels with T-, I- and HAT-stiffeners were modelled with ANSYS, NASTRAN and ABAQUS finite element codes to study their buckling behaviour as a function of skin and stiffener lay-ups, stiffener height, stiffener top and root width. Owing to the large dimension of numerical problems to be solved, an optimization methodology was developed employing the method of experimental design and response surface technique. Optimal results obtained in terms of cross-sectional areas were verified successfully using ANSYS and ABAQUS shared-node models and a NASTRAN rigid-linked model, and were used later to estimate the weight of the Advanced Low Cost Aircraft Structures (ALCAS) lateral wing upper cover.

Resting energy expenditure and body composition in bedridden institutionalized elderly women with advanced-stage pressure sores.

PubMed

Sergi, Giuseppe; Coin, Alessandra; Mulone, Silvana; Castegnaro, Eugenio; Giantin, Valter; Manzato, Enzo; Busetto, Luca; Inelmen, Emine Meral; Marin, Sara; Enzi, Giuliano

2007-03-01

Our study investigated nutritional status, body composition, and resting energy expenditure (REE) in elderly patients with advanced-stage pressure sores (PS), in addition to researching any hypermetabolic condition and its relationship with PS size. The study involved 52 institutionalized bedridden elderly women (aged 83.7 +/- 6.3 years), divided into two groups: 23 with advanced-stage (stage 3 and 4) PS and 29 without PS. Albumin, prealbumin, and retinol-binding protein were measured in all patients, and fat-free mass (FFM) and fat mass (FM) were obtained by dual-energy x-ray absorptiometry (DEXA). REE was measured by indirect calorimetry and predicted with the Harris-Benedict formula. PS area and volume were also measured. The elderly women with and without PS were comparable in age, FFM, and FM. Mean albumin, prealbumin, and retinol-binding protein values were lower in cases with PS. Unadjusted mean REE was significantly higher in patients with PS (1212.3 +/- 236.7 vs 1085.5 +/- 161.3 kcal/d; p <.05), even after adjusting for FFM or expressed per kilogram of body weight (25.8 +/- 6.7 vs 21.1 +/- 4.0 kcal/d/kg; p <.01). Hypermetabolism, i.e., a measured REE > 110% of the predicted REE, was seen in 74% of patients with PS and 38% of controls. The difference between measured and predicted REE (DeltaREE) correlated with PS volume (r = 0.58; p <.01), but not with area. Advanced-stage PS in elderly women are associated with a hypermetabolic state that is influenced by the volume of the PS.

Artist concept of Galileo with inertial upper stage (IUS) in low Earth orbit

NASA Image and Video Library

1989-08-25

S89-42940 (April 1989) --- In this artist's rendition, the Galileo spacecraft is being boosted into its inter-planetary trajectory by the Inertial Upper Stage (IUS) rocket. The Space Shuttle Atlantis, which is scheduled to take Galileo and the IUS from Earth's surface into space, is depicted against the curve of Earth. Galileo will be placed on a trajectory to Venus, from which it will return to Earth at higher velocity and then gain still more energy in two gravity-assist passes, until it has enough velocity to reach Jupiter. Passing Venus, it will take scientific data using instruments designed for observing Jupiter; later, it will make measurements at Earth and the moon, crossing above the moon's north pole in the second pass. Between the two Earth passes, it will edge into the asteroid belt, beyond Mars' orbit; there, the first close-up observation of an asteroid is planned. Crossing the belt later, another asteroid flyby is possible.

Prediction of 30-day morbidity after primary cytoreductive surgery for advanced stage ovarian cancer.

PubMed

Gerestein, C G; Nieuwenhuyzen-de Boer, G M; Eijkemans, M J; Kooi, G S; Burger, C W

2010-01-01

Treatment in advanced stage epithelial ovarian cancer (EOC) is based on primary cytoreductive surgery followed by platinum-based chemotherapy. Successful cytoreduction to minimal residual tumour burden is the most important determinant of prognosis. However, extensive surgical procedures to achieve maximal debulking are inevitably associated with postoperative morbidity and mortality. The objective of this study is to determine predictors of 30-day morbidity after primary cytoreductive surgery for advanced stage EOC. All patients in the South Western part of the Netherlands who underwent primary cytoreductive surgery for advanced stage EOC between January 2004 and December 2007 were identified from the Rotterdam Cancer Registry database. All peri- and postoperative complications within 30 days after surgery were registered and classified according to the definitions of the National Surgical Quality Improvement Programme (NSQIP). To investigate independent predictors of 30-day morbidity, a Cox proportional hazards model with backward stepwise elimination was utilised. The identified predictors were entered into a nomogram. Two hundred and ninety-three patients entered the study protocol. Optimal cytoreduction was achieved in 136 (46%) patients. 30-day morbidity was seen in 99 (34%) patients. Postoperative morbidity could be predicted by age (P=0.007; odds ratio [OR] 1.034), WHO performance status (P=0.046; OR 1.757), extent of surgery (P=0.1308; OR=2.101), and operative time (P=0.017; OR 1.007) with an optimism corrected c-statistic of 0.68. 30-day morbidity could be predicted by age, WHO performance status, operative time and extent of surgery. The generated nomogram could be valuable for predicting operative risk in the individual patient.

HIV-infection has no prognostic impact on advanced-stage Hodgkin lymphoma.

PubMed

Sorigué, Marc; García, Olga; Tapia, Gustavo; Baptista, Maria-Joao; Moreno, Miriam; Mate, José-Luis; Sancho, Juan M; Feliu, Evarist; Ribera, Josep-Maria; Navarro, José-Tomás

2017-06-19

Classical Hodgkin lymphoma (cHL) is a non-AIDS-defining cancer with a good response to chemotherapy in the combined antiretroviral therapy (cART) era. The aim of the present study was to compare the characteristics, the response to treatment and the survival of advanced-stage cHL treated with adriamycin, bleomycin, vinblastine and dacarbazine (ABVD) between cART-treated HIV-positive and HIV-negative patients. We retrospectively analyzed advanced-stage cHL patients from a single institution, uniformly treated with ABVD. All HIV-positive patients received cART concomitantly with ABVD. A total of 69 patients were included in the study: 21 were HIV-positive and 48 were HIV-negative. HIV-positive patients had more aggressive features at cHL diagnosis, such as worse performance status, more frequent bone marrow involvement and mixed cellularity histologic subtype. There were no differences in complete response rate (89% in HIV-positive vs. 91% in HIV-negative), P = 1; disease-free survival (DFS) [10-year DFS probability (95% CI) 70% (41-99%) vs. 74% (57-91%)], P = 0.907 and overall survival (OS) [10-year OS probability (95% CI) 73% (52-94%) vs. 68% (51-85%)], P = 0.904. On multivariate analysis, HIV infection did not correlate with worse OS. Although HIV-positive patients with cHL had more aggressive baseline features in this series, there were no differences in response rate or survival between HIV-positive and HIV-negative patients.

Risk factors for competing noncancer mortality after definitive treatment for advanced-stage head and neck cancer.

PubMed

Kim, Yong Han; Roh, Jong-Lyel; Kim, Sung-Bae; Choi, Seung-Ho; Nam, Soon Yuhl; Kim, Sang Yoon

2018-05-27

Patients with head and neck cancer (HNC) can die of index tumor progression and second tumor or noncancer causes. Here, we investigated the risk factors for competing noncancer mortality (NCM) in a prospective cohort of patients with advanced-stage HNC. A prospective observational study was conducted with 604 patients who underwent definitive treatment for advanced-stage HNC between 2010 and 2015. Main outcomes were NCM and cancer mortality (CM) defined as death from noncancer causes and HNC or second cancers, respectively. Cumulative incidence and cause-specific hazard functions were used to analyze the risk factors of NCM and CM. Age, smoking, Charlson comorbidity index (CCI), performance status, body mass index, rural residence, education and hemoglobin level at diagnosis, and chemotherapy were significantly associated with NCM (all P<0.05). Multivariate analyses showed that age, CCI, and hemoglobin were independent factors of NCM. Age (≥65 years), CCI (≥2), and hemoglobin (<11 g/dL) were related to 4.5-, 3.2-, and 2.7-fold increased adjusted risk of NCM, respectively. Old age, comorbidity, and hemoglobin at diagnosis were independent predictors of NCM. The risk factors could be used to predict noncancer death after definitive treatment for advanced-stage HNC. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Anterior Urethral Advancement as a Single-Stage Technique for Repair of Anterior Hypospadias: Our Experience.

PubMed

Gite, Venkat A; Nikose, Jayant V; Bote, Sachin M; Patil, Saurabh R

2017-07-02

Many techniques have been described to correct anterior hypospadias with variable results. Anterior urethral advancement as one stage technique was first described by Ti Chang Shing in 1984. It was also used for the repair of strictures and urethrocutaneous fistulae involving distal urethra. We report our experience of using this technique with some modification for the repair of anterior hypospadias. In the period between 2013-2015, 20 cases with anterior hypospadias including 2 cases of glanular, 3 cases of coronal, 12 cases of subcoronal and 3 cases of distal penile hypospadias were treated with anterior urethral advancement technique. Patients' age groups ranged from 18 months to 10 years. Postoperatively, patients were passing urine from tip of neomeatus with satisfactory stream during follow up period of 6 months to 2 years. There were no major complications in any of our patients except in one patient who developed meatal stenosis which was treated by periodic dilatation. Three fold urethral mobilization was sufficient in all cases. Anterior urethral advancement technique is a single-stage procedure with good cosmetic results and least complications for anterior hypospadias repair in properly selected cases.

Perioperative BRAF inhibitors in locally advanced stage III melanoma.

PubMed

Zippel, Douglas; Markel, Gal; Shapira-Frommer, Roni; Ben-Betzalel, Guy; Goitein, David; Ben-Ami, Eytan; Nissan, Aviram; Schachter, Jacob; Schneebaum, Schlomo

2017-12-01

Stage III malignant melanoma is a heterogeneous disease where those cases deemed marginally resectable or irresecatble are frequently incurable by surgery alone. Targeted therapy takes advantage of the high incidence of BRAF mutations in melanomas, most notably the V600E mutation. These agents have rarely been used in a neoadjuvant setting prior to surgery. Thirteen consecutive patients with confirmed BRAF V600E regionally advanced melanoma deemed marginally resectable or irrresectable, were treated with BRAF inhibiting agents, prior to undergoing surgery. The primary outcome measures were a successful resection and pathological response. Disease-free survival was a secondary outcome measure. Overall, 12/13 patients showed a marked clinical responsiveness to medical treatment, enabling a macroscopically successful resection in all cases. Four patients had a complete pathological response with no viable tumor evident in the resected specimens and eight patients showed evidence of minimally residual tumor with extensive tumoral necrosis and fibrosis. One patient progressed and died before surgery. At a median follow up of 20 months, 10 patients remain free of disease. Perioperative treatment with BRAF inhibiting agents in BRAFV600E mutated Stage III melanoma patients facilitates surgical resection and affords satisfactory disease free survival. © 2017 Wiley Periodicals, Inc.

Development and validation of a clinically applicable score to classify cachexia stages in advanced cancer patients

PubMed Central

Zhou, Ting; Wang, Bangyan; Liu, Huiquan; Yang, Kaixiang; Thapa, Sudip; Zhang, Haowen; Li, Lu

2018-01-01

Abstract Background Cachexia is a multifactorial syndrome that is highly prevalent in advanced cancer patients and leads to progressive functional impairments. The classification of cachexia stages is essential for diagnosing and treating cachexia. However, there is a lack of simple tools with good discrimination for classifying cachexia stages. Therefore, our study aimed to develop a clinically applicable cachexia staging score (CSS) and validate its discrimination of clinical outcomes for different cachexia stages. Methods Advanced cancer patients were enrolled in our study. A CSS comprising the following five components was developed: weight loss, a simple questionnaire of sarcopenia (SARC‐F), Eastern Cooperative Oncology Group, appetite loss, and abnormal biochemistry. According to the CSS, patients were classified into non‐cachexia, pre‐cachexia, cachexia, and refractory cachexia stages, and clinical outcomes were compared among the four groups. Results Of the 297 participating patients, data from 259 patients were ultimately included. Based on the CSS, patients were classified into non‐cachexia (n = 69), pre‐cachexia (n = 68), cachexia (n = 103), and refractory cachexia (n = 19) stages. Patients with more severe cachexia stages had lower skeletal muscle indexes (P = 0.002 and P = 0.004 in male and female patients, respectively), higher prevalence of sarcopenia (P = 0.017 and P = 0.027 in male and female patients, respectively), more severe symptom burden (P < 0.001), poorer quality of life (P < 0.001 for all subscales except social well‐being), and shorter survival times (P < 0.001). Conclusions The CSS is a simple and clinically applicable tool with excellent discrimination for classifying cachexia stages. This score is extremely useful for the clinical treatment and prognosis of cachexia and for designing clinical trials. PMID:29372594

Advanced Transportation System Studies. Technical Area 3: Alternate Propulsion Subsystem Concepts. Volume 1; Executive Summary

NASA Technical Reports Server (NTRS)

Levack, Daniel J. H.

2000-01-01

The Alternate Propulsion Subsystem Concepts contract had seven tasks defined that are reported under this contract deliverable. The tasks were: FAA Restart Study, J-2S Restart Study, Propulsion Database Development. SSME Upper Stage Use. CERs for Liquid Propellant Rocket Engines. Advanced Low Cost Engines, and Tripropellant Comparison Study. The two restart studies, F-1A and J-2S, generated program plans for restarting production of each engine. Special emphasis was placed on determining changes to individual parts due to obsolete materials, changes in OSHA and environmental concerns, new processes available, and any configuration changes to the engines. The Propulsion Database Development task developed a database structure and format which is easy to use and modify while also being comprehensive in the level of detail available. The database structure included extensive engine information and allows for parametric data generation for conceptual engine concepts. The SSME Upper Stage Use task examined the changes needed or desirable to use the SSME as an upper stage engine both in a second stage and in a translunar injection stage. The CERs for Liquid Engines task developed qualitative parametric cost estimating relationships at the engine and major subassembly level for estimating development and production costs of chemical propulsion liquid rocket engines. The Advanced Low Cost Engines task examined propulsion systems for SSTO applications including engine concept definition, mission analysis. trade studies. operating point selection, turbomachinery alternatives, life cycle cost, weight definition. and point design conceptual drawings and component design. The task concentrated on bipropellant engines, but also examined tripropellant engines. The Tripropellant Comparison Study task provided an unambiguous comparison among various tripropellant implementation approaches and cycle choices, and then compared them to similarly designed bipropellant engines in the

Comparison of different methods of splenic hilar lymph node dissection for advanced upper- and/or middle-third gastric cancer.

PubMed

Ji, Xin; Fu, Tao; Bu, Zhao-De; Zhang, Ji; Wu, Xiao-Jiang; Zong, Xiang-Long; Jia, Zi-Yu; Fan, Biao; Zhang, Yi-Nan; Ji, Jia-Fu

2016-10-03

Surgery for advanced gastric cancer (AGC) often includes dissection of splenic hilar lymph nodes (SHLNs). This study compared the safety and effectiveness of different approaches to SHLN dissection for upper- and/or middle-third AGC. We retrospectively compared and analyzed clinicopathologic and follow-up data from a prospectively collected database at the Peking University Cancer Hospital. Patients were divided into three groups: in situ spleen-preserved, ex situ spleen-preserved and splenectomy. We analyzed 217 patients with upper- and/or middle-third AGC who underwent R0 total or proximal gastrectomy with splenic hilar lymphadenectomy from January 2006 to December 2011, of whom 15.2 % (33/217) had metastatic SHLNs, and from whom 11.4 % (53/466) of the dissected SHLNs were metastatic. The number of harvested SHLNs per patient was higher in the ex situ group than in the in situ group (P = 0.017). Length of postoperative hospital stay was longer in the splenectomy group than in the in situ group (P = 0.002) or the ex situ group (P < 0.001). The splenectomy group also lost more blood volume (P = 0.007) and had a higher postoperative complication rate (P = 0.005) than the ex situ group. Kaplan-Meier (log rank test) analysis showed significant survival differences among the three groups (P = 0.018). Multivariate analysis showed operation duration (P = 0.043), blood loss volume (P = 0.046), neoadjuvant chemotherapy (P = 0.005), and N stage (P < 0.001) were independent prognostic factors for survival. The ex situ procedure was more effective for SHLN dissection than the in situ procedure without sacrificing safety, whereas splenectomy was not more effective, and was less safe. The SHLN dissection method was not an independent risk factor for survival in this study.

Preoperative tumour staging with multidisciplinary team assessment improves the outcome in locally advanced primary rectal cancer.

PubMed

Palmer, G; Martling, A; Cedermark, B; Holm, T

2011-12-01

Multidisciplinary team meetings have been introduced as a result of developments in preoperative radiological tumour staging and neoadjuvant treatment. Multidisciplinary team recommendations will influence treatment decisions but their effect on patient outcome is unknown. The aim of this study was to assess outcome in relation to preoperative local and distant staging, with or without multidisciplinary team assessment. A population-based registry of all patients with rectal cancer, treated in the Stockholm region from 1995 to 2004, identified 303 patients with locally advanced primary rectal cancer. The patients were classified into three groups: group 1, preoperative local and distant radiological tumour staging with discussion at a multidisciplinary team meeting; group 2, preoperative staging but no multidisciplinary team assessment; and group 3, no proper preoperative radiological staging. Neoadjuvant treatment was more prevalent in groups 1 and 2 than in group 3. The incidence of R0 resection differed significantly between the groups (52% in group 1, 43% in group 2 and 21% in group 3; P < 0.001). Local tumour control was achieved in 57%, 36%, and 19% of patients in groups 1, 2 and 3, respectively (P < 0.001). The estimated overall 5-year survival of patients was 30%, 28% and 12% in groups 1, 2 and 3, respectively. Preoperative radiological tumour staging in patients with locally advanced primary rectal cancer and discussion at a multidisciplinary team meeting increases the proportion of patients receiving neoadjuvant treatment and cancer-specific end-points. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

Drivers of advanced stage at breast cancer diagnosis in the multicountry African breast cancer – disparities in outcomes (ABC‐DO) study

PubMed Central

Zietsman, Annelle; Galukande, Moses; Anele, Angelica; Adisa, Charles; Parham, Groesbeck; Pinder, Leeya; Cubasch, Herbert; Joffe, Maureen; Kidaaga, Frederick; Lukande, Robert; Offiah, Awa U.; Egejuru, Ralph O.; Shibemba, Aaron; Schuz, Joachim; Anderson, Benjamin O.; dos Santos Silva, Isabel; McCormack, Valerie

2017-01-01

Breast cancer (BC) survival rates in sub‐Saharan Africa (SSA) are low in part due to advanced stage at diagnosis. As one component of a study of the entire journey of SSA women with BC, we aimed to identify shared and setting‐specific drivers of advanced stage BC. Women newly diagnosed in the multicountry African Breast Cancer–Disparities in Outcomes (ABC‐DO) study completed a baseline interview and their stage information was extracted from medical records. Ordinal logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for advanced stage (I, II, III, IV) in relation to individual woman‐level, referral and biological factors. A total of 1795 women were included from Nigeria, Uganda, Zambia, and the multiracial populations of Namibia and South Africa, 1091 of whom (61%) were stage III/IV. Stage was lower in women with greater BC knowledge (OR 0.77 (95% CI: 0.70, 0.85) per point on a 6 point scale). More advanced stage was associated with being black (4.00 (2.79, 5.74)), having attended stage BC in SSA is largely attributed to modifiable factors and strategies to improve BC education and awareness in women and the health system should be intensified. PMID:29197068

Advances in single- and multi-stage Stirling-type pulse tube cryocoolers for space applications in NLIP/SITP/CAS

NASA Astrophysics Data System (ADS)

Dang, Haizheng; Tan, Jun; Zha, Rui; Li, Jiaqi; Zhang, Lei; Zhao, Yibo; Gao, Zhiqian; Bao, Dingli; Li, Ning; Zhang, Tao; Zhao, Yongjiang; Zhao, Bangjian

2017-12-01

This paper presents a review of recent advances in single- and multi-stage Stirling-type pulse tube cryocoolers (SPTCs) for space applications developed at the National Laboratory for Infrared Physics, Shanghai Institute of Technical Physics, Chinese Academy of Sciences (NLIP/SITP/CAS). A variety of single-stage SPTCs operating at 25-150 K have been developed, including several mid-sized ones operating at 80-110 K. Significant progress has been achieved in coolers operating at 30-40 K which use common stainless steel meshes as regenerator matrices. Another important advance is the micro SPTCs with an overall mass of 300-800 g operating at high frequencies varying from 100 Hz to 400 Hz. The main purpose of developing two-stage SPTCs is to simultaneously acquire cooling capacities at both stages, obviating the need for auxiliary precooling in various applications. The three-stage SPTCs are developed mainly for applications at around 10 K, which are also used for precooling the J-T coolers to achieve further lower temperatures. The four-stage SPTCs are developed to directly achieve the liquid helium temperature for cooling space low-Tc superconducting devices and for the deep space exploration as well. Several typical development programs are described and an overview of the cooler performances is presented.

Functional Impairment of Myeloid Dendritic Cells during Advanced Stage of HIV-1 Infection: Role of Factors Regulating Cytokine Signaling.

PubMed

Sachdeva, Meenakshi; Sharma, Aman; Arora, Sunil K

2015-01-01

Severely immunocompromised state during advanced stage of HIV-1 infection has been linked to functionally defective antigen presentation by dendritic cells (DCs). The molecular mechanisms behind DC impairment are still obscure. We investigated changes in DC function and association of key regulators of cytokine signaling during different stages of HIV-1 infection and following antiretroviral therapy (ART). Phenotypic and functional characteristics of circulating myeloid DCs (mDCs) in 56 ART-naive patients (23 in early and 33 in advanced stage of disease), 36 on ART and 24 healthy controls were evaluated. Sixteen patients were studied longitudinally prior-to and 6 months after the start of ART. For functional studies, monocyte-derived DCs (Mo-DCs) were evaluated for endocytosis, allo-stimulation and cytokine secretion. The expression of suppressor of cytokine signaling (SOCS)-1 and other regulators of cytokine signaling was evaluated by real-time RT-PCR. The ability to respond to an antigenic stimulation was severely impaired in patients in advanced HIV-1 disease which showed partial recovery in the treated group. Mo-DCs from patients with advanced HIV-disease remained immature with low allo-stimulation and reduced cytokine secretion even after TLR-4 mediated stimulation ex-vivo. The cells had an increased expression of negative regulatory factors like SOCS-1, SOCS-3, SH2-containing phosphatase (SHP)-1 and a reduced expression of positive regulators like Janus kinase (JAK)2 and Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB)1. A functional recovery after siRNA mediated silencing of SOCS-1 in these mo-DCs confirms the role of negative regulatory factors in functional impairment of these cells. Functionally defective DCs in advanced stage of HIV-1 infection seems to be due to imbalanced state of negative and positive regulatory gene expression. Whether this is a cause or effect of increased viral replication at this stage of disease, needs

An Effective Technique for Endoscopic Resection of Advanced Stage Angiofibroma

PubMed Central

Mohammadi Ardehali, Mojtaba; Samimi, Seyyed Hadi; Bakhshaee, Mehdi

2014-01-01

Introduction: In recent years, the surgical management of angiofibroma has been greatly influenced by the use of endoscopic techniques. However, large tumors that extend into difficult anatomic sites present major challenges for management by either endoscopy or an open-surgery approach which needs new technique for the complete en block resection. Materials and Methods: In a prospective observational study we developed an endoscopic transnasal technique for the resection of angiofibroma via pushing and pulling the mass with 1/100000 soaked adrenalin tampons. Thirty two patients were treated using this endoscopic technique over 7 years. The mean follow-up period was 36 months. The main outcomes measured were tumor staging, average blood loss, complications, length of hospitalization, and residual and/or recurrence rate of the tumor. Results: According to the Radkowski staging, 23,5, and 4 patients were at stage IIC, IIIA, and IIIB, respectively. Twenty five patients were operated on exclusively via transnasal endoscopy while 7 patients were managed using endoscopy-assisted open-surgery techniques. Mean blood loss in patients was 1261± 893 cc. The recurrence rate was 21.88% (7 cases) at two years following surgery. Mean hospitalization time was 3.56 ± 0.6 days. Conclusion: Using this effective technique, endoscopic removal of more highly advanced angiofibroma is possible. Better visualization, less intraoperative blood loss, lower rates of complication and recurrence, and shorter hospitalization time are some of the advantages. PMID:24505571

Two stage sorption type cryogenic refrigerator including heat regeneration system

NASA Technical Reports Server (NTRS)

Jones, Jack A. (Inventor); Wen, Liang-Chi (Inventor); Bard, Steven (Inventor)

1989-01-01

A lower stage chemisorption refrigeration system physically and functionally coupled to an upper stage physical adsorption refrigeration system is disclosed. Waste heat generated by the lower stage cycle is regenerated to fuel the upper stage cycle thereby greatly improving the energy efficiency of a two-stage sorption refrigerator. The two stages are joined by disposing a first pressurization chamber providing a high pressure flow of a first refrigerant for the lower stage refrigeration cycle within a second pressurization chamber providing a high pressure flow of a second refrigerant for the upper stage refrigeration cycle. The first pressurization chamber is separated from the second pressurization chamber by a gas-gap thermal switch which at times is filled with a thermoconductive fluid to allow conduction of heat from the first pressurization chamber to the second pressurization chamber.

Prognostic impact of perineural invasion and lymphovascular invasion in advanced stage oral squamous cell carcinoma.

PubMed

Jardim, J F; Francisco, A L N; Gondak, R; Damascena, A; Kowalski, L P

2015-01-01

Perineural invasion (PNI) and lymphovascular invasion (LVI) have been associated with the risk of local recurrences and lymph node metastasis. The aim of this study was to evaluate the prognostic impact of PNI and LVI in patients with advanced stage squamous cell carcinoma of the tongue and floor of the mouth. One hundred and forty-two patients without previous treatment were selected. These patients underwent radical surgery with neck dissection and adjuvant treatment. Clinicopathological data were retrieved from the medical charts, including histopathology and surgery reports. Univariate analysis was performed to assess the impact of studied variables on survival. Overall survival was negatively influenced by six tumour-related factors: increasing T stage (P = 0.003), more than two clinically positive nodes (P = 0.002), extracapsular spread of lymph node metastasis (P < 0.001), tumour thickness (P = 0.04), PNI (P < 0.001), and LVI (P = 0.012). Disease-free survival was influenced by PNI (P = 0.04), extracapsular spread of lymph node metastasis (P = 0.008), and N stage (P = 0.006). Multivariate analysis showed PNI to be an independent predictor for overall survival (P = 0.01) and disease-free survival (P = 0.03). Thus the presence of PNI in oral carcinoma surgical specimens has a significant impact on survival outcomes in patients with advanced stage tumours submitted to radical surgery and adjuvant radiotherapy/radiochemotherapy. Copyright © 2014 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

GOES-S Atlas V Centaur Stage Transport to VIF

NASA Image and Video Library

2018-02-08

The Centaur upper stage that will help launch NOAA's Geostationary Operational Environmental Satellite-S, or GOES-S, departs the Delta Operations Center for the Vertical Integration Facility at Space Launch Complex 41 at Cape Canaveral Air Force Station in Florida. The Centaur then will be mated to a United Launch Alliance Atlas V booster. GOES-S is the second in a series of four advanced geostationary weather satellites that will significantly improve the detection and observation of environmental phenomena that directly affect public safety, protection of property and the nation's economic health and prosperity. GOES-S is slated to launch March 1, 2018.

GOES-S Atlas V Centaur Stage Transport to VIF

NASA Image and Video Library

2018-02-08

The Centaur upper stage that will help launch NOAA's Geostationary Operational Environmental Satellite-S, or GOES-S, arrives at the Vertical Integration Facility at Space Launch Complex 41 at Cape Canaveral Air Force Station in Florida. The Centaur will be mated to a United Launch Alliance Atlas V booster. GOES-S is the second in a series of four advanced geostationary weather satellites that will significantly improve the detection and observation of environmental phenomena that directly affect public safety, protection of property and the nation's economic health and prosperity. GOES-S is slated to launch March 1, 2018.

MRI helps depict clinically undetectable risk factors in advanced stage retinoblastomas.

PubMed

Galluzzi, Paolo; Hadjistilianou, Theodora; Cerase, Alfonso; Toti, Paolo; Leonini, Sara; Bracco, Sandra; de Francesco, Sonia; Galimberti, Daniela; Balducci, Donatella; Piu, Pietro; Monti, Lucia; Bellini, Matteo; Caini, Mauro; Rossi, Alessandro

2015-02-01

This study compared high-resolution MRI with histology in advanced stage retinoblastomas in which ophthalmoscopy and ultrasonography did not give an exhaustive depiction of the tumour and/or its extension. MRI of orbits and head in 28 retinoblastoma patients (28 eyes) treated with primary enucleation were evaluated. Iris neoangiogenesis, infiltrations of optic nerve, choroid, anterior segment and sclera suspected at MR and histology were compared. Abnormal anterior segment enhancement (AASE) was also correlated with histologically proven infiltrations. Brain images were also evaluated. Significant values were obtained for: prelaminar optic nerve (ON) sensitivity (0.88), positive predictive value (PPV) (0.75) and negative predictive value (NPV) (0.71); post-laminar ON sensitivity (0.50), specificity (0.83), PPV (0.50) and NPV (0.83); overall choroid sensitivity (0.82), and massive choroid NPV (0.69); scleral specificity (1), and NPV (1). AASE correlated with iris neoangiogenesis in 14 out of 19 eyes, and showed significant values for: overall ON PPV (0.65), prelaminar ON sensitivity (0.65), and PPV (0.61), post-laminar ON NPV (0.64); overall choroid sensitivity (0.77), PPV (0.59) and NPV (0.73); scleral NPV (0.83); anterior segment sensitivity (1), and NPV (1). Odds ratios (OR) and accuracy were significant in scleral and prelaminar optic nerve infiltration. Brain examination was unremarkable in all cases. High-resolution MRI may add important findings to clinical evaluation of advanced stage retinoblastomas. © The Author(s) 2015 Reprints and permissions:]br]sagepub.co.uk/journalsPermissions.nav.

Health-related quality-of-life outcomes: a reflexology trial with patients with advanced-stage breast cancer.

PubMed

Wyatt, Gwen; Sikorskii, Alla; Rahbar, Mohammad Hossein; Victorson, David; You, Mei

2012-11-01

To evaluate the safety and efficacy of reflexology, a complementary therapy that applies pressure to specific areas of the feet. Longitudinal, randomized clinical trial. Thirteen community-based medical oncology clinics across the midwestern United States. A convenience sample of 385 predominantly Caucasian women with advanced-stage breast cancer receiving chemotherapy and/or hormonal therapy. Following the baseline interview, women were randomized into three primary groups: reflexology (n = 95), lay foot manipulation (LFM) (n = 95), or conventional care (n = 96). Two preliminary reflexology (n = 51) and LFM (n = 48) test groups were used to establish the protocols. Participants were interviewed again postintervention at study weeks 5 and 11. Breast cancer-specific health-related quality of life (HRQOL), physical functioning, and symptoms. No adverse events were reported. A longitudinal comparison revealed significant improvements in physical functioning for the reflexology group compared to the control group (p = 0.04). Severity of dyspnea was reduced in the reflexology group compared to the control group (p < 0.01) and the LFM group (p = 0.02). No differences were found on breast cancer-specific HRQOL, depressive symptomatology, state anxiety, pain, and nausea. Reflexology may be added to existing evidence-based supportive care to improve HRQOL for patients with advanced-stage breast cancer during chemotherapy and/or hormonal therapy. Reflexology can be recommended for safety and usefulness in relieving dyspnea and enhancing functional status among women with advanced-stage breast cancer.

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

PubMed

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

2016-11-01

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

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

PubMed Central

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

2017-01-01

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

Locally advanced breast cancer in Saudi Arabia: high frequency of stage III in a young population.

PubMed

Ezzat, A A; Ibrahim, E M; Raja, M A; Al-Sobhi, S; Rostom, A; Stuart, R K

1999-07-01

In the Kingdom of Saudi Arabia (KSA), breast cancer constitutes 18% of all cancers in Saudi women. Whilst locally advanced breast cancer disease is unusual in Western countries, it constitutes more than 40% of all non-metastatic breast cancer in KSA. The relative frequency of locally advanced disease among our breast cancer population and the lack of a uniform consensus in the literature about its optimal management have prompted this retrospective analysis of the medical records of patients with Stage III breast cancer patients seen at King Faisal Specialist Hospital and Research Center between 1981 and 1991. In all, 315 patients were identified. Their median age +/- SD was 46 +/- 11.6 years which is distinctly different from the 60-65 years median age in industrial Western nations. Most patients were younger than 50 years (64%) and premenopausal (62%). Patients were approximately equally divided between Stage IIIA and Stage III B. Patients received multimodality treatment, including surgery, adjuvant chemotherapy, tamoxifen, and adjuvant radiotherapy. Sixty-one patients were excluded from survival analysis as they were considered lost to follow-up. Of the remaining 254 patients, 73 (29%) were alive and disease free, and 18 patients (7%) were alive but with evidence of the disease. The remaining 163 (64%) had died from breast cancer or its related complications. Their median overall survival (OS) was 54 months, (95% CI, 27 to 121 months) and the median progression-free survival (PFS) was 28.8 months (95% CI, 14.2 to 113 months). Cox proportional hazard model identified Stage III B and the number of positive axillary lymph nodes as poor predictors of OS and PFS. Radiotherapy was the only adjuvant modality that affected survival favourably. The prognosis of patients with Stage III disease remains poor despite the use of a multimodality approach. The overall young age of our patients may have contributed to the poor outcome. Moreover, the adverse effect of Stage III

Long-Term Survival and Local Relapse Following Surgery Without Radiotherapy for Locally Advanced Upper Rectal Cancer

PubMed Central

Park, Jun Seok; Sakai, Yoshiharu; Simon, NG Siu Man; Law, Wai Lun; Kim, Hyeong Rok; Oh, Jae Hwan; Shan, Hester Cheung Yui; Kwak, Sang Gyu; Choi, Gyu-Seog

2016-01-01

Abstract Controversy remains regarding whether preoperative chemoradiation protocol should be applied uniformly to all rectal cancer patients regardless of tumor height. This pooled analysis was designed to evaluate whether preoperative chemoradiation can be safely omitted in higher rectal cancer. An international consortium of 7 institutions was established. A review of the database that was collected from January 2004 to May 2008 identified a series of 2102 patients with stage II/III rectal or sigmoid cancer (control arm) without concurrent chemoradiation. Data regarding patient demographics, recurrence pattern, and oncological outcomes were analyzed. The primary end point was the 5-year local recurrence rate. The local relapse rate of the sigmoid colon cancer (SC) and upper rectal cancer (UR) cohorts was significantly lower than that of the mid/low rectal cancer group (M-LR), with 5-year estimates of 2.5% for the SC group, 3.5% for the UR group, and 11.1% for the M-LR group, respectively. A multivariate analysis showed that tumor depth, nodal metastasis, venous invasion, and lower tumor level were strongly associated with local recurrence. The cumulative incidence rate of local failure was 90.6%, 92.5%, and 94.4% for tumors located within 5, 7, and 9 cm from the anal verge, respectively. Routine use of preoperative chemoradiation for stage II/III rectal tumors located more than 8 to 9 cm above the anal verge would be excessive. The integration of a more individualized approach focused on systemic control is warranted to improve survival in patients with upper rectal cancer. PMID:27258487

Distribution of early life history stages of fishes in selected pools of the upper Mississippi River

USGS Publications Warehouse

Holland, L.E.

1986-01-01

Effective management of the fishery resources of the Upper Mississippi River and successful mitigation of the loss of critical habitat depend in part on an understanding of the reproductive and early life history requirements of the affected fishes. However, little is known about the use of nursery areas by fishes in the river. Of the nearly 130 species identified in the adult ichthyofauna, only a few are represented proportionally in the available data on early life stages because study designs have not included consideration of the early stages, collection gears have not adequately sampled the young, and eggs and larvae of some species are difficult to sample by conventional approaches. For the species collected, information is available on seasonal variations in total densities, composition, and catch among different habitat types. However, the data are most accurate for species with buoyant early life stages, such as freshwater drum (Aplodinotus grunniens) and gizzard shad (Dorosoma cepedianum). Eggs and larvae of freshwater drum dominate collections made in the main channel, whereas other larval fishes are usually most abundant in backwater habitats. The species found there usually deposit eggs on the substrate or on vegetation. Habitat preferences (as indicated by relative abundance) often shift as development proceeds and physical and behavioral changes occur in the larvae. Only limited information is available on the distribution of larvae within habitats, but it is clear that variations within habitats are significant.

Computer program for post-flight evaluation of a launch vehicle upper-stage on-off reaction control system

NASA Technical Reports Server (NTRS)

Knauber, R. N.

1982-01-01

This report describes a FORTRAN IV coded computer program for post-flight evaluation of a launch vehicle upper stage on-off reaction control system. Aerodynamic and thrust misalignment disturbances are computed as well as the total disturbing moments in pitch, yaw, and roll. Effective thrust misalignment angle time histories of the rocket booster motor are calculated. Disturbing moments are integrated and used to estimate the required control system total inpulse. Effective control system specific inpulse is computed for the boost and coast phases using measured control fuel useage. This method has been used for more than fifteen years for analyzing the NASA Scout launch vehicle second and third-stage reaction control system performance. The computer program is set up in FORTRAN IV for a CDC CYBER 175 system. With slight modification it can be used on other machines having a FORTRAN compiler. The program has optional CALCOMP plotting output. With this option the program requires 19K words of memory and has 786 cards. Running time on a CDC CYBER 175 system is less than three (3) seconds for a typical problem.

Sub-classification of Advanced-Stage Hepatocellular Carcinoma: A Cohort Study Including 612 Patients Treated with Sorafenib.

PubMed

Yoo, Jeong-Ju; Chung, Goh Eun; Lee, Jeong-Hoon; Nam, Joon Yeul; Chang, Young; Lee, Jeong Min; Lee, Dong Ho; Kim, Hwi Young; Cho, Eun Ju; Yu, Su Jong; Kim, Yoon Jun; Yoon, Jung-Hwan

2018-04-01

Advanced hepatocellular carcinoma (HCC) is associated with various clinical conditions including major vessel invasion, metastasis, and poor performance status. The aim of this study was to establish a prognostic scoring system and to propose a sub-classification of the Barcelona-Clinic Liver Cancer (BCLC) stage C. This retrospective study included consecutive patientswho received sorafenib for BCLC stage C HCC at a single tertiary hospital in Korea. A Cox proportional hazard model was used to develop a scoring system, and internal validationwas performed by a 5-fold cross-validation. The performance of the model in predicting risk was assessed by the area under the curve and the Hosmer-Lemeshow test. A total of 612 BCLC stage C HCC patients were sub- classified into strata depending on their performance status. Five independent prognostic factors (Child-Pugh score, α-fetoprotein, tumor type, extrahepatic metastasis, and portal vein invasion) were identified and used in the prognostic scoring system. This scoring system showed good discrimination (area under the receiver operating characteristic curve, 0.734 to 0.818) and calibration functions (both p < 0.05 by the Hosmer-Lemeshow test at 1 month and 12 months, respectively). The differences in survival among the different risk groups classified by the total score were significant (p < 0.001 by the log-rank test in both the Eastern Cooperative Oncology Group 0 and 1 strata). The heterogeneity of patientswith BCLC stage C HCC requires sub-classification of advanced HCC. A prognostic scoring system with five independent factors is useful in predicting the survival of patients with BCLC stage C HCC.

Airway reconstruction: review of an approach to the advanced-stage laryngotracheal stenosis.

PubMed

Bitar, Mohamad Ahmad; Al Barazi, Randa; Barakeh, Rana

The management of laryngotracheal stenosis is complex and is influenced by multiple factors that can affect the ultimate outcome. Advanced lesions represent a special challenge to the treating surgeon to find the best remedying technique. To review the efficacy of our surgical reconstructive approach in managing advanced-stage laryngotracheal stenosis treated at a tertiary medical center. A retrospective review of all patients that underwent open laryngotracheal repair/reconstruction by the senior author between 2002 and 2014. Patients with mild/moderate stenosis (e.g. stage 1 or 2), or those who had an open reconstructive procedure prior to referral, were excluded. Patients who had only endoscopic treatment (e.g. laser, balloon dilatation) and were not subjected to an open reconstructive procedure at our institution, were not included in this study. Variables studied included patient demographics, clinical presentation, etiology of the laryngotracheal pathology, the location of stenosis, the stage of stenosis, the type of corrective or reconstructive procedure performed with the type of graft used (where applicable), the type and duration of stent used, the post-reconstruction complications, and the duration of follow-up. Outcome measures included decannulation rate, total number of reconstructive surgeries needed to achieve decannulation, and the number of post-operative endoscopies needed to reach a safe patent airway. Twenty five patients were included, aged 0.5 months to 45 years (mean 13.5 years, median 15 years) with 16 males and 9 females. Seventeen patients (68%) were younger than 18 years. Most patients presented with stridor, failure of decannulation, or respiratory distress. Majority had acquired etiology for their stenosis with only 24% having a congenital pathology. Thirty-two reconstructive procedures were performed resulting in decannulating 24 patients (96%), with 15/17 (88%) pediatric patients and 5/8 (62.5%) adult patients requiring only a single

A 20k Payload Launch Vehicle Fast Track Development Concept Using an RD-180 Engine and a Centaur Upper Stage

NASA Technical Reports Server (NTRS)

Toelle, Ronald (Compiler)

1995-01-01

A launch vehicle concept to deliver 20,000 lb of payload to a 100-nmi orbit has been defined. A new liquid oxygen/kerosene booster powered by an RD-180 engine was designed while using a slightly modified Centaur upper stage. The design, development, and test program met the imposed 40-mo schedule by elimination of major structural testing by increased factors of safety and concurrent engineering concepts. A growth path to attain 65,000 lb of payload is developed.

Dual-Fuel Propulsion in Single-Stage Advanced Manned Launch System Vehicle

NASA Technical Reports Server (NTRS)

Lepsch, Roger A., Jr.; Stanley, Douglas O.; Unal, Resit

1995-01-01

As part of the United States Advanced Manned Launch System study to determine a follow-on, or complement, to the Space Shuttle, a reusable single-stage-to-orbit concept utilizing dual-fuel rocket propulsion has been examined. Several dual-fuel propulsion concepts were investigated. These include: a separate-engine concept combining Russian RD-170 kerosene-fueled engines with space shuttle main engine-derivative engines: the kerosene- and hydrogen-fueled Russian RD-701 engine; and a dual-fuel, dual-expander engine. Analysis to determine vehicle weight and size characteristics was performed using conceptual-level design techniques. A response-surface methodology for multidisciplinary design was utilized to optimize the dual-fuel vehicles with respect to several important propulsion-system and vehicle design parameters, in order to achieve minimum empty weight. The tools and methods employed in the analysis process are also summarized. In comparison with a reference hydrogen- fueled single-stage vehicle, results showed that the dual-fuel vehicles were from 10 to 30% lower in empty weight for the same payload capability, with the dual-expander engine types showing the greatest potential.

Trousseau's syndrome in a patient with advanced stage gastric cancer.

PubMed

Chien, Tai-Long; Rau, Kung-Ming; Chung, Wen-Jung; Tai, Wei-Chen; Wang, Shih-Ho; Chiu, Yi-Chun; Wu, Keng-Liang; Chou, Yeh-Pin; Wu, Chia-Che; Chen, Yen-Hao; Chuah, Seng-Kee

2015-09-14

Patients with cancer are at high risk for thrombotic events, which are known collectively as Trousseau's syndrome. Herein, we report a 66-year-old male patient who was diagnosed with terminal stage gastric cancer and liver metastasis and who had an initial clinical presentation of upper gastrointestinal bleeding. Acute ischemia of the left lower leg that resulted in gangrenous changes occurred during admission. Subsequent angiography of the left lower limb was then performed. This procedure revealed arterial thrombosis of the left common iliac artery with extension to the external iliac artery, the left common iliac artery, the posterior tibial artery, and the peroneal artery, which were occluded by thrombi. Aspiration of the thrombi demonstrated that these were not tumor thrombi. The interesting aspect of our case was that the disease it presented as arterial thrombotic events, which may correlate with gastric adenocarcinoma. In summary, we suggested that the unexplained thrombotic events might be one of the initial presentations of occult malignancy and that thromboprophylaxis should always be considered.

Intensity-modulated radiation therapy with concurrent chemotherapy for locally advanced cervical and upper thoracic esophageal cancer.

PubMed

Wang, Shu-Lian; Liao, Zhongxing; Liu, Helen; Ajani, Jaffer; Swisher, Stephen; Cox, James D; Komaki, Ritsuko

2006-09-14

To evaluate the dosimetry, efficacy and toxicity of intensity-modulated radiation therapy (IMRT) and concurrent chemotherapy for patients with locally advanced cervical and upper thoracic esophageal cancer. A retrospective study was performed on 7 patients who were definitively treated with IMRT and concurrent chemotherapy. Patients who did not receive IMRT radiation and concurrent chemotherapy were not included in this analysis. IMRT plans were evaluated to assess the tumor coverage and normal tissue avoidance. Treatment response was evaluated and toxicities were assessed. Five- to nine-beam IMRT were used to deliver a total dose of 59.4-66 Gy (median: 64.8 Gy) to the primary tumor with 6-MV photons. The minimum dose received by the planning tumor volume (PTV) of the gross tumor volume boost was 91.2%-98.2% of the prescription dose (standard deviation [SD]: 3.7%-5.7%). The minimum dose received by the PTV of the clinical tumor volume was 93.8%-104.8% (SD: 4.3%-11.1%) of the prescribed dose. With a median follow-up of 15 mo (range: 3-21 mo), all 6 evaluable patients achieved complete response. Of them, 2 developed local recurrences and 2 had distant metastases, 3 survived with no evidence of disease. After treatment, 2 patients developed esophageal stricture requiring frequent dilation and 1 patient developed tracheal-esophageal fistula. Concurrent IMRT and chemotherapy resulted in an excellent early response in patients with locally advanced cervical and upper thoracic esophageal cancer. However, local and distant recurrence and toxicity remain to be a problem. Innovative approaches are needed to improve the outcome.

Health-Related Quality-of-Life Outcomes: A Reflexology Trial With Patients With Advanced-Stage Breast Cancer

PubMed Central

Wyatt, Gwen; Sikorskii, Alla; Rahbar, Mohammad Hossein; Victorson, David; You, Mei

2013-01-01

Purpose/Objectives To evaluate the safety and efficacy of reflexology, a complementary therapy that applies pressure to specific areas of the feet. Design Longitudinal, randomized clinical trial. Setting Thirteen community-based medical oncology clinics across the midwestern United States. Sample A convenience sample of 385 predominantly Caucasian women with advanced-stage breast cancer receiving chemotherapy and/or hormonal therapy. Methods Following the baseline interview, women were randomized into three primary groups: reflexology (n = 95), lay foot manipulation (LFM) (n = 95), or conventional care (n = 96). Two preliminary reflexology (n = 51) and LFM (n = 48) test groups were used to establish the protocols. Participants were interviewed again postintervention at study weeks 5 and 11. Main Research Variables Breast cancer–specific health-related quality of life (HRQOL), physical functioning, and symptoms. Findings No adverse events were reported. A longitudinal comparison revealed significant improvements in physical functioning for the reflexology group compared to the control group (p = 0.04). Severity of dyspnea was reduced in the reflexology group compared to the control group (p < 0.01) and the LFM group (p = 0.02). No differences were found on breast cancer–specific HRQOL, depressive symptomatology, state anxiety, pain, and nausea. Conclusions Reflexology may be added to existing evidence-based supportive care to improve HRQOL for patients with advanced-stage breast cancer during chemotherapy and/or hormonal therapy. Implications for Nursing Reflexology can be recommended for safety and usefulness in relieving dyspnea and enhancing functional status among women with advanced-stage breast cancer. PMID:23107851

Aktiv De-Orbiting Onboard System from Leo of Upper Stages of Launchers

NASA Astrophysics Data System (ADS)

Trushlyakov, V.; Shalay, V.; Shatrov, J.; Jakovlev, M.; Kostantino, A.

2009-03-01

The active de-orbiting onboard system (VDOS) of upper separable parts (USP) stage of launchers from LEO into orbits of utilization with term of existence orbital lifetimes till 25 years is offered. ADOS it is based on use of power resources of not produced rests of liquid fuel onboard USP launchers with liquid propulsion module (LPM). Following systems enter in structure VDOS: the gas jet propulsion system consisting of a system of gasification, chambers of gas engines (GE), a control system. For gasification of the rests of liquid fuel the heat-carrier received in the autonomous gas generator is used. The gasification propellant components from each tank with temperature and the pressure determined by strength of the corresponding tank, move in chambers of the GE established on a top of a fuel compartment. After separation of a payload execute twist USP for preservation of its position in the space by activity of the GE. Ways of increase of a system effectiveness of gasification are offered by superposition on the entered heat-carrier of ultrasonic oscillations, and also introduction in gaseous fuel nanopowder of aluminum. The volume of adaptations of construction USP, connected with introduction VDOS does not exceed 5 % from weight of a dry construction.

Discordance between Ureteroscopic Biopsy and Final Pathology for Upper Tract Urothelial Carcinoma.

PubMed

Margolin, Ezra J; Matulay, Justin T; Li, Gen; Meng, Xiaosong; Chao, Brian; Vijay, Varun; Silver, Hayley; Clinton, Timothy N; Krabbe, Laura-Maria; Woldu, Solomon L; Singla, Nirmish; Bagrodia, Aditya; Margulis, Vitaly; Huang, William C; Bjurlin, Marc A; Shah, Ojas; Anderson, Christopher B

2018-06-01

We evaluated the discordance between ureteroscopic biopsy and surgical pathology findings for grading and staging upper tract urothelial carcinoma. We also sought to establish preoperative predictors of aggressive tumors. We retrospectively reviewed the records of 314 patients who underwent ureteroscopic biopsy followed by surgical management of upper tract urothelial carcinoma from 2000 to 2016 at a total of 3 institutions. Our primary outcomes were muscle invasive (pT2 or greater) disease at surgical pathology and upgrading of clinical low grade tumors to pathological high grade. At biopsy 61% of the patients had clinical high grade tumors and 21% had subepithelial connective tissue invasion (cT1+). On final pathology 79% of the patients had pathological high grade tumors and 45% had stage pT2 or greater. On multivariate analysis advanced patient age, clinical high grade and cT1+ were independently associated with pT2 or greater. The combined presence of clinical high grade and cT1+ had 86% positive predictive value for muscle invasion while the combined absence of clinical high grade and cT1+ had 80% negative predictive value. The likelihood of missing invasion on biopsy in patients with muscle invasive disease was increased when biopsy fragments were limited to 1 mm or less. Of clinical low grade cases on biopsy 51% were upgraded at surgery. The presence of positive urine cytology was associated with an increased risk of upgrading but this was not statistically significant. Clinical high grade, cT1+ on biopsy and advanced patient age are independent risk factors for muscle invasive upper tract urothelial carcinoma. There is a significant risk of upgrading in patients with clinical low grade tumors on biopsy, especially when urine cytology is positive. The predictive value of biopsy can likely be improved by more extensive ureteroscopic sampling. Copyright © 2018 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights

Space Launch System Spacecraft/Payloads Integration and Evolution Office Advanced Development FY 2014 Annual Report

NASA Technical Reports Server (NTRS)

Crumbly, C. M.; Bickley, F. P.; Hueter, U.

2015-01-01

The Advanced Development Office (ADO), part of the Space Launch System (SLS) program, provides SLS with the advanced development needed to evolve the vehicle from an initial Block 1 payload capability of 70 metric tons (t) to an eventual capability Block 2 of 130 t, with intermediary evolution options possible. ADO takes existing technologies and matures them to the point that insertion into the mainline program minimizes risk. The ADO portfolio of tasks covers a broad range of technical developmental activities. The ADO portfolio supports the development of advanced boosters, upper stages, and other advanced development activities benefiting the SLS program. A total of 36 separate tasks were funded by ADO in FY 2014.

Optimized ex-ovo culturing of chick embryos to advanced stages of development.

PubMed

Cloney, Kellie; Franz-Odendaal, Tamara Anne

2015-01-24

Research in anatomy, embryology, and developmental biology has largely relied on the use of model organisms. In order to study development in live embryos model organisms, such as the chicken, are often used. The chicken is an excellent model organism due to its low cost and minimal maintenance, however they present observational challenges because they are enclosed in an opaque eggshell. In order to properly view the embryo as it develops, the shell must be windowed or removed. Both windowing and ex ovo techniques have been developed to assist researchers in the study of embryonic development. However, each of the methods has limitations and challenges. Here, we present a simple, optimized ex ovo culture technique for chicken embryos that enables the observation of embryonic development from stage HH 19 into late stages of development (HH 40), when many organs have developed. This technique is easy to adopt in both undergraduate classes and more advanced research laboratories where embryo manipulations are conducted.

Lernpunkt Deutsch--Stage 1.

ERIC Educational Resources Information Center

Theil, Elvira

1997-01-01

Evaluates the first stage of "Lernpunkt Deutsch," a new three-stage German course designed for upper elementary and early secondary school. Describes the publisher's package of materials and the appropriateness of the course, utility of the different package elements, format of the materials, and assesses whether the course provides pedagogically…

Weld Residual Stress and Distortion Analysis of the ARES I-X Upper Stage Simulator (USS)

NASA Technical Reports Server (NTRS)

Raju, Ivatury; Dawicke, David; Cheston, Derrick; Phillips, Dawn

2008-01-01

An independent assessment was conducted to determine the critical initial flaw size (CIFS) for the flange-to-skin weld in the Ares I-X Upper Stage Simulator (USS). The Ares system of space launch vehicles is the US National Aeronautics and Space Administration s plan for replacement of the aging space shuttle. The new Ares space launch system is somewhat of a combination of the space shuttle system and the Saturn launch vehicles used prior to the shuttle. Here, a series of weld analyses are performed to determine the residual stresses in a critical region of the USS. Weld residual stresses both increase constraint and mean stress thereby having an important effect on fatigue and fracture life. While the main focus of this paper is a discussion of the weld modeling procedures and results for the USS, a short summary of the CIFS assessment is provided.

The ideas about advanced life support and affecting factors at the end-stage of life in a hospital in Turkey.

PubMed

Albayrak, Turgay; Şencan, İrfan; Akça, Ömer; Koç, Esra Meltem; Aksoy, Hilal; Ünsal, Selim; Bülbül, İskender; Bahadır, Adem; Kasım, İsmail; Kahveci, Rabia; Özkara, Adem

2017-01-01

The participation of the people in health decisions may be structured in various levels. One of these is participation in decisions for the treatment. "Advanced directives" is one of the examples for the participation in decisions for the treatment. We wanted to determine the decisions on advanced life support at the end-stage of life in case of a life-threatening illness for the people themselves and their first degree relatives and the factors effecting these decisions. The cross-sectional study was conducted with volunteers among patients and patient relatives who applied to all polyclinics of the Ankara Numune Training and Research Hospital except the emergency, oncology and psychiatry polyclinics between 15.12.2012 and 15.03.2013. A questionnaire, the Hospital Anxiety Depression (HAD) scale, and Templer's Death Anxiety Scale (TDA) were applied to all individuals. SPSS for Win. Ver. 17.0 and MS-Excel 2010 Starter software bundles were used for all statistical analysis and calculations. The participants want both themselves and their first degree relatives included in end-stage decision-making process. Therefore, the patients and their families should be informed adequately during decision making process and quality communication must be provided. Participants who have given their end-stage decisions previously want to be treated according to these decisions. This desire can just be possible by advanced directives.When moral and material loads of end-stage process are taken into consideration, countries, in which advanced directives are practiced, should be examined well and participants' desire should be evaluated in terms of practicability.

Complete response in 5 out of 38 patients with advanced hepatocellular carcinoma treated with stem cell differentiation stage factors: case reports from a single centre.

PubMed

Livraghi, Tito; Ceriani, R; Palmisano, A; Pedicini, V; Pich, M G; Tommasini, M A; Torzilli, G

2011-02-01

Hepatocellular carcinoma (HCC) represents the third cause of cancer-related death. Because HCC is multi-centric with time, excluding the few transplanted patients, sooner or later it becomes untreatable with loco-regional therapies and, until some years ago, it was not responsive to systemic therapies. In 2005 a randomized trial indicated the efficacy of a product containing stem cell differentiation stage factors (SCDSF) taken from zebra fish embryos during the stage in which the totipotent stem cells are differentiating into the pluripotent adult stem cells. In such a trial the patients, with "intermediate" and "advanced" HCC according to BCLC/AASLD guidelines, presented benefit in terms of performance status (PS) and objective tumoral response, with some cases (2.4%) of complete response (CR). The aim of this cohort study is to report the experience of a tertiary referral center on the evidence of cases of CR in patients with "advanced" stage HCC treated with SCDSF as supportive care. CR was regarded as sustained disappearance of the neoplastic areas or blood supply therein, accompanied by normalization of AFP levels. Out of 49 patients consecutively recruited and retrospectively evaluated, 38 had "advanced" stage and 11 "terminal" stage. In 5 patients with "advanced" stage a sustained CR was reported (13.1%). Improvement on PS was obtained in 17 patients (34.6%). No side effects occurred. SCDSF treatment confirmed its efficacy in patients with "advanced" HCC, in terms of PS and tumoral response.

Evaluation of pelvic posterior exenteration in the management of advanced-stage ovarian cancer.

PubMed

Tixier, Hervé; Fraisse, Jean; Chauffert, Bruno; Mayer, Françoise; Causeret, Sylvain; Loustalot, Catherine; Deville, Coralie; Bonnetain, Franck; Sagot, Paul; Douvier, Serge; Cuisenier, Jean

2010-03-01

The main aim of this study was to show the interest of pelvic posterior exenteration to obtain complete resection of the tumor in case of invasion of the rectum by contiguity in advanced-stage ovarian cancer. The secondary aim was to determine the morbidity of this surgery. It is a multicentric, retrospective study of a series of 41 patients, who underwent posterior pelvectomy for advanced-stage ovarian cancer, over a period of 18 years, from July 1989 to July 2007. The surgery resulted in macroscopically complete resection in 19 patients (46.34%), a residual tumor <2 cm in 19 patients (46.34%) and >2 cm in 3 patients (7.32%). In 34 patients (34/41), digestive continuity with satisfactory anal sphincter function was restored immediately or in the short term. The mean delay to the start of complementary treatment was 36 days. Median overall survival was 33 months. The main aim of surgery for ovarian peritoneal carcinomatosis is to obtain a complete resection. In the case of direct invasion of the rectum by contiguity, when there is no cleavage plane between the uterus and the rectum, pelvic posterior exenteration is an effective method to achieve this objective. Morbidity is relatively high, but acceptable given the poor prognosis of this disease, the improved survival after surgery, and improvements in post-operative quality of life and functions.

Flight Results of the Chandra X-ray Observatory Inertial Upper Stage Space Mission

NASA Technical Reports Server (NTRS)

Tillotson, R.; Walter, R.

2000-01-01

Under contract to NASA, a specially configured version of the Boeing developed Inertial Upper Stage (IUS) booster was provided by Boeing to deliver NASA's 1.5 billion dollar Chandra X-Ray Observatory satellite into a highly elliptical transfer orbit from a Shuttle provided circular park orbit. Subsequently, the final orbit of the Chandra satellite was to be achieved using the Chandra Integral Propulsion System (IPS) through a series of IPS burns. On 23 July 1999 the Shuttle Columbia (STS-93) was launched with the IUS/Chandra stack in the Shuttle payload bay. Unfortunately, the Shuttle Orbiter was unexpectantly inserted into an off-nominal park orbit due to a Shuttle propulsion anomaly occurring during ascent. Following the IUS/Chandra on-orbit deployment from the Shuttle, at seven hours from liftoff, the flight proven IUS GN&C system successfully injected Chandra into the targeted transfer orbit, in spite of the off-nominal park orbit. This paper describes the IUS GN&C system, discusses the specific IUS GN&C mission data load development, analyses and testing for the Chandra mission, and concludes with a summary of flight results for the IUS part of the Chandra mission.

Staged cascade fluidized bed combustor

DOEpatents

Cannon, Joseph N.; De Lucia, David E.; Jackson, William M.; Porter, James H.

1984-01-01

A fluid bed combustor comprising a plurality of fluidized bed stages interconnected by downcomers providing controlled solids transfer from stage to stage. Each stage is formed from a number of heat transfer tubes carried by a multiapertured web which passes fluidizing air to upper stages. The combustor cross section is tapered inwardly from the middle towards the top and bottom ends. Sorbent materials, as well as non-volatile solid fuels, are added to the top stages of the combustor, and volatile solid fuels are added at an intermediate stage.

Advanced space program studies: Overall executive summary

NASA Technical Reports Server (NTRS)

Sitney, L. R.

1974-01-01

Studies were conducted to provide NASA with advanced planning analyses which relate integrated space program goals and options to credible technical capabilities, applications potential, and funding resources. The studies concentrated on the following subjects: (1) upper stage options for the space transportation system based on payload considerations, (2) space servicing and standardization of payloads, (3) payload operations, and (4) space transportation system economic analyses related to user charges and new space applications. A systems cost/performance model was developed to synthesize automated, unmanned spacecraft configurations based on the system requirements and a list of equipments at the assembly level.

Lung cancer staging now and in the future.

PubMed

Liam, Chong-Kin; Andarini, Sita; Lee, Pyng; Ho, James Chung-Man; Chau, Ngo Quy; Tscheikuna, Jamsak

2015-05-01

For a long time lung cancer was associated with a fatalistic approach by healthcare professionals. In recent years, advances in imaging, improved diagnostic techniques and more effective treatment modalities are reasons for optimism. Accurate lung cancer staging is vitally important because treatment options and prognosis differ significantly by stage. The staging algorithm should include a contrast computed tomography (CT) of the chest and the upper abdomen including adrenals, positron emission tomography/CT for staging the mediastinum and to rule out extrathoracic metastasis in patients considered for surgical resection, endosonography-guided needle sampling procedure replacing mediastinoscopy for near complete mediastinal staging, and brain imaging as clinically indicated. Applicability of evidence-based guidelines for staging of lung cancer depends on the available expertise and level of resources and is directly impacted by financial issues. Considering the diversity of healthcare infrastructure and economic performance of Asian countries, optimal and cost-effective use of staging methods appropriate to the available resources is prudent. The pulmonologist plays a central role in the multidisciplinary approach to lung cancer diagnosis, staging and management. Regional respiratory societies such as the Asian Pacific Society of Respirology should work with national respiratory societies to strive for uniform standards of care. For developing countries, a minimum set of care standards should be formulated. Cost-effective delivery of optimal care for lung cancer patients, including staging within the various healthcare systems, should be encouraged and most importantly, tobacco control implementation should receive an absolute priority status in all countries in Asia. © 2015 Asian Pacific Society of Respirology.

Esophageal dysfunction in different stages of Parkinson's disease.

PubMed

Suttrup, I; Suttrup, J; Suntrup-Krueger, S; Siemer, M-L; Bauer, J; Hamacher, C; Oelenberg, S; Domagk, D; Dziewas, R; Warnecke, T

2017-01-01

Dysphagia is a clinically relevant symptom in patients with Parkinson's disease (PD) leading to pronounced reduction in quality of life and other severe complications. Parkinson's disease-related dysphagia may affect the oral and pharyngeal, as well as the esophageal phase of swallowing. To examine the nature and extend of esophageal dysphagia in different stages of PD and their relation to oropharyngeal dysfunction, we examined 65 PD patients (mean age 66.3±9.7 years, mean disease duration 7.9±5.8 years, mean Hoehn & Yahr [H&Y] stage 2.89±0.91) and divided into three groups (early [H&Y I+II; n=21], intermediate [H&Y III; n=25], and advanced stadium [H&Y IV+V; n=19]), using esophageal high-resolution manometry (HRM) to detect esophageal motor disorders. Oropharyngeal impairment was assessed using fiberoptic endoscopic evaluation of swallowing. Major esophageal motor disorders were detected in nearly one third of the PD patients. Minor impairment of the esophageal body was present in 95% of participants and throughout all disease stages with pathological findings especially in peristalsis and intrabolus pressure (IBP). The IBP was found to significantly increase in the advanced stadium. Although dysfunction of the upper and lower esophageal sphincters was observed in individual patients, alterations in these esophageal segments revealed no statistical significance compared with normative data. No clear association was found between the occurrence of oropharyngeal dysphagia and esophageal impairment. Esophageal body impairment in PD is a frequent phenomenon during all disease stages, which possibly reflects α-synucleinopathy in the enteric nervous system. © 2016 John Wiley & Sons Ltd.

Forensic age estimation based on magnetic resonance imaging of third molars: converting 2D staging into 3D staging.

PubMed

De Tobel, Jannick; Hillewig, Elke; Verstraete, Koenraad

2017-03-01

Established methods to stage development of third molars for forensic age estimation are based on the evaluation of radiographs, which show a 2D projection. It has not been investigated whether these methods require any adjustments in order to apply them to stage third molars on magnetic resonance imaging (MRI), which shows 3D information. To prospectively study root stage assessment of third molars in age estimation using 3 Tesla MRI and to compare this with panoramic radiographs, in order to provide considerations for converting 2D staging into 3D staging and to determine the decisive root. All third molars were evaluated in 52 healthy participants aged 14-26 years using MRI in three planes. Three staging methods were investigated by two observers. In sixteen of the participants, MRI findings were compared with findings on panoramic radiographs. Decisive roots were palatal in upper third molars and distal in lower third molars. Fifty-seven per cent of upper third molars were not assessable on the radiograph, while 96.9% were on MRI. Upper third molars were more difficult to evaluate on radiographs than on MRI (p < .001). Lower third molars were equally assessable on both imaging techniques (93.8% MRI, 98.4% radiograph), with no difference in level of difficulty (p = .375). Inter- and intra-observer agreement for evaluation was higher in MRI than in radiographs. In both imaging techniques lower third molars showed greater inter- and intra-observer agreement compared to upper third molars. MR images in the sagittal plane proved to be essential for staging. In age estimation, 3T MRI of third molars could be valuable. Some considerations are, however, necessary to transfer known staging methods to this 3D technique.

Designing the Ares I Crew Launch Vehicle Upper Stage Element and Integrating the Stack at NASA's Marshall Space Flight Center

NASA Technical Reports Server (NTRS)

Otte, Neil E.; Lyles, Garry; Reuter, James L.; Davis, Daniel J.

2008-01-01

Fielding an integrated launch vehicle system entails many challenges, not the least of which is the fact that it has been over 30 years since the United States has developed a human-rated vehicle - the venerable Space Shuttle. Over time, whole generations of rocket scientists have passed through the aerospace community without the opportunity to perform such exacting, demanding, and rewarding work. However, with almost 50 years of experience leading the design, development, and end-to-end systems engineering and integration of complex launch vehicles, the National Aeronautics and Space Administration's (NASA's) Marshall Space Flight Center offers the in-house talent - both junior- and senior-level personnel - to shape a new national asset to meet the requirements for safe, reliable, and affordable space exploration solutions. The technical personnel are housed primarily in Marshall's Engineering Directorate and are matrixed into the programs and projects that reside at the rocket center. Fortunately, many Apollo-era and Shuttle engineers, as well as those who gained valuable hands-on experience in the 1990s by conducting technology demonstrator projects such as the Delta-Clipper Experimental Advanced, X-33, X-34, and X-37, as well as the short-lived Orbital Space Plane, work closely with industry partners to advance the nation's strategic capability for human access to space. The Ares Projects Office, resident at Marshall, is managing the design and development of America's new space fleet, including the Ares I, which will loft the Orion crew capsule for its first test flight in the 2013 timeframe, as well as the heavy-lift Ares V, which will round out the capability to leave low-Earth orbit once again, when it delivers the Altair lunar lander to orbit late next decade. This paper provides information about the approach to integrating the Ares I stack and designing the upper stage in house, using unique facilities and an expert workforce to revitalize the nation

Seismic stratigraphy of the Mississippi-Alabama shelf and upper continental slope

USGS Publications Warehouse

Kindinger, J.L.

1988-01-01

The Mississippi-Alabama shelf and upper continental slope contain relatively thin Upper Pleistocene and Holocene deposits. Five stages of shelf evolution can be identified from the early Wisconsinan to present. The stages were controlled by glacioeustatic or relative sea-level changes and are defined by the stratigraphic position of depositional and erosional episodes. The stratigraphy was identified on seismic profiles by means of geomorphic pattern, high-angle clinoform progradational deposits, buried stream entrenchments, planar conformities, and erosional unconformities. The oldest stage (stage 1) of evolution occurred during the early Wisconsinan lowstand; the subaerially exposed shelf was eroded to a smooth seaward-sloping surface. This paleosurface is overlain by a thin (< 10 m) drape of transgressive deposits (stage 2). Stage 3 occurred in three phases as the late Wisconsinan sea retreated: (1) fluvial channel systems eroded across the shelf, (2) deposited a thick (90 m) shelf-margin delta, and (3) contemporaneously deposited sediments on the upper slope. Stage 4 included the rapid Holocene sea-level rise that deposited a relatively thin transgressive facies over parts of the shelf. The last major depositional episode (stage 5) was the progradation of the St. Bernard delta over the northwestern and central parts of the area. A depositional hiatus has occurred since the St. Bernard progradation. These Upper Quaternary shelf and slope deposits provide models for analogous deposits in the geologic record. Primarily, they are examples of cyclic sedimentation caused by changes in sea level and may be useful in describing short-term, sandy depositional episodes in prograding shelf and slope sequences. ?? 1988.

Does Radiation Have a Role in Advanced Stage Hodgkin's or Non-Hodgkin Lymphoma?

PubMed

Specht, Lena

2016-01-01

Radiation therapy (RT) is one of the most effective agents available in the treatment of lymphomas. However, it is a local treatment, and today, with systemic treatments assuming a primary role for induction of response, RT is primarily used for consolidation. For advanced stage lymphomas, the indications for the use of RT have been questioned and debated, and proper randomized evidence is sparse. RT has significant long-term side effects, and the very extended RT fields of the past yielded unacceptable toxicity in many patients. Modern advanced imaging and conformal RT techniques now enable treatment of larger and anatomically more challenging target volumes with much less radiation to normal tissues and consequently much lower risks of long-term complications. The modern concept of involved site radiation therapy (ISRT) has now been accepted as standard in lymphomas. In advanced Hodgkin lymphoma (HL), RT to residual disease and/or initial bulk benefits some patients, depending on the chemotherapy regimen used. The more intensive the chemotherapy regimen, the fewer patients benefit from RT. In advanced aggressive non-Hodgkin lymphoma (NHL), most of the evidence comes from the most common type, the diffuse large B cell lymphoma (DLBCL). In patients treated with modern immunochemotherapy, RT to initial bulky disease or extralymphatic involvement is beneficial. For both HL and aggressive NHL, RT to residual masses after systemic treatment is of benefit. The role of PET in the evaluation and indication for RT to residual masses has not been tested in randomized trials. In advanced indolent NHL, very low dose RT offers excellent palliation with very few side effects. Modern RT in advanced lymphomas warrants further evaluation in randomized trials.

The ideas about advanced life support and affecting factors at the end-stage of life in a hospital in Turkey

PubMed Central

Albayrak, Turgay; Şencan, İrfan; Akça, Ömer; Aksoy, Hilal; Ünsal, Selim; Bülbül, İskender; Bahadır, Adem; Kasım, İsmail; Kahveci, Rabia; Özkara, Adem

2017-01-01

Background The participation of the people in health decisions may be structured in various levels. One of these is participation in decisions for the treatment. “Advanced directives” is one of the examples for the participation in decisions for the treatment. Aim We wanted to determine the decisions on advanced life support at the end-stage of life in case of a life-threatening illness for the people themselves and their first degree relatives and the factors effecting these decisions. Design and setting The cross-sectional study was conducted with volunteers among patients and patient relatives who applied to all polyclinics of the Ankara Numune Training and Research Hospital except the emergency, oncology and psychiatry polyclinics between 15.12.2012 and 15.03.2013. Method A questionnaire, the Hospital Anxiety Depression (HAD) scale, and Templer’s Death Anxiety Scale (TDA) were applied to all individuals. SPSS for Win. Ver. 17.0 and MS-Excel 2010 Starter software bundles were used for all statistical analysis and calculations. Results The participants want both themselves and their first degree relatives included in end-stage decision-making process. Therefore, the patients and their families should be informed adequately during decision making process and quality communication must be provided. Conclusion Participants who have given their end-stage decisions previously want to be treated according to these decisions. This desire can just be possible by advanced directives.When moral and material loads of end-stage process are taken into consideration, countries, in which advanced directives are practiced, should be examined well and participants’ desire should be evaluated in terms of practicability. PMID:28732071

Prognosis for advanced-stage primary peritoneal serous papillary carcinoma and serous ovarian cancer in Taiwan.

PubMed

Chao, Kuan-Chong; Chen, Yi-Jen; Juang, Chi-Mou; Lau, Hei-Yu; Wen, Kuo-Chang; Sung, Pi-Lin; Fang, Feng-Ying; Twu, Nae-Fang; Yen, Ming-Shyen

2013-03-01

To compare the prognosis of patients with advanced-stage primary peritoneal serous papillary carcinoma (PSPC) or papillary serous ovarian cancer (PSOC). This was a retrospective case-control study and included two study groups: one with stage III/IV PSPC (n = 38) patients and the other with PSOC (n = 53) patients. Patients were matched for histologic subtype (serous tumor), tumor stage, tumor grade, residual disease at the end of debulking surgery (primary or interval), and age (±5 years). Mean age was significantly greater for patients with PSPC (63.03 ± 11.88 years) than for patients with PSOC (55.92 ± 12.56 years, p = 0.008). Optimal debulking surgery was performed initially in 71.9% of PSPC patients and 66.0% of PSOC patients. In addition, 93.9% of PSPC patients and 92.3% of PSOC patients were treated with platinum-paclitaxel chemotherapy. The frequency of high-grade tumors was significantly higher in the PSPC (100%) than in the PSOC group (68.3%; p < 0.001). Progression-free survival (PFS) was similar in the PSPC [median 12 months, 95% confidence interval (CI) 7.3-16.7] and PSOC groups (median 16.7 months, 95% CI 12.9-20.4; p = 0.470). Overall survival was shorter in the PSPC (median 62 months, 95% CI 19.6-104.4) than in the PSOC group (median 77.5 months, 95% CI 69.7-85.2; p = 0.006, log-rank statistic). PFS was similar for advanced-stage PSPC and PSOC patients. Since the PSPC patients tended to be older and have more high-grade tumors, OS was shorter for PSPC than for POSC patients. Thus, management of the two types of cancer should not differ. Copyright © 2013. Published by Elsevier B.V.

Urinary Tract Resections in Advanced-stage Cervical Cancer - A Series of Eight Cases.

PubMed

Oprescu, Dana Nuti; Bacalbasa, Nicolae; Balescu, Irina; Filipescu, Alexandru

2017-06-01

Cervical cancer is one of the most frequent malignancies in women worldwide and is unfortunately diagnosed in advanced stages of the disease. Whenever local invasion is present, neoadjuvant therapy might be needed in order to limit the degree of local invasion. However, in certain cases local invasion persists even after completing the neoadjuvant radiochemotherapy; in these patients more extensive resections might be needed in order to achieve a radical resection. We present a case series of eight patients in whom segmental ureteral or uretero-vesical resections were performed as part of the radical resections for locally advanced cervical tumors. The continuity of the urinary tract was re-established by performing ureteral reimplantation via uretero-neocystostomy, augmentation cystoplasties with ureteral reimplantations. In a single case ureteral reimplantation was not feasible, a definitive cutaneous ureterostomy being performed. The postoperative course was uneventful in seven cases while in a single case urinary leak occurred, necessitating the exteriorization of the ureter in terminal cutaneous ureterostomy. Ureteral resections can be safely performed in patients with locally advanced cervical cancer. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Content of Advance Directives for Individuals with Advanced Dementia

PubMed Central

Black, Betty S.; Phillips, Hilary; Fahrendorf, Sarah Richardson; Schwartz, Jack; Angelino, Andrew F.; Anderson, Danielle; Rabins, Peter V.

2010-01-01

Objectives To examine how people with end-stage dementia have conveyed their wishes for end-of-life care in advance directives. Methods The documents of 123 residents of three Maryland nursing homes, all with end-stage dementia, were reviewed. Results More years of education and White race were significantly associated with having an advance directive. With the exceptions of comfort care and pain treatment, advance directives were used primarily to restrict, not request, many forms of care at the end-of-life. Decisions about care for end-stage conditions such as Alzheimer's dementia are less often addressed in these documents than for terminal conditions and persistent vegetative state. Discussion In order for advance directives to better reflect a person's wishes, discussions with individuals and families about advance directives should include a range of care issues in the settings of terminal illness, persistent vegetative state or end-stage illness. These documents should be reviewed periodically to make certain they convey accurately the person's treatment preferences. PMID:18625761

Cell-free DNA levels and correlation to stage and outcome following treatment of locally advanced rectal cancer.

PubMed

Boysen, Anders Kindberg; Wettergren, Yvonne; Sorensen, Boe Sandahl; Taflin, Helena; Gustavson, Bengt; Spindler, Karen-Lise Garm

2017-11-01

Accurate staging of rectal cancer remains essential for optimal patient selection for combined modality treatment, including radiotherapy, chemotherapy and surgery. We aimed at examining the correlation of cell free DNA with the pathologic stage and subsequent risk of recurrence for patients with locally advanced rectal cancer undergoing preoperative chemoradiation. We examined 75 patients with locally advanced rectal cancer receiving preoperative chemoradiation. Blood samples for translational use were drawn prior to rectal surgery. The level of cell free DNA was quantified by digital droplet PCR and expressed as copy number of beta 2 microglobulin. We found a median level of cell free DNA in the AJCC stages I-III of 3100, 8300, and 10,700 copies/mL respectively. For patients with 12 sampled lymph nodes or above, the median level of cell free DNA were 2400 copies/mL and 4400 copies/mL (p = 0.04) for node negative and node positive disease respectively. The median follow-up was 39 months and 11 recurrences were detected (15%). The median level for patients with recurrent disease was 13,000 copies/mL compared to 5200 copies/mL for non-recurrent patients (p = 0.08). We have demonstrated a correlation between the level of total cell free DNA and the pathologic stage and nodal involvement. Furthermore, we have found a trend towards a correlation with the risk of recurrence following resection of localized rectal cancer.

Smooth Transition for Advancement to Graduate Education (STAGE) for Underrepresented Groups in the Mathematical Sciences Pilot Project: Broadening Participation through Mentoring

ERIC Educational Resources Information Center

Eubanks-Turner, Christina; Beaulieu, Patricia; Pal, Nabendu

2018-01-01

The Smooth Transition for Advancement to Graduate Education (STAGE) project was a three-year pilot project designed to mentor undergraduate students primarily from under-represented groups in the mathematical sciences. The STAGE pilot project focused on mentoring students as they transitioned from undergraduate education to either graduate school…

Evolution and clinical impact of co-occurring genetic alterations in advanced-stage EGFR-mutant lung cancers

PubMed Central

Blakely, Collin M.; Watkins, Thomas B.K.; Wu, Wei; Gini, Beatrice; Chabon, Jacob J.; McCoach, Caroline E.; McGranahan, Nicholas; Wilson, Gareth A.; Birkbak, Nicolai J.; Olivas, Victor R.; Rotow, Julia; Maynard, Ashley; Wang, Victoria; Gubens, Matthew A.; Banks, Kimberly C.; Lanman, Richard B.; Caulin, Aleah F.; John, John St.; Cordero, Anibal R.; Giannikopoulos, Petros; Simmons, Andrew D.; Mack, Philip C.; Gandara, David R.; Husain, Hatim; Doebele, Robert C.; Riess, Jonathan W.; Diehn, Maximilian; Swanton, Charles; Bivona, Trever G.

2017-01-01

A widespread approach to modern cancer therapy is to identify a single oncogenic driver gene and target its mutant protein product (e.g. EGFR inhibitor treatment in EGFR-mutant lung cancers). However, genetically-driven resistance to targeted therapy limits patient survival. Through genomic analysis of 1122 EGFR-mutant lung cancer cell-free DNA samples and whole exome analysis of seven longitudinally collected tumor samples from an EGFR-mutant lung cancer patient, we identify critical co-occurring oncogenic events present in most advanced-stage EGFR-mutant lung cancers. We define new pathways limiting EGFR inhibitor response, including WNT/β-catenin and cell cycle gene (e.g. CDK4, CDK6) alterations. Tumor genomic complexity increases with EGFR inhibitor treatment and co-occurring alterations in CTNNB1, and PIK3CA exhibit non-redundant functions that cooperatively promote tumor metastasis or limit EGFR inhibitor response. This study challenges the prevailing single-gene driver oncogene view and links clinical outcomes to co-occurring genetic alterations in advanced-stage EGFR-mutant lung cancer patients. PMID:29106415

The prediction of progression-free and overall survival in women with an advanced stage of epithelial ovarian carcinoma.

PubMed

Gerestein, C G; Eijkemans, M J C; de Jong, D; van der Burg, M E L; Dykgraaf, R H M; Kooi, G S; Baalbergen, A; Burger, C W; Ansink, A C

2009-02-01

Prognosis in women with ovarian cancer mainly depends on International Federation of Gynecology and Obstetrics stage and the ability to perform optimal cytoreductive surgery. Since ovarian cancer has a heterogeneous presentation and clinical course, predicting progression-free survival (PFS) and overall survival (OS) in the individual patient is difficult. The objective of this study was to determine predictors of PFS and OS in women with advanced stage epithelial ovarian cancer (EOC) after primary cytoreductive surgery and first-line platinum-based chemotherapy. Retrospective observational study. Two teaching hospitals and one university hospital in the south-western part of the Netherlands. Women with advanced stage EOC. All women who underwent primary cytoreductive surgery for advanced stage EOC followed by first-line platinum-based chemotherapy between January 1998 and October 2004 were identified. To investigate independent predictors of PFS and OS, a Cox' proportional hazard model was used. Nomograms were generated with the identified predictive parameters. The primary outcome measure was OS and the secondary outcome measures were response and PFS. A total of 118 women entered the study protocol. Median PFS and OS were 15 and 44 months, respectively. Preoperative platelet count (P = 0.007), and residual disease <1 cm (P = 0.004) predicted PFS with a optimism corrected c-statistic of 0.63. Predictive parameters for OS were preoperative haemoglobin serum concentration (P = 0.012), preoperative platelet counts (P = 0.031) and residual disease <1 cm (P = 0.028) with a optimism corrected c-statistic of 0.67. PFS could be predicted by postoperative residual disease and preoperative platelet counts, whereas residual disease, preoperative platelet counts and preoperative haemoglobin serum concentration were predictive for OS. The proposed nomograms need to be externally validated.

Low-Noise Potential of Advanced Fan Stage Stator Vane Designs Verified in NASA Lewis Wind Tunnel Test

NASA Technical Reports Server (NTRS)

Hughes, Christopher E.

1999-01-01

With the advent of new, more stringent noise regulations in the next century, aircraft engine manufacturers are investigating new technologies to make the current generation of aircraft engines as well as the next generation of advanced engines quieter without sacrificing operating performance. A current NASA initiative called the Advanced Subsonic Technology (AST) Program has set as a goal a 6-EPNdB (effective perceived noise) reduction in aircraft engine noise relative to 1992 technology levels by the year 2000. As part of this noise program, and in cooperation with the Allison Engine Company, an advanced, low-noise, high-bypass-ratio fan stage design and several advanced technology stator vane designs were recently tested in NASA Lewis Research Center's 9- by 15-Foot Low-Speed Wind Tunnel (an anechoic facility). The project was called the NASA/Allison Low Noise Fan.

Computer program for prediction of fuel consumption statistical data for an upper stage three-axes stabilized on-off control system

NASA Technical Reports Server (NTRS)

1982-01-01

A FORTRAN coded computer program and method to predict the reaction control fuel consumption statistics for a three axis stabilized rocket vehicle upper stage is described. A Monte Carlo approach is used which is more efficient by using closed form estimates of impulses. The effects of rocket motor thrust misalignment, static unbalance, aerodynamic disturbances, and deviations in trajectory, mass properties and control system characteristics are included. This routine can be applied to many types of on-off reaction controlled vehicles. The pseudorandom number generation and statistical analyses subroutines including the output histograms can be used for other Monte Carlo analyses problems.

Science advancements key to increasing management value of life stage monitoring networks for endangered Sacramento River winter-run Chinook salmon in California

USGS Publications Warehouse

Johnson, Rachel C.; Windell, Sean; Brandes, Patricia L.; Conrad, J. Louise; Ferguson, John; Goertler, Pascale A. L.; Harvey, Brett N.; Heublein, Joseph; Isreal, Joshua A.; Kratville, Daniel W.; Kirsch, Joseph E.; Perry, Russell W.; Pisciotto, Joseph; Poytress, William R.; Reece, Kevin; Swart, Brycen G.

2017-01-01

A robust monitoring network that provides quantitative information about the status of imperiled species at key life stages and geographic locations over time is fundamental for sustainable management of fisheries resources. For anadromous species, management actions in one geographic domain can substantially affect abundance of subsequent life stages that span broad geographic regions. Quantitative metrics (e.g., abundance, movement, survival, life history diversity, and condition) at multiple life stages are needed to inform how management actions (e.g., hatcheries, harvest, hydrology, and habitat restoration) influence salmon population dynamics. The existing monitoring network for endangered Sacramento River winterrun Chinook Salmon (SRWRC, Oncorhynchus tshawytscha) in California’s Central Valley was compared to conceptual models developed for each life stage and geographic region of the life cycle to identify relevant SRWRC metrics. We concluded that the current monitoring network was insufficient to diagnose when (life stage) and where (geographic domain) chronic or episodic reductions in SRWRC cohorts occur, precluding within- and among-year comparisons. The strongest quantitative data exist in the Upper Sacramento River, where abundance estimates are generated for adult spawners and emigrating juveniles. However, once SRWRC leave the upper river, our knowledge of their identity, abundance, and condition diminishes, despite the juvenile monitoring enterprise. We identified six system-wide recommended actions to strengthen the value of data generated from the existing monitoring network to assess resource management actions: (1) incorporate genetic run identification; (2) develop juvenile abundance estimates; (3) collect data for life history diversity metrics at multiple life stages; (4) expand and enhance real-time fish survival and movement monitoring; (5) collect fish condition data; and (6) provide timely public access to monitoring data in open data

Increased expression of tumor necrosis factor-α is associated with advanced colorectal cancer stages.

PubMed

Al Obeed, Omar A; Alkhayal, Khayal A; Al Sheikh, Abdulmalik; Zubaidi, Ahmad M; Vaali-Mohammed, Mansoor-Ali; Boushey, Robin; Mckerrow, James H; Abdulla, Maha-Hamadien

2014-12-28

To detect the expression of tumor necrosis factor-α (TNF-α) in colorectal cancer (CRC) cells among Saudi patients, and correlate its expression with clinical stages of cancer. Archival tissue specimens were collected from 30 patients with CRC who had undergone surgical intervention at King Khalid University Hospital. Patient demographic information, including age and gender, tumor sites, and histological type of CRC, was recorded. To measure TNF-α mRNA expression in CRC, total RNA was extracted from tumor formalin-fixed, paraffin-embedded, and adjacent normal tissues. Reverse transcription and reverse transcription polymerase chain reaction were performed. Colorectal tissue microarrays were constructed to investigate the protein expression of TNF-α by immunohistochemistry. The relative expression of TNF-α mRNA in colorectal cancer was significantly higher than that seen in adjacent normal colorectal tissue. High TNF-α gene expression was associated with Stage III and IV neoplasms when compared with earlier tumor stages (P = 0.004). Eighty-three percent of patients (25/30) showed strong TNF-α positive staining, while only 10% (n = 3/30) of patients showed weak staining, and 7% (n = 2/30) were negative. We showed the presence of elevated TNF-α gene expression in cancer cells, which strongly correlated with advanced stages of tumor. High levels of TNF-α expression could be an independent diagnostic indicator of colorectal cancer, and targeting TNF-α might be a promising prognostic tool by assessment of the clinical stages of CRC.

Increased expression of tumor necrosis factor-α is associated with advanced colorectal cancer stages

PubMed Central

Al Obeed, Omar A; Alkhayal, Khayal A; Al Sheikh, Abdulmalik; Zubaidi, Ahmad M; Vaali-Mohammed, Mansoor-Ali; Boushey, Robin; Mckerrow, James H; Abdulla, Maha-Hamadien

2014-01-01

AIM: To detect the expression of tumor necrosis factor-α (TNF-α) in colorectal cancer (CRC) cells among Saudi patients, and correlate its expression with clinical stages of cancer. METHODS: Archival tissue specimens were collected from 30 patients with CRC who had undergone surgical intervention at King Khalid University Hospital. Patient demographic information, including age and gender, tumor sites, and histological type of CRC, was recorded. To measure TNF-α mRNA expression in CRC, total RNA was extracted from tumor formalin-fixed, paraffin-embedded, and adjacent normal tissues. Reverse transcription and reverse transcription polymerase chain reaction were performed. Colorectal tissue microarrays were constructed to investigate the protein expression of TNF-α by immunohistochemistry. RESULTS: The relative expression of TNF-α mRNA in colorectal cancer was significantly higher than that seen in adjacent normal colorectal tissue. High TNF-α gene expression was associated with Stage III and IV neoplasms when compared with earlier tumor stages (P = 0.004). Eighty-three percent of patients (25/30) showed strong TNF-α positive staining, while only 10% (n = 3/30) of patients showed weak staining, and 7% (n = 2/30) were negative. We showed the presence of elevated TNF-α gene expression in cancer cells, which strongly correlated with advanced stages of tumor. CONCLUSION: High levels of TNF-α expression could be an independent diagnostic indicator of colorectal cancer, and targeting TNF-α might be a promising prognostic tool by assessment of the clinical stages of CRC. PMID:25561807

Upper Extremity Amputations and Prosthetics

PubMed Central

Ovadia, Steven A.; Askari, Morad

2015-01-01

Upper extremity amputations are most frequently indicated by severe traumatic injuries. The location of the injury will determine the level of amputation. Preservation of extremity length is often a goal. The amputation site will have important implications on the functional status of the patient and options for prosthetic reconstruction. Advances in amputation techniques and prosthetic reconstructions promote improved quality of life. In this article, the authors review the principles of upper extremity amputation, including techniques, amputation sites, and prosthetic reconstructions. PMID:25685104

Intra-abdominal temperature distribution during consolidation hyperthermic intraperitoneal chemotherapy with carboplatin in the treatment of advanced stage ovarian carcinoma.

PubMed

Rettenmaier, Mark A; Mendivil, Alberto A; Gray, Crystal M; Chapman, Amber P; Stone, Michelle K; Tinnerman, Erin J; Goldstein, Bram H

2015-06-01

Hyperthermic intraperitoneal chemotherapy (HIPEC) involves the continuous heating and circulation of chemotherapy throughout the abdominal cavity in an attempt to enhance cytotoxicity. Despite the potential of this chemotherapy procedure, there are scant anatomical temperature distribution studies reporting on this therapeutic process. We prospectively evaluated the temperature of select anatomical (e.g. upper abdominal, mid-abdominal and supra-pubic) sites in 11 advanced stage ovarian cancer patients who were treated with consolidation HIPEC carboplatin (AUC 10). The temperature of the aforementioned anatomical regions and the inflow/outflow tubing was measured at baseline and at 15-min intervals until the procedure's completion. The lowest observed mean composite temperature was 41.1 °C at the supra-pubic site whereas the highest temperature was 42.6 °C, in association with the inflow/outflow tubing. During the various time intervals we also ascertained that the lowest composite temperature was 40.9 °C at baseline (i.e. time 0), whereas the highest value (41.8 °C) occurred at multiple time periods (e.g., 15, 45 and 60 min). The HIPEC temperature variation amongst the various abdominal sites and time intervals was minimal. We also discerned that uniform temperature distribution throughout the abdominal cavity was facilitated when the abdomen was both maximally distended with fluid and a high flow rate was maintained.

Cutaneous Lymphoma International Consortium Study of Outcome in Advanced Stages of Mycosis Fungoides and Sézary Syndrome: Effect of Specific Prognostic Markers on Survival and Development of a Prognostic Model

PubMed Central

Scarisbrick, Julia J.; Prince, H. Miles; Vermeer, Maarten H.; Quaglino, Pietro; Horwitz, Steven; Porcu, Pierluigi; Stadler, Rudolf; Wood, Gary S.; Beylot-Barry, Marie; Pham-Ledard, Anne; Foss, Francine; Girardi, Michael; Bagot, Martine; Michel, Laurence; Battistella, Maxime; Guitart, Joan; Kuzel, Timothy M.; Martinez-Escala, Maria Estela; Estrach, Teresa; Papadavid, Evangelia; Antoniou, Christina; Rigopoulos, Dimitis; Nikolaou, Vassilki; Sugaya, Makoto; Miyagaki, Tomomitsu; Gniadecki, Robert; Sanches, José Antonio; Cury-Martins, Jade; Miyashiro, Denis; Servitje, Octavio; Muniesa, Cristina; Berti, Emilio; Onida, Francesco; Corti, Laura; Hodak, Emilia; Amitay-Laish, Iris; Ortiz-Romero, Pablo L.; Rodríguez-Peralto, Jose L.; Knobler, Robert; Porkert, Stefanie; Bauer, Wolfgang; Pimpinelli, Nicola; Grandi, Vieri; Cowan, Richard; Rook, Alain; Kim, Ellen; Pileri, Alessandro; Patrizi, Annalisa; Pujol, Ramon M.; Wong, Henry; Tyler, Kelly; Stranzenbach, Rene; Querfeld, Christiane; Fava, Paolo; Maule, Milena; Willemze, Rein; Evison, Felicity; Morris, Stephen; Twigger, Robert; Talpur, Rakhshandra; Kim, Jinah; Ognibene, Grant; Li, Shufeng; Tavallaee, Mahkam; Hoppe, Richard T.; Duvic, Madeleine; Whittaker, Sean J.; Kim, Youn H.

2015-01-01

Purpose Advanced-stage mycosis fungoides (MF; stage IIB to IV) and Sézary syndrome (SS) are aggressive lymphomas with a median survival of 1 to 5 years. Clinical management is stage based; however, there is wide range of outcome within stages. Published prognostic studies in MF/SS have been single-center trials. Because of the rarity of MF/SS, only a large collaboration would power a study to identify independent prognostic markers. Patients and Methods Literature review identified the following 10 candidate markers: stage, age, sex, cutaneous histologic features of folliculotropism, CD30 positivity, proliferation index, large-cell transformation, WBC/lymphocyte count, serum lactate dehydrogenase, and identical T-cell clone in blood and skin. Data were collected at specialist centers on patients diagnosed with advanced-stage MF/SS from 2007. Each parameter recorded at diagnosis was tested against overall survival (OS). Results Staging data on 1,275 patients with advanced MF/SS from 29 international sites were included for survival analysis. The median OS was 63 months, with 2- and 5-year survival rates of 77% and 52%, respectively. The median OS for patients with stage IIB disease was 68 months, but patients diagnosed with stage III disease had slightly improved survival compared with patients with stage IIB, although patients diagnosed with stage IV disease had significantly worse survival (48 months for stage IVA and 33 months for stage IVB). Of the 10 variables tested, four (stage IV, age > 60 years, large-cell transformation, and increased lactate dehydrogenase) were independent prognostic markers for a worse survival. Combining these four factors in a prognostic index model identified the following three risk groups across stages with significantly different 5-year survival rates: low risk (68%), intermediate risk (44%), and high risk (28%). Conclusion To our knowledge, this study includes the largest cohort of patients with advanced-stage MF/SS and

Cutaneous Lymphoma International Consortium Study of Outcome in Advanced Stages of Mycosis Fungoides and Sézary Syndrome: Effect of Specific Prognostic Markers on Survival and Development of a Prognostic Model.

PubMed

Scarisbrick, Julia J; Prince, H Miles; Vermeer, Maarten H; Quaglino, Pietro; Horwitz, Steven; Porcu, Pierluigi; Stadler, Rudolf; Wood, Gary S; Beylot-Barry, Marie; Pham-Ledard, Anne; Foss, Francine; Girardi, Michael; Bagot, Martine; Michel, Laurence; Battistella, Maxime; Guitart, Joan; Kuzel, Timothy M; Martinez-Escala, Maria Estela; Estrach, Teresa; Papadavid, Evangelia; Antoniou, Christina; Rigopoulos, Dimitis; Nikolaou, Vassilki; Sugaya, Makoto; Miyagaki, Tomomitsu; Gniadecki, Robert; Sanches, José Antonio; Cury-Martins, Jade; Miyashiro, Denis; Servitje, Octavio; Muniesa, Cristina; Berti, Emilio; Onida, Francesco; Corti, Laura; Hodak, Emilia; Amitay-Laish, Iris; Ortiz-Romero, Pablo L; Rodríguez-Peralto, Jose L; Knobler, Robert; Porkert, Stefanie; Bauer, Wolfgang; Pimpinelli, Nicola; Grandi, Vieri; Cowan, Richard; Rook, Alain; Kim, Ellen; Pileri, Alessandro; Patrizi, Annalisa; Pujol, Ramon M; Wong, Henry; Tyler, Kelly; Stranzenbach, Rene; Querfeld, Christiane; Fava, Paolo; Maule, Milena; Willemze, Rein; Evison, Felicity; Morris, Stephen; Twigger, Robert; Talpur, Rakhshandra; Kim, Jinah; Ognibene, Grant; Li, Shufeng; Tavallaee, Mahkam; Hoppe, Richard T; Duvic, Madeleine; Whittaker, Sean J; Kim, Youn H

2015-11-10

Advanced-stage mycosis fungoides (MF; stage IIB to IV) and Sézary syndrome (SS) are aggressive lymphomas with a median survival of 1 to 5 years. Clinical management is stage based; however, there is wide range of outcome within stages. Published prognostic studies in MF/SS have been single-center trials. Because of the rarity of MF/SS, only a large collaboration would power a study to identify independent prognostic markers. Literature review identified the following 10 candidate markers: stage, age, sex, cutaneous histologic features of folliculotropism, CD30 positivity, proliferation index, large-cell transformation, WBC/lymphocyte count, serum lactate dehydrogenase, and identical T-cell clone in blood and skin. Data were collected at specialist centers on patients diagnosed with advanced-stage MF/SS from 2007. Each parameter recorded at diagnosis was tested against overall survival (OS). Staging data on 1,275 patients with advanced MF/SS from 29 international sites were included for survival analysis. The median OS was 63 months, with 2- and 5-year survival rates of 77% and 52%, respectively. The median OS for patients with stage IIB disease was 68 months, but patients diagnosed with stage III disease had slightly improved survival compared with patients with stage IIB, although patients diagnosed with stage IV disease had significantly worse survival (48 months for stage IVA and 33 months for stage IVB). Of the 10 variables tested, four (stage IV, age > 60 years, large-cell transformation, and increased lactate dehydrogenase) were independent prognostic markers for a worse survival. Combining these four factors in a prognostic index model identified the following three risk groups across stages with significantly different 5-year survival rates: low risk (68%), intermediate risk (44%), and high risk (28%). To our knowledge, this study includes the largest cohort of patients with advanced-stage MF/SS and identifies markers with independent prognostic value

GOES-S Atlas V Centaur Stage Transport from ASOC to DOC

NASA Image and Video Library

2018-01-24

The Centaur upper stage that will help launch NOAA's Geostationary Operational Environmental Satellite-S, or GOES-S, arrives at the Delta Operations Center at Cape Canaveral Air Force Station for further processing. GOES-S is the second in a series of four advanced geostationary weather satellites. The GOES-R series - consisting of the GOES-R, GOES-S, GOES-T and GOES-U spacecraft - will significantly improve the detection and observation of environmental phenomena that directly affect public safety, protection of property and the nation's economic health and prosperity. GOES-S is slated to launch March 1, 2018 aboard a United Launch Alliance Atlas V rocket.

GOES-S Atlas V Centaur Stage Transport from ASOC to DOC

NASA Image and Video Library

2018-01-24

The Centaur upper stage that will help launch NOAA's Geostationary Operational Environmental Satellite-S, or GOES-S, has been lifted from its transporter inside the Delta Operations Center at Cape Canaveral Air Force Station for further processing. GOES-S is the second in a series of four advanced geostationary weather satellites. The GOES-R series - consisting of the GOES-R, GOES-S, GOES-T and GOES-U spacecraft - will significantly improve the detection and observation of environmental phenomena that directly affect public safety, protection of property and the nation's economic health and prosperity. GOES-S is slated to launch March 1, 2018 aboard a United Launch Alliance Atlas V rocket.

GOES-S Atlas V Centaur Stage Transport from ASOC to DOC

NASA Image and Video Library

2018-01-24

The Centaur upper stage that will help launch NOAA's Geostationary Operational Environmental Satellite-S, or GOES-S, has been positioned in at test cell inside the Delta Operations Center at Cape Canaveral Air Force Station for further processing. GOES-S is the second in a series of four advanced geostationary weather satellites. The GOES-R series - consisting of the GOES-R, GOES-S, GOES-T and GOES-U spacecraft - will significantly improve the detection and observation of environmental phenomena that directly affect public safety, protection of property and the nation's economic health and prosperity. GOES-S is slated to launch March 1, 2018 aboard a United Launch Alliance Atlas V rocket.

GOES-S Atlas V Centaur Stage Transport from ASOC to DOC

NASA Image and Video Library

2018-01-24

The Centaur upper stage that will help launch NOAA's Geostationary Operational Environmental Satellite-S, or GOES-S, is being transported to the Delta Operations Center at Cape Canaveral Air Force Station for further processing. GOES-S is the second in a series of four advanced geostationary weather satellites. The GOES-R series - consisting of the GOES-R, GOES-S, GOES-T and GOES-U spacecraft - will significantly improve the detection and observation of environmental phenomena that directly affect public safety, protection of property and the nation's economic health and prosperity. GOES-S is slated to launch March 1, 2018 aboard a United Launch Alliance Atlas V rocket.

GOES-S Atlas V Centaur Stage Transport from ASOC to DOC

NASA Image and Video Library

2018-01-24

The Centaur upper stage that will help launch NOAA's Geostationary Operational Environmental Satellite-S, or GOES-S, arrives inside the Delta Operations Center at Cape Canaveral Air Force Station for further processing. GOES-S is the second in a series of four advanced geostationary weather satellites. The GOES-R series - consisting of the GOES-R, GOES-S, GOES-T and GOES-U spacecraft - will significantly improve the detection and observation of environmental phenomena that directly affect public safety, protection of property and the nation's economic health and prosperity. GOES-S is slated to launch March 1, 2018 aboard a United Launch Alliance Atlas V rocket.

10-year changes in upper body strength and power in elite professional rugby league players--the effect of training age, stage, and content.

PubMed

Baker, Daniel G

2013-02-01

The purpose of this investigation was to observe changes in maximal upper body strength and power across a 10-year period in professional athletes who were experienced resistance trainers. Six professional rugby league players were observed with test data reported according to 2 important training stages in their professional careers. The first stage (1996-1998) monitored the changes as the subjects strived to establish themselves as elite professionals in their sport. The remaining test data are from the latter stage (2000-2006), which is characterized by a longer competition schedule and shorter periods devoted to improving physical preparation. The changes in upper body strength, assessed by the 1 repetition maximum bench press and mean maximum power during bench press throws with various barbell resistances of 40-80 kg, were assessed by effect size (ES) and smallest worthwhile change (SWC) statistics. Large increases in strength and power of approximately 22-23% were reported across the 10-year period, however, only small changes (as determined by ES) in strength or power occurred after year 2000 till 2006. This result of only small changes in strength or power despite 6 years of intense resistance training was attributed to 3 main factors. Key among them are the possible existence of a "strength ceiling" for experienced resistance trainers, the Long-term Athlete Development model, and possibly an inappropriate volume of strength-endurance training from 2004 to 2005. The fact that an SWC in strength and power occurred in the year after the cessation of strength-endurance training suggests that training program manipulation is still an influencing factor in continuing strength and power gains in experienced resistance trainers.

An update on the role of advanced diagnostic bronchoscopy in the evaluation and staging of lung cancer

PubMed Central

Belanger, Adam R.; Akulian, Jason A.

2017-01-01

Lung cancer remains a common and deadly disease. Many modalities are available to the bronchoscopist to evaluate and stage lung cancer. We review the role of bronchoscopy in the staging of the mediastinum with convex endobronchial ultrasound (EBUS) and discuss emerging role of esophageal ultrasonography as a complementary modality. In addition, we discuss advances in scope technology and elastography. We review the bronchoscopic methods available for the diagnosis of peripheral lung nodules including radial EBUS and navigational bronchoscopy (NB) with a consideration of the basic methodologies and diagnostic accuracies. We conclude with a discussion of the comparison of the various methodologies. PMID:28470104

Changing the facial features of patients with Treacher Collins syndrome: protocol for 3-stage treatment of hard and soft tissue hypoplasia in the upper half of the face.

PubMed

Mitsukawa, Nobuyuki; Saiga, Atsuomi; Satoh, Kaneshige

2014-07-01

Treacher Collins syndrome is a disorder characterized by various congenital soft tissue anomalies involving hypoplasia of the zygoma, maxilla, and mandible. A variety of treatments have been reported to date. These treatments can be classified into 2 major types. The first type involves osteotomy for hard tissue such as the zygoma and mandible. The second type involves plastic surgery using bone grafting in the malar region and soft tissue repair of eyelid deformities. We devised a new treatment to comprehensively correct hard and soft tissue deformities in the upper half of the face of Treacher Collins patients. The aim was to "change facial features and make it difficult to tell that the patients have this disorder." This innovative treatment strategy consists of 3 stages: (1) placement of dermal fat graft from the lower eyelid to the malar subcutaneous area, (2) custom-made synthetic zygomatic bone grafting, and (3) Z-plasty flap transposition from the upper to the lower eyelid and superior repositioning and fixation of the lateral canthal tendon using a Mitek anchor system. This method was used on 4 patients with Treacher Collins syndrome who had moderate to severe hypoplasia of the zygomas and the lower eyelids. Facial features of these patients were markedly improved and very good results were obtained. There were no major complications intraoperatively or postoperatively in any of the patients during the series of treatments. In synthetic bone grafting in the second stage, the implant in some patients was in the way of the infraorbital nerve. Thus, the nerve was detached and then sutured under the microscope. Postoperatively, patients had almost full restoration of sensory nerve torpor within 5 to 6 months. We devised a 3-stage treatment to "change facial features" of patients with hypoplasia of the upper half of the face due to Treacher Collins syndrome. The treatment protocol provided a very effective way to treat deformities of the upper half of the face

Computer program for prediction of capture maneuver probability for an on-off reaction controlled upper stage

NASA Technical Reports Server (NTRS)

Knauber, R. N.

1982-01-01

A FORTRAN coded computer program which computes the capture transient of a launch vehicle upper stage at the ignition and/or separation event is presented. It is for a single degree-of-freedom on-off reaction jet attitude control system. The Monte Carlo method is used to determine the statistical value of key parameters at the outcome of the event. Aerodynamic and booster induced disturbances, vehicle and control system characteristics, and initial conditions are treated as random variables. By appropriate selection of input data pitch, yaw and roll axes can be analyzed. Transient response of a single deterministic case can be computed. The program is currently set up on a CDC CYBER 175 computer system but is compatible with ANSI FORTRAN computer language. This routine has been used over the past fifteen (15) years for the SCOUT Launch Vehicle and has been run on RECOMP III, IBM 7090, IBM 360/370, CDC6600 and CDC CYBER 175 computers with little modification.

Ares I-X Upper Stage Simulator Structural Analyses Supporting the NESC Critical Initial Flaw Size Assessment

NASA Technical Reports Server (NTRS)

Knight, Norman F., Jr.; Phillips, Dawn R.; Raju, Ivatury S.

2008-01-01

The structural analyses described in the present report were performed in support of the NASA Engineering and Safety Center (NESC) Critical Initial Flaw Size (CIFS) assessment for the ARES I-X Upper Stage Simulator (USS) common shell segment. The structural analysis effort for the NESC assessment had three thrusts: shell buckling analyses, detailed stress analyses of the single-bolt joint test; and stress analyses of two-segment 10 degree-wedge models for the peak axial tensile running load. Elasto-plastic, large-deformation simulations were performed. Stress analysis results indicated that the stress levels were well below the material yield stress for the bounding axial tensile design load. This report also summarizes the analyses and results from parametric studies on modeling the shell-to-gusset weld, flange-surface mismatch, bolt preload, and washer-bearing-surface modeling. These analyses models were used to generate the stress levels specified for the fatigue crack growth assessment using the design load with a factor of safety.

Acquired hemochromatosis with pronounced pigment deposition of the upper eyelids.

PubMed

Chacon, Anna H; Morrison, Brian; Hu, Shasa

2013-10-01

primary (hereditary) or secondary (acquired). The acquired type most commonly occurs after massive intake of iron supplements or blood transfusions and is also known as transfusional iron overload. In the past, hemochromatosis was usually recognized at an advanced stage by the classic triad of hyperpigmentation, diabetes mellitus ("bronze diabetes"), and hepatic cirrhosis. Cutaneous hyperpigmentation is present in 70 percent of patients due to two different mechanisms: (1) hemosiderin deposition resulting in diffuse, slate-gray darkening and (2) increased production of melanin in the epidermis. A 47-year-old woman who receives regular transfusions due to low iron and chronic, unresolving anemia and who subsequently developed pronounced hyperpigmentation of the upper eyelids is described. The presentation, diagnosis, pathogenesis, and treatment options of hyperpigmentation due to secondary hemochromatosis are discussed.

Rocket stage - Trans-orbit booster Fregat

NASA Astrophysics Data System (ADS)

Asyushkin, V. A.; Papkov, O. V.

1993-10-01

This paper discusses a proposal for increasing the payload-carrying capability of a launch vehicle by using the Fregat booster stage (as the fourth stage for the R-7A launcher and as the fifth stage for the Proton launch vehicle). Particular attention is given to the tasks which the Fregat booster stage is designed to fulfill, the systems which are part of the Fregat, and the launch vehicles which will use Fregat as the upper stage. The main performance parameters of the Fregat stage are presented, as well as diagrams illustrating the performance of the Fregat booster stage.

Six-minute walk test and heart rate variability: lack of association in advanced stages of heart failure.

PubMed

Woo, M A; Moser, D K; Stevenson, L W; Stevenson, W G

1997-09-01

The 6-minute walk and heart rate variability have been used to assess mortality risk in patients with heart failure, but their relationship to each other and their usefulness for predicting mortality at 1 year are unknown. To assess the relationships between the 6-minute walk test, heart rate variability, and 1-year mortality. A sample of 113 patients in advanced stages of heart failure (New York Heart Association Functional Class III-IV, left ventricular ejection < 0.25) were studied. All 6-minute walks took place in an enclosed, level, measured corridor and were supervised by the same nurse. Heart rate variability was measured by using (1) a standard-deviation method and (2) Poincaré plots. Data on RR intervals obtained by using 24-hour Holter monitoring were analyzed. Survival was determined at 1 year after the Holter recording. The results showed no significant associations between the results of the 6-minute walk and the two measures of heart rate variability. The results of the walk were related to 1-year mortality but not to the risk of sudden death. Both measures of heart rate variability had significant associations with 1-year mortality and with sudden death. However, only heart rate variability measured by using Poincaré plots was a predictor of total mortality and risk of sudden death, independent of left ventricular ejection fraction, serum levels of sodium, results of the 6-minute walk test, and the standard-deviation measure of heart rate variability. Results of the 6-minute walk have poor association with mortality and the two measures of heart rate variability in patients with advanced-stage heart failure and a low ejection fraction. Further studies are needed to determine the optimal clinical usefulness of the 6-minute walk and heart rate variability in patients with advanced-stage heart failure.

Evaluation of Therapeutics for Advanced-Stage Heart Failure and Other Severely-Debilitating or Life-Threatening Diseases.

PubMed

Prescott, J S; Andrews, P A; Baker, R W; Bogdanffy, M S; Fields, F O; Keller, D A; Lapadula, D M; Mahoney, N M; Paul, D E; Platz, S J; Reese, D M; Stoch, S A; DeGeorge, J J

2017-08-01

Severely-debilitating or life-threatening (SDLT) diseases include conditions in which life expectancy is short or quality of life is greatly diminished despite available therapies. As such, the medical context for SDLT diseases is comparable to advanced cancer and the benefit vs. risk assessment and development of SDLT disease therapeutics should be similar to that of advanced cancer therapeutics. A streamlined development approach would allow patients with SDLT conditions earlier access to therapeutics and increase the speed of progression through development. In addition, this will likely increase the SDLT disease therapeutic pipeline, directly benefiting patients and reducing the economic and societal burden of SDLT conditions. Using advanced-stage heart failure (HF) as an example that illustrates the concepts applicable to other SDLT indications, this article proposes a streamlined development paradigm for SDLT disease therapeutics and recommends development of aligned global regulatory guidance. © 2017 American Society for Clinical Pharmacology and Therapeutics.

Evidence of prostate cancer "reverse stage migration" toward more advanced disease at diagnosis: Data from the Pennsylvania Cancer Registry.

PubMed

Reese, Adam C; Wessel, Sean R; Fisher, Susan G; Mydlo, Jack H

2016-08-01

The widespread adoption of prostate-specific antigen-based prostate cancer screening caused a stage migration toward earlier stage disease at diagnosis. We investigated whether this stage migration has persisted in a contemporary analysis of a population-based statewide cancer registry. We analyzed the Pennsylvania Cancer Registry, a statewide registry of all newly diagnosed cancers. Data were collected on prostate cancers diagnosed between 1992 and 2012. We determined age-adjusted prostate cancer incidence and mortality rates, as well as the distribution of tumor stage (localized, regional, or metastatic) at diagnosis, and assessed for changes in these variables over time using joinpoint analysis. Between 1992 and 2012, 210,831 new cases of prostate cancer were diagnosed in Pennsylvania, and 33,948 men died of disease. Age-adjusted prostate cancer incidence rates, and specifically the incidence of localized disease, have decreased dramatically since 2007 to 2008. Due to the decreased diagnosis of localized disease, regional and metastatic tumors have made up a greater percentage of all prostate cancer diagnoses in recent years, despite a relatively stable incidence of these advanced stage tumors. Over the past 2 decades, age-adjusted prostate cancer incidence rates in Pennsylvania have decreased, primarily because of the decreased detection of early-stage disease. There has been a corresponding shift toward more advanced disease at diagnosis. These findings may be explained by the decreased use of prostate-specific antigen-based screening, among other factors. The 2012 United States Preventative Services Task Force recommendations against prostate cancer screening may exacerbate this concerning trend, potentially resulting in an increase in prostate cancer-specific mortality. Copyright © 2016 Elsevier Inc. All rights reserved.

Determining the satisfaction levels of the family members of patients with advanced-stage cancer.

PubMed

Ozcelik, Hanife; Cakmak, Deniz Ezgi; Fadiloglu, Cicek; Yildirim, Yasemin; Uslu, Ruchan

2015-06-01

The objective of our study was to determine the satisfaction levels of family members of patients with advanced-stage cancer. This descriptive study was conducted in the palliative care and medical oncology clinics of a university hospital in the province of Izmir between April of 2011 and January of 2012. The study sample consisted of a total of 145 family members, who were selected from among the family members of patients with advanced-stage cancer receiving palliative treatment. The study data were obtained using the Patient Description Form and Family Satisfaction Scale during face-to-face interviews with patients. Some 67% of patients were female and 33% male, 70% were married, 35% were high school graduates, and 34.5% were housewives. The average total family satisfaction score was 76.87 ± 1.14, and the average scores for the component variables were as follows: information giving 74.37 ± 1.28, availability of care 78.40 ± 1.17, physical care 78.99 ± 1.09, and psychosocial care 74.52 ± 1.30. We found a relationship between the level of satisfaction of family members and (1) gender, (2) occupation, (3) presence of someone supporting the care, and (4) possession of sufficient information about the patient (p < 0.05). Satisfaction levels of participants were determined to be high. We found that family member satisfaction levels were affected by gender and occupation, the existence of someone supporting the care, and possession of sufficient information about the patient.

Irreversible electroporation of stage 3 locally advanced pancreatic cancer: optimal technique and outcomes

PubMed Central

2015-01-01

Objective Irreversible electroporation (IRE) of stage 3 pancreatic adenocarcinoma has been used to provide quality of life time in patients who have undergone appropriate induction therapy. The optimal technique has been reported within the literature, but not in video form. IRE of locally advanced pancreatic cancer is technically demanding requiring precision ultrasound use for continuous imaging in multiple needle placements and during IRE energy delivery. Methods Appropriate patients with locally advanced pancreatic cancer should have undergone appropriate induction chemotherapy for a reasonable duration. The safe and effective technique for irreversible electroporation is preformed through an open approach with the emphasis on intra-operative ultrasound and intra-operative electroporation management. Results The technique of open irreversible electroporation of the pancreas involves bracketing the target tumor with IRE probes and any and all invaded vital structures including the celiac axis, superior mesenteric artery (SMA), superior mesenteric-portal vein, and bile duct with continuous intraoperative ultrasound imaging through a caudal to cranial approach. Optimal IRE delivery requires a change in amperage of at least 12 amps from baseline tissue conductivity in order to achieve technical success. Multiple pull-backs are necessary since the IRE ablation probe lengths are 1 cm and thus needed to achieve technical success along the caudal to cranial plane. Conclusions Irreversible electroporation in combination with multi-modality therapy for locally advanced pancreatic carcinoma is feasible for appropriate patients with locally advanced cancer. Technical demands are high and require the highest quality ultrasound for precise spacing measurements and optimal delivery to ensure adequate change in tissue resistance. PMID:29075594

A heartrending burden of gynaecological cancers in advance stage at nuclear institute of medicine and radiotherapy Jamshoro Sindh

PubMed Central

Bibi, Seema; Ashfaque, Sanober; Laghari, Naeem Ahmed

2016-01-01

Objectives: In Pakistan gynaecological cancers are among the leading causes of women’s morbidity and mortality posing huge financial burden on families, communities and state. Due to lack of national cancer registry exact facts and figures are unknown therefore this study was planned to find out prevalence, age, site and stage of presentation of gynaecological cancers at Nuclear Institute of Medicine and Radiotherapy (NIMRA), Jamshoro. Methods: A retrospective, cross sectional study was conducted from 1st January 2011 to 31st December 2011 at NIMRA Jamshoro. All cases of genital tract cancers were evaluated, required data was entered on predesigned performa and results were analyzed manually. Results: Out of 2401 total registered cancer cases, 231 (9.6%) patients were suffering from gynaecological cancer making it third most common cancer. Ovary was commonest site followed by cervix and uterus. More than 60% cases presented in advanced stage, mostly during 4th and 5th decade of life. Conclusion: Gynecological cancer was among top three cancers at one of the busiest public sector cancer institute in Sindh province and significant number presented in advance stage making treatment difficult and expensive. There is urgent need for development and implementation of an effective health policy regarding cancer prevention and treatment. PMID:27022358

Development of an Interactive Shoreline Management Tool for the Lower Wood River Valley, Oregon - Phase I: Stage-Volume and Stage-Area Relations

USGS Publications Warehouse

Haluska, Tana L.; Snyder, Daniel T.

2007-01-01

This report presents the parcel and inundation area geographic information system (GIS) layers for various surface-water stages. It also presents data tables containing the water stage, inundation area, and water volume relations developed from analysis of detailed land surface elevation derived from Light Detection and Ranging (LiDAR) data recently collected for the Wood River Valley at the northern margin of Agency Lake in Klamath County, Oregon. Former shoreline wetlands that have been cut off from Upper Klamath and Agency Lakes by dikes might in the future be reconnected to Upper Klamath and Agency Lakes by breaching the dikes. Issues of interest associated with restoring wetlands in this way include the area that will be inundated, the volume of water that may be stored, the change in wetland habitat, and the variation in these characteristics as surface-water stage is changed. Products from this analysis can assist water managers in assessing the effect of breaching dikes and changing surface-water stage. The study area is in the approximate former northern margins of Upper Klamath and Agency Lakes in the Wood River Valley.

The J-2X Upper Stage Engine: From Design to Hardware

NASA Technical Reports Server (NTRS)

Byrd, Thomas

2010-01-01

NASA is well on its way toward developing a new generation of launch vehicles to support of national space policy to retire the Space Shuttle fleet, complete the International Space Station, and return to the Moon as the first step in resuming this nation s exploration of deep space. The Constellation Program is developing the launch vehicles, spacecraft, surface systems, and ground systems to support those plans. Two launch vehicles will support those ambitious plans the Ares I and Ares V. (Figure 1) The J-2X Upper Stage Engine is a critical element of both of these new launchers. This paper will provide an overview of the J-2X design background, progress to date in design, testing, and manufacturing. The Ares I crew launch vehicle will lift the Orion crew exploration vehicle and up to four astronauts into low Earth orbit (LEO) to rendezvous with the space station or the first leg of mission to the Moon. The Ares V cargo launch vehicle is designed to lift a lunar lander into Earth orbit where it will be docked with the Orion spacecraft, and provide the thrust for the trans-lunar journey. While these vehicles bear some visual resemblance to the 1960s-era Saturn vehicles that carried astronauts to the Moon, the Ares vehicles are designed to carry more crew and more cargo to more places to carry out more ambitious tasks than the vehicles they succeed. The government/industry team designing the Ares rockets is mining a rich history of technology and expertise from the Shuttle, Saturn and other programs and seeking commonality where feasible between the Ares crew and cargo rockets as a way to minimize risk, shorten development times, and live within the budget constraints of its original guidance.

ranibizumab in the management of advanced Coats disease Stages 3B and 4: long-term outcomes.

PubMed

Gaillard, Marie-Claire; Mataftsi, Assimina; Balmer, Aubin; Houghton, Susan; Munier, Francis L

2014-11-01

Laser photocoagulation and cryotherapy to completely destroy telangiectatic vessels and ischemic retina in Coats disease is barely applicable in advanced cases with total retinal detachment, and globe survival is notoriously poor in Stages 3B and 4. Anti-vascular endothelial growth factor intravitreal injections may offer new prospects for these patients. This study is a retrospective review of all consecutive patients with Coats disease treated with neoadjuvant or adjuvant intravitreal ranibizumab plus conventional and amblyopia treatment as appropriate. Nine patients (median age, 13 months) presenting Coats Stages 3B and 4 (5 and 4 eyes, respectively) were included. Iris neovascularization resolved within 2 weeks and retinal reapplication within 4 months in all patients. At last follow-up, globe survival was 100% with anatomical success in 8 of the 9 eyes. With a median follow-up of 50 months, fibrotic vitreoretinopathy was developed in 5 of the 9 cases, one leading to tractional retinal detachment and ultimately phthisis bulbi. The remaining 4 of the 9 eyes achieved some vision (range, 0.02-0.063). To the best of the authors' knowledge, this is the largest reported series of late-stage Coats undergoing anti-vascular endothelial growth factor therapy, a homogenous cohort of patients treated with a single agent and with the longest follow-up. This study supports the role of ranibizumab in advanced disease by transient restoration of the hemato-retinal barrier and suppression of neovascularization to facilitate classic treatment. At the last follow-up, the authors report unprecedented anatomical success and functional outcome.

Utility of palmatolepids and icriodontids in recognizing Upper Devonian Series, Stage, and possible substage boundaries

USGS Publications Warehouse

Ziegler, W.; Sandberg, C.A.

2000-01-01

Conodonts are accepted internationally to define Devonian Series and Stage boundaries. Hence, the evolution and taxonomy of pelagic palmatolepids, primarily Palmatolepis and its direct ancestor Mesotaxis, and shallow-water icriodontids, Icriodus, Pelekysgnathus, and "Icriodus", are the major tools for recognizing subdivisions of the Upper Devonian. Palmatolepids are the basis for the Late Devonian Standard Conodont Zonation (ZIEGLER & SANDBERG 1990), whereas icriodontids are the basis for the alternative, integrated shallow-water zonation (SANDBERG & DREESEN 1984). However, an alternative palmatolepid taxonomy for some Frasnian species has been employed recently by some conodont workers using the Montagne Noire (M.N.) zonation, shape analyses of Pa elements, and multielement reconstructions of KLAPPER (1989), KLAPPER & FOSTER (1993); and KLAPPER et al. (1996). Herein, the evolution of palmatolepids and icriodontids is summarized in terms of our zonation and some of the taxonomic differences with the alternative M.N. zonation are exemplified. One of the problems in relating the Standard and M.N. zonations arises from previous errors of interpretation and drafting of the Martenberg section in Germany. This section was designated the reference section for the Frasnian transitans through jamieae Zones by ZIEGLER & SANDBERG (1990). Herein, the early and middle Frasnian zonal boundaries at Martenberg are improved by re-study of our old and recent collections from three profiles, spaced only 4 m apart. Serious problems exist with the Global Stratotype Sections and Points (GSSP's), selected by the Subcommission on Devonian Stratigraphy, following the paleontologic definition of the bases of the Frasnian, Famennian, and Tournaisian Stages, because of the difficulty in making global correlations from these GSSP's. Our summary of these problems should be helpful if future workers decide to relocate these GSSP's.

Advanced Concept

NASA Image and Video Library

2008-03-15

A CONCEPT IMAGE SHOWS THE ARES I CREW LAUNCH VEHICLE DURING ASCENT. ARES I IS AN IN-LINE, TWO-STAGE ROCKET CONFIGURATION TOPED BY THE ORION CREW EXPLORATION VEHICLE AND LAUNCH ABORT SYSTEM. THE ARES I FIRST STAGE IS A SINGLE, FIVE-SEGMENT REUSABLE SOLID ROCKET BOOSTER, DERIVED FROM THE SPACE SHUTTLE. ITS UPPER STAGE IS POWERED BY A J-2X ENGINE. ARES I WILL CARRY THE ORION WITH ITS CRW OF UP TO SIX ASTRONAUTS TO EARTH ORBIT.

A Mechanism for Upper Airway Stability during Slow Wave Sleep

PubMed Central

McSharry, David G.; Saboisky, Julian P.; DeYoung, Pam; Matteis, Paul; Jordan, Amy S.; Trinder, John; Smales, Erik; Hess, Lauren; Guo, Mengshuang; Malhotra, Atul

2013-01-01

Study Objectives: The severity of obstructive sleep apnea is diminished (sometimes markedly) during slow wave sleep (SWS). We sought to understand why SWS stabilizes the upper airway. Increased single motor unit (SMU) activity of the major upper airway dilating muscle (genioglossus) should improve upper airway stability. Therefore, we hypothesized that genioglossus SMUs would increase their activity during SWS in comparison with Stage N2 sleep. Design: The activity of genioglossus SMUs was studied on both sides of the transition between Stage N2 sleep and SWS. Setting: Sleep laboratory. Participants: Twenty-nine subjects (age 38 ± 13 yr, 17 males) were studied. Intervention: SWS. Measurement and Results: Subjects slept overnight with fine-wire electrodes in their genioglossus muscles and with full polysomnographic and end tidal carbon dioxide monitors. Fifteen inspiratory phasic (IP) and 11 inspiratory tonic (IT) units were identified from seven subjects and these units exhibited significantly increased inspiratory discharge frequencies during SWS compared with Stage N2 sleep. The peak discharge frequency of the inspiratory units (IP and IT) was 22.7 ± 4.1 Hz in SWS versus 20.3 ± 4.5 Hz in Stage N2 (P < 0.001). The IP units also fired for a longer duration (expressed as a percentage of inspiratory time) during SWS (104.6 ± 39.5 %TI) versus Stage N2 sleep (82.6 ± 39.5 %TI, P < 0.001). The IT units fired faster during expiration in SWS (14.2 ± 1.8 Hz) versus Stage N2 sleep (12.6 ± 3.1 Hz, P = 0.035). There was minimal recruitment or derecruitment of units between SWS and Stage N2 sleep. Conclusion: Increased genioglossus SMU activity likely makes the airway more stable and resistant to collapse throughout the respiratory cycle during SWS. Citation: McSharry DG; Saboisky JP; DeYoung P; Matteis P; Jordan AS; Trinder J; Smales E; Hess L; Guo M; Malhotra A. A mechanism for upper airway stability during slow wave sleep. SLEEP 2013;36(4):555-563. PMID:23565001

Impact of variable river water stage on the simulation of groundwater-river interactions over the Upper Rhine Graben hydrosystem

NASA Astrophysics Data System (ADS)

Habets, F.; Vergnes, J.

2013-12-01

The Upper Rhine alluvial aquifer is an important transboundary water resource which is particularly vulnerable to pollution from the rivers due to anthropogenic activities. A realistic simulation of the groundwater-river exchanges is therefore of crucial importance for effective management of water resources, and hence is the main topic of the NAPROM project financed by the French Ministry of Ecology. Characterization of these fluxes in term of quantity and spatio-temporal variability depends on the choice made to represent the river water stage in the model. Recently, a couple surface-subsurface model has been applied to the whole aquifer basin. The river stage was first chosen to be constant over the major part of the basin for the computation of the groundwater-river interactions. The present study aims to introduce a variable river water stage to better simulate these interactions and to quantify the impact of this process over the simulated hydrological variables. The general modeling strategy is based on the Eau-Dyssée modeling platform which couples existing specialized models to address water resources and quality in regional scale river basins. In this study, Eau-Dyssée includes the RAPID river routing model and the SAM hydrogeological model. The input data consist in runoff and infiltration coming from a simulation of the ISBA land surface scheme covering the 1986-2003 period. The QtoZ module allows to calculate river stage from simulated river discharges, which is then used to calculate the exchanges between aquifer units and river. Two approaches are compared. The first one uses rating curves derived from observed river discharges and river stages. The second one is based on the Manning's formula. Manning's parameters are defined with geomorphological parametrizations and topographic data based on Digital Elevation Model (DEM). First results show a relatively good agreement between observed and simulated river water height. Taking into account a

Neodymium isotope evolution of NW Tethyan upper ocean waters throughout the Cretaceous

NASA Astrophysics Data System (ADS)

Pucéat, Emmanuelle; Lécuyer, Christophe; Reisberg, Laurie

2005-08-01

Neodymium isotope compositions of twenty-four fish teeth, nineteen from the NW Tethys and five from different locations within the Tethys, are interpreted to reflect the evolution of Tethyan upper ocean water composition during the Cretaceous and used to track changes in erosional inputs to the NW Tethys and in oceanic circulation throughout the Cretaceous. The rather high ɛNd (up to - 7.6) of the NW Tethyan upper ocean waters recorded from the Late Berriasian to the Early Aptian and the absence of negative excursions during this interval support the presence of a permanent westward flowing Tethys Circumglobal Current (TCC). This implies that temperature variations during this time period, inferred from the oxygen isotope analysis of fish tooth enamel, were not driven by changes in surface oceanic currents, but rather by global climatic changes. The results presented here represent a significant advance over previously published Cretaceous seawater Nd isotope records. Our newly acquired data now allow the identification of two stages of low ɛNd values in the NW Tethys, during the Early Albian-Middle Albian interval (down to - 10) and the Santonian-Early Campanian (down to - 11.4), which alternate with two stages of higher ɛNd values (up to - 9) during the Late Albian-Turonian interval and the Maastrichtian. Used in conjunction with the oxygen isotope record, the fluctuations of ɛNd values can be related to major climatic, oceanographic, and tectonic events that appeared in the western Tethyan domain.

Predictive models and prognostic factors for upper tract urothelial carcinoma: a comprehensive review of the literature.

PubMed

Mbeutcha, Aurélie; Mathieu, Romain; Rouprêt, Morgan; Gust, Kilian M; Briganti, Alberto; Karakiewicz, Pierre I; Shariat, Shahrokh F

2016-10-01

In the context of customized patient care for upper tract urothelial carcinoma (UTUC), decision-making could be facilitated by risk assessment and prediction tools. The aim of this study was to provide a critical overview of existing predictive models and to review emerging promising prognostic factors for UTUC. A literature search of articles published in English from January 2000 to June 2016 was performed using PubMed. Studies on risk group stratification models and predictive tools in UTUC were selected, together with studies on predictive factors and biomarkers associated with advanced-stage UTUC and oncological outcomes after surgery. Various predictive tools have been described for advanced-stage UTUC assessment, disease recurrence and cancer-specific survival (CSS). Most of these models are based on well-established prognostic factors such as tumor stage, grade and lymph node (LN) metastasis, but some also integrate newly described prognostic factors and biomarkers. These new prediction tools seem to reach a high level of accuracy, but they lack external validation and decision-making analysis. The combinations of patient-, pathology- and surgery-related factors together with novel biomarkers have led to promising predictive tools for oncological outcomes in UTUC. However, external validation of these predictive models is a prerequisite before their introduction into daily practice. New models predicting response to therapy are urgently needed to allow accurate and safe individualized management in this heterogeneous disease.

Staging of breast cancer and the advanced applications of digital mammogram: what the physician needs to know?

PubMed

Helal, Maha H; Mansour, Sahar M; Zaglol, Mai; Salaleldin, Lamia A; Nada, Omniya M; Haggag, Marwa A

2017-03-01

To study the role of advanced applications of digital mammogram, whether contrast-enhanced spectral mammography (CESM) or digital breast tomosynthesis (DBT), in the "T" staging of histologically proven breast cancer before planning for treatment management. In this prospective analysis, we evaluated 98 proved malignant breast masses regarding their size, multiplicity and the presence of associated clusters of microcalcifications. Evaluation methods included digital mammography (DM), 3D tomosynthesis and CESM. Traditional DM was first performed then in a period of 10-14-day interval; breast tomosynthesis and contrast-based mammography were performed for the involved breast only. Views at tomosynthesis were acquired in a "step-and-shoot" tube motion mode to produce multiple (11-15), low-dose images and in contrast-enhanced study, low-energy (22-33 kVp) and high-energy (44-49 kVp) exposures were taken after the i.v. injection of the contrast agent. Operative data were the gold standard reference. Breast tomosynthesis showed the highest accuracy in size assessment (n = 69, 70.4%) than contrast-enhanced (n = 49, 50%) and regular mammography (n = 59, 60.2%). Contrast-enhanced mammography presented the least performance in assessing calcifications, yet it was most sensitive in the detection of multiplicity (92.3%), followed by tomosynthesis (77%) and regular mammography (53.8%). The combined analysis of the three modalities provided an accuracy of 74% in the "T" staging of breast cancer. The combined application of tomosynthesis and contrast-enhanced digital mammogram enhanced the performance of the traditional DM and presented an informative method in the staging of breast cancer. Advances in knowledge: Staging and management planning of breast cancer can divert according to tumour size, multiplicity and the presence of microcalcifications. DBT shows sharp outlines of the tumour with no overlap tissue and spots microcalcifications. Contrast

Staging of breast cancer and the advanced applications of digital mammogram: what the physician needs to know?

PubMed Central

Helal, Maha H; Zaglol, Mai; Salaleldin, Lamia A; Nada, Omniya M; Haggag, Marwa A

2017-01-01

Objective: To study the role of advanced applications of digital mammogram, whether contrast-enhanced spectral mammography (CESM) or digital breast tomosynthesis (DBT), in the “T” staging of histologically proven breast cancer before planning for treatment management. Methods: In this prospective analysis, we evaluated 98 proved malignant breast masses regarding their size, multiplicity and the presence of associated clusters of microcalcifications. Evaluation methods included digital mammography (DM), 3D tomosynthesis and CESM. Traditional DM was first performed then in a period of 10–14-day interval; breast tomosynthesis and contrast-based mammography were performed for the involved breast only. Views at tomosynthesis were acquired in a “step-and-shoot” tube motion mode to produce multiple (11–15), low-dose images and in contrast-enhanced study, low-energy (22–33 kVp) and high-energy (44–49 kVp) exposures were taken after the i.v. injection of the contrast agent. Operative data were the gold standard reference. Results: Breast tomosynthesis showed the highest accuracy in size assessment (n = 69, 70.4%) than contrast-enhanced (n = 49, 50%) and regular mammography (n = 59, 60.2%). Contrast-enhanced mammography presented the least performance in assessing calcifications, yet it was most sensitive in the detection of multiplicity (92.3%), followed by tomosynthesis (77%) and regular mammography (53.8%). The combined analysis of the three modalities provided an accuracy of 74% in the “T” staging of breast cancer. Conclusion: The combined application of tomosynthesis and contrast-enhanced digital mammogram enhanced the performance of the traditional DM and presented an informative method in the staging of breast cancer. Advances in knowledge: Staging and management planning of breast cancer can divert according to tumour size, multiplicity and the presence of microcalcifications. DBT shows sharp outlines of the tumour with no overlap

GOES-S Atlas V Centaur Stage Transport from ASOC to DOC

NASA Image and Video Library

2018-01-24

Under the watchful eyes of technicians and engineers, the Centaur upper stage that will help launch NOAA's Geostationary Operational Environmental Satellite-S, or GOES-S, arrives inside the Delta Operations Center at Cape Canaveral Air Force Station for further processing. GOES-S is the second in a series of four advanced geostationary weather satellites. The GOES-R series - consisting of the GOES-R, GOES-S, GOES-T and GOES-U spacecraft - will significantly improve the detection and observation of environmental phenomena that directly affect public safety, protection of property and the nation's economic health and prosperity. GOES-S is slated to launch March 1, 2018 aboard a United Launch Alliance Atlas V rocket.

GOES-S Atlas V Centaur Stage Transport from ASOC to DOC

NASA Image and Video Library

2018-01-24

The Centaur upper stage that will help launch NOAA's Geostationary Operational Environmental Satellite-S, or GOES-S, is being transported from the Atlas Spaceflight Operations Center at Cape Canaveral Air Force Station to the Delta Operations Center for further processing. GOES-S is the second in a series of four advanced geostationary weather satellites. The GOES-R series - consisting of the GOES-R, GOES-S, GOES-T and GOES-U spacecraft - will significantly improve the detection and observation of environmental phenomena that directly affect public safety, protection of property and the nation's economic health and prosperity. GOES-S is slated to launch March 1, 2018 aboard a United Launch Alliance Atlas V rocket.

Comparison of Oral Contrast-Enhanced Transabdominal Ultrasound Imaging With Transverse Contrast-Enhanced Computed Tomography in Preoperative Tumor Staging of Advanced Gastric Carcinoma.

PubMed

He, Xuemei; Sun, Jing; Huang, Xiaoling; Zeng, Chun; Ge, Yinggang; Zhang, Jun; Wu, Jingxian

2017-12-01

This study assessed the diagnostic performance of transabdominal oral contrast-enhanced ultrasound (US) imaging for preoperative tumor staging of advanced gastric carcinoma by comparing it with transverse contrast-enhanced computed tomography (CT). This retrospective study included 42 patients with advanced gastric cancer who underwent laparoscopy, radical surgery, or palliative surgery because of serious complications and had a body mass index of less than 25 kg/m 2 . A cereal-based oral contrast agent was used for transabdominal oral contrast-enhanced US. Retrospective analyses were conducted using preoperative tumor staging data acquired by either transabdominal oral contrast-enhanced US or transverse contrast-enhanced CT. Both contrast-enhanced US and contrast-enhanced CT examinations were reviewed by 2 experienced radiologists independently for preoperative tumor staging according to the seventh edition of the TNM classification. The accuracy, sensitivity, and specificity were calculated by comparing the results of contrast-enhanced US and contrast-enhanced CT with pathologic findings. The overall accuracies of the imaging modalities were compared by the McNemar test. No significant difference was noted in the overall accuracy of transabdominal oral contrast-enhanced US (86% [36 of 42]) and transverse contrast-enhanced CT (83% [35 of 42] P > .999). For stage T2 to T4 gastric cancer, the accuracies of transabdominal oral contrast-enhanced US were 88%, 86%, and 98%, respectively, and those of transverse contrast-enhanced CT were 93%, 83%, and 90%. The overall accuracy of transabdominal oral contrast-enhanced US was comparable with that of transverse contrast-enhanced CT for preoperative tumor staging of advanced gastric cancer. © 2017 by the American Institute of Ultrasound in Medicine.

Does aggressive surgical resection improve survival in advanced stage 3 and 4 neuroblastoma? A systematic review and meta-analysis.

PubMed

Mullassery, Dhanya; Farrelly, Paul; Losty, Paul D

2014-11-01

The role of surgery in the management of advanced staged neuroblastoma (NBL) is controversial. A systematic review and meta-analysis is reported to address robust evidence for curative "gross total tumor resection" (GTR) in Stage 3 and Stage 4 neuroblastoma. Studies were identified using Medline, Embase, and Cochrane databases using pre-specified search terms. Primary outcomes were 5-year overall (OS) and disease-free survival (DFS) after GTR and subtotal resection (STR) in Stage 3 or 4 NBL. Data were analyzed using Review Manager. The Mantel-Haenszel method and a random effects model was utilized to calculate odds ratios (95% CI). Fifteen studies (five Stage 3 and 13 Stage 4) met full inclusion criteria. The pooled odds ratio for 5 year OS in Stage 3 following GTR compared to STR was 2.4 (95% CI 1.19-4.85). In Stage 4 disease, the pooled odds ratio for 5 year overall survival (OS) following GTR compared to STR was 1.65 (95% CI 0.96-1.91); a pooled odds ratio for 5 year DFS following GTR compared to STR was 1.55 (95% CI 1.12-2.14). A clear survival benefit is shown for GTR over STR in Stage 3 NBL only. Though some advantage can be demonstrated for GTR as defined by DFS in Stage 4 NBL GTR did not significantly improve OS in Stage 4 disease.

Acquired Hemochromatosis with Pronounced Pigment Deposition of the Upper Eyelids

PubMed Central

Morrison, Brian; Hu, Shasa

2013-01-01

Hemochromatosis may be classified into two groups: primary (hereditary) or secondary (acquired). The acquired type most commonly occurs after massive intake of iron supplements or blood transfusions and is also known as transfusional iron overload. In the past, hemochromatosis was usually recognized at an advanced stage by the classic triad of hyperpigmentation, diabetes mellitus (“bronze diabetes”), and hepatic cirrhosis. Cutaneous hyperpigmentation is present in 70 percent of patients due to two different mechanisms: (1) hemosiderin deposition resulting in diffuse, slate-gray darkening and (2) increased production of melanin in the epidermis. A 47-year-old woman who receives regular transfusions due to low iron and chronic, unresolving anemia and who subsequently developed pronounced hyperpigmentation of the upper eyelids is described. The presentation, diagnosis, pathogenesis, and treatment options of hyperpigmentation due to secondary hemochromatosis are discussed. PMID:24155994

[No interrupted surgical defects of the white upper lip: repair by a combined advancement and rotation flap in the lip subunit].

PubMed

Guillot, P

2013-01-01

A solid understanding of anatomy, basic surgical principles, and tissue movement is essential when undertaking the reconstruction of facial cutaneous surgical defects. Aesthetic facial reconstruction requires understanding ability to use the tissue adjacent to the defect to create a reconstruction that preserves the function of the area and the cosmetic facial units and subunits. The closure of non interrupted white upper lip defects by using a combined advancement and rotation flap is preferred for defects not overtaking 2.5 cm in diameter.

Interferon after surgery for women with advanced (Stage II-IV) epithelial ovarian cancer.

PubMed

Lawal, Aramide O; Musekiwa, Alfred; Grobler, Liesl

2013-06-06

Epithelial ovarian cancer (EOC) is a life-threatening disease. Most often women become symptomatic only in the advanced stages of the disease, increasing the difficulty of treatment. Whilst the disease responds well to surgery and chemotherapy, the relapse rate is high. New treatments to prevent disease recurrence or progression, prolong survival, and increase the quality of life are needed. To assess the effectiveness and safety of interferon after surgery in the treatment of advanced (stage II-IV) EOC. The Cochrane Gynaecological Cancer Review Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL) Issue 1, 2012, MEDLINE and EMBASE were searched to January 2012. Handsearching of conference proceedings was also undertaken. Reference lists of reviews and included trials were screened and experts in the field were contacted for additional trials. Clinical trials registers were searched for ongoing trials. Randomised controlled trials (RCTs) involving participants with advanced EOC that compared post-operative chemotherapy alone with post-operative interferon therapy in combination with chemotherapy or post-operative chemotherapy followed by interferon or observation alone Two review authors (AL and AM) independently screened the search results for relevant trials and extracted pre-specified information from each included trial. Data were managed using Review Manager 5.1. Hazard ratios (HR) were calculated for time-to-event outcomes and risk ratios (RR) for dichotomous outcomes, with corresponding 95% confidence intervals (CI). Five trials, including 1476 participants, were included in the review. Two trials compared interferon with observation alone and three trials compared interferon plus chemotherapy with chemotherapy alone. A meta-analysis of two trials involving 370 participants found no significant difference in both overall survival (HR 1.14, 95% CI 0.84 to 1.55) and progression free survival (HR 0.99, 95% CI 0.79 to 1.24) between

Progress on the J-2X Upper Stage Engine for the Ares I Crew Launch Vehicle and the Ares V Cargo Launch Vehicle

NASA Technical Reports Server (NTRS)

Byrd, Thomas D.; Kynard, Michael .

2007-01-01

NASA's Vision for Exploration requires a safe, reliable, affordable upper stage engine to power the Ares I Crew Launch Vehicle (CLV) and the Ares V Cargo Launch Vehicle. The J-2X engine is being developed for that purpose, epitomizing NASA's philosophy of employing legacy knowledge, heritage hardware, and commonality to carry the next generation of explorers into low-Earth orbit and out into the solar system This presentation gives top-level details on accomplishments to date and discusses forward work necessary to bring the J-2X engine to the launch pad.

Single stage, low noise, advanced technology fan. Volume 1: Aerodynamic design

NASA Technical Reports Server (NTRS)

Sullivan, T. J.; Younghans, J. L.; Little, D. R.

1976-01-01

The aerodynamic design for a half-scale fan vehicle, which would have application on an advanced transport aircraft, is described. The single stage advanced technology fan was designed to a pressure ratio of 1.8 at a tip speed of 503 m/sec 11,650 ft/sec). The fan and booster components are designed in a scale model flow size convenient for testing with existing facility and vehicle hardware. The design corrected flow per unit annulus area at the fan face is 215 kg/sec sq m (44.0 lb m/sec sq ft) with a hub-tip ratio of 0.38 at the leading edge of the fan rotor. This results in an inlet corrected airflow of 117.9 kg/sec (259.9 lb m/sec) for the selected rotor tip diameter if 90.37 cm (35.58 in.). The variable geometry inlet is designed utilizing a combination of high throat Mach number and acoustic treatment in the inlet diffuser for noise suppression (hybrid inlet). A variable fan exhaust nozzle was assumed in conjunction with the variable inlet throat area to limit the required area change of the inlet throat at approach and hence limit the overall diffusion and inlet length. The fan exit duct design was primarily influenced by acoustic requirements, including length of suppressor wall treatment; length, thickness and position on a duct splitter for additional suppressor treatment; and duct surface Mach numbers.

Mechanical design of a precision linear flexural stage for 3D x-ray diffraction microscope at the Advanced Photon Source

NASA Astrophysics Data System (ADS)

Shu, D.; Liu, W.; Kearney, S.; Anton, J.; Tischler, J. Z.

2015-09-01

The 3-D X-ray diffraction microscope is a new nondestructive tool for the three-dimensional characterization of mesoscopic materials structure. A flexural-pivot-based precision linear stage has been designed to perform a wire scan as a differential aperture for the 3-D diffraction microscope at the Advanced Photon Source, Argonne National Laboratory. The mechanical design and finite element analyses of the flexural stage, as well as its initial mechanical test results with laser interferometer are described in this paper.

Design and overall performance of four highly loaded, high speed inlet stages for an advanced high-pressure-ratio core compressor

NASA Technical Reports Server (NTRS)

Reid, L.; Moore, R. D.

1978-01-01

The detailed design and overall performances of four inlet stages for an advanced core compressor are presented. These four stages represent two levels of design total pressure ratio (1.82 and 2.05), two levels of rotor aspect ratio (1.19 and 1.63), and two levels of stator aspect ratio (1.26 and 1.78). The individual stages were tested over the stable operating flow range at 70, 90, and 100 percent of design speeds. The performances of the low aspect ratio configurations were substantially better than those of the high aspect ratio configurations. The two low aspect ratio configurations achieved peak efficiencies of 0.876 and 0.872 and corresponding stage efficiencies of 0.845 and 0.840. The high aspect ratio configurations achieved peak ratio efficiencies of 0.851 and 0.849 and corresponding stage efficiencies of 0.821 and 0.831.

Morphology of Upper and Lower Bainite with 0.7 Mass Pct C

NASA Astrophysics Data System (ADS)

Yin, Jiaqing; Hillert, Mats; Borgenstam, Annika

2017-09-01

There has been an on-going discussion on the difference in formation mechanisms of upper and lower bainite. Various suggestions have been supported by reference to observed morphologies and illustrated with idealized sketches of morphologies. In order to obtain a better basis for discussions about the difference in mechanism, the morphology of bainite in an Fe-C alloy with 0.7 mass pct carbon was now studied in some detail from 823 K to 548 K (550 °C to 275 °C) at temperature intervals of 50 K or less. The work focused on bainite seen to start from a grain boundary in the plane of polish and showing an advancing tip in the remaining austenite. The results indicate that there is no essential difference with temperature regarding the ferritic skeleton of feathery bainite. The second stage of bainite formation, which involves the formation of both ferrite and cementite, was regarded as a eutectoid transformation and the resulting morphologies were analyzed in terms of two modes, degenerate and cooperative eutectoid transformation. There was no sharp difference between upper and lower bainite. Ways to define the difference were discussed.

Upper Limits on Gravitational Waves from Scorpius X-1 from a Model-based Cross-correlation Search in Advanced LIGO Data

NASA Astrophysics Data System (ADS)

Abbott, B. P.; Abbott, R.; Abbott, T. D.; Acernese, F.; Ackley, K.; Adams, C.; Adams, T.; Addesso, P.; Adhikari, R. X.; Adya, V. B.; Affeldt, C.; Afrough, M.; Agarwal, B.; Agathos, M.; Agatsuma, K.; Aggarwal, N.; Aguiar, O. D.; Aiello, L.; Ain, A.; Ajith, P.; Allen, B.; Allen, G.; Allocca, A.; Altin, P. A.; Amato, A.; Ananyeva, A.; Anderson, S. B.; Anderson, W. G.; Antier, S.; Appert, S.; Arai, K.; Araya, M. C.; Areeda, J. S.; Arnaud, N.; Arun, K. G.; Ascenzi, S.; Ashton, G.; Ast, M.; Aston, S. M.; Astone, P.; Aufmuth, P.; Aulbert, C.; AultONeal, K.; Avila-Alvarez, A.; Babak, S.; Bacon, P.; Bader, M. K. M.; Bae, S.; Baker, P. T.; Baldaccini, F.; Ballardin, G.; Ballmer, S. W.; Banagiri, S.; Barayoga, J. C.; Barclay, S. E.; Barish, B. C.; Barker, D.; Barone, F.; Barr, B.; Barsotti, L.; Barsuglia, M.; Barta, D.; Bartlett, J.; Bartos, I.; Bassiri, R.; Basti, A.; Batch, J. C.; Baune, C.; Bawaj, M.; Bazzan, M.; Bécsy, B.; Beer, C.; Bejger, M.; Belahcene, I.; Bell, A. S.; Berger, B. K.; Bergmann, G.; Berry, C. P. L.; Bersanetti, D.; Bertolini, A.; Betzwieser, J.; Bhagwat, S.; Bhandare, R.; Bilenko, I. A.; Billingsley, G.; Billman, C. R.; Birch, J.; Birney, R.; Birnholtz, O.; Biscans, S.; Bisht, A.; Bitossi, M.; Biwer, C.; Bizouard, M. A.; Blackburn, J. K.; Blackman, J.; Blair, C. D.; Blair, D. G.; Blair, R. M.; Bloemen, S.; Bock, O.; Bode, N.; Boer, M.; Bogaert, G.; Bohe, A.; Bondu, F.; Bonnand, R.; Boom, B. A.; Bork, R.; Boschi, V.; Bose, S.; Bouffanais, Y.; Bozzi, A.; Bradaschia, C.; Brady, P. R.; Braginsky, V. B.; Branchesi, M.; Brau, J. E.; Briant, T.; Brillet, A.; Brinkmann, M.; Brisson, V.; Brockill, P.; Broida, J. E.; Brooks, A. F.; Brown, D. A.; Brown, D. D.; Brown, N. M.; Brunett, S.; Buchanan, C. C.; Buikema, A.; Bulik, T.; Bulten, H. J.; Buonanno, A.; Buskulic, D.; Buy, C.; Byer, R. L.; Cabero, M.; Cadonati, L.; Cagnoli, G.; Cahillane, C.; Calderón Bustillo, J.; Callister, T. A.; Calloni, E.; Camp, J. B.; Canepa, M.; Canizares, P.; Cannon, K. C.; Cao, H.; Cao, J.; Capano, C. D.; Capocasa, E.; Carbognani, F.; Caride, S.; Carney, M. F.; Casanueva Diaz, J.; Casentini, C.; Caudill, S.; Cavaglià, M.; Cavalier, F.; Cavalieri, R.; Cella, G.; Cepeda, C. B.; Cerboni Baiardi, L.; Cerretani, G.; Cesarini, E.; Chamberlin, S. J.; Chan, M.; Chao, S.; Charlton, P.; Chassande-Mottin, E.; Chatterjee, D.; Chatziioannou, K.; Cheeseboro, B. D.; Chen, H. Y.; Chen, Y.; Cheng, H.-P.; Chincarini, A.; Chiummo, A.; Chmiel, T.; Cho, H. S.; Cho, M.; Chow, J. H.; Christensen, N.; Chu, Q.; Chua, A. J. K.; Chua, S.; Chung, A. K. W.; Chung, S.; Ciani, G.; Ciolfi, R.; Cirelli, C. E.; Cirone, A.; Clara, F.; Clark, J. A.; Cleva, F.; Cocchieri, C.; Coccia, E.; Cohadon, P.-F.; Colla, A.; Collette, C. G.; Cominsky, L. R.; Constancio, M., Jr.; Conti, L.; Cooper, S. J.; Corban, P.; Corbitt, T. R.; Corley, K. R.; Cornish, N.; Corsi, A.; Cortese, S.; Costa, C. A.; Coughlin, M. W.; Coughlin, S. B.; Coulon, J.-P.; Countryman, S. T.; Couvares, P.; Covas, P. 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G.; Garufi, F.; Gaudio, S.; Gaur, G.; Gayathri, V.; Gehrels, N.; Gemme, G.; Genin, E.; Gennai, A.; George, D.; George, J.; Gergely, L.; Germain, V.; Ghonge, S.; Ghosh, Abhirup; Ghosh, Archisman; Ghosh, S.; Giaime, J. A.; Giardina, K. D.; Giazotto, A.; Gill, K.; Glover, L.; Goetz, E.; Goetz, R.; Gomes, S.; González, G.; Gonzalez Castro, J. M.; Gopakumar, A.; Gorodetsky, M. L.; Gossan, S. E.; Gosselin, M.; Gouaty, R.; Grado, A.; Graef, C.; Granata, M.; Grant, A.; Gras, S.; Gray, C.; Greco, G.; Green, A. C.; Groot, P.; Grote, H.; Grunewald, S.; Gruning, P.; Guidi, G. M.; Guo, X.; Gupta, A.; Gupta, M. K.; Gushwa, K. E.; Gustafson, E. K.; Gustafson, R.; Hall, B. R.; Hall, E. D.; Hammond, G.; Haney, M.; Hanke, M. M.; Hanks, J.; Hanna, C.; Hannuksela, O. A.; Hanson, J.; Hardwick, T.; Harms, J.; Harry, G. M.; Harry, I. W.; Hart, M. J.; Haster, C.-J.; Haughian, K.; Healy, J.; Heidmann, A.; Heintze, M. C.; Heitmann, H.; Hello, P.; Hemming, G.; Hendry, M.; Heng, I. S.; Hennig, J.; Henry, J.; Heptonstall, A. W.; Heurs, M.; Hild, S.; Hoak, D.; Hofman, D.; Holt, K.; Holz, D. E.; Hopkins, P.; Horst, C.; Hough, J.; Houston, E. A.; Howell, E. J.; Hu, Y. M.; Huerta, E. A.; Huet, D.; Hughey, B.; Husa, S.; Huttner, S. H.; Huynh-Dinh, T.; Indik, N.; Ingram, D. R.; Inta, R.; Intini, G.; Isa, H. N.; Isac, J.-M.; Isi, M.; Iyer, B. R.; Izumi, K.; Jacqmin, T.; Jani, K.; Jaranowski, P.; Jawahar, S.; Jiménez-Forteza, F.; Johnson, W. W.; Jones, D. I.; Jones, R.; Jonker, R. J. G.; Ju, L.; Junker, J.; Kalaghatgi, C. V.; Kalogera, V.; Kandhasamy, S.; Kang, G.; Kanner, J. B.; Karki, S.; Karvinen, K. S.; Kasprzack, M.; Katolik, M.; Katsavounidis, E.; Katzman, W.; Kaufer, S.; Kawabe, K.; Kéfélian, F.; Keitel, D.; Kemball, A. J.; Kennedy, R.; Kent, C.; Key, J. S.; Khalili, F. Y.; Khan, I.; Khan, S.; Khan, Z.; Khazanov, E. A.; Kijbunchoo, N.; Kim, Chunglee; Kim, J. C.; Kim, W.; Kim, W. S.; Kim, Y.-M.; Kimbrell, S. J.; King, E. J.; King, P. J.; Kirchhoff, R.; Kissel, J. S.; Kleybolte, L.; Klimenko, S.; Koch, P.; Koehlenbeck, S. M.; Koley, S.; Kondrashov, V.; Kontos, A.; Korobko, M.; Korth, W. Z.; Kowalska, I.; Kozak, D. B.; Krämer, C.; Kringel, V.; Krishnan, B.; Królak, A.; Kuehn, G.; Kumar, P.; Kumar, R.; Kumar, S.; Kuo, L.; Kutynia, A.; Kwang, S.; Lackey, B. D.; Lai, K. H.; Landry, M.; Lang, R. N.; Lange, J.; Lantz, B.; Lanza, R. K.; Lartaux-Vollard, A.; Lasky, P. D.; Laxen, M.; Lazzarini, A.; Lazzaro, C.; Leaci, P.; Leavey, S.; Lee, C. H.; Lee, H. K.; Lee, H. M.; Lee, H. W.; Lee, K.; Lehmann, J.; Lenon, A.; Leonardi, M.; Leroy, N.; Letendre, N.; Levin, Y.; Li, T. G. F.; Libson, A.; Littenberg, T. B.; Liu, J.; Lo, R. K. L.; Lockerbie, N. A.; London, L. T.; Lord, J. E.; Lorenzini, M.; Loriette, V.; Lormand, M.; Losurdo, G.; Lough, J. D.; Lousto, C. O.; Lovelace, G.; Lück, H.; Lumaca, D.; Lundgren, A. P.; Lynch, R.; Ma, Y.; Macfoy, S.; Machenschalk, B.; MacInnis, M.; Macleod, D. M.; Magaña Hernandez, I.; Magaña-Sandoval, F.; Magaña Zertuche, L.; Magee, R. M.; Majorana, E.; Maksimovic, I.; Man, N.; Mandic, V.; Mangano, V.; Mansell, G. L.; Manske, M.; Mantovani, M.; Marchesoni, F.; Marion, F.; Márka, S.; Márka, Z.; Markakis, C.; Markosyan, A. S.; Maros, E.; Martelli, F.; Martellini, L.; Martin, I. W.; Martynov, D. V.; Mason, K.; Masserot, A.; Massinger, T. J.; Masso-Reid, M.; Mastrogiovanni, S.; Matas, A.; Matichard, F.; Matone, L.; Mavalvala, N.; Mayani, R.; Mazumder, N.; McCarthy, R.; McClelland, D. E.; McCormick, S.; McCuller, L.; McGuire, S. C.; McIntyre, G.; McIver, J.; McManus, D. J.; McRae, T.; McWilliams, S. T.; Meacher, D.; Meadors, G. D.; Meidam, J.; Mejuto-Villa, E.; Melatos, A.; Mendell, G.; Mercer, R. A.; Merilh, E. L.; Merzougui, M.; Meshkov, S.; Messenger, C.; Messick, C.; Metzdorff, R.; Meyers, P. M.; Mezzani, F.; Miao, H.; Michel, C.; Middleton, H.; Mikhailov, E. E.; Milano, L.; Miller, A. L.; Miller, A.; Miller, B. B.; Miller, J.; Millhouse, M.; Minazzoli, O.; Minenkov, Y.; Ming, J.; Mishra, C.; Mitra, S.; Mitrofanov, V. P.; Mitselmakher, G.; Mittleman, R.; Moggi, A.; Mohan, M.; Mohapatra, S. R. P.; Montani, M.; Moore, B. C.; Moore, C. J.; Moraru, D.; Moreno, G.; Morriss, S. R.; Mours, B.; Mow-Lowry, C. M.; Mueller, G.; Muir, A. W.; Mukherjee, Arunava; Mukherjee, D.; Mukherjee, S.; Mukund, N.; Mullavey, A.; Munch, J.; Muniz, E. A. M.; Murray, P. G.; Napier, K.; Nardecchia, I.; Naticchioni, L.; Nayak, R. K.; Nelemans, G.; Nelson, T. J. N.; Neri, M.; Nery, M.; Neunzert, A.; Newport, J. M.; Newton, G.; Ng, K. K. Y.; Nguyen, T. T.; Nichols, D.; Nielsen, A. B.; Nissanke, S.; Nitz, A.; Noack, A.; Nocera, F.; Nolting, D.; Normandin, M. E. N.; Nuttall, L. K.; Oberling, J.; Ochsner, E.; Oelker, E.; Ogin, G. H.; Oh, J. J.; Oh, S. H.; Ohme, F.; Oliver, M.; Oppermann, P.; Oram, Richard J.; O'Reilly, B.; Ormiston, R.; Ortega, L. F.; O'Shaughnessy, R.; Ottaway, D. J.; Overmier, H.; Owen, B. J.; Pace, A. E.; Page, J.; Page, M. A.; Pai, A.; Pai, S. A.; Palamos, J. R.; Palashov, O.; Palomba, C.; Pal-Singh, A.; Pan, H.; Pang, B.; Pang, P. T. H.; Pankow, C.; Pannarale, F.; Pant, B. C.; Paoletti, F.; Paoli, A.; Papa, M. A.; Paris, H. R.; Parker, W.; Pascucci, D.; Pasqualetti, A.; Passaquieti, R.; Passuello, D.; Patricelli, B.; Pearlstone, B. L.; Pedraza, M.; Pedurand, R.; Pekowsky, L.; Pele, A.; Penn, S.; Perez, C. J.; Perreca, A.; Perri, L. M.; Pfeiffer, H. P.; Phelps, M.; Piccinni, O. J.; Pichot, M.; Piergiovanni, F.; Pierro, V.; Pillant, G.; Pinard, L.; Pinto, I. M.; Pitkin, M.; Poggiani, R.; Popolizio, P.; Porter, E. K.; Post, A.; Powell, J.; Prasad, J.; Pratt, J. W. W.; Predoi, V.; Prestegard, T.; Prijatelj, M.; Principe, M.; Privitera, S.; Prix, R.; Prodi, G. A.; Prokhorov, L. G.; Puncken, O.; Punturo, M.; Puppo, P.; Pürrer, M.; Qi, H.; Qin, J.; Qiu, S.; Quetschke, V.; Quintero, E. A.; Quitzow-James, R.; Raab, F. J.; Rabeling, D. S.; Radkins, H.; Raffai, P.; Raja, S.; Rajan, C.; Rakhmanov, M.; Ramirez, K. E.; Rapagnani, P.; Raymond, V.; Razzano, M.; Read, J.; Regimbau, T.; Rei, L.; Reid, S.; Reitze, D. H.; Rew, H.; Reyes, S. D.; Ricci, F.; Ricker, P. M.; Rieger, S.; Riles, K.; Rizzo, M.; Robertson, N. A.; Robie, R.; Robinet, F.; Rocchi, A.; Rolland, L.; Rollins, J. G.; Roma, V. J.; Romano, R.; Romel, C. L.; Romie, J. H.; Rosińska, D.; Ross, M. P.; Rowan, S.; Rüdiger, A.; Ruggi, P.; Ryan, K.; Rynge, M.; Sachdev, S.; Sadecki, T.; Sadeghian, L.; Sakellariadou, M.; Salconi, L.; Saleem, M.; Salemi, F.; Samajdar, A.; Sammut, L.; Sampson, L. M.; Sanchez, E. J.; Sandberg, V.; Sandeen, B.; Sanders, J. R.; Sassolas, B.; Sathyaprakash, B. S.; Saulson, P. R.; Sauter, O.; Savage, R. L.; Sawadsky, A.; Schale, P.; Scheuer, J.; Schmidt, E.; Schmidt, J.; Schmidt, P.; Schnabel, R.; Schofield, R. M. S.; Schönbeck, A.; Schönbeck, A.; Schreiber, E.; Schuette, D.; Schulte, B. W.; Schutz, B. F.; Schwalbe, S. G.; Scott, J.; Scott, S. M.; Seidel, E.; Sellers, D.; Sengupta, A. S.; Sentenac, D.; Sequino, V.; Sergeev, A.; Shaddock, D. A.; Shaffer, T. J.; Shah, A. A.; Shahriar, M. S.; Shao, L.; Shapiro, B.; Shawhan, P.; Sheperd, A.; Shoemaker, D. H.; Shoemaker, D. M.; Siellez, K.; Siemens, X.; Sieniawska, M.; Sigg, D.; Silva, A. D.; Singer, A.; Singer, L. P.; Singh, A.; Singh, R.; Singhal, A.; Sintes, A. M.; Slagmolen, B. J. J.; Smith, B.; Smith, J. R.; Smith, R. J. E.; Son, E. J.; Sonnenberg, J. A.; Sorazu, B.; Sorrentino, F.; Souradeep, T.; Spencer, A. P.; Srivastava, A. K.; Staley, A.; Steinke, M.; Steinlechner, J.; Steinlechner, S.; Steinmeyer, D.; Stephens, B. C.; Stone, R.; Strain, K. A.; Stratta, G.; Strigin, S. E.; Sturani, R.; Stuver, A. L.; Summerscales, T. Z.; Sun, L.; Sunil, S.; Sutton, P. J.; Swinkels, B. L.; Szczepańczyk, M. J.; Tacca, M.; Talukder, D.; Tanner, D. B.; Tápai, M.; Taracchini, A.; Taylor, J. A.; Taylor, R.; Theeg, T.; Thomas, E. G.; Thomas, M.; Thomas, P.; Thorne, K. A.; Thorne, K. S.; Thrane, E.; Tiwari, S.; Tiwari, V.; Tokmakov, K. V.; Toland, K.; Tonelli, M.; Tornasi, Z.; Torrie, C. I.; Töyrä, D.; Travasso, F.; Traylor, G.; Trifirò, D.; Trinastic, J.; Tringali, M. C.; Trozzo, L.; Tsang, K. W.; Tse, M.; Tso, R.; Tuyenbayev, D.; Ueno, K.; Ugolini, D.; Unnikrishnan, C. S.; Urban, A. L.; Usman, S. A.; Vahi, K.; Vahlbruch, H.; Vajente, G.; Valdes, G.; Vallisneri, M.; van Bakel, N.; van Beuzekom, M.; van den Brand, J. F. J.; Van Den Broeck, C.; Vander-Hyde, D. C.; van der Schaaf, L.; van Heijningen, J. V.; van Veggel, A. A.; Vardaro, M.; Varma, V.; Vass, S.; Vasúth, M.; Vecchio, A.; Vedovato, G.; Veitch, J.; Veitch, P. J.; Venkateswara, K.; Venugopalan, G.; Verkindt, D.; Vetrano, F.; Viceré, A.; Viets, A. D.; Vinciguerra, S.; Vine, D. J.; Vinet, J.-Y.; Vitale, S.; Vo, T.; Vocca, H.; Vorvick, C.; Voss, D. V.; Vousden, W. D.; Vyatchanin, S. P.; Wade, A. R.; Wade, L. E.; Wade, M.; Walet, R.; Walker, M.; Wallace, L.; Walsh, S.; Wang, G.; Wang, H.; Wang, J. Z.; Wang, M.; Wang, Y.-F.; Wang, Y.; Ward, R. L.; Warner, J.; Was, M.; Watchi, J.; Weaver, B.; Wei, L.-W.; Weinert, M.; Weinstein, A. J.; Weiss, R.; Wen, L.; Wessel, E. K.; Wessels, P.; Westphal, T.; Wette, K.; Whelan, J. T.; Whiting, B. F.; Whittle, C.; Williams, D.; Williams, R. D.; Williamson, A. R.; Willis, J. L.; Willke, B.; Wimmer, M. H.; Winkler, W.; Wipf, C. C.; Wittel, H.; Woan, G.; Woehler, J.; Wofford, J.; Wong, K. W. K.; Worden, J.; Wright, J. L.; Wu, D. S.; Wu, G.; Yam, W.; Yamamoto, H.; Yancey, C. C.; Yap, M. J.; Yu, Hang; Yu, Haocun; Yvert, M.; Zanolin, M.; Zelenova, T.; Zendri, J.-P.; Zevin, M.; Zhang, L.; Zhang, M.; Zhang, T.; Zhang, Y.-H.; Zhao, C.; Zhou, M.; Zhou, Z.; Zhu, X. J.; Zucker, M. E.; Zweizig, J.; LIGO Scientific Collaboration; Virgo Collaboration; Steeghs, D.; Wang, L.

2017-09-01

We present the results of a semicoherent search for continuous gravitational waves from the low-mass X-ray binary Scorpius X-1, using data from the first Advanced LIGO observing run. The search method uses details of the modeled, parametrized continuous signal to combine coherently data separated by less than a specified coherence time, which can be adjusted to trade off sensitivity against computational cost. A search was conducted over the frequency range 25-2000 {Hz}, spanning the current observationally constrained range of binary orbital parameters. No significant detection candidates were found, and frequency-dependent upper limits were set using a combination of sensitivity estimates and simulated signal injections. The most stringent upper limit was set at 175 {Hz}, with comparable limits set across the most sensitive frequency range from 100 to 200 {Hz}. At this frequency, the 95% upper limit on the signal amplitude h 0 is 2.3× {10}-25 marginalized over the unknown inclination angle of the neutron star’s spin, and 8.0× {10}-26 assuming the best orientation (which results in circularly polarized gravitational waves). These limits are a factor of 3-4 stronger than those set by other analyses of the same data, and a factor of ˜7 stronger than the best upper limits set using data from Initial LIGO science runs. In the vicinity of 100 {Hz}, the limits are a factor of between 1.2 and 3.5 above the predictions of the torque balance model, depending on the inclination angle; if the most likely inclination angle of 44° is assumed, they are within a factor of 1.7.

A mechanism for upper airway stability during slow wave sleep.

PubMed

McSharry, David G; Saboisky, Julian P; Deyoung, Pam; Matteis, Paul; Jordan, Amy S; Trinder, John; Smales, Erik; Hess, Lauren; Guo, Mengshuang; Malhotra, Atul

2013-04-01

The severity of obstructive sleep apnea is diminished (sometimes markedly) during slow wave sleep (SWS). We sought to understand why SWS stabilizes the upper airway. Increased single motor unit (SMU) activity of the major upper airway dilating muscle (genioglossus) should improve upper airway stability. Therefore, we hypothesized that genioglossus SMUs would increase their activity during SWS in comparison with Stage N2 sleep. The activity of genioglossus SMUs was studied on both sides of the transition between Stage N2 sleep and SWS. Sleep laboratory. Twenty-nine subjects (age 38 ± 13 yr, 17 males) were studied. SWS. Subjects slept overnight with fine-wire electrodes in their genioglossus muscles and with full polysomnographic and end tidal carbon dioxide monitors. Fifteen inspiratory phasic (IP) and 11 inspiratory tonic (IT) units were identified from seven subjects and these units exhibited significantly increased inspiratory discharge frequencies during SWS compared with Stage N2 sleep. The peak discharge frequency of the inspiratory units (IP and IT) was 22.7 ± 4.1 Hz in SWS versus 20.3 ± 4.5 Hz in Stage N2 (P < 0.001). The IP units also fired for a longer duration (expressed as a percentage of inspiratory time) during SWS (104.6 ± 39.5 %TI) versus Stage N2 sleep (82.6 ± 39.5 %TI, P < 0.001). The IT units fired faster during expiration in SWS (14.2 ± 1.8 Hz) versus Stage N2 sleep (12.6 ± 3.1 Hz, P = 0.035). There was minimal recruitment or derecruitment of units between SWS and Stage N2 sleep. Increased genioglossus SMU activity likely makes the airway more stable and resistant to collapse throughout the respiratory cycle during SWS.

Mid Holocene lake level and shoreline behavior during the Nipissing phase of the upper Great Lakes at Alpena, Michigan, USA

USGS Publications Warehouse

Thompson, T.A.; Lepper, K.; Endres, A.L.; Johnston, J.W.; Baedke, S.J.; Argyilan, E.P.; Booth, R.K.; Wilcox, D.A.

2011-01-01

The Nipissing phase was the last pre-modern high-water stage of the upper Great Lakes. Represented as either a one- or two-peak highstand, the Nipissing occurred following a long-term lake-level rise. This transgression was primarily an erosional event with only the final stage of the transgression preserved as barriers, spits, and strandplains of beach ridges. South of Alpena, Michigan, mid to late Holocene coastal deposits occur as a strandplain between Devils Lake and Lake Huron. The landward part of this strandplain is a higher elevation platform that formed during the final stage of lake-level rise to the Nipissing peak. The pre-Nipissing shoreline transgressed over Devils Lake lagoonal deposits from 6.4 to 6.1. ka. The first beach ridge formed ~ 6. ka, and then the shoreline advanced toward Lake Huron, producing beach ridges about every 70. years. This depositional regression produced a slightly thickening wedge of sediment during a lake-level rise that formed 20 beach ridges. The rise ended at 4.5. ka at the Nipissing peak. This peak was short-lived, as lake level fell > 4. m during the following 500. years. During this lake-level rise and subsequent fall, the shoreline underwent several forms of shoreline behavior, including erosional transgression, aggradation, depositional transgression, depositional regression, and forced regression. Other upper Great Lakes Nipissing platforms indicate that the lake-level change observed at Alpena of a rapid pre-Nipissing lake-level rise followed by a slower rise to the Nipissing peak, and a post-Nipissing rapid lake-level fall is representative of mid Holocene lake level in the upper Great Lakes. ?? 2011 Elsevier B.V.

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

PubMed

Rice, T W; Ishwaran, H; Hofstetter, W L; Kelsen, D P; Apperson-Hansen, C; Blackstone, E H

2016-11-01

We report analytic and consensus processes that produced recommendations for pathologic stage groups (pTNM) of esophageal and esophagogastric junction cancer for the AJCC/UICC cancer staging manuals, 8th edition. The Worldwide Esophageal Cancer Collaboration provided data for 22,654 patients with epithelial esophageal cancers; 13,300 without preoperative therapy had pathologic assessment after esophagectomy or endoscopic treatment. Risk-adjusted survival for each patient was developed using random survival forest analysis to identify data-driven pathologic stage groups wherein survival decreased monotonically with increasing group, was distinctive between groups, and homogeneous within groups. The AJCC Upper GI Task Force, by smoothing, simplifying, expanding, and assessing clinical applicability, produced consensus pathologic stage groups. For pT1-3N0M0 squamous cell carcinoma (SCC) and pT1-2N0M0 adenocarcinoma, pT was inadequate for grouping; subcategorizing pT1 and adding histologic grade enhanced staging; cancer location improved SCC staging. Consensus eliminated location for pT2N0M0 and pT3N0M0G1 SCC groups, and despite similar survival, restricted stage 0 to pTis, excluding pT1aN0M0G1. Metastases markedly reduced survival; pT, pN, and pM sufficiently grouped advanced cancers. Stage IIA and IIB had different compositions for SCC and adenocarcinoma, but similar survival. Consensus stage IV subgrouping acknowledged pT4N+ and pN3 cancers had poor survival, similar to pM1. Anatomic pathologic stage grouping, based on pTNM only, produced identical consensus stage groups for SCC and adenocarcinoma at the cost of homogeneity in early groups. Pathologic staging can neither direct pre-treatment decisions nor aid in prognostication for treatment other than esophagectomy or endoscopic therapy. However, it provides a clean, single therapy reference point for esophageal cancer. © 2016 International Society for Diseases of the Esophagus.

Bevacizumab, Carboplatin and Paclitaxel Combination Treatment in Advanced Stage Ovarian Cancer: The First Experience in Thammasat University Hospital, Thailand: A Case Report.

PubMed

Suwannarurk, Komsun; Thaweekul, Yudthadej; Mairaing, Karicha; Poomtavorn, Yenrudee; Tangtiang, Kaan; Piyawang, Wichet; Bhamarapravatana, Kornkarn

2015-04-01

Bevacizumab, a humanized monoclonal antibody targeting vascular endothelial growthfactor (VEGF), has been approvedfor concurrent treatment with first line chemotherapy in advanced epithelial ovarian cancer. A case of an advanced stage epithelial ovarian cancer (EOC) receiving a combination of bevacizumab, carboplatin andpaclitaxel chemotherapy was reported. A 44-year-old woman was presented with abdominal discomfort and distention for 4 months. Bilateral 12 cm diameter ovarian tumors were diagnosed as FIGO stage IIIc after surgical staging operation. Histopathology report showed the mixed type of serous and endometriod adenocarcinoma. The patient was then started on carboplatin/paclitaxel combination chemotherapy for 6 cycles after surgery every 3 weeks. Bevacizumab (7.5 mg/ m2) was concurrently administered with chemotherapy every 3 weeks startingfrom the 2nd cycle. A complete remission was achieved after the end of the chemotherapy treatment. Bevacizumab was continued for one year after the completion of the standard chemotherapy. Bone marrow suppression, hypertension and proteinuria were not found during Bevacizumab treatment. At bevacizumab treatment completion, a platinum-sensitive recurrent ovarian cancer was diagnosed at the two weeks postprogram routine check-up. The patient was counseled to start second line chemotherapy treatment and has yet to come back with her decision. Combination of bevacizumab, carboplatin and paclitaxelfor first line chemotherapy in advanced EOC in this case had no serious side effects and need further study.

High-volume ovarian cancer care: survival impact and disparities in access for advanced-stage disease.

PubMed

Bristow, Robert E; Chang, Jenny; Ziogas, Argyrios; Randall, Leslie M; Anton-Culver, Hoda

2014-02-01

To characterize the impact of hospital and physician ovarian cancer case volume on survival for advanced-stage disease and investigate socio-demographic variables associated with access to high-volume providers. Consecutive patients with stage IIIC/IV epithelial ovarian cancer (1/1/96-12/31/06) were identified from the California Cancer Registry. Disease-specific survival analysis was performed using Cox-proportional hazards model. Multivariate logistic regression analyses were used to evaluate for differences in access to high-volume hospitals (HVH) (≥20 cases/year), high-volume physicians (HVP) (≥10 cases/year), and cross-tabulations of high- or low-volume hospital (LVH) and physician (LVP) according to socio-demographic variables. A total of 11,865 patients were identified. The median ovarian cancer-specific survival for all patients was 28.2 months, and on multivariate analysis the HVH/HVP provider combination (HR = 1.00) was associated with superior ovarian cancer-specific survival compared to LVH/LVP (HR = 1.31, 95%CI = 1.16-1.49). Overall, 2119 patients (17.9%) were cared for at HVHs, and 1791 patients (15.1%) were treated by HVPs. Only 4.3% of patients received care from HVH/HVP, while 53.1% of patients were treated by LVH/LVP. Both race and socio-demographic characteristics were independently associated with an increased likelihood of being cared for by the LVH/LVP combination and included: Hispanic race (OR = 1.72, 95%CI = 1.22-2.42), Asian/Pacific Islander race (OR = 1.57, 95%CI = 1.07-2.32), Medicaid insurance (OR = 2.51, 95%CI = 1.46-4.30), and low socioeconomic status (OR = 2.84, 95%CI = 1.90-4.23). Among patients with advanced-stage ovarian cancer, the provider combination of HVH/HVP is an independent predictor of improved disease-specific survival. Access to high-volume ovarian cancer providers is limited, and barriers are more pronounced for patients with low socioeconomic status, Medicaid insurance, and racial minorities. Copyright © 2013

Staged Hard and Soft Tissue Reconstruction Followed by Implant Supported Restoration in the Aesthetic Zone: A Case Report.

PubMed

Parthasarathy, Harinath; Ramachandran, Lakshmi; Tadepalli, Anupama; Ponnaiyan, Deepa

2017-04-01

Alveolar ridge deficiency is a common clinical consequence following tooth loss due to chronic periodontitis complicating ideal implant placement. Advanced hard and soft tissue augmentation procedures have been developed in the recent past with predictable clinical outcomes. A male patient presented with a Grade III mobile upper right central incisor associated with advanced bone loss and soft tissue deficit. Following extraction of tooth #11, socket augmentation was done using an autogenous cortico-cancellous block graft and subsequent soft tissue augmentation was done with palatal connective tissue graft. At the end of six months, a tapered self tapping implant fixture was placed with adequate primary stability and after eight weeks, second stage implant surgery was done with the Misch technique in order to recreate papillae and the implant was prosthetically restored. The alveolar ridge was adequately recontoured following the staged surgical protocol. The implant was well integrated at the end of 15 months. Execution of sequential surgical procedures in a highly deficient edentulous site made it possible to achieve of optimal pink and white aesthetics with stable implant supported fixed prosthesis.

Increased AAA-TOB3 correlates with lymph node metastasis and advanced stage of lung adenocarcinoma.

PubMed

Liu, Yanfeng; Bu, Lina; Li, Wei; Wu, Wei; Wang, Shengyu; Diao, Xin; Zhou, Jing; Chen, Guoan; Yang, Shuanying

2017-07-24

This study was to investigate the differential mitochondrial protein expressions in human lung adenocarcinoma and provide preliminary data for further exploration of the carcinogenic mechanism. Total proteins of A549 and 16HBE mitochondria were extracted through 2D polyacrylamide gel electrophoresis (2-DE). The differential mitochondria proteins were identified by liquid chromatography-tandem mass spectrometry (LC-MS/MS) and were further confirmed by Western blot, immunoelectron microscopy and immunohistochemistry (IHC) in A549 cells as well as lung adenocarcinoma tissues. A total of 41 differentially expressed protein spots were found in A549 mitochondria. Of them, 15 proteins were highly expressed and 26 proteins were lowly expressed in the mitochondria of A549 (by more than 1.5 times). Among the 15 more highly expressed proteins, AAA-TOB3 (by more than 3 times) was highly expressed in the mitochondria of A549 compared with the 16HBE, by LC-MS/MS identification. High electron density and clear circular colloidal gold-marked AAA-TOB3 particles were observed in the A549 cells via immunoelectron microscopy. Besides, AAA-TOB3 was confirmed to be elevated in lung adenocarcinoma by Western blot and IHC. Moreover, increased AAA-TOB3 correlated with lymph node metastasis and advanced stage of lung adenocarcinoma (p<0.05). AAA-TOB3 was highly expressed in lung adenocarcinoma, and the up-regulation of AAA-TOB3 correlated with lymph node metastasis and advanced stage of lung adenocarcinoma, which suggested that it could serve as a potential molecular marker for lung adenocarcinoma.

Brief cognitive assessment of Alzheimer's disease in advanced stages: Proposal for a Brazilian version of the Short Battery for Severe Impairment (SIB-8).

PubMed

Wajman, José Roberto; Bertolucci, Paulo Henrique Ferreira

2013-01-01

The measurement of cognitive abilities of patients with severe dementia can serve a wide range of methodological and clinical needs. To validate a proposed severe impairment battery SIB-8 for a Brazilian population sample as part of the neuropsychological assessment of patients with Alzheimer's disease (AD) in advanced stages. After a systematic process of translation and back-translation, the SIB-8 was applied to 95 patients with AD at different stages; moderate, moderately severe and severe according to FAST subdivisions (5, 6 and 7), with scores on the Mini-Mental State Examination (MMSE) of between 5 and 15 and followed by the Division of Behavioral Neurology and the Center for Aging Brain of the Federal University of São Paulo - UNIFESP. Inferential data revealed that the SIB-8 instrument behaved differently at each stage of the disease with a statistical value of sensitivity p<0.001, gradually reflecting the expected course of the dementia, inherent with the decline of cognitive functions. Findings indicated that the SIB-8 is a useful tool for the evaluation and prospective comparison of AD patients in advanced stages, retaining its original characteristics in our population.

Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding: an update 2018.

PubMed

Sung, Joseph Jy; Chiu, Philip Cy; Chan, Francis K L; Lau, James Yw; Goh, Khean-Lee; Ho, Lawrence Hy; Jung, Hwoon-Young; Sollano, Jose D; Gotoda, Takuji; Reddy, Nageshwar; Singh, Rajvinder; Sugano, Kentaro; Wu, Kai-Chun; Wu, Chun-Yin; Bjorkman, David J; Jensen, Dennis M; Kuipers, Ernst J; Lanas, Angel

2018-04-24

Non-variceal upper gastrointestinal bleeding remains an important emergency condition, leading to significant morbidity and mortality. As endoscopic therapy is the 'gold standard' of management, treatment of these patients can be considered in three stages: pre-endoscopic treatment, endoscopic haemostasis and post-endoscopic management. Since publication of the Asia-Pacific consensus on non-variceal upper gastrointestinal bleeding (NVUGIB) 7 years ago, there have been significant advancements in the clinical management of patients in all three stages. These include pre-endoscopy risk stratification scores, blood and platelet transfusion, use of proton pump inhibitors; during endoscopy new haemostasis techniques (haemostatic powder spray and over-the-scope clips); and post-endoscopy management by second-look endoscopy and medication strategies. Emerging techniques, including capsule endoscopy and Doppler endoscopic probe in assessing adequacy of endoscopic therapy, and the pre-emptive use of angiographic embolisation, are attracting new attention. An emerging problem is the increasing use of dual antiplatelet agents and direct oral anticoagulants in patients with cardiac and cerebrovascular diseases. Guidelines on the discontinuation and then resumption of these agents in patients presenting with NVUGIB are very much needed. The Asia-Pacific Working Group examined recent evidence and recommends practical management guidelines in this updated consensus statement. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Advanced Concept

NASA Image and Video Library

2008-02-15

THIS IMAGE SHOWS THE DEVELOPMENT AND CONSTRUCTION OF THE A3 TEST STAND IN SUPPORT OF THE ARES/CLV UPPER STAGE ENGINE AT STENNIS SPACE CENTER, MISSISSIPPI. THIS IMAGE IS EXTRACTED FROM A HIGH DEFINITION VIDEO FILE AND IS THE HIGHEST RESOLUTION AVAILABLE.

Advances in upper limb stroke rehabilitation: a technology push.

PubMed

Loureiro, Rui C V; Harwin, William S; Nagai, Kiyoshi; Johnson, Michelle

2011-10-01

Strokes affect thousands of people worldwide leaving sufferers with severe disabilities affecting their daily activities. In recent years, new rehabilitation techniques have emerged such as constraint-induced therapy, biofeedback therapy and robot-aided therapy. In particular, robotic techniques allow precise recording of movements and application of forces to the affected limb, making it a valuable tool for motor rehabilitation. In addition, robot-aided therapy can utilise visual cues conveyed on a computer screen to convert repetitive movement practice into an engaging task such as a game. Visual cues can also be used to control the information sent to the patient about exercise performance and to potentially address psychosomatic variables influencing therapy. This paper overviews the current state-of-the-art on upper limb robot-mediated therapy with a focal point on the technical requirements of robotic therapy devices leading to the development of upper limb rehabilitation techniques that facilitate reach-to-touch, fine motor control, whole-arm movements and promote rehabilitation beyond hospital stay. The reviewed literature suggest that while there is evidence supporting the use of this technology to reduce functional impairment, besides the technological push, the challenge ahead lies on provision of effective assessment of outcome and modalities that have a stronger impact transferring functional gains into functional independence.

[Comparative analysis of TACE alone or plus RFA in the treatment of 167 cases of intermediate and advanced staged primary hepatocellular carcinoma].

PubMed

Zhao, Ming; Wang, Jian-peng; Wu, Pei-hong; Zhang, Fu-jun; Huang, Zi-lin; Li, Wang; Zhang, Liang; Pan, Chang-chuan; Li, Chuan-xing; Jiang, Yong

2010-11-09

To evaluate the clinical efficacy and survival rate of transarterial chemoembolization (TACE) alone or plus radiofrequency ablation (RFA) in patients with intermediate or advanced stage primary hepatocellular carcinoma (HCC). In this retrospective study, 467 cases received RFA or TACE plus RFA. Among them, 167 cases with strict clinical procedure (TACE alone or plus RFA) and complete follow-up data were included. Eighty-seven cases received TACE and 80 cases had TACE plus RFA between January 2000 and December 2006. Hierarchical analyses were performed using log-rank tests and survival curve was estimated by Kaplan-Meier method. A total of 167 patients received TACE alone or plus RFA for a follow-up period of 1 to 89 months. In the TACE alone group, the time-to-progression (TTP) was an average of 3.6 months. The median survival was 13 months, one-year survival rate 52.9%, three-year survival rate 11.5% and five-year survival rate 4.6%. In the TACE plus RFA group, the TTP time was an average of 10.8 months. The median survival time was 30 months, one-year survival rate 85.0%, three-year survival rate 45.0% and five-year survival rate 11.3%. In the TACE alone group, the median survival of intermediate stage HCC was 14 months, one-year survival rate 62.2%, three-year survival rate 13.3% and five-year survival rate 4.4%; In the TACE plus RFA group, the median survival of intermediate stage HCC was 14 months, one-year survival rate 90.1%, three-year survival rate 52.9% and five-year survival rate 13.7%. All differences of two groups has statistical significance (P < 0.05). In intermediate stage HCC, the median survival of TACE alone group was 14 months, one-year survival rate 62.2%, three-year survival rate 13.3%, five-year survival rate 4.4% versus 32 months, 90.1%, 52.9%, 13.7% in the TACE plus RFA group respectively. For the advanced stage HCC, the median survival time was 12 months, one-year survival rate 35%, three-year survival rate 7.1% and five-year survival rate

Solid propulsion advanced concepts

NASA Technical Reports Server (NTRS)

Nakamura, Y.; Shafer, J. I.

1972-01-01

The feasibility and application of a solid propulsion powered spacecraft concept to implement high energy missions independent of multiplanetary swingby opportunities are assessed and recommendations offered for future work. An upper stage, solid propulsion launch vehicle augmentation system was selected as the baseline configuration in view of the established program goals of low cost and high reliability. Spacecraft and propulsion system data that characterize mission performance capabilities were generated to serve as the basis for subsequent tradeoff studies. A cost effectiveness model was used for the preliminary feasibility assessment to provide a meaningful comparative effectiveness measure of the various candidate designs. The results substantiated the feasibility of the powered spacecraft concept when used in conjunction with several intermediate-sized launch vehicles as well as the existence of energy margins by which to exploit the attainment of extended mission capabilities. Additionally, in growth option applications, the employment of advanced propulsion systems and alternate spacecraft approaches appear promising.

Single stage, low noise, advanced technology fan. Volume 5: Fan acoustics. Section 1: Results and analysis

NASA Technical Reports Server (NTRS)

Jutras, R. R.

1976-01-01

The acoustic tests and data analysis for a 0.508-scale fan vehicle of a 111,300 newton (25,000 pound) thrust, full-size engine, which would have application on an advanced transport aircraft, is described. The single-stage advanced technology fan was designed to a pressure ratio of 1.8 at a tip speed of 503 m/sec (1,650 ft/sec) to achieve the desired pressure ratio in a single-stage fan with low radius ratio (0.38), and to maintain adequate stall margin. The fan has 44 tip-shrouded rotor blades and 90 outlet guide vanes. The two basic approaches taken in the acoustic design were: (1) minimization of noise at the source, and (2) suppression of the generated noise in the inlet and bypass exhaust duct. Suppression of the generated noise was accomplished in the inlet through use of the hybrid concept (wall acoustic treatment plus airflow acceleration suppression) and in the exhaust duct with extensive acoustic treatment including a splitter. The goal of the design was attainment of twenty effective perceived noise decibels (20 EPNdB) below current Federal Air Regulation noise standards for a full-scale fan at the takeoff, cutback, and approach conditions. The suppression goal of FAR 36-20 was not reached, but improvements in the technology of both front and aft fan-noise suppression were realized. The suppressed fan noise was shown to be consistent with the proposed federal regulation on aircraft noise.

Spacesuit Soft Upper Torso Sizing Systems

NASA Technical Reports Server (NTRS)

Graziosi, David; Splawn, Keith

2011-01-01

The passive sizing system consists of a series of low-profile pulleys attached to the front and back of the shoulder bearings on a spacesuit soft upper torso (SUT), textile cord or stainless steel cable, and a modified commercial ratchet mechanism. The cord/cable is routed through the pulleys and attached to the ratchet mechanism mounted on the front of the spacesuit within reach of the suited subject. Upon actuating the ratchet mechanism, the shoulder bearing breadth is changed, providing variable upper torso sizing. The active system consists of a series of pressurizable nastic cells embedded into the fabric layers of a spacesuit SUT. These cells are integrated to the front and back of the SUT and are connected to an air source with a variable regulator. When inflated, the nastic cells provide a change in the overall shoulder bearing breadth of the spacesuit and thus, torso sizing. The research focused on the development of a high-performance sizing and actuation system. This technology has application as a suit-sizing mechanism to allow easier suit entry and more accurate suit fit with fewer torso sizes than the existing EMU (Extravehicular Mobility Unit) suit system. This advanced SUT will support NASA s Advanced EMU Evolutionary Concept of a two-sizes-fit-all upper torso for replacement of the current EMU hard upper torso (HUT). Both the passive and nastic sizing system approaches provide astronauts with real-time upper torso sizing, which translates into a more comfortable suit, providing enhanced fit resulting in improved crewmember performance during extravehicular activity. These systems will also benefit NASA by reducing flight logistics as well as overall suit system cost. The nastic sizing system approach provides additional structural redundancy over existing SUT designs by embedding additional coated fabric and uncoated fabric layers. Two sizing systems were selected to build into a prototype SUT: one active and one passive. From manned testing, it

Upper-stage space shuttle propulsion by means of separate scramjet and rocket engines

NASA Technical Reports Server (NTRS)

Franciscus, L. C.; Allen, J. L.

1972-01-01

A preliminary mission study of a reusable vehicle from staging to orbit indicates payload advantages for a dual-propulsion system consisting of separate scramjet and rocket engines. In the analysis the scramjet operated continuously and the initiation of rocket operation was varied. For a stage weight of 500,000 lb the payload was 10.4 percent of stage weight or 70 percent greater than that of a comparable all-rocket-powered stage. When compared with a reusable two-state rocket vehicle having 50,000 lb payload, the use of the dual propulsion system for the second stage resulted in significant decreases in lift-off weight and empty weight, indicating possible lower hardware costs.

[Upper lateral incisor with 2 canals].

PubMed

Fabra Campos, H

1991-01-01

Clinical case summary of the patient with an upper lateral incisor with two root canals. The suspicion that there might be an anatomic anomaly in the root that includes a complex root canal system was made when an advanced radicular groove was detected in the lingual surface or an excessively enlarged cingulum.

"EXHALE": exercise as a strategy for rehabilitation in advanced stage lung cancer patients: a randomized clinical trial comparing the effects of 12 weeks supervised exercise intervention versus usual care for advanced stage lung cancer patients.

PubMed

Quist, Morten; Langer, Seppo W; Rørth, Mikael; Christensen, Karl Bang; Adamsen, Lis

2013-10-14

Lung cancer is the leading cause of cancer death in North America and Western Europe. Patients with lung cancer in general have reduced physical capacity, functional capacity, poor quality of life and increased levels of anxiety and depression. Intervention studies indicate that physical training can address these issues. However, there is a lack of decisive evidence regarding the effect of physical exercise in patients with advanced lung cancer. The aim of this study is to evaluate the effects of a twelve weeks, twice weekly program consisting of: supervised, structured training in a group of advanced lung cancer patients (cardiovascular and strength training, relaxation). A randomized controlled trial will test the effects of the exercise intervention in 216 patients with advanced lung cancer (non-small cell lung cancer (NSCLC) stage IIIb-IV and small cell lung cancer (SCLC) extensive disease (ED)). Primary outcome is maximal oxygen uptake (VO₂peak). Secondary outcomes are muscle strength (1RM), functional capacity (6MWD), lung capacity (Fev1) and patient reported outcome (including anxiety, depression (HADS) and quality of life (HRQOL)). The present randomized controlled study will provide data on the effectiveness of a supervised exercise intervention in patients receiving systemic therapy for advanced lung cancer. It is hoped that the intervention can improve physical capacity and functional level, during rehabilitation of cancer patients with complex symptom burden and help them to maintain independent function for as long as possible. http://ClinicalTrials.gov, NCT01881906.

Laparoscopic common hepatic artery ligation and staging followed by distal pancreatectomy with en bloc resection of celiac artery for advanced pancreatic cancer.

PubMed

Raut, V; Takaori, K; Kawaguchi, Y; Mizumoto, M; Kawaguchi, M; Koizumi, M; Kodama, S; Kida, A; Uemoto, S

2011-11-01

Adeno-carcinomas of pancreatic body are usually asymptomatic and progress to advanced stage with involvement of major arteries. Resection of advanced cancer along with en bloc resection of a common hepatic artery and celiac trunk enables a "curative" resections and only possible treatment. However, the celiac axis resection always has a risk of compromising blood supply to liver, resulting in the hepatic insufficiency. We evaluated practicability of a two-stage procedure for the advanced pancreases body cancer, laparoscopic clamping of a common hepatic artery followed by open distal pancreatectomy with en bloc celiac arterial resection to prevent the hepatic insufficiency. Seventy-five-year-old woman diagnosed with a 50-mm pancreatic body mass, invading splenic artery, common hepatic artery, splenic vein, and portal vein at the confluence. STAGE-1: At laparoscopy, after confirming absence of the peritoneal, superficial liver metastases and negative peritoneal cytology; we approached the common hepatic artery through the lesser sac and ligated. STAGE-2: Her liver function tests were normal after 2 weeks, and CT angiography showed complete blockage of the common hepatic artery with sufficient collateral circulation to the liver through inferior pancreatico-duodenal artery and gastro-duodenal artery. We performed an open distal pancreatectomy with en bloc resection of celiac artery. Histopathology examination confirmed R0 resection. The celiac axis resection with distal pancreatectomy improves the chance of R0 resection and potentially, survival of the patient. Preoperative laparoscopic ligation of the common hepatic artery is a safe, effective, and in-expensive technique to prevent postoperative hepatic insufficiency and improves the safety of en bloc celiac artery resection with a distal pancreatectomy. Also these patients have high risk of peritoneal dissemination. Diagnostic laparoscopy is useful to detect occult metastasis, which are missed by per-operative CT

Initial Misdiagnosis of Proximal Pancreatic Adenocarcinoma Is Associated with Delay in Diagnosis and Advanced Stage at Presentation.

PubMed

Swords, Douglas S; Mone, Mary C; Zhang, Chong; Presson, Angela P; Mulvihill, Sean J; Scaife, Courtney L

2015-10-01

Delay in diagnosis of pancreatic ductal adenocarcinoma (PDAC) is associated with decreased survival. The effect of an initial misdiagnosis on delay in diagnosis and stage of PDAC is unknown. This study is a retrospective review (2000-2010) from a University-based cancer center of new diagnoses of proximal PDAC. Of 313 patients, 98 (31.3 %) had an initial misdiagnosis. Misdiagnosed patients were younger, 62.8 ± 12.6 vs. 68.0 ± 10.1 (p < 0.001). The most common initial misdiagnoses were: gallbladder disease, gastroesophageal reflux disease, and peptic ulcer disease. After excluding patients with prior cholecystectomy, 14.2 % were misdiagnosed with gallbladder disease and underwent cholecystectomy before PDAC diagnosis. Misdiagnosed patients had higher rates of abdominal pain (p < 0.001), weight loss (p = 0.04), and acute pancreatitis (p < 0.001) and lower rate of jaundice (p < 0.001). Median time between symptoms to PDAC diagnosis was longer in misdiagnosed: 4.2 months vs. 1.4 (p < 0.001). Median time from contact with medical provider to axial imaging was longer in misdiagnosed (p < 0.001). Rate of stages III-IV disease at diagnosis was higher in misdiagnosed: 61.2 vs. 43.7 % (p = 0.004), with a 1.4 (95 % confidence interval (CI), 1.12-1.74) higher risk of stages III-IV disease at diagnosis; however, there was no difference in median overall survival in misdiagnosed patients (9.6 months in misdiagnosed vs. 10.3 months in correctly diagnosed, p = 0.69). Initial misdiagnosis of patients with proximal PDAC is associated with delay in diagnosis and higher risk of locally advanced or advanced disease at time of PDAC diagnosis.

Orion Stage Adapter Arrival

NASA Image and Video Library

2018-04-03

NASA's Super Guppy aircraft touches down at the Shuttle Landing Facility at the agency's Kennedy Space Center in Florida. The Super Guppy is carrying the Orion Stage Adapter (OSA), the second flight-hardware section of NASA's Space Launch System (SLS) rocket that has arrived at Kennedy. The OSA will connect the Orion spacecraft to the upper part of the SLS rocket, the interim cryogenic propulsion stage (ICPS). Both the OSA and ICPS are being stored for processing in the center's Space Station Processing Facility in preparation for Exploration Mission-1, the first uncrewed, integrated launch of the SLS rocket and Orion spacecraft.

Stage Separation Failure: Model Based Diagnostics and Prognostics

NASA Technical Reports Server (NTRS)

Luchinsky, Dmitry; Hafiychuk, Vasyl; Kulikov, Igor; Smelyanskiy, Vadim; Patterson-Hine, Ann; Hanson, John; Hill, Ashley

2010-01-01

Safety of the next-generation space flight vehicles requires development of an in-flight Failure Detection and Prognostic (FD&P) system. Development of such system is challenging task that involves analysis of many hard hitting engineering problems across the board. In this paper we report progress in the development of FD&P for the re-contact fault between upper stage nozzle and the inter-stage caused by the first stage and upper stage separation failure. A high-fidelity models and analytical estimations are applied to analyze the following sequence of events: (i) structural dynamics of the nozzle extension during the impact; (ii) structural stability of the deformed nozzle in the presence of the pressure and temperature loads induced by the hot gas flow during engine start up; and (iii) the fault induced thrust changes in the steady burning regime. The diagnostic is based on the measurements of the impact torque. The prognostic is based on the analysis of the correlation between the actuator signal and fault-induced changes in the nozzle structural stability and thrust.

Optimal debulking targets in women with advanced stage ovarian cancer: a retrospective study of immediate versus interval debulking surgery.

PubMed

Altman, Alon D; Nelson, Gregg; Chu, Pamela; Nation, Jill; Ghatage, Prafull

2012-06-01

The objective of this study was to examine both overall and disease-free survival of patients with advanced stage ovarian cancer after immediate or interval debulking surgery based on residual disease. We performed a retrospective chart review at the Tom Baker Cancer Centre in Calgary, Alberta of patients with pathologically confirmed stage III or IV ovarian cancer, fallopian tube cancer, or primary peritoneal cancer between 2003 and 2007. We collected data on the dates of diagnosis, recurrence, and death; cancer stage and grade, patients' age, surgery performed, and residual disease. One hundred ninety-two patients were included in the final analysis. The optimal debulking rate with immediate surgery was 64.8%, and with interval surgery it was 85.9%. There were improved overall and disease-free survival rates for optimally debulked disease (< 1 cm) with both immediate and interval surgery (P < 0.001) compared to suboptimally debulked disease. Overall survival rates for optimally debulked disease were not significantly different in patients having immediate and interval surgery (P = 0.25). In the immediate surgery group, patients with microscopic residual disease had better disease-free survival (P = 0.015) and overall survival (P = 0.005) than patients with < 1 cm residual disease. In patients who had interval surgery, those who had microscopic residual disease had more improved disease-free survival than those with < 1 cm disease (P = 0.05), but they did not have more improved overall survival (P = 0.42). Patients with microscopic residual disease who had immediate surgery had a significantly better overall survival rate than those who had interval surgery (P = 0.034). In women with advanced stage ovarian cancer, the goal of surgery should be resection of disease to microscopic residual at the initial procedure. This results in improved overall survival than lesser degrees of resection. Further studies are required to determine optimal surgical management.

Predictors of Timely Access of Oncology Services and Advanced-Stage Cancer in an HIV-Endemic Setting

PubMed Central

Suneja, Gita; Tapela, Neo; Mapes, Abigail; Pusoentsi, Malebogo; Mmalane, Mompati; Hodgeman, Ryan; Boyer, Matthew; Musimar, Zola; Ramogola-Masire, Doreen; Grover, Surbhi; Nsingo-Bvochora, Memory; Kayembe, Mukendi; Efstathiou, Jason; Lockman, Shahin; Dryden-Peterson, Scott

2016-01-01

Background. Three-quarters of cancer deaths occur in resource-limited countries, and delayed presentation contributes to poor outcome. In Botswana, where more than half of cancers arise in HIV-infected individuals, we sought to explore predictors of timely oncology care and evaluate the hypothesis that engagement in longitudinal HIV care improves access. Methods. Consenting patients presenting for oncology care from October 2010 to September 2014 were interviewed and their records were reviewed. Cox and logistic models were used to examine the effect of HIV and other predictors on time to oncology care and presentation with advanced cancer (stage III or IV). Results. Of the 1,146 patients analyzed, 584 (51%) had HIV and 615 (54%) had advanced cancer. The initial clinic visit occurred a mean of 144 days (median 29, interquartile range 0–185) after symptom onset, but subsequent mean time to oncology care was 406 days (median 160, interquartile range 59–653). HIV status was not significantly associated with time to oncology care (adjusted hazard ratio [aHR] 0.91, 95% confidence interval [CI] 0.79–1.06). However, patients who reported using traditional medicine/healers engaged in oncology care significantly faster (aHR 1.23, 95% CI 1.09–1.40) and those with advanced cancer entered care earlier (aHR 1.48, 95% CI 1.30–1.70). Factors significantly associated with advanced cancer included income <$50 per month (adjusted odds ratio [aOR] 1.35, 95% CI 1.05–1.75), male sex (aOR 1.45, 95% CI 1.12–1.87), and pain as the presenting symptom (aOR 1.39, 95% CI 1.03–1.88). Conclusion. Longitudinal HIV care did not reduce the substantial delay to cancer treatment. Research focused on reducing health system delay through coordination and navigation is needed. Implications for Practice: The majority (54%) of patients in this large cohort from Botswana presented with advanced-stage cancer despite universal access to free health care. Median time from first symptom to

Predictors of Timely Access of Oncology Services and Advanced-Stage Cancer in an HIV-Endemic Setting.

PubMed

Brown, Carolyn A; Suneja, Gita; Tapela, Neo; Mapes, Abigail; Pusoentsi, Malebogo; Mmalane, Mompati; Hodgeman, Ryan; Boyer, Matthew; Musimar, Zola; Ramogola-Masire, Doreen; Grover, Surbhi; Nsingo-Bvochora, Memory; Kayembe, Mukendi; Efstathiou, Jason; Lockman, Shahin; Dryden-Peterson, Scott

2016-06-01

Three-quarters of cancer deaths occur in resource-limited countries, and delayed presentation contributes to poor outcome. In Botswana, where more than half of cancers arise in HIV-infected individuals, we sought to explore predictors of timely oncology care and evaluate the hypothesis that engagement in longitudinal HIV care improves access. Consenting patients presenting for oncology care from October 2010 to September 2014 were interviewed and their records were reviewed. Cox and logistic models were used to examine the effect of HIV and other predictors on time to oncology care and presentation with advanced cancer (stage III or IV). Of the 1,146 patients analyzed, 584 (51%) had HIV and 615 (54%) had advanced cancer. The initial clinic visit occurred a mean of 144 days (median 29, interquartile range 0-185) after symptom onset, but subsequent mean time to oncology care was 406 days (median 160, interquartile range 59-653). HIV status was not significantly associated with time to oncology care (adjusted hazard ratio [aHR] 0.91, 95% confidence interval [CI] 0.79-1.06). However, patients who reported using traditional medicine/healers engaged in oncology care significantly faster (aHR 1.23, 95% CI 1.09-1.40) and those with advanced cancer entered care earlier (aHR 1.48, 95% CI 1.30-1.70). Factors significantly associated with advanced cancer included income <$50 per month (adjusted odds ratio [aOR] 1.35, 95% CI 1.05-1.75), male sex (aOR 1.45, 95% CI 1.12-1.87), and pain as the presenting symptom (aOR 1.39, 95% CI 1.03-1.88). Longitudinal HIV care did not reduce the substantial delay to cancer treatment. Research focused on reducing health system delay through coordination and navigation is needed. The majority (54%) of patients in this large cohort from Botswana presented with advanced-stage cancer despite universal access to free health care. Median time from first symptom to specialized oncology care was 13 months. For HIV-infected patients (51% of total

Validation of the Omron M3 Intellisense (HEM-7051-E) upper arm blood pressure monitor, for self-measurement, according to the European Society of Hypertension International Protocol revision 2010 in a stage 3-5 chronic kidney disease population.

PubMed

Akpolat, Tekin; Erdem, Emre; Aydogdu, Türkan

2012-01-01

Encouragement of home blood pressure (BP) monitoring has a great potential to improve hypertension control rates. The purpose of this study was to test validation of the Omron M3 Intellisense (HEM-7051-E) upper arm BP measuring monitor for self-measurement according to the European Society of Hypertension International Protocol revision 2010 (ESH-IP2) in stage 3-5 chronic kidney disease (CKD) patients. 66 patients having CKD stage 3-5 were included in the study. Nine consecutive measurements were made according to the ESH-IP2 protocol. The Omron M3 Intellisense device fulfills the validation criteria of the ESH-IP2 for stage 3-5 CKD patients. Although arterial stiffness can affect accurate BP measurement, there are limited data regarding the use of automated oscillometric devices in CKD. To our knowledge, this is the first study investigating validation of an oscillometric device in stage 3-5 predialysis CKD patients. This study validates the Omron M3 Intellisense upper arm device for stage 3-5 CKD patients. New validation studies investigating other oscillometric sphygmomanometers for CKD patients and involvement of nephrologists in these studies have great potential to increase patient care in CKD. Copyright © 2011 S. Karger AG, Basel.

Hydromechanical Advanced Coal Excavator

NASA Technical Reports Server (NTRS)

Estus, Jay M.; Summers, David

1990-01-01

Water-jet cutting reduces coal dust and its hazards. Advanced mining system utilizes full-face, hydromechanical, continuous miner. Coal excavator uses high-pressure water-jet lances, one in each of cutting heads and one in movable lance, to make cuts across top, bottom and middle height, respectively, of coal face. Wedge-shaped cutting heads advance into lower and upper cuts in turn, thereby breaking coal toward middle cut. Thrust cylinders and walking pads advance excavator toward coal face.

Enhanced liver fibrosis test using ELISA assay accurately discriminates advanced stage of liver fibrosis as determined by transient elastography fibroscan in treatment naïve chronic HCV patients.

PubMed

Omran, Dalia; Yosry, Ayman; Darweesh, Samar K; Nabeel, Mohammed M; El-Beshlawey, Mohammed; Saif, Sameh; Fared, Azza; Hassany, Mohamed; Zayed, Rania A

2018-02-01

Evaluation of liver fibrosis stage is crucial in the assessment of chronic HCV patients, regarding decision to start treatment and during follow-up. Our aim was to assess the validity of the enhanced liver fibrosis (ELF) score in discrimination of advanced stage of liver fibrosis in naïve chronic HCV patients. We prospectively evaluated liver fibrosis stage in one hundred eighty-one naïve chronic HCV Egyptian patients by transient elastography (TE)-FibroScan. Patients were categorized into mild to moderate fibrosis (≤F2) group and advanced fibrosis (≥F3) group. The ELF score components, hyaluronic acid (HA), amino-terminal propeptide of type-III-procollagen (PIIINP) and tissue inhibitor of metalloproteinase type-1 (TIMP-1), were done using ELISA test. The mean values of ELF and its individual components significantly correlated with the hepatic fibrosis stage as measured by TE-FibroScan (P value 0.001). ELF cutoff value of 9.8 generated a sensitivity of 77.8%, specificity of 67.1%, area under the receiver operator characteristic curve (AUROC) of 0.76 with 95% confidence interval [CI] (0.68-0.83) for detecting advanced fibrosis (F ≥ 3). ELF panel is a good, reliable noninvasive test and showed comparable results to TE-FibroScan in detecting liver fibrosis stage in treatment naïve chronic HCV patients.

der(11)t(11;17): a distinct cytogenetic pathway of advanced stage neuroblastoma (NBL) - detected by spectral karyotyping (SKY).

PubMed

Stark, Batia; Jeison, Marta; Glaser-Gabay, Leticia; Bar-Am, Irit; Mardoukh, Jacques; Ash, Shifra; Atias, Dina; Stein, Jerry; Zaizov, Rina; Yaniv, Isaac

2003-07-18

Conventional cytogenetic, molecular cytogenic and genetic methods disclosed a broad spectrum of genetic abnormalities leading to gain and loss of chromosomal segments in advanced stage neuroblastoma (NBL). Specific correlation between the genetic findings could delineate distinct genetic pathways, of which the biology and prognostic significance is as yet undetermined. Using spectral karyotyping (SKY) and fluorescence in situ hybridization (FISH) on metaphases from 16 patients with advanced stage NBL, it was possible to explore the whole spectrum of rearrangement within complex karyotypes and to detect hidden recurrent translocations. All translocations were unbalanced. The most prevalent recurrent unbalanced translocations resulted in 17q gain in 12 patients (75%), 11q loss in nine patients (56%), and 1p deletion/imbalance in eight patients (50%). The most frequent recurrent translocation was der(11)t(11;17) in six patients. Three cytogenetic pathways could be delineated. The first, with six patients, was characterized by the unbalanced translocation der(11)t(11;17), detected only by SKY, resulting in the concomitant 17q gain and 11q loss. No MYCN amplification or 1p deletion (except one patient with 1p imbalance) were found, while 3p deletion, and complex karyotypes were common. The second subgroup, with four patients, had 17q gain and 1p deletion, and in two patients 11q loss, that was apparent only by FISH. 1p deletion occurred through der(1)t(1;17) or del(1p). The third subgroup of four patients was characterized by MYCN amplification with 17q gain and 1p deletion, very rarely with 11q loss (one patient) through a translocation with a non-17q partner. The SKY subclassifications were in accordance with the findings reported by molecular genetic techniques, and may indicate that distinct oncogenes and suppressor genes are involved in the der(11)t(11;17) pathway of advanced stage NBL.

Biweekly irinotecan plus bolus 5-fluorouracil and folinic acid in patients with advanced stage colorectal cancer.

PubMed

Yalcin, Suayib; Oksuzoglu, Berna; Tekuzman, Gülten; Engin, Hüseyin; Celik, Ismail; Turker, Alev; Barista, Ibrahim; Gullu, Ibrahim; Guler, Nilufer; Altundag, Kadri; Ozisik, Yavuz; Kars, Ayse

2003-11-01

In this study, we evaluated the efficacy and tolerability of biweekly irinotecan (CPT-11) plus 5-fluorouracil (5-FU) and folinic acid (FA) regimen (IFL) in patients with advanced stage colorectal cancer. A total of 28 patients were examined. The median age was 51 years (range, 30-74 years). One treatment cycle consisted of CPT-11 180 mg/m(2) on days 1 and 15; 5-FU 425 mg/m(2) on days 1, 2, 15 and 16; and FA 20 mg/m(2) on days 1, 2, 15 and 16, every 4 weeks. A total of 119 cycles (median, 4.0 cycles) were administered. Of the 28 patients, 18 received the chemotherapy as first line treatment, seven received it as second line and three received it as third line. An overall objective response rate of 21.5% was achieved in the patient group. However, the overall response rate for the 18 patients receiving first line treatment was 27.7%. The median response duration was 10.5 months (range, 3-19 months). An additional 28.6% of the patients had stable disease for a median duration of 6.5 months (range, 3-8 months). Median time to disease progression was 4.5 months (range, 1-22+ months) and median overall survival time was 11+ months (95% confidence interval, 9-15 months). Toxicities were mild and manageable. We conclude that biweekly IFL is a practical and tolerable treatment option with a disease control rate of 50.1% in patients with advanced stage colorectal cancer.

An Updated Zero Boil-Off Cryogenic Propellant Storage Analysis Applied to Upper Stages or Depots in a LEO Environment

NASA Technical Reports Server (NTRS)

Plachta, David; Kittel, Peter

2003-01-01

Previous efforts have shown the analytical benefits of zero boil-off (ZBO) cryogenic propellant storage in launch vehicle upper stages of Mars transfer vehicles for conceptual Mars Missions. However, recent NASA mission investigations have looked at a different and broad array of missions, including a variety of orbit transfer vehicle (OTV) propulsion concepts, some requiring cryogenic storage. For many of the missions, this vehicle will remain for long periods (greater than one week) in low earth orbit (LEO), a relatively warm thermal environment. Under this environment, and with an array of tank sizes and propellants, the performance of a ZBO cryogenic storage system is predicted and compared with a traditional, passive-only storage concept. The results show mass savings over traditional, passive-only cryogenic storage when mission durations are less than one week in LEO for oxygen, two weeks for methane, and roughly 2 months for LH2. Cryogenic xenon saves mass over passive storage almost immediately.

Impact of upper airway abnormalities on the success and adherence to mandibular advancement device treatment in patients with Obstructive Sleep Apnea Syndrome.

PubMed

Prescinotto, Renato; Haddad, Fernanda Louise Martinho; Fukuchi, Ilana; Gregório, Luiz Carlos; Cunali, Paulo Afonso; Tufik, Sérgio; Bittencourt, Lia Rita Azeredo

2015-01-01

The mandibular advancement device (MAD) is a option to treat patients with Obstructive Sleep Apnea Syndrome (OSAS). To assess the influence of upper airway abnormalities on the success of and adherence to MAD in patients with OSAS. Prospective study with 30 patients with mild to moderate OSAS and indications for MAD. The protocol included questionnaires addressing sleep and nasal complaints, polysomnography, and upper airway assessment. The analyzed parameters of patients who showed therapeutic success and failure and those who exhibited good and poor treatment adherence were compared. 28 patients completed the protocol; 64.3% responded successfully to treatment with MAD, and 60.7% exhibited good adherence to treatment. Factors associated with greater success rates were younger age (p=0.02), smaller cervical circumference (p=0.05), and lower AHI at baseline (p=0.05). There was a predominance of patients without nasal abnormalities among patients treated successfully compared to those with treatment failure (p=0.04), which was not observed in relation to adherence. Neither pharyngeal nor facial skeletal abnormalities were significantly associated with either therapeutic success or adherence. MAD treatment success was significantly lower among patients with nasal abnormalities; however, treatment adherence was not influenced by the presence of upper airway or facial skeletal abnormalities. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Designing the Ares I Crew Launch Vehicle Upper Stage Element and Integrating the Stack at NASA's Marshall Space Flight Center

NASA Technical Reports Server (NTRS)

Lyles, Garry; Otte, Neil E.

2008-01-01

transportation system for missions to the International Space Station in the next decade and to explore the Moon and establish an outpost around the 2020 timeframe.4 Based on this extensive study, NASA selected the Ares I crew launch vehicle configuration and the heavy-lift Ares V cargo launch vehicle (fig 1). This paper will give an overview of NASA's approach to integrating the Ares I vehicle stack using capabilities and assets that are resident in Marshall's Engineering Directorate, working in partnership with other NASA Centers and the U.S. aerospace industry. It also will provide top-level details on the progress of the in-house design of the Ares I vehicle's upper stage element.

Three Orbital Burns to Molniya Orbit Via Shuttle_Centaur G Upper Stage

NASA Technical Reports Server (NTRS)

Williams, Craig H.

2015-01-01

An unclassified analytical trajectory design, performance, and mission study was done for the 1982 to 1986 joint National Aeronautics and Space Administration (NASA)-United States Air Force (USAF) Shuttle/Centaur G upper stage development program to send performance-demanding payloads to high orbits such as Molniya using an unconventional orbit transfer. This optimized three orbital burn transfer to Molniya orbit was compared to the then-baselined two burn transfer. The results of the three dimensional trajectory optimization performed include powered phase steering data and coast phase orbital element data. Time derivatives of the orbital elements as functions of thrust components were evaluated and used to explain the optimization's solution. Vehicle performance as a function of parking orbit inclination was given. Performance and orbital element data was provided for launch windows as functions of launch time. Ground track data was given for all burns and coasts including variation within the launch window. It was found that a Centaur with fully loaded propellant tanks could be flown from a 37 deg inclination low Earth parking orbit and achieve Molniya orbit with comparable performance to the baselined transfer which started from a 57 deg inclined orbit: 9,545 versus 9,552 lb of separated spacecraft weight, respectively. There was a significant reduction in the need for propellant launch time reserve for a 1 hr window: only 78 lb for the three burn transfer versus 320 lb for the two burn transfer. Conversely, this also meant that longer launch windows over more orbital revolutions could be done for the same amount of propellant reserve. There was no practical difference in ground tracking station or airborne assets needed to secure telemetric data, even though the geometric locations of the burns varied considerably. There was a significant adverse increase in total mission elapsed time for the three versus two burn transfer (12 vs. 1-1/4 hr), but could be

Three Orbital Burns to Molniya Orbit via Shuttle Centaur G Upper Stage

NASA Technical Reports Server (NTRS)

Williams, Craig H.

2014-01-01

An unclassified analytical trajectory design, performance, and mission study was done for the 1982-86 joint NASA-USAF Shuttle/Centaur G upper stage development program to send performance-demanding payloads to high orbits such as Molniya using an unconventional orbit transfer. This optimized three orbital burn transfer to Molniya orbit was compared to the then-baselined two burn transfer. The results of the three dimensional trajectory optimization performed include powered phase steering data and coast phase orbital element data. Time derivatives of the orbital elements as functions of thrust components were evaluated and used to explain the optimization's solution. Vehicle performance as a function of parking orbit inclination was given. Performance and orbital element data was provided for launch windows as functions of launch time. Ground track data was given for all burns and coasts including variation within the launch window. It was found that a Centaur with fully loaded propellant tanks could be flown from a 37deg inclination low Earth parking orbit and achieve Molniya orbit with comparable performance to the baselined transfer which started from a 57deg inclined orbit: 9,545 lb vs. 9,552 lb of separated spacecraft weight respectively. There was a significant reduction in the need for propellant launch time reserve for a one hour window: only 78 lb for the three burn transfer vs. 320 lb for the two burn transfer. Conversely, this also meant that longer launch windows over more orbital revolutions could be done for the same amount of propellant reserve. There was no practical difference in ground tracking station or airborne assets needed to secure telemetric data, even though the geometric locations of the burns varied considerably. There was a significant adverse increase in total mission elapsed time for the three vs. two burn transfer (12 vs. 11/4 hrs), but could be accommodated by modest modifications to Centaur systems. Future applications were

Space Technology Mission Directorate Game Changing Development Program FY2015 Annual Program Review: Advanced Manufacturing Technology

NASA Technical Reports Server (NTRS)

Vickers, John; Fikes, John

2015-01-01

The Advance Manufacturing Technology (AMT) Project supports multiple activities within the Administration's National Manufacturing Initiative. A key component of the Initiative is the Advanced Manufacturing National Program Office (AMNPO), which includes participation from all federal agencies involved in U.S. manufacturing. In support of the AMNPO the AMT Project supports building and Growing the National Network for Manufacturing Innovation through a public-private partnership designed to help the industrial community accelerate manufacturing innovation. Integration with other projects/programs and partnerships: STMD (Space Technology Mission Directorate), HEOMD, other Centers; Industry, Academia; OGA's (e.g., DOD, DOE, DOC, USDA, NASA, NSF); Office of Science and Technology Policy, NIST Advanced Manufacturing Program Office; Generate insight within NASA and cross-agency for technology development priorities and investments. Technology Infusion Plan: PC; Potential customer infusion (TDM, HEOMD, SMD, OGA, Industry); Leverage; Collaborate with other Agencies, Industry and Academia; NASA roadmap. Initiatives include: Advanced Near Net Shape Technology Integrally Stiffened Cylinder Process Development (launch vehicles, sounding rockets); Materials Genome; Low Cost Upper Stage-Class Propulsion; Additive Construction with Mobile Emplacement (ACME); National Center for Advanced Manufacturing.

Stage-directed individualized therapy in esophageal cancer.

PubMed

Goense, Lucas; van Rossum, Peter S N; Kandioler, Daniela; Ruurda, Jelle P; Goh, Khean-Lee; Luyer, Misha D; Krasna, Mark J; van Hillegersberg, Richard

2016-10-01

Esophageal cancer is the eighth most common cancer worldwide, and the incidence of esophageal carcinoma is rapidly increasing. With the advent of new staging and treatment techniques, esophageal cancer can now be managed through various strategies. A good understanding of the advances and limitations of new staging techniques and how these can guide in individualizing treatment is important to improve outcomes for esophageal cancer patients. This paper outlines the recent progress in staging and treatment of esophageal cancer, with particularly attention to endoscopic techniques for early-stage esophageal cancer, multimodality treatment for locally advanced esophageal cancer, assessment of response to neoadjuvant treatment, and the role of cervical lymph node dissection. Furthermore, advances in robot-assisted surgical techniques and postoperative recovery protocols that may further improve outcomes after esophagectomy are discussed. © 2016 The Authors. Annals of the New York Academy of Sciences published by Wiley Periodicals Inc. on behalf of The New York Academy of Sciences.

75 FR 81125 - Drawbridge Operation Regulation; Upper Mississippi River, Rock Island, IL

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-27

... Operation Regulation; Upper Mississippi River, Rock Island, IL AGENCY: Coast Guard, DHS. ACTION: Notice of... the Upper Mississippi River, mile 481.4, at Rock Island, Illinois. The deviation is necessary to allow... Rock Island, Illinois to open on signal if at least 24 hours advance notice is given for 44 days from...

Multidisciplinary management of very advanced stage III and IV melanoma: Proof-of-principle.

PubMed

Gutman, Haim; Ben-Ami, Eytan; Shapira-Frommer, Roni; Schachter, Jacob

2012-08-01

Patients with potentially resectable advanced stage III and IV melanoma are a selected subgroup that gain maximal advantage if treated in a melanoma center. Surgery combined with chemo/chemobiotherapy may yield durable remission and long-term palliation. Thirty-seven non-randomly selected patients underwent systemic therapy with the aim of consolidating treatment by surgery. Data were collected prospectively, and analyzed retrospectively. The median follow-up from diagnosis was 50 (3-307) months and 15 (1-156) months when calculated from the last intervention. Twenty-two males and 15 females, with a median age at diagnosis of 44 (20-71) years, with 13 trunk, 13 extremity, 3 head and neck and 8 unknown primary melanomas were included. There were 17 stage III and 20 stage IV patients with a median Breslow thickness of 3.7 (0.45-26) mm. Chemo/chemobiotherapy achieved 7 clinical complete responses (cCRs), 28 partial responses (PRs) and 2 instances of stable disease. Six of the 7 cCRs were operated on, securing pathological complete response in 5 and PR in one. Four of these five and the PR patient still have no evidence of disease (NED). Twenty-one of 30 PR patients were rendered NED by surgery; 14 of these 21 patients succumbed to melanoma, and one is alive with stable disease. Overall, 11 of 37 patients have not succumbed to melanoma, with a median of 72 (14-156) months survival following the last intervention. Of the eight patients with unknown primary melanomas, five have not succumbed to melanoma, with a median of 89 (30-156) months survival following the last intervention. Patients with marginally resectable stage III and IV melanoma have a significant 30% chance, according to this series, for durable remission if treated by a multidisciplinary team in a melanoma center using induction chemobiotherapy and surgery. Results are more favorable for patients with an unknown primary lesion. In view of the currently approved new effective treatments for melanoma, this

Evaluation of the dosimetric impact of applying flattening filter-free beams in intensity-modulated radiotherapy for early-stage upper thoracic carcinoma of oesophagus

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, Wuzhe; Lin, Zhixiong; Yang, Zhining

2015-06-15

Flattening filter-free (FFF) radiation beams have recently become clinically available on modern linear accelerators in radiation therapy. This study aimed to evaluate the dosimetric impact of using FFF beams in intensity-modulated radiotherapy (IMRT) for early-stage upper thoracic oesophageal cancer. Eleven patients with primary stage upper thoracic oesophageal cancer were recruited. For each patient, two IMRT plans were computed using conventional beams (Con-P) and FFF beams (FFF-P), respectively. Both plans employed a five-beam arrangement and were prescribed with 64 Gy to (planning target volume) PTV1 and 54 Gy to PTV2 in 32 fractions using 6 MV photons. The dose parameters ofmore » the target volumes and organs at risks (OARs), and treatment parameters including the monitor units (MU) and treatment time (TT) for Con-P and FFF-P were recorded and compared. The mean D{sub 5} of PTV1 and PTV2 were higher in FFF-P than Con-P by 0.4 Gy and 0.3 Gy, respectively. For the OARs, all the dose parameters did not show significant difference between the two plans except the mean V{sub 5} and V{sub 10} of the lung in which the FFF-P was lower (46.7% vs. 47.3% and 39.1% vs. 39.6%, respectively). FFF-P required 54% more MU but 18.4% less irradiation time when compared to Con-P. The target volume and OARs dose distributions between the two plans were comparable. However, FFF-P was more effective in sparing the lung from low dose and reduced the mean TT compared with Con-P. Long-term clinical studies are suggested to evaluate the radiobiological effects of FFF beams.« less

Tissue expansion in the treatment of giant congenital melanocytic nevi of the upper extremity

PubMed Central

Ma, Tengxiao; Fan, Ke; Li, Lei; Xie, Feng; Li, Hao; Chou, Haiyan; Zhang, Zhengwen

2017-01-01

Abstract The aim of our study was to use tissue expansion for the treatment of giant congenital melanocytic nevi of the upper extremity and examine potential advantages over traditional techniques. There were 3 stages in the treatment of giant congenital melanocytic nevi of the upper extremities using tissue expansion: first, the expander was inserted into the subcutaneous pocket; second, the expander was removed, lesions were excised, and the wound of the upper extremity was placed into the pocket to delay healing; third, the residual lesion was excised and the pedicle was removed. The pedicle flap was then unfolded to resurface the wound. During the period between June 2007 and December 2015, there were 11 patients with giant congenital melanocytic nevi of the upper extremities who underwent reconstruction at our department with skin expansion. Few complications were noted in each stage of treatment. The functional and aesthetic results were observed and discussed in this study. Optimal aesthetic and functional results were obtained using tissue expansion to reconstruct the upper extremities due to the giant congenital melanocytic nevi. PMID:28353563

Are Upper-Body Axial Symptoms a Feature of Early Parkinson’s Disease?

PubMed Central

Moreau, Caroline; Baille, Guillaume; Delval, Arnaud; Tard, Céline; Perez, Thierry; Danel-Buhl, Nicolas; Seguy, David; Labreuche, Julien; Duhamel, Alain; Delliaux, Marie; Dujardin, Kathy; Defebvre, Luc

2016-01-01

Background Axial disorders are considered to appear late in the course of Parkinson’s disease (PD). The associated impact on quality of life (QoL) and survival and the lack of an effective treatment mean that understanding and treating axial disorders is a key challenge. However, upper-body axial disorders (namely dysarthria, swallowing and breathing disorders) have never been prospectively assessed in early-stage PD patients. Objectives To characterize upper-body axial symptoms and QoL in consecutive patients with early-stage PD. Methods We prospectively enrolled 66 consecutive patients with early-stage PD (less than 3 years of disease progression) and assessed dysarthria, dysphagia and respiratory function (relative to 36 controls) using both objective and patient-reported outcomes. Results The mean disease duration was 1.26 years and the mean UPDRS motor score was 19.4 out of 108. 74% of the patients presented slight dysarthria (primarily dysprosodia). Men appeared to be more severely affected (i.e. dysphonia). This dysfunction was strongly correlated with low swallowing speed (despite the absence of complaints about dysphagia), respiratory insufficiency and poor QoL. Videofluorography showed that oral-phase swallowing disorders affected 60% of the 31 tested patients and that pharyngeal-phase disorders affected 21%. 24% of the patients reported occasional dyspnea, which was correlated with anxiety in women but not in men. Marked diaphragmatic dysfunction was suspected in 42% of the patients (predominantly in men). Conclusion Upper body axial symptoms were frequent in men with early-stage PD, whereas women presented worst non-motor impairments. New assessment methods are required because currently available tools do not reliably detect these upper-body axial disorders. PMID:27654040

Association of code status discussion with invasive procedures among advanced-stage cancer and noncancer patients.

PubMed

Sasaki, Akinori; Hiraoka, Eiji; Homma, Yosuke; Takahashi, Osamu; Norisue, Yasuhiro; Kawai, Koji; Fujitani, Shigeki

2017-01-01

Code status discussion is associated with a decrease in invasive procedures among terminally ill cancer patients. We investigated the association between code status discussion on admission and incidence of invasive procedures, cardiopulmonary resuscitation (CPR), and opioid use among inpatients with advanced stages of cancer and noncancer diseases. We performed a retrospective cohort study in a single center, Ito Municipal Hospital, Japan. Participants were patients who were admitted to the Department of Internal Medicine between October 1, 2013 and August 30, 2015, with advanced-stage cancer and noncancer. We collected demographic data and inquired the presence or absence of code status discussion within 24 hours of admission and whether invasive procedures, including central venous catheter placement, intubation with mechanical ventilation, and CPR for cardiac arrest, and opioid treatment were performed. We investigated the factors associated with CPR events by using multivariate logistic regression analysis. Among the total 232 patients, code status was discussed with 115 patients on admission, of which 114 (99.1%) patients had do-not-resuscitate (DNR) orders. The code status was not discussed with the remaining 117 patients on admission, of which 69 (59%) patients had subsequent code status discussion with resultant DNR orders. Code status discussion on admission decreased the incidence of central venous catheter placement, intubation with mechanical ventilation, and CPR in both cancer and noncancer patients. It tended to increase the rate of opioid use. Code status discussion on admission was the only factor associated with the decreased use of CPR ( P <0.001, odds ratio =0.03, 95% CI =0.004-0.21), which was found by using multivariate logistic regression analysis. Code status discussion on admission is associated with a decrease in invasive procedures and CPR in cancer and noncancer patients. Physicians should be educated about code status discussion to

Urothelial carcinoma of the bladder and the upper tract: disparate twins.

PubMed

Green, David A; Rink, Michael; Xylinas, Evanguelos; Matin, Surena F; Stenzl, Arnulf; Roupret, Morgan; Karakiewicz, Pierre I; Scherr, Douglas S; Shariat, Shahrokh F

2013-04-01

Urothelial carcinoma of the bladder is the 4th most common malignancy in men and the 8th most common cause of male cancer death in the United States. Conversely, upper tract urothelial carcinoma accounts for only 5% to 10% of all urothelial carcinoma. Due to the relative preponderance of urothelial carcinoma of the bladder, much of the clinical decision making regarding upper tract urothelial carcinoma is extrapolated from evidence that is based on urothelial carcinoma of the bladder cohorts. In fact, only 1 major urological organization has treatment guidelines specific for upper tract urothelial carcinoma. While significant similarities exist between these 2 diseases, ignoring the important differences may be preventing us from optimizing therapy in patients with upper tract urothelial carcinoma. Therefore, we explored these dissimilarities, including the differential importance of gender, anatomy, staging, intracavitary therapy, surgical lymphadenectomy and perioperative systemic chemotherapy on the behavior of urothelial carcinoma of the bladder and upper tract urothelial carcinoma. A nonsystematic literature search using the MEDLINE/PubMed® database was conducted to identify original articles, review articles and editorials. Searches were limited to the English language and studies in humans and in adults, and used the key words urothelial carcinoma, upper tract urothelial carcinoma or transitional cell carcinoma combined with several different sets of key words to identify appropriate publications for each section of the manuscript. The key words, broken down by section, were 1) epidemiology, sex, gender; 2) location, tumor location; 3) staging, stage; 4) intracavitary, intravesical, topical therapy; 5) lymphadenectomy, lymph node, lymph node dissection and 6) adjuvant, neoadjuvant, chemotherapy. Women who present with urothelial carcinoma of the bladder do so with less favorable tumor characteristics and have worse survival than men. However, gender does

Method and apparatus for advanced staged combustion utilizing forced internal recirculation

DOEpatents

Rabovitser, Iosif K.; Knight, Richard A.; Cygan, David F.; Nester, Serguei; Abbasi, Hamid A.

2003-12-16

A method and apparatus for combustion of a fuel in which a first-stage fuel and a first-stage oxidant are introduced into a combustion chamber and ignited, forming a primary combustion zone. At least about 5% of the total heat output produced by combustion of the first-stage fuel and the first-stage oxidant is removed from the primary combustion zone, forming cooled first-stage combustion products. A portion of the cooled first-stage combustion products from a downstream region of the primary combustion zone is recirculated to an upstream region of primary combustion zone. A second-stage fuel is introduced into the combustion chamber downstream of the primary combustion zone and ignited, forming a secondary combustion zone. At least about 5% of the heat from the secondary combustion zone is removed. In accordance with one embodiment, a third-stage oxidant is introduced into the combustion chamber downstream of the secondary combustion zone, forming a tertiary combustion zone.

Orion Stage Adapter Arrival

NASA Image and Video Library

2018-04-03

NASA's Super Guppy aircraft taxies onto the tarmac after touching down at the Shuttle Landing Facility at the agency's Kennedy Space Center in Florida. The Super Guppy is carrying the Orion Stage Adapter (OSA), the second flight-hardware section of NASA's Space Launch System (SLS) rocket that has arrived at Kennedy. The OSA will connect the Orion spacecraft to the upper part of the SLS rocket, the interim cryogenic propulsion stage (ICPS). Both the OSA and ICPS are being stored for processing in the center's Space Station Processing Facility in preparation for Exploration Mission-1, the first uncrewed, integrated launch of the SLS rocket and Orion spacecraft.

Orion Stage Adapter Arrival

NASA Image and Video Library

2018-04-03

NASA's Super Guppy aircraft glides to a stop at the Shuttle Landing Facility at the agency's Kennedy Space Center in Florida. The Super Guppy is carrying the Orion Stage Adapter (OSA), the second flight-hardware section of NASA's Space Launch System (SLS) rocket that has arrived at Kennedy. The OSA will connect the Orion spacecraft to the upper part of the SLS rocket, the interim cryogenic propulsion stage (ICPS). Both the OSA and ICPS are being stored for processing in the center's Space Station Processing Facility in preparation for Exploration Mission-1, the first uncrewed, integrated launch of the SLS rocket and Orion spacecraft.

Orion Stage Adapter Arrival

NASA Image and Video Library

2018-04-03

NASA's Super Guppy aircraft prepares to touch down at the Shuttle Landing Facility at the agency's Kennedy Space Center in Florida. The Super Guppy is carrying the Orion Stage Adapter (OSA), the second flight-hardware section of NASA's Space Launch System (SLS) rocket that has arrived at Kennedy. The OSA will connect the Orion spacecraft to the upper part of the SLS rocket, the interim cryogenic propulsion stage (ICPS). Both the OSA and ICPS are being stored for processing in the center's Space Station Processing Facility in preparation for Exploration Mission-1, the first uncrewed, integrated launch of the SLS rocket and Orion spacecraft.

The Impact of a Multidimensional Exercise Intervention on Physical and Functional Capacity, Anxiety, and Depression in Patients With Advanced-Stage Lung Cancer Undergoing Chemotherapy.

PubMed

Quist, Morten; Adamsen, Lis; Rørth, Mikael; Laursen, Jørgen H; Christensen, Karl B; Langer, Seppo W

2015-07-01

Patients with advanced-stage lung cancer face poor survival and experience co-occurring chronic physical and psychosocial symptoms. Despite several years of research in exercise oncology, few exercise studies have targeted advanced lung cancer patients undergoing chemotherapy. The aim of the present study was to investigate the benefits of a 6-week supervised group exercise intervention and to outline the effect on aerobic capacity, strength, health-related quality of life (HRQoL), anxiety, and depression. VO2peak was assessed using an incremental exercise test. Muscle strength was measured with one repetition maximum test (1RM). HRQoL, anxiety, and depression were assessed using Functional Assessment of Cancer Therapy-Lung (FACT-L) scale and the Hospital Anxiety and Depression Scale (HADS). One hundred and forthteen patients with advanced stage lung cancer were recruited. Forty-three patients dropped out. No serious adverse events were reported. Exercise adherence in the group training was 68%. Improvements in VO2peak (P < .001) and 6-minute walk distance (P < .001) and muscle strength measurements (P < .05) were seen. There was a reduction in anxiety level (P = .0007) and improvement in the emotional well-being parameter (FACT-L) but no statistically significant changes in HRQoL were observed. The results of the present study show that during a 6-week hospital-based supervised, structured, and group-based exercise program, patients with advanced-stage lung cancer (NSCLC IIIb-IV, ED-SCLC) improve their physical capacity (VO2peak, 1RM), functional capacity, anxiety level, and emotional well-being, but not their overall HRQoL. A randomized controlled trial testing the intervention including 216 patients is currently being carried out. © The Author(s) 2015.

SU-E-J-87: Ventilation Weighting Effect On Mean Doses of Both Side Lungs for Patients with Advanced Stage Lung Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Qu, H; Xia, P; Yu, N

Purpose: To study ventilation weighting effect on radiation doses to both side lungs for patients with advanced stage lung cancer. Methods: Fourteen patients with advanced stage lung cancer were included in this retrospective study. Proprietary software was developed to calculate the lung ventilation map based on 4DCT images acquired for radiation therapy. Two phases of inhale (0%) and exhale (50%) were used for the lung ventilation calculations. For each patient, the CT images were resampled to the same dose calculation resolution of 3mmx3mmx3mm. The ventilation distribution was then normalized by the mean value of the ventilation. The ventilation weighted dosemore » was calculated by applying linearly weighted ventilation to the dose of each pixel. The lung contours were automatically delineated from patient CT image with lung window, excluding the tumor and high density tissues. For contralateral and ipsilateral lungs, the mean lung doses from the original plan and ventilation weighted mean lung doses were compared using two tail t-Test. Results: The average of mean dose was 6.1 ±3.8Gy for the contralateral lungs, and 26.2 ± 14.0Gy for the ipsilateral lungs. The average of ventilation weighted dose was 6.3± 3.8Gy for the contralateral lungs and 24.6 ± 13.1Gy for the ipsilateral lungs. The statistics analysis shows the significance of the mean dose increase (p<0.015) for the contralateral lungs and decrease (p<0.005) for the ipsilateral lungs. Conclusion: Ventilation weighted doses were greater than the un-weighted doses for contralateral lungs and smaller for ipsilateral lungs. This Result may be helpful to understand the radiation dosimetric effect on the lung function and provide planning guidance for patients with advance stage lung cancer.« less

Barriers to Advance Care Planning in End-Stage Renal Disease: Who is to Blame, and What Can be Done?

PubMed

Kelley, Alan Taylor; Turner, Jeffrey; Doolittle, Benjamin

2018-07-01

Patients with end-stage renal disease experience significant mortality and morbidity, including cognitive decline. Advance care planning has been emphasized as a responsibility and priority of physicians caring for patients with chronic kidney disease in order to align with patient values before decision-making capacity is lost and to avoid suffering. This emphasis has proven ineffective, as illustrated in the case of a patient treated in our hospital. Is this ineffectiveness a consequence of failure in the courtroom or the clinic? Through our own experience we affirm what has been written before: that legal precedent favors intensive treatment in virtually all cases without 'clear and convincing evidence' of a patient's previously declared wishes to the contrary. Equally clear is that more than 20 years of support in the clinical literature suggesting advance care planning early in the course of disease can address challenges in the legal system for those lacking capacity. However, many physicians fail to recognize the need for advance care planning in a timely manner and lack the necessary training to provide it. The need for more training and new tools to recognize opportunities for advance care planning in daily practice remains unmet.

Rare upper gastrointestinal hemorrhage of cetuximab: A case report.

PubMed

Duan, Shi-Jie; Gao, Zi-Ming; Wang, Peng-Liang; Gong, Bao-Cheng; Huang, Han-Wei; Luo, Lei; Wang, Xin; Xing, Ya-Nan; Xu, Hui-Mian; Liu, Fu-Nan

2017-12-01

cetuximab, an epidermal growth factor receptor inhibitor, is a targeted therapeutic regimen of colorectal cancers. Several common adverse effects have been found, such as cutaneous or gastrointestinal toxicity. However, according to the articles had been published, upper gastrointestinal bleeding (UGIB) is considered to be rare and its mechanism remains unclear. In this report, we presented a 42-year-old male patient with advanced recto-sigmoid cancer. After palliative operation, the patient suffered from complete upper gastrointestinal (GI) obstruction, which was induced by extensive abdominal metastasis of the tumor. Considering his poor condition, we chose the targeted drug, cetuximab, as his further treatment. But after the application of cetuximab, the UGIB immediately happened twice in this patient. UGIB, as a rare complication of cetuximab, occured to the patient. We stopped the bleeding with thrombin, hemocoagulase and somatostatin and suspended the subsequent treatment plan of cetuximab. At the same time, anti-shock treatment was given immediately. He was died of respiratory and circulatory failure caused by UGIB and advanced tumor eventually. UGIB should be considered as a rare but severe complication of cetuximab. When cetuximab is applied for patients with advanced colon tumors, more cautions should be required if the patients are accompanied by upper gastrointestinal obstruction. In addition, for those patients who suffered from UGIB recently, cetuximab should be prohibited if the Rockall score ranged > 5 points. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

Textural features of pretreatment 18F-FDG PET/CT images: prognostic significance in patients with advanced T-stage oropharyngeal squamous cell carcinoma.

PubMed

Cheng, Nai-Ming; Fang, Yu-Hua Dean; Chang, Joseph Tung-Chieh; Huang, Chung-Guei; Tsan, Din-Li; Ng, Shu-Hang; Wang, Hung-Ming; Lin, Chien-Yu; Liao, Chun-Ta; Yen, Tzu-Chen

2013-10-01

Previous studies have shown that total lesion glycolysis (TLG) may serve as a prognostic indicator in oropharyngeal squamous cell carcinoma (OPSCC). We sought to investigate whether the textural features of pretreatment (18)F-FDG PET/CT images can provide any additional prognostic information over TLG and clinical staging in patients with advanced T-stage OPSCC. We retrospectively analyzed the pretreatment (18)F-FDG PET/CT images of 70 patients with advanced T-stage OPSCC who had completed concurrent chemoradiotherapy, bioradiotherapy, or radiotherapy with curative intent. All of the patients had data on human papillomavirus (HPV) infection and were followed up for at least 24 mo or until death. A standardized uptake value (SUV) of 2.5 was taken as a cutoff for tumor boundary. The textural features of pretreatment (18)F-FDG PET/CT images were extracted from histogram analysis (SUV variance and SUV entropy), normalized gray-level cooccurrence matrix (uniformity, entropy, dissimilarity, contrast, homogeneity, inverse different moment, and correlation), and neighborhood gray-tone difference matrix (coarseness, contrast, busyness, complexity, and strength). Receiver-operating-characteristic curves were used to identify the optimal cutoff values for the textural features and TLG. Thirteen patients were HPV-positive. Multivariate Cox regression analysis showed that age, tumor TLG, and uniformity were independently associated with progression-free survival (PFS) and disease-specific survival (DSS). TLG, uniformity, and HPV positivity were significantly associated with overall survival (OS). A prognostic scoring system based on TLG and uniformity was derived. Patients who presented with TLG > 121.9 g and uniformity ≤ 0.138 experienced significantly worse PFS, DSS, and OS rates than those without (P < 0.001, < 0.001, and 0.002, respectively). Patients with TLG > 121.9 g or uniformity ≤ 0.138 were further divided according to age, and different PFS and DSS were observed

Upper Gastrointestinal Tract Motility Disorders in Women, Gastroparesis, and Gastroesophageal Reflux Disease.

PubMed

Zia, Jasmine K; Heitkemper, Margaret M

2016-06-01

This article reviews the sex differences in upper gastrointestinal (GI) motility for both healthy and common dysmotility conditions. It focuses on gastroesophageal reflux disease and other esophageal motor disorders for the esophagus and on gastroparesis and accelerated gastric emptying for the stomach. It also describes differences in upper GI motility signs and symptoms during each female hormonal stage (ie, menstrual cycle, pregnancy, perimenopause, menopause) for both healthy participants and those suffering from one of the aforementioned upper GI dysmotility conditions. More research still needs to be conducted to better understand sex differences in upper GI motility. Copyright © 2016 Elsevier Inc. All rights reserved.

Assessment of capabilities in persons with advanced stage of dementia: Validation of The Montessori Assessment System (MAS).

PubMed

Erkes, Jérôme; Camp, Cameron J; Raffard, Stéphane; Gély-Nargeot And, Marie-Christine; Bayard, Sophie

2017-01-01

This study evaluated the validity and reliability of the Montessori Assessment System. The Montessori Assessment System assesses preserved abilities in persons with moderate to severe dementia. In this respect, this instrument provides crucial information for the development of effective person-centered care plans. A total of 196 persons with a diagnosis of dementia in the moderate to severe stages of dementia were recruited in 10 long-term care facilities in France. All participants completed the Montessori Assessment System, the Clinical Dementia Rating Scale and/or the Mini Mental State Examination and the Severe Impairment Battery-short form. The internal consistency and temporal stability of the Montessori Assessment System were high. Additionally, good construct and divergent validity were demonstrated. Factor analysis showed a one-factor structure. The Montessori Assessment System demonstrated satisfactory psychometric properties while being a useful instrument to assess capabilities in persons with advanced stages of dementia and hence to develop person-centered plans of care.

Transport and Use of a Centaur Second Stage in Space

NASA Technical Reports Server (NTRS)

Strong, James M.; Morgowicz, Bernard; Drucker, Eric; Tompkins, Paul D.; Kennedy, Brian; Barber, Robert D,; Luzod, Louie T.; Kennedy, Brian Michael; Luzod, Louie T.

2010-01-01

As nations continue to explore space, the desire to reduce costs will continue to grow. As a method of cost reduction, transporting and/or use of launch system components as integral components of missions may become more commonplace in the future. There have been numerous scenarios written for using launch vehicle components (primarily space shuttle used external tanks) as part of flight missions or future habitats. Future studies for possible uses of launch vehicle upper stages might include asteroid diverter using gravity orbital perturbation, orbiting station component, raw material at an outpost, and kinetic impactor. The LCROSS (Lunar CRater Observation and Sensing Satellite) mission was conceived as a low-cost means of determining whether water exists at the polar regions of the moon. Manifested as a secondary payload with the LRO (Lunar Reconnaissance Orbiter) spacecraft aboard an Atlas V launch vehicle, LCROSS guided its spent Centaur Earth Departure Upper Stage (EDUS) into the lunar crater Cabeu's, as a kinetic impactor. This paper describes some of the challenges that the LCROSS project encountered in planning, designing, launching with and carrying the Centaur upper stage to the moon.

The role of high-resolution endoscopy and narrow-band imaging in the evaluation of upper GI neoplasia in familial adenomatous polyposis.

PubMed

Lopez-Ceron, Maria; van den Broek, Frank J C; Mathus-Vliegen, Elisabeth M; Boparai, Karam S; van Eeden, Susanne; Fockens, Paul; Dekker, Evelien

2013-04-01

The Spigelman classification stratifies cancer risk in familial adenomatous polyposis (FAP) patients with duodenal adenomatosis. High-resolution endoscopy (HRE) and narrow-band imaging (NBI) may identify lesions at high risk. To compare HRE and NBI for the detection of duodenal and gastric polyps and to characterize duodenal adenomas harboring advanced histology with HRE and NBI. Prospective, nonrandomized, comparative study. Retrospective image evaluation study. Tertiary-care center. Thirty-seven FAP patients undergoing surveillance upper endoscopies. HRE endoscopy was followed by NBI. The number of gastric polyps and Spigelman staging were compared. Duodenal polyp images were systematically reviewed in a learning and validation phase. Number of gastric and duodenal polyps detected by HRE and NBI and prevalence of specific endoscopic features in duodenal adenomas with advanced histology. NBI did not identify additional gastric polyps but detected more duodenal adenomas in 16 examinations, resulting in upgrades of the Spigelman stage in 2 cases (4.4%). Pictures of 168 duodenal adenomas (44% advanced histology) were assessed. In the learning phase, 3 endoscopic features were associated with advanced histology: white color, enlarged villi, and size ≥1 cm. Only size ≥1 cm was confirmed in the validation phase (odds ratio 3.0; 95% confidence interval, 1.2-7.4). Nonrandomized study, scant number of high-grade dysplasia adenomas. Inspection with NBI did not lead to a clinically relevant upgrade in the Spigelman classification and did not improve the detection of gastric polyps in comparison with HRE. The only endoscopic feature that predicted advanced histology of a duodenal adenoma was size ≥1 cm. Copyright © 2013 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Application of RFID technology-upper extremity rehabilitation training.

PubMed

Chen, Chih-Chen; Chen, Yu-Luen; Chen, Shih-Ching

2016-01-01

[Purpose] Upper extremity rehabilitation after an injury is very important. This study proposes radio frequency identification (RFID) technology to improve and enhance the effectiveness of the upper extremity rehabilitation. [Subjects and Methods] People use their upper extremities to conduct daily activities. When recovering from injuries, many patients neglect the importance of rehabilitation, which results in degraded function. This study recorded the training process using the traditional rehabilitation hand gliding cart with a RFID reader, RFID tags in the panel, and a servo host computer. [Results] Clinical evidence, time taken to achieve a full score, counts of missing the specified spots, and Brunnstrom stage of aided recovery, the proximal part of the upper extremity show that the RFID-based upper extremity training significantly and reduce negative impacts of the disability in daily life and activities. [Conclusion] This study combined a hand-gliding cart with an RFID reader, and when patients moved the cart, the movement could be observed via the activated RFID tags. The training data was collected and quantified for a better understanding of the recovery status of the patients. Each of the participating patients made progress as expected.

Histologic parameters predictive of disease outcome in women with advanced stage ovarian carcinoma treated with neoadjuvant chemotherapy.

PubMed

Samrao, Damanzoopinder; Wang, Dan; Ough, Faith; Lin, Yvonne G; Liu, Song; Menesses, Teodulo; Yessaian, Annie; Turner, Nicole; Pejovic, Tanja; Mhawech-Fauceglia, Paulette

2012-12-01

The use of neoadjuvant chemotherapy followed by tumor reduction surgery, also called interval debulking surgery (IDS), is considered an alternative therapeutic regimen for selected patients with advanced stage epithelial ovarian cancer (EOC). Although minimal residual disease has been proven to be a prognostic factor in traditional cytoreduction for advanced stage EOC, predictive factors after IDS still remain unexplored. The aim of this study was to determine the prognostic value of post-neoadjuvant histologic changes with clinical outcome. Three pathologists evaluated 67 cases for the following parameters: fibrosis, necrosis, residual tumor, and inflammation. The Cohen's kappa statistic was used to measure agreement among pathologists. Univariate and multivariate Cox proportional hazards models were used to determine the association between histologic parameters and recurrence-free survival (RFS) and overall survival (OS). There was substantial to almost perfect agreement among the three pathologists in all four histologic parameters (k ranged from 0.65 to 0.97). Fibrosis was associated with longer RFS (P = 0.0257) with a median of 20 months for tumors with fibrosis (3+) versus 12 months for tumors with fibrosis (1+, 2+) and longer OS (P = 0.0249) with a median of 51 months for tumors with fibrosis (3+) versus 32 months for tumors with fibrosis (1+, 2+). Our results revealed that patients with tumors exhibiting fibrosis (1+, 2+), as well as necrosis (0, 1+), had significant shorter RFS and OS (P = 0.059 and P = 0.0234, respectively). We suggest that the assessment of fibrosis and necrosis should be implemented in pathologic evaluation and prospectively validated in future studies.

Bioinformatics Analysis Reveals Distinct Molecular Characteristics of Hepatitis B-Related Hepatocellular Carcinomas from Very Early to Advanced Barcelona Clinic Liver Cancer Stages.

PubMed

Kong, Fan-Yun; Wei, Xiao; Zhou, Kai; Hu, Wei; Kou, Yan-Bo; You, Hong-Juan; Liu, Xiao-Mei; Zheng, Kui-Yang; Tang, Ren-Xian

2016-01-01

Hepatocellular carcinoma (HCC)is the fifth most common malignancy associated with high mortality. One of the risk factors for HCC is chronic hepatitis B virus (HBV) infection. The treatment strategy for the disease is dependent on the stage of HCC, and the Barcelona clinic liver cancer (BCLC) staging system is used in most HCC cases. However, the molecular characteristics of HBV-related HCC in different BCLC stages are still unknown. Using GSE14520 microarray data from HBV-related HCC cases with BCLC stages from 0 (very early stage) to C (advanced stage) in the gene expression omnibus (GEO) database, differentially expressed genes (DEGs), including common DEGs and unique DEGs in different BCLC stages, were identified. These DEGs were located on different chromosomes. The molecular functions and biology pathways of DEGs were identified by gene ontology (GO) analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and the interactome networks of DEGs were constructed using the NetVenn online tool. The results revealed that both common DEGs and stage-specific DEGs were associated with various molecular functions and were involved in special biological pathways. In addition, several hub genes were found in the interactome networks of DEGs. The identified DEGs and hub genes promote our understanding of the molecular mechanisms underlying the development of HBV-related HCC through the different BCLC stages, and might be used as staging biomarkers or molecular targets for the treatment of HCC with HBV infection.

Two stage launch vehicle

NASA Technical Reports Server (NTRS)

1987-01-01

The Advanced Space Design project for 1986-87 was the design of a two stage launch vehicle, representing a second generation space transportation system (STS) which will be needed to support the space station. The first stage is an unmanned winged booster which is fully reusable with a fly back capability. It has jet engines so that it can fly back to the landing site. This adds safety as well as the flexibility to choose alternate landing sites. There are two different second stages. One of the second stages is a manned advanced space shuttle called Space Shuttle II. Space Shuttle II has a payload capability of delivering 40,000 pounds to the space station in low Earth orbit (LEO), and returning 40,000 pounds to Earth. Servicing the space station makes the ability to return a heavy payload to Earth as important as being able to launch a heavy payload. The other second stage is an unmanned heavy lift cargo vehicle with ability to deliver 150,000 pounds of payload to LEO. This vehicle will not return to Earth; however, the engines and electronics can be removed and returned to Earth in the Space Shuttle II. The rest of the vehicle can then be used on orbit for storage or raw materials, supplies, and space manufactured items awaiting transport back to Earth.

A Model to Predict the Use of Surgical Resection for Advanced-Stage Non-Small Cell Lung Cancer Patients.

PubMed

David, Elizabeth A; Andersen, Stina W; Beckett, Laurel A; Melnikow, Joy; Kelly, Karen; Cooke, David T; Brown, Lisa M; Canter, Robert J

2017-11-01

For advanced-stage non-small cell lung cancer, chemotherapy and chemoradiotherapy are the primary treatments. Although surgical intervention in these patients is associated with improved survival, the effect of selection bias is poorly defined. Our objective was to characterize selection bias and identify potential surgical candidates by constructing a Surgical Selection Score (SSS). Patients with clinical stage IIIA, IIIB, or IV non-small cell lung cancer were identified in the National Cancer Data Base from 1998 to 2012. Logistic regression was used to develop the SSS based on clinical characteristics. Estimated area under the receiver operating characteristic curve was used to assess discrimination performance of the SSS. Kaplan-Meier analysis was used to compare patients with similar SSSs. We identified 300,572 patients with stage IIIA, IIIB, or IV non-small cell lung cancer without missing data; 6% (18,701) underwent surgical intervention. The surgical cohort was 57% stage IIIA (n = 10,650), 19% stage IIIB (n = 3,483), and 24% stage IV (n = 4,568). The areas under the receiver operating characteristic curve from the best-fit logistic regression model in the training and validation sets were not significantly different, at 0.83 (95% confidence interval, 0.82 to 0.83) and 0.83 (95% confidence interval, 0.82 to 0.83). The range of SSS is 43 to 1,141. As expected, SSS was a good predictor of survival. Within each quartile of SSS, patients in the surgical group had significantly longer survival than nonsurgical patients (p < 0.001). A prediction model for selection of patients for surgical intervention was created. Once validated and prospectively tested, this model may be used to identify patients who may benefit from surgical intervention. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Dilemmas in Lung Cancer Staging.

PubMed

Vlahos, Ioannis

2018-05-01

The advent of the 8th edition of the lung cancer staging system reflects a further meticulous evidence-based advance in the stratification of the survival of patients with lung cancer. Although addressing many limitations of earlier staging systems, several limitations in staging remain. This article reviews from a radiological perspective the limitations of the current staging system, highlighting the process of TNM restructuring, the residual issues with regards to the assignment of T, N, M descriptors, and their associated stage groupings and how these dilemmas impact guidance of multidisciplinary teams taking care of patients with lung cancer. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

Design options for advanced manned launch systems

NASA Astrophysics Data System (ADS)

Freeman, Delma C.; Talay, Theodore A.; Stanley, Douglas O.; Lepsch, Roger A.; Wilhite, Alan W.

1995-03-01

Various concepts for advanced manned launch systems are examined for delivery missions to space station and polar orbit. Included are single-and two-stage winged systems with rocket and/or air-breathing propulsion systems. For near-term technologies, two-stage reusable rocket systems are favored over single-stage rocket or two-stage air-breathing/rocket systems. Advanced technologies enable viable single-stage-to-orbit (SSTO) concepts. Although two-stage rocket systems continue to be lighter in dry weight than SSTO vehicles, advantages in simpler operations may make SSTO vehicles more cost-effective over the life cycle. Generally, rocket systems maintain a dry-weight advantage over air-breathing systems at the advanced technology levels, but to a lesser degree than when near-term technologies are used. More detailed understanding of vehicle systems and associated ground and flight operations requirements and procedures is essential in determining quantitative discrimination between these latter concepts.

Guidelines on Chemotherapy in Advanced Stage Gynecological Malignancies: An Evaluation of 224 Professional Societies and Organizations

PubMed Central

Polyzos, Nikolaos P.; Mauri, Davide; Ioannidis, John P. A.

2011-01-01

Background Clinical practice guidelines are important for guiding practice, but it is unclear if they are commensurate with the available evidence. Methods We examined guidelines produced by cancer and gynecological societies and organizations and evaluated their coverage of and stance towards chemotherapy for advanced stage disease among 4 gynecological malignancies (breast, ovarian, cervical, endometrial cancer) where the evidence for the use of chemotherapy is very different (substantial and conclusive for breast and ovarian cancer, limited and suggesting no major benefit for cervical and endometrial cancer). Eligible societies and organizations were identified through systematic internet searches (last update June 2009). Pertinent websites were scrutinized for presence of clinical practice guidelines, and relative guidelines were analyzed. Results Among 224 identified eligible societies and organizations, 69 (31%) provided any sort of guidelines, while recommendations for chemotherapy on advanced stage gynecological malignancies were available in 20 of them. Only 14 had developed their own guideline, and only 5 had developed guidelines for all 4 malignancies. Use of levels of evidence and grades of recommendations, and aspects of the production, implementation, and timeliness of the guidelines did not differ significantly across malignancies. Guidelines on breast and ovarian cancer utilized significantly more randomized trials and meta-analyses. Guidelines differed across malignancies on their coverage of disease-free survival (p = 0.033), response rates (p = 0.024), symptoms relief (p = 0.005), quality of life (p = 0.001) and toxicity (p = 0.039), with breast and ovarian cancer guidelines typically covering more frequently these outcomes. All guidelines explicitly or implicitly endorsed the use of chemotherapy. Conclusions Clinical practice guidelines are provided by the minority of professional societies and organizations. Available

Newly combined 40Ar/39Ar and U-Pb ages of the Upper Cretaceous timescale from Hokkaido, Japan

NASA Astrophysics Data System (ADS)

Gaylor, J. R.; Heredia, B. D.; Quidelleur, X.; Takashima, R.; Nishi, H.; Mezger, K.

2011-12-01

The main targets for GTS next project (www.gtsnext.eu) are to develop highly refined geological time scales, including the Upper Cretaceous. The Cretaceous period is characterised by numerous global anoxic events in the marine realm, rich ammonitic fossil assemblages and specialised foraminifera. However, lack of age diagnostic macro and micro fossils in the North Pacific sections has made it difficult to link these with global sections such as the Western Interior Basin (North America). Using advances with terrestrial C-isotope and planktic foraminifera records within Central Hokkaido we are able to correlate these sections globally. The Cretaceous Yezo group in Central Hokkaido comprises deep marine mudstones and turbidite sandstones interbedded with acidic volcanic tuffs. Using various sections within the Yezo group, we radiometrically dated tuffs at the main stage boundaries in the Upper Cretaceous. The samples derive from the Kotanbetsu, Shumarinai, Tiomiuchi and the Hakkin river sections, spanning the time from the Albian-Cenomanian up until the Campanian-Santonian boundaries, and were dated using 40Ar/39Ar, K/Ar and U-Pb techniques. Recent age constraints in the Hokkaido counterparts (Kotanbetsu sections) show good coherence between radiometric chronometers on the various Upper Cretaceous stage boundaries. These additional ages together with our isotope ages from the different sections around the Hokkaido basin are well linked by the various faunal assemblages and C-isotope curves. The combined radio isotope ages contribute to previous attempts (such as those focused in the Western Interior Basin) supporting the synchronicity of events such as global oceanic anoxic events. Finally, the ages obtained here also compliment the previous C-isotope and planktic foraminifera records allowing for a more precise climatic history of the Northwest Pacific during the Cretaceous. The research within the GTSnext project is funded by the European Community's Seventh

Innovations in prosthetic interfaces for the upper extremity.

PubMed

Kung, Theodore A; Bueno, Reuben A; Alkhalefah, Ghadah K; Langhals, Nicholas B; Urbanchek, Melanie G; Cederna, Paul S

2013-12-01

Advancements in modern robotic technology have led to the development of highly sophisticated upper extremity prosthetic limbs. High-fidelity volitional control of these devices is dependent on the critical interface between the patient and the mechanical prosthesis. Recent innovations in prosthetic interfaces have focused on several control strategies. Targeted muscle reinnervation is currently the most immediately applicable prosthetic control strategy and is particularly indicated in proximal upper extremity amputations. Investigation into various brain interfaces has allowed acquisition of neuroelectric signals directly or indirectly from the central nervous system for prosthetic control. Peripheral nerve interfaces permit signal transduction from both motor and sensory nerves with a higher degree of selectivity. This article reviews the current developments in each of these interface systems and discusses the potential of these approaches to facilitate motor control and sensory feedback in upper extremity neuroprosthetic devices.

Macroscopic appearance of Type IV and giant Type III is a high risk for a poor prognosis in pathological stage II/III advanced gastric cancer with postoperative adjuvant chemotherapy

PubMed Central

Yamashita, Keishi; Ema, Akira; Hosoda, Kei; Mieno, Hiroaki; Moriya, Hiromitsu; Katada, Natsuya; Watanabe, Masahiko

2017-01-01

AIM To evaluate whether a high risk macroscopic appearance (Type IV and giant Type III) is associated with a dismal prognosis after curative surgery, because its prognostic relevance remains elusive in pathological stage II/III (pStage II/III) gastric cancer. METHODS One hundred and seventy-two advanced gastric cancer (defined as pT2 or beyond) patients with pStage II/III who underwent curative surgery plus adjuvant S1 chemotherapy were evaluated, and the prognostic relevance of a high-risk macroscopic appearance was examined. RESULTS Advanced gastric cancers with a high-risk macroscopic appearance were retrospectively identified by preoperative recorded images. A high-risk macroscopic appearance showed a significantly worse relapse free survival (RFS) (35.7%) and overall survival (OS) (34%) than an average risk appearance (P = 0.0003 and P < 0.0001, respectively). A high-risk macroscopic appearance was significantly associated with the 13th Japanese Gastric Cancer Association (JGCA) pT (P = 0.01), but not with the 13th JGCA pN. On univariate analysis for RFS and OS, prognostic factors included 13th JGCA pStage (P < 0.0001) and other clinicopathological factors including macroscopic appearance. A multivariate Cox proportional hazards model for univariate prognostic factors identified high-risk macroscopic appearance (P = 0.036, HR = 2.29 for RFS and P = 0.021, HR = 2.74 for OS) as an independent prognostic indicator. CONCLUSION A high-risk macroscopic appearance was associated with a poor prognosis, and it could be a prognostic factor independent of 13th JGCA stage in pStage II/III advanced gastric cancer. PMID:28451064

Development of upper limb prostheses: current progress and areas for growth.

PubMed

González-Fernández, Marlís

2014-06-01

Upper extremity prosthetic technology has significantly changed in recent years. The devices available and those under development are more and more able to approximate the function of the lost limb; however, other challenges remain. This article provides a brief perspective on the most advanced upper limb prostheses available and the challenges present for continued development of the technology. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Advanced stages of embryonic development and cotylocidial morphogenesis in the intrauterine eggs of Aspidogaster limacoides Diesing, 1835 (Aspidogastrea), with comments on their phylogenetic implications.

PubMed

Świderski, Zdzisław; Poddubnaya, Larisa G; Gibson, David I; Młocicki, Daniel

2012-06-01

Ultrastructural aspects of the advanced embryonic development and cotylocidial morphogenesis of the aspidogastrean Aspidogaster limacoides are described. The posterior or distal regions of the uterus are filled with eggs containing larvae at advanced stages of morphogenesis and fully-formed cotylocidia. Various stages and organs of this larva are described in detail, including the aspects of the developing and fully-differentiated cotylocidium, the body wall (tegument and musculature), glandular regions and the protonephridial excretory system. Blastomere multiplication by means of mitotic divisions takes place simultaneously with the degeneration or apoptosis of some micromeres; this frequently observed characteristic is compared and discussed in relation to corresponding reports for other neodermatans. During the advanced stages of the embryonic development of A. limacoides, the vitelline syncytium disappears and the size of the embryo increases rapidly. Evident polarization of the differentiating larva was observed; towards one pole of the egg, cytodifferentiation of the mouth, surrounded by the oral sucker and cephalic glands, takes place, whereas, towards the opposite pole, differentiation of the posterior sucker (incipient ventral disc) occurs. The oral and posterior suckers are formed from numerous embryonic cells which have differentiated into myocytes. The central part of the oral sucker undergoes invagination and forms the future pharynx and intestine. Fully-developed cotylocidia of A. limacoides have a neodermatan type of tegument, flame cells and two types of glandular structures. These results suggest a sister relationship between the Aspidogastrea and the Digenea, although the systematic position of aspidogastreans in relation to other platyhelminth taxa remains somewhat equivocal.

Endoscopic Criteria for Evaluating Tumor Stage after Preoperative Chemoradiation Therapy in Locally Advanced Rectal Cancer.

PubMed

Han, Kyung Su; Sohn, Dae Kyung; Kim, Dae Yong; Kim, Byung Chang; Hong, Chang Won; Chang, Hee Jin; Kim, Sun Young; Baek, Ji Yeon; Park, Sung Chan; Kim, Min Ju; Oh, Jae Hwan

2016-04-01

Local excision may be an another option for selected patients with markedly down-staged rectal cancer after preoperative chemoradiation therapy (CRT), and proper evaluation of post-CRT tumor stage (ypT) is essential prior to local excision of these tumors. This study was designed to determine the correlations between endoscopic findings and ypT of rectal cancer. In this study, 481 patients with locally advanced rectal cancer who underwent preoperative CRT followed by surgical resection between 2004 and 2013 at a single institution were evaluated retrospectively. Pathological good response (p-GR) was defined as ypT ≤ 1, and pathological minimal or no response (p-MR) as ypT ≥ 2. The patients were randomly classified according to two groups, a testing (n=193) and a validation (n=288) group. Endoscopic criteria were determined from endoscopic findings and ypT in the testing group and used in classifying patients in the validation group as achieving or not achieving p-GR. Based on findings in the testing group, the endoscopic criteria for p-GR included scarring, telangiectasia, and erythema, whereas criteria for p-MR included nodules, ulcers, strictures, and remnant tumors. In the validation group, the kappa statistic was 0.965 (p < 0.001), and the sensitivity, specificity, positive predictive value, and negative predictive value were 0.362, 0.963, 0.654, and 0.885, respectively. The endoscopic criteria presented are easily applicable for evaluation of ypT after preoperative CRT for rectal cancer. These criteria may be used for selection of patients for local excision of down-staged rectal tumors, because patients with p-MR could be easily ruled out.

Orion Stage Adapter (OSA) Offload

NASA Image and Video Library

2018-04-04

NASA Kennedy Space Center security officers prepare to escort the Orion Stage Adapter (OSA), secured on a flatbed transporter, along State Road 3 to the Space Station Processing Facility (SSPF) at NASA's Kennedy Space Center in Florida. The OSA is the second flight-hardware section of the agency's Space Launch System (SLS) rocket to arrive at Kennedy. The OSA will connect the Orion spacecraft to the upper part of the SLS, the interim cryogenic propulsion stage (ICPS). Both the OSA and ICPS are being stored for processing in the SSPF in preparation for Exploration Mission-1, the first uncrewed, integrated launch of the SLS rocket and Orion spacecraft.

Nuclear Cryogenic Propulsion Stage

NASA Technical Reports Server (NTRS)

Houts, Michael G.; Borowski, S. K.; George, J. A.; Kim, T.; Emrich, W. J.; Hickman, R. R.; Broadway, J. W.; Gerrish, H. P.; Adams, R. B.

2012-01-01

The fundamental capability of Nuclear Thermal Propulsion (NTP) is game changing for space exploration. A first generation Nuclear Cryogenic Propulsion Stage (NCPS) based on NTP could provide high thrust at a specific impulse above 900 s, roughly double that of state of the art chemical engines. Characteristics of fission and NTP indicate that useful first generation systems will provide a foundation for future systems with extremely high performance. The role of the NCPS in the development of advanced nuclear propulsion systems could be analogous to the role of the DC-3 in the development of advanced aviation. Progress made under the NCPS project could help enable both advanced NTP and advanced NEP.

38. DETAIL OF CYLINDER LEVELING SYSTEM SHOWING TYPICAL UPPER AND ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

38. DETAIL OF CYLINDER LEVELING SYSTEM SHOWING TYPICAL UPPER AND LOWER PULLEY BRACKET. F.C. TORKELSON DRAWING NUMBER 842-ARVFS-701-S-8. INEL INDEX CODE - Idaho National Engineering Laboratory, Advanced Reentry Vehicle Fusing System, Scoville, Butte County, ID

Reduced Empathy Scores in Patients with Parkinson's Disease: A Non-Motor Symptom Associated with Advanced Disease Stages.

PubMed

Schmidt, Nele; Paschen, Laura; Deuschl, Günther; Witt, Karsten

2017-01-01

Empathy describes the ability to infer and share emotional experiences of other people and is a central component of normal social functioning. Impaired empathy might be a non-motor symptom in Parkinson's disease (PD). To examine empathic abilities and their relationship to clinical and cognitive functioning in PD patients. Empathy was measured in 75 non-demented PD patients and 34 age-matched healthy controls using a German version of the Interpersonal Reactivity Index. Moreover, we collected demographic and clinical data and conducted a comprehensive neuropsychological test battery. PD patients had a significant lower global empathy score than healthy controls. Furthermore, we found significant group differences for the cognitive empathy scales but not for the scales which are sensitive for affective empathy components. The empathy decrease was significantly higher in advanced Hoehn & Yahr stages. There were only sporadic significant correlations between empathy scores and cognitive variables. PD patients show a stage dependent empathy score decrease which is driven mainly by cognitive aspects of empathy. However, emotional empathy aspects are not reduced.

Robotic planetary science missions enabled with small NTR engine/stage technologies

NASA Astrophysics Data System (ADS)

Borowski, Stanley K.

1995-10-01

The high specific impulse (Isp) and engine thrust-to-weight ratio of liquid hydrogen (LH2)-cooled nuclear thermal rocket (NTR) engines makes them ideal for upper stage applications to difficult robotic planetary science missions. A small 15 thousand pound force (klbf) NTR engine using a uranium-zirconium-niobium 'ternary carbide' fuel (Isp approximately 960 seconds at approximately 3025K) developed in the Commonwealth of Independent States (CIS) is examined and its use on an expendable injection stage is shown to provide major increases in payload delivered to the outer planets (Saturn, Uranus, Neptune and Pluto). Using a single 'Titan IV-class' launch vehicle, with a lift capability to low Earth orbit (LEO) of approximately 20 metric tons (t), an expendable NTR upper stage can inject two Pluto 'Fast Flyby' spacecraft (PFF/SC) plus support equipment-combined mass of approximately 508 kg--on high energy, '6.5-9.2 year' direct trajectory missions to Pluto. A conventional chemical propulsion mission would use a liquid oxygen (LOX)/LH2 'Centaur' upper stage and two solid rocket 'kick motors' to inject a single PFF/SC on the same Titan IV launch vehicle. For follow on Pluto missions, the NTR injection stage would utilize a Jupiter 'gravity assist' (JGA) maneuver to launch a LOX/liquid methane (CH4) capture stage (Isp approximately 375 seconds) and a Pluto 'orbiter' spacecraft weighing between approximately 167-312 kg. With chemical propulsion, a Pluto orbiter mission is not a viable option because c inadequate delivered mass. Using a 'standardized' NTR injection stage and the same single Titan IV launch scenario, 'direct flight' (no gravity assist) orbiter missions to Saturn, Uranus and Neptune are also enabled with transit times of 2.3, 6.6, and 12.6 years, respectively. Injected mass includes a storable, nitrogen tetroxide/monomethyl hydrazine (N2O4/MMH) capture stage (Isp approximately 330 seconds) and orbiter payloads 340 to 820% larger than that achievable using a

Robotic Planetary Science Missions Enabled with Small NTR Engine/Stage Technologies

NASA Technical Reports Server (NTRS)

Borowski, Stanley K.

1995-01-01

The high specific impulse (Isp) and engine thrust-to-weight ratio of liquid hydrogen (LH2)-cooled nuclear thermal rocket (NTR) engines makes them ideal for upper stage applications to difficult robotic planetary science missions. A small 15 thousand pound force (klbf) NTR engine using a uranium-zirconium-niobium 'ternary carbide' fuel (Isp approximately 960 seconds at approximately 3025K) developed in the Commonwealth of Independent States (CIS) is examined and its use on an expendable injection stage is shown to provide major increases in payload delivered to the outer planets (Saturn, Uranus, Neptune and Pluto). Using a single 'Titan IV-class' launch vehicle, with a lift capability to low Earth orbit (LEO) of approximately 20 metric tons (t), an expendable NTR upper stage can inject two Pluto 'Fast Flyby' spacecraft (PFF/SC) plus support equipment-combined mass of approximately 508 kg--on high energy, '6.5-9.2 year' direct trajectory missions to Pluto. A conventional chemical propulsion mission would use a liquid oxygen (LOX)/LH2 'Centaur' upper stage and two solid rocket 'kick motors' to inject a single PFF/SC on the same Titan IV launch vehicle. For follow on Pluto missions, the NTR injection stage would utilize a Jupiter 'gravity assist' (JGA) maneuver to launch a LOX/liquid methane (CH4) capture stage (Isp approximately 375 seconds) and a Pluto 'orbiter' spacecraft weighing between approximately 167-312 kg. With chemical propulsion, a Pluto orbiter mission is not a viable option because c inadequate delivered mass. Using a 'standardized' NTR injection stage and the same single Titan IV launch scenario, 'direct flight' (no gravity assist) orbiter missions to Saturn, Uranus and Neptune are also enabled with transit times of 2.3, 6.6, and 12.6 years, respectively. Injected mass includes a storable, nitrogen tetroxide/monomethyl hydrazine (N2O4/MMH) capture stage (Isp approximately 330 seconds) and orbiter payloads 340 to 820% larger than that achievable using a

The Modern Role of Radiation Therapy in Treating Advanced-Stage Retinoblastoma: Long-Term Outcomes and Racial Differences

DOE Office of Scientific and Technical Information (OSTI.GOV)

Orman, Amber; Koru-Sengul, Tulay; Miao, Feng

2014-12-01

Purpose/Objective(s): To evaluate the effects of various patient characteristics and radiation therapy treatment variables on outcomes in advanced-stage retinoblastoma. Methods and Materials: This was a retrospective review of 41 eyes of 30 patients treated with external beam radiation therapy between June 1, 1992, and March 31, 2012, with a median follow-up time of 133 months (11 years). Outcome measures included overall survival, progression-free survival, local control, eye preservation rate, and toxicity. Results: Over 90% of the eyes were stage V. Definitive external beam radiation therapy (EBRT) was delivered in 43.9% of eyes, adjuvant EBRT in 22% of eyes, and second-line/salvage EBRT inmore » 34.1% of eyes. A relative lens sparing (RLS) technique was used in 68.3% of eyes and modified lens sparing (MLS) in 24.4% of eyes. Three eyes were treated with other techniques. Doses ≥45 Gy were used in 68.3% of eyes. Chemotherapy was a component of treatment in 53.7% of eyes. The 10-year overall survival was 87.7%, progression-free survival was 80.5%, and local control was 87.8%. White patients had significantly better overall survival than did African-American patients in univariate analysis (hazard ratio 0.09; 95% confidence interval 0.01-0.84; P=.035). Toxicity was seen in 68.3% of eyes, including 24.3% with isolated acute dermatitis. Conclusions: External beam radiation therapy continues to be an effective treatment modality for advanced retinoblastoma, achieving excellent long-term local control and survival with low rates of treatment-related toxicity and secondary malignancy.« less

[Remote intelligent Brunnstrom assessment system for upper limb rehabilitation for post-stroke based on extreme learning machine].

PubMed

Wang, Yue; Yu, Lei; Fu, Jianming; Fang, Qiang

2014-04-01

In order to realize an individualized and specialized rehabilitation assessment of remoteness and intelligence, we set up a remote intelligent assessment system of upper limb movement function of post-stroke patients during rehabilitation. By using the remote rehabilitation training sensors and client data sampling software, we collected and uploaded the gesture data from a patient's forearm and upper arm during rehabilitation training to database of the server. Then a remote intelligent assessment system, which had been developed based on the extreme learning machine (ELM) algorithm and Brunnstrom stage assessment standard, was used to evaluate the gesture data. To evaluate the reliability of the proposed method, a group of 23 stroke patients, whose upper limb movement functions were in different recovery stages, and 4 healthy people, whose upper limb movement functions were normal, were recruited to finish the same training task. The results showed that, compared to that of the experienced rehabilitation expert who used the Brunnstrom stage standard table, the accuracy of the proposed remote Brunnstrom intelligent assessment system can reach a higher level, as 92.1%. The practical effects of surgery have proved that the proposed system could realize the intelligent assessment of upper limb movement function of post-stroke patients remotely, and it could also make the rehabilitation of the post-stroke patients at home or in a community care center possible.

Phase 1 Development Testing of the Advanced Manufacturing Demonstrator Engine

NASA Technical Reports Server (NTRS)

Case, Nicholas L.; Eddleman, David E.; Calvert, Marty R.; Bullard, David B.; Martin, Michael A.; Wall, Thomas R.

2016-01-01

The Additive Manufacturing Development Breadboard Engine (BBE) is a pressure-fed liquid oxygen/pump-fed liquid hydrogen (LOX/LH2) expander cycle engine that was built and operated by NASA at Marshall Space Flight Center's East Test Area. The breadboard engine was conceived as a technology demonstrator for the additive manufacturing technologies for an advanced upper stage prototype engine. The components tested on the breadboard engine included an ablative chamber, injector, main fuel valve, turbine bypass valve, a main oxidizer valve, a mixer and the fuel turbopump. All parts minus the ablative chamber were additively manufactured. The BBE was successfully hot fire tested seven times. Data collected from the test series will be used for follow on demonstration tests with a liquid oxygen turbopump and a regeneratively cooled chamber and nozzle.

[The necessary perseverance of surgery for the treatment of locally advanced colorectal cancer].

PubMed

Gu, Jin

2018-03-25

Colorectal cancer, a malignant tumor arising from the colon or rectum, is a common cancer in China, with most patients diagnosed at the advanced stage or locally advanced stage. Large tumor size results in the invasion of adjacent organs and the multiple organ involvement, which poses certain challenges for clinical treatment. When facing advanced stage colorectal cancer, some surgeons do not consider surgery, a reasonable option. However, in fact, multi-disciplinary treatment can achieve relatively good treatment outcomes in patients with advanced stage or locally advanced stage colorectal cancer. Therefore, reasonable surgery should not be hastily abandoned. For patients with large tumors without distant metastases but with multiple organ involvement, directly surgical resection is difficult, therefore, preoperative adjuvant therapy can be considered. The basic principle of surgical treatment is to accomplish maximum protection of organ functions and to perform reasonable regional lymph node dissection on the basis of achieving R0 resection. Common surgical procedures for locally advanced colorectal cancer are as follows: (1)Right-sided colon cancer with duodenal invasion: first, the colon must be freed from three directions, namely the right posterior surface of the colon, the left side of the tumor, and the upper side of the tumor inferior to the pylorus, so as to expose and assess the spatial relationship between the tumor and the duodenum; the actual tumor invasion depth in the duodenum may be shallow. (2) Splenic flexure colon cancer with invasion of the cauda pancreatis and hilum lienis: multivisceral resection must be performed without separating the attachment between the tumor and spleen. The tumor border can be found more easily through manipulations starting from the descending colon. (3) Giant sigmoid colorectal cancer with bladder invasion: invasion usually occurs at the bladder fundus. Therefore, during surgery, the attachment between the rectum and

Common data items in seven European oesophagogastric cancer surgery registries: towards a European upper GI cancer audit (EURECCA Upper GI).

PubMed

de Steur, W O; Henneman, D; Allum, W H; Dikken, J L; van Sandick, J W; Reynolds, J; Mariette, C; Jensen, L; Johansson, J; Kolodziejczyk, P; Hardwick, R H; van de Velde, C J H

2014-03-01

Seven countries (Denmark, France, Ireland, the Netherlands, Poland, Sweden, United Kingdom) collaborated to initiate a EURECCA (European Registration of Cancer Care) Upper GI project. The aim of this study was to identify a core dataset of shared items in the different data registries which can be used for future collaboration between countries. Item lists from all participating Upper GI cancer registries were collected. Items were scored 'present' when included in the registry, or when the items could be deducted from other items in the registry. The definition of a common item was that it was present in at least six of the seven participating countries. The number of registered items varied between 40 (Poland) and 650 (Ireland). Among the 46 shared items were data on patient characteristics, staging and diagnostics, neoadjuvant treatment, surgery, postoperative course, pathology, and adjuvant treatment. Information on non-surgical treatment was available in only 4 registries. A list of 46 shared items from seven participating Upper GI cancer registries was created, providing a basis for future quality assurance and research in Upper GI cancer treatment on a European level. Copyright © 2013 Elsevier Ltd. All rights reserved.

Novel single-nucleotide polymorphism markers confirm successful spawning of endangered pallid sturgeon in the upper Missouri River Basin

USGS Publications Warehouse

Eichelberger, Jennifer S.; Braaten, P. J.; Fuller, D. B.; Krampe, Matthew S.; Heist, Edward J.

2014-01-01

Spawning of the federally endangered Pallid Sturgeon Scaphirhynchus albus is known to occur in the upper Missouri River basin, but progeny from natural reproductive events have not been observed and recruitment to juvenile or adult life stages has not been documented in recent decades. Identification of Pallid Sturgeon progeny is confounded by the fact that Shovelnose Sturgeon S. platorynchus occurs throughout the entire range of Pallid Sturgeon and the two species are essentially indistinguishable (morphometrically and meristically) during early life stages. Moreover, free embryos of sympatric Paddlefish Polyodon spathula are very similar to the two sturgeon species. In this study, three single-nucleotide polymorphism (SNP) assays were employed to screen acipenseriform free embryos and larvae collected from the upper Missouri River basin in 2011, 2012, and 2013. A mitochondrial DNA SNP discriminates Paddlefish from sturgeon, and specific multilocus genotypes at two nuclear DNA SNPs occurred in 98.9% of wild adult Pallid Sturgeon but only in 3% of Shovelnose Sturgeon sampled in the upper Missouri River. Individuals identified as potential Pallid Sturgeon based on SNP genotypes were further analyzed at 19 microsatellite loci for species discrimination. Out of 1,423 free embryos collected over 3 years of sampling, 971 Paddlefish, 446 Shovelnose Sturgeon, and 6 Pallid Sturgeon were identified. Additionally, 249 Scaphirhynchus spp. benthic larvae were screened, but no Pallid Sturgeon were detected. These SNP markers provide an efficient method of screening acipenseriform early life stages for the presence of Pallid Sturgeon in the Missouri River basin. Detection of wild Pallid Sturgeon free embryos in the upper Missouri and Yellowstone rivers supports the hypothesis that the failure of wild Pallid Sturgeon to recruit to the juvenile life stage in the upper Missouri River basin is caused by early life stage mortality rather than by lack of successful spawning.

Two-stage, low noise advanced technology fan. 4: Aerodynamic final report

NASA Technical Reports Server (NTRS)

Harley, K. G.; Keenan, M. J.

1975-01-01

A two-stage research fan was tested to provide technology for designing a turbofan engine for an advanced, long range commercial transport having a cruise Mach number of 0.85 -0.9 and a noise level 20 EPNdB below current requirements. The fan design tip speed was 365.8m/sec (1200ft/sec);the hub/tip ratio was 0.4; the design pressure ratio was 1.9; and the design specific flow was 209.2 kg/sec/sq m(42.85lbm/sec/sq ft). Two fan-versions were tested: a baseline configuration, and an acoustically treated configuration with a sonic inlet device. The baseline version was tested with uniform inlet flow and with tip-radial and hub-radial inlet flow distortions. The baseline fan with uniform inlet flow attained an efficiency of 86.4% at design speed, but the stall margin was low. Tip-radial distortion increased stall margin 4 percentage points at design speed and reduced peak efficiency one percentage point. Hub-radial distortion decreased stall margin 4 percentage points at all speeds and reduced peak efficiency at design speed 8 percentage points. At design speed, the sonic inlet in the cruise position reduced stall margin one percentage point and efficiency 1.5 to 4.5 percentage points. The sonic inlet in the approach position reduced stall margin 2 percentage points.

Weekly docetaxel is safe and effective in the treatment of advanced-stage acquired immunodeficiency syndrome-related Kaposi sarcoma.

PubMed

Lim, Soon Thye; Tupule, Anil; Espina, Byron M; Levine, Alexandra M

2005-01-15

Intravenous paclitaxel, 100 mg/m(2), given over 3 hours every 2 weeks is associated with a response rate of 59% in patients with recurrent or refractory acquired immunodeficiency syndrome (AIDS)-related Kaposi sarcoma (KS). However, this regimen is associated with significant myelosuppression, and the inconvenience of a 3-hour infusion. Moreover, no effective therapies have been defined for use after treatment failure with this agent. A Phase II trial was conducted with weekly docetaxel in patients with advanced-stage KS to assess safety and antitumor activity. Docetaxel was administered at a dose of 25 mg/m(2) intravenously over 15-30 minutes weekly for 8 weeks. Thereafter, if the patient experienced stable disease or better response, treatment doses were given every other week until complete disease remission, disease progression, or unacceptable toxicity occurred. Twelve patients were accrued-9 had > 25 mucocutaneous lesions, 1 had lymphedema, and 2 had visceral involvement. Ten patients (83%) had previous systemic chemotherapy, including 4 who received previous paclitaxel. Treatment was well tolerated, with no Grade 4 toxicity of any type. Grade 3 neutropenia occurred in 33% of patients but no patient had neutropenic fever. Five patients (42%) achieved a partial response, including 1 who had previously failed to respond to paclitaxel. The median time to disease progression was 26 months (range, 5-53 months). With a median follow-up period of 45 months, the median survival point had not been reached. Weekly docetaxel is safe, with reasonable antitumor activity in patients with advanced-stage, recurrent, or refractory AIDS-related KS. (c) 2004 American Cancer Society.

Cardiac autonomic modulation impairments in advanced breast cancer patients.

PubMed

Arab, Claudia; Vanderlei, Luiz Carlos Marques; da Silva Paiva, Laércio; Fulghum, Kyle Levi; Fristachi, Carlos Elias; Nazario, Afonso Celso Pinto; Elias, Simone; Gebrim, Luiz Henrique; Ferreira Filho, Celso; Gidron, Yori; Ferreira, Celso

2018-05-02

To compare cardiac autonomic modulation in early- versus advanced-stage breast cancer patients before any type of cancer treatment and investigate associated factors. This cross-sectional study included women (30-69 years old) with primary diagnosis of breast cancer and women with benign breast tumors. We evaluated cardiac modulation by heart rate variability and assessed factors of anxiety, depression, physical activity, and other relevant medical variables. Patients were divided into three groups based on TNM staging of cancer severity: early-stage cancer (n = 42), advanced-stage cancer (n = 37), or benign breast tumors to serve as a control (n = 37). We analyzed heart rate variability in time and frequency domains. The advanced-stage cancer group had lower vagal modulation than early-stage and benign groups; also, the advance-stage group had lower overall heart rate variability when compared to benign conditions. Heart rate variability was influenced by age, menopausal status, and BMI. Heart rate variability seems to be a promising, non-invasive tool for early diagnosis of autonomic dysfunction in breast cancer and detection of cardiovascular impairments at cancer diagnosis. Cardiac autonomic modulation is inversely associated with breast cancer staging.

Effects of wearing rubber gloves on activities of the forearm and shoulder muscles during different dishwashing stages

PubMed Central

Yoo, Won-Gyu

2015-01-01

[Purpose] The present study examined the effects of wearing rubber gloves on the activities of the forearm and shoulder muscles during two dishwashing stages. [Subjects] This study included 10 young females. [Methods] The participants performed two dishwashing stages (washing and rinsing) with and without rubber gloves. The activities of the wrist flexor and upper trapezius muscles were measured using wireless electromyography. [Results] During the washing stage, the activities of the wrist flexor and upper trapezius muscles were significantly greater without gloves than with gloves when performing the same tasks. However, during the rinsing stage, the activities of these muscles did not differ significantly according to the use of gloves. [Conclusion] Dishwashers should wear gloves during the washing stage to prevent wrist and shoulder pain. PMID:26311980

Primed Physical Therapy Enhances Recovery of Upper Limb Function in Chronic Stroke Patients.

PubMed

Ackerley, Suzanne J; Byblow, Winston D; Barber, P Alan; MacDonald, Hayley; McIntyre-Robinson, Andrew; Stinear, Cathy M

2016-05-01

Recovery of upper limb function is important for regaining independence after stroke. To test the effects of priming upper limb physical therapy with intermittent theta burst stimulation (iTBS), a form of noninvasive brain stimulation. Eighteen adults with first-ever chronic monohemispheric subcortical stroke participated in this randomized, controlled, triple-blinded trial. Intervention consisted of priming with real or sham iTBS to the ipsilesional primary motor cortex immediately before 45 minutes of upper limb physical therapy, daily for 10 days. Changes in upper limb function (Action Research Arm Test [ARAT]), upper limb impairment (Fugl-Meyer Scale), and corticomotor excitability, were assessed before, during, and immediately, 1 month and 3 months after the intervention. Functional magnetic resonance images were acquired before and at one month after the intervention. Improvements in ARAT were observed after the intervention period when therapy was primed with real iTBS, but not sham, and were maintained at 1 month. These improvements were not apparent halfway through the intervention, indicating a dose effect. Improvements in ARAT at 1 month were related to balancing of corticomotor excitability and an increase in ipsilesional premotor cortex activation during paretic hand grip. Two weeks of iTBS-primed therapy improves upper limb function at the chronic stage of stroke, for at least 1 month postintervention, whereas therapy alone may not be sufficient to alter function. This indicates a potential role for iTBS as an adjuvant to therapy delivered at the chronic stage. © The Author(s) 2015.

Dynamic Changes in the Myometrium during the Third Stage of Labor, Evaluated Using Two-Dimensional Ultrasound, in Women with Normal and Abnormal Third Stage of Labor and in Women with Obstetric Complications.

PubMed

Patwardhan, Manasi; Hernandez-Andrade, Edgar; Ahn, Hyunyoung; Korzeniewski, Steven J; Schwartz, Alyse; Hassan, Sonia S; Romero, Roberto

2015-01-01

To investigate dynamic changes in myometrial thickness during the third stage of labor. Myometrial thickness was measured using ultrasound at one-minute time intervals during the third stage of labor in the mid-region of the upper and lower uterine segments in 151 patients including: women with a long third stage of labor (n = 30), postpartum hemorrhage (n = 4), preterm delivery (n = 7) and clinical chorioamnionitis (n = 4). Differences between myometrial thickness of the uterine segments and as a function of time were evaluated. There was a significant linear increase in the mean myometrial thickness of the upper uterine segments, as well as a significant linear decrease in the mean myometrial thickness of the lower uterine segments until the expulsion of the placenta (p < 0.001). The ratio of the measurements of the upper to the lower uterine segments increased significantly as a function of time (p < 0.0001). In women with postpartum hemorrhage, preterm delivery, and clinical chorioamnionitis, an uncoordinated pattern among the uterine segments was observed. A well-coordinated activity between the upper and lower uterine segments is demonstrated in normal placental delivery. In some clinical conditions this pattern is not observed, increasing the time for placental delivery and the risk of postpartum hemorrhage. © 2015 S. Karger AG, Basel.

Dynamic changes in the myometrium during the third stage of labor, evaluated using two-dimensional ultrasound, in women with normal and abnormal third stage of labor and in women with obstetric complications

PubMed Central

Patwardhan, Manasi; Hernandez-Andrade, Edgar; Ahn, Hyunyoung; Korzeniewski, Steven J; Schwartz, Alyse; Hassan, Sonia S; Romero, Roberto

2015-01-01

Objective To investigate dynamic changes in myometrial thickness during the third stage of labor. Methods Myometrial thickness was measured using ultrasound at one-minute time intervals during the third stage of labor in the mid-region of the upper and lower uterine segments in 151 patients including: women with a long third stage of labor (n=30), post-partum hemorrhage (n=4), preterm delivery (n=7) or clinical chorioamnionitis (n=4). Differences between uterine segments and as a function of time were evaluated. Results There was a significant linear increase in the mean myometrial thickness of the upper uterine segments, as well as a significant linear decrease in the mean myometrial thickness of the lower uterine segments until the expulsion of the placenta (p<0.001). The ratio of the measurements of the upper to the lower uterine segments increased significantly as a function of time (p<0.0001). In women with postpartum hemorrhage, preterm delivery and clinical chorioamnionitis, an uncoordinated pattern between the uterine segments was observed. Conclusion A well-coordinated activity between the upper and lower uterine segments is demonstrated in normal placental delivery. In some clinical conditions this pattern is not observed, increasing the time for placental delivery and the risk for post-partum hemorrhage. PMID:25634647

[Treatment tactics of hemorroidal disease stage III-IV].

PubMed

Goncharuk, R A; Stegniĭ, K V; Krekoten', A A; Grossman, S S; Sarychev, V A

2013-01-01

The Miligan-Morgan's operation has long been considered to be the "golden standard" of hemorrhoids' stage I-III treatment. The invention of distal branches of the upper rectal artery' suture ligation with mucopexia and lifting of the anal canal mucosa discovered new possibilities for hemorrhoids surgery, though there are still some questions considering long-term results. 151 cases of recurrence within 1-6 months were analyzed. The use of CT-angiography with 3D reconstruction of the upper rectal artery allowed to chose the operative technique more relevant and thus improve the treatment results.

Single stage, low noise, advanced technology fan. Volume 5: Fan acoustics. Section 2: One-third octave data tabulations and selected narrowband traces

NASA Technical Reports Server (NTRS)

Jutras, R. R.

1976-01-01

The raw-acoustic data corrected to standard day, from acoustic tests performed on a 0.508-scale fan vehicle of a 111,300 newton thrust, full-size engine, which has application on an advanced transport aircraft, are presented. The single-stage advanced technology fan was designed to a pressure ratio of 1.8 at a tip speed of 503 m/sec to achieve the desired pressure ratio in a single-stage fan with low radius ratio, and to maintain adequate stall margin. The two basic approaches taken in the acoustic design were: (1) minimization of noise at the source, and (2) suppression of the generated noise in the inlet and bypass exhaust duct. Suppression of the generated noise was accomplished in the inlet through use of the hybrid concept (wall acoustic treatment plus airflow acceleration suppression) and in the exhaust duct with extensive acoustic treatment including a splitter. The goal of the design was attainment of twenty effective perceived noise decibels. The suppression goal of FAR 36-20 was not reached, but improvements in the technology of both front and aft fan-noise suppression were realized.

Treatment of localized-stage follicular lymphoma.

PubMed

Sorigue, Marc; Tuset, Victòria; Sancho, Juan-Manuel

2018-05-12

Follicular lymphoma (FL) is the most common indolent lymphoma and it most frequently presents in an advanced-stage. Therapeutic considerations for advanced-stage are different from those of localized-stage FL, in which radiotherapy (RT) is generally recommended. However, the available evidence suffers from shortcomings that are relatively specific to this clinical entity due to its rarity and long survival with all available treatment modalities, including that most of the existing evidence originated at a time when diagnostic classifications, staging procedures and radiotherapeutic standards were different from those available today and when anti-CD20 monoclonal antibodies were not available. Available treatment modalities include observation, systemic therapy only, RT only and RT in combination with systemic therapy. We review the evidence available with each of them and the data from present day clinical practice studies as well as briefly discuss what diagnostic and therapeutic developments may take place in the next few years. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Scientific Reasoning and Its Relationship with Problem Solving: The Case of Upper Primary Science Teachers

ERIC Educational Resources Information Center

Alshamali, Mahmoud A.; Daher, Wajeeh M.

2016-01-01

This study aimed at identifying the levels of scientific reasoning of upper primary stage (grades 4-7) science teachers based on their use of a problem-solving strategy. The study sample (N = 138; 32 % male and 68 % female) was randomly selected using stratified sampling from an original population of 437 upper primary school teachers. The…

Automatic age-related macular degeneration detection and staging

NASA Astrophysics Data System (ADS)

van Grinsven, Mark J. J. P.; Lechanteur, Yara T. E.; van de Ven, Johannes P. H.; van Ginneken, Bram; Theelen, Thomas; Sánchez, Clara I.

2013-03-01

Age-related macular degeneration (AMD) is a degenerative disorder of the central part of the retina, which mainly affects older people and leads to permanent loss of vision in advanced stages of the disease. AMD grading of non-advanced AMD patients allows risk assessment for the development of advanced AMD and enables timely treatment of patients, to prevent vision loss. AMD grading is currently performed manually on color fundus images, which is time consuming and expensive. In this paper, we propose a supervised classification method to distinguish patients at high risk to develop advanced AMD from low risk patients and provide an exact AMD stage determination. The method is based on the analysis of the number and size of drusen on color fundus images, as drusen are the early characteristics of AMD. An automatic drusen detection algorithm is used to detect all drusen. A weighted histogram of the detected drusen is constructed to summarize the drusen extension and size and fed into a random forest classifier in order to separate low risk from high risk patients and to allow exact AMD stage determination. Experiments showed that the proposed method achieved similar performance as human observers in distinguishing low risk from high risk AMD patients, obtaining areas under the Receiver Operating Characteristic curve of 0.929 and 0.934. A weighted kappa agreement of 0.641 and 0.622 versus two observers were obtained for AMD stage evaluation. Our method allows for quick and reliable AMD staging at low costs.

Language Learning at Key Stage 2: Findings from a Longitudinal Study

ERIC Educational Resources Information Center

Cable, Carrie; Driscoll, Patricia; Mitchell, Rosamond; Sing, Sue; Cremin, Teresa; Earl, Justine; Eyres, Ian; Holmes, Bernardette; Martin, Cynthia; Heins, Barbara

2012-01-01

This paper discusses some of the findings from a 3-year longitudinal study of language learning in the upper stage of English primary schools, i.e. at Key Stage 2. This largely qualitative study (commissioned by the then Department for Children, Schools and Families) was designed to explore and document developing provision and practice in a…

Deciphering tectonic, climatic-induced and hydrothermal signals in the late-stage exhumation history of the upper Rhône valley (Swiss Alps)

NASA Astrophysics Data System (ADS)

Valla, Pierre; Rahn, Meinert; Shuster, David; van der Beek, Peter

2015-04-01

Neogene exhumation of the European Alps is understood as the interplay between tectonics and climatic-induced erosion. While the former has been influenced by a decrease in plate convergence, the latter has been suggested to be affected by climatic variation and the onset of Plio-Quaternary glaciations, leading to relief amplification. However, even though geomorphologic and sedimentologic studies both suggest topographic relief change and transition from fluvial to oscillations between glacial/fluvial conditions, precise quantification on both the timing and magnitude of this transition are yet sparse. Our study focuses on the upper Rhône valley (Swiss Central Alps) within the Visp-Brig area (Aar massif). This area encompasses some of the most spectacular reliefs within the Alps with several nearby summits around or above 4000 m crosscut by the glacially overdeepened Rhône valley. It also shows among the highest late Neogene exhumation rates within the Western-Central European Alps, influenced by tectonic activity along the major Simplon-Rhône extensional fault system. Moreover, the upper Rhône valley has experienced enhanced glacial erosion associated with strong relief development during the Pliocene-Quaternary period. Finally, structural inheritance, late-stage tectonics and rapid exhumation may have promoted recent hydrothermal activity in this region, although timing of its onset and its precise causes remain poorly understood. We investigated the late-stage cooling history by using different low-temperature thermochronometers along a pseudo-vertical bedrock profile (elevation between 600 and 2900 m) and additional samples from an on-site 500-m geothermal well, resulting in a total elevation difference of nearly 3 km. Apatite fission-track (AFT) ages and track-length data have been added to previously published and new apatite (U-Th-Sm)/He (AHe) and 4He/3He data. Our results confirm high-exhumation rates (0.6 to 0.9 km/Myr) within late-Cenozoic to

Geographic divergence in upper thermal limits across insect life stages: does behavior matter?

PubMed

MacLean, Heidi J; Higgins, Jessica K; Buckley, Lauren B; Kingsolver, Joel G

2016-05-01

Insects with complex life cycles vary in size, mobility, and thermal ecology across life stages. We examine how differences in the capacity for thermoregulatory behavior influence geographic differences in physiological heat tolerance among egg and adult Colias butterflies. Colias adults exhibit differences in morphology (wing melanin and thoracic setal length) along spatial gradients, whereas eggs are morphologically indistinguishable. Here we compare Colias eriphyle eggs and adults from two elevations and Colias meadii from a high elevation. Hatching success and egg development time of C. eriphyle eggs did not differ significantly with the elevation of origin. Egg survival declined in response to heat-shock temperatures above 38-40 °C and egg development time was shortest at intermediate heat-shock temperatures of 33-38 °C. Laboratory experiments with adults showed survival in response to heat shock was significantly greater for Colias from higher than from lower elevation sites. Common-garden experiments at the low-elevation field site showed that C. meadii adults initiated heat-avoidance and over-heating behaviors significantly earlier in the day than C. eriphyle. Our study demonstrates the importance of examining thermal tolerances across life stages. Our findings are inconsistent with the hypothesis that thermoregulatory behavior inhibits the geographic divergence of physiological traits in mobile stages, and suggest that sessile stages may evolve similar heat tolerances in different environments due to microclimatic variability or evolutionary constraints.

Groundwater Discharge to Upper Barataria Basin Driven by Mississippi River Stage

NASA Astrophysics Data System (ADS)

Cable, J. E.; Kim, J.; Johannesson, K. H.; Kolker, A.; Telfeyan, K.; Breaux, A.

2017-12-01

Groundwater flow into deltaic wetlands occurs despite the heterogeneous and anisotropic depositional environment of deltas. Along the Mississippi River this groundwater flow is augmented by the vast alluvial aquifer and the levees which confine the river to a zone much more narrow than the historical floodplain. The effect of the levees has been to force the river stage to as much as 10 m above the adjacent back-levee wetlands. Consequently, the head difference created by higher river stages can drive groundwater flow into these wetlands, especially during flood seasons. We measured Rn-222 in the surface waters of a bayou draining a bottomland hardwood swamp in the lower Mississippi River valley over a 14-month period. With a half-life of 3.83 days and its conservative geochemical behavior, Rn-222 is a well-known tracer for groundwater inputs in both fresh and marine environments. Transects from the mouth to the headwaters of the bayou were monitored for Rn-222 in real-time using Rad-7s on a semi-monthly basis. We found that Rn-222 decreased exponentially from the swamp at the headwaters to the mouth of the bayou. Using a mass balance approach, we calculated groundwater inputs to the bayou headwaters and compared these discharge estimates to variations in Mississippi River stage. Groundwater inputs to the Barataria Basin, Louisiana, represent a significant fraction of the freshwater budget of the basin. The flow appears to occur through the sandy Point Bar Aquifer that lies adjacent to the river and underlies many of the freshwater swamps of the Basin. Tracer measurements throughout the Basin in these swamp areas appear to confirm our hypothesis about the outlet for groundwater in this deltaic environment.

Body weight, hemoglobin, and absolute neutrophil count in patients with advanced-stage epithelial ovarian cancer who received chemotherapy: A single-center study

NASA Astrophysics Data System (ADS)

Gunawan, Y.; Winarto, H.

2017-08-01

The side effects of chemotherapy, a treatment modality of ovarian cancer, can disrupt overall treatment. To date, the clinical and laboratory profiles of ovarian cancer patients during chemotherapy have not been investigated. This study aimed to elucidate the clinical and laboratory profiles of patients with advanced-stage epithelial ovarian cancer who received chemotherapy in Dr. Cipto Mangunkusumo Hospital, including body mass index (BMI), hemoglobin (Hb), and absolute neutrophil count (ANC). To generate these clinical and laboratory profiles, we collected secondary data from the medical records of advanced-stage epithelial ovarian cancer patients who received six cycles of carboplatin and paclitaxel chemotherapy. We enrolled 23 patients with advanced-stage epithelial ovarian cancer patients who received six cycles of chemotherapy. Mean patient BMI before and after chemotherapy was 22.86 kg/m2 and 21.78 kg/m2, respectively. Hb levels before chemotherapy were 8-13 g/dl, with Hb < 10 g/dl in one patient (4.35%) and Hb ≥ 10 g/dl in 22 patients (95.65%). Mean ANC was 5845.6 ± 3325.0. An average of 24.65% of patients experienced anemia after each cycle of chemotherapy. Mean ANC before chemotherapy was 3.5582 ± 3.3250. An average of 26.81% of patients had ANC <1500 after each cycle of chemotherapy; no patients had ANC <1500 before chemotherapy initiation. After six cycles of chemotherapy, three patients (13.04%) had mild neutropenia, four patients (17.39%) had moderate neutropenia, and one patient (4.35%) had severe neutropenia. Of the 22 patients with Hb ≥ 10 g/dl before chemotherapy, 16 (72.72%) experienced a decrease in ANC during chemotherapy. Of the 20 patients (60.87%) with normal BMI or higher, 14 experienced a decrease in ANC during chemotherapy. The mean patient body weight decreased after six cycles of chemotherapy. Hb and ANC were persistently decreased in approximately a quarter of the 23 subjects. The decrease in ANC was not influenced by initial Hb

Reflections on the present and future of upper limb prostheses.

PubMed

Farina, Dario; Amsüss, Sebastian

2016-01-01

Despite progress in research and media attention on active upper limb prostheses, presently the most common commercial upper limb prosthetic devices are not fundamentally different from solutions offered almost one century ago. Limited information transfer for both control and sensory-motor integration and challenges in socket technology have been major obstacles. By analysing the present state-of-the-art and academic achievements, we provide our opinion on the future of upper limb prostheses. We believe that surgical procedures for muscle reinnervation and osseointegration will become increasingly clinically relevant; muscle electrical signals will remain the main clinical means for prosthetic control; and chronic electrode implants, first in muscles (control), then in nerves (sensory feedback), will become viable clinical solutions. After decades of suspended clinically relevant progress, it is foreseeable that a new generation of upper limb prostheses will enter the market in the near future based on such advances, thereby offering substantial clinical benefit for patients.

Continuing the Original Stanford Sleep Surgery Protocol From Upper Airway Reconstruction to Upper Airway Stimulation: Our First Successful Case.

PubMed

Liu, Stanley Yung; Riley, Robert Wayne

2017-07-01

In 1993, a surgical protocol for dynamic upper airway reconstruction in patients with obstructive sleep apnea (OSA) was published, and it became commonly known as the Stanford phase 1 and 2 sleep surgery protocol. It served as a platform on which research and clinical studies have continued to perfect the surgical care of patients with OSA. However, relapse is inevitable in a chronic condition such as OSA, and a subset of previously cured surgical patients return with complaints of excessive daytime sleepiness. This report describes a patient who was successfully treated with phase 1 and 2 operations more than a decade previously. He returned at 65 years of age with relapse of moderate OSA, and after workup with polysomnography and drug-induced sleep endoscopy, he underwent upper airway stimulation of the hypoglossal nerve that resulted in a cure of OSA. This case shows why upper airway stimulation is an appropriate option for patients with OSA relapse, after previously successful maxillomandibular advancement. Copyright © 2017. Published by Elsevier Inc.

Ares I-X First Stage Separation Loads and Dynamics Reconstruction

NASA Technical Reports Server (NTRS)

Demory, Lee; Rooker, BIll; Jarmulowicz, Marc; Glaese, John

2011-01-01

The Ares I-X flight test provided NASA with the opportunity to test hardware and gather critical data to ensure the success of future Ares I flights. One of the primary test flight objectives was to evaluate the environment during First Stage separation to better understand the conditions that the J-2X second stage engine will experience at ignition [1]. A secondary objective was to evaluate the effectiveness of the stage separation motors. The Ares I-X flight test vehicle was successfully launched on October 29, 2009, achieving most of its primary and secondary test objectives. Ground based video camera recordings of the separation event appeared to show recontact of the First Stage and the Upper Stage Simulator followed by an unconventional tumbling of the Upper Stage Simulator. Closer inspection of the videos and flight test data showed that recontact did not occur. Also, the motion during staging was as predicted through CFD analysis performed during the Ares I-X development. This paper describes the efforts to reconstruct the vehicle dynamics and loads through the staging event by means of a time integrated simulation developed in TREETOPS, a multi-body dynamics software tool developed at NASA [2]. The simulation was built around vehicle mass and geometry properties at the time of staging and thrust profiles for the first stage solid rocket motor as well as for the booster deceleration motors and booster tumble motors. Aerodynamic forces were determined by models created from a combination of wind tunnel testing and CFD. The initial conditions such as position, velocity, and attitude were obtained from the Best Estimated Trajectory (BET), which is compiled from multiple ground based and vehicle mounted instruments. Dynamic loads were calculated by subtracting the inertial forces from the applied forces. The simulation results were compared to the Best Estimated Trajectory, accelerometer flight data, and to ground based video.

[Factors associated with advanced thyroid cancer in pediatric patients in a high specialty medical unit in Northeast Mexico].

PubMed

García-Castillo, Lizbeth Ariana; Bahena-García, Ana Laura; Sánchez-Sánchez, Luz María; del Carmen Palacios-Saucedo, Gerardo

2015-01-01