Open reduction and internal fixation of patellar fractures with tension band wiring through cannulated screws.

PubMed

Malik, Mudasir; Halwai, Manzoor Ahmad

2014-10-01

The purpose of this study was to evaluate effectiveness and safety of a relatively new technique of open reduction and internal fixation of displaced transverse patellar fractures with tension band wiring (TBW) through parallel cannulated compression screws. A total of 30 patients with displaced transverse patellar fracture were enrolled in this prospective study. Of the 30 patients, 20 patients had trauma due to fall, 5 due to road traffic accident, 2 due to fall of heavy object on the knee, 2 due to forced flexion of knee, and 1 had fracture due to being beaten. All 30 patients were treated with vertical skin exposure, fracture open reduction, and internal fixation by anterior TBW through 4.0 mm cannulated screws. The postoperative rehabilitation protocol was standardized. The patients were followed postsurgery to evaluate time required for radiographic bone union, knee joint range of motion (ROM), loss of fracture reduction, material failure, and the overall functional result of knee using Bostman scoring. All the fractures healed radiologically, at an average time of 10.7 weeks (range, 8-12 weeks). The average ROM arc was 129.7 degrees (range, 115-140 degrees). No patient had loss of fracture reduction, implant migration, or material failure. The average Bostman score was 28.6 out of 30. Anterior TBW through cannulated screws for displaced transverse fractures is safe and effective alternative treatment. Good functional results and recovery can be expected. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Development of Active Catheter,Active Guide Wire and Micro Sensor Systems

PubMed Central

Haga, Y.; Mineta, T.; Totsu, K.; Makishi, W.; Esashi, M.

2001-01-01

Summary Active catheters and active guide wires which move like a snake have been developed for catheter-based minimally invasive diagnosis and therapy. Communication and control IC chips in the active catheter reduce the number of lead wires for control. The active catheter can be not only bent but also torsioned and extended. An ultra minature fiber-optic pressure sensor; a forward-looking ultrasonic probe and a magnetic position and orientation sensor have been developed for catheters and guide wires. These moving mechanisms and several sensors which are fitted near the tip of the catheter and the guide wire will provide detailed information near the tip and enable delicate and effective catheter intervention. PMID:20663389

Ultrasonic Guided Waves for Aging Wire Insulation Assessment

NASA Technical Reports Server (NTRS)

Anastasi, Robert F.; Madaras, Eric I.

2001-01-01

Environmentally aged wire insulation can become brittle and crack and thus expose the underlying conductive wire to the potential for short circuits and fire. The feasibility of using ultrasonic guided waves to measure insulation condition was examined. First a simple model to study guided wave propagation in a bare and thin plastic coated wire was examined and then some aviation grade wire samples that had been heat-damaged. Initial measurements indicate that ultrasonic guided wave velocity can be used to monitor insulation stiffness.

A biomechanical evaluation of a cannulated compressive screw for use in fractures of the scaphoid.

PubMed

Rankin, G; Kuschner, S H; Orlando, C; McKellop, H; Brien, W W; Sherman, R

1991-11-01

The compressive force generated by a 3.5 mm ASIF cannulated cancellous screw with a 5 mm head was compared with that generated by a standard 3.5 mm ASIF screw (6 mm head), a 2.7 mm ASIF screw (5 mm head), and a Herbert screw. The screws were evaluated in the laboratory with the use of a custom-designed load washer (transducer) to the maximum compressive force generated by each screw until failure, either by thread stripping or by head migration into the specimen. Testing was done on paired cadaver scaphoids. To minimize the variability that occurs with human bone, and because of the cost and difficulty of obtaining human tissue specimens, a study was also done on polyurethane foam simulated bones. The 3.5 cannulated screw generated greater compressive forces than the Herbert screw but less compression than the 2.7 mm and 3.5 mm ASIF cortical screws. The 3.5 mm cannulated screw offers more rigid internal fixation for scaphoid fractures than the Herbert screw and gives the added advantage of placement over a guide wire.

Influence of bolt tightening torque, wire size, and component reuse on wire fixation in circular external fixation.

PubMed

Wosar, Marc A; Marcellin-Little, Denis J; Roe, Simon C

2002-01-01

To evaluate the effects of bolt torque, wire size, and component reuse on the ability to maintain wire tension in 3 external skeletal fixation systems. Biomechanical study. Yield strength in tension of 1.0-, 1.2-, 1.5-, and 1.6-mm-diameter wires, and yield strength in torque of Hofmann Small Bone Fixation (SBF) cannulated and slotted bolts and IMEX regular and miniature bolts were determined on a testing machine. The minimum bolt tightening torque needed to prevent wire slippage at clinically recommended wire tensions was determined. Components were tested 10 times, and loads at slippage were recorded. The IMEX system required a mean of 8 Nm of bolt tightening torque to maintain 900 N (1.6-mm wires). The SBF system required a mean of 3 Nm bolt torque to maintain 300 N (1.0-mm wires) and 5 Nm to maintain 600 N (1.2-mm wires). The SBF cannulated bolt required 9 Nm of torque to maintain 900 N (1.5-mm wires). The SBF slotted bolts could only maintain 800 N before yield. The IMEX miniature system required a mean bolt torque of 1.1 Nm to maintain 300 N. The cannulated and slotted bolts from both manufacturers failed to maintain 70% of initial wire tension after 7 and 4 uses, respectively. The IMEX systems and the SBF system using 1.0- and 1.2-mm wires could maintain clinically recommended wire tension safely. Only the IMEX system could maintain clinically recommended wire tension safely using 1.5- or 1.6-mm wires. The SBF system using 1.0- and 1.2-mm wires and the IMEX system using all wire sizes can maintain clinically relevant wire tension. The SBF system using 1.5-mm wires could not. Cannulated and slotted bolts should not be used more than 6 and 3 times, respectively. Nuts should not be reused. Copyright 2002 by The American College of Veterinary Surgeons

Endoscopic treatment for pancreatic diseases: Needle-knife-guided cannulation via the minor papilla

PubMed Central

Wang, Wei; Gong, Biao; Jiang, Wei-Song; Liu, Lei; Bielike, Kouken; Xv, Bin; Wu, Yun-Lin

2015-01-01

AIM: To determine the efficacy and safety of meticulous cannulation by needle-knife. METHODS: Three needle-knife procedures were used to facilitate cannulation in cases when standard cannulation techniques failed. A total of 104 cannulations via the minor papilla attempted in 74 patients at our center between January 2008 and June 2014 were retrospectively reviewed. RESULTS: Standard methods were successful in 79 cannulations. Of the 25 cannulations that could not be performed by standard methods, 19 were performed by needle-knife, while 17 (89.5%) were successful. Needle-knife use improved the success rate of cannulation [76.0%, 79/104 vs 92.3%, (79 + 17)/104; P = 0.001]. When the 6 cases not appropriate for needle-knife cannulation were excluded, the success rate was improved further (80.6%, 79/98 vs 98.0%, 96/98; P = 0.000). There were no significant differences in the rates of post-endoscopic retrograde cholangiopancreatography adverse events between the group using standard methods alone and the group using needle-knife after failure of standard methods (4.7% vs 10.5%, P = 0.301). CONCLUSION: The needle-knife procedure may be an alternative method for improving the success rate of cannulation via the minor papilla, particularly when standard cannulation has failed. PMID:26019460

Endoscopic treatment for pancreatic diseases: Needle-knife-guided cannulation via the minor papilla.

PubMed

Wang, Wei; Gong, Biao; Jiang, Wei-Song; Liu, Lei; Bielike, Kouken; Xv, Bin; Wu, Yun-Lin

2015-05-21

To determine the efficacy and safety of meticulous cannulation by needle-knife. Three needle-knife procedures were used to facilitate cannulation in cases when standard cannulation techniques failed. A total of 104 cannulations via the minor papilla attempted in 74 patients at our center between January 2008 and June 2014 were retrospectively reviewed. Standard methods were successful in 79 cannulations. Of the 25 cannulations that could not be performed by standard methods, 19 were performed by needle-knife, while 17 (89.5%) were successful. Needle-knife use improved the success rate of cannulation [76.0%, 79/104 vs 92.3%, (79 + 17)/104; P = 0.001]. When the 6 cases not appropriate for needle-knife cannulation were excluded, the success rate was improved further (80.6%, 79/98 vs 98.0%, 96/98; P = 0.000). There were no significant differences in the rates of post-endoscopic retrograde cholangiopancreatography adverse events between the group using standard methods alone and the group using needle-knife after failure of standard methods (4.7% vs 10.5%, P = 0.301). The needle-knife procedure may be an alternative method for improving the success rate of cannulation via the minor papilla, particularly when standard cannulation has failed.

Towards Vision-Based Control of a Handheld Micromanipulator for Retinal Cannulation in an Eyeball Phantom

PubMed Central

Becker, Brian C.; Yang, Sungwook; MacLachlan, Robert A.; Riviere, Cameron N.

2012-01-01

Injecting clot-busting drugs such as t-PA into tiny vessels thinner than a human hair in the eye is a challenging procedure, especially since the vessels lie directly on top of the delicate and easily damaged retina. Various robotic aids have been proposed with the goal of increasing safety by removing tremor and increasing precision with motion scaling. We have developed a fully handheld micromanipulator, Micron, that has demonstrated reduced tremor when cannulating porcine retinal veins in an “open sky” scenario. In this paper, we present work towards handheld robotic cannulation with the goal of vision-based virtual fixtures guiding the tip of the cannula to the vessel. Using a realistic eyeball phantom, we address sclerotomy constraints, eye movement, and non-planar retina. Preliminary results indicate a handheld micromanipulator aided by visual control is a promising solution to retinal vessel occlusion. PMID:24649479

Effectiveness of IV Cannulation Skills Laboratory Training and Its Transfer into Clinical Practice: A Randomized, Controlled Trial

PubMed Central

Lund, Frederike; Schultz, Jobst-Hendrik; Maatouk, Imad; Krautter, Markus; Möltner, Andreas; Werner, Anne; Weyrich, Peter; Jünger, Jana; Nikendei, Christoph

2012-01-01

Background The effectiveness of skills laboratory training is widely recognized. Yet, the transfer of procedural skills acquired in skills laboratories into clinical practice has rarely been investigated. We conducted a prospective, randomised, double-blind, controlled trial to evaluate, if students having trained intravenous (IV) cannulation in a skills laboratory are rated as more professional regarding technical and communication skills compared to students who underwent bedside teaching when assessed objectively by independent video assessors and subjectively by patients. Methodology and Principal Findings 84 volunteer first-year medical students were randomly assigned to one of two groups. Three drop-outs occurred. The intervention group (IG; n = 41) trained IV cannulation in a skills laboratory receiving instruction after Peyton's ‘Four-Step Approach’. The control group (CG; n = 40) received a bedside teaching session with volunteer students acting as patients. Afterwards, performance of IV cannulation of both groups in a clinical setting with students acting as patients was video-recorded. Two independent, blinded video assessors scored students' performance using binary checklists (BC) and the Integrated Procedural Protocol Instrument (IPPI). Patients assessed students' performance with the Communication Assessment Tool (CAT) and a modified IPPI. IG required significantly shorter time needed for the performance on a patient (IG: 595.4 SD(188.1)s; CG: 692.7 SD(247.8)s; 95%CI 23.5 s to 45.1 s; p = 0.049) and completed significantly more single steps of the procedure correctly (IG: 64% SD(14) for BC items; CG: 53% SD(18); 95%CI 10.25% to 11.75%; p = 0.004). IG also scored significantly better on IPPI ratings (median: IG: 3.1; CG: 3.6; p = 0.015;). Rated by patients, students' performance and patient-physician communication did not significantly differ between groups. Conclusions Transfer of IV cannulation-related skills acquired in a

Management of Retained Intervention Guide-wire: A Literature Review

PubMed Central

Al-Moghairi, Abdulrahman M; Al-Amri, Hussein S

2013-01-01

Percutaneous coronary angioplasty is increasingly employed in the treatment of patients with complex coronary artery disease. Different steerable guide wires used to open occluded vessel and facilitate balloon and stent deployment. However, the guide-wire itself is not without hazard: it may perforate or dissect the vessel, but fracture or entrapment is uncommon. Its management depends on the clinical situation of the patient, as well as the position and length of the remnant. In this review we discuss the angioplasty guide-wire fracture and entrapment risk factors, potential risks and management. PMID:23116055

Sequential algorithm analysis to facilitate selective biliary access for difficult biliary cannulation in ERCP: a prospective clinical study.

PubMed

Lee, Tae Hoon; Hwang, Soon Oh; Choi, Hyun Jong; Jung, Yunho; Cha, Sang Woo; Chung, Il-Kwun; Moon, Jong Ho; Cho, Young Deok; Park, Sang-Heum; Kim, Sun-Joo

2014-02-17

Numerous clinical trials to improve the success rate of biliary access in difficult biliary cannulation (DBC) during ERCP have been reported. However, standard guidelines or sequential protocol analysis according to different methods are limited in place. We planned to investigate a sequential protocol to facilitate selective biliary access for DBC during ERCP. This prospective clinical study enrolled 711 patients with naïve papillae at a tertiary referral center. If wire-guided cannulation was deemed to have failed due to the DBC criteria, then according to the cannulation algorithm early precut fistulotomy (EPF; cannulation time > 5 min, papillary contacts > 5 times, or hook-nose-shaped papilla), double-guidewire cannulation (DGC; unintentional pancreatic duct cannulation ≥ 3 times), and precut after placement of a pancreatic stent (PPS; if DGC was difficult or failed) were performed sequentially. The main outcome measurements were the technical success, procedure outcomes, and complications. Initially, a total of 140 (19.7%) patients with DBC underwent EPF (n = 71) and DGC (n = 69). Then, in DGC group 36 patients switched to PPS due to difficulty criteria. The successful biliary cannulation rate was 97.1% (136/140; 94.4% [67/71] with EPF, 47.8% [33/69] with DGC, and 100% [36/36] with PPS; P < 0.001). The mean successful cannulation time (standard deviation) was 559.4 (412.8) seconds in EPF, 314.8 (65.2) seconds in DGC, and 706.0 (469.4) seconds in PPS (P < 0.05). The DGC group had a relatively low successful cannulation rate (47.8%) but had a shorter cannulation time compared to the other groups due to early switching to the PPS method in difficult or failed DGC. Post-ERCP pancreatitis developed in 14 (10%) patients (9 mild, 1 moderate), which did not differ significantly among the groups (P = 0.870) or compared with the conventional group (P = 0.125). Based on the sequential protocol analysis, EPF, DGC, and PPS may be safe and feasible for DBC. The use of

Wire-Guide Manipulator For Automated Welding

NASA Technical Reports Server (NTRS)

Morris, Tim; White, Kevin; Gordon, Steve; Emerich, Dave; Richardson, Dave; Faulkner, Mike; Stafford, Dave; Mccutcheon, Kim; Neal, Ken; Milly, Pete

1994-01-01

Compact motor drive positions guide for welding filler wire. Drive part of automated wire feeder in partly or fully automated welding system. Drive unit contains three parallel subunits. Rotations of lead screws in three subunits coordinated to obtain desired motions in three degrees of freedom. Suitable for both variable-polarity plasma arc welding and gas/tungsten arc welding.

MR-compatible polyetheretherketone-based guide wire assisting MR-guided stenting of iliac and supraaortic arteries in swine: feasibility study.

PubMed

Kos, Sebastian; Huegli, Rolf; Hofmann, Eugen; Quick, Harald H; Kuehl, Hilmar; Aker, Stephanie; Kaiser, Gernot M; Borm, Paul J A; Jacob, Augustinus L; Bilecen, Deniz

2009-01-01

The purpose of this study was to demonstrate first magnetic resonance (MR)-guided stenting of iliac and supraaortic arteries using a polyetheretherketone-based (PEEK) MR-compatible guide wire. In vitro and animal experiments were performed in a short magnet wide-bore scanner (1.5 Tesla, Espree, Siemens Healthcare, Erlangen, Germany). For all experiments, a 0.035'' MR-compatible guide wire prototoype was used. This wire had a compound core of PEEK with reinforcing fibres, a soft and atraumatic tip and a hydrophilic coating. For its passive visualization, paramagnetic markings were attached. All experiments were performed through a vascular introducer sheath under MR-guidance. In vitro repetitive selective over the wire catheterizations of either the right carotid artery and the left subclavian artery were performed. In vivo, selective catheterization and over-the-wire stenting of the brachiocephalic trunk and the left subclavian artery were performed. The common iliac arteries were catheterized retrogradely (left) and cross-over (right). Angioplasty and stenting were performed over-the-wire. All procedures were successful. Visibility of the PEEK-based guide-wire was rated good in vitro and acceptable in vivo. Guide wire pushability and endovascular device support were good. The PEEK-based MR-compatible guide wire is well visible and usable under MR-guidance. It supports over-the-wire treatment of iliac arteries and supraaortic arteries.

New concepts and materials for the manufacturing of MR-compatible guide wires.

PubMed

Brecher, Christian; Emonts, Michael; Brack, Alexander; Wasiak, Christian; Schütte, Adrian; Krämer, Nils; Bruhn, Robin

2014-04-01

This paper shows the development of a new magnetic resonance imaging (MRI)-compatible guide wire made from fiber-reinforced plastics. The basic material of the developed guide wire is manufactured using a specially developed micro-pullwinding technology, which allows the adjustment of tensile, bending, and torsional stiffness independent from each other. Additionally, the micro-pullwinding technology provides the possibility to vary the stiffness along the length of the guide wire in a continuous process. With the possibilities of this technology, the mechanical properties of the guide wire were precisely adjusted for the intended usage in MRI-guided interventions. The performance of the guide wire regarding the mechanical properties was investigated. It could be shown, that the mechanical properties could be changed independently from each other by varying the process parameters. Especially, the torsional stiffness could be significantly improved with only a minor influence on bending and tensile properties. The precise influence of the variation of the winding angle on the mechanical and geometrical properties has to be further investigated. The usability of the guide wire as well as its visibility in MRI was investigated by radiologists. With the micro-pullwinding technology, a continuous manufacturing technique for highly stressable, MRI-safe profiles is available and can be the trigger for a new class of medical devices.

Coronary angioscopy: a monorail angioscope with movable guide wire.

PubMed

Nanto, S; Ohara, T; Mishima, M; Hirayama, A; Komamura, K; Matsumura, Y; Kodama, K

1991-03-01

A new angioscope was devised for easier visualization of the coronary artery. In its tip, the angioscope (Olympus) with an outer diameter of 0.8 mm had a metal lumen, through which a 0.014-in steerable guide wire passed. Using a 8F guiding catheter and a guide wire, it was introduced into the distal coronary artery. With injection of warmed saline through the guiding catheter, the coronary segments were visualized. In the attempted 70 vessels (32 left anterior descending [LAD], 10 right coronary [RCA], 28 left circumflex [LCX]) from 48 patients, 60 vessels (86%) were successfully examined. Twenty-two patients who underwent attempted examination of both LAD and LCX; both coronary arteries were visualized in 19 patients (86%). In the proximal site of the lesion, 40 patients have the diagonal branch or the obtuse marginal branch. In 34 patients (85%) the angioscope was inserted beyond these branches. In 12 very tortuous vessels, eight vessels (67%) were examined. In conclusion, the new monorail coronary angioscope with movable guide wire is useful to examine the stenotic lesions of the coronary artery.

Guide wire entrapment by inferior vena cava filters: an experimental study.

PubMed

Rosen, Michael J; Burns, Justin M; Cobb, William S; Jacobs, David G; Heniford, B Todd; Sing, Ronald F

2005-09-01

In situ vena cava filters are at risk for complications with the use of J-tipped guide wires. The purpose of this study was to evaluate the impact of two commonly used J-tipped guide wires on the stability of the four most recently released vena cava filters in an in vitro flow model. Four filters (OptEase [F1], Günther Tulip [F2], Vena Tech LP [F3], and Recovery [F4]) were inserted into an in vitro flow model. Two J-tipped guide wires (0.032-inch [GW-1], 0.035-inch [GW-2]) were passed through each filter (n = 50 passes per wire) for a distance of 10 cm. The inserter was blind as to the effects of the wire. The filters were monitored by an independent observer for adverse events occurring between the filters and the guide wires. These were defined as: migrations (>1 cm), change of position (tilt>10 degrees), and entrapment of the wire (unable to remove wire). Descriptive statistics, chi-square, and Fisher's exact test were used (p < 0.05 considered significant). GW-1 resulted in a lower incidence of entrapment, migration, and tilt for all filters compared with GW-2 (F1, p = 0.003; F2, p < 0.0001; F3, p < 0.0001; F4, p = 0.0004). GW-1 resulted in entrapment in 0%, migration in 7.5%, and tilt in 10.5% of insertions. GW-2 resulted in entrapment in 1%, migration in 26.5%, and tilt in 5.5% of insertions. The incidence of adverse events for GW-1 was significantly different compared with all filters (F1, 0%; F2, 46%; F3, 4%; and F4, 22%; p < 0.0001). Similarly, the incidence of adverse events for GW-2 was significantly different when evaluating all filters (F1, 12%; F2, 48%; F3, 22%; F4 60%; p < 0.0001). The smaller-diameter guide wire resulted in a decreased incidence of adverse events for all filters, but there is still risk for complications. Knowledge of potential complications associated with vena cava filters and the postinsertion use of guide wires are essential to avoid potential mishaps.

Electricity: Residential Wiring. Secondary Schools. Curriculum Guide.

ERIC Educational Resources Information Center

Trust Territory of the Pacific Islands Dept. of Education, Saipan.

This curriculum guide on residential wiring for secondary students is one of six developed for inservice teachers at Marianas High School in Saipan. The guide provides the rationale, description, goals, and objectives of the program; the program of studies and performance objectives by levels; samples of lesson plans for effective delivery of…

Bending stiffness of catheters and guide wires.

PubMed

Wünsche, P; Werner, C; Bloss, P

2002-01-01

An important property of catheters and guide wires to assess their pushability behavior is their bending stiffness. To measure bending stiffness, a new bending module with a new clamping device was developed. This module can easily be mounted in commercially available tensile testing equipment, where bending force and deflection due to the bending force can be measured. To achieve high accuracy for the bending stiffness, the bending distance has to be measured with even higher accuracy by using a laser-scan micrometer. Measurement results of angiographic catheters and guide wires were presented and discussed. The bending stiffness shows a significant dependence on the angle of the test specimen's rotation around its length axis.

Intravascular ultrasound guided wiring re-entry technique for complex chronic total occlusions.

PubMed

Huang, Wei-Chieh; Teng, Hsin-I; Hsueh, Chien-Hung; Lin, Shing-Jong; Chan, Wan-Leong; Lu, Tse-Min

2018-05-03

The successful recanalization rate of chronic total occlusion (CTO) lesions without retrograde collaterals available is always low. Intravascular ultrasound (IVUS) may be useful to guide the subintimal guidewire to re-enter the true lumen. We evaluated the clinical feasibility and efficacy of the IVUS-guided wiring re-entry technique for these complex CTO lesions. Twenty consecutive patients (19 male, mean age: 65.3 ± 12.8 years) with both failed antegrade and retrograde approaches were enrolled. The IVUS catheter was introduced into the subintimal space to identify the entry point into the subintimal space, and guide another stiff wire to re-enter the true lumen with the adjacent side-branch or first wire as markers, or using IVUS-guided parallel wire technique. The entry point into the subintimal space was identified by IVUS in all cases, and the IVUS-guided wiring re-entry technique succeeded in 17 cases (85%). No procedure-related complication was noted except one case of delayed cardiac tamponade due to the wire perforation. During the mean follow-up period of 1.9 ± 1.3 years, there was no adverse cardiac event, except one patient died of the complication of cardiac transplantation. The IVUS-guided wiringre-entry technique might be feasible and safe for the recanalization of complex CTO lesions. © 2018, Wiley Periodicals, Inc.

Accurate guide wire of lag screw placement in the intertrochanteric fractures: a technical note.

PubMed

Li, Jiang; Wang, Liao; Li, Xiaodong; Feng, Kai; Tang, Jian; Wang, Xiaoqing

2017-09-01

Cephalomedullary fixations are commonly used in the treatment of intertrochanteric fractures. In clinical practice, one of the difficulties is when we exit the guide wire in a wrong position of femoral neck and insert near the hole again, the guide wire often flow into the previous track. This study develops a surgical technique to direct the guide wire to slip away the previous track and slip into a right position. When guide wire is exited to the cortex of femoral, we let the wire in and out at the cortical layer for several times to enlarge the entry hole. After that, electric drill is inverted, rubbed and entered slowly at a right angle. When guide wire encountered new resistance, the electric drill is turned back instantly. This technique can help trauma and orthopedic surgeons to obtain precision placement of the lag screw after the first try is failed.

Cannulated screw and cable are superior to modified tension band in the treatment of transverse patella fractures.

PubMed

Tian, Yun; Zhou, Fang; Ji, Hongquan; Zhang, Zhishan; Guo, Yan

2011-12-01

Although the modified tension band technique (eg, tension band supplemented by longitudinal Kirschner wires) has long been the mainstay for fixation of transverse fractures of the patella, it has shortcomings, such as bad reduction, loosening of implants, and skin irritation. We conducted a retrospective comparison of the modified tension band technique and the titanium cable-cannulated screw tension band technique. We retrospectively reviewed 101 patients aged 22 to 85 years (mean, 56.6 years) with AO/OTA 34-C1 fractures (n = 68) and 34-C2 fractures (n = 33). Fifty-two patients were in the modified tension band group and 49 were in the titanium cable-cannulated screw tension band group. Followup was at least 1 year (range, 1-3 years). Comparison criteria were fracture reduction, fracture healing time, and the Iowa score for knee function. The titanium cable-cannulated screw tension band group showed improved fracture reduction, reduced healing time, and better Iowa score, compared with the modified tension band group. In the modified tension band group, eight patients experienced wire migration, three of these requiring a second operation. There were no complications in the titanium cable-cannulated screw tension band group. The titanium cable-cannulated screw tension band technique showed superior results and should be considered as an alternative method for treatment of transverse patellar fractures. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Silicon sensors for catheters and guide wires

NASA Astrophysics Data System (ADS)

Goosen, Hans F.

2001-11-01

One area that can make use of the miniature size of present day micro electromechanical systems (MEMS) is that of the medical field of minimally invasive interventions. These procedures, used for both diagnosis and treatment, use catheters that are advanced through the blood vessels deep into the body, without the need for surgery. However, once inside the body, the doctor performing the procedure is completely reliant on the information the catheter(s) can provide in addition to the projection imaging of a fluoroscope. A good range of sensors for catheters is required for a proper diagnosis. To this end, miniature sensors are being developed to be fitted to catheters and guide wires. As the accurate positioning of these instruments is problematic, it is necessary to combine several sensors on the same guide wire or catheter to measure several parameters in the same location. This however, brings many special problems to the design of the sensors, such as small size, low power consumption, bio-compatibility of materials, robust design for patient safety, a limited number of connections, packaging, etc. This paper will go into both the advantages and design problems of micromachined sensors and actuators in catheters and guide wires. As an example, a multi parameter blood sensor, measuring flow velocity, pressure and oxygen saturation, will be discussed.

The efficacy of nasal tip hold-press on venous cannulation pain in children: a prospective randomize controlled study.

PubMed

Maghsoudi, Behzad; Jookar, Mehrdad; Haddad, Hosein; Zoonobi, Zahra; Rakhshan, Mahnaz

2016-12-22

Venipuncture is a common and quiet unpleasant experience for pediatric patients. The pain associated with venous cannulation disturbs the children. Different methods have been used to minimize the pain. The present study evaluated the efficacy of holding and pressing the tip of the nose on the venipuncture pain in pediatric patients. A prospective randomize controlled study carried out using the Visual analogue scale (YAS) for assessment cannulation pain and the Yale preoperative anxiety scale (YPAS) for the assessment of anxiety before cannulation. 60 patients, 6-12 years old, who needed venipuncture for general anesthesia were divided in to two groups of 30 each: the control and the study group. Nasal tip was held and pressed during venipuncture by the parents in the study group. No intervention was done in the control group. The anxiety scale (YPAS) was not different between the two groups before venous cannulation (P = 0.136). Comparing the two groups. There was no different regarding the change in HR and BP during venous cannulation. There was significantly lower cannulation pain in the study in comparison with the control group (P value = 0.010). Holding and pressing the tip of the nose during venipuncture reduce the severity of venipuncture pain in pediatric patients. This could be secondary to distraction along with the physiological effect of the valsalva maneuver on pain. Therefore, we recommend that holding and pressing the tip of the nose is a safe and effective method for reducing the severity of pain from venipuncture in pediatric patients.

Samurai cannulation (direct true-lumen cannulation) for acute Stanford Type A aortic dissection.

PubMed

Kitamura, Tadashi; Torii, Shinzo; Kobayashi, Kensuke; Tanaka, Yuki; Sasahara, Akihiro; Ohtomo, Yuki; Horikoshi, Rihito; Miyaji, Kagami

2018-02-27

In this study, we investigated early outcomes of patients who underwent surgical aortic repair for acute Stanford Type A aortic dissection at the Kitasato University Hospital and compared the results of Samurai cannulation (direct true-lumen cannulation) with other cannulation options. Inpatient and outpatient records were retrospectively reviewed. Among the 100 patients who were operated on for acute Type A aortic dissection between April 2011 and April 2017, sole Samurai cannulation was used in 61 patients (Group S) and other cannulation options were used in the remaining 39 patients (Group O). No significant difference was observed in preoperative demographics between the groups. True-lumen cannulation was successful in all Group S patients, whereas 3 cannulation-related complications were observed in Group O patients. In Group S, the 30-day and in-hospital mortality occurred in 3 (5%) and 4 (7%) patients, respectively, and in Group O, these occurred in 3 (8%), and 6 (15%) patients, respectively. Four patients in each group (7% and 10%) experienced disabling or fatal strokes. Early mortality or stroke rate between the groups were not significantly different. During follow-up, there was no statistically significant difference between the groups in terms of survival, freedom from aorta-related death or freedom from aortic events. Early outcomes of the initial series of surgery for Stanford Type A aortic dissection with Samurai cannulation was favourable with acceptable mortality and stroke rates without cannulation-related complications. Samurai cannulation represents an easy, safe and reasonable option for cardiopulmonary bypass in surgery for acute Stanford Type A aortic dissection.

Operation and force analysis of the guide wire in a minimally invasive vascular interventional surgery robot system

NASA Astrophysics Data System (ADS)

Yang, Xue; Wang, Hongbo; Sun, Li; Yu, Hongnian

2015-03-01

To develop a robot system for minimally invasive surgery is significant, however the existing minimally invasive surgery robots are not applicable in practical operations, due to their limited functioning and weaker perception. A novel wire feeder is proposed for minimally invasive vascular interventional surgery. It is used for assisting surgeons in delivering a guide wire, balloon and stenting into a specific lesion location. By contrasting those existing wire feeders, the motion methods for delivering and rotating the guide wire in blood vessel are described, and their mechanical realization is presented. A new resistant force detecting method is given in details. The change of the resistance force can help the operator feel the block or embolism existing in front of the guide wire. The driving torque for rotating the guide wire is developed at different positions. Using the CT reconstruction image and extracted vessel paths, the path equation of the blood vessel is obtained. Combining the shapes of the guide wire outside the blood vessel, the whole bending equation of the guide wire is obtained. That is a risk criterion in the delivering process. This process can make operations safer and man-machine interaction more reliable. A novel surgery robot for feeding guide wire is designed, and a risk criterion for the system is given.

A nurse-guided, basal-prandial insulin treatment protocol for achieving glycaemic control of hospitalized, non-critically ill diabetes patients, is non-inferior to physician-guided therapy: A pivotal, nurse-empowerment study.

PubMed

Segal, Gad; Karniel, Eli; Mahagna, Ahmed; Kaa'dan, Fadi; Levi, Zehava; Balik, Chaya

2015-12-01

Basal-prandial insulin is established for glycaemic control for hospitalized, type 2 diabetes patients. Empowering nurses to guide such protocols could be advantageous.The study aims to comparatively assess the efficacy and safety of glycaemic control by a nurse-guided protocol with physician-guided therapy. It also aims to assess the impact of empowerment on the nurses' sense of competence. This is a prospective, controlled, randomized, single-blinded study. Validated protocol utilizing basal-prandial insulin was used. Glycaemic control was the primary efficacy outcome, whereas hypoglycaemia and laboratory parameters were followed for safety. Assessment of nurses' psychological empowerment was done. One hundred fifty-eight treatment days of 53 patients were included. Patients were randomized to either study group (n = 27) or control group (n = 26). Glycaemia deviation from liberal range (60-300 mg/dL) was 7.4% of days for nurse-guided, basal-prandial insulin treatment protocol (NGP) and 7.84% for physician-guided therapy (PGT), P = 0.901. Rate of glycaemia deviation from the strict range (100-180 mg/dL) was 49.76% for NGP and 47.38% for PGT, P = 0.703. Mean range of daily deviation was similar (77.05 mg/dL for NGP and 76.04 mg/dL for PGT, P = 0.93). There were no significant differences in safety parameters. An empowerment questionnaire showed tendency for increased nurses' sense of competence. Nurse-guided protocol is non-inferior to physician-guided treatment in efficacy and safety parameters. Nurses' sense of competence was positively influenced. © 2014 Wiley Publishing Asia Pty Ltd.

Use of fluoroscopy-guided wire manipulation and/or laparoscopic surgery in the repair of malfunctioning peritoneal dialysis catheters.

PubMed

Kim, Hee Jin; Lee, Tae Won; Ihm, Chun Gyoo; Kim, Myung Jae

2002-01-01

Peritoneal catheter is the lifeline for the continuous ambulatory peritoneal dialysis (CAPD) patients. Over the years, obstruction or displacement of the CAPD catheter has been one of the common complications of CAPD. Fluoroscopy-guided wire manipulation or laparoscopic surgery has been developed to manage outflow obstruction. We analyzed the catheter outcome of fluoroscopy-guided wire manipulation or laparoscopic surgery to determine the ultimate benefit of these procedures. From June 1996 to August 2000, catheter complications were manipulated in 24 patients. Eleven (46%) of these patients were initially managed by guide wire under fluoroscopic control. The remaining 13 (54%) patients were manipulated by laparoscopic surgery. A successful outcome was defined as maintained normal peritoneal catheter function at 30 days after the manipulations. Among the catheters manipulated, 18 (75%) were inserted by nephrologist and 6 (25%) by surgeons at the initiation of CAPD. Tenckhoff double-cuff peritoneal catheters were inserted to all patients. The time elapsed between catheter insertion and manipulation varied from 1 to 60 days with a mean of 11 days. The primary causes of catheter malfunction were kinking in 1 case, omental wrapping with adhesions in 9 cases, and catheter displacements in the remaining 14 cases. Thirty-day catheter function was achieved in 50% (12/24) of initial catheter manipulations, with guide wire under fluoroscopic control (46%, 5/11) and laparoscopic surgery (54%, 7/13). Overall success rate of repeated manipulation was 71% (17 of 24). The successful outcome in repairing of the malfunctioning CAPD catheters could be increased by the combination of fluoroscopy-guided wire manipulation and laparoscopic surgery. Copyright 2002 S. Karger AG, Basel

Mountain Plains Learning Experience Guide: Electrical Wiring. Course: Electrical Wiring Trim-Out.

ERIC Educational Resources Information Center

Arneson, R.; And Others

One of two individualized courses included in an electrical wiring curriculum, this course covers electrical materials installation for the trim-out stage. The course is comprised of five units: (1) Outlets, (2) Fixtures, (3) Switches, (4) Appliances, and (5) Miscellaneous. Each unit begins with a Unit Learning Experience Guide that gives…

Residential Wiring. Fourth Edition. Teacher Edition [and] Student Guide [and] Student Workbook.

ERIC Educational Resources Information Center

Taylor, Mark

Residential Wiring, the second publication in a series of three wiring publications, prepares students for entry-level employment in the residential wiring trade. Instructional materials include a teacher edition, student guide, and student workbook. The teacher edition begins with introductory pages, including a training and competency profile,…

Extra Luminal Entrapment of Guide Wire; A Rare Complication of Central Venous Catheter Placement in Right Internal Jugular Vein.

PubMed

Ansari, Md Abu Masud; Kumar, Naveen; Kumar, Shailesh; Kumari, Sarita

2016-10-01

Central venous Catheterization (CVC) is a commonly performed procedure for venous access. It is associated with several complications. We report a rare case of extra luminal entrapment of guide wire during CVC placement in right jugular vein. We report a case of 28 years old female patient presented in our emergency with history of entrapped guide wire in right side of neck during CVC. X-ray showed coiling of guide wire in neck. CT Angiography showed guide wire coursing in between common carotid artery and internal jugular vein (IJV), closely abutting the wall of both vessels. The guide wire was coiled with end coursing behind the esophageal wall. Guide wire was removed under fluoroscopic guide manipulation under local anesthesia. We want to emphasize that even though CVC placement is common and simple procedure, serious complication can occur in hands of untrained operator. The procedure should be performed under supervision, if done by trainee. Force should never be applied to advance the guide wire if resistance is encountered.

Aging Wire Insulation Assessment by Phase Spectrum Examination of Ultrasonic Guided Waves

NASA Technical Reports Server (NTRS)

Anastasi, Robert F.; Madaras, Eric I.

2003-01-01

Wire integrity has become an area of concern to the aerospace community including DoD, NASA, FAA, and Industry. Over time and changing environmental conditions, wire insulation can become brittle and crack. The cracks expose the wire conductor and can be a source of equipment failure, short circuits, smoke, and fire. The technique of using the ultrasonic phase spectrum to extract material properties of the insulation is being examined. Ultrasonic guided waves will propagate in both the wire conductor and insulation. Assuming the condition of the conductor remains constant then the stiffness of the insulator can be determined by measuring the ultrasonic guided wave velocity. In the phase spectrum method the guided wave velocity is obtained by transforming the time base waveform to the frequency domain and taking the phase difference between two waveforms. The result can then be correlated with a database, derived by numerical model calculations, to extract material properties of the wire insulator. Initial laboratory tests were performed on a simple model consisting of a solid cylinder and then a solid cylinder with a polymer coating. For each sample the flexural mode waveform was identified. That waveform was then transformed to the frequency domain and a phase spectrum was calculated from a pair of waveforms. Experimental results on the simple model compared well to numerical calculations. Further tests were conducted on aircraft or mil-spec wire samples, to see if changes in wire insulation stiffness can be extracted using the phase spectrum technique.

Retrieval of a subintimal fractured guide wire from the brachial artery following saphenous vein graft stenting.

PubMed

Danson, Edward J; Ward, Michael

2015-06-01

We present a case of a 58-year-old woman with diabetes mellitus with a history of angina, coronary artery bypass 24 years previously and who underwent retrieval of a fractured coronary buddy wire from the right brachial artery following attempted coronary intervention to a saphenous vein graft via the right radial route. Attempted removal of the guide wire had caused guide catheter-induced dissection of the vein graft in addition to a distal stent edge dissection before fracture in the brachial artery. The fractured end of the buddy wire was found to be in the subintimal space and could only be retrieved by advancing the wire into the subclavian artery by means of wrapping its free portion around the guiding catheter. Its fractured end could then be snared into the guiding catheter but could only be withdrawn from behind the stented segment in the vein graft by means of a trap balloon in the guiding catheter. Successful stenting of a guide catheter-induced dissection and distal stent edge dissection within the vein graft was then performed. This case highlights the hazards of deploying stents over buddy wires and of fractured guide wires in coronary intervention. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

A comparison of longitudinal and transverse approaches to ultrasound-guided axillary vein cannulation by experienced operators.

PubMed

He, Yi-Zhou; Zhong, Ming; Wu, Wei; Song, Jie-Qiong; Zhu, Du-Ming

2017-04-01

The axillary vein is an easily accessible vessel that can be used for ultrasound-guided central vascular access and offers an alternative to the internal jugular and subclavian veins. The objective of this study was to identify which transducer orientation, longitudinal or transverse, is better for imaging the axillary vein with ultrasound. We analyzed 236 patients who had undergone central venous cannulation of axillary vein in this retrospective study. Patients were divided into two groups, the longitudinal approach group (n=120) and transverse approach group (n=116). Recorded the one-attempt success rate, operation time, arterial puncture rate and pneumothorax rate. We perform chest radiography to confirm pneumothorax on all patients. We compared the one-attempt success rate, operation time, arterial puncture rate and pneumothorax rate between the two groups. The two groups were comparable with clinical characters of patients. The overall success rates of the longitudinal group and the transverse group were both 100%. The rate of one-attempt success in the longitudinal approach group is higher than the transverse approach group (91.7% vs. 82.8%, P=0.040). The transverse approach group had shorter operation time than the longitudinal group (184.7±8.1 vs. 287.5±19.6 seconds, P=0.000). The two groups had lower postoperative complications. Arterial puncture occurred in 1 of 120 longitudinal and 2 of 116 transverse attempts and this difference was no significant (P=0.541). No pneumothorax occurred in the two groups. The longitudinal approach during ultrasound-guided axillary vein cannulation is associated with greater one-attempt success rate compared with the transverse approach by experienced operators. The transverse approach has shorter operation time. The two groups have lower postoperative complications and are comparable with pneumothorax and arterial puncture.

A comparison of longitudinal and transverse approaches to ultrasound-guided axillary vein cannulation by experienced operators

PubMed Central

He, Yi-Zhou; Zhong, Ming; Wu, Wei; Song, Jie-Qiong

2017-01-01

Background The axillary vein is an easily accessible vessel that can be used for ultrasound-guided central vascular access and offers an alternative to the internal jugular and subclavian veins. The objective of this study was to identify which transducer orientation, longitudinal or transverse, is better for imaging the axillary vein with ultrasound. Methods We analyzed 236 patients who had undergone central venous cannulation of axillary vein in this retrospective study. Patients were divided into two groups, the longitudinal approach group (n=120) and transverse approach group (n=116). Recorded the one-attempt success rate, operation time, arterial puncture rate and pneumothorax rate. We perform chest radiography to confirm pneumothorax on all patients. We compared the one-attempt success rate, operation time, arterial puncture rate and pneumothorax rate between the two groups. Results The two groups were comparable with clinical characters of patients. The overall success rates of the longitudinal group and the transverse group were both 100%. The rate of one-attempt success in the longitudinal approach group is higher than the transverse approach group (91.7% vs. 82.8%, P=0.040). The transverse approach group had shorter operation time than the longitudinal group (184.7±8.1 vs. 287.5±19.6 seconds, P=0.000). The two groups had lower postoperative complications. Arterial puncture occurred in 1 of 120 longitudinal and 2 of 116 transverse attempts and this difference was no significant (P=0.541). No pneumothorax occurred in the two groups. Conclusions The longitudinal approach during ultrasound-guided axillary vein cannulation is associated with greater one-attempt success rate compared with the transverse approach by experienced operators. The transverse approach has shorter operation time. The two groups have lower postoperative complications and are comparable with pneumothorax and arterial puncture. PMID:28523170

Computed tomography angiography-fluoroscopy image fusion allows visceral vessel cannulation without angiography during fenestrated endovascular aneurysm repair.

PubMed

Schwein, Adeline; Chinnadurai, Ponraj; Behler, Greg; Lumsden, Alan B; Bismuth, Jean; Bechara, Carlos F

2018-07-01

Fenestrated endovascular aneurysm repair (FEVAR) is an evolving technique to treat juxtarenal abdominal aortic aneurysms (AAAs). Catheterization of visceral and renal vessels after the deployment of the fenestrated main body device is often challenging, usually requiring additional fluoroscopy and multiple digital subtraction angiograms. The aim of this study was to assess the clinical utility and accuracy of a computed tomography angiography (CTA)-fluoroscopy image fusion technique in guiding visceral vessel cannulation during FEVAR. Between August 2014 and September 2016, all consecutive patients who underwent FEVAR at our institution using image fusion guidance were included. Preoperative CTA images were fused with intraoperative fluoroscopy after coregistering with non-contrast-enhanced cone beam computed tomography (syngo 3D3D image fusion; Siemens Healthcare, Forchheim, Germany). The ostia of the visceral vessels were electronically marked on CTA images (syngo iGuide Toolbox) and overlaid on live fluoroscopy to guide vessel cannulation after fenestrated device deployment. Clinical utility of image fusion was evaluated by assessing the number of dedicated angiograms required for each visceral or renal vessel cannulation and the use of optimized C-arm angulation. Accuracy of image fusion was evaluated from video recordings by three raters using a binary qualitative assessment scale. A total of 26 patients (17 men; mean age, 73.8 years) underwent FEVAR during the study period for juxtarenal AAA (17), pararenal AAA (6), and thoracoabdominal aortic aneurysm (3). Video recordings of fluoroscopy from 19 cases were available for review and assessment. A total of 46 vessels were cannulated; 38 of 46 (83%) of these vessels were cannulated without angiography but based only on image fusion guidance: 9 of 11 superior mesenteric artery cannulations and 29 of 35 renal artery cannulations. Binary qualitative assessment showed that 90% (36/40) of the virtual ostia overlaid

Subarachnoid and basal cistern navigation through the sacral hiatus with guide wire assistance.

PubMed

Layer, Lauren; Riascos, Roy; Firouzbakht, Farhood; Amole, Adewumi; Von Ritschl, Rudiger; Dipatre, Pier; Cuellar, Hugo

2011-07-01

Intraspinal navigation with catheters and fiberscopes has shown feasible results for diagnosis and treatment of intraspinal and intracranial lesions. The most common approach, lumbar puncture, has allowed access to the spinal cord, however, coming with the difficulties of fiberscope damage and decreased torque for guidance. Our objective in this study is to allow an alternate access, the sacral hiatus, with guide wire assistance into the subarachnoid and intracranial structures, while easing the angle of entry and increasing torque. We advanced catheters with guide wire and fluoroscopy assistance into the sacral hiatus of three cadavers. After entry, the thecal sac was punctured and the catheter with guide wire was advanced rostrally until positioned in the basal cisterns of the brain. We confirmed catheter placement with contrast injection, autopsy, and dissection. In our study, the sacral hiatus was easily accessed, but resistance was found when attempting to puncture the thecal sac. The advancement of the catheter with guide wire assistance glided easily rostrally until some mild resistance was discovered at entry into the foramen magnum. With redirection, all catheters passed with ease into the basal cisterns. Positioning was confirmed with contrast injection with fluoroscopy evidence, autopsy, and dissection. There was no macroscopic or microscopic evidence of damage to the spinal roots, spinal cord, or cranial nerves. The sacral hiatus with guide wire assistance is an accessible conduit for uncomplicated entry into the subarachnoid and basal cistern space without damaging surrounding structures.

Application of Ultrasonic Guided Waves for Evaluating Aging Wire Insulation

NASA Technical Reports Server (NTRS)

Anastasi, Robert F.; Madaras, Eric I.

2005-01-01

Aging wiring has become a critical issue to the aerospace and aircraft industries due to Shuttle and aircraft incidents. The problem is that over time the insulation on wire becomes brittle and cracks. This exposes the underlying conductive wire to the potential for short circuits and fire. Popular methods of monitoring aging wire problems focuses on applying electrical sensing techniques that are sensitive to the conductor's condition, but not very sensitive to the wire insulation's condition. Measurement of wire insulation stiffness and ultrasonic properties by ultrasonic guided waves is being examined. Experimental measurements showed that the lowest order extensional mode could be sensitive to stiffness changes in the wire insulation. To test this theory conventional wire samples were heat damaged in an oven, in a range of heating conditions. The samples were 12, 16, and 20 gauge and the heat damage introduced material changes in the wire insulation that made the originally flexible insulation brittle and darker in color. Results showed that extensional mode phase velocity increased for the samples that were exposed to heat for longer duration.

Inexpensive homemade models for ultrasound-guided vein cannulation training.

PubMed

Di Domenico, Stefano; Santori, Gregorio; Porcile, Elisa; Licausi, Martina; Centanaro, Monica; Valente, Umberto

2007-11-01

To test the hypothesis that low-cost homemade models may be used to acquire the basic skills for ultrasound-guided central vein puncture. Training study. University transplantation department. Training was performed using three different homemade models (A, B, and C). Segments of a common rubber tourniquet (V1) and Silastic tube (V2) were used to simulate vessels within agar-based models. Overall cost for each model was less than 5 euro (US$7). For each test (test I, A-V1; II, A-V2; III, B-V1; IV, C-V2), the number of punctures and attempts needed to locate the needle inside the lumen were recorded. Each test was considered completed when participants punctured the vessels at the first attempt for three consecutive times. In test I, the mean number of punctures and attempts were 3.85 +/- 1.26 and 4.95 +/- 3.05; in test II, 4.60 +/- 1.14 and 6.30 +/- 2.51; in test III, 4.80 +/- 1.06 and 4.65 +/- 2.21; and in test IV, 4.45 +/- 1.23 and 6.05 +/- 2.92, respectively. For each test, no statistical difference was found by comparison of number of punctures and attempts for anesthesiologists versus nonanesthesiologists, men versus women, or previous experience versus no experience with central vein cannulation (CVC). Video game users obtained better results than did nonusers in test I (punctures, P = 0.033; attempts, P = 0.038), test II (punctures, P = 0.052; attempts, P = 0.011), and test IV (punctures, P = 0.001; attempts, P = 0.003). A posttraining questionnaire showed favorable opinions about the clarity of the instructions, aptness of the models, and adequacy of the training. In our operative unit, the use of ultrasound guidance for CVC increased from 2% to 23% in the first month after training. Low-cost homemade models are useful in acquiring basic coordination skills for ultrasound-guided CVC.

A Phase 1 Study of a Novel Bidirectional Perfusion Cannula in Patients Undergoing Femoral Cannulation for Cardiac Surgery.

PubMed

Marasco, Silvana F; Tutungi, Elli; Vallance, Shirley A; Udy, Andrew A; Negri, Justin C; Zimmet, Adam D; McGiffin, David C; Pellegrino, Vincent A; Moshinsky, Randall A

Leg ischemia is a serious complication of femoral artery cannulation. The primary aim of this study was to assess the safety and efficacy of a novel bidirectional femoral arterial cannula (Sorin Group USA, a wholly owned subsidiary of LivaNova PLC, Arvada, CO USA) that provides both antegrade and retrograde flow, in patients undergoing peripheral cannulation for cardiopulmonary bypass during cardiac surgery. Patients undergoing routine cardiac surgery requiring femoral artery cannulation for cardiopulmonary bypass were identified preoperatively. Informed written consent was obtained in all cases. Bidirectional cannula insertion used either a surgical cut-down and wire through needle approach or a percutaneous technique. Flow in the superficial femoral artery was assessed using Doppler ultrasound after commencement of cardiopulmonary bypass. Lower limb perfusion was assessed using reflectance near-infrared spectroscopy to measure regional oxygen saturations in the cannulated limb during cardiopulmonary bypass. Fifteen patients (median age = 61.3 years, range = 26-79 years, 10 males, 5 females) underwent femoral arterial cannulation using the novel bidirectional femoral cannula between August 2016 and May 2017. Fourteen cannulae were inserted directly into the femoral artery via a surgical cut-down and wire through needle technique. One bidirectional cannula was inserted using a percutaneous insertion technique. Indications included minimally invasive mitral and aortic valve surgery, thoracic aortic aneurysm repair, and redo cardiac surgery. The median duration of cardiopulmonary bypass was 129 minutes (range = 53-228 minutes). The cannula was inserted and positioned without difficulty in 14 of 15 patients. Incorrect sizing and arterial spasm prevented correct cannula positioning in one patient. Antegrade flow in the superficial femoral artery was observed on Doppler ultrasound in 12 of 12 patients in which this was performed. Continuous stable distal perfusion was

Entrapment of Guide Wire in an Inferior Vena Cava Filter: A Technique for Removal

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

Abdel-Aal, Ahmed Kamel, E-mail: akamel@uabmc.edu; Saddekni, Souheil; Hamed, Maysoon Farouk

Entrapment of a central venous catheter (CVC) guide wire in an inferior vena cava (IVC) filter is a rare, but reported complication during CVC placement. With the increasing use of vena cava filters (VCFs), this number will most likely continue to grow. The consequences of this complication can be serious, as continued traction upon the guide wire may result in filter dislodgement and migration, filter fracture, or injury to the IVC. We describe a case in which a J-tipped guide wire introduced through a left subclavian access without fluoroscopic guidance during CVC placement was entrapped at the apex of anmore » IVC filter. We describe a technique that we used successfully in removing the entrapped wire through the left subclavian access site. We also present simple useful recommendations to prevent this complication.« less

Investigating the Use of Ultrasonic Guided Waves for Aging Wire Insulation Assessment

NASA Technical Reports Server (NTRS)

Anastasi, Robert F.; Madaras, Eric I.

2002-01-01

Aging wiring has become a critical issue to DoD, NASA, FAA, and Industry. The problem is that insulation on environmentally aged wire becomes brittle and cracks. This exposes the underlying conductive wire to the potential for short circuits and fire. The difficulty is that techniques to monitor aging wire problems focus on applying electrical sensing techniques that are not very sensitive to the wire insulation. Thus, the development of methods to quantify and monitor aging wire insulation is highly warranted. Measurement of wire insulation stiffness by ultrasonic guided waves is being examined. Initial laboratory tests were performed on a simple model consisting of a solid cylinder and then a solid cylinder with a polymer coating. Experimental measurements showed that the lowest order axisymmetric mode may be sensitive to stiffness changes in the wire insulation. To test this theory, mil-spec wire samples MIL-W-81381, MIL-W-22759/34, and MIL-W-22759/87 (typically found in aircraft) were heat-damaged in an oven, in a range of heating conditions. The samples were 12, 16, and 20 gauge and the heat-damage introduced material changes in the wire-insulation that made the originally flexible insulation brittle and darker in color. Axisymmetric mode phase velocity increased for the samples that were exposed to heat for longer duration. For example, the phase velocity in the 20-gauge MIL-W-22759/34 wire changed from a baseline value of 2790m/s to 3280m/s and 3530m/s for one-hour exposures to 3490C and 3990C, respectively. Although the heat-damage conditions are not the same as environmental aging, we believe that with further development and refinements, the ultrasonic guided waves can be used to inspect wire-insulation for detrimental environmental aging conditions.

Magnetic guide-wire navigation in pulmonary and systemic arterial catheterization: initial experience in pigs.

PubMed

Grosse-Wortmann, Lars; Grabitz, Ralf; Seghaye, Marie-Christine

2007-04-01

Cardiovascular catheterization can be challenging whenever a stenosis or an abnormal vascular course interferes with probing the target vessel. This study addresses the feasibility of navigating a guide wire with a magnetic tip by an external magnetic field through pulmonary and systemic arteries in an experimental porcine model. We investigated six piglets using magnetic guide-wire navigation. Two pulmonary arteriograms were taken from different angles in order to reconstruct the three-dimensional vessel anatomy. A computer interface then calculated three-dimensional coordinates for the vessel in space. Using these coordinates, two external magnets were positioned to create magnetic vectors along the expected vessel course. Magnetically enabled guide wires were then navigated into the vessels using the magnetic field to orient the guide-wire tips. Aortic and renal branches were addressed in a similar fashion. Difficulty in reaching the target vessel was reflected by the number of attempts that were necessary. After 10 failed attempts, the maneuver was recorded to have failed. Thirty-five of 37 (94.6%) arteries with branches at acute angles were reached successfully using magnetic navigation. In two pigs, the left upper lobe artery could not be probed. Peripheral arteries of small diameter were easier to reach than large central arteries, requiring less attempts. Magnetic guide-wire navigation is feasible in the arteries of the lungs, the head and neck, and the kidneys. It is particularly useful in entering small arterial branches at acute angles and may facilitate interventional therapy in a variety of vascular diseases in children and adults.

Sphincterotomy by triple lumen needle knife using guide wire in patients with Billroth II gastrectomy

PubMed Central

Park, Su Bum; Kim, Hyung Wook; Kang, Dae Hwan; Choi, Cheol Woong; Yoon, Ki Tae; Cho, Mong; Song, Byeong Jun

2013-01-01

AIM: To investigate the usefulness of a guide wire and triple lumen needle knife for removing stones in Billroth II (B-II) gastrectomy patients. METHODS: Endoscopic sphincterotomy in patients with B-II gastrectomy is challenging. We used a new guide wire technique involving sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy. This technique was performed in nine patients between August 2010 and June 2012. Sphincterotomy as described above was performed. Adequate sphincterotomy, successful stone removal, and complications were investigated prospectively. RESULTS: Sphincterotomy by triple lumen needle knife using guide wire was successful in all nine patients. Sphincterotomy started towards the 4-5 o’clock direction and continued to the upper margin of the papillary roof. Complete stone removal in one session was achieved in all patients. There were no procedure related complications, such as bleeding, pancreatitis, or perforation. CONCLUSION: In patients with B-II gastrectomy, guide wire using sphincterotomy by triple lumen needle knife through a forward-viewing endoscopy seems to be an effective and safe procedure for the removal of common bile duct stones. PMID:24409069

Entrapment of guide-wire during oesophageal dilation.

PubMed

Misra, S P; Dwivedi, M

1997-01-01

We report a patient who developed oesophageal stricture after accidental ingestion of acid. During one of the oesophageal dilation sessions, a Savary-Gillard guide-wire got entrapped in the stomach and had to be removed surgically. A Foley catheter, placed for feeding purposes, migrated into the proximal small intestine causing acute intestinal obstruction. The balloon of the Foley catheter had to be punctured using a sclerotherapy needle and the catheter withdrawn.

Vapocoolants (cold spray) for pain treatment during intravenous cannulation.

PubMed

Griffith, Rebecca J; Jordan, Vanessa; Herd, David; Reed, Peter W; Dalziel, Stuart R

2016-04-26

Intravenous cannulation is a painful procedure that can provoke anxiety and stress. Injecting local anaesthetic can provide analgesia at the time of cannulation, but it is a painful procedure. Topical anaesthetic creams take between 30 and 90 minutes to produce an effect. A quicker acting analgesic allows more timely investigation and treatment. Vapocoolants have been used in this setting, but studies have reported mixed results. To determine effects of vapocoolants on pain associated with intravenous cannulation in adults and children. To explore variables that might affect the performance of vapocoolants, including time required for application, distance from the skin when applied and time to cannulation. To look at adverse effects associated with the use of vapocoolants. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Latin American Caribbean Health Sciences Literature (LILACS), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Institute for Scientific Information (ISI) Web of Science and the http://clinicaltrials.gov/, http://www.controlled-trials.com/ and http://www.trialscentral.org/ databases to 1 May 2015. We applied no language restrictions. We also scanned the reference lists of included papers. We included all blinded and unblinded randomized controlled trials (RTCs) comparing any vapocoolant with placebo or control to reduce pain during intravenous cannulation in adults and children. Three review authors independently assessed trial quality and extracted data, contacted study authors for additional information and assessed included studies for risk of bias. We collected and analysed data for the primary outcome of pain during cannulation, and for the secondary outcomes of pain associated with application of the vapocoolant, first attempt success rate of intravenous cannulation, adverse events and participant satisfaction. We performed subgroup analyses for the primary outcome to examine

Ultrasonography-guided central venous catheterisation in haematological patients with severe thrombocytopenia

PubMed Central

Napolitano, Mariasanta; Malato, Alessandra; Raffaele, Francesco; Palazzolo, Manuela; Iacono, Giorgio Lo; Pinna, Roberto; Geraci, Girolamo; Modica, Giuseppe; Saccullo, Giorgia; Siragusa, Sergio; Cajozzo, Massimo

2013-01-01

Background Cannulation of the internal jugular vein (CVC) is a blind surface landmark-guided technique that could be potentially dangerous in patients with very low platelet counts. In such patients, ultrasonography (US)-guided CVC may be a valid approach. There is a lack of published data on the efficacy and safety of urgent US-guided CVC performed in haematological patients with severe thrombocytopenia. Materials and methods We retrospectively studied the safety of urgent CVC procedures in haematological patients including those with severe thrombocytopenia (platelet count <30×109/L). From January 1999 to June 2009, 431 CVC insertional procedures in 431 consecutive patients were evaluated. Patients were included in the study if they had a haematological disorder and required urgent CVC insertion. Patients were placed in Trendelenburg's position, an 18-gauge needle and guide-wire were advanced under real-time US guidance into the last part of the internal jugular vein; central venous cannulation of the internal jugular vein was performed using the Seldinger technique in all the procedures. Major and minor procedure-related complications were recorded. Results All 431 patients studied had haematological disorders: 39 had severe thrombocytopenia, refractory to platelet transfusion (group 1), while 392 did not have severe thrombocytopenia (group 2). The general characteristics of the patients in the two groups differed only for platelet count. The average time taken to perform the procedure was 4 minutes. Success rates were 97.4% and 97.9% in group 1 and group 2, respectively. No major complications occurred in either group. Discussion US-guided CVC is a safe and effective approach in haematological patients with severe thrombocytopenia requiring urgent cannulation for life support, plasma-exchange, chemotherapy and transfusion. PMID:23399356

Physician Attitudes toward Adopting Genome-Guided Prescribing through Clinical Decision Support

PubMed Central

Overby, Casey Lynnette; Erwin, Angelika Ludtke; Abul-Husn, Noura S.; Ellis, Stephen B.; Scott, Stuart A.; Obeng, Aniwaa Owusu; Kannry, Joseph L.; Hripcsak, George; Bottinger, Erwin P.; Gottesman, Omri

2014-01-01

This study assessed physician attitudes toward adopting genome-guided prescribing through clinical decision support (CDS), prior to enlisting in the Clinical Implementation of Personalized Medicine through Electronic Health Records and Genomics pilot pharmacogenomics project (CLIPMERGE PGx). We developed a survey instrument that includes the Evidence Based Practice Attitude Scale, adapted to measure attitudes toward adopting genome-informed interventions (EBPAS-GII). The survey also includes items to measure physicians’ characteristics (awareness, experience, and perceived usefulness), attitudes about personal genome testing (PGT) services, and comfort using technology. We surveyed 101 General Internal Medicine physicians from the Icahn School of Medicine at Mount Sinai (ISMMS). The majority were residency program trainees (~88%). Prior to enlisting into CLIPMERGE PGx, most physicians were aware of and had used decision support aids. Few physicians, however, were aware of and had used genome-guided prescribing. The majority of physicians viewed decision support aids and genotype data as being useful for making prescribing decisions. Most physicians had not heard of, but were willing to use, PGT services and felt comfortable interpreting PGT results. Most physicians were comfortable with technology. Physicians who perceived genotype data to be useful in making prescribing decisions, had more positive attitudes toward adopting genome-guided prescribing through CDS. Our findings suggest that internal medicine physicians have a deficit in their familiarity and comfort interpreting and using genomic information. This has reinforced the importance of gathering feedback and guidance from our enrolled physicians when designing genome-guided CDS and the importance of prioritizing genomic medicine education at our institutions. PMID:25562141

A haptic device for guide wire in interventional radiology procedures.

PubMed

Moix, Thomas; Ilic, Dejan; Bleuler, Hannes; Zoethout, Jurjen

2006-01-01

Interventional Radiology (IR) is a minimally invasive procedure where thin tubular instruments, guide wires and catheters, are steered through the patient's vascular system under X-ray imaging. In order to perform these procedures, a radiologist has to be trained to master hand-eye coordination, instrument manipulation and procedure protocols. The existing simulation systems all have major drawbacks: the use of modified instruments, unrealistic insertion lengths, high inertia of the haptic device that creates a noticeably degraded dynamic behavior or excessive friction that is not properly compensated for. In this paper we propose a quality training environment dedicated to IR. The system is composed of a virtual reality (VR) simulation of the patient's anatomy linked to a robotic interface providing haptic force feedback. This paper focuses on the requirements, design and prototyping of a specific haptic interface for guide wires.

Iatrogenic submucosal tunnel in the ureter: a rare complication during advancement of the guide wire.

PubMed

El Darawany, Hamed; Barakat, Alaa; Madi, Maha Al; Aldamanhori, Reem; Al Otaibi, Khalid; Al-Zahrani, Ali A

2016-01-01

Inserting a guide wire is a common practice during endo-urological procedures. A rare complication in patients with ureteral stones where an iatrogenic submucosal tunnel (IST) is created during endoscopic guide wire placement. Summarize data on IST. Retrospective descriptive study of patients treated from from October 2009 until January 2015. King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. Patients with ureteral stones were divided to 2 groups. In group I (335 patients), the ureteral stones were removed by ureteroscopy in one stage. Group II (97 patients) had a 2-staged procedure starting with a double J-stent placement for kidney drainage followed within 3 weeks with ureteroscopic stone removal. Endoscopic visualization of ureteric submucosal tunneling by guide wire. IST occurred in 9/432 patients with ureteral stones (2.1%). The diagnosis in group I was made during ureteroscopy by direct visualization of a vanishing guide wire at the level of the stone (6 patients). In group II, IST was suspected when renal pain was not relieved after placement of the double J-stent or if imaging by ultrasound or intravenous urography showed persistent back pressure to the obstructed kidney (3 patients). The condition was subsequently confirmed by ureteroscopy. Forceful advancement of the guide wire in an inflamed and edematous ureteral segment impacted by a stone is probably the triggering factor for development of IST. Definitive diagnosis is possible only by direct visualization during ureteroscopy. Awareness of this potential complication is important to guard against its occurrence. Relatively small numbers of subjects and the retrospective nature of the study.

Basic Wiring. Fourth Edition. Teacher Edition [and] Student Guide [and] Student Workbook 1 [and] Student Workbook 2.

ERIC Educational Resources Information Center

Kaltwasser, Stan; Flowers, Gary; Blasingame, Don

Basic Wiring, first in a series of three wiring publications, serves as the foundation for students enrolled in a wiring program. It is a prerequisite to Commercial and Industrial Wiring or Residential Wiring. Instructional materials include a teacher edition, student guide, and two student workbooks. The teacher edition begins with introductory…

Radiofrequency Guide Wire Recanalization of Venous Occlusions in Patients with Malignant Superior Vena Cava Syndrome

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

Davis, Robert M.; David, Elizabeth; Pugash, Robyn A.

Fibrotic central venous occlusions in patients with thoracic malignancy and prior radiotherapy can be impassable with standard catheters and wires, including the trailing or stiff end of a hydrophilic wire. We report two patients with superior vena cava syndrome in whom we successfully utilized a radiofrequency guide wire (PowerWire, Baylis Medical, Montreal, Quebec, Canada) to perforate through the occlusion and recanalize the occluded segment to alleviate symptoms.

Performance of magnetic field‐guided navigation system for interventional neurosurgical and cardiac procedures

PubMed Central

Chu, James C.H.; Hsi, Wen Chien; Hubbard, Lincoln; Zhang, Yunkai; Bernard, Damian; Reeder, Pamela; Lopes, Demetrius

2005-01-01

A hospital‐based magnetic guidance system (MGS) was installed to assist a physician in navigating catheters and guide wires during interventional cardiac and neurosurgical procedures. The objective of this study is to examine the performance of this magnetic field‐guided navigation system. Our results show that the system's radiological imaging components produce images with quality similar to that produced by other modern fluoroscopic devices. The system's magnetic navigation components also deflect the wire and catheter tips toward the intended direction. The physician, however, will have to oversteer the wire or catheter when defining the steering angle during the procedure. The MGS could be clinically useful in device navigation deflection and vessel access. PACS numbers: 07.55.Db, 07.85.‐m PMID:16143799

Use of Flexible Cystoscopy to Insert a Foley Catheter over a Guide Wire in Spinal Cord Injury Patients: Special Precautions to be Observed.

PubMed

Vaidyanathan, Subramanian; Soni, Bakul; Singh, Gurpreet; Hughes, Peter; Oo, Tun

2011-01-01

When urethral catheterisation is difficult or impossible in spinal cord injury patients, flexible cystoscopy and urethral catheterisation over a guide wire can be performed on the bedside, thus obviating the need for emergency suprapubic cystostomy. Spinal cord injury patients, who undergo flexible cystoscopy and urethral catheterisation over a guide wire, may develop potentially serious complications. (1) Persons with lesion above T-6 are susceptible to develop autonomic dysreflexia during cystoscopy and urethral catheterisation over a guide wire; nifedipine 5-10 milligrams may be administered sublingually just prior to the procedure to prevent autonomic dysreflexia. (2) Spinal cord injury patients are at increased risk for getting urine infections as compared to able-bodied individuals. Therefore, antibiotics should be given to patients who get haematuria or urethral bleeding following urethral catheterisation over a guide wire. (3) Some spinal cord injury patients may have a small capacity bladder; in these patients, the guide wire, which is introduced into the urinary bladder, may fold upon itself with the tip of guide wire entering the urethra. If this complication is not recognised and a catheter is inserted over the guide wire, the Foley catheter will then be misplaced in urethra despite using cystoscopy and guide wire.

Use of Flexible Cystoscopy to Insert a Foley Catheter over a Guide Wire in Spinal Cord Injury Patients: Special Precautions to be Observed

PubMed Central

Vaidyanathan, Subramanian; Soni, Bakul; Singh, Gurpreet; Hughes, Peter; Oo, Tun

2011-01-01

When urethral catheterisation is difficult or impossible in spinal cord injury patients, flexible cystoscopy and urethral catheterisation over a guide wire can be performed on the bedside, thus obviating the need for emergency suprapubic cystostomy. Spinal cord injury patients, who undergo flexible cystoscopy and urethral catheterisation over a guide wire, may develop potentially serious complications. (1) Persons with lesion above T-6 are susceptible to develop autonomic dysreflexia during cystoscopy and urethral catheterisation over a guide wire; nifedipine 5–10 milligrams may be administered sublingually just prior to the procedure to prevent autonomic dysreflexia. (2) Spinal cord injury patients are at increased risk for getting urine infections as compared to able-bodied individuals. Therefore, antibiotics should be given to patients who get haematuria or urethral bleeding following urethral catheterisation over a guide wire. (3) Some spinal cord injury patients may have a small capacity bladder; in these patients, the guide wire, which is introduced into the urinary bladder, may fold upon itself with the tip of guide wire entering the urethra. If this complication is not recognised and a catheter is inserted over the guide wire, the Foley catheter will then be misplaced in urethra despite using cystoscopy and guide wire. PMID:22110492

A Kirschner wire as a transverse-axis guide to improve acetabular cup positioning.

PubMed

Ishidou, Y; Hirotsu, M; Setoguchi, T; Nagano, S; Kakoi, H; Yokouchi, M; Yamamoto, T; Komiya, S

2016-04-01

To compare cup-positioning accuracy in total hip arthroplasty (THA) with or without use of a Kirschner wire as a transverse-axis guide for pelvic alignment. Records of 18 men and 73 women (mean age, 60 years) who underwent primary THA with (n=49) or without (n=42) use of a Kirschner wire as a transverse-axis guide for pelvic alignment were reviewed. A 2.4-mm Kirschner wire as a transversea-xis guide was inserted to the anterior superior iliac spine and was parallel to a line linking the left and right anterior superior iliac spine. The safe zone for cup positioning was defined as 30º to 50° abduction and 10º to 30º anteversion. Of the 5 operative surgeons, 2 were classified as experienced (total surgical volume >300) and 3 as inexperienced (total surgical volume of <50). The proportion of patients with the cup in the safe zone was compared in patients with or without use of the transverse-axis guide and in experienced and inexperienced surgeons. For inexperienced surgeons, the use of the transverse-axis guide significantly improved the proportion of patients with the cup in the safe zone from 90% to 100% for abduction, from 50% to 82.4% for anteversion, and from 40% to 82.4% for both. Patients with the cup inside or outside the safe zone were comparable in terms of body height, weight, BMI, subcutaneous fat thickness, incision length, and acetabular cup size. The use of the transverse-axis guide improved the accuracy of cup positioning by inexperienced surgeons.

Use of a very flexible guide wire to permit dilation of complex malignant strictures of the esophagus.

PubMed

Vargas-Tank, L; Ovalle, L; Fernández, C; Mella, B; Estay, R; del Solar, M P; Soto, J R

1995-01-01

Risk of perforation is a major impediment to the use of polyvinyl bougies in palliative dilation of cancerous strictures of the esophagus. We encountered 23 patients with complex malignant strictures in whom initial dilation with Savary-Gilliard bougies was thwarted because attempts to pass a conventional Eder-Puestow guide wire were unsuccessful. As a recourse, we probed these strictures with a very flexible guide wire of the type used to implant prostheses in the biliary tract. The purpose was to establish a passage through which a standard guide wire could then be inserted. The procedure was successful in all but 4 of the 23 patients. We conclude that in such cases the preliminary use of the very flexible guide, even though time-consuming, improves the chance of effective dilation with minimal added risk.

Plasma arc torch with coaxial wire feed

DOEpatents

Hooper, Frederick M

2002-01-01

A plasma arc welding apparatus having a coaxial wire feed. The apparatus includes a plasma arc welding torch, a wire guide disposed coaxially inside of the plasma arc welding torch, and a hollow non-consumable electrode. The coaxial wire guide feeds non-electrified filler wire through the tip of the hollow non-consumable electrode during plasma arc welding. Non-electrified filler wires as small as 0.010 inches can be used. This invention allows precision control of the positioning and feeding of the filler wire during plasma arc welding. Since the non-electrified filler wire is fed coaxially through the center of the plasma arc torch's electrode and nozzle, the wire is automatically aimed at the optimum point in the weld zone. Therefore, there is no need for additional equipment to position and feed the filler wire from the side before or during welding.

Patella Fracture Fixation with Suture and Wire: you Reap what you Sew

PubMed Central

Egol, Kenneth; Howard, Daniel; Monroy, Alexa; Crespo, Alexander; Tejwani, Nirmal; Davidovitch, Roy

2014-01-01

Introduction Operative fixation of displaced inferior pole patella fractures has now become the standard of care. This study aims to quantify clinical, radiographic and functional outcomes, as well as identify complications in a cohort of patients treated with non-absorbable braided suture fixation for inferior pole patellar fractures. These patients were then compared to a control group of patients treated for mid-pole fractures with K-wires or cannulated screws with tension band wiring. Methods In this IRB approved study, we identified a cohort of patients who were diagnosed and treated surgically for a displaced patella fracture. Demographic, injury, and surgical information were recorded. All patients were treated with a standard surgical technique utilizing non-absorbable braided suture woven through the patellar tendon and placed through drill holes to achieve reduction and fracture fixation. All patients were treated with a similar post-operative protocol and followed up at standard intervals. Data were collected concurrently at follow up visits. For purpose of comparison, we identified a control cohort with middle third patella fractures treated with either k-wires or cannulated screws and tension band technique. Patients were followed by the treating surgeon at regular follow-up intervals. Outcomes included self-reported function and knee range of motion compared to the uninjured side. Results Forty-nine patients with 49 patella fractures identified retrospectively were treated over 9 years. This cohort consisted of 31 females (63.3%) and 18 males (36.7%) with an average age of 57.1 years (range 26 - 88 years). Patients had an average BMI of 26.48 (range 19 - 44.08). Thirteen patients with inferior pole fractures underwent suture fixation and 36 patients with mid-pole fractures underwent tension band fixation (K-wire or cannulated screws with tension band). In the suture cohort, one fracture failed open repair (7.6%), which was revised again with sutures

Patella fracture fixation with suture and wire: you reap what you sew.

PubMed

Egol, Kenneth; Howard, Daniel; Monroy, Alexa; Crespo, Alexander; Tejwani, Nirmal; Davidovitch, Roy

2014-01-01

Operative fixation of displaced inferior pole patella fractures has now become the standard of care. This study aims to quantify clinical, radiographic and functional outcomes, as well as identify complications in a cohort of patients treated with non-absorbable braided suture fixation for inferior pole patellar fractures. These patients were then compared to a control group of patients treated for mid-pole fractures with K-wires or cannulated screws with tension band wiring. In this IRB approved study, we identified a cohort of patients who were diagnosed and treated surgically for a displaced patella fracture. Demographic, injury, and surgical information were recorded. All patients were treated with a standard surgical technique utilizing non-absorbable braided suture woven through the patellar tendon and placed through drill holes to achieve reduction and fracture fixation. All patients were treated with a similar post-operative protocol and followed up at standard intervals. Data were collected concurrently at follow up visits. For purpose of comparison, we identified a control cohort with middle third patella fractures treated with either k-wires or cannulated screws and tension band technique. Patients were followed by the treating surgeon at regular follow-up intervals. Outcomes included self-reported function and knee range of motion compared to the uninjured side. Forty-nine patients with 49 patella fractures identified retrospectively were treated over 9 years. This cohort consisted of 31 females (63.3%) and 18 males (36.7%) with an average age of 57.1 years (range 26-88 years). Patients had an average BMI of 26.48 (range 19-44.08). Thirteen patients with inferior pole fractures underwent suture fixation and 36 patients with mid-pole fractures underwent tension band fixation (K-wire or cannulated screws with tension band). In the suture cohort, one fracture failed open repair (7.6%), which was revised again with sutures and progressed to union. Of the 36

Pre-operative localization of solitary pulmonary nodules with computed tomography-guided hook wire: report of 181 patients.

PubMed

Hanauer, Matthieu; Perentes, Jean Yannis; Krueger, Thorsten; Ris, Hans-Beat; Bize, Pierre; Schmidt, Sabine; Gonzalez, Michel

2016-01-16

Video-assisted thoracic surgery (VATS) is currently performed to diagnose and treat solitary pulmonary nodules (SPN). However, the intra-operative identification of deep nodules can be challenging with VATS as the lung is difficult to palpate. The aim of the study was to report the utility and the results of pre-operative computed tomography (CT)-guided hook wire localization of SPN. All records of the patients undergoing CT-guided hook wire localization prior to VATS resection for SPN between 2002 and 2013 were reviewed. The efficacy in localizing the nodule, hook wire complications, necessity to convert VATS to thoracotomy and the histology of SPN are reported. One hundred eighty-one patients (90 females, mean age 63 y, range 28-82 y) underwent 187 pulmonary resections after CT-guided hook wire localization. The mean SPN diameter was 10.3 mm (range: 4-29 mm). The mean distance of the lesion from the pleural surface was 11.6 mm (range: 0-45 mm). The mean time interval from hook wire insertion to VATS resection was 224 min (range 54-622 min). Hook wire complications included pneumothorax requiring chest tube drainage in 4 patients (2.1%) and mild parenchymal haemorrhage in 11 (5.9%) patients. Migration of the hook wire occurred in 7 patients (3.7%) although it did not affect the success of VATS resection (nodule location guided by the lung puncture site). Three patients underwent additional wedge resection by VATS during the same procedure because no lesion was identified in the surgical specimen. Conversion thoracotomy was required in 13 patients (7 %) for centrally localized lesions (6 patients) and pleural adhesions (7 patients). The mean operative time was 60 min (range 18-135 min). Pathological examination revealed a malignant lesion in 107 patients (59 %). The diagnostic yield was 98.3 %. VATS resection for SPN after CT-guided hook wire localization for SPN is safe and allows for proper diagnosis with a low thoracotomy conversion rate.

Dual wire welding torch and method

DOEpatents

Diez, Fernando Martinez; Stump, Kevin S.; Ludewig, Howard W.; Kilty, Alan L.; Robinson, Matthew M.; Egland, Keith M.

2009-04-28

A welding torch includes a nozzle with a first welding wire guide configured to orient a first welding wire in a first welding wire orientation, and a second welding wire guide configured to orient a second welding wire in a second welding wire orientation that is non-coplanar and divergent with respect to the first welding wire orientation. A method of welding includes moving a welding torch with respect to a workpiece joint to be welded. During moving the welding torch, a first welding wire is fed through a first welding wire guide defining a first welding wire orientation and a second welding wire is fed through a second welding wire guide defining a second welding wire orientation that is divergent and non-coplanar with respect to the first welding wire orientation.

A new cannulation method for isolated mitral valve surgery--"apicoaortic-pa" cannulation.

PubMed

Wada, J; Komatsu, S; Nakae, S; Kazui, T

1976-06-01

The present paper describes experimental and clinical studies of a new method "Apicoaortic-PA" cannulation for mitral valve surgery. Our experimental study showed that this method was more rapid and more physiological for cardiopulmonary bypass. We used this technique in 55 cases of isolated mitral valve surgery with successful results. Our general philosophy of surgical approach to the mitral valve diseases is also discussed. We advocate the utilization of the "Apicoaortic Pulmonary Artery" cannulation method for clinical use in isolated mitral valve surgery through the left thoracotomy.

A Prospective Randomized Controlled Trial of Nonpharmacological Pain Management During Intravenous Cannulation in a Pediatric Emergency Department.

PubMed

Miller, Kate; Tan, Xianghong; Hobson, Andrew Dillon; Khan, Asaduzzaman; Ziviani, Jenny; OʼBrien, Eavan; Barua, Kim; McBride, Craig A; Kimble, Roy M

2016-07-01

Intravenous (IV) cannulation is commonly performed in pediatric emergency departments (EDs). The busy ED environment is often not conducive to conventional nonpharmacological pain management. This study assessed the use of Ditto (Diversionary Therapy Technologies, Brisbane, Australia), a handheld electronic device which provides procedural preparation and distraction, as a means of managing pain and distress during IV cannulation performed in the pediatric ED. A randomized controlled trial with 98 participants, aged 3 to 12 years, was conducted in a pediatric ED. Participants were recruited and randomized into 5 intervention groups as follows: (1) Standard Distraction, (2) PlayStation Portable Distraction, (3) Ditto Distraction, (4) Ditto Procedural Preparation, and (5) Ditto Preparation and Distraction. Children's pain and distress levels were assessed via self-reports and observational reports by caregivers and nursing staff across the following 3 time points: (1) before, (2) during, and (3) after IV cannulation. Caregivers and nursing staff reported significantly reduced pain and distress levels in children accessing the combined preparation and distraction Ditto protocol, as compared to standard distraction (P ≤ 0.01). This intervention also saw the greatest reduction in pain and distress as reported by the child. Caregiver reports indicate that using the combined Ditto protocol was most effective in reducing children's pain experiences while undergoing IV cannulation in the ED. The use of Ditto offers a promising opportunity to negotiate barriers to the provision of nonpharmacological approaches encountered in the busy ED environment, and provide nonpharmacological pain-management interventions in pediatric EDs.

The development of a guideline implementability tool (GUIDE-IT): a qualitative study of family physician perspectives

PubMed Central

2014-01-01

useful, but urged to involve “regular” or community family physicians in the process, and suggested that an online system would be the most efficient way to deliver it. Conclusions Our study identified facilitators and barriers of guideline implementability from the perspective of community and academic family physicians that will be used to build our GUIDE-IT prototype. Our findings build on current knowledge by showing that family physicians perceive guideline uptake mostly according to factors that are in the control of guideline developers. PMID:24476491

Real-time ultrasound-guided catheterisation of the internal jugular vein: a prospective comparison with the landmark technique in critical care patients

PubMed Central

Karakitsos, Dimitrios; Labropoulos, Nicolaos; De Groot, Eric; Patrianakos, Alexandros P; Kouraklis, Gregorios; Poularas, John; Samonis, George; Tsoutsos, Dimosthenis A; Konstadoulakis, Manousos M; Karabinis, Andreas

2006-01-01

Introduction Central venous cannulation is crucial in the management of the critical care patient. This study was designed to evaluate whether real-time ultrasound-guided cannulation of the internal jugular vein is superior to the standard landmark method. Methods In this randomised study, 450 critical care patients who underwent real-time ultrasound-guided cannulation of the internal jugular vein were prospectively compared with 450 critical care patients in whom the landmark technique was used. Randomisation was performed by means of a computer-generated random-numbers table, and patients were stratified with regard to age, gender, and body mass index. Results There were no significant differences in gender, age, body mass index, or side of cannulation (left or right) or in the presence of risk factors for difficult venous cannulation such as prior catheterisation, limited sites for access attempts, previous difficulties during catheterisation, previous mechanical complication, known vascular abnormality, untreated coagulopathy, skeletal deformity, and cannulation during cardiac arrest between the two groups of patients. Furthermore, the physicians who performed the procedures had comparable experience in the placement of central venous catheters (p = non-significant). Cannulation of the internal jugular vein was achieved in all patients by using ultrasound and in 425 of the patients (94.4%) by using the landmark technique (p < 0.001). Average access time (skin to vein) and number of attempts were significantly reduced in the ultrasound group of patients compared with the landmark group (p < 0.001). In the landmark group, puncture of the carotid artery occurred in 10.6% of patients, haematoma in 8.4%, haemothorax in 1.7%, pneumothorax in 2.4%, and central venous catheter-associated blood stream infection in 16%, which were all significantly increased compared with the ultrasound group (p < 0.001). Conclusion The present data suggest that ultrasound-guided

PPM-based System for Guided Waves Communication Through Corrosion Resistant Multi-wire Cables

NASA Astrophysics Data System (ADS)

Trane, G.; Mijarez, R.; Guevara, R.; Pascacio, D.

Novel wireless communication channels are a necessity in applications surrounded by harsh environments, for instance down-hole oil reservoirs. Traditional radio frequency (RF) communication schemes are not capable of transmitting signals through metal enclosures surrounded by corrosive gases and liquids. As an alternative to RF, a pulse position modulation (PPM) guided waves communication system has been developed and evaluated using a corrosion resistant 4H18 multi-wire cable, commonly used to descend electronic gauges in down-hole oil applications, as the communication medium. The system consists of a transmitter and a receiver that utilizes a PZT crystal, for electrical/mechanical coupling, attached to each extreme of the multi-wire cable. The modulator is based on a microcontroller, which transmits60 kHz guided wave pulses, and the demodulator is based on a commercial digital signal processor (DSP) module that performs real time DSP algorithms. Experimental results are presented, which were obtained using a 1m corrosion resistant 4H18multi-wire cable, commonly used with downhole electronic gauges in the oil sector. Although there was significant dispersion and multiple mode excitations of the transmitted guided wave energy pulses, the results show that data rates on the order of 500 bits per second are readily available employing PPM and simple communications techniques.

A new adjustable parallel drill guide for internal fixation of femoral neck fracture: a developmental and experimental study.

PubMed

Yuenyongviwat, Varah; Tuntarattanapong, Pakjai; Tangtrakulwanich, Boonsin

2016-01-11

Internal fixation is one treatment for femoral neck fracture. Some devices and techniques reported improved accuracy and decreased fluoroscopic time. However, these are not widely used nowadays due to the lack of available special instruments and techniques. To improve the surgical procedure, the authors designed a new adjustable drill guide and tested the efficacy of the device. The authors developed a new adjustable drill guide for cannulated screw guide wire insertion for multiple screw fixation. Eight orthopaedic surgeons performed the experimental study to evaluate the efficacy of this device. Each surgeon performed guide wire insertion for multiple screw fixation in six synthetic femurs: three times with the new device and three times with the conventional technique. The fluoroscopic time, operative time and surgeon satisfaction were evaluated. In the operations with the new adjustable drill guide, the fluoroscopic and operative times were significantly lower than the operations with the conventional technique (p < 0.05). The mean score for the level of satisfaction of this device was also statistically significantly better (p = 0.02) than the conventional technique. The fluoroscopic and operative times with the new adjustable drill guide were reduced for multiple screw fixation of femoral neck fracture and the satisfaction of the surgeons was good.

Development of a smart guide wire using an electrostrictive polymer: option for steerable orientation and force feedback

NASA Astrophysics Data System (ADS)

Ganet, F.; Le, M. Q.; Capsal, J. F.; Lermusiaux, P.; Petit, L.; Millon, A.; Cottinet, P. J.

2015-12-01

The development of steerable guide wire or catheter designs has been strongly limited by the lack of enabling actuator technologies. This paper presents the properties of an electrostrive actuator technology for steerable actuation. By carefully tailoring material properties and the actuator design, which can be integrated in devices, this technology should realistically make it possible to obtain a steerable guide wire design with considerable latitude. Electromechanical characteristics are described, and their impact on a steerable design is discussed.

Wiring design for the control of electromagnetic interference (EMI)

NASA Technical Reports Server (NTRS)

Kopasakis, George

1995-01-01

Wiring design is only one important aspect of EMI control. Other important areas for EMI are: circuit design, filtering, grounding, bonding, shielding, lighting, electrostatic discharge (ESD), transient suppression, and electromagnetic pulse (EMP). Topics covered include: wire magnetic field emissions at low frequencies; wire radiated magnetic field emissions at frequencies; wire design guidelines for EMI control; wire design guidelines for EMI control; high frequency emissions from cables; and pulse frequency spectra.

Arthroscopic fixation of the clavicle shaft fracture.

PubMed

Kim, Yang-Soo; Lee, Hyo-Jin; Kim, Jong-Ick; Yang, Hyo; Jin, Hong-Ki; Patel, Hiren Kirtibhai; Kim, Jong-Ho; Park, In

2017-01-01

This article describes an arthroscopic technique for the fixation of clavicle shaft fractures. A viewing portal is made 2 cm anterior to the fracture site, and a working portal is made 2 cm lateral to the fracture site. The guide wire for a 4.0-mm cannulated screw is inserted through the fracture site to the medial fracture fragment under arthroscopic guidance. Through the medial fragment, the guide wire is delivered through the skin anteriorly. The fracture is reduced, and then, the guide wire is drilled back across the fracture site to the lateral fracture fragment. After confirming the reduction under arthroscopy, the appropriately sized cannulated screw is inserted after reaming. This arthroscopic technique would be useful for the precise reduction and minimal invasive fixation of clavicle shaft fractures. Preliminary results are encouraging, and further studies with long-term follow-up are needed to determine the precise indications and limitations of the procedure.

Commercial and Industrial Wiring. Fourth Edition. Teacher Edition [and] Student Guide [and] Student Workbook 1 [and] Student Workbook 2.

ERIC Educational Resources Information Center

Kaltwasser, Stan; Flowers, Gary

Commercial and Industrial Wiring, third in a series of three wiring publications, includes the additional technical knowledge and applications required for job entry in the commercial and industrial wiring trade. Instructional materials include a teacher edition, student guide, and two student workbooks. The teacher edition begins with…

An Analysis of Physician Assistant LibGuides: A Tool for Collection Development.

PubMed

Johnson, Catherine V; Johnson, Scott Y

2017-01-01

The Physician Assistant (PA) specialty encompasses many subject areas and requires many types of library resources. An analysis of PA LibGuides was performed to determine most frequently recommended resources. A sample of LibGuides from U.S. institutions accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) was included in this study. Resources presented on guides were tabulated and organized by resource type. Databases and point-of-care tools were the types of resources listed by the most LibGuides. There were over 1,000 books listed on the 45 guides, including over 600 unique books listed. There were fewer journals listed, only 163. Overall, while the 45 LibGuides evaluated list many unique resources in each category, a librarian can create an accepted list of the most frequently listed resources from the data gathered.

Cannulation in patients with large periampullary diverticulum using SpyBite miniforceps.

PubMed

Balkrishanan, Mahadevan; Jain, Mayank; Snk, Chenduran; Cg, Sridhar; Ramakrishnan, Ravi; Venkataraman, Jayanthi

2018-03-01

Cannulation is difficult in patients with periampullary diverticulum (PAD). The described success rate varies from 61% to 95.4%. Four cases with PAD in which, despite repeated attempts, we were unable to locate the papilla and cannulate. To overcome this difficulty, we used SpyBite forceps (Boston Scientific) to pull out the papillary orifice and then perform the cannulation using a sphincterotome introduced through the same working channel. This method reduced the time required for cannulation. In all four of our cases, we had 100% success in cannulation. Use of SpyBite miniforceps in difficult cannulations in patients with PAD is useful and has an excellent success rate.

Fixed-angle plate osteosynthesis of the patella - an alternative to tension wiring?

PubMed

Wild, M; Eichler, C; Thelen, S; Jungbluth, P; Windolf, J; Hakimi, M

2010-05-01

The goal of this study is carry out a biomechanical evaluation of the stability of a bilateral, polyaxial, fixed-angle 2.7 mm plate system specifically designed for use on the patella. The results of this approach are then compared to the two currently most commonly used surgical techniques for patella fractures: modified anterior tension wiring with K-wires and cannulated lag screws with anterior tension wiring. A transient biomechanical analysis determining material failure points of all osteosyntheses were conducted on 21 identical left polyurethane foam patellae, which were osteotomized horizontally. Evaluated were load (N), displacement (mm) and run-time (s) as well as elastic modulus (MPa), tensile strength (MPa) and strain at failure (%). With a maximum load capacity of 2396 (SD 492) N, the fixed-angle plate proved to be significantly stronger than the cannulated lag screws with anterior tension wiring (1015 (SD 246) N) and the modified anterior tension wiring (625 (SD 84.9) N). The fixed-angle plate displayed significantly greater stiffness and lower fracture gap dehiscence than the other osteosyntheses. Additionally, osteosynthesis deformation was found to be lower for the fixed-angle plate. A bilateral fixed-angle plate was the most rigid and stable osteosynthesis for horizontal patella fractures with the least amount of fracture gap dehiscence. Further biomechanical trials performed under cycling loading with fresh cadaver specimen should be done to figure out if a fixed-angle plate may be an alternative in the surgical treatment of patella fractures. Copyright 2009 Elsevier Ltd. All rights reserved.

Reoperation Rates in Ductal Carcinoma In Situ vs Invasive Breast Cancer After Wire-Guided Breast-Conserving Surgery.

PubMed

Langhans, Linnea; Jensen, Maj-Britt; Talman, Maj-Lis M; Vejborg, Ilse; Kroman, Niels; Tvedskov, Tove F

2017-04-01

New techniques for preoperative localization of nonpalpable breast lesions may decrease the reoperation rate in breast-conserving surgery (BCS) compared with rates after surgery with the standard wire-guided localization. However, a valid reoperation rate for this procedure needs to be established for comparison, as previous studies on this procedure include a variety of malignant and benign breast lesions. To determine the reoperation rate after wire-guided BCS in patients with histologically verified nonpalpable invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS) and to examine whether the risk of reoperation is associated with DCIS or histologic type of the IBC. This nationwide study including women with histologically verified IBC or DCIS having wire-guided BCS performed between January 1, 2010, and December 31, 2013, used data from the Danish National Patient Registry that were cross-checked with the Danish Breast Cancer Group database and the Danish Pathology Register. Reoperation rate after wire-guided BCS in patients with IBC or DCIS. Wire-guided BCS was performed in 4118 women (mean [SD] age, 60.9 [8.7] years). A total of 725 patients (17.6%) underwent a reoperation: 593 were reexcisions (14.4%) and 132 were mastectomies (3.2%). Significantly more patients with DCIS (271 of 727 [37.3%]) than with IBC (454 of 3391 [13.4%]) underwent a reoperation (adjusted odds ratio, 3.82; 95% CI, 3.19-4.58; P < .001). After the first reexcision, positive margins were still present in 97 patients (16.4%). The risk of repeated positive margins was significantly higher in patients with DCIS vs those with IBC (unadjusted odds ratio, 2.21; 95% CI, 1.42-3.43; P < .001). The risk of reoperation was significantly increased in patients with lobular carcinoma vs those with ductal carcinoma (adjusted odds ratio, 1.44; 95% CI 1.06-1.95; P = .02). A total of 202 patients (4.9%) had a subsequent completion mastectomy, but no difference was found in the type of

Improving vascular access outcomes: attributes of arteriovenous fistula cannulation success

PubMed Central

Harwood, Lori E.; Wilson, Barbara M.; Oudshoorn, Abe

2016-01-01

Background Arteriovenous fistulas (AVFs) are the preferred access for hemodialysis (HD) yet they are underutilized. Cannulation of the fistula is a procedure requiring significant skill development and refinement and if not done well can have negative consequences for patients. The nurses' approach, attitude and skill with cannulation impacts greatly on the patient experience. Complications from miscannulation or an inability to needle fistulas can result in the increased use of central venous catheters. Some nurses remain in a state of a ‘perpetual novice’ resulting in a viscous cycle of negative patient consequences (bruising, pain), further influencing patients' decisions not to pursue a fistula or abandon cannulation. Method This qualitative study used organizational development theory (appreciative inquiry) and research method to determine what attributes/activities contribute to successful cannulation. This can be applied to interventions to promote change and skill development in staff members who have not advanced their proficiency. Eighteen HD nurses who self-identified with performing successful cannulation participated in audio-recorded interviews. The recordings were transcribed verbatim. The data were analyzed using content analysis. Results Four common themes, including patient-centered care, teamwork, opportunity and skill and nurse self-awareness, represented successful fistula cannulation. Successful cannulation is more than a learned technique to correctly insert a needle, but rather represents contextual influences and interplay between the practice environment and personal attributes. Conclusions Practice changes based on these results may improve cannulation, decrease complications and result in better outcomes for patients. Efforts to nurture positive patient experiences around cannulation may influence patient decision-making regarding fistula use. PMID:26985384

Researching on Control Device of Prestressing Wire Reinforcement

NASA Astrophysics Data System (ADS)

Si, Jianhui; Guo, Yangbo; Liu, Maoshe

2017-06-01

This paper mainly introduces a device for controlling prestress and its related research methods, the advantage of this method is that the reinforcement process is easy to operate and control the prestress of wire rope accurately. The relationship between the stress and strain of the steel wire rope is monitored during the experiment, and the one - to - one relationship between the controllable position and the pretightening force of the steel wire rope is confirmed by the 5mm steel wire rope, and the results are analyzed theoretically by the measured elastic modulus. The results show that the method can effectively control the prestressing force, and the result provides a reference method for strengthening the concrete column with prestressed steel strand.

Evaluation of a novel, ultrathin, tip-bending endoscope in a synthetic force-sensing pancreas with comparison to medical guide wires

PubMed Central

Chandler, John E; Lee, Cameron M; Babchanik, Alexander P; Melville, C David; Saunders, Michael D; Seibel, Eric J

2012-01-01

Purpose Direct visualization of pancreatic ductal tissue is critical for early diagnosis of pancreatic diseases and for guiding therapeutic interventions. A novel, ultrathin (5 Fr) scanning fiber endoscope (SFE) with tip-bending capability has been developed specifically to achieve high resolution imaging as a pancreatoscope during endoscopic retrograde cholangiopancreatography (ERCP). This device has potential to dramatically improve both diagnostic and therapeutic capabilities during ERCP by providing direct video feedback and tool guidance to clinicians. Methods Invasiveness of the new tip-bending SFE was evaluated by a performance comparison to ERCP guide wires, which are routinely inserted into the pancreatic duct during ERCP. An in vitro test model with four force sensors embedded in a synthetic pancreas was designed to detect and compare the insertion forces for 0.89 mm and 0.53 mm diameter guide wires as well as the 1.7 mm diameter SFE. Insertions were performed through the working channel of a therapeutic duodenoscope for the two types of guide wires and using a statistically similar direct insertion method for comparison to the SFE. Results Analysis of the forces detected by the sensors showed the smaller diameter 0.53 mm wire produced significantly less average and maximum forces during insertion than the larger diameter 0.89 mm wire. With the use of tip-bending and optical visualization, the 1.7 mm diameter SFE produced significantly less average force during insertion than the 0.89 mm wire at every sensor, despite its larger size. It was further shown that the use of tip-bending with the SFE significantly reduced the forces at all sensors, compared to insertions when tip-bending was not used. Conclusion Combining high quality video imaging with two-axis tip-bending allows a larger diameter guide wire-style device to be inserted into the pancreatic duct during ERCP with improved capacity to perform diagnostics and therapy. PMID:23166452

Electrode carrying wire for GTAW welding

NASA Technical Reports Server (NTRS)

Morgan, Gene E. (Inventor); Dyer, Gerald E. (Inventor)

1990-01-01

A welding torch for gas tungsten arc welding apparatus has a hollow tungsten electrode including a ceramic liner and forms the filler metal wire guide. The wire is fed through the tungsten electrode thereby reducing the size of the torch to eliminate clearance problems which exist with external wire guides. Since the wire is preheated from the tungsten more wire may be fed into the weld puddle, and the wire will not oxidize because it is always within the shielding gas.

Fluoroscopic guide wire manipulation of malfunctioning peritoneal dialysis catheters initially placed by interventional radiologists.

PubMed

Kwon, Young Ho; Kwon, Se Hwan; Oh, Joo Hyeong; Jeong, Kyung Hwan; Lee, Tae Won

2014-06-01

To assess the efficacy of fluoroscopic guide wire manipulation in patients with malfunctioning peritoneal dialysis (PD) catheters that were initially placed by interventional radiologists under fluoroscopic guidance. From January 2002 to April 2012, 52 patients (mean age, 52.8 y ± 2.10s; range, 12-79 y) with malfunctioning PD catheters in whom fluoroscopic guide wire manipulation was performed were retrospectively reviewed. Technical success, clinical success, and complications were evaluated. Technical success was defined as fluoroscopically verified, successful catheter repositioning and adequate dialysate drainage after the procedure. Clinical success was defined as maintenance of PD catheter function for at least 30 days after the manipulation. During the study period, 72 manipulations (68 initial manipulations and 4 remanipulations) for malfunctioning PD catheters were done. The technical success rate was 74% (50 of 68) for initial manipulations and 75% (3 of 4) for remanipulations. The overall clinical success rate was 47% (32 of 68) for initial manipulations and 0% (0 of 4) for remanipulations. The primary causes of catheter malfunction were extraluminal obstruction by omental wrapping or adhesions in 43 of 68 cases (63.2%) and catheter malposition in 25 of 68 (36.8%) cases. There were no procedure-related major complications. Fluoroscopic guide wire manipulation in patients with malfunctioning PD catheters initially placed by interventional radiologists is a simple procedure, an effective way of prolonging PD catheter life, and a recommended procedure before invasive surgical procedures. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

Antitrust law and collective physician negotiations with third parties: the relative value guide object lesson.

PubMed

Pfizenmayer, R F

1982-01-01

This article examines the role of collective physician participation in the third-party reimbursement system. It critiques the Havighurst-Kissam analysis of the antitrust implications of professionally-developed relative value guides and, using lessons derived from the only litigated case on relative value guides, argues that collective physician input into third-party reimbursement plans can be made in a manner which is consistent with the antitrust law as and cost-containment policy objectives. In particular, collective "negotiations" by organized physicians with third parties, unaccompanied by fee agreements among physicians or by actual or threatened physician boycotts, are found to be procompetitive and hence permissible under the rule of reason.

A multiplanar complex resection of a low-grade chondrosarcoma of the distal femur guided by K-wires previously inserted under CT-guide: a case report.

PubMed

Zoccali, Carmine; Rossi, Barbara; Ferraresi, Virginia; Anelli, Vincenzo; Rita, Alessandro

2014-08-13

In muscular skeletal oncology aiming to achieve wide surgical margin is one of the main factors influencing patient prognosis. In cases where lesions are either meta or epiphyseal, surgery most often compromises joint integrity and stability because muscles, tendons and ligaments are involved in wide resection. When lesions are well circumscribed they can be completely resected by performing multi-planar osteotomies guided by computer-assisted navigation. We describe a case of low-grade chondrosarcoma of the distal femur where a simple but effective technique was useful to perform complex multiplanar osteotomies. No similar techniques are reported in the literature. A 57 year-old Caucasian female was referred to our department for the presence of a distal femur chondrosarcoma. A resection with the presenting technique was scheduled. The first step consists of inserting several K-wires under CT-scan control to delimitate the tumor; the second step consists of tumor removal: in operative theatre, following surgical access, k-wires are used as guide positioning; scalpels are externally placed to k-wires to perform a safe osteotomy. Computed assisted resections can be considered the most advantageous method to reach the best surgical outcome; unfortunately navigation systems are only available in specialized centres. The present technique allows for a multiplanar complex resection when navigation systems are not available. This technique can be applied in low-grade tumours where a minimal wide margin can be considered sufficient.

A multiplanar complex resection of a low-grade chondrosarcoma of the distal femur guided by K-wires previously inserted under CT-guide: a case report

PubMed Central

2014-01-01

Background In muscular skeletal oncology aiming to achieve wide surgical margin is one of the main factors influencing patient prognosis. In cases where lesions are either meta or epiphyseal, surgery most often compromises joint integrity and stability because muscles, tendons and ligaments are involved in wide resection. When lesions are well circumscribed they can be completely resected by performing multi-planar osteotomies guided by computer-assisted navigation. We describe a case of low-grade chondrosarcoma of the distal femur where a simple but effective technique was useful to perform complex multiplanar osteotomies. No similar techniques are reported in the literature. Case presentation A 57 year-old Caucasian female was referred to our department for the presence of a distal femur chondrosarcoma. A resection with the presenting technique was scheduled. The first step consists of inserting several K-wires under CT-scan control to delimitate the tumor; the second step consists of tumor removal: in operative theatre, following surgical access, k-wires are used as guide positioning; scalpels are externally placed to k-wires to perform a safe osteotomy. Conclusions Computed assisted resections can be considered the most advantageous method to reach the best surgical outcome; unfortunately navigation systems are only available in specialized centres. The present technique allows for a multiplanar complex resection when navigation systems are not available. This technique can be applied in low-grade tumours where a minimal wide margin can be considered sufficient. PMID:25123066

Effectiveness of external cold and vibration for procedural pain relief during peripheral intravenous cannulation in pediatric patients.

PubMed

Canbulat, Nejla; Ayhan, Fatma; Inal, Sevil

2015-02-01

The aim of this study was to investigate the effect of external cold and vibration stimulation via Buzzy on the pain and anxiety level of children during peripheral intravenous (IV) cannulation. This study was a prospective, randomized controlled trial. The sample consisted of 176 children ages 7 to 12 years who were randomly assigned to two groups: a control group that received no peripheral IV cannulation intervention and an experimental group that received external cold and vibration via Buzzy. The same nurse conducted the peripheral IV cannulation in all the children, and the same researcher applied the external cold and vibration to all the children. The external cold and the vibration were applied 1 minute before the peripheral IV cannulation procedure and continued until the end of the procedure. Preprocedural anxiety was assessed using the Children's Fear Scale, along with reports by the children, their parents, and an observer. Procedural anxiety was assessed with the Children's Fear Scale and the parents' and the observer's reports. Procedural pain was assessed using the Wong Baker Faces Scale and the visual analog scale self-reports of the children. Preprocedural anxiety did not differ significantly. Comparison of the two groups showed significantly lower pain and anxiety levels in the experimental group than in the control group during the peripheral IV cannulation. Buzzy can be considered to provide an effective combination of coldness and vibration. This method can be used during pediatric peripheral IV cannulation by pediatric nurses. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

A pragmatic guide on how physicians can take over financial control of their clinical practice.

PubMed

Jacobs, Volker R; Fischer, Thorsten

2012-01-01

Control of clinical cost is becoming increasingly important in health care worldwide. Physicians should accept the limitation of resources and take responsibility to improve their clinical cost-reimbursement ratio. To achieve this, they will need basic education in clinic management to control and adjust costs and reimbursement, without impacting professional quality of care. Rational use of diagnostics and therapy should be implemented and frequently verified. Physicians are the only professionals that are able to integrate economics with health care. This is in the best interest of patients and will improve a physician's position, influence, and professional freedom levels within our hospitals.

In elective arch surgery with circulatory arrest, does the arterial cannulation site really matter? A propensity score analysis of right axillary and innominate artery cannulation.

PubMed

Preventza, Ourania; Price, Matt D; Spiliotopoulos, Konstantinos; Amarasekara, Hiruni S; Cornwell, Lorraine D; Omer, Shuab; de la Cruz, Kim I; Zhang, Qianzi; Green, Susan Y; LeMaire, Scott A; Rosengart, Todd K; Coselli, Joseph S

2018-05-01

The preferred arterial cannulation site for elective proximal aortic procedures requiring circulatory arrest varies, and different sites have been tried. We evaluated the relationships between arterial cannulation site and adverse outcomes, including stroke, in patients undergoing elective aortic arch surgery. We reviewed the records of 938 patients who underwent elective hemiarch or total arch surgery with circulatory arrest between 2006 and 2016. Five cannulation sites were used: the right axillary (n = 515; 54.9%), innominate (n = 376; 40.1%), and right common carotid arteries (n = 15; 1.6%), each with a side graft; the ascending aorta (n = 19; 2.0%); and the femoral artery (n = 13; 1.4%). Multivariable logistic regression analysis was used to model the effects of cannulation site on adverse outcomes for the entire cohort and for a subcohort of 891 patients who underwent innominate or axillary artery cannulation. Propensity-matching yielded 564 patients (282 pairs) from the right axillary and innominate artery groups. For the entire cohort, mortality, stroke, and composite adverse outcome (operative death or persistent stroke or renal failure at hospital discharge) rates were 7.0%, 4.1%, and 9.8%. In the multivariable analysis of the axillary/innominate subcohort, cannulation site did not independently predict operative mortality, persistent stroke, or composite adverse event. These results were confirmed with the propensity-matched analysis, where both axillary and innominate artery cannulation provided equivalent composite adverse event rates, operative death rates, and overall stroke rates. During elective arch surgery, right axillary artery cannulation and innominate artery cannulation (both via a side graft) produce excellent results and can be used interchangeably. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Waveguide bends from nanometric silica wires

NASA Astrophysics Data System (ADS)

Tong, Limin; Lou, Jingyi; Mazur, Eric

2005-02-01

We propose to use bent silica wires with nanometric diameters to guide light as optical waveguide bend. We bend silica wires with scanning tunneling microscope probes under an optical microscope, and wire bends with bending radius smaller than 5 μm are obtained. Light from a He-Ne laser is launched into and guided through the wire bends, measured bending loss of a single bend is on the order of 1 dB. Brief introductions to the optical wave guiding and elastic bending properties of silica wires are also provided. Comparing with waveguide bends based on photonic bandgap structures, the waveguide bends from silica nanometric wires show advantages of simple structure, small overall size, easy fabrication and wide useful spectral range, which make them potentially useful in the miniaturization of photonic devices.

30 CFR 77.515 - Bare signal or control wires; voltage.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Bare signal or control wires; voltage. 77.515... COAL MINES Electrical Equipment-General § 77.515 Bare signal or control wires; voltage. The voltage on bare signal or control wires accessible to personal contact shall not exceed 40 volts. ...

30 CFR 77.515 - Bare signal or control wires; voltage.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Bare signal or control wires; voltage. 77.515... COAL MINES Electrical Equipment-General § 77.515 Bare signal or control wires; voltage. The voltage on bare signal or control wires accessible to personal contact shall not exceed 40 volts. ...

Application of Virtual Navigation with Multimodality Image Fusion in Foramen Ovale Cannulation.

PubMed

Qiu, Xixiong; Liu, Weizong; Zhang, Mingdong; Lin, Hengzhou; Zhou, Shoujun; Lei, Yi; Xia, Jun

2017-11-01

Idiopathic trigeminal neuralgia (ITN) can be effectively treated with radiofrequency thermocoagulation. However, this procedure requires cannulation of the foramen ovale, and conventional cannulation methods are associated with high failure rates. Multimodality imaging can improve the accuracy of cannulation because each imaging method can compensate for the drawbacks of the other. We aim to determine the feasibility and accuracy of percutaneous foramen ovale cannulation under the guidance of virtual navigation with multimodality image fusion in a self-designed anatomical model of human cadaveric heads. Five cadaveric head specimens were investigated in this study. Spiral computed tomography (CT) scanning clearly displayed the foramen ovale in all five specimens (10 foramina), which could not be visualized using two-dimensional ultrasound alone. The ultrasound and spiral CT images were fused, and percutaneous cannulation of the foramen ovale was performed under virtual navigation. After this, spiral CT scanning was immediately repeated to confirm the accuracy of the cannulation. Postprocedural spiral CT confirmed that the ultrasound and CT images had been successfully fused for all 10 foramina, which were accurately and successfully cannulated. The success rates of both image fusion and cannulation were 100%. Virtual navigation with multimodality image fusion can substantially facilitate foramen ovale cannulation and is worthy of clinical application. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Evaluation of robotic endovascular catheters for arch vessel cannulation.

PubMed

Riga, Celia V; Bicknell, Colin D; Hamady, Mohamad S; Cheshire, Nicholas J W

2011-09-01

Conventional catheter instability and embolization risk limits the adoption of endovascular therapy in patients with challenging arch anatomy. This study investigated whether arch vessel cannulation can be enhanced by a remotely steerable robotic catheter system. Seventeen clinicians with varying endovascular experience cannulated all arch vessels within two computed tomography-reconstructed pulsatile flow phantoms (bovine type I and type III aortic arches), under fluoroscopic guidance, using conventional and robotic techniques. Quantitative (catheterization times, catheter tip movements, vessel wall hits, catheter deflection) and qualitative metrics (Imperial College Complex Endovascular Cannulation Scoring Tool [IC3ST]) performance scores were compared. Robotic catheterization techniques resulted in a significant reduction in median carotid artery cannulation times and the median number of catheter tip movements for all vessels. Vessel wall contact with the aortic arch wall was reduced to a median of zero with robotic catheters. During stiff guidewire exchanges, robotic catheters maintained stability with zero deflection, independent of the distance the catheter was introduced into the carotid vessels. Overall IC3ST performance scores (interquartile range) were significantly improved using the robotic system: Type I arch score was 26/35 (20-30.8) vs 33/35 (31-34; P = .001), and type III arch score was 20.5/35 (16.5-28.5) vs 26.5/35 (23.5-28.8; P = .001). Low- and medium-volume interventionalists demonstrated an improvement in performance with robotic cannulation techniques. The high-volume intervention group did not show statistically significant improvement, but cannulation times, movements, and vessel wall hits were significantly reduced. Robotic technology has the potential to reduce the time, risk of embolization and catheter dislodgement, radiation exposure, and the manual skill required for carotid and arch vessel cannulation, while improving overall

Video-assisted thoracoscopic surgery for pulmonary nodules after computed tomography-guided marking with a spiral wire.

PubMed

Eichfeld, Uwe; Dietrich, Arne; Ott, Rudolph; Kloeppel, Rainer

2005-01-01

Peripheral pulmonary nodules are preferably removed by minimally invasive techniques, such as video-assisted thoracoscopic (VATS) surgery. These nodules should be marked preoperatively for better intraoperative detection and removal. Twenty-two cases with a single pulmonary nodule requiring surgical removal for histologic examination were included in a prospective study. Guided by computed tomography, nodules were marked preoperatively using a laser marker system and fixed with a spiral wire. The marked nodules were removed by VATS surgery immediately after the marking. The marking wire was placed in all 22 patients without any complications. The marked nodule was completely removed by VATS surgery in 19 patients. Conversion to thoracotomy was necessary in 3 patients, twice because of thoracoscopy-related problems and once because of a marking failure. The average times for the marking procedure and operation were 24 minutes and 32 minutes, respectively. This new method of computed tomography-guided nodule marking with a spiral wire and subsequent VATS surgery is very efficient in terms of localization and stable fixation of subpleural pulmonary nodules.

Towards Robot-Assisted Retinal Vein Cannulation: A Motorized Force-Sensing Microneedle Integrated with a Handheld Micromanipulator †

PubMed Central

Gonenc, Berk; Chae, Jeremy; Gehlbach, Peter; Taylor, Russell H.; Iordachita, Iulian

2017-01-01

Retinal vein cannulation is a technically demanding surgical procedure where therapeutic agents are injected into the retinal veins to treat occlusions. The clinical feasibility of this approach has been largely limited by the technical challenges associated with performing the procedure. Among the challenges to successful vein cannulation are identifying the moment of venous puncture, achieving cannulation of the micro-vessel, and maintaining cannulation throughout drug delivery. Recent advances in medical robotics and sensing of tool-tissue interaction forces have the potential to address each of these challenges as well as to prevent tissue trauma, minimize complications, diminish surgeon effort, and ultimately promote successful retinal vein cannulation. In this paper, we develop an assistive system combining a handheld micromanipulator, called “Micron”, with a force-sensing microneedle. Using this system, we examine two distinct methods of precisely detecting the instant of venous puncture. This is based on measured tool-tissue interaction forces and also the tracked position of the needle tip. In addition to the existing tremor canceling function of Micron, a new control method is implemented to actively compensate unintended movements of the operator, and to keep the cannulation device securely inside the vein following cannulation. To demonstrate the capabilities and performance of our uniquely upgraded system, we present a multi-user artificial phantom study with subjects from three different surgical skill levels. Results show that our puncture detection algorithm, when combined with the active positive holding feature enables sustained cannulation which is most evident in smaller veins. Notable is that the active holding function significantly attenuates tool motion in the vein, thereby reduces the trauma during cannulation. PMID:28946634

Metal wires for terahertz wave guiding.

PubMed

Wang, Kanglin; Mittleman, Daniel M

2004-11-18

Sources and systems for far-infrared or terahertz (1 THz = 10(12) Hz) radiation have received extensive attention in recent years, with applications in sensing, imaging and spectroscopy. Terahertz radiation bridges the gap between the microwave and optical regimes, and offers significant scientific and technological potential in many fields. However, waveguiding in this intermediate spectral region still remains a challenge. Neither conventional metal waveguides for microwave radiation, nor dielectric fibres for visible and near-infrared radiation can be used to guide terahertz waves over a long distance, owing to the high loss from the finite conductivity of metals or the high absorption coefficient of dielectric materials in this spectral range. Furthermore, the extensive use of broadband pulses in the terahertz regime imposes an additional constraint of low dispersion, which is necessary for compatibility with spectroscopic applications. Here we show how a simple waveguide, namely a bare metal wire, can be used to transport terahertz pulses with virtually no dispersion, low attenuation, and with remarkable structural simplicity. As an example of this new waveguiding structure, we demonstrate an endoscope for terahertz pulses.

Advanced signal processing methods applied to guided waves for wire rope defect detection

NASA Astrophysics Data System (ADS)

Tse, Peter W.; Rostami, Javad

2016-02-01

Steel wire ropes, which are usually composed of a polymer core and enclosed by twisted wires, are used to hoist heavy loads. These loads are different structures that can be clamshells, draglines, elevators, etc. Since the loading of these structures is dynamic, the ropes are working under fluctuating forces in a corrosive environment. This consequently leads to progressive loss of the metallic cross-section due to abrasion and corrosion. These defects can be seen in the forms of roughened and pitted surface of the ropes, reduction in diameter, and broken wires. Therefore, their deterioration must be monitored so that any unexpected damage or corrosion can be detected before it causes fatal accident. This is of vital importance in the case of passenger transportation, particularly in elevators in which any failure may cause a catastrophic disaster. At present, the widely used methods for thorough inspection of wire ropes include visual inspection and magnetic flux leakage (MFL). Reliability of the first method is questionable since it only depends on the operators' eyes that fails to determine the integrity of internal wires. The later method has the drawback of being a point by point and time-consuming inspection method. Ultrasonic guided wave (UGW) based inspection, which has proved its capability in inspecting plate like structures such as tubes and pipes, can monitor the cross-section of wire ropes in their entire length from a single point. However, UGW have drawn less attention for defect detection in wire ropes. This paper reports the condition monitoring of a steel wire rope from a hoisting elevator with broken wires as a result of corrosive environment and fatigue. Experiments were conducted to investigate the efficiency of using magnetostrictive based UGW for rope defect detection. The obtained signals were analyzed by two time-frequency representation (TFR) methods, namely the Short Time Fourier Transform (STFT) and the Wavelet analysis. The location of

Use of beam deflection to control an electron beam wire deposition process

NASA Technical Reports Server (NTRS)

Taminger, Karen M. (Inventor); Hofmeister, William H. (Inventor); Hafley, Robert A. (Inventor)

2013-01-01

A method for controlling an electron beam process wherein a wire is melted and deposited on a substrate as a molten pool comprises generating the electron beam with a complex raster pattern, and directing the beam onto an outer surface of the wire to thereby control a location of the wire with respect to the molten pool. Directing the beam selectively heats the outer surface of the wire and maintains the position of the wire with respect to the molten pool. An apparatus for controlling an electron beam process includes a beam gun adapted for generating the electron beam, and a controller adapted for providing the electron beam with a complex raster pattern and for directing the electron beam onto an outer surface of the wire to control a location of the wire with respect to the molten pool.

What influences pre-hospital cannulation intentions in paramedics? An application of the theory of reasoned action.

PubMed

Banerjee, Smita C; Siriwardena, A Niroshan; Iqbal, Mohammad

2011-02-01

Intravenous cannulation is a common and important intervention undertaken by paramedics for administration of fluids and drugs in the pre-hospital setting. This study was a partial application of the theory of reasoned action to the prediction of pre-hospital cannulation intentions as part of an evaluation of an educational intervention to change cannulation behaviour in paramedics in line with national guidance. In 2008 a self-completion questionnaire was sent to paramedics from Nottinghamshire and Lincolnshire divisions of East Midlands Ambulance Service NHS Trust, UK. This included measures of prior behaviour related to cannulation, attitude towards cannulation, normative influence related to cannulation and intention to cannulate as well as demographic information. Of the 323 paramedics sent questionnaires 137 (42.2%) responded. Attitude towards cannulation (but not normative or peer influence) was a necessary factor for prediction of intention to cannulate in respondents. Past cannulation behaviour was indirectly related to intention to cannulate through the mediation of attitude towards cannulation. The theory of reasoned action provides a parsimonious way to predict intentions to cannulate. This study suggests that design and evaluation of interventions to reduce inappropriate cannulation should be targeted towards changing attitudes of paramedics, rather than towards addressing behavioural norms. Future research could utilize social-psychological theories to better understand clinical behaviour prior to implementation of complex educational or organizational interventions. © 2010 Blackwell Publishing Ltd.

Augmented reality fluoroscopy simulation of the guide-wire insertion in DHS surgery: A proof of concept study.

PubMed

van Duren, B H; Sugand, K; Wescott, R; Carrington, R; Hart, A

2018-05-01

Hip fractures contribute to a significant clinical burden globally with over 1.6 million cases per annum and up to 30% mortality rate within the first year. Insertion of a dynamic hip screw (DHS) is a frequently performed procedure to treat extracapsular neck of femur fractures. Poorly performed DHS fixation of extracapsular neck of femur fractures can result in poor mobilisation, chronic pain, and increased cut-out rate requiring revision surgery. A realistic, affordable, and portable fluoroscopic simulation system can improve performance metrics in trainees, including the tip-apex distance (the only clinically validated outcome), and improve outcomes. We developed a digital fluoroscopic imaging simulator using orthogonal cameras to track coloured markers attached to the guide-wire which created a virtual overlay on fluoroscopic images of the hip. To test the accuracy with which the augmented reality system could track a guide-wire, a standard workshop femur was used to calibrate the system with a positional marker fixed to indicate the apex; this allowed for comparison between guide-wire tip-apex distance (TAD) calculated by the system to be compared to that physically measured. Tests were undertaken to determine: (1) how well the apex could be targeted; (2) the accuracy of the calculated TAD. (3) The number of iterations through the algorithm giving the optimal accuracy-time relationship. The calculated TAD was found to have an average root mean square error of 4.2 mm. The accuracy of the algorithm was shown to increase with the number of iterations up to 20 beyond which the error asymptotically converged to an error of 2 mm. This work demonstrates a novel augmented reality simulation of guide-wire insertion in DHS surgery. To our knowledge this has not been previously achieved. In contrast to virtual reality, augmented reality is able to simulate fluoroscopy while allowing the trainee to interact with real instrumentation and performing the procedure on

Positioning and joining of organic single-crystalline wires

PubMed Central

Wu, Yuchen; Feng, Jiangang; Jiang, Xiangyu; Zhang, Zhen; Wang, Xuedong; Su, Bin; Jiang, Lei

2015-01-01

Organic single-crystal, one-dimensional materials can effectively carry charges and/or excitons due to their highly ordered molecule packing, minimized defects and eliminated grain boundaries. Controlling the alignment/position of organic single-crystal one-dimensional architectures would allow on-demand photon/electron transport, which is a prerequisite in waveguides and other optoelectronic applications. Here we report a guided physical vapour transport technique to control the growth, alignment and positioning of organic single-crystal wires with the guidance of pillar-structured substrates. Submicrometre-wide, hundreds of micrometres long, highly aligned, organic single-crystal wire arrays are generated. Furthermore, these organic single-crystal wires can be joined within controlled angles by varying the pillar geometries. Owing to the controllable growth of organic single-crystal one-dimensional architectures, we can present proof-of-principle demonstrations utilizing joined wires to allow optical waveguide through small radii of curvature (internal angles of ~90–120°). Our methodology may open a route to control the growth of organic single-crystal one-dimensional materials with potential applications in optoelectronics. PMID:25814032

Perioperative ultrasound-guided wire marking of calcific deposits in calcifying tendinitis of the rotator cuff.

PubMed

Sigg, Andreas; Draws, Detlev; Stamm, Axel; Pfeiffer, Michael

2011-03-01

The identification of a calcific deposit in the rotator cuff can often cause difficulties. A new technique is described to identify the calcific deposit perioperatively with a ultrasound-guided wire. The technique allows a safe direct marking of calcific deposits making the procedure faster especially in difficult cases.

Becoming a Physician

MedlinePlus

... for USMLE® or COMLEX-USA® Find tips on test preparation courses to study for medical and licensing exams with confidence. Learn More Related Content AMA Wire® Few physicians are fluent in data. New program aims to fix that AMA Wire® Pre-residency boot camps prep med school grads for ...

Admittance Control for Robot Assisted Retinal Vein Micro-Cannulation under Human-Robot Collaborative Mode.

PubMed

Zhang, He; Gonenc, Berk; Iordachita, Iulian

2017-10-01

Retinal vein occlusion is one of the most common retinovascular diseases. Retinal vein cannulation is a potentially effective treatment method for this condition that currently lies, however, at the limits of human capabilities. In this work, the aim is to use robotic systems and advanced instrumentation to alleviate these challenges, and assist the procedure via a human-robot collaborative mode based on our earlier work on the Steady-Hand Eye Robot and force-sensing instruments. An admittance control method is employed to stabilize the cannula relative to the vein and maintain it inside the lumen during the injection process. A pre-stress strategy is used to prevent the tip of microneedle from getting out of vein in in prolonged infusions, and the performance is verified through simulations.

Pressure-wire-guided percutaneous transluminal pulmonary angioplasty: a breakthrough in catheter-interventional therapy for chronic thromboembolic pulmonary hypertension.

PubMed

Inami, Takumi; Kataoka, Masaharu; Shimura, Nobuhiko; Ishiguro, Haruhisa; Yanagisawa, Ryoji; Fukuda, Keiichi; Yoshino, Hideaki; Satoh, Toru

2014-11-01

This study sought to prove the safety and effectiveness of pressure-wire-guided percutaneous transluminal pulmonary angioplasty (PTPA). PTPA has been demonstrated to be effective for treatment of chronic thromboembolic pulmonary hypertension. However, a major and occasionally fatal complication after PTPA is reperfusion pulmonary edema. To avoid this, we developed the PEPSI (Pulmonary Edema Predictive Scoring Index). The pressure wire has been used to detect insufficiency of flow in a vessel. We included 350 consecutive PTPA sessions in 103 patients with chronic thromboembolic pulmonary hypertension from January 1, 2009 to December 31, 2013. During these 5 years, 140 PTPA sessions were performed without guidance, 65 with guidance of PEPSI alone, and 145 with both PEPSI and pressure-wire guidance. Each PTPA session was finished after achieving PEPSI scores of <35.4 with PEPSI guidance and each target lesion achieving distal mean pulmonary arterial pressure <35 mm Hg with pressure-wire guidance. The occurrence of clinically critical reperfusion pulmonary edema and vessel injuries were lowest in the group using the guidance of both pressure wire and PEPSI (0% and 6.9%, respectively). Furthermore, the group guided by pressure wire and PEPSI accomplished the same hemodynamic improvements with fewer numbers of target lesions treated and sessions performed. The combined approach using pressure wire and PEPSI produced more efficient clinical results and greatly reduced reperfusion pulmonary edema and vessel complications. This is further evidence that PTPA is an alternative strategy for treating chronic thromboembolic pulmonary hypertension. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

MRI-guided Wire Localization Surgical Biopsy in an Adolescent Patient with a Difficult to Diagnose Case of Lymphoma

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

Thompson, Scott M., E-mail: Thompson.scott@mayo.edu; Gorny, Krzysztof R.; Jondal, Danielle E.

A 17-year-old previously healthy female presented with a progressive soft tissue infiltrative process involving the neck and thorax. Extensive diagnostic evaluation including multiple imaging, laboratory, and biopsy studies was nondiagnostic. Due to an urgent need to establish a diagnosis and several previous nondiagnostic biopsies, she was referred to interventional radiology for MRI-guided wire localization immediately prior to open surgical biopsy. Under general anesthesia, wires were placed in the areas of increased T2 signal within the bilateral splenius capitis muscles using intermittent MRI-guidance followed by immediate surgical biopsy down to the wires. Pathology confirmed the diagnosis of diffuse large B-cell lymphoma.

Does the arterial cannulation site for circulatory arrest influence stroke risk?

PubMed

Svensson, Lars G; Blackstone, Eugene H; Rajeswaran, Jeevanantham; Sabik, Joseph F; Lytle, Bruce W; Gonzalez-Stawinski, Gonzalo; Varvitsiotis, Poseidon; Banbury, Michael K; McCarthy, Patrick M; Pettersson, Gösta B; Cosgrove, Delos M

2004-10-01

We investigated whether axillary/subclavian artery inflow with a side graft decreases the risk of stroke versus cannulation at other sites during hypothermic circulatory arrest. Between January 1993 and May 2003, 1,352 operations with circulatory arrest were performed for complex adult cardiac problems. A single arterial inflow cannulation site was used in 1,336 operations, and these formed the basis for comparative analyses. Cannulation sites were axillary plus graft in 299 operations, direct cannulation of the aorta in 471, femoral in 375, innominate in 24, and axillary or subclavian without a side graft in 167. Retrograde brain perfusion was used in 933 (69%). A total of 272 (20%) were for emergencies, 432 (32%) were reoperations, and 439 (32%) were for dissections. A total of 617 (46%) had aortic valve replacement and 1,160 (87%) ascending, 415 arch (31%), and 248 descending (18%) aortic replacements. Indications also included arteriosclerosis (n = 301) and calcified aorta (n = 278). Primary comparisons were made by using propensity matching, and, secondarily, risk factors for stroke or hospital mortality were identified by multivariable logistic regression. Stroke occurred in 6.1% of patients (81/1,336): 4.0% (12/299) of those had axillary plus graft and 6.7% who had direct cannulation (69/1,037; p = 0.09; p = 0.05 among propensity-matched pairs). Operative variables associated with stroke included direct aortic cannulation, aortic arteriosclerosis, descending aorta repair, and mitral valve replacement. The risk of hospital mortality was higher (11%; 42/375) for patients who had femoral cannulation than axillary plus graft (7.0%; 21/299; p = 0.06; p = 0.02 among propensity-matched pairs). Axillary inflow plus graft reduces stroke and is our method of choice for complex cardiac and cardioaortic operations that necessitate circulatory arrest. Retrograde or antegrade perfusion is used selectively.

Method and apparatus for diamond wire cutting of metal structures

DOEpatents

Parsells, Robert; Gettelfinger, Geoff; Perry, Erik; Rule, Keith

2005-04-19

A method and apparatus for diamond wire cutting of metal structures, such as nuclear reactor vessels, is provided. A diamond wire saw having a plurality of diamond beads with beveled or chamfered edges is provided for sawing into the walls of the metal structure. The diamond wire is guided by a plurality of support structures allowing for a multitude of different cuts. The diamond wire is cleaned and cooled by CO.sub.2 during the cutting process to prevent breakage of the wire and provide efficient cutting. Concrete can be provided within the metal structure to enhance cutting efficiency and reduce airborne contaminants. The invention can be remotely controlled to reduce exposure of workers to radioactivity and other hazards.

Community Physician-Guided Long-Term Domiciliary Oxygen Therapy Combined With Conventional Therapy in Stage IV COPD Patients.

PubMed

Bao, Hong; Wang, Jiaman; Zhou, Ding; Han, Zhaoyong; Zhang, Yuan; Su, Ling; Ye, Xiong; Xu, Chunyan; Fu, Meihong; Li, Qinghua

The aim of the study was to explore clinical effect of community physician-guided long-term domiciliary oxygen therapy (LTDOT) on patients with Stage IV chronic obstructive pulmonary disease (COPD). A retrospective study. Fifty-four patients with Stage IV COPD were recruited and randomly divided into two groups (the LTDOT group and the control group). Patients in LTDOT group accepted additional oxygen therapy for more than 15 hours every day with continuous low flow (1-2 L/min) for 3 years. PaO2 (O2 pressure), FEV1/FVC (forced vital capacity), and FEV1% (percentage of forced expiratory volume in 1 second) in the LTDOT group increased significantly after treatment. A significant decrease was observed on the BODE index in the LTDOT group (p < .05) but not in control group (p > .05). Frequencies and costs of hospitalization therapy and emergency medical services were markedly decreased after 3 years of LTDOT. Community physician-guided LTDOT can improve prognosis and reduce the costs for stage IV COPD patients. Rehabilitation nurses can be instrumental in helping patients with stage IV COPD learn principles of LTDOT.

Pancreatic stent insertion after an unintentional guidewire cannulation of the pancreatic duct during ERCP.

PubMed

García-Cano, Jesús; Viñuelas Chicano, Miriam; Del Moral Martínez, María; Muñiz Muñoz, Marta; Murillo Matamoros, Claudio; Suárez Matías, Miguel; Valiente González, Laura; Martínez Pérez, Teresa; Martínez Fernández, Raquel; Gómez Ruiz, Carmen Julia; Pérez García, José Ignacio; Morillas Ariño, Julia

2018-04-24

the guidewire (GW) may enter the pancreatic duct during common bile duct (CBD) cannulation attempts in endoscopic retrograde cholangiopancreatography (ERCP). After GW passage into the pancreas, the most effective maneuver for CBD cannulation and pancreatitis prevention has not been determined. to study CBD cannulation and post-ERCP pancreatitis rates when a pancreatic stent is inserted after an unintentional GW cannulation of the pancreatic duct. a retrospective analysis of patients undergoing ERCP for biliary drainage that were included prospectively into a database. After unintentional GW cannulation of the pancreatic duct, a straight 5-Fr and 4-cm long plastic stent was inserted. The stents had no internal flaps to facilitate expulsion. CBD cannulation attempts were made above the stent. A pancreatic sphincterotomy was performed in patients older than 60 years before stent insertion. a total of 46 pancreatic stents were inserted during 154 ERCP (29.8%) procedures. In the stent group, CBD cannulation was accomplished in 44/46 (95.6%) subjects. A total of 21/46 (45.6%) pancreatic sphincterotomies were performed. Only 1/46 (2.17%) mild pancreatitis cases were observed and most stents were spontaneously expelled. in this study, the CBD was eventually reached with the insertion of a plastic pancreatic stent after an unintentional GW passage into the pancreatic duct while attempting a CBD cannulation. No adverse events were observed following pancreatic stent insertion.

Mountain Plains Learning Experience Guide: Electrical Wiring. Course: Electrical Wiring Rough-In.

ERIC Educational Resources Information Center

Arneson, R.; And Others

One of two individualized courses included in an electrical wiring curriculum, this course covers electrical installations that are generally hidden within the structure. The course is comprised of four units: (1) Outlet and Switch Boxes, (2) Wiring, (3) Service Entrance, and (4) Signal and Low Voltage Systems. Each unit begins with a Unit…

The effect of hospital control strategies on physician satisfaction and physician-hospital conflict.

PubMed Central

Burns, L R; Andersen, R M; Shortell, S M

1990-01-01

This article examines several strategies that hospitals use to control their medical staffs. Such strategies include placing physicians on salary, developing exclusive hospital affiliations with physicians, and involving physicians in decision-making bodies. Using regression techniques, we investigate which hospitals are more likely to utilize these strategies and whether such strategies are effective in promoting physician-hospital integration. Contrary to our expectations, corporate hospital structures (e.g., for-profit hospitals, membership in multihospital systems) generally do not employ these strategies more often and oftentimes employ them less. There is also little evidence that control strategies are effective levers for increasing physician satisfaction or decreasing physician-hospital conflict. We suggest that control strategies are useful for purposes other than promoting physician-hospital integration. Finally, hospital ownership appears to exert the biggest effect on physician satisfaction and conflict. PMID:2380074

Controlled motion of domain walls in submicron amorphous wires

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

Ţibu, Mihai; Lostun, Mihaela; Rotărescu, Cristian

Results on the control of the domain wall displacement in cylindrical Fe{sub 77.5}Si{sub 7.5}B{sub 15} amorphous glass-coated submicron wires prepared by rapid quenching from the melt are reported. The control methods have relied on conical notches with various depths, up to a few tens of nm, made in the glass coating and in the metallic nucleus using a focused ion beam (FIB) system, and on the use of small nucleation coils at one of the sample ends in order to apply magnetic field pulses aimed to enhance the nucleation of reverse domains. The notch-based method is used for the firstmore » time in the case of cylindrical ultrathin wires. The results show that the most efficient technique of controlling the domain wall motion in this type of samples is the simultaneous use of notches and nucleation coils. Their effect depends on wire diameter, notch depth, its position on the wire length, and characteristics of the applied pulse.« less

Wire rope tension control of hoisting systems using a robust nonlinear adaptive backstepping control scheme.

PubMed

Zhu, Zhen-Cai; Li, Xiang; Shen, Gang; Zhu, Wei-Dong

2018-01-01

This paper concerns wire rope tension control of a double-rope winding hoisting system (DRWHS), which consists of a hoisting system employed to realize a transportation function and an electro-hydraulic servo system utilized to adjust wire rope tensions. A dynamic model of the DRWHS is developed in which parameter uncertainties and external disturbances are considered. A comparison between simulation results using the dynamic model and experimental results using a double-rope winding hoisting experimental system is given in order to demonstrate accuracy of the dynamic model. In order to improve the wire rope tension coordination control performance of the DRWHS, a robust nonlinear adaptive backstepping controller (RNABC) combined with a nonlinear disturbance observer (NDO) is proposed. Main features of the proposed combined controller are: (1) using the RNABC to adjust wire rope tensions with consideration of parameter uncertainties, whose parameters are designed online by adaptive laws derived from Lyapunov stability theory to guarantee the control performance and stability of the closed-loop system; and (2) introducing the NDO to deal with uncertain external disturbances. In order to demonstrate feasibility and effectiveness of the proposed controller, experimental studies have been conducted on the DRWHS controlled by an xPC rapid prototyping system. Experimental results verify that the proposed controller exhibits excellent performance on wire rope tension coordination control compared with a conventional proportional-integral (PI) controller and adaptive backstepping controller. Copyright © 2017 ISA. All rights reserved.

Robot-Assisted Retinal Vein Cannulation with Force-Based Puncture Detection: Micron vs. the Steady-Hand Eye Robot*

PubMed Central

Gonenc, Berk; Tran, Nhat; Gehlbach, Peter; Taylor, Russell H.; Iordachita, Iulian

2018-01-01

Retinal vein cannulation is a demanding procedure where therapeutic agents are injected into occluded retina veins. The feasibility of this treatment is limited due to challenges in identifying the moment of venous puncture, achieving cannulation and maintaining it throughout the drug delivery period. In this study, we integrate a force-sensing microneedle with two distinct robotic systems: the handheld micromanipulator Micron, and the cooperatively controlled Steady-Hand Eye Robot (SHER). The sensed tool-to-tissue interaction forces are used to detect venous puncture and extend the robots’ standard control schemes with a new position holding mode (PHM) that assists the operator hold the needle position fixed and maintain cannulation for a longer time with less trauma on the vasculature. We evaluate the resulting systems comparatively in a dry phantom, stretched vinyl membranes. Results have shown that modulating the admittance control gain of SHER alone is not a very effective solution for preventing the undesired tool motion after puncture. However, after using puncture detection and PHM the deviation from the puncture point is significantly reduced, by 65% with Micron, and by 95% with SHER representing a potential advantage over freehand for both. PMID:28269417

No reliable evidence to guide initial arch wire choice for fixed appliance therapy.

PubMed

Flores-Mir, Carlos

2013-12-01

The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase databases were searched. Conference proceedings and abstracts from the British Orthodontic Conference European Orthodontic Conference and the International Association for Dental Research were also searched together with the reference lists of identified studies. Study authors were contacted for additional information. Randomised controlled trials of initial arch wire involving participants with upper and/or lower full arch fixed orthodontic appliances were included. Study selection, data extraction and risk of bias assessment were carried out independently by at least two reviewers. Nine RCTs with 571 participants were included in this review. All trials were at high risk of bias. All trials had at least one potentially confounding factor (such as bracket type, slot size, ligation method, extraction of teeth) which is likely to have influenced the outcome and was not controlled in the trial. None of the trials reported the important adverse outcome of root resorption. The comparisons were made between:Multistrand stainless steel initial arch wires compared to superelastic nickel titanium (NiTi) initial arch wires. There were four trials in this group, with different comparisons and outcomes reported at different times. No meta-analysis was possible. There is insufficient evidence from these trials to determine whether or not there is a difference in either rate of alignment or pain between stainless steel and NiTi initial arch wires.Conventional (stabilised) NiTi initial arch wires compared to superelastic NiTi initial arch wires. There were two trials in this group, one reporting the outcome of alignment over six months and the other reporting pain over one week. There is insufficient evidence from these trials to determine whether or not there is any difference between conventional (stabilised) and superelastic NiTi initial arch

Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography

PubMed Central

Swan, Michael P; Bourke, Michael J; Williams, Stephen J; Alexander, Sina; Moss, Alan; Hope, Rick; Ruppin, David

2011-01-01

AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary cannulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identifiable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 naïve papilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or post-ERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017). CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures. PMID:22174549

Online C-arm calibration using a marked guide wire for 3D reconstruction of pulmonary arteries

NASA Astrophysics Data System (ADS)

Vachon, Étienne; Miró, Joaquim; Duong, Luc

2017-03-01

3D reconstruction of vessels from 2D X-ray angiography is highly relevant to improve the visualization and the assessment of vascular structures such as pulmonary arteries by interventional cardiologists. However, to ensure a robust and accurate reconstruction, C-arm gantry parameters must be properly calibrated to provide clinically acceptable results. Calibration procedures often rely on calibration objects and complex protocol which is not adapted to an intervention context. In this study, a novel calibration algorithm for C-arm gantry is presented using the instrumentation such as catheters and guide wire. This ensures the availability of a minimum set of correspondences and implies minimal changes to the clinical workflow. The method was evaluated on simulated data and on retrospective patient datasets. Experimental results on simulated datasets demonstrate a calibration that allows a 3D reconstruction of the guide wire up to a geometric transformation. Experiments with patients datasets show a significant decrease of the retro projection error to 0.17 mm 2D RMS. Consequently, such procedure might contribute to identify any calibration drift during the intervention.

Beliefs About Control in the Physician-patient Relationship

PubMed Central

Street, Richard L; Krupat, Edward; Bell, Robert A; Kravitz, Richard L; Haidet, Paul

2003-01-01

OBJECTIVES Effective communication is a critical component of quality health care, and to improve it we must understand its dynamics. This investigation examined the extent to which physicians' and patients' preferences for control in their relationship (e.g., shared control vs doctor control) were related to their communications styles and adaptations (i.e., how they responded to the communication of the other participant). DESIGN Stratified case-controlled study. PATIENTS/PARTICIPANTS Twenty family medicine and internal medicine physicians and 135 patients. MEASUREMENTS Based on scores from the Patient-Practitioner Orientation Scale, 10 patient-centered physicians (5 male, 5 female) and 10 doctor-centered physicians (5 male, 5 female) each interacted with 5 to 8 patients, roughly half of whom preferred shared control and the other half of whom were oriented toward doctor control. Audiotapes of 135 consultations were coded for behaviors indicative of physician partnership building and active patient participation. MAIN RESULTS Patients who preferred shared control were more active participants (i.e., expressed more opinions, concerns, and questions) than were patients oriented toward doctor control. Physicians' beliefs about control were not related to their use of partnership building. However, physicians did use more partnership building with male patients. Not only were active patient participation and physician partnership building mutually predictive of each other, but also approximately 14% of patient participation was prompted by physician partnership building and 33% of physician partnership building was in response to active patient participation. CONCLUSIONS Communication in medical encounters is influenced by the physician's and patient's beliefs about control in their relationship as well as by one another's behavior. The relationship between physicians' partnership building and active patient participation is one of mutual influence such that

The effectiveness of a near-infrared vascular imaging device to support intravenous cannulation in children with dark skin color: a cluster randomized clinical trial.

PubMed

van der Woude, Olga C P; Cuper, Natascha J; Getrouw, Chavalleh; Kalkman, Cor J; de Graaff, Jurgen C

2013-06-01

Poor vein visibility can make IV cannulation challenging in children with dark skin color. In the operating room, we studied the effectiveness of a near-infrared vascular imaging device (VascuLuminator) to facilitate IV cannulation in children with dark skin color. In the operating room of a general hospital in Curacao, all consecutive children (0-15 years of age) requiring IV cannulation were included in a pragmatic cluster randomized clinical trial. The VascuLuminator was made available to anesthesiologists at the operating complex in randomized clusters of 1 week. Success at first attempt was 63% (27/43, 95% confidence interval [CI], 47%-77%) in the VascuLuminator group vs 51% (23 of 45 patients, 95% CI, 36%-66%) in the control group (P = 0.27). Median time to successful cannulation was 53 seconds (interquartile range: 34-154) in the VascuLuminator group and 68 seconds (interquartile range: 40-159) in the control group (P = 0.54), and hazard ratio was 1.12 (95% CI, 0.73-1.71). The VascuLuminator has limited value in improving success at first attempt of facilitating IV cannulation in children with dark skin color.

CANNULATION STRATEGY FOR AORTIC ARCH RECONSTRUCTION USING DEEP HYPOTHERMIC CIRCULATORY ARREST

PubMed Central

de Zéicourt, Diane; Jung, Philsub; Horner, Marc; Pekkan, Kerem; Kanter, Kirk R.; Yoganathan, Ajit P.

2013-01-01

Background Aortic arch reconstruction in neonates is commonly performed using deep hypothermic circulatory arrest. However, concerns have arisen regarding potential adverse neurologic outcomes from this complex procedure, raising questions as to best arterial cannulation approach for cerebral perfusion and effective systemic hypothermia. In this study, we use computational fluid dynamics to investigate the impact of different cannulation strategies in neonates. Methods Using a realistic hypoplastic neonatal aorta template as the base geometry, four different cannulation options were investigated: 1) right innominate artery, 2) innominate root, 3) patent ductus arteriosus (PDA), or 4) both innominate root and PDA. Performance was evaluated based on the numerically predicted cerebral and systemic flow distributions compared with physiological perfusion under neonatal conditions. Results The four cannulation strategies were associated with different local hemodynamics, but this did not translate into any significant effect on the measured flow distributions. The largest difference only represented 0.8% of the cardiac output and was measured in the innominate artery, which received 23.2% of the cardiac output in Option 3 vs. 24% in Option 4. PA snaring benefited all systemic vessels uniformly. Conclusion Due to the very high vascular resistances in neonates, flow distribution to the different vascular beds was dictated by the downstream vascular resistances rather than the cannulation strategy, allowing the surgical team to choose their method of preference. However, patients with aortic coarctation warrant further investigation and will most likely benefit from a two cannulae approach (Option 4). PMID:22608717

Comparison of two cannulation methods for assessment of intracavernosal pressure in a rat model

PubMed Central

Luo, Lianmin; Wang, Jiamin; Li, Ermao; Luo, Jintai; Liu, Luhao; Wan, ShawPong

2018-01-01

Intracavernous pressure (ICP) measurement is a well-established technique for assessing the erectile function, which was performed by cannulating either crus or shaft of the penis. However, there are no studies concerning the experimental performance of the two cannulation sites yet. The aim of this study was to compare the measuring outcomes using two different cannulation sites. To validate the capacity of our study, both normal and the castration-induced erectile dysfunction rat models were conducted. Fifty adult male Sprague-Dawley rats were randomized equally into two groups: an intact group and a castration group. Five rats from each group firstly underwent different stimulation parameters to detect the optimal erectile responses. The residual rats in each group were further assigned into two subgroups (n = 10 per subgroup) according to two different cannulation sites (crus or shaft of the corpus cavernosum). The ICP values were compared between groups after different interventions. The optimal parameters for mean maximum ICP were recorded at 2.5V and a frequency of 15 Hz. The rats under the two different cannulation sites tended to show similar ICP values in both the intact and the castration groups. However, the success rate in monitoring ICP was significantly higher in the groups cannulating into the shaft of the penis compared to the crus (100% vs. 70%; P = 0.02). Our data suggested that the method of cannulation into the penile shaft could serve as a better alternative for the ICP measurement in rats. PMID:29486011

CT fluoroscopy-guided preoperative short hook wire placement for small pulmonary lesions: evaluation of safety and identification of risk factors for pneumothorax.

PubMed

Iguchi, Toshihiro; Hiraki, Takao; Gobara, Hideo; Fujiwara, Hiroyasu; Matsui, Yusuke; Miyoshi, Shinichiro; Kanazawa, Susumu

2016-01-01

To retrospectively evaluate the safety of computed tomography (CT) fluoroscopy-guided short hook wire placement for video-assisted thoracoscopic surgery and the risk factors for pneumothorax associated with this procedure. We analyzed 267 short hook wire placements for 267 pulmonary lesions (mean diameter, 9.9 mm). Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for pneumothorax. Complications (219 grade 1 and 4 grade 2 adverse events) occurred in 196 procedures. No grade 3 or above adverse events were observed. Univariate analysis revealed increased vital capacity (odds ratio [OR], 1.518; P = 0.021), lower lobe lesion (OR, 2.343; P =0.001), solid lesion (OR, 1.845; P = 0.014), prone positioning (OR, 1.793; P = 0.021), transfissural approach (OR, 11.941; P = 0.017), and longer procedure time (OR, 1.036; P = 0.038) were significant predictors of pneumothorax. Multivariate analysis revealed only the transfissural approach (OR, 12.171; P = 0.018) and a longer procedure time (OR, 1.048; P = 0.012) as significant independent predictors. Complications related to CT fluoroscopy-guided preoperative short hook wire placement often occurred, but all complications were minor. A transfissural approach and longer procedure time were significant independent predictors of pneumothorax. Complications related to CT fluoroscopy-guided preoperative short hook wire placement often occur. Complications are usually minor and asymptomatic. A transfissural approach and longer procedure time are significant independent predictors of pneumothorax.

Parent-healthcare provider interaction during peripheral vein cannulation with resistive preschool children.

PubMed

Svendsen, Edel Jannecke; Moen, Anne; Pedersen, Reidar; Bjørk, Ida Torunn

2016-03-01

The aim of this study was to increase understanding of parent-healthcare provider interaction in situations where newly admitted preschool children resist peripheral vein cannulation. Parent-healthcare provider interaction represents an important context for understanding children's resistance to medical procedures. Knowledge about this interaction can provide a better understanding of how restraint is used and talked about. Symbolic interactionism informed the understanding of interaction. An exploratory, qualitative study was chosen because little is known about these interactions. During 2012-2013, 14 naturalistic peripheral vein cannulation -attempts with six newly hospitalized preschool children were video recorded. Eight parents/relatives, seven physicians and eight nurses participated in this study. The analytical foci of turn-taking and participant structure were used. The results comprised three patterns of interactions. The first pattern, 'parents supported the interaction initiated by healthcare providers', was a response to the children's expressed resistance and they performed firm restraint together. The second pattern, 'parents create distance in interaction with healthcare providers', appeared after failed attempts and had a short time span. Parents stopped following up on the healthcare providers' interaction and their restraint became less firm. In the third pattern, 'healthcare providers reorient in interaction', healthcare providers took over more of the restraint and either helped each other to continue the interaction or they stopped it. Knowledge about the identified patterns of interactions can help healthcare providers to better understand and thereby prepare both parents and themselves for situations with potential use of restraint. © 2015 John Wiley & Sons Ltd.

Small-bore wire-guided chest drains: safety, tolerability, and effectiveness in pneumothorax, malignant effusions, and pleural empyema.

PubMed

Cafarotti, Stefano; Dall'Armi, Valentina; Cusumano, Giacomo; Margaritora, Stefano; Meacci, Elisa; Lococo, F; Vita, M L; Porziella, V; Bonassi, S; Cesario, Alfredo; Granone, Pierluigi

2011-03-01

The use of small-bore wire-guided chest drains for pleural effusions and pneumothorax has become popular; however, limited data are available on its efficacy and morbidity. The aim of this retrospective study is to measure, via the analysis of the so far largest reported cohort, the efficacy, safety, and tolerability of this approach in different clinical conditions. In the period from January 2002 to December 2008, 1092 patients have undergone the positioning of a small-bore wire-guided chest drain (12F) for the evidence of pneumothorax or pleural effusion and have been monitored over time for morbidity, pain at the time of insertion (measured via the visual analogue scale), and drain failure for misplacement or blockage. Patients with trauma were excluded from this study. Male/female ratio and mean age were respectively 418:674 and 55.85 ± 18.6. Three-hundred ninety-nine (36.5%) drains were inserted for pneumothorax, 324 (29.7%) for malignant effusion, 97 (8.9%) for empyema, and 272 (24.9%) for nonmalignant effusion. The pain experience was on average "very mild" (mean visual analogue scale = 4.6 mm). The overall drain failure rate was 12.9%. The percentage of successful cases was 93.8% in malignant effusion, 93% in pneumothorax, and 92.3% in nonmalignant effusion; in the cases of pathologically diagnosed empyema, drains were more likely to get blocked (74.2%). We recorded 1 serious complication within the malignant effusion group. Wire-guided 12F Seldinger-type drains are a well-tolerated and effective method of treating pneumothorax and uncomplicated pleural effusions (malignant and nonmalignant) with acceptable morbidity. The use of 12F small-bore chest drain is not indicated for the treatment of empyema. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

A comparison of line enhancement techniques: applications to guide-wire detection and respiratory motion tracking

NASA Astrophysics Data System (ADS)

Bismuth, Vincent; Vancamberg, Laurence; Gorges, Sébastien

2009-02-01

During interventional radiology procedures, guide-wires are usually inserted into the patients vascular tree for diagnosis or healing purpose. These procedures are monitored with an Xray interventional system providing images of the interventional devices navigating through the patient's body. The automatic detection of such tools by image processing means has gained maturity over the past years and enables applications ranging from image enhancement to multimodal image fusion. Sophisticated detection methods are emerging, which rely on a variety of device enhancement techniques. In this article we reviewed and classified these techniques into three families. We chose a state of the art approach in each of them and built a rigorous framework to compare their detection capability and their computational complexity. Through simulations and the intensive use of ROC curves we demonstrated that the Hessian based methods are the most robust to strong curvature of the devices and that the family of rotated filters technique is the most suited for detecting low CNR and low curvature devices. The steerable filter approach demonstrated less interesting detection capabilities and appears to be the most expensive one to compute. Finally we demonstrated the interest of automatic guide-wire detection on a clinical topic: the compensation of respiratory motion in multimodal image fusion.

Progressive migration of broken Kirschner wire into the proximal tibia following tension-band wiring technique of a patellar fracture--case report.

PubMed

Konda, Sanjit R; Dayan, Alan; Egol, Kenneth A

2012-01-01

Wire breakage and migration is a known complication of using a wire tension band construct to treat displaced patella fractures. We report a case of a broken K-wire that migrated from the patella completely into the proximal tibia without complication 9 years after the index surgery. This report highlights the fact that wire migration can occur long after fracture healing and be relatively asymptomatic. But because the complications of wire migration can be deadly, it requires diligence on the part of the physician to educate the patient that new knee pain after operative fixation requires formal evaluation by the treating surgeon.

Pull-pull position control of dual motor wire rope transmission.

PubMed

Guo, Quan; Jiao, Zongxia; Yan, Liang; Yu, Qian; Shang, Yaoxing

2016-08-01

Wire rope transmission is very efficient because of the small total moving object mass. The wire rope could only transmit pulling force. Therefore it has to be kept in a tightened state during transmission; in high speed applications the dynamic performance depends on the rope's stiffness, which can be adjusted by the wire rope tension. To improve the system dynamic performance output, this paper proposes a novel pull-pull method based on dual motors connected by wire ropes, for precise, high speed position control applications. The method can regulate target position and wire rope tension simultaneously. Wire ropes remain in a pre-tightening state at all times, which prevents the influence of elasticity and reduces the position tracking error in the changing direction process. Simulations and experiments were conducted; the results indicate that both position precision and superior dynamic performance can be synchronously achieved. The research is relevant to space craft precision pointing instruments.

Residential Wiring. Second Edition.

ERIC Educational Resources Information Center

Taylor, Mark; And Others

This guide is designed to assist teachers conducting a course to prepare students for entry-level employment in the residential wiring trade. Included in the guide are six instructional units and the following sections of information for teachers: guidelines in using the unit components; academic and workplace skills classifications and…

Effect of first cannulation time and dialysis machine blood flows on survival of arteriovenous fistulas.

PubMed

Wilmink, Teun; Powers, Sarah; Hollingworth, Lee; Stevenson, Tamasin

2018-05-01

To study the effect of cannulation time on arteriovenous fistula (AVF) survival. Methods. Analysis of two prospective databases of access operations and dialysis sessions from 12 January 2002 through 4 January 2015 with follow-up until 4 January 2016. First cannulation time (FCT), defined from operation to first cannulation, was categorized as <2 weeks, 2-4 weeks, 4-8 weeks, 8-16 weeks and ≥16 weeks. Early cannulation was defined as FCT within 4 weeks. AVF survival was defined as the date until the AVF was abandoned. Maximum machine blood flow rate (BFR) for the first 29 dialysis sessions on AVF was analysed. Altogether, 1167 AVF with functional dialysis use were analysed: 667 (57%) radial cephalic AVF, 383 (33%) brachiocephalic AVF and 117 (10%) brachiobasilic AVF. The 631 (54%) AVF created in on-dialysis patients were analysed separately from 536 (46%) AVF created in pre-dialysis patients. AVF survival was similar between cannulation categories for both pre-dialysis patients (P = 0.19) and on-dialysis patients (P = 0.83). Early cannulation was associated with similar AVF survival in both pre-dialysis patients (P = 0.82) and on-dialysis patients (P = 0.17). Six consecutive successful cannulations from the start were associated with improved AVF survival (P = 0.0002). A below-median BFR at the start of dialysis was associated with better AVF survival (P < 0.0001). A below-median increase in BFR in the first 2 months was associated with worse AVF survival (P = 0.007). The type of AVF, diabetes, pre-dialysis state at operation and six successful cannulations from the start were independent predictors for AVF survival. FCT is not associated with AVF survival. Failures to achieve six successful cannulations from the start of dialysis and higher machine BFR in the first week of dialysis are associated with decreased AVF survival.

Self-designed femoral neck guide pin locator for femoral neck fractures.

PubMed

Xia, Shengli; Wang, Ziping; Wang, Minghui; Wu, Zuming; Wang, Xiuhui

2014-01-01

Closed reduction and fixation with 3 cannulated screws is a widely accepted surgery for the treatment of femoral neck fractures. However, how to obtain optimal screw placement remains unclear. In the current study, the authors designed a guide pin positioning system for femoral neck fracture cannulated screw fixation and examined its application value by comparing it with freehand guide needle positioning and with general guide pin locator positioning provided by equipment manufacturers. The screw reset rate, screw parallelism, triangle area formed by the link line of the entry point of 3 guide pins, and maximum vertical load bearing of the femoral neck after internal fixation were recorded. As expected, the triangle area was largest in the self-designed positioning group, followed by the general positioning group and the freehand positioning group. The difference among the 3 groups was statistically significant (P<.05). Anteroposterior and lateral radiographs showed that the screws were more parallel in the self-designed positioning group and general positioning group compared with the freehand positioning group (P<.05). The screw reset rate in the self-designed positioning group was significantly lower than that in the general positioning group and the freehand positioning group (P<.05). Maximum bearing load among the 3 groups was equivalent, showing no statistically significant difference (P>.05). The authors’ self-designed guide pin positioning system has the potential to accurately insert cannulated screws in femoral neck fractures and may reduce bone loss and unnecessary radiation.

Precision wire feeder for small diameter wire

DOEpatents

Brandon, Eldon D.; Hooper, Frederick M.; Reichenbach, Marvin L.

1992-01-01

A device for feeding small diameter wire having a diameter less than 0.04 mm (16 mil) to a welding station includes a driving wheel for controllably applying a non-deforming driving force to the wire to move the free end of the wire towards the welding station; and a tension device such as a torque motor for constantly applying a reverse force to the wire in opposition to the driving force to keep the wire taut.

Precision wire feeder for small diameter wire

DOEpatents

Brandon, E.D.; Hooper, F.M.; Reichenbach, M.L.

1992-08-11

A device for feeding small diameter wire having a diameter less than 0.04 mm (16 mil) to a welding station includes a driving wheel for controllably applying a non-deforming driving force to the wire to move the free end of the wire towards the welding station; and a tension device such as a torque motor for constantly applying a reverse force to the wire in opposition to the driving force to keep the wire taut. 1 figure.

Minimally invasive treatment of clavicular fractures with cannulated screw.

PubMed

Sun, Jun-zhan; Zheng, Guo-hai; Zhao, Ke-yi

2014-05-01

To evaluate minimally invasive treatment of clavicular fractures with cannulated screw. Data of 65 patients who had undergone minimally invasive treatment with cannulated screws for clavicular fractures from April 2009 to October 2010 were retrospectively analyzed and compared with those of 65 patients with clavicular fractures who had been treated by the same surgeons with plates. In the study group, there were 41 males and 24 females, aged from 19-67 years (mean, 35.8 years). According to Craig's classification, there were 29 group 1 and 36 of group 2-II. Neer scores were used to evaluate shoulder function and radiographs to assess fracture union. The incision length was 4-5 cm in the cannulated screw group (CSG) and 10-11 cm in the reconstructive plate group (RPG). Radiographs showed bone union was achieved in both groups, the bone healing time being 13.2 ± 6.9 weeks in the CSG and 16.3 ± 8.7 weeks in the RPG. All patients were followed up for 6 to 20 months (average, 10.6 months). The average Neer score was 96.6 ± 3.4 in the CSG and 94.2 ± 5.8 in the RPG. In the CSG, screw loosening occurred in five, and fracture displacement in three. There was a significant difference in fracture healing time between two groups but not in Neer score. Minimally invasive treatment of clavicular fractures with cannulated screws has the advantages of minimal invasion, short bone healing time, good clinical outcomes, and being relatively inexpensive. © 2014 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

Use of CCSDS Packets Over SpaceWire to Control Hardware

NASA Technical Reports Server (NTRS)

Haddad, Omar; Blau, Michael; Haghani, Noosha; Yuknis, William; Albaijes, Dennis

2012-01-01

For the Lunar Reconnaissance Orbiter, the Command and Data Handling subsystem consisted of several electronic hardware assemblies that were connected with SpaceWire serial links. Electronic hardware would be commanded/controlled and telemetry data was obtained using the SpaceWire links. Prior art focused on parallel data buses and other types of serial buses, which were not compatible with the SpaceWire and the core flight executive (CFE) software bus. This innovation applies to anything that utilizes both SpaceWire networks and the CFE software. The CCSDS (Consultative Committee for Space Data Systems) packet contains predetermined values in its payload fields that electronic hardware attached at the terminus of the SpaceWire node would decode, interpret, and execute. The hardware s interpretation of the packet data would enable the hardware to change its state/configuration (command) or generate status (telemetry). The primary purpose is to provide an interface that is compatible with the hardware and the CFE software bus. By specifying the format of the CCSDS packet, it is possible to specify how the resulting hardware is to be built (in terms of digital logic) that results in a hardware design that can be controlled by the CFE software bus in the final application

The Wire-Grasping Method as a New Technique for Forceps Biopsy of Biliary Strictures: A Prospective Randomized Controlled Study of Effectiveness

PubMed Central

Yamashita, Yasunobu; Ueda, Kazuki; Kawaji, Yuki; Tamura, Takashi; Itonaga, Masahiro; Yoshida, Takeichi; Maeda, Hiroki; Magari, Hirohito; Maekita, Takao; Iguchi, Mikitaka; Tamai, Hideyuki; Ichinose, Masao; Kato, Jun

2016-01-01

Background/Aims Transpapillary forceps biopsy is an effective diagnostic technique in patients with biliary stricture. This prospective study aimed to determine the usefulness of the wire-grasping method as a new technique for forceps biopsy. Methods Consecutive patients with biliary stricture or irregularities of the bile duct wall were randomly allocated to either the direct or wire-grasping method group. In the wire-grasping method, forceps in the duodenum grasps a guide-wire placed into the bile duct beforehand, and then, the forceps are pushed through the papilla without endoscopic sphincterotomy. In the direct method, forceps are directly pushed into the bile duct alongside a guide-wire. The primary endpoint was the success rate of obtaining specimens suitable for adequate pathological examination. Results In total, 32 patients were enrolled, and 28 (14 in each group) were eligible for analysis. The success rate was significantly higher using the wire-grasping method than the direct method (100% vs 50%, p=0.016). Sensitivity and accuracy for the diagnosis of cancer were comparable in patients with the successful procurement of biopsy specimens between the two methods (91% vs 83% and 93% vs 86%, respectively). Conclusions The wire-grasping method is useful for diagnosing patients with biliary stricture or irregularities of the bile duct wall. PMID:27021502

Cannulation for veno-venous extracorporeal membrane oxygenation

PubMed Central

2018-01-01

Extracorporeal membrane oxygenation (ECMO) is described as a modified, smaller cardiopulmonary bypass circuit. The veno-venous (VV) ECMO circuit drains venous blood, oxygenate the blood, and pump the blood back into the same venous compartment. Draining and reinfusing in the same compartment means there are a risk of recirculation. The draining position within the venous system, ECMO pump flow, return flow position within the venous system and the patients cardiac output (CO) all have an impact on recirculation. Using two single lumen cannulas or one dual lumen cannula, but also the design of the venous cannula, can have an impact on where within the venous system the cannula is draining blood and will affect the efficiency of the ECMO circuit. VV ECMO can be performed with different cannulation strategies. The use of two single lumen cannulas draining in inferior vena cava (IVC) and reinfusing in superior vena cava (SVC) or draining in SVC and reinfusing in IVC, or one dual lumen cannula inserted in right jugular vein is all possible cannulation strategies. Independent of cannulation strategy there will be a risk of recirculation. Efficiency can be reasonable in either strategy if the cannulas are carefully positioned and monitored during the dynamic procedure of pulmonary disease. The disadvantage draining from IVC only occurs when there is a need for converting from VV to veno-arterial (VA) ECMO, reinfusing in the femoral artery. Then draining from SVC is the most efficient strategy, draining low saturated venous blood, and also means low risk of dual circulation. PMID:29732177

Two-Stage Rumen Cannulation Technique in Dairy Cows.

PubMed

Martineau, Roger; Proulx, Julien G; Côrtes, Cristiano; Brito, Andre F; Duffield, Todd F

2015-07-01

To describe a 2-stage rumen cannulation technique for dairy cows. Case series. 172 dairy cows from 2 research institutions. The 2-stage rumen cannulation technique first exteriorized a rumen segment within a wooden clamp, fixing the clamp to the skin with 6 mattress sutures. After 1 week, the necrotic rumen segment was removed, leaving a rumen fistula in which a 7.5 cm cannula was inserted. This was replaced by a 10 cm cannula a further 1 week later. The surgery took an average of 30 minutes. At least 1 assistant is required for the technique. The overall complication frequency was 7/172 (4%). One cow and 1 heifer aborted less than 10 days after surgery. Two late-pregnant heifers died from peritonitis after insertion of the 7.5 cm cannula because of incomplete adhesion of the rumen to the abdominal wall. The exteriorized rumen segment slipped back in the abdomen in 3 cows but was successfully re-clamped prior to insertion of the 7.5 cm cannula. A high success rate was achieved with this 2-stage cannulation technique. Postoperative complications were attributed to delayed adhesion of the rumen, perhaps because of stress-related factors (e.g., transport, mixing with other animals, transition period). © 2015 by The American College of Veterinary Surgeons.

3D printing-based minimally invasive cannulated screw treatment of unstable pelvic fracture.

PubMed

Cai, Leyi; Zhang, Yingying; Chen, Chunhui; Lou, Yiting; Guo, Xiaoshan; Wang, Jianshun

2018-04-04

Open reduction and internal fixation of pelvic fractures could restore the stability of the pelvic ring, but there were several problems. Minimally invasive closed reduction cannulated screw treatment of pelvic fractures has lots advantages. However, how to insert the cannulated screw safely and effectively to achieve a reliable fixation were still hard for orthopedist. Our aim was to explore the significance of 3D printing technology as a new method for minimally invasive cannulated screw treatment of unstable pelvic fracture. One hundred thirty-seven patients with unstable pelvic fractures from 2014 to 2016 were retrospectively analyzed. Based on the usage of 3D printing technology for preoperative simulation surgery, they were assigned to 3D printing group (n = 65) and control group (n = 72), respectively. These two groups were assessed in terms of operative time, intraoperative fluoroscopy, postoperative reduction effect, fracture healing time, and follow-up function. The effect of 3D printing technology was evaluated through minimally invasive cannulated screw treatment. There was no significant difference in these two groups with respect to general conditions, such as age, gender, fracture type, time from injury to operation, injury cause, and combined injury. Length of surgery and average number of fluoroscopies were statistically different for 3D printing group and the control group (p < 0.01), i.e., 58.6 vs. 72.3 min and 29.3 vs. 37 min, respectively. Using the Matta radiological scoring systems, the reduction was scored excellent in 21/65 cases (32.3%) and good in 30/65 cases (46.2%) for the 3D printing group, versus 22/72 cases (30.6%) scored as excellent and 36/72 cases (50%) as good for the control group. On the other hand, using the Majeed functional scoring criteria, there were 27/65 (41.5%) excellent and 26/65 (40%) good cases for the 3D printing group in comparison to 30/72 (41.7%) and 28/72 (38.9%) cases for the control group

Mechanical Backup For Fly-By-Wire Control System

NASA Technical Reports Server (NTRS)

Stewart, Eric C.

1992-01-01

Mechanical device eliminates need for redundant fly-by-wire subsystems. Main components are two linkages. One connected to control column in conventional, reversible control system. Other slides inside first linkage and connected to pilot's control wheel. In addition to aircraft applications, design used in control systems in which computer control desirable but safety backup systems required; for example, in boat rudders, engine controls in boats and automobiles, and controls in construction equipment.

Single jugular vein cannulated rats may not be suitable for intravenous pharmacokinetic screening of high logP compounds.

PubMed

Gaud, Nilesh; Kumar, Anoop; Matta, Muralikrishna; Kole, Prashant; Sridhar, Srikanth; Mandlekar, Sandhya; Holenarsipur, Vinay K

2017-03-01

Rat is commonly used for pharmacokinetic screening during pharmaceutical lead optimization. To handle the large number of compounds, rats with a single jugular vein cannulation are commonly utilized for intravenous pharmacokinetic studies, where the same cannula is used both for dose administration and blood sampling. We demonstrate that the single cannula method is not suitable for all compounds, especially for high logP compounds. We propose an alternative dual cannulation technique in which two cannulas are placed in the same jugular vein, thus avoiding an additional surgery. Compounds were administered orally or via intravenous infusion to compare PK parameters, including bioavailability, using both procedures. For itraconazole and amiodarone, known to bind to the cannula, the measured plasma exposures were substantially higher in the single cannulated rats than those from dual cannulated rats. Area under the plasma concentration time curve differed by 79% and 74% for itraconazole and amiodarone, respectively. When compared to the single cannulation approach, clearance, volume of distribution and bioavailability determined by dual cannulation were 39%, 60% and 38% higher for itraconazole, and 46%, 34% and 42% higher for amiodarone, respectively. In contrast, all pharmacokinetic parameters were similar between single and dual-cannulated rats for the hydrophilic compound atenolol. Based on these results, we recommend the use of dual cannulated rats for intravenous pharmacokinetic studies when testing a series of hydrophobic compounds that may be prone to non-specific binding to the cannula. If single cannulated model is selected for pharmacokinetic screening, we recommend a bridging study with dual cannulated rats with representative compounds of a given chemical series. Copyright © 2016 Elsevier B.V. All rights reserved.

Intradermal bacteriostatic 0.9% sodium chloride containing the preservative benzyl alcohol compared with intradermal lidocaine hydrochloride 1% for attenuation of intravenous cannulation pain.

PubMed

McNelis, K A

1998-12-01

This study compared the efficacy of a common medication diluent, bacteriostatic 0.9% sodium chloride containing the preservative benzyl alcohol with lidocaine hydrochloride 1% as an intradermal pretreatment for the relief of pain associated with intravenous cannulation. Forty adult presurgical patients requiring two large bore intravenous catheters were used. They served as their own controls. The inner aspect of one forearm received the usual pretreatment, lidocaine hydrochloride 1%, and the inner aspect of the opposite arm received intradermal pretreatment with bacteriostatic 0.9% sodium chloride with the preservative benzyl alcohol. Intravenous cannulation was accomplished on the first attempt, and pain reported with cannulation was rated using a visual analogue scale (VAS). A paired t test was used to compare differences in VAS scores with the pretreatment bacteriostatic 0.9% sodium chloride containing the preservative benzyl alcohol with the pretreatment lidocaine hydrochloride 1%. Analysis of the data revealed no significant difference in the report of perceived pain of intravenous cannulation based on the intradermal pretreatment. These findings suggest that intradermal bacteriostatic 0.9% sodium chloride containing the preservative benzyl alcohol is as effective as intradermal lidocaine hydrochloride 1% in the attenuation of intravenous cannulation pain.

Ethics Guide Recommendations for Organ-Donation-Focused Physicians: Endorsed by the Canadian Medical Association.

PubMed

Shemie, Sam D; Simpson, Christy; Blackmer, Jeff; MacDonald, Shavaun; Dhanani, Sonny; Torrance, Sylvia; Byrne, Paul

2017-05-01

Donation physicians are specialists with expertise in organ and tissue donation and have been recognized internationally as a key contributor to improving organ and tissue donation services. Subsequent to a 2011 Canadian Critical Care Society-Canadian Blood Services consultation, the donation physician role has been gradually implemented in Canada. These professionals are generally intensive care unit physicians with an enhanced focus and expertise in organ/tissue donation. They must manage the dual obligation of caring for dying patients and their families while providing and/or improving organ donation services. In anticipation of actual, potential or perceived ethical challenges with the role, Canadian Blood Services in partnership with the Canadian Medical Association organized the development of an evidence-informed consensus process of donation experts and bioethicists to produce an ethics guide. This guide includes overarching principles and benefits of the DP role, and recommendations in regard to communication with families, role disclosure, consent discussions, interprofessional conflicts, conscientious objection, death determination, donation specific clinical practices in neurological determination of death and donation after circulatory death, end-of-life care, performance metrics, resources and remuneration. Although this report is intended to inform donation physician practices, it is recognized that the recommendations may have applicability to other professionals (eg, physicians in intensive care, emergency medicine, neurology, neurosurgery, pulmonology) who may also participate in the end-of-life care of potential donors in various clinical settings. It is hoped that this guidance will assist practitioners and their sponsoring organizations in preserving their duty of care, protecting the interests of dying patients, and fulfilling best practices for organ and tissue donation.

The family physician's perceived role in preventing and guiding hospital admissions at the end of life: a focus group study.

PubMed

Reyniers, Thijs; Houttekier, Dirk; Pasman, H Roeline; Stichele, Robert Vander; Cohen, Joachim; Deliens, Luc

2014-01-01

Family physicians play a pivotal role in providing end-of-life care and in enabling terminally ill patients to die in familiar surroundings. The purpose of this study was to explore the family physicians' perceptions of their role and the difficulties they have in preventing and guiding hospital admissions at the end of life. Five focus groups were held with family physicians (N= 39) in Belgium. Discussions were transcribed verbatim and analyzed using a constant comparative approach. Five key roles in preventing and guiding hospital admissions at the end of life were identified: as a care planner, anticipating future scenarios; as an initiator of decisions in acute situations, mostly in an advisory manner; as a provider of end-of-life care, in which competency and attitude is considered important; as a provider of support, particularly by being available during acute situations; and as a decision maker, taking overall responsibility. Family physicians face many different and complex roles and difficulties in preventing and guiding hospital admissions at the end of life. Enhancing the family physician's role as a gatekeeper to hospital services, offering the physicians more end-of-life care training, and developing or expanding initiatives to support them could contribute to a lower proportion of hospital admissions at the end of life. © 2014 Annals of Family Medicine, Inc.

The GuideView System for Interactive, Structured, Multi-modal Delivery of Clinical Guidelines

NASA Technical Reports Server (NTRS)

Iyengar, Sriram; Florez-Arango, Jose; Garcia, Carlos Andres

2009-01-01

GuideView is a computerized clinical guideline system which delivers clinical guidelines in an easy-to-understand and easy-to-use package. It may potentially enhance the quality of medical care or allow non-medical personnel to provide acceptable levels of care in situations where physicians or nurses may not be available. Such a system can be very valuable during space flight missions when a physician is not readily available, or perhaps the designated medical personnel is unable to provide care. Complex clinical guidelines are broken into simple steps. At each step clinical information is presented in multiple modes, including voice,audio, text, pictures, and video. Users can respond via mouse clicks or via voice navigation. GuideView can also interact with medical sensors using wireless or wired connections. The system's interface is illustrated and the results of a usability study are presented.

Vocational Preparation Curriculum: Electrical Wiring.

ERIC Educational Resources Information Center

Usoro, Hogan

This document is a curriculum guide for instructors teaching vocational preparation for electrical wiring to special needs students. The purpose of the curriculum guide is to provide minimum skills for disadvantaged and handicapped students entering the mainstream; to supplement vocational skills of those students already in a regular training…

Optimum time for intravenous cannulation after induction with sevoflurane, oxygen, and nitrous oxide in children without any premedication.

PubMed

Hasan, Abm Kamrul; Sivasankar, Raman; Nair, Salil G; Hasan, Wamia U; Latif, Zulaidi

2018-02-01

Intravenous cannulation is usually done in children after inhalational induction with volatile anesthetic agents. The optimum time for safe intravenous cannulation after induction with sevoflurane, oxygen, and nitrous oxide has been studied in premedicated children, but there is no information for the optimum time for cannulation with inhalational induction in children without premedication. The aim of this study was to determine the optimum time for intravenous cannulation after the induction of anesthesia with sevoflurane, oxygen, and nitrous oxide in children without any premedication. This is a prospective, observer-blinded, up-and-down sequential allocation study in unpremedicated ASA grade 1 children aged 2-6 years undergoing elective dental surgery. Intravenous cannulation was attempted after inhalational induction with sevoflurane, oxygen, and nitrous oxide. The timing of cannulation was considered adequate if there was no movement, coughing, or laryngospasm. The cannulation attempt for the first child was set at 4 minutes after the loss of eyelash reflex and the time for intravenous cannulation was determined by the up-and-down method using 15 seconds as step size. Probit test was used to analyze the up-down sequences for the study. The adequate time for effective cannulation after induction with sevoflurane, oxygen, and nitrous oxide in 50% and 95% of patients was 53.02 seconds (95% confidence limits, 20.23-67.76 seconds) and 87.21 seconds (95% confidence limits, 70.77-248.03 seconds), respectively. We recommend waiting for 1 minute 45 seconds (105 seconds) after the loss of eyelash reflex before attempting intravenous cannulation in pediatric patients induced with sevoflurane, oxygen, and nitrous oxide without any premedication. © 2018 John Wiley & Sons Ltd.

[Application of the International Guide for the Diagnosis and Treatment of Asthma using first-contact physicians, before and after an educational strategy].

PubMed

Segura Méndez, Nora Hilda; Herrera, Sonia; Hernández Martínez, Eduardo; Torres Salazar, Augusto; Espinola Reyna, Gerardo; del Rivero Hernández, Leonel

2003-01-01

The objective of the International Guide on Diagnosis and Treatment of Asthma is to reduce prevalence, mortality and morbidity of asthma. To demonstrate that implementation of educational workshop increases the knowledge of first contact physicians on the International Guide for Diagnosis and Treatment of Asthma. Fifty-nine first contact physicians participated. A validated questionnaire was applied before and after the workshop on the International Guide on Diagnosis and Treatment of Asthma. The Student's t test of the program SPSS was used for a statistical analysis. The grades obtained were 36% of correct answers before the workshop and 59% of correct answers after the workshop with a significant p < 0.05 specially in the general area of knowledge. As an educational technique this workshop improves the level of knowledge on the International Guide on Diagnosis and Treatment of Asthma of first contact physicians.

Evaluating the efficacy of lavender aromatherapy on peripheral venous cannulation pain and anxiety: A prospective, randomized study.

PubMed

Karaman, Tugba; Karaman, Serkan; Dogru, Serkan; Tapar, Hakan; Sahin, Aynur; Suren, Mustafa; Arici, Semih; Kaya, Ziya

2016-05-01

This study was designed to evaluate the effectiveness of lavender aromatherapy on pain, anxiety, and level of satisfaction associated with the peripheral venous cannulation (PVC) in patients undergoing surgery. One hundred and six patients undergoing surgery were randomized to receive aromatherapy with lavender essential oil (the lavender group) or a placebo (the control group) during PVC. The patients' pain, anxiety, and satisfaction scores were measured. There was no statistically significantly difference between the groups in terms of demographic data. After cannulation, the pain and anxiety scores (anxiety 2) of the patients in the lavender group were significantly lower than the control group (for p = 0.01 for pain scores; p < 0.001 for anxiety 2 scores). In addition, patient satisfaction was significantly higher in the lavender group than in the control group (p = 0.003). Lavender aromatherapy had beneficial effects on PVC pain, anxiety, and satisfaction level of patients undergoing surgery. Copyright © 2016 Elsevier Ltd. All rights reserved.

A Physician's Guide to Radon

EPA Pesticide Factsheets

This booklet has been developed for physicians by the U.S. Environmental Protection Agency in consultation with the American Medical Association (AMA). Its purpose is to enlist physicians in the national effort to inform the American public about radon.

Biomechanical testing of bioabsorbable cannulated screws for slipped capital femoral epiphysis fixation.

PubMed

Kroeber, Markus W; Rovinsky, David; Haskell, Andrew; Heilmann, Moira; Llotz, Jeff; Otsuka, Norman

2002-06-01

This study compared cannulated 4.5-mm bioabsorbable screws made of self-reinforced poly-levolactic acid to cannulated 4.5-mm steel and titanium screws for resistance to shear stress and ability to generate compression in a polyurethane foam model of slipped capital femoral epiphysis fixation. The maximum shear stress resisted by the three screw types was similar (self-reinforced poly-levolactic acid 371 +/- 146 MPa, steel 442 +/- 43 MPa, and titanium 470 +/- 91 MPa). The maximum compression generated by both the self-reinforced poly-levolactic acid screw (68.5 +/- 3.3 N) and the steel screw (63.3 +/- 5.9 N) was greater than that for the titanium screw (3 +/- 1.4 N, P <.05). These data suggest cannulated self-reinforced poly-levolactic acid screws can be used in the treatment of slipped capital femoral epiphysis because of their sufficient biomechanical strength.

Enhancement of holding strength of cannulated screw supported with PMMA: a biomechanical study on femoral head [corrected].

PubMed

Zeynalov, Reşad; Ağır, İsmail; Akgülle, Ahmet Hamdi; Kocaoğlu, Barış; Yalçın, Mithat Selim

2015-07-01

The aim of this study was to evaluate the holding strength of cannulated screw with multiple holes on threaded area, supported with PMMA in femoral head. A total of 48 human femoral heads were divided into two groups after mineral density measurement with Q-CT. Seven-millimeter cannulated screws with multiple holes on threaded area supported with PMMA were used in the study group, while in the control group standard 7-mm cannulated screws were used. Each group was divided into three subgroups with eight femoral heads. Mineral density of each subgroup was equal to the other. Groups were compared in terms of pull-out, maximum extraction torque and cut-out. In pull-out group, maximum holding strength (N) was measured, while axial pull-out of 0.5 mm/sec applied with Instron. Results showed meaningful significant difference (p < 0.011) between two groups. In cut-out group, femoral heads were placed into Instron and loading was started from 5 N at 2 mm per minute at first, and it was continued until a failure, at least 5 mm, of implant was observed. Results showed significant difference (p < 0.05) between two groups. In maximum extraction group, 4° per second reverse torque (Nm) was applied with torque meter. Highest torque value was measured during extraction time, and results showed very significant difference (p < 0. 001) between two groups. The results of our new design of cannulated screw augmented with PMMA provided background data to clinical application.

Double-arterial cannulation for aortic valve replacement with porcelain aorta.

PubMed

De Paulis, Ruggero; Maselli, Daniele; Scaffa, Raffaele; Nardella, Saverio

2009-10-01

We describe a new technique of aortic valve replacement (AVR) in patients with porcelain aorta. Three patients (mean age 75 years) were treated. The cardiopulmonary bypass (CPB) was established after side-graft right axillary artery and direct femoral artery cannulation. Venous drainage was obtained by atrio-caval cannulation. The procedures were performed in mild hypothermia (30 degrees C). Cerebral perfusion was carried out by clamping the innominate artery and all epiaortic vessels. The aorta was endoclamped by a Foley balloon inserted into the isthmus. The aorta was then opened longitudinally for 10 cm to expose and replace the aortic valve. Near-infra-red spectroscopy (NIRS) and bilateral radial artery pressure were used to monitor effective cerebral perfusion. Operative mortality was absent. The mean time of CPB was 73 min. NIRS-derived tissue oxygenation was maintained above 55%. Postoperative course was uneventful. This technique has several advantages: first, the cannulation of right axillary and the common femoral artery allows simultaneous cerebral and systemic perfusion. Second, any form of cross-clamp is avoided and the aorta is occluded away from the epiaortic vessels. Third, there is an increased freedom to choose the best place for aortotomy.

Tortuous iliac systems--a significant burden to conventional cannulation in the visceral segment: is there a role for robotic catheter technology?

PubMed

Riga, Celia V; Bicknell, Colin D; Hamady, Mohamad; Cheshire, Nicholas

2012-10-01

To attempt to quantify the effect of varying degrees of iliac tortuosity on maneuverability and "torquability" of endovascular catheters in the visceral segment, comparing conventional and robotic cannulation techniques. In a fenestrated endograft within a pulsatile phantom, 10 experienced operators cannulated the renal arteries via three different access vessels of varying iliac tortuosity with the use of conventional and robotic techniques. All procedures were performed in the angiography suite and recorded for blinded video assessment for quantitative (time, catheter-tip movements) and qualitative metrics (operator performance scores). In total, 120 cannulations were observed. With increasing iliac tortuosity, median time and number of catheter movements required for renal cannulation with conventional techniques increased in stepwise fashion for mild, moderate, and severe iliac tortuosity (times, 7.6 min [interquartile range (IQR), 4.6-9.3 min] vs 6.9 min [4.2-11.4 min] vs 17.7 min [13.3-22.6 min], respectively; movements, 184 [IQR, 110-351] vs 251 [207-395] vs 569 [409-616], respectively). Median renal cannulation times were significantly reduced with the use of the robotic system irrespective of mild, moderate, or severe tortuosity (times, 1.4 min [IQR, 1.1-1.9 min] vs 3 min [2.3-3.3 min] vs 2.8 min [1.5-3.9 min], respectively; movements, 19 [IQR, 14-27] vs 46 [43-58] vs 45 [40-66], respectively; P < .005). Overall operator performance scores improved significantly with the use of the robotic system irrespective of iliac tortuosity severity. In cases of moderate to severe iliac tortuosity, conventional catheter manipulation and control becomes an issue. The improvement in positional control and predictability seen with advanced catheter designs may be amplified in cases of severe iliac tortuosity. Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

JAG Tearing Technique with Radiofrequency Guide Wire for Aortic Fenestration in Thoracic Endovascular Aneurysm Repair

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

Ricci, Carmelo; Ceccherini, Claudio, E-mail: claudiocec@hotmail.it; Leonini, Sara

An innovative approach, the JAG tearing technique, was performed during thoracic endovascular aneurysm repair in a patient with previous surgical replacement of the ascending aorta with a residual uncomplicated type B aortic dissection who developed an aneurysm of the descending thoracic aorta with its lumen divided in two parts by an intimal flap. The proximal landing zone was suitable to place a thoracic stent graft. The distal landing zone was created by cutting the intimal flap in the distal third of the descending thoracic aorta with a radiofrequency guide wire and intravascular ultrasound catheter.

Radiofrequency Wire Recanalization of Chronically Thrombosed TIPS

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

Majdalany, Bill S., E-mail: bmajdala@med.umich.edu; Elliott, Eric D., E-mail: eric.elliott@osumc.edu; Michaels, Anthony J., E-mail: Anthony.michaels@osumc.edu

Radiofrequency (RF) guide wires have been applied to cardiac interventions, recanalization of central venous thromboses, and to cross biliary occlusions. Herein, the use of a RF wire technique to revise chronically occluded transjugular intrahepatic portosystemic shunts (TIPS) is described. In both cases, conventional TIPS revision techniques failed to revise the chronically thrombosed TIPS. RF wire recanalization was successfully performed through each of the chronically thrombosed TIPS, demonstrating initial safety and feasibility in this application.

Developing renal nurses' buttonhole cannulation skills using e-learning.

PubMed

Blackman, Ian R; Mannix, Trudi; Sinclair, Peter M

2014-03-01

It has previously been shown that nurses can learn clinical nursing skills by e-learning (online), and that many variables will influence how well nurses adopt learned clinical skills using distance education. This study aimed to identify and measure the strength of those factors which would simultaneously influence registered nurses' (RNs') beliefs about their own learning about buttonhole cannulation, using e-learning. An online Likert style survey consisting of a list of statements related to knowledge and skill domains considered crucial in the area of buttonhole cannulation was distributed to 101 RNs before and after completing an e-learning programme. Participants were required to identify their current level of self-confidence in relationship to each of the statements. Measures of RNs' self-rated abilities to assess and implement buttonhole cannulation after completing a related e-learning program were tested using a Partial Least Squares Analysis (PLS-PATH) programme. The study's results strongly identify that the nurses' ability to meet both clinical and educational outcomes of the renal e-learning module can be predicted by six variables, none of which are directly related to the participants' demographic or clinical backgrounds. These findings support the use of e-learning to teach clinical skills to RNs, and demonstrate the value of Partial Least Squares Analysis in determining influential learning factors. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Bacteriology of the Buttonhole Cannulation Tract in Hemodialysis Patients: A Prospective Cohort Study.

PubMed

Christensen, Line Dahlstrøm; Skadborg, Mai-Britt; Mortensen, Agnete H; Mortensen, Carsten; Møller, Jens K; Lemming, Lars; Høgsberg, Irene; Petersen, Steffen E; Buus, Niels H

2018-03-29

The buttonhole cannulation technique for arteriovenous fistulas is widely used, but has been associated with an increased rate of vascular access-related infections. We describe the frequency and type of bacterial colonization of the buttonhole tract over time and associated clinical infections. A prospective observational cohort study with 9 months of follow-up. 84 in-center hemodialysis patients using the buttonhole cannulation technique at 2 Danish dialysis centers. Bacterial growth from the buttonhole tract and dialysis cannula tip and clinically important infections during follow-up. On 3 occasions 1 month apart, cultures before dialysis (from the skin surrounding the buttonhole before disinfection and from the cannulation tract after disinfection and scab removal) and the cannula tip after dialysis. Patients with positive cultures from the buttonhole tract or cannula tip had repeat cultures within 1 week, along with blood cultures. Growth from the cannulation tract and/or cannula tip at each of the 3 monthly sets of cultures was found in 18%, 20%, and 17% of patients, respectively. 38% of patients had at least 1 positive culture from the buttonhole tract. Sustained growth was detected in 11% of patients, whereas asymptomatic bacteremia was seen in 30% of those with positive buttonhole cultures. Staphylococci species were the most common pathogens (Staphylococcus aureus, 25%; and Staphylococcus epidermidis, 41%). Colonization-positive buttonholes had more localized redness and slightly more tenderness. During follow-up, significantly more access-related infections were diagnosed among those with positive buttonhole cultures (P<0.001). No comparison to area puncture cannulation technique. Blood cultures were obtained only from patients with positive buttonhole bacteriology. Transient or sustained colonization of the buttonhole tract by staphylococci and asymptomatic bacteremia is common in hemodialysis patients, implying a substantial risk for access

Initial experience of a novel sheath guide for transbrachial coil embolization of cerebral aneurysms in the anterior cerebral circulation.

PubMed

Iwata, Tomonori; Mori, Takahisa; Tajiri, Hiroyuki; Miyazaki, Yuichi; Nakazaki, Masahito; Mizokami, Koji

2013-03-01

The transfemoral approach is a common technique for coil embolization of cerebral aneurysms in the anterior cerebral circulation. However, it is difficult to advance a guiding catheter into the carotid artery via the femoral route in patients with a tortuous aortic arch, an unfavorable supra-aortic takeoff, aortic diseases, or occlusion of the femoral artery. To report our initial experiences of coil embolization of cerebral aneurysms in the anterior cerebral circulation with a novel sheath guide for transbrachial carotid cannulation. A sheath guide designed specifically for transbrachial carotid cannulation was developed; transbrachial coil embolization for cerebral aneurysms began in May 2011. Included for analysis were patients who underwent transbrachial coil embolization for cerebral aneurysms in the anterior cerebral circulation from May 2011 to January 2012. Adjuvant techniques, angiographic results, procedural success, and periprocedural complications were investigated. Ten patients underwent transbrachial coil embolization of cerebral aneurysms in the anterior cerebral circulation. All procedures were successful using the brachial route. No periprocedural complications occurred. Patients were permitted to get seated immediately after coil embolization even during hemostasis. The sheath guide specifically designed for transbrachial carotid cannulation was useful for coil embolization of cerebral aneurysms in the anterior cerebral circulation.

Effects on Subtalar Joint Stress Distribution After Cannulated Screw Insertion at Different Positions and Directions.

PubMed

Yuan, Cheng-song; Chen, Wan; Chen, Chen; Yang, Guang-hua; Hu, Chao; Tang, Kang-lai

2015-01-01

We investigated the effects on subtalar joint stress distribution after cannulated screw insertion at different positions and directions. After establishing a 3-dimensional geometric model of a normal subtalar joint, we analyzed the most ideal cannulated screw insertion position and approach for subtalar joint stress distribution and compared the differences in loading stress, antirotary strength, and anti-inversion/eversion strength among lateral-medial antiparallel screw insertion, traditional screw insertion, and ideal cannulated screw insertion. The screw insertion approach allowing the most uniform subtalar joint loading stress distribution was lateral screw insertion near the border of the talar neck plus medial screw insertion close to the ankle joint. For stress distribution uniformity, antirotary strength, and anti-inversion/eversion strength, lateral-medial antiparallel screw insertion was superior to traditional double-screw insertion. Compared with ideal cannulated screw insertion, slightly poorer stress distribution uniformity and better antirotary strength and anti-inversion/eversion strength were observed for lateral-medial antiparallel screw insertion. Traditional single-screw insertion was better than double-screw insertion for stress distribution uniformity but worse for anti-rotary strength and anti-inversion/eversion strength. Lateral-medial antiparallel screw insertion was slightly worse for stress distribution uniformity than was ideal cannulated screw insertion but superior to traditional screw insertion. It was better than both ideal cannulated screw insertion and traditional screw insertion for anti-rotary strength and anti-inversion/eversion strength. Lateral-medial antiparallel screw insertion is an approach with simple localization, convenient operation, and good safety. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Guiding Principles for Physician Reentry Programs

ERIC Educational Resources Information Center

Kenagy, Gretchen P.; Schneidman, Barbara S.; Barzansky, Barbara; Dalton, Claudette; Sirio, Carl A.; Skochelak, Susan E.

2011-01-01

Physician reentry is defined by the American Medical Association (AMA) as: "A return to clinical practice in the discipline in which one has been trained or certified following an extended period of clinical inactivity not resulting from discipline or impairment." Physician reentry programs are creating an avenue for physicians who have left…

Effects of albendazole nanoparticles in mice with hepatic echinococosis: Portal vein cannulation versus intravenous administration.

PubMed

Zhu, Di-Wen; Zhang, Ming-Xing; Bao, Ying-Jun; Gu, Jun-Peng; Ji, Wei-Zheng; Zhang, Hai-Xiao; Ren, Wei-Xin

2015-07-01

To compare the ABZ and its metabolites concentration in cyst tissue of hepatic alveolar echinococcosis administered by different routes, forty male Wistar rats receiving albendazole nanoparticles from tail vein and portal vein were divided into two groups, the concentration of ABZ and its metabolites ABZSO, ABZSO2, in the cyst tissue, were analyzed by HPLC at 2, 4, 8, 24, 36 h after administration. The parent drug and its metabolites were detected in plasm and the cyst tissue after portal cannulation and intravenous administration. The last results were the concentration of ABZ in the portal cannulation group was higher than in the intravenous group at every time point (p < 0.05). Compared to the intravenous group, the portal cannulation administration of ABZ led to a lower plasm concentration of ABZ. The concentration of ABZ and the active ABZSO were significantly higher in the portal cannulation group than that of the intravenous group. Copyright © 2015 Elsevier Inc. All rights reserved.

Commercial and Industrial Wiring. Second Edition.

ERIC Educational Resources Information Center

Kaltwasser, Stan; Flowers, Gary

This guide is designed to assist teachers conducting a course to prepare students for entry-level employment in the commercial and industrial wiring trade. Included in the guide are 15 instructional units and the following sections of information for teachers: guidelines in using the unit components; academic and workplace skills classifications…

Meeting the imperative to improve physician well-being: assessment of an innovative program.

PubMed

Dunn, Patrick M; Arnetz, Bengt B; Christensen, John F; Homer, Louis

2007-11-01

Improving physician health and performance is critical to successfully meet the challenges facing health systems that increasingly emphasize productivity. Assessing long-term efficacy and sustainability of programs aimed at enhancing physician and organizational well-being is imperative. To determine whether data-guided interventions and a systematic improvement process to enhance physician work-life balance and organizational efficacy can improve physician and organizational well-being. From 2000 to 2005, 22-32 physicians regularly completed 3 questionnaires coded for privacy. Results were anonymously reported to physicians and the organization. Data-guided interventions to enhance physician and organizational well-being were built on physician control over the work environment, order in the clinical setting, and clinical meaning. Questionnaires included an ACP/ASIM survey on physician satisfaction, the Maslach Burnout Inventory (MBI), and the Quality Work Competence (QWC) survey. Emotional and work-related exhaustion decreased significantly over the study period (MBI, p = 0.002; QWC, p = 0.035). QWC measures of organizational health significantly improved initially and remained acceptable and stable during the rest of the study. A data-guided program on physician well-being, using validated instruments and process improvement methods, enhanced physician and organizational well-being. Given the increases in physician burnout, organizations are encouraged to urgently create individual and systems approaches to lessen burnout risk.

Mechanical and photoelastic analysis of conventional screws and cannulated screws for sagittal split osteotomy fixation: a comparative study.

PubMed

Lima, Cristina Jardelino de; Falci, Saulo Gabriel Moreira; Rodrigues, Danillo Costa; Marchiori, Érica Cristina; Moreira, Roger Willian Fernandes

2015-12-01

The aim of the present study was to use mechanical and photoelastic tests to compare the performance of cannulated screws with solid-core screws in sagittal split osteotomy fixation. Ten polyurethane mandibles, with a prefabricated sagittal split ramus osteotomy, were fixed with an L inverted technique and allocated to each group as follows: cannulated screw group (CSG), fixed with three 2.3-cannulated screws; and solid-core screw group (SCSG), fixed with three 2.3-solid-core screws. Vertical linear loading tests were performed. The differences between mean values were analyzed through T test for independent samples. The photoelastic test was carried out using a polariscope. The results revealed differences between the two groups only at 1 mm of displacement, in which the cannulated-screw revealed more resistance. Photoelastic test showed higher stress concentration close to mandibular branch in the solid-core group. Cannulated screws performed better than solid-core ones in a mechanical test at 1-mm displacement and photoelastic tests.

Recurrent clot anuria following laparoscopic pyeloplasty in a solitary functioning kidney: managing with double guide wire technique

PubMed Central

Kumar, Santosh; Singh, Shivanshu; Parmar, Kalpesh Mahesh; Garg, Nitin

2014-01-01

Clot anuria in a solitary functioning kidney is an emergency situation. Haematuria with clot anuria in an early postoperative period represents a challenge, as treatment options are limited. Manipulation of the anastomotic site may lead to anastomotic disruption and urinoma while use of thrombolytic therapy poses the danger of increasing haematuria. We report a case of anuria due to clot retention in the upper tract following laparoscopic dismembered pyeloplasty in a solitary functioning kidney, managed successfully with double guide wire technique. PMID:25540210

Manufacture and quality control of interconnecting wire hardnesses, Volume 1

NASA Technical Reports Server (NTRS)

1972-01-01

A standard is presented for manufacture, installation, and quality control of eight types of interconnecting wire harnesses. The processes, process controls, and inspection and test requirements reflected are based on acknowledgment of harness design requirements, acknowledgment of harness installation requirements, identification of the various parts, materials, etc., utilized in harness manufacture, and formulation of a typical manufacturing flow diagram for identification of each manufacturing and quality control process, operation, inspection, and test. The document covers interconnecting wire harnesses defined in the design standard, including type 1, enclosed in fluorocarbon elastomer convolute, tubing; type 2, enclosed in TFE convolute tubing lines with fiberglass braid; type 3, enclosed in TFE convolute tubing; and type 5, combination of types 3 and 4. Knowledge gained through experience on the Saturn 5 program coupled with recent advances in techniques, materials, and processes was incorporated.

Meeting the Imperative to Improve Physician Well-being: Assessment of an Innovative Program

PubMed Central

Arnetz, Bengt B.; Christensen, John F.; Homer, Louis

2007-01-01

BACKGROUND Improving physician health and performance is critical to successfully meet the challenges facing health systems that increasingly emphasize productivity. Assessing long-term efficacy and sustainability of programs aimed at enhancing physician and organizational well-being is imperative. OBJECTIVE To determine whether data-guided interventions and a systematic improvement process to enhance physician work-life balance and organizational efficacy can improve physician and organizational well-being. DESIGN AND PARTICIPANTS From 2000 to 2005, 22–32 physicians regularly completed 3 questionnaires coded for privacy. Results were anonymously reported to physicians and the organization. Data-guided interventions to enhance physician and organizational well-being were built on physician control over the work environment, order in the clinical setting, and clinical meaning. MEASUREMENTS Questionnaires included an ACP/ASIM survey on physician satisfaction, the Maslach Burnout Inventory (MBI), and the Quality Work Competence (QWC) survey. RESULTS Emotional and work-related exhaustion decreased significantly over the study period (MBI, p = 0.002; QWC, p = 0.035). QWC measures of organizational health significantly improved initially and remained acceptable and stable during the rest of the study. CONCLUSIONS A data-guided program on physician well-being, using validated instruments and process improvement methods, enhanced physician and organizational well-being. Given the increases in physician burnout, organizations are encouraged to urgently create individual and systems approaches to lessen burnout risk. PMID:17891503

[Intramedullary nailing combined with cannulated screw in treating femoral condyles fractures].

PubMed

Shen, Guo-Qing; Zhang, Hao; Long, Da-Fu; Li, Zheng-Wen; Tan, Ying-Dong

2017-07-25

To observe the clinical effects of retrograde intramedullary nailing and cannulated screws in the treatment of femoral condylar fracture. From June 2009 to June 2015, 13 patients with femoral condyles fracture were treated by retrograde intramedullary nailing and cannulated screws including 6 males and 7 females with an average age of 46.1 years old ranging from 16 to 76 years old. There were 10 cases of closed fractures, 3 cases of open fraetures. According to AO classification criteriam, 4 cases were type C1, 7 cases were type C2, 2 cases were type C3. Postoperative reduction of fracture and the knee joint function recovery were observed. All patients were followed up for 12 to 36 months with a mean of 24 months. X-ray examination showed that the union time of fracture was 18 to 24 weeks, 21 weeks on average. There were no cases of loosening, breakage of internal fixators and re-fracture. Hospital for Special Surgery(HSS) knee score was 90.07±4.99 at 1 year after the operation. The clinical efficacy for retrograde intramedullary nailing and cannulated screw for the treatment of femoral condyles fracture was excellent. It can improve the anatomical reattachment rate and reduce the complications and promote the knee functional recovery.

Outcomes of multiple wire localization for larger breast cancers: when can mastectomy be avoided?

PubMed

Kirstein, Laurie J; Rafferty, Elizabeth; Specht, Michelle C; Moore, Richard H; Taghian, Alphonse G; Hughes, Kevin S; Gadd, Michele A; Smith, Barbara L

2008-09-01

Mastectomy is often recommended when mammography shows a breast cancer with extensive calcifications. We wished to determine whether the use of multiple localizing wires to guide lumpectomy in this setting was associated with increased rates of breast conservation. We also wanted to identify factors that predicted a poor chance of successful lumpectomy, to avoid multiple lumpectomy attempts in a patient who would ultimately require mastectomy. Records of 153 women with breast cancer who underwent lumpectomy for larger lesions that required multiple wire localization and 196 controls who required only single wire localization were reviewed retrospectively. The number of localizing wires, specimen volume, largest specimen dimension, number of surgical procedures, and rates of breast conservation were scored. Seventy-seven percent of patients requiring multiple wire localization had successful breast conservation, compared with 90% of those needing only single wire localization. Only 28% of multiple wire patients required more than 1 excision to achieve clear margins, compared with 36% of single wire patients (p < 0.01). Breast conservation is possible in the great majority of breast cancer patients whose mammographic lesions require multiple localizing wires for excision. The use of multiple wires can decrease the number of procedures required to obtain clear lumpectomy margins.

Thin wire pointing method

NASA Technical Reports Server (NTRS)

Green, G.; Mattauch, R. J. (Inventor)

1983-01-01

A method is described for forming sharp tips on thin wires, in particular phosphor bronze wires of diameters such as one-thousandth inch used to contact micron size Schottky barrier diodes, which enables close control of tip shape and which avoids the use of highly toxic solutions. The method includes dipping an end of a phosphor bronze wire into a dilute solution of sulfamic acid and applying a current through the wire to electrochemically etch it. The humidity in the room is controlled to a level of less than 50%, and the voltage applied between the wire and another electrode in the solutions is a half wave rectified voltage. The current through the wire is monitored, and the process is stopped when the current falls to a predetermined low level.

Umbilical cannulation optimizes circuit flows in premature lambs supported by the EXTra-uterine Environment for Neonatal Development (EXTEND).

PubMed

Hornick, Matthew A; Davey, Marcus G; Partridge, Emily A; Mejaddam, Ali Y; McGovern, Patrick E; Olive, Aliza M; Hwang, Grace; Kim, Jenny; Castillo, Orlando; Young, Kathleen; Han, Jiancheng; Zhao, Sheng; Connelly, James T; Dysart, Kevin C; Rychik, Jack; Peranteau, William H; Flake, Alan W

2018-05-01

Bronchopulmonary dysplasia is a disease of extreme prematurity that occurs when the immature lung is exposed to gas ventilation. We designed a novel 'artificial womb' system for supporting extreme premature lambs (called EXTEND) that obviates gas ventilation by providing oxygen via a pumpless arteriovenous circuit with the lamb submerged in sterile artificial amniotic fluid. In the present study, we compare different arteriovenous cannulation strategies on EXTEND, including carotid artery/jugular vein (CA/JV), carotid artery/umbilical vein (CA/UV) and umbilical artery/umbilical vein (UA/UV). Compared to CA/JV and CA/UV cannulation, UA/UV cannulation provided significantly higher, physiological blood flows to the oxygenator, minimized flow interruptions and supported significantly longer circuit runs (up to 4 weeks). Physiological circuit blood flow in UA/UV lambs made possible normal levels of oxygen delivery, which is a critical step toward the clinical application of artificial womb technology. EXTEND (EXTra-uterine Environment for Neonatal Development) is a novel system that promotes physiological development by maintaining the premature lamb in a sterile fluid environment and providing gas exchange via a pumpless arteriovenous oxygenator circuit. During the development of EXTEND, different cannulation strategies evolved with the aim of improving circuit flow. The present study examines how different cannulation strategies affect EXTEND circuit haemodynamics in extreme premature lambs. Seventeen premature lambs were cannulated at gestational ages 105-117 days (term 145-150 days) and supported on EXTEND for up to 4 weeks. Experimental groups were distinguished by cannulation strategy: carotid artery outflow and jugular vein inflow (CA/JV; n = 4), carotid artery outflow and umbilical vein inflow (CA/UV; n = 5) and double umbilical artery outflow and umbilical vein inflow (UA/UV; n = 8). Circuit flows and pressures were measured continuously. As we

Early institution of pre-cutting for difficult biliary cannulation: a prospective study comparing conventional vs. a modified technique.

PubMed

Kaffes, Arthur J; Sriram, Parupudi V J; Rao, Guduru V; Santosh, Darisetti; Reddy, D Nageshwar

2005-11-01

Pre-cutting techniques have been used to gain biliary access at the expense of an increased complication rate. This may be because of the multiple attempts to achieve cannulation by using standard methods before pre-cutting and causing excess edema and papillary trauma. There are limited data on the early use of pre-cutting techniques. We performed a prospective study of the early introduction of needle-knife techniques in patients with difficult biliary cannulation. Standard biliary cannulation was attempted with a sphincterotome and a guidewire. If this failed within 10 minutes or if there were more than 5 pancreatic cannulations, the needle-knife technique was used. Either a standard method of pre-cutting (below-upward) from the papillary orifice or the modified technique of pre-cutting (above-downward), stopping short of the papillary orifice, was adopted, as per the discretion of the endoscopist. If pre-cutting failed, the cannulation was reattempted 24 to 48 hours later. A total of 346 therapeutic biliary ERCP procedures were performed between April and August 2003. Of these, 70 patients (20%) (mean age, 54 years; 38 men) underwent needle-knife pre-cut sphincterotomy (16 with the standard technique). In 58 patients (83%), the procedure was successful with the initial pre-cutting, making the total success at initial ERCP 334/346 (96.5%). Nine patients in whom pre-cut failed, returned for a second-attempt ERCP, with 7 completed successfully. The total success rate of pre-cutting was 65/70 (93%). The overall success rate of biliary cannulation, after two ERCP attempts, was 341/346 (98.5%). Six patients had mild bleeding, and one had mild pancreatitis. There was no difference in these complications between the two types of pre-cut techniques. The early use of needle knife for difficult biliary cannulation is safe and effective, irrespective of the technique used.

Ambulatory extracorporeal membrane oxygenation with subclavian venoarterial cannulation to increase mobility and recovery in a patient awaiting cardiac transplantation

PubMed Central

Jacob, Samuel; MacHannaford, Juan C.; Chamogeorgakis, Themistokles; Gonzalez-Stawinski, Gonzalo V.; Felius, Joost; Rafael, Aldo E.; Malyala, Rajasekhar S.

2017-01-01

Venoarterial extracorporeal membrane oxygenation (ECMO) can provide temporary cardiopulmonary support for patients in hemodynamic extremis or refractory heart failure until more durable therapies—such as cardiac transplantation or a left ventricular assist device—can be safely implemented. Conventional ECMO cannulation strategies commonly employ the femoral artery and vein, constraining the patients to the supine position for the duration of ECMO support. We have recently adopted a modified cannulation approach to promote patient mobility, rehabilitation, and faster recovery and to mitigate complications associated with femoral arterial cannulation, such as limb ischemia and compartment syndrome. This technique involves cannulation of the subclavian artery and vein. The current case report details our recent experience with this approach in a critically ill patient awaiting cardiac transplantation. PMID:28405091

Automated, computer-guided PASI measurements by digital image analysis versus conventional physicians' PASI calculations: study protocol for a comparative, single-centre, observational study.

PubMed

Fink, Christine; Uhlmann, Lorenz; Klose, Christina; Haenssle, Holger A

2018-05-17

Reliable and accurate assessment of severity in psoriasis is very important in order to meet indication criteria for initiation of systemic treatment or to evaluate treatment efficacy. The most acknowledged tool for measuring the extent of psoriatic skin changes is the Psoriasis Area and Severity Index (PASI). However, the calculation of PASI can be tedious and subjective and high intraobserver and interobserver variability is an important concern. Therefore, there is a great need for a standardised and objective method that guarantees a reproducible PASI calculation. Within this study we will investigate the precision and reproducibility of automated, computer-guided PASI measurements in comparison to trained physicians to address these limitations. Non-interventional analyses of PASI calculations by either physicians in a prospective versus retrospective setting or an automated computer-guided algorithm in 120 patients with plaque psoriasis. All retrospective PASI calculations by physicians or by the computer algorithm are based on total body digital images. The primary objective of this study is comparison of automated computer-guided PASI measurements by means of digital image analysis versus conventional, prospective or retrospective physicians' PASI assessments. Secondary endpoints include (1) the assessment of physicians' interobserver variance in PASI calculations, (2) the assessment of physicians' intraobserver variance in PASI assessments of the same patients' images after a time interval of at least 4 weeks, (3) the assessment of the deviation between physicians' prospective versus retrospective PASI calculations, and (4) the reproducibility of automated computer-guided PASI measurements by assessment of two sets of total body digital images of the same patients taken at one time point. Ethical approval was provided by the Ethics Committee of the Medical Faculty of the University of Heidelberg (ethics approval number S-379/2016). DRKS00011818; Results. �

Evaluation of stability of osteosynthesis with K-wires on an artificial model of tibial malleolus fracture.

PubMed

Bumči, Igor; Vlahović, Tomislav; Jurić, Filip; Žganjer, Mirko; Miličić, Gordana; Wolf, Hinko; Antabak, Anko

2015-11-01

Paediatric ankle fractures comprise approximately 4% of all paediatric fractures and 30% of all epiphyseal fractures. Integrity of the ankle "mortise", which consists of tibial and fibular malleoli, is significant for stability and function of the ankle joint. Tibial malleolar fractures are classified as SH III or SH IV intra-articular fractures and, in cases where the fragments are displaced, anatomic reposition and fixation is mandatory. Type SH III-IV fractures of the tibial malleolus are usually treated with open reduction and fixation with cannulated screws that are parallel to the physis. Two K-wires are used for temporary stabilisation of fragments during reduction. A third "guide wire" for the screw is then placed parallel with the physis. Considering the rules of mechanics, it is assumed that the two temporary pins with the additional third pin placed parallel to the physis create a strong triangle and thus provide strong fracture fixation. To prove this hypothesis, an experiment was conducted on the artificial models of the lower end of the tibia from the company "Sawbones". Each model had been sawn in a way that imitates the fracture of medial malleoli and then reattached with 1.8mm pins in various combinations. Prepared models were then tested for tensile and pressure forces. The least stable model was that in which the fractured pieces were attached with only two parallel pins. The most stable model comprised three pins, where two crossed pins were inserted in the opposite compact bone and the third pin was inserted through the epiphysis parallel with and below the growth plate. A potential method of choice for fixation of tibial malleolar fractures comprises three K-wires, where two crossed pins are placed in the opposite compact bone and one is parallel with the growth plate. The benefits associated with this method include shorter operating times and avoidance of a second operation for screw removal. Copyright © 2015 Elsevier Ltd. All rights

A Hybrid Reality Radiation-free Simulator for Teaching Wire Navigation Skills

PubMed Central

Kho, Jenniefer Y.; Johns, Brian D.; Thomas, Geb. W.; Karam, Matthew D.; Marsh, J. Lawrence; Anderson, Donald D.

2016-01-01

Objectives Surgical simulation is an increasingly important method to facilitate the acquiring of surgical skills. Simulation can be helpful in developing hip fracture fixation skills because it is a common procedure for which performance can be objectively assessed (i.e., the tip-apex distance). The procedure requires fluoroscopic guidance to drill a wire along an osseous trajectory to a precise position within bone. The objective of this study was to assess the construct validity for a novel radiation-free simulator designed to teach wire navigation skills in hip fracture fixation. Methods Novices (N=30) with limited to no surgical experience in hip fracture fixation and experienced surgeons (N=10) participated. Participants drilled a guide wire in the center-center position of a synthetic femoral head in a hip fracture simulator, using electromagnetic sensors to track the guide wire position. Sensor data were gathered to generate fluoroscopic-like images of the hip and guide wire. Simulator performance of novice and experienced participants was compared to measure construct validity. Results The simulator was able to discriminate the accuracy in guide wire position between novices and experienced surgeons. Experienced surgeons achieved a more accurate tip-apex distance than novices (13 vs 23 mm, respectively, p=0.009). The magnitude of improvement on successive simulator attempts was dependent on level of expertise; tip-apex distance improved significantly in the novice group, while it was unchanged in the experienced group. Conclusions This hybrid reality, radiation-free hip fracture simulator, which combines real-world objects with computer-generated imagery demonstrates construct validity by distinguishing the performance of novices and experienced surgeons. There is a differential effect depending on level of experience, and it could be used as an effective training tool in novice surgeons. PMID:26165262

[Biomechanical properties of bioabsorbable cannulated screws for surgical fixation of dislocated epiphysiolysis capitis femoris].

PubMed

Kröber, M W; Rovinsky, D; Lotz, J; Carstens, C; Otsuka, N Y

2002-06-01

Bioabsorbable materials are well suited for fixation of slipped capital femoral epiphysis (SCFE) as they are resorbable, compatible with magnetic resonance imaging, and well tolerated by the pediatric population. We compared cannulated 4.5-mm bioabsorbable screws made of self-reinforced polylevolactic acid (SR-PLLA) to cannulated 4.5-mm steel and titanium screws for their resistance to shear stress and ability to generate compression in a polyurethane foam model of SCFE fixation. The maximum shear stress resisted by the three screw types was similar (SR-PLLA 371 +/- 146, steel 442 +/- 43, titanium 470 +/- 91 MPa, NS). The maximum compression generated by both the SR-PLLA screw (68.5 +/- 3.3 N) and the steel screw (63.3 +/- 5.9 N) was greater than that for the titanium screw (3.0 +/- 1.4 N, p < 0.05). These data suggest that cannulated SR-PLLA screws have sufficient biomechanical strength to be used in the treatment of SCFE.

Mechanization of and experience with a triplex fly-by-wire backup control system

NASA Technical Reports Server (NTRS)

Lock, W. P.; Petersen, W. R.; Whitman, G. B.

1976-01-01

A redundant three axis analog control system was designed and developed to back up a digital fly by wire control system for an F-8C airplane. The mechanization and operational experience with the backup control system, the problems involved in synchronizing it with the primary system, and the reliability of the system are discussed. The backup control system was dissimilar to the primary system, and it provided satisfactory handling through the flight envelope evaluated. Limited flight tests of a variety of control tasks showed that control was also satisfactory when the backup control system was controlled by a minimum displacement (force) side stick. The operational reliability of the F-8 digital fly by wire control system was satisfactory, with no unintentional downmodes to the backup control system in flight. The ground and flight reliability of the system's components is discussed.

Fatigue testing of controlled memory wire nickel-titanium rotary instruments.

PubMed

Shen, Ya; Qian, Wei; Abtin, Houman; Gao, Yuan; Haapasalo, Markus

2011-07-01

To improve the fracture resistance of nickel-titanium (NiTi) files, manufacturers have introduced new alloys to manufacture NiTi files and developed new manufacturing processes. This study was aimed to examine the fatigue behavior of NiTi instruments from a novel controlled memory NiTi wire (CM Wire). Instruments of ProFile, Typhoon (TYP), Typhoon CM (TYP CM), DS-SS0250425NEYY (NEYY), and DS-SS0250425NEYY CM (NEYY CM) (DS Dental, Johnson City, TN) all size 25/.04 were subjected to rotational bending at the curvature of 35° and 45° in air at the temperature of 23° ± 2°C, and the number of revolutions to fracture (N(f)) was recorded. The fracture surface of all fragments was examined by a scanning electron microscope. The crack-initiation sites, the percentage of dimple area to the whole fracture cross-section, and the surface strain amplitude (ε(a)) were noted. The new alloy yielded an improvement of over three to eight times in N(f) of CM files than that of conventional NiTi files (P < .05). The vast majority of CM instruments (50%-92%) showed multiple crack origins, whereas most instruments made from conventional NiTi wire (58%-100%) had one crack origin. The values of the fraction area occupied by the dimple region were significantly smaller on CM NiTi instruments compared with conventional NiTi instruments (P < .01). The square (NEYY CM) versus the triangular (TYP CM) configuration showed a significantly different lifetime on CM wire at both curvatures (P < .01). The material property had a substantial impact on fatigue lifetime. Instruments made from CM Wire had a significantly higher N(f) and lower surface strain amplitude than the conventional NiTi wire files with identical design. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Physician Guide to Appropriate Opioid Prescribing for Noncancer Pain.

PubMed

Munzing, Timothy

2017-01-01

Prescription opioid use for relief of noncancer pain has risen dramatically in the last 15 years, contributing to a quadrupling of opioid overdoses and prescription opioid-related deaths. This crisis is resulting in heightened attention by health care professionals and organizations, law enforcement, and the government. In this article, I highlight key topics in the management of patients using opioids (or potentially needing opioids) in outpatient clinical practice; federal and state law enforcement actions regarding physicians' illegal prescribing of opioids; multimodal approaches to pain control; nonmedication management of pain; response strategies when suspecting a patient of diverting or misusing opioids; and warning signs for abuse or diversion. For those patients for whom opioids are appropriate, I describe key elements for prescribing, including documentation of a detailed history and examination, appropriate evaluation to arrive at a specific diagnosis, individualizing management, and ongoing monitoring (including the use of urine drug screening and a prescription drug monitoring program). In addition to individual action, when possible, the initiation of systemwide and clinicwide safe prescribing practices supports the physician and patient such that the patient's well-being is at the heart of all pain management decisions. Physicians are encouraged to further educate themselves to treat pain safely and effectively; to screen patients for opioid use disorder and, when diagnosed, to connect them with evidence-based treatment; and to follow Centers for Disease Control and Prevention guidelines whenever possible.

Laser Wire Stripper

NASA Technical Reports Server (NTRS)

1983-01-01

NASA-developed space shuttle technology is used in a laser wire stripper designed by Raytheon Company. Laser beams cut through insulation on a wire without damaging conductive metal, because laser radiation that melts plastic insulation is reflected by the metal. The laser process is fast, clean, precise and repeatable. It eliminates quality control problems and the expense of rejected wiring.

Perfusion pressure of a new cannulating fenestrated pedicle screw during cement augmentation.

PubMed

Wang, Zhirong; Zhang, Wen; Xu, Hao; Lu, Aiqing; Yang, Huilin; Luo, Zong-Ping

2018-06-18

Cannulating fenestrated pedicle screws are effective for fixating osteoporotic vertebrae. However, a major limitation is the excessive pressure required to inject a sufficient amount of cement into the vertebral body through the narrow hole of a pedicle screw. We have recently proposed a new cannulating fenestrated pedicle screw with a large hole diameter and a matched inner pin for screw-strength maintenance. Our purpose was to determine whether the new screw can significantly reduce bone-cement perfusion pressure during cement augmentation, METHODS: Two different methods were used to examine perfusion pressure. Hagen-Poisseuille's flow model in a tube was used to calculate pressure drop in the bone-cement channel. Experimentally, both Newtonian silicone oil and bone-cement (polymethyl methacrylate) were tested using a cement pusher through the cannulating screw at a constant rate of 2 ml/min. The internal hollow portion of the screw was the bottleneck of the perfusion, and the new design significantly reduced the perfusion pressure. Specifically, perfusion pressure dropped by 59% (P < 0.05) when diameter size was doubled. The new design effectively improved the application of bone-cement augmentation with the ease of bone-cement perfusion, thereby enhancing operational safety. Copyright © 2018. Published by Elsevier Ltd.

A novel four-wire-driven robotic catheter for radio-frequency ablation treatment.

PubMed

Yoshimitsu, Kitaro; Kato, Takahisa; Song, Sang-Eun; Hata, Nobuhiko

2014-09-01

   Robotic catheters have been proposed to increase the efficacy and safety of the radio-frequency ablation treatment. The robotized motion of current robotic catheters mimics the motion of manual ones-namely, deflection in one direction and rotation around the catheter. With the expectation that the higher dexterity may achieve further efficacy and safety of the robotically driven treatment, we prototyped a four-wire-driven robotic catheter with the ability to deflect in two- degree-of-freedom motions in addition to rotation.    A novel quad-directional structure with two wires was designed and developed to attain yaw and pitch motion in the robotic catheter. We performed a mechanical evaluation of the bendability and maneuverability of the robotic catheter and compared it with current manual catheters.    We found that the four-wire-driven robotic catheter can achieve a pitching angle of 184.7[Formula: see text] at a pulling distance of wire for 11 mm, while the yawing angle was 170.4[Formula: see text] at 11 mm. The robotic catheter could attain the simultaneous two- degree-of-freedom motions in a simulated cardiac chamber.    The results indicate that the four-wire-driven robotic catheter may offer physicians the opportunity to intuitively control a catheter and smoothly approach the focus position that they aim to ablate.

[LIMB LENGH SHORTENING AFTER ARTERIAL CANNULATION IN INFANCY].

PubMed

Díaz-Ben, B; Balvís-Balvís, P; Lozano-Balseiro, M; González-Herranz, P

2016-01-01

The aim of this study was to assess the relationship between arterial cannulations and the development of limb length discrepancies in childhood or impaired growth of the proximal femur. A retrospective study was conducted on 300 children who required arterial cannulation and/or cardiac catheterisation during childhood in relation to congenital heart diseases. Seven of these patients were referred from the Paediatric Cardiology clinic due to a limb length discrepancy and/or proximal femoral deformities. Seven children, with a mean age of 10 years, were referred to our clinic. The mean length discrepancy was 2.7cm, and was more frequent on the right side. Three of the patients presented with proximal femoral deformities: two cases of caput valgum and one of bilateral physeal arrest of the greater trochanter. All children were initially treated with a shoe lift in the shortest limb. One of them required a tibial lengthening and two others are awaiting a similar procedure. We recommend clinical and radiological follow-up of patients who have undergone catheterisation during their infancy due to the relationship between these techniques and the risk of developing a limb length discrepancy. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

Mechanization of and experience with a triplex fly-by-wire backup control system

NASA Technical Reports Server (NTRS)

Lock, W. P.; Petersen, W. R.; Whitman, G. B.

1975-01-01

A redundant three-axis analog control system was designed and developed to back up a digital fly-by-wire control system for an F-8C airplane. Forty-two flights, involving 58 hours of flight time, were flown by six pilots. The mechanization and operational experience with the backup control system, the problems involved in synchronizing it with the primary system, and the reliability of the system are discussed. The backup control system was dissimilar to the primary system, and it provided satisfactory handling through the flight envelope evaluated. Limited flight tests of a variety of control tasks showed that control was also satisfactory when the backup control system was controlled by a minimum-displacement (force) side stick. The operational reliability of the F-8 digital fly-by-wire control system was satisfactory, with no unintentional downmodes to the backup control system in flight. The ground and flight reliability of the system's components is discussed.

Randomized controlled study of the safety and efficacy of nitrous oxide-sedated endoscopic ultrasound-guided fine needle aspiration for digestive tract diseases.

PubMed

Wang, Cai-Xia; Wang, Jian; Chen, Yuan-Yuan; Wang, Jia-Ni; Yu, Xin; Yang, Feng; Sun, Si-Yu

2016-12-14

To evaluate the efficacy and safety of nitrous oxide-sedated endoscopic ultrasound-guided fine needle aspiration. Enrolled patients were divided randomly into an experimental group (inhalation of nitrous oxide) and a control group (inhalation of pure oxygen) and heart rate, blood oxygen saturation, blood pressure, electrocardiogram (ECG) changes, and the occurrence of complications were monitored and recorded. All patients and physicians completed satisfaction questionnaires about the examination and scored the process using a visual analog scale. There was no significant difference in heart rate, blood oxygen saturation, blood pressure, ECG changes, or complication rate between the two groups of patients ( P > 0.05). However, patient and physician satisfaction were both significantly higher in the nitrous oxide compared with the control group ( P < 0.05). Nitrous oxide-sedation is a safe and effective option for patients undergoing endoscopic ultrasound-guided fine needle aspiration.

Electrochemical Fabrication of Metallic Quantum Wires

ERIC Educational Resources Information Center

Tao, Nongjian

2005-01-01

The fabrication of metallic quantum wires using simple electrochemical techniques is described. The conductance of the system can be readily measured that allows one to constantly monitor the conductance during fabrication and use conductance quantization as a signature to guide the fabrication.

DNA G-Wire Formation Using an Artificial Peptide is Controlled by Protease Activity.

PubMed

Usui, Kenji; Okada, Arisa; Sakashita, Shungo; Shimooka, Masayuki; Tsuruoka, Takaaki; Nakano, Shu-Ichi; Miyoshi, Daisuke; Mashima, Tsukasa; Katahira, Masato; Hamada, Yoshio

2017-11-16

The development of a switching system for guanine nanowire (G-wire) formation by external signals is important for nanobiotechnological applications. Here, we demonstrate a DNA nanostructural switch (G-wire <--> particles) using a designed peptide and a protease. The peptide consists of a PNA sequence for inducing DNA to form DNA-PNA hybrid G-quadruplex structures, and a protease substrate sequence acting as a switching module that is dependent on the activity of a particular protease. Micro-scale analyses via TEM and AFM showed that G-rich DNA alone forms G-wires in the presence of Ca 2+ , and that the peptide disrupted this formation, resulting in the formation of particles. The addition of the protease and digestion of the peptide regenerated the G-wires. Macro-scale analyses by DLS, zeta potential, CD, and gel filtration were in agreement with the microscopic observations. These results imply that the secondary structure change (DNA G-quadruplex <--> DNA/PNA hybrid structure) induces a change in the well-formed nanostructure (G-wire <--> particles). Our findings demonstrate a control system for forming DNA G-wire structures dependent on protease activity using designed peptides. Such systems hold promise for regulating the formation of nanowire for various applications, including electronic circuits for use in nanobiotechnologies.

Endovascular intervention for central venous cannulation in patients with vascular occlusion after previous catheterization.

PubMed

Pikwer, Andreas; Acosta, Stefan; Kölbel, Tilo; Åkeson, Jonas

2010-01-01

This study was designed to assess endovascular intervention for central venous cannulation in patients with vascular occlusion after previous catheterization. Patients referred for endovascular management of central venous occlusion during a 42-month period were identified from a regional endovascular database, providing prospective information on techniques and clinical outcome. Corresponding patient records, angiograms, and radiographic reports were analyzed retrospectively. Sixteen patients aged 48 years (range 0.5-76), including 11 females, were included. All patients but 1 had had multiple central venous catheters with a median total indwelling time of 37 months. Eleven patients cannulated for hemodialysis had had significantly fewer individual catheters inserted compared with 5 patients cannulated for nutritional support (mean 3.6 vs. 10.2, p<0.001) before endovascular intervention. Preoperative imaging by magnetic resonance tomography (MRT) in 8 patients, computed tomography (CT) venography in 3, conventional angiography in 6, and/or ultrasonography in 8, verified 15 brachiocephalic, 13 internal jugular, 3 superior caval, and/or 3 subclavian venous occlusions. Patients were subjected to recanalization (n=2), recanalization and percutaneous transluminal angioplasty (n=5), or stenting for vena cava superior syndrome (n=1) prior to catheter insertion. The remaining 8 patients were cannulated by avoiding the occluded route. Central venous occlusion occurs particularly in patients under hemodialysis and with a history of multiple central venous catheterizations with large-diameter catheters and/or long total indwelling time periods. Patients with central venous occlusion verified by CT or MRT venography and need for central venous access should be referred for endovascular intervention.

Early experience of placing image-guided minimally invasive pedicle screws without K-wires or bone-anchored trackers.

PubMed

Malham, Gregory M; Parker, Rhiannon M

2018-04-01

OBJECTIVE Image guidance for spine surgery has been reported to improve the accuracy of pedicle screw placement and reduce revision rates and radiation exposure. Current navigation and robot-assisted techniques for percutaneous screws rely on bone-anchored trackers and Kirchner wires (K-wires). There is a paucity of published data regarding the placement of image-guided percutaneous screws without K-wires. A new skin-adhesive stereotactic patient tracker (SpineMask) eliminates both an invasive bone-anchored tracker and K-wires for pedicle screw placement. This study reports the authors' early experience with the use of SpineMask for "K-wireless" placement of minimally invasive pedicle screws and makes recommendations for its potential applications in lumbar fusion. METHODS Forty-five consecutive patients (involving 204 screws inserted) underwent K-wireless lumbar pedicle screw fixation with SpineMask and intraoperative neuromonitoring. Screws were inserted by percutaneous stab or Wiltse incisions. If required, decompression with or without interbody fusion was performed using mini-open midline incisions. Multimodality intraoperative neuromonitoring assessing motor and sensory responses with triggered electromyography (tEMG) was performed. Computed tomography scans were obtained 2 days postoperatively to assess screw placement and any cortical breaches. A breach was defined as any violation of a pedicle screw involving the cortical bone of the pedicle. RESULTS Fourteen screws (7%) required intraoperative revision. Screws were removed and repositioned due to a tEMG response < 13 mA, tactile feedback, and 3D fluoroscopic assessment. All screws were revised using the SpineMask with the same screw placement technique. The highest proportion of revisions occurred with Wiltse incisions (4/12, 33%) as this caused the greatest degree of SpineMask deformation, followed by a mini midline incision (3/26, 12%). Percutaneous screws via a single stab incision resulted in the

Physicians' preference for controller medication in mild persistent asthma.

PubMed

Bakirtas, Arzu; Kutlu, Ali; Baccioglu, Ayse; Erkekol, Ferda Oner; Bavbek, Sevim; Kalayci, Omer

2017-10-01

Although the asthma guidelines recommend inhaled corticosteroids(ICS) or leukotriene receptor antagonists-(LTRAs) for the treatment of mild persistent asthma, factors governing the physicians' preference are unknown. We aimed to investigate the preference of physicians for the controller medication and the factors governing their choice. A self-administered questionnaire composed of 16 questions that aimed to determine the preference of the physicians for the first choice controller medication in mild persistent asthma and physician and patient related factors that may be associated with this selection was e-mailed to the members of the Turkish National Society of Allergy and Clinical Immunology and distributed to participants in the 21st congress. Of the 670 questionnaires, there were 51% participants and 336 of them were complete enough to be included in the analysis. Low dose ICS was preferred as the first choice controller medication for mild persistent asthma by 84.5% of the physicians. The reasons for physicians' preference were different for ICS and LTRA. In the logistic regression analysis, use of asthma guidelines (OR:3.5, 95%CI:1.3-9.3, p = 0.01), alignment in guidelines (OR:2.9, 95%CI:1.4-5.8, p = 0.002) and the opinion that it is a more effective (OR:2.3, 95%CI:1.1-4.8, p = 0.02) were independently associated with ICS preference. Being a pediatrician (OR:5.4, 95%CI: 2.7-10.5, p < 0.001) and the opinion that it has better patient compliance (OR:4.4, 95%CI: 1.6-12.0, p = 0.004) were independently associated with LTRA preference. Surveyed Turkish physicians, the majority of whom were specialists, preferred ICS over LTRA as controller medication in mild persistent asthma. Asthma guidelines, training background (pediatrician versus not) and perceived efficacy and patient compliance appeared to influence their preferences. Copyright © 2017. Published by Elsevier Ltd.

Impact of nitroglycerin and glucagon administration on selective common bile duct cannulation and prevention of post-ERCP pancreatitis.

PubMed

Katsinelos, Panagiotis; Lazaraki, Georgia; Chatzimavroudis, Grigoris; Katsinelos, Taxiarchis; Georgakis, Nikos; Anastasiadou, Kyriaki; Gatopoulou, Anthi; Zeglinas, Christos; Psarras, Kyriakos; Kountouras, Jannis

2017-01-01

Easy common bile duct (CBD) cannulation is associated with low complication rate. This study aimed to investigate the potential impact of nitroglycerin and glucagon administration on selective CBD cannulation and prevention of post-ERCP pancreatitis. A prospective single center, double-blind randomized study in which a total of 455 patients were randomly assigned to CBD cannulation by receiving 6 puffs (2.4 mg) sublingual nitroglycerin and glucagon 1 mg intravenously (n = 227, group A) or 6 puffs sterile water and 20 mg hyoscine-n-butyl bromide intravenously (n = 228, group B). After ERCP, patients were followed for the development of drugs' side-effects and post-ERCP complications. There were no statistically significant differences between the two groups regarding demographic data and ERCP findings. Success rate of selective CΒD cannulation was 95.15% in group A versus 82.29% in group B (p < .001). Time required for CBD cannulation was 2.82 ± 2.31 min in group A versus 4.27 ± 3.84 min in group B (p = .021). Needle-knife papillotomy was used in 11 (4.85%) patients of group A and 39 (17.11%) patients of group B (p = .001). The frequency of post-ERCP pancreatitis was significantly lower in group A than in group B (3.08% versus 7.46%, p = .037). No difference was observed between the two groups with regard to the occurrence of post-procedure hemorrhage. There was no procedure-related mortality; no adverse event related to the combination regimen was observed. Combined nitroglycerin and glucagon administration achieves a high selective CBC cannulation rates with concomitant reduction of post-ERCP pancreatitis incidence. However, further relative large-scale studies are needed to confirm our findings before definite conclusions can be drawn (Clinical trial registration number: NT: 4321).

Early cannulation prosthetic graft (Acuseal) for arteriovenous access: a useful option to provide a personal vascular access solution.

PubMed

Aitken, Emma L; Jackson, Andrew J; Kingsmore, David B

2014-01-01

Early cannulation arteriovenous grafts (ecAVGs), such as the GORE Acuseal, have "low bleed" properties permitting cannulation within 24 hours of insertion. They may provide an alternative to tunneled central venous catheters (and associated line complications) in patients requiring urgent vascular access. We present our early experience of 37 patients treated with the GORE Acuseal ecAVG. A total of 11 upper limb, 24 lower limb and 2 complex graft procedures were performed. Indications for ecAVG were as follows: bridge to transplantation (21.6%); bridge to arteriovenous fistula (AVF) maturation (8.1%); AVF salvage (8.1%); no native options (67.6%, including 17 patients with bilateral central vein stenosis); 36 AVGs (97.3%) were successfully cannulated. Mean time to first cannulation: 30.4±23.4 hours (range: 2-192). Primary and secondary patency rates at 3, 6 and 12 months were 64.9%, 48.6%, 32.4% and 70.2%, 59.4%, 40.5% respectively. The systemic bacteremia rate was 0.2 per 1,000 access days. There was one perioperative death. Other complications included hematoma at cannulation sites (n=9), pseudoaneurysm (n=3) and local infection at graft site (n=6). A total of 26 of 37 patients (70.6%) achieved a "personal vascular access solution": bridge to transplantation (n=8), bridge to functioning AVF/interposition AVG (n=5), maintenance hemodialysis via ecAVG (n=13); death with functioning AVG (n=1). Early experience with the GORE Acuseal is encouraging. Patency and bacteremia rates are at least comparable to standard polytetrafluoroethylene grafts. ecAVGs have permitted cannulation within 24 hours of insertion and line avoidance in the majority of patients. Nearly three-quarters of patients achieved a definitive "personal vascular access solution" from their ecAVG.

Selected developments in laser wire stripping. [cutting insulation from aerospace-type wires and cables

NASA Technical Reports Server (NTRS)

1977-01-01

The operation of mechanical and thermal strippers and the early development of laser wire strippers are reviewed. NASA sponsored development of laser wire stripping for space shuttle includes bench-type strippers as well as an advanced portable hand-held stripper which incorporates a miniaturized carbon dioxide laser and a rotating optics unit with a gas-jet assist and debris exhaust. Drives and controls girdle the wire and slit the remaining slug without manual assistance. This unit can strip wire sizes 26 through 12 gage. A larger-capacity hand-held unit for wire sizes through 1/0 gage was built using a neodynium-doped yttrium aluminum garnet (Nd:YAG) laser. The hand-held units have a flexible umbilical cable to an accompanying cart that carries the power supply, gas supply, cooling unit, and the controls.

Determination of optimum time for intravenous cannulation after induction with sevoflurane and nitrous oxide in children premedicated with midazolam.

PubMed

Kilicaslan, Alper; Gök, Funda; Erol, Atilla; Okesli, Selmin; Sarkilar, Gamze; Otelcioglu, Seref

2014-06-01

It has been shown that early placement of an intravenous line in children administered sevoflurane anesthesia increased the incidence of laryngospasm and movement. However, the optimal time for safe cannulation after the loss of the eyelash reflex during the administration of sevoflurane and nitrous oxide is not known. The aim of the study was to determine the optimum time for intravenous cannulation after the induction of anesthesia with sevoflurane and nitrous oxide in children premedicated with oral midazolam. We performed a prospective, observer-blinded, up-down sequential, allocation study, and children, aged 2-6 years, ASA physical status I, scheduled for an elective procedure undergoing inhalational induction were included in the study. Anesthesia was induced with sevoflurane and nitrous oxide after premedication with oral midazolam. For the first child, 4 min after the loss of the eyelash reflex, the intravenous cannulation was attempted by an experienced anesthesiologist. The time for intravenous cannulation was considered adequate if movement, coughing, or laryngospasm did not occur. The time for cannulation was increased by 15 s if the time was inadequate in the previous patient, and conversely, the time for cannulation was decreased by 15 s if the time was adequate in the previous patient. The probit test was used in the analysis of up-down sequences. A total of 32 children were enrolled sequentially during the study period. The adequate time for effective intravenous cannulation after induction with sevoflurane and nitrous oxide in 50% and 95% of patients were 1.29 min (95% confidence interval, 0.96-1.54 min) and 1.86 min (95% confidence interval 1.58-4.35 min), respectively. We recommend waiting 2 min for attempting intravenous placement following the loss of the eyelash reflex in children sedated with midazolam and receiving an inhalation induction with sevoflurane and nitrous oxide. © 2014 John Wiley & Sons Ltd.

A novel injectable calcium phosphate-based nanocomposite for the augmentation of cannulated pedicle-screw fixation

PubMed Central

Sun, Haolin; Liu, Chun; Liu, Huiling; Bai, Yanjie; Zhang, Zheng; Li, Xuwen; Li, Chunde; Yang, Huilin; Yang, Lei

2017-01-01

Polymethyl methacrylate (PMMA)-augmented cannulated pedicle-screw fixation has been routinely performed for the surgical treatment of lumbar degenerative diseases. Despite its satisfactory clinical outcomes and prevalence, problems and complications associated with high-strength, stiff, and nondegradable PMMA have largely hindered the long-term efficacy and safety of pedicle-screw fixation in osteoporotic patients. To meet the unmet need for better bone cement for cannulated pedicle-screw fixation, a new injectable and biodegradable nanocomposite that was the first of its kind was designed and developed in the present study. The calcium phosphate-based nanocomposite (CPN) exhibited better anti-pullout ability and similar fluidity and dispersing ability compared to clinically used PMMA, and outperformed conventional calcium phosphate cement (CPC) in all types of mechanical properties, injectability, and biodegradability. In term of axial pullout strength, the CPN-augmented cannulated screw reached the highest force of ~120 N, which was higher than that of PMMA (~100 N) and CPC (~95 N). The compressive strength of the CPN (50 MPa) was three times that of CPC, and the injectability of the CPN reached 95%. In vivo tests on rat femur revealed explicit biodegradation of the CPN and subsequent bone ingrowth after 8 weeks. The promising results for the CPN clearly suggest its potential for replacing PMMA in the application of cannulated pedicle-screw fixation and its worth of further study and development for clinical uses. PMID:28490878

Development of a new technique for pedicle screw and Magerl screw insertion using a 3-dimensional image guide.

PubMed

Kawaguchi, Yoshiharu; Nakano, Masato; Yasuda, Taketoshi; Seki, Shoji; Hori, Takeshi; Kimura, Tomoatsu

2012-11-01

We developed a new technique for cervical pedicle screw and Magerl screw insertion using a 3-dimensional image guide. In posterior cervical spinal fusion surgery, instrumentation with screws is virtually routine. However, malpositioning of screws is not rare. To avoid complications during cervical pedicle screw and Magerl screw insertion, the authors developed a new technique which is a mold shaped to fit the lamina. Cervical pedicle screw fixation and Magerl screw fixation provide good correction of cervical alignment, rigid fixation, and a high fusion rate. However, malpositioning of screws is not a rare occurrence, and thus the insertion of screws has a potential risk of neurovascular injury. It is necessary to determine a safe insertion procedure for these screws. Preoperative computed tomographic (CT) scans of 1-mm slice thickness were obtained of the whole surgical area. The CT data were imported into a computer navigation system. We developed a 3-dimensional full-scale model of the patient's spine using a rapid prototyping technique from the CT data. Molds of the left and right sides at each vertebra were also constructed. One hole (2.0 mm in diameter and 2.0 cm in length) was made in each mold for the insertion of a screw guide. We performed a simulated surgery using the bone model and the mold before operation in all patients. The mold was firmly attached to the surface of the lamina and the guide wire was inserted using the intraoperative image of lateral vertebra. The proper insertion point, direction, and length of the guide were also confirmed both with the model bone and the image intensifier in the operative field. Then, drilling using a cannulated drill and tapping using a cannulated tapping device were carried out. Eleven consecutive patients who underwent posterior spinal fusion surgery using this technique since 2009 are included. The screw positions in the sagittal and axial planes were evaluated by postoperative CT scan to check for

Soft J-tipped guide wire-induced cardiac perforation in a patient with right ventricular lipomatosis and wall thinning.

PubMed

Hiroshima, Yuki; Tajima, Katsushi; Shiono, Yousuke; Suzuki, Ikuko; Kohno, Kei; Kato, Yuichi; Shunji, Kawamura; Kato, Takeo

2012-01-01

Cardiac tamponade caused by perforation is a rare but potentially lethal complication of central venous catheter (CVC) insertion. We herein report a case of cardiac perforation associated with the use of a soft J-tipped guide wire. Twenty minutes after the insertion of a CVC, the patient developed unexpected cardiac arrest. An autopsy revealed 400 mL of pericardial blood. The right ventricular wall was 1 mm thick with about 10 myocyte layers, which is one-third that of the normal heart. A histological analysis revealed widespread fatty infiltration of the right ventricular wall (right ventricular lipomatosis).

[Physicians' knowledge in Israel on the biology and control of head lice].

PubMed

Mumcuoglu, Kosta Y; Mumcuoglu, Michael; Danilevich, Maria; Gilead, Leon

2008-10-01

Health providers such as physicians, nurses and pharmacists should be knowledgeable about the biology of head lice and the ways to control them effectively, in order to reduce the proportion of children infested with head lice. To evaluate the knowledge of physicians in Israel on the biology and epidemiology of lice, as well as their experience with infested individuals and their preferences for diagnosis, prophylaxis and control. An anonymous questionnaire with 37 questions was used. The first 20 questions addressed the general knowledge of physicians on lice biology and control, while the remaining 17 questions were related to their personal experience with lice and louse treatment. Out of 273 physicians interviewed 66.8% had good knowledge of lice, while the remaining 33.2% had some knowledge on lice. The difference between the groups of physicians with medium and good knowledge on lice was borderline significant (P=0.0722), with the dermatologists borderline significantly less knowledgeable than the rest (P=0.0765). Significant differences were found between those physicians with 4-6 or 11-20 years of professional experience and the remaining groups (twice P<0.001). Although the percentage of female physicians who had a good knowledge on louse biology and control was higher than male physicians (39.4% and 29.4%, respectively), the differences were borderline significant (P=0.09). Pediatricians and dermatologists examined significantly more children than family physicians and general practitioners (P <0.001). The results of this study suggest that healthcare professionals' knowledge is of paramount importance for the correct diagnosis and control of head louse infestations.

Using wire shaping techniques and holographic optics to optimize deposition characteristics in wire-based laser cladding.

PubMed

Goffin, N J; Higginson, R L; Tyrer, J R

2016-12-01

In laser cladding, the potential benefits of wire feeding are considerable. Typical problems with the use of powder, such as gas entrapment, sub-100% material density and low deposition rate are all avoided with the use of wire. However, the use of a powder-based source material is the industry standard, with wire-based deposition generally regarded as an academic curiosity. This is because, although wire-based methods have been shown to be capable of superior quality results, the wire-based process is more difficult to control. In this work, the potential for wire shaping techniques, combined with existing holographic optical element knowledge, is investigated in order to further improve the processing characteristics. Experiments with pre-placed wire showed the ability of shaped wire to provide uniformity of wire melting compared with standard round wire, giving reduced power density requirements and superior control of clad track dilution. When feeding with flat wire, the resulting clad tracks showed a greater level of quality consistency and became less sensitive to alterations in processing conditions. In addition, a 22% increase in deposition rate was achieved. Stacking of multiple layers demonstrated the ability to create fully dense, three-dimensional structures, with directional metallurgical grain growth and uniform chemical structure.

Using wire shaping techniques and holographic optics to optimize deposition characteristics in wire-based laser cladding

PubMed Central

Higginson, R. L.; Tyrer, J. R.

2016-01-01

In laser cladding, the potential benefits of wire feeding are considerable. Typical problems with the use of powder, such as gas entrapment, sub-100% material density and low deposition rate are all avoided with the use of wire. However, the use of a powder-based source material is the industry standard, with wire-based deposition generally regarded as an academic curiosity. This is because, although wire-based methods have been shown to be capable of superior quality results, the wire-based process is more difficult to control. In this work, the potential for wire shaping techniques, combined with existing holographic optical element knowledge, is investigated in order to further improve the processing characteristics. Experiments with pre-placed wire showed the ability of shaped wire to provide uniformity of wire melting compared with standard round wire, giving reduced power density requirements and superior control of clad track dilution. When feeding with flat wire, the resulting clad tracks showed a greater level of quality consistency and became less sensitive to alterations in processing conditions. In addition, a 22% increase in deposition rate was achieved. Stacking of multiple layers demonstrated the ability to create fully dense, three-dimensional structures, with directional metallurgical grain growth and uniform chemical structure. PMID:28119550

A Simulation Study on Take-Off and Landing Dynamics of the Aircraft of a Fly-By-Wire Control System

DTIC Science & Technology

1993-01-07

L:V,"DIN G DYN;AMICS OF THE AIRCRAFT OF A FLY-BY-WIRE CONTROL SYSTEM by Y achang Feng, Gang Chert, Peiqiong Li 93-00985 Distribution unlimit ed. FASTC...FLY-BY-WIRE CONTROL SYSTEM By: Yachang Feng, Gang Chen, Peiqiong- Li English pages: 17 Source: Hangkon, Xuebao, Vol. 12, No. 6, June, 1991; pp. 252-258...Landing Dynamics of the Aircraft of a Fly-By-Wire Control System Beijing University of Aeronautics and Astronautics Yachang FENG, Gang CHEN and Peiqiong Li

Residential Wiring. Teacher Edition [and] Student Edition. Third Edition.

ERIC Educational Resources Information Center

Taylor, Mark; Batson, Larry; Carroll, Charles; Ipock, Dan; Leak, Lester; Onstott, Todd

This revised curriculum guide for teachers and students is designed to help prepare students for entry-level employment in the residential wiring trade. The curriculum guide contains six units that cover the following topics: (1) blueprint reading and load calculations; (2) service; (3) rough-in; (4) trim out and troubleshooting; (5) low voltage…

Implementing Cleaner Printed Wiring Board Technologies: Surface Finishes

EPA Pesticide Factsheets

This document describes the problems, solutions, and time and effort involved in implementing alternative surface finish technologies, and this guide is produced as part of the DfE Printed Wiring Board Project

Leading the Wired Organization: The Information Professional's Guide to Managing Technological Change.

ERIC Educational Resources Information Center

Stover, Mark

This book explains through descriptive narrative, illustrative examples, and practical suggestions how today's information specialists can navigate in the new "wired" organizations. The emphasis is on practical, useful, relevant advice. The following ten chapters are included: (1) "Communicating Online: The Heart of the Wired Organization"…

Randomized controlled study of the safety and efficacy of nitrous oxide-sedated endoscopic ultrasound-guided fine needle aspiration for digestive tract diseases

PubMed Central

Wang, Cai-Xia; Wang, Jian; Chen, Yuan-Yuan; Wang, Jia-Ni; Yu, Xin; Yang, Feng; Sun, Si-Yu

2016-01-01

AIM To evaluate the efficacy and safety of nitrous oxide-sedated endoscopic ultrasound-guided fine needle aspiration. METHODS Enrolled patients were divided randomly into an experimental group (inhalation of nitrous oxide) and a control group (inhalation of pure oxygen) and heart rate, blood oxygen saturation, blood pressure, electrocardiogram (ECG) changes, and the occurrence of complications were monitored and recorded. All patients and physicians completed satisfaction questionnaires about the examination and scored the process using a visual analog scale. RESULTS There was no significant difference in heart rate, blood oxygen saturation, blood pressure, ECG changes, or complication rate between the two groups of patients (P > 0.05). However, patient and physician satisfaction were both significantly higher in the nitrous oxide compared with the control group (P < 0.05). CONCLUSION Nitrous oxide-sedation is a safe and effective option for patients undergoing endoscopic ultrasound-guided fine needle aspiration. PMID:28028373

Occupational burnout and empathy influence blood pressure control in primary care physicians.

PubMed

Yuguero, Oriol; Marsal, Josep Ramon; Esquerda, Montserrat; Soler-González, Jorge

2017-05-12

Good physician-patient communication can favor the adoption of healthy lifestyle habits, which is essential in high blood pressure (BP) management. More empathic physicians tend to have lower burnout and better communication skills. We analyzed the association between burnout and empathy among primary care physicians and nurses and investigated the influence on BP control performance. Descriptive study conducted in 2014 investigating burnout and empathy levels in 267 primary care physicians and nurses and BP control data for 301,657 patients under their care. We administered the Maslach Burnout Inventory and the Jefferson Scale of Physician Empathy and defined good BP control as a systolic BP <130 mmHg. Low burnout and high empathy were observed in 58.8% and 33.7% of practitioners, respectively. Burnout and empathy were significantly negatively associated (p < 0.009). Practitioners with high empathy and low burnout had significantly better BP control and performance than those with low empathy and high burnout (p < 0.05). Low burnout and high empathy were significantly associated with improved BP control and performance, possibly in relation to better physician/nurse-patient communication.

Complicated sternal dehiscence: reconstruction with plates, cables, and cannulated screws.

PubMed

Voss, Bernhard; Bauernschmitt, Robert; Brockmann, Gernot; Krane, Markus; Will, Albrecht; Lange, Rüdiger

2009-04-01

Sternal dehiscence after median sternotomy can be a challenging problem in case of multiple fractures or infection. For sternal refixation, the principles of rigid plate and screw osteosynthesis gained from orthopedic surgery have been recommended by several authors. We present a new system for sternal reconstruction consisting of reconstruction plates, steel cables, and cannulated screws.

Mitral valve surgery using right anterolateral thoracotomy: is the aortic cannulation a safety procedure?

PubMed

Guedes, Marco Antonio Vieira; Pomerantzeff, Pablo Maria Alberto; Brandão, Carlos Manuel de Almeida; Vieira, Marcelo Luiz Campos; Grinberg, Max; Stolf, Noedir Antonio Groppo

2010-01-01

The right anterolateral thoracotomy is an alternative technique for surgical approach of mitral valve. In these cases, femoral-femoral bypass still has been used, rising occurrence of complications related to femoral cannulation. Describe the technique and results of mitral valve treatment by right anterolateral thoracotomy using aortic cannulation for cardiac pulmonary bypass (CPB). From 1983 e 2008, 100 consecutive female patients, with average age 35 ±13 years, 96 (96%) underwent mitral valve surgical treatment in the Heart Institute of São Paulo. A right anterolateral thoracotomy approach associated with aortic cannulation was used for CPB. Eighty (80%) patients had rheumatic disease and 84 (84%) patients presented functional class III or IV. Were performed 45 (45%) comissurotomies, 38 (38%) valve repairs, 7(7%) mitral valve replacements, seven (7%) recomissurotomies and three (3%) prosthesis replacement. Sparing surgery was performed in 90 (90%) patients. The average CPB and clamp time were 57 ± 27 min e 39 ± 19 min, respectively. There were no in-hospital death, reoperation due to bleeding and convertion to sternotomy. Introperative complications were related to heart harvest (5%), especially in reoperations (3%). The most important complications in postoperative period were related to pulmonary system (11%), followed by atrial fibrilation (10%) but without major systemic repercussions. The mean inhospital length of stay was 8 ± 3 days. Follow-up was 6.038 patients/month. Actuarial survival was 98.0 ± 1.9% and freedom from reoperation was 81.4 ± 7.8% in 180 months. The right anterolateral thoracotomy associated with aortic cannulation in mitral valve surgery is a simple technique, reproducible and safety.

Documenting wife abuse: a guide for physicians

PubMed Central

Ferris, L E; McMain-Klein, M; Silver, L

1997-01-01

An estimated 12% to 30% of women are assaulted by their male partners at least once during the relationship. Therefore, in their everyday practice, physicians are likely to encounter women who have suffered domestic abuse. The authors define wife abuse, outline epidemiologic aspects and discuss common signs and symptoms. In cases of suspected or confirmed abuse, it is very important for physicians to document the details of the injuries, the patient visit, any treatment and follow-up as well as to screen for associated conditions and ensure that any samples taken are not tampered with. When asked to disclose information by police or courts, physicians need to know when they are obliged to submit copies of their patients' medical records, when patient consent is required, what information should be divulged and how to defend this information in court. The authors present information about the necessary, relevant and appropriate evidence to be collected and documented for both medical and legal purposes. They also discuss the criminal justice system and the role of physicians in legal proceedings concerning wife abuse. PMID:9099172

Vascular access cannulation in hemodialysis patients - a survey of current practice and its relation to dialysis dose.

PubMed

Gauly, Adelheid; Parisotto, Maria Teresa; Skinder, Aleksandra; Schoder, Volker; Furlan, Andreja; Schuh, Erika; Marcelli, Daniele

2011-01-01

The appropriate use of vascular access is of fundamental importance in the treatment of hemodialysis (HD) patients. This survey entailed collecting data on current practice of vascular access cannulation to assess its relation to dialysis dose. This international, multicenter, observational, cross-sectional survey was performed in 171 dialysis centers of the European dialysis network of Fresenius Medical Care in Europe and South Africa during April 2009. Practice patterns of vascular access cannulations were documented by means of a 24-item questionnaire. Dialysis dose from the documented hemodialysis treatments was derived from the clinical database EuCliD®. In total, 10,807 cannulations in hemodialysis patients with either arteriovenous fistula (91%) or arteriovenous graft (9%) were documented. For the puncture, the area technique was applied most frequently using 15G and 16G needles. Blood flow rates were mostly between 300 and 400 mL/min and adjusted to the needle size used. In two-thirds of cases the arterial needle was placed first, mostly in an antegrade direction, with an average distance to the venous needle of 7.0±3.7 cm. More than two-thirds of the cannulations were performed by nurses with more than 5 years of experience in dialysis. A logistic regression model revealed a significantly higher odds ratio to attain Kt/V = 1.2 for retrograde placement of the arterial needle, and for using needles with bigger diameter. This survey covered a broad number of countries and centers and provides information on current practice of vascular access cannulation, their effect on dialysis dose, and serves as feedback to the dialysis centers for their quality management process.

Horner syndrome after unsuccessful venous port implantation by cannulation of the right internal jugular vein.

PubMed

Nowak, Łukasz R; Duda, Krzysztof; Mizianty, Marek; Wilczek, Małgorzata; Bieda, Tomasz

2015-01-01

Horner syndrome is a rare but likely underdiagnosed complication of internal jugular vein cannulation. We present a case of a young woman undergoing chemotherapy for gestational trophoblastic disease for whom venous port implantation was attempted due to poor peripheral vein access. Despite ultrasound guidance, the procedure was unsuccessful and complicated by a local haematoma, causing compression of the sympathetic nerves with Horner syndrome. The symptoms subsided within 3 weeks without treatment. The possible pathomechanisms of Horner syndrome after central venous cannulation are presented with suggested diagnostic and therapeutic approaches. Special emphasis must be placed on excluding carotid artery dissection because it carries the risk of subsequent cerebral vascular incidents. In the event of a carotid dissection, a multidisciplinary team must choose a pharmacological (antiplatelet drugs/anticoagulation) or interventional approach. Even with ultrasonography, central venous cannulation is not free of serious risks. In case of anisocoria following an uneventful procedure, diagnostic imaging of the vascular structures in the neck is mandatory for the exclusion of potentially serious complications, such as carotid dissection or venous thrombosis.

Dr. Charles Alexander Eastman, Sioux Physician-Author, 1858-1939. With Teacher's Guide. Native Americans of the Twentieth Century.

ERIC Educational Resources Information Center

Minneapolis Public Schools, MN.

A biography for elementary school students of a 19th century American Indian physician and author, Charles Alexander Eastman (Sioux), includes photographs of Dr. Eastman and his wife. A teacher's guide following the bibliography contains information on the Sioux Uprising of 1862 and the Wounded Knee Massacre, learning objectives and directions for…

Building Trades. Carpentry, Electrical Wiring, Plumbing.

ERIC Educational Resources Information Center

Missouri Univ., Columbia. Instructional Materials Lab.

This curriculum guide contains 21 units of self-paced, self-contained instructional materials in the complete building trades curriculum. It is divided into vocational areas of carpentry, electrical wiring, and plumbing. The purpose of the curriculum is to provide minimum skills for disadvantaged and handicapped students entering mainstream…

Abuse of family physicians by patients seeking controlled substances.

PubMed

Saveland, Christine; Hawker, Leisha; Miedema, Baukje; Macdougall, Peter

2014-02-01

To examine family physicians' career prevalence and monthly incidence of workplace abuse by controlled substance prescription seekers. A 4-page cross-sectional survey. A family medicine continuing medical education event in Halifax, NS. The survey was distributed to 316 family physicians attending the continuing medical education event. Career prevalence and monthly incidence of workplace abuse related to the act of prescribing controlled substances. Fifty-six percent (n = 178) of the 316 surveys were returned completed. Half the study participants were men (49%). Most study participants were in private practice and lived in Nova Scotia, and approximately half (51%) practised in urban settings. On average, the study participants had 20 years of practice experience. The career prevalence of abusive encounters related to controlled substance prescribing was divided into "minor," "major," and "severe" incidents. Overall, 95% of study participants reported having experienced at least 1 incident of minor abuse; 48% had experienced at least 1 incident of major abuse; and 17% had experienced at least 1 incident of severe abuse during their careers. Further, 30% reported having been abused in the past month; among those, the average number of abusive encounters was 3. Most (82%) of the abusers were male with a history of addiction (85%) and mental illness (39%). Opioids were the most frequently sought controlled substance. Abuse of family physicians by patients seeking controlled substances is substantial. Family physicians who prescribe controlled substances are at risk of being subjected to minor, major, or even severe abuse. Opioids were the most often sought controlled substance. A national discussion to deal with this issue is needed.

Risk factors for difficult peripheral venous cannulation in hospitalised patients. Protocol for a multicentre case-control study in 48 units of eight public hospitals in Spain.

PubMed

Rodriguez-Calero, Miguel Angel; Fernandez-Fernandez, Ismael; Molero-Ballester, Luis Javier; Matamalas-Massanet, Catalina; Moreno-Mejias, Luis; de Pedro-Gomez, Joan Ernest; Blanco-Mavillard, Ian; Morales-Asencio, Jose Miguel

2018-02-08

Patients with difficult venous access experience undesirable effects during healthcare, such as delayed diagnosis and initiation of treatment, stress and pain related to the technique and reduced satisfaction. This study aims to identify risk factors with which to model the appearance of difficulty in achieving peripheral venous puncture in hospital treatment. Case-control study. We will include adult patients requiring peripheral venous cannulation in eight public hospitals, excluding those in emergency situations and women in childbirth or during puerperium. The nurse who performs the technique will record in an anonymised register variables related to the intervention. Subsequently, a researcher will extract the health variables from the patient's medical history. Patients who present one of the following conditions will be assigned to the case group: two or more failed punctures, need for puncture support, need for central access after failure to achieve peripheral access, or decision to reject the technique. The control group will be obtained from records of patients who do not meet the above conditions. It has been stated a minimum sample size of 2070 patients, 207 cases and 1863 controls.A descriptive analysis will be made of the distribution of the phenomenon. The variables hypothesised to be risk factors for the appearance of difficult venous cannulation will be studied using a logistic regression model. The study was funded in January 2017 and obtained ethical approval from the Research Ethics Committee of the Balearic Islands. Informed consent will be obtained prior to data collection. Results will be published in a peer-reviewed scientific journal. © 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.

Human Trafficking: A Guide to Identification and Approach for the Emergency Physician.

PubMed

Shandro, Jamie; Chisolm-Straker, Makini; Duber, Herbert C; Findlay, Shannon Lynn; Munoz, Jessica; Schmitz, Gillian; Stanzer, Melanie; Stoklosa, Hanni; Wiener, Dan E; Wingkun, Neil

2016-10-01

Human trafficking is a significant human rights problem that is often associated with psychological and physical violence. There is no demographic that is spared from human trafficking. Traffickers maintain control of victims through physical, sexual, and emotional violence and manipulation. Because victims of trafficking seek medical attention for the medical and psychological consequences of assault and neglected health conditions, emergency clinicians are in a unique position to recognize victims and intervene. Evaluation of possible trafficking victims is challenging because patients who have been exploited rarely self-identify. This article outlines the clinical approach to the identification and treatment of a potential victim of human trafficking in the emergency department. Emergency practitioners should maintain a high index of suspicion when evaluating patients who appear to be at risk for abuse and violence, and assess for specific indicators of trafficking. Potential victims should be evaluated with a multidisciplinary and patient-centered technique. Furthermore, emergency practitioners should be aware of national and local resources to guide the approach to helping identified victims. Having established protocols for victim identification, care, and referrals can greatly facilitate health care providers' assisting this population. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

NEMA wire and cable standards development programs

NASA Astrophysics Data System (ADS)

Baird, Robert W.

1994-01-01

The National Electrical Manufacturers Association (NEMA) is the nation's largest trade association for manufacturers of electrical equipment. Its member companies produce components, end-use equipment and systems for the generation, transmission, distribution, control and use of electricity. The wire and cable division is presented in 6 sections: building wire and cable, fabricated conductors, flexible cords, high performance wire and cable, magnet wire, and power and control cable. Participating companies are listed.

A simple customized surgical guide for orthodontic miniplates with tube.

PubMed

Paek, Janghyun; Su, Ming-Jeaun; Kwon, Soon-Yong; Kim, Seong-Hun; Chung, Kyu-Rhim; Nelson, Gerald

2012-09-01

This article reports the use of a customized surgical guide for simple and precise C-tube plate placement with minimized incision. Patients who were planning to have orthodontic miniplate treatment because of narrow interradicular space were recruited for this study. A combined silicone and stainless steel wire surgical guide for the C-tube was fabricated on the cast model. The taller wire of the positioning guide is used to accurately start the incision. The incision guide-wire position is verified by placing the miniplate on the coronal horizontal wire to confirm that the incision will coordinate with the screw holes. Because the miniplate is firmly held in place, there is no risk of the miniplate anchoring screws (diameter, 1.5 mm; length, 4 mm) sliding on the bone surface during placement with a manual hand driver. The surgical guide was placed on the clinical site, and it allowed precise placement of the miniplate with minimum incision and preventing from slippage or path-of-insertion angulation errors that might interfere with accurate placement. Customized surgical guide enables precise planning for miniplate positions in anatomically complex sites.

Wire EDM for Refractory Materials

NASA Technical Reports Server (NTRS)

Zellars, G. R.; Harris, F. E.; Lowell, C. E.; Pollman, W. M.; Rys, V. J.; Wills, R. J.

1982-01-01

In an attempt to reduce fabrication time and costs, Wire Electrical Discharge Machine (Wire EDM) method was investigated as tool for fabricating matched blade roots and disk slots. Eight high-strength nickel-base superalloys were used. Computer-controlled Wire EDM technique provided high quality surfaces with excellent dimensional tolerances. Wire EDM method offers potential for substantial reductions in fabrication costs for "hard to machine" alloys and electrically conductive materials in specific high-precision applications.

Evaluation of tensile strength and surface topography of orthodontic wires after infection control procedures: An in vitro study

PubMed Central

Brindha, M.; Kumaran, N. Kurunji; Rajasigamani, K.

2014-01-01

Aim: The aim of this study is to evaluate, the influence of four types of sterilization/disinfection procedures (autoclave, hot air oven, glutaraldehyde, and ultraviolet [UV] light) on the tensile strength and surface topography of three orthodontic wires (stainless steel (SS), titanium - molybdenum alloy [TMA], and cobalt chromium (CoCr)). Materials and Methods: Sample comprised of three types of 8 inches straight length segments of orthodontic wires. They were divided into three groups according to wire composition comprising of 50 samples each. Totally 50 samples of each group were then equally divided into five subgroups according to sterilization method. After sterilization and disinfection of the experimental group, surface topography was examined with scanning electron microscope (SEM) and tensile strength was tested using universal testing machine. Result: The results of this study show that the mean ultimate tensile strength (UTS) of SS wire after four sterilization procedures were similar to the control group (1845.815 ± 142.29 MPa). The mean UTS of TMA wire increases after four sterilization procedures when compared with the control group (874.107 ± 275.939 MPa). The mean UTS of CoCr wire remains same after UV light disinfection, but increases after other three sterilization procedures when compared with the control group (1449.759 ± 156.586 MPa). SEM photographs of the present study shows gross increase in pitting roughness of the surface topography of all the three types of wires after four types of sterilization. Conclusion: Orthodontists who want to offer maximum safety for their patients can sterilize orthodontic wires before placement, as it does not deteriorate the tensile strength and surface roughness of the alloys. PMID:25210383

Evaluation of tensile strength and surface topography of orthodontic wires after infection control procedures: An in vitro study.

PubMed

Brindha, M; Kumaran, N Kurunji; Rajasigamani, K

2014-07-01

The aim of this study is to evaluate, the influence of four types of sterilization/disinfection procedures (autoclave, hot air oven, glutaraldehyde, and ultraviolet [UV] light) on the tensile strength and surface topography of three orthodontic wires (stainless steel (SS), titanium - molybdenum alloy [TMA], and cobalt chromium (CoCr)). Sample comprised of three types of 8 inches straight length segments of orthodontic wires. They were divided into three groups according to wire composition comprising of 50 samples each. Totally 50 samples of each group were then equally divided into five subgroups according to sterilization method. After sterilization and disinfection of the experimental group, surface topography was examined with scanning electron microscope (SEM) and tensile strength was tested using universal testing machine. The results of this study show that the mean ultimate tensile strength (UTS) of SS wire after four sterilization procedures were similar to the control group (1845.815 ± 142.29 MPa). The mean UTS of TMA wire increases after four sterilization procedures when compared with the control group (874.107 ± 275.939 MPa). The mean UTS of CoCr wire remains same after UV light disinfection, but increases after other three sterilization procedures when compared with the control group (1449.759 ± 156.586 MPa). SEM photographs of the present study shows gross increase in pitting roughness of the surface topography of all the three types of wires after four types of sterilization. Orthodontists who want to offer maximum safety for their patients can sterilize orthodontic wires before placement, as it does not deteriorate the tensile strength and surface roughness of the alloys.

Long-axis view for ultrasound-guided central venous catheter placement via the internal jugular vein.

PubMed

Mahan, Angel F; McEvoy, Matthew D; Gravenstein, Nikolaus

2016-04-01

In modern practice, real-time ultrasound guidance is commonly employed for the placement of internal jugular vein catheters. With a new tool, such as ultrasound, comes the opportunity to refine and further optimize the ultrasound view during jugular vein catheterization. We describe jugular vein access techniques and use the long-axis view as an alternative to the commonly employed short-axis cross-section view for internal jugular vein access and cannulation. The long-axis ultrasound-guided internal jugular vein approach for internal jugular vein cannulation is a useful alternative technique that can provide better needle tip and guidewire visualization than the more traditional short-axis ultrasound view.

The effect of patient race and blood pressure control on patient-physician communication.

PubMed

Cené, Crystal W; Roter, Debra; Carson, Kathryn A; Miller, Edgar R; Cooper, Lisa A

2009-09-01

Racial disparities in hypertension control contribute to higher rates of cardiovascular mortality among blacks. Patient-physician communication quality is associated with better health outcomes, including blood pressure (BP) control. Both race/ethnicity and BP control may adversely affect communication. To determine whether being black and having poor BP control interact to adversely affect patient-physician communication more than either condition alone, a situation referred to as "double jeopardy." Cross-sectional study of enrollment data from a randomized controlled trial of interventions to enhance patient adherence to therapy for hypertension. Participants included 226 hypertensive patients and 39 physicians from 15 primary care practices in Baltimore, MD. Communication behaviors and visit length from coding of audiotapes. After controlling for patient and physician characteristics, blacks with uncontrolled BP have shorter visits (B = -3.9 min, p < 0.01) with less biomedical (B = -24.0, p = 0.05), psychosocial (B = -19.4, p < 0.01), and rapport-building (B = -19.5, p = 0.01) statements than whites with controlled BP. Of all communication outcomes, blacks with uncontrolled BP are only in "double jeopardy" for a patient positive affect-coders give them lower ratings than all other patients. Blacks with controlled BP also experience shorter visits and less communication with physicians than whites with controlled BP. There are no significant communication differences between the visits of whites with uncontrolled versus controlled BP. This study reveals that patient race is associated with the quality of patient-physician communication to a greater extent than BP control. Interventions that improve patient-physician communication should be tested as a strategy to reduce racial disparities in hypertension care and outcomes.

Physician's Guide to Air Pollution.

ERIC Educational Resources Information Center

Weisburd, Mel

Prepared at the request of the American Medical Association Council on Environmental and Public Health, this pamphlet on air pollution is one of a series of publications published by the Council as part of its continuing responsibility to provide current information on environmental health problems to the physician, the medical society, the…

Disparities in assessments of asthma control between children, parents, and physicians.

PubMed

Shefer, Galit; Donchin, Milka; Manor, Orly; Levy-Hevroni, Revital; Schechter, Abraham; Cohen, Rinat; Cohen, Herman A; Kerem, Eitan; Engelhard, Dan

2014-10-01

Assessment of asthma control in children by physicians, patients and their parents was compared, assuming parents may underestimate symptoms in asthmatic children and exploring whether physicians tend to agree with them. Asthma control perception was assessed in 4- to 11-year-old asthmatic children and their parents, using C-ACT, during 2011-2012. Pediatric pulmonologists used GINA guidelines for their assessment; pediatricians, not having spirometry, used the information given in addition to physical examination. The C-ACT scores given by the children and their parents were further analyzed separately, and compared with their physicians' assessment. Statistical methods, which also measured possible influence of different variables, included kappa, Chi-square, linear-by-linear association, McNemar test and logistic regression. The study comprised 354 parents and children aged 4-11 years with moderate-severe asthma; 129 (36.4%) were treated by 23 pediatricians; 225 (63.6%) by 11 pediatric pulmonologists. The C-ACT was generally found valid in assessing asthma control (P < 0.001; κ 0.529; CI 0.441, 0.617) and showed that in 229/354 (53%) of children the asthma was uncontrolled. Nevertheless, of the 229 children who indicated their asthma was uncontrolled, 124 (54.1%) of their parents (κ 0.245; CI 0.15, 0.34) and 96 (41.9%) of their physicians believed it to be controlled (κ 0.331; 0.24, 0.43). Comparing the physician-child discordance vis-à-vis the parents, the significant difference was when 96/229 children (41.9%) and 34/126 parents (27.0%) indicated the asthma was uncontrolled while the physician determined it controlled (OR 1.95; 1.19, 3.24). There were no significant differences between pediatric pulmonologists and pediatricians. In addition to increasing awareness of parents to symptoms in their asthmatic children, physicians should question the child appropriately, as well as using the children's responses to C-ACT as an information source for properly

Asthma in Asia: Physician perspectives on control, inhaler use and patient communications.

PubMed

Price, David; David-Wang, Aileen; Cho, Sang-Heon; Ho, James Chung-Man; Jeong, Jae-Won; Liam, Chong-Kin; Lin, Jiangtao; Muttalif, Abdul Razak; Perng, Diahn-Warng; Tan, Tze-Lee; Yunus, Faisal; Neira, Glenn

2016-09-01

We examined the physician perspectives on asthma management in Asia. An online/face-to-face, questionnaire-based survey of respiratory specialists and primary care physicians from eight Asian countries/region was carried out. The survey explored asthma control, inhaler selection, technique and use; physician-patient communications and asthma education. Inclusion criteria were >50% of practice time spent on direct patient care; and treated >30 patients with asthma per month, of which >60% were aged >12 years. REALISE Asia (Phase 2) involved 375 physicians with average 15.9(±6.8) years of clinical experience. 89.1% of physicians reporting use of guidelines estimated that 53.2% of their patients have well-controlled (GINA-defined) asthma. Top consideration for inhaler choice was asthma severity (82.4%) and lowest, socio-economic status (32.5%). Then 54.7% of physicians checked their patients' inhaler techniques during consultations but 28.2(±19.1)% of patients were using their inhalers incorrectly; 21.1-57.9% of physicians could spot improper inhaler techniques in video demonstrations. And 79.6% of physicians believed combination inhalers could increase adherence because of convenience (53.7%), efficacy (52.7%) and usability (18.9%). Initial and follow-up consultations took 16.8(±8.4) and 9.2(±5.3) minutes, respectively. Most (85.1%) physicians used verbal conversations and least (24.5%), video demonstrations of inhaler use; 56.8% agreed that patient attitudes influenced their treatment approach. Physicians and patients have different views of 'well-controlled' asthma. Although physicians informed patients about asthma and inhaler usage, they overestimated actual usage and patients' knowledge was sub-optimal. Physician-patient interactions can be augmented with understanding of patient attitudes, visual aids and ancillary support to perform physical demonstrations to improve treatment outcomes.

In-Human Robot-Assisted Retinal Vein Cannulation, A World First.

PubMed

Gijbels, Andy; Smits, Jonas; Schoevaerdts, Laurent; Willekens, Koen; Vander Poorten, Emmanuel B; Stalmans, Peter; Reynaerts, Dominiek

2018-05-24

Retinal Vein Occlusion (RVO) is a blinding disease caused by one or more occluded retinal veins. Current treatment methods only focus on symptom mitigation rather than targeting a solution for the root cause of the disorder. Retinal vein cannulation is an experimental eye surgical procedure which could potentially cure RVO. Its goal is to dissolve the occlusion by injecting an anticoagulant directly into the blocked vein. Given the scale and the fragility of retinal veins on one end and surgeons' limited positioning precision on the other, performing this procedure manually is considered to be too risky. The authors have been developing robotic devices and instruments to assist surgeons in performing this therapy in a safe and successful manner. This work reports on the clinical translation of the technology, resulting in the world-first in-human robot-assisted retinal vein cannulation. Four RVO patients have been treated with the technology in the context of a phase I clinical trial. The results show that it is technically feasible to safely inject an anticoagulant into a [Formula: see text]-thick retinal vein of an RVO patient for a period of 10 min with the aid of the presented robotic technology and instrumentation.

XV-15 Tilt Rotor fly-by-wire collective control demonstrator development specifications

NASA Technical Reports Server (NTRS)

Meuleners, R. J.

1981-01-01

A fly by wire system in the collective control system for XV-15 Tilt Rotor Research Aircraft was evaluated. The collective control system was selected because it requires a system tracking accuracy between right and left rotors of approximately 0.1%. The performance characteristics of the collectors axel provide typical axis control response data. The demonstrator is bread boarded as a dual system instead of the triplex system.

Control of the electrical resistivity of Ni-Cr wires using low pressure chemical vapor deposition of tin

NASA Astrophysics Data System (ADS)

Kim, Jun-Hyun; Bak, Jeong Geun; Lee, Kangtaek; Kim, Chang-Koo

2018-01-01

Control of the electrical resistivity of Ni-Cr wires is demonstrated using low pressure chemical vapor deposition (LPCVD) of tin on the surface of the wire, after which the effects of the deposition temperature on the structural, morphological, and compositional characteristics of the tin-deposited Ni-Cr wires are investigated. As the deposition temperature is increased, the resistivity of the Ni-Cr wires increases in the temperature range 300-400 °C; then remains nearly constant as the temperature increased to 700 °C. The increase in the resistivity of the Ni-Cr wires is attributed to formation of Ni3Sn2 particulates on the surface of the wire. Compositional analysis shows that the pattern of change in the tin content with the deposition temperature is similar to that of resistivity with temperature, implying that the atomic content of tin on Ni-Cr directly affects the electrical resistivity.

Treatment of a Simple Bone Cyst Using a Cannulated Hydroxyapatite Pin

PubMed Central

Shirai, Toshiharu; Tsuchiya, Hiroyuki; Terauchi, Ryu; Tsuchida, Shinji; Mizoshiri, Naoki; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Miwa, Shinji; Kimura, Hiroaki; Takeuchi, Akihiko; Hayashi, Katsuhiro; Yamamoto, Norio; Kubo, Toshikazu

2015-01-01

Abstract Simple bone cysts (SBCs) are benign bone tumors. However, the treatment of SBCs remains controversial because of their healing rate and the invasiveness of surgery. The purpose of the present study was to evaluate the treatment of SBCs using a cannulated hydroxyapatite (HA) pin. A total of 43 patients (35 males, 8 females; mean age 12.1 years; age range, 5–22 years) with SBCs were treated with continuous decompression by inserting ceramic HA pins between 1989 and 2014. The SBCs were located in the calcaneus in 23, the humerus in 15, the femur in 3, and the pelvis in 2 cases. In all patients, minimal fenestration of the cyst wall and curettage and multiple drilling in the cyst wall were performed, followed by insertion of the HA pin. The mean follow-up period was 26.6 months. Operating time, healing period, risk factors for recurrence, and the cure rate were evaluated. Healing was achieved without intervention in 38 patients after a mean of 6.4 months. Two patients had persistent small residual cysts, which had no changes after 1 year at the latest follow-up. There were 5 patients with recurrences (humerus 4, femur 1), who were cured by curettage and artificial bone grafting. The final healing rate by cannulation only using an HA pin was 88.2%. On Fisher exact test, age, site of SBCs, and distance from the physis were found to be significantly associated with SBC recurrence (P < 0.05). In the present study, cannulation using an HA pin for SBCs was found to be a useful technique, particularly for calcaneal cysts, because it is a minimally invasive procedure with a high cure rate. In patients <10 years, involvement of the humerus and contact with the growth plate were significant risk factors for SBC recurrence. PMID:26107670

Commercial and Industrial Wiring. Teacher Edition [and] Student Edition. Third Edition.

ERIC Educational Resources Information Center

Kaltwasser, Stan; Flowers, Gary; Aneke, Norbert O.

This revised curriculum guide for teachers and students includes the additional technical knowledge and applications required to help prepare students for job entry in the commercial and industrial wiring trade. The curriculum guide contains 16 units that cover the following topics: (1) blueprint reading and load calculations; (2) tools and…

Cannulation method for intra-diverticular papilla with long oral protrusion using biopsy forceps for axis alignment.

PubMed

Takenaka, Mamoru; Minaga, Kosuke; Kudo, Masatoshi

2018-06-22

Intra-diverticular papilla is considered as a difficult anatomical orientation for biliary cannulation. 1 2 3 To our knowledge, this is the first report to show the usefulness of biopsy forceps for cannulation not only to expose the ampulla in the case of an intra-diverticular papilla but also for axis alignment.An 85-year-old woman underwent endoscopic retrograde cholangiopancreatography for a common bile duct (CBD) stone. A duodenoscope (TJF TYPE 260V; Olympus Medical Systems, Tokyo, Japan) was inserted into Vater's papilla. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Effectiveness of a Skin Cancer Control Educational Intervention for Internal Medicine Housestaff and Attending Physicians

PubMed Central

Dolan, Nancy C; Ng, Jennie S; Martin, Gary J; Robinson, June K; Rademaker, Alfred W

1997-01-01

OBJECTIVES To evaluate the effects of a brief educational program on beliefs, knowledge, and behaviors related to skin cancer control among internal medicine housestaff and attending physicians. DESIGN Randomized controlled trial. SETTING Urban academic general medicine practice. PARTICIPANTS Internal medicine housestaff and attending physicians with continuity clinics at the practice site. INTERVENTION Two 1-hour educational seminars on skin cancer control conducted jointly by a general internist and a dermatologist. MEASUREMENTS AND MAIN RESULTS Self-reported attitudes and beliefs about skin cancer control, ability to identify and make treatment decisions on 18 skin lesions, and knowledge of skin cancer risk factors were measured by a questionnaire before and after the teaching intervention. Exit surveys of patients at moderate to high risk of skin cancer were conducted 1 month before and 1 month after the intervention to measure physician skin cancer control practices reported by patients. Eighty-two physicians completed baseline questionnaires and were enrolled in the study, 46 in the intervention group and 36 in the control group. Twenty-five physicians attended both sessions, 11 attended one, and 10 attended neither. Postintervention, the percentage of physicians feeling adequately trained increased from 35% to 47% in the control group ( p = .34) and from 37% to 57% in the intervention group ( p = .06). Intervention physicians had an absolute mean improvement in their risk factor identification score of 6.7%, while control physicians’ mean score was unchanged ( p = .06). Intervention and control physicians had similar increases in their postintervention lesion identification and management scores. Postintervention, the mean proportion of patients per physician stating they were advised to watch their moles increased more among intervention physicians than control physicians (absolute difference of 19% vs −8%, p = .04). Other changes in behavior were not

The Wire-Grasping Method as a New Technique for Forceps Biopsy of Biliary Strictures: A Prospective Randomized Controlled Study of Effectiveness.

PubMed

Yamashita, Yasunobu; Ueda, Kazuki; Kawaji, Yuki; Tamura, Takashi; Itonaga, Masahiro; Yoshida, Takeichi; Maeda, Hiroki; Magari, Hirohito; Maekita, Takao; Iguchi, Mikitaka; Tamai, Hideyuki; Ichinose, Masao; Kato, Jun

2016-07-15

Transpapillary forceps biopsy is an effective diagnostic technique in patients with biliary stricture. This prospective study aimed to determine the usefulness of the wire-grasping method as a new technique for forceps biopsy. Consecutive patients with biliary stricture or irregularities of the bile duct wall were randomly allocated to either the direct or wire-grasping method group. In the wiregrasping method, forceps in the duodenum grasps a guidewire placed into the bile duct beforehand, and then, the forceps are pushed through the papilla without endoscopic sphincterotomy. In the direct method, forceps are directly pushed into the bile duct alongside a guide-wire. The primary endpoint was the success rate of obtaining specimens suitable for adequate pathological examination. In total, 32 patients were enrolled, and 28 (14 in each group) were eligible for analysis. The success rate was significantly higher using the wire-grasping method than the direct method (100% vs 50%, p=0.016). Sensitivity and accuracy for the diagnosis of cancer were comparable in patients with the successful procurement of biopsy specimens between the two methods (91% vs 83% and 93% vs 86%, respectively). The wire-grasping method is useful for diagnosing patients with biliary stricture or irregularities of the bile duct wall.

1 mil gold bond wire study.

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

Huff, Johnathon; McLean, Michael B.; Jenkins, Mark W.

2013-05-01

In microcircuit fabrication, the diameter and length of a bond wire have been shown to both affect the current versus fusing time ratio of a bond wire as well as the gap length of the fused wire. This study investigated the impact of current level on the time-to-open and gap length of 1 mil by 60 mil gold bond wires. During the experiments, constant current was provided for a control set of bond wires for 250ms, 410ms and until the wire fused; non-destructively pull-tested wires for 250ms; and notched wires. The key findings were that as the current increases, themore » gap length increases and 73% of the bond wires will fuse at 1.8A, and 100% of the wires fuse at 1.9A within 60ms. Due to the limited scope of experiments and limited data analyzed, further investigation is encouraged to confirm these observations.« less

Description and Flight Test Results of the NASA F-8 Digital Fly-by-Wire Control System

NASA Technical Reports Server (NTRS)

1975-01-01

A NASA program to develop digital fly-by-wire (DFBW) technology for aircraft applications is discussed. Phase I of the program demonstrated the feasibility of using a digital fly-by-wire system for aircraft control through developing and flight testing a single channel system, which used Apollo hardware, in an F-8C airplane. The objective of Phase II of the program is to establish a technology base for designing practical DFBW systems. It will involve developing and flight testing a triplex digital fly-by-wire system using state-of-the-art airborne computers, system hardware, software, and redundancy concepts. The papers included in this report describe the Phase I system and its development and present results from the flight program. Man-rated flight software and the effects of lightning on digital flight control systems are also discussed.

Physician Guide to Appropriate Opioid Prescribing for Noncancer Pain

PubMed Central

Munzing, Timothy

2017-01-01

Prescription opioid use for relief of noncancer pain has risen dramatically in the last 15 years, contributing to a quadrupling of opioid overdoses and prescription opioid-related deaths. This crisis is resulting in heightened attention by health care professionals and organizations, law enforcement, and the government. In this article, I highlight key topics in the management of patients using opioids (or potentially needing opioids) in outpatient clinical practice; federal and state law enforcement actions regarding physicians’ illegal prescribing of opioids; multimodal approaches to pain control; nonmedication management of pain; response strategies when suspecting a patient of diverting or misusing opioids; and warning signs for abuse or diversion. For those patients for whom opioids are appropriate, I describe key elements for prescribing, including documentation of a detailed history and examination, appropriate evaluation to arrive at a specific diagnosis, individualizing management, and ongoing monitoring (including the use of urine drug screening and a prescription drug monitoring program). In addition to individual action, when possible, the initiation of systemwide and clinicwide safe prescribing practices supports the physician and patient such that the patient’s well-being is at the heart of all pain management decisions. Physicians are encouraged to further educate themselves to treat pain safely and effectively; to screen patients for opioid use disorder and, when diagnosed, to connect them with evidence-based treatment; and to follow Centers for Disease Control and Prevention guidelines whenever possible. PMID:28488993

Financial transparency and physicians: the physician leader's guide to sharing numbers.

PubMed

Paskert, James P

2014-01-01

Review critical factors such as length of stay, case mix, financial statements, ratios and days cash on hand that physicians need to understand to adequately manage hospital patients and engage in the success of the organization.

Research on Mechanisms and Controlling Methods of Macro Defects in TC4 Alloy Fabricated by Wire Additive Manufacturing.

PubMed

Ji, Lei; Lu, Jiping; Tang, Shuiyuan; Wu, Qianru; Wang, Jiachen; Ma, Shuyuan; Fan, Hongli; Liu, Changmeng

2018-06-28

Wire feeding additive manufacturing (WFAM) has broad application prospects because of its advantages of low cost and high efficiency. However, with the mode of lateral wire feeding, including wire and laser additive manufacturing, gas tungsten arc additive manufacturing etc., it is easy to generate macro defects on the surface of the components because of the anisotropy of melted wire, which limits the promotion and application of WFAM. In this work, gas tungsten arc additive manufacturing with lateral wire feeding is proposed to investigate the mechanisms of macro defects. The results illustrate that the defect forms mainly include side spatters, collapse, poor flatness, and unmelted wire. It was found that the heat input, layer thickness, tool path, and wire curvature can have an impact on the macro defects. Side spatters are the most serious defects, mainly because the droplets cannot be transferred to the center of the molten pool in the lateral wire feeding mode. This research indicates that the macro defects can be controlled by optimizing the process parameters. Finally, block parts without macro defects were fabricated, which is meaningful for the further application of WFAM.

Welding wire pressure sensor assembly

NASA Technical Reports Server (NTRS)

Morris, Timothy B. (Inventor); Milly, Peter F., Sr. (Inventor); White, J. Kevin (Inventor)

1994-01-01

The present invention relates to a device which is used to monitor the position of a filler wire relative to a base material being welded as the filler wire is added to a welding pool. The device is applicable to automated welding systems wherein nonconsumable electrode arc welding processes are utilized in conjunction with a filler wire which is added to a weld pool created by the electrode arc. The invention senses pressure deviations from a predetermined pressure between the filler wire and the base material, and provides electrical signals responsive to the deviations for actuating control mechanisms in an automatic welding apparatus so as to minimize the pressure deviation and to prevent disengagement of the contact between the filler wire and the base material.

Controlled electron doping into metallic atomic wires: Si(111)4×1-In

NASA Astrophysics Data System (ADS)

Morikawa, Harumo; Hwang, C. C.; Yeom, Han Woong

2010-02-01

We demonstrate the controllable electron doping into metallic atomic wires, indium wires self-assembled on the Si(111) surface, which feature one-dimensional (1D) band structure and temperature-driven metal-insulator transition. The electron filling of 1D metallic bands is systematically increased by alkali-metal adsorption, which, in turn, tunes the macroscopic property, that is, suppresses the metal-insulator transition. On the other hand, the dopant atoms induce a local lattice distortion without a band-gap opening, leading to a microscopic phase separation on the surface. The distinct bifunctional, electronic and structural, roles of dopants in different length scales are thus disclosed.

Towards a Reduced-Wire Interface for CMUT-Based Intravascular Ultrasound Imaging Systems

PubMed Central

Lim, Jaemyung; Tekes, Coskun; Degertekin, F. Levent; Ghovanloo, Maysam

2016-01-01

Having intravascular ultrasound (IVUS) imaging capability on guide wires used in cardiovascular interventions may eliminate the need for separate IVUS catheters and expand the use of IVUS in a larger portion of the vasculature. High frequency capacitive micro machined ultrasonic transducer (CMUT) arrays should be integrated with interface electronics and placed on the guide wire for this purpose. Besides small size, this system-on-a-chip (SoC) front-end should connect to the back-end imaging system with a minimum number of wires to preserve the critical mechanical properties of the guide wire. We present a 40 MHz CMUT array interface SoC, which will eventually use only two wires for power delivery and transmits image data using a combination of analog-to-time conversion (ATC) and an impulse radio ultra-wideband (IR-UWB) wireless link. The proof-of-concept prototype ASIC consumes only 52.8 mW and occupies 4.07 mm2 in a 0.35-μm standard CMOS process. A rectifier and regulator power the rest of the SoC at 3.3 V from a 10 MHz power carrier that is supplied through a 2.4 m micro-coax cable with an overall efficiency of 49.1%. Echo signals from an 8-element CMUT array are amplified by a transimpedance amplifier (TIA) array and down-converted to baseband by quadrature sampling using a 40 MHz clock, derived from the power carrier. The ATC generates pulse-width-modulated (PWM) samples at 2 × 10 MS/s with 6 bit resolution, while the entire system achieved 5.1 ENOB. Preliminary images from the prototype system are presented, and alternative data transmission and possible future directions towards practical implementation are discussed. PMID:27662686

Towards a Reduced-Wire Interface for CMUT-Based Intravascular Ultrasound Imaging Systems.

PubMed

Lim, Jaemyung; Tekes, Coskun; Degertekin, F Levent; Ghovanloo, Maysam

2017-04-01

Having intravascular ultrasound (IVUS) imaging capability on guide wires used in cardiovascular interventions may eliminate the need for separate IVUS catheters and expand the use of IVUS in a larger portion of the vasculature. High frequency capacitive micro machined ultrasonic transducer (CMUT) arrays should be integrated with interface electronics and placed on the guide wire for this purpose. Besides small size, this system-on-a-chip (SoC) front-end should connect to the back-end imaging system with a minimum number of wires to preserve the critical mechanical properties of the guide wire. We present a 40 MHz CMUT array interface SoC, which will eventually use only two wires for power delivery and transmits image data using a combination of analog-to-time conversion (ATC) and an impulse radio ultra-wideband (IR-UWB) wireless link. The proof-of-concept prototype ASIC consumes only 52.8 mW and occupies 4.07 [Formula: see text] in a 0.35- [Formula: see text] standard CMOS process. A rectifier and regulator power the rest of the SoC at 3.3 V from a 10 MHz power carrier that is supplied through a 2.4 m micro-coax cable with an overall efficiency of 49.1%. Echo signals from an 8-element CMUT array are amplified by a transimpedance amplifier (TIA) array and down-converted to baseband by quadrature sampling using a 40 MHz clock, derived from the power carrier. The ATC generates pulse-width-modulated (PWM) samples at 2 × 10 MS/s with 6 bit resolution, while the entire system achieved 5.1 ENOB. Preliminary images from the prototype system are presented, and alternative data transmission and possible future directions towards practical implementation are discussed.

Feasibility of sedation and analgesia interruption following cannulation in neonates on extracorporeal membrane oxygenation

PubMed Central

Wildschut, E. D.; Hanekamp, M. N.; Vet, N. J.; Houmes, R. J.; Ahsman, M. J.; Mathot, R. A. A.; de Wildt, S. N.

2010-01-01

Purpose In most extracorporeal membrane oxygenation (ECMO) centers patients are heavily sedated to prevent accidental decannulation and bleeding complications. In ventilated adults not on ECMO, daily sedation interruption protocols improve short- and long-term outcome. This study aims to evaluate safety and feasibility of sedation interruption following cannulation in neonates on ECMO. Methods Prospective observational study in 20 neonates (0.17–5.8 days of age) admitted for ECMO treatment. Midazolam (n = 20) and morphine (n = 18) infusions were discontinued within 30 min after cannulation. Pain and sedation were regularly assessed using COMFORT-B and visual analog scale (VAS) scores. Midazolam and/or morphine were restarted and titrated according to protocolized treatment algorithms. Results Median (interquartile range, IQR) time without any sedatives was 10.3 h (5.0–24.1 h). Median interruption duration for midazolam was 16.5 h (6.6–29.6 h), and for morphine was 11.2 h (6.7–39.4 h). During this period no accidental extubations, decannulations or bleeding complications occurred. Conclusions This is the first study to show that interruption of sedatives and analgesics following cannulation in neonates on ECMO is safe and feasible. Interruption times are 2–3 times longer than reported for adult ICU patients not on ECMO. Further trials are needed to substantiate these findings and evaluate short- and long-term outcomes. PMID:20508914

Electrophoretic-like gating used to control metal-insulator transitions in electronically phase separated manganite wires.

PubMed

Guo, Hangwen; Noh, Joo H; Dong, Shuai; Rack, Philip D; Gai, Zheng; Xu, Xiaoshan; Dagotto, Elbio; Shen, Jian; Ward, T Zac

2013-08-14

Electronically phase separated manganite wires are found to exhibit controllable metal-insulator transitions under local electric fields. The switching characteristics are shown to be fully reversible, polarity independent, and highly resistant to thermal breakdown caused by repeated cycling. It is further demonstrated that multiple discrete resistive states can be accessed in a single wire. The results conform to a phenomenological model in which the inherent nanoscale insulating and metallic domains are rearranged through electrophoretic-like processes to open and close percolation channels.

Deformable 3D-2D registration for guiding K-wire placement in pelvic trauma surgery

NASA Astrophysics Data System (ADS)

Goerres, J.; Jacobson, M.; Uneri, A.; de Silva, T.; Ketcha, M.; Reaungamornrat, S.; Vogt, S.; Kleinszig, G.; Wolinsky, J.-P.; Osgood, G.; Siewerdsen, J. H.

2017-03-01

Pelvic Kirschner wire (K-wire) insertion is a challenging surgical task requiring interpretation of complex 3D anatomical shape from 2D projections (fluoroscopy) and delivery of device trajectories within fairly narrow bone corridors in proximity to adjacent nerves and vessels. Over long trajectories ( 10-25 cm), K-wires tend to curve (deform), making conventional rigid navigation inaccurate at the tip location. A system is presented that provides accurate 3D localization and guidance of rigid or deformable surgical devices ("components" - e.g., K-wires) based on 3D-2D registration. The patient is registered to a preoperative CT image by virtually projecting digitally reconstructed radiographs (DRRs) and matching to two or more intraoperative x-ray projections. The K-wire is localized using an analogous procedure matching DRRs of a deformably parametrized model for the device component (deformable known-component registration, or dKC-Reg). A cadaver study was performed in which a K-wire trajectory was delivered in the pelvis. The system demonstrated target registration error (TRE) of 2.1 ± 0.3 mm in location of the K-wire tip (median ± interquartile range, IQR) and 0.8 ± 1.4º in orientation at the tip (median ± IQR), providing functionality analogous to surgical tracking / navigation using imaging systems already in the surgical arsenal without reliance on a surgical tracker. The method offers quantitative 3D guidance using images (e.g., inlet / outlet views) already acquired in the standard of care, potentially extending the advantages of navigation to broader utilization in trauma surgery to improve surgical precision and safety.

Assessing the effects of manual dexterity and playing computer games on catheter-wire manipulation for inexperienced operators.

PubMed

Alsafi, Z; Hameed, Y; Amin, P; Shamsad, S; Raja, U; Alsafi, A; Hamady, M S

2017-09-01

To investigate the effect of playing computer games and manual dexterity on catheter-wire manipulation in a mechanical aortic model. Medical student volunteers filled in a preprocedure questionnaire assessing their exposure to computer games. Their manual dexterity was measured using a smartphone game. They were then shown a video clip demonstrating renal artery cannulation and were asked to reproduce this. All attempts were timed. Two-tailed Student's t-test was used to compare continuous data, while Fisher's exact test was used for categorical data. Fifty students aged 18-22 years took part in the study. Forty-six completed the task at an average of 168 seconds (range 103-301 seconds). There was no significant difference in the dexterity score or time to cannulate the renal artery between male and female students. Students who played computer games for >10 hours per week had better dexterity scores than those who did not play computer games: 9.1 versus 10.2 seconds (p=0.0237). Four of 19 students who did not play computer games failed to complete the task, while all of those who played computer games regularly completed the task (p=0.0168). Playing computer games is associated with better manual dexterity and ability to complete a basic interventional radiology task for novices. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Anomalous Coronary Artery From the Opposite Sinus (ACAOS): Technical Challenges During Percutaneous Coronary Intervention.

PubMed

Sinha, Santosh Kumar; Razi, Mahmodula; Mahrotra, Anupam; Aggarwal, Puneet; Singh, Anupam; Rekwal, Lokendra; Tripathi, Sunil; Abhishekh, Nishant Kumar; Krishna, Vinay

2018-04-01

Anomalies of the coronary arteries are reported in 1-2% of patients among diagnostic angiogram. Ectopic origin of right coronary artery (RCA) from opposite sinus is one of the most common and they are mainly benign, but at times may be malignant. We report a case of a 69-year-old male who underwent early invasive percutaneous coronary intervention for non-ST-segment elevation myocardial infarction (NSTEMI) where RCA arising from left sinus at the root of left main artery was culprit and various technical challenges were encountered while intervening in form of cannulation to tracking of hardwares. RCA was cannulated with floating wire technique using hockey stick guide catheter and revascularized by deployment of 3.5 × 38 mm Promus Premier Everolimus eluting stent (Boston Scientific, USA). To the best of our knowledge, this is the first ever report of ectopic RCA being revascularized by using hockey stick catheter.

Clinical competence of biopsychosocially trained physicians and controls.

PubMed

Adler, Rolf H; Minder, Christoph E

2012-07-25

To assess and compare clinical observations and interpretations by physicians trained in biopsychosocial internal medicine (group A) and a control group (C) of physicians with no such special training. A verbatim first-interview of a 36-year old woman, seen for consultation by RHA, was presented to both groups (A, trained physicians: n = 30, and C, controls: n = 29). The patient's symptoms included: shaky knees, strange sensations in the abdomen and chest, insecurity and dizziness. The symptoms had begun before her final nursing- exam and exacerbated on her mother's 60th birthday two months later. The patient's mother is the sole caretaker for the patient's sister, who also attended the birthday party. The patient's sister is 19 and had been diagnosed with storage disease and is wheelchair-bound. The doctors were asked to record their observations and interpretations while reviewing the case report. Group A-physicians mentioned and interpreted the physician-patient relationship and the patient's body language as described in the case report more often (p = 0.002, Wilcoxon-Mann-Whitney rank sum test (RS)), mentioned physical symptoms more often (p = 0.0099, Fisher's exact test (FE)) and more often interpreted illness settings with respect to the patient's fear and guilt (Fisher's exact test, p = 0.007 and p = 0.015). A precise integrative diagnosis (life events leading to stress, the latter evoking fear and guilt, leading to symptoms of the fight-flight reaction) was suggested by 7 of group A and 4 of group C. Extensive laboratory work-up and requests for consultations were more frequently asked for by the C group (p = 0.048, RS). Residency training in biopsychosocial medicine in an Internal Medicine Department increased sensitivity to and interpretation of biological and psychosocial data many years after the training and decreased the extent of work-up and consultation costs. However it only tended to enhance psychosomatic conceptualisation with respect to anxiety

Guided Growth of Horizontal ZnSe Nanowires and their Integration into High-Performance Blue-UV Photodetectors.

PubMed

Oksenberg, Eitan; Popovitz-Biro, Ronit; Rechav, Katya; Joselevich, Ernesto

2015-07-15

Perfectly aligned horizontal ZnSe nano-wires are obtained by guided growth, and easily integrated into high-performance blue-UV photodetectors. Their crystal phase and crystallographic orientation are controlled by the epitaxial relations with six different sapphire planes. Guided growth paves the way for the large-scale integration of nanowires into optoelectronic devices. © 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Trade Electricity. Signal Wiring--Level 1. Standardized Curriculum.

ERIC Educational Resources Information Center

New York City Board of Education, Brooklyn, NY. Office of Occupational and Career Education.

This curriculum guide consists of nine modules on signal wiring, one of the three divisions of the standardized trade electricity curriculum in high schools in New York City. The modules cover the following subjects: bells, double contact pushbuttons, annunciator circuits, open circuit burglar alarms, closed circuit burglar alarms, fire alarms,…

Evaluating Thermally Damaged Polyimide Insulated Wiring (MIL-W-81381) with Ultrasound

NASA Technical Reports Server (NTRS)

Madaras, Eric I.; Anastasi, Robert F.

2002-01-01

A series of experiments to investigate the use of ultrasound for measuring wire insulation have been conducted. Initial laboratory tests were performed on MIL-W-81381/7,/12, and /21 aviation wire, a wire that has polyimide (Kapton Registered Trademark) layers for insulation. Samples of this wiring were exposed to 370C temperatures for different periods of time to induce a range of thermal damage. For each exposure, 12 samples of each gauge (12, 16, and 20 gauges) were processed. The velocity of the lowest order axisymmetric ultrasonic guided mode, a mode that is sensitive to the geometry and stiffness of the wire conductor and insulation, was measured. The phase velocity for the 20-gauge MIL-W-81381/7 wire had a baseline value of 3023 +/- 78 m/s. After exposure to the high temperatures, the wire's phase velocity rapidly increased, and reached an asymptotic value of 3598 +/- 20 m/s after 100 hours exposure. Similar behavior was measured for the 16 gauge MIL-W-81381/21 wire and 12 gauge MIL-W-81381/12 wire which had baseline values of 3225 +/- 22 m/s and 3403 +/- 33 m/s respectively, and reached asymptotic values of 3668 +/- 19 m/s, and 3679 +/- 42 m/s respectively. These measured velocity changes represent changes of 19, 14, and 8 percent respectively for the 20, 16, and 12 gauge wires. Finally, some results for a wire with an ethylene tetrafluoroethylene insulation are reported. Qualitatively similar behaviors are noted ultrasonically.

A gesture-controlled projection display for CT-guided interventions.

PubMed

Mewes, A; Saalfeld, P; Riabikin, O; Skalej, M; Hansen, C

2016-01-01

The interaction with interventional imaging systems within a sterile environment is a challenging task for physicians. Direct physician-machine interaction during an intervention is rather limited because of sterility and workspace restrictions. We present a gesture-controlled projection display that enables a direct and natural physician-machine interaction during computed tomography (CT)-based interventions. Therefore, a graphical user interface is projected on a radiation shield located in front of the physician. Hand gestures in front of this display are captured and classified using a leap motion controller. We propose a gesture set to control basic functions of intervention software such as gestures for 2D image exploration, 3D object manipulation and selection. Our methods were evaluated in a clinically oriented user study with 12 participants. The results of the performed user study confirm that the display and the underlying interaction concept are accepted by clinical users. The recognition of the gestures is robust, although there is potential for improvements. The gesture training times are less than 10 min, but vary heavily between the participants of the study. The developed gestures are connected logically to the intervention software and intuitive to use. The proposed gesture-controlled projection display counters current thinking, namely it gives the radiologist complete control of the intervention software. It opens new possibilities for direct physician-machine interaction during CT-based interventions and is well suited to become an integral part of future interventional suites.

Saccular lung cannulation in a ball python (Python regius) to treat a tracheal obstruction.

PubMed

Myers, Debbie A; Wellehan, James F X; Isaza, Ramiro

2009-03-01

An adult male ball python (Python regius) presented in a state of severe dyspnea characterized by open-mouth breathing and vertical positioning of the head and neck. The animal had copious discharge in the tracheal lumen acting as an obstruction. A tube was placed through the body wall into the caudal saccular aspect of the lung to allow the animal to breathe while treatment was initiated. The ball python's dyspnea immediately improved. Diagnostics confirmed a bacterial respiratory infection with predominantly Providencia rettgeri. The saccular lung (air sac) tube was removed after 13 days. Pulmonary endoscopy before closure showed minimal damage with a small amount of hemorrhage in the surrounding muscle tissue. Respiratory disease is a common occurrence in captive snakes and can be associated with significant morbidity and mortality. Saccular lung cannulation is a relatively simple procedure that can alleviate tracheal narrowing or obstruction, similar to air sac cannulation in birds.

Early diagnostic suggestions improve accuracy of family physicians: a randomized controlled trial in Greece.

PubMed

Kostopoulou, Olga; Lionis, Christos; Angelaki, Agapi; Ayis, Salma; Durbaba, Stevo; Delaney, Brendan C

2015-06-01

In a recent randomized controlled trial, providing UK family physicians with 'early support' (possible diagnoses to consider before any information gathering) was associated with diagnosing hypothetical patients on computer more accurately than control. Another group of physicians, who gathered information, gave a diagnosis, and subsequently received a list of possible diagnoses to consider ('late support'), were no more accurate than control, despite being able to change their initial diagnoses. To replicate the UK study findings in another country with a different primary health care system. All study materials were translated into Greek. Greek family physicians were randomly allocated to one of three groups: control, early support and late support. Participants saw nine scenarios in random order. After reading some information about the patient and the reason for encounter, they requested more information to diagnose. The main outcome measure was diagnostic accuracy. One hundred fifty Greek family physicians participated. The early support group was more accurate than control [odds ratio (OR): 1.67 (1.21-2.31)]. Like their UK counterparts, physicians in the late support group rarely changed their initial diagnoses after receiving support. The pooled OR for the early support versus control comparison from the meta-analysis of the UK and Greek data was 1.40 (1.13-1.67). Using the same methodology with a different sample of family physicians in a different country, we found that suggesting diagnoses to consider before physicians start gathering information was associated with more accurate diagnoses. This constitutes further supportive evidence of a generalizable effect of early support. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

A guide to organizing joint ventures with physicians.

PubMed

Peters, G R

1986-12-01

Catholic health care facilities must consider the business and legal risks, canon law, and other constraints when planning a joint venture with physicians. Participants should first establish goals and compatibility, then determine the venture's type (property, service), form ("true," lease, contract), and structure (corporation, partnership, joint property ownership, trust). The administrator must decide whether the facility will participate directly in the venture or form a separate organization. Participants must determine their relationships with the venture, choosing among many options. The administrator should consider whether a venture raises any canon law issues, especially regarding ecclesiastical and secular assets, approval by the local bishop or Holy See, and need for consultation. Other pertinent legal issues include: Fraud and abuse. The venture should not appear as compensation to induce referrals. Physician referrals. Many states prohibit or restrict referrals by physician participants. Antitrust law. Participants may be liable for actions constituting on antitrust violation. Securities low. Organizers must clarify Securities and Exchange Commission registration exemptions and observe state "blue sky" laws. Tax issues. Catholic health care facilities must consider such factors as tax-exempt status, unrelated business income, taxable subsidiaries, and public charity status. Other considerations include tax ramifications for physicians; tax shelter registration; certificate of need (CON), licensing, and building standards; effects on reimbursement and pension plans; organizational and bond documents; corporate medical practice and fee-splitting questions; and labor and contractual issues.

Locating difficult veins for venepuncture and cannulation.

PubMed

Shaw, Sally Jane

2017-02-15

Vein location and assessment are essential to improve the success rates for vascular access. However, problems remain with first attempt success rates for peripheral cannulation and locating difficult veins. Practitioners may not be aware of developments in technology and aids to assist in the location and assessment of veins to achieve vascular access. This article provides an overview of two vein location aids that can be used to locate difficult veins: the IV-eye vein imager and the Vacuderm tourniquet. It discusses the patient factors that can increase the difficulty of vein assessment and location, and emphasises the importance of vessel health and preservation, and vein palpation. Practitioners should be experienced and skilled in the assessment of veins, and they are encouraged to revisit how they locate and assess veins.

30 CFR 77.1802 - Insulation of trolley wires, trolley feeder wires and bare signal wires; guarding of trolley...

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Insulation of trolley wires, trolley feeder wires and bare signal wires; guarding of trolley wires and trolley feeder wires. 77.1802 Section 77.1802... Wires and Trolley Feeder Wires § 77.1802 Insulation of trolley wires, trolley feeder wires and bare...

30 CFR 77.1802 - Insulation of trolley wires, trolley feeder wires and bare signal wires; guarding of trolley...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Insulation of trolley wires, trolley feeder wires and bare signal wires; guarding of trolley wires and trolley feeder wires. 77.1802 Section 77.1802... Wires and Trolley Feeder Wires § 77.1802 Insulation of trolley wires, trolley feeder wires and bare...

General Construction Trades. Volume 2. Teacher's Guide.

ERIC Educational Resources Information Center

East Texas State Univ., Commerce. Occupational Curriculum Lab.

Twenty-one general construction units are presented in this teacher's guide. The units are organized as follow: concrete finishing-two units (e.g., site preparation, pouring and finishing); plumbing-five units (e.g., pipe joints, angles, and flow; fixtures and valves); electrical wiring-five units (e.g., wiring procedures, planning a layout);…

Bilateral Pneumothoraces Following Central Venous Cannulation

PubMed Central

Pazos, F.; Masterson, K.; Inan, C.; Robert, J.; Walder, B.

2009-01-01

We report the occurrence of a bilateral pneumothoraces after unilateral central venous catheterization of the right subclavian vein in a 70-year-old patient. The patient had no history of pulmonary or pleural disease and no history of cardiothoracic surgery. Two days earlier, she had a median laparotomy under general and epidural anaesthesia. Prior to the procedure, the patient was hemodynamically stable and her transcutaneous oxygen saturation was 97% in room air. We punctured the right pleural space before cannulation of the right subclavian vein. After the procedure, the patient slowly became hemodynamically instable with respiratory distress. A chest radiograph revealed a complete left-side pneumothorax and a mild right-side pneumothorax. The right-side pneumothorax became under tension after left chest tube insertion. The symptoms finally resolved after insertion of a right chest tube. After a diagnostic work-up, we suspect a congenital “Buffalo chests” explaining bilateral pneumothoraces and a secondary tension pneumothorax. PMID:19901997

Revision rates and cumulative financial burden in patients treated with hemiarthroplasty compared to cannulated screws after femoral neck fractures.

PubMed

Shields, Edward; Kates, Stephen L

2014-12-01

This study compares re-operation rates and financial burden following the treatment of femoral neck fractures treated with hemiarthroplasty compared to non-displaced femoral neck fractures treated with cannulated screws. Data was retrospectively analyzed from a prospective database at a university hospital setting on patients undergoing hemiarthroplasty after femoral neck fractures and those with non-displaced femoral neck fractures treated with cannulated screws over a 7-year period. Re-operation rates were determined and financial data was analyzed. Charges refer to amounts billed by the hospital to insurance carriers, while costs refer to financial burden carried by the hospital during treatment. There were 491 femoral neck fractures (475 patients) that underwent hemiarthroplasty (HA) and 120 non-displaced fractures (119 patients) treated with cannulated screw (CannS) fixation. Both groups had similar age, sex, Charlson co-morbidity scores, pre-operative Parker mobility scores, and 12-month mortality. There were 29 (5.9 %) reoperations in the HA group and 16 (13.3 %) in the CannS group (P = 0.007). The majority of re-operations occurred within 12 months for both groups [21/29 (72 %) HA group; 15/16 (94 %) CannS group; P = 0.13]. Average hospital charges per patient for the index procedure were higher in the HA group ($17,880 ± 745) compared to the CannS group ($14,104 ± 5,047; P < 0.001). After accounting for additional procedures related to their initial surgical fixation, average hospital charges and costs remained higher in the HA group. Patients treated with hemiarthroplasty for femoral neck fractures have lower re-operation rates than patients treated with cannulated screws for non-displaced femoral neck fractures, with 80 % of re-operations occurring in the first 12 months. Hospital charges and costs to the hospital for treating patients undergoing hemiarthroplasty were higher than patients treated with cannulated screws for the index procedure alone

Adjustable Bracket For Entry Of Welding Wire

NASA Technical Reports Server (NTRS)

Gilbert, Jeffrey L.; Gutow, David A.

1993-01-01

Wire-entry bracket on welding torch in robotic welding system provides for adjustment of angle of entry of welding wire over range of plus or minus 30 degrees from nominal entry angle. Wire positioned so it does not hide weld joint in view of through-the-torch computer-vision system part of robot-controlling and -monitoring system. Swiveling bracket also used on nonvision torch on which wire-feed-through tube interferes with workpiece. Angle simply changed to one giving sufficient clearance.

SpaceWire- Based Control System Architecture for the Lightweight Advanced Robotic Arm Demonstrator [LARAD

NASA Astrophysics Data System (ADS)

Rucinski, Marek; Coates, Adam; Montano, Giuseppe; Allouis, Elie; Jameux, David

2015-09-01

The Lightweight Advanced Robotic Arm Demonstrator (LARAD) is a state-of-the-art, two-meter long robotic arm for planetary surface exploration currently being developed by a UK consortium led by Airbus Defence and Space Ltd under contract to the UK Space Agency (CREST-2 programme). LARAD has a modular design, which allows for experimentation with different electronics and control software. The control system architecture includes the on-board computer, control software and firmware, and the communication infrastructure (e.g. data links, switches) connecting on-board computer(s), sensors, actuators and the end-effector. The purpose of the control system is to operate the arm according to pre-defined performance requirements, monitoring its behaviour in real-time and performing safing/recovery actions in case of faults. This paper reports on the results of a recent study about the feasibility of the development and integration of a novel control system architecture for LARAD fully based on the SpaceWire protocol. The current control system architecture is based on the combination of two communication protocols, Ethernet and CAN. The new SpaceWire-based control system will allow for improved monitoring and telecommanding performance thanks to higher communication data rate, allowing for the adoption of advanced control schemes, potentially based on multiple vision sensors, and for the handling of sophisticated end-effectors that require fine control, such as science payloads or robotic hands.

Electromagnetic tracking of flexible robotic catheters enables "assisted navigation" and brings automation to endovascular navigation in an in vitro study.

PubMed

Schwein, Adeline; Kramer, Benjamin; Chinnadurai, Ponraj; Virmani, Neha; Walker, Sean; O'Malley, Marcia; Lumsden, Alan B; Bismuth, Jean

2018-04-01

Combining three-dimensional (3D) catheter control with electromagnetic (EM) tracking-based navigation significantly reduced fluoroscopy time and improved robotic catheter movement quality in a previous in vitro pilot study. The aim of this study was to expound on previous results and to expand the value of EM tracking with a novel feature, assistednavigation, allowing automatic catheter orientation and semiautomatic vessel cannulation. Eighteen users navigated a robotic catheter in an aortic aneurysm phantom using an EM guidewire and a modified 9F robotic catheter with EM sensors at the tip of both leader and sheath. All users cannulated two targets, the left renal artery and posterior gate, using four visualization modes: (1) Standard fluoroscopy (control). (2) 2D biplane fluoroscopy showing real-time virtual catheter localization and orientation from EM tracking. (3) 2D biplane fluoroscopy with novel EM assisted navigation allowing the user to define the target vessel. The robotic catheter orients itself automatically toward the target; the user then only needs to advance the guidewire following this predefined optimized path to catheterize the vessel. Then, while advancing the catheter over the wire, the assisted navigation automatically modifies catheter bending and rotation in order to ensure smooth progression, avoiding loss of wire access. (4) Virtual 3D representation of the phantom showing real-time virtual catheter localization and orientation. Standard fluoroscopy was always available; cannulation and fluoroscopy times were noted for every mode and target cannulation. Quality of catheter movement was assessed by measuring the number of submovements of the catheter using the 3D coordinates of the EM sensors. A t-test was used to compare the standard fluoroscopy mode against EM tracking modes. EM tracking significantly reduced the mean fluoroscopy time (P < .001) and the number of submovements (P < .02) for both cannulation tasks. For the posterior gate

Fabrication of a smart air intake structure using shape memory alloy wire embedded composite

NASA Astrophysics Data System (ADS)

Jung, Beom-Seok; Kim, Min-Saeng; Kim, Ji-Soo; Kim, Yun-Mi; Lee, Woo-Yong; Ahn, Sung-Hoon

2010-05-01

Shape memory alloys (SMAs) have been actively studied in many fields utilizing their high energy density. Applying SMA wire-embedded composite to aerospace structures, such as air intake of jet engines and guided missiles, is attracting significant attention because it could generate a comparatively large actuating force. In this research, a scaled structure of SMA wire-embedded composite was fabricated for the air intake of aircraft. The structure was composed of several prestrained Nitinol (Ni-Ti) SMA wires embedded in ∩-shape glass fabric reinforced plastic (GFRP), and it was cured at room temperature for 72 h. The SMA wire-embedded GFRP could be actuated by applying electric current through the embedded SMA wires. The activation angle generated from the composite structure was large enough to make a smart air intake structure.

Cost-Effectiveness of a Physician-Pharmacist Collaboration Intervention to Improve Blood Pressure Control.

PubMed

Polgreen, Linnea A; Han, Jayoung; Carter, Barry L; Ardery, Gail P; Coffey, Christopher S; Chrischilles, Elizabeth A; James, Paul A

2015-12-01

Previous studies have demonstrated the cost-effectiveness of physician-pharmacist collaborations to improve hypertension control. However, most studies have limited generalizability, lacking minority and low-income populations. The Collaboration Among Pharmacist and Physicians to Improve Blood Pressure Now (CAPTION) trial randomized 625 patients from 32 medical offices in 15 states. Each office had an existing clinical pharmacist on staff. Pharmacists in intervention offices communicated with patients and made recommendations to physicians about changes in therapy. Demographic information, blood pressure (BP), medications, and physician visits were recorded. In addition, pharmacists tracked time spent with each patient. Costs were assigned to medications and pharmacist and physician time. Cost-effectiveness ratios were calculated based on changes in BP measurements and hypertension control rates. Thirty-eight percent of patients were black, 14% were Hispanic, and 49% had annual income <$25 000. At 9 months, average systolic BP was 6.1 mm Hg lower (±3.5), diastolic was 2.9 mm Hg lower (±1.9), and the percentage of patients with controlled hypertension was 43% in the intervention group and 34% in the control group. Total costs for the intervention group were $1462.87 (±132.51) and $1259.94 (±183.30) for the control group, a difference of $202.93. The cost to lower BP by 1 mm Hg was $33.27 for systolic BP and $69.98 for diastolic BP. The cost to increase the rate of hypertension control by 1 percentage point in the study population was $22.55. Our results highlight the cost-effectiveness of a clinical pharmacy intervention for hypertension control in primary care settings. © 2015 American Heart Association, Inc.

Welding wire selection critical to jet engine repair work

NASA Astrophysics Data System (ADS)

1992-11-01

A review is provided of issues related to the selection of welding wire for aircraft gas-turbine engines emphasizing the importance of cleanliness in the welding wire product. A three-step metallurgical control process is described for the production of welding wire that is clean and suitable for turbine repair. The process is based on: (1) vacuum induction melting; (2) contamination-free processing of the wire; and (3) environmentally controlled packaging. Weld work on aerospace casting is shown to be useful and suitable for many alloy and superalloy materials with various filler materials.

Droplet centrifugation, droplet DNA extraction, and rapid droplet thermocycling for simpler and faster PCR assay using wire-guided manipulations

PubMed Central

2012-01-01

A computer numerical control (CNC) apparatus was used to perform droplet centrifugation, droplet DNA extraction, and rapid droplet thermocycling on a single superhydrophobic surface and a multi-chambered PCB heater. Droplets were manipulated using “wire-guided” method (a pipette tip was used in this study). This methodology can be easily adapted to existing commercial robotic pipetting system, while demonstrated added capabilities such as vibrational mixing, high-speed centrifuging of droplets, simple DNA extraction utilizing the hydrophobicity difference between the tip and the superhydrophobic surface, and rapid thermocycling with a moving droplet, all with wire-guided droplet manipulations on a superhydrophobic surface and a multi-chambered PCB heater (i.e., not on a 96-well plate). Serial dilutions were demonstrated for diluting sample matrix. Centrifuging was demonstrated by rotating a 10 μL droplet at 2300 round per minute, concentrating E. coli by more than 3-fold within 3 min. DNA extraction was demonstrated from E. coli sample utilizing the disposable pipette tip to cleverly attract the extracted DNA from the droplet residing on a superhydrophobic surface, which took less than 10 min. Following extraction, the 1500 bp sequence of Peptidase D from E. coli was amplified using rapid droplet thermocycling, which took 10 min for 30 cycles. The total assay time was 23 min, including droplet centrifugation, droplet DNA extraction and rapid droplet thermocycling. Evaporation from of 10 μL droplets was not significant during these procedures, since the longest time exposure to air and the vibrations was less than 5 min (during DNA extraction). The results of these sequentially executed processes were analyzed using gel electrophoresis. Thus, this work demonstrates the adaptability of the system to replace many common laboratory tasks on a single platform (through re-programmability), in rapid succession (using droplets), and with a high level of

Teaching basic trauma: validating FluoroSim, a digital fluoroscopic simulator for guide-wire insertion in hip surgery.

PubMed

Sugand, Kapil; Wescott, Robert A; Carrington, Richard; Hart, Alister; Van Duren, Bernard H

2018-05-10

Background and purpose - Simulation is an adjunct to surgical education. However, nothing can accurately simulate fluoroscopic procedures in orthopedic trauma. Current options for training with fluoroscopy are either intraoperative, which risks radiation, or use of expensive and unrealistic virtual reality simulators. We introduce FluoroSim, an inexpensive digital fluoroscopy simulator without the need for radiation. Patients and methods - This was a multicenter study with 26 surgeons in which everyone completed 1 attempt at inserting a guide-wire into a femoral dry bone using surgical equipment and FluoroSim. 5 objective performance metrics were recorded in real-time to assess construct validity. The surgeons were categorized based on the number of dynamic hip screws (DHS) performed: novices (< 10), intermediates (10-39) and experts (≥ 40). A 7-point Likert scale questionnaire assessed the face and content validity of FluoroSim. Results - Construct validity was present for 2 clinically validated metrics in DHS surgery. Experts and intermediates statistically significantly outperformed novices for tip-apex distance and for cut-out rate. Novices took the least number of radiographs. Face and content validity were also observed. Interpretation - FluoroSim discriminated between novice and intermediate or expert surgeons based on tip-apex distance and cut-out rate while demonstrating face and content validity. FluoroSim provides a useful adjunct to orthopedic training. Our findings concur with results from studies using other simulation modalities. FluoroSim can be implemented for education easily and cheaply away from theater in a safe and controlled environment.

Approach for chronic total occlusion with intravascular ultrasound-guided reverse controlled antegrade and retrograde tracking technique: single center experience.

PubMed

Dai, Jian; Katoh, Osamu; Kyo, Eisho; Tsuji, Takafumi; Watanabe, Satoshi; Ohya, Hidefumi

2013-10-01

Controlled antegrade and retrograde subintimal tracking (CART) or reverse CART techniques is the final step for percutaneous revascularization of coronary chronic total occlusion (CTO), but it still represents technical challenges and risk in interventional procedures. Our purpose was to utilize intravascular ultrasound (IVUS)-guided reverse CART approach for percutaneous revascularization of CTO in our heart center, focusing on its safety, efficacy, and latest technical developments. From November 2006 to November 2012, 49 patients with CTO failed to antegrade and/or retrograde percutaneous revascularization of CTO from true lumen to true lumen were enrolled in and underwent IVUS guided reverse CART approach. The mean J-CTO score of cases was 2.5. IVUS guidance was successfully implemented in 95.9%; IVUS identified that 61.7% of retrograde wires were located at intimal space, and 59.5% of antegrade wires were located at subintimal space. A Corsair channel dilator was used in 77.6% of cases. The success rates of technique and procedure were 95.9% and 93.9%, respectively; the technical minor complications were observed in 10.2% of cases, without significant clinic outcomes; 2.0% of cases occurred with a major adverse cardiac event of non-ST-elevation myocardial infarction; and no case occurred with target vessel revascularization or death. The mean length of stent implanted in a single CTO vessel was 51.3 mm. No patient appeared with radiation dermatitis and contrast-induced rise of creatinine. IVUS guided reverse CART approach is effective and safe for percutaneous revascularization of complex CTO, with a high success and a low complication rate. It is feasible to develop this approach for percutaneous revascularization of complex CTO. However, suitable case selection and lately device handling by experienced operators are the crucial points of success. © 2013, Wiley Periodicals, Inc.

Cavitation guide for control valves

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

Tullis, J.P.

1993-04-01

This guide teaches the basic fundamentals of cavitation to provide the reader with an understanding of what causes cavitation, when it occurs, and the potential problems cavitation can cause to a valve and piping system. The document provides guidelines for understanding how to reduce the cavitation and/or select control valves for a cavitating system. The guide provides a method for predicting the cavitation intensity of control valves, and how the effect of cavitation on a system will vary with valve type, valve function, valve size, operating pressure, duration of operation and details of the piping installation. The guide defines sixmore » cavitation limits identifying cavitation intensities ranging from inception to the maximum intensity possible. The intensity of the cavitation at each limit Is described, including a brief discussion of how each level of cavitation influences the valve and system. Examples are included to demonstrate how to apply the method, including making both size and pressure scale effects corrections. Methods of controlling cavitation are discussed providing information on various techniques which can be used to design a new system or modify an existing one so it can operate at a desired level of cavitation.« less

30 CFR 75.1003 - Insulation of trolley wires, trolley feeder wires and bare signal wires; guarding of trolley...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Insulation of trolley wires, trolley feeder wires and bare signal wires; guarding of trolley wires and trolley feeder wires. 75.1003 Section 75.1003... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Trolley Wires and Trolley Feeder Wires § 75.1003...

30 CFR 75.1003 - Insulation of trolley wires, trolley feeder wires and bare signal wires; guarding of trolley...

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Insulation of trolley wires, trolley feeder wires and bare signal wires; guarding of trolley wires and trolley feeder wires. 75.1003 Section 75.1003... MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Trolley Wires and Trolley Feeder Wires § 75.1003...

A deployable .015 inch diameter wire antenna

NASA Technical Reports Server (NTRS)

Dibiasi, L.

1979-01-01

This mechanism was developed to dispense a small diameter wire which serves as a receiving antenna for electric field measurements on an Earth orbiting satellite. The antenna is deployed radially from a spinning satellite. A brushless dc motor drives a storage spool to dispense the wire at a controlled rate. Centrifugal force, acting on a mass attached to the end of the wire, keeps the wire in the radial position. The mechanism design, testing, and performance characteristics are discussed. Finally, operational data of the mechanism while in orbit are presented.

From the doctor's workshop to the iron cage? Evolving modes of physician control in US health systems.

PubMed

Kitchener, Martin; Caronna, Carol A; Shortell, Stephen M

2005-03-01

As national health systems pursue the common goals of containing expenditure growth and improving quality, many have sought to replace autonomous modes (systems) of physician control that rely on initial professional training and subsequent peer review. A common approach has involved extending bureaucratic modes of physician control that employ techniques such as hierarchical coordination and salaried positions. This paper applies concepts from studies of professional work to frame an empirical analysis of emergent bureaucratic modes of physician control in US hospital-based systems. Conceptually, we draw from recent studies to update Scott's (Health Services Res. 17(3) (1982) 213) typology to specify three bureaucratic modes of physician control: heteronomous, conjoint, and custodial. Empirically, we use case study evidence from eight US hospital-based systems to illustrate the heterogeneity of bureaucratic modes of physician control that span each of the ideal types. The findings indicate that some influential analysts perpetuate a caricature of bureaucratic organization which underplays its capacity to provide multiple modes of physician control that maintain professional autonomy over the content of work, and present opportunities for aligning practice with social goals.

Physicians' degree of motivation regarding their perception of hypertension, and blood pressure control.

PubMed

Consoli, Silla M; Lemogne, Cédric; Levy, Alain; Pouchain, Denis; Laurent, Stephane

2010-06-01

Despite clear international guidelines, the achievement of blood pressure (BP) control is still disappointing. To determine whether physicians' perception of hypertension, in general, is related to their patients' BP measures. DUO-HTA is a French cross-sectional survey, which included a representative sample of 346 general practitioners, 209 cardiologists and 2014 hypertensive patients. Data were collected using two self-administered questionnaires filled out by the hypertensive patients and their physicians. A cluster analysis was performed on the responses given by the physicians, prior to the inclusion of their patients into the study, to 13 questions concerning their perception of hypertension. Physicians were divided into five groups, ranging from 'poorly motivated' to 'highly motivated' physicians, with regard to their perception of hypertension. More motivated physicians had a more confident and optimistic approach of hypertension, looked more empathetic and supportive towards patients and were characterized by higher rates of patients with controlled BP included into the study (range 32-42%, P=0.01 for trend). After adjusting for sociodemographic, clinical and psychological patient-related variables, separate analyses for the patients included into the survey by general practitioners or cardiologists found a significant decreasing gradient for SBP according to physicians' level of motivation (respectively, P=0.029 and P=0.021). Close results were observed in multivariate logistic regression analyses of uncontrolled hypertension. These results underline the importance of physicians' perception of hypertension, in addition or concurrently to their compliance with international guidelines, for a successful management of hypertensive patients

Spatiotemporal dynamics of brain activity during the transition from visually guided to memory-guided force control

PubMed Central

Poon, Cynthia; Chin-Cottongim, Lisa G.; Coombes, Stephen A.; Corcos, Daniel M.

2012-01-01

It is well established that the prefrontal cortex is involved during memory-guided tasks whereas visually guided tasks are controlled in part by a frontal-parietal network. However, the nature of the transition from visually guided to memory-guided force control is not as well established. As such, this study examines the spatiotemporal pattern of brain activity that occurs during the transition from visually guided to memory-guided force control. We measured 128-channel scalp electroencephalography (EEG) in healthy individuals while they performed a grip force task. After visual feedback was removed, the first significant change in event-related activity occurred in the left central region by 300 ms, followed by changes in prefrontal cortex by 400 ms. Low-resolution electromagnetic tomography (LORETA) was used to localize the strongest activity to the left ventral premotor cortex and ventral prefrontal cortex. A second experiment altered visual feedback gain but did not require memory. In contrast to memory-guided force control, altering visual feedback gain did not lead to early changes in the left central and midline prefrontal regions. Decreasing the spatial amplitude of visual feedback did lead to changes in the midline central region by 300 ms, followed by changes in occipital activity by 400 ms. The findings show that subjects rely on sensorimotor memory processes involving left ventral premotor cortex and ventral prefrontal cortex after the immediate transition from visually guided to memory-guided force control. PMID:22696535

Pressure-assisted melt-filling and optical characterization of Au nano-wires in microstructured fibers.

PubMed

Lee, H W; Schmidt, M A; Russell, R F; Joly, N Y; Tyagi, H K; Uebel, P; Russell, P St J

2011-06-20

We report a novel splicing-based pressure-assisted melt-filling technique for creating metallic nanowires in hollow channels in microstructured silica fibers. Wires with diameters as small as 120 nm (typical aspect ration 50:1) could be realized at a filling pressure of 300 bar. As an example we investigate a conventional single-mode step-index fiber with a parallel gold nanowire (wire diameter 510 nm) running next to the core. Optical transmission spectra show dips at wavelengths where guided surface plasmon modes on the nanowire phase match to the glass core mode. By monitoring the side-scattered light at narrow breaks in the nanowire, the loss could be estimated. Values as low as 0.7 dB/mm were measured at resonance, corresponding to those of an ultra-long-range eigenmode of the glass-core/nanowire system. By thermal treatment the hollow channel could be collapsed controllably, permitting creation of a conical gold nanowire, the optical properties of which could be monitored by side-scattering. The reproducibility of the technique and the high optical quality of the wires suggest applications in fields such as nonlinear plasmonics, near-field scanning optical microscope tips, cylindrical polarizers, optical sensing and telecommunications.

Flight experience with a fail-operational digital fly-by-wire control system

NASA Technical Reports Server (NTRS)

Brown, S. R.; Szalai, K. J.

1977-01-01

The NASA Dryden Flight Research Center is flight testing a triply redundant digital fly-by-wire (DFBW) control system installed in an F-8 aircraft. The full-time, full-authority system performs three-axis flight control computations, including stability and command augmentation, autopilot functions, failure detection and isolation, and self-test functions. Advanced control law experiments include an active flap mode for ride smoothing and maneuver drag reduction. This paper discusses research being conducted on computer synchronization, fault detection, fault isolation, and recovery from transient faults. The F-8 DFBW system has demonstrated immunity from nuisance fault declarations while quickly identifying truly faulty components.

Mechanical behavior of M-Wire and conventional NiTi wire used to manufacture rotary endodontic instruments.

PubMed

Pereira, Erika S J; Gomes, Renata O; Leroy, Agnès M F; Singh, Rupinderpal; Peters, Ove A; Bahia, Maria G A; Buono, Vicente T L

2013-12-01

Comparison of physical and mechanical properties of one conventional and a new NiTi wire, which had received an additional thermomechanical treatment. Specimens of both conventional (NiTi) and the new type of wire, called M-Wire (MW), were subjected to tensile and three-point bending tests, Vickers microhardness measurements, and to rotating-bending fatigue tests at a strain-controlled level of 6%. Fracture surfaces were observed by scanning electron microscopy and the non-deformed microstructures by transmission electron microscopy. The thermomechanical treatment applied to produce the M-Wire apparently increased the tensile strength and Vickers microhardness of the material, but its apparent Young modulus was smaller than that of conventionally treated NiTi. The three-point bending tests showed a higher flexibility for MW which also exhibited a significantly higher number of cycles to failure. M-Wire presented mechanical properties that can render endodontic instruments more flexible and fatigue resistant than those made with conventionally processed NiTi wires. Copyright © 2013 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Effect of environment on fatigue failure of controlled memory wire nickel-titanium rotary instruments.

PubMed

Shen, Ya; Qian, Wei; Abtin, Houman; Gao, Yuan; Haapasalo, Markus

2012-03-01

This study examined the fatigue behavior of 2 types of nickel-titanium (NiTi) instruments made from a novel controlled memory NiTi wire (CM wire) under various environment conditions. Three conventional superelastic NiTi instruments of ProFile (Dentsply Maillefer, Ballaigues, Switzerland), Typhoon (Clinician's Choice Dental Products, New Milford, CT), and DS-SS0250425NEYY (Clinician's Choice Dental Products) and 2 new CM wire instruments of Typhoon CM and DS-SS0250425NEYY CM were subjected to rotational bending at the curvature of 35° in air, deionized water, 17% EDTA, or deionized water after immersion in 6% sodium hypochlorite for 25 minutes, and the number of revolutions of fracture (N(f)) was recorded. The fracture surface of all fragments was examined by a scanning electron microscope. The crack-initiation sites and the percentage of dimple area to the whole fracture cross-section were noted. Two new CM Wire instruments yielded an improvement of >4 to 9 times in N(f) than conventional NiTi files with the same design under various environments (P < .05). The fatigue life of 3 conventional superelastic NiTi instruments was similar under various environments, whereas the N(f) of 2 new CM Wire instruments was significantly longer in liquid media than in air (P < .05). The vast majority of CM instruments showed multiple crack origins, whereas most instruments made from conventional NiTi wire had one crack origin. The values of the area fraction occupied by the dimple region were significantly smaller on CM NiTi instruments than in conventional NiTi instruments under various environments (P < .05). Within the limitations of this study, the type of NiTi metal alloy (CM files vs conventional superelastic NiTi files) influences the cyclic fatigue resistance under various environments. The fatigue life of CM instruments is longer in liquid media than in air. Copyright © 2012 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

49 CFR 236.74 - Protection of insulated wire; splice in underground wire.

Code of Federal Regulations, 2013 CFR

2013-10-01

... THE INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.74 Protection of insulated...

49 CFR 236.74 - Protection of insulated wire; splice in underground wire.

Code of Federal Regulations, 2014 CFR

2014-10-01

... THE INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.74 Protection of insulated...

49 CFR 236.74 - Protection of insulated wire; splice in underground wire.

Code of Federal Regulations, 2012 CFR

2012-10-01

... THE INSTALLATION, INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.74 Protection of insulated...

Randomised controlled trial of a mobile phone infant resuscitation guide.

PubMed

Hawkes, Gavin A; Murphy, Geraldine; Dempsey, Eugene M; Ryan, Anthony C

2015-11-01

The aim of this study was to develop a mobile phone resuscitation guide (MPRG) and to evaluate its use during simulated resuscitation of a mannequin. An MPRG was developed using EpiSurveyor. A randomised controlled trial was performed in school-going children aged 15-16 years. All subjects were taught infant CPR skills using the American Heart Association Infant CPR Anytime. Two weeks later, the students were randomised to use of MPRG or not, and their CPR skills were re-assessed. The assessment was conducted using previously validated checklists. Twenty-one students participated in this trial. The MPRG group performed notably better in the areas of calling emergency services (80% vs. 36.4%, P = 0.044), completing sufficient CPR cycles (90% vs. 45.5%, P = 0.047) and following the correct CPR sequence (60% vs. 9.1%, P = 0.013). No difference in resuscitation skills of participants was observed. We have shown that participants were more likely to call emergency services if they were using the MPRG. Further trials are needed to investigate the utility of mobile phone guides and whether or not they can reduce the time taken to contact emergency services as well as if they can sustain correct CPR sequence in an in-vivo setting. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

A New Flying Wire System for the Tevatron

NASA Astrophysics Data System (ADS)

Blokland, Willem; Dey, Joseph; Vogel, Greg

1997-05-01

A new Flying Wires system replaces the old system to enhance the analysis of the beam emittance, improve the reliability, and handle the upcoming upgrades of the Tevatron. New VME data acquisition modules and timing modules allow for more bunches to be sampled more precisely. The programming language LabVIEW, running on a Macintosh computer, controls the VME modules and the nuLogic motion board that flies the wires. LabVIEW also analyzes and stores the data, and handles local and remote commands. The new system flies three wires and fits profiles of 72 bunches to a gaussian function within two seconds. A new console application operates the flying wires from any control console. This paper discusses the hardware and software setup, the capabilities and measurement results of the new Flying Wires system.

In Situ Electrochemical Deposition of Microscopic Wires

NASA Technical Reports Server (NTRS)

Yun, Minhee; Myung, Nosang; Vasquez, Richard

2005-01-01

A method of fabrication of wires having micron and submicron dimensions is built around electrochemical deposition of the wires in their final positions between electrodes in integrated circuits or other devices in which the wires are to be used. Heretofore, nanowires have been fabricated by a variety of techniques characterized by low degrees of controllability and low throughput rates, and it has been necessary to align and electrically connect the wires in their final positions by use of sophisticated equipment in expensive and tedious post-growth assembly processes. The present method is more economical, offers higher yields, enables control of wire widths, and eliminates the need for post-growth assembly. The wires fabricated by this method could be used as simple electrical conductors or as transducers in sensors. Depending upon electrodeposition conditions and the compositions of the electroplating solutions in specific applications, the wires could be made of metals, alloys, metal oxides, semiconductors, or electrically conductive polymers. In this method, one uses fabrication processes that are standard in the semiconductor industry. These include cleaning, dry etching, low-pressure chemical vapor deposition, lithography, dielectric deposition, electron-beam lithography, and metallization processes as well as the electrochemical deposition process used to form the wires. In a typical case of fabrication of a circuit that includes electrodes between which microscopic wires are to be formed on a silicon substrate, the fabrication processes follow a standard sequence until just before the fabrication of the microscopic wires. Then, by use of a thermal SiO-deposition technique, the electrodes and the substrate surface areas in the gaps between them are covered with SiO. Next, the SiO is electron-beam patterned, then reactive-ion etched to form channels having specified widths (typically about 1 m or less) that define the widths of the wires to be formed. Drops

Metallurgical characterization of controlled memory wire nickel-titanium rotary instruments.

PubMed

Shen, Ya; Zhou, Hui-Min; Zheng, Yu-Feng; Campbell, Les; Peng, Bin; Haapasalo, Markus

2011-11-01

To improve the fracture resistance of nickel-titanium (NiTi) files, manufacturers have introduced new alloys and developed new manufacturing processes for the fabrication of NiTi files. This study aimed to examine the phase transformation behavior and microstructure of NiTi instruments from a novel controlled memory NiTi wire (CM wire). Instruments of EndoSequence (ES), ProFile (PF), ProFile Vortex (Vortex), Twisted Files (TF), Typhoon (TYP), and Typhoon™ CM (TYP CM), all size 25/.04, were examined by differential scanning calorimetry (DSC) and x-ray diffraction (XRD). Microstructures of etched instruments were observed by optical microscopy and scanning electron microscopy with x-ray energy-dispersive spectrometric (EDS) analyses. The DSC analyses showed that each segment of the TYP CM and Vortex instruments had an austenite transformation completion or austenite-finish (A(f)) temperature exceeding 37°C, whereas the NiTi instruments made from conventional superelastic NiTi wire (ES, PF, and TYP) and TF had A(f) temperatures substantially below mouth temperature. The higher A(f) temperature of TYP CM instruments was consistent with a mixture of austenite and martensite structure, which was observed at room temperature with XRD. All NiTi instruments had room temperature martensite microstructures consisting of colonies of lenticular features with substantial twinning. EDS analysis indicated that the precipitates in all NiTi instruments were titanium-rich, with an approximate composition of Ti(2)Ni. The TYP CM and Vortex instruments with heat treatment contribute to increase austenite transformation temperature. The CM instrument has significant changes in the phase transformation behavior, compared with conventional superelastic NiTi instruments. Copyright © 2011 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

A Preliminary Inquiry into Physicians' Perceptions of Patient Self-Control.

ERIC Educational Resources Information Center

Shapiro, Johanna; Shapiro, Deane H., Jr.

1980-01-01

The findings of a small pilot study, in which the perception of 16 obstetrician/gynocologists regarding their patients' degree of self-control as it related to medical problems, are analyzed. Findings suggested the physicians exhibited confusion about the concept of self-control and its applicability to patient care. (Author/MLW)

Electromagnetic navigation versus fluoroscopy in aortic endovascular procedures: a phantom study.

PubMed

Tystad Lund, Kjetil; Tangen, Geir Arne; Manstad-Hulaas, Frode

2017-01-01

To explore the possible benefits of electromagnetic (EM) navigation versus conventional fluoroscopy during abdominal aortic endovascular procedures. The study was performed on a phantom representing the abdominal aorta. Intraoperative cone beam computed tomography (CBCT) of the phantom was acquired and merged with a preoperative multidetector CT (MDCT). The CBCT was performed with a reference plate fixed to the phantom that, after merging the CBCT with the MDCT, facilitated registration of the MDCT volume with the EM space. An EM field generator was stationed near the phantom. Navigation software was used to display EM-tracked instruments within the 3D image volume. Fluoroscopy was performed using a C-arm system. Five operators performed a series of renal artery cannulations using modified instruments, alternatingly using fluoroscopy or EM navigation as the sole guidance method. Cannulation durations and associated radiation dosages were noted along with the number of cannulations complicated by loss of guidewire insertion. A total of 120 cannulations were performed. The median cannulation durations were 41.5 and 34.5 s for the fluoroscopy- and EM-guided cannulations, respectively. No significant difference in cannulation duration was found between the two modalities (p = 0.736). Only EM navigation showed a significant reduction in cannulation duration in the latter half of its cannulation series compared with the first half (p = 0.004). The median dose area product for fluoroscopy was 0.0836 [Formula: see text]. EM-guided cannulations required a one-time CBCT dosage of 3.0278 [Formula: see text]. Three EM-guided and zero fluoroscopy-guided cannulations experienced loss of guidewire insertion. Our findings indicate that EM navigation is not inferior to fluoroscopy in terms of the ability to guide endovascular interventions. Its utilization may be of particular interest in complex interventions where adequate visualization or minimal use of contrast agents is

Power and Control: Contracts and the Patient-Physician Relationship

PubMed Central

Lieber, Sarah R.; Kim, Scotty Y.; Volk, Michael L.

2011-01-01

Contracts with patients have become increasingly common in clinical practice and the medical literature. These include behavioral contracts for managing “difficult patients” 1, opioid contracts2–5, suicide prevention contracts6,7, and healthy living contracts8. Some physician practices have even asked patients to sign contracts promising not to litigate or post defamatory comments on the Internet9. Despite widespread adoption, few have stopped to consider the potential risks and ethical concerns with using these documents. This perspective will describe how patient contracts are ultimately about power and control, and if not used carefully could damage the patient-physician relationship. PMID:22093528

46 CFR 111.30-19 - Buses and wiring.

Code of Federal Regulations, 2010 CFR

2010-10-01

... control wiring must be— (1) Suitable for installation within in a switchboard enclosure and be rated at 90... 46 Shipping 4 2010-10-01 2010-10-01 false Buses and wiring. 111.30-19 Section 111.30-19 Shipping... REQUIREMENTS Switchboards § 111.30-19 Buses and wiring. (a) General. Each bus must meet the requirements of...

Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis.

PubMed

Panagioti, Maria; Panagopoulou, Efharis; Bower, Peter; Lewith, George; Kontopantelis, Evangelos; Chew-Graham, Carolyn; Dawson, Shoba; van Marwijk, Harm; Geraghty, Keith; Esmail, Aneez

2017-02-01

Burnout is prevalent in physicians and can have a negative influence on performance, career continuation, and patient care. Existing evidence does not allow clear recommendations for the management of burnout in physicians. To evaluate the effectiveness of interventions to reduce burnout in physicians and whether different types of interventions (physician-directed or organization-directed interventions), physician characteristics (length of experience), and health care setting characteristics (primary or secondary care) were associated with improved effects. MEDLINE, Embase, PsycINFO, CINAHL, and Cochrane Register of Controlled Trials were searched from inception to May 31, 2016. The reference lists of eligible studies and other relevant systematic reviews were hand searched. Randomized clinical trials and controlled before-after studies of interventions targeting burnout in physicians. Two independent reviewers extracted data and assessed the risk of bias. The main meta-analysis was followed by a number of prespecified subgroup and sensitivity analyses. All analyses were performed using random-effects models and heterogeneity was quantified. The core outcome was burnout scores focused on emotional exhaustion, reported as standardized mean differences and their 95% confidence intervals. Twenty independent comparisons from 19 studies were included in the meta-analysis (n = 1550 physicians; mean [SD] age, 40.3 [9.5] years; 49% male). Interventions were associated with small significant reductions in burnout (standardized mean difference [SMD] = -0.29; 95% CI, -0.42 to -0.16; equal to a drop of 3 points on the emotional exhaustion domain of the Maslach Burnout Inventory above change in the controls). Subgroup analyses suggested significantly improved effects for organization-directed interventions (SMD = -0.45; 95% CI, -0.62 to -0.28) compared with physician-directed interventions (SMD = -0.18; 95% CI, -0.32 to -0.03). Interventions delivered in

Basic Wiring.

ERIC Educational Resources Information Center

Kaltwasser, Stan; And Others

This module is the first in a series of three wiring publications; it serves as the foundation for students enrolled in a wiring program. It is a prerequisite to either "Residential Wiring" or "Commercial and Industrial Wiring." The module contains 16 instructional units that cover the following topics: occupational…

Computerized Numerical Control Curriculum Guide.

ERIC Educational Resources Information Center

Reneau, Fred; And Others

This guide is intended for use in a course in programming and operating a computerized numerical control system. Addressed in the course are various aspects of programming and planning, setting up, and operating machines with computerized numerical control, including selecting manual or computer-assigned programs and matching them with…

The professional responsibility model of physician leadership.

PubMed

Chervenak, Frank A; McCullough, Laurence B; Brent, Robert L

2013-02-01

The challenges physician leaders confront today call to mind Odysseus' challenge to steer his fragile ship successfully between Scylla and Charybdis. The modern Scylla takes the form of ever-increasing pressures to provide more resources for professional liability, compliance, patient satisfaction, central administration, and a host of other demands. The modern Charybdis takes the form of ever-increasing pressures to procure resources when fewer are available and competition is continuously increasing the need for resources, including managed care, hospital administration, payers, employers, patients who are uninsured or underinsured, research funding, and philanthropy. This publication provides physician leaders with guidance for identifying and managing common leadership challenges on the basis of the professional responsibility model of physician leadership. This model is based on Plato's concept of leadership as a life of service and the professional medical ethics of Drs John Gregory and Thomas Percival. Four professional virtues should guide physician leaders: self-effacement, self-sacrifice, compassion, and integrity. These professional virtues direct physician leaders to treat colleagues as ends in themselves, to provide justice-based resource management, to use power constrained by medical professionalism, and to prevent and respond effectively to organizational dysfunction. The professional responsibility model guides physician leaders by proving an explicit "tool kit" to complement managerial skills. Copyright © 2013 Mosby, Inc. All rights reserved.

Community Guide to Cholesterol Resources.

ERIC Educational Resources Information Center

National Heart and Lung Inst. (DHHS/NIH), Bethesda, MD.

This guide is divided into two sections, one for physicians and the other for patients. The physician section lists different resources including continuing medical education opportunities on the medical and scientific aspects of cholesterol and heart disease and on the physician's role in diagnosis and patient management. Additional materials on…

Air traffic control system baseline methodology guide.

DOT National Transportation Integrated Search

1999-06-01

The Air Traffic Control System Baseline Methodology Guide serves as a reference in the design and conduct of baseline studies. : Engineering research psychologists are the intended audience for the Methodology Guide, which focuses primarily on techni...

Porous coatings from wire mesh for bone implants

DOEpatents

Sump, Kenneth R.

1986-01-01

A method of coating areas of bone implant elements and the resulting implant having a porous coating are described. Preselected surface areas are covered by a preform made from continuous woven lengths of wire. The preform is compressed and heated to assure that diffusion bonding occurs between the wire surfaces and between the surface boundaries of the implant element and the wire surfaces in contact with it. Porosity is achieved by control of the resulting voids between the bonded wire portions.

Wire stripper

NASA Technical Reports Server (NTRS)

Economu, M. A. (Inventor)

1978-01-01

An insulation stripper is described which is especially useful for shielded wire, the stripper including a first pair of jaws with blades extending substantially perpendicular to the axis of the wire, and a second pair of jaws with blades extending substantially parallel to the axis of the wire. The first pair of jaws is pressed against the wire so the blades cut into the insulation, and the device is turned to form circumferential cuts in the insulation. Then the second pair of jaws is pressed against the wire so the blades cut into the insulation, and the wire is moved through the device to form longitudinal cuts that permit easy removal of the insulation. Each of the blades is located within the concave face of a V-block, to center the blades on the wire and to limit the depth of blade penetration.

30 CFR 75.701-4 - Grounding wires; capacity of wires.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Grounding wires; capacity of wires. 75.701-4... SAFETY AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Grounding § 75.701-4 Grounding wires; capacity of wires. Where grounding wires are used to ground metallic sheaths, armors, conduits, frames...

30 CFR 75.701-4 - Grounding wires; capacity of wires.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Grounding wires; capacity of wires. 75.701-4... SAFETY AND HEALTH MANDATORY SAFETY STANDARDS-UNDERGROUND COAL MINES Grounding § 75.701-4 Grounding wires; capacity of wires. Where grounding wires are used to ground metallic sheaths, armors, conduits, frames...

Comparison Between Retrograde and Antegrade Peripheral Venous Cannulation in Intensive Care Unit Patients: Assessment of Thrombus Formation.

PubMed

Abdelaal Ahmed Mahmoud, Ahmed; El-Shafei, Hassan Ismail; Yassin, Hany Mahmoud; Elramely, Mohamed Adly; Abdelhaq, Mohamed Mohamed; El Kady, Hany Wafiq; Awada, Wael Nabil Fahemy

2017-06-01

Antegrade cannulation of peripheral veins is the usual practice. Blood stasis between a catheter and the wall of the vein or at its tip in addition to catheter-induced phlebitis may initiate a thrombosis. The use of retrograde ventriculojugular shunts against the direction of the blood flow with resultant decrease in the incidence of venous thrombosis encouraged us to compare retrograde versus conventional antegrade peripheral venous cannulation. Monocentric, nonblinded, prospective observational cohort of 40 intensive care unit patients receiving 2 peripheral venous catheters in upper limbs, 1 inserted in the direction of blood flow (antegrade cannula) and the other inserted in an opposite direction to blood flow (retrograde cannula). Daily ultrasound assessment of the angle between the catheter and the vascular wall was done to detect onset and progression of thrombus formation. The study included 40 patients, aged 46.7 ± 10.132 years. The incidence of thrombus formation was 100% in both techniques. The onset time of thrombus formation between the catheter and the wall of a vein was significantly longer with the retrograde catheters than with the antegrade catheters with median time (interquartile range [range]) 6 days (5-6.75 [4-8]) with 95% confidence interval (CI), 5.58-6.42 vs 3 days (3-4 [2-5]) with 95% CI (2.76-3.24), respectively, with a P value <.001. The time needed by the recently detected thrombus to reach the catheter tip determined by ultrasound with or without catheter failure was significantly longer in the retrograde catheters than in the antegrade catheter with median time (interquartile range [range]) 9 days (8-9 [7-10]) with 95% CI, 8.76-9.24 vs 4 days (4-5 [3-6]) with 95% CI, 3.76-4.24, respectively, with a P value <.001. Retrograde cannulation did not decrease the incidence of thrombus formation, but significantly increased the onset time until thrombus formation and prolonged the time needed by the newly formed thrombus to reach the

Web-Based Physician Ratings for California Physicians on Probation

PubMed Central

2017-01-01

Background  Web-based physician ratings systems are a popular tool to help patients evaluate physicians. Websites help patients find information regarding physician licensure, office hours, and disciplinary records along with ratings and reviews. Whether higher patient ratings are associated with higher quality of care is unclear. Objective  The aim of this study was to characterize the impact of physician probation on consumer ratings by comparing website ratings between doctors on probation against matched controls. Methods  A retrospective review of data from the Medical Board of California for physicians placed on probation from December 1989 to September 2015 was performed. Violations were categorized into nine types. Nonprobation controls were matched by zip code and specialty with probation cases in a 2:1 ratio using the California Department of Consumer Affairs website. Web-based reviews were recorded from vitals.com, healthgrades.com, and ratemds.com (ratings range from 1-5). Results  A total of 410 physicians were placed on probation for 866 violations. The mean (standard deviation [SD]) number of ratings per doctor was 5.2 (7.8) for cases and 4 (6.3) for controls (P=.003). The mean rating for physicians on probation was 3.7 (1.6) compared with 4.0 (1.0) for controls when all three rating websites were pooled (P<.001). Violations for medical documentation, incompetence, prescription negligence, and fraud were found to have statistically significant lower rating scores. Conversely, scores for professionalism, drugs or alcohol, crime, sexual misconduct, and personal illness were similar between cases and controls. In a univariate analysis, probation was found to be associated with lower rating, odds ratio=1.5 (95% CI 1.0-2.2). This association was not significant in a multivariate model when we included age and gender. Conclusions  Web-based physician ratings were lower for doctors on probation indicating that patients may perceive a difference

Wire inhomogeneity detector having a core with opposing pole pieces and guide pieces adjacent the opposing pole pieces

DOEpatents

Gibson, George H.; Smits, Robert G.; Eberhard, Philippe H.

1989-01-01

A device for uncovering imperfections in electrical conducting wire, particularly superconducting wire, by detecting variations in eddy currents. Eddy currents effect the magnetic field in a gap of an inductor, contained in a modified commercial ferrite core, through which the wire being tested is passed. A small increase or decrease in the amount of conductive material, such as copper, in a fixed cross section of wire will unbalance a bridge used to measure the impedance of the inductor, tripping a detector and sounding an alarm.

Measurement and Modeling of Dispersive Pulse Propagation in Drawn Wire Waveguides

NASA Technical Reports Server (NTRS)

Madaras, Eric I.; Kohl, Thomas W.; Rogers, Wayne P.

1995-01-01

An analytical model of dispersive pulse propagation in semi-infinite cylinders due to transient axially symmetric end conditions has been experimentally investigated. Specifically, the dispersive propagation of the first axially symmetric longitudinal mode in thin wire waveguides, which have ends in butt contact with longitudinal piezoelectric ultrasonic transducers, is examined. The method allows for prediction of a propagated waveform given a measured source waveform, together with the material properties of the cylinder. Alternatively, the source waveform can be extracted from measurement of the propagated waveform. The material properties required for implementation of the pulse propagation model are determined using guided wave phase velocity measurements. Hard tempered aluminum 1100 and 304 stainless steel wires, with 127, 305, and 406 micron diam., were examined. In general, the drawn wires were found to behave as transversely isotropic media.

Measurement and modeling of dispersive pulse propagation in draw wire waveguides

NASA Technical Reports Server (NTRS)

Madaras, Eric I.; Kohl, Thomas W.; Rogers, Wayne P.

1995-01-01

An analytical model of dispersive pulse propagation in semi-infinite cylinders due to transient axially symmetric end conditions has been experimentally investigated. Specifically, the dispersive propagation of the first axially symmetric longitudinal mode in thin wire waveguides, which have ends in butt contact with longitudinal piezoelectric ultrasonic transducers, is examined. The method allows for prediction of a propagated waveform given a measured source waveform, together with the material properties of the cylinder. Alternatively, the source waveform can be extracted from measurement of the propagated waveform. The material properties required for implementation of the pulse propagation model are determined using guided wave phase velocity measurements. Hard tempered aluminum 1100 and 304 stainless steel wires, with 127, 305, and 406 micron diam., were examined. In general, the drawn wires were found to behave as transversely isotropic media.

Si Wire-Array Solar Cells

NASA Astrophysics Data System (ADS)

Boettcher, Shannon

2010-03-01

Micron-scale Si wire arrays are three-dimensional photovoltaic absorbers that enable orthogonalization of light absorption and carrier collection and hence allow for the utilization of relatively impure Si in efficient solar cell designs. The wire arrays are grown by a vapor-liquid-solid-catalyzed process on a crystalline (111) Si wafer lithographically patterned with an array of metal catalyst particles. Following growth, such arrays can be embedded in polymethyldisiloxane (PDMS) and then peeled from the template growth substrate. The result is an unusual photovoltaic material: a flexible, bendable, wafer-thickness crystalline Si absorber. In this paper I will describe: 1. the growth of high-quality Si wires with controllable doping and the evaluation of their photovoltaic energy-conversion performance using a test electrolyte that forms a rectifying conformal semiconductor-liquid contact 2. the observation of enhanced absorption in wire arrays exceeding the conventional light trapping limits for planar Si cells of equivalent material thickness and 3. single-wire and large-area solid-state Si wire-array solar cell results obtained to date with directions for future cell designs based on optical and device physics. In collaboration with Michael Kelzenberg, Morgan Putnam, Joshua Spurgeon, Daniel Turner-Evans, Emily Warren, Nathan Lewis, and Harry Atwater, California Institute of Technology.

Adaptive Fuzzy Hysteresis Band Current Controller for Four-Wire Shunt Active Filter

NASA Astrophysics Data System (ADS)

Hamoudi, F.; Chaghi, A.; Amimeur, H.; Merabet, E.

2008-06-01

This paper presents an adaptive fuzzy hysteresis band current controller for four-wire shunt active power filters to eliminate harmonics and to compensate reactive power in distribution systems in order to keep currents at the point of common coupling sinusoidal and in phase with the corresponding voltage and the cancel neutral current. The conventional hysteresis band known for its robustness and its advantage in current controlled applications is adapted with a fuzzy logic controller to change the bandwidth according to the operating point in order to keep the frequency modulation at tolerable limits. The algorithm used to identify the reference currents is based on the synchronous reference frame theory (dqγ). Finally, simulation results using Matlab/Simulink are given to validate the proposed control.

Sulfur Content Precision Control Technology for CO2-Shielded Welding Wire Steel

NASA Astrophysics Data System (ADS)

Chaofa, Zhang; Huaqiang, Hao; Youbing, Xiang; Shanxi, Liu

As a kind of impurity and displaying with FeS and MnS form in steel, Sulfur can make the disadvantage effect on the performance of hot-working, welding and corrosion resistance. The high content sulfur in steel can cause the hot brittle phenomenon for the steel. For the welding steel, when the sulfur content is higher, the drawing performance of wire rod become worst and the yield of wire rod decrease. When the sulfur is lower, the automatic wire feeding performance for the gas shielded welding become worst and the weld seam is not smooth. According to the results of welding expert research, 0.010%≤ S≤ 0.020% in CO2-shielded welding wire steel is reasonable.

Effects produced by CDU improvement of resist pattern with PEB temperature control for wiring resistance variation reduction

NASA Astrophysics Data System (ADS)

Tadokoro, Masahide; Shinozuka, Shinichi; Ogata, Kunie; Morimoto, Tamotsu

2008-03-01

Semiconductor manufacturing technology has shifted towards finer design rules, and demands for critical dimension uniformity (CDU) of resist patterns have become greater than ever. One of the methods for improving CDU of resist pattern is to control the temperature of post-exposure bake (PEB). When ArF resist is used, there is a certain relationship between critical dimension (CD) and PEB temperature. By utilizing this relationship, Resist Pattern CDU can be improved through control of within-wafer temperature distribution in the PEB process. We have already applied this method to Resist Pattern CDU improvement and have achieved these results. In this evaluation, we aim at: 1. Clarifying the relationship between the improvement in Resist Pattern CDU through PEB temperature control and the improvement in Etching Pattern CDU. 2. Verifying whether Resist Pattern CDU improvement through PEB temperature control has any effect on the reduction in wiring resistance variation. The evaluation procedure is: 1. Preparation of wafers with base film of doped Poly-Si (D-Poly). 2. Creation of two sets of samples on the base, a set of samples with good Resist Pattern CDU and a set of samples with poor Resist Pattern CDU. 3. Etching of the two sets under the same conditions. 4. Measurements of CD and wiring resistance. We used Optical CD Measurement (OCD) for measurement of resist pattern and etching pattern for the reason that OCD is minimally affected by Line Edge Roughness (LER). As a result, we found that; 1. The improvement in Resist Pattern CDU leads to the improvement in Etching Pattern CDU . 2. The improvement in Resist Pattern CDU has an effect on the reduction in wiring resistance variation. There is a cause-and-effect relationship between wiring resistance variation and transistor characteristics. From this relationship, we expect that the improvement in Resist Pattern CDU through PEB temperature control can contribute to device performance improvement.

Retention of Physician Assistants in Rural Health Clinics

ERIC Educational Resources Information Center

Henry, Lisa R.; Hooker, Roderick S.

2007-01-01

Context: Improvement of rural health care access has been a guiding principle of federal and state policy regarding physician assistants (PAs). Purpose: To determine the factors that influence autonomous rural PAs (who work less than 8 hours per week with their supervising physician) to remain in remote locations. Methods: A qualitative…

Strain-controlled skyrmion creation and propagation in ferroelectric/ferromagnetic hybrid wires

NASA Astrophysics Data System (ADS)

Li, Zhi; Zhang, Youguang; Huang, Yangqi; Wang, Chengxiang; Zhang, Xichao; Liu, Yan; Zhou, Yan; Kang, Wang; Koli, Shradha Chandrashekhar; Lei, Na

2018-06-01

The control of magnetic skyrmion creation and pinning through strain is studied by micromagnetic simulations. A single stable skyrmion can be created by a vertical strain pulse on Pd/Fe/Ir hybrid structure on Pb(Zr1-xTix)O3 nanowire with -1.8 V pulse voltage from 1.2 ns to 2.0 ns. Then the skyrmion is pinned by the vertical strain independent of the polarity during its propagation in the wire driven by the current. The proposed device integrates strain-controlled skyrmion creation and pinning in a single nanowire structure, which would open a new route for skyrmion-based memory and logic devices with ultra-low power consumption.

Physician control of needle and syringe during aspiration-injection procedures with the new reciprocating syringe.

PubMed

Sibbitt, Wilmer; Sibbitt, Randy R; Michael, Adrian A; Fu, Druce I; Draeger, Hilda T; Twining, Jon M; Bankhurst, Arthur D

2006-04-01

To evaluate physician control of needle and syringe during aspiration-injection syringe procedures by comparing the new reciprocating procedure syringe to a traditional conventional syringe. Twenty-six physicians were tested for their individual ability to control the reciprocating and conventional syringes in typical aspiration-injection procedures using a novel quantitative needle-based displacement procedure model. Subsequently, the physicians performed 48 clinical aspiration-injection (arthrocentesis) procedures on 32 subjects randomized to the reciprocating or conventional syringes. Clinical outcomes included procedure time, patient pain, and operator satisfaction. Multivariate modeling methods were used to determine the experimental variables in the syringe control model most predictive of clinical outcome measures. In the model system, the reciprocating syringe significantly improved physician control of the syringe and needle, with a 66% reduction in unintended forward penetration (p < 0.001) and a 68% reduction in unintended retraction (p < 0.001). In clinical arthrocentesis, improvements were also noted: 30% reduction in procedure time (p < 0.03), 57% reduction in patient pain (p < 0.001), and a 79% increase in physician satisfaction (p < 0.001). The variables in the experimental system--unintended forward penetration, unintended retraction, and operator satisfaction--independently predicted the outcomes of procedure time, patient pain, and physician satisfaction in the clinical study (p < or = 0.001). The reciprocating syringe reduces procedure time and patient pain and improves operator satisfaction with the procedure syringe. The reciprocating syringe improves physician performance in both the validated quantitative needle-based displacement model and in real aspiration-injection syringe procedures, including arthrocentesis.

1976 Commercial Vegetable Pest Control Guide.

ERIC Educational Resources Information Center

MacNab, A. A.; And Others

This guide contains pest control information for commercial vegetable production. It was prepared for agricultural supply dealers, extension agents, fieldmen, and growers. It gives general precautions, information on seed treatment, growing disease-free seedlings and transplants, general soil insect control, general weed control, and spraying…

Effect of nutritional status and sampling intensity on recovery after dorsal aorta cannulation in free-swimming Atlantic salmon (Salmo salar L.).

PubMed

Djordjevic, B; Kristensen, T; Øverli, Ø; Rosseland, B O; Kiessling, A

2012-02-01

Recovery from implantation of a cannula in the dorsal aorta (DA) of Atlantic salmon (Salmo salar) was studied in relation to nutritional status and sampling intensity. The incentive for the study was the inconsistency between published reports and our own experience of recovery and longevity of fish exposed to this protocol. In two studies using starved fish, blood (0.3 ml) was sampled 0, 1 and 24 h after DA-cannulation, and thereafter at 48 and 72 h and thereafter once weekly for four weeks. In a third study using fed fish, four consecutive samples (0, 3, 6 and 12 h after a meal) were obtained twice a week over a four-week period. All fish displayed a sharp increase in pCO(2) and haematocrit (Hct) during surgery, followed by a marked raise in cortisol, glucose, sodium and potassium (1 h). pCO(2), pH and Hct approached baseline levels as early as the 1 h post-surgery sample, while this was not the case for cortisol and electrolytes before the 24 h post-surgery sample. Glucose did not display any significant changes post surgery. From then on, all variables displayed minor but non-significant (P > 0.05) changes indicating a steady state close to baseline values for unstressed fish. This pattern was independent of sampling procedure, i.e. repeated single or multiple samples and thus volume of blood removed. Nutritional status (fed vs. starved) did not affect post-surgical recovery pattern. Only K(+) and Hct displayed consistent and significant post-prandial patterns. We found marked differences between baseline level of cannulated fish and uncannulated control fish, in pH, K(+) and Hct indicating that cannulation may be the preferred method to obtain representative resting values in fish.

Method of fabricating a homogeneous wire of inter-metallic alloy

DOEpatents

Ohriner, Evan Keith; Blue, Craig Alan

2001-01-01

A method for fabricating a homogeneous wire of inter-metallic alloy comprising the steps of providing a base-metal wire bundle comprising a metal, an alloy or a combination thereof; working the wire bundle through at least one die to obtain a desired dimension and to form a precursor wire; and, controllably heating the precursor wire such that a portion of the wire will become liquid while simultaneously maintaining its desired shape, whereby substantial homogenization of the wire occurs in the liquid state and additional homogenization occurs in the solid state resulting in a homogenous alloy product.

Physician communication in the operating room.

PubMed

Kirschbaum, Kristin A; Rask, John P; Fortner, Sally A; Kulesher, Robert; Nelson, Michael T; Yen, Tony; Brennan, Matthew

2015-01-01

In this study, communication research was conducted with multidisciplinary groups of operating-room physicians. Theoretical frameworks from intercultural communication and rhetoric were used to (a) measure latent cultural communication variables and (b) conduct communication training with the physicians. A six-step protocol guided the research with teams of physicians from different surgical specialties: anesthesiologists, general surgeons, and obstetrician-gynecologists (n = 85). Latent cultural communication variables were measured by surveys administered to physicians before and after completion of the protocol. The centerpiece of the 2-hour research protocol was an instructional session that informed the surgical physicians about rhetorical choices that support participatory communication. Post-training results demonstrated scores increased on communication variables that contribute to collaborative communication and teamwork among the physicians. This study expands health communication research through application of combined intercultural and rhetorical frameworks, and establishes new ways communication theory can contribute to medical education.

STRS SpaceWire FPGA Module

NASA Technical Reports Server (NTRS)

Lux, James P.; Taylor, Gregory H.; Lang, Minh; Stern, Ryan A.

2011-01-01

An FPGA module leverages the previous work from Goddard Space Flight Center (GSFC) relating to NASA s Space Telecommunications Radio System (STRS) project. The STRS SpaceWire FPGA Module is written in the Verilog Register Transfer Level (RTL) language, and it encapsulates an unmodified GSFC core (which is written in VHDL). The module has the necessary inputs/outputs (I/Os) and parameters to integrate seamlessly with the SPARC I/O FPGA Interface module (also developed for the STRS operating environment, OE). Software running on the SPARC processor can access the configuration and status registers within the SpaceWire module. This allows software to control and monitor the SpaceWire functions, but it is also used to give software direct access to what is transmitted and received through the link. SpaceWire data characters can be sent/received through the software interface, as well as through the dedicated interface on the GSFC core. Similarly, SpaceWire time codes can be sent/received through the software interface or through a dedicated interface on the core. This innovation is designed for plug-and-play integration in the STRS OE. The SpaceWire module simplifies the interfaces to the GSFC core, and synchronizes all I/O to a single clock. An interrupt output (with optional masking) identifies time-sensitive events within the module. Test modes were added to allow internal loopback of the SpaceWire link and internal loopback of the client-side data interface.

Magnetorheological fluid based automotive steer-by-wire systems

NASA Astrophysics Data System (ADS)

Ahmadkhanlou, Farzad; Washington, Gregory N.; Bechtel, Stephen E.; Wang, Yingru

2006-03-01

The idea of this paper is to design a Magnetorheological (MR) fluid based damper for steer-by-wire systems to provide sensory feedback to the driver. The advantages of using MR fluids in haptic devices stem from the increase in transparency gained from the lightweight semiactive system and controller implementation. The performance of MR fluid based steer-by wire system depends on MR fluid model and specifications, MR damper geometry, and the control algorithm. All of these factors are addressed in this study. The experimental results show the improvements in steer-by-wire by adding force feedback to the system.

Angular Relationship Between the Foramen Ovale and the Trigeminal Impression: Percutaneous Cannulation Trajectories for Trigeminal Neuralgia.

PubMed

Zdilla, Matthew J; Hatfield, Scott A; Mangus, Kelsey R

2016-11-01

The debilitating pain of trigeminal neuralgia often necessitates neurosurgical intervention via percutaneous transovale cannulation. While most percutaneous treatments of trigeminal neuralgia are successful, severe adverse events resulting from failure to properly cannulate the foramen ovale (FO) have been reported. With regard to specific targeting of particular trigeminal divisions (ie, V1, V2, V3, and combinations thereof), operative techniques have been described; however, these descriptions have not included specific angulation data. This anatomic study analyzed the angular relationship between the centroid and anteromedial- and posterolateral-most aspects of the FO and the boundaries of the trigeminal impression. The study is the first to detail the angular relationship between the FO boundaries and the boundaries of the trigeminal impression in dry human skulls relative to the coronal plane. The information may be used to prevent miscannulation and also target specific branches of the trigeminal nerve for optimal operative results.

Modeling and Control of a Trailing Wire Antenna Towed by an Orbiting Aircraft

DTIC Science & Technology

1992-09-01

do not induce significant oscillations in the wire. The development of the dynamic model also assumed that wire bending , torsion and stretching...it was reasonable to assume that the wire bending forces did not contribute significantly to the oscillations. 8= (4.54)8EI pg=0.005176 ibf in E

Space Shuttle Columbia Aging Wiring Failure Analysis

NASA Technical Reports Server (NTRS)

McDaniels, Steven J.

2005-01-01

A Space Shuttle Columbia main engine controller 14 AWG wire short circuited during the launch of STS-93. Post-flight examination divulged that the wire had electrically arced against the head of a nearby bolt. More extensive inspection revealed additional damage to the subject wire, and to other wires as well from the mid-body of Columbia. The shorted wire was to have been constructed from nickel-plated copper conductors surrounded by the polyimide insulation Kapton, top-coated with an aromatic polyimide resin. The wires were analyzed via scanning electron microscope (SEM), energy dispersive X-Ray spectroscopy (EDX), and electron spectroscopy for chemical analysis (ESCA); differential scanning calorimetry (DSC) and thermal gravimetric analysis (TGA) were performed on the polyimide. Exemplar testing under laboratory conditions was performed to replicate the mechanical damage characteristics evident on the failed wires. The exemplar testing included a step test, where, as the name implies, a person stepped on a simulated wire bundle that rested upon a bolt head. Likewise, a shear test that forced a bolt head and a torque tip against a wire was performed to attempt to damage the insulation and conductor. Additionally, a vibration test was performed to determine if a wire bundle would abrade when vibrated against the head of a bolt. Also, an abrasion test was undertaken to determine if the polyimide of the wire could be damaged by rubbing against convolex helical tubing. Finally, an impact test was performed to ascertain if the use of the tubing would protect the wire from the strike of a foreign object.

Dengue and Chikungunya Vector Control Pocket Guide

USDA-ARS?s Scientific Manuscript database

This technical guide consolidates information and procedures for surveillance and control of mosquitoes that transmit dengue and chikungunya viruses. The guide focuses on mosquitoes that transmit dengue but also makes reference to chikungunya and yellow fever because the pathogens that cause these ...

Trade Electricity. Motors & Controls--Level 3. Standardized Curriculum.

ERIC Educational Resources Information Center

New York City Board of Education, Brooklyn, NY. Office of Occupational and Career Education.

This curriculum guide consists of seven modules on motors and controls, one of the three divisions of the standardized trade electricity curriculum in high schools in New York City. The seven modules cover the following subjects: energy conservation wiring, direct current (DC) motor repair and rewinding, DC motor controls, alternating current (AC)…

Autoclaving and clinical recycling: effects on mechanical properties of orthodontic wires.

PubMed

Oshagh, M; Hematiyan, M R; Mohandes, Y; Oshagh, M R; Pishbin, L

2012-01-01

About half of the orthodontists recycle and reuse orthodontic wires because of their costs. So when talking about reuse and sterilization of wires, their effects on mechanical properties of wires should be clarified. The purpose of this study was to assess the effects of sterilization and clinical use on mechanical properties of stainless steel wires. Thirty stainless steel orthodontic wires were divided into three equal groups of control, autoclave (sterilized by autoclave), and recycle group (wires were used for orthodontic patients up to 4 weeks, cleaned by isopropyl alcohol and sterilized by autoclave). The mechanical properties (tensile test, three-point loading test for load-deflection curve) were determined. Fracture force, yield strength, stiffness and modulus of elasticity in recycle groups were significantly lower than the other groups (P < 0.05). Although recycle wires were softer than those of control group, relatively small differences and also various properties of available wires have obscured the clinical predictability of their application. There is seemingly no problem in terms of mechanical properties to recycle orthodontic wires.

Synchronized epiaortic two-dimensional and color Doppler echocardiographic guidance enables routine ascending aortic cannulation in type A acute aortic dissection.

PubMed

Inoue, Yoshito; Takahashi, Ryuichi; Ueda, Toshihiko; Yozu, Ryohei

2011-02-01

Preference for arterial inflow during surgery for type A acute aortic dissection remains controversial. Antegrade central perfusion prevents malperfusion and retrograde embolism, and the ascending aorta provides arterial access for rapid establishment of systemic perfusion, especially if there is hemodynamic instability. It has not been used routinely, however, because of the disruption caused to the aorta. We evaluated the safety and efficacy of routine cannulation of the dissected aorta for the repair of type A dissection. Surgical results were analyzed for 83 consecutive patients with type A acute aortic dissection between 2002 and 2009. They were treated surgically by prosthetic graft replacement under hypothermic circulatory arrest. The ascending aorta was routinely cannulated using the Seldinger technique with epiaortic echocardiographic guidance; antegrade systemic perfusion was evaluated by color Doppler ultrasound. Systemic antegrade perfusion via the dissected ascending aorta was performed safely in all cases. There was no malperfusion or thromboembolism as a result of ascending aortic cannulation. Epiaortic 2-dimensional and color Doppler imaging provided real-time monitoring adequate for the placement and for proper systemic perfusion. There were 5 in-hospital deaths (5/83=6.0%) and 8 strokes (preoperative 6/83=7.2%, postoperative 2/83=2.4%). A total of 78 patients (78/83=94%) were discharged and have been followed up without major adverse cardiac events for a mean duration of 31.8 months. Ascending aortic cannulation is a simple and safe technique that provides a rapid and reliable route of antegrade central systemic perfusion in type A aortic dissection. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Sliding Mode Tracking Control of a Wire-Driven Upper-Limb Rehabilitation Robot with Nonlinear Disturbance Observer.

PubMed

Niu, Jie; Yang, Qianqian; Wang, Xiaoyun; Song, Rong

2017-01-01

Robot-aided rehabilitation has become an important technology to restore and reinforce motor functions of patients with extremity impairment, whereas it can be extremely challenging to achieve satisfactory tracking performance due to uncertainties and disturbances during rehabilitation training. In this paper, a wire-driven rehabilitation robot that can work over a three-dimensional space is designed for upper-limb rehabilitation, and sliding mode control with nonlinear disturbance observer is designed for the robot to deal with the problem of unpredictable disturbances during robot-assisted training. Then, simulation and experiments of trajectory tracking are carried out to evaluate the performance of the system, the position errors, and the output forces of the designed control scheme are compared with those of the traditional sliding mode control (SMC) scheme. The results show that the designed control scheme can effectively reduce the tracking errors and chattering of the output forces as compared with the traditional SMC scheme, which indicates that the nonlinear disturbance observer can reduce the effect of unpredictable disturbances. The designed control scheme for the wire-driven rehabilitation robot has potential to assist patients with stroke in performing repetitive rehabilitation training.

The Physician's Workstation: Recording a Physical Examination Using a Controlled Vocabulary

PubMed Central

Cimino, James J.; Barnett, G. Octo

1987-01-01

A system has been developed which runs on MS-DOS personal computers and serves as an experimental model of a physician's workstation. The program provides an interface to a controlled vocabulary which allows rapid selection of appropriate terms and modifiers for entry of clinical information. Because it captures patient descriptions, it has the ability to serve as an intermediary between the physician and computer-based medical knowledge resources. At present, the vocabulary permits rapid, reliable representation of cardiac physical examination findings.

Web-Based Physician Ratings for California Physicians on Probation.

PubMed

Murphy, Gregory P; Awad, Mohannad A; Osterberg, E Charles; Gaither, Thomas W; Chumnarnsongkhroh, Thanabhudee; Washington, Samuel L; Breyer, Benjamin N

2017-08-22

 Web-based physician ratings systems are a popular tool to help patients evaluate physicians. Websites help patients find information regarding physician licensure, office hours, and disciplinary records along with ratings and reviews. Whether higher patient ratings are associated with higher quality of care is unclear.  The aim of this study was to characterize the impact of physician probation on consumer ratings by comparing website ratings between doctors on probation against matched controls.  A retrospective review of data from the Medical Board of California for physicians placed on probation from December 1989 to September 2015 was performed. Violations were categorized into nine types. Nonprobation controls were matched by zip code and specialty with probation cases in a 2:1 ratio using the California Department of Consumer Affairs website. Web-based reviews were recorded from vitals.com, healthgrades.com, and ratemds.com (ratings range from 1-5).  A total of 410 physicians were placed on probation for 866 violations. The mean (standard deviation [SD]) number of ratings per doctor was 5.2 (7.8) for cases and 4 (6.3) for controls (P=.003). The mean rating for physicians on probation was 3.7 (1.6) compared with 4.0 (1.0) for controls when all three rating websites were pooled (P<.001). Violations for medical documentation, incompetence, prescription negligence, and fraud were found to have statistically significant lower rating scores. Conversely, scores for professionalism, drugs or alcohol, crime, sexual misconduct, and personal illness were similar between cases and controls. In a univariate analysis, probation was found to be associated with lower rating, odds ratio=1.5 (95% CI 1.0-2.2). This association was not significant in a multivariate model when we included age and gender.  Web-based physician ratings were lower for doctors on probation indicating that patients may perceive a difference. Despite these statistical findings, the absolute

Successful percutaneous coronary intervention with GuideLiner® catheter for subtotal occlusive lesion in the right coronary artery with anomalous origin from the left sinus of Valsalva: a case report.

PubMed

Shirota, Ayumi; Nomura, Tetsuya; Kubota, Hiroshi; Taminishi, Shunta; Urata, Ryota; Sugimoto, Takeshi; Higuchi, Yusuke; Kato, Taku; Keira, Natsuya; Tatsumi, Tetsuya

2015-07-28

Because of the unusual anatomy of an anomalous origin of the right coronary artery from the left sinus of Valsalva, selective cannulation of the guiding catheter in percutaneous coronary intervention for these cases is always challenging. A 58-year-old Japanese man was admitted to our hospital complaining of worsening exertional chest pain. He was suspected of having unstable angina pectoris and underwent cardiac catheterization. We found a subtotal occlusive lesion in the mid-portion of his right coronary artery that originated from the left sinus of Valsalva. On the previous percutaneous coronary intervention, we failed to cannulate the guiding catheter to the anomalous orifice of the right coronary artery. Therefore, we decided to use the GuideLiner catheter for stable back-up support from the beginning. A 6Fr GuideLiner catheter was introduced into the right coronary artery by anchoring it coaxially with a semi-compliant balloon catheter. And we successfully deployed two drug-eluting stents by crossing over the posterior-descending artery. Final angiography demonstrated favorable dilatation of the target lesion, and native blood flow in the right coronary artery was completely recovered. GuideLiner is a monorail-type "child" support catheter that facilitates coaxial guiding catheter engagement and an appropriate back-up force, achieving successful device delivery to target lesions in this kind of complex percutaneous coronary intervention.

Method for fabricating thin californium-containing radioactive source wires

DOEpatents

Gross, Ian G; Pierce, Larry A

2006-08-22

A method for reducing the cross-sectional diameter of a radioactive californium-containing cermet wire while simultaneously improving the wire diameter to a more nearly circular cross section. A collet fixture is used to reduce the wire diameter by controlled pressurization pulses while simultaneously improving the wire cross-sectional diameter. The method is especially suitable for use in hot cells for the production of optimized cermet brachytherapy sources that contain large amounts of radioactive californium-252.

Controlling exposure to chemicals: a simple guide.

PubMed

Hay, Alastair

2006-09-01

Controlling exposure to chemicals in the workplace has been made easier by the use of a guide published by the U.K. Health and Safety Executive (HSE). Known as COSHH (Control of Substances Hazardous to Health Regulations) Essentials, the guide is a simple five-step procedure to devise appropriate control strategies to reduce exposures to various substances under different conditions. U.K. health and safety law requires risk assessments prior to use of hazardous substances and installation of appropriate control strategies before work commences. A 1996 survey of 1500 safety managers and trade union safety representatives revealed that the majority had little understanding of occupational safety limits for chemicals. Small- and medium-sized companies had little understanding of limits, and most could not develop control strategies. A new approach was required. COSHH Essentials is it. Developed over 3 years by a working group of hygienists and toxicologists representing HSE, industry, trade unions, and independent experts, the guide is now available in both paper-based and internet versions. It applies a hazard banding approach validated by data for 111 substances that have well-founded U.K. occupational exposure limits. New users select an appropriate hazard band for chemicals based on risk phrases. Details about dustiness for powders or volatility for liquids are inserted, and the guide allocates substances to one of four exposure bands linked, in turn, to specific control strategies. Now accessible through the HSE web site, COSHH Essentials will offer control strategies for both single chemicals and whole processes. To date over 300,000 risk assessments have been carried out using the internet version of COSHH Essentials.

Health-related quality-of-life assessments and patient-physician communication: a randomized controlled trial.

PubMed

Detmar, Symone B; Muller, Martin J; Schornagel, Jan H; Wever, Lidwina D V; Aaronson, Neil K

2002-12-18

There has been increasing interest in the use of health-related quality-of-life (HRQL) assessments in daily clinical practice, yet few empirical studies have been conducted to evaluate the usefulness of such assessments. To evaluate the efficacy of standardized HRQL assessments in facilitating patient-physician communication and increasing physicians' awareness of their patients' HRQL-related problems. Prospective, randomized crossover trial. Outpatient clinic of a cancer hospital in the Netherlands. Ten physicians and 214 patients (76% women; mean age, 57 years) undergoing palliative chemotherapy who were invited to participate between June 1996 and June 1998. At 3 successive outpatient visits, patients completed an HRQL questionnaire (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30). The responses were computer scored and transformed into a graphic summary. Physicians and patients received a copy of the summary before the consultation. Audiotapes of the consultations were content analyzed to evaluate patient-physician communication. Physicians' awareness of their patients' health problems was assessed by comparing physicians' and patients' ratings on the Dartmouth Primary Care Cooperative Information Functional Health Assessment (COOP) and the World Organisation Project of National Colleges and Academics (WONCA) charts. The HRQL-related issues were discussed significantly more frequently in the intervention than in the control group (mean [SD] communication composite scores: 4.5 [2.3] vs 3.7 [1.9], respectively (P =.01). Physicians in the intervention group identified a greater percentage of patients with moderate-to-severe health problems in several HRQL domains than did those in the control group. All physicians and 87% of the patients believed that the intervention facilitated communication and expressed interest in its continued use. Incorporating standardized HRQL assessments in daily clinical oncology

Seizure Recognition and Observation: A Guide for Allied Health Professionals.

ERIC Educational Resources Information Center

Epilepsy Foundation of America, Landover, MD.

Intended for allied health professionals, this guide provides information on seizure recognition and classification to help them assist the patient, the family, and the treating physician in obtaining control of epileptic seizures. A section on seizure recognition describes epilepsy and seizures, covering seizure classification and the causes of…

Wire-chamber radiation detector with discharge control

DOEpatents

Perez-Mendez, V.; Mulera, T.A.

1982-03-29

A wire chamber; radiation detector has spaced apart parallel electrodes and grids defining an ignition region in which charged particles or other ionizing radiations initiate brief localized avalanche discharges and defining an adjacent memory region in which sustained glow discharges are initiated by the primary discharges. Conductors of the grids at each side of the memory section extend in orthogonal directions enabling readout of the X-Y coordinates of locations at which charged particles were detected by sequentially transmitting pulses to the conductors of one grid while detecting transmissions of the pulses to the orthogonal conductors of the other grid through glow discharges. One of the grids bounding the memory region is defined by an array of conductive elements each of which is connected to the associated readout conductor through a separate resistance. The wire chamber avoids ambiguities and imprecisions in the readout of coordinates when large numbers of simultaneous or; near simultaneous charged particles have been detected. Down time between detection periods and the generation of radio frequency noise are also reduced.

Umbilical cord blood: a guide for primary care physicians.

PubMed

Martin, Paul L; Kurtzberg, Joanne; Hesse, Brett

2011-09-15

Umbilical cord blood stem cell transplants are used to treat a variety of oncologic, genetic, hematologic, and immunodeficiency disorders. Physicians have an important role in educating, counseling, and offering umbilical cord blood donation and storage options to patients. Parents may donate their infant's cord blood to a public bank, pay to store it in a private bank, or have it discarded. The federal government and many state governments have passed laws and issued regulations regarding umbilical cord blood, and some states require physicians to discuss cord blood options with pregnant women. Five prominent medical organizations have published recommendations about cord blood donation and storage. Current guidelines recommend donation of umbilical cord blood to public banks when possible, or storage through the Related Donor Cord Blood Program when a sibling has a disease that may require a stem cell transplant. Experts do not currently recommend private banking for unidentified possible future use. Step-by-step guidance and electronic resources are available to physicians whose patients are considering saving or donating their infant's umbilical cord blood.

A Comparison of Zero Mean Strain Rotating Beam Fatigue Test Methods for Nitinol Wire

NASA Astrophysics Data System (ADS)

Norwich, Dennis W.

2014-07-01

Zero mean strain rotating beam fatigue testing has become the standard for comparing the fatigue properties of Nitinol wire. Most commercially available equipment consists of either a two-chuck or a chuck and bushing system, where the wire length and center-to-center axis distance determine the maximum strain on the wire. For the two-chuck system, the samples are constrained at either end of the wire, and both chucks are driven at the same speed. For the chuck and bushing system, the sample is constrained at one end in a chuck and rides freely in a bushing at the other end. These equivalent systems will both be herein referred to as Chuck-to-Chuck systems. An alternate system uses a machined test block with a specific radius to guide the wire at a known strain during testing. In either system, the test parts can be immersed in a temperature-controlled fluid bath to eliminate any heating effect created in the specimen due to dissipative processes during cyclic loading (cyclic stress induced the formation of martensite) Wagner et al. ( Mater. Sci. Eng. A, 378, p 105-109, 1). This study will compare the results of the same starting material tested with each system to determine if the test system differences affect the final results. The advantages and disadvantages of each system will be highlighted and compared. The factors compared will include ease of setup, operator skill level required, consistency of strain measurement, equipment test limits, and data recovery and analysis. Also, the effect of test speed on the test results for each system will be investigated.

Dynamic hip system blade versus cannulated compression screw for the treatment of femoral neck fractures: A retrospective study.

PubMed

Chen, Chao; Yu, Li; Tang, Xin; Liu, Mo-Zhen; Sun, Li-Zhong; Liu, Changjian; Zhang, Zhen; Li, Chang-Zhou

2017-10-01

The aim of this study was to compare clinical outcomes of patients with femoral neck fractures treated with the dynamic hip system blade (DHS-BLADE) or cannulated compression screws. Eighty-six patients with femoral neck fractures were treated by closed reduction internal fixation with a DHS-BLADE (n = 42; 18 males and 24 females; mean age: 56.3 years (37-87)) or cannulated compression screws (n = 44; 20 males and 24 females; mean age: 53.8 years (26-83)) between March 2011 and August 2013. The groups were compared with Harris hip score, operation time, surgical blood loss, incision size, hospital stay, and related complications. The average follow-up time was 27 months (range, 24-36 months). There was no significant difference for the operation time, incision size, hospital stay, and Harris hip score between the groups. Also, no statistically significant differences in the rates of nonunion (4.5% vs. 0) and avascular necrosis of the femoral head (9.1% vs. 7.1%) were observed. However, the screw group experienced significantly less surgical blood loss (32.4 ± 24.7 ml) than the blade group (87.2 ± 46.6 ml; P = 0.041). The incidence of femoral neck shortening above 10 mm in the screw group was significantly higher than that in the blade group (15.9% vs. 2.4%, P = 0.031). The blade group had a significantly lower incidence of screw migration than the screw group (4.8% vs. 22.7%, P = 0.016). The DHS-BLADE and cannulated compression screws might be equally effective in terms of postoperative fracture union. However, the DHS-BLADE has advantages over cannulated compression screws for preventing femoral neck shortening, screw migration, and cut-out. Level III, Therapeutic study. Copyright © 2017 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

Hot-Film and Hot-Wire Anemometry for a Boundary Layer Active Flow Control Test

NASA Technical Reports Server (NTRS)

Lenahan, Keven C.; Schatzman, David M.; Wilson, Jacob Samuel

2013-01-01

Unsteady active flow control (AFC) has been used experimentally for many years to minimize bluff-body drag. This technology could significantly improve performance of rotorcraft by cleaning up flow separation. It is important, then, that new actuator technologies be studied for application to future vehicles. A boundary layer wind tunnel was constructed with a 1ft-x-3ft test section and unsteady measurement instrumentation to study how AFC manipulates the boundary layer to overcome adverse pressure gradients and flow separation. This unsteady flow control research requires unsteady measurement methods. In order to measure the boundary layer characteristics, both hot-wire and hot-film Constant Temperature Anemometry is used. A hot-wire probe is mounted in the flow to measure velocity while a hot-film array lays on the test surface to measure skin friction. Hot-film sensors are connected to an anemometer, a Wheatstone bridge circuit with an output that corresponds to the dynamic flow response. From this output, the time varying flow field, turbulence, and flow reversal can be characterized. Tuning the anemometers requires a fan test on the hot-film sensors to adjust each output. This is a delicate process as several variables drastically affect the data, including control resistance, signal input, trim, and gain settings.

Guided magnonic Michelson interferometer

PubMed Central

Ahmed, Muhammad H.; Jeske, Jan; Greentree, Andrew D.

2017-01-01

Magnonics is an emerging field with potential applications in classical and quantum information processing. Freely propagating magnons in two-dimensional media are subject to dispersion, which limits their effective range and utility as information carriers. We show the design of a confining magnonic waveguide created by two surface current carrying wires placed above a spin-sheet, which can be used as a primitive for reconfigurable magnonic circuitry. We theoretically demonstrate the ability of such guides to counter the transverse dispersion of the magnon in a spin-sheet, thus extending the range of the magnon. A design of a magnonic directional coupler and controllable Michelson interferometer is shown, demonstrating its utility for information processing tasks. PMID:28134271

Visually Guided Control of Movement

NASA Technical Reports Server (NTRS)

Johnson, Walter W. (Editor); Kaiser, Mary K. (Editor)

1991-01-01

The papers given at an intensive, three-week workshop on visually guided control of movement are presented. The participants were researchers from academia, industry, and government, with backgrounds in visual perception, control theory, and rotorcraft operations. The papers included invited lectures and preliminary reports of research initiated during the workshop. Three major topics are addressed: extraction of environmental structure from motion; perception and control of self motion; and spatial orientation. Each topic is considered from both theoretical and applied perspectives. Implications for control and display are suggested.

Distal Superficial Femoral Vein Cannulation for Peripherally Inserted Central Catheter Placement in Infants with Cardiac Disease.

PubMed

Richter, Robert P; Law, Mark A; Borasino, Santiago; Surd, Jessica A; Alten, Jeffrey A

2016-12-01

To describe a novel real-time ultrasound (US)-guided distal superficial femoral vein (DSFV) cannulation technique for insertion of peripherally inserted central catheters (PICC) in critically ill infants with congenital heart disease. Descriptive retrospective cohort study SETTING: Pediatric cardiac intensive care unit in a pediatric tertiary hospital PATIENTS: First 28 critically ill infants that received DSFV PICCs via this new technique. Thirty-seven US-guided DSFV PICCs were attempted on 31 infants from September 2012 to November 2014; 34 PICCs were placed in 28 patients (success rate 92%). Twenty-six of 28 patients underwent cardiac surgery. Median (IQR) age at time of PICC placement 39 days (13, 151); weight 3.4 kg (3.2, 5.3). 25/34 PICCs were placed in patients with STAT 4 or 5 category. Median PICC duration 16 days (11, 29); maximum duration 123 days. Ten infants (36%) had DSFV PICCs placed as the primary central venous access in perioperative period. Ten of 28 patients underwent cardiac catheterization while DSFV PICC was in place, four of which were performed through ipsilateral common femoral vein. Two patients had femoral arterial lines placed in the ipsilateral femoral artery while DSFV PICC was in place. There were no reported inadvertent arterial punctures. The PICC-associated infection rate was 4.6 per 1000 line days. Four of 34 DSFV PICCs (11.8%) were associated with deep venous thrombosis. DSFV is a novel venous access site for PICC placement with high success rate and sufficient longevity and flexibility for critically ill infants with cardiac disease. More experience and larger studies are needed to confirm its potential advantages. © 2016 Wiley Periodicals, Inc.

Plasmonic mode converter for controlling optical impedance and nanoscale light-matter interaction.

PubMed

Hung, Yun-Ting; Huang, Chen-Bin; Huang, Jer-Shing

2012-08-27

To enable multiple functions of plasmonic nanocircuits, it is of key importance to control the propagation properties and the modal distribution of the guided optical modes such that their impedance matches to that of nearby quantum systems and desired light-matter interaction can be achieved. Here, we present efficient mode converters for manipulating guided modes on a plasmonic two-wire transmission line. The mode conversion is achieved through varying the path length, wire cross section and the surrounding index of refraction. Instead of pure optical interference, strong near-field coupling of surface plasmons results in great momentum splitting and modal profile variation. We theoretically demonstrate control over nanoantenna radiation and discuss the possibility to enhance nanoscale light-matter interaction. The proposed converter may find applications in surface plasmon amplification, index sensing and enhanced nanoscale spectroscopy.

Wire-bonder-assisted integration of non-bondable SMA wires into MEMS substrates

NASA Astrophysics Data System (ADS)

Fischer, A. C.; Gradin, H.; Schröder, S.; Braun, S.; Stemme, G.; van der Wijngaart, W.; Niklaus, F.

2012-05-01

This paper reports on a novel technique for the integration of NiTi shape memory alloy wires and other non-bondable wire materials into silicon-based microelectromechanical system structures using a standard wire-bonding tool. The efficient placement and alignment functions of the wire-bonding tool are used to mechanically attach the wire to deep-etched silicon anchoring and clamping structures. This approach enables a reliable and accurate integration of wire materials that cannot be wire bonded by traditional means.

Fixation of a split fracture of the lateral tibial plateau with a locking screw plate instead of cannulated screws would allow early weight bearing: a computational exploration.

PubMed

Carrera, Ion; Gelber, Pablo Eduardo; Chary, Gaetan; González-Ballester, Miguel A; Monllau, Juan Carlos; Noailly, Jerome

2016-10-01

To assess, with finite element (FE) calculations, whether immediate weight bearing would be possible after surgical stabilization either with cannulated screws or with a locking plate in a split fracture of the lateral tibial plateau (LTP). A split fracture of the LTP was recreated in a FE model of a human tibia. A three-dimensional FE model geometry of a human femur-tibia system was obtained from the VAKHUM project database, and was built from CT images from a subject with normal bone morphologies and normal alignment. The mesh of the tibia was reconverted into a geometry of NURBS surfaces. A split fracture of the lateral tibial plateau was reproduced by using geometrical data from patient radiographs. A locking screw plate (LP) and a cannulated screw (CS) systems were modelled to virtually reduce the fracture and 80 kg static body-weight was simulated. While the simulated body-weight led to clinically acceptable interfragmentary motion, possible traumatic bone shear stresses were predicted nearby the cannulated screws. With a maximum estimation of about 1.7 MPa maximum bone shear stresses, the Polyax system might ensure more reasonable safety margins. Split fractures of the LTP fixed either with locking screw plate or cannulated screws showed no clinically relevant IFM in a FE model. The locking screw plate showed higher mechanical stability than cannulated screw fixation. The locking screw plate might also allow full or at least partial weight bearing under static posture at time zero.

Moses Maimonides: medieval physician and scholar.

PubMed

Simon, S R

1999-09-13

Moses Maimonides (1135-1204), physician and philosopher, was the greatest Jewish thinker of the Middle Ages. Faced with a life of persecution, exile, and tragedy, Maimonides overcame obstacles to become the leading physician in his era, a clinician whose skills were sought across continents. Despite long days caring for patients, Maimonides wrote extensively about both medicine and philosophy. His medical works span all topics of clinical medicine and reflect rational thinking and an understanding of the relationship between mind and body. Well known for his philosophical writings, such as The Guide for the Perplexed, Maimonides codified Jewish law and revolutionized Jewish thinking. This review of his life and achievements provides insight into the world of a remarkable 12th-century physician and may offer valuable lessons for physicians today.

Concerns about losing control when breaking bad news to terminally ill patients with cancer: physicians' perspective.

PubMed

Friedrichsen, Maria; Milberg, Anna

2006-06-01

To study and explore problems perceived by physicians when breaking bad news to advanced cancer patients about discontinuing or not offering tumor-specific treatment due to incurable cancer. A qualitative phenomenographic interview study. The county of Ostergötland in Sweden. Thirty physicians with different demographic characteristics. According to the physicians' answers breaking bad news was perceived as involving a risk of losing control in different ways, regarding emotions, oneself, confidence, professionalism and patient trust. Four different main categories described as problems were identified; perceptions focusing on existential thoughts, relationships, knowledge, and perceptions related to time and environmental disturbances. Physicians perceived that breaking bad news to dying patients with cancer involved a risk of losing control. Existential thoughts and a lack of knowledge contribute to this risk. Theoretical education in existentiality/spirituality and clinical practice in a palliative context may help maintaining control.

49 CFR 234.241 - Protection of insulated wire; splice in underground wire.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 4 2011-10-01 2011-10-01 false Protection of insulated wire; splice in underground wire. 234.241 Section 234.241 Transportation Other Regulations Relating to Transportation... of insulated wire; splice in underground wire. Insulated wire shall be protected from mechanical...

49 CFR 234.241 - Protection of insulated wire; splice in underground wire.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 4 2010-10-01 2010-10-01 false Protection of insulated wire; splice in underground wire. 234.241 Section 234.241 Transportation Other Regulations Relating to Transportation... of insulated wire; splice in underground wire. Insulated wire shall be protected from mechanical...

Hot-wire anemometry in hypersonic helium flow

NASA Technical Reports Server (NTRS)

Wagner, R. D.; Weinstein, L. M.

1974-01-01

Hot-wire anemometry techniques are described that have been developed and used for hypersonic-helium-flow studies. The short run time available dictated certain innovations in applying conventional hot-wire techniques. Some examples are given to show the application of the techniques used. Modifications to conventional equipment are described, including probe modifications and probe heating controls.

Metering Wheel-Wire Track Wire Boom Deployment Mechanism

NASA Technical Reports Server (NTRS)

Granoff, Mark S.

2014-01-01

The NASA MMS Spin Plane Double Probe (SDP) Deployer utilizes a helical path, rotating Metering Wheel and a spring loaded Wire "Holding" Track to pay out a "fixed end" 57 meter x 1.5 mm diameter Wire Boom stored between concentric storage cylinders. Unlike rotating spool type storage devices, the storage cylinders remain stationary, and the boom wire is uncoiled along the length of the cylinder via the rotation of the Metering Wheel. This uncoiling action avoids the need for slip-ring contacts since the ends of the wire can remain stationary. Conventional fixed electrical connectors (Micro-D type) are used to terminate to operational electronics.

Terminal Sliding Mode Tracking Controller Design for Automatic Guided Vehicle

NASA Astrophysics Data System (ADS)

Chen, Hongbin

2018-03-01

Based on sliding mode variable structure control theory, the path tracking problem of automatic guided vehicle is studied, proposed a controller design method based on the terminal sliding mode. First of all, through analyzing the characteristics of the automatic guided vehicle movement, the kinematics model is presented. Then to improve the traditional expression of terminal sliding mode, design a nonlinear sliding mode which the convergence speed is faster than the former, verified by theoretical analysis, the design of sliding mode is steady and fast convergence in the limited time. Finally combining Lyapunov method to design the tracking control law of automatic guided vehicle, the controller can make the automatic guided vehicle track the desired trajectory in the global sense as well as in finite time. The simulation results verify the correctness and effectiveness of the control law.

Reasons for misuse of prescription medication among physicians undergoing monitoring by a physician health program.

PubMed

Merlo, Lisa J; Singhakant, Supachoke; Cummings, Simone M; Cottler, Linda B

2013-01-01

Substance-related impairment of physicians is a small but serious problem, with significant consequences for patient safety and public health. The purpose of this study was to identify reasons for prescription drug misuse among physicians referred to a physician health program for monitoring because of substance-related impairment, to develop better mechanisms for prevention and intervention. A total of 55 physicians (94.5% male) who were being monitored by their State physician health program because of substance-related impairment participated in guided focus group discussions. Participation was anonymous. Discussions were transcribed from 9 separate focus groups, lasting 60 to 90 minutes each. Qualitative analyses were conducted to examine themes. All participants were diagnosed with substance dependence, and 69.1% of them endorsed a history of misusing prescription drugs. Participants documented the following 5 primary reasons for prescription drug misuse: (1) to manage physical pain, (2) to manage emotional/psychiatric distress, (3) to manage stressful situations, (4) to serve recreational purposes, and (5) to avoid withdrawal symptoms. Our results emphasize the importance of self-medication as a leading reason for misusing prescription medications, although recreational use was also an important factor. Prevention efforts targeting prescription drug misuse among physicians should be initiated during medical training, with continuing education requirements throughout the physicians' careers.

Terahertz generation from laser-driven ultrafast current propagation along a wire target

NASA Astrophysics Data System (ADS)

Zhuo, H. B.; Zhang, S. J.; Li, X. H.; Zhou, H. Y.; Li, X. Z.; Zou, D. B.; Yu, M. Y.; Wu, H. C.; Sheng, Z. M.; Zhou, C. T.

2017-01-01

Generation of intense coherent THz radiation by obliquely incidenting an intense laser pulse on a wire target is studied using particle-in-cell simulation. The laser-accelerated fast electrons are confined and guided along the surface of the wire, which then acts like a current-carrying line antenna and under appropriate conditions can emit electromagnetic radiation in the THz regime. For a driving laser intensity ˜3 ×1018W /cm2 and pulse duration ˜10 fs, a transient current above 10 KA is produced on the wire surface. The emission-cone angle of the resulting ˜0.15 mJ (˜58 GV/m peak electric field) THz radiation is ˜30∘ . The conversion efficiency of laser-to-THz energy is ˜0.75 % . A simple analytical model that well reproduces the simulated result is presented.

Terahertz generation from laser-driven ultrafast current propagation along a wire target.

PubMed

Zhuo, H B; Zhang, S J; Li, X H; Zhou, H Y; Li, X Z; Zou, D B; Yu, M Y; Wu, H C; Sheng, Z M; Zhou, C T

2017-01-01

Generation of intense coherent THz radiation by obliquely incidenting an intense laser pulse on a wire target is studied using particle-in-cell simulation. The laser-accelerated fast electrons are confined and guided along the surface of the wire, which then acts like a current-carrying line antenna and under appropriate conditions can emit electromagnetic radiation in the THz regime. For a driving laser intensity ∼3×10^{18}W/cm^{2} and pulse duration ∼10 fs, a transient current above 10 KA is produced on the wire surface. The emission-cone angle of the resulting ∼0.15 mJ (∼58 GV/m peak electric field) THz radiation is ∼30^{∘}. The conversion efficiency of laser-to-THz energy is ∼0.75%. A simple analytical model that well reproduces the simulated result is presented.

Delamination of Pearlitic Steel Wires: The Defining Role of Prior-Drawing Microstructure

NASA Astrophysics Data System (ADS)

Durgaprasad, A.; Giri, S.; Lenka, S.; Sarkar, Sudip Kumar; Biswas, Aniruddha; Kundu, S.; Mishra, S.; Chandra, S.; Doherty, R. D.; Samajdar, I.

2018-06-01

This article reports the occasional (< 10 pct of the actual production) delamination of pearlitic wires subjected to a drawing strain of 2.5. The original wire rods which exhibited post-drawing delamination had noticeably lower axial alignment of the pearlite: 22 ± 5 pct vs 34 ± 4 pct in the nondelaminated wires. Although all wires had similar through-thickness texture and stress gradients, delaminated wires had stronger gradients in composition and higher hardness across the ferrite-cementite interface. Carbide dissolution and formation of supersaturated ferrite were clearly correlated with delamination, which could be effectively mitigated by controlled laboratory annealing at 673 K. Direct observations on samples subjected to simple shear revealed significant differences in shear localizations. These were controlled by pearlite morphology and interlamellar spacing. Prior-drawing microstructure of coarse misaligned pearlite thus emerged as a critical factor in the wire drawing-induced delamination of the pearlitic wires.

Manufacture and quality control of interconnecting wire harnesses

NASA Technical Reports Server (NTRS)

1973-01-01

Four-volume series of documents has been prepared as standard reference. Each volume may be used separately and covers wire and cable preparation as well as harness fabrication and installation. Series should be useful addition to libraries of manufactures of electrical and electronic equipment.

Thermal Control Method for High-Current Wire Bundles by Injecting a Thermally Conductive Filler

NASA Technical Reports Server (NTRS)

Rodriguez-Ruiz, Juan; Rowles, Russell; Greer, Greg

2011-01-01

A procedure was developed to inject thermal filler material (a paste-like substance) inside the power wire bundle coming from solar arrays. This substance fills in voids between wires, which enhances the heat path and reduces wire temperature. This leads to a reduced amount of heat generated. This technique is especially helpful for current and future generation high-power spacecraft (1 kW or more), because the heat generated by the power wires is significant enough to cause unacceptable overheating to critical components that are in close contact with the bundle.

Control of Domestic Rats & Mice, Training Guide--Rodent Control Series.

ERIC Educational Resources Information Center

Bjornson, Bayard F.; And Others

As one booklet in a series on rodent control, this training guide has been developed to assist administrators, rodent-control operators, and others responsible for rodent-control operations in the training of employees in this field. Topics covered include rodents and human welfare, description and habits of domestic rats and mice, rodent-borne…

Resources available to help family physicians provide advice to travellers.

PubMed Central

Lechky, O

1995-01-01

Because many Canadians are travelling to exotic destinations, family physicians may be asked for advice on immunization and health tips to prevent illnesses such as malaria, altitude disease, meningitis and schistosomiasis. A Toronto family physician who is on staff at a travel clinic says a few guiding principles and good resources can help family physicians ensure that their patients are healthy when they return from a trip. PMID:7553504

Development of a Production Ready Automated Wire Delivery System

NASA Technical Reports Server (NTRS)

1997-01-01

The current development effort is a Phase 3 research study entitled "A Production Ready Automated Wire Delivery System", contract number NAS8-39933, awarded to Nichols Research Corporation (NRC). The goals of this research study were to production harden the existing Automated Wire Delivery (AWDS) motion and sensor hardware and test the modified AWDS in a range of welding applications. In addition, the prototype AWDS controller would be moved to the VME bus platform by designing, fabricating and testing a single board VME bus AWDS controller. This effort was to provide an AWDS that could transition from the laboratory environment to production operations. The project was performed in two development steps. Step 1 modified and tested an improved MWG. Step 2 developed and tested the AWDS single board VME bus controller. Step 3 installed the Wire Pilot in a Weld Controller with the imbedded VME bus controller.

Pairing Physician Education With Patient Activation to Improve Shared Decisions in Prostate Cancer Screening: A Cluster Randomized Controlled Trial

PubMed Central

Wilkes, Michael S.; Day, Frank C.; Srinivasan, Malathi; Griffin, Erin; Tancredi, Daniel J.; Rainwater, Julie A.; Kravitz, Richard L.; Bell, Douglas S.; Hoffman, Jerome R.

2013-01-01

BACKGROUND Most expert groups recommend shared decision making for prostate cancer screening. Most primary care physicians, however, routinely order a prostate-specific antigen (PSA) test with little or no discussion about whether they believe the potential benefits justify the risk of harm. We sought to assess whether educating primary care physicians and activating their patients to ask about prostate cancer screening had a synergistic effect on shared decision making, rates and types of discussions about prostate cancer screening, and the physician’s final recommendations. METHODS Our study was a cluster randomized controlled trial among primary care physicians and their patients, comparing usual education (control), with physician education alone (MD-Ed), and with physician education and patient activation (MD-Ed+A). Participants included 120 physicians in 5 group practices, and 712 male patients aged 50 to 75 years. The interventions comprised a Web-based educational program for all intervention physicians and MD-Ed+A patients compared with usual education (brochures from the Centers for Disease Control and Prevention). The primary outcome measure was patients’ reported postvisit shared decision making regarding prostate cancer screening; secondary measures included unannounced standardized patients’ reported shared decision making and the physician’s recommendation for prostate cancer screening. RESULTS Patients’ ratings of shared decision making were moderate and did not differ between groups. MD-Ed+A patients reported that physicians had higher prostate cancer screening discussion rates (MD-Ed+A = 65%, MD-Ed = 41%, control=38%; P <.01). Standardized patients reported that physicians seeing MD-Ed+A patients were more neutral during prostate cancer screening recommendations (MD-Ed+A=50%, MD-Ed=33%, control=15%; P <.05). Of the male patients, 80% had had previous PSA tests. CONCLUSIONS Although activating physicians and patients did not lead to

Improving blood pressure control in diabetes: limitations of a clinical reminder in influencing physician behavior.

PubMed

Sanders, Karen M; Satyvavolu, Anuradha

2002-01-01

Hypertension should be aggressively treated, especially in diabetic patients. But studies of physician prescribing habits reveal that physicians often delay making medication changes or initiating antihypertensive therapy. A chart-based reminder was designed to improve physician medication prescribing in this clinical situation. A randomized controlled trial was conducted at the Veterans Affairs Medical Center in Richmond, Virginia. Patients with diabetes and hypertension were selected. A highly visible chart reminder was applied to the front of outpatient charts in the intervention group practice. A chart review was conducted to assess physician-directed medication changes. A successful outcome was defined as any antihypertensive medication increase or addition at that same visit. Physicians were more likely to intensify antihypertensive medication as the blood pressure increased regardless of the reminder. Overall, only 33% of visits resulted in a medication change, even though 93% of patients had elevations over target blood pressure at the follow-up visit. Physicians in the intervention and control groups made changes to medication at similar rates (chi 2 = 0.621, p = .511). In this study, a chart reminder failed to improve physician compliance with the clinical guideline for hypertension management in diabetics, Sixth Report of the Joint National Committee on the Detection, Evaluation, Prevention and Treatment of High Blood Pressure. To inform the design of effective intervention strategies, further research should explore specific barriers to guideline adherence in this clinical situation.

Taking health care back: the physician's role in quality improvement.

PubMed

Becher, Elise C; Chassin, Mark R

2002-10-01

Physicians now enjoy a moment of tactical advantage in the evolution of the struggle for control over health care in the United States. The most effective way to capitalize on this-perhaps fleeting-position and to more permanently alter the balance of power in their favor is for physicians to establish strong and visionary leadership in health care quality improvement. Such an undertaking, if successful, could place the very essence of health care-defining, measuring, and improving its quality-in the hands of physicians. To succeed requires understanding the relationships between the different kinds of quality problems that plague our health care system, the various kinds of errors that lead to them, and how amenable these different kinds of errors may be to different interventions. The authors delineate a conceptual framework that describes these relationships, as well as their implications for conducting effective and durable quality improvement. The authors then illustrate how physicians could engage in this activity in three different settings: a four-or-five-physician primary care practice, a 50-physician multispecialty group, and a 450-bed community hospital. Finally, the authors submit that now is an opportune time for physicians and the organizations they direct or guide to take the leadership role in conducting health care quality improvement. Realizing the opportunity will require dedicating significant resources and changing traditional approaches to quality, but in so doing, physicians can regain much of the autonomy over the practice of medicine previously lost to government and managed care.

Titrating guidance: a model to guide physicians in assisting patients and family members who are facing complex decisions.

PubMed

Goldstein, Nathan E; Back, Anthony L; Morrison, R Sean

2008-09-08

Over the last century, developments in new medical treatments have led to an exponential increase in longevity, but, as a consequence, patients may be left with chronic illness associated with long-term severe functional and cognitive disability. Patients and their families are often forced to make a difficult and complex choice between death and long-term debility, neither of which is an acceptable outcome. Traditional models of medical decision making, however, do not fully address how clinicians should best assist with these decisions. Herein, we present a new paradigm that demonstrates how the role of the physician changes over time in response to the curved relationship between the predictability of a patient's outcome and the chance of returning to an acceptable quality of life. To translate this model into clinical practice, we propose a 5-step model for physicians with which they can (1) determine at which point the patient is on our model; (2) identify the cognitive factors and preferences for outcomes that affect the decision-making process of the patient and his or her family; (3) reflect on their own reaction to the decision at hand; (4) acknowledge how these factors can be addressed in conversation; and (5) guide the patient and his or her family in creating a plan of care. This model can help improve patient-physician communication and decision making so that complex and difficult decisions can be turned into ones that yield to medical expertise, good communication, and personal caring.

A medical book collection for physician assistants.

PubMed

Grodzinski, A

2001-07-01

Selecting resources for physician assistants is challenging and can be overwhelming. Although several core lists exist for nursing, allied health, and medical libraries, judging the scope and level of these resources in relation to the information needs of the physician assistant is difficult. Medical texts can be highly specialized and very expensive, in essence, "overkill" for the needs of the physician assistant. This bibliography is meant to serve as a guide to appropriate medical texts for physician assistants. Titles were selected from the Brandon/Hill list, Doody's Electronic Journal, and various other reference resources. Resources were evaluated based on the subject and scope, audience, authorship, cost, and currency. The collection includes 195 titles from 33 specialty areas. Standard texts in each area are also included.

In defense of industry-physician relationships.

PubMed

Nakayama, Don K

2010-09-01

The objective was to examine the economic, ethical, and legal foundations for conflict of interest restrictions between physicians and pharmaceutical and medical device industries ("industry"). Recently academic medical centers and professional organizations have adopted policies that restrict permissible interactions between industry and physicians. The motive is to avoid financial conflicts of interest that compromise core values of altruism and fiduciary relationships. Productive relationships between industry and physicians provide novel drugs and devices of immense benefit to society. The issues are opposing views of medical economics, profit motives, medical professionalism, and extent to which interactions should be lawfully restricted. Industry goals are congruent with those of physicians: patient welfare, safety, and running a profitable business. Profits are necessary to develop drugs and devices. Physician collaborators invent products, refine them, and provide feedback and so are appropriately paid. Marketing is necessary to bring approved products to patients. Economic realities limit the extent to which physicians treat their patients altruistically and as fiduciaries. Providing excellent service to patients may be a more realistic standard. Statements from industry and the American College of Surgeons appropriately guide professional behavior. Preservation of industry-physician relationships is vital to maintain medical innovation and progress.

49 CFR 236.71 - Signal wires on pole line and aerial cable.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 4 2013-10-01 2013-10-01 false Signal wires on pole line and aerial cable. 236.71..., INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.71 Signal wires on pole line and aerial cable. Signal wire on...

49 CFR 236.71 - Signal wires on pole line and aerial cable.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 4 2012-10-01 2012-10-01 false Signal wires on pole line and aerial cable. 236.71..., INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.71 Signal wires on pole line and aerial cable. Signal wire on...

49 CFR 236.71 - Signal wires on pole line and aerial cable.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 4 2014-10-01 2014-10-01 false Signal wires on pole line and aerial cable. 236.71..., INSPECTION, MAINTENANCE, AND REPAIR OF SIGNAL AND TRAIN CONTROL SYSTEMS, DEVICES, AND APPLIANCES Rules and Instructions: All Systems Wires and Cables § 236.71 Signal wires on pole line and aerial cable. Signal wire on...

Wire Array Photovoltaics

NASA Astrophysics Data System (ADS)

Turner-Evans, Dan

Over the past five years, the cost of solar panels has dropped drastically and, in concert, the number of installed modules has risen exponentially. However, solar electricity is still more than twice as expensive as electricity from a natural gas plant. Fortunately, wire array solar cells have emerged as a promising technology for further lowering the cost of solar. Si wire array solar cells are formed with a unique, low cost growth method and use 100 times less material than conventional Si cells. The wires can be embedded in a transparent, flexible polymer to create a free-standing array that can be rolled up for easy installation in a variety of form factors. Furthermore, by incorporating multijunctions into the wire morphology, higher efficiencies can be achieved while taking advantage of the unique defect relaxation pathways afforded by the 3D wire geometry. The work in this thesis shepherded Si wires from undoped arrays to flexible, functional large area devices and laid the groundwork for multijunction wire array cells. Fabrication techniques were developed to turn intrinsic Si wires into full p-n junctions and the wires were passivated with a-Si:H and a-SiNx:H. Single wire devices yielded open circuit voltages of 600 mV and efficiencies of 9%. The arrays were then embedded in a polymer and contacted with a transparent, flexible, Ni nanoparticle and Ag nanowire top contact. The contact connected >99% of the wires in parallel and yielded flexible, substrate free solar cells featuring hundreds of thousands of wires. Building on the success of the Si wire arrays, GaP was epitaxially grown on the material to create heterostructures for photoelectrochemistry. These cells were limited by low absorption in the GaP due to its indirect bandgap, and poor current collection due to a diffusion length of only 80 nm. However, GaAsP on SiGe offers a superior combination of materials, and wire architectures based on these semiconductors were investigated for multijunction

Topical Nitroglycerine for Neonatal Arterial Associated Peripheral Ischemia following Cannulation: A Case Report and Comprehensive Literature Review

PubMed Central

Mosalli, Rafat; Elbaz, Mohamed; Paes, Bosco

2013-01-01

Arterial cannulation in neonates is usually performed for frequent blood pressure monitoring and blood sampling. The procedure, while easily executed by skilled neonatal staff, can be associated with serious complications such as vasospasm, thrombosis, embolism, hematoma, infection, peripheral nerve damage, ischemia, and tissue necrosis. Several treatment options are available to reverse vascular induced ischemia and tissue damage. Applied interventions depend on the extent of tissue involvement and whether the condition is progressive and deemed life threatening. Standard, noninvasive measures include immediate catheter removal, limb elevation, and warming the contralateral extremity. Topical vasodilators, anticoagulation, thrombolysis, and surgery are considered secondary therapeutic strategies. A comprehensive literature search indicates that topical nitroglycerin has been utilized for the treatment of tissue ischemia in three preterms with umbilical arterial catheters and four with peripheral arterial lines. We report the first successful use of nitroglycerine ointment in a critically ill preterm infant with ischemic hand changes after brachial artery cannulation. PMID:24251058

A novel integrated chassis controller for full drive-by-wire vehicles

NASA Astrophysics Data System (ADS)

Song, Pan; Tomizuka, Masayoshi; Zong, Changfu

2015-02-01

In this paper, a systematic design with multiple hierarchical layers is adopted in the integrated chassis controller for full drive-by-wire vehicles. A reference model and the optimal preview acceleration driver model are utilised in the driver control layer to describe and realise the driver's anticipation of the vehicle's handling characteristics, respectively. Both the sliding mode control and terminal sliding mode control techniques are employed in the vehicle motion control (MC) layer to determine the MC efforts such that better tracking performance can be attained. In the tyre force allocation layer, a polygonal simplification method is proposed to deal with the constraints of the tyre adhesive limits efficiently and effectively, whereby the load transfer due to both roll and pitch is also taken into account which directly affects the constraints. By calculating the motor torque and steering angle of each wheel in the executive layer, the total workload of four wheels is minimised during normal driving, whereas the MC efforts are maximised in extreme handling conditions. The proposed controller is validated through simulation to improve vehicle stability and handling performance in both open- and closed-loop manoeuvres.

Investigation of Axial Electric Field Measurements with Grounded-Wire TEM Surveys

NASA Astrophysics Data System (ADS)

Zhou, Nan-nan; Xue, Guo-qiang; Li, Hai; Hou, Dong-yang

2018-01-01

The grounded-wire transient electromagnetic (TEM) surveying is often performed along the equatorial direction with its observation lines paralleling to the transmitting wire with a certain transmitter-receiver distance. However, such method takes into account only the equatorial component of the electromagnetic field, and a little effort has been made on incorporating the other major component along the transmitting wire, here denoted as axial field. To obtain a comprehensive understanding of its fundamental characteristics and guide the designing of the corresponding observation system for reliable anomaly detection, this study for the first time investigates the axial electric field from three crucial aspects, including its decay curve, plane distribution, and anomaly sensitivity, through both synthetic modeling and real application to one major coal field in China. The results demonstrate a higher sensitivity to both high- and low-resistivity anomalies by the electric field in axial direction and confirm its great potentials for robust anomaly detection in the subsurface.

Preoperative computed tomography-guided percutaneous hookwire localization of metallic marker clips in the breast with a radial approach: initial experience.

PubMed

Uematsu, T; Kasami, M; Uchida, Y; Sanuki, J; Kimura, K; Tanaka, K; Takahashi, K

2007-06-01

Hookwire localization is the current standard technique for radiological marking of nonpalpable breast lesions. Stereotactic directional vacuum-assisted breast biopsy (SVAB) is of sufficient sensitivity and specificity to replace surgical biopsy. Wire localization for metallic marker clips placed after SVAB is needed. To describe a method for performing computed tomography (CT)-guided hookwire localization using a radial approach for metallic marker clips placed percutaneously after SVAB. Nineteen women scheduled for SVAB with marker-clip placement, CT-guided wire localization of marker clips, and, eventually, surgical excision were prospectively entered into the study. CT-guided wire localization was performed with a radial approach, followed by placement of a localizing marker-clip surgical excision. Feasibility and reliability of the procedure and the incidence of complications were examined. CT-guided wire localization surgical excision was successfully performed in all 19 women without any complications. The mean total procedure time was 15 min. The median distance on CT image from marker clip to hookwire was 2 mm (range 0-3 mm). CT-guided preoperative hookwire localization with a radial approach for marker clips after SVAB is technically feasible.

Stiffness and frictional resistance of a superelastic nickel-titanium orthodontic wire with low-stress hysteresis.

PubMed

Liaw, Yu-Cheng; Su, Yu-Yu M; Lai, Yu-Lin; Lee, Shyh-Yuan

2007-05-01

Stress-induced martensite formation with stress hysteresis that changes the elasticity and stiffness of nickel-titanium (Ni-Ti) wire influences the sliding mechanics of archwire-guided tooth movement. This in-vitro study investigated the frictional behavior of an improved superelastic Ni-Ti wire with low-stress hysteresis. Improved superelastic Ni-Ti alloy wires (L & H Titan, Tomy International, Tokyo, Japan) with low-stress hysteresis were examined by using 3-point bending and frictional resistance tests with a universal test machine at a constant temperature of 35 degrees C, and compared with the former conventional austenitic-active superelastic Ni-Ti wires (Sentalloy, Tomy International). Wire stiffness levels were derived from differentiation of the polynomial regression of the unloading curves, and values for kinetic friction were measured at constant bending deflection distances of 0, 2, 3, and 4 mm, respectively. Compared with conventional Sentalloy wires, the L & H Titan wire had a narrower stress hysteresis including a lower loading plateau and a higher unloading plateau. In addition, L & H Titan wires were less stiff than the Sentalloy wires during most unloading stages. Values of friction measured at deflections of 0, 2, and 3 mm were significantly (P <.05) increased in both types of wire. However, they showed a significant decrease in friction from 3 to 4 mm of deflection. L & H Titan wires had less friction than Sentalloy wires at all bending deflections (P <.05). Stress-induced martensite formation significantly reduced the stiffness and thus could be beneficial to decrease the binding friction of superelastic Ni-Ti wires during sliding with large bending deflections. Austenitic-active alloy wires with low-stress hysteresis and lower stiffness and friction offer significant potential for further investigation.

An intervention to increase patients' trust in their physicians. Stanford Trust Study Physician Group.

PubMed

Thom, D H; Bloch, D A; Segal, E S

1999-02-01

To investigate the effect of a one-day workshop in which physicians were taught trust-building behaviors on their patients' levels of trust and on outcomes of care. In 1994, the study recruited 20 community-based family physicians and enrolled 412 consecutive adult patients from those physicians' practices. Ten of the physicians (the intervention group) were randomly assigned to receive a one-day training course in building and maintaining patients' trust. Outcomes were patients' trust in their physicians, patients' and physicians' satisfaction with the office visit, continuity in the patient-physician relationship, patients' adherence to their treatment plans, and the numbers of diagnostic tests and referrals. Physicians and patients in the intervention and control groups were similar in demographic and other data. There was no significant difference in any outcome. Although their overall ratings were not statistically significantly different, the patients of physicians in the intervention group reported more positive physician behaviors than did the patients of physicians in the control group. The trust-building workshop had no measurable effect on patients' trust or on outcomes hypothesized to be related to trust.

Deflection load characteristics of laser-welded orthodontic wires.

PubMed

Watanabe, Etsuko; Stigall, Garrett; Elshahawy, Waleed; Watanabe, Ikuya

2012-07-01

To compare the deflection load characteristics of homogeneous and heterogeneous joints made by laser welding using various types of orthodontic wires. Four kinds of straight orthodontic rectangular wires (0.017 inch × 0.025 inch) were used: stainless-steel (SS), cobalt-chromium-nickel (Co-Cr-Ni), beta-titanium alloy (β-Ti), and nickel-titanium (Ni-Ti). Homogeneous and heterogeneous end-to-end joints (12 mm long each) were made by Nd:YAG laser welding. Two types of welding methods were used: two-point welding and four-point welding. Nonwelded wires were also used as a control. Deflection load (N) was measured by conducting the three-point bending test. The data (n  =  5) were statistically analyzed using analysis of variance/Tukey test (P < .05). The deflection loads for control wires measured were as follows: SS: 21.7 ± 0.8 N; Co-Cr-Ni: 20.0 ± 0.3 N; β-Ti: 13.9 ± 1.3 N; and Ni-Ti: 6.6 ± 0.4 N. All of the homogeneously welded specimens showed lower deflection loads compared to corresponding control wires and exhibited higher deflection loads compared to heterogeneously welded combinations. For homogeneous combinations, Co-Cr-Ni/Co-Cr-Ni showed a significantly (P < .05) higher deflection load than those of the remaining homogeneously welded groups. In heterogeneous combinations, SS/Co-Cr-Ni and β-Ti/Ni-Ti showed higher deflection loads than those of the remaining heterogeneously welded combinations (significantly higher for SS/Co-Cr-Ni). Significance (P < .01) was shown for the interaction between the two factors (materials combination and welding method). However, no significant difference in deflection load was found between four-point and two-point welding in each homogeneous or heterogeneous combination. Heterogeneously laser-welded SS/Co-Cr-Ni and β-Ti/Ni-Ti wires provide a deflection load that is comparable to that of homogeneously welded orthodontic wires.

Flow Control via a Single Spanwise Wire on the Surface of a Stationary Cylinder

NASA Astrophysics Data System (ADS)

Ekmekci, Alis; Rockwell, Donald

2007-11-01

The flow structure arising from a single spanwise wire attached along the surface of a circular stationary cylinder is investigated experimentally via a cinema technique of digital particle image velocimetry (DPIV). Consideration is given to wires that have smaller and larger scales than the thickness of the unperturbed boundary layer that develops around the cylinder prior to flow separation. The wires have diameters that are 1% and 3% of the cylinder diameter. Over a certain range of angular positions with respect to the approach flow, both small- and large-scale wires show important global effects on the entire near-wake. Two critical angles are identified on the basis of the near-wake structure. These critical angles are associated with extension and contraction of the near-wake, relative to the wake in absence of the effect of a surface disturbance. The critical angle of the wire that yields near-wake extension is associated with bistable oscillations of the separating shear layer, at irregular time intervals, much longer that the time scale associated with classical Karman vortex shedding. Moreover, for the large scale wire, in specific cases, either attenuation or enhancement of the Karman mode of vortex formation is observed.

Wire chamber radiation detector with discharge control

DOEpatents

Perez-Mendez, Victor; Mulera, Terrence A.

1984-01-01

A wire chamber radiation detector (11) has spaced apart parallel electrodes (16) and grids (17, 18, 19) defining an ignition region (21) in which charged particles (12) or other ionizing radiations initiate brief localized avalanche discharges (93) and defining an adjacent memory region (22) in which sustained glow discharges (94) are initiated by the primary discharges (93). Conductors (29, 32) of the grids (18, 19) at each side of the memory section (22) extend in orthogonal directions enabling readout of the X-Y coordinates of locations at which charged particles (12) were detected by sequentially transmitting pulses to the conductors (29) of one grid (18) while detecting transmissions of the pulses to the orthogonal conductors (36) of the other grid (19) through glow discharges (94). One of the grids (19) bounding the memory region (22) is defined by an array of conductive elements (32) each of which is connected to the associated readout conductor (36) through a separate resistance (37). The wire chamber (11) avoids ambiguities and imprecisions in the readout of coordinates when large numbers of simultaneous or near simultaneous charged particles (12) have been detected. Down time between detection periods and the generation of radio frequency noise are also reduced.

Degradation of orthodontic wires under simulated cariogenic and erosive conditions.

PubMed

Jaber, Laura Cavalcante Lima; Rodrigues, José Augusto; Amaral, Flávia Lucisano Botelho; França, Fabiana Mantovani Gomes; Basting, Roberta Tarkany; Turssi, Cecilia Pedroso

2014-01-01

This study examined the effect of cariogenic and erosive challenges (CCs and ECs, respectively) on the degradation of copper-nickel-titanium (CuNiTi) orthodontic wires. Sixty wire segments were divided into four treatment groups and exposed to CCs, ECs, artificial saliva, or dry storage (no-treatment control). CC and EC were simulated using a demineralizing solution (pH 4.3) and a citric acid solution (pH 2.3), respectively. Following treatment, the average surface roughness (Ra) of the wires was assessed, and friction between the wires and a passive self-ligating bracket was measured. CuNiTi wires subjected to ECs exhibited significantly higher Ra values than did those that were stored in artificial saliva. In contrast, surface roughness was not affected by CCs. Finally, friction between the treated wires and brackets was not affected by ECs or CCs. Our results indicate that CuNiTi orthodontic wires may suffer degradation within the oral cavity, as ECs increased the surface roughness of these wires. However, rougher surfaces did not increase friction between the wire and the passive self-ligating bracket.

Transthoracic ultrasound guided balloon dilation of cor triatriatum dexter in 2 Rottweiler puppies.

PubMed

Birettoni, F; Caivano, D; Bufalari, A; Giorgi, M E; Miglio, A; Paradies, P; Porciello, F

2016-12-01

Balloon dilation was performed in two Rottweiler puppies with cor triatriatum dexter and clinical signs of ascites using transthoracic echocardiographic guidance. The dogs were positioned on a standard echocardiography table in right lateral recumbency, and guide wires and balloon catheters were imaged by echocardiographic views optimized to allow visualization of the defect. The procedures were performed successfully without complications and clinical signs were resolved completely in both cases. Guide wires and balloon catheters appeared hyperechoic on transthoracic echocardiography image and could be clearly monitored and guided in real-time. These two cases demonstrate that it is possible to perform balloon catheter dilation of cor triatriatum dexter under transthoracic guidance alone. Copyright © 2016 Elsevier B.V. All rights reserved.

2D projection-based software application for mobile C-arms optimises wire placement in the proximal femur - An experimental study.

PubMed

Swartman, B; Frere, D; Wei, W; Schnetzke, M; Beisemann, N; Keil, H; Franke, J; Grützner, P A; Vetter, S Y

2017-10-01

A new software application can be used without fixed reference markers or a registration process in wire placement. The aim was to compare placement of Kirschner wires (K-wires) into the proximal femur with the software application versus the conventional method without guiding. As study hypothesis, we assumed less placement attempts, shorter procedure time and shorter fluoroscopy time using the software. The same precision inside a proximal femur bone model using the software application was premised. The software detects a K-wire within the 2D fluoroscopic image. By evaluating its direction and tip location, it superimposes a trajectory on the image, visualizing the intended direction of the K-wire. The K-wire was positioned in 20 artificial bones with the use of software by one surgeon; 20 bones served as conventional controls. A brass thumb tack was placed into the femoral head and its tip targeted with the wire. Number of placement attempts, duration of the procedure, duration of fluoroscopy time and distance to the target in a postoperative 3D scan were recorded. Compared with the conventional method, use of the application showed fewer attempts for optimal wire placement (p=0.026), shorter duration of surgery (p=0.004), shorter fluoroscopy time (p=0.024) and higher precision (p=0.018). Final wire position was achieved in the first attempt in 17 out of 20 cases with the software and in 9 out of 20 cases with the conventional method. The study hypothesis was confirmed. The new application optimised the process of K-wire placement in the proximal femur in an artificial bone model while also improving precision. Benefits lie especially in the reduction of placement attempts and reduction of fluoroscopy time under the aspect of radiation protection. The software runs on a conventional image intensifier and can therefore be easily integrated into the daily surgical routine. Copyright © 2017 Elsevier Ltd. All rights reserved.

Tobacco use, cessation advice to patients and attitudes to tobacco control among physicians in Ukraine.

PubMed

Squier, Christopher; Hesli, Vicki; Lowe, John; Ponamorenko, Victor; Medvedovskaya, Natalia

2006-10-01

To examine the relationship between physicians' smoking behaviors and their attitudes toward tobacco use by their patients and tobacco control in the Ukraine, a 70-item questionnaire was administered to 799 general practitioners (287 men and 512 women) working in both rural (278 physicians) and urban (521 physicians) areas of three regions of Ukraine. In all, 13.9% of physicians were current smokers and 21.6% reported being past smokers, with significantly (P<0.001) more men than women being current or past smokers. Odds ratios from logistic regression analysis reveal that physicians who are heavy smokers are 26% less likely to record tobacco use by patients than medium smokers. Heavy smokers devote significantly less effort to providing cessation information to patients and are 36% less likely to support the complete prohibition of smoking in the physician's workplace. Older physicians, female physicians and physicians working in urban areas are significantly more likely than younger, male and rural physicians to advise their patients on smoking. The provision of smoking cessation to patients by general practitioners in Ukraine is influenced by several factors, a major one being the smoking status of the physician. If smoking among physicians declines, this will encourage the patient to consider a serious quit attempt in several ways, most notably: (1) physicians act as societal role models and can promote non-smoking as a norm and (2) the likelihood that a patient will be provided smoking cessation counseling increases.

Explosion symmetry improvement of polyimide-coated tungsten wire in vacuum on negative discharge facility

NASA Astrophysics Data System (ADS)

Li, Mo; Wu, Jian; Lu, Yihan; Li, Xingwen; Li, Yang; Qiu, Mengtong

2018-01-01

Tungsten wire explosion is very asymmetric when fast current rate and insulated coatings are both applied on negative discharge facility using a 24-mm-diameter cathode geometry, which is commonly used on mega-ampere facilities. It is inferred, based on an analytical treatment of the guiding center drift and COMSOL simulations, that the large negative radial electric field causes early voltage breakdown and terminates energy deposition into the wire core on the anode side of the wire. After the anode side is short circuited, the radial electric field along the wire surface on the cathode side will change its polarity and thus leading to additional energy deposition into the wire core. This change causes ˜10 times larger energy deposition and ˜14 times faster explosion velocity in the cathode side than the anode side. In order to reduce this asymmetry, a hollow cylindrical cathode geometry was used to reverse the polarity of radial electric field and was optimized to use on multi-MA facilities. In this case, fully vaporized polyimide-coated tungsten wire with great symmetry improvement was achieved with energy deposition of ˜8.8 eV/atom. The atomic and electronic density distributions for the two different load geometries were obtained by the double-wavelength measurement.

Job attitudes and well-being among public vs. private physicians: organizational justice and job control as mediators.

PubMed

Heponiemi, Tarja; Kuusio, Hannamaria; Sinervo, Timo; Elovainio, Marko

2011-08-01

The present study examined whether there are differences in job-related attitudes and well-being among physicians working in private sector and public sector. In addition, we examined whether psychosocial factors (organizational justice and job control) could mediate these possible differences in different sectors. Cross-sectional survey data from the Finnish Health Professional Study was used. A random sample of Finnish physicians included 1522 women and 1047 men aged 25-65 years. Outcome variables were job satisfaction, organizational commitment, psychological distress, work ability and sleeping problems. Job control and organizational justice were measured using established questionnaires. Series of regression analyses were performed and the mediational effects were tested following the procedures outlined by Baron and Kenny. Physicians working in private sector had higher levels of job satisfaction and organizational commitment and lower levels of psychological distress and sleeping problems when compared with physicians working in public sector. Private physicians also had higher levels of organizational justice, which acted as a mediator behind more positive attitudes and better well-being in private sector. Private physicians had higher levels of job control but it did not act as a mediator. Private physicians feel better than public physicians and this is partly due to higher organizational justice in private sector. Public health care organizations should invest effort to increase the fairness in their organizations and management and pay more attention in improving the well-being of their employees, which could possibly increase the attractiveness of public sector as a career option.

Random vibration (stress screening) of printed wiring assemblies

NASA Technical Reports Server (NTRS)

Bastien, Gilbert J.

1988-01-01

The results of a random vibration test screening (RVSS) study of the determination of the upper and lower vibration limits on printed wiring assemblies (PWA) are summarized. The study results are intended to serve as a guide for engineers and designers who make decisions on PWA features that need to withstand the stresses of dynamic testing and screening. The maximum allowable PWA deflection, G levels, and PSD levels are compared to the expected or actual levels to determine if deleterious effects will occur.

What constitutes responsiveness of physicians: A qualitative study in rural Bangladesh

PubMed Central

George, Asha; Ahmed, Syed Masud; Rashid, Sabina Faiz; Sarker, Malabika

2017-01-01

Responsiveness entails the social actions by health providers to meet the legitimate expectations of patients. It plays a critical role in ensuring continuity and effectiveness of care within people centered health systems. Given the lack of contextualized research on responsiveness, we qualitatively explored the perceptions of outpatient users and providers regarding what constitute responsiveness in rural Bangladesh. An exploratory study was undertaken in Chuadanga, a southwestern Bangladeshi District, involving in-depth interviews of physicians (n = 17) and users (n = 7), focus group discussions with users (n = 4), and observations of patient provider interactions (three weeks). Analysis was guided by a conceptual framework of responsiveness, which includes friendliness, respecting, informing and guiding, gaining trust and optimizing benefits. In terms of friendliness, patients expected physicians to greet them before starting consultations; even though physicians considered this unusual. Patients also expected physicians to hold social talks during consultations, which was uncommon. With regards to respect patients expected physicians to refrain from disrespecting them in various ways; but also by showing respect explicitly. Patients also had expectations related to informing and guiding: they desired explanation on at least the diagnosis, seriousness of illness, treatment and preventive steps. In gaining trust, patients expected that physicians would refrain from illegal or unethical activities related to patients, e.g., demanding money against free services, bringing patients in own private clinics by brokers (dalals), colluding with diagnostic centers, accepting gifts from pharmaceutical representatives. In terms of optimizing benefits: patients expected that physicians should be financially sensitive and consider individual need of patients. There were multiple dimensions of responsiveness- for some, stakeholders had a consensus; context was an important

Concealed wire tracing apparatus

DOEpatents

Kronberg, J.W.

1994-05-31

An apparatus and method that combines a signal generator and a passive signal receiver to detect and record the path of partially or completely concealed electrical wiring without disturbing the concealing surface is disclosed. The signal generator applies a series of electrical pulses to the selected wiring of interest. The applied pulses create a magnetic field about the wiring that can be detected by a coil contained within the signal receiver. An audible output connected to the receiver and driven by the coil reflects the receivers position with respect to the wiring. The receivers audible signal is strongest when the receiver is directly above the wiring and the long axis of the receivers coil is parallel to the wiring. A marking means is mounted on the receiver to mark the location of the wiring as the receiver is directed over the wiring's concealing surface. Numerous marks made on various locations of the concealing surface will trace the path of the wiring of interest. 4 figs.