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Sample records for access staging laparoscopy

  1. Mini-access for retroperitoneal laparoscopy.

    PubMed

    Gaur, D D; Gopichand, M; Dubey, M; Jhunjhunwala, V

    2002-10-01

    The purpose of this study was to establish the feasibility of primary mini-access to the retroperitoneal space to perform certain retroperitoneoscopic procedures in which an enlarged port is not required for extraction of the specimen. Mini-laparoscopy or needlescopic laparoscopy has been performed in the past via the transperitoneal route, but this has not yet been reported for a retroperitoneoscopic procedure. Through a 5-mm primary access and 3- or 5-mm secondary ports, retroperitoneoscopic surgery was performed in seven adults for ureterolithotomy, renal biopsy, simple nephrectomy, nephropexy, cyst decortication, or drainage of a subphrenic abscess. The access technique used was a mini-version of a previously described percutaneous access technique with some modifications. The retroperitoneoscopic procedure was successful in all seven patients, and no complications developed. The operative time, blood loss, analgesic intake, and length of hospital stay were comparable with those of a standard retroperitoneoscopic procedure. However, the cosmetic results were better. Mini-retroperitoneoscopy is feasible and is a better alternative for patients in whom the whole procedure can be performed through 5-mm or smaller ports.

  2. Fluorescence staging laparoscopy for gastrointestinal malignancies: experimental experience

    NASA Astrophysics Data System (ADS)

    Prosst, Ruediger L.; Pietschmann, Mathias; Rheinwald, Markus; Haase, Thomas; Herfarth, Christian; Gahlen, Johannes

    2001-01-01

    Accurate staging can be a major problem in therapeutic planning of advanced abdominal malignancies. We experimentally combined conventional staging laparoscopy with aminolevulinic acid (ALA) induced fluorescence diagnosis (FD) to improve the detection of disseminated peritoneal tumors. Using different photosensitization times and ALA concentrations we evaluated the optimal fluorescence parameters for laparoscopic fluorescence diagnosis of intra abdominal tumor spread. In a rat tumor model we performed conventional and fluorescence laparoscopy to determine the increase of sensitivity gained by FD in terms of additionally detected lesions. After laparoscopic examination, the fluorescence emission from the tumors was spectrometically analyzed. Serum levels of ALA and PpIX were measured by HPLC to determine their systemic metabolism. Fluorescence staging laparoscopy was able to visualize even macroscopically occult neoplasms. Using 1.5 percent ALA solution and a photosensitization time of 4 hours as favorable parameters the diagnostic value of conventional staging laparoscopy was significantly improved: 35 percent of all malignant lesions were detected only by FD. Therefore, fluorescence laparoscopy suggest to be a highly promising preoperative staging tool requiring minimal technical and clinical expenditure. It provides the laparoscopist with a rapid and accurate technique to assess more thoroughly the full extent of malignant tumor growth in the abdominal cavity.

  3. Carcinoma of the pancreatic head and periampullary region. Tumor staging with laparoscopy and laparoscopic ultrasonography.

    PubMed Central

    John, T G; Greig, J D; Carter, D C; Garden, O J

    1995-01-01

    OBJECTIVE: The authors performed a prospective evaluation of staging laparoscopy with laparoscopic ultrasonography in predicting surgical resectability in patients with carcinomas of the pancreatic head and periampullary region. SUMMARY BACKGROUND DATA: Pancreatic resection with curative intent is possible in a select minority of patients who have carcinomas of the pancreatic head and periampullary region. Patient selection is important to plan appropriate therapy and avoid unnecessary laparotomy in patients with unresectable disease. Laparoscopic ultrasonography is a novel technique that combines the proven benefits of staging laparoscopy with high resolution intraoperative ultrasound of the liver and pancreas, but which has yet to be evaluated critically in the staging of pancreatic malignancy. METHODS: A cohort of 40 consecutive patients referred to a tertiary referral center and with a diagnosis of potentially resectable pancreatic or periampullary cancer underwent staging laparoscopy with laparoscopic ultrasonography. The diagnostic accuracy of staging laparoscopy alone and in conjunction with laparoscopic ultrasonography was evaluated in predicting tumor resectability (absence of peritoneal or liver metastases; absence of malignant regional lymphadenopathy; tumor confined to pancreatic head or periampullary region). RESULTS: "Occult" metastatic lesions were demonstrated by staging laparoscopy in 14 patients (35%). Laparoscopic ultrasonography demonstrated factors confirming unresectable tumor in 23 patients (59%), provided staging information in addition to that of laparoscopy alone in 20 patients (53%), and changed the decision regarding tumor resectability in 10 patients (25%). Staging laparoscopy with laparoscopic ultrasonography was more specific and accurate in predicting tumor resectability than laparoscopy alone (88% and 89% versus 50% and 65%, respectively). CONCLUSIONS: Staging laparoscopy is indispensable in the detection of "occult" intra

  4. Comparison of Laparoscopy and Laparotomy in Surgical Staging of Apparent Early Ovarian Cancer

    PubMed Central

    Lu, Qi; Qu, Hong; Liu, Chongdong; Wang, Shuzhen; Zhang, Zhiqiang; Zhang, Zhenyu

    2016-01-01

    Abstract The aim of this study was to compare the safety and morbidity of laparoscopic versus laparotomic comprehensive staging of apparent early stage ovarian cancer. In this retrospective study, the outcomes of patients with apparent stage I ovarian cancer who underwent laparoscopic or laparotomic comprehensive surgical staging from January 2002 to January 2014 were evaluated. The long-term survival of patients with early ovarian cancer was compared. Forty-two patients were treated by laparoscopy, and 50 were treated by laparotomy. The median operative time was 200 minutes in the laparoscopy group and 240 minutes in the laparotomy group (P >0.05). The median length of hospital stay was 3 days in the laparoscopy group and 7 days in the laparotomy group (P <0.05). Following laparoscopic and laparotomic staging, the cancer was upstaged for 9 (21.4%) and 10 (20.0%) women, respectively. The median follow-up time was 82 months in the laparoscopic and laparotomic groups, respectively. Excluding the upstaged patients, no recurrence was observed in the present study, and the overall survival and 5-year survival rates were 100% in both the laparoscopy and laparotomy groups. Laparoscopic and laparotomic comprehensive staging of early ovarian cancer were similar in terms of staging adequacy, accuracy and survival rate. Laparoscopic staging was associated with a significantly reduced hospital stay. Prospective randomized trials are required to evaluate the overall oncologic outcomes. PMID:27196468

  5. Radical Hysterectomy for Early Stage Cervical Cancer: Laparoscopy Versus Laparotomy

    PubMed Central

    McBee, William C.; Richard, Scott D.; Edwards, Robert P.

    2011-01-01

    Objectives: Gynecologic oncologists have recently begun using laparoscopic techniques to treat early stage cervical cancer. We evaluated a single institution's experience of laparoscopic radical hysterectomy and staging compared with laparotomy. Methods: A retrospective chart review identified stage IA2 and IB1 cervical cancer patients who underwent laparoscopic radical hysterectomy and pelvic lymph node dissection from July 2003 to April 2009. A 2:1 cohort of patients treated with laparotomy were matched by stage. Results: Nine laparoscopic patients (3 stage IA2, 6 stage IB1) with 18 matched controls (6 and 12) were identified. Demographics for each group were similar. None had positive margins or lymph nodes. An average of 11.2 vs.13.9 pelvic lymph nodes (P=0.237) were removed. Average operating time was 231.7 vs. 207.2 minutes (P=0.434), and average estimated blood loss was 161.1 vs. 394.4mL (P=0.059). Average length of stay was 2.9 vs. 5.5 days (P=0.012). No transfusions or operative complications were noted in the laparoscopic group vs. 3 each in the open group (P=0.194). No laparoscopic patients and 5 open patients had a postoperative wound infection (P=0.079). No recurrences were noted. Conclusions: Laparoscopic radical hysterectomy is a feasible alternative to laparotomy for early stage cervical cancer. Similar surgical outcomes are achieved with significantly less morbidity. PMID:21902978

  6. Lesser sac endoscopy and laparoscopy in pancreatic carcinoma definitive diagnosis, staging and palliation.

    PubMed

    Charukhchyan, S A; Lucas, G W

    1998-09-01

    Laparoscopy with lesser sac endoscopy (LSE) were used in combination from 1987 to 1992 in 103 patients for differentiation between pancreatic carcinoma and other peripancreatic pathology, staging, and palliation. LSE identified pancreatic carcinoma in 38 patients; pancreatic cystadenocarcinoma in 2 patients; pancreatic cystadenoma in 3 patients; pancreatic adenoma in 1 patient; pancreatic metastases from liver in 2 patients; and pancreatic cysts in 5 patients. False negative diagnosis of pancreatic carcinoma occurred in two cases. Nontumor pancreatic pathology was revealed in 10 patients. Specifically, acute pancreatitis was found in four patients, and chronic pancreatitis was found in six patients. Extrapancreatic cancers were identified in 15 patients: retroperitoneal extraorgan tumors were found in 2 patients; extrahepatic biliary tract cancer in 6 patients; gallbladder cancer in 1 patient; liver cancer in 3 patients; and stomach cancer in 1 patient. In five cases no pathology was found. Overall correct definitive diagnosis was established in 101 patients. Sensitivity of laparoscopy with LSE for pancreatic carcinoma diagnosis proved to be 95 per cent (38 of 40 patients), for pancreatic tumors diagnosis 96.22 per cent (51 of 53 patients); specificity of the method 100 per cent; and accuracy of diagnosis 98 per cent (101 of 103 patients). Thus, the accuracy of the method was as high as the accuracy of combination of all known modalities. Criteria of unresectability were revealed with the combination of LSE and laparoscopy in 75 per cent (30 of 40 cases) of pancreatic carcinoma. Moreover, laparoscopy allowed palliation of pancreatic carcinoma. Laparoscopic cholecystostomy was performed in 10 patients, and laparoscopic cholecystojejunostomy with enteroenterostomy was performed in 6 patients.

  7. Laparoscopy-assisted orchiopexy versus laparoscopic two-stage fowler stephens orchiopexy for nonpalpable testes: Comparative study

    PubMed Central

    Alzahem, Abdulrahman

    2013-01-01

    Background/Purpose: To assess the outcome of the primary laparoscopy-assisted orchiopexy (LAO) and the laparoscopic two-stage Fowler Stephens orchiopexy (FSO) for managing patients with nonpalpable testis in terms of safety, feasibility and efficacy. Materials and Methods: This study included 94 patients (110 nonpalpable testes) who underwent laparoscopy at King Khalid University Hospital, Riyadh between July 1998 and June 2012. Patients were evaluated postoperatively to check the location and size of testes and to exclude any other complications. Results: Mean age at presentation was 24+/−19 months (9-96 months). Orchiectomy was done for 5 atrophic testes. 36 open orchiopexy was done for 29 canalicular testes and 7 peeping testes. 35 LAO were done for 1 canalicular testis, 5 peeping testes, 16 low intraabdominal testes and 13 high intraabdominal testes. 34 FSO were done for 23 high intraabdominal testes, 9 low intraabdominal testes and 2 peeping testes. Median follow up was 12 months (1-84 months) and 6 patients were lost to follow up. The overall success rates for LAO and FSO were 88% and 63%, respectively. Overall testicular atrophy rates were 3% and 30% for LAO and FSO, respectively (OR 0.08 [95% CI, 0.01-0.69], P = 0.006). For high intraabdominal testes, the atrophy rates were 3% and 20% for LAO and FSO, respectively (OR 0.14 [95% CI, 0.02-1.21, P = 0.049).Testicular displacement rates were 9% and 7% for LAO and FSO, respectively (OR 1.5, 95% CI, 0.24-9.59, P = 0.514). Conclusions: Laparoscopy provides a safe and accurate modality for diagnosing and managing patients with nonpalpable testes. LAO appears to be feasible and effective in management of high intraabdominal testes. Further well-conducted comparative studies are needed. PMID:23798870

  8. Non-Randomized Confirmatory Trial of Laparoscopy-Assisted Total Gastrectomy and Proximal Gastrectomy with Nodal Dissection for Clinical Stage I Gastric Cancer: Japan Clinical Oncology Group Study JCOG1401

    PubMed Central

    Kataoka, Kozo; Mizusawa, Junki; Katayama, Hiroshi; Nakamura, Kenichi; Morita, Shinji; Yoshikawa, Takaki; Ito, Seiji; Kinoshita, Takahiro; Fukagawa, Takeo; Sasako, Mitsuru

    2016-01-01

    Several prospective studies on laparoscopy-assisted distal gastrectomy for early gastric cancer have been initiated, but no prospective study evaluating laparoscopy-assisted total gastrectomy or laparoscopy-assisted proximal gastrectomy has been completed to date. A non-randomized confirmatory trial was commenced in April 2015 to evaluate the safety of laparoscopy-assisted total gastrectomy and laparoscopy-assisted proximal gastrectomy for clinical stage I gastric cancer. A total of 245 patients will be accrued from 42 Japanese institutions over 3 years. The primary endpoint is the proportion of patients with anastomotic leakage. The secondary endpoints are overall survival, relapse-free survival, proportion of patients with completed laparoscopy-assisted total gastrectomy or laparoscopy-assisted proximal gastrectomy, proportion of patients with conversion to open surgery, adverse events, and short-term clinical outcomes. The UMIN Clinical Trials Registry number is UMIN000017155. PMID:27433394

  9. Bilateral salpingo-oophorectomy and adhesiolysis with single port access laparoscopy and use of diode laser in a BRCA carrier.

    PubMed

    Angioni, S; Pontis, A; Sorrentino, F; Nappi, L

    2015-01-01

    Herein the authors report the first case of prophylactic bilateral salpingo-ovariectomy (BSO) in single port access laparoscopy (SPAL) with use of diode laser in a patient with BRCA1 mutation. As fimbria could be considered the site of origin for many serous carcinomas in BRCA mutation carriers, many studies are carried out to evaluate the possibility of preventing ovarian carcinoma with BSO. SPAL is a development of endoscopic surgery which further reduces invasiveness of surgical procedures. Diode laser presents a recognized precision for tissue cutting and coagulation and its use could be highly advantageous in SPAL surgery and in particular in such situations avoiding fallopian tube histology distortion and consequently improve the prognosis of BRCA carriers.

  10. Pelvic laparoscopy

    MedlinePlus

    ... cut in the skin below the belly button. Carbon dioxide gas is pumped into the abdomen to help ... appendectomy , removing lymph nodes) After the laparoscopy, the carbon dioxide gas is released, and the cuts are closed.

  11. Role of laparoscopy in hepatobiliary malignancies.

    PubMed

    Arumugam, Prabhu; Balarajah, Vickna; Watt, Jennifer; Abraham, Ajit T; Bhattacharya, Satyajit; Kocher, Hemant M

    2016-04-01

    The many benefits of laparoscopy, including smaller incision, reduced length of hospital stay and more rapid return to normal function, have seen its popularity grow in recent years. With concurrent improvements in non-surgical cancer management the importance of accurate staging is becoming increasingly important. There are two main applications of laparoscopic surgery in managing hepato-pancreatico-biliary (HPB) malignancy: accurate staging of disease and resection. We aim to summarize the use of laparoscopy in these contexts. The role of staging laparoscopy has become routine in certain cancers, in particular T[2] staged, locally advanced gastric cancer, hilar cholangiocarcinoma and non-Hodgkin's lymphoma. For other cancers, in particular colorectal, laparoscopy has now become the gold standard management for resection such that there is no role for stand-alone staging laparoscopy. In HPB cancers, although staging laparoscopy may play a role, with ever improving radiology, its role remains controversial. PMID:27377496

  12. Laparoscopy assisted distal gastrectomy for T1 to T2 stage gastric cancer: a pilot study of three ports technique.

    PubMed

    Amin, Anwar Tawfik; Gabr, Adel; Abbas, Hamza

    2015-03-01

    Laparoscopy assisted distal gastrectomy (LADG) was first reported in 1994. Since then, it has gradually gained maturity. This procedure is less invasive than conventional open gastrectomy, and the oncologic outcomes are comparable. Recently, single-incision laparoscopic surgery (SILS) has been developed, which seems to be less invasive than conventional laparoscopic surgery. However, SILS technique is characterized by a limited working area, crowding and crossing of instruments which make it difficult to be applied for oncologic gastrectomy. In a trial to overcome SILS difficulties, the authors report their initial clinical experience of LADG with D1 lymphadenectomy using a novel 3-ports technique. Twenty-one patients have been enrolled for 3-ports laparoscopic gastrectomy. The patient's demographic and perioperative data have been collected prospectively. The mean operative time in the first ten cases was 170 min and for the last eleven cases was 140 min (P = 0.01). The mean estimated blood loss was 65 ml. There was no use for additional ports or conversion to open surgery. There were no intra-operative major complications. The mean time for hospital stay was 9 days. One case of pneumonia and one death were the postoperative complications. The mean number of retrieved lymph nodes was 21 and all the cases had free surgical margin. Three-ports LADG with D1 lymphadenectomy could be a safe and oncologically feasible procedure; however, a prospective randomized controlled trial comparing three ports LADG with conventional multi-ports LADG is required. It is a step towards three-port total laparoscopic distal gastrectomy. PMID:25663585

  13. Difference of Postoperative Stool Frequency in Hirschsprung Disease According to Anastomosis Level in a Single-Stage, Laparoscopy-Assisted Transanal Endorectal Pull-Through Procedure

    PubMed Central

    Oh, Chaeyoun; Lee, Sanghoon; Lee, Suk-Koo; Seo, Jeong-Meen

    2016-01-01

    Abstract Anorectal innervation that governs sensation, motor function, and rectal accommodation can be influenced by the type of surgical procedure used to treat children with Hirschsprung disease. At our institution, we began to perform single-stage, laparoscopy-assisted transanal endorectal pull-through (LATEP) with submucosal dissection and anastomosis of the ganglionated bowel at 2 different levels relative to the dentate line. This retrospective study describes postoperative stool frequency changes in response to this procedure. Forty infants who underwent single-stage LATEP between September 2003 and April 2012 in a single center by the same surgeon were included in our analysis. The patients were divided in 2 groups: Group A (n = 23) underwent submucosal dissection and anastomosis at 2 mm above the dentate line, and Group B (n = 17) underwent the same procedure with anastomosis 15 mm above the dentate line. Clinical characteristics, clinical findings on the first postoperative visit, and instances of coexisting anomalies did not differ between the 2 groups. Aganglionic segments were found in the rectosigmoid colon in 18 cases (78.2%) in Group A and in 15 cases (88.2%) in Group B. Although the stool frequency was no different at 1, 3, 6, and 12 months after the operation, Group B showed significantly fewer bowel movements than Group A after 2 years (3.77 in Group A vs 2.0 in Group B; P = 0.035) and after 3 years (3.92 vs 1.29; P = 0.009) in patients who had aganglionosis of the rectosigmoid colon. The mean follow-up period was 65.87 ± 28.08 months for Group A and 35.59 ± 18.68 for Group B. The level of submucosal dissection and anastomosis in single-stage LATEP influenced the stool frequency in rectosigmoid aganglionosis. PMID:27057833

  14. [The role of laparoscopy in ovarian carcinoma].

    PubMed

    Angioli, R; Muzii, L; Battista, C; Terranova, C; Oronzi, I; Sereni, M I; De Oronzo, M A; Damiani, P; Collettini, F; Graziano, M; Benedetti Panici, P

    2009-02-01

    The role of minimally invasive surgery in the management of gynecologic cancers is continuously expanding. Although few trials have focused on the safety of laparoscopy in oncology, laparoscopy is now widely used for most gynecological malignancies. Laparoscopy is widely used to manage benign ovarian masses, but its role in managing ovarian cancer still needs to be defined. The role of laparoscopy in ovarian cancer surgery may be divided into three following categories: 1) laparoscopic staging of apparent early ovarian cancer; 2) laparoscopic assessment of disease extent and potential for resectability; 3) laparoscopic reassessment, or second-look operation, or rule out recurrence. Laparoscopic approach has shown several advantages like a reduction in operating time, blood loss, hospital stay, and total hospital charges. The limitations of laparoscopic practice include inadequate port-site metastasis, tumour dissemination due to cyst rupture and incomplete staging. In addition, there were limitations in performing extensive laparoscopic sampling of areas of tumor persistence including retroperitoneal lymph nodes. In literature there are no randomized studies assessing the use of laparoscopy in the management of ovarian cancer. Moreover, most of the studies in literature comparing laparoscopy and laparotomy are carried out by surgeons specialized in one of two approaches, so that the results can not be compared.

  15. Exotic Mammal Laparoscopy.

    PubMed

    Sladakovic, Izidora; Divers, Stephen J

    2016-01-01

    Laparoscopy is an evolving field in veterinary medicine, and there is an increased interest in using laparoscopic techniques in nondomestic mammals, including zoo animals, wildlife, and exotic pets. The aim of this article is to summarize the approach to laparoscopic procedures, including instrumentation, patient selection and preparation, and surgical approaches, and to review the current literature on laparoscopy in exotic mammals.

  16. Gasless balloon laparoscopy

    PubMed Central

    Lienert, Mark; Horstmann, Olaf

    2009-01-01

    Background The concept of balloon laparoscopy (B-LSC) pursues the simplification of conventional diagnostic laparoscopy (LSC). The pneumoperitoneum is replaced by a transparent balloon, which is positioned in front of the optical system. It shall be shown that with this arrangement diagnostic LSC can be performed outside of the operating room without requiring general anesthesia. Methods An inflatable balloon was developed for a 30°/3.5-mm rod lens. Intra-abdominally the balloon was expanded to a diameter of 30 mm by air insufflation, and B-LSC was performed. Twelve patients were examined in general anesthesia before laparoscopic surgery. Twelve patients were subjected to B-LSC fully awake or with sedation (midazolam or propofol/S-ketamine) as a “second-look” procedure by way of a flexible trocar (port) left in the abdominal wall at the end of previous operation. Eight patients have been first provided with a trocar under sedation (midazolam or propofol/S-ketamine) combined with local anesthesia, and B-LSC was performed before laparoscopic surgery. Results On a scale of 1–5, the general impression was rated 1.9, the navigability to the different abdominal organs 2.5, the resolution 1.5, the stability of the system optic/trocar 2.1, the suitability of the balloon format 1.9, and the stability of the balloon against lateral shear forces 2.4. The degree of painfulness of the examination was rated 2.8, the tolerance of the port 1.4, and the degree of painfulness of trocar placement at 2.5. On a scale of 1 to 3, the strain of the abdominal musculature was rated 1.4 and the obstruction by adhesions 1.7. Discussion B-LSC is technically practicable with good imaging qualities and without requiring pneumoperitoneum. It is tolerated in great extent under slight sedation and particularly well under deep sedation. The procedure is suitable for diagnostics of unclear abdominal conditions, as a second-look LSC and also as a staging LSC. PMID:20039067

  17. Large bowel injuries during gynecological laparoscopy

    PubMed Central

    Ülker, Kahraman; Anuk, Turgut; Bozkurt, Murat; Karasu, Yetkin

    2014-01-01

    Laparoscopy is one of the most frequently preferred surgical options in gynecological surgery and has advantages over laparotomy, including smaller surgical scars, faster recovery, less pain and earlier return of bowel functions. Generally, it is also accepted as safe and effective and patients tolerate it well. However, it is still an intra-abdominal procedure and has the similar potential risks of laparotomy, including injury of a vital structure, bleeding and infection. Besides the well-known risks of open surgery, laparoscopy also has its own unique risks related to abdominal access methods, pneumoperitoneum created to provide adequate operative space and the energy modalities used during the procedures. Bowel, bladder or major blood vessel injuries and passage of gas into the intravascular space may result from laparoscopic surgical technique. In addition, the risks of aspiration, respiratory dysfunction and cardiovascular dysfunction increase during laparoscopy. Large bowel injuries during laparoscopy are serious complications because 50% of bowel injuries and 60% of visceral injuries are undiagnosed at the time of primary surgery. A missed or delayed diagnosis increases the risk of bowel perforation and consequently sepsis and even death. In this paper, we aim to focus on large bowel injuries that happen during gynecological laparoscopy and review their diagnostic and management options. PMID:25516859

  18. Regional anesthesia for laparoscopy.

    PubMed

    Collins, L M; Vaghadia, H

    2001-03-01

    A variety of laparoscopic procedures can be performed on patients under regional anesthesia. Diagnostic laparoscopy in elective and emergency patients, pain mapping, laparoscopy for infertility, and tubal sterilization are some examples. The key benefits of regional anesthesia include less emesis, less postoperative pain, shorter postoperative stay, improved patient satisfaction, and overall safety. Regional techniques, such as rectus sheath blocks, inguinal blocks, and caudal blocks, are useful adjuncts to general anesthesia and facilitate postoperative analgesia. Other techniques, such as spinal and epidural anesthesia, and combination of the two, are suitable as a sole anesthetic technique for laparoscopy. The physiologic changes during laparoscopy in the awake patient appear to be tolerated well under regional anesthesia. It is reasonable to assume that with advances in instrumentation and surgical techniques, the role of laparoscopy will increase in the future. The benefits conferred by regional anesthesia make it an attractive option to general anesthesia for many patients and procedures. Successful implementation of regional anesthesia is an important determinant of how anesthesiologists, surgeons, and surgical facilities cope with new challenges. In the future, it could be possible to provide "walk-in/walk-out" regional anesthesia with a real possibility of fast tracking patients through the recovery process after ambulatory surgery. For maximal patient safety, however, facilities offering regional anesthesia must have appropriately trained anesthesia personnel and the equipment necessary for monitoring and providing full resuscitation in the event of complications or a need to convert to general anesthesia. PMID:11244919

  19. [Laparoscopy in the gynecologic clinic].

    PubMed

    Palatyński, A

    1992-11-01

    Three thousand and twelve (3012) diagnostic laparoscopies in children, girls and women were carried out during the period 1970--1992. The age of the patients was between 6--49 years. The present studies show that laparoscopy fills up the space between the clinical investigation and laparotomy probatoria. It helps to solve in a clear way, a lot of diagnostic problems in gynecology in adult women, in gynecology of developmental age and gynecological endocrinology. There were the following indications to laparoscopy: 1. Adnexitis chronica 2. Infertility-primary and secondary. 3. Unclear tumor and pelvic infections in adolescence. 4. Primary and secondary failure of ovaries. 5. Suspicion of polycystic ovaries. 6. Second look laparoscopy. 7. Suspicion of endometriosis. 8. Suspicion of ectopic pregnancy. 9. Developmental faults of sexual organs. 10. Pubertas praecox. PMID:1305570

  20. [Laparoscopy. Experience in 307 cases].

    PubMed

    Gutiérrez Rodríguez, L; Grau Cobos, L M; Pulido Moncayo, M; Padilla Monroy, F

    1990-01-01

    We performed 307 laparoscopies in 8 years. Most common indications were: Hepatic disorders 53% neoplasms 17%; therapeutical studies 7%. We made the first 4 cholecystectomies by laparoscopy in Mexico, without serious problems; 8 Tenckhoff catheters were collocated without surgical intervention; drainage of amebic abscess were done in 8 cases. In 18 patients the procedure was because of acute abdomen, being excluded this possibility in 8. Percutaneous cholangiography was done in 6. Our complications were minimal, non required surgical intervention. We did not have mortality among our patients by the procedure.

  1. Office laparoscopy under local anesthesia.

    PubMed

    Zacherl, A; Love, B; McCorvey, R

    1997-01-01

    It is no secret that health care has changed, and we must change with it. As equipment and drugs become more sophisticated, surgical procedures are becoming less complicated to perform, and patients are experiencing less morbidity and mortality. Industry is continually addressing the product needs of surgeons who are or will be performing office laparoscopy under local anesthesia so that it can be done with the greatest of ease and safety. Therefore, the environment in which surgical procedures are performed should become less technically complicated as well. As hospitals are downsizing and more and more procedures are moving into outpatient and office settings, there is a tremendous opportunity for nurses to assume the challenge of OLULA and expand their horizons in a new direction. There is no better time for nurses to use the professional skills they were educated for, that is, to provide continuous bedside nursing care for patients undergoing office laparoscopy under local anesthesia while maintaining the perioperative skills that they have grown to love. For more information about office laparoscopy, contact the American Association of Office Endoscopy, 3088 Rosa Parks Avenue, Montgomery, AL, 36105. Telephone: (334) 262-0259.

  2. Video stereo-laparoscopy system

    NASA Astrophysics Data System (ADS)

    Xiang, Yang; Hu, Jiasheng; Jiang, Huilin

    2006-01-01

    Minimally invasive surgery (MIS) has contributed significantly to patient care by reducing the morbidity associated with more invasive procedures. MIS procedures have become standard treatment for gallbladder disease and some abdominal malignancies. The imaging system has played a major role in the evolving field of minimally invasive surgery (MIS). The image need to have good resolution, large magnification, especially, the image need to have depth cue at the same time the image have no flicker and suit brightness. The video stereo-laparoscopy system can meet the demand of the doctors. This paper introduces the 3d video laparoscopy has those characteristic, field frequency: 100Hz, the depth space: 150mm, resolution: 10pl/mm. The work principle of the system is introduced in detail, and the optical system and time-division stereo-display system are described briefly in this paper. The system has focusing image lens, it can image on the CCD chip, the optical signal can change the video signal, and through A/D switch of the image processing system become the digital signal, then display the polarized image on the screen of the monitor through the liquid crystal shutters. The doctors with the polarized glasses can watch the 3D image without flicker of the tissue or organ. The 3D video laparoscope system has apply in the MIS field and praised by doctors. Contrast to the traditional 2D video laparoscopy system, it has some merit such as reducing the time of surgery, reducing the problem of surgery and the trained time.

  3. Laparoscopy in the morbidly obese: physiologic considerations and surgical techniques to optimize success.

    PubMed

    Scheib, Stacey A; Tanner, Edward; Green, Isabel C; Fader, Amanda N

    2014-01-01

    The objectives of this review were to analyze the literature describing the benefits of minimally invasive gynecologic surgery in obese women, to examine the physiologic considerations associated with obesity, and to describe surgical techniques that will enable surgeons to perform laparoscopy and robotic surgery successfully in obese patients. The Medline database was reviewed for all articles published in the English language between 1993 and 2013 containing the search terms "gynecologic laparoscopy" "laparoscopy," "minimally invasive surgery and obesity," "obesity," and "robotic surgery." The incidence of obesity is increasing in the United States, and in particular morbid obesity in women. Obesity is associated with a wide range of comorbid conditions that may affect perioperative outcomes including hypertension, atherosclerosis, angina, obstructive sleep apnea, and diabetes mellitus. In obese patients, laparoscopy or robotic surgery, compared with laparotomy, is associated with a shorter hospital stay, less postoperative pain, and fewer wound complications. Specific intra-abdominal access and trocar positioning techniques, as well as anesthetic maneuvers, improve the likelihood of success of laparoscopy in women with central adiposity. Performing gynecologic laparoscopy in the morbidly obese is no longer rare. Increases in the heaviest weight categories involve changes in clinical practice patterns. With comprehensive and thoughtful preoperative and surgical planning, minimally invasive gynecologic surgery may be performed safely and is of particular benefit in obese patients. PMID:24100146

  4. Laparoscopy

    MedlinePlus

    ... often can be removed during the same procedure. • Fibroids —Fibroids are growths that form inside the wall of the uterus or outside the uterus. Most fibroids are benign (not cancer), but a very small ...

  5. A Review of Equine Laparoscopy

    PubMed Central

    Hendrickson, Dean A.

    2012-01-01

    Minimally invasive surgery in the human was first identified in mid 900's. The procedure as is more commonly practiced now was first reported in 1912. There have been many advances and new techniques developed in the past 100 years. Equine laparoscopy, was first reported in the 1970's, and similarly has undergone much transformation in the last 40 years. It is now considered the standard of care in many surgical techniques such as cryptorchidectomy, ovariectomy, nephrosplenic space ablation, standing abdominal exploratory, and many other reproductive surgeries. This manuscript describes the history of minimally invasive surgery, and highlights many of the techniques that are currently performed in equine surgery. Special attention is given to instrumentation, ligating techniques, and the surgical principles of equine minimally invasive surgery. PMID:23762585

  6. Asymptomatic intraperitoneal ascariasis: Importance of diagnostic laparoscopy

    PubMed Central

    Anand, Santhosh; Sharma, Aditya P; Aggarwal, Sandeep; Nath, Devajit; Mathur, Sandeep

    2014-01-01

    Migration of Ascaris from intestine into peritoneal cavity is rare and usually presents as acute abdomen. We report a case of 41-year-old male who was admitted for laparoscopic mesh rectopexy for rectal prolapse. During the initial laparoscopy, purulent fluid was seen in pelvis. A complete diagnostic laparoscopy was done. An omental nodule was found, which was excised and extracted in a bag. On histopathology, the omental nodule revealed gravid Ascaris lumbricoides. PMID:25013334

  7. Laparoscopic Suturing Skills Acquisition: A Comparison Between Laparoscopy-Exposed and Laparoscopy-Naive Surgeons

    PubMed Central

    Tamang, Tseten; Misra, Mahesh C.; Prakash, Pradeep; Rajan, Karthik; Bhattacharjee, Hemanga K.; Kumar, Subodh; Goswami, Amit

    2012-01-01

    Background: Laparoscopic suturing is a difficult skill to master but can be acquired with extensive training outside the operating room. This study was done with the primary aim of assessing whether prior exposure to laparoscopic surgery helped trainees in acquiring laparoscopic suturing skills more quickly than trainees with no prior exposure to laparoscopic surgery. Materials and Methods: Twenty laparoscopy-exposed and 20 laparoscopy-naïve surgeons performed 5 laparoscopic gastrojejunostomies each on a phantom porcine model. The performance was evaluated for operation time, overall anastomotic score (calculated by adding scores of anastomotic leak, size of the anastomosis, suture placement, and mucosal approximation), and the level of difficulty. The performance at the beginning of training (baseline) was compared to the performance at the end of training. Results: All participants showed statistically significant improvement in operation time, overall anastomotic score, and difficulty level. Laparoscopy-exposed surgeons had a significantly better operation time than laparoscopy-naïve surgeons at the beginning of training; however, the difference became insignificant by the end of training. The difference in overall anastomotic score was not significant between laparoscopy-exposed and naïve-surgeons. Laparoscopy-exposed surgeons showed significant improvements in anastomotic leak rate and size of the anastomosis, whereas laparoscopy naïve surgeons showed improvements in all the parameters, although these were not significant statistically. Conclusion: Training improves the laparoscopic suturing skills of laparoscopy-exposed as well as laparoscopy-naïve surgeons. Prior experience in laparoscopic surgery does not seem to influence the acquisition of laparoscopic suturing skills as laparoscopic-naïve surgeons manage to catch up with the skills of the laparoscopy-exposed surgeons. PMID:23484575

  8. Lexical Access in Early Stages of Visual Word Processing: A Single-Trial Correlational MEG Study of Heteronym Recognition

    ERIC Educational Resources Information Center

    Solomyak, Olla; Marantz, Alec

    2009-01-01

    We present an MEG study of heteronym recognition, aiming to distinguish between two theories of lexical access: the "early access" theory, which entails that lexical access occurs at early (pre 200 ms) stages of processing, and the "late access" theory, which interprets this early activity as orthographic word-form identification rather than…

  9. Laparoscopy During Pregnancy: A Literature Review

    PubMed Central

    Tazuke, Salli; Nezhat, Ceana H.; Seidman, Daniel S.; Phillips, Douglas R.; Nezhat, Camran R.

    1997-01-01

    Objective: To review the literature regarding the role of laparoscopy during pregnancy, particularly adnexal mass and non-obstetric surgery, incorporating the results of a series of 9 cases of laparoscopy during pregnancy at our centers. Materials and Methods: A Medline search was performed to review the literature, and the reference lists provided by those articles were further explored for citations regarding laparoscopic adnexal surgery, appendectomy, and cholecystectomy. Our series of 9 patients consisted of pregnant patients with adnexal mass or acute abdomen who would otherwise have undergone exploratory laparotomy. Follow-up data for these 9 cases were collected by office visits, inquiry to the primary referring physicians, and telephone calls to the patient. Results: The literature search yielded 42 additional cases of operative pelvic laparoscopy and 51 cases of abdominal operative laparoscopy (cholecystectomy and appendectomy). The publications, particularly regarding cholecystectomy, were supportive of the laparoscopic approach during pregnancy. All of the patients in our series had favorable outcomes. Conclusions: Advanced operative laparoscopy has been successfully performed for certain indications during pregnancy. PMID:9876642

  10. Use of Laparoscopy in Pediatric Urology

    PubMed Central

    Kim, Christina; Docimo, Steven G

    2005-01-01

    The goal of laparoscopy is to minimize patient morbidity while maintaining successful outcomes. The use of laparoscopy in urology has grown significantly over the past 30 years. Its use has been slower to gain acceptance in pediatrics than in the adult population. Laparoscopic orchidopexies and nephrectomies are commonly performed and have become widely accepted as alternatives to open surgery, if not the gold standard. The more technically demanding procedures, such as laparoscopic pyeloplasty, laparoscopic-assisted bladder reconstruction, and laparoscopic ureteral reimplantation, tend to be performed at selected centers and have yet to achieve widespread acceptance. As laparoscopy is applied more widely in pediatric urology, its potential benefits and drawbacks will be clarified. PMID:16985833

  11. Pelvic meningocele can be missed during laparoscopy.

    PubMed

    Cheung, Vincent Y T; Rosenthal, David M

    2006-01-01

    Pelvic meningocele is an uncommon condition and is frequently asymptomatic. The diagnosis easily can be mistaken as ovarian cyst on pelvic sonography. In many reported cases, the diagnosis was made during laparotomy for presumed ovarian cysts. Myelography, computerized tomography (CT), or magnetic resonance imaging (MRI) is useful for definitive diagnosis. A 49-year-old woman, who had a normal diagnostic laparoscopy 3 years prior, was referred for a persistent ovarian cyst. Repeat laparoscopy revealed a retroperitoneal cyst in the left pelvic sidewall. Both ovaries and fallopian tubes were normal. Subsequent CT and MRI were used to diagnose pelvic meningocele. We speculate that pelvic meningoceles can be missed during laparoscopy due to the increased intraperitoneal pressure and the potential reduction in the cerebrospinal fluid pressure at the lumbosacral level.

  12. Motion Planning for a Three-Stage Multilumen Transoral Lung Access System

    PubMed Central

    Kuntz, Alan; Torres, Luis G.; Feins, Richard H.; Webster, Robert J.; Alterovitz, Ron

    2015-01-01

    Lung cancer is the leading cause of cancer-related death, and early-stage diagnosis is critical to survival. Biopsy is typically required for a definitive diagnosis, but current low-risk clinical options for lung biopsy cannot access all biopsy sites. We introduce a motion planner for a multilumen transoral lung access system, a new system that has the potential to perform safe biopsies anywhere in the lung, which could enable more effective early-stage diagnosis of lung cancer. The system consists of three stages in which a bronchoscope is deployed transorally to the lung, a concentric tube robot pierces through the bronchial tubes into the lung parenchyma, and a steerable needle deploys through a properly oriented concentric tube and steers through the lung parenchyma to the target site while avoiding anatomical obstacles such as significant blood vessels. A sampling-based motion planner computes actions for each stage of the system and considers the coupling of the stages in an efficient manner. We demonstrate the motion planner's fast performance and ability to compute plans with high clearance from obstacles in simulated anatomical scenarios. PMID:26942041

  13. Advancing frontiers in anaesthesiology with laparoscopy.

    PubMed

    Sood, Jayashree

    2014-10-21

    The introduction of laparoscopy in the surgeon's armamentarium was in fact a "revolution in the history of surgery". Since this technique involves insufflation of carbon dioxide it produces several pathophysiological changes which have to be understood by the anaesthesiologist who can modify the anaesthesia technique accordingly. Advantages of laparoscopy include reduced pain, small scars and early return to work. Certain complications specific to laparoscopic surgery are due to carboperitoneum and increased intra-abdominal pressure. Venous air embolism, although very rare, can be lethal if not managed promptly. Other complications include subcutaneous emphysema, haemodynamic compromise and arrhythmias. Although associated with minimal postoperative morbidity, postoperative pain, nausea and vomiting can be quite problematic. The limitations of laparoscopy have been overcome by the introduction of robotic surgery. There are important implications for the anaesthesiologist during robotic surgeries which have to be practiced accordingly. Robotic surgery has a learning curve for both the surgeon and the anaesthesiologist. The robot is bulky, and cannot be disengaged after docking. Therefore it is important that the anaesthetized patient remains immobile throughout surgery and anaesthesia is reversed only after the robot has been disengaged at the end of surgery. Advances in laparoscopy and robotic surgery have modified anaesthetic techniques too.

  14. Second-look laparoscopy after ectopic pregnancy.

    PubMed

    Lundorff, P; Thorburn, J; Lindblom, B

    1990-04-01

    During the 4-year period of 1984 to 1987, 102 women with ectopic pregnancy (EP) underwent second-look laparoscopy 6 to 10 weeks after EP surgery. Benefits of this procedure, e.g., adhesiolysis and/or selection of women for further fertility interventions (in vitro fertilization [IVF], gamete intrafallopian transfer [GIFT], tubal microsurgery), were evaluated. On the basis of the second-look laparoscopy, 13% of the women were offered tubal microsurgery and 14% recommended for IVF. Patients without risk factors for EP developed adhesions as frequently as those with known risk factors and no specific surgical procedure was correlated to impairment of the pelvic status. Almost 40% of the patients presented with an impairment of adhesions on the affected side compared with the status at the time of EP surgery. Lysis of adhesions was performed during the second-look laparoscopy in 42 patients (41%). We conclude that second-look laparoscopy should be recommended to all EP patients with a desire for pregnancy. PMID:2138569

  15. Pediatric laparoscopy: Facts and factitious claims

    PubMed Central

    Raveenthiran, V.

    2010-01-01

    Background: Pediatric laparoscopy (LS) is claimed to be superior to open surgery (OS). This review questions the scientific veracity of this assertion by systematic analysis of published evidences comparing LS versus OS in infants and children. Materials and Methods: Search of PubMed data base and the available literature on pediatric LS is analyzed. Results: One hundred and eight articles out of a total of 426 papers were studied in detail. Conclusions: High quality evidences indicate that LS is, at the best, as invasive as OS; and is at the worst, more invasive than conventional surgery. There are no high quality evidences to suggest that LS is minimally invasive, economically profitable and is associated with fewer complications than OS. Evidences are equally distributed for and against the benefits of LS regarding postoperative pain. Proof of cosmetic superiority of LS or otherwise is not available. The author concludes that pediatric laparoscopy, at the best, is simply comparable to laparotomy and its superiority over the latter could not be sustained on the basis of available scientific evidences. Benefits of laparoscopy appear to recede with younger age. Concerns are raised on the quick adoption, undue promotion and frequent misuse of laparoscopy in children. PMID:21170193

  16. [Anesthesia for laparoscopy in sterile patients].

    PubMed

    Schönrath, B; Borgwardt, D; Langanke, D; Alexander, H; Baier, D; Haake, K W

    1990-01-01

    During 5 years 382 laparoscopies were carried through in female patients with sterility in different kinds of anaesthesia (Intubation anaesthesia, spinal anaesthesia, and i.v. anaesthesia). We found the most advantageous results in the cases of i.v. anaesthesia with Ketamin and Diazepam.

  17. Advancing frontiers in anaesthesiology with laparoscopy.

    PubMed

    Sood, Jayashree

    2014-10-21

    The introduction of laparoscopy in the surgeon's armamentarium was in fact a "revolution in the history of surgery". Since this technique involves insufflation of carbon dioxide it produces several pathophysiological changes which have to be understood by the anaesthesiologist who can modify the anaesthesia technique accordingly. Advantages of laparoscopy include reduced pain, small scars and early return to work. Certain complications specific to laparoscopic surgery are due to carboperitoneum and increased intra-abdominal pressure. Venous air embolism, although very rare, can be lethal if not managed promptly. Other complications include subcutaneous emphysema, haemodynamic compromise and arrhythmias. Although associated with minimal postoperative morbidity, postoperative pain, nausea and vomiting can be quite problematic. The limitations of laparoscopy have been overcome by the introduction of robotic surgery. There are important implications for the anaesthesiologist during robotic surgeries which have to be practiced accordingly. Robotic surgery has a learning curve for both the surgeon and the anaesthesiologist. The robot is bulky, and cannot be disengaged after docking. Therefore it is important that the anaesthetized patient remains immobile throughout surgery and anaesthesia is reversed only after the robot has been disengaged at the end of surgery. Advances in laparoscopy and robotic surgery have modified anaesthetic techniques too. PMID:25339818

  18. End-stage renal disease (ESRD) and vascular access grafting: a critical review.

    PubMed

    Szycher, M

    1999-04-01

    End-Stage Renal Disease (ESRD) is a major disease state, costing the U.S. $9.5 billion in 1992, and increasing 10% yearly. The growth in the number of ESRD patients can be attributed principally to demographic trends: the aging of the general population and the improved treatment and increased survival rate of patients with diabetes, hypertension, and other illnesses that lead to ESRD. Moreover, improved dialysis technology has enabled older patients and those who previously could not tolerate dialysis due to other illnesses to benefit from this treatment. Three modalities exist for the treatment of ESRD: hemodialysis, peritoneal dialysis, and kidney transplant. This article reviews the medical treatments and the synthetic polymers used in the manufacture of vascular access grafts. We report on the development of a new, polyurethane-based microporous vascular graft, which displays self-sealing and improved compliance characteristics for use in vascular access grafting.

  19. Use of laparoscopy as the initial surgical approach of impalpable testes: 10-year experience

    PubMed Central

    Chan, Kin Wai Edwin; Lee, Kim Hung; Wong, Hei Yi Vicky; Tsui, Siu Yan Bess; Wong, Yuen Shan; Pang, Kit Yi Kristine; Mou, Jennifer Wai Cheung; Tam, Yuk Him

    2015-01-01

    AIM: To review the experience in the management of impalpable testes using laparoscopy as the initial approach and the need for inguinal exploration. METHODS: From January 2004 to June 2014, 339 patients with undescended testes underwent operation in our institute. Fifty patients (15%) had impalpable testes. All children with impalpable testes underwent initial laparoscopy. A retrospective review was conducted on this group of patients and the outcome was analyzed. RESULTS: Forty children had unilateral impalpable testis. Ten children had bilateral impalpable testes. Thirty-one children (78%) in the unilateral group underwent subsequent inguinal exploration while 4 children (40%) in the bilateral group underwent inguinal exploration (P < 0.05). Orchidopexy was performed in 16 children (40%) in the unilateral group and 9 children (90%) in the bilateral group (P < 0.05). Regarding the 24 children with unilateral impalpable testis and underwent orchidectomy for testicular nubbin (n = 19) or atrophic testes (n = 2) or has vanishing testes (n = 3); contralateral testicular hypertrophy was noticed in 10 (41%). No intra-operative complication was encountered. Two children after staged Fowler-Stephens procedure and 1 child after inguinal orchidopexy had atrophic testes. CONCLUSION: The use of laparoscopy in children with impalpable testes is a safe procedure and can guide the need for subsequent inguinal exploration. Children with unilateral impalpable testis were associated with an increased need for inguinal exploration after laparoscopy. Orchidopexies could be performed successfully in 90% of children with bilateral impalpable testes. PMID:26566489

  20. Laparoscopy for resolving Müllerian abnormalities.

    PubMed

    Motashaw, N D; Dastur, A; Vaidya, R A; Aloorkar, M

    1978-07-01

    One hundred thirty-five patients with various müllerian abnormalities underwent laparoscopy. At a glance the precise malformation was diagnosed correctly: 44 patients revealed a complete absence of the müllerian system; 35 were found to have a transverse ridge across the pelvis, the lateral ends of which were well developed; 33 patients had rudimentary uteri; 7, a median müllerian nodule; 5 belonged to the group with the testicular feminization syndrome; 4 were classified as having a bicornuate uterus; 3 had unicornuate uteri; and 3, septate uteri. One rare variety of müllerian abnormality is also described. Laparoscopy was found to be invaluable in the diagnosis of müllerian abnormalities.

  1. [Gynecologic laparoscopy at the ABC Hospital. Analysis of 882 cases].

    PubMed

    Díaz Argüello, D; Barrón Vallejo, J; Rojas Poceros, G; Kably Ambe, A

    1998-10-01

    The objective was to evaluate the indications and clinical evolution of patients treated with laparoscopy. Eight hundred eighty two women undergoing conventional laparoscopy for gynecological pathology, patients were not preselected, preoperative and postoperative data were registered retrospectively. Main indications to perform laparoscopy were dismenorrhea and infertility. Endometriosis and pelvic adhesions were the most frequent findings detected in the study subjects. Endoscopic treatment resulted in minimal complications and short postoperative stay. As conclusion classic laparoscopy is a safe and efficacious technique for treatment gynecological pathology.

  2. Laparoscopy in trauma: An overview of complications and related topics

    PubMed Central

    Kindel, Tammy; Latchana, Nicholas; Swaroop, Mamta; Chaudhry, Umer I; Noria, Sabrena F; Choron, Rachel L; Seamon, Mark J; Lin, Maggie J; Mao, Melissa; Cipolla, James; El Chaar, Maher; Scantling, Dane; Martin, Niels D; Evans, David C; Papadimos, Thomas J; Stawicki, Stanislaw P

    2015-01-01

    The introduction of laparoscopy has provided trauma surgeons with a valuable diagnostic and, at times, therapeutic option. The minimally invasive nature of laparoscopic surgery, combined with potentially quicker postoperative recovery, simplified wound care, as well as a growing number of viable intraoperative therapeutic modalities, presents an attractive alternative for many traumatologists when managing hemodynamically stable patients with selected penetrating and blunt traumatic abdominal injuries. At the same time, laparoscopy has its own unique complication profile. This article provides an overview of potential complications associated with diagnostic and therapeutic laparoscopy in trauma, focusing on practical aspects of identification and management of laparoscopy-related adverse events. PMID:26557490

  3. Geographic variation in end-stage renal disease incidence and access to deceased donor kidney transplantation.

    PubMed

    Mathur, A K; Ashby, V B; Sands, R L; Wolfe, R A

    2010-04-01

    The effect of demand for kidney transplantation, measured by end-stage renal disease (ESRD) incidence, on access to transplantation is unknown. Using data from the U.S. Census Bureau, Centers for Medicare & Medicaid Services (CMS) and the Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients (OPTN/SRTR) from 2000 to 2008, we performed donation service area (DSA) and patient-level regression analyses to assess the effect of ESRD incidence on access to the kidney waiting list and deceased donor kidney transplantation. In DSAs, ESRD incidence increased with greater density of high ESRD incidence racial groups (African Americans and Native Americans). Wait-list and transplant rates were relatively lower in high ESRD incidence DSAs, but wait-list rates were not drastically affected by ESRD incidence at the patient level. Compared to low ESRD areas, high ESRD areas were associated with lower adjusted transplant rates among all ESRD patients (RR 0.68, 95% CI 0.66-0.70). Patients living in medium and high ESRD areas had lower transplant rates from the waiting list compared to those in low ESRD areas (medium: RR 0.68, 95% CI 0.66-0.69; high: RR 0.63, 95% CI 0.61-0.65). Geographic variation in access to kidney transplant is in part mediated by local ESRD incidence, which has implications for allocation policy development.

  4. Geographic access to mammography and its relationship to breast cancer screening and stage at diagnosis: a systematic review

    PubMed Central

    Khan-Gates, Jenna A.; Ersek, Jennifer L.; Eberth, Jan M.; Adams, Swann A.; Pruitt, Sandi

    2016-01-01

    Introduction A review was conducted to summarize the current evidence and gaps in the literature on geographic access to mammography and its relationship to breast cancer-related outcomes. Methods Ovid Medline and PubMed were searched for articles published between January 1, 2000 and April 1, 2013 using Medical Subject Headings and key terms representing geographic accessibility and breast cancer-related outcomes. Due to a paucity of breast cancer treatment and mortality outcomes meeting the criteria (N=6), outcomes were restricted to breast cancer screening and stage at diagnosis. Studies included one or more of the following types of geographic accessibility measures: capacity, density, distance and travel time. Study findings were grouped by outcome and type of geographic measure. Results Twenty-one articles met inclusion criteria. Fourteen articles included stage at diagnosis as an outcome, five included mammography utilization, and two included both. Geographic measures of mammography accessibility varied widely across studies. Findings also varied, but most articles found either increased geographic access to mammography associated with increased utilization and decreased late-stage at diagnosis or no statistically significant association. Conclusion The gaps and methodologic heterogeneity in the literature to date limit definitive conclusions about an underlying association between geographic mammography access and breast cancer-related outcomes. Future studies should focus on the development and application of more precise and consistent measures of geographic access to mammography. PMID:26219677

  5. Pulmonary Hypertension Among End-Stage Renal Failure Patients Following Hemodialysis Access Thrombectomy

    SciTech Connect

    Harp, Richard J.; Stavropoulos, S. William; Wasserstein, Alan G.; Clark, Timothy W.I.

    2005-01-15

    Purpose: Percutaneous hemodialysis thrombectomy causes subclinical pulmonary emboli without short-term clinical consequence; the long-term effects on the pulmonary arterial vasculature are unknown. We compared the prevalence of pulmonary hypertension between patients who underwent one or more hemodialysis access thrombectomy procedures with controls without prior thrombectomy.Methods: A retrospective case-control study was performed. Cases (n = 88) had undergone one or more hemodialysis graft thrombectomy procedures, with subsequent echocardiography during routine investigation of comorbid cardiovascular disease. Cases were compared with controls without end-stage renal disease (ESRD) (n = 100, group 1), and controls with ESRD but no prior thrombectomy procedures (n = 117, group 2). The presence and velocity of tricuspid regurgitation on echocardiography was used to determine the prevalence and grade of pulmonary hypertension; these were compared between cases and controls using the chi-square test and logistic regression.Results: The prevalence of pulmonary hypertension among cases was 52% (46/88), consisting of mild, moderate and severe in 26% (n = 23), 10% (n = 9) and 16% (n = 14), respectively. Prevalence of pulmonary hypertension among group 1 controls was 26% (26/100), consisting of mild, moderate and severe pulmonary hypertension in 14%, 5% and 7%, respectively. Cases had 2.7 times greater odds of having pulmonary hypertension than group 1 controls (p = 0.002). The prevalence of pulmonary hypertension among group 2 controls was 42% (49/117), consisting of mild, moderate and severe pulmonary arterial hypertension in 25% (n = 49), 10% (n = 12) and 4% (n = 5), respectively. Cases were slightly more likely to have pulmonary hypertension than group 2 controls (OR = 1.5), although this failed to reach statistical significance (p = 0.14).Conclusion: Prior hemodialysis access thrombectomy does not appear to be a risk factor for pulmonary arterial hypertension

  6. Excision of the urachal remnant using the abdominal wall-lift laparoscopy: A case report

    PubMed Central

    Kobayashi, Kosuke; Sasaki, Kazuhito; Iijima, Tatsuo; Yoshimi, Fuyo; Nagai, Hideo

    2016-01-01

    Introduction Here, we report the surgical excision of the urachal remnant using the abdominal wall-lift laparoscopy with a camera port in the umbilicus, combined with a small Pfannenstiel incision to optimally treat the bladder apex. Presentation of case A 21-year-old woman presented with periumbilical discharge and pain on urination. Contrast enhanced CT and MRI showed an abscess in the umbilical region that was connected to the bladder via a long tube-like structure. It was diagnosed as an infected urachal sinus. Partial excision of the umbilical fossa followed by dissection of the urachal remnant was easily performed using the abdominal wall-lift laparoscopy from the umbilicus down to the bladder without pneumoperitoneum or additional trocar placement. A Pfannenstiel incision was made above the pubis to get access to the junction between the urachal remnant and the bladder. Under direct vision, we succeeded in accurately dividing the remnant tract, and we adequately closed the bladder opening with absorbable sutures. This method has the advantage of easily closing peritoneal defects after excision of the urachal remnant with direct sutures under a laparoscopic view from the umbilicus. Cosmetic satisfaction was obtained postoperatively. Discussion and conclusion Urachal sinus excision using the abdominal wall-lift laparoscopy seems to surpass the previously reported methods in term of safety, cosmetics, and adequacy of surgical procedures. PMID:27064744

  7. [Dimitrij Oscarovic Ott (1855-1929) "Ventroscopy" : His contribution to development of laparoscopy].

    PubMed

    Hatzinger, M; Fesenko, A; Büger, L; Sohn, M

    2013-10-01

    Dimitri Oscarovic Ott (1855-1929) can be justified in calling himself one of the true pioneers of laparoscopy and especially of natural orifices transluminal endoscopic surgery (NOTES). As early as 1901 he performed abdominal examinations via a transvaginal access and called this procedure ventroscopy. The publication of his first results and a description of the method and equipment were released in 1902. He was one of the pioneers of present day laparoscopy in addition to Georg Kelling (1866-1945) and Hans Christian Jacobaeus (1879-1937).While Kelling published and presented his first results of animal trials in 1901 and 9 years later in 1910 Jacobaeus performed his first interventions on human beings, Ott had already used the new method developed by him in clinical practice since 1901. Through a single incision in the cul-de-sac and using a head lamp system similar to reflector lamps used by otolaryngologists, he inspected the abdominal cavity with the aid of a gynecological speculum. The patient was positioned in an extreme head-down position and for better lighting he used an additional light source which was connected to the speculum. Even today Prof. Ott is a legend in Russia and especially in St. Petersburg. He was director of the National Institute of Obstetrics and personal physician to Tsarina Aleksandra Fedorovna (1874-1918). He is regarded as the father of the Russian school of obstetrics and gynecology as well as founder of endoscopic surgery and laparoscopy in Russia. PMID:23811726

  8. The first human laparoscopy and NOTES operation: Dimitrij Oscarovic Ott (1855-1929).

    PubMed

    Hatzinger, Martin; Fesenko, Alexander; Sohn, Michael

    2014-01-01

    Dimitrij Oscarovic Ott (1855-1929) can undoubtedly be called the true pioneer of laparoscopy, especially of natural orifice transluminal endoscopic surgery. In 1901 already he performed abdominal examinations via a transvaginal access calling this procedure 'ventroscopy'. In 1902 the publication of his first results, as well as a description of the method and the equipment used, were released. In addition to Georg Kelling (1866-1945) and Hans Christian Jacobaeus (1879-1937), he therefore was one of the pioneers of present-day laparoscopy. Whereas Kelling published and presented his first results of merely animal trials in 1901 and Jacobaeus performed his first interventions on humans only in 1910, Ott had already used his new method in clinical practice since 1901. By only one incision in the cul-de-sac and utilizing a head lamp system similar to reflector lamps used by otolaryngologists, he inspected the abdominal cavity making use of a gynecological speculum. The patient was positioned in an extreme head-down position; for better lighting he used an additional light source which was connected to the speculum. Nowadays in Russia Prof. Ott still is a legend, especially in St. Petersburg. He was the director of the National Institute of Obstetrics and the personal physician to Empress Aleksandra Fedorovna (1872-1918). He is regarded as the father of the Russian school of obstetrics and gynecology as well as the founder of endoscopic surgery and laparoscopy in Russia. PMID:24852454

  9. Laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography in bariatric Roux-en-Y gastric bypass patients

    PubMed Central

    Snauwaert, Christophe; Laukens, Pierre; Dillemans, Bruno; Himpens, Jacques; De Looze, Danny; Deprez, Pierre Henri; Badaoui, Abdenor

    2015-01-01

    Background: Performing endoscopic retrograde cholangiopancreatography in bariatric patients who underwent Roux-en-Y gastric bypass surgery is challenging due to the long anatomical route required to reach the biliopancreatic limb. Aim: Assessment of the feasibility and performance of laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography. Methods: A retrospective multicenter observational consecutive-patient cohort study of all patients in the period May 2008 to September 2014 with a history of Roux-en-Y gastric bypass who presented with complicated biliary disease and who underwent a laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography. The laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography procedure was similar in all centers and was performed through a 15 mm or 18 mm trocar that was inserted in the gastric remnant. Cholecystectomy was performed concomitantly when indicated. Results: In total, 23 patients underwent a laparoscopy-assisted transgastric endoscopic retrograde cholangiopancreatography procedure. Two patients required a mini-laparotomy for transgastric access because of a complex surgical history resulting in multiple adhesions. Indications included ascending cholangitis, choledocholithiasis, and biliary pancreatitis. Of the 23 patients, 13 underwent concomitant cholecystectomy. All patients successfully underwent biliary cannulation and sphincterotomy. No endoscopic procedure-related complications (i. e. bleeding, pancreatitis or retroperitoneal perforation) occurred. Mean hospital stay was 2.8 days (range 2 – 4). Conclusions: Transgastric endoscopic retrograde cholangiopancreatography is a feasible approach in the treatment of pancreaticobiliary disease in Roux-en-Y gastric bypass patients, without major complications in our series and allows endoscopic treatment and cholecystectomy to be performed consecutively in a single procedure. In Roux-en-Y gastric

  10. Virtual Reality Simulation of Gynecologic Laparoscopy

    PubMed

    Bernstein

    1996-08-01

    Realistic virtual simulation of gynecologic laparoscopy would permit the surgeon to practice any procedure, with any degree of pathology, at any time and as many times as necessary to achieve proficiency before attempting it in the operating room. Effective computer simulation requires accurate anatomy, realistic three-dimensional computer graphics, the ability to cut and deform tissue in response to instruments, and an appropriate hardware interface. The Visible Human Project from the National Library of Medicine has made available extremely accurate, three-dimensional, digital data that computer animation companies have begun to transform to three-dimensional graphic images. The problem of tissue deformation and movement is approached by a software package called TELEOS. Hardware consisting of two scissor-grip laparoscopic handles mounted on a sensor can interface with any simulation program to simulate a multiplicity of laparoscopic instruments. The next step will be to combine TELEOS with the three-dimensional anatomy data and configure it for gynecologic surgery.

  11. Tissue identification during Pneumoperitoneum in laparoscopy

    NASA Astrophysics Data System (ADS)

    Chang, Yin; Tseng, Chi-Yang

    2015-03-01

    Pneumoperitoneum is the beginning procedure of laparoscopy to enlarge the abdominal cavity in order to allow the surgical instruments to insert for surgical purpose. However, the insertion of Veress needle is a blind fashion that could cause blood vessels or visceral injury without attention and results in undetectable internal bleeding. Seriously it may cause a life-threatened complication. We have developed a method that can monitor the tissue reflective spectrum, which can be used for tissue discrimination, in real time during the puncture of the Veress needle. The system includes a modified Veress needle which containes an optical bundle, a light spectrum analyzing and control unit. Therefore, the tissue reflective spectrum can be vivid observed and analyzed through the fiber optical technology during the procedure of the Veress needle insertion. In this study, we have measured the reflective spectra of various porcine abdominal tissues. The features of their spectra were analyzed and characterized to build up the data base and create an algorithm for tissue discrimination in laparoscopy. The results showed that the correlation coefficient (r) of the reflective spectrum can be 0.79-0.95 for the wavelength range of 350-1000 nm and 0.85-0.98 for the wavelength range of 350-650 nm in the same tissue of various samples which were obtained from different days. An alternative way for tissue discrimination is achieved through a decision making tree according to the characteristics of tissue spectrum. For single blind test the success rate is nearly 100%. It seems that both the algorithms mentioned above for tissue discrimination are all very promising. Therefore, these algorithms will be applied to in vivo study in animal in the near future.

  12. [The role of laparoscopy in emergency abdominal surgery].

    PubMed

    Balén, E; Herrera, J; Miranda, C; Tarifa, A; Zazpe, C; Lera, J M

    2005-01-01

    Abdominal emergencies can also be operated on through the laparoscopic approach: the approach can be diagnostic laparoscopy, surgery assisted by laparoscopy or laparotomy directed according to the findings of the laparoscopy. The general contraindications refer above all to the state of haemodynamic instability of the patient and to seriously ill patients (ASA IV). In the absence of any specific counter-indications for the specific laparoscopic procedure to be carried out, many abdominal diseases requiring emergency surgery can be performed with the laparoscopic approach. The most frequent indications are appendicitis, acute colecistitis, gastroduodenal perforation, occlusion of the small intestine, and some abdominal traumas. With a correct selection of patients and the appropriate experience of the surgeon, the results are excellent and better than open surgery (less infection of the wound, complications, hospital stay and postoperative pain). A detailed explanation is given of the basic aspects of the surgical technique in the most frequent procedures of emergency laparoscopy.

  13. [Significant laparoscopy and ultrasound findings in chronic hepatic porphyria].

    PubMed

    Fengler, J D; Binus, R; Hintsche-Kilger, B; Baumgarten, R

    1990-09-01

    In the years from 1983 to 1989 we diagnosed in altogether 69 patients a chronic hepatic porphyria. As a rule the light microscopic and sonographic findings in the liver use to be uncharacteristic. Yet, unexpectedly by sonography in eight patients findings, suspicious for metastases, were stated. Multiple coin lesions with a marginal edge mostly rich in echoes were impressing. The laparoscopy resulted in grey/blue-discoloured depressions in an otherwise even surface of the liver, thus suggesting mass necroses respectively rebuilding processes. Subclinical stages of a chronic hepatic porphyria could have been proved by the partial red-fluorescence of bioptates and a corresponding porphyrin secretion. The histological changes of the liver were--in contrary to the impressing laparoscopic picture--rather insignificant. In case of a successful intervention the pathological porphyrin secretion was done in about eight months. Mostly, more than a year used to pass away till the sonographic findings normalized. The seldom described phenomena use to conceal the danger of a false interpretation and an unnecessary stress for the patient. More over the causes and the development of these peculiar porphyria findings are unclear; they need in an discussion among medical special branches.

  14. A wireless robot for networked laparoscopy.

    PubMed

    Castro, Cristian A; Alqassis, Adham; Smith, Sara; Ketterl, Thomas; Sun, Yu; Ross, Sharona; Rosemurgy, Alexander; Savage, Peter P; Gitlin, Richard D

    2013-04-01

    State-of-the-art laparoscopes for minimally invasive abdominal surgery are encumbered by cabling for power, video, and light sources. Although these laparoscopes provide good image quality, they interfere with surgical instruments, occupy a trocar port, require an assistant in the operating room to control the scope, have a very limited field of view, and are expensive. MARVEL is a wireless Miniature Anchored Robotic Videoscope for Expedited Laparoscopy that addresses these limitations by providing an inexpensive in vivo wireless camera module (CM) that eliminates the surgical-tool bottleneck experienced by surgeons in current laparoscopic endoscopic single-site (LESS) procedures. The MARVEL system includes 1) multiple CMs that feature a wirelessly controlled pan/tilt camera platform, which enable a full hemisphere field of view inside the abdominal cavity, wirelessly adjustable focus, and a multiwavelength illumination control system; 2) a master control module that provides a near-zero latency video wireless communications link, independent wireless control for multiple MARVEL CMs, digital zoom; and 3) a wireless human-machine interface that gives the surgeon full control over CM functionality. The research reported in this paper is the first step in developing a suite of semiautonomous wirelessly controlled and networked robotic cyber-physical devices to enable a paradigm shift in minimally invasive surgery and other domains such as wireless body area networks. PMID:23232365

  15. Indications and general techniques for lasers in advanced operative laparoscopy.

    PubMed

    Dorsey, J H

    1991-09-01

    Lasers are but one of the several energy delivery systems used by the operative laparoscopist in the performance of advanced operative laparoscopy. Safety is a key factor in the selection of a laser because the tissue damage produced by this instrument is absolutely predictable. The surgeon must be totally familiar with the chosen wavelength and its tissue reaction if this safety factor is to be realized. Other instruments complement the use of lasers in advanced operative laparoscopy, and without thorough knowledge of all available techniques and instruments, the operative laparoscopist will not achieve the full potential of this specialty. It is beyond the scope of this issue on gynecologic laser surgery to present all of the useful nonlaser techniques. Suffice it to say that we often use laser, loop ligature, sutures, hemoclips, bipolar electricity, hydrodissection, and endocoagulation during the course of a day in the operating room and sometimes during one case. As enthusiasm for advanced operative laparoscopy grows and endoscopic capability increases, more complicated and prolonged surgical feats are reported. Radical hysterectomy and lymphadenectomy have been performed by the laparoscopic route, and endoscopic management of ovarian tumors also has been reported. At this moment, these must be viewed as "show and tell" procedures unsupported by statistics to demonstrate any advantage (or disadvantage) when compared with conventional surgical methods. The time required of advanced operative laparoscopy for any given procedure is certainly an important factor. Prolonged operative and anesthesia time certainly can negate the supposed benefit of small incisions and minimally invasive surgery. What goes on inside the abdomen is certainly the most important part of advanced operative laparoscopy. Good surgeons must recognize their own limitations and the limitations of available technology. The operative laparoscopist must know when to quit and institute a

  16. Diagnostic Laparoscopy in the Pre-operative Assessment of Patients Undergoing Cytoreductive Surgery and HIPEC for Peritoneal Surface Malignancies.

    PubMed

    Seshadri, Ramakrishnan Ayloor; Hemanth Raj E

    2016-06-01

    The introduction of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has led to an improvement in the survival of select patients with peritoneal surface malignancies (PSM). However, it is important to carefully identify patients who will benefit from this procedure and to avoid an unnecessary laparotomy in those who will not. The currently available imaging modalities are unable to accurately predict the peritoneal cancer index (PCI) score or the completeness of cytoreduction. In this article, we review the current status of staging laparoscopy in the assessment of patients with PSM who are planned for CRS & HIPEC. We discuss the patient selection, techniques, complications and efficacy of staging laparoscopy. To summarise, staging laparoscopy is a safe and feasible method of pre-operative assessment of patients with PSM. It has a high sensitivity and positive predictive value in identifying patients who can undergo a complete cytoreduction, thereby preventing many patients from undergoing an unnecessary laparotomy. With the exception of pseudomyxoma peritonei, it should be considered as a part of the routine assessment of patients with PSM who are being considered for CRS & HIPEC. PMID:27065714

  17. Technical efficiency of Critical Access Hospitals: an application of the two-stage approach with double bootstrap.

    PubMed

    Nedelea, Iustin Cristian; Fannin, James Matthew

    2013-03-01

    The Critical Access Hospital (CAH) Program has offered Medicare cost-based reimbursement to small hospitals that meet certain eligibility criteria to improve their financial viability and quality of care. However, cost-based reimbursement has been associated with inefficiency in hospital operations. This study uses a two-stage approach and bootstrap procedures to examine the effects of environmental variables on the technical efficiency of CAHs. The two-stage approach with quality controls significantly improved statistical efficiency of parameter estimates in the second stage bootstrapped truncated regression relative to a similar model without quality controls. Overall, our results suggest that enhanced Medicare reimbursement may not have had detrimental effects on the technical efficiency of CAHs.

  18. Laser laparoscopy in the treatment of polycystic ovarian disease

    NASA Astrophysics Data System (ADS)

    Mutrynowski, Andrzej; Zabielska, Renata

    1996-03-01

    A polycystic ovaries disease occurs in the case of women with anovulatory cycles as the result of neurohormonal disorders. Patients with this disease suffer from infertility and many symptoms, such as: irregular menstrual bleeding, hirsutism, obesity. The paper presents a method of the carbon dioxide laser laparoscopy in the polycystic ovary disease treatment. The study included 96 women operated on (carbon dioxide laser laparoscopy) in the II Clinic Of Obstetric and Gynecology in Warsaw. Each woman measured her body temperature in order to evaluate her menstrual cycle and had vaginal USG examination or a cytohormonal one before laparoscopy and within 6 months after the surgery. Performing the laparoscopy the operator punctured each ovary in at least 15 points using the carbon dioxide laser. The patients were followed-up for 6 months. The Chi test was used to make the statistic analysis. Comparing the percent of ovulatory cycles and regular ones before and after surgery we noticed that the differences were statistically relevant. Eighty-five patients (88%) had regular cycles and in 88 cases (92%) there was a diphasic curve of the body temperature after the laparoscopy. Fourteen percent of infertile women with polycystic ovary disease conceived.

  19. Healthcare systems and end-stage renal disease (ESRD) therapies--an international review: access to ESRD treatments.

    PubMed

    Hörl, W H; de Alvaro, F; Williams, P F

    1999-01-01

    Assessment of healthcare technology and economics can be used to assess the access to healthcare, its quality and efficacy as well as its cost and cost efficiency. This report addresses these issues for the provision of care for end-stage renal disease (ESRD) patients. An international comparison of access to ESRD treatment modalities was made with reference to the healthcare provider structure in a range of industrial countries. The countries were grouped into 'public' (Beveridge model), 'mixed' (Bismarck model) and 'private' (Private Insurance model). In 'public' provider countries, 20-52% of dialysis patients are treated with home therapies (haemodialysis and peritoneal dialysis), and the number of patients with renal transplants is 45-81% of all ESRD patients. In 'mixed' provider countries, only 9 17% of all dialysis patients are treated with home therapies, and 20-48% of ESRD patients have renal transplants. In 'private' provider countries, 17% of US and 6% Japanese dialysis patients are treated with home therapies. Japan has 0.3% and the US has 26% of ESRD patients who receive renal transplants. It thus seems that provider structure influences access to and choice of ESRD treatment. With a growing elderly population and longer life expectancy, there will be an increased requirement for ESRD treatments in all industrial countries. Equal access to, and quality of ESRD care in the future will require adequate funding and reimbursement strategies in a cost-constrained healthcare environment. growing elderly population, new and innovative healthcare technologies, increasing expectations of the population and the dilemma of economic constraints. Therefore, new disciplines such as health technology assessment and healthcare economics are developing to support the needs of health policy decision makers. Their main objective is to create a balance between the three key factors of a healthcare system: access to healthcare (equity for all), quality of healthcare

  20. Lexical and Sentential Priming in Competition: Implications for Two-Stage Theories of Lexical Access.

    ERIC Educational Resources Information Center

    Hernandez, Arturo E.; Fennema-Notestine, Christine; Udell, Care; Bates, Elizabeth

    2001-01-01

    Presents a new method that can compare lexical priming (word-word) and sentential priming (sentence-word) directly within a single paradigm. Shows that it can be used to address modular theories of word comprehension, which propose that the effects of sentence context occur after lexical access has taken place. (Author/VWL)

  1. Laparoscopy in the Surgical Management of the Non-Palpable Testis

    PubMed Central

    Castillo-Ortiz, Javier; Muñiz-Colon, Luis; Escudero, Karina; Perez-Brayfield, Marcos

    2014-01-01

    Introduction: To demonstrate that laparoscopic intervention should be considered as the initial surgical approach in the management of the non-palpable testis (NPT). Methods: From 2007 to 2011, 100 testicular units underwent same surgeon laparoscopic management for NPT. Diagnostic laparoscopy was performed in all NPT and intra-abdominal testes (IAT) were managed by laparoscopic orchiopexy if low, laparoscopic Fowler-Stephens technique if high, and laparoscopic orchiectomy if atrophic. Percutaneous access to the abdomen was performed in most cases and laparoscopic management was performed with three 5 mm ports. We compared patient’s age, race, pre/post-operative exam, pre-operative work up, and IAT location upon laparoscopic intervention with surgical outcome. Fisher’s exact test for two independent proportions was used for statistical analysis and reported our results. Results: One hundred testicular units underwent diagnostic laparoscopy for NPT. All patients were from Puerto Rican descent. 55.0% were found to be intra-abdominal and were subdivided into groups according to surgical intervention. Mean post-operative follow-up was 24 months. Patients 24 months of age or younger undergoing diagnostic laparoscopy for NPT had a statistically significant probability of resulting in successful laparoscopic orchiopexy as opposed to laparoscopic orchiectomy due to an atrophied IAT (n = 55 testicular units, p < 0.05). No laparoscopic related complications were reported. Conclusion: Our findings support the use of an initial laparoscopic approach in the NPT as the majority of these patients will have IAT, avoiding unnecessary inguinal and scrotal explorations. We also recommend that patients with IAT should undergo laparoscopic orchiopexy prior to 2 years of age to increase probability of successful management. Further studies focusing in patients with NPT are needed in the future to confirm our findings. PMID:24783184

  2. Open Versus Closed Laparoscopy: Yet an Unresolved Controversy

    PubMed Central

    Fazal, Syed Abul; Pegu, David; Saikia, Dayanada

    2016-01-01

    Introduction Safe placement of the Verres needle or the primary trocar for establishment of pneumoperitoneum is the most critical step in laparoscopic procedure as it is associated with bowel, bladder and life threatening vascular injuries and embolism. In the last few decades many techniques and guidelines have been introduced to eliminate complications in creation of pneumoperitoneum. Classical closed technique (Verres needle) and the open classic technique (Hasson) are the most commonly used techniques for creation of pneumoperitoneum. Aim To compare the rate of occurrence and nature of complications in open and closed laparoscopy during establishment of pneumoperitoneum in different surgical and gynaecological procedures. Materials and Methods This was a comparative study conducted at three hospitals in Dibrugarh district, Assam, India from January 2012 to December 2014. Total 3000 cases were included in the study with 1500 cases of open laparoscopy and 1500 cases of closed laparoscopy. Complications occurring in both the groups were compared by using Fisher’s-exact test. Results In closed laparoscopy group minor complications occurred in 80 (5.33%) and major complications in 20 (1.33%) cases. In open laparoscopy group minor complications were observed in 60 (4%) and major complications in 2 (0.13%). The p-value of the difference between the two groups for minor complications was 0.0834 and for major complications was 0.0001(significant). Conclusion Open laparoscopy was seen to be better than closed laparoscopy in terms of not only the rate of occurrence of complications but also the nature and severity of the complications. This study is clinically relevant as there is no consensus for a particular method of safe entry in to the peritoneal cavity warranting the need for more research. Open technique can be performed in all cases irrespective of previous operative scar, suspected intra peritoneal adhesions or obesity. Favourable outcome may be achieved in

  3. Use of the Vectra polyetherurethaneurea graft for dialysis access in HIV-positive patients with end-stage renal disease.

    PubMed

    Schild, A Frederick; Perez, Eduardo A; Gillaspie, Erin; Patel, Asha R; Noicely, Karlene; Baltodano, Neyton

    The primary objective of this study was to establish the safety, efficacy, infection rate, and patency of the Vectra graft (polyetherurethaneurea) for dialysis access in patients diagnosed with human immunodeficiency virus (HIV) and end-stage renal disease. The Vectra graft has a unique self-sealing property; therefore we hypothesize that these patients will have fewer infections. A Vectra graft was implanted in 30 consecutive HIV-positive patients without sufficient veins for an autologous fistula. These surgeries were carried out over a 2.5-year period. Primary graft patency was 42% at 12 months and 3 (10%) of the grafts developed infection. This rate of graft infection was less (10% vs 45%) than both our prior experience and published reports using polytetrafluorothene bridge grafts. The unique self-sealing property of the Vectra graft minimizes the development of perigraft hematoma with repetitive needle cannulation and in the immunosuppressed HIV-positive patient, may account for the observed decrease in dialysis access infection.

  4. An update of the effect of far infrared therapy on arteriovenous access in end-stage renal disease patients.

    PubMed

    Chen, Chun-Fan; Yang, Wu-Chang; Lin, Chih-Ching

    2016-07-12

    The life qualities of end-stage renal disease (ESRD) patients rely largely on adequate dialysis, and a well-functioning vascular access is indispensable for high quality hemodialysis. Despite the advancement of surgical skills and the optimal maintenance of arteriovenous fistula (AVF), malfunction of AVF is still frequently encountered and has great impact on the life of ESRD patients. Several medical, mechanical and genetic prognostic factors are documented to affect the patency of AVF and arteriovenous graft (AVG). Heme oxygenase-1 (HO-1) is one of the genetic factors reported to play a role in cardiovascular disease and the patency of vascular access. Far infrared (FIR), a novel therapeutic modality, can not only conduct heat energy to AVF but also stimulate the non-thermal reactions mediated by HO-1. The use of FIR therapy significantly enhances the primary patency rate and maturation of AVF with fewer unfavorable adverse effects, and also achieves higher post-angioplasty patency rate for AVG. The only limitation in proving the effectiveness of FIR therapy in enhancing patency of AVF is that all the studies were conducted in Chinese people in Taiwan and thus, there is a lack of evidence and experience in people of other ethnicities. PMID:27312759

  5. A portable electro-immobilization and laparoscopy system for sex determination and gonadal biopsy in largemouth bass Micropterus salmoides.

    PubMed

    Matsche, M A

    2013-11-01

    A portable electro-immobilization and laparoscopy system is described that is suitable for sex determination, gonadal biopsy and immediate release of largemouth bass Micropterus salmoides. Continuous direct current at a power density of 52·2 µW cm⁻¹ for 2 min was sufficient to immobilize fish for surgery, but induced a mild, transient hypokalaemia and hyperglycaemia. Insertion of a 4·8 mm laparoscopic instrument set through the urogenital pore provided access to the gonads for examination and biopsy with mild tissue trauma. PMID:24580673

  6. A portable electro-immobilization and laparoscopy system for sex determination and gonadal biopsy in largemouth bass Micropterus salmoides.

    PubMed

    Matsche, M A

    2013-11-01

    A portable electro-immobilization and laparoscopy system is described that is suitable for sex determination, gonadal biopsy and immediate release of largemouth bass Micropterus salmoides. Continuous direct current at a power density of 52·2 µW cm⁻¹ for 2 min was sufficient to immobilize fish for surgery, but induced a mild, transient hypokalaemia and hyperglycaemia. Insertion of a 4·8 mm laparoscopic instrument set through the urogenital pore provided access to the gonads for examination and biopsy with mild tissue trauma.

  7. The role of laparoscopy in children with groin problems

    PubMed Central

    Aggarwal, Himanshu

    2014-01-01

    The use of laparoscopic surgery has grown dramatically in recent years in most all types of surgery. Historically, the early use of laparoscopic surgery was for pelvic and groin problems. In this article we review the current technique, indications, benefits and complications of laparoscopy in diagnosis and management of various groin problems in children including undescended testes (non-palpable and palpable) and inguinal hernia. PMID:26816798

  8. Low vs Standard Pressures in Gynecologic Laparoscopy: a Systematic Review

    PubMed Central

    Kyle, Esther B.; Boutin, Amélie; Laberge, Philippe Y.; Lemyre, Madeleine

    2016-01-01

    Background: The optimal intraperitoneal pressure during laparoscopy is not known. Recent literature found benefits of using lower pressures, but the safety of doing abdominal surgery with low peritoneal pressures needs to be assessed. This systematic review compares low with standard pneumoperitoneum during gynecologic laparoscopy. Database: We searched Medline, Embase, and the Cochrane Library for randomized controlled trials comparing intraperitoneal pressures during gynecologic laparoscopy. Two authors reviewed references and extracted data from included trials. Risk ratios, mean differences, and standard mean differences were calculated and pooled using RevMan5. Of 2251 studies identified, three were included in the systematic review, for a total of 238 patients. We found a statistically significant but modest diminution in postoperative pain of 0.38 standardized unit based on an original 10-point scale (95% confidence interval [CI], –0.67 to –0.08) during the immediate postoperative period when using low intraperitoneal pressure of 8 mm Hg compared with ≥12 mm Hg and of 0.50 (95% CI, –0.80 to –0.21) 24 hours after the surgery. Lower pressures were associated with worse visualization of the surgical field (risk ratio, 10.31; 95% CI, 1.29–82.38). We found no difference between groups over blood loss, duration of surgery, hospital length of stay, or the need for increased pressure. Conclusion: Low intraperitoneal pressures during gynecologic laparoscopy cannot be recommended on the behalf of this review because improvement in pain scores is minimal and visualization of the surgical field is affected. The safety of this intervention as well as cost-effectiveness considerations need to be further studied. PMID:26955258

  9. Mini-laparotomy with Adjunctive Care versus Laparoscopy for Placement of Gastric Electrical Stimulation

    PubMed Central

    SMITH, ALISON; CACCHIONE, ROBERT; MILLER, ED; McELMURRAY, LINDSAY; ALLEN, ROBERT; STOCKER, ABIGAIL; ABELL, THOMAS L.; HUGHES, MICHAEL G.

    2016-01-01

    We compared outcomes for two gastric electrical stimulation placement strategies, mini-laparotomy with adjunctive care (MLAC) versus laparoscopy without adjunctive care (LAPA). For electrode placement, the peritoneal cavity was accessed with either a single 2.5 to 3.0 cm midline incision (MLAC) or three trocar incisions (LAPA). For both groups, generator was placed subcutaneously over the anterior rectus sheath. For MLAC, adjunctive pain control measures were used for placement of both electrode and generator (transversus abdominus plane block). For LAPA, those that could not be completed by laparoscopy were converted to traditional open approach and kept in the analysis. MLAC (n = 128) resulted in shorter operative times than LAPA (n = 37) (median operative time: 87.5 vs 137.0 minutes, P ≤ 0.01). Hospital length of stay was also shorter for MLAC than for LAPA (median: 2.0 vs 3.0 days, P ≤ 0.01) without any increase in readmission rates to the hospital within 30 days of discharge (11.0 vs 16.2%, P = 0.39). After equalizing learning curves, these differences were even greater (median operative time: 84.5 vs 137.0 minutes, P < 0.01; median length of stay: 1.0 vs 3.0 days; P < 0.01) without increasing 30-day readmission rates (9.1 vs 16.2%, P = 0.25). For implantation of gastric electrical stimulators, mini-laparotomy can result in improved outcomes when coupled with adjunctive pain control measures. PMID:27097627

  10. Mini-laparotomy with Adjunctive Care versus Laparoscopy for Placement of Gastric Electrical Stimulation.

    PubMed

    Smith, Alison; Cacchione, Robert; Miller, Ed; McElmurray, Lindsay; Allen, Robert; Stocker, Abigail; Abell, Thomas L; Hughes, Michael G

    2016-04-01

    We compared outcomes for two gastric electrical stimulation placement strategies, minilaparotomy with adjunctive care (MLAC) versus laparoscopy without adjunctive care (LAPA). For electrode placement, the peritoneal cavity was accessed with either a single 2.5 to 3.0 cm midline incision (MLAC) or three trocar incisions (LAPA). For both groups, generator was placed subcutaneously over the anterior rectus sheath. For MLAC, adjunctive pain control measures were used for placement of both electrode and generator (transversus abdominus plane block). For LAPA, those that could not be completed by laparoscopy were converted to traditional open approach and kept in the analysis. MLAC (n = 128) resulted in shorter operative times than LAPA (n = 37) (median operative time: 87.5 vs 137.0 minutes, P ≤ 0.01). Hospital length of stay was also shorter for MLAC than for LAPA (median: 2.0 vs 3.0 days, P ≤ 0.01) without any increase in readmission rates to the hospital within 30 days of discharge (11.0 vs 16.2%, P = 0.39). After equalizing learning curves, these differences were even greater (median operative time: 84.5 vs 137.0 minutes, P < 0.01; median length of stay: 1.0 vs 3.0 days; P < 0.01) without increasing 30-day readmission rates (9.1 vs 16.2%, P = 0.25). For implantation of gastric electrical stimulators, minilaparotomy can result in improved outcomes when coupled with adjunctive pain control measures. PMID:27097627

  11. Robot-assisted laparoscopy for infertility treatment: current views.

    PubMed

    Carbonnel, Marie; Goetgheluck, Julie; Frati, Albane; Even, Marc; Ayoubi, Jean Marc

    2014-03-01

    To determine the interest of using robotic laparoscopic surgery in the management of female infertility, we reviewed our own activity and searched the Medline database for publications on robotic technology in infertility surgery, with the use of the following search words: robotic laparoscopy, tubal anastomosis, myomectomy, deep infiltrating endometriosis, and adnexal surgery. Robot-assisted laparoscopic surgery has seen rapid progression over the past few years. It has been mostly used for myomectomy, proximal tubal reanastomosis, and deep endometriosis surgery. Despite its increased range of indications, no randomized control studies are available. The place of robotic surgery in the management of infertility remains undetermined. PMID:24559616

  12. Occasional finding of mesenteric lipodystrophy during laparoscopy: A difficult diagnosis

    PubMed Central

    Vettoretto, Nereo; Diana, Domenico Roberto; Poiatti, Roberto; Matteucci, Armando; Chioda, Caterina; Giovanetti, Maurizio

    2007-01-01

    Mesenteric lipodystrophy is a rare pathological condition affecting the mesentery. Its initial presentation is typically asymptomatic. Pathological characteristics are unspecific, and generally attributed to inflammation, unless the diagnosis is suspected. Laparoscopy done for other reasons has been, as in this case, unsuccessful in providing evidence for the correct diagnosis, thus requiring laparotomy due to lack of diagnostic tissue. After 6 mo no further medical therapy is required, as the patient remains asymptomatic. Discussion of this case and a brief review of the literature are presented in the following paragraphs. PMID:17879414

  13. Laparoscopy or open surgery for the treatment of hydatid cyst?

    PubMed

    Ahumada, Vanessa; Moraga, Felipe; Rada, Gabriel

    2016-03-22

    The laparoscopic approach has taken a prominent role in the last decades for various surgical conditions, including liver hydatid cyst. However there is controversy about whether it can replace open surgery. Using Epistemonikos database, which is maintained by screening 30 databases, we identified three systematic reviews which together include four relevant studies, all nonrandomized. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded it is unclear whether laparoscopy for hepatic hydatid cyst reduces mortality, morbidity or recurrence compared with open surgery because the certainty of the evidence is very low.

  14. [Routine documentation in laparoscopy using the Polaroid camera].

    PubMed

    Henning, H; Look, D

    1971-01-01

    Use of the Polaroid-Land camera for the documentation of laparoscopy findings is discussed. With modern equipment, large full-color photographs, showing fine details of pigments blood and lymph vessels, and other structures, can be taken of internal organs. (The liver is shown by way of example.) Modern Polaroid film gives clear photographs with very fine color, which can be reproduced or even enlarged as slides. In addition to their value in the hospital, these photos may be sent to the attending physician. PMID:4277271

  15. Laparoscopy or open surgery for the treatment of hydatid cyst?

    PubMed

    Ahumada, Vanessa; Moraga, Felipe; Rada, Gabriel

    2016-01-01

    The laparoscopic approach has taken a prominent role in the last decades for various surgical conditions, including liver hydatid cyst. However there is controversy about whether it can replace open surgery. Using Epistemonikos database, which is maintained by screening 30 databases, we identified three systematic reviews which together include four relevant studies, all nonrandomized. We combined the evidence using meta-analysis and generated a summary of findings table following the GRADE approach. We concluded it is unclear whether laparoscopy for hepatic hydatid cyst reduces mortality, morbidity or recurrence compared with open surgery because the certainty of the evidence is very low. PMID:27028137

  16. Flexible transinguinal laparoscopy to assess the contralateral ring in pediatric inguinal hernias.

    PubMed

    Pavlovich, C P; Gmyrek, G A; Gardner, T A; Poppas, D P; Mininberg, D T

    1998-09-01

    The incidence of contralateral patent processus vaginalis (CPPV) is >50% in infants with clinical unilateral inguinal hernia (CUIH) and decreases only slowly with advancing age. Laparoscopy through the hernia sac (transinguinal laparoscopy) to detect suspected CPPV is a safe and efficient way to minimize routine contralateral inguinal exploration, but can be technically difficult. We used flexible urologic instruments and/or angled cystoscopic lenses to make transinguinal laparoscopy easier. Over a 3-year period, 37 patients (34 boys and 3 girls) ranging in age from 4 months to 12 years (mean age 59 months) with CUIH underwent ipsilateral groin exploration and diagnostic transinguinal laparoscopy. Laparoscopy was performed with flexible 17F cystoscopes (26 cases), flexible 9F ureteroscopes (2 cases), and rigid 70 degrees cystoscope lenses (9 cases). We detected eight CPPV (22%) in our series of 20 right and 17 left inguinal hernias, in a mean transinguinal laparoscopy time of 4.5 minutes. At 26-month mean follow-up, no patient whose contralateral inguinal ring was deemed closed had developed a hernia. Flexible fiberoptic urologic scopes and/or angled cystoscope lenses make transinguinal laparoscopy easy and efficacious in the pediatric population. Our series represents the longest longitudinal study of transinguinal laparoscopy for the diagnosis of CPPV. PMID:9800892

  17. Clinical comparison of laparoscopy vs open surgery in a radical operation for rectal cancer: A retrospective case-control study

    PubMed Central

    Huang, Chen; Shen, Jia-Cheng; Zhang, Jing; Jiang, Tao; Wu, Wei-Dong; Cao, Jun; Huang, Ke-Jian; Qiu, Zheng-Jun

    2015-01-01

    AIM: To assess the diverse immediate and long-term clinical outcomes, a retrospective comparison between laparoscopic and conventional operation was performed. METHODS: A total number of 916 clinical cases, from January 2006 to December 2013 in our hospital, were analyzed which covered 492 patients underwent the laparoscopy in radical resection (LRR) and 424 cases in open radical resection (ORR). A retrospective analysis was proceeded by comparing the general information, surgery performance, pathologic data, postoperative recovery and complications as well as long-term survival to investigate the diversity of immediate and long-term clinical outcomes of laparoscopic radical operation. RESULTS: There were no statistically significance differences between gender, age, height, weight, body mass index (BMI), tumor loci, tumor node metastasis stages, cell differentiation degree or American Society of Anesthesiologists scores of the patients (P > 0.05). In contrast to the ORR group, the LRR group experienced less operating time (P < 0.001), a lower blood loss (P < 0.001), and had a 2.44% probability of conversion to open surgery. Postoperative bowel function recovered more quickly, analgesic usage and the average hospital stay (P < 0.001) were reduced after LRR. Lymph node dissection during LRR appeared to be slightly more than in ORR (P = 0.338). There were no obvious differences in the lengths and margins (P = 0.182). And the occurrence rate in the two groups was similar (P = 0.081). Overall survival rate of ORR and LRR for 1, 3 and 5 years were 94.0% and 93.6% (P = 0.534), 78.1% and 80.9% (P = 0.284) and 75.2% and 77.0% (P = 0.416), respectively. CONCLUSION: Laparoscopy as a radical operation for rectal cancer was safe, produced better immediate outcomes. Long-term survival of laparoscopy revealed that it was similar to the open operation. PMID:26730165

  18. Telerobotics surgery in a transatlantic experiment: application in laparoscopy

    NASA Astrophysics Data System (ADS)

    Rovetta, Alberto; Sala, Remo; Cosmi, Francesca; Wen, Xia; Sabbadini, Dario; Milanesi, Santo; Togno, Arianna; Angelini, Licinio; Bejczy, Antal K.

    1993-12-01

    This paper describes the significance in human, scientific, and technical terms of the first experiment of robotic telesurgery effected between the Telerobotics Laboratory of the Politecnico di Milano and the Jet Propulsion Laboratory, NASA, in Pasadena California, on 7 July 1993. An Italian surgeon controlled from the U.S. A. an Italian robot in the Telerobotics Laboratory in such a way that the robot performed a biopsy, on a model containing the organs of a pig, carrying out an aspiration of organic material and two incisions for the commencement of the surgical operation of laparoscopy. Transmission was effected by means of a double satellite link with three stations -- one in Italy, one in New York and one in Pasadena -- and two geostationary satellites, the first over the Atlantic and the second over the United States.

  19. Video display during laparoscopy – where should it be placed?

    PubMed Central

    Pawełczak, Dariusz; Piotrowski, Piotr; Trzeciak, Piotr W.; Jędrzejczyk, Adam; Pasieka, Zbigniew

    2014-01-01

    Introduction During laparoscopy, the monitor is usually placed near the operating table, at eye level, which significantly affects hand-eye coordination. First, it is impossible for the surgeon to simultaneously observe the operative field and hand movement. Second, the axis of view of the endoscope rarely matches the natural axis of the surgeon's sight: it resembles a direct view into the operative field. Finally, as the arms of the tools act as levers with a fulcrum at the site of the skin incision, the action of the tool handles is a mirror image of the movement of the tool tips seen on the monitor. Studies have shown that a neutral position with the head flexed at 15–45° is the most ergonomically suitable. Aim To evaluate whether the level of monitor placement exerts an influence on laparoscopic performance. Material and methods A group of 52 students of medicine were asked to pass a thread through 9 holes of different sizes, placed at different levels and angles, using a self-made laparoscopic simulator. Each student performed the task four times in two monitor positions: at eye level, and placed on a simulator. The order of monitor placement was randomized. Results The task was performed more quickly when the monitor was placed on the simulator and the sight was forced downwards. Lower placement was also found to be more beneficial for students with experience in laparoscopy. Conclusions New technologies which place the display on the patient, thus improving the ergonomics of the operation, should be developed. PMID:25960798

  20. A brief history of endoscopy, laparoscopy, and laparoscopic surgery.

    PubMed

    Spaner, S J; Warnock, G L

    1997-12-01

    The ideas that form the framework for laparoscopic surgery were initially reported over a century ago. However, the introduction of the technique into the field of general surgery has been a relatively recent development. Laparoscopic surgery owes much of its history to the development of endoscopic technique. Early physicians such as the Arabian, Albukasim (936-1013 A.D.), and later in 1805, the Frankfurt-born physician, Phillip Bozzini, were among the first to develop methods to examine body orifices. Throughout the mid 1800's, several scientists attempted to construct endoscope-like instruments. The first effective open-tube endoscope was developed in 1853 by Desormeaux. This instrument was used to examine the urethra and the bladder. In the late 1800's, other physicians including Kussmaul and Nitze refined the original endoscopic models and began utilizing their new tools in their medical practice. Laparoscopy or endoscopically examining the peritoneal cavity was first attempted in 1901 by George Kelling who called this examining procedure "Celioscopy". In the early 1930's, the first reports of laparoscopic interventions for nondiagnostic purposes were published. Initial procedures included lysis of abdominal adhesions and diagnostic biopsies of abdominal organs under direct visualization. Throughout the 1960's and 1970's, laparoscopy became a vital part of gynecological practice. Despite these technological advances, it was not until after 1986, following the development of a video computer chip that allowed the magnification and projection of images onto television screens, that the techniques of laparoscopic surgery truly became integrated into the discipline of general surgery. The first laparoscopic cholecystectomy performed on a human patient was done in 1987 by the French physician Mouret. The rapid acceptance of the technique of laparoscopic surgery by the general population is unparalleled in surgical history. It has changed the field of general

  1. The Impact of Hemodialysis and Arteriovenous Access Flow on Extracranial Hemodynamic Changes in End-Stage Renal Disease Patients.

    PubMed

    Chung, Sarah; Jeong, Hye Seon; Choi, Dae Eun; Song, Hee-Jung; Lim, Young Gi; Ham, Joo Yeon; Na, Ki Ryang; Lee, Kang Wook

    2016-08-01

    In this study, we characterized cerebral blood flow changes by assessment of blood flow parameters in neck arteries using carotid duplex ultrasonography and predictive factors for these hemodynamic changes. Hemodynamic variables were measured before and during hemodialysis in 81 patients with an arteriovenous access in their arm. Hemodialysis produced significant lowering in peak systolic velocity and flow volume of neck arteries and calculated total cerebral blood flow (1,221.9 ± 344.9 [before hemodialysis] vs. 1,085.8 ± 319.2 [during hemodialysis], P < 0.001). Effects were greater in vessels on the same side as the arteriovenous access and these changes were influenced by arteriovenous access flow during hemodialysis, both in the CCA (r = -0.277, P = 0.015) and the VA (r = -0.239, P = 0.034). The change of total cerebral blood flow during hemodialysis was independently related with age, presence of diabetes, and systemic blood pressure. PMID:27478334

  2. Comparison of Two Techniques of Laparoscopy-Assisted Peritoneal Vaginoplasty.

    PubMed

    Wu, Jie; Guo, Ruixia; Chu, Danxia; Wang, Xinyan; Li, Liuxia; Bian, Aiping; Zhao, Qian; Shi, Huirong

    2016-01-01

    Neovagina creation is essential for patients with the Mayer-Rokitansky-Kuster-Hauser syndrome. We compared a technique involved the pushing down of the peritoneum with the technique of separating the peritoneum for laparoscopy-assisted peritoneal vaginoplasty. We collected patients with congenital absence of vagina who underwent laparoscopy-assisted peritoneal vaginoplasty of the First Affiliated Hospital of Zhengzhou University between January 2011 and May 2013. The 2 surgical groups (pushing group and separating group) were compared for various parameters. The values of the following parameters were significantly lower for the pushing group compared with the separating group: mean operating time (78 ± 13 minutes vs 135 ± 28 minutes), mean duration of hospitalization (12.9 ± 2.7 days vs 18.0 ± 3.8 days), mean cost of hospitalization (14 016 ± 1640 RMB vs 18 783 ± 2143 RMB), requirement for a drainage tube (4% vs 27%; χ(2) = 8.864), requirement for analgesic drugs (20% vs 40%; χ(2) = 3.977), and postoperative rehospitalization (3.3% vs 10.0% at 2 months and 6.7% vs 26.7% at 6 months; χ(2) = 4.268 and 5.196). Mean values for blood loss (57 ± 19 mL vs 66 ± 20 mL), time to pass gas (21 ± 4 hours vs 23 ± 7 hours), and length of the reconstructed vagina (9.0 ± 0.4 cm vs 8.9 ± 0.5 cm) were not significantly different between the 2 groups. In addition, mean postoperative Female Sexual Function Index score did not differ significantly between the 2 groups or among the 2 groups and a control group (27.0 ± 4.8 vs 26.7 ± 5.2 vs 27.9 ± 4.5; p > .05). The technique involving pushing down of the peritoneum offers advantages of reduced cost, complications, hospitalization, operative time, and pain over the traditional technique. Sexuality approaches so-called "normal" sexuality. PMID:26546181

  3. 39% access time improvement, 11% energy reduction, 32 kbit 1-read/1-write 2-port static random-access memory using two-stage read boost and write-boost after read sensing scheme

    NASA Astrophysics Data System (ADS)

    Yamamoto, Yasue; Moriwaki, Shinichi; Kawasumi, Atsushi; Miyano, Shinji; Shinohara, Hirofumi

    2016-04-01

    We propose novel circuit techniques for 1 clock (1CLK) 1 read/1 write (1R/1W) 2-port static random-access memories (SRAMs) to improve read access time (tAC) and write margins at low voltages. Two-stage read boost (TSR-BST) and write word line boost (WWL-BST) after the read sensing schemes have been proposed. TSR-BST reduces the worst read bit line (RBL) delay by 61% and RBL amplitude by 10% at V DD = 0.5 V, which improves tAC by 39% and reduces energy dissipation by 11% at V DD = 0.55 V. WWL-BST after read sensing scheme improves minimum operating voltage (V min) by 140 mV. A 32 kbit 1CLK 1R/1W 2-port SRAM with TSR-BST and WWL-BST has been developed using a 40 nm CMOS.

  4. Quality of life and sexuality in disease-free survivors of cervical cancer after radical hysterectomy alone: A comparison between total laparoscopy and laparotomy.

    PubMed

    Xiao, Meizhu; Gao, Huiqiao; Bai, Huimin; Zhang, Zhenyu

    2016-09-01

    The aim of the present study was to evaluate the possible differences between total laparoscopy and laparotomy regarding their impact on postoperative quality of life and sexuality in disease-free cervical cancer survivors who received radical hysterectomy (RH) and/or lymphadenectomy alone and were followed for >1 year.We reviewed all patients with cervical cancer who had received surgical treatment in our hospital between January 2001 and March 2014. Consecutive sexually active survivors who received RH and/or lymphadenectomy for early stage cervical cancer were enrolled and divided into 2 groups based on surgical approach. Survivors were interviewed and completed validated questionnaires, including the European Organization for Research Treatment of Cancer Quality-of-Life Core Questionnaire including 30 items, the Cervical Cancer-Specific Module of European Organization for Research Treatment of Cancer Quality-of-Life Questionnaire including 24 items (EORTC QLQ-CX24), and the Female Sexual Function Index (FSFI).In total, 273 patients with histologically confirmed cervical cancer were retrospectively reviewed. However, only 64 patients had received RH and/or lymphadenectomy alone; 58 survivors meeting the inclusion criteria were enrolled, including 42 total laparoscopy cases and 16 laparotomy cases, with an average follow-up of 46.1 and 51.2 months, respectively. The survivors in the 2 groups obtained good and similar scores on all items of the European Organization for Research Treatment of Cancer Quality-of-Life Core Questionnaire including 30 items and Cervical Cancer-Specific Module of European Organization for Research Treatment of Cancer Quality-of-Life Questionnaire including 24 items, without significant differences after controlling for covariate background characteristics. To the date of submission, 21.4% (9/42) of cases in the total laparoscopy group and 31.2% (5/16) of cases in the laparotomy group had not resumed sexual behavior after RH. Additionally

  5. Laparoscopy for Small Bowel Obstruction Caused by Single Adhesive Band

    PubMed Central

    Suh, Suk Won

    2016-01-01

    Background and Objectives: There are still concerns about the comparative outcomes of operative treatment (OT) and conservative (nonsurgical) treatment (CT) for small bowel obstruction (SBO), especially that caused by single adhesive bands. We performed a retrospective study to compare surgical with nonsurgical outcomes. Methods: A total of 62 patients were enrolled. The OT group underwent laparoscopy (n = 16), and the CT group (n = 46) did not. We compared early and late outcomes between the 2 groups. Results: Times to first flatus, oral intake, and defecation after treatment were shorter in the OT group (P = .030, .033, and .024), and the recurrence rate was lower in the OT group than in the CT group (6.2% vs 32.6%; P = .038). Time from discharge to first recurrence was longer in the OT group than in the CT group (172 vs 104.6 ± 26.5 days, P = .027). Conclusions: SBO related to a single adhesive band is not effectively treated by CT. However, laparoscopic OT provides notable success if the surgery is performed early. Therefore, it should be the preferred treatment. PMID:27647979

  6. Training of basic laparoscopy skills on SimSurgery SEP.

    PubMed

    Buzink, Sonja N; Goossens, Richard H M; De Ridder, Huib; Jakimowicz, Jack J

    2010-01-01

    The aim of this study was to assess the performance curve for novices training in bimanual tissue manipulation and angled laparoscope navigation, and compare those performances with the performances of experienced laparoscopic surgeons. The Camera Navigation task with a 30 degrees angled laparoscope and the Place Arrow task of the new SimSurgery SEP virtual reality simulator were used. Fourteen medical trainees (no laparoscopy experience) performed four training sessions within one week, including 15 repetitions of each task in total. The experienced participants (>50 procedures & familiar with angled laparoscope) performed each task twice. The performance on both tasks by the novices improved significantly over the training sessions. The experienced participants performed both tasks significantly better than the novices in repetition 3. After repetition 15, the performances of the novices on both tasks were of the same level as the performances of the experienced participants. By training on SimSurgery SEP, medical trainees can extensively improve their skills in navigation with 30 degrees angled laparoscope and bimanual tissue manipulation. Further research should focus on the transfer of skills acquired on the simulator to the clinical setting. Knowledge on proficiency thresholds and training end-points for pre-clinical criterion-based training of different laparoscopic tasks also needs to be extended.

  7. Reducing the Cost of Laparoscopy: Reusable versus Disposable Laparoscopic Instruments.

    PubMed

    Manatakis, Dimitrios K; Georgopoulos, Nikolaos

    2014-01-01

    Cost-effectiveness in health care management is critical. The situation in debt-stricken Greece is further aggravated by the financial crisis and constant National Health System expense cut-downs. In an effort to minimize the cost of laparoscopy, our department introduced reusable laparoscopic instruments in December 2011. The aim of this study was to assess potential cost reduction of laparoscopic operations in the field of general surgery. Hospital records, invoice lists, and operative notes between January 2012 and December 2013, were retrospectively reviewed and data were collected on laparoscopic procedures, instrument failures, and replacement needs. Initial acquisition cost of 5 basic instrument sets was €21,422. Over the following 24 months, they were used in 623 operations, with a total maintenance cost of €11,487. Based on an average retail price of €490 per set, projected cost with disposable instruments would amount to €305,270, creating savings of €272,361 over the two-year period under study. Despite the seemingly high purchase price, each set amortized its acquisition cost after only 9 procedures and instrument cost depreciated to less than €55 per case. Disposable instruments cost 9 times more than reusable ones, and their high price would almost equal the total hospital reimbursement by social security funds for many common laparoscopic procedures. PMID:25152814

  8. Reducing the Cost of Laparoscopy: Reusable versus Disposable Laparoscopic Instruments

    PubMed Central

    Manatakis, Dimitrios K.; Georgopoulos, Nikolaos

    2014-01-01

    Cost-effectiveness in health care management is critical. The situation in debt-stricken Greece is further aggravated by the financial crisis and constant National Health System expense cut-downs. In an effort to minimize the cost of laparoscopy, our department introduced reusable laparoscopic instruments in December 2011. The aim of this study was to assess potential cost reduction of laparoscopic operations in the field of general surgery. Hospital records, invoice lists, and operative notes between January 2012 and December 2013, were retrospectively reviewed and data were collected on laparoscopic procedures, instrument failures, and replacement needs. Initial acquisition cost of 5 basic instrument sets was €21,422. Over the following 24 months, they were used in 623 operations, with a total maintenance cost of €11,487. Based on an average retail price of €490 per set, projected cost with disposable instruments would amount to €305,270, creating savings of €272,361 over the two-year period under study. Despite the seemingly high purchase price, each set amortized its acquisition cost after only 9 procedures and instrument cost depreciated to less than €55 per case. Disposable instruments cost 9 times more than reusable ones, and their high price would almost equal the total hospital reimbursement by social security funds for many common laparoscopic procedures. PMID:25152814

  9. Single-incision multiport laparoscopy versus multichannel-tipped single port laparoscopy in gynecologic surgery: outcomes and benefits

    PubMed Central

    Zhao, Mingzhi; Zhao, Jing; Hua, Keqin; Zhu, Zhiling; Hu, Changdong

    2015-01-01

    Objective: To estimate the feasibility and safety of single-incision multiport laparoscopy (SIMPL) used in patients who underwent laparoendoscopic single-site surgery (LESS) for gynecologic disease, and the cosmetic outcome and economic benefit compared with multichannel-tipped single port laparoscopy (MSPL). Intervention: We underwent LESS via a single 2.5- to 3.0-cm umbilical incision with the Single-Incision Multiport Laparoscopic Surgery Trocar available on the market, briefly named MSPL. Since January 2014, we improved the procedure and named SIMPL. In SIMPL group, two traditional laparoscopic trocar (diameter=5 mm) and one mini-laparoscopic trocar (diameter =3 mm) were inserted into the peritoneum separately through a single 1.5- to 1.8-cm umbilical transcutaneous incision. Subject demographics and clinical variables were collected and perioperative outcomes analyzed. In addition, the size of umbilicus was measured in all patients prior to the operation and the levels of cosmetic satisfaction were evaluated at 4 weeks after surgery. Measurements and main results: From January 2014 to December 2014, there were 32 patients who underwent SIMPL for ovarian cystectomy. Hospital cost was significantly lower in SIMPL group compared with MSPL group (RMB 10207.0 vs 17973.7 yuan), P<0.001. Compared with MSPL group, the SIMPL group reported significantly higher cosmetic satisfaction at 4 weeks afer surgery (P<0.1). Besides, the SIMPL procedures performed in benign gynecologic surgery were myomectomy (n=8), salpingpoophorectomy (n=2), salpingectomy (n=5), adhesiolysis and fimbrioplasty (n=32), ovarian drilling (n=3), salpingotomy for ectopic pregnancy (n=3). All surgeries were completed successfully without conversion to the traditional laparoscopic approach. Two postoperative complications occurred were delay healing of umbilicus incision after myomectomy. The cosmetic satisfactory rate was 100%. Conclusion: According to our experience, SIMPL is safe and efficient for

  10. Iniquities in the access to renal transplant for patients with end-stage chronic renal disease in Brazil.

    PubMed

    Machado, Elaine Leandro; Caiaffa, Waleska Teixeira; César, Cibele Comini; Gomes, Isabel Cristina; Andrade, Eli Iola Gurgel; Acúrcio, Francisco de Assis; Cherchiglia, Mariangela Leal

    2011-01-01

    The objective of this present study is to analyze individual and contextual factors associated with access to renal transplant in Brazil. An observational, prospective and non-concurrent study was carried out, based on data from the National Database on renal replacement therapies in Brazil. Patients undergoing dialysis between 01/Jan/2000 and 31/Dec/2000 were included and monitored up to the point of transplant, death or until the end of the study period. Variables that were analyzed included: individual variables (age, sex, region of residence, primary renal disease, hospitalizations); and context variables concerning both the dialysis unit (level of complexity, juridical nature, hemodialysis machines and location) and the city (geographic region, location and HDI). Proportional hazard models were adjusted with hierarchical entry to identify factors associated with the risk of transplant. The results point to differentials in access according to socio-demographic, clinical, geographic and social factors, indicating that the organ allocation system has not eliminated avoidable disparities for those who compete for an organ in the nationwide waiting list.

  11. Postmortem Evaluation of Left Flank Laparoscopic Access in an Adult Female Giraffe (Giraffa camelopardalis).

    PubMed

    Pizzi, R; Cracknell, J; Dalrymple, L

    2010-01-01

    There are still few reports of laparoscopy in megavertebrates. The giraffe (Giraffa camelopardalis) is the tallest land mammal, and the largest ruminant species. An 18-year-old multiparous female hybrid giraffe, weighing 650 kg, was euthanized for chronic health problems, and left flank laparoscopy was performed less than 30 minutes after death. Safe primary access was achieved under visualisation using an optical bladed trocar (Visiport Plus, Tyco healthcare UK Ltd) without prior abdominal insufflation. A left paralumbar fossa approach allowed access to the spleen, rumen, left kidney, and intestines, but did not allow access to the reproductive tract which in nongravid females is intrapelvic in nature. PMID:20445792

  12. HALON—hysterectomy by transabdominal laparoscopy or natural orifice transluminal endoscopic surgery: a randomised controlled trial (study protocol)

    PubMed Central

    Baekelandt, Jan; De Mulder, Peter A; Le Roy, Ilse; Mathieu, Chantal; Laenen, Annouschka; Enzlin, Paul; Weyers, Steven; Mol, Ben WJ; Bosteels, Jan JA

    2016-01-01

    Introduction Natural orifice transluminal endoscopic surgery (NOTES) uses natural body orifices to access the cavities of the human body to perform surgery. NOTES limits the magnitude of surgical trauma and has the potential to reduce postoperative pain. This is the first randomised study in women bound to undergo hysterectomy for benign gynaecological disease comparing NOTES with classical laparoscopy. Methods and analysis All women aged 18–70 years, regardless of parity, consulting at our practice with an indication for hysterectomy due to benign gynaecological disease will be eligible. After stratification according to uterine size on clinical examination, participants will be randomised to be treated by laparoscopy or by transvaginal NOTES. Participants will be evaluated on day 0, days 1–7 and at 3 and 6 months. The following data will be collected: the proportion of women successfully treated by removing the uterus by the intended approach as randomised; the proportion of women admitted to the inpatient hospital; postoperative pain scores measured twice daily by the women from day 1 to 7; the total amount of analgesics used from day 1 to 7; readmission during the first 6 weeks; presence and intensity of dyspareunia and sexual well-being at baseline, 3 and 6 months (Short Sexual Functioning Scale (SSFS) scale); duration of surgery; postoperative infection or other surgical complications; direct and indirect costs incurred up to 6 weeks following surgery. The primary outcome will be the proportion of women successfully treated by the intended technique; all other outcomes are secondary. Ethics and dissemination The study was approved on 1 December 2015 by the Ethics Committee of the Imelda Hospital, Bonheiden, Belgium. The first patient was randomised on 17 December 2015. The last participant randomised should be treated before 30 November 2017. The results will be presented in peer-reviewed journals and at scientific meetings within 4

  13. Robotically assisted laparoscopy benefits surgical performance under stress.

    PubMed

    Moore, Lee J; Wilson, Mark R; Waine, Elizabeth; McGrath, John S; Masters, Rich S W; Vine, Samuel J

    2015-12-01

    While the benefits of robotic surgery for the patient have been relatively well established, little is known about the benefits for the surgeon. This study examined whether the advantages of robotically assisted laparoscopy (improved dexterity, a 3-dimensional view, reduction in tremors, etc.) enable the surgeon to better deal with stressful tasks. Subjective and objective (i.e. cardiovascular) responses to stress were assessed while surgeons performed on either a robotic or conventional laparoscopic system. Thirty-two surgeons were assigned to perform a surgical task on either a robotic system or a laparoscopic system, under three stress conditions. The surgeons completed self-report measures of stress before each condition. Furthermore, the surgeons' cardiovascular responses to stress were recorded prior to each condition. Finally, task performance was recorded throughout each condition. While both groups reported experiencing similar levels of stress, compared to the laparoscopic group, the robotic group displayed a more adaptive cardiovascular response to the stress conditions, reflecting a challenge state (i.e. higher blood flow and lower vascular resistance). Furthermore, despite no differences in completion time, the robotic group performed the tasks more accurately than the laparoscopic group across the stress conditions. These results highlight the benefits of using robotic technology during stressful situations. Specifically, the results show that stressful tasks can be performed more accurately with a robotic platform, and that surgeons' cardiovascular responses to stress are more favourable. Importantly, the 'challenge' cardiovascular response to stress displayed when using the robotic system has been associated with more positive long-term health outcomes in domains where stress is commonly experienced (e.g. lower cardiovascular disease risk). PMID:26530839

  14. Staging Early Esophageal Cancer.

    PubMed

    Old, O J; Isabelle, M; Barr, H

    2016-01-01

    Staging esophageal cancer provides a standardized measure of the extent of disease that can be used to inform decisions about therapy and guide prognosis. For esophageal cancer, the treatment pathways vary greatly depending on stage of disease, and accurate staging is therefore crucial in ensuring the optimal therapy for each patient. For early esophageal cancer (T1 lesions), endoscopic resection can be curative and simultaneously gives accurate staging of depth of invasion. For tumors invading the submucosa or more advanced disease, comprehensive investigation is required to accurately stage the tumor and assess suitability for curative resection. A combined imaging approach of computed tomography (CT), positron emission tomography (PET), and endoscopic ultrasound (EUS) offers complementary diagnostic information and gives the greatest chance of accurate staging. Staging laparoscopy can identify peritoneal disease and small superficial liver lesions that could be missed on CT or PET, and alters management in up to 20 % of patients. Optical diagnostic techniques offer the prospect of further extending the possibilities of endoscopic staging in real time. Optical coherence tomography can image superficial lesions and could provide information on depth of invasion for these lesions. Real-time lymph node analysis using optical diagnostics such as Raman spectroscopy could be used to support immediate endoscopic therapy without waiting for results of cytology or further investigations. PMID:27573772

  15. Reference genes for accessing differential expression among developmental stages and analysis of differential expression of OBP genes in Anastrepha obliqua

    PubMed Central

    Nakamura, Aline Minali; Chahad-Ehlers, Samira; Lima, André Luís A.; Taniguti, Cristiane Hayumi; Sobrinho Jr., Iderval; Torres, Felipe Rafael; de Brito, Reinaldo Alves

    2016-01-01

    The West Indian fruit fly, Anastrepha obliqua, is an important agricultural pest in the New World. The use of pesticide-free methods to control invasive species such as this reinforces the search for genes potentially useful in their genetic control. Therefore, the study of chemosensory proteins involved with a range of responses to the chemical environment will help not only on the understanding of the species biology but may also help the development of environmentally friendly pest control strategies. Here we analyzed the expression patterns of three OBP genes, Obp19d_2, Obp56a and Obp99c, across different phases of A. obliqua development by qPCR. In order to do so, we tested eight and identified three reference genes for data normalization, rpl17, rpl18 and ef1a, which displayed stability for the conditions here tested. All OBPs showed differential expression on adults and some differential expression among adult stages. Obp99c had an almost exclusive expression in males and Obp56a showed high expression in virgin females. Thereby, our results provide relevant data not only for other gene expression studies in this species, as well as for the search of candidate genes that may help in the development of new pest control strategies. PMID:26818909

  16. Reference genes for accessing differential expression among developmental stages and analysis of differential expression of OBP genes in Anastrepha obliqua.

    PubMed

    Nakamura, Aline Minali; Chahad-Ehlers, Samira; Lima, André Luís A; Taniguti, Cristiane Hayumi; Sobrinho, Iderval; Torres, Felipe Rafael; de Brito, Reinaldo Alves

    2016-01-01

    The West Indian fruit fly, Anastrepha obliqua, is an important agricultural pest in the New World. The use of pesticide-free methods to control invasive species such as this reinforces the search for genes potentially useful in their genetic control. Therefore, the study of chemosensory proteins involved with a range of responses to the chemical environment will help not only on the understanding of the species biology but may also help the development of environmentally friendly pest control strategies. Here we analyzed the expression patterns of three OBP genes, Obp19d_2, Obp56a and Obp99c, across different phases of A. obliqua development by qPCR. In order to do so, we tested eight and identified three reference genes for data normalization, rpl17, rpl18 and ef1a, which displayed stability for the conditions here tested. All OBPs showed differential expression on adults and some differential expression among adult stages. Obp99c had an almost exclusive expression in males and Obp56a showed high expression in virgin females. Thereby, our results provide relevant data not only for other gene expression studies in this species, as well as for the search of candidate genes that may help in the development of new pest control strategies.

  17. [Georg Kelling (1866-1945): the man who introduced modern laparoscopy into medicine].

    PubMed

    Hatzinger, M; Badawi, J K; Häcker, A; Langbein, S; Honeck, P; Alken, P

    2006-07-01

    On 23 September 1901, Georg Kelling (1866-1945) from Dresden performed a celioscopy with a Nitze cystoscope on a dog in Hamburg. This was the beginning of the era of laparoscopy.His doctoral thesis already reflected his early interest in the anatomy and physiology of the gastrointestinal tract. This experience, together with his knowledge on air insufflation of the abdomen, enabled him to be the first to develop the procedure he named "celioscopy." During this pioneer time of laparoscopy, he developed various basic principles that are still valid today and demonstrated astonishingly visionary skills. Although his pioneering achievements have hardly been acknowledged to this day, modern laparoscopy has confirmed Kelling's visions and scientific work in almost all aspects. His name and achievements have most definitely earned a place in the history of endoscopy. PMID:16773385

  18. The role of gasless laparoscopy in differential diagnosis of acute abdomen

    PubMed Central

    Moga, MA; Arvatescu, CA; Pratilas, GC; Bigiu, NF; Dinas, K; Burtea, V

    2015-01-01

    Background: The diagnosis of acute abdomen in the emergency setting, still remains a challenging problem. In these cases timely diagnosis and management is of great importance, while the anesthetic risk is high. The combination of the risk of an open laparotomy and the relative high likelihood of negative findings when performed, creates the need for a better approach. The alternative actually exists since 1911 when Eruheim made the first gasless laparoscopy. The aim of this study is to put back into the spotlight, gasless laparoscopy in the differential diagnosis of acute abdomen and to underline the advantages of this simple, cheap and very useful technique, especially in patients that require prompt diagnosis and have relative or absolute contraindications to general anesthesia or pneumoperitoneum. Methods: This study included 49 patients that were managed with gasless laparoscopy for the diagnosis of acute abdomen, from 2011 to 2013. Two techniques were used: the mechanical lift of the anterior abdominal wall and the LapVision device. Results: From the 49 patients included in the study, 41 were diagnosed with gasless laparoscopy while in eight the results were uncertain or there wasn’t any pathology involved. With both techniques used, sample of the intraperitoneal fluid or biopsy could be obtained. Conclusion: The gasless technique for laparoscopy is an extremely useful mean of diagnosis in emergency conditions, or for patients with contraindications to undergo laparoscopy by pneumoperitoneum. Requiring only local or regional anesthesia, this technique could easily find application in diagnosis and treatment, while avoiding unnecessary laparotomies. Hippokratia 2015, 19 (1): 69-72. PMID:26435651

  19. Laparoscopy-Assisted Single-Port Appendectomy in Children

    PubMed Central

    Sesia, Sergio B.; Berger, Eliane; Holland-Cunz, Stefan; Mayr, Johannes; Häcker, Frank-Martin

    2015-01-01

    Abstract Because of its low complication rate, favorable safety, cost-effectiveness, and technical ease, mono-instrumental, laparoscopy-assisted single-port appendectomy (SPA) has been the standard therapy for appendicitis in our department since its introduction 10 years ago. We report our experience with this technique and compare its outcome to open appendectomy (OA). The records of all children who underwent appendectomy at our institution over a period of 8 years were analyzed retrospectively. Patient baseline data, markers of inflammation, operative time, length of hospital stay, complication rate according to the classification of Clavien-Dindo, and histologic grading were assessed to compare the 2 surgical techniques (SPA and OA). The chi square test, the Student's t test and the Wilcoxon-Mann-Whitney test were used to analyze the data and the comparisons of the mean values. A P value < 0.05 was considered significant. Overall, 975 patients were included in the study. A total of 555 children had undergone SPA and 420 had been treated by OA. Median operative time of SPA was longer than that of OA (60.8 min vs 57.4 min; P < 0.05). Length of hospital stay after SPA was shorter than after OA (4.4 days and 5.9 days, respectively; P < 0.001). The overall complication rate was lower for SPA than that for OA (4.0% vs 5.7%), but the difference of complications for SPA and OA was not statistically significant (P < 0.22). SPA was successfully performed in 85.9% of children. In 53.8% of patients with perforated appendicitis, no conversion was required. In the group of children with perforated appendicitis, the complication rate of ∼20% was independent of the surgical technique applied. With respect to operative time, length of hospital stay, and postoperative complication rate, SPA is not inferior to OA. SPA is safe and efficient, even in the management of perforated appendicitis. PMID:26683962

  20. Factors affecting outcomes in patients reaching end-stage kidney disease worldwide: differences in access to renal replacement therapy, modality use, and haemodialysis practices.

    PubMed

    Robinson, Bruce M; Akizawa, Tadao; Jager, Kitty J; Kerr, Peter G; Saran, Rajiv; Pisoni, Ronald L

    2016-07-16

    More than 2 million people worldwide are being treated for end-stage kidney disease (ESKD). This Series paper provides an overview of incidence, modality use (in-centre haemodialysis, home dialysis, or transplantation), and mortality for patients with ESKD based on national registry data. We also present data from an international cohort study to highlight differences in haemodialysis practices that affect survival and the experience of patients who rely on this therapy, which is both life-sustaining and profoundly disruptive to their quality of life. Data illustrate disparities in access to renal replacement therapy of any kind and in the use of transplantation or home dialysis, both of which are widely considered preferable to in-centre haemodialysis for many patients with ESKD in settings where infrastructure permits. For most patients with ESKD worldwide who are treated with in-centre haemodialysis, overall survival is poor, but longer in some Asian countries than elsewhere in the world, and longer in Europe than in the USA, although this gap has reduced. Commendable haemodialysis practice includes exceptionally high use of surgical vascular access in Japan and in some European countries, and the use of longer or more frequent dialysis sessions in some countries, allowing for more effective volume management. Mortality is especially high soon after ESKD onset, and improved preparation for ESKD is needed including alignment of decision making with the wishes of patients and families.

  1. IMPLEMENTING LAPAROSCOPY IN BRAZIL'S NATIONAL PUBLIC HEALTH SYSTEM: THE BARIATRIC SURGEONS' POINT OF VIEW

    PubMed Central

    SUSSENBACH, Samanta; SILVA, Everton N; PUFAL, Milene Amarante; ROSSONI, Carina; CASAGRANDE, Daniela Schaan; PADOIN, Alexandre Vontobel; MOTTIN, Cláudio Corá

    2014-01-01

    Background Although Brazilian National Public Health System (BNPHS) has presented advances regarding the treatment for obesity in the last years, there is a repressed demand for bariatric surgeries in the country. Despite favorable evidences to laparoscopy, the BNPHS only performs this procedure via laparotomy. Aim 1) Estimate whether bariatric surgeons would support the idea of incorporating laparoscopic surgery in the BNPHS; 2) If there would be an increase in the total number of surgeries performed; 3) As well as how BNPHS would redistribute both procedures. Methods A panel of bariatric surgeons was built. Two rounds to answer the structured Delphi questionnaire were performed. Results From the 45 bariatric surgeons recruited, 30 (66.7%) participated in the first round. For the second (the last) round, from the 30 surgeons who answered the first round, 22 (48.9%) answered the questionnaire. Considering the possibility that BNPHS incorporated laparoscopic surgery, 95% of surgeons were interested in performing it. Therefore, in case laparoscopic surgery was incorporated by the BNPHS there would be an average increase of 25% in the number of surgeries and they would be distributed as follows: 62.5% via laparoscopy and 37.5% via laparotomy. Conclusion 1) There was a preference by laparoscopy; 2) would increase the number of operations compared to the current model in which only the laparotomy is available to users of the public system; and 3) the distribution in relation to the type of procedure would be 62.5% and 37.5% for laparoscopy laparotomy. PMID:25409964

  2. Laparoscopy-assisted percutaneous endoscopic gastrostomy enables enteral nutrition even in patients with distorted anatomy

    PubMed Central

    Hermanowicz, Adam; Matuszczak, Ewa; Komarowska, Marta; Jarocka-Cyrta, Elzbieta; Wojnar, Jerzy; Debek, Wojciech; Matysiak, Konrad; Klek, Stanislaw

    2013-01-01

    AIM: To analyzed whether laparoscopy-assisted percutaneous endoscopic gastrostomy (PEG) could be a valuable option for patients with complicated anatomy. METHODS: A retrospective analysis of twelve patients (seven females, five males; six children, six young adults; mean age 19.2 years) with cerebral palsy, spastic quadriparesis, severe kyphoscoliosis and interposed organs and who required enteral nutrition (EN) due to starvation was performed. For all patients, standard PEG placement was impossible due to distorted anatomy. All the patients qualified for the laparoscopy-assisted PEG procedure. RESULTS: In all twelve patients, the laparoscopy-assisted PEG was successful, and EN was introduced four to six hours after the PEG placement. There were no complications in the perioperative period, either technical or metabolic. All the patients were discharged from the hospital and were then effectively fed using bolus methods. CONCLUSION: Laparoscopy-assisted PEG should become the method of choice for gastrostomy tube placement and subsequent EN if PEG placement cannot be performed safely. PMID:24282357

  3. [Laparoscopy in the examination of patients with non-palpable undescended testis].

    PubMed

    Iunusov, M Iu; Ugarov, B A; Ten, S L

    1991-01-01

    Diagnostic laparoscopy was performed in 28 patients at the age of from 5 to 32 years. The endoscopic semiotics of the inguinal and intraabdominal retention, testicular agenesia were studied. Laparoscopic and intraoperative diagnoses coincided in all the cases. No complications were observed.

  4. Laparoscopy in the Management of Children with Chronic Recurrent Abdominal Pain

    PubMed Central

    Berezin, Stuart H.; Bostwick, Howard E.; Halata, Michael S.

    1999-01-01

    Background and Objectives: The purpose of the present study was to evaluate the results of diagnostic laparoscopy in children with chronic recurrent abdominal pain. Patients and Methods: Thirteen children with chronic recurrent abdominal pain were subjected to diagnostic laparoscopy. Ages varied from 10 to 17 years. There were six males and seven females. Abdominal pain was present from 3 weeks to 12 months (mean, 2 months). Extensive laboratory and imaging studies did not contribute to the diagnosis. In all patients, the pain was disabling and severe enough to warrant repeated visits to the pediatrician, emergency room visits, or hospital admissions, as well as absence from school. Results: All children recovered uneventfully. Laparoscopic findings that identified the cause of abdominal pain were obtained in 12 of 13 patients. Laparoscopic appendectomy was done in all patients. There were no operative complications. One child presented three months later with incomplete small bowel obstruction, which resolved with conservative management. There were no other postoperative complications. Follow-up varied from six months to three years. Abdominal pain resolved in ten patients. One patient presented eight months later with biliary dyskinesia. She improved following laparoscopic cholecystectomy and later on sphincterotomy, but her pain has not yet completely resolved. One patient presented six months later with abdominal pain secondary to intestinal adhesions. Her pain completely resolved after laparoscopic lysis of adhesions. A third patient who developed lower abdominal pain six months after laparoscopy improved with conservative management and antibiotics for pelvic inflammatory disease. Conclusions: Diagnostic laparoscopy is a valuable procedure in the management of children with chronic recurrent abdominal pain. In the present study, laparoscopic examination revealed the cause of abdominal pain in most patients, and this pain resolved in most cases. Based on our

  5. Intrauterine synechiae after myomectomy; laparotomy versus laparoscopy: Non-randomized interventional trial

    PubMed Central

    Asgari, Zahra; Hafizi, Leili; Hosseini, Rayhaneh; Javaheri, Atiyeh; Rastad, Hathis

    2015-01-01

    Background: Leiomyomata is the most frequent gynecological neoplasm. One of the major complications of myomectomy is intrauterine adhesion (synechiae). Objective: To evaluate and compare the rate and severity of synechiae formation after myomectomy by laparotomy and laparoscopy. Materials and Methods: In this non-randomized interventional trial, hysteroscopy was performed in all married fertile women who had undergone myomectomy (type 3-6 interamural and subserosal fibroids) via laparotomy and laparoscopy in Tehran’s Arash Hospital from 2010 to 2013. Three months after the operation, the occurrence rate and severity of intrauterine synechiae, and its relationship with type, number and location of myomas were investigated and compared in both groups. Results: Forty patients (19 laparoscopy and 21 laparotomy cases) were studied. Both groups were similar regarding the size, type (subserosal or intramural), number and location of myoma. The occurrence rate of synechiae in the laparoscopy and laparotomy group was 21% and 19%, respectively; showing no significant difference (p=0.99). Among all patients, no significant relationship was found between the endometrial opening (p=0.92), location (p=0.14) and type of myoma (p=0.08) with the occurrence rate of synechiae. However, a significant relationship was observed between myoma’s size (p=0.01) and the location of the largest myoma with the occurrence of synechiae (p=0.02). Conclusion: With favorable suturing methods, the outcome of intrauterine synechiae formation after myomectomy, either performed by laparotomy or laparoscopy, is similar. In all cases of myomectomy in reproductive-aged women, postoperative hysteroscopy is highly recommended to better screen intrauterine synechiae. PMID:26000007

  6. Comparison of laparoscopy-assisted and open radical gastrectomy for advanced gastric cancer

    PubMed Central

    Hao, Yingxue; Yu, Peiwu; Qian, Feng; Zhao, Yongliang; Shi, Yan; Tang, Bo; Zeng, Dongzhu; Zhang, Chao

    2016-01-01

    Abstract Laparoscopy-assisted gastrectomy (LAG) has gained international acceptance for the treatment of early gastric cancer (EGC). However, the use of laparoscopic surgery in the management of advanced gastric cancer (AGC) has not attained widespread acceptance. This retrospective large-scale patient study in a single center for minimally invasive surgery assessed the feasibility and safety of LAG for T2 and T3 stage AGC. A total of 628 patients underwent LAG and 579 patients underwent open gastrectomy (OG) from Jan 2004 to Dec 2011. All cases underwent radical lymph node (LN) dissection from D1 to D2+. This study compared short- and long-term results between the 2 groups after stratifying by pTNM stages, including the mean operation time, volume of blood loss, number of harvested LNs, average days of postoperative hospital stay, mean gastrointestinal function recovery time, intra- and post-operative complications, recurrence rate, recurrence site, and 5-year survival curve. Thirty-five patients (5.57%) converted to open procedures in the LAG group. There were no significant differences in retrieved LN number (30.4 ± 13.4 vs 28.1 ± 17.2, P = 0.43), proximal resection margin (PRM) (6.15 ± 1.63 vs 6.09 ± 1.91, P = 0.56), or distal resection margin (DRM) (5.46 ± 1.74 vs 5.40 ± 1.95, P = 0.57) between the LAG and OG groups, respectively. The mean volume of blood loss (154.5 ± 102.6 vs 311.2 ± 118.9 mL, P < 0.001), mean postoperative hospital stay (7.6 ± 2.5 vs 10.7 ± 3.6 days, P < 0.001), mean time for gastrointestinal function recovery (3.3 ± 1.4 vs 3.9 ± 1.5 days, P < 0.001), and postoperative complications rate (6.4% vs 10.5%, P = 0.01) were clearly lower in the LAG group compared to the OG group. However, the recurrence pattern and site were not different between the 2 groups, even they were stratified by the TNM stage. The 5-year overall survival (OS) rates were 85.38%, 79

  7. Stages of Pancreatic Neuroendocrine Tumors

    MedlinePlus

    ... ultrasound. Tissue may also be removed during a laparoscopy (a surgical incision made in the wall of ... The instrument may be used during surgery or laparoscopy or inserted through the skin. This procedure is ...

  8. Antioxidant capacity and total phenolic content in fruit tissues from accessions of Capsicum chinense Jacq. (Habanero pepper) at different stages of ripening.

    PubMed

    Castro-Concha, Lizbeth A; Tuyub-Che, Jemina; Moo-Mukul, Angel; Vazquez-Flota, Felipe A; Miranda-Ham, Maria L

    2014-01-01

    In the past few years, there has been a renewed interest in studying a wide variety of food products that show beneficial effects on human health. Capsicum is an important agricultural crop, not only because its economic importance, but also for the nutritional values of its pods, mainly due to the fact that they are an excellent source of antioxidant compounds, and also of specific constituents such as the pungent capsaicinoids localized in the placental tissue. This current study was designed to evaluate the antioxidant capacity and total phenolic contents from fruits tissues of two Capsicum chinense accessions, namely, Chak k'an-iik (orange) and MR8H (red), at contrasting maturation stages. Results showed that red immature placental tissue, with a Trolox equivalent antioxidant capacity (TEAC) value of 55.59 μmols TE g(-1) FW, exhibited the strongest total antioxidant capacity using both the 2,2-diphenyl-1-picrylhydrazyl (DPPH) and the CUPRAC methods. Placental tissue also had the highest total phenolic content (27 g GAE 100 g(-1) FW). The antioxidant capacity of Capsicum was directly related to the total amount of phenolic compounds detected. In particular, placentas had high levels of capsaicinoids, which might be the principal responsible for their strong antioxidant activities.

  9. [Early second-look laparoscopy following surgical sterility interventions with the CO2 laser].

    PubMed

    Schieder, K; Kölbl, H; Dadak, C; Janisch, H

    1987-10-01

    10 (48%) bilateral, 5 (24%) unilateral tubostomies, 1 (5%) unilateral and 1 (5%) bilateral fimbrioplastic were performed in 21 sterility patients. 21 female sterility patients underwent short-interval second-look-laparoscopy 8 days after reconstructive surgery (salpingostomy-10 bilateral/5 unilateral, fimbrioplasty-1 bilateral/1 unilateral, adhaesiolysis--16 bilateral/3 uni-lateral). The occurrence of postoperative adhesions was judged by the use of an adhesions-score. Compared to fertility surgery the initial median adhesion-score significantly decreased (p less than 0.0003--Wilcoxon Signed Ranks Test). A further reduction of the median adhesions-score could be achieved by short-interval-second-look-laparoscopy (p less than 0.0001). Within an observation time of 11 +/- 3.8 months one (5%) ectopic and 4 intrauterine pregnancies (19%) were found.

  10. Abdominal Wall Endometriosis on the Right Port Site After Laparoscopy: Case Report and Literature Review

    PubMed Central

    Cozzolino, Mauro; Magnolfi, Stefania; Corioni, Serena; Moncini, Daniela; Mattei, Alberto

    2015-01-01

    Background Endometriosis can be intrapelvic or, rarely, extrapelvic. Endometriosis involving the rectus abdominis muscle on the trocar port site is a rare event; until now, only 16 cases have been reported in the literature. The majority of cases were associated with previous abdominal surgery such as diagnostic laparoscopy, cyst excision, appendectomy, myomectomy, or cholecystectomy. We review all the reported cases of this unusual form of extrapelvic endometriosis. Case Report We report a new case of abdominal wall endometriosis at the trocar port site in the rectus abdominis muscle in a woman who had undergone 2 laparoscopies for endometriosis in the 3 years before coming to our attention. The diagnosis was made by sonography. We performed a surgical resection of the lesion with a free macroscopic margin of 5-10 mm. Conclusion Endometriosis should be considered in the differential diagnosis of any abdominal swelling. In our experience, surgery is the treatment of choice. PMID:26412997

  11. [Inguinal hernia in Africa and laparoscopy: utopia or realism?].

    PubMed

    Pallas, G; Simon, F; Sockeel, P; Chapuis, O; Jancovici, R

    2000-01-01

    Inguinal hernia is a common indication for surgery in Africa. Most cases involve men and are treated in advanced stages often with complications. Until now the benchmark technique for surgical management has been the well-defined herniorrhaphy technique. Use of prosthetic implants has been rare because of high cost. Recently there has been a growing interest in video-assisted surgery throughout developing countries. However this enthusiasm should not obscure the fact that the technique is still in the developing stage and thus is more costly for the local economy. Indications for video-assisted surgery should be carefully selected in function of local conditions as well as problems specific to developing countries.

  12. Parecoxib increases muscle pain threshold and relieves shoulder pain after gynecologic laparoscopy: a randomized controlled trial

    PubMed Central

    Zhang, Hufei; Liu, Xinhe; Jiang, Hongye; Liu, Zimeng; Zhang, Xu-Yu; Xie, Hong-Zhe

    2016-01-01

    Objectives Postlaparoscopic shoulder pain (PLSP) remains a common problem after laparoscopies. The aim of this study was to investigate the correlation between pressure pain threshold (PPT) of different muscles and PLSP after gynecologic laparoscopy, and to explore the effect of parecoxib, a cyclooxygenase-2 inhibitor, on the changes of PPT. Materials and methods The patients were randomly allocated into two groups; group P and group C. In group P, parecoxib 40 mg was intravenously infused at 30 minutes before surgery and 8 and 20 hours after surgery. In group C, normal saline was infused at the corresponding time point. PPT assessment was performed 1 day before surgery and at postoperative 24 hours by using a pressure algometer at bilateral shoulder muscles (levator scapulae and supraspinatus) and forearm (flexor carpi ulnaris). Meanwhile, bilateral shoulder pain was evaluated through visual analog scale score at 24 hours after surgery. Results Preoperative PPT level of the shoulder, but not of the forearm, was significantly and negatively correlated with the intensity of ipsilateral PLSP. In group C, PPT levels of shoulder muscles, but not of forearm muscles, decreased after laparoscopy at postoperative 24 hours. The use of parecoxib significantly improved the decline of PPT levels of bilateral shoulder muscles (all P<0.01). Meanwhile, parecoxib reduced the incidence of PLSP (group P: 45% vs group C: 83.3%; odds ratio: 0.164; 95% confidence interval: 0.07–0.382; P<0.001) and the intensity of bilateral shoulder pain (both P<0.01). Conclusion Preoperative PPT levels of shoulder muscles are closely associated with the severity of shoulder pain after gynecologic laparoscopy. PPT levels of shoulder muscles, but not of forearm muscles, significantly decreased after surgery. Parecoxib improved the decrease of PPT and relieved PLSP.

  13. Parecoxib increases muscle pain threshold and relieves shoulder pain after gynecologic laparoscopy: a randomized controlled trial

    PubMed Central

    Zhang, Hufei; Liu, Xinhe; Jiang, Hongye; Liu, Zimeng; Zhang, Xu-Yu; Xie, Hong-Zhe

    2016-01-01

    Objectives Postlaparoscopic shoulder pain (PLSP) remains a common problem after laparoscopies. The aim of this study was to investigate the correlation between pressure pain threshold (PPT) of different muscles and PLSP after gynecologic laparoscopy, and to explore the effect of parecoxib, a cyclooxygenase-2 inhibitor, on the changes of PPT. Materials and methods The patients were randomly allocated into two groups; group P and group C. In group P, parecoxib 40 mg was intravenously infused at 30 minutes before surgery and 8 and 20 hours after surgery. In group C, normal saline was infused at the corresponding time point. PPT assessment was performed 1 day before surgery and at postoperative 24 hours by using a pressure algometer at bilateral shoulder muscles (levator scapulae and supraspinatus) and forearm (flexor carpi ulnaris). Meanwhile, bilateral shoulder pain was evaluated through visual analog scale score at 24 hours after surgery. Results Preoperative PPT level of the shoulder, but not of the forearm, was significantly and negatively correlated with the intensity of ipsilateral PLSP. In group C, PPT levels of shoulder muscles, but not of forearm muscles, decreased after laparoscopy at postoperative 24 hours. The use of parecoxib significantly improved the decline of PPT levels of bilateral shoulder muscles (all P<0.01). Meanwhile, parecoxib reduced the incidence of PLSP (group P: 45% vs group C: 83.3%; odds ratio: 0.164; 95% confidence interval: 0.07–0.382; P<0.001) and the intensity of bilateral shoulder pain (both P<0.01). Conclusion Preoperative PPT levels of shoulder muscles are closely associated with the severity of shoulder pain after gynecologic laparoscopy. PPT levels of shoulder muscles, but not of forearm muscles, significantly decreased after surgery. Parecoxib improved the decrease of PPT and relieved PLSP. PMID:27695359

  14. [Role of laparoscopy in the management of the abnormalities of sex differentiation: about 12 cases].

    PubMed

    Goultaiene, Aissam; Elmortaji, Khalid; Sentissi, Reda; Moataz, Amine; Rabii, Redouane; Aboutaib, Rachid; Dakir, Mohammed; Debbagh, Adil; Meziane, Fethi

    2016-01-01

    Disorders of sex differentiation cause a discrepancy between sex itself (phenotype) and genetic sex (genotype) which poses a problem in sex determination. In lower socioeconomic level countries where prenatal diagnosis is often absent and technical equipments are inadequate, medical and surgical management is difficult. The aim of this study is to clarify the role of laparoscopy in the management of sexual ambiguity through observation of 4 cases and review of the literature. PMID:27303583

  15. Implementation of a Cross-specialty Training Program in Basic Laparoscopy

    PubMed Central

    Sorensen, Jette Led; Thinggaard, Ebbe; Strandbygaard, Jeanett; Konge, Lars

    2015-01-01

    Background and Objectives: Several surgical specialties use laparoscopy and share many of the same techniques and challenges, such as entry approaches, equipment, and complications. However, most basic training programs focus on a single specialty. The objective of this study was to describe the implementation of a regional cross-specialty training program for basic laparoscopy, to increase the flexibility of educational courses, and to provide a more efficient use of simulation equipment. Methods: Using a regional training program in basic laparoscopy for gynecology as a model, we developed a cross-specialty training program for residents in surgery, gynecology, urology, and thoracic surgery. We reviewed data on training for the first year of the program and evaluated the program by using a scoring system for quality criteria for laparoscopic curricula and skills. Results: We held 6 full-day theoretical courses involving 67 residents between September 1, 2013, and August 31, 2014. In the weeks following each course, residents practiced in a self-directed, distributed, and proficiency-based manner at a simulation center and in local hospital departments. A total of 57 residents completed the self-practice and a subsequent practical animal laboratory–based course. The structure of the training program was evaluated according to identified quality criteria for a skills laboratory, and the program scored 38 of a maximum 62 points. Discussion: Implementation of a regional cross-specialty training program in basic laparoscopy is feasible. There are several logistic benefits of using a cross-specialty approach; however, it is important that local departments include specialty-specific components, together with clinical departmental follow-up. PMID:26527858

  16. Management of Selected Adnexal Masses in Postmenopausal Women by Operative Laparoscopy-A Multicentered Study

    PubMed

    Parker; Levine; Howard; Sansone; Berek

    1994-08-01

    With careful preoperative assessment we have selected postmenopausal women who were believed to have benign adnexal masses and who were candidates for removal of these masses via operative laparoscopy. Criteria for inclusion were: postmenopausal status; cystic adnexal mass less than 10 cm. with distinct borders and without irregular solid parts or thick septa; CA 125<35 U/ml; and no contraindications for surgery. Sixty-one women were entered into the study. All of the masses were benign, including 27 serous cysts, 15 serous cystadenomas, 1 mucinous cystadenoma, 5 serous cystadenofibromas, 6 paratubal cysts, 3 retroperitoneal cysts, and 4 chronic hydrosalpinges. Fifty-eight patients had successful pelviscopic removal of their adnexal mass. Three patients (5%) required laparotomy. For patients managed by operative laparoscopy, mean operating time was 63 minutes, mean postoperative stay was 12 hours, and mean time to return to normal activity was 5.6 days. We conclude that the combination of CA 125 values and pelvic ultrasound can successfully predict benign masses in postmenopausal women, and removal of these masses by operative laparoscopy is acceptable in carefully selected women.

  17. A simplified laparoscopy technique for repeated ovarian observation in the water buffalo (Bubalus bubalis).

    PubMed

    Ambrose, J D; Manik, R S; Singla, S K; Madan, M L

    1993-09-01

    A simplified technique of laparoscopy was developed for ovarian observation in the riverine buffalo, through a right paralumbar incision. The technique differed from previously described ones in that it involved only a single puncture and required no abdominal insufflation. A Hopkins 0 degrees forward viewing endoscope (5.5 mm x 500 mm) in combination with an endoscope sheath having a built-in instrument channel, and a long flexible forceps (630 mm) were used. Of the 23 observation attempts on 13 buffalo, 21 successful observations were conducted. Laparoscopies were performed using a combination of Xylazine, local infiltration and epidural anesthesia in a standing position. Six repeated observations were made within a 21-day period on 1 buffalo, with no postoperative complications. Observation of both left and right ovaries was possible through the same puncture. The technique was useful in buffalo to confirm ovarian structures which could not be determined with certainty through palpation per rectum. Our results suggest that the single puncture laparoscopy technique can be safely used for repeated ovarian examination in the water buffalo.

  18. The role of laparoscopy in recurrent right lower quadrant pain in children.

    PubMed

    Caiazzo, Paolo; Esposito, Maria; Del Vecchio, Giovanni; Papparella, Alfonso; Cavaiuolo, Silvia; Tramutoli, Pio Rocco; Parmeggiani, Pio

    2015-01-01

    According to scientific literature, laparoscopy as aid in diagnosis and therapy for chronic pain in the right iliac quadrant shows a undeniable advantage thanks to its mini-invasiveness, the possibility of a methodical and thorough exploration of the entire abdominal cavity in those cases of recurrent pain, emotionally and socially debilitating, that do not find an answer in the usual etiological diagnostic clinical-instrumental. In those cases in which any significant organic pathology that justifies the recurring pain in the right iliac fossa is found during laparoscopic exploration, it has been seen that it is useful to perform appendectomy anyway, that leads to the disappearance of symptoms, which are probably due to inflammatory recurrent catarrhal phenomena of appendix in such patients, as it is demonstrated by the adhesions found at cecum-appendicular level. From January 2011 to December 2013, 24 children with chronic recurrent right lower quadrant pain were subjected to diagnostic laparoscopy. Ages varied from 11 to 18 years (mean, 14 years). There were 6 males and 18 females. Laparoscopic findings included macroscopical signs of acute appendicitis in 15 patients; cecal adhesions in 20 patients, kink of the appendix in 3. The abdominal pain completely resolved in all the patients following laparoscopy.

  19. Retroperitoneal laparoscopy for the management of renal hydatid cyst.

    PubMed

    Khan, Muneer; Sajjad Nazir, Syed; Ahangar, Shahnawaz; Farooq Qadri, Syed Javid; Ahmad Salroo, Nazir

    2010-01-01

    Hydatid disease is one of the common parasitic afflictions seen in sheep rearing areas of world, with certain areas in northern India showing a very high incidence. It is caused by the larval/cyst stage of Echinococcus granulosus, in which humans are an intermediate host. The cysts are located in liver 75% times, lungs 15%, other organs 10%. Isolated involvement of kidneys is rare and forms 2-4% of cases. The treatment usually requires some form of intervention ranging from minimally invasive percutaneous aspiration techniques to laparoscopic and the maximally invasive, open techniques. Herein, we describe two cases of isolated renal hydatid cysts that were treated successfully by retroperitoneal laparoscopic approach to prevent the soiling of peritoneal cavity. One of the cases had a preoperative diagnosis of simple renal cyst. No complications occurred at peroperative and postoperative periods. The patients were given 3 cycles of Albendazole (10 mg/kg in two divided doses), each for a period of four weeks followed by a weeks rest. The patients are under strict follow-up and no recurrence has been documented yet.

  20. The Robotic-Assisted Laparoscopy, Isthmusectomy, and Pyeloplasty in a Patient With Horseshoe Kidney: A Case Report.

    PubMed

    Tai, Sheng; Wang, Jianzhong; Zhou, Jun; Hao, Zongyao; Shi, Haoqiang; Zhang, Yifei; Liang, Chaozhao

    2016-01-01

    The aim of this case report was to evaluate the results of isthmusectomy and pyeloplasty of horseshoe kidney with the da Vinci robotic-assisted laparoscopy system.This case presented 1 patient with left back pain, associated with lower abdominal pain, and then she underwent the isthmusectomy and dismembered pyeloplasty using robotic-assisted laparoscopy simultaneously. The operation was performed by a transperitoneal approach using 5 ports.We cut the renal isthmus by means of bipolar scissors and then closed the renal parenchyma with 3-0 absorbed stitches. The total operation time was 123 min including simultaneous dismembered pyeloplasty. Blood loss was <50 mL. There were no complications either during or after the procedure. The oral nutrition and mobilization were included on the second day after surgery. The peritoneal drainage was removed on the eighth day. Long-term follow-up after treatment showed good results.The da Vinci robotic-assisted laparoscopy is an alternative to open surgery and laparoscopy, particularly in the correction of congenital defects of the urinary tract. Furthermore, the da Vinci robotic-assisted laparoscopy technique in isthmusectomy and pyeloplasty is safe for patient as shown by our results. PMID:26765474

  1. 5-millimeter Trocar-site Hernias After Laparoscopy Requiring Surgical Repair.

    PubMed

    Pereira, Nigel; Hutchinson, Anne P; Irani, Mohamad; Chung, Eric R; Lekovich, Jovana P; Chung, Pak H; Zarnegar, Rasa; Rosenwaks, Zev

    2016-01-01

    Trocar-site hernias are rare complications of laparoscopic surgery. Although trocar-site hernias occur more often at >10-mm sites, hernias can still develop at 5-mm sites after laparoscopy and can lead to serious complications. The primary objective of this review is to summarize the current medical literature pertaining to the clinical presentation and predisposing risk factors of trocar-site hernias at 5-mm sites after laparoscopy. A total of 295 publications were identified, 17 (5.76%) of which met the inclusion criteria. Twenty-seven patients with trocar-site hernias were identified after laparoscopic cases. The median age (interquartile range) for all adult patients with trocar-site hernias was 63 years (interquartile range, 39.5-66.5 years). Eight of the 18 patients (44.4%) undergoing gynecologic laparoscopy were parous although details of parity were not reported in most publications. Simple manual reduction or laparoscopic reduction with fascial closure (21 patients [84%]) was used more often compared with exploratory laparotomy (4 patients [16%], p < .001) to manage trocar-site hernias. There was no statistical difference in the location of trocar-site hernias (i.e., umbilical [14 patients, 56%] vs nonumbilical/lateral [11 patients, 44%], p = .12). Findings of this review suggest that increased operative times and excessive manipulation can extend 5-mm fascial incisions, thereby increasing the risk of trocar-site hernias. Parous women older than 60 years may have unrecognized fascial defects, which confer a higher risk of trocar-site hernias after laparoscopic surgery, even in the absence of incision manipulation or prolonged surgical duration. Such patients may benefit from closure of 5-mm fascial incisions although prospective data are required to validate the overall generalizability of this management strategy.

  2. Extraperitoneal laparoscopy-assisted percutaneous nephrolithotomy in a patient with osteogenesis imperfecta.

    PubMed

    Basal, Seref; Ozgok, Yasar; Tahmaz, Lutfi; Atim, Abdulkadir; Zor, Murat; Bilgic, Serkan; Istanbulluoglu, Okan

    2011-02-01

    Osteogenesis imperfecta (OI) patients represent a challenge to all physicians, as they do for anesthetists and urologists, when they develop symptomatic stones in the urinary tract. We recently treated an OI patient with renal pelvic stone by extraperitoneal laparoscopy-assisted percutaneous nephrolithotomy (PCNL). To our knowledge, this combined treatment modality has not been reported previously in OI. An 18-year-old paraplegic girl with OI presented to our urology department because of right-sided flank pain. She pointed out that she had right kidney stone for the previous 2 years, and because of risks of general anesthesia and surgical procedures, surveillance was recommended. Intravenous pyelography was performed and an 11.9-mm stone at the pelvis of the right kidney and grade 1-2 hydronephrosis at the same side with normal kidney functions and severe left-sided scoliosis were detected. After explanation of risks of the treatment modality and general anesthesia to the patient, extraperitoneal laparoscopy-assisted PCNL was performed. No complications occurred due to general anesthesia or surgical procedure. The operation time was 95 min and no blood transfusion was required. The nephrostomy tube and retroperitoneal drain were removed 2 and 3 days after the procedure, respectively. The patient was doing well at a follow-up of 6 months. Extraperitoneal laparoscopy-assisted PCNL approach may decrease the risk of surgery as an alternative treatment modality for OI patients. Such cases should be operated on at centers with significant experience in the field of endourology, where all the equipment and specialized personnel are readily available.

  3. The role of laparoscopy in the identification and management of missing accessory spleens after primary splenectomy: A case report and literature review

    PubMed Central

    Vaos, George; Mantadakis, Elpis; Gardikis, Stefanos; Pitiakoudis, Michael

    2016-01-01

    We present a 7-year-old boy with recurrent thrombocytopenia after primary laparoscopic splenectomy for immune thrombocytopenia (ITP). Imaging modalities (ultrasound, computed tomography scan, and scintigraphy) revealed two accessory spleens while the subsequent second laparoscopy revealed 11, which were successfully removed. The relevant medical literature is reviewed, and the value of laparoscopy for chronic ITP is highlighted. PMID:27695216

  4. The role of laparoscopy in the identification and management of missing accessory spleens after primary splenectomy: A case report and literature review

    PubMed Central

    Vaos, George; Mantadakis, Elpis; Gardikis, Stefanos; Pitiakoudis, Michael

    2016-01-01

    We present a 7-year-old boy with recurrent thrombocytopenia after primary laparoscopic splenectomy for immune thrombocytopenia (ITP). Imaging modalities (ultrasound, computed tomography scan, and scintigraphy) revealed two accessory spleens while the subsequent second laparoscopy revealed 11, which were successfully removed. The relevant medical literature is reviewed, and the value of laparoscopy for chronic ITP is highlighted.

  5. Spontaneous Bilateral Tubal Ectopic Pregnancy: Incidental Finding During Laparoscopy – Brief Report and Review of Literature

    PubMed Central

    Hoffmann, S.; Abele, H.; Bachmann, C.

    2016-01-01

    Objective: Bilateral tubal ectopic pregnancies are rare; the reported incidence is only 1 in 200 000 pregnancies. Detecting bilateral tubal ectopic pregnancy is urgent because of the associated morbidity and mortality. The appropriate fertility-preserving surgery must also be considered, as preservation of both tubes is presumed to offer better fertility prospects. Case Report: A 39-year-old gravida 2, para 1 presented with vaginal bleeding at 8 + 4 weeks of gestation. An approximately 18 mm adnexal mass in the right fallopian tube was detected on ultrasound. Laparoscopy was performed because ectopic pregnancy was suspected. This suspicion was confirmed during laparoscopy; the right fallopian tube was found to contain a mass measuring 20 mm in the isthmic part. Ultrasound of the left fallopian tube also showed a mass in the ampullary region (diameter: 10 mm), also suspicious for ectopic pregnancy. Bilateral salpingotomy was performed laparoscopically. Pathological examination confirmed the diagnosis. Conclusions for Practice: Although ectopic tubal pregnancy is seen more often after assisted reproductive techniques, bilateral spontaneous ectopic pregnancies must also be considered in other cases. Laparoscopic surgery is effective to confirm the diagnosis and treat heterotopic pregnancies. Further studies will be needed to confirm whether unilateral or bilateral conservative fertility-preserving surgery is more appropriate. PMID:27134298

  6. Varied Practice in Laparoscopy Training: Beneficial Learning Stimulation or Cognitive Overload?

    PubMed Central

    Spruit, Edward N.; Kleijweg, Luca; Band, Guido P. H.; Hamming, Jaap F.

    2016-01-01

    Determining the optimal design for surgical skills training is an ongoing research endeavor. In education literature, varied practice is listed as a positive intervention to improve acquisition of knowledge and motor skills. In the current study we tested the effectiveness of a varied practice intervention during laparoscopy training. Twenty-four trainees (control group) without prior experience received a 3 weeks laparoscopic skills training utilizing four basic and one advanced training task. Twenty-eight trainees (experimental group) received the same training with a random training task schedule, more frequent task switching and inverted viewing conditions on the four basic training tasks, but not the advanced task. Results showed inferior performance of the experimental group on the four basic laparoscopy tasks during training, at the end of training and at a 2 months retention session. We assume the inverted viewing conditions have led to the deterioration of learning in the experimental group because no significant differences were found between groups on the only task that had not been practiced under inverted viewing conditions; the advanced laparoscopic task. Potential moderating effects of inter-task similarity, task complexity, and trainee characteristics are discussed. PMID:27242599

  7. Role of laparoscopy in ureteropelvic junction obstruction with concomitant pathology: a case series study

    PubMed Central

    El-Fayoumi, Abdel-Rahman; Gakis, Georgios; Amend, Bastian; Khairul-Asri, Mohd Ghani; Stenzl, Arnulf; Schwentner, Christian

    2015-01-01

    Introduction Laparoscopic pyeloplasty is considered a standard treatment for ureteropelvic junction obstruction (UPJO). However, the presence of another pathology makes it a more challenging operation and guides the surgeon towards open conversion. In this study, we present our experience in difficult pyeloplasty cases managed by laparoscopy. Material and methods Six patients (4 females and 2 males) with an average age of 44 and a range of 27 to 60 years old, were diagnosed for UPJO. Three were on the left side and 3 on the right side. In addition to UPJO, 2 patients had renal stones, one patient had both renal ptosis and an umbilical hernia, 3 patients had a para-pelvic cyst, hepatomegaly and malrotated kidney, respectively. All patients had a preoperative ultrasound, CT or IVU, and a renal isotope scan. Laparoscopic pyeloplasty was performed according to the dismembered Anderson-Hynes technique with auxiliary maneuver, according to the pathology. Results All patients were treated successfully for UPJO and the concomitant pathologies, except hepatomegaly and malrotation. Mean operative time was 125 minutes and estimated blood loss was <50 ml. Conclusions Laparoscopic pyeloplasty can be performed in difficult situations provided that the surgeon has enough experience with laparoscopy. PMID:26855804

  8. Breaking new ground or just digging a hole? An evaluation of gynecologic operative laparoscopy.

    PubMed

    Howard, F M

    1992-01-01

    The gynecological surgical procedures that may be accomplished via operative laparoscopy have dramatically increased in the past decade. Ideally, strong evidence of advantages over traditional surgical approaches should be presented for each surgical procedure before widespread use occurs. Such evidence is generally lacking. This review of recent publications concludes that laparoscopic operations for tubal ectopic pregnancy have been demonstrated generally to be preferable to laparotomy. Although evidence is very suggestive, clear superiority of laparoscopy has not been proven for endometriosis, ovarian cystectomy, oophorectomy, distal salpingostomy, or adhesiolysis for infertility. There is not adequate evidence to reach a conclusion on the use of laparoscopic myomectomy for fertility. When appropriately indicated, vaginal hysterectomy seems preferable to abdominal or laparoscopic hysterectomy, and preliminary evidence suggests that laparoscopic hysterectomy may have some advantages over abdominal hysterectomy. There is no evidence that laparoscopic tubal sterilization is better than minilaparotomy tubal sterilization. Much more scientific study of operative laparoscopic procedures is needed before universal change to these procedures can be fully endorsed. PMID:10171580

  9. Diagnostic laparoscopy should be performed before definitive resection for pancreatic cancer: a financial argument

    PubMed Central

    Jayakrishnan, Thejus T; Nadeem, Hasan; Groeschl, Ryan T; George, Ben; Thomas, James P; Ritch, Paul S; Christians, Kathleen K; Tsai, Susan; Evans, Douglas B; Pappas, Sam G; Gamblin, T Clark; Turaga, Kiran K

    2015-01-01

    Objectives Laparoscopy is recommended to detect radiographically occult metastases in patients with pancreatic cancer before curative resection. This study was conducted to test the hypothesis that diagnostic laparoscopy (DL) is cost-effective in patients undergoing curative resection with or without neoadjuvant therapy (NAT). Methods Decision tree modelling compared routine DL with exploratory laparotomy (ExLap) at the time of curative resection in resectable cancer treated with surgery first, (SF) and borderline resectable cancer treated with NAT. Costs (US$) from the payer's perspective, quality-adjusted life months (QALMs) and incremental cost-effectiveness ratios (ICERs) were calculated. Base case estimates and multi-way sensitivity analyses were performed. Willingness to pay (WtP) was US$4166/QALM (or US$50 000/quality-adjusted life year). Results Base case costs were US$34 921 for ExLap and US$33 442 for DL in SF patients, and US$39 633 for ExLap and US$39 713 for DL in NAT patients. Routine DL is the dominant (preferred) strategy in both treatment types: it allows for cost reductions of US$10 695/QALM in SF and US$4158/QALM in NAT patients. Conclusions The present analysis supports the cost-effectiveness of routine DL before curative resection in pancreatic cancer patients treated with either SF or NAT. PMID:25123702

  10. Systematic review of robotic surgery in gynecology: robotic techniques compared with laparoscopy and laparotomy.

    PubMed

    Gala, Rajiv B; Margulies, Rebecca; Steinberg, Adam; Murphy, Miles; Lukban, James; Jeppson, Peter; Aschkenazi, Sarit; Olivera, Cedric; South, Mary; Lowenstein, Lior; Schaffer, Joseph; Balk, Ethan M; Sung, Vivian

    2014-01-01

    The Society of Gynecologic Surgeons Systematic Review Group performed a systematic review of both randomized and observational studies to compare robotic vs nonrobotic surgical approaches (laparoscopic, abdominal, and vaginal) for treatment of both benign and malignant gynecologic indications to compare surgical and patient-centered outcomes, costs, and adverse events associated with the various surgical approaches. MEDLINE and the Cochrane Central Register of Controlled Trials were searched from inception to May 15, 2012, for English-language studies with terms related to robotic surgery and gynecology. Studies of any design that included at least 30 women who had undergone robotic-assisted laparoscopic gynecologic surgery were included for review. The literature yielded 1213 citations, of which 97 full-text articles were reviewed. Forty-four studies (30 comparative and 14 noncomparative) met eligibility criteria. Study data were extracted into structured electronic forms and reconciled by a second, independent reviewer. Our analysis revealed that, compared with open surgery, robotic surgery consistently confers shorter hospital stay. The proficiency plateau seems to be lower for robotic surgery than for conventional laparoscopy. Of the various gynecologic applications, there seems to be evidence that renders robotic techniques advantageous over traditional open surgery for management of endometrial cancer. However, insofar as superiority, conflicting data are obtained when comparing robotics vs laparoscopic techniques. Therefore, the specific method of minimally invasive surgery, whether conventional laparoscopy or robotic surgery, should be tailored to patient selection, surgeon ability, and equipment availability.

  11. Stages of Cervical Cancer

    MedlinePlus

    ... checked under a microscope for signs of cancer. Laparoscopy : A surgical procedure to look at the organs ... a laparoscope , the operation is called a total laparoscopic hysterectomy. Enlarge Hysterectomy. The uterus is surgically removed ...

  12. Diagnostic laparoscopy

    MedlinePlus

    Fried GM. Emerging technology in surgery: informatics, robotics, and electronics. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery . 19th ed. Philadelphia, PA: Saunders Elsevier; 2012: ...

  13. Laparoscopy as a Diagnostic and Definitive Therapeutic Tool in Cases of Inflamed Simple Lymphatic Cysts of the Mesentery

    PubMed Central

    Abdelaal, Abdelrahman; Sulieman, Ibnouf; Aftab, Zia; Ahmed, Ayman; Al-Mudares, Saif; Al Tarakji, Mohannad; Almuzrakchi, Ahmad; Di Carlo, Isidoro

    2015-01-01

    Mesenteric cysts are rare benign abdominal tumors. These cysts, especially those of lymphatic origin, very rarely become inflamed. The diagnosis of inflamed lymphatic cysts of the mesentery may be difficult. We herein report two cases of inflamed simple lymphatic cysts of the mesentery definitively diagnosed and excised by laparoscopy. PMID:26064760

  14. Surgical Treatment of Early-Stage Cervical Cancer.

    PubMed

    Brucker, Sara Y; Ulrich, Uwe A

    2016-01-01

    Surgical treatment of cervical cancer has been a cornerstone in the management of this malignancy for more than 100 years. Today, for early-stage and low-risk cervical cancer, surgery is still considered the gold standard. If the preoperative assessment of the tumor reveals a situation prompting postoperative adjuvant radiochemotherapy, the latter should be planned as the primary treatment option, being preceded by staging laparoscopy including pelvic and paraaortic lymph node dissection. As an alternative to the open approach, the definitive surgical treatment should be either performed laparoscopically, or be laparoscopic-assisted, or laparoscopically robotic-assisted. PMID:27614875

  15. Suggested set-up and layout of instruments and equipment for advanced operative laparoscopy.

    PubMed

    Winer, W K; Lyons, T L

    1995-02-01

    Crucial elements that ensure the organization and smoothness of a laparoscopic procedure are clear communication among well-trained endoscopy team members, properly maintained equipment, and a sensible layout of the instruments. The team consists of the surgeon, surgical assistant, circulator, scrub nurse, laser nurse, and anesthesiologist. To promote continuity and interaction and to ensure a systematic, pleasant pace for laparoscopic procedures, the team should establish a specific routine, as well as set-up and layout of tables, equipment, and instruments. Key ingredients for advanced operative laparoscopy to be performed with optimum efficiency and effectiveness are the best organization and placement of the equipment, instrumentation, and team in a particular setting in the operating room. PMID:9050565

  16. 3D reconstruction in laparoscopy with close-range photometric stereo.

    PubMed

    Collins, Toby; Bartoli, Adrien

    2012-01-01

    In this paper we present the first solution to 3D reconstruction in monocular laparoscopy using methods based on Photometric Stereo (PS). Our main contributions are to provide the new theory and practical solutions to successfully apply PS in close-range imaging conditions. We are specifically motivated by a solution with minimal hardware modification to existing laparoscopes. In fact the only physical modification we make is to adjust the colour of the laparoscope's illumination via three colour filters placed at its tip. Once calibrated, our approach can compute 3D from a single image, does not require correspondence estimation, and computes absolute depth densely. We demonstrate the potential of our approach with ground truth ex-vivo and in-vivo experimentation. PMID:23286102

  17. A case of a glomus tumor of the stomach resected by laparoscopy endoscopy cooperative surgery.

    PubMed

    Nakajo, Keiichiro; Chonan, Akimichi; Tsuboi, Rumiko; Nihei, Kousuke; Iwaki, Tomoyuki; Yamaoka, Hajime; Sato, Shun; Matsuda, Tomomi; Nakahori, Masato; Endo, Mareyuki

    2016-09-01

    A 56-year-old woman who was found to have a submucosal tumor (SMT) of the stomach in a medical check-up was admitted to our hospital for a detailed investigation of the SMT. Upper gastrointestinal endoscopy revealed an SMT of 20mm at the anterior wall of the antrum of the stomach. Endoscopic ultrasonography showed a hyperechoic tumor in the fourth layer of the stomach wall. CT examination showed a strongly enhancing tumor on arterial phase images and persistent enhancement on portal venous phase images. Laparoscopy endoscopy cooperative surgery was performed with a diagnosis of SMT of the stomach highly suspicious of a glomus tumor. Immunohistochemistry revealed expression of α-SMA but no expression of desmin, c-kit, CD34, or S-100. The tumor was finally diagnosed as a glomus tumor of the stomach.

  18. Intragastric surgery using laparoscopy and oral endoscopy for gastric submucosal tumors

    PubMed Central

    Tagaya, Nobumi; Tatsuoka, Teppei; Kubota, Yawara; Takegami, Masayuki; Sugamata, Nana; Saito, Kazuyuki; Okuyama, Takashi; Sugamata, Yoshitake; Oya, Masatoshi

    2015-01-01

    We review the techniques and outcomes of the intragastric resection for gastric submucosal tumors (GSTs) using laparoscope and oral endoscope. In the literature, the mean operation time, intraoperative blood loss, pathological size of the tumor and postoperative hospital stay were 134 min, minimal, 31 mm and 6.4 d, respectively. There were no particular perioperative complications during the follow-up period (mean: 121.3 mo). Intragastric surgery using laparoscopy and oral endoscopy can be considerably beneficial for patients with GSTs locating in the upper third of the stomach between 2-5 cm in diameter and < 8 cm2 in cross-sectional area and located in the upper third of the stomach. PMID:25610534

  19. A case of a glomus tumor of the stomach resected by laparoscopy endoscopy cooperative surgery.

    PubMed

    Nakajo, Keiichiro; Chonan, Akimichi; Tsuboi, Rumiko; Nihei, Kousuke; Iwaki, Tomoyuki; Yamaoka, Hajime; Sato, Shun; Matsuda, Tomomi; Nakahori, Masato; Endo, Mareyuki

    2016-09-01

    A 56-year-old woman who was found to have a submucosal tumor (SMT) of the stomach in a medical check-up was admitted to our hospital for a detailed investigation of the SMT. Upper gastrointestinal endoscopy revealed an SMT of 20mm at the anterior wall of the antrum of the stomach. Endoscopic ultrasonography showed a hyperechoic tumor in the fourth layer of the stomach wall. CT examination showed a strongly enhancing tumor on arterial phase images and persistent enhancement on portal venous phase images. Laparoscopy endoscopy cooperative surgery was performed with a diagnosis of SMT of the stomach highly suspicious of a glomus tumor. Immunohistochemistry revealed expression of α-SMA but no expression of desmin, c-kit, CD34, or S-100. The tumor was finally diagnosed as a glomus tumor of the stomach. PMID:27593365

  20. [Segmental angiography of the liver with laparoscopy and electro-coagulation. Selective hepatography (author's transl)].

    PubMed

    Wannagat, L

    1975-09-01

    Segmental angiography of the liver with laparoscopy and electro-coagulation has high diagnostic value. The circulatory systems of the liver may be studied selectively or in various combinations. Morphologic lesions as well as functional disturbances of liver arteries and veins, the portal vein and to a certain degree lymph vessels can be visualized precisely. An improved indication for shunt operations and a more reliable prognosis may be achieved by direct transhepatic pressure measurements, especially within the hepatic artery and portal vein. An early diagnosis of the Budd-Chiari-Syndrome is enabled by the combined segmental veno- and portography which could not be achieved by the known techniques so far. Complications are rarely seen. In 1070 examinations there was one suspicion for bilihemia, one case of hemobilia, and one case of a subcapsular hematoma. Twice a liver lobe was perforated. There was never a permanent damage to the patient. Biochemical and nuclear medicine studies are suggested.

  1. Transanal Total Mesorectal Excision With Single-Incision Laparoscopy for Rectal Cancer

    PubMed Central

    Foo, Dominic Chi-chung; Choi, Hok Kwok; Wei, Rockson; Yip, Jeremy

    2016-01-01

    Background and Objectives: There has been great enthusiasm for the technique of transanal total mesorectal excision. Coupled with this procedure, we performed single-incision laparoscopic surgery for left colon mobilization. This is a description of our initial experience with the combined approach. Methods: Patients with distal or mid rectal cancer were included. The operation was performed by 2 teams: one team performed the single-incision mobilization of the left colon via the right lower quadrant ileostomy site, and the other team performed the total mesorectal excision with a transanal platform. Results: During the study period, 10 patients (5 men) with cancer of the rectum underwent the surgery. The mean age was 62.2 ± 11.1 years, and the mean body mass index was 23.4 ± 3.2 kg/m2. The tumor's mean distance from the anal verge was 5.1 ± 2.5 cm. The median operating time was 247.5 minutes (range, 188–462 minutes). The mean estimated blood loss was 124 ± 126 mL (range, 10–188 mL). Conversion to multiport laparoscopy was needed in one case (10%). Postoperative pain, as reflected by the pain score, was minimal. The mean number of lymph nodes harvested was 15.6 ± 3.8. All specimens had clear distal and circumferential radial margins. The overall complication rate was 10%. Conclusion: Our experience showed transanal total mesorectal excision with single-incision laparoscopy to be a feasible option for rectal cancer. Patients reported minimal postoperative pain. Further studies on the long-term outcome are warranted. PMID:27186068

  2. Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy

    PubMed Central

    Costi, Renato; Gnocchi, Alessandro; Di Mario, Francesco; Sarli, Leopoldo

    2014-01-01

    Biliary lithiasis is an endemic condition in both Western and Eastern countries, in some studies affecting 20% of the general population. In up to 20% of cases, gallbladder stones are associated with common bile duct stones (CBDS), which are asymptomatic in up to one half of cases. Despite the wide variety of examinations and techniques available nowadays, two main open issues remain without a clear answer: how to cost-effectively diagnose CBDS and, when they are finally found, how to deal with them. CBDS diagnosis and management has radically changed over the last 30 years, following the dramatic diffusion of imaging, including endoscopic ultrasound (EUS) and magnetic resonance cholangiography (MRC), endoscopy and laparoscopy. Since accuracy, invasiveness, potential therapeutic use and cost-effectiveness of imaging techniques used to identify CBDS increase together in a parallel way, the concept of “risk of carrying CBDS” has become pivotal to identifying the most appropriate management of a specific patient in order to avoid the risk of “under-studying” by poor diagnostic work up or “over-studying” by excessively invasive examinations. The risk of carrying CBDS is deduced by symptoms, liver/pancreas serology and ultrasound. “Low risk” patients do not require further examination before laparoscopic cholecystectomy. Two main “philosophical approaches” face each other for patients with an “intermediate to high risk” of carrying CBDS: on one hand, the “laparoscopy-first” approach, which mainly relies on intraoperative cholangiography for diagnosis and laparoscopic common bile duct exploration for treatment, and, on the other hand, the “endoscopy-first” attitude, variously referring to MRC, EUS and/or endoscopic retrograde cholangiography for diagnosis and endoscopic sphincterotomy for management. Concerning CBDS diagnosis, intraoperative cholangiography, EUS and MRC are reported to have similar results. Regarding management, the recent

  3. Echinococcus multilocularis Detection in Live Eurasian Beavers (Castor fiber) Using a Combination of Laparoscopy and Abdominal Ultrasound under Field Conditions

    PubMed Central

    Gottstein, Bruno; Cracknell, John; Schwab, Gerhard; Rosell, Frank

    2015-01-01

    Echinococcus multilocularis is an important pathogenic zoonotic parasite of health concern, though absent in the United Kingdom. Eurasian beavers (Castor fiber) may act as a rare intermediate host, and so unscreened wild caught individuals may pose a potential risk of introducing this parasite to disease-free countries through translocation programs. There is currently no single definitive ante-mortem diagnostic test in intermediate hosts. An effective non-lethal diagnostic, feasible under field condition would be helpful to minimise parasite establishment risk, where indiscriminate culling is to be avoided. This study screened live beavers (captive, n = 18 or wild-trapped in Scotland, n = 12) and beaver cadavers (wild Scotland, n = 4 or Bavaria, n = 11), for the presence of E. multilocularis. Ultrasonography in combination with minimally invasive surgical examination of the abdomen by laparoscopy was viable under field conditions for real-time evaluation in beavers. Laparoscopy alone does not allow the operator to visualize the parenchyma of organs such as the liver, or inside the lumen of the gastrointestinal tract, hence the advantage of its combination with abdominal ultrasonography. All live beavers and Scottish cadavers were largely unremarkable in their haematology and serum biochemistry with no values suspicious for liver pathology or potentially indicative of E. multilocularis infection. This correlated well with ultrasound, laparoscopy, and immunoblotting, which were unremarkable in these individuals. Two wild Bavarian individuals were suspected E. multilocularis positive at post-mortem, through the presence of hepatic cysts. Sensitivity and specificity of a combination of laparoscopy and abdominal ultrasonography in the detection of parasitic liver cyst lesions was 100% in the subset of cadavers (95%Confidence Intervals 34.24–100%, and 86.7–100% respectively). For abdominal ultrasonography alone sensitivity was only 50% (95%CI 9.5–90.6%), with

  4. Echinococcus multilocularis Detection in Live Eurasian Beavers (Castor fiber) Using a Combination of Laparoscopy and Abdominal Ultrasound under Field Conditions.

    PubMed

    Campbell-Palmer, Róisín; Del Pozo, Jorge; Gottstein, Bruno; Girling, Simon; Cracknell, John; Schwab, Gerhard; Rosell, Frank; Pizzi, Romain

    2015-01-01

    Echinococcus multilocularis is an important pathogenic zoonotic parasite of health concern, though absent in the United Kingdom. Eurasian beavers (Castor fiber) may act as a rare intermediate host, and so unscreened wild caught individuals may pose a potential risk of introducing this parasite to disease-free countries through translocation programs. There is currently no single definitive ante-mortem diagnostic test in intermediate hosts. An effective non-lethal diagnostic, feasible under field condition would be helpful to minimise parasite establishment risk, where indiscriminate culling is to be avoided. This study screened live beavers (captive, n = 18 or wild-trapped in Scotland, n = 12) and beaver cadavers (wild Scotland, n = 4 or Bavaria, n = 11), for the presence of E. multilocularis. Ultrasonography in combination with minimally invasive surgical examination of the abdomen by laparoscopy was viable under field conditions for real-time evaluation in beavers. Laparoscopy alone does not allow the operator to visualize the parenchyma of organs such as the liver, or inside the lumen of the gastrointestinal tract, hence the advantage of its combination with abdominal ultrasonography. All live beavers and Scottish cadavers were largely unremarkable in their haematology and serum biochemistry with no values suspicious for liver pathology or potentially indicative of E. multilocularis infection. This correlated well with ultrasound, laparoscopy, and immunoblotting, which were unremarkable in these individuals. Two wild Bavarian individuals were suspected E. multilocularis positive at post-mortem, through the presence of hepatic cysts. Sensitivity and specificity of a combination of laparoscopy and abdominal ultrasonography in the detection of parasitic liver cyst lesions was 100% in the subset of cadavers (95%Confidence Intervals 34.24-100%, and 86.7-100% respectively). For abdominal ultrasonography alone sensitivity was only 50% (95%CI 9.5-90.6%), with

  5. Assessment of morbidity in gynaecologic oncology laparoscopy and identification of possible risk factors

    PubMed Central

    Peña-Fernández, Maite; Solar-Vilariño, Inés; Rodríguez-Álvarez, María Xosé; Zapardiel, Ignacio; Estévez, Francisco; Gayoso-Diz, Pilar

    2015-01-01

    Background The aim of this study was to ascertain the incidence of and the risk factors associated with morbidity in laparoscopy performed on patients with cervical cancer and endometrial cancer. Methods This was an observational study of a cohort of 128 women, 89 with endometrial cancer and 39 with cervical cancer from January 2000 to December 2011. We used the Student’s t-test or the Mann-Whitney U test for continuous variables, and the Chi-square or Fisher’s exact test for categorical variables. Results Complications were found in 44 patients (34.4%). After a multivariate analysis, among the risk factors associated with the presence of complications as the only type of surgery was found to be statistically significant (p = 0.043), more frequent in the most complex procedures such as Wertheim operation, trachelectomy, and para-aortic lymphadenectomy. Type of surgery (p = 0.003) and tumour type (p = 0.003) were risk factors associated with conversion to laparotomy. It was more frequent among the most complex procedures and cervical cancer cases. Regarding the need for transfusion, significant differences were observed in terms of surgery duration (p < 0.001), more frequent in longer surgery. Conclusion Morbidity in laparoscopic surgical oncology is related to the surgery complexity, where the basal characteristics of the patient are not a factor of influence in the development of complications. PMID:26715943

  6. Use of laparoscopy in the diagnosis and treatment of patients with surgical abdominal sepsis.

    PubMed

    Geis, W P; Kim, H C

    1995-02-01

    Patients often present to the surgeon with abdominal pain, tenderness, and fever. Many exhibit progressive sepsis due to abdominal pathology. Delay in diagnosis and treatment often occurs due to the use of multiple, time-consuming, expensive diagnostic studies. We delineate the use of diagnostic laparoscopy in subsets of patients in whom confusion exists as to the cause of abdominal sepsis--i.e., females in child-bearing years, elderly patients, obese patients, immunosuppressed patients, and patients with suppression of physical findings. The methodical assessment of the entire abdominal cavity is performed utilizing manipulation of the patient's position (Trendelenburg, supine, reverse Trendelenburg, left side up, right side up) and meticulous inspection of the entire small bowel. Diagnoses included acute appendicitis, gangrenous appendicitis, perforated appendicitis with peritonitis or abscess, gangrenous cholecystitis, ischemic bowel disease, perforating carcinoma of the colon, perforating diverticulitis with abscess or peritonitis, tubo-ovarian abscess, closed-loop small-bowel obstruction, megacolon, and perforation of the colon. Laparoscopic treatment of 96% of the patients was performed successfully and a laparoscopic-assisted approach was used in the remainder. There was one mortality (cardiac) and no major morbidity. The development of a Formal Diagnostic Exploratory Laparoscopic (FDEL) approach has aided in the assessment of each of the diagnoses of sepsis in the abdominal cavity. The diagnostic and therapeutic approach laparoscopically avoids extensive preoperative studies, avoids delay in operative intervention, and appears to minimize morbidity and shorten the postoperative recovery interval.

  7. Comparison between two portal laparoscopy and open surgery for ovariectomy in dogs

    PubMed Central

    Shariati, Elnaz; Bakhtiari, Jalal; Khalaj, Alireza; Niasari-Naslaji, Amir

    2014-01-01

    Ovariectomy (OVE) is a routine surgical procedure for neutering in small animal practice. Laparoscopy is a new surgical technique which contains advantages such as less trauma, smaller incision and excellent visualization than traditional open surgery. The present study was conducted to examine the feasibility and safety of laparoscopic procedure through two portal comparing with the conventional open surgery for OVE in healthy female bitches (n=16). Dogs were divided in two equal groups. In laparoscopic group, two 5 and 10 mm portals were inserted; First in the umbilicus for introducing the camera and the second, caudal to the umbilicus for inserting the forceps. Laparoscopic procedure involved grasping and tacking the ovary to the abdominal wall, followed by electrocautery, resection and removal of the ovary. In open surgery, routine OVE was conducted through an incision from umbilicus to caudal midline. Mean operative time, total length of scar, blood loss, clinical and blood parameters and all intra and post-operative complications were recorded in both groups. Mean operative time, total length of scar, blood loss and post-operative adhesions were significantly less in laparoscopic group compared with open surgery. In conclusion, laparoscopic OVE is an acceptable procedure due to more advantages in comparison with traditional OVE. PMID:25568722

  8. Gastric carcinoma originating from the heterotopic submucosal gastric gland treated by laparoscopy and endoscopy cooperative surgery

    PubMed Central

    Imamura, Taisuke; Komatsu, Shuhei; Ichikawa, Daisuke; Kobayashi, Hiroki; Miyamae, Mahito; Hirajima, Shoji; Kawaguchi, Tsutomu; Kubota, Takeshi; Kosuga, Toshiyuki; Okamoto, Kazuma; Konishi, Hirotaka; Shiozaki, Atsushi; Fujiwara, Hitoshi; Ogiso, Kiyoshi; Yagi, Nobuaki; Yanagisawa, Akio; Ando, Takashi; Otsuji, Eigo

    2015-01-01

    Gastric carcinoma is derived from epithelial cells in the gastric mucosa. We reported an extremely rare case of submucosal gastric carcinoma originating from the heterotopic submucosal gastric gland (HSG) that was safely diagnosed by laparoscopy and endoscopy cooperative surgery (LECS). A 66-year-old man underwent gastrointestinal endoscopy, which detected a submucosal tumor (SMT) of 1.5 cm in diameter on the lesser-anterior wall of the upper gastric body. The tumor could not be diagnosed histologically, even by endoscopic ultrasound-guided fine-needle aspiration biopsy. Local resection by LECS was performed to confirm a diagnosis. Pathologically, the tumor was an intra-submucosal well differentiated adenocarcinoma invading 5000 μm into the submucosal layer. The resected tumor had negative lateral and vertical margins. Based on the Japanese treatment guidelines, additional laparoscopic proximal gastrectomy was curatively performed. LECS is a less invasive and safer approach for the diagnosis of SMT, even in submucosal gastric carcinoma originating from the HSG. PMID:26306144

  9. Comparison of robotic surgery and laparoscopy to perform total hysterectomy with pelvic adhesions or large uterus

    PubMed Central

    Chiu, Li-Hsuan; Chen, Ching-Hui; Tu, Pei-Chia; Chang, Ching-Wen; Yen, Yuan-Kuei; Liu, Wei-Min

    2015-01-01

    BACKGROUND: Currently, benefits of robotic surgery in patients with benign gynecological conditions remain unclear. In this study, we compared the surgical outcome of robotic and laparoscopic total hysterectomies and evaluated the feasibility of robotic surgery in cases with pelvic adhesions or large uterus. MATERIALS AND METHODS: A total of 216 patients receiving total hysterectomy via robotic or laparoscopic approach were included in this study. Of all 216 patients, 88 underwent robotic total hysterectomy and 128 underwent laparoscopic total hysterectomy. All cases were grouped by surgical type, adhesion score, and uterine weight to evaluate the interaction or individual effect to the surgical outcomes. The perioperative parameters, including operation time, blood loss, postoperative pain score, time to full diet resumption, length of hospital stay, conversion rate, and surgery-related complications were compared between the groups. RESULTS: Operation time and blood loss were affected by both surgical type and adhesion score. For cases with severe adhesions (adhesion score greater than 4), robotic surgery was associated with a shortened operation time (113.9 ± 38.4 min versus 164.3 ± 81.4 min, P = 0.007) and reduced blood loss (187.5 ± 148.7 mL versus 385.7 ± 482.6, P=0.044) compared with laparoscopy. Moreover, robotic group showed a lower postoperative pain score than laparoscopic group, as the effect was found to be independent of adhesion score or uterine weight. The grade-II complication rate was also found to be lower in the robotic group. CONCLUSIONS: Comparing to laparoscopic approach, robotic surgery is a feasible and potential alternative for performing total hysterectomy with severe adhesions. PMID:25598606

  10. Laparoscopy versus mini-laparotomy peritoneal catheter insertion of ventriculoperitoneal shunts: a systematic review and meta-analysis.

    PubMed

    He, Mingliang; Ouyang, Leping; Wang, Shengwen; Zheng, Meiguang; Liu, Anmin

    2016-09-01

    OBJECTIVE Ventriculoperitoneal (VP) shunt treatment is the main treatment method for hydrocephalus. The traditional operative approach for peritoneal catheter insertion is mini-laparotomy. In recent years, laparoscopy-assisted insertion has become increasingly popular. It seems likely that use of an endoscope could lower the incidence of shunt malfunction. However, there is no consensus about the benefits of laparoscopy-assisted peritoneal catheter insertion. METHODS A systematic search was performed using the PubMed, Embase, ScienceDirect, and Cochrane Library databases. A manual search for reference lists was conducted. The protocol was prepared according to the interventional systematic reviews of the Cochrane Handbook, and the article was written on the basis of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. RESULTS Eleven observational trials and 2 randomized controlled trials were included. Seven operation-related outcome measures were analyzed, and 3 of these showed no difference between operative techniques. The results of the meta-analysis are as follows: in the laparoscopy group, the rate of distal shunt failure was lower (OR 0.41, 95% CI 0.25-0.67; p = 0.0003), the absolute effect is 7.11% for distal shunt failure, the number needed to treat is 14 (95% CI 8-23), operative time was shorter (mean difference [MD], -12.84; 95% CI -20.68 to -5.00; p = 0.001), and blood loss was less (MD -9.93, 95% CI -17.56 to -2.31; p = 0.01). In addition, a borderline statistically significant difference tending to laparoscopic technique was observed in terms of hospital stay (MD -1.77, 95% CI -3.67 to 0.13; p = 0.07). CONCLUSIONS To some extent, a laparoscopic insertion technique could yield a better prognosis, mainly because it is associated with a lower distal failure rate and shorter operative time, which would be clinically relevant.

  11. Laparoscopy versus mini-laparotomy peritoneal catheter insertion of ventriculoperitoneal shunts: a systematic review and meta-analysis.

    PubMed

    He, Mingliang; Ouyang, Leping; Wang, Shengwen; Zheng, Meiguang; Liu, Anmin

    2016-09-01

    OBJECTIVE Ventriculoperitoneal (VP) shunt treatment is the main treatment method for hydrocephalus. The traditional operative approach for peritoneal catheter insertion is mini-laparotomy. In recent years, laparoscopy-assisted insertion has become increasingly popular. It seems likely that use of an endoscope could lower the incidence of shunt malfunction. However, there is no consensus about the benefits of laparoscopy-assisted peritoneal catheter insertion. METHODS A systematic search was performed using the PubMed, Embase, ScienceDirect, and Cochrane Library databases. A manual search for reference lists was conducted. The protocol was prepared according to the interventional systematic reviews of the Cochrane Handbook, and the article was written on the basis of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. RESULTS Eleven observational trials and 2 randomized controlled trials were included. Seven operation-related outcome measures were analyzed, and 3 of these showed no difference between operative techniques. The results of the meta-analysis are as follows: in the laparoscopy group, the rate of distal shunt failure was lower (OR 0.41, 95% CI 0.25-0.67; p = 0.0003), the absolute effect is 7.11% for distal shunt failure, the number needed to treat is 14 (95% CI 8-23), operative time was shorter (mean difference [MD], -12.84; 95% CI -20.68 to -5.00; p = 0.001), and blood loss was less (MD -9.93, 95% CI -17.56 to -2.31; p = 0.01). In addition, a borderline statistically significant difference tending to laparoscopic technique was observed in terms of hospital stay (MD -1.77, 95% CI -3.67 to 0.13; p = 0.07). CONCLUSIONS To some extent, a laparoscopic insertion technique could yield a better prognosis, mainly because it is associated with a lower distal failure rate and shorter operative time, which would be clinically relevant. PMID:27581319

  12. Access cavity preparation.

    PubMed

    Adams, N; Tomson, P L

    2014-03-01

    Each stage of root canal treatment should be carried out to the highest possible standard. The access cavity is arguably the most important technical stage, as subsequent preparation of the root canal(s) can be severely comprised if this is not well executed. Inadequate access can lead to canals being left untreated, poorly disinfected, difficult to shape and obturate, and may ultimately lead to the failure of the treatment. This paper highlights common features in root canal anatomy and outlines basic principles for locating root canals and producing a good access cavity. It also explores each phase of the preparation in detail and offers suggestions of instruments that have been specifically designed to overcome potential difficulties in the process. Good access design and preparation will result in an operative environment which will facilitate cleaning, shaping and obturation of the root canal system in order to maximise success.

  13. Accessibility Videos.

    PubMed

    Kurppa, Ari; Nordlund, Marika

    2016-01-01

    It can be difficult to understand accessibility, if you do not have the personal experience. The Accessibility Centre ESKE produced short videos which demonstrate the meaning of accessibility in different situations. Videos will raise accessibility awareness of architects, other planners and professionals in the construction field and maintenance. PMID:27534282

  14. Laparoscopy-Assisted Single-Port Appendectomy in Children: Safe Alternative also for Perforated Appendicitis?

    PubMed

    Sesia, Sergio B; Berger, Eliane; Holland-Cunz, Stefan; Mayr, Johannes; Häcker, Frank-Martin

    2015-12-01

    Because of its low complication rate, favorable safety, cost-effectiveness, and technical ease, mono-instrumental, laparoscopy-assisted single-port appendectomy (SPA) has been the standard therapy for appendicitis in our department since its introduction 10 years ago. We report our experience with this technique and compare its outcome to open appendectomy (OA). The records of all children who underwent appendectomy at our institution over a period of 8 years were analyzed retrospectively. Patient baseline data, markers of inflammation, operative time, length of hospital stay, complication rate according to the classification of Clavien-Dindo, and histologic grading were assessed to compare the 2 surgical techniques (SPA and OA). The chi square test, the Student's t test and the Wilcoxon-Mann-Whitney test were used to analyze the data and the comparisons of the mean values. A P value < 0.05 was considered significant. Overall, 975 patients were included in the study. A total of 555 children had undergone SPA and 420 had been treated by OA. Median operative time of SPA was longer than that of OA (60.8  min vs 57.4  min; P < 0.05). Length of hospital stay after SPA was shorter than after OA (4.4 days and 5.9 days, respectively; P < 0.001). The overall complication rate was lower for SPA than that for OA (4.0% vs 5.7%), but the difference of complications for SPA and OA was not statistically significant (P < 0.22). SPA was successfully performed in 85.9% of children. In 53.8% of patients with perforated appendicitis, no conversion was required. In the group of children with perforated appendicitis, the complication rate of ∼20% was independent of the surgical technique applied. With respect to operative time, length of hospital stay, and postoperative complication rate, SPA is not inferior to OA. SPA is safe and efficient, even in the management of perforated appendicitis.

  15. Real-Time Internet Connections: Implications for Surgical Decision Making in Laparoscopy

    PubMed Central

    Broderick, Timothy J.; Harnett, Brett M.; Doarn, Charles R.; Rodas, Edgar B.; Merrell, Ronald C.

    2001-01-01

    Objective To determine whether a low-bandwidth Internet connection can provide adequate image quality to support remote real-time surgical consultation. Summary Background Data Telemedicine has been used to support care at a distance through the use of expensive equipment and broadband communication links. In the past, the operating room has been an isolated environment that has been relatively inaccessible for real-time consultation. Recent technological advances have permitted videoconferencing over low-bandwidth, inexpensive Internet connections. If these connections are shown to provide adequate video quality for surgical applications, low-bandwidth telemedicine will open the operating room environment to remote real-time surgical consultation. Methods Surgeons performing a laparoscopic cholecystectomy in Ecuador or the Dominican Republic shared real-time laparoscopic images with a panel of surgeons at the parent university through a dial-up Internet account. The connection permitted video and audio teleconferencing to support real-time consultation as well as the transmission of real-time images and store-and-forward images for observation by the consultant panel. A total of six live consultations were analyzed. In addition, paired local and remote images were “grabbed” from the video feed during these laparoscopic cholecystectomies. Nine of these paired images were then placed into a Web-based tool designed to evaluate the effect of transmission on image quality. Results The authors showed for the first time the ability to identify critical anatomic structures in laparoscopy over a low-bandwidth connection via the Internet. The consultant panel of surgeons correctly remotely identified biliary and arterial anatomy during six laparoscopic cholecystectomies. Within the Web-based questionnaire, 15 surgeons could not blindly distinguish the quality of local and remote laparoscopic images. Conclusions Low-bandwidth, Internet-based telemedicine is inexpensive

  16. Laparoscopy assisted percutaneous stone surgery can be performed in multiple ways for pelvic ectopic kidneys.

    PubMed

    Soylemez, Haluk; Penbegül, Necmettin; Utangac, Mehmet Mazhar; Dede, Onur; Çakmakçı, Süleyman; Hatipoglu, Namık Kemal

    2016-08-01

    Pelvic kidney stones remain a unique challenge to the endourologists. Treatment options include open surgery, extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy (PNL), retrograde intrarenal surgery, and laparoscopy assisted PNL (LA-PNL). As a minimal invasive option, LA-PNL can decrease the risk for bowel and major vessel injury. Here, we describe our experience using the LA-PNL procedures with different combinations, to treat kidney stones in multiple patients with a pelvic ectopic kidney (PEK). Eight patients, with PEK, kidney stones, and no other treatment choice, but open surgery, were included in the study. Two different laparoscopic techniques such as mesocolon dissection and transmesocolic, and four different percutaneous procedures such as standard-PNL, mini-PNL, micro-PNL, and a PNL through the renal pelvis were used for stone extraction in these patients. The mean age of patients was 25.6 ± 12.9 years and mean stone size was 524.1 ± 430.3 mm(2). Mean operation time was 150.5 ± 40.0 (77-210) min which was composed of retrograde catheterization (14.8 ± 2.9 min), laparoscopic procedure (48.7 ± 20.6 min) and PNL procedure (86.8 ± 31.1 min). Residual stones were seen in two patients (no additional treatment was need), while a 'stone-free' procedure was achieved in six patients (75.0 %). On the post-operative first month visit, a stone was observed on radiological examinations in only one patient (87.5 % stone-free). Mean hospitalization time was 2.8 ± 0.9 days. No perioperative or post-operative complication was observed in all patients. LA-PNL surgery is a safe and effective option for treatment of PEK stones, and has several alternative approaches.

  17. Laparoscopy assisted percutaneous stone surgery can be performed in multiple ways for pelvic ectopic kidneys.

    PubMed

    Soylemez, Haluk; Penbegül, Necmettin; Utangac, Mehmet Mazhar; Dede, Onur; Çakmakçı, Süleyman; Hatipoglu, Namık Kemal

    2016-08-01

    Pelvic kidney stones remain a unique challenge to the endourologists. Treatment options include open surgery, extracorporeal shockwave lithotripsy, percutaneous nephrolithotomy (PNL), retrograde intrarenal surgery, and laparoscopy assisted PNL (LA-PNL). As a minimal invasive option, LA-PNL can decrease the risk for bowel and major vessel injury. Here, we describe our experience using the LA-PNL procedures with different combinations, to treat kidney stones in multiple patients with a pelvic ectopic kidney (PEK). Eight patients, with PEK, kidney stones, and no other treatment choice, but open surgery, were included in the study. Two different laparoscopic techniques such as mesocolon dissection and transmesocolic, and four different percutaneous procedures such as standard-PNL, mini-PNL, micro-PNL, and a PNL through the renal pelvis were used for stone extraction in these patients. The mean age of patients was 25.6 ± 12.9 years and mean stone size was 524.1 ± 430.3 mm(2). Mean operation time was 150.5 ± 40.0 (77-210) min which was composed of retrograde catheterization (14.8 ± 2.9 min), laparoscopic procedure (48.7 ± 20.6 min) and PNL procedure (86.8 ± 31.1 min). Residual stones were seen in two patients (no additional treatment was need), while a 'stone-free' procedure was achieved in six patients (75.0 %). On the post-operative first month visit, a stone was observed on radiological examinations in only one patient (87.5 % stone-free). Mean hospitalization time was 2.8 ± 0.9 days. No perioperative or post-operative complication was observed in all patients. LA-PNL surgery is a safe and effective option for treatment of PEK stones, and has several alternative approaches. PMID:26494553

  18. Stage design

    DOEpatents

    Shacter, J.

    1975-12-01

    A method is described of cycling gases through a plurality of diffusion stages comprising the steps of admitting the diffused gases from a first diffusion stage into an axial compressor, simultaneously admitting the undiffused gases from a second diffusion stage into an intermediate pressure zone of said compressor corresponding in pressure to the pressure of said undiffused gases, and then admitting the resulting compressed mixture of diffused and undiffused gases into a third diffusion stage.

  19. Comparison of laparoscopy-assisted and open radical gastrectomy for advanced gastric cancer: A retrospective study in a single minimally invasive surgery center.

    PubMed

    Hao, Yingxue; Yu, Peiwu; Qian, Feng; Zhao, Yongliang; Shi, Yan; Tang, Bo; Zeng, Dongzhu; Zhang, Chao

    2016-06-01

    Laparoscopy-assisted gastrectomy (LAG) has gained international acceptance for the treatment of early gastric cancer (EGC). However, the use of laparoscopic surgery in the management of advanced gastric cancer (AGC) has not attained widespread acceptance. This retrospective large-scale patient study in a single center for minimally invasive surgery assessed the feasibility and safety of LAG for T2 and T3 stage AGC. A total of 628 patients underwent LAG and 579 patients underwent open gastrectomy (OG) from Jan 2004 to Dec 2011. All cases underwent radical lymph node (LN) dissection from D1 to D2+. This study compared short- and long-term results between the 2 groups after stratifying by pTNM stages, including the mean operation time, volume of blood loss, number of harvested LNs, average days of postoperative hospital stay, mean gastrointestinal function recovery time, intra- and post-operative complications, recurrence rate, recurrence site, and 5-year survival curve. Thirty-five patients (5.57%) converted to open procedures in the LAG group. There were no significant differences in retrieved LN number (30.4 ± 13.4 vs 28.1 ± 17.2, P = 0.43), proximal resection margin (PRM) (6.15 ± 1.63 vs 6.09 ± 1.91, P = 0.56), or distal resection margin (DRM) (5.46 ± 1.74 vs 5.40 ± 1.95, P = 0.57) between the LAG and OG groups, respectively. The mean volume of blood loss (154.5 ± 102.6 vs 311.2 ± 118.9 mL, P < 0.001), mean postoperative hospital stay (7.6 ± 2.5 vs 10.7 ± 3.6 days, P < 0.001), mean time for gastrointestinal function recovery (3.3 ± 1.4 vs 3.9 ± 1.5 days, P < 0.001), and postoperative complications rate (6.4% vs 10.5%, P = 0.01) were clearly lower in the LAG group compared to the OG group. However, the recurrence pattern and site were not different between the 2 groups, even they were stratified by the TNM stage. The 5-year overall survival (OS) rates were 85.38%, 79.70%, 57

  20. Web Accessibility and Accessibility Instruction

    ERIC Educational Resources Information Center

    Green, Ravonne A.; Huprich, Julia

    2009-01-01

    Section 508 of the Americans with Disabilities Act (ADA) mandates that programs and services be accessible to people with disabilities. While schools of library and information science (SLIS*) and university libraries should model accessible Web sites, this may not be the case. This article examines previous studies about the Web accessibility of…

  1. Accessibility in E-Assessment

    ERIC Educational Resources Information Center

    Ball, Simon

    2009-01-01

    E-assessment offers many opportunities to broaden the range of tools at the assessor's disposal and thereby improve the overall accessibility of the assessment experience. In 2006, TechDis commissioned a report, produced by Edexcel, on the state of guidance on accessibility at the various stages of the assessment process--question design,…

  2. Study Protocol – Improving Access to Kidney Transplants (IMPAKT): A detailed account of a qualitative study investigating barriers to transplant for Australian Indigenous people with end-stage kidney disease

    PubMed Central

    Devitt, Jeannie; Cass, Alan; Cunningham, Joan; Preece, Cilla; Anderson, Kate; Snelling, Paul

    2008-01-01

    Background Indigenous Australians are slightly more than 2% of the total Australian population however, in recent years they have comprised between 6 and 10% of new patients beginning treatment for end-stage kidney disease (ESKD). Although transplant is considered the optimal form of treatment for many ESKD patients there is a pronounced disparity between the rates at which Indigenous ESKD patients receive transplants compared with their non-Indigenous counterparts. The IMPAKT (Improving Access to Kidney Transplants) Interview study investigated reasons for this disparity through a large scale, in-depth interview study involving patients, nephrologists and key decision-making staff at selected Australian transplant and dialysis sites. Methods The design and conduct of the study reflected the multi-disciplinary membership of the core IMPAKT team. Promoting a participatory ethos, IMPAKT established partnerships with a network of hospital transplant units and hospital dialysis treatment centres that provide treatment to the vast majority of Indigenous patients across Australia. Under their auspices, the IMPAKT team conducted in-depth interviews in 26 treatment/service centres located in metropolitan, regional and remote Australia. Peer interviewing supported the engagement of Indigenous patients (146), and nephrologists (19). In total IMPAKT spoke with Indigenous and non-Indigenous patients (241), key renal nursing and other (non-specialist) staff (95) and a small number of relevant others (28). Data analysis was supported by QSR software. At each site, IMPAKT also documented educational programs and resources, mapped an hypothetical ‘patient journey’ to transplant through the local system and observed patient care and treatment routines. Discussion The national scope, inter-disciplinary approach and use of qualitative methods in an investigation of a significant health inequality affecting Indigenous people is, we believe, an Australian first. An exceptionally

  3. The value of laparoscopy in the diagnosis and therapy of violin-string like perihepatic nonpostoperative adhesions.

    PubMed

    Sarli, L; Villa, F; Iusco, D R

    2001-03-01

    We report three cases of Fitrz-Hugh Curtis syndrome (FHCs) that were diagnosed laparoscopically and showed microbiological or serological evidence of chlamydial infection. The case histories underscore the part played by abdominal right quadrant symptoms. In all three cases, right quadrant pain and tenderness constituted the presenting features. The patients were thought to have acute cholecystitis or acute appendicitis, but investigations proved negative. Laparoscopy was the key to the diagnosis, revealing the violin-string-like perihepatic adhesions typical of this syndrome. Lysis of the adhesions resolved the patients' symptoms of persistent severe abdominal pain. In the first case, the pain lessened dramatically only after the third operation, when the perihepatic adhesions were lysed. In the two other cases, the lysis was performed laparoscopically by fulguration and cutting. We consider this procedure to be an excellent therapeutic modality for the pain associated with FHCs. PMID:11344440

  4. The use of laparoscopy in the diagnosis and treatment of abdominal complications of ventriculo-peritoneal shunts in children.

    PubMed

    Esposito, C; Porreca, A; Gangemi, M; Garipoli, V; De Pasquale, M

    1998-07-01

    Ventriculo-peritoneal shunts (VPS) are the most frequent operative procedures used to treat hydrocephalic children. Abdominal complications of VPS are now a rare event; however, their frequency varies from 5% to 47% according to reports. Anything that causes an obstruction or impediment of the VP derivation system will lead to intracranial hypertension, which requires immediate surgery. From 1985 to 1995 at the Division of Pediatric Surgery of the Federico II University of Naples, ten laparoscopies were performed in ten children with VPS complications. Cerebrospinal fluid pseudocysts were found in four infants. There was one case of abdominal wall perforation by the tip of the catheter at the umbilical level, two bowel obstructions, and one catheter was lost in the abdominal cavity. Finally, two children had malfunctioning of the peritoneal limb of the catheter. The laparoscopic technique was curative in all ten cases, thus avoiding a conventional laparotomy and the consequent risk of adhesions, which could cause further complications.

  5. Carbon dioxide pneumothorax occurring during laparoscopy-assisted gastrectomy due to a congenital diaphragmatic defect: a case report

    PubMed Central

    Park, Hye-Jin

    2016-01-01

    During laparoscopic surgery, carbon dioxide (CO2) pneumothorax can develop due to a congenital defect in the diaphragm. We present a case of a spontaneous massive left-sided pneumothorax that occurred during laparoscopy-assisted gastrectomy, because of an escape of intraperitoneal CO2 gas, under pressure, into the pleural cavity through a congenital defect in the esophageal hiatus of the left diaphragm. This was confirmed on intraoperative chest radiography and laparoscopic inspection. This CO2 pneumothorax caused tolerable hemodynamic and respiratory consequences, and was rapidly reversible after release of the pneumoperitoneum. Thus, a conservative approach was adopted, and the remainder of the surgery was completed, laparoscopically. Due to the high solubility of CO2 gas and the extra-pulmonary mechanism, CO2 pneumothorax with otherwise hemodynamically stable conditions can be managed by conservative modalities, avoiding unnecessary chest tube insertion or conversion to an open procedure. PMID:26885310

  6. Umbilical only access laparoscopic pyeloplasty in children: Preliminary report

    PubMed Central

    Nerli, Rajendra B.; Magdum, Prasad V.; Ghagane, Shridhar C.; Hiremath, Murigendra B.; Reddy, Mallikarjuna

    2016-01-01

    Background: Over the past three decades, laparoscopic surgery has become a well-established alternative to open surgery in the management of ureteropelvic junction (UPJ) obstruction. Currently, several efforts are being made, aimed at further reducing the morbidity associated with conventional laparoscopy. We report our experience with modified umbilical port laparoscopic pyeloplasty in children. Materials and Methods: Children presenting with hydronephrosis secondary to UPJ obstruction formed the study group. A 5 mm endoscopic port was placed on the inferior umbilical crease. The two 3 mm instruments were introduced through puncture sites created a few mm superior and lateral to the endoscopic port, under vision. Total operating time, the time taken for insertion of double pigtail catheter, time taken for pyeloplasty anastomosis and complications were noted. Results: During the study period, 16 children underwent modified umbilical only access laparoscopic pyeloplasty. The total operating time and the time for insertion of double pigtail catheter were significantly more in our earlier half of cases. Conclusions: Modified umbilical port laparoscopic pyeloplasty reduces the morbidity associated with conventional multiport laparoscopy without the need of expensive multichannel cannulas, curved laparoscopic instruments and longer laparoscopic endoscopes. Though crossing instruments are a factor which prolongs the duration of surgery, it does not hinder complex suturing needed during pyeloplasty. PMID:27251522

  7. Third Stage

    NASA Video Gallery

    Once the third stage finishes its work, Kepler will have sufficient energy to leave the gravitational pull of Earth and go into orbit around the Sun, trailing behind Earth and slowly drifting away ...

  8. Access to space studies

    NASA Technical Reports Server (NTRS)

    Martin, James A.

    1993-01-01

    The National Aeronautics and Space Administration is currently considering possible directions in Earth-to-orbit vehicle development under a study called 'Access to Space.' This agency-wide study is considering commercial launch vehicles, human transportation, space station logistics, and other space transportation requirements over the next 40 years. Three options are being considered for human transportation: continued use of the Space Shuttle; development of a small personnel carrier (personnel logistics system (PLS)); or development of an advanced vehicle such as a single-stage-to-orbit (SSTO). Several studies related to the overall Access to Space study are reported in this document.

  9. Treatment independent pregnancy with operative laparoscopy for endometriosis in an in vitro fertilization program.

    PubMed

    Damewood, M D; Rock, J A

    1988-09-01

    Thirty-nine patients with Stage I to IV endometriosis and at least 5 years of primary infertility were enrolled in the Johns Hopkins In Vitro Fertilization Program. At the time of laparoscopic oocyte retrieval, operative endoscopy with lysis of adhesions, fulguration or resection of pelvic endometriosis, or enucleation of ovarian endometriomas was performed. Although the in vitro fertilization-embryo transfer cycle did not result in pregnancy, 12 patients (28%) conceived within 10 months of the operative laparoscopic procedure. Nine of the pregnancies occurred in patients with Stage I to II endometriosis.

  10. Access Denied

    ERIC Educational Resources Information Center

    Villano, Matt

    2008-01-01

    Building access control (BAC)--a catchall phrase to describe the systems that control access to facilities across campus--has traditionally been handled with remarkably low-tech solutions: (1) manual locks; (2) electronic locks; and (3) ID cards with magnetic strips. Recent improvements have included smart cards and keyless solutions that make use…

  11. Open Access

    ERIC Educational Resources Information Center

    Suber, Peter

    2012-01-01

    The Internet lets us share perfect copies of our work with a worldwide audience at virtually no cost. We take advantage of this revolutionary opportunity when we make our work "open access": digital, online, free of charge, and free of most copyright and licensing restrictions. Open access is made possible by the Internet and copyright-holder…

  12. Combined hysteroscopy-laparoscopy approach for excision of pelvic nitinol fragment from Essure contraceptive device: Role of intraoperative fluoroscopy for uterine conservation

    PubMed Central

    Palermo, Gianpiero D.

    2016-01-01

    We describe the successful removal of a pelvic contraceptive coil in a symptomatic 46-year-old patient who had Essure devices for four years, using a combined hysteroscopy-laparoscopy-fluoroscopy approach. Following normal hysteroscopy, at laparoscopy the right Essure implant was disrupted and its outer nitinol coil had perforated the fallopian tube. However, the inner rod (containing polyethylene terephthalate) had migrated to an extrapelvic location, near the proximal colon. In contrast, the left implant was situated within the corresponding tube. Intraoperative fluoroscopy was used to confirm complete removal of the device, which was further verified by postoperative computed tomography. The patient's condition improved after surgery and she continues to do well. This is the first report to describe this technique in managing Essure complications remote from time of insertion. Our case highlights the value and limitations of preoperative and intraoperative imaging to map Essure fragment location before surgery. PMID:27462605

  13. Subject Access Points in Electronic Retrieval.

    ERIC Educational Resources Information Center

    Hjorland, Birger; Nielsen, Lykke Kyllesbech

    2001-01-01

    Discussion of subject access points in databases concentrates on the broader theoretical perspective. Topics include technology-driven stages in the development of subject access points; a taxonomy of subject access points; document titles; abstracts; references and citations; full text; and descriptors, identifiers, classification codes, and…

  14. Gaining Access.

    ERIC Educational Resources Information Center

    Kennedy, Mike

    2000-01-01

    Discusses issues schools and universities have encountered in complying with the Americans with Disabilities Act (ADA) and making their facilities more accessible to the disabled. The ADA's vagueness and the architect's need for understanding the regulations is highlighted. (GR)

  15. Equal Access.

    ERIC Educational Resources Information Center

    De Patta, Joe

    2003-01-01

    Presents an interview with Stephen McCarthy, co-partner and president of Equal Access ADA Consulting Architects of San Diego, California, about designing schools to naturally integrate compliance with the Americans with Disabilities Act (ADA). (EV)

  16. Capital access.

    PubMed

    Towne, Jennifer

    2004-06-01

    To maintain their viability, hospitals are being compelled to invest in big capital projects such as information technology and renovation and construction. This gatefold examines the trends in credit and capital, and how they affect hospitals' access to money.

  17. Treatment Options by Stage (Cervical Cancer)

    MedlinePlus

    ... checked under a microscope for signs of cancer. Laparoscopy : A surgical procedure to look at the organs ... a laparoscope , the operation is called a total laparoscopic hysterectomy. Enlarge Hysterectomy. The uterus is surgically removed ...

  18. Hemodialysis access - self care

    MedlinePlus

    Kidney failure - chronic-hemodialysis access; Renal failure - chronic-hemodialysis access; Chronic renal insufficiency - hemodialysis access; Chronic kidney failure - hemodialysis access; Chronic renal failure - hemodialysis access; dialysis - hemodialysis access

  19. [Anesthetic considerations in laparoscopy for removal of a kidney from a live donor].

    PubMed

    Monsma, M; Gómez, G; Vidal, A; Vera, C D; Barberá, M

    2010-05-01

    Kidney transplantation is the main therapeutic alternative for patients with end-stage renal failure. However, the main constraint at present is the lack of available organs. Removal of a kidney from a live donor is a better option than conventional transplantation of a cadaver-donated organ. Among the advantages are a shorter waiting time for the organ recipient and greater assurance of graft quality and survival. The postoperative conditions made possible by laparoscopic surgery have encouraged the donation of tissues by live donors. Anesthetic treatment for patients undergoing laparoscopic surgery must be based on an understanding of the pathophysiologic changes that occur in this type of procedure so that complications can be prevented. This review provides an update of progress in laparoscopic surgery and the repercussions of anesthetic management, particularly with respect to anesthesia for kidney donors. PMID:20527345

  20. Pregnancy diagnosis by laparoscopy in free range rhesus macaques (Macaca mulatta)

    PubMed Central

    Kumar, V.; Raj, A.; Kumar, P.

    2011-01-01

    The present study involved 50 adult female rhesus macaques (Macaca mulatto) of age ranging between 4 to 15 years. Pregnancy diagnosis was done by using laparoscopic method. Anesthesia was achieved by using xylazine (2mg/kg) and ketamine (10mg/kg) intramuscularly. The gravid uterus was located close to the urinary bladder in early pregnancy and in abdominal cavity in the mid and late stage of pregnancy. The procedure was completed within 10 - 12 minutes. There were no complications after the surgery and recovery of animal was smooth and uneventful. The results of this study showed that laparoscopic method is also one of the methods of pregnancy diagnosis in rhesus macaques and it can be a precise and a reliable method of pregnancy diagnosis in rhesus macaques. PMID:26623277

  1. Evolution of laparoscopy in colorectal surgery: An evidence-based review

    PubMed Central

    Blackmore, Alexander Emmanuel; Wong, Mark Te Ching; Tang, Choong Leong

    2014-01-01

    Open surgery for colorectal disease has progressed significantly over the past century from humble beginnings to form the mainstay of treatment for colorectal cancer and a number of benign conditions. Following the introduction of laparoscopic abdominal surgery, the next stage in the evolution of the specialty began in the 1990s with the first laparoscopic colonic resection. Following some early concerns regarding its safety and oncological efficacy during the latter part of that decade, laparoscopic colorectal surgery rapidly came into mainstream use in the early part of the current century with evidence supporting its use being made available from large scale randomised controlled trials. This article provides an evidence-based summary of this evolutionary process as it relates to both benign and malignant colorectal disease, as well as discussion of the next phase of new technologies such as robotic surgery. PMID:24803804

  2. Easy Access

    ERIC Educational Resources Information Center

    Gettelman, Alan

    2009-01-01

    School and university restrooms, locker and shower rooms have specific ADA accessibility requirements that serve the needs of staff, students and campus visitors who are disabled as a result of injury, illness or age. Taking good care of them is good for the reputation of a sensitive community institution, and fosters positive public relations.…

  3. Access Denied

    ERIC Educational Resources Information Center

    Raths, David

    2012-01-01

    As faculty members add online and multimedia elements to their courses, colleges and universities across the country are realizing that there is a lot of work to be done to ensure that disabled students (and employees) have equal access to course material and university websites. Unfortunately, far too few schools consider the task a top priority.…

  4. Expanding Access

    ERIC Educational Resources Information Center

    Roach, Ronald

    2007-01-01

    There is no question that the United States lags behind most industrialized nations in consumer access to broadband Internet service. For many policy makers and activists, this shortfall marks the latest phase in the struggle to overcome the digital divide. To remedy this lack of broadband affordability and availability, one start-up firm--with…

  5. Ureteral Obstruction Swine Model through Laparoscopy and Single Port for Training on Laparoscopic Pyeloplasty

    PubMed Central

    Díaz-Güemes Martín-Portugués, Idoia; Hernández-Hurtado, Laura; Usón-Casaús, Jesús; Sánchez-Hurtado, Miguel Angel; Sánchez-Margallo, Francisco Miguel

    2013-01-01

    This study aims firstly to assess the most adequate surgical approach for the creation of an ureteropelvic juntion obstruction (UPJO) animal model, and secondly to validate this model for laparoscopic pyeloplasty training among urologists. Thirty six Large White pigs (28.29±5.48 Kg) were used. The left ureteropelvic junction was occluded by means of an endoclip. According to the surgical approach for model creation, pigs were randomized into: laparoscopic conventional surgery (LAP) or single port surgery (LSP). Each group was further divided into transperitoneal (+T) or retroperitoneal (+R) approach. Time needed for access, surgical field preparation, wound closure, and total surgical times were registered. Social behavior, tenderness to the touch and wound inflammation were evaluated in the early postoperative period. After ten days, all animals underwent an Anderson-Hynes pyeloplasty carried out by 9 urologists, who subsequently assessed the model by means of a subjective validation questionnaire. Total operative time was significantly greater in LSP+R (p=0.001). Tenderness to the touch was significantly increased in both retroperitoneal approaches, (p=0.0001). Surgeons rated the UPJO porcine model for training on laparoscopic pyeloplasty with high or very high scores, all above 4 on a 1-5 point Likert scale. Our UPJO animal model is useful for laparoscopic pyeloplasty training. The model created by retroperitoneal single port approach presented the best score in the subjective evaluation, whereas, as a whole, transabdominal laparoscopic approach was preferred. PMID:23801892

  6. Surgical Method, Postoperative Complications, and Gastrointestinal Motility of Thoraco-Laparoscopy 3-Field Esophagectomy in Treatment of Esophageal Cancer

    PubMed Central

    Wan, Jun; Che, Yun; Kang, Ningning; Zhang, Renquan

    2016-01-01

    Background The aim of this study was to investigate the surgical method, postoperative complications, and gastrointestinal motility of thoraco-laparoscopic esophagectomy in the treatment of esophageal cancer. Material/Methods Using random sampling method, we selected 132 esophageal cancer patients who were treated in our hospital from January 2012 to December 2014; these patients were regarded as the study group and underwent thoraco-laparoscopy 3-field surgery treatment. Another 108 esophageal cancer patients admitted to our hospital over the same period were regarded as the control group and underwent traditional open McKeown esophagectomy. Results The amount of blood loss and postoperative drainage of pleural fluid in the study group were significantly lower (P<0.05) and the time to removal of the chest tube and hospital stay were significantly shorter (P<0.05). The incidence of anastomotic fistula, vocal cord paralysis, chylothorax, and arrhythmia were significantly lower in the study group than in the control group (P<0.05). However, no significant differences in the incidence of pneumonia, atelectasis, or acute respiratory distress were detected (P>0.05). For postoperative gastrointestinal motility, first flatus time, first defecation time, and bowel tone recovery time after the operation, as well as the total amount of gastric juice draining, were reduced in the thoraco-laparoscopic esophagectomy group (P<0.05). The postoperative MTL and NO levels were higher but VIP level was lower in the thoraco-laparoscopic group (P<0.05). Conclusions Thoraco-laparoscopic esophagectomy was technically feasible and safe; it was associated with lower incidence of certain postoperative complications and had less effect on postoperative gastrointestinal motility. Skilled technique and cooperation could further shorten the operation time and might lead to better patient outcomes. PMID:27310399

  7. [A case of solitary adrenal metastasis from breast cancer successfully resected by laparoscopy].

    PubMed

    Mizuyama, Yoko; Shinto, Osamu; Tamura, Tatsuro; Nakagawa, Hiroji; Ohno, Yoshioki; Takashima, Tsutomu; Ishikawa, Tetsuro

    2013-11-01

    A 47-year-old woman had undergone breast-conserving treatment for right breast cancer (T3, N1, M0, Stage IIIA, human epidermal growth factor receptor[ HER]-2 enriched subtype) after primary systemic chemotherapy with trastuzumab. Pathological examination revealed a quasi-pathological complete response( CR) in the breast tumor and no axillary nodal involvement. The patient then received conventional breast irradiation and adjuvant trastuzumab therapy. However, adjuvant anti- HER2 therapy was discontinued in the 19th week because of a decreased left ventricular ejection fraction( approximately 50%). A left adrenal tumor was detected by abdominal computed tomography (CT) 2 years after surgery. Positron emission tomography( PET) scans showed strong accumulation in the left adrenal gland and in the lymph node near the adrenal tumor. No other obvious lesion was detected on meticulous examination. Laparoscopic adrenalectomy was performed for diagnosis and treatment. Pathological examination of the resected specimen revealed that the tumor was a metastatic adenocarcinoma with overexpression of the HER2 protein but without expression of hormonal receptors. The patient received 12 cycles of chemotherapy with paclitaxel and trastuzumab, which was followed by trastuzumab monotherapy. However, trastuzumab monotherapy could not be continued because the left ventricular ejection fraction decreased to 50% at 24 weeks after initiation of chemotherapy. The patient has been observed since the cessation of trastuzumab, without the administration of anticancer therapy, and she continues to have a good performance status without relapse. Herein, we report a case of solitary adrenal metastasis from breast cancer, an extremely rare condition, and review the relevant literature.

  8. Hemodialysis access procedures

    MedlinePlus

    Kidney failure - chronic-dialysis access; Renal failure - chronic-dialysis access; Chronic renal insufficiency-dialysis access; Chronic kidney failure-dialysis access; Chronic renal failure-dialysis access

  9. Role of laparoscopy as a minimally invasive procedure in treatment of ruptured uterine scar during second-trimester induction of abortion.

    PubMed

    Zheng, Yanmei; Jiang, Qiaoying; Lv, Ya-Er; Liu, Feng; Yang, Liwei

    2016-04-01

    Uterine rupture is an uncommon complication following termination of pregnancy and is usually accompanied by severe lower abdominal pain and shock caused by intra-abdominal hemorrhage. Laparotomy should be carried out promptly in order to repair the uterus or even to resect the uterus. Here we present a case of uterine rupture of a scarred uterus, which occurred during a second-trimester induced abortion. The patient was successfully treated by laparoscopy with the help of laparoscopic ultrasound. This case suggests an alternative, effective approach to the diagnosis and treatment of uterine rupture. PMID:26695381

  10. Single-port versus conventional multiport access prophylactic laparoscopic bilateral salpingo-oophorectomy in high-risk patients for ovarian cancer: a comparison of surgical outcomes

    PubMed Central

    Angioni, Stefano; Pontis, Alessandro; Sedda, Federica; Zampetoglou, Theodoros; Cela, Vito; Mereu, Liliana; Litta, Pietro

    2015-01-01

    Bilateral salpingo-oophorectomy (BSO) in carriers of BRCA1 and BRCA2 mutations is widely recommended as part of a risk-reduction strategy for ovarian or breast cancer due to an underlying genetic predisposition. BSO is also performed as a therapeutic intervention for patients with hormone-positive premenopausal breast cancer. BSO may be performed via a minimally invasive approach with the use of three to four 5 mm and/or 12 mm ports inserted through a skin incision. To further reduce the morbidity associated with the placement of multiple port sites and to improve cosmetic outcomes, single-port laparoscopy has been developed with a single access point from the umbilicus. The purpose of this study was to evaluate the surgical outcomes associated with reducing the risks of salpingo-oophorectomy performed in a single port, while comparing multiport laparoscopy in women with a high risk for ovarian cancer. Single-port laparoscopy–BSO is feasible and safe, with favorable surgical and cosmetic outcomes when compared to conventional laparoscopy. PMID:26170692

  11. Ability of Serum C-Reactive Protein Concentrations to Predict Complications After Laparoscopy-Assisted Gastrectomy: A Prospective Cohort Study.

    PubMed

    Zhang, Kecheng; Xi, Hongqing; Wu, Xiaosong; Cui, Jianxin; Bian, Shibo; Ma, Liangang; Li, Jiyang; Wang, Ning; Wei, Bo; Chen, Lin

    2016-05-01

    Inflammatory markers, including C-reactive protein (CRP) and white blood cell (WBC), are widely available in clinical practice. However, their predictive roles for infectious complications following laparoscopy-assisted gastrectomy (LAG) have not been investigated. Our aim was to investigate the diagnostic accuracy of CRP concentrations and WBC counts for early detection of infectious complications following LAG and to construct a nomogram for clinical decision-making.The clinical data of consecutive patients who underwent LAG with curative intent between December 2013 and March 2015 were prospectively collected. Postoperative complications were recorded according to the Clavien-Dindo classification. The diagnostic value of CRP concentrations and WBC counts was evaluated by area under the curve of receiver-operating characteristic curves. Optimal cutoff values were determined by Youden index. Univariate and multivariate logistic regression analyses were performed to identify risk factors for complications, after which a nomogram was constructed.Twenty-nine of 278 patients (10.4%) who successfully underwent LAG developed major complications (grade ≥III). CRP concentration on postoperative day 3 (POD 3) and WBC count on POD 7 had the highest diagnostic accuracy for major complications with an area under the curve value of 0.86 (95% confidence interval [CI], 0.79-0.92] and 0.68 (95% CI, 0.56-0.79) respectively. An optimal cutoff value of 172.0 mg/L was identified for CRP, yielding a sensitivity of 0.79 (95% CI, 0.60-0.92) and specificity 0.74 (95% CI, 0.68-0.80). Multivariate analysis identified POD3 CRP concentrations ≥172.0 mg/L, Eastern Cooperative Oncology Group Performance Status ≥1, presence of preoperative comorbidity, and operation time ≥240 min as risk factors for major complications after LAG.The optimal cut-off value of CRP on POD3 to predict complications following LAG was 172.0 mg/L and a CRP-based nomogram may contribute to early

  12. Diagnostic laparoscopy in a twelve year old girl with right iliac fossa pain: A life changing diagnosis of complete androgen insensitivity syndrome

    PubMed Central

    Meshkat, Babak; Matcovici, Melania; Buckley, Claire; Salama, Muhammad; Perthiani, Haresh K.

    2014-01-01

    INTRODUCTION Right iliac fossa (RIF) pain is one of the most common presenting complaints faced by general surgeons in the emergency department. Correct diagnosis and appropriate surgical intervention can often pose a challenge. PRESENTATION OF CASE A 12-year-old girl presented to the emergency department with a four day history of initially central acute abdominal pain, now localised in the RIF. During laparoscopy, the following findings were made: macroscopically dilated appendix, right and left gonads at the internal opening of the inguinal canal, empty pelvis with a rudimentary uterus on the right side. No evidence of fallopian tubes or connection of uterus to the vagina and broad based, non-inflamed Meckel's diverticulum. An incidental diagnosis of complete androgen insensitivity syndrome was made. DISCUSSION Androgen insensitivity syndrome (AIS) is a disorder of hormone resistance characterised by a female phenotype in an individual with an XY karyotype and testes producing age-appropriate normal concentrations of androgens. CONCLUSION This case report highlights the advantage of laparoscopy as a diagnostic and treatment tool in a twelve year old girl with multiple intra-abdominal findings. While the ultimate diagnosis responsible for her symptom of RIF pain was acute appendicitis, the additional diagnosis of CAIS and incidental Meckel's would have otherwise likely gone undetected. PMID:24995665

  13. New approaches to gastric cancer staging: Beyond endoscopic ultrasound, computed tomography and positron emission tomography

    PubMed Central

    Yoon, Hyuk; Lee, Dong Ho

    2014-01-01

    Currently, there is no single gold standard modality for staging of gastric cancer and several methods have been used complementarily in the each clinical situation. To make up for the shortcomings of conventional modalities such as endoscopic ultrasound, computed tomography and 18F-fluoro-2-deoxyglucose positron emission tomography, numerous attempts with new approaches have been made for gastric cancer staging. For T staging, magnifying endoscopy with narrow-band was evaluated to differentiate mucosal cancer from submucosal cancer. Single/double contrast-enhanced ultrasound and diffusion-weighted magnetic resonance imaging were also tried to improve diagnostic accuracy of gastric cancer. For intraoperative staging with sentinel node mapping, indocyanine green infrared and fluorescence imaging was introduced. In addition, to detect micrometastasis, real-time reverse transcription-polymerase chain reaction system with multiple markers was studied. Staging laparoscopy using 5-aminolevulinic acid-mediated photodynamic diagnosis and percutaneous diagnostic peritoneal lavage were also evaluated. However, most studies reporting new staging methods is preliminary and further studies for validation in clinical practice are needed. In this mini-review, we discuss new progress in gastric cancer staging. Especially, we focus on new diagnostic approach to gastric cancer staging beyond the conventional modalities and briefly review the remarkable clinical results of the studies published over the past three years. PMID:25320516

  14. Second Stage Separation

    NASA Video Gallery

    When the second stage burn is complete, the spacecraft and third stage are spun up to 55 rpm to stabilize the third stage during its short firing. The second stage is then jettisoned and the third ...

  15. Robot-assisted versus conventional laparoscopic surgery for endometrial cancer staging: A meta-analysis.

    PubMed

    Chen, Shao-Hui; Li, Zhao-Ai; Huang, Rui; Xue, Hui-Qin

    2016-08-01

    This meta-analysis broadly compared the safety and efficacy of robot-assisted laparoscopy (RAL) with that of conventional laparoscopy (CL) for endometrial cancer staging. The advantages of RAL were evaluated through the outcomes in terms of conversion rates, complications, length of operation, blood loss, number of lymph nodes harvested, and length of hospitalization. Three electronic databases (PubMed, MEDLINE, and EmBASE) were searched to identify eligible studies. We selected all retrospective studies documenting a comparison between RAL and CL for endometrial cancer staging between 2005 and 2015, and tallied with meta-analyses criteria. Only studies published in English were included in this analysis. The outcomes of the extracted data were pooled and estimated by the Review Manager version 5.1 software. Seventeen studies met the eligibility criteria. Among the 2105 patients reported, 912 underwent RAL and the other 1193 underwent CL for endometrial cancer staging. Compared with CL, RAL had lower conversion rates [risk ratio, 0.4; 95% confidence interval (CI), 0.25-0.64; p = 0.0002]. Its complications were also less than that of CL (risk ratio, 0.72; 95% CI, 0.56-0.94; p = 0.02). RAL was associated with significantly less intraoperative blood loss (weighted mean difference, -79.2 mL; 95% CI, from -103.43 to -54.97; p < 0.00001) and a shorter length of hospitalization (weighted mean difference, -0.37 days; 95% CI, from -0.57 to -0.17; p = 0.0003). We found no significant differences in the length of operation and number of lymph nodes harvested between the two groups. From our meta-analysis results, RAL is a safe and effective alternative to CL for endometrial cancer staging. Further studies are required to determine potential advantages or disadvantages of RAL.

  16. Robot-assisted versus conventional laparoscopic surgery for endometrial cancer staging: A meta-analysis.

    PubMed

    Chen, Shao-Hui; Li, Zhao-Ai; Huang, Rui; Xue, Hui-Qin

    2016-08-01

    This meta-analysis broadly compared the safety and efficacy of robot-assisted laparoscopy (RAL) with that of conventional laparoscopy (CL) for endometrial cancer staging. The advantages of RAL were evaluated through the outcomes in terms of conversion rates, complications, length of operation, blood loss, number of lymph nodes harvested, and length of hospitalization. Three electronic databases (PubMed, MEDLINE, and EmBASE) were searched to identify eligible studies. We selected all retrospective studies documenting a comparison between RAL and CL for endometrial cancer staging between 2005 and 2015, and tallied with meta-analyses criteria. Only studies published in English were included in this analysis. The outcomes of the extracted data were pooled and estimated by the Review Manager version 5.1 software. Seventeen studies met the eligibility criteria. Among the 2105 patients reported, 912 underwent RAL and the other 1193 underwent CL for endometrial cancer staging. Compared with CL, RAL had lower conversion rates [risk ratio, 0.4; 95% confidence interval (CI), 0.25-0.64; p = 0.0002]. Its complications were also less than that of CL (risk ratio, 0.72; 95% CI, 0.56-0.94; p = 0.02). RAL was associated with significantly less intraoperative blood loss (weighted mean difference, -79.2 mL; 95% CI, from -103.43 to -54.97; p < 0.00001) and a shorter length of hospitalization (weighted mean difference, -0.37 days; 95% CI, from -0.57 to -0.17; p = 0.0003). We found no significant differences in the length of operation and number of lymph nodes harvested between the two groups. From our meta-analysis results, RAL is a safe and effective alternative to CL for endometrial cancer staging. Further studies are required to determine potential advantages or disadvantages of RAL. PMID:27590368

  17. Sterilization by Laparoscopy

    MedlinePlus

    ... sleep-like state to prevent pain during surgery. Human Immunodeficiency Virus (HIV): A virus that attacks certain cells of the body’s immune system and causes acquired immunodeficiency syndrome (AIDS). Hysteroscopic Sterilization: ...

  18. Laparoscopy and Hysteroscopy

    MedlinePlus

    ... de fluid in the lungs, blood clotting, fluid overload, electrolyte imbalance, and severe allergic reactions. Severe or ... line, type “Attention: Patient Education Committee.” For more information on this and other reproductive health topics, visit ...

  19. Pelvic laparoscopy - series (image)

    MedlinePlus

    ... infections (pelvic inflammatory disease) not responsive to drug therapy suspected twisting (torsion) of an ovary ovarian cyst scar tissue (adhesions) in pelvis puncture through the uterus (uterine perforation) ...

  20. [About the discovery of a hepatic subcapsular collection as early complication of transperitoneal laparoscopy. Review of the clinical implications based on the hepatic capsular and retroperitoneal anatomy, its subdivisions and communications].

    PubMed

    Buts, S; Fillet, M; Bonnet, P

    2008-12-01

    We report a case of hepatic subcapsular collection as early complication of transperitoneal laparoscopy. The etiology seems to be a detachment of the hepatic capsule induced by laparoscopic gas. We discuss the anatomic data about the liver capsule, renal fascia and retroperitoneal subdivisions supporting such a mechanism.

  1. Hysteroscopy- and laparoscopy-based diagnosis and treatment of girls with unbroken hymen with an obstructing uterine septum: two case reports

    PubMed Central

    2014-01-01

    Introduction Obstructing uterine septum is a rare uterine malformation. Patients with obstructing uterine septum are usually treated with laparouterotomy, causing obvious injury to both the uterus and body of the patients. Therefore, using the natural channel of the vagina is undoubtedly the best way to carry out the surgery. However, obstructing uterine septum usually occurs in puberty in girls without a history of sexual intercourse, thus iatrogenic damage to the hymen during the diagnosis and treatment cannot probably be avoided. However, Chinese people traditionally tend to use hymen intactness as a standard to judge whether an unmarried woman is chaste. Therefore, in China, to protect the hymen from damage during hysteroscopic diagnosis and treatment is of special significance for girls and women with unbroken hymens. None of the previously reported cases were treated with electrosurgical obstructing uterine septum excision based on B-ultrasound-guided hymen-protecting hysteroscopy and laparoscopy. Case presentation Case 1 patient was a virgo intacta 13-year-old Chinese girl. She was admitted due to an 8-day post-menstruation lower abdominal pain. With the guidance of B-ultrasound, we observed a 30mm×20mm mixed echogenicity mass in her uterine cavity. Case 2 patient was a virgo intacta 14-year-old Chinese girl. She was admitted to our hospital more than 6 months after secondary dysmenorrhea and 6 days after B-ultrasound-diagnosed uterine malformations. We observed a 30mm×25mm mixed echoic area in her uterine cavity with the guidance of B-ultrasound. Both patients were surgically treated without hymen damage with B-ultrasound-guided combined therapy of hysteroscopy and laparoscopy. A needle electrode with an 8mm diameter was placed into their uterine cavities under hysteroscopy. After obstructing uterine septum removal, their uterine cavities showed normal morphology. To protect their hymens, misoprostol was placed into their rectums to soften their cervices

  2. Place de la laparoscopie dans la prise en charge des anomalies de différenciation sexuelle: à propos de 4 cas

    PubMed Central

    Goultaiene, Aissam; Elmortaji, Khalid; Sentissi, Reda; Moataz, Amine; Rabii, Redouane; Aboutaib, Rachid; Dakir, Mohammed; Debbagh, Adil; Meziane, Fethi

    2016-01-01

    Les troubles de la différenciation sexuelle sont à l'origine d'une discordance entre le sexe proprement dit (phénotypique) et le sexe génétique (génotypique) ce qui pose un problème de détermination du sexe. Dans les pays de faible niveau socio-économique où le diagnostic anténatal est souvent absent et les plateaux techniques insuffisants, la prise en charge médico-chirurgicale est difficile. Le but de ce travail est de préciser la place de la laparoscopie dans la prise en charge de l'ambiguïté sexuelle à travers l'observation de 4 cas et une revue de la littérature. PMID:27303583

  3. Seventh tumor-node-metastasis staging of gastric cancer: Five-year follow-up.

    PubMed

    Rausei, Stefano; Ruspi, Laura; Galli, Federica; Pappalardo, Vincenzo; Di Rocco, Giuseppe; Martignoni, Francesco; Frattini, Francesco; Rovera, Francesca; Boni, Luigi; Dionigi, Gianlorenzo

    2016-09-14

    Seventh tumor-node-metastasis (TNM) classification for gastric cancer, published in 2010, introduced changes in all of its three parameters with the aim to increase its accuracy in prognostication. The aim of this review is to analyze the efficacy of these changes and their implication in clinical practice. We reviewed relevant Literature concerning staging systems in gastric cancer from 2010 up to March 2016. Adenocarcinoma of the esophago-gastric junction still remains a debated entity, due to its peculiar anatomical and histological situation: further improvement in its staging are required. Concerning distant metastases, positive peritoneal cytology has been adopted as a criterion to define metastatic disease: however, its search in clinical practice is still far from being routinely performed, as staging laparoscopy has not yet reached wide diffusion. Regarding definition of T and N: in the era of multimodal treatment these parameters should more influence both staging and surgery. The changes about T-staging suggested some modifications in clinical practice. Differently, many controversies on lymph node staging are still ongoing, with the proposal of alternative classification systems in order to minimize the extent of lymphadenectomy. The next TNM classification should take into account all of these aspects to improve its accuracy and the comparability of prognosis in patients from both Eastern and Western world. PMID:27678357

  4. Seventh tumor-node-metastasis staging of gastric cancer: Five-year follow-up

    PubMed Central

    Rausei, Stefano; Ruspi, Laura; Galli, Federica; Pappalardo, Vincenzo; Di Rocco, Giuseppe; Martignoni, Francesco; Frattini, Francesco; Rovera, Francesca; Boni, Luigi; Dionigi, Gianlorenzo

    2016-01-01

    Seventh tumor-node-metastasis (TNM) classification for gastric cancer, published in 2010, introduced changes in all of its three parameters with the aim to increase its accuracy in prognostication. The aim of this review is to analyze the efficacy of these changes and their implication in clinical practice. We reviewed relevant Literature concerning staging systems in gastric cancer from 2010 up to March 2016. Adenocarcinoma of the esophago-gastric junction still remains a debated entity, due to its peculiar anatomical and histological situation: further improvement in its staging are required. Concerning distant metastases, positive peritoneal cytology has been adopted as a criterion to define metastatic disease: however, its search in clinical practice is still far from being routinely performed, as staging laparoscopy has not yet reached wide diffusion. Regarding definition of T and N: in the era of multimodal treatment these parameters should more influence both staging and surgery. The changes about T-staging suggested some modifications in clinical practice. Differently, many controversies on lymph node staging are still ongoing, with the proposal of alternative classification systems in order to minimize the extent of lymphadenectomy. The next TNM classification should take into account all of these aspects to improve its accuracy and the comparability of prognosis in patients from both Eastern and Western world. PMID:27678357

  5. Seventh tumor-node-metastasis staging of gastric cancer: Five-year follow-up

    PubMed Central

    Rausei, Stefano; Ruspi, Laura; Galli, Federica; Pappalardo, Vincenzo; Di Rocco, Giuseppe; Martignoni, Francesco; Frattini, Francesco; Rovera, Francesca; Boni, Luigi; Dionigi, Gianlorenzo

    2016-01-01

    Seventh tumor-node-metastasis (TNM) classification for gastric cancer, published in 2010, introduced changes in all of its three parameters with the aim to increase its accuracy in prognostication. The aim of this review is to analyze the efficacy of these changes and their implication in clinical practice. We reviewed relevant Literature concerning staging systems in gastric cancer from 2010 up to March 2016. Adenocarcinoma of the esophago-gastric junction still remains a debated entity, due to its peculiar anatomical and histological situation: further improvement in its staging are required. Concerning distant metastases, positive peritoneal cytology has been adopted as a criterion to define metastatic disease: however, its search in clinical practice is still far from being routinely performed, as staging laparoscopy has not yet reached wide diffusion. Regarding definition of T and N: in the era of multimodal treatment these parameters should more influence both staging and surgery. The changes about T-staging suggested some modifications in clinical practice. Differently, many controversies on lymph node staging are still ongoing, with the proposal of alternative classification systems in order to minimize the extent of lymphadenectomy. The next TNM classification should take into account all of these aspects to improve its accuracy and the comparability of prognosis in patients from both Eastern and Western world.

  6. Pancreatic Cancer Stage 3

    MedlinePlus

    ... historical Searches are case-insensitive Pancreatic Cancer Stage 3 Add to My Pictures View /Download : Small: 720x576 ... Large: 3000x2400 View Download Title: Pancreatic Cancer Stage 3 Description: Stage III pancreatic cancer; drawing shows cancer ...

  7. United States Access Board

    MedlinePlus

    ... Communications & IT Access to information and communication technology (ICT) is addressed by Board standards and guidelines issued ... Engineer (November 3) Access Board Approves Rules on ICT Refresh and Medical Diagnostic Equipment (September 14) Access ...

  8. Sporadic gastric carcinoid tumor successfully treated by two-stage laparoscopic surgery: A case report

    PubMed Central

    Kinoshita, Takahiro; Oshiro, Takashi; Urita, Tasuku; Yoshida, Yutaka; Ooshiro, Mitsuru; Okazumi, Shinichi; Katoh, Ryoji; Sasai, Daisuke; Hiruta, Nobuyuki

    2010-01-01

    We report a case of sporadic gastric carcinoid tumor successfully treated by two-stage laparoscopic surgery. A 38-year old asymptomatic woman was referred to our hospital for evaluation of a submucosal tumor of the stomach. Endoscopic examination showed a solitary submucosal tumor without ulceration or central depression on the posterior wall of the antrum and biopsy specimens were not sufficient to determine the diagnosis. Endoscopic ultrasound revealed a tumor nearly 2 cm in diameter arising from the muscle layer and a computed tomography scan showed the tumor enhanced in the arterial phase. Laparoscopic wedge resection was performed for definitive diagnosis. Pathologically, the tumor was shown to be gastric carcinoid infiltrating the muscle layer which indicated the probability of lymph node metastasis. Serum gastrin levels were normal. As a radical treatment, laparoscopy-assisted distal gastrectomy with regional lymphadenectomy was performed 3 wk after the initial surgery. Finally, pathological examination revealed no lymph node metastasis. PMID:21160902

  9. Technological update of the video-endoscopic approach of the diagnosis and staging of tumors in children.

    PubMed

    Drăghici, Isabela Magdalena; Luca, Dragoş-Constantin; Popescu, Maria-Delia; Drăghici, Liviu

    2014-01-01

    The pediatric patient is often difficult to diagnose, especially since the surgical pathology is tumoral. Establishing the histopathological diagnosis of a tumor, staging of a disease and certifying the existence of rare pediatric affections are three of the motives for which the specialists frequently appeal to an exploratory laparoscopy, accompanied by biopsy procedures. The paper presents the laparoscopic biopsy experience of the team from the Department of Pediatric Surgery, "Maria Skłodowska Curie" Emergency Clinical Hospital for Children, Bucharest, Romania. From 2000 to 2013, 95 such procedures were performed (7.76% of a total of 1224 laparoscopic interventions). In many cases, the laparoscopy had an exclusive diagnostic purpose, of whose success has been primarily responsible the targeted biopsy. Current issues are discussed, centered on the most advanced technologies used in minimally invasive approach of pediatric malignancies, referring to the effect of minimizing the possible complications that can arise from this type of intervention. The authors concluded that laparoscopic technique is the method of choice in comparison to other ways of biopsy (classical surgery, ultrasound guidance, tomography, etc.), and it is characterized by a high diagnostic value.

  10. A Theory of Access

    ERIC Educational Resources Information Center

    Ribot, Jesse C.; Peluso, Nancy Lee

    2003-01-01

    The term "access" is frequently used by property and natural resource analysts without adequate definition. In this paper we develop a concept of access and examine a broad set of factors that differentiate access from property. We define access as "the "ability" to derive benefits from things," broadening from property's classical definition as…

  11. World Wide Access: Accessible Web Design.

    ERIC Educational Resources Information Center

    Washington Univ., Seattle.

    This brief paper considers the application of "universal design" principles to Web page design in order to increase accessibility for people with disabilities. Suggestions are based on the World Wide Web Consortium's accessibility initiative, which has proposed guidelines for all Web authors and federal government standards. Seven guidelines for…

  12. Lunar Module Ascent Stage

    NASA Technical Reports Server (NTRS)

    1969-01-01

    The Lunar Module 'Spider' ascent stage is photographed from the Command/Service Module on the fifth day of the Apollo 9 earth-orbital mission. The Lunar Module's descent stage had already been jettisoned.

  13. Stages of Adolescence

    MedlinePlus

    ... Español Text Size Email Print Share Stages of Adolescence Page Content Article Body Adolescence, these years from puberty to adulthood, may be roughly divided into three stages: early adolescence, generally ages eleven to fourteen; middle adolescence, ages ...

  14. Breast cancer staging

    MedlinePlus

    Doctors use 7 main stages to describe breast cancer. Stage 0, also called carcinoma in situ. This is cancer that is confined to the lobules or ducts in the breast. It has not spread to surrounding tissue. ...

  15. Ovarian Cancer Stage IV

    MedlinePlus

    ... hyphen, e.g. -historical Searches are case-insensitive Ovarian Cancer Stage IV Add to My Pictures View /Download : ... 1200x1335 View Download Large: 2400x2670 View Download Title: Ovarian Cancer Stage IV Description: Drawing of stage IV shows ...

  16. Ovarian Cancer Stage IIIC

    MedlinePlus

    ... hyphen, e.g. -historical Searches are case-insensitive Ovarian Cancer Stage IIIC Add to My Pictures View /Download : ... 1530x1350 View Download Large: 3060x2700 View Download Title: Ovarian Cancer Stage IIIC Description: Drawing of stage IIIC shows ...

  17. Ovarian Cancer Stage II

    MedlinePlus

    ... hyphen, e.g. -historical Searches are case-insensitive Ovarian Cancer Stage II Add to My Pictures View /Download : ... 1650x675 View Download Large: 3300x1350 View Download Title: Ovarian Cancer Stage II Description: Three-panel drawing of stage ...

  18. Ovarian Cancer Stage I

    MedlinePlus

    ... hyphen, e.g. -historical Searches are case-insensitive Ovarian Cancer Stage I Add to My Pictures View /Download : ... 1650x675 View Download Large: 3300x1350 View Download Title: Ovarian Cancer Stage I Description: Three-panel drawing of stage ...

  19. Beyond Erikson's Eight Stages.

    ERIC Educational Resources Information Center

    Whitney, Ruth

    1979-01-01

    Erik Erikson has described eight stages of the healthy personality. This essay offers a revised version of the eight stages. Although most individuals develop through the eight stages, each is personally unique because patterns of fluctuation between safety and growth differ from one individual to another. (Author)

  20. Real-time cadaveric laparoscopy and laparoscopic video demonstrations in gross anatomy: an observation of impact on learning and career choice.

    PubMed

    Saberski, Ean R; Orenstein, Sean B; Matheson, Dale; Novitsky, Yuri W

    2015-01-01

    Medical curricula are continually evolving and increasing clinical relevance. Gross anatomy educators have tested innovations to improve the clinical potency of anatomic dissection and found that clinical correlations are an effective method to accomplish this goal. Recently, surgical educators defined a role for laparoscopy in teaching anatomy. We aimed to expand this role by using surgical educators to create clinical correlates between gross anatomy and clinical surgery. We held supplements to traditional anatomy open dissection for medical students, including viewing prerecorded operative footage and live laparoscopic dissection performed on cadavers. The main outcome measures were assessed through pre- and postsession surveys. Greater than 75 per cent of students found the demonstrations highly valuable, and students perceived a significant increase in their understanding of abdominopelvic anatomy (P < 0.01). Additionally, 62 per cent of students with previous interest in surgery and 10 per cent of students without previous interest in surgery reported increased interest in pursuing surgical careers. Our demonstrations advance the use of minimally invasive surgical technology to teach gross anatomy. Live laparoscopic demonstrations augment traditional anatomic instruction by reinforcing the clinical relevance of abdominopelvic anatomy. Additionally, laparoscopic demonstrations generate interest in surgery that would otherwise be absent in the preclinical years.

  1. Is robotic ventral mesh rectopexy better than laparoscopy in the treatment of rectal prolapse and obstructed defecation? A meta-analysis.

    PubMed

    Ramage, L; Georgiou, P; Tekkis, P; Tan, E

    2015-07-01

    Ventral mesh rectopexy is an approach in the treatment of internal and external rectal prolapse and rectocele. Our aim was to assess whether robotic surgery confers any significant advantages over laparoscopy, and the associated complication rate. Two reviewers performed a literature search using MEDLINE and PubMed databases for studies comparing robotic versus laparoscopic surgery. Five prospective, non-randomised studies were identified and included. A total of 244 patients (101 robotic and 143 laparoscopic) were included in the analysis. Operative time was shorter with laparoscopic surgery, mean weighted difference 27.94 [confidence interval (CI) 19.30-36.57; p < 0.00001]. The conversion rate was not significantly different between groups. There was a trend towards a reduction in length of inpatient stay and early post-operative complications in the robotic group; however, these did not reach statistical significance. Recurrence rates were similar between groups (odds ratio 0.91, CI 0.32-2.63; p = 0.87). Functional results were comparable between groups. Early studies show that robotic ventral rectopexy is a safe option compared to the laparoscopic approach, with overall comparable results. There appeared to be a trend towards a reduction in length of inpatient stay and post-operative complications. These perceived benefits may offset the longer operative times and outlay costs. Larger randomised controlled trials are needed to further evaluate clinical value and cost-effectiveness.

  2. Second stage of labor.

    PubMed

    Cheng, Yvonne W; Caughey, Aaron B

    2015-06-01

    Current American College of Obstetricians and Gynecologists' definition of prolonged second stage diagnoses 10% to 14% of nulliparous and 3% to 3.5% of multiparous women as having a prolonged second stage. The progression of labor in modern obstetrics may have deviated from the current labor norms established in the 1950s, likely due to differences in obstetric population characteristics and variation in clinical practice. Optimal management of the second stage in women with and without epidural remains debatable. Although prolonged second stage is associated with increased risk of maternal morbidity, conflicting data exist regarding the duration of second stage and associated neonatal morbidity and mortality.

  3. Cetuximab, Cisplatin, and Radiation Therapy in Treating Patients With Stage IB, Stage II, Stage III, or Stage IVA Cervical Cancer

    ClinicalTrials.gov

    2014-12-29

    Cervical Adenocarcinoma; Cervical Adenosquamous Carcinoma; Cervical Small Cell Carcinoma; Cervical Squamous Cell Carcinoma; Stage IB Cervical Cancer; Stage IIA Cervical Cancer; Stage IIB Cervical Cancer; Stage III Cervical Cancer; Stage IVA Cervical Cancer

  4. TBCC Fan Stage Operability and Performance

    NASA Technical Reports Server (NTRS)

    Suder, Kenneth L.

    2007-01-01

    NASA s Fundamental Aeronautics Program is investigating turbine-based propulsion systems for access to space because it provides the potential for aircraft-like, space-launch operations that may significantly reduce launch costs and improve safety. Studies performed under NASA s NGLT and the NASP High Speed Propulsion Assessment (HiSPA) program indicated a variable cycle turbofan/ramjet was the best configuration to satisfy access-to-space mission requirements because this configuration maximizes the engine thrust-to-weight ratio while minimizing frontal area. To this end, NASA and GE teamed to design a Mach 4 variable cycle turbofan/ramjet engine for access to space. To enable the wide operating range of a Mach 4+ variable cycle turbofan ramjet required the development of a unique fan stage design capable of multi-point operation to accommodate variations in bypass ratio (10X), fan speed (7X), inlet mass flow (3.5X), inlet pressure (8X), and inlet temperature (3X). The primary goal of the fan stage was to provide a high pressure ratio level with good efficiency at takeoff through the mid range of engine operation, while avoiding stall and losses at the higher flight Mach numbers, without the use of variable inlet guide vanes. Overall fan performance and operability therefore requires major consideration, as competing goals at different operating points and aeromechanical issues become major drivers in the design. To mitigate risk of meeting the unique design requirements for the fan stage, NASA and GE teamed to design and build a 57% engine scaled fan stage to be tested in NASA s transonic compressor facility. The objectives of this test are to assess the aerodynamic and aero mechanic performance and operability characteristics of the fan stage over the entire range of engine operation including: 1) sea level static take-off, 2) transition over large swings in fan bypass ratio, 3) transition from turbofan to ramjet, and 4) fan windmilling operation at high Mach

  5. Open Access Alternatives

    ERIC Educational Resources Information Center

    Tenopir, Carol

    2004-01-01

    Open access publishing is a hot topic today. But open access publishing can have many different definitions, and pros and cons vary with the definitions. Open access publishing is especially attractive to companies and small colleges or universities that are likely to have many more readers than authors. A downside is that a membership fee sounds…

  6. [Accessible Rural Housing.

    ERIC Educational Resources Information Center

    Baker, Nick, Ed.

    1995-01-01

    This issue of the quarterly newsletter "Rural Exchange" provides information and resources on accessible rural housing for the disabled. "Accessible Manufactured Housing Could Increase Rural Home Supply" (Nick Baker) suggests that incorporation of access features such as lever door handles and no-step entries into manufactured housing could help…

  7. Demystifying Remote Access

    ERIC Educational Resources Information Center

    Howe, Grant

    2009-01-01

    With money tight, more and more districts are considering remote access as a way to reduce expenses and budget information technology costs more effectively. Remote access allows staff members to work with a hosted software application from any school campus without being tied to a specific physical location. Each school can access critical…

  8. Open Access and beyond.

    PubMed

    Mathur, Shawn; Schmidt, Christian; Das, Chhaya; Tucker, Philip W

    2006-01-01

    Uncensored exchange of scientific results hastens progress. Open Access does not stop at the removal of price and permission barriers; still, censorship and reading disabilities, to name a few, hamper access to information. Here, we invite the scientific community and the public to discuss new methods to distribute, store and manage literature in order to achieve unfettered access to literature. PMID:16956402

  9. Reflective Database Access Control

    ERIC Educational Resources Information Center

    Olson, Lars E.

    2009-01-01

    "Reflective Database Access Control" (RDBAC) is a model in which a database privilege is expressed as a database query itself, rather than as a static privilege contained in an access control list. RDBAC aids the management of database access controls by improving the expressiveness of policies. However, such policies introduce new interactions…

  10. Staged Repository Development Programmes

    SciTech Connect

    Isaacs, T

    2003-10-01

    Programs to manage and ultimately dispose of high-level radioactive wastes are unique from scientific and technological as well as socio-political aspects. From a scientific and technological perspective, high-level radioactive wastes remain potentially hazardous for geological time periods-many millennia-and scientific and technological programs must be put in place that result in a system that provides high confidence that the wastes will be isolated from the accessible environment for these many thousands of years. Of course, ''proof'' in the classical sense is not possible at the outset, since the performance of the system can only be known with assurance, if ever, after the waste has been emplaced for those geological time periods. Adding to this challenge, many uncertainties exist in both the natural and engineered systems that are intended to isolate the wastes, and some of the uncertainties will remain regardless of the time and expense in attempting to characterize the system and assess its performance. What was perhaps underappreciated in the early days of waste management and repository program development were the unique and intense reactions that the institutional, political, and public bodies would have to repository program development, particularly in programs attempting to identify and then select sites for characterization, design, licensing, and ultimate development. Reactions in most nations were strong, focused, unrelenting, and often successful in hindering, derailing, and even stopping national repository programs. The reasons for such reactions and the measures to successfully respond to them are still evolving and continue to be the focus of many national program and political leaders. Adaptive Staging suggests an approach to repository program development that reflects the unique challenges associated with the disposal of high-level radioactive waste. The step-wise, incremental, learn-as-you-go approach is intended to maximize the

  11. Staged electrostatic precipitator

    DOEpatents

    Miller, Stanley J.; Almlie, Jay C.; Zhuang, Ye

    2016-03-01

    A device includes a chamber having an air inlet and an air outlet. The device includes a plurality of stages including at least a first stage adjacent a second stage. The plurality of stages are disposed in the chamber and each stage has a plurality of discharge electrodes disposed in an interior region and is bounded by an upstream baffle on an end proximate the air inlet and bounded by a downstream baffle on an end proximate the air outlet. Each stage has at least one sidewall between the upstream baffle and the downstream baffle. The sidewall is configured as a collection electrode and has a plurality of apertures disposed along a length between the upstream baffle and the downstream baffle. The upstream baffle of the first stage is positioned in staggered alignment relative to the upstream baffle of the second stage and the downstream baffle of the first stage are positioned in staggered alignment relative to the downstream baffle of the second stage.

  12. Two stage catalytic combustor

    NASA Technical Reports Server (NTRS)

    Alvin, Mary Anne (Inventor); Bachovchin, Dennis (Inventor); Smeltzer, Eugene E. (Inventor); Lippert, Thomas E. (Inventor); Bruck, Gerald J. (Inventor)

    2010-01-01

    A catalytic combustor (14) includes a first catalytic stage (30), a second catalytic stage (40), and an oxidation completion stage (49). The first catalytic stage receives an oxidizer (e.g., 20) and a fuel (26) and discharges a partially oxidized fuel/oxidizer mixture (36). The second catalytic stage receives the partially oxidized fuel/oxidizer mixture and further oxidizes the mixture. The second catalytic stage may include a passageway (47) for conducting a bypass portion (46) of the mixture past a catalyst (e.g., 41) disposed therein. The second catalytic stage may have an outlet temperature elevated sufficiently to complete oxidation of the mixture without using a separate ignition source. The oxidation completion stage is disposed downstream of the second catalytic stage and may recombine the bypass portion with a catalyst exposed portion (48) of the mixture and complete oxidation of the mixture. The second catalytic stage may also include a reticulated foam support (50), a honeycomb support, a tube support or a plate support.

  13. Staging memory for massively parallel processor

    NASA Technical Reports Server (NTRS)

    Batcher, Kenneth E. (Inventor)

    1988-01-01

    The invention herein relates to a computer organization capable of rapidly processing extremely large volumes of data. A staging memory is provided having a main stager portion consisting of a large number of memory banks which are accessed in parallel to receive, store, and transfer data words simultaneous with each other. Substager portions interconnect with the main stager portion to match input and output data formats with the data format of the main stager portion. An address generator is coded for accessing the data banks for receiving or transferring the appropriate words. Input and output permutation networks arrange the lineal order of data into and out of the memory banks.

  14. 42 CFR 1001.1301 - Failure to grant immediate access.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Failure to grant immediate access. 1001.1301... § 1001.1301 Failure to grant immediate access. (a) Circumstance for exclusion. (1) The OIG may exclude...)(3) of the Act; (J) An end-stage renal disease facility is meeting the requirements of section...

  15. Preliminary application of a single-port access technique for laparoscopic ovariohysterectomy in dogs

    PubMed Central

    Sánchez-Margallo, F. M.; Tapia-Araya, A.; Díaz-Güemes, I.

    2015-01-01

    Laparoscopic ovariohysterectomy using single-portal access was performed in nine selected owned dogs admitted for elective ovariohysterectomy and the surgical technique and outcomes were detailed. A multiport device (SILS Port, Covidien, USA) was placed at the umbilical area through a single 3 cm incision. Three cannulae were introduced in the multiport device through the access channels and laparoscopic ovariohysterectomy was performed using a 5-mm sealing device, a 5-mm articulating grasper and a 5-mm 30° laparoscope. The mean total operative time was 52.66±15.20 minutes and the mean skin incision during surgery was 3.09±0.20 cm. Of the nine cases examined, in the one with an ovarian tumour, the technique was converted to multiport laparoscopy introducing an additional 5-mm trocar. No surgical complications were encountered and intraoperative blood loss was minimum in all animals. Clashing of the instruments and reduced triangulation were the main limitations of this technique. The combination of articulated and straight instruments facilitated triangulation towards the surgical field and dissection capability. One month after surgery a complete wound healing was observed in all animals. The present data showed that ovariohysterectomy performed with a single-port access is technically feasible in dogs. The unique abdominal incision minimises the abdominal trauma with good cosmetic results. PMID:26568831

  16. Stages in the research process.

    PubMed

    Gelling, Leslie

    2015-03-01

    Research should be conducted in a systematic manner, allowing the researcher to progress from a general idea or clinical problem to scientifically rigorous research findings that enable new developments to improve clinical practice. Using a research process helps guide this process. This article is the first in a 26-part series on nursing research. It examines the process that is common to all research, and provides insights into ten different stages of this process: developing the research question, searching and evaluating the literature, selecting the research approach, selecting research methods, gaining access to the research site and data, pilot study, sampling and recruitment, data collection, data analysis, and dissemination of results and implementation of findings.

  17. Current topics on vascular access for hemodialysis.

    PubMed

    Tordoir, J H M; Van Der Sande, F M; De Haan, M W

    2004-09-01

    Vascular access remains the lifeline for end-stage renal failure patients, which have been treated by chronic intermittent hemodialysis. Due to the steady increase in the number of patients with difficulties to create access, in particular in elderly with various comorbidities, the need for more insight and regulations have evolved into the publications of the American and European guidelines. From the latter it may be obvious that an adequate preoperative assessment followed by the creation of autogenous arteriovenous fistulas (AVFs) is far better and preferred to the implantation of grafts. Vascular access maintenance by monitoring and elective percutanuous or surgical revision is of utmost importance to keep the access site functional. Despite up-to-date measures for vascular access maintenance, various complications may treaten not only the access site but also quality and expectance of life. Thrombotic occlusion remains a major event, leading to permanent failure in 10% of AVFs and 20% of grafts each year. Interventional (percutaneous transluminal angioplasty and/or stent implantation) or surgical revision of thrombosed accesses have similar outcomes with a high rate of reinterventions. The elderly diabetic population with peripheral arteriosclerotic obstructive disease is in particular prone to angio-access induced handischemia. When not timely and properly treated this may lead to minor or major amputation, further hampering quality of life. Also, the enormous application in the past 2 decades of acute central venous lines has lead to a significant increase of central venous obstruction with concomittent morbidity and problems creating vascular access in the upper extremities. Radiological intervention in these cases is a primary option, leaving surgical reconstruction as a second best method. It may be obvious that creation and maintenance of hemodialysis vascular access has become an important and time-consuming speciality. Only an up

  18. Comparison of hysterosalpingograms with laparoscopy in the diagnostic of tubal factor of female infertility at the Yaoundé General Hospital, Cameroon

    PubMed Central

    Ngowa, Jean Dupont Kemfang; Kasia, Jean Marie; Georges, NGuefack-Tsague; Nkongo, Victorine; Sone, Charles; Fongang, Emmanuel

    2015-01-01

    Introduction The objectives were to assess the diagnostic value of hysterosalpingography (HSG) with laparoscopy as gold standard in the evaluation of tubal patency and pelvic adhesions in women suffering from infertility. Methods We conducted a comparative cross sectional study on 208 medical files of infertile women followed up at the Yaoundé General Hospital during a period of five years (December 2007 to December 2012). Tubal patency, hydrosalpinx and pelvic adhesions detected at HSG were compared with laparoscopic findings as the gold standard. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of HSG were calculated with 95% confidence interval (CI). Results Mean age of the patients was 31.4± 6.45 years. Secondary infertility was the most frequent type of infertility (66.82%). HSG had a moderate sensitivity (51.0%; 95% IC. 37.5-64.4), high specificity (90.0%; 95% IC.74.4-96.5), high PPV (89.3%; 95% IC. 72.8-96.3) and a moderate NPV (52.9%; 95% IC. 39.5-65.9) in the diagnosis of bilateral proximal tubal occlusion. Concerning, distal tubal patency, HSG had a high sensitivity (86.8%; 95% IC. 76.7-92.9), low specificity (42.2%; 95% CI. 29.0-56.7), moderate PPV (69.4%; 95% IC. 58.9-78.2) and a moderate NPV (67.9%; 95% IC. 49.3-82.0) in the diagnosis of bilateral or unilateral distal tubal occlusion. However, HSG had a low diagnostic value (27.8%; 95%IC.18.8-39.0) in the pelvic adhesions. Conclusion HSG is of limited diagnostic value in tubal factor infertility and is of low diagnostic value for pelvic adhesions. PMID:26958127

  19. Stages of Esophageal Cancer

    MedlinePlus

    ... writer, artist, or publisher to obtain permission for reuse. We welcome your comments on this post. All ... POLICIES Accessibility Comment Policy Disclaimer FOIA Privacy & Security Reuse & Copyright Syndication Services Website Linking U.S. Department of ...

  20. Access to modern contraception.

    PubMed

    Welsh, Michael J; Stanback, John; Shelton, James

    2006-06-01

    Access to modern contraception has become a recognized human right, improving the health and well-being of women, families and societies worldwide. However, contraceptive access remains uneven. Irregular contraceptive supply, limited numbers of service delivery points and specific geographic, economic, informational, psychosocial and administrative barriers (including medical barriers) undermine access in many settings. Widening the range of providers enabled to offer contraception can improve contraceptive access, particularly where resources are most scarce. International efforts to remove medical barriers include the World Health Organization's Medical Eligibility Criteria. Based on the best available evidence, these criteria provide guidance for weighing the risks and benefits of contraceptive choice among women with specific clinical conditions. Clinical job aids can also improve access. More research is needed to further elucidate the pathways for expanding contraceptive access. Further progress in removing medical barriers will depend on systems for improving provider education and promoting evidence-based contraceptive service delivery. PMID:16443395

  1. Exhausting Multiple Hemodialysis Access Failures

    PubMed Central

    Bolleke, Erjola; Seferi, Saimir; Rroji, Merita; Idrizi, Alma; Barbullushi, Myftar; Thereska, Nestor

    2014-01-01

    ABSTRACT Introduction: Vascular access is often considered the Achilles heel the of hemodialysis because of its impact on morbidity, all cause mortality and finally costs of these patients. The most common complication of permanent hemodialysis (HD) vascular access is thrombosis, with some cases being related to hypercoagulability states. Antiphospholipid antibody syndrome (APAS) is a cause of increased thrombotic tendency, and this may complicate the management of such patients on HD. Case report: We describe a 41-year-old woman with end stage renal disease (ESRD) from Adult Polycystic Kidney Disease who was referred to our tertiary care center for treatment and selection of renal replacement therapy form. It was thought to initiate with peritoneal dialysis considering her actual conditions. She was putted on hemodialysis for several sessions, and a subclavian cathether was her first vascular access. The surgeon created an arterio-venous fistula which did not mature. After the implantation of the peritoneal cathether she started peritoneal dialysis and continued living with that for 2 years. She felt exhausted and because of a grave peritonitis episode accompanied with procedure failure and a long hospitalization she was transferred to hemodialysis. Renal transplantation was not possible because she didn’t have a kidney donation. She was maintained on regular HD, but her dialysis care was complicated by recurrent vascular access failures. She had multiple interventions for arterio-venous fistulas and grafts but almost all of them failed due to thrombosis to the extent that only one access site was available for her routine renal replacement treatment. A thorough thrombophilia screen confirmed the presence of antiphospholipid antibodies. A diagnosis of APAS was made and she was anticoagulated with warfarin. The AVG made in this last available site is still working from 18 months. If it fails we have no answers and solutions for her. Conclusion: The presence of

  2. Web Accessibility and Guidelines

    NASA Astrophysics Data System (ADS)

    Harper, Simon; Yesilada, Yeliz

    Access to, and movement around, complex online environments, of which the World Wide Web (Web) is the most popular example, has long been considered an important and major issue in the Web design and usability field. The commonly used slang phrase ‘surfing the Web’ implies rapid and free access, pointing to its importance among designers and users alike. It has also been long established that this potentially complex and difficult access is further complicated, and becomes neither rapid nor free, if the user is disabled. There are millions of people who have disabilities that affect their use of the Web. Web accessibility aims to help these people to perceive, understand, navigate, and interact with, as well as contribute to, the Web, and thereby the society in general. This accessibility is, in part, facilitated by the Web Content Accessibility Guidelines (WCAG) currently moving from version one to two. These guidelines are intended to encourage designers to make sure their sites conform to specifications, and in that conformance enable the assistive technologies of disabled users to better interact with the page content. In this way, it was hoped that accessibility could be supported. While this is in part true, guidelines do not solve all problems and the new WCAG version two guidelines are surrounded by controversy and intrigue. This chapter aims to establish the published literature related to Web accessibility and Web accessibility guidelines, and discuss limitations of the current guidelines and future directions.

  3. Reoperative venous access.

    PubMed

    Juno, Russell J; Knott, Andrew W; Racadio, John; Warner, Brad W

    2003-05-01

    The maintenance of long-term venous access is critical to the livelihood of children in a variety of clinical situations, especially those who are dependent on parenteral nutrition. Whereas the traditional routes of either peripheral or central venous access are initially adequate, most of these sites eventually succumb to the pitfalls associated with long-term venous access. This review provides a comprehensive and multidisciplinary approach to the management of reoperative venous access with regard to preoperative planning and imaging and specific techniques in interventional radiology and surgery.

  4. Access Interface Strategies

    PubMed Central

    Fager, Susan; Beukelman, David R.; Fried-Oken, Melanie; Jakobs, Tom; Baker, John

    2013-01-01

    Individuals who rely on augmentative and alternative communication (AAC) devices to support their communication often have physical movement challenges that require alternative methods of access. Technology that supports access, particularly for those with the most severe movement deficits, have expanded substantially over the years. The purposes of this article are to review the state of the science of access technologies that interface with augmentative and alternative communication devices and to propose a future research and development agenda that will enhance access options for people with limited movement capability due to developmental and acquired conditions. PMID:22590797

  5. Channel Access in Erlang

    SciTech Connect

    Nicklaus, Dennis J.

    2013-10-13

    We have developed an Erlang language implementation of the Channel Access protocol. Included are low-level functions for encoding and decoding Channel Access protocol network packets as well as higher level functions for monitoring or setting EPICS process variables. This provides access to EPICS process variables for the Fermilab Acnet control system via our Erlang-based front-end architecture without having to interface to C/C++ programs and libraries. Erlang is a functional programming language originally developed for real-time telecommunications applications. Its network programming features and list management functions make it particularly well-suited for the task of managing multiple Channel Access circuits and PV monitors.

  6. Updating realistic access.

    PubMed

    Rossner, Mike

    2010-05-01

    Nearly six years ago Ira Mellman, then Editor-in-Chief of the JCB, published an editorial entitled "Providing realistic access" (1). It described the Journal's efforts to reconcile its subscription-based business model with the goal of providing public access to scholarly journal content. Since then, developments in the public-access movement are bringing us closer to the ideal of universal public access. But will there still be a place for selective journals like the JCB when we achieve that objective? PMID:20375430

  7. AccessAbility @ Cleveland Public Library.

    ERIC Educational Resources Information Center

    Mates, Barbara T.

    2003-01-01

    Describes several programs that were developed by staff at the Cleveland (Ohio) Public Library to be accessible to users with disabilities. Highlights include a Braille reading program; sensory garden; poetry club; book club based on talking books; wheelchair athletics; touching museum artifacts; and a mobile library for users who could not visit…

  8. Staging for vulvar cancer.

    PubMed

    Hacker, Neville F; Barlow, Ellen L

    2015-08-01

    Vulvar cancer has been staged by the International Federation of Gynaecology and Obstetrics (FIGO) since 1969, and the original staging system was based on clinical findings only. This system provided a very good spread of prognostic groupings. Because vulvar cancer is virtually always treated surgically, the status of the lymph nodes is the most important prognostic factor and this can only be determined with certainty by histological examination of resected lymph nodes, FIGO introduced a surgical staging system in 1988. This was modified in 1994 to include a category of microinvasive vulvar cancer (stage IA), because such patients have virtually no risk of lymph node metastases. This system did not give a reasonably even spread of prognostic groupings. In addition, patients with stage III disease were shown to be a heterogeneous group prognostically, and the number of positive nodes and the morphology of those nodes were not taken into account. A new surgical staging system for vulvar cancer was introduced by FIGO in 2009. Initial retrospective analyses have suggested that this new staging system has overcome the major deficiencies in the 1994 system.

  9. Access to Higher Education

    ERIC Educational Resources Information Center

    Briscoe, Felecia; De Oliver, Miguel

    2006-01-01

    This case study researches the degree to which the location and services offered by a multicampus university, geographically situated consistent with the commercial principles of a large mass-market enterprise, facilitate access for educationally underserved groups. First, the necessity of democratizing educational access to an underprivileged…

  10. Accessing the Microform Publication.

    ERIC Educational Resources Information Center

    Schindler, Stan

    1985-01-01

    Characterizes types of indexing programs used by Research Publications, Inc. and describes provision of access to four major projects: "The Official Washington Post Index" (provides access to newspaper and microfilm edition); "The Eighteenth Century"; "The Declassified Documents Reference System" (ongoing fiche project abstracted and indexed…

  11. Planning for Accessibility.

    ERIC Educational Resources Information Center

    Cassell, Marianne Kotch

    This practical manual provides useful, concrete ideas and suggestions to help public libraries make libraries more accessible to persons with disabilities. Most suggestions are for persons who have difficulty with mobility. Reviews of pertinent laws and regulations are followed by concrete, step-by step suggestions for planning for accessibility,…

  12. Intellectual Access to Images.

    ERIC Educational Resources Information Center

    Chen, Hsin-Liang; Rasmussen, Edie M.

    1999-01-01

    The increased availability of digital images is accompanied by a need for solutions to the problems inherent in indexing them for retrieval. Problems in image description and access are discussed, with a perspective on traditional and new solutions. Recent developments in intellectual access to images are surveyed and contrasted with…

  13. Granting Each Equal Access.

    ERIC Educational Resources Information Center

    Walling, Linda Lucas

    1992-01-01

    Summarizes federal legislation regarding equal access for students with disabilities and discusses environmental barriers to accessibility in the library media center. Solutions to these design problems are suggested in the following areas: material formats and space requirements; the physical setting, including furniture, floor coverings,…

  14. Improving School Access Control

    ERIC Educational Resources Information Center

    National Clearinghouse for Educational Facilities, 2008

    2008-01-01

    Few things are more important for school safety and security than controlling access to buildings and grounds. It is relatively easy to incorporate effective access control measures in new school designs but more difficult in existing schools, where most building and site features cannot be readily altered or reconfigured. The National…

  15. Staging Airliner Service

    NASA Technical Reports Server (NTRS)

    Hahn, Andrew S.

    2007-01-01

    There is a general consensus building that historically high fuel prices and greater public awareness of the emissions that result from burning fuel are going to be long-term concerns for those who design, build, and operate airliners. The possibility of saving both fuel and reducing emissions has rekindled interest in breaking very long-range airline flights into multiple stages or even adopting in-flight refueling. It is likely that staging will result in lower fuel burn, and recent published reports have suggested that the savings are substantial, particularly if the airliner is designed from the outset for this kind of operation. Given that staging runs against the design and operation historical trend, this result begs for further attention. This paper will examine the staging question, examining both analytic and numeric performance estimation methodologies to quantify the likely amount of fuel savings that can be expected and the resulting design impacts on the airliner.

  16. Understanding cancer staging

    MedlinePlus

    ... the body. The spread of cancer is called metastasis . Cancer staging is used to help describe the ... cancer has spread to nearby lymph nodes (N) Metastasis (M) , or if and how much the cancer ...

  17. Stages of Pregnancy

    MedlinePlus

    ... your baby in these three stages. First trimester (week 1-week 12) First trimester See how your baby is ... is each pregnancy. Return to top Second trimester (week 13-week 28) Second trimester See how your ...

  18. Cryogenic Propulsion Stage

    NASA Technical Reports Server (NTRS)

    Jones, David

    2011-01-01

    The CPS is an in-space cryogenic propulsive stage based largely on state of the practice design for launch vehicle upper stages. However, unlike conventional propulsive stages, it also contains power generation and thermal control systems to limit the loss of liquid hydrogen and oxygen due to boil-off during extended in-space storage. The CPS provides the necessary (Delta)V for rapid transfer of in-space elements to their destinations or staging points (i.e., E-M L1). The CPS is designed around a block upgrade strategy to provide maximum mission/architecture flexibility. Block 1 CPS: Short duration flight times (hours), passive cryo fluid management. Block 2 CPS: Long duration flight times (days/weeks/months), active and passive cryo fluid management.

  19. Stages of Pancreatic Cancer

    MedlinePlus

    ... cancer) cells form in the tissues of the pancreas. The pancreas is a gland about 6 inches ... spleen , and bile ducts . Tests that examine the pancreas are used to detect (find), diagnose, and stage ...

  20. Radar stage uncertainty

    USGS Publications Warehouse

    Fulford, J.M.; Davies, W.J.

    2005-01-01

    The U.S. Geological Survey is investigating the performance of radars used for stage (or water-level) measurement. This paper presents a comparison of estimated uncertainties and data for radar water-level measurements with float, bubbler, and wire weight water-level measurements. The radar sensor was also temperature-tested in a laboratory. The uncertainty estimates indicate that radar measurements are more accurate than uncorrected pressure sensors at higher water stages, but are less accurate than pressure sensors at low stages. Field data at two sites indicate that radar sensors may have a small negative bias. Comparison of field radar measurements with wire weight measurements found that the radar tends to measure slightly lower values as stage increases. Copyright ASCE 2005.

  1. Precision adjustable stage

    DOEpatents

    Cutburth, Ronald W.; Silva, Leonard L.

    1988-01-01

    An improved mounting stage of the type used for the detection of laser beams is disclosed. A stage center block is mounted on each of two opposite sides by a pair of spaced ball bearing tracks which provide stability as well as simplicity. The use of the spaced ball bearing pairs in conjunction with an adjustment screw which also provides support eliminates extraneous stabilization components and permits maximization of the area of the center block laser transmission hole.

  2. Multiple stage railgun

    DOEpatents

    Hawke, Ronald S.; Scudder, Jonathan K.; Aaland, Kristian

    1982-01-01

    A multiple stage magnetic railgun accelerator (10) for accelerating a projectile (15) by movement of a plasma arc (13) along the rails (11,12). The railgun (10) is divided into a plurality of successive rail stages (10a-n) which are sequentially energized by separate energy sources (14a-n) as the projectile (15) moves through the bore (17) of the railgun (10). Propagation of energy from an energized rail stage back towards the breech end (29) of the railgun (10) can be prevented by connection of the energy sources (14a-n) to the rails (11,12) through isolation diodes (34a-n). Propagation of energy from an energized rail stage back towards the breech end of the railgun can also be prevented by dividing the rails (11,12) into electrically isolated rail sections (11a-n, 12a-n). In such case means (55a-n) are used to extinguish the arc at the end of each energized stage and a fuse (31) or laser device (61) is used to initiate a new plasma arc in the next energized rail stage.

  3. Bioimpedance Spectroscopy in Detecting Lower-Extremity Lymphedema in Patients With Stage I, Stage II, Stage III, or Stage IV Vulvar Cancer Undergoing Surgery and Lymphadenectomy

    ClinicalTrials.gov

    2016-02-09

    Lymphedema; Perioperative/Postoperative Complications; Stage IA Vulvar Cancer; Stage IB Vulvar Cancer; Stage II Vulvar Cancer; Stage IIIA Vulvar Cancer; Stage IIIB Vulvar Cancer; Stage IIIC Vulvar Cancer; Stage IVA Vulvar Cancer; Stage IVB Vulvar Cancer

  4. Role of access surveillance and preemptive intervention.

    PubMed

    Work, Jack

    2011-06-01

    Vascular access dysfunction continues to be a major cause of morbidity and mortality in the end-stage renal patient. Thrombosis is the primary cause of prosthetic arteriovenous access (ie, graft) failure caused by the progressive development of neointimal hyperplasia, which eventually leads to a stenosis, usually at the venous anastomosis. More than 20 years ago, observational studies using a variety of surveillance techniques, coupled with preemptive angioplasty, convincingly demonstrated the ability to detect venous stenosis, and elective treatment of stenoses significantly decreased both thrombosis and access loss. Although multiple observational studies have shown a benefit from surveillance, these studies generally had no control population, used historical controls, or used incorrect statistical analysis. However, five randomized controlled trials that evaluated the effect of graft surveillance coupled with preemptive angioplasty have failed to demonstrate a benefit on graft outcomes, including prolongation of graft survival. This review will examine the role of access surveillance and preemptive angioplasty in achieving the goal of reducing vascular access thrombosis and prolonging access survival.

  5. Chemotherapy Toxicity On Quality of Life in Older Patients With Stage I, Stage II, Stage III, or Stage IV Ovarian Epithelial, Primary Peritoneal Cavity, or Fallopian Tube Cancer

    ClinicalTrials.gov

    2016-02-09

    Stage I Ovarian Cancer; Stage IA Fallopian Tube Cancer; Stage IB Fallopian Tube Cancer; Stage IC Fallopian Tube Cancer; Stage II Ovarian Cancer; Stage IIA Fallopian Tube Cancer; Stage IIB Fallopian Tube Cancer; Stage IIC Fallopian Tube Cancer; Stage III Ovarian Cancer; Stage III Primary Peritoneal Cancer; Stage IIIA Fallopian Tube Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIC Fallopian Tube Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Cancer; Stage IV Primary Peritoneal Cancer

  6. Multiple Access Trade Study

    NASA Technical Reports Server (NTRS)

    Motamedi, Masoud

    1990-01-01

    The Personal Access Satellite System (PASS) strawman design uses a hybrid Time Division Multiple Access (TDMA)/Frequency Division Multiple Access (FDMA) implementation. TDMA is used for the forward direction (from Suppliers to Users), and FDMA for the return direction (from Users to Suppliers). An alternative architecture is proposed that will require minimal real time coordination and yet provide a fast access method by using random access Code Division Multiple Access (CDMA). The CDMA system issues are addressed such as connecting suppliers and users, both of whom may be located anywhere in the CONUS, when the user terminals are constrained in size and weight; and providing efficient traffic routing under highly variable traffic requirements. It is assumed that bandwidth efficiency is not of paramount importance. CDMA or Spread Spectrum Multiple Access (SSMA) communication is a method in which a group of carriers operate at the same nominal center frequency but are separable from each other by the low cross correlation of the spreading codes used. Interference and multipath rejection capability, ease of selective addressing and message screening, low density power spectra for signal hiding and security, and high resolution ranging are among the benefits of spread spectrum communications.

  7. Robot-assisted surgical staging for ovarian cancer in pregnant women.

    PubMed

    Al-Badawi, Ismail A; Al-Aker, Murad; Kurdi, Wesam; Alsubhi, Jamal

    2012-06-01

    The use of the da Vinci Surgical System is becoming popular among surgeons as it allows more control than the standard laparoscopic approach, with comparable benefits and risks. The use of the da Vinci Surgical System during pregnancy was reported earlier and showed to be as safe as laparoscopy. The use of the da Vinci Surgical System in ovarian cancer during pregnancy has not been reported before. To our knowledge, this is the first report of robot-assisted surgical staging for presumed early ovarian cancer. Two women aged 29 and 39 underwent laparotomy for ovarian cystectomy, for presumed benign pathology; the final pathology showed ovarian malignancy. Both patients were referred to a tertiary center and meanwhile became pregnant, and decided to keep the pregnancy. The staging was achieved using robot-assisted surgery in mid-trimester. The use of the da Vinci Surgical System during pregnancy is feasible and safe at mid-trimester. More robot-assisted surgeries during pregnancy will be needed before final recommendations can be made. PMID:27628281

  8. Use of Modified Polysaccharide 4DryField® PH for Adhesion Prevention and Hemostasis in Gynecological Surgery: A Two-Center Observational Study by Second-Look Laparoscopy

    PubMed Central

    Korell, Matthias; Ziegler, Nicole; De Wilde, Rudy Leon

    2016-01-01

    Purpose. This study evaluates both scopes of 4DryField PH, certified for adhesion prevention and hemostasis, in patients undergoing surgery for various and severe gynecological disorders. Methods. This is a two-institutional study. Adhesion prevention efficacy was evaluated using video documentation of first-look laparoscopies (FLL) and second-look laparoscopies (SLL); other patient data were analyzed retrospectively. Twenty patients with various disorders were evaluated, 4 assigned to a uterus pathology, 10 to endometriosis, and 6 to an adhesion disease group. Nine patients received 4DryField primarily for hemostasis and 11 solely for adhesion prevention. Nineteen patients had SLL after 5 to 12 weeks and one after 13 months. Results. At FLL with 4DryField, immediate hemostasis could be achieved in diffuse bleeding. At SLL, effective adhesion prevention was observed in 18 of all 20 women, with only 2 revealing major adhesions. In particular, only 1 of the 6 women with adhesion disease as predominant disorder showed major adhesions at SLL. Conclusions. Modified polysaccharide 4DryField is not only effective in diffuse bleeding. In this cohort with extensive surgery for various gynecological pathologies, 4DryField showed effective adhesion prevention as confirmed at SLL, too. Its use as premixed gel is a convenient variant for treatment of large peritoneal wounds. PMID:26904672

  9. Metadata management staging system

    SciTech Connect

    2013-08-01

    Django application providing a user-interface for building a file and metadata management system. An evolution of our Node.js and CouchDb metadata management system. This one focuses on server functionality and uses a well-documented, rational and REST-ful API for data access.

  10. Optical Access Networks

    NASA Astrophysics Data System (ADS)

    Zheng, Jun; Ansari, Nirwan

    2005-01-01

    Call for Papers: Optical Access Networks

    Guest Editors Jun Zheng, University of Ottawa Nirwan Ansari, New Jersey Institute of Technology

    Submission Deadline: 1 June 2005

    Background

    With the wide deployment of fiber-optic technology over the past two decades, we have witnessed a tremendous growth of bandwidth capacity in the backbone networks of today's telecommunications infrastructure. However, access networks, which cover the "last-mile" areas and serve numerous residential and small business users, have not been scaled up commensurately. The local subscriber lines for telephone and cable television are still using twisted pairs and coaxial cables. Most residential connections to the Internet are still through dial-up modems operating at a low speed on twisted pairs. As the demand for access bandwidth increases with emerging high-bandwidth applications, such as distance learning, high-definition television (HDTV), and video on demand (VoD), the last-mile access networks have become a bandwidth bottleneck in today's telecommunications infrastructure. To ease this bottleneck, it is imperative to provide sufficient bandwidth capacity in the access networks to open the bottleneck and thus present more opportunities for the provisioning of multiservices. Optical access solutions promise huge bandwidth to service providers and low-cost high-bandwidth services to end users and are therefore widely considered the technology of choice for next-generation access networks. To realize the vision of optical access networks, however, many key issues still need to be addressed, such as network architectures, signaling protocols, and implementation standards. The major challenges lie in the fact that an optical solution must be not only robust, scalable, and flexible, but also implemented at a low cost comparable to that of existing access solutions in order to increase the

  11. The Five Stage Cycle Model: An Online Integrated Approach to Teaching Physics

    ERIC Educational Resources Information Center

    Al-arfaj, Maher

    2011-01-01

    The five stage cycle model is an interactive flash platform that proposes a challenging scenario with associated questions about light wave features and correlations. As the students navigate from stage to stage, they are able to access some related resources and engage in small group discussions. The students are able to revisit their responses…

  12. 2-Stage Classification Modeling

    1994-11-01

    CIRCUIT2.4 is used to design optimum two-stage classification configurations and operating conditions for energy conservation. It permits simulation of five basic grinding-classification circuits, including one single-stage and four two-stage classification arrangements. Hydrocyclones, spiral classifiers, and sieve band screens can be simulated, and the user may choose the combination of devices for the flowsheet simulation. In addition, the user may select from four classification modeling methods to achieve the goals of a simulation project using themore » most familiar concepts. Circuit performance is modeled based on classification parameters or equipment operating conditions. A modular approach was taken in designing the program, which allows future addition of other models with relatively minor changes.« less

  13. 2-Stage Classification Modeling

    SciTech Connect

    Baltich, L. K.

    1994-11-01

    CIRCUIT2.4 is used to design optimum two-stage classification configurations and operating conditions for energy conservation. It permits simulation of five basic grinding-classification circuits, including one single-stage and four two-stage classification arrangements. Hydrocyclones, spiral classifiers, and sieve band screens can be simulated, and the user may choose the combination of devices for the flowsheet simulation. In addition, the user may select from four classification modeling methods to achieve the goals of a simulation project using the most familiar concepts. Circuit performance is modeled based on classification parameters or equipment operating conditions. A modular approach was taken in designing the program, which allows future addition of other models with relatively minor changes.

  14. Critical Access Hospitals (CAH)

    MedlinePlus

    ... CAH Conditions of Participation . What are the location requirements for CAH status? Critical Access Hospitals must be ... clinic that does not meet the CAH distance requirements? As of January 1, 2008, all CAHs, including ...

  15. HRP Data Accessibility 2009

    NASA Video Gallery

    Dr. Clarence Sams spoke at the 2009 Human Research Program's Investigators Workshop on the current status of Data Accessibility. In this presentation he discusses the content of the Human Life Scie...

  16. Accessibility and assistive products

    PubMed Central

    Rodríguez-Porrero, Cristina

    2009-01-01

    Introduction Accessibility and assistive products and technologies are needed to ensure the rights of persons with disabilities and older persons. Many developments have been implemented in laws, standards, markets and from the consumers perspective, at international, European and national levels. The real issue is that not all the potential users benefit from the use of assistive products or accessible measures. Discussion Innovative methods are needed to allow all potential users to have real advantage of assistive technologies and accessible and design for all facilities. Best practices will be presented and existing gaps and recommendations will be discussed. Cost-benefits aspects will also be presented. Conclusion In order to get advantages from opportunities of globalization, hard work and responsibilities of all stakeholders are needed, so that assistive products and accessibility reach a whole range of situations and environments and contribute to ensure quality of life in a society for all.

  17. Extra- and intrathoracic access.

    PubMed

    Lazarides, Miltos K; Georgakarakos, Efstratios I; Schoretsanitis, Nikolaos

    2014-01-01

    The most complex patients requiring vascular access are those with bilateral central vein occlusions. Endovascular repair of the central lesions when feasible allow upper extremity use for access. When endovascular repair is not feasible, femoral vein transposition should be the next choice. When lower limb access sites have been exhausted or are contraindicated as in obese patients and in patients with peripheral arterial obstructive disease, a range of extrathoracic "exotic" extra-anatomic access procedures as the necklace cross-chest arteriovenous (AV) grafts, the ipsilateral axillo-axillary loops, the brachial-jugular AV grafts, the axillo-femoral AV grafts or even intra-thoracic ones as the right atrial AV bypasses represent the vascular surgeon's last resort. The selection among those extra-anatomical chest-wall procedures should be based upon each patient's anatomy or patient-specific factors. PMID:24817469

  18. Remote Access Astronomy.

    ERIC Educational Resources Information Center

    O'Connor, Erin

    1994-01-01

    Describes the Remote Access Astronomy Project, a computerized optical telescope and dial-in data distribution system that places high-quality images and image processing techniques into computer workstations in junior and high school classrooms. (PR)

  19. Staging of prostate cancer.

    PubMed

    Cheng, Liang; Montironi, Rodolfo; Bostwick, David G; Lopez-Beltran, Antonio; Berney, Daniel M

    2012-01-01

    Prostatic carcinoma (PCa) is a significant cause of cancer morbidity and mortality worldwide. Accurate staging is critical for prognosis assessment and treatment planning for PCa. Despite the large volume of clinical activity and research, the challenge to define the most appropriate and clinically relevant staging system remains. The pathologically complex and uncertain clinical course of prostate cancer further complicates the design of staging classification and a substaging system suitable for individualized care. This review will focus on recent progress and controversial issues related to prostate cancer staging. The 2010 revision of the American Joint Committee on Cancer/Union Internationale Contre le Cancer (AJCC/UICC) tumour, node and metastasis (TNM) system is the most widely used staging system at this time. Despite general acceptance of the system as a whole, there is controversy and uncertainty about its application, particularly for T2 subclassification. The three-tiered T2 classification system for organ-confined prostate cancer is superfluous, considering the biology and anatomy of PCa. A tumour size-based substaging system may be considered in the future TNM subclassification of pT2 cancer. Lymph node status is one of the most important prognostic factors for prostate cancer. Nevertheless, clinical outcomes in patients with positive lymph nodes are variable. Identification of patients at the greatest risk of systemic progression helps in the selection of appropriate therapy. The data suggest that the inherent aggressiveness of metastatic prostate cancer is closely linked to the tumour volume of lymph node metastasis. We recommend that a future TNM staging system should consider subclassification of node-positive cancer on the basis of nodal cancer volume, using the diameter of the largest nodal metastasis and/or the number of positive nodes.

  20. Staging of prostate cancer.

    PubMed

    Cheng, Liang; Montironi, Rodolfo; Bostwick, David G; Lopez-Beltran, Antonio; Berney, Daniel M

    2012-01-01

    Prostatic carcinoma (PCa) is a significant cause of cancer morbidity and mortality worldwide. Accurate staging is critical for prognosis assessment and treatment planning for PCa. Despite the large volume of clinical activity and research, the challenge to define the most appropriate and clinically relevant staging system remains. The pathologically complex and uncertain clinical course of prostate cancer further complicates the design of staging classification and a substaging system suitable for individualized care. This review will focus on recent progress and controversial issues related to prostate cancer staging. The 2010 revision of the American Joint Committee on Cancer/Union Internationale Contre le Cancer (AJCC/UICC) tumour, node and metastasis (TNM) system is the most widely used staging system at this time. Despite general acceptance of the system as a whole, there is controversy and uncertainty about its application, particularly for T2 subclassification. The three-tiered T2 classification system for organ-confined prostate cancer is superfluous, considering the biology and anatomy of PCa. A tumour size-based substaging system may be considered in the future TNM subclassification of pT2 cancer. Lymph node status is one of the most important prognostic factors for prostate cancer. Nevertheless, clinical outcomes in patients with positive lymph nodes are variable. Identification of patients at the greatest risk of systemic progression helps in the selection of appropriate therapy. The data suggest that the inherent aggressiveness of metastatic prostate cancer is closely linked to the tumour volume of lymph node metastasis. We recommend that a future TNM staging system should consider subclassification of node-positive cancer on the basis of nodal cancer volume, using the diameter of the largest nodal metastasis and/or the number of positive nodes. PMID:22212080

  1. Adapting Web Browsers for Accessibility.

    ERIC Educational Resources Information Center

    Hendrix, Paul; Birkmire, Mike

    This paper examines ways to make World Wide Web browsers accessible for individuals with disabilities, and through them, gain access to the information on the Web. It discusses which browsers can be made more accessible and evaluates different types of input. Mouse access, keyboard access, and voice input are reviewed. Processing aids, such as…

  2. Mobile multiple access study

    NASA Technical Reports Server (NTRS)

    1977-01-01

    Multiple access techniques (FDMA, CDMA, TDMA) for the mobile user and attempts to identify the current best technique are discussed. Traffic loading is considered as well as voice and data modulation and spacecraft and system design. Emphasis is placed on developing mobile terminal cost estimates for the selected design. In addition, design examples are presented for the alternative techniques of multiple access in order to compare with the selected technique.

  3. Stage cementing apparatus

    SciTech Connect

    Blamford, D.M.; Easter, J.H.

    1988-06-21

    A stage cementing apparatus for selectively passing cement from the interior passage of a casing to the annulus between the exterior of the casing and borehole, the casing having an upper portion and a lower portion, is described comprising: a barrel secured to the upper portion of the casing; a mandrel secured to the lower portion of the casing, and a stage cementing tool having a generally cylindrical configuration adapted for attachment to the lower end of the barrel about a portion of the mandrel.

  4. Staged fluidized bed

    DOEpatents

    Mallon, R.G.

    1983-05-13

    The invention relates to oil shale retorting and more particularly to staged fluidized bed oil shale retorting. Method and apparatus are disclosed for narrowing the distribution of residence times of any size particle and equalizing the residence times of large and small particles in fluidized beds. Particles are moved up one fluidized column and down a second fluidized column with the relative heights selected to equalize residence times of large and small particles. Additional pairs of columns are staged to narrow the distribution of residence times and provide complete processing of the material.

  5. Access to health care

    PubMed Central

    Fortin, Martin; Maltais, Danielle; Hudon, Catherine; Lapointe, Lise; Ntetu, Antoine Lutumba

    2005-01-01

    OBJECTIVE To explore access to health care for patients presenting with multiple chronic conditions and to identify barriers and factors conducive to access. DESIGN Qualitative study with focus groups. SETTING Family practice unit in Chicoutimi (Saguenay), Que. PARTICIPANTS Twenty-five male and female adult patients with at least four chronic conditions but no cognitive disorders or decompensating conditions. METHODS For this pilot study, only three focus group discussions were held. MAIN FINDINGS The main barriers to accessing follow-up appointments included long waits on the telephone, automated telephone-answering systems, and needing to attend at specific times to obtain appointments. The main barriers to specialized care were long waiting times and the need to get prescriptions and referrals from family physicians. Factors reported conducive to access included systematic callbacks and the personal involvement of family physicians. Good communication between family physicians and specialists was also perceived to be an important factor in access. CONCLUSION Systematic callbacks, family physicians’ personal efforts to obtain follow-up visits, and better physician-specialist communication were all suggested as ways to improve access to care for patients with multiple chronic conditions. PMID:16926944

  6. Vascular Access in Children

    SciTech Connect

    Krishnamurthy, Ganesh Keller, Marc S.

    2011-02-15

    Establishment of stable vascular access is one of the essential and most challenging procedures in a pediatric hospital. Many clinical specialties provide vascular service in a pediatric hospital. At the top of the 'expert procedural pyramid' is the pediatric interventional radiologist, who is best suited and trained to deliver this service. Growing awareness regarding the safety and high success rate of vascular access using image guidance has led to increased demand from clinicians to provide around-the-clock vascular access service by pediatric interventional radiologists. Hence, the success of a vascular access program, with the pediatric interventional radiologist as the key provider, is challenging, and a coordinated multidisciplinary team effort is essential for success. However, there are few dedicated pediatric interventional radiologists across the globe, and also only a couple of training programs exist for pediatric interventions. This article gives an overview of the technical aspects of pediatric vascular access and provides useful tips for obtaining vascular access in children safely and successfully using image guidance.

  7. ANALYSIS OF STANDARD MULTI-PORT VS. SINGLE SITE ACCESS FOR LAPAROSCOPIC SKILLS TRAINING

    PubMed Central

    Cox, Daniel R; Zeng, Wenjing; Frisella, Margaret M; Brunt, L. Michael

    2015-01-01

    Introduction Single site access (SSA) laparoscopy is more challenging to perform than multi-port(MP) laparoscopy. We examined MP versus SSA skills training on laparoscopic performance in surgically naive individuals. Methods Forty end-of-1st year medical students were randomized into two groups. Both were trained on 4 basic laparoscopic drills (peg, rope, bean drop, pattern cutting) using a standard MP setup (Group 1) or SSA approach (Group 2). Time to proficiency and number of repetitions (reps) were recorded. Each group then crossed over to the alternate approach where the sequence was repeated. Data are mean ± SD and statistical analysis was with two-tailed, unpaired t-test. Results Total times to proficiency for the SSA and MP approaches was not significantly different between groups (Group 1 M-P 234.0 ± 114.9 min vs Group 2 SSA 216.4 ± 106.5 min, p=0.67). The MP-trained group took less time to reach proficiency on the standard MP setup than the SSA group on the SSA approach (119.1 ± 69.7 min vs 178.0 ± 93.4 min, p=0.058) with significantly fewer repetitions (77.6 ± 42.6 vs. 118.8 ± 54.3, p=0.027). The SSA-trained group took significantly less time to reach proficiency on the MP setup than the standard MP-trained group (38.4 ± 29.4 min vs. 119.1 ± 69.7 min; p=0.0013) requiring only a mean of 26.9 total repetitions. When the standard MP group crossed over to the SSA setup, they took significantly less time to reach proficiency with the SSA approach than the SSA-trained group (114.8 ± 50.5 min vs. 178.0 ± 93.4 min, p=0.026) but with more total repetitions than with the M-P approach (86.2 ± 35.2 vs 77.6 ± 42.6, p= NS). Conclusions Laparoscopic single site access skills training results in longer times and more repetitions to achieve proficiency than multi-port training, but the skills acquired transfer well to the multi-port approach. PMID:20872019

  8. Crescentic ramp turbine stage

    NASA Technical Reports Server (NTRS)

    Lee, Ching-Pang (Inventor); Tam, Anna (Inventor); Kirtley, Kevin Richard (Inventor); Lamson, Scott Henry (Inventor)

    2007-01-01

    A turbine stage includes a row of airfoils joined to corresponding platforms to define flow passages therebetween. Each airfoil includes opposite pressure and suction sides and extends in chord between opposite leading and trailing edges. Each platform includes a crescentic ramp increasing in height from the leading and trailing edges toward the midchord of the airfoil along the pressure side thereof.

  9. Pancreatic Cancer Stage 4

    MedlinePlus

    ... lung, liver, and peritoneal cavity. An inset shows cancer cells spreading from the pancreas, through the blood and lymph system, to another ... abdomen that contains the intestines, stomach, and liver). Cancer may also have spread to ... pancreas or to lymph nodes. Stage IV pancreatic cancer. ...

  10. Stage a Water Show

    ERIC Educational Resources Information Center

    Frasier, Debra

    2008-01-01

    In the author's book titled "The Incredible Water Show," the characters from "Miss Alaineus: A Vocabulary Disaster" used an ocean of information to stage an inventive performance about the water cycle. In this article, the author relates how she turned the story into hands-on science teaching for real-life fifth-grade students. The author also…

  11. STS upper stage operations

    NASA Technical Reports Server (NTRS)

    Kitchens, M. D.; Schnyer, A. D.

    1977-01-01

    Several design/development and operational approaches for STS upper stages are being pursued to realize maximum operational and economic benefits upon the introduction of the STS in the 1980s. The paper focuses special attention on safety operations, launch site operations and on-orbit operations.

  12. End-Stage.

    ERIC Educational Resources Information Center

    Moua, Mai Neng

    2001-01-01

    Through her reflections on dealing with dialysis for end-stage renal disease and awaiting a kidney transplant, the author presents insights into how her experience was shaped by the physical, emotional, and multicultural forces she faced. Among the issues discussed are her ambivalent feelings between pursuing a regular lifestyle and receiving…

  13. Electrocardiograph abnormalities revealed during laparoscopy.

    PubMed

    Nijjer, Sukhjinder; Dubrey, Simon William

    2010-01-01

    This brief case presents a well patient in whom an electrocardiograph abnormality consistent with an accessory pathway was found during a routine procedure. We present the electrocardiographs, explain the underlying condition, and consider why the abnormality was revealed in this manner.

  14. MICE Staging and Status

    NASA Astrophysics Data System (ADS)

    Hanlet, Pierrick

    2010-03-01

    Ionization cooling will be a key technique for a high-intensity Neutrino Factory or Muon Collider. The Muon Ionization Cooling Experiment (MICE) is a high-precision, staged accelerator experiment being performed at Rutherford Appleton Laboratory in the UK. Its goal is the first demonstration, with 0.1% resolution, of the feasibility of reducing the transverse emittance of a beam of muons by ionization cooling in low-Z absorbers. MICE is being staged in the following steps: I. Creating and characterizing a beam of muons; II. Measuring their emittance; III. Systematic comparison of successive measurements; IV. Inserting absorber; V. Reaccelerating longitudinally; and VI. Complete "10%-cooling" test. Step I is currently in progress with Step II to commence next year; completion of Step VI is anticipated in ˜2012.

  15. Saturn IB Second Stage (S-IVB Stage)

    NASA Technical Reports Server (NTRS)

    1968-01-01

    This cutaway drawing shows the S-IVB stage in its Saturn IB configuration. As a part of the Marshall Space Flight Center's (MSFC) 'building block' approach to the Saturn development, the S-IVB stage was utilized in the Saturn IB launch vehicle as a second stage and, later, the Saturn V launch vehicle as a third stage. The stage was powered by a single J-2 engine, initially capable of 200,000 pounds of thrust.

  16. Staged Event Architecture

    SciTech Connect

    Hoschek, Wolfgang; Berket, Karlo

    2005-05-30

    Sea is a framework for a Staged Event Architecture, designed around non-blocking asynchronous communication facilities that are decoupled from the threading model chosen by any given application, Components for P networking and in-memory communication are provided. The Sea Java library encapsulates these concepts. Sea is used to easily build efficient and flexible low-level network clients and servers, and in particular as a basic communication substrate for Peer-to-Peer applications.

  17. Treatment of Early Stage Endometrial Cancer by Transumbilical Laparoendoscopic Single-Site Surgery Versus Traditional Laparoscopic Surgery

    PubMed Central

    Cai, Hui-hua; Liu, Mu-biao; He, Yuan-li

    2016-01-01

    Abstract To compare the outcomes of transumbilical laparoendoscopic single-site surgery (TU-LESS) versus traditional laparoscopic surgery (TLS) for early stage endometrial cancer (EC). We retrospectively reviewed the medical records of patients with early stage EC who were surgically treated by TU-LESS or TLS between 2011 and 2014 in a tertiary care teaching hospital. We identified 18 EC patients who underwent TU-LESS. Propensity score matching was used to match this group with 18 EC patients who underwent TLS. All patients underwent laparoscopic-assisted vaginal hysterectomy, bilateral salpingo-oophorectomy, and systematic pelvic lymphadenectomy by TU-LESS or TLS without conversion to laparoscopy or laparotomy. Number of pelvic lymph nodes retrieved, operative time and estimated blood loss were comparable between 2 groups. Satisfaction values of the cosmetic outcome evaluated by the patient at day 30 after surgery were significantly higher in TU-LESS group than that in TLS group (9.6 ± 0.8 vs 7.5 ± 0.7, P < 0.001), while there was no statistical difference in postoperative complications within 30 days after surgery, postoperative hospital stay, and hospital cost. For the surgical management of early stage EC, TU-LESS may be a feasible alternative approach to TLS, with comparable short-term surgical outcomes and superior cosmetic outcome. Future large-scale prospective studies are needed to identify these benefits. PMID:27057851

  18. Staged depressurization system

    DOEpatents

    Schulz, T.L.

    1993-11-02

    A nuclear reactor having a reactor vessel disposed in a containment shell is depressurized in stages using depressurizer valves coupled in fluid communication with the coolant circuit. At least one sparger submerged in the in-containment refueling water storage tank which can be drained into the containment sump communicates between one or more of the valves and an inside of the containment shell. The depressurizer valves are opened in stages, preferably at progressively lower coolant levels and for opening progressively larger flowpaths to effect depressurization through a number of the valves in parallel. The valves can be associated with a pressurizer tank in the containment shell, coupled to a coolant outlet of the reactor. At least one depressurization valve stage openable at a lowest pressure is coupled directly between the coolant circuit and the containment shell. The reactor is disposed in the open sump in the containment shell, and a further valve couples the open sump to a conduit coupling the refueling water storage tank to the coolant circuit for adding water to the coolant circuit, whereby water in the containment shell can be added to the reactor from the open sump. 4 figures.

  19. Staged depressurization system

    DOEpatents

    Schulz, Terry L.

    1993-01-01

    A nuclear reactor having a reactor vessel disposed in a containment shell is depressurized in stages using depressurizer valves coupled in fluid communication with the coolant circuit. At least one sparger submerged in the in-containment refueling water storage tank which can be drained into the containment sump communicates between one or more of the valves and an inside of the containment shell. The depressurizer valves are opened in stages, preferably at progressively lower coolant levels and for opening progressively larger flowpaths to effect depressurization through a number of the valves in parallel. The valves can be associated with a pressurizer tank in the containment shell, coupled to a coolant outlet of the reactor. At least one depressurization valve stage openable at a lowest pressure is coupled directly between the coolant circuit and the containment shell. The reactor is disposed in the open sump in the containment shell, and a further valve couples the open sump to a conduit coupling the refueling water storage tank to the coolant circuit for adding water to the coolant circuit, whereby water in the containment shell can be added to the reactor from the open sump.

  20. Nutraceutical use in late-stage cancer

    PubMed Central

    Morris, Jay; Brown, Vondina; Ellis, Jane; Logothetis, Britt; Weber, Rebecca

    2012-01-01

    Access to a wealth of information on the internet has led many cancer patients to use complementary methods as an adjunct to traditional therapy for cancer, with, and more often, without informing their primary caregiver. Of the common complementary modalities, the use of dietary supplements appears to be highly prevalent in patients in active treatment for cancer, and later in cancer survivors. Emerging research suggests that some plant-based agents may, indeed, impact late-stage cancer, influencing molecular processes corrupted by tumor cells to evade detection, expand clonally, and invade surrounding tissues. The intent of this article is to review some of the current science underpinning the use of nutraceuticals in the latter stages of cancer. PMID:20714787

  1. Staged cascade fluidized bed combustor

    DOEpatents

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

    1984-01-01

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

  2. Flexible transbronchial needle aspiration for staging of bronchogenic carcinoma.

    PubMed

    Wang, K P; Brower, R; Haponik, E F; Siegelman, S

    1983-11-01

    Flexible transbronchial needle aspiration (TBNA) provides access to mediastinal lymph nodes, but its role in staging bronchogenic carcinoma is unknown. To determine the efficacy and safety of this procedure for staging the extent of mediastinal disease, the results of TBNA performed during fiberoptic bronchoscopy in 39 patients without known extrathoracic metastases were reviewed. Flexible TBNA was found to be a safe, effective method for determining the presence or absence of mediastinal metastases from bronchogenic carcinoma. Furthermore, TBNA results compare favorably with roentgenographic staging techniques, with the added advantage of providing cytopathologic information. PMID:6313305

  3. Managing Information Resources for Accessibility.

    ERIC Educational Resources Information Center

    General Services Administration, Washington, DC. Clearinghouse on Computer Accommodation.

    This handbook presents guidance for federal managers and other personnel who are unfamiliar with the policy and practice of information accessibility to accommodate users with disabilities and to provide for their effective access to information resources. It addresses federal requirements for accessibility, adopting accessibility as a sound…

  4. Digital Scholarship and Open Access

    ERIC Educational Resources Information Center

    Losoff, Barbara; Pence, Harry E.

    2010-01-01

    Open access publications provide scholars with unrestricted access to the "conversation" that is the basis for the advancement of knowledge. The large number of open access journals, archives, and depositories already in existence demonstrates the technical and economic viability of providing unrestricted access to the literature that is the…

  5. Steps Toward Campus Accessibility.

    ERIC Educational Resources Information Center

    Association of Physical Plant Administrators of Universities and Colleges, Washington, DC.

    Photo-essays focus on the progress colleges and universities have made in achieving program accessibility for handicapped persons in compliance with Section 504 of the Rehabilitation Act of 1973. Both common problems and innovative solutions to unique problems are included. "People We Never See" introduces the challenge higher education faces to…

  6. ACCESS Project: Final Report

    SciTech Connect

    Weller, Heiko

    2015-04-01

    The ACCESS project addressed the development, testing, and demonstration of the proposed advanced technologies and the associated emission and fuel economy improvement at an engine dynamometer and on a full-scale vehicle. Improve fuel economy by 25% with minimum performance penalties Achieve SULEV level emissions with gasoline Demonstrate multi-mode combustion engine management system

  7. Managing access block.

    PubMed

    Cameron, Peter; Scown, Paul; Campbell, Donald

    2002-01-01

    There is pessimism regarding the ability of the Acute Health Sector to manage access block for emergency and elective patients. Melbourne Health suffered an acute bed crisis in 2001 resulting in record ambulance diversions and emergency department (ED) delays. We conducted an observational study to reduce access block for emergency patients whilst maintaining elective throughput at Melbourne Health. This involved a clinician-led taskforce using previously proven principles for organisational change to implement 51 actions to improve patient access over a three-month period. The primary outcome measures were ambulance diversion, emergency patients waiting more than 12 hours for an inpatient bed, elective throughput and theatre cancellations. Despite a reduction in multi-day bed numbers all primary objectives were met, ambulance diversion decreased to minimal levels, 12-hour waits decreased by 40% and elective throughput was maintained. Theatre cancellations were also minimised. We conclude that access block can be improved by clinician-led implementation of proven process improvements over a short time frame. The ability to sustain change over the longer term requires further study.

  8. Partners: Promoting Accessible Recreation.

    ERIC Educational Resources Information Center

    Sable, Janet; Gravink, Jill

    1995-01-01

    The Promoting Accessible Recreation through Networking, Education, Resources and Services (PARTNERS) Project, a partnership between Northeast Passage, the University of New Hampshire, and Granite State Independent Living Foundation, helps create barrier-free recreation for individuals with physical disabilities. The paper describes PARTNERS and…

  9. Internet 2 Access Grid.

    ERIC Educational Resources Information Center

    Simco, Greg

    2002-01-01

    Discussion of the Internet 2 Initiative, which is based on collaboration among universities, businesses, and government, focuses on the Access Grid, a Computational Grid that includes interactive multimedia within high-speed networks to provide resources to enable remote collaboration among the research community. (Author/LRW)

  10. Accessibility Standards, Illustrated.

    ERIC Educational Resources Information Center

    Jones, Michael A.

    The book sets forth Illinois environmental accessibility standards for disabled persons based on observation and interview data. Photographs, drawings, and detailed floor plans are included in sections dealing with human data (including space requirements for maneuvering wheelchairs, color blindness, incontinence, and severe auditory or visual…

  11. College Access Marketing

    ERIC Educational Resources Information Center

    Tremblay, Christopher W.

    2011-01-01

    College Access Marketing (CAM) is a relatively new phenomenon that seeks to positively influence the college-going rate. This report defines CAM, describes CAM examples, and discusses how CAM seeks to counter barriers to college. It explores four main elements of CAM: information, marketing, advocacy, and social mobilization. Further, it…

  12. Serving up Access

    ERIC Educational Resources Information Center

    Rich, Sarah

    2011-01-01

    When low-income students returned to Chicago public schools this fall, many had better access to technology, thanks to a public-private partnership. Chicago families with children enrolled in the National School Lunch Program are eligible for subsidized computers and Internet connections through an agreement between the city and telecom giant…

  13. Unique Access to Learning

    ERIC Educational Resources Information Center

    Goble, Don

    2009-01-01

    This article describes the many learning opportunities that broadcast technology students at Ladue Horton Watkins High School in St. Louis, Missouri, experience because of their unique access to technology and methods of learning. Through scaffolding, stepladder techniques, and trial by fire, students learn to produce multiple television programs,…

  14. CAS. Controlled Access Security

    SciTech Connect

    Martinez, B.; Pomeroy, G.

    1989-12-01

    The Security Alarm System is a data acquisition and control system which collects data from intrusion sensors and displays the information in a real-time environment for operators. The Access Control System monitors and controls the movement of personnel with the use of card readers and biometrics hand readers.

  15. Fixed Access Network Sharing

    NASA Astrophysics Data System (ADS)

    Cornaglia, Bruno; Young, Gavin; Marchetta, Antonio

    2015-12-01

    Fixed broadband network deployments are moving inexorably to the use of Next Generation Access (NGA) technologies and architectures. These NGA deployments involve building fiber infrastructure increasingly closer to the customer in order to increase the proportion of fiber on the customer's access connection (Fibre-To-The-Home/Building/Door/Cabinet… i.e. FTTx). This increases the speed of services that can be sold and will be increasingly required to meet the demands of new generations of video services as we evolve from HDTV to "Ultra-HD TV" with 4k and 8k lines of video resolution. However, building fiber access networks is a costly endeavor. It requires significant capital in order to cover any significant geographic coverage. Hence many companies are forming partnerships and joint-ventures in order to share the NGA network construction costs. One form of such a partnership involves two companies agreeing to each build to cover a certain geographic area and then "cross-selling" NGA products to each other in order to access customers within their partner's footprint (NGA coverage area). This is tantamount to a bi-lateral wholesale partnership. The concept of Fixed Access Network Sharing (FANS) is to address the possibility of sharing infrastructure with a high degree of flexibility for all network operators involved. By providing greater configuration control over the NGA network infrastructure, the service provider has a greater ability to define the network and hence to define their product capabilities at the active layer. This gives the service provider partners greater product development autonomy plus the ability to differentiate from each other at the active network layer.

  16. Open access intrapartum CTG database

    PubMed Central

    2014-01-01

    Background Cardiotocography (CTG) is a monitoring of fetal heart rate and uterine contractions. Since 1960 it is routinely used by obstetricians to assess fetal well-being. Many attempts to introduce methods of automatic signal processing and evaluation have appeared during the last 20 years, however still no significant progress similar to that in the domain of adult heart rate variability, where open access databases are available (e.g. MIT-BIH), is visible. Based on a thorough review of the relevant publications, presented in this paper, the shortcomings of the current state are obvious. A lack of common ground for clinicians and technicians in the field hinders clinically usable progress. Our open access database of digital intrapartum cardiotocographic recordings aims to change that. Description The intrapartum CTG database consists in total of 552 intrapartum recordings, which were acquired between April 2010 and August 2012 at the obstetrics ward of the University Hospital in Brno, Czech Republic. All recordings were stored in electronic form in the OB TraceVue®;system. The recordings were selected from 9164 intrapartum recordings with clinical as well as technical considerations in mind. All recordings are at most 90 minutes long and start a maximum of 90 minutes before delivery. The time relation of CTG to delivery is known as well as the length of the second stage of labor which does not exceed 30 minutes. The majority of recordings (all but 46 cesarean sections) is – on purpose – from vaginal deliveries. All recordings have available biochemical markers as well as some more general clinical features. Full description of the database and reasoning behind selection of the parameters is presented in the paper. Conclusion A new open-access CTG database is introduced which should give the research community common ground for comparison of results on reasonably large database. We anticipate that after reading the paper, the reader will understand the

  17. Dual stage check valve

    NASA Technical Reports Server (NTRS)

    Whitten, D. E. (Inventor)

    1973-01-01

    A dual stage seat valve head arrangement is described which consists of a primary sealing point located between a fixed orifice seat and a valve poppet, and a secondary sealing point between an orifice poppet and a valve poppet. Upstream of the valve orifice is a flexible, convoluted metal diaphragm attached to the orifice poppet. Downstream of the valve orifice, a finger spring exerts a force against the valve poppet, tending to keep the valve in a closed position. The series arrangement of a double seat and poppet is able to tolerate small particle contamination while minimizing chatter by controlling throttling or metering across the secondary seat, thus preserving the primary sealing surface.

  18. Nuclear Cryogenic Propulsion Stage

    NASA Technical Reports Server (NTRS)

    Houts, Michael G.; Borowski, S. K.; George, J. A.; Kim, T.; Emrich, W. J.; Hickman, R. R.; Broadway, J. W.; Gerrish, H. P.; Adams, R. B.

    2012-01-01

    The fundamental capability of Nuclear Thermal Propulsion (NTP) is game changing for space exploration. A first generation Nuclear Cryogenic Propulsion Stage (NCPS) based on NTP could provide high thrust at a specific impulse above 900 s, roughly double that of state of the art chemical engines. Characteristics of fission and NTP indicate that useful first generation systems will provide a foundation for future systems with extremely high performance. The role of the NCPS in the development of advanced nuclear propulsion systems could be analogous to the role of the DC-3 in the development of advanced aviation. Progress made under the NCPS project could help enable both advanced NTP and advanced NEP.

  19. Chimpanzee sleep stages.

    NASA Technical Reports Server (NTRS)

    Freemon, F. R.; Mcnew, J. J.; Adey, W. R.

    1971-01-01

    The electroencephalogram and electro-oculogram of two unrestrained juvenile chimpanzees was monitored for 7 consecutive nights using telemetry methods. Of the sleeping time, 23% was spent in the rapid eye movement of REM type of sleep, whereas 8, 4, 15, and 10% were spent in non-REM stages 1 through 4, respectively. Seven to nine periods of REM sleep occurred per night. The average time from the beginning of one REM period to the beginning of the next was approximately 85 min.

  20. Two stages splicing system

    NASA Astrophysics Data System (ADS)

    Mudaber, Mohammad Hassan; Yusof, Yuhani

    2015-05-01

    The study of the biological process of deoxyribonucleic acid (DNA) splicing system in a translucent approach was investigated in 2012 by Yusof under the framework of formal language theory. In this work, the concepts of splicing system in two stages as well as splicing languages are mathematically and biologically discussed. Additionally, some theorems based on recognition site factor of initial strings at the existence of two initial strings and two rules are provided via Yusof-Goode (Y-G) approach. Besides, an example is also given in showing the biological meaning of the introduced concept.

  1. Accessing FMS Functionality: The Impact of Design on Learning

    NASA Technical Reports Server (NTRS)

    Fennell, Karl; Sherry, Lance; Roberts, Ralph, Jr.

    2004-01-01

    In modern commercial and military aircraft, the Flight Management System (FMS) lies at the heart of the functionality of the airplane. The nature of the FMS has also caused great difficulties learning and accessing this functionality. This study examines actual Air Force pilots who were qualified on the newly introduced advanced FMS and shows that the design of the system itself is a primary source of difficulty learning the system. Twenty representative tasks were selected which the pilots could be expected to accomplish on an ' actual flight. These tasks were analyzed using the RAFIV stage model (Sherry, Polson, et al. 2002). This analysis demonstrates that a great burden is placed on remembering complex reformulation of the task to function mapping. 65% of the tasks required retaining one access steps in memory to accomplish the task, 20% required two memorized access steps, and 15% required zero memorized access steps. The probability that a participant would make an access error on the tasks was: two memorized access steps - 74%, one memorized access step - 13%, and zero memorized access steps - 6%. Other factors were analyzed as well, including experience with the system and frequency of use. This completed the picture of a system with many memorized steps causing difficulty with the new system, especially when trying to fine where to access the correct function.

  2. Vascular access creation and care should be provided by nephrologists.

    PubMed

    Malovrh, Marko

    2015-01-01

    The long-term survival and quality of life of patients on hemodialysis is dependent on the adequacy of dialysis via an appropriately placed vascular access. Recent clinical practice guidelines recommend the creation of native arteriovenous fistula or synthetic graft before start of chronic hemodialysis therapy to prevent the need for complication-prone dialysis catheters. The direct involvement of nephrologists in the management of referral patterns, predialysis follow-up, policy of venous preservation, preoperative evaluation, vascular access surgery and vascular access care seems to be important and productive targets for the quality of care delivered to the patients with end-stage renal disease. Early referral to nephrologists is important for delay progression of both kidney disease and its complications by specific and adequate treatment, for education program which should include modification of lifestyle, medication management, selection of treatment modality and instruction for vein preservation and vascular access. Nephrologists are responsible for on-time placement and adequate maturation of vascular access. The number of nephrologists around the world who create their own fistulas and grafts is growing, driven by a need for better patient outcomes on hemodialysis. Nephrologists have also a key role for care of vascular access during hemodialysis treatment by following vascular access function using clinical data, physical examination and additional ultrasound evaluation. Timely detection of malfunctioning vascular access means timely surgical or radiological intervention and increases the survival of vascular access. PMID:25751545

  3. Changes in Brain Function in Patients With Stage I, Stage II, Stage III, or Stage IV Ovarian, Primary Peritoneal, or Fallopian Tube Cancer Who Are Receiving Chemotherapy

    ClinicalTrials.gov

    2016-10-26

    Cognitive Side Effects of Cancer Therapy; Malignant Ovarian Epithelial Tumor; Ovarian Brenner Tumor; Ovarian Carcinosarcoma; Ovarian Choriocarcinoma; Ovarian Clear Cell Cystadenocarcinoma; Ovarian Dysgerminoma; Ovarian Embryonal Carcinoma; Ovarian Endometrioid Adenocarcinoma; Ovarian Mixed Germ Cell Tumor; Ovarian Mucinous Cystadenocarcinoma; Ovarian Polyembryoma; Ovarian Sarcoma; Ovarian Seromucinous Carcinoma; Ovarian Serous Cystadenocarcinoma; Ovarian Teratoma; Ovarian Yolk Sac Tumor; Stage I Ovarian Cancer; Stage IA Fallopian Tube Cancer; Stage IA Ovarian Cancer; Stage IA Ovarian Germ Cell Tumor; Stage IB Fallopian Tube Cancer; Stage IB Ovarian Cancer; Stage IB Ovarian Germ Cell Tumor; Stage IC Fallopian Tube Cancer; Stage IC Ovarian Cancer; Stage IC Ovarian Germ Cell Tumor; Stage II Ovarian Cancer; Stage IIA Fallopian Tube Cancer; Stage IIA Ovarian Cancer; Stage IIA Ovarian Germ Cell Tumor; Stage IIB Fallopian Tube Cancer; Stage IIB Ovarian Cancer; Stage IIB Ovarian Germ Cell Tumor; Stage IIC Fallopian Tube Cancer; Stage IIC Ovarian Cancer; Stage IIC Ovarian Germ Cell Tumor; Stage IIIA Fallopian Tube Cancer; Stage IIIA Ovarian Cancer; Stage IIIA Ovarian Germ Cell Tumor; Stage IIIA Primary Peritoneal Cancer; Stage IIIB Fallopian Tube Cancer; Stage IIIB Ovarian Cancer; Stage IIIB Ovarian Germ Cell Tumor; Stage IIIB Primary Peritoneal Cancer; Stage IIIC Fallopian Tube Cancer; Stage IIIC Ovarian Cancer; Stage IIIC Ovarian Germ Cell Tumor; Stage IIIC Primary Peritoneal Cancer; Stage IV Fallopian Tube Cancer; Stage IV Ovarian Cancer; Stage IV Ovarian Germ Cell Tumor; Stage IV Primary Peritoneal Cancer; Undifferentiated Ovarian Carcinoma

  4. Upper stage technology evaluation studies

    NASA Technical Reports Server (NTRS)

    1972-01-01

    Studies to evaluate advanced technology relative to chemical upper stages and orbit-to-orbit stages are reported. The work described includes: development of LH2/LOX stage data, development of data to indicate stage sensitivity to engine tolerance, modified thermal routines to accommodate storable propellants, added stage geometries to computer program for monopropellant configurations, determination of the relative gain obtainable through improvement of stage mass fraction, future propulsion concepts, effect of ultrahigh chamber-pressure increases, and relative gains obtainable through improved mass fraction.

  5. Training and certification in dialysis access.

    PubMed

    Ross, John; Dolmatch, Bart; Gallichio, Michael; Gallieni, Maurizio; Slakey, Douglas; Vesely, Tom; Davidson, Ingemar

    2014-10-01

    Decreasing and eliminating the gaps in knowledge, skills, and effective communication are the mainstays for a successful dialysis access training program curriculum and at the core of the human factors training philosophy. Many of these skills can be learned in the simulation environment. Education and training will reduce gaps in knowledge and technical skills, before exposing patients to procedure-related risk. For dialysis access, a reliable workplace environment depends upon a culture where safety and accountability are balanced to recognize the human contribution to success or failure in the complex care of patients with end-stage renal disease. Rigorous testing and certification adds value to the participants and validates the training program. PMID:25362979

  6. Entanglement-assisted random access codes

    SciTech Connect

    Pawlowski, Marcin; Zukowski, Marek

    2010-04-15

    An (n,m,p) random access code (RAC) makes it possible to encode n bits in an m-bit message in such a way that a receiver of the message can guess any of the original n bits with probability p greater than (1/2). In quantum RACs (QRACs), one transmits n qubits. The full set of primitive entanglement-assisted random access codes (EARACs) is introduced, in which parties are allowed to share a two-qubit singlet. It is shown that via a concatenation of these, one can build for any n an (n,1,p) EARAC. QRACs for n>3 exist only if parties also share classical randomness. We show that EARACs outperform the best of known QRACs not only in the success probabilities but also in the amount of communication needed in the preparatory stage of the protocol. Upper bounds on the performance of EARACs are given and shown to limit also QRACs.

  7. Remote access thyroid surgery

    PubMed Central

    Bhatia, Parisha; Mohamed, Hossam Eldin; Kadi, Abida; Walvekar, Rohan R.

    2015-01-01

    Robot assisted thyroid surgery has been the latest advance in the evolution of thyroid surgery after endoscopy assisted procedures. The advantage of a superior field vision and technical advancements of robotic technology have permitted novel remote access (trans-axillary and retro-auricular) surgical approaches. Interestingly, several remote access surgical ports using robot surgical system and endoscopic technique have been customized to avoid the social stigma of a visible scar. Current literature has displayed their various advantages in terms of post-operative outcomes; however, the associated financial burden and also additional training and expertise necessary hinder its widespread adoption into endocrine surgery practices. These approaches offer excellent cosmesis, with a shorter learning curve and reduce discomfort to surgeons operating ergonomically through a robotic console. This review aims to provide details of various remote access techniques that are being offered for thyroid resection. Though these have been reported to be safe and feasible approaches for thyroid surgery, further evaluation for their efficacy still remains. PMID:26425450

  8. Pancreatic Cancer Stage 2B

    MedlinePlus

    ... 2B Description: Stage IIB pancreatic cancer; drawing shows cancer in the pancreas and in nearby lymph nodes. Also shown are the bile duct, pancreatic duct, and duodenum. Stage IIB pancreatic cancer. Cancer has spread to nearby lymph nodes and ...

  9. Pancreatic Cancer Stage 2A

    MedlinePlus

    ... 2A Description: Stage IIA pancreatic cancer; drawing shows cancer in the pancreas and duodenum. The bile duct and pancreatic duct are also shown. Stage IIA pancreatic cancer. Cancer has spread to nearby tissue and organs ...

  10. After Access: Underrepresented Students' Postmatriculation Perceptions of College Access Capital

    ERIC Educational Resources Information Center

    Means, Darris R.; Pyne, Kimberly B.

    2016-01-01

    This qualitative study explores the perceived impact of college-going capital gained during participation in a college access program. In three, semistructured interviews spanning the first-year college experience, 10 first-year college students who participated in a college access program articulate the value of access programming and also raise…

  11. Gaining Access: A Practical and Theoretical Guide for Qualitative Researchers.

    ERIC Educational Resources Information Center

    Feldman, Martha S.; Bell, Jeannine; Berger, Michele Tracy

    This book offers useful, prescriptive advice on how to enter different field settings for interviewing and observation. The chapters of part 1, "Stages of Access," are: (1) "Finding Informants"; (2) "Human Subjects and Permission To Contact Informants"; (3) "Making Initial Contact"; (4) "Developing a Rapport"; and (5) "Exiting: Ending the…

  12. An Evaluative Checklist for Self-Access Materials

    ERIC Educational Resources Information Center

    Reinders, Hayo; Lewis, Marilyn

    2006-01-01

    Self-access centres (SACs) are playing an increasingly pivotal role in supporting the (self-) study of languages. Selecting suitable resources thus becomes more and more important. At the selection stage, identifying problems with available resources is not an easy task, and is made more difficult by a lack of published guidelines. Linked with…

  13. Phage on the stage

    PubMed Central

    Temple, Louise; Lewis, Lynn

    2015-01-01

    The resurgence of interest in bacteriophages for use in combating antibiotic resistant bacteria is coincident with an urgent call for more effective science education practices, including hands-on learning opportunities. To address this issue, a number of solutions have been proposed, including a large educational experiment, begun in 2007 by the Howard Hughes Medical Institute and currently involving over 85 colleges and universities, which has students discovering unique phages, obtaining images, and purifying phage DNA. A subset of these phage genomes is sequenced and analyzed using bioinformatics tools. Papers describing individual phage discoveries and comparative genomic studies are being published regularly. The vast majority of students in the program are in their first year of college, a critical time in capturing their interest and retaining them as science majors. This viral discovery model is being adopted and modified by a wide variety of educational institutions using a number of different bacterial hosts. In the opinion of the authors, this program and others like it represent a model accessible to virtually any undergraduate setting. And because of these programs, bacteriophage enthusiasts (academics, health professionals, biotechnology companies) can look forward to more well prepared students entering their ranks and should anticipate many more potentially useful phages discovered and characterized. PMID:26442195

  14. Bevacizumab, Cisplatin, Radiation Therapy, and Fluorouracil in Treating Patients With Stage IIB, Stage III, Stage IVA, or Stage IVB Nasopharyngeal Cancer

    ClinicalTrials.gov

    2014-04-21

    Stage II Squamous Cell Carcinoma of the Nasopharynx; Stage III Lymphoepithelioma of the Nasopharynx; Stage III Squamous Cell Carcinoma of the Nasopharynx; Stage IV Lymphoepithelioma of the Nasopharynx; Stage IV Squamous Cell Carcinoma of the Nasopharynx

  15. Oblimersen Sodium and Combination Chemotherapy in Treating Patients With Newly Diagnosed Stage I, Stage II, Stage III, or Stage IV Diffuse Large B-Cell Lymphoma

    ClinicalTrials.gov

    2012-10-11

    Contiguous Stage II Adult Diffuse Large Cell Lymphoma; Noncontiguous Stage II Adult Diffuse Large Cell Lymphoma; Stage I Adult Diffuse Large Cell Lymphoma; Stage III Adult Diffuse Large Cell Lymphoma; Stage IV Adult Diffuse Large Cell Lymphoma

  16. The Two-Word Stage: Motivated by Linguistic or Cognitive Constraints?

    ERIC Educational Resources Information Center

    Berk, Stephanie; Lillo-Martin, Diane

    2012-01-01

    Child development researchers often discuss a "two-word" stage during language acquisition. However, there is still debate over whether the existence of this stage reflects primarily cognitive or linguistic constraints. Analyses of longitudinal data from two Deaf children, Mei and Cal, not exposed to an accessible first language (American Sign…

  17. Ares 1 First Stage Design, Development, Test, and Evaluation

    NASA Technical Reports Server (NTRS)

    Williams, Tom; Cannon, Scott

    2006-01-01

    The Ares I Crew Launch Vehicle (CLV) is an integral part of NASA s exploration architecture that will provide crew and cargo access to the International Space Station as well as low earth orbit support for lunar missions. Currently in the system definition phase, the CLV is planned to replace the Space Shuttle for crew transport in the post 2010 time frame. It is comprised of a solid rocket booster (SRB) first stage derived from the current Space Shuttle SRB, a liquid oxygen/hydrogen fueled second stage utilizing a derivative of the Apollo upper stage engine for propulsion, and a Crew Exploration Vehicle (CEV) composed of command and service modules. This paper deals with current design, development, test, and evaluation planning for the CLV first stage SRB. Described are the current overall point-of-departure design and booster subsystems, systems engineering approach, and milestone schedule requirements.

  18. Melanoma staging: facts and controversies.

    PubMed

    Forschner, Andrea; Eigentler, Thomas Kurt; Pflugfelder, Annette; Leiter, Ulrike; Weide, Benjamin; Held, Laura; Meier, Friedegund; Garbe, Claus

    2010-01-01

    The value of staging examinations remains controversial for the initial staging in melanoma patients at the time of the primary diagnosis and for surveillance. Issues concerning tumor recurrences and progression must be discussed separately for different risk groups. For low-risk patients (stage IA; tumor thickness less than 1 mm), staging examinations like sentinel lymph node biopsy (SLNB), blood tests, or imaging can generally be abandoned. Baseline staging with simple techniques is at the discretion of the physician. In intermediate-risk patients (stages IB and IIA), an initial staging examination involving SLNB and computed tomography (CT) scans is recommended. Further follow-up may be restricted to physical examinations, blood tests of tumor marker protein S100beta, and to lymph node ultrasonography. If findings are suspicious, further imaging procedures may be involved. In high-risk patients (stages IIB to III), an initial staging examination with CT is recommended, and regular follow-up every 6 months with whole body imaging by CT or magnetic resonance imaging seems useful. Physical examinations, blood tests of tumor marker protein S100beta, and lymph node ultrasound imaging should be routine. This intense follow-up may enable surgical treatments with complete removal of all recognizable metastases in about 15% to 25% of patients and improve their prognosis. The risk of recurrence or tumor progression is very high in stage IV patients, and their management is individualized. PMID:20541679

  19. Stage Cylindrical Immersive Display

    NASA Technical Reports Server (NTRS)

    Abramyan, Lucy; Norris, Jeffrey S.; Powell, Mark W.; Mittman, David S.; Shams, Khawaja S.

    2011-01-01

    Panoramic images with a wide field of view intend to provide a better understanding of an environment by placing objects of the environment on one seamless image. However, understanding the sizes and relative positions of the objects in a panorama is not intuitive and prone to errors because the field of view is unnatural to human perception. Scientists are often faced with the difficult task of interpreting the sizes and relative positions of objects in an environment when viewing an image of the environment on computer monitors or prints. A panorama can display an object that appears to be to the right of the viewer when it is, in fact, behind the viewer. This misinterpretation can be very costly, especially when the environment is remote and/or only accessible by unmanned vehicles. A 270 cylindrical display has been developed that surrounds the viewer with carefully calibrated panoramic imagery that correctly engages their natural kinesthetic senses and provides a more accurate awareness of the environment. The cylindrical immersive display offers a more natural window to the environment than a standard cubic CAVE (Cave Automatic Virtual Environment), and the geometry allows multiple collocated users to simultaneously view data and share important decision-making tasks. A CAVE is an immersive virtual reality environment that allows one or more users to absorb themselves in a virtual environment. A common CAVE setup is a room-sized cube where the cube sides act as projection planes. By nature, all cubic CAVEs face a problem with edge matching at edges and corners of the display. Modern immersive displays have found ways to minimize seams by creating very tight edges, and rely on the user to ignore the seam. One significant deficiency of flat-walled CAVEs is that the sense of orientation and perspective within the scene is broken across adjacent walls. On any single wall, parallel lines properly converge at their vanishing point as they should, and the sense of

  20. Publisher's Note: EPL and Open Access Articles

    NASA Astrophysics Data System (ADS)

    Ancarani, Barbara; Brassac, Catherine; Burr, Frédéric; Dose, Volker; King, Caroline

    2008-01-01

    In May 2007 the EPLA Board of Directors welcomed the CERN initiative for the creation of a Sponsoring Consortium for Open Access Publishing in Particle Physics (SCOAP3) and agreed to enter into negotiations to enable high energy physics papers to be published in EPL with selective open access. At a subsequent meeting in August 2007, the Board decided to offer substantial initial discount while open access remained a small fraction of the content of EPL. A necessary precursor to negotiation with SCOAP3 is a general open access policy. The Directors agreed that this policy should offer a free-to-read option for all authors in all sections of EPL and so provide fair opportunities across the broad range of physics covered by EPL. The policy for the journal should allow individual authors, their institutions, funding agencies or sponsoring consortia to pay for published articles to be freely available to all, permanently. The Board stressed the importance of maintaining EPL as a refereed journal with robust and reliable content, in contrast to a repository or preprint server. EPL would remain a subscription journal for content that is not free to read and authors, institutions or funding agencies may choose to pay for their articles to be open access. As an initial step in this open access venture, a single-article fee of € 1000 ( 1330) can now be paid by individuals who choose to have their article published free to all. This pricing, which is substantially discounted, ensures that EPL remains competitive with other similar journals. EPL will continue to ensure this policy is sustainable although the journal must remain financially viable and the pricing scheme will be under continual review. At this stage we welcome enquires concerning an institutional membership fee that would allow that institute to pay in advance for open access publications in EPL for authors from that institute. The fee would follow a band structure, based on the number of articles that

  1. Macroscopic characterisations of Web accessibility

    NASA Astrophysics Data System (ADS)

    Lopes, Rui; Carriço, Luis

    2010-12-01

    The Web Science framework poses fundamental questions on the analysis of the Web, by focusing on how microscopic properties (e.g. at the level of a Web page or Web site) emerge into macroscopic properties and phenomena. One research topic on the analysis of the Web is Web accessibility evaluation, which centres on understanding how accessible a Web page is for people with disabilities. However, when framing Web accessibility evaluation on Web Science, we have found that existing research stays at the microscopic level. This article presents an experimental study on framing Web accessibility evaluation into Web Science's goals. This study resulted in novel accessibility properties of the Web not found at microscopic levels, as well as of Web accessibility evaluation processes themselves. We observed at large scale some of the empirical knowledge on how accessibility is perceived by designers and developers, such as the disparity of interpretations of accessibility evaluation tools warnings. We also found a direct relation between accessibility quality and Web page complexity. We provide a set of guidelines for designing Web pages, education on Web accessibility, as well as on the computational limits of large-scale Web accessibility evaluations.

  2. [Accessible health information: a question of age?].

    PubMed

    Loos, E F

    2012-04-01

    Aging and digitalisation are important trends which have their impact on information accessibility. Accessible information about products and services is of crucial importance to ensure that all citizens can participate fully as active members of society. Senior citizens who have difficulties using new media run the risk of exclusion in today's information society. Not all senior citizens, however, encounter problems with new media. Not by a long shot. There is much to be said for 'aged heterogeneity', the concept that individual differences increase as people age. In two explorative qualitative case studies related to accessible health information--an important issue for senior citizens--that were conducted in the Netherlands, variables such as gender, education level and frequency of internet use were therefore included in the research design. In this paper, the most important results of these case studies will be discussed. Attention will be also paid to complementary theories (socialisation, life stages) which could explain differences in information search behaviour when using old or new media. PMID:22642049

  3. Staged membrane oxidation reactor system

    SciTech Connect

    Repasky, John Michael; Carolan, Michael Francis; Stein, VanEric Edward; Chen, Christopher Ming-Poh

    2013-04-16

    Ion transport membrane oxidation system comprising (a) two or more membrane oxidation stages, each stage comprising a reactant zone, an oxidant zone, one or more ion transport membranes separating the reactant zone from the oxidant zone, a reactant gas inlet region, a reactant gas outlet region, an oxidant gas inlet region, and an oxidant gas outlet region; (b) an interstage reactant gas flow path disposed between each pair of membrane oxidation stages and adapted to place the reactant gas outlet region of a first stage of the pair in flow communication with the reactant gas inlet region of a second stage of the pair; and (c) one or more reactant interstage feed gas lines, each line being in flow communication with any interstage reactant gas flow path or with the reactant zone of any membrane oxidation stage receiving interstage reactant gas.

  4. Staged membrane oxidation reactor system

    SciTech Connect

    Repasky, John Michael; Carolan, Michael Francis; Stein, VanEric Edward; Chen, Christopher Ming-Poh

    2014-05-20

    Ion transport membrane oxidation system comprising (a) two or more membrane oxidation stages, each stage comprising a reactant zone, an oxidant zone, one or more ion transport membranes separating the reactant zone from the oxidant zone, a reactant gas inlet region, a reactant gas outlet region, an oxidant gas inlet region, and an oxidant gas outlet region; (b) an interstage reactant gas flow path disposed between each pair of membrane oxidation stages and adapted to place the reactant gas outlet region of a first stage of the pair in flow communication with the reactant gas inlet region of a second stage of the pair; and (c) one or more reactant interstage feed gas lines, each line being in flow communication with any interstage reactant gas flow path or with the reactant zone of any membrane oxidation stage receiving interstage reactant gas.

  5. Staged membrane oxidation reactor system

    DOEpatents

    Repasky, John Michael; Carolan, Michael Francis; Stein, VanEric Edward; Chen, Christopher Ming-Poh

    2012-09-11

    Ion transport membrane oxidation system comprising (a) two or more membrane oxidation stages, each stage comprising a reactant zone, an oxidant zone, one or more ion transport membranes separating the reactant zone from the oxidant zone, a reactant gas inlet region, a reactant gas outlet region, an oxidant gas inlet region, and an oxidant gas outlet region; (b) an interstage reactant gas flow path disposed between each pair of membrane oxidation stages and adapted to place the reactant gas outlet region of a first stage of the pair in flow communication with the reactant gas inlet region of a second stage of the pair; and (c) one or more reactant interstage feed gas lines, each line being in flow communication with any interstage reactant gas flow path or with the reactant zone of any membrane oxidation stage receiving interstage reactant gas.

  6. Access to water

    NASA Astrophysics Data System (ADS)

    Stein, Robyn; Niklaas, Lindie

    This paper will examine the legal implications of the South African Constitutional judgement of Government of the Republic of South Africa and others vs Grootboom and others (2001(1) SA 46 (CC)) in view of the developing debate on socio-economic rights under the constitution on the constitutional right of access to sufficient water. It will look at the manner in which effect is being given to this right at municipal level through the provision of free water and the constitutional implications of an adequate basic minimum level set by the State and local authorities. The paper will also explore the implications of relevant legislation, which enables local authorities to cut off water supplies as well as the implications of the Grootboom decision for communities facing water cut-offs.

  7. Chemists, Access, Statistics

    NASA Astrophysics Data System (ADS)

    Holmes, Jon L.

    2000-06-01

    New JCE Internet Feature at JCE Online Biographical Snapshots of Famous Chemists is a new JCE Internet feature on JCE Online. Edited by Barbara Burke, this feature provides biographical information on leading chemists, especially women and minority chemists, fostering the attitude that the practitioners of chemistry are as human as those who endeavor to learn about it. Currently, the column features biographical "snapshots" of 30 chemists. Each snapshot includes keywords and bibliography and several contain links to additional online information about the chemist. More biographical snapshots will appear in future installments. In addition, a database listing over 140 women and minority chemists is being compiled and will be made available online with the snapshots in the near future. The database includes the years of birth and death, gender and ethnicity, major and minor discipline, keywords to facilitate searching, and references to additional biographical information. We welcome your input into what we think is a very worthwhile resource. If you would like to provide additional biographical snapshots, see additional chemists added to the database, or know of additional references for those that are already in the database, please contact JCE Online or the feature editor. Your feedback is welcome and appreciated. You can find Biographical Snapshots of Famous Chemists starting from the JCE Online home page-- click the Features item under JCE Internet and then the Chemist Bios item. Access JCE Online without Name and Password We have recently been swamped by libraries requesting IP-number access to JCE Online. With the great benefit IP-number authentication gives to librarians (no user names and passwords to administer) and to their patrons (no need to remember and enter valid names and passwords) this is not surprising. If you would like access to JCE Online without the need to remember and enter a user name and password, you should tell your librarian about our

  8. CT in ovarian cancer staging: how to review and report with emphasis on abdominal and pelvic disease for surgical planning.

    PubMed

    Sahdev, Anju

    2016-01-01

    CT of the abdomen and pelvis is the first line imaging modality for staging, selecting treatment options and assessing disease response in ovarian cancer. The staging CT provides disease distribution, disease burden and is the imaging surrogate for surgico-pathological FIGO staging. Optimal cyto-reductive surgery offers patients' the best chance for disease control or cure, but sub-optimal resection confers no advantage over chemotherapy and adversely increases the risk of post surgical complications. Although there is extensive literature comparing performance of CT against laparoscopy and surgery, for the staging abdominal and pelvic CT, there are currently no accepted guidelines for interpretation or routinely used minimum data set templates for reporting these complex CT scans often with extensive radiological findings. This review provides a systematic approach for identifying the important radiological findings and highlighting important sites of disease within the abdomen and pelvis, which may alter or preclude surgery at presentation or after adjuvant chemotherapy. The distribution of sites and volume of disease can be used to categorize patients as suitable, probably suitable or not suitable for optimal cyto-reductive surgery. This categorization can potentially assist oncological surgeons and oncologists as a semi objective assessment tool useful for selecting patient treatment, streamlining multi disciplinary discussion and improving the reproducibility and correlation of CT with surgical findings. The review also highlights sites of disease and complications of ovarian cancer which should be included as part of the radiological report as these may require additional surgical input from non gynaecological surgeons or influence treatment selection. PMID:27484100

  9. Thrombosis in end-stage renal disease.

    PubMed

    Casserly, Liam F; Dember, Laura M

    2003-01-01

    Although renal failure has classically been associated with a bleeding tendency, thrombotic events are common among patients with end-stage renal disease (ESRD). A variety of thrombosis-favoring hematologic alterations have been demonstrated in these patients. In addition, "nontraditional" risk factors for thrombosis, such as hyperhomocysteinemia, endothelial dysfunction, inflammation, and malnutrition, are present in a significant proportion of chronic dialysis patients. Hemodialysis (HD) vascular access thrombosis, ischemic heart disease, and renal allograft thrombosis are well-recognized complications in these patients. Deep venous thrombosis and pulmonary embolism are viewed as rare in chronic dialysis patients, but recent studies suggest that this perception should be reconsidered. Several ESRD treatment factors such as recombinant erythropoietin (EPO) administration, dialyzer bioincompatibility, and calcineurin inhibitor administration may have prothrombotic effects. In this article we review the pathogenesis and clinical manifestations of thrombosis in ESRD and evaluate the evidence that chronic renal failure or its management predisposes to thrombotic events.

  10. Carboplatin and Paclitaxel With or Without Cisplatin and Radiation Therapy in Treating Patients With Stage I, Stage II, Stage III, or Stage IVA Endometrial Cancer

    ClinicalTrials.gov

    2016-02-09

    Endometrial Clear Cell Adenocarcinoma; Endometrial Serous Adenocarcinoma; Stage IA Uterine Corpus Cancer; Stage IB Uterine Corpus Cancer; Stage II Uterine Corpus Cancer; Stage IIIA Uterine Corpus Cancer; Stage IIIB Uterine Corpus Cancer; Stage IIIC Uterine Corpus Cancer; Stage IVA Uterine Corpus Cancer

  11. Second stage gasifier in staged gasification and integrated process

    SciTech Connect

    Liu, Guohai; Vimalchand, Pannalal; Peng, Wan Wang

    2015-10-06

    A second stage gasification unit in a staged gasification integrated process flow scheme and operating methods are disclosed to gasify a wide range of low reactivity fuels. The inclusion of second stage gasification unit operating at high temperatures closer to ash fusion temperatures in the bed provides sufficient flexibility in unit configurations, operating conditions and methods to achieve an overall carbon conversion of over 95% for low reactivity materials such as bituminous and anthracite coals, petroleum residues and coke. The second stage gasification unit includes a stationary fluidized bed gasifier operating with a sufficiently turbulent bed of predefined inert bed material with lean char carbon content. The second stage gasifier fluidized bed is operated at relatively high temperatures up to 1400.degree. C. Steam and oxidant mixture can be injected to further increase the freeboard region operating temperature in the range of approximately from 50 to 100.degree. C. above the bed temperature.

  12. Public Access and Open Access: Is There a Difference? | Poster

    Cancer.gov

    By Robin Meckley, Contributing Writer, and Tracie Frederick, Guest Writer Open access and public access—are they different concepts or are they the same? What do they mean for the researchers at NCI at Frederick? “Open-access (OA) literature is digital, online, free of charge, and free of most copyright and licensing restrictions. What makes it possible is the Internet and the consent of the author or copyright-holder,” according to an open access website maintained by Peter Suber, director, Harvard Open Access Project.

  13. Access to space

    NASA Technical Reports Server (NTRS)

    1994-01-01

    The goal of this conceptual design was to devise a reusable, commercially viable, single-stage-to-orbit vehicle. The vehicle has the ability to deliver a 9100 kg (20,000 lb) payload to a low earth orbit of 433 km to 933 km (250 n.mi. - 450 n.mi.). The SSTO vehicle is 51 meters in length and has a gross takeoff mass of 680,400 kg (1,500,000 lb). The vehicle incorporates three RD-701 engines for the main propulsion system and two RL-10 engines for the orbital maneuvering system. The vehicle is designed for a three day stay on orbit with two crew members.

  14. Pore volume accessibility of particulate and monolithic stationary phases.

    PubMed

    Urban, Jiří

    2015-05-29

    A chromatographic characterization of pore volume accessibility for both particulate and monolithic stationary phases is presented. Size-exclusion calibration curves have been used to determine the pore volume fraction that is accessible for six alkylbenzenes and twelve polystyrene standards in tetrahydrofuran as the mobile phase. Accessible porosity has been then correlated with the size of the pores from which individual compounds are just excluded. I have determined pore volume accessibility of commercially available columns packed with fully and superficially porous particles, as well as with silica-based monolithic stationary phase. I also have investigated pore accessibility of polymer-based monolithic stationary phases. Suggested protocol is used to characterize pore formation at the early stage of the polymerization, to evaluate an extent of hypercrosslinking during modification of pore surface, and to characterize the pore accessibility of monolithic stationary phases hypercrosslinked after an early termination of polymerization reaction. Pore volume accessibility was also correlated to column efficiency of both particulate and monolithic stationary phases. PMID:25892635

  15. Multiple stage miniature stepping motor

    DOEpatents

    Niven, William A.; Shikany, S. David; Shira, Michael L.

    1981-01-01

    A stepping motor comprising a plurality of stages which may be selectively activated to effect stepping movement of the motor, and which are mounted along a common rotor shaft to achieve considerable reduction in motor size and minimum diameter, whereby sequential activation of the stages results in successive rotor steps with direction being determined by the particular activating sequence followed.

  16. A Model of Moral Stages

    ERIC Educational Resources Information Center

    Reed, Don Collins

    2008-01-01

    The argument of this paper focuses on the relationship between cognitive structures and structures of interaction. It contends that there is still a place in moral development theory and research for a concept of moral stages. The thesis, in short, is that moral stages are not structures of thought. They are structures of action encoded in…

  17. The Theatre Student: Stage Violence.

    ERIC Educational Resources Information Center

    Katz, Albert M.

    Stage violence is a complex art which, when conceived inventively, approached with professional care and respect, and practiced with patience and energy, can be the highlight of a scene or of an entire play. This book is designed for amateurs who have not had the benefit of formal training in stage violence. Chapters discuss falling (the…

  18. Stage fluctuations of Wisconsin lakes

    USGS Publications Warehouse

    House, Leo B.

    1985-01-01

    This report describes lake-stage fluctuations of 83 gaged lakes in Wisconsin and presents techniques for estimating stage fluctuation at ungaged lakes. Included are stage information at 83 lakes and stage-frequency data for 32 of these lakes that had sufficient record for analysis. Lakes are classified by a hydrologic-topographic lake classification scheme as ground-water flowthrough (GWF) lakes, surface-water drainage (SWD) lakes, and surface-water flow-through (SWF) lakes. Lakes within the same class were found to have similar water-level fluctuations. The lake-stage records indicate that most annual maximums occur during the months of May and June for all three classes. Annual minimum lake levels generally occur in September for surface-water drainage lakes, in March for surface-water flowthrough lakes, and in November for ground-water flow-through lakes. Data for each lake include location, period of water-level record, hydrologic classification, drainage area, surface area, lake volume, maximum depth, long-term mean stage and its standard deviation, maximum and minimum observed lake stage, and the average annual lake-stage fluctuation.

  19. Writing Stages: A Developmental Hierarchy.

    ERIC Educational Resources Information Center

    Milner, Joseph O.

    The developmental stages of writing can be related to Jean Piaget's final three stages of development (preoperational, concrete operational, and formal operational) and to the narrative, descriptive, explanative, analytical, and artistic rhetorical modes. As the child enters kindergarten or the first grade, narrative blooms. By this age most young…

  20. Lung Cancer Staging and Prognosis.

    PubMed

    Woodard, Gavitt A; Jones, Kirk D; Jablons, David M

    2016-01-01

    The seventh edition of the non-small cell lung cancer (NSCLC) TNM staging system was developed by the International Association for the Staging of Lung Cancer (IASLC) Lung Cancer Staging Project by a coordinated international effort to develop data-derived TNM classifications with significant survival differences. Based on these TNM groupings, current 5-year survival estimates in NSLCC range from 73 % in stage IA disease to 13 % in stage IV disease. TNM stage remains the most important prognostic factor in predicting recurrence rates and survival times, followed by tumor histologic grade, and patient sex, age, and performance status. Molecular prognostication in lung cancer is an exploding area of research where interest has moved beyond TNM stage and into individualized genetic tumor analysis with immunohistochemistry, microarray, and mutation profiles. However, despite intense research efforts and countless publications, no molecular prognostic marker has been adopted into clinical use since most fail in subsequent cross-validation with few exceptions. The recent interest in immunotherapy for NSCLC has identified new biomarkers with early evidence that suggests that PD-L1 is a predictive marker of a good response to new immunotherapy drugs but a poor prognostic indicator of overall survival. Future prognostication of outcomes in NSCLC will likely be based on a combination of TNM stage and molecular tumor profiling and yield more precise, individualized survival estimates and treatment algorithms. PMID:27535389

  1. Remote Data Access with IDL

    NASA Technical Reports Server (NTRS)

    Galloy, Michael

    2013-01-01

    A tool based on IDL (Interactive Data Language) and DAP (Data Access Protocol) has been developed for user-friendly remote data access. A difficulty for many NASA researchers using IDL is that often the data to analyze are located remotely and are too large to transfer for local analysis. Researchers have developed a protocol for accessing remote data, DAP, which is used for both SOHO and STEREO data sets. Server-side side analysis via IDL routine is available through DAP.

  2. Stages of Chronic Myelogenous Leukemia

    MedlinePlus

    ... a piece of chromosome 22 break off and trade places. The bcr-abl gene is formed on ... Publications Site Map Digital Standards for NCI Websites POLICIES Accessibility Comment Policy Disclaimer FOIA Privacy & Security Reuse & ...

  3. Using the life history model to set the stage(s) of growth and senescence in bioarchaeology and paleodemography.

    PubMed

    Roksandic, Mirjana; Armstrong, Stephanie D

    2011-07-01

    Paleodemography, the study of demographic parameters of past human populations, relies on assumptions including biological uniformitarianism, stationary populations, and the ability to determine point age estimates from skeletal material. These assumptions have been widely criticized in the literature and various solutions have been proposed. The majority of these solutions rely on statistical modeling, and have not seen widespread application. Most bioarchaeologists recognize that our ability to assess chronological age is inherently limited, and have instead resorted to large, qualitative, age categories. However, there has been little attempt in the literature to systematize and define the stages of development and ageing used in bioarchaeology. We propose that stages should be based in the human life history pattern, and their skeletal markers should have easily defined and clear endpoints. In addition to a standard five-stage developmental model based on the human life history pattern, current among human biologists, we suggest divisions within the adult stage that recognize the specific nature of skeletal samples. We therefore propose the following eight stages recognizable in human skeletal development and senescence: infancy, early childhood, late childhood, adolescence, young adulthood, full adulthood, mature adulthood, and senile adulthood. Striving toward a better prediction of chronological ages will remain important and could eventually help us understand to what extent past societies differed in the timing of these life stages. Furthermore, paleodemographers should try to develop methods that rely on the type of age information accessible from the skeletal material, which uses life stages, rather than point age estimates. PMID:21469078

  4. Using the life history model to set the stage(s) of growth and senescence in bioarchaeology and paleodemography.

    PubMed

    Roksandic, Mirjana; Armstrong, Stephanie D

    2011-07-01

    Paleodemography, the study of demographic parameters of past human populations, relies on assumptions including biological uniformitarianism, stationary populations, and the ability to determine point age estimates from skeletal material. These assumptions have been widely criticized in the literature and various solutions have been proposed. The majority of these solutions rely on statistical modeling, and have not seen widespread application. Most bioarchaeologists recognize that our ability to assess chronological age is inherently limited, and have instead resorted to large, qualitative, age categories. However, there has been little attempt in the literature to systematize and define the stages of development and ageing used in bioarchaeology. We propose that stages should be based in the human life history pattern, and their skeletal markers should have easily defined and clear endpoints. In addition to a standard five-stage developmental model based on the human life history pattern, current among human biologists, we suggest divisions within the adult stage that recognize the specific nature of skeletal samples. We therefore propose the following eight stages recognizable in human skeletal development and senescence: infancy, early childhood, late childhood, adolescence, young adulthood, full adulthood, mature adulthood, and senile adulthood. Striving toward a better prediction of chronological ages will remain important and could eventually help us understand to what extent past societies differed in the timing of these life stages. Furthermore, paleodemographers should try to develop methods that rely on the type of age information accessible from the skeletal material, which uses life stages, rather than point age estimates.

  5. Multi-stage wax hydrocracking

    SciTech Connect

    Lipinski, J.J.; Nye, J.R.; Soudek, M.

    1991-02-19

    This patent describes improvement in a process for the shape selective catalytic dewaxing of a wax containing feed. It consists of at least one of atmospheric gas oil and vacuum gas oil by passing the feed with about 1000 to 5000 standard cubic feet per barrel of hydrogen over a dewaxing catalyst comprising a shape selective zeolite to produce a dewaxed product and wherein the hydrogen is added to retard catalyst aging. The improvement comprises conducting the dewaxing reaction in at least two states, with a first stage containing at least 20 wt. % of the dewaxing catalyst and in at least one second stage containing at least 20 wt. % of the dewaxing catalyst and adding at least a portion of the hydrogen downstream of the first stage reactor wherein the total hydrogen to the second stage is greater than the total hydrogen to the first stage.

  6. Subminiature infrared detector translation stage

    NASA Astrophysics Data System (ADS)

    Bell, Alan D.

    1989-11-01

    This paper describes a precision subminiature three-axis translation stage used in the GOES Sounder to provide positional adjustment of 12 cooled infrared detectors. Four separate translation stages and detectors are packaged into a detector mechanism which has an overall size of 0.850 x 1.230 x 0.600 inches. Each translation stage is capable of + or - 0.015 inch motion in the X and Y axes and +0.050/-0.025 inch motion in the Z axis with a sensitivity of 0.0002 inches. The function of the detector translation stage allows real time detector signal peaking during Sounder alignment. The translation stage operates in a cryogenic environment under a 10 to the -6th torr vacuum.

  7. Subminiature infrared detector translation stage

    NASA Technical Reports Server (NTRS)

    Bell, Alan D.

    1989-01-01

    This paper describes a precision subminiature three-axis translation stage used in the GOES Sounder to provide positional adjustment of 12 cooled infrared detectors. Four separate translation stages and detectors are packaged into a detector mechanism which has an overall size of 0.850 x 1.230 x 0.600 inches. Each translation stage is capable of + or - 0.015 inch motion in the X and Y axes and +0.050/-0.025 inch motion in the Z axis with a sensitivity of 0.0002 inches. The function of the detector translation stage allows real time detector signal peaking during Sounder alignment. The translation stage operates in a cryogenic environment under a 10 to the -6th torr vacuum.

  8. Atomic memory access hardware implementations

    DOEpatents

    Ahn, Jung Ho; Erez, Mattan; Dally, William J

    2015-02-17

    Atomic memory access requests are handled using a variety of systems and methods. According to one example method, a data-processing circuit having an address-request generator that issues requests to a common memory implements a method of processing the requests using a memory-access intervention circuit coupled between the generator and the common memory. The method identifies a current atomic-memory access request from a plurality of memory access requests. A data set is stored that corresponds to the current atomic-memory access request in a data storage circuit within the intervention circuit. It is determined whether the current atomic-memory access request corresponds to at least one previously-stored atomic-memory access request. In response to determining correspondence, the current request is implemented by retrieving data from the common memory. The data is modified in response to the current request and at least one other access request in the memory-access intervention circuit.

  9. Vehicle barrier with access delay

    DOEpatents

    Swahlan, David J; Wilke, Jason

    2013-09-03

    An access delay vehicle barrier for stopping unauthorized entry into secure areas by a vehicle ramming attack includes access delay features for preventing and/or delaying an adversary from defeating or compromising the barrier. A horizontally deployed barrier member can include an exterior steel casing, an interior steel reinforcing member and access delay members disposed within the casing and between the casing and the interior reinforcing member. Access delay members can include wooden structural lumber, concrete and/or polymeric members that in combination with the exterior casing and interior reinforcing member act cooperatively to impair an adversarial attach by thermal, mechanical and/or explosive tools.

  10. Nonvolatile random access memory

    NASA Technical Reports Server (NTRS)

    Wu, Jiin-Chuan (Inventor); Stadler, Henry L. (Inventor); Katti, Romney R. (Inventor)

    1994-01-01

    A nonvolatile magnetic random access memory can be achieved by an array of magnet-Hall effect (M-H) elements. The storage function is realized with a rectangular thin-film ferromagnetic material having an in-plane, uniaxial anisotropy and inplane bipolar remanent magnetization states. The thin-film magnetic element is magnetized by a local applied field, whose direction is used to form either a 0 or 1 state. The element remains in the 0 or 1 state until a switching field is applied to change its state. The stored information is detcted by a Hall-effect sensor which senses the fringing field from the magnetic storage element. The circuit design for addressing each cell includes transistor switches for providing a current of selected polarity to store a binary digit through a separate conductor overlying the magnetic element of the cell. To read out a stored binary digit, transistor switches are employed to provide a current through a row of Hall-effect sensors connected in series and enabling a differential voltage amplifier connected to all Hall-effect sensors of a column in series. To avoid read-out voltage errors due to shunt currents through resistive loads of the Hall-effect sensors of other cells in the same column, at least one transistor switch is provided between every pair of adjacent cells in every row which are not turned on except in the row of the selected cell.

  11. A quantum access network.

    PubMed

    Fröhlich, Bernd; Dynes, James F; Lucamarini, Marco; Sharpe, Andrew W; Yuan, Zhiliang; Shields, Andrew J

    2013-09-01

    The theoretically proven security of quantum key distribution (QKD) could revolutionize the way in which information exchange is protected in the future. Several field tests of QKD have proven it to be a reliable technology for cryptographic key exchange and have demonstrated nodal networks of point-to-point links. However, until now no convincing answer has been given to the question of how to extend the scope of QKD beyond niche applications in dedicated high security networks. Here we introduce and experimentally demonstrate the concept of a 'quantum access network': based on simple and cost-effective telecommunication technologies, the scheme can greatly expand the number of users in quantum networks and therefore vastly broaden their appeal. We show that a high-speed single-photon detector positioned at a network node can be shared between up to 64 users for exchanging secret keys with the node, thereby significantly reducing the hardware requirements for each user added to the network. This point-to-multipoint architecture removes one of the main obstacles restricting the widespread application of QKD. It presents a viable method for realizing multi-user QKD networks with efficient use of resources, and brings QKD closer to becoming a widespread technology. PMID:24005413

  12. ACCESS: Detector Performance

    NASA Astrophysics Data System (ADS)

    Morris, Matthew J.; Kaiser, M.; Rauscher, B. J.; Kimble, R. A.; Kruk, J. W.; Mott, D. B.; Wen, Y.; Foltz, R.; McCandliss, S. R.; Pelton, R. S.; Wright, E. L.; Feldman, P. D.; Moos, H. W.; Riess, A. G.; Benford, D. J.; Gardner, J. P.; Woodgate, B. E.; Bohlin, R.; Deustua, S. E.; Dixon, W. V.; Sahnow, D. J.; Kurucz, R. L.; Lampton, M.; Perlmutter, S.

    2013-01-01

    ACCESS, Absolute Color Calibration Experiment for Standard Stars, is a series of rocket-borne sub-orbital missions and ground-based experiments that will enable improvements in the precision of the astrophysical flux scale through the transfer of absolute laboratory detector standards from the National Institute of Standards and Technology (NIST) to a network of stellar standards with a calibration accuracy of 1% and a spectral resolving power of 500 across the 0.35 to 1.7 micron bandpass (overview Kaiser et al.). The flight detector and detector spare have been integrated with their electronics and flight mount. The controller electronics have been flight qualified. Vibration testing to launch loads and thermal vacuum testing of the detector, mount, and housing have been performed. The flight detector controller boards have been installed into a ruggedized flight housing. They have been successfully vacuum tested for periods significantly longer than the flight length, and components have been heat-sunk and reinforced as necessary. Thermal stability tests have been performed, and results will be presented. Goddard Space Flight Center’s Detector Characterization Lab (DCL) executed initial characterization tests for the flight detector in 2007. These were repeated in 2012, to ensure and establish baseline performance. Current lab characterization tests at Johns Hopkins are ongoing, and results will be presented. NASA sounding rocket grant NNX08AI65G supports this work.

  13. Remote direct memory access

    DOEpatents

    Archer, Charles J.; Blocksome, Michael A.

    2012-12-11

    Methods, parallel computers, and computer program products are disclosed for remote direct memory access. Embodiments include transmitting, from an origin DMA engine on an origin compute node to a plurality target DMA engines on target compute nodes, a request to send message, the request to send message specifying a data to be transferred from the origin DMA engine to data storage on each target compute node; receiving, by each target DMA engine on each target compute node, the request to send message; preparing, by each target DMA engine, to store data according to the data storage reference and the data length, including assigning a base storage address for the data storage reference; sending, by one or more of the target DMA engines, an acknowledgment message acknowledging that all the target DMA engines are prepared to receive a data transmission from the origin DMA engine; receiving, by the origin DMA engine, the acknowledgement message from the one or more of the target DMA engines; and transferring, by the origin DMA engine, data to data storage on each of the target compute nodes according to the data storage reference using a single direct put operation.

  14. Access to space study

    NASA Technical Reports Server (NTRS)

    1994-01-01

    This report summarizes the results of a comprehensive NASA in-house study to identify and assess alternate approaches to access to space through the year 2030, and to select and recommend a preferred cause of action. The goals of the study were to identify the best vehicles and transportation architectures to make major reductions in the cost of space transportation (at least 50%), while at the same time increasing safety for flight crews by at least an order of magnitude. In addition, vehicle reliability was to exceed 0.98 percent, and, as important, the robustness, pad time, turnaround time, and other aspects of operability were to be vastly improved. This study examined three major optional architectures: (1) retain and upgrade the Space Shuttle and expendable launch vehicles; (2) develop new expendable vehicles using conventional technologies and transition from current vehicles beginning in 2005; and (3) develop new reusable vehicles using advanced technology, and transition from current vehicles beginning in 2008. The launch-needs, mission model utilized for for the study was based upon today's projection of civil, defense, and commercial mission payload requirements.

  15. Making Astronomy Accessible

    NASA Astrophysics Data System (ADS)

    Grice, Noreen A.

    2011-05-01

    A new semester begins, and your students enter the classroom for the first time. You notice a student sitting in a wheelchair or walking with assistance from a cane. Maybe you see a student with a guide dog or carrying a Braille computer. Another student gestures "hello” but then continues hand motions, and you realize the person is actually signing. You wonder why another student is using an electronic device to speak. Think this can't happen in your class? According to the U.S. Census, one out of every five Americans has a disability. And some disabilities, such as autism, dyslexia and arthritis, are considered "invisible” disabilities. This means you have a high probability that one of your students will have a disability. As an astronomy instructor, you have the opportunity to reach a wide variety of learners by using creative teaching strategies. I will share some suggestions on how to make astronomy and your part of the universe more accessible for everyone.

  16. Access to postacute rehabilitation.

    PubMed

    Buntin, Melinda Beeuwkes

    2007-11-01

    Each year, more than 10 million Medicare beneficiaries are discharged from acute care hospitals into postacute care (PAC) settings, including inpatient rehabilitation facilities, skilled nursing facilities, and homes with services from home health agencies. These beneficiaries include very frail and vulnerable elders, many of whom have suffered from an acute event such as a stroke or a fall resulting in hip fracture, all of whom are judged unable to return to their homes without further care. Whether beneficiaries receive PAC and the type and intensity of care they receive is influenced not only by clinical factors, but by nonclinical factors including provider supply and financing, especially Medicare's methods of payment. This article provides a definition of PAC and discusses the wide cross-sectional variation in the use of postacute rehabilitation. It then discusses recent changes to PAC provider payment that have raised concerns about access to postacute rehabilitation, trends in the use of PAC, and what these trends imply about the appropriateness of PAC as it is now delivered. It concludes by identifying issues about the policy and research implications of recent developments and the PAC literature reviewed.

  17. Mobile access control vestibule

    NASA Astrophysics Data System (ADS)

    DePoy, Jennifer M.

    1998-12-01

    The mobile access control vestibule (MACV) is an adaptation of techniques developed for mobile military command centers. The overall configuration of modules acts as an entry control/screening facility or transportable command center. The system would provide the following capabilities: (1) A key element for force protection, rapid deployment units sent to areas having no prepositioned equipment or where there has been a degradation of that equipment as a result of natural disasters or civil unrest. (2) A rapidly deployable security control center to upgrade the security at nonmilitary sites (e.g., diplomatic or humanitarian organizations). (3) Personnel screening, package screening, badge/identification card production for authorized personnel, centralized monitoring of deployed perimeter sensors, and centralized communications for law enforcement personnel. (4) Self-contained screening and threat detection systems, including explosives detection using the system developed by Sandia National Laboratories for the FAA. When coupled with transportable electric generators, the system is self-sufficient. The communication system for the MACV would be a combination of physically wired and wireless communication units that supports by ad hoc networking.

  18. Stage measurement at gaging stations

    USGS Publications Warehouse

    Sauer, Vernon B.; Turnipseed, D. Phil

    2010-01-01

    Stream and reservoir stage are critical parameters in the computation of stream discharge and reservoir volume, respectively. In addition, a record of stream stage is useful in the design of structures that may be affected by stream elevation, as well as for the planning for various uses of flood plains. This report describes equipment and methodology for the observation, sensing, and recording of stage in streams and reservoirs. Although the U.S. Geological Survey (USGS) still uses the traditional, basic stilling-well float system as a predominant gaging station, modern electronic stage sensors and water-level recorders are now commonly used. Bubble gages coupled with nonsubmersible pressure transducers eliminate the need for stilling wells. Submersible pressure transducers have become common in use for the measurement of stage in both rivers and lakes. Furthermore, noncontact methods, such as radar, acoustic, and laser methods of sensing water levels, are being developed and tested, and in the case of radar, are commonly used for the measurement of stage. This report describes commonly used gaging-station structures, as well as the design and operation of gaging stations. Almost all of the equipment and instruments described in this report will meet the accuracy standard set by the USGS Office of Surface Water (OSW) for the measurement of stage for most applications, which is ?0.01 foot (ft) or 0.2 percent of the effective stage. Several telemetry systems are used to transmit stage data from the gaging station to the office, although satellite telemetry has become the standard. These telemetry systems provide near real-time stage data, as well as other information that alerts the hydrographer to extreme or abnormal events, and instrument malfunctions.

  19. Long-term clinical outcomes of laparoscopy-assisted distal gastrectomy versus open distal gastrectomy for early gastric cancer: A comprehensive systematic review and meta-analysis of randomized control trials.

    PubMed

    Lu, Wei; Gao, Jian; Yang, Jingyun; Zhang, Yijian; Lv, Wenjie; Mu, Jiasheng; Dong, Ping; Liu, Yingbin

    2016-07-01

    The objective of this study was to compare long-term surgical outcomes and complications of laparoscopy-assisted distal gastrectomy (LADG) with open distal gastrectomy (ODG) for the treatment of early gastric cancer (EGC) based on a review of available randomized controlled trials (RCTs) evaluated using the Cochrane methodology.RCTs comparing LADG and ODG were identified by a systematic literature search in PubMed, Cochrane Library, MEDLINE, EMBASE, Scopus, and the China Knowledge Resource Integrated Database, for papers published from January 1, 2003 to July 30, 2015. Meta-analyses were performed to compare the long-term clinical outcomes.Our systematic literature search identified 8 eligible RCTs including 732 patients (374 LADGs and 358 ODGs), with low overall risk of bias. Long-term mortality and relapse rate were comparable for both techniques. The long-term complication rate was 8.47% in LADG groups and 13.62% in the ODG group, indicating that LADG was associated with lower risk for long-term complications (RR = 0.63; 95%CI = 0.39-1.00; P = 0.03).In the treatment of EGC, LADG lowered the rate of long- and short-term complications and promoted earlier recovery, with comparable oncological outcomes to ODG. PMID:27399073

  20. Is Your Church Accessible? Houses of Worship: Physical Accessibility Checklist.

    ERIC Educational Resources Information Center

    Ensign, Arselia, Ed.

    1991-01-01

    This checklist is intended to help churches evaluate the accessibility of their facilities to those with physical disabilities. Categories covered are: basic accessibility, parking lots, walks, ramps, entrances/exits, doors and doorways, stairs and steps, floors, worship space, rest rooms, controls, water fountains, identification, warning…

  1. Airbreathing/Rocket Single-Stage-to-Orbit Design Matrix

    NASA Technical Reports Server (NTRS)

    Hunt, James L.

    1995-01-01

    A definitive design/performance study was performed on a single-stage-to-orbit (SSTO) airbreathing propelled orbital vehicle with rocket propulsion augmentation in the Access to Space activities during 1993. A credible reference design was established, but by no means an optimum. The results supported the viability of SSTO airbreathing/rocket vehicles for operational scenarios and indicated compelling reasons to continue to explore the design matrix. This paper will (1) summarize the Access to Space design activity from the SSTO airbreathing/rocket perspective, (2) present an airbreathing/rocket SSTO design matrix established for continued optimization of the design space, and (3) focus on the compelling reasons for airbreathing vehicles in Access to Space scenarios.

  2. Prediction of Protein Structure Using Surface Accessibility Data

    PubMed Central

    Hartlmüller, Christoph; Göbl, Christoph

    2016-01-01

    Abstract An approach to the de novo structure prediction of proteins is described that relies on surface accessibility data from NMR paramagnetic relaxation enhancements by a soluble paramagnetic compound (sPRE). This method exploits the distance‐to‐surface information encoded in the sPRE data in the chemical shift‐based CS‐Rosetta de novo structure prediction framework to generate reliable structural models. For several proteins, it is demonstrated that surface accessibility data is an excellent measure of the correct protein fold in the early stages of the computational folding algorithm and significantly improves accuracy and convergence of the standard Rosetta structure prediction approach. PMID:27560616

  3. Prediction of Protein Structure Using Surface Accessibility Data.

    PubMed

    Hartlmüller, Christoph; Göbl, Christoph; Madl, Tobias

    2016-09-19

    An approach to the de novo structure prediction of proteins is described that relies on surface accessibility data from NMR paramagnetic relaxation enhancements by a soluble paramagnetic compound (sPRE). This method exploits the distance-to-surface information encoded in the sPRE data in the chemical shift-based CS-Rosetta de novo structure prediction framework to generate reliable structural models. For several proteins, it is demonstrated that surface accessibility data is an excellent measure of the correct protein fold in the early stages of the computational folding algorithm and significantly improves accuracy and convergence of the standard Rosetta structure prediction approach.

  4. Prediction of Protein Structure Using Surface Accessibility Data.

    PubMed

    Hartlmüller, Christoph; Göbl, Christoph; Madl, Tobias

    2016-09-19

    An approach to the de novo structure prediction of proteins is described that relies on surface accessibility data from NMR paramagnetic relaxation enhancements by a soluble paramagnetic compound (sPRE). This method exploits the distance-to-surface information encoded in the sPRE data in the chemical shift-based CS-Rosetta de novo structure prediction framework to generate reliable structural models. For several proteins, it is demonstrated that surface accessibility data is an excellent measure of the correct protein fold in the early stages of the computational folding algorithm and significantly improves accuracy and convergence of the standard Rosetta structure prediction approach. PMID:27560616

  5. Frog virus 3 prevalence in tadpole populations inhabiting cattle-access and non-access wetlands in Tennessee, USA.

    PubMed

    Gray, Matthew J; Miller, Debra L; Schmutzer, A Chandler; Baldwin, Charles A

    2007-09-14

    Ranaviruses have been associated with most of the reported larval anuran die-offs in the United States. It is hypothesized that anthropogenically induced stress may increase pathogen prevalence in amphibian populations by compromising immunity. Cattle use of wetlands may stress resident tadpole populations by reducing water quality. We isolated a Ranavirus from green frog Rana clamitans (n = 80) and American bullfrog R. catesbeiana (n = 104) tadpoles collected at 5 cattle-access and 3 non-access wetlands on the Cumberland Plateau, Tennessee, USA. Sequencing confirmed Frog virus 3 (FV3); therefore, we compared its prevalence between tadpole populations inhabiting cattle-access and non-access wetlands, and among 3 seasons (winter, summer, and autumn) in 2005. We found FV3 in both tadpole species and cattle land-use types; however, prevalence of FV3 was greater in green frog tadpoles residing in cattle-access wetlands compared to those in non-access wetlands. No difference in FV3 prevalence was detected between cattle land uses for American bullfrog tadpoles. A seasonal trend in FV3 prevalence also existed, with prevalence greater in autumn and winter than in summer for both species. In addition, we found that FV3 prevalence decreased significantly as Gosner stage increased in American bullfrog tadpoles. No trend was detected between FV3 prevalence and developmental stage for green frog tadpoles. Our results suggest that cattle use of wetlands may increase prevalence of FV3 in Rana tadpoles, although this effect may depend on species, season, and tadpole developmental stage. PMID:17972750

  6. The Importance of Process-Oriented Accessibility Guidelines for Web Developers.

    PubMed

    Steen-Hansen, Linn; Fagernes, Siri

    2016-01-01

    Current accessibility research shows that in the web development, the process itself may lead to inaccessible web sites and applications. Common practices typically do not allow sufficient testing. The focus is mainly on complying with minimum standards, and treating accessibility compliance as a sort of bug-fixing process, missing the user perspective. In addition, there is an alarming lack of knowledge and experience with accessibility issues. It has also been argued that bringing accessibility into the development process at all stages is the only way to achieve the highest possible level of accessibility. The work presented in this paper is based on a previous project focusing on guidelines for developing accessible rich Internet applications. The guidelines were classified as either process-oriented or technology-oriented. In this paper, we examine the process-oriented guidelines and give a practical perspective on how these guidelines will make the development process more accessibility-friendly. PMID:27534339

  7. Internet Access to Spacecraft

    NASA Technical Reports Server (NTRS)

    Rash, James; Parise, Ron; Hogie, Keith; Criscuolo, Ed; Langston, Jim; Jackson, Chris; Price, Harold; Powers, Edward I. (Technical Monitor)

    2000-01-01

    The Operating Missions as Nodes on the Internet (OMNI) project at NASA's Goddard Space flight Center (GSFC), is demonstrating the use of standard Internet protocols for spacecraft communication systems. This year, demonstrations of Internet access to a flying spacecraft have been performed with the UoSAT-12 spacecraft owned and operated by Surrey Satellite Technology Ltd. (SSTL). Previously, demonstrations were performed using a ground satellite simulator and NASA's Tracking and Data Relay Satellite System (TDRSS). These activities are part of NASA's Space Operations Management Office (SOMO) Technology Program, The work is focused on defining the communication architecture for future NASA missions to support both NASA's "faster, better, cheaper" concept and to enable new types of collaborative science. The use of standard Internet communication technology for spacecraft simplifies design, supports initial integration and test across an IP based network, and enables direct communication between scientists and instruments as well as between different spacecraft, The most recent demonstrations consisted of uploading an Internet Protocol (IP) software stack to the UoSAT- 12 spacecraft, simple modifications to the SSTL ground station, and a series of tests to measure performance of various Internet applications. The spacecraft was reconfigured on orbit at very low cost. The total period between concept and the first tests was only 3 months. The tests included basic network connectivity (PING), automated clock synchronization (NTP), and reliable file transfers (FTP). Future tests are planned to include additional protocols such as Mobile IP, e-mail, and virtual private networks (VPN) to enable automated, operational spacecraft communication networks. The work performed and results of the initial phase of tests are summarized in this paper. This work is funded and directed by NASA/GSFC with technical leadership by CSC in arrangement with SSTL, and Vytek Wireless.

  8. Communication Access to Conversational Narrative

    ERIC Educational Resources Information Center

    Waller, Annalu

    2006-01-01

    This article describes methods that have been developed to provide augmentative and alternative communication communicators with better access to narrative conversation. It begins by highlighting the need to provide access to conversational narrative for people with complex communication needs, arguing that this type of conversation plays an…

  9. Distributed Access to Administrative Systems.

    ERIC Educational Resources Information Center

    Carson, Eugene

    1987-01-01

    Administrators, faculty, and staff should have electronic access to records needed to perform their jobs, and students should have access to their own records--course registration and addresses. User-directed analysis and reporting are discussed and the security and audit issues are examined. (Author/MLW)

  10. "Accessions": Researching, Designing Higher Education

    ERIC Educational Resources Information Center

    Taylor, Yvette

    2011-01-01

    This brief viewpoint piece depicts educational (dis)engagements apparent in researching and (re)designing higher education in and through "Accessions". "Accessions", a collaborative research-design project, probed at how cultures, climates and conditions of higher education may be reproducing or reshaping social inequalities and divisions. Here,…

  11. Communication Access to the Arts

    ERIC Educational Resources Information Center

    Duchan, Judith; Jennings, Marian; Barrett, Ray; Butler, Brian

    2006-01-01

    Art galleries, theaters, and museums are often communicatively inaccessible to people with aphasia. This article describes how a group of people with aphasia and a group of health and arts service providers worked together to develop an arts access initiative that involved people with aphasia in accessing museums and arts courses in the community…

  12. Automatically Producing Accessible Learning Objects

    ERIC Educational Resources Information Center

    Di Iorio, Angelo; Feliziani, Antonio Angelo; Mirri, Silvia; Salomoni, Paola; Vitali, Fabio

    2006-01-01

    The "Anywhere, Anytime, Anyway" slogan is frequently associated to e-learning with the aim to emphasize the wide access offered by on-line education. Otherwise, learning materials are currently created to be used with a specific technology or configuration, leaving out from the virtual classroom students who have limited access capabilities and,…

  13. Editorial: Next Generation Access Networks

    NASA Astrophysics Data System (ADS)

    Ruffini, Marco; Cincotti, Gabriella; Pizzinat, Anna; Vetter, Peter

    2015-12-01

    Over the past decade we have seen an increasing number of operators deploying Fibre-to-the-home (FTTH) solutions in access networks, in order to provide home users with a much needed network access upgrade, to support higher peak rates, higher sustained rates and a better and more uniform broadband coverage of the territory.

  14. Accessible Multimedia for the Web.

    ERIC Educational Resources Information Center

    Zaparyniuk, Nicholas; Code, Jillianne

    With the Internet taking a dominant role in corporate training, education, retail, and customer based product exploration, authors of Web-based information need to ensure that the media they deliver is accessible to the widest possible audience. Whether users have a visual, auditory, physical, or developmental disability, accessible multimedia can…

  15. Teaching for Our Times: Access.

    ERIC Educational Resources Information Center

    Cassara, Shirley, Ed.; Bernard, Jean M., Ed.

    This volume of Bunker Hill Community College's (Massachusetts) series, "Teaching for Our Times," focuses on issues of access. The original concept for community colleges included access as an open door to learning, where anyone, even without a high school diploma, could begin a new academic life in an institution free from the barriers imposed by…

  16. Digital Image Representation and Access.

    ERIC Educational Resources Information Center

    Mostafa, Javed

    1994-01-01

    Reviews the literature relating to the development and application of modern imaging technology between 1987 and 1993. Highlights include image representation, including image data, compression, and image formats; and image access, including indexing and modeling, user interface design, and distributed access. (143 references) (LRW)

  17. Accessibility on the Hudson River

    ERIC Educational Resources Information Center

    Exceptional Parent, 2010

    2010-01-01

    This article describes how Beverly and Martin Ryfa, working with an architect who specializes in accessible design, were able to build a house that is handicap accessible for their 9-year-old daughter, Danielle, who suffered an intraventricular hemorrhage when she was three days old. The article describes the features of their house that make…

  18. Minority Access to Higher Education

    ERIC Educational Resources Information Center

    Jackson, Nathaniel

    2012-01-01

    Blacks, Hispanics, Native Americans, and Asian Americans are entitled to equal access to all institutions of higher education. Ensuring greater access and participation by minorities in higher education is one of the most practical ways of moving America closer to the ideal of equal opportunity, which is the actualization of the American dream.…

  19. Administering an epoch initiated for remote memory access

    DOEpatents

    Blocksome, Michael A; Miller, Douglas R

    2014-03-18

    Methods, systems, and products are disclosed for administering an epoch initiated for remote memory access that include: initiating, by an origin application messaging module on an origin compute node, one or more data transfers to a target compute node for the epoch; initiating, by the origin application messaging module after initiating the data transfers, a closing stage for the epoch, including rejecting any new data transfers after initiating the closing stage for the epoch; determining, by the origin application messaging module, whether the data transfers have completed; and closing, by the origin application messaging module, the epoch if the data transfers have completed.

  20. Administering an epoch initiated for remote memory access

    DOEpatents

    Blocksome, Michael A; Miller, Douglas R

    2012-10-23

    Methods, systems, and products are disclosed for administering an epoch initiated for remote memory access that include: initiating, by an origin application messaging module on an origin compute node, one or more data transfers to a target compute node for the epoch; initiating, by the origin application messaging module after initiating the data transfers, a closing stage for the epoch, including rejecting any new data transfers after initiating the closing stage for the epoch; determining, by the origin application messaging module, whether the data transfers have completed; and closing, by the origin application messaging module, the epoch if the data transfers have completed.

  1. Administering an epoch initiated for remote memory access

    DOEpatents

    Blocksome, Michael A.; Miller, Douglas R.

    2013-01-01

    Methods, systems, and products are disclosed for administering an epoch initiated for remote memory access that include: initiating, by an origin application messaging module on an origin compute node, one or more data transfers to a target compute node for the epoch; initiating, by the origin application messaging module after initiating the data transfers, a closing stage for the epoch, including rejecting any new data transfers after initiating the closing stage for the epoch; determining, by the origin application messaging module, whether the data transfers have completed; and closing, by the origin application messaging module, the epoch if the data transfers have completed.

  2. CLV First Stage Design, Development, Test and Evaluation

    NASA Technical Reports Server (NTRS)

    Burt, Richard K.; Brasfield, F.

    2006-01-01

    The Crew Launch Vehicle (CLV) is an integral part of NASA's Exploration architecture that will provide crew and cargo access to the International Space Station as well as low earth orbit support for lunar missions. Currently in the system definition phase, the CLV is planned to replace the Space Shuttle for crew transport in the post 2010 time frame. It is comprised of a solid rocket booster first stage derived from the current Space Shuttle SRB, a LOX/hydrogen liquid fueled second stage utilizing a derivative of the Space Shuttle Main Engine (SSME) for propulsion, and a Crew Exploration Vehicle (GEV) composed of Command and Service Modules. This paper deals with current DDT&E planning for the CLV first stage solid rocket booster. Described are the current overall point-of-departure design and booster subsystems, systems engineering approach, and milestone schedule requirements.

  3. Automatic sleep staging using state machine-controlled decision trees.

    PubMed

    Imtiaz, Syed Anas; Rodriguez-Villegas, Esther

    2015-01-01

    Automatic sleep staging from a reduced number of channels is desirable to save time, reduce costs and make sleep monitoring more accessible by providing home-based polysomnography. This paper introduces a novel algorithm for automatic scoring of sleep stages using a combination of small decision trees driven by a state machine. The algorithm uses two channels of EEG for feature extraction and has a state machine that selects a suitable decision tree for classification based on the prevailing sleep stage. Its performance has been evaluated using the complete dataset of 61 recordings from PhysioNet Sleep EDF Expanded database achieving an overall accuracy of 82% and 79% on training and test sets respectively. The algorithm has been developed with a very small number of decision tree nodes that are active at any given time making it suitable for use in resource-constrained wearable systems. PMID:26736278

  4. Automatic sleep staging using state machine-controlled decision trees.

    PubMed

    Imtiaz, Syed Anas; Rodriguez-Villegas, Esther

    2015-01-01

    Automatic sleep staging from a reduced number of channels is desirable to save time, reduce costs and make sleep monitoring more accessible by providing home-based polysomnography. This paper introduces a novel algorithm for automatic scoring of sleep stages using a combination of small decision trees driven by a state machine. The algorithm uses two channels of EEG for feature extraction and has a state machine that selects a suitable decision tree for classification based on the prevailing sleep stage. Its performance has been evaluated using the complete dataset of 61 recordings from PhysioNet Sleep EDF Expanded database achieving an overall accuracy of 82% and 79% on training and test sets respectively. The algorithm has been developed with a very small number of decision tree nodes that are active at any given time making it suitable for use in resource-constrained wearable systems.

  5. Dialysis access thrombosis in a family cohort.

    PubMed Central

    Bornak, Arash; Kirksey, Lee

    2007-01-01

    In 2004, 464,952 individuals were newly diagnosed with chronic renal insufficiency (CRI); 102,356 of those newly diagnosed patients required initiation of dialysis for end-stage renal disease (ESRD). Among the ESRD population, about one third is African American despite the fact that this population represent only about 12% of the total population in the United States (U.S. Renal Data System 2006). Familial aggregation of kidney disease disproportionately affects minorities. This paper describes the detection and management of dialysis access failure due to hypercoagulable states in a genetically related group. We also discuss the implications that associated familial disorders may have on the diagnoses, treatment and survival for this devastating illness. PMID:17722673

  6. Cognitive Development and Group Stages.

    ERIC Educational Resources Information Center

    Saidla, Debie D.

    1990-01-01

    Attempts to integrate Perry's (1970) scheme of the cognitive development of college students with a model of group development adapted by Waldo (1985) based on Tuckman's (1965) formulation of developmental group stages. (Author)

  7. Evaluating the Stage Learning Hypothesis.

    ERIC Educational Resources Information Center

    Thomas, Hoben

    1980-01-01

    A procedure for evaluating the Genevan stage learning hypothesis is illustrated by analyzing Inhelder, Sinclair, and Bovet's guided learning experiments (in "Learning and the Development of Cognition." Cambridge: Harvard University Press, 1974). (Author/MP)

  8. Two stage to orbit design

    NASA Technical Reports Server (NTRS)

    1991-01-01

    A preliminary design of a two-stage to orbit vehicle was conducted with the requirements to carry a 10,000 pound payload into a 300 mile low-earth orbit using an airbreathing first stage, and to take off and land unassisted on a 15,000 foot runway. The goal of the design analysis was to produce the most efficient vehicle in size and weight which could accomplish the mission requirements. Initial parametric analysis indicated that the weight of the orbiter and the transonic performance of the system were the two parameters that had the largest impact on the design. The resulting system uses a turbofan ramjet powered first stage to propel a scramjet and rocket powered orbiter to the stage point of Mach 6 to 6.5 at an altitude of 90,000 ft.

  9. Two stage liquefaction of coal

    DOEpatents

    Neuworth, Martin B.

    1981-01-01

    A two stage coal liquefaction process and apparatus comprising hydrogen donor solvent extracting, solvent deashing, and catalytic hydrocracking. Preferrably, the catalytic hydrocracking is performed in an ebullating bed hydrocracker.

  10. Staged regenerative sorption heat pump

    NASA Technical Reports Server (NTRS)

    Jones, Jack A. (Inventor)

    1995-01-01

    A regenerative adsorbent heat pump process and system for cooling and heating a space. A sorbent is confined in a plurality of compressors of which at least four are first stage and at least four are second stage. The first stage operates over a first pressure region and the second stage over a second pressure region which is higher than the first. Sorbate from the first stage enters the second stage. The sorbate loop includes a condenser, expansion valve, evaporator and the compressors. A single sorbate loop can be employed for single-temperature-control such as air conditioning and heating. Two sorbate loops can be used for two-temperature-control as in a refrigerator and freezer. The evaporator temperatures control the freezer and refrigerator temperatures. Alternatively the refrigerator temperature can be cooled by the freezer with one sorbate loop. A heat transfer fluid is circulated in a closed loop which includes a radiator and the compressors. Low temperature heat is exhausted by the radiator. High temperature heat is added to the heat transfer fluid entering the compressors which are desorbing vapor. Heat is transferred from compressors which are sorbing vapor to the heat transfer fluid, and from the heat transfer fluid to the compressors which are desorbing vapor. Each compressor is subjected to the following phases, heating to its highest temperature, cooling down from its highest temperature, cooling to its lowest temperature, and warming up from its lowest temperature. The phases are repeated to complete a cycle and regenerate heat.

  11. Crew Launch Vehicle Upper Stage

    NASA Technical Reports Server (NTRS)

    Davis, D. J.; Cook, J. R.

    2006-01-01

    The Agency s Crew Launch Vehicle (CLV) will be the first human rated space transportation system developed in the United States since the Space Shuttle. The CLV will utilize existing Shuttle heritage hardware and systems combined with a "clean sheet design" for the Upper Stage. The Upper Stage element will be designed and developed by a team of NASA engineers managed by the Marshall Space Flight Center (MSFC) in Huntsville, Alabama. The team will design the Upper Stage based on the Exploration Systems Architecture Study (ESAS) Team s point of departure conceptual design as illustrated in the figure below. This concept is a self-supporting cylindrical structure, approximately 1 15 feet long and 216 inches in diameter. While this "clean-sheet" upper stage design inherently carries more risk than utilizing a modified design, the approach also has many advantages. This paper will discuss the advantages and disadvantages of pursuing a "clean-sheet" design for the new CLV Upper Stage as well as describe in detail the overall design of the Upper Stage and its integration into NASA s CLV.

  12. Data Access Performance Through Parallelization and Vectored Access: Some Results

    SciTech Connect

    Furano, Fabrizio; Hanushevsky, Andrew; /SLAC

    2011-11-10

    High Energy Physics data processing and analysis applications typically deal with the problem of accessing and processing data at high speed. Recent studies, development and test work have shown that the latencies due to data access can often be hidden by parallelizing them with the data processing, thus giving the ability to have applications which process remote data with a high level of efficiency. Techniques and algorithms able to reach this result have been implemented in the client side of the Scalla/xrootd system, and in this contribution we describe the results of some tests done in order to compare their performance and characteristics. These techniques, if used together with multiple streams data access, can also be effective in allowing to efficiently and transparently deal with data repositories accessible via a Wide Area Network.

  13. Recipient's unemployment restricts access to renal transplantation.

    PubMed

    Sandhu, Gurprataap S; Khattak, Muhammad; Pavlakis, Martha; Woodward, Robert; Hanto, Douglas W; Wasilewski, Marcy A; Dimitri, Noelle; Goldfarb-Rumyantzev, Alexander

    2013-01-01

    Equitable distribution of a scarce resource such as kidneys for transplantation can be a challenging task for transplant centers. In this study, we evaluated the association between recipient's employment status and access to renal transplantation in patients with end-stage renal disease (ESRD). We used data from the United States Renal Data System (USRDS). The primary variable of interest was employment status at ESRD onset. Two outcomes were analyzed in Cox model: (i) being placed on the waiting list for renal transplantation or being transplanted (whichever occurred first); and (ii) first transplant in patients who were placed on the waiting list. We analyzed 429 409 patients (age of ESRD onset 64.2 ± 15.2 yr, 55.0% males, 65.1% White). Compared with patients who were unemployed, patients working full time were more likely to be placed on the waiting list/transplanted (HR 2.24, p < 0.001) and to receive a transplant once on the waiting list (HR 1.65, p < 0.001). Results indicate that recipient's employment status is strongly associated with access to renal transplantation, with unemployed and partially employed patients at a disadvantage. Adding insurance status to the model reduces the effect size, but the association still remains significant, indicating additional contribution from other factors.

  14. Recipient's unemployment restricts access to renal transplantation.

    PubMed

    Sandhu, Gurprataap S; Khattak, Muhammad; Pavlakis, Martha; Woodward, Robert; Hanto, Douglas W; Wasilewski, Marcy A; Dimitri, Noelle; Goldfarb-Rumyantzev, Alexander

    2013-01-01

    Equitable distribution of a scarce resource such as kidneys for transplantation can be a challenging task for transplant centers. In this study, we evaluated the association between recipient's employment status and access to renal transplantation in patients with end-stage renal disease (ESRD). We used data from the United States Renal Data System (USRDS). The primary variable of interest was employment status at ESRD onset. Two outcomes were analyzed in Cox model: (i) being placed on the waiting list for renal transplantation or being transplanted (whichever occurred first); and (ii) first transplant in patients who were placed on the waiting list. We analyzed 429 409 patients (age of ESRD onset 64.2 ± 15.2 yr, 55.0% males, 65.1% White). Compared with patients who were unemployed, patients working full time were more likely to be placed on the waiting list/transplanted (HR 2.24, p < 0.001) and to receive a transplant once on the waiting list (HR 1.65, p < 0.001). Results indicate that recipient's employment status is strongly associated with access to renal transplantation, with unemployed and partially employed patients at a disadvantage. Adding insurance status to the model reduces the effect size, but the association still remains significant, indicating additional contribution from other factors. PMID:23808849

  15. Visual accessibility of ramps and steps.

    PubMed

    Legge, Gordon E; Yu, Deyue; Kallie, Christopher S; Bochsler, Tiana M; Gage, Rachel

    2010-01-01

    The visual accessibility of a space refers to the effectiveness with which vision can be used to travel safely through the space. For people with low vision, the detection of steps and ramps is an important component of visual accessibility. We used ramps and steps as visual targets to examine the interacting effects of lighting, object geometry, contrast, viewing distance, and spatial resolution. Wooden staging was used to construct a sidewalk with transitions to ramps or steps. Forty-eight normally sighted subjects viewed the sidewalk monocularly through acuity-reducing goggles and made recognition judgments about the presence of the ramps or steps. The effects of variation in lighting were milder than expected. Performance declined for the largest viewing distance but exhibited a surprising reversal for nearer viewing. Of relevance to pedestrian safety, the step up was more visible than the step down. We developed a probabilistic cue model to explain the pattern of target confusions. Cues determined by discontinuities in the edge contours of the sidewalk at the transition to the targets were vulnerable to changes in viewing conditions. Cues associated with the height in the picture plane of the targets were more robust.

  16. Perceived accessibility versus actual physical accessibility of healthcare facilities.

    PubMed

    Sanchez, J; Byfield, G; Brown, T T; LaFavor, K; Murphy, D; Laud, P

    2000-01-01

    This study addressed how healthcare clinics perceive themselves in regard to accessibility for persons with spinal cord injuries (SCI). All 40 of the clinics surveyed reported that they were wheelchair accessible; however, there was significant variability in the number of sites that actually met the guidelines of the Americans with Disability Act. In general, a person using a wheelchair could enter the building, the examination room, and the bathroom. The majority of sites did not have an examination table that could be lowered to wheelchair level. Most reported limited experience in working with persons with (SCI), yet they claimed to be able to assist with difficult transfers. Only one site knew about autonomic dysreflexia. Problems of accessibility appeared to be seriously compounded by the clinics' perception of how they met physical accessibility guidelines without consideration of the actual needs of persons with SCI. This study addressed the perception of accessibility as reported by clinic managers versus actual accessibility in healthcare clinics in a Midwestern metropolitan area for persons using wheelchairs. PMID:10754921

  17. Spleen-Preserving Versus Spleen-Sacrificing Distal Pancreatectomy in Laparoscopy and Open Method-Perioperative Outcome Analysis-14 Years Experience.

    PubMed

    Panda, Nilanjan; Bansal, Nitin Kumar; Narsimhan, Mohan; Ardhanari, Ramesh; Bronson, Joseph Raja B

    2016-04-01

    We analyzed perioperative outcome of distal pancreatectomies with or without splenic preservation both in laparoscopic and open method to determine best approach. Retrospective data was collected from 1999 to 2013. We divided all distal pancreatectomies into four groups. Group 1-laparoscopic spleen-preserving distal pancreatectomy (LSPDP). Group 2-laparoscopic splenectomy + distal pancreatectomy (LSDP). Group 3-open spleen-preserving distal pancreatectomy. Group 4-open splenectomy + distal pancreatectomy. We recorded demographic data, intra and post operative complications, operative time, estimated blood loss, length of stay, pancreatic leak rate, and final pathology result. A total of 38 distal pancreatectomies were included. In group 1, patients were significantly younger (mean 29 vs 47 to 50 in other groups, p = 0.014). Tumor size (average 2.5 vs 5 to 9.5 cm in other groups, p = 0.023) and operative time (average 98 min vs 125 to 141 in other groups, p = 0.004) and hospital stay (average 6 vs 8 to 19 days in other groups, p = 0.009) in LSPDP were all significantly less than other groups taken together. However, intra-operative blood loss was equivalent. We further analyzed that between LSPDP and LSDP, age and tumor size were significantly less in LSPDP. Further we analyzed between spleen-preserving (groups 1 + 3) vs spleen-sacrificing (groups 2 + 4) distal pancreatectomies and between overall laparoscopic (groups 1 + 2) vs open (groups 3 + 4). Laparoscopic spleen-preserving distal pancreatectomy has all the advantages of minimal access surgery especially in small lesions and low-grade malignancy. PMID:27303115

  18. Saturn IB First Stage (S-IB Stage) at MSFC

    NASA Technical Reports Server (NTRS)

    1965-01-01

    Marshall Space Flight Center (MSFC) workers lower S-IB-200D, a dynamic test version of the Saturn IB launch vehicle's first stage (S-IB stage), into the Center's Dynamic Test Stand on January 12, 1965. Test Laboratory persornel assembled a complete Saturn IB to test the structural soundness of the launch vehicle. Developed by the MSFC as an interim vehicle in MSFC's 'building block' approach to Saturn rocket development, the Saturn IB utilized Saturn I technology to further develop and refine large boosters and the Apollo spacecraft capabilities required for the manned lunar missions.

  19. Saturn IB First Stage (S-IB Stage) at MSFC

    NASA Technical Reports Server (NTRS)

    1965-01-01

    Workers at the Marshall Space Flight Center (MSFC) begin hoisting S-IB-200D, a dynamic test version of the Saturn IB launch vehicle's first stage (S-IB stage), into the Center's Dynamic Test Stand on January 11, 1965. Test Laboratory persornel assembled a complete Saturn IB to test the structural soundness of the launch vehicle. Developed by the MSFC as an interim vehicle in MSFC's 'building block' approach to Saturn rocket development, the Saturn IB utilized Saturn I technology to further develop and refine large boosters and the Apollo spacecraft capabilities required for the manned lunar missions.

  20. Two-Stage Centrifugal Fan

    NASA Technical Reports Server (NTRS)

    Converse, David

    2011-01-01

    Fan designs are often constrained by envelope, rotational speed, weight, and power. Aerodynamic performance and motor electrical performance are heavily influenced by rotational speed. The fan used in this work is at a practical limit for rotational speed due to motor performance characteristics, and there is no more space available in the packaging for a larger fan. The pressure rise requirements keep growing. The way to ordinarily accommodate a higher DP is to spin faster or grow the fan rotor diameter. The invention is to put two radially oriented stages on a single disk. Flow enters the first stage from the center; energy is imparted to the flow in the first stage blades, the flow is redirected some amount opposite to the direction of rotation in the fixed stators, and more energy is imparted to the flow in the second- stage blades. Without increasing either rotational speed or disk diameter, it is believed that as much as 50 percent more DP can be achieved with this design than with an ordinary, single-stage centrifugal design. This invention is useful primarily for fans having relatively low flow rates with relatively high pressure rise requirements.

  1. Three stages of medical dialogue.

    PubMed

    Abramovitch, H; Schwartz, E

    1996-06-01

    The negative consequences of physicians' failure to establish and maintain personal relationships with patients are at the heart of the "humanistic crisis" in medicine. To resolve this crisis, a new model of doctor-patient interaction is proposed, based on the ideas of Martin Buber's philosophy of dialogue. This model shows how the physician may successfully combine the personal (I-Thou) and impersonal (I-It) aspects of medicine in three stages. These "Three Stages of Medical Dialogue" include: 1. An Initial Personal Meeting stage, which initiates the doctor-patient relationship and involves mutual confirmation; 2. An Examination stage, which requires a shift from a personal to an impersonal style of interaction; 3. An Integration Through Dialogue or "Healing Through Meeting" Stage, which involves the integration of the impersonal medical data into the ongoing dialogue between doctor and patient, as a basis for shared decision-making. The use of the model, as well as common failures of doctor-patient dialogue are discussed.

  2. Stage Separation Performance Analysis Project

    NASA Technical Reports Server (NTRS)

    Chen, Yen-Sen; Zhang, Sijun; Liu, Jiwen; Wang, Ten-See

    2001-01-01

    Stage separation process is an important phenomenon in multi-stage launch vehicle operation. The transient flowfield coupled with the multi-body systems is a challenging problem in design analysis. The thermodynamics environment with burning propellants during the upper-stage engine start in the separation processes adds to the complexity of the-entire system. Understanding the underlying flow physics and vehicle dynamics during stage separation is required in designing a multi-stage launch vehicle with good flight performance. A computational fluid dynamics model with the capability to coupling transient multi-body dynamics systems will be a useful tool for simulating the effects of transient flowfield, plume/jet heating and vehicle dynamics. A computational model using generalize mesh system will be used as the basis of this development. The multi-body dynamics system will be solved, by integrating a system of six-degree-of-freedom equations of motion with high accuracy. Multi-body mesh system and their interactions will be modeled using parallel computing algorithms. Adaptive mesh refinement method will also be employed to enhance solution accuracy in the transient process.

  3. Open Access Publishing in Astronomy

    NASA Astrophysics Data System (ADS)

    Grothkopf, U.; Meakins, S.

    2012-08-01

    Open Access (OA) in scholarly literature means the "immediate, free availability on the public internet, permitting any users to read, download, copy, distribute, print, search or link to the full text of these articles". The Open Access movement has been made possible thanks to the wide-spread availability of internet access and has received increasing interest since the 1990s, mostly due to the fast rising journal subscription prices. This presentation will review the current situation of Open Access in astronomy. It will answer the question why it makes sense to publish in an OA journal and will provide criteria to judge the quality of OA journals and publishers, along with suggestions how to identify so-called predatory publishers.

  4. Computer access security code system

    NASA Technical Reports Server (NTRS)

    Collins, Earl R., Jr. (Inventor)

    1990-01-01

    A security code system for controlling access to computer and computer-controlled entry situations comprises a plurality of subsets of alpha-numeric characters disposed in random order in matrices of at least two dimensions forming theoretical rectangles, cubes, etc., such that when access is desired, at least one pair of previously unused character subsets not found in the same row or column of the matrix is chosen at random and transmitted by the computer. The proper response to gain access is transmittal of subsets which complete the rectangle, and/or a parallelepiped whose opposite corners were defined by first groups of code. Once used, subsets are not used again to absolutely defeat unauthorized access by eavesdropping, and the like.

  5. Astronauts Access Web from Space

    NASA Video Gallery

    Aboard the International Space Station, Expedition 22 Commander Jeff Williams and Flight Engineers Soichi Noguchi and T.J. Creamer share their thoughts about Internet access from space and post a r...

  6. Just the Facts: Vascular Access

    MedlinePlus

    ... vein thicker so it can be used for dialysis. A fistula is often the longest-lasting access. ... Artery Graft Illustration from Core Curriculum for the Dialysis Technician , 1998 Vein A catheter is a plastic ...

  7. Computer Security Systems Enable Access.

    ERIC Educational Resources Information Center

    Riggen, Gary

    1989-01-01

    A good security system enables access and protects information from damage or tampering, but the most important aspects of a security system aren't technical. A security procedures manual addresses the human element of computer security. (MLW)

  8. Clinical Outcome of Modified Laparoscopy-Assisted Proximal Gastrectomy Compared to Conventional Proximal Gastrectomy or Total Gastrectomy for Upper-Third Early Gastric Cancer with Special References to Postoperative Reflux Esophagitis

    PubMed Central

    Huh, Yeon-Ju; Oh, Seung-Young; Lee, Kyung-Goo; Yang, Jun-Young; Ahn, Hye-Seong; Suh, Yun-Suhk; Kong, Seong-Ho; Lee, Kuhn-Uk; Yang, Han-Kwang

    2015-01-01

    Purpose This study evaluated the functional and oncological outcomes of proximal gastrectomy (PG) in comparison with total gastrectomy (TG) for upper-third early gastric cancer (EGC). Materials and Methods The medical records of upper-third EGC patients who had undergone PG (n=192) or TG (n=157) were reviewed. The PG group was further subdivided into patients who had undergone conventional open PG (cPG; n=157) or modified laparoscopy-assisted PG (mLAPG; n=35). Patients who had undergone mLAPG had a longer portion of their intra-abdominal esophagus preserved than patients who had undergone cPG. Surgical morbidity, recurrence, long-term nutritional status, and the incidence of reflux esophagitis were compared between the groups. Results The rate of postoperative complications was significantly lower for PG than TG (16.7% vs. 31.2%), but the five-year overall survival rate was comparable between the two groups (99.3% vs. 96.3%). Postoperative levels of hemoglobin and albumin were significantly higher for patients who had undergone PG. However, the incidence of reflux esophagitis was higher for PG than for TG (37.4% vs. 3.7%; P<0.001). mLAPG was related to a lower incidence of reflux esophagitis after PG (P<0.001). Conclusions Compared to TG, PG showed an advantage in terms of postoperative morbidity and nutrition, and there was a comparable prognosis between the two procedures. Preserving the intra-abdominal esophagus may lower the incidence of reflux esophagitis associated with PG. PMID:26468417

  9. Preparing for the New Remote Access.

    ERIC Educational Resources Information Center

    Taylor, William E.

    1997-01-01

    Integrated remote access servers support many different types of access. Remote access has been integrated as a strategic tool as application developers build remote access capabilities into their software. Discusses demands of using remote access as a strategic component and management matters. (AEF)

  10. 36 CFR 9.32 - Access.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... MANAGEMENT Non-Federal Oil and Gas Rights § 9.32 Access. (a) No access on, across or through lands or waters... CFR 2.17. (d) No access to a site outside a unit will be permitted across unit lands unless such access is by foot, pack animal, or designated road. Persons using designated roads for access to such...

  11. 32 CFR 154.49 - Granting access.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false Granting access. 154.49 Section 154.49 National... SECURITY PROGRAM REGULATION Issuing Clearance and Granting Access § 154.49 Granting access. (a) Access to classified information shall be granted to persons whose official duties require such access and who have...

  12. 5 CFR 2606.203 - Granting access.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 5 Administrative Personnel 3 2012-01-01 2012-01-01 false Granting access. 2606.203 Section 2606... Access to Records and Accounting of Disclosures § 2606.203 Granting access. (a) The methods for allowing access to records, when such access has been granted by OGE or the other agency concerned are:...

  13. 32 CFR 154.49 - Granting access.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 1 2013-07-01 2013-07-01 false Granting access. 154.49 Section 154.49 National... SECURITY PROGRAM REGULATION Issuing Clearance and Granting Access § 154.49 Granting access. (a) Access to classified information shall be granted to persons whose official duties require such access and who have...

  14. 32 CFR 154.49 - Granting access.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 1 2014-07-01 2014-07-01 false Granting access. 154.49 Section 154.49 National... SECURITY PROGRAM REGULATION Issuing Clearance and Granting Access § 154.49 Granting access. (a) Access to classified information shall be granted to persons whose official duties require such access and who have...

  15. 32 CFR 154.49 - Granting access.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 1 2012-07-01 2012-07-01 false Granting access. 154.49 Section 154.49 National... SECURITY PROGRAM REGULATION Issuing Clearance and Granting Access § 154.49 Granting access. (a) Access to classified information shall be granted to persons whose official duties require such access and who have...

  16. 36 CFR 9.32 - Access.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... MANAGEMENT Non-Federal Oil and Gas Rights § 9.32 Access. (a) No access on, across or through lands or waters... CFR 2.17. (d) No access to a site outside a unit will be permitted across unit lands unless such access is by foot, pack animal, or designated road. Persons using designated roads for access to such...

  17. 36 CFR 9.32 - Access.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... MANAGEMENT Non-Federal Oil and Gas Rights § 9.32 Access. (a) No access on, across or through lands or waters... CFR 2.17. (d) No access to a site outside a unit will be permitted across unit lands unless such access is by foot, pack animal, or designated road. Persons using designated roads for access to such...

  18. Memory availability and referential access

    PubMed Central

    Johns, Clinton L.; Gordon, Peter C.; Long, Debra L.; Swaab, Tamara Y.

    2013-01-01

    Most theories of coreference specify linguistic factors that modulate antecedent accessibility in memory; however, whether non-linguistic factors also affect coreferential access is unknown. Here we examined the impact of a non-linguistic generation task (letter transposition) on the repeated-name penalty, a processing difficulty observed when coreferential repeated names refer to syntactically prominent (and thus more accessible) antecedents. In Experiment 1, generation improved online (event-related potentials) and offline (recognition memory) accessibility of names in word lists. In Experiment 2, we manipulated generation and syntactic prominence of antecedent names in sentences; both improved online and offline accessibility, but only syntactic prominence elicited a repeated-name penalty. Our results have three important implications: first, the form of a referential expression interacts with an antecedent’s status in the discourse model during coreference; second, availability in memory and referential accessibility are separable; and finally, theories of coreference must better integrate known properties of the human memory system. PMID:24443621

  19. [The concepts of health access].

    PubMed

    Sanchez, Raquel Maia; Ciconelli, Rozana Mesquita

    2012-03-01

    This article describes four dimensions of health access-availability, acceptability, ability to pay and information-correlating these dimensions to indicators and discussing the complexity of the concept of access. For a study of these four dimensions, searches were conducted using the PubMed/MEDLINE, LILACS, SciELO, and World Health Organization Library & Information Networks for Knowledge (WHOLIS) databases. Large-circulation media vehicles, such as The Economist, The Washington Post, and the BBC network were also searched. The concept of health access has become more complex with time. The first analyses, carried out in the 1970s, suggested a strong emphasis on geographical (availability) and financial (ability to pay) aspects. More recently, the literature has focused on less tangible aspects, such as cultural, educational, and socioeconomic issues, incorporating the element of acceptability into the notion of health access. The literature also shows that information provides the starting point for access to health, in association with health empowerment and literacy for health care decision-making. The study concludes that improvements in access to health and the guarantee of equity will not be achieved by initiatives focusing on health care systems alone, but rather will depend on intersectoral actions and social and economic policies aimed at eliminating income and education differences.

  20. Next stages in HDR technology development

    SciTech Connect

    Duchane, D.V.

    1993-03-01

    Twenty years of research and development have brought HDR heat mining technology from the purely conceptual stage to the establishment of an engineering-scale heat mine at Fenton Hill, NM. In April 1992, a long-term flow test (LTFT) of the HDR reservoir at Fenton Hill was begun. The test was carried out under steady-state conditions on a continuous basis for four months, but a major equipment failure in late July forced a temporary suspension of operations. Even this short test provided valuable information and extremely encouraging results as summarized below: There was no indication of thermal drawdown of the reservoir. There was evidence of increasing access to hot rock with time. Water consumption was in the rangki of 10--12%. Measured pumping costs were $0.003 per kilowatt of energy produced. Temperature logs conducted in the reservoir production zone during and after the flow test confirmed the fact that there was no decline in the average temperature of the fluid being produced from the reservoir. In fact, tracer testing showed that the fluid was taking more indirect pathways and thus contacting a greater amount of hot rock as the test progressed. Water usage quickly dropped to a level of 10--15 gallons per minute, an amount equivalent to about 10--12% of the injected fluid volume. At a conversion rate of 10--15%, these would translate to effective ``fuel costs`` of 2--3{cents} per kilowatt hour of electricity production potential. The completion of the LTFT will set the stage for commercialization of HDR but will not bring HDR technology to maturity. Relatively samples extensions of the current technology may bring significant improvements in efficiency, and these should be rapidly investigated. In the longer run, advanced operational concepts could further improve the efficiency of HDR energy extraction and may even offer the possibility of cogeneration schemes which solve both energy and water problems throughout the world.

  1. First Stage of a Highly Reliable Reusable Launch System

    NASA Technical Reports Server (NTRS)

    Kloesel, Kurt J.; Pickrel, Jonathan B.; Sayles, Emily L.; Wright, Michael; Marriott, Darin; Holland, Leo; Kuznetsov, Stephen

    2009-01-01

    Electromagnetic launch assist has the potential to provide a highly reliable reusable first stage to a space access system infrastructure at a lower overall cost. This paper explores the benefits of a smaller system that adds the advantages of a high specific impulse air-breathing stage and supersonic launch speeds. The method of virtual specific impulse is introduced as a tool to emphasize the gains afforded by launch assist. Analysis shows launch assist can provide a 278-s virtual specific impulse for a first-stage solid rocket. Additional trajectory analysis demonstrates that a system composed of a launch-assisted first-stage ramjet plus a bipropellant second stage can provide a 48-percent gross lift-off weight reduction versus an all-rocket system. The combination of high-speed linear induction motors and ramjets is identified, as the enabling technologies and benchtop prototypes are investigated. The high-speed response of a standard 60 Hz linear induction motor was tested with a pulse width modulated variable frequency drive to 150 Hz using a 10-lb load, achieving 150 mph. A 300-Hz stator-compensated linear induction motor was constructed and static-tested to 1900 lbf average. A matching ramjet design was developed for use on the 300-Hz linear induction motor.

  2. Biomass accessibility analysis using electron tomography

    DOE PAGES

    Hinkle, Jacob D.; Ciesielski, Peter N.; Gruchalla, Kenny; Munch, Kristin R.; Donohoe, Bryon S.

    2015-12-25

    Substrate accessibility to catalysts has been a dominant theme in theories of biomass deconstruction. Furthermore, current methods of quantifying accessibility do not elucidate mechanisms for increased accessibility due to changes in microstructure following pretreatment.

  3. 36 CFR 228.12 - Access.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... other means of access, including but not limited to off-road vehicles, be used until the operator has... Minerals § 228.12 Access. An operator is entitled to access in connection with operations, but no...

  4. GEWEX-RFA Web Access Data

    Atmospheric Science Data Center

    2013-06-26

    ... access is restricted to assessment participants Maps and time series data products Details:  GEWEX-RFA Web Access Data Screenshot:  ... GEWEX Category:  FTP and Web Access for Select Products Screenshot 2:  ...

  5. Drama for Classroom and Stage.

    ERIC Educational Resources Information Center

    Johnson, Albert and Bertha

    This book with a three-part format contains information which the would-be thespian needs to know for maximum enjoyment and success in stage activities. The first part, "Heritage," traces the history and development of the theater from primitive ritual through the drama of classical Greece and Rome, the Renaissance, and modern Europe and America,…

  6. Stage 2--Information Seeking Strategies

    ERIC Educational Resources Information Center

    Elsenberg, Michael B.

    2005-01-01

    A brief overview of one Big6 stage by Mike Eisenberg, followed by articles by two exemplary Big6 teachers, Barbara Jansen and Rob Darrow, offering practical uses of the Big6 in elementary and secondary situations is presented. The two-part nature of information seeking strategies that includes brainstorming and choosing is emphasized.

  7. The Beginning Stages of Reading.

    ERIC Educational Resources Information Center

    Wilkie, Fiona, Comp.

    Noting that in the beginning stages of reading it is helpful for children to be surrounded by the written word and to be read to by adults, this article offers brief encapsulations of and responses to five articles about beginning reading and reading readiness. The five articles are as follows: (1) "Three-Year-Olds in Their Reading Corner" by…

  8. Ares I Stage Separation Test

    NASA Technical Reports Server (NTRS)

    2007-01-01

    Under the goals of the Vision for Space Exploration, Ares I is a chief component of the cost-effective space transportation infrastructure being developed by NASA's Constellation Program. This transportation system will safely and reliably carry human explorers back to the moon, and then onward to Mars and other destinations in the solar system. The Ares I effort includes multiple project element teams at NASA centers and contract organizations around the nation, and is managed by the Exploration Launch Projects Office at NASA's Marshall Space Flight Center (MFSC). ATK Launch Systems near Brigham City, Utah, is the prime contractor for the first stage booster. ATK's subcontractor, United Space Alliance of Houston, is designing, developing and testing the parachutes at its facilities at NASA's Kennedy Space Center in Florida. NASA's Johnson Space Center in Houston hosts the Constellation Program and Orion Crew Capsule Project Office and provides test instrumentation and support personnel. Together, these teams are developing vehicle hardware, evolving proven technologies, and testing components and systems. Their work builds on powerful, reliable space shuttle propulsion elements and nearly a half-century of NASA space flight experience and technological advances. Ares I is an inline, two-stage rocket configuration topped by the Crew Exploration Vehicle, its service module, and a launch abort system. In this HD video image, an Ares I x-test involves the upper stage separating from the first stage. This particular test was conducted at the NASA Langley Research Center in July 2007. (Highest resolution available)

  9. Multi-stage flash degaser

    DOEpatents

    Rapier, P.M.

    1980-06-26

    A multi-stage flash degaser is incorporated in an energy conversion system having a direct-contact, binary-fluid heat exchanger to remove essentially all of the noncondensable gases from geothermal brine ahead of the direct-contact binary-fluid heat exchanger in order that the heat exchanger and a turbine and condenser of the system can operate at optimal efficiency.

  10. All the World's a Stage

    ERIC Educational Resources Information Center

    Stanistreet, Paul

    2011-01-01

    Open Stages is Britain's biggest amateur theatre project, a hugely ambitious scheme to bring the professional and amateur theatre worlds together. It is a learning project but, as the Royal Shakespeare Company's Ian Wainwright tells this author, it is not only the amateurs who are learning. Wainwright states that the amateur and professional…

  11. Stage I: Development of VOICE.

    ERIC Educational Resources Information Center

    Echternacht, Gary J.; And Others

    The initial stages of test development of the Vocational and Occupational Interest Choice Examination (VOICE), developed for Air Force recruiters, are described. Reviewed are a number of relevant occupational interest inventories from which a pool of 400 items was drawn corresponding to eight career fields: general accounting, administration,…

  12. Development of an integrated staircase lift for home access

    PubMed Central

    Mattie, Johanne L.; Borisoff, Jaimie F.; Leland, Danny; Miller, William C.

    2015-01-01

    Purpose Stairways into buildings present a significant environmental barrier for those with mobility impairments, including older adults. A number of home access solutions that allow users to safely enter and exit the home exist, however these all have some limitations. The purpose of this work was to develop a novel, inclusive home access solution that integrates a staircase and a lift into one device. Method The development of an integrated staircase lift followed a structured protocol with stakeholders providing feedback at various stages in the design process, consistent with rehabilitation engineering design methods. Results A novel home access device was developed. The integrated staircase-lift has the following features: inclusivity, by a universal design that provides an option for either use of stairs or a lift; constant availability, with a lift platform always ready for use on either level; and potential aesthetic advantages when integrating the device into an existing home. The potential also exists for emergency descent during a power outage, and self-powered versions. Conclusions By engaging stakeholders in a user centred design process, insight on the limitations of existing home access solutions and specific feedback on our design guided development of a novel home access device. PMID:26793318

  13. Suitability and accessibility of immature Agrilus planipennis (Coleoptera: Buprestidae) stages to Tetrastichus planipennisi (Hymenoptera: Eulophidae)

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Tetrastichus planipennisi Yang (Hymenoptera: Eulophidae), a gregarious larval endoparasitoid, is one of three biocontrol agents from Asia currently being released in the United States to combat the invasive emerald ash borer (EAB), Agrilus planipennis Fairmaire. The current protocol for rearing T. ...

  14. Angling for Access, Bartering for Change: How Second-Stage Teachers Experience Differentiated Roles in Schools

    ERIC Educational Resources Information Center

    Donaldson, Morgaen L.; Johnson, Susan Moore; Kirkpatrick, Cheryl L.; Marinell, William H.; Steele, Jennifer L.; Szczesiul, Stacy Agee

    2008-01-01

    Background/Context: Increasingly, instructional reforms in US schools place teachers in differentiated roles, such as literacy coach or data analyst. Not only do these roles hold promise for reforming instruction, but they also may make the teaching career more rewarding by offering teachers new challenges over time. In the past, teachers who held…

  15. Breast cancer stage at diagnosis: is travel time important?

    PubMed

    Henry, Kevin A; Boscoe, Francis P; Johnson, Christopher J; Goldberg, Daniel W; Sherman, Recinda; Cockburn, Myles

    2011-12-01

    Recent studies have produced inconsistent results in their examination of the potential association between proximity to healthcare or mammography facilities and breast cancer stage at diagnosis. Using a multistate dataset, we re-examine this issue by investigating whether travel time to a patient's diagnosing facility or nearest mammography facility impacts breast cancer stage at diagnosis. We studied 161,619 women 40 years and older diagnosed with invasive breast cancer from ten state population based cancer registries in the United States. For each woman, we calculated travel time to their diagnosing facility and nearest mammography facility. Logistic multilevel models of late versus early stage were fitted, and odds ratios were calculated for travel times, controlling for age, race/ethnicity, census tract poverty, rural/urban residence, health insurance, and state random effects. Seventy-six percent of women in the study lived less than 20 min from their diagnosing facility, and 93 percent lived less than 20 min from the nearest mammography facility. Late stage at diagnosis was not associated with increasing travel time to diagnosing facility or nearest mammography facility. Diagnosis age under 50, Hispanic and Non-Hispanic Black race/ethnicity, high census tract poverty, and no health insurance were all significantly associated with late stage at diagnosis. Travel time to diagnosing facility or nearest mammography facility was not a determinant of late stage of breast cancer at diagnosis, and better geographic proximity did not assure more favorable stage distributions. Other factors beyond geographic proximity that can affect access should be evaluated more closely, including facility capacity, insurance acceptance, public transportation, and travel costs.

  16. CRYOGENIC UPPER STAGE SYSTEM SAFETY

    NASA Technical Reports Server (NTRS)

    Smith, R. Kenneth; French, James V.; LaRue, Peter F.; Taylor, James L.; Pollard, Kathy (Technical Monitor)

    2005-01-01

    NASA s Exploration Initiative will require development of many new systems or systems of systems. One specific example is that safe, affordable, and reliable upper stage systems to place cargo and crew in stable low earth orbit are urgently required. In this paper, we examine the failure history of previous upper stages with liquid oxygen (LOX)/liquid hydrogen (LH2) propulsion systems. Launch data from 1964 until midyear 2005 are analyzed and presented. This data analysis covers upper stage systems from the Ariane, Centaur, H-IIA, Saturn, and Atlas in addition to other vehicles. Upper stage propulsion system elements have the highest impact on reliability. This paper discusses failure occurrence in all aspects of the operational phases (Le., initial burn, coast, restarts, and trends in failure rates over time). In an effort to understand the likelihood of future failures in flight, we present timelines of engine system failures relevant to initial flight histories. Some evidence suggests that propulsion system failures as a result of design problems occur shortly after initial development of the propulsion system; whereas failures because of manufacturing or assembly processing errors may occur during any phase of the system builds process, This paper also explores the detectability of historical failures. Observations from this review are used to ascertain the potential for increased upper stage reliability given investments in integrated system health management. Based on a clear understanding of the failure and success history of previous efforts by multiple space hardware development groups, the paper will investigate potential improvements that can be realized through application of system safety principles.

  17. Operation of staged membrane oxidation reactor systems

    DOEpatents

    Repasky, John Michael

    2012-10-16

    A method of operating a multi-stage ion transport membrane oxidation system. The method comprises providing a multi-stage ion transport membrane oxidation system with at least a first membrane oxidation stage and a second membrane oxidation stage, operating the ion transport membrane oxidation system at operating conditions including a characteristic temperature of the first membrane oxidation stage and a characteristic temperature of the second membrane oxidation stage; and controlling the production capacity and/or the product quality by changing the characteristic temperature of the first membrane oxidation stage and/or changing the characteristic temperature of the second membrane oxidation stage.

  18. Overview of Transonic to Hypersonic Stage Separation Tool Development for Multi-Stage-to-Orbit Concepts

    NASA Technical Reports Server (NTRS)

    Murphy, Kelly J.; Bunning, Pieter G.; Pamadi, Bandu N.; Scallion, William I.; Jones, Kenneth M.

    2004-01-01

    An overview of research efforts at NASA in support of the stage separation and ascent aerothermodynamics research program is presented. The objective of this work is to develop a synergistic suite of experimental, computational, and engineering tools and methods to apply to vehicle separation across the transonic to hypersonic speed regimes. Proximity testing of a generic bimese wing-body configuration is on-going in the transonic (Mach numbers 0.6, 1.05, and 1.1), supersonic (Mach numbers 2.3, 3.0, and 4.5) and hypersonic (Mach numbers 6 and 10) speed regimes in four wind tunnel facilities at the NASA Langley Research Center. An overset grid, Navier-Stokes flow solver has been enhanced and demonstrated on a matrix of proximity cases and on a dynamic separation simulation of the bimese configuration. Steady-state predictions with this solver were in excellent agreement with wind tunnel data at Mach 3 as were predictions via a Cartesian-grid Euler solver. Experimental and computational data have been used to evaluate multi-body enhancements to the widely-used Aerodynamic Preliminary Analysis System, an engineering methodology, and to develop a new software package, SepSim, for the simulation and visualization of vehicle motions in a stage separation scenario. Web-based software will be used for archiving information generated from this research program into a database accessible to the user community. Thus, a framework has been established to study stage separation problems using coordinated experimental, computational, and engineering tools.

  19. [Medical journals and open access].

    PubMed

    Sember, Marijan

    2008-01-01

    The open access (OA) or the idea of a free access to scholarly literature published in electronic form has been already well established in the field of medicine. Medline has already been free for a decade, PubMed Central has been growing steadily. The global crisis of the scientific publishing, becoming increasingly dominated by multinational companies and constant increase of journal prices have moved to action not only individuals and institutions but governments and research charities too. The aim of this article is to give an overview of the main open access initiatives and resources in biomedicine (PubMed, PubMed Central, BioMed Central, PLoS). The OA pros and cons are briefly discussed emphasizing the benefits of OA to medical research and practice. PMID:18792564

  20. Dynamics of chromatin accessibility and gene regulation by MADS-domain transcription factors in flower development

    PubMed Central

    2014-01-01

    Background Development of eukaryotic organisms is controlled by transcription factors that trigger specific and global changes in gene expression programs. In plants, MADS-domain transcription factors act as master regulators of developmental switches and organ specification. However, the mechanisms by which these factors dynamically regulate the expression of their target genes at different developmental stages are still poorly understood. Results We characterized the relationship of chromatin accessibility, gene expression, and DNA binding of two MADS-domain proteins at different stages of Arabidopsis flower development. Dynamic changes in APETALA1 and SEPALLATA3 DNA binding correlated with changes in gene expression, and many of the target genes could be associated with the developmental stage in which they are transcriptionally controlled. We also observe dynamic changes in chromatin accessibility during flower development. Remarkably, DNA binding of APETALA1 and SEPALLATA3 is largely independent of the accessibility status of their binding regions and it can precede increases in DNA accessibility. These results suggest that APETALA1 and SEPALLATA3 may modulate chromatin accessibility, thereby facilitating access of other transcriptional regulators to their target genes. Conclusions Our findings indicate that different homeotic factors regulate partly overlapping, yet also distinctive sets of target genes in a partly stage-specific fashion. By combining the information from DNA-binding and gene expression data, we are able to propose models of stage-specific regulatory interactions, thereby addressing dynamics of regulatory networks throughout flower development. Furthermore, MADS-domain TFs may regulate gene expression by alternative strategies, one of which is modulation of chromatin accessibility. PMID:24581456

  1. Predictors of excessive renal displacement during access in percutaneous nephrolithotomy: a randomized clinical trial.

    PubMed

    Aminsharifi, Alireza; Haghpanah, Reza; Haghpanah, Sezaneh

    2014-02-01

    To determine the magnitude of renal displacement (a major cause of access failure or loss) during the renal access steps in percutaneous nephrolithotomy (PCNL), investigate predictors of excessive renal displacement, and compare the effect of one-stage versus gradual dilation on renal displacement during access. Sixty-six adult patients undergoing PCNL were randomized into two groups containing 33 patients each: Group 1 underwent gradual tract dilation with Alken metal dilators, and Group 2 received one-stage tract dilation. In each patient, maximum renal displacement was measured in three planes (cephalocaudal, anteroposterior, and mediolateral) during the three access steps (needle puncture, Alken guide insertion, and dilator advancement). The patients' demographic data and intraoperative parameters were compared. In both groups, net renal displacement during the three access steps was in the cephalad, medial, and anterior directions. There were no significant differences in the magnitude of renal displacement in patients with gradual versus one-stage tract dilation. Renal displacement was significantly more pronounced in all planes and in all access steps in female patients and in those with no previous history of open stone surgery on the ipsilateral kidney. High body mass index (BMI) showed a significant negative correlation with cephalad and anterior renal displacement, but not with medial displacement. Three-dimensional movement of the kidney during percutaneous access in PCNL is similar when gradual versus one-stage tract dilation is used. Inherent patient characteristics, such as female sex, BMI, and a previous ipsilateral flank scar are major determinants of the magnitude of renal displacement during the PCNL access steps. PMID:23963103

  2. Upper-Stage Flight Experiment

    NASA Technical Reports Server (NTRS)

    Anderson, W. E.; Boxwell, R.; Crockett, D. V.; Ross, R.; Lewis, T.; McNeal, C.; Verdarame, K.

    1999-01-01

    For propulsion applications that require that the propellants are storable for long periods, have a high density impulse, and are environmentally clean and non-toxic, the best choice is a combination of high-concentration hydrogen peroxide (High Test Peroxide, or HTP) and a liquid hydrocarbon (LHC) fuel. The HTP/LHC combination is suitable for low-cost launch vehicles, space taxi and space maneuvering vehicles, and kick stages. Orbital Sciences Corporation is under contract with the NASA Marshall Space Flight Center in cooperation with the Air Force Research Lab to design, develop and demonstrate a new low-cost liquid upper stage based on HTP and JP-8. The Upper Stage Flight Experiment (USFE) focuses on key technologies necessary to demonstrate the operation of an inherently simple propulsion system with an innovative, state-of-the-art structure. Two key low-cost vehicle elements will be demonstrated - a 10,000 lbf thrust engine and an integrated composite tank structure. The suborbital flight test of the USFE is scheduled for 2001. Preceding the flight tests are two major series of ground tests at NASA Stennis Space Center and a subscale tank development program to identify compatible composite materials and to verify their compatibility over long periods of time. The ground tests include a thrust chamber development test series and an integrated stage test. This paper summarizes the results from the first phase of the thrust chamber development tests and the results to date from the tank material compatibility tests. Engine and tank configurations that meet the goals of the program are described.

  3. Multi-stage flash degaser

    DOEpatents

    Rapier, Pascal M.

    1982-01-01

    A multi-stage flash degaser (18) is incorporated in an energy conversion system (10) having a direct-contact, binary-fluid heat exchanger to remove essentially all of the noncondensable gases from geothermal brine ahead of the direct-contact binary-fluid heat exchanger (22) in order that the heat exchanger (22) and a turbine (48) and condenser (32) of the system (10) can operate at optimal efficiency.

  4. Early stage of nanocrystal growth

    SciTech Connect

    2012-01-01

    Berkeley Lab researchers at the Molecular Foundry have elucidated important mechanisms behind oriented attachment, the phenomenon that drives biomineralization and the growth of nanocrystals. This electron microscopy movie shows the early stage of nanocrystal growth. Nanoparticles make transient contact at many points and orientations until their lattices are perfectly matched. The particles then make a sudden jump-to-contact to form attached aggregates. (Movie courtesy of Jim DeYoreo)

  5. Commercializing the transfer orbit stage

    NASA Technical Reports Server (NTRS)

    Miller, M. W.

    1984-01-01

    Key milestones necessary to establish the transfer orbit stage are examined. The selection of the project concept and synthesis of the company are described followed by an analysis venture capability support and the selection of a major aerospace company as prime contractor. A landmark agreement with NASA sanctioned the commercial TOS concept and provided the critical support necessary to raise the next round of venture capital. Project management and customer commitments are also discussed.

  6. Ares I Upper Stage Update

    NASA Technical Reports Server (NTRS)

    Davis, Daniel J.

    2010-01-01

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

  7. Functionalized Metallated Cavitands via Imidation and Late-Stage Elaboration

    PubMed Central

    Zhao, Yanchuan

    2015-01-01

    Efficient methods for the preparation of functionalized metallated cavitands are described. Functional groups can be either introduced by an imidation of metal-oxo complexes or by a late-stage elaboration of the imido ligands. By using diversified iminophosphorane (PPh3=NR) reagents, π-conjugated pyrene, redox active ferrocene and polymerizable norbornene moieties were successfully introduced. Furthermore, the iodo and alkynyl groups on the imido ligands are capable of undergoing efficient Sonogashira cross-coupling and copper-catalyzed azide alkyne cycloaddition reactions, thereby providing facile access to complex architectures containing metallated cavitands. PMID:26962300

  8. J-2X: Progress on the Ares Upper Stage Engine

    NASA Technical Reports Server (NTRS)

    Byrd, Thomas D.; Kynard, Michael H.

    2007-01-01

    NASA's Vision for Exploration requires a safe, reliable, affordable upper stage engine to power the Ares I Crew Launch Vehicle (CLV) and the Ares V Cargo Launch Vehicle (CaLV). The J-2X engine epitomizes NASA's philosophy of employing legacy knowledge, heritage hardware, and commonality to carry the next generation of explorers into low-Earth orbit and out into the solar system. As envisioned by the Exploration Systems Architecture Study (ESAS), the reference lunar mission would begin by launching the Ares V into orbit with the Earth Departure Stage (EDS) transporting the Lunar Surface Access Module (LSAM), followed by the Ares I, carrying the Orion Crew Exploration Vehicle, which would rendezvous with the EDS/LSAM before beginning its journey to the Moon.

  9. Reflexive Learning: Stages towards Wisdom with Dreyfus

    ERIC Educational Resources Information Center

    McPherson, Ian

    2005-01-01

    The Dreyfus (2001) account of seven stages of learning is considered in the context of the Dreyfus (1980s) account of five stages of skill development. The two new stages, Mastery and Practical Wisdom, make more explicit certain themes implicit in the five-stage account. In this way Dreyfus (2001) encourages a more reflexive approach. The themes…

  10. Equity for open-access journal publishing.

    PubMed

    Shieber, Stuart M

    2009-08-01

    Open-access journals, which provide access to their scholarly articles freely and without limitations, are at a systematic disadvantage relative to traditional closed-access journal publishing and its subscription-based business model. A simple, cost-effective remedy to this inequity could put open-access publishing on a path to become a sustainable, efficient system. PMID:19652697

  11. Educational Access in Bangladesh. Country Policy Brief

    ERIC Educational Resources Information Center

    Ahmed, Manzoor

    2008-01-01

    This Policy Brief describes and explains patterns of access to schooling in Bangladesh. It outlines types of educational provision and provides some basic statistics on access, vulnerability and exclusion, as well as insights into the characteristics of those denied access. It is based on findings from the "Country Analytic Review on Access to…

  12. Educational Access in India. Country Policy Brief

    ERIC Educational Resources Information Center

    Online Submission, 2009

    2009-01-01

    This Policy Brief describes and explains patterns of access to schools in India. It outlines policy and legislation on access to education and provides an analysis of access, vulnerability and exclusion. The quantitative data is supported by a review of research which explains the patterns of access and exclusion. It is based on findings from the…

  13. 5 CFR 2606.203 - Granting access.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... operational control over the records in a system of records determines that an individual seeking access has... Access to Records and Accounting of Disclosures § 2606.203 Granting access. (a) The methods for allowing... employees. Current or former employees requesting access to records pertaining to them in a system...

  14. 77 FR 26149 - Access Authorization Fees

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-03

    ... Access and Management System (ADAMS): You may access publicly available documents online in the NRC... 11--CRITERIA AND PROCEDURES FOR DETERMINING ELIGIBILITY FOR ACCESS TO OR CONTROL OVER SPECIAL NUCLEAR... RIN 3150-AJ00 Access Authorization Fees AGENCY: Nuclear Regulatory Commission. ACTION: Direct...

  15. 5 CFR 2606.203 - Granting access.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... operational control over the records in a system of records determines that an individual seeking access has... Access to Records and Accounting of Disclosures § 2606.203 Granting access. (a) The methods for allowing... employees. Current or former employees requesting access to records pertaining to them in a system...

  16. Educational Access in Ghana. Country Policy Brief

    ERIC Educational Resources Information Center

    Akyeampong, K.; Djangmah, J.; Oduro, A.; Seidu, A.; Hunt, F.

    2008-01-01

    This Policy Brief describes and explains patterns of access to schools in Ghana. It outlines policy and legislation on access to education and provides an analysis of access, vulnerability and exclusion. It is based on findings from the Country Analytic Report on Access to Basic Education in Ghana (Akyeampong et al, 2007) [ED508809] which can be…

  17. Virtual reality: emerging role of simulation training in vascular access.

    PubMed

    Davidson, Ingemar J A; Lok, Charmaine; Dolmatch, Bart; Gallieni, Maurizio; Nolen, Billy; Pittiruti, Mauro; Ross, John; Slakey, Douglas

    2012-11-01

    Evolving new technologies in vascular access mandate increased attention to patient safety; an often overlooked yet valuable training tool is simulation. For the end-stage renal disease patient, simulation tools are effective for all aspects of creating access for peritoneal dialysis and hemodialysis. Based on aviation principles, known as crew resource management, we place equal emphasis on team training as individual training to improve interactions between team members and systems, cumulating in improved safety. Simulation allows for environmental control and standardized procedures, letting the trainee practice and correct mistakes without harm to patients, compared with traditional patient-based training. Vascular access simulators range from suture devices, to pressurized tunneled conduits for needle cannulation, to computer-based interventional simulators. Simulation training includes simulated case learning, root cause analysis of adverse outcomes, and continual update and refinement of concepts. Implementation of effective human to complex systems interaction in end-stage renal disease patients involves a change in institutional culture. Three concepts discussed in this article are as follows: (1) the need for user-friendly systems and technology to enhance performance, (2) the necessity for members to both train and work together as a team, and (3) the team assigned to use the system must test and practice it to a proficient level before safely using the system on patients.

  18. Arts Accessibility for the Deaf.

    ERIC Educational Resources Information Center

    Bergman, Eugene

    The booklet provides information and resources for cultural organizations and institutions interested in making the arts accessible to deaf citizens. Preliminary information includes a discussion of deafness in America and the deaf in the history of the arts and notes that the era of silent films was the golden age of cinema. Listed are 36…

  19. RNA Accessibility in cubic time

    PubMed Central

    2011-01-01

    Background The accessibility of RNA binding motifs controls the efficacy of many biological processes. Examples are the binding of miRNA, siRNA or bacterial sRNA to their respective targets. Similarly, the accessibility of the Shine-Dalgarno sequence is essential for translation to start in prokaryotes. Furthermore, many classes of RNA binding proteins require the binding site to be single-stranded. Results We introduce a way to compute the accessibility of all intervals within an RNA sequence in (n3) time. This improves on previous implementations where only intervals of one defined length were computed in the same time. While the algorithm is in the same efficiency class as sampling approaches, the results, especially if the probabilities get small, are much more exact. Conclusions Our algorithm significantly speeds up methods for the prediction of RNA-RNA interactions and other applications that require the accessibility of RNA molecules. The algorithm is already available in the program RNAplfold of the ViennaRNA package. PMID:21388531

  20. Garnet Random-Access Memory

    NASA Technical Reports Server (NTRS)

    Katti, Romney R.

    1995-01-01

    Random-access memory (RAM) devices of proposed type exploit magneto-optical properties of magnetic garnets exhibiting perpendicular anisotropy. Magnetic writing and optical readout used. Provides nonvolatile storage and resists damage by ionizing radiation. Because of basic architecture and pinout requirements, most likely useful as small-capacity memory devices.

  1. Proximity Displays for Access Control

    ERIC Educational Resources Information Center

    Vaniea, Kami

    2012-01-01

    Managing access to shared digital information, such as photographs and documents. is difficult for end users who are accumulating an increasingly large and diverse collection of data that they want to share with others. Current policy-management solutions require a user to proactively seek out and open a separate policy-management interface when…

  2. Ballistic representation for kinematic access

    NASA Astrophysics Data System (ADS)

    Alfano, Salvatore

    2011-01-01

    This work uses simple two-body orbital dynamics to initially determine the kinematic access for a ballistic vehicle. Primarily this analysis was developed to assess when a rocket body might conjunct with an orbiting satellite platform. A family of access opportunities can be represented as a volume for a specific rocket relative to its launch platform. Alternately, the opportunities can be represented as a geographical footprint relative to aircraft or satellite position that encompasses all possible launcher locations for a specific rocket. A thrusting rocket is treated as a ballistic vehicle that receives all its energy at launch and follows a coasting trajectory. To do so, the rocket's burnout energy is used to find its equivalent initial velocity for a given launcher's altitude. Three kinematic access solutions are then found that account for spherical Earth rotation. One solution finds the maximum range for an ascent-only trajectory while another solution accommodates a descending trajectory. In addition, the ascent engagement for the descending trajectory is used to depict a rapid access scenario. These preliminary solutions are formulated to address ground-, sea-, or air-launched vehicles.

  3. Academic Access and New Learning

    ERIC Educational Resources Information Center

    Mandell, Alan; Herman, Lee

    2008-01-01

    Over the past 30+ years, many colleges have made themselves more accessible for adult students. These innovations include flexible scheduling, online learning, professionally-oriented degrees, and credit for what students already know. However, there is more work to be done, particularly in the areas of financial aid for the very large number of…

  4. Access & Equity Newsletter. Volume 6

    ERIC Educational Resources Information Center

    South Carolina Commission on Higher Education, 2004

    2004-01-01

    Included in this edition of the "In-the-Know" Access & Equity Newsletter are: (1) State Losing Black Instructors (Gina Smith); (2) Time to Join Together to Seek "Economic Rights" (Darla Moore); and (3) "Advancing Diversity in Higher Education--Diversity Digest" (Mark Giles, Ed.), which is a reprint of an article originally published in…

  5. AccessSTEM: Building Capacity

    ERIC Educational Resources Information Center

    DO-IT, 2009

    2009-01-01

    A series of activities were undertaken to understand the underrepresentation of people with disabilities in science, technology, engineering, and mathematics (STEM) careers and increase their participation in these fields. "AccessSTEM" collaborated with key stakeholders to conduct a "Capacity-Building Institute" ("CBI") in April 2009; share…

  6. The Inevitability of Open Access

    ERIC Educational Resources Information Center

    Lewis, David W.

    2012-01-01

    Open access (OA) is an alternative business model for the publication of scholarly journals. It makes articles freely available to readers on the Internet and covers the costs associated with publication through means other than subscriptions. This article argues that Gold OA, where all of the articles of a journal are available at the time of…

  7. Accessibility: Maximum Mobility and Function.

    ERIC Educational Resources Information Center

    Smyser, Michael

    2003-01-01

    Describes how to design school and university labs to comply with Americans with Disabilities Act (ADA) standards, focusing on counter height for students in wheelchairs; appropriate knee space and sink height in sink areas; ADA-compliant fume hoods; accessible laboratory doors and entryways; and safety concerns (e.g., emergency eyewash stations…

  8. LANSCE personnel access control system

    SciTech Connect

    Sturrock, J.C.; Gallegos, F.R.; Hall, M.J.

    1997-01-01

    The Radiation Security System (RSS) at the Los Alamos Neutron Science Center (LANSCE) provides personnel protection from prompt radiation due to accelerated beam. The Personnel Access Control System (PACS) is a component of the RSS that is designed to prevent personnel access to areas where prompt radiation is a hazard. PACS was designed to replace several older personnel safety systems (PSS) with a single modem unified design. Lessons learned from the operation over the last 20 years were incorporated into a redundant sensor, single-point failure safe, fault tolerant, and tamper-resistant system that prevents access to the beam areas by controlling the access keys and beam stoppers. PACS uses a layered philosophy to the physical and electronic design. The most critical assemblies are battery backed up, relay logic circuits; less critical devices use Programmable Logic Controllers (PLCs) for timing functions and communications. Outside reviewers have reviewed the operational safety of the design. The design philosophy, lessons learned, hardware design, software design, operation, and limitations of the device are described.

  9. Accessing ITP: Accommodating the Disabled.

    ERIC Educational Resources Information Center

    Stewart, R. Wayne

    The Information Technology Project (ITP) at Clayton College & State University (CCSU) (Georgia) focuses on information technology as a central part of teaching and learning, primarily through Universal Personal Information Technology Access (UPITA). UPITA equips each student and faculty member with a powerful multimedia notebook computer with…

  10. Minorities Access to Research Careers.

    ERIC Educational Resources Information Center

    American Association of State Colleges and Universities, Washington, DC.

    The Minorities Access to Research Careers (MARC) program at Hunter College, New York is designed to provide an in-depth 2-year research training experience for minority students in order to prepare them for graduate school and eventual research careers in alcohol, drug abuse, and mental health fields. The target groups include Blacks, Hispanics,…

  11. Plated wire random access memories

    NASA Technical Reports Server (NTRS)

    Gouldin, L. D.

    1975-01-01

    A program was conducted to construct 4096-work by 18-bit random access, NDRO-plated wire memory units. The memory units were subjected to comprehensive functional and environmental tests at the end-item level to verify comformance with the specified requirements. A technical description of the unit is given, along with acceptance test data sheets.

  12. Accessible Computers from the Box.

    ERIC Educational Resources Information Center

    Vanderheiden, Gregg C.

    The paper briefly discusses the design of computers to allow their use by the 20% of the American population who have reduced abilities in such areas as manipulation, vision, hearing, and cognition. The role of manufacturers of standard computers in increasing computer accessibility is one of providing computers that can be used by an increasing…

  13. Remotely Accessible Management System (RAMS).

    ERIC Educational Resources Information Center

    Wood, Rex

    Oakland Schools, an Intermediate School District for Administration, operates a Remotely Accessible Management System (RAMS). RAMS is composed of over 100 computer programs, each of which performs procedures on the files of the 28 local school districts comprising the constituency of Oakland Schools. This regional service agency covers 900 square…

  14. Card Access Know-How.

    ERIC Educational Resources Information Center

    College Planning & Management, 2000

    2000-01-01

    Provides tips for expanding a school's card access system and making it more productive for all concerned. Tips include the use of electronic locks for better security; the need for state-of-the-art card reader system to save money in the long run; selecting vendors to one that manufactures, installs, and supports the card system; and having…

  15. Saturn IB First Stage (S-IB Stage) at MSFC

    NASA Technical Reports Server (NTRS)

    1965-01-01

    S-IB-200D, a dynamic test version of the Saturn IB launch vehicle's first stage (S-IB), makes its way to the Marshall Space Flight Center (MSFC) East Test Area on January 4, 1965. Test Laboratory persornel assembled a complete Saturn IB to test the structural soundness of the launch vehicle in the Dynamic Test Stand. Developed by the MSFC as an interim vehicle in MSFC's 'building block' approach to the Saturn rocket development, the Saturn IB utilized Saturn I technology to further develop and refine the larger boosters and the Apollo spacecraft capabilities required for the manned lunar missions.

  16. Controlling Access to Suicide Means

    PubMed Central

    Sarchiapone, Marco; Mandelli, Laura; Iosue, Miriam; Andrisano, Costanza; Roy, Alec

    2011-01-01

    Background: Restricting access to common means of suicide, such as firearms, toxic gas, pesticides and other, has been shown to be effective in reducing rates of death in suicide. In the present review we aimed to summarize the empirical and clinical literature on controlling the access to means of suicide. Methods: This review made use of both MEDLINE, ISI Web of Science and the Cochrane library databases, identifying all English articles with the keywords “suicide means”, “suicide method”, “suicide prediction” or “suicide prevention” and other relevant keywords. Results: A number of factors may influence an individual’s decision regarding method in a suicide act, but there is substantial support that easy access influences the choice of method. In many countries, restrictions of access to common means of suicide has lead to lower overall suicide rates, particularly regarding suicide by firearms in USA, detoxification of domestic and motor vehicle gas in England and other countries, toxic pesticides in rural areas, barriers at jumping sites and hanging, by introducing “safe rooms” in prisons and hospitals. Moreover, decline in prescription of barbiturates and tricyclic antidepressants (TCAs), as well as limitation of drugs pack size for paracetamol and salicylate has reduced suicides by overdose, while increased prescription of SSRIs seems to have lowered suicidal rates. Conclusions: Restriction to means of suicide may be particularly effective in contexts where the method is popular, highly lethal, widely available, and/or not easily substituted by other similar methods. However, since there is some risk of means substitution, restriction of access should be implemented in conjunction with other suicide prevention strategies. PMID:22408588

  17. Automated Computer Access Request System

    NASA Technical Reports Server (NTRS)

    Snook, Bryan E.

    2010-01-01

    The Automated Computer Access Request (AutoCAR) system is a Web-based account provisioning application that replaces the time-consuming paper-based computer-access request process at Johnson Space Center (JSC). Auto- CAR combines rules-based and role-based functionality in one application to provide a centralized system that is easily and widely accessible. The system features a work-flow engine that facilitates request routing, a user registration directory containing contact information and user metadata, an access request submission and tracking process, and a system administrator account management component. This provides full, end-to-end disposition approval chain accountability from the moment a request is submitted. By blending both rules-based and rolebased functionality, AutoCAR has the flexibility to route requests based on a user s nationality, JSC affiliation status, and other export-control requirements, while ensuring a user s request is addressed by either a primary or backup approver. All user accounts that are tracked in AutoCAR are recorded and mapped to the native operating system schema on the target platform where user accounts reside. This allows for future extensibility for supporting creation, deletion, and account management directly on the target platforms by way of AutoCAR. The system s directory-based lookup and day-today change analysis of directory information determines personnel moves, deletions, and additions, and automatically notifies a user via e-mail to revalidate his/her account access as a result of such changes. AutoCAR is a Microsoft classic active server page (ASP) application hosted on a Microsoft Internet Information Server (IIS).

  18. Neurophysiological correlates of mismatch in lexical access

    PubMed Central

    Friedrich, Claudia K

    2005-01-01

    Background In the present study neurophysiological correlates related to mismatching information in lexical access were investigated with a fragment priming paradigm. Event-related brain potentials were recorded for written words following spoken word onsets that either matched (e.g., kan – Kante [Engl. edge]), partially mismatched (e.g., kan – Konto [Engl. account]), or were unrelated (e.g., kan – Zunge [Engl. tongue]). Previous psycholinguistic research postulated the activation of multiple words in the listeners' mental lexicon which compete for recognition. Accordingly, matching words were assumed to be strongly activated competitors, which inhibit less strongly activated partially mismatching words. Results ERPs for matching and unrelated control words differed between 300 and 400 ms. Difference waves (unrelated control words – matching words) replicate a left-hemispheric P350 effect in this time window. Although smaller than for matching words, a P350 effect and behavioural facilitation was also found for partially mismatching words. Minimum norm solutions point to a left hemispheric centro-temporal source of the P350 effect in both conditions. The P350 is interpreted as a neurophysiological index for the activation of matching words in the listeners' mental lexicon. In contrast to the P350 and the behavioural responses, a brain potential ranging between 350 and 500 ms (N400) was found to be equally reduced for matching and partially mismatching words as compared to unrelated control words. This latter effect might be related to strategic mechanisms in the priming situation. Conclusion A left-hemispheric neuronal network engaged in lexical access appears to be gradually activated by matching and partially mismatching words. Results suggest that neural processing of matching words does not inhibit processing of partially mismatching words during early stages of lexical identification. Furthermore, the present results indicate that neurophysiological

  19. Remote I/O : fast access to distant storage.

    SciTech Connect

    Foster, I.; Kohr, D., Jr.; Krishnaiyer, R.; Mogill, J.

    1997-12-17

    As high-speed networks make it easier to use distributed resources, it becomes increasingly common that applications and their data are not colocated. Users have traditionally addressed this problem by manually staging data to and from remote computers. We argue instead for a new remote I/O paradigm in which programs use familiar parallel I/O interfaces to access remote file systems. In addition to simplifying remote execution, remote I/O can improve performance relative to staging by overlapping computation and data transfer or by reducing communication requirements. However, remote I/O also introduces new technical challenges in the areas of portability, performance, and integration with distributed computing systems. We propose techniques designed to address these challenges and describe a remote I/O library called RIO that we have developed to evaluate the effectiveness of these techniques. RIO addresses issues of portability by adopting the quasi-standard MPI-IO interface and by defining a RIO device and RIO server within the ADIO abstract I/O device architecture. It addresses performance issues by providing traditional I/O optimizations such as asynchronous operations and through implementation techniques such as buffering and message forwarding to off load communication overheads. RIO uses the Nexus communication library to obtain access to configuration and security mechanisms provided by the Globus wide area computing tool kit. Microbenchmarks and application experiments demonstrate that our techniques achieve acceptable performance in most situations and can improve turnaround time relative to staging.

  20. Selective access and editing in a database

    NASA Technical Reports Server (NTRS)

    Maluf, David A. (Inventor); Gawdiak, Yuri O. (Inventor)

    2010-01-01

    Method and system for providing selective access to different portions of a database by different subgroups of database users. Where N users are involved, up to 2.sup.N-1 distinguishable access subgroups in a group space can be formed, where no two access subgroups have the same members. Two or more members of a given access subgroup can edit, substantially simultaneously, a document accessible to each member.