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Sample records for airway management techniques

  1. Airway management in emergency situations.

    PubMed

    Dörges, Volker

    2005-12-01

    Securing and monitoring the airway are among the key requirements of appropriate therapy in emergency patients. Failures to secure the airways can drastically increase morbidity and mortality of patients within a very short time. Therefore, the entire range of measures needed to secure the airway in an emergency, without intermediate ventilation and oxygenation, is limited to 30-40 seconds. Endotracheal intubation is often called the 'gold standard' for airway management in an emergency, but multiple failed intubation attempts do not result in maintaining oxygenation; instead, they endanger the patient by prolonging hypoxia and causing additional trauma to the upper airways. Thus, knowledge and availability of alternative procedures are also essential in every emergency setting. Given the great variety of techniques available, it is important to establish a well-planned, methodical protocol within the framework of an algorithm. This not only facilitates the preparation of equipment and the training of personnel, it also ensures efficient decision-making under time pressure. Most anaesthesia-related deaths are due to hypoxaemia when difficulty in securing the airway is encountered, especially in obstetrics during induction of anaesthesia for caesarean delivery. The most commonly occurring adverse respiratory events are failure to intubate, failure to recognize oesophageal intubation, and failure to ventilate. Thus, it is essential that every anaesthesiologist working on the labour and delivery ward is comfortable with the algorithm for the management of failed intubation. The algorithm for emergency airway management describing the sequence of various procedures has to be adapted to internal standards and to techniques that are available.

  2. Airway management for cervical spine surgery.

    PubMed

    Farag, Ehab

    2016-03-01

    Cervical spine surgery is one of the most commonly performed spine surgeries in the United States, and 90% of the cases are related to degenerative cervical spine disease (the rest to cervical spine trauma and/or instability). The airway management for cervical spine surgery represents a crucial step in the anesthetic management to avoid injury to the cervical cord. The crux for upper airway management for cervical spine surgery is maintaining the neck in a neutral position with minimal neck movement during endotracheal intubation. Therefore, the conventional direct laryngoscopy (DL) can be unsuitable for securing the upper airway in cervical spine surgery, especially in cases of cervical spine instability and myelopathy. This review discusses the most recent evidence-based facts of the main advantages and limitations of different techniques available for upper airway management for cervical spine surgery.

  3. Techniques of endoscopic airway tumor treatment

    PubMed Central

    Mhanna, Laurent; Droneau, Sylvain; Plat, Gavin; Didier, Alain; Mazieres, Julien; Hermant, Christophe

    2016-01-01

    Interventional bronchoscopy has a predominant role in the management of both early and advanced-stage airway tumors. Given the very poor prognosis of lung cancer, there is a need for new tools to improve early detection and bronchoscopic treatment of endo-bronchial precancerous lesions. In more advanced stages, interventional bronchoscopy plays an important role, as nearly a third of lung cancers lead to proximal airway obstruction. This will cause great discomfort or even life-threatening symptoms related to local extension, such as dyspnea, post-obstructive pneumonia, and hemoptysis. Surgery for very locally advanced disease is only effective for a limited number of patients and the effects of conventional antitumor therapies, like radiation therapy or chemotherapy, are inconstant and are too delayed in a palliative context. In this review, we aim to provide pulmonologists with an exhaustive technical overview of (I) the bronchoscopic management of benign endobronchial lesions; (II) the bronchoscopic management of malignant tumors, including the curative treatment of localized lesions and palliative management of malignant proximal airway stenosis; and (III) descriptions of the emerging endoscopic techniques used to treat peripheral lung tumors. PMID:28066616

  4. Central airway tumors: interventional bronchoscopy in diagnosis and management

    PubMed Central

    Lin, Chun-Yu

    2016-01-01

    The diagnosis of central airway tumors is usually challenging because of the vague presentations. Advances in visualization technology in bronchoscopy aid early detection of bronchial lesion. Cryotechnology has great impact on endobronchial lesion sampling and provides better diagnostic yield. Airway tumor involvements result in significant alteration in life quality and lead to poor life expectancy. Timely and efficiently use ablation techniques by heat or cold energy provide symptoms relief for central airway obstruction. Prostheses implantation is effective in maintaining airway patency after ablative procedure or external compression. Combined interventional bronchoscopy modalities and other adjunctive therapies have improvement in quality of life and further benefit in survival. This review aims to provide a diagnostic approach to central airway tumors and an overview of currently available techniques of interventional bronchoscopy in managing symptomatic central airway obstruction. PMID:27867582

  5. Airway management: induced tension pneumoperitoneum

    PubMed Central

    Ahmed, Khedher; Amine, El Ghali Mohamed; Abdelbaki, Azouzi; Jihene, Ayachi; Khaoula, Meddeb; Yamina, Hamdaoui; Mohamed, Boussarsar

    2016-01-01

    Pneumoperitoneum is not always associated with hollow viscus perforation. Such condition is called non-surgical or spontaneous pneumoperitoneum. Intrathoracic causes remain the most frequently reported mechanism inducing this potentially life threatening complication. This clinical condition is associated with therapeutic dilemma. We report a case of a massive isolated pneumoperitoneum causing acute abdominal hypertension syndrome, in a 75 year female, which occurred after difficult airway management and mechanical ventilation. Emergent laparotomy yielded to full recovery. The recognition of such cases for whom surgical management can be avoided is primordial to avoid unnecessary laparotomy and its associated morbidity particularly in the critically ill.

  6. Recent trends in airway management

    PubMed Central

    Karlik, Joelle; Aziz, Michael

    2017-01-01

    Tracheal intubation remains a life-saving procedure that is typically not difficult for experienced providers in routine conditions. Unfortunately, difficult intubation remains challenging to predict and intubation conditions may make the event life threatening. Recent technological advances aim to further improve the ease, speed, safety, and success of intubation but have not been fully investigated. Video laryngoscopy, though proven effective in the difficult airway, may result in different intubation success rates in various settings and in different providers’ hands. The rescue surgical airway remains a rarely used but critical skill, and research continues to investigate optimal techniques. This review highlights some of the new thoughts and research on these important topics. PMID:28299194

  7. Comments to Role of upper airway ultrasound in airway management.

    PubMed

    Lien, Wan-Ching

    2017-01-01

    Tracheal ultrasound can be an alternative diagnostic tool in airway management, besides traditional confirmatory methods such as capnography and auscultation. The standard image is a hyperechoic air-mucosa (A-M) interface with a reverberation artifact posteriorly (comet-tail artifact). If the second A-M interface appears, which we call a "double-tract sign," esophageal intubation is considered.

  8. [Airway clearance techniques in chronic obstructive pulmonary syndrome : 2011 update].

    PubMed

    Opdekamp, C

    2011-09-01

    For many years the airway clearance techniques used in chest physical therapy were assimilated with the singular technique of postural drainage, percussions and vibrations. However the side effects and counter indications and the lack of scientific proof regarding this technique have forced reflection and development of other techniques more comfortable and without deleterious effects. If all these techniques show a high efficiency in terms of improved mucociliary clearance, the literature is unanimous on how little effect these techniques have in the short and the long-term with regards to lung function and arterial blood gases. In view of the scientific literature, it is clear that the airway clearance techniques don't have the same recognition concerning their efficiency in all obstructive pulmonary diseases. As the cornerstone in the management of cystic fibrosis, the efficiency of the bronchial hygiene techniques are in general poorly documented in the management of the non-cystic fibrosis bronchiectasis, bronchitis or emphysema. The use of the chest physical therapy seems more to do with the interpretation of the imagery and symptomatology. The airway clearance techniques should be individualised according to symptoms, the amount of expectorated mucus and the objectives signs of secretions retention or subjective signs of difficulty expectorating secretions with progression of the disease.

  9. Difficult Airway Response Team: A Novel Quality Improvement Program for Managing Hospital-Wide Airway Emergencies

    PubMed Central

    Mark, Lynette J.; Herzer, Kurt R.; Cover, Renee; Pandian, Vinciya; Bhatti, Nasir I.; Berkow, Lauren C.; Haut, Elliott R.; Hillel, Alexander T.; Miller, Christina R.; Feller-Kopman, David J.; Schiavi, Adam J.; Xie, Yanjun J.; Lim, Christine; Holzmueller, Christine; Ahmad, Mueen; Thomas, Pradeep; Flint, Paul W.; Mirski, Marek A.

    2015-01-01

    Background Difficult airway cases can quickly become emergencies, increasing the risk of life-threatening complications or death. Emergency airway management outside the operating room is particularly challenging. Methods We developed a quality improvement program—the Difficult Airway Response Team (DART)—to improve emergency airway management outside the operating room. DART was implemented by a team of anesthesiologists, otolaryngologists, trauma surgeons, emergency medicine physicians, and risk managers in 2005 at The Johns Hopkins Hospital in Baltimore, Maryland. The DART program had three core components: operations, safety, and education. The operations component focused on developing a multidisciplinary difficult airway response team, standardizing the emergency response process, and deploying difficult airway equipment carts throughout the hospital. The safety component focused on real-time monitoring of DART activations and learning from past DART events to continuously improve system-level performance. This objective entailed monitoring the paging system, reporting difficult airway events and DART activations to a web-based registry, and using in situ simulations to identify and mitigate defects in the emergency airway management process. The educational component included development of a multispecialty difficult airway curriculum encompassing case-based lectures, simulation, and team building/communication to ensure consistency of care. Educational materials were also developed for non-DART staff and patients to inform them about the needs of patients with difficult airways and ensure continuity of care with other providers after discharge. Results Between July 2008 and June 2013, DART managed 360 adult difficult airway events comprising 8% of all code activations. Predisposing patient factors included body mass index > 40, history of head and neck tumor, prior difficult intubation, cervical spine injury, airway edema, airway bleeding, and previous

  10. Cine CT technique for dynamic airway studies

    SciTech Connect

    Ell, S.R.; Jolles, H.; Keyes, W.D.; Galvin, J.R.

    1985-07-01

    The advent of cine CT scanning with its 50-msec data acquisition time promises a much wider range of dynamic CT studies. The authors describe a method for dynamic evaluation of the extrathoracic airway, which they believe has considerable potential application in nonfixed upper-airway disease, such as sleep apnea and stridor of unknown cause. Conventional CT is limited in such studies by long data acquisition time and can be used to study only prolonged maneuvers such as phonation. Fluoroscopy and digital subtraction studies are limited by relatively high radiation dose and inability to image all wall motions simultaneously.

  11. Techniques of assessing small airways dysfunction

    PubMed Central

    McNulty, William; Usmani, Omar S.

    2014-01-01

    The small airways are defined as those less than 2 mm in diameter. They are a major site of pathology in many lung diseases, not least chronic obstructive pulmonary disease (COPD) and asthma. The small airways are frequently involved early in the course of these diseases, with significant pathology demonstrable often before the onset of symptoms or changes in spirometry and imaging. Despite their importance, they have proven relatively difficult to study. This is in part due to their relative inaccessibility to biopsy and their small size which makes their imaging difficult. Traditional lung function tests may only become abnormal once there is a significant burden of disease within them. This has led to the term ‘the quiet zone’ of the lung. In recent years, more specialised tests have been developed which may detect these changes earlier, perhaps offering the possibility of earlier diagnosis and intervention. These tests are now moving from the realms of clinical research laboratories into routine clinical practice and are increasingly useful in the diagnosis and monitoring of respiratory diseases. This article gives an overview of small airways physiology and some of the routine and more advanced tests of airway function. PMID:26557240

  12. Strategies and algorithms for management of the difficult airway.

    PubMed

    Heidegger, Thomas; Gerig, Hans J; Henderson, John J

    2005-12-01

    Management of the difficult airway is the most important patient safety issue in the practice of anaesthesia. Many national societies have developed algorithms and guidelines for management of the difficult airway. The key issues of this chapter are definition of terms, the advantages and disadvantages of the use of guidelines, and a comparison of different algorithms and guidelines for management of the most important clinical airway scenarios. Although there is no strong evidence of benefit for any specific strategy or algorithm for management of the difficult airway, there is strong agreement that a pre-planned strategy may lead to improved outcome.

  13. MOEBIUS SYNDROME: CHALLENGES OF AIRWAY MANAGEMENT.

    PubMed

    Budić, Ivana; Šurdilović, Dušan; Slavković, Anđelka; Marjanović, Vesna; Stević, Marija; Simić, Dušica

    2016-03-01

    Moebius syndrome is a rare nonprogressive congenital neurological disorder with a wide range of severity and variability of symptoms. This diversity is a consequence of dysfunction of different cranial nerves (most often facial and abducens nerves), accompanying orofacial abnormalities, musculoskeletal malformations, congenital cardiac diseases, as well as specific associations of Moebius and other syndromes. The authors present anesthesia and airway management during the multiple tooth extraction surgery in a 10-year-old girl with Moebius syndrome associated with Poland and trigeminal trophic syndromes.

  14. Improving the safety of remote site emergency airway management.

    PubMed

    Wijesuriya, Julian; Brand, Jonathan

    2014-01-01

    Airway management, particularly in non-theatre settings, is an area of anaesthesia and critical care associated with significant risk of morbidity & mortality, as highlighted during the 4th National Audit Project of the Royal College of Anaesthetists (NAP4). A survey of junior anaesthetists at our hospital highlighted a lack of confidence and perceived lack of safety in emergency airway management, especially in non-theatre settings. We developed and implemented a multifaceted airway package designed to improve the safety of remote site airway management. A Rapid Sequence Induction (RSI) checklist was developed; this was combined with new advanced airway equipment and drugs bags. Additionally, new carbon dioxide detector filters were procured in order to comply with NAP4 monitoring recommendations. The RSI checklists were placed in key locations throughout the hospital and the drugs and advanced airway equipment bags were centralised in the Intensive Care Unit (ICU). It was agreed with the senior nursing staff that an appropriately trained ICU nurse would attend all emergency situations with new airway resources upon request. Departmental guidelines were updated to include details of the new resources and the on-call anaesthetist's responsibilities regarding checks and maintenance. Following our intervention trainees reported higher confidence levels regarding remote site emergency airway management. Nine trusts within the Northern Region were surveyed and we found large variations in the provision of remote site airway management resources. Complications in remote site airway management due lack of available appropriate drugs, equipment or trained staff are potentially life threatening and completely avoidable. Utilising the intervention package an anaesthetist would be able to safely plan and prepare for airway management in any setting. They would subsequently have the drugs, equipment, and trained assistance required to manage any difficulties or complications

  15. EXIT procedure: technique and indications with prenatal imaging parameters for assessment of airway patency.

    PubMed

    Dighe, Manjiri K; Peterson, Suzanne E; Dubinsky, Theodore J; Perkins, Jonathan; Cheng, Edith

    2011-01-01

    Successful management of fetal conditions in which airway obstruction is anticipated is now possible because of advances in prenatal imaging and the development of innovative techniques to secure the fetal airway before complete separation of the fetus from the maternal circulation. Fetal ultrasonography and fetal magnetic resonance imaging are complementary imaging modalities in the assessment of fetuses with potential airway obstruction. The ex utero intrapartum therapy (EXIT) procedure is used to secure the fetal airway before complete delivery of the fetus. However, successful intrapartum treatment of fetuses who may need prolonged placental support depends on a multidisciplinary assessment in which the benefits of the EXIT procedure for the fetus are weighed against the risk of maternal complications that may occur during prolongation of the intrapartum period to secure the fetal airway. This multidisciplinary approach requires an understanding of the types of lesions in which intrapartum fetal airway access would be beneficial, a knowledge of the prenatal images that would best delineate the anatomic defect and thus help guide the best approach to securing the airway, and consensus and coordination among medical ethicists, radiologists, obstetric anesthesiologists and obstetricians, pediatric surgeons and anesthesiologists, and neonatologists.

  16. Oxygenation, Ventilation, and Airway Management in Out-of-Hospital Cardiac Arrest: A Review

    PubMed Central

    Henlin, Tomas; Michalek, Pavel; Tyll, Tomas; Hinds, John D.; Dobias, Milos

    2014-01-01

    Recently published evidence has challenged some protocols related to oxygenation, ventilation, and airway management for out-of-hospital cardiac arrest. Interrupting chest compressions to attempt airway intervention in the early stages of OHCA in adults may worsen patient outcomes. The change of BLS algorithms from ABC to CAB was recommended by the AHA in 2010. Passive insufflation of oxygen into a patent airway may provide oxygenation in the early stages of cardiac arrest. Various alternatives to tracheal intubation or bag-mask ventilation have been trialled for prehospital airway management. Simple methods of airway management are associated with similar outcomes as tracheal intubation in patients with OHCA. The insertion of a laryngeal mask airway is probably associated with worse neurologically intact survival rates in comparison with other methods of airway management. Hyperoxemia following OHCA may have a deleterious effect on the neurological recovery of patients. Extracorporeal oxygenation techniques have been utilized by specialized centers, though their use in OHCA remains controversial. Chest hyperinflation and positive airway pressure may have a negative impact on hemodynamics during resuscitation and should be avoided. Dyscarbia in the postresuscitation period is relatively common, mainly in association with therapeutic hypothermia, and may worsen neurological outcome. PMID:24724081

  17. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults.

    PubMed

    Frerk, C; Mitchell, V S; McNarry, A F; Mendonca, C; Bhagrath, R; Patel, A; O'Sullivan, E P; Woodall, N M; Ahmad, I

    2015-12-01

    These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team.

  18. An Anesthesiologist's Perspective on the History of Basic Airway Management: The "Preanesthetic" Era-1700 to 1846.

    PubMed

    Matioc, Adrian A

    2016-02-01

    Basic airway management modern history starts in the early 18th century in the context of resuscitation of the apparently dead. History saw the rise and fall of the mouth-to-mouth and then of the instrumental positive-pressure ventilation generated by bellows. Pulmonary ventilation had a secondary role to external and internal organ stimulation in resuscitation of the apparently dead. Airway access for the extraglottic technique was to the victim's nose. The bellows-to-nose technique was the "basic airway management technique" applicable by both medical and nonmedical personnel. Although the techniques had been described at the time, very few physicians practiced glottic (intubation) and subglottic (tracheotomy) techniques. Before the anesthetic era, positive-pressure ventilation was discredited and replaced by manual negative-pressure techniques. In the middle of the 19th century, physicians who would soon administer anesthetic gases were unfamiliar with the positive-pressure ventilation concept.

  19. Evaluation of Fastrach Laryngeal Mask Airway as an Alternative to Fiberoptic Bronchoscope to Manage Difficult Airway: A Comparative Study

    PubMed Central

    Shyam, Radhey; Sachan, Pushplata; Singh, Prithvi Kumar; Singh, Gyan Prakash; Bhatia, Vinod Kumar; Chandra, Girish; Singh, Dinesh

    2017-01-01

    Introduction Awake intubation via Fiberoptic Bronchoscope (FB) is the gold standard for management of difficult airway but patients had to face problems like oxygen desaturation, tachycardia, hypertension and anxiety due to awake state. This study was conducted to assess feasibility of Fastrach Laryngeal Mask Airway (FLMA) to manage difficult airway as a conduit for intubation as well as for ventilation. Materials and Methods After ethical approval and informed consent, 60 patients with difficult airway were randomly enrolled in FB group and FLMA group. In FB group, patients were sedated with midazolam/fentanyl. Airway anaesthetization of oropharynx was done with xylocaine spray and viscous and larynx and trachea by superior laryngeal nerve block and transtracheal block respectively. In FLMA group, initially patients were induced with propofol for FLMA insertion then succinylcholine was given for Tracheal Intubation (TI). The first TI attempt was done blindly via the FLMA and all subsequent attempts were performed with fiberoptic guidance. Haemodynamic monitoring was done during induction, intubation, immediately post insertion and there after at five minutes interval for 30 minutes. Results All patients in the FLMA group were successfully ventilated (100%). In both the groups 28 (93.33%) patients were successfully intubated. However, first/second/third attempt intubation rate in FLMA vs FB group was 15 (50%) vs 13 (43.3%), 8 (26.66%) vs 10 (33.33%) and 5 (16.66%) in both groups respectively. Patients in the FLMA group were more satisfied with their method of TI and had lesser complications (p<0.05). Conclusion So the FLMA may be a better technique for management of patients with difficult airways. PMID:28274023

  20. Airway management using a supraglottic airway device without endotracheal intubation for positive ventilation of anaesthetized rats.

    PubMed

    Cheong, S H; Lee, J H; Kim, M H; Cho, K R; Lim, S H; Lee, K M; Park, M Y; Yang, Y I; Kim, D K; Choi, C S

    2013-04-01

    Endotracheal intubation is often necessary for positive pressure ventilation of rats during open thoracic surgery. Since endotracheal intubation in rats is technically difficult and is associated with numerous complications, many techniques using various devices have been described in the scientific literature. In this study, we compared the effectiveness of airway management of a home-made supraglottic airway device (SAD), which is cheap to fabricate and easy to place with that of an endotracheal intubation tube in enflurane-anaesthetized rats. Twenty male Sprague-Dawley rats (200-300 g) were randomly assigned to two equal groups for positive pressure mechanical ventilation using either the SAD or an endotracheal intubation tube. The carotid artery of each rat was cannulated for continuous blood pressure measurements and obtaining blood samples for determination of oxygen tension, carbon dioxide tension, and blood acidity before, during and after SAD placement or endotracheal intubation. Proper placement of the SAD was confirmed by observing chest wall movements that coincided with the operation of the mechanical ventilator. No complications and adverse events were encountered in the rats in which the SAD was placed, during SAD placement and immediate removal, during their mechanical ventilation through the SAD, and one week after SAD removal. From the results of blood gas analyses, we conclude that anaesthetized rats can be successfully ventilated using an SAD for open thoracic surgery.

  1. The usefulness of biomarkers of airway inflammation in managing asthma.

    PubMed

    Patil, Sarita U; Long, Aidan A

    2010-01-01

    The goal of managing asthma is to maintain disease control. Current approaches to assessment of control do not include measurement of airway inflammation. This study was designed to assess the usefulness of biomarkers of airway inflammation in guiding asthma management decisions. A literature review was performed. Bronchial biopsy is a direct measure of airway inflammation but not practical for routine use. Enumeration of sputum eosinophils is very useful in guiding changes in controller medication to decrease asthma exacerbations, whereas measurement of exhaled nitric oxide has not proven to be useful in this regard. Serial measurement of airway hyperreactivity as a guide to asthma management yields inconclusive results. Use of indirect stimuli for bronchial challenge offers both practical and theoretical advantages in the assessment of airway hyperreactivity. Data on the analysis of exhaled breath condensate have not yet been studied adequately in guiding management decisions. Enumeration of sputum cell counts appears to be the most useful biomarker of airway inflammation in guiding asthma management decisions. Combined approaches using simple methods of measuring airway hyperreactivity and obtaining sputum samples hold promise for the future, particularly if rapid analysis of cellular products in sputum can be developed.

  2. A cohort and database study of airway management in patients undergoing thyroidectomy for retrosternal goitre.

    PubMed

    Gilfillan, N; Ball, C M; Myles, P S; Serpell, J; Johnson, W R; Paul, E

    2014-11-01

    Patients undergoing thyroid surgery with retrosternal goitre may raise concerns for the anaesthetist, especially airway management. We reviewed a multicentre prospective thyroid surgery database and extracted data for those patients with retrosternal goitre. Additionally, we reviewed the anaesthetic charts of patients with retrosternal goitre at our institution to identify the anaesthetic induction technique and airway management. Of 4572 patients in the database, 919 (20%) had a retrosternal goitre. Two cases of early postoperative tracheomalacia were reported, one in the retrosternal group. Despite some very large goitres, no patient required tracheostomy or cardiopulmonary bypass and there were no perioperative deaths. In the subset of 133 patients managed at our institution over six years, there were no major adverse anaesthetic outcomes and no patient had a failed airway or tracheomalacia. In the latter cohort, of 32 (24%) patients identified as having a potentially difficult airway, 17 underwent awake fibreoptic tracheal intubation, but two of these were abandoned and converted to intravenous induction and general anaesthesia. Eleven had inhalational induction; two of these were also abandoned and converted to intravenous induction and general anaesthesia. Of those suspected as having a difficult airway, 28 (87.5%) subsequently had direct laryngoscopy where the laryngeal inlet was clearly visible. We found no good evidence that thyroid surgery patients with retrosternal goitre, with or without symptoms and signs of tracheal compression, present the experienced anaesthetist with an airway that cannot be managed using conventional techniques. This does not preclude the need for multidisciplinary discussion and planning.

  3. Airway Management in a Patient with Wolf-Hirschhorn Syndrome

    PubMed Central

    Udani, Andrea G.

    2016-01-01

    We present a case of a 3-month-old female with Wolf-Hirschhorn syndrome (WHS) undergoing general anesthesia for laparoscopic gastrostomy tube placement with a focus on airway management. WHS is a rare 4p microdeletion syndrome resulting in multiple congenital abnormalities, including craniofacial deformities. Microcephaly, micrognathia, and glossoptosis are common features in WHS patients and risk factors for a pediatric airway that is potentially difficult to intubate. We discuss anesthesia strategies for airway preparation and management in a WHS patient requiring general anesthesia with endotracheal intubation. PMID:27752382

  4. Airway Management in Maxillofacial Trauma: Do We Really Need Tracheostomy/Submental Intubation

    PubMed Central

    Mittal, Geeta; Mittal, Rajinder K.; Katyal, Sunil; Uppal, Sanjeev; Mittal, Varun

    2014-01-01

    Background: There are various techniques available for airway management in patients with maxillofacial trauma. Patients with panfacial injuries may need surgical airway access like submental intubation or tracheostomy, which have their associated problems. We have been managing these types of cases by a novel technique, i.e, intraoperative change of nasotracheal to orotracheal intubation. Aim: To review our experience about various techniques for the airway management in patient with maxillofacial trauma. To analyse the possibility of using nasotracheal intubation and intraoperative change of nasotracheal to orotracheal intubation in panfacial fractures. Materials and Methods: In a tertiary care centre four hundred eighty seven patients of maxillofacial injuries, operated over a period of 2 years were reviewed in relation to age, sex, mode of injury, type of facial fractures, methods of airway management and their associated complications. Results: Young patients with male predominance is the most common affected population. Panfacial fracture is the most common type of injury (39.83%) among facial fractures. Airway was managed with intraoperative change of nasotracheal to orotracheal intubation in 33.05% of the patients whereas submental intubation or tracheostomy was done in 8.62% of the patients. Conclusion: Nasal route for endotracheal intubation is not a contraindication in the presence of nasal fractures, base of skull fractures and CSF leak. By changing the nasotracheal intubation to orotracheal intubation intraoperatively in cases panfacial fractures, most of the tracheostomies and submental intubations can be avoided. PMID:24783087

  5. INDUCED SPUTUM DERIVES FROM THE CENTRAL AIRWAYS: CONFIRMATION USING A RADIOLABELED AEROSOL BOLUS DELIVERY TECHNIQUE

    EPA Science Inventory

    Indirect evidence suggests that induced sputum derives from the surfaces of the bronchial airways. To confirm this experimentally, we employed a radiolabeled aerosol bolus delivery technique that preferentially deposits aerosol in the central airways in humans. We hypothesized th...

  6. Airway-Clearance Techniques in Children and Adolescents with Chronic Suppurative Lung Disease and Bronchiectasis

    PubMed Central

    Lee, Annemarie L.; Button, Brenda M.; Tannenbaum, Esta-Lee

    2017-01-01

    Common symptoms of chronic suppurative lung disease or bronchiectasis in children and adolescents are chronic cough with sputum production, retention of excess secretions in dilated airways, and a history of recurrent infections. Clinical management includes the prescription of airway-clearance techniques (ACTs) to facilitate mucociliary clearance, optimize sputum expectoration, relieve symptoms, and improve well-being. A wide range of ACTs are available for selection, and these strategies may be applied in isolation or in combination. The choice of technique will depend in part on the age of the child, their clinical state, and factors which may influence treatment adherence. While the evidence base for ACTs in children and adolescent with these conditions is not robust, the current available evidence in addition to clinical expertise provides guidance for technique prescription and clinical effect. An overview of the most commonly applied ACTs, including their physiological rationale and discussion of factors influencing prescription in children and adolescents is outlined in this review. PMID:28168184

  7. [EXIT procedure in the management of severe foetal airway obstruction. the paediatric otolaryngologist's perspective].

    PubMed

    Pellicer, Marc; Pumarola, Félix; Peiró, José Luis; Martínez Ibáñez, Vicente; García Vaquero, Juan Antono; Carreras, Elena; Manrique, Susana; Vinzo, Joan; Perelló, Enrique

    2007-12-01

    The ex-utero intrapartum treatment (EXIT) procedure is a technique designed to allow partial foetal delivery via caesarean section with establishment of a safe foetal airway by either intubation, bronchoscopy, or tracheostomy while foetal oxygenation is maintained through utero-placental circulation. The most common indication for the EXIT procedure is the presence of foetal airway obstruction, which is usually caused by a prenatal diagnosed neck mass. We report three cases of head and neck tumours with airway obstruction treated by means of EXIT and with different solutions in the management of the airway. With the involvement of Paediatric Otolaryngologists in EXIT, new indications and select variations from the standard EXIT protocol should be considered.

  8. Submental intubation: alternative short-term airway management in maxillofacial trauma

    PubMed Central

    Kumar, Ravi Raja; Vyloppilli, Suresh; Thangavelu, Annamala; Joseph, Benny; Ahsan, Auswaf

    2016-01-01

    Objectives To assess submental route intubation as an alternative technique to a tracheostomy in the management of the airway in cranio-maxillofacial trauma, along with an assessment of its morbidity and complications. Materials and Methods Submental intubation was performed in 17 patients who had maxillofacial panfacial trauma and management was done under general anesthesia during a period of one year from 2013 to 2014 at Departments of Oral and Maxillofacial Surgery and Dentistry, the Malankara Orthodox Syrian Church Medical College, Kochi, India. Results In all 17 cases, the technique of submental intubation was found to be simple and reliable. Hypertrophic scars were noted in three cases, orocutaneous fistula and mucocele in one case each. All these complications were managed comfortably without significant morbidity to the patient. Conclusion Submental intubation is a good technique that can be used regularly in the management of the airway in cranio-maxillofacial trauma, but with some manageable complications. PMID:27429937

  9. Educating the Educator: Teaching Airway Adjunct Techniques in Athletic Training

    ERIC Educational Resources Information Center

    Berry, David C.; Seitz, S. Robert

    2011-01-01

    The 5th edition of the "Athletic Training Education Competencies" ("Competencies") now requires athletic training educators (ATEs) to introduce into the curriculum various types of airway adjuncts including: (1) oropharyngeal airways (OPA), (2) nasopharyngeal airways (NPA), (3) supraglottic airways (SGA), and (4) suction. The addition of these…

  10. Rigid bronchoscopy and silicone stents in the management of central airway obstruction

    PubMed Central

    Yarmus, Lonny

    2015-01-01

    The field of interventional pulmonology has grown significantly over the past several decades now including the diagnosis and therapeutic treatment of complex airway disease. Rigid bronchoscopy is an invaluable tool in the diagnosis and management of several malignant and non-malignant causes of central airway obstruction (CAO) and has become integral after the inception of airway stenting. The management of CAO can be a complicated endeavor with significant risks making the understanding of basic rigid bronchoscopy techniques, ablative technologies, anesthetic care and stenting of utmost importance in the care of these complex patients. This review article will focus on the history of rigid bronchoscopy, the technical aspects of performing a rigid bronchoscopy as well as the use of silicone stents their indications, complications and placement techniques. PMID:26807283

  11. Simulation Based Training Improves Airway Management for Helicopter EMS Teams

    NASA Technical Reports Server (NTRS)

    Dhindsa, Harinder S.; Reid, Renee; Murray, David; Lovelady, James; Powell, Katie; Sayles, Jeff; Stevenson, Christopher; Baker, Kathy; Solada, Brian; Carroll, Scott; Seay, Louis; Powell, Jeff; Van de Bussche, Todd; Giangrasso, Tina

    2011-01-01

    The use of paralytic medications in the performance of RSI intubation is a high risk intervention used by many HEMS crews. There is no margin for error in RSI intubation as the results can be fatal. Operating room access for airway management training has become more difficult, and is not representative of the environment in which HEMS crews typically function. LifeEvac of Virginia designed and implemented an SST airway management program to provide a realistic, consistent training platform. The dynamic program incorporates standardized scenarios, and real life challenging cases that this and other programs have encountered. SST is done in a variety of settings including the helicopter, back of ambulances, staged car crashes and simulation centers. The result has been the indoctrination of a well defined, consistent approach to every airway management intervention. The SST program facillitates enhancement of technical skills. as well as team dynamics and communication.

  12. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults†

    PubMed Central

    Frerk, C.; Mitchell, V. S.; McNarry, A. F.; Mendonca, C.; Bhagrath, R.; Patel, A.; O'Sullivan, E. P.; Woodall, N. M.; Ahmad, I.

    2015-01-01

    These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team. PMID:26556848

  13. Airway Management in Patients with Tracheal Compression Undergoing Thyroidectomy: A Retrospective Analysis

    PubMed Central

    Sajid, Binu; Rekha, K.

    2017-01-01

    Background: Airway management in large and retrosternal goiters with tracheal compression is often fraught with challenges and is a source of apprehension among anesthesiologists globally. Aims: In this study we attempt to delineate the preferred techniques of airway management of such cases in our institution and also to assess whether airway management was unnecessarily complicated. Setting and Design: Retrospective analysis. Materials and Methods: A retrospective review was conducted of thyroidectomies performed in our institution over a three year period from January 2013. Clinical, radiological, pathological, anesthetic and surgical data were obtained from hospital case records. Statistical Analysis: Qualitative data is represented as frequencies and percentages and quantitative data as mean and standard deviation. Results: Of 1861 thyroidectomies tracheal compression were present in 50 patients with minimum tracheal diameter ranging from 4-12mm (mean 7.84); with majority(95%) having a benign pathology. Critical tracheal compression (≤5 mm) was observed in four patients. Conventional intravenous induction and intubation under muscle relaxant was performed in majority (64%) of these patients. The rest of the cases (n=18) were intubated while preserving spontaneous ventilation after induction. Primary technique of airway management was reported successful in all cases with no instances of difficult ventilation or intubation. Postoperative morbidity in few cases resulted from hematoma (n=1), recurrent laryngeal nerve palsy (n=1), tracheomalacia (n=1) and pulmonary complications (n=2). Conclusion: Airway management in patients with tracheal compression due to benign goiter is quite straightforward and can be managed in the conventional manner with little or no complications. PMID:28298767

  14. Airway Management of the Cardiac Surgical Patients: Current Perspective

    PubMed Central

    Choudhury, Arindam; Gupta, Nishkarsh; Magoon, Rohan; Kapoor, Poonam Malhotra

    2017-01-01

    The difficult airway (DA) is a common problem encountered in patients undergoing cardiac surgery. However, the challenge is not only just establishment of airway but also maintaining a definitive airway for the safe conduct of cardiopulmonary bypass from initiation to weaning after surgical correction or palliation, de-airing of cardiac chambers. This review describes the management of the DA in a cardiac theater environment. The primary aims are recognition of DA both anatomical and physiological, necessary preparations for (and management of) difficult intubation and extubation. All patients undergoing cardiac surgery should initially be considered as having potentially DA as many of them have poor physiologic reserve. Making the cardiac surgical theater environment conducive to DA management is as essential as it is to deal with low cardiac output syndrome or acute heart failure. Tube obstruction and/or displacement should be suspected in case of a new onset ventilation problem, especially in the recovery unit. Cardiac anesthesiologists are often challenged with DA while inducing general endotracheal anesthesia. They ought to be familiar with the DA algorithms and possess skill for using the latest airway adjuncts. PMID:28074820

  15. An Anesthesiologist's Perspective on the History of Basic Airway Management: The "Artisanal Anesthetic" Era: 1846 to 1904.

    PubMed

    Matioc, Adrian A

    2017-03-01

    This second installment of the history of basic airway management covers the early-artisanal-years of anesthesia from 1846 to 1904. Anesthesia was invented and practiced as a supporting specialty in the context of great surgical and medical advances. The current-day anesthesia provider tends to equate the history of airway management with the history of intubation, but for the first 58 yr after the introduction of ether anesthesia, airway management was provided by basic airway techniques with or without the use of a face mask. The jaw thrust and chin lift were described in the artisanal years and used primarily with inhalation anesthesia in the spontaneously breathing patient and less often with negative-pressure ventilation in the apneic victim. Positive-pressure ventilation and intubation stayed at the fringes of medical practice, and airway techniques and devices were developed by trial and error. At the beginning of the 20th century, airway management and anesthetic techniques lagged behind surgical requirements.

  16. Management of the critical airway when an EXIT procedure is not an option: A case report.

    PubMed

    Diercks, Gillian R; Hartnick, Christopher J; Bates, Sara V

    2015-12-01

    Perinatal imaging facilitates detection of congenital head and neck masses to plan fetal procedures which secure the airway. Ex utero intrapartum therapy (EXIT) procedures are preferred to protect the neonatal airway. Herein we present a case in which a neonate with a large oropharyngeal lymphovascular malformation was delivered and the airway successfully managed without an EXIT procedure using a multidisciplinary approach. Preparations for the non-EXIT delivery and critical airway management are described.

  17. Comparison of three insertion techniques of ProSeal laryngeal mask airway: A randomized clinical trial

    PubMed Central

    Nalini, Kadirehally Bheemanna; Shivakumar, Shivanna; Archana, Shivashankar; Sandhya Rani, Doddagavanahalli Channaiah; Mohan, Chadalavada Venkata Rama

    2016-01-01

    Background and Aims: We aimed to compare three techniques for insertion of ProSeal laryngeal mask airway (PLMA). Material and Methods: Two hundred ten patients (American Society of Anaethesiologists I-II, aged 18–60 years) undergoing general anesthesia using the PLMA as an airway management device were randomly allocated to digital (D), rotational (R), or pharyngoscopic (P) techniques. In the D group (n = 70), the PLMA insertion was performed by using digital manipulation. In the R group (n = 70), the PLMA was inserted into the mouth, rotated anticlockwise through 90° and advanced into the hypopharynx. In the P group (n = 70), the PLMA was inserted after gentle pharyngoscopy using laryngoscope. Success rate at the first attempt, insertion time, airway manipulations required, and postoperative complications were noted. Results: Insertion at first attempt was more successful with P technique than the R and D groups (100% vs. 98.5% vs. 81.4% respectively, P < 0.01). Insertion time was shortest for the P group which was statistically significant compared to the group D (P < 0.001), but comparable with the R group. None of the patients required manipulation in the P group compared to the group R (P = 0.04) and D (P < 0.001). Blood staining (group P = 2.8% vs. group R = 2.8% vs. group D = 22%, P < 0.0001) and sore throat (group P = 0% vs. group R = 6.9% vs. group D = 16.7%, both: P < 0.005) were lower with the pharyngoscopic technique. Conclusion: We conclude that the pharyngoscopic technique for PLMA insertion is more successful with lower incidence of complications (mucosal bleeding and sore throat). PMID:28096585

  18. Radical evolution: the 2015 Difficult Airway Society guidelines for managing unanticipated difficult or failed tracheal intubation.

    PubMed

    Marshall, S D; Pandit, J J

    2016-02-01

    There is little doubt that these guidelines incorporate advances made in airway management since 2004. They will change day-to-day practice of anaesthesia, as outlined above, from pre-operative airway assessment, to integrating the WHO team briefing, to the use and provision of equipment and drugs, and the recording of information on the anaesthesia chart. They will inform the later analysis of any critical airway incidents, especially as documentation and postoperative management are addressed, and they will encourage training in a range of techniques. Taken together, not quite a revolution but certainly a very 'radical evolution'.Assessment of the utility of the new guidelines should consider if they can be used as tools to enhance knowledge and training, or in addition as a prosthesis to bridge the gap between the requirements of and our abilities during emergencies. Formal testing may reveal which aspects of their design, complex as it is, may distract from, rather than enhance, airway management during crises.All guidelines represent a standard of care or a normative approach to a clinical problem. As such, they not only help guide clinicians, but they also provide the broader community with the opportunity to improve standards, to ensure equipment is available, and that training for the skills and processes required are in place to ensure successful adoption.

  19. 4,871 Emergency Airway Encounters by Air Medical Providers: A Report of the Air Transport Emergency Airway Management (NEAR VI: “A-TEAM”) Project

    PubMed Central

    Brown, Calvin A.; Cox, Kelly; Hurwitz, Shelley; Walls, Ron M.

    2014-01-01

    Introduction Pre-hospital airway management is a key component of resuscitation although the benefit of pre-hospital intubation has been widely debated. We report a large series of pre-hospital emergency airway encounters performed by air-transport providers in a large, multi-state system. Methods We retrospectively reviewed electronic intubation flight records from an 89 rotorcraft air medical system from January 01, 2007, through December 31, 2009. We report patient characteristics, intubation methods, success rates, and rescue techniques with descriptive statistics. We report proportions with 95% confidence intervals and binary comparisons using chi square test with p-values <0.05 considered significant. Results 4,871 patients had active airway management, including 2,186 (44.9%) medical and 2,685 (55.1%) trauma cases. There were 4,390 (90.1%) adult and 256 (5.3%) pediatric (age ≤ 14) intubations; 225 (4.6%) did not have an age recorded. 4,703 (96.6%) had at least one intubation attempt. Intubation was successful on first attempt in 3,710 (78.9%) and was ultimately successful in 4,313 (91.7%). Intubation success was higher for medical than trauma patients (93.4% versus 90.3%, p=0.0001 JT test). 168 encounters were managed primarily with an extraglottic device (EGD). Cricothyrotomy was performed 35 times (0.7%) and was successful in 33. Patients were successfully oxygenated and ventilated with an endotracheal tube, EGD, or surgical airway in 4809 (98.7%) encounters. There were no reported deaths from a failed airway. Conclusion Airway management, predominantly using rapid sequence intubation protocols, is successful within this high-volume, multi-state air-transport system. PMID:24672610

  20. Augmented reality and training for airway management procedures.

    PubMed

    Davis, Larry; Ha, Yonggang; Frolich, Seth; Martin, Glenn; Meyer, Catherine; Pettitt, Beth; Norfleet, Jack; Lin, Kuo-Chi; Rolland, Jannick P

    2002-01-01

    Augmented reality is often used for interactive, three-dimensional visualization within the medical community. To this end, we present the integration of an augmented reality system that will be used to train military medics in airway management. The system demonstrates how a head-mounted projective display can be integrated with a desktop PC to create an augmented reality visualization. Furthermore, the system, which uses a lightweight optical tracker, demonstrates the low cost and the portability of the application.

  1. Airway complications and management after lung transplantation: ischemia, dehiscence, and stenosis.

    PubMed

    Santacruz, Jose Fernando; Mehta, Atul C

    2009-01-15

    Overall survival rates of lung transplantation have improved since the first human lung transplantation was performed. A decline in the incidence of airway complications (AC) had been a key feature to achieve the current outcomes. Several proposed risk factors to the development of airway complications have been identified, ranging from the surgical technique to the immunosuppressive regimen. There are essentially six different airway complications post-lung transplantation. The most frequently reported complication is bronchial stenosis. Other complications include bronchial dehiscence, exophytic excessive granulation tissue formation, tracheo-bronchomalacia, bronchial fistulas, and endobronchial infections. The management of post-transplant bronchial complications needs a multispecialty team approach. Prevention of some complications may be possible by early and aggressive medical management as well as by using certain surgical techniques for transplantation. Interventional bronchoscopic procedures, including balloon bronchoplasty, cryotherapy, laser photoresection, electrocautery, high-dose endobronchial brachytherapy, and bronchial stents are among the armamentarium. Also, medical management, like antibiotic prophylaxis and therapy for endobronchial infections, or noninvasive positive-pressure ventilation in case of bronchomalacia, are used to treat an AC. In some cases, different surgical approaches are occasionally required. In this article we review the risk factors, the clinical presentation, the diagnostic methods, as well as the management options of the most common AC after lung transplantation.

  2. Crisis resource management of the airway in a patient with Klippel-Feil syndrome, congenital deafness, and aortic dissection.

    PubMed

    Khawaja, Omar M; Reed, J Taylor; Shaefi, Shahzad; Chitilian, Hovig V; Sandberg, Warren S

    2009-04-01

    Klippel-Feil syndrome is a visually arresting deformity wherein severe restriction of cervical motion predicts a difficult airway. Even minor distraction of the neck risks cervical spine or neurologic injury, so regional techniques, awake fiberoptic intubation, or awake tracheostomy are recommended anesthetic approaches. We present a case of aortic dissection in a Klippel-Feil syndrome patient for whom congenital bilateral deafness, coupled with the urgency of the surgery, mitigated against the recommended first-choice techniques. Using anesthesia crisis resource management methods, a multi-member team rehearsed predefined roles and then managed the airway via inhaled induction of anesthesia, followed by flexible fiberoptic intubation.

  3. Athletic Training Students Demonstrate Airway Management Skill Decay, but Retain Knowledge over 6 Months

    ERIC Educational Resources Information Center

    Popp, Jennifer K.; Berry, David C.

    2016-01-01

    Context: Airway management (AM) knowledge and skills are taught in all athletic training programs; however, research suggests that skill decay occurs with acute care skills as length of nonpractice increases. Objective: Evaluate retention of AM knowledge and skills, specifically oropharyngeal airway (OPA) and nasopharyngeal airway (NPA) use, in…

  4. Airway Assessment for Office Sedation/Anesthesia.

    PubMed

    Rosenberg, Morton B; Phero, James C

    2015-01-01

    Whenever a patient is about to receive sedation or general anesthesia, no matter what the technique, the preoperative assessment of the airway is one of the most important steps in ensuring patient safety and positive outcomes. This article, Part III in the series on airway management, is directed at the ambulatory office practice and focuses on predicting the success of advanced airway rescue techniques.

  5. Investigation of pulmonary acoustic simulation: comparing airway model generation techniques

    NASA Astrophysics Data System (ADS)

    Henry, Brian; Dai, Zoujun; Peng, Ying; Mansy, Hansen A.; Sandler, Richard H.; Royston, Thomas

    2014-03-01

    Alterations in the structure and function of the pulmonary system that occur in disease or injury often give rise to measurable spectral, spatial and/or temporal changes in lung sound production and transmission. These changes, if properly quantified, might provide additional information about the etiology, severity and location of trauma, injury, or pathology. With this in mind, the authors are developing a comprehensive computer simulation model of pulmonary acoustics, known as The Audible Human Project™. Its purpose is to improve our understanding of pulmonary acoustics and to aid in interpreting measurements of sound and vibration in the lungs generated by airway insonification, natural breath sounds, and external stimuli on the chest surface, such as that used in elastography. As a part of this development process, finite element (FE) models were constructed of an excised pig lung that also underwent experimental studies. Within these models, the complex airway structure was created via two methods: x-ray CT image segmentation and through an algorithmic means called Constrained Constructive Optimization (CCO). CCO was implemented to expedite the segmentation process, as airway segments can be grown digitally. These two approaches were used in FE simulations of the surface motion on the lung as a result of sound input into the trachea. Simulation results were compared to experimental measurements. By testing how close these models are to experimental measurements, we are evaluating whether CCO can be used as a means to efficiently construct physiologically relevant airway trees.

  6. Fiberoptic intubation through laryngeal mask airway for management of difficult airway in a child with Klippel-Feil syndrome.

    PubMed

    Bhat, Ravi; Mane, Rajesh S; Patil, Manjunath C; Suresh, S N

    2014-07-01

    The ideal airway management modality in pediatric patients with syndromes like Klippel-Feil syndrome is a great challenge and is technically difficult for an anesthesiologist. Half of the patients present with the classic triad of short neck, low hairline, and fusion of cervical vertebra. Numerous associated anomalies like scoliosis or kyphosis, cleft palate, respiratory problems, deafness, genitourinary abnormalities, Sprengel's deformity (wherein the scapulae ride high on the back), synkinesia, cervical ribs, and congenital heart diseases may further add to the difficulty. Fiberoptic bronchoscopy alone can be technically difficult and patient cooperation also becomes very important, which is difficult in pediatric patients. Fiberoptic bronchoscopy with the aid of supraglottic airway devices is a viable alternative in the management of difficult airway in children. We report a case of Klippel-Feil syndrome in an 18-month-old girl posted for cleft palate surgery. Imaging of spine revealed complete fusion of the cervical vertebrae with hypoplastic C3 and C6 vertebrae and thoracic kyphosis. We successfully managed airway in this patient by fiberoptic intubation through classic laryngeal mask airway (LMA). After intubation, we used second smaller endotracheal tube (ETT) to stabilize and elongate the first ETT while removing the LMA.

  7. Fiberoptic Guided Retrograde Intubation in an Anticipated Difficult Airway: Revival of an Antiquated Technique

    PubMed Central

    Ninu, Marie; Yunus, Md.; Syiemiong, Newstar

    2016-01-01

    Retrograde intubation is an invaluable technique which can be helpful in anticipated difficult airway situation. In this advanced era where fiberoptic intubation and video laryngoscopes are in abundant use, retrograde intubation is a forgotten technique. However, it may be useful in various difficult airway situations in this advanced era. In our case the patient had a bitter experience with previous fiberoptic intubation. Owing to that we had planned and performed a fiber optic guided retrograde intubation, where we had kept the fiberoptic bronchoscope in the pharynx keeping larynx and vocal cords in the focus to facilitate the emergence of guide wire through one of the nostrils as well as direct visual confirmation of intubation. This fiber optic guided retrograde intubation is a first reported case of its kind in a predicted difficult airway which can be beneficial in different difficult airway situations. PMID:27891428

  8. Essentials of Airway Management, Oxygenation, and Ventilation: Part 1: Basic Equipment and Devices

    PubMed Central

    Becker, Daniel E.; Rosenberg, Morton B.; Phero, James C.

    2014-01-01

    Offices and outpatient dental facilities must be properly equipped with devices for airway management, oxygenation, and ventilation. Optimizing patient safety using crisis resource management (CRM) involves the entire dental office team being familiar with airway rescue equipment. Basic equipment for oxygenation, ventilation, and airway management is mandated in the majority of US dental offices per state regulations. The immediate availability of this equipment is especially important during the administration of sedation and anesthesia as well as the treatment of medical urgencies/emergencies. This article reviews basic equipment and devices essential in any dental practice whether providing local anesthesia alone or in combination with procedural sedation. Part 2 of this series will address advanced airway devices, including supraglottic airways and armamentarium for tracheal intubation and invasive airway procedures. PMID:24932982

  9. Airway management using submental intubation in head and neck surgery.

    PubMed

    Szantyr, Aleksandra; Szuta, Mariusz; Zapała, Jan

    2016-01-01

    In 1995 the first tracheosubmental intubation (TSI) in Poland was performed in the Clinic and De- partment of Cranio-Maxillofacial Surgery at Jagiellonian University Medical College in Kraków. Our 20 years of experience with using TSI in the eld of cranio-maxillofacial surgery, with 316 successfully performed intubations, resulted in one of the largest bodies of material analysed in the literature so far. The aim of this study was to evaluate the eficacy and complications of TSI in the field of cranio-maxillofacial surgery in patients where orotracheal or nasotracheal intubation is contraindicated and tracheostomy can be avoided. To fulfil this objective we present our own experience with the use of TSI in the field of cranio-maxillofacial surgery. This retrospective study included 316 patients who were operated on with general anaesthesia via TSI in the Department of Cranio-Maxillofacial Surgery, Jagiellonian University Medical College, Kraków, from 1995 to 2014 (20 years). Indications for TSI were as follows: multifragmentaric fractures of the bones of mid- and lower face in 262 patients (82.9%), simultaneous osteotomies of the maxilla and mandible due to mandibular prognathism with maxillary compression in 62 patients (19.6%), extensive facial cancer infiltrating both the nose and lips in 4 patients (1.2%) and posttraumatic deformities of the nose and jaws in 4 patients (1.2%). In all 316 patients TSI was successfully performed and proved to be the optimal method of airway management, providing a comfortable surgical approach with the operating field free from an intubation tube. Complications were observed in 12 patients (3.8%) and included wound infection in 7 patients (2.21%), transitory salivary fistula in 3 patients (0.95%), and hypertrophic scarring in 2 patients (0.63%). TSI is considered to be a safe and simple technique of intubation, which makes it possible to to avoid tracheotomy complications when it is difficult or impossible to perform

  10. Implementation of NAP4 emergency airway management recommendations in a quaternary-level pediatric hospital.

    PubMed

    Long, Elliot; Cincotta, Domenic; Grindlay, Joanne; Pellicano, Anastasia; Clifford, Michael; Sabato, Stefan

    2017-02-28

    Emergency airway management, particularly outside of the operating room, is associated with a high incidence of life-threatening adverse events. Based on the recommendations of the 4th National Audit Project, we aimed to develop hospital-wide systems changes to improve the safety of emergency airway management. We describe a framework for governance in the form of a hospital airway special interest group. We describe the development and implementation of the following systems changes: 1. A local intubation algorithm modified from the Difficult Airway Society's plan A-B-C-D approach, including clear pathways for airway escalation, and emphasizing the concepts of resuscitation prior to intubation, planning for failure, and avoidance of fixation error. 2. Simplified and standardized airway equipment located in identical airway carts in all critical care areas. 3. A preintubation checklist and equipment template to standardize preparation for airway management. 4. Availability of continuous waveform endtidal capnography in all critical care areas for confirmation of correct endotracheal tube placement. 5. Multidisciplinary team training to address the technical and nontechnical aspects of nonoperating room intubation. In addition, we describe methodology for ongoing monitoring of performance through a quality assurance framework. In conclusion, changes in the process of emergency airway management at a hospital level are feasible through collaboration. Their impact on patient-based outcomes requires further study.

  11. Insertion Success of the Laryngeal Tube in Emergency Airway Management.

    PubMed

    Bernhard, Michael; Gries, André; Ramshorn-Zimmer, Alexandra; Wenzel, Volker; Hossfeld, Bjoern

    2016-01-01

    Background. Emergency airway management (AM) is a priority when resuscitating critically ill or severely injured patients. The goal of this study was to determine the success rates of LT insertion during AM. Methods. Studies that included LT first-pass insertion (FPI) and overall-pass insertion (OPI) success by emergency medical services and in-hospital providers performing AM for emergency situations as well as for scheduled surgery published until July 2014 were searched systematically in Medline. Results. Data of 36 studies (n = 1,897) reported a LT FPI success by physicians of 82.5% with an OPI success of 93.6% (p < 0.001). A cumulative analysis of all 53 studies (n = 3,600) led to FPI and OPI success of 80.1% and 92.6% (p < 0.001), respectively. The results of 26 studies (n = 2,159) comparing the LT with the laryngeal mask airway (LMA) demonstrated a FPI success of 77.0 versus 78.7% (p = 0.36) and an OPI success of 92.2 versus 97.7% (p < 0.001). Conclusion. LT insertion failed in the first attempt in one out of five patients, with an overall failure rate in one out of 14 patients. When compared with the LT, the LMA had a cumulative 5.5% better OPI success rate.

  12. Insertion Success of the Laryngeal Tube in Emergency Airway Management

    PubMed Central

    Gries, André; Ramshorn-Zimmer, Alexandra; Wenzel, Volker

    2016-01-01

    Background. Emergency airway management (AM) is a priority when resuscitating critically ill or severely injured patients. The goal of this study was to determine the success rates of LT insertion during AM. Methods. Studies that included LT first-pass insertion (FPI) and overall-pass insertion (OPI) success by emergency medical services and in-hospital providers performing AM for emergency situations as well as for scheduled surgery published until July 2014 were searched systematically in Medline. Results. Data of 36 studies (n = 1,897) reported a LT FPI success by physicians of 82.5% with an OPI success of 93.6% (p < 0.001). A cumulative analysis of all 53 studies (n = 3,600) led to FPI and OPI success of 80.1% and 92.6% (p < 0.001), respectively. The results of 26 studies (n = 2,159) comparing the LT with the laryngeal mask airway (LMA) demonstrated a FPI success of 77.0 versus 78.7% (p = 0.36) and an OPI success of 92.2 versus 97.7% (p < 0.001). Conclusion. LT insertion failed in the first attempt in one out of five patients, with an overall failure rate in one out of 14 patients. When compared with the LT, the LMA had a cumulative 5.5% better OPI success rate. PMID:27642595

  13. Virtual endoscopy--a new assessment tool in difficult airway management.

    PubMed

    Ahmad, I; Millhoff, B; John, M; Andi, K; Oakley, R

    2015-09-01

    Preemptive mapping of the airway is a useful adjunct to conventional clinical assessments when airway management planning for patients with complex head and neck pathology. Nasendoscopy is frequently used for this purpose but is also invasive and poorly tolerated in a subset of patients and, even in expert hands, may not allow complete visualization of the glottis and subglottic structures. We present a novel tool for difficult airway management planning in the form of virtual endoscopy by applying free online OsiriX software to head and neck computed tomographic scans to generate a "fly-through" airway reconstruction. To highlight how well virtual endoscopy correlates to conventional fibreoscopy, we compare both of these assessment tools in 3 patients with glottic, subglottic, and multilevel airway pathologies. Virtual endoscopy represents a unique, noninvasive, safe, and accurate airway assessment and educational resource, which warrants further exploration.

  14. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in Paediatrics

    PubMed Central

    Pawar, Dilip K; Doctor, Jeson Rajan; Raveendra, Ubaradka S; Ramesh, Singaravelu; Shetty, Sumalatha Radhakrishna; Divatia, Jigeeshu Vasishtha; Myatra, Sheila Nainan; Shah, Amit; Garg, Rakesh; Kundra, Pankaj; Patwa, Apeksh; Ahmed, Syed Moied; Das, Sabyasachi; Ramkumar, Venkateswaran

    2016-01-01

    The All India Difficult Airway Association guidelines for the management of the unanticipated difficult tracheal intubation in paediatrics are developed to provide a structured, stepwise approach to manage unanticipated difficulty during tracheal intubation in children between 1 and 12 years of age. The incidence of unanticipated difficult airway in normal children is relatively rare. The recommendations for the management of difficult airway in children are mostly derived from extrapolation of adult data because of non-availability of proven evidence on the management of difficult airway in children. Children have a narrow margin of safety and mismanagement of the difficult airway can lead to disastrous consequences. In our country, a systematic approach to airway management in children is lacking, thus having a guideline would be beneficial. This is a sincere effort to protocolise airway management in children, using the best available evidence and consensus opinion put together to make airway management for children as safe as possible in our country. PMID:28003692

  15. The Development and Application of Airway Devices in China

    PubMed Central

    Chen, Xiangdong; Ma, Wuhua; Liu, Renyu; Yao, Shanglong

    2017-01-01

    Airway management is one of the most important tasks for anesthesiologists. Anesthesiologists are experts in airway management and have made tremendous contribution to the development of the airway devices. Chinese anesthesiologists have made significant contribution in introducing advanced airway management and developing innovative techniques and devices for airway management in China. This article overviews the development and application of airway devices in China as well as the dedication and contribution of Chinese experts in the development of novel airway devices. With the development of science and technology accompanied by the advanced knowledge in airway management, more effective and safe artificial airways will be developed for clinical practice. The authors believe that Chinese experts will continue their outstanding contribution to the development of innovative airway devices, systems and knowledge. PMID:28191485

  16. The Diagnosis and Management of Airway Complications Following Lung Transplantation.

    PubMed

    Mahajan, Amit K; Folch, Erik; Khandhar, Sandeep J; Channick, Colleen L; Santacruz, Jose F; Mehta, Atul C; Nathan, Steven D

    2017-03-05

    Airway complications following lung transplantation result in considerable morbidity and are associated with a mortality of 2-4 percent. The incidence of lethal and non-lethal airway complications has decreased since the early experiences with double- and single-lung transplantation. The most common risk factor associated with post-lung transplant airway complications is anastomotic ischemia. Airway complications include development of exophytic granulation tissue, bronchial stenosis, bronchomalacia, airway fistula, endobronchial infection, and anastomotic dehiscence. The broadening array of bronchoscopic therapies has enhanced treatment options for lung transplant recipients with airway complications. This article reviews the risk factors, clinical manifestations, and treatments of airway complications following lung transplantation, and provides our expert opinion where evidence is lacking.

  17. All India Difficult Airway Association 2016 guidelines for the management of anticipated difficult extubation

    PubMed Central

    Kundra, Pankaj; Garg, Rakesh; Patwa, Apeksh; Ahmed, Syed Moied; Ramkumar, Venkateswaran; Shah, Amit; Divatia, Jigeeshu Vasishtha; Shetty, Sumalatha Radhakrishna; Raveendra, Ubaradka S; Doctor, Jeson R; Pawar, Dilip K; Singaravelu, Ramesh; Das, Sabyasachi; Myatra, Sheila Nainan

    2016-01-01

    Extubation has an important role in optimal patient recovery in the perioperative period. The All India Difficult Airway Association (AIDAA) reiterates that extubation is as important as intubation and requires proper planning. AIDAA has formulated an algorithm based on the current evidence, member survey and expert opinion to incorporate all patients of difficult extubation for a successful extubation. The algorithm is not designed for a routine extubation in a normal airway without any associated comorbidity. Extubation remains an elective procedure, and hence, patient assessment including concerns related to airway needs to be done and an extubation strategy must be planned before extubation. Extubation planning would broadly be dependent on preventing reflex responses (haemodynamic and cardiovascular), presence of difficult airway at initial airway management, delayed recovery after the surgical intervention or airway difficulty due to pre-existing diseases. At times, maintaining a patent airway may become difficult either due to direct handling during initial airway management or due to surgical intervention. This also mandates a careful planning before extubation to avoid extubation failure. Certain long-standing diseases such as goitre or presence of obesity and obstructive sleep apnoea may have increased chances of airway collapse. These patients require planned extubation strategies for extubation. This would avoid airway collapse leading to airway obstruction and its sequelae. AIDAA suggests that the extubation plan would be based on assessment of the airway. Patients requiring suppression of haemodynamic responses would require awake extubation with pharmacological attenuation or extubation under deep anaesthesia using supraglottic devices as bridge. Patients with difficult airway (before surgery or after surgical intervention) or delayed recovery or difficulty due to pre-existing diseases would require step-wise approach. Oxygen supplementation should

  18. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in adults

    PubMed Central

    Myatra, Sheila Nainan; Shah, Amit; Kundra, Pankaj; Patwa, Apeksh; Ramkumar, Venkateswaran; Divatia, Jigeeshu Vasishtha; Raveendra, Ubaradka S; Shetty, Sumalatha Radhakrishna; Ahmed, Syed Moied; Doctor, Jeson Rajan; Pawar, Dilip K; Ramesh, Singaravelu; Das, Sabyasachi; Garg, Rakesh

    2016-01-01

    The All India Difficult Airway Association (AIDAA) guidelines for management of the unanticipated difficult airway in adults provide a structured, stepwise approach to manage unanticipated difficulty during tracheal intubation in adults. They have been developed based on the available evidence; wherever robust evidence was lacking, or to suit the needs and situation in India, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. We recommend optimum pre-oxygenation and nasal insufflation of 15 L/min oxygen during apnoea in all patients, and calling for help if the initial attempt at intubation is unsuccessful. Transnasal humidified rapid insufflations of oxygen at 70 L/min (transnasal humidified rapid insufflation ventilatory exchange) should be used when available. We recommend no more than three attempts at tracheal intubation and two attempts at supraglottic airway device (SAD) insertion if intubation fails, provided oxygen saturation remains ≥ 95%. Intubation should be confirmed by capnography. Blind tracheal intubation through the SAD is not recommended. If SAD insertion fails, one final attempt at mask ventilation should be tried after ensuring neuromuscular blockade using the optimal technique for mask ventilation. Failure to intubate the trachea as well as an inability to ventilate the lungs by face mask and SAD constitutes ‘complete ventilation failure’, and emergency cricothyroidotomy should be performed. Patient counselling, documentation and standard reporting of the airway difficulty using a ‘difficult airway alert form’ must be done. In addition, the AIDAA provides suggestions for the contents of a difficult airway cart. PMID:28003690

  19. [Imaging techniques in the examination of the distal airways: asthma and COPD].

    PubMed

    Franquet, Tomás

    2011-04-01

    Imaging techniques are highly useful diagnostic tools to study small airway diseases. Despite their differences, from a clinical pathological perspective, these diseases show similar radiological manifestations. High-resolution computed tomography (CT) is the technique of choice to study diffuse diseases and those of the small airways; the slices obtained in expiratory high-resolution CT scan should form part of the study protocol of small airway diseases. Based on the findings of high-resolution CT, small airway diseases can be divided into two large groups: (a) those presenting direct morphological signs of bronchiolar involvement, and (b) those showing indirect signs of bronchiolar involvement (air trapping/mosaic pattern). High-resolution CT is highly useful to study the complications of asthma (allergic bronchopulmonary aspergillosis) and to evaluate clinically similar processes, such as hypersensitivity pneumonitis. In asthmatic patients, multi-detector CT (MDTC) allows clinical symptoms, thickening of the airway wall and the degree of airflow obstruction to be directly correlated. MDTC is also useful for quantitative evaluation of the degree of air trapping in patients with emphysema. Magnetic resonance imaging after inhalation of distinct gases, such as (3)He and xenon-129 and dual-energy CT are also useful imaging techniques in the direct or indirect evaluation of the degree of airflow obstruction (air trapping).

  20. Airway Preparation Techniques for the Cervical Spine-Injured Football Player

    PubMed Central

    Ray, Richard; Luchies, Carl; Bazuin, Doug; Farrell, Robert N.

    1995-01-01

    Athletic health care professionals have been concerned about how to optimize the emergency care the cervical spine-injured football player receives on the field. Much of the discussion has centered on how to best expose and prepare the airway for rescue breathing in the quickest and safest manner possible. This study compared the time required and the extraneous motion induced at the cervical spine during three traditional and one new airway exposure and preparation technique. Twelve subjects wearing football helmets and shoulder pads were exposed to multiple trials of airway exposure via face mask repositioning using a manual screwdriver, power screwdriver, and the Trainer's Angel cutting device. Subjects also underwent airway preparation using the pocket mask insertion technique. Cervical spine motion was measured in two dimensions using an optoelectronic motion analysis system. Time and qualitative assessment were obtained through videotape analysis. Significant differences were found between the techniques with respect to time and cervical spine motion. The pocket mask allowed quicker activation of rescue breathing than the other three traditional techniques. There was no significant difference in the amount of extraneous motion induced at the cervical spine between the pocket mask, manual screwdriver, and power screwdriver techniques. The Trainer's Angel induced significantly more motion than the other three techniques in each of the four motions measured. Changes in traditional protocols used to treat cervical spine-injured football players on the field are recommended based on these data. ImagesFig 1.Fig 2. PMID:16558339

  1. Bronchoscopic management of critical central airway obstruction by thyroid cancer: Combination airway stenting using tracheal and inverted-Y carinal self-expanding metallic stents

    PubMed Central

    Madan, Karan; Shrestha, Prajowl; Garg, Rakesh; Hadda, Vijay; Mohan, Anant; Guleria, Randeep

    2017-01-01

    Central airway obstruction (CAO) can result from various benign and malignant etiologies. Anaplastic thyroid cancer (ATC) is the most aggressive form of thyroid cancer. Rapid airway compromise is the main cause of death in ATC. We report a patient with ATC who presented with a large neck mass leading to CAO with long segment tracheal and right main bronchial compression and respiratory failure. Urgent Rigid Bronchoscopy was performed for airway stabilization and patient was managed with a combination airway stenting approach. A combination of self expanding, metallic, covered inverted Y and straight tracheal stents was used to stabilize the near complete airway structure. We herein highlight the role of therapeutic rigid bronchoscopy with airway stenting as an efficacious treatment modality for management of malignant CAO. PMID:28360477

  2. Present-day prehospital airway management in the former Eastern German state of Thuringia: equipment and education of emergency physicians.

    PubMed

    Hüter, Lars; Schreiber, Torsten; Reichel, Jens; Schwarzkopf, Konrad

    2009-04-01

    We describe the condition of education and equipment regarding prehospital airway management in the German federal state of Thuringia, representing a part of former Eastern Germany. In 2006 a postal survey of the 39 emergency medical stations (EMS) in Thuringia was carried out. The response rate was 100%. In 72% of the EMS, a device for extraglottic airway management and in all EMS a device for cricothyrotomy was available. A device to monitor end-tidal CO2 was available in 41%. Difficulties in airway management in the past two years were reported from 74% of the EMS. Ongoing training and education in airway management is provided in 82% of the emergency districts. This survey reveals wide variations in the equipment for airway management available to prehospital emergency physicians in Thuringia. Given the reported difficulties in airway management, availability of a more standardized set of airway management devices in Thuringia may be helpful.

  3. Airway management of patients with traumatic brain injury/C-spine injury

    PubMed Central

    2015-01-01

    Traumatic brain injury (TBI) is usually combined with cervical spine (C-spine) injury. The possibility of C-spine injury is always considered when performing endotracheal intubation in these patients. Rapid sequence intubation is recommended with adequate sedative or analgesics and a muscle relaxant to prevent an increase in intracranial pressure during intubation in TBI patients. Normocapnia and mild hyperoxemia should be maintained to prevent secondary brain injury. The manual-in-line-stabilization (MILS) technique effectively lessens C-spine movement during intubation. However, the MILS technique can reduce mouth opening and lead to a poor laryngoscopic view. The newly introduced video laryngoscope can manage these problems. The AirWay Scope® (AWS) and AirTraq laryngoscope decreased the extension movement of C-spines at the occiput-C1 and C2-C4 levels, improving intubation conditions and shortening the time to complete tracheal intubation compared with a direct laryngoscope. The Glidescope® also decreased cervical movement in the C2-C5 levels during intubation and improved vocal cord visualization, but a longer duration was required to complete intubation compared with other devices. A lightwand also reduced cervical motion across all segments. A fiberoptic bronchoscope-guided nasal intubation is the best method to reduce cervical movement, but a skilled operator is required. In conclusion, a video laryngoscope assists airway management in TBI patients with C-spine injury. PMID:26045922

  4. Airway management of patients with traumatic brain injury/C-spine injury.

    PubMed

    Jung, Jin Yong

    2015-06-01

    Traumatic brain injury (TBI) is usually combined with cervical spine (C-spine) injury. The possibility of C-spine injury is always considered when performing endotracheal intubation in these patients. Rapid sequence intubation is recommended with adequate sedative or analgesics and a muscle relaxant to prevent an increase in intracranial pressure during intubation in TBI patients. Normocapnia and mild hyperoxemia should be maintained to prevent secondary brain injury. The manual-in-line-stabilization (MILS) technique effectively lessens C-spine movement during intubation. However, the MILS technique can reduce mouth opening and lead to a poor laryngoscopic view. The newly introduced video laryngoscope can manage these problems. The AirWay Scope® (AWS) and AirTraq laryngoscope decreased the extension movement of C-spines at the occiput-C1 and C2-C4 levels, improving intubation conditions and shortening the time to complete tracheal intubation compared with a direct laryngoscope. The Glidescope® also decreased cervical movement in the C2-C5 levels during intubation and improved vocal cord visualization, but a longer duration was required to complete intubation compared with other devices. A lightwand also reduced cervical motion across all segments. A fiberoptic bronchoscope-guided nasal intubation is the best method to reduce cervical movement, but a skilled operator is required. In conclusion, a video laryngoscope assists airway management in TBI patients with C-spine injury.

  5. Impact of airway gas exchange on the multiple inert gas elimination technique: theory.

    PubMed

    Anderson, Joseph C; Hlastala, Michael P

    2010-03-01

    The multiple inert gas elimination technique (MIGET) provides a method for estimating alveolar gas exchange efficiency. Six soluble inert gases are infused into a peripheral vein. Measurements of these gases in breath, arterial blood, and venous blood are interpreted using a mathematical model of alveolar gas exchange (MIGET model) that neglects airway gas exchange. A mathematical model describing airway and alveolar gas exchange predicts that two of these gases, ether and acetone, exchange primarily within the airways. To determine the effect of airway gas exchange on the MIGET, we selected two additional gases, toluene and m-dichlorobenzene, that have the same blood solubility as ether and acetone and minimize airway gas exchange via their low water solubility. The airway-alveolar gas exchange model simulated the exchange of toluene, m-dichlorobenzene, and the six MIGET gases under multiple conditions of alveolar ventilation-to-perfusion, VA/Q, heterogeneity. We increased the importance of airway gas exchange by changing bronchial blood flow, Qbr. From these simulations, we calculated the excretion and retention of the eight inert gases and divided the results into two groups: (1) the standard MIGET gases which included acetone and ether and (2) the modified MIGET gases which included toluene and m-dichlorobenzene. The MIGET mathematical model predicted distributions of ventilation and perfusion for each grouping of gases and multiple perturbations of VA/Q and Qbr. Using the modified MIGET gases, MIGET predicted a smaller dead space fraction, greater mean VA, greater log(SDVA), and more closely matched the imposed VA distribution than that using the standard MIGET gases. Perfusion distributions were relatively unaffected.

  6. Airway Management of the Patient with Maxillofacial Trauma: Review of the Literature and Suggested Clinical Approach

    PubMed Central

    Barak, Michal; Bahouth, Hany; Leiser, Yoav; Abu El-Naaj, Imad

    2015-01-01

    According to the Advanced Trauma Life Support recommendations for managing patients with life-threatening injuries, securing the airway is the first task of a primary caregiver. Airway management of patients with maxillofacial trauma is complex and crucial because it can dictate a patient's survival. Securing the airway of patients with maxillofacial trauma is often extremely difficult because the trauma involves the patient's airway and their breathing is compromised. In these patients, mask ventilation and endotracheal intubation are anticipated to be difficult. Additionally, some of these patients may not yet have been cleared of a cervical spine injury, and all are regarded as having a full stomach and having an increased risk of regurgitation and pulmonary aspiration. The requirements of the intended maxillofacial operation may often preclude the use of an oral intubation tube, and alternative methods for securing the airway should be considered before the start of the surgery. In order to improve the clinical outcome of patients with maxillofacial trauma, cooperation between maxillofacial surgeons, anesthesiologists, and trauma specialists is needed. In this review, we discuss the complexity and difficulties of securing the airway of patients with maxillofacial trauma and present our approach for airway management of such patients. PMID:26161411

  7. Airway management evolution - in a search for an ideal extraglottic airway device.

    PubMed

    Michálek, Pavel; Miller, Donald M

    2014-01-01

    Extraglottic airway devices (EADs) are commonly used equipment for airway maintenance during elective procedures under general anaesthesia. They may be used also in other indications such as conduit for tracheal intubation or rescue airway device in prehospital medicine. Current classifications of the EADs lack systematic approach and therefore classification according to the sealing sites and sealing mechanisms is suggested in this review article. Modern EADs are disposable, latex-free devices made of plastic materials most commonly from polyvinylchloride (PVC). The bowl of uncuffed sealers is manufactured from different materials such as thermoplastic elastomers or ethylene-vinyl-acetate co-polymer. EADs create various physical forces exerted on the adjacent tissues which may contribute to different sealing characteristic of particular device or to variable incidence of postoperative complications. Desired features of an ideal EAD involve easy insertion, high insertion success rate even by inexperienced users, protection against aspiration of gastric contents and low incidence of postoperative complications such as sore throat, hoarseness, cough or swallowing difficulties.

  8. A retropharyngeal–mediastinal hematoma with supraglottic and tracheal obstruction: The role of multidisciplinary airway management

    PubMed Central

    Birkholz, Torsten; Kröber, Stefanie; Knorr, Christian; Schiele, Albert; Bumm, Klaus; Schmidt, Joachim

    2010-01-01

    A 77-year-old man suffered hypoxemic cardiac arrest by supraglottic and tracheal airway obstruction in the emergency department. A previously unknown cervical fracture had caused a traumatic retropharyngeal–mediastinal hematoma. A lifesaving surgical emergency tracheostomy succeeded. Supraglottic and tracheal obstruction by a retropharyngeal–mediastinal hematoma with successful resuscitation via emergency tracheostomy after hypoxemic cardiac arrest has never been reported in a context of trauma. This clinically demanding case outlines the need for multidisciplinary airway management systems with continuous training and well-implemented guidelines. Only multidisciplinary staff preparedness and readily available equipments for the unanticipated difficult airway solved the catastrophic clinical situation. PMID:21063569

  9. Obstetric Anaesthetists' Association and Difficult Airway Society guidelines for the management of difficult and failed tracheal intubation in obstetrics*

    PubMed Central

    Mushambi, M C; Kinsella, S M; Popat, M; Swales, H; Ramaswamy, K K; Winton, A L; Quinn, A C

    2015-01-01

    The Obstetric Anaesthetists' Association and Difficult Airway Society have developed the first national obstetric guidelines for the safe management of difficult and failed tracheal intubation during general anaesthesia. They comprise four algorithms and two tables. A master algorithm provides an overview. Algorithm 1 gives a framework on how to optimise a safe general anaesthetic technique in the obstetric patient, and emphasises: planning and multidisciplinary communication; how to prevent the rapid oxygen desaturation seen in pregnant women by advocating nasal oxygenation and mask ventilation immediately after induction; limiting intubation attempts to two; and consideration of early release of cricoid pressure if difficulties are encountered. Algorithm 2 summarises the management after declaring failed tracheal intubation with clear decision points, and encourages early insertion of a (preferably second-generation) supraglottic airway device if appropriate. Algorithm 3 covers the management of the ‘can't intubate, can't oxygenate’ situation and emergency front-of-neck airway access, including the necessity for timely perimortem caesarean section if maternal oxygenation cannot be achieved. Table 1 gives a structure for assessing the individual factors relevant in the decision to awaken or proceed should intubation fail, which include: urgency related to maternal or fetal factors; seniority of the anaesthetist; obesity of the patient; surgical complexity; aspiration risk; potential difficulty with provision of alternative anaesthesia; and post-induction airway device and airway patency. This decision should be considered by the team in advance of performing a general anaesthetic to make a provisional plan should failed intubation occur. The table is also intended to be used as a teaching tool to facilitate discussion and learning regarding the complex nature of decision-making when faced with a failed intubation. Table 2 gives practical considerations of how

  10. Accurate measurement of respiratory airway wall thickness in CT images using a signal restoration technique

    NASA Astrophysics Data System (ADS)

    Park, Sang Joon; Kim, Tae Jung; Kim, Kwang Gi; Lee, Sang Ho; Goo, Jin Mo; Kim, Jong Hyo

    2008-03-01

    Airway wall thickness (AWT) is an important bio-marker for evaluation of pulmonary diseases such as chronic bronchitis, bronchiectasis. While an image-based analysis of the airway tree can provide precise and valuable airway size information, quantitative measurement of AWT in Multidetector-Row Computed Tomography (MDCT) images involves various sources of error and uncertainty. So we have developed an accurate AWT measurement technique for small airways with three-dimensional (3-D) approach. To evaluate performance of these techniques, we used a set of acryl tube phantom was made to mimic small airways to have three different sizes of wall diameter (4.20, 1.79, 1.24 mm) and wall thickness (1.84, 1.22, 0.67 mm). The phantom was imaged with MDCT using standard reconstruction kernel (Sensation 16, Siemens, Erlangen). The pixel size was 0.488 mm × 0.488 mm × 0.75 mm in x, y, and z direction respectively. The images were magnified in 5 times using cubic B-spline interpolation, and line profiles were obtained for each tube. To recover faithful line profile from the blurred images, the line profiles were deconvolved with a point spread kernel of the MDCT which was estimated using the ideal tube profile and image line profile. The inner diameter, outer diameter, and wall thickness of each tube were obtained with full-width-half-maximum (FWHM) method for the line profiles before and after deconvolution processing. Results show that significant improvement was achieved over the conventional FWHM method in the measurement of AWT.

  11. Transmigration and phagocytosis of macrophages in an airway infection model using four-dimensional techniques.

    PubMed

    Ding, Peishan; Wu, Huimei; Fang, Lei; Wu, Ming; Liu, Rongyu

    2014-07-01

    During infection, recruited phagocytes transmigrate across the epithelium to remove the pathogens deposited on the airway surface. However, it is difficult to directly observe cellular behaviors (e.g., transmigration) in single-cell layer cultures or in live animals. Combining a three-dimensional (3D) cell coculture model mimicking airway infection with time-lapse confocal imaging as a four-dimensional technique allowed us to image the behaviors of macrophages in 3D over time. The airway infection model was moved to a glass-bottomed dish for live-cell imaging by confocal laser scanning microscopy. Using time-lapse confocal imaging, we recorded macrophages transmigrating across the polyethylene terephthalate (PET) membrane of the inserts through the 5-μm pores in the PET membrane. Macrophages on the apical side of the insert exhibited essentially three types of movements, one of which was transmigrating across the epithelial cell monolayer and arriving at the surface of monolayer. We found that adding Staphylococcus aureus to the model increased the transmigration index but not the transmigration time of the macrophages. Only in the presence of S. aureus were the macrophages able to transmigrate across the epithelial cell monolayer. Apical-to-basal transmigration of macrophages was visualized dynamically. We also imaged the macrophages phagocytizing S. aureus deposited on the surface of the monolayer in the airway infection model. This work provides a useful tool to study the cellular behaviors of immune cells spatially and temporally during infection.

  12. [Anaesthetic management in a paediatric patient with a difficult airway due to epidermolysis bullosa dystrophica].

    PubMed

    Blázquez Gómez, E; Garcés Aletá, A; Monclus Diaz, E; Manen Berga, F; García-Aparicio, L; Ontanilla López, A

    2015-05-01

    Dystrophic epidermolysis bullosa (DEB) is a rare inherited disorder characterized by blistering after minimal trauma. These blisters tend to form dystrophic scars, leading to limiting and life-threatening sequelae. The anaesthetic management of patients with DEB is a challenge, even for the most experienced anaesthesiologists, but basic principles can help us prepare the plan of care. The main goals are to prevent trauma/infection of skin/mucous, and to establish a secure airway without causing bullae. Patient positioning and the instruments used to monitor vital signs and administering anaesthetic agents can cause new lesions. It is advisable to lubricate the instruments and to avoid adhesive material and shearing forces on the skin. Besides the implications of the comorbidities, there is a potential difficult intubation and difficult vascular access. Acute airway obstruction can occur due to airway instrumentation. We report the case of a patient diagnosed with EBD difficult airway and undergoing correction of syndactylyl and dental extractions.

  13. A three-microphone acoustic reflection technique using transmitted acoustic waves in the airway.

    PubMed

    Fujimoto, Yuki; Huang, Jyongsu; Fukunaga, Toshiharu; Kato, Ryo; Higashino, Mari; Shinomiya, Shohei; Kitadate, Shoko; Takahara, Yutaka; Yamaya, Atsuyo; Saito, Masatoshi; Kobayashi, Makoto; Kojima, Koji; Oikawa, Taku; Nakagawa, Ken; Tsuchihara, Katsuma; Iguchi, Masaharu; Takahashi, Masakatsu; Mizuno, Shiro; Osanai, Kazuhiro; Toga, Hirohisa

    2013-10-15

    The acoustic reflection technique noninvasively measures airway cross-sectional area vs. distance functions and uses a wave tube with a constant cross-sectional area to separate incidental and reflected waves introduced into the mouth or nostril. The accuracy of estimated cross-sectional areas gets worse in the deeper distances due to the nature of marching algorithms, i.e., errors of the estimated areas in the closer distances accumulate to those in the further distances. Here we present a new technique of acoustic reflection from measuring transmitted acoustic waves in the airway with three microphones and without employing a wave tube. Using miniaturized microphones mounted on a catheter, we estimated reflection coefficients among the microphones and separated incidental and reflected waves. A model study showed that the estimated cross-sectional area vs. distance function was coincident with the conventional two-microphone method, and it did not change with altered cross-sectional areas at the microphone position, although the estimated cross-sectional areas are relative values to that at the microphone position. The pharyngeal cross-sectional areas including retropalatal and retroglossal regions and the closing site during sleep was visualized in patients with obstructive sleep apnea. The method can be applicable to larger or smaller bronchi to evaluate the airspace and function in these localized airways.

  14. Negative Expiratory Pressure Technique: An Awake Test to Measure Upper Airway Collapsibility in Adolescents

    PubMed Central

    Carrera, Helena Larramona; Marcus, Carole L.; McDonough, Joseph M.; Morera, Joan C. Oliva; Huang, Jingtao; Farre, Ramon; Montserrat, Josep M.

    2015-01-01

    Study Objectives: Upper airway (UA) collapsibility is a major pathophysiologic feature of the obstructive sleep apnea syndrome (OSAS). In adolescents, it is measured by obtaining the slope of pressure-flow relationship (SPF) while applying negative nasal pressure during sleep. An easier technique to assess UA collapsibility, consisting of application of negative expiratory pressure (NEP) during wakefulness, has demonstrated differences between control and OSAS subjects. We hypothesized that the NEP technique would correlate with SPF as a measurement of UA collapsibility in adolescents. Design: During wakefulness, NEP of −5 cm H2O in the seated and supine position was applied during the first second of expiration. The area under the expiratory flow-volume curve during NEP was compared to tidal breathing (RatioNEP). In addition, adolescents underwent SPF measurements during sleep. Two SPF techniques were performed to measure the activated and relatively hypotonic UA. Setting: Pediatric sleep laboratory. Participants: Seven adolescents with OSAS and 20 controls. Results: In the seated position, there was a correlation between RatioNEP and both hypotonic SPF (r = −0.39, P = 0.04) and activated SPF (r = −0.62, P = 0.001). In the supine position, there was a correlation between RatioNEP and activated SPF (r = −0.43, P = 0.03) and a trend for hypotonic SPF (r = −0.38, P = 0.06). Conclusions: The negative expiratory pressure (NEP) technique correlates with the hypotonic and activated slope of pressure-flow relationship measurements. The seated position showed the strongest correlation. The NEP technique can be used as an alternative method to evaluate upper airway collapsibility in adolescents. Citation: Carrera HL, Marcus CL, McDonough JM, Morera JC, Huang J, Farre R, Montserrat JM. Negative expiratory pressure technique: an awake test to measure upper airway collapsibility in adolescents. SLEEP 2015;38(11):1783–1791. PMID:26158888

  15. Clinical Factors Associated with the Non-Operative Airway Management of Patients with Robin Sequence

    PubMed Central

    Wood, Benjamin C.; Han, Kevin D.; Yi, Sojung; Seruya, Mitchel; Rogers, Gary F.; Oh, Albert K.

    2016-01-01

    Background The indications for surgical airway management in patients with Robin sequence (RS) and severe airway obstruction have not been well defined. While certain patients with RS clearly require surgical airway intervention and other patients just as clearly can be managed with conservative measures alone, a significant proportion of patients with RS present with a more confusing and ambiguous clinical course. The purpose of this study was to describe the clinical features and objective findings of patients with RS whose airways were successfully managed without surgical intervention. Methods The authors retrospectively reviewed the medical charts of infants with RS evaluated for potential surgical airway management between 1994 and 2014. Patients who were successfully managed without surgical intervention were included. Patient demographics, nutritional and respiratory status, laboratory values, and polysomnography (PSG) findings were recorded. Results Thirty-two infants met the inclusion criteria. The average hospital stay was 16.8 days (range, 5–70 days). Oxygen desaturation (<70% by pulse oximetry) occurred in the majority of patients and was managed with temporary oxygen supplementation by nasal cannula (59%) or endotracheal intubation (31%). Seventy-five percent of patients required a temporary nasogastric tube for nutritional support, and a gastrostomy tube placed was placed in 9%. All patients continued to gain weight following the implementation of these conservative measures. PSG data (n=26) demonstrated mild to moderate obstruction, a mean apneahypopnea index (AHI) of 19.2±5.3 events/hour, and an oxygen saturation level <90% during only 4% of the total sleep time. Conclusions Nonsurgical airway management was successful in patients who demonstrated consistent weight gain and mild to moderate obstruction on PSG, with a mean AHI of <20 events/hour. PMID:27896179

  16. Prehospital airway management: high tech meets trauma: an air medical perspective.

    PubMed

    Bauer, Kris

    2012-01-01

    Trauma is the leading cause of death in the United States for those younger than 35 years and injuries sustained from trauma are a significant source of moderate to severe disability. The inability to establish, secure, or maintain a definitive airway is a major cause of preventable death and secondary injury due to inadequate oxygenation and ventilation. Prehospital airway management is an essential skill of any prehospital care provider. A critical component to providing excellent airway management is the ability of the provider to quickly establish endotracheal intubation without complications such as hypoxia, hyper/hypocapnea, or hypotension. These complications have been shown to cause increased morbidity and mortality, especially in patients suffering from traumatic brain injury. This article presents some of the challenges faced by flight nurses in the air medical environment and how Airlift Northwest has developed a structured, standardized approach to airway management both in training and it the prehospital setting. We will discuss the process improvements that lead to the implementation of video laryngoscopy as our first-line intubation tool. The ultimate goal of any air medical or prehospital emergency medical services program is to manage 100% of airways without complications, which will decrease morbidity and mortality, ultimately improving patient outcomes.

  17. Airway Management During Upper GI Endoscopic Procedures: State of the Art Review.

    PubMed

    Goudra, Basavana; Singh, Preet Mohinder

    2017-01-01

    With the growing popularity of propofol mediated deep sedation for upper gastrointestinal (GI) endoscopic procedures, challenges are being felt and appreciated. Research suggests that management of the airway is anything but routine in this setting. Although many studies and meta-analyses have demonstrated the safety of propofol sedation administered by registered nurses under the supervision of gastroenterologists (likely related to the lighter degrees of sedation than those provided by anesthesia providers and is under medicolegal controversy in the United States), there is no agreement on the optimum airway management for procedures such as endoscopic retrograde cholangiopancreatography. Failure to rescue an airway at an appropriate time has led to disastrous consequences. Inability to evaluate and appreciate the risk factors for aspiration can ruin the day for both the patient and the health care providers. This review apprises the reader of various aspects of airway management relevant to the practice of sedation during upper GI endoscopy. New devices and modification of existing devices are discussed in detail. Recognizing the fact that appropriate monitoring is important for timely recognition and management of potential airway disasters, these issues are explored thoroughly.

  18. Pre-hospital advanced airway management by anaesthesiologists: Is there still room for improvement?

    PubMed Central

    Sollid, Stephen JM; Heltne, Jon Kenneth; Søreide, Eldar; Lossius, Hans Morten

    2008-01-01

    Background Endotracheal intubation is an important part of pre-hospital advanced life support that requires training and experience, and should only be performed by specially trained personnel. In Norway, anaesthesiologists serve as Helicopter Emergency Medical Service HEMS physicians. However, little is known about how they themselves evaluate the quality and safety of pre-hospital advanced airway management. Method Using a semi-structured questionnaire, we interviewed anaesthesiologists working in the three HEMS programs covering Western Norway. We compared answers from specialists and non-specialists as well as full- and part-time HEMS physicians. Results Of the 17 available respondents, most (88%) felt that their continuous exposure to intubations was not sufficient. Additional training was mainly acquired through other clinical practice and mannequin- or cadaver-based skills training. Of the respondents, 77% and 35% reported having experienced difficult and failed intubations, respectively. Further, 59% reported knowledge of airway management-related deaths in their HEMS program. Significantly more full- than part-time HEMS physicians had experienced these problems. All respondents had airway back-up equipment in their service, but 29% were not familiar with all the equipment. Conclusion The majority of anaesthesiologists working as HEMS physicians view pre-hospital advanced airway management as a high-risk procedure. Relevant airway management competencies for HEMS physicians in Norway seem to be insufficiently trained and maintained. A better-defined level of competence with better training methods and systems seems warranted. PMID:18957064

  19. Emergency Difficult Airway Management in a Patient with Severe Epidermolysis Bullosa

    PubMed Central

    Özkan, Ahmet Selim; Kayhan, Gülay Erdoğan; Akbaş, Sedat; Kaçmaz, Osman; Durmuş, Mahmut

    2016-01-01

    Epidermolysis bullosa (EB) is a rare disease characterised by vesiculobullous lesions with minimal trauma to the skin and mucous membranes. Bleeding, scar tissue, contractures, oedema and lesions that can spread throughout the body can cause a difficult airway and vascular access in patients with EB. Therefore, anaesthetic management in patients with EB is a major problem even for experienced anaesthesiologists. Herein, we report a case of difficult airway management in a patient diagnosed with severe EB who presented for emergency tracheostomy because of respiratory failure under general anaesthesia. PMID:27909609

  20. Airway management in laryngotracheal injuries from blunt neck trauma in children.

    PubMed

    Chatterjee, Debnath; Agarwal, Rita; Bajaj, Lalit; Teng, Sarena N; Prager, Jeremy D

    2016-02-01

    Pediatric laryngotracheal injuries from blunt neck trauma are extremely rare, but can be potentially catastrophic. Early diagnosis and skillful airway management is critical in avoiding significant morbidity and mortality associated with these cases. We present a case of a patient who suffered a complete tracheal transection and cervical spine fracture following a clothesline injury to the anterior neck. A review of the mechanisms of injury, clinical presentation, initial airway management, and anesthetic considerations in laryngotracheal injuries from blunt neck trauma in children are presented.

  1. CT reconstruction techniques for improved accuracy of lung CT airway measurement

    SciTech Connect

    Rodriguez, A.; Ranallo, F. N.; Judy, P. F.; Gierada, D. S.; Fain, S. B.

    2014-11-01

    Purpose: To determine the impact of constrained reconstruction techniques on quantitative CT (qCT) of the lung parenchyma and airways for low x-ray radiation dose. Methods: Measurement of small airways with qCT remains a challenge, especially for low x-ray dose protocols. Images of the COPDGene quality assurance phantom (CTP698, The Phantom Laboratory, Salem, NY) were obtained using a GE discovery CT750 HD scanner for helical scans at x-ray radiation dose-equivalents ranging from 1 to 4.12 mSv (12–100 mA s current–time product). Other parameters were 40 mm collimation, 0.984 pitch, 0.5 s rotation, and 0.625 mm thickness. The phantom was sandwiched between 7.5 cm thick water attenuating phantoms for a total length of 20 cm to better simulate the scatter conditions of patient scans. Image data sets were reconstructed using STANDARD (STD), DETAIL, BONE, and EDGE algorithms for filtered back projection (FBP), 100% adaptive statistical iterative reconstruction (ASIR), and Veo reconstructions. Reduced (half) display field of view (DFOV) was used to increase sampling across airway phantom structures. Inner diameter (ID), wall area percent (WA%), and wall thickness (WT) measurements of eight airway mimicking tubes in the phantom, including a 2.5 mm ID (42.6 WA%, 0.4 mm WT), 3 mm ID (49.0 WA%, 0.6 mm WT), and 6 mm ID (49.0 WA%, 1.2 mm WT) were performed with Airway Inspector (Surgical Planning Laboratory, Brigham and Women’s Hospital, Boston, MA) using the phase congruency edge detection method. The average of individual measures at five central slices of the phantom was taken to reduce measurement error. Results: WA% measures were greatly overestimated while IDs were underestimated for the smaller airways, especially for reconstructions at full DFOV (36 cm) using the STD kernel, due to poor sampling and spatial resolution (0.7 mm pixel size). Despite low radiation dose, the ID of the 6 mm ID airway was consistently measured accurately for all methods other than STD

  2. CT reconstruction techniques for improved accuracy of lung CT airway measurement

    PubMed Central

    Rodriguez, A.; Ranallo, F. N.; Judy, P. F.; Gierada, D. S.; Fain, S. B.

    2014-01-01

    Purpose: To determine the impact of constrained reconstruction techniques on quantitative CT (qCT) of the lung parenchyma and airways for low x-ray radiation dose. Methods: Measurement of small airways with qCT remains a challenge, especially for low x-ray dose protocols. Images of the COPDGene quality assurance phantom (CTP698, The Phantom Laboratory, Salem, NY) were obtained using a GE discovery CT750 HD scanner for helical scans at x-ray radiation dose-equivalents ranging from 1 to 4.12 mSv (12–100 mA s current–time product). Other parameters were 40 mm collimation, 0.984 pitch, 0.5 s rotation, and 0.625 mm thickness. The phantom was sandwiched between 7.5 cm thick water attenuating phantoms for a total length of 20 cm to better simulate the scatter conditions of patient scans. Image data sets were reconstructed using STANDARD (STD), DETAIL, BONE, and EDGE algorithms for filtered back projection (FBP), 100% adaptive statistical iterative reconstruction (ASIR), and Veo reconstructions. Reduced (half) display field of view (DFOV) was used to increase sampling across airway phantom structures. Inner diameter (ID), wall area percent (WA%), and wall thickness (WT) measurements of eight airway mimicking tubes in the phantom, including a 2.5 mm ID (42.6 WA%, 0.4 mm WT), 3 mm ID (49.0 WA%, 0.6 mm WT), and 6 mm ID (49.0 WA%, 1.2 mm WT) were performed with Airway Inspector (Surgical Planning Laboratory, Brigham and Women’s Hospital, Boston, MA) using the phase congruency edge detection method. The average of individual measures at five central slices of the phantom was taken to reduce measurement error. Results: WA% measures were greatly overestimated while IDs were underestimated for the smaller airways, especially for reconstructions at full DFOV (36 cm) using the STD kernel, due to poor sampling and spatial resolution (0.7 mm pixel size). Despite low radiation dose, the ID of the 6 mm ID airway was consistently measured accurately for all methods other than STD

  3. Operative endoscopy of the airway

    PubMed Central

    Walters, Dustin M.

    2016-01-01

    Airway endoscopy has long been an important and useful tool in the management of thoracic diseases. As thoracic specialists have gained experience with both flexible and rigid bronchoscopic techniques, the technology has continued to evolve so that bronchoscopy is currently the foundation for diagnosis and treatment of many thoracic ailments. Airway endoscopy plays a significant role in the biopsy of tumors within the airways, mediastinum, and lung parenchyma. Endoscopic methods have been developed to treat benign and malignant airway stenoses and tracheomalacia. And more recently, techniques have been conceived to treat end-stage emphysema and prolonged air leaks in select patients. This review describes the abundant uses of airway endoscopy, as well as technical considerations and limitations of the current technologies. PMID:26981263

  4. To characterize the incidence of airway misplacement of nasogastric tubes in anesthetized intubated patients by using a manometer technique.

    PubMed

    Hsieh, Shao-Wei; Chen, Hung-Shu; Chen, Yi-Ting; Hung, Kuo-Chuan

    2017-04-01

    This study characterized the incidence of airway misplacement of nasogastric (NG) tubes in surgical patients, and the benefit of using a manometer to discriminate gastric placement from airway placement of NG tubes. Subjects included adult patients scheduled for abdominal surgery. After tracheal intubation, a 16 Fr. NG tube was inserted blindly through the nostril, and its position was assessed using the auscultation (10-ml air insufflation) or manometer (attached to NG tubes) techniques. Briefly, a biphasic pressure change synchronous with airway pressure during mechanical ventilation indicated airway misplacement. The presence of a notable pressure change while compressing the epigastric area indicated a gastric placement. A surgeon made the final confirmation of NG tube placement within the stomach using manual palpation of the tube immediately after laparotomy. The first-attempt success rate was 82.7 % in 104 patients. There were 29 misplacements of 130 attempted insertions (oral cavity, n = 23; trachea, n = 3; distal esophagus, n = 3). The incidence of airway misplacement was 2.9 % (3 of 104 cases). For confirmation of gastric placement, the auscultation technique had a sensitivity of 100.0 % and a specificity of 79.3 %. In contrast, the manometer technique had a sensitivity of 100.0 % and a specificity of 100.0 % in the discrimination of gastric placement from airway placement of NG tubes. Airway misplacement of NG tubes is not uncommon in surgical patients, and the manometer technique may be a reliable and safe method to discriminate gastric placement from airway placement of NG tubes.

  5. [Emergency medicine at the limit: shock-, analgesic therapy and airway management in difficult terrain].

    PubMed

    Rauch, Simon; Schenk, Kai; Rainer, Bernhard; Strapazzon, Giacomo; Paal, Peter; Brugger, Hermann

    2016-01-01

    Rescue operations in mountain and remote areas pose special challenges for the rescue team and often differ substantially from rescue missions in the urban environment. Given the growing sports and leisure activities in mountains, incidence of alpine emergencies is expected to rise further. The following article describes the treatment of haemorrhagic shock, analgesic therapy and airway management in mountain rescue.

  6. [Inadequate management of a difficult airway. Case SENSAR of the trimester].

    PubMed

    2015-01-01

    A clinical case reported to SENSAR is presented (www.sensar.org). A patient came to the operating room for surgery for parathyroidectomy. She had several predictors of difficult airway management, including a story of difficulties in previous intubations in other hospitals, as the patient reported. Therefore, after evaluation in preoperative consultation, fibreoptic bronchoscopy intubation was recommended. The day of surgery after induction of general anesthesia direct laryngoscopy was performed, without recognizing any glottic structure (Cormack-Lehane grade iv). Conventional laryngoscope was changed to a videolaryngoscope (Airtraq(®)) to try to improve the laryngoscopic view, but there were difficulties with handling and insertion of it, causing minor injuries to the lingual mucosa. Finally, tracheal intubation was achieved after several attempts. Analysis of the incident revealed the active error due to lack of experience of the professional who performed intubation maneuvers, favored by latent factors or contributors as were the complex pathology of the patient and the absence of protocols to difficult airway management in the hospital. Communication and analysis of this incident served to highlight the importance of the security protocols in Anesthesia, and as a result a working group that conducted the current algorithm approach to a difficult airway management was formed, established guidelines for further information patient and deals since clinical training and professional practice for the management of airway devices availables in the hospital.

  7. Emergency ventilation of the tracheostomy patient, part II: a story of tracheotomy history and emergency airway management--advocating education for emergency resuscitation.

    PubMed

    Sharp, Deidra Lynn

    2005-01-01

    Over a period of 5000 years, dramatic changes have occurred in airway management, tracheotomy procedure terminology, indications, techniques, instruments, settings where procedures are performed, tube design and patient outcomes. Specialized knowledge and skills necessary to safely care for tracheostomy patients and to provide effective respiratory resuscitation are reviewed. The purpose of this paper is to document the history of the tracheotomy as a backdrop for understanding patient management. Recommendations for staff education regarding emergency ventilation of the tracheostomy patient are presented.

  8. Prehospital Glidescope video laryngoscopy for difficult airway management in a helicopter rescue program with anaesthetists.

    PubMed

    Struck, Manuel Florian; Wittrock, Maike; Nowak, Andreas

    2011-10-01

    The objective of this study was to analyze the prehospital use of a Glidescope video laryngoscope (GSVL) due to anticipated and unexpected difficult airway in a helicopter emergency medical service setting in which emergency physicians (EP) are experienced anesthetists. Retrospective observational study and survey of the experiences of EP were conducted for more than a 3-year period (July 2007-August 2010). In 1675 missions, 152 tracheal intubations (TI) were performed. GSVL was used in 23 cases (15%). A total of 17 patients presented with multiple traumas, including nine with cervical spine immobilization, three with burns, and three with nontraumatic diagnoses. Eight patients experienced previously failed TI with conventional laryngoscopy (five by nonhelicopter emergency medical service EP). In two patients, the EP required two attempts with GSVL to obtain a successful TI. Since the introduction of the GSVL, no other backup airway device was necessary. GSVL may be a valuable support instrument in the prehospital management of difficult airways in emergency patients.

  9. Cystic fibrosis lung microbiome: opportunities to reconsider management of airway infection.

    PubMed

    Caverly, Lindsay J; Zhao, Jiangchao; LiPuma, John J

    2015-10-01

    The importance of infection in the pathogenesis of cystic fibrosis (CF) lung disease has been long recognized, and the use of antibiotics targeting bacteria identified in cultures of respiratory specimens has played a critical role in improving outcomes for individuals with CF. Over the past ∼15 years, the use of culture-independent methods to assess airway microbiology in CF has revealed complex and dynamic CF airway bacterial communities. Recent areas of investigation of the CF lung microbiome have included exploring how bacterial community structures change over time, particularly with respect to disease progression or pulmonary exacerbation, and in response to antibiotic therapies. This review will discuss what has been learned from these studies as well as how these findings offer opportunities to further refine management of CF airway infection.

  10. [Difficult airway management for general anesthesia in two patients with Kartagener syndrome].

    PubMed

    Andoh, Taiki; Momota, Yoshihiro; Murata, Kenji; Kotani, Junichiro

    2010-05-01

    Two patients with Kartagener syndrome were managed under general anesthesia by nasal intubation for sagital split ramus osteotomy. Many episodes of expectoration were encountered in the former patient's perioperative period and the expectoration discharge was inadequate by postoperative nausea, leading to trouble in airway management. In the second patient, tube collapse was caused after intubation by serious nasal cavity strangulation, and re-intubation was necessary. Expectoration is seen resulting from decreased ciliary function with bronchiectasis during anesthetic management of patients with Kartagener syndrome. It is important to prevent lung complications by nausea prevention and pain killing in the postoperative period, in addition to proper suctioning in the perioperative period. Furthermore, there is nasal cavity narrowing by chronic sinusitis. When performing nasal intubation, the difficult airway management is required.

  11. Emergency bronchoscopy for foreign-body aspiration in a child with type I mucopolysaccharidosis: a challenging airway management experience.

    PubMed

    Kendigelen, Pinar; Tunali, Yusuf; Tutuncu, Ayse; Ashyralyyeva, Gulruh; Emre, Senol; Kaya, Guner

    2016-08-01

    The mucopolysaccharidosis (MPS) is a rare lysosomal storage disease. Glycosaminoglycans (GAG) accumulate in musculoskeletal system, connective tissues. Enlarged tongue, short immobile neck, and limited mobility of the cervical spine and temporomandibular joints render the airway management potentially risky. MPS children have high anesthetic risks, especially in airway management of emergency situations. The foreign-body aspiration requiring intervention with rigid bronchoscopy is an urgent and risky clinical situation. We present our experience with a challenging airway management with a three-year-old child with MPS who needed emergency bronchoscopy due to peanut aspiration.

  12. [Difficult Ventilation Requiring Emergency Endotracheal Intubation during Awake Craniotomy Managed by Laryngeal Mask Airway].

    PubMed

    Matsuda, Asako; Mizota, Toshiyuki; Tanaka, Tomoharu; Segawa, Hajime; Fukuda, Kazuhiko

    2016-04-01

    We report a case of difficult ventilation requiring emergency endotracheal intubation during awake craniotomy managed by laryngeal mask airway (LMA). A 45-year-old woman was scheduled to receive awake craniotomy for brain tumor in the frontal lobe. After anesthetic induction, airway was secured using ProSeal LMA and patient was mechanically ventilated in pressure-control mode. Patient's head was fixed with head-pins at anteflex position, and the operation started. About one hour after the start of the operation, tidal volume suddenly decreased. We immediately started manual ventilation, but the airway resistance was extremely high and we could not adequately ventilate the patient. We administered muscle relaxant for suspected laryngospasm, but ventilatory status did not improve; so we decided to conduct emergency endotracheal intubation. We tried to intubate using Airwayscope or LMA-Fastrach, but they were not effective in our case. Finally trachea was intubated using transnasal fiberoptic bronchoscopy. We discuss airway management during awake craniotomy, focusing on emergency endotracheal intubation during surgery.

  13. Airway management in newborn with Klippel-Feil syndrome.

    PubMed

    Altay, Nuray; Yüce, Hasan H; Aydoğan, Harun; Dörterler, Mustafa E

    2016-01-01

    Klippel-Feil syndrome (KFS) has a classical triad that includes short neck, low hair line and restriction in neck motion and is among one of the congenital causes of difficult airway. Herein, we present a 26-day, 3300g newborn with KFS who was planned to be operated for correction of an intestinal obstruction. She had features of severe KFS. Anesthesia was induced by inhalation of sevoflurane 2-3% in percentage 100 oxygen. Sevoflurane inhalation was stopped after 2min. Her Cornmack Lehane score was 2 and oral intubation was performed with 3.5mm ID non-cuffed endotracheal tube in first attempt. Operation lasted for 45min. Following uneventful surgery, she was not extubated and was transferred to the newborn reanimation unit. On the postoperative third day, the patient died due to hyperdynamic heart failure. This case is the youngest child with Klippel-Feil syndrome in literature and on whom oral intubation was performed. We also think that positioning of this younger age group might be easier than older age groups due to incomplete ossification process.

  14. Patient safety in emergency airway management and rapid sequence intubation: metaphorical lessons from skydiving.

    PubMed

    Levitan, Richard M

    2003-07-01

    Concern about patient safety and failed rapid sequence intubation has led to an increased awareness of potentially difficult laryngoscopy situations and algorithms promoting techniques in awake patients. Given the low overall incidence of failed laryngoscopy, however, prediction of difficult laryngoscopy has poor positive predictive value and uncertain clinical utility, especially in emergency settings. Non-rapid sequence intubation approaches have comparatively lower chances of intubation success, require more time, and are associated with more complications. As a specialty, emergency medicine has adopted rapid sequence intubation as the mainstay of emergency airway treatment for many appropriate reasons; the problem that must be addressed is how patient safety can be ensured while what is an inherently dangerous procedure is performed. A novel way to conceptualize patient risk and safety issues in rapid sequence intubation is to examine how inherent risk is managed in skydiving. Metaphorical lessons from skydiving that are applicable to rapid sequence intubation include (1) a redundancy of safety; (2) a methodic approach to primary chute deployment; (3) use of backup chutes that are fast, simple, and easy to deploy; (4) attention to monitoring; and (5) equipment vigilance. This article reviews how each of these lessons apply metaphorically to rapid sequence intubation, wherein the primary chute is laryngoscopy, the backup chute is rescue ventilation, and monitoring involves pulse oximetry.

  15. Extraglottic airway devices: A review

    PubMed Central

    Ramaiah, Ramesh; Das, Debasmita; Bhananker, Sanjay M; Joffe, Aaron M

    2014-01-01

    Extraglottic airway devices (EAD) have become an integral part of anesthetic care since their introduction into clinical practice 25 years ago and have been used safely hundreds of millions of times, worldwide. They are an important first option for difficult ventilation during both in-hospital and out-of-hospital difficult airway management and can be utilized as a conduit for tracheal intubation either blindly or assisted by another technology (fiberoptic endoscopy, lightwand). Thus, the EAD may be the most versatile single airway technique in the airway management toolbox. However, despite their utility, knowledge regarding specific devices and the supporting data for their use is of paramount importance to patient's safety. In this review, number of commercially available EADs are discussed and the reported benefits and potential pitfalls are highlighted. PMID:24741502

  16. Submandibular intubation as an alternative for intra-operative airway management in maxillofacial fractures - our institutional experience

    PubMed Central

    Banerjee, Praveer K; Jain, Abhineet; Behera, Bikram

    2016-01-01

    Background and Aims: Airway management in anaesthesia for maxillofacial surgical procedures is tricky at times when the nasal/oral routes are contraindicated or are impossible. Tracheostomy as an alternative inherits its own complications. We present a case series of the submandibular route for tracheal intubation as an alternative. Methods: The procedure was performed in ten selected adult patients with maxillofacial/mandibular fractures associated with a fracture of skull base or nasal bone. All of them were medically stable with no need of intensive care or mechanical ventilation in post-operative period. Results: Submandibular intubation in all ten patients of panfacial fractures allowed uninterrupted surgical techniques with a secured airway. All patients were reverted to oro-tracheal tube at the end of surgery as immediate maxillomandibular fixation was not necessary. The patients were extubated after recovery from anaesthesia before they left the operating theatre. One patient in the post-operative period had a superficial infection of incision site that responded well to local treatment. No other complications were encountered in the intra-operative or post-operative period. Conclusion: In complex maxillofacial injuries, when oral or nasal intubation hampers surgeon's field of view, submandibular intubation offers an effective alternative to short-term tracheostomy along with small risk potential. There is a need to emphasise its regular application in such cases so that technique can be mastered by both surgeons and anaesthesiologist. PMID:27601740

  17. Spray cryotherapy (SCT): institutional evolution of techniques and clinical practice from early experience in the treatment of malignant airway disease

    PubMed Central

    Turner, J. Francis; Parrish, Scott

    2015-01-01

    Background Spray cryotherapy (SCT) was initially developed for gastroenterology (GI) endoscopic use in the esophagus. In some institutions where a device has been utilized by GI, transition to use in the airways by pulmonologists and thoracic surgeons occurred. Significant differences exist, however, in the techniques for safely using SCT in the airways. Methods We describe the early experience at Walter Reed National Military Medical Center from 2011 to 2013 using SCT in patients with malignant airway disease and the evolution of our current techniques and clinical practice patterns for SCT use in patients. In November 2013 enrollment began in a multi-institutional prospective SCT registry in which we are still enrolling and will be reported on separately. Results Twenty-seven patients that underwent 80 procedures (2.96 procedures/patient). The average age was 63 years with a range of 20 to 87 years old. The average Eastern Cooperative Oncology Group (ECOG) status was 1.26. All malignancies were advanced stage disease. All procedures were performed in the central airways. Other modalities were used in combination with SCT in 31 (39%) of procedures. Additionally 45 of the 80 (56%) procedures were performed in proximity to a silicone, hybrid, or metal stent. Three complications occurred out of the 80 procedures. All three were transient hypoxia that limited continued SCT treatments. These patients were all discharged from the bronchoscopy recovery room to their pre-surgical state. Conclusions SCT can be safely used for treatment of malignant airway tumor (MAT) in the airways. Understanding passive venting of the nitrogen gas produced as the liquid nitrogen changes to gas is important for safe use of the device. Complications can be minimized by adopting strict protocols to maximize passive venting and to allow for adequate oxygenation in between sprays. PMID:26807288

  18. Aerospace management techniques: Commercial and governmental applications

    NASA Technical Reports Server (NTRS)

    Milliken, J. G.; Morrison, E. J.

    1971-01-01

    A guidebook for managers and administrators is presented as a source of useful information on new management methods in business, industry, and government. The major topics discussed include: actual and potential applications of aerospace management techniques to commercial and governmental organizations; aerospace management techniques and their use within the aerospace sector; and the aerospace sector's application of innovative management techniques.

  19. [Two cases of congenital airway obstruction managed with ex utero intrapartum treatment procedures: anesthetic implications].

    PubMed

    Manrique, S; Blasco, J; Munar, F; Andreu, E; Mateo, M D; Suescun, M C; López Gil, M V

    2007-01-01

    An ex utero intrapartum treatment (EXIT) procedure provides sufficient time to gain control of the potentially obstructed fetal upper airway while uterine placental circulation is maintained during cesarean section. We report 2 cases in which fetal congenital upper airway obstruction was managed without complications during EXIT procedures. We also discuss general considerations concerning the obstetric patient and the performance of intramuscular fetal anesthesia. Before the hysterotomy, sevoflurane at 1.5 minimum alveolar concentration was administered to assure sufficient uterine relaxation during EXIT. The 2 parturients remained hemodynamically stable during the procedure and uterine and placental perfusion was adequate. Nasotracheal intubation was possible in 1 fetus after a cervical mass was dissected. In the other, a tracheostomy was created. After the umbilical cord was clamped, the concentration of sevoflurane anesthetic gas was reduced and oxytocin and methylergometrine were administered to induce adequate uterine contractions within a few minutes. Both neonates survived the EXIT procedure with no complications.

  20. Controversies in Pediatric Perioperative Airways

    PubMed Central

    Klučka, Jozef; Štourač, Petr; Štoudek, Roman; Ťoukálková, Michaela; Harazim, Hana; Kosinová, Martina

    2015-01-01

    Pediatric airway management is a challenge in routine anesthesia practice. Any airway-related complication due to improper procedure can have catastrophic consequences in pediatric patients. The authors reviewed the current relevant literature using the following data bases: Google Scholar, PubMed, Medline (OVID SP), and Dynamed, and the following keywords: Airway/s, Children, Pediatric, Difficult Airways, and Controversies. From a summary of the data, we identified several controversies: difficult airway prediction, difficult airway management, cuffed versus uncuffed endotracheal tubes for securing pediatric airways, rapid sequence induction (RSI), laryngeal mask versus endotracheal tube, and extubation timing. The data show that pediatric anesthesia practice in perioperative airway management is currently lacking the strong evidence-based medicine (EBM) data that is available for adult subpopulations. A number of procedural steps in airway management are derived only from adult populations. However, the objective is the same irrespective of patient age: proper securing of the airway and oxygenation of the patient. PMID:26759809

  1. EMS-physicians' self reported airway management training and expertise; a descriptive study from the Central Region of Denmark

    PubMed Central

    2011-01-01

    Background Prehospital advanced airway management, including prehospital endotracheal intubation is challenging and recent papers have addressed the need for proper training, skill maintenance and quality control for emergency medical service personnel. The aim of this study was to provide data regarding airway management-training and expertise from the regional physician-staffed emergency medical service (EMS). Methods The EMS in this part of The Central Region of Denmark is a two tiered system. The second tier comprises physician staffed Mobile Emergency Care Units. The medical directors of the programs supplied system data. A questionnaire addressing airway management experience, training and knowledge was sent to the EMS-physicians. Results There are no specific guidelines, standard operating procedures or standardised program for obtaining and maintaining skills regarding prehospital advanced airway management in the schemes covered by this study. 53/67 physicians responded; 98,1% were specialists in anesthesiology, with an average of 17,6 years of experience in anesthesiology, and 7,2 years experience as EMS-physicians. 84,9% reported having attended life support course(s), 64,2% an advanced airway management course. 24,5% fulfilled the curriculum suggested for Danish EMS physicians. 47,2% had encountered a difficult or impossible PHETI, most commonly in a patient in cardiac arrest or a trauma patient. Only 20,8% of the physicians were completely familiar with what back-up devices were available for airway management. Conclusions In this, the first Danish study of prehospital advanced airway management, we found a high degree of experience, education and training among the EMS-physicians, but their equipment awareness was limited. Check-outs, guidelines, standard operating procedures and other quality control measures may be needed. PMID:21303510

  2. Surgical management of dysphagia and airway obstruction in patients with prominent ventral cervical osteophytes.

    PubMed

    Carlson, Matthew L; Archibald, David J; Graner, Darlene E; Kasperbauer, Jan L

    2011-03-01

    Large projecting ventral cervical osteophytes are associated with senile degenerative skeletal disease, post-traumatic osteophytogenesis, and diffuse idiopathic skeletal hyperostosis (DISH). The vast majority of patients with cervical osteophytes are asymptomatic. However, in a small subset this condition may lead to upper aerodigestive compromise manifesting as dysphagia and/or airway obstruction. Conservative medical therapy is usually sufficient, but patients with intractable disease may require surgical intervention, including tracheostomy, feeding tube placement, or osteophytectomy. A retrospective chart review was performed on all patients who presented to a tertiary referral center over a decade (1998-2008) with complaints of dysphagia and/or respiratory compromise and underwent osteophytectomy for treatment of recalcitrant symptoms. A total of nine patients met criteria. Six patients were diagnosed with DISH, two with trauma-associated osteophytogenesis, and one with senile degenerative vertebral disease. The mean age was 68 years and included seven males and two females. All patients had symptoms of dysphagia and two had simultaneous airway complaints. All patients underwent an anterolateral approach for osteophyte decompression, one of which required concurrent tracheostomy. Following surgery, 100% of patients had significant improvement in dysphagia and respiratory complaints. Eight of nine patients returned to an unrestricted diet and only one required postoperative abstinence from bulky foods; both patients with additional airway complaints were successfully decannulated after surgery. Degenerative conditions and DISH may lead to osteophyte-associated dysphagia and/or airway complaints. Surgical decompression through osteophytectomy is an effective alternative to tracheostomy and feeding tube in carefully selected patients and should be considered for surgically fit patients who fail conservative medical management.

  3. Analysis of a Dynamic Multi-Track Airway Concept for Air Traffic Management

    NASA Technical Reports Server (NTRS)

    Wing, David J.; Smith, Jeremy C.; Ballin, Mark G.

    2008-01-01

    The Dynamic Multi-track Airways (DMA) Concept for Air Traffic Management (ATM) proposes a network of high-altitude airways constructed of multiple, closely spaced, parallel tracks designed to increase en-route capacity in high-demand airspace corridors. Segregated from non-airway operations, these multi-track airways establish high-priority traffic flow corridors along optimal routes between major terminal areas throughout the National Airspace System (NAS). Air traffic controllers transition aircraft equipped for DMA operations to DMA entry points, the aircraft use autonomous control of airspeed to fly the continuous-airspace airway and achieve an economic benefit, and controllers then transition the aircraft from the DMA exit to the terminal area. Aircraft authority within the DMA includes responsibility for spacing and/or separation from other DMA aircraft. The DMA controller is responsible for coordinating the entry and exit of traffic to and from the DMA and for traffic flow management (TFM), including adjusting DMA routing on a daily basis to account for predicted weather and wind patterns and re-routing DMAs in real time to accommodate unpredicted weather changes. However, the DMA controller is not responsible for monitoring the DMA for traffic separation. This report defines the mature state concept, explores its feasibility and performance, and identifies potential benefits. The report also discusses (a) an analysis of a single DMA, which was modeled within the NAS to assess capacity and determine the impact of a single DMA on regional sector loads and conflict potential; (b) a demand analysis, which was conducted to determine likely city-pair candidates for a nationwide DMA network and to determine the expected demand fraction; (c) two track configurations, which were modeled and analyzed for their operational characteristic; (d) software-prototype airborne capabilities developed for DMA operations research; (e) a feasibility analysis of key attributes in

  4. Careers in Airway Science.

    ERIC Educational Resources Information Center

    Federal Aviation Administration (DOT), Washington, DC.

    The Federal Aviation Administration (FAA) has initiated the Airway Science curriculum as a method of preparing the next generation of aviation technicians and managers. This document: (1) discusses the FAA's role in the Airway Science program; (2) describes some of the career fields that FAA offers to Airway Science graduates (air traffic control…

  5. Management of severe obstructive sleep apnea using mandibular advancement devices with auto continuous positive airway pressures

    PubMed Central

    Upadhyay, Rashmi; Dubey, Abhishek; Kant, Surya; Singh, Balendra Pratap

    2015-01-01

    The use of continuous positive airway pressures (CPAP) is considered standard treatment of moderate to severe obstructive sleep apnea (OSA). Treatment of the disease poses a great challenge not only for its diagnostic purpose but also for its treatment part. In about 29-83% of the patients, treatment is difficult because of non-compliance resulting due to high pressures, air leaks and other related issues. In such situations, alternative methods of treatment need to be looked for so as to ascertain better management. Mandibular advancement devices along with CPAP may show better treatment outcome in specific situations. PMID:25814802

  6. Patient safety events in out-of-hospital paediatric airway management: a medical record review by the CSI-EMS

    PubMed Central

    Hansen, Matthew; Meckler, Garth; Lambert, William; Dickinson, Caitlin; Dickinson, Kathryn; Van Otterloo, Joshua

    2016-01-01

    Objective To describe the frequency and characterise the nature of patient safety events in paediatric out-of-hospital airway management. Methods We conducted a retrospective cross-sectional medical record review of all ‘lights and sirens’ emergency medicine services transports from 2008 to 2011 in patients <18 years of age in the Portland Oregon metropolitan area. A chart review tool (see online supplementary appendix) was adapted from landmark patient safety studies and revised after pilot testing. Expert panels of physicians and paramedics performed blinded reviews of each chart, identified safety events and described their nature. The primary outcomes were presence and severity of patient safety events related to airway management including oxygen administration, bag-valve-mask ventilation (BVM), airway adjuncts and endotracheal intubation (ETI). 10.1136/bmjopen-2016-012259.supp1 supplementary appendix Results From the 11 328 paediatric transports during the study period, there were 497 ‘lights and sirens’ (code 3) transports (4.4%). 7 transports were excluded due to missing data. Of the 490 transports included in the analysis, 329 had a total of 338 airway management procedures (some had more than 1 procedure): 61.6% were treated with oxygen, 15.3% with BVM, 8.6% with ETI and 2% with airway adjuncts. The frequency of errors was: 21% (71/338) related to oxygen use, 9.8% (33/338) related to BVM, 9.5% (32/338) related to intubation and 0.9% (3/338) related to airway adjunct use. 58% of intubations required 3 or more attempts or failed altogether. Cardiac arrest was associated with higher odds of a severe error. Conclusions Errors in paediatric out-of-hospital airway management are common, especially in the context of intubations and during cardiac arrest. PMID:27836871

  7. Assessing the degree of involvement of Certified Registered Nurse Anesthetists in airway management and trauma stabilization in rural hospitals.

    PubMed

    Penn, Marlo; Ruthman, Jacklyn

    2005-06-01

    Certified Registered Nurses Anesthetists (CRNAs) are airway experts who can stabilize the condition of trauma patients with skills acquired from practice as an anesthetist. CRNAs practice in a variety of settings; one of the most challenging is the rural hospital. Anesthetists have a wide range of skills. However, the setting in which CRNAs practice may influence the skills needed. This study was designed to address the issue of CRNA involvement in airway management and trauma stabilization in rural hospitals through a descriptive, quantitative, nonexperimental design study. A random sample of 382 CRNAs who practice in rural hospitals were invited to answer questions using a practice pattern questionnaire about these experiences developed for this study. Data were analyzed descriptively. The 13-item Airway Management and Trauma Stabilization Practice Pattern Questionnaire performed reliably (alpha = .8320). Results revealed the majority of CRNAs working in rural and semirural settings manage airways and stabilize the condition of trauma patients. Practice patterns suggest that nurse anesthesia students be trained to manage airways and stabilize trauma, particularly if they plan to work in rural or semirural settings.

  8. Web-Based Learning for Emergency Airway Management in Anesthesia Residency Training

    PubMed Central

    Hindle, Ada; Cheng, Ji; Thabane, Lehana; Wong, Anne

    2015-01-01

    Introduction. Web-based learning (WBL) is increasingly used in medical education; however, residency training programs often lack guidance on its implementation. We describe how the use of feasibility studies can guide the use of WBL in anesthesia residency training. Methods. Two case-based WBL emergency airway management modules were developed for self-directed use by anesthesia residents. The feasibility of using this educational modality was assessed using a single cohort pretest/posttest design. Outcome measures included user recruitment and retention rate, perceptions of educational value, and knowledge improvement. The differences between pre- and postmodule test scores and survey Likert scores were analysed using the paired t test. Results. Recruitment and retention rates were 90% and 65%, respectively. User-friendliness of the modules was rated highly. There was a significant improvement in perceptions of the value of WBL in the postsurvey. There was a significant knowledge improvement of 29% in the postmodule test. Conclusions. Feasibility studies can help guide appropriate use of WBL in curricula. While our study supported the potential feasibility of emergency airway management modules for training, collaboration with other anesthesia residency programs may enable more efficient development, implementation, and evaluation of this resource-intensive modality in anesthesia education and practice. PMID:26788056

  9. Hypoglossal Nerve Palsy After Airway Management for General Anesthesia: An Analysis of 69 Patients

    PubMed Central

    Shah, Aalap C.; Barnes, Christopher; Spiekerman, Charles F.; Bollag, Laurent A.

    2014-01-01

    Isolated hypoglossal nerve palsy (HNP), or neurapraxia, a rare postoperative complication after airway management, causes ipsilateral tongue deviation, dysarthria, and dysphagia. We reviewed the pathophysiological causes of hypoglossal nerve injury and discuss the associated clinical and procedural characteristics of affected patients. Furthermore, we identified procedural factors potentially affecting HNP recovery duration and propose several measures that may reduce the risk of HNP. While HNP can occur after a variety of surgeries, most cases in the literature were reported after orthopedic and otolaryngology operations, typically in males. The diagnosis is frequently missed by the anesthesia care team in the recovery room due to the delayed symptomatic onset and often requires neurology and otolaryngology evaluations to exclude serious etiologies. Signs and symptoms are self-limited, with resolution occurring within 2 months in 50% of patients, and 80% resolving within 4 months. Currently, there are no specific preventive or therapeutic recommendations. We found 69 cases of HNP after procedural airway management reported in the literature from 1926–2013. PMID:25625257

  10. Web-Based Learning for Emergency Airway Management in Anesthesia Residency Training.

    PubMed

    Hindle, Ada; Cheng, Ji; Thabane, Lehana; Wong, Anne

    2015-01-01

    Introduction. Web-based learning (WBL) is increasingly used in medical education; however, residency training programs often lack guidance on its implementation. We describe how the use of feasibility studies can guide the use of WBL in anesthesia residency training. Methods. Two case-based WBL emergency airway management modules were developed for self-directed use by anesthesia residents. The feasibility of using this educational modality was assessed using a single cohort pretest/posttest design. Outcome measures included user recruitment and retention rate, perceptions of educational value, and knowledge improvement. The differences between pre- and postmodule test scores and survey Likert scores were analysed using the paired t test. Results. Recruitment and retention rates were 90% and 65%, respectively. User-friendliness of the modules was rated highly. There was a significant improvement in perceptions of the value of WBL in the postsurvey. There was a significant knowledge improvement of 29% in the postmodule test. Conclusions. Feasibility studies can help guide appropriate use of WBL in curricula. While our study supported the potential feasibility of emergency airway management modules for training, collaboration with other anesthesia residency programs may enable more efficient development, implementation, and evaluation of this resource-intensive modality in anesthesia education and practice.

  11. COMPUTER SIMULATIONS OF LUNG AIRWAY STRUCTURES USING DATA-DRIVEN SURFACE MODELING TECHNIQUES

    EPA Science Inventory

    ABSTRACT

    Knowledge of human lung morphology is a subject critical to many areas of medicine. The visualization of lung structures naturally lends itself to computer graphics modeling due to the large number of airways involved and the complexities of the branching systems...

  12. [Difficult airway management using the air-Q in a patient with Klippel-Feil syndrome].

    PubMed

    Komasawa, Nobuyasu; Miyazaki, Shinichiro; Soen, Masako; Kusunoki, Tomohiro; Tatsumi, Shinichi; Minami, Toshiaki

    2014-06-01

    Patients with Klippel-Feil syndrome (KFS) frequently encounter difficult airway management due to skeletal abnormalities, including fusion of two or more vertebrae and short neck. We report successful tracheal intubation using the air-Q supraglottic airway device (air-Q). A 46-year-old woman (height, 149 cm; weight, 62 kg) with KFS was scheduled to undergo vertebral arch plasty for cervical spondylotic myelopathy. She could open her mouth sufficiently but could not tilt her head due to C1-3 fusion. Following administration of fentanyl 100 microg and propofol 120 mg, mask ventilation was achieved with jaw thrust maneuver. We then administered rocuronium 50 mg for immobilization and attempted tracheal intubation using the Pentax-AWS Airwayscope with a thin pediatric Intlock. However, we could not target the glottis, and ventilation via a size 3 i-gel or size 3.5 air-Q was unsuccessful. Using a size 2.5 air-Q, sufficient ventilation was finally achieved. We performed fiberoptic tracheal intubation through the air-Q using a tube with an internal diameter of 6.0-mm. We then exchanged the 6.0-mm tracheal tube with a 7.0-mm spiral tube using a 10 Fr tracheal tube introducer.

  13. Airway and ventilation management during repair of a large acquired tracheoesophageal fistula: the novel use of a readily available tool.

    PubMed

    Malik, Asif M; Ahmed, Zulfiqar; Durgham, Nasser; Stockmann, Paul T; Belenky, Walter M; Zestos, Maria

    2012-03-01

    Acquired tracheoesophageal fistula (TEF) is a life-threatening disorder of the airway that requires early diagnosis and treatment. The case of an infant who had delayed development of a TEF following endoscopic removal of a disc battery lodged in the midesophagus is reported. A repeat bronchoscopy, performed for respiratory distress 4 days later, showed a large defect in the posterior wall of the distal trachea, including the carina. A Foley catheter was used for airway management in the repair of the acquired TEF.

  14. Airway management in an infant with alobar holoprosencephaly and cebocephaly associated with maternal diabetes mellitus.

    PubMed

    Petersson, Rajanya S; Carey, William A; Thompson, Dana M

    2013-01-01

    We report a case of alobar holoprosencephaly (HPE) and cebocephaly associated with uncontrolled maternal type 1 (insulin-dependent) diabetes mellitus. Alobar HPE is the most severe form of HPE. Patients with cebocephaly have ocular hypotelorism and a proboscis with a single, blind-ended nostril. Shortly after our patient was born, we were consulted for airway management, as the parents' goal was to bring their child home. A tracheostomy tube was placed, and choanal atresia repair was eventually performed. The infant was never decannulated, however, and she died at the age of 9 months of acute respiratory distress syndrome secondary to an upper respiratory infection. To the best of our knowledge, this case represents the longest reported survival of an infant with alobar HPE and cebocephaly. Decisions regarding the care of these infants should be made in a collaborative, multidisciplinary fashion, with special attention paid to the primary caregivers' goals of care.

  15. Out-of-Hospital Surgical Airway Management: Does Scope of Practice Equal Actual Practice?

    PubMed Central

    Furin, Molly; Kohn, Melissa; Overberger, Ryan; Jaslow, David

    2016-01-01

    Introduction Pennsylvania, among other states, includes surgical airway management, or cricothyrotomy, within the paramedic scope of practice. However, there is scant literature that evaluates paramedic perception of clinical competency in cricothyrotomy. The goal of this project is to assess clinical exposure, education and self-perceived competency of ground paramedics in cricothyrotomy. Methods Eighty-six paramedics employed by four ground emergency medical services agencies completed a 22-question written survey that assessed surgical airway attempts, training, skills verification, and perceptions about procedural competency. Descriptive statistics were used to evaluate responses. Results Only 20% (17/86, 95% CI [11–28%]) of paramedics had attempted cricothyrotomy, most (13/17 or 76%, 95% CI [53–90%]) of whom had greater than 10 years experience. Most subjects (63/86 or 73%, 95% CI [64–82%]) did not reply that they are well-trained to perform cricothyrotomy and less than half (34/86 or 40%, 95% CI [30–50%]) felt they could correctly perform cricothyrotomy on their first attempt. Among subjects with five or more years of experience, 39/70 (56%, 95% CI [44–68%]) reported 0–1 hours per year of practical cricothyrotomy training within the last five years. Half of the subjects who were able to recall (40/80, 50% 95% CI [39–61%]) reported having proficiency verification for cricothyrotomy within the past five years. Conclusion Paramedics surveyed indicated that cricothyrotomy is rarely performed, even among those with years of experience. Many paramedics felt that their training in this area is inadequate and did not feel confident to perform the procedure. Further study to determine whether to modify paramedic scope of practice and/or to develop improved educational and testing methods is warranted. PMID:27330674

  16. Classroom Management Techniques and Student Discipline.

    ERIC Educational Resources Information Center

    Doyle, Walter

    This paper reviews concepts and research findings on classroom management techniques and explores how these techniques are related to student discipline strategies. The first section surveys descriptive and experimental research recently accumulated on classroom management practice, concentrating on strategies for monitoring and guiding classroom…

  17. Systems management techniques and problems

    NASA Technical Reports Server (NTRS)

    1971-01-01

    Report is reviewed which discusses history and trends of systems management, its basic principles, and nature of problems that lend themselves to systems approach. Report discusses systems engineering as applied to weapons acquisition, ecology, patient monitoring, and retail merchandise operations.

  18. Three-Dimensional Mapping of Ozone-Induced Injury in the Nasal Airways of Monkeys Using Magnetic Resonance Imaging and Morphometric Techniques

    SciTech Connect

    Carey, Stephen A.; Minard, Kevin R.; Trease, Lynn L.; Wagner, James G.; Garcia, Guilherme M.; Ballinger, Carol A.; Kimbell, Julia; Plopper, Charles G.; Corley, Rick A.; Postlewait, Ed; Harkema, Jack R.

    2007-03-01

    ABSTRACT Age-related changes in gross and microscopic structure of the nasal cavity can alter local tissue susceptibility as well as the dose of inhaled toxicant delivered to susceptible sites. This article describes a novel method for the use of magnetic resonance imaging, 3-dimensional airway modeling, and morphometric techniques to characterize the distribution and magnitude of ozone-induced nasal injury in infant monkeys. Using this method, we are able to generate age-specific, 3-dimensional, epithelial maps of the nasal airways of infant Rhesus macaques. The principal nasal lesions observed in this primate model of ozone-induced nasal toxicology were neutrophilic rhinitis, along with necrosis and exfoliation of the epithelium lining the anterior maxilloturbinate. These lesions, induced by acute or cyclic (episodic) exposures, were examined by light microscopy, quantified by morphometric techniques, and mapped on 3-dimensional models of the nasal airways. Here, we describe the histopathologic, imaging, and computational biology methods developed to efficiently characterize, localize, quantify, and map these nasal lesions. By combining these techniques, the location and severity of the nasal epithelial injury were correlated with epithelial type, nasal airway geometry, and local biochemical and molecular changes on an individual animal basis. These correlations are critical for accurate predictive modeling of exposure-dose-response relationships in the nasal airways, and subsequent extrapolation of nasal findings in animals to humans for developing risk assessment.

  19. Modern Reservoir Sedimentation Management Techniques with Examples

    NASA Astrophysics Data System (ADS)

    Annandale, G. W.

    2014-12-01

    Implementation of reservoir sedimentation management approaches results in a win-win scenario, it assists in enhancing the environment by preserving river function downstream of dams while concurrently providing opportunities to sustainably manage water resource infrastructure. This paper summarizes the most often used reservoir sedimentation management techniques with examples of where they have been implemented. Three categories can be used to classify these technologies, i.e. catchment management, sediment routing and sediment removal. The objective of catchment management techniques is to minimize the amount of sediment that may discharge into a reservoir, thereby reducing the loss of storage space due to sedimentation. Reservoir routing is a set of techniques that aim at minimizing the amount of sediment that may deposit in a reservoir, thereby maximizing the amount of sediment that may be passed downstream. The third group consists of techniques that may be used to remove previously deposited sediment from reservoirs. The selection of reservoir sedimentation management approaches is site specific and depends on various factors, including dam height, reservoir volume, reservoir length, valley shape, valley slope, sediment type and hydrology. Description of the different reservoir sedimentation management techniques that are used in practice will be accompanied by case studies, including video, illustrating criteria that may be used to determine the potential success of implementing the techniques.

  20. Stress Management Techniques for Young Children.

    ERIC Educational Resources Information Center

    Piper, Francesca M.

    The director of a not-for-profit nursery school adapted the adult stress management techniques of exercise and relaxation for use with 3- to 5-year-old children. Specifically, children were taught visualization techniques and yoga exercises involving deep breathing. The goal of the practicum was to rechannel children's negative stress-related…

  1. Lessons learned from a randomized trial of airway secretion clearance techniques in cystic fibrosis

    PubMed Central

    Sontag, Marci K.; Quittner, Alexandra L.; Modi, Avani C.; Koenig, Joni M.; Giles, Don; Oermann, Christopher M.; Konstan, Michael W.; Castile, Robert; Accurso, Frank J.

    2014-01-01

    Rationale Airway secretion clearance therapies are a cornerstone of cystic fibrosis care, however longitudinal comparative studies are rare. Our objectives were to compare three therapies [postural drainage and percussion: (postural drainage), flutter device, and high frequency chest wall oscillation: (vest)], by studying 1) change in pulmonary function; 2) time to need for IV antibiotics, 3) use of pulmonary therapies, 4) adherence to treatment, 5) treatment satisfaction, and 6) quality of life. Methods Participants were randomly assigned to one of three therapies twice daily. Clinical outcomes were assessed quarterly over 3 years. Results Enrollment goals were not met, and withdrawal rates were high, especially in postural drainage (51%) and flutter device (26%), compared to vest (9%), resulting in early termination. FEV1 decline, time to need IV antibiotics, and other pulmonary therapies were not different. The annual FEF25–75% predicted rate of decline was greater in those using vest (p=0.02). Adherence was not significantly different (p=0.09). Overall treatment satisfaction was higher in vest and flutter device than in postural drainage (p<0.05). Health-related quality of life was not different. The rate of FEV1 decline was 1.23% predicted/year. Conclusions The study was ended early due to dropout and smaller than expected decline in FEV1. Patients were more satisfied with vest and flutter device. The longitudinal decline in FEF25–75% was faster in vest; we found no other difference in lung function decline, taken together this warrants further study. The slow decline in FEV1 illustrates the difficulty with FEV1 decline as a clinical trial outcome. PMID:20146387

  2. Analysis of the therapeutic evolution in the management of airway infantile hemangioma

    PubMed Central

    Vivas-Colmenares, Grecia V; Fernandez-Pineda, Israel; Lopez-Gutierrez, Juan Carlos; Fernandez-Hurtado, Miguel Angel; Garcia-Casillas, Maria Antonia; Matute de Cardenas, Jose Antonio

    2016-01-01

    AIM: To analyze the evolution in the management of airway infantile hemangioma (AIH) and to report the results from 3 pediatric tertiary care institutions. METHODS: A retrospective study of patients with diagnosis of AIH and treated in 3 pediatric tertiary care institutions from 1996 to 2014 was performed. RESULTS: Twenty-three patients with diagnosis of AIH were identified. Mean age at diagnosis was 6 mo (range, 1-27). Single therapy was indicated in 16 patients and 7 patients received combined therapy. Two therapeutic groups were identified: Group A included 14 patients who were treated with steroids, interferon, laser therapy and/or surgery; group B included 9 patients treated with oral propranolol. In group A, oral corticosteroids were used in 9 patients with a good response in 3 cases (no requiring other therapeutic option), the other patients required additional treatment options. Cushing syndrome was observed in 3 patients. One patient died of a fulminant sepsis. Open surgical excision and endoscopic therapy were performed in 11 patients (in 5 of them as a single treatment) with a response rate of 54.5%. Stridor persisted in 2 cases, and one patient died during the clinical course of bronchial aspiration. In group B, oral propranolol was used in 9 patients (in 8 of them as a single treatment) with a response rate of 100%, with an mean treatment duration of 7 mo (range, 5-10); complications were not observed. CONCLUSION: Our experience and the medical literature support the use of propranolol as a first line of treatment in AIH. PMID:26862508

  3. Airway Management in Disaster Response: A Manikin Study Comparing Direct and Video Laryngoscopy for Endotracheal Intubation by Prehospital Providers in Level C Personal Protective Equipment.

    PubMed

    Yousif, Sami; Machan, Jason T; Alaska, Yasser; Suner, Selim

    2017-03-20

    Introduction Airway management is one of many challenges that medical providers face in disaster response operations. The use of personal protective equipment (PPE), in particular, was found to be associated with higher failure rates and a prolonged time to achieve airway control. Hypothesis/Problem The objective of this study was to determine whether video laryngoscopy could facilitate the performance of endotracheal intubation by disaster responders wearing Level C PPE.

  4. Intermittent positive airway pressure to manage hypoxia during one-lung anaesthesia.

    PubMed

    Russell, W J

    2009-05-01

    The effect of intermittent positive airway pressure to the non-ventilated lung was assessed in 10 patients who desaturated during one-lung ventilation. Once their saturation fell below 95% they were given a slow inflation of 2 l/min of oxygen into the non-ventilated lung for two seconds. This was repeated every 10 seconds for five minutes or until the saturation rose to 98%, whichever was sooner. The initial mean SpO2 was 89.3% +/- 4.2%. All 10 patients had an increase in saturation. The mean saturation following intermittent positive airway pressure was 96.5% +/- 1.6% (P < 0.0001). Similarly, the mean oxygen tension rose from 67.2 +/- 12.8 mmHg to 98.9 +/- 19.8 mmHg. Intermittent positive airway pressure should be considered for patients who desaturate while undergoing one-lung ventilation.

  5. All India Difficult Airway Association 2016 guidelines for the management of unanticipated difficult tracheal intubation in obstetrics

    PubMed Central

    Ramkumar, Venkateswaran; Dinesh, Ekambaram; Shetty, Sumalatha Radhakrishna; Shah, Amit; Kundra, Pankaj; Das, Sabyasachi; Myatra, Sheila Nainan; Ahmed, Syed Moied; Divatia, Jigeeshu Vasishtha; Patwa, Apeksh; Garg, Rakesh; Raveendra, Ubaradka S; Doctor, Jeson Rajan; Pawar, Dilip K; Ramesh, Singaravelu

    2016-01-01

    The various physiological changes in pregnancy make the parturient vulnerable for early and rapid desaturation. Severe hypoxaemia during intubation can potentially compromise two lives (mother and foetus). Thus tracheal intubation in the pregnant patient poses unique challenges, and necessitates meticulous planning, ready availability of equipment and expertise to ensure maternal and foetal safety. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for the safe management of the airway in obstetric patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists (ISA). Modified rapid sequence induction using gentle intermittent positive pressure ventilation with pressure limited to ≤20 cm H2O is acceptable. Partial or complete release of cricoid pressure is recommended when face mask ventilation, placement of supraglottic airway device (SAD) or tracheal intubation prove difficult. One should call for early expert assistance. Maternal SpO2 should be maintained ≥95%. Apnoeic oxygenation with nasal insufflation of 15 L/min oxygen during apnoea should be performed in all patients. If tracheal intubation fails, a second- generation SAD should be inserted. The decision to continue anaesthesia and surgery via the SAD, or perform fibreoptic-guided intubation via the SAD or wake up the patient depends on the urgency of surgery, foeto-maternal status and availability of resources and expertise. Emergency cricothyroidotomy must be performed if complete ventilation failure occurs. PMID:28003691

  6. Supraglottic airway devices in children

    PubMed Central

    Ramesh, S; Jayanthi, R

    2011-01-01

    Modern anaesthesia practice in children was made possible by the invention of the endotracheal tube (ET), which made lengthy and complex surgical procedures feasible without the disastrous complications of airway obstruction, aspiration of gastric contents or asphyxia. For decades, endotracheal intubation or bag-and-mask ventilation were the mainstays of airway management. In 1983, this changed with the invention of the laryngeal mask airway (LMA), the first supraglottic airway device that blended features of the facemask with those of the ET, providing ease of placement and hands-free maintenance along with a relatively secure airway. The invention and development of the LMA by Dr. Archie Brain has had a significant impact on the practice of anaesthesia, management of the difficult airway and cardiopulmonary resuscitation in children and neonates. This review article will be a brief about the clinical applications of supraglottic airways in children. PMID:22174464

  7. Airway evaluation in obstructive sleep apnea.

    PubMed

    Stuck, Boris A; Maurer, Joachim T

    2008-12-01

    As the interest in sleep-disordered breathing has increased, various attempts have been made to assess upper airway anatomy in patients with this relatively frequent disorder. The aim is not only to reveal potential differences in upper airway anatomy to better understand origin and pathophysiology of the disease but also to improve patient management and treatment success. The present review is based on a systematic literature search with regard to upper airway evaluation in sleep-disordered breathing; the articles were selected and discussed in light of our clinical experiences. Based on clinical assessment including endoscopy during wakefulness, the value of the Mueller Maneuver, static radiologic imaging techniques (X-ray cephalometry, computed tomography (CT) scanning and magnetic resonance imaging (MRI)), dynamic scanning protocols (e.g. ultrafast CT or cine MRI), upper airway endoscopy during sleep and sedated sleep, pressure measurements and the assessment of the critical closing pressure are discussed. Each technique itself and its history in the field of sleep medicine are briefly reviewed and problems of standardization and interpretation are discussed when appropriate. Insights into the pathophysiology of the disease gained with the help of the investigational techniques are presented and the impact of the techniques on patient management is reported. Although all these additional techniques for upper airway assessment have substantially improved our understanding of sleep-disordered breathing, their significance in daily practice is limited. In contrast to the widespread use of the Mueller maneuver and sedated endoscopy, convincing data supporting their use in terms of treatment outcome are lacking. So far, there is only very limited evidence that selected techniques improve treatment outcome for selected indications. In general, there is not enough evidence that these techniques are superior to the routine clinical assessment.

  8. Morbidly obese parturient: Challenges for the anaesthesiologist, including managing the difficult airway in obstetrics. What is new?

    PubMed

    Rao, Durga Prasada; Rao, Venkateswara A

    2010-11-01

    The purpose of this article is to review the fundamental aspects of obesity, pregnancy and a combination of both. The scientific aim is to understand the physiological changes, pathological clinical presentations and application of technical skills and pharmacological knowledge on this unique clinical condition. The goal of this presentation is to define the difficult airway, highlight the main reasons for difficult or failed intubation and propose a practical approach to management Throughout the review, an important component is the necessity for team work between the anaesthesiologist and the obstetrician. Certain protocols are recommended to meet the anaesthetic challenges and finally concluding with "what is new?" in obstetric anaesthesia.

  9. A randomised trial to compare i-gel and ProSeal™ laryngeal mask airway for airway management in paediatric patients

    PubMed Central

    Nirupa, R; Gombar, Satinder; Ahuja, Vanita; Sharma, Preeti

    2016-01-01

    Background and Aims: i-gel™ is a newer supraglottic airway device with a unique non-inflatable cuff. We aimed to compare i-gel™ with ProSeal™ laryngeal mask airway (PLMA™) in children scheduled for surgery under general anaesthesia (GA) with controlled ventilation. Methods: This prospective, randomised controlled study was conducted in 100 surgical patients, aged 2–6 years of American Society of Anesthesiologists Physical Status I–II scheduled under GA. Patients were randomly allocated to receive either size 2 i-gel™ or PLMA™ as an airway device. The primary aim was oropharyngeal leak pressure assessed at 5 min following correct placement of the device. Secondary outcomes measured included number of attempts, ease of insertion, time of insertion, quality of initial airway, fibre-optic grading and effects on pulmonary mechanics. Statistical analysis was done using paired t-test and Chi-square test. Results: The demographic data were similar in both the groups. The oropharyngeal leak pressure in the i-gel™ group was 29.5 ± 2.5 cmH2 O as compared to 26.1 ± 3.8 cmH2 O in PLMA™ group (P = 0.002). The time taken for successful insertion in PLMA™ was longer as compared to i-gel (12.4 ± 2.7 vs. 10.2 ± 1.9 s, P = 0.007). The quality of initial airway was superior with i-gel™. The number of attempts, ease of insertion of supraglottic device, insertion of orogastric tube and pulmonary mechanics were similar in both the groups. Conclusion: Size 2 i-gel™ exhibited superior oropharyngeal leak pressure and quality of airway in paediatric patients with controlled ventilation as compared to PLMA™ although the pulmonary mechanics were similar. PMID:27761035

  10. A national survey of practical airway training in UK anaesthetic departments. Time for a national policy?

    PubMed

    Lindkaer Jensen, N H; Cook, T M; Kelly, F E

    2016-11-01

    The Fourth National Audit Project (NAP4) recommended airway training for trainee and trained anaesthetists. As the skills required for management of airway emergencies differ from routine skills and these events are rare, practical training is likely to require training workshops. In 2013, we surveyed all UK National Health Service hospitals to examine the current practices regarding airway training workshops. We received responses from 206 hospitals (62%) covering all regions. Regarding airway workshops, 16% provide none and 51% only for trainees. Of those providing workshops, more than half are run less than annually. Workshop content varies widely, with several Difficult Airway Society (DAS) guideline techniques not taught or only infrequently. Reported barriers to training include lack of time and departmental or individual interest. Workshop-based airway training is variable in provision, frequency and content, and is often not prioritised by departments or individual trainers. It could be useful if guidance on workshop organisation, frequency and content was considered nationally.

  11. (Low-level radioactive waste management techniques)

    SciTech Connect

    Van Hoesen, S.D.; Kennerly, J.M.; Williams, L.C.; Lingle, W.N.; Peters, M.S.; Darnell, G.R.; USDOE Oak Ridge Operations Office, TN; Du Pont de Nemours and Co., Aiken, SC . Savannah River Plant; Idaho National Engineering Lab., Idaho Falls, ID )

    1988-08-08

    The US team consisting of representatives of Oak Ridge National Laboratory (ORNL), Savannah River plant (SRP), Idaho National Engineering Laboratory (INEL), and the Department of Energy, Oak Ridge Operations participated in a training program on French low-level radioactive waste (LLW) management techniques. Training in the rigorous waste characterization, acceptance and certification procedures required in France was provided at Agence Nationale pour les Gestion des Dechets Radioactif (ANDRA) offices in Paris.

  12. [Emergency anesthesia, airway management and ventilation in major trauma. Background and key messages of the interdisciplinary S3 guidelines for major trauma patients].

    PubMed

    Bernhard, M; Matthes, G; Kanz, K G; Waydhas, C; Fischbacher, M; Fischer, M; Böttiger, B W

    2011-11-01

    Patients with multiple trauma presenting with apnea or a gasping breathing pattern (respiratory rate <6/min) require prehospital endotracheal intubation (ETI) and ventilation. Additional indications are hypoxia (S(p)O(2)<90% despite oxygen insufflation and after exclusion of tension pneumothorax), severe traumatic brain injury [Glasgow Coma Scale (GCS)<9], trauma-associated hemodynamic instability [systolic blood pressure (SBP)<90 mmHg] and severe chest trauma with respiratory insufficiency (respiratory rate >29/min). The induction of anesthesia after preoxygenation is conducted as rapid sequence induction (analgesic, hypnotic drug, neuromuscular blocking agent). With the availability of ketamine as a viable alternative, the use of etomidate is not encouraged due to its side effects on adrenal function. An electrocardiogram (ECG), blood pressure measurement and pulse oximetry are needed to monitor the emergency anesthesia and the secured airway. Capnography is absolutely mandatory to confirm correct placement of the endotracheal tube and to monitor tube dislocations as well as ventilation and oxygenation in the prehospital and hospital setting. Because airway management is often complicated in trauma patients, alternative devices and a fiber-optic endoscope need to be available within the hospital. Use of these alternative measures for airway management and ventilation should be considered at the latest after a maximum of three unsuccessful intubation attempts. Emergency medical service (EMS) physicians should to be trained in emergency anesthesia, ETI and alternative methods of airway management on a regular basis. Within hospitals ETI, emergency anesthesia and ventilation are to be conducted by trained and experienced anesthesiologists. When a difficult airway or induction of anesthesia is expected, endotracheal intubation should be supervised or conducted by an anesthesiologist. Normoventilation should be the goal of mechanical ventilation. After arrival in the

  13. Management of the Difficult Paediatric Airway with a Simple Fiberoptic-Assisted Laryngoscope: A Report of Two Cases with Pierre Robin and Patau’s (Trisomy 13) Syndrome

    PubMed Central

    Kılıçaslan, Alper; Erol, Atilla; Topal, Ahmet; Et, Tayfun; Otelcioğlu, Şeref

    2014-01-01

    Airway management of children with congenital craniofacial anomalies is a challenge for paediatric anaesthesiologists. We do not have any video-assisted airway device in our department for difficult paediatric intubations. We decided to attach a regular fiberoptic (outer diameter; 3.7 mm, Karl Storz, Germany) scope to a conventional Macintosh Laryngoscope (size 1). We describe two cases of Pierre Robin and Patau’s (Trisomy 13) syndrome successfully intubated with a fiberoptic-assisted laryngoscope (FOL). A fiberoptic scope and any size of a laryngoscope blade can be easily assembled in the operating room. The FOL may be a useful device in the setting of difficult paediatric intubation. PMID:27366452

  14. AANA journal course: update for nurse anesthetists. The SLAM Emergency Airway Flowchart: a new guide for advanced airway practitioners.

    PubMed

    Rich, James M; Mason, Andrew M; Ramsay, Michael A E

    2004-12-01

    Advanced airway practitioners in anesthesiology, emergency medicine, and prehospital care can suddenly and unexpectedly face difficult airway situations that can surface without warning during mask ventilation or tracheal intubation. Although tracheal intubation remains the "gold standard" in airway management, it is not always achievable, and, when it proves impossible, appropriate alternative interventions must be used rapidly to avoid serious morbidity or mortality. The SLAM Emergency Airway Flowchart (SEAF) is intended to prevent the 3 reported primary causes of adverse respiratory events (ie, inadequate ventilation, undetected esophageal intubation, and difficult intubation). The 5 pathways of the SEAF include primary ventilation, rapid-sequence intubation, difficult intubation, rescue ventilation, and cricothyrotomy. It is intended for use with adult patients by advanced airway practitioners competent in direct laryngoscopy, tracheal intubation, administration of airway drugs, rescue ventilation, and cricothyrotomy. The SEAF has limitations (eg, suitable only for use with adult patients, cannot be used by certain categories of rescue personnel, and depends heavily on assessment of Spo2). A unique benefit is provision of simple alternative techniques that can be used when another technique fails.

  15. Seeing is believing: the importance of video laryngoscopy in teaching and in managing the difficult airway.

    PubMed

    Kaplan, M B; Ward, D; Hagberg, C A; Berci, G; Hagiike, M

    2006-04-01

    Of the several million patients who undergo surgery in North America annually, a large proportion undergo intubation of the trachea. In approximately 90% of these patients, the endotracheal tube is introduced using a traditional laryngoscope with a battery in the handle and a small bulb near the tip of the blade. This bulb provides a limited and often dim view of the glottic structures. In about 10% of cases, the patient is intubated using a flexible fiberoptic intubating scope. The authors have developed a video laryngoscope that preserves the standard blade configuration with a modified handle. A 3-mm image light guide is built into the blade, replacing the bulb. A small TV camera with an incorporated light bundle is inserted into the handle. A wide-angle panoramic view of the upper airway anatomy is displayed on a TV screen, which can be positioned at a convenient working distance. The use of a TV monitor is a well-accepted standard during minimally invasive surgical procedures.

  16. Recent advances in the management of obstructive airways disease. Auxiliary MDI aerosol delivery systems.

    PubMed

    Sackner, M A; Kim, C S

    1985-08-01

    Aerosol delivered through metered-dose inhalers (MDI) offers a potentially convenient way to deliver bronchodilator agents and corticosteroids to the lungs of patients with asthma and COPD. Unfortunately, most patients are unable to coordinate satisfactorily their actuation with inhalation, a problem overcome by using auxiliary MDI aerosol delivery systems. Left to their own judgment, patients often inhale the aerosol with a high inspiratory flow rather than slowly to produce optimal aerosol deposition within the airways. This problem has been corrected by one of the auxiliary MDI aerosol delivery systems (InspirEase) through auditory, visual, and tactile feedback mechanisms. MDI devices release aerosol at a high jet velocity in large particle sizes, depositing most of the aerosol in the oropharynx which can lead to potential systemic absorption of adrenergic agonists with CNS and cardiovascular side effects, oral thrush, and suppression of adrenocortical activity. All the auxiliary MDI aerosol systems promote delivery of small aerosol particles and markedly diminish oropharyngeal impaction. Of all the systems, only InspirEase provides volume and flow feedback controls to ensure an optimal inhalation maneuver. Auxiliary MDI aerosol systems should always be used for aerosolized corticosteroid administration because they minimize oropharyngeal deposition and improve aerosol delivery efficiency.

  17. Spiral computed tomographic scanning of the chest with three dimensional imaging in the diagnosis and management of paediatric intrathoracic airway obstruction.

    PubMed Central

    Sagy, M.; Poustchi-Amin, M.; Nimkoff, L.; Silver, P.; Shikowitz, M.; Leonidas, J. C.

    1996-01-01

    BACKGROUND: The usefulness of spiral computed tomographic (CT) scans of the chest with three dimensional imaging (3D-CT) of intrathoracic structures in the diagnosis and management of paediatric intrathoracic airway obstruction was assessed. METHODS: A retrospective review was made of five consecutive cases (age range six months to four years) admitted to the paediatric intensive care unit and paediatric radiology division of a tertiary care children's hospital with severe respiratory decompensation suspected of being caused by intrathoracic large airway obstruction. Under adequate sedation, the patients underwent high speed spiral CT scanning of the thorax. Non-ionic contrast solution was injected in two patients to demonstrate the anatomical relationship between the airway and the intrathoracic large vessels. Using computer software, three-dimensional images of intrathoracic structures were then reconstructed by the radiologist. RESULTS: In all five patients the imaging results were useful in directing the physician to the correct diagnosis and appropriate management. In one patient, who had undergone repair of tetralogy of Fallot with absent pulmonary valve, the 3D-CT image showed bilateral disruptions in the integrity of the tracheobronchial tree due to compression by a dilated pulmonary artery. This patient underwent pulmonary artery aneurysmorrhaphy and required continued home mechanical ventilation via tracheostomy. In three other patients with symptoms of lower airway obstruction the 3D-CT images showed significant stenosis in segments of the tracheobronchial tree in two of them, and subsequent bronchoscopy established a diagnosis of segmental bronchomalacia. These two patients required mechanical ventilation and distending pressure to relieve their bronchospasm. In another patient who had undergone surgical repair of intrathoracic tracheal stenosis three years prior to admission the 3D-CT scan ruled out restenosis as the reason for her acute respiratory

  18. Data Management Techniques for Acoustical Planetary Data

    NASA Astrophysics Data System (ADS)

    Eichelberger, Hans; Prattes, Gustav; Schwingenschuh, Konrad; Tokano, T.; Jernej, I.; Stachel, Manfred; Besser, B. P.; Aydogar, Oe.

    We discuss data management techniques for acoustical data obtained from future atmospheric planetary in-situ probes with the aim of event oriented scientific analysis. The immediate objec-tive is the localisation (acoustic wave telescope) and characterisation of acoustic phenomena of atmospheres and surfaces, e.g. in the frame of the proposed NASA/ESA Titan Saturn System Mission (TSSM) with the Acoustic Sensor Package (ACU) multi-microphone array. Contrary to huge amounts of source data obtained through the electromagnetic windows, acoustical sig-nals are seldom recorded and few files exist. One example is pressure sensor data from the instrument HASI/PWA during Huygens descent, mission Cassini-Huygens. Nevertheless, a lot of acoustic point and noise sources, e.g. caused by rain, drizzle or wind abound in Titan's atmosphere. In almost all cases, due to limitations in telemetry rate, a careful strategy for onboard event handling and data reduction -the first step in data management -has to be selected, e.g. sampling rates in kHz range or averaging in the frequency domain. This pre-processing together with complementary investigations at the space segment directly influences the scientific data return in terms of long-term continuous or short-term event based studies. The database at the ground segment with science data and metadata entries after final calibra-tion has to support the combined investigations with other instruments. This second step in data management fully explores the acoustic environment of planetary atmospheres in terms of background noise and spacecraft generated disturbances, location and characterisation of source regions and correlation between the experiments. Currently we're running databases for magnetic field data from various ground-based and satellite related experiments, historical balloon data included. Comparisons of data between experiments are possible. This framework based on dependability considerations with several different

  19. Do Not Burn Your Airway Bridge: A Technique to Safely Exchange a Tracheostomy Tube for a Tracheal Tube.

    PubMed

    Patiño, Miguel Alejandro; Truong, Dam-Thuy; Truong, Angela; Cata, Juan Pablo

    2016-10-01

    Tracheostomy is one of the most ancient and commonly performed surgical procedures. When tracheostomized patients require a subsequent intervention, it is usually necessary to exchange the tracheostomy tube for a tracheal tube, which can be dangerous. These potential complications may be overlooked or underestimated by the anesthesia providers. An inability to ventilate the patient and replace the tube after removal of a fresh tracheostomy tube can escalate rapidly to a life-threatening crisis. We present a case in which an airway exchange catheter was used to safely replace a tracheostomy tube with a tracheal tube in a patient with a fresh tracheostomy.

  20. A Review of the Usefulness of R & D Management Techniques.

    DTIC Science & Technology

    1981-09-01

    could also be classified as a "style" of management. A management technique according to John Argenti is "a recognized method of analyzing or solving a...toward Accountability for Performance. Homewood, Illinois: Ricnard D. Irwin, Inc., 1978, pp. 82-87. 3. Argenti , John. Management Techniques: A Practical

  1. Fault Management Techniques in Human Spaceflight Operations

    NASA Technical Reports Server (NTRS)

    O'Hagan, Brian; Crocker, Alan

    2006-01-01

    This paper discusses human spaceflight fault management operations. Fault detection and response capabilities available in current US human spaceflight programs Space Shuttle and International Space Station are described while emphasizing system design impacts on operational techniques and constraints. Preflight and inflight processes along with products used to anticipate, mitigate and respond to failures are introduced. Examples of operational products used to support failure responses are presented. Possible improvements in the state of the art, as well as prioritization and success criteria for their implementation are proposed. This paper describes how the architecture of a command and control system impacts operations in areas such as the required fault response times, automated vs. manual fault responses, use of workarounds, etc. The architecture includes the use of redundancy at the system and software function level, software capabilities, use of intelligent or autonomous systems, number and severity of software defects, etc. This in turn drives which Caution and Warning (C&W) events should be annunciated, C&W event classification, operator display designs, crew training, flight control team training, and procedure development. Other factors impacting operations are the complexity of a system, skills needed to understand and operate a system, and the use of commonality vs. optimized solutions for software and responses. Fault detection, annunciation, safing responses, and recovery capabilities are explored using real examples to uncover underlying philosophies and constraints. These factors directly impact operations in that the crew and flight control team need to understand what happened, why it happened, what the system is doing, and what, if any, corrective actions they need to perform. If a fault results in multiple C&W events, or if several faults occur simultaneously, the root cause(s) of the fault(s), as well as their vehicle-wide impacts, must be

  2. X-Ray based Lung Function measurement–a sensitive technique to quantify lung function in allergic airway inflammation mouse models

    PubMed Central

    Dullin, C.; Markus, M. A.; Larsson, E.; Tromba, G.; Hülsmann, S.; Alves, F.

    2016-01-01

    In mice, along with the assessment of eosinophils, lung function measurements, most commonly carried out by plethysmography, are essential to monitor the course of allergic airway inflammation, to examine therapy efficacy and to correlate animal with patient data. To date, plethysmography techniques either use intubation and/or restraining of the mice and are thus invasive, or are limited in their sensitivity. We present a novel unrestrained lung function method based on low-dose planar cinematic x-ray imaging (X-Ray Lung Function, XLF) and demonstrate its performance in monitoring OVA induced experimental allergic airway inflammation in mice and an improved assessment of the efficacy of the common treatment dexamethasone. We further show that XLF is more sensitive than unrestrained whole body plethysmography (UWBP) and that conventional broncho-alveolar lavage and histology provide only limited information of the efficacy of a treatment when compared to XLF. Our results highlight the fact that a multi-parametric imaging approach as delivered by XLF is needed to address the combined cellular, anatomical and functional effects that occur during the course of asthma and in response to therapy. PMID:27805632

  3. X-Ray based Lung Function measurement-a sensitive technique to quantify lung function in allergic airway inflammation mouse models.

    PubMed

    Dullin, C; Markus, M A; Larsson, E; Tromba, G; Hülsmann, S; Alves, F

    2016-11-02

    In mice, along with the assessment of eosinophils, lung function measurements, most commonly carried out by plethysmography, are essential to monitor the course of allergic airway inflammation, to examine therapy efficacy and to correlate animal with patient data. To date, plethysmography techniques either use intubation and/or restraining of the mice and are thus invasive, or are limited in their sensitivity. We present a novel unrestrained lung function method based on low-dose planar cinematic x-ray imaging (X-Ray Lung Function, XLF) and demonstrate its performance in monitoring OVA induced experimental allergic airway inflammation in mice and an improved assessment of the efficacy of the common treatment dexamethasone. We further show that XLF is more sensitive than unrestrained whole body plethysmography (UWBP) and that conventional broncho-alveolar lavage and histology provide only limited information of the efficacy of a treatment when compared to XLF. Our results highlight the fact that a multi-parametric imaging approach as delivered by XLF is needed to address the combined cellular, anatomical and functional effects that occur during the course of asthma and in response to therapy.

  4. X-Ray based Lung Function measurement–a sensitive technique to quantify lung function in allergic airway inflammation mouse models

    NASA Astrophysics Data System (ADS)

    Dullin, C.; Markus, M. A.; Larsson, E.; Tromba, G.; Hülsmann, S.; Alves, F.

    2016-11-01

    In mice, along with the assessment of eosinophils, lung function measurements, most commonly carried out by plethysmography, are essential to monitor the course of allergic airway inflammation, to examine therapy efficacy and to correlate animal with patient data. To date, plethysmography techniques either use intubation and/or restraining of the mice and are thus invasive, or are limited in their sensitivity. We present a novel unrestrained lung function method based on low-dose planar cinematic x-ray imaging (X-Ray Lung Function, XLF) and demonstrate its performance in monitoring OVA induced experimental allergic airway inflammation in mice and an improved assessment of the efficacy of the common treatment dexamethasone. We further show that XLF is more sensitive than unrestrained whole body plethysmography (UWBP) and that conventional broncho-alveolar lavage and histology provide only limited information of the efficacy of a treatment when compared to XLF. Our results highlight the fact that a multi-parametric imaging approach as delivered by XLF is needed to address the combined cellular, anatomical and functional effects that occur during the course of asthma and in response to therapy.

  5. Pan American World Airways flight training: A new direction. Flight operations resource management

    NASA Technical Reports Server (NTRS)

    Butler, Roy

    1987-01-01

    The Pan Am Flight Training Department shares the experiences it is having in its attempt to integrate cockpit resource management philosophies into its training programs. A slide-tape presentation on Pan Am's new direction in flight training is presented and briefly discussed.

  6. Airway complications after lung transplantation.

    PubMed

    Machuzak, Michael; Santacruz, Jose F; Gildea, Thomas; Murthy, Sudish C

    2015-01-01

    Airway complications after lung transplantation present a formidable challenge to the lung transplant team, ranging from mere unusual images to fatal events. The exact incidence of complications is wide-ranging depending on the type of event, and there is still evolution of a universal characterization of the airway findings. Management is also wide-ranging. Simple observation or simple balloon bronchoplasty is sufficient in many cases, but vigilance following more severe necrosis is required for late development of both anastomotic and nonanastomotic airway strictures. Furthermore, the impact of coexisting infection, rejection, and medical disease associated with high-level immunosuppression further complicates care.

  7. A retrospective analysis of airway management in patients with obstructive sleep apnea and its effects on postanesthesia care unit length of stay.

    PubMed

    Brousseau, Claire A; Dobson, Gregory R; Milne, Andrew D

    2014-01-01

    Obstructive sleep apnea (OSA) is a form of sleep-disordered breathing characterized by periods of partial or complete obstruction of the upper airway during sleep, resulting in oxygen desaturations. Symptoms and risk factors for OSA are of particular importance in the management of OSA patients in the perioperative setting. The present study collected data regarding the intraoperative airway management of OSA patients and their course in the postanesthesia care unit (PACU) over a six-month period. A total of 86 patients underwent general anesthesia, 63 of whom were intubated by direct laryngoscopy. Of these, 43% were classified as a grade 1 view by direct laryngoscopy, 43% were grade 2 and 14% were classified as grade 3. Apnea events or periods of desaturation in the PACU were observed in 27% of cases. Length of stay was significantly longer for cases in which PACU nurses had indicated that OSA had affected the individuals' postoperative course of treatment. Overall, OSA patients had an increased frequency of grade 3 views compared with the general population, and adjuncts were commonly used to help secure the airway in OSA patients. Symptomatic OSA patients placed increased demands on the PACU in terms of length of stay and hospital resources.

  8. Development of Sub-optimal Airway Protocols for the International Space Station (ISS) by the Medical Operation Support Team (MOST)

    NASA Technical Reports Server (NTRS)

    Polk, James D.; Parazynski, Scott; Kelly, Scott; Hurst, Victor, IV; Doerr, Harold K.

    2007-01-01

    Airway management techniques are necessary to establish and maintain a patent airway while treating a patient undergoing respiratory distress. There are situations where such settings are suboptimal, thus causing the caregiver to adapt to these suboptimal conditions. Such occurrences are no exception aboard the International Space Station (ISS). As a result, the NASA flight surgeon (FS) and NASA astronaut cohorts must be ready to adapt their optimal airway management techniques for suboptimal situations. Based on previous work conducted by the Medical Operation Support Team (MOST) and other investigators, the MOST had members of both the FS and astronaut cohorts evaluate two oral airway insertion techniques for the Intubating Laryngeal Mask Airway (ILMA) to determine whether either technique is sufficient to perform in suboptimal conditions within a microgravity environment. Methods All experiments were conducted in a simulated microgravity environment provided by parabolic flight aboard DC-9 aircraft. Each participant acted as a caregiver and was directed to attempt both suboptimal ILMA insertion techniques following a preflight instruction session on the day of the flight and a demonstration of the technique by an anesthesiologist physician in the simulated microgravity environment aboard the aircraft. Results Fourteen participants conducted 46 trials of the suboptimal ILMA insertion techniques. Overall, 43 of 46 trials (94%) conducted were properly performed based on criteria developed by the MOST and other investigators. Discussion The study demonstrated the use of airway management techniques in suboptimal conditions relating to space flight. Use of these techniques will provide a crew with options for using the ILMA to manage airway issues aboard the ISS. Although it is understood that the optimal method for patient care during space flight is to have both patient and caregiver restrained, these techniques provide a needed backup should conditions not present

  9. Representation of Knowledge on Some Management Accounting Techniques in Textbooks

    ERIC Educational Resources Information Center

    Golyagina, Alena; Valuckas, Danielius

    2016-01-01

    This paper examines the coverage of management accounting techniques in several popular management accounting texts, assessing each technique's claimed position within practice, its benefits and limitations, and the information sources substantiating these claims. Employing the notion of research genres, the study reveals that textbooks in their…

  10. Group decision-making techniques for natural resource management applications

    USGS Publications Warehouse

    Coughlan, Beth A.K.; Armour, Carl L.

    1992-01-01

    This report is an introduction to decision analysis and problem-solving techniques for professionals in natural resource management. Although these managers are often called upon to make complex decisions, their training in the natural sciences seldom provides exposure to the decision-making tools developed in management science. Our purpose is to being to fill this gap. We present a general analysis of the pitfalls of group problem solving, and suggestions for improved interactions followed by the specific techniques. Selected techniques are illustrated. The material is easy to understand and apply without previous training or excessive study and is applicable to natural resource management issues.

  11. Rehabilitation techniques to maximize spasticity management.

    PubMed

    Logan, Lynne Romeiser

    2011-01-01

    Improvement in functional skills is typically a goal of spasticity management. Spasticity management alone will improve the positive signs of the upper motor neuron syndrome without functional change. In this review, we demonstrate that a variety of therapy modalities are required to facilitate these improvements and impact the negative signs of the upper motor neuron syndrome. The evidence for neuromuscular electrical stimulation, surface electromyography training, serial casting, body weight-supported treadmill training, constraint-induced movement therapy, strengthening, and endurance training is reviewed as it relates to spasticity management.

  12. Economic Techniques of Occupational Health and Safety Management

    NASA Astrophysics Data System (ADS)

    Sidorov, Aleksandr I.; Beregovaya, Irina B.; Khanzhina, Olga A.

    2016-10-01

    The article deals with the issues on economic techniques of occupational health and safety management. Authors’ definition of safety management is given. It is represented as a task-oriented process to identify, establish and maintain such a state of work environment in which there are no possible effects of hazardous and harmful factors, or their influence does not go beyond certain limits. It was noted that management techniques that are the part of the control mechanism, are divided into administrative, organizational and administrative, social and psychological and economic. The economic management techniques are proposed to be classified depending on the management subject, management object, in relation to an enterprise environment, depending on a control action. Technoeconomic study, feasibility study, planning, financial incentives, preferential crediting of enterprises, pricing, profit sharing and equity, preferential tax treatment for enterprises, economic regulations and standards setting have been distinguished as economic techniques.

  13. ISWHM: Tools and Techniques for Software and System Health Management

    NASA Technical Reports Server (NTRS)

    Schumann, Johann; Mengshoel, Ole J.; Darwiche, Adnan

    2010-01-01

    This presentation presents status and results of research on Software Health Management done within the NRA "ISWHM: Tools and Techniques for Software and System Health Management." Topics include: Ingredients of a Guidance, Navigation, and Control System (GN and C); Selected GN and C Testbed example; Health Management of major ingredients; ISWHM testbed architecture; and Conclusions and next Steps.

  14. Project management techniques for highly integrated programs

    NASA Technical Reports Server (NTRS)

    Stewart, J. F.; Bauer, C. A.

    1983-01-01

    The management and control of a representative, highly integrated high-technology project, in the X-29A aircraft flight test project is addressed. The X-29A research aircraft required the development and integration of eight distinct technologies in one aircraft. The project management system developed for the X-29A flight test program focuses on the dynamic interactions and the the intercommunication among components of the system. The insights gained from the new conceptual framework permitted subordination of departments to more functional units of decisionmaking, information processing, and communication networks. These processes were used to develop a project management system for the X-29A around the information flows that minimized the effects inherent in sampled-data systems and exploited the closed-loop multivariable nature of highly integrated projects.

  15. Airway Management with Cervical Spine Immobilisation: A Comparison between the Macintosh Laryngoscope, Truview Evo2, and Totaltrack VLM Used by Novices--A Manikin Study.

    PubMed

    Aleksandrowicz, Dawid; Gaszyński, Tomasz

    2016-01-01

    Airway management in patients with suspected cervical spine injury plays an important role in the pathway of care of trauma patients. The aim of this study was to evaluate three different airway devices during intubation of a patient with reduced cervical spine mobility. Forty students of the third year of emergency medicine studies participated in the study (F = 26, M = 14). The time required to obtain a view of the entry to the larynx and successful ventilation time were recorded. Cormack-Lehane laryngoscopic view and damage to the incisors were also assessed. All three airway devices were used by each student (a novice) and they were randomly chosen. The mean time required to obtain the entry-to-the-larynx view was the shortest for the Macintosh laryngoscope 13.4 s (±2.14). Truview Evo2 had the shortest successful ventilation time 35.7 s (±9.27). The best view of the entry to the larynx was obtained by the Totaltrack VLM device. The Truview Evo2 and Totaltrack VLM may be an alternative to the classic Macintosh laryngoscope for intubation of trauma patients with suspected injury to the cervical spine. The use of new devices enables achieving better laryngoscopic view as well as minimising incisor damage during intubation.

  16. Optimization Techniques for College Financial Aid Managers

    ERIC Educational Resources Information Center

    Bosshardt, Donald I.; Lichtenstein, Larry; Palumbo, George; Zaporowski, Mark P.

    2010-01-01

    In the context of a theoretical model of expected profit maximization, this paper shows how historic institutional data can be used to assist enrollment managers in determining the level of financial aid for students with varying demographic and quality characteristics. Optimal tuition pricing in conjunction with empirical estimation of…

  17. Endonasal management of pediatric congenital transsphenoidal encephaloceles: nuances of a modified reconstruction technique. Technical note and report of 3 cases.

    PubMed

    Zeinalizadeh, Mehdi; Sadrehosseini, Seyed Mousa; Habibi, Zohreh; Nejat, Farideh; Silva, Harley Brito da; Singh, Harminder

    2017-03-01

    OBJECTIVE Congenital transsphenoidal encephaloceles are rare malformations, and their surgical treatment remains challenging. This paper reports 3 cases of transsphenoidal encephalocele in 8- to 24-month-old infants, who presented mainly with airway obstruction, respiratory distress, and failure to thrive. METHODS The authors discuss the surgical management of these lesions via a minimally invasive endoscopic endonasal approach, as compared with the traditional transcranial and transpalatal approaches. A unique endonasal management algorithm for these lesions is outlined. The lesions were repaired with no resection of the encephalocele sac, and the cranial base defects were reconstructed with titanium mesh plates and vascular nasoseptal flaps. RESULTS Reduction of the encephalocele and reconstruction of the skull base was successfully accomplished in all 3 cases, with favorable results. CONCLUSIONS The described endonasal management algorithm for congenital transsphenoidal encephaloceles is a safe, viable alternative to traditional transcranial and transpalatal approaches, and avoids much of the morbidity associated with these open techniques.

  18. Optical Techniques for Space Environment Management

    NASA Astrophysics Data System (ADS)

    Greene, B.; Bennett, J.; Smith, C.

    2016-09-01

    The Space Environment Research Centre (SERC) is a fully-funded multi-national research collaboration for the management and mitigation of space debris using optical technologies. SERC is tasked with developing mitigation strategies for the many debris objects not amenable to space-based interventions. SERC research leverages very accurate information from a new optical space tracking network to develop viable near-term strategies to manage debris using only ground-based infrastructure. SERC has sufficient resources to conduct full-scale on-orbit testing of candidate approaches. We report on SERC progress in astrodynamics, precision catalogs, conjunction processing, adaptive optics and high power lasers as well as the architecture of the research effort.

  19. United airway disease: current perspectives

    PubMed Central

    Giavina-Bianchi, Pedro; Aun, Marcelo Vivolo; Takejima, Priscila; Kalil, Jorge; Agondi, Rosana Câmara

    2016-01-01

    Upper and lower airways are considered a unified morphological and functional unit, and the connection existing between them has been observed for many years, both in health and in disease. There is strong epidemiologic, pathophysiologic, and clinical evidence supporting an integrated view of rhinitis and asthma: united airway disease in the present review. The term “united airway disease” is opportune, because rhinitis and asthma are chronic inflammatory diseases of the upper and lower airways, which can be induced by allergic or nonallergic reproducible mechanisms, and present several phenotypes. Management of rhinitis and asthma must be jointly carried out, leading to better control of both diseases, and the lessons of the Allergic Rhinitis and Its Impact on Asthma initiative cannot be forgotten. PMID:27257389

  20. The Phillips airway.

    PubMed

    Haridas, R P; Wilkinson, D J

    2012-07-01

    The Phillips airway was developed by George Ramsay Phillips. There is no known original description of the airway and the earliest known reference to it is from 1919. The airway and its modifications are described.

  1. Airway remodeling in asthma: what really matters.

    PubMed

    Fehrenbach, Heinz; Wagner, Christina; Wegmann, Michael

    2017-03-01

    Airway remodeling is generally quite broadly defined as any change in composition, distribution, thickness, mass or volume and/or number of structural components observed in the airway wall of patients relative to healthy individuals. However, two types of airway remodeling should be distinguished more clearly: (1) physiological airway remodeling, which encompasses structural changes that occur regularly during normal lung development and growth leading to a normal mature airway wall or as an acute and transient response to injury and/or inflammation, which ultimately results in restoration of a normal airway structures; and (2) pathological airway remodeling, which comprises those structural alterations that occur as a result of either disturbed lung development or as a response to chronic injury and/or inflammation leading to persistently altered airway wall structures and function. This review will address a few major aspects: (1) what are reliable quantitative approaches to assess airway remodeling? (2) Are there any indications supporting the notion that airway remodeling can occur as a primary event, i.e., before any inflammatory process was initiated? (3) What is known about airway remodeling being a secondary event to inflammation? And (4), what can we learn from the different animal models ranging from invertebrate to primate models in the study of airway remodeling? Future studies are required addressing particularly pheno-/endotype-specific aspects of airway remodeling using both endotype-specific animal models and "endotyped" human asthmatics. Hopefully, novel in vivo imaging techniques will be further advanced to allow monitoring development, growth and inflammation of the airways already at a very early stage in life.

  2. PBPC collections: Management, techniques and risks.

    PubMed

    Gašová, Zdenka; Bhuiyan-Ludvíková, Zdeňka; Böhmová, Martina; Marinov, Iuri; Vacková, Blanka; Pohlreich, David; Trněný, Marek

    2010-10-01

    We evaluated the efficiency, safety and risks of three techniques which were used for autologous PBPC collections: (a) large-volume leukapheresis (LVL), (b) standard collections, and (c) a new modified technique which was named as "Mixed" collections. In spite of the fact that the standard and LVL collection techniques are used routinely, there may occur special conditions in which the procedures cannot be recommended. Some patients may suffer from serious clinical complications and they cannot tolerate either standard procedures with administration of higher doses of ACD-A, or the high extent of procedure in the course of LVL. We tried to find the safe and efficient collection technique which could help this group of patients to overcome their problems. The "Mixed" collection technique could be such a choice. The numbers of 136 autologous PBPC collections were performed in 98 patients who suffered from hemato-oncological diseases. We evaluated the results of (a) 93 LVL (more than 3 TBV, total blood volumes of the patients were processed; anticoagulation: ACD-A and Heparin), (b) 16 Standard procedures (less than 3 TBV were processed; anticoagulation: ACD-A), and (c) 27 "Mixed" collections (less than 3 TBV of patients were processed; anticoagulation: ACD-A+ Heparin). Collections were performed by the use of separator Cobe Spectra, Caridian. In patients (a) with a good effect of mobilization (precollection CD 34+ cells in blood higher than 20×10(3)/mL) we prepared almost the same median dose of CD 34+ cells from the standard and "Mixed" collections, 3.8 and 4×10(6)/kg, respectively. In LVL the median yield of CD 34+ cells was 8.2×10(6)/kg. In patients (b) who were mobilized weakly (precollection CD 34+ cells in blood lower than 20×10(3)/mL), LVL enabled to prepare 1.5×10(6) of CD 34+/kg from one collection, while the median yield of CD 34+ cells from the standard and "Mixed" collections was 0.9 and 1.2×10(6)/kg. All the standard, LVL and "Mixed" procedures were

  3. Living with lipoedema: reviewing different self-management techniques.

    PubMed

    Fetzer, Amy; Wise, Christine

    2015-10-01

    At present, there is no proven cure for lipoedema. Nevertheless, much can be done to help improve symptoms and prevent progression. Many of these improvements can be achieved by patients using self-management techniques. This article describes the range of self-management techniques that community nurses can discuss with patients, including healthy eating, low-impact exercise, compression garments, self-lymphatic drainage, and counselling.

  4. Managing difficult polyps: techniques and pitfalls

    PubMed Central

    Tholoor, Shareef; Tsagkournis, Orestis; Basford, Peter; Bhandari, Pradeep

    2013-01-01

    There is no standardized definition of difficult polyps. However, polyps become difficult and challenging to remove endoscopically when they are large in size, flat in nature, situated in a high-risk location and when access to them is very awkward. Recently, an SMSA (Size, Morphology, Site, Access) classification has been proposed that helps to qualify the degree of difficulty by scoring on the above parameters. This article reviews the features that make polyps difficult to remove and provides some practical tips in managing these difficult polyps. We believe that ‘difficult polyp’ is a relative term and each endoscopist should define their own level of difficulty and what they would be able to handle safely. However, in expert trained hands, most difficult polyps can be safely removed by an endoscopic approach. PMID:24714799

  5. Management of Intracranial Meningiomas Using Keyhole Techniques

    PubMed Central

    Burks, Joshua D; Conner, Andrew K; Bonney, Phillip A; Archer, Jacob B; Christensen, Blake; Smith, Jacqueline; Safavi-Abbasi, Sam

    2016-01-01

    Background: Keyhole craniotomies are increasingly being used for lesions of the skull base. Here we review our recent experience with these approaches for resection of intracranial meningiomas. Methods: Clinical and operative data were gathered on all patients treated with keyhole approaches by the senior author from January 2012 to June 2013. Thirty-one meningiomas were resected in 27 patients, including 9 supratentorial, 5 anterior fossa, 7 middle fossa, 6 posterior fossa, and 4 complex skull base tumors. Twenty-nine tumors were WHO Grade I, and 2 were Grade II.  Results: The mean operative time was 8 hours, 22 minutes (range, 2:55-16:14) for skull-base tumors, and 4 hours, 27 minutes (range, 1:45-7:13) for supratentorial tumors. Simpson Resection grades were as follows: Grade I = 8, II = 8, III = 1, IV = 15, V = 0. The median postoperative hospital stay was 4 days (range, 1-20 days). In the 9 patients presenting with some degree of visual loss, 7 saw improvement or complete resolution. In the 6 patients presenting with cranial nerve palsies, 4 experienced improvement or resolution of the deficit postoperatively. Four patients experienced new neurologic deficits, all of which were improved or resolved at the time of the last follow-up. Technical aspects and surgical nuances of these approaches for management of intracranial meningiomas are discussed.  Conclusions: With careful preoperative evaluation, keyhole approaches can be utilized singly or in combination to manage meningiomas in a wide variety of locations with satisfactory results. PMID:27284496

  6. Continuous Positive Airway Pressure for Motion Management in Stereotactic Body Radiation Therapy to the Lung: A Controlled Pilot Study

    SciTech Connect

    Goldstein, Jeffrey D.; Lawrence, Yaacov R.; Appel, Sarit; Landau, Efrat; Ben-David, Merav A.; Rabin, Tatiana; Benayun, Maoz; Dubinski, Sergey; Weizman, Noam; Alezra, Dror; Gnessin, Hila; Goldstein, Adam M.; Baidun, Khader; Segel, Michael J.; Peled, Nir; Symon, Zvi

    2015-10-01

    Objective: To determine the effect of continuous positive airway pressure (CPAP) on tumor motion, lung volume, and dose to critical organs in patients receiving stereotactic body radiation therapy (SBRT) for lung tumors. Methods and Materials: After institutional review board approval in December 2013, patients with primary or secondary lung tumors referred for SBRT underwent 4-dimensional computed tomographic simulation twice: with free breathing and with CPAP. Tumor excursion was calculated by subtracting the vector of the greatest dimension of the gross tumor volume (GTV) from the internal target volume (ITV). Volumetric and dosimetric determinations were compared with the Wilcoxon signed-rank test. CPAP was used during treatment if judged beneficial. Results: CPAP was tolerated well in 10 of the 11 patients enrolled. Ten patients with 18 lesions were evaluated. The use of CPAP decreased tumor excursion by 0.5 ± 0.8 cm, 0.4 ± 0.7 cm, and 0.6 ± 0.8 cm in the superior–inferior, right–left, and anterior–posterior planes, respectively (P≤.02). Relative to free breathing, the mean ITV reduction was 27% (95% confidence interval [CI] 16%-39%, P<.001). CPAP significantly augmented lung volume, with a mean absolute increase of 915 ± 432 cm{sup 3} and a relative increase of 32% (95% CI 21%-42%, P=.003), contributing to a 22% relative reduction (95% CI 13%-32%, P=.001) in mean lung dose. The use of CPAP was also associated with a relative reduction in mean heart dose by 29% (95% CI 23%-36%, P=.001). Conclusion: In this pilot study, CPAP significantly reduced lung tumor motion compared with free breathing. The smaller ITV, the planning target volume (PTV), and the increase in total lung volume associated with CPAP contributed to a reduction in lung and heart dose. CPAP was well tolerated, reproducible, and simple to implement in the treatment room and should be evaluated further as a novel strategy for motion management in radiation therapy.

  7. Blockage of upper airway

    MedlinePlus

    ... Airway obstruction - acute upper Images Throat anatomy Choking Respiratory system References Cukor J, Manno M. Pediatric respiratory emergencies: upper airway obstruction and infections. In: Marx ...

  8. Coping Styles as Mediators of Teachers' Classroom Management Techniques

    ERIC Educational Resources Information Center

    Lewis, Ramon; Roache, Joel; Romi, Shlomo

    2011-01-01

    This study reports the relationships between coping styles of Australian teachers and the classroom based classroom management techniques they use to cope with student misbehaviour. There is great interest internationally in improving educational systems by upgrading the quality of teachers' classroom management. However, the relationship between…

  9. Behavior Management Techniques in Predoctoral and Postdoctoral Pediatric Dentistry Programs.

    ERIC Educational Resources Information Center

    Belanger, Gary K.; Tilliss, Terri S.

    1993-01-01

    A survey determined the extent to which selected pediatric dental behavior management techniques are taught both didactically and clinically in 46 predoctoral and 45 postdoctoral programs. Results and trends are reported within the four categories of sedation, restraint, parental presence, and communications behavior management. (GLR)

  10. USING BIOASSAYS TO EVALUATE THE PERFORMANCE OF RISK MANAGEMENT TECHNIQUES

    EPA Science Inventory

    Often, the performance of risk management techniques is evaluated by measuring the concentrations of the chemials of concern before and after risk management effoprts. However, using bioassays and chemical data provides a more robust understanding of the effectiveness of risk man...

  11. Classroom Management Through the Application of Behavior Modification Techniques.

    ERIC Educational Resources Information Center

    Ferinden, William E., Jr.

    The primary aim of this book is to bring to the grade school teacher a survey of the most recent techniques and ideas of behavior modification which are applicable to good classroom management. All of the approaches and techniques presented could be of interest to teachers working at all grade levels. Since research has shown that the systematic…

  12. Capitalizing on Stress Management Techniques in Developmental Classes.

    ERIC Educational Resources Information Center

    Price, Elsa C.

    Mastering stress management techniques can help college developmental class educators protect themselves from burnout. These techniques can also be taught to students in developmental classes to enable them to maximize the benefits from these classes. This paper outlines the causes of stress, identifies stressors, describes responses to stress,…

  13. Radiation treatment for the right naris in a pediatric anesthesia patient using an adaptive oral airway technique

    SciTech Connect

    Sponseller, Patricia Pelly, Nicole; Trister, Andrew; Ford, Eric; Ermoian, Ralph

    2015-10-01

    Radiation therapy for pediatric patients often includes the use of intravenous anesthesia with supplemental oxygen delivered via the nasal cannula. Here, we describe the use of an adaptive anesthesia technique for electron irradiation of the right naris in a preschool-aged patient treated under anesthesia. The need for an intranasal bolus plug precluded the use of standard oxygen supplementation. This novel technique required the multidisciplinary expertise of anesthesiologists, radiation therapists, medical dosimetrists, medical physicists, and radiation oncologists to ensure a safe and reproducible treatment course.

  14. Calcaneal Fracture Management: Extensile Lateral Approach Versus Small Incision Technique.

    PubMed

    Kiewiet, Nathan J; Sangeorzan, Bruce J

    2017-03-01

    Calcaneal fracture management has historically been a controversial topic and represents an area of sustained interest over the past several decades. The authors review current methods for calcaneal fracture fixation with an extensile lateral approach and small incision techniques. Early reports of small incision techniques have reported promising outcomes and reduced risks for complications. These techniques may be beneficial to reduce the risk of soft tissue complications and improve the rate of recovery.

  15. Advanced thermal management techniques for space power electronics

    NASA Astrophysics Data System (ADS)

    Reyes, Angel Samuel

    1992-01-01

    Modern electronic systems used in space must be reliable and efficient with thermal management unaffected by outer space constraints. Current thermal management techniques are not sufficient for the increasing waste heat dissipation of novel electronic technologies. Many advanced thermal management techniques have been developed in recent years that have application in high power electronic systems. The benefits and limitations of emerging cooling technologies are discussed. These technologies include: liquid pumped devices, mechanically pumped two-phase cooling, capillary pumped evaporative cooling, and thermoelectric devices. Currently, liquid pumped devices offer the most promising alternative for electronics thermal control.

  16. Contingency Management: Development of Management Problems X Techniques Matrix.

    DTIC Science & Technology

    1980-05-01

    develops preventive actions to avoid those adverse consequences. B-3 15. Organizational Mirror This technique (a) identifies a target group and two or...more other groups to serve as "mirrors" for this group, (b) collects data concerning perceptions of human processes in the target group , (c) analyzes...34 groups discuss their perceptions of the target group in the presence of the target group , but without its involvement, to clarify, understand, and

  17. Power Management Techniques for Data Centers: A Survey

    SciTech Connect

    Mittal, Sparsh

    2014-07-01

    With growing use of internet and exponential growth in amount of data to be stored and processed (known as ``big data''), the size of data centers has greatly increased. This, however, has resulted in significant increase in the power consumption of the data centers. For this reason, managing power consumption of data centers has become essential. In this paper, we highlight the need of achieving energy efficiency in data centers and survey several recent architectural techniques designed for power management of data centers. We also present a classification of these techniques based on their characteristics. This paper aims to provide insights into the techniques for improving energy efficiency of data centers and encourage the designers to invent novel solutions for managing the large power dissipation of data centers.

  18. Hoshin Kanri: a technique for strategic quality management.

    PubMed

    Tennant, C; Roberts, P A

    2000-01-01

    This paper describes a technique for Strategic Quality Management (SQM), known as Hoshin Kanri, which has been operated as a management system in many Japanese companies since the 1960s. It represents a core aspect of Japanese companies' management systems, and is stated as: the means by which the overall control system and Total Quality Management (TQM) are deployed. Hoshin Kanri is not particularly unique in its concept of establishing and tracking individual goals and objectives, but the manner in which the objectives and the means to achieve them are developed and deployed is. The problem with applying the concept of Strategic Quality Management (SQM) using Hoshin Kanri, is that it can tend to challenge the traditional authoritarian strategic planning models, which have become the paradigms of modern business. Yet Hoshin Kanri provides an appropriate tool for declaration of the strategic vision for the business while integrating goals and targets in a single holistic model. There have been various adaptations of Hoshin Kanri to align the technique to Western thinking and management approaches, yet outside Japan its significance has gone largely unreported. It is proposed that Hoshin Kanri is an effective methodology for SQM, which has a number of benefits over the more conventional planning techniques. The benefits of Hoshin Kanri as a tool for Strategic Quality Management (SQM) compared to conventional planning systems include: integration of strategic objectives with tactical daily management, the application of the plan-do-check-act cycle to business process management, parallel planning and execution methodology, company wide approach, improvements in communication, increased consensus and buy-in to goal setting, and cross-functional-management integration.

  19. Advanced endoscopic ultrasound management techniques for preneoplastic pancreatic cystic lesions

    PubMed Central

    Arshad, Hafiz Muhammad Sharjeel; Bharmal, Sheila; Duman, Deniz Guney; Liangpunsakul, Suthat; Turner, Brian G

    2017-01-01

    Pancreatic cystic lesions can be benign, premalignant or malignant. The recent increase in detection and tremendous clinical variability of pancreatic cysts has presented a significant therapeutic challenge to physicians. Mucinous cystic neoplasms are of particular interest given their known malignant potential. This review article provides a brief but comprehensive review of premalignant pancreatic cystic lesions with advanced endoscopic ultrasound (EUS) management approaches. A comprehensive literature search was performed using PubMed, Cochrane, OVID and EMBASE databases. Preneoplastic pancreatic cystic lesions include mucinous cystadenoma and intraductal papillary mucinous neoplasm. The 2012 International Sendai Guidelines guide physicians in their management of pancreatic cystic lesions. Some of the advanced EUS management techniques include ethanol ablation, chemotherapeutic (paclitaxel) ablation, radiofrequency ablation and cryotherapy. In future, EUS-guided injections of drug-eluting beads and neodymium:yttrium aluminum agent laser ablation is predicted to be an integral part of EUS-guided management techniques. In summary, International Sendai Consensus Guidelines should be used to make a decision regarding management of pancreatic cystic lesions. Advanced EUS techniques are proving extremely beneficial in management, especially in those patients who are at high surgical risk. PMID:27574295

  20. Double blind randomised controlled trial of two different breathing techniques in the management of asthma

    PubMed Central

    Slader, C A; Reddel, H K; Spencer, L M; Belousova, E G; Armour, C L; Bosnic‐Anticevich, S Z; Thien, F C K; Jenkins, C R

    2006-01-01

    Background Previous studies have shown that breathing techniques reduce short acting β2 agonist use and improve quality of life (QoL) in asthma. The primary aim of this double blind study was to compare the effects of breathing exercises focusing on shallow nasal breathing with those of non‐specific upper body exercises on asthma symptoms, QoL, other measures of disease control, and inhaled corticosteroid (ICS) dose. This study also assessed the effect of peak flow monitoring on outcomes in patients using breathing techniques. Methods After a 2 week run in period, 57 subjects were randomised to one of two breathing techniques learned from instructional videos. During the following 30 weeks subjects practised their exercises twice daily and as needed for relief of symptoms. After week 16, two successive ICS downtitration steps were attempted. The primary outcome variables were QoL score and daily symptom score at week 12. Results Overall there were no clinically important differences between the groups in primary or secondary outcomes at weeks 12 or 28. The QoL score remained unchanged (0.7 at baseline v 0.5 at week 28, p = 0.11 both groups combined), as did lung function and airway responsiveness. However, across both groups, reliever use decreased by 86% (p<0.0001) and ICS dose was reduced by 50% (p<0.0001; p>0.10 between groups). Peak flow monitoring did not have a detrimental effect on asthma outcomes. Conclusion Breathing techniques may be useful in the management of patients with mild asthma symptoms who use a reliever frequently, but there is no evidence to favour shallow nasal breathing over non‐specific upper body exercises. PMID:16517572

  1. Timing of hypertonic saline and airway clearance techniques in adults with cystic fibrosis during pulmonary exacerbation: pilot data from a randomised crossover study

    PubMed Central

    O'Neill, Katherine; Moran, Fidelma; Tunney, Michael M; Elborn, J Stuart; Bradbury, Ian; Downey, Damian G; Rendall, Jackie; Bradley, Judy M

    2017-01-01

    Background Streamlining the timing of treatments in cystic fibrosis (CF) is important to optimise adherence while ensuring efficacy. The optimal timing of treatment with hypertonic saline (HTS) and airway clearance techniques (ACT) is unknown. Objectives This study hypothesised that HTS before ACT would be more effective than HTS during ACT as measured by Lung Clearance Index (LCI). Methods Adults with CF providing written informed consent were randomised to a crossover trial of HTS before ACT or HTS during ACT on consecutive days. ACT treatment consisted of Acapella Duet. Patients completed LCI and spirometry at baseline and 90 min post treatment. Mean difference (MD) and 95% CIs were reported. Results 13 subjects completed the study (mean (SD) age 33 (12) years, forced expiratory volume in 1second % (FEV1%) predicted 51% (22), LCI (no. turnovers) 14 (4)). Comparing the two treatments (HTS before ACT vs HTS during ACT), the change from baseline to 90 min post treatment in LCI (MD (95% CI) −0.02 (−0.63 to 0.59)) and FEV1% predicted (MD (95% CI) −0.25 (−2.50 to 1.99)) was not significant. There was no difference in sputum weight (MD (95% CI) −3.0 (−14.9 to 8.9)), patient perceived ease of clearance (MD (95% CI) 0.4 (−0.6 to 1.3) or satisfaction (MD (95% CI) 0.4 (−0.6 to 1.5)). The time taken for HTS during ACT was significantly shorter (MD (95% CI) 14.7 (9.8 to 19.6)). Conclusions In this pilot study, HTS before ACT was no more effective than HTS during ACT as measured by LCI. Trial registration number NCT01753869; Pre-results. PMID:28123751

  2. Triggers of airway inflammation.

    PubMed

    Kerrebijn, K F

    1986-01-01

    Most asthmatics have hyperresponsive airways. This makes them more sensitive than non-asthmatics to bronchoconstricting environmental exposures which, in their turn, may enhance responsiveness. Airway inflammation is considered to be a key determinant of airway hyperresponsiveness: the fact that chronic airway inflammation in cystic fibrosis does not lead to airway hyperresponsiveness of any importance indicates, however, that the role of airway inflammation is complex and incompletely elucidated. The main inducers of airway inflammation are viral infections, antigens, occupational stimuli and pollutants. Although exercise, airway cooling and hyper- or hypotonic aerosols are potent stimuli of bronchoconstriction, it is questionable if airway inflammation is involved in their mode of action. Each of the above-mentioned stimuli is discussed, with emphasis laid on the relation of symptoms to mechanisms.

  3. Preparation of the patient and the airway for awake intubation

    PubMed Central

    Ramkumar, Venkateswaran

    2011-01-01

    Awake intubation is usually performed electively in the presence of a difficult airway. A detailed airway examination is time-consuming and often not feasible in an emergency. A simple 1-2-3 rule for airway examination allows one to identify potential airway difficulty within a minute. A more detailed airway examination can give a better idea about the exact nature of difficulty and the course of action to be taken to overcome it. When faced with an anticipated difficult airway, the anaesthesiologist needs to consider securing the airway in an awake state without the use of anaesthetic agents or muscle relaxants. As this can be highly discomforting to the patient, time and effort must be spent to prepare such patients both psychologically and pharmacologically for awake intubation. Psychological preparation is best initiated by an anaesthesiologist who explains the procedure in simple language. Sedative medications can be titrated to achieve patient comfort without compromising airway patency. Additional pharmacological preparation includes anaesthetising the airway through topical application of local anaesthetics and appropriate nerve blocks. When faced with a difficult airway, one should call for the difficult airway cart as well as for help from colleagues who have interest and expertise in airway management. Preoxygenation and monitoring during awake intubation is important. Anxious patients with a difficult airway may need to be intubated under general anaesthesia without muscle relaxants. Proper psychological and pharmacological preparation of the patient by an empathetic anaesthesiologist can go a long way in making awake intubation acceptable for all concerned. PMID:22174458

  4. Self Management Techniques and Disclosure of Sero Status

    ERIC Educational Resources Information Center

    Falaye, Ajibola; Afolayan, Joel Adeleke

    2015-01-01

    This study looked at using Self Management Technique (SMT) to promote self-disclosure of Sero status in Kwara State, Nigeria. A pre-test, post-test and control group quasi experimental design using a 2x2x2 factorial matrix was adopted. Sixty participants were sampled by balloting from two HIV/AIDS screening centres. Four instruments were used such…

  5. Structured Information Management Using New Techniques for Processing Text.

    ERIC Educational Resources Information Center

    Gibb, Forbes; Smart, Godfrey

    1990-01-01

    Describes the development of a software system, SIMPR (Structured Information Management: Processing and Retrieval), that will process documents by indexing them and classifying their subjects. Topics discussed include information storage and retrieval, file inversion techniques, modelling the user, natural language searching, automatic indexing,…

  6. Conflict Management Techniques for Kindergarten through Fourth Grade.

    ERIC Educational Resources Information Center

    Conn, Edith Janell Rudd

    An elementary school teacher discusses conflict management techniques appropriate for use with children in kindergarten through the fourth grade. Discussion first recapitulates developmental theory from several perspectives, including those of Freud, Erikson, Piaget, and profiles conflict theory. Illustrative contemporary social problems that…

  7. New technique for the management of vesicorectal fistulas

    SciTech Connect

    Leifer, G.; Jacobs, W.H.

    1988-08-01

    We report a new technique for the management of the complications of vesicorectal fistulas. The patient we present had a fistula and severe skin excoriation. The fistula was caused by carcinoma of the prostate that had been treated by radiation therapy. The fistula was patched with a rectal prosthesis similar to that used to patch esophageal-tracheal and esophageal-bronchial fistulas.

  8. Using Powerpoint Animations to Teach Operations Management Techniques and Concepts

    ERIC Educational Resources Information Center

    Treleven, Mark D.; Penlesky, Richard J.; Callarman, Thomas E.; Watts, Charles A.; Bragg, Daniel J.

    2014-01-01

    This article examines the value of using complex animated PowerPoint presentations to teach operations management techniques and concepts. To provide context, literature covering the use of PowerPoint animations in business education is briefly reviewed. The specific animations employed in this study are identified and their expected benefits to…

  9. Lenses for learning: visual techniques in natural resource management.

    PubMed

    Petheram, L; High, C; Campbell, B M; Stacey, N

    2011-10-01

    In this study, we explored the use of selected visual techniques (e.g. video, photography, diagramming) in facilitating learning among Indigenous communities living in remote protected areas at sites in Vietnam and Australia. The techniques were employed during interviews and workshops aimed at accessing and enhancing local peoples' perspectives on their landscape and on specific natural resource management issues. The effectiveness of the different techniques for enabling learning varied markedly with the context, highlighting the need for facilitator skill and flexibility in application of techniques. Visual techniques helped to engage participants; encourage unrestrained and lateral thinking; provide opportunities for self-expression and reflection; and to expose participants to perspectives of other community members. Valuable insights emerged on broad aspects of learning and these were incorporated into a simple model that highlights three types of conceptualisation found to be important in these processes.

  10. Intrathoracic airway measurement: ex-vivo validation

    NASA Astrophysics Data System (ADS)

    Reinhardt, Joseph M.; Raab, Stephen A.; D'Souza, Neil D.; Hoffman, Eric A.

    1997-05-01

    High-resolution x-ray CT (HRCT) provides detailed images of the lungs and bronchial tree. HRCT-based imaging and quantitation of peripheral bronchial airway geometry provides a valuable tool for assessing regional airway physiology. Such measurements have been sued to address physiological questions related to the mechanics of airway collapse in sleep apnea, the measurement of airway response to broncho-constriction agents, and to evaluate and track the progression of disease affecting the airways, such as asthma and cystic fibrosis. Significant attention has been paid to the measurements of extra- and intra-thoracic airways in 2D sections from volumetric x-ray CT. A variety of manual and semi-automatic techniques have been proposed for airway geometry measurement, including the use of standardized display window and level settings for caliper measurements, methods based on manual or semi-automatic border tracing, and more objective, quantitative approaches such as the use of the 'half-max' criteria. A recently proposed measurements technique uses a model-based deconvolution to estimate the location of the inner and outer airway walls. Validation using a plexiglass phantom indicates that the model-based method is more accurate than the half-max approach for thin-walled structures. In vivo validation of these airway measurement techniques is difficult because of the problems in identifying a reliable measurement 'gold standard.' In this paper we report on ex vivo validation of the half-max and model-based methods using an excised pig lung. The lung is sliced into thin sections of tissue and scanned using an electron beam CT scanner. Airways of interest are measured from the CT images, and also measured with using a microscope and micrometer to obtain a measurement gold standard. The result show no significant difference between the model-based measurements and the gold standard; while the half-max estimates exhibited a measurement bias and were significantly

  11. Risk Management Techniques and Practice Workshop Workshop Report

    SciTech Connect

    Quinn, T; Zosel, M

    2008-12-02

    At the request of the Department of Energy (DOE) Office of Science (SC), Lawrence Livermore National Laboratory (LLNL) hosted a two-day Risk Management Techniques and Practice (RMTAP) workshop held September 18-19 at the Hotel Nikko in San Francisco. The purpose of the workshop, which was sponsored by the SC/Advanced Scientific Computing Research (ASCR) program and the National Nuclear Security Administration (NNSA)/Advanced Simulation and Computing (ASC) program, was to assess current and emerging techniques, practices, and lessons learned for effectively identifying, understanding, managing, and mitigating the risks associated with acquiring leading-edge computing systems at high-performance computing centers (HPCCs). Representatives from fifteen high-performance computing (HPC) organizations, four HPC vendor partners, and three government agencies attended the workshop. The overall workshop findings were: (1) Standard risk management techniques and tools are in the aggregate applicable to projects at HPCCs and are commonly employed by the HPC community; (2) HPC projects have characteristics that necessitate a tailoring of the standard risk management practices; (3) All HPCC acquisition projects can benefit by employing risk management, but the specific choice of risk management processes and tools is less important to the success of the project; (4) The special relationship between the HPCCs and HPC vendors must be reflected in the risk management strategy; (5) Best practices findings include developing a prioritized risk register with special attention to the top risks, establishing a practice of regular meetings and status updates with the platform partner, supporting regular and open reviews that engage the interests and expertise of a wide range of staff and stakeholders, and documenting and sharing the acquisition/build/deployment experience; and (6) Top risk categories include system scaling issues, request for proposal/contract and acceptance testing, and

  12. Emergency airway puncture

    MedlinePlus

    ... support for only a very short period of time. Alternative Names Needle cricothyrotomy Images Emergency airway puncture Cricoid cartilage Emergency airway puncture - series References Hebert RB, Bose S, Mace SE. Cricothyrotomy and ...

  13. Upper airway biopsy

    MedlinePlus

    ... upper airway Images Upper airway test Bronchoscopy Throat anatomy References Yung RC, Boss EF. Tracheobronchial endoscopy. In: Flint PW, Haughey BH, Lund LJ, et al, eds. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, PA: Elsevier Mosby; ...

  14. Management of segmental skeletal defects by the induced membrane technique

    PubMed Central

    El-Alfy, Barakat Sayed; Ali, Ayman M

    2015-01-01

    Background: Surgical reconstruction of segmental skeletal defects represents a true challenge for the orthopedic surgeons. Recently, Masquelet et al. described a two-stage technique for reconstruction of bone defects, known as the induced membrane technique. The aim of this study is to assess the results of the induced membrane technique in the management of segmental skeletal defects resulting from debridement of bone infection. Materials and Methods: Seventeen patients with segmental skeletal defects were treated in our institution by the induced membrane technique. The average age of the patients was 43 years (range 26- 58 years). The causes of the defects were infected gap nonunion in 12 cases and debridement of osteomyelitis in 5 cases. The defects were located in the tibia (n = 13) and the femur (n = 4). The mean defect was 7 cm (range 4 cm - 11 cm). All cases were treated by the induced membrane technique in two-stages. Results: Bone union happened in 14 patients. The limb length discrepancy did not exceed 2.5 cm in the healed cases. The mean time of healing was 10 months (range 6-19 months). The complications included nonunion of the graft in five cases, failure of graft maturation in two cases, reactivation of infection in two cases and refracture after removal of the frame in one case. These complications were managed during the course of treatment and they did not affect the final outcome in all patients except three. Conclusion: The induced membrane technique is a valid option for the management of segmental skeletal defects. It is a simple and straight forward procedure, but the time required for growth and maturation of the graft is relatively long. PMID:26806972

  15. Study of the variability in upper and lower airway morphology in Sprague-Dawley rats using modern micro-CT scan-based segmentation techniques.

    PubMed

    De Backer, Jan W; Vos, Wim G; Burnell, Patricia; Verhulst, Stijn L; Salmon, Phil; De Clerck, Nora; De Backer, Wilfried

    2009-05-01

    Animal models are being used extensively in pre-clinical and safety assessment studies to assess the effectiveness and safety of new chemical entities and delivery systems. Although never entirely replacing the need for animal testing, the use of computer simulations could eventually reduce the amount of animals needed for research purposes and refine the data acquired from the animal studies. Computational fluid dynamics is a powerful tool that makes it possible to simulate flow and particle behavior in animal or patient-specific respiratory models, for purposes of inhaled delivery. This tool requires an accurate representation of the respiratory system, respiration and dose delivery attributes. The aim of this study is to develop a representative airway model of the Sprague-Dawley rat using static and dynamic micro-CT scans. The entire respiratory tract was modeled, from the snout and nares down to the central airways at the point where no distinction could be made between intraluminal air and the surrounding tissue. For the selection of the representative model, variables such as upper airway movement, segmentation length, airway volume and size are taken into account. Dynamic scans of the nostril region were used to illustrate the characteristic morphology of this region in anaesthetized animals. It could be concluded from this study that it was possible to construct a highly detailed representative model of a Sprague-Dawley rat based on imaging modalities such as micro-CT scans.

  16. Project TEAMS (Techniques and Education for Achieving Management Skills): Independent Business Owner/Managers.

    ERIC Educational Resources Information Center

    Platte Technical Community Coll., Columbus, NE.

    These Project TEAMS (Techniques and Education for Achieving Managerial Skills) instructional materials consist of five units for use in training independent business owner/managers. The first unit contains materials which deal with management skills relating to personal characteristics of successful business people, knowledge of self and chosen…

  17. Modified Surgical Techniques for Managing Intraoperative Floppy Iris Syndrome

    PubMed Central

    Charukamnoetkanok, Puwat

    2016-01-01

    Purpose. To report a modified surgical strategy in the management of intraoperative floppy iris syndrome-associated iris prolapse. Methods. Prolapsed iris is left as is and a new corneal incision near the original wound but at a different site is created. Depending on the location of the original incision and the surgeon's preference, this additional incision can be used as a new port for phacoemulsification tip or can be the new site for the iris to securely prolapse, allowing for the surgery to proceed safely. Results. We present 2 cases of iris prolapse and inadequate pupil dilation in patients with IFIS. Along with our modified technique, additional iris retractors were placed to increase the workspace for the phacoemulsification tip. The cataract surgery was performed successfully without further complications in both cases. Conclusion. This surgical technique could be an adjunct to allow the surgeons to expand the armamentarium for the management of IFIS-associated iris prolapse. PMID:27999697

  18. Evolution of the extraglottic airway: a review of its history, applications, and practical tips for success.

    PubMed

    Hernandez, Michael R; Klock, P Allan; Ovassapian, Adranik

    2012-02-01

    The development of the laryngeal mask airway in 1981 was an important first step toward widespread use and acceptance of the extraglottic airway (EGA). The term extraglottic is used in this review to encompass those airways that do not violate the larynx, in addition to those with a supraglottic position. Although the term extraglottic may be broad and include airways such as tracheostomy tubes, the term supraglottic does not describe a large number of devices with subglottic components and is too narrow for a discussion of modern devices. EGAs have flourished in practice, and now a wide variety of devices are available for an ever-expanding array of applications. In this review we attempt to clarify the current state of EGA devices new and old, and to illustrate their use in numerous settings. Particular attention is paid to the use of EGAs in special situations such as obstetric, pediatric, prehospital, and nontraditional "out of the operating room" settings. The role of the EGA in difficult airway management is discussed. EGA devices have saved countless lives because they facilitate ventilation when facemask ventilation and tracheal intubation were not possible. Traditionally, difficult airway management focused on successful tracheal intubation. The EGA has allowed a paradigm shift, changing the emphasis of difficult airway management from tracheal intubation to ventilation and oxygenation. EGA devices have proved to be useful adjuncts to tracheal intubation; in particular, the combination of EGA devices and fiberoptic guidance is a powerful technique for difficult airway management. Despite their utility, EGAs do have disadvantages. For example, they typically do not provide the same protection from pulmonary aspiration of regurgitated gastric material as a cuffed tracheal tube. The risk of aspiration of gastric contents persists despite advances in EGA design that have sought to address the issue. The association between excessive EGA cuff pressure and

  19. A prosthetic management technique for osteopetrosis affecting the maxilla.

    PubMed

    Dewan, Karun; Bishop, Karl; Hollisey-Mclean, David

    2007-06-01

    Bony anatomical anomalies can complicate the construction and successful wearing of removable prostheses. Osteopetrosis is a group of diseases that affect the growth and continuous remodelling of bone which in turn can result in gross irregular alveolar bone morphology. This paper describes the management of a patient with this problem and emphasises the challenges in constructing a successful complete maxillary removable prosthesis. The utilisation of a flexible base plate material as an alternative to traditional materials will be highlighted. Irregular bony morphology is a recognised potential obstacle to the successful construction of removable prostheses. In most cases the problem can be overcome but in extreme and less common circumstances, management of these features can be more problematic. This paper describes a technique used to manage extreme alveolar irregularity which may perhaps be applied to those problems more commonly encountered in every day clinical practice but are less extreme then those described in this paper.

  20. Wetland assessment, monitoring and management in India using geospatial techniques.

    PubMed

    Garg, J K

    2015-01-15

    Satellite remote sensing and GIS have emerged as the most powerful tools for inventorying, monitoring and management of natural resources and environment. In the special context of wetland ecosystems, remotely sensed data from orbital platforms have been extensively used in India for the inventory, monitoring and preparation of action plans for conservation and management. First scientific inventory of wetlands in India was carried out in 1998 by Space Applications Centre (ISRO), Ahmedabad using indigenous IRS (Indian Remote Sensing Satellite) data of 1992-93 timeframe, which stimulated extensive use of geospatial techniques for wetland conservation and management. Subsequently, with advances in GIS, studies were carried out for development of Wetland Information System for a state (West Bengal) and for Loktak lake wetland (a Ramsar site) as a prelude to National Wetland Information System. Research has also been carried out for preparation of action plans especially for Ramsar sites in the country. In a novel research, use of the geospatial technology has also been demonstrated for biodiversity conservation using landscape ecological metrics. A country-wide estimate of emission of methane, a Green House Gas, from wetlands has also been made using MODIS data. Present article critically reviews the work carried out in India for wetland conservation and management using geospatial techniques.

  1. Comparison of analysis methods for airway quantification

    NASA Astrophysics Data System (ADS)

    Odry, Benjamin L.; Kiraly, Atilla P.; Novak, Carol L.; Naidich, David P.

    2012-03-01

    Diseased airways have been known for several years as a possible contributing factor to airflow limitation in Chronic Obstructive Pulmonary Diseases (COPD). Quantification of disease severity through the evaluation of airway dimensions - wall thickness and lumen diameter - has gained increased attention, thanks to the availability of multi-slice computed tomography (CT). Novel approaches have focused on automated methods of measurement as a faster and more objective means that the visual assessment routinely employed in the clinic. Since the Full-Width Half-Maximum (FWHM) method of airway measurement was introduced two decades ago [1], several new techniques for quantifying airways have been detailed in the literature, but no approach has truly become a standard for such analysis. Our own research group has presented two alternative approaches for determining airway dimensions, one involving a minimum path and the other active contours [2, 3]. With an increasing number of techniques dedicated to the same goal, we decided to take a step back and analyze the differences of these methods. We consequently put to the test our two methods of analysis and the FWHM approach. We first measured a set of 5 airways from a phantom of known dimensions. Then we compared measurements from the three methods to those of two independent readers, performed on 35 airways in 5 patients. We elaborate on the differences of each approach and suggest conclusions on which could be defined as the best one.

  2. Integrating modal-based NDE techniques and bridge management systems using quality management

    NASA Astrophysics Data System (ADS)

    Sikorsky, Charles S.

    1997-05-01

    The intent of bridge management systems is to help engineers and managers determine when and where to spend bridge funds such that commerce and the motoring public needs are satisfied. A major shortcoming which states are experiencing is the NBIS data available is insufficient to perform certain functions required by new bridge management systems, such as modeling bridge deterioration and predicting costs. This paper will investigate how modal based nondestructive damage evaluation techniques can be integrated into bridge management using quality management principles. First, quality from the manufacturing perspective will be summarized. Next, the implementation of quality management in design and construction will be reinterpreted for bridge management. Based on this, a theory of approach will be formulated to improve the productivity of a highway transportation system.

  3. Utility of a Gum-Elastic Bougie for Difficult Airway Management in Infants: A Simulation-Based Crossover Analysis

    PubMed Central

    Komasawa, Nobuyasu; Hyoda, Akira; Matsunami, Sayuri; Majima, Nozomi; Minami, Toshiaki

    2015-01-01

    Background. Direct laryngoscopy with the Miller laryngoscope (Mil) for infant tracheal intubation is often difficult to use even for skilled professionals. We performed a simulation trial evaluating the utility of a tracheal tube introducer (gum-elastic bougie (GEB)) in a simulated, difficult infant airway model. Methods. Fifteen anesthesiologists performed tracheal intubation on an infant manikin at three different degrees of difficulty (normal [Cormack-Lehane grades (Cormack) 1-2], cervical stabilization [Cormack 2-3], and anteflexion [Cormack 3-4]) with or without a GEB, intubation success rate, and intubation time. Results. In the normal and cervical stabilization trials, all intubation attempts were successful regardless of whether or not the GEB was used. In contrast, only one participant succeeded in tracheal intubation without the GEB in the anteflexion trial; the success rate significantly improved with the GEB (P = 0.005). Intubation time did not significantly change under the normal trial with or without the GEB (without, 12.7 ± 3.8 seconds; with, 13.4 ± 3.6 seconds) but was significantly shorter in the cervical stabilization and anteflexion trials with the GEB. Conclusion. GEB use shortened the intubation time and improved the success rate of difficult infant tracheal intubation by anesthesiologists in simulations. PMID:26495306

  4. Hemostatic Techniques for Laparoscopic Management of Cornual Pregnancy: Double-Impact Devascularization Technique.

    PubMed

    Afifi, Yousri; Mahmud, Ayesha; Fatma, Alfia

    2016-02-01

    Cornual pregnancy is a rare form of ectopic pregnancy, accounting for up to 2% to 4% of all ectopic pregnancies, with a mortality range of 2.0% to 2.5%. Hemorrhage is a key concern in the management of such pregnancies. Traditional treatment options include a conservative approach, failing which patients are offered surgical options such as cornual resection at laparotomy, which carries a high risk of hysterectomy. In recent years newer laparoscopic cornual resection or cornuotomy techniques have been used successfully to achieve better outcomes with fewer complications. We present the double-impact devascularization (DID) technique for laparoscopic management of cornual ectopic pregnancies. This technique permits hemostatic control by compression effect, which in turn allows reduction in procedure-related patient morbidity and mortality. We also provide an overview of other reported methods of hemostatic control used in similar laparoscopic procedures. DID appears to be a useful, safe, minimally invasive technique that can be used in both laparoscopic and open surgical procedures.

  5. Mobility management techniques for the next-generation wireless networks

    NASA Astrophysics Data System (ADS)

    Sun, Junzhao; Howie, Douglas P.; Sauvola, Jaakko J.

    2001-10-01

    The tremendous demands from social market are pushing the booming development of mobile communications faster than ever before, leading to plenty of new advanced techniques emerging. With the converging of mobile and wireless communications with Internet services, the boundary between mobile personal telecommunications and wireless computer networks is disappearing. Wireless networks of the next generation need the support of all the advances on new architectures, standards, and protocols. Mobility management is an important issue in the area of mobile communications, which can be best solved at the network layer. One of the key features of the next generation wireless networks is all-IP infrastructure. This paper discusses the mobility management schemes for the next generation mobile networks through extending IP's functions with mobility support. A global hierarchical framework model for the mobility management of wireless networks is presented, in which the mobility management is divided into two complementary tasks: macro mobility and micro mobility. As the macro mobility solution, a basic principle of Mobile IP is introduced, together with the optimal schemes and the advances in IPv6. The disadvantages of the Mobile IP on solving the micro mobility problem are analyzed, on the basis of which three main proposals are discussed as the micro mobility solutions for mobile communications, including Hierarchical Mobile IP (HMIP), Cellular IP, and Handoff-Aware Wireless Access Internet Infrastructure (HAWAII). A unified model is also described in which the different micro mobility solutions can coexist simultaneously in mobile networks.

  6. Airway pressure with chest compressions versus Heimlich manoeuvre in recently dead adults with complete airway obstruction.

    PubMed

    Langhelle, A; Sunde, K; Wik, L; Steen, P A

    2000-04-01

    In a previous case report a standard chest compression successfully removed a foreign body from the airway after the Heimlich manoeuvre had failed. Based on this case, standard chest compressions and Heimlich manoeuvres were performed by emergency physicians on 12 unselected cadavers with a simulated complete airway obstruction in a randomised crossover design. The mean peak airway pressure was significantly lower with abdominal thrusts compared to chest compressions, 26.4+/-19.8 cmH(2)O versus 40.8+/-16.4 cmH(2)O, respectively (P=0.005, 95% confidence interval for the mean difference 5.3-23.4 cmH(2)O). Standard chest compressions therefore have the potential of being more effective than the Heimlich manoeuvre for the management of complete airway obstruction by a foreign body in an unconscious patient. Removal of the Heimlich manoeuvre from the resuscitation algorithm for unconscious patients with suspected airway obstruction will also simplify training.

  7. Current techniques in the management of cervical myelopathy and radiculopathy.

    PubMed

    Gerard, Carter S; O'Toole, John E

    2014-04-01

    Posterior decompressive procedures are a fundamental component of the surgical treatment of symptomatic cervical degenerative disease. Posterior approaches have the appeal of avoiding complications associated with anterior approaches such as esophageal injury, recurrent laryngeal nerve paralysis, dysphagia, and adjacent-level disease after fusion. Although open procedures are effective, the extensive subperiosteal stripping of the paraspinal musculature leads to increased blood loss, longer hospital stays, and more postoperative pain, and potentially contributes to instability. Minimally invasive access has been developed to limit approach-related morbidity. This article reviews current techniques in minimally invasive surgical management of cervical myelopathy and radiculopathy.

  8. An improved coding technique for image encryption and key management

    NASA Astrophysics Data System (ADS)

    Wu, Xu; Ma, Jie; Hu, Jiasheng

    2005-02-01

    An improved chaotic algorithm for image encryption on the basis of conventional chaotic encryption algorithm is proposed. Two keys are presented in our technique. One is called private key, which is fixed and protected in the system. The other is named assistant key, which is public and transferred with the encrypted image together. For different original image, different assistant key should be chosen so that one could get different encrypted key. The updated encryption algorithm not only can resist a known-plaintext attack, but also offers an effective solution for key management. The analyses and the computer simulations show that the security is improved greatly, and can be easily realized with hardware.

  9. Surgical management of abdominal compartment syndrome; indications and techniques

    PubMed Central

    Leppäniemi, Ari

    2009-01-01

    The indications for surgical decompression of abdominal compartment syndrome (ACS) are not clearly defined, but undoubtedly some patients benefit from it. In patients without recent abdominal incisions, it can be achieved with full-thickness laparostomy (either midline, or transverse subcostal) or through a subcutaneous linea alba fasciotomy. In spite of the improvement in physiological variables and significant decrease in IAP, however, the effects of surgical decompression on organ function and outcome are less clear. Because of the significant morbidity associated with surgical decompression and the management of the ensuing open abdomen, more research is needed to better define the appropriate indications and techniques for surgical intervention. PMID:19366442

  10. Slowly Adapting Sensory Units Have More Receptors in Large Airways than in Small Airways in Rabbits

    PubMed Central

    Liu, Jun; Song, Nana; Guardiola, Juan; Roman, Jesse; Yu, Jerry

    2016-01-01

    Sensory units of pulmonary slowly adapting receptors (SARs) are more active in large airways than in small airways. However, there is no explanation for this phenomenon. Although sensory structures in large airways resemble those in small airways, they are bigger and more complex. Possibly, a larger receptor provides greater surface area for depolarization, and thus has a lower activating threshold and/or a higher sensitivity to stretch, leading to more nerve electrical activities. Recently, a single sensory unit has been reported to contain multiple receptors. Therefore, sensory units in large airways may contain more SARs, which may contribute to high activities. To test this hypothesis, we used a double staining technique to identify sensory receptor sizes. We labeled the sensory structure with Na+/K+-ATPase antibodies and the myelin sheath with myelin basic protein (MBP) antibodies. A SAR can be defined as the end formation beyond MBP labeling. Thus, we are able to compare sizes of sensory structures and SARs in large (trachea and bronchi) vs. small (bronchioles <500 μm in diameter) airways in the rabbit. We found that even though the sensory structure was bigger in large airways than in small airways (3340 ± 223 vs. 1168 ± 103 μm2; P < 0.0001), there was no difference in receptor sizes (349 ± 14 vs. 326 ± 16 μm2; > 0.05). However, the sensory structure contains more SARs in large airways than in small airways (9.6 ± 0.6 vs. 3.6 ± 0.3; P < 0.0001). Thus, our data support the hypothesis that greater numbers of SARs in sensory units of large airways may contribute to higher activities. PMID:28018231

  11. Slowly Adapting Sensory Units Have More Receptors in Large Airways than in Small Airways in Rabbits.

    PubMed

    Liu, Jun; Song, Nana; Guardiola, Juan; Roman, Jesse; Yu, Jerry

    2016-01-01

    Sensory units of pulmonary slowly adapting receptors (SARs) are more active in large airways than in small airways. However, there is no explanation for this phenomenon. Although sensory structures in large airways resemble those in small airways, they are bigger and more complex. Possibly, a larger receptor provides greater surface area for depolarization, and thus has a lower activating threshold and/or a higher sensitivity to stretch, leading to more nerve electrical activities. Recently, a single sensory unit has been reported to contain multiple receptors. Therefore, sensory units in large airways may contain more SARs, which may contribute to high activities. To test this hypothesis, we used a double staining technique to identify sensory receptor sizes. We labeled the sensory structure with Na(+)/K(+)-ATPase antibodies and the myelin sheath with myelin basic protein (MBP) antibodies. A SAR can be defined as the end formation beyond MBP labeling. Thus, we are able to compare sizes of sensory structures and SARs in large (trachea and bronchi) vs. small (bronchioles <500 μm in diameter) airways in the rabbit. We found that even though the sensory structure was bigger in large airways than in small airways (3340 ± 223 vs. 1168 ± 103 μm(2); P < 0.0001), there was no difference in receptor sizes (349 ± 14 vs. 326 ± 16 μm(2); > 0.05). However, the sensory structure contains more SARs in large airways than in small airways (9.6 ± 0.6 vs. 3.6 ± 0.3; P < 0.0001). Thus, our data support the hypothesis that greater numbers of SARs in sensory units of large airways may contribute to higher activities.

  12. Cleft lift procedure for pilonidal disease: technique and perioperative management.

    PubMed

    Favuzza, J; Brand, M; Francescatti, A; Orkin, B

    2015-08-01

    Pilonidal disease is a common condition affecting young patients. It is often disruptive to their lifestyle due to recurrent abscesses or chronic wound drainage. The most common surgical treatment, "cystectomy," removes useful tissue unnecessarily and does not address the etiology of the condition. Herein, we describe the etiology of pilonidal disease and our technique for definitive management of pilonidal disease using the cleft lift procedure. In this paper, we present our method of performing the cleft lift procedure for pilonidal disease including perioperative management and surgical technique. We have used the cleft lift procedure in nearly 200 patients with pilonidal disease, in both primary and salvage procedures settings. It has been equally successful in both settings with a high rate of success. It results in a closed wound with relatively minimal discomfort and straightforward wound care. We have described our current approach to recurrent and complex pilonidal disease using the cleft lift procedure. Once learned, the cleft lift procedure is a straightforward and highly successful solution to a chronic and challenging condition.

  13. Comparison of thermal management techniques for semiconductor disk lasers

    NASA Astrophysics Data System (ADS)

    Giet, S.; Kemp, A. J.; Burns, D.; Calvez, S.; Dawson, M. D.; Suomalainen, S.; Harkonen, A.; Guina, M.; Okhotnikov, O.; Pessa, M.

    2008-02-01

    Semiconductor Disk Lasers (SDLs) are compact lasers suitable for watt to multi-watt direct generation in the 670- 2350nm waveband and frequency-doubled operation in the ultraviolet and visible regions. This is, however, critically dependent on the thermal management strategy used as, in this type of laser, the pump is absorbed over micrometer lengths and the gain and loss are temperature sensitive. In this paper, we compare the two heat dissipation techniques that have been successfully deployed to-date: the "thin device" approach where the semiconductor active mirror is bonded onto a heatsink and its substrate subsequently removed, and the "heatspreader" technique where a high thermal conductivity platelet is directly bonded onto the active part of the unprocessed epilayer. We show that for SDLs emitting at 1060nm with pump spots of ~80µm diameter, the heatspreader approach outperforms the thin-device alternative, with the best results being obtained with a diamond heatspreader. Indeed, the thermal resistances are measured to be 4.9, 10.4 and 13.0 K/W for diamond-bonded, SiC-bonded and flip-chip devices respectively. It is also observed, as expected, that the thermal management strategy indirectly affects the optimum output coupling and thus the overall performance of these lasers.

  14. Use of the laryngeal mask airway for laser treatment of the subglottis.

    PubMed

    Jameson, J J; Moses, R D; Vellayappan, U; Lathi, K G

    2000-07-01

    A technique for treating subglottic lesions with the intubating laryngeal mask airway is described. It provides unhampered exposure of the subglottis and upper trachea, excellent airway control, and a means of access for ablation with flexible laser bronchoscopy.

  15. Upper airway imaging in patients with sleep-related breathing disorders.

    PubMed

    Coche, E

    2002-01-01

    This paper focuses primarily on upper airway anatomy and its variations during breathing and highlights the advantages/disadvantages of the different imaging techniques. The major indications of upper airway imaging are also discussed.

  16. Therapeutic bronchoscopic interventions for malignant airway obstruction

    PubMed Central

    Dalar, Levent; Özdemir, Cengiz; Abul, Yasin; Karasulu, Levent; Sökücü, Sinem Nedime; Akbaş, Ayşegül; Altın, Sedat

    2016-01-01

    Abstract There is no definitive consensus about the factors affecting the choice of interventional bronchoscopy in the management of malignant airway obstruction. The present study defines the choice of the interventional bronchoscopic modality and analyzes the factors influencing survival in patients with malignant central airway obstruction. Totally, over 7 years, 802 interventional rigid bronchoscopic procedures were applied in 547 patients having malignant airway obstruction. There was a significant association between the type of stent and the site of the lesion in the present study. Patients with tracheal involvement and/or involvement of the main bronchi had the worst prognosis. The sites of the lesion and endobronchial treatment modality were independent predictors of survival in the present study. The selection of different types of airway stents can be considered on the base of site of the lesion. Survival can be estimated based on the site of the lesion and endobronchial brochoscopic modality used. PMID:27281104

  17. Living with asthma and chronic obstructive airways disease: Using technology to support self-management - An overview.

    PubMed

    Morrison, Deborah; Mair, Frances S; Yardley, Lucy; Kirby, Sarah; Thomas, Mike

    2016-08-10

    Long-term respiratory conditions such as asthma and chronic obstructive pulmonary disease (COPD) are common, and cause high levels of morbidity and mortality. Supporting self-management is advocated for both asthma and increasingly so for COPD, and there is growing interest in the potential role of a range of new technologies, such as smartphone apps, the web or telehealth to facilitate and promote self-management in these conditions. Treatment goals for both asthma and COPD include aiming to control symptoms, maintain activities, achieve the best possible quality of life and minimize risks of exacerbation. To do this, health professionals should be (a) helping patients to recognize deteriorating symptoms and act appropriately; (b) promoting adherence to maintenance therapy; (c) promoting a regular review where triggers can be established, and strategies for managing such triggers discussed; and (d) promoting healthy lifestyles and positive self-management of symptoms. In particular, low uptake of asthma action plans is a modifiable contributor to morbidity and possibly also to mortality in those with asthma and should be addressed as a priority. Using technology to support self-management is an evolving strategy that shows promise. This review provides an overview of self-management support and discusses how newer technologies may help patients and health professionals to meet key treatment goals.

  18. Effects of Educational Interventions for Chronic Airway Disease on Primary Care.

    PubMed

    Lee, Jung Yeon; Yoo, Kwang Ha; Kim, Deog Kyeom; Kim, Sang-Ha; Kim, Tae-Eun; Kim, Tae-Hyung; Rhee, Chin Kook; Park, Yong Bum; Yoon, Hyoung Kyu; Yum, Ho-Kee

    2016-07-01

    Education has been known to essential for management of chronic airway diseases. However the real benefits remain unclear. We evaluated the effectiveness of an organized educational intervention for chronic airway diseases directed at primary care physicians and patients. The intervention was a 1-month education program of three visits, during which subjects were taught about their disease, an action plan in acute exacerbation and inhaler technique. Asthma control tests (ACT) for asthma and, chronic obstructive pulmonary disease (COPD) assessment tests (CAT) for COPD subjects were compared before and after education as an index of quality of life. Educational effectiveness was also measured associated with improvement of their knowledge for chronic airway disease itself, proper use of inhaler technique, and satisfaction of the subjects and clinicians before and after education. Among the 285 participants, 60.7% (n = 173) were men and the mean age was 62.2 ± 14.7. ACT for asthma and CAT in COPD patients were significantly improved by 49.7% (n = 79) and 51.2% (n = 65) more than MCID respectively after education (P < 0.05). In all individual items, knowledge about their disease, inhaler use and satisfaction of the patients and clinicians were also improved after education (P < 0.05). This study demonstrates the well-organized education program for primary care physicians and patients is a crucial process for management of chronic airway diseases.

  19. Design and Implementation of the Resuscitation Outcomes Consortium Pragmatic Airway Resuscitation Trial (PART)

    PubMed Central

    Wang, Henry E.; Prince, David; Stephens, Shannon W.; Herren, Heather; Daya, Mohamud; Richmond, Neal; Carlson, Jestin; Warden, Craig; Colella, M. Riccardo; Brienza, Ashley; Aufderheide, Tom P.; Idris, Ahamed; Schmicker, Robert; May, Susanne; Nichol, Graham

    2016-01-01

    Airway management is an important component of resuscitation from out-of-hospital cardiac arrest (OHCA). The optimal approach to advanced airway management is unknown. The Pragmatic Airway Resuscitation Trial (PART) will compare the effectiveness of endotracheal intubation (ETI) and Laryngeal Tube (LT) insertion upon 72-hour survival in adult OHCA. Encompassing United States Emergency Medical Services agencies affiliated with the Resuscitation Outcomes Consortium (ROC), PART will use a cluster-crossover randomized design. Participating subjects will include adult, non-traumatic OHCA requiring bag-valve-mask ventilation. Trial interventions will include 1) initial airway management with ETI and 2) initial airway management with LT. The primary and secondary trial outcomes are 72-hour survival and return of spontaneous circulation. Additional clinical outcomes will include airway management process and adverse events. The trial will enroll a total of 3,000 subjects. Results of PART may guide the selection of advanced airway management strategies in OHCA. PMID:26851059

  20. Introducing Risk Management Techniques Within Project Based Software Engineering Courses

    NASA Astrophysics Data System (ADS)

    Port, Daniel; Boehm, Barry

    2002-03-01

    In 1996, USC switched its core two-semester software engineering course from a hypothetical-project, homework-and-exam course based on the Bloom taxonomy of educational objectives (knowledge, comprehension, application, analysis, synthesis, and evaluation). The revised course is a real-client team-project course based on the CRESST model of learning objectives (content understanding, problem solving, collaboration, communication, and self-regulation). We used the CRESST cognitive demands analysis to determine the necessary student skills required for software risk management and the other major project activities, and have been refining the approach over the last 5 years of experience, including revised versions for one-semester undergraduate and graduate project course at Columbia. This paper summarizes our experiences in evolving the risk management aspects of the project course. These have helped us mature more general techniques such as risk-driven specifications, domain-specific simplifier and complicator lists, and the schedule as an independent variable (SAIV) process model. The largely positive results in terms of review of pass / fail rates, client evaluations, product adoption rates, and hiring manager feedback are summarized as well.

  1. Techniques for Efficiently Managing Large Geosciences Data Sets

    NASA Astrophysics Data System (ADS)

    Kruger, A.; Krajewski, W. F.; Bradley, A. A.; Smith, J. A.; Baeck, M. L.; Steiner, M.; Lawrence, R. E.; Ramamurthy, M. K.; Weber, J.; Delgreco, S. A.; Domaszczynski, P.; Seo, B.; Gunyon, C. A.

    2007-12-01

    We have developed techniques and software tools for efficiently managing large geosciences data sets. While the techniques were developed as part of an NSF-Funded ITR project that focuses on making NEXRAD weather data and rainfall products available to hydrologists and other scientists, they are relevant to other geosciences disciplines that deal with large data sets. Metadata, relational databases, data compression, and networking are central to our methodology. Data and derived products are stored on file servers in a compressed format. URLs to, and metadata about the data and derived products are managed in a PostgreSQL database. Virtually all access to the data and products is through this database. Geosciences data normally require a number of processing steps to transform the raw data into useful products: data quality assurance, coordinate transformations and georeferencing, applying calibration information, and many more. We have developed the concept of crawlers that manage this scientific workflow. Crawlers are unattended processes that run indefinitely, and at set intervals query the database for their next assignment. A database table functions as a roster for the crawlers. Crawlers perform well-defined tasks that are, except for perhaps sequencing, largely independent from other crawlers. Once a crawler is done with its current assignment, it updates the database roster table, and gets its next assignment by querying the database. We have developed a library that enables one to quickly add crawlers. The library provides hooks to external (i.e., C-language) compiled codes, so that developers can work and contribute independently. Processes called ingesters inject data into the system. The bulk of the data are from a real-time feed using UCAR/Unidata's IDD/LDM software. An exciting recent development is the establishment of a Unidata HYDRO feed that feeds value-added metadata over the IDD/LDM. Ingesters grab the metadata and populate the Postgre

  2. Fish discards management: pollution levels and best available removal techniques.

    PubMed

    Antelo, Luis T; Lopes, Carla; Franco-Uría, Amaya; Alonso, Antonio A

    2012-07-01

    Fish discards and by-catch issues are highly topical subjects that are permanently under a social focus. Two main approaches are being considered to address this discard problem: reducing the by-catch and increasing by-catch utilization. Interest in increased by-catch valorization may arise from a greater demand for fish products, such as the development of new markets for previously discarded species, the use of low-value specimens for aquaculture or the creation of value-added fish products for the food, pharmaceutical or cosmetic industries. However, contaminants present in fish discards may be transferred to their valorized products, leading to possible long-term bioaccumulation and subsequent adverse health effects. In this valorization framework, the aim is to promote responsible and sustainable management of marine resources. The pollutant levels in catches from European fisheries and the best available decontamination techniques for marine valorized discards/by-products are compiled and analyzed in this work.

  3. Role of Endoscopic Gastroplasty Techniques in the Management of Obesity

    PubMed Central

    Jung, Yunho

    2017-01-01

    Health and wellness represent a major global concern. Trends such as a lack of exercise and excessive consumption of calories are major causes of the rapid increase in obesity worldwide. Obesity should be controlled because it can result in other illnesses, such as diabetes, high blood pressure, high cholesterol, coronary artery disease, stroke, breathing disorders, or cancer. However, many people have difficulty in managing obesity through exercise, dietary control, behavioral modifications, and drug therapy. Bariatric surgery is not commonly used due to a variety of complications, even though it has been demonstrated to produce reliable results with respect to adequate weight loss when performed using an open or a laparoscopic approach. Endoscopic bariatric procedures are emerging techniques that are less invasive and safer compared with current surgical approaches. However, the evaluation of endoluminal procedures is limited by the small number of studies and their short-term follow-up. PMID:28147478

  4. Role of Endoscopic Gastroplasty Techniques in the Management of Obesity.

    PubMed

    Jung, Yunho

    2017-01-01

    Health and wellness represent a major global concern. Trends such as a lack of exercise and excessive consumption of calories are major causes of the rapid increase in obesity worldwide. Obesity should be controlled because it can result in other illnesses, such as diabetes, high blood pressure, high cholesterol, coronary artery disease, stroke, breathing disorders, or cancer. However, many people have difficulty in managing obesity through exercise, dietary control, behavioral modifications, and drug therapy. Bariatric surgery is not commonly used due to a variety of complications, even though it has been demonstrated to produce reliable results with respect to adequate weight loss when performed using an open or a laparoscopic approach. Endoscopic bariatric procedures are emerging techniques that are less invasive and safer compared with current surgical approaches. However, the evaluation of endoluminal procedures is limited by the small number of studies and their short-term follow-up.

  5. Anesthetic concerns in a huge congenital sublingual swelling obscuring airway access

    PubMed Central

    Kumar, Nilesh; Bindra, Ashish; Kumar, Niraj; Yadav, Naveen; Sharma, Shilpa

    2015-01-01

    Presence of intraoral pathology poses a great challenge during management of pediatric airway. We report management of big intraoral cystic swelling physically occupying the entire oral cavity restricting access to airway. Preintubation aspiration of swelling was done to decrease its size and make room for airway manipulation, followed by laryngoscopy and intubation in lateral position. Airway patency is at risk in postoperative period also, in this case, though the swelling decreased in size postoperatively but presence of significant edema required placement of tongue stitch and modified nasopharyngeal airway. Case report highlights simple maneuvers to manage a difficult case. PMID:25829912

  6. Crop management techniques to enhance harvest index in rice.

    PubMed

    Yang, Jianchang; Zhang, Jianhua

    2010-07-01

    A major challenge in rice (Oryza sativa L.) production is to enhance water use efficiency (WUE) and maintain or even increase grain yield. WUE, if defined as the biomass accumulation over water consumed, may be fairly constant for a given species in given climate. WUE can be enhanced by less irrigation. However, such enhancement is largely a trade-off against lower biomass production. If WUE is defined as the grain production per unit amount of water irrigated, it would be possible to increase WUE without compromising grain yield through the manipulation of harvest index. Harvest index has been shown to be a variable factor in crop production, and in many situations, it is closely associated with WUE and grain yield in cereals. Taking rice as an example, this paper discussed crop management techniques that can enhance harvest index. Several practices such as post-anthesis controlled soil drying, alternate wetting and moderate soil drying regimes during the whole growing season, and non-flooded straw mulching cultivation, could substantially enhance WUE and maintain or even increase grain yield of rice, mainly via improved canopy structure, source activity, sink strength, and enhanced remobilization of pre-stored carbon reserves from vegetative tissues to grains. All the work has proved that a proper crop management holds great promise to enhance harvest index and, consequently, achieve the dual goal of increasing grain production and saving water.

  7. Translocations of amphibians: Proven management method or experimental technique

    USGS Publications Warehouse

    Seigel, Richard A.; Dodd, C. Kenneth

    2002-01-01

    In an otherwise excellent review of metapopulation dynamics in amphibians, Marsh and Trenham (2001) make the following provocative statements (emphasis added): If isolation effects occur primarily in highly disturbed habitats, species translocations may be necessary to promote local and regional population persistence. Because most amphibians lack parental care, they areprime candidates for egg and larval translocations. Indeed, translocations have already proven successful for several species of amphibians. Where populations are severely isolated, translocations into extinct subpopulations may be the best strategy to promote regional population persistence. We take issue with these statements for a number of reasons. First, the authors fail to cite much of the relevant literature on species translocations in general and for amphibians in particular. Second, to those unfamiliar with current research in amphibian conservation biology, these comments might suggest that translocations are a proven management method. This is not the case, at least in most instances where translocations have been evaluated for an appropriate period of time. Finally, the authors fail to point out some of the negative aspects of species translocation as a management method. We realize that Marsh and Trenham's paper was not concerned primarily with translocations. However, because Marsh and Trenham (2001) made specific recommendations for conservation planners and managers (many of whom are not herpetologists or may not be familiar with the pertinent literature on amphibians), we believe that it is essential to point out that not all amphibian biologists are as comfortable with translocations as these authors appear to be. We especially urge caution about advocating potentially unproven techniques without a thorough review of available options.

  8. Surgical Tips in Frozen Abdomen Management: Application of Coliseum Technique.

    PubMed

    Kyriazanos, Ioannis D; Manatakis, Dimitrios K; Stamos, Nikolaos; Stoidis, Christos

    2015-01-01

    Wound dehiscence is a serious postoperative complication, with an incidence of 0.5-3% after primary closure of a laparotomy incision, and represents an acute mechanical failure of wound healing. Relatively recently the concept of "intentional open abdomen" was described and both clinical entities share common pathophysiological and clinical pathways ("postoperative open abdominal wall"). Although early reconstruction is the target, a significant proportion of patients will develop adhesions between abdominal viscera and the anterolateral abdominal wall, a condition widely recognized as "frozen abdomen," where delayed wound closure appears as the only realistic alternative. We report our experience with a patient who presented with frozen abdomen after wound dehiscence due to surgical site infection and application of the "Coliseum technique" for its definitive surgical management. This novel technique represents an innovative alternative to abdominal exploration, for cases of "malignant" frozen abdomen due to peritoneal carcinomatosis. Lifting the edges of the surgical wound upwards and suspending them under traction by threads from a retractor positioned above the abdomen facilitates approach to the peritoneal cavity, optimizes exposure of intra-abdominal organs, and prevents operative injury to the innervation and blood supply of abdominal wall musculature, a crucial step for subsequent hernia repair.

  9. Architectural Techniques For Managing Non-volatile Caches

    SciTech Connect

    Mittal, Sparsh

    2013-01-01

    As chip power dissipation becomes a critical challenge in scaling processor performance, computer architects are forced to fundamentally rethink the design of modern processors and hence, the chip-design industry is now at a major inflection point in its hardware roadmap. The high leakage power and low density of SRAM poses serious obstacles in its use for designing large on-chip caches and for this reason, researchers are exploring non-volatile memory (NVM) devices, such as spin torque transfer RAM, phase change RAM and resistive RAM. However, since NVMs are not strictly superior to SRAM, effective architectural techniques are required for making them a universal memory solution. This book discusses techniques for designing processor caches using NVM devices. It presents algorithms and architectures for improving their energy efficiency, performance and lifetime. It also provides both qualitative and quantitative evaluation to help the reader gain insights and motivate them to explore further. This book will be highly useful for beginners as well as veterans in computer architecture, chip designers, product managers and technical marketing professionals.

  10. FAMM Flap in Reconstructing Postsurgical Nasopharyngeal Airway Stenosis

    PubMed Central

    Nangole, Ferdinand Wanjala; Khainga, Stanley Ominde

    2014-01-01

    Introduction. Postsurgical nasopharyngeal airway stenosis can be a challenge to manage. The stenosis could be as a result of any surgical procedure in the nasopharyngeal region that heals extensive scarring and fibrosis. Objective. To evaluate patients with nasopharyngeal stenosis managed with FAMM flap. Study Design. Prospective study of patients with nasopharyngeal stenosis at the Kenyatta National Hospital between 2010 and 2013 managed with FAMM flap. Materials and Methods. Patients with severe nasopharyngeal airway stenosis were reviewed and managed with FAMM flaps at the Kenyatta National Hospital. Postoperatively they were assessed for symptomatic improvement in respiratory distress, patency of the nasopharyngeal airway, and donor site morbidity. Results. A total of 8 patients were managed by the authors in a duration of 4 years with nasopharyngeal stenosis. Five patients were managed with unilateral FAMM flaps in a two-staged surgical procedure. Four patients had complete relieve of the airway obstruction with a patent airway created. One patient had a patent airway created though with only mild improvement in airway obstruction. Conclusion. FAMM flap provides an alternative in the management of postsurgical severe nasopharyngeal stenosis. It is a reliable flap that is easy to raise and could provide adequate epithelium for the stenosed pharynx. PMID:25328699

  11. Multidetector computed tomography of pediatric large airway diseases: state-of-the-art.

    PubMed

    Lee, Edward Y; Greenberg, S Bruce; Boiselle, Phillip M

    2011-09-01

    Advances in multidetector computed tomography (MDCT) technology have given rise to improvements in the noninvasive and comprehensive assessment of the large airways in pediatric patients. Superb two-dimensional and three-dimensional reconstruction MDCT images have revolutionized the display of large airways and enhanced the ability to diagnose large airway diseases in children. The 320-MDCT scanner, which provides combined detailed anatomic and dynamic functional information assessment of the large airways, is promising for the assessment of dynamic large airway disease such as tracheobronchomalacia. This article discusses imaging techniques and clinical applications of MDCT for assessing large airway diseases in pediatric patients.

  12. Machine Learning Techniques for Decision Support in Intelligent Data Management

    NASA Astrophysics Data System (ADS)

    Lynnes, C.; Miller, J.; Ramapriyan, H.; Isaac, D.; Harberts, R.

    2002-12-01

    NASA's growth in remote sensing data volumes has kept pace with Moore's Law, i.e., doubling every 18 months, with future growth likely from new instruments. Also, advances in instrumental design (e.g., hyperspectral scanners) and science algorithms are enabling more near-real-time applications of the data. The confluence of low-latency requirements with high data volumes and numbers of files poses major challenges for archive data management. In order to make the right data available at the right time, an archive will need to apply knowledge of the data content in its data management decisions. This decision support domain includes aspects such as automatic quality assessment, feature detection to support caching decisions, and content-based metadata to support efficient data selection. In this study, we evaluate a variety of machine learning algorithms for use in several decision support roles in intelligent data management. Machine learning algorithms such as neural networks and clustering have been used for decision support in business and policy domains. These techniques have found some use in remote sensing, e.g., for cloud and land cover classification. Yet most research on remote sensing data rests on science-based algorithms, such as those based on radiative transfer equations. Machine learning for scientific applications faces challenges such as discretization constraints, non-physical basis, and the difficulty of assembling training sets. However, these difficulties may be less significant in the decision support role. For instance, it is often enough to know whether a data attribute exceeds a certain threshold when selecting it for an application, without knowing the exact value. The training data problem can be surmounted by using products output by the science-based algorithms. On the other hand, an advantage of machine learning algorithms for decision support is their speed once they have been trained. Data management decisions must be made while the

  13. Autonomous management of distributed information systems using evolutionary computation techniques

    NASA Astrophysics Data System (ADS)

    Oates, Martin J.

    1999-03-01

    As the size of typical industrial strength information systems continues to rise, particularly in the arena of Internet based management information systems and multimedia servers, the issue of managing data distribution over clusters or `farms' to overcome performance and scalability issues is becoming of paramount importance. Further, where access is global, this can cause points of geographically localized load contention to `follow the sun' during the day. Traditional site mirroring is not overly effective in addressing this contention and so a more dynamic approach is being investigated to tackle load balancing. The general objective is to manage a self-adapting, distributed database so as to reliably and consistently provide near optimal performance as perceived by client applications. Such a management system must be ultimately capable of operating over a range of time varying usage profiles and fault scenarios, incorporate considerations for communications network delays, multiple updates and maintenance operations. It must also be shown to be capable of being scaled in a practical fashion to ever larger sized networks and databases. Two key components of such an automated system are an optimiser capable of efficiently finding new configuration options, and a suitable model of the system capable of accurately reflecting the performance (or any other required quality of service metric) of the real world system. As conditions change in the real world system, these are fed into the model. The optimiser is then run to find new configurations which are tested in the model prior to implementation in the real world. The model therefore forms an evaluation function which the optimiser utilises to direct its search. Whilst it has already been shown that Genetic Algorithms can provide good solutions to this problem, there are a number of issues associated with this approach. In particular, for industrial strength applications, it must be shown that the GA employed

  14. High-resolution airway morphometry from polyurethane casts

    NASA Astrophysics Data System (ADS)

    Neufeld, Gordon R.; Vargas, John; Hoford, John D.; Craft, Jeanne; Shroff, Sunil; McRae, Karen M.

    1995-05-01

    An airway cast was made and imbedded in a solid polyurethane block of a contrasting color. The block was sequentially milled and photographed. The sequential photographs were scanned to create an image database which was analyzed on VIDA; a multidimensional image analysis software package. The technique shows promise as a semi-automated process for generating a high resolution morphometric database from airway casts.

  15. An evolutionary outlook of air traffic flow management techniques

    NASA Astrophysics Data System (ADS)

    Kistan, Trevor; Gardi, Alessandro; Sabatini, Roberto; Ramasamy, Subramanian; Batuwangala, Eranga

    2017-01-01

    In recent years Air Traffic Flow Management (ATFM) has become pertinent even in regions without sustained overload conditions caused by dense traffic operations. Increasing traffic volumes in the face of constrained resources has created peak congestion at specific locations and times in many areas of the world. Increased environmental awareness and economic drivers have combined to create a resurgent interest in ATFM as evidenced by a spate of recent ATFM conferences and workshops mediated by official bodies such as ICAO, IATA, CANSO the FAA and Eurocontrol. Significant ATFM acquisitions in the last 5 years include South Africa, Australia and India. Singapore, Thailand and Korea are all expected to procure ATFM systems within a year while China is expected to develop a bespoke system. Asia-Pacific nations are particularly pro-active given the traffic growth projections for the region (by 2050 half of all air traffic will be to, from or within the Asia-Pacific region). National authorities now have access to recently published international standards to guide the development of national and regional operational concepts for ATFM, geared to Communications, Navigation, Surveillance/Air Traffic Management and Avionics (CNS+A) evolutions. This paper critically reviews the field to determine which ATFM research and development efforts hold the best promise for practical technological implementations, offering clear benefits both in terms of enhanced safety and efficiency in times of growing air traffic. An evolutionary approach is adopted starting from an ontology of current ATFM techniques and proceeding to identify the technological and regulatory evolutions required in the future CNS+A context, as the aviation industry moves forward with a clearer understanding of emerging operational needs, the geo-political realities of regional collaboration and the impending needs of global harmonisation.

  16. Percutaneous endoscopic gastrostomy: Indications, technique, complications and management

    PubMed Central

    Rahnemai-Azar, Ata A; Rahnemaiazar, Amir A; Naghshizadian, Rozhin; Kurtz, Amparo; Farkas, Daniel T

    2014-01-01

    Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition. Besides its well-known advantages over parenteral nutrition, PEG offers superior access to the gastrointestinal system over surgical methods. Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide, knowing its indications and contraindications is of paramount importance in current medicine. PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish. Broadly, the two main indications of PEG tube placement are enteral feeding and stomach decompression. On the other hand, distal enteral obstruction, severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients. Although generally considered to be a safe procedure, there is the potential for both minor and major complications. Awareness of these potential complications, as well as understanding routine aftercare of the catheter, can improve the quality of care for patients with a PEG tube. These complications can generally be classified into three major categories: endoscopic technical difficulties, PEG procedure-related complications and late complications associated with PEG tube use and wound care. In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance. Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the “pull” technique being the most common method. In the last section of this review, the reader is presented with a brief discussion of these procedures, techniques and related issues

  17. Percutaneous endoscopic gastrostomy: indications, technique, complications and management.

    PubMed

    Rahnemai-Azar, Ata A; Rahnemaiazar, Amir A; Naghshizadian, Rozhin; Kurtz, Amparo; Farkas, Daniel T

    2014-06-28

    Percutaneous endoscopic gastrostomy (PEG) is the preferred route of feeding and nutritional support in patients with a functional gastrointestinal system who require long-term enteral nutrition. Besides its well-known advantages over parenteral nutrition, PEG offers superior access to the gastrointestinal system over surgical methods. Considering that nowadays PEG tube placement is one of the most common endoscopic procedures performed worldwide, knowing its indications and contraindications is of paramount importance in current medicine. PEG tubes are sometimes placed inappropriately in patients unable to tolerate adequate oral intake because of incorrect and unrealistic understanding of their indications and what they can accomplish. Broadly, the two main indications of PEG tube placement are enteral feeding and stomach decompression. On the other hand, distal enteral obstruction, severe uncorrectable coagulopathy and hemodynamic instability constitute the main absolute contraindications for PEG tube placement in hospitalized patients. Although generally considered to be a safe procedure, there is the potential for both minor and major complications. Awareness of these potential complications, as well as understanding routine aftercare of the catheter, can improve the quality of care for patients with a PEG tube. These complications can generally be classified into three major categories: endoscopic technical difficulties, PEG procedure-related complications and late complications associated with PEG tube use and wound care. In this review we describe a variety of minor and major tube-related complications as well as strategies for their management and avoidance. Different methods of percutaneous PEG tube placement into the stomach have been described in the literature with the "pull" technique being the most common method. In the last section of this review, the reader is presented with a brief discussion of these procedures, techniques and related issues

  18. Project TEAMS (Techniques and Education for Achieving Management Skills): Business and Industrial Supervisors.

    ERIC Educational Resources Information Center

    Platte Technical Community Coll., Columbus, NE.

    These Project TEAMS (Techniques and Education for Achieving Management Skills) instructional materials consist of five units for use in training business and industrial supervisors. Unit 1 is designed to help managers in business or industry increase management skills in regard to leadership techniques, problem solving and decision making, and…

  19. Injection techniques in the management of local pain.

    PubMed

    Fischer, A A

    1996-01-01

    This is a review of local anesthetic (LA) injections and infiltrations particularly combined with 'needling' for management of local musculoskeletal pain. New techniques are described including preinjection blocks (PIBs) which consist of blocking the sensory input from an area prior to giving an injection. PIBs prevent pain which would be caused by needle penetration of sensitive tissue. Needling and infiltration (N and I) with 1% lidocaine has been performed after PIB in 179 tender spots (TSs), trigger points (TrPs), and muscle spasms by the author, in 123 patients with the goal to relieve pain and promote healing. The immediate effect after the procedure as well as long-term results from 1 week to 7 months have been evaluated independently by a physiatrist experienced with injections (Dr. Tae Mo Chang). N and I extending over the entire taut band of abnormal muscle fibers, caused effective relief of pain and functional improvement in tender spots (TSs), trigger points (TrPs) and in muscle spasm caused by a variety of conditions including: acute and chronic sports and work injuries, motor vehicle accidents, muscle and ligament sprains (supraspinous, sacroiliac), overuse and repetitive stress syndromes, tennis elbow; local injuries or radicular irritation; and local inflammations such as bursitis, tendinitis, and osteoarthritis; and traumatic dystrophy, a type of reflex sympathetic dystrophy. Needling and infiltration of trigger areas and tender spots is effective treatment in several conditions. Pre-injection blocks allow the performance of the N and I of tender areas without pain.

  20. Intrathoracic airway wall detection using graph search and scanner PSF information

    NASA Astrophysics Data System (ADS)

    Reinhardt, Joseph M.; Park, Wonkyu; Hoffman, Eric A.; Sonka, Milan

    1997-05-01

    Measurements of the in vivo bronchial tree can be used to assess regional airway physiology. High-resolution CT (HRCT) provides detailed images of the lungs and has been used to evaluate bronchial airway geometry. Such measurements have been sued to assess diseases affecting the airways, such as asthma and cystic fibrosis, to measure airway response to external stimuli, and to evaluate the mechanics of airway collapse in sleep apnea. To routinely use CT imaging in a clinical setting to evaluate the in vivo airway tree, there is a need for an objective, automatic technique for identifying the airway tree in the CT images and measuring airway geometry parameters. Manual or semi-automatic segmentation and measurement of the airway tree from a 3D data set may require several man-hours of work, and the manual approaches suffer from inter-observer and intra- observer variabilities. This paper describes a method for automatic airway tree analysis that combines accurate airway wall location estimation with a technique for optimal airway border smoothing. A fuzzy logic, rule-based system is used to identify the branches of the 3D airway tree in thin-slice HRCT images. Raycasting is combined with a model-based parameter estimation technique to identify the approximate inner and outer airway wall borders in 2D cross-sections through the image data set. Finally, a 2D graph search is used to optimize the estimated airway wall locations and obtain accurate airway borders. We demonstrate this technique using CT images of a plexiglass tube phantom.

  1. Emergency surgical airway in life-threatening acute airway emergencies--why are we so reluctant to do it?

    PubMed

    Greenland, K B; Acott, C; Segal, R; Goulding, G; Riley, R H; Merry, A F

    2011-07-01

    'Can't intubate, can't oxygenate' scenarios are rare but are often poorly managed, with potentially disastrous consequences. In our opinion, all doctors should be able to create a surgical airway if necessary. More practically, at least all anaesthetists should have this ability. There should be a change in culture to one that encourages and facilitates the performance of a life-saving emergency surgical airway when required. In this regard, an understanding of the human factors that influence the decision to perform an emergency surgical airway is as important as technical skill. Standardisation of difficult airway equipment in areas where anaesthesia is performed is a step toward ensuring that an emergency surgical airway will be performed appropriately Information on the incidence and clinical management of 'can't intubate, can't oxygenate' scenarios should be compiled through various sources, including national coronial inquest databases and anaesthetic critical incident reporting systems. A systematic approach to teaching and maintaining human factors in airway crisis management and emergency surgical airway skills to anaesthetic trainees and specialists should be developed: in our opinion participation should be mandatory. Importantly, the view that performing an emergency surgical airway is an admission of anaesthetist failure should be strongly countered.

  2. Quantitative computed tomography imaging of airway remodeling in severe asthma

    PubMed Central

    Fetita, Catalin I.; Brillet, Pierre-Yves

    2016-01-01

    Asthma is a heterogeneous condition and approximately 5–10% of asthmatic subjects have severe disease associated with structure changes of the airways (airway remodeling) that may develop over time or shortly after onset of disease. Quantitative computed tomography (QCT) imaging of the tracheobronchial tree and lung parenchyma has improved during the last 10 years, and has enabled investigators to study the large airway architecture in detail and assess indirectly the small airway structure. In severe asthmatics, morphologic changes in large airways, quantitatively assessed using 2D-3D airway registration and recent algorithms, are characterized by airway wall thickening, luminal narrowing and bronchial stenoses. Extent of expiratory gas trapping, quantitatively assessed using lung densitometry, may be used to assess indirectly small airway remodeling. Investigators have used these quantitative imaging techniques in order to attempt severity grading of asthma, and to identify clusters of asthmatic patients that differ in morphologic and functional characteristics. Although standardization of image analysis procedures needs to be improved, the identification of remodeling pattern in various phenotypes of severe asthma and the ability to relate airway structures to important clinical outcomes should help target treatment more effectively. PMID:26981458

  3. Quantitative computed tomography imaging of airway remodeling in severe asthma.

    PubMed

    Grenier, Philippe A; Fetita, Catalin I; Brillet, Pierre-Yves

    2016-02-01

    Asthma is a heterogeneous condition and approximately 5-10% of asthmatic subjects have severe disease associated with structure changes of the airways (airway remodeling) that may develop over time or shortly after onset of disease. Quantitative computed tomography (QCT) imaging of the tracheobronchial tree and lung parenchyma has improved during the last 10 years, and has enabled investigators to study the large airway architecture in detail and assess indirectly the small airway structure. In severe asthmatics, morphologic changes in large airways, quantitatively assessed using 2D-3D airway registration and recent algorithms, are characterized by airway wall thickening, luminal narrowing and bronchial stenoses. Extent of expiratory gas trapping, quantitatively assessed using lung densitometry, may be used to assess indirectly small airway remodeling. Investigators have used these quantitative imaging techniques in order to attempt severity grading of asthma, and to identify clusters of asthmatic patients that differ in morphologic and functional characteristics. Although standardization of image analysis procedures needs to be improved, the identification of remodeling pattern in various phenotypes of severe asthma and the ability to relate airway structures to important clinical outcomes should help target treatment more effectively.

  4. Severe micrognathia: indications for EXIT-to-Airway.

    PubMed

    Morris, Lee M; Lim, Foong-Yen; Elluru, Ravindhra G; Hopkin, Robert J; Jaekle, Ronald K; Polzin, William J; Crombleholme, Timothy M

    2009-01-01

    The ex utero intrapartum treatment (EXIT) procedure has become an important management option in cases of fetal airway obstruction. Select cases of severe micrognathia may be candidates for EXIT-to-Airway due to high-risk of airway obstruction at birth. Here we present three successful EXIT-to-Airway procedures for the management of congenital micrognathia in its most severe manifestations. CASE 1: A 23-year-old G3P1011 with a pregnancy complicated by severe micorgnathia, jaw index <5th percentile, as well as polyhydramnios. At 36 weeks EXIT-to-Airway was performed utilizing a bronchoscopically positioned laryngeal mask airway (LMA) during 23 min of uteroplacental support followed by tracheostomy. CASE 2: A 26-year-old G4P0120 with a pregnancy complicated by severe micrognathia, jaw index <5th percentile, and an obstructed oropharynx associated with polyhydramnios. At 37 weeks EXIT-to-Airway was performed with placement of tracheostomy. CASE 3: A 36-year-old G6P3023 with fetal magnetic resonance imaging (MRI) revealing esophageal atresia, polyhydramnios, and severe micrognathia with a jaw index <5th percentile. At 35 weeks the patient underwent EXIT-to-Airway with formal tracheostomy during 35 min of uteroplacental bypass. In the most severe cases of fetal micrognathia, EXIT-to-Airway provides time to evaluate and secure the fetal airway prior to delivery. We propose indications for EXIT-to-Airway in micrognathia to include a jaw index <5%, with indirect evidence of aerodigestive tract obstruction such as polyhydramnios, glossoptosis or an absent stomach bubble.

  5. Technical management techniques for identification and control of industrial safety and pollution hazards

    NASA Technical Reports Server (NTRS)

    Campbell, R.; Dyer, M. K.; Hoard, E. G.; Little, D. G.; Taylor, A. C.

    1972-01-01

    Constructive recommendations are suggested for pollution problems from offshore energy resources industries on outer continental shelf. Technical management techniques for pollution identification and control offer possible applications to space engineering and management.

  6. An institutional approach to the management of the 'Can't Intubate, Can't Oxygenate' emergency in children.

    PubMed

    Sabato, Stefano C; Long, Elliot

    2016-08-01

    The 'Can't Intubate Can't Oxygenate' emergency is rare in children. Nevertheless, airway clinicians involved in pediatric airway management must be able to rescue the airway percutaneously through the front of the neck should this situation be encountered. Little evidence exists in children to guide rescue techniques, and extrapolation of adult evidence may be problematic due to anatomical differences. This document reviews the currently available evidence, and presents a practical approach to standardizing equipment, techniques, and training for managing the 'Can't Intubate Can't Oxygenate' emergency in children.

  7. [Use of ProSeal laryngeal mask airway in a patient with spontaneous ventilation for anesthetic management in off-pump coronary artery bypass grafting by lower-end sternal splitting approach].

    PubMed

    Matsumoto, Kappei

    2006-10-01

    Use of the laryngeal mask airway in off-pump coronary artery bypass grafting is controversial, largely because of a concern about increased risk for derangement in pulmonary mechanics. The author used the ProSeal LMA in a patient with spontaneous respiration for anesthetic management of off-pump coronary artery bypass grafting by the lower-end sternal splitting approach. There were no critical hypercapnea, hypoxia, ventilatory problems and pulmonary hypertension. This method provided suitable conditions for maintenance and emergence of anesthesia, providing shorter stay of less than 22 hours in ICU.

  8. Computed tomography of nonanesthetized cats with upper airway obstruction.

    PubMed

    Stadler, Krystina; O'Brien, Robert

    2013-01-01

    Upper airway obstruction is a potentially life-threatening problem in cats and for which a noninvasive, sensitive method rapid diagnosis is needed. The purposes of this prospective study were to describe a computed tomography (CT) technique for nonanesthetized cats with upper airway obstruction, CT characteristics of obstructive diseases, and comparisons between CT findings and findings from other diagnostic tests. Ten cats with clinical signs of upper airway obstruction were recruited for the study. Four cats with no clinical signs of upper airway obstruction were recruited as controls. All cats underwent computed tomography imaging without sedation or anesthesia, using a 16-slice helical CT scanner and a previously described transparent positional device. Three-dimensional (3D) internal volume rendering was performed on all CT image sets and 3D external volume rendering was also performed on cats with evidence of mass lesions. Confirmation of upper airway obstruction was based on visual laryngeal examination, endoscopy, fine-needle aspirate, biopsy, or necropsy. Seven cats were diagnosed with intramural upper airway masses, two with laryngotracheitis, and one with laryngeal paralysis. The CT and 3D volume-rendered images identified lesions consistent with upper airway disease in all cats. In cats with mass lesions, CT accurately identified the mass and location. Findings from this study supported the use of CT imaging as an effective technique for diagnosing upper airway obstruction in nonanesthetized cats.

  9. Airway responsiveness to psychological processes in asthma and health

    PubMed Central

    Ritz, Thomas

    2012-01-01

    Psychosocial factors have been found to impact airway pathophysiology in respiratory disease with considerable consistency. Influences on airway mechanics have been studied particularly well. The goal of this article is to review the literature on airway responses to psychological stimulation, discuss potential pathways of influence, and present a well-established emotion-induction paradigm to study airway obstruction elicited by unpleasant stimuli. Observational studies have found systematic associations between lung function and daily mood changes. The laboratory-based paradigm of bronchoconstrictive suggestion has been used successfully to elicit airway obstruction in a substantial proportion of asthmatic individuals. Other studies have demonstrated modulation of airway responses to standard airway challenges with exercise, allergens, or pharmacological agents by psychological factors. Standardized emotion-induction techniques have consistently shown airway constriction during unpleasant stimulation, with surgery, blood, and injury stimuli being particularly powerful. Findings with various forms of stress induction have been more mixed. A number of methodological factors may account for variability across studies, such as choice of measurement technique, temporal association between stimulation and measurement, and the specific quality and intensity of the stimulus material, in particular the extent of implied action-orientation. Research has also begun to elucidate physiological processes associated with psychologically induced airway responses, with vagal excitation and ventilatory influences being the most likely candidate pathways, whereas the role of specific central nervous system pathways and inflammatory processes has been less studied. The technique of emotion-induction using films has the potential to become a standardized challenge paradigm for the further exploration of airway hyperresponsiveness mediated by central nervous system processes. PMID

  10. What does airway resistance tell us about lung function?

    PubMed

    Kaminsky, David A

    2012-01-01

    Spirometry is considered the primary method to detect the air flow limitation associated with obstructive lung disease. However, air flow limitation is the end-result of many factors that contribute to obstructive lung disease. One of these factors is increased airway resistance. Airway resistance is traditionally measured by relating air flow and driving pressure using body plethysmography, thus deriving airway resistance (R(aw)), specific airway resistance (sR(aw)), and specific airway conductance (sG(aw)). Other methods to measure airway resistance include the forced oscillation technique (FOT), which allows calculation of respiratory system resistance (R(RS)) and reactance (X(RS)), and the interrupter technique, which allows calculation of interrupter resistance (R(int)). An advantage of these other methods is that they may be easier to perform than spirometry, making them particularly suited to patients who cannot perform spirometry, such as young children, patients with neuromuscular disorders, or patients on mechanical ventilation. Since spirometry also requires a deep inhalation, which can alter airway resistance, these alternative methods may provide more sensitive measures of airway resistance. Furthermore, the FOT provides unique information about lung mechanics that is not available from analysis using spirometry, body plethysmography, or the interrupter technique. However, it is unclear whether any of these measures of airway resistance contribute clinically important information to the traditional measures derived from spirometry (FEV(1), FVC, and FEV(1)/FVC). The purpose of this paper is to review the physiology and methodology of these measures of airway resistance, and then focus on their clinical utility in relation to each other and to spirometry.

  11. Jihadist Terrorist Use of Strategic Communication Management Techniques

    DTIC Science & Technology

    2008-12-01

    terrorism studies, defense planning, arms control, peacekeeping, crisis management, regional and cooperative security. The Marshall Center...and with our partners and allies, to harmonize international efforts in the global war on terror within a grand strategy ( Opheim & Bowen 2008). This...Perceptions and the Future Perspectives of Strategic Information Management. The Development of Crisis Communication from the Kosovo Operation “Allied

  12. Utilizing Project Management Techniques in the Design of Instructional Materials.

    ERIC Educational Resources Information Center

    Murphy, Charles

    1994-01-01

    Discussion of instructional design in large organizations highlights a project management approach. Topics addressed include the role of the instructional designer; project team selection; role of the team members; role of the project manager; focusing on what employees need to know; types of project teams; and monitoring time and responsibility.…

  13. The difficult airway: mechanisms for effective dissemination of critical information.

    PubMed

    Mark, L J; Beattie, C; Ferrell, C L; Trempy, G; Dorman, T; Schauble, J F

    1992-01-01

    The perioperative management and dissemination of critical information regarding a patient with an unexpected difficult intubation, including successful application of a difficult airway algorithm (Figure 1), are described. Documentation and dissemination of critical information include entry of patient data into an in-hospital computerized Difficult Airway/Intubation Registry, simultaneous application of a highly visible Difficult Airway/Intubation Patient Wrist Band (coded for access to computer registry), summary reports distributed to health care providers, and enrollment of the patient in the Medic Alert Foundation International's newly established category difficult airway/intubation for 24-hour access. We postulate that the widespread use of the procedures described in this report may reduce the contribution of unexpected difficult airway/intubation to anesthetic morbidity and mortality.

  14. Software-Enabled Project Management Techniques and Their Relationship to the Triple Constraints

    ERIC Educational Resources Information Center

    Elleh, Festus U.

    2013-01-01

    This study investigated the relationship between software-enabled project management techniques and the triple constraints (time, cost, and scope). There was the dearth of academic literature that focused on the relationship between software-enabled project management techniques and the triple constraints (time, cost, and scope). Based on the gap…

  15. Predicting Student Misbehavior, Responsibility and Distraction from Schoolwork from Classroom Management Techniques: The Students' Views

    ERIC Educational Resources Information Center

    Tran, Van Dat

    2015-01-01

    This study reports students' perceptions of the classroom management techniques utilized in fourteen classrooms at eight junior high schools in one province in Vietnam. It examines data from 498 students in fifteen high schools in one district in Vietnam in grades 10 to 12 to identify how teachers' use of various management techniques, and the…

  16. Comprehensive and Conservative Management of Talon Cusp: A New Technique

    PubMed Central

    Lodha, Surendra

    2016-01-01

    Talon cusp is a common dental anomaly affecting maxillary central incisors. Gradual grinding of this additional cusp is commonly followed now. Advocated below is a new technique explaining the use of air abrasion and putty index during the stepwise reduction of the cusp. The technique is advantageous in preventing patient discomfort and tracking the amount of reduction in a predictable way. PMID:28105377

  17. An anterior mediastinal mass: delayed airway compression and using a double lumen tube for airway patency.

    PubMed

    Lee, Jeounghyuk; Rim, Yong Chul; In, Junyong

    2014-06-01

    Perioperative management of patients with an anterior mediastinal mass is difficult. We present a 35-year-old woman who showed delayed compression of the carina and left main bronchus despite no preoperative respiratory signs, symptoms, or radiologic findings due to an anterior mediastinal mass and uneventful stepwise induction of general anesthesia. Even use of a fiberoptic bronchoscope (FB) after induction of anesthesia was not helpful to predict delayed compression of the airway. Therefore, the anesthesiologist and the cardiothoracic surgeon must prepare for unexpected delayed compression of the airway, even in low risk patients who are asymptomatic or mildly symptomatic without postural symptoms or radiographic evidence of significant compression of structures. We also describe successful management for the compressed carina and left main bronchus with a double lumen tube (DLT) as a stent during surgery. FB guided DLT intubation is a possible solution to maintain airway patency.

  18. Study of systems and techniques for data base management

    NASA Technical Reports Server (NTRS)

    1976-01-01

    Data management areas were studied to identify pertinent problems and issues that will affect future NASA data users in terms of performance and cost. Specific topics discussed include the identifications of potential NASA data users other than those normally discussed, consideration affecting the clustering of minicomputers, low cost computer system for information retrieval and analysis, the testing of minicomputer based data base management systems, ongoing work related to the use of dedicated systems for data base management, and the problems of data interchange among a community of NASA data users.

  19. Integrating RFID technique to design mobile handheld inventory management system

    NASA Astrophysics Data System (ADS)

    Huang, Yo-Ping; Yen, Wei; Chen, Shih-Chung

    2008-04-01

    An RFID-based mobile handheld inventory management system is proposed in this paper. Differing from the manual inventory management method, the proposed system works on the personal digital assistant (PDA) with an RFID reader. The system identifies electronic tags on the properties and checks the property information in the back-end database server through a ubiquitous wireless network. The system also provides a set of functions to manage the back-end inventory database and assigns different levels of access privilege according to various user categories. In the back-end database server, to prevent improper or illegal accesses, the server not only stores the inventory database and user privilege information, but also keeps track of the user activities in the server including the login and logout time and location, the records of database accessing, and every modification of the tables. Some experimental results are presented to verify the applicability of the integrated RFID-based mobile handheld inventory management system.

  20. Management of excessive movable tissue: a modified impression technique.

    PubMed

    Shum, Michael H C; Pow, Edmond H N

    2014-08-01

    Excessive movable tissue is a challenge in complete denture prosthetics. A modified impression technique is presented with polyvinyl siloxane impression material and a custom tray with relief areas and perforations in the area of the excessive movable tissue.

  1. Magnamosis: a novel technique for the management of rectal atresia

    PubMed Central

    Russell, Katie W; Rollins, Michael D; Feola, G Peter; Scaife, Eric R

    2014-01-01

    We report a case of rectal atresia treated using magnets to create a rectal anastomosis. This minimally invasive technique is straightforward and effective for the treatment of rectal atresia in children. PMID:25096648

  2. Research to Develop Effective Teaching and Management Techniques for Severely Disturbed and Retarded Children. Final Report.

    ERIC Educational Resources Information Center

    Kauffman, James M.; Birnbrauer, Jay S.

    The final report of a project on teaching and management techniques with severely disturbed and/or retarded children presents analysis of single subject research using contingent imitation of the child as an intervention technique. The effects of this technique were examined on the following behaviors: toyplay and reciprocal imitation, self…

  3. Surgical management of metastatic long bone fractures: principles and techniques.

    PubMed

    Scolaro, John Alan; Lackman, Richard D

    2014-02-01

    Management of metastatic long bone fractures requires identification of the lesion and the use of sound fracture fixation principles to relieve pain and restore function. The treating surgeon must understand the principles of pathologic fracture fixation before initiating treatment. Because these fractures occur in the context of a progressive systemic disease, management typically involves a multidisciplinary approach. When considering surgical stabilization of these fractures, the abnormal (or absent) healing environment associated with diseased bone and the overall condition of the patient must be taken into account. The goal of surgery is to obtain a rigid mechanical construct, which allows for early mobility and weight bearing. This can be achieved using internal fixation with polymethyl methacrylate cement or segmental resection and joint reconstruction. Prosthetic joint arthroplasty is a more reliable means of fracture management when insufficient bone is present for fixation. Prophylactic stabilization of impending pathologic fractures can reduce the morbidity associated with metastatic lesions.

  4. Upper airway radiographs in infants with upper airway insufficiency.

    PubMed Central

    Tonkin, S L; Davis, S L; Gunn, T R

    1994-01-01

    Upper airway measurements in nine infants considered to be at risk of upper airway insufficiency, six of whom presented after an apnoeic episode, were compared with measurements taken in two age groups of healthy infants. Paired, inspiratory and expiratory, lateral upper airway radiographs were obtained while the infants were awake and breathing quietly. The radiographs of all nine infants demonstrated narrowing in the oropharyngeal portion of the airway during inspiration and in six infants there was ballooning of the upper airway during expiration. Seven of the nine infants subsequently experienced recurrent apnoeic episodes which required vigorous stimulation to restore breathing. Experience suggests that respiratory phase timed radiographs are a useful adjunct to the evaluation of infants who are suspected of having upper airway dysfunction. They provide information regarding both the dimensions and compliance of the upper airway as well as the site of any restriction. Images PMID:8048825

  5. A Survey Of Techniques for Managing and Leveraging Caches in GPUs

    SciTech Connect

    Mittal, Sparsh

    2014-09-01

    Initially introduced as special-purpose accelerators for graphics applications, graphics processing units (GPUs) have now emerged as general purpose computing platforms for a wide range of applications. To address the requirements of these applications, modern GPUs include sizable hardware-managed caches. However, several factors, such as unique architecture of GPU, rise of CPU–GPU heterogeneous computing, etc., demand effective management of caches to achieve high performance and energy efficiency. Recently, several techniques have been proposed for this purpose. In this paper, we survey several architectural and system-level techniques proposed for managing and leveraging GPU caches. We also discuss the importance and challenges of cache management in GPUs. The aim of this paper is to provide the readers insights into cache management techniques for GPUs and motivate them to propose even better techniques for leveraging the full potential of caches in the GPUs of tomorrow.

  6. Case Management and Rehabilitation Counseling: Procedures and Techniques. Fourth Edition

    ERIC Educational Resources Information Center

    Roessler, Richard T.; Rubin, Stanford E.

    2006-01-01

    "Case Management and Rehabilitation Counseling" discusses procedures that are useful to rehabilitation professionals working in many settings. Specifically, this book reviews the finer points relating to diagnosing, arranging services, monitoring program outcomes, arranging for placement, planning for accommodations, ethical decision making,…

  7. Fluoroscopy assisted tracheal intubation in a case of anticipated difficult airway: Fail safe devices can also fail.

    PubMed

    Arulvelan, Appavoo; Soumya, Madhusudhan; Santhosh, Kannath

    2015-01-01

    Difficulty in airway management is the most important cause of major anesthesia-related morbidity and mortality. Unexpected difficulties may arise even with proper preanesthesia planning. Here, we report a case of anticipated difficult airway primarily planned for flexible fibreoptic bronchoscope assisted intubation, but due to unexpected failure of light source, fluoroscopy was used, and the airway was successfully secured.

  8. Contemporary behavior management techniques in clinical pediatric dentistry: out with the old and in with the new?

    PubMed

    Oliver, Kelly; Manton, David John

    2015-01-01

    Effective behavior management guides children through the complex social context of dentistry utilizing techniques based on a current understanding of the social, emotional, and cognitive development of children. Behavior management techniques facilitate effective communication and establish social and behavioral guidelines for the dental environment. Contemporary parenting styles, expectations, and attitudes of modern parents and society have influenced the use of behavior management techniques with a prevailing emphasis on communicative techniques and pharmacological management over aversive techniques.

  9. Maintaining Sanity in the Classroom. Classroom Management Techniques. Second Edition.

    ERIC Educational Resources Information Center

    Dreikurs, Rudolf; Brunwald, Bernice Bronia; Pepper, Floy C.

    This book, based on Adlerian psychology, applies the techniques of motivation modification to realistic classroom problems, dealing step-by-step with handling behavior difficulties and providing the background that enables student teachers to understand the group dynamics of various classroom situations. The book is divided into five parts with 30…

  10. Regional environmental analysis and management: New techniques for current problems

    NASA Technical Reports Server (NTRS)

    Honea, R. B.; Paludan, C. T. N.

    1974-01-01

    Advances in data acquisition and processing procedures for regional environmental analysis are discussed. Automated and semi-automated techniques employing Earth Resources Technology Satellite data and conventional data sources are presented. Experiences are summarized. The ERTS computer compatible tapes provide a very complete and flexible record of earth resources data and represent a viable medium to enhance regional environmental analysis research.

  11. Comprehensive Flood Plain Studies Using Spatial Data Management Techniques.

    DTIC Science & Technology

    1978-06-01

    and subbasin hydraulic length. The technique adopted is a modest extension and automation of the method developed for San Diego County (Franziniet al...land classified as 14 I ____.4_ natural vegetation under existing conditions is 272 acres while the total amount of landA classified as natural

  12. Syk Regulates Neutrophilic Airway Hyper-Responsiveness in a Chronic Mouse Model of Allergic Airways Inflammation

    PubMed Central

    Juvet, Stephen; Scott, Jeremy A.; Chow, Chung-Wai

    2017-01-01

    Background Asthma is a chronic inflammatory disease characterized by airways hyper-responsiveness (AHR), reversible airway obstruction, and airway inflammation and remodeling. We previously showed that Syk modulates methacholine-induced airways contractility in naïve mice and in mice with allergic airways inflammation. We hypothesize that Syk plays a role in the pathogenesis of AHR; this was evaluated in a chronic 8-week mouse model of house dust mite (HDM)-induced allergic airways inflammation. Methods We used the Sykflox/flox//rosa26CreERT2 conditional Syk knock-out mice to assess the role of Syk prior to HDM exposure, and treated HDM-sensitized mice with the Syk inhibitor, GSK143, to evaluate its role in established allergic airways inflammation. Respiratory mechanics and methacholine (MCh)-responsiveness were assessed using the flexiVent® system. Lungs underwent bronchoalveolar lavage to isolate inflammatory cells or were frozen for determination of gene expression in tissues. Results MCh-induced AHR was observed following HDM sensitization in the Syk-intact (Sykflox/flox) and vehicle-treated BALB/c mice. MCh responsiveness was reduced to control levels in HDM-sensitized Sykdel/del mice and in BALB/c and Sykflox/flox mice treated with GSK143. Both Sykdel/del and GSK143-treated mice mounted appropriate immune responses to HDM, with HDM-specific IgE levels that were comparable to Sykflox/flox and vehicle-treated BALB/c mice. HDM-induced increases in bronchoalveolar lavage cell counts were attenuated in both Sykdel/del and GSK143-treated mice, due primarily to decreased neutrophil recruitment. Gene expression analysis of lung tissues revealed that HDM-induced expression of IL-17 and CXCL-1 was significantly attenuated in both Sykdel/del and GSK143-treated mice. Conclusion Syk inhibitors may play a role in the management of neutrophilic asthma. PMID:28107345

  13. Improved outage management techniques for better plant availability

    SciTech Connect

    Bemer, J.P.

    1989-01-01

    To maintain high availability of nuclear generating units is one of the most important management objectives. The duration of outages-whether planned or unplanned-is the main parameter impacting on plant availability, but the planned outages, and essentially the refueling outages, are the most important in this respect, and they also have a heavy impact on the economics of plant operation. The following factors influence the duration of the outages: (1) modifications; (2) preventive maintenance operations; and (3) corrective maintenance operations of generic faults. In this paper, the authors examine how the outage management organization of Electricite de France (EdF) plants is tending to optimize the solutions to the above-mentioned points.

  14. Charles bonnet syndrome, management with simple behavioral technique.

    PubMed

    Issa, Baba Awoye; Yussuf, Abdullahi Dasliva

    2013-01-01

    Charles Bonnet syndrome occurs in visually impaired but cognitively normal individuals. This report describes a condition of vivid visual hallucination (phantom images) in an 85-year-old conscious man, who had been blind by bilateral progressively worsening glaucoma. This common, but rarely reported, condition was managed by behavioral approach of repeated blinking, intermittent eyes closure, and reassurance. While emotional, mood and cognitive disorders need to be ruled out, the condition, though frightening to the afflicted, is benign and remediable with simple, inexpensive approach. Health workers managing people with terminal blindness should always ask for the presence of hallucinations from their patients to forestall a preventable distress resulting from wrong perception without visual stimulus.

  15. Blepharoplasty techniques in the management of orbito-temporal neurofibromatosis.

    PubMed

    Li, Jin; Lin, Ming; Shao, Chunyi; Ge, Shengfang; Fan, Xianqun

    2014-11-01

    We aimed to present blepharoplasty techniques we used for severe orbito-temporal neurofibromatosis (NF). A retrospective noncomparative single-center case study was undertaken on patients with orbito-temporal NF. Twenty-two patients with orbito-temporal NF treated at the Department of Ophthalmology of Shanghai Ninth People's Hospital between 2007 and 2011 participated in the study. They underwent a standard ophthalmologic assessment for orbito-temporal NF involving both the orbito-temporal soft tissue and bony orbits. The orbits were examined with three-dimensional computed tomography (CT) and all 22 patients underwent tumor debulking, blepharoplasty, and orbital reconstruction. We modified the conventional procedures. Our reconstructive techniques included eyelid reduction; lateral canthal reattachment; for patients with collapse of the lateral orbital margin, reconstruction of the orbital margin to be performed before reattaching the lateral canthus to the implanted titanium mesh; anterior levator resection; and frontalis suspension according to preoperative levator muscle function. Visual acuity, tumor recurrence, and postoperative palpebral fissure and orbital appearance were evaluated to assess outcomes. Acceptable cosmetic results were obtained in 22 patients after debulking of the orbito-temporal NF and surgical reconstruction. There was no loss of vision or visual impairment postoperatively. All patients did not display recrudescence after a follow-up period of >1 year. Three patients with residual ptosis were successfully treated with a second ptosis repair. We believe that the blepharoplasty techniques described in the treatment of orbito-palpebral NF may provide both functional and esthetic benefits.

  16. A Comparison of Perceived Crisis Training Management and Optimum Training Management Techniques in the Army

    DTIC Science & Technology

    1980-08-27

    Ambiguity and Time Management relating to crisis management are key issues for consideration in the development of this investigation. These concepts are...themselves to be optimum-management-oriented. The study indicates the possibility of continuing problems in the areas of time management contributing to

  17. Techniques for cash management in scheduling manufacturing operations

    NASA Astrophysics Data System (ADS)

    Morady Gohareh, Mehdy; Shams Gharneh, Naser; Ghasemy Yaghin, Reza

    2016-10-01

    The objective in traditional scheduling is usually time based. Minimizing the makespan, total flow times, total tardi costs, etc. are instances of these objectives. In manufacturing, processing each job entails a cost paying and price receiving. Thus, the objective should include some notion of managing the flow of cash. We have defined two new objectives: maximization of average and minimum available cash. For single machine scheduling, it is demonstrated that scheduling jobs in decreasing order of profit ratios maximizes the former and improves productivity. Moreover, scheduling jobs in increasing order of costs and breaking ties in decreasing order of prices maximizes the latter and creates protection against financial instability.

  18. Pediatric Enteric Feeding Techniques: Insertion, Maintenance, and Management of Problems

    SciTech Connect

    Nijs, Els L. F.; Cahill, Anne Marie

    2010-12-15

    Enteral feeding is considered a widespread, well-accepted means of delivering nutrition to adults and children who are unable to consume food by mouth or who need support in maintaining adequate nutrition for a variety of reasons, including acute and chronic disease states. Delivery of enteral feeding to nutritionally deprived patients may be achieved by several means. In this article, the indications and insertion of enteral access in children will be reviewed. In addition, common complications and management of problems will be discussed.

  19. When continuous positive airway pressure (CPAP) fails

    PubMed Central

    Virk, Jagdeep S.

    2016-01-01

    Obstructive sleep apnoea (OSA) is increasingly prevalent, particularly in the context of the obesity epidemic, and is associated with a significant social, health and economic impact. The gold standard of treatment for moderate to severe OSA is continuous positive airway pressure (CPAP). However compliance rates can be low. Methodology to improve patient tolerance to CPAP alongside with alternative, non-surgical and surgical, management strategies are discussed. All patients that fail CPAP therapy would benefit from formal upper airway evaluation by the otolaryngologist to identify any obvious causes and consider site-specific surgical therapies. Patient selection is integral to ensuring successful outcomes. A multidisciplinary team is needed to manage these patients. PMID:27867577

  20. Manifesto on small airway involvement and management in asthma and chronic obstructive pulmonary disease: an Interasma (Global Asthma Association - GAA) and World Allergy Organization (WAO) document endorsed by Allergic Rhinitis and its Impact on Asthma (ARIA) and Global Allergy and Asthma European Network (GA(2)LEN).

    PubMed

    Braido, F; Scichilone, N; Lavorini, F; Usmani, O S; Dubuske, L; Boulet, L P; Mosges, R; Nunes, C; Sanchez-Borges, M; Ansotegui, I J; Ebisawa, M; Levi-Schaffer, F; Rosenwasser, L J; Bousquet, J; Zuberbier, T; Canonica, G Walter; Cruz, A; Yanez, A; Yorgancioglu, A; Deleanu, D; Rodrigo, G; Berstein, J; Ohta, K; Vichyanond, P; Pawankar, R; Gonzalez-Diaz, S N; Nakajima, S; Slavyanskaya, T; Fink-Wagner, A; Loyola, C Baez; Ryan, D; Passalacqua, G; Celedon, J; Ivancevich, J C; Dobashi, K; Zernotti, M; Akdis, M; Benjaponpitak, S; Bonini, S; Burks, W; Caraballo, L; El-Sayed, Z Awad; Fineman, S; Greenberger, P; Hossny, E; Ortega-Martell, J A; Saito, H; Tang, M; Zhang, L

    2016-01-01

    Evidence that enables us to identify, assess, and access the small airways in asthma and chronic obstructive pulmonary disease (COPD) has led INTERASMA (Global Asthma Association) and WAO to take a position on the role of the small airways in these diseases. Starting from an extensive literature review, both organizations developed, discussed, and approved the manifesto, which was subsequently approved and endorsed by the chairs of ARIA and GA(2)LEN. The manifesto describes the evidence gathered to date and defines and proposes issues on small airway involvement and management in asthma and COPD with the aim of challenging assumptions, fostering commitment, and bringing about change. The small airways (defined as those with an internal diameter <2 mm) are involved in the pathogenesis of asthma and COPD and are the major determinant of airflow obstruction in these diseases. Various tests are available for the assessment of the small airways, and their results must be integrated to confirm a diagnosis of small airway dysfunction. In asthma and COPD, the small airways play a key role in attempts to achieve disease control and better outcomes. Small-particle inhaled formulations (defined as those that, owing to their size [usually <2 μm], ensure more extensive deposition in the lung periphery than large molecules) have proved beneficial in patients with asthma and COPD, especially those in whom small airway involvement is predominant. Functional and biological tools capable of accurately assessing the lung periphery and more intensive use of currently available tools are necessary. In patients with suspected COPD or asthma, small airway involvement must be assessed using currently available tools. In patients with subotpimal disease control and/or functional or biological signs of disease activity, the role of small airway involvement should be assessed and treatment tailored. Therefore, the choice between large- and small-particle inhaled formulations must reflect

  1. Proceedings of the National Conference on Energy Resource Management. Volume 1: Techniques, Procedures and Data Bases

    NASA Technical Reports Server (NTRS)

    Brumfield, J. O. (Editor); Schiffman, Y. M. (Editor)

    1982-01-01

    Topics dealing with the integration of remotely sensed data with geographic information system for application in energy resources management are discussed. Associated remote sensing and image analysis techniques are also addressed.

  2. Techniques for early diagnosis and management of cervicofacial necrotising fasciitis

    PubMed Central

    Lee, Judy W; Immerman, Sara B; Morris, Luc GT

    2010-01-01

    Background Cervicofacial necrotising fasciitis carries high rates of morbidity and mortality, and is not often initially suspected due to its rarity and misleadingly innocuous presentation. We propose an algorithm for the timely diagnosis and management of cervicofacial necrotising fasciitis. Methods Retrospective review of seven patients ultimately diagnosed with cervicofacial necrotising fasciitis. Results In these seven patients, common presenting symptoms included sore throat, fever and neck pain. On initial examination and imaging, only three had obvious findings. One patient’s diagnosis was facilitated via a bedside cut-down procedure. Six patients underwent surgical debridement. Four required tracheotomy, and five wounds closed via secondary intention. There were two deaths. Conclusion The severity of cervical necrotising fasciitis and its rapid spread necessitate early diagnosis and timely surgical management. The presentation often appears benign. A high index of clinical suspicion should be maintained in cases of neck cellulitis with nonspecific clinical findings, especially in diabetic or otherwise immunocompromised patients. A normal computed tomography scan does not rule out necrotising fasciitis. A cut-down procedure may be critical to early diagnosis in some cases. PMID:20298644

  3. Statistical and Economic Techniques for Site-specific Nematode Management.

    PubMed

    Liu, Zheng; Griffin, Terry; Kirkpatrick, Terrence L

    2014-03-01

    Recent advances in precision agriculture technologies and spatial statistics allow realistic, site-specific estimation of nematode damage to field crops and provide a platform for the site-specific delivery of nematicides within individual fields. This paper reviews the spatial statistical techniques that model correlations among neighboring observations and develop a spatial economic analysis to determine the potential of site-specific nematicide application. The spatial econometric methodology applied in the context of site-specific crop yield response contributes to closing the gap between data analysis and realistic site-specific nematicide recommendations and helps to provide a practical method of site-specifically controlling nematodes.

  4. The airway approach to a neonate with Treacher Collins syndrome - Case report.

    PubMed

    Marques-Pires, R; Trindade, H

    2017-01-13

    Neonates and small infants with syndromes characterized by the presence of craniofacial abnormalities may represent great challenges regarding the management of the airway. We describe the case of a 9-day-old neonate with Treacher Collins syndrome, in which a laryngeal mask was essential to improve the airway obstruction, ventilate the patient and serve as an airway conduit for a fiberoptic intubation. By presenting this case, we intend to show that in neonates with Treacher Collins syndrome, in whom difficulties ventilation and intubation are expected, a thoughtful airway management planning is mandatory.

  5. Thermal Management Techniques for Oil-Free Turbomachinery Systems

    NASA Technical Reports Server (NTRS)

    Radil, Kevin; DellaCorte, Chris; Zeszotek, Michelle

    2006-01-01

    Tests were performed to evaluate three different methods of utilizing air to provide thermal management control for compliant journal foil air bearings. The effectiveness of the methods was based on bearing bulk temperature and axial thermal gradient reductions during air delivery. The first method utilized direct impingement of air on the inner surface of a hollow test journal during operation. The second, less indirect method achieved heat removal by blowing air inside the test journal to simulate air flowing axially through a hollow, rotating shaft. The third method emulated the most common approach to removing heat by forcing air axially through the bearing s support structure. Internal bearing temperatures were measured with three, type K thermocouples embedded in the bearing that measured general internal temperatures and axial thermal gradients. Testing was performed in a 1 atm, 260 C ambient environment with the bearing operating at 60 krpm and supporting a load of 222 N. Air volumetric flows of 0.06, 0.11, and 0.17 cubic meters per minute at approximately 150 to 200 C were used. The tests indicate that all three methods provide thermal management but at different levels of effectiveness. Axial cooling of the bearing support structure had a greater effect on bulk temperature for each air flow and demonstrated that the thermal gradients could be influenced by the directionality of the air flow. Direct air impingement on the journal's inside surface provided uniform reductions in both bulk temperature and thermal gradients. Similar to the direct method, indirect journal cooling had a uniform cooling effect on both bulk temperatures and thermal gradients but was the least effective of the three methods.

  6. Early airway infection, inflammation, and lung function in cystic fibrosis

    PubMed Central

    Nixon, G; Armstrong, D; Carzino, R; Carlin, J; Olinsky, A; Robertson, C; Grimwood, K

    2002-01-01

    Aims: To determine the relation between lower airway infection and inflammation, respiratory symptoms, and lung function in infants and young children with cystic fibrosis (CF). Methods: A prospective study of children with CF aged younger than 3 years, diagnosed by a newborn screening programme. All were clinically stable and had testing as outpatients. Subjects underwent bronchial lavage (BL) and lung function testing by the raised volume rapid thoracoabdominal compression technique under general anaesthesia. BL fluid was cultured and analysed for neutrophil count, interleukin 8, and neutrophil elastase. Lung function was assessed by forced expiratory volume in 0.5, 0.75, and 1 second. Results: Thirty six children with CF were tested on 54 occasions. Lower airway infection shown by BL was associated with a 10% reduction in FEV0.5 compared with subjects without infection. No relation was identified between airway inflammation and lung function. Daily moist cough within the week before testing was reported on 20/54 occasions, but in only seven (35%) was infection detected. Independent of either infection status or airway inflammation, those with daily cough had lower lung function than those without respiratory symptoms at the time of BL (mean adjusted FEV0.5 195 ml and 236 ml respectively). Conclusions: In young children with CF, both respiratory symptoms and airway infection have independent, additive effects on lung function, unrelated to airway inflammation. Further studies are needed to understand the mechanisms of airway obstruction in these young patients. PMID:12244003

  7. Coupled cellular therapy and magnetic targeting for airway regeneration.

    PubMed

    Ordidge, Katherine L; Gregori, Maria; Kalber, Tammy L; Lythgoe, Mark F; Janes, Sam M; Giangreco, Adam

    2014-06-01

    Airway diseases including COPD (chronic obstructive pulmonary disease), cystic fibrosis and lung cancer are leading causes of worldwide morbidity and mortality, with annual healthcare costs of billions of pounds. True regeneration of damaged airways offers the possibility of restoring lung function and protecting against airway transformation. Recently, advances in tissue engineering have allowed the development of cadaveric and biosynthetic airway grafts. Although these have produced encouraging results, the ability to achieve long-term functional airway regeneration remains a major challenge. To promote regeneration, exogenously delivered stem and progenitor cells are being trialled as cellular therapies. Unfortunately, current evidence suggests that only small numbers of exogenously delivered stem cells engraft within lungs, thereby limiting their utility for airway repair. In other organ systems, magnetic targeting has shown promise for improving long-term robust cell engraftment. This technique involves in vitro cell expansion, magnetic actuation and magnetically guided cell engraftment to sites of tissue damage. In the present paper, we discuss the utility of coupling stem cell-mediated cellular therapy with magnetic targeting for improving airway regeneration.

  8. Flight test configuration for verifying inertial sensor redundancy management techniques

    NASA Technical Reports Server (NTRS)

    Bryant, W. H.; Morrell, F. R.; Bailey, M. L.

    1984-01-01

    The Redundant Strapdown Inertial Measurement Unit presently tested in flight configuration consists of a semioctahedral array of four dynamically tuned, two-degree-of-freedom (TDOF) gyros and four TDOF accelerometers which can provide dual, fail-operational performance for integrated avionics systems. Attention is given to the multilevel algorithm used for the detection and isolation of three ranges of sensor failure in an integrated avionics context. A technique for the generation of accelerometer and gyro error thresholds which is sensitive to dynamic sensor errors and separation effects is presented, together with simulation results. Emphasis is placed on the ensuring of highly reliable data for flight control/navigation functions, while minimizing false or missed alarms.

  9. Suitability of online 3D visualization technique in oil palm plantation management

    NASA Astrophysics Data System (ADS)

    Mat, Ruzinoor Che; Nordin, Norani; Zulkifli, Abdul Nasir; Yusof, Shahrul Azmi Mohd

    2016-08-01

    Oil palm industry has been the backbone for the growth of Malaysia economy. The exports of this commodity increasing almost every year. Therefore, there are many studies focusing on how to help this industry increased its productivity. In order to increase the productivity, the management of oil palm plantation need to be improved and strengthen. One of the solution in helping the oil palm manager is by implementing online 3D visualization technique for oil palm plantation using game engine technology. The potential of this application is that it can helps in fertilizer and irrigation management. For this reason, the aim of this paper is to investigate the issues in managing oil palm plantation from the view of oil palm manager by interview. The results from this interview will helps in identifying the suitable issues could be highlight in implementing online 3D visualization technique for oil palm plantation management.

  10. CT based computerized identification and analysis of human airways: A review

    SciTech Connect

    Pu Jiantao; Gu Suicheng; Liu Shusen; Zhu Shaocheng; Wilson, David; Siegfried, Jill M.; Gur, David

    2012-05-15

    As one of the most prevalent chronic disorders, airway disease is a major cause of morbidity and mortality worldwide. In order to understand its underlying mechanisms and to enable assessment of therapeutic efficacy of a variety of possible interventions, noninvasive investigation of the airways in a large number of subjects is of great research interest. Due to its high resolution in temporal and spatial domains, computed tomography (CT) has been widely used in clinical practices for studying the normal and abnormal manifestations of lung diseases, albeit there is a need to clearly demonstrate the benefits in light of the cost and radiation dose associated with CT examinations performed for the purpose of airway analysis. Whereas a single CT examination consists of a large number of images, manually identifying airway morphological characteristics and computing features to enable thorough investigations of airway and other lung diseases is very time-consuming and susceptible to errors. Hence, automated and semiautomated computerized analysis of human airways is becoming an important research area in medical imaging. A number of computerized techniques have been developed to date for the analysis of lung airways. In this review, we present a summary of the primary methods developed for computerized analysis of human airways, including airway segmentation, airway labeling, and airway morphometry, as well as a number of computer-aided clinical applications, such as virtual bronchoscopy. Both successes and underlying limitations of these approaches are discussed, while highlighting areas that may require additional work.

  11. CT based computerized identification and analysis of human airways: a review.

    PubMed

    Pu, Jiantao; Gu, Suicheng; Liu, Shusen; Zhu, Shaocheng; Wilson, David; Siegfried, Jill M; Gur, David

    2012-05-01

    As one of the most prevalent chronic disorders, airway disease is a major cause of morbidity and mortality worldwide. In order to understand its underlying mechanisms and to enable assessment of therapeutic efficacy of a variety of possible interventions, noninvasive investigation of the airways in a large number of subjects is of great research interest. Due to its high resolution in temporal and spatial domains, computed tomography (CT) has been widely used in clinical practices for studying the normal and abnormal manifestations of lung diseases, albeit there is a need to clearly demonstrate the benefits in light of the cost and radiation dose associated with CT examinations performed for the purpose of airway analysis. Whereas a single CT examination consists of a large number of images, manually identifying airway morphological characteristics and computing features to enable thorough investigations of airway and other lung diseases is very time-consuming and susceptible to errors. Hence, automated and semiautomated computerized analysis of human airways is becoming an important research area in medical imaging. A number of computerized techniques have been developed to date for the analysis of lung airways. In this review, we present a summary of the primary methods developed for computerized analysis of human airways, including airway segmentation, airway labeling, and airway morphometry, as well as a number of computer-aided clinical applications, such as virtual bronchoscopy. Both successes and underlying limitations of these approaches are discussed, while highlighting areas that may require additional work.

  12. Information Landscaping: Information Mapping, Charting, Querying and Reporting Techniques for Total Quality Knowledge Management.

    ERIC Educational Resources Information Center

    Tsai, Bor-sheng

    2003-01-01

    Total quality management and knowledge management are merged and used as a conceptual model to direct and develop information landscaping techniques through the coordination of information mapping, charting, querying, and reporting. Goals included: merge citation analysis and data mining, and apply data visualization and information architecture…

  13. Teaching Natural Resource Management-Teaching Techniques and Difficulties in Greek Vocational Lyceum: A Case Study

    ERIC Educational Resources Information Center

    Koutsoukos, Marios; Mouratidis, Antonios

    2016-01-01

    The aim of the present study is to investigate the teaching techniques applied, as well as the difficulties, with which educators in teaching Natural Resource Management are confronted. For research purposes, a case study was conducted on teaching Natural Resource Management in the Third Grade of Vocational Lyceum (EPAL) in Northern Greece. It was…

  14. Managing Age Discrimination: An Examination of the Techniques Used when Seeking Employment

    ERIC Educational Resources Information Center

    Berger, Ellie D.

    2009-01-01

    Purpose: This article examines the age-related management techniques used by older workers in their search for employment. Design and Methods: Data are drawn from interviews with individuals aged 45-65 years (N = 30). Results: Findings indicate that participants develop "counteractions" and "concealments" to manage perceived age discrimination.…

  15. The Impact of Teachers' Aggressive Management Techniques on Students' Attitudes to Schoolwork

    ERIC Educational Resources Information Center

    Romi, Shlomo; Lewis, Ramon; Roache, Joel; Riley, Philip

    2011-01-01

    Previous studies have shown that teachers' aggressive classroom management impacts negatively on students. The authors compared student reaction to teachers' use of aggressive management techniques in Australia, China, and Israel. Reactions included distraction negativity toward teachers and perceptions that teachers' responses were unjustified,…

  16. Airway Surgery in Tracheostomised Patients with Wegener Granulomatosis Leading to Subglottic Stenosis.

    PubMed

    Altun, Demet; Sivrikoz, Nükhet; Çamcı, Emre

    2015-10-01

    Wegener granulomatosis (WG) is a multisystemic disorder characterised by granulomatous inflammation of the respiratory system. The growing of proliferative tissue towards the larynx and trachea may cause airway obstruction on account of subglottic stenosis. In this situation, the surgical goal is to eliminate the airway obstruction by providing natural airway anatomy. While mild lesions do not require surgical intervention, in fixed lesions, surgical intervention is required, such as tracheostomy, laser resection and dilatation. In tracheostomised patients, granuloma formation surrounding the tracheostomy cannula may occur in the trachea. Inflammation and newly formed granulation tissue result in severe stenosis in the airways. During surgical treatment of such patients, airway management is important. In this case report, we will discuss gas exchange and airway management with jet ventilation (JV) during excision of the granulation tissue with endolaryngeal laser surgery, leading to subglottic stenosis in tracheostomised patients in WG.

  17. Moisture Management in an Active Sportswear: Techniques and Evaluation—A Review Article

    NASA Astrophysics Data System (ADS)

    Senthilkumar, Mani; Sampath, M. B.; Ramachandran, T.

    2013-07-01

    Moisture management property is an important aspect of any fabric meant for active sportswear, which decides the comfort level of that fabric. Every human being sweats during different kinds of activities. An important feature of any fabric is how it transports this water out of the body, so as to make the wearer feel comfortable. This paper reports the concept of moisture management, various production techniques and evaluation of the moisture management characteristics on fabrics for active sportswear.

  18. First Approximations of Prescribed Fire Risks Relative to Other Management Techniques Used on Private Lands

    PubMed Central

    Twidwell, Dirac; Wonkka, Carissa L.; Sindelar, Michael T.; Weir, John R.

    2015-01-01

    Fire is widely recognized as a critical ecological and evolutionary driver that needs to be at the forefront of land management actions if conservation targets are to be met. However, the prevailing view is that prescribed fire is riskier than other land management techniques. Perceived risks associated with the application of fire limits its use and reduces agency support for prescribed burning in the private sector. As a result, considerably less cost-share support is given for prescribed fire compared to mechanical techniques. This study tests the general perception that fire is a riskier technique relative to other land management options. Due to the lack of data available to directly test this notion, we use a combination of approaches including 1) a comparison of fatalities resulting from different occupations that are proxies for techniques employed in land management, 2) a comparison of fatalities resulting from wildland fire versus prescribed fire, and 3) an exploration of causal factors responsible for wildland fire-related fatalities. This approach establishes a first approximation of the relative risk of fatality to private citizens using prescribed fire compared to other management techniques that are readily used in ecosystem management. Our data do not support using risks of landowner fatalities as justification for the use of alternative land management techniques, such as mechanical (machine-related) equipment, over prescribed fire. Vehicles and heavy machinery are consistently leading reasons for fatalities within occupations selected as proxies for management techniques employed by ranchers and agricultural producers, and also constitute a large proportion of fatalities among firefighters. Our study provides the foundation for agencies to establish data-driven decisions regarding the degree of support they provide for prescribed burning on private lands. PMID:26465329

  19. Remote sensing techniques for monitoring and managing irrigated lands

    NASA Astrophysics Data System (ADS)

    Allan, J. A.

    Agriculture in semi-arid tracts of the world depends on water to sustain its irrigation systems. Such agricultural systems either derive from government investments in the control of surface flow or they have been developed through the exploitation of groundwater sometimes by a large community of unsupervised individuals seeking to maximise their own advantage without concern for the resource upon which they depend in the medium and long term. In both cases government agencies need data on the area irrigated and the volume of water used. In countries with highly developed scientific and agricultural institutions the contribution of remote sensing, though significant, may only provide between five and ten per cent of the data required to guide regional and national managers. In countries without such institutions the proportion contributed by remote sensing can be very much higher, as shown in a recent study in North Africa. The paper will emphasise the importance of carefully structured sampling procedures, both to improve the areal estimates from satellite imagery and the estimates of water use based upon them. The role of satellite imagery in providing information on the status of water resources, on trends in water use and in the implementation of policies to extend or diminish irrigated land are discussed.

  20. Investment, regulation, and uncertainty: managing new plant breeding techniques.

    PubMed

    Smyth, Stuart J; McDonald, Jillian; Falck-Zepeda, Jose

    2014-01-01

    As with any technological innovation, time refines the technology, improving upon the original version of the innovative product. The initial GM crops had single traits for either herbicide tolerance or insect resistance. Current varieties have both of these traits stacked together and in many cases other abiotic and biotic traits have also been stacked. This innovation requires investment. While this is relatively straight forward, certain conditions need to exist such that investments can be facilitated. The principle requirement for investment is that regulatory frameworks render consistent and timely decisions. If the certainty of regulatory outcomes weakens, the potential for changes in investment patterns increases.   This article provides a summary background to the leading plant breeding technologies that are either currently being used to develop new crop varieties or are in the pipeline to be applied to plant breeding within the next few years. Challenges for existing regulatory systems are highlighted. Utilizing an option value approach from investment literature, an assessment of uncertainty regarding the regulatory approval for these varying techniques is undertaken. This research highlights which technology development options have the greatest degree of uncertainty and hence, which ones might be expected to see an investment decline.

  1. The Tulip GT® airway versus the facemask and Guedel airway: a randomised, controlled, cross-over study by Basic Life Support-trained airway providers in anaesthetised patients.

    PubMed

    Shaikh, A; Robinson, P N; Hasan, M

    2016-03-01

    We performed a randomised, controlled, cross-over study of lung ventilation by Basic Life Support-trained providers using either the Tulip GT® airway or a facemask with a Guedel airway in 60 anaesthetised patients. Successful ventilation was achieved if the provider produced an end-tidal CO2 > 3.5 kPa and a tidal volume > 250 ml in two of the first three breaths, within 60 sec and within two attempts. Fifty-seven (95%) providers achieved successful ventilation using the Tulip GT compared with 35 (58%) using the facemask (p < 0.0001). Comparing the Tulip GT and facemask, the mean (SD) end-tidal CO2 was 5.0 (0.7) kPa vs 2.5 (1.5) kPa, tidal volume was 494 (175) ml vs 286 (186) ml and peak inspiratory pressure was 18.3 (3.4) cmH2 O vs 13.6 (7) cmH2 O respectively (all p < 0.0001). Forty-seven (78%) users favoured the Tulip GT airway. These results are similar to a previous manikin study using the same protocol, suggesting a close correlation between human and manikin studies for this airway device. We conclude that the Tulip GT should be considered as an adjunct to airway management both within and outside hospitals when ventilation is being undertaken by Basic Life Support-trained airway providers.

  2. Pregnancy termination: techniques, risks, and complications and their management.

    PubMed

    Castadot, R G

    1986-01-01

    This article outlines the current modalities of pregnancy termination, as well as their risks and complications, in 3 phases of pregnancy: 1) up to 49 days past the last menstrual period, 2) 8-15 weeks, and 3) 16-24 weeks. Before 8 weeks of pregnancy, suction dilatation and curettage (D and C) is the preferred method. However, a medical approach, possibly self-administered, is viewed as more satisfactory and requires only an improvement in side effects. From 8-15 weeks' gestation, suction D and C and dilatation and evacuation (D and E) are the methods of choice. The use of laminaria tents improves both the facility and safety of these procedures in nulliparous patients and perhaps in multiparous patients. Priming of the cervix with prostaglandin could further decrease the difficulty and risks of these procedures. The use of a hydrogel compound is especially worthy of consideration. There is controversy about the preferred method between 16-20 weeks' gestation. D and E appears to have fewer complications and to be more cost-effective than hypertonic saline injection. Urea-prostaglandin has fewer and less severe complications than saline injection, and seems to be more cost-effective than saline injection in terms of duration of hospitalization. The high frequency of failure and side effects, combined with the possibility of expulsion of a live fetus, make prostaglandin-only injection less desirable. After 20 weeks' gestation, urea-prostaglandin injection is probably the safer method. Given the rapid increase in complications with passing weeks, any delay in providing late abortion services should be avoided. 2nd trimester pregnancy terminations, especially those after 18 weeks' gestation, are associated with increased mortality and morbidity and should be performed at specialized centers where providers are better equipped to manage complications.

  3. The role of bronchoscopy in the diagnosis of airway disease

    PubMed Central

    Dixon, Jennifer; Tieu, Brandon H.

    2016-01-01

    Endoscopy of the airway is a valuable tool for the evaluation and management of airway disease. It can be used to evaluate many different bronchopulmonary diseases including airway foreign bodies, tumors, infectious and inflammatory conditions, airway stenosis, and bronchopulmonary hemorrhage. Traditionally, options for evaluation were limited to flexible and rigid bronchoscopy. Recently, more sophisticated technology has led to the development of endobronchial ultrasound (EBUS) and electromagnetic navigational bronchoscopy (ENB). These technological advances, combined with increasing provider experience have resulted in a higher diagnostic yield with endoscopic biopsies. This review will focus on the role of bronchoscopy, including EBUS, ENB, and rigid bronchoscopy in the diagnosis of bronchopulmonary diseases. In addition, it will cover the anesthetic considerations, equipment, diagnostic yield, and potential complications. PMID:28149583

  4. Classification of pulmonary airway disease based on mucosal color analysis

    NASA Astrophysics Data System (ADS)

    Suter, Melissa; Reinhardt, Joseph M.; Riker, David; Ferguson, John Scott; McLennan, Geoffrey

    2005-04-01

    Airway mucosal color changes occur in response to the development of bronchial diseases including lung cancer, cystic fibrosis, chronic bronchitis, emphysema and asthma. These associated changes are often visualized using standard macro-optical bronchoscopy techniques. A limitation to this form of assessment is that the subtle changes that indicate early stages in disease development may often be missed as a result of this highly subjective assessment, especially in inexperienced bronchoscopists. Tri-chromatic CCD chip bronchoscopes allow for digital color analysis of the pulmonary airway mucosa. This form of analysis may facilitate a greater understanding of airway disease response. A 2-step image classification approach is employed: the first step is to distinguish between healthy and diseased bronchoscope images and the second is to classify the detected abnormal images into 1 of 4 possible disease categories. A database of airway mucosal color constructed from healthy human volunteers is used as a standard against which statistical comparisons are made from mucosa with known apparent airway abnormalities. This approach demonstrates great promise as an effective detection and diagnosis tool to highlight potentially abnormal airway mucosa identifying a region possibly suited to further analysis via airway forceps biopsy, or newly developed micro-optical biopsy strategies. Following the identification of abnormal airway images a neural network is used to distinguish between the different disease classes. We have shown that classification of potentially diseased airway mucosa is possible through comparative color analysis of digital bronchoscope images. The combination of the two strategies appears to increase the classification accuracy in addition to greatly decreasing the computational time.

  5. Informing Parents about the Pharmacological and Invasive Behavior Management Techniques Used in Pediatric Dentistry.

    PubMed

    Paryab, Mehrysa; Afshar, Hossein; Mohammadi, Razie

    2014-01-01

    Background and aims. Parental acceptance and consent are important parameters in selecting the required behavior management technique during pediatric dental treatment. The present study sought to assess the effect of three different informing methods on the parental acceptance, consent and concern regarding the pharmacological and invasive behavior management techniques used in pediatric dentistry. Materials and methods. Ninety mothers of 3-6-year-old uncooperative children were selected and randomly assigned to three study groups. The parents in each group were initially asked to answer three questions related to their levels of 'acceptance','consent', and 'concern' toward the five behavior management techniques. Then, the information about the techniques was presented through a piece of writing in group I, verbal presentation in group II and showing a film in group III. At last, the parents answered the same three questions again. Score changes were analyzed by using ANOVA, correlations, Mann-Whitney U and Kruskal-Wallis methods. Results. There were no statistically significant differences in score changes of parental acceptance, consent and concern between the three groups, overall and in relation to each behaviour management technique (P > 0.05). Mothers with aca-demic education revealed more statistically significant concern following presentation of information by film (P < 0.05). Conclusion. None of the presentation methods had a significant preference over the others; in selecting the behavioral management techniques, it is advisable to observe individual factors, such as the level of education of the mothers.

  6. Challenges in the transfer of contingency management techniques: comment on Silverman et al. (2001).

    PubMed

    Petry, N M

    2001-02-01

    This article critiques K. Silverman, D. Svikis, E. Robles, M. L. Stitzer, and G. E. Bigelow's (2001) study of a contingency management intervention for reinforcing development of job-related skills in substance abusing women. The strengths of Silverman et al.'s study include studying a patient population of major public health concern, expanding contingency management techniques to a vocational training setting, reinforcing gradual approximations, implementing the intervention for a long duration, and carefully designing and executing the experimental procedures. However, many of these strengths may also be interpreted as weaknesses if the ultimate goal is to apply contingency management techniques in self-sustaining, community-based settings. The need to evaluate long-term cost-effectiveness of these procedures is described, and the difficulties in transferring contingency management techniques to real-world settings is discussed.

  7. Upper airway imaging in sleep-disordered breathing.

    PubMed

    Poirrier, Anne-Lise; Fanielle, Julien; Bruwier, Annick; Chakar, Bassam; Poirrier, Robert

    2014-06-01

    Our understanding of sleep-disordered breathing has evolved considerably over the past three decades, and clinical techniques of evaluation have progressed tremendously. Myriad imaging techniques are now available for the physician to approach the dynamic features resulting in turbulent airflow, upper airway narrowing or collapse at different levels. Controversy exists in the choice of investigations, probably because the best evaluation should be a combination of different techniques. Physical, radiographic, endoscopic and acoustic evaluations could be integrated to understand the degree and the levels of airway reduction and/or obstruction in a given patient. This review focuses on cost-effective and easily implemented techniques in daily practice, allowing quality assessment of the dynamic anatomy of sleep-disordered breathing: cephalometry, (sleep-)endoscopy and acoustic reflectometry of the upper airway.

  8. A survey of techniques for architecting and managing GPU register file

    DOE PAGES

    Mittal, Sparsh

    2016-04-07

    To support their massively-multithreaded architecture, GPUs use very large register file (RF) which has a capacity higher than even L1 and L2 caches. In total contrast, traditional CPUs use tiny RF and much larger caches to optimize latency. Due to these differences, along with the crucial impact of RF in determining GPU performance, novel and intelligent techniques are required for managing GPU RF. In this paper, we survey the techniques for designing and managing GPU RF. We discuss techniques related to performance, energy and reliability aspects of RF. To emphasize the similarities and differences between the techniques, we classify themmore » along several parameters. Lastly, the aim of this paper is to synthesize the state-of-art developments in RF management and also stimulate further research in this area.« less

  9. A survey of techniques for architecting and managing GPU register file

    SciTech Connect

    Mittal, Sparsh

    2016-04-07

    To support their massively-multithreaded architecture, GPUs use very large register file (RF) which has a capacity higher than even L1 and L2 caches. In total contrast, traditional CPUs use tiny RF and much larger caches to optimize latency. Due to these differences, along with the crucial impact of RF in determining GPU performance, novel and intelligent techniques are required for managing GPU RF. In this paper, we survey the techniques for designing and managing GPU RF. We discuss techniques related to performance, energy and reliability aspects of RF. To emphasize the similarities and differences between the techniques, we classify them along several parameters. Lastly, the aim of this paper is to synthesize the state-of-art developments in RF management and also stimulate further research in this area.

  10. Carinal and tubular airway particle concentrations in the large airways of non-smokers in the general population: evidence for high particle concentration at airway carinas.

    PubMed Central

    Churg, A; Vedal, S

    1996-01-01

    OBJECTIVE: To evaluate the extent to which human airway carinas accumulate ambient atmospheric particles, a newly developed technique was used to micro-dissect and analyse particle concentration in tubular segments and carinas of the large airways of 10 necropsy lungs from non-smokers from the general population of Vancouver. METHODS: Ratios of the particle concentrations on the carinas to the tubular segment immediately preceding it were measured with analytical electron microscopy for the mainstem bronchus, upper and lower lobe bronchi, and four different segmental or subsegmental bronchi--that is, Weibel generations 1 to about 5. A total of 119 carinal-tubular pairs was evaluated. RESULTS: Over all cases, both carinal and tubular particle concentrations increased with increasing airway generation; the median ratio of carinal to tubular particle concentration was 9:1 and did not show any trend with airway generation. The ratio was > 5 in 71% of carinal-tubular pairs, > 10 in 42% of pairs, > 20 in 31% of pairs, and > 100 in 9% of pairs. Some subjects showed a notable tendency to high ratios, with many ratios > 100, and other subjects had a tendency toward low ratios. The predominant mineral species in both carinas and tubular airway segments was crystalline silica and the relative proportion was similar in both sites; however, mean particle diameter was consistently less in the carinal tissues. CONCLUSIONS: These findings suggest that the ratio of carinal to tubular retained particles in the large airways in non-smokers is higher than might be supposed from data generated in airway casts, and that there is considerable variation in this ratio between subjects. This finding is of potential interest in models of carcinogen, toxin, and dose of fibrogenic agent to the large airways as it suggests high and sometimes extreme concentrations of toxic particles at carinas, and thus reinforces the notion that carinas may be sites of initiation of disease. PMID:8983467

  11. Distal airways in humans: dynamic hyperpolarized 3He MR imaging--feasibility

    NASA Technical Reports Server (NTRS)

    Tooker, Angela C.; Hong, Kwan Soo; McKinstry, Erin L.; Costello, Philip; Jolesz, Ferenc A.; Albert, Mitchell S.

    2003-01-01

    Dynamic hyperpolarized helium 3 (3He) magnetic resonance (MR) imaging of the human airways is achieved by using a fast gradient-echo pulse sequence during inhalation. The resulting dynamic images show differential contrast enhancement of both distal airways and the lung periphery, unlike static hyperpolarized 3He MR images on which only the lung periphery is seen. With this technique, up to seventh-generation airway branching can be visualized. Copyright RSNA, 2003.

  12. Systems physiology of the airways in health and obstructive pulmonary disease.

    PubMed

    Bates, Jason H T

    2016-09-01

    Fresh air entering the mouth and nose is brought to the blood-gas barrier in the lungs by a repetitively branching network of airways. Provided the individual airway branches remain patent, this airway tree achieves an enormous amplification in cross-sectional area from the trachea to the terminal bronchioles. Obstructive lung diseases such as asthma occur when airway patency becomes compromised. Understanding the pathophysiology of these obstructive diseases thus begins with a consideration of the factors that determine the caliber of an individual airway, which include the force balance between the inward elastic recoil of the airway wall, the outward tethering forces of its parenchymal attachments, and any additional forces due to contraction of airway smooth muscle. Other factors may also contribute significantly to airway narrowing, such as thickening of the airway wall and accumulation of secretions in the lumen. Airway obstruction becomes particularly severe when these various factors occur in concert. However, the effect of airway abnormalities on lung function cannot be fully understood only in terms of what happens to a single airway because narrowing throughout the airway tree is invariably heterogeneous and interdependent. Obstructive lung pathologies thus manifest as emergent phenomena arising from the way in which the airway tree behaves a system. These emergent phenomena are studied with clinical measurements of lung function made by spirometry and by mechanical impedance measured with the forced oscillation technique. Anatomically based computational models are linking these measurements to underlying anatomic structure in systems physiology terms. WIREs Syst Biol Med 2016, 8:423-437. doi: 10.1002/wsbm.1347 For further resources related to this article, please visit the WIREs website.

  13. Independent Business Owner/Managers. Project TEAMS. (Techniques and Education for Achieving Management Skills).

    ERIC Educational Resources Information Center

    Platte Technical Community Coll., Columbus, NE.

    Prepared as part of Platte Technical Community College's project to help managers and supervisors develop practical, up-to-date managerial skills in a relatively short time, this instructional workbook provides information and exercises applicable to on-the-job situations encountered by independent business owner/managers. Unit I provides…

  14. Focused suggestion with somatic anchoring technique: rapid self-hypnosis for pain management.

    PubMed

    Donatone, Brooke

    2013-04-01

    This article details a self-hypnosis technique designed to teach patients how to manage acute or chronic pain through directed focus. The focused suggestion with somatic anchoring technique has been used with various types of pain, including somatic pain (arthritis, post-injury pain from bone breaks, or muscle tears), visceral pain (related to irritable bowel disease), and neuropathic pain (related to multiple sclerosis). This technique combines cognitive restructuring and mindfulness meditation with indirect and direct suggestions during hypnosis. The case examples demonstrate how the focused suggestion with somatic anchoring technique is used with both acute and chronic pain conditions when use of long-term medication has been relatively ineffective.

  15. A Subject-Specific Acoustic Model of the Upper Airway for Snoring Sounds Generation

    NASA Astrophysics Data System (ADS)

    Saha, Shumit; Bradley, T. Douglas; Taheri, Mahsa; Moussavi, Zahra; Yadollahi, Azadeh

    2016-05-01

    Monitoring variations in the upper airway narrowing during sleep is invasive and expensive. Since snoring sounds are generated by air turbulence and vibrations of the upper airway due to its narrowing; snoring sounds may be used as a non-invasive technique to assess upper airway narrowing. Our goal was to develop a subject-specific acoustic model of the upper airway to investigate the impacts of upper airway anatomy, e.g. length, wall thickness and cross-sectional area, on snoring sounds features. To have a subject-specific model for snoring generation, we used measurements of the upper airway length, cross-sectional area and wall thickness from every individual to develop the model. To validate the proposed model, in 20 male individuals, intensity and resonant frequencies of modeled snoring sounds were compared with those measured from recorded snoring sounds during sleep. Based on both modeled and measured results, we found the only factor that may positively and significantly contribute to snoring intensity was narrowing in the upper airway. Furthermore, measured resonant frequencies of snoring were inversely correlated with the upper airway length, which is a risk factor for upper airway collapsibility. These results encourage the use of snoring sounds analysis to assess the upper airway anatomy during sleep.

  16. A Subject-Specific Acoustic Model of the Upper Airway for Snoring Sounds Generation

    PubMed Central

    Saha, Shumit; Bradley, T. Douglas; Taheri, Mahsa; Moussavi, Zahra; Yadollahi, Azadeh

    2016-01-01

    Monitoring variations in the upper airway narrowing during sleep is invasive and expensive. Since snoring sounds are generated by air turbulence and vibrations of the upper airway due to its narrowing; snoring sounds may be used as a non-invasive technique to assess upper airway narrowing. Our goal was to develop a subject-specific acoustic model of the upper airway to investigate the impacts of upper airway anatomy, e.g. length, wall thickness and cross-sectional area, on snoring sounds features. To have a subject-specific model for snoring generation, we used measurements of the upper airway length, cross-sectional area and wall thickness from every individual to develop the model. To validate the proposed model, in 20 male individuals, intensity and resonant frequencies of modeled snoring sounds were compared with those measured from recorded snoring sounds during sleep. Based on both modeled and measured results, we found the only factor that may positively and significantly contribute to snoring intensity was narrowing in the upper airway. Furthermore, measured resonant frequencies of snoring were inversely correlated with the upper airway length, which is a risk factor for upper airway collapsibility. These results encourage the use of snoring sounds analysis to assess the upper airway anatomy during sleep. PMID:27210576

  17. Global airway disease beyond allergy.

    PubMed

    Hellings, Peter W; Prokopakis, Emmanuel P

    2010-03-01

    Besides the anatomic continuity of the upper and lower airways, inflammation in one part of the airway influences the homeostasis of the other. The mechanisms underlying this interaction have been studied primarily in allergic disease, showing systemic immune activation, induction of inflammation at a distance, and a negative impact of nasal inflammation on bronchial homeostasis. In addition to allergy, other inflammatory conditions of the upper airways are associated with lower airway disease. Rhinosinusitis is frequently associated with asthma and chronic obstructive pulmonary disease. The impairment of purification, humidification, and warming up of the inspired air by the nose in rhinosinusitis may be responsible in part for bronchial pathology. The resolution of sinonasal inflammation via medical and/or surgical treatment is responsible for the beneficial effect of the treatment on bronchial disease. This article provides a comprehensive overview of the current knowledge of upper and lower airway communication beyond allergic disease.

  18. Recurrent airway obstruction: a review.

    PubMed

    Pirie, R S

    2014-05-01

    Recurrent airway obstruction is a widely recognised airway disorder, characterised by hypersensitivity-mediated neutrophilic airway inflammation and lower airway obstruction in a subpopulation of horses when exposed to suboptimal environments high in airborne organic dust. Over the past decade, numerous studies have further advanced our understanding of different aspects of the disease. These include clarification of the important inhaled airborne agents responsible for disease induction, improving our understanding of the underlying genetic basis of disease susceptibility and unveiling the fundamental immunological mechanisms leading to establishment of the classic disease phenotype. This review, as well as giving a clinical overview of recurrent airway obstruction, summarises much of the work in these areas that have culminated in a more thorough understanding of this debilitating disease.

  19. The airway microbiome and disease.

    PubMed

    Marsland, Benjamin J; Yadava, Koshika; Nicod, Laurent P

    2013-08-01

    Although traditionally thought to be sterile, accumulating evidence now supports the concept that our airways harbor a microbiome. Thus far, studies have focused upon characterizing the bacterial constituents of the airway microbiome in both healthy and diseased lungs, but what perhaps provides the greatest impetus for the exploration of the airway microbiome is that different bacterial phyla appear to dominate diseased as compared with healthy lungs. As yet, there is very limited evidence supporting a functional role for the airway microbiome, but continued research in this direction is likely to provide such evidence, particularly considering the progress that has been made in understanding host-microbe mutualism in the intestinal tract. In this review, we highlight the major advances that have been made discovering and describing the airway microbiome, discuss the experimental evidence that supports a functional role for the microbiome in health and disease, and propose how this emerging field is going to impact clinical practice.

  20. Early-Onset Pneumonia in Non-Traumatic Out-of-Hospital Cardiac Arrest Patients with Special Focus on Prehospital Airway Management

    PubMed Central

    Christ, Martin; von Auenmueller, Katharina Isabel; Amirie, Scharbanu; Sasko, Benjamin Michel; Brand, Michael; Trappe, Hans-Joachim

    2016-01-01

    Background More than half of all non-traumatic out-of-hospital cardiac arrest (OHCA) patients die in the hospital. Early-onset pneumonia (EOP) has been described as one of the most common complications after successful cardiopulmonary resuscitation. However, the expanded use of alternative airway devices (AAD) might influence the incidence of EOP following OHCA. Material/Methods We analyzed data from all OHCA patients admitted to our hospital between 1 January 2008 and 31 December 2014. EOP was defined as proof of the presence of a pathogenic microorganism in samples of respiratory secretions within the first 5 days after hospital admission. Results There were 252 patients admitted: 155 men (61.5%) and 97 women (38.5%), with a mean age of 69.1±13.8 years. Of these, 164 patients (77.6%) were admitted with an endotracheal tube (ET) and 62 (27.4%) with an AAD. We found that 36 out of a total of 80 respiratory secretion samples (45.0%) contained pathogenic microorganisms, with Staphylococcus aureus as the most common bacteria. Neither bacterial detection (p=0.765) nor survival rates (p=0.538) differed between patients admitted with ET and those with AAD. Conclusions Irrespective of increasing use of AAD, the incidence of EOP remains high. PMID:27295123

  1. Prevention and management of postoperative nausea and vomiting: a look at complementary techniques.

    PubMed

    Mamaril, Myrna E; Windle, Pamela E; Burkard, Joseph F

    2006-12-01

    Complementary modalities, used alone or in combination with pharmacologic therapies, play an important role in the prevention and management of postoperative nausea and vomiting (PONV) and post discharge nausea and vomiting (PDNV). This article will review the evidence for the effective use of complementary modalities: acupuncture and related techniques, aromatherapy, and music therapy that may be integrated in the perianesthesia nurse's plan of care to prevent or manage PONV.

  2. High resolution lung airway cast segmentation with proper topology suitable for computational fluid dynamic simulations.

    PubMed

    Carson, James P; Einstein, Daniel R; Minard, Kevin R; Fanucchi, Michelle V; Wallis, Christopher D; Corley, Richard A

    2010-10-01

    Developing detailed lung airway models is an important step towards understanding the respiratory system. While modern imaging and airway casting approaches have dramatically improved the potential detail of such models, challenges have arisen in image processing as the demand for greater detail pushes the image processing approaches to their limits. Airway segmentations with proper topology have neither loops nor invalid voxel-to-voxel connections. Here we describe a new technique for segmenting airways with proper topology and apply the approach to an image volume generated by magnetic resonance imaging of a silicone cast created from an excised monkey lung.

  3. Current role of modern radiotherapy techniques in the management of breast cancer

    PubMed Central

    Ozyigit, Gokhan; Gultekin, Melis

    2014-01-01

    Breast cancer is the most common type of malignancy in females. Advances in systemic therapies and radiotherapy (RT) provided long survival rates in breast cancer patients. RT has a major role in the management of breast cancer. During the past 15 years several developments took place in the field of imaging and irradiation techniques, intensity modulated RT, hypofractionation and partial-breast irradiation. Currently, improvements in the RT technology allow us a subsequent decrease in the treatment-related complications such as fibrosis and long-term cardiac toxicity while improving the loco-regional control rates and cosmetic results. Thus, it is crucial that modern radiotherapy techniques should be carried out with maximum care and efficiency. Several randomized trials provided evidence for the feasibility of modern radiotherapy techniques in the management of breast cancer. However, the role of modern radiotherapy techniques in the management of breast cancer will continue to be defined by the mature results of randomized trials. Current review will provide an up-to-date evidence based data on the role of modern radiotherapy techniques in the management of breast cancer. PMID:25114857

  4. CO2 laser excision of pediatric airway lesions.

    PubMed

    Bagwell, C E

    1990-11-01

    Treatment of life-threatening pediatric airway lesions has been greatly enhanced by development of the CO2 laser. Using this modality, endoscopic access and precise tissue destruction are possible with minimal local inflammation and subsequent edema of the narrow airway. From October 1986 through October 1988, 26 patients underwent 96 laser procedures for excision of airway lesions, in 23 patients via bronchoscopy and in three patients via microlaryngoscopy. Ages ranged from 1 day to 20 years, with most patients under 2 years of age. Diagnoses included: laryngeal cysts (1); cystic hygroma (3); tumor (neurofibroma, 1) subglottic hemangioma (1); excision of airway granulation tissue (8); and tracheal stenosis (13, including subglottic stenosis in 9). Therapy of the offending lesion required from one to eight laser procedures (mean, 2.8), excluding one patient with congenital long-segment tracheal stenosis who required 24 laser treatments for repeated excision of tracheal granulation tissue. Most lesions responded to only one or two laser treatments. No bleeding or perforation occurred secondary to laser use. Use of the laser was responsible for salvaging the airway or simplifying management of the airway in 21 of the 26 patients. In three patients with cystic hygroma affecting the laryngeal structures as well as soft tissues of the neck, laser excision was performed to maintain upper airway patency with a tracheostomy for airway control. Two patients with critical subglottic stenosis initially responded to laser excision, but moved away from the area and developed recurrence of their subglottic stenosis requiring tracheostomy, because further laser treatment was either unavailable or was deferred in their new locale.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Altered Epithelial Gene Expression in Peripheral Airways of Severe Asthma

    PubMed Central

    Singhania, Akul; Rupani, Hitasha; Jayasekera, Nivenka; Lumb, Simon; Hales, Paul; Gozzard, Neil; Davies, Donna E.

    2017-01-01

    Management of severe asthma remains a challenge despite treatment with glucocorticosteroid therapy. The majority of studies investigating disease mechanisms in treatment-resistant severe asthma have previously focused on the large central airways, with very few utilizing transcriptomic approaches. The small peripheral airways, which comprise the majority of the airway surface area, remain an unexplored area in severe asthma and were targeted for global epithelial gene expression profiling in this study. Differences between central and peripheral airways were evaluated using transcriptomic analysis (Affymetrix HG U133 plus 2.0 GeneChips) of epithelial brushings obtained from severe asthma patients (N = 17) and healthy volunteers (N = 23). Results were validated in an independent cohort (N = 10) by real-time quantitative PCR. The IL-13 disease signature that is associated with an asthmatic phenotype was upregulated in severe asthmatics compared to healthy controls but was predominantly evident within the peripheral airways, as were genes related to mast cell presence. The gene expression response associated with glucocorticosteroid therapy (i.e. FKBP5) was also upregulated in severe asthmatics compared to healthy controls but, in contrast, was more pronounced in central airways. Moreover, an altered epithelial repair response (e.g. FGFBP1) was evident across both airway sites reflecting a significant aspect of disease in severe asthma unadressed by current therapies. A transcriptomic approach to understand epithelial activation in severe asthma has thus highlighted the need for better-targeted therapy to the peripheral airways in severe asthma, where the IL-13 disease signature persists despite treatment with currently available therapy. PMID:28045928

  6. Altered Epithelial Gene Expression in Peripheral Airways of Severe Asthma.

    PubMed

    Singhania, Akul; Rupani, Hitasha; Jayasekera, Nivenka; Lumb, Simon; Hales, Paul; Gozzard, Neil; Davies, Donna E; Woelk, Christopher H; Howarth, Peter H

    2017-01-01

    Management of severe asthma remains a challenge despite treatment with glucocorticosteroid therapy. The majority of studies investigating disease mechanisms in treatment-resistant severe asthma have previously focused on the large central airways, with very few utilizing transcriptomic approaches. The small peripheral airways, which comprise the majority of the airway surface area, remain an unexplored area in severe asthma and were targeted for global epithelial gene expression profiling in this study. Differences between central and peripheral airways were evaluated using transcriptomic analysis (Affymetrix HG U133 plus 2.0 GeneChips) of epithelial brushings obtained from severe asthma patients (N = 17) and healthy volunteers (N = 23). Results were validated in an independent cohort (N = 10) by real-time quantitative PCR. The IL-13 disease signature that is associated with an asthmatic phenotype was upregulated in severe asthmatics compared to healthy controls but was predominantly evident within the peripheral airways, as were genes related to mast cell presence. The gene expression response associated with glucocorticosteroid therapy (i.e. FKBP5) was also upregulated in severe asthmatics compared to healthy controls but, in contrast, was more pronounced in central airways. Moreover, an altered epithelial repair response (e.g. FGFBP1) was evident across both airway sites reflecting a significant aspect of disease in severe asthma unadressed by current therapies. A transcriptomic approach to understand epithelial activation in severe asthma has thus highlighted the need for better-targeted therapy to the peripheral airways in severe asthma, where the IL-13 disease signature persists despite treatment with currently available therapy.

  7. A Study of the Applicability of Scientific Management Techniques for the Administration of Small, Private Church-Related Colleges.

    ERIC Educational Resources Information Center

    Ferguson, Albert S.

    Experiences with various modern management techniques and practices in selected small, private church-related colleges were studied. For comparative purposes, practices in public colleges and universities were also assessed. Management techniques used in small companies were identified through review of the literature and the management seminars…

  8. Modeling the Nonlinear Motion of the Rat Central Airways.

    PubMed

    Ibrahim, G; Rona, A; Hainsworth, S V

    2016-01-01

    Advances in volumetric medical imaging techniques allowed the subject-specific modeling of the bronchial flow through the first few generations of the central airways using computational fluid dynamics (CFD). However, a reliable CFD prediction of the bronchial flow requires modeling of the inhomogeneous deformation of the central airways during breathing. This paper addresses this issue by introducing two models of the central airways motion. The first model utilizes a node-to-node mapping between the discretized geometries of the central airways generated from a number of successive computed tomography (CT) images acquired dynamically (without breath hold) over the breathing cycle of two Sprague-Dawley rats. The second model uses a node-to-node mapping between only two discretized airway geometries generated from the CT images acquired at end-exhale and at end-inhale along with the ventilator measurement of the lung volume change. The advantage of this second model is that it uses just one pair of CT images, which more readily complies with the radiation dosage restrictions for humans. Three-dimensional computer aided design geometries of the central airways generated from the dynamic-CT images were used as benchmarks to validate the output from the two models at sampled time-points over the breathing cycle. The central airway geometries deformed by the first model showed good agreement to the benchmark geometries within a tolerance of 4%. The central airway geometry deformed by the second model better approximated the benchmark geometries than previous approaches that used a linear or harmonic motion model.

  9. Virtual 3D Modeling of Airways in Congenital Heart Defects.

    PubMed

    Speggiorin, Simone; Durairaj, Saravanan; Mimic, Branko; Corno, Antonio F

    2016-01-01

    The involvement of the airway is not uncommon in the presence of complex cardiovascular malformations. In these cases, a careful inspection of the relationship between the airway and the vasculature is paramount to plan the surgical procedure. Three-dimensional printing enhanced the visualization of the cardiovascular structure. Unfortunately, IT does not allow to remove selected anatomy to improve the visualization of the surrounding ones. Computerized modeling has the potential to fill this gap by allowing a dynamic handling of different anatomies, increasing the exposure of vessels or bronchi to show their relationship. We started to use this technique to plan the surgical repair in these complex cases where the airway is affected. This technique is routinely used in our Institution as an additional tool in the presurgical assessment. We report four cases in which the airways were compressed by vascular structures - ascending aorta in one, left pulmonary artery sling in one, patent ductus arteriosus in one, and major aorto-pulmonary collateral artery in one. We believe this technique can enhance the understanding of the causes of airway involvement and facilitate the creation of an appropriate surgical plan.

  10. Virtual 3D Modeling of Airways in Congenital Heart Defects

    PubMed Central

    Speggiorin, Simone; Durairaj, Saravanan; Mimic, Branko; Corno, Antonio F.

    2016-01-01

    The involvement of the airway is not uncommon in the presence of complex cardiovascular malformations. In these cases, a careful inspection of the relationship between the airway and the vasculature is paramount to plan the surgical procedure. Three-dimensional printing enhanced the visualization of the cardiovascular structure. Unfortunately, IT does not allow to remove selected anatomy to improve the visualization of the surrounding ones. Computerized modeling has the potential to fill this gap by allowing a dynamic handling of different anatomies, increasing the exposure of vessels or bronchi to show their relationship. We started to use this technique to plan the surgical repair in these complex cases where the airway is affected. This technique is routinely used in our Institution as an additional tool in the presurgical assessment. We report four cases in which the airways were compressed by vascular structures – ascending aorta in one, left pulmonary artery sling in one, patent ductus arteriosus in one, and major aorto-pulmonary collateral artery in one. We believe this technique can enhance the understanding of the causes of airway involvement and facilitate the creation of an appropriate surgical plan. PMID:27833903

  11. Surgery of the airway: historic notes

    PubMed Central

    2016-01-01

    Prior to the 20th century, the need for surgical procedures on the airway was infrequent and consisted mainly of tracheostomy to relieve airway obstruction or repair of tracheal injuries such as lacerations. Even the ability of tracheal suture lines to heal primarily was viewed with concern due to the rigidity of the tracheal wall, its precarious blood supply and uncertainty as to whether the cartilage components could heal without complications. In the 20th century the evolution of tracheal procedures on major airways evolved to meet the challenges provided by the expanding fields of thoracic surgery and advent of mechanical respiratory support with its associated complications. In the first half of the century lobar and lung resections done for tuberculosis and lung cancer required methods for safe closure of the resulting bronchial stumps and end-to-end bronchial anastomosis in the case of sleeve resections of the lung. Beginning in mid-century the advent of respiratory care units for the treatment of polio and for the expanding fields of thoracic and cardiac surgery resulted in a significant number of post-intubation tracheal stenosis requiring resection and primary repair. In the last 20 years of the century the development of lung transplantation with its requirement for successful bronchial anastomoses between the donor and recipient bronchi, created unique challenges including ischemia of the donor bronchus the adverse effects of immunosuppression, donor lung preservation and diagnosis and management of post-transplant infection and rejection. PMID:26981261

  12. Topical airway anesthesia for awake fiberoptic intubation: Comparison between airway nerve blocks and nebulized lignocaine by ultrasonic nebulizer

    PubMed Central

    Gupta, Babita; Kohli, Santvana; Farooque, Kamran; Jalwal, Gopal; Gupta, Deepak; Sinha, Sumit; Chandralekha

    2014-01-01

    Overview: Awake fiberoptic bronchoscope (FOB) guided intubation is the gold standard of airway management in patients with cervical spine injury. It is essential to sufficiently anesthetize the upper airway before the performance of awake FOB guided intubation in order to ensure patient comfort and cooperation. This randomized controlled study was performed to compare two methods of airway anesthesia, namely ultrasonic nebulization of local anesthetic and performance of airway blocks. Materials and Methods: A total of 50 adult patients with cervical spine injury were randomly allocated into two groups. Group L received airway anesthesia through ultrasonic nebulization of 10 ml of 4% lignocaine and Group NB received airway blocks (bilateral superior laryngeal and transtracheal recurrent laryngeal) each with 2 ml of 2% lignocaine and viscous lignocaine gargles. FOB guided orotracheal intubation was then performed. Hemodynamic variables at baseline and during the procedure, patient recall, vocal cord visibility, ease of intubation, coughing/gagging episodes, and signs of lignocaine toxicity were noted. Results: The observations did not reveal any significant differences in demographics or hemodynamic parameters at any time during the study. However, the time taken for intubation was significantly lower in Group NB as compared with the Group L. Group L had an increased number of coughing/gagging episodes as compared with Group NB. Vocal cord visibility and ease of intubation were better in patients who received airway blocks and hence the amount of supplemental lignocaine used was less in this group. Overall patient comfort was better in Group NB with fewer incidences of unpleasant recalls as compared with Group L. Conclusion: Upper airway blocks provide better quality of anesthesia than lignocaine nebulization as assessed by patient recall of procedure, coughing/gagging episodes, ease of intubation, vocal cord visibility, and time taken to intubate. PMID:25538514

  13. A novel technique of anesthesia induction in supine position with impaled knife in the back

    PubMed Central

    Kumar, Ajay; Saha, Kamales Kumar; Jagiasi, Bharat; Saha, Kakalee K

    2015-01-01

    Current technique of airway management for impaled knife in the back includes putting the patient in lateral position and intubation. We present here a novel technique of anesthesia induction (intubation and central line insertion) in a patient with impaled knife in the back which is simple and easily reproducible. This technique can be used for single lung ventilation using double lumen tube or bronchial blocker also if desired. PMID:25849698

  14. Oral airway flow dynamics in healthy humans.

    PubMed

    Amis, T C; O'Neill, N; Wheatley, J R

    1999-02-15

    1. Oral airway resistance (RO) is an important determinant of oro-nasal partitioning of airflow (e.g. during exercise and sleep); however, little is known of factors influencing its magnitude and measurement. 2. We developed a non-invasive standardized technique for measuring RO (based on a modification of posterior rhinomanometry) and examined inspiratory RO in 17 healthy male subjects (age, 36 +/- 2 years (mean +/- s.e.m.); height, 177 +/- 2 cm; weight, 83 +/- 3 kg). 3. Inspiratory RO (at 0.4 l s-1) was 0.86 +/- 0.23 cmH2O l-1 s-1 during resting mouthpiece breathing in the upright posture. RO was unaffected by assumption of the supine posture, tended to decrease with head and neck extension and increased to 1.22 +/- 0.19 cmH2O l-1 s-1 (n = 10 subjects, P < 0.01) with 40-45 deg of head and neck flexion. When breathing via a mouth-mask RO was 2.98 +/- 0.42 cmH2O l-1 s-1 (n = 7) and not significantly different from nasal airway resistance. 4. Thus, in awake healthy male subjects with constant jaw position, RO is unaffected by body posture but increases with modest degrees of head and neck flexion. This influence on upper airway patency may be important when oral route breathing is associated with alterations in head and neck position, e.g. during sleep.

  15. Putting the Squeeze on Airway Epithelia

    PubMed Central

    Park, Jin-Ah; Fredberg, Jeffrey J.

    2015-01-01

    Asthma is characterized by chronic inflammation, airway hyperresponsiveness, and progressive airway remodeling. The airway epithelium is known to play a critical role in the initiation and perpetuation of these processes. Here, we review how excessive epithelial stress generated by bronchoconstriction is sufficient to induce airway remodeling, even in the absence of inflammatory cells. PMID:26136543

  16. Results of a Survey Software Development Project Management in the U.S. Aerospace Industry. Volume II. Project Management Techniques, Procedures and Tools.

    DTIC Science & Technology

    1979-12-18

    PROJECT MANAGEMENT IN THE U.S. AEROSPACE INDUSTRY Volume I1 PROJECT MANAGEMENT TECHNIQUES, PROCEDURES AND TOOLS RICHARD Hf. THAYER SACRAMENTO AIR...MANAGEMENT TECHNIQUES AND PROCEDURES USED IN SOFTWARE DEVELOPMENT PROJECTS BY THE US AEROSPACE INDUSTRY BY Richard H. Thayer and John H. Lehman This report...contains the results of a survey conducted in 1977 and 1978 on how the US Aerospace Industry manages its software development projects. The sample of

  17. Review of Budgeting Techniques in Academic and Research Libraries. ARL Management Supplement Volume One, Number Two.

    ERIC Educational Resources Information Center

    Association of Research Libraries, Washington, DC. Office of Univ. Library Management Studies.

    Recent years have seen increased interest in extending the concept of budgeting to include activities related to planning, coordinating, and monitoring the entire operation of a library. There is strong evidence that the budgeting technique used can affect management potential. About 80% of total libraries use traditional line item or lump sum…

  18. Management of Giant Cell Tumour Radius in a Three Year old Child with an Improvised Technique

    PubMed Central

    Puri, Ajay; Gulia, Ashish; Sharma, Seema; Verma, Amit K

    2014-01-01

    Giant cell tumours of immature skeleton have a very low incidence and epi-metaphyseal location. We are presenting giant cell tumour distal radius in a skeletally immature patient; an uncontained defect with a large soft tissue component which was managed by wide excision and reconstruction with an improvised technique. PMID:25654002

  19. Techniques of Document Management: A Review of Text Retrieval and Related Technologies.

    ERIC Educational Resources Information Center

    Veal, D. C.

    2001-01-01

    Reviews present and possible future developments in the techniques of electronic document management, the major ones being text retrieval and scanning and OCR (optical character recognition). Also addresses document acquisition, indexing and thesauri, publishing and dissemination standards, impact of the Internet, and the document management…

  20. The Use of Contingency Management Techniques--An Applied Classroom Project

    ERIC Educational Resources Information Center

    Carter, Dianne Knotts; And Others

    1970-01-01

    Describes a Title I project whose purpose was "to determine if a series of three group and three individual instruction sessions with classroom teachers were adequate to train them in the use of basic behavioral modification techniques, by judging whether or not this instruction was evidenced by their management of children in the classroom."…

  1. Cultural Variations in Mothers' Acceptance of and Intent to Use Behavioral Child Management Techniques

    ERIC Educational Resources Information Center

    Mah, Janet W. T.; Johnston, Charlotte

    2012-01-01

    We examined cultural differences in mothers' acceptance of and intent to use behavioral parenting techniques for managing disruptive child behavior, and the possible roles of parenting styles and implicit theories in explaining these cultural differences. A community sample of 117 Euro-Canadian and Chinese-immigrant mothers of boys aged 4- to…

  2. An examination of the potential applications of automatic classification techniques to Georgia management problems

    NASA Technical Reports Server (NTRS)

    Rado, B. Q.

    1975-01-01

    Automatic classification techniques are described in relation to future information and natural resource planning systems with emphasis on application to Georgia resource management problems. The concept, design, and purpose of Georgia's statewide Resource AS Assessment Program is reviewed along with participation in a workshop at the Earth Resources Laboratory. Potential areas of application discussed include: agriculture, forestry, water resources, environmental planning, and geology.

  3. Classroom Management: Teaching Techniques and Strategies for Dealing with Discipline Problems.

    ERIC Educational Resources Information Center

    Atlanta Teacher Corps Consortium, GA.

    Techniques and activities for effective classroom management are presented in this module. The stated objectives of the module are to promote appropriate student behavior, to develop good interpersonal relationships and a positive socioemotional climate, and to establish and maintain a productive classroom organization. Samples of pre-post…

  4. Laparoscopic Heller Myotomy and Dor Fundoplication for Esophageal Achalasia: Technique and Perioperative Management.

    PubMed

    Andolfi, Ciro; Fisichella, P Marco

    2016-11-01

    Surgical correction of achalasia using laparoscopic Heller myotomy with Dor fundoplication is argued to be the gold standard treatment for patients with achalasia. The goal of this technical report is to illustrate our preferred approach to patients with achalasia and to provide the reader with a detailed description of our operative technique, its rationale, and our pre and postoperative management.

  5. Increasing Acceptance of Behavioral Child Management Techniques: What Do Parents Say?

    ERIC Educational Resources Information Center

    Pemberton, Joy R.; Borrego, Joaquin

    2007-01-01

    Consumers' willingness to accept treatments is an important concern of clinicians and clinical researchers, particularly when treating children. However, few studies have directly asked parents to give reasons for accepting or refusing treatments. In the current study, 82 parents read descriptions of six behavioral child management techniques,…

  6. Mobility Based Key Management Technique for Multicast Security in Mobile Ad Hoc Networks

    PubMed Central

    Madhusudhanan, B.; Chitra, S.; Rajan, C.

    2015-01-01

    In MANET multicasting, forward and backward secrecy result in increased packet drop rate owing to mobility. Frequent rekeying causes large message overhead which increases energy consumption and end-to-end delay. Particularly, the prevailing group key management techniques cause frequent mobility and disconnections. So there is a need to design a multicast key management technique to overcome these problems. In this paper, we propose the mobility based key management technique for multicast security in MANET. Initially, the nodes are categorized according to their stability index which is estimated based on the link availability and mobility. A multicast tree is constructed such that for every weak node, there is a strong parent node. A session key-based encryption technique is utilized to transmit a multicast data. The rekeying process is performed periodically by the initiator node. The rekeying interval is fixed depending on the node category so that this technique greatly minimizes the rekeying overhead. By simulation results, we show that our proposed approach reduces the packet drop rate and improves the data confidentiality. PMID:25834838

  7. Mobility based key management technique for multicast security in mobile ad hoc networks.

    PubMed

    Madhusudhanan, B; Chitra, S; Rajan, C

    2015-01-01

    In MANET multicasting, forward and backward secrecy result in increased packet drop rate owing to mobility. Frequent rekeying causes large message overhead which increases energy consumption and end-to-end delay. Particularly, the prevailing group key management techniques cause frequent mobility and disconnections. So there is a need to design a multicast key management technique to overcome these problems. In this paper, we propose the mobility based key management technique for multicast security in MANET. Initially, the nodes are categorized according to their stability index which is estimated based on the link availability and mobility. A multicast tree is constructed such that for every weak node, there is a strong parent node. A session key-based encryption technique is utilized to transmit a multicast data. The rekeying process is performed periodically by the initiator node. The rekeying interval is fixed depending on the node category so that this technique greatly minimizes the rekeying overhead. By simulation results, we show that our proposed approach reduces the packet drop rate and improves the data confidentiality.

  8. Difficult airway equipment: a survey of standards across metropolitan Perth.

    PubMed

    Alakeson, N; Flett, T; Hunt, V; Ramgolam, A; Reynolds, W; Hartley, K; Hegarty, M; von Ungern-Sternberg, B S

    2014-09-01

    The importance of appropriate equipment to manage the difficult airway has been highlighted by the publication of the Australian and New Zealand College of Anaesthetists (ANZCA) guidelines in 2012. We set out to audit compliance with these guidelines in all public and private sites providing general anaesthesia in metropolitan Perth. Public and private health care websites identified 39 sites of which 37 were studied. Institutional and ethics approval was obtained. A tick-box design audit tool, based on the ANZCA guidelines, was used to collect information regarding the dedicated difficult airway container (DDAC) at each site. As recommended in the guidelines, only equipment within the DDAC was considered. Further data about each site, including the number of theatre suites, satellite anaesthetic areas, use of capnography and categories of patients treated (adult, obstetric and paediatric) were collected. An adult DDAC was found at 92% of all sites, but none of the sites had all the essential equipment listed in the ANZCA guidelines. There was limited provision of adult difficult airway equipment within private sites compared to public, and less provision of paediatric difficult airway equipment across all sites treating paediatric patients in metropolitan Perth. Capnography was available in 76% of post anaesthesia care units and used regularly in 27%. Adherence to the ANZCA guidelines regarding the DDAC could be improved. Standardised equipment across a metropolitan region would be of value in the management of the difficult airway.

  9. Investigation of energy management strategies for photovoltaic systems - An analysis technique

    NASA Technical Reports Server (NTRS)

    Cull, R. C.; Eltimsahy, A. H.

    1982-01-01

    Progress is reported in formulating energy management strategies for stand-alone PV systems, developing an analytical tool that can be used to investigate these strategies, applying this tool to determine the proper control algorithms and control variables (controller inputs and outputs) for a range of applications, and quantifying the relative performance and economics when compared to systems that do not apply energy management. The analysis technique developed may be broadly applied to a variety of systems to determine the most appropriate energy management strategies, control variables and algorithms. The only inputs required are statistical distributions for stochastic energy inputs and outputs of the system and the system's device characteristics (efficiency and ratings). Although the formulation was originally driven by stand-alone PV system needs, the techniques are also applicable to hybrid and grid connected systems.

  10. Gene Delivery to the Airway

    PubMed Central

    Keiser, Nicholas W.; Engelhardt, John F.

    2013-01-01

    This unit describes generation of and gene transfer to several commonly used airway models. Isolation and transduction of primary airway epithelial cells are first described. Next, the preparation of polarized airway epithelial monolayers is outlined. Transduction of these polarized cells is also described. Methods are presented for generation of tracheal xenografts as well as both ex vivo and in vivo gene transfer to these xenografts. Finally, a method for in vivo gene delivery to the lungs of rodents is included. Methods for evaluating transgene expression are given in the support protocols. PMID:23853081

  11. A comparison between audio and audiovisual distraction techniques in managing anxious pediatric dental patients.

    PubMed

    Prabhakar, A R; Marwah, N; Raju, O S

    2007-01-01

    Pain is not the sole reason for fear of dentistry. Anxiety or the fear of unknown during dental treatment is a major factor and it has been the major concern for dentists for a long time. Therefore, the main aim of this study was to evaluate and compare the two distraction techniques, viz, audio distraction and audiovisual distraction, in management of anxious pediatric dental patients. Sixty children aged between 4-8 years were divided into three groups. Each child had four dental visits--screening visit, prophylaxis visit, cavity preparation and restoration visit, and extraction visit. Child's anxiety level in each visit was assessed using a combination of four measures: Venham's picture test, Venham's rating of clinical anxiety, pulse rate, and oxygen saturation. The values obtained were tabulated and subjected to statistical analysis. It was concluded that audiovisual distraction technique was more effective in managing anxious pediatric dental patient as compared to audio distraction technique.

  12. A Novel Surgical Pre-suturing Technique for the Management of Ankyloglossia.

    PubMed

    Khairnar, Mayur; Pawar, Babita; Khairnar, Darshana

    2014-01-01

    Ankyloglossia or "tongue-tie" is a congenital anomaly caused by tight lingual frenulum that abnormally connects the tongue base to the floor of the mouth. Ankyloglossia can results in difficulty during speech and deglutition. This case series presents a novel surgical technique in the management of ankyloglossia in using presuturing technique in which different sets of sutures are given on lingual frenum before severing it. This results in reduced opening of the wound, minimal bleeding, pain and discomfort. Two male patients with severe ankyloglossia had been managed with this technique and after 2 years of follow-up of these cases showed satisfactory protrusive and lateral movement of the tongue with minimal scarring and discomfort.

  13. A Novel Surgical Pre-suturing Technique for the Management of Ankyloglossia

    PubMed Central

    Khairnar, Mayur; Pawar, Babita; Khairnar, Darshana

    2014-01-01

    Ankyloglossia or “tongue-tie” is a congenital anomaly caused by tight lingual frenulum that abnormally connects the tongue base to the floor of the mouth. Ankyloglossia can results in difficulty during speech and deglutition. This case series presents a novel surgical technique in the management of ankyloglossia in using presuturing technique in which different sets of sutures are given on lingual frenum before severing it. This results in reduced opening of the wound, minimal bleeding, pain and discomfort. Two male patients with severe ankyloglossia had been managed with this technique and after 2 years of follow-up of these cases showed satisfactory protrusive and lateral movement of the tongue with minimal scarring and discomfort. PMID:25598942

  14. Using mediation techniques to manage conflict and create healthy work environments.

    PubMed

    Gerardi, Debra

    2004-01-01

    Healthcare organizations must find ways for managing conflict and developing effective working relationships to create healthy work environments. The effects of unresolved conflict on clinical outcomes, staff retention, and the financial health of the organization lead to many unnecessary costs that divert resources from clinical care. The complexity of delivering critical care services makes conflict resolution difficult. Developing collaborative working relationships helps to manage conflict in complex environments. Working relationships are based on the ability to deal with differences. Dealing with differences requires skill development and techniques for balancing interests and communicating effectively. Techniques used by mediators are effective for resolving disputes and developing working relationships. With practice, these techniques are easily transferable to the clinical setting. Listening for understanding, reframing, elevating the definition of the problem, and forming clear agreements can foster working relationships, decrease the level of conflict, and create healthy work environments that benefit patients and professionals.

  15. Resistance Management Techniques of Milton H. Erickson, M.D.: An Application to Nonhypnotic Mental Health Counseling.

    ERIC Educational Resources Information Center

    Otani, Akira

    1989-01-01

    Delineates five selected hypnotically based techniques of client resistance management pioneered by Milton H. Erickson: acceptance; paradoxical encouragement; reframing; displacement; dissociation. Explains how techniques can be applied to nonhypnotic mental health counseling. Discusses relevant clinical, theoretical, and empirical issues related…

  16. Management of maxillofacial trauma in emergency: An update of challenges and controversies

    PubMed Central

    Jose, Anson; Nagori, Shakil Ahmed; Agarwal, Bhaskar; Bhutia, Ongkila; Roychoudhury, Ajoy

    2016-01-01

    Trauma management has evolved significantly in the past few decades thereby reducing mortality in the golden hour. However, challenges remain, and one such area is maxillofacial injuries in a polytrauma patient. Severe injuries to the maxillofacial region can complicate the early management of a trauma patient owing to the regions proximity to the brain, cervical spine, and airway. The usual techniques of airway breathing and circulation (ABC) management are often modified or supplemented with other methods in case of maxillofacial injuries. Such modifications have their own challenges and pitfalls in an already difficult situation. PMID:27162439

  17. Using economic valuation techniques to inform water resources management: a survey and critical appraisal of available techniques and an application.

    PubMed

    Birol, Ekin; Karousakis, Katia; Koundouri, Phoebe

    2006-07-15

    The need for economic analysis for the design and implementation of efficient water resources management policies is well documented in the economics literature. This need is also emphasised in the European Union's recent Water Framework Directive (2000/60/EC), and is relevant to the objectives of Euro-limpacs, an EU funded project which inter alia, aims to provide a decision-support system for valuing the effects of future global change on Europe's freshwater ecosystems. The purpose of this paper is to define the role of economic valuation techniques in assisting in the design of efficient, equitable and sustainable policies for water resources management in the face of environmental problems such as pollution, intensive land use in agriculture and climate change. The paper begins with a discussion of the conceptual economic framework that can be used to inform water policy-making. An inventory of the available economic valuation methods is presented and the scope and suitability of each for studying various aspects of water resources are critically discussed. Recent studies that apply these methods to water resources are reviewed. Finally, an application of one of the economic valuation methods, namely the contingent valuation method, is presented using a case study of the Cheimaditida wetland in Greece.

  18. Apoptosis and the Airway Epithelium

    PubMed Central

    White, Steven R.

    2011-01-01

    The airway epithelium functions as a barrier and front line of host defense in the lung. Apoptosis or programmed cell death can be elicited in the epithelium as a response to viral infection, exposure to allergen or to environmental toxins, or to drugs. While apoptosis can be induced via activation of death receptors on the cell surface or by disruption of mitochondrial polarity, epithelial cells compared to inflammatory cells are more resistant to apoptotic stimuli. This paper focuses on the response of airway epithelium to apoptosis in the normal state, apoptosis as a potential regulator of the number and types of epithelial cells in the airway, and the contribution of epithelial cell apoptosis in important airways diseases. PMID:22203854

  19. Management strategy evaluation of pheromone-baited trapping techniques to improve management of invasive sea lamprey

    USGS Publications Warehouse

    Dawson, Heather; Jones, Michael L.; Irwin, Brian J.; Johnson, Nicholas; Wagner, Michael C.; Szymanski, Melissa

    2016-01-01

    We applied a management strategy evaluation (MSE) model to examine the potential cost-effectiveness of using pheromone-baited trapping along with conventional lampricide treatment to manage invasive sea lamprey. Four pheromone-baited trapping strategies were modeled: (1) stream activation wherein pheromone was applied to existing traps to achieve 10−12 mol/L in-stream concentration, (2) stream activation plus two additional traps downstream with pheromone applied at 2.5 mg/hr (reverse-intercept approach), (3) trap activation wherein pheromone was applied at 10 mg/hr to existing traps, and (4) trap activation and reverse-intercept approach. Each new strategy was applied, with remaining funds applied to conventional lampricide control. Simulating deployment of these hybrid strategies on fourteen Lake Michigan streams resulted in increases of 17 and 11% (strategies 1 and 2) and decreases of 4 and 7% (strategies 3 and 4) of the lakewide mean abundance of adult sea lamprey relative to status quo. MSE revealed performance targets for trap efficacy to guide additional research because results indicate that combining lampricides and high efficacy trapping technologies can reduce sea lamprey abundance on average without increasing control costs.

  20. A novel technique of otic barotrauma management using modified intravenous cannulae.

    PubMed

    Zhang, Qi; Banks, Catherine; Choroomi, Sim; Kertesz, Thomas

    2013-09-01

    This article provides the first detailed description and systematic evaluation of the management of otic barotrauma using modified intravenous cannulae. A 24-gauge IC cannula was modified as a tool for tympanostomy tube placement and middle ear ventilation. The medical records of 271 ears of 156 adult patients (median age 49 years) who underwent this procedure were reviewed retrospectively. Hundred and ninty-one tubes were placed for otalgia because of hyperbaric oxygen therapy, 58 tubes were inserted for air travel prophylaxis and 22 tubes were placed for management of otic barotrauma post-flight. All the patients who had this procedure for prophylaxis experienced regular otic barotrauma symptoms during air travel prior to tube placement. All patients were reviewed 6 weeks (range 2-9 weeks) post-procedure. This technique of otic barotrauma management worked effectively in 99 % of treated patients. On follow-up, 88 % of tubes were found to be extruded and non-extruded tubes were removed in clinic without any anaesthesia. 99.6 % of tympanic membrane had healed completely and spontaneously without sequelae. Given the safety, effectiveness, low risk of complications associated with this novel tympanostomy technique, it provided a simple yet effective therapeutic option for the management of otic barotrauma. Finally, this technique can be easily applied in all health settings as it only requires medical supplies readily available in hospitals, therefore there is no additional cost.

  1. A new removable airway stent

    PubMed Central

    Amundsen, Tore; Sørhaug, Sveinung; Leira, Håkon Olav; Tyvold, Stig Sverre; Langø, Thomas; Hammer, Tommy; Manstad-Hulaas, Frode; Mattsson, Erney

    2016-01-01

    Background Malignant airway obstruction is a feared complication and will most probably occur more frequently in the future because of increasing cancer incidence and increased life expectancy in cancer patients. Minimal invasive treatment using airway stents represents a meaningful and life-saving palliation. We present a new removable airway stent for improved individualised treatment. Methods To our knowledge, the new airway stent is the world's first knitted and uncovered self-expanding metal stent, which can unravel and be completely removed. In an in vivo model using two anaesthetised and spontaneously breathing pigs, we deployed and subsequently removed the stents by unravelling the device. The procedures were executed by flexible bronchoscopy in an acute and a chronic setting – a ‘proof-of-principle’ study. Results The new stent was easily and accurately deployed in the central airways, and it remained fixed in its original position. It was easy to unravel and completely remove from the airways without clinically significant complications. During the presence of the stent in the chronic study, granulation tissue was induced. This tissue disappeared spontaneously with the removal. Conclusions The new removable stent functioned according to its purpose and unravelled easily, and it was completely removed without significant technical or medical complications. Induced granulation tissue disappeared spontaneously. Further studies on animals and humans are needed to define its optimal indications and future use. PMID:27608269

  2. Implementation of quality improvement techniques for management and technical processes in the ACRV project

    NASA Technical Reports Server (NTRS)

    Raiman, Laura B.

    1992-01-01

    Total Quality Management (TQM) is a cooperative form of doing business that relies on the talents of everyone in an organization to continually improve quality and productivity, using teams and an assortment of statistical and measurement tools. The objective of the activities described in this paper was to implement effective improvement tools and techniques in order to build work processes which support good management and technical decisions and actions which are crucial to the success of the ACRV project. The objectives were met by applications in both the technical and management areas. The management applications involved initiating focused continuous improvement projects with widespread team membership. The technical applications involved applying proven statistical tools and techniques to the technical issues associated with the ACRV Project. Specific activities related to the objective included working with a support contractor team to improve support processes, examining processes involved in international activities, a series of tutorials presented to the New Initiatives Office and support contractors, a briefing to NIO managers, and work with the NIO Q+ Team. On the technical side, work included analyzing data from the large-scale W.A.T.E.R. test, landing mode trade analyses, and targeting probability calculations. The results of these efforts will help to develop a disciplined, ongoing process for producing fundamental decisions and actions that shape and guide the ACRV organization .

  3. Advanced techniques in IR thermography as a tool for the pest management professional

    NASA Astrophysics Data System (ADS)

    Grossman, Jon L.

    2006-04-01

    Within the past five years, the Pest Management industry has become aware that IR thermography can aid in the detection of pest infestations and locate other conditions that are within the purview of the industry. This paper will review the applications that can be utilized by the pest management professional and discuss the advanced techniques that may be required in conjunction with thermal imaging to locate insect and other pest infestations, moisture within structures, the verification of data and the special challenges associated with the inspection process.

  4. Airflow and nanoparticle deposition in a 16-generation tracheobronchial airway model

    EPA Science Inventory

    In order to achieve both manageable simulation and local accuracy of airflow and nanoparticle deposition in a representative human tracheobronchial (TB) region, the complex airway network was decomposed into adjustable triple-bifurcation units, spreading axially and laterally. Gi...

  5. Developing nondestructive techniques for managing conflicts between fisheries and double-crested cormorant colonies

    USGS Publications Warehouse

    Suzuki, Yasuko; Roby, Daniel D.; Lyons, Donald E.; Courtot, Karen; Collis, Ken

    2015-01-01

    Double-crested cormorants (Phalacrocorax auritus) have been identified as the source of significant mortality to juvenile salmonids (Oncorhynchus spp.) in the Columbia River Basin. Management plans for reducing the size of a large colony on East Sand Island (OR, USA) in the Columbia River estuary are currently being developed. We evaluated habitat enhancement and social attraction as nondestructive techniques for managing cormorant nesting colonies during 2004–2007. We tested these techniques on unoccupied plots adjacent to the East Sand Island cormorant colony. Cormorants quickly colonized these plots and successfully raised young. Cormorants also were attracted to nest and raised young on similar plots at 2 islands approximately 25 km from East Sand Island; 1 island had a history of successful cormorant nesting whereas the other was a site where cormorants had previously nested unsuccessfully. On a third island with no history of cormorant nesting or nesting attempts, these techniques were unsuccessful at attracting cormorants to nest. Our results suggest that some important factors influencing attraction of nesting cormorants using these techniques include history of cormorant nesting, disturbance, and presence of breeding cormorants nearby. These techniques may be effective in redistributing nesting cormorants away from areas where fish stocks of conservation concern are susceptible to predation, especially if sites with a recent history of cormorant nesting are available within their foraging or dispersal range. Published 2015. Wiley Periodicals, Inc. This article is a US Government work and, as such, is in the public domain in the United States of America.

  6. Truncal blocks for perioperative pain management: a review of the literature and evolving techniques.

    PubMed

    Go, Ramon; Huang, Yolanda Y; Weyker, Paul D; Webb, Christopher Aj

    2016-10-01

    As the American healthcare system continues to evolve and reimbursement becomes tied to value-based incentive programs, perioperative pain management will become increasingly important. Regional anesthetic techniques are only one component of a successful multimodal pain regimen. In recent years, the use of peripheral and paraneuraxial blocks to provide chest wall and abdominal analgesia has gained popularity. When used within a multimodal regimen, truncal blocks may provide similar analgesia when compared with other regional anesthetic techniques. While there are other reviews that cover this topic, our review will also highlight the emerging role for serratus plane blocks, pectoral nerve blocks and quadratus lumborum blocks in providing thoracic and abdominal analgesia.

  7. Advances in Surgical Reconstructive Techniques in the Management of Penile, Urethral, and Scrotal Cancer.

    PubMed

    Bickell, Michael; Beilan, Jonathan; Wallen, Jared; Wiegand, Lucas; Carrion, Rafael

    2016-11-01

    This article reviews the most up-to-date surgical treatment options for the reconstructive management of patients with penile, urethral, and scrotal cancer. Each organ system is examined individually. Techniques and discussion for penile cancer reconstruction include Mohs surgery, glans resurfacing, partial and total glansectomy, and phalloplasty. Included in the penile cancer reconstruction section is the use of penile prosthesis in phalloplasty patients after penectomy, tissue engineering in phallic regeneration, and penile transplantation. Reconstruction following treatment of primary urethral carcinoma and current techniques for scrotal cancer reconstruction using split-thickness skin grafts and flaps are described.

  8. A modified technique for the laparoscopic management of large gastric bezoars

    PubMed Central

    Ulukent, Suat C.; Ozgun, Yigit M.; Sahbaz, Nuri A.

    2016-01-01

    Bezoar is an intraluminal mass formed by the accumulation of undigested material anywhere in the gastrointestinal system. Most of small bezoars are removed by gastrointestinal endoscopy, while the best approach for the larger ones is surgical removal. Currently, laparoscopic technique is successfully used in the treatment of bezoars, which are used to be managed by open surgery. In the laparoscopic treatment of bezoars, contamination of peritoneal cavity is a major problem. We describe a modified laparoscopic technique in which an endobag is placed in the stomach instead of the peritoneal cavity in order to avoid spillage of the bezoar during laparoscopic removal. PMID:27570860

  9. The diagnosis and management of pre-invasive breast disease: The role of new diagnostic techniques

    PubMed Central

    Nerurkar, Ashutosh; Osin, Peter

    2003-01-01

    In recent years we have seen significantly increased use of minimally invasive diagnostic techniques in the management of breast disease. There is wide recognition of fine needle aspiration and core biopsy as the principal diagnostic methods. However, concerns exist regarding their reliability. This article provides a brief overview of the major diagnostic issues related to use of fine needle aspiration, core biopsy and ductal lavage. It summarizes areas of use for each technique, outlines the main diagnostic pitfalls and their causes, and provides a perspective on future developments in the field. PMID:14580247

  10. Kinematic MRI study of upper-airway biomechanics using electrical muscle stimulation

    NASA Astrophysics Data System (ADS)

    Brennick, Michael J.; Margulies, Susan S.; Ford, John C.; Gefter, Warren B.; Pack, Allan I.

    1997-05-01

    We have developed a new and powerful method to study the movement and function of upper airway muscles. Our method is to use direct electrical stimulation of individual upper airway muscles, while performing state of the art high resolution magnetic resonance imaging (MRI). We have adapted a paralyzed isolated UA cat model so that positive or negative static pressure in the UA can be controlled at specific levels while electrical muscle stimulation is applied during MRI. With these techniques we can assess the effect of muscle stimulation on airway cross-sectional area compliance and soft tissue motion. We are reporting the preliminary results and MRI techniques which have enabled us to examine changes in airway dimensions which result form electrical stimulation of specific upper airway dilator muscles. The results of this study will be relevant to the development of new clinical treatments for obstructive sleep apnea by providing new information as to exactly how upper airway muscles function to dilate the upper airway and the strength of stimulation required to prevent the airway obstruction when overall muscle tone may not be sufficient to maintain regular breathing.

  11. Self-expandable metallic stents in nonmalignant large airway disease.

    PubMed

    Fortin, Marc; MacEachern, Paul; Hergott, Christopher A; Chee, Alex; Dumoulin, Elaine; Tremblay, Alain

    2015-01-01

    Airway self-expandable metallic stents (SEMS) were initially studied in malignant airway obstruction; however, their use in benign airway diseases has become progressively more frequent. This may be explained by their ease of insertion compared with silicone stents, which require rigid bronchoscopy for insertion. While initial experience with SEMS in benign disease suggested efficacy and promising short-term safety profile, long-term follow-up revealed significant complication rates. In addition to a high complication rate, the management of these complications is made more difficult by the semipermanent nature of these devices. Reported complications include infection, granulation tissue formation, stent migration, stent fracture, airway perforation and fistula formation, as well as extension of the initial injury, potentially eliminating other therapeutic options such as surgical resection. Therefore, SEMS should only be used in nonmalignant large airway disease as a last resort for patients in whom other endoscopic methods, including silicone stents and dilations, as well as surgical options have failed or are technically not feasible.

  12. Human airway ciliary dynamics

    PubMed Central

    Thompson, Kristin; Knowles, Michael R.; Davis, C. William

    2013-01-01

    Airway cilia depend on precise changes in shape to transport the mucus gel overlying mucosal surfaces. The ciliary motion can be recorded in several planes using video microscopy. However, cilia are densely packed, and automated computerized systems are not available to convert these ciliary shape changes into forms that are useful for testing theoretical models of ciliary function. We developed a system for converting planar ciliary motions recorded by video microscopy into an empirical quantitative model, which is easy to use in validating mathematical models, or in examining ciliary function, e.g., in primary ciliary dyskinesia (PCD). The system we developed allows the manipulation of a model cilium superimposed over a video of beating cilia. Data were analyzed to determine shear angles and velocity vectors of points along the cilium. Extracted waveforms were used to construct a composite waveform, which could be used as a standard. Variability was measured as the mean difference in position of points on individual waveforms and the standard. The shapes analyzed were the end-recovery, end-effective, and fastest moving effective and recovery with mean (± SE) differences of 0.31(0.04), 0.25(0.06), 0.50(0.12), 0.50(0.10), μm, respectively. In contrast, the same measures for three different PCD waveforms had values far outside this range. PMID:23144323

  13. Airway Hydration and COPD

    PubMed Central

    Ghosh, Arunava; Boucher, R.C.; Tarran, Robert

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is one of the prevalent causes of worldwide mortality and encompasses two major clinical phenotypes, i.e., chronic bronchitis (CB) and emphysema. The most common cause of COPD is chronic tobacco inhalation. Research focused on the chronic bronchitic phenotype of COPD has identified several pathological processes that drive disease initiation and progression. For example, the lung’s mucociliary clearance (MCC) system performs the critical task of clearing inhaled pathogens and toxic materials from the lung. MCC efficiency is dependent on: (i) the ability of apical plasma membrane ion channels such as the cystic fibrosis transmembrane conductance regulator (CFTR) and the epithelial Na+ channel (ENaC) to maintain airway hydration; (ii) ciliary beating; and, (iii) appropriate rates of mucin secretion. Each of these components is impaired in CB and likely contributes to the mucus stasis/accumulation seen in CB patients. This review highlights the cellular components responsible for maintaining MCC and how this process is disrupted following tobacco exposure and with CB. We shall also discuss existing therapeutic strategies for the treatment of chronic bronchitis and how components of the MCC can be used as biomarkers for the evaluation of tobacco or tobacco-like-product exposure. PMID:26068443

  14. Management strategies for infected total hip arthroplasty. A critical appreciation of problems and techniques.

    PubMed

    Karachalios, Theofilos; Koutalos, Antonios; Komnos, George

    2014-10-02

    Infection is a devastating complication of total hip arthroplasty (THA). Risk factors have been recognised and prevention is possible. The nature of the disease is heterogeneous and for satisfactory management one has to weigh factors related to pathogen, host, local soft tissue, bone stock, surgeon experience and financial resources. Available data in the current literature is of poor quality and there is a lack of data comparing different techniques. Referral of patients to dedicated departments with the appropriate facilities may be more appropriate.

  15. Arrow shaft injury of the wrist and hand: case report, management, and surgical technique.

    PubMed

    Launikitis, Robert A; Viegas, Steven F

    2009-01-01

    A case of accidental, self-inflicted injury to the hand from a hollow carbon shaft arrow which broke in its midshaft while attempting to shoot the arrow from a compound bow is presented. Basic knowledge of low velocity gunshot wounds and arrow injuries was applied in the treatment of this injury along with a unique management technique. The outcome, including hand function was good without any functional loss.

  16. Management of pulp canal obliteration using the Modified-Tip instrument technique

    PubMed Central

    Siddiqui, Shoaib Haider

    2014-01-01

    The incidence of pulp canal obliteration following dental trauma has been reported to be approximately 4 – 24% and its management can be quite challenging for the practitioner. Locating the canal and negotiating it to full working length may lead to iatrogenic errors such as fractured instrument and perforation. This case report deals with such a case using the modified tip instrument technique to gain access and negotiate the canal to the apex followed by conventional root canal preparation and obturation. PMID:25780361

  17. Efficacy of Surgical Airway Plasty for Benign Airway Stenosis

    PubMed Central

    Takahama, Makoto; Nakajima, Ryu; Kimura, Michitaka; Inoue, Hidetoshi; Yamamoto, Ryoji

    2015-01-01

    Background: Long-term patency is required during treatment for benign airway stenosis. This study investigated the effectiveness of surgical airway plasty for benign airway stenosis. Methods: Clinical courses of 20 patients, who were treated with surgical plasty for their benign airway stenosis, were retrospectively investigated. Results: Causes of stenosis were tracheobronchial tuberculosis in 12 patients, post-intubation stenosis in five patients, malacia in two patients, and others in one patient. 28 interventional pulmonology procedures and 20 surgical plasty were performed. Five patients with post-intubation stenosis and four patients with tuberculous stenosis were treated with tracheoplasty. Eight patients with tuberculous stenosis were treated with bronchoplasty, and two patients with malacia were treated with stabilization of the membranous portion. Anastomotic stenosis was observed in four patients, and one to four additional treatments were required. Performance status, Hugh–Jones classification, and ventilatory functions were improved after surgical plasty. Outcomes were fair in patients with tuberculous stenosis and malacia. However, efficacy of surgical plasty for post-intubation stenosis was not observed. Conclusion: Surgical airway plasty may be an acceptable treatment for tuberculous stenosis. Patients with malacia recover well after surgical plasty. There may be untreated patients with malacia who have the potential to benefit from surgical plasty. PMID:26567879

  18. AIRWAY IDENTIFICATION WITHIN PLANAR GAMMA CAMERA IMAGES USING COMPUTER MODELS OF LUNG MORPHOLOGY

    EPA Science Inventory

    The quantification of inhaled aerosols could be improved if a more comprehensive assessment of their spatial distribution patterns among lung airways were obtained. A common technique for quantifying particle deposition in human lungs is with planar gamma scintigraphy. However, t...

  19. Physical therapy modalities and rehabilitation techniques in the management of neuropathic pain.

    PubMed

    Akyuz, Gulseren; Kenis, Ozge

    2014-03-01

    Neuropathic pain is an important problem because of its complex natural history, unclear etiology, and poor response to standard physical therapy agents. It causes severe disability unrelated to its etiology. The primary goals of the management of neuropathic pain are to detect the underlying cause, to define the differential diagnosis and eliminate risk factors, and to reduce the pain. The physician should also know the functional and psychologic conditions of the patient. Therefore, a multimodal management plan in neuropathic pain is essential. This review aimed to reflect a diverse point of view about various physical therapy modalities and rehabilitation techniques. Physical therapy modalities and rehabilitation techniques are important options and must be considered when pharmacotherapy alone is not sufficient. In addition, psychosocial support and cognitive behavioral therapy could also be taken into consideration. It has been suggested that the importance of pain rehabilitation techniques will increase in time and these will take a larger part in the management of neuropathic pain. However, it is now early to comment on these methods because of the lack of adequate publications.

  20. Regional aerosol deposition in human upper airways. Final report

    SciTech Connect

    Swift, D.L.

    1997-11-01

    During the award period, a number of studies have been carried out related to the overall objective of the project which is to elucidate important factors which influence the upper airway deposition and dose of particles in the size range 0.5 nm - 10 {mu}m, such as particle size, breathing conditions, age, airway geometry, and mode of breathing. These studies are listed below. (1) A high voltage electrospray system was constructed to generate polydispersed 1-10 {mu}m diameter di-ethylhexyl sebacate aerosol for particle deposition studies in nasal casts and in human subjects. (2) The effect of nostril dimensions, nasal passage geometry, and nasal resistance on particle deposition efficiency in forty healthy, nonsmoking adults at a constant flowrate were studied. (3) The effect of nostril dimensions, nasal passage dimensions and nasal resistance on the percentage of particle deposition in the anterior 3 cm of the nasal passage of spontaneously breathing humans were studied. (4) The region of deposition of monodispersed aerosols were studied using replicate casts. (5) Ultrafine aerosol deposition using simulated breath holding path and natural path was compared. (6) An experimental technique was proposed and tested to measure the oral deposition of inhaled ultrafine particles. (7) We have calculated the total deposition fraction of ultrafine aerosols from 5 to 200 n in the extrathoracic airways and in the lung. (8) The deposition fraction of radon progeny in the head airways was studied using several head airway models.

  1. Airway microbiota and acute respiratory infection in children.

    PubMed

    Hasegawa, Kohei; Camargo, Carlos A

    2015-01-01

    Acute respiratory infections (ARIs), such as bronchiolitis and pneumonia, are the leading cause of hospitalization of infants in the US. While the incidence and severity of ARI can vary widely among children, the reasons for these differences are not fully explained by traditional risk factors (e.g., prematurity, viral pathogens). The recent advent of molecular diagnostic techniques has revealed the presence of highly functional communities of microbes inhabiting the human body (i.e., microbiota) that appear to influence development of local and systemic immune response. We propose a 'risk and resilience' model in which airway microbiota are associated with an increased (risk microbiota) or decreased (resilience microbiota) incidence and severity of ARI in children. We also propose that modulating airway microbiota (e.g., from risk to resilience microbiota) during early childhood will optimize airway immunity and, thereby, decrease ARI incidence and severity in children.

  2. Ventilated post-mortem computed tomography through the use of a definitive airway.

    PubMed

    Rutty, Guy N; Biggs, Mike J P; Brough, Alison; Robinson, Claire; Mistry, Reena; Amoroso, Jasmin; Deshpande, Aparna; Morgan, Bruno

    2015-03-01

    Ventilated post-mortem computed tomography (VPMCT) has been shown to achieve lung expansion in cadavers and has been proposed to enhance the diagnosis of lung pathology. Two key problems of the method of ventilation have been identified: firstly, the presence of head and neck rigor making airway insertion challenging and, secondly, air leak, if there is not a good seal around the airway, which diminishes lung expansion and causes inflation of the stomach. Simple procedures to insert a 'definitive' cuffed airway, which has a balloon inflated within the trachea, are therefore desirable. This study aims to test different procedures for inserting cuffed airways in cadavers and compare their ventilation efficacy and to propose a decision algorithm to select the most appropriate method. We prospectively tested variations on two ways of inserting a cuffed airway into the trachea: firstly, using an endotracheal tube (ET) approach, either blind or by direct visualisation, and, secondly, using a tracheostomy incision, either using a standard tracheostomy tube or shortened ET tube. We compare these approaches with a retrospective analysis of a previously reported series using supraglottic airways. All techniques, except 'blind' insertion of ET tubes, were possible with adequate placement of the airway in most cases. However, achieving both adequate insertion and a complete tracheal seal was better for definitive airways with 56 successful cases from 59 (95 %), compared with 9 cases from 18 (50 %) using supraglottic airways (p < 0.0001). Good lung expansion was achieved using all techniques if the airway was adequately positioned and achieved a good seal, and there was no significant chest pathology. We prefer inserting a shortened ET tube via a tracheostomy incision, as we find this the easiest technique to perform and train. Based on our experience, we have developed a decision algorithm to select the most appropriate method for VPMCT.

  3. Task force: a management technique that produces quality decisions and employee commitment.

    PubMed

    Moore, C H; Kovach, K M

    1988-01-01

    A task force is a technique that can be used by the dietitian-manager to develop solutions for specific, identified problems. Because employees are directly involved in the decision-making process, better solutions--ones that are also more acceptable to the work group--result. To implement a task force, management must plan the strategy: Select a facilitator, explain the concept and problem to the work group, select task force participants, and make meeting arrangements. The task force meetings should be structured to maximize efficiency and productivity. The plan of action is developed by the task force members; all decisions are based upon input from the work group. Successful implementation of the solutions is the responsibility of the task force. Applications for task forces in both the clinical and food management areas are numerous and result in both tangible and intangible benefits.

  4. Uncertainty Management for Diagnostics and Prognostics of Batteries using Bayesian Techniques

    NASA Technical Reports Server (NTRS)

    Saha, Bhaskar; Goebel, kai

    2007-01-01

    Uncertainty management has always been the key hurdle faced by diagnostics and prognostics algorithms. A Bayesian treatment of this problem provides an elegant and theoretically sound approach to the modern Condition- Based Maintenance (CBM)/Prognostic Health Management (PHM) paradigm. The application of the Bayesian techniques to regression and classification in the form of Relevance Vector Machine (RVM), and to state estimation as in Particle Filters (PF), provides a powerful tool to integrate the diagnosis and prognosis of battery health. The RVM, which is a Bayesian treatment of the Support Vector Machine (SVM), is used for model identification, while the PF framework uses the learnt model, statistical estimates of noise and anticipated operational conditions to provide estimates of remaining useful life (RUL) in the form of a probability density function (PDF). This type of prognostics generates a significant value addition to the management of any operation involving electrical systems.

  5. Innovative techniques for estimating illegal activities in a human-wildlife-management conflict.

    PubMed

    Cross, Paul; St John, Freya A V; Khan, Saira; Petroczi, Andrea

    2013-01-01

    Effective management of biological resources is contingent upon stakeholder compliance with rules. With respect to disease management, partial compliance can undermine attempts to control diseases within human and wildlife populations. Estimating non-compliance is notoriously problematic as rule-breakers may be disinclined to admit to transgressions. However, reliable estimates of rule-breaking are critical to policy design. The European badger (Meles meles) is considered an important vector in the transmission and maintenance of bovine tuberculosis (bTB) in cattle herds. Land managers in high bTB prevalence areas of the UK can cull badgers under license. However, badgers are also known to be killed illegally. The extent of illegal badger killing is currently unknown. Herein we report on the application of three innovative techniques (Randomized Response Technique (RRT); projective questioning (PQ); brief implicit association test (BIAT)) for investigating illegal badger killing by livestock farmers across Wales. RRT estimated that 10.4% of farmers killed badgers in the 12 months preceding the study. Projective questioning responses and implicit associations relate to farmers' badger killing behavior reported via RRT. Studies evaluating the efficacy of mammal vector culling and vaccination programs should incorporate estimates of non-compliance. Mitigating the conflict concerning badgers as a vector of bTB requires cross-disciplinary scientific research, departure from deep-rooted positions, and the political will to implement evidence-based management.

  6. A Novel Technique for the Management of Blandin-Nuhn Mucocele: A Case Report

    PubMed Central

    Kumaresan, Ramesh; Mohammed, Faraz; Thapasum Fairozekhan, Arishiya

    2013-01-01

    ABSTRACT Mucocele, a common benign cystic lesion of minor salivary gland and associated ducts develops following extravasation or retention of mucous material in the subepithelial tissue. Occurrence of mucocele of tongue is considered less frequent when compared to a higher incidence of mucocele in the lower lip of young patients. Different modalities of treatment, such as conventional surgical excision followed by newer techniques like cryosurgery, electrocautery have been proposed to completely remove the lesion and reduce the chances of recurrence. Herewith, we report a novel treatment technique using alginate impression material to aid in complete excision of mucocele of glands of Blandin-Nuhn. How to cite this article: Kumaresan R, Karthikeyan P, Mohammed F, Fairozekhan TA. A Novel Technique for the Management of Blandin-Nuhn Mucocele: A Case Report. Int J Clin Pediatr Dent 2013;6(3):201-204. PMID:25206223

  7. Remote sensing techniques for conservation and management of natural vegetation ecosystems

    NASA Technical Reports Server (NTRS)

    Parada, N. D. J. (Principal Investigator); Verdesio, J. J.; Dossantos, J. R.

    1981-01-01

    The importance of using remote sensing techniques, in the visible and near-infrared ranges, for mapping, inventory, conservation and management of natural ecosystems is discussed. Some examples realized in Brazil or other countries are given to evaluate the products from orbital platform (MSS and RBV imagery of LANDSAT) and aerial level (photography) for ecosystems study. The maximum quantitative and qualitative information which can be obtained from each sensor, at different level, are discussed. Based on the developed experiments it is concluded that the remote sensing technique is a useful tool in mapping vegetation units, estimating biomass, forecasting and evaluation of fire damage, disease detection, deforestation mapping and change detection in land-use. In addition, remote sensing techniques can be used in controling implantation and planning natural/artificial regeneration.

  8. Interventional pain management for spinal disorders: a review of injection techniques.

    PubMed

    Wewalka, Mathias

    2016-02-01

    Chronic spinal pain has a high prevalence and a severe economic, societal and health impact. In the last decades the practice and research of interventional techniques for the diagnosis and treatment of spinal pain has increased sharply. The level of evidence of the most common techniques is well documented. With image-guided precise diagnostic blocks it is possible to identify the source of chronic spinal pain in well over 60% of the cases. Nonsurgical specialties such as PM&R increasingly resort to the possibilities of interventional pain management for musculoskeletal disorders. For many forms of spinal pain there is at least fair evidence for long-term pain relief after a guided therapeutic injection often reducing the intake of analgesic medication or the need for surgery. This review focuses on the evidence, the application spectrum and special considerations of injection techniques for the treatment of spinal disorders.

  9. A pilot study of the impact of stress management techniques on the classroom behavior of elementary school students.

    PubMed

    Petosa, R; Oldfield, D

    1985-02-01

    Intervention studies have demonstrated the benefit of stress management techniques on health-related variables among school-age children. It was hypothesized that teaching elementary school children stress management skills would promote appropriate classroom study behavior by enhancing student ability to attend to teacher assigned tasks. This pilot study supports the contention that stress management skills can increase classroom "on-task" behavior.

  10. Republication: All India Difficult Airway Association 2016 Guidelines for Tracheal Intubation in the Intensive Care Unit

    PubMed Central

    Myatra, Sheila Nainan; Ahmed, Syed Moied; Kundra, Pankaj; Garg, Rakesh; Ramkumar, Venkateswaran; Patwa, Apeksh; Shah, Amit; Raveendra, Ubaradka S.; Shetty, Sumalatha Radhakrishna; Doctor, Jeson Rajan; Pawar, Dilip K.; Ramesh, Singaravelu; Das, Sabyasachi; Divatia, Jigeeshu Vasishtha

    2017-01-01

    Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often lifesaving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with under evaluation of the airway and suboptimal response to preoxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; Wherever, robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the (AIDAA) and Indian Society of Anaesthesiologists. Noninvasive positive pressure ventilation for preoxygenation provides adequate oxygen stores during TI for patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnea before hypoxemia sets in. High flow nasal cannula oxygenation at 60–70 L/min may also increase safety during intubation of critically ill patients. Stable hemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful.

  11. The Airway Microbiome at Birth

    PubMed Central

    Lal, Charitharth Vivek; Travers, Colm; Aghai, Zubair H.; Eipers, Peter; Jilling, Tamas; Halloran, Brian; Carlo, Waldemar A.; Keeley, Jordan; Rezonzew, Gabriel; Kumar, Ranjit; Morrow, Casey; Bhandari, Vineet; Ambalavanan, Namasivayam

    2016-01-01

    Alterations of pulmonary microbiome have been recognized in multiple respiratory disorders. It is critically important to ascertain if an airway microbiome exists at birth and if so, whether it is associated with subsequent lung disease. We found an established diverse and similar airway microbiome at birth in both preterm and term infants, which was more diverse and different from that of older preterm infants with established chronic lung disease (bronchopulmonary dysplasia). Consistent temporal dysbiotic changes in the airway microbiome were seen from birth to the development of bronchopulmonary dysplasia in extremely preterm infants. Genus Lactobacillus was decreased at birth in infants with chorioamnionitis and in preterm infants who subsequently went on to develop lung disease. Our results, taken together with previous literature indicating a placental and amniotic fluid microbiome, suggest fetal acquisition of an airway microbiome. We speculate that the early airway microbiome may prime the developing pulmonary immune system, and dysbiosis in its development may set the stage for subsequent lung disease. PMID:27488092

  12. [Upper airway's 3D analysis of patients with obstructive sleep apnea using tomographic cone beam].

    PubMed

    Bruwier, A; Poirrier, A L; Limme, M; Poirrier, R

    2014-12-01

    The progress of medical imaging over the last decades has led to a better understanding of the upper airway structure in sleep-disordered patients. The Obstructive Sleep Apnea Syndrome (OSA) is attributed to a functional narrowing of the upper airway, particularly of the oropharynx, during sleep. This narrowing is multifactorial. We have shown that in 60% cases, the maxilla (nasal pyramid) seems too narrow. A mandible retroposition may also play a dominant role in 30% of the cases. Both scenarios can be combined. Cone Beam Computed Tomography (CBCT) is a new medical imaging technique that permits to visualize the upper airway with less ionizing radiation than the conventional scanner. To date, only five authors have performed an upper airway's 3D analysis of sleep apnea patients with cone beam. A better understanding of the affected segment of the upper airway should help refine treatment options.

  13. Anaesthetic Management in a Child with Goldenhar Syndrome.

    PubMed

    Khan, Waqas Ahmed; Salim, Bushra; Khan, Ausaf Ahmed; Chughtai, Shakaib

    2017-03-01

    Goldenhar syndrome is a congenital disorder involving deformities of the face. It usually affects one side of the face only and poses significant challenges in the airway management. We herein, report an 8-year boy, known case of Goldenhar syndrome, who presented to our radiology suite for a magnetic resonance imaging (MRI) brain, followed by a computed tomography (CT) scan brain. The boy had various features of Goldenhar syndrome, e.g. cleft palate, absent right eye and ear, right mandibular hypoplasia, micrognathia, and preauricular tags. His developmental milestones were delayed. Airway evaluation showed Mallampati class II with limited movements of head and neck, which suggested possibility of difficult laryngoscopy and intubation. He had no vertebral anomalies or cardiac disease. A difficult airway continues to be a major cause of anaesthesia-related morbidity and mortality; and maintaining spontaneous breathing remains a vital technique in its management. Lack of anaesthesia-related complications with supraglottic devices encouraged us to present the advantage of utilising a laryngeal mask airway (LMA) under anaesthesia for successful management of predicted difficult airway.

  14. Cystic Fibrosis Transmembrane Conductance Regulator in Sarcoplasmic Reticulum of Airway Smooth Muscle. Implications for Airway Contractility

    PubMed Central

    Cook, Daniel P.; Rector, Michael V.; Bouzek, Drake C.; Michalski, Andrew S.; Gansemer, Nicholas D.; Reznikov, Leah R.; Li, Xiaopeng; Stroik, Mallory R.; Ostedgaard, Lynda S.; Abou Alaiwa, Mahmoud H.; Thompson, Michael A.; Prakash, Y. S.; Krishnan, Ramaswamy; Meyerholz, David K.; Seow, Chun Y.

    2016-01-01

    Rationale: An asthma-like airway phenotype has been described in people with cystic fibrosis (CF). Whether these findings are directly caused by loss of CF transmembrane conductance regulator (CFTR) function or secondary to chronic airway infection and/or inflammation has been difficult to determine. Objectives: Airway contractility is primarily determined by airway smooth muscle. We tested the hypothesis that CFTR is expressed in airway smooth muscle and directly affects airway smooth muscle contractility. Methods: Newborn pigs, both wild type and with CF (before the onset of airway infection and inflammation), were used in this study. High-resolution immunofluorescence was used to identify the subcellular localization of CFTR in airway smooth muscle. Airway smooth muscle function was determined with tissue myography, intracellular calcium measurements, and regulatory myosin light chain phosphorylation status. Precision-cut lung slices were used to investigate the therapeutic potential of CFTR modulation on airway reactivity. Measurements and Main Results: We found that CFTR localizes to the sarcoplasmic reticulum compartment of airway smooth muscle and regulates airway smooth muscle tone. Loss of CFTR function led to delayed calcium reuptake following cholinergic stimulation and increased myosin light chain phosphorylation. CFTR potentiation with ivacaftor decreased airway reactivity in precision-cut lung slices following cholinergic stimulation. Conclusions: Loss of CFTR alters porcine airway smooth muscle function and may contribute to the airflow obstruction phenotype observed in human CF. Airway smooth muscle CFTR may represent a therapeutic target in CF and other diseases of airway narrowing. PMID:26488271

  15. [Orthodontics and the upper airway].

    PubMed

    Cobo Plana, J; de Carlos Villafranca, F; Macías Escalada, E

    2004-03-01

    One of the general aims of orthodontic treatment and of the combination of orthodontics and orthognathic surgery is to achieve good occlusion and aesthetic improvement, especially in cases of severe dentoskeletal deformities. However, on many occasions, the parameters of the upper airways are not taken into account when the aims of conventional treatment are fulfilled. Patients with obstructive alterations during sleep represent for the orthodontist a type of patient who differs from the normal; for them, treatment should include the objective of improving oxygen saturation. Here, functional considerations should outweigh purely aesthetic ones. It is important, when making an orthodontic, surgical or combined diagnosis for a patient, to bear in mind the impact that treatment may have on the upper airways. Good aesthetics should never be achieved for some of our patients at the expense of diminishing the capacity of their upper airways.

  16. Comparative Analysis between Podography and Radiography in the Management of Idiopathic Clubfeet by Ponseti Technique

    PubMed Central

    Badhwar, Sumit; Dube, Abhay S

    2017-01-01

    Introduction Idiopathic clubfoot is one of the most common and oldest congenital foot anomalies. There are controversies regarding its optimum management protocol and methodologies to be employed for its functional outcome evaluation. This paper attempts to propose a simple, reasonable and easily reproducible technique of podography for clinical and functional evaluation of clubfoot treated by the popular Ponseti technique. Aim To compare the Foot Bimalleolar (FBM) angle method (podography) and radiography with respect to management of idiopathic clubfoot by Ponseti’s Technique and its functional evaluation. Materials and Methods Sixty feet of 48 patients with idiopathic clubfoot deformity were assessed in terms of FBM by podography (foot print on paper and FBM angle drawing) and radiologically; before starting treatment, after 6 weeks and at 6 monthly intervals with a maximum follow up period of 4.8 years (Range 1.2 to 4.8 years). Mean age at start of treatment was 1.5 years (2 months to 2.5 years). Functional evaluation was done by Magone’s scoring system. Results After treatment, 92 percent patients had good correction (FBM greater than 70 degrees) which correlated well with post treatment Magone’s score of greater than 80 (good to excellent) in nearly 85 percent of cases. Radiologically, talocalcaneal angles in both the views improved in only 60 percent of cases. Conclusion Radiological criteria show inconsistent correlation with functional outcome for feet treated by Ponseti’s Technique. Podography (FBM angle analysis) is a very simple, objective, cost effective, radiation free, easily reproducible and highly reliable clinical criterion for the assessment of deformity correction in club foot by Ponseti’s Technique with an excellent correlation with functional outcome.

  17. Real-time non-invasive detection of inhalable particulates delivered into live mouse airways.

    PubMed

    Donnelley, Martin; Morgan, Kaye S; Fouras, Andreas; Skinner, William; Uesugi, Kentaro; Yagi, Naoto; Siu, Karen K W; Parsons, David W

    2009-07-01

    Fine non-biological particles small enough to be suspended in the air are continually inhaled as we breathe. These particles deposit on airway surfaces where they are either cleared by airway defences or can remain and affect lung health. Pollutant particles from vehicles, building processes and mineral and industrial dusts have the potential to cause both immediate and delayed health problems. Because of their small size, it has not been possible to non-invasively examine how individual particles deposit on live airways, or to consider how they behave on the airway surface after deposition. In this study, synchrotron phase-contrast X-ray imaging (PCXI) has been utilized to detect and monitor individual particle deposition. The in vitro detectability of a range of potentially respirable particulates was first determined. Of the particulates tested, only asbestos, quarry dust, fibreglass and galena (lead sulfate) were visible in vitro. These particulates were then examined after delivery into the nasal airway of live anaesthetized mice; all were detectable in vivo but each exhibited different surface appearances and behaviour along the airway surface. The two fibrous particulates appeared as agglomerations enveloped by fluid, while the non-fibrous particulates were present as individual particles. Synchrotron PCXI provides the unique ability to non-invasively detect and track deposition of individual particulates in live mouse airways. With further refinement of particulate sizing and delivery techniques, PCXI should provide a novel approach for live animal monitoring of airway particulates relevant to lung health.

  18. Balloon-Occlusion Technique for Managing Portal Vein Hemorrhage in Liver Transplantation

    PubMed Central

    Seal, John B.; Bohorquez, Humberto; Battula, Naren; DeGregorio, Lucia; Bugeaud, Emily; Bruce, David S.; Carmody, Ian C.; Cohen, Ari J.; Loss, George E.

    2017-01-01

    Background: Portal vein thrombosis (PVT) is relatively common among candidates for liver transplantation and can present significant intraoperative challenges. Depending on the extent of PVT, thromboendovenectomy (TEV), portal bypass, or systemic inflow may be required to restore portal inflow. While TEV is the most commonly used approach to restore anatomic portal inflow, portal vein injury and life-threatening hemorrhage are risks with this technique. Case Report: We present a salvage technique for managing portal vein injury during TEV using intraluminal balloon occlusion of the portal vein during portal vein repair and reconstruction. This alternative mode of bleeding control optimizes exposure to the retropancreatic space and avoids direct application of vascular clamps that can cause further injury to the vessel and surrounding tissue. Conclusion: Careful preoperative planning and anticipation of potential problems are essential for safe and effective management of complex PVT intraoperatively. The balloon-occlusion technique can facilitate safe and efficient repair of a portal vein injury during TEV for liver transplantation. PMID:28331452

  19. The state of the art in clinical knowledge management: An inventory of tools and techniques

    PubMed Central

    Sittig, Dean F.; Wright, Adam; Simonaitis, Linas; Carpenter, James D.; Allen, George O.; Doebbeling, Bradley N.; Sirajuddin, Anwar Mohammad; Ash, Joan S.; Middleton, Blackford

    2009-01-01

    Purpose To explore the need for, and use of, high-quality, collaborative, clinical knowledge management (CKM) tools and techniques to manage clinical decision support content. Methods In order to better understand the current state of the art in CKM, we developed a survey of potential CKM tools and techniques. We conducted an exploratory study by querying a convenience sample of respondents about their use of specific practices in CKM. Results The following tools and techniques should be priorities in organizations interested in developing successful computer-based provider order entry (CPOE) and clinical decision support (CDS) implementations: 1) A multidisciplinary team responsible for creating and maintaining the clinical content; 2) An external organizational repository of clinical content with web-based viewer that allows anyone in the organization to review it; 3) An online, collaborative, interactive, internet-based tool to facilitate content development; 4) An enterprise-wide tool to maintain the controlled clinical terminology concepts. Even organizations that have been successfully using Computer-based Provider Order Entry with advanced Clinical Decision Support features for well over 15 years are not using all of the CKM tools or practices that we identified. Conclusions If we are to further stimulate progress in the area of clinical decision support, we must continue to develop and refine our understanding and use of advanced CKM capabilities. PMID:19828364

  20. Comparison based on environmental effects of nitrogen management techniques in a manure digestate case study.

    PubMed

    Paccanelli, Nicola; Teli, Aronne; Scaglione, Davide; Insabato, Gabriele; Casula, Alessandro

    2015-01-01

    Due to climate issues and favourable energy market, biogas is spreading as a manure management technique. Digestate is rich in nutrient and has to be handled in order to respect the 'nitrate directive' that limits nitrogen field application in areas defined as vulnerable. In this study, we compared different nitrogen management scenarios: a non-treatment option, a biological short-cut nitrification, a complete autotrophic process (anammox) and ammonia stripping from membrane filtration concentrate. The environmental effect comparison was obtained with 'Cross media effects analysis' and life cycle assessment (LCA). The results were different in some aspects, especially the impacts on eutrophication. According to cross media, the best process is DENO 2, while LCA shows similar impacts for all techniques and the best solution would be the no-treatment option. The main reason to adopt a digestate treatment technique is the lack of area for a correct disposal. If LCA eutrophication results are multiplied with the hectares necessary for each technology, a result similar to that of cross media is obtained.

  1. Management of Congenital Talipes Equino Varus (CTEV) by Ponseti Casting Technique in Neonates: Our Experience

    PubMed Central

    Saif Ullah, Md; Shahjahan, Md; Abu Sayed, Sk

    2013-01-01

    Objective: The purpose of this study is to evaluate the results of Ponseti technique in the management of congenital Talipes Equino Varus (CTEV) in neonatal age group. Methods: It is a prospective observational study, conducted during the period of July 2010 to December 2011 at the Department of Pediatric Surgery in a tertiary hospital. All the neonates with CTEV were treated with Ponseti casting technique. Neonates with other congenital deformities, arthrogryposis and myelomeningocele were excluded. Results: Total 58 CTEV feet of 38 neonates were treated. Twenty six were males and 12 were females. Thirty seven (63.8%) feet were of rigid variety and 21(36.2 %) feet were of non-rigid variety. Twenty patients had bilateral and 18 had unilateral involvement. Mean pre-treatment Pirani score of study group was 5.57. Mean number of plaster casts required per CTEV was 3.75 (range: 2-6). Thirty five rigid and 15 non-rigid (total 86.2%) feet required percutaneous tenotomy. Out of 58 feet 56 (96.6%) were managed successfully. Three (5.2%) patients developed complications like skin excoriation and blister formation. Mean post-treatment Pirani score of the study group was: 0.36 ± 0.43. Conclusion: The Ponseti technique is an excellent, simple, effective, minimally invasive, and inexpensive procedure for the treatment CTEV deformity. Ideally it can be performed as a day case procedure without general anesthesia even in neonatal period. PMID:26023437

  2. Low level waste management: a compilation of models and monitoring techniques. Volume 1

    SciTech Connect

    Mosier, J.E.; Fowler, J.R.; Barton, C.J.

    1980-04-01

    In support of the National Low-Level Waste (LLW) Management Research and Development Program being carried out at Oak Ridge National Laboratory, Science Applications, Inc., conducted a survey of models and monitoring techniques associated with the transport of radionuclides and other chemical species from LLW burial sites. As a result of this survey, approximately 350 models were identified. For each model the purpose and a brief description are presented. To the extent possible, a point of contact and reference material are identified. The models are organized into six technical categories: atmospheric transport, dosimetry, food chain, groundwater transport, soil transport, and surface water transport. About 4% of the models identified covered other aspects of LLW management and are placed in a miscellaneous category. A preliminary assessment of all these models was performed to determine their ability to analyze the transport of other chemical species. The models that appeared to be applicable are identified. A brief survey of the state-of-the-art techniques employed to monitor LLW burial sites is also presented, along with a very brief discussion of up-to-date burial techniques.

  3. Stress Management Apps With Regard to Emotion-Focused Coping and Behavior Change Techniques: A Content Analysis

    PubMed Central

    Hoffmann, Alexandra; Bleser, Gabriele

    2017-01-01

    Background Chronic stress has been shown to be associated with disease. This link is not only direct but also indirect through harmful health behavior such as smoking or changing eating habits. The recent mHealth trend offers a new and promising approach to support the adoption and maintenance of appropriate stress management techniques. However, only few studies have dealt with the inclusion of evidence-based content within stress management apps for mobile phones. Objective The aim of this study was to evaluate stress management apps on the basis of a new taxonomy of effective emotion-focused stress management techniques and an established taxonomy of behavior change techniques. Methods Two trained and independent raters evaluated 62 free apps found in Google Play with regard to 26 behavior change and 15 emotion-focused stress management techniques in October 2015. Results The apps included an average of 4.3 behavior change techniques (SD 4.2) and 2.8 emotion-focused stress management techniques (SD 2.6). The behavior change technique score and stress management technique score were highly correlated (r=.82, P=.01). Conclusions The broad variation of different stress management strategies found in this sample of apps goes in line with those found in conventional stress management interventions and self-help literature. Moreover, this study provided a first step toward more detailed and standardized taxonomies, which can be used to investigate evidence-based content in stress management interventions and enable greater comparability between different intervention types. PMID:28232299

  4. Mucoactive agents for airway mucus hypersecretory diseases.

    PubMed

    Rogers, Duncan F

    2007-09-01

    Airway mucus hypersecretion is a feature of a number of severe respiratory diseases, including asthma, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF). However, each disease has a different airway inflammatory response, with consequent, and presumably linked, mucus hypersecretory phenotype. Thus, it is possible that optimal treatment of the mucus hypersecretory element of each disease should be disease-specific. Nevertheless, mucoactive drugs are a longstanding and popular therapeutic option, and numerous compounds (eg, N-acetylcysteine, erdosteine, and ambroxol) are available for clinical use worldwide. However, rational recommendation of these drugs in guidelines for management of asthma, COPD, or CF has been hampered by lack of information from well-designed clinical trials. In addition, the mechanism of action of most of these drugs is unknown. Consequently, although it is possible to categorize them according to putative mechanisms of action, as expectorants (aid and/or induce cough), mucolytics (thin mucus), mucokinetics (facilitate cough transportability), and mucoregulators (suppress mechanisms underlying chronic mucus hypersecretion, such as glucocorticosteroids), it is likely that any beneficial effects are due to activities other than, or in addition to, effects on mucus. It is also noteworthy that the mucus factors that favor mucociliary transport (eg, thin mucus gel layer, "ideal" sol depth, and elasticity greater than viscosity) are opposite to those that favor cough effectiveness (thick mucus layer, excessive sol height, and viscosity greater than elasticity), which indicates that different mucoactive drugs would be required for treatment of mucus obstruction in proximal versus distal airways, or in patients with an impaired cough reflex. With the exception of mucoregulatory agents, whose primary action is unlikely to be directed against mucus, well-designed clinical trials are required to unequivocally determine the

  5. Montgomery T-tube: anesthetic management.

    PubMed

    Agrawal, Sanjay; Payal, Y S; Sharma, J P; Meher, Ravi; Varshney, Saurabh

    2007-03-01

    The Montgomery T-tube is a device used as a combined tracheal stent and airway after laryngotracheoplasty. It is a valuable option in the management of upper and mid-tracheal lesions. Because its use is sporadic, many anesthesiologists may not be familiar with this device, and its anesthetic management may pose a challenge. Safe management of such patients requires careful planning. We describe different techniques of anaesthetic management in two cases of injuries to the throat, for which this tube was inserted as a tracheal stent.

  6. A review of the surgical management of breast cancer: plastic reconstructive techniques and timing implications.

    PubMed

    Rosson, Gedge D; Magarakis, Michael; Shridharani, Sachin M; Stapleton, Sahael M; Jacobs, Lisa K; Manahan, Michele A; Flores, Jaime I

    2010-07-01

    The oncologic management of breast cancer has evolved over the past several decades from radical mastectomy to modern-day preservation of chest and breast structures. The increased rate of mastectomies over recent years made breast reconstruction an integral part of the breast cancer management. Plastic surgery now offers patients a wide variety of reconstruction options from primary closure of the skin flaps to performance of microvascular and autologous tissue transplantation. Well-coordinated partnerships between surgical oncologists, plastic surgeons, and patients address concerns of tumor control, cosmesis, and patients' wishes. The gamut of breast reconstruction options is reviewed, particularly noting state-of-the-art techniques, as well as the advantages and disadvantages of various timing modalities.

  7. Power Management Based Current Control Technique for Photovoltaic-Battery Assisted Wind-Hydro Hybrid System

    NASA Astrophysics Data System (ADS)

    Ram Prabhakar, J.; Ragavan, K.

    2013-07-01

    This article proposes new power management based current control strategy for integrated wind-solar-hydro system equipped with battery storage mechanism. In this control technique, an indirect estimation of load current is done, through energy balance model, DC-link voltage control and droop control. This system features simpler energy management strategy and necessitates few power electronic converters, thereby minimizing the cost of the system. The generation-demand (G-D) management diagram is formulated based on the stochastic weather conditions and demand, which would likely moderate the gap between both. The features of management strategy deploying energy balance model include (1) regulating DC-link voltage within specified tolerances, (2) isolated operation without relying on external electric power transmission network, (3) indirect current control of hydro turbine driven induction generator and (4) seamless transition between grid-connected and off-grid operation modes. Furthermore, structuring of the hybrid system with appropriate selection of control variables enables power sharing among each energy conversion systems and battery storage mechanism. By addressing these intricacies, it is viable to regulate the frequency and voltage of the remote network at load end. The performance of the proposed composite scheme is demonstrated through time-domain simulation in MATLAB/Simulink environment.

  8. Scientific or rule-of-thumb techniques of ground-water management--Which will prevail?

    USGS Publications Warehouse

    McGuinness, Charles Lee

    1969-01-01

    Emphasis in ground-water development, once directed largely to quantitatively minor (but sociologically vital) service of human and stock needs, is shifting: aquifers are treated as possible regulating reservoirs managed conjunctively with surface water. Too, emphasis on reducing stream pollution is stimulating interest in aquifers as possible waste-storage media. Such management of aquifers requires vast amounts of data plus a much better understanding of aquifer-system behavior than now exists. Implicit in this deficiency of knowledge is a need for much new research, lest aquifers be managed according to ineffective rule-of-thumb standards, or even abandoned as unmanageable. The geohydrologist's task is to define both internal and boundary characteristics of aquifer systems. Stratigraphy is a primary determinant of these characteristics, but stratigraphically minor features may make aquifers transcend stratigraphic boundaries. For example, a structurally insignificant fracture may carry more water than a major fault; a minor stratigraphic discontinuity may be a major hydrologic boundary. Hence, there is a need for ways of defining aquifer boundaries and quantifying aquifer and confining-bed characteristics that are very different from ordinary stratigraphic techniques. Among critical needs are techniques for measuring crossbed permeability; for extrapolating and interpolating point data on direction and magnitude of permeability in defining aquifer geometry; and for accurately measuring geochemical properties of water and aquifer material, and interpreting those measurements in terms of source of water, rate of movement, and waste-sorbing capacities of aquifers and of confining beds--in general, techniques adequate for predicting aquifer response to imposed forces whether static, hydraulic, thermal, or chemical. Only when such predictions can be made routinely can aquifer characteristics be inserted into a master model that incorporates both the hydrologic and

  9. Assessment of major airway obstruction using image analysis of digital CT information

    NASA Astrophysics Data System (ADS)

    McLennan, Geoffrey; Shamsolkottabi, Susanne; Hoffman, Eric A.

    1996-04-01

    Major airway obstruction (trachea, right and left main bronchi) is an important cause of morbidity and mortality. Management requires adequate assessment of the position, extent and severity of the obstructing or stenotic segment. The objective of this study was to evaluate 3D reconstruction of the major airways using volumetric image display and analysis (VIDA), in subjects with major airflow obstruction. We have evaluated five subjects with major airway obstruction using Electron Beam Computed Tomography (EBCT) with a contiguous 3 mm slice thickness at total lung capacity. The digital information was transferred to a Sun Workstation (SPARC 5) for data analysis using VIDA. From this data set, the airway dimensions were calculated using a method for airway centerline determination and slice reformatting so as to section the airway perpendicular to its local long axis. Once appropriately sectioned, a number of different methods were used in edge finding. The airways were also presented as a surface rendered 3D image in either still or movie format. Finally, all subjects underwent flexible bronchoscopy to assess the abnormalities by direct visualization, with results of the bronchoscopic assessment being compared to the VIDA measurements. In all subjects, the volumetric image display and analysis gave anatomically correct and detailed images, which could be accurately measured. This information enabled appropriate pre-planning of operative corrective procedures, that included laser therapy, stent placement and balloon bronchoplasty. We conclude that the volumetric image display and analysis provides useful and reliable information for the management of major airflow obstruction.

  10. Ureteroscopy for management of stone disease: an up to date on surgical technique and disposable devices.

    PubMed

    Torricelli, Fabio C; Marchini, Giovanni S; Pedro, Renato N; Monga, Manoj

    2016-12-01

    The surgical management of urinary stone disease developed substantially over the past decades and advanced minimally invasive techniques have been successfully introduced into clinical practice. Retrograde ureteroscopy and ureterorrenoscopy have become the first-line option for treatment of ureteral and renal stones worldwide with high success rates allied with a low morbidity profile. In this review, we will discuss some key points in ureteroscopy for stone disease, such as the access to upper urinary tract, including balloon and catheter dilation; how to choose and use some disposable devices (hydrophilic versus PTFE guide wires, ureteral catheters, and laser fiber setting); and lastly present and compare different techniques for kidney or ureteral stone treatment (dusting versus basketing).

  11. Interventional Radiology in the Management of Visceral Artery Pseudoaneurysms: A Review of Techniques and Embolic Materials

    PubMed Central

    Venkatesh, Hosur Ananthashayana; Gamanagatti, Shivanand; Garg, Pramod; Srivastava, Deep Narayan

    2016-01-01

    Visceral artery pseudoaneurysms occur mostly as a result of inflammation and trauma. Owing to high risk of rupture, they require early treatment to prevent lethal complications. Knowledge of the various approaches of embolization of pseudoaneurysms and different embolic materials used in the management of visceral artery pseudoaneurysms is essential for successful and safe embolization. We review and illustrate the endovascular, percutaneous and endoscopic ultrasound techniques used in the treatment of visceral artery pseudoaneurysm and briefly discuss the embolic materials and their benefits and risks. PMID:27134524

  12. Incorporating Piaget's theories into behavior management techniques for the child dental patient.

    PubMed

    Delitala, G

    2000-01-01

    This presentation reviews psychologist Jean Piaget's contributions to knowledge of cognitive development in children, relating it to behavior management techniques. Piaget theorized that children's knowledge about reality is realized by touching and observing; he termed this constructivism. He recognized that there are stages of development in knowledge acquisition. Practitioners should try to stimulate these needs to develop a positive dental experience. Another Piaget model is egocentrism, wherein a child views the world subjectively. The dentist should let the child patient know what's going on and have an active part in treatment.

  13. The Application of Biomedical Engineering Techniques to the Diagnosis and Management of Tropical Diseases: A Review

    PubMed Central

    Ibrahim, Fatimah; Thio, Tzer Hwai Gilbert; Faisal, Tarig; Neuman, Michael

    2015-01-01

    This paper reviews a number of biomedical engineering approaches to help aid in the detection and treatment of tropical diseases such as dengue, malaria, cholera, schistosomiasis, lymphatic filariasis, ebola, leprosy, leishmaniasis, and American trypanosomiasis (Chagas). Many different forms of non-invasive approaches such as ultrasound, echocardiography and electrocardiography, bioelectrical impedance, optical detection, simplified and rapid serological tests such as lab-on-chip and micro-/nano-fluidic platforms and medical support systems such as artificial intelligence clinical support systems are discussed. The paper also reviewed the novel clinical diagnosis and management systems using artificial intelligence and bioelectrical impedance techniques for dengue clinical applications. PMID:25806872

  14. Chiropractic management of shoulder pain and dysfunction of myofascial origin using ischemic compression techniques

    PubMed Central

    Hains, Guy

    2002-01-01

    Shoulder pain and dysfunction is a chief complaint commonly presenting to a chiropractor's office. The purpose of this article is to review the most common etiologies of shoulder pain, focusing on those conditions of a myofascial origin. In addition to a review of the literature, the author draws upon his own clinical experience to describe a method to diagnose and manage, patients with shoulder pain of myofascial origin using ischemic compression techniques. This hands-on therapeutic approach conveys several benefits including: positive therapeutic outcomes; a favorable safety profile and; it is minimally strenuous on the doctor and well tolerated by the patient. ImagesFigure 7

  15. The application of biomedical engineering techniques to the diagnosis and management of tropical diseases: a review.

    PubMed

    Ibrahim, Fatimah; Thio, Tzer Hwai Gilbert; Faisal, Tarig; Neuman, Michael

    2015-03-23

    This paper reviews a number of biomedical engineering approaches to help aid in the detection and treatment of tropical diseases such as dengue, malaria, cholera, schistosomiasis, lymphatic filariasis, ebola, leprosy, leishmaniasis, and American trypanosomiasis (Chagas). Many different forms of non-invasive approaches such as ultrasound, echocardiography and electrocardiography, bioelectrical impedance, optical detection, simplified and rapid serological tests such as lab-on-chip and micro-/nano-fluidic platforms and medical support systems such as artificial intelligence clinical support systems are discussed. The paper also reviewed the novel clinical diagnosis and management systems using artificial intelligence and bioelectrical impedance techniques for dengue clinical applications.

  16. The management of femoral bone stock in THA revision: indications and techniques.

    PubMed

    Bianchi, Luca; Galante, Claudio; Zagra, Luigi

    2014-10-02

    Following the increasing number of total hip arthroplasties, the amount of hip revision procedures continue to rise. Careful patient selection and bone loss evaluation is crucial for a correct management of femoral revision procedures. The key point in femoral revision is to obtain a reliable primary stability of the stem, with the least invasive implant as possible, to preserve and if possible to restore the bone stock. In this article we present the indications and the techniques for the femoral revisions most commonly used in Europe, referring to the evidence in the literature and our personal experiences.

  17. The sterile-male-release technique in Great Lakes sea lamprey management

    USGS Publications Warehouse

    Twohey, Michael B.; Heinrich, John W.; Seelye, James G.; Fredricks, Kim T.; Bergstedt, Roger A.; Kaye, Cheryl A.; Scholefield, Ron J.; McDonald, Rodney B.; Christie, Gavin C.

    2003-01-01

    The implementation of a sterile-male-release technique from 1991 through 1999 and evaluation of its effectiveness in the Great Lakes sea lamprey (Petromyzon marinus) management program is reviewed. Male sea lampreys were injected with the chemosterilant bisazir (P,P-bis(1-aziridinyl)-N-methylphosphinothioic amide) using a robotic device. Quality assurance testing indicated the device delivered a consistent and effective dose of bisazir. Viability of embryos in an untreated control group was 64% compared to 1% in a treatment group. A task force developed nine hypotheses to guide implementation and evaluation of the technique. An annual average of 26,000 male sea lampreys was harvested from as many as 17 Great Lakes tributaries for use in the technique. An annual average of 16,100 sterilized males was released into 33 tributaries of Lake Superior to achieve a theoretical 59% reduction in larval production during 1991 to 1996. The average number of sterile males released in the St. Marys River increased from 4,000 during 1991 to 1996 to 20,100 during 1997 to 1999. The theoretical reduc-stertion in reproduction when combined with trapping was 57% during 1991 to 1996 and 86% during 1997 to 1999. Evaluation studies demonstrated that sterilized males were competitive and reduced production of larvae in streams. Field studies and simulation models suggest reductions in reproduction will result in fewer recruits, but there is risk of periodic high recruitment events independent of sterile-male release. Strategies to reduce reproduction will be most reliable when low densities of reproducing females are achieved. Expansion of the technique is limited by access to additional males for sterilization. Sterile-male release and other alternative controls are important in delivering integrated pest management and in reducing reliance on pesticides.

  18. A refined electrofishing technique for collecting Silver Carp: Implications for management

    USGS Publications Warehouse

    Bouska, Wesley W.; Glover, David C.; Bouska, Kristen; Garvey, James E.

    2017-01-01

    Detecting nuisance species at low abundance or in newly established areas is critical to developing pest management strategies. Due to their sensitivity to disturbance and erratic jumping behavior, Silver Carp Hypophthalmichthys molitrix can be difficult to collect with traditional sampling methods. We compared catch per unit effort (CPUE) of all species from a Long Term Resource Monitoring (LTRM) electrofishing protocol to an experimental electrofishing technique designed to minimize Silver Carp evasion through tactical boat maneuvering and selective application of power. Differences in CPUE between electrofishing methods were detected for 2 of 41 species collected across 2 years of sampling at 20 sites along the Illinois River. The mean catch rate of Silver Carp using the experimental technique was 2.2 times the mean catch rate of the LTRM electrofishing technique; the increased capture efficiency at low relative abundance emphasizes the utility of this method for early detection. The experimental electrofishing also collected slightly larger Silver Carp (mean: 510.7 mm TL versus 495.2 mm TL), and nearly four times as many Silver Carp independently jumped into the boat during experimental transects. Novel sampling approaches, such as the experimental electrofishing technique used in this study, should be considered to increase probability of detection for aquatic nuisance species.

  19. Airway response to sirolimus therapy for the treatment of complex pediatric lymphatic malformations.

    PubMed

    Alemi, A Sean; Rosbe, Kristina W; Chan, Dylan K; Meyer, Anna K

    2015-12-01

    Head and neck lymphatic malformations can create airway management challenges requiring tracheotomy. Sirolimus, an inhibitor of mammalian target of rapamycin (mTOR), may inhibit growth of lymphatic malformations. We describe two patients born with large lymphatic malformations with improved airway symptoms following sirolimus therapy. Patient #1 underwent tracheotomy and multi-modal therapy including sirolimus with reduction in airway involvement but regrowth after discontinuation of sirolimus. Patient #2 also experienced a significant response to sirolimus allowing for extubation and discharge without tracheotomy. Early initiation of sirolimus therapy should be considered as a means to avoid tracheotomy in complex head and neck lymphatic malformations.

  20. Upper airway obstruction in a patient with Ehlers-Danlos syndrome.

    PubMed

    Chatzoudis, D; Kelly, T J; Lancaster, J; Jones, T M

    2015-04-01

    We report a case of recurrent airway obstruction episodes resulting from laryngeal hypermobility in a patient with Ehlers-Danlos syndrome. A 44-year-old woman, with known Ehlers-Danlos syndrome, presented with recent onset of episodes of upper airway obstruction due to hypermobility of her larynx. A suitable conservative management strategy proved elusive and the patient finally underwent a thyrohyoidopexy. The patient remains symptom free nine months after the procedure. This is the first report of spontaneous life threatening upper airway obstruction due to hypermobility of the suprahyoid suspensory soft tissues in Ehlers-Danlos syndrome.

  1. Effective behaviour change techniques in the prevention and management of childhood obesity.

    PubMed

    Martin, J; Chater, A; Lorencatto, F

    2013-10-01

    Rates of childhood obesity are increasing, and it is essential to identify the active components of interventions aiming to prevent and manage obesity in children. A systematic review of behaviour change interventions was conducted to find evidence of behaviour change techniques (BCTs) that are most effective in changing physical activity and/or eating behaviour for the prevention or management of childhood obesity. An electronic search was conducted for randomised controlled trials published between January 1990 and December 2009. Of 4309 titles and abstracts screened, full texts of 135 articles were assessed, of which 17 published articles were included in this review. Intervention descriptions were coded according to the behaviour-specific CALO-RE taxonomy of BCTs. BCTs were identified and compared across obesity management (n=9) vs prevention (n=8) trials. To assess the effectiveness of individual BCTs, trials were further divided into those that were effective (defined as either a group reduction of at least 0.13 body mass index (BMI) units or a significant difference in BMI between intervention and control groups at follow-up) vs non-effective (reported no significant differences between groups). We reliably identified BCTs utilised in effective and non-effective prevention and management trials. To illustrate the relative effectiveness of each BCT, effectiveness ratios were calculated as the ratio of the number of times each BCT was a component of an intervention in an effective trial divided by the number of times they were a component of all trials. Results indicated six BCTs that may be effective components of future management interventions (provide information on the consequences of behaviour to the individual, environmental restructuring, prompt practice, prompt identification as role model/position advocate, stress management/emotional control training and general communication skills training), and one that may be effective in prevention

  2. The Lung Microbiome and Airway Disease.

    PubMed

    Lynch, Susan V

    2016-12-01

    A growing body of literature has demonstrated relationships between the composition of the airway microbiota (mixed-species communities of microbes that exist in the respiratory tract) and critical features of immune response and pulmonary function. These studies provide evidence that airway inflammatory status and capacity for repair are coassociated with specific taxonomic features of the airway microbiome. Although directionality has yet to be established, the fact that microbes are known drivers of inflammation and tissue damage suggests that in the context of chronic inflammatory airway disease, the composition and, more importantly, the function, of the pulmonary microbiome represent critical factors in defining airway disease outcomes.

  3. Airway nerves: in vitro electrophysiology.

    PubMed

    Fox, Alyson

    2002-06-01

    Recording the activity of single airway sensory fibres or neuronal cell bodies in vitro has allowed detailed characterisation of fibre types and membrane properties. Fibre types can be identified by their conduction velocities and further studied by the application of drugs to their receptive field. C-fibres are sensitive to mechanical stimuli and a range of irritant chemicals (bradykinin, capsaicin, low pH, platelet-activating factor), whereas Adelta-fibres are relatively insensitive to chemical stimuli and appear to correlate to the rapidly adapting receptors identified in airways in vivo. Their site of origin also differs: upper airway C-fibres arise predominantly from the jugular ganglion and Adelta-fibres from the jugular and nodose ganglia. Intracellular recording from cell bodies in the ganglia has revealed a calcium-dependent potassium current common to many putative C-fibre cell bodies. This slow after hyperpolarisation current may be inhibited by stimuli that excite and sensitise C-fibres - this could be an important mechanism underlying the sensitisation of C-fibres in airway irritability.

  4. Forced expiratory technique, directed cough, and autogenic drainage.

    PubMed

    Fink, James B

    2007-09-01

    In health, secretions produced in the respiratory tract are cleared by mucociliary transport, cephalad airflow bias, and cough. In disease, increased secretion viscosity and volume, dyskinesia of the cilia, and ineffective cough combine to reduce secretion clearance, leading to increased risk of infection. In obstructive lung disease these conditions are further complicated by early collapse of airways, due to airway compression, which traps both gas and secretions. Techniques have been developed to optimize expiratory flow and promote airway clearance. Directed cough, forced expiratory technique, active cycle of breathing, and autogenic drainage are all more effective than placebo and comparable in therapeutic effects to postural drainage; they require no special equipment or care-provider assistance for routine use. Researchers have suggested that standard chest physical therapy with active cycle of breathing and forced expiratory technique is more effective than chest physical therapy alone. Evidence-based reviews have suggested that, though successful adoption of techniques such as autogenic drainage may require greater control and training, patients with long-term secretion management problems should be taught as many of these techniques as they can master for adoption in their therapeutic routines.

  5. Airway malacia in children with achondroplasia.

    PubMed

    Dessoffy, Kimberly E; Modaff, Peggy; Pauli, Richard M

    2014-02-01

    This study was undertaken to assess the frequency of airway malacia in infants and young children with achondroplasia, a population well known to be at risk for a variety of respiratory problems. We also wished to evaluate what, if any, contribution airway malacia makes to the complex respiratory issues that may be present in those with achondroplasia. Retrospective chart review of all infants and young children with achondroplasia who were assessed through the Midwest Regional Bone Dysplasia Clinics from 1985 through 2012 (n = 236) was completed. Records of comprehensive clinical examinations, polysomnographic assessments, and airway visualization were reviewed and abstracted using a data collection form. Analyses were completed comparing the group with and those without evidence for airway malacia. Thirteen of 236 patients (5.5%) were found to have airway malacia. Most of those affected had lower airway involvement (9/13). The presence of airway malacia was correlated with an increased occurrence of obstructive sleep apnea as well as need for oxygen supplementation, airway surgeries and tracheostomy placement. Although estimates of the frequency of airway malacia in the general population are limited, its frequency in children with achondroplasia appears to be much higher than any published general population estimate. The presence of airway malacia appears to confound other breathing abnormalities in this population and results in the need for more invasive airway treatments.

  6. Repeated allergen exposure of sensitized Brown-Norway rats induces airway cell DNA synthesis and remodelling.

    PubMed

    Salmon, M; Walsh, D A; Koto, H; Barnes, P J; Chung, K F

    1999-09-01

    Chronic inflammation in asthmatic airways can lead to characteristic airway smooth muscle (ASM) thickening and pathological changes within the airway wall. This study assessed the effect of repeated allergen exposure on ASM and epithelial cell deoxyribonucleic acid (DNA) synthesis, cell recruitment and airway wall pathology. Brown-Norway rats were sensitized and then exposed to ovalbumin or saline aerosol every 3 days on six occasions. After the final exposure, rats were administered twice daily for 7 days with the DNA S-phase marker bromodeoxyuridine (BrdU). Using a triple immunohistochemical staining technique, BrdU incorporation into ASM and epithelium was quantified employing computer-assisted image analysis. There were >3-fold mean increases in BrdU incorporation into ASM from 1.3% of cells (95% confidence interval (CI) 1.0-1.6) in saline controls to 4.7% (95% CI 2.6-6.7) after allergen exposure (p<0.001), and in airway epithelium, from 1.3 (95% CI 0.6-2.0) BrdU-positive cells x mm basement membrane(-1) in saline controls to 4.9 (95% CI 3.0-6.7) after allergen exposure (p<0.001). There was increased subepithelial collagen deposition and mucus secretion along with a significant eosinophil and lymphocyte recruitment to the airways. Increased rates of deoxyribonucleic acid synthesis in both airway smooth muscle and epithelial cells along with changes to the airway wall pathology may precede the establishment of smooth muscle thickening and airway remodelling after repeated allergen exposure in rats. This model seems to be appropriate for studying structural changes within the airways as observed in asthma.

  7. Reliability and Efficacy of Water Use Estimation Techniques and their Impact on Water Management and Policy

    NASA Astrophysics Data System (ADS)

    Singh, A.; Deeds, N.; Kelley, V.

    2012-12-01

    Estimating how much water is being used by various water users is key to effective management and optimal utilization of groundwater resources. This is especially true for aquifers like the Ogallala that are severely stressed and display depleting trends over the last many years. The High Plains Underground Water Conservation District (HPWD) is the largest and oldest of the Texas water conservation districts, and oversees approximately 1.7 million irrigated acres. Water users within the 16 counties that comprise the HPWD draw from the Ogallala extensively. The HPWD has recently proposed flow-meters as well as various 'alternative methods' for water users to report water usage. Alternative methods include using a) site specific energy conversion factors to convert total amount of energy used (for pumping stations) to water pumped, b) reporting nozzle package (on center pivot irrigation systems) specifications and hours of usage, and c) reporting concentrated animal feeding operations (CAFOs). The focus of this project was to evaluate the reliability and effectiveness for each of these water use estimation techniques for regulatory purposes. Reliability and effectiveness of direct flow-metering devices was also addressed. Findings indicate that due to site-specific variability and hydrogeologic heterogeneity, alternative methods for estimating water use can have significant uncertainties associated with water use estimates. The impact of these uncertainties on overall water usage, conservation, and management was also evaluated. The findings were communicated to the Stakeholder Advisory Group and the Water Conservation District with guidelines and recommendations on how best to implement the various techniques.

  8. Native Small Airways Secrete Bicarbonate

    PubMed Central

    Quinton, Paul M.

    2014-01-01

    Since the discovery of Cl− impermeability in cystic fibrosis (CF) and the cloning of the responsible channel, CF pathology has been widely attributed to a defect in epithelial Cl− transport. However, loss of bicarbonate (HCO3−) transport also plays a major, possibly more critical role in CF pathogenesis. Even though HCO3− transport is severely affected in the native pancreas, liver, and intestines in CF, we know very little about HCO3− secretion in small airways, the principle site of morbidity in CF. We used a novel, mini-Ussing chamber system to investigate the properties of HCO3− transport in native porcine small airways (∼ 1 mm φ). We assayed HCO3− transport across small airway epithelia as reflected by the transepithelial voltage, conductance, and equivalent short-circuit current with bilateral 25-mM HCO3− plus 125-mM NaGlu Ringer’s solution in the presence of luminal amiloride (10 μM). Under these conditions, because no major transportable anions other than HCO3− were present, we took the equivalent short-circuit current to be a direct measure of active HCO3− secretion. Applying selective agonists and inhibitors, we show constitutive HCO3− secretion in small airways, which can be stimulated significantly by β-adrenergic– (cAMP) and purinergic (Ca2+) -mediated agonists, independently. These results indicate that two separate components for HCO3− secretion, likely via CFTR- and calcium-activated chloride channel–dependent processes, are physiologically regulated for likely roles in mucus clearance and antimicrobial innate defenses of small airways. PMID:24224935

  9. Sarcoidosis of the upper and lower airways.

    PubMed

    Morgenthau, Adam S; Teirstein, Alvin S

    2011-12-01

    Sarcoidosis is a systemic granulomatous disease of undetermined etiology characterized by a variable clinical presentation and disease course. Although clinical granulomatous inflammation may occur within any organ system, more than 90% of sarcoidosis patients have lung disease. Sarcoidosis is considered an interstitial lung disease that is frequently characterized by restrictive physiologic dysfunction on pulmonary function tests. However, sarcoidosis also involves the airways (large and small), causing obstructive airways disease. It is one of a few interstitial lung diseases that affects the entire length of the respiratory tract - from the nose to the terminal bronchioles - and causes a broad spectrum of airways dysfunction. This article examines airway dysfunction in sarcoidosis. The anatomical structure of the airways is the organizational framework for our discussion. We discuss sarcoidosis involving the nose, sinuses, nasal passages, larynx, trachea, bronchi and small airways. Common complications of airways disease, such as, atelectasis, fibrosis, bullous leions, bronchiectasis, cavitary lesions and mycetomas, are also reviewed.

  10. Bilateral airway foreign body aspiration as a cause of recurrent pneumonia

    PubMed Central

    Rehman, Sameer Ur; Sharif, Nadia; Zubairi, Ali Bin Sarwar

    2010-01-01

    Foreign body aspiration (FBA) into the lower airway requires a high index of suspicion. Identification of the problem can be difficult as it has a broad range of clinical presentation and often mimics other medical conditions. A delay in diagnosis and management can result in serious complications. The authors report the case of a middle aged man with bilateral airway FBA who had a history of six hospitalisations over the previous 10 years with recurrent pneumonias. PMID:22802469

  11. Software Health Management: A Short Review of Challenges and Existing Techniques

    NASA Technical Reports Server (NTRS)

    Pipatsrisawat, Knot; Darwiche, Adnan; Mengshoel, Ole J.; Schumann, Johann

    2009-01-01

    Modern spacecraft (as well as most other complex mechanisms like aircraft, automobiles, and chemical plants) rely more and more on software, to a point where software failures have caused severe accidents and loss of missions. Software failures during a manned mission can cause loss of life, so there are severe requirements to make the software as safe and reliable as possible. Typically, verification and validation (V&V) has the task of making sure that all software errors are found before the software is deployed and that it always conforms to the requirements. Experience, however, shows that this gold standard of error-free software cannot be reached in practice. Even if the software alone is free of glitches, its interoperation with the hardware (e.g., with sensors or actuators) can cause problems. Unexpected operational conditions or changes in the environment may ultimately cause a software system to fail. Is there a way to surmount this problem? In most modern aircraft and many automobiles, hardware such as central electrical, mechanical, and hydraulic components are monitored by IVHM (Integrated Vehicle Health Management) systems. These systems can recognize, isolate, and identify faults and failures, both those that already occurred as well as imminent ones. With the help of diagnostics and prognostics, appropriate mitigation strategies can be selected (replacement or repair, switch to redundant systems, etc.). In this short paper, we discuss some challenges and promising techniques for software health management (SWHM). In particular, we identify unique challenges for preventing software failure in systems which involve both software and hardware components. We then present our classifications of techniques related to SWHM. These classifications are performed based on dimensions of interest to both developers and users of the techniques, and hopefully provide a map for dealing with software faults and failures.

  12. Difficult airway and difficult intubation in postintubation tracheal stenosis: a case report and literature review

    PubMed Central

    Zarogoulidis, Paul; Kontakiotis, Theodoros; Tsakiridis, Kosmas; Karanikas, Michael; Simoglou, Christos; Porpodis, Konstantinos; Mitrakas, Alexandros; Esebidis, Agisilaos; Konoglou, Maria; Katsikogiannis, Nikolaos; Zervas, Vasilis; Aggelopoulou, Christina; Mikroulis, Dimitrios; Zarogoulidis, Konstantinos

    2012-01-01

    Management of a “difficult airway” remains one of the most relevant and challenging tasks for anesthesiologists and pulmonary physicians. Several conditions, such as inflammation, trauma, tumor, and immunologic and metabolic diseases, are considered responsible for the difficult intubation of a critically ill patient. In this case report we present the case of a 46-year-old male with postintubation tracheal stenosis. We will focus on the method of intubation used, since the patient had a “difficult airway” and had to be intubated immediately because he was in a life-threatening situation. Although technology is of utter importance, clinical examination and history-taking remain invaluable for the appropriate evaluation of the critically ill patient in everyday medical life. Every physician who will be required to perform intubation has to be familiar with the evaluation of the difficult airway and, in the event of the unanticipated difficult airway, to be able to use a wide variety of tools and techniques to avoid complications and fatality. PMID:22802693

  13. Distal airway dysfunction identifies pulmonary inflammation in asymptomatic smokers

    PubMed Central

    Berger, Kenneth I.; Pradhan, Deepak R.; Goldring, Roberta M.; Oppenheimer, Beno W.; Rom, William N.

    2016-01-01

    Smoking induced inflammation leads to distal airway destruction. However, the relationship between distal airway dysfunction and inflammation remains unclear, particularly in smokers prior to the development of airway obstruction. Seven normal controls and 16 smokers without chronic obstructive pulmonary disease (COPD) were studied. Respiratory function was assessed using the forced oscillation technique (FOT). Abnormal FOT was defined as elevated resistance at 5 Hz (R5). Parameters reflecting distal lung function included frequency dependence of resistance (R5–20) and dynamic elastance (X5). Inflammation was quantified in concentrated bronchoalveolar lavage utilising cell count differential and cytokines expressed as concentration per mL epithelial lining fluid. All control subjects and seven smokers had normal R5. Nine smokers had elevated R5 with abnormal R5–20 and X5, indicating distal lung dysfunction. The presence of abnormal FOT was associated with two-fold higher lymphocyte and neutrophil counts (p<0.025) and with higher interleukin (IL)-8, eotaxin and fractalkine levels (p<0.01). Reactivity of R5–20 and X5 correlated with levels of IL-8, eotaxin, fractalkine, IL-12p70 and transforming growth factor-α (r>0.47, p<0.01). Distal airway dysfunction in smokers without COPD identifies the presence of distal lung inflammation that parallel reported observations in established COPD. These findings were not evident on routine pulmonary function testing and may allow the identification of smokers at risk of progression to COPD. PMID:27995132

  14. Biomechanics of liquid-epithelium interactions in pulmonary airways

    PubMed Central

    Ghadiali, Samir N.; Gaver, Donald P.

    2008-01-01

    The delicate structure of the lung epithelium makes it susceptible to surface tension induced injury. For example, the cyclic reopening of collapsed and/or fluid-filled airways during the ventilation of injured lungs generates hydrodynamic forces that further damage the epithelium and exacerbate lung injury. The interactions responsible for epithelial injury during airway reopening are fundamentally multiscale, since air-liquid interfacial dynamics affect global lung mechanics, while surface tension forces operate at the molecular and cellular scales. This article will review the current state-of-knowledge regarding the effect of surface tension forces on a) the mechanics of airway reopening and b) epithelial cell injury. Due to the complex nature of the liquid-epithelium system, a combination of computational and experimental techniques are being used to elucidate the mechanisms of surface-tension induced lung injury. Continued research is leading to an integrated understanding of the biomechanical and biological interactions responsible for cellular injury during airway reopening. This information may lead to novel therapies that minimize ventilation induced lung injury. PMID:18511356

  15. Distal airway dysfunction identifies pulmonary inflammation in asymptomatic smokers.

    PubMed

    Berger, Kenneth I; Pradhan, Deepak R; Goldring, Roberta M; Oppenheimer, Beno W; Rom, William N; Segal, Leopoldo N

    2016-10-01

    Smoking induced inflammation leads to distal airway destruction. However, the relationship between distal airway dysfunction and inflammation remains unclear, particularly in smokers prior to the development of airway obstruction. Seven normal controls and 16 smokers without chronic obstructive pulmonary disease (COPD) were studied. Respiratory function was assessed using the forced oscillation technique (FOT). Abnormal FOT was defined as elevated resistance at 5 Hz (R5). Parameters reflecting distal lung function included frequency dependence of resistance (R5-20) and dynamic elastance (X5). Inflammation was quantified in concentrated bronchoalveolar lavage utilising cell count differential and cytokines expressed as concentration per mL epithelial lining fluid. All control subjects and seven smokers had normal R5. Nine smokers had elevated R5 with abnormal R5-20 and X5, indicating distal lung dysfunction. The presence of abnormal FOT was associated with two-fold higher lymphocyte and neutrophil counts (p<0.025) and with higher interleukin (IL)-8, eotaxin and fractalkine levels (p<0.01). Reactivity of R5-20 and X5 correlated with levels of IL-8, eotaxin, fractalkine, IL-12p70 and transforming growth factor-α (r>0.47, p<0.01). Distal airway dysfunction in smokers without COPD identifies the presence of distal lung inflammation that parallel reported observations in established COPD. These findings were not evident on routine pulmonary function testing and may allow the identification of smokers at risk of progression to COPD.

  16. Effectiveness of applying continuous positive airway pressure in a patient with paradoxical vocal fold movement after endotracheal extubation: a case report

    PubMed Central

    Song, Keu La Me; Ko, Dong Chan; Pin, Jung Woo; Ryu, Kyong Ho; Kim, Hyun Soo

    2016-01-01

    Paradoxical vocal fold movement (PVFM) is an uncommon upper airway disorder defined as paradoxical adduction of the vocal folds during inspiration. The etiology and treatment of PVFM are unclear. The physician should manage this condition because of the possibility of near complete airway obstruction in severe case of PVFM. We report a case of successful airway management in a patient with PVFM by applying continuous positive airway pressure (CPAP). In this case, PVFM was detected after removing an endotracheal tube from a 67-year-old male who underwent excision of a laryngeal mass. The patient recovered without complications in 1 day with support by CPAP. PMID:26885309

  17. Endotracheal intubation - A life saving procedure, still potential hazardous to upper airway: A case report.

    PubMed

    Afreen, Mahrukh; Ansari, Murtaza Ahsan

    2015-12-01

    Endotracheal intubation plays a key role in the management of upper airway obstruction in emergency situations. It is non-invasive and easily learned technique by medical professionals as compared to other more skilled, surgical procedures, e.g., tracheostomy and cricothyrotomies etc. But prolonged intubation may result in numerous complications, most notorious being tracheoesophageal fistula and narrowing of subglottic area. We report a profile of a patient who had been diagnosed as case of Guillian-Barre Syndrome, had difficulty in breathing due to paralysis of respiratory muscles. The patient was admitted in Medical Intensive Care Unit (MICU) for 40 days and was kept on artificial breathing through endotracheal intubation, which remained in place for 19 days. Later tracheostomy was performed. Patient ultimately developed severe subglottic stenosis and became dependent on tracheostomy tube.

  18. Non-malignant central airway obstruction.

    PubMed

    Barros Casas, David; Fernández-Bussy, Sebastian; Folch, Erik; Flandes Aldeyturriaga, Javier; Majid, Adnan

    2014-08-01

    The most common causes of non-malignant central airway obstruction are post-intubation and post-tracheostomytracheal stenosis, followed by the presence of foreign bodies, benign endobronchial tumours and tracheobronchomalacia. Other causes, such as infectious processes or systemic diseases, are less frequent. Despite the existence of numerous classification systems, a consensus has not been reached on the use of any one of them in particular. A better understanding of the pathophysiology of this entity has allowed us to improve diagnosis and treatment. For the correct diagnosis of nonspecific clinical symptoms, pulmonary function tests, radiological studies and, more importantly, bronchoscopy must be performed. Treatment must be multidisciplinary and tailored to each patient, and will require surgery or endoscopic intervention using thermoablative and mechanical techniques.

  19. Integrated care pathways for airway diseases (AIRWAYS-ICPs).

    PubMed

    Bousquet, J; Addis, A; Adcock, I; Agache, I; Agusti, A; Alonso, A; Annesi-Maesano, I; Anto, J M; Bachert, C; Baena-Cagnani, C E; Bai, C; Baigenzhin, A; Barbara, C; Barnes, P J; Bateman, E D; Beck, L; Bedbrook, A; Bel, E H; Benezet, O; Bennoor, K S; Benson, M; Bernabeu-Wittel, M; Bewick, M; Bindslev-Jensen, C; Blain, H; Blasi, F; Bonini, M; Bonini, S; Boulet, L P; Bourdin, A; Bourret, R; Bousquet, P J; Brightling, C E; Briggs, A; Brozek, J; Buhl, R; Bush, A; Caimmi, D; Calderon, M; Calverley, P; Camargos, P A; Camuzat, T; Canonica, G W; Carlsen, K H; Casale, T B; Cazzola, M; Cepeda Sarabia, A M; Cesario, A; Chen, Y Z; Chkhartishvili, E; Chavannes, N H; Chiron, R; Chuchalin, A; Chung, K F; Cox, L; Crooks, G; Crooks, M G; Cruz, A A; Custovic, A; Dahl, R; Dahlen, S E; De Blay, F; Dedeu, T; Deleanu, D; Demoly, P; Devillier, P; Didier, A; Dinh-Xuan, A T; Djukanovic, R; Dokic, D; Douagui, H; Dubakiene, R; Eglin, S; Elliot, F; Emuzyte, R; Fabbri, L; Fink Wagner, A; Fletcher, M; Fokkens, W J; Fonseca, J; Franco, A; Frith, P; Furber, A; Gaga, M; Garcés, J; Garcia-Aymerich, J; Gamkrelidze, A; Gonzales-Diaz, S; Gouzi, F; Guzmán, M A; Haahtela, T; Harrison, D; Hayot, M; Heaney, L G; Heinrich, J; Hellings, P W; Hooper, J; Humbert, M; Hyland, M; Iaccarino, G; Jakovenko, D; Jardim, J R; Jeandel, C; Jenkins, C; Johnston, S L; Jonquet, O; Joos, G; Jung, K S; Kalayci, O; Karunanithi, S; Keil, T; Khaltaev, N; Kolek, V; Kowalski, M L; Kull, I; Kuna, P; Kvedariene, V; Le, L T; Lodrup Carlsen, K C; Louis, R; MacNee, W; Mair, A; Majer, I; Manning, P; de Manuel Keenoy, E; Masjedi, M R; Melen, E; Melo-Gomes, E; Menzies-Gow, A; Mercier, G; Mercier, J; Michel, J P; Miculinic, N; Mihaltan, F; Milenkovic, B; Molimard, M; Momas, I; Montilla-Santana, A; Morais-Almeida, M; Morgan, M; N'Diaye, M; Nafti, S; Nekam, K; Neou, A; Nicod, L; O'Hehir, R; Ohta, K; Paggiaro, P; Palkonen, S; Palmer, S; Papadopoulos, N G; Papi, A; Passalacqua, G; Pavord, I; Pigearias, B; Plavec, D; Postma, D S; Price, D; Rabe, K F; Radier Pontal, F; Redon, J; Rennard, S; Roberts, J; Robine, J M; Roca, J; Roche, N; Rodenas, F; Roggeri, A; Rolland, C; Rosado-Pinto, J; Ryan, D; Samolinski, B; Sanchez-Borges, M; Schünemann, H J; Sheikh, A; Shields, M; Siafakas, N; Sibille, Y; Similowski, T; Small, I; Sola-Morales, O; Sooronbaev, T; Stelmach, R; Sterk, P J; Stiris, T; Sud, P; Tellier, V; To, T; Todo-Bom, A; Triggiani, M; Valenta, R; Valero, A L; Valiulis, A; Valovirta, E; Van Ganse, E; Vandenplas, O; Vasankari, T; Vestbo, J; Vezzani, G; Viegi, G; Visier, L; Vogelmeier, C; Vontetsianos, T; Wagstaff, R; Wahn, U; Wallaert, B; Whalley, B; Wickman, M; Williams, D M; Wilson, N; Yawn, B P; Yiallouros, P K; Yorgancioglu, A; Yusuf, O M; Zar, H J; Zhong, N; Zidarn, M; Zuberbier, T

    2014-08-01

    The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking and environmental exposure; 3) aiding risk stratification in chronic disease patients, using a common strategy; 4) having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and in the long-term (healthy ageing); 5) proposing a common simulation tool to assist physicians; and 6) ultimately reducing the healthcare burden (emergency visits, avoidable hospitalisations, disability and costs) while improving quality of life. In the longer term, the incidence of disease may be reduced by innovative prevention strategies. AIRWAYSICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers).

  20. Evaluating the Effect of Three Water Management Techniques on Tomato Crop

    PubMed Central

    Elnesr, Mohammad Nabil; Alazba, Abdurrahman Ali; Zein El-Abedein, Assem Ibrahim; El-Adl, Mahmoud Maher

    2015-01-01

    The effects of three water management techniques were evaluated on subsurface drip irrigated tomatoes. The three techniques were the intermittent flow (3 pulses), the dual-lateral drip system (two lateral lines per row, at 15 and 25cm below soil surface), and the physical barrier (buried at 30 cm below soil surface). Field experiments were established for two successive seasons. Water movement in soil was monitored using continuously logging capacitance probes up to 60 cm depth. The results showed that the dual lateral technique positively increased the yield up to 50%, water use efficiency up to 54%, while the intermittent application improved some of the quality measures (fruit size, TSS, and Vitamin C), not the quantity of the yield that decreased in one season, and not affected in the other. The physical barrier has no significant effect on any of the important growth measures. The soil water patterns showed that the dual lateral method lead to uniform wetting pattern with depth up to 45 cm, the physical barrier appeared to increase lateral and upward water movement, while the intermittent application kept the wetting pattern at higher moisture level for longer time. The cost analysis showed also that the economic treatments were the dual lateral followed by the intermittent technique, while the physical barrier is not economical. The study recommends researching the effect of the dual lateral method on the root growth and performance. The intermittent application may be recommended to improve tomato quality but not quantity. The physical barrier is not recommended unless in high permeable soils. PMID:26057380

  1. Evaluating the Effect of Three Water Management Techniques on Tomato Crop.

    PubMed

    Elnesr, Mohammad Nabil; Alazba, Abdurrahman Ali; Zein El-Abedein, Assem Ibrahim; El-Adl, Mahmoud Maher

    2015-01-01

    The effects of three water management techniques were evaluated on subsurface drip irrigated tomatoes. The three techniques were the intermittent flow (3 pulses), the dual-lateral drip system (two lateral lines per row, at 15 and 25 cm below soil surface), and the physical barrier (buried at 30 cm below soil surface). Field experiments were established for two successive seasons. Water movement in soil was monitored using continuously logging capacitance probes up to 60 cm depth. The results showed that the dual lateral technique positively increased the yield up to 50%, water use efficiency up to 54%, while the intermittent application improved some of the quality measures (fruit size, TSS, and Vitamin C), not the quantity of the yield that decreased in one season, and not affected in the other. The physical barrier has no significant effect on any of the important growth measures. The soil water patterns showed that the dual lateral method lead to uniform wetting pattern with depth up to 45 cm, the physical barrier appeared to increase lateral and upward water movement, while the intermittent application kept the wetting pattern at higher moisture level for longer time. The cost analysis showed also that the economic treatments were the dual lateral followed by the intermittent technique, while the physical barrier is not economical. The study recommends researching the effect of the dual lateral method on the root growth and performance. The intermittent application may be recommended to improve tomato quality but not quantity. The physical barrier is not recommended unless in high permeable soils.

  2. [Rare problem with the insertion of a Supreme™ laryngeal mask airway device. Case of the trimester].

    PubMed

    2014-03-01

    A breast tumor was resected under general anesthesia. After induction, the airway was managed with a Supreme™ laryngeal mask airway device. The insertion of the laryngeal mask airway device, the insertion of the orogastric tube through the drain tube, as well as the mechanical ventilation, were very difficult from the beginning. On removing the laryngeal mask airway device to solve the problem, it was observed that the drain tube was broken, and the orogastric tube had passed into the anterior, laryngeal part of the device through the split. It was later found out that the laryngeal mask airway device, as well as the whole manufacturing batch, had suffered a design modification: the cuff was constructed with a softer material without reinforcement in the tip, and the drain tube had a heat-sealing defect that facilitated the break. The incident was reported to the local supplier and the manufacturer, and the defective batch of laryngeal mask airway devices was recalled. The incident was also reported to other hospitals via SENSAR, to warn other users of the potential dangers of the design modification in the Supreme™ laryngeal mask airway.

  3. Host-Integration of a Tissue-Engineered Airway Patch: Two-Year Follow-Up in a Single Patient

    PubMed Central

    Dally, Iris; Friedel, Godehard; Walles, Heike; Walles, Thorsten

    2015-01-01

    Different bioengineering techniques have been applied repeatedly for the reconstruction of extensive airway defects in the last few years. While short-term surgical success is evident, there is a lack of long-term results in patients. Here, we report the case of a young male who received a 5×2 cm bioartificial airway patch for tracheoesophageal reconstruction focusing on clinical defect healing and histomorphological tissue reorganization 2.5 years after surgery. We generated bioartificial airway tissue using a cell-free biological vascularized scaffold that was re-endothelialized and reseeded with the recipient's autologous primary cells and we implanted it into the recipient's left main bronchus. To investigate host-integration 2.5 years after the implantation, we obtained biopsies of the implant and adjacent tracheal tissue and processed these for histological and immunohistochemical analyses. The early postoperative course was uneventful and the transplanted airway tissue was integrated into the host. 2.5 years after transplantation, a bronchoscopy confirmed the scar-free reconstruction of the former airway defect. Histological work-up documented respiratory airway mucosa lining the bronchial reconstruction, making it indistinguishable from native airway mucosa. After transplantation, our bioartificial airway tissue provided perfect airway healing, with no histological evidence of tissue dedifferentiation. PMID:25316325

  4. The Contribution of Small Airway Obstruction to the Pathogenesis of Chronic Obstructive Pulmonary Disease.

    PubMed

    Hogg, James C; Paré, Peter D; Hackett, Tillie-Louise

    2017-04-01

    The hypothesis that the small conducting airways were the major site of obstruction to airflow in normal lungs was introduced by Rohrer in 1915 and prevailed until Weibel introduced a quantitative method of studying lung anatomy in 1963. Green repeated Rohrer's calculations using Weibels new data in 1965 and found that the smaller conducting airways offered very little resistance to airflow. This conflict was resolved by seminal experiments conducted by Macklem and Mead in 1967, which confirmed that a small proportion of the total lower airways resistance is attributable to small airways <2 mm in diameter. Shortly thereafter, Hogg, Macklem, and Thurlbeck used this technique to show that small airways become the major site of obstruction in lungs affected by emphysema. These and other observations led Mead to write a seminal editorial in 1970 that postulated the small airways are a silent zone within normal lungs where disease can accumulate over many years without being noticed. This review provides a progress report since the 1970s on methods for detecting chronic obstructive pulmonary disease, the structural nature of small airways' disease, and the cellular and molecular mechanisms that are thought to underlie its pathogenesis.

  5. Generation of Pig Airways using Rules Developed from the Measurements of Physical Airways

    PubMed Central

    Azad, Md Khurshidul; Mansy, Hansen A.

    2017-01-01

    Background A method for generating bronchial tree would be helpful when constructing models of the tree for benchtop experiments as well as for numerical modeling of flow or sound propagation in the airways. Early studies documented the geometric details of the human airways that were used to develop methods for generating human airway tree. However, methods for generating animal airway tree are scarcer. Earlier studies suggested that the morphology of animal airways can be significantly different from that of humans. Hence, using algorithms for the human airways may not be accurate in generating models of animal airway geometry. Objective The objective of this study is to develop an algorithm for generating pig airway tree based on the geometric details extracted from the physical measurements. Methods In the current study, measured values of branch diameters, lengths and bifurcation angles and rotation of bifurcating planes were used to develop an algorithm that is capable of generating a realistic pig airway tree. Results The generation relations between parent and daughter branches were found to follow certain trends. The diameters and the length of different branches were dependent on airway generations while the bifurcation angles were primarily dependent on bifurcation plane rotations. These relations were sufficient to develop rules for generating a model of the pig large airways. Conclusion The results suggested that the airway tree generated from the algorithm can provide an approximate geometric model of pig airways for computational and benchtop studies. PMID:28255517

  6. Western pond turtle: Biology, sampling techniques, inventory and monitoring, conservation, and management: Northwest Fauna No. 7

    USGS Publications Warehouse

    Bury, R.B.; Welsh, Hartwell H.; Germano, David J.; Ashton, Donald T.

    2012-01-01

    One of only two native, freshwater turtle species in the western United States, western pond turtles are declining in portions of their original range. Declines are mostly due to habitat loss, introduction of non-native species, pollution, and lack of connectivity among populations. USGS zoologist R. Bruce Bury and colleagues from the U.S. Forest Service, California State University, and other agencies compiled and edited a new review and field manual of this charismatic species. Objectives were to determine its current distribution and abundance, summarize and evaluate population features, review techniques to detect population and habitat changes, and improve monitoring for long-term trends. Methods described in the manual should improve consistency, efficiency, and accuracy of survey data, resulting in improved management and conservation efforts.

  7. Project planning and management techniques of the fast-paced TMX-Upgrade construction

    SciTech Connect

    Seberger, C.D.; Chargin, A.K.

    1981-10-26

    The Tandem Mirror Experiment-Upgrade (TMX-Upgrade) construction will be completed in 18 months at a total cost of $14.5 million. This paper describes the project planning and the management techniques used to complete the TMX-Upgrade within its allocated cost and schedule. In the planning stages of a project, before approval of the proposal, we define major project objectives, create a work breakdown structure (WBS), detail a technical description for each level of the WBS, and provide detailed bottoms-up cost estimates and summary schedules. In the operating phase, which continues throughout the project, we establish budget and schedule baselines. The reporting phase includes The Department of Energy (DOE) reviews of project status at monthly, quarterly, and semiannual intervals. These reports include cost, schedule, manpower, major procurement, and technical status information.

  8. Assessment of frequent cutting as a plant-community management technique in power-line corridors

    NASA Astrophysics Data System (ADS)

    Luken, James O.; Hinton, Andrew C.; Baker, Douglas G.

    1991-05-01

    Repeated cutting of vegetation at or near ground level in power-line corridors is a common practice for inhibiting tree growth and regeneration. However, few data exist on long-term community responses. In this study, we sampled 20 northern Kentucky power-line corridors and compared their seedling and sapling communities to the edges and interiors of adjacent undisturbed forests. Mean seedling and sapling density in corridors was roughly twice that of adjacent undisturbed forest interiors, suggesting that repeated cutting is not a viable method of inhibiting tree regeneration. Corridor communities were dominated by Robinia pseudoacacia (black locust) and Fraxinus americana (white ash), but ordinations indicated strong similaritties among communities in corridors and adjacent forests. Many of the tree species found in adjacent forests, with the exception of a few shade-tolerant species, had highest seedling and sapling densities in corridors. Stump or root sprouting by many species appears to regenerate forests quickly after cutting. However, disturbed soil and detritus accumulations caused by management crews and their equipment may also create a large variety of microsites for seedling establishment. Because repeated cutting selects for dominance by species with highest sprout growth rates, it should not be used as the sole management technique. It may instead be used to alter the vigor, stature, and stored reserves of trees so that herbicides or other methods of tree control can be used more efficiently.

  9. Application of capillary fluid management techniques to the design of a phase separating microgravity bioreactor

    NASA Technical Reports Server (NTRS)

    Finger, Barry W.; Neville, Gale E., Jr.; Sager, John C.

    1993-01-01

    Manned space missions require the development of compact, efficient, and reliable life support systems. A number of aqueous biological conversion processes are associated with bioregenerative life support systems. Vessels, or bioreactors, capable of supporting these processes in microgravity must be developed. An annular flow bioreactor has been conceived. It has the potential to incorporate containment, phase separation, gas exchange, and illumination into a single vessel. The bioreactor utilizes capillary fluid management techniques and is configured as a cylindrical tube in which a two-phase liquid-gas flow is maintained. Vanes placed around the inner perimeter enhance capillary forces and cause the liquid phase to attach and flow along the interior surface of the tube. No physical barrier is required to complete phase separation. It is shown analytically that liquid film thickness is limited only by vane geometry and that an annular flow bioreactor capable of managing 284 liters would occupy 0.7 cubic m, less than half the volume of a Spacelab experiment rack.

  10. Bicondylar tibial plateau fractures managed with the Sheffield Hybrid Fixator. Biomechanical study and operative technique.

    PubMed

    Ali, A M; Yang, L; Hashmi, M; Saleh, M

    2001-12-01

    The two main challenges in the management of bicondylar tibial plateau fractures are: Firstly, the compromised skin and soft tissue envelope which invite a high rate of complications following attempted open reduction and dual plating. Secondly, poor bone quality and comminuted fracture patterns, which create difficulty in achieving stable fixation. Although dual plating is considered to be the best mechanical method of stabilizing these complex fractures, there remains concern regarding the high rate of complications associated with extensive soft tissue dissection, required for the insertion of these plates in an already compromised knee. The Sheffield Hybrid fixator (SHF) technique offers a solution to the two main problems of these difficult fractures by minimizing soft tissue dissection, since bone fragments are reduced and fixed percutaneously, and providing superior cancellous bone purchase with beam loading stabilization for comminuted fractures. Our biomechanical testing showed the SHF with four tensioned wires to be as strong as dual plating and able to provide adequate mechanical stability in the fixation of bicondylar tibial plateau fractures. This was confirmed clinically by a prospective review of the use of the SHF at our centre, for managing complex and high-energy tibial plateau fractures with a good final outcome and no cases of deep infection or septic arthritis.

  11. Breast Cancer-Related Arm Lymphedema: Incidence Rates, Diagnostic Techniques, Optimal Management and Risk Reduction Strategies

    SciTech Connect

    Shah, Chirag; Vicini, Frank A.

    2011-11-15

    As more women survive breast cancer, long-term toxicities affecting their quality of life, such as lymphedema (LE) of the arm, gain importance. Although numerous studies have attempted to determine incidence rates, identify optimal diagnostic tests, enumerate efficacious treatment strategies and outline risk reduction guidelines for breast cancer-related lymphedema (BCRL), few groups have consistently agreed on any of these issues. As a result, standardized recommendations are still lacking. This review will summarize the latest data addressing all of these concerns in order to provide patients and health care providers with optimal, contemporary recommendations. Published incidence rates for BCRL vary substantially with a range of 2-65% based on surgical technique, axillary sampling method, radiation therapy fields treated, and the use of chemotherapy. Newer clinical assessment tools can potentially identify BCRL in patients with subclinical disease with prospective data suggesting that early diagnosis and management with noninvasive therapy can lead to excellent outcomes. Multiple therapies exist with treatments defined by the severity of BCRL present. Currently, the standard of care for BCRL in patients with significant LE is complex decongestive physiotherapy (CDP). Contemporary data also suggest that a multidisciplinary approach to the management of BCRL should begin prior to definitive treatment for breast cancer employing patient-specific surgical, radiation therapy, and chemotherapy paradigms that limit risks. Further, prospective clinical assessments before and after treatment should be employed to diagnose subclinical disease. In those patients who require aggressive locoregional management, prophylactic therapies and the use of CDP can help reduce the long-term sequelae of BCRL.

  12. Catheter fixation and ligation: a simple technique for ventriculostomy management following endovascular stenting.

    PubMed

    Sweeney, Justin M; Vasan, Rohit; van Loveren, Harry R; Youssef, A Samy; Agazzi, Siviero

    2013-05-01

    The object of this study was to describe a unique method of managing ventriculostomy catheters in patients on antithrombotic therapy following endovascular treatment of ruptured intracranial aneurysms. The authors retrospectively reviewed 3 cases in which a unique method of ventriculostomy management was used to successfully avoid catheter-related hemorrhage while the patient was on dual antiplatelet therapy. In this setting, ventriculostomy catheters are left in place and fixed to the calvarium with titanium straps effectively ligating them. The catheter is divided and the distal end is removed. The proximal end can be directly connected to a distal shunt system during this stage or at a later date if necessary. The method described in this report provided a variety of management options for patients requiring external ventricular drainage for subarachnoid hemorrhage. No patient suffered catheter-related hemorrhage. This preliminary report demonstrates a safe and effective method for discontinuing external ventricular drainage and/or placing a ventriculoperitoneal shunt in the setting of active coagulopathy or antithrombotic therapy. The technique avoids both the risk of hemorrhage related to catheter removal and reinsertion and the thromboembolic risks associated with the reversal of antithrombotic therapy. Some aneurysm centers have avoided the use of stent-assisted coiling in cases of ruptured aneurysms to circumvent ventriculostomy-related complications; however, the method described herein should allow continued use of this important treatment option in ruptured aneurysm cases. Further investigation in a larger cohort with long-term follow-up is necessary to define the associated risks of infection using this method.

  13. The sterile-male-release technique in Great Lakes sea lamprey management

    USGS Publications Warehouse

    Bergstedt, Roger A.; Twohey, Michael B.

    2005-01-01

    The parasitic sea lamprey (Petromyzon marinus) has been a serious pest since its introduction into the Great Lakes, where it contributed to severe imbalances in the fish communities by selectively removing large predators (Smith 1968; Christie 1974; Schneider et al.1996). Since the 1950s, restoration and maintenance of predator-prey balance has depended on the Great Lakes Fishery Commission (GLFC) sea lamprey management program. Initially, management relied primarily on stream treatments with a selective lampricide to kill larvae, on barriers to migration, and on trapping to remove potential spawners (Smith and Tibbles 1980). By the late 1970s, however, it was clear that the future of sea lamprey management lay in development of a larger array of control strategies, including more alternatives to lampricide applications (Sawyer 1980). Since then the only new alternative to chemical control to reach operational status is the release of sterilized male sea lampreys. Research on the concept began at the USGS, Hammond Bay Biological Station in Millersburg, MI (HBBS) during the 1970s (Hanson and Manion 1980). Development and evaluation continued through the 1980s, leading to the release of sterilized males in Great Lakes tributaries since 1991 (Twohey et al. 2003a). The objectives of this paper are 1) to review the implementation and evaluations of sterile-male-release technique (SMRT) as it is being applied against sea lampreys in the Great Lakes, 2) to review our current understanding of its efficacy, and 3) to identify additional research areas and topics that would increase either the efficacy of SMRT or expand its geographic potential for application.

  14. The Limits of Corporate Social Responsibility: Techniques of Neutralization, Stakeholder Management and Political CSR.

    PubMed

    Fooks, Gary; Gilmore, Anna; Collin, Jeff; Holden, Chris; Lee, Kelley

    2013-01-01

    Since scholarly interest in corporate social responsibility (CSR) has primarily focused on the synergies between social and economic performance, our understanding of how (and the conditions under which) companies use CSR to produce policy outcomes that work against public welfare has remained comparatively under-developed. In particular, little is known about how corporate decision-makers privately reconcile the conflicts between public and private interests, even though this is likely to be relevant to understanding the limitations of CSR as a means of aligning business activity with the broader public interest. This study addresses this issue using internal tobacco industry documents to explore British-American Tobacco's (BAT) thinking on CSR and its effects on the company's CSR Programme. The article presents a three-stage model of CSR development, based on Sykes and Matza's theory of techniques of neutralization, which links together: how BAT managers made sense of the company's declining political authority in the mid-1990s; how they subsequently justified the use of CSR as a tool of stakeholder management aimed at diffusing the political impact of public health advocates by breaking up political constituencies working towards evidence-based tobacco regulation; and how CSR works ideologically to shape stakeholders' perceptions of the relative merits of competing approaches to tobacco control. Our analysis has three implications for research and practice. First, it underlines the importance of approaching corporate managers' public comments on CSR critically and situating them in their economic, political and historical contexts. Second, it illustrates the importance of focusing on the political aims and effects of CSR. Third, by showing how CSR practices are used to stymie evidence-based government regulation, the article underlines the importance of highlighting and developing matrices to assess the negative social impacts of CSR.

  15. Partial airway obstruction following manufacturing defect in laryngeal mask airway (Laryngeal Mask Silken™).

    PubMed

    Jangra, Kiran; Malhotra, Surender Kumar; Saini, Vikas

    2014-10-01

    Laryngeal mask (LM) airway is commonly used for securing airway in day-care surgeries. Various problems have been described while using LM airway. Out of those, mechanical obstruction causing airway compromise is most common. Here, we describe a case report of 4-year-old child who had partial upper airway obstruction due to LM manufacturer's defect. There was a silicon band in upper one-third of shaft of LM airway. This band was made up of the same material as that of LM airway so it was not identifiable on external inspection of transparent shaft. We suggest that such as non-transparent laryngeal mask, a transparent LM airway should also be inspected looking inside the lumen with naked eyes or by using a probe to rule out any manufacturing defect before its insertion.

  16. Managing complex processing of medical image sequences by program supervision techniques

    NASA Astrophysics Data System (ADS)

    Crubezy, Monica; Aubry, Florent; Moisan, Sabine; Chameroy, Virginie; Thonnat, Monique; Di Paola, Robert

    1997-05-01

    Our objective is to offer clinicians wider access to evolving medical image processing (MIP) techniques, crucial to improve assessment and quantification of physiological processes, but difficult to handle for non-specialists in MIP. Based on artificial intelligence techniques, our approach consists in the development of a knowledge-based program supervision system, automating the management of MIP libraries. It comprises a library of programs, a knowledge base capturing the expertise about programs and data and a supervision engine. It selects, organizes and executes the appropriate MIP programs given a goal to achieve and a data set, with dynamic feedback based on the results obtained. It also advises users in the development of new procedures chaining MIP programs.. We have experimented the approach for an application of factor analysis of medical image sequences as a means of predicting the response of osteosarcoma to chemotherapy, with both MRI and NM dynamic image sequences. As a result our program supervision system frees clinical end-users from performing tasks outside their competence, permitting them to concentrate on clinical issues. Therefore our approach enables a better exploitation of possibilities offered by MIP and higher quality results, both in terms of robustness and reliability.

  17. Effective management of medical information through a novel blind watermarking technique.

    PubMed

    Das, Sudeb; Kundu, Malay Kumar

    2012-10-01

    Medical Data Management (MDM) domain consists of various issues of medical information like authentication, security, privacy, retrieval and storage etc. Medical Image Watermarking (MIW) techniques have recently emerged as a leading technology to solve the problems associated with MDM. This paper proposes a blind, Contourlet Transform (CNT) based MIW scheme, robust to high JPEG and JPEG2000 compression and simultaneously capable of addressing a range of MDM issues like medical information security, content authentication, safe archiving and controlled access retrieval etc. It also provides a way for effective data communication along with automated medical personnel teaching. The original medical image is first decomposed by CNT. The Low pass subband is used to embed the watermark in such a way that enables the proposed method to extract the embedded watermark in a blind manner. Inverse CNT is then applied to get the watermarked image. Extensive experiments were carried out and the performance of the proposed scheme is evaluated through both subjective and quantitative measures. The experimental results and comparisons, confirm the effectiveness and efficiency of the proposed technique in the MDM paradigm.

  18. The impact of different management techniques on carbon balance of a pine stand after windthrow

    NASA Astrophysics Data System (ADS)

    Ziemblinska, Klaudia; Urbaniak, Marek; Merbold, Lutz; Chojnicki, Bogdan H.; Olejnik, Janusz

    2015-04-01

    Forest ecosystems cover approximately 1/3 of the global land area (and 29.8% in Poland). Since forests are constantly exposed to various types of disturbances - both natural and anthropogenic such as fires, wind, insects outbreaks or clear cuts - it is important to investigate the impact of such damages on the carbon dynamics. This becomes even more important due to the fact that future climate change will most likely result in a higher frequency and intensity of extreme climatic events. Even though wind damages cause large disturbances to forests only few places in the world exist where continuous measurements of carbon exchange (CO2) in windthrown sites are carried out. Besides the opportunity to assess the carbon dynamics following wind disturbance, there is an additional possibility of evaluating differences in post windthrow forest management practices. To fill this knowledge gap we set up two measuring stations in north-western Poland in the 500ha area of pine forest damaged by tornado in July 2012, to assess the impact of such disturbance on CO2 and H2O exchange by use of Eddy Covariance (EC) technique (Tlen I and Tlen II). Both sites are characterized by similar climatic as well as soil conditions and are located 3km from each other. While at the site Tlen I all biomass (coarse and fine woody debris were collected together with stumps) was removed and ploughed thereafter, at Tlen II only trunks and main branches were taken out from the site without ploughing. Total harvested biomass per hectare, as derived from local forest inventory, were almost 18 % higher at Tlen I than Tlen II site (where uprooted stumps were left to decompose). First analysis of the eddy covariance data shows that both sites are significant carbon sources. Emissions of carbon dioxide from the non-ploughed site (Tlen II) are higher than from the ploughed site (Tlen I). Both sites released more than 8.1 t of CO2 per ha during a three month time period (mid July to mid August 2014) after

  19. Successful weaning of a laryngeal mask airway after a tongue-lip adhesion operation in a case with cerebro-costo-mandibular syndrome.

    PubMed

    So, Chi-Yung; Ng, Yan-Yan; Peng, Chih-Yu; Hu, Jui-Ming; Chen, Suh-Jen; Chen, Jia-Yuh; Su, Pen-Hua

    2010-02-01

    Cerebro-costo-mandibular syndrome (CCMS) consists of severe micrognathia, glossoptosis, posterior rib-gap defects and developmental delay. It may cause upper airway obstruction andflail chest, resulting in neonatal hypoxia, and possibly death. Early airway management or surgical intervention to maintain a patent airway is critical to avoid hypoxia in CCMS patients. We report a newborn with CCMS who was successfully weaned from a laryngeal mask after undergoing a tongue-lip adhesion operation at 164 days of age.

  20. Small is the new big: An overview of newer supraglottic airways for children.

    PubMed

    Goyal, Rakhee

    2015-01-01

    Almost all supraglottic airways (SGAs) are now available in pediatric sizes. The availability of these smaller sizes, especially in the last five years has brought a marked change in the whole approach to airway management in children. SGAs are now used for laparoscopic surgeries, head and neck surgeries, remote anesthesia; and for ventilation during resuscitation. A large number of reports have described the use of SGAs in difficult airway situations, either as a primary or a rescue airway. Despite this expanded usage, there remains little evidence to support its usage in prolonged surgeries and in the intensive care unit. This article presents an overview of the current options available, suitability of one over the other and reviews the published data relating to each device. In this review, the author also addresses some of the general concerns regarding the use of SGAs and explores newer roles of their use in children.

  1. Small is the new big: An overview of newer supraglottic airways for children

    PubMed Central

    Goyal, Rakhee

    2015-01-01

    Almost all supraglottic airways (SGAs) are now available in pediatric sizes. The availability of these smaller sizes, especially in the last five years has brought a marked change in the whole approach to airway management in children. SGAs are now used for laparoscopic surgeries, head and neck surgeries, remote anesthesia; and for ventilation during resuscitation. A large number of reports have described the use of SGAs in difficult airway situations, either as a primary or a rescue airway. Despite this expanded usage, there remains little evidence to support its usage in prolonged surgeries and in the intensive care unit. This article presents an overview of the current options available, suitability of one over the other and reviews the published data relating to each device. In this review, the author also addresses some of the general concerns regarding the use of SGAs and explores newer roles of their use in children. PMID:26702197

  2. Maxillary, mandibular, and chin advancement: treatment planning based on airway anatomy in obstructive sleep apnea.

    PubMed

    Schendel, Stephen; Powell, Nelson; Jacobson, Richard

    2011-03-01

    Surgical correction of obstructive sleep apnea (OSA) syndrome involves understanding a number of parameters, of which the 3-dimensional airway anatomy is important. Visualization of the upper airway based on cone beam computed tomography scans and automated computer analysis is an aid in understanding normal and abnormal airway conditions and their response to surgery. The goal of surgical treatment of OSA syndrome is to enlarge the velo-oropharyngeal airway by anterior/lateral displacement of the soft tissues and musculature by maxillary, mandibular, and possibly, genioglossus advancement. Knowledge of the specific airway obstruction and characteristics based on 3-dimensional studies permits a directed surgical treatment plan that can successfully address the area or areas of airway obstruction. The end occlusal result can be improved when orthodontic treatment is combined with the surgical plan. The individual with OSA, though, is more complicated than the usual orthognathic patient, and both the medical condition and treatment length need to be judiciously managed when OSA and associated conditions are present. The perioperative management of the patient with OSA is more complex and the margin for error is reduced, and this needs to be taken into consideration and the care altered as indicated.

  3. Method for 3D Airway Topology Extraction

    PubMed Central

    Grothausmann, Roman; Kellner, Manuela; Heidrich, Marko; Lorbeer, Raoul-Amadeus; Ripken, Tammo; Meyer, Heiko; Kuehnel, Mark P.; Ochs, Matthias; Rosenhahn, Bodo

    2015-01-01

    In lungs the number of conducting airway generations as well as bifurcation patterns varies across species and shows specific characteristics relating to illnesses or gene variations. A method to characterize the topology of the mouse airway tree using scanning laser optical tomography (SLOT) tomograms is presented in this paper. It is used to test discrimination between two types of mice based on detected differences in their conducting airway pattern. Based on segmentations of the airways in these tomograms, the main spanning tree of the volume skeleton is computed. The resulting graph structure is used to distinguish between wild type and surfactant protein (SP-D) deficient knock-out mice. PMID:25767561

  4. Automated Lobe-Based Airway Labeling

    PubMed Central

    Gu, Suicheng; Wang, Zhimin; Siegfried, Jill M.; Wilson, David; Bigbee, William L.; Pu, Jiantao

    2012-01-01

    Regional quantitative analysis of airway morphological abnormalities is of great interest in lung disease investigation. Considering that pulmonary lobes are relatively independent functional unit, we develop and test a novel and efficient computerized scheme in this study to automatically and robustly classify the airways into different categories in terms of pulmonary lobe. Given an airway tree, which could be obtained using any available airway segmentation scheme, the developed approach consists of four basic steps: (1) airway skeletonization or centerline extraction, (2) individual airway branch identification, (3) initial rule-based airway classification/labeling, and (4) self-correction of labeling errors. In order to assess the performance of this approach, we applied it to a dataset consisting of 300 chest CT examinations in a batch manner and asked an image analyst to subjectively examine the labeled results. Our preliminary experiment showed that the labeling accuracy for the right upper lobe, the right middle lobe, the right lower lobe, the left upper lobe, and the left lower lobe is 100%, 99.3%, 99.3%, 100%, and 100%, respectively. Among these, only two cases are incorrectly labeled due to the failures in airway detection. It takes around 2 minutes to label an airway tree using this algorithm. PMID:23093951

  5. Anatomic Optical Coherence Tomography of Upper Airways

    NASA Astrophysics Data System (ADS)

    Chin Loy, Anthony; Jing, Joseph; Zhang, Jun; Wang, Yong; Elghobashi, Said; Chen, Zhongping; Wong, Brian J. F.

    The upper airway is a complex and intricate system responsible for respiration, phonation, and deglutition. Obstruction of the upper airways afflicts an estimated 12-18 million Americans. Pharyngeal size and shape are important factors in the pathogenesis of airway obstructions. In addition, nocturnal loss in pharyngeal muscular tone combined with high pharyngeal resistance can lead to collapse of the airway and periodic partial or complete upper airway obstruction. Anatomical optical coherence tomography (OCT) has the potential to provide high-speed three-dimensional tomographic images of the airway lumen without the use of ionizing radiation. In this chapter we describe the methods behind endoscopic OCT imaging and processing to generate full three dimensional anatomical models of the human airway which can be used in conjunction with numerical simulation methods to assess areas of airway obstruction. Combining this structural information with flow dynamic simulations, we can better estimate the site and causes of airway obstruction and better select and design surgery for patients with obstructive sleep apnea.

  6. Inhaled Antibiotics for Lower Airway Infections

    PubMed Central

    Quon, Bradley S.; Goss, Christopher H.

    2014-01-01

    Inhaled antibiotics have been used to treat chronic airway infections since the 1940s. The earliest experience with inhaled antibiotics involved aerosolizing antibiotics designed for parenteral administration. These formulations caused significant bronchial irritation due to added preservatives and nonphysiologic chemical composition. A major therapeutic advance took place in 1997, when tobramycin designed for inhalation was approved by the U.S. Food and Drug Administration (FDA) for use in patients with cystic fibrosis (CF) with chronic Pseudomonas aeruginosa infection. Attracted by the clinical benefits observed in CF and the availability of dry powder antibiotic formulations, there has been a growing interest in the use of inhaled antibiotics in other lower respiratory tract infections, such as non-CF bronchiectasis, ventilator-associated pneumonia, chronic obstructive pulmonary disease, mycobacterial disease, and in the post–lung transplant setting over the past decade. Antibiotics currently marketed for inhalation include nebulized and dry powder forms of tobramycin and colistin and nebulized aztreonam. Although both the U.S. Food and Drug Administration and European Medicines Agency have approved their use in CF, they have not been approved in other disease areas due to lack of supportive clinical trial evidence. Injectable formulations of gentamicin, tobramycin, amikacin, ceftazidime, and amphotericin are currently nebulized “off-label” to manage non-CF bronchiectasis, drug-resistant nontuberculous mycobacterial infections, ventilator-associated pneumonia, and post-transplant airway infections. Future inhaled antibiotic trials must focus on disease areas outside of CF with sample sizes large enough to evaluate clinically important endpoints such as exacerbations. Extrapolating from CF, the impact of eradicating organisms such as P. aeruginosa in non-CF bronchiectasis should also be evaluated. PMID:24673698

  7. Ultrasonography - A viable tool for airway assessment

    PubMed Central

    Reddy, Preethi B; Punetha, Pankaj; Chalam, Kolli S

    2016-01-01

    Background and Aims: Accurate prediction of the Cormack-Lehane (CL) grade preoperatively can help in better airway management of the patient during induction of anaesthesia. Our aim was to determine the utility of ultrasonography in predicting CL grade. Methods: We studied 100 patients undergoing general endotracheal anaesthesia. Mallampati (MP) class, thyromental distance (TMD) and sternomental distance (SMD) were noted. Ultrasound measurements of the anterior neck soft tissue thickness at the level of the hyoid (ANS-Hyoid), anterior neck soft tissue thickness at the level of the vocal cords (ANS-VC) and ratio of the depth of the pre-epiglottic space (Pre-E) to the distance from the epiglottis to the mid-point of the distance between the vocal cords (E-VC) were obtained. CL grade was noted during intubation. Chi-square test was employed to determine if there was any statistical difference in the measurements of patients with different CL grades. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated for the various parameters. Results: The incidence of difficult intubation was 14%. An ANS-VC >0.23 cm had a sensitivity of 85.7% in predicting a CL Grade of 3 or 4, which was higher than that of MP class, TMD and SMD. However, the specificity, PPV and accuracy were lower than the physical parameters. The NPV was comparable. Conclusion: Ultrasound is a useful tool in airway assessment. ANS-VC >0.23 cm is a potential predictor of difficult intubation. ANS-Hyoid is not indicative of difficult intubation. The ratio Pre-E/E-VC has a low to moderate predictive value. PMID:27942053

  8. TIVA-A Promising Approach to Anaesthetic Management of Montgomery T-tube Insertion

    PubMed Central

    Kurdi, Madhuri S.; Sindhupriya

    2015-01-01

    One of the treatment modalities for tracheal stenosis is tracheal dilatation and stenting using silicone Montgomery T-tube. Various techniques have been reported for this procedure. For safe anaesthetic management, anaesthesiologist must be aware of the surgical procedure, limitations of T-tube, likelihood of compromised airway besides the inherent problems of sharing the airway with surgeons. Total intravenous anaesthesia (TIVA) is a technique which has become very popular and possible now a days for various surgical procedures owing to its advantages. The anaesthetic technique should be based on the provider’s experience and severity of tracheal stenosis. We present here the anaesthetic management using TIVA technique with propofol and atracurium for the insertion of Montgomery T-tube in a case of post intubation tracheal stenosis. PMID:26436024

  9. [Obstruction of the upper airways in humans and animal models].

    PubMed

    Schulz, R

    2010-07-01

    Obstructive sleep apnea (OSA) is caused by repetitive collapse of a narrow upper airway during sleep with the main risk factor being obesity. Apneas are followed by hypoxia, sympathetic activation, intrathoracic pressure swings and arousals. In most animal studies, only the cyclical pattern of hypoxia characteristic of OSA is simulated, however, more complex models have also been developed which additionally reflect the other pathophysiological changes associated with sleep-disordered breathing. These models have contributed to a deeper understanding of the cardiovascular and metabolic consequences of OSA. From other experiments the concept of the pharynx behaving like a collapsible tube, i. e. a Starling resistor, has emerged. Finally, the neurotransmitter modulation of upper airway muscle tone has been elucidated by using IN VIVO microdialysis of the caudal medulla of rats. It is hoped that findings from animal studies will in the future impact on the management of patients with OSA, in particular if they are non-compliant with CPAP therapy.

  10. Aerosol bolus dispersion in acinar airways--influence of gravity and airway asymmetry.

    PubMed

    Ma, Baoshun; Darquenne, Chantal

    2012-08-01

    The aerosol bolus technique can be used to estimate the degree of convective mixing in the lung; however, contributions of different lung compartments to measured dispersion cannot be differentiated unambiguously. To estimate dispersion in the distal lung, we studied the effect of gravity and airway asymmetry on the dispersion of 1 μm-diameter particle boluses in three-dimensional computational models of the lung periphery, ranging from a single alveolar sac to four-generation (g4) structures of bifurcating airways that deformed homogeneously during breathing. Boluses were introduced at the beginning of a 2-s inhalation, immediately followed by a 3-s exhalation. Dispersion was estimated by the half-width of the exhaled bolus. Dispersion was significantly affected by the spatial orientation of the models in normal gravity and was less in zero gravity than in normal gravity. Dispersion was strongly correlated with model volume in both normal and zero gravity. Predicted pulmonary dispersion based on a symmetric g4 acinar model was 391 ml and 238 ml under normal and zero gravity, respectively. These results accounted for a significant amount of dispersion measured experimentally. In zero gravity, predicted dispersion in a highly asymmetric model accounted for ∼20% of that obtained in a symmetric model with comparable volume and number of alveolated branches, whereas normal gravity dispersions were comparable in both models. These results suggest that gravitational sedimentation and not geometrical asymmetry is the dominant factor in aerosol dispersion in the lung periphery.

  11. Clinical review: Biphasic positive airway pressure and airway pressure release ventilation

    PubMed Central

    Putensen, Christian; Wrigge, Hermann

    2004-01-01

    This review focuses on mechanical ventilation strategies that allow unsupported spontaneous breathing activity in any phase of the ventilatory cycle. By allowing patients with the acute respiratory distress syndrome to breathe spontaneously, one can expect improvements in gas exchange and systemic blood flow, based on findings from both experimental and clinical trials. In addition, by increasing end-expiratory lung volume, as occurs when using biphasic positive airway pressure or airway pressure release ventilation, recruitment of collapsed or consolidated lung is likely to occur, especially in juxtadiaphragmatic lung legions. Traditional approaches to mechanical ventilatory support of patients with acute respiratory distress syndrome require adaptation of the patient to the mechanical ventilator using heavy sedation and even muscle relaxation. Recent investigations have questioned the utility of sedation, muscle paralysis and mechanical control of ventilation. Furthermore, evidence exists that lowering sedation levels will decrease the duration of mechanical ventilatory support, length of stay in the intensive care unit, and overall costs of hospitalization. Based on currently available data, we suggest considering the use of techniques of mechanical ventilatory support that maintain, rather than suppress, spontaneous ventilatory effort, especially in patients with severe pulmonary dysfunction. PMID:15566621

  12. Assessment of alternative management techniques of tank bottom petroleum sludge in Oman.

    PubMed

    Al-Futaisi, Ahmed; Jamrah, Ahmad; Yaghi, Basma; Taha, Ramzi

    2007-03-22

    This paper investigated several options for environmentally acceptable management techniques of tank bottom oily sludge. In particular, we tested the applicability of managing the sludge by three options: (1) as a fuel supplement; (2) in solidification; (3) as a road material. Environmental testing included determination of heavy metals concentration; toxic organics concentration and radiological properties. The assessment of tank bottom sludge as a fuel supplement included various properties such as proximate analysis, ultimate analysis and energy content. Solidified sludge mixtures and road application sludge mixtures were subjected to leaching using the toxicity characteristic leaching procedure (TCLP). Tank bottom sludge was characterized as having higher concentrations of lead, zinc, and mercury, but lower concentrations of nickel, copper and chromium in comparison with values reported in the literature. Natural occurring radioactive minerals (NORM) activity values obtained on different sludge samples were very low or negligible compared to a NORM standard value of 100Bq/g. The fuel assessment results indicate that the heating values, the carbon content and the ash content of the sludge samples are comparable with bituminous coal, sewage sludge, meat and bone meal and petroleum coke/coal mixture, but lower than those in car tyres and petroleum coke. The nitrogen content is lower than those fuels mentioned above, while the sulfur content seems comparable with bituminous coal, petroleum coke and a petroleum coke/coal mixture. The apparent lack of leachability of metals from solidification and road material sludge applications suggests that toxic metals and organics introduced to these applications are not readily attacked by weak acid solutions and would not be expected to migrate or dissolved into the water. Thus, in-terms of trace metals and organics, the suggested sludge applications would not be considered hazardous as defined by the TCLP leaching procedure.

  13. Distribution of airway narrowing responses across generations and at branching points, assessed in vitro by anatomical optical coherence tomography

    PubMed Central

    2010-01-01

    Background Previous histological and imaging studies have shown the presence of variability in the degree of bronchoconstriction of airways sampled at different locations in the lung (i.e., heterogeneity). Heterogeneity can occur at different airway generations and at branching points in the bronchial tree. Whilst heterogeneity has been detected by previous experimental approaches, its spatial relationship either within or between airways is unknown. Methods In this study, distribution of airway narrowing responses across a portion of the porcine bronchial tree was determined in vitro. The portion comprised contiguous airways spanning bronchial generations (#3-11), including the associated side branches. We used a recent optical imaging technique, anatomical optical coherence tomography, to image the bronchial tree in three dimensions. Bronchoconstriction was produced by carbachol administered to either the adventitial or luminal surface of the airway. Luminal cross sectional area was measured before and at different time points after constriction to carbachol and airway narrowing calculated from the percent decrease in luminal cross sectional area. Results When administered to the adventitial surface, the degree of airway narrowing was progressively increased from proximal to distal generations (r = 0.80 to 0.98, P < 0.05 to 0.001). This 'serial heterogeneity' was also apparent when carbachol was administered via the lumen, though it was less pronounced. In contrast, airway narrowing was not different at side branches, and was uniform both in the parent and daughter airways. Conclusions Our findings demonstrate that the bronchial tree expresses intrinsic serial heterogeneity, such that narrowing increases from proximal to distal airways, a relationship that is influenced by the route of drug administration but not by structural variations accompanying branching sites. PMID:20092657

  14. Airway obstructed by foreign material: the Heimlich maneuver.

    PubMed

    Guildner, C W; Williams, D; Subitch, T

    1976-09-01

    To investigate the application of a cough-creating thrust for the removal of airway-obstructing foreign material, the thrust was applied to six adult male anesthetized volunteers at the waist, at the low chest level, and at the midchest level, with the subjects in both the horizontal-lateral and the sitting positions. Air volume, peak air flow rate, and airway measurements were made. Both the low chest and midchest thrusts produced significantly better results than did the abdominal thrust. There were no side effects attributable to the thrusts. The ease of application and consistently better level of results indicate that the chest thrust is the technique of choice. The application of the chest thrust should be integrated into the concepts of basic life-support and cardiopulmonary resuscitation.

  15. Airway smooth muscle dynamics: a common pathway of airway obstruction in asthma.

    PubMed

    An, S S; Bai, T R; Bates, J H T; Black, J L; Brown, R H; Brusasco, V; Chitano, P; Deng, L; Dowell, M; Eidelman, D H; Fabry, B; Fairbank, N J; Ford, L E; Fredberg, J J; Gerthoffer, W T; Gilbert, S H; Gosens, R; Gunst, S J; Halayko, A J; Ingram, R H; Irvin, C G; James, A L; Janssen, L J; King, G G; Knight, D A; Lauzon, A M; Lakser, O J; Ludwig, M S; Lutchen, K R; Maksym, G N; Martin, J G; Mauad, T; McParland, B E; Mijailovich, S M; Mitchell, H W; Mitchell, R W; Mitzner, W; Murphy, T M; Paré, P D; Pellegrino, R; Sanderson, M J; Schellenberg, R R; Seow, C Y; Silveira, P S P; Smith, P G; Solway, J; Stephens, N L; Sterk, P J; Stewart, A G; Tang, D D; Tepper, R S; Tran, T; Wang, L

    2007-05-01

    Excessive airway obstruction is the cause of symptoms and abnormal lung function in asthma. As airway smooth muscle (ASM) is the effecter controlling airway calibre, it is suspected that dysfunction of ASM contributes to the pathophysiology of asthma. However, the precise role of ASM in the series of events leading to asthmatic symptoms is not clear. It is not certain whether, in asthma, there is a change in the intrinsic properties of ASM, a change in the structure and mechanical properties of the noncontractile components of the airway wall, or a change in the interdependence of the airway wall with the surrounding lung parenchyma. All these potential changes could result from acute or chronic airway inflammation and associated tissue repair and remodelling. Anti-inflammatory therapy, however, does not "cure" asthma, and airway hyperresponsiveness can persist in asthmatics, even in the absence of airway inflammation. This is perhaps because the therapy does not directly address a fundamental abnormality of asthma, that of exaggerated airway narrowing due to excessive shortening of ASM. In the present study, a central role for airway smooth muscle in the pathogenesis of airway hyperresponsiveness in asthma is explored.

  16. Mechanisms of inflammation-mediated airway smooth muscle plasticity and airways remodeling in asthma.

    PubMed

    Halayko, Andrew J; Amrani, Yassine

    2003-09-16

    Recent evidence points to progressive structural change in the airway wall, driven by chronic local inflammation, as a fundamental component for development of irreversible airway hyperresponsiveness. Acute and chronic inflammation is orchestrated by cytokines from recruited inflammatory cells, airway myofibroblasts and myocytes. Airway myocytes exhibit functional plasticity in their capacity for contraction, proliferation, and synthesis of matrix protein and cytokines. This confers a principal role in driving different components of the airway remodeling process, and mediating constrictor hyperresponsiveness. Functional plasticity of airway smooth muscle (ASM) is regulated by an array of environmental cues, including cytokines, which mediate their effects through receptors and a number of intracellular signaling pathways. Despite numerous studies of the cellular effects of cytokines on cultured airway myocytes, few have identified how intracellular signaling pathways modulate or induce these cellular responses. This review summarizes current understanding of these concepts and presents a model for the effects of inflammatory mediators on functional plasticity of ASM in asthma.

  17. Assessment of Limited Chest X-ray Technique in Postcardiac Surgery Management

    PubMed Central

    Salehi, Mehrdad; Saberi, Kianoush; Rahmanian, Mehrzad; Bakhshandeh, Ali Reza; Sharifi, Shahnaz

    2017-01-01

    Objectives: The objective of this study is to investigate the safety of elimination of chest radiography in the postcardiac surgery Intensive Care Unit (ICU). Methods and Design: We compared patients in two different groups of routine CXR (RCXR) and limited CXR (LCXR) and their diagnostic and therapeutic outcome in a University hospital-based single center from 2014 to 2016. 3 CXR in the RCXR group and 1 CXR in the limited group was performed, in addition to on-demand criteria. Measurement and Main Results: A total of 978 samples were acceptable for analysis which 55.21% of RCXR and 59.50% of LCXR were male patients. In total, 523 abnormalities in RCXR group and 154 occasions in LCXR group resulted in 26.73% diagnostic efficacy for RCXRs and 28.57% for LCXR. From 1956 CXR that was taken in RCXR group, 72 occasions required intervention (3.68%) and 84 cases out of 539 (15.58%) LCXR needed an action to therapy. This means a 14.40% in RCXRs’ abnormalities and 56.00% of LCXRs’ abnormalities were accompanied with some interventions. Conclusions: Abolishing routine CXR in the ICUs would not be harmful for the patients, and it can be managed based on their clinical status and other safer imaging techniques. PMID:28074793

  18. Elective use of veno-venous extracorporeal membrane oxygenation and high-flow nasal oxygen for resection of subtotal malignant distal airway obstruction.

    PubMed

    Fung, Rkf; Stellios, J; Bannon, P G; Ananda, A; Forrest, P

    2017-01-01

    We describe the use of peripheral veno-venous extracorporeal membrane oxygenation (VV ECMO) and high-flow nasal oxygen as procedural support in a patient undergoing debulking of a malignant tumour of the lower airway. Due to the significant risk of complete airway obstruction upon induction of anaesthesia, ECMO was established while the patient was awake, and was maintained without systemic anticoagulation to minimise the risk of intraoperative bleeding. This case illustrates that ECMO support with high-flow nasal oxygen can be considered as part of the algorithm for airway management during surgery for subtotal lower airway obstruction, as it may be the only viable option for maintaining adequate gas exchange.

  19. 21 CFR 868.5110 - Oropharyngeal airway.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Oropharyngeal airway. 868.5110 Section 868.5110 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5110 Oropharyngeal airway....

  20. 21 CFR 868.5100 - Nasopharyngeal airway.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Nasopharyngeal airway. 868.5100 Section 868.5100 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5100 Nasopharyngeal airway....

  1. SUBCHRONIC ENDOTOXIN INHALATION CAUSES PERSISTENT AIRWAY DISEASE

    EPA Science Inventory

    ABSTRACT

    The endotoxin component of organic dusts causes acute reversible airflow obstruction and airway inflammation. To test the hypothesis that endotoxin alone causes airway remodeling, we have compared the response of two inbred mouse strains to subchronic endotoxin ...

  2. Upper airway resistance: species-related differences.

    PubMed

    Kirschvink, N; Reinhold, P

    2010-07-01

    In veterinary medicine, upper airway resistance deserves a particular attention in equines athletes and brachycephalic dogs. Due to the anatomical peculiarities of the upper airway and/or pathological conditions, significant alterations of performance and/or well being might occur in horses and dogs. Physiological specificities and pathological changes of the lower respiratory tract deserve a major attention in other species.

  3. Airway and Extracellular Matrix Mechanics in COPD

    PubMed Central

    Bidan, Cécile M.; Veldsink, Annemiek C.; Meurs, Herman; Gosens, Reinoud

    2015-01-01

    Chronic obstructive pulmonary disease (COPD) is one of the most common lung diseases worldwide, and is characterized by airflow obstruction that is not fully reversible with treatment. Even though airflow obstruction is caused by airway smooth muscle contraction, the extent of airway narrowing depends on a range of other structural and functional determinants that impact on active and passive tissue mechanics. Cells and extracellular matrix in the airway and parenchymal compartments respond both passively and actively to the mechanical stimulation induced by smooth muscle contraction. In this review, we summarize the factors that regulate airway narrowing and provide insight into the relative contributions of different constituents of the extracellular matrix and their biomechanical impact on airway obstruction. We then review the changes in extracellular matrix composition in the airway and parenchymal compartments at different stages of COPD, and finally discuss how these changes impact airway narrowing and the development of airway hyperresponsiveness. Finally, we position these data in the context of therapeutic research focused on defective tissue repair. As a conclusion, we propose that future works should primarily target mild or early COPD, prior to the widespread structural changes in the alveolar compartment that are more characteristic of severe COPD. PMID:26696894

  4. The All India Difficult Airway Association 2016 guidelines for tracheal intubation in the Intensive Care Unit

    PubMed Central

    Myatra, Sheila Nainan; Ahmed, Syed Moied; Kundra, Pankaj; Garg, Rakesh; Ramkumar, Venkateswaran; Patwa, Apeksh; Shah, Amit; Raveendra, Ubaradka S; Shetty, Sumalatha Radhakrishna; Doctor, Jeson Rajan; Pawar, Dilip K; Ramesh, Singaravelu; Das, Sabyasachi; Divatia, Jigeeshu Vasishtha

    2016-01-01

    Tracheal intubation (TI) is a routine procedure in the Intensive Care Unit (ICU) and is often life-saving. In contrast to the controlled conditions in the operating room, critically ill patients with respiratory failure and shock are physiologically unstable. These factors, along with a suboptimal evaluation of the airway and limited oxygen reserves despite adequate pre-oxygenation, are responsible for a high incidence of life-threatening complications such as severe hypoxaemia and cardiovascular collapse during TI in the ICU. The All India Difficult Airway Association (AIDAA) proposes a stepwise plan for safe management of the airway in critically ill patients. These guidelines have been developed based on available evidence; wherever robust evidence was lacking, recommendations were arrived at by consensus opinion of airway experts, incorporating the responses to a questionnaire sent to members of the AIDAA and the Indian Society of Anaesthesiologists. Non-invasive positive pressure ventilation during pre-oxygenation improves oxygen stores in patients with respiratory pathology. Nasal insufflation of oxygen at 15 L/min can increase the duration of apnoea before the occurrence of hypoxaemia. High-flow nasal cannula oxygenation at 60–70 L/min may also increase safety during TI in critically ill patients. Stable haemodynamics and gas exchange must be maintained during rapid sequence induction. It is necessary to implement an intubation protocol during routine airway management in the ICU. Adherence to a plan for difficult airway management incorporating the use of intubation aids and airway rescue devices and strategies is useful. PMID:28003694

  5. Student Well-Being Interventions: The Effects of Stress Management Techniques and Gratitude Journaling in the Management Education Classroom

    ERIC Educational Resources Information Center

    Flinchbaugh, Carol L.; Moore, E. Whitney G.; Chang, Young K.; May, Douglas R.

    2012-01-01

    Student well-being in the management classroom is of concern to both educators and managers. Well-being is conceptualized here as students' reduction in stress, enhanced experienced meaning and engagement in the classroom, and, ultimately, heightened satisfaction with life. The authors investigated whether purposeful semester-long classroom…

  6. The critical airway in adults: The facts

    PubMed Central

    Bonanno, Fabrizio Giuseppe

    2012-01-01

    An algorithm on the indications and timing for a surgical airway in emergency as such cannot be drawn due to the multiplicity of variables and the inapplicability in the context of life-threatening critical emergency, where human brain elaborates decisions better in cluster rather than in binary fashion. In particular, in emergency or urgent scenarios, there is no clear or established consensus as to specifically who should receive a tracheostomy as a life-saving procedure; and more importantly, when. The two classical indications for emergency tracheostomy (laryngeal injury and failure to secure airway with endotracheal intubation or cricothyroidotomy) are too generic and encompass a broad spectrum of possibilities. In literature, specific indications for emergency tracheostomy are scattered and are biased, partially comprehensive, not clearly described or not homogeneously gathered. The review highlights the indications and timing for an emergency surgical airway and gives recommendations on which surgical airway method to use in critical airway. PMID:22787346

  7. An Unexpected Airway Complication in a Male Patient with Goltz Syndrome

    PubMed Central

    Smith, Sadie; Gadhok, Kavita

    2016-01-01

    Goltz syndrome, also known as focal dermal hypoplasia, is a rare X-linked dominant multisystem syndrome presenting with cutaneous, skeletal, dental ocular, central nervous system and soft tissue abnormalities. This case report discusses an adult male patient with Goltz syndrome that was noted to have large, papillomatous, hypopharyngeal lesions upon induction of general anesthesia. We highlight challenges with airway management intraoperatively and postoperatively in patients with Goltz syndrome. Our aim is to increase awareness of the potential airway complications associated with this genetic disorder and to provide suggestions for optimal perioperative management for patients afflicted with Goltz syndrome. PMID:27721997

  8. The Availability of Advanced Airway Equipment and Experience with Videolaryngoscopy in the UK: Two UK Surveys

    PubMed Central

    Gill, Rachel L.; Jeffrey, Audrey S. Y.; McNarry, Alistair F.; Liew, Geoffrey H. C.

    2015-01-01

    Fibreoptic intubation, high frequency jet ventilation, and videolaryngoscopy form part of the Royal College of Anaesthetists compulsory higher airway training module. Curriculum delivery requires equipment availability and competent trainers. We sought to establish (1) availability of advanced airway equipment in UK hospitals (Survey I) and (2) if those interested in airway management (Difficult Airway Society (DAS) members) had access to videolaryngoscopes, their basic skill levels and teaching competence with these devices and if they believed that videolaryngoscopy was replacing conventional or fibreoptic laryngoscopy (Survey II). Data was obtained from 212 hospitals (73.1%) and 554 DAS members (27.6%). Most hospitals (202, 99%) owned a fiberscope, 119 (57.5%) had a videolaryngoscope, yet only 62 (29.5%) had high frequency jet ventilators. DAS members had variable access to videolaryngoscopes with Airtraq 319 (59.6%) and Glidescope 176 (32.9%) being the most common. More DAS members were happy to teach or use videolaryngoscopes in a difficult airway than those who had used them more than ten times. The majority rated Macintosh laryngoscopy as the most important airway skill. Members rated fibreoptic intubation and videolaryngoscopy skills equally. Our surveys demonstrate widespread availability of fibreoptic scopes, limited availability of videolaryngoscopes, and limited numbers of experienced videolaryngoscope tutors. PMID:25628653

  9. Investigating the geometry of pig airways using computed tomography

    NASA Astrophysics Data System (ADS)

    Mansy, Hansen A.; Azad, Md Khurshidul; McMurray, Brandon; Henry, Brian; Royston, Thomas J.; Sandler, Richard H.

    2015-03-01

    Numerical modeling of sound propagation in the airways requires accurate knowledge of the airway geometry. These models are often validated using human and animal experiments. While many studies documented the geometric details of the human airways, information about the geometry of pig airways is scarcer. In addition, the morphology of animal airways can be significantly different from that of humans. The objective of this study is to measure the airway diameter, length and bifurcation angles in domestic pigs using computed tomography. After imaging the lungs of 3 pigs, segmentation software tools were used to extract the geometry of the airway lumen. The airway dimensions were then measured from the resulting 3 D models for the first 10 airway generations. Results showed that the size and morphology of the airways of different animals were similar. The measured airway dimensions were compared with those of the human airways. While the trachea diameter was found to be comparable to the adult human, the diameter, length and branching angles of other airways were noticeably different from that of humans. For example, pigs consistently had an early airway branching from the trachea that feeds the superior (top) right lung lobe proximal to the carina. This branch is absent in the human airways. These results suggested that the human geometry may not be a good approximation of the pig airways and may contribute to increasing the errors when the human airway geometric values are used in computational models of the pig chest.

  10. The influence of reconstruction algorithm on the measurement of airway dimensions using computed tomography

    NASA Astrophysics Data System (ADS)

    Wong, Jonathan C.; Nakano, Yasutaka; Coxson, Harvey O.; Müller, Nestor L.; Paré, Peter D.; Hogg, James C.

    2008-03-01

    The assessment of airway dimensions is important in understanding the pathophysiology of various lung diseases. A number of methods have been developed to measure airways on computed tomography, but no study has been done to validate the different CT scanning techniques, CT scanners, and reconstruction algorithms. In our study, we constructed an artificial "airway" and "lung" phantom using hollow plastic tubes and foam blocks. The phantom was CT scanned using axial or helical techniques, and the images were reconstructed using a very high spatial frequency algorithm, a high spatial frequency algorithm, or a low spatial frequency algorithm. Custom software was then used to analyze the "airways" and measure lumen area (Ai) and "airway" wall area (Aaw). WA% (WA% = 100 x Aaw / (Ai + Aaw)) was also calculated. The cross-sectional area of the lumen and wall of the plastic tubes were measured using an optical micrometer. CT measurements of airway dimensions were virtually identical, comparing axial and helical techniques, and comparing a single-slice CT scanner to a multi-slice CT scanner. Using the plastic tube measurements as a "gold standard", Ai was estimated better with the very high or high spatial frequency algorithm (4.1 and 7.4 % error) vs. low spatial frequency algorithm (10.4% error). Aaw was better estimated with the low or high special frequency algorithm (3.8% and 6.1%) vs. very high spatial frequency algorithm (12.9%), and WA% was better estimated with the high or low spatial frequency algorithm (3.5% and 5.1%) vs. very high spatial frequency algorithm (7.3%). Based on these results, we recommend the high spatial frequency algorithm for the CT measurement of airway dimensions.

  11. Enhancing Learning Management Systems Utility for Blind Students: A Task-Oriented, User-Centered, Multi-Method Evaluation Technique

    ERIC Educational Resources Information Center

    Babu, Rakesh; Singh, Rahul

    2013-01-01

    This paper presents a novel task-oriented, user-centered, multi-method evaluation (TUME) technique and shows how it is useful in providing a more complete, practical and solution-oriented assessment of the accessibility and usability of Learning Management Systems (LMS) for blind and visually impaired (BVI) students. Novel components of TUME…

  12. Conservative surgical and microsurgical techniques for the management of dental implants that impinge on the inferior alveolar nerve.

    PubMed

    Gennaro, Paolo; Chisci, Glauco; Gabriele, Guido; Iannetti, Giorgio

    2014-07-01

    Loss of sensation in the lip after insertion of an implant is annoying. The aim of this paper was to describe two techniques for management of osseointegrated dental implants that impinge on the mandibular nerve, the purpose of which is to improve sensation without unscrewing the dental implant.

  13. Risk assessment of sleeping disorder breathing based on upper airway centerline evaluation

    NASA Astrophysics Data System (ADS)

    Alsufyani, Noura; Shen, Rui; Cheng, Irene; Major, Paul

    2013-02-01

    One of the most important breathing disorders in childhood is obstructive sleep apnea syndrome which affects 2-3% of children, and the reported failure rate of surgical treatment was as high as 54%. A possible reason in respiratory complications is having reduced dimensions of the upper airway which are further compressed when muscle tone is decreased during sleep. In this study, we use Cone-beam computed tomography (CBCT) to assess the location or cause of the airway obstruction. To date, all studies analyzing the upper airway in subjects with Sleeping Disorder Breathing were based on linear, area, or volumetric measurements, which are global computations and can easily ignore local significance. Skeletonization was initially introduced as a 3D modeling technique by which representative medial points of a model are extracted to generate centerlines for evaluations. Although centerlines have been commonly used in guiding surgical procedures, our novelty lies in comparing its geometric properties before and after surgeries. We apply 3D data refinement, registration and projection steps to quantify and localize the geometric deviation in target airway regions. Through cross validation with corresponding subjects' therapy data, we expect to quantify the tolerance threshold beyond which reduced dimensions of the upper airway are not clinically significant. The ultimate goal is to utilize this threshold to identify patients at risk of complications. Outcome from this research will also help establish a predictive model for training and to estimate treatment success based on airway measurements prior to intervention. Preliminary results demonstrate the feasibility of our approach.

  14. Computational analysis of microbubble flows in bifurcating airways: role of gravity, inertia, and surface tension.

    PubMed

    Chen, Xiaodong; Zielinski, Rachel; Ghadiali, Samir N

    2014-10-01

    Although mechanical ventilation is a life-saving therapy for patients with severe lung disorders, the microbubble flows generated during ventilation generate hydrodynamic stresses, including pressure and shear stress gradients, which damage the pulmonary epithelium. In this study, we used computational fluid dynamics to investigate how gravity, inertia, and surface tension influence both microbubble flow patterns in bifurcating airways and the magnitude/distribution of hydrodynamic stresses on the airway wall. Direct interface tracking and finite element techniques were used to simulate bubble propagation in a two-dimensional (2D) liquid-filled bifurcating airway. Computational solutions of the full incompressible Navier-Stokes equation were used to investigate how inertia, gravity, and surface tension forces as characterized by the Reynolds (Re), Bond (Bo), and Capillary (Ca) numbers influence pressure and shear stress gradients at the airway wall. Gravity had a significant impact on flow patterns and hydrodynamic stress magnitudes where Bo > 1 led to dramatic changes in bubble shape and increased pressure and shear stress gradients in the upper daughter airway. Interestingly, increased pressure gradients near the bifurcation point (i.e., carina) were only elevated during asymmetric bubble splitting. Although changes in pressure gradient magnitudes were generally more sensitive to Ca, under large Re conditions, both Re and Ca significantly altered the pressure gradient magnitude. We conclude that inertia, gravity, and surface tension can all have a significant impact on microbubble flow patterns and hydrodynamic stresses in bifurcating airways.

  15. Using palaeoecological techniques to inform contemporary hydrological management of a peatland

    NASA Astrophysics Data System (ADS)

    Blundell, Antony; Holden, Joseph

    2014-05-01

    Realization of the economic and environmental value of upland peatlands has led both public and private organizations to implement 'restoration' schemes. The word 'restore' implies that we seek to reverse adverse effects that have occurred and return the ecosystem to a pre-disturbance state. Restoration schemes in UK upland peatlands focus on the objectives of raising the water table through blocking drainage channels and gullies and re-vegetating bare areas of peat that are prone to erosion. The target is often the reinstatement of Sphagnum as a significant part of the peatland flora as this will produce an accumulating peat system. Restoration of a peatland implies that we have knowledge of its previous ecological history from which we can attain a restoration blueprint but restoration schemes often take little, if any, account of the ecological history of the site. This study is an example of how palaeoecological techniques have been employed at a UK upland catchment with findings to support the peatland restoration schemes. The study combined an extensive stratigraphic survey of the catchment and a detailed core-based analysis. Macrofossil, testate amoebae, humification and charcoal analysis were employed to determine the historical representation of Sphagnum at the site, the changes in water-table level, the degree of decomposition and also burning history. Stratigraphic survey and core results show that Sphagnum has played a significant role in parts but not all of the catchment, persisting in the main core until late 19th century. They also demonstrate that the loss of Sphagnum and subsequent abundance of Calluna vulgaris is coincident with evidence of wildfire. Continued absence of Sphagnum and abundance of Calluna vulgaris is coincident with further, less intense, burning likely due to grouse moor management. The 3000 year old record from the main core demonstrates the importance of historical climate change in changing water-table levels, vegetation, and

  16. Advanced InSAR techniques for the management and characterization of geothermal resources

    NASA Astrophysics Data System (ADS)

    Bellotti, F.; Falorni, G.; Morgan, J.; Rucci, A.; Ferretti, A.

    2012-04-01

    InSAR is a remote sensing tool that has applications in both geothermal exploitation and in the management of producing fields. The technique has developed rapidly in recent years and the most evolved algorithms, now capable of providing precise ground movement measurements with unprecedented spatial density over large areas, allow the monitoring of the effects of fluid injection and extraction on surface deformation and the detection of active faults. Multi-interferogram approaches have been used at several geothermal sites in different stages of development. SqueeSAR™, which represents the latest breakthrough in InSAR technology, provides a significant increase in the spatial density of measurement points by exploiting signal returns from both point-like and distributed scatterers. Furthermore, recent satellite radar sensors have a higher spatial resolution (down to 1 m), as well as a higher temporal frequency of image acquisitions (down to a few days). The coupling of the new algorithm with this new generation of satellites provides a valuable tool for monitoring the different phases of geothermal production and in support of the decision making process. Some examples from the US are presented here: the first case study involves the use of InSAR within a suite of tools for exploration of the San Emidio geothermal field in Nevada. This project aimed to develop geophysical techniques to identify and map large aperture fractures for the placement of new production/exploration wells. The second and third examples examine two zones in California: the Salton Sea area, where multi-interferogram InSAR provided an overview of surface deformation at a producing geothermal reservoir. Surface deformation in this area was complex, and the added detail provided insight into the interplay of tectonics and production activities. Additional InSAR studies have also been carried out at the Geysers field in order to evaluate the behavior of an Enhanced Geothermal System (EGS) in

  17. New Tools, New Times: Strategic Planning. A Seminar Focusing on Proactive Management Techniques (Chapel Hill, North Carolina, June 17-19, 1991).

    ERIC Educational Resources Information Center

    Morrison, James L.; Ashley, William C.

    This handbook was designed to accompany a three-day workshop for senior administrators in higher education on proactive management techniques in higher education. Proactive management allows for anticipating change and managing uncertainty in place of crisis management or reactive actions. The workshop covered: (1) strategic thinking; (2)…

  18. Role of Recipient-site Preparation Techniques and Post-operative Wound Dressing in the Surgical Management of Vitiligo

    PubMed Central

    Al-Hadidi, Nour; Griffith, James L; Al-Jamal, Mohammed S; Hamzavi, Iltefat

    2015-01-01

    Vitiligo is an acquired skin disorder characterized by the destruction of melanocytes resulting in achromic macules and patches involving the affected skin. Multiple methods of treatments have emerged to manage vitiligo, including medical and surgical techniques. Among the surgical techniques described in the management of vitiligo are minipunch grafting, split-thickness skin grafting, hair follicle transplantation, suction blister grafting, and cultured and non-cultured autologous melanocyte transplantation. However, prior to grafting optimal recipient-site preparation is needed for graft survival and successful repigmentation outcomes. Similarly, post-operative care of the recipient site is vital to yielding a viable graft irrespective of the transplantation technique employed. This article reviews the multiple methods employed to prepare the recipient site in vitiligo surgeries and the post-surgical conditions which optimize graft viability. A pubmed search was conducted utilizing the key words listed below. PMID:26157306

  19. Comparison of different final impression techniques for management of resorbed mandibular ridge: a case report.

    PubMed

    Yadav, Bhupender; Jayna, Manisha; Yadav, Harish; Suri, Shrey; Phogat, Shefali; Madan, Reshu

    2014-01-01

    The history of complete denture impression procedures has been influenced largely by the development of impression materials from which new techniques and ideas arose. The purpose of this study was to compare the retention of complete dentures made by using different impression techniques like conventional, admixed, all green, and functional techniques. The results showed that there was significant difference in retention between the six techniques where functional technique showed the highest mean value of retention followed by elastomeric, all green, and admixed, while cocktail and green stick compound showed the lowest mean value. However, on clinical examination, the retention produced by the six techniques was satisfactory.

  20. Quality management systems for fruit fly (Diptera: Tephritidae) sterile insect technique

    SciTech Connect

    Caceres, C.; Robinson, A.; Shelly, T.; Hendrichs, J.

    2007-03-15

    The papers presented in this issue are focused on developing and validating procedures to improve the overall quality of sterile fruit flies for use in area-wide integrated pest management (AW-IPM) programs with a sterile insect technique (SIT) component. The group was coordinated and partially funded by the Joint FAO/IAEA Programme of Nuclear Techniques in Food and Agriculture, International Atomic Energy Agency, Vienna, Austria, under a five-year Coordinated Research Project (CRP) on 'Quality Assurance in Mass-Reared and Released Fruit Flies for Use in SIT Programmes'. Participants in the CRP from 16 countries came from both basic and applied fields of expertise to ensure that appropriate and relevant procedures were developed. A variety of studies was undertaken to develop protocols to assess strain compatibility and to improve colonization procedures and strain management. Specific studies addressed issues related to insect nutrition, irradiation protocols, field dispersal and survival, field cage behavior assessments, and enhancement of mating competitiveness. The main objective was to increase the efficiency of operational fruit fly programs using sterile insects and to reduce their cost. Many of the protocols developed or improved during the CRP will be incorporated into the international quality control manual for sterile tephritid fruit flies, standardizing key components of the production, sterilization, shipment, handling, and release of sterile insects. (author) [Spanish] Los articulos presentados en este numero se enfocan en el desarrollo y la validacion de procedimientos para mejorar la calidad total de moscas de las frutas esteriles para su uso en programas de manejo integrado de plagas en donde la tecnica del insecto esteril (TIE) es uno de los componentes clave. El grupo fue coordinado y parcialmente financiado por la Division Conjunta de Tecnicas Nucleares para la Alimentacion y la Agricultura de la FAO/OIEA, Viena, Austria, por un periodo de